Combining autologous ventral hernia repair using component separation with DIEP breast reconstruction

License: CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).Concern about flap viability and abdominal wall integrity would normally exclude a patient with a large ventral midline hernia from having a breast reconstruction with a deep inferior epigastric perforator (DIEP) flap. Ventral hernia repair using the abdominoplasty approach has been reported before. The abdominoplasty flap would normally be discarded. This article presents a unique case of a patient with a large incisional midline hernia who had a combined procedure of autologous hernia repair using component separation technique and DIEP breast reconstruction. The indications for DIEP breast reconstruction are therewith expanded

Perfusion dynamics in abdominal skin after free abdominal flap breast reconstruction using internal mammary vessels as recipient vessels. A clinical study using Dynamic Infrared Thermography

Background: Wound healing problems at the donor site in free abdominal flap breast reconstruction cause significant morbidity to patients. No studies have investigated what impact the use of the internal mammary artery in free abdominal flap breast reconstruction has on abdominal skin perfusion. We hypothesized that harvesting the internal mammary vessels (IMV) has a negative effect on abdominal skin perfusion. Methods: The abdomen and anterior thoracic wall of 17 patients scheduled for secondary free abdominal flap breast reconstruction using IMV was pre-, intra-, and postoperatively examined with dynamic infrared thermography. Qualitative and quantitative analyses of the rate and pattern of recovery in Huger’s vascular zones were made with each patient being its own control. Zone III on the side where IMV were used was numbered zone IV. The contralateral zone III was used as reference. Results: Postoperative abdominal skin perfusion in zone IV was always significantly reduced compared with zone III (1-tailed t test, P < 0.05). The difference between zones II and III was statistically significant for day 1 and 3, but not for day 6 (2-tailed t test, P < 0.05). Skin perfusion in zones II and IV increased during consecutive postoperative days with an increase of hot spots in these areas. Conclusions: Using the IMV in free abdominal flap breast reconstruction had a significant effect on abdominal skin perfusion and may contribute to abdominal wound healing problems. The reperfusion of the abdominal skin was a dynamic process showing an increase in perfusion in the affected areas during the postoperative days

Fracture resistance of monolithic zirconia crowns: The importance of the compressive strength of the dental cements used.

Background: Monolithic zirconia crowns have not been used for a very long period in dentistry even though zirconia with veneering porcelain, as crown and bridge material has been used for several years with great clinical success. Several different luting materials have been purposed for zirconia but concerning monolithic zirconia the knowledge of the influence of the cement seem to be limited. The aim of the study was to investigate three different cements (one phosphate, one self adhesive and one dual cured resin based cement) and their influence on fracture strength of monolithic zirconia crowns in vitro with the null hypothesis tested that the compression strength of the cement would have no statistical influence on the fracture strength of the monolithic zirconia crowns tested. Materials and methods: Eighteen CAD-CAM produced monolithic zirconia crowns (Th=0.5 mm) divided into 3 groups (n=6) and cemented with 3 different cements were tested. In advance the Poissons ratio, modulus and flexural strength of the composite abutment used, fit of the crowns and their quality was evaluated. Two tests were then conducted for the cement study: Compressive strength of the cements used were tested and recorded as well as load to failure test. The 3 groups of crowns cemented with the three different cements were tested until fracture after water storage for 24 hours at 37°C±1. The tests were done with guidance of ISO 9917:1 and comparative test procedures for load to failure test. Light microscope and SEM analysis were conducted and differences between the groups tested were statistically evaluated. Results and conclusion: The composite abutment showed similar Poissons ratio and modulus values as wet dentin. Even though the phosphate cement showed significantly less compressive strength, no significant difference in load to failure for the crowns tested were found. The compressive strength of the cement used seemed to be of no importance for the fracture resistance of monolithic zirconia crowns

Impact on Abdominal Skin Perfusion following Abdominoplasty

Background: Wound healing problems following abdominoplasty may be a result of impaired tissue perfusion. This study evaluated the impact a standard abdominoplasty may have on abdominal skin perfusion. Methods: A standard abdominoplasty was performed in 16 patients. Dynamic infrared thermography (DIRT) using a mild and a stronger cold challenge was performed pre-, intra-, and postoperatively on day 1, 2, and in week 6. The abdomen was divided into Huger’s vascular zones. A two-tailed t test was used to evaluate differences in mean temperature between zones. Statistical significance was defined as P Results: Two patients suffered wound healing problems. Abdominal skin perfusion showed a hyperaemic state on day 1, day 2, and week 6, postoperatively. Hotspots in zones I and II had all disappeared at the end of surgery and on day 1, except in the cranial part of zone I. Hotspots reappeared in zones I and II during day 2. A statistically significant difference between zones I and II was seen on day 1 and 2, with zone II being cooler. This difference had disappeared in week 6 for the mild cold challenge but not for the stronger cold challenge. Conclusions: A standard abdominoplasty has a significant impact on abdominal skin perfusion. The skin perfusion is a dynamic process with a gradual improvement over time. The strongest effect was seen in zone II near the lower transverse incision line, where skin perfusion was the least. Such may contribute to impaired wound healing at this sit

Impact on Abdominal Skin Perfusion following Abdominoplasty

Background: Wound healing problems following abdominoplasty may be a result of impaired tissue perfusion. This study evaluated the impact a standard abdominoplasty may have on abdominal skin perfusion. Methods: A standard abdominoplasty was performed in 16 patients. Dynamic infrared thermography (DIRT) using a mild and a stronger cold challenge was performed pre-, intra-, and postoperatively on day 1, 2, and in week 6. The abdomen was divided into Huger’s vascular zones. A two-tailed t test was used to evaluate differences in mean temperature between zones. Statistical significance was defined as P Results: Two patients suffered wound healing problems. Abdominal skin perfusion showed a hyperaemic state on day 1, day 2, and week 6, postoperatively. Hotspots in zones I and II had all disappeared at the end of surgery and on day 1, except in the cranial part of zone I. Hotspots reappeared in zones I and II during day 2. A statistically significant difference between zones I and II was seen on day 1 and 2, with zone II being cooler. This difference had disappeared in week 6 for the mild cold challenge but not for the stronger cold challenge. Conclusions: A standard abdominoplasty has a significant impact on abdominal skin perfusion. The skin perfusion is a dynamic process with a gradual improvement over time. The strongest effect was seen in zone II near the lower transverse incision line, where skin perfusion was the least. Such may contribute to impaired wound healing at this sit

Internal Mammary Vessels’ Impact on Abdominal Skin Perfusion in Free Abdominal Flap Breast Reconstruction

Background:. Wound healing problems at the donor site in free abdominal flap breast reconstruction cause significant morbidity to patients. No studies have investigated what impact the use of the internal mammary artery in free abdominal flap breast reconstruction has on abdominal skin perfusion. We hypothesized that harvesting the internal mammary vessels (IMV) has a negative effect on abdominal skin perfusion. Methods:. The abdomen and anterior thoracic wall of 17 patients scheduled for secondary free abdominal flap breast reconstruction using IMV was pre-, intra-, and postoperatively examined with dynamic infrared thermography. Qualitative and quantitative analyses of the rate and pattern of recovery in Huger’s vascular zones were made with each patient being its own control. Zone III on the side where IMV were used was numbered zone IV. The contralateral zone III was used as reference. Results:. Postoperative abdominal skin perfusion in zone IV was always significantly reduced compared with zone III (1-tailed t test, P < 0.05). The difference between zones II and III was statistically significant for day 1 and 3, but not for day 6 (2-tailed t test, P < 0.05). Skin perfusion in zones II and IV increased during consecutive postoperative days with an increase of hot spots in these areas. Conclusions:. Using the IMV in free abdominal flap breast reconstruction had a significant effect on abdominal skin perfusion and may contribute to abdominal wound healing problems. The reperfusion of the abdominal skin was a dynamic process showing an increase in perfusion in the affected areas during the postoperative days

Effect of cements on fracture resistance of monolithic zirconia crowns

Objectives The present study investigated the effect of cements on fracture resistance of monolithic zirconia crowns in relation to their compressive strength. Materials and methods Four different cements were tested: zinc phosphate cement (ZPC), glass-ionomer cement (GIC), self-adhesive resin-based cement (SRC) and resin-based cement (RC). RC was used in both dual cure mode (RC-D) and chemical cure mode (RC-C). First, the compressive strength of each cement was tested according to a standard (ISO 9917-1:2004). Second, load-to-failure test was performed to analyze the crown fracture resistance. CAD/CAM-produced monolithic zirconia crowns with a minimal thickness of 0.5 mm were prepared and cemented to dies with each cement. The crown–die samples were loaded until fracture. Results The compressive strength of SRC, RC-D and RC-C was significantly higher than those of ZPC and GIC (p < 0.05). However, there was no significant difference in the fracture load of the crown between the groups. Conclusion The values achieved in the load-to-failure test suggest that monolithic zirconia crowns with a minimal thickness of 0.5 mm may have good resistance against fracture regardless of types of cements