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Winder G, Gronovich Y, Elias N, Segal E, Ben-David MA, Tsur R, Maisel Lotan A, Scheflan M. Autologous Fat Grafting With CO2 Tissue Preparation (Carbo-pneumodissection): A Safe Method for Expanding and Enhancing Recipient Site Capacity and Aesthetic Outcomes. Aesthet Surg J 2023; 43:NP244-NP253. [PMID: 36322704 DOI: 10.1093/asj/sjac284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/24/2022] [Accepted: 10/25/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Autologous fat grafting (AFG) is commonly used as part of aesthetic and reconstruction procedures, but expanding and enhancing the recipient site capacity remains a major challenge. OBJECTIVES The aim of this study was to describe and assess an innovative intraoperative carbon dioxide (CO2) pneumodissection (CPD) recipient site preconditioning procedure intended to improve recipient site capacity and AFG outcomes. METHODS From June 2019 to August 2021, 53 patients after mastectomy or lumpectomy (76 breasts) underwent 96 AFG procedures as a separate stage immediately following tissue preconditioning with CPD. RESULTS There were no systemic or major local complications. The mean number of AFG procedures required to complete the reconstruction was 1.3 per breast. The vast majority of patients achieved a final satisfactory aesthetic outcome with either 1 or 2 procedures (77.6% and 18.4%, respectively). The volume of fat graft delivered into the recipient site per session following CPD was higher than previous literature reports for all study groups. Furthermore, the CPD procedure was associated with a reduced need for subsequent AFG to complete the reconstruction. The positive effect of CPD, in terms of AFG volume delivered, was even more prominent among scarred irradiated breasts. Despite the large fat graft volumes delivered in our study, only 5.3% of breasts experienced fat necrosis following the procedure. CONCLUSIONS CPD constitutes a safe, innovative, intraoperative method to expand and enhance recipient site capacity and fat grafting outcome. CPD allows cavernous expansion alongside preservation of the microcirculation. CPD works for both healthy and compromised tissues, in either reconstructive or aesthetic procedures. LEVEL OF EVIDENCE: 4
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Scheflan M, Allweis TM, Ben Yehuda D, Maisel Lotan A. Meshed Acellular Dermal Matrix in Immediate Prepectoral Implant-based Breast Reconstruction. Plast Reconstr Surg Glob Open 2020; 8:e3265. [PMID: 33299724 PMCID: PMC7722619 DOI: 10.1097/gox.0000000000003265] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/28/2020] [Indexed: 04/11/2023]
Abstract
UNLABELLED Prepectoral implant placement has many potential advantages in immediate breast reconstruction. Acellular dermal matrices (ADMs) are commonly used in these surgeries. ADM meshing may enhance integration, decrease seroma and infection rates, and reduce surgical costs. METHODS This was a retrospective, single-center study of 49 women (71 breasts) undergoing immediate, prepectoral, implant-based breast reconstruction with 2:1 meshed, bovine-derived ADM (SurgiMend). Outcomes were compared against those of 77 patients (105 breasts) undergoing a similar procedure but with partial subpectoral implant placement. RESULTS In the prepectoral group, the mean age was 49.1 years and mean body mass index was 24.7 kg/m2. There were no significant differences in baseline characteristics versus the partial subpectoral control group. Mean follow-up was 18.6 months (prepectoral) and 21.3 months (partial subpectoral). Mean time to drain removal was reduced in the prepectoral group (6.5 versus 8.5 days; P < 0.001). Rates of minor and major complications with prepectoral implant placement were 15.5% and 11.3%, respectively - similar to partial subpectoral placement (15.2% and 14.3%) (overall P = 0.690). Capsular contracture and explantation were associated with radiation therapy, and rates were similar between groups. CONCLUSIONS Prepectoral implant placement with meshed ADM is a safe and reproducible alternative to partial muscle coverage with meshed ADM. Recovery may be easier and animation deformity avoided. It could therefore become the standard of care for implant-based breast reconstruction.
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Affiliation(s)
| | - Tanir M. Allweis
- From the Assuta Medical Center, Tel Aviv, Israel
- Kaplan Medical Center, Rehovot, Israel
- Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Adi Maisel Lotan
- From the Assuta Medical Center, Tel Aviv, Israel
- Hebrew University of Jerusalem, Jerusalem, Israel
- Shaare Zedek Medical Center, Jerusalem, Israel
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Scheflan M, Allweis TM, Ben Yehuda D, Maisel Lotan A. Meshed Acellular Dermal Matrix in Immediate Prepectoral Implant-based Breast Reconstruction. Plast Reconstr Surg Glob Open 2020. [PMID: 33299724 DOI: 10.1097/gox.0000000000003265,november25,2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
UNLABELLED Prepectoral implant placement has many potential advantages in immediate breast reconstruction. Acellular dermal matrices (ADMs) are commonly used in these surgeries. ADM meshing may enhance integration, decrease seroma and infection rates, and reduce surgical costs. METHODS This was a retrospective, single-center study of 49 women (71 breasts) undergoing immediate, prepectoral, implant-based breast reconstruction with 2:1 meshed, bovine-derived ADM (SurgiMend). Outcomes were compared against those of 77 patients (105 breasts) undergoing a similar procedure but with partial subpectoral implant placement. RESULTS In the prepectoral group, the mean age was 49.1 years and mean body mass index was 24.7 kg/m2. There were no significant differences in baseline characteristics versus the partial subpectoral control group. Mean follow-up was 18.6 months (prepectoral) and 21.3 months (partial subpectoral). Mean time to drain removal was reduced in the prepectoral group (6.5 versus 8.5 days; P < 0.001). Rates of minor and major complications with prepectoral implant placement were 15.5% and 11.3%, respectively - similar to partial subpectoral placement (15.2% and 14.3%) (overall P = 0.690). Capsular contracture and explantation were associated with radiation therapy, and rates were similar between groups. CONCLUSIONS Prepectoral implant placement with meshed ADM is a safe and reproducible alternative to partial muscle coverage with meshed ADM. Recovery may be easier and animation deformity avoided. It could therefore become the standard of care for implant-based breast reconstruction.
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Affiliation(s)
| | - Tanir M Allweis
- Assuta Medical Center, Tel Aviv, Israel
- Kaplan Medical Center, Rehovot, Israel
- Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Adi Maisel Lotan
- Assuta Medical Center, Tel Aviv, Israel
- Shaare Zedek Medical Center, Jerusalem, Israel
- Hebrew University of Jerusalem, Jerusalem, Israel
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Scheflan M, Allweis TM. What Can Breast and Plastic Surgeons Do to Help Fight the Opioid Crisis: The Interpectoral Block for Pain Control Following Aesthetic and Reconstructive Breast Surgery. Aesthet Surg J Open Forum 2020; 2:ojaa009. [PMID: 33791629 PMCID: PMC7780501 DOI: 10.1093/asjof/ojaa009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
With the heightened awareness of the dangers of opioid administration, the importance of providing effective non-opioid postoperative pain management is evident. Regional analgesia for breast surgery has been described, but it is unclear how widely it is utilized. The authors describe a simple block performed during ablative, aesthetic, and reconstructive breast surgery to improve postoperative pain control and significantly decrease the need for postoperative pain medications. The interpectoral (PECS I) block covers the lateral and medial pectoral nerves and can be administered by the anesthesiologist under ultrasound guidance after induction of general anesthesia, or by the surgeon under direct vision, using a blunt cannula, at the time of surgery. The authors have been practicing this technique in every patient undergoing aesthetic, ablative, and reconstructive breast surgery in the last 4 years. In approximately 350 patients, none received opioids after discharge, which was either same day or the following day. The authors provide a brief review of the literature and a detailed description of the technique along with a video demonstrating the procedures. Intraoperative pectoral block is a simple and effective technique for decreasing postoperative pain and analgesic requirements and could be widely adopted as a standard of care in breast surgery.
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Affiliation(s)
- Michael Scheflan
- Plastic Surgeon, Scheflan Plastic Surgery, Tel Aviv, Israel
- Corresponding Author: Dr. Michael Scheflan, Scheflan Plastic Surgery, 18 Raul Wallenberg, Tel Aviv 69710, Israel. E-mail: ; Twitter: @MichaelScheflan
| | - Tanir M Allweis
- Breast Surgeon, Assuta Medical Center and Kaplan Medical Center, Tel Aviv, Israel
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Cohen SR, Tiryaki T, Womack HA, Canikyan S, Schlaudraff KU, Scheflan M. Cellular Optimization of Nanofat: Comparison of Two Nanofat Processing Devices in Terms of Cell Count and Viability. Aesthet Surg J Open Forum 2019; 1:ojz028. [PMID: 33791619 PMCID: PMC7780476 DOI: 10.1093/asjof/ojz028] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2019] [Indexed: 12/18/2022] Open
Abstract
Background Nanofat was introduced by Tonnard and Verpaele in 2013. Their initial observations in intradermal applications showed improvement in the appearance of the skin. Since then, a number of Nanofat devices have been introduced. The cellular content in the processing of Nanofat is not the same in every device, yet the cellular composition is responsible for the biologic action of Nanofat. The authors sought to find a different means to produce a matrix rich Nanofat to optimize the cellular content. Objectives The primary objective of this study was to compare cell counts, cultures, and cell viabilities produced by LipocubeNano (Lipocube, Inc., London, UK) in comparison to Tulip’s NanoTransfer (Tulip Medical, San Diego, CA) processing methods. Methods Twenty milliliters of fat were harvested from 10 patients in order to test two methods of Nanofat production. Ten milliliters of fat were used to assess each method and, after the final product was obtained, enzymatic digestion for stromal vascular fraction (SVF) isolation was performed. A Muse Flow-cytometer was used to measure cell counts and cell viabilities, cell cultures were performed, and cell images were taken with a florescent microscope. Results The LipocubeNano was shown to be superior to Tulip’s NanoTransfer system of progressive downsizing with final filtering, which appeared to trap more fibrous tissue leading to lower amounts of SVF. LipocubeNano resulted in higher cell counts (2.24 × 106/cc), whereas Tulip’s NanoTransfer method resulted in a lower cell count at 1.44 × 106/cc. Cell viability was the same (96.05%) in both groups. Conclusions Nanofat from LipocubeNano has a higher regenerative cell count and more SVF cells than the other common mechanical method of Nanofat processing. This new means of mechanical processing preserves more matrix, optimizing the cellular content of the Nanofat, thus having potentially a higher regenerative effect. Level of Evidence: 5
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Affiliation(s)
| | - Tunç Tiryaki
- University of California, San Diego, San Diego, CA.,Kansas City University of Medicine and Biosciences, Kansas City, MO.,Onkim Stem Cell Technologies, Istanbul Technical University - KOSGEB, Istanbul, Turkey
| | - Hayley A Womack
- Kansas City University of Medicine and Biosciences, Kansas City, MO
| | - Serli Canikyan
- Onkim Stem Cell Technologies, Istanbul Technical University - KOSGEB, Istanbul, Turkey
| | - Kai Uwe Schlaudraff
- University of California, San Diego, San Diego, CA.,Kansas City University of Medicine and Biosciences, Kansas City, MO.,Onkim Stem Cell Technologies, Istanbul Technical University - KOSGEB, Istanbul, Turkey
| | - Michael Scheflan
- University of California, San Diego, San Diego, CA.,Kansas City University of Medicine and Biosciences, Kansas City, MO.,Onkim Stem Cell Technologies, Istanbul Technical University - KOSGEB, Istanbul, Turkey
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Scheflan M, Maisel Lotan A, Allweis TM. Trans-Vertical Mastectomy With Immediate Implant-Based Reconstruction: A Retrospective, Observational Study. Aesthet Surg J 2019; 39:733-742. [PMID: 30052751 PMCID: PMC6594202 DOI: 10.1093/asj/sjy181] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background In women with large and ptotic breasts who require a mastectomy and immediate, implant-based reconstruction, long flaps pose a high risk for flap ischemia and necrosis. A new trans-vertical incision for skin-reducing mastectomy is described, which reduces the skin envelope and lifts the breast. Objectives The authors sought to describe the new mastectomy access incision and assess its efficacy and safety when followed by immediate implant-based reconstruction. Methods This retrospective analysis included 70 consecutive patients (101 breasts) with large and ptotic breasts who underwent a unilateral (n = 39; 55.7%) or bilateral (n = 31; 44.3%), skin-reducing mastectomy utilizing the trans-vertical approach for either breast cancer or risk reduction. All received immediate one- (n = 86; 85.5%) or two-stage (n = 15; 14.5%), implant-based reconstruction utilizing acellular dermal matrix. Results Mean age was 50.1 years and mean body mass index was 25.6 kg/m2. After a median follow-up of 4.9 years, the number of breasts with minor and major complications was 21 (20.8%) and 26 (25.7%), respectively. The most common major complications were skin-flap necrosis (n = 12; 11.9%) and infection (n = 8; 7.9%). All occurred within 3 months postsurgically. There were 7 cases of capsular contracture (6.9%) and 5 reconstruction failures (5.0%). Higher body mass index (P < 0.01) and breast weight (P < 0.05) were associated with increased complication rates. According to BREAST-Q, 55/64 patients (85.9%) were somewhat or very satisfied with the aesthetic outcome. Conclusions The trans-vertical approach is an effective, reproducible, and safe alternative to conventional skin-reducing mastectomy, with favorable aesthetic outcomes, in patients with large and ptotic breasts. Level of Evidence: 4
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Affiliation(s)
| | | | - Tanir M Allweis
- Assuta Medical Center, Tel Aviv, and Kaplan Medical Center, Rehovot, Israel
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Affiliation(s)
- G Patrick Maxwell
- Dr Maxwell is a Clinical Professor of Plastic Surgery at the Loma Linda School of Medicine, Loma Linda, CA. Dr Scheflan is a plastic surgeon in private practice in Tel Aviv, Israel. Dr Spear is a Professor and Chairman of the Department of Plastic Surgery at the Georgetown University Hospital, Washington, DC. Dr Nava is a plastic surgeon and Head of the Plastic Unit of the IRCCS Foundation at the National Cancer Institute, Milan, Italy. Dr Hedén is an Associate Professor of Plastic Surgery at Akademikliniken, Stockholm, Sweden
| | - Michael Scheflan
- Dr Maxwell is a Clinical Professor of Plastic Surgery at the Loma Linda School of Medicine, Loma Linda, CA. Dr Scheflan is a plastic surgeon in private practice in Tel Aviv, Israel. Dr Spear is a Professor and Chairman of the Department of Plastic Surgery at the Georgetown University Hospital, Washington, DC. Dr Nava is a plastic surgeon and Head of the Plastic Unit of the IRCCS Foundation at the National Cancer Institute, Milan, Italy. Dr Hedén is an Associate Professor of Plastic Surgery at Akademikliniken, Stockholm, Sweden
| | - Scott Spear
- Dr Maxwell is a Clinical Professor of Plastic Surgery at the Loma Linda School of Medicine, Loma Linda, CA. Dr Scheflan is a plastic surgeon in private practice in Tel Aviv, Israel. Dr Spear is a Professor and Chairman of the Department of Plastic Surgery at the Georgetown University Hospital, Washington, DC. Dr Nava is a plastic surgeon and Head of the Plastic Unit of the IRCCS Foundation at the National Cancer Institute, Milan, Italy. Dr Hedén is an Associate Professor of Plastic Surgery at Akademikliniken, Stockholm, Sweden
| | - Maurizio B Nava
- Dr Maxwell is a Clinical Professor of Plastic Surgery at the Loma Linda School of Medicine, Loma Linda, CA. Dr Scheflan is a plastic surgeon in private practice in Tel Aviv, Israel. Dr Spear is a Professor and Chairman of the Department of Plastic Surgery at the Georgetown University Hospital, Washington, DC. Dr Nava is a plastic surgeon and Head of the Plastic Unit of the IRCCS Foundation at the National Cancer Institute, Milan, Italy. Dr Hedén is an Associate Professor of Plastic Surgery at Akademikliniken, Stockholm, Sweden
| | - Per Hedén
- Dr Maxwell is a Clinical Professor of Plastic Surgery at the Loma Linda School of Medicine, Loma Linda, CA. Dr Scheflan is a plastic surgeon in private practice in Tel Aviv, Israel. Dr Spear is a Professor and Chairman of the Department of Plastic Surgery at the Georgetown University Hospital, Washington, DC. Dr Nava is a plastic surgeon and Head of the Plastic Unit of the IRCCS Foundation at the National Cancer Institute, Milan, Italy. Dr Hedén is an Associate Professor of Plastic Surgery at Akademikliniken, Stockholm, Sweden
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Wiser I, Scheflan M, Heller L. [The history of plastic surgery in Israel]. Harefuah 2014; 153:550-556. [PMID: 25417494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The medical institutions in the country have advanced together with the development of the state of Israel. Plastic surgery, which has progressed significantly during the 20th century, has also grown rapidly in the new state. The arrival of Jewish plastic surgeons from all over the world with the knowledge and experience gained in their countries of origin, as well as the need for reconstructive surgical treatment for many combat injured soldiers, also contributed to the development of plastic surgery. This review tells the story of plastic surgery in Israel, since its foundation until nowadays. This article reviews the work of the founders of plastic surgery in Israel, indicating significant milestones in its development, and clinical and scientific contribution to the international plastic surgery profession. Moreover, the article describes the current condition of the field of plastic surgery in Israel and presents the trends and the future challenges facing the next generation of plastic surgery in Israel.
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Maxwell GP, Scheflan M, Spear S, Nava MB, Hedén P. Benefits and Limitations of Macrotextured Breast Implants and Consensus Recommendations for Optimizing Their Effectiveness. Aesthet Surg J 2014; 34:876-81. [PMID: 25024450 DOI: 10.1177/1090820x14538635] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2013] [Indexed: 11/17/2022] Open
Abstract
Implant texture is an important factor influencing implant selection for breast augmentation. Natrelle Biocell implants are characterized by macrotextured shell surfaces containing irregularly arranged concavities with large open-pore diameters and depths. These properties facilitate adhesion of the implant to the surrounding tissue, thereby promoting implant immobilization. Relative to implants with other surfaces, macrotextured implants offer low rates of capsular contracture; low rates of malposition, rotation, and rippling; and high rates of patient satisfaction. However, macrotextured implants are associated with a slightly higher risk of double capsule and late seroma. The surgeon can minimize these risks with straightforward techniques that encourage tissue adhesion. This report presents experience-based recommendations to optimize the effectiveness of Biocell anatomic implants. The authors discuss the application of best practices to all aspects of the breast implantation process, from implant selection and surgical planning to operative technique and postoperative management. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- G Patrick Maxwell
- Dr Maxwell is a Clinical Professor of Plastic Surgery at the Loma Linda School of Medicine, Loma Linda, California
| | - Michael Scheflan
- Dr Scheflan is a plastic surgeon in private practice in Tel Aviv, Israel
| | - Scott Spear
- Dr Spear is a Professor and Chairman of the Department of Plastic Surgery, Georgetown University Hospital, Washington, DC
| | - Maurizio B Nava
- Dr Nava is a plastic surgeon and Head of the Plastic Unit, IRCCS Foundation, National Cancer Institute, Milan, Italy
| | - Per Hedén
- Dr Hedén is an Associate Professor of Plastic Surgery at Akademikliniken, Stockholm, Sweden
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Andree C, Farhadi J, Goossens D, Masia J, Sarfati I, Germann G, Macmillan RD, Scheflan M, Van Not HP, Catanuto G, Nava MB. A position statement on optimizing the role of oncoplastic breast surgery. Eplasty 2012; 12:e40. [PMID: 22977675 PMCID: PMC3426932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To propose initiatives and actions that could improve access to and outcomes from oncoplastic breast surgery. METHODS The author group met in May 2010 to draft position statements on key unmet needs in oncoplastic breast surgery and how these may be addressed. At a second meeting in December 2010, the statements were voted upon and adjusted as necessary to achieve unanimous agreement. RESULTS It was agreed that every patient undergoing breast cancer surgery should be assessed by an oncoplastic team capable of offering the full range of surgical options. However, currently, not all women are adequately informed about the surgical options available. Furthermore, levels of multidisciplinary working, standards of care, and levels of surgical training in the full range of breast oncoplastic techniques are suboptimal. Institution-specific guidelines relating to the optimal patient pathway, the definition of clinical standards, and improved education in reconstructive surgery are required. Oncoplastic breast surgery should be offered to all patients, within the context of multidisciplinary teams that include accredited surgeons who consult with each other early in the treatment pathway. These teams should be focused on achieving not just positive oncologic outcomes, but also esthetic outcomes in line with patient wishes, to achieve optimal quality of life. CONCLUSIONS There is a desire within the surgical community to improve patient outcomes by better incorporating oncoplastic procedures into the treatment pathways for breast cancer. These position statements represent the perspectives of a group of European plastic surgeons on the key elements required to achieve this goal.
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Affiliation(s)
- Christoph Andree
- aDepartment of Plastic and Aesthetic Surgery, Sana Hospital Düsseldorf, Germany,Correspondence:
| | - Jian Farhadi
- bDepartment of Plastic Surgery, Guy's and St Thomas' Hospital, Westminster Bridge Road, London, United Kingdom
| | - Dennis Goossens
- cZiekenhuis Walcheren, Middelburgsestraat, Zeeland, The Netherlands
| | - Jaume Masia
- dPlastic Surgery Department, Sant Pau University Hospital, Barcelona, Spain
| | | | - Günter Germann
- fClinic for Plastic and Reconstructive Surgery, Preventive and Aesthetic Medicine at Heidelberg University Hospital, Heidelberg, Germany
| | | | | | | | - Giuseppe Catanuto
- jUnit of Plastic and Reconstructive Surgery, Fondazione IRCCS, Istituto Nazionale Tumori, Milano, Italy
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Lask G, Fournier N, Trelles M, Elman M, Scheflan M, Slatkine M, Naimark J, Harth Y. The utilization of nonthermal blue (405–425 nm) and near infrared (850–890 nm) light in aesthetic dermatology and surgery—a multicenter study. J COSMET LASER THER 2009; 7:163-70. [PMID: 16414904 DOI: 10.1080/14764170500344302] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND A major cause of skin aging is a chronic micro-inflammation triggered by UV radiation and external pollutants. It has been demonstrated that blue light diminishes inflammatory conditions and near infrared light enhances circulation. OBJECTIVES To assess the effectiveness of a non thermal dual wavelength -- blue (405 - 420 nm) and near infrared (850 - 900 nm) -- light source in skin rejuvenation, in the reduction of the duration of post skin resurfacing erythema and in the acceleration of healing of post surgical conditions (face lift and breast augmentation). METHODS We have utilized a non contact, hand free dual wavelength light source (iClearXL and Clear100XL, Curelight Ltd) to treat over 60 patients and perform three controlled studies in four centers. Follow up duration was three months. Control group for photo-rejuvenation consisted of patients treated with Glycolic peeling and daily appliance of vitamin C Control group for post skin resurfacing erythema duration consisted of patients untreated by the light source and control group for post surgical healing consisted of patients untreated by the light source or treated by the light source on one side only. RESULTS Post skin resurfacing erythema duration is reduced by 90%. The healing of post surgical conditions is substantially accelerated and discomfort is reduced. The anti aging effect of the light source includes: reduction of pore size in 90% of patients with stable results at three months follow up, enhanced skin radiance in 90% of patients with stable results at three months follow up and smoothing of fine wrinkles in 45% of patients with stable results at three months follow up. The control group showed poor results which were stable for a duration of less than one month. CONCLUSIONS A non thermal, non contact / hand free light source emitting at 405-420 nm and 850-900 nm considerably enhances aesthetic and surgical aesthetic procedures without consuming user time.
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Affiliation(s)
- Gary Lask
- UCLA Medical School, Los Angeles, CA
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Hedén P, Adams WP, Maxwell P, Nava M, Scheflan M, Stan C. Aesthetic breast surgery: consulting for the future--proposals for improving doctor-patient interactions. Aesthetic Plast Surg 2009; 33:388-94; discussion 395. [PMID: 19365670 DOI: 10.1007/s00266-009-9329-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Accepted: 02/19/2009] [Indexed: 10/20/2022]
Abstract
This report summarizes the opinions advanced by an international panel of acknowledged expert plastic surgeons convened to discuss women's attitudes about aesthetic breast surgery. To inform the discussions, a survey was undertaken to explore women's attitudes and opinions. The survey showed that significant numbers of women take the initial steps but do not proceed to surgery. This represents a failure to meet the needs of many women who stand to benefit from surgery. It also represents a waste of resources. Cost and fear are important factors, but a crucial consideration for women is whether they can find a surgeon they can trust. The panel recommends using standard consultation procedures, ensuring good clinic organization, managing expectations, dispelling myths, and providing adequate patient education to build trust and contribute to the successful treatment of women who desire breast surgery.
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Har-Shai Y, Gil T, Metanes I, Scheflan M. Brow lift for the correction of visual field impairment. Aesthet Surg J 2008; 28:512-7. [PMID: 19083571 DOI: 10.1016/j.asj.2008.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2008] [Accepted: 07/02/2008] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Eyebrow ptosis and hooding gives the eye a sad, heavy look that often disturbs the visual field. OBJECTIVE A direct extended scalpel-shaped brow lift is proposed to correct this functional and aesthetic disfigurement. This manuscript reviews our experience with the presented technique and evaluates the clinical results in the light of ongoing concerns regarding the appearance of the postoperative scar. In addition, the indications and patient selection criteria are elaborated. METHODS An incision was made along the superior border of the brow, extending laterally and downward, often within a "crow's feet" crease. The upper border of the incision joined the 2 extremities of the skin outline of the lower incision in a gentle convex curve. The general outline of the incision resembled the shape of a No. 20 scalpel blade, in which the maximal width is located laterally at the temple "crow's feet" area. RESULTS Fourteen patients, including 8 males (48-74 yrs of age) and 6 females (67-71 yrs of age) underwent this procedure. The surgical scar was hardly noticeable after 6 to 9 months, and often fell within a preexisting crow's feet crease. Elimination of some of the crow's feet occurred in all the patients. Subjective and objective functional relief with respect to the vision field and the heavy-feeling brow and satisfaction with the aesthetic result were reported by all patients. CONCLUSIONS The most appropriate candidates for the direct extended scalpel-shaped brow lift are patients older than 50 years of age, with eyebrow ptosis accompanied with lateral hooding, well developed crow's feet, and forehead skin laxity; long, dense eyebrows, and low transverse forehead wrinkles aid in concealment of the scar.
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Affiliation(s)
- Yaron Har-Shai
- Carmel Medical Center, Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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Grotting J, Zocchi M, Fisher J, Scheflan M, Di Spaltro F, Sampaio Góes JC. Ultrasonic-Assisted Lipoplasty. Semin Plast Surg 2008. [DOI: 10.1055/s-2008-1080279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Friedman T, Davidovitch N, Scheflan M. Comparative double blind clinical study on round versus shaped cohesive gel implants. Aesthet Surg J 2006; 26:530-6. [PMID: 19338941 DOI: 10.1016/j.asj.2006.08.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Accepted: 06/28/2006] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Highly cohesive round or shaped implants are used today by most plastic surgeons performing breast augmentation outside North America. OBJECTIVES This study was conducted to (1) compare aesthetic outcomes of round versus shaped implants in breast augmentation by defining the preferences of the general female population and plastic surgeons towards two groups of augmented breasts (implanted with either round or shaped devices); and (2) to determine whether or not plastic surgeons could identify the type of implant used in each patient based on the postoperative appearance. METHODS The study surveyed 30 breast augmentation patients, 15 with shaped implants and 15 with round devices. Two cohort categories evaluated the postoperative photographs of the patients: the first group comprised 235 female lay respondents and the second group included 11 male plastic surgeons. The lay respondents were asked to score breast beauty and naturalness, and to assess the upper pole. The plastic surgeons were asked similar questions and were additionally asked to try to identify the implant type. RESULTS With respect to "breast beauty," both respondent categories scored round and shaped implant patients similarly. With regard to "naturalness," both groups scored round implant patients significantly higher (P < .001). Concerning upper pole assessment, the round implant group was scored higher and better than the shaped implant group (P < .001). The plastic surgeons' correct identification rate was 64% for round implants, and 47% for shaped implants. CONCLUSIONS We believe that in the hands of an experienced surgeon who takes all soft tissue variables into consideration, the aesthetic result may not be differentiable when using round versus shaped implants in well-selected patients.
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Abstract
Facial aging occurs secondary to gravity-induced tissue ptosis and photoaging. Combined face lifting and carbon dioxide laser resurfacing provides a comprehensive one-stage approach to facial rejuvenation but is condemned by many plastic surgeons due to the nonspecific thermal effects of the laser and risk of skin necrosis. Newer high-energy erbium:YAG lasers allow precise tissue ablation with minimal thermal effect. In this study, various facial rejuvenation techniques were combined with simultaneous erbium:YAG laser resurfacing to assess results and complications. A total of 257 patients from Florida, Melbourne, Australia, and Tel Aviv, Israel, underwent combined erbium:YAG laser resurfacing and surgical facial rejuvenation. Various face-lift methods were used, including endoscopic, deep plane, and subcutaneous. Simultaneous, full-facial laser resurfacing was performed using a variety of erbium:YAG lasers. It was found that combined laser resurfacing and face lifting was successful in greater than 95 percent of patients with minimal morbidity. Two patients (1 percent) (both heavy smokers) developed small areas of skin necrosis that healed with minor pigment changes. Five patients (2 percent) developed synechia that was treated with no residual effect. Two additional patients (1 percent) developed temporary ectropion. There were no other cases of scarring, infection, or cosmetically obvious hypopigmentation. Although larger studies are necessary, it seems that the lack of thermal injury from the erbium:YAG laser makes it possible to safely perform laser resurfacing with surgical facial rejuvenation in nonsmokers. However, the authors caution that familiarity with the nuances of erbium:YAG laser resurfacing be obtained before performing combined laser resurfacing and face lifting.
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19
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20
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Weinstein C, Scheflan M. Simultaneously combined ER:YAG and carbon dioxide laser (derma K) for skin resurfacing. Clin Plast Surg 2000; 27:273-85, xi. [PMID: 10812526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
The simultaneously combined Er:YAG and carbon dioxide laser is ideally suited for treating deeper wrinkles with greater accuracy than either laser alone. By combining the precise ablative properties of the Er:YAG laser with the coagulative properties of the carbon dioxide laser, it is possible to control the depth of skin resurfacing to minimize complications and improve difficult and substantial wrinkles.
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Affiliation(s)
- C Weinstein
- Laser Surgery Institute of Melbourne, East Melbourne, Victoria, Australia
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22
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Abstract
A case report of a young patient with marked asymmetry treated successfully with ultrasonically assisted lipectomy with a good functional cosmetic result, undetectable scars, and mammographic control and showing no ill-effect on the breast parenchyma is presented. Further studies and follow-up are needed to confirm the value and advisability of using ultrasonic energy in the female breast.
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Abstract
As endoscopic subperiosteal lifting of the upper face is explored, it may significantly limit the indications for the open approach. However, this report is based on our combined large experience and long follow-up in open bicoronal subperiosteal lifting. The combined experience of four surgeons in four countries with an open subperiosteal approach to lifting of the upper face in 545 patients is described. The complications of the procedure, both common and rare, and techniques to avoid untoward effects are discussed. Reasons for patient dissatisfaction are addressed. Based on their evaluation of results and complications of the surgery over a 6-year period (1986-1992), we conclude that subperiosteal lifting is an effective, reliable, reproducible, and safe operation.
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Affiliation(s)
- M Scheflan
- Plastic & Aesthetic Surgical Center of Maryland, Baltimore 21093, USA
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24
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Abstract
The subperiosteal lift developed by Tessier is a technique for rejuvenating the face and emphasizing beauty. It is performed using two approaches: intraoral and bicoronal or precapillary. It entails a total subperiosteal undermining of the face beginning 2 cm over the orbits and continuing on the orbital rims, the zygomatic arches, and the malar bones. This allows total lifting of the soft tissues of the face (DMAS, deep musculo aponeurotic system). The lateral and vertical traction allows elevation of the superior two thirds of the face, eyebrows, and cheeks. Lifting pulls up from the forehead to the mandibular line. The fixation of the superficial layer of the temporal aponeurosis in traction to the upper part also has an effect on tissue elevation. The best candidates for this procedure are women in their late 30s or early 40s but can be used on those from 30 to 50 and more. It is highly specialized operation which requires substantial surgical experience both in selecting the patient and in execution.
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Affiliation(s)
- M A Goldenhersh
- Department of Dermatology, Hadassah University Hospital, Jerusalem, Israel
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26
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Zeligowski A, Scheflan M. The lasso-loop: a simple device for improving symmetry in breast and nipple-areola surgery. Eur J Plast Surg 1992. [DOI: 10.1007/bf00660516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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27
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Maillard GF, Cornette de St Cyr B, Scheflan M. The subperiosteal bicoronal approach to total facelifting: the DMAS--deep musculoaponeurotic system. Aesthetic Plast Surg 1991; 15:285-91. [PMID: 1950800 DOI: 10.1007/bf02273874] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Craniofacial surgery, developed by Paul Tessier, has shown that subperiosteal undermining and lifting of the soft tissues of the upper two-thirds of the face results in an excellent and long-lasting rejuvenated look to the entire face. The result is significantly more durable and longer lasting than the classic subcutaneous facelift reinforced with SMAS plication, transposition, and shortening. The authors--three surgeons working independently--are convinced that we have entered a new era in facelift procedures. We decided to combine our experiences which total 250 patients with followups of 6 months to 6 years.
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28
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29
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Zeligowski A, Scheflan M. The "zipper" stitch for intradermal closure. Plast Reconstr Surg 1990; 86:804-5. [PMID: 2217606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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30
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Scheflan M. Author’s letter in response. Eur J Plast Surg 1989. [DOI: 10.1007/bf02892661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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31
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32
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Scheflan M. [Breast reconstruction after mastectomy--why who, when and how]. Harefuah 1987; 113:24-8. [PMID: 3319829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Abstract
Our experience with the distally based latissimus dorsi flap in 12 patients (7 primary closures and 5 secondary procedures) indicates that it is an extremely reliable and useful flap in this setting. It provides coverage of the dural repair with viable soft tissues under a minimum of tension. The suture lines are distant from the dural closure, the donor defect closes primarily, and in the event of a complete failure, the contralateral latissimus dorsi remains available. In those cases of meningomyelocele where direct primary closure is not possible, we view this as the procedure of choice.
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Scheflan M. Building a breast without a prosthesis. The transverse abdominal island flap. Clin Plast Surg 1984; 11:303-15. [PMID: 6233060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Use of the transverse abdominal island flap for breast reconstruction enables the plastic surgeon to redistribute the body's excess fat and skin into more fashionable and aesthetic proportions. The operation remains a complex and detailed procedure. Patient selection, suitability, and preparation for the operation are critical to its success.
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36
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Scheflan M, Kalisman M. Complications of breast reconstruction. Clin Plast Surg 1984; 11:343-50. [PMID: 6233063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The authors discuss general complications of breast reconstruction, complications associated with reconstruction with subcutaneous or submuscular prostheses, complications of latissimus dorsi musculocutaneous flaps, and complications of transverse abdominal island flaps. Although no surgeon can expect to perform a series of complex yet delicate operations such as breast reconstructions and escape the complications described, it is hoped that by utilizing sound judgment in patient and procedure selection and having detailed knowledge of the procedure to be performed, such complications can be kept to a minimum and managed to a satisfactory resolution if and when they do occur.
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Abstract
The surgical repair of the bilateral cleft lip should take into consideration restoration of normal anatomy throughout the lip. If it is well done, it contributes to both form and function. A composite technique is presented here, with additions taking advantage of all tissues and based on this principle. Preoperative orthodontic preparation is used to achieve more satisfactory spatial relationships when appropriate and to permit a one-stage repair without lip adhesions. The technical aspects are clearly outlined and supported by case presentations. The technique saves all tissue; avoids tightness; provides good muscular function; constructs a labial sulcus providing for proper movement of the lip; provides good nasal sills and floors; is adaptable to complete or incomplete clefts; can be easily revised or used for secondary revisions in other cases, and so on.
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Georgiade GS, Voci VE, Riefkohl R, Scheflan M. Potential problems with the transverse rectus abdominis myocutaneous flap in breast reconstruction and how to avoid them. Br J Plast Surg 1984; 37:121-5. [PMID: 6229304 DOI: 10.1016/0007-1226(84)90055-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The transverse rectus abdominis myocutaneous flap offers a versatile and reliable technique of repair provided certain anatomical, physiological and surgical principles are closely followed. The operative technique and technical details are described and discussed.
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40
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41
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42
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43
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Abstract
The transverse abdominal island flap is not just another myocutaneous flap. Although it derives its blood supply from myocutaneous perforators, the portion of the skin and fat that overlies muscle comprises only about 20% of its surface. The surface area of the flap by far exceeds the surface area of the entire muscle that carries it. Its hemodynamics are more complicated than usual and consist of delicate communications between the superior and inferior deep epigastric systems and the deep and superficial epigastric systems across the midline. Its use in breast reconstruction has been as exciting as it is complex. We describe our experience with 60 consecutive patients and 65 transverse abdominal island flaps.
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44
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Abstract
Four test conditions of increasing complexity were used to evaluate the clinical efficacy of amniotic membranes as biologic dressings on donor sites and burn wounds in children. These were the clean-skin donor-site wound, the uncontaminated shallow partial-thickness burn wound, the bed of freshly excised full-thickness wounds, and the granulating surface of colonized burn wounds. The rate of epithelialization under amniotic membranes was the same as that under 5% scarlet red ointment or 0.5% silver nitrate solution dressings. Preservation of a healthy excised wound bed and maintenance of a low bacterial count in contaminated wounds paralleled the experience with human allograft dressings despite technical difficulties and the absence of vascularization of amniotic membrane and its fragile structure. Tentative conclusions are drawn as to the mechanisms by which biologic dressings exert their beneficial effects.
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45
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46
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Scheflan M, Hartrampf CR, Black PW. Breast reconstruction with a transverse abdominal island flap. Plast Reconstr Surg 1982; 69:908-9. [PMID: 7071252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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47
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48
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Scheflan M. Distally based ("reverse") latissimus dorsi myocutaneous flap. Ann Plast Surg 1982; 8:267-8. [PMID: 7103384 DOI: 10.1097/00000637-198203000-00023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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49
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Abstract
Several surgical modalities are available for closing ischial pressure wounds, but while they all aim for a permanently closed and well-padded ischial area, the manner in which this objective is achieved is different for each operation. Each technique has its unique design, transposes variable amounts and quality of soft tissue, and creates different scars and donor defects. These factors, in return, influence to a considerable extent the durability of each operation and, more important, create scars that dictate the nature of the secondary surgery in the all too common event of recurrent ulceration. No tissue is immune to pressure, and therefore there is no one best operation for closing pressure ulcers. This article critically reviews and updates contemporary surgical management and presents an orderly approach to selecting an operation for closing ischial pressure ulcers.
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50
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Abstract
A rectus abdominis musculocutaneous island flap for breast reconstruction following mastectomy is presented. The vascular anatomy of the abdominal wall has been clinically studied in patients undergoing abdominal lipectomy. Cadaver dissections are shown, demonstrating the anatomy, arc of rotation, and design alternatives of the rectus abdominis flap. The surgical technique is demonstrated and representative patients are shown.
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