Reversal of epigenetic aging and immunosenescent trends in humans.

Epigenetic "clocks" can now surpass chronological age in accuracy for estimating biological age. Here, we use four such age estimators to show that epigenetic aging can be reversed in humans. Using a protocol intended to regenerate the thymus, we observed protective immunological changes, improved risk indices for many age-related diseases, and a mean epigenetic age approximately 1.

Comparison of superior gluteal artery musculocutaneous and superior gluteal artery perforator flaps for microvascular breast reconstruction.

Background: At the authors' institution, the superior gluteal artery musculocutaneous flap has been replaced by the superior gluteal artery perforator flap for autologous breast reconstruction. The authors present a head-to-head comparison of the two techniques.

Methods: A retrospective chart review of 102 gluteal flap transfers in 80 patients compared the two methods with regard to perioperative details, complications (especially anastomotic), and the number of secondary procedures required to achieve optimal outcome.

Risk factors for abdominal donor-site morbidity in free flap breast reconstruction.

Background: The lower abdomen is the most popular donor site for autologous tissue breast reconstruction. Several studies have reported abdominal morbidity following pedicled and free flap reconstructions using this donor site, yet few studies have compared the various types of free flaps and investigated specific operative and patient-related factors that are associated with higher rates of abdominal complications.

Methods: The authors conducted a retrospective review of all free flap breast reconstructions performed at University of California Los Angeles Medical Center between July of 2002 and July of 2005.

Late free-flap salvage with catheter-directed thrombolysis.

Introduction: Despite high success rates with free-tissue transfer, flap loss continues to be a devastating event. Flap salvage is often successful if vascular complications are recognized and treated early. However, delayed presentation of flap compromise is an ominous predictor of flap loss.

Complications after microvascular breast reconstruction: experience with 1195 flaps.

Background: Reconstruction is an important adjunct to breast cancer management. This study evaluated the frequency of major and minor complications in the largest reported series of consecutive mastectomy patients treated with free tissue transfer for breast reconstruction.

Methods: All patients treated with microvascular breast reconstruction at the University of California, Los Angeles, Medical Center over an 11-year period were identified using a retrospective analysis.

Suction-assisted lipoplasty: physics, optimization, and clinical verification.

Background: Although suction-assisted lipoplasty (SAL) has been clinically practiced for more than 25 years, comparatively little investigation into fundamental physics of the instrumentation used in the procedure has been conducted. Moreover, relatively little is known about the clinical impact or merit of the wide variety of instrumentation currently available.

Objective: In this study, we examined the physics related to the various components of instrumentation used in lipoplasty, and developed means to optimize performance based on quantified bench and clinical data.

Improving recipient vessel exposure during microvascular breast reconstruction.

Microvascular tissue transfer has become the gold standard for breast reconstruction. The primary drawback to these procedures is the technical expertise required for microsurgical anastomosis. This problem is compounded by the difficulties in the exposure of recipient vessels deep within the axilla.

Reconstruction of composite through-and-through mandibular defects with a double-skin paddle fibular osteocutaneous flap.

Microsurgical reconstruction of composite through-and-through defects of the oral cavity involving mucosa, bone, and external skin has often required two free flaps or double-skin paddle scapular or radial forearm flaps for successful functional and aesthetic outcomes. A safe, reliable technique using a double-skin paddle fibular osteocutaneous flap to restore the intraoral lining, mandibular bone, and external skin is described. A large elliptical or rectangular skin paddle is designed 90 degrees to the longitudinal axis of the fibula, over the junction of the middle and distal thirds of the lower leg, based only on the posterolateral septocutaneous perforators.

Alternative venous outflow vessels in microvascular breast reconstruction.

The lack of adequate recipient vessels often complicates microvascular breast reconstruction in patients who have previously undergone mastectomy and irradiation. In addition, significant size mismatch, particularly in the outflow veins, is an important contributor to vessel thrombosis and flap failure. The purpose of this study was to review the authors' experience with alternative venous outflow vessels for microvascular breast reconstruction.

Surgical treatment of breast cancer in previously augmented patients.

The incidence of breast cancer is increasing each year. Concomitantly, cosmetic breast augmentation has become the second most often performed cosmetic surgical procedure. As the augmented patient population ages, an increasing number of breast cancer cases among previously augmented women can be anticipated.