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Biomedical subjects

J Joris Hage

Publications and source records attributed to J Joris Hage.

At least 19 recordsLinked to original sources
PubMed2007

A prospective assessment of surgical risk factors in 400 cases of skin-sparing mastectomy and immediate breast reconstruction with implants to establish selection criteria.

BACKGROUND: Although attempts have been made to identify the risk factors leading to complications after combined skin-sparing mastectomy and immediate prosthetic breast reconstruction, hardly any criteria are available to preoperatively distinguish patients in whom such an eventful postoperative course may be expected. Therefore, the authors wanted to establish which factors increase the risk of surgical complications to such a level as to adjust their indications for immediate breast reconstruction after skin-sparing mastectomy. METHODS: The authors prospectively studied the clinical relevance of six patient-related and nine procedure-related characteristics as potential risk factors for a complicated surgical outcome in 400 combined procedures in 309 patients by univariate and multivariate logistic regression analysis. Risk factors that proved significantly correlated with loss of implant by both analyses were accepted as clinical selection criteria that distinguish potential candidates with an unacceptably high risk of such loss. RESULTS: Mild complications occurred significantly more often in patients who were older than the mean age of 43 years and in breasts that were more than average sized or operated on by a fellow in oncologic surgery. Implants were lost significantly more often in patients who were obese or smoked and in breasts that were more than average sized. CONCLUSIONS: The clinically relevant increase of risk of implant loss should lead to reluctance to perform combined skin-sparing mastectomy and immediate prosthetic breast reconstruction in obese patients who smoke (32 percent loss) and in those with more than average sized breasts (27 percent loss).

Breast↗
PubMed2006

Measurement, calculation, and normal range of the ankle-arm index: a bibliometric analysis and recommendation for standardization.

Since its introduction in 1950, a variety of methods of measurement and calculation have been used to establish the ankle-arm index (AAI). This has resulted in variations of its normal range and difficulty in comparing study results. Hence, the objective of our study was to analyze the disparate methods used to assess AAI and its normal range and to recommend a standardized method to assess AAI based on that analysis. We made an inventory of the disparate AAI methods and its normal range reported in 100 randomly selected publications and recommend the means of such standardization. We recommend that an experienced observer assess AAI with the patient at rest in the supine position. The width of the sphygmometer cuffs should be 1.5 times that of the extremity to be measured, and brachial and crural pulses should be detected using a Doppler device. Systolic pressures should be measured at both arms and over the anterior and posterior arteries of both legs, with the cuff placed just proximally to the malleoli. The left arm pressure ought to be used as denominator and the mean of pressures of both crural arteries of each leg ought to be used for the numerator of the AAI for that leg. We advocate 0.90 as the cut-off value to distinguish patients who need further arterial assessment.

Ankle↗
PubMed2006

Risk of breast cancer among reduction mammaplasty patients and the strategies used by plastic surgeons to detect such cancer.

BACKGROUND: Estimates of the occurrence of breast cancer among reduction mammaplasty patients vary from 0.05 to 1.66 percent, and the chance of finding such cancers is affected by the thoroughness of preoperative and postoperative examinations. The authors' aims were to make a more exact and age-specific estimation of this occurrence and to evaluate the strategies used by Netherlands plastic surgeons to detect these cancers. METHODS: The annual number of reduction mammaplasty patients per 5-year age group and the annual age-specific incidence rate of breast cancer for the years 1992 through 2001 were obtained from two national registries. Using these, the authors estimated the expected number of breast cancers among reduction mammaplasty patients in each year. In 2002, the authors sent an anonymous questionnaire to 220 Dutch consultant and trainee plastic surgeons to evaluate their detection strategies. RESULTS: The fraction of patients aged 50 years or older increased from 9.6 percent to 23 percent, and the estimated occurrence of breast cancer among patients increased from 0.05 percent to 0.11 percent. Responders to the questionnaire were inconsistent regarding their preoperative and postoperative detection strategies, with only 3 percent of them routinely requiring a preoperative mammogram and 75 percent of them routinely submitting the surgical specimen for histopathologic examination. CONCLUSIONS: The occurrence of previously undetected breast cancer among reduction mammaplasty patients in The Netherlands is likely to increase further. The authors advocate preoperative mammography for all reduction mammaplasty patients aged 40 years or older and argue that a history and physical examination should be performed for all patients.

Adult↗
PubMed2006

Skin-sparing mastectomy and immediate breast reconstruction by use of implants: an assessment of risk factors for complications and cancer control in 120 patients.

BACKGROUND: Combined skin-sparing mastectomy and immediate reconstruction by use of an implant is increasingly accepted as a therapy for patients with breast cancer or a hereditary risk of breast cancer. Because little and contradictory evidence regarding possible risk factors for postoperative complications is available, the authors retrospectively assessed 13 such factors. They also evaluated the oncological safety of the procedure. METHODS: From July of 1996 through June of 2000, 174 skin-sparing mastectomies were combined with immediate breast reconstruction in 120 patients. The authors assessed the influence of five patient-related and eight breast-related characteristics on the incidence of a complicated postoperative course by univariate and multivariate analyses. Oncological safety was evaluated by observed recurrent disease and 5-year survival. RESULTS: Severe complications were observed in 17 patients of the 120 patients (14 percent), or 19 of the 174 breasts (11 percent). The patient-related characteristics of age and being operated on unilaterally significantly increased the risk of complications. Resident plastic surgeons and previous breast-conserving therapy including radiotherapy significantly increased the risk of implant loss. The local relapse rate among patients operated on for cancer was 0.02. The actuarial 5-year survival rate among patients who underwent curative mastectomies was 0.96. CONCLUSIONS: Combined skin-sparing mastectomy and immediate reconstruction by use of an implant is oncologically safe, but the risk of postoperative complications cannot be neglected. The authors' observations may offer guidance for adapting indication and treatment strategies for patients with breast cancer or increased hereditary risk of such cancer.

Adult↗
PubMed2006

Routine histologic examination of 728 mastectomy scars: did it benefit our patients?

BACKGROUND: Routine histologic examination of secondarily excised mastectomy scars is considered good practice, even though the microscopic detection of a metastasis in clinically unsuspected mastectomy scars is rare. Because cost-effective use of histologic services is required, the occurrence rate of metastases in such scars needs to be established to assess the possible benefit of such routine examination. METHODS: The histologic observations on 728 clinically unsuspected scars from prophylactic (n = 151) or curative (n = 395) mastectomy or breast-conservation treatment in 424 patients were traced and correlated to the indication of initial breast surgery, possible adjuvant therapy, and time lapse between initial surgery and scar examination. RESULTS: In none of the 728 scars was a scar metastasis or de novo tumor found. CONCLUSIONS: Routine histologic examination of clinically unsuspected scars excised at the time of breast reconstruction or scar correction after prophylactic or curative breast surgery did not benefit the authors' patients.

Adult↗
PubMed2006

The segmental pectoralis major free flap: anatomical features of its vascular pedicle.

BACKGROUND: The pectoralis major muscle may be suited for free transplantation of a segment of the muscle. We investigated the length and diameter of its vascular pedicle to determine its feasibility. METHODS: The length of the pedicle, its arterial diameter, and its entry point into the muscle were determined in 17 cadaveric flaps. RESULTS: The pedicle length up to the medial border of the pectoralis minor muscle averaged 6.6 cm. The mean external arterial diameter was 1.8 mm, and the venous diameter was consistently larger. The vascular pedicle consistently entered the muscle lateral to the midpoint of, and a mean of, 8.8 cm caudal to the clavicular line. CONCLUSION: The vascular length and diameter are sufficient for microvascular anastomosis. Although an anatomic landmark for the cranial border of the flap could not be defined, the sternocostal part of the pectoralis major muscle may potentially be used as a segmental free flap.

Anastomosis, Surgical↗
PubMed2006

Saving labium minus skin to treat possible urethral stenosis in female-to-male transsexuals.

In our hands, neourethral stenosis is the main complication following metaidoioplasty in female-to-male transsexuals. We introduce the use of surplus of minor labial skin to correct these stenoses. The surplus was used as a subcutaneously pedicled flap with a 1.5 x 3.5 cm skin paddle to correct the circumferential deficit of neourethral lining at the level of the stenosis. After minimum undermining, the pedicle was retracted laterally to allow for a median external urethrotomy. The skin paddle was turned outside in to fit the resulting longitudinal neourethral defect. Subsequently, the major labial subcutis and skin were approximated in layers to cover the subcutaneous pedicled flap and to close the labioscrotum in the midline. Patients were kept immobilized for 3 days, and a suprapubic catheter was left open for 7 days. This technique was applied successfully in 15 of the 70 female-to-male transsexuals who consequently underwent metaidoioplasty in Amsterdam up to March of 1999. We conclude that the surplus of labial skin ought to be retained during primary surgery because it is an ideal substitute to correct neourethral stenosis.

Female↗
PubMed2006

Long-term outcome of metaidoioplasty in 70 female-to-male transsexuals.

In 1996, metaidoioplasty was introduced as an alternative to phalloplasty in female-to-male transsexuals. To assess the long-term outcome in 70 consecutive patients (mean follow-up 8 years), we established the characteristics of postoperative events and additional surgical procedures. Metaidoioplasty and primary or secondary scrotoplasty was uneventful in 8 patients. In the other patients, postoperative events included immediate postoperative complications (n = 23), urethral fistulas (n = 26) or strictures (n = 25), or loss (n = 22) or dislocation (n = 34) of testicular prostheses. An average of 2.6 surgical procedures per patient was needed to complete genital confirmation and cope with all events. Additional phalloplasty was performed or scheduled in 17 patients. We conclude that genital reassignment by metaidoioplasty cannot usually be completed in 1 step and that phalloplasty is feasible subsequent to metaidoioplasty. We still consider metaidoioplasty to be a method of choice in selected patients.

Adult↗
PubMed2005

Donor-site necrosis following fibula free-flap transplantation: a report of three cases.

The free fibula flap is the microsurgeon's workhorse for the reconstruction of osseous or osteocutaneous defects. Donor-site morbidity of this flap is reported to occur infrequently, and is generally considered minor and transient. We present the case histories of three patients with necrosis at the fibula flap donor site to stress the risks and explain the possible mechanisms of such severe complications. The small risk of debilitating donor-site necrosis should be considered and discussed preoperatively with the patient.

Adult↗
PubMed2005

Spastic muscle properties are affected by length changes of adjacent structures.

Recent animal experiments have shown that up to 37% of muscle force may be transmitted to adjacent structures rather than reach the insertion of the muscle's tendon, and that the extent of such force transmission depends on the length and relative position of these structures. We tested whether the force-length characteristics of the distally tenotomized human flexor carpi ulnaris muscle (FCU) of nine patients with cerebral palsy varied with the change of relative length of adjacent structures induced by a change of wrist position. In four patients, the FCU exerted up to 40% more active force in a flexed wrist position at short FCU length, whereas the active force was not significantly higher in the other five. In the same manner, passive force-length characteristics of the spastic FCU changed upon changes in wrist position. Variability in myofascial force transmission may partly explain the variability in success of the FCU-transfer.

Adolescent↗
PubMed2005

Who benefits from peer review? An analysis of the outcome of 100 requests for review by Plastic and Reconstructive Surgery.

BACKGROUND: Little is known of what is done with the comments on submitted manuscripts provided by peer reviewers or to what extent these comments benefit the editor in deciding to accept or reject the manuscript, the author(s) in revising their manuscript, or the readership at large. Furthermore, nothing is known of any possible benefits of the process to the peer reviewer. Finally, the peer-review process may even be maleficent because of its implicit delay of publication and a possible bias against manuscripts originating from non-Anglo-American countries. METHODS: The authors evaluated the benefits of the peer-review process to authors, editor, readers, and reviewers by a bibliometric analysis of the outcome of 100 requests for review made by the editor of Plastic and Reconstructive Surgery from 1992 through 2003. The publication delay and potential geographical bias were evaluated as potential disadvantages. RESULTS: The authors' reviewer advised acceptance of 56 percent of the manuscripts, and the editor mostly agreed with his advice. This suggests that the editor benefited from the review. The authors addressed 48 to 81 percent of the reviewer's constructive suggestions, and this suggests that they and the readers benefited also. Readers of Plastic and Reconstructive Surgery may further benefit because manuscripts rejected by Plastic and Reconstructive Surgery end up in less prestigious journals. The implicit delay of publication is limited, and the authors found no bias against non-Anglo-American submissions. The cost-effectiveness of the process for the peer reviewer remains unclear. CONCLUSIONS: The peer-review system of Plastic and Reconstructive Surgery, in general, is beneficial.

Bibliometrics↗
PubMed2005

The truly distal lateral arm flap: rationale and risk factors of a microsurgical workhorse in 30 patients.

The forearm part of the extended lateral arm flap may be separately raised on the most distal septocutaneous perforator of the posterior collateral radial artery. This truly distal lateral arm flap shares most of the advantages of the radial forearm flap and is associated with less donor site morbidity. From April 2000 to March 2004, we used 30 such flaps as the fasciocutaneous free flap of choice, mostly for reconstructions in the head and neck region. The eventful postoperative course observed in 5 of these flaps motivated us to evaluate the rationale and risk factors of this procedure. We prospectively analyzed the influence on the incidence of partial or complete flap loss of 19 patient-related or procedure-related characteristics that may have acted as risk factors. None were found to be of statistical significance. We found the distal lateral arm flap to have a less robust vascular anatomy than the radial forearm flap, resulting in the need for advanced surgical expertise to raise and handle it. As we recognized the difficulty of this flap to be associated predominantly with this anatomy of its vascular pedicle, we now take a more liberal stand toward the possibility of intraoperative conversion to the use of a radial forearm flap.

Adult↗
PubMed2005

The lateral thoracodorsal flap as a salvage procedure for partial transverse rectus abdominis myocutaneous or deep inferior epigastric perforator flap loss in breast reconstruction.

The transverse rectus abdominis musculocutaneous flap and deep inferior epigastric perforator flap are the flaps of choice for autologous breast reconstruction. The better understanding of the vascular anatomy of these flaps has reduced the incidence of flap loss and fat necrosis, and positioning the flap's least vascularized zone laterally in the newly reconstructed breast may limit partial flap loss to that area. Still, the resulting defect of such partial loss remains a challenge. We introduce the use of the lateral thoracodorsal flap as an easy and straightforward salvage procedure in such cases and present the history of 4 of our patients with a mean age of 45 years to illustrate this use. The procedure can be done as early as 6 weeks after initial reconstruction, reducing the burden of daily wound care for the patient and offering her an immediate restoration of the lateral contour of the reconstructed breast.

Adult↗
PubMed2005

Extended deepithelialization to secure double-breasted closure of the skin.

Double-breasted closure of the skin is achieved by deepithelialization of 1 edge of a wound and advancement of the opposite edge over this deepithelialized area. Such closure may prevent contamination or exposure of the implant in cases where immediate breast reconstruction with prosthetic material is obtained after skin sparing mastectomy. The deepithelialization routinely extends as far as the incision to be closed and, consequently, the skin suture at the end of the incision immediately overlies thedeep suture or implant in cases where the implant is not fully covered by muscle. To prevent contamination or exposure of the implant when suture infection or wound dehiscence occurs in these cases, we extend the deepithelialization beyond and around the limit of the skin incision. This allows for complete and secured double-breasted closure of the entire wound and lessens the risk of implant contamination or exposure.

Breast Implants↗
PubMed2004

Digital innervation patterns following median or ulnar nerve laceration and their correlation to anatomic variations of the communicating branch between these nerves.

The midline of the ring finger is classically considered as the neural watershed between the median and ulnar nerve sensory territories on the palmar surfaces of the fingers. Variations of this division exist and may be explained by a communicating branch between the third and fourth common digital nerves. The palmar sensibility patterns of fingers were assessed with Semmes Weinstein filaments after either a complete median or an ulnar nerve transection in 43 patients. Eight out of nine observed sensibility patterns could be explained by known anatomic types and subtypes of the communicating branch. The type of communicating branch, but not its subtype, could be established in the one remaining pattern.

Adolescent↗
PubMed2004

Overstretching of sarcomeres may not cause cerebral palsy muscle contracture.

To answer the question whether the muscle contracture in patients with cerebral palsy is caused by overstretching of in-series sarcomeres we studied the active and passive force-length relationship of the flexor carpi ulnaris muscle (FCU) in relation to its operating length range in 14 such patients with a flexion deformity of the wrist. Force-length relationship was measured intra-operatively using electrical stimulation, a force transducer, and a data-acquisition system. Muscle length was measured in maximally flexed and maximally extended position of the wrist. The spastic FCU was found to exert over 80% of its maximum active force at maximal extension of the wrist and this indicates abundant overlap of the sarcomeres. At maximal wrist extension, FCU passive force corresponded with only 0.7-18% of maximum active force. Both findings imply that the FCU sarcomeres are not overstretched when the wrist is extended. We conclude that the overstretching of in-series sarcomeres appears not to be the cause of contracture of the spastic FCU.

Adolescent↗
PubMed2004

Deep circumflex iliac artery (DCIA) free flap without DCIA: report of a unique case.

The iliac crest free flap is a reliable source of cancellous bone, muscle, and skin. The vascularization of this flap arises from the deep circumflex iliac artery (DCIA) which allegedly is always present. The authors report a unique case of successful microvascular transplantation of an iliac crest osteomyocutaneous free flap in a patient in whom the DCIA and DCIV were absent.

Abdominal Muscles↗