Repair of a large wound of the back, post-Mohs micrographical excision, using chronic skin expansion.

Background: Large defects not otherwise closed primarily may be closed after chronic skin expansion.

Objective: If chronic expansion were deemed indicated for the closure of a proposed defect expected to result from Mohs micrographic surgery, can it be performed before Mohs surgery, avoiding the increased chance of expander extrusion via the defect when done postoperatively?

Methods: A team approach of a Mohs surgeon and a plastic surgeon coordinated scheduling an insertion of and staged infiltration of a tissue expander before Mohs surgical removal of a large basal cell carcinoma on the back of a young woman. The reconstruction after Mohs surgery was scheduled for the immediate postoperative period.

Polyester as a bioimplantable material.

In response to the recent controversy over silicone gel implants, alternative substances are being sought to offer new options in bioimplantable materials. Polyester is a Food and Drug Administration-approved prosthetic material utilized in vascular grafts for decades without significant problems in body tolerance. Working with textile scientists, polyester (both in its woven and fibrous forms) was engineered to influence differential fibrous ingrowth.

A method of breast reconstruction with a deepithelialized TRAM flap via the abdominal approach for failed implant salvage in postmastectomy patients.

Postmastectomy reconstruction of breasts is one of the most commonly performed procedures of the plastic surgeon today. Tissue expansion with subsequent implant placement, transverse rectus abdominis musculocutaneous (TRAM) flaps, latissimus dorsi flaps, gluteal flaps, Ruben's fat pad flaps, and free flaps from other areas have all been utilized with consistently good aesthetic results. One special class of patient is the woman who has undergone breast reconstruction with tissue expansion, with or without subsequent implant placement, who than receives external beam radiation therapy.

External oblique myocutaneous flap coverage of large chest-wall defects following resection of breast tumors.

Defects resulting from resection of advanced breast tumors can be quite large, posing a difficult reconstructive challenge. A significant number of such patients present with local recurrences after receiving external beam radiation and/or chemotherapy treatments. Pectoralis major, latissimus dorsi, rectus abdominis, and omental flaps with split-thickness skin grafts have been recommended for closure of chest-wall defects.

Breast reconstruction after mastectomy: who seeks it, who refuses?

Recent Food and Drug Administration hearings on silicone gel implants have drawn attention to the paucity of information about women who seek reconstruction after mastectomy compared with those who do not. New analyses of data gathered in the early 1980s address this issue. Three groups of mastectomy patients were compared: 117 women who sought and obtained delayed reconstruction, 26 who sought but decided against delayed reconstruction, and a comparison group of 53 who were not seeking reconstruction.