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[PMID]: 29523904
[Au] Autor:Yazar S; Karadag EC; Altinkaya A; Kara H; Uras C
[Ad] Address:Plastic, Reconstructive and Aesthetic Surgery, School of Medicine, Acibadem Maslak Hospital, Acibadem University, Istanbul, Turkey.
[Ti] Title:Risk Factor Analysis for Survival of Becker-Type Expander in Immediate Breast Reconstruction.
[So] Source:Aesthetic Plast Surg;, 2018 Mar 09.
[Is] ISSN:1432-5241
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Breast reconstruction with a Becker-type expander is a common technique following mastectomy. However, inconsistency remains in the literature regarding risk factors for the survival of a Becker-type expander following immediate breast reconstruction. This study's purpose is to investigate possible risk factors for the Becker-type expander survival and to evaluate the complications related to expander removal following immediate breast reconstruction. METHODS: We performed a retrospective chart review of consecutive women who underwent a mastectomy followed by immediate breast reconstruction with a Becker-type expander from November 2010 to November 2016. Electronic medical records were analyzed retrospectively for demographic, clinical, operative characteristics, and outcomes. Univariate Cox regression analysis was performed to determine the risk factors for the survival of the Becker-type expander following immediate breast reconstruction. RESULTS: A total of 74 Becker-type expanders were used in 72 patients who underwent immediate breast reconstruction. The patients' ages ranged from 27 to 71 years, with a mean ± standard deviation age of 44.6 ± 9.1 years. The most frequent complication was capsular contracture which occurred in 25 breasts (33.8%) followed by mastectomy skin flap necrosis in 6 breasts (8.1%), seroma in 4 breasts (5.4%), nipple-areolar complex necrosis in 4 breasts (5.4%), hematoma in 3 breasts (4.1%), and infection in 2 breasts (2.7%). The mean intraoperative expander fill volume (109.6 ± 66.9 cc [p = 0.039]) and mean total volume (386.5 ± 94.7 cc [p = 0.034]) were both significantly lower for patients with capsular contracture compared with those without capsular contracture. In patients with partial NAC necrosis, the mean mastectomy specimen volume (737.5 ± 242.8 cc) was significantly higher compared with patients without partial NAC necrosis (489.8 ± 219.0 cc; p = 0.027). A univariate Cox regression analysis showed that smoking and neoadjuvant therapy were significantly associated with expander removal (p = 0.023 and p = 0.006, respectively). CONCLUSION: The total volume of the expander and intraoperative fill volume of the expander appear to be predictive factors in the development of capsular contracture. However, there is no statistically significant association between radiotherapy and capsular contracture or expander survival in contrast with other published reports. Our findings reveal that the main risk factors for the survival of Becker-type expanders following immediate breast reconstruction are smoking and neoadjuvant therapy. To our knowledge, this is the first study to evaluate the most likely risk factors associated with Becker-type expander survival in immediate breast reconstruction. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180310
[Lr] Last revision date:180310
[St] Status:Publisher
[do] DOI:10.1007/s00266-018-1111-4

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[PMID]: 29519487
[Au] Autor:Senderoff DM
[Ad] Address:Mount Sinai Beth Israel Medical Center, New York, NY, USA. Electronic address: aestheticdoc@aol.com.
[Ti] Title:Practice-Based Patient Management Strategies in Gluteal Augmentation with Implants.
[So] Source:Clin Plast Surg;45(2):187-195, 2018 Apr.
[Is] ISSN:1558-0504
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:This article focuses on practice-based recommendations for surgeons performing gluteal augmentation with implants (GAI). Preoperative planning, including the indications, precautions, and contraindications to GAI, is discussed. Advantages and disadvantages of subfascial and intramuscular implantation are addressed along with recommendations for implant size, shape, and position. Recommendations for patient management before and after surgery along with operative and nonoperative strategies for postoperative complications, including wound dehiscence, infection, and seroma, are included. Aesthetic concerns and recommendations for the management of poor results are addressed. A comprehensive literature review is included along with illustrative preoperative and postoperative photos.
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Em] Entry month:1803
[Cu] Class update date: 180309
[Lr] Last revision date:180309
[St] Status:In-Process

  3 / 3869 MEDLINE  
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[PMID]: 29516364
[Au] Autor:Killelea BK; Long JB; Dang W; Mougalian SS; Evans SB; Gross CP; Wang SY
[Ad] Address:Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale Cancer Center and Yale University School of Medicine, New Haven, CT, USA.
[Ti] Title:Associations Between Sentinel Lymph Node Biopsy and Complications for Patients with Ductal Carcinoma In Situ.
[So] Source:Ann Surg Oncol;, 2018 Mar 07.
[Is] ISSN:1534-4681
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:PURPOSE: To examine the associations between sentinel lymph node biopsy (SLNB) and complications among older patients who underwent breast-conserving surgery (BCS) for ductal carcinoma in situ (DCIS). METHODS: We identified women from the Surveillance, Epidemiology, and End Results-Medicare dataset aged 67-94 years diagnosed during 1998-2011 with DCIS who underwent BCS as initial treatment. We assessed incidence of complications, including lymphedema, wound infection, seroma, or pain, within 9 months of diagnosis. We used Mahalanobis matching and generalized linear models to estimate the associations between SLNB and complications. RESULTS: Our sample consisted of 15,515 beneficiaries, 2409 (15.5%) of whom received SLNB. Overall, 16.8% of women who received SLNB had complications, compared with 11.3% of women who did not receive SLNB (p < 0.001). Use of SLNB was associated with subsequent mastectomy but not radiotherapy. Multivariate analyses of the matched sample showed that, compared with no SLNB, SLNB use was significantly associated with incidence of any complication [adjusted odds ratio (AOR) 1.39; 99% confidence interval (CI) 1.18-1.63], lymphedema (AOR 4.45; 99% CI 2.27-8.75), wound infection (AOR 1.24; 99% CI 1.00-1.54), seroma (AOR 1.40; 99% CI 1.03-1.91), and pain (AOR 1.31; 99% CI 1.04-1.65). Sensitivity analyses excluding patients who underwent mastectomy yielded qualitatively similar results regarding the associations between SLNB and complications. CONCLUSIONS: Among older women with DCIS who received BCS, SLNB use was associated with higher risks of short-term complications. These findings support consensus guidelines recommending against SLNB for this population and provide empirical information for patients.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher
[do] DOI:10.1245/s10434-018-6410-0

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[PMID]: 29432568
[Au] Autor:Uebel CO; Piccinini PS; Martinelli A; Aguiar DF; Matta Ramos RF
[Ad] Address:Plastic Surgery Division, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.
[Ti] Title:Cellulite: A Surgical Treatment Approach.
[So] Source:Aesthet Surg J;, 2018 Feb 08.
[Is] ISSN:1527-330X
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Background: Cellulite is one of the most common skin and subcutaneous tissue conditions, affecting predominantly the thighs and hips in post-adolescent women. Its etiology is not well defined, and multiple available treatments show variable efficacy. Objective: To describe a technique for treatment of cellulite of the gluteal region, thighs, and hips through superficial liposuction utilizing a special cannula, combined with subcutaneous autologous fat grafting. Methods: A retrospective review was performed of patients treated over 26 years at the Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil. Patients underwent pretreatment evaluation as to the extent of their cellulite, and pretreatment and posttreatment photographs were obtained for visual evaluation of the results. Results: Procedures were performed on 126 patients: 121 (96%) women and 5 (4%) men. The majority considered their results good or excellent. The complication rate was low, with the most common complications being ecchymosis, contour irregularities, partial recurrence of cellulite, seroma, and numbness. Conclusions: We describe an effective method for the treatment of cellulite. Whereas subcision techniques utilize a needle or microblade to cut fibrous septa, we utilize a special cannula; larger areas can be treated than with subcision. Fat grafting is utilized to correct depressions and improve skin quality, which are added benefits compared to traditional subcision. Considering the multiple available cellulite treatments and their limitations, and the high patient satisfaction rate we achieved, with a low recurrence and complication rate, this technique can be a safe and effective option for patients with cellulite.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher
[do] DOI:10.1093/asj/sjy028

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[PMID]: 29365064
[Au] Autor:Gabriel A; Sigalove S; Sigalove NM; Storm-Dickerson TL; Rice J; Pope N; Patrick Maxwell G
[Ad] Address:Department of Plastic Surgery, Loma Linda University Medical Center, Loma Linda, CA.
[Ti] Title:Prepectoral Revision Breast Reconstruction for Treatment of Implant-Associated Animation Deformity: A Review of 102 Reconstructions.
[So] Source:Aesthet Surg J;, 2018 Jan 20.
[Is] ISSN:1527-330X
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Background: Animation deformity is a direct consequence of subpectoral implant placement for breast reconstruction following mastectomy. Current treatment options ameliorate but do not address the source of the problem. Moving the implant from subpectoral to prepectoral has the potential to eliminate animation deformity. Objectives: Describe the technique and outcomes of prepectoral revision reconstruction in over 100 cases and discuss patient selection criteria for a successful outcome. Methods: Patients who presented with animation deformity following two-stage implant reconstruction were included in this retrospective study. Revision surgery involved removal of the existing implant via the previous incision site along the inframammary fold, suturing of the pectoralis major muscle back to the chest wall, creation of a prepectoral pocket for the new implant, use of acellular dermal matrix to reinforce the prepectoral pocket and completely cover the implant, and fat grafting to enhance soft tissue. Patients were evaluated for resolution of animation deformity and occurrence of complications during follow up. Results: Fifty-seven patients (102 breasts) underwent prepectoral revision reconstruction with complete resolution of animation deformity. Complications occurred in 4 breasts (3.9%) and included seroma (2 breasts), skin necrosis (3 breasts), and wound dehiscence (1 breast). All 4 breasts with complications had their implants removed and replaced. There were no incidences of infection or clinically significant capsular contracture in this series. Conclusions: Revision reconstruction with prepectoral implant placement and complete coverage with acellular dermal matrix resolves animation deformity and results in aesthetically pleasing soft breasts. Patient selection is critical for the success of this technique.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher
[do] DOI:10.1093/asj/sjx261

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[PMID]: 29360916
[Au] Autor:Gould DJ; Macias LH; Saeg F; Dauwe P; Hammoudeh Z; Grant Stevens W
[Ad] Address:Division of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA.
[Ti] Title:Seroma Rates Are Not Increased When Combining Liposuction With Progressive Tension Suture Abdominoplasty: A Retrospective Cohort Study of 619 Patients.
[So] Source:Aesthet Surg J;, 2018 Jan 18.
[Is] ISSN:1527-330X
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Background: Several studies have demonstrated that progressive tension sutures (PTS) reduce seroma. Many fear that adding liposuction to abdominoplasty will increase seroma rates and avoid drainless abdominoplasty when performing concomitant liposuction. Objectives: We sought to identify whether liposuction increases seroma in PTS and non-PTS abdominoplasty. Methods: In this retrospective study, 619 patients underwent abdominoplasty between 2009 and 2017, of which 299 patients had drainless abdominoplasty with PTS and 320 had drain-based abdominoplasty. We compared complications among PTS patients with and without liposuction and among drain-based abdominoplasty patients with and without liposuction. Results: Demographics were similar between PTS and drain patients and between liposuction and nonliposuction PTS. Mean liposuction volume with PTS was 1592 ± 1048 mL. Seroma in the PTS group was found to be 2.6%, which is consistent with previous data. PTS without liposuction had a rate of seroma of 6.67% compared to a rate of 2.2% with liposuction; these rates were not significantly different (P = 0.20). A total of 207 patients had drain-based abdominoplasty with liposuction, and 113 had it without liposuction. Seroma with liposuction was 9.17% and without liposuction was 6.19%, although these differences were not significant (P = 0.52). PTS lipoabdominoplasty had less seroma compared with drain-based lipoabdominoplasty (P = 0.01). Conclusions: Liposuction was performed in 80% of the patients, and patients with lipoabdominoplasty were not at a higher risk of seroma, in the drain group or the PTS group. More patients may allow validation that liposuction may actually be protective with PTS. Regardless, there is no increase in seroma with the addition of liposuction to PTS drainless abdominoplasty.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher
[do] DOI:10.1093/asj/sjx235

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[PMID]: 29309330
[Au] Autor:McNichols CHL; Diaconu S; Liang Y; Ikheloa E; Kumar S; Kumar S; Nam A; Rasko Y
[Ti] Title:Outcomes of Ventral Hernia Repair With Concomitant Panniculectomy.
[So] Source:Ann Plast Surg;80(4):391-394, 2018 Apr.
[Is] ISSN:1536-3708
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:PURPOSE: Combined ventral hernia repair and panniculectomy (VHR/PAN) is controversial, and the safety profile including anticipated complications has been questioned. We present a retrospective case series review of patients from the University of Maryland Medical Center to help surgeons counsel patients on the risks and benefits of this procedure. METHODS: A retrospective database was collected using current procedural terminology codes for VHR/PAN. The patient-specific variables that were studied include the following: sex, body mass index (BMI), smoking, diabetes, chronic obstructive pulmonary disease, cirrhosis, immunosuppression, length of operation, acute incarcerated hernias, hernia size and location, mesh size and location, pannus weight, concomitant component separation, use of negative-pressure wound therapy, intestinal violation, follow-up duration, ventral hernia working group, history of bariatric surgery, previous hernia repair, skin dehiscence, skin necrosis, chronic wound, surgical site infection, seroma, hematoma, fascial dehiscence, hernia recurrence, unplanned return to operating room, and medical complication. Both univariate and multivariate analyses were performed to determine which factors affected the complication outcomes. RESULTS: There were 106 patients with an average age and BMI of 53 years and 39, respectively. Fifty-eight patients (54.72%) had at least 1 surgical site occurrence. Twenty-three patients (21.70%) had at least 1 repair failure. Twenty-eight patients (26.42%) had an unplanned trip back to the operating room. Seventeen patients (16.04%) had at least 1 medical complication. CONCLUSIONS: The risk factors associated with developing complications are higher BMI, longer operating time, larger mesh size, larger hernia size, component separation, use of biologic mesh, chronic obstructive pulmonary disease, and intestinal violation. The use of negative-pressure wound therapy decreased complication rates, and patients with a previous hernia repair seemed to benefit the most from having a combined VHR/PAN. However, when compared with previous reports of VHR alone, VHR/PAN does seem to increase wound complications and reoperation rates.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:In-Data-Review
[do] DOI:10.1097/SAP.0000000000001277

  8 / 3869 MEDLINE  
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[PMID]: 29309328
[Au] Autor:Burm JS; Hwang J; Lee YK
[Ad] Address:From the Department of Plastic and Reconstructive Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.
[Ti] Title:A New Option for the Reconstruction of Primary or Recurrent Ischial Pressure Sores: Hamstring-Adductor Magnus Muscle Advancement Flap and Direct Closure.
[So] Source:Ann Plast Surg;80(4):400-405, 2018 Apr.
[Is] ISSN:1536-3708
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: Owing to the high recurrence rates of ischial pressure sores, surgeons should consider the possibility of future secondary flap surgery during flap selection. The purpose of this article is to present a new surgical option for the reconstruction of primary or recurrent ischial pressure sores using a simple hamstring-adductor magnus advancement flap and direct closure. METHODS: After horizontal fusiform skin excision, complete bursa excision and ischiectomy were performed. The tenomuscular origin of the adductor magnus and the conjoined tenomuscular origin of the biceps femoris long head and semitendinosus were isolated and completely detached from the inferior border of the ischial tuberosity. They were then advanced in a cephalad direction without detachment of the distal tendon or muscle and securely affixed to the sacrotuberous ligament. The wound was directly closed without further incision or dissection. RESULTS: Twelve ischial pressure sores (6 primary and 6 recurrent; 12 patients) were surgically corrected. The follow-up period was 12 to 65 months. All patients healed successfully without early postoperative complications, such as hematoma, seroma, infection, wound dehiscence, or partial necrosis. Late complications included wound disruption 5 weeks after surgery that spontaneously healed in 1 case and recurrence 3 years later in another case. CONCLUSIONS: The new surgical option presented herein, which involves hamstring-adductor magnus advancement flap and direct closure, is a simple and reliable method for providing sufficient muscle bulk to fill the dead space and proper padding to the bone stump while preserving the main vascular perforators and pedicles as well as future surgical options.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1801
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:In-Data-Review
[do] DOI:10.1097/SAP.0000000000001280

  9 / 3869 MEDLINE  
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[PMID]: 29272500
[Au] Autor:Choi N; Kim JY; Yu T; Kang HC; Kim HS; Kim HJ; Kim IH
[Ad] Address:Department of Radiation Oncology.
[Ti] Title:Does fluid collection impact radiotherapy outcomes after wide excision of lower extremity soft tissue sarcoma?
[So] Source:Jpn J Clin Oncol;48(2):153-159, 2018 Feb 01.
[Is] ISSN:1465-3621
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Background: Fluid collection (FC) of lymph or blood may accumulate at the site of excision after surgery for soft tissue sarcoma, with reported incidence rates from 10% to 36%. The purpose of this study is to analyze the impact of FC on local recurrence (LR) and wound complication rates after adjuvant postoperative radiotherapy (PORT) in lower extremity soft tissue sarcoma (LE-STS). Methods: Eighty-eight patients diagnosed with LE-STS were curatively treated with wide excision and PORT. FC developed in 51.1% of patients. Full FC volumes were included in the irradiation field throughout the full course of PORT for 36 patients (80.0%). A median of 61.2 and 63 Gy was prescribed for patients with and without FC, respectively. Results: After a median follow-up of 4.3 years, patients with and without FC had 5-year local control rates of 77.7% and 90.8% (P = 0.105). Eight patients with FC had LR, of which six patients had recurrent tumors at or within 4 cm of the FC wall and three of these patients had out-of-field LR. Wound complication occurred after RT in 3 (6.7%) of 45 patients with FC and 1 (2.3%) of 43 patients without FC. Conclusions: FC presents a potential risk for increased LR, particularly near the FC wall. Based on reasonable wound complication rates, we suggest the need and feasibility of fully including FC volumes in the irradiation field.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:In-Process
[do] DOI:10.1093/jjco/hyx162

  10 / 3869 MEDLINE  
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[PMID]: 29267868
[Au] Autor:Senderoff DM
[Ad] Address:Dr Senderoff is a plastic surgeon in private practice in New York, NY.
[Ti] Title:Biceps Augmentation Using Solid Silicone Implants.
[So] Source:Aesthet Surg J;, 2017 Dec 18.
[Is] ISSN:1527-330X
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:Background: Biceps augmentation using solid silicone implants has been increasingly requested in recent years despite a paucity of literature evaluating the safety and efficacy of this procedure. Objectives: The purpose of this study was to provide information about complications, surgical planning, and aesthetic outcomes of biceps augmentation. Methods: A retrospective chart review was conducted for patients undergoing solid silicone biceps augmentation in the author's practice from April 2011 through May 2016. Collected data were analyzed to assess the indications for surgery, quantity of complications, and need for surgical revision, and to evaluate aesthetic outcome. Results: Twenty-one male patients were included in the study. The mean age was 42.6 years and the mean follow up was 7.1 months. Indications for surgery include a desire to increase biceps size (n = 16), and correction of biceps deformity after biceps tendon rupture (n = 5). Eight patients underwent subfascial implant placement and 13 submuscular implant placement. Complications occurred in 10 patients (48%) including asymmetry (n = 4), seroma (n = 3), surgical site infection (SSI) (n = 1), cellulitis (n = 1), and hematoma (n = 1). The overall reoperation rate was 23.8%. Implant malposition occurred in 3 of the 8 (38%) of subfascial implant placement patients. Complications requiring revision surgery were higher for subfascial implants 37.5% vs 15.4% for submuscular. Conclusions: Biceps augmentation with a solid silicone implant can increase upper arm volume and correct asymmetry and deformity resulting from muscle injury. Submuscular biceps implant placement is recommended over subfascial insertion to avoid implant malposition.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1712
[Cu] Class update date: 180308
[Lr] Last revision date:180308
[St] Status:Publisher
[do] DOI:10.1093/asj/sjx164


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