Cancer trends: breast reconstruction after mastectomy.
Explore the source record for details and available documents.
Biomedical subjects
Publications and source records attributed to J B McCraw.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
The pectoralis paddle myocutaneous flap is extremely dependable and provides an added advantage of covering the vital structures of the neck with adequate length without excessive bulk. The donor defect is more acceptable than any we have previously encountered. The use of this skin muscle paddle in irradiated necks has distinct advantages. In addition, the ability to carry bony segments for use in mandibular reconstruction proved a distinct advantage in the two cases in which it was used.
Defects of the shoulder area pose difficult problems for the hand surgeon, especially when associated with irradiation or exposed, infected bone. The development of muscle and myocutaneous flaps has greatly simplified the reconstruction of such defects. This report discusses the use of the pectoralis and the latissimus flaps for this purpose, with case examples and emphasis upon technique and applications.
The vastus lateralis muscle can provide a broad sheet of muscle for repair of defects of the lower abdomen, groin, perineum, hip, and ischium. The authors limit the use of the vastus lateralis muscle to situations in which more traditional techniques are not feasible. This muscle is especially suitable for defects involving irradiated tissue, infected bone, or infected prosthetic material. Although the vastus lateralis muscle has no cutaneous component, it may be used to augment an overlying tensor fascia lata flap.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Several aspects must be considered in the performance of muscle and musculocutaneous flaps. Some of the most important are not at all related to the technical elevation and manipulation of the individual flap. It is hoped that this brief outline will prove beneficial to many successful future reconstructive applications of these flaps. Never before has the discerning reconstructive surgeon been required to consider so many ingenious options and apply them with such perception. Certainly, the future of reconstructive surgery is secure if we respond reasonably and knowledgeably.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
To determine policies of health insurance companies regarding payment for breast reconstruction following mastectomy, we polled 50 companies selected at random, as well as every Blue Cross-Blue Shield company. To verify that insurance carriers' replies represented their practices, we polled 96 plastic and reconstructive surgeons in 47 states. Although most health insurance carriers claim to fully cover breast reconstruction following mastectomy for cancer, practices vary widely; many postmastectomy patients receive incomplete or no coverage for reconstruction. Two major reasons for discrepancies appear to be (1) inadequate coverage prompted by unrealistic conception of reconstruction on the part of carriers and (2) specific contractual exclusion. We suggest (1) educating lay and professional persons about breast reconstruction, (2) encouraging more realistic coverage from insurance companies, and (3) if necessary, legislative protection for the postmastectomy patient.
The use of fluorescein as a predictor of skin viability in the rat flap model of avascular skin necrosis is well known in the field of plastic surgery. Inherent in this model are several faults that must be corrected if it is to become a valid standard. Fluorescence readings are one of the main variables in flap models. By carefully shaving rat backs with a double-edged razor, taking fluorescence readings in a uniformly darkened space, carefully tattooing the exact extent of both the bright and the mottled areas of fluorescence on the flap, and placing a plastic barrier between the flap and the body to prevent any part of the flap from acting as a graft, we were able to quantitatively predict which portions of a flap would survive and which would die after fourteen days. The bright fluorescent area (mean = 11.99 cm2, SEM +/- 0.53 cm2) is equal to the amount of tissue that will survive (mean = 11.91 cm2, SEM +/- 0.50 cm2; NS), while the sum of the nonfluorescent area and the mottled fluorescent area (mean = 27.69(2), SEM +/- 0.52 cm2) is equal to the amount of tissue that will die (mean = 27.99 cm2, SEM +/- 0.52 cm2; NS).
Both of these myocutaneous flaps can supplant forehead and deltopectoral flaps, in certain indications. They are additional arterialized flaps for the armamentarium of the reconstructive surgeon, and can be useful in many repairs in the head and neck region.
An adjunctive technique for lower lid blepharoplasty is presented. This operative procedure uses the principle of anchoring the upper margin of the lower lid by suturing a triangular muscle flap from it to the lateral-superior part of the orbital rim. This more effective support for the lower lid margin permits one to excise more redundant tissue without getting an ectropion.
About 62 percent of the patients with meningomyeloceles will have essentially normal sensation in the area supplied by the lateral femoral cutaneous nerve (which is also the territory of the extended tensor fasciae latae flap), despite the fact that they may have complete anesthesia in their sitting area. In these, pressure sores can be healed and future ones prevented by transposing a sensation-bearing tensor fasciae latae flap to provide virtually normal sensibility in the sitting area.