Ductal carcinoma in situ (DCIS) of the breast: diagnostic and therapeutic controversies.
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Antineoplastic Agents, Hormonal↗
Biomedical subjects
J C Grotting
Publications and source records attributed to J C Grotting.
Cervicofacial rejuvenation using ultrasound-assisted lipectomy.
This article discusses a technique of cervicofacial rejuvenation that involves ultrasound-assisted lipectomy. This method is indicated for those patients who might be early candidates for a rhytidectomy, and/or those with an adipose volume excess in the lower facial and cervical areas. The application of ultrasonic energy stimulates skin retraction and allows for the superficial fat to be more safely accessed than can be accomplished with conventional liposuction methods. This technique, along with a retrospective analysis of the first 26 cases treated with the technique, will be presented in this article.
Adult↗
Breast reconstruction with free-tissue transfer.
LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Understand the rationale for the use of free tissue transfer for breast reconstruction. 2. Understand the indications, advantages, and disadvantages of this method of reconstruction. The authors discuss the indications, advantages, and disadvantages of free-tissue transfer for breast reconstruction. The most common free flaps used today are individually discussed. Details about indications, contraindications, pertinent anatomy, pedicle characteristics, flap pliability, perfusion characteristics, advantages, and disadvantages for each of these flaps are presented. Details pertaining to the more common recipient vessels are presented. Future considerations are also briefly discussed.
Adult↗
Ultrasound-assisted lipectomy using the solid probe: a retrospective review of 100 consecutive cases.
Ultrasound-assisted lipectomy using the solid probe is a predictable and safe method that can yield excellent results. This method is particularly useful and is indicated when the subdermis must be approached to smooth out surface irregularities and/or to stimulate skin retraction. The authors present their method using the solid probe and a retrospective study of their first 100 consecutive cases. The indications for using the solid probe, its advantages and disadvantages, associated complications, and representative cases are presented.
Adult↗
The solid-probe technique in ultrasound-assisted lipoplasty.
The solid-probe ultrasound-assisted lipoplasty technique is a predictable method for obtaining optimal results in body contouring for select patients. Patients with inelastic skin, cellulite, skin laxity, and those undergoing secondary contouring procedures are ideal candidates for the solid-probe technique. The solid probe is thought to be a more efficient fat emulsification device because it imparts more focal ultrasonic energy per amplitude than hollow probes.
Humans↗
Lack of evidence of systemic inflammatory rheumatic disorders in symptomatic women with breast implants.
Breast implants containing silicone have been used for approximately 30 years for breast augmentation or reconstruction. In general, the implants have been well tolerated and reports have indicated a high degree of patient satisfaction. Nonetheless, there have been anecdotal reports of patients with musculoskeletal complaints that have been attributed to silicone breast implants. To investigate this further, we prospectively examined 70 women with silicone breast implants who had complaints that they or their referring physicians thought were related to their implants. On clinical examination, the majority of the patients had fibromyalgia, osteoarthritis, or soft-tissue rheumatism. One patient had rheumatoid arthritis, which predated her implants, and one had Sjõgren's syndrome. Because many of our patients had myalgic symptoms, we further evaluated these patients by measuring circulating levels of soluble factors including interleukin-6, interleukin-8, tumor necrosis factor-alpha, soluble intercellular adhesion molecule-1, and soluble interleukin-2 receptor, which have been previously found to be elevated in patients with inflammatory diseases. We found that the levels of these molecules in women with silicone breast implants were not different from those seen in normal subjects and were significantly less than those seen when examining chronic inflammatory disorders such as rheumatoid arthritis or systemic lupus erythematosus. In summary, our clinical and laboratory evaluation of symptomatic breast implant patients argues against an association of silicone breast implants with a distinctive rheumatic disease or a systemic inflammatory disorder. Given these findings and the clinical picture, it is our impression that most symptomatic women with silicone breast implants have well-delineated noninflammatory musculoskeletal syndromes. Moreover, these data fail to support the concept that their symptoms are due to a systemic inflammatory response related to their implants.
Breast Implants↗
Conceptual considerations in breast reconstruction.
As the therapy for breast cancer evolves, the plastic surgeon must consider the type of mastectomy, the stage of disease, the timing of operations, and the use of adjunctive therapy to continue to provide the best reconstructive option to the patient. All reconstructive results are judged by comparison to the opposite breast, which sometimes should be improved with a conservative reduction or mastopexy. The timing of secondary procedures should be appropriate to avoid interference with adjuvant therapy and provide a lasting result. The plastic surgeon also must be able to follow the reconstructed breast, recognize the pattern of local recurrence, and offer reconstructive options should the therapy require additional resection.
Breast Neoplasms↗
An epidermal proliferative reaction associated with a silicone gel breast implant.
A variety of local and systemic adverse reactions has been attributed to silicone prostheses used for augmentation or reconstructive mammoplasty. We present a patient who developed an unusual local cutaneous reaction to a silicone breast implant, which was characterized clinically by macular erythema and focal ulceration and histologically by a basaloid proliferative epidermal reaction. The epidermal changes seen histologically simulated those overlying dermatofibromas and were felt to be reactive secondary to silicone leakage and fibrosis. The process resolved postexplantation of the prosthesis.
Breast Diseases↗
Immediate breast reconstruction using the free TRAM flap.
This article presents the author's experience using the free TRAM flap for immediate breast reconstruction at the time of mastectomy. Indications and contraindications, preoperative preparation, and surgical technique are emphasized.
Breast Neoplasms↗
Soft tissue reconstruction. Coverage of the chest wall and spine.
Advances in reconstructive surgery achieved during the past decade have considerably broadened the range of options available for coverage of the chest wall and spine. Flaps can be designed to maximize function and provide bulk, bony rigidity, sensation, or function, when needed. Local musculocutaneous and muscle flaps are preferred, but, at times, a free flap is more appropriate, either because the local tissue is inadequate or because a free flap best meets the needs of the recipient site. With current techniques, donor-site morbidity, flap survival, and, ultimately, patient outcome can be optimized to a much greater extent than in years past.
Humans↗
Aeromonas hydrophila infections following use of medicinal leeches in replantation and flap surgery.
Aeromonas hydrophila infections are a recognized complication of postoperative leech application, and can occur with measurable frequency in populations of patients treated with leeches. We review 11 previously reported leech-related Aeromonas infections and analyze seven unreported cases. These infections range from minor wound complications to extensive tissue loss and sepsis. Often, these infections followed leech application to tissue with questionable arterial perfusion. Onset of clinical infection in these patients ranged from within 24 hours of leech application to 10 days or more after leech application. Late infections may represent bacterial invasion from colonized necrotic tissue. Based on these observations, we recommend that leech applications be restricted to tissue with arterial perfusion to minimize contamination of necrotic tissue. We also recommend that patients treated with leeches receive antibiotics effective against Aeromonas hydrophila before leech application. Patients treated with leeches and discharged with eschars or open wounds might benefit from oral antibiotic therapy until wound closure. These precautions may minimize or eliminate this complication of leech use.
Adolescent↗
The free abdominoplasty flap for immediate breast reconstruction.
As free flap breast reconstruction has become more common, we have sought to further refine donor sites. A woman is presented in whom a free flap from the low abdominal wall based on the superficial inferior epigastric artery and vein is used. This procedure results in total sparing of the rectus abdominis muscles and may be applicable in thinner women with smaller breasts, who cannot spare the larger ellipse of the conventional transverse rectus abdominis musculocutaneous (TRAM) flap. As we have sought to further refine breast reconstruction using autogenous tissue, microvascular tissue transfers are assuming a more important role. At the present time, it is possible to evaluate each individual woman for the most appropriate and available donor tissue to achieve a symmetrical reconstruction. In any given woman, it may be more appropriate to use the abdomen, hips, or buttocks, depending on the size and shape of the opposite breast and where the tissue can be most easily spared. We report here a woman in whom immediate breast reconstruction was performed using only the excess skin and fat of the lower abdominal wall pedicled on a unilateral superficial inferior epigastric artery and vein.
Breast Neoplasms↗
Prevention of complications and correction of postoperative problems in microsurgery of the lower extremity.
Prevention of complications in microsurgery of the lower extremities begins with proper patient selection and patient preparation. Complications are highest in elderly patients who have had multiple trauma, smokers, patients with arterial or venous insufficiency, and those with hypercoagulability. Some patients may be best served by primary amputation. If multiple flaps are required, a higher success rate can be achieved with simultaneous rather than sequential transfers. However, for simultaneous transfers, a higher re-exploration rate must be anticipated. The key to avoiding long-term problems with infection is adequate preparation of the wound. Multiple debridements may be necessary. If early coverage can be obtained in trauma cases, a lower rate of chronic osteomyelitis has been observed. Attention to details in the operating room, such as patient warmth and perfusion, will increase the success rate. Recipient vessels must be out of the "zone of injury" and normal in appearance and pulsatility. It is safer to use normal recipient vessels and vein grafts than to attempt anastomoses to vessels affected by "post-traumatic vascular disease." If thrombosis occurs in the early postoperative period, prompt re-exploration can result in flap salvage, with a high degree of predictability if the cause of the thrombosis can be determined and corrected.
Adult↗
Functional restoration in the upper extremity using free muscle transplantation.
Since 1973, fourteen free muscle transfers for functional upper limb reconstruction have been performed in twelve patients at the Ralph K. Davies Medical Center in San Francisco. All of the patients in this series had lost finger flexion, extension, and/or thumb opposition and were not candidates for simpler methods of reconstruction because of weakness or traumatic loss of balancing musculature. The 12 patients have been followed for one to 9 years. All muscles were successfully transferred without flap loss. Evaluation of the EMG data has shown evidence of reinnervation beginning at approximately two months with fibrillation potentials decreasing and recruitment of increasing numbers of motor units over two to three years. Eleven of the 14 muscles attained movement against resistance; two had movement against gravity and one regained only a flicker of motion. In our experience, the use of free muscle transplantation to restore function is not only technically feasible, but moreover, has resulted in a relatively high degree of patient satisfaction.
Adolescent↗
Free-flap reconstruction of large head and neck defects in the elderly.
Advanced-stage and recurrent malignancies of the head and neck place severe demands on both the surgical team and the patient. Marked alterations in cosmesis and function are to be expected following major ablative surgery. The use of free tissue transfer with microvascular anastomoses has provided the head and neck surgeon the freedom to resect these lesions aggressively and to provide the patient with improved cosmesis, function, and protection of vital structures. A series of six cases involving patients at The University of Alabama at Birmingham over the past year is presented.
Aged↗
Conventional TRAM flap versus free microsurgical TRAM flap for immediate breast reconstruction.
Immediate breast reconstruction using the transverse abdominal myocutaneous island (TRAM) flap was performed in 54 patients over the past 3 years at our institution. This represented approximately 59 percent of patients undergoing all types of immediate breast reconstruction. In 10 patients, the abdominal island flap was transferred as a free flap based on the deep inferior epigastric pedicle. These patients were compared with the other 44 patients, in whom the flap was transferred using the conventional technique. The TRAM flap is well suited for immediate breast reconstruction because the procedure can be carried out simultaneously with mastectomy using separate operating teams and instruments. The operation is safe and relatively free of complications. The free TRAM group compared favorably with the conventional group in terms of complications, operating time, estimated blood loss, hospitalization, and return to functional baseline. The free TRAM flap appears to be as safe as the conventional technique with the advantages of a more limited rectus muscle harvest, improved medial contour of the breast due to the lack of tunneling, and perhaps a healthier flap because of the large donor vessels.
Abdominal Muscles↗
Clinical evaluation of flap viability with a dermal surface fluorometer.
A dermal surface fluorometer was used to monitor vascular perfusion in 22 patients who underwent reconstructive surgical procedures with a variety of flaps (e.g., skin flaps, musculocutaneous flaps, fasciocutaneous flaps, and Z-plasties). Sodium fluorescein (1.5 mg per kilogram of body weight) was administered intravenously at the completion of the operative procedure. Quantitative fluorescence readings were obtained at different points in each flap by means of the surface fluorometer (Fluoroscan). The readings were taken at several time intervals and compared with those of normal skin (control). A perfusion ratio was determined in each case according to the following formula: flap reading/(normal skin control reading X 100). Partial necrosis occurred in 4 patients, correlating with low fluorescein perfusion measurements. From our findings, it appears that a perfusion ratio of 15% or greater 10 minutes following injection will accurately predict tissue viability. No systemic reactions were observed in these patients. We believe that this minimally invasive technique should be of considerable assistance in the postoperative evaluation of flap viability.
Adult↗
Sapphire ring constriction syndrome.
An uncommon case of a partially embedded ring under the skin is presented. A technique for removal is described. All previously reported cases as well as ours occurred in mentally handicapped individuals.
Adult↗