Microsurgical breast reconstruction and primary hypercoagulable disorders.

Background: Primary hypercoagulable disorders pose a significant challenge to microsurgeons and have traditionally been regarded as a relative contraindication to free tissue transfer. Since free flaps offer numerous advantages in breast reconstruction, there is an effort to expand the population to whom these operations can be safely offered. The purpose of this study is to describe our chemoprophylaxis regimen in cases of primary hypercoagulability, as well as to compare flap outcomes and complications between women with and without hypercoagulability.

Clinical course of venous thromboembolism following abdominally based microsurgical breast reconstruction: A case series.

Background: Venous thromboembolism (VTE) is a potentially devastating complication following abdominally based microsurgical breast reconstruction, with a reported incidence of 0.08-4%. The authors aim to describe disease presentation and clinical course following VTE diagnosis in patients within their practice.

Microsurgical Breast Reconstruction in the Obese: A Better Option Than Tissue Expander/Implant Reconstruction?

Background: Obesity has reached epidemic proportions, with 72 million people in the United States classified as obese in 2010. This significant increase in obese patients is reflected in the breast cancer population seeking breast reconstruction. Previous studies demonstrated increased complication rates and decreased satisfaction in obese patients undergoing breast reconstruction.

Discussion of preoperative mammography in women undergoing reduction mammaplasty.

Purpose: Reduction mammaplasty is one of the most common procedures performed by plastic surgeons. Previous studies demonstrated that most plastic surgeons do not require preoperative mammography prior to reduction mammaplasty. The incidental discovery of malignant or high-risk lesions in breast reduction specimens may preclude the possibility of breast-conserving surgery.

Current Practices in the Management of Postoperative Arterial Vasospasm in Microsurgery.

Background:  Postoperative microvascular arterial vasospasm is a rare clinical entity. There are no published management algorithms and also the pathophysiology of this phenomenon has not been elucidated.

Methods:  An email survey of American Society for Reconstructive Microsurgery (ASRM) and World Society for Reconstructive Microsurgery (WSRM) members regarding their experiences with postoperative arterial vasospasm was conducted, returning 116 responses.

Endoscopic-assisted Fascial Decompression for Forearm Exertional Compartment Syndrome: A Case Report and Review of the Literature.

A case of chronic exertional compartment syndrome of the forearm treated with endoscopic-assisted fascial decompression is presented. The diagnosis of exertional compartment syndrome of the forearm was confirmed by direct measurement of intracompartmental pressures. Following endoscopic-assisted fascial decompression, the patient was able to begin rehabilitation therapy within 2 weeks.

Oblique pedicled paraumbilical perforator-based flap for reconstruction of complex proximal and mid-forearm defects: a report of two cases.

Reconstruction of complex proximal and mid-forearm wounds can be challenging. Free tissue transfer might not be feasible in certain patients or at institutions lacking microsurgical expertise and equipment. Traditional pedicled flaps are either insufficient in length to reach more proximal forearm defects or are used sparingly due to donor site complications and extremity stiffness.

Advancing deep inferior epigastric artery perforator flap breast reconstruction through multidetector row computed tomography: an evolution in preoperative imaging.

Perforator flaps have become increasingly popular tools in microvascular breast reconstruction. Previous criticism of these techniques, particularly deep inferior epigastric artery perforator (DIEAP) flap, have included the variability in the path of the perforators through the rectus muscle, the tedious and time-consuming need to look for and to clamp various perforators to determine the "dominant" perforator, and uncertainty whether adequate perforators exist following previous abdominal surgery. Preoperative imaging has contributed significantly to the reliability, speed, and minimal donor site morbidity of these procedures.

Shaping the breast in aesthetic and reconstructive breast surgery: an easy three-step principle. Part IV--aesthetic breast surgery.

This is part IV of four articles describing the three-step principle for easy shaping of the breast in reconstructive and aesthetic breast surgery. This article may seem overdue because aesthetic corrections are routinely performed, frequently written about, and easier to execute, as no prior ablative surgery or radiotherapy has damaged the gland. Nevertheless, a number of difficult aesthetic breast surgery cases can present themselves that might be more challenging to correct (e.

Shaping the breast in aesthetic and reconstructive breast surgery: an easy three-step principle. Part III--reconstruction following breast conservative treatment.

Of the relatively few studies that exist regarding the cosmetic satisfaction of patients following breast conservation therapy, several indicate significant dissatisfaction in many patients. Breast conservation often results in some of the most challenging and complex reconstructive problems. Indeed, even defining the problem or analyzing the defect can be difficult for the junior surgeon.

Shaping the breast in aesthetic and reconstructive breast surgery: an easy three-step principle. Part II--Breast reconstruction after total mastectomy.

This is Part II of four parts describing the three-step principle being applied in reconstructive and aesthetic breast surgery. Part I explains how to analyze a problematic breast by understanding the main anatomical features of a breast and how they interact: the footprint, the conus of the breast, and the skin envelope. This part describes how one can optimize results with breast reconstructions after complete mastectomy.

Shaping the breast in aesthetic and reconstructive breast surgery: an easy three-step principle.

Creating or recreating an aesthetically pleasing breast shape in reconstructive and aesthetic breast surgery is an act that most experienced "breast" surgeons will find self-evident. We propose a simple three-step philosophical and hands-on approach that will make it easier for young and unexperienced plastic surgeons to not only analyze the problematic breast but also come up with an easy surgical strategy to create reproducible results.This is Part I of four parts describing the three-step principle being applied in reconstructive and aesthetic breast surgery.

Surgical technique in pedicled thoracodorsal artery perforator flaps: a clinical experience with 99 patients.

Background: The thoracodorsal artery perforator flap is considered a technically difficult flap because of significant anatomical variations in perforator location. The authors' strategy to facilitate the harvest of these flaps includes careful preoperative mapping of perforators and a standardized planning and harvesting technique. The authors evaluated 99 pedicled thoracodorsal artery perforator flaps, with an emphasis on preoperative planning, surgical technique, and analysis of complications.

Autologous breast augmentation with the lateral intercostal artery perforator flap in massive weight loss patients.

The body contour deformities that develop in morbidly obese patients following bariatric surgery often involve the breasts. Mastopexy is virtually always required in the female massive weight loss patient, and breast augmentation is often an important adjunct to breast-lifting procedures. The lateral intercostal artery perforator (LICAP) pedicled flap provides ample material for autogenous breast augmentation in such patients.

Improved myoelectric prosthesis control accomplished using multiple nerve transfers.

Background: The control of shoulder-level disarticulation prostheses is significantly more difficult than that of prostheses for more distal amputations. Amputees have significant difficulties coordinating the separate functions of prosthetic shoulder, elbow, wrist, and hand/hook components. The user must lock one joint at a particular position in space before subsequently moving a different joint.

Transdermal sustained-delivery oxygen improves epithelial healing in a rabbit ear wound model.

Hypothesis: Transdermal sustained-delivery oxygen therapy improves wound healing.

Design: Experimental study using a well-established rabbit ear model for acute wound healing.

Setting: Wound-healing research laboratory in a university center.

Early results with use of gracilis muscle flap coverage of infected groin wounds after vascular surgery.

Introduction: Management of a nonhealing femoral wound after vascular surgery can pose a challenging problem, particularly when there is prosthetic material involved. We prefer to use pedicled gracilis muscle flaps (PGMFs) to cover problematic groin wounds when more conventional management is not possible.

Methods: We describe the technique for using PGMFs to provide groin coverage, report a summary of our short-term and long-term results, and describe why we prefer this reconstructive technique.

Platelet-derived growth factor B, but not fibroblast growth factor 2, plasmid DNA improves survival of ischemic myocutaneous flaps.

Hypothesis: Tissue flaps are commonly used for surgical reconstruction, especially to cover difficult wounds and in breast reconstruction following mastectomy. Complications due to inadequate flap perfusion are a source of morbidity and, in the lower extremity, can result in amputation.

Setting: Laboratory.