http://www.afrh.fr/web-content/documents/Basedocumentairemedicale2/ScienceDirect.pdf

Hidradenitis suppurativa: pathogenesis and management

The creation of the nipple-areola complex is often the final step in the surgical treatment of breast cancer patients, and it consequently has important symbolic and aesthetic implications. Patient expectations and the need for symmetry make nipple projection a crucial aesthetic determinant of nipple reconstruction. We hypothesize that long-term nipple projection and shape can be achieved in a predictable fashion using the modified star dermal fat flap technique. Prospectively, 93 nipples were reconstructed by a single surgeon using a modified star dermal fat flap technique in 44 implant and 49 TRAM flap breast reconstructions. Flap dimensions (base diameter and flap length) were designed according to patient desire or to the base diameter and projection of the opposite breast nipple. A standardized, 3-month postoperative care regimen was observed in all patients. Nipple projection was assessed by the same observer at each follow-up examination. The average length of follow-up was 730 days (745 for TRAM reconstructions and 713 for implants). Consistently, an average of 41 percent of the intraoperative projection remained intact in both groups at final evaluation (SD 12 percent). The total flap length was strongly predictive of intraoperative and long-term projection (r = 0.64 and 0.86, p < 0.0001). Flap lengths ranged from 5.5 to 9.0 cm, and in a linear correlation, resulted in intraoperative projection of 1.0 to 2.1 cm, respectively, and long-term projection of 0.4 to 0.83 cm, respectively. Based on the linear relationship, every 1-cm increase in flap length could be expected to result in a 0.16-cm increase in projection. When controlled for flap length and intraoperative projection, there was no difference between TRAM and implant nipple reconstruction in predicting postoperative nipple projection. Intraoperative planning and execution are critical to achieve predictable nipple shape, size, and projection. The dimensions of the star dermal fat flap can be strategically modified to allow the surgeon predictable projection with a consistent 41-percent preservation of intraoperative nipple projection in both TRAM and implant patients at 2 years.

Long-term predictable nipple projection following reconstruction.

The incidence of pressure sores was studied in the well-defined population of the County of Arhus (517 000). Visits were paid to 98% of all hospital departments and special nursing homes, while pressure sores in patients admitted to general nursing homes and homes for the aged or living in their own homes were recorded by means of questionnaires sent to all general practitioners (98% responded) and visiting nurses. The investigation revealed an incidence of 43.1 patients with sores and 61.5 sores per 100 000. Of the patients concerned, 59% were in hospital, and the frequency of pressure sores among hospitalised patients was 3.0%. The frequency increased steeply with advancing age. The underlying diseases were particularly those associated with old age, renal insufficiency, cancer, fractures, especially of the femoral neck, traumatic and non-traumatic paraplegia and disseminated sclerosis. Of the sores, 96% were located caudal to the level of the umbilicus, including 67% around the hips and buttocks. In ab...

The epidemiology of pressure sores

Background: The nipple is an uncommon site for breast cancer development, but the nipple-areola complex is routinely excised in breast cancer treatment. The authors evaluated the risks and benefits of nipple- or areola-sparing mastectomy with breast reconstruction. Methods: The authors analyzed data on 115 consecutive nipple- or areola-sparing mastectomies with immediate tissue expander breast reconstruction performed in 66 patients from 1998 to 2008 at a single tertiary-care cancer center. Nipple-sparing mastectomies were performed for prophylaxis (n = 75) or treatment of disease (n = 40). Results: Mean patient age was 45 years (range, 24 to 61 years) and mean follow-up time was 22 months (range, 2 weeks to 91 months). There were 115 nipple- or areola-sparing mastectomies (48 bilateral and 19 unilateral), including 111 nipple-sparing and four areola-sparing mastectomies. On pathologic review, 20 breasts had ductal carcinoma in situ, 20 breasts had invasive cancer, 11 breasts had lobular carcinoma in situ, one breast had phyllodes tumor, one breast had mucinous carcinoma, and 62 breasts were cancer-free. Incision placement was periareolar and radial (n = 61), inframammary (n = 25), omega type (n = 14), customized to include a previous scar (n = 10), or transareolar (n = 5). Of all 115 nipple- or areola-sparing mastectomies, six nipples were lost because of occult disease (5.2 percent), and four nipples were lost because of wound-healing problems (3.5 percent). Conclusions: In the authors' series of nipple- and areola-sparing mastectomies performed for risk reduction or breast cancer, there was a low incidence of occult disease (5.2 percent). Nipple- and areola-sparing mastectomy may be feasible in selected patients and should be the subject of additional investigation.

Nipple-sparing mastectomy and immediate tissue expander/implant breast reconstruction.

BackgroundHidradenitis suppurativa (HS) is a chronic, recurrent, painful, debilitating, and emotionally distressing disease.ObjectiveThis article aims to provide a comprehensive review of HS, with a focus on surgical and procedural therapies for this devastating disease.Materials and methodsBy searc

Hidradenitis Suppurativa: Surgical and Other Management Techniques

https://www.jprasurg.com/article/S0007-1226(03)00583-6/pdf

Osteofasciocutaneous flap based on the dorsal ulnar artery. A new option for reconstruction of composite hand defects

Since the presentation of the tuberous breast deformity by Rees and Aston in 1976, many surgical procedures have been developed, but the correction of such a deformity still remains a surgical challenge.

Tuberous breast: a surgical challenge.

The reconstruction of defects of the head and neck, no matter the cause, begins with a careful assessment of the patient and the defect. Ideally, it ends with the successful execution of the reconstructive procedure that optimally restores form and function with minimal morbidity. There are several treatment possibilities that differ in their indications, technical difficulty, safety, and incidence of complications. This is a review over a period of 13 years of 117 cases of head and neck reconstruction performed by the author. Sixty-eight patients were treated with five different musculocutaneous pedicled flaps, mainly during the first half of the 13-year period. Those based on the pectoral major and latissimus dorsi were the most frequently utilized, mainly in pharyngolaryngeal reconstructions and sometimes as osteomyocutaneous flaps for oromandibular defects. Forty-nine patients had microvascular reconstructive procedures with 12 different types of free flaps. The latissimus dorsi flap was used for reconstruction of the scalp and after excision of intracranial lesions, whereas the serratus anterior or rectus abdominis free flaps were utilized for reconstruction of complex defects of the middle-third of the face. The radial forearm flap and the free jejunum have become the choice for intraoral and pharyngoesophageal reconstruction, respectively. Good results were obtained in both functional and social rehabilitation of the patients. There were three flap losses due to thrombosis of the microvascular anastomosis. There was no surgical mortality. The indications for each pedicled and free flap are discussed.

Head and neck reconstruction: a review of 117 cases

https://www.jprasurg.com/article/S0007-1226(96)90084-3/pdf

The distally based posterior tibial myofasciocutaneous island flap in foot reconstruction

The Breast Journal, Volume 11 Number 3, 2005 215–216 Address correspondence and reprint requests to: Pedro Manuel Costa Ferreira, MD, Lugar de Vila-Chã/Carvalhal, 4755-106 Barcelos, Portugal, or email: pedro.oferreira@mail.pt. Blackwell Science, Ltd Oxford, UK TBJ he Breast Journal 1075-122X 2 0 Blackwell Publishing M y/June 2005 1 3 riginal Artic e Ne lected Chest Wall Radiation-Induced Ulcers fe re a t al. BREAST IMAGES

Neglected Chest Wall Radiation-Induced Ulcers

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