Radiation effects on the cosmetic outcomes of immediate and delayed autologous breast reconstruction: an argument about timing.

OBJECTIVE: To conduct a systematic review to gather the available evidence on the optimum timing of the radiotherapy in relation to autologous breast reconstruction. MATERIAL AND METHODS: The data was extracted from scientific databases, and a manual follow-up of references. The studies were selected which included at least 20 patients with any method of autologous breast reconstruction who were treated with adjuvant radiotherapy either before or after their reconstruction, and had addressed the effects of radiotherapy on the cosmetic outcome in their results. The principal outcome was cosmetic appearance. Secondary outcomes were immediate and delayed complications. RESULTS: We could not find any randomised controlled trial on this topic. Ten studies were included, most were retrospective, heterogeneous in terms of control groups, radiation doses, follow-up duration, and outcome measurements. Two studies included no control groups, and four studies compared the outcomes of patients with radiotherapy either before (n=3) or after (n=1) autologous breast reconstruction. The overall incidence of complications was increased in patients with radiotherapy in three out of these four studies. Only four studies directly compared the outcomes of patients who received radiotherapy before with patients who received radiotherapy after autologous breast reconstruction and two out of these reported worse outcomes associated with post-reconstruction radiotherapy. CONCLUSIONS: Despite the paucity of the published data, the current evidence suggests that the radiation has a deleterious effect on autologous flap reconstruction. Until better methods of radiation delivery can be devised to minimise the long term radiation sequelae in the irradiated tissue, delayed reconstruction seems to be a safe option in most of the cases. However, the findings from these studies should be interpreted with great caution before generalising from their results.

Fingertip reconstruction with a dorsal island homodigital flap.

A distal dorsal island homodigital flap has been used for reconstruction of fingertips in nine patients who sustained traumatic amputations either obliquely or transversely through the middle of the distal phalanx. Seven of the nine patients attended for follow-up. All the flaps survived with the exception of a small area of partial necrosis in one patient. Fingertip reconstruction with this flap is a one-stage procedure, safe, easy to perform and provides durable tissue support for the nail to regrow undeformed.

Regeneration of the distal phalanx. A case report.

A patient who suffered a traumatic avulsion of the distal phalanx of the right index finger is described. Following simple wound toilet and closure, the distal phalanx generated to give an excellent functional result.

The complications of tissue expansion in breast reconstruction: a review of 75 cases.

Seventy-five consecutive cases of breast reconstruction using tissue expansion are reviewed and the complications encountered are discussed. We conclude that, with careful patient selection, tissue expansion offers a simple, safe and reliable method of breast reconstruction.

The complications of fasciocutaneous flaps.

We analyzed the complications in a series of 126 fasciocutaneous flaps. The overall complication rate was 40%, which included both early and late complications. The early complications were divided into major and minor groups. The main avoidable causes of major complications were poor design; the presence of orthopedic metal in the wound; and late referral of infected wounds, particularly of the lower leg. In all the cases in which partial necrosis occurred, the fascia had an adequate blood supply, either to allow the wound to heal with dressings or, if the necrosis was more extensive, to provide a good bed for a split-skin graft.

Breast reconstruction by tissue expansion.

The techniques of tissue expansion for use in breast reconstruction is described, together with the results of its use in 33 patients. The advantages and disadvantages of tissue expansion in relation to other currently favoured techniques are discussed. It is concluded that tissue expansion represents a major advance in the field of breast reconstruction.

A prospective study of nasal fractures.

A prospective survey of 60 patients requiring manipulation under anaesthetic for nasal fractures has been carried out using pre- and post-operative photographs in conjunction with a standardized proforma. The results are presented and discussed.

The correction of scalp hair defects by tissue expansion.

This paper presents the results and complications in the correction of partial scalp alopecia in ten patients using the technique of 'tissue expansion'. The average size of defect that was covered by expanded hair bearing scalp was 45.9 cms2, and the largest defect covered measured 11 X 6 cm. This series indicates that tissue expansion is now one of the most promising methods available for dealing with the difficult problems of partial alopecia which can present to surgeons and physicians in a wide range of specialties.

Continuous subcutaneous tissue pH measurement as a monitor of blood flow in skin flaps: an experimental study.

A miniaturised glass pH probe that makes possible the continuous measurement of subcutaneous tissue pH is described. This instrument has been evaluated as a monitor of blood flow in experimental skin flaps. A rapid fall in tissue pH in response to either arterial or venous occlusion was observed. The results suggest that this technique may be a useful method of monitoring microvascular free flaps.