Outcomes of 270 Consecutive Deep Inferior Epigastric Perforator Flaps for Breast Reconstruction.

BACKGROUND: The deep inferior epigastric perforator (DIEP) flap has gradually become the superior choice for autologous breast reconstruction because it reduces donor site morbidity, abdominal wall complications, and postoperative recovery time when compared with other flap types. METHODS: The purposes of this study are to report on the experience and clinical outcomes of consecutive DIEP flap breast reconstructions performed by a single surgeon at a cancer center between April 2011 and May 2016 and to characterize the trends among these flaps. RESULTS: Two hundred seventy DIEP flaps from 202 consecutive patients were assessed. Patient ages ranged from 31 to 73 years, with a mean (SD) of 52.81 (9.89) years. Ischemia time ranged from 17 to 211 minutes (mean [SD], 51.51 [23.02] minutes), and procedure length (including mastectomy time) was between 224 and 950 minutes (mean [SD], 548.13 [154.77] minutes). Venous coupler size was between 2 and 4 mm (mean [SD], 2.69 [0.33] mm), and 1 to 3 perforating vessels were maintained per flap (mean [SD], 1.71 [0.68] perforators). Total reexploration rate was 3.3% (n = 9), and the total complete flap loss rate was 1.1% (n = 3). CONCLUSIONS: In our experience, the DIEP flap is a safe, consistent, and reliable option for breast reconstruction

Hydrocolloid dressing for precise nipple positioning after nipple- or skin-sparing mastectomy

An apparatus and method/technique that uses a hydrocolloid dressing that results in both improved circulation and aesthetic success with optimal nipple positioning. By applying a specific pattern of the adhesive hydrocolloid dressing to the mastectomy flaps, stability of the nipple-areolar complex (NAC) in the desired higher position could be achieved. In operation, the hydrocolloid dressing is placed over the breast after surgery (while also leaving the incision site uncovered), and remains in place for a suitable amount of time. The hydrocolloid dressing can be applied on either side or both sides of the nipple during expansion phase to precisely control nipple position. Different designs of the hydrocolloid dressing are contemplated herein

Improvement in Existing Chest Wall Irregularities During Breast Reconstruction

Mastectomies for both cancer resection and risk reduction are becoming more common. Existing chest wall irregularities are found in these women presenting for breast reconstruction after mastectomy and can pose reconstructive challenges. Women who desired breast reconstruction after mastectomy were evaluated preoperatively for existing chest wall irregularities. Case reports were selected to highlight common irregularities and methods for improving cosmetic outcome concurrently with breast reconstruction procedures. Muscular anomalies, pectus excavatum, scoliosis, polythelia case reports are discussed. Relevant data from the literature are presented. Chest wall irregularities are occasionally encountered in women who request breast reconstruction. Correction of these deformities is possible and safe during breast reconstruction and can lead to improved cosmetic outcome and patient satisfaction

Oncoplastic Surgery: Keeping It Simple With 5 Essential Volume Displacement Techniques for Breast Conservation in a Patient With Moderate- to Large-Sized Breasts

Oncoplastic surgery is an evolving field in breast surgery combining the strengths of breast surgical oncology with plastic surgery. It provides the surgeon the ability to excise large areas of the breast in the oncologic resection without compromising, and possibly improving, its aesthetic appearance. The purpose of this review is to provide a guide that could help a breast surgeon excise breast cancer in most areas of the breast using 5 oncoplastic techniques. These techniques would be used depending primarily on the location of the cancer in the breast and also on the size of the tumor

Improvement in Existing Chest Wall Irregularities During Breast Reconstruction

Mastectomies for both cancer resection and risk reduction are becoming more common. Existing chest wall irregularities are found in these women presenting for breast reconstruction after mastectomy and can pose reconstructive challenges. Women who desired breast reconstruction after mastectomy were evaluated preoperatively for existing chest wall irregularities. Case reports were selected to highlight common irregularities and methods for improving cosmetic outcome concurrently with breast reconstruction procedures. Muscular anomalies, pectus excavatum, scoliosis, polythelia case reports are discussed. Relevant data from the literature are presented. Chest wall irregularities are occasionally encountered in women who request breast reconstruction. Correction of these deformities is possible and safe during breast reconstruction and can lead to improved cosmetic outcome and patient satisfaction

Traumatic peripheral nerve injury: a wartime review

Incidence of peripheral nerve injury in extremity trauma is low, with reported rates of 1.5 to 2.8%; however there is significant associated morbidity and outcomes of peripheral nerve repair are poor, especially when delayed. In this article, we provide a brief review of pathophysiology, classification, and surgery of peripheral nerve injuries, with special emphasis on wartime injuries

Review of Procedures for Reconstruction of Soft Tissue Chest Wall Defects Following Advanced Breast Malignancies

The purpose of this article is to review closure options for complex chest wounds in patients with locally advanced breast cancer. Experiences of the plastic and oncologic surgery teams at Moffitt Cancer Center were reviewed, and the literature researched for various surgical options of complex chest wound closure. Multiple treatment modalities exist for reconstruction of complex chest wall wounds with the external oblique and V-Y latissimus dorsi musculocutaneous advancement flaps serving as workhorses in reconstruction. Treatment of cancer has moved from simply a surgical solution to include other modalities such as hormonal therapy, chemotherapy, and radiation—the latter 2 having serious consequences for wound healing. A team approach and knowledge of available flap options are vital for closure of complex wounds in a timely manner. Appropriate planning can optimize the primary goal of the oncologic surgeon to remove the cancer and the plastic surgeon’s objective to reconstruct the defect and achieve a closed, durable wound prior to chemotherapy and radiation. We present the experience at the Moffitt Cancer Center in reconstructing challenging chest defects and review the reconstructive ladder

Review of Procedures for Reconstruction of Soft Tissue Chest Wall Defects Following Advanced Breast Malignancies

The purpose of this article is to review closure options for complex chest wounds in patients with locally advanced breast cancer. Experiences of the plastic and oncologic surgery teams at Moffitt Cancer Center were reviewed, and the literature researched for various surgical options of complex chest wound closure. Multiple treatment modalities exist for reconstruction of complex chest wall wounds with the external oblique and V-Y latissimus dorsi musculocutaneous advancement flaps serving as workhorses in reconstruction. Treatment of cancer has moved from simply a surgical solution to include other modalities such as hormonal therapy, chemotherapy, and radiation—the latter 2 having serious consequences for wound healing. A team approach and knowledge of available flap options are vital for closure of complex wounds in a timely manner. Appropriate planning can optimize the primary goal of the oncologic surgeon to remove the cancer and the plastic surgeon’s objective to reconstruct the defect and achieve a closed, durable wound prior to chemotherapy and radiation. We present the experience at the Moffitt Cancer Center in reconstructing challenging chest defects and review the reconstructive ladder