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At least 631 records · Page 35Linked to original sources
PubMed1994

Postoperative irradiation following immediate breast reconstruction using a temporary tissue expander.

Ten consecutive patients at Howard University Hospital underwent modified radical mastectomy with immediate breast reconstruction using a temporary tissue expander. Postoperative irradiation was delivered to the breast mound encompassing the tissue expander. The effects of expansion on the delivery of postoperative irradiation was assessed. Dosimetric measurements with thermoluminescent dosimeters revealed that the saline-filled expander attenuated the photon beam 3% less than tissue-equivalent material of equal volume. This dose variation was negligible, so no adjustments were made. Postoperative treatment consisted of 5040 cGy to 5220 cGy delivered in 5 to 10 weeks using 4 mV photon tangentials. Cosmesis was assessed over a 2-year period. Six patients completed reconstruction and irradiation without complications. Cosmesis was good in five and fair in one. One patient developed a moist reaction secondary to postoperative irradiation; however, final cosmesis was good. Three patients developed complications leading to the loss of the reconstructed breast. Successful final reconstruction can be achieved with careful patient selection and close follow-up by the plastic surgeon and radiation oncologist.

Adult↗
PubMed1994

[Tissue expansion. Part 1: Technical and physiologic principles].

The technique of tissue expansion can now be used to prepare skin for reconstructive operations. This method has been propagated during the last 15 years, but its use has varied from great enthusiasm with exaggerated expectations to disillusion due to high complication rates. For an efficient and successful application of skin expansion an understanding of skin reactions and their control is mandatory. In this review, the biological principles of expansion, various expansion protocols and their objectives, control during the filling phase and preventive measures to avoid complications are described. For clinical use it is important that there is not one but three distinct types of expansion: an intraoperative, intermittent expansion for gentle subcutaneous skin mobilization, a short time period for expansion (between 1-2 weeks) to increase the dermal microcirculation and the "classic" prolonged period of expansion to create new skin for the reconstruction required.

Cell Division↗
PubMed1994

[Reconstruction of the scrotum using a tissue expander].

Traditionally, reconstruction of the scrotum has involved the use of split skin or pedicle flaps with often unsatisfactory aesthetic results. We present two cases with loss of the scrotum as a consequence of Fournier's gangrene. The use of tissue expanders for scrotal reconstruction involves the following advantages: excellent functional and cosmetic results, natural appearance of the neoscrotum, preservation of normal function and sensitivity of scrotal skin, no additional scars from skin grafting, and a simple surgical technique.

Adult↗
PubMed1994

The combination of expanders with autogenous tissue in breast reconstruction.

Combining the use of tissue expanders and implants with autogenous tissue techniques of breast reconstruction takes maximal advantage of the benefits associated with each method. This approach provides an additional reconstructive option that is particularly useful in patients who are not ideal candidates for either method alone. Reconstruction may be performed in an immediate or delayed fashion, and the aesthetic results are excellent.

Female↗
PubMed1994

Breast reconstruction in older women.

BACKGROUND: More than 50% of breast cancer care in the United States occurs in women over age 65 years. This study investigates age-related differences in breast reconstruction practices after mastectomy for breast cancer. METHODS: Retrospective review of University of Michigan Breast Care Center patients revealed 242 female patients with breast cancer who underwent postmastectomy breast reconstruction from 1980 through 1991. Data were complied concerning patient age, reconstruction interval (immediate or delayed), type of breast reconstruction performed, reconstruction-associated complications, and the number of postreconstruction procedures required to obtain the final result. Statistical comparisons were made with the chi-squared test. RESULTS: There were 224 patients aged less than 60 years (range 27 to 59 years; median, 44 years) and 18 patients aged 60 years or more (oldest, 68 years). Of the 18 older patients, three underwent delayed transverse rectus abdominus muscle (TRAM) reconstruction; one received a delayed latissimus dorsi flap placed over a silicone gel prosthesis, and 14 underwent 18 reconstructions (4 bilateral) with silicone gel implants (6 immediate, 12 delayed). The younger patients underwent 269 breast reconstructions (45 bilateral), including 92 autogenous tissue reconstructions (34 immediate TRAM, 58 delayed TRAM), 60 immediate and 88 delayed insertions of an expander or prosthesis, and 29 latissimus dorsi flaps with implant reconstructions (3 immediate, 26 delayed). Seven complications (32%) occurred in the 22 breast reconstructions performed in older women, including capsular contracture surrounding an implant (six patients) and a ventral hernia in one patient with a TRAM flap. Complications occurred in 134 breast reconstructions (50%) performed in younger women. All were related to the reconstruction. In the older women a mean of 1.7 +/- 0.7 operations was required to achieve a final reconstruction result versus 2.1 +/- 1.1 in the younger women (not significant). More operations were required in younger women undergoing prosthetic reconstruction than in older women, but this difference was not statistically significant (2.4 +/- 1.2 versus 1.9 +/- 0.7; p = 0.07). Autogenous tissue reconstruction was performed less frequently in older women (14% versus 34%; p < 0.05). No age-related difference was noted in the rate of immediate (versus delayed) reconstruction (27% versus 36%, respectively). Complications occurred more frequently in women who underwent prosthetic breast reconstruction, particularly in younger women (32% in older women and 64% in younger women; p < 0.01). The complication rate for immediate breast reconstruction in older women (all prosthetic) was less than in younger women (17% versus 59%; p < 0.05). For delayed prosthetic reconstructions, complications also occurred less frequently in older than younger women (38% versus 67%; p < 0.05). Between 1988 and 1992, 91 older women and 180 younger women underwent mastectomy for breast cancer; only 7% of older women versus 38% of younger women underwent breast reconstruction (p < 0.001). CONCLUSIONS: Breast reconstruction is a safe option for older women requiring mastectomy. The full array of reconstruction options (autogenous tissue or implants, immediate or delayed) should be considered for use in women of all ages.

Adult↗
PubMed1993

Isolated locally recurrent rectal cancer: a review of incidence, presentation, and management.

Locoregional recurrence after treatment for rectal cancer may be largely prevented by wide pelvic surgical margins, adjuvant radiotherapy, and chemotherapy. Approximately half of these recurrences will present with recurrence only at the surgical site; one third to one half will be resectable with conventional surgical procedures, but the rest will require extended resections, including sacrum and hypogastric vessels, to achieve clean margins. Only a small fraction of those treated will be cured. There is no proof that radiotherapy or chemotherapy added to surgical excision afford better results, since no trials have been or are likely to occur, given the rarity of the situation. However, best results seem to follow multimodality therapy using complete surgical resection and radiotherapy (IORT or brachytherapy with or without teletherapy) with chemopotentiation. Yet, there is no multimodality series with a sufficient number of patients and follow-up period to be able to distinguish the actual value of the treatment and which patients are most likely to benefit. It is important to note that there will be some patients with second LRR who can be further aided by aggressive locoregional therapy.

Brachytherapy↗
PubMed1993

The permeability of tissue expanders to bacteria: an experimental study.

Infection is an occasional but serious complication of tissue expansion. Bacteria in many cases are found both inside and outside the expander. The mechanism of how they spread inside and out is not fully understood. In the current study, we have assessed both the expander membranes (n = 28) and the port (n = 42) in terms of leakage and transmission of Staphylococcus aureus in normal expansion (100 percent) and overexpansion (400 percent) in an in vitro model. Our results indicate that the membrane was impermeable to S. aureus, whereas the bacteria were able to migrate freely through the puncture sites in the ports.

Cell Membrane Permeability↗
PubMed1993

Breast reconstruction at a district general hospital.

Breast reconstruction is normally carried out by plastic surgeons, but the advent of permanent tissue expanders places post-mastectomy reconstruction within easy reach of the general surgeon. Nineteen patients underwent breast reconstruction between 1989 and 1991 using a subpectoral silicone-based, double lumen tissue expander. Assessment of results was by: (a) patient completed questionnaire; and (b) third party evaluation of standardized photographs. The mean operating time was 58 min (40-80 min) and mean hospital stay 3 days (2-7 days). Complications included one flap necrosis and one leaking injection port. Outpatient tissue expansion required an average of seven visits (4-11) and was completed in an average of 12 months (7-19). The injection port was subsequently removed under local anaesthetic as a day case. The fully dressed appearance following reconstruction was graded good or excellent by 100% of patients and in over 80% of third-party assessments. Equivalent figures for the appearance when wearing a bra were 93% and 60% and undressed 57% and 47%, respectively. All patients recommended the procedure but 25% found inflation uncomfortable. Subpectoral tissue expansion is a safe, cosmetically acceptable method of breast reconstruction which is associated with a high level of patient satisfaction.

Breast↗
PubMed1993

[Baldness: indications].

The author presents his indications for the various types of baldness. Grafts, for which the technique used has been recently modified, allow covering small patches of alopecia, especially on the anterior frontal line. High-hinged flaps are used for more advanced baldness. Lastly, scalp lift and scalp expansion allow solving the problem of extensive baldness of the vertex and of the anterior frontal line.

Adult↗
PubMed1993

[Forum on tissue expansion. Conclusion. How to master expansion...].

The author presents several reflections based on more than ten years of experience with skin expansion. In order to master expansion, a number of rules must be respected at each step of the procedure:--start by defining the treatment plan,--choose appropriate material,--apply the expander(s) according to a rigorous approach,--prevent and treat all complications,--ensure sufficient expansion to eradicate the entire lesion. The authors views are illustrated by particular clinical examples using expanded transposition flaps: treatment of extensive baldness, ear reconstruction, repair of major sequelae of thoraco-abdominal burns.

Alopecia↗