Type Of Reconstructive Surgery Research Articles

A retrospective investigation of women’s experience with breast reconstruction after mastectomy

A diagnosis of breast cancer is often accompanied by the fear of loss of previous body image and attractiveness. Hence, many patients opt for reconstructive surgery. This study evaluated the effects of different types of reconstructive surgery after mastectomy on the functional and psychological adjustment of patients. In a cohort study, patients, who had breast reconstruction after mastectomy by means of four different allogenic or autologues techniques between 1999-2006 were retrospectively interviewed in person or by telephone. The questions addressed complication rates, physical complaints, functional impairments, body image outcomes, sexuality and patient satisfaction. Of 139 patients, 89 (64.7 %) completed the survey. 32 (35.9 %) patients experienced one or more postoperative complications like seroma, hematoma, infections or necrosis. 16 (20 %) and 13 (16 %) patients reported strong and moderate adverse effects on sexuality, respectively. 62 (70 %) patients indicated that they were actively included in the decision making process. Patient ratings of good or bad medical advice were associated with complication rates (p = 0.008). Patients, who evaluated their first preoperative counseling positively, reported higher consent rates when a re-reconstruction became necessary (p ≤ 0.001). Satisfaction with the functional outcome after reconstruction and satisfaction with the cosmetic result was highly correlated (p < 0.001). A significant association of patient satisfaction with postoperative complications and the decision for a re-reconstruction was demonstrated. Furthermore, our results emphasize the importance of detailed preoperative counseling for women's adjustment to reconstructive surgery.

REPLACEMENT OF PROXIMAL INTERPHALANGEAL JOINTS IN HAMMER TOE DEFORMITY

Objective: to assess the results of Hammertoe Implant Procedure (HIP) in the treatment of hammer toes deformation. 28 operations were carried out in 16 patients aged 26 to 58 years with stage II-III (according to the classification of MI Kuslik) of hammer toes from September 2009 to March 2011. In 50% of them surgeries were performed on one foot, in the second half - on two feet. Mean duration of follow-up was 12.4 months, range 6-21. Results: evaluation of the results was carried out by scale of AOFAS. A significant improvement was noted after HIP: in average score before surgery - 47, in the postoperative period - 92. In evaluating the average preoperative pain score was 24.3, postoperative - 36.0 (complete absence of pain is estimated to be 40 points). Improving the function of the foot with an average of 19 before surgery after surgery reached 41 points, while the position of the fingers (the alignment of the foot and toes) is changed from the average value of 2.4 to 12.4 after surgery. Conclusion. Analysis of results showed the effectiveness of the HIP method in the treatment of hammertoe 2-3 fingers. HIP has allowed to achieve good functional and cosmetic results in early and the follow-up postoperative period. In our view, HIP with complex deformations forefoot can be used as an adjunct to other types of reconstructive surgery on the anterior part of the foot, and cases with recurrent strains hammer toes after surgery, HIP can be operation of choice.

Patient-reported satisfaction with reconstructed breasts in the long-term survivorship period: Comparison of autologous and nonautologous breast reconstruction.

9043 Background: Breast cancer patients undergoing mastectomy may choose to have reconstruction performed using either their own tissue or an implant. As many patients are candidates for both, valid and reliable patient-centered outcomes data are crucial to shared medical decision-making. The objective of this study is to determine whether patient-reported satisfaction with their reconstructed breasts is dependent on type of reconstructive surgery and length of time from reconstruction. Methods: Participants were recruited from Memorial Sloan-Kettering Cancer, NY and the University of British Columbia, Canada. Patients completed the BREAST-Q, a new patient-reported outcome measure for breast surgery patients. The dependent variable was the BREAST-Q Satisfaction with Breast score, a 16-item scale scored from 0-100. Procedure type, time since surgery, and patient characteristics were independent variables. Univariate analysis and clinical judgment were used to identify variables included in the model, and multivariate linear regression models were constructed to control for confounders. Results: The study sample consisted of 510 women (response rate 62%). The sample was on average aged 54.3 ± 9.3 (range 21-81), surveyed 3.71 years ± 1.55 (range 1-9) after surgery, 66% were reconstructed using an implant. Type of surgery and laterality were found to be variables that predicted higher patient satisfaction with their breasts after controlling for radiation therapy, follow-up time, timing of surgery, age, body mass index, and major complications (surgery type p&lt;0.001; laterality p&lt;0.001, R-square=0.17). Conclusions: As there is a growing population of breast cancer survivors, understanding how a woman’s satisfaction with her reconstructed breasts changes over time is essential. This study suggests that patient satisfaction with breast reconstruction depends on the type of reconstruction a woman undergoes. This patient-centered outcome data can be used to enhance shared medical decision-making by providing patients with information about realistic expectations for satisfaction with breasts related to type of surgery chosen.

Employing Rapid Prototyping to Assist Free Fibular Flap Reconstructive Surgery of Mandibular Defects

Patients suffering from mandible tumors often require a reconstructive surgery to repair the defects caused by large tumors. The particular type of reconstructive surgery studied in this paper is called free fibular flap reconstruction, which uses fibular segments to replace removed sections of the mandible and a titanium plate to provide strength. In order to decrease the dependence on design experience, decrease surgery time, and enhance the participation of surgeons in the design process, Rapid Prototyping (RP) biomedical models were employed to enable good visualization of the original and reconstructed geometry and for use as forming guides for the customized titanium plates. This study reports on one male and one female patients who underwent mandibular reconstruction. In one case, the operation time was reduced 2 hours and the other one was reduced 1.8 hours. The customized titanium plate shapes conformed to the patients’ mandible anatomy and were thick enough to provide the strength and stiffness needed to fix the mandible until the bone grafts and soft tissues heal.

Reconstructive Options of Burn Injuries to the Hand and Upper Extremity

ANY BURN PATIENTS are now surviving their burn injuries as critical care techniques improve, leading to an emphasis on preserving function and decreasing overall morbidity. Despite skin grafting and adequate wound coverage, many burn scars can limit function because of acquired web space contractures and burn syndactylies. Many of the burns that require formal reconstruction are fourth-degree burns that involve extension of the injury zone into underlying structures such as muscle, tendon, and bone. These are extreme injuries and often involve staged reconstructions and occasional amputations. This article focuses on prevention of secondary wound contractures, early reconstruction of burn deformities, as well as later reconstruction. As with any type of reconstructive surgery, initial treatments can limit the degree of reconstruction needed later. PREVENTION The surgeon must begin thinking about functional salvage from the earliest hours of burn care. A critically important preventive strategy to preserve vascularity and diminish excessive tissue pressures is early escharotomy and nerve decompression of the fingers, thumb, and hand. The injury patterns most likely to benefit from early release are electrical injuries, circumferential burns, and combined crush/burns. Median nerve decompression is useful especially in circumferential burns to the hands in clinical situations in which the patient is not able to respond to a sensory examination, or when the patient’s sensation is compromised by the burn itself. Some burn centers release the median nerve

Adipose Tissue Remodeling under Ischemia: Death of Adipocytes and Activation of Stem/Progenitor Cells

Following various types of plastic surgery, such as adipose grafting and flap elevation, adipose tissue undergoes ischemia, leading to hypoxia and nutrient depletion. However, few studies have examined ischemic and/or hypoxic changes in adipose tissue. The authors established surgically induced ischemia models by severing blood vessels supplying the inguinal fat pads in mice. The partial pressure of oxygen in adipose tissue was measured with an oxygen monitor, and ischemic changes were analyzed by whole-mount staining, immunohistochemistry, flow cytometry, and Western blotting. The authors also examined cell survival under a hypoxic condition in vitro. Models for three degrees (mild, intermediate, and severe) of ischemia showed approximately 75, 55, and 20 percent of the partial pressure of oxygen level in normal adipose tissue (50.5±1.3 mm Hg), respectively. Adipose tissue atrophy with substantial fibrosis on day 28 was seen, depending on the severity of ischemia. Intermediate and severe ischemia induced elevated expression of hypoxia-inducible factor 1α and fibroblast growth factor 2 on day 1 and degenerative changes (i.e., apoptosis, necrosis, and macrophage infiltration and phagocytosis) in adipose tissue. Dead cells included adipocytes, vascular endothelial cells, and blood-derived cells, but not adipose-derived stem/progenitor cells. Subsequent to degenerative changes, regenerative changes were seen, including angiogenesis, adipogenesis, and proliferation of cells (adipose-derived stem/progenitor cells, vascular endothelial cells, and blood cells). The authors found that, in vitro, the experimentally differentiated adipocytes underwent apoptosis and/or necrosis under severe hypoxia, but adipose-derived stem/progenitor cells remained viable. Severe ischemia/hypoxia induces degenerative changes in adipose tissue and subsequent adaptive tissue remodeling. Adipocytes die easily under ischemic conditions, whereas adipose-derived stem/progenitor cells are activated and contribute to adipose tissue repair.

Retentissement de la chirurgie du prolapsus génital sur la sexualité des patientes

Objective To evaluate quality of life and sexual life of female patients after abdominal or vaginal approach for prolapse surgery. Patients and methods Two hundred and nineteen patients with stage 2 or 3 prolapse underwent surgery over a period of 7 years. In this retrospective work, patients have been invited by mail to answer questions on the phone. The questionnaire is a French translation of PISQ12. Time between surgery and study is about 4 years. Results We got 176 answers: 52.3% of women underwent abdominal surgery (group 1) and 47.7% vaginal reconstructive surgery (group 2). In terms of quality of life, only 8.5% of patients are not satisfied in group 1, compared to 9.5% in group 2. In terms of sexuality, 64% have sexual intercourses. We find a significant total score difference to the detriment of vaginal way after surgery ( p = 0.005). We note indeed a significant decrease in sexual desire, orgasm frequency and excitement and a significant worsening in dyspareunia after vaginal reconstructive surgery. The other significant factors on sexuality are age and urinary incontinence. After a multivaried study, only age remains the significant factor. Discussion and conclusion This work confirms that both ways of surgery are an effective prolapse treatment, with identical functional results. Influence on sexuality seems to depend more on age than on the type of reconstructive surgery.

Fournier's Gangrene: Population Based Epidemiology and Outcomes

Case series have shown a Fournier's gangrene mortality rate of 20% to 40% with an incidence of as high as 88% in some studies. Because to our knowledge there are no population based data, we used a national database to investigate the epidemiology of Fournier's gangrene. We used the State Inpatient Databases, the largest hospital based database available in the United States, which includes 100% of hospital discharges from participating states. Inpatients diagnosed with Fournier's gangrene (ICD-9 CM 608.83) who underwent genital/perineal débridement or died in the hospital were identified from 13 participating states in 2001 and from 21 in 2004. Population based incidence, regional trends and case fatality rates were estimated. We identified 1,641 males and 39 females with Fournier's gangrene. Cases represented less than 0.02% of hospital admissions. The overall incidence was 1.6/100,000 males, which peaked in males who were 50 to 79 years old (3.3/100,000) with the highest rate in the South (1.9/100,000). The overall case fatality rate was 7.5%. Patients with Fournier's gangrene were rarely treated at hospitals (mean +/- SD 0.6 +/- 1.2 per year, median 0, range 0 to 23). Overall 0 to 4 and 5 or greater cases were treated at 66%, 17%, 10%, 4%, 1% and 1% of hospitals, respectively. Patients with Fournier's gangrene are rarely treated at most hospitals. The population based mortality rate of 7.5% was substantially lower than that reported in case series from tertiary care centers.

Relation between the area affected by Fournier's gangrene and the type of reconstructive surgery used: a study with 80 patients

To assess the affected skin area and the reconstructive techniques used in 80 patients affected by Fournier's gangrene. Eighty patients ranging in age from 19 to 85 years (mean = 51) affected by Fournier's gangrene were studied. When admitted to the emergency room the patients were submitted to clinical and laboratory examinations to analyze the gravity of the case. All patients were submitted to an extensive debridement of the lesion, urinary derivation by cystostomy and colostomy whenever necessary. Only 13 patients (16.25%) died. From the 67 remaining patients, in 44 (65.6%) debridement was restricted to the scrotum, in 10 (14.9%) there has been scrotum and penile lesions and in 13 (19.3%) there has been a debridement of the scrotum and the perineal region. In 11 cases (16.4%) there was no need for reconstructive surgery with wound closing by second intention, in 16 cases (23.8%) reconstructive surgery was performed with mobilization of local skin, in 19 (28.3%) we have used skin grafts, 20 patients (29.8%) needed reconstructive surgery with the use of skin flaps and in 1 case (1.4%) there has been the use of skin flaps and grafts simultaneously. Fournier's gangrene is a serious pathology and should be treated aggressively with an extensive debridement of the area with necrosis. The use of precocious reconstructive surgery of the genitals present good results and tends to greatly reduce the length of hospital stay and improve the psychological conditions of these patients.

TV News Coverage of Plastic Surgery, 1972-2004

This study content analyzed all of the 265 news story abstracts on various types of plastic surgery from the five major TV networks during the past three decades. Coverage increased during the time periods, concentrating in the 1990s when public health controversy about breast implants erupted. Overall, TV network news coverage was most concerned with the issue of safety and health risk and framed coverage with an emphasis on risk. Unlike traditional health reporting, which relies mostly on doctors in the field, news coverage about plastic surgery extensively used experts from other fields.

A Nationwide Study of Connective Tissue Disease and Other Rheumatic Conditions Among Danish Women With Long-Term Cosmetic Breast Implantation

Numerous epidemiologic studies have demonstrated that breast implants are not associated with connective tissue diseases (CTDs). However, many CTDs are rare, and continued follow-up of women with breast implants is warranted. We extended by 5 years the follow-up of our earlier population-based cohort study of Danish women with cosmetic breast implants (n = 2761) and comparison groups of women with other types of cosmetic surgery (n = 8807). All women were followed from January 1977 through December 2001. Hospitalization and outpatient data for CTD and ill-defined and other rheumatic conditions in the implant and comparison groups were compared with those in the general Danish population. Additionally, CTDs and fibromyalgia were confirmed through medical chart review, and direct comparisons of the breast implant cohort with the comparison cohort were performed. When compared with general population rates, CTDs were not statistically significantly elevated in either the implant or the comparison cohorts. However, unspecified rheumatism was similarly increased in the implant (standardized rate ratio = 1.9; 95% confidence interval = 1.6 to 2.2) and comparison (standardized rate ratio = 1.5; 95% confidence interval = 1.4 to 1.7) cohorts. In analyses of diagnoses validated by chart review, women with cosmetic breast implants compared with those having other types of plastic surgery or consultation for plastic surgery had no statistically significant excess for any specific confirmed CTD or combined CTDs (hazard ratio = 1.3; 95% CI = 0.9 to 1.9). In addition, there was no relation between breast implants and confirmed fibromyalgia (hazard ratio = 1.2; 95% CI = 0.6 to 2.1). This extension of our earlier cohort study further supports the consensus of epidemiologic research that breast implants are unrelated to the development of CTD.

Mortality among augmentation mammoplasty patients.

Much attention has focused on disease risks among women receiving silicone breast implants, but there has been little evaluation of their mortality experience. We undertook a retrospective cohort study of 13,488 women receiving cosmetic implants and 3,936 patients with other types of plastic surgery at 18 plastic surgery practices. After an average of 13 years of follow-up, deficits in overall mortality were found as compared with the general population (U.S. rates) for both implant [255 deaths; standardized mortality ratio (SMR) = 0.69, 95% confidence interval (CI) = 0.6-0.8] and comparison subjects (125 deaths; SMR = 0.58, 95% CI = 0.5-0.7). These findings indicate that patients seeking plastic surgery are in general healthier than their peers. Implant patients, however, experienced excess risks of death compared with the general population for brain cancer (SMR = 2.45) and suicide (SMR = 1.54). Internal analyses showed a higher overall mortality among the implant than among the comparison patients (relative risk = 1.27, 95% CI = 1.0-1.6). This overall excess reflected increases for respiratory tract (SMR = 3.03) and brain (SMR = 2.25) cancers and for suicide (SMR = 4.24).

Cancer Risk at Sites Other than the Breast Following Augmentation Mammoplasty

PURPOSE: There has been limited investigation of cancer risk other than breast cancer among patients with breast implants, despite some clinical and laboratory evidence suggesting links with certain cancer sites, including hematopoietic and connective tissue malignancies. METHODS: A retrospective cohort study of 13,488 patients who received cosmetic breast implants at 18 plastic surgery practices in six geographic areas was conducted to assess long-term health effects. After an average of 12 years of follow-up, questionnaires were administered to subjects located and alive (78% of eligible population). Attempts were made to obtain death certificates for deceased subjects and medical verification for all reported cancers. Expected numbers of cancers were derived using general population cancer incidence rates and an internal comparison series of 3936 patients who received other types of plastic surgery at the same practices as the implant patients. RESULTS: A total of 359 malignancies was observed versus 295.95 expected based on general population rates, resulting in a standardized incidence ratio (SIR) of 1.21 [95% confidence interval (CI) 1.1–1.4]. Individual malignancies for which incidence was significantly elevated included cancers of the stomach (SIR = 2.65), cervix (SIR = 3.18), vulva (SIR = 2.51), brain (SIR = 2.16), and leukemia (SIR = 2.19). No excess risks were observed for other hematopoietic malignancies, including multiple myeloma. The internal analyses, however, based on cancer rates derived among the comparison patients, showed no increased cancer risk among the implant patients [relative risk (RR) = 1.00, 95% CI 0.8–1.2], as well as no statistically significant elevations for most individual sites. Cervical cancer continued to be elevated (RR = 1.78), although to a lesser extent than in the external analyses, while the risk for respiratory cancers was higher (RR = 2.40). Non-significant elevations in risk persisted in this analysis for liver cancer (RR = 2.65), brain cancer (RR = 2.83), and leukemia (RR = 1.83). Many of the cancers showing excesses were defined on the basis of death certificates, requiring caution in interpretation. The histologies of the leukemias were quite varied, which makes a biologic relationship appear unlikely. However, respiratory cancers showed some evidence of increasing risk with follow-up time and both respiratory and brain cancers were elevated in the mortality analyses. CONCLUSIONS: Although excesses of cervical and vulvar cancer among implant patients might be attributable to lifestyle factors, reasons for excesses of respiratory and brain cancers were less apparent.

Characteristics of a Population of Women with Breast Implants as Compared with Women Seeking Other Types of Plastic Surgery by Louise A. Brinton, Ph.D., S. Lori Brown, Ph.D., M.P.H., Theodore Colton, Sc.D., Mary Cay Burich, M.A., and Jay Lubin, Ph.D.

Received for publication September 13, 1999. S. Michael Kalick, Ph.D. Psychology Department University of Massachusetts 100 Morrissey Blvd. Boston, Mass. 02125 [email protected]

Sexual Expression, Body Alteration, and the Defence of Consent

The controversy surrounding R. v. Brown, Laskey, Lucas, Jaggard, and Carter' has a significance which extends beyond the world of sado-masochist, or dominant and submissive sexual relations. The courts' treatment of those who are differently pleasured should, therefore, be viewed in a wider context. For example, the decision can be compared with other limitations which are placed upon freedom of bodily control, bodily self-expression, and sexual gratification. This paper adopts a contextual approach. The starting point is the decision in Brown. Beyond this, it considers legal reactions to other forms of body alteration with the focus being placed upon the boundary between the tolerable, the problematic, and the criminal. Generally accepted forms of body alteration, like the various types of plastic surgery and body improvement surgery available, can be compared with other less legally acceptable procedures like sex change operations, and both with a number of 'nonmainstream body modification'2 techniques including piercing, tattooing, scarification, cutting, and female circumcision. It is in the distinctions which can be made between the legal, the questionable, and the illegal that most can be learned about legal attitudes in this area.

Growth Patterns of the Nasolabial Region: A Morphometric Study

Age-related growth changes in the nasolabial region were analyzed through six measurements taken between 1 year and 18 years of age in 1,593 North American Caucasians. By 1 year of age, the length of the cutaneous portion of the upper lip and the width of the nose showed the highest levels of development compared with their adult size, 80.3 and 79.5%, respectively. By 5 years, the developmental level of the nasolabial region except nasal tip protrusion approached their maturation level. Our nasal measurements indicated that growth of the nose between 5 and 18 years was significantly greater than that of the upper lip, which revealed significantly greater growth increments between 1 and 5 years of age. The cutaneous upper lip height reached its adult size in 3-year-old females (12.7 mm) and 6-year-old males (14.4 mm). Nose width and height were fully developed in females by age 12 and in males by age 14 or 15. Rapid growth occurred in the upper lip, nose height, and nasal tip protrusion between the ages of 1 and 4 years. Knowledge of these age-related morphologic variations within the nose and upper lip may be useful in planning the time and type of reconstructive surgery and in anticipating further change in the operated regions after the surgical reconstruction.

EXPERIENCE WITH THE CEREBRAL FUNCTION MONITOR DURING DELIBERATE HYPOTENSION

Forty-five healthy patients (30 aged 15-46 yr and 15 aged 58-82 yr) undergoing various types of plastic surgery were studied during deliberate hypotension produced by a combination of ganglion- and beta-blockade, halothane, head-up tilt and positive end expiratory pressure. A Cerebral Function Monitor was used to assess the adequacy of cerebral perfusion. Cerebral activity did not undergo any significant change if the systolic arterial pressure was decreased gradually and maintained at approximately 60 mm Hg at heart level. However, a rapid decrease in pressure may depress cerebral activity in a reversible manner.

Long-Term Follow-up of Patients With Austin Moore Prostheses

A retrospective study of the long-term follow-up of patients with Austin Moore prostheses is presented. Sufficient data were present to evaluate 78 hips postoperatively at six months, and 1, 5, 10, and 15 years when applicable. The average age of patients at the time of operation was 56.1 years. Most preoperative diagnoses resulted from previous operative procedures which had failed (there were only six fresh fractures). The operative technic is discussed. Postoperatively, cessation of pain is relatively early and the return of function increases linearly but at a slower rate. The importance of partial weight-bearing for four to six months postoperatively as well as daily physical therapy is emphasized. The mean amount of settling of the prostheses (total in the femur and acetabulum) was 1.63 cm in all patients. We believe that certain postoperative principles are applicable to all types of reconstructive surgery of the hip.

THE USE OF THE PLANTARIS TENDON IN CERTAIN TYPES OF PLASTIC SURGERY.

Australian and New Zealand Journal of SurgeryVolume 2, Issue 1 p. 64-67 THE USE OF THE PLANTARIS TENDON IN CERTAIN TYPES OF PLASTIC SURGERY. D. J. Glissan, D. J. Glissan Sydney.Search for more papers by this author D. J. Glissan, D. J. Glissan Sydney.Search for more papers by this author First published: June 1932 https://doi.org/10.1111/j.1445-2197.1932.tb02533.xCitations: 6AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume2, Issue1June 1932Pages 64-67 RelatedInformation

THE SURGICAL TREATMENT OF URINARY INCONTINENCE IN THE FEMALE

Progress in the treatment of urinary incontinence of the female is essentially a story of surgical growth and development. Beginning in the eighteenth century with crude operations for the correction of vesicovaginal fistulas, the scope of this type of plastic surgery has so broadened that today most of the congenital and acquired bladder deformities are successfully treated by surgical means. From a practical point of view, it would seem desirable to eliminate methods which appear to be basically unsound and encourage refinement and use of operations already proved. Regardless of the explanations given by the originators of the various operations, investigation fails to indicate convincingly on just what the successful result depends. Continence following repair of the torn or relaxed internal bladder sphincter may simply be a matter of narrowing the urethral lumen. Success following plaiting of the pubovesicocervical muscle sheet (external sphincter) has been attributed to replacement of the