Oncological Safety, Surgical Outcome, and Patient Satisfaction of Oncoplastic Breast-Conserving Surgery With Contralateral Balancing Reduction Mammoplasty.

INTRODUCTION: Oncoplastic breast-conserving surgery (OBCS) is considered a cornerstone in the management of locally invasive breast cancer. We evaluated patient-reported outcomes of OBCS with contralateral balancing breast reduction mammoplasty and reviewed its oncologic outcomes and complications. METHODS: This is mixed method study design using retrospective chart review and prospective cohort study. Patient demographics were reviewed. Outcome measures included clinicopathologic characteristics, complications, margin status, local recurrence, tumor histopathologies, duration of follow-up, patient satisfaction, self-esteem, event-related stress, and quality of life. RESULTS: A total of 48 patients were included in this study. Complete excision with negative margins was obtained in 42 (87.5%) patients, positive margins in 6 (12.5%) patients, all who had re-excision with repeat lumpectomy. Thirteen patients developed minor complications, defined as being managed as an outpatient. No patients developed major complications requiring inpatient admission. These complications did not delay commencement of chemotherapy or radiotherapy. Postsurgery BREAST-QTM26 scores demonstrated no statistical difference in satisfaction with breasts, nipples, and sexual well-being. There was high satisfaction with overall outcome with average score of 80.8%. For the Rosenberg self-esteem scale, the results were similar for 3- and 12-month post-operative indicating maintenance of normal self-esteem post-operatively. The Impact of Events Scale showed statistically significant difference at 12-month post-operative (25.1) when compared with preoperative scores indicating that patients had lower event-related stress. There was no significant change in Hospital Anxiety and Depression Scale. CONCLUSION: Our study has shown that the patient who undergo OBCS have high patient-reported outcomes with acceptable oncologic outcomes and complication rates.

INTRODUCTION: La chirurgie oncoplastique de conservation mammaire (COCM) est considérée comme un pilier de la prise en charge du cancer du sein localement invasif. Les chercheurs ont évalué le pronostic de COCM déclaré par les patientes après une mammoplastie de réduction avec symétrie controlatérale et ont analysé les résultats oncologiques et les complications. MÉTHODOLOGIE: Dans la présente étude à méthodologie mixte, les chercheurs ont privilégié une analyse rétrospective de dossiers et une étude de cohorte prospective. Les chercheurs ont examiné la démographie des patients. Les mesures de résultat incluaient les caractéristiques clinicopathologiques, les complications, l'état des marges, les récurrences locales, l'histopathologie des tumeurs, la durée du suivi, la satisfaction des patientes, l'estime de soi, le stress lié à l'événement et la qualité de vie. RÉSULTATS: Au total, 48 patientes ont participé à l'étude. De ce nombre, 42 (87,5 %) ont subi une excision complète aux marges négatives, et six (12,5 %), une excision complète aux marges positives et toutes ont subi réexcision avec une reprise de la lumpectomie. Treize patientes ont développé des complications mineures, définies comme prises en charge dans un contexte ambulatoire. Aucune patiente n'a développé de complications majeures exigeant une hospitalisation. Les complications n'ont pas retardé le début de la chimiothérapie ou de la radiothérapie. Les scores BREAST-QTM26 après l'opération n'ont démontré aucune différence statistique pour ce qui est de la satisfaction envers les seins, les mamelons et le bien-être sexuel. Les patientes avaient un taux de satisfaction élevé à l'égard des résultats globaux, pour un score moyen de 80,8 %. Sur l'échelle d'estime de soi de Rosenberg, le maintien de l'estime de soi normal était semblable trois et 12 mois après l'opération. L'échelle d'effet des événements a révélé une différence statistiquement significative 12 mois après l'opération (25,1) par rapport aux scores avant l'opération, indiquant que les patientes ressentaient moins de stress envers l'événement. Il n'y avait pas de changement significatif dans l'échelle d'anxiété et de dépression à l'hôpital. CONCLUSION: La présente étude a révélé que la patiente qui subit une COCM déclare des résultats très positifs, dont les pronostics oncologiques et le taux de complications sont acceptables.

Preservation solutions for attenuation of ischemia-reperfusion injury in vascularized composite allotransplantation.

Vascularized composite allotransplantation represents the final level of the reconstructive ladder, offering treatment options for severe tissue loss and functional deficiencies. Vascularized composite allotransplantation is particularly susceptible to ischemia-reperfusion injury and requires preservation techniques when subjected to extended storage times prior to transplantation. While static cold storage functions to reduce ischemic damage and is widely employed in clinical settings, there exists no consensus on the ideal preservation solution for vascularized composite allotransplantation. This review aims to highlight current clinical and experimental advances in preservation solution development and their critical role in attenuating ischemia-reperfusion injury in the context of vascularized composite allotransplantation.

Diaphragm function in acute respiratory failure and the potential role of phrenic nerve stimulation.

PURPOSE OF REVIEW: The aim of this review was to describe the risk factors for developing diaphragm dysfunction, discuss the monitoring techniques for diaphragm activity and function, and introduce potential strategies to incorporate diaphragm protection into conventional lung-protective mechanical ventilation strategies. RECENT FINDINGS: It is increasingly apparent that an approach that addresses diaphragm-protective ventilations goals is needed to optimize ventilator management and improve patient outcomes. Ventilator-induced diaphragm dysfunction (VIDD) is common and is associated with increased ICU length of stay, prolonged weaning and increased mortality. Over-assistance, under-assistance and patient-ventilator dyssynchrony may have important downstream clinical consequences related to VIDD. Numerous monitoring techniques are available to assess diaphragm function, including respiratory system pressures, oesophageal manometry, diaphragm ultrasound and electromyography. Novel techniques including phrenic nerve stimulation may facilitate the achievement of lung and diaphragm-protective goals for mechanical ventilation. SUMMARY: Diaphragm protection is an important consideration in optimizing ventilator management in patients with acute respiratory failure. The delicate balance between lung and diaphragm-protective goals is challenging. Phrenic nerve stimulation may be uniquely situated to achieve and balance these two commonly conflicting goals.

The Toronto Sarcoma Flap Score: A Validated Wound Complication Classification System for Extremity Soft Tissue Sarcoma Flap Reconstruction.

BACKGROUND: Flap reconstruction plays an important role in limb preservation after wide resection of extremity soft tissue sarcoma (ESTS), but can be associated with high rates of postoperative wound complications. Currently, no standardized system exists for the classification of these complications. This study aimed to develop a standardized classification system for wound complications after ESTS flap reconstruction. METHODS: Outcomes of ESTS flap reconstructions were analyzed in a retrospective cohort of 300 patients. All wound- and flap-related complications were identified and categorized. Based on these data, a scoring system was developed and validated with a prospective cohort of 100 patients who underwent ESTS flap reconstruction. RESULTS: A 10-point scoring system was developed based on the level of intervention required to treat each complication observed in the retrospective cohort. Raters applied the scoring system to the prospective patient cohort. Validation studies demonstrated excellent inter-rater and intra-rater reliability (weighted Cohen's kappa range, 0.82 [95% CI, 0.5-1.0] to 0.99 [95% CI, 0.98-1.0] and 0.95 [95% CI, 0.84-1.0] to 0.97 [95% CI, 0.92-1.0], respectively). The majority of the raters reported the score to be simple, objective, and reproducible (respective mean scores, 4.76 ± 0.43, 4.53 ± 0.62, and 4.56 ± 0.56 on 5-point Likert scales). CONCLUSION: The Toronto Sarcoma Flap Score (TSFS) is a simple and objective classification system with excellent inter- and intra-rater reliability. Universal adoption of the TSFS could standardize outcome reporting in future studies and aid in the establishment of clinical benchmarks to improve the quality of care in sarcoma reconstruction.

Cost and outcome analysis of breast reconstruction paradigm shift.

Increased bilateral mastectomy for breast cancer treatment has generated an increased demand for bilateral breast reconstruction. This study examines changing patterns of reconstruction over the last decade to accommodate increased case volume and decreased morbidity associated with reconstruction. A single institution series of 3171 consecutive breast reconstruction cases of more than 10 years was divided into 2 periods, that is, 1999 to 2004 and 2005 to 2010. Bilateral breast reconstruction case volume increased 260% from 1999 to 2004 (n = 237) to 2005 to 2010 (n = 634). Mean patient age at diagnosis decreased by 7 years (P < 0.001). In 2005 to 2010, autologous reconstruction decreased from 60% to 26%, implant-based reconstruction increased from 40% to 74%. There was a noted increase in single-stage implant reconstruction and selective application of perforator flaps for bilateral autologous reconstruction (P < 0.001). Two-staged tissue expander reconstruction accounted for the greatest share of total cost (45%) in the later period. A younger patient demographic and increased case volume were accommodated through increased single-staged and prosthesis-based procedures.