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At least 847 records · Page 47Linked to original sources
PubMed1998

Use of pedicled flaps and tissue expanders to reconstruct burn scars of the skin of the anterior abdomen and chest.

Extensive scarring of the skin of the abdomen and chest is sometimes encountered postburn. It is possible to excise the burn scar serially and replace it with unburned skin from areas such as the lower abdomen by means of various advancement flaps. Expanders may be inserted to facilitate coverage as indicated. We report 9 patients (3 males and 6 females) in whom such staged procedures were carried out. Original burn size ranged from 4% to 52%, with a mean total body surface area of 23.8%. No major complications or blood loss requiring transfusion were encountered.

Burns↗
PubMed1998

Breast reconstruction in previously irradiated patients using tissue expanders and implants: a potentially unfavorable result.

There exists a paucity of definitive information on the suitability of implant reconstructions in previously irradiated breast cancer patients. This controversial topic prompted a review of our prosthetic reconstructions in this select group of patients. A retrospective study of patients treated between 1976 and 1993 with lumpectomy and radiation therapy for early breast cancer revealed 67 patients with local recurrences. Nine of these patients (10 breasts) underwent a two-stage prosthetic reconstruction following a salvage mastectomy. The average age was 47.9 years. The mean dose of irradiation was 6,070 cGy. The average interval from radiation therapy to placement of a tissue expander was 4.6 years. In one patient (10%) the tissue expander extruded. The average follow-up for 8 patients (9 breasts) who underwent exchange to a permanent prosthesis was 5.1 years. In four reconstructions (40%) there was an uneventful postoperative course. Two cases (20%) were difficult to expand and the final result lacked projection. One patient (10%) developed an infection requiring removal of the permanent prosthesis. Two patients (20%) developed Baker class III or IV capsular contractures. Overall, in our group of 10 implant reconstructions, 60% of the patients resulted in either a complication or an unfavorable result.

Breast Implantation↗
PubMed2001

Use of the SpaceMaker balloon in sternal wound closure: comparison with other techniques.

Sternal wound infection is surgically treated by debridement of the infected sternum and closure of the defect with a muscular flap. These operations tend to be long, stressful, and time-consuming and to involve heavy blood loss. To facilitate wound closure, the SpaceMaker balloon was applied intraoperatively to expand the pectoralis major muscles and enable tensionless closure with musculocutaneous flaps. The aim of the present study was to compare the effectiveness and feasibility of this technique with a variety of others described in the literature. The study population consisted of 40 consecutive patients with sternal wound infection following median sternotomy who were treated with the advancement flap, turnover flap, transposition flap, or SpaceMaker balloon-assisted advancement flap technique (n = 10 each). The balloon-assisted technique was associated with a shorter length of operation and fewer blood transfusions than the other methods. Furthermore, there was no need for reoperation and there were no cases of skin necrosis. In conclusion, closure with the SpaceMaker balloon-assisted bilateral pectoralis major musculocutaneous flap may serve as an adjunctive measure in the treatment of sternal wound infection. This technique seems to have advantages over simple pectoralis major musculocutaneous advancement, particularly for midsternal wounds.

Aged↗
PubMed2004

Which is the best position for the remote injection dome using the adjustable expander/prosthesis in breast reconstruction? A comparative study.

Breast reconstruction using mammary implants is a routinely performed surgical procedure that gives good aesthetic results with a relatively simple operation for the patients. When an adjustable expander/prosthesis with remote dome is used for reconstruction, the device is filled through an injection dome connected to the implant through a filling tube. The injection dome is usually inserted into a subcutaneous pocket, either in the axillary area or, most frequently, in the lower lateral thoracic area. Sometimes, this location is not well tolerated by the patient because of pain or discomfort in the breast-thoracic area and can give problems related to the distance, which causes kinking of the filling tube. To avoid this inconvenience and because of frequent patient complaints, the authors decided 3 years ago to place the injection dome in a parasternal position and compare this location with the previously used lower lateral thoracic location. Two hundred sixty patients were divided into two groups (130 patients in each group) and evaluated. All patients underwent mammary reconstruction in the authors' department using Becker adjustable implants. In all patients, the injection microdome was used. In group A, the injection microdome was positioned in the lower lateral thoracic area; in group B, the injection microdome was positioned in a parasternal area. Both groups were compared, considering different features such as pain, discomfort, ease of injection, pain during puncture, aesthetic appearance, risk of kinking, and risk of upside-down rotation of the dome. Average follow-up was 1.6 years. Statistical analysis was performed using Pearson's chi-square test regarding the differences in frequency of two features-aesthetic appearance and pain during puncture-between the two groups. The comparisons regarding both aesthetic appearance and pain during puncture did show a significant difference between the two groups, with a value of p < 0.05 in both cases. In the present study, the results showed how the patients had less pain during puncture and a better aesthetic appearance when the microdome was located in the parasternal position instead of the lower lateral thoracic area. Advantages and disadvantages of the locations used are discussed in this article.

Adult↗
PubMed2005

Pre-expanded ultra-thin supraclavicular flaps for (full-) face reconstruction with reduced donor-site morbidity and without the need for microsurgery.

BACKGROUND: The expanded supraclavicular island flap, as described in 1997 by the senior author (Pallua), is a useful tool for total facial reconstruction, providing satisfactory results without microsurgical prefabrication. The authors report the use of this technique in 12 patients requiring large flaps who presented with extensive facial scarring that had been previously reconstructed using disfiguring, pigmented skin grafts. METHODS: On the basis of their anatomical dissection studies and knowledge of the constant anatomy of the supraclavicular artery and two draining veins, the authors carefully inserted tissue expanders under the supraclavicular island flaps. After the flaps were expanded, all scars were removed and the covering flaps were transferred into place. Sixteen pre-expanded supraclavicular island flaps were used in 11 patients. RESULTS: There were no complications. CONCLUSIONS: The authors present a method of facial reconstruction that has the advantages of creating a large amount of thin tissue of both good color and texture, without the disadvantages of donor-site morbidity, lengthy operative time, and high cost. In their opinion, this is the method of choice for total facial reconstruction.

Adolescent↗
PubMed2005

The conjoined sternalis-pectoralis muscle flap in immediate tissue expander reconstruction after mastectomy.

The sternalis muscle is an accessory muscle of the anterior chest wall. This is a rare anatomic variant reported in approximately 8% of the population, with variation among races. While several anatomic studies of the sternalis muscle exist, nothing in the literature addresses the implications of this muscle on reconstruction of the breast after mastectomy. Based on several encounters of this muscle variant by the senior author over a 15-year period, we offer a strategy and rationale for dealing with this rare, but known, anatomic variant during immediate tissue expander reconstruction of the breast after mastectomy. First is the importance of recognizing the presence of a sternalis muscle, which may present in a variety of configurations. We offer our technique of conjoined sternalis-pectoralis muscle flap during tissue expander reconstruction of the breast. This allows for the creation of a larger, more properly placed submuscular pocket with adequate muscle coverage of the tissue expander. Our experience illustrates that the reconstructive surgeon must be familiar with the sternalis muscle and be prepared to adapt his or her technique for tissue expander placement when faced with this accessory muscle.

Adult↗
PubMed2005

Reconstruction of major forehead soft tissue defects with adjacent tissue and minimal scar formation.

Repair and reconstruction of soft tissue defects involving over 50% of the forehead using remaining forehead tissue has not been reported in the literature. The few existing reports mainly concern cases in which less than half of the forehead was involved. The forehead comprises one third of the face and with regard to its prominent position, it is one of the major contributing components to facial beauty. Considering the excellent color, thickness, and quality matching of the adjacent forehead skin, it is considered the ideal substitute for repair of forehead defects. Use of skin graft or free flaps for reconstruction of defects involving 50% or more of the forehead have not reported acceptable results because of the lack of similarity of the donor tissue with the remaining forehead tissue. In this study, we describe successful reconstruction of major forehead soft tissue defects of two thirds to three fourths of the forehead with use of a tissue expander and transverse supratrochlear pedicle flap in four patients who were diagnosed with giant hairy nevus. There were no serious complications such as hematoma, bleeding, infection, or flap necrosis. We recommend this technique for reconstruction of extensive forehead soft tissue defects.

Adolescent↗
PubMed1993

Scalp lifting. An 8-year experience with over 1,230 cases.

BACKGROUND: This article reviews the author's 8-year experience with extensive scalp-lifting, which includes 1,230 cases. OBJECTIVE: To overview extensive scalp-lifting paying particular attention to the areas of complications and the ways to reduce them. METHOD: Retrospective analysis of 1,230 cases was done. Necrosis, infection, hematoma, numbness, and scarring were evaluated. RESULTS: 1) Vertical incision occipital artery ligatory should be performed 4 to 8 weeks prior to a scalp lift. 2) Use a delay procedure prior to a frontoparietal advancement flap. 3) Use only lateral lifts on patients with prior punch-grafting. 4) Locate the temporal arteries preoperatively with Doppler ultrasonography. 5) Do not perform frontoparietal advancement flaps on patients with prior punch-grafts. CONCLUSION: Scalp lifting is an extremely effective and expedient method to treat alopecia; however, certain precautionary measures must be taken to obtain excellent, consistent results.

Alopecia↗