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Promny T, Huberth P, Müller-Seubert W, Promny D, Cai A, Horch RE, Arkudas A. The Impact of Technical Innovations and Donor-Site Mesh Repair on Autologous Abdominal-Based Breast Reconstruction-A Retrospective Analysis. J Clin Med 2024; 13:2165. [PMID: 38673438 PMCID: PMC11050223 DOI: 10.3390/jcm13082165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/06/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Background: The aim of this study was to examine the potential benefit that may be achieved through the introduction of technical innovations and the incorporation of mesh for fascial donor site closure in uni- and bilateral autologous breast reconstruction with abdominal tissue. Methods: A retrospective single-center review of all breast reconstructions with a DIEP or MS-TRAM flap between January 2004 and December 2019 was performed. Donor and recipient site complications and operation times were evaluated before and after the implementation of coupler anastomoses, preoperative computed tomography angiography (CTA), indocyanine green (ICG) angiography, and the inclusion of mesh in donor site repair. Results: A total of 396 patients were included, accounting for 447 flaps. Operation time was significantly shorter in unilateral reconstructions after the implementation of CTA (p < 0.0001). ICG angiography significantly reduced the rates of partial flap loss (p = 0.02) and wound healing disorders (p = 0.02). For unilateral reconstructions, abdominal bulging or hernia was observed more often in MS1-TRAM flaps without synthetic mesh repair (p = 0.001), whereas conservatively treated seroma developed more frequently after mesh implantation (p = 0.03). Conclusions: Recent technological advancements developed over the past few decades have made a substantial impact on decreasing surgical duration and enhancing procedure safety.
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Affiliation(s)
- Theresa Promny
- Department of Plastic and Hand Surgery and Laboratory for Tissue Engineering and Regenerative Medicine, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (P.H.); (W.M.-S.); (D.P.); (A.C.); (R.E.H.); (A.A.)
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Wei M, Meng S, Dai F, Xiao L, Mu X, Tang J, Liu Y. Comparison of two 3D reconstruction models for understanding of complicated female pelvic tumors. Int J Gynaecol Obstet 2024. [PMID: 38425240 DOI: 10.1002/ijgo.15441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 02/03/2024] [Accepted: 02/07/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Three-dimensional (3D) reconstructed models have been shown to improve visualization in complex female pelvic tumors. Cinematic rendering (CR) is a 3D imaging technique for computed tomography (CT) images, which creates more realistic images with the ability to enhance imaging of anatomical features for diagnosis. This study was set up to compare two types of 3D models and to validate the use of 3D anatomical techniques for the diagnosis of complex female pelvic tumors. METHODS The preclinical, randomized, two-sequence crossover investigation was performed from December 2022 to January 2023 at First Affiliated Hospital of Chongqing Medical University. Sixteen residents and 10 attending surgeons assessed the cases of 23 patients with two types of 3D model images. The surgeons were randomly assigned to two assessment sequences (CR-3D model group and CT-3D model group). For each case, participants selected one question that probed fundamental questions about the tumor's genesis throughout each assessment period. Following a 4-week washout period, case assessments were transferred to the other image modality. RESULTS The main result assessment was the accuracy of the answers. The time to answer the questions and the case assessment questionnaire was added as a secondary outcome. The mean scores in the CR-3D models (19.35 ± 1.87) varied significantly from those in the CT-CR group (16.77 ± 1.8) (P < 0.001), and solving the questions in the CT-3D model sequence (41.96 ± 6.31 s) varied significantly from that in the CR-3D model sequence (52.88 ± 5.95 s) (P < 0.001). Subgroup analysis revealed that there were statistically significant variations in the scores of female reproductive tumors, pelvic tumors other than the reproductive system, and retroperitoneal tumors (P = 0.005). Analysis of the assessment questionnaire showed that more surgeons choose CR 3D reconstruction (8.31 ± 0.76 vs 7.15 ± 1.19, P < 0.001). CONCLUSIONS The results suggest that each 3D reconstruction method has its own advantages. Surgeons feel that CR reconstruction models are a useful technique that can improve their comprehension of complex pelvic tumors, while traditional 3D models have an advantage in terms of speed to diagnosis.
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Affiliation(s)
- Miao Wei
- Department of Radiology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shenglan Meng
- Department of Thoracic Surgery, Army Medical Center of People's Liberation Army of China, Chongqing, China
| | - Fengqin Dai
- Department of Gynecology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lin Xiao
- Department of Gynecology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoling Mu
- Department of Gynecology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Junying Tang
- Department of Gynecology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yingwei Liu
- Department of Gynecology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Is Instillational Topical Negative Pressure Wound Therapy in Peri-Prosthetic Infections of the Breast Effective? A Pilot Study. J Pers Med 2022; 12:jpm12122054. [PMID: 36556274 PMCID: PMC9786689 DOI: 10.3390/jpm12122054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/04/2022] [Accepted: 12/08/2022] [Indexed: 12/15/2022] Open
Abstract
Peri-prosthetic breast infections pose a risk of severe complications after breast implant surgery. The need to remove the breast implant, control the infection and perform additional surgical procedures are the consequences. Reimplantation of an alloplastic implant is only appropriate after an infection-free interval. In this retrospective cohort study, we investigated the effectiveness of negative pressure wound treatment with instillation and dwell time (NPWTi-d) on peri-prosthetic breast infections in combination with implant removal and antibiotic therapy. Twelve patients treated with NPWTi-d due to breast implant infection were included in the study. The bacterial burden was analyzed using wound swabs before and after NPWTi-d. Additionally, laboratory values were determined before NPWTi-d and immediately before wound closure. A total of 13 peri-prosthetic breast infections in 12 patients were treated using implant removal and NPWTi-d. In 76.9% (n = 10) of the cases, the patients had undergone alloplastic breast reconstruction following cancer-related mastectomy, whereas 23.1% (n = 3) of the patients had undergone breast augmentation for cosmetic reasons. The bacterial burden in the breast pocket decreased statistically significant after implant removal and NPWTi-d. No shift from Gram-positive to Gram-negative bacteria was observed. Inflammatory markers rapidly decreased following treatment. NPWTi-d had a positive impact on the healing process after peri-prosthetic breast infections, leading to a decrease in bacterial burden within the wounds and contributing to uneventful healing. Therefore, secondary reimplantation of breast prostheses might be positively influenced when compared to conventional implant removal and simple secondary closure. Further studies are required to conclusively establish the beneficial long-term effects of using NPWTi-d for the treatment of peri-prosthetic breast infections.
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Kueckelhaus M, Kolbenschlag J, Kirschniak A, Beier JP, Enzinger S, Harder Y, Kneser U, Lehnhardt M, Rab M, Daigeler A. [New Technologies in Microsurgery: Potential, Indications and Economical Aspects - Report of the Consensus Workshop of the German-Speaking Society for Microsurgery of Peripheral Nerves and Vessels (DAM)]. HANDCHIR MIKROCHIR P 2022; 54:507-515. [PMID: 36283407 DOI: 10.1055/a-1942-6510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Recently, several new technologies to support microsurgeons have received European market approval. This article summarizes and discusses the impressions of an expert panel to classify the potential of new technologies in terms of benefits for the surgeon, specific indications and economic aspects during the 42nd Annual Meeting of the German-speaking Working Group for Microsurgery of Peripheral Nerves and Vessels (DAM) in Graz, Austria. In general, the expert panel addressed the principles and prerequisite for the successful establishment of new technologies and, in particular, novel optical and robotic systems. For this purpose, the current scientific literature was reviewed and initial clinical experience in the context of case series and retrospective studies was presented by the members of the expert panel. In the ensuing discussion, it was pointed out that it will first be necessary to identify patient subgroups in which the use of the new technologies is most likely to achieve a clinical benefit. Since clinical approval has already been granted for some systems, an approach can be developed for immediate clinical application from the simplest possible use to ever finer applications, i. e. from microsurgery to supermicrosurgery. Initially, funding for cost-intensive systems would presumably not be possible through revenue from standard care, but only through grants or subsidized clinical trials. In a final survey, the majority of meeting participants see the need for a price reduction of both visualization and surgical robotics technologies to enable widespread clinical establishment. Likewise, a majority of participants would prefer a combination of an exoscope or robotic microscope and a surgical robot for clinical use. The present consensus work addresses the development of a strategy for the effective establishment of new technologies, which should further increase the surgical quality of selected interventions.
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Affiliation(s)
- Maximilian Kueckelhaus
- Abteilung für Plastische und Rekonstruktive Medizin, Westfälische Wilhelms-Universität Münster Institut für Muskuloskelettale Medizin, Münster, Germany.,Abteilung für Plastische, Rekonstruktive und Ästhetische Chirurgie, Handchirurgie, Fachklinik Hornheide e V, Münster, Germany
| | - Jonas Kolbenschlag
- Universitätsklinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, BG Klinik Tübingen, Tubingen, Germany
| | - Andreas Kirschniak
- Klinik für Allgemein- und Viszeralchirurgie, Kliniken Maria Hilf Mönchengladbach, Mönchengladbach, Germany
| | - Justus P Beier
- Department of Plastic Surgery, Hand Surgery - Burn Center, University Hospital RWTH Aachen, Aachen, Germany.,Universitätsklinik für Mund- Kiefer- und Gesichtschirurgie, Uniklinikum Salzburg - Christian-Doppler-Klinik, Salzburg, Austria
| | - Simon Enzinger
- Universitätsklinik für Mund- Kiefer- und Gesichtschirurgie, Uniklinikum Salzburg - Christian-Doppler-Klinik, Salzburg, Austria
| | - Yves Harder
- Plastic, Reconstructive and Aesthetic Surgery, Repubblica e Cantone Ticino Ente Ospedaliero Cantonale, Viganello - Lugano, Switzerland
| | - Ulrich Kneser
- Klinik für Hand, Plastische und Rekonstruktive Chirurgie Schwerbrandverletztenzentrum Klinik für Plastische Chirurgie, BG Unfallklinik Ludwigshafenund Ruprecht-Karls-Universität Heidelberg, Ludwigshafen, Germany
| | - Marcus Lehnhardt
- Klinik für Plastische Chirurgie und Handchirurgie, Schwerbrandverletztenzentrum, BG-Universitätsklinikum Bergmannsheil Bochum, Bochum, Germany
| | - Matthias Rab
- Abt. f. Plastische Ästhetische und Rekonstruktive Chirurgie, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Adrien Daigeler
- Klinik für Hand, Plastische, Rekonstruktive und Verbrennungschirurgie, BG Unfallklinik Tübingen an der Eberhard Karls Universität Tübingen, Tübingen, Germany
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