Is There a Need for Preoperative Imaging of the Internal Mammary Recipient Site for Autologous Breast Reconstruction?

Preoperative imaging of recipient-site vasculatur in autologous breast reconstruction may potentiate improved outcomes through the identification of individual variations in vascular architecture. There are a range of both normal and pathologic states which can substantially affect the internal mammary vessels in particular, and the identification of these preoperatively may significantly affect operative approach. There are a range of imaging modalities available, with ultrasound particularly useful, and computed tomography angiography (CTA) evolving as a useful option, albeit with radiation exposure. The benefits of CTA must be balanced against its risks, which include contrast nephrotoxicity and allergic reactions, and radiation exposure. The radiation risk with thoracic imaging is substantially higher than that for donor sites, such as the abdominal wall, with reasons including exposure of the contralateral breast to radiation (with a risk of contralateral breast cancer in this population 2 to 6 times higher than that of primary breast cancer, reaching a 20-year incidence of 15%), as well as proximity to the thyroid gland. Current evidence suggests that although many cases may not warrant such imaging because of risk, the benefits of preoperative CTA in selected patients may outweigh the risks of exposure, prompting an individualized approach

Plant-Derived Biomaterials: A Review of 3D Bioprinting and Biomedical Applications

The pursuit of appropriate, biocompatible materials is one of the primary challenges in translational bioprinting. The requirement to refine a biomaterial into a bioink places additional demands on the criteria for candidate biomaterials. The material must enable extrusion as a liquid bioink and yet be capable of maintaining its shape in the post-printing phase to yield viable tissues, organs and biological materials. Plant-derived biomaterials show great promise in harnessing both the natural strength of plant microarchitecture combined with their natural biological roles as supporters of cell growth. The aim of this review article is to outline the most widely used biomaterials derived from land plants and marine algae: nanocellulose, pectin, starch, alginate, agarose, fucoidan, and carrageenan, with an in-depth focus on nanocellulose and alginate. The properties that render these materials as promising bioinks for three dimensional bioprinting is herein discussed alongside their potential in 3D bioprinting for tissue engineering, drug delivery, wound healing, and implantable medical devices

A novel, cost effective escharotomy simulator and trainee assessment

Over the last two decades, virtual reality, haptics, simulators, robotics, and other "advanced technologies" have emerged as important innovations in medical learning and practice. In the 21st century, however, it is important to continue to develop simple teaching aids which are available to large audiences in low and middle-income countries. We present a simple 'escharotomy simulator' which has been well received, resulting in an increase in knowledge, and an increase in confidence to carry out the procedure

Candidate Bioinks for Extrusion 3D Bioprinting—A Systematic Review of the Literature

PurposeOur aim was to identify biomaterials that have been found to be suitable for extrusion 3D bioprinting, outline their biomechanical properties and biocompatibility towards their application for bioprinting specific tissue types. This systematic review provides an in depth overview of current biomaterials suitable for extrusion to aid bioink selection for specific research purposes and facilitate design of novel tailored bioinks

Perineal and posterior vaginal wall reconstruction with superior and inferior gluteal artery perforator flaps

Perineal and posterior vaginal wall reconstruction following abdominoperineal and local cancer resection entails replacement of volume between the perineum and sacrum and restoration of a functional vagina. Ideal local reconstructive options include those which avoid functional muscle sacrifice, do not interfere with colostomy formation, and avoid the use of irradiated tissue. In avoiding the donor site morbidity of other options, we describe a fasciocutaneous option for the reconstruction of the perineum and posterior vaginal wall. We present our technique of superior and inferior gluteal artery perforator (SGAP or IGAP) flaps to reconstruct such defects. Fourteen patients between 2004 and 2008 underwent 11 SGAP and three IGAP flaps. There were no flap failures or partial flap losses and no postoperative hernias. All female patients reported resumption of sexual intercourse following this procedure. Our experience in both the immediate and delayed setting is that this technique produces a good functional outcome with low donor-site morbidity

Measuring the Pressure in the Superficial Inferior Epigastric Vein to Monitor for Venous Congestion in Deep Inferior Epigastric Artery Perforator Breast Reconstructions: A Pilot Study

During deep inferior epigastric artery perforator (DIEP) flap dissection, we noted that in many cases the superficial vein on the ipsilateral side of the flap was engorged and tense, and in others, it was empty. This led us to believe that the pressure is increased as the result of preferential outflow through the superficial vein in some cases, which could result in venous congestion of the flap if this vessel was not anastomosed. To test this hypothesis, we measured the venous pressure in the superficial venous system before and after flap dissection. The pressure in the superficial inferior epigastic vein of a DIEP flap was measured in 26 consecutive flaps to investigate the correlation between the pressure and venous congestion of the flap. The first measurement was performed at the beginning of the dissection, and the second measurement was taken after the flap had been completely raised on a single perforator. The mean increase in pressure after flap dissection was 10.6 mm Hg (mu = 10.6; range -1 to 31; O +/- 7.0 mm Hg). Clinical signs of venous congestion were observed in one case. In this case, the increase in venous pressure was with 31 mm Hg, also the highest. Although the results of this report are preliminary, they indicate that the pressure in the superficial vein of DIEP flaps might be of predictive value for venous congestion

Preoperative CT angiography reduces surgery time in perforator flap reconstruction

The use of perforator flaps in breast reconstructions has increased considerably in the past decade. A disadvantage of the perforator flap is difficult dissection, which results in a longer procedure. During spring 2006, we introduced CT angiography (CTA) as part of the diagnostic work-up in perforator flap reconstructions to visualise each perforator more accuratety. The main objectives were to reduce surgery time and the number of complications. A chart review was conducted 1 year after CTA introduction to investigate if these objectives were met. Materials and methods: Patients with a deep inferior epigastric perforator (DIEP) flap who underwent preoperative analysis through CTA were retrospectively evaluated. The population Results: One hundred and thirty-eight DIEP breast reconstructions were done; 70 underwent preoperative CTA analysis, and 68 had preoperative Doppler investigation. Surgery time in the CTA group was significantly lower (P <0.001) than in the control group, 264 min (SD +/- 62) versus 354 min (SD +/- 83), respectively. There was a tendency for fewer complications in the CTA group compared with the control group. All flaps were successful in the CTA group. In the control group, one flap failed and partial necrosis occurred in three flaps. The differences were not statistically significant. Conclusions: Preoperative CTA in the assessment of vascular anatomy during perforator flap reconstruction was safe and reliable. It helped reduce surgery time, and may prevent the number of postoperative complications. (C) 2008 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons