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Biomedical subjects

P Berrino

Publications and source records attributed to P Berrino.

At least 19 recordsLinked to original sources
PubMed1999

The "parasite" TRAM flap for autogenous tissue breast reconstruction in patients with vertical midabdominal scars.

Abdominal scars play an important role in risk factors in transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction. In particular, vertical midline scars are a difficult problem to solve. Traditional techniques include the use of a single hemiflap (which may be insufficient to achieve an adequate volume), the transfer of a double-pedicle flap (which causes major trauma to the abdominal wall), or more complicated procedures such as two free hemiflaps. Since 1991 the authors have used an innovative technique to improve vascularity in the contralateral side of a standard unipedicled TRAM flap. They call this flap the recharged TRAM flap. By means of their technique, the retrograde flow coming from the deep inferior epigastric vessels raised in continuity with a superiorly pedicled flap is used to "recharge" the contralateral rectus muscle harvested as a free flap. On the basis of hemodynamic studies, this procedure was carried out in patients with vertical midabdominal scars. This flap was named the parasite flap because the free unit survives on the vascular source of the pedicled unit-the superior epigastric artery supplying both flaps in a retrograde fashion. Sixteen patients with vertical midabdominal scars underwent this procedure. Total flap survival was observed in 15 patients. One patient developed a partial flap necrosis and 1 patient developed abdominal bulging on the pedicled side. According to the surgeons' evaluation, aesthetic outcome was considered to be good to excellent in all patients.

Abdomen↗
PubMed1998

Prefabricated engineered bone flaps: an experimental model of tissue reconstruction in plastic surgery.

In light of the recently described experimental technique of in vivo bone reconstitution with biotechnologic methods (from bone marrow stromal cells) and the prefabrication flap procedures, the possibility to obtain autologous bone growth in a myocutaneous flap, thus creating a composite osteomyocutaneous preformed flap, is postulated. Human bone marrow stromal cells were delivered into the latissimus dorsi of athymic mice by a porous hydroxyapatite ceramic model. Eight weeks after the implantation, histologic examination revealed the presence of spongious bone tissue. A simple myocutaneous flap was thus transformed into a composite osteomyocutaneous flap. This flap is called the biotechnologic prefabricated flap, because it was the result of ex vivo expanded osteogenic precursor cells and in vivo bone tissue neoformation. The shape of the bone flap was exactly the same as the shape of the ceramic model used. A possible clinical application may be the correction of skeletal defects. The advantages of this procedure are simple surgical execution, the possibility of preshaping the graft to the exact characteristics of the defect, and the availability of autogenous donor tissue without donor site morbidity.

Animals↗
PubMed1998

Long-term advantages of permanent expandable implants in breast aesthetic surgery.

Permanent expandable implants are widely used in breast reconstructive surgery, but their use in aesthetic surgery is still uncommon. Previous reports on breast expansion-augmentation using permanent expandable implants focused on immediate and early advantages but failed to evaluate long-term benefits, because the reservoir was removed a few months after implantation and the ability to adjust the implant size was lost. Since 1986, we have used permanent expandable implants in 129 women for unilateral or bilateral breast augmentation using the following approach: implants were positioned submuscularly through a transaxillary incision; the filling port was placed a few centimeters below the incision and permanently retained; the implants were positioned underinflated and then overexpanded starting 2 weeks after implantation; after a period of overinflation, deflation to the preoperatively planned volume was scheduled; patients' suggestions regarding final volume adjustments were followed; the effects of repeated overinflations and deflations were investigated in several different conditions. Permanent expandable implants offer unique long-term technical and psychological advantages in the management of highly demanding patients and in the following clinical situations: pregnancy, impending capsular contracture, contralateral progressive ptosis, tubular breasts(s), difficult mammographic examination, spontaneous deflation, and rippling. Disadvantages include economical cost, port-related problems, and repeated requests by patients for volume changes. Saline permanent expandable implants allowed less flexibility in adjusting the breast size and caused discomfort when overexpanded. Permanent expandable implants in breast aesthetic surgery offer several advantages, and because patients can play an active role in deciding volume adjustments, compliance is very high.

Adolescent↗
PubMed1995

Psychological evaluation of patients undergoing breast reconstruction using two different methods: autologous tissues versus prostheses.

Breast reconstruction has become an available option for most patients undergoing mastectomy. In fact, many authors agree that breast reconstruction does not interfere with possible therapies and improves the women's quality of life. The aim of this study was to evaluate the psychological adjustment of patients who had immediate or delayed reconstruction using two different methods: implants and autologous tissues. Specifically, it was explored whether the different methods of breast reconstruction have caused significant changes in psychological functioning. The study population (102 patients) was derived from patients who underwent breast reconstruction in the period January 1988 to December 1991 at the Department of Plastic and Reconstructive Surgery of the National Institute for Cancer Research in Genoa, Italy. Fifty-two patients underwent breast reconstruction using implants and 50 using the transverse rectus abdominis myocutaneous (TRAM) flap. Demographic information was gathered from each patient. The psychological instruments consisted of three standardized self-administered questionnaires: Psychological Distress Inventory, State Trait Anxiety Inventory, Form Y, and the Eysenck Personality Inventory. To better assess the changes in body image after breast reconstruction, three more specific questions about sexual desire, physical image, and social relationships were added. The 102 patients assessed in this study indicated a low incidence of psychological distress. Impairment was reported regarding body image by patients who underwent delayed reconstruction; these patients also showed higher distress scores. The type of breast reconstruction also seems to influence body image, showing in the patients with TRAM flap reconstruction more relevant psychological discomfort.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗
PubMed1994

Hemodynamic analysis of the TRAM. Applications to the "recharged" TRAM flap.

The clinical observation that a free TRAM hemiflap can survive when its vascular pedicle is anastomosed to the deep inferior epigastric vessels of a superiorly based TRAM hemiflap prompted the application of the same principle to improve the vascularity of the contralateral "random" portion of pedicled TRAM flaps. In 12 patients undergoing pedicled TRAM flap breast reconstruction, who were considered at risk for partial flap necrosis, the deep inferior epigastric vessels of the carrier rectus muscle were anastomosed to the contralateral deep inferior epigastric vessels harvested along with a small muscle plug containing three to five perforating vessels to the overlying skin island. A vascular arcade that joined the two sides of the flap was, thus, created, producing the following hemodynamic changes in the contralateral, previously "random" portion of the flap: (1) Direct arterial flow is supplied by the perforators coming from the underlying muscle plug; (2) Venous outflow follows the main and most favorable route to the ipsilateral deep venous system; and (3) The deep fat layer below the Scarpa's fascia, which is independent of the superficial vascular system, is connected directly to the deep system.

Breast↗
PubMed1992

[Permanent expanders in esthetic, corrective and reconstructive surgery of the breast].

Since 1986 we used the permanent expandable implant (PEI) as the first choice of prosthesis in breast surgery. The possibilities offered by multiple over-expansions and deflations have been explored: 224 PEI were utilized in 162 patients for aesthetic (38 with bilateral hypoplasia), corrective (20 with asymmetry, tubular breasts or Poland's Syndrome) and reconstructive breast surgery (104 patients for immediate and delayed reconstruction following radical, modified radical, partial and subcutaneous mastectomy). All implants were positioned submuscularly; a latissimus dorsi flap was transposed when pectoralis major was absent or damaged. Either the Becker or the Gibney implant was used. All PEI were immediately or progressively overinflated by 25-80% and then deflated to the planned volume. Twenty-two patients developing capsular contracture were treated by overinflations and deflations with subjective and objective improvement. Many of augmentation mammaplasty patients refused implant deflation to the planned preoperative volume. The over-expansion/deflation process proved to be effective in obtaining ptosis, in maintaining permanent volume symmetry and in keeping the base of tubular breast unfolded.

Adult↗
PubMed1992

Long-term evaluation of the abdominal wall competence after total and selective harvesting of the rectus abdominis muscle.

Fifty patients who underwent unilateral breast reconstruction by transverse rectus abdominis musculocutaneous flap transposition between January 1987 and December 1989 are the object of this study. Every patient underwent selective harvesting of the medial portion of the muscle, whereas the lateral strip was left in place and studied intraoperatively by selective stimulation of the ninth intercostal motor nerve before closure of the fascial defect. Two separate ecographic scans of the abdominal wall were performed respectively 7 days and 6 months postoperatively, to evaluate the diameters of the residual portion of the rectus muscle and its long-term evolution. Our results show that in a considerable number of patients, the lateral strip of rectus was denervated at surgery. Long-term ecographic scans demonstrate, however, that in spite of this finding, the residual muscle usually maintains its diameters, thus significantly contributing to the competence of the abdominal wall, at least from the static point of view.

Abdominal Muscles↗
PubMed1992

Correction of type II breast deformities following conservative cancer surgery.

Breast deformities following conservative cancer surgery are seen with increasing frequency and often represent difficult reconstructive problems. Type II deformities are characterized by localized tissue insufficiency, which can be due to skin insufficiency (type IIa), subcutaneous tissue insufficiency (type IIb), or both (type IIab). Correction of a locally damaged breast is a surgical challenge that can result in a fully restored breast if selection of the surgical procedure is properly carried out. A series of 37 patients who underwent correction of type II deformities from 1980 to 1989 was reviewed. Results obtained with different surgical procedures, including simple submuscular placement of traditional or expandable implants, breast reshaping, transposition of a latissimus dorsi muscle or musculocutaneous flap, TRAM flap, and reverse abdominoplasty, were evaluated. Aesthetic outcome was judged to be good or excellent in 78 percent of patients. Guidelines for selection of the most appropriate surgical procedure according to the defect's etiology, morphology, and location and to the breast's size and shape are presented.

Adult↗
PubMed1992

Reconstruction of the penis in transsexual patients.

In the article, the authors offer a review of the modalities available for phalloplasty in transsexual patients. The classic methods for multi-stage transplantation of tubulized flaps in the lumbar and inguinal regions, in mid-thigh as well as current methods for one-stage reconstruction are discussed. The paper contains the case report of a transsexual patient undergoing one-stage reconstruction of the penis using m. rectus abdominis with the inferior pedicle, urethral reconstruction by a skin graft from simultaneous mastectomy with a free forearm flap covering the muscle. The paper examines the pros and cons of each method for reconstruction.

Adult↗
PubMed1991

A systematic aesthetic approach to primary closure of the donor site following transposition of vertical forehead flaps.

Twenty patients underwent transposition of a vertical forehead flap to correct defects of the middle third of the face. The treatment and results are reported and evaluated. Based of the width of the secondary forehead defect, the best technique of direct closure was determined. Simpler cases were resolved by careful application of the basic techniques of plastic surgery--undermining and scalp flap rotation. When a forehead defect larger than 4.5 cm was expected, previous forehead skin expansion seemed advisable. A primary, tension-free suture of the forehead defect was achieved in every case, thus significantly improving the aesthetic outcome of the operation.

Adult↗
PubMed1991

The transverse rectus abdominis musculocutaneous flap for breast reconstruction in obese patients.

Transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction has often been considered contra-indicated in obese women. The morphological characteristics peculiar to this population, however, make obese women ideal candidates for this procedure because the reconstructed breast must often match a large ptotic contralateral breast. About one-third of our postmastectomy patients are corpulent, middle-aged women with "Mediterranean" body structures. Thirty-four obese women underwent TRAM flap breast reconstruction from 1985 to 1988. According to the Body Mass Index, 23 women had type II obesity and 11 had type III obesity. The preoperative and postoperative management and the surgical procedure were adapted to this particular group of women. The complication rate in this series of women was superior to that of a nonobese population; however, no severe complications were observed. The majority of women were extremely satisfied with aesthetic results; the surgeons also judged the final cosmetic outcome to be very favorable and, indeed, superior to that obtainable with simpler methods. Obesity uncomplicated by other risk factors does not represent an absolute contraindication to TRAM flap procedure.

Abdominal Muscles↗
PubMed1990

Surgical correction of breast deformities following long-lasting complications of polyurethane-covered implants.

Breast deformities following long-lasting complications associated with the use of polyurethane prostheses are encountered with increasing frequency in our practice. Patients with this problem often feel frustrated after a long period of unsuccessful treatment and multiple operations. The anatomopathological bases of the deformity in such patients can be summarized as follows: volumetric mammary defect, soft tissue deficiency, and distortion and fibrosis of residual breast tissues. The reconstructive procedure should provide adequate aesthetic results with permanent or long-lasting symmetry, possibly in a single operative stage. The procedures employed in 12 patients are reviewed, and 3 representative cases are described in detail. The best aesthetic results in difficult cases have been achieved with either a latissimus dorsi muscular flap raised through minimal posterior incisions and transposed anteriorly to cover a permanent, expandable implant, or a suitably tailored, partly deepithelialized transverse rectus abdominis musculocutaneous flap.

Adult↗
PubMed1988

Transposition of myocutaneous flaps in breast reconstruction following radical mastectomy: latissimus dorsi vs. rectus abdominis flap.

We evaluated two homogeneous groups of patients (20 each) who had undergone radical mastectomy and who underwent breast reconstruction in our department by transposition of a latissimus dorsi or of a rectus abdominis myocutaneous flap. The results achieved were very similar (in terms of postoperative hospitalization, complication rate, thoracic symmetry). We therefore believe that both these techniques should be considered as first choice in breast reconstruction following radical mastectomy. However, from the aesthetic viewpoint, the use of the latissimus dorsi is best suited to tall, slim patients, whereas the rectus abdominis allows us to obtain better results in patients of sturdy build, with a voluminous residual breast.

Adult↗