Dermal Sling Research Articles

A pure dermal sling for implant reconstruction after mastectomy in the generous breast

A pure dermal sling for implant reconstruction after mastectomy in the generous breast

A safe, cost-effective and efficacious immediate breast reconstruction? Single stage immediate breast reconstruction with a dermal sling, implant and free nipple graft.

A safe, cost-effective and efficacious immediate breast reconstruction? Single stage immediate breast reconstruction with a dermal sling, implant and free nipple graft.

Outcome after autologous dermal sling-assisted immediate breast reconstruction

In selected patients undergoing mastectomy and immediate reconstruction, a de-epithelialized skin flap (dermal sling) may be used to complete the submuscular pocket. This study examined the safety and efficacy of an autologous dermal sling in providing inferolateral support to the implant or tissue expander during immediate breast reconstruction. Patients were identified from an electronic prospective database. Records of all patients were reviewed for details of management, complications and follow-up. Patient satisfaction and quality of life in the postoperative period were determined using the BREAST-Q(©) questionnaire. Between October 2008 and August 2010, 21 patients underwent 28 dermal sling-assisted breast reconstruction procedures. Their median age was 48 (range 30-70) years. Median hospital stay was 5 (range 3-7) days. Drains were removed at a median of 5 (range 3-7) days after surgery. During the operation a median volume of 150 ml was added to the tissue expander. The most common postoperative complication was superficial -junction breakdown in five patients, followed by seroma and infection each in three patients, but no implant required removal. BREAST-Q(©) responses indicated a high level of satisfaction overall with the reconstructed breast. Dermal sling-assisted immediate breast reconstruction has a low serious complication rate, provides stable soft tissue cover for the tissue expander and is associated with a high level of patient satisfaction. A larger pocket can be created, permitting more fluid to be added to the expander.

The Dermal Suspension Sling: Shaping the Inferior Pedicle during Breast Reduction

Complaints following reduction mammaplasty using the inferior pedicle include the migration of the deep tissue, a lack of medial fullness, poor projection, and bottoming-out. These are attributed to the lack of deep tissue suspension and skin envelope relaxation. We address these issues through horizontal dermal suspension and plication of the inferior pedicle. The inferior pedicle is designed with medial and lateral triangular flaps in the areas, which would normally be excised. These triangular flaps are deepithelialized and defatted. The flaps are attached to the chest wall above the inferior pedicle to create a dermal sling. The breast mound is further contoured by horizontally plicating the dermis below the nipple-areola complex (NAC), which creates projection and rotates the NAC into the desired position in relation to the chest wall. Sixty-six women have undergone breast reduction using the horizontal dermal suspension sling modification to the inferior pedicle breast reduction technique. Breast projection and shape were sustained during follow-up, of which the median interval was 16months. Dermal suspension and horizontal dermal plication provides a structural foundation to the inferior pedicle. The sling-like effect from the dermal suspension maintains a defined inframammary fold and maintains medial and lateral borders of the breast. Horizontal dermal plication shortens the length of the inferior pedicle while generating improved breast projection by rotating the NAC anteriorly. The firmly shaped inferior pedicle breast mound allows the skin flap to drape over the breast mound with minimal tension.

Improving Shape and Symmetry in Mastopexy With Autologous or Cadaveric Dermal Slings

Mastopexy and reduction mammaplasty reshape breast parenchyma and restore youthful contour in women with ptotic breasts. However, recurrent ptosis and breast base widening are common. We have been using internal autologous or cadaveric (AlloDerm) dermal slings to circumferentially support and shape the breasts for symmetry or rejuvenation. Ten patients underwent unilateral mastopexy (3), unilateral reduction-mastopexy (1), bilateral mastopexy (5), or bilateral reduction-mastopexy (1) with an internal dermal sling to correct breast reconstruction asymmetry (2), congenital asymmetry (2), or acquired ptosis (6). Three of 6 patients acquired breast ptosis after massive weight loss. Autologous dermis was used in 5 patients, and 5 patients were reconstructed with AlloDerm. Patients have maintained projection and breast base width after 6 months to 3 years. In conclusion, internal dermal slings improve shape, breast projection, and base width in select patients undergoing mastopexy. An algorithm based on quantity and quality of native skin is provided.

Acellular Dermis-Assisted Breast Reconstruction

In 2004, the authors reported their findings with placement of tissue expanders for breast reconstruction in the partial submuscular position, the equivalent of the "dual-plane" technique for breast augmentation. Limitations with subpectoral expander placement include difficulty controlling the lower pole of the pocket during expansion, unprotected device coverage by a thin inferior mastectomy flap, possible effacement of the inframammary fold, and limited control over the superior migration of the pectoralis major muscle. This study aimed to examine the safety and efficacy of an acellular dermal sling in providing inferolateral support to the device during immediate breast reconstruction and expansion. This study prospectively investigated 58 breasts of 43 consecutive women who underwent immediate breast reconstruction with tissue expanders and acellular dermis. After completion of adjuvant therapy and expansion, the devices were exchanged for implants. The patients were tracked through January, 2007. The study parameters included demographic information, oncologic data, complications, and aesthetic outcomes. The mean time required to complete reconstruction was 8.6 months. The overall complication rate after expander/acellular dermis placement was 12%, whereas the complication rate after exchange to implants was 2.2%. The aesthetic outcome for reconstructed breasts did not differ significantly from that for the control subjects who had no surgery. Acellular dermis appears to be a useful adjunct in immediate prosthetic breast reconstruction. Acellular dermis-assisted breast reconstruction has a low complication rate, helps to reconstruct an aesthetically pleasing breast, and facilitates expeditious completion of the reconstruction.

Day‐case sling surgery for stress urinary incontinence: feasibility and safety

To prospectively assess the feasibility for discharge 10 h after a porcine dermal pubovaginal sling procedure (PVS), to examine the surgical factors (postoperative complications) affecting discharge, and to measure the short-term cure rate for stress urinary incontinence (SUI). Between June 2003 and December 2003, 40 consecutive patients with SUI and scheduled for treatment using a porcine dermal sling were enrolled in this prospective study. Patients were admitted with a planned overnight stay and returned to the ward with no urinary catheter. Outcome measures were bladder emptying efficiency (EE) at 10 h after surgery, time intervals to the first three spontaneous voids, EE of the first three voids, time required to achieve an EE of > or = 75%, a visual analogue scale pain score, perioperative complications, and short-term cure rate of SUI. Patients were considered suitable for discharge from hospital when the EE was > or = 75% or when they were self-catheterizing confidently with adequate pain control and no significant complication. All patients were followed for 6 months. The median EE at 10 h was 61%; 16 patients (40%) achieved efficient emptying and were suitable for discharge 10 h after surgery. The median intervals to the first three spontaneous voids were 7, 10 and 17 h, and the median EEs for the first three voids 46%, 61% and 75%. The median visual analogue scale pain score was 3.5. Patients with intrinsic sphincter deficiency (ISD) were significantly less likely to achieve efficient emptying at 10 h (39% vs 70%). Overall SUI was cured or improved in 90% of patients at the 6-month follow-up. In the present study only 40% of patients were suitable for day-case sling surgery. Early bladder emptying inefficiency was the main limiting factor. Exclusion of patients with ISD and possibly decreasing the EE threshold to 50% would improve the discharge rate. The short-term results of this PVS are similar to those obtained with the autologous fascial sling.

PAPER 17: Failure Rates for Porcine Dermal and Cadaveric Fascial Slings as Compared to Autologous Tissue for Treatment of Urodynamic Stress Incontinence

PAPER 17: Failure Rates for Porcine Dermal and Cadaveric Fascial Slings as Compared to Autologous Tissue for Treatment of Urodynamic Stress Incontinence

PORCINE DERMIS INTERPOSITION GRAFT FOR REPAIR OF HIGH GRADE ANTERIOR COMPARTMENT DEFECTS WITH OR WITHOUT CONCOMITANT PELVIC ORGAN PROLAPSE PROCEDURES

Recent literature suggests that graft interposition may decrease the incidence of cystocele recurrence. We describe our experience with porcine dermis interposition grafts for the repair of high grade cystoceles. We retrospectively reviewed the charts of all women who underwent surgical repair of high grade cystocele. Prolapse was graded with the Baden-Walker and Pelvic Organ Prolapse Quantitation systems, and all patients were evaluated with multichannel videourodynamics. Concomitant stress urinary incontinence was corrected with a pubovaginal sling and vault prolapse was corrected with iliococcygeus vault suspension. Postoperatively patients were evaluated at 2 weeks, 2 months, 6 months and annually thereafter. A total of 70 patients underwent cystocele repair with a porcine dermis interposition graft. Concomitant procedures included a pubovaginal sling in 65 patients and vaginal vault suspension in 50. Mean followup was 24 months. There were no intraoperative complications. Of the patient 59 (91%) are currently dry. One patient had recurrent vault prolapse without cystocele (C -2), which was successfully repaired with abdominal sacral colpopexy. Six patients (8.6%) experienced recurrent grade II (Ba 0) cystocele but continued to be asymptomatic. Three others (4.3%) had recurrence of grade III (Ba +2) cystocele and elected not to undergo reoperation. Two of 6 de novo rectoceles (grade II, Ap and -1 and Bp 0) were repaired with site specific repairs. Superficial vaginal wound separation in 1 case was successfully treated conservatively. In cases of high grade cystocele interposition of porcine dermis represents a successful and safe treatment option. Cystocele recurrence is typically low grade and it frequently may not require additional surgery.

A New Method for Treatment of Oral Cancer Postoperative Sialorrhea-Dermal Sling Operation

The treatment of oral cancer is mainly of operative resection. Due to huge extent of resection, reconstructive surgery is performed at the same time to cover soft/and or bony defect. The reconstruction method was mainly of pectoralis major myocutaneous pedicle flap, forehead flap, temporalis muscle flap, deltopectoral flap, and trapezius myocutaneous flap in the past. However, due to progress in microsurgical technique, the free flap becomes preferred reconstruction method recently. Although advances in reconstruction surgery, there are still many sequelae to patients who received extensive surgery. These sequelae include poor outer appearance, and functional disturbance as dysphagia, impaired speech and drooling etc. The goal of reconstruction surgery has to consider wound closure, cosmesis, and preservation of function at the same time if possible. The sialorrhea is one of the main post-operative sequelae to the patient. We have described a new ”dermal sling operation” to improve the post-operative sialorrhea. The ”dermal sling operation” uses a strip of de-epithelized tissue containing dermis and a portion of subcutaneous fat from the flap itself to suspend the mouth angle. There were 78 patients suffered from oral cancer underwent wide excision of lesion and free flap reconstruction from December1999 to March 2001. Post-operative sialorrhea was noted in 11 patients. The ”dermal sling operation” was performed to treat the problem in 7 patients. The follow up period ranged from 3months to 19 months with good results.

Urethropexy with porcine dermal sling in complicated stress incontinence

Urethropexy with a porcine dermal sling was performed in 47 elderly women with urinary stress incontinence and maximum urethral closure pressure averaging 23 cmH2O. At follow-up 7–49 (mean 20) months postoperatively, 68% of the patients were continent and 9% had residual minor leakage. The operation failed in 23%. Women younger than 60 years had a higher cure rate (86%). Complications were few and mostly transient. A dermal sling is recommended for patients previously operated on or with concomitant prolapse, and for elderly women with severe sphincter insufficiency. The method may also be considered for patients with moderate weakness of the pelvic floor.

Combination of the square flap method and the dermal sling to correct flat or inverted nipples.

A technique for the correction of flat or inverted nipples is presented. The procedure is a combination of the square flap method, which better shapes the corrected nipple, and the dermal sling, which provides good support for the repaired nipple.

Simple technique for correction of inverted nipple.

The described method for correction of the inverted nipple adds both bulk and structural stability to the nipple. This is done by means of a dermal sling and creation of a narrow base to prevent inversion of the nipple.

MASTOPEXY IN CONJUNCTION WITH SUBCUTANEOUS MASTECTOMY

A subcutaneous mastectomy without mastopexy can result in downward directed nipples, over-augmentation or asymmetry in cases of contralateral reconstruction. A mastopexy can prevent these problems without adding to the morbidity or complicating the procedure. The procedure described provides a dermal sling to support the implant and give greater protection to the implant through the closure.

SUBCUTANEOUS MASTECTOMY

Subcantaneous mastectomy through a lateral approach, with preservation of the nipple and areola on a dermal pedicle, removing the excess skin at the time of aubautaneous mastectomy, is a safe procedure which results in esthetically acceptable breasts. The surgical approach greatly facilitates the removal of the entire glandular portion of the breast. The need for a second surgical procedure is eliminated. Lateral biopsy scars can be reinforced by the dermal sling support, thereby decreasing the chances of exposure of the implant. The implant is also successfully and easily held in position by the use of the dermal-fat sling support. The nipple and areola survive quite well on the dermal pedicle, with preservation of contractility and sensation, as well as of blood supply.