A classification system and treatment algorithm for mastectomy flap ischemia in alloplastic breast reconstruction.

Background: Mastectomy flap necrosis remains a major cause of failed breast reconstruction with an associated significant financial/psychological burden. Language describing ischemic mastectomy flaps is imprecise as ischemia can result from many causes and can manifest in different ways. Similarly, management of mastectomy flap ischemia varies depending on its etiology.

Perfusion Zones of Extended Transverse Skin Paddles in Muscle-Sparing Latissimus Dorsi Myocutaneous Flaps for Breast Reconstruction.

Background: The authors report their experience using extended transversely oriented skin paddles in muscle-sparing latissimus dorsi pedicled flaps for breast reconstruction as an alternative to thoracodorsal artery perforator flaps.

Methods: A retrospective review was conducted of patients who underwent muscle-sparing latissimus dorsi flap pedicled breast reconstruction from January of 2009 to July of 2014 with at least 3-month follow-up. Surgical outcomes and complications were analyzed.

Autologous Fat Grafting in the Treatment of Cleft Lip Volume Asymmetry.

Background: The goal of cleft lip repair is a symmetrical balanced lip with minimal scar. Fat grafting is an established procedure in cosmetic and reconstructive surgery for restoration or correction of contour deformity, volume loss, and improved tissue characteristics. In this study, we evaluated the use of fat grafting in correction of cleft lip volume asymmetry.

Breast Reconstruction After Solid Organ Transplant.

Background: Solid organ transplant patients frequently develop posttransplant malignancies including breast cancer. They may desire breast reconstruction after mastectomy, which could potentially be complicated by their transplant status, immunosuppressive regimen, and previous operations. We review our experience with patients who have undergone solid organ transplant and subsequent breast reconstruction after mastectomy

Methods: After institutional review board approval, we queried our prospective breast reconstruction and solid organ transplant databases for corresponding patients.

Breast cancer recurrence in patients receiving epidural and paravertebral anesthesia: a retrospective, case-control study.

Purpose: Studies have suggested an association between the use of regional paravertebral or epidural anesthesia and a reduction in tumor recurrence following breast cancer surgery. To examine this relationship we performed a retrospective case-control study of patients undergoing breast cancer surgery receiving regional, regional and general, or general anesthesia.

Methods: A retrospective chart review was performed of patients undergoing surgery for stage 0 to III breast cancer.

An evaluation of trauma outcomes related to insurance status in patients requiring prehospital helicopter transport.

Introduction: Disparities in access to medical care and outcomes of medical treatment related to insurance status are documented. However, little attention has been given to the effect of health care funding status on outcomes in trauma patients. Hypothesis/Problem This study evaluated if adult trauma patients who arrived by air transport to a trauma center had different clinical outcomes based on their health insurance status.

A prospective randomized controlled trial comparing N-butyl-2 cyanoacrylate (Histoacryl), octyl cyanoacrylate (Dermabond), and subcuticular suture for closure of surgical incisions.

Introduction: The use of tissue adhesives for the closure of surgical incisions is increasing. Few studies directly compare tissue adhesives to one another or focus on the difference in wound closure time between tissue adhesives. We compared the use of N-butyl-2 cyanoacrylate (Histoacryl), octyl cyanoacrylate (Dermabond), or subcuticular suture in incisions resulting from reduction mammoplasty, mastopexy, panniculectomy, and abdominoplasty.

Evaluation of options for large scalp defect reconstruction: a 12-year experience.

Objective: Multiple options for reconstruction of scalp defects exist with local tissue advancement and free tissue transfer the mainstay of reconstruction. Over the last 12 years, our tertiary referral hospital has performed more than 150 scalp reconstructions. We reviewed our experience with large scalp defects and evaluated whether free tissue transfer is a viable first option for reconstruction.

Direct long bone invasion by Basal cell carcinoma: a case report and review of the literature.

Introduction: Basal cell carcinoma is the most prevalent form of cancer worldwide, usually arising in the head and neck region, which is cured by surgical excision and rarely invades or metastasizes. Many reports exist of bony invasion in the head and neck but very rarely into long bones.

Methods: We report an unusual case of basal cell carcinoma that despite surgical excision, directly invaded the left humerus.

Pharyngo-cutaneous fistula complicating laryngectomy in the chemo-radiotherapy organ-preservation epoch.

Pharyngo-cutaneous fistula is a serious complication of laryngectomy, with a significant associated morbidity and mortality. The oncologic success of organ-preservation protocols with radiotherapy or chemo-radiotherapy for laryngeal carcinoma means laryngectomy is increasingly reserved for surgical salvage in the event of persistent or recurrent disease. A retrospective review of fistula incidence after laryngectomy in 171 patients in a UK tertiary referral centre over the last decade was conducted to identify trends in this complication in the epoch of non-surgical organ preservation.

Predictors of accuracy in preoperative parathyroid adenoma localization using ultrasound and Tc-99m-Sestamibi: a 4-quadrant analysis.

Purpose: To compare the accuracy of preoperative parathyroid adenoma localization in patients with primary hyperparathyroidism (pHPT) due to a single adenoma using a detailed 4-quadrant analysis and to identify patient and tumor characteristics associated with accurate preoperative localization.

Materials And Methods: Retrospective review of 203 patients who underwent parathyroidectomy for pHPT due to a single adenoma between 2008 and 2011. Results from preoperative ultrasound and Tc-99m-sestamibi were compared to operative findings to determine accuracy of localization studies.

Breast surgery outcomes as quality measures according to the NSQIP database.

Background: The National Surgical Quality Improvement Program (NSQIP) is a risk-adjusted database designed to benchmark quality initiatives. NSQIP captures uniform morbidity variables for all operations and calculates expected morbidity probabilities. Given the frequent need for reoperation following breast-conserving surgery (BCS) and mastectomy, we hypothesized that NSQIP may inaccurately reflect surgical morbidity after breast cancer operations.

Persistent ischiorectal fistula with supralevator origin secondary to a chronic tubo-ovarian abscess: report of a case and review of the literature.

Background: Chronic tubo-ovarian abscess is an uncommon finding in postmenopausal women. This abscess may rupture or fistulize to adjacent organs into the ischiorectal space.

Case: A gravida three, para three, postmenopausal woman with extensive sigmoid diverticulosis presented with perianal fistula of 2 years' duration.

Latissimus dorsi myocutaneous flap for breast reconstruction: bad rap or good flap?

Objective: This article serves to review latissimus dorsi myocutaneous flap as an option for breast reconstruction postmastectomy. Since the introduction of the latissimus dorsi myocutaneous flap in the late 1970s, its use has always been as a secondary technique, particularly after the development of the transverse rectus abdominus myocutaneous flap in the 1980s.

Methods: A literature review of the history of latissimus dorsi myocutaneous flap utilized for breast reconstruction as well as a review of our institution's experience with latissimus dorsi myocutaneous flap and tissue expander placement was performed.