PubMed · 2407912
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V Schumpelick. 1990. [Hernia surgery today].. https://doi.org/10.1007/bf00186112
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BACKGROUND: The authors' goal was to demonstrate a technique of gaining added width from the right pectoralis major muscle flap through muscle fascia release, with the hope of attaining sturdier, tension-free dead space closure of the debrided mediastinum in cases of mediastinitis. METHODS: The authors measured the preincisional and postincisional widths of the right pectoralis major flap following release of the fascia in nine patients who underwent mediastinal reconstruction using pectoralis major muscle flaps from 2002 to 2004 at the Detroit Medical Center. RESULTS: The average width of the nine muscles was 16.3 +/- 1.7 cm before fascia release and 22.1 +/- 1.3 cm after release. The average increase in width was 5.8 +/- 1.3 cm, with a 95 percent confidence interval of 4.8 to 6.8 cm. A value of p < 0.0001 indicated that this increase in width was statistically significant. After fascial release, the width of the muscles increased by an average of 26.1 percent, with a 95 percent confidence interval of 21.6 to 30.6 percent. CONCLUSIONS: The authors present a new technique that can be used to gain additional width from the right pectoralis major muscle in cases of mediastinal reconstruction using the pectoralis major muscle flap. With the added 26 percent of width obtained from the right pectoralis major muscle with fascia release, the authors contend that a sturdier and tension-free closure of the mediastinal dead space can be obtained, further expanding the indications for use of the pectoralis major muscle flap as the sole closure modality in even the most complicated cases of mediastinitis.
We report the successful use of Surgisis in the repair of the abdominal donor site fascial defect following a free transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction. No abdominal wall weakness in the flap donor site was evidenced by a series of clinical examinations to at least 14 months after Surgisis placement. A well-formed and thickened fascial layer at the abdominal donor fascial repair site was revealed by computed tomography scan. This objective finding, along with our clinical observation, supports the use of Surgisis for repair of the abdominal donor site fascial defect following a TRAM flap harvesting.
BACKGROUND: The objective of this study was to assess a new procedure for breast mastopexy, fascial suspension mastopexy. METHODS: Between December of 2001 and July of 2004, 52 patients (102 breasts) underwent fascial suspension mastopexy. Sixteen women had grade 1 ptosis (30 percent), 31 had grade 2 ptosis (60 percent), two had grade 3 ptosis (4 percent), two (4 percent) had breast asymmetry and underwent unilateral mastopexy, and one had pseudoptosis (2 percent). Of the 52 patients, 43 (83 percent) underwent fascial suspension mastopexy only, whereas nine patients (17 percent) underwent fascial suspension mastopexy combined with breast parenchymal excision of less than 120 g in each breast. Three patients (6 percent) underwent combined procedures. RESULTS: The complication rate was 7.7 percent (four patients). Two patients underwent conversion of the vertical scar into a horizontal scar. One patient underwent drainage of a hematoma 1 day after her operation, and one patient developed a hypertrophic scar. The average follow-up was 1.4 years, with the longest follow-up being 3.5 years. On a scale of 1 (very poor) to 10 (excellent), postoperative ptosis correction was rated as 8.8, breast symmetry as 8.4, postoperative upper pole fullness as 9.1, postoperative medial breast fullness as 7.8, and overall breast shape and contour as 8.6. CONCLUSIONS: Fascial suspension mastopexy is safe, simple, and versatile; does not require pectoralis major flap harvesting; and achieves an excellent suspension of breast parenchyma, creating a projected and rejuvenated breast shape with upper pole fullness and long-standing breast contour.