Total Reconstruction Research Articles

Reconstruction mammaire secondaire unilatérale par lambeau dorsal pédiculé épargnant le muscle grand dorsal (TDAP et MSLD) chez les patientes aux antécédents de mastectomie totale pour cancer du sein. Étude observationnelle monocentrique

The use of pedicled dorsal flaps sparing the latissimus dorsi muscle (TDAP and MSLD flap) is a well-described reconstruction method in breast reconstruction after breast cancer. However, little data exists regarding patient satisfaction after this surgery. The main objective of this study was to evaluate patient satisfaction after unilateral total secondary breast reconstruction using a TDAP or MSLD flap. The secondary objectives corresponded to the evaluation of postoperative complications following this surgery, the evaluation of the duration of the reconstruction and the nature of additional interventions, the evaluation of the functional after-effects, and the evaluation of the chest size when the reconstruction is completed. This is a monocentric, retrospective cohort study, including 22 patients who underwent unilateral secondary total breast reconstruction using a TDAP or MSLD flap between January 1, 2018 and December 31, 2022. Patient satisfaction was assessed using three questionnaires validated in breast reconstruction: the Reconstruction module of the BREAST-Q, the MBROS-S and the MBROS-BI. The MBROS-S satisfaction score is 71.4%. The MBROS-BI body image score is 62%. With the BREAST-Q, the Satisfaction with Breast score is estimated at 53.1; the Satisfaction with Back score is estimated at 75.5; the physical well-being score regarding the chest is evaluated at 71.7; the physical well-being score concerning the shoulder and back is evaluated at 67.4; the psychosocial well-being score is assessed at 67.4; the sexual well-being score is estimated at 48.7; and for women who have benefited from reconstruction associated with a prosthesis, the satisfaction score regarding the implant is 71.6. Unilateral total secondary breast reconstruction with a dorsal pedicled flap sparing the latissimus dorsi muscle is an elegant, reliable, and respectful way to reconstruct a breast, and appears to give high levels of satisfaction.

Is an extended alloplastic replacement (eTMJR) device an option for the management of mandibular defects involving the temporomandibular joint? - A prospective cohort study

The reconstruction of large mandibular deficits involving the temporomandibular joint (TMJ) can be challenging. Extended alloplastic total temporomandibular joint reconstruction (eTMJR) is one treatment option.This single center, prospective, long-term observational study evaluates the objective and subjective outcomes of 21 eTMJR subjects followed >5 years postoperatively. The long-term stability of the eTMJR was determined by collecting objective data (mandibular kinematics, contralateral surface electromyography (sEMG), maximum voluntary clenching (MVC)) and subjective oral health related quality of life (oHrQoL).Except for mandibular deviation on opening, the objective variables markedly improved. A statistically significant decrease was found for ipsilateral condylar hypermobility (P = 0.001), and an increase in bilateral MVC (ipsilateral P = 0.029, contralateral P = 0.015). The subjective outcomes 'diet consistency’ (P = 0.001) and 'physical distress' (P = 0.043) improved significantly.Based on the stability of the eTMJR devices over the study period, improved objective and subjective variables, eTMJR appears to be a safe and effective predictable management option for patients with large mandibular deficits including the TMJ.

Application of hybrid operating room in the surgical treatment for intracranial aneurysm

BackgroundIntracranial aneurysms are associated with a high mortality rate in the event of a rupture and significant morbidity during subsequent treatment. Hybrid treatment approaches for vascular diseases have been incorporated into modern operating rooms as guides for surgical interventions now. The current study evaluates the feasibility and effectiveness of hybrid operating room system and its application in the surgical treatment of intracranial aneurysms. AimsTo evaluate the feasibility and effectiveness of hybrid operating room system and its application in the surgical treatment for aneurysms. Methods76 patients with 84 intracranial aneurysms were surgically treated in Hybrid operating room with intraoperative angiography between March 2018 and March 2021. Aneurysm clipping was performed in 76 (94.7 %) cases; Aneurysm trapping with extracranial-intracranial (EC-IC) bypass in 4 (5.3 %) cases. Patient demographics, aneurysm size, location, Hunt and Hess score, were recorded. 69 (90.8 %) patients were followed up 6–12 months post operation. ResultsIntraoperative angiography demonstrated 5 (6.9%) unexpected aneurysm neck residuals leading to adjustment; 6 (8.3%) parent vessel stenosis in which 5 returned to normal after adjustment. Four giant paraclinoid aneurysms trapping with EC-IC bypass showed total successful vessel reconstruction and complete aneurysm exclusion (100%). The postoperative outcome was evaluated with the modified Rankin Scale (mRS). 53 (76.8%) patients showed good outcome (mRS 0), 11 (15.9%) showed mild neurological defect (mRS 1–2), 3 (4.3%) showed poor outcome (mRS 5), and 2 (2.9%) patients died (mRS 6, Hunt-Hess grade V before surgery). Conclusion: Hybrid operating room provides new concepts in the surgically treatment of intracranial aneurysms, especially valuable for the complex aneurysms. The combination of intraoperative imaging of angiography and clipping surgery may offer the opportunity of radical clipping and reduced complications for aneurysm patients.

Total water storage anomalies reconstruction using noise-augmented u-shaped network: A case study in the Yangtze River Basin

The satellite mission of Gravity Recovery and Climate Experiment (GRACE) and its follow-on mission (GRACE-FO) have characterized global total water storage anomalies (TWSA) with unprecedented accuracy. However, the data gap between GRACE and GRACE-FO from July 2017 to May 2018 represents challenges for interpreting long-term water storage changes. In this study, we present a deep learning model, a noise-augmented u-shaped network (NA-UNet), to bridge the gap over the Yangtze River Basin (YRB). This model has been trained on precipitation, temperature, and hydrological model data. We show that the NA-UNet model achieves a state-of-the-art TWSA reconstruction, outperforming the standard UNet model and previous studies. At the basin scale, the NA-UNet model agrees favorably well with GRACE observations, with a correlation coefficient (CC) of 0.99, Nash-Sutcliff efficient (NSE) of 0.97, and normalized root-mean-square error (NRMSE) of 0.04 during the testing period. At the grid-cell scale, our model has a much more stable performance with median CC/NSE/NRMSE values of 0.99/0.96/0.05. This significant improvement in the gap-filling ability addresses the issue with discontinuous TWSA observations while laying the foundation for predicting future changes in total water storage.

Alloplastic total joint reconstruction for severe temporomandibular joint ankylosis in the skeletally immature patient: a narrative review

Alloplastic total joint reconstruction for severe temporomandibular joint ankylosis in the skeletally immature patient: a narrative review

Treatment of temporomandibular joint ankylosis with total prosthetic joint reconstruction: a case series and scoping review of the literature

Treatment of temporomandibular joint ankylosis with total prosthetic joint reconstruction: a case series and scoping review of the literature

Novel single-centre experience - evaluation of outcomes post-implementation of a coordinated combined breast reconstruction service.

Autologous breast reconstruction services are logistically complex and challenging to implement but have better outcomes than implants. This study aimed to evaluate the effect of implementing a coordinated, low-cost combined breast reconstruction service (0.8 FTE nurse liaison, 0.25 FTE plastic surgeon, two dedicated breast surgeons 0.05 FTE each and protected weekly all-day oncoplastic theatre) on unit productivity and efficiency in reducing wait times for immediate autologous breast reconstruction. A retrospective cohort study was conducted on all patients who underwent immediate autologous breast reconstruction at Fiona Stanley Hospital between two study periods, pre-intervention - February 2016 to June 2019 and post-intervention - November 2022. Data were analysed using SPSS v.27. One hundred twenty-seven participants were included, with 49% (n = 62) in the post-intervention group. Most procedures performed were therapeutic (n = 108, 85%). DIEP was the most common flap (84%), and the mean BMI was 26.9 (SD ± 4.2). There was a statistically significant increase in the number of high-risk gene carriers' prophylactic cases and bilateral cases performed post-intervention (5% to 26%, P = 0.001) and (29% to 55%, P = 0.003), respectively. Time to surgery on the waitlist did not significantly change after the intervention (therapeutic group: 3.1 to 3.5 weeks, P = 0.821; prophylactic group: 55.0 to 61.1 weeks, P = 1.000). Overall, there was a marked increase in the overall productivity of the breast service unit in terms of mastectomies, total reconstructions, and autologous reconstructions performed. This single-centre experience showed that implementing a coordinated service significantly increased the unit's productivity. This low-cost intervention can be applied to other healthcare settings.

Early outcome of simplified total arch reconstruction under mild hypothermia (30–32 °C) with distal aortic perfusion

ObjectiveWe designed a simplified total arch reconstruction (s-TAR) technique which could be performed under mild hypothermia (30–32 °C) with distal aortic perfusion. This study aimed to compare its efficacy of organ protection with the conventional total arch reconstruction (c-TAR).MethodsWe reviewed the clinical data of 195 patients who had ascending aortic aneurysm with extended aortic arch dilation and underwent simultaneous ascending aorta replacement and TAR procedure between January 2018 and December 2022 in our center. 105 received c-TAR under moderate hypothermia (25–28 °C) with circulatory arrest (c-TAR group); rest 90 received s-TAR under mild hypothermia (30–32 °C) with distal aortic perfusion (s-TAR group).ResultsThe s-TAR group demonstrated shorter CPB time, cross-clamp time and lower body circulatory arrest time compared with the c-TAR group. The 30-day mortality was 2.9% for the c-TAR group and 1.1% for the s-TAR group (P = 0.043). The mean duration of mechanical ventilation was shorter in the s-TAR group. Paraplegia was observed in 4 of 105 patients (3.8%) in the c-TAR group, while no such events were observed in the s-TAR group. The incidence of temporary neurologic dysfunction was significantly higher in the c-TAR group. The incidence of permanent neurologic dysfunction also showed a tendency to be higher in the c-TAR group, without statistical significance. Furthermore, the incidence of reoperation for bleeding were significantly lower in the s-TAR group. The rate of postoperative hepatic dysfunction and all grades of AKI was remarkably lower in the s-TAR group. The 3-year survival rate was 95.6% in the s-TAR group and 91.4% in the c-TAR group.Conclusionss-TAR under mild hypothermia (30–32℃) with distal aortic perfusion is associated with lower mortality and morbidity, offering better neurological and visceral organ protection compared with c-TAR.

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.

Deep learning based coherence holography reconstruction of 3D objects.

We propose a reconstruction method for coherence holography using deep neural networks. cGAN and U-NET models were developed to reconstruct 3D complex objects from recorded interferograms. Our proposed methods, dubbed deep coherence holography (DCH), predict the non-diffracted fields or the sub-objects included in the 3D object from the captured interferograms, yielding better reconstructed objects than the traditional analytical imaging methods in terms of accuracy, resolution, and time. The DCH needs one image per sub-object as opposed to N images for the traditional sin-fit algorithm, and hence the total reconstruction time is reduced by N×. Furthermore, with noisy interferograms the DCH amplitude mean square reconstruction error (MSE) is 5×104× and 104× and phase MSE is 102× and 3×103× better than Fourier fringe and sin-fit algorithms, respectively. The amplitude peak signal to noise ratio (PSNR) is 3× and 2× and phase PSNR is 5× and 3× better than Fourier fringe and sin-fit algorithms, respectively. The reconstruction resolution is the same as sin-fit but 2× better than the Fourier fringe analysis technique.

Stacked fibula flap for unilateral total maxillectomy reconstruction with orbital preservation.

Unilateral total maxillectomy is indicated for locally advanced maxillary tumors that require complete removal of the midface bony structure and inferior orbital rim. Reconstruction of this defect is challenging due to aesthetic and functional concerns. A retrospective review of patients at two tertiary-care institutions undergoing unilateral total maxillectomy reconstruction with a stacked fibula flap from 2018 to 2022 was performed. Each patient's clinical course was reviewed, and attention was focused on the demonstration of surgical steps with photos. Twenty patients underwent stacked fibula flap reconstruction for unilateral total maxillectomy orbital preservation defects. Surgical extirpation was performed for malignancy (80%, 16/20) and for osteoradionecrosis or benign tumor in 20% (4/20). The complication rate was 30% (6/20). Most flaps survived (95%, 19/20). We present a modified, reproducible method of fibula flap reconstruction for unilateral total maxillectomy with orbital preservation that only requires two segments and maintains positive aesthetic and functional results.

Successful fat-only whole breast reconstruction using cultured mature adipocytes and conditioned medium containing MCP-1

A mastectomy is a curative treatment for breast cancer. It causes breast and soft tissue deficits, resulting in a chest with poor vascularity. Autologous tissue breast reconstruction is commonly associated with donor site morbidity. Breast implants are another reconstruction alternative, but they are associated with infection, rupture, and the need for replacement. Autologous aspirated fat grafting has appeared as an ideal breast reconstruction method, but low graft viability and high resorption remain as the main shortcomings. We developed a novel method for fat-only grafts using cultured mature adipocytes (CMAs) mixed with their condition medium. Twenty-five mastectomy patients, aged 32–72 years, received a mixed grafting of CMAs, MCP1-containing condition medium, and fat grafts for total breast reconstruction. In follow-up periods of 24–75 months, MRI analysis showed full thickness fat-engraftment. The cell proliferation marker Ki67 was negative in post-transplant biopsy specimens from all patients. Aesthetic full breast morphology was achieved, patient satisfaction was evaluated 1 year and 3–6 years after surgery. All grafts were confirmed safe, demonstrating high reliability and long-term sustainability.

Management of urethral complications after total phallic reconstruction: A single centre experience

Management of urethral complications after total phallic reconstruction: A single centre experience

Early outcomes of a triple-branched stent graft implantation in elderly patients with acute type a aortic dissection

PurposeOlder patients with acute type A aortic dissection (ATAAD) have higher risk of mortality than that of younger patients when a total arch reconstruction (TAR) is required. Triple-branched stent graft (TBSG) implantation is a novel technique for TAR. However, early outcomes of a TBSG implantation in older patients have not been reported. This study aimed to evaluate the early outcomes of the TBSG technique in older patients with ATAAD.MethodsFrom February 2015 to December 2020, 640 patients who simultaneously underwent an emergent open aortic surgery and TBSG implantation for ATAAD were enrolled in this study. They were categorized into the younger (age ≤ 70 years old, n = 573) and older groups (age > 70 years, n = 67). Clinical data of all patients were retrospectively reviewed.ResultThe mean ages of the patients in the younger and older groups were 45.3 ± 9.6 years old and 73.5 ± 3.0 years old, respectively. Preoperative characteristics were similar between the two groups, except for weight and incidence of moderate or greater aortic regurgitation, which were lower in the older group than those in the younger group. Surgical procedure and duration (i.e., duration for cardiopulmonary bypass, aortic cross-clamp, selected cerebral perfusion, and total circulation arrest) were comparable between the two groups (p > 0.05). Patients in the older group had higher incidence of dialysis for acute kidney injury and longer ICU stay compared with those in the younger group. However, the incidences of 30-day mortality (5.1% in younger group vs. 7.5% in older group, p = 0.407) and other major complications (i.e., neurological adverse events) were similar between the two groups.ConclusionTBSG implantation for ATAAD resulted in an acceptable mortality rate in patients above 70 years old, thus, it could be a feasible surgical procedure to perform in older patients with ATAAD when a TAR is required.

Total lower lip reconstruction: a review of recent advances.

This review describes the fundamental principles and recent advances in the reconstruction of total lower lip defects to restore peri-oral aesthetic and function. Modifications to the Abbe flap and visor flap have recently been described. Recent advances to free flap techniques have focused on dynamic restoration of lower lip sling function after reconstruction. This involves the transfer of innervated or noninnervated muscle tissue to reconstruct the lower lip to restore the sphincter function of the lips. The reconstructive goals for a full thickness lower lip defect are to restore a functional oral sphincter, replace mucosal and external skin, and maintain a functional size of the oral aperture. Local flap reconstruction of sub-total lower lip defects is possible, but use of local flaps for total lip reconstruction often leads to microstomia. Several static and dynamic free tissue transfer options exist for lower lip reconstruction and have been summarized in this review.

Physiotherapy Rehabilitation for Accelerating the Recovery of Patient with Anterior Cruciate Ligament Total Reconstruction and Meniscal Repair: A Case Report

Background: The Anterior Cruciate Ligament (ACL) is a ligament that functions to limit the movement of the tibia toward the anterior and excessive rotation, while the meniscus serves as shock absorption, load transmission, and the stabilizer of the knee joint. About 22% to 86% meniscal tear incidences occurring along with ACL injuries is. The study aims to determine the role of physiotherapists in the postoperative rehabilitation process of patients of ACL Reconstruction (ACLR) and meniscal repair in preventing postoperative complications and functional abilities of patients. Case Report: The patient was a 35-year-old adult male who suffered a complete tear in the ACL and meniscus of the left knee. The patient underwent ACLR and meniscal repair with arthroscopic surgery 2 years after injury with Bone-Pattelar tendon-bone autograph. 2 weeks post-surgery the patient visited the physiotherapy polyclinic with medical conditions of difficulty in bending and straightening the knee, still feeling pain and thick in the knee area. Results: The physiotherapist program was conducted three times and it was a home program-based exercise. The physiotherapist program and outcomes used in the first phase focused on exercises to improve ROM (Goniometer), oedema management (Medline), pain reduction (Numerical Rating Scale), activation exercises, and surrounding muscle strength (Sphygmomanometer), and improve functional ability (Tegner Lysholm Knee Scale) as well as the provision of home programs Performed by regular monitoring of exercise intensity using isometric, isotonic, and isokinetic exercises, which were given according to the concept of progressive loading. Conclusion: This case study shows that surgery combined with a comprehensive physiotherapy program plan in ACLR and meniscal repair cases, as well as adding home-based exercise programs with intense monitoring, generate more effective results. Keywords: physiotherapy rehabilitation, anterior cruciate ligament total, meniscal repair Correspondence: Suryo Saputra Perdana. Physiotherapist Profession Education Department, Faculty of Health Sciences, Universitas Muhammadiyah Surakarta, Sukoharjo, Central Java, Indonesia. Email: suryo.saputra@ums.ac.id. Mobile: +6281298563988.

Oncological and functional outcome of robotic-assisted radical cystectomy with total intracorporeal stentless J-pouch neobladder reconstruction.

Robotic-assisted radical cystectomy (RARC) with neobladder reconstruction has gained popularity in recent years. We conducted a retrospective study of 17 consecutive patients who underwent RARC with totally intracorporeal J-pouch neobladder reconstruction without ureteral stent by a single experienced surgeon to evaluate perioperative, oncological and functional outcomes. The median follow-up duration was 32.8months (range: 17.4-59.0months), and the 2-year disease-free survival rate was 88.2%. Five out of 12 patients were totally continent, and none required more than one pad per day. The overall complication rate was 41.2%, and hydronephrosis was the most common adverse event. The renal function remained stable, and no long-term renal function impairment was detected. Our study suggests that RARC with totally intracorporeal J-pouch neobladder reconstruction without ureteral stent is a safe and feasible option for the treatment of muscle-invasive bladder cancer, with good oncological and functional outcomes.

Aesthetic results were more satisfactory after oncoplastic surgery than after total breast reconstruction according to patients and surgeons.

Patient satisfaction after breast cancer surgery has an impact on body image, sexual function, self-esteem, and quality of life and may differ from the perception of the attending physician. This study aimed to compare the aesthetic outcomes and satisfaction with conservative oncoplastic surgeries, mastectomies, and total breast reconstruction. We included 760 women diagnosed with invasive breast carcinoma or phyllodes tumors who returned at least 6 months after surgery or radiotherapy at two public hospitals and a private clinic between 2014 and 2022. Data was collected prospectively from patients and retrospectively from their medical records using a specific form after obtaining their informed consent. Aesthetic outcomes and quality of life were assessed using the BREAST-Q©, Harris Scale, and BCCT.core software. Data were evaluated using the SPSS statistical software. Statistical significance was set at p<0.05. This study was approved by the hospital ethics committees. A total of 405 (53.29%) partial and 355 (46.71%) total reconstructions were included. Patients who underwent partial reconstruction were older and had higher body mass index. Patients who underwent total reconstruction had larger tumors with advanced clinical and pathological stages. Clinical and surgical complications occurred more frequently in the total reconstruction group. A greater number of reparative surgeries and lipofilling procedures were required for total reconstruction. According to the BREAST-Q, the partial reconstruction group showed significantly higher levels of women's satisfaction with their breasts, the surgical outcomes, psychosocial and sexual well-being, provision of information, and the reconstructive surgeon. Only physical well-being was slightly higher in the total reconstruction group. In most cases, the results were rated good or excellent. Physicians considered partial reconstructions to have better results than total reconstructions, although this difference was not perceived by the BCCT.core software. Women who underwent partial breast reconstruction had higher levels of satisfaction in several domains, lower frequency of complications, and required fewer surgeries to complete their reconstruction than women who underwent total reconstruction. Physicians were also more satisfied with the results of partial reconstructions.

Roux-en Y with J pouch versus simple roux-en Y reconstruction after total gastrectomy for gastric cancer functional assessment and quality of life

Background Replacement of the reservoir function of the stomach after total gastrectomy is of particular importance. And several types of gastric substitutes have been suggested. The most widely accepted is the Hunt-Lawrence- Rodino or Jejunal pouch. Aim and objectives To compare the nutritional, functional outcomes and quality life of a Jejunal pouch reconstruction to the simple Roux -en-Y esophago jejunostomy in patients who had total gastrectomy due to cancer. Subjects and methods 40 patients underwent total gastrectomy and reconstruction at the upper GIT surgery unit of the Department of Surgery of the University Medical School of Ain shams between august 2020 and October 2022. Patients divided into two groups, group (A) 20 patients reconstructed by simple roux -en – y esophagojejunostomy. Group (B) 20 patients reconstructed by roux - en – y esophagojejunostomy with oral type jejunal pouch. Both groups were compared regarding anthropometeric, nutritional and laboratory values at preoperative, 3 and 6 months p o , also early postoperative complications, post gastrectomy and reflux symptoms and patient’s QOLI using Eypasch questionnaire at 6 month p o. Results No significant difference regarding morbidity or mortality associated with pouch reconstruction (P-value &gt;0.05) .also no significance regarding body weight, BMI at 3 and 6 months p o. the pouch group was associated with a lower incidence of dumping, diarrhea and reflux symptoms (P-value &lt;0.05)., also a better food intake, and better quality of life parameters at 6 months post -operative (P-value &lt;0.05). Conclusion In a 6-month follow-up after total gastrectomy, pouch reconstruction was superior to Roux-en-Y esophagojejunostomy in terms of p o food intake, incidence of dumping, diarrhoea, and reflux symptoms, as well as quality of life.

TCT-637 19-Year Outcomes of Total Arterial Reconstruction After Coronary Endarterectomy in 948 Patients

TCT-637 19-Year Outcomes of Total Arterial Reconstruction After Coronary Endarterectomy in 948 Patients