改良箭式皮瓣乳头再造术的临床疗效观察

目的探讨改良箭式皮瓣乳头再造术的临床疗效。方法收集2018年1月至2019年10月在南京市中医院甲乳外科住院接受改良箭式皮瓣乳头再造的患者10例,对再造乳头回缩率、患者满意度及局部皮瓣并发症发生率进行评价。结果10例患者手术时间为(15.10±1.52)min,范围为13~18 min。所有患者随访时间为(14.60±1.07)个月,范围为3~24个月。乳头高度回缩率为(28.53±3.02)%,范围为23.5%~33.2%。乳头直径回缩率为(8.92±1.05)%,范围为7.1%~10.5%。患者满意度为(97.90±1.60)%,范围为96%~100%。10例患者均未出现切口愈合不良、切口裂开、皮瓣坏死等并发症。结论改良箭头式皮瓣设计简便,操作简单,疗效满意,术后并发症发生率低。     

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.     

Long-term evaluation of modified Tanzer ear reconstruction

This article presents the author's experience using the Tanzer technique with modifications. Included also are changes in technique based on results from long-term follow-up studies.     

A modified technique for nipple reconstruction: the 'arrow flap'.

It is well known that nipples reconstructed using local tissue flaps slowly flatten. Furthermore, patients with implant reconstruction show the highest amount of nipple projection loss. This article describes some modifications to the technique proposed by Thomas et al in order to maintain flap projection. We undertook a prospective study to evaluate the effectiveness of our technique, named 'arrow flap'. We compared a series of patients with unilateral breast reconstruction (16 implants, 16 TRAM flaps) who underwent nipple reconstruction using either the 'modified star flap' or the 'arrow flap'. The statistical significance of the results was determined by Student's t test. The arrow flap proved to have a higher residual projection and these results were statistically significant. Furthermore, it has been equally useful on implant and autologous reconstructions. This technique is easy to learn and to perform. The procedure is reliable and patient satisfaction and compliance are very good.     

Triple-V flap: nipple reconstruction using a modified C-V flap technique for long-lasting improvement of projection

Background

Reconstruction of the nipple–areola complex is the last procedure in breast reconstruction after mastectomy. Various techniques have been described, but the creation of a long-lasting projection represents a challenge in plastic surgery causing frequent nipple projection loss.

Methods

From December 2008 and September 2010, we performed 43 nipple reconstructions using our new technique named “triple-V flap.” This procedure is similar to C-V flap but uses a further V limb area that is de-epithelialized and provides significant support to the new nipple. Clinical assessment was performed with a caliper measuring nipple projection at 1, 6, and 12 months after the surgical procedure.

Results

We evaluated the triple-V nipple reconstruction technique in 43 patients. Reconstructed nipple projection ranged between 3.3 and 6.4 mm (mean 4.8 mm). Mean decrease in nipple projection was 0.2 mm at 1 month, 1.4 mm at 6 months, and 1.6 mm at 1 year. After 1 year, mean nipple projection decrease was 34 %.

Conclusions

Our triple-V technique allows the maintenance of long-lasting projection of the reconstructed nipple at 12 months after surgery. Ease and speed of execution made our technique usable in all patients who need to complete the breast reconstruction process. Level of Evidence: Level IV, therapeutic study.     

Purse-string nipple areolar reconstruction

We present a surgical technique of nipple areolar reconstruction that uses a purse-string to increase areolar projection while reducing loss of nipple projection. A permanent purse-string is used around a modified CV flap to advance tissue centrally to the base of the nipple reconstruction. Two opposing hemiareolar island flaps are advanced toward the base of the nipple to add tissue volume. The resulting circumareolar full thickness skin is closed using a permanent purse-string suture. Synching the purse-string suture produces an effect similar to that of a periareolar mastopexy and enhances areolar projection. Eighty-two patients underwent 108 nipple areola reconstructions. Ninety-six percent of the patients achieved good results without any flap loss or suture infections. Revision surgery was necessary in 4 patients for minor problems including asymmetry or loss of projection. The purse-string nipple areolar reconstruction method described results in a high rate of maintenance of projection and patient satisfaction.     

Results of nipple areola reconstruction

Reconstruction of the nipple-areola complex is being performed for about a quarter of postmastectomy breast reconstruction patients. The methods used and results achieved in thirteen reconstructions were reviewed. Full thickness skin grafts from the upper inner thigh were used for the areola, with 100% success. For the nipple proper, most (eight) had a composite graft from the opposite nipple, with 100% take if the dressing was kept in place for 10-12 days. Earlobe tissue made an excellent nipple reconstruction for bilateral cases (four). It is concluded that nipple-areola reconstruction is safe, simple and predictable. A second operation is recommended for this surgery to ensure symmetry of nipple position, a fundamental requirement for a good result.     

Long-term follow-up of nonvascularized fibular autografts for distal radial reconstruction

Three patients with giant cell tumors of the distal radius had en bloc excision of the distal radius and replacement with the ipsilateral fibula. Two of the patients were followed for 16 years and one for 14 1/2 years. Forearm rotation, as well as wrist motion, was limited in all three patients, yet they remained functional and pain free except during periods of prolonged or excessive use. All three patients were pleased with the results. Bone union occurred primarily in all three patients without a supplemental bone graft or microvascular anastomosis. This method has a definite place in the hand surgeon's armamentarium when compared with radial allografts and microvascular free fibular translocation.     

Long-term follow-up of the modified Delorme procedure for rectal prolapse

HYPOTHESIS: The modified Delorme operation is a safe, effective, and durable treatment for complete rectal prolapse. DESIGN: Retrospective analysis of outcomes in adult patients undergoing the modified Delorme operation. SETTING: Community-based tertiary referral center with a 5-year general surgery residency program. PATIENTS: A total of 52 consecutive patients undergoing surgery for the treatment of complete rectal prolapse during the 26-year period ending December 2001. INTERVENTIONS: Modified Delorme operation.Main Outcomes Measured Method of anesthesia, morbidity, mortality, recurrence rates, length of follow-up, and incontinence. RESULTS: In the 52 patients, the mean length of prolapse was 8.2 cm. The mean operating time was 75 minutes. Forty-five patients were administered general anesthesia, 4 were administered spinal anesthesia, and 3 were administered local anesthesia. The mean postoperative stay was 4.9 days for 1975 through 2001 and 2.8 days for 1990 through 2001. No patients died as a result of the procedure. Patients were followed up for 61.4 months. Major medical comorbidities occurred in 40 patients. Preoperative incontinence was present in 12 patients, 10 of whom improved after the procedure, and postoperative incontinence in 8. The recurrent postoperative prolapse rate at 5 years was 6% (3/52) and the recurrent postoperative prolapse rate to the end of the study was 10% (5/52). Two patients (4%) had complications that required operative intervention in the postoperative period. CONCLUSIONS: The modified Delorme operation is a safe and effective surgical treatment for complete rectal prolapse. The risk of recurrent prolapse is low, and the procedure may be safely performed in patients with significant medical comorbidities.     

Safe delayed procedure of nipple reconstruction in poorly circulated nipple

Nipple‐areolar complex reconstruction represents the final step in breast reconstruction. However, there is no gold standard nipple reconstruction technique that addresses the issue of blood circulation in the flap, which is the most basic complication. Nipple reconstruction was performed in 21 patients. A delayed procedure was performed when a poor outcome was expected due to marginal pinpoint bleeding in the distal tip after flap elevation during nipple reconstruction. The delayed nipple reconstruction can be viewed as a safe and reliable method for improving nipple blood circulation, reducing complications, and enabling long‐term nipple projection maintenance in high‐risk patients.     

Long-term follow-up for reconstruction of strictures of the fossa navicularis with a single technique

OBJECTIVE: To retrospectively review our experience with the ventral transverse skin island elevated on a dartos fascia flap. PATIENTS AND METHODS: In all, 45 patients were consecutively operated by the senior author using this technique from March 1987 to January 2006. The files of 35 patients were assessed for the study. Success was defined as a patent urethral calibre of >/=16 F that did not require further procedures. Follow-up consisted of, endoscopy with calibration, office visits, and telephone calls. This procedure was described in 1987 by Jordan. The overall outcome as well as indications after the follow-up period are presented. RESULTS: The overall success rate was 83% with a mean long-term follow-up of 10.2 years. All of the patients with a non-lichen sclerosus (LS)/balanitis xerotica obliterans (BXO) diagnosis had excellent results (23/23) with a mean follow-up of 10.2 years. LS/BXO recurred at the fossa or meatus in six of 12 patients. Seventeen patients (48%) were lost to follow-up, and three patients (9%) died from other causes. CONCLUSIONS: The ventral transverse penile skin island flap has proven to be effective, reliable, reproducible, and with good functional and aesthetic results in all fossa navicularis strictures with the exception of those strictures resulting from LS/BXO.     

Lastissimus dorsi three-flap nipple reconstruction

The author describes the use of latissimus dorsi skin in a one-stage procedure for reconstruction of the nipple. Three flaps of skin are fashioned based on a central disk design.     

保留乳头改良根治术乳头存活的临床研究

目的 探讨行保留乳头改良根治术后乳头存活的可能性及影响因素.方法 回顾性分析近7年多来采用保留乳头的改良根治术治疗乳腺癌40例患者的临床资料.结果 40例保留乳头全部存活.手术适应证的选择、术中手术技巧和完善的术后处理是保证术后乳头存活的重要因素.结论 严格掌握适应证,注意手术技巧,合适的术后处理能提高保留乳头改良根治术乳头存活的存活率.