The cardiac implications of breast reconstruction using the internal mammary artery as the recipient vessel.

Background: Microsurgical breast reconstruction is a popular choice in breast reconstruction. Recipient vessel use for these autologous tissue reconstructions has shifted from the thoracodorsal to the internal mammary vessels. Coronary artery bypass (CAB) surgery remains the optimal revascularization strategy in patients with significant, diffuse coronary artery disease.

Can internal thoracic arteries be used for both coronary artery bypass and breast reconstruction?

Objectives: Recently, the internal thoracic arteries have been preferentially used in autologous breast reconstruction at the levels of the third or fourth intercostal spaces. This may compromise future treatment of occult coronary disease. We hypothesized that internal thoracic artery length at the fourth intercostal space would allow both breast reconstruction and future coronary artery bypass grafting (CABG).

Feasibility of internal mammary vessel use in breast reconstruction versus coronary artery bypass surgery: an anatomic, cadaveric evaluation.

Background: Autologous free flap breast reconstruction using the internal mammary artery is common; however, its use may compromise treatment of occult coronary artery disease. The authors investigated whether internal mammary artery harvest for breast reconstruction is compatible with future use for coronary bypass.

Methods: An anatomic analysis of 10 preserved female cadavers was performed.

Klebsiella oxytoca necrotizing fasciitis after orthotopic heart transplant.

We report a case of Klebsiella necrotizing fasciitis after heart transplantation. The infection required debridement of discontinuous areas on three extremities as well as on the trunk. Klebsiella sp necrotizing fasciitis is a rare entity and has not been described previously in concert with heart transplantation.

Reconstruction of the pelvic ring with vascularized double-strut fibular flap following internal hemipelvectomy.

Background: After internal hemipelvectomy, successful pelvic reconstruction can provide a durable and pain-free reconstruction for the young, active patient. Such reconstruction is extremely challenging, and often patients have less than optimal ambulation with a limp, leg length discrepancy, or leg instability. The authors present an innovative method for pelvic ring reconstruction using a vascularized double-strut fibular bone flap that provides a stable pelvis and recovery of normal or near-normal gait.

Cosmetic outcomes following breast conservation therapy: in search of a reliable scale.

Introduction: Multiple scales to evaluate breast cosmesis following breast conserving treatment (BCT) have been developed, however reliability is a problem. Panel scores, where scores from two or more individuals are combined, were assessed to examine their effect on reliability for two different cosmetic scales.

Methods: Women, two or more years following BCT, were recruited from a single breast centre.

Thoracodorsal artery perforator (TAP) flap reconstruction of a soft-tissue defect of the knee following below-knee amputation.

Soft-tissue coverage of lower extremity defects with thin, sensate, mobile, and durable soft tissue is challenging. Reconstructive options are further limited in the setting of a below-knee amputation. The authors present the first report of an innervated thoracodorsal artery perforator (TAP) flap for coverage of an anterior knee soft-tissue defect in a patient with bilateral below-knee amputations following disseminated meningococcemia.