The differential effect of BMI on prosthetic versus autogenous breast reconstruction: A multivariate analysis of 12,986 patients

BackgroundThe comparative safety of breast reconstruction in obese patients remains to be clearly defined. This study utilized multi-institutional data to characterize the effect of body mass index (BMI) on breast reconstruction outcomes.MethodsUtilizing Current Procedural Terminology (CPT) codes, patients undergoing tissue expander, pedicled transverse rectus abdominis myocutaneous (TRAM) flap, latissimus dorsi flap, and free flap breast reconstruction were identified in the National Surgical Quality Improvement Program (NSQIP) database. Patients were stratified as obese (BMI ≥ 30) and non-obese (BMI < 30). Overall postoperative morbidity, flap complications, non-flap complications, and reoperation rates were compared among the groups.ResultsOf 12,986 patients who underwent breast reconstruction, 3636 (28.0%) were obese. Overall morbidity was significantly elevated in obese patients across all forms of reconstruction (p < 0.05). BMI was correlated with increased surgical complications for tissue expander, pedicled TRAM, and free flap reconstructions (OR = 1.09, OR = 1.05, OR = 1.10, respectively; p < 0.05). Medical complications were higher in obese patients undergoing tissue expander and pedicled TRAM reconstructions (p = 0.001 and p < 0.001), but no significant difference was observed in latissimus and free flap reconstruction patients. Compared with obese tissue expander recipients, obese patients reconstructed using autologous tissue had higher rates of reoperations (12.8% versus 9.1%), overall morbidity (18.0% versus 9.5%), surgical (12.7% versus 8.3%), and medical complications (9.0% versus 2.2%).ConclusionsThe NSQIP database allows for evaluation and comparison of reconstructive outcomes in the obese population. Increased BMI was associated with higher morbidity in autologous reconstruction than tissue expander reconstruction. Among autologous procedures, latissimus flaps experienced the lowest captured 30 day morbidity.     

Post-mastectomy reconstruction: A risk-stratified comparative analysis of outcomes

IntroductionAlthough breast reconstruction following mastectomy plays a role in the psychological impact of breast cancer, only one in three women undergo reconstruction. Few multi-institutional studies have compared complication profiles of reconstructive patients to non-reconstructive.MethodsUsing the National Surgical Quality Improvement database, all patients undergoing mastectomy from 2006 to 2010, with or without reconstruction, were identified and risk-stratified using propensity scored quintiles. The incidence of complications and comorbidities were compared.ResultsOf 37,723 mastectomies identified, 30% received immediate breast reconstruction. After quintile matching for comorbidities, complications rates between reconstructive and non-reconstructives were similar. This trend was echoed across all quintiles, except in the sub-group with highest comorbidities. Here, the reconstructive patients had significantly more complications than the non-reconstructive (22.8% versus 7.0%, p < 0.001).ConclusionImmediate breast reconstruction is a well-tolerated surgical procedure. However, in patients with high comorbidities, surgeons must carefully counterbalance surgical risks with psychosocial benefits to maximize patient outcomes.Level of evidenceLevel 3     

肠道造瘘口扩张器的研制

目的：研制一种新型的肠道造瘘口扩张器,从根本上解决用手指对肠道造瘘口进行扩张训练时存在的诸多缺陷。方法：选择合适的塑料原料,利用注塑机和不同的模具制作出各种型号的肠道造瘘口扩张器,用于肠道造瘘口的扩张训练。结果：该肠道造瘘口扩张器可以很好地满足不同患者的个性化需求,能有效解决医务人员用手指对患者肠道造瘘口进行扩张时带来的诸多不便,同时也减轻了患者的经济负担。结论：研制出的肠道造瘘口扩张器经实践检验,能有效解决用手指对肠道造瘘口进行扩张时带来的诸多缺陷,值得推广使用。     

皮肤扩张术治疗小儿颈胸部烧伤后瘢痕畸形

目的探讨皮肤软组织扩张器治疗小儿颈胸部烧伤后瘢痕畸形的方法及效果。方法对22例颈胸部烧伤后瘢痕形成伴颈部功能受限的患儿,应用皮肤软组织扩张器治疗。结果 22例患儿皮瓣转移后全部成活,其中11例皮瓣尖端部分有水肿、渗液,换药治愈后对功能无明显影响。随访2年,外形及功能均得到改善,颈部活动无明显受限。结论采用皮肤软组织扩张器治疗小儿颈胸部瘢痕畸形,临床效果满意。     

自体髂嵴骨骺游离移植重建内踝缺损初步报告

目的介绍儿童创伤性内踝缺损的重建方法。方法采用分期重建方法,第一期采用软组织扩张术修复内踝软组织缺损,第二期采用自体髂嵴骨骺游离移植重建胫骨远端内侧骺板缺损。结果随访2年,患儿踝关节外形正常,稳定性良好。结论采用软组织扩张术和自体髂嵴骨骺游离移植方法修复儿童内踝缺损,可使踝关节保持良好的稳定性能。     

椎体扩张器?Kyphon球囊和Sky骨膨胀器三种后凸成形术的临床应用比较研究

目的:比较椎体扩张器、Kyphon球囊和Sky骨膨胀器后凸成形术的临床应用结果及优缺点。方法:回顾性研究2006年10月至2010年2月,分别对71例71椎、55例55椎和22例22椎骨质疏松脊柱压缩骨折患者行椎体扩张器后凸成形术(dilator-kyphoplasty,DKP)、Kyphon球囊后凸成形术(balloon-kyphoplasty,BKP)和Sky骨膨胀器后凸成形术(Sky-bone expanderkyphoplasty,EKP)。记录手术时间、术中出血量、骨水泥注射量,观察手术前后疼痛视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(oswestry disability index,ODI)评分情况,测量病椎的高度和Cobb角改变。结果:3组手术时间、出血量相比,差异无统计学意义,骨水泥注入量EKP组与其他组比较有显著差异。3组术后椎体高度和后凸Cobb角、VAS评分、ODI评分均较术前明显改善。DKP组椎体高度和后凸Cobb角恢复较其他组显著。骨水泥渗漏:DKP组2例少量渗入椎体侧方,BKP组4例,EKP组9例,均无临床症状。结论:DKP...     

Onlay bone grafting of the mandible after periosteal expansion with an osmotic tissue expander: an experimental study in rabbits

Objectives: To evaluate the space‐maintaining capacity of a titanium mesh or a bioresorbable mesh after periosteal expansion and to assess bone formation under a titanium mesh or a bioresorbable mesh on the lateral border of the mandible by qualitative and quantitative histological analysis. Material and methods: In 13 rabbits, a self‐inflatable soft tissue expander was placed intraorally, bilaterally under the mandibular periosteum via an extra oral approach. After 2 weeks, the expanders were removed and a particulated onlay bone graft was placed and covered by a titanium mesh or a bioresorbable mesh. After 3 months, the animals were sacrificed and specimens were collected for histology. Results: The osmotic soft tissue expander created a subperiosteal pocket and a ridge of new bone had formed at the edges of the expanded periosteum in all sites. After the healing period of 3 months, soft tissue dehiscence was recorded in two of the sites with bioresorbable meshes. The mean bone fill was 65% under the titanium mesh and 85% under the bioresorbable mesh (P<0.05). There was no significant difference between the titanium mesh and the bioresorbable mesh regarding the height of the meshes, mesh area and mineralized bone area. Scanning electron microscopy shows that new bone is growing in direct contact with the resorbable mesh and the titanium mesh. Conclusion: This study confirms that an osmotic soft tissue expander creates a surplus of periosteum and soft tissue and that new bone can be generated under a titanium mesh or bioresorbable mesh. To cite this article:
Abrahamsson P, Isaksson S, Gordh M, Andersson G. Onlay bone grafting of the mandible after periosteal expansion with an osmotic tissue expander: an experimental study in rabbits.
Clin. Oral Impl. Res 21 , 2010; 1404–1410.
doi: 10.1111/j.1600‐0501.2010.01967.x