Abstract:
BACKGROUND:In 2002, the author implemented a new two-stage approach, "delayed-immediate breast reconstruction," for patients who desire breast reconstruction and who are at an increased risk for conditions necessitating postmastectomy radiotherapy. There is increasing acceptance of this approach in clinical practice. This report highlights important technical and timing considerations in delayed-immediate reconstruction that help ensure the best outcomes with low rates of expander loss. METHODS:Stage 1 of delayed-immediate reconstruction consists of skin-sparing mastectomy with insertion of a saline-filled tissue expander to serve as an adjustable scaffold to preserve the three-dimensional shape of the breast skin envelope. Patients who do not require postmastectomy radiation therapy undergo stage 2 (definitive breast reconstruction) within 2 weeks after stage 1 to avoid delays in the start of adjuvant chemotherapy and to preserve the ptotic shape of the preserved breast skin envelope. In patients who do require radiation, the tissue expander is deflated before the therapy to create a flat chest wall surface to permit modern three-beam radiation delivery. Beginning 2 weeks after completion of radiation therapy, the expander is reinflated to the predeflation volume. Three months after the therapy, a "skin-preserving" delayed reconstruction is performed, with removal of the expander and transfer of an autologous tissue flap. CONCLUSIONS:Delayed-immediate reconstruction allows patients who do not require postmastectomy radiation therapy to receive the benefits of skin-sparing mastectomy with aesthetic outcomes similar to those of immediate reconstruction. Patients who do require radiation receive a skin-preserving delayed reconstruction, while avoiding the problems that can be associated with radiation delivery after an immediate breast reconstruction.
journal_name
Plast Reconstr Surgjournal_title
Plastic and reconstructive surgeryauthors
Kronowitz SJdoi
10.1097/PRS.0b013e3181c82d58subject
Has Abstractpub_date
2010-02-01 00:00:00pages
463-474issue
2eissn
0032-1052issn
1529-4242pii
00006534-201002000-00005journal_volume
125pub_type
杂志文章abstract:BACKGROUND:Although reconstruction of anterior mandibular oncologic defects with bony free flaps is considered the standard method of treatment, the optimal reconstruction of posterior defects is controversial. The authors' goal was to compare outcomes using either a vascularized bone flap or a soft-tissue free flap fo...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0b013e3181d62aef
更新日期:2010-05-01 00:00:00
abstract:BACKGROUND:Diabetes impairs the ability of tissue to respond adequately to ischemia. The underlying mechanisms contributing to this impaired response remain unknown. Because increases in apoptosis have been linked to a spectrum of diabetic complications, the authors examined whether programmed cell death is involved in...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/01.prs.0000302499.18738.c2
更新日期:2008-04-01 00:00:00
abstract::Poland's syndrome comprises a spectrum of chest-wall deformities affecting, to various degrees, the rib cage, the chest-wall muscles, the neurovascular structures of the ipsilateral arm, and the overlying breast. This study details our experience with nine female Poland's syndrome patients who had chest-wall and breas...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199702000-00017
更新日期:1997-02-01 00:00:00
abstract:BACKGROUND:Breast augmentation with subglandular versus subpectoral implants may differentially impact the early detection of breast cancer and treatment recommendations. The authors assessed the impact of prior augmentation on the diagnosis and management of breast cancer in women undergoing mastectomy. METHODS:Breas...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000003342
更新日期:2017-06-01 00:00:00
abstract:BACKGROUND:Nipple-sparing mastectomy with immediate prosthetic reconstruction is routinely performed because of excellent aesthetic results and safe oncologic outcomes. Typically, subpectoral expanders are placed, but in select patients, this can lead to significant postoperative pain and animation deformity, caused by...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000003627
更新日期:2017-09-01 00:00:00
abstract:BACKGROUND:The management of postoperative deep sternal wound infection varies widely based on the discretion of the cardiovascular surgeon and the plastic surgeon. METHODS:Analysis of patients with deep sternal wound infection undergoing one-step radical sternal débridement and muscle flap reconstruction by a single ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0b013e3181a205f9
更新日期:2009-05-01 00:00:00
abstract::Ehlers-Danlos syndrome is an inherited collagen disorder characterized by skin hyperextensibility, joint laxity, and tissue friability. In this study, it was hypothesized that Ehlers-Danlos syndrome is frequently undiagnosed in patients who present for repair of ventral abdominal wall hernias. A retrospective chart re...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-200012000-00012
更新日期:2000-12-01 00:00:00
abstract::We have studied the chemomigration activity of an epithelial carcinoma cell line using a modified 96-well Boyden chamber apparatus consisting of upper and lower wells separated by an 8-microns pore polycarbonate filter. Cells from the malignant squamous carcinoma cell line A-431 were plated in the upper wells over a c...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199512000-00024
更新日期:1995-12-01 00:00:00
abstract:LEARNING OBJECTIVES:After studying this article, the participant should be able to: 1. Identify the subtypes of squamous cell carcinoma of the skin. 2. Identify factors that affect recurrence and/or metastasis. 3. Develop a surgical management plan for treating high-risk squamous cell carcinoma of the skin. In treating...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章,评审
doi:10.1097/01.prs.0000138243.45735.8a
更新日期:2004-11-01 00:00:00
abstract::A noncontact three-dimensional measuring system (liquid crystal range finder system) is described. Three-dimensional facial surface data (more than 30,000 points) could be obtained in 1 second, and the resolution was approximately 0.4 mm. The reliability and repeatability of the results were validated with a calibrati...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199811000-00046
更新日期:1998-11-01 00:00:00
abstract:BACKGROUND:Enhanced recovery after surgery (ERAS) protocols have known benefits in the inpatient setting, but little is known about their impact in the subsequent outpatient setting. On discharge, multimodal analgesia has been discontinued, nerve blocks and pain pumps have worn off, and patients enter a substantially d...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000006546
更新日期:2020-03-01 00:00:00
abstract:BACKGROUND:Although nearly all medical students pursuing integrated plastic surgery residency participate in elective rotations away from their home medical school, the value and costs of these "away" rotations have not been well studied. METHODS:The authors surveyed all integrated plastic surgery program directors an...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000002029
更新日期:2016-04-01 00:00:00
abstract::This article presents a method for passing a cerclage suture around the nasal tip complex to narrow it. The method does not require elevation of the skin from the lower lateral cartilages. The method requires a double-pointed straight needle with the suture swaged on in the center. ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:
更新日期:1999-11-01 00:00:00
abstract::A case of total reconstruction of skull and scalp in a patient with a large defect from aplasia cutis congenita is reported. Tissue expansion was successfully employed on two occasions: first to construct a well-vascularized space to sustain multiple rib grafts for cranial reconstruction and then to develop adequate q...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198604000-00026
更新日期:1986-04-01 00:00:00
abstract:BACKGROUND:Although the fibula free flap is preferred for bony head and neck reconstruction, donor-site morbidity remains a concern. The authors' goal was to evaluate potential risk factors for complications and whether the type of wound closure and timing of postoperative ambulation had an effect on the development of...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0b013e318221dc2a
更新日期:2011-09-01 00:00:00
abstract:BACKGROUND:This study examined the patient satisfaction and longevity of Radiesse, a calcium hydroxylapatite compound, as a facial soft-tissue filler for the glabellar lines, the lips, the nose, the face, and the infraorbital region. METHODS:Radiesse, 0.5 to 2.0 ml, was injected into the designated area in each of the...
journal_title:Plastic and reconstructive surgery
pub_type: 临床试验,杂志文章
doi:10.1097/01.prs.0000234902.61284.c9
更新日期:2006-09-01 00:00:00
abstract::This study was undertaken to evaluate the feasibility of performing vascularized musculoskeletal xenografts between mice and rats using immunosuppression. Vascularized musculoskeletal grafts were harvested from the hind limb of C57BL/6J (B6) mice, transplanted heterotopically into Lewis rats, and revascularized by mic...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-200004050-00015
更新日期:2000-04-01 00:00:00
abstract::After nearly any form of cardiac surgery, an acute febrile illness characterized by leukocytosis, pericarditis with pericardial effusion, and pleural effusion may occur. In some instances, this postpericardiotomy syndrome may suggest the presence of mediastinal infection. Treatment of postpericardiotomy syndrome is co...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:
更新日期:1995-09-01 00:00:00
abstract::The results of the slide-swing plasty are reviewed over a period of 16 years. A total of 1,308 patients were analyzed with regard to location and etiology. The slide-swing plasty has proved successful in practice. Its great advantage consists in the possibility of closing large defects without skin grafting. Compared ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198104000-00008
更新日期:1981-04-01 00:00:00
abstract::The basic principles of successful wound closure remain the same: careful preoperative evaluation, removal of underlying nonviable tissue, and well-vascularized soft-tissue coverage. Many complex or "hostile" back wound closures also require stabilization of the spine and a two-layered wound closure. The use of long a...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-200006000-00022
更新日期:2000-06-01 00:00:00
abstract::Fibrous capsules surrounding silicone implants were investigated in a new guinea pig model to delineate some of the factors leading to capsular contracture. Both the implant surfaces and tissue capsules were examined by light and scanning transmission electron microscopy (STEM + SEM) with x-ray energy spectroscopy (XE...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198401000-00021
更新日期:1984-01-01 00:00:00
abstract::This study of suction lipectomy aspirates from 15 consecutive patients was undertaken to biochemically quantitate the blood-to-fat ratios of the aspirates. A wide variation in the blood-to-fat ratios (8 to 54 percent) was noted, but the authors failed to demonstrate any relationship between the blood-to-fat ratios and...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198678060-00009
更新日期:1986-12-01 00:00:00
abstract::The construction details for an inexpensive, easy-to-build operating table for hand surgery have been described. The table was specifically designed according to the needs of those working with it. It has been in daily use for over 2 years and has proved to be a popular product with all staff members. ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198802000-00025
更新日期:1988-02-01 00:00:00
abstract::In a rat model designed to simulate clinical angiography, preoperative angiography had no effect on free-flap survival. Only when a large dose of RCM was delivered directly into a surgically isolated circulation did significant free-flap loss ensue. ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-198108000-00013
更新日期:1981-08-01 00:00:00
abstract::Since the advent of three-dimensional (3D) printing in the 1980s, it is now possible to produce physical objects from digital files and create 3D objects by adding one layer at a time following a predetermined pattern. Due to the continued development of inexpensive and easy- to- use 3D printers and bioprinting, this ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0000000000000150
更新日期:2016-01-21 00:00:00
abstract::This case describes a repair of a unilateral cleft lip complicated by a lip hemangioma. The relevant issues regarding timing of the repair include safety of the procedure by minimizing blood loss during excision of the hemangioma and minimizing anesthesia risk. In obtaining a lasting cosmetic result, excision of the h...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199701000-00035
更新日期:1997-01-01 00:00:00
abstract::Necrotizing abdominal wall infections, enteric fistulae, or exposed prosthetic material after ventral hernia repair often results in a loss of abdominal wall integrity. Further surgical reconstruction with prosthetic material is usually contraindicated in the contaminated wound because of the high infection rate neces...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199804040-00014
更新日期:1998-04-01 00:00:00
abstract::A patient is presented in whom augmentation of the pyriform aperture of the maxilla was performed with porous hydroxyapatite in concert with a face and brow lift. Basic research has recently shown that remodeling of the facial skeleton continues throughout life and that this remodeling process leads to changes in the ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199902000-00050
更新日期:1999-02-01 00:00:00
abstract::The anomaly of facial cleft no. 1 has been encountered recently. It is a rare finding and, accordingly, is being reported with the hope that more craniofacial clefts will be seen in the future and direct the attention of the medical community to the problems. ...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/00006534-199412000-00022
更新日期:1994-12-01 00:00:00
abstract:BACKGROUND:The long-term implications of components separation for the lateral oblique and rectus muscles remain unknown. The authors hypothesized that recreation of the tendinous insertion of the linea alba through components separation results in expansion of the rectus muscle with potential atrophy of the external o...
journal_title:Plastic and reconstructive surgery
pub_type: 杂志文章
doi:10.1097/PRS.0b013e3182589d79
更新日期:2012-08-01 00:00:00