Unilateral Autologous Breast Reconstruction with Bi-pedicled, Conjoined Deep Inferior Epigastric Perforator Flaps.

Background:  The abdomen remains the most popular and reliable donor site for autologous breast reconstruction. Some patients, however, lack sufficient tissue to recreate an aesthetic breast mound using a single-pedicle, deep inferior epigastric perforator (DIEP) flap, particularly when matching a contralateral native breast. The amount of abdominal skin and/or soft tissue reliably supplied by one vascular pedicle is frequently insufficient to adequately restore the breast skin envelope and "footprint.

Recurrence Rates Over 20 Years in the Treatment of Malignant Melanoma: Immediate Versus Delayed Reconstruction.

Unlabelled: Wide local excision (WLE) with a safety margin is the standard of treatment for primary head and neck cutaneous malignant melanoma (HNCMM). Studies have demonstrated inconsistency in recurrence rates following immediate versus delayed reconstruction. The objectives of this study were to assess and compare recurrence rates after WLE of HNCMM followed by immediate or delayed reconstruction in determining recurrence-free survival estimates.

Oxygen-Sensing Paint-On Bandage: Calibration of a Novel Approach in Tissue Perfusion Assessment.

Background: Knowledge of tissue oxygenation status is fundamental in the prevention of postoperative flap failure. Recently, the authors introduced a novel oxygen-sensing paint-on bandage that incorporated an oxygen-sensing porphyrin with a commercially available liquid bandage matrix. In this study, the authors extend validation of their oxygen-sensing bandage by comparing it to the use of near-infrared tissue oximetry in addition to Clark electrode measurements.

National and Regional Differences in 32,248 Postmastectomy Autologous Breast Reconstruction Using the Updated National Inpatient Survey.

Background: The incidence of breast cancer (BC) cases has increased significantly. The number of breast reconstruction (BR) procedures performed has mirrored this trend. Although implant-only procedures remain the most commonly used type of immediate BR, autologous techniques involving donor sites account for approximately 20%.

Preoperative CT-angiography in autologous breast reconstruction.

Background: CT-angiography (CTA) has been introduced as a means of evaluating arterial anatomy and vascular integrity prior to free autologous breast reconstruction. There is limited published data, however, regarding the incidence, indications, and impact of preoperative CTA (pCTA) on procedural and flap outcomes.

Methods: Retrospective review was performed of all autologous microsurgical breast reconstruction procedures at a single academic center between January 2004 and July 2014.

Increased Osteoid Formation in BMP-2-Loaded Silk-Based Screws.

Background: Resorbable osteosynthesis systems are used to treat craniofacial fractures. However, conventional synthetic polyester materials are potentially associated with inflammatory reaction and negative host response and may result in incomplete bone remodeling. The authors have developed a resorbable silk fibroin-based osteosynthesis system and propose that silk screws loaded with bone morphogenetic protein-2 (BMP-2) may exhibit biocompatibility and promote bone remodeling.

Does Increased Experience with Tissue Oximetry Monitoring in Microsurgical Breast Reconstruction Lead to Decreased Flap Loss? The Learning Effect.

Background: Early studies have shown that near-infrared monitoring with tissue oximetry shows promise in providing earlier detection of free flap vascular compromise. However, large-scale clinical evaluation of this technology on flap outcome has not previously been established. This study examines the effect of tissue oximetry on flap reexploration rates and salvage over a 10-year period.

Analyzing Regional Differences over a 15-Year Trend of One-Stage versus Two-Stage Breast Reconstruction in 941,191 Postmastectomy Patients.

Background: Implant-based reconstruction is the predominant form of breast reconstruction, with the two-stage tissue expander/implant approach being the most popular. Recently, the direct-to-implant, one-stage breast reconstruction procedure has gained momentum. In this study, national and regional trends across the United States for the two different types of implant-based reconstructions were evaluated.

The Current Role of Three-Dimensional Printing in Plastic Surgery.

Since the advent of three-dimensional printing in the 1980s, it has become possible to produce physical objects from digital files and create three-dimensional objects by adding one layer at a time following a predetermined pattern. Because of the continued development of inexpensive and easy-to-use three-dimensional printers and bioprinting, this technique has gained more momentum over time, especially in the field of medicine. This article reviews the current and possible future application of three-dimensional printing technology within the field of plastic and reconstructive surgery.

The Current Role of Three-Dimensional (3D) Printing in Plastic Surgery.

Since the advent of three-dimensional (3D) printing in the 1980s, it is now possible to produce physical objects from digital files and create 3D objects by adding one layer at a time following a predetermined pattern. Due to the continued development of inexpensive and easy- to- use 3D printers and bioprinting, this technique has gained more momentum over time, especially in the field of medicine. This paper reviews the current and possible future application of 3D printing technology within the field of plastic and reconstructive surgery.

Readability of online patient resources for melanoma.

Medical information is often difficult for patients to understand. With specialized vocabulary and complex pathophysiology, even well-educated adults have trouble interpreting information about their healthcare. The average American adult reads at a seventh-grade level.

Is There an Association between Component Separation and Venous Thromboembolism? Analysis of the NSQIP.

Background: Patients undergoing incisional/ventral hernia repair are at risk of developing several postoperative complications particularly venous thromboembolism (VTE), which is a major cause of morbidity and mortality. The aim of this study was to assess 30-day postoperative morbidity and mortality of patients undergoing incisional/ventral hernia repair and to determine the association between component separation and VTE.

Methods: We reviewed the 2005-2011 American College of Surgeons National Surgical Quality Improvement Program databases to identify patients undergoing incisional/ventral hernia repair.

Acellular Dermal Matrix in Reconstructive Breast Surgery: Survey of Current Practice among Plastic Surgeons.

Background: Acellular dermal matrices (ADMs) in plastic surgery have become increasingly popular particularly for breast reconstruction. Despite their advantages, questions exist regarding their association with a possible increased incidence of complications. We describe a collective experience of plastic surgeons' use of ADMs in reconstructive breast surgery using an internet-based survey.

Bipedicle-conjoined perforator flaps in breast reconstruction.

Background: For some patients seeking autologous breast reconstruction, there may be insufficient abdominal skin and soft tissue to reconstruct an adequately sized breast. Perfusion from a single-pedicle deep inferior epigastric perforator artery flap has a high degree of variability across the midline, and this further limits perfusion. We have found that bipedicle-conjoined abdominal perforator flaps are a novel and reliable technique for reconstruction in these women, and this study examines our experience.

Does acellular dermal matrix really improve aesthetic outcome in tissue expander/implant-based breast reconstruction?

Background: The expectation for improved results by women undergoing postmastectomy reconstruction has steadily risen. A majority of these operations are tissue expander/implant-based breast reconstructions. Acellular dermal matrix (ADM) offers numerous advantages in these procedures.

Tumescent mastectomy technique in autologous breast reconstruction.

Background: Use of the tumescent mastectomy technique has been reported to facilitate development of a hydrodissection plane, reduce blood loss, and provide adjunct analgesia. Previous studies suggest that tumescent dissection may contribute to adverse outcomes after immediate implant reconstruction; however, its effect on autologous microsurgical reconstruction has not been established.

Methods: A retrospective review was conducted of all immediate microsurgical breast reconstruction procedures at a single academic center between January 2004 and December 2013.

Are patients with low body mass index candidates for deep inferior epigastric perforator flaps for unilateral breast reconstruction?

Thin women have not traditionally been considered ideal candidates for autologous breast reconstruction. The purpose of this study was to examine the use of deep inferior epigastric perforator (DIEP) flap reconstruction in thin women undergoing immediate unilateral breast reconstruction. A retrospective review of 1,040 consecutive patients was performed.

Highest Impact Articles in Microsurgery: A Citation Analysis.

Background: Microsurgery has developed significantly since the inception of the first surgical microscope. There have been few attempts to describe "classic" microsurgery articles. In this study citation analysis was done to identify the most highly cited clinical and basic science articles published in five peer-reviewed plastic surgery journals.

Analysis of morbidity and mortality in patients undergoing skull base reconstruction.

The relative rarity of skull base tumors has limited surgeons' ability to report on morbidity and mortality in a large and nationwide patient series. We aimed to assess the impact of reconstructive procedures on patients undergoing skull base surgery and to determine whether 30-day postoperative morbidity and mortality varied between patients who underwent reconstruction and those who did not. We performed a retrospective analysis using American College of Surgeons National Surgical Quality Improvement Program 2005 to 2012 databases.

Absorbable biologically based internal fixation.

Absorbable devices for use in internal fixation have advanced over the years to become reliable and cost-effective alternatives to metallic hardware. In the past, biodegradable fixation involved a laborious implantation process, and induced osteolysis and inflammatory reactions. Modern iterations exhibit increased strength, smoother resorption, and lower rates of reactivity.

Non-invasive transdermal two-dimensional mapping of cutaneous oxygenation with a rapid-drying liquid bandage.

Oxygen plays an important role in wound healing, as it is essential to biological functions such as cell proliferation, immune responses and collagen synthesis. Poor oxygenation is directly associated with the development of chronic ischemic wounds, which affect more than 6 million people each year in the United States alone at an estimated cost of $25 billion. Knowledge of oxygenation status is also important in the management of burns and skin grafts, as well as in a wide range of skin conditions.

Rapid prototyped sutureless anastomosis device from self-curing silk bio-ink.

Sutureless anastomosis devices are designed to reduce surgical time and difficulty, which may lead to quicker and less invasive cardiovascular anastomosis. The implant uses a barb-and-seat compression fitting composed of one male and two female components. The implant body is resorbable and capable of eluting heparin.

Patient selection optimization following combined abdominal procedures: analysis of 4925 patients undergoing panniculectomy/abdominoplasty with or without concurrent hernia repair.

Background: Massive weight loss following bariatric surgery causes unwanted excess skin and subcutaneous tissue. Intraoperative abdominal wall exposure during abdominal contouring surgery provides the possibility for concurrent ventral, umbilical, or inguinal hernia repair. The authors evaluated the incidence of postoperative complications following abdominal contouring surgery with or without concurrent hernia repair and the impact of surgical specialty.