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Biomedical subjects

G Jurell

Publications and source records attributed to G Jurell.

At least 19 recordsLinked to original sources
PubMed2007

Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer.

BACKGROUND: Intraoperative tumour perforation, positive tumour margins, wound complications and local recurrence are frequent difficulties with conventional abdominoperineal resection (APR) for rectal cancer. An alternative technique is the extended posterior perineal approach with gluteus maximus flap reconstruction of the pelvic floor. The aim of this study was to report the technique and early experience of extended APR in a select cohort of patients. METHODS: The principles of operation are that the mesorectum is not dissected off the levator muscles, the perineal dissection is done in the prone position and the levator muscles are resected en bloc with the anus and lower rectum. The perineal defect is reconstructed with a gluteus maximus flap. Between 2001 and 2005, 28 patients with low rectal cancer were treated accordingly at the Karolinska Hospital. RESULTS: Two patients had ypT0 tumours, 20 ypT3 and six ypT4 tumours. Bowel perforation occurred in one, the circumferential resection margin (CRM) was positive in two, and four patients had local perineal wound complications. Two patients developed local recurrence after a median follow-up of 16 months. CONCLUSION: The extended posterior perineal approach with gluteus maximus flap reconstruction in APR has a low risk of bowel perforation, CRM involvement and local perineal wound complications. The rate of local recurrence may be lower than with conventional APR.

Aged↗
PubMed1998

Technical aspects of immediate breast reconstruction--two year follow-up of 100 patients treated consecutively.

We report the technical aspects of immediate breast reconstruction of the first 100 consecutive patients done at the Karolinska Hospital. Two patients had bilateral cancer. Preoperative chemotherapy had been given to five patients and postoperative chemotherapy to 13 patients. In 96 patients the indication was breast carcinoma. Mean tumour size was 13.1 mm and always less than 100.0 mm. Radiotherapy had been given preoperatively in nine patients and postoperatively in 10 patients. Mean operation time was 127 minutes, and median operating time 100 minutes. Hospital stay was five days. Breast reconstructions were performed with permanent prostheses in 22, expanders in 66, pedicled TRAM flaps in eight, and free TRAM flaps in four patients. To complete the breast reconstruction one major and 1.4 minor operations were needed. Total time to reconstruction was 461 days. The overall complication rate was 16%, with 13 local complications. Three developed haematomas, seven lost their implants, two developed partial necroses of pedicled TRAM flaps, and one developed abdominal bulging after a free TRAM flap. Patients were followed up after 2.0-5.7 years. The capsular contracture rate in the implant group was 24%.

Adult↗
PubMed1998

Donor-site morbidity after pedicled or free TRAM flap surgery: a prospective and objective study.

The main disadvantage when the transverse rectus abdominis musculocutaneous (TRAM) flap is used for breast reconstruction is the potential for weakening of the abdominal wall. This prospective study was initiated to objectively evaluate abdominal muscle strength after pedicled and free TRAM flap breast reconstructions over time. Twenty-three patients with pedicled TRAM flaps and 19 patients with free TRAM flaps were included. A dynamic dynamometer system, KIN-COM, was used to measure maximal voluntary trunk flexor and extensor strength preoperatively and 6 and 12 months postoperatively. The patients' subjective opinions 1 year postoperatively were recorded by means of a questionnaire. A transient decrease in abdominal strength, in both groups, occurred at 6 months but was essentially regained at 12 months. The use of a pedicled or free TRAM flap did not influence postoperative abdominal strength per se. The balance between the abdominal strength and back strength remained in the free flap group but was altered postoperatively in the pedicled flap group; back strength was increased and remained so after 12 months. The difference between the two procedures is relatively small compared with individual variations, indicating that there are more important factors than the kind of surgery influencing the restoration of muscle strength. The questionnaire revealed a greater occurrence of abdominal wall bulging in the free flap group (82 percent) versus 48 percent in the pedicled flap group. No postoperative differences regarding exercise frequency or sensitivity of the abdominal wall were found between the pedicled and free TRAM flap groups.

Abdominal Muscles↗
PubMed1997

Low capsular contraction rate after primary and secondary breast reconstruction with a textured expander prosthesis.

The expander prosthesis has the advantage over the temporary expander of being permanent and thus does not require an operation when the implant has to be exchanged for a permanent prosthesis. Forty-nine women who had had either primary or secondary breast reconstruction performed with a permanent textured expander prosthesis were included in the study. No patient in either group had received radiotherapy. Breast softness was evaluated by an objective method, applanation tonometry, when saline was extracted from the implant to the desired breast volume after 3 months of slight overexpansion. Follow-up examinations were done 6 and 12 months later. In both groups the breasts became harder between the extraction of saline and the 6-month follow-up but then remained unchanged at the 12-month checkup. The capsular contracture rate after 6 months was 11 percent in the primary breast reconstruction group (n = 37) and 0 percent in the secondary breast reconstruction group (n = 11). After 12 months, the results were constant. There was no statistically significant difference between the two groups at any time. The low capsular contracture rate in both groups shows the suitability of the expander prosthesis for achieving good results in both primary and secondary breast reconstruction. Objective evaluation of the results in order to compare different materials and methods of breast reconstruction should be mandatory.

Breast Implants↗
PubMed1996

Textured or smooth implants for submuscular breast augmentation: a controlled study.

Capsular contracture consistently has been the most frequently noted complication of submuscular and subglandular breast augmentation. The etiology of this complication is still unknown, although silicone bleed, hematoma, infection, foreign bodies, and surgical trauma have been implicated. In this prospective, double-blind study, 61 women undergoing submuscular breast augmentation were randomized between Dow Corning textured and smooth-walled silicone gel implants. Any consequent capsular contracture was assessed by an independent plastic surgeon and also by the patients themselves. Objective evaluation was made by applanation tonometry. It was found that depending on doctors, patients, and objective method used, 3 to 9 percent grade III and IV encapsulation followed submuscular augmentation with textured implants and 10 to 20 percent with smooth-walled implants after 1 year. The differences were significant according to both patient assessment and applanation tonometry but not according to the physicians' evaluations. There was no correlation of capsular contracture with the age of the patient, duration of the operation, or degree of blood loss. There was a small but inconclusive difference in capsular contracture rate that favored the placement of textured rather than smooth implants in the submuscular pocket.

Adult↗
PubMed1996

Measurement of breast volume with thermoplastic casts.

A pilot study was carried through to assess the reproducibility of a new method of measuring breast volume. Twenty healthy female volunteers participated. A negative replica of the breast was made with thermoplastic cast material. The volume was measured by filling the cast with water until it reached two opposite points of the boundaries of the breast delineated on the cast. Three measurements were made of every cast and the mean was calculated. The range of the three measurements expressed as a percentage of the mean volume was 2.9 (SD 1.6)%. Each volunteer's breasts were measured twice with a brief intervening pause. The coefficient of variation between the two corresponding measurements was 6%.

Adult↗
PubMed1995

Immediate breast reconstruction: short-term experience in 75 consecutive cases.

Immediate breast reconstructions are being done more often nowadays to avoid the stress that the patient experiences while living without a breast. In this paper, the procedure and short term outcome of 75 patients who underwent immediate breast reconstructions at the Karolinska Hospital are reported. The median age of the patients was 48 years, and most of the tumours were stage O to 2 at the time of the operation, though reconstructions were also done for patients with more advanced cancer, for psychological reasons. The approach was multidisciplinary with oncologists, general surgeons, and plastic surgeons involved. Different reconstructive methods were used, and the operations were tailor-made for each patient. Twenty one permanent prostheses, 11 expanders, 33 expander prostheses, and eight pedicled and two free transverse rectus abdominis musculocutaneous (TRAM) flaps were used for reconstruction. The opposite breast was adjusted in 43 (57%) of the patients. There were 11 postoperative complications (15%), and in only one patient (1%), could the reconstruction not be completed. There was a tendency towards more complicated reconstructive procedures over time. The demand for immediate breast reconstruction is steadily increasing from both patients and doctors.

Adult↗
PubMed1994

Skin thickness in expanded human breast skin.

By means of an ultrasonic technique, skin thickness was measured in 13 women subjected to mammary reconstruction by tissue expansion. Measurements were performed the day before introduction of the expander, after the last inflation, the day before introduction of the permanent implant, and at 2 weeks and 6 months after this operation. Five patients had their expanders inflated every day (rapid expansion), and 8 patients, once a week (slow expansion). A decrease in skin thickness during the inflation period was recorded, and this decrease was permanent even 6 months after the second operation. After exchange of the expander for a permanent implant, there was a transient statistically significant increase in skin thickness. There was no statistical difference between the groups of rapid and slow expansion.

Adult↗
PubMed1992

Alterations in skin properties during rapid and slow tissue expansion for breast reconstruction.

This study comprises 23 women who had had mastectomies because of breast cancer. They were randomly divided into two groups when they were admitted for breast reconstruction by tissue expansion. The first group was expanded rapidly, i.e., every day, and the other group was expanded slowly, i.e., every week. There were no other differences in the treatment between the two groups. Three months after completion of expansion, the expander was replaced by a permanent prosthesis. The follow-up time was up to 6 months after the second operation. Three different parameters--distensibility, elasticity, and hysteresis--were measured noninvasively on the breast skin and at a control site on several occasions throughout the treatment. During the treatment period there were no differences in skin properties between rapidly and slowly expanded patients. Of the three parameters, distensibility showed the most prominent changes: decreasing during the expansion period, increasing after the expander had been replaced by a permanent prosthesis, and decreasing during the following 6 months. Elasticity did not change significantly, except decreasing after insertion of the permanent prosthesis, and the hysteresis increased at the same time. These findings indicate that tissue expansion alters breast skin only to a small extent and that the mechanical resistance sometimes encountered during tissue expansion is due to deeper structures such as underlying muscles or capsule formation.

Body Water↗
PubMed1992

Breast reconstruction using tissue expansion.

To assess the advantages of tissue expansion as a method of breast reconstruction, a prospective, consecutive study was carried out in 41 women who had undergone mastectomy. The expander was positioned in the submuscular plane and expanded weekly to double the volume of the calculated permanent implant. A permanent gel implant was inserted after 10 weeks. Two examiners judged the rate of capsular contracture after 15 and 32 months according to the Breast Augmentation Classification. The rate of capsular contracture was 28% at the second follow-up. Major complications were rare--7%. The patients were pleased with the overall result in 82% of cases. We conclude that tissue expansion is safe, produces a good result and causes few complications with only minor discomfort to the patient.

Adult↗
PubMed1991

Circulatory and metabolic changes in expanded pig skin flaps.

To evaluate circulatory and metabolic changes in pig skin during tissue expansion, the buttock skin of 12 pigs was expanded for 5 weeks. In a second operation, island buttock flaps were elevated bilaterally. Flap temperature, laser Doppler flow (LDF), and fluorescein penetration borders were recorded. Norepinephrine infusions were given twice. After cannulation of the external iliac veins, the total venous outflow from the flaps and metabolic parameters such as glucose and oxygen consumption and lactate production were measured bilaterally. No significant difference in fluorescein staining was found, but laser Doppler flow in the expanded tissue was higher than in nonexpanded skin, whereas the total flap blood flow was not significantly different. A flow reduction was seen in expanded flaps during norepinephrine infusion, whereas nonexpanded flaps showed a slightly increased blood flow. This adrenergic supersensitivity indicates that it is possible that not only surgical nerve section but also tissue expansion can result in sympathetic denervation. No differences in the metabolic parameters were observed.

Animals↗
PubMed1990

Capsular contracture after breast reconstruction with silicone-gel and saline-filled implants: a 6-year follow-up.

A major problem after breast reconstruction with augmentation mammaplasty is contracture of the fibrous capsule around the prosthesis. In a series of 72 breasts in 65 women, silicone-gel and saline-filled implants were randomly selected prior to breast reconstruction. The results were judged with respect to consistency, tenderness, wrinkles, and sounds by two independent plastic surgeons according to the breast augmentation classification (BAC) and by the patients themselves. Capsular contracture was found by the surgeons in 50 percent of the gel implant group and in 16 percent of the saline implant group, which is in conformity with the results of the follow-up 5 years earlier. The incidence of deflation was 16 percent in the saline group and occurred in different sizes of both overinflated and underinflated prostheses. The degree of slow leakage from saline implants will be discussed. Despite the high rate of contractures in the gel group, 85 percent of all patients were satisfied with the result of the reconstruction.

Adult↗
PubMed1990

Preoperative antibiotics and capsular contracture in augmentation mammaplasty.

The main drawback with augmentation mammaplasty using implants is capsular contracture. The cause of this complication is still unknown. Silicone particles, hematoma, and bacterial contamination are some of the etiologic factors discussed. In this randomized, double-blind study on 76 breast-augmented women, 50 percent of the patients had preoperative prophylaxis with benzylpenicillin and dicloxacillin. Bacteria samples were taken intraoperatively. The number of negative cultures increased significantly with antibiotic prophylaxis. In four follow-ups during the first postoperative year, the rate of contractures was evaluated by subjective and objective methods. The results showed no statistically significant difference between the placebo and the antibiotic group with respect to the incidence of capsular contracture.

Adult↗
PubMed1989

Results of subglandular breast augmentation using a new classification method--18-year follow-up.

The main problem after augmentation mammaplasty is the formation of capsular contractures. The frequency of this complication varies in different reports. In this study the results in 60 women 15-21 years after subglandular breast augmentation are presented. The patients completed a questionnaire and the breasts were judged according to a new Breast Augmentation Classification (BAC) scale. Of all breasts examined 79% had grade III or IV, but 77% of the patients were satisfied with the final result. However, 84% thought that their breasts were too hard. Breast cancer had not developed in any patient. Rheumatoid arthritis developed in one patient 4 years after the operation. Capsular contracture and unacceptable results after subglandular breast augmentation were found in the major portion of the patients in this study.

Adult↗
PubMed1988

Continuous wave (CW) dye laser vs. CW argon laser treatment of port wine stain (PWS).

Pulsed dye laser treatment has shown specific vessel damage and thrombosis and good clinical bleaching of PWS at lower energy densities than continuous wave (CW) argon laser treatment. Based on a pilot study with CW dye laser treatment of PWS, we wanted to investigate whether CW dye laser would be more beneficial in PWS treatment than argon laser treatment. The hypothesis was tested in 20 randomized PWS patients, but no difference in treatment results was detected between the two treatment modalities.

Adolescent↗
PubMed1988

Argon laser treatment of port wine stain.

The authors achieved excellent results using argon laser treatment of PWS in 45% of 84 patients. Punch biopsies were taken preoperatively in all patients. Their classification according to fullness of erythrocytes of the vessels was found to be of relative value in predicting the treatment result. It is thus found to be advisable to administer a test treatment of a limited area in all patients.

Adolescent↗