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PubMed2005

[Amniotic membrane transplantation for oculopalpebral and reconstructive surgery].

INTRODUCTION: Amniotic membrane has been used for many years for ocular surface defects. It is also commonly used in laboratories for cellular growth. Amniotic membrane has antiadhesive properties, can promote epithelialization, and decrease neovascularization, inflammation, and fibrosis. There is no histocompatibility problem, as amniotic membrane has no HLA antigens. In this study, amniotic membrane transplantation was used for oculopalpebral and reconstructive surgery as an alternative to the oral mucous graft, particularly in the reconstruction of the conjunctival fornices after inflammatory disease, burns, conjunctival tumors, and enucleation with orbital implants. MATERIAL AND METHOD: Forty-eight interventions using amniotic membrane transplantation were done on 44 patients. In 16 cases conjunctival fornices were created or reconstructed, allowing the installation of an ocular prosthesis; 14 had reconstruction of fornices for inflammatory disease, or chemical or thermal burns; 11 had palpebral skin and conjunctival reconstruction (malformations or skin tumours); and seven cases had conjunctival reconstruction after conjunctival tumor excision. RESULTS: Thirty-nine cases presented good functional and cosmetic results. One case had no follow-up. Eight cases gave poor results: four cases of conjunctival fornix refection (with two irradiated cavities), three cases of fornix reconstruction after chemical burn, and one case in whom palpebral reconstruction partially failed (coloboma). DISCUSSION AND CONCLUSION: Functional and cosmetic results were good for 39 cases, allowing ocular prosthetic equipment when necessary. In nine cases, two complete fornix retractions and two partial fornix retractions were observed; one palpebral reconstruction for malformation partially failed; and four cases (two with amniotic membrane and two with oral mucus graft) required a second surgery to obtain a satisfactory result. Amniotic membrane transplantation is an excellent alternative material to oral mucous membrane in oculopalpebral and reconstructive surgery except when graft rigidity is necessary. Its use is more difficult in cases of chemical burns or after orbital irradiation.

Adolescent↗

PubMed2003

Microvascular flap reconstruction of the mandible: a comparison of bone grafts and bridging plates for restoration of mandibular continuity.

OBJECTIVE: To compare the efficacy of vascularized bone grafts and bridging mandibular reconstruction plates for restoration of mandibular continuity in patients who undergo free flap reconstruction after segmental mandibulectomy. Study design and setting A total of 210 patients underwent microvascular flap reconstruction after segmental mandibulectomy. The rate of successful restoration of mandibular continuity in 151 patients with vascularized bone grafts was compared to 59 patients with soft tissue free flaps combined with bridging plates. RESULTS: Mandibular continuity was restored successfully for the duration of the follow-up period in 94% of patients who received bone grafts compared with 92% of patients with bridging mandibular reconstruction plates. This difference was not statistically significant. In patients who received bone grafts, most cases of reconstructive failure occurred during the perioperative period and were due to patient death or free flap thrombosis. In patients who received bridging plates, all instances of reconstructive failure were delayed for several months and were due to hardware extrusion or plate fracture. CONCLUSIONS: Vascularized bone-containing free flaps are preferred for reconstruction of most segmental mandibulectomy defects in patients undergoing microvascular flap reconstruction. However, use of a soft tissue flap with a bridging mandibular reconstruction plate is a reasonable alternative in patients with lateral oromandibular defects when the nature of the defect favors use of a soft tissue free flap. SIGNIFICANCE: Both bone grafts and bridging plates represent effective methods of restoring mandibular continuity following segmental mandibulectomy, with the former being the preferred technique for patients undergoing microvascular reconstruction.

Adult↗

PubMed1997

Intrinsic balancing in reconstruction of the tetraplegic hand.

This article reviews 183 hand reconstructions in 135 consecutive tetraplegic patients. Comparisons were made between 103 extrinsic reconstructions with intrinsic balancing procedures and 80 extrinsic reconstructions without intrinsic balancing procedures. Extrinsic reconstructions (tendon transfers and tenodesis in the forearm muscles) were augmented by intrinsic reconstructive procedures (tendon transfers or tenodesis to improve the intrinsic balance of the fingers) in patients exhibiting digital imbalance. Intrinsic procedures included primarily the flexor digitorum superficialis (FDS) lasso procedure or the intrinsic tenodesis procedure. The patients were stratified by level of spinal cord injury and by type of extrinsic and intrinsic reconstruction. Hands reconstructed with intrinsic balancing versus without intrinsic balancing, as well as intrinsic balancing using a FDS lasso procedure versus an intrinsic tenodesis procedure, were compared with patients with the same level of spinal cord function. Patients who underwent reconstructions with intrinsic balancing had more grip strength, by an average of 13-26 N, than those who did not undergo intrinsic balancing. When different intrinsic procedures were compared, there was improvement in grip strength and function in activities of daily living for all hands, but there was no significant difference between FDS lasso or intrinsic tenodesis procedures. The indications for intrinsic balancing during extrinsic reconstruction are developed into treatment algorithms based on the senior author's surgical experience. The authors recommended that digital intrinsic procedures be included in hand reconstruction for tetraplegic patients exhibiting intrinsic imbalance to help improve digital function and provide increased grip strength.

Adolescent↗

PubMed2000

Surgical reconstruction of the extracranial vertebral artery: management and outcome.

PURPOSE: The purpose of this study was to identify the risk and outcome of reconstruction of the extracranial vertebral artery (ECVA). METHOD: The study was conducted as a retrospective review of 369 consecutive ECVA reconstructions. RESULTS: The clinical presentations consisted of hemispheric symptoms alone in 4% of the cases, hemispheric and vertebrobasilar symptoms in 30%, and vertebrobasilar symptoms alone in 60%. The cause of the lesion was atherosclerosis (n = 300), extrinsic compression (n = 42), dissection (n = 7), radiation arteritis (n = 5), intimal hyperplasia (n = 3), fibromuscular dysplasia (n = 2), previous surgical ligation (n = 3), aneurysm (n = 2), and other (n = 5). All the patients underwent preoperative arteriography. There were 252 proximal ECVA reconstructions (218 transpositions, 42 bypass grafting procedures, and two other) and 117 distal ECVA reconstructions (85 bypass grafting procedures, 25 transpositions, and seven other). In 83 patients, the ECVA operation was performed concomitant with a carotid or supraaortic trunk reconstruction. This series was analyzed in two separate sets: before 1991 (n = 215), when changes in indications and management were occurring; and after 1991 (n = 154), when we acquired a dedicated anesthesia team and digital arteriography in the operating room and established uniform protocols for the management of ECVA disease. The stroke, death, and stroke/death rates for the period before 1991 were, respectively, 4. 1%, 3.2% and 5.1%. The stroke, death, and stroke/death rates for the period after 1991 were, respectively, 1.9%, 0.6% and 1.9%. The patency rate at 5 years was 80%. The survival rate at 5 years was 70%. Most of the deaths during the follow-up period were caused by cardiac disease. Among the survivors, the protection rate from stroke was 97%. CONCLUSION: The changes in operative selection and management have improved the results of ECVA reconstruction. The data reported for ECVA reconstruction in patients who underwent operation since 1991 reflect the outcome of ECVA reconstruction today. In our experience, a reconstruction of the ECVA is less risky than a carotid reconstruction.

Angiography↗

PubMed1998

Primary temporary AO plate reconstruction of the mandible.

OBJECTIVE: This study assessed the incidence of complications and revisions after primary temporary AO plate reconstructions of the mandible performed from 1971 through 1996. STUDY DESIGN: In a retrospective record review, the data of 51 patients undergoing primary temporary AO plate reconstructions after composite mandibular resection were analyzed according to age, gender, date of reconstruction, anatomic location of reconstruction, use of additional radiotherapy and/or flap surgery, and incidence of associated complications and revisions. RESULTS: Associated complications and revisions accompanying primary temporary AO plate reconstructions were evaluated through use of the incidence rates of associated complications (IACs) and revisions (IARs), which are reported as the numbers of associated complications and revisions, respectively, per 100 patients. Of the entire sample, the highest incidence rate of associated complications was associated with infection (33.5); this was followed by the rates for plate exposure (27.9) and plate fracture (10.7). With an overall incidence rate of 38.3 revisions per 100 patients, the corresponding site-related incidence rates of associated revisions were found to be 55.0 for reconstructions of the anterior mandible crossing the midline, 37.1 for those of the body segment of the mandible, and 31.1 for reconstructions involving the ramus and/or condyle area of the mandible. Revision rates were observed to be significantly higher in irradiated (53.6 vs 31.5) and non-flap-added reconstructions (43.2 vs 24.8). Analysis of treatment group-related incidences revealed irradiated non-flap-added reconstructions to be associated with the highest failure rates, whereas additional flap surgery resulted in a significant reduction in complications (50.0 vs 108.0) and revisions (20.0 vs 65.7). CONCLUSIONS: This study showed primary temporary AO plate reconstructions after composite mandibular resection to be associated with a high rate of complications and revisions. The results emphasize the need to relate outcome measures to site-related and treatment-related parameters.

Adult↗

PubMed1998

A retrospective study of combined fixed-removable reconstructions with their analysis of failures.

The survival rate and the reasons for failures of 130 combined fixed-removable reconstructions (CFR), incorporated in 112 patients, were assessed. Each CFR reconstruction was classified depending on its attachments: 76 reconstructions were attached with rigid, precise attachments, and constituted the rigid group; 54 reconstructions were attached with either semi-precision or individual attachments and were defined as the semi-rigid group. Of the 130 reconstructions, 41 were determined as complete successes, 39 as partial successes and 50 as failures, leading to 37 major repairs and to 13 new reconstructions. Three reconstructions failed due to technical reasons, 36 due to biological reasons and for 11 reconstructions, both categories of reasons were responsible for their failure. In total, technical reasons were counted 15 times in comparison to 73 biological reasons for those 50 failed reconstruction, with 29 fractured abutment teeth as the most common biological reason. Within the rigid group, 45 failed reconstructions were observed, whereas within the semi rigid group only 5 failures occurred, leading to an 8-year survival estimate (+/- SD) of 30.1% (+/- 6.9%) for the rigid group and 93.1% (+/- 3.9%) for the semi rigid group. Beside the attachment type, the anatomy of the partially edentulous tooth arch in form of the free-end situation and the dentate opposing jaw were identified as risk factors.

Adult↗

PubMed2000

Minimal lead sets for reconstruction of 12-lead electrocardiograms.

It may not always be possible to record all precordial leads of the standard 12-lead electrocardiogram (ECG). Especially in monitoring situations, a minimal lead set from which the 12-lead ECG can be reconstructed, would be valuable. This article assesses how well missing precordial leads could be synthesized from the remaining leads of the 12-lead ECG. A total of 2,372 diagnostic 12-lead ECG recordings were obtained from subjects with chest pain suggestive for acute myocardial infarction. Representative average beats were computed from the digital 12-lead ECG recordings with our Modular ECG Analysis System. The recordings were divided into a learning set and a test set. We considered all lead sets with one or more precordial leads removed, but always including limb leads I and II. By using the learning set, general reconstruction coefficients were computed to synthesize the missing precordial leads to each lead set. Performance of the synthesis was assessed by cross correlation between the original and the reconstructed leads. Also, patient-specific reconstruction coefficients were derived for each ECG in the test set and correlations were determined. High correlation coefficients were found with both reconstruction techniques. For different sizes of lead sets, the best patient-specific reconstructions had higher correlation values than the general reconstructions. For example, when 2 precordial leads were excluded, the best patient-specific median correlation was 0.994 compared to 0.963 for the best general reconstruction correlation. General reconstruction allows synthesis of 2 or 3 excluded precordial leads in good approximation. When patient-specific reconstruction can be applied, a minimal lead set including the limb leads and only 2 precordial leads suffices.

Electrocardiography↗

PubMed2001

[Reconstruction of the breast areola complex. Comparison of different techniques].

Different methods have been used in our department for nipple-areola reconstruction. This study was undertaken in order to find out which method of reconstruction shows optimal long-term results. Between 1983 and 1999, breast reconstruction was performed in 204 patients and different methods were used for nipple-areola reconstruction. 91 patients could be examined. For areola reconstruction full-thickness skin grafts from the groin were used as well as skin grafts from the contralateral areola, vaginal mucosal grafts, and tattoos. For nipple reconstruction we used nipple sharing, labium grafts, local flaps, and a tattoo. Areola reconstruction with full-thickness skin grafts from the groin was performed in 45 patients, in 16 patients a graft from the contralateral areola was used and in 19 patients the technique of intradermal tattoo was applied. One patient had a vaginal mucosal graft, in another patient the nipple areola complex was transplanted to the groin after mastectomy for later reconstruction. Nipple projection was measured and the colour of the reconstructed areola was compared to the other side. Concerning the match of colour, best results were achieved with grafting from the contralateral areola, followed by areola tattoo and skin grafts from the groin. The vaginal mucosal graft was too dark. The transplanted original nipple-areola complex maintained its colour. Nipple projection between 3 and 4 mm was achieved by nipple sharing and local flaps. With grafts from the labium, a projection from 1 to 2 mm was achieved. Thus, best results were achieved by nipple sharing, local flaps for nipple reconstruction and areola skin grafts from the contralateral side. Vaginal mucosal grafts and grafts from the labium are not recommended.

Esthetics↗

PubMed2004

[Comparison of the nipple projection after reconstruction with three different methods].

The creation of the nipple-areola complex represents the final stage in the surgical treatment of breast cancer patients. Preservation of the nipple projection is important and difficult to achieve. A huge number of different methods for nipple reconstruction have been well described, but some of them fail secondary to scar contraction with loss of projection. Furthermore, there are only few studies investigating the degree of shrinkage over time in nipple projection. Aim of this study was to determine the long-term projection of the reconstructed nipple. We compared three different methods that have been used in our department for nipple-reconstruction. Between May 1994 and December 2001, reconstruction of the breast mound was performed in 146 patients. 86 patients who underwent a unilateral reconstruction of the nipple have been examined. The nipple reconstructions were performed by using either a modified skate-flap (n = 29), a quadrapod-flap (n = 37) or by nipple sharing (n = 20). Nipple projection was measured at least six months after the reconstruction. Patients were followed an average of 10.9 +/- 3.62 months. 38 patients had tissue expansion and implantation for breast mound reconstruction. 29 patients had autologous breast mound reconstruction and 19 patients were treated by a combination of both. The mean projection was 3.45 mm (+/- 1.23) in the nipple sharing group, 6.03 mm (+/- 1.86) in the quadrapod-flap group and 9,24 mm (+/- 2.45) in the skate-flap group. The mean decrease in projection for the nipple sharing was 27.6 +/- 18.2 % while the skate flap lost 45.0 +/- 11.1 % and the quadrapod flap 49.9 +/- 11.56 %. Comparison between the three groups using a Student-t test showed a statistical significance between the nipple sharing and the two other groups (p < 0.001), while there was no significance between the local flap groups (p = 0.082). The best long-term nipple projection was obtained by the nipple sharing, but the indication therefore is rare whereas local flaps are used more often. We conclude that although both methods are effective, the skate flap allows the surgeon to overbuild the nipple and achieve a higher projection. In addition, the results also indicated that nipple projection on the breast mound reconstructed with autologous tissue achieved a better long-term outcome.

Breast Implants↗

PubMed2005

[Microsurgical reconstruction of the burned upper extremity].

BACKGROUND: Free tissue transplantation is a rarely indicated procedure in burn reconstruction. As the versatility and variability of free flaps have significantly increased during recent years, so too have the indications for these procedures expanded. MATERIAL AND METHODS: We retrospectively report the results of 42 free flaps for upper extremity reconstruction in 35 severely burned patients using 13 different free flaps. This experience has enabled us to establish reconstructive principles pertinent to the type of injury (burn versus high voltage injuries) and the timing of reconstruction procedures. RESULTS: In high voltage injuries (n = 17) early free flap coverage (< 21 days after trauma) with muscular flaps was the most frequently used type of reconstruction. Reconstruction site was predominately the forearm. In burn injuries (flame, contact, fluid), free flap coverage was performed during a later stage of the treatment course (3 to 6 weeks after trauma), or as a secondary procedure. Reconstruction with cutaneous or fascial flaps was the preferred method. The elbow and the dorsum of the hand underwent defect coverage in most circumstances. For the reconstruction of complex or large defects (n = 6) combined "chimeric" flaps, preexpansion of free flaps, or the combination of a free and local flap were used. Overall, the flap failure rate was 12 % (n = 5). Interestingly, there was a relationship between flap failure rate and timing of the procedure. Four out of five flap failures occurred within 5 to 21 days after trauma, all five flap failures occurred between five days and six weeks. No flap failure was seen during secondary reconstruction. CONCLUSION: Our data demonstrate that burn and high voltage injuries are distinct entities, each requiring custom-tailored reconstructive solutions for limb salvage. Even if our flap failures all occurred during the first six weeks it should not be forgotten that this type of coverage is the only alternative to amputation in selective cases.

Adolescent↗

PubMed1997

[Cinematographic functional diagnosis of swallowing after plastic reconstruction of large tumor defects of the mouth cavity and pharynx].

BACKGROUND: Reestablishing good swallowing function after resection and reconstruction of head and neck tumors is very important for our patients' well-being. Today many different surgical concepts for reconstruction after tumor surgery are in common use. It is necessary to establish a good diagnostic procedure for postoperative assessment of the swallowing function. High-speed cineradiography at a minimum of 50 frames per second is well established for evaluating swallowing problems in head and neck patients. METHODS: Thirty-six patients divided into three groups were examined using high speed cineradiography after surgical treatment of pharyngeal and oral cavity cancer. Group 1 (n = 12) included patients with a subtotal or total tongue resection and reconstruction with infrahyoid myofascial flap and jejunal flap; Group II (n = 8), patients with total resection of the oropharynx soft palate and velum and reconstruction with a free radial forearm flap; Group III (n = 15), patients with total laryngopharyngektomy and reconstruction with jejunal flap and siphon and with or without repair of the digastric muscle. RESULTS: Group I: All patients with tongue reconstruction were able to swallow normally from the oral cavity into the pharynx. All patients had normal bolus propulsion because of a good tongue volume and tongue motility. There was only one case of aspiration after total glossectomy with the larynx left in place. All patients could swallow with the head and neck in a normal position. Group II: All patients with reconstruction of the soft palate and velum were able to initiate proper bolus propulsion without nasal regurgitation or rhinolalia aperta. Only one patients suffered from chronic aspiration after hemiresection of the oropharynx and hypopharynx. Group III: All patients with pharynx reconstruction had no problems with bolus transfer through the reconstructed pharynx. Aspiration into the reconstructed pharynx was a major problem for those patients without repair of the digastric muscle (5/8 = 63%). Better results were observed in the patients who underwent repair of the digastric muscle. There was only one case (13%) of aspiration. CONCLUSIONS: By using high-speed cineradiography it is possible to make a detailed description of the swallowing function after extensive surgical treatment of pharyngeal and oral cavity cancer. We think that high-speed cineradiography is a very sensitive diagnostic procedure capable of detecting all functional aspects of swallowing. High-speed cineradiography should be one of the standard diagnostic studies performed surgery of the oral cavity and pharynx.

Adult↗

PubMed2002

Long-term results of revised infrainguinal arterial reconstructions.

PURPOSE: Infrainguinal arterial reconstruction with vein as the conduit has been regarded as the gold standard within the past two decades. However, as many as 20% of patients undergoing these bypass grafting procedures may need secondary interventions for continued patency. Once these reconstructions have been altered, there is concern about the continued patency of these types of revascularizations. In this study, we evaluated the long-term patency of venous reconstructions that had been revised, compared them with those bypass grafting procedures that did not require any intervention, and analyzed long-term outcome. METHODS: In the past 15 years, 3944 infrainguinal arterial reconstructions were completed with vein as the conduit. A total of 2780 were performed with the vein in situ, and 1164 were performed by using excised vein in a single piece or spliced configuration. Indication, risk factors, and patient demographics were evaluated. Grafts were stratified into revised and unrevised, in situ and excised; excised vein was then stratified into spliced and non-spliced. All grafts were followed with duplex ultrasound scans performed at 3, 6, and 12 months in the first year and every 6 months thereafter. Statistical analysis was performed by using Gehan's generalized Wilcoxon test. RESULTS: Demographics and indications were similar between groups. Nine percent of all excised veins required some revision, compared with 10% of all in situ reconstructions. When the excised veins were further stratified, 6% of single-piece venous conduits were revised, as opposed to 14% of reconstructions with spliced venous reconstruction. The 5-year patency rates were 67% for revised reconstructions and 78% for unrevised reconstructions (P <.0001). The 5-year patency rate of unrevised in situ bypass grafts was 81%, as compared with 69% for revised in situ reconstruction (P <.0001), and the 5-year patency rate for unrevised excised veins was 68%, with revised excised vein having a 5-year patency rate of 59% (P = not significant). CONCLUSION: Venous conduits that require revision have a significantly lower long-term patency rate than those that were unrevised. Grafts that require revision may be best suited for aggressive surveillance protocol to maximize long-term patency.

Aged↗

PubMed2000

Is daily mortality associated specifically with fine particles? Data reconstruction and replication of analyses.

In 1996, Schwartz, Dockery, and Neas reported that daily mortality was more strongly associated with concentrations of PM2.5 than with concentrations of larger particles (coarse mass [CM]) in six U.S. cities ("original paper"/"original analyses"). Because of the public policy implications of the findings and the uniqueness of the concentration data, we undertook a reanalysis of these results. This paper presents results of the reconstruction of these data and replication of the original analyses using the reconstructed data. The original investigators provided particulate air pollution data for this paper. Daily weather and daily counts of total and cause-specific deaths were reconstructed from original public records. The reconstructed particulate air pollution and weather data were consistent with the summaries presented in the original paper. Daily counts of deaths in the reconstructed data set were lower than in the original paper because of restrictions on residence and place of death. The reconstruction process identified an administrative change in county codes that led to higher numbers of deaths in St. Louis. Despite these differences in daily counts of deaths, the estimated effects of particulate air pollution from the reconstructed dataset, using analytic methods as described in the original paper, produced combined effect estimates essentially equivalent to the originally published results. For example, the estimated association of a 10 micrograms/m3 increase in 2-day mean particulate air pollution on total mortality was 1.3% (95% confidence interval [CI] 0.9-1.7%, t = 6.53) for PM2.5 based on the reconstructed dataset, compared to the originally reported association of 1.5% (95% CI 1.1-1.9%, t = 7.41). For coarse particles, the estimated association from the reconstructed dataset was 0.4% (95% CI -0.2-0.9%, t = 1.43) compared to the originally reported association of 0.4% (95% CI -0.1-1.0%, t = 1.48). These results from the reconstructed data suggest that the original results reported by Schwartz, Dockery, and Neas were essentially replicated.

Adolescent↗

PubMed1999

Optical tomographic reconstruction in a complex head model using a priori region boundary information.

In this paper we investigate the application of anatomical prior information to image reconstruction in optical tomography. We propose a two-stage reconstruction scheme. The first stage is a reconstruction into a low-dimensional region basis, obtained by segmentation of an image obtained by an independent imaging modality, into areas of distinct tissue types. The reconstruction into this basis recovers global averages of the optical tissue parameters of each region. The recovered distribution of region values provides the starting point for the second stage of the reconstruction into the spatially resolved final image basis. This second step recovers localized perturbations within the regions. The benefit of this method is the improved stability and faster convergence of the imaging process compared with a direct reconstruction into a spatially resolved basis. This is particularly important for the simultaneous reconstruction of absorption and scattering images, where ambiguities between the two parameters and the resulting problems of crosstalk require a good initial parameter distribution to ensure convergence of the reconstruction. We use a segmented brain model obtained from a magnetic resonance image as a test case to compare the performance of the two-stage reconstruction and the direct reconstruction from a flat prior, and show that the former achieves superior results in the recovery of localized absorption and scattering hot spots embedded in the background tissue.

Algorithms↗

PubMed2006

Three-dimensional reconstruction of partially 3D-digitized peach tree canopies.

A simplified method for building three-dimensional (3D) mock-ups of peach trees is presented. The method combines partial digitizing of tree structure with reconstruction rules for non-digitized organs. Reconstruction was applied at two scales: leaves on current-year shoots (CYS) and shoots on 1-year-old shoots (OYOS). Reconstruction rules make use of allometric relationships, random sampling of shoot attribute distribution and additional hypotheses (e.g., constant internode length). The method was quantitatively assessed for two training systems (tight goblet and wide-double-Y), at a range of spatial scales. For this purpose, light interception properties of reference and reconstructed mock-ups were compared. Mock-up quality depended on scale. Foliage reconstruction on CYS was unsuitable for generating a given CYS. Similarly, CYS reconstruction on OYOS was unsuitable for generating a given OYOS. This is because generic rules derived at the population scale do not consider specific foliage or shoot attributes of a given CYS or OYOS. In contrast, foliage reconstruction on CYS was able to generate OYOS mock-ups having light properties similar to the reference mock-ups. The same held for CYS reconstruction on OYOS for light capture properties at the tree scale. The CYS reconstruction on OYOS was also suitable for deriving OYOS distribution as a function of light interception ability. Reconstruction rules were successfully used to build the vegetation neighborhood of a reference shoot. The proposed method could therefore be used to make 3D tree mock-ups usable for a range of some, but not all, light computations. Because the simplified method allows large time savings, it could be used in virtual experiments requiring large numbers of replicates, such as comparative studies of tree genotypes or training systems.

Image Processing, Computer-Assisted↗

PubMed1994

Postmastectomy complications in breast reconstruction.

In a group of patients where breast reconstruction was performed at the time of mastectomy, the incidence of complications was studied. One hundred one consecutive patients had an autologous reconstruction using the transverse rectus abdominis musculocutaneous flap, and 115 consecutive patients had a prosthetic reconstruction with tissue expanders or with tissue expander and/or implant. One patient in the autologous reconstruction group had a cardiac arrhythmia requiring monitoring, but there were no other serious complications. Infection was more common in the group undergoing prosthetic reconstruction (5% compared with 3% in the autologous reconstruction group). A total of 8% of the patients in the group undergoing prosthetic reconstruction had to have their implants removed because of infection or exposure of the implant. Seven percent of the transverse rectus abdominis musculocutaneous flap patients had significant necrosis of a portion of the flap. Secondary surgical revision of the reconstructed breast was much more common (20%) in the prosthetic reconstruction group compared with 6% in the autologous reconstruction group.

Adult↗

PubMed1999

Long-term follow-up of a modified Anton-Hartrampf nipple reconstruction.

This study was performed to determine the degree of shrinkage over time in nipple projection after reconstruction. Nipple-areolar reconstruction was performed using the modified Anton-Hartrampf technique, and pigmentation was achieved with tattooing. This study looked at 28 consecutive patients with nipple reconstruction performed at The Milton S. Hershey Medical Center of the Penn State Geisinger Health Systems between September 1989 and November 1993. Two patients were lost to follow-up and 3 patients died of breast cancer. Thus, 23 patients and a total of 32 nipples were investigated. Initial measurements of nipple projection were taken 2 weeks postoperatively. Patients were followed an average of 38.7 months (range, 11-66 months). Ten patients (18 nipples) had tissue expansion and implantation for breast mound reconstruction. Thirteen patients (14 nipples) had autologous breast mound reconstruction. The mean decrease in projection of the tissue expansion and implantation group was 76.7+/-9.7%. The mean decrease in projection of the autologous reconstruction group was 64.3+/-12.1%. The mean decrease in projection for the entire group was 71.3+/-21.9%. Comparison between the two groups using a two-sample t-test showed p = 0.0047. The authors concluded that there is a significant reduction in nipple projection over time using the modified Anton-Hartrampf technique regardless of the type of breast mound reconstruction. In addition, their results also indicated that nipple projection on the breast mound reconstructed with an autologous musculocutaneous flap technique achieved a better long-term outcome. This study is potentially helpful in planning the initial size of the reconstructed nipple papule to match the opposite normal nipple. Additional studies need to be performed on other types of nipple-areolar reconstruction.

Breast Implants↗

PubMed2001

Breast reconstruction among inner city women with breast carcinoma.

Despite the known benefits of breast reconstruction, the numbers of patients undergoing breast reconstruction remains lower than expected. The goal of this study was to survey systematically the experience of inner city breast cancer patients with regard to breast reconstruction in an urban public hospital setting. Between July 1999 and April 2000, 60 patients attending the Kings County Hospital Center Outpatient Breast Cancer Clinic were enrolled in this study. A multidimensional questionnaire was designed to explore the factors that determine breast reconstruction among inner city women. Demographic analysis failed to show any difference in education, insurance status, and economics between women who undergo breast reconstruction (N = 11) and nonreconstructed patients (N = 49). Patients who have undergone reconstruction are satisfied with their results. Reconstructed women have a higher rating of satisfaction with their sex life than nonreconstructed women (p = 0.041). The women without breast reconstruction had a tendency toward more embarrassment when undressing in front of a partner and lower partner satisfaction with their bodies. The most commonly sited reason patients did not undergo breast reconstruction was the lack of knowledge about breast reconstruction before mastectomy. This emphasizes the importance of educating patients on all the options in the management of breast carcinoma.

Adult↗