Effect of neoadjuvant chemotherapy on skin-sparing mastectomy and breast reconstruction modalities in 409 patients

Aim: While skin-sparing mastectomy (SSM) can be performed in patients with stage II-III breast cancer, the impact of neoadjuvant chemotherapy (NAC) on SSM rates and reconstructive modalities in these patients is not known.Methods: Between January 2007 and December 2009, 409 immediate breast reconstructions (IBRs) were performed in patients with Stage II-III breast cancer. Data were collected on preoperative, operative, and postoperative factors.Results: There was a statistically significant relationship between clinical stage of disease and the utilization of SSM or non-SSM (P < 0.0001). Seventy-five percent of all patients with stage II disease and 50% of patients with stage III disease underwent SSM; similarly, 75.5% of patients with stage II and 49.1% of patients with stage III disease who received NAC underwent SSM with immediate reconstruction, in spite of having a greater proportion of stage III patients (P < 0.01). In addition, patients who received NAC followed by SSM with IBR had larger tumors (mean, 3.5 cm vs. 3.1 cm, P < 0.001). The type of IBR, and size of skin defect was significantly affected by whether the patient underwent SSM or non-SSM (P = 0.001, P < 0.01, respectively).Conclusion: We are increasingly considering NAC to be an important tool to potentially reduce the morbidity of mastectomy, including the need to resect breast skin, which can subsequently enhance reconstructive outcomes in patients with clinical stage II and III breast cancer. Specifically, our data suggest that NAC patients with stage II and III breast cancer and larger tumors can reliably and safely undergo SSM in nearly half of cases, thus improving reconstructive outcomes and patient well-being

An analysis of underweight status on 30-day outcomes after breast reconstruction

Aim: To examine the impact of underweight body mass index (BMI) values on breast reconstruction outcomes.Methods: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was retrospectively reviewed for all patients who underwent breast reconstruction between 2006 and 2011. Patients were first stratified by breast reconstruction modality into prosthetic or autologous cohorts, and second by BMI values into underweight (BMI < 18.5), normal to overweight (reference, BMI 18.5-29.99), moderate obesity (BMI 30-34.99), severe obesity (BMI 35-39.99), and morbid obesity cohorts. Multivariate logistic regression models were used to determine independent predictors of complications.Results: With regard to prosthetic breast reconstruction patients, obese patients demonstrated increased rates of surgical complications, while underweight patients did not have any differences on multivariable analysis. With respect to autologous reconstruction, risk-adjusted multivariate regression models showed a dose dependent response between obesity and risk for surgical complications and reoperation, but not for underweight patients.Conclusion: On multivariable analysis of over 4,600 patients, there were no significant differences in the rates of adverse events between underweight patients (BMI < 18.5) and their reference-weight counterparts, in spite of a significant increase in surgical and medical complication rates in underweight patients on univariate analysis

Nanotechnology applications in osteodistraction

Most current strategies for bone regeneration have relatively satisfactory results. However, there are drawbacks and limitations associated with their use and availability, and even controversial reports about their efficacy and cost-effectiveness. The induction of new bone formation through distraction osteogenesis (DO) is widespread clinical application in the treatment of bone defects, limb deformities, and fracture nonunions. However, a lengthy period of external fixation is usually needed to allow the new bone to consolidate, and complications such as refracture at the distraction gap often occur. Although various biomaterials have been used as injectable delivery systems in DO models, little has been reported on the use of nanobiomaterials as carrier materials for the sustained release of growth factors in bone regeneration. One area of focus in nanotechnology is the delivery of osteogenic factors in an attempt to modulate the formation of bone. This review article seeks to demonstrate the potential of nanobiomaterials to improve biological applications pertinent to osteodistraction

Current and future applications of nanotechnology in plastic and reconstructive surgery

Although nanotechnology is a relatively young field, there are countless biomedical applications in use or under investigation. Many specialties have benefitted from nanoscale refinements of diagnostic and therapeutic techniques. Plastic and reconstructive surgery is an incredibly diverse specialty, encompassing craniofacial and hand surgery; trauma, oncologic and congenital reconstruction; burn care, and aesthetic surgery. Advances in nanotechnology have significantly impacted wound management, topical skin care, implant and prosthetic design, tissue engineering, and drug delivery systems. Currently, plastic surgeons are researching the utility of nanoscale tools for bone regeneration, bone prosthetics, and drug delivery. Nanotechnology will continue to build upon preceding discoveries, and its biomedical applications in the field of plastic and reconstructive surgery will expand significantly

Use of negative pressure wound therapy in pediatric oncology patients: a single-center review of 66 patients

Aim: Negative pressure wound therapy (NPWT) has been studied extensively in adult patients, but less is known about pediatric patients. This study assesses the efficacy and safety of vacuum-assisted closure® usage in pediatric oncology patients.Methods: Retrospective data on all patients treated with NPWT at a single pediatric oncology hospital were collected between April 2005 and September 2013. Details on pre-treatment factors, treatment course, and post-treatment events were collected. No control group was available for comparison.Results: Sixty-six patients were identified, with a total of 74 wounds. Median age at the time of NPWT application was 13 years (range, 10 months-23 years). Median duration of treatment was 21 days (range, 3-236 days). NPWT therapy was started with continuous high negative pressures (125 mmHg) in most patients. Sixty-nine percent of patients had their wounds healed without intervention, and 20% of patients required surgical closure. NPWT was discontinued temporarily secondary to skin maceration or cellulitis in 12% of patients. NPWT was used in a number of non-standard clinical situations, including primarily-closed incisional wound NPWT and bridging NPWT through adjuvant chemotherapy.Conclusion: In pediatric oncology patients, NPWT is safe, effective, and well-tolerated. Although this study is retrospective in nature, and there was no control group for comparison, these data are important for clinicians to guide therapy as device monitoring agencies and payors increasingly require outcomes data for the approval of therapeutic decisions

A propensity score matched analysis of obesity as an independent risk factor for postoperative complications in reduction mammaplasty

Aim: Reduction mammaplasty is a commonly performed procedure for the treatment of symptomatic macromastia and is increasingly desired by the obese population. With the increasing prevalence obesity in the population, it is imperative to understand its effect on postoperative outcomes. The purpose of this study is to evaluate obesity as an independent risk factor for postoperative complications in breast reduction surgery using 1:1 patient matching through propensity scores between obese patients and non-obese controls.Methods: Between 2005 and 2013, the National Surgical Quality Improvement Program dataset identified a total of 6,016 patients as having undergone primary reduction mammaplasty with 30-day postoperative follow-up. Patients were divided into obese [body mass index (BMI) of 30 or more] vs. not obese (BMI below 30). Patients were initially analyzed using standard multivariable analysis. Using propensity scores obtained from a logistic regression model, patients were subsequently matched 1:1 according to preoperative and operative variables to truly isolate the effect of obesity on surgical outcomes. Outcomes were compared between the matched cohorts using McNemar’s test and the Wilcoxon signed rank test.Results: In unmatched multivariable analysis, rates of overall complications (7.2% vs. 5.3%, P = 0.0024), wound complications (5.5% vs. 3.6%, P = 0.0004), superficial surgical site infection (4.1% vs. 2.8%, P = 0.0050), and wound dehiscence (0.3% vs. 1.1%, P = 0.0005) were found to be statistically different between obese vs. non-obese, respectively. However, when comparing 1:1 matched obese and non-obese patients, only wound complications (4.6% vs. 3.1%, P = 0.0334) were significantly increased in the obese cohort.Conclusion: Using the most robust statistical tools available, obesity was determined to affect wound complications after breast reduction without increased detriment on other major complications when compared to the non-obese. Obesity should be a considered with other preoperative comorbidities, rather than an independent contraindication to surgery. Breast reduction appears to be safe in the obese patient who is otherwise healthy