The Biomechanical Properties of Meshed versus Perforated Acellular Dermal Matrices (ADMs).

Unlabelled: Acellular dermal matrices (ADMs) are used for soft tissue augmentation across surgical specialties. Since allograft incorporation depends on direct opposition between the ADM and a vascular bed, seroma formation can be detrimental to incorporation. Since most ADM products are available in many meshed and perforated forms, there is a lack of consistency between manufacture designs.

Inpatient Flap Monitoring after Deep Inferior Epigastric Artery Perforator Flap Breast Reconstruction: How Long Is Long Enough?

Background:  There is a growing trend across health care to perform increasingly complex procedures in less acute settings. This shift has been fueled, in part, by enhanced recovery protocols, which have shortened hospital stays after major surgeries. We set out to determine the timing of microvascular complications after deep inferior epigastric artery perforator (DIEP) free flap breast reconstruction in a high-volume practice using continuous flap monitoring technologies.

Evidence-Based Performance Measures: Quality Metrics for the Care of Patients Undergoing Breast Reconstruction.

The American Society of Plastic Surgeons commissioned the Breast Reconstruction Performance Measure Development Work Group to identify and draft quality measures for the care of patients undergoing breast reconstruction surgery. Two outcome measures were identified. The first desired outcome was to reduce the number of returns to the operating room following reconstruction within 60 days of the initial reconstructive procedure.

A Therapeutic Role for Survivin in Mitigating the Harmful Effects of Ionizing Radiation.

Background. Radiation therapy is a form of adjuvant care used in many oncological treatment protocols. However, nonmalignant neighboring tissues are harmed as a result of this treatment.

Patient attitudes toward resident participation in cosmetic vs reconstructive outpatient consultations.

Objectives: The goal of residency programs is to provide trainees with exposure to all aspects of their chosen field so that they exit the program ready to be independent practitioners. However, it is common in some plastic surgery residency training programs to exclude residents from participation in consultations with patients who are seeking cosmetic surgery. The purpose of this study was to determine whether cosmetic surgery patients had a different view about resident involvement than reconstructive surgery patients and to evaluate what factors might be linked to patient attitudes on this topic.

Improvement in stress urinary incontinence after abdominoplasty.

Background: Abdominoplasty is indicated in cosmetic surgery to improve body contour. Results from several studies suggest that abdominoplasty also could be therapeutic for certain individuals with urinary incontinence.

Objectives: The authors sought to determine the potential therapeutic effect of abdominoplasty on urinary incontinence in a large population to confirm the findings of smaller studies and to identify common characteristics of patients who experience the greatest improvement in these symptoms postoperatively.

Biologic matrices in oncologic breast reconstruction after mastectomy.

As the demand for post-mastectomy breast reconstruction has continued to rise, options for the implantable soft-tissue replacement products which enhance the aesthetic and reconstructive outcome of these procedures has grown as well. While the most common product used in an alloplastic breast reconstruction is an acellular dermal matrix derived from human sources, many other options are currently available, each offering their own unique properties and benefits. This review presents a concise description of each of the biologic matrices currently available and discusses their use in the context of one-stage and two-stage breast reconstructions.

A review of devices used in the monitoring of microvascular free tissue transfers.

The use of microvascular anastomoses to allow transfer of viable tissue is a fundamental technique of reconstructive surgery, and is used to treat a broad spectrum of clinical problems. The primary threat to this type of reconstructive surgery is anastomotic vascular thrombosis, which can lead to complete loss of tissue with potentially devastating consequences. Monitoring of tissue perfusion postoperatively is critical, since early recognition of vascular compromise and prompt surgical intervention is correlated with the ability for tissue salvage.

Optimizing the closed suction surgical drainage system.

Background: Closed suction drains are indicated in a wide array of postoperative settings, with many distinct drainage systems available to the surgeon. The purpose of this study was to compare the suction gradients achieved using 2 different sizes of suction reservoirs and 2 different techniques for generating negative pressure.

Materials And Methods: Drainage reservoirs of 100 and 400 ml were chosen to evaluate their ability to achieve suction.

Fat grafting as a vehicle for the delivery of recombinant adenoassociated viral vectors to achieve gene modification of muscle flaps.

Background: The combination of gene therapy and plastic surgery may have the potential to improve the specificity that is needed to achieve clinically applicable treatment regimens. Our goal was to develop a method for gene modification that would yield sustainable production of gene products but would be less time consuming than existing protocols.

Methods: An adenoassociated virus was used to deliver gene products to pectoralis muscle flaps.

The use of free microvascular techniques to improve the results of Van Nes rotationplasty.

Van Nes rotationplasty is a limb-salvage used for reconstruction after resection of a distal femoral or proximal tibial osteosarcoma in the pediatric patient. After resection, the distal leg is reapproximated to the level of tumor resection. The goal is to optimize extremity functionality such that the ankle functions as a knee joint.

Can the DermaClose device contribute to periwound tissue ischemia and necrosis: a case presentation and discussion?

The anterolateral thigh flaps allows for a large amount of vascularized skin and subcutaneous tissue for transfer as a locoregional flap or for microvascular free tissue transfer. In the settings of a large flap, primary closure of the donor site can be difficult. Multiple techniques, including the use of tissue expansion, can be used to assist with donor site closure.

Distal interphalangeal joint arthrodesis with the Herbert headless compression screw: outcomes and complications in 64 consecutively treated joints.

Background: Arthrodesis of the distal interphalangeal (DIP) joint is indicated for the treatment of arthritis. While several techniques have been recommended, the use of headless compression screws has grown in popularity. Rates of union reported vary widely, ranging from 80% to 100%, with most studies based on small series.

A reliable method for the preoperative estimation of tissue to be removed during reduction mammaplasty.

Background: Insurance requirements for prior authorization of reduction mammaplasty are becoming increasingly stringent, with the sole criterion determined by the surgeon being the estimation of the amount of tissue to be removed. Previous formulas for predicting resected tissue weights have been inconsistent and particularly unreliable in smaller reductions. This study describes a dependable, surgeon-specific method based on two simple preoperative measurements to estimate tissue resection weights in patients undergoing reduction mammaplasty.

One versus two venous anastomoses in microvascular free flap surgery.

Background: The authors' goal was to determine whether one or two venous anastomoses results in superior blood flow through microvascular free flaps.

Methods: During flap harvest, blood velocity was measured in each of two venae comitantes using Doppler ultrasonography. Next, one of the two veins was occluded with a microvascular clamp and blood velocity was measured in the open vein.

Combined use of preoperative 18F FDG-PET imaging and intraoperative gamma probe detection for accurate assessment of tumor recurrence in patients with colorectal cancer.

Background: The purpose of this study was to combine intraoperative gamma probe (GP) detection with preoperative fluorine 18-fluoro-2-deoxy-glucose positron emission tomography (18F FDG-PET) imaging in order to improve detection of tumor recurrence in colorectal cancer (CRC) patients.

Methods: Twenty-one patients (12 females, 9 males) with a mean age of 54 years (range 31-78) were enrolled. Patients were suspected to have recurrent CRC by elevated CEA (n = 11), suspicious CT findings (n = 1), and clinically suspicious findings (n = 9).

B7-deficient autoreactive T cells are highly susceptible to suppression by CD4(+)CD25(+) regulatory T cells.

CD4(+)CD25(+) regulatory T cells (Tregs) suppress immunity to infections and tumors as well as autoimmunity and graft-vs-host disease. Since Tregs constitutively express CTLA-4 and activated T cells express B7-1 and B7-2, it has been suggested that the interaction between CTLA-4 on Tregs and B7-1/2 on the effector T cells may be required for immune suppression. In this study, we report that autopathogenic T cells from B7-deficient mice cause multiorgan inflammation when adoptively transferred into syngeneic RAG-1-deficient hosts.

Image guidance during abdominal exploration for recurrent colorectal cancer.

Background: Real-time intraoperative image guidance has been successfully applied to malignancies of the head, neck and central nervous system. Few attempts have been made to apply this technology to gastrointestinal cancers. Our purpose was to determine if a computer-assisted navigation system could be accurately used at the time of abdominal exploration.

Immune competence of cancer-reactive T cells generated de novo in adult tumor-bearing mice.

The impact of timing of antigen introduction into fetus and neonates leads to the suggestion that pre-existing antigens are tolerogenic to immunocompetent cells generated thereafter. This hypothesis predicts that in patients with cancer who are undergoing bone marrow transplantation, newly produced T cells with specificity for pre-existing tumor cells will be inactivated by the tumor antigens in the host. Because the effect of tumor cells on developing cancer-reactive T cells has not been investigated, we set out to systematically analyze the impact of tumor cells in the periphery on the development of tumor-reactive T cells in the thymus and their immunocompetence in the periphery.

Combination therapy with anti-CTL antigen-4 and anti-4-1BB antibodies enhances cancer immunity and reduces autoimmunity.

The majority of cancer antigens identified thus far have limited expression in normal tissues. It has been suggested that autoimmune disease is a necessary price for cancer immunity. This notion is supported by a recent clinical trial involving an anti-CTL antigen-4 (CTLA-4) antibody that showed significant clinical responses but severe autoimmune diseases in melanoma patients.

Massive and destructive T cell response to homeostatic cue in CD24-deficient lymphopenic hosts.

In response to a lymphopenic cue, T lymphocytes undergo a slow-paced homeostatic proliferation in an attempt to restore T cell cellularity. The molecular interaction that maintains the pace of homeostatic proliferation is unknown. In this study, we report that in lymphopenic CD24-deficient mice, T cells launch a massive proliferation that results in the rapid death of the recipient mice.

Abdominal positron-emission tomography lesions with increased standardized uptake values correlate with intraoperative findings.

Background: The reporting of standardized uptake value (SUV) on fluoro-2-deoxy-D-glucose positron-emission tomography (FDG-PET) in colorectal cancer is becoming common practice, but its clinical utility remains to be determined. This study was designed to compare FDG-PET uptake as measured by SUV with operative findings.

Methods: A colorectal cancer database was queried to identify patients who underwent FDG-PET scans with reported SUVs followed by exploratory laparotomy within 3 months and compare these results to determine FDG-PET sensitivity.