Donor Site Morbidity in Unilateral and Bilateral Transverse Musculocutaneous Gracilis (TMG) Flap Breast Reconstruction: Sensation, Function, Aesthesis and Patient-Reported Outcomes.

The transverse musculocutaneous gracilis (TMG) flap has become a popular choice for breast reconstruction. This study aimed to compare the donor site morbidity in unilateral and bilateral procedures. Patients receiving a TMG flap (January 2008-October 2019) were invited to a follow-up and grouped according to unilateral (UL group) or bilateral (BL group) breast reconstruction. Outcome criteria included sensation, function and aesthesis of the thighs. Patient-reported outcomes were surveyed using validated questionnaires. The number and kind of refinement procedures for aesthetic purposes on the donor thighs were evaluated. Thirty-eight patients with 59 TMG flaps were included in the study (UL group: n = 17, BL group: n = 21). Normal to slightly diminished superficial skin sensation was maintained in most of the thigh skin (98.4%). Strength and mobility were without impairment in >80% of the thighs in both groups. Thigh symmetry was achieved in both groups. Symmetrisation procedures were significantly more often performed in the UL group (p = 0.005). The total number of refinement procedures was similar in both groups. Patient-reported outcomes were similar with good appearance of the thighs and scars, excellent function and low pain levels. The TMG flap offers excellent function and sensation on the donor thigh. Thigh symmetry and good patient satisfaction may be achieved in both unilateral and bilateral breast reconstructions.

Safety and donor site morbidity of the transverse musculocutaneous gracilis (TMG) flap in autologous breast reconstruction-A systematic review and meta-analysis.

BACKGROUND AND OBJECTIVES: The transverse musculocutaneous gracilis (TMG) flap has gained popularity for breast reconstruction. However, the literature regarding its donor site morbidity is heterogeneous. This systematic review sought to clarify the evidence on donor site morbidity. METHODS: A systematic literature search was conducted. We included all articles reporting on donor-site morbidity of the TMG flap for breast reconstruction. The results were analyzed in R and its extension meta. A generalized linear mixed model was used to combine proportions and their 95% confidence intervals (CIs) in a random-effects meta-analysis. RESULTS: Nineteen articles provided an overall sample of 843 TMG flaps. The total flap loss was low at 2% (95% CI, 1%-3%). All patients were normal weight (pooled body mass index 22.75, 95% CI, 21.88-23.63). The incidence of wound dehiscence (8%, 95% CI, 4%-16%), seroma (4%, 95% CI, 2%-7%), hematoma (2%, 95% CI, 1%-4%) and infection (0%-5%) on the TMG donor site was low. Functional impairments included sensory disturbance (0%-74%), motoric deficits (0%-50%), and changes in the genital region (0%-24%), all of which were modest. CONCLUSIONS: This review confirms the safety and low donor site morbidity of the TMG flap in normal-weight patients, which is comparable to that of other popular free flaps in breast reconstruction.

Exposed children, protected parents; shade in playgrounds as a previously unstudied intervention field of cancer prevention.

For children, playgrounds represent a central place for physical activity and social interaction. However, at the playground, children are often exposed to sunlight. It is therefore surprising that sun exposure and shade levels at children's playgrounds have, to date, received very little attention internationally. The 'PlaSMa' study presented here addresses this gap in the research, analyzing the percentage of shaded areas compared with the total playground area and the main play area for children in 144 playgrounds in the German city of Mannheim. In addition to this hierarchical linear modeling was used to investigate various social contexts. It was found that, on average, 41% of the total playground area was shaded, while only 22% of the main play area for children was in the shade. Consequently, in many cases, children play in direct sunlight, while parents and caregivers sit in the shade. These results were found to be independent of social area characteristics.

Do Poorer Children Have Poorer Playgrounds? A Geographically Weighted Analysis of Attractiveness, Cleanliness, and Safety of Playgrounds in Affluent and Deprived Urban Neighborhoods.

Background: Playgrounds are a central resource when it comes to physical activity among minors. This study assesses the association between area deprivation and the quality of playgrounds. Methods: All playgrounds in the city of Mannheim, Germany (145 km2, 311,000 inhabitants) were visited between July 2016 and January 2017 as part of a systematic audit. Each playground's amenities, attractiveness, cleanliness, and safety were operationalized using well-established, validated instruments. Global and geographically weighted regression models were fitted to investigate the association of the amenities, attractively, cleanliness, and safety of playgrounds with sociodemographic indicators on the social area level. Results: A total of 271 playgrounds were identified. Overall, population density showed the strongest association with all quality variables in the global models, followed by the central official poverty indicator. Significant spatial variation in parameter estimates was found for most of the deprivation indicators with regard to attractiveness, cleanliness, and safety of playgrounds indicating locally negative associations between area-level deprivation and quality. Conclusion: Our findings illustrate the importance of a qualitative approach by analyzing physical activity resources. Concerning the quality of playgrounds, the data from this study support the deprivation amplification hypothesis, meaning that children who are already socially disadvantaged might experience a further contextual disadvantage.