One-stage Reconstruction Research Articles

The free style “Twin V/Y Nasal Perforator Flaps”. An alternative to the forehead flap for nasal tip reconstruction. A case control study

IntroductionReplacing the skin along the nasal tip remains a challenge.Depending on the extent of the skin loss different local or regional flaps are available for reconstruction. If cutaneous replacement involves the nasal tip, the forehead flap can be used successfully. However, it requires a multi-stage procedure and can leave considerable scarring on the patient’s forehead. As an alternative, the authors present the free style “Twin V/Y Nasal Perforator Flaps” (TVYNPF), which can be used as a one-stage procedure for nasal tip reconstruction. Material and MethodsA series of five patients aged between 69 and 89 years with extensive basal cell carcinomas (BCC) at the nasal tip are presented (Table 1). The surgical procedure is explained in detail. Follow up ranged from 8 to 12 months. ResultsHealing was uneventful for all five patients and the shape, symmetry and aesthetical unity of the nasal tip and the alae of the nose were preserved in all patients without any functional impairment. All scars presented inconspicuous. ConclusionIn selected patients the free style TVYNPF proved to be a good alternative to the forehead flap for one-stage reconstruction of significant skin loss along the nasal tip, while preserving the aesthetics and function of the nose.

Antibiotic-Loaded Hydrogel for the Treatment of Lower-Limb Fracture-Related Infections: A Single Center's Multidisciplinary Experience.

A fracture-related infection (FRI) is a severe complication of an orthopedic trauma, often leading to challenging treatments and poor outcomes. The surgical strategies are typically categorized into one-stage or two-stage procedures, with the use of systemic and local antibiotics being crucial for infection management. This study assessed the efficacy of an antibiotic-loaded hydrogel (ALH) applied over the internal fixation devices for treating FRIs, comparing the outcomes between the one-stage (OS) and two-stage (TS) reconstructions. This retrospective study included 17 patients with an FRI treated using the ALH at a single center. The patients were divided into OS and TS reconstruction groups. The data on demographics, surgical procedures, antibiotic regimens, and outcomes were collected. The primary and secondary outcomes included the infection cure rate, bone union, complications, and reoperation rates. Among the 17 patients (mean age 48.5 years, 16 males), infections were predominantly in the tibia, with 12 chronic and 5 acute cases. Seven patients had monomicrobial infections, and nine had multidrug-resistant pathogens. No significant differences were found between the OS and TS groups in terms of the infection cure rate, bone union, or complications. One patient in the OS group experienced an infection recurrence, and bone healing was achieved in all but one case. Additional complications included delayed wound closure in two cases and implant failure in one case, requiring a reoperation. The ALH demonstrated potential as an effective local antibiotic treatment for FRIs, particularly in the one-stage reconstructions, allowing for a safe application of internal fixation devices. However, further research with larger sample sizes and longer follow-ups is needed to validate these findings.

One-stage revision for reconstructing acetabular defects by trabecular metal acetabular revision system in periprosthetic joint infection

Objective: To investigates the clinical efficacy of the trabecular metal acetabular revision system (TMARS) in one-stage reconstruction of acetabular deficiencies associated with periprosthetic joint infection (PJI). Methods: This is a retrospective case series study,including the data of 59 patients with PJI underwent acetabular defect reconstruction by TMARS during one-stage revisions in the Department of Orthopaedics, the First Affiliated Hospital of Xinjiang Medical University from January 2013 to December 2021. There were 32 males and 27 females, aged (59.5±14.6) years (range: 26 to 84 years). Among them, 29 cases used tantalum cups, 13 cases used tantalum cups and tantalum reinforcing blocks, 9 cases used cup-cage, and 8 cases used multi-cup reconstruction techniques. The surgery procedure, Harris Hip score (HHS), recovery of the hip rotation center, implant survival rate, postoperative reinfection rate, and complications were recorded. Data were compared using the Wilcoxon rank-sum test. Results: All of the 59 patients underwent the operations successfully. Operation time was (188.9±48.4) minutes (range: 110 to 340 minutes), and intraoperative bleeding volume was (M(IQR)) 1 000(400)ml (range: 600 to 1 800 ml). After a postoperative follow-up of 5.1 (2.6) years (range: 2.0 to 10.5 years), the prosthesis survival rate was 94.9% (56/59). Recurrence of infection occurred in 3 cases (5.1%), aseptic loosening in 1case(1.7%), and hip dislocation in 4 cases (6.8%). At the last follow-up, HHS improved significantly(84 (12) vs. 44 (9), Z=-6.671, P<0.01), and the center of rotation of the hips were recovered in all cases. Conclusions: In one-stage revision surgeries aimed at reconstructing acetabular defects, utilizing the TMARS can provide stable initial fixation, restore a more natural center of rotation, significantly enhance early postoperative hip joint function, and reduce the likelihood of infection recurrence. This approach stands as a reliable choice for addressing acetabular defects during revision surgeries for infected hip joints.

Еffect of Radiation Therapy on Breast Reconstruction in Breast Cancer Patients

Background. The surgical stage remains the main one in the combined and complex treatment of breast cancer. Radical mastectomy and reconstructive plastic surgery are the main option for surgical treatment of vast majority patients. Radiation therapy can lead to the development of complications after breast reconstruction, and vice versa, the reconstructed mammary gland can cause technical difficulties for the radiologist to properly adjust the required dose of irradiation. Aim — to choose the optimal method of breast reconstruction using various implants, as well as endoprostheses to minimize post-radiation complications and maintain a high level of quality of life for patients after breast cancer treatment. Methods. The retrospective study was conducted in the department of oncology and reconstructive plastic surgery of the breast and skin in the P.A. Herzen Moscow Research Oncology Institute from June 2013 to November 2017. There were performed 132 operations: 111 subcutaneous mastectomy with one-stage reconstruction with an endoprothesis and 21 mastectomy with a one-stage reconstruction with an endoprothesis. The distribution by stages: I — 57, IIA — 39, IIB — 17, IIIA — 13, IIIC 4; 2 cases of breast sarcoma. Prophylactic mastectomy of the contralateral gland was performed in 22 patients, mastopexy in 8, augmentation in 20. Polyurethane implants were applied in 82 cases (62%). Radiation therapy was performed in 47 patients with total dose 45 Gy. Bilateral reconstruction was performed in 22 patients. Results. The mean follow-up period was 28.44 ± 14.66 months (from 6 to 48 months). The most frequent complication in the postoperative period was the development of capsular contracture: seroma — 20 patients, hematoma — 2, edge necrosis — 6, protrusion — 6, infection — 2 patients. The most common capsular contracture by Baker was III degree, n = 18. The average period of development of capsular contracture was 7.6 ± 11.65 months. Conclusion. Despite the greater number of complications during the one-stage reconstruction, the implants remain in advantage in choosing a method of treating breast cancer by both the patient and the surgeon.

Reconstruction of the extensor tendon on the dorsal pedis with a chimeric skin-aponeurosis flap from the groin region

BackgroundComplex defects involving the extensor tendon on the dorsal pedis have been reconstructed using multiple procedures. Skin coverage and tendon transfers have also been performed. This study aimed to present our experience using a chimeric skin-aponeurosis flap for one-stage reconstruction of composite soft-tissue defects on the dorsal pedis. MethodsBetween May 2017 and September 2020, 12 patients with these defects received total treatment using a chimeric groin flap. Based on the superficial circumflex iliac vessels, the skin paddle resurfaced the cutaneous defect, and the vascularised external oblique aponeurosis was rolled to form a tendon-like structure to simultaneously replace the absent segment of the extensor tendons. A suitable “Y” bifurcation was dissected to enlarge the vessel diameter. Single-stage reconstruction was performed using a set of vascular anastomoses at the recipient site. ResultsFlap survival was achieved without significant complications. The hammertoe deformity was completely removed. The average dimension of the skin paddle was 8.0 × 13.0 cm (range, 6.5 × 11.0–10.0 × 14.0 cm), and the mean size of the aponeurosis was 8.0 × 4.0 cm (range, 6.0 × 3.0–10.0 × 5.0 cm). At the last follow-up visit, no morbidity was observed at the donor site. Natural shapes and walking functions were successfully achieved with a protective sensation. ConclusionThe chimeric groin flap with sheets of external oblique aponeurosis is a great candidate for one-stage reconstruction of composite soft tissue loss on the dorsal pedis. This approach provides cosmetic coverage, allowing faster wound healing and reduced tendon adhesions.

Nasal Dorsum Rotation-Transposition Flap Associated with Guitar-String Sutures: One-Stage Reconstruction of Large Defects on the Nose.

(1) Background: The preferred reconstructive option for closing small- or medium-sized defects of the distal half of the nose is the use of local flaps. The dorsal nasal (Rieger) flap is suitable for closing medium-sized defects at this location, especially when they are medially located, and are wider rather than tall. We describe a rotation-transposition dorsal nasal flap reconstruction for large nasal defects. The novelty of this design includes the addition of a small transposition lobe to the rotation flap, enabling the acquisition of tissue from either the lateral sidewall or the nasolabial sulcus, facilitating closure with guitar-string sutures. (2) Methods: We conducted a retrospective chart review of all the patients with large defects (>20 mm) of the nose who underwent nasal dorsum rotation-transposition flap repair between January 2019 and November 2022 at a single academic center. (3) Results: Fourteen patients (eight males, six females; ages 47-83, mean age 60 years) with defects (range: 20.00-35.00 mm) on the dorsum and nasal tip were recruited. Follow-up duration ranged from 12 months to 3 years, with all cases showing good or excellent oncologic and cosmetic results. (4) Conclusions: The rotation-transposition dorsal nasal flap was demonstrated to be a reproducible one-stage technique for large defects of the dorsum and nasal tip, with minimal risk of aesthetic or functional complications. Guitar-string sutures allowed the reduction of the defect size, facilitating a smaller flap design.

Salvage of the cochlear implant in cases of skin breakdown over the receiver/stimulator in children

Objective and method: Skin breakdown over receiver/stimulator (RS) after cochlear implantation poses a serious challenge. We report our experience using a one-stage reconstruction and implant salvage approach. Results: Between the years 2005 and 2017 five children, all females, with congenital- bilateral sensorineural hearing loss were identified. In all cases, a temporoparietal fascia flap (TPFF) and a large scalp flap were used to provide a two-layer coverage to the exposed RS. In the first three cases, a split-thickness skin graft was used to cover the donor site defect. In the latter two cases, a larger rotation flap was used, and a skin graft was not required. One case required revision due to the dehiscence of the wound and exposure of the RS. In another case, an accidental electrode array explantation occurred and the patient underwent a revision cochlear implantation. All patients had achieved complete healing and no change in hearing thresholds with the implants. Conclusions: We demonstrate our one-stage salvage technique with TPFF that saves the implant and prevents a two-stage procedure. The success rate can be improved with special care at reconstruction and with better protection of the implant during the procedure.

ОДНОЭТАПНАЯ КОРРЕКЦИЯ ПОСЛЕДСТВИЙ ПОВРЕЖДЕНИЯ ЛОКТЕВОГО НЕРВА

Objective: : To enhance the outcomes of surgical treatment for chronic ulnar nerve injuries by performing one-stage correction. Methods: From 2015 to 2023, 11 patients with chronic ulnar neurovascular bundle (NVB) injuries underwent one-stage reconstruction to restore hand function. The operations were performed on 8 men and 3 women aged 16 to 23. The duration of treatment for patients from the time of injury varied from 1.2 years to 5 years Results: In cases where there was a diastasis between the neural ends of no more than 3 cm in the upper third of the forearm due to nerve damage, restoration of the nerve with epineural suture was performed in 2 patients, while in two other cases with more significant gaps of 3.5 and 5 cm, epineural repair was carried out after anterior transposition of the nerve trunk. In one case of nerve damage in the middle third of the forearm, epineural sutures were applied to a 2.5 cm gap. Among 6 patients with damage to the ulnar NVB in the lower third of the forearm, 4 received epineural restoration of the ulnar nerve, and autologous neuroplasty was performed in gaps exceeding 3 cm in 2 patients. In cases of damage to the ulnar artery, 3 patients received autologous vein grafting, while in 3 other cases, there were no indications for vascular reconstruction. No infectious or inflammatory complications were observed in the immediate postoperative period, and there were no cases of thrombosis of autologous vein grafts of the ulnar artery. After evaluating all patients for 6 months to 2 years, it was found that 9 cases showed favorable and satisfactory long-term functional outcomes, while 2 cases exhibited unsatisfactory results. Conclusion: Restoring hand function after damage to the ulnar nerve is greatly influenced by the location, extent, and type of the damage, as well as the choice of an appropriate reconstruction method. Breaking the procedure into multiple stages can prolong patient recovery and negatively impact treatment outcomes. Conversely, performing the operation in a single stage within a relatively short timeframe can restore hand function and significantly reduce overall treatment and rehabilitation time Keywords: Ulnar nerve, neurovascular bundle, injury, tendon-muscular transfer, epineural suture

Reconstruction of laryngeal function by thyroid cartilage fenestration and draw-out resection followed by internal fixation with titanium microplates for early glottic carcinoma: a novel and efficient surgical approach.

To explore the clinical effectiveness of reconstructing laryngeal function using thyroid cartilage fenestration and "draw-out" resection, supplemented by internal fixation with titanium microplates in early glottic carcinoma. Data from 99 patients with glottic carcinoma treated in the Second Affiliated Hospital of Fujian Medical University between January 2014 and September 2021 were retrospectively analyzed. Forty-eight patients who underwent thyroid cartilage fenestration and resection followed by internal fixation with titanium microplates for laryngeal function reconstruction were assigned to the thyroid cartilage fenestration group (TCF group), while the other 51 patients who underwent sternohyoid muscle and fascia repair for laryngeal function reconstruction were assigned to the sternohyoid muscle repair group (SMR group). Patients were followed up for 1-8 years. Data on postoperative phonatory function, respiratory function, swallowing function, and survival status were collected. Compared to the SMR group, patients in the TCF group showed better postoperative recovery in phonatory function and verbal communication (all P<0.05). In the TCF group, patients demonstrated stable respiration and the extubation rate was 100.00%, which was significantly higher than 82.35% in the SMR group (P<0.05). Patients in both groups showed good postoperative recovery of swallowing function (P>0.05). One-stage reconstruction of laryngeal function by thyroid cartilage fenestration and "draw-out" resection with adjuvant internal titanium microplate fixation in early glottic carcinoma demonstrates good postoperative recovery and good preservation of the laryngeal function.

One-stage reconstruction of four fingers in children using microsurgical autotransplantation of foot tissue complexes

BACKGROUND: Toe-to-hand transfer is still the most promising and relevant method for restoring fingers that are missing from birth or after injury. In cases requiring the restoration of two or more digits, simultaneous transplantation of tissue complexes from both feet, including one or two toes, is possible and necessary. Thus, a maximum of four fingers can be restored during one operation. Such operations, according to the literature, are performed extremely rarely because they are very extensive and time-consuming.&#x0D; AIM: To present the results of simultaneous microsurgical autotransplantation of four toes to the hand in children with congenital and acquired pathologies.&#x0D; MATERIALS AND METHODS: The study used clinical, radiological, and biomechanical methods to assess the results of nine patients with congenital and acquired upper limb deformities who underwent simultaneous microsurgical autotransplantation of two tissue complexes from each foot, including toes II–III. The indications for performing this method of microsurgical reconstruction in children with the absence of four (or all five) fingers have been determined. The results, postoperative complications, and conditions of the donor and recipient zones were analyzed.&#x0D; RESULTS: To date, 914 such operations have been performed in children. In nine cases, four toes were simultaneously transplanted (two from each foot). The average age of the patients was 4.2 years. Two children had congenital malformations of the hand, and seven had consequences of trauma. In eight cases, fingers II–V were restored, and in one case, fingers I–IV were restored. Complications associated with impaired blood circulation in the grafts were observed in 22% of the cases; however, they were temporary. All transplanted grafts survived. All patients required continued surgical treatment after the toe transfer to improve their appearance and function. Biomechanical examination methods showed complete restoration of function on average of 4 months (±1 month) after surgery.&#x0D; CONCLUSIONS: This study showed the possibility and effectiveness of using toes for hand transfer in children with both congenital and acquired hand pathologies that require the restoration of four fingers. Simultaneous microsurgical transplantation of toes ensures the restoration of a good appearance of the hand and its functionality.

Various soft tissue defect reconstructions using anterolateral thigh and vascularized fascia lata composite free flap.

The anterolateral thigh flap (ALT) is versatile for soft-tissue reconstruction of various body defects because of its thick and vascularized fascia component. We present our clinical experience with the functional one-stage reconstruction of complicated soft-tissue defects using ALTs with vascularized fascia lata (FL). Between April 2018 and February 2022, we transferred ALTs with FL components for various soft-tissue defects in 15 patients. The FL component was used for reconstruction of hand & forearm tendon, medial and lateral patellar synovial membrane, plantar aponeurosis, abdominal wall, dura and Achilles tendon. Functional outcomes were evaluated in each patient. Partial flap necrosis occurred in 2 patients and were treated successfully with minimal surgical debridement and dressing. The vascularized fascia could replace a tendon and fascial component and all the patients achieved satisfactory results without major postoperative complications. Anterolateral thigh flaps with vascularized FL provide reliable fascial and tendon components for single-stage reconstruction of complex soft tissue defects.

Extensive head and neck skin cancers: Carcinologic surgery as a cornerstone of treatment

Background and ObjectiveThe prevalence of extensive skin cancers increases with the aging of the population. Surgical management is the gold standard of curative treatment while morbidity is not negligible. There are few data in the literature concerning extensive head and neck cutaneous cancers. The aim of this article is to report our experience of curative management of head and neck extensive skin cancers. MethodIn this single-center retrospective observational study, we report a series of 17 patients with extensive skin facial cancers treated by surgery between 2013 and 2022 in the maxillofacial surgery department of the Pitié-Salpêtrière Hospital. We collected clinical, therapeutic, histological, and carcinologic data. ResultsThe median age of the patients was 66 years [35–94]. There were 9 male and 8 women. Scalp (39 %) and cheek (22 %) locations were the most frequent ones. The most frequent histological types were squamous cell carcinoma (61 %) and basal cell carcinoma (17 %). Three patients received neoadjuvant treatment. The surgical treatment consisted mainly of carcinological resection followed by one-stage reconstruction by free flap for 5 (30 %) patients and without reconstruction for primary for 12 (70 %) patients, of whom 8 benefited from secondary reconstruction. Five patients received adjuvant radiotherapy or radio-chemotherapy. With a median follow-up of 40 months (2–72), the median overall survival was 40 months (12–72). ConclusionWe know that extensive skin cancers of the face have a good prognosis on condition that the carcinological and reconstructive requirements are respected. Surgery remains the cornerstone of treatment while the improvement of adjuvant therapies, in particular the rise of immunotherapies or other targeted therapies, may allow to limit recurrences.

Analysis of the influencing factors of short-term and long-term facial nerve function after vestibular schwannoma resection via suboccipital retrosigmoid approach

Objective: To summarize the experience of facial nerve(FN) preservation in microsurgical treatment of vestibular schwannoma (VS) resection via suboccipital retrosigmoid approach and to analyze the influencing factors of facial function prognosis in short-term and long-term period. Methods: Patients with VS who underwent microsurgery via suboccipital retrosigmoid approach by the skull base surgery team in Huashan Hospital from January 2013 to February 2018 were enrolled. A total of 308 patients were included in this study, including 132 males and 176 females. The average age was 47.9 year-old (Range: 17-79 year-old). The patient's clinical data and FN function prognosis were recorded. Univariate and multivariate analysis by SPSS 23.0 statistical software were performed to evaluate the factors affecting facial function prognosis and its recovery. Results: Gross total resection was achieved in 304 cases, and subtotal resection was in 4 cases. The facial nerve preservation rate anatomically was 99.4%. The facial nerve of 2 cases was thin due to large tumor compression and severed, and a one-stage reconstruction was performed during surgery.Of the 308 patients, 300 cases were successfully followed up, and 8 cases were lost to follow-up. The mean follow-up time was 52 months. In short-term (2 weeks after surgery), satisfactory facial nerve function (House-Brackmann (H-B) grade Ⅰ-Ⅱ) was achieved in 96 cases, and 212 cases were unsatisfactory function (H-B grade Ⅲ-Ⅵ). After 1 year, 198 were satisfactory function and 97 were unsatisfactory. After 3 years, 219 were satisfactory function and 75 were unsatisfactory. Five years later, 155 were satisfactory function and 34 were unsatisfactory. According to the results of logistic regression analysis, the impact factors of FN function in short-term were tumor size (P=0.011) and stimulation threshold (ST) of EMG monitoring (P<0.001). The impact factors in long-term were tumor size (P=0.005), ST of EMG monitoring (P=0.005) and FN rehabilitation training. Conclusions: Tumor diameter is an independent factor related to FN function, and the larger the tumor, the worse the postoperative FN function. The ST of EMG (ST≤0.05 mA) can predict short-term and long-term FN function. The systematic facial rehabilitation training can effectively promote the recovery of FN after surgery.

One-stage reconstruction of old flexor tendon lesions by hetero-digital transfer of half of the FDP in children. About 6 cases

One-stage reconstruction of old flexor tendon lesions by hetero-digital transfer of half of the FDP in children. About 6 cases

Articular Cartilage Reconstruction with Hyaluronate-Based Scaffold Significantly Decreases Pain and Improves Patient's Functioning.

Articular cartilage lesions negatively affect patients' well-being, causing severe pain and significantly limiting functioning. The purpose of this study was to evaluate the effectiveness of a one-stage reconstruction, performed arthroscopically using a hyaluronate-based scaffold. Pain reduction and functional improvement were assessed. The study also evaluated if postoperative vitamin D supplementation and rehabilitation protocol impact obtained outcomes. A group of 29 patients was included in a retrospective study. All the participants underwent arthroscopic reconstruction of osteochondral lesions using hyaluronate-based scaffolds. The study group used standard questionnaires to self-assess their condition before surgery and at the time of completion. Despite the aforementioned, all the participants fulfilled two original questionnaires on postoperative rehabilitation and vitamin D supplementation. Significant pain reduction (mean NRS 1.83 vs. 7.21, p < 0.0001) and functional improvement (mean Lysholm score 82.38 vs. 40.38, p < 0.0001; mean OKS 40.2 vs. 23.1, p < 0.0001) were found. No differences in pain reduction and functional improvement were seen between genders. The impact of post-operative rehabilitation and vitamin D supplementation on clinical outcomes was found to be statistically nonsignificant. The results obtained in this study clearly confirm the effectiveness of osteochondral reconstruction using hyaluronate-based scaffolds. The outcomes were equally favorable, regardless of postoperative rehabilitation and vitamin D supplementation.

Aortoesophageal fistula treated using one-stage total reconstruction: a case report from a high-volume center

BackgroundAortoesophageal fistula (AEF) is a rare but typically life-threatening condition. Although several treatment strategies exist, including conservative treatment with intraluminal stent graft and open thoracic aortic replacement, the overall outcome remains poor, ranging from 16 to 39%. Furthermore, esophageal reconstruction methods vary between hospitals. Herein, we report a case of aortoesophageal fistula treated using one-stage total reconstruction.Case presentationThis case involved a 58-year-old woman who developed acute type A aortic dissection and underwent successful total arch replacement at the other hospital. However, she developed AEF 1 year later and underwent urgent thoracic endovascular aortic repair, which eventually failed. We performed thoracic aortic replacement, total esophagectomy, gastric tube reconstruction, and omental flap in a one-stage operation. The patient was extubated the next day and transferred to the general ward on postoperative day 3. Computed tomography revealed favorable results.ConclusionsFor postoperative AEF, dedicated debridement with reconstruction is more effective than conservative treatment. In an experienced center, post-procedure-related AEF can be easily treated using one-stage reconstruction.

Experience in the use of osteoplastic material Kollapan-L for perforation of the maxillary sinus

The main complication that occurs during the operation of removing the teeth of the lateral group in the upper jaw is the perforation of the bottom of the maxillary sinuses. In such cases, the main method of treatment is plastic flap of soft tissue structures, however, the restoration of the resulting bone defect is often not considered. In this article, the issue of performing plasty of perforation of the bottom of the maxillary sinus with one-stage reconstruction of the bone tissue of the alveolar process with the osteoplastic material Kollapan-L was studied.The purpose of this article is to increase the effectiveness of surgical treatment of perforation of the floor of the maxillary sinus using the bone-plastic material Kollapan-L and an autoplasmic membrane.Materials and research methods. On the basis of the Department of Maxillofacial Surgery and Dentistry of the Clinic of the Samara State Medical University of the Ministry of Health of Russia, 56 patients aged 18 to 63 years were operated on. The gender difference was as follows: 32 women and 24 men. All patients were diagnosed with perforation of the floor of the maxillary sinus. Most of the patients initially applied for the extraction of the first or second molars in the upper jaw (47 people) and pushing the roots of the removed teeth into the floor of the maxillary sinus (9 people).Results and discussion. The obtained clinical results demonstrated that patients treated with osteoplastic material in combination with centrifuged plasma (main group) had a more stable postoperative period: edema was mild or absent, the facial configuration did not change.Conclusions. The analysis of the clinical results of treatment of 56 patients with perforation of the floor of the maxillary sinus demonstrated a high efficiency of using osteoplastic material in combination with the obtained plasma.

Prepectoral Direct-To-Implant One-Stage Reconstruction With ADMs: Safety and Outcome in “Thin Patients”

BackgroundPrepectoral direct-to-implant reconstruction with acellular dermal matrix (ADM) represents a safe, fast, and successful option in breast reconstruction in a selected cohort of patients. Nowadays, this procedure is considered challenging in thin. Meanwhile, his cohort has not been accurately analyzed yet. MethodsA single institution retrospective cohort study was performed between January 2019 and March 2023 in all women who underwent mastectomy. Biometrical and clinical data were recorded. Also, surgical technique, operating room (OR) time, mastectomy weights, implant choice, and acellular dermal matrix (ADM) types were properly noted. Postoperative complications represented the main topic: these were classified into early and late ones based on onset time. At least 12-month follow-up was required. A comparison between thin and ideal body mass index (BMI) populations was performed. ResultsEarly complications did not seem to differ between the 2 groups with 37.8% and 38.9% of women having at least 1 early complication in thin and ideal-weight women, respectively (P = .919). In univariable regression analysis, compared with women with a BMI of 22.1 to 25.0, women with a BMI ≤ 22.0 were associated with an increased risk of late complications of 2.84 (1.13-7.14). Specifically, thin women appeared to have a 3-fold increased risk (OR = 2.97, 95% CI 1.08-8.18) of ripples/wrinkles compared with women with ideal weight. ConclusionsPrepectoral reconstruction with ADM in thin patients may be considered as safe as in standard BMI patients. Rippling may be more frequent, but, whenever needed, easy to correct with a few sessions of lipo-grafts. Level of EvidenceIII.

Comparative analysis of the frequency of complications in one-stage and two-stage breast reconstruction after subcutaneous/skin-saving mastectomy in combination with radiotherapy

Background. Breast cancer (BC) is not only a global medical problem, but a social problem associated with its steady growth and spread. Thus, the prevalence of BC in women in Russia in 2021 was 21.1 %. Combined or complex treatment is used in the vast majority of cases (surgery, drug and radiation therapy); in 2021, this percentage was 64.5 %. Currently, there is no doubt that radiation therapy is necessary as part of the complex treatment of patients with T1–3N1–2 BC, as it leads to an increase in survival rates. The development of reconstructive plastic surgery makes it possible to restore the removed breast using implants or autologous tissues. Reconstruction with endoprostheses is the main method, it accounts for up to 70 % of all reconstructive breast surgeries. Until recently, the most popular method was a two-stage reconstruction. Especially in cases where radiation therapy is planned. However, our own experience of one-stage reconstructions in combination with radiation therapy showed good aesthetic results with a low complication rate, which was the reason for this study.Aim. To study and compare the incidence of complications in one- and two-stage breast reconstruction after subcutaneous/skin-sparing mastectomy in combination with radiation therapy.Materials and methods. A prospective study of 92 patients diagnosed with BC was carried out. The patients were divided into 2 groups: group I (study) included 50 women, who underwent one stage – subcutaneous/skin-sparing mastectomy with breast reconstruction using an implant, II (control) group included 42 patients, who underwent subcutaneous/skin-preserving mastectomy with breast reconstruction with an expander, followed by replacement of the expander with an implant. After radiation therapy, the groups underwent a comparative assessment of anthropometric and anamnestic data, a study of the somatic anamnesis, the results of pathomorphological typing of the tumor, treatment tactics and complications.Results and conclusion. Subcutaneous/skin-sparing mastectomy with simultaneous breast reconstruction using an implant does not increase the incidence of postoperative complications when combined with radiation therapy, and also does not limit the appointment of concomitant treatment methods in the complex therapy of women with BC. This method of surgical treatment can be used in patients with IIA, IIB and IIIA stages of tumor growth.

Impact of radiation on immediate breast reconstruction: a retrospective single institution cohort study.

While the trend towards immediate breast reconstruction is growing, data on the long-term outcomes of patients receiving irradiation afterwards are scarce. We retrospectively reviewed the long-term complication rates in patients who received adjuvant radiation therapy after immediate breast reconstruction in our institution. We included 134 patients with breast cancer who underwent single-stage immediate breast reconstruction between January 2008 and December 2018. Sixty-eight patients received adjuvant irradiation and 66 patients did not. Autologous tissue, implant-based, and combined (implant and flap) reconstruction were performed in 40, 55, and 39 patients, respectively. Flap and implant complications data were collected. Baker's classification was used to assess capsular contracture. The average follow-up was 47 months. Both groups had similar baseline clinical characteristics and treatments received. The irradiated-group had a higher incidence of adjuvant chemotherapy (P<0.01) and a significantly higher rate of grade III/IV capsular contracture (42.1% vs. 26.9%; P=0.004) than that of the non-irradiated group. The median time to the development of capsular contracture was 37 vs. 41 months in the irradiated vs. the non-irradiated group, respectively. There were no differences in the incidence of flap complications between both groups. The only significant risk factor associated with grade III/IV capsular contracture was adjuvant post-mastectomy irradiation. The irradiated group had a higher risk of developing grade III/IV capsular contracture [odds ratio (OR), 4.35; 95% confidence interval (CI): 1.55-12.27]. Postmastectomy radiotherapy adversely affects implant-based immediate one-stage reconstruction by increasing the rate of moderate to severe capsular contracture but is not associated with flap complications.