Journal articles: 'Surgical reconstruction'

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Nevil, Collin, Eric Heffern, Wojciech Przylecki, and Brian T. Andrews. "Surgical Decision Making in Complex Facial Gunshot Wound Reconstruction." FACE 2, no. 4 (October 17, 2021): 329–35. http://dx.doi.org/10.1177/27325016211053351.

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Introduction: With a rise in gun violence across the United States, facial gunshot wounds (GSWs) present a challenging reconstructive problem that was once seldom encountered in civilian populations. Reconstruction of facial GSW injuries requires a combination of both microvascular and craniofacial surgical techniques. The aim of this study is to explore our experience with facial GSW injuries through an anatomic classification scheme and investigate the surgical techniques necessary to complete such reconstructions. Methods: A retrospective review was conducted at a tertiary academic center. All subjects who suffered facial GSWs and underwent definitive reconstruction at our institution were included. Facial GSWs were classified into 4 distinct anatomical zones of injury: lower (mandible), middle (maxilla and orbit), upper (above the orbit), and multi-zone injury. Microvascular reconstruction was further investigated based on the types of flaps used and the location of flap inset. Surgical outcomes, numbers of procedures, and complications were assessed, and statistical comparisons were made. Results: Thirty-six subjects underwent a total of 322 surgeries. Twenty subjects had multi-zone injury; 16 had single zone injury. Eighteen of the 36 subjects (50%) required microvascular reconstruction. These 18 subjects underwent a significantly increased number of reconstructive procedures ( P = .023). Twenty-six flaps were used, as multiple subjects required >1 flap. Fourteen of the 26 flaps were used in the middle third (54%), 7 in the lower third (27%), and 5 in the upper third (19%). Six flap complications required further surgical revision. On average, multi-zone injuries required more surgical procedures to complete reconstruction ( P = .018). Conclusion: Composite multi-zone facial GSW injuries present a higher degree of reconstructive complexity, and thus often require more surgical procedures, especially when the midface is involved. In our experience, microvascular reconstruction is more often used in multizone injury, and in our series was associated with an increased number of reconstructive procedures.

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Franchelli, Simonetta, Maria Stella Leone, Pietro Berrino, Barbara Passarelli, Silvia Cicchetti, Giuseppe Perniciaro, Eliano Delfino, and Pierluigi Santi. "Can the Cost Affect the Choice of Various Methods of Postmastectomy Breast Reconstruction?" Tumori Journal 84, no. 3 (May 1998): 383–86. http://dx.doi.org/10.1177/030089169808400314.

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Aim and background A wide range of methodologies for breast reconstruction is now available. For immediate breast reconstruction we prefer to use implants, whereas reconstruction using autologous tissues, such as transverse rectus abdominis musculocutaneous flaps (TRAMF) and muscular latissimus dorsi flaps, is applied only in selected cases. In contrast, for delayed reconstruction the choice between prostheses and autologous tissue depends on various conditions. The different reconstructive methods can be adopted as a single procedure or as a combination of surgical procedures. Following the issue of legislation defining the new structure of the Italian Health Service, the need to accurately assess the costs incurred for the execution of surgical operations has taken on paramount importance. The aim of the study was to evaluate not only the clinical limits of each surgical technique, but also its cost, in order to optimize the choice of the same procedures, conditions being equal. Methods The study population included 105 patients who underwent breast reconstruction in the period 1st January 1994-30th June 1995. The reconstructive procedures included 48 immediate implants, 7 immediate TRAMF, 17 delayed implants, 30 delayed TRAMF, and 3 delayed latissimus dorsi muscular flaps. Results After data evaluation, we concluded that reconstruction using permanent expandable implants is the most convenient among implant reconstructions for its low global treatment cost. In fact, reconstructive procedures using temporary expanders, which require two surgical operations, have a higher cost than breast reconstruction using permanent expandable implants. Breast reconstruction using TRAMF is the most convenient because it limits the cost of surgical materials and because flap versatility limits the number of modifications on the contralateral breast. In contrast, breast reconstruction using latissimus dorsi flaps has high costs. Conclusions There is no balance between price list and effective cost of the different surgical reconstructive procedures, which may be a point of departure to see whether it is impossible to improve the efficiency of the Health Care System and in any case open a debate between the Regions and hospitals to improve the service, keeping it at a good level.

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Tran, Khanh Linh, Matthew Lee Mong, James Scott Durham, and Eitan Prisman. "Benefits of Patient-Specific Reconstruction Plates in Mandibular Reconstruction Surgical Simulation and Resident Education." Journal of Clinical Medicine 11, no. 18 (September 9, 2022): 5306. http://dx.doi.org/10.3390/jcm11185306.

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Poorly contoured mandibular reconstruction plates are associated with postoperative complications. Recently, a technique emerged whereby preoperative patient-specific reconstructive plates (PSRP) are developed in the hopes of eliminating errors in the plate-bending process. This study’s objective is to determine if reconstructions performed with PSRP are more accurate than manually contoured plates. Ten Otolaryngology residents each performed two ex vivo mandibular reconstructions, first using a PSRP followed by a manually contoured plate. Reconstruction time, CT scans, and accuracy measurements were collected. Paired Student’s t-test was performed. There was a significant difference between reconstructions with PSRP and manually contoured plates in: plate-mandible distance (0.39 ± 0.21 vs. 0.75 ± 0.31 mm, p = 0.0128), inter-fibular segment gap (0.90 ± 0.32 vs. 2.24 ± 1.03 mm, p = 0.0095), mandible-fibula gap (1.02 ± 0.39 vs. 2.87 ± 2.38 mm, p = 0.0260), average reconstruction deviation (1.11 ± 0.32 vs. 1.67 ± 0.47 mm, p = 0.0228), mandibular angle width difference (5.13 ± 4.32 vs. 11.79 ± 4.27 mm, p = 0.0221), and reconstruction time (16.67 ± 4.18 vs. 33.78 ± 8.45 min, p = 0.0006). Lower plate-mandible distance has been demonstrated to correlate with decreased plate extrusion rates. Similarly, improved bony apposition promotes bony union. PSRP appears to provide a more accurate scaffold to guide the surgeons in assembling donor bone segments, which could potentially improve patient outcome and reduce surgical time. Additionally, in-house PSRP can serve as a low-cost surgical simulation tool for resident education.

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Götzl, Rebekka, Sebastian Sterzinger, Andreas Arkudas, Anja M. Boos, Sabine Semrau, Nikolaos Vassos, Robert Grützmann, et al. "The Role of Plastic Reconstructive Surgery in Surgical Therapy of Soft Tissue Sarcomas." Cancers 12, no. 12 (November 26, 2020): 3534. http://dx.doi.org/10.3390/cancers12123534.

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Background: Soft tissue sarcoma (STS) treatment is an interdisciplinary challenge. Along with radio(chemo)therapy, surgery plays the central role in STS treatment. Little is known about the impact of reconstructive surgery on STS, particularly whether reconstructive surgery enhances STS resection success with the usage of flaps. Here, we analyzed the 10-year experience at a university hospital’s Comprehensive Cancer Center, focusing on the role of reconstructive surgery. Methods: We performed a retrospective analysis of STS-patients over 10 years. We investigated patient demographics, diagnosis, surgical management, tissue/function reconstruction, complication rates, resection status, local recurrence and survival. Results: Analysis of 290 patients showed an association between clear surgical margin (R0) resections and higher-grade sarcoma in patients with free flaps. Major complications were lower with primary wound closure than with flaps. Comparison of reconstruction techniques showed no significant differences in complication rates. Wound healing was impaired in STS recurrence. The local recurrence risk was over two times higher with primary wound closure than with flaps. Conclusion: Defect reconstructions in STS are reliable and safe. Plastic surgeons should have a permanent place in interdisciplinary surgical STS treatment, with the full armamentarium of reconstruction methods.

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Balkishan, Brahmanpally, and Ashrith Reddy Gowni. "Reconstruction of surgical defects following Cancer surgery." Asian Pacific Journal of Health Sciences 3, no. 4 (November 30, 2016): 95–102. http://dx.doi.org/10.21276/apjhs.2016.3.4.15.

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GHEORGHE, D. C., and A. ZAMFIR-CHIRU-ANTON. "Canal wall reconstruction – surgical considerations." Romanian Journal of Medical Practice 10, no. 4 (December 31, 2015): 397–99. http://dx.doi.org/10.37897/rjmp.2015.4.15.

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Recurrent cholesteatoma and local mastoid morbidity account for common patient complaints in our pediatric department. Objective. To describe a surgical technique used for 2 difficult cholesteatoma pediatric cases, in order to prevent mastoid cavity associated disease. Material. 2 cases with recurrent cholesteatoma and mastoid morbidity were surgically approached by reconstructing the posterior osseous canal wall. Results. Anatomical results were satisfactory on short term monitoring. Long-term results need further evaluation. Conclusion. Posterior canal wall reconstruction represents a useful option for mastoid cavity patients with local recurrent disease.

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Grosfeld, Eline C., Jeroen M. Smit, Gertruud A. Krekels, Julien H. A. van Rappard, and Maarten M. Hoogbergen. "Facial Reconstruction following Mohs Micrographic Surgery: A Report of 622 Cases." Journal of Cutaneous Medicine and Surgery 18, no. 4 (July 2014): 265–70. http://dx.doi.org/10.2310/7750.2013.13188.

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Background: Around 100 to 200 patients undergo surgical reconstruction every year at our department of plastic and reconstructive surgery after Mohs micrographic surgery for nonmelanoma skin cancer. Objective: The aim of this report is to provide an overview of the type of facial reconstructions performed and investigate whether we achieved increased, definitive closure rates of the defect on the day of the excision after further improving the collaboration between the involved departments. Methods: All patients who underwent facial reconstruction at the Department of Plastic and Reconstructive Surgery following Mohs micrographic surgery between January 2006 and January 2011 were retrospectively systematically reviewed. Results: A total of 564 patients with 622 defects were identified. The different reconstructions used per aesthetic unit are described. The number of cases in which a reconstruction was performed on the same day as the resection significantly increased from 31 to 81% ( p < .001). Conclusion: Facial reconstruction following Mohs micrographic surgery is challenging. The type of reconstruction used depends on the type of defect and patient characteristics. A structured multidisciplinary approach improves the process from defect to reconstruction and can facilitate referrals.

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Robb, Geoffrey L., Mark T. Marunick, Jack W. Martin, and Ian M. Zlotolow. "Midface reconstruction: Surgical reconstruction versus prosthesis." Head & Neck 23, no. 1 (2000): 48–58. http://dx.doi.org/10.1002/1097-0347(200101)23:1<48::aid-hed8>3.0.co;2-h.

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Sammarco, G. James, and Hiram A. Carrasquillo. "Surgical Revision after Failed Lateral Ankle Reconstruction." Foot & Ankle International 16, no. 12 (December 1995): 748–53. http://dx.doi.org/10.1177/107110079501601202.

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Ten patients were treated with revision ankle ligament reconstruction from 1989 through 1994 for recurrent symptomatic instability of the ankle after failure of a primary reconstruction. There were seven female and three male patients with an average age of 28 years. In four patients, symptoms developed shortly after the first reconstruction and in six patients, symptoms developed 56.2 months (average) after the initial reconstruction surgery. The average follow-up was 14 months after revision surgery. All patients had significant functional impairment before surgery and all failed to respond to conservative treatment, which included physical therapy and bracing. Seven revision ligament reconstructions included the use of a tendon graft, including the pero-neus brevis, accessory peroneus, plantaris, and peroneus tertius. All revision procedures were modifications of the Elmslie procedure, (Sammarco-DiRaimondo). In addition, three Brostrom-Gould procedures were performed. The average follow-up was 31 months. All patients had clinical stability of the ankle following revision reconstruction. Nine patients (90%) returned to their previous functional level. After surgery, two patients had minimal pain and mononeuritis multiplex developed in one patient. The outcome of revision ankle ligament reconstruction compares favorably with reports for primary ankle reconstruction. Revision ankle reconstruction is a good procedure for selected patients. It is an appropriate option when conservative therapy fails to relieve recurrent symptoms of ankle instability following primary reconstruction.

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Moore, Gary F., C. Scott Howe, and Anthony J. Yonkers. "The use of Silastic Prosthetics in the Reconstruction of Nasal Facial Deformities." American Journal of Rhinology 1, no. 1 (March 1987): 59–63. http://dx.doi.org/10.2500/105065887781390372.

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Maxillofacial deformities resulting from the loss of tissue from the midfacial region may cause serious disfigurement. Modern facial plastic reconstructive techniques have been able to produce satisfactory results in the reconstruction of many of these facial deformities. There are specific indications where the use of a silastic prosthetic device may have a distinct advantage over a surgical reconstruction. Shortened hospitalization, early rehabilitation, decreased morbidity, and an excellent access to the surgical site for follow-up of cancer resection patients are important advantages when considering prosthetic rehabilitation. This technique does not supplant established surgical facial reconstructive methods, but offers a valuable adjunct for reconstruction of extensive lesions caused either by trauma or surgical resection.

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Ragbir, M., J. S. Brown, and H. Mehanna. "Reconstructive considerations in head and neck surgical oncology: United Kingdom National Multidisciplinary Guidelines." Journal of Laryngology & Otology 130, S2 (May 2016): S191—S197. http://dx.doi.org/10.1017/s0022215116000621.

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AbstractThis is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. The reconstructive needs following ablative surgery for head and neck cancer are unique and require close attention to both form and function. The vast experience accrued with microvascular reconstructive surgery has meant a significant expansion in the options available. This paper discusses the options for reconstruction available following ablative surgery for head and neck cancer and offers recommendations for reconstruction in the various settings.Recommendations• Microsurgical free flap reconstruction should be the primary reconstructive option for most defects of the head and neck that need tissue transfer. (R)• Free flaps should be offered as first choice of reconstruction for all patients needing circumferential pharyngoesophageal reconstruction. (R)• Free flap reconstruction should be offered for patients with class III or higher defects of the maxilla. (R)• Composite free tissue transfer should be offered as first choice to all patients needing mandibular reconstruction. (R)• Patients undergoing salvage total laryngectomy should be offered vascularised flap reconstruction to reduce pharyngocutaneous fistula rates. (R)

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Mende, Konrad, José Annelie Suurmeijer, and Michael Alan Tonkin. "Surgical techniques for reconstruction of the hypoplastic thumb." Journal of Hand Surgery (European Volume) 44, no. 1 (August 22, 2018): 15–24. http://dx.doi.org/10.1177/1753193418793579.

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The reconstruction of a congenital hypoplastic thumb usually involves release of a tight first web space, metacarpophalangeal joint stabilization, reconstruction of intrinsic muscle function, and extrinsic tendon reconstruction, as appropriate. Numerous surgical options and combinations are available, but the approaches vary among surgeons who work in the field of congenital hand surgery and the empirical evidence that allows for evaluation of the results of techniques is scarce. Both the pre-operative assessment and intra-operative findings of all thumb elements – bone, joints, and soft tissues – should be considered in the surgical decision-making and eventually define the methods of reconstruction. This article summarizes the different reconstructive options.

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Kozak, Krzysztof, Rafal Wojcik, Maciej Czerwonka, Slawomir Mandziuk, and Barbara Madej-Czerwonka. "Oncoplastic breast surgery techniques - a new look at surgical treatment of breast cancer." Current Issues in Pharmacy and Medical Sciences 31, no. 3 (September 1, 2018): 131–34. http://dx.doi.org/10.1515/cipms-2018-0025.

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Abstract Breast cancer is the most common cancer among Polish women [1], thus, the problem of surgical treatment of breasts, especially with regard to conserving and/or reconstruction surgery, is extensively discussed. Currently, in Poland, efforts are made to increase the number of oncologic and reconstructive breast centers which offer specialized treatment of this cancer, the so-called ‘Breast Units’ [1]. This paper analyzes methods of reconstructions, discusses the techniques used in particular types of surgeries and additionally informs the reader of the oncological aspects of the procedures. Based on literature, statistical data of breast reconstructions from Poland and the world are presented. Moreover, complications and psychological aspects of mammary gland surgery are dealt with, and the aesthetic effects of breast reconstructions are discussed. To support of our findings, we also present selected clinical cases from the oncological and reconstructive point of view.

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Hong, Sang Duk. "Reconstruction Strategy After Endoscopic Skull-Base Surgery." Journal of Rhinology 29, no. 2 (July 31, 2022): 69–75. http://dx.doi.org/10.18787/jr.2021.00401.

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Endoscopic skull-base surgery (ESBS) is a rapidly growing surgical area that involves collaboration of otolaryngology-head and neck surgeons and neurosurgeons. Various tumor pathologies and extents have been successfully treated with ESBS, and diverse reconstruction methods have been adopted since its introduction. The optimal reconstructive strategy should be based on heterogeneous surgical situations and tumor extent. Nevertheless, there are few current guidelines for selecting reconstructive methods. Therefore, we review diverse options for endoscopic skull-base reconstruction.

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Ahmad, Jamal. "Treatment of Catastrophic Failures of Achilles Tendon Repairs Due to Deep Wound Complications." Foot & Ankle Orthopaedics 2, no. 3 (September 1, 2017): 2473011417S0000. http://dx.doi.org/10.1177/2473011417s000086.

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Category: Sports Introduction/Purpose: The Achilles tendon is the most commonly injured tendon in the lower extremity. Whether these ruptures are acute or chronic, a surgical Achilles repair or reconstruction is often needed to restore tendon integrity and function. Risks from such surgeries include superficial or deep wound infections and/or dehiscence. To date, there is scant literature regarding the treatment of catastrophic failures of Achilles tendon repairs or reconstructions from deep wound infection and dehiscence. The purpose of this study is to retrospectively examine clinical outcomes from uniform single-stage surgical treatment of catastrophic failures of Achilles tendon repairs or reconstructions from deep wound complications. Methods: Between 2007 and 2016, 10 patients developed a deep wound infection and dehiscence after surgical treatment of an acute or chronic Achilles rupture. Medical co-morbidities included obesity in 4, diabetes in 3, and nicotine use in 2 patients. Six and 4 patients had a mid-substance and insertional Achilles rupture respectively. Three patients had an acute injury that received an end-to-end suture repair. Seven patients had a chronic injury with Achilles retraction, which necessitated proximal Achilles or gastrocnemius lengthening. These patients required surgery for their wound problem due to depth and involvement of their Achilles repair/reconstruction site. Surgery involved a single-stage wound irrigation and debridement, Achilles excisional debridement at the repair/reconstruction site, flexor hallucis longus transfer to the calcaneus to replace the compromised or failed Achilles repair/reconstruction, and primary or vacuum assisted wound closure. Patients were followed for 6 months after this surgery and invited for recent follow-up to collect data. Results: With uniform surgical treatment, full resolution of deep wound infection and dehiscence after Achilles repair/reconstruction was achieved in all 10 patients. No patients developed a recurrence of wound complications and/or infection to necessitate any further surgical debridements. All 10 patients presented for recent follow-up at a mean of 57.3 months. Mean Foot and Ankle Ability Measures increased from 36.3% at initial presentation before Achilles repair/reconstructive surgery to 84.2% at latest follow-up (P<0.05). Mean Visual Analog Scores of pain decreased from 6.6 of 10 before the Achilles repair/reconstruction to 1.5 of 10 at latest follow-up (P<0.05). All patients were able to return to normal gait and full activities at home, with 3 reporting difficulties with prolonged ankle activities at work. Conclusion: This study demonstrates that our method of single-stage surgical treatment of catastrophic failures of Achilles tendon repairs or reconstructions from deep wound complications can achieve a high rate of improved patient function and pain relief. Clinical outcomes of treating patients with this particular complication of Achilles repair/reconstruction in this manner have not been previously reported in the orthopaedic literature. As catastrophic failures of Achilles tendon repairs or reconstructions from deep wound complications are studied further, our method of surgical care should be strongly considered as treatment.

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Badhey, Arvind, Sameep Kadakia, Moustafa Mourad, Jared Inman, and Yadranko Ducic. "Calvarial Reconstruction." Seminars in Plastic Surgery 31, no. 04 (October 25, 2017): 222–26. http://dx.doi.org/10.1055/s-0037-1606557.

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AbstractCalvarial reconstruction is a challenge to reconstructive surgeons, especially considering protection of intracranial contents. In recent years, the advent of multiple reconstructive materials adds tools to the surgical armamentarium. Options include autologous split calvarial and rib grafts and alloplastic materials such as titanium mesh, methyl methacrylate, calcium hydroxyapatite, and polyetheretherketone. The most important aspect of cranial reconstruction still lies in finding the most aesthetic, safe, and reliable means of filling a defect.

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Nistor, Claudiu-Eduard, Adrian Ciuche, Anca-Pati Cucu, Bogdan Serban, Adrian Cursaru, Bogdan Cretu, and Catalin Cirstoiu. "Clavicular Malignancies: A Borderline Surgical Management." Medicina 58, no. 7 (July 8, 2022): 910. http://dx.doi.org/10.3390/medicina58070910.

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Nearly 1% of all bone cancers are primary clavicular tumors and because of their rarity, treating clinicians are unfamiliar with their diagnosis, classification, treatment options, and prognosis. In terms of preserving function and avoiding complications, clavicle reconstruction seems logical; however, further studies are needed to support this measure. Reconstruction techniques are difficult taking into account the anatomical structures surrounding the clavicle. When chest wall defects are present, a multidisciplinary team, including an orthopedist and thoracic and plastic surgeons, is of paramount importance for optimal surgical management. Malignant clavicle tumors may include primary and secondary malignancies and neighboring tumors with clavicular invasion. Surgical resection of complex thoracic tumors invading the clavicles can result in larger defects, requiring chest wall reconstruction, which is a substantial challenge for surgeons. Correct diagnosis with proper preoperative planning is essential for limiting complications. Post-resection reconstruction of the partial or total claviculectomy is important for several reasons, including maintaining the biomechanics of the scapular girdle, protecting the vessels and nerves, reducing pain, and maintaining the anatomical appearance of the shoulder. The chest wall resection and reconstruction techniques can involve either partial or full chest wall thickness, influencing the choice of reconstructive technique and materials. In the present paper, we aimed to synthesize the anatomical and physiopathological aspects and the small number of therapeutic surgical options that are currently available for these patients.

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Dieterich, Max, Adrian Dragu, Angrit Stachs, and Johannes Stubert. "Clinical Approaches to Breast Reconstruction: What Is the Appropriate Reconstructive Procedure for My Patient." Breast Care 12, no. 6 (2017): 368–73. http://dx.doi.org/10.1159/000484926.

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Breast reconstruction after breast cancer is an emotional subject for women. Consequently, the correct timing and surgical procedure for each individual woman are important. In general, heterologous or autologous reconstructive procedures are available, both having advantages and disadvantages. Breast size, patient habitus, and previous surgeries or radiation therapy need to be considered, independent of the chosen procedure. New surgical techniques, refinement of surgical procedures, and the development of supportive materials have increased the general patient collective eligible for breast reconstruction. This review highlights the different approaches to immediate breast reconstruction using autologous or heterologous techniques.

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Marcasciano, Marco, Mauro Tarallo, Michele Maruccia, Benedetta Fanelli, Giorgio La Viola, Donato Casella, Lenia Sanchèz Wals, Sergio Ciaschi, and Paolo Fioramonti. "Surgical Treatment with Locoregional Flap for the Nose." BioMed Research International 2017 (2017): 1–8. http://dx.doi.org/10.1155/2017/9750135.

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Nonmelanotic skin cancers (NMSCs) are the most frequent of all neoplasms and nasal pyramid represents the most common site for the presentation of such cutaneous malignancies, particularly in sun-exposed areas: ala, dorsum, and tip. Multiple options exist to restore functional and aesthetic integrity after skin loss for oncological reasons; nevertheless, the management of nasal defects can be often challenging and the best “reconstruction” is still to be found. In this study, we retrospectively reviewed a total of 310 patients who presented to our Department of Plastic and Reconstructive Surgery for postoncological nasal reconstruction between January 2011 and January 2016. Nasal region was classified into 3 groups according to the anatomical zones affected by the lesion: proximal, middle, and distal third. We included an additional fourth group for complex defects involving more than one subunit. Reconstruction with loco regional flaps was performed in all cases. Radical tumor control and a satisfactory aesthetic and functional result are the primary goals for the reconstructive surgeon. Despite tremendous technical enhancements in nasal reconstruction techniques, optimal results are usually obtained when “like is used to repair like.” Accurate evaluation of the patients clinical condition and local defect should be always considered in order to select the best surgical option.

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Hentz, Vincent R., Charles Hamlin, and Leo A. Keoshian. "Surgical Reconstruction in Tetraplegia." Hand Clinics 4, no. 4 (November 1988): 601–7. http://dx.doi.org/10.1016/s0749-0712(21)01226-9.

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Weng, Chau-Jin. "Surgical reconstruction in cryptophthalmos." British Journal of Plastic Surgery 51, no. 1 (January 1998): 17–21. http://dx.doi.org/10.1054/bjps.1997.0167.

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Ehmke, Myriam, and Volker Schwipper. "Surgical Reconstruction of Eyelids." Facial Plastic Surgery 27, no. 03 (May 12, 2011): 276–83. http://dx.doi.org/10.1055/s-0031-1275777.

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MARICEVICH, PABLO, ANDRÉ MANSUR, ACRYSIO PEIXOTO, JULIA AMANDO, EDUARDO PANTOJA, ANDRÉ BRAUNE, JOSÉ AUGUSTO NASSER, and RICARDO LOPES DA CRUZ. "Cranioplasties: surgical reconstruction strategies." Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery 31, no. 1 (2016): 32–42. http://dx.doi.org/10.5935/2177-1235.2016rbcp0006.

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Isomura, Tadashi. "Surgical left ventricular reconstruction." General Thoracic and Cardiovascular Surgery 59, no. 5 (May 2011): 315–25. http://dx.doi.org/10.1007/s11748-010-0742-4.

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Kaduk, Wolfram M. H., Fred Podmelle, and Patrick J. Louis. "Surgical Navigation in Reconstruction." Oral and Maxillofacial Surgery Clinics of North America 25, no. 2 (May 2013): 313–33. http://dx.doi.org/10.1016/j.coms.2013.01.003.

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Clune, James E., and Deepak Narayan. "Surgical Reconstruction in Melanoma." Current Problems in Cancer 35, no. 4 (July 2011): 185–99. http://dx.doi.org/10.1016/j.currproblcancer.2011.07.006.

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Vincent, Aurora, Mofiyinfolu Sokoya, Tom Shokri, Eli Gordin, Jared C. Inman, Spiros Manolidis, and Yadranko Ducic. "Management of Skull Fractures and Calvarial Defects." Facial Plastic Surgery 35, no. 06 (November 29, 2019): 651–56. http://dx.doi.org/10.1055/s-0039-3399522.

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AbstractScalp and calvarial defects can result from a myriad of causes including but not limited to trauma, infection, congenital malformations, neoplasm, and surgical management of tumors or other pathologies. While some small, nondisplaced fractures with minimal overlying skin injury can be managed conservatively, more extensive wounds will need surgical repair and closure. There are many autologous and alloplastic materials to aid in dural and calvarial reconstruction, but no ideal reconstructive method has yet emerged. Different reconstructive materials and methods are associated with different advantages, disadvantages, and complications that reconstructive surgeons should be aware of. Herein, we discuss different methods and materials for the surgical reconstruction of calvarial defects.

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Wilde, Jeffrey, Asheesh Bedi, and David W. Altchek. "Revision Anterior Cruciate Ligament Reconstruction." Sports Health: A Multidisciplinary Approach 6, no. 6 (August 20, 2013): 504–18. http://dx.doi.org/10.1177/1941738113500910.

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Context: Reconstruction of the anterior cruciate ligament (ACL) is one of the most common surgical procedures, with more than 200,000 ACL tears occurring annually. Although primary ACL reconstruction is a successful operation, success rates still range from 75% to 97%. Consequently, several thousand revision ACL reconstructions are performed annually and are unfortunately associated with inferior clinical outcomes when compared with primary reconstructions. Evidence Acquisition: Data were obtained from peer-reviewed literature through a search of the PubMed database (1988-2013) as well as from textbook chapters and surgical technique papers. Study Design: Clinical review. Level of Evidence: Level 4. Results: The clinical outcomes after revision ACL reconstruction are largely based on level IV case series. Much of the existing literature is heterogenous with regard to patient populations, primary and revision surgical techniques, concomitant ligamentous injuries, and additional procedures performed at the time of the revision, which limits generalizability. Nevertheless, there is a general consensus that the outcomes for revision ACL reconstruction are inferior to primary reconstruction. Conclusion: Excellent results can be achieved with regard to graft stability, return to play, and functional knee instability but are generally inferior to primary ACL reconstruction. A staged approach with autograft reconstruction is recommended in any circumstance in which a single-stage approach results in suboptimal graft selection, tunnel position, graft fixation, or biological milieu for tendon-bone healing. Strength-of-Recommendation Taxonomy (SORT): Good results may still be achieved with regard to graft stability, return to play, and functional knee instability, but results are generally inferior to primary ACL reconstruction: Level B.

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Baskies, Michael A., David Tuckman, Nader Paksima, and Martin A. Posner. "A New Technique for Reconstruction of the Ulnar Collateral Ligament of the Thumb." American Journal of Sports Medicine 35, no. 8 (August 2007): 1321–25. http://dx.doi.org/10.1177/0363546507303663.

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Background Several previous studies have described reconstructive methods for the treatment of an injury to the ulnar collateral ligament of the thumb. However, there are few biomechanical studies to date to analyze the strength of the surgical reconstruction. Purpose To evaluate 2 reconstruction techniques with use of a cadaveric model (1) reconstruction with the use of a free tendon graft placed in a figure-of-8 fashion through drill holes in the metacarpal and proximal phalanx of the thumb, and (2) reconstruction with the use of the Bio-Tenodesis Screw System. Study Design Controlled laboratory study. Methods Eight matched pairs of cadaveric specimens underwent removal of the proper and accessory ulnar collateral ligaments. One of the 2 reconstruction methods was performed, and specimens were mounted on a materials-testing machine. The specimens were subjected to valgus stress to failure at 30° of flexion. Failure was defined as valgus laxity of 30° at the metacarpophalangeal joint. Results The peak load to failure was 23.5 ± 11.4 N for the figure-of-8 reconstruction and 24.3 ± 12.3 N for the reconstruction using the Bio-Tenodesis Screw System. Comparing the 2 groups, there was no statistically significant difference in peak loads to failure (P = .88). Conclusion There was no statistically significant difference between the peak loads to failure of the 2 reconstructions. Clinical Relevance The Bio-Tenodesis Screw System may provide another viable option for surgical reconstruction of the ulnar collateral ligament of the thumb.

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Tierney, Brian P., Jason P. Hodde, and Daniela I. Changkuon. "Biologic Collagen Cylinder with Skate Flap Technique for Nipple Reconstruction." Plastic Surgery International 2014 (July 10, 2014): 1–6. http://dx.doi.org/10.1155/2014/194087.

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A surgical technique using local tissue skate flaps combined with cylinders made from a naturally derived biomaterial has been used effectively for nipple reconstruction. A retrospective review of patients who underwent nipple reconstruction using this technique was performed. Comorbidities and type of breast reconstruction were collected. Outcome evaluation included complications, surgical revisions, and nipple projection. There were 115 skate flap reconstructions performed in 83 patients between July 2009 and January 2013. Patients ranged from 32 to 73 years old. Average body mass index was 28.0. The most common comorbidities were hypertension (39.8%) and smoking (16.9%). After breast reconstruction, 68.7% of the patients underwent chemotherapy and 20.5% underwent radiation. Seventy-one patients had immediate breast reconstruction with expanders and 12 had delayed reconstruction. The only reported complications were extrusions (3.5%). Six nipples (5.2%) in 5 patients required surgical revision due to loss of projection; two patients had minor loss of projection but did not require surgical revision. Nipple projection at time of surgery ranged from 6 to 7 mm and average projection at 6 months was 3–5 mm. A surgical technique for nipple reconstruction using a skate flap with a graft material is described. Complications are infrequent and short-term projection measurements are encouraging.

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Cirstoiu, Catalin, Bogdan Cretu, Sergiu Iordache, Mihnea Popa, Bogdan Serban, and Adrian Cursaru. "Surgical management options for long-bone metastasis." EFORT Open Reviews 7, no. 3 (March 1, 2022): 206–13. http://dx.doi.org/10.1530/eor-21-0119.

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Bone metastases are difficult to treat surgically, necessitating a multidisciplinary approach that must be applied to each patient depending on the specifics of their case. The main indications for surgical treatment are a lack of response to chemotherapy, radiation therapy, hormone therapy, immunotherapy, and bisphosphonates which is defined by persistent pain or tumor progression; the risk of imminent pathological bone fracture; and surgical treatment for single bone metastases. An important aspect of choosing the right treatment for these patients is accurately estimating life expectancy. Improved chemotherapy, postoperative radiation therapy, and sustainable reconstructive modalities will increase the patient’s life expectancy. The surgeon should select the best surgical strategy based on the primary tumor and its characteristics, the presence of single or multiple metastases, age, anatomical location, and the functional resources of the patient. Preventive osteosynthesis, osteosynthesis to stabilize a fracture, resections, and reconstructions are the main surgical options for bone metastases. Resection and reconstruction with a modular prosthesis remain the generally approved surgical option to restore functionality, increase the quality of life, and increase life expectancy. Preoperative embolization is necessary, especially in the case of metastases of renal or thyroid origin. This procedure is extremely important to avoid complications, with a major impact on survival rates.

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Yumi Nakai, Marianne, Lucas Ribeiro Tenório, Antonio Augusto Tupinambá Bertelli, Júlio Patrocínio Moraes, Marlos Cortez Sampaio, Juliana Maria de Almeida Vital, Marcelo Benedito Menezes, and Antonio José Gonçalves. "Retalho miocutâneo infra-hióideo em defeitos de cabeça e pescoço: experiência de uma única instituição." Relatos de Casos Cirúrgicos do Colégio Brasileiro de Cirurgiões 8, no. 4 (December 31, 2022): 1–8. http://dx.doi.org/10.30928/2527-2039e-20223419.

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ABSTRACT Introduction: The infrahyoid flap is a pedicled flap with a simple harvesting technique. It may be an alternative for free flaps in elderly or patients with multiple comorbidities. This article evaluates 15 patients submitted to reconstruction of head and neck defects. Case report: Case series of patients submitted to infrahyoid flap reconstruction in a referral center. We evaluate surgical and functional outcomes associated with reconstruction with infrahyoid flap from November of 2013 to May of 2017. Conclusion: Infrahyoid flap is a thin and flexible flap with low rates of complications and does not require another surgical team. The majority of the patients had complete functional rehabilitation. Keywords: Reconstructive Surgical Procedures. Myocutaneous Flap. Surgical Flaps. Head and Neck Neoplasms.

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di Stefano, C., G. P. Incarbone, F. Arena, G. Calbiani, G. Ugolotti, and P. Cortellini. "Surgical Reconstruction for Major Renal Trauma: Follow-Up Results." Urologia Journal 65, no. 4 (August 1998): 553–55. http://dx.doi.org/10.1177/039156039806500416.

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The management of major renal trauma is still controversial and there are few studies about preservation of renal function after surgical reconstruction. We report our results on 10 patients who underwent renal reconstruction and quantitative assessment of differential renal function by radionuclide scintigraphy (99m-TC DMSA); mean follow-up was 6.6 years. Function was 25% or more in 9 reconstructed kidneys: this value is considered an adequate preservation of renal function. We consider reconstructive surgery an appropriate method to manage major renal injuries.

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Perkins, Rodney. "Tympanoplasty 1995." Otolaryngology–Head and Neck Surgery 112, no. 5 (May 1995): P63. http://dx.doi.org/10.1016/s0194-5998(05)80133-0.

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Educational objectives: To present practical and reliable techniques for surgical reconstruction of the tympanic membrane and ossicular chain and to emphasize an integrated system of surgical techniques that allows multiple reconstructive options to the surgeon within a cohesive reconstructive philosophy.

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Neville, William Evans, Paul J. P. Bolanowski, and Delores Bentley. "Tracheal Reconstruction." AORN Journal 54, no. 3 (September 1991): 470–82. http://dx.doi.org/10.1016/s0001-2092(07)66766-0.

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Fahey, Victora A., and John J. Bergan. "Venous Reconstruction." AORN Journal 41, no. 2 (February 1985): 423–34. http://dx.doi.org/10.1016/s0001-2092(07)63279-7.

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Dinner, Melvyn I., and Carol Coleman. "Breast Reconstruction." AORN Journal 42, no. 4 (October 1985): 490–96. http://dx.doi.org/10.1016/s0001-2092(07)64861-3.

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Kershner, Deborah D., and Judith A. Claussen. "Craniofacial Reconstruction." AORN Journal 44, no. 4 (October 1986): 551–80. http://dx.doi.org/10.1016/s0001-2092(07)65406-4.

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Latief, Mohammad Adhitya. "THE ROLE OF 3D MODEL AS SURGICAL GUIDANCE IN MANDIBULAR RECONSTRUCTION SURGERY." Jurnal Ilmiah dan Teknologi Kedokteran Gigi 16, no. 2 (February 23, 2021): 79–85. http://dx.doi.org/10.32509/jitekgi.v16i2.1079.

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reconstruction surgery is a challenging surgery that require well prepared presurgical plan to minimize the risk of failure, to accommodate the need for precision preoperative planning, surgeons frequently need guidance such as a3-dimensional (3D) model to display complex cranial structures. Evaluation of the 3D model as surgical guidance require a review measurement regarding its efficiency and pitfalls. Purpose: the purpose of this research is to understand the importants key points that will resulted succesfull reconstructive surgery using 3D model as surgical guidance. Method: the evaluation of surgical result in mandibular reconstruction surgery from our Department Oral and Maxillofacial surgery, Universitas Indonesia from 2012 to 2017 reveal the differences. We analyze several keypoints that may affect to the succesfull of reconstruction surgery result. Result: we compared the result between years before and after 2015, this is where we start obligate all reconstruction surgery need to have preoperative planning using3D Model. Several keypoints in using 3D model is acknowledgeable. Conclusion: the use of 3D models as surgical guidance has important role to minimize post reconstructive surgery result, surgeon need to understand the principal and keypoints in preoperative planning and regarding the use of 3D model.

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Hessam, Schapoor, Dimitrios Georgas, Michael Sand, and Falk G. Bechara. "Complete Skin Resection of the Dorsum of the Hand: A Prophylactic Approach Using a Dermal Regeneration Template." Journal of Cutaneous Medicine and Surgery 18, no. 1 (January 2014): 56–59. http://dx.doi.org/10.2310/7750.2013.13061.

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Background: Surgical treatment of multiple and recurring invasive carcinomas on the dorsum of the hand often results in a reconstructive challenge. Reconstruction is limited due to reduced adjacent tissue. Preserving the functionality of the hand is pivotal and needs to be respected while planning reconstruction. Objective: We present a case of extensive, multiple, and recurring invasive squamous cell carcinoma on the dorsum of the hand and describe a prophylactic surgical approach. Methods: We performed a radical excision of the skin on the dorsum of the hand and surgical reconstruction using a bilayer dermal skin substitute and split-thickness skin grafting. Results: After a 1-year follow-up, we observed an excellent cosmetic and functional result with no signs of recurrence. Conclusions: In case of extensive invasive squamous cell carcinoma on the dorsum of the hand, prophylactic resection and surgical reconstruction using a dermal regeneration template should be considered.

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Namikawa, Tsutomu, Eri Munekage, Masaya Munekage, Hiromichi Maeda, Hiroyuki Kitagawa, Yusuke Nagata, Michiya Kobayashi, and Kazuhiro Hanazaki. "Reconstruction with Jejunal Pouch after Gastrectomy for Gastric Cancer." American Surgeon 82, no. 6 (June 2016): 510–17. http://dx.doi.org/10.1177/000313481608200611.

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The construction of a gastric substitute pouch after gastrectomy for gastric cancer has been proposed to help ameliorate postprandial symptoms and nutritional performance. Adequate reconstruction after gastrectomy is an important issue, because postoperative patient quality of life (QOL) primarily depends on the reconstruction method. To this end, jejunal pouch (JP) reconstructions were developed to improve the patient's eating capacity and QOL by creating large reservoirs with improved reflux barriers to prevent esophagitis and residual gastritis. It is important that such reconstructions also preserve blood and extrinsic neural integrity for maintaining pouch function, because JP motility is associated directly with QOL. Some problems remain to be resolved with the JP reconstructions method including gastrointestinal motility, which plays a major role in food transfer, digestion, and absorption of nutrients. Further studies including basic research and larger prospective randomized control trials are also needed to obtain definitive results. With persistent innovations in surgical techniques, JP after gastrectomy could become a safe and preferable reconstructive modality to improve patient QOL after gastrectomy.

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Martins, Francisco E., Natália M. Martins, Luís Campos Pinheiro, Luís Ferraz, Luís Xambre, and Tomé M. Lopes. "Management of iatrogenic urorectal fistulae in men with pelvic cancer." Canadian Urological Association Journal 11, no. 9 (September 14, 2017): E372–8. http://dx.doi.org/10.5489/cuaj.4427.

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Introduction: Urorectal fistula (URF) is a devastating complication of pelvic cancer treatments and a surgical challenge for the reconstructive surgeon. We report a series of male patients with URF resulting from pelvic cancer treatments, specifically prostate (PCa), bladder (BCa), and rectal cancer (RCa), and explore the differences and impact on outcomes between purely surgical and non-surgical treatment modalities.Methods: Between October 2008 and June 2015, 15 male patients, aged 59‒78 years (mean 67), with URF induced by pelvic cancer treatments were identified in our institutions. Patients with a history of diverticulitis, inflammatory bowel disease, or other benign conditions were excluded. We reviewed the patients’ medical records for symptoms, diagnostic tests performed, type and etiology of the fistula, type of surgical reconstruction, followup, and outcomes.Results: Fourteen patients underwent surgical reconstruction. One patient developed metastatic disease before URF repair and, therefore, was excluded from this study. Mean followup (FU) was 32.7 months (14‒79). All patients received diverting colostomy and temporary urinary diversion. An exclusively transperineal approach was used in nine (64.3%) patients and a combined abdominoperineal in five (35.7%). Overall successful URF closure was achieved in 12 (85.7%) patients, nine (64.3%) of whom at the first reconstructive attempt, two (14.3%) after two attempts (in our institution), and one (7.1%) after three attempts (two of which elsewhere). An interposition flap was used in seven (50%) patients. Surgical reconstruction failed ultimately in two (14.3%) patients who still have a colostomy and do not wish any further reconstruction.Conclusions: Our study has several limitations, including its retrospective nature and the heterogeneity of our small patient cohort. Nonetheless, although surgical reconstruction of URF may be extremely difficult and complex in the non-surgical/energy ablation patients, its successful reconstruction is possible in most through a transperineal, or a more aggressive abdominoperineal, approach with tissue interposition in selected patients.

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Adani, Roberto, and Sang Hyun Woo. "Microsurgical thumb repair and reconstruction." Journal of Hand Surgery (European Volume) 42, no. 8 (August 8, 2017): 771–88. http://dx.doi.org/10.1177/1753193417723310.

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In this article, we review microsurgical reconstructive techniques available to treat thumb amputation at different levels based on our experience. We reference techniques used by other surgeons and identify the most suitable technique for different clinical situations. Indications and techniques for microsurgical partial or composite transfer of the great or second toe for thumb reconstruction are summarized. Different microsurgical transfer techniques suggest a great freedom of surgical choices. However, the choices are considerably restricted if all functional and cosmetic requirements are to be met. We recommend individualized surgical design and reconstruction because each case of thumb amputation is unique.

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Simal-Julián, Juan Antonio, Pablo Miranda-Lloret, Laila Pérez de San Román Mena, Pablo Sanromán-Álvarez, Alfonso García-Piñero, Rosa Sanchis-Martín, Carlos Botella-Asunción, and Amin Kassam. "Impact of Multilayer Vascularized Reconstruction after Skull Base Endoscopic Endonasal Approaches." Journal of Neurological Surgery Part B: Skull Base 81, no. 02 (February 28, 2019): 128–35. http://dx.doi.org/10.1055/s-0039-1677705.

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Abstract Background The use of vascularized flap to reconstruct the skull base defects has dramatically changed the postoperative cerebrospinal fluid (CSF) leak rates allowing the expansion of endoscopic skull base procedures. At present, there is insufficient scientific evidence to permit identification of the optimal reconstruction technique after the endoscopic endonasal approach (EEA). Objective The main purpose of this article is to establish the risk factors for failure in the reconstruction after EEA and whether the use of a surgical reconstruction protocol can improve the surgical results. Material and Methods A retrospective cohort study was conducted in our institution, selecting patients that underwent EEA with intraoperative CSF leak. Two reconstructive protocols were defined based on different reconstructive techniques; both were vascularized but one monolayer and the other multilayer. A multivariate analysis was performed with outcome variable presentation of postoperative leak. Results One hundred one patients were included in the study. Patients reconstructed with protocol 1, with the diagnosis different to the pituitary adenoma and older than 45 years old had higher risk of presenting postoperative leak, and with statistically significant differences when we adjusted for the remaining variables. Conclusion The vascularized reconstructions after endoscopic endonasal skull base approaches have demonstrated to be able to obtain a low rate of postoperative CSF leak. The multilayer vascularized technique may provide a more evolved technique, even reducing the postoperative leak rates comparing with the monolayer vascularized one. The reconstructive protocol employed in each case, as well as age and histological diagnosis, is independent risk factor for presenting postoperative leak.

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Heidekrueger, Paul, Elisabeth Haas, Michaela Coenen, Riccardo Giunta, Milomir Ninkovic, P. Broer, and Denis Ehrl. "Does Cigarette Smoking Harm Microsurgical Free Flap Reconstruction?" Journal of Reconstructive Microsurgery 34, no. 07 (April 1, 2018): 492–98. http://dx.doi.org/10.1055/s-0038-1639377.

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Background Free tissue transfers can successfully address a wide range of reconstructive requirements. While the negative influence of cigarette smoking is well documented, its effects in the setting of microsurgical free flap reconstruction remain debated. This study evaluates the impact of cigarette smoking on microsurgical reconstructions. Methods Over a 7-year period, 897 patients underwent 969 microvascular free flap reconstructions at a single surgical center. The cases were divided into “smoker” (S) and “nonsmoker” (NS) groups according to their cigarette smoking status. The data were retrospectively screened for patients' demographics, perioperative details, surgical complications, free flap types, recipient sites, flap survival, and overall outcomes. Results Both groups were comparable regarding comorbidities including hypertension, peripheral artery disease, diabetes, American Society of Anesthesiologists scores, types of performed free flaps, and recipient sites. While patients in the NS group were significantly older and had a higher prevalence of obesity (p < 0.05), there were no significant differences regarding the rate of major or minor complications during our 3-month follow-up period (p > 0.05). Conclusion While minor and major complications were increased regarding virtually all examined parameters, cigarette smoking did not have significant effects on the overall outcomes of microsurgical free flap reconstructions.

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Karpushin, A. A., D. G. Naumov, A. A. Vishnevsky, and A. A. Nakaev. "Thoracolumbar tuberculosis spondylitis: an analytical literature review of surgical reconstruction techniques." Genij Ortopedii 29, no. 1 (February 2023): 104–9. http://dx.doi.org/10.18019/1028-4427-2023-29-1-104-109.

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Introduction Tuberculous spondylitis is the most common extrapulmonary tuberculosis. The thoracolumbar lesion due to tuberculous spondylitis is one of the most difficult locations for surgical treatment. Analysis of the recent literature shows a limited amount of data on the results of various current surgical reconstruction techniques. Purpose To review the literature on surgical treatment of thoracolumbar tuberculous spondylitis published during the last five years and judge upon an optimal method. Materials and methods A systematic literature review was performed of the sources from eLibrary, PubMed, Cochrane Library databases. Inclusion criteria: etiologically verified tuberculous spondylitis of thoracolumbar location, follow-up ≥ 1 year, patients older than 18 years. Twenty-one studies that summarize 1,209 cases were selected. Patients were divided into three groups depending on the method of spinal reconstruction (group 1 – ventral approach, group 2 – combined approach, group 3 – dorsal approach). Surgical indicators, correction of kyphotic deformity and its dynamics in the long-term period, rates of complications and the length of hospital stay were analyzed. Results and discussion Blood loss and duration of the intervention were significantly lower in the reconstruction of the thoracolumbar spine from the dorsal approach (599.6 ± 195.1 ml and 196.3 ± 35.6 min). Correction of kyphotic deformity from posterior and combined approaches was higher than in the reconstruction from the ventral approach (64 and 69 %, respectively). At the same time, an inverse proportional dependence of the degree of correction loss in the long-term period was revealed, which was higher with anterior fusion (7.3° ± 1.7° according to Cobb). The duration of hospital stay was shorter in patients with reconstructions from the dorsal approach (13.7 ± 8.2 days). The rate of complications in group 3 was significantly lower (p < 0.0001), while the assessment of their structure indicates prevalence of neurological deficits in dorsal reconstructions, while in ventral and combined reconstructions, infectious complications, pneumothorax, and chronic pain syndrome in the area of autologous costal graft harvesting. Conclusion The optimal method of surgical treatment of thoracolumbar tuberculous spondylitis is a three-column reconstruction from the dorsal approach. The advantages of the method are a decrease in the rate of postoperative complications, a reduction in the duration of inpatient treatment, surgical blood loss and duration of surgical intervention.

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Neoh, Derek, and Kimberley Hughes. "Neoadjuvant Radiotherapy: Changing the Treatment Sequence to Allow Immediate Free Autologous Breast Reconstruction." Journal of Reconstructive Microsurgery 34, no. 08 (June 16, 2018): 624–31. http://dx.doi.org/10.1055/s-0038-1660871.

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Background Locally advanced breast cancer (LABC) is traditionally treated with a multimodal approach of chemotherapy, surgery, and postmastectomy radiotherapy (PMRT). The advantages of immediate breast reconstruction (IBR) are well described and include improved aesthetic outcomes, fewer surgical procedures, shorter treatment period, and a higher quality of life. However, this sequence makes immediate free autologous reconstruction more challenging as PMRT can have deleterious and unpredictable effects on the flap. We have reversed this treatment sequence with neoadjuvant chemotherapy and radiotherapy, followed by mastectomy and immediate free autologous reconstruction. To our knowledge, this is the first series to assess the outcomes of neoadjuvant radiotherapy on immediate free microvascular breast reconstruction. Methods A review of patients with LABC who underwent immediate free autologous breast reconstruction post neoadjuvant chemoradiotherapy between 2013 and 2017 was conducted. All reconstructions were performed by a single reconstructive team. The primary end points were flap failure and surgical complications. Secondary end points were pathological response rate and disease recurrence. Results A total of 40 women with an average age of 48.1 (36–61) and average body mass index of 25.6 (18–37) were included. The most common choice of flap was immediate deep inferior epigastric perforator (DIEP, 31), followed by transverse or diagonal upper gracilis (5), muscle-sparing transversus abdominis (3), and stacked DIEP (1). Our major complication rate was 12.5% and minor complication 15%. There were no cases of local recurrence and only three cases (7.5%) of distant disease progression. Conclusion From our experience, this treatment sequence allows patients to have an immediate gold standard reconstruction without an increase in surgical morbidity. It affords the benefits of IBR without concern in delaying adjuvant therapy and appears to be safe from an oncological perspective.

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Rashed, Aref, Károly Gombocz, Magdolna Frenyó, Nasri Alotti, and Zsófia Verzár. "A poststernotomiás sebfertőzések kezelési sikertelenségének prediktív faktorai." Orvosi Hetilap 159, no. 14 (April 2018): 566–70. http://dx.doi.org/10.1556/650.2018.31002.

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Abstract: Introduction and aim: Post-sternotomy wound infection is still a major concern and it affects morbidity, mortality, and hospital costs. Reconstruction failure may further increase these risks with significant financial implications. Method: Here, we attempted to verify some factors that may significantly influence the success of the surgical treatment. We performed a single-center retrospective analysis of data from 3177 consecutive patients who underwent midline sternotomy. The diagnostic signs of post-sternotomy wound infections were observed in 60 patients (1.9%). These data were thoroughly analyzed. Results: Beside late diagnosis, the positive microbiological culture of the wounds, radical surgical intervention and peripheral vascular disease were found to significantly contribute to the development of surgical reconstruction failure. Radical surgical reconstruction was associated with a higher success rate (81.8 vs. 11.1%), p<0.001. Conclusion: Identification of the predictive factors that may lead to treatment failure can assist in developing treatment algorithms and improving the success rates of surgical reconstructions. Orv Hetil. 2018; 159(14): 566–570.

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Mattox, Douglas E., and Ugo Fisch. "Surgical Correction of Congenital Atresia of the Ear." Otolaryngology–Head and Neck Surgery 94, no. 5 (June 1986): 574–77. http://dx.doi.org/10.1177/019459988609400507.

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Severe congenital atresia of the ear often requires—or indicates the need for—reconstructive surgery. We have developed a new technique for reconstruction of the external auditory canal. What follows is description of this technique and the results of its implementation.

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Mattox, Douglas E., and Ugo Fisch. "Surgical Correction of Congenital Atresia of the Ear." Otolaryngology–Head and Neck Surgery 94, no. 6 (June 1986): 574–77. http://dx.doi.org/10.1177/019459988609400607.

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Severe congenital atresia of the ear often requires—or indicates the need for—reconstructive surgery. We have developed a new technique for reconstruction of the external auditory canal. What follows is description of this technique and the results of its implementation.

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Journal articles on the topic 'Surgical reconstruction'

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