SEARCH · PubMed Health

Results for “Reconstruction”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 559 records · Page 31Linked to original sources

PubMed1991

Anatomical reconstruction of the anterior cruciate ligament in goats.

A surgical procedure was developed for the implantation of an anatomical, two-banded anterior cruciate ligament (ACL) prosthesis. Prostheses were fabricated of braided long-chain polyethylene fibers. The left ACL of adult male goats was surgically excised and replaced with either an anatomical reconstruction (5 goats) or a conventional reconstruction (5 goats). The anatomical reconstruction required drilling four bone tunnels, two each in the femur and tibia. Each band of the prosthesis was placed through one tunnel in the femur and the corresponding tunnel in the tibia, recreating the anteromedial and posterolateral bands. The two bands were tensioned independently and stapled in place. In the conventional procedure, the prosthesis was doubled and placed through two larger tunnels, one in the femur and one in the tibia, tensioned and stapled together. All animals were terminated 3 months after surgery. Clinical evaluation of passive range of motion, antero-posterior laxity and the appearance of the joint space showed little or no difference between the reconstruction methods. The ultimate failure load for the natural (unoperated) ACL was 1691 +/- 210 N, while the anatomical and conventional reconstruction groups had mean ultimate failure loads of 1233 +/- 732 and 1012 +/- 220 N, respectively. The elongation to failure of all groups was similar: the natural ACL group = 7.1 +/- 2.8 mm, the anatomical group = 7.2 +/- 2.9 mm, and the conventional group = 7.7 +/- 3.9 mm. The slope of the load-deformation curve, or stiffness, was significantly higher for the natural ACL (4.53 +/- 1.24 x 10(5) N/m) than for either of the reconstruction methods (2.75 +/- 1.59 x 10(5) N/m for the anatomical and 2.34 +/- 0.60 x 10(5) N/m for the conventional). The energy to failure, or area under the load-deformation curve, showed no significant difference between groups. In conclusion, both types of reconstructions were less strong, stiff, and tough than the natural ACL. There was no significant difference observed between the anatomical and conventional reconstruction methods over the 3-month implantation time in either clinical evaluation or mechanical testing. Therefore, at 3 months postsurgery, the anatomical reconstruction technique was considered no better and no worse than the conventional reconstruction technique.

Animals↗

PubMed2002

[Evaluation of median filtering after reconstruction with maximum likelihood expectation maximization (ML-EM) by real space and frequency space].

Maximum likelihood expectation maximization (ML-EM) image quality is sensitive to the number of iterations, because a large number of iterations leads to images with checkerboard noise. The use of median filtering in the reconstruction process allows both noise reduction and edge preservation. We examined the value of median filtering after reconstruction with ML-EM by comparing filtered back projection (FBP) with a ramp filter or ML-EM without filtering. SPECT images were obtained with a dual-head gamma camera. The acquisition time was changed from 10 to 200 (seconds/frame) to examine the effect of the count statistics on the quality of the reconstructed images. First, images were reconstructed with ML-EM by changing the number of iterations from 1 to 150 in each study. Additionally, median filtering was applied following reconstruction with ML-EM. The quality of the reconstructed images was evaluated in terms of normalized mean square error (NMSE) values and two-dimensional power spectrum analysis. Median filtering after reconstruction by the ML-EM method provided stable NMSE values even when the number of iterations was increased. The signal element of the image was close to the reference image for any repetition number of iterations. Median filtering after reconstruction with ML-EM was useful in reducing noise, with a similar resolution achieved by reconstruction with FBP and a ramp filter. Especially in images with poor count statistics, median filtering after reconstruction with ML-EM is effective as a simple, widely available method.

Filtration↗

PubMed1999

A sociodemographic and economic comparison of breast reconstruction, mastectomy, and conservative surgery.

BACKGROUND: There are a variety of surgical choices for women with early-stage breast cancer, including breast-conserving surgery, mastectomy, or mastectomy plus reconstructive surgery. This report examines some of the factors that affect these choices and the costs of the various treatment options. METHODS: Data from the Virginia Cancer Registry were linked to insurance claims from the Trigon Blue Cross and Blue Shield Company for women with local and regional staged breast cancer from 1989 to 1991 in Virginia. Multivariate analyses and cost studies were performed. RESULTS: There were 592 women who underwent breast-conserving surgery (BCS, 26%), mastectomy (58%), or mastectomy plus reconstruction (16%). Increasing age reduced the use of reconstruction. The choice of reconstruction was not affected by tumor size, nodal status, or race. Sixty percent of women had immediate breast reconstruction at the time of mastectomy; the majority had the implant procedure. The cost of BCS ($21,582) was higher than that of mastectomy ($16,122, P < .01). The costs for BCS and mastectomy were significantly lower than for mastectomy plus reconstruction ($31,047, P < .05). The 2-year cost for immediate reconstruction was $8200 less than for delayed procedures and was similar to the cost of BCS. CONCLUSIONS: Age was the driving force in reconstruction decisions. Clinical factors such as tumor size and nodal status were more important for the choice between BCS and mastectomy. There are significant cost differences between the various procedures. For a similar cosmetic outcome, BCS is less expensive than breast reconstruction. When reconstruction is required, a simultaneous procedure is less expensive.

Blue Cross Blue Shield Insurance Plans↗

PubMed2000

[Skin sparing incision mastectomy and immediate TRAM flap breast reconstruction].

OBJECTIVE: In order to achieve a high-quality reconstructed breast, we improved the operation method using the skin sparing incision mastectomy and immediate TRAM flap breast reconstruction. METHODS: Patients with duct carcinoma in situ were selected to undergo mastectomy with a skin sparing incision. The site of the previous biopsy incision was marked around the areola, and then the preferred skin sparing incision included the nipple-areola complex and a margin around the biopsy site for the non-ptotic breast. The excised skin was replaced as precisely as possible with the TRAM flap skin immediately. While the mastectomy was being performed the TRAM flap was incised and elevated. The pedicled or free TRAM flap has been used for 34 patients. Nipple-areola reconstruction was made at the second stage. RESULTS: The results of the skin sparing breast reconstruction are better than other breast reconstruction techniques in the breast's shape, colour, sensation, symmetry and incision scar. CONCLUSIONS: Skin sparing incision mastectomy with immediate TRAM flap breast reconstruction technique is an ideal breast reconstructive method for the patients with breast duct carcinoma in situ. The advantages of the method include 1. The TRAM flap is an autograft without rejection; 2. The reconstructed breast has good shape and better sensation than other autograft reconstructive techniques since most breast skin has been spared; 3. The symmetry of the reconstructed breast with the contralateral breast is improved.

Adult↗

PubMed2003

[Influence of different procedures of alimentary tract reconstruction after total gastrectomy for gastric cancer on the nutrition and metabolism of patients: a prospective clinical study].

OBJECTIVE: To investigate the influence of different alimentary tract reconstruction procedures after total gastrectomy for treatment of gastric cancer on nutrition and metabolism and explore an ideal reconstruction procedure. METHODS: A total of 149 patients with gastric cancer who had undergone total gastrectomy were randomly allocated into 5 groups of 30 patients (except the group HLD with 29 cases) to undergo 5 different alimentary tract reconstruction procedures: simple esophagojejunostomy using Roux-en-Y technique (RY), P pouch with Roux-en-Y reconstruction (PRY), jejunal pouch reconstruction according to Hunt-Lawrence technique (HL), jejunal pouch original interposition reconstruction modified by the authors (JOP), and Hunt-Lawrence reconstruction technique maintaining duodenal passage (HLD). Three and six months after operation, quality of life (Visick grade), PNI; body weight; and serum nutritional parameters, including albumin, (ALB), total protein (TP), transferrin (TF), hemoglobin (HB), and serum iron (SI), were evaluated. RESULTS: In comparison with those of the PRY, HL, JOP, and HLD groups, the patients of the RY group show greater weigh loss, and lower ALB, TP, and TF (all P < 0.05). The HB, SI, and TS levels in the JOP group and HLD group were significantly higher than those in the RY, PRY, and HL groups (all P < 0.05). CONCLUSION: Different procedures of alimentary tract reconstruction after total gastrectomy have great influence on the patients' nutrition at different degrees. The patients undergoing the procedures with a reservoir show higher serum nutritional parameters and better body weight. The volume of reservoir has no major clinical importance. The jejunal pouch original interposition reconstruction modified by the authors (JOP), constructing a gastric reservoir and maintaining the alimentary tract flowing through the duodenum is an ideal choice for the reconstruction after total gastrectomy.

Adenocarcinoma↗

PubMed2004

[The surgical treatment and reconstructive methods in management of hypopharyngeal cancer].

OBJECTIVE: To study the surgical treatment and the long-term effect of different reconstructive methods in surgical treatment of hypopharyngeal cancer. METHODS: A retrospective review of 303 (265 males, 38 females, ages ranging from 32 to 77 years) cases with hypopharyngeal cancer that were treated with surgical treatment from 1965 to 1998 were accomplished. Of the 303 cases, 130 cases were treated with different reconstructive methods and 173 cases without reconstruction. Of the 130 (stage II, 5; III, 16; IV, 109) cases, 94 were originated from pyriform sinus, 18 from posterior pharyngeal wall and 18 from postcricoid. Fifteen patients were reconstructed with free jejunum. Eighty-one patients were performed total pharyngo-larygo-oesophagectomy and gastric pull-up. Ten patients were treated with vascularized colon. Twenty patients were reconstructed with pectorals major myocutaneous flap. Four patients were reconstructed with other methods. Of the 173 (stage I, 7; II, 12; III, 51; IV, 103) cases, 160 were originated from pyriform sinus, 8 from posterior pharyngeal wall and 5 from postcricoid. RESULTS: The overall 3 and 5 years survival rate of 130 patients with reconstruction were 43.2%, 36.4% respectively. The overall 5 years survival rate of 173 patients with no reconstruction was 47.7%. The overall rate of regular swallowing was over 80%. The mortality rate in period of surgery of gastric pull-up and pectorals major myocutaneous flap were 8.6% and 15% respectively. No patients with free jejunum and vascularized colon died. The overall complication rate in nineties was lower than before 1990 (chi2 = 13.457, P = 0.004). The highest complication rate occurred in patients with pectorals major myocutaneous flap. In contrast to other reconstruction methods, the rate of success of swallowing was higher in patients with free jejunum. CONCLUSIONS: In selected patients these reconstruction techniques enable functional rehabilitation of swallowing. Even high survival rate was obtained after extended partial pharyngolaryngectomy.

Adult↗

PubMed2005

Multidisciplinary approach to abdominal wall reconstruction after decompressive laparotomy for abdominal compartment syndrome.

INTRODUCTION: Decompressive laparotomy for abdominal compartment syndrome has been shown to reduce mortality in critically ill patients, but little is known about the outcome of abdominal wall reconstruction. This study investigates the role of plastic surgeons in the management and reconstruction of these abdominal wall defects. METHODS: We performed a retrospective review of 82 consecutive critically ill patients who underwent decompressive laparotomy for abdominal compartment syndrome, at a university level 1 trauma center, from April 2000 to May 2004. Patients reconstructed by trauma surgeons alone (n = 15) were compared with patients reconstructed jointly with plastic surgeons (n = 12), using Student t test and chi analysis. RESULTS: Eighty-two patients underwent decompressive laparotomy for abdominal compartment syndrome, yielding 50 survivors (61%). Of the 27 patients who underwent abdominal wall reconstruction, 6 had early primary fascial repair, and 21 had staged reconstruction with primary fascial closure (n = 4), components separation alone (n = 3), components separation with mesh (n = 10), or permanent mesh only (n = 4). Compared with patients whose reconstruction was performed by trauma surgeons, patients who underwent a combined approach with plastic surgeons were older (50.5 versus 31.7 years, P < 0.05), had more comorbidities (P < 0.001), were less likely to have a traumatic etiology (P < 0.001), had a longer delay to reconstruction (407 versus 119 days, P < 0.05), and were more likely to undergo components separation (P < 0.05). Mean follow-up of 11.5 months revealed 2 recurrent hernias in the combined reconstruction group, both of which were successfully repaired. CONCLUSIONS: A multidisciplinary approach is essential to the successful management of abdominal wall defects after decompressive laparotomy for abdominal compartment syndrome. Although carefully selected patients can undergo early primary fascial repair, most of reconstructed patients had staged closure of the abdominal wall via components separation, with a low rate of recurrent hernia. High-risk patients with large defects and comorbidities appear to benefit from the involvement of a plastic surgeon.

Abdomen↗

PubMed2005

The use of tensor fascia lata pedicled flap in reconstructing full thickness abdominal wall defects and groin defects following tumor ablation.

BACKGROUND: The tensor fascia lata is a versatile flap with many uses in reconstructive plastic surgery. As a pedicled flap its reach to the lower abdomen and groin made it an attractive option for reconstructing soft tissue defects after tumor ablation. However, debate exists on the safe dimension of the flap, as distal tip necrosis is common. Also, the adequacy of the fascia lata as a sole substitute for abdominal wall muscles has been disputable. The aim of the current study is to report our experience and clinical observations with this flap in reconstructing those challenging defects and to discuss the possible options to minimize the latter disputable issues. PATIENTS AND METHODS: From April 2001 to April 2004, 12 pedicled TFL flaps were used to reconstruct 5 central abdominal wall full thickness defects and 6 groin soft tissue defects following tumor resection. In one case, bilateral flaps were used to reconstruct a large central abdominal wall defect. There were 4 males and 7 females. Their age ranged from 19 to 60. From the abdominal wall defects group, all repairs were enforced primarily with a prolene mesh except for one patient who was the first in this study. Patients presenting with groin defects required coverage of exposed vessels following tumor resection. All patients in the current study underwent immediate reconstruction. RESULTS: The resulting soft tissue defects in this study were due to resection of 4 abdominal wall desmoid tumors, a colonic carcinoma infiltrating the abdominal wall, 4 primary groin soft tissue sarcomas, a metastatic SCC of the leg to groin nodes, and a primary SCC of the groin. The size of the flaps used ranged from 20 x 10 cm to 31 x 18 cm. All flaps survived. However, distal flap necrosis occurred in 4 cases. Three of those cases developed in flaps reconstructing abdominal wall defects, and one case developed in a flap used to cover a groin defect. In the former 3 cases, the flap was simply transposed without complete islanding of the flap. In the latter case, a very large flap was harvested beyond the safe limits with its distal edge just above the knee. In addition, wound dehiscence of the flap occurred in 2 other cases from the groin 132 group. Nevertheless, all the wounds healed spontaneously with repeated dressings. Out of the 5 cases that underwent abdominal wall reconstruction, one case developed ventral hernia, in which bilateral TFL flaps were used without mesh enforcement. There was minimal donor site morbidity in the form of partial skin graft loss in 2 cases. The average follow up period in this study ranged from 6 months to 2 years. Only one patient died of distant metastasis of a SCC of the groin skin, 8 months postoperatively and another 2 patients with abdominal desmoid tumors developed local recurrence. CONCLUSION: The tensor fascia lata flap is a reliable and a versatile flap, with minimal donor site morbidity. Problems with the flap's vascularity of its distal part should not be encountered, if the flap is harvested within the safe limits and properly designed and the edges comfortably insetted to the defect. A pedicled flap would be appropriate for lower abdominal wall defects, and is better islanded to achieve extra mobilization and allow a tension free closure, while for groin defects, simple flap transposition should be enough. Nevertheless, reconstruction for full thickness abdominal wall defects by this flap is a static reconstruction. We therefore strongly recommend enforcing the repair with a synthetic mesh primarily to minimize the incidence of ventral hernia. However, further studies with larger number of cases are needed to confirm this observation.

Abdominal Neoplasms↗

PubMed1998

A survey of general surgeons' attitudes towards breast reconstruction after mastectomy.

Within the last 15-20 years there have been many changes in the management of breast cancer. Along with changes in treatment, possibilities for breast reconstruction have become increasingly sophisticated and commonplace. Despite the availability of breast reconstruction, we have noted large variations in referral patterns. Because the surgical treatment of breast cancer is largely undertaken by general surgeons, we investigated general surgeons' attitudes towards reconstruction using a postal questionnaire. In 1995, a questionnaire involving hypothetical criticisms was sent to general surgical members of the Association of Surgeons of Great Britain and Ireland. A total of 136 surgeons responded, 79 (58%) of whom had a specialist interest in breast cancer. Each surgeon saw an average of 68 new cases of breast cancer per year (range 0-400). The general surgeons were concerned about three areas: (1) 32.3% felt that breast reconstruction might adversely delay the detection of local recurrence; (2) 16.6% were worried that breast reconstruction has high morbidity; and (3) 17.4% said that patients did not want breast reconstruction despite being advised of its availability. To investigate these concern's further, an extensive literature search was undertaken. There is no evidence that breast reconstruction delays the detection of local recurrence. With appropriate patient selection, the morbidity of reconstructive options appears very acceptable. Finally, immediate breast reconstruction has psychological benefits when compared with delayed reconstruction.

Attitude of Health Personnel↗

PubMed2026

Technical note: reconstructing dose distributions from manually planned electron boosts in breast radiotherapy.

PURPOSE: In breast radiotherapy, delivery of manually-calculated electron boosts limits retrospective dose-response analyses as dose distribution is unavailable. This work evaluates the feasibility of reconstructing dose distributions from manually planned electron boosts in breast-conserving radiotherapy. METHODS: Only 72 out of 198 breast cancer patients had complete stored dose distributions from sequential electron boosts in the REQUITE study. Arbitrary data from 70/72 patients were used to develop and validate dose reconstruction method. Twenty patients were used to determine optimal parameters for Monte-Carlo-based (MC) electron dose reconstruction on RayStation (v.11B-R), considering CT-calibration curve, MC-history number, andcalculation grid resolution. Remaining 50 patients were used to quantify dose reconstruction accuracy. The similarity between reconstructed and stored dose was evaluated using 3D-gamma index and dosimetric parameters extracted from breast and tumour bed contours. Dose difference location was evaluated using dose-location histogram. RESULTS: Calculation grid resolution significantly impacted electron dose distribution (p < 0.01), where the finest grid (0.15 cm) showed highest similarity to stored doses. CT-calibration curve and MC-history number had a negligible influence on dose reconstruction. Dosimetric difference between reconstructed and stored doses was < 1 Gy for breast and tumour bed. Reconstructed dose was achieved > 90% gamma passing rate in the validation set. However, around 2.5 Gy dose differences were observed at the skin and tissue interface regions. CONCLUSIONS: Retrospective electron boost dose reconstruction is feasible with acceptable accuracy, and could increase data completeness in large cohort studies. Caution is advised when assessing dose near tissue interface and further validation is needed outside the REQUITE dataset.

Electrons↗

PubMedDate not supplied

Nasal reconstruction in the elderly patient. The case for not letting age determine method.

OBJECTIVES: To review a series of nasal reconstructive procedures in elderly patients, and to discuss management issues related to reconstructing nasal defects in patients 80 years and older. DESIGN: Retrospective review identifying patients 80 years and older undergoing significant nasal reconstructive surgery. SETTING: University and private practice settings. PATIENTS: Patients 80 years and older requiring significant nasal reconstructive surgery, with nasal defect large enough to require a forehead flap for skin resurfacing. Patients whose defects were allowed to granulate or who had skin grafts were excluded. INTERVENTION: Nasal reconstructive surgery using advanced surgical techniques such as forehead flaps and cartilage grafts. MAIN OUTCOME MEASURES: Complications related to surgery or use of anesthesia and whether patients believed the effort and resources required to complete the nasal reconstruction were worth it. RESULTS: Fifteen patients 80 years and older underwent nasal reconstructive surgery using forehead flaps. In addition, 5 patients had intranasal mucosal grafts and 6 had cartilage grafts. There were no instances of anesthetic or perioperative morbidity or mortality. In addition, all flaps completely survived, and results were judged as good to excellent. CONCLUSIONS: Actuarial evidence shows that a 90-year-old American woman has a 40% chance of living to be 95 years old. Presently, with the improved level of functioning of octogenarians and nonagenarians, we are also concerned with their facial appearance, and want to use the optimum reconstructive technique. The decision of what type of reconstructive surgery to perform should not be based simply on a patient's age but must also take into account the patient's mental status and wishes, and medical condition. Our evidence supports the concept that, in the appropriately chosen patient 80 years and older, forehead flaps and cartilage grafting can be performed without significant morbidity.

Aged↗

PubMed1998

Functional results of primary closure vs flaps in oropharyngeal reconstruction: a prospective study of speech and swallowing.

BACKGROUND: The preservation of speech and swallowing function is the primary goal when reconstructing soft tissue defects in the oral cavity or oropharynx. The type of reconstructive procedure used should be based on outcome data examining speech and swallowing function; yet, there is a paucity of such information. OBJECTIVES: To present the results of a multi-institutional prospective study of speech and swallowing function before and after soft tissue reconstruction of the oral cavity and oropharynx, and to compare 3 methods of reconstruction with respect to speech and swallowing function: primary closure, distal myocutaneous flap, and microvascular free flap. DESIGN: Prospective case-comparison study. SETTING: Four leading head and neck cancer institutions. PATIENTS: The patients were selected from a database of 284 patients treated at the different institutions. The patients were matched for the location of the oral cavity or oropharyngeal defect and the percentage of oral tongue and tongue base resection. Those patients who had previous speech and swallowing deficits and patients in whom postoperative fistulas or wound infections developed were excluded from the study. METHODS: The patients underwent speech and swallowing evaluation preoperatively and 3 months after healing. This evaluation included videofluoroscopic studies of swallowing and tests of speech intelligibility and sentence articulation. Videofluoroscopy provided measures of swallowing efficiency and bolus movement. Liquid and paste consistencies were used in evaluating swallowing function. MAIN OUTCOME MEASURE: The functional results of the reconstruction. RESULTS: Patients who had primary closure were more efficient at swallowing liquids, had less pharyngeal residue, a longer oral transit time with paste, and higher conversational intelligibility than patients who underwent reconstruction with a distal flap. Compared with patients who underwent reconstruction with a free flap, those who had primary closure had more efficient swallowing of liquids, less pharyngeal residue, and shorter pharyngeal delay times with paste. No difference in the speech and swallowing function existed between patients treated with distal myocutaneous flaps and those treated with microvascular free flaps. CONCLUSION: Contrary to the current theory of oral and oropharyngeal reconstruction, we found that the use of primary closure resulted in equal or better function than the use of flap reconstruction in patients with a comparable locus of resection and percentage of oral tongue and tongue base resection.

Deglutition↗

PubMed1998

Secondary reconstruction of upper midface and orbit after total maxillectomy.

OBJECTIVE: To evaluate the aesthetic and functional results of secondary reconstruction of the upper midface and lower orbit following globe-sparing maxillectomy. DESIGN: Retrospective analysis. SETTING: University medical center. PATIENTS: Six patients, all having previously undergone globe-sparing maxillectomies with or without postoperative radiotherapy, were selected for secondary reconstruction of the upper midface. INTERVENTION: Free calvarial bone grafts (CBGs) alone or in conjunction with alloplastic material were used to reconstruct the upper midface and lower orbit both aesthetically and functionally. Bone grafts were secured using lag screw and nonrigid techniques. Pedicled temporoparietal fascia (TPF) flaps provided coverage of the reconstructions and internal lining of the maxillectomy cavity. OUTCOME MEASURES: Aesthetic and functional results of upper midface and lower orbit as determined by preoperative and postoperative photographs and physical examination. RESULTS: All patients had considerable improvement in upper midfacial contours. All patients had improvement of globe position. Patients with diplopia before reconstruction noted improvement after reconstruction, although 1 patient continued to have moderate diplopia. Complications included persistent globe malposition, persistent diplopia, bone graft resorption, partial loss of 1 TPF flap, need for revision surgery, and subjectively worsened appearance in 1 patient. CONCLUSIONS: Reconstruction with CBGs, alloplastic material, and TPF may reliably, effectively, and efficiently rehabilitate the functional and aesthetic upper midfacial deficits of select patients with secondary reconstruction after globe-sparing maxillectomy. However, patients with evidence of excessive scarring may benefit more from free-tissue transfer reconstruction.

Aged↗

PubMed1989

A critical analysis of immediate and delayed mandibular reconstruction using A-O plates.

Eleven patients who underwent mandibular reconstruction with A-O plates were followed up for as long as 40 months. The patients underwent either immediate or delayed mandibular reconstruction. Nine patients had free cortical bone grafts included in the reconstruction. Complications in patients who underwent immediate reconstruction included loss of the bone graft due to infection, external and intraoral exposure of the reconstruction plate, pain, and infection. In the patients with immediate reconstruction, more than 50% of the bone grafts resorbed. There were less complications and minimal bone graft resorption in patients who underwent delayed reconstruction. The cosmetic results were initially good in both immediate and delayed reconstruction but deteriorated as more surgery was required for management of complications. At 40 months, 7 of 11 patients (5 of 9 with immediate reconstruction) had died of local recurrence, distant metastasis, or another primary tumor. No patients were rehabilitated prosthetically. We conclude that while A-O plating is technically easy and has a low perioperative morbidity rate, the long-term morbidity rate is high. This must be weighed against the benefits of the procedure and the probability that the patients will have a poor functional outcome.

Bone Plates↗

PubMed1995

Esthetic refinements in forehead flap nasal reconstruction.

OBJECTIVE: To identify refinements in forehead flap nasal reconstruction that consistently provide better esthetic and functional results. DESIGN: Case series of patients undergoing forehead flap nasal reconstruction from July 1, 1987, to May 31, 1994. SETTING: University hospital ambulatory surgery department. PATIENTS: Thirty-two patients with various nasal defects. INTERVENTIONS: Modifications of currently accepted techniques of paramedian forehead flap nasal reconstruction, namely, flap harvest and contouring, W-plasty closure of the superior forehead donor site, and creation of soft-tissue triangles. The principles of open-structure rhinoplasty are incorporated into cartilaginous reconstruction of the nasal tip and columella. The alar rim is reconstructed with cartilage grafts placed at the nasal rim. MAIN OUTCOME MEASURES: Esthetic and functional results of nasal reconstruction were subjectively graded by three otolaryngologists (V.C.Q., D.A.S., and M.F.R.) and the patients. RESULTS: Improved esthetic and functional nasal reconstruction. The most common nasal subunits reconstructed were as follows: ala, 27 patients (84%); side-wall, 22 patients (69%); dorsum, 18 patients (56%), and tip, 15 patients (47%). The esthetic results ranged from average to excellent (3 to 5 on a scale of 5), the functional results ranged from improved to much improved over preoperative breathing (4 to 5). Two patients required unplanned surgical revisions. Forty-seven percent of patients chose to undergo dermabrasion. Five patients required postoperative intradermal injection of triamcinolone acetonide (Kenalog). Three patients required preoperative tissue expansion. Flap or graft loss, infection, or hematoma did not occur. CONCLUSIONS: The predictability of the techniques in providing excellent results in patients undergoing nasal reconstruction decreases the need for revision procedures and helps the patient and the surgeon achieve the desired outcome.

Aged↗

PubMed1997

A comparison of masticatory function in patients with or without reconstruction of the mandible.

BACKGROUND: The functional benefits of mandibular reconstruction following a composite resection remain unclear. Although microvascular surgical techniques have dramatically increased the predictability of bone and soft-tissue reconstruction towards presurgical anatomic norms, the specific factors responsible for improved function remain controversial. Objective measures of masticatory function need to be more clearly determined before the predictability and efficacy of reconstructive approaches is established. METHODS: We evaluated objective measures of oral function and patient reports of function in 10 reconstructed mandibulectomy patients, 10 without reconstruction, and 10 controls. Measures of oral function included bite force assessed at the first molar and incisal edge, a measure of tongue and cheek function, and patient reports of food they could eat. RESULTS: Both reconstructed and nonreconstructed patients presented decreased biting force, a more restricted diet, and compromised cheek and tongue function as compared with normals. However, reconstructed patients had significantly better measures of tongue function and ability to eat a varied diet than did nonreconstructed patients. Of the objective measures used to measure masticatory performance, bite force was poorly correlated, whereas measures of tongue function strongly correlated with successful mastication. CONCLUSION: Both reconstructed and nonreconstructed patients presented with a significant functional deficit when compared with normals, with reconstructed patients having better overall function than nonreconstructed patients.

Aged↗

PubMed1984

Breast reconstruction. State of the art.

Some variant of mastectomy remains the mainstay of the treatment of the primary tumor for the vast majority of the 110,000 new cases of cancer of the breast which will be treated this year in the United States. Reconstruction of the breast after ablation for cancer has become an integral part of the therapeutic regimen of this disease. With the increase in availability and dissemination of information about reconstruction, women expect the opportunity to discuss the options of such surgical rehabilitation after mastectomy. The three major questions arise in regard to reconstruction of the breast: (1) Who should be reconstructed? (2) When should the reconstruction be performed? (3) How should the goals of reconstruction be realized? In answer to these questions, healthy reconstruction is available for any patient, provided she is well enough to undergo the surgical procedure. This may be performed immediately at the time of the ablative mastectomy or delayed for a period of 3 months or more. The nature of the reconstructive procedure is tailored according to the nature of the mastectomy and residual deformity. The authors present their philosophy as to who should be reconstructed, when the optimum time is for this procedure, and their techniques for fulfilling these goals.

Breast↗

PubMed1995

Reconstruction after mastectomy.

Although reconstruction after mastectomy offers an opportunity for cosmetic rehabilitation that should make mastectomy more acceptable and contribute to overall rehabilitation, the procedure is relatively underutilized. The best cosmetic results usually come from breast conservation rather than from mastectomy and subsequent reconstruction, and most small (T0-T2) cancers can be treated by means of breast-conserving measures. The surgeon who is performing the mastectomy plays a key role in explaining reconstruction to the patient and encouraging her to consider the process. Surgeon- and patient-related factors contribute to under-utilization. Physician assessment of the results of reconstruction, particularly with use of implants, tends to be less favorable than that of the patient. Surgeons may overemphasize the inadequacies of the results and patients may be overwhelmed by the diagnosis and array of decisions that must be made. Immediate reconstruction poses little risk of treatment delay or limitation. Reconstruction after mastectomy does not interfere with follow-up for recurrence. Choices for reconstruction have been limited by the withdrawal of silicone implants from the market. The availability of reconstruction has encouraged the inappropriate use of mastectomy for low risk disease. Prophylactic mastectomies and reconstruction should be performed for appropriate indications. To be effective, prophylactic mastectomy must include the nipple areolar complex. The availability of genetic testing to define very high risk groups brings into question the adequacy of protection offered by this procedure. Whereas prophylaxis in humans for premalignant mastopathy appears to be nearly complete, mastectomy appears to offer little protection in a rodent carcinogen model. The effectiveness of mastectomy for prophylaxis in a genetically high risk human population is unknown.

Breast Implants↗