10-year experience with the gracilis myofasciocutaneous flap.
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Adult↗
Biomedical subjects
Thomas R Stevenson
Publications and source records attributed to Thomas R Stevenson.
Abdominoplasty, liposuction of the flanks, and obesity: analyzing risk factors for seroma formation.
BACKGROUND: The purpose of this study was to determine whether seroma formation following abdominoplasty is associated with simultaneous liposuction of the flanks and to stratify the risk of developing seromas according to body mass index. METHODS: A retrospective review was conducted of 118 consecutive patients who underwent abdominoplasty with or without flank liposuction from 1992 to 2002. Patients in the abdominoplasty with flank liposuction category were further substratified according to the use of conventional versus ultrasound-assisted liposuction. Data regarding patient age, body mass index, and the occurrence of seromas were collected and analyzed. RESULTS: Fifteen of the 39 patients who underwent abdominoplasty alone (38 percent) developed seromas. This was comparable to the 23 of 79 patients (29 percent) who developed seromas after abdominoplasty combined with flank liposuction (p = not significant). Eight of 19 patients (42 percent) who had liposuction performed with ultrasound assistance developed seromas, compared with 15 of 60 patients (25 percent) who underwent conventional liposuction without ultrasound (p = not significant). When stratified according to body mass index, overweight or obese patients were more likely to develop seromas than patients of normal weight, whether liposuction was performed in the same setting or not [seromas in seven of 37 (19 percent) of normal weight patients versus 31 of 81 (38 percent) of overweight and obese patients, p < 0.05]. CONCLUSIONS: Liposuction of the flanks in concert with abdominoplasty does not appear to increase the risk of seroma formation. Patients who are overweight or obese present a statistically significantly higher risk for developing seromas postoperatively than patients of normal weight.
Abdomen↗
Pneumothorax as a complication of breast augmentation.
BACKGROUND: Pneumothorax is a recognized complication of breast augmentation which, until now, was thought to be rare. The authors hypothesize that it is more common than generally appreciated. METHODS: A fax survey was sent to 363 members of the California Society of Plastic Surgeons in 2001, questioning their experience with this complication. RESULTS: The survey response rate was 50 percent, revealing that one in three members of the California Society of Plastic Surgeons had at least one patient who experienced a pneumothorax, and one in 10 had experienced two or more complications of pneumothorax while performing breast augmentation. Sixty-two members reported a total of 83 separate pneumothoraces in their career. No local or hypodermic needle injections were used in 24 percent of these patients. Fifty-five percent of patients were hospitalized, with 71 percent of the cases paid for by insurance companies. Treatment consisted of observation and repeated chest radiograph in 33 percent, needle aspiration alone in 16 percent, and chest tube insertion in 47 percent. CONCLUSIONS: The cause is difficult to determine, but causes suspected by respondents included intraoperative laceration of the pleura (43 percent), needle puncture at the time of local injection (37 percent), ruptured pulmonary blebs during or after the procedure (16 percent), and high anesthetic ventilation pressures (3 percent). The authors believe the complication of pneumothorax is more common than generally appreciated and is not necessarily caused by negligence. The authors now include this complication in their consent form and recommend keeping an intracatheter, pigtail catheter, or Heimlich valve in surgical facilities for treatment of a possible tension pneumothorax.
California↗
Immediate breast reconstruction after mastectomy increases wound complications: however, initiation of adjuvant chemotherapy is not delayed.
BACKGROUND: Immediate breast reconstruction is being increasingly used after mastectomy, although it may increase the incidence of wound complications. The indications for chemotherapy in breast cancer are expanding and wound complications following mastectomy may delay the initiation of adjuvant chemotherapy. HYPOTHESIS: Immediate breast reconstruction after mastectomy for breast cancer does not lead to an increased incidence of wound complications nor delay the initiation of systemic chemotherapy. DESIGN AND SETTING: Retrospective medical record review at a tertiary care center. PATIENTS: One hundred twenty-eight women treated with a mastectomy for breast cancer over an 8-year period (January 1, 1995, through December 31, 2002). MAIN OUTCOME MEASURES: Surgical site complications (infectious and noninfectious) and time to initiation of postoperative chemotherapy. RESULTS: One hundred forty-eight mastectomy procedures in 128 women with breast cancer were evaluated. We analyzed 4 subgroups according to whether or not immediate breast reconstruction was part of the surgical procedure (76 or 72 procedures, respectively) and whether or not postoperative adjuvant chemotherapy was administered (81 or 47 patients, respectively). There was an increased incidence of wound complications in patients who underwent immediate breast reconstruction compared with those who did not (6/72 [8.3%] vs 17/76 [22.3%]; P = .02). However, these complications did not delay initiation of postoperative chemotherapy. CONCLUSIONS: Although we observed an increased incidence of wound complications when immediate breast reconstruction was combined with mastectomy, there was no delay in the initiation of adjuvant therapy. Immediate breast reconstruction should remain an important treatment option after mastectomy even when postoperative chemotherapy is anticipated.
Adult↗
The infected median sternotomy wound: management with the rectus abdominis musculocutaneous flap.
Treatment of patients with infected median sternotomy wounds includes debridement and closure using vascularized tissue, most often the pectoralis major muscle. However, occasionally, surgeons use other flaps to close sternotomy wounds. The purpose of this study is to review 1 center's experience with infected median sternotomy wounds utilizing a less common technique, the rectus abdominis musculocutaneous flap.
Adolescent↗