ALGORITHM OF PARTIAL BREAST RECONSTRUCTION WITH PEDICLED PERFORATOR FLAPS

INTRODUCTION: The authors present an algorithm of partial breast reconstruction following quadrantectomy that allows to restore the breast volume defect with the use of pedicled perforator flaps. MATERIAL AND METHODS: Between March 2009 and May 2010, at the Plastic and Reconstructive Institute of University of Palermo, pedicled perforator flaps were used to integrate volume and/or breast skin in 12 patients after benign and malignant breast tumors. The flaps used were based on perforators of the thoraco-dorsal artery (TDAP) and of the intercostal arteries (ICAP). TDAP flaps were used to reconstruct defects in any breast quadrant, while ICAP perforator were used to reconstruct lateral and central inferior pole defects. RESULTS: All flaps survived completely. Breast size, shape and volume were satisfactorily restored. Contralateral breast procedure to adjust symmetry were not necessary. Donor sites scars were well hidden in the inframammary fold or under the brassiere. CONCLUSIONS : Partial breast reconstruction can be performed, in selected patients, with pedicled perforator flaps to restore both volume, shape and skin envelope. Donor site scars are negligible and better with the anterior ICAP because the scar is hidden in the submammary sulcus

A multi-country test of brief reappraisal interventions on emotions during the COVID-19 pandemic.

The COVID-19 pandemic has increased negative emotions and decreased positive emotions globally. Left unchecked, these emotional changes might have a wide array of adverse impacts. To reduce negative emotions and increase positive emotions, we tested the effectiveness of reappraisal, an emotion-regulation strategy that modifies how one thinks about a situation. Participants from 87 countries and regions (n = 21,644) were randomly assigned to one of two brief reappraisal interventions (reconstrual or repurposing) or one of two control conditions (active or passive). Results revealed that both reappraisal interventions (vesus both control conditions) consistently reduced negative emotions and increased positive emotions across different measures. Reconstrual and repurposing interventions had similar effects. Importantly, planned exploratory analyses indicated that reappraisal interventions did not reduce intentions to practice preventive health behaviours. The findings demonstrate the viability of creating scalable, low-cost interventions for use around the world

Perforator mapping in the trunk: a guide for freestyle flap surgery and an introduction to the sustainable anatomical study

Introduction: Freestyle Perforator flaps minimize flap harvest morbidity and can be harvested anywhere in the body if perforators anatomy is well known. A study of trunk perforator vessels has been performed on recycled CT scans avoiding cadaver investigations or unnecessary radiation exposure. Materials and Methods: 200 CT scans, performed for the study of liver or pancreatic disease, were examined. No unnecessary radiation was administered. Previous abdominal surgery was reason of exclusion. The trunk between the xyphoid process and Downloaded by: Biomedische Bibliotheek 193.191.170.2 - 10/8/2014 8:35:28 AM Abstracts Eur Surg Res 2012;49:130–216 215 the umbilicus was studied. On axial scans, the trunk was divided in 4 quadrants: Q1 anterior right, Q2 anterior left, Q3 posterior left, Q4 posterior right,. Scans were examined and the position of any perforator >1mm in caliber was measured. The values were transferred on a MS excel® data sheet and analyzed. Results: The average number of perforators per patient was 25,63 (6,09 Q1, 7,21 Q2, 6,20 Q3, 6,14 Q4). Anteriorly, the majority of perforators were between 0 and 5cm from the midline, while posteriorly between 5 and 10 cm. The perforators are more numerous and symmetric anteriorly (Q1 and Q2). Perforators course within the subcutaneous tissue was vertical or oblique for perforators of the Superior Epigastric Artery, horizontal or oblique for perforators of the lateral intercostal arteries, vertical or oblique for perforators of the posterior intercostal arteries. Conclusions: The region of the trunk between the xyphoid process and the umbilicus has several perforators of more than 1mm in caliber that might potentially be used as pedicle of freestyle flaps. This study provides a map of the location of perforator in the middle trunk to serve as a guide for the surgeon to harvest free style flaps in this area. This study also introduces the concept of recycling existing CT scans for the purposes of anatomical investigation and might encourage others to exploi