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Biomedical subjects

P Berrino

Publications and source records attributed to P Berrino.

36 records · Page 2Linked to original sources
PubMed1988

Metastatic spread of floor of the mouth squamous cell carcinoma via pectoralis major myocutaneous flap.

In a patient with recurrent head and neck squamous cell carcinoma, reconstruction of the floor of the mouth was carried out by transposition of a pectoralis major myocutaneous flap after composite resection. Twelve months after surgery, a chest wall metastasis corresponding to the site of the vascular pedicle was observed. It appears that the lymphatic and hematogenous tumor spread can occur along the vascular pathways of a transposed myocutaneous flap.

Adult↗
PubMed1988

Preoperative TRAM flap planning for postmastectomy breast reconstruction.

The techniques for transverse rectus abdominis musculocutaneous flap planning, which have previously been described in international literature, do not provide adequate guidelines for preoperative marking that can be followed in patients with different types of contralateral breast. Because in most patients we tend to reconstruct the new breast on the model of the contralateral one without significant changes in the patient's body image, some parameters were needed that could provide adequate preoperative marking. The technique we describe for preoperative planning is simple and reliable and can be used in most patients. It allows immediate deepithelialization and tailoring of the dermoadipose extensions of the flap at the beginning of the operation. In our experience this type of preoperative marking has significantly reduced operative time and the need for secondary correction and contralateral mammaplasty. The incidence of marginal flap necrosis and liponecrosis has also been reduced because minimal contralateral random portion of the skin island is used.

Adult↗
PubMed1988

Unilateral reduction mammaplasty: sculpturing the breast from the undersurface.

Various traditional mammaplasty techniques have been suggested for unilateral breast reduction, and an inverted-T incision is still the most popular approach. However, unilaterally performed traditional techniques can rarely provide long-lasting symmetry because the operated and the unoperated breasts react differently to aging, weight changes, and pregnancy. Considerable residual scarring, interference with clinical and mammographic evaluation, and limited versatility are all major drawbacks of traditional procedures. We have performed unilateral mammaplasties on 47 patients with various types of congenital and acquired asymmetries, reducing and sculpturing the breast from the undersurface by means of minimal incisions, always avoiding horizontal scarring in the inframammary crease. Through a vertical infra-areolar incision, the breast is completely detached from the underlying pectoralis fascia and hooked up, thus completely exposing the undersurface of the mammary cone. The breast can thereafter be reshaped according to the size and shape of the contralateral breast by means of a discoid resection and/or selective sectoral removal of excessive subcutaneous tissues; modifications of the basic discoid resection can increase anterior projection of the new breast mound and can change the inclination of the anteroposterior breast axis on the anterior chest wall both on the horizontal and vertical planes. The results show that if criteria for patient selection are carefully respected, the procedure can provide long-lasting symmetry with minimal residual scarring and fully preserve the breast anatomy, function, and vascularization.

Adult↗
PubMed1987

Present day role of plastic surgery in management of chronic radiation wounds: our experience.

Traditional procedures to resurface soft tissues defects following excision of chronic radiation wounds involve the use of skin grafts or skin flaps. However, the poor vascularity of the recipient bed is the reason for the high failure rate of skin grafts. Local skin flaps will often fail because of radiation injury to tissues within the flap itself. Distant skin flaps allow repair with healthy tissues, but these complicated multistaged procedures require prolonged hospitalization. The main advantage of myocutaneous flaps is the possibility of resurfacing large wounds in one step only, with tissues transposed from areas far from the radiation field. The Authors' experience using myocutaneous flaps of latissimus dorsi, pectoralis major, rectus abdominis and tensor fascia lata and the results obtained so are discussed.

Humans↗
PubMed1987

Postquadrantectomy breast deformities: classification and techniques of surgical correction.

The deformity which is encountered following quadrantectomy (or similar procedures such as segmentectomy or partial mastectomy) and radiation therapy is difficult to evaluate objectively, and subjective assessment of the cosmetic outcome is extremely variable. In a group of 54 patients who underwent the procedure between 1979 and 1983, the types of cosmetic changes were evaluated and classified according to morphologic criteria. Four types of deformities and their related etiopathologic factors were identified. Type I is characterized by malposition and distortion of the nipple-areola complex and is mainly due to postoperative fibrosis and scar contracture. In type II deformity, localized tissue insufficiency is observed, which may be due to skin deficiency (type IIa), subcutaneous tissue deficiency (type IIb), or both (type IIab). Type III deformity is characterized by breast retraction and shrinkage and is mainly due to the effects of radiotherapy on residual breast parenchyma. In type IV deformity, severe radiation-induced damage to the skin, nipple-areola complex, and subcutaneous and glandular tissues is present. Surgical correction of each type of deformity is discussed, and examples are reported.

Adult↗
PubMed1986

New options in breast reconstructive surgery: alternatives to the latissimus dorsi musculocutaneous flap.

Transposition of the latissimus dorsi musculocutaneous flap is still considered by most authors a first-choice technique for breast reconstruction. However, the aesthetic drawbacks of the technique are significant: In our experience the posterior scar and the "patchlike" skin island are of concern to more than 30% of patients. Recent alternatives have sharply reduced the use of the latissimus dorsi myocutaneous flap as our first-choice technique. The utilization of a latissimus dorsi muscular flap in association with submuscular placement of a tissue expander is now our favorite technique for the majority of patients: Residual scarring is insignificant since the whole muscle can be raised through a 5-7-cm-long, S-shaped incision placed along the anterior border of the latissimus dorsi. The results obtained in a group of 35 patients demonstrate that the final results of the procedure in terms of shape and projection of the reconstructed breasts are absolutely similar to those obtained using the latissimus dorsi musculocutaneous flap. However, in patients with heavy body structure and large contralateral breast, satisfactory symmetry and a natural-looking reconstructed breast are obtained more effectively by transposition of a rectus abdominis myocutaneous flap. The precautions to be taken in order to make the procedure suitable for over-weight patients are described and the results are discussed.

Adult↗
PubMed1986

Long-lasting complications with the use of polyurethane-covered breast implants.

Polyurethane-covered breast implants have been recommended by some authors for aesthetic and reconstructive procedures, since with these implants the incidence of capsular contracture is insignificant and risks of implant displacement or exposure are reduced. Reports on the use of these implants focus merely on aesthetic aspects, and risks associated with disintegration and incorporation of the polyurethane-coating are often overlooked. The authors have observed several complications associated with the use of these prostheses; two cases of long-lasting complication are described, which are ascribed to difficult removal of infected fragments of the coat and to delayed foreign body reaction to polyurethane. The authors believe that the hazards associated with these implants outweigh their advantages for primary use, but suggest their use for secondary procedures in patients who have had recurrent problems with smooth implants.

Breast↗
PubMed1986

Anterior transposition of the latissimus dorsi muscle through minimal incisions.

Latissimus dorsi transposition is a useful procedure for the correction of various congenital and acquired thoracic deformities. The authors describe a surgical technique which allows anterior transposition of the whole muscle through minimal incisions. The technique has been used in 33 patients with post-mastectomy or post-subcutaneous mastectomy deformities, Poland's syndrome, deep radionecrosis, quadrantectomy, or breast underdevelopment following burns. The technique has proven safe and reliable, although the control of bleeding is difficult. Results are evaluated and compared with those obtained using traditional techniques; the absence of any significant posterior deformity is pointed out. The authors also suggest the use of this technique for breast reconstruction in patients presenting skin deficiencies: a tissue expander placed under the muscular flap makes it possible to avoid the transposition of a skin island.

Breast↗
PubMed1985

Poland's syndrome: correction of thoracic anomaly through minimal incisions.

A method that minimizes residual scarring following Poland's syndrome correction by latissimus dorsi muscle transposition and placement of a submuscular breast implant is described. In order to reduce any resulting unsightly scarring and, in particular, eliminate the anterior thoracic scar, both a dorsal S-shape and an axillary incision were made and the muscle flap was raised. A prosthesis was then inserted and the muscle flap sutured to the anterior chest wall through an anterior incision symmetrical to the inferior border of the contralateral areola. The latter is a previously undescribed approach that produces good cosmetic results.

Adult↗
PubMed1984

Immediate breast reconstruction following modified radical mastectomy.

Reducing postoperative psychological morbidity is an important goal in breast cancer patient care; a multidisciplinary approach is crucial in order to select candidates for immediate breast reconstruction. There is no oncologic reason for a delay after a modified radical mastectomy. Our procedure allows immediate breast reconstruction without significantly prolonging operative time and hospitalization. Complete muscular coverage of the implant and shifting of the redundant skin to the mastectomy site minimize the risk of postoperative complications and provide a natural looking reconstructed breast. Delayed reconstruction of the nipple-areolar complex performed at the time of contralateral mammaplasty ensures satisfactory breast symmetry. Satisfactory reconstruction of the nipple-areolar complex is achieved without additional scars by means of grafts taken from the opposite breast or utilizing the cryopreserved nipple and areola.

Breast↗
PubMedDate not supplied

Vertical mammaplasty: a personal approach.

We have been using the vertical mammaplasty technique with personal adjustments for reduction mammaplasty and glandular resection since 1989. There were 63 cases of aesthetic reduction mammaplasty and mastopexy and 38 cases of reduction mammaplasty and mastopexy contralateral to breast reconstruction with implants and/or autologous tissues performed during the period from 1989 to 1993. The aim of this work is to discuss the complications, long-term results, and limitations to this technique.

Adult↗
PubMedDate not supplied

Can the cost affect the choice of various methods of postmastectomy breast reconstruction?

AIM AND BACKGROUND: A wide range of methodologies for breast reconstruction is now available. For immediate breast reconstruction we prefer to use implants, whereas reconstruction using autologous tissues, such as transverse rectus abdominis musculocutaneous flaps (TRAMF) and muscular latissimus dorsi flaps, is applied only in selected cases. In contrast, for delayed reconstruction the choice between prostheses and autologous tissue depends on various conditions. The different reconstructive methods can be adopted as a single procedure or as a combination of surgical procedures. Following the issue of legislation defining the new structure of the Italian Health Service, the need to accurately assess the costs incurred for the execution of surgical operations has taken on paramount importance. The aim of the study was to evaluate not only the clinical limits of each surgical technique, but also its cost, in order to optimize the choice of the same procedures, conditions being equal. METHODS: The study population included 105 patients who underwent breast reconstruction in the period 1st January 1994-30th June 1995. The reconstructive procedures included 48 immediate implants, 7 immediate TRAMF, 17 delayed implants, 30 delayed TRAMF, and 3 delayed latissimus dorsi muscular flaps. RESULTS: After data evaluation, we concluded that reconstruction using permanent expandable implants is the most convenient among implant reconstructions for its low global treatment cost. In fact, reconstructive procedures using temporary expanders, which require two surgical operations, have a higher cost than breast reconstruction using permanent expandable implants. Breast reconstruction using TRAMF is the most convenient because it limits the cost of surgical materials and because flap versatility limits the number of modifications on the contralateral breast. In contrast, breast reconstruction using latissimus dorsi flaps has high costs. CONCLUSIONS: There is no balance between price list and effective cost of the different surgical reconstructive procedures, which may be a point of departure to see whether it is impossible to improve the efficiency of the Health Care System and in any case open a debate between the Regions and hospitals to improve the service, keeping it at a good level.

Female↗