Evidence-Based Clinical Practice Guideline: Reconstruction after Skin Cancer Resection.

A multi-disciplinary work group involving stakeholders from various backgrounds and societies was convened to develop guidelines for the management of reconstruction after skin cancer resection. The goal was to identify areas of common ground and provide evidence-based recommendations to improve patient care. Given the heterogeneity of reconstructive techniques and clinical scenarios, investigation centered around common elements in the process.

Evidence-based clinical practice guideline: Reconstruction after skin cancer resection.

A multi-disciplinary work group involving stakeholders from various backgrounds and societies was convened to develop guidelines for the management of reconstruction after skin cancer resection. The goal was to identify areas of common ground and provide evidence-based recommendations to improve patient care. Given the heterogeneity of reconstructive techniques and clinical scenarios, investigation centered around common elements in the process.

Evidence-Based Clinical Practice Guideline: Reconstruction after Skin Cancer Resection.

A multi-disciplinary work group involving stakeholders from various backgrounds and societies was convened to develop guidelines for the management of reconstruction after skin cancer resection. The goal was to identify areas of common ground and provide evidence-based recommendations to improve patient care. Given the heterogeneity of reconstructive techniques and clinical scenarios, investigation centered around common elements in the process.

Anchored Transosseous-Equivalent Versus Anchorless Transosseous Rotator Cuff Repair: A Biomechanical Analysis in a Cadaveric Model.

Background: The original approach for the repair of torn rotator cuffs involved an open technique with sutures passing through the greater tuberosity and tendon. The development of suture anchors allowed for an all-arthroscopic approach with anchor configurations attempting to re-create a transosseous fixation pattern. Presently, an arthroscopic approach can be combined with a transosseous suture configuration without using anchors.

Breast reconstruction using a staged nipple-sparing mastectomy following mastopexy or reduction.

Background: To address those patients who do not meet anatomical criteria for nipple-sparing mastectomy, the authors use a staged approach: (1) mastopexy or breast reduction, (2) nipple-sparing mastectomy through the mastopexy incisions after a minimum of 3 to 4 weeks, and (3) the final reconstruction.

Methods: Fifteen patients underwent nipple-sparing mastectomy at Georgetown University Hospital between 2007 and 2010 after planned or unrelated mastopexy or reduction. An institutional review board-approved retrospective chart review recorded demographic information and outcomes such as skin necrosis and device failure.

Nipple-sparing mastectomy for prophylactic and therapeutic indications.

Background: Nipple-sparing mastectomy remains controversial and its adoption has been slow because of oncologic and surgical concerns.

Methods: A retrospective study evaluated all nipple-sparing mastectomies performed at a single institution for therapeutic or prophylactic indications for which records were available.

Results: Between 1989 and 2010, 162 nipple-sparing mastectomies were performed in 101 women.

A head-to-head comparison of quality of life and aesthetic outcomes following immediate, staged-immediate, and delayed oncoplastic reduction mammaplasty.

Background: Oncoplastic reduction mammaplasty offers patients breast conservation with the added benefit of functional improvement in symptoms related to macromastia. The reduction can be performed in the immediate setting with the lumpectomy, in a staged-immediate fashion after final pathology has been confirmed or in a delayed fashion after completion of both lumpectomy and radiation. This study compared quality of life and aesthetic outcomes for these different cohorts.

Special considerations in the management of osteomyelitis defects (diabetes, the ischemic or dysvascular bed, and irradiation).

Although osteomyelitis is a difficult problem, certain conditions make it even more difficult to address. Diabetes, peripheral vascular disease, and radiation are all comorbidities that interfere with wound healing and therefore make the treatment of osteomyelitis challenging. In this article, we discuss these conditions, their pathophysiology, and highlight the special considerations in treating osteomyelitis in patients with these comorbidities.

Nipple-sparing mastectomy.

Background: The debate over nipple-sparing mastectomy continues to evolve. Over the past several years, it has become more widely accepted, especially in the setting of prophylactic mastectomy, but its role in the treatment of breast cancer has only recently been reexamined.

Methods: Two indications for the procedure are discussed: prophylactic, for the high-risk patient; and the more controversial topic, therapeutic nipple-sparing mastectomy, for the patient with breast cancer.

Surgical algorithm for management of HIV lipodystrophy.

Background: The accepted standard for treatment of human immunodeficiency virus disease, highly active antiviral therapy, may cause significant side effects, such as facial lipoatrophy and lipodystrophy. Facial wasting or a buffalo hump deformity may be pathognomonic for treated human immunodeficiency virus disease. In addition to facial wasting, cystic parotid degeneration may further distort the face.

The effect of smoking on flap and donor-site complications in pedicled TRAM breast reconstruction.

Background: The detrimental effects of smoking on pedicled and free flap reconstruction are well documented. The purpose of this study was to examine the effect of smoking on flap, donor-site, and other individual and multiple complications in pedicled transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction.

Methods: A retrospective review was carried out of 224 pedicled TRAM flaps in 200 patients over a 10-year period.

Safety and risk factors for breast reconstruction with pedicled transverse rectus abdominis musculocutaneous flaps: a 10-year analysis.

Background: The purpose of this study is to examine the effect of various risk factors on complications in patients undergoing pedicled transverse rectus abdominis musculocutaneous (TRAM) flap breast reconstruction.

Methods: A retrospective review of 224 pedicled TRAMs in 200 patients over a 10-year period was carried out. Patients were divided into subgroups based on smoking history, weight, radiation status, and pedicle type.