One-Stage Implant-Based Breast Reconstruction With Polyurethane-Coated Device: Standardized Assessment of Outcomes

BACKGROUND

Nipple-sparing mastectomies (NSMs) and implant-based breast reconstructions have evolved from 2-stage reconstructions with tissue expansion and implant exchange to direct-to-implant procedures. In this study, we tested safety and efficacy of polyurethane-based implants according to standard assessment tools.

OBJECTIVES

This study aimed to test safety and feasibility of polyurethane-coated implants with standardized assessment employing internationally acknowledged evaluation criteria.

METHODS

Cases of NSMs followed by breast reconstruction in 1 stage with immediate prepectoral polyurethane-coated implant placement were retrospectively reviewed. Preoperative characteristics of the population have been collected. Adherence to quality assurance criteria of the Association of Breast Surgery-British Association of Plastic Reconstructive and Aesthetic Surgeons was verified. Complications were assessed with the Clavien Dindo classification, modified for the breast. Rippling, implant rotation, and malposition were also evaluated.

RESULTS

Sixty-three consecutive patients underwent 74 NSMs and immediate breast reconstruction with micro polyurethane foam-coated anatomic implants. In 5 cases we had unplanned readmissions with return to the operating room under general anesthesia (6.7%) and implant loss within 3 months from breast reconstruction (5 implants, 6.7%). Postoperative complications according to Clavien Dindo were grade 1 in 6 cases (8.1%), grade 2 in 3 cases (4%), and 3b in 5 cases (6.7%).

CONCLUSIONS

Polyurethane-coated implants may prevent rotation and malposition and capsular contracture in the short term. Unplanned readmission rates and implant loss rates in the short term may be slightly higher.See the abstract translated into Hindi, Portuguese, Korean, German, Italian, Arabic, Chinese, and Taiwanese online here: https://doi.org/10.1093/asj/sjad301.

LEVEL OF EVIDENCE: 4

[The intestinal infarct. Personal casistics and management of the patients]

AIM OF THE STUDY

Intestinal infarction is caused by secondary ischemic damage due to partial or complete obstruction of blood flow usually of arterial origin. About 50% of acute mesenteric infarctions are due to superior mesenteric artery emboli. Arterial thrombosis are most commonly caused to atherosclerosis, less commonly vasculitis, or hypercoaguable states. Venous thrombosis represents only 5-10% of cases usually associated with an hypercoagulable state, less commonly inflammation, portal hypertension or trauma. Non occlusive ischemia may represent up to 25% of acute mesenteric infarction, and is most commonly associated with shock, cardiac arrhythmia or acute pulmonary edema.

MATERIAL AND METHODS

From January 2002 to March 2007, 19 patients with intestinal infarction were treated, at the General Surgery and Oncology Department of Catania University. All patients were submitted to RX direct (RX) and computed tomography (CT). In 94.7% of patients RX has demonstrated clear bowel gaseous distension. Preoperative arteriography was carried out in 15.7%, whereas multislice angio-CT only in 36.8%. Second look laparotomy was executed to evaluate the effectiveness of treatments.

RESULTS

In 2/19 (10.5%) embolectomy of superior mesenteric artery were executed and in one case 30 cm of ileo resection only. In another 10.5% cases a surgical revascolarization of intestinal arteries with an anterograde by-pass technique was carried out. A resection with anastomosis has been necessary in 78.9% but in 26% of these procedures a second look laparotomy was necessary.

DISCUSSION

Three months survival was showed in 36.8% of patients. Completion angiography showed successful recanalization of the superior mesenteric artery without any complication and with satisfactory distal flow. Symptoms of the patients were alleviated.

CONCLUSION

Mesenteric ischaemia is a relatively uncommon cause of abdominal pain, but one with significant mortality.

[Complications in the laparoscopic treatment of primary and secondary hernias of the abdominal wall]

INTRODUCTION

Hernia is a common problem in general surgery practice. Incisional hernia can develop in 15-25% patients after abdominal surgery. The aim of this study is to evaluate the complications of hernia surgery.

MATERIALS AND METHODS

A retrospective analysis of database of surgery department from January 2003 to April 2009 has involved 84 patients who were treated in laparoscopy at the General Surgery and Oncology Department of Catania University. Sixty-three cases were incisional hernia, 21 primitive ventral hernia. In 51 cases (64.5%) the Dual Mesh were applied and in 28 (35.4%) the Bard Composix Mesh. Postoperatory complications were classified in early and late ones, respectively according to their occurrence before or after 30 days from surgery. Clinical follow ups were performed at one month and thereafter at quarterly intervals for the first year and then annually.

RESULTS

Among the early complications we found that patients treated with the Dual Mesh had an incidence of seroma, 8.9% versus 7.8% if compared to those treated with the Bard Composix. Insignificant was the impact of other early complications related to both types of mesh. Some influence in the onset of complications is BMI, in fact the average of complicated cases were 29.5%, while uncomplicated ones were lower: 25 (p < 0.05).

DISCUSSION

In our study we looked at early and late complications that can follow laparoscopic treatment of the parietal defects. We have not found statistically significant differences between the two types of implants, which are nevertheless among the early seroma complications which are found to be more frequent in cases treated with the Dual Mesh.

CONCLUSION

During this study we observed a higher incidence of seroma and recurrence in cases treated with Dual Mesh in agreement with data reported in literature.

[Treatment of microcarcinoma and papillary carcinoma of the thyroid]

AIM OF THE STUDY

Of our is to demonstrate that total thyroidectomy with lymphadenectomy of the six level is effective in papillary thyroid carcinomas than for microcarcinoma, according to recent acquisitions on the biological behavior of some microcarcinoma.

MATERIALS AND METHODS

Ours is a retrospective study based on analysis of the process of therapy in 2849 patients undergoing total thyroidectomy, performed from January 1985 to January 2008 by our group at the U.O. Clinica Chirurgica Ospedale "Vittorio Emanuele" of Catania, Italy.

RESULTS

Of all the interventions of total thyroidectomy, 75% performed for benign disease and 25% for malignant disease (PTMC 356 cases, 291 PTC cases, 56 cases of follicular carcinoma, 5 cases of medullary carcinoma, anaplastic carcinoma, 2 cases). 40% of PTMC underwent TT and subsequent follow up, because the diagnosis was placed postoperatively and in 60% diagnosis was placed during surgery with indication for TT and lymphadenectomy of the sixth level and subsequent follow-up showed no evidence of residual disease or relapse. PTC of 40% underwent a TT with lymphadenectomy of the sixth level. 60% of patients with PTC underwent a TT with lymphadenectomy of the sixth level and lateral cervical lymphadenectomy was performed only in 3 cases with a TT level VI lymphadenectomy of the bilateral lateral cervical lymphadenectomy. All patients in the follow-up post-operatively does not show in the following years, signs of residual disease or relapse.

CONCLUDING REMARKS

From the results we can confirm that a total thyroidectomy with lymphadenectomy of the sixth level, the more lateral lymphadenectomy of the neck when needed, ensures a good prognosis and few complications, if ever performed in expert hands. This applies to papillary carcinomas than for microcarcinoma whose surgical treatment (total thyroidectomy, lobectomy, subtotal thyroidectomy or near-total) is still debated.

[Parathyroid cyst. Case report]

Parathyroid cysts (PCS) are rare, and less than 300 cases have been reported in literature till now. They occur in most cases as a swelling at the lower third of the neck or are identified by means of diagnostic tests performed for other neck diseases. They are rarely symptomatic. They are often confused with thyroid nodules. Rarely give compressive symptoms. PCS are divided into functional (causing hyperparathyroidism, hypercalcemia and hypophosphatemia) and not functional PCS that represent about 10% of PCS. The non functional PCS are considereted true PCS because their wall is lined by secretory epithelium, instead of the functioning ones that are cystic degeneration of parathyroid gland adenomas. The histopathological data suggest the origin of two different variants of PCS. Their diagnosis requires knowledge of the disease and an high suspicion for it. Ultrasound associated with FNA is the first instance investigation. The ultrasound study allows to verify the nature of the cystic lesion and its peripheral vasculature, whereas FNA can observe the macroscopic characteristics of the liquid sample (clear liquid called "water from rocks") and to dose the levels of PTH and C-terminal/mid-region of PTH itself. The dose of intracystc PTH is the universally accepted method for diagnosis of PCS. The first treatment is the aspiration FNA, which can be curative, but recurrences can be treated surgically. Here is a case of PCS, which we observed in June 2009.