DIEAP flap for safe definitive autologous breast reconstruction

BackgroundBreast cancer is the commonest form of cancer in women affecting almost a quarter of a million patients in the US annually. 30 percent of these patients and patients with genetic mutations undergo removal of the breast, as highlighted in a high profile celebrity patient. Although breast reconstruction with free microvascular transfer of a DIEAP flap from the abdomen is an ideal form of reconstruction, there have been misgivings about the complexity and potential complications. This study was aimed at clearing these misunderstandings and establishing the value of this form of breast reconstruction.Methods1036 DIEAP flap breast reconstructions carried out at the University Hospital, Gent (five year period) and at the Sana Kliniken, Düsseldorf (three year period) were included prospectively. Comorbid factors like chemotherapy, radiotherapy, patient age >65 years, BMI >30 and smoking were recorded. Outcomes were evaluated over a mean follow up of 2 years.ResultsOverall complication rate related to the reconstructed breast and donor abdominal area was 6.8 percent. Total flap loss was seen in only 0.8 percent. The mean operating time was less than five hours. Older age, higher BMI, chemotherapy and radiotherapy did not have a significant influence on complication rates, however smoking resulted in significant delay in wound healing in the breast (p = 0.025) and abdominal wounds (p = 0.019).ConclusionThe DIEAP flap is an excellent option for breast reconstruction, with a low level of donor site morbidity and complications. It is an autologous reconstruction that provides a stable long term result.     

Collaboration between the breast and plastic surgeon in restoring sensation after mastectomy

Breast cancer is the most commonly diagnosed invasive cancer in women worldwide. While hypoesthesia is a known sequela after mastectomy, patients are now inquiring with renewed interest about the degree and timing of sensation after mastectomy. This is a topic that has generated much research interest. However, while there have been advances in the field, there are few, well‐done studies that allow for an accurate answer to this question. In this article, relevant breast and donor site anatomy is reviewed for sensate autologous breast reconstruction. Additional donor sites apart from the typically utilized abdomen are analyzed with relevant anatomical discussions. Outcomes are presented; however, due to the heterogeneity of the patient population, surgical approach and postoperative sensory testing, it is difficult to compare results between studies. Future directions and unanswered questions regarding sensate autologous breast reconstruction are highlighted. While great strides have been made in providing sensate autologous breast reconstruction, there are still many unanswered questions. Thus, the collaboration between surgical teams and sharing of outcomes is crucial to allow for optimization of this powerful surgical approach.     

乳腺癌术后乳房重建时机及术式选择

结合整形外科的理念和手段，在保证肿瘤安全性的前提下对乳腺癌病人进行乳房重建修复，成为乳腺外科领域重要的发展方向。乳房重建可以与全乳切除或部分乳房切除术同时进行，也可以延迟至完成辅助治疗后的适当时间进行，前者称为即刻乳房重建，后者称为延期乳房重建。临床上根据病人的疾病情况和自身的需求来确定重建时机。部分病人采用延迟-即刻乳房重建来降低辅助放疗给重建带来的不利影响，减少术后严重并发症的发生。从重建的技术手段来看，乳房重建有自体皮瓣乳房重建、假体乳房重建以及自体联合假体的乳房重建。植入物重建是即刻乳房重建中最常用的术式。在延期乳房重建中，更常采用自体皮瓣乳房重建或两步法的植入物重建术。     

The use of a template to accurately position the inframammary fold in breast reconstruction

Reconstruction of the inframammary fold (IMF) during breast reconstruction is vital in achieving good aesthetic outcomes and avoiding further corrective surgery. The IMF is usually reconstructed by comparing with the other side and estimating its correct position. The IMF template can be used to accurately and consistently mark the position of the IMF relative to the contralateral side thus aiding accurate reconstruction without the need to estimate.     

Beard and Moustache Reconstruction

Beard and moustache reconstruction has gained more popularity and acceptance over the last decade. The procedure is done for the correction of facial areas with hair density deficit and also for the cosmetic enhancement of pre-existing facial hair. The surgical technique includes the harvesting of grafts from the scalp by the follicular unit excision (FUE) or follicular unit transplantation (FUT) technique and then placing them in either premade slits or by stick and place method. The advancement and refinement of procedure over the years has aided in achieving the optimal aesthetic results, with minimal side effects.     

耳郭再造的再认识

耳郭再造技术的细节较多且难以把控,往往不易获得稳定效果。经过60余年的发展,该技术有了显著提高,Nagata二次法、部分扩张皮瓣法、完全扩张皮瓣法均得到了广泛应用。而获得再造耳满意效果和高优良率的前提是能够认识和理解每种再造方法,并根据患者的实际条件及每种耳郭再造技术的优势和不足,建立个性化治疗方案,有利于提高耳郭再造的整体效果和优良率。同时,也应对耳郭再造的整形医师进行系统规范培训,从而整体提高我国耳郭再造的技术水平。     

前置龟头或残余阴茎的阴茎再造术

目的：解决阴茎发育不良但龟头发育基本正常或外伤性阴茎部分缺损等治疗的难题。方法：应用吻合血管神经的前臂皮瓣前置龟头或残余阴茎进行阴茎再造术，治疗１２例，随访１～１２年不等。结果：手术成功１１例，失败１例。随访见再造阴茎不仅保持良好的外形，而且具有良好的感觉和勃起功能，两点分辨觉５～８ｍｍ，有３例婚后已生育子女。结论：利用龟头或残余阴茎再造阴茎是一种较符合生理状态的手术治疗新方法。     

MELANOMA OF THE FACE: THE SAFETY OF NARROW EXCISION MARGINS

Recent studies have shown that narrower excision margins may be safe, but the optimal or minimum margin for melanoma is unknown. Wide margins of excision are possible on the trunk and limbs, but functional and cosmetic constraints often limit the extent of excision on the face. A collaborative study from two continents (Cape Town, South Africa and Northwood, England) investigated the outcome of different excision margins of 106 patients with stage I melanoma of the face. The margin of excision was measured from the records of the pathological specimen. Thirty patients had margins of less than 1 cm, 64 had margins of between 1 and 2 cm, and 12 had margins greater than 2 cm. Primary apposition or flap closure was possible in 85 patients. Seven patients developed local recurrences and these were not influenced by the excision margin. This study supports the contention that the primary treatment of cutaneous melanoma on the face should be histologically confirmed complete excision, and that this can be achieved with margins of excision less than 1 cm. Local recurrence is not related to the margin of excision or to tumour thickness.     

The "Swiss-Roll" flap: a modified C-V flap for nipple reconstruction

Nipple reconstruction is an integral step in breast reconstruction. There are a variety of local-flap based techniques however one of the most commonly used is the C-V flap. The traditional flap forms a nipple shell composed of dermis and epidermis containing a core of subcutaneous fat. The shortcomings of this technique are that it relies on subcutaneous fat for nipple bulk and with time loses a significant part of its volume. We present a modification of the C-V flap designed for use in breasts with little subcutaneous fat in order to minimise post-operative nipple projection loss.     

瘢痕性隐耳的手术修复

目的探讨瘢痕性隐耳的定义及其伴有部分或完全耳垂缺损的手术修复效果。方法采用局部皮瓣加全厚皮片分区移植法，分别完成耳廓与颅侧壁及乳突部粘连松解、颅耳角形成、耳轮重建、耳垂再造或重建手术，对26例33只瘢痕性隐耳进行矫正。结果所有皮瓣均100％成活，移植皮片95％以上存活；耳廓外形尚较满意，主要结构可辨，颅耳角基本恢复。术后随访3个月至1年．结果表明，耳廓外形保持良好，患者满意。结论针对瘢痕性隐耳的畸形特征，采取相应的手术方法，是矫正瘢痕性隐耳的有效手段。