The importance of a skin bridge in peripheral tissue perfusion in perforator flaps.

BACKGROUND: Perforator flaps are increasingly used in reconstructive surgery. However, the microvascular perfusion pattern within these flaps remains essentially unknown. In perforator flaps, the importance of preserving the skin bridge at the base is still an object of debate. The authors hypothesized that dividing the skin bridge will increase peripheral tissue perfusion in islanded perforator flaps. METHODS: The abdominal panniculus in patients submitted to elective abdominoplasty was used (n = 24). Flap perfusion was measured by dynamic laser-induced fluorescence videoangiography. The fluorescent dye indocyanine green was injected intravenously before and after conversion of a perforator flap with an intact skin bridge into an islanded perforator flap. To evaluate perfusion, mean pixel intensity and mean perfusion index were calculated in a control zone and in two zones in the flap. RESULTS: In zone I (the most peripheral zone), surgical release of the skin bridge increased mean pixel intensity (19.1 ± 1.9 versus 24.1 ± 2.1; p < 0.001). The mean perfusion index was calculated as 7.5 ± 5.5 and 12.6 ± 6.3 before and after surgical conversion to islanded perforator flaps, respectively. In zone II (the more proximal zone), mean pixel intensity increased (from 30.8 ± 2.8 to 33.7 ± 2.3; p < 0.001) after surgical release of the skin bridge. The mean perfusion index was 18.5 ± 11.1 and 15.6 ± 6.2. CONCLUSIONS: In this human experimental study, conversion of a perforator flap with a skin bridge into an islanded perforator flap increases peripheral tissue perfusion. This finding provides a physiologic basis for using islanded perforator flaps, with enhanced flap mobility and length.

Brief report: improved pain relief using intermittent bupivacaine injections at the donor site after breast reconstruction with deep inferior epigastric perforator flap.

BACKGROUND: Deep inferior epigastric perforator flap surgery usually results in postoperative pain from the donor site requiring opioids. METHOD: We examined the effect of bupivacaine 2.5 mg/mL, 20 mL given every third hour for 72 hours postoperatively through 2 thin catheters placed on the donor site in a double-blind placebo-controlled study consisting of 2 x 20 patients. RESULTS: The bupivacaine group had significantly reduced pain at rest and during coughing. The placebo group needed 2 to 3 times more opioids in the 72-hour observation period. No difference was seen in the frequency of nausea or the consumption of antiemetic drugs. CONCLUSION: We conclude that intermittent delivery of bupivacaine at the abdominal donor site significantly reduces the postoperative pain and need for narcotic rescue medication.

[40 years of silicone breast implants]. / Silikonbrystimplantater gjennom 40 år.

BACKGROUND: It is estimated that approximately 50,000 Norwegian women have silicone breast implants following breast augmentation or breast reconstruction. Their numbers are growing and doctors will more often be confronted with the health problems related to these implants. MATERIAL AND METHODS: This review is based on information retrieved from Medline and our clinical experience. RESULTS AND INTERPRETATION: The modern silicone breast implant is the product of four decades of development. The ongoing debate on health problems associated with the implants has been a vibrant stimulator for research, but a causal relationship between implants and the development of breast cancer and autoimmune defects has not been found. The implants are not, however, without complications; more research is required in order to improve the implants and for quality assurance of treatment and follow up.

[Breast reconstruction following mastectomy]. / Brystrekonstruksjon etter mastektomi.

BACKGROUND: Breast cancer is the most common cancer in women, many of whom feel less feminine after the loss of a breast. Breast reconstruction can strengthen their self image, hence it is an excellent treatment option for those who have had a mastectomy. MATERIAL AND METHODS: This review is based on information retrieved from Medline and on clinical experience. We have also asked all departments of plastic surgery in Norway which methods of breast reconstruction they are using. RESULTS AND INTERPRETATION: Breast reconstruction following mastectomy is performed by plastic surgeons and if necessary in cooperation with breast surgeons. The missing breast can be reconstructed with an implant, autologous tissue or by combining the two methods. Many years of experience have resulted in high standards within reconstructive breast surgery. In Norway breast reconstruction is performed in every department of plastic surgery.

[Keloid and hypertrophic scars]. / Keloid og hypertrofisk arrdanning.

BACKGROUND: Keloid and hypertrophic scars develop most frequently in wounds with high skin tension and especially on the upper truncus. Both are characterized by an excessive dysfunctional collagen metabolism. MATERIAL AND METHODS: The article presents data from research in current literature and discuss the treatment of keloid and hypertrophic scars. RESULTS AND INTERPRETATION: Patients that are undergoing elective surgery should be handled with surgical techniques that reduce wound closing tension. Patients who are at high-risk or show excessive scar development should follow standard treatment. First-line therapy is silicone sheeting and/or pressure. In case of minimal response, steroid injections should be started after two months. The patient must be re-evaluated for a surgical approach combined with conservative treatment if the result is unsatisfactory after 12 months.