Annals of plastic surgery
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Annals of plastic surgery · May 2014
Outcomes of breast reconstruction in breast cancer patients with a history of mantle radiation for Hodgkin lymphoma.
Although mantle radiation (ie, extended field radiation) represented the standard of care in the past for Hodgkin disease, contemporary treatment of lymphoma consists of a multimodal approach with chemotherapy. Patients who were exposed to mantle radiation have a higher risk of breast cancer and are more susceptible to postoperative complications after breast reconstruction due to radiation. In this study, we present postoperative outcomes in patients with a history of mantle radiation who underwent mastectomy and breast reconstruction. ⋯ Although the risk of complications associated with preoperative radiation is well documented, physicians and patients should be cognizant of the increased risk of complications after mantle radiation as it represents a unique modality of radiation exposure.
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Marjolin's ulcers are rare cutaneous malignancies that most commonly present as squamous cell carcinomas in previously injured, chronically inflamed, or scarred skin. Acute and chronic types have been distinguished by the length of latency; by definition, the acute type occurs within 12 months of injury whereas the chronic type appears over 12 months after injury. In this report, 3 cases of acute Marjolin's ulcers are described and questions are raised about the diagnosis of acute Marjolin's ulcer. ⋯ Moreover, the rarity of the diagnosis and the relatively rapid rate of malignant degeneration from the inciting injury lead one to question whether the injury may have simply revealed or accelerated a previously existing occult cutaneous malignancy. With no definitive clinical, histological, or prognostic distinction between acute and chronic Marjolin's ulcers, the use of such terminology may not benefit a clinician's understanding or practice. In fact, it merely supports the clinical guideline that any nonhealing wound, acute or chronic, should be biopsied and sent for pathologic examination to ensure that it does not represent a Marjolin's ulcer.
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Annals of plastic surgery · May 2014
Case ReportsExtended reverse dorsal metacarpal artery flap for coverage of finger defects distal to the proximal interphalangeal joint.
Finger reconstruction distal to the proximal interphalangeal (PIP) joint is a challenging task for hand surgeons. Although extended reverse dorsal metacarpal artery (RDMA) flaps were described for coverage of finger defects, reports on repairs beyond the PIP joint are limited. The occurrence of venous congestion of the flaps and their treatments require further clarification. ⋯ Extended RDMA flaps can be effectively applied in the reconstruction of finger defects beyond PIP joint. Its advantages include a simple dissection, single-stage reconstruction, and preservation of digital artery and nerve. The donor site can be primarily closed if the flap width is less than 3 cm. Multiple subcutaneous heparin injection is a preferred solution in cases where venous congestion occurs in the flap.
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Annals of plastic surgery · May 2014
Transfusions in autologous breast reconstructions: an analysis of risk factors, complications, and cost.
Free tissue transfer requires lengthy operative times and can be associated with significant blood loss. The goal of our study was to determine independent risk factors for blood transfusions and transfusion-related complications and costs. ⋯ Prognostic/risk category, level III.
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Annals of plastic surgery · May 2014
The value of color duplex imaging for planning and performing a free anterolateral thigh perforator flap.
The free anterolateral thigh (ALT) flap has been used successfully for various soft tissue reconstructions. However, the drawback of this flap has been the difficulty associated with finding consistent perforators due to the variable anatomy. In this study, the value of color duplex imaging for reliably identifying the perforators of the flap was investigated. ⋯ The color duplex scan is a useful imaging modality for planning and performing free ALT flap. It enables surgeons to improve efficiency in the operating room and overall outcomes, as well as shortens the learning curve when first performing these highly variable flaps. The close working relationship between the vascular technologist and the surgeon may be the key to its success.