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PubMed2002

[Our experience with two stage ear reconstruction of typical microtia].

One of the most difficult reconstructive procedures is the reconstruction of the auricle, since it has a very difficult form to imitate. During the last four decades there have been numerous reconstructive attempts throughout the world especially for cases of microtia. The principle is to build a framework from cartilage that will be used for the reconstruction. A prominent personality in this field is Dr. Burt Brent, who is identified with this challenge. Dr. Brent has established the method of reconstruction in four stages. In order to limit the operative stages Dr. S. Nagata suggested doing the reconstruction in two stages, using a different cartilage framework and elevating the auricle using temporo-parietal fascial flap and skin graft. His method was improved further by Dr. Francoise Firmin. The first stage is conducted at the age of 9-10, during which the ipsilateral rib cartilage is harvested, carved and put together into a cartilage framework and than inserted into a skin pocket in the area awaiting reconstruction. Half a year later, the auricle is elevated by inserting a wedge cartilage behind it, covering with temporo-parietal fascial flap and skin graft. Our experience using this method in ten microtia cases proves that it is a good choice in total auricle reconstruction for microtia patients.

Ear↗

PubMed2002

[Breast reconstruction--where are we heading?].

Breast reconstruction has become a routine procedure, being performed in a growing part of the mastectomy patients' population. Proven improvement in body image and in coping with breast cancer encouraged plastic and general surgeons to warmly recommend the procedure. The advances in the genetic evaluation of the breast cancer population cause an increase in prophylactic surgery and subsequent reconstructions. Today, we can offer two types of reconstruction: by using tissue expanders or by using autologous tissues from various sources: abdomen, back and the gluteal region. The advancement in surgical techniques enable us to offer a custom made reconstruction that is performed according to the patient condition and desire. We describe our experience in breast reconstruction using Becker implant-expanders in 229 patients in the last decade. We detail the organization chart of our multidisciplinary breast reconstruction team clinic and we suggest a flow chart for the evaluation and planning of breast reconstruction. Custom made reconstruction, done in the envelope of a multidisciplinary supporting system is the future of this procedure.

Breast Implants↗

PubMed2003

Evaluating image reconstruction methods for tumor detection in 3-dimensional whole-body PET oncology imaging.

UNLABELLED: We compare 3 image reconstruction algorithms for use in 3-dimensional (3D) whole-body PET oncology imaging. We have previously shown that combining Fourier rebinning (FORE) with 2-dimensional (2D) statistical image reconstruction via the ordered-subsets expectation-maximization (OSEM) and attenuation-weighted OSEM (AWOSEM) algorithms demonstrates improvements in image signal-to-noise ratios compared with the commonly used analytic 3D reprojection (3DRP) or FORE+FBP (2D filtered backprojection) reconstruction methods. To assess the impact of these reconstruction methods on detecting and localizing small lesions, we performed a human observer study comparing the different reconstruction methods. The observer study used the same volumetric visualization software tool that is used in clinical practice, instead of a planar viewing mode as is generally used with the standard receiver operating characteristic (ROC) methodology. This change in the human evaluation strategy disallowed the use of a ROC analysis, so instead we compared the fraction of actual targets found and reported (fraction-found) and also investigated the use of an alternative free-response operating characteristic (AFROC) analysis. METHODS: We used a non-Monte Carlo technique to generate 50 statistically accurate realizations of 3D whole-body PET data based on an extended mathematic cardiac torso (MCAT) phantom and with noise levels typical of clinical scans performed on a PET scanner. To each realization, we added 7 randomly located 1-cm-diameter lesions (targets) whose contrasts were varied to sample the range of detectability. These targets were inserted in 3 organs of interest: lungs, liver, and soft tissues. The images were reconstructed with 3 reconstruction strategies (FORE+OSEM, FORE+AWOSEM, and FORE+FBP). Five human observers reported (localized and rated) 7 targets within each volume image. An observer's performance accuracy with each algorithm was measured, as a function of the lesion contrast and organ type, by the fraction of those targets reported and by the area below the AFROC curve. This AFROC curve plots the fraction of reported targets at each rating threshold against the fraction of cases with (> or =1) similarly rated false reports. RESULTS: Images reconstructed with FORE+AWOSEM yielded the best overall target detection as compared with FORE+FBP and FORE+OSEM, although these differences in detectability were region specific. The FORE+FBP and FORE+AWOSEM algorithms had similar performances for liver targets. The FORE+OSEM algorithm performed significantly worse at target detection, especially in the liver. We speculate that this is the result of using an incorrect statistical model for OSEM and that the incorporation of attenuation weighting in AWOSEM largely compensates for this model inaccuracy. These results were consistent for both the fraction of actual targets found and the AFROC analysis. CONCLUSION: We demonstrated the efficacy of performing observer detection studies using the same visualization tools as those used in clinical PET oncology imaging. These studies demonstrated that the FORE+AWOSEM algorithm led to the best overall detection and localization performance for 1-cm-diameter targets compared with the FORE+OSEM and FORE+FBP algorithms.

Algorithms↗

PubMed2003

Clinical impact of adjunctive donor microvascular reconstruction on renal transplantation.

INTRODUCTION: Microvascular reconstruction was incorporated into our donor organ harvesting algorithm for kidneys with anatomic anomalies or injury of the vasculature. The impact of adjunctive microsurgery was appraised in terms of organ availability and graft quality procedures. METHODS: Out of a total of 441 renal transplant procedures performed by one surgeon (JLC) between 1984 and 1997, 104 allografts (83 cadaveric, 21 living related) required ex-vivo microvascular reconstruction. Micro-reconstruction using 2.5-10 X magnification was employed to create a single artery and vein for subsequent in-situ anastomosis. Side-to-side or end-to-side anastomosis was performed, depending on the vascular arrangement. Multiple vessels and those injured during harvesting were reconstructed with a combination of the above techniques. RESULTS: Eleven kidneys had two or more arterial anastomoses; 12 had combination (arterial and venous) anastomoses while 74 required a single micro-reconstruction. In addition, seven kidneys with severely traumatized vessels were salvaged. Average bench surgery times were 30 and 50 minutes for single and multiple reconstructions respectively. Mean warm ischemic time was 29 minutes. Three kidneys were lost due to vascular thrombosis (two venous, one arterial) where in-situ technical difficulties were encountered in all three cases. With mean follow-up of 30 months, 23 kidneys had been lost due to chronic rejection with the remainder functioning. CONCLUSION: Extensive microvascular reconstruction salvaged 30 suboptimal or previously deemed unusable grafts (30/439 = 7%) and facilitated the vascular anastomosis in another 74 cases (17%). The warm ischemic time and the possibility of in-situ technical errors with small-calibre vessels were minimized. This report affirms the contention that microvascular reconstruction should be available as an adjunctive technique for renal transplantation, to maximize the quantity and quality of donor kidneys.

Adult↗

PubMedDate not supplied

Successful use of preserved sclera of eyelid reconstruction.

Eyelid surgery involving resection of more than half the eyelid and formation of full-thickness defect requires not only reconstruction of the anterior lamella, but also reconstruction of the posterior lamella, including the tarsal plate and palpebral conjunctiva. However, no reconstruction methods are of complete satisfaction. We describe our successful experience with 5 cases of eyelid reconstruction using preserved sclera and a report of a typical case of them. Based on our 5 case experience and literature, we compared eyelid reconstruction using preserved sclera to reconstruction using nasal septal or auricular cartilage in terms of external appearance and functions of the eyelid. The outcomes for reconstruction using preserved sclera in all 5 of our patients have been favorable. Previous papers as to this method, even though small in number, also reported no functional and esthetic problems. This method is recommended for eyelid reconstruction due to the good results and its simplicity.

Aged↗

PubMed2003

Types of spinal instability that require interbody support in posterior lumbar reconstruction: an in vitro biomechanical investigation.

STUDY DESIGN: Pedicle screw fixation alone for sequential spinal instabilities was biomechanically compared with pedicle screw fixation using interbody cages. OBJECTIVE: To evaluate biomechanical effects of interbody cages on construct stiffness, pedicle-screw strain, and the adjacent level in posterior lumbar reconstruction using pedicle screw fixation. SUMMARY OF BACKGROUND DATA: It remains undetermined what types of spinal instability require interbody support in posterior lumbar reconstruction. METHODS: For this study, 10 calf spines (L3-L6) were used. Sequential destabilization was performed at L4-L5 followed by posterior reconstruction using pedicle screw fixation (PS) and interbody cages as follows: intact + PS (I-PS), medial facetectomy + PS (MF-PS), total facetectomy + PS (TF-PS), partial discectomy + PS (D-PS), and D-PS + interbody cages (PLIF). Biomechanical testing was performed under flexion and extension loading modes. Construct stiffness (L4-L5), rod-screw bending strain, and range of motion (ROM) at the upper adjacent level (L3-L4) were analyzed. RESULTS: In terms of construct stiffness (L4-L5), all the reconstructions except D-PS demonstrated higher construct stiffness than the intact spine (P < 0.05). The PLIF showed the highest stiffness among all the reconstructions (P < 0.05). In terms of ROM (L3-L4), all the reconstructions increased the ROM, as compared with the intact state (P < 0.05). Importantly, PLIF showed significantly greater ROM than all the other reconstructions except I-PS (P < 0.05). In terms of rod-screw strain, the D-PS resulted in higher strain than the other groups (P < 0.05). The PLIF presented less strain than the other reconstructions (P < 0.05). CONCLUSIONS: For spinal instability with preserved anterior load sharing, pedicle screw fixation alone is biomechanically adequate, and interbody cages should not be used because they further increase segmental motion at the adjacent segment. However, PS alone provides insufficient stability and high implant strain in case of damaged anterior column. In such cases, additional interbody cages significantly increase construct stiffness and decrease hardware strain. However, they increase ROM at the adjacent segment as well.

Animals↗

PubMed1992

Reconstruction of the radiated partial mastectomy defect with autogenous tissues.

As conservative surgery and radiation therapy have become accepted treatments for early-stage breast cancer, increasing attention has focused on the cosmetic results of this technique. When partial mastectomy--a term which encompasses a diversity of excisional techniques--is followed by radiation therapy, breast defects characterized by parenchymal loss, nipple-areola complex distortion, and cutaneous abnormalities can occur. From 1981 to 1990, eight patients sought reconstructive correction of a radiated partial mastectomy deformity. Patients were from 42 to 70 years of age (mean 49 years). All had breast cancer, except for one patient with diffuse and chronic breast abscesses. Six patients were reconstructed with latissimus dorsi flaps and two with rectus flaps. No patient underwent reconstruction sooner than 1 year after completion of radiation therapy; for the entire group, a mean of 2.6 years elapsed from completion of radiation therapy to flap reconstruction of the breast. Mammograms were obtained on all the breast cancer patients before and after the myocutaneous flap procedure. Follow-up extended from 1 to 9 years after reconstruction (mean 3.6 years) and included both physical examination and serial mammographic evaluations. Myocutaneous flap reconstruction with either latissimus or rectus flaps achieved an aesthetic improvement of the partial mastectomy deformity in all eight patients. Complications consisted only of seroma formation in two patients following latissimus flap reconstruction. Mammographic evaluation revealed fibrofatty degeneration of the soft tissues of both types of flaps, a change that occurs as early as 6 months after operation and appears as a radiolucent area. The feasibility of mammography as a screening adjunct for recurrent cancer in this group of patients is demonstrated. Advantages of this technique of autogenous tissue reconstruction are improvement of contour deformities associated with conservative surgery and radiation therapy, preservation of normal, sensate breast skin, enhancement of symmetry with the contralateral breast, and avoidance of a prosthesis.

Adult↗

PubMed2004

Pancreatoduodenectomy with vascular reconstruction in treating carcinoma of the pancreatic head.

BACKGROUND: The incidence of carcinoma of the pancreas is increasing in the world. Pancreatic carcinoma is characterized by early local extension to contiguous structures and metastases to regional lymph nodes and the liver. This study was conducted to increase the rate of pancreatoduodenectomy combined with vascular reconstruction. METHODS: Pancreatoduodenectomy with vascular reconstruction was performed for 79 patients at a number of hospitals in Fujian Province, Zhejiang Province, Shanghai and Xinjiang Uyghur Autonomous Region from April 1994 to December 2003. One of these patients also underwent right hemicolectomy; but all received through superior mesenteric vein (SMV)-portal vein (PV) reconstruction. The reconstructions of the superior mesenteric artery (SMA) and hepatic artery (HA) were performed in 4 patients, and reconstructions of the SMA or HA were carried out in 7 and 4 patients respectively. Partial reconstruction of the inferior vena cava (ICV) was done in 2 patients when the tumor was adhering to the wall of the inferior caval vein. RESULTS: Four patients died during the peri-operative period, with a mortality rate of 5%. No complications such as biliary or pancreatic fistulae or artificial blood vessel infection were noted. Histological examination showed one patient with neuroendocrine cancer and the other 78 patients with adenocarcinoma of the pancreatic head. Resected endothelia and vascular margins proved to be microscopically tumor-free. Follow-up for 3 months to 10 years for all except two patients showed 7 of the 9 patients who had undergone resection and reconstruction of the SMA and HA died 7 months or 4 years after operation and 37 survived for over 3 years and 12 for more than 5 years. The rest are still under follow-up. CONCLUSION: Pancreatoduodenectomy with vascular reconstruction for carefully selected patients with carcinoma of the pancreatic head has proved to be a safe and reliable treatment, capable of raising the rates of tumor resection and survival.

Adenocarcinoma↗

PubMed2004

[Resection and reconstruction for primary pelvic tumors around acetabular].

OBJECTIVE: To discuss the resection of tumors, reconstruction of defects and the postoperative complications. METHODS: Thirty-one patients with tumors around acetabular were treated surgically in People's Hospital between July 1997 and July 2003. The series comprised 19 males and 12 females. Twelve patients were diagnosed with chondrosarcoma, 1 with Ewing sarcoma, 3 with osteosarcoma, 1 with lymphoma, 1 with carcinosarcoma, 1 with malignant fibrohistiocytoma (MFH), 2 with myeloma, 9 with giant cell tumor (GCT), 1 with aneurysmal bone cyst. Among 31 patients with peri-acetabular tumors, 8 were reconstructed with hemi-pelvic prosthesis, 7 with saddle prosthesis, 6 with cauterized tumor bone and total hip arthroplasty, 10 with total hip replacement after curettage of lesion and cemented. RESULTS: Among 21 patients who underwent tumor resection and reconstruction in region II, 6 had local relapse. Two of 3 patients with osteosarcoma were dead. Five of 12 patients with chondrosarcoma were free of disease. Twenty-one patients with acetabular reconstruction after resection of lesions in region II could sit and stand normally and walked with a cane, several of which even had normal gait. CONCLUSION: Allograft or pelvic prosthesis can be used to reconstruct the acetabulum after resection of tumors. We must pay more attention on the following points in the surgical treatment of periacetabular tumors: (1) Extensively resect tumors as far as possible; (2) Be acquainted with advantages and disadvantages of different reconstructive methods of acetabulum to prevent the complications; (3) The reconstructed acetabulum is unstable, so the patients must stand with a cane to protect the reconstructed hip joint; (4) Prevent wound necrosis and infection; (5) Surgical treatment of pelvic tumors would easily result in poor wound healing especially in the patients receiving chemotherapy or radiotherapy because of extensive soft tissue stripping. The destroyed soft tissue caused by chemotherapy or radiotherapy may increase the great tissue tension after implantation of allograft. And the factors of poor blood supply and hematoma in the wound theoretically increase the chance of infection.

Acetabulum↗

PubMed2005

[The clinical application and biomechanical study of reconstruction of anterior and posterior cruciate ligament with hamstring tendons knot implant fixation].

OBJECTIVE: To investigate the feasibility of reconstruction of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) with hamstring tendons knot implant fixation. METHODS: Fifty-two cases of ACL and PCL old injury were reconstructed under the arthroscopy with double bundles hamstring tendons knot implant fixated in the bottle-necked femoral tunnel. The tibia side were fixated by tendon weave suture cross tied a knot at the bone bridge of tibia. In this group reconstruction of ACL was in 25, PCL and ACL at the same time reconstruction in 15, PCL in 12. The failure test and displacement evaluation were used to study the biomechanics of reconstruction of ACL by hamstring tendon knot implant fixation (n = 13) in porcine knees. The control group were reconstructed with bone-patellar tendon-bone B-PT-B and interference screw (n = 11). The tibia side tendon weave suture immobility by cross tied a knot at the tibia bone bridge (n = 7) and interference screw in the tibia tunnel (n = 8). RESULTS: Forty-nine cases were followed up, average 14.6 months. The results of Lanchman test was negative in 46 cases, positive in 3 cases. Preoperative Lysholm score was 56.7, and postoperative was 92.8. According to the knee joint effective evaluate standard, 46 were excellent and 3 good. The maximal pull-out force of hamstring tendons knot implanted fixation had been greater than B-PT-B fixation by interference screw. There were similar displacement in 100 N and 400 N load between hamstring tendons knot implant fixation and B-PT-B (P > 0.05). Peak force test maximal displacement evaluation and failure energy absorption measurement showed that hamstring tendons knot implant fixation was significantly greater than B-PT-B (P < 0.01). The failure test and displacement evaluation of tendon fixation by weave suture knot at the tibia bone bridge cross tie were greater than B-PT-B fixation by interference screw. CONCLUSION: The methods of reconstruct of ACL and PCL by hamstring tendons knot implant fixation are feasible. The advantages include: it is biological fixation, not machine fixation; it may benefit for tendons with bone tunnel healing and decrease medical cost. Decreasing or eliminating displacement is helpful to prevent relaxation after reconstruction of ACL and PCL.

Animals↗

PubMed1992

Eighty-four consecutive breast reconstructions using a textured silicone tissue expander.

Breast reconstruction utilizing smooth-surface silicone tissue expanders is associated with certain problems. Significant capsular contracture may develop around the expander with subsequent expander displacement necessitating repositioning or capsulectomy at the time of expander removal. Infection, pain on expansion, chest-wall compression, and complications related to the remote fill valve also have been reported. A textured-surface silicone expander with an integrated fill valve was developed to address these issues. Eighty-four consecutive breast reconstructions were performed by a single surgeon using textured expanders in 55 patients. Intraexpander pressures were measured during expansion for a group of these patients, and both initial and postinflation pressure readings were quite low (average initial pressure 2.88 mmHg; average postinflation pressure 12.87 mmHg). Eighty-one of the reconstructions have been completed without any expander losses and with minimal complications. Tissue expander volume averaged 580 cc, and the expansion duration averaged 5.6 months. Various types and configurations of permanent implants were used to complete the reconstructions. Eighty-four percent of our patients' completed reconstructions (including nippleareola reconstruction and opposite breast alteration, when necessary) were accomplished with just two procedures. Seventeen long-term adjustable textured-surface expander/implants with anatomic breast shape are still in place, all after only one operation. The inframmary fold has generally been established passively by the expansion process alone. Textured-surface silicone expanders have stayed where positioned, have expanded easily with minimal patient pain, and have created a noncontractile soft-tissue cover for the final implant. The textured expander with an integrated fill valve has simplified breast reconstruction by helping to limit the problems encountered with smooth silicone expanders. The resulting reconstructions have remained soft with a very acceptable aesthetic appearance. The patient office and hospital charts and photographs of this consecutive series were notarized and submitted to the Editor of this Journal, whose biostatistician randomly selected the cases illustrated.

Equipment Design↗

PubMed1989

Microtia reconstruction: does the cartilage framework grow?

The use of free rib cartilage ear frameworks in unilateral microtia reconstruction has prompted much discussion about their potential for growth. The senior author has reconstructed ear frameworks in 132 microtia patients, most of whom were under 3 years of age when surgery was initiated. Of this group, 29 were assessed for ear growth through comparison of the lead-plate model of the original normal ear to the normal ear growth and the reconstructed ear framework after a period of at least 2 years. Similarly, 14 reconstructed ears were compared to 14 normal ears at least 2 years after reconstruction. The perimeters of tracings made from the original lead plates and of tracings of normal and reconstructed ears were determined by image analysis techniques. The results demonstrated no significant difference in growth between normal ears and reconstructed ear frameworks after an interval of at least 2.5 years. Therefore, the reconstructed ear is growing at a rate similar to that of the normal ear.

Cartilage↗

PubMedDate not supplied

[Recent advances in breast reconstruction].

In ten years, breast reconstruction has become a routine procedure. It is now well established that it does not influence breast cancer. Techniques have been refined, and even use the excess of skin and fat of the lower abdomen to reconstruct a breast without a prosthesis. The indications of reconstruction remain mainly psychological, and it is difficult to predict which patients will be candidates for a reconstructive procedure after their mastectomy. Immediate reconstruction is more often proposed since expansion prostheses are used. It should however be reserved to highly selected cases. An unusual type of reconstruction is now becoming more common, after conservative treatment of breast cancer. It is asked by patients who are disappointed by the aspect of their breast after partial mastectomy and irradiation. Reconstructive surgery is specially difficult in these cases, and may induce more complications than usual reconstruction. It is therefore important that surgeons keep such procedures for cases in which they have good chances to leave a breast with satisfactory volume, consistency and aspect.

Breast↗

PubMed1983

Recent advances in reconstruction in the head and neck region.

A better understanding of the detailed blood supply of skin and its underlying soft tissue has provided the reconstructive surgeon with a wider choice of reliable skin and muscle flaps for the reconstruction of head and neck defects after ablative surgery. The forehead, cervical and delto-pectoral flaps have been the standard flaps used for head and neck reconstruction. More recently, myocutaneous flaps like the pectoralis major myocutaneous flap and the latissimus dorsi myocutaneous flap have been used for head and neck reconstruction. The skin of these flaps provides the lining tissue and the muscle provides support as well as bulk and therefore greatly increases the scope of functional as well as cosmetic reconstruction. Finally, fat sculpturing techniques done as a secondary procedure on these myocutaneous flaps enables defects in the contour of the reconstructed face to be symmetrical with the normal side. This paper summarises the various flaps used in reconstruction of the head and neck region and discusses in detail the most promising myocutaneous flap for head and neck reconstruction in use today - the pectoralis major myocutaneous flap.

Carcinoma, Squamous Cell↗

PubMed1984

Cholelithiasis and aortic reconstruction.

Identification of cholelithiasis during abdominal aortic reconstruction with placement of a vascular prosthesis provides cause for hesitation in performing a simultaneous cholecystectomy because of the potential contamination of the graft. However, the association of cholelithiasis with cholecystitis is well established and was observed in a group of patients who had known cholelithiasis following aortic reconstruction. Cholelithiasis was noted in 50 of 250 patients who underwent reconstruction of the abdominal aorta or its major branches. Seventeen of the 50 patients with cholelithiasis underwent a cholecystectomy prior to aortic reconstruction. Sixteen patients underwent a cholecystectomy at the time of aortic reconstruction and experienced no morbidity related to the cholecystectomy. Seventeen patients with cholelithiasis did not undergo cholecystectomy. All were asymptomatic. Nine of these individuals developed cholecystitis or symptoms related to their gallstones following aortic reconstruction. A subsequent cholecystectomy was performed in all nine patients. The interval between aortic reconstruction and cholecystectomy was from 2 weeks to 108 months. The remaining eight patients with cholelithiasis have been followed up for 17 to 50 months. Six of these patients remain asymptomatic. The two patients followed up for the longest period (42 and 50 months, respectively) have become symptomatic. If there are no mitigating circumstances, cholecystectomy is advised for patients undergoing aortic reconstruction with associated cholelithiasis.

Aged↗

PubMed1994

[Initial results of immediate reconstruction of the breast following mastectomy].

OBJECTIVE: Evaluation of the results of immediate reconstruction after mastectomy for breast cancer by means of a silicone implant. DESIGN: Retrospective analysis. SETTING: Department of Surgical Oncology of the Dr Daniël den Hoed Cancer Centre and Department of Surgery of the Zuiderziekenhuis, Rotterdam, the Netherlands. METHOD: From September 1990 till July 1993, 37 immediate reconstructions of the breast after mastectomy were performed in 35 patients by means of a silicone implant. Indications for the treatment, consequences for further oncological treatment, additional plastic surgery, and complications of the reconstruction were evaluated. RESULTS: The indications for mastectomy and immediate reconstruction were local recurrence after breast conservative treatment (6 operations), multifocal disease (8), extensive in situ carcinoma (8), non-radically removed tumour at lumpectomy (5), anticipated poor cosmetics after breast conservative treatment (6), prophylactic ablation of the breast (2), and patient preference (1). 5 patients received adjuvant systemic chemotherapy, which could be administered without delay, and without negative influence on the result of the breast reconstruction. Additional plastic surgical treatment consisting of reconstruction of the areolar complex and correction of the breast symmetry, was performed in 5 and 3 patients respectively. In 8 of the 37 reconstructions (22%) complications were encountered. The main complications were haematoma (2), infection (4), implant removal (3), capsular contracture (2), skin necrosis (2), and luxation of the implant (1). CONCLUSION: Immediate reconstruction after mastectomy is a valuable treatment modality in breast cancer.

Adult↗

PubMedDate not supplied

[The use of the jejunum free flap in the reconstruction of the oral cavity].

The rapid development of surgical techniques in the head and neck area has greatly assisted in enabling reconstructive surgery to bring about prompt positive results. Radical tumor excision alone is no longer an acceptable treatment. Through new reconstructive techniques, psychological and social isolation of the patients, due to difficulties in such vital functions as chewing, speech, swallowing and breathing, can be reduced remarkably. In the past numerous techniques which employed myocutaneous flaps in the reconstruction of the oropharynx have been described. During the last ten years, however, many Authors have proposed the use of free flaps for this reconstructive surgery. Our Department presents its personal experience in reconstruction of the oral cavity using the jejunal flap, which facilitates superior physiological and histological adaptation when compared to that had with other flaps. Our histological study shows metaplastic transformation of the columnar epithelium into squamous epithelium (similar to oral cavity epithelium), phenomenon already observed in "cervix uteri" and anorectal area. The primary reconstruction with a free revascularized jejunal loop associated with mandibular replacement offers certain significant advantages such as satisfactory reconstruction of large defects, high flexibility of the flap and a productions of mucous which cleans the surface of transplants. Furthermore, the mesenteric foot tissue serves as good transplant material for extended soft-tissue loss. In agreement with a Study begun by Carrel in 1906 and that of Reuther (1982), we believe that reconstruction of large defects in the oral cavity by means of transplantation of the mucosa is the ideal treatment.

Adult↗

PubMed1993

[Results of reconstructive surgery in fractures of the proximal humerus].

In treatment of comminuted dislocation fractures of the proximal humerus the most serious therapeutic problem still remains the 6th group of Neer's classification, in particular fractures with four fragments and with a completely dislocated and devitalized head. The authors present in a retrospective study an overall comparison of results assembled in 30 patients (and 19 checked patients resp.) who were operated by the technique of anatomical reconstruction (13 and 8 patients resp.) or by the authors own technique of non-anatomical reconstruction (17 and 11 patients resp.), all operated on account of comminuted dislocation fractures of the proximal humerus at the orthopaedic clinics of the First and Third Medical Faculty, Charles University, Prague in 1976-1988. Analysis of the results of the checked patients made the authors draw the following conclusions: 1. Fractures of the proximal end of the humerus is a relative frequent injury, in particular in the elderly. About 20% of these injuries call for surgical treatment. 2. In all non-anatomical reconstructions the mobility is very restricted in particular exorotation, in anatomical reconstructions the restriction is much smaller. 3. In all patients operated by the technique of non-anatomical reconstruction within three years necrobiotic reconstruction of the fragment of the head occurred which is the greater, the larger the fragment of the head which was preserved. 4. The result of the reconstruction depends on the preservation of nurture of the fragment of the head and on selection of an adequate technique of osteosynthesis. 5. In anatomical reconstructions the most frequent complication was loosening of the osteosynthetic material, a varus position of the head and pseudoarthrosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗