Tissue Expander Implantation Research Articles

Prophylactic Local Antibiotics for Tissue Expansion (PLATE) Improve Breast Reconstruction Outcomes.

Infection following tissue expander (TE) breast reconstruction is frequent and impactful. Preliminary reports demonstrate value of local antibiotic delivery for implant salvage and prophylactic potential. Herein is a multi-institutional retrospective study employing surgeon-crafted tobramycin-vancomycin PMMA plates (PLATE) during TE implantation for infection prophylaxis. The authors hypothesized the intervention would be associated with fewer infections compared to historical practice. In 2021, surgeons at three institutions began independently offering PLATE for primary TE breast reconstructions. After independent IRB approvals, data were retrospectively collected for PLATE subjects and pre-intervention cohorts of equivalent sizes. Subjects were followed for seven months, or to second stage removal. The primary outcome, complication requiring readmission/reoperation, was compared between aggregated cohorts. Analysis included logistic modeling and Kaplan-Meyer survival. The aggregate sample included 183 intervention subjects (292 breasts) and 183 controls (301 breasts), each with 5+/-2-month follow-up. Overall, complications were significantly less frequent with PLATE (13.1% vs 21.9%, p<0.01*). This was driven by significantly fewer infections (4.8% vs 12.6%, p<0.01*) with no difference in rates of tissue necrosis, seroma, or other complications (p>0.05). In multivariable regression, the intervention was associated with significantly reduced odds of any complication (OR=0.53, 95%CI: [0.3-0.93]) and infection (OR=0.22, 95%CI: [0.08-0.50]). Kaplan-Meyer curves demonstrated significant longitudinal reduction in complication and infection (p<0.01*) without notable rebound throughout dissipation of the antibiotic eluent. Prophylactic employment of intraoperatively-crafted PLATE during TE implantation was associated with significant infection reduction without increase in local or systemic complications. This reproducible tool may be highly valuable in alloplastic breast reconstruction.

Endoscopic Tissue Expander Implantation in Postburn Reconstruction: A Review of the Literature.

Tissue expansion generates new tissue that can be used in postburn reconstruction. Expanders are placed through small incisions, requiring difficult and sometimes blind dissection to prepare an adequate pocket. Recently, the use of endoscopy to assist in expander placement has been described, which may improve intraoperative visualization and allow for a smaller incision. In this review, we summarize the existing literature on endoscopic tissue expander (TE) placement in postburn reconstruction and highlight areas for future research. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were utilized to conduct this review. The following databases were queried for the initial search of relevant articles: PubMed, Embase, Scopus, Cochrane, and Web of Science. The data were assessed qualitatively due to the heterogeneity in reporting between the studies. Our literature query yielded 1023 studies. Sixteen manuscripts underwent full-text review, and 7 met inclusion criteria. All studies demonstrated that the endoscopic approach led to successful tissue expansion. Four articles performed a comparative analysis between the open and endoscopic approach, all of which found a significant reduction in complications like seroma, hematoma formation, and device exposure with endoscopic TE implantation. Two studies demonstrated that the use of endoscopy significantly reduced operative time and length of stay. Endoscopy is a safe and effective tool in tissue expansion for postburn reconstruction. Further prospective research should include evaluating the cost-benefit of this approach and long-term outcomes for patients who have undergone endoscopic-assisted TE placement.

Complications and Burden of 2-Stage Tissue Expander to Implant-Based Reconstructive Surgery: A Single-Center Retrospective Study

Introduction: Two-stage reconstruction with a tissue expander/implant (TE/I) technique remains the most common breast reconstructive approach following mastectomy. This study analyzes the post-operative complications and burden associated with 2-stage TE/I reconstruction independent of acellular dermal matrix (ADM). Methods: A retrospective chart review identified patients that underwent 2-stage, reconstruction with TE/I without ADM. Demographics, implant characteristics, tissue expansion information, and complications were recorded. Patients were followed for 3 months post-implant exchange. Logistic regression analysis was used to determine which variables were predictors for complications. Results: Ninety-one TE/I reconstructions without ADM were performed in 55 patients. The incidence of complications was 45% (n = 25). Mean complications per patient was 0.84 ± 1.2, with the most common being infection with the TE (n = 15, 24.2%). Mean number of fill appointments was 3.6 ± 1.7 (range: 1-8). Univariate linear regression showed for every increase in BMI, there was a 14.8 cc increase in implant volume, on average ( P &lt; .001). Multivariable logistic regression model identified radiation history ( P = .036) and increasing BMI ( P = .049) as significant predictors for complications. Conclusion: Infection remains to be the leading cause of short-term complications in TE/I breast reconstruction patients. BMI and radiation are significant predictors. Larger, multicenter observational study data may elicit nuanced variation among different population demographics.

Subcutaneous Implantation of Unidirectional Self-Inflating Anisotropic Tissue Expander Has No Effect on the Physiological Parameters and Behaviours of Horses

The tissue expansion technique is one of the most important innovations in skin reconstructive surgery in human and veterinary medicine. This study investigated horses’ physiological and behavioural responses to subcutaneous implantation of a unidirectional self-inflating anisotropic tissue expander. The tissue expanders were subcutaneously implanted on six horses at three different locations: the frontal region of the head, the lateral side of the right shoulder, and the dorsomedial part of the cannon region of the right forelimb. Prior to the tissue expander implantation, each horse was clinically examined, and the observed vital parameters and behaviour were recorded as baseline data. For six days post implantations, the horses were clinically examined, implantation sites monitored, and the horse’s behaviour was recorded both during the day by visual observation and at night with a video camera. The results showed that all horses tolerated the subcutaneous gradual skin expansion by implantation of the tissue expanders, and all surgical sites healed without any complications. The implantation of the tissue expanders does not affect the vital parameters or overall horse behaviour either during the day or at night. In conclusion, the subcutaneous implantation of unidirectional anisotropic tissue expanders in horses resulted in successful skin growth with no physiological and psychological discomfort; hence skin expansion is a good option to be considered when pursuing equine skin reconstructive surgery.

Characteristics and distribution of chronic pain after mastectomy and breast reconstruction: a long-term prospective cohort study.

Chronic pain following breast surgery is a concern for breast cancer survivors; however, few studies have investigated the localization of persistent postoperative pain. We conducted this study to identify the location of pain following breast reconstruction. A total of 213 Japanese women undergoing mastectomy only or breast reconstruction with a tissue expander/implant (TE/Imp) or a deep inferior epigastric perforator (DIEP) flap were enrolled in the study. Questionnaires related to pain location were sent to patients at the end of postoperative year (POY) 1 and POY 5. Multiple comparisons of the types of operation and cross-tabulation were made between the two time points. Surveys were completed by 107 of the women. Severe pain in the upper medial breast was significantly more common in POY 1 after DIEP reconstruction than after mastectomy only (P = 0.01), whereas abdominal pain was worse in POY 5 after DIEP reconstruction than after mastectomy only (P = 0.04). Pain in the medial arm and axilla had resolved better after TE/Imp (P = 0.03) and DIEP reconstruction (P = 0.01) than after mastectomy only by POY 5, but the difference between TE/Imp and DIEP reconstruction was not significant. These results show that localization of prolonged postoperative pain following breast reconstruction differs depending on the surgical strategy.

Long-Term Patient Satisfaction and Quality of Life Following Breast Reconstruction Using the BREAST-Q: A Prospective Cohort Study.

BackgroundBreast reconstruction is a promising surgical technique to improve health-related quality of life (HRQoL) in patients with breast cancer. However, the long-term risk factors associated with HRQoL after breast surgery are still unclear. Our aim was to evaluate breast satisfaction and HRQoL following breast reconstruction to identify clinical factors associated with each domain of BREAST-Q in the long-term.MethodsPatient-reported BREAST-Q outcomes were analyzed 1 and 5 years after breast reconstruction in a single-blinded, prospective study. Multiple regression analysis was performed to identify the risk and protective factors associated with BREAST-Q scores. These scores at 1 and 5 years were also compared across three types of operation: mastectomy only, tissue expander/implant (TE/Imp), and a deep inferior epigastric perforator (DIEP) flap.ResultsSurveys were completed by 141 subjects after 1 year and 131 subjects after 5 years. Compared to mastectomy only, breast reconstruction was significantly associated with greater “Satisfaction with breasts” (TE/Imp, p < 0.001; DIEP, p < 0.001) and “Psychosocial well-being” (TE/Imp, p < 0.001; DIEP, p < 0.001), higher body mass index (BMI) resulted in lower “Satisfaction with breasts” (p = 0.004), and a history of psychiatric or neurological medication was significantly associated with “Physical well-being” at 1-year postoperatively (p = 0.02). At 5 years, reconstructive procedures were significantly positively associated with greater “Satisfaction with breasts” (TE/Imp, p < 0.001; DIEP, p < 0.001) and “Psychosocial well-being” (TE/Imp, p = 0.03; DIEP, p < 0.001), and a bilateral procedure was a significant risk factor for lower “Psychosocial well-being” (p = 0.02).ConclusionsThe results of this study show that breast reconstruction improves “Satisfaction with Breasts” and “Psychosocial well-being” compared to mastectomy. Among all three types of operation, DIEP gave the best scores at 5 years postoperatively. Thus, autologous reconstruction is recommended for promotion of long-term HRQoL after breast surgery.

Pre-pectoral breast reconstruction: early and long-term safety evaluation of 146 unselected cases of the early pre-pectoral era of a single-institution, including cases with previous breast irradiation and post-mastectomy radiation therapy.

We re-evaluated acute and early-late toxicity-related factors among pre-pectoral immediate tissue expander/implant (TE/I) breast reconstruction (BR) unselected, first-era, cases, including previous breast radiation treatment and post-mastectomy radiation therapy (PMRT). A retrospective analysis of 146 (117 therapeutic and 29 prophylactic) pre-pectoral reconstructions, between 2012 and 2016, considered patient-related (age, body mass index [BMI], smoke-history, comorbidity, BRCA mutation), and treatment-related characteristics (previous irradiation, axillary surgery, PMRT, pre- and postoperative chemotherapy, endocrine therapy, and target-therapy). Safety was evaluated as acute and early-late complications, and TE/I failures. At multivariate analysis of the 146 cases (117 patients submitted to BR) a significant factor related to acute toxicity was: BMI ≥ 25 (31.3% [≥ 25] vs 8.8% [< 25]; OR 4.44, 95% CI 1.56-12.6; p = 0.003), while previous breast surgery on ipsilateral side presented a borderline significance (31.6% [previous surgery] vs 7.4% [no previous surgery]; OR 3.74, 95% CI 0.97-14.40; p = 0.055). Factors significantly related to TE/I failure were: current or previous smoking exposition (13.8% [smokers] vs 2.6% [non-smokers]; OR 7.32, 95% CI 1.37-39.08; p = 0.02) and preoperative chemotherapy (18.8% [yes] vs 3.5% [no]; OR 8.16, 95% CI 1.29-51.63; p = 0.026). At 4-year median follow-up, 3 deaths, 5 locoregional recurrences, and 14 distant metastases occurred. Immediate pre-pectoral BR is safe and effective, with low rates of acute and early-late complications. BMI and previous breast surgery were related to higher complications but not failure; smoking and preoperative chemotherapy were related to TE/I explant. Previous RT and PMRT were related neither to early-late toxicity nor failure.

Fine-needle aspiration for periprosthetic fluid removal after implantation of a remote internal-port tissue expander

BackgroundUse of internal filling ports in tissue expander–based reconstructions are advantageous because of easier self-care, lower infection rates, and fewer instances of capsule formation. The appearance of periprosthetic fluid accumulation after internal-port tissue expander implantation is a common complication that warrants treatment. In this study, we introduced a noninvasive method using fine-needle aspiration (FNA) to remove fluids accumulated after implantation of a remote internal-port tissue expander. MethodsIn this study, 245 patients who underwent implantation of remote internal-port tissue expanders in our hospital from July 1, 2012, to July 1, 2019, were included and divided into two groups. In the control group, patients underwent tissue expander implantation before July 1, 2016, and large quantities of fluids were removed with surgical aspiration procedures in most cases. In the FNA group, the patients underwent implantation after July 1, 2016, and large quantities of fluids were removed first with the FNA procedure. Patients’ demographic data, indications for FNA application, and related complications were collected and analyzed. ResultsOverall, 395 expanders were placed in 245 patients. Postoperative management was similar in both groups. Fluids were managed with 23 expanders in the control group and with 31 expanders in the FNA group. There was no difference in the fluid aspiration rate between the two groups. The surgical aspiration rate was 11.1% (23/208) in the control group. The success rate of FNA was 90.3% (28/31). In the FNA group, the surgical aspiration rate was 1.6% (3/187), which was significantly lower than that in the control group. There were no significant differences in complications between the two groups. ConclusionFNA can be used for periprosthetic fluid removal after the implantation of a remote internal-port tissue expander in most cases. This method is more convenient and safer than surgical aspiration for the postoperative management of internal-port tissue expander implantation.

Study of Inflammatory and Infection Markers in Periprosthetic Fluid: Correlation with Blood Analysis in Retrospective and Prospective Studies.

Background Surgical site infection represents the most severe complication in prosthetic breast reconstruction. Risk profiling represents a useful tool for both clinicians and patients. Materials and Methods In our hospital, 534 breast reconstructions with tissue expander implants, in 500 patients, were performed. Several clinical variables were collected. In our study, we evaluated the different inflammatory markers present in the periprosthetic fluid and we compared them with the ones present in plasma. Results The surgical site infection rate resulted to be 10.5%, and reconstruction failed in 4.5% of the cases. The hazard ratio for complications was 2.3 in women over 60 (CI: 1.3-4.07; p = 0.004), 2.57 in patients with expander volume ≥ 500 cc (CI: 1.51-4.38; p < 0.001), 2.14 in patients submitted to previous radiotherapy (CI: 1.05-4.36; p < 0.037), and 1.05 in prolonged drain use (CI: 1.03-1.07; p < 0.001). 25-OH, PCT, and total protein were less concentrated, and ferritin and LDH were more concentrated in the periprosthetic fluid than in plasma (p < 0.001). CRP (p = 0.190) and β-2 microglobulin (p = 0.344) did not change in the two fluids analyzed. PCT initial value is higher in patients who underwent radiotherapy, and it could be related to the higher rate of their postoperative complications. Patients with a tissue expander with a volume ≥ 500 cc show an increasing trend for CRP in time (p = 0.009). Conclusions Several risk factors (prolonged time of drains, age older than 60 years, and radiotherapy) have been confirmed by our study. The study of markers in the periprosthetic fluid with respect to their study in plasma could point toward earlier infection detection and support early management.

Combination of Extended Paramedian Forehead Flap and Laser Hair Removal in the Reconstruction of Distal Nasal Defect.

The study sought to determine whether extended forehead flap by using part of the scalp combined with laser hair removal is a practical approach when repairing distal nasal defect. A retrospective study was conducted with 6 patients who underwent reconstruction of nasal defects with extended forehead flaps (including scalp combined with subsequent laser hair removal) at Shanghai Ninth People's Hospital between June 2016 and December 2018. Surgical data collected included age, causes of defects, sizes of defects, invaded nasal subunits, implantation of tissue expander, time elapsed between the formation of defects and surgical treatments, sessions of laser hair removal, and follow-up results. All patients had nasal defects after removal of a benign nevus (diameter, >1.5 cm), which invaded distal nasal subunits (including the nasal tip, soft triangle, columella, and nasal ala) and could not be repaired using adjacent tissue. Preoperative and postoperative assessments of esthetic outcomes were analyzed, including skin color and texture match, appearance deformity, and scar appearance. All 6 female patients (ages 4 to 24 years) accepted the extended forehead flap technique and subsequent laser hair removal treatments. Among the 6 patients, 2 had nasal tip defects, 1 had a columella nasi defect, one had an alar defect, and 2 had multiunit defects. All transferred forehead flaps survived with no necrosis and underwent 2 to 5 subsequent laser hair removal treatments. The color and texture of the transferred flaps was similar to the adjacent skin in all patients. All patients were satisfied with the final outcome of the reconstructed nose with no obvious scarring during follow-up. Extending the forehead flap using the scalp is a practical and safe approach for the repair of large and distal nasal defects. Subsequent laser hair removal can eliminate the hair follicles of the scalp and improve the appearance and color of the flap.

Biomechanical Effects of Unidirectional Expansion Using Anisotropic Expanders in Horse Skin Tissue

The use of a self-inflating tissue expander is a technique to stretch cutaneous tissues for potential use in reconstructive skin surgeries. This study investigates the mechanical properties of horse skin stretched by the subcutaneous implantation of anisotropic tissue expanders at the forehead, right shoulder, and dorsomedial part of the cannon region of the right forelimb in six (n = 6) horses. After 14 days of skin expansion, expanded and normal (control) skin samples were harvested and their mechanical properties of elastic modulus (EM), maximum force (MF), maximum stress (MSs) and maximum strain (MSr) were evaluated using uniaxial tension test. The expanded skin from shoulder area has higher EM, MSs, MSr and MF than the normal skin when compared to the forehead and lower forelimb. Statistically, there was a significant (P= .02) mean difference for MSs between the expanded shoulder and lower forelimb skin, but the pairwise comparison of EM, MSr and MF showed no significant difference between the locations. The overall effect of locations on EM and MSs was statistically significant (P < .05), however, there was no overall effect of horse factor, treatment factor (normal and expanded skin) and location interaction on the EM, MSS, MF and MSr. In conclusion, the expanded skin from the frontal head and the distal limb are less elastic (stiffer) compared to that of the expanded skin of the shoulder, thus anatomical location of the skin has some degree of effect on EM and MSs.

Comparing the Clinical and Cost-Effectiveness of Abdominal-based Autogenous Tissue and Tissue-Expander Implant: A Feasibility Study.

To determine the superiority of autologous abdominal tissue (AAT) or tissue-expander implant (TE/I) reconstruction, a robust comparative cohort study is required. This study sought to determine the feasibility of a future large pragmatic cohort study comparing clinical and cost-effectiveness of AAT and TE/I at 12 months postoperative. Potential participants were screened during consultation with their surgeon. Three health-related quality-of-life scales, the Health Utility Index Mark 3, the 12-Item Short Form Health Survey, and the BREAST-Q were used preoperatively, 1, 6, and 12 months postoperatively. Direct medical costs and postoperative patient/caregiver productivity loss were collected using patient diaries. Feasibility was assessed through patient recruitment rates and compliance of patients and study staff to complete required study documentation. Sixty-three patients consented to participate, 44 completed baseline questionnaires; the feasibility objective of recruiting 80% of eligible patients was not met. A 90% completion rate for patient questionnaires was seen at 1-month follow-up and decreased up to 12 months. Quality-adjusted life years were calculated at 0.77 and 0.89 for the AAT and TE/I group, respectively. Case report form completion by study staff and patient diary completion was moderate and low, respectively. Collaborating with hospital case-costing specialists to identify direct medical costs was reliable and efficient. A future large-scale study is feasible. However, due to a diminishing rate of questionnaire completion, almost twice as many patients need to be recruited than expected to have adequate power. Cost data collection from hospital sources was reliable. Case report forms need to be tailored more toward a busy hospital setting.

Cost-effectiveness Analysis of Abdominal-based Autogenous Tissue and Tissue-expander Implant following Mastectomy.

Background:Patients who had undergone both autologous abdominal tissue (AAT) and tissue expander and implant (TE/I) breast reconstruction reported satisfaction with their reconstruction. While aesthetics and quality of life are important, the cost associated with these procedures must also be considered when choosing one method over the other. The objective of this study was to determine whether AAT-based breast reconstruction is cost-effective compared with 2-stage TE/I reconstruction at a 12-month follow-up.Methods:Thirty-five patients consented and complied to participate in the study with a follow-up of 12 months. The effectiveness of both AAT and TE/I was measured using the Health Utilities Index Mark 3 (HUI-3). From the HUI-3 results, quality-adjusted life years were calculated for each reconstructive approach. Direct healthcare and productivity costs were captured from surgeon billing codes, patient files, and patient diaries. The perspectives of both the Ministry of Health and of society were considered.Results:From the perspectives of both the Ministry of Health and of society, AAT was less effective and more costly when compared with TE/I.Conclusions:In this economic evaluation, TE/I dominated AAT, in that TE/I was more effective and less costly as compared with AAT from the perspectives of both the Ministry of Health and of society at 12 months of follow-up. This conclusion should be interpreted with caution due to a small sample size, the short timespan of the study, and the nonrandomized study design.

Meteorological Influence on Tissue Expander-Related Major Infection

ABSTRACT Background Infection is a relevant complication of tissue expander surgery that may compromise the flap. The effects of meteorological variables on surgical site infection have been observed in many surgeries; however, their influence on tissue expander infection is unknown. Methods We identified tissue expander implantation and infection based on their International Classification of Diseases, 10th revision, codes in electronic hospitalization summary reports of 26 cities from January 1, 2014 to December 31, 2015. The data of the present study were collected for administrative purposes without any personal identifiers. The Cox proportional hazard model was used to investigate the association between meteorological variables and tissue expander-related major infection with six covariates. Results A total of 3,089 patients were enrolled. Of them, 8.7% experienced a major infection during the study period. The optimal daily average temperature was between 22.9 °C and 26.8 °C, and the risk of major infection was significantly decreased in this range. The minimal infection temperature was 24.4 °C, with a hazard ratio of 0.85. When the average relative humidity was 37%, the infection risk was minimal with a hazard ratio of 0.86; however, a relative humidity of ≥ 79% significantly increased the risk of infection. Conclusions This is the first study to investigate the impact of temperature and relative humidity on tissue expander-related major infection. Our study suggests that there may be an optimal range of both temperature (22.9 °C–26.8 °C) and relative humidity (

Clinical effect of pre-expanded deltopectoral flap in the repair of faciocervical lesion and defect

Objective: To explore the clinical effect of pre-expanded deltopectoral flap in the repair of faciocervical lesion and defect. Methods: From July 2004 to August 2018, 355 patients with faciocervical lesion and defect were admitted to the First Affiliated Hospital of Air Force Medical University, including 200 males and 155 females aged 4 to 48 years with major conditions including thermal burn scars, and type Ⅲ and Ⅳ facial-cervical deformities. During the stage Ⅰ skin soft tissue expander implantation surgery, according to the size and location of lesion and defect, expanders with appropriate volume were placed to expand the deltopectoral area. During the stage Ⅱ flap pedicled transposition surgery, after the expander was expanded to the desired volume, the impairment tissue was removed, the flap was designed according to the size of the defect (the unilateral defect area was 7 cm×5 cm to 17 cm×16 cm) and pedicled transposition was carried out. The incision in the chest donor area was directly sutured and closed. After the flap survived, stage Ⅲ flap delay and pedicle division surgery was carried out. The area of one single flap was 8 cm×5 cm to 20 cm×18 cm. The numbers of flaps and expanders, rated volume and expansion of expander, the intervals between surgeries in each stage, flap survival, postoperative complications in surgeries in each stage, and follow-up were recorded and analyzed. Results: A total of 460 pre-expanded deltopectoral flaps were used, including 250 unilateral flaps and 105 bilateral flaps. Totally 460 expanders were used in this group of patients. The rated volume was mostly 500 mL (163 expanders) and 600 mL (142 expanders). The expansion multiple of the expander was (1.14±0.19) times of the rated volume. The flap expansion time of the patients was (96±30) d, the pedicle time was (32±8) d, and the delay time was (7.5±1.6) d. The postoperative complications of patients mainly included infection (29 patients), expander exposure (18 patients), and hematoma (10 patients). During the follow-up of 6 to 120 months, the elasticity, texture, and color of the flaps of patients were similar to the surrounding tissue of the recipient area, and the face and neck were symmetrical, not bloated. Conclusions: The deltopectoral flap obtained by overexpansion has a larger area and a thinner thickness, and the elasticity, texture, and color are similar to the surrounding tissue of the recipient area. After transfer, a stable appearance of the face and neck can be obtained. The main complications are infection and expander exposure, most of which occurred after stage Ⅰ skin soft tissue expander implantation surgery.

Implantation of tissue expander prior to irradiation in the era of intensity modulated radiotherapy: impact on the management of patients with pelvic digestive cancers.

Before the introduction of intensity-modulated radiation therapy (IMRT), few teams used to implant a pelvic tissue expander to keep the bowel away from the radiation field, so as to reduce the risk of acute and late enteritis. However, this unexpected surgery could impact patient's overall treatment and may be no more necessary in the era of modern radiotherapy. This is a retrospective cross-sectional study including 13 patients who underwent tissue expander implantation before radiotherapy or chemoradiotherapy for rectal or anal carcinoma between November 2008 and March 2019. First, we aim to show that IMRT could sometimes be insufficient to respect dosimetric constraints, and then we aim to report the impact of tissue expander implantation on the global strategy of care of patients with anal and rectal cancers. Seventy-seven percent of the included patients were treated for anal neoplasms, while the remaining 23% had locally advanced rectal cancer. The median follow-up since implantation of the expander was 51months [3.7-115]. Three patients recurred. One patient developed grade III toxicity related to the implantation of a tissue expander. The delay between diagnosis and the start of irradiation was significantly prolonged (median of 3months), requiring unusual induction chemotherapy. Implantation of tissue expander prior to chemoradiotherapy should be considered, even in the era of IMRT, when irradiated peritoneal cavity volume (V15Gy-V45Gy) far exceeds usual dose constraints. However, it impacts the global strategy of care by delaying the start of irradiation, by introducing induction chemotherapy, and rarely by causing post-operative complications.

Microtia Ear Reconstruction Using Tissue Expander and Autologous Costal Cartilage: Our Experience and Comparing Two Age Groups.

BACKGROUNDEar reconstruction is one of the most challenging surgeries faced by reconstructive surgeons because of its complex three-dimensional structure. Various surgical methods and materials have been used over the years. The process of microtia reconstruction using tissue expander is performed in three stages of first that is implantation of tissue expander, second stage involves framework fabrication using autologous costal cartilage and implantation in the pocket and third stage involves tragus and concha reconstruction.METHODSTotally 180 cases of microtia reconstruction using tissue expander and autologous costal cartilage over 2 years were enrolled, while two age groups were compared regarding operative time, tissue expansion, number of autologous costal cartilage harvested and complications during and after reconstruction.RESULTSThe overall complication in microtia reconstruction was 25%. No major difference was found between complication rates among the 2 age groups. Similarly, no significant difference was found between two groups in term of surgical time and tissue expansion. The major difference was found in number of costal cartilage harvested for the framework fabrication among the two groups. CONCLUSIONMicrotia reconstruction using tissue expander and autologous costal cartilage is a standard method of ear reconstruction with good satisfaction rate for surgeons and patients. Although the complication rate was high in our study, most of the cases were managed with acceptable results. Therefore, a standard protocol should be developed regarding the timing of the surgery for microtia reconstruction, considering pre-operative radiological analysis of the costal cartilage development along with age and weight of the patient.

The Potential Role of Intensity-modulated Proton Therapy in the Regional Nodal Irradiation of Breast Cancer: A Treatment Planning Study

AimsTo investigate the role of intensity-modulated proton therapy (IMPT) for regional nodal irradiation in patients with breast carcinoma in comparison with volumetric-modulated arc therapy (VMAT). Materials and methodsA cohort of 20 patients (10 in the breast-conserving surgery group and 10 post-mastectomy patients with tissue expander implants) was investigated. Proton plans were also computed using robust optimisation methods. Plan quality was assessed by means of dose–volume histograms and scored with conventional metrics. Estimates of the risk of secondary cancer induction (excess absolute risk, EAR) were carried out, taking into account fractionation, repopulation and repair. ResultsConcerning target coverage, the data proved a substantial equivalence of VMAT and IMPT: for example, coverage for the 50 Gy target, expressed in terms of V98%, was 47.8 ± 0.4, 47.6 ± 0.4, 47.3 ± 0.8, consistent with the objective of 47.5 Gy, for post-mastectomy patients for the three groups of patients. Also, the conformality of the dose distributions was similar for the two techniques, about 1.1, without statistically significant differences. Organ at risk planning aims were achieved for all structures for both techniques. The mean dose to the ipsilateral lung was 10.8 ± 1.1, 6.2 ± 0.8, 7.2 ± 1.0; for the contralateral lung was 3.2 ± 0.7, 0.3 ± 0.2, 0.4 ± 0.2; for the contralateral breast was: 3.1 ± 0.7, 0.3 ± 0.3 and 0.3 ± 0.3, whereas it was 3.9 ± 0.9, 0.4 ± 0.3 and 0.5 ± 0.5, respectively, for the heart for VMAT, IMPT and robust IMPT plans over the whole group of patients. Robust optimisation affected the near-to-maximum dose values for contralateral lung and breast, the mean dose for the heart and ipsilateral lung, with a deterioration ranging from 20 to 40% of the nominal value of IMPT plans (e.g. from 8.1 ± 6.4 to 11.4 ± 8.8 for the heart compared with 16.2 ± 5.2 for the VMAT plans). The numerical values of EAR per 10 000 patient-years were about one order of magnitude higher for VMAT than for IMPT for contralateral structures: 11.66 ± 2.01, 0.89 ± 0.80, 0.98 ± 0.77 for the contralateral breast and the three groups of plans, respectively; 14.31 ± 2.75, 1.42 ± 0.80, 1.78 ± 0.87 for the contralateral lung; and 34.86 ± 2.64, 18.85 ± 2.15, 20.98 ± 2.35 for the ipsilateral lung. ConclusionIMPT with or without robust optimisation seems to be a potentially promising approach for the radiation treatment of breast cancer when nodal volumes should be irradiated. This was measured in terms of dosimetric advantage and predicted clinical benefit. In fact, the significant reduction in estimated EAR could add further clinical value to the dosimetric sparing of the organs at risk achievable with IMPT.

Implantation of Tissue Expander in Poland Syndrome Patient

Implantation of Tissue Expander in Poland Syndrome Patient

Postoperative outcomes of breast reconstruction after mastectomy: A retrospective study.

Breast reconstruction after mastectomy plays an active role in improving the quality-of-life (QoL) and alleviating the psychological trauma of breast cancer patients, and has become an indispensable part of the comprehensive treatment in breast cancer. However, compared with mastectomy alone, breast reconstruction also increase operative complications. The surgical, oncological outcomes, and cosmetic effect of breast reconstruction remains to be evaluated. Data for patients with breast cancer who underwent breast reconstruction after mastectomy from February 2009 to November 2015 in our hospital were retrospectively analyzed, with a median follow-up time of 44 months. The operating time, blood loss, drainage fluid, postoperative complications, postoperative cosmesis, oncological outcomes, and QoL were evaluated and compared between different reconstruction types. A total of 151 women were included. The flap-based group had higher complication rates of marginal necrosis of incision, while the incidence of capsular contracture was higher in immediate implant group. There was no difference in blood loss, drainage fluid, and other postoperative complications. Several independent factors were associated with increased postoperative complications included diabetic, obese, and reconstruction with flap. There was no significant difference in the disease-free survival rate and overall survival rate between different surgical groups. In terms of cosmetic effect, patients in the tissue expander group were more likely to get a satisfactory postoperative breast appearance. QoL outcomes shown that the tissue expander group has better body image and sexual enjoyment, while there was no significant difference for other QoL domains. In conclusion, different methods of breast reconstruction are safe and feasible for patients with breast cancer, tissue expander implantation following delayed implant breast reconstruction is a more effective treatment on cosmetic and QoL outcomes.