Combining Autologous and Prosthetic Techniques: The Breast Reconstruction Scale Principle

Background:. The latissimus dorsi (LD) flap remains a good option for immediate or delayed breast reconstruction. The main limitation of this flap is the small volume provided. To improve the reconstructed breast volume, the LD flap is usually combined with a breast implant. Recently, fat grafting to the LD flap was described to maximize flap volume and obtain a totally autologous breast reconstruction. We report our experience with hybrid breast reconstruction using both breast implants and fat-enriched latissimus dorsi (FELD) flaps. Methods:. Between 2013 and 2016, 74 patients underwent breast reconstruction with FELD flaps only or FELD flaps combined with a breast implant. The LD flap was harvested as previously described. Donor sites for fat harvesting were chosen according to each patient’s natural fat distribution. Fat was harvested, centrifuged, and injected into the LD flap. After fat grafting, breast sizers were employed to determine the final breast volume when the addition of an implant was indicated. Results:. Good cosmetic outcomes were achieved in all cases, with a mean follow-up of 2.1 years. No patients had cancer reoccurrences. Four patients experienced a seroma of the LD donor site, 1 had a breast hematoma, and 1 developed Baker grade III capsular contracture. One year postoperatively, a clinically relevant area of fat necrosis was observed in 1 patient and was surgically treated. Additional fat grafting sessions were required in 3 cases. Conclusion:. In elected cases, a FELD flap alone or in combination with a small implant is a valuable technique for breast reconstruction surgery

Bowel intussusceptions in adults: the role of imaging

Intestinal intussusception in adults is a rare condition, accounting for about 0.003-0.02 % of all hospital admissions. This condition in adults represents only 5 % of all cases of intussusceptions and is different from paediatric intussusception, which is usually idiopathic. In contrast, almost 90 % of cases in adults are secondary to various pathologies that serve as a lead point, such as polyps, Meckel's diverticulum, colonic diverticulum, or malignant or benign neoplasm. The aim of the present study was to assess the capabilities of multislice computed tomography (MSCT) in the diagnosis and correct characterisation of intussusception, especially in distinguishing between intussusceptions with a lead point and those without. Indeed, although the MSCT findings that help to differentiate between lead point and non-lead point intussusceptions have not been well studied, abdominal MSCT remains the most sensitive radiological tool to confirm bowel intussusceptions. Moreover, differentiating intussusceptions with a lead point condition from those without is crucial for directing the patient towards the most appropriate treatment, avoiding surgery when not necessary