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Biomedical subjects

J M Drever

Publications and source records attributed to J M Drever.

18 recordsLinked to original sources
PubMed1990

Suction lipectomy: an excellent adjutant to improve the results of breast reconstruction with RAM flaps.

It has been said about breast reconstruction with implants that a patient should not expect more than a mound that will fill out her brassiere or bathing suit. Autogenous tissue breast reconstruction has changed this. One of the great advantages of autogenous reconstruction over implants is that the breast remains soft, supple, and warm, improving with time as the scars begin to fade and becoming more natural and pendulous. Furthermore, since the new breast is made of fat, we can change its size, enhance its shape, and sculpture it with a suction lipectomy cannula to make it look practically identical to the opposite. We look upon breast reconstruction with rectus abdominis myocutaneous (RAM) flaps as a torsoplasty because of the improvements to the two areas involved: the reconstructed breast and the resulting abdominal lipectomy. This torsoplasty is done in two stages: One is the actual transfer of the rectus abdominis flap in which the skin and fat involved is designed to try to give an aesthetic dermolipectomy but without compromising the vascularity of the flap. Three or four months later, we perform the second-stage torsoplasty where the suction-assisted lipectomy plays a fundamental role and which is the subject of this article.

Abdominal Muscles↗
PubMed1990

Psychological preparation of the patient for breast reconstruction.

Just as the amputation of the breast is traumatic, the reconstruction of the breast has its own psychological effects and problems. In this article we review over 100 women who had undergone rectus abdominis musculocutaneous flap reconstruction. We address the psychological issues motivating the patient for surgery and the psychological problems to be considered by the plastic surgeon. We also outline the method of psychological preparation used with these women and report on an evaluative study of the program provided as written and prerecorded material. A protocol and verbalization for hypnotic relaxation is included.

Adult↗
PubMed1985

Closure of the donor defect for breast reconstruction with rectus abdominis myocutaneous flaps.

The abdominal muscles not only constitute a multidirectional cinch that holds the abdominal contents in place, but they also determine the flexion and rotational movements of the trunk. The rectus is mainly responsible for flexion and the obliques are responsible for rotating the trunk. It is therefore important to maintain the tone and direction of pull of the oblique muscles. The key to closure of the fascial defect is to replace the same area of anterior rectus fascia (tendon of both obliques and transversus muscles) as has been removed with the rectus abdominis flap pedicle. This replacement, done with a double Merselene mesh, should extend up to the costal margin and should be of the same width as the fascia taken with the muscle pedicle. This technique was drawn from experience with 186 patients. Of these, 31 were simply approximated, and 43 percent developed weakness, bulging, or hernias, of which 5 required secondary repair. A total of 155 patients were closed with Merselene mesh, and only 4 percent developed bulging that was later repaired and attributed to technical mistakes. There were two cases of infection and three cases of exposed mesh due to necrosis (mesh did not need removal). Seromas were common (14 percent), but the incidence was reduced to 5 percent after tacking stitches were done from the mesh to the subcutaneous fascia.

Abdominal Muscles↗
PubMed1982

Immediate breast reconstruction after mastectomy using a rectus abdominis myodermal flap without an implant.

In the authors' opinion there is no physical reason for a waiting period after total mastectomy before the breast is reconstructed. If the duration of the patient's survival is limited, the sooner the breast is reconstructed the better. The authors do not use silicone implants that may be blamed for the appearance of recurrent tumour but reconstruct the breast with a vertical rectus abdominis myodermal flap immediately after the mastectomy. The flap is an island of skin, fat and muscle extending from the xiphoid to the pubis; it receives its blood supply from the perforators of the superior-inferior epigastric vascular axis on the same side as the mastectomy. The rectus abdominis muscle is the pedicle and carrier of the vessels that feed the ellipse of skin. The flap is doubled on itself and thus forms a cone. It is then passed into the breast area by undermining the intervening bridge of skin. Nipple and areola are grafted onto the flap. This operation enables a wide resection, so that the principles of cancer management are not compromised.

Abdominal Muscles↗
PubMed1979

Rhytidectomy: a better way to suture the earlobe.

We propose suturing the earlobe in facelifts into a deepithelialized area of the facial skin flap in order to achieve a less noticeable scar, fewer lobe deformities, and better blood supply to the postauricular flap.

Ear, External↗
PubMed1977

The epigastric island flap.

We describe a paramedian epigastric island flap fed by the perforators of the superior-inferior epigastric vessels. It is transferred with an intervening strip of muscle and fascia. A case is reported and the future possibilities of the flap are discussed.

Abdomen↗
PubMedDate not supplied

Lipocontouring in breast reconstructive surgery.

The increasing popularity of the TRAM Flap for breast reconstruction has created a much greater request by many patients for further aesthetic improvement in the appearance of the new breast and of the abdominal donor site as well. This can be provided by greater use of a second-stage liposuction sculpturing of both the breast mound and the abdominal contours.

Breast↗