ABSTRACT
PURPOSE: The transverse rectus abdominis musculocutaneous(TRAM) flap is the most commonly used autogenous tissue flap for breast reconstruction. Postoperatively, partial flap loss or fat necrosis are relatively common and it may result in a smaller breast volume with marked contour irregularities. These defects are not easy to reconstruct with local tissue rearrangement or with breast implants. The current authors present the results of 2 patients who underwent Latissimus dorsi(LD) flap reconstruction to correct partial flap or fat necrosis that developed after TRAM flap breast reconstruction. METHODS: Case1: A 50-year-old woman with left breast cancer visited for breast reconstruction after radical mastectomy. Initially, breast reconstruction with pedicled TRAM was performed. Postoperatively partial flap necrosis was developed. Secondary breast reconstruction using LD flap was done. Case2: A 51-year-old woman with left breast cancer visited for breast reconstruction after radical mastectomy. Initially, breast reconstruction with pedicled TRAM was performed. Postoperatively fat necrosis was developed. Secondary breast reconstruction using LD flap was done. RESULTS: Secondary breast reconstruction using LD flap survived completely and produce successful reconstruction. There was no significant complication in both patients. CONCLUSION: LD flap provides sufficient, vascularized skin and soft tissue. The flap can be molded easily to replace deficient tissue in all areas of the breast. These attributes make it an ideal candidate for salvage of the partially failed TRAM flap breast reconstruction.
Subject(s)
Female , Humans , Middle Aged , Breast , Breast Implants , Breast Neoplasms , Fat Necrosis , Fungi , Mammaplasty , Mastectomy, Radical , Necrosis , Rectus Abdominis , SkinABSTRACT
BACKGROUND: We evaluated the role and effects of prolotherapy in patients presenting with lower back pain and detected sacral asymlocation, by retrospectively analyzing the results of prolotherapy performed at our institute. METHODS: Twenty-three patients with referred pain in the lower back rather than distinct radiculopathy, were detected to have sacral asymlocation by simple X-ray from May 2004 through July 2005. The patients were treated with prolotherapy and manipulation by the Ongley's method around the lumbosacral junction, iliolumbar ligament, and sacroiliac joint. They were treated for approximately one to two week intervals, and during this period were rechecked by X-ray and evaluated using the visual analogue scale (VAS). RESULTS: A total of 23 patients were included in the study (10 male and 13 female), and the average age was 41 years. The average VAS at the time of visit was 8.5, the average treatment time was 4.7 days, and the average VAS after treatment was 2.1. CONCLUSIONS: Back pain, and associated leg and buttock pain, originate from several causes. In these case analyses, instability around the lumbosacral area and sacral asymlocation might have been important causes of patient back pain and associated buttock and leg pain. We therefore applied prolotherapy as well as manipulation techniques devised by Ongley to these patients, and obtained good results.
Subject(s)
Humans , Male , Back Pain , Buttocks , Diagnosis , Leg , Ligaments , Low Back Pain , Pain, Referred , Radiculopathy , Retrospective Studies , Sacroiliac JointABSTRACT
OBJECTIVE: Complete obliteration of aneurysm while preserving the parent artery, its branches, and perforators is sometimes difficult in case of internal carotid artery(ICA) aneurysm because of its anatomic feature. To solve this problem, we report an experience of neuroendoscope in the surgery of the ICA aneurysm. METHODS: Between September 2002 and May 2003, eighteen patients with 19 ICA aneurysms underwent microsurgical clipping with the help of the neuroendoscope. A rigid rod lens neuroendoscope (Karl Storz, Tuttllingen, Germany) with the diameter of 4.0mm and angles of 0 or 30 degrees was used for all patients. RESULTS: The clips were repositioned or changed in 6 patients with detection of remnant aneurysm in neuroendoscope. Occlusion of the branch of anterior choroidal artery by clip in 2 patients was observed along the aneurysmal neck in neuroendoscope. There were no neuroendoscope-related complications. CONCLUSION: Neuroendoscope is a safe and useful instrument to confirm the optimal position of the clip in the microsurgery of patients with ICA aneurysm.