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Biomedical subjects

S S Kroll

Publications and source records attributed to S S Kroll.

126 records · Page 7Linked to original sources
PubMed1989

Transpelvic rectus abdominis flap reconstruction of defects following abdominal-perineal resection.

Abdominal-perineal resection for advanced rectal carcinoma may leave a large defect for which complete secondary healing can be slow. In such cases, the inferiorly based rectus abdominis myocutaneous flap, passed through the pelvis into the perineum, can provide a large amount of well-vascularized tissue that may be placed in the defect to facilitate primary healing and allow a quicker recovery. Additional advantages include displacement of the bowel out of the pelvis to facilitate postoperative radiotherapy, and the ability to reconstruct vaginal wall defects. We report a series of seven patients for whom the transpelvic rectus abdominis myocutaneous flap was used to cover perineal defects following abdominal-perineal resection. Although one flap failed, all patients healed rapidly and the only lasting complication was a possibly related small upper-abdominal hernia found one year after surgery.

Abdominal Muscles↗
PubMed1989

Current concepts in breast reconstruction after mastectomy.

Breast reconstruction has been playing an increasing role in breast cancer therapy at The University of Texas M. D. Anderson Cancer Center. Our goal is not only to correct cosmetic deformity but also to allow mastectomy patients to wear normal clothing and function as normally as possible in society. Reconstruction is now available to most women who request it. The most commonly used techniques, in our institution, are tissue expansion, use of the latissimus dorsi flap, and use of the transverse rectus abdominis musculocutaneous (TRAM) flap. Each has advantages and disadvantages, with the choice of method depending on individual circumstances. In most cases, successful breast reconstruction can be achieved.

Breast↗
PubMed1988

Perforator-based flaps for low posterior midline defects.

A new type of flap is described based on unnamed perforators located near the midline of the lower back region. Such flaps combine the superior blood supply of the myocutaneous flap with the lack of donor-site morbidity of a skin flap. Five clinical cases are presented, showing how such perforators can augment skin flaps or create custom-designed island flaps. The dissection of the flap is described, and further possibilities for its use are suggested.

Adult↗
PubMed1988

A comparison of deepithelialization and deskinning in inferior pedicle breast reduction.

To test the hypothesis that deskinning instead of deepithelializing the pedicle can save time when using the inferior pedicle technique of breast reduction without incurring added risk, a comparison of deskinning with deepithelialization was performed in nine patients undergoing breast reduction. Each patient served as her own control. No increase in complications or decrease in the quality of result ensued from use of the deskinning technique. The savings in time, however, was relatively insignificant, and several other minor disadvantages outweighed the gain, so that this author has chosen to continue to use the traditional deepithelialization of the pedicle when performing breast reduction surgery.

Adult↗
PubMed1987

A new twist to the nasolabial flap for reconstruction of lateral alar defects.

The nasolabial flap remains the favored technique for alar and lateral nasal reconstruction. Results with currently popular techniques tend to be inartistic and aesthetically disappointing. Improved results can be achieved, however, by a technique using a medially based nasolabial turnover flap for lining with a distal extension providing the cover. Reconstruction of the ala begins by designing a nasolabial flap with its base as close as possible to the site of the proposed ala. The flap is incised to the required margins, carrying 2 to 3 mm of underlying fat; then, hinged on its base, the flap is flipped over medially like the page of a book. As the proximal flap is sutured to the lining side of the defect, the distal flap gracefully twists 90 degrees and is then folded on itself to form the external surface of the ala. The donor site is closed primarily. With this procedure, a natural-appearing and appropriately positioned ala may be reconstructed in one step, although a second procedure may be helpful to sculpture the margin or precisely position the alar base.

Aged↗
PubMed1987

Sulfamylon allergy simulating chondritis.

A case of atopic reaction to Sulfamylon is described that occurred in a patient receiving this medication as a topical treatment for burned ears. The presenting signs were similar to those of a persistent chondritis, with which it was initially confused. All signs and symptoms cleared rapidly after the Sulfamylon was discontinued. Physicians should be aware of this entity so as to avoid inappropriate surgical debridement of ears with this relatively minor problem.

Adult↗
PubMed1987

Aesthetic considerations of the medial gastrocnemius myocutaneous flap.

A technique for the repair of a high anterior tibial defect is described in three clinical cases using a modified medial gastrocnemius myocutaneous island flap. The repair was done in such a way as to preserve as much of the normal contour as possible, after the fashion of the muscle flap alone, while retaining the advantages of full-thickness myocutaneous coverage of the defect. The result was an aesthetically improved reconstruction that we feel justifies further use of the gastrocnemius myocutaneous flap in selected patients.

Adult↗
PubMed1984

Subcutaneous endoscopy in suction lipectomy.

Subcutaneous photographs of tissues treated by suction lipectomy have been obtained by adapting fiberoptic endoscopy equipment. These photographs document the presence of an intact neurovascular supply to the overlying skin and lend support to the concept of suction lipectomy with the blunt cannula. The technique of subcutaneous endoscopy is described, and additional uses for the method are suggested.

Adipose Tissue↗
PubMedDate not supplied

Presentation, treatment, and outcome of local recurrence afterskin-sparing mastectomy and immediate breast reconstruction.

BACKGROUND: The local recurrence (LR) rate with skin-sparing mastectomy (SSM) and immediate breast reconstruction (IBR) has been reported as comparable to the LR rate after conventional mastectomy. However, limited data are available on the prognostic significance and management of LR following SSM. METHODS: A prospective database maintained at the University of Texas M. D. Anderson Cancer Center identified 437 SSMs performed for 372 invasive T1/T2 breast cancers between 1986 and 1993. RESULTS: Twenty-three LRs were identified, with a LR rate of 6.2% (23/372). Twenty-two of these (96%) presented as palpable skin-flap masses. The median time to recurrence was 25 months (range, 3 to 98 months). Fourteen patients were treated with a combination of surgery and systemic therapy. Resection of the reconstructed breast was performed in only three patients. Complete local control of the recurrent disease was achieved in 17 patients (74%). Nine patients (39%) developed distant metastatic disease. At a median follow-up of 26 months, 14 of 23 patients (61%) are alive without evidence of disease, and 7 (30%) have died from breast cancer. CONCLUSIONS: Because LR rate with SSM is low and likelihood of local control and survival is high, SSM and IBR is an acceptable treatment option for early stage breast cancer.

Adult↗
PubMedDate not supplied

Local rotational flaps for breast conservation therapy as an alternative to mastectomy.

BACKGROUND: An anticipated poor cosmetic result has traditionally been deemed a relative contraindication for breast conservation therapy (BCT). We sought to determine whether a local rotational flap could achieve satisfactory cosmesis in patients who were anticipated to have a poor cosmetic result following standard segmental mastectomy but who nevertheless desired BCT. METHODS: Within the past 3 years, nine patients were treated with BCT using local rotational flap techniques. Their records were reviewed for patient characteristics, pre- and postoperative treatment, disease-free status, and patient satisfaction with cosmesis. RESULTS: The cosmetic outcome following a segmental mastectomy was anticipated to be unacceptable due to the following features: a large previous biopsy cavity with unknown or positive margins (three patients); initial large primary tumors with unknown extent of residual disease following induction chemotherapy (five patients); and pre-existing poor cosmesis (one patient). One patient had refused modified radical mastectomy and had satellitosis from inadequately treated primary tumor (excisional biopsy with positive margins and no further therapy). The median initial tumor size was 2.7 cm (range, 1.5 cm to 5.0 cm). Final resection margins were negative in all patients. Postoperative radiotherapy was given in seven patients; one patient did not receive radiotherapy because of a pre-lupus condition and one did not require radiotherapy because her pathologic diagnosis was Paget's disease without an invasive component. Cosmesis was judged to be good to excellent by eight of nine patients. The patient who refused mastectomy was dissatisfied with cosmesis because of mild asymmetry. With a median follow-up of 24 months, only one patient has developed a local recurrence. CONCLUSION: Local rotational flaps composed of adjacent breast tissue are an acceptable method of achieving satisfactory cosmesis in selected patients who desire BCT.

Adult↗
PubMedDate not supplied

Feasibility of postmastectomy radiation therapy after TRAM flap breast reconstruction.

BACKGROUND: Postoperative radiotherapy (PORT) has been shown to decrease locoregional failure rates in high-risk breast cancer patients following modified radical mastectomy. However, there had not been a study evaluating the effect of PORT in patients after transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction. Therefore, we evaluated flap viability, cosmetic results, and locoregional recurrence in patients who underwent TRAM flap reconstruction and PORT. METHODS: The charts of patients who had undergone modified radical mastectomy with TRAM flap reconstruction and PORT at our institution were reviewed. Patients were examined in the clinic and interviewed by telephone to evaluate their perceptions of the cosmetic result. RESULTS: PORT was delivered to 19 patients with TRAM flaps (3 pedicled and 16 free flaps) between 1988 and 1994. There were no TRAM flap losses as a result of either surgical or radiotherapy complications. Two patients developed fat necrosis, one with a pedicled and one with a free TRAM flap. Patients with pedicled TRAM flaps noted more volume loss in the breast after radiation therapy. Eighty-four percent of patients felt their overall cosmetic result was excellent or good; only one patient reported a poor cosmetic result. Local control was achieved in three of the four patients who received PORT for local recurrence. There was only one local recurrence among the 14 patients who received PORT because they were at high risk of local recurrence. CONCLUSIONS: These results suggest that PORT can be given safely to high-risk patients following TRAM flap breast reconstruction with excellent cosmetic results and good locoregional control.

Adult↗
PubMedDate not supplied

Risk of recurrence after treatment of early breast cancer with skin-sparing mastectomy.

BACKGROUND: Skin-sparing mastectomy, combined with immediate breast reconstruction, has become increasingly popular. However, there are no published long-term data to support its oncologic safety. Our purpose was to evaluate the long-term oncologic risk of skin-sparing mastectomy. METHODS: The records of all patients who had undergone treatment of T1 or T2 breast cancer by mastectomy and immediate breast reconstruction, and who were followed for at least 5 years or developed recurrence of disease before that time were reviewed. Local and distant recurrence rates observed in patients treated by skin-sparing mastectomy were compared with those in patients treated by conventional, non-skin-sparing mastectomy. RESULTS: A total of 104 patients were treated with skin-sparing mastectomies. In that group, 6.7% developed local recurrences, 12.5% developed distant metastases, 88.5% remained free of disease, and 7.7% died of their disease. Among the 27 patients who did not have skin-sparing mastectomies. 7.4% had local recurrences, 25.9% had distant metastases, 74.1% remained free of disease, and 18.5% died of disease. These recurrence rates are similar to those reported elsewhere after treatment with conventional mastectomy and without reconstruction. CONCLUSIONS: Our findings suggest that skin-sparing mastectomy does not significantly increase the risk of local or systemic disease recurrence in patients with early breast cancer.

Breast Neoplasms↗
PubMedDate not supplied

Feasibility of immediate breast reconstruction for locally advanced breast cancer.

BACKGROUND: Immediate breast reconstruction (IBR) has been considered contraindicated for patients with locally advanced breast cancer (LABC). Our goal was to determine whether IBR resulted in delayed postoperative chemotherapy, increased postoperative complications, or increased risk of recurrent disease. METHODS: A prospective database of 540 modified radical mastectomies performed with IBR between 1990 and 1993 identified 50 patients with LABC. Postoperative management and outcome were compared to that of 72 patients undergoing modified radical mastectomy without IBR treated on a standardized LABC protocol using preoperative chemotherapy, postoperative chemotherapy, and radiotherapy during the same time period. RESULTS: Results were evaluated by chi2 analysis. The median ages for the patients with IBR versus those not undergoing IBR were 44 and 46 years, respectively. The stage distribution for the IBR patients versus patients not undergoing IBR was as follows: IIB, 46% versus 17%; IIIA, 44% versus 39%; and IIIB, 10% versus 44%. The types of IBR were transverse rectus abdominis myocutaneous (TRAM) flap (68%), latissimus dorsi flap (2%), and implants (30%). Chemotherapy was given to all IBR patients: 24% preoperatively and 96% postoperatively. Radiotherapy was used in 40%. Four postoperative complications (8%) necessitated prolongation of hospitalization, including two patients requiring surgical debridement for partial flap loss; there were no complete flap losses. The incidences of major and minor wound complications in the group not undergoing IBR were 7% and 4%, respectively. Of the 15 patients receiving implant reconstruction, 7 (47%) required subsequent implant removal because of contractures or infections. The median interval between surgery and postoperative chemotherapy was 35 days for the IBR patients and 21 days for the patients not undergoing IBR. This difference was marginally significant (P =.05). With a median follow-up of 58.4 months, no significant differences in local or distant relapse rates were detected. CONCLUSIONS: IBR can be performed with low morbidity in patients with LABC. Use of autogenous tissue is preferable because of poor results with implants. IBR is associated with somewhat longer intervals to resumption of postoperative chemotherapy, but this does not appear to be clinically significant-the local and distant relapse rates are similar for LABC patients undergoing modified radical mastectomy with or without IBR.

Adult↗