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PubMed1988

Errors in reconstruction of resistivity images using a linear reconstruction technique.

Reconstruction of electrical impedance images using the filtered back projection method of Barber and Brown makes several important assumptions about the object being imaged. These are principally that the object has a circular boundary, is two-dimensional and of impedance close to uniform, and has electrodes equally spaced on its boundary. In practice few of these assumptions are met, yet the method appears to give sensible and useful images. This paper looks at errors of reconstruction produced by non-ideal placement of the electrodes and shows that the reconstruction method is insensitive to such placement errors.

Algorithms↗

PubMed1995

Improved aesthetics in breast reconstruction: modified mastectomy incision and immediate autologous tissue reconstruction.

A common detraction from the aesthetic results of breast reconstruction is the presence of a transverse mastectomy scar and the patch-like effect of the paler abdominal skin contrasting with the thoracic skin. The technique described involves a modified mastectomy approach in which the breast parenchyma and nipple are first mobilized through a periareolar incision and then removed, along with the axillary lymph nodes, through an axillary counter-incision. A de-epithelialized transverse rectus abdominis musculocutaneous flap is then used to fill the empty "skin brassiere," effectively replacing the glandular defect, and a small patch of skin is exteriorized to match the areolar defect. Excellent symmetry can be attained usually without having to manipulate the opposite breast. After nipple-areolar reconstruction, the breast looks quite normal without the usual stigmas of mastectomy. In 21 breast reconstructions performed since 1991, there has been no incidence of skin flap necrosis or local recurrence.

Adult↗

PubMed2001

Reconstruction of the submammary crease for correction of postoperative deformities in aesthetic and reconstructive breast surgery.

This article discusses a method of reconstruction of breast crease for correction of postoperative deformities. These deformities are usually the result of implant insertion for the purpose of breast enlargement or reconstruction. The operation is performed by creating a new crease in the appropriate site by suturing capsular and soft tissue structures from the anterior to the posterior wall of the pocket to eliminate excess space at the lower, medial, or lateral breast. This article will detail crease reconstruction through an internal approach. Patient selection, technique, and results are discussed.

Breast↗

PubMed1988

Mandibular reconstruction with the titanium hollow screw reconstruction plate (THORP) system: evaluation of 62 cases.

The titanium hollow screw reconstruction plate (THORP) system for reconstruction of lower jaw defects provides a functional stable fixation and is used as a long-term or permanent implant in tumor surgery and in traumatology. The rigid fixation of the head of the screw to the plate, avoiding unphysiologic loads to the bone underneath the plate, and the titanium plasma-coated perforated hollow screws, enabling the development of direct bone-titanium contact as well as the ingrowth of bone into the lumen and perforations, are the major advantages of this system compared to conventional systems. The different surgical methods, such as preservation of the condylar process with only two screws, intraoperative freely adjustable condylar prosthesis, lingual application of the plate, and primary bone transplantation, are described. The evaluation of 62 patients reconstructed with the THORP system between 1981 and 1986 revealed no plate loosening, even in irradiated bone, and showed satisfactory aesthetic and functional results.

Adult↗

PubMed1990

Immediate breast reconstruction with deepithelialized TRAM flaps: techniques for improving breast reconstruction.

In selected patients with lower quadrant breast masses, large breasts, and sufficient abdominal tissue, standard techniques for breast reconstruction can be modified to improve overall results. The transverse abdominal island flap can be deepithelialized and mobilized to reconstruct unilateral or bilateral defects. Furthermore, skin markings prior to mastectomy that conform to a modified Wise pattern will allow for more aesthetic positioning of eventual scars. We present a case report of a patient who underwent immediate breast reconstruction with bilateral deepithelialized lower rectus abdominis myodermal flaps.

Adenocarcinoma, Mucinous↗

PubMed2004

Development of new reconstructive techniques: use of Integra in combination with fibrin glue and negative-pressure therapy for reconstruction of acute and chronic wounds.

Large wounds resulting from severe injuries are generally treated with extended reconstructive operations (e.g., free flaps), which are accompanied by long hospitalizations and risks of infection, thrombosis, and flap loss. Integra is a collagen template that can be used for reconstruction of defects. The take rate and the rate of infection are essential for the successful use of Integra (Johnson and Johnson, Hamburg, Germany). Whether the take rate and integration of Integra could be improved with the use of fibrin glue and negative-pressure therapy was assessed. Between January of 2002 and December of 2002, patients with large defects who underwent Integra grafting for reconstruction were randomly divided into groups receiving either a new treatment with fibrin glue-anchored Integra and postoperative negative-pressure therapy or conventional treatment. Demographic features, cause of the wound, location of the wound, take rate, complications of Integra coverage, time from Integra coverage to skin transplantation, and functional and aesthetic results were assessed. Twelve patients (with similar group distributions with respect to sex, age, and location and cause of the injury) were included in the study. The take rate was 78 +/- 8 percent in the conventional treatment group and 98 +/- 2 percent in the fibrin/negative-pressure therapy group (p < 0.003). The mean period from Integra coverage to skin transplantation was 24 +/- 3 days in the conventional treatment group but only 10 +/- 1 days in the fibrin/negative-pressure therapy group (p < 0.002). The decrease in the interval between coverage with Integra and skin transplantation resulted in shorter hospital stays. The use of fibrin glue and negative-pressure therapy in combination with Integra could shorten the period from coverage to integration, which would be beneficial in terms of decreased risks of infection, thrombosis, and catabolism. Therefore, it is suggested that Integra be used in combination with fibrin glue and negative-pressure therapy to improve clinical outcomes and shorten hospital stays, with decreased risks of accompanying complications.

Adult↗

PubMed2006

Use of regenerative human acellular tissue (AlloDerm) to reconstruct the abdominal wall following pedicle TRAM flap breast reconstruction surgery.

BACKGROUND: Harvest of transverse rectus abdominis musculocutaneous (TRAM) flaps for breast reconstruction leaves a variable defect in the anterior rectus fascia. Inadequate closure of the defect could lead to the development of hernia or abdominal wall bulging. Various techniques have been developed to reduce the incidence of hernia and abdominal wall bulging. The authors describe a novel technique of using a regenerative human acellular matrix (AlloDerm) as a fascial substitute in closing the defect. METHODS: Fifty-four consecutive patients who opted for pedicle TRAM flap procedures for breast reconstruction postmastectomy were scheduled for donor-site repair with the use of AlloDerm. AlloDerm was placed interpositionally as an inlay graft to mimic the anterior rectus fascia. RESULTS: Hernia or infection did not develop in any of the patients. There was a greater incidence of seroma and bulging among the first 18 patients, with eight seromas (44.4 percent) and six bulges (33.3 percent). When the technique was ameliorated in the next 36 patients, there was a reduction in the incidence of seromas (16.7 percent, p = 0.03) and bulges (16.7 percent, p = 0.17). Of the three patients who experienced wound dehiscence, partial AlloDerm exposure occurred in two, but was resolved without further consequences. Biopsy specimens of AlloDerm, obtained 12 and 14 months after TRAM donor-site repair, showed full tissue integration. The cell density, vasculature, and collagen orientation in the biopsies were consistent with abdominal fascia tissue. CONCLUSION: Based on these results, the authors recommend the use of AlloDerm as an alternative option for abdominal fascia closure after TRAM flap harvest for breast reconstruction.

Abdominal Wall↗

PubMed2007

Maxillary and mandibular reconstruction using bicortical calvarial bone grafts: a retrospective study of 122 reconstructions in 73 patients.

BACKGROUND: Using classic maxillary and mandibular reconstruction with mandibular bone grafts or unicortical calvarial bone grafts, the authors performed 122 reconstructions in 73 patients using bicortical calvarial bone grafts and report the results in this article. Such a technique has not been previously described in the world literature. METHODS: Seventy-three patients, 55 women and 18 men, with severely atrophied maxillas or mandibles were treated with bicortical calvarial bone grafts and placement of implants over a 5-year period. Patient selection was based on the important insufficient remaining height or width of bone placement of multiple 10-mm implants and the thinness of the calvaria (<5 mm). All patients had major bone atrophy. RESULTS: Twenty-nine patients had 121 implants placed in vertical bicortical bone grafts and 40 patients had 170 implants placed in horizontal bicortical bone grafts. All patients underwent a two-stage procedure, with the implants being placed 4 to 5 months after the grafting procedure. The majority of maxillary implants were placed between the canine eminence and zygomatic buttress. Of the 122 bicortical calvarial bone grafts that took, two cases presented an incised wound of the dura. A simple nonabsorbable suture was performed in these two cases without any postoperative problems. There were no cerebral injuries encountered with the donor sites. CONCLUSIONS: Bicortical bone grafting seems to be a solution for reconstruction of voluminous bone atrophy in cases of thin calvaria. Because of legal issues, such a technique must be performed by a trained craniofacial surgery team. The resorption rate seems to be lower in cases of bicortical bone graft.

Adolescent↗

PubMed2003

Reconstruction of the middle and lower face with three simultaneous free flaps: combined use of bilateral fibular flaps for maxillomandibular reconstruction.

A 23-year-old man sustained massive maxillofacial destruction from a close-range, high-velocity gunshot injury. The devastating nature of the injury led to extensive soft-tissue and bone loss involving nearly the total middle and lower portions of his face, including the deeper anatomic structures. Reconstruction of this extraordinarily extensive and three-dimensional defect was accomplished by simultaneous transfer of three free flaps during one session. A specially designed radial forearm flap replaced the internal lining and external cover of the nose, a large fibular osteocutaneous flap restored the lower face, and a second fibular osteocutaneous flap harvested from the other leg restored the midface. The second fibular flap was revascularized by combining it with the first one in a flow-through manner, and its pedicle vessels were anastomosed to the distal ends of the vessels of the first flap. Dorsal nasal reconstruction with an expanded paramedian forehead flap, commissurotomy, and intraoral flap debulking were additional procedures performed to improve cosmetic and functional outcome during the following 1-year period. Along with a radial forearm flap, combined use of bilateral osteocutaneous fibular flaps provided simultaneous, single-stage reconstruction of a huge facial defect involving both the lower and middle face with an acceptable result.

Adult↗

PubMedDate not supplied

Current trends in anterior cruciate ligament reconstruction. Part 1: Biology and biomechanics of reconstruction.

With today's increasing emphasis on sporting activities, the incidence of anterior cruciate ligament injuries has also increased. Epidemiologic studies estimate that the prevalence of anterior cruciate ligament injuries is about 1 per 3000 Americans. Management of these injuries has evolved from nonoperative treatment to extracapsular augmentation and primary ligament repair to anterior cruciate ligament reconstruction. Treatment of these injuries has significantly improved over the last few decades with the application of knowledge gained from both basic science and clinical research. This article is composed of two parts. The first part reviews the biology and biomechanics of the injured anterior cruciate ligament and the basic science of reconstruction. In the second part, to be published later, current operative concepts of reconstruction, as well as clinical correlations, are reviewed. Summarizing the latest information on basic scientific as well as clinical studies regarding the anterior cruciate ligament, this article intends to demonstrate the correlation between the application of basic science knowledge and improvement of clinical outcomes.

Anterior Cruciate Ligament↗

PubMed2006

Multilayer image grid reconstruction technology: four-dimensional interactive image reconstruction of microsurgical neuroanatomic dissections.

OBJECTIVE: Cadaveric dissection is the gold standard for training physicians in various surgical specialties. However, limitations in acquiring and storing sufficient cadaveric material, recent pressures in training opportunities, and progress in digital image technology have led to advances in virtual or artificial visual means to augment surgical training. For training neurosurgeons, the appearance of reality is still crucial for learning anatomic structures and procedures. We developed a four-dimensional (including time) multilayer digital image reconstruction technology (MIGRT) that allows users to manipulate a "volumetric" set of photographic image data from exquisite cadaveric intracranial dissections and to navigate through stages of neurosurgical procedures as the dissection progresses. METHODS: A robotic microscope with two digital cameras was used to capture dissection images, usually in stereoscopic mode. A grid space was created to define positions at which images are captured. Images were acquired from identical angles at the same grid coordinates but at different stages of various dissections. RESULTS: Image data are reconstructed according to the sequence of acquisition into a multilayer image grid system by the MIGRT software. The single interactive, four-dimensional montage is viewable a on common computer platform. CONCLUSION: MIGRT uniquely focuses on capturing anatomic content that preserves natural appearances, including procedure, texture, and color, which is far superior and preferable to images and a reconstructed image environment based on artificial or animated concepts. MIGRT shows time-dependent changes in procedures, provides depth perception by stereoscopy or unique sequential motion, and allows simultaneous interactivity at each step of the procedure.

Brain↗

PubMed2006

Magnification of 3D reconstructed images in integral imaging using an intermediate-view reconstruction technique.

A new integral imaging (II) system that can magnify 3D reconstructed images by employing an intermediate-view reconstruction technique (IVRT) is proposed in which the number of the elemental images obtained from a one-step pickup process can be computationally increased by use of an IVRT without mechanical movement and a long multistep pickup process. To show the feasibility of the proposed II system, some optical experiments on the magnification of 3D reconstructed images with a real 3D object have been carried out and results are presented.

Algorithms↗

PubMed1995

[Vascular reconstruction of the carotid artery--studies of a one stage ipsilateral reconstructive procedure].

Recent advance in vascular surgery have made vascular reconstruction of the carotid artery possible. Since 1990, the authors have performed en bloc resection of the carotid artery and vascular reconstruction of the carotid artery, using a temporary shunt tube, in 10 cases. Among these 10 cases of tumors involving the carotid artery, two cases had carotid body tumors and the other eight cases had metastatic lymph nodes from head and neck cancers. Transient motor paralysis occurred in three cases and disorientation in one after the operation. None has developed severe neurological complications such as death, coma or permanent hemiplegia. Despite preoperative irradiation, local infection was noted in only one case after the operation. Rupture of the vein graft was prevented by using a DP flap to cover dead space at the anastomotic site. The two patients with a carotid body tumor are alive without evidence of recurrence. Among eight patients with cancer, three are still alive and disease free (respectively 44, 30 and 16 months). Two patients died of local recurrence, two of distant metastasis and the other of acute heart failure. Local tumor control was possible in six out of eight patients. We were able to safely perform en bloc resection of the carotid artery and vascular reconstruction of the carotid artery using a temporary shunt tube. In conclusion, we anticipate increasing curability of advanced tumors involving the carotid artery using this procedure.

Adult↗

PubMed2006

[Evaluation of change in the optimal image reconstruction phase in retrospective ECG-gated reconstruction].

The purpose of this study was to optimize the reconstruction phase in order to improve depiction of the coronary artery in the relative delay method of the retrospective electrocardiogram (ECG)-gated reconstruction technique using a multi-slice computed tomography (MSCT) scanner with four channels. The following items were evaluated; 1) image quality of the coronary arteriogram, 2) degree of difference between the standard phase corresponding to the diastasis period and the selected phase, which was determined in each case to obtain the best image, and 3) the factors causing the phase difference. The image quality in the selected phase was better than that in the standard phase. A positive correlation was observed between the degree of phase difference and the median value and standard deviation of the heart rate. The degradation of image quality was remarkable in cases showing a large degree of phase difference. A negative correlation was observed between image quality in the selected phase and the degree of phase difference. Individualizing the reconstruction phase is required to improve the image quality of coronary arteriograms with MSCT. It should be noted that the condition of a low and stable heart rate results in reduction in the degree of phase difference, which is useful for the acquisition of better images.

Adolescent↗

PubMed2000

[Fifty years of plastic surgery in the Netherlands. IX. Reconstructive surgery illustrated by breast reconstruction].

The earliest reports on reconstructive surgery are more than two thousand years old. However, the most significant developments took place in the past four decades. At the beginning of the 21st century we are able to perform reconstructions with a moderate functional and good cosmetic result and limited donor site morbidity. The reconstructive options regarding the mammary region include application of mammary implantation only, and techniques in which autologous tissues are applied, with or without implantations. Autologous tissue is used in transposition of the M. latissimus dorsi, in application of the myocutaneous flap of the M. rectus abdominis ('transverse rectus abdominis myocutaneous flap' (TRAM flap)), which is refined in the 'deep inferior epigastric artery perforator' (DIEP) flap procedure.

Female↗

PubMed2001

Aesthetically successful mandibular reconstruction with a single reconstruction plate.

Aesthetically successful mandibular reconstruction can be performed with free fibular flaps and with a single low-profile reconstruction plate. The keys to aesthetic success are accurate bending of the reconstruction plate, accurate alignment of the bone, and maintenance of the lower border of the mandible. If only the mandible and overlying oral lining are missing, the results can be indistinguishable from normal. In massive defects that include other structures besides the mandible, however, excellent aesthetic results can be difficult or impossible. Massive soft tissue deficits and heavy doses of postoperative radiation therapy can impact severely the aesthetic quality of the result. Patients should be aware of these limitations and have appropriately realistic expectations.

Bone Plates↗

PubMed2003

[Evaluation of ultra-low-dose thoracic multi-detector-row CT using different reconstruction kernels and new reconstruction algorithms].

CT has great advantages in detecting early-stage small lung cancer and is becoming common in lung cancer screening. Multi-detector-row CT (MDCT) can provide thin-slice images with low radiation exposure. In this study, ultra-low-dose (5 mAs: 10 mAs, 0.5 sec/rot) thoracic MDCT images were evaluated. We describe the differences in image quality and quantity between the different reconstruction kernels. We also propose a new reconstruction algorithm (ultra-low-dose reconstruction algorithm: ULR) for ultra-low-dose thoracic CT, to reduce noise and streak artifacts. We are convinced of the usefulness and possibility of ultra-low-dose thoracic MDCT with ULR algorithms for lung cancer screening.

Algorithms↗

PubMed2003

[Value of autologous transplantation of osteo-chondral paste in reconstruction of experimental cartilage defects. Part II. Microscopic analysis of integration with surrounding cartilage, structural integrity and subchondral bone reconstruction in repair tissue].

INTRODUCTION: A limited ability of the cartilage to heal after trauma was the reason to start research on new methods concerning better cartilage reconstruction. The aim of the study was evaluation of repair tissue integration with surrounding cartilage, its structural integrity and subchondral bone reconstruction after osteo-chondral paste transplantation. MATERIAL AND METHODS: Full thickness defect (IV degree--ICRS scale) on distal rabbit femur joint surface was made. Three groups were specified: A--defect with paste graft (cartilage and contiguous bone collected from joint surface, crushed into homogenous paste; B--defect with the paste graft covered with periosteum; C--defect left unfilled. The follow-up periods were established at 4, 8, 12 weeks. Repair tissue was evaluated microscopically according to modified O'Driscoll scale. RESULTS: Newly formed tissue was well integrated with surrounding cartilage in group A (paste graft). That trade of repair tissue in group A was much better than in other groups, especially in late observations. Structural integrity of tissue filling the defect was similar to integrity of normal cartilage in groups A and C, but tissue formed in group C didn't represent a hyaline-like cartilage character. In all the examined groups reconstruction of subchondral bone exhibited similar rate. 12 weeks from the procedure, around 80% of subchondral bone was rebuilt. The obtained results indicate, that osteo-chondral paste autologous transplantation in cartilage defects treatment effects with forming well integrated (structurally and with surrounding cartilage) cartilage tissue, of almost complete subchondral bone rebuilding.

Animals↗