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PubMed1989

[Mastectomy and primary breast reconstruction].

Primary breast reconstruction after mastectomy may be proposed individually after careful consultation of the patient. Whereas postoperative chemotherapy or hormone therapy are not contraindications, radiotherapy is a relative contraindication. Methods include the submuscular silicone implant (+/- expansion), mobilisation of the abdominal skin or flap reconstruction (thoracoepigastric or latissimus flap). The indications, pros and cons, are discussed. Mastectomy and primary reconstruction are good alternatives to the so-called conservative treatment with irradiation.

Adult↗
PubMed1989

[Surgical procedure for secondary breast reconstruction after mastectomy].

The type of reconstruction is determined by the mastectomy deformity and requirements for symmetry. There are five basic techniques. A silicone breast implant placed submuscularly beneath the available tissues is the most straight-forward procedure. Latissimus dorsi flap is used with a silicone breast implant when additional skin and/or muscular cover is needed. Transverse rectus abdominis musculocutaneous utilizes excess lower abdominal tissue for reconstruction of the breast with autogenous tissue. The tissue expander is most frequently used following modified radical mastectomy. The external oblique rectus abdominis musculofascial turn-over flap is an attractive new technique.

Breast Neoplasms↗
PubMed1989

Tissue expansion in perspective.

Tissue expansion is a recent advance in skin cover technique. Its empirical use has enabled many previously difficult reconstructions to be completed without recourse to distant flaps. Its high complication rate and lack of basic scientific understanding at present restrict its use to selected cases, but the quality of repairs possible by this method encourage further serious scientific study.

Breast↗
PubMed1989

Tissue expanders in soft tissue reconstruction.

In order to reconstruct soft tissue defects, plastic and reconstructive surgeons have developed various means that range from the simplest skin grafts to the most complex transfer of microvascular free flaps, but there are no other more than tissue expansion can achieve good results in both aesthetic and functional aspects. From Oct. 1986 to Oct. 1988, tissue expansion was used in seven male and six female patients aged from 11 to 40 years, with a mean of 25. They were divided into 3 groups according to the location of defects: head and neck, 6 cases; trunk, 2 cases; and extremity, 5 cases. Seven cases had successful results and 6 cases failed: one due to infection, one due to leakage of bag and another 4 due to expander extrusion. We know that tissue expansion is a relatively new technique. It expands the healthy tissue immediately adjacent to the defects and provides tissue with near perfect color match, texture, sensation and hair distribution for reconstruction. Although high risk of failure was noted (6 in 13 cases), it still deserves trying for its reasonable aesthetic and functional results.

Adolescent↗
PubMed1989

Tissue expanders in surgery.

The technique of tissue expansion using inflatable expanders has gained widespread attention in the surgical literature. We give two examples of its use and emphasise possible complications which may arise. The search for methods to close complex wounds, often associated with radiation-damaged tissue or exposed bone, has resulted in a progression from random skin flaps to axial pattern flaps with a longer length to breadth ratio guaranteed by anatomically constant vessels. Musculocutaneous, fasciocutaneous and free flaps have been described over the body surface allowing complex reconstruction at local and distant sites. The use of expansion is of particular value in allowing local tissue to fill defects with minimal functional and aesthetic disturbance. In the face and scalp, in particular, tissue expansion appears to be a promising method of at least partially removing disfiguring lesions and is useful in reconstruction following traumatic loss. The concept of tissue expansion in medicine is not new. During pregnancy the abdominal skin becomes gradually stretched over the expanding uterus. Large skin excisions can be carried out in abdominoplasty following weight loss. Skin and mucosa can be seen to expand rapidly over benign enlarging neoplasms. The serial excision of large naevi has been practised for many years by plastic surgeons. Skin grafts placed over fasciotomy wounds to obtain tension-free closure can be subsequently excised in stages to obtain a minimally stretched linear scar.

Adult↗
PubMed1989

Correction of congenital microtia using the tissue expander.

We attempted auricular reconstruction using Radovan-type inflatable silicone expanders in six children and one adult, with the complete hypoplastic, the conchal remnant, and constricted type of microtia. Ear frameworks, including the helix, anthelix, concha, and tragus, were prepared using autologous rib cartilage. Based on the surface area of the normal adult auricle, the silicone expander was tentatively shaped and sized into a rotated semiellipse and expanded with 70 cc saline. Auricular reconstruction on the framework was completed at the time of insertion in four of the seven patients, requiring no elevation of the ear. The reconstructed auricle was satisfactory in both color and texture and had nearly normal sensation. Mild complications were noted in three of the seven patients. However, no resorption of the inserted rib cartilage has been observed 14 months to 2 years and 5 months after the operation. Slight shrinkage of the expanded skin was noted in each patient.

Adolescent↗
PubMed1995

Soft tissue reconstructive choices for craniofacial reconstruction.

The extensive blood supply to the scalp enables the use of local flaps based mainly on the superficial temporal artery: these include skin, temporoparietal fascia, subgaleal fascia, and temporal fascia. Also, the temporalis muscle provides flaps based upon the temporal branches of the internal maxillary artery. On top of the skull, scalp flaps, galeal flaps, and pericranial flaps can be used as random flaps or as axial flaps based on the problems or anatomic reasons that would preclude microvascular reconstruction. The pectoralis, latissimus, splenius capitis, and trapezius muscle flaps can dependably reach the base of the skull. The increasing reliability and versatility of microvascular reconstruction render their use standard for craniofacial reconstruction.

Adult↗
PubMed1995

[Free tissue transplantation for correction of calf asymmetry. A case report].

A case of aesthetic calf augmentation by a microsurgical free deepithelialized VRAM-flap is reported. As a result of poliomyelitis infection in childhood and atrophy of the m. gastrocnemius medialis sinister, the contour of the left calf was deformed. The reconstruction by autologous material was performed by use of the free VRAM-flap. The indications, advantages, and disadvantages of this method compared to calf augmentation by silicon prostheses are discussed.

Female↗