Biologic collagen cylinder with skate flap technique for nipple reconstruction.

A surgical technique using local tissue skate flaps combined with cylinders made from a naturally derived biomaterial has been used effectively for nipple reconstruction. A retrospective review of patients who underwent nipple reconstruction using this technique was performed. Comorbidities and type of breast reconstruction were collected. Outcome evaluation included complications, surgical revisions, and nipple projection. There were 115 skate flap reconstructions performed in 83 patients between July 2009 and January 2013. Patients ranged from 32 to 73 years old. Average body mass index was 28.0. The most common comorbidities were hypertension (39.8%) and smoking (16.9%). After breast reconstruction, 68.7% of the patients underwent chemotherapy and 20.5% underwent radiation. Seventy-one patients had immediate breast reconstruction with expanders and 12 had delayed reconstruction. The only reported complications were extrusions (3.5%). Six nipples (5.2%) in 5 patients required surgical revision due to loss of projection; two patients had minor loss of projection but did not require surgical revision. Nipple projection at time of surgery ranged from 6 to 7 mm and average projection at 6 months was 3-5 mm. A surgical technique for nipple reconstruction using a skate flap with a graft material is described. Complications are infrequent and short-term projection measurements are encouraging.

First experience with the use of a collagen fistula plug to treat enterocutaneous fistulas.

This report describes the authors' first experiences with the use of the Biodesign Enterocutaneous Fistula Plug (EFP). Six patients presented with intraperitoneal abscess and associated chronic bowel fistulas. The fistulas were treated by delivering an EFP by using radiologic guidance. The EFP placement procedure was successfully performed in all patients. All fistulas were closed within 2 weeks. Fistula recurrence occurred in two patients (33%) at 9 and 12 months after the procedure. One recurrence was associated with an adverse reaction to chemotherapy. The other was associated with the silicone flange migrating out of the bowel lumen. The Biodesign EFP offers a promising new approach for the treatment of enterocutaneous fistulas.