Abstract:
:Immediate breast reconstruction (IBR) combined with post-mastectomy radiotherapy (PMRT) is associated with an increased risk for complications. Here, we analyse whether IBR combined with PMRT is ethically acceptable. We employ normative analysis following reflective equilibrium and the principles of Beauchamp and Childress: non-maleficence, beneficence, autonomy, and justice. From the perspective of beneficence and non-maleficence, we can choose either IBR or PMRT according to documented risks and complications, delayed autologous breast reconstruction with corresponding benefits but less risk for complications, or even no reconstruction, which for some women, might be equally beneficial. In such a situation, given the level of severity associated with lacking a breast after mastectomy, IBR violates the principles of beneficence and non-maleficence. To deny an IBR in the context of PMRT does not violate the principle of autonomy as it is normally interpreted in the healthcare system, not even when patient-centred care is taken into consideration. Moreover, there is a risk that the decision of the patient will be affected by heuristics, optimism bias, and surgeon bias. IBR in the context of PMRT could be in conflict with the principle of justice, as it could lead to displacement of care for other patient groups. Furthermore, an acceptable level of cost effectiveness should be low, given that living without a breast is a condition of moderate severity. In conclusion, given the current knowledgebase and established ethical norms within the healthcare system, we find strong ethical reasons not to offer IBR when PMRT is expected.
journal_name
J Plast Surg Hand Surgjournal_title
Journal of plastic surgery and hand surgeryauthors
Hansson E,Elander A,Hallberg H,Sandman Ldoi
10.1080/2000656X.2019.1688165subject
Has Abstractpub_date
2020-04-01 00:00:00pages
83-88issue
2eissn
2000-656Xissn
2000-6764journal_volume
54pub_type
杂志文章abstract::Arthrodesis of the thumb metacarpophalangeal (MP) joint exhibits good results in rheumatoid patients but is controversial in post-traumatic conditions. This study evaluated the subjective outcome after thumb MP joint arthrodesis in chronic injuries and non-rheumatoid degenerative disorders. Forty-six patients were eva...
journal_title:Journal of plastic surgery and hand surgery
pub_type: 杂志文章
doi:10.3109/2000656X.2012.742020
更新日期:2013-04-01 00:00:00
abstract::Because of the lack of agreement on when rectus diastasis (RD) is pathologic, the aim was to investigate indications for surgical repair. This study presents classifications of RD, current knowledge on the relation to pregnancy, and conservative and surgical management. A systematic search in Pubmed, Embase, Cochrane,...
journal_title:Journal of plastic surgery and hand surgery
pub_type: 杂志文章,评审
doi:10.3109/2000656X.2013.859145
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abstract:OBJECTIVES:Ischaemic preconditioning and postconditioning, which consist of one or a series of short ischaemic events. This study aimed to determine the efficiency of post-conditioning a flap in the minimisation of flap loss after a preconditioned skin flap. METHODS:The rats were divided into five groups: sham group, ...
journal_title:Journal of plastic surgery and hand surgery
pub_type: 杂志文章
doi:10.3109/2000656X.2016.1154468
更新日期:2016-08-01 00:00:00
abstract:BACKGROUND:In mandibular reconstruction with vascularised free fibula transfer, there are situations where the neck on the operated site lacks recipient vessels for vascular anastomosis due to previous radiological/surgical interventions. METHODS:The present study aims to clarify the availability of neck vessels on th...
journal_title:Journal of plastic surgery and hand surgery
pub_type: 杂志文章
doi:10.1080/2000656X.2017.1281820
更新日期:2017-10-01 00:00:00
abstract:BACKGROUND:Premature sagittal synostosis (SS) can be surgically corrected using extensive cranioplasties or using less invasive methods, e.g. spring-assisted surgery (SAS). AIM:The aim of the present study was to perform a proper systematic review of springs in the treatment of SS. METHODS:A literature search was per...
journal_title:Journal of plastic surgery and hand surgery
pub_type: 杂志文章,评审
doi:10.3109/2000656X.2014.981268
更新日期:2015-06-01 00:00:00
abstract::Since the 1980s, prenatal detection of cleft lip with or without cleft palate (CLP) is possible with a transabdominal ultrasound. The improvement of prenatal detection has resulted in an increased demand for prenatal information and counselling. The aim of this study was to, by means of a questionnaire, evaluate how f...
journal_title:Journal of plastic surgery and hand surgery
pub_type: 杂志文章
doi:10.3109/2000656X.2012.698416
更新日期:2012-09-01 00:00:00
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journal_title:Journal of plastic surgery and hand surgery
pub_type: 杂志文章
doi:10.3109/2000656X.2013.787935
更新日期:2013-12-01 00:00:00
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journal_title:Journal of plastic surgery and hand surgery
pub_type: 杂志文章
doi:10.3109/2000656X.2013.868811
更新日期:2014-08-01 00:00:00
abstract::Septic arthritis of the sternoclavicular joint (SC) is rare. The most accepted technique for reconstruction of the defect after SC joint resection is the use of muscle flaps. We hypothesized that resection of ribs with the SC joint impacts timing, type and outcomes of reconstruction. This is a retrospective review of ...
journal_title:Journal of plastic surgery and hand surgery
pub_type: 杂志文章
doi:10.1080/2000656X.2020.1856672
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journal_title:Journal of plastic surgery and hand surgery
pub_type: 杂志文章
doi:10.1080/2000656X.2018.1515770
更新日期:2019-02-01 00:00:00
abstract:BACKGROUND:Phonological disorders are common in 3-year-olds born with cleft palate compared to non-cleft peers. However, published results have been based on small samples. The purpose was to expand the knowledge on phonology of Swedish-speaking 3-year-olds with unilateral cleft lip and palate (UCLP), treated with prim...
journal_title:Journal of plastic surgery and hand surgery
pub_type: 杂志文章
doi:10.1080/2000656X.2016.1194280
更新日期:2017-04-01 00:00:00
abstract:BACKGROUND:Carpal tunnel syndrome (CTS) and trigger digits are among the most common nontraumatic hand disorders treated by plastic surgeons. The onset of trigger digits after carpal tunnel release (CTR) has been inconsistently reported. This systematic review assessed the prevalence of trigger digits development in pa...
journal_title:Journal of plastic surgery and hand surgery
pub_type: 杂志文章,评审
doi:10.1080/2000656X.2017.1345751
更新日期:2018-04-01 00:00:00
abstract::Irradiation of the recipient site has been associated with postoperative complications and an increased rate of flap failure in facial reconstruction. The aim of this study was to report the outcomes of our use of four different types of flaps (two free and two pedicled) for the reconstruction of patients with nasopha...
journal_title:Journal of plastic surgery and hand surgery
pub_type: 杂志文章
doi:10.3109/2000656X.2012.729510
更新日期:2013-02-01 00:00:00
abstract:PURPOSE:This study evaluated the composite graft survival rate in distal digital amputations with respect to injury type and amputation level. METHODS:Twenty-seven patients with complete fingertip amputations (32 digits) distal to the distal interphalangeal joint who were treated by composite grafting from January 201...
journal_title:Journal of plastic surgery and hand surgery
pub_type: 杂志文章
doi:10.3109/2000656X.2015.1020314
更新日期:2015-01-01 00:00:00
abstract:BACKGROUND:In this study, markers of coagulation and fibrinolysis were assessed during early and delayed microsurgical reconstruction in patients with traumatic defects of their lower legs to analyse whether an imbalance of the hemostasis after trauma might predispose the development of vascular complications. METHODS...
journal_title:Journal of plastic surgery and hand surgery
pub_type: 杂志文章
doi:10.1080/2000656X.2017.1303499
更新日期:2017-12-01 00:00:00
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journal_title:Journal of plastic surgery and hand surgery
pub_type: 杂志文章
doi:10.1080/2000656X.2017.1419142
更新日期:2018-08-01 00:00:00
abstract::Many authors have advocated early surgical intervention to avoid muscle degeneration in patients with blowout fractures with evidence of extraocular muscle entrapment imaged under computed tomography. However, there is still no golden standard with regard to the target timing of operations for releasing extraocular mu...
journal_title:Journal of plastic surgery and hand surgery
pub_type: 杂志文章
doi:10.3109/2000656X.2013.779581
更新日期:2013-12-01 00:00:00
abstract::Head and neck skin cancer surgery using a full thickness skin graft is a common procedure. Evidence concerning the effects of perioperative antithrombotic treatment on complications is limited. The aim of this study was to evaluate whether perioperative antithrombotic treatment is associated with risk of necrosis, ble...
journal_title:Journal of plastic surgery and hand surgery
pub_type: 杂志文章
doi:10.1080/2000656X.2018.1498789
更新日期:2018-12-01 00:00:00
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journal_title:Journal of plastic surgery and hand surgery
pub_type: 杂志文章
doi:10.3109/02844310903123379
更新日期:2010-12-01 00:00:00
abstract:BACKGROUND:While Realdo Colombo from Cremona, Italy has, to date, been acknowledged to be the first to describe the possible absence of the palmaris longus muscle in men in 1559, the authors found this absence to be recorded in the first edition of "De Humani Corporis Fabrica Libri Septum" by Andreas Vesalius, publishe...
journal_title:Journal of plastic surgery and hand surgery
pub_type: 历史文章,杂志文章
doi:10.3109/2000656X.2015.1073156
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journal_title:Journal of plastic surgery and hand surgery
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journal_title:Journal of plastic surgery and hand surgery
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doi:10.1080/2000656X.2017.1313260
更新日期:2018-02-01 00:00:00
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journal_title:Journal of plastic surgery and hand surgery
pub_type: 杂志文章
doi:10.1080/2000656X.2018.1520123
更新日期:2018-12-01 00:00:00
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journal_title:Journal of plastic surgery and hand surgery
pub_type: 杂志文章
doi:10.1080/2000656X.2019.1693391
更新日期:2020-04-01 00:00:00
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journal_title:Journal of plastic surgery and hand surgery
pub_type: 杂志文章
doi:10.3109/2000656X.2013.765885
更新日期:2013-09-01 00:00:00
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journal_title:Journal of plastic surgery and hand surgery
pub_type: 杂志文章
doi:10.3109/2000656X.2012.729652
更新日期:2013-04-01 00:00:00
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journal_title:Journal of plastic surgery and hand surgery
pub_type: 杂志文章
doi:10.3109/2000656X.2011.583515
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journal_title:Journal of plastic surgery and hand surgery
pub_type: 杂志文章
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更新日期:2020-02-01 00:00:00
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journal_title:Journal of plastic surgery and hand surgery
pub_type: 杂志文章
doi:10.1080/2000656X.2021.1874398
更新日期:2021-01-28 00:00:00
abstract::The timing of repair of a cleft lip continues to be debated. One of the reasons for delaying operation has been the belief that there is an increased risk of anaesthesia during the neonatal period. As a contribution to this debate we have analysed the anaesthetic and surgical complications of neonatal cleft lip repair...
journal_title:Journal of plastic surgery and hand surgery
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