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Biomedical subjects

G W Carlson

Publications and source records attributed to G W Carlson.

At least 37 records · Page 2Linked to original sources
PubMed1997

The tensor fascia lata free flap in abdominal-wall reconstruction.

The pedicled tensor fascia lata flap (TFL flap) is a method of choice for abdominal-wall reconstruction. Frequently, the size and location of the defect produce this option. Microsurgical transfer may overcome these disadvantages. Therefore, the ability of the TFL free flap to reconstruct complex abdominal wounds was evaluated. Seven patients with full-thickness abdominal-wall defects reconstructed by TFL free flaps were reviewed. Their average age was 44.6 years (range: 27 years to 59 years); follow-up averaged 10.5 months (range: 2 months to 18 months). Fifty-seven percent of the wounds were either infected or contaminated; the defect averaged 15 cm x 26 cm Six 85.7 percent) of the wounds involved the epigastrum. No total flap loss was seen, but three flaps developed distal tip necrosis (42.9%). Microsurgical transfer of the TFL free flap overcomes the limitations of the arc of rotation seen with the pedicled flap. It increases the vascularity of the distal portion of the flap. The TFL free flap is therefore an option in abdominal wounds, particularly those with defects of large size or supraumbilical location.

Abdominal Injuries↗
PubMed1997

Cellulitis of the breast as a complication of breast-conserving surgery and irradiation.

Breast-conserving therapy (BCT) has become a standard treatment option for patients with early-stage breast cancer. We have observed cellulitis of the treated breast as a complication occurring before, during, and after breast irradiation. The cases of five women (median follow-up, 28 months; range, 24-65 months) who developed cellulitis before (n = 1), during (n = 2), or after (n = 2) breast irradiation were reviewed. A consecutive series of BCT patients at Emory University was reviewed to determine the incidence of this complication. Four of five women had an axillary dissection, yielding a median of 14 negative lymph nodes (range, 6-22 nodes). Two of four patients developed axillary seromas requiring aspiration. In these four patients, only the breast was irradiated. A fifth patient had no axillary dissection and had breast and supraclavicular/axillary irradiation. The median whole breast dose was 50 Gy (range, 46-50.4 Gy). The clinical features of cellulitis included erythema, edema, tenderness, and warmth in all patients. Cellulitis was a relapsing problem for four of the five patients. The incidence of this complication in our series of BCT patients was approximately 1%. Cellulitis in the ipsilateral breast can be a relapsing complication of BCT and can be seen before, during, or after breast irradiation. Axillary seromas and aspiration seem to indicate a subset of patients at risk of early cellulitis. Late cellulitis may be caused by a variety of factors related to modifications of vascular and skin integrity by surgery and radiotherapy. Prompt diagnosis and appropriate antibiotic therapy is recommended. This problem need not interrupt a course of breast irradiation, and does not necessarily lead to a poor cosmetic result.

Adult↗
PubMed1997

Skin-sparing mastectomy. Oncologic and reconstructive considerations.

OBJECTIVE: The authors compared skin-sparing mastectomy and traditional mastectomy both followed by immediate reconstruction in the treatment of breast cancer. SUMMARY BACKGROUND DATA: Skin-sparing mastectomy is used increasingly in the treatment of breast cancer to improve the aesthetic results of immediate reconstruction. The oncologic and reconstructive outcomes of this procedure have never been analyzed closely. METHODS: Institutional experience with 435 consecutive patients who underwent total mastectomy and immediate reconstruction from January 1989 through December 1994 was examined. Mastectomies were stratified into skin-sparing (SSM) and non-skin-sparing (non-SSM) types. RESULTS: Three hundred twenty-seven SSMs and 188 non-SSMs were performed. The mean follow-up was 41.3 months (SSM, 37.5 months, non-SSM, 48.2 months). Local recurrences from invasive cancer occurred after 4.8% of SSMs versus 9.5% of non-SSMs. Sixty-five percent of patients who underwent SSMs had nothing performed on the opposite breast versus 45% in the group of patients who underwent non-SSM (p = 0.0002). Native skin flap necrosis occurred in 10.7% of patients who underwent SSMs versus 11.2% of patients who underwent non-SSMs. CONCLUSIONS: Skin-sparing mastectomy facilitates immediate breast reconstruction by reducing remedial surgery on the opposite breast. Native skin flap necrosis is not increased over that seen with non-SSM. Skin-sparing mastectomies can be used in the treatment of invasive cancer without compromising local control.

Adolescent↗
PubMed1997

The effects of radiation treatment after TRAM flap breast reconstruction.

A subgroup of mastectomy patients receives adjuvant radiation therapy after autogenous breast reconstruction for locoregional control of cancer. The effects of radiation therapy on pedicled transverse rectus abdominis musculocutaneous (TRAM) flaps were determined to evaluate complication rates and aesthetic results. Nineteen patients from 1981 to 1994 receiving radiation therapy after a pedicled TRAM flap reconstruction were compared with 108 patients who received radiation prior to reconstruction and 572 patients who underwent breast reconstruction without radiation. Retrospective reviews of patient charts were completed. Adjuvant radiation therapy was given for chest-wall recurrence in 13 of 19 patients. With a mean follow-up of 47.6 months from the time of reconstruction, 10 patients (52.6 percent) demonstrated postradiation changes in the TRAM flap reconstruction, and 6 required surgical intervention (31.6 percent). Overall complication rates were increased but were not found to be statistically significant between the radiated TRAM flap group and patients with preoperative radiation followed by TRAM flap reconstruction (31 versus 25 percent). Fibrosis was not found in patients with pre-TRAM flap radiation or in patients without radiation but was seen in 31.6 percent of patients who received radiation after the reconstruction. Fat necrosis was not significantly increased between the two groups of radiated patients. The complication rate does not change whether a patient receives radiation before or after her reconstruction; only the nature of the complication changes (fat necrosis to fibrosis).

Breast Neoplasms↗
PubMed1997

Reconstruction of the breast.

The options for breast reconstruction include implant and expander, latissimus dorsi flap, TRAM flap, and free flaps. The moratorium on silicone gel implants has increased the use of TRAM and free flap breast reconstruction. Immediate reconstruction after preoperative planning with the surgical oncologist has improved the aesthetic results. Morbidity has been reduced through refinement in surgical technique and careful patient selection.

Breast Neoplasms↗
PubMed1996

Immediate breast reconstruction for stage III breast cancer using transverse rectus abdominis musculocutaneous (TRAM) flap.

BACKGROUND: The management of state III breast cancer is challenging; it often includes multimodal treatment with systemic therapy and/or radiation therapy and surgery. Immediate breast reconstruction has not traditionally been performed in these patients. We review the results of immediate transverse rectus abdominis musculocutaneous (TRAM) flap in 21 patients treated for stage III breast cancer. METHODS: Data have been collected retrospectively on 21 patients diagnosed with stage III breast cancer between 1987 and 1994. All patients had mastectomy and immediate TRAM reconstruction. Thirteen patients received primary systemic therapy, 10 patients received postoperative consolidation radiotherapy to the operative site, and 3 patients received preoperative radiation. RESULTS: Mean follow-up for the group was 26 months. Two patients died with disseminated disease: neither of them developed local disease recurrence in the operative site; 82% of the patients followed for at least two years are free of disease. Sixty-two percent of the patients received preoperative chemotherapy, the remaining patients received postoperative multiagent chemotherapy and/or radiation therapy. Two of the patients received autologous bone marrow transplants after their adjuvant therapy. Ten patients had postoperative radiotherapy for consolidation; three patients received preoperative radiation. CONCLUSIONS: Immediate TRAM reconstruction for stage III breast cancer is not associated with a delay in adjuvant therapy or an increased risk of local relapse. It facilitates wide resection of involved skin without skin grafting. Radiation therapy can be delivered to the reconstructed breast when indicated without difficulty. Breast reconstruction facilitates surgical resection of stage III breast cancer with primary closure and should be considered if the patient desires immediate breast reconstruction.

Breast Neoplasms↗
PubMed1996

Preservation of the inframammary fold: what are we leaving behind?

Preservation of the inframammary fold (IMF) at the time of mastectomy facilitates immediate breast reconstruction. Twenty-four IMF specimens were removed separately after mastectomy for cancer, were serially sectioned, and were examined histologically. Computer image analysis was used to calculate the percentage of breast tissue in each specimen. The mean volume of IMF tissue removed was 99 cm3 (27.3-205.2 cm3), and the mean area examined histologically was 3,036.3 mm2 (294-11,755 mm2). Breast tissue was identified in 13 of the 24 specimens. All cases were negative for carcinoma, but one case had a focus of ductal hyperplasia, usual type. The mean percent breast tissue in those positive for breast tissue was 0.04 percent and 0.02 percent overall. Preservation of the IMF leaves a minimal amount of breast tissue and does not appreciably effect the completeness of a mastectomy.

Aged↗
PubMed1996

Skin sparing mastectomy: anatomic and technical considerations.

Skin sparing mastectomy is a relatively new technique based on the fascial anatomy of the breast. It removes the breast, nipple-areola complex, previous biopsy incisions, and skin overlying superficial tumors. Preservation of native skin and the inframammary fold greatly enhances the aesthetic result of breast reconstruction. The operation has been adopted for patients with early breast cancer treated by total mastectomy and immediate reconstruction, but has received little attention in the general surgery literature. The anatomical and technical aspects of skin sparing mastectomy are described.

Adult↗
PubMed1996

Short gut syndrome: treatment by neovascularization of the small intestine.

Surgical treatment for short bowel syndrome has been directed toward slowing intestinal transit or increasing the absorptive surface area of the bowel. In the present work, we attempted to enhance bowel absorption by increasing vascularity, using the omentum's unique ability to revascularize incorporated tissue. After a 90% resection of small bowel with primary anastomosis in 5 mongrel dogs, an omental flap based on the right gastroepiploic vessels was incorporated into a seromuscular incision on the antimesenteric border of the remnant small bowel. Five control dogs underwent a similar resection and seromuscular incision with an omentectomy. Serum d-xylose assays, hemoglobin, and total protein levels were measured preoperatively and at 3, 6, 9, and 12 weeks postoperatively. Weekly weights were followed. The mean percent d-xylose absorption in the experimental group increased from 96% of the baseline at 3 weeks to 136%, 163%, and 179% at 6, 9, and 12 weeks respectively (p < 0.5). The control group maintained absorption levels between 54% and 74%. Weight loss in the experimental group was significantly less than the controls at weeks 6 and 9, but by 12 weeks, weights were similar for the two groups. Small bowel absorption of d-xylose was significantly enhanced by incorporation of the omentum into the bowel remnant.

Animals↗
PubMed1995

Transverse rectus abdominis musculocutaneous flap breast reconstruction in sickle cell disease.

Patients with homozygous sickle cell disease pose an enormous challenge to the reconstructive surgeon. Historically, the risk of attempting flap reconstruction was considered prohibitive. A successful case of immediate breast reconstruction with a "supercharged" bipedicled transverse rectus abdominis musculocutaneous flap is presented. Perioperative transfusions that maintained the sickle hemoglobin S level below 30% were crucial in preventing erythrocyte sickling in the microcirculation of the flap during the period of relative ischemia.

Anemia, Sickle Cell↗
PubMed1995

Endoscopic techniques in aesthetic breast surgery. Augmentation, mastectomy, biopsy, capsulotomy, capsulorrhaphy, reduction, mastopexy, and reconstructive techniques.

Endoscopy is a new tool in the armamentarium for surgery of the breast. Endoscopic techniques may offer decreased scarring and morbidity rates for a variety of aesthetic and reconstructive procedures. Whereas initial clinical experiences are encouraging, most endoscopic procedures of the breast remain developmental, both in technique and instrumentation. Additional development, refinement, and experience will be required to define fully the utility of endoscopic techniques.

Adult↗
PubMed1994

Breast reconstruction. Surgical options and patient selection.

Breast reconstruction has undergone a steady evolution since the introduction of the silicone gel prosthesis in the early 1960s. Current restrictions of the use of breast implants have increased the reliance on autologous tissue reconstruction. The improvement in the quality of breast reconstruction can be attributed in part to a refinement in mastectomy technique. There is an increasing emphasis on skin preservation, which makes it easier to match the remaining breast. In this paper, various methods, including tissue expansion, the latissimus dorsi flap, the transverse rectus abdominis musculocutaneous flap, and free flaps, are described. The indications as well as potential complications for each methods also are discussed. Local recurrence after breast conservation generally necessitates a total mastectomy. Radiation fibrosis and endarteritis interfere with skin blood supply and impair wound healing. Reconstruction in this setting has a potential for increased operative morbidity. Treatment options, including techniques to reduce potential complications, are presented.

Breast Neoplasms↗
PubMed1994

Salvage of colon interposition by antethoracic free jejunal transfer.

Intrathoracic disruption of an esophagocolonic anastomosis after colon interposition can be a fatal complication. A case is presented in which an antethoracic free jejunal transfer achieved successful salvage. The patient returned to oral alimentation with no functional impairment.

Aged↗
PubMed1994

Tumor angiogenesis as a prognostic factor in oral cavity tumors.

BACKGROUND: Lymph-node metastasis is the single greatest predictor of survival in patients with oral cavity cancers. Tumor angiogenesis has been correlated with metastasis in breast cancer and may have prognostic value in other tumors. PATIENTS AND METHODS: Sixty-six patients with clinically node-negative oral cavity squamous cell cancers were reviewed. Samples were cut and stained for factor VIII. The percentage of area of tissue stained for factor VIII was quantitated by a computerized image analyzer. Tumor depth was measured with an ocular micrometer to the nearest 0.1 mm. Variables were statistically examined against regional recurrence. RESULTS: The probability of metastasis (%) was 2 for tumor staining of < or = 10% and 93 for tumor staining > 10% (P < 0.0001). The tumor depth was < or = 4 mm in 10 and > 4 mm in 83 (P < 0.0001). Patients with < or = 4 mm and < or = 10% staining had a 2% rate of recurrence, and patients with > 4 mm and > 10% staining had a 100% rate of recurrence (P < 0.0001). CONCLUSION: Although tumor thickness was suggestive of predictability, only angiogenesis was a statistically significant predictor of recurrence in a multivariate analysis (P < 0.0001). Angiogenesis showed a strong correlation with regional recurrence and may be used as an independent prognostic indicator.

Adult↗
PubMed1993

Surgical anatomy of the neck.

Surgical treatment of diseases of the neck requires precise knowledge of anatomy. The neck has distinct facial layers that facilitate the extirpation of metastatic cancer as well as the treatment of infections. Knowledge of the course of the facial nerve enables safe removal of parotid tumors.

Fascia↗