Breast reconstruction with tissue expanders: implementation of a standardized best-practices protocol to reduce infection rates.

Background: Periprosthetic infection remains a frustrating and costly complication of breast reconstruction with tissue expanders. Although some specific steps have been previously shown to reduce periprosthetic infections, no comprehensive protocol addressing all aspects of preoperative, intraoperative, and postoperative patient management has been evaluated in the literature. The authors' goal was to evaluate the effectiveness of their protocol at reducing periprosthetic infections.

Aesthetic outcomes in women undergoing breast-conserving therapy followed by mastectomy and microsurgical reconstruction.

Background: In women with early-stage breast cancer, breast-conserving therapy (BCT) provides comparable survival to mastectomy. BCT has the advantage of preserving most of the breast, its skin envelope and the nipple-areola complex. However, deformity may result from the excision of significant amounts of breast tissue, as well as radiation therapy.

External hemipelvectomy pelvic ring stabilization: the unique application of chimeric lower extremity pedicled fillet flaps.

Reconstruction of large external hemipelvectomy oncologic defects of the proximal limb and trunk remains a formidable surgical challenge. Large pelvic defects can result in exposed bones, neurovascular structures, and surgical hardware due to a paucity of soft tissue coverage. When the size of a hemipelvectomy defect precludes coverage by local posterior- or anterior-based hemipelvectomy flaps, the use of other local flaps must be considered before resorting to free tissue transfer.

Evaluating sterile human acellular dermal matrix in immediate expander-based breast reconstruction: a multicenter, prospective, cohort study.

Background: Human acellular dermal matrices have gained increasing use in immediate expander-based breast reconstruction. However, some studies suggest that these grafts may be associated with a higher incidence of infection and seroma. To evaluate complication rates after matrix-based breast reconstruction, the authors conducted a prospective, multicenter, cohort study to evaluate a sterile human acellular dermal matrix in immediate expander-based breast reconstruction, specifically, to determine whether it offered a more favorable risk profile with respect to infection and seroma.

Reconstruction of an external hemipelvectomy defect with a two-stage fillet of leg-free flap.

The defect created by external hemipelvectomy for bone and soft tissue tumor resection is a challenge to reconstruct because of the exposure of bone, neurovascular structures, and peritoneal contents, particularly in the setting of previous radiotherapy. In a nonsalvageable limb with extensive tumor involvement and radiation damage, a free fillet of leg flap can be used to provide the necessary large volume of tissue for reconstruction without donor site morbidity. Because of the lengthy operative time for the hemipelvectomy procedure, the fillet of leg flap may be subject to long ischemia time and a subsequently compromised outcome.

Independent risk factors for infection in tissue expander breast reconstruction.

Background: Postoperative infection in tissue expander breast reconstruction causes increased morbidity, cost, and suboptimal patient outcomes. To improve outcomes, it is important to preoperatively identify factors that might predispose to infection and minimize them when possible. It is hypothesized that certain patient characteristics are associated with an increased infection rate.

Decreased narcotic use with an implantable local anesthetic catheter after deep inferior epigastric perforator flap breast reconstruction.

This study evaluated narcotic use after deep inferior epigastric perforator flap breast reconstruction when a local anesthetic catheter was used. A retrospective analysis was performed comparing 40 consecutive control patients (no catheter) to 40 consecutive study patients who had received a pain pump catheter. The catheter was left in the abdomen for 72 hours.

Outcomes of various techniques of abdominal fascia closure after TRAM flap breast reconstruction.

Background: There is no consensus regarding the optimal technique for closure of the abdominal fascia after transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction. The authors reviewed outcomes with various techniques to identify the optimal one.

Methods: The authors reviewed the charts of 81 consecutive patients who underwent TRAM flap breast reconstruction at their institution from 2002 to 2005.

Options in reconstructing the irradiated breast.

Background: As radiation therapy becomes more prevalent in the treatment of breast cancer, more patients requesting breast reconstruction for mastectomy defects will have a history of radiation therapy.

Methods: A retrospective chart review study was performed of a single surgeon's 5-year experience with reconstruction of the irradiated breast.

Results: Sixty-six primary patients and 13 secondary patients were treated over a 5-year period (2001-2005).

Reconstructive application of the endotine suspension devices.

Objective: To illustrate the potential reconstructive opportunities that the Endotine suspension devices can provide for patients with soft tissue ptosis secondary to facial nerve dysfunction, posttraumatic deformity, and postablative deformity.

Methods: A review was performed of 23 Endotine midface and eyebrow suspension devices in 10 patients with facial nerve sacrifice, facial trauma, or tumor extirpation.

Results: A total of 12 midface and 11 eyebrow suspension devices were used in 10 patients.

The role of the latissimus dorsi flap in reconstruction of the irradiated breast.

Background: The role of the latissimus dorsi flap with a prosthesis in reconstruction of the previously irradiated breast is examined in this retrospective review of one surgeon's 10-year experience.

Methods: Twenty-eight patients with available charts were divided into five groups: (1) 11 patients with previous breast conservation therapy and recurrence; (2) eight patients with previous mastectomy and radiation; (3) four patients with an expander that had been irradiated; (4) three patients with prior irradiation and implant reconstruction presenting for revision; and (5) two patients with breast deformity from breast conservation therapy.

Results: Eighteen patients had a latissimus flap placed at the time of the expander and 10 had a latissimus flap at the time of implant placement or exchange.

Augmentation/mastopexy: a 3-year review of a single surgeon's practice.

Background: Augmentation/mastopexy is of considerable interest to plastic surgeons who perform breast surgery because of its complexity as well as its high rate of legal claims.

Methods: This single-surgeon, 3-year study evaluated complications, outcomes, and reoperation rates among 166 patients who underwent 171 procedures for primary and secondary augmentation and primary and secondary augmentation/mastopexy. Aspects of the treatment plan were reviewed, including classification of ptosis, procedure selection, surgical planning, and operative technique.

Repairing esophageal perforations with a transverse cervical musculofascial flap.

Objectives/hypothesis: Although rare, perforations of the esophagus following spinal surgery via an anterior approach are serious life-threatening problems. Complications include abscess formation, mediastinitis, sepsis, and fistula that can carry a mortality rate of 20%-50%. Early diagnosis and treatment are imperative.

Vascularized rib for facial reconstruction.

The reconstruction of maxillectomy defects is a complex problem encountered in plastic surgery. Defects can range in size and complexity from small defects requiring only soft tissue to complete maxillectomies requiring large tissue bulk, bone, and one or more skin paddles. The most difficult defects involve the skull base and orbit.

The infected or exposed breast implant: management and treatment strategies.

Among the potential complications associated with the use of breast implants are the risks of periprosthetic infection and device extrusion. There is little published information about the effective management of these situations. Conservative recommendations include antibiotic therapy and removal of the implant until resolution of the infection or until the wound has healed.