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PubMed2006

All-ceramic two- to five-unit implant-supported reconstructions. A randomized, prospective clinical trial.

The purpose of this study was to evaluate the clinical performance of two to five-unit implant-supported all-ceramic reconstructions and to compare the results of two different all-ceramic systems, Denzir (DZ) and In-Ceram Zirconia (InZ). Eighteen patients were treated with a total of 25 two- to five-unit implant-supported reconstructions. Nine patients were given reconstructions of the DZ system and the other nine reconstructions of the InZ system. The reconstructions were cemented with zinc phosphate cement onto preparable titanium abutments and were evaluated after 6 and 12 months. At the 12-month follow-up, all reconstructions were in function; none had fractured. Superficial cohesive (chip-off) fractures were, however, observed in 6 of the 18 patients (8 of 25 reconstructions). Nine units in the DZ group (in 7 of 13 reconstructions) and one in the InZ group (1 of 12 reconstructions) had chip-off fractures. The difference between the two groups regarding frequency of chip-off fractures was statistically significant (P < 0.01). Marginal integrity was rated excellent at 34 abutments (56%) and acceptable at 27 (44%). Results from this 12-month trial suggest that all-ceramic implant-supported fixed partial dentures of two- to five-units may be considered a treatment alternative. When comparing the two ceramic systems under study, however, this study concludes that the DZ system exhibits an unacceptable amount of veneering porcelain fractures and thus cannot be recommended for the type of treatment evaluated in this trial. Further studies and long-term follow-ups must be performed before the materials and technique can be recommended for general use.

Aluminum Oxide↗

PubMed2006

[Functional outcome following shoulder tumor resection and reconstruction].

OBJECTIVE: To analyze the long-term limb sparing outcomes of various reconstructive procedures and complications associated with extensive excision in bone tumours of the shoulder girdle. METHODS: Shoulder reconstruction following resection of bone tumors of the shoulder girdle was reviewed retrospectively for 32 patients at the Wesley Hospital or Princess Alexandra Hospital. The reconstructions were including arthrodesis (8 cases), allograft-prosthetic composite (7 cases), spacer (6 cases), no bone reconstruction (5 cases), prosthesis (3 cases), vascular fibular graft (2 cases) and allograft (1 case). RESULTS: The average duration of follow-up was 81 months for the 23 patients who were still alive at the time of the latest follow-up examination. Functional results were related to the type of resection and the method of shoulder reconstruction. After intra-articular resection of the proximal humerus with loss of the abductor mechanism, arthrodesis resulted in 87% functional score and more strength was found after reconstruction with prosthesis or allograft-prosthetic composite. Allograft-prosthetic composite had better function (Score 79%) than prosthesis alone after intra-articular resection of the humerus because reconstruction of the deltoid and the rotator cuff could be performed without increased prevalence of complication related to the allograft. After extra-articular resection of the glenoid cavity and the proximal humerus with abductor mechanism, reconstruction with a functional spacer frequently resulted in superior subluxation of the implant and only fair function (Score 66%) of the shoulder. With two teen-aged patients, a free fibular graft inserted after intra-articular resection of the proximal humerus led to fair function (Score 73%), to be followed by secondary arthrodesis when growth was complete. CONCLUSIONS: Indications for the method of reconstruction depend on type of resection, age, gender, occupation, the expected functional level and restriction of activity. After resection of the abductor mechanism, arthrodesis results in more strength and is the preferred option for the young active demanding patients. If the abductor mechanism is preserved, allograft-prosthetic composite gives good results.

Adolescent↗

PubMed1991

[Preservation of pulmonary function by chest wall reconstruction].

Thirteen mongrel dogs were resected 4 ribs with surrounding tissue. Eight dogs had the chest wall closed by skin alone, and in five animals, the chest wall reconstructed by a polyethylene mesh or marlex sandwich. In the latter PaO2 was significantly higher than that of animals not undergoing reconstruction 3 days after operation. Pulmonary function was appeared to be preserved by reconstruction. Clinically, 68 cases underwent chest wall resection and in 28 cases, defects were reconstructed. Although only portions of 1 or 2 ribs were resected in the non-reconstructed cases, VC, FEV1, and TLC significantly dropped post-operatively. In the reconstructed cases, VC significantly dropped postoperatively. Post-operative complications occurred in 3.6% of the reconstructed cases and in 9.8% of the non-reconstructed cases. Since only 1 rib resection led to reduced ventilatory function clinically, reconstruction for small chest wall defects appears advisable for maintaining pulmonary function.

Adolescent↗

PubMed1990

Lineus as a model for studying developmental processes in animals reconstructed from adult pieces.

The difficulties that prevent reconstruction of animals by piecing together body fragments from several adults are overcome by using nemerteans of the genus Lineus. For 25 years I have managed to make viable composite worms by grafting body parts cut out of Lineus specimens either from the same clonal strain (syngeneically reconstructed worms) or from the same species (allogeneically reconstructed worms) or else from different species (xenogeneically reconstructed worms). Body reconstruction has usually been carried out orthotopically, i.e., the components of composite animals have been selected so as to be anatomically complementary. However, reconstruction has been made heterotopically when it was essential to obtain morphogenetic events in the adults. Here, I shall review some of the developmental processes that took place in such reconstructed animals. First, I shall report immune responses in composite worms derived from various combinations of body pieces grafted together. Second, I shall study sex differentiation during gonad development in growing or regenerating chimeric worms made by the grafting of male and female components. I shall refer also to gonadogenesis in the asexual progeny of bipartite chimeras derived from lateral body halves of both sexes fused together (clones of bilaterally allophenic worms). Third, I shall analyze regulative processes (regeneration, transgeneration) during localized morphogenesis occurring in heterotopically reconstructed worms. The data show how reconstructed Lineus may be exploited to increase our knowledge of developmental mechanisms, especially in the misunderstood field of organismal pattern homeostasis.

Animals↗

PubMed1990

[Psychosocial effects of plastic surgery reconstruction of the female breast following amputation for malignant/benign tumor].

A total of 98 woman (malignant/benign tumors of the breast, mastectomy with/without subsequent reconstructive surgery as well as healthy controls) were examined in terms of subjective well-being, psychosomatic reaction patterns, subjective impairment due to mastectomy and satisfaction with the outcome of reconstructive surgery in this empiric retrospective study. In addition, numerous sociographic data were obtained. On the average, the examined women were satisfied with the outcome of reconstructive surgery and tended to be disappointed with regard to the desired psychosocial improvement. Objective tests demonstrate that subjective well-being was less favorable after reconstructive breast surgery than in women without reconstruction. In the group "benign tumor with subsequent reconstruction" the reaction to emotional strain was significantly more characterized by regressive behavior and withdrawal than in the group "benign tumor without reconstruction". In the group "malignant tumor with reconstruction" this difference was less pronounced. On the basis of these results we cannot confirm the assumption that reconstructive surgery of the breast has a supportive function.

Adaptation, Psychological↗

PubMed1987

The current approach to breast reconstruction.

Over the last 30 years, breast reconstruction has become a standard part of the care of the breast cancer patient. While it may take another 30 years for many of the traditional oncologic concerns about reconstruction to be answered, indications are that reconstruction does not alter the patient's prognosis in any way. The increased understanding of breast cancer as a disease which is systemic from early in its course has removed many of the former objections to reconstruction. Reconstruction can be performed after almost any type of mastectomy. Chemotherapy does not interfere with reconstruction, as long as the timing of doses is considered. However, therapeutic radiation does present problems which may preclude reconstruction. Conversely, having had reconstruction does not interfere with later chemo or radiation therapy. The author describes reconstructive options and their relationship to oncological decisions and concerns.

Breast↗

PubMed1988

Psychosocial and surgical aspects of breast reconstruction.

Why are only less than 1% of the mastectomized women in The Netherlands reconstructed? We report the results of four studies, among reconstructed patients and their partners, among women who had an amputation only and among general and plastic surgeons in The Netherlands. In contrast to what is thought by (plastic) surgeons, women do not opt in the first place for breast reconstruction because of emotional or cosmetic reasons, but to be freed from the prosthesis. Surgeons hardly ever take the initiative to inform patients about breast reconstruction. Knowledge about breast reconstruction is gained mainly from the mass media. Nearly all reconstructed patients are satisfied with the results. This is independent of the objective cosmetic results. In our opinion amputated women should be informed about breast reconstruction in the same way as about the external prostheses. We also reviewed the surgical aspects concerning indications, timing and available techniques of breast reconstruction. We concluded that the improved surgical procedures make breast reconstruction less burdensome for the patients than the older surgical techniques.

Adult↗

PubMed1987

A comparison of replacement and reconstruction in patients with mitral regurgitation.

The factors that make mitral reconstruction an attractive alternative to valve replacement are increased anatomical valve orifice, preservation of the valvular apparatus, improved longevity over porcine xenografts, and no requirement for long-term anticoagulation. In our experience the majority of patients with mitral regurgitation have degenerative valve disease. This comparative series of patients operated on over a 10 year interval includes 72 with replacement and 112 with reconstruction. The average cross-clamp times were 69 minutes for reconstruction and 44 minutes for replacement. The hospital mortalities were 3.6% and 18.1%, respectively. Postoperative valve areas as determined by Doppler echocardiography were 2.69 cm2 for replacement and 2.67 cm2 for reconstruction (p = 0.9). The valve failure rate was 2.0% per patient-year for reconstruction and there were no failures in the replacement group. The reoperation incidence for reconstruction was 20% at 10 years. The remaining patients, although clinically well, had varying degrees of stable, nonprogressive mitral regurgitation. Forty-five percent had mild to trivial regurgitation detectable by echocardiographic studies. The decision between mitral valve reconstruction and mitral valve replacement remains a highly controversial issue. The failure of our data to demonstrate superior valve function for patients with mitral regurgitation undergoing valve reconstruction suggests a need for careful analysis of reconstruction with respect to effective valve orifice and incidence of regurgitation.

Bioprosthesis↗

PubMed1995

[Psychological assessment of patients who have ++undergone breast reconstruction using 2 different technics: autologous tissue versus prosthesis].

Breast reconstruction has become an available option for most patients undergoing mastectomy: in fact many authors agree that breast reconstruction does not interfere with possible therapies and improves the quality of life of women. The aim of the study was to evaluate the psychological adjustment of patients who had immediate or delayed reconstruction using 2 different methods: implants and autologous tissues. The study population (115 patients) was derived from patients who underwent breast reconstruction in the period January 1988-December 1991, in follow-up at the Department of Plastic and Reconstructive Surgery; no patient was undergoing psychological therapy. 58 patients underwent breast reconstruction using implants and 57 using Transverse Rectus Abdominis Myocutaneous Flap (TRAMF). Informations were gathered, including the patient's age, the number of offspring, the marital status, the scholastic education, the job and the relapse between mastectomy and reconstruction. The psychological instruments consisted in three standardized self-administered questionnaires: Psychological Distress Inventory (PDI), State Trait Anxiety Inventory form Y (STAI), Eysenk Personality Inventory (EPQ-R). These tests were chosen to gauge the psychological distress, such anxiety, anger, depression and psychosocial maladjustment. To better perform the changes of body image after breast reconstruction, women were requested to answer three more specific questions about the sexual desire, physical image and social relationships. The 102 patients assessed in this study indicate low incidence of psychological distress and adaptive coping strategies. Impairment was reported, regarding body image, by patients undergoing delayed reconstruction; in these patients higher scores in distress tests were observed.

Adaptation, Psychological↗

PubMed1994

[A proposal for the use of tridimensional reconstruction in oncology to better assess tumor stage and response to therapy].

Besides radiation therapy, diagnostic imaging has always been considered the main medical application of three-dimensional (3D) reconstruction. On the contrary, our study focused mainly on the use of 3D reconstruction for both spatial characterization and morphometric evaluation of the reconstructed objects. We aimed at assisting physicians to solve clinical and therapeutic problems. In particular, in oncology, 3D reconstruction may allow the objective and accurate quantification of the volume of neoplastic lesions. Therefore, we decided to focus our attention on the spatial characterization and morphometric assessment of the examined neoplastic masses. Volumetric measurements based on 3D reconstruction may be of great value to assess volume changes after irradiation and/or chemotherapy of neoplastic lesions. This might also allow to compare, on the basis of such changes, the role of different treatment protocols on similar neoplastic lesions and, possibly, to lead to a new TNM staging system no longer based on 2D measurements but on volumes. To meet these clinical requirements, we developed a software system for accurate volume measurements. We believed 3D reconstruction to be suited to this purpose and therefore we implemented a software incorporating 3D reconstruction capabilities of abnormal anatomical structures from 2D images, the rotation of the volume of interest for better assessment of spatial relationships, and finally morphometric evaluation, for accurate volume measurements. Instead of calculating the volume of a neoplastic lesion by means of a 3D reconstruction algorithm considering voxels as indivisible (voxel-based approach), we implemented a surface rendering algorithm using a cell-based approach, because it allowed voxels to be represented as small volume units, which could be further divided by means of linear interpolation. Thus, great flexibility was possible in the determination of surfaces, together with a good approximation of the volume of the neoplastic lesions. To assess the reliability of the developed software system, we used a real phantom. Its known actual volume was compared with the one measured by our system and the difference, expressed as a percentage of the actual volume itself, was compared with the one obtained by using reconstruction algorithms with a voxel-based approach (1.4% vs 4.4%). The error produced by the latter is three times greater than the one produced by our algorithm. This is a major result for the physician: better approximation of the actual volume of a neoplastic lesion means better evaluation of the number of neoplastic cells in the lesion. This may be useful for the clinical management of the patient. In the paper, the first clinical applications of our algorithm are reported.

Algorithms↗

PubMed1995

Breast reconstruction after mastectomy: who seeks it, who refuses?

Recent Food and Drug Administration hearings on silicone gel implants have drawn attention to the paucity of information about women who seek reconstruction after mastectomy compared with those who do not. New analyses of data gathered in the early 1980s address this issue. Three groups of mastectomy patients were compared: 117 women who sought and obtained delayed reconstruction, 26 who sought but decided against delayed reconstruction, and a comparison group of 53 who were not seeking reconstruction. Results indicated that although younger and more knowledgeable about reconstruction, patients in the reconstruction group were similar to those in the comparison group. However, the women who sought but chose not to proceed with reconstruction appear to have been at greater risk for physical and emotional disappointment with the results of reconstruction, which suggests that poor candidates for reconstruction may select themselves out at the time of consultation.

Female↗

PubMed1995

[Primary breast reconstruction after mastectomy for breast cancer].

Primary breast reconstruction in connection with mastectomy is a well-established procedure. The reconstruction may be carried out by the submuscular implantation of a prosthesis, in some cases preceded by tissue expansion. In situations where there is insufficient skin--or muscle-coverage, a musculocutaneous transposition flap may be used. The aim of breast reconstruction is to prevent the psychosocial sequelae of mastectomy. From experiences with secondary reconstruction, it seems that the reconstruction especially helps correct loss of feminine identity and negative body-image. Certain investigations indicate that primary reconstruction results in a clearly reduced postoperative psychological stress, whereas the extent of social and sexual sequelae seems not to vary when compared to results of secondary reconstruction. Conditions for adjuvant treatment as well as for follow-up concerning loco-regional tumour reappearance do not seem to be affected by the reconstruction. In studies published to date, consisting of relatively small patient groups and short observation periods, numbers without relapse and overall survival are found to be equivalent to that following mastectomy without reconstruction.

Breast Implants↗

PubMed1995

Interposed jejunal segment with nipple valve to prevent reflux in biliary reconstruction.

BACKGROUND: Resection is the accepted management of a choledochal cyst. However, the debate continues regarding the optimal method of biliary reconstruction. The Roux-en-Y limb is used most frequently, but concerns have been raised about this method due to associated peptic ulcer disease, cholangitis, and poor growth. A method of reconstruction using an interposed segment of jejunum with a nipple valve placed between the common bile duct and the duodenum has been proposed. STUDY DESIGN: We have reviewed a series of 12 children requiring biliary reconstruction for choledochal cyst (11 children) and biliary stricture (one child). All had reconstruction with a nipple valve, and ten had an interposed segment of jejunum. RESULTS: All of the children are alive and have had follow-up evaluation from six months to 8.5 years (median of three years). Sequential examinations with ultrasound and biliary excretion scans have shown no evidence of obstruction, and liver function tests have remained normal. Three children have had cholangitis. One child had a brief episode in the perioperative period. The second child had cholangitis 16 months postoperatively, and the third child had multiple episodes of cholangitis. These latter two children were unique. One had Alonso-Lej type IV choledochal cyst with intrahepatic dilatation, which persisted after reconstruction. The other had a prior diversion with a Roux-en-Y limb from the gallbladder after resection of a choledochal cyst and had multiple episodes of cholangitis before reconstruction. These episodes are now controlled with chronic antibiotic suppression. Postoperative complications were limited to two episodes of obstruction of the small bowel requiring lysis of adhesions. No child has had peptic ulcer disease. These children have grown well after reconstruction, except for three with multiple anomalies or chronic pancreatitis. CONCLUSIONS: Biliary reconstruction with a jejunal interposition containing a nipple valve can be performed safely with a low incidence of complications. It offers a more physiologic method of reconstruction and a low incidence of postoperative cholangitis.

Adolescent↗

PubMed1994

Bilateral breast reconstruction: conventional versus free TRAM.

Free TRAM flap transfer is now routinely offered to patients requiring breast reconstruction. This study compares results of conventional superior-pedicled TRAM flaps and free TRAM flaps in bilateral breast reconstructions. A total of 92 breasts were reconstructed in 46 patients. Eighteen patients had free TRAM flap reconstructions, and 28 patients were reconstructed with conventional TRAM flaps. Comparison of average operative blood loss and average operative time for the two techniques showed blood loss of 575 cc and an operative time of 9.6 hours for the free TRAM reconstructions and a blood loss of 313 cc and an operative time of 6.6 hours for the conventional TRAM reconstructions. For free TRAM flap reconstructions, both blood loss and operative time decreased significantly between the first and second group of nine patients: from 819 to 360 cc of blood loss and from 10.5 to 8.9 hours of operative time. Partial flap loss (skin and fat necrosis) and fat necrosis only occurred in 13 and 7 percent, respectively, of conventional TRAM flaps, but neither occurred in free TRAM flaps. However, early in the series, three free flaps were lost in two patients, requiring implant placement. Bilateral breast reconstruction using the free TRAM flap may offer a lower complication rate than the conventional TRAM flap by virtue of improved blood supply and less abdominal wall disruption. Surgeons, however, are forewarned that this procedure has a steep learning curve, and surgeons lacking microsurgical expertise may be better served by the conventional TRAM flap.

Blood Loss, Surgical↗

PubMed1993

Breast reconstruction utilizing implants: a local experience and comparison of three techniques.

The breast reconstruction patient requires accurate information about the complications, failures, and additional surgeries associated with implant reconstruction. In this series of consecutive patients, we examine three methods of implant reconstruction: (1) immediate with a permanent implant/expander (86 patients/107 breasts), (2) delayed with a permanent implant/expander (57/73), and (3) delayed serial expansion with gel/saline (54/68). Implant/expander reconstructions had an equal interval to completion (immediate 118 days, delayed 127 days), a significant need for revisions (immediate 57 percent, delayed 30 percent), and a similar complication rate (10 percent) and failure rate (3.5 percent). The delayed serial expansion patients were completed with one operation 66 percent of the time, and only 9 percent required revisional surgery. The data obtained from the largest private health care provider in the state confirmed a significant difference (p = 0.003) in the need for revisional surgery between immediate and delayed reconstructions. The data showed immediate implant reconstructions to (1) be safe (low failure rate), (2) require more capsular intervention procedures, (3) have a greater expense, and (4) have good aesthetic results (90 percent Baker class I or II) because of revisional surgery. The immediate implant breast reconstruction patients are committed to their reconstruction and undergo revisional surgery to improve their aesthetic result. Delayed implant reconstruction patients are less likely to undergo further surgery to correct capsular deformities.

Adult↗

PubMed1996

[Chest wall reconstruction for lung cancer patient].

To prevent flail chest after chest wall resection, chest wall reconstruction was performed to 74 primary lung cancer patients during the period between 1975 and 1994, out of 1,435 resected lung cancer patients, while in 29 cases, chest wall resection were performed without reconstruction. Numbers of ribs resected were from 1 to 5, mean 2.7, median 3. Chest wall reconstructions were performed in 66.7% of the patients for 2 ribs resected cases, 83.8% for 3 ribs cases, and 90.9% for more than 4 ribs cases. For chest wall reconstruction double layered Marlex mesh was used since 1982, while Dacron or Teflon felt was used until 1984. There was no flail chest, wound infection or operative death in the patients with chest wall resection and reconstruction. Survival curve of the p-T 3 N 0, 1 M 0 received chest wall reconstruction was compatible to the stage II cases out of 1,435 resected lung cancer patients (47.1% and 43.0% at 5 years). There is no need to perform chest wall reconstruction in cases like 1st to 3rd rib resection, or whose chest wall defect is covered with scapula. If the chest wall defect is lower than that and also lateral or anterior, chest wall reconstruction is indicated, even if resected ribs are less than 3. We should not hesitate to remove chest wall in order to get complete resection of the tumor, if tumor invasion is suspected surgically. Because we can reconstruct the chest wall with satisfactorily low risk of complications.

Biocompatible Materials↗

PubMed1995

Total auricular reconstruction with a three-dimensional costal cartilage framework.

Microtia (hypoplasia of the auricle) is known to result from incomplete development of the auricle during embryonic development so that the size and shape of the deformity vary from case to case. Total auricular reconstruction for microtia is dependent on the degree of hypoplasia in comparison to that of the normal auricle on which the specific reconstruction method is based. I have classified microtia into 3 major types: 1) The lobule type. 2) The concha type, and 3) The small concha type which has been previously described [32]. Regardless of the size and shape of the deformity, the ultimate goal of total reconstruction of the auricle consists of construction of an auricle with an appearance as close as possible to that of a normal auricle. With this objective in mind, total reconstruction of the article is a science and not just a form of art as frequently considered. If it is only an art, the constructed auricle is greatly influenced by the artist's individuality and by the observer's. Thus, as a reconstructive plastic surgeon, the final outcome or result of total reconstruction of the auricle is that the constructed auricle should resemble as closely as possible the normal auricle, regardless of the observer and without any personal influence of the surgeon. I therefore consider total reconstruction of the auricle to be a field of science attained by numerous refinements and modifications in the procedures and techniques [33-36] and not just a simple form of art. The auricle constitutes only a small portion of the total body surface area, but it is probably one of the most complicated and/or sophisticated morphological structures of the body. It is necessary to fully understand the three-dimensional (3-D) morphological properties of the auricle and to pursue the ultimate goal of reconstructing an everlasting auricle as to the normal auricle. In other words, the constructed close as possible auricle must not be a sculptured object or structure, but is a living structure. A healthy constructed auricle is lasting and alive. Follow-up studies must be performed with strict standards and evaluation criteria in order to determine whether or not a reconstructed auricle is healthy.

Adolescent↗

PubMed1997

True reconstruction of vessel geometry from combined X-ray angiographic and intracoronary ultrasound data.

At present a rapidly expanding variety of methods appear to provide three-dimensional (3-D) reconstructions of blood vessels in a patient. Generally the results of such methods look very realistic. However, only a few produce a true 3-D reconstruction. We strongly suggest that for a true 3-D reconstruction of a blood vessel the following criteria should at least be fulfilled: (1) the arterial wall rather than the lumen must be reconstructed; (2) the spatially curved course of the vessel must be included; and (3) the orientation of local vessel wall characteristics, for example, plaque eccentricity, with respect to the luminal course must be correctly maintained. Currently, only methods combining biplane X-ray angiography and intravascular ultrasound imaging (IVUS) have succeeded in providing true 3-D reconstruction of a segment of a vessel. Accuracy of those reconstructions is derived from studies using phantoms having precisely known geometry. In patients, data on accuracy are more difficult to obtain. Nevertheless, a comparison can be made between the actual length of an IVUS pull-back trajectory and its reconstructed length showing relative differences of less than 3%. Further knowledge can be obtained by comparing simulated angiograms derived from the 3-D reconstruction with the real contrast angiograms. True 3-D reconstruction methods of the vessel wall and lumen, applicable in the individual patient, have become feasible and produce accurate results. Application of such a method will be helpful to understand immediate and long-term vessel remodelling induced by all types of catheter interventions and in the study of progression or regression of atherosclerotic wall disease.

Coronary Angiography↗