Archives of Plastic Surgery最新文献_第4页

Clavicle Fracture Site Surgical Contouring: A Case Report 锁骨骨折部位手术塑形：病例报告

Archives of Plastic Surgery Pub Date : 2024-02-07 DOI: 10.1055/s-0043-1775880

Annachiara Cavaliere, Vincenzo Cepparulo, G. Pezone, F. Schonauer

{"title":"Clavicle Fracture Site Surgical Contouring: A Case Report","authors":"Annachiara Cavaliere, Vincenzo Cepparulo, G. Pezone, F. Schonauer","doi":"10.1055/s-0043-1775880","DOIUrl":"https://doi.org/10.1055/s-0043-1775880","url":null,"abstract":"Clavicle fractures are frequent injuries accounting for approximately 4% of all fractures in adults with about 35% occurring in the shoulder region among which midshaft fractures are the most common (>66%). Nonsurgical management is the treatment of choice for most clavicle fractures; however, poor functional and aesthetic outcomes may result from nonunion, symptomatic malunion, and aesthetic impairment which are the most common complications. A young woman was referred to our clinic for a “Step Deformity” resulting after primary, nonsurgical treatment of a midshaft clavicle fracture. Residual deformity was corrected with a novel simple and little invasive approach. Midshaft clavicle fractures typically only require conservative nonsurgical treatment, nevertheless suboptimal outcomes may occur. Selective osteotomies and fixation are deemed too invasive when only cosmetic impairment of the clavicle contour is present without any functional or sensitive damage and most patients are discouraged from undergoing surgery. Thus far, no specific focus on this topic, nor exploration of possible correction can be found in the published literature. These residual deformities may be very noticeable sometimes and cause psychological distress and social life impairment. Despite no related functional impairment, this deformity should still be addressed, to improve patients' quality of life.","PeriodicalId":505284,"journal":{"name":"Archives of Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139857348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Salvage reconstruction of composite defects of the anterior mandible, floor of mouth and lip 下颌骨前部、口底和唇部复合缺损的挽救性重建

Archives of Plastic Surgery Pub Date : 2024-02-07 DOI: 10.1055/a-2263-8046

F. A. Khalid, Omar A Ahmed, Almeotan P Khurshid, A. Mujahid, Junaid Ahmad, Muhammad Saleem, M. A. Yousaf, M. Tarar, Farooq Shahzad

{"title":"Salvage reconstruction of composite defects of the anterior mandible, floor of mouth and lip","authors":"F. A. Khalid, Omar A Ahmed, Almeotan P Khurshid, A. Mujahid, Junaid Ahmad, Muhammad Saleem, M. A. Yousaf, M. Tarar, Farooq Shahzad","doi":"10.1055/a-2263-8046","DOIUrl":"https://doi.org/10.1055/a-2263-8046","url":null,"abstract":"Anterior mandible defects result in loss of support for the tongue, floor of the mouth and lower lip, resulting in impairment of airway, feeding and speech. We treated 4 patients with these ”Andy Gump” deformities. Reconstruction was performed with two free flaps: a fibula osteocutaneous flap for the anterior mandible and floor of the mouth, and a soft tissue free flap for the lip, chin, and anterior neck. The lower lip was suspended cranially with fascia or tendon grafts +/- mini-temporalis turndown flaps. All flaps survived completely. All patients were tube feed dependent before surgery; they all resumed an oral diet. All tracheostomies were decannulated. Lip competence was restored as evidenced by cessation of drooling. Speech improved from unintelligible to intelligible with frequent repetitions. Objectively assessment was performed with the functional intraoral Glasgow scale (FIGS); the mean FIGS score improved from 3.25 (range 3 to 4) to 11 (range 9 to 13). We conclude that composite anterior mandible and tongue defects have large tissue requirements that require multiple free flaps. Reconstruction leads to significant improvement in function.","PeriodicalId":505284,"journal":{"name":"Archives of Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139796216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Using 3D-bioprinted autologous minimally manipulated homologous adipose tissue for limb salvage in the treatment of diabetic foot ulcer 在糖尿病足溃疡治疗中使用三维生物打印自体微操作同源脂肪组织进行肢体救治

Archives of Plastic Surgery Pub Date : 2024-02-07 DOI: 10.1055/a-2263-7957

Hyeonmin Yoon, Woojin Song

{"title":"Using 3D-bioprinted autologous minimally manipulated homologous adipose tissue for limb salvage in the treatment of diabetic foot ulcer","authors":"Hyeonmin Yoon, Woojin Song","doi":"10.1055/a-2263-7957","DOIUrl":"https://doi.org/10.1055/a-2263-7957","url":null,"abstract":"Reconstructive surgeons face challenges when considering limb salvage methods for the treatment of diabetic foot ulcers (DFUs). In this article, we present our experience with autologous fat grafting as a viable alternative in cases where flap reconstruction is difficult. We encountered a 78-year-old female patient with a non-healing DFU who had multiple comorbidities, including renal failure and severe peripheral arterial disease (PAD). During the initial multidisciplinary meeting, due to extensive necrosis and osteomyelitis, amputation was recommended. However, the patient expressed a strong preference for a salvage procedure and refused amputation. After careful consideration, we opted to reconstruct the patient's foot using 3D-bioprinted autologous minimally manipulated homologous adipose tissue (3D-AMHAT). The AMHAT was engrafted well without complications such as autolysis, graft failure or infection. After the operation, the large defect with partial bone exposure was covered with healthy granulation tissue. The size of the wound decreased to less than half its original size after 6 weeks of surgery, and it decreased to less than 25% after 12 weeks of surgery. The AMHAT may be an appealing treatment option for diabetic foot patients who are unsuitable for flap reconstruction due to comorbidities.","PeriodicalId":505284,"journal":{"name":"Archives of Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139796412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Incidence of Velopharyngeal insufficiency After Primary Cleft Palate Repair: A 27-Year Assessment of One Surgeon’s Experience 初级腭裂修复术后伶咽功能不全的发生率：一位外科医生 27 年的经验评估

Archives of Plastic Surgery Pub Date : 2024-02-07 DOI: 10.1055/a-2263-7857

Chan Woo Jung, H. Seo, Yeseul Choi, Yong Chan Bae

{"title":"Incidence of Velopharyngeal insufficiency After Primary Cleft Palate Repair: A 27-Year Assessment of One Surgeon’s Experience","authors":"Chan Woo Jung, H. Seo, Yeseul Choi, Yong Chan Bae","doi":"10.1055/a-2263-7857","DOIUrl":"https://doi.org/10.1055/a-2263-7857","url":null,"abstract":"Background: Velopharyngeal insufficiency (VPI) is a major complication of cleft palate repair. The purpose of this study was to evaluate the incidence and predictive factors of VPI after cleft palate repair based on 27 years of one surgeon’s experience.\u0000Methods: Medical records were retrospectively reviewed for 652 patients who underwent cleft palate repair between 1995 and 2021. After exclusion of those with other syndromes or developmental disorders, the study included 374 patients with sufficient follow-up until the age of 4 years, when language evaluation was possible. VPI status was categorized through subjective and objective tests into normal, VPI, and borderline. We analyzed potential differences in VPI incidence by multiple factors. Factors with significance were analyzed to confirm the relationships between sub-variables.\u0000Results: Of the 374 patients, 311 (83.2%) exhibited normal pronunciation, 51 (13.6%) had VPI, and 12 (3.2%) were borderline. Primary cleft palate repair performed after 18 months was associated with a higher incidence of VPI than repair conducted before 18 months (p=0.005). The incidence of VPI was higher in cases of submucous cleft palate than in the other types based on the Veau classification (p=0.011). However, in the multivariable analysis, only the submucous type showed statistically significant results (p=0.026). \u0000Conclusions: A total of 374 people underwent primary cleft palate repair, and 13.6% of those with VPI required secondary therapy. The incidence of VPI was relatively high among patients with primary cleft palate repair after 18 months and patients with submucous cleft palate.\u0000","PeriodicalId":505284,"journal":{"name":"Archives of Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139797041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Incidence of Velopharyngeal insufficiency After Primary Cleft Palate Repair: A 27-Year Assessment of One Surgeon’s Experience 初级腭裂修复术后伶咽功能不全的发生率：一位外科医生 27 年的经验评估

Archives of Plastic Surgery Pub Date : 2024-02-07 DOI: 10.1055/a-2263-7857

Chan Woo Jung, H. Seo, Yeseul Choi, Yong Chan Bae

{"title":"Incidence of Velopharyngeal insufficiency After Primary Cleft Palate Repair: A 27-Year Assessment of One Surgeon’s Experience","authors":"Chan Woo Jung, H. Seo, Yeseul Choi, Yong Chan Bae","doi":"10.1055/a-2263-7857","DOIUrl":"https://doi.org/10.1055/a-2263-7857","url":null,"abstract":"Background: Velopharyngeal insufficiency (VPI) is a major complication of cleft palate repair. The purpose of this study was to evaluate the incidence and predictive factors of VPI after cleft palate repair based on 27 years of one surgeon’s experience.\u0000Methods: Medical records were retrospectively reviewed for 652 patients who underwent cleft palate repair between 1995 and 2021. After exclusion of those with other syndromes or developmental disorders, the study included 374 patients with sufficient follow-up until the age of 4 years, when language evaluation was possible. VPI status was categorized through subjective and objective tests into normal, VPI, and borderline. We analyzed potential differences in VPI incidence by multiple factors. Factors with significance were analyzed to confirm the relationships between sub-variables.\u0000Results: Of the 374 patients, 311 (83.2%) exhibited normal pronunciation, 51 (13.6%) had VPI, and 12 (3.2%) were borderline. Primary cleft palate repair performed after 18 months was associated with a higher incidence of VPI than repair conducted before 18 months (p=0.005). The incidence of VPI was higher in cases of submucous cleft palate than in the other types based on the Veau classification (p=0.011). However, in the multivariable analysis, only the submucous type showed statistically significant results (p=0.026). \u0000Conclusions: A total of 374 people underwent primary cleft palate repair, and 13.6% of those with VPI required secondary therapy. The incidence of VPI was relatively high among patients with primary cleft palate repair after 18 months and patients with submucous cleft palate.\u0000","PeriodicalId":505284,"journal":{"name":"Archives of Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139856828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Using 3D-bioprinted autologous minimally manipulated homologous adipose tissue for limb salvage in the treatment of diabetic foot ulcer 在糖尿病足溃疡治疗中使用三维生物打印自体微操作同源脂肪组织进行肢体救治

Archives of Plastic Surgery Pub Date : 2024-02-07 DOI: 10.1055/a-2263-7957

Hyeonmin Yoon, Woojin Song

{"title":"Using 3D-bioprinted autologous minimally manipulated homologous adipose tissue for limb salvage in the treatment of diabetic foot ulcer","authors":"Hyeonmin Yoon, Woojin Song","doi":"10.1055/a-2263-7957","DOIUrl":"https://doi.org/10.1055/a-2263-7957","url":null,"abstract":"Reconstructive surgeons face challenges when considering limb salvage methods for the treatment of diabetic foot ulcers (DFUs). In this article, we present our experience with autologous fat grafting as a viable alternative in cases where flap reconstruction is difficult. We encountered a 78-year-old female patient with a non-healing DFU who had multiple comorbidities, including renal failure and severe peripheral arterial disease (PAD). During the initial multidisciplinary meeting, due to extensive necrosis and osteomyelitis, amputation was recommended. However, the patient expressed a strong preference for a salvage procedure and refused amputation. After careful consideration, we opted to reconstruct the patient's foot using 3D-bioprinted autologous minimally manipulated homologous adipose tissue (3D-AMHAT). The AMHAT was engrafted well without complications such as autolysis, graft failure or infection. After the operation, the large defect with partial bone exposure was covered with healthy granulation tissue. The size of the wound decreased to less than half its original size after 6 weeks of surgery, and it decreased to less than 25% after 12 weeks of surgery. The AMHAT may be an appealing treatment option for diabetic foot patients who are unsuitable for flap reconstruction due to comorbidities.","PeriodicalId":505284,"journal":{"name":"Archives of Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139856439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Smooth versus Textured Tissue Expanders: Comparison of Outcomes and Complications in 536 Implants 光滑组织扩张器与纹理组织扩张器：536 例植入物的效果和并发症比较

Archives of Plastic Surgery Pub Date : 2024-02-07 DOI: 10.1055/s-0043-1775592

O. Allam, Jacob Dinis, Mariana N. Almeida, Alexandra Junn, M. A. Mozaffari, Rema Shah, Lauren Chong, Olamide Olawoyin, Sumarth Mehta, K. Park, Tomer Avraham, M. Alperovich

{"title":"Smooth versus Textured Tissue Expanders: Comparison of Outcomes and Complications in 536 Implants","authors":"O. Allam, Jacob Dinis, Mariana N. Almeida, Alexandra Junn, M. A. Mozaffari, Rema Shah, Lauren Chong, Olamide Olawoyin, Sumarth Mehta, K. Park, Tomer Avraham, M. Alperovich","doi":"10.1055/s-0043-1775592","DOIUrl":"https://doi.org/10.1055/s-0043-1775592","url":null,"abstract":"\u0000 Background Increasing concerns regarding the safety of textured surface implants have resulted in surgeons transitioning from textured tissue expanders (TEs) to smooth TEs. Given this change has only recently occurred, this study evaluated outcomes between smooth and textured TEs.\u0000 Methods Women who underwent two-stage breast reconstruction using TEs from 2013 to 2022 were included. TE-specific variables, perioperative information, pain scores, and complications were collected. Chi-squared, t-test, and linear regression analyses were performed.\u0000 Results A total of 320 patients received a total of 384 textured and 152 smooth TEs. Note that 216 patients received bilateral reconstruction. TEs were removed in 9 cases. No significant differences existed between groups regarding comorbidities. Smooth TEs had a higher proportion of prepectoral placement (p < 0.001). Smooth TEs had less fills (3 ± 1 vs. 4 ± 2, p < 0.001), shorter expansion periods (60 ± 44 vs. 90 ± 77 days, p < 0.001), smaller expander fill volumes (390 ± 168 vs. 478 ± 177 mL, p < 0.001), and shorter time to exchange (80 ± 43 vs. 104 ± 39 days, p < 0.001). Complication rates between textured and smooth TEs were comparable. Smooth TE had a greater proportion of TE replacements (p = 0.030). On regression analysis, pain scores were more closely associated with age (p = 0.018) and TE texture (p = 0.046). Additional procedures at time of TE exchange (p < 0.001) and textured TE (p = 0.017) led to longer operative times.\u0000 Conclusion As many surgeons have transitioned away from textured implants, our study shows that smooth TEs have similar outcomes to the textured alternatives.","PeriodicalId":505284,"journal":{"name":"Archives of Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139856243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Improvement of Shoulder Motion in Two-Stage Dual-Plane Implant-Based Breast Reconstruction followed by Radiation Therapy through Delayed Prepectoral Conversion 通过延迟胸前转换改善两阶段双平面植入物乳房重建术后放疗的肩部活动度

Archives of Plastic Surgery Pub Date : 2024-02-07 DOI: 10.1055/s-0043-1775591

Jin Sol Park, U. Jin

{"title":"Improvement of Shoulder Motion in Two-Stage Dual-Plane Implant-Based Breast Reconstruction followed by Radiation Therapy through Delayed Prepectoral Conversion","authors":"Jin Sol Park, U. Jin","doi":"10.1055/s-0043-1775591","DOIUrl":"https://doi.org/10.1055/s-0043-1775591","url":null,"abstract":"\u0000 Background Although prepectoral implant-based breast reconstruction has recently gained popularity, dual-plane reconstruction is still a better option for patients with poor-quality mastectomy skin flaps. However, shoulder morbidity is aggravated by subpectoral reconstruction, especially in irradiated patients. This study aimed to demonstrate shoulder exercise improvement in subpectoral reconstruction by delayed prepectoral conversion with an acellular dermal matrix (ADM) inlay graft technique at the time of expander-to-implant exchange after irradiation.\u0000 Methods Patients with breast cancer treated for expander-to-implant exchange after subpectoral expander insertion and subsequent radiotherapy between January 2021 and June 2022 were enrolled. An ADM inlay graft was inserted between the pectoralis major muscle and the previously inserted ADM. The ADM was sutured partially overlapping the pectoralis muscle from the medial side with the transition part, to the muscle border at the lateral side. Perioperative shoulder joint active range-of-motion (ROM) for forward flexion, abduction, and external rotation was also evaluated.\u0000 Results A total of 35 patients were enrolled in the study. Active shoulder ROM significantly improved from 163 degrees preoperatively to 176 degrees postoperatively in forward flexion, 153 to 175 degrees in abduction, and 69 to 84 degrees in external rotation. There was no difference in patient satisfaction regarding the final outcome between the conventional prepectoral reconstruction group and the study group.\u0000 Conclusion Shoulder exercises in irradiated patients who underwent subpectoral reconstruction were improved by delayed prepectoral conversion using an ADM inlay graft. It is recommended that subpectoral reconstruction not be ruled out due to concerns regarding muscle contracture and shoulder morbidity in radiation-planned patients with poor mastectomy skin flaps.","PeriodicalId":505284,"journal":{"name":"Archives of Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139795499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Clavicle Fracture Site Surgical Contouring: A Case Report 锁骨骨折部位手术塑形：病例报告

Archives of Plastic Surgery Pub Date : 2024-02-07 DOI: 10.1055/s-0043-1775880

Annachiara Cavaliere, Vincenzo Cepparulo, G. Pezone, F. Schonauer

{"title":"Clavicle Fracture Site Surgical Contouring: A Case Report","authors":"Annachiara Cavaliere, Vincenzo Cepparulo, G. Pezone, F. Schonauer","doi":"10.1055/s-0043-1775880","DOIUrl":"https://doi.org/10.1055/s-0043-1775880","url":null,"abstract":"Clavicle fractures are frequent injuries accounting for approximately 4% of all fractures in adults with about 35% occurring in the shoulder region among which midshaft fractures are the most common (>66%). Nonsurgical management is the treatment of choice for most clavicle fractures; however, poor functional and aesthetic outcomes may result from nonunion, symptomatic malunion, and aesthetic impairment which are the most common complications. A young woman was referred to our clinic for a “Step Deformity” resulting after primary, nonsurgical treatment of a midshaft clavicle fracture. Residual deformity was corrected with a novel simple and little invasive approach. Midshaft clavicle fractures typically only require conservative nonsurgical treatment, nevertheless suboptimal outcomes may occur. Selective osteotomies and fixation are deemed too invasive when only cosmetic impairment of the clavicle contour is present without any functional or sensitive damage and most patients are discouraged from undergoing surgery. Thus far, no specific focus on this topic, nor exploration of possible correction can be found in the published literature. These residual deformities may be very noticeable sometimes and cause psychological distress and social life impairment. Despite no related functional impairment, this deformity should still be addressed, to improve patients' quality of life.","PeriodicalId":505284,"journal":{"name":"Archives of Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139797758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Improvement of Shoulder Motion in Two-Stage Dual-Plane Implant-Based Breast Reconstruction followed by Radiation Therapy through Delayed Prepectoral Conversion 通过延迟胸前转换改善两阶段双平面植入物乳房重建术后放疗的肩部活动度

Archives of Plastic Surgery Pub Date : 2024-02-07 DOI: 10.1055/s-0043-1775591

Jin Sol Park, U. Jin

{"title":"Improvement of Shoulder Motion in Two-Stage Dual-Plane Implant-Based Breast Reconstruction followed by Radiation Therapy through Delayed Prepectoral Conversion","authors":"Jin Sol Park, U. Jin","doi":"10.1055/s-0043-1775591","DOIUrl":"https://doi.org/10.1055/s-0043-1775591","url":null,"abstract":"\u0000 Background Although prepectoral implant-based breast reconstruction has recently gained popularity, dual-plane reconstruction is still a better option for patients with poor-quality mastectomy skin flaps. However, shoulder morbidity is aggravated by subpectoral reconstruction, especially in irradiated patients. This study aimed to demonstrate shoulder exercise improvement in subpectoral reconstruction by delayed prepectoral conversion with an acellular dermal matrix (ADM) inlay graft technique at the time of expander-to-implant exchange after irradiation.\u0000 Methods Patients with breast cancer treated for expander-to-implant exchange after subpectoral expander insertion and subsequent radiotherapy between January 2021 and June 2022 were enrolled. An ADM inlay graft was inserted between the pectoralis major muscle and the previously inserted ADM. The ADM was sutured partially overlapping the pectoralis muscle from the medial side with the transition part, to the muscle border at the lateral side. Perioperative shoulder joint active range-of-motion (ROM) for forward flexion, abduction, and external rotation was also evaluated.\u0000 Results A total of 35 patients were enrolled in the study. Active shoulder ROM significantly improved from 163 degrees preoperatively to 176 degrees postoperatively in forward flexion, 153 to 175 degrees in abduction, and 69 to 84 degrees in external rotation. There was no difference in patient satisfaction regarding the final outcome between the conventional prepectoral reconstruction group and the study group.\u0000 Conclusion Shoulder exercises in irradiated patients who underwent subpectoral reconstruction were improved by delayed prepectoral conversion using an ADM inlay graft. It is recommended that subpectoral reconstruction not be ruled out due to concerns regarding muscle contracture and shoulder morbidity in radiation-planned patients with poor mastectomy skin flaps.","PeriodicalId":505284,"journal":{"name":"Archives of Plastic Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139855253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0