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Biomedical subjects

S S Kroll

Publications and source records attributed to S S Kroll.

At least 73 records · Page 4Linked to original sources
PubMed1995

Abdominal wall strength, bulging, and hernia after TRAM flap breast reconstruction.

The incidence of postoperative abdominal bulge, hernia, and the ability to do sit-ups was reviewed in a series of 268 patients who had undergone free TRAM (FTRAM) or conventional TRAM (CTRAM) flap breast reconstruction. Minimum follow-up was 6 months. Patients were divided into four groups: unilateral FTRAM (FT1P; n = 123), double-pedicle bilateral FTRAM (FT2P; n = 45), single-pedicle CTRAM (CT1P; n = 40), and double-pedicle or bilateral CTRAM (CT2P; n = 60). The incidence of abdominal bulges (3.8 percent) and hernia (2.6 percent) was similar in the four groups. Synthetic mesh, however, was required for reinforcement of donor site closure twice as often in the CTRAM patients. The ability to perform sit-ups was greatest in the FT1P group (63.0 percent), slightly lower in the CT1P group (57.1 percent), still lower in the FT2P group (46.2 percent), and lowest in the CT2P group (27.1 percent; p = 0.0005). Patients reconstructed with an FTRAM flap were more likely to be able to do sit-ups (58.3 percent) than were those reconstructed with a CTRAM flap (38.2 percent; p = 0.0074). Patients who had only one muscle pedicle used were more likely to be able to do sit-ups (61.7 percent) than were those who had two muscle pedicles used (35.6 percent; p = 0.0003). We conclude that the incidence of abdominal bulge or hernia is relatively independent of the type of TRAM flap used and the number of muscle pedicles harvested. On the other hand, postoperative abdominal strength, as measured by the ability do sit-ups, is influenced significantly by both of these factors.

Abdominal Muscles↗
PubMed1995

Anticoagulants and hematomas in free flap surgery.

A review of systemic anticoagulant use in 517 free flap procedures was performed to determine the associated risk of hematoma formation. Patients were divided retrospectively (not randomly) into five groups: no anticoagulation (227 flaps, 5.3 percent hematomas), low-dose heparin bolus of 2000 to 3000 units and postoperative infusion at a rate of 100 to 400 units/hr for 5 to 7 days (192 flaps, 6.7 percent hematomas), intraoperative bolus of 5000 units of heparin without postoperative anticoagulation (46 flaps, 6.5 percent hematomas), high-dose heparin infusion at a rate of 500 to 1200 units/hr (30 flaps, 20 percent hematomas), and dextran 40 infusion at a rate of 25 ml/hr (22 flaps, 9.1 percent hematomas). Intraoperative blood loss was similar for all groups. The flap loss rate was lower in the bolus (1.0 percent) and low-dose (1.0 percent) heparin groups than in the no-anticoagulation group (4.4 percent), but this difference was not statistically significant. The pedicle thrombosis rate also was lower in the bolus (2.2 percent) and low-dose (2.1 percent) heparin groups than in the no-anticoagulation group (6.2 percent). A cause-and-effect relationship between the use of anticoagulants and flap loss or prevention of thrombosis could not be established. We can conclude, however, that the use of low-dose heparin does not increase significantly the risk of hematoma or intraoperative bleeding.

Blood Loss, Surgical↗
PubMed1995

A comparison of factors affecting aesthetic outcomes of TRAM flap breast reconstructions.

The aesthetic results of TRAM flap breast reconstructions were assessed in 237 consecutive breast cancer patients. Nine independent judges, none of whom were plastic surgeons or members of the reconstructive team, assigned an aesthetic score to each patient after viewing postoperative photographs. We found that bilateral reconstructions were aesthetically superior to unilateral reconstructions (p = 0.0013), that immediate reconstructions were aesthetically superior to delayed reconstructions (p = 0.0001), and that previous irradiation of the chest wall reduced the mean aesthetic score (p = 0.0010). We also found that the mean aesthetic score assigned to patients who had reconstructions with free TRAM flaps was superior to that assigned to those who had reconstructions with conventional TRAM flaps, but when tested by multiple regression analysis, this trend was not statistically significant (p = 0.2972).

Breast↗
PubMed1995

Morbidity and functional outcome of free jejunal transfer reconstruction for circumferential defects of the pharynx and cervical esophagus.

Free jejunal transfer has been criticized by some surgeons as unreliable, poorly tolerant of radiation therapy, and associated with significant morbidity and dysphagia. To determine the validity of these criticisms, we reviewed 93 patients who underwent 96 free jejunal transfers for repair of circumferential pharyngoesophageal defects over a 5-year period. The free jejunal transfer success rate was 97 percent; all 3 failures were repaired with repeated free jejunal transfer. The complication rate was 57 percent (55 of 96); fistula (19 percent) and stricture (15 percent) were the most common complications. An oral diet was tolerated by 80 percent of patients; 85 percent of these resumed their diet within 2 weeks of surgery. Causes of dysphagia were multifactorial. Postoperative radiation therapy did not increase morbidity or dysphagia. The perioperative mortality rate was 2 percent. We conclude that free jejunal transfer is a reliable method of pharyngoesophageal reconstruction that has an acceptable morbidity rate and a low mortality rate. Postoperative radiation therapy is well tolerated by the free jejunal transfer.

Adolescent↗
PubMed1995

Reconstruction and the radiated breast: is there a role for implants?

The use of breast implants in irradiated patients is controversial. Recently, 39 irradiated implants were compared with 338 nonirradiated implants in 297 patients between January of 1975 and October of 1994 at The University of Texas M. D. Anderson Cancer Center. Tissue expanders and follow-up time of less than 6 months excluded patients from the study. Five groups of patients were identified. Group 1 consisted of 7 patients and 7 implants who received postoperative adjuvant radiotherapy after implant placement. Group 2 consisted of 5 patients and 7 implants who received preoperative adjuvant radiotherapy prior to implant placement. Groups 3 and 4 consisted of 2 and 12 patients (2 and 19 implants) placed beneath latissimus dorsi flaps who had postoperative and preoperative adjuvant radiotherapy, respectively. Group 5 contained 4 patients with 4 implants placed beneath a transverse rectus abdominis myocutaneous (TRAM) flap who had preoperative radiotherapy. All implants were placed submuscularly or beneath autogenous flaps. The average irradiated breast received 50 Gy. For statistical purposes, two categories were identified. Capsular contracture (Baker III or greater), pain, exposure, and implant removal in 6 of 14 implants that received radiotherapy were compared with similar complications in 33 of 266 implants without irradiation (p = 0.001). The second category contained 10 complications in 25 implants placed beneath autogenous reconstructions with radiotherapy compared with 6 of 72 similar complications in implants placed beneath autogenous reconstructions without radiotherapy (p = 0.000). Results showed that irradiation has significant negative effects on the reconstructive outcome with implants. Autogenous reconstruction did not appear to offer a protective role when placed over implants.(ABSTRACT TRUNCATED AT 250 WORDS)

Breast Implants↗
PubMed1995

Surgical and medical management of local-regional treatment failures in advanced primary breast cancer.

The strength in the management of locally advanced breast cancer lies in the team approach to multimodality care. The oncologist must be a careful listener and incorporate the patient's perspective of her goals before arriving at a final decision about a treatment plan for either the initial presentation of the disease or its locoregional relapse. Treatment strategies based on the genetic or biologic features of breast cancer arising within the individual patient are currently being investigated.

Breast Neoplasms↗
PubMed1994

Immediate versus delayed free-tissue transfer salvage of the lower extremity in soft tissue sarcoma patients.

BACKGROUND: Free tissue transfer (FTT) can extend the limits of limb salvage in patients with soft tissue sarcoma (STS), but few data exist on the efficacy and morbidity in this patient population. METHODS: We prospectively examined 19 patients who underwent resection of STS and an immediate or a delayed FTT reconstruction between November 1989 and May 1992. RESULTS: There were 11 immediate and eight delayed FTT reconstructions (mean age 52 years). All delayed patients presented with complications resulting from previous STS treatment. Defects involved the leg (n = 7), knee (n = 2), and thigh (n = 10) and had a mean size of 129 cm2, 154 cm2, and 283 cm2, respectively. Preoperative radiatiotherapy had been administered to 74% of patients in the series (mean dose 53 Gy). FTT success rate was 95% (one failure in the delayed group). Limb salvage and postreconstruction ambulatory rates were both 95%. The overall complication rate was 47%, with the trend of a higher rate (63%) in the delayed group compared with the immediate group (36%). The immediate reconstruction group required no additional operative procedures before FTT and had a shorter hospital stay (13 days) compared with that of the delayed reconstruction group (40.6 days). Mean follow-up was 11.9 months (range 2-30). CONCLUSIONS: FTT is a reliable and versatile adjunctive treatment for lower extremity salvage of patients with STS. Immediate reconstruction appears to carry a lower complication rate and a faster rehabilitation for the patient.

Female↗
PubMed1994

Rationale for elective contralateral mastectomy with immediate bilateral reconstruction.

BACKGROUND: Women with breast cancer treated by mastectomy with immediate breast reconstruction can get exceptionally good results if the reconstruction is performed with autogenous tissue using the transverse rectus abdominis myocutaneous (TRAM) flap. Bilateral reconstruction with TRAM flaps is also possible, but only if both breasts are reconstructed at the same time. To avoid the possibility of subsequently developing contralateral malignancy and having to undergo assymetrical reconstruction with a different technique, some patients have chosen the alternative of bilateral mastectomy with bilateral immediate reconstruction. This is only reasonable if the incidence of failure in bilateral breast reconstruction is very low. METHODS: We prospectively studied reconstructive outcomes in 100 patients who had breast cancer and who underwent bilateral mastectomy and reconstruction (using implants as well as TRAM flaps). We also reviewed the histologic findings in 88 prophylactically removed high-risk breasts. RESULTS: Successful outcomes were initially achieved in 95 patients; of the 5 failures, two were successfully reconstructed with alternative techniques for an overall success rate of 97%. Of the 63 patients reconstructed with bilateral TRAM flaps, all but one (98%) were successful on the first try. TRAM flap reconstructions were significantly more likely to be successful than were those based on implants (p = 0.05). Previously unsuspected invasive cancer was found in 3 patients (3.4%), whereas carcinoma in situ was found in 5 patients (5.7%) and in another 18 patients (20%) cellular atypia was present. CONCLUSIONS: Bilateral breast reconstruction has a low incidence of failure, particularly if TRAM flaps are used. For selected patients, elective contralateral mastectomy with immediate bilateral reconstruction is a reasonable treatment alternative provided that the necessary expertise is available and the patients clearly understand the risks.

Adult↗
PubMed1994

Long-term effects of radiotherapy administered in childhood for the treatment of malignant diseases.

BACKGROUND: The use of radiotherapy for the treatment of childhood malignancy has improved long-term survival significantly, and many treated children now survive well into adulthood. As a consequence, long-term effects of childhood irradiation are being seen with increasing frequency. METHODS: The medical records of 236 patients who had been treated for malignant disease with radiotherapy during childhood were examined to determine the long-term effect of the radiation on their growth and development. RESULTS: Mean treatment dose was 35.5 Gy; mean age at treatment was 7.2 years; and mean follow-up was 14.5 years. Adjuvant chemotherapy was given to 82%. Some degree of bone deformity (usually with overlying soft-tissue hypoplasia) was seen in 40%; 21% developed some type of endocrine deficiency; 30% developed atrophic skin changes; and 7% developed second malignancies. The incidence of bone deformity and hormonal deficiency increased with the radiation dose; the incidence of second malignancy was independent of dose. Bone deformities were more common when radiation was administered before the age of 2 years. CONCLUSIONS: The consequences of radiotherapy in childhood are significant and must be considered when planning treatment. Even when treatment is essential, families should be informed of the possibility of growth disturbance to prevent subsequent misunderstanding.

Adolescent↗
PubMed1994

The radial forearm free flap for head and neck reconstruction: a review.

BACKGROUND: The radial forearm free flap has become a workhorse flap in head and neck reconstruction. Its lack of bulk, ease of dissection, vascularity, and malleability are among its many advantages. PATIENTS AND METHODS: A review of 157 radial forearm free flaps performed in 155 patients between March 1988 and June 1994 at The University of Texas M.D. Anderson Cancer Center was undertaken to determine outcome. Patient age ranged from 22 to 80 years (mean 56). There were 79 men and 76 women. Follow-up ranged from 2 to 75 months. The most prevalent neoplasm was squamous cell carcinoma (n = 129). RESULTS: The most frequent tumor staging was T3, N0, M0. Various defects were observed; however, those requiring floor-of-mouth coverage were most common (n = 95). Partial or segmental mandibular resection was seen in 42. An osseous component was included in the radial forearm flap in 9 patients, and 64 patients had undergone some form of previous tumor resection. Fifty-seven patients received preoperative irradiation and 52, postoperative. The internal jugular vein (n = 131) and the external carotid artery (n = 134) were the most frequent recipient sites for microvascular anastomosis. Vein grafts were needed in 4 cases, and end-to-side anastomoses were most commonly performed. Total flap loss occurred in 7 cases (4.5%) and partial flap loss in 1 (0.6%). For total flap loss, salvage was accomplished by a second radial forearm free flap in 2 cases and alternative rotational flaps in 5. Other complications (infection, hematoma, fistula formation, etc.) were seen in 34%. Donor-site difficulties were seen in 21 cases. CONCLUSION: The radial forearm free flap offers a variety of reconstructive options for the head and neck. Its low flap loss and complication rates offer the best choice for oral lining restoration if bulk is not required.

Adult↗
PubMed1994

Morbidity associated with free-tissue transfer after radiotherapy and chemotherapy in elderly cancer patients.

Because of their ages and associated medical problems, many elderly cancer patients are treated with radiotherapy and/or chemotherapy to avoid the increased morbidity perceived to occur with prolonged surgical procedures such as tumor resection and reconstruction with free tissue transfer (FTT). The failure of such therapy still often requires tumor resection and reconstruction in irradiated tissue, which may add to the morbidity of surgery. To determine the validity of these concerns, 66 elderly cancer patients who underwent tumor resection and FTT after previous radiotherapy and/or chemotherapy (PT) were compared to a similar group of 64 elderly patients who had not received such previous therapy (NPT). Despite the two groups having similar patient traits, reconstructive-site characteristics, types of flaps used, medical risk factors, and time variables, there were no statistically significant differences between groups for FTT failure (PT3 percent, NPT 6 percent), medical complication rate (PT 16 percent, NPT 27 percent), surgical complication rate (PT 41 percent, NPT 49 percent), or wound-healing problems. The perioperative mortality rate was 2 percent. The authors conclude, that when medical problems are appropriately corrected before surgery, FTT may be safely performed in elderly patients with a high degree of success, acceptable morbidity, and low mortality. Previous cancer treatment does not appear to predispose elderly patients to a higher rate of FTT failure or wound-healing problems after FTT reconstruction.

Aged↗
PubMed1994

The free transverse rectus abdominis musculocutaneous flap for breast reconstruction: one center's experience with 211 consecutive cases.

All patients undergoing breast reconstruction with free transverse rectus abdominis musculocutaneous (TRAM) flaps from February 1989 to November 1992 were registered into a computerized database and followed prospectively. There were 211 free TRAM flap breast reconstructions in 163 patients; 48 reconstructions were bilateral. A muscle split technique was used in 108 of 211 reconstructions (51%). Total flap loss occurred in 3 of 211 reconstructions for a success rate of 99%. Complications occurred in 81 of 211 reconstructions (38%). Fat necrosis or partial flap loss occurred in 15 of 211 (7%). Hernia or bulge occurred in 11 patients (5%). The bulge/hernia rate tended to be lower in the muscle split group (4 of 108 [4%]) than in those who did not have muscle split procedures (7 of 103 [7%]), whereas the fat necrosis rate was slightly higher in the former group (9 of 108 [8%]) than in the latter (6 of 103 [6%]). Neither difference was statistically significant. However, patients who currently or previously smoked cigarettes did have a significantly higher incidence of fat necrosis: 12 of 99 smokers (12%) had fat necrosis compared with 3 of 112 nonsmokers (3%; p = 0.02).

Adult↗
PubMed1994

Risk of dissemination of cancer to flap donor sites during immediate reconstructive surgery.

We reviewed a series of 617 immediate reconstructions with distant flaps of defects caused by extirpation of malignant tumors to determine the incidence of tumor implantation in the flap donor sites. In this large series, there was only one instance of tumor dissemination to a flap donor site. We conclude that, despite possible theoretical concerns about host immunosuppression caused by surgical stress, the risk of tumor dissemination to flap donor sites as a consequence of immediate reconstruction is negligible.

Humans↗
PubMed1994

Deep-plane cervicofacial rotation-advancement flap for reconstruction of large cheek defects.

The blood supply and reliability of cervicofacial rotation-advancement flaps for cheek reconstruction can be improved significantly by dissecting the flap in the deep plane (i.e., below the superficial musculoaponeurotic system and the platysma). This modification, similar in technique to that used in composite or deep-plane face lift, was used successfully in seven patients, including several heavy cigarette smokers who were unlikely to have achieved a successful outcome with a conventional cervicofacial flap. No facial nerve weaknesses were observed. We now believe that the deep plane is the level of choice for dissection of cervicofacial flaps when used for reconstruction of cheek or other facial defects.

Basal Cell Carcinoma↗
PubMed1994

Necrosis of abdominoplasty and other secondary flaps after TRAM flap breast reconstruction.

The risks of abdominoplasty flap necrosis, umbilical necrosis, and mastectomy flap edge necrosis were compared in a series of 227 patients who had undergone transverse rectus abdominis myocutaneous (TRAM) flap breast reconstructions. Abdominoplasty flap necrosis was more common in patients who smoked or previously had smoked (27.5 percent) than in nonsmokers (5.9 percent). It also was more common in patients who had had conventional TRAM flaps (16.5 percent) than in those with free TRAM flaps (7.8 percent). Similarly, umbilical necrosis was more common in smokers (27.5 percent) than in nonsmokers (11.8 percent). Current smokers had higher risks than ex-smokers, who in turn had higher risks than patients who had never smoked. Obesity appeared to have only a minor influence on abdominal flap and umbilical necrosis. Mastectomy flap edge necrosis, which had little or no impact on the final outcome, was more common after free TRAM flaps than after conventional TRAM flaps.

Adult↗
PubMed1994

Head and neck reconstruction with the rectus abdominis free flap.

The rectus abdominis free flap is a versatile tool that is well suited to a variety of reconstructive problems in the head and neck, including defects of the orbit, the tongue, the cheek, the posterior mandible, and the neck. This flap, which has a high success rate, can be harvested while the ablative team is still excising the tumor. The donor site morbidity is minimal, and the time required to complete the surgery is less than that for most other free flaps. For these reasons, the rectus abdominis free flap has become an increasingly popular tool for use in head and neck reconstruction.

Head and Neck Neoplasms↗
PubMed1994

Breast reconstruction with myocutaneous flaps in previously irradiated patients.

Breast reconstructions performed with latissimus dorsi and transverse rectus abdominis myocutaneous (TRAM) flaps in 82 patients with a history of previous chest-wall irradiation were compared with similar reconstructions in 202 nonirradiated patients to determine whether prior irradiation was associated with more frequent complications and to determine the success rate of breast reconstruction using distant flaps in irradiated patients. The mean dose of radiation administered was 5637 cGy. Complications in the reconstructed breast were more frequent in the irradiated patients (39 percent) than in the nonirradiated patients (25 percent; p = 0.03). In the irradiated group, breast complications were more common in reconstructions performed with the latissimus dorsi flap (63 percent) than in those performed with the TRAM flap (33 percent; p = 0.063). Aesthetic outcomes also were slightly poorer in the irradiated patients. Although complications were more common and aesthetic outcomes not as good in previously irradiated patients, we do not consider such irradiation to be a contraindication to breast reconstruction.

Abdominal Muscles↗