Plastic and Reconstructive Surgery
Công bố khoa học tiêu biểu
* Dữ liệu chỉ mang tính chất tham khảo
Sắp xếp:
The Radial Forearm Flap Donor Site
Plastic and Reconstructive Surgery - Tập 91 Số Supplement - Trang 865-870 - 1993
Autologous Breast Reconstruction after Failed Implant-Based Reconstruction: Evaluation of Surgical and Patient-Reported Outcomes and Quality of Life
Background:
There is a subset of patients who initially undergo implant-based breast reconstruction but later change to autologous reconstruction after failure of the implant reconstruction. The purpose of this study was to examine outcomes and quality of life in this group of patients.
Methods:
After institutional review board approval, a retrospective chart review of a prospectively maintained database was performed and BREAST-Q surveys were evaluated.
Results:
One hundred thirty-seven patients underwent autologous breast reconstruction following failed implant-based reconstruction with 192 total flaps. Failure of implant reconstruction was defined as follows: capsular contracture causing pain and/or cosmetic deformity [n = 106 (77 percent)], dissatisfaction with the aesthetic result [n = 15 (11 percent)], impending exposure of the implant/infection [n = 8 (6 percent)], and unknown [n = 8 (6 percent)]. Complications requiring operative intervention included partial flap loss [n = 5 (3 percent)], hematoma [n = 5 (3 percent)], vascular compromise requiring intervention for salvage [n = 2 (1 percent)], and total flap loss [n = 1 (1 percent)]. Thirty-four patients (23 percent) had BREAST-Q surveys. There was a statistically significant increase in overall outcomes (p < 0.001), satisfaction with appearance of breasts (p < 0.001), psychosocial well-being (p < 0.001), and physical well-being of the chest (p = 0.003). A statistically significant decrease in physical well-being of the abdomen was observed (p = 0.001).
Conclusions:
Autologous breast reconstruction after failed implant-based reconstruction has an acceptable complication rate and is associated with significantly improved patient satisfaction and quality of life.
CLINICAL QUESTION/LEVEL OF EVIDENCE:
Therapeutic, IV.
Plastic and Reconstructive Surgery - Tập 143 Số 2 - Trang 373-379 - 2019
How to Diagnose and Treat Breast Implant–Associated Anaplastic Large Cell Lymphoma
Learning Objectives:
After reading this article, the participant should be able to: 1. Describe the diagnostic criteria for breast implant–associated (BIA) anaplastic large cell lymphoma (ALCL). 2. Appropriately evaluate a patient with suspected BIA-ALCL, including appropriate imaging, laboratory tests, and pathologic evaluation. 3. Understand the operative treatment of BIA-ALCL, and indications for systemic chemotherapy and/or radiation therapy in advanced disease. 4. Understand treatment outcomes and prognosis based on stage of disease.
Summary:
The goal of this continuing medical education module is to present the assessment of a patient with suspected breast implant–associated anaplastic large cell lymphoma, the evaluation and diagnosis, the preoperative oncologic workup, the formation and execution of a surgical treatment plan, and the inclusion of adjunct treatments when indicated. In addition, staging and disease progression for treatment of breast implant–associated anaplastic large cell lymphoma are discussed.
Plastic and Reconstructive Surgery - Tập 141 Số 4 - Trang 586e-599e - 2018
Options in Reconstructing the Irradiated Breast
Plastic and Reconstructive Surgery - Tập 122 Số 2 - Trang 379-388 - 2008
Proliferation-Promoting Effect of Platelet-Rich Plasma on Human Adipose–Derived Stem Cells and Human Dermal Fibroblasts
Plastic and Reconstructive Surgery - Tập 122 Số 5 - Trang 1352-1360 - 2008
A Four-Year Institutional Experience of Immediate Lymphatic Reconstruction
Introduction:
Up to 1 in 3 patients may go on to develop breast cancer-related lymphedema (BCRL) after treatment. Immediate Lymphatic Reconstruction (ILR) is a surgical procedure that has been shown in early studies to reduce the risk of BCRL. However, long-term outcomes are limited due to its recent introduction and different institutions’ eligibility requirements. This study evaluates the incidence of BCRL in a cohort that underwent ILR over the long-term.
Methods:
A retrospective review of all patients referred for ILR at our institution from September 2016 through September 2020 was performed. Patients with preoperative measurements, a minimum 6-months follow-up data and at least one completed lymphovenous bypass were identified. Medical records were reviewed for demographics, cancer treatment data, intra-operative management and lymphedema incidence.
Results: A total of 186 patients with unilateral node-positive breast cancer underwent axillary nodal surgery and attempt at ILR over the study period. Ninety patients underwent successful ILR and met all eligibility criteria, with a mean patient age of 54 (sd: 12.1) years and median BMI of 26.6 (q1-q3: 24.0-30.7) kg/m2. Median number of lymph nodes removed was 14 (q1-q3: 8-19). Median follow-up was 17 months (range: 6-49). 87% of patients underwent adjuvant radiotherapy of which 97% received regional lymph node radiation. At the end of the study period, we found an overall 9% rate of LE.
Conclusion:
Utilizing strict follow-up guidelines over the long-term, our findings support ILR at time of axillary lymph node dissection is an effective procedure that reduces the risk of BCRL in a high-risk patient population.
Plastic and Reconstructive Surgery -
The Impact of Postmastectomy Radiotherapy on Two-Stage Implant Breast Reconstruction
Plastic and Reconstructive Surgery - Tập 134 Số 4 - Trang 588-595 - 2014
Use of Acellular Dermal Matrix in Postmastectomy Breast Reconstruction
Plastic and Reconstructive Surgery - Tập 136 Số 4 - Trang 647-653 - 2015
A Prospective and Randomized Study, “SVEA,” Comparing Effects of Three Methods for Delayed Breast Reconstruction on Quality of Life, Patient-Defined Problem Areas of Life, and Cosmetic Result
Plastic and Reconstructive Surgery - Tập 105 Số 1 - Trang 66-74 - 2000
Consensus Review of Optimal Perioperative Care in Breast Reconstruction: Enhanced Recovery after Surgery (ERAS) Society Recommendations Background: Enhanced recovery following surgery can be achieved through the introduction of evidence-based perioperative maneuvers. This review aims to present a consensus for optimal perioperative management of patients undergoing breast reconstructive surgery and to provide evidence-based recommendations for an enhanced perioperative protocol. Methods: A systematic review of meta-analyses, randomized controlled trials, and large prospective cohorts was conducted for each protocol element. Smaller prospective cohorts and retrospective cohorts were considered only when higher level evidence was unavailable. The available literature was graded by an international panel of experts in breast reconstructive surgery and used to form consensus recommendations for each topic. Each recommendation was graded following a consensus discussion among the expert panel. Development of these recommendations was endorsed by the Enhanced Recovery after Surgery Society. Results: High-quality randomized controlled trial data in patients undergoing breast reconstruction informed some of the recommendations; however, for most items, data from lower level studies in the population of interest were considered along with extrapolated data from high-quality studies in non–breast reconstruction populations. Recommendations were developed for a total of 18 unique enhanced recovery after surgery items and are discussed in the article. Key recommendations support use of opioid-sparing perioperative medications, minimal preoperative fasting and early feeding, use of anesthetic techniques that decrease postoperative nausea and vomiting and pain, use of measures to prevent intraoperative hypothermia, and support of early mobilization after surgery. Conclusion: Based on the best available evidence for each topic, a consensus review of optimal perioperative care for patients undergoing breast reconstruction is presented. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
Plastic and Reconstructive Surgery - Tập 139 Số 5 - Trang 1056e-1071e - 2017
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