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Biomedical subjects

Leonie A E Woerdeman

Publications and source records attributed to Leonie A E Woerdeman.

12 recordsLinked to original sources
PubMed2007

A prospective assessment of surgical risk factors in 400 cases of skin-sparing mastectomy and immediate breast reconstruction with implants to establish selection criteria.

BACKGROUND: Although attempts have been made to identify the risk factors leading to complications after combined skin-sparing mastectomy and immediate prosthetic breast reconstruction, hardly any criteria are available to preoperatively distinguish patients in whom such an eventful postoperative course may be expected. Therefore, the authors wanted to establish which factors increase the risk of surgical complications to such a level as to adjust their indications for immediate breast reconstruction after skin-sparing mastectomy. METHODS: The authors prospectively studied the clinical relevance of six patient-related and nine procedure-related characteristics as potential risk factors for a complicated surgical outcome in 400 combined procedures in 309 patients by univariate and multivariate logistic regression analysis. Risk factors that proved significantly correlated with loss of implant by both analyses were accepted as clinical selection criteria that distinguish potential candidates with an unacceptably high risk of such loss. RESULTS: Mild complications occurred significantly more often in patients who were older than the mean age of 43 years and in breasts that were more than average sized or operated on by a fellow in oncologic surgery. Implants were lost significantly more often in patients who were obese or smoked and in breasts that were more than average sized. CONCLUSIONS: The clinically relevant increase of risk of implant loss should lead to reluctance to perform combined skin-sparing mastectomy and immediate prosthetic breast reconstruction in obese patients who smoke (32 percent loss) and in those with more than average sized breasts (27 percent loss).

Breast↗
PubMed2006

Skin-sparing mastectomy and immediate breast reconstruction by use of implants: an assessment of risk factors for complications and cancer control in 120 patients.

BACKGROUND: Combined skin-sparing mastectomy and immediate reconstruction by use of an implant is increasingly accepted as a therapy for patients with breast cancer or a hereditary risk of breast cancer. Because little and contradictory evidence regarding possible risk factors for postoperative complications is available, the authors retrospectively assessed 13 such factors. They also evaluated the oncological safety of the procedure. METHODS: From July of 1996 through June of 2000, 174 skin-sparing mastectomies were combined with immediate breast reconstruction in 120 patients. The authors assessed the influence of five patient-related and eight breast-related characteristics on the incidence of a complicated postoperative course by univariate and multivariate analyses. Oncological safety was evaluated by observed recurrent disease and 5-year survival. RESULTS: Severe complications were observed in 17 patients of the 120 patients (14 percent), or 19 of the 174 breasts (11 percent). The patient-related characteristics of age and being operated on unilaterally significantly increased the risk of complications. Resident plastic surgeons and previous breast-conserving therapy including radiotherapy significantly increased the risk of implant loss. The local relapse rate among patients operated on for cancer was 0.02. The actuarial 5-year survival rate among patients who underwent curative mastectomies was 0.96. CONCLUSIONS: Combined skin-sparing mastectomy and immediate reconstruction by use of an implant is oncologically safe, but the risk of postoperative complications cannot be neglected. The authors' observations may offer guidance for adapting indication and treatment strategies for patients with breast cancer or increased hereditary risk of such cancer.

Adult↗
PubMed2006

Routine histologic examination of 728 mastectomy scars: did it benefit our patients?

BACKGROUND: Routine histologic examination of secondarily excised mastectomy scars is considered good practice, even though the microscopic detection of a metastasis in clinically unsuspected mastectomy scars is rare. Because cost-effective use of histologic services is required, the occurrence rate of metastases in such scars needs to be established to assess the possible benefit of such routine examination. METHODS: The histologic observations on 728 clinically unsuspected scars from prophylactic (n = 151) or curative (n = 395) mastectomy or breast-conservation treatment in 424 patients were traced and correlated to the indication of initial breast surgery, possible adjuvant therapy, and time lapse between initial surgery and scar examination. RESULTS: In none of the 728 scars was a scar metastasis or de novo tumor found. CONCLUSIONS: Routine histologic examination of clinically unsuspected scars excised at the time of breast reconstruction or scar correction after prophylactic or curative breast surgery did not benefit the authors' patients.

Adult↗
PubMed2005

Donor-site necrosis following fibula free-flap transplantation: a report of three cases.

The free fibula flap is the microsurgeon's workhorse for the reconstruction of osseous or osteocutaneous defects. Donor-site morbidity of this flap is reported to occur infrequently, and is generally considered minor and transient. We present the case histories of three patients with necrosis at the fibula flap donor site to stress the risks and explain the possible mechanisms of such severe complications. The small risk of debilitating donor-site necrosis should be considered and discussed preoperatively with the patient.

Adult↗
PubMed2005

The truly distal lateral arm flap: rationale and risk factors of a microsurgical workhorse in 30 patients.

The forearm part of the extended lateral arm flap may be separately raised on the most distal septocutaneous perforator of the posterior collateral radial artery. This truly distal lateral arm flap shares most of the advantages of the radial forearm flap and is associated with less donor site morbidity. From April 2000 to March 2004, we used 30 such flaps as the fasciocutaneous free flap of choice, mostly for reconstructions in the head and neck region. The eventful postoperative course observed in 5 of these flaps motivated us to evaluate the rationale and risk factors of this procedure. We prospectively analyzed the influence on the incidence of partial or complete flap loss of 19 patient-related or procedure-related characteristics that may have acted as risk factors. None were found to be of statistical significance. We found the distal lateral arm flap to have a less robust vascular anatomy than the radial forearm flap, resulting in the need for advanced surgical expertise to raise and handle it. As we recognized the difficulty of this flap to be associated predominantly with this anatomy of its vascular pedicle, we now take a more liberal stand toward the possibility of intraoperative conversion to the use of a radial forearm flap.

Adult↗
PubMed2005

The lateral thoracodorsal flap as a salvage procedure for partial transverse rectus abdominis myocutaneous or deep inferior epigastric perforator flap loss in breast reconstruction.

The transverse rectus abdominis musculocutaneous flap and deep inferior epigastric perforator flap are the flaps of choice for autologous breast reconstruction. The better understanding of the vascular anatomy of these flaps has reduced the incidence of flap loss and fat necrosis, and positioning the flap's least vascularized zone laterally in the newly reconstructed breast may limit partial flap loss to that area. Still, the resulting defect of such partial loss remains a challenge. We introduce the use of the lateral thoracodorsal flap as an easy and straightforward salvage procedure in such cases and present the history of 4 of our patients with a mean age of 45 years to illustrate this use. The procedure can be done as early as 6 weeks after initial reconstruction, reducing the burden of daily wound care for the patient and offering her an immediate restoration of the lateral contour of the reconstructed breast.

Adult↗
PubMed2005

Extended deepithelialization to secure double-breasted closure of the skin.

Double-breasted closure of the skin is achieved by deepithelialization of 1 edge of a wound and advancement of the opposite edge over this deepithelialized area. Such closure may prevent contamination or exposure of the implant in cases where immediate breast reconstruction with prosthetic material is obtained after skin sparing mastectomy. The deepithelialization routinely extends as far as the incision to be closed and, consequently, the skin suture at the end of the incision immediately overlies thedeep suture or implant in cases where the implant is not fully covered by muscle. To prevent contamination or exposure of the implant when suture infection or wound dehiscence occurs in these cases, we extend the deepithelialization beyond and around the limit of the skin incision. This allows for complete and secured double-breasted closure of the entire wound and lessens the risk of implant contamination or exposure.

Breast Implants↗
PubMed2004

Verifying surgical results and risk factors of the lateral thoracodorsal flap.

In 1986, the combined use of the lateral thoracodorsal flap and an implant was introduced as an alternative method of delayed reconstruction of small to medium-size breasts for postmastectomy patients who are reluctant or unable to consider reconstruction by tissue expansion or by more extensive autologous tissue transplantation. So far, the technique has only been proven reproducible in Sweden. Postmastectomy radiotherapy has been proven to increase the risk of wound-healing complications after lateral thoracodorsal transplantation, and additional risk factors such as advanced age, obesity, smoking, and some general health characteristics have been indicated. The authors initiated a prospective study to assess the reproducibility of this technique outside Sweden and to confirm the proven risk factor, prove or refute the alleged ones, and possibly identify additional factors. Additionally, they applied the technique for immediate breast reconstruction and tried to expand the indications and applications of the lateral thoracodorsal flap even further. The authors report on their initial experience with 60 lateral thoracodorsal flaps and conclude that the use of this flap is a well-reproducible technique for breast reconstruction, with few complications leading to failure. Using the lateral thoracodorsal flap in combination with tissue expanders allows for reconstruction of breasts of larger than medium size. Moreover, the authors successfully applied fully deepithelialized lateral thoracodorsal flaps for additional indications. The statistical significance of postmastectomy radiotherapy as a risk factor could not be confirmed, but some general health characteristics were found to be significant patient-related risk factors. Out of five procedure-related characteristics, only increased flap length was proven to negatively influence the outcome of the procedure.

Adult↗
PubMed2004

Breast-conserving therapy in patients with a relatively large (T2 or T3) breast cancer: long-term local control and cosmetic outcome of a feasibility study.

Breast-conserving therapy is widely accepted as an appropriate method of primary treatment of T1 and T2 breast cancers that measure up to 5 cm. For safe and cosmetically acceptable breast-conserving therapy in patients with larger breast cancers, the tumor volume has to be reduced preoperatively, and lost tissue volume should be replaced after wide local excision. In 1993, the authors' group reported encouraging short-term results of a combination of preoperative radiotherapy, breast-conserving surgery, and immediate tissue replacement by myocutaneous (myosubcutaneous) latissimus dorsi flap transplantation in patients with relatively large T2 and T3 breast cancers. To evaluate the long-term oncologic local control and cosmetic outcome of this treatment modality, the authors studied the results obtained in 20 patients after a minimum follow-up of 5 years. The local control rate was 0.95, as locoregional recurrence was observed in one patient who refused adjuvant chemotherapy. Both the observed 5-year survival (0.75) and the actuarial 10-year survival (0.60) in the authors' series equaled that of more radical surgical therapy. The cosmetic outcome compared with that obtained by conventional breast-conserving therapy modalities for small breast cancers. In general, patient assessment of cosmetic outcome (2.8 of 3) was higher than the assessment of a professional panel (6.3 of 10). Of six criteria providing a detailed description of the cosmesis of the reconstructed breast and donor area, the symmetry and shape of the reconstructed breast were felt to be most important by the patients and professionals alike. The authors conclude that breast-conserving therapy combining preoperative irradiation and immediate myocutaneous (myosubcutaneous) latissimus dorsi flap reconstruction is an oncologically safe and cosmetically rewarding but logistically straining modality of treatment of relatively large T2 and T3 breast cancers.

Adult↗
PubMed2004

Lower limb necrosis after use of the anterolateral thigh free flap: is preoperative angiography indicated?

The large and potentially sensate skin territory, the reliability, and the versatility of the anterolateral thigh flap have led to its use for the reconstruction of soft-tissue defects of the head and neck region, extremities, and trunk. Most authors describe the functional disturbances in the donor site as minimal and, to date, no cases of circulatory disturbance of the lower limb as a result of anterolateral thigh flap transplantation have been described. The authors report a patient with partial necrosis of the foot and calf caused by the interruption of the descending branch of the lateral circumflex femoral artery, which acted as a critical collateral for the obstructed superficial femoral artery. Based on their observations of this patient, the authors recommend preoperative angiography of the donor leg in patients in whom palpable popliteal pulsations are lacking. Intraoperatively, the chances of postoperative circulatory disturbance of the lower leg can be decreased by observation of the lower leg circulation after clamping of the flap's pedicle. Immediate arterial reconstruction using a venous graft is to be considered in cases in which the adequacy of circulation is debatable.

Angiography↗
PubMed2002

Acute renal failure during dextran-40 antithrombotic prophylaxis: report of two microsurgical cases.

Dextran is often used to enhance the successful outcome of microvascular transplantations. So far, some 60 cases of dextran-induced acute renal failure have been reported. Among them, only one has been reported as an adverse reaction to antithrombotic prophylaxis during microvascular surgery. To stress that dextran prophylaxis can be a serious threat to microsurgical patients, the authors report on two more such patients and discuss how to prevent and treat this condition. Hypovolemic patients of older age are at risk, as are patients with cardiovascular diseases, renal artery stenosis, and preexisting renal insufficiency. Dextran should be discontinued promptly in patients with decreased urinary output or with high urine specific gravity. Dextran-induced acute renal failure may be severe and it may last several days. Plasmapheresis is the therapy of choice and, usually, diuresis and renal function resume shortly after such treatment.

Acute Kidney Injury↗