Duplex echography as an adjuvant tool to clinical examination to detect early postoperative free flap vascular compromise.

BACKGROUND: Clinical examination remains the cornerstone for postoperative monitoring of free flaps but is highly dependent on the surgeon's ability and experience. Duplex echography provides a noninvasive objective evaluation of tissue perfusion. The authors hypothesized that duplex echography may be a more sensitive and specific monitoring method for early detection of postoperative flap compromise compared to clinical examination alone. The goal was to evaluate any differences between combined duplex echography and clinical examination flap monitoring versus isolated clinical evaluation. METHODS: A total of 730 free flaps in 700 patients were included in the study. We conducted an intra-subject prospective study of a cohort of patients who underwent free flap reconstruction in our unit to compare clinical examination with duplex echography for postoperative monitoring. An inter-subject study was also undertaken comparing the prospective cohort with a historical control group of patients in whom free flap monitoring was made using clinical examination alone. The patency flow and velocities through the artery and vein of the flap were measured at the donor and recipient vessels of every anastomosis by duplex scanning, by the same plastic surgeon every 4 hr, during the first 18 hr after surgery. RESULTS: Duplex echography and clinical evaluation were used in 175 patients. The historical cohort included a total of 525 flaps. Every patient with suspicion of vascular compromise based on duplex echography was taken back for surgical re-exploration. There were no cases of overdiagnosis using duplex echography (Sensitivity 100%, Specificity 100%). Clinical evaluation detected issues with the vascularan astomoses in 23/175 flaps. However, it failed to detect 12/22 cases which presented with vascular complications and gave a false indication of possible complications in 13 flaps (Sensitivity 45%, Specificity 92%). CONCLUSION: In our practice, duplex echography is considered a useful adjunct monitoring tool for early detection of postoperative flap compromise, which compliments clinical evaluation. It provides anatomic and hemodynamic information of the vascular status and may therefore increase survival of flaps by allowing earlier detection of vascular compromise, compared to clinical examination alone, in postoperative monitoring of free flaps.

Fat Grafting Technique, A Paradigm Shift in the Treatment of Tuberous Breast.

BACKGROUND: The tuberous breast syndrome is a condition that affects young women and can bring on serious disorders of self-esteem. There are numerous surgical techniques to correct this condition, but most of them include the use of breast implants to replace lack of volume. Nowadays, patients are increasingly becoming more demanding to get a definitive solution with minimal aesthetic sequelae. METHODS: We present a series of 11 patients with tuberous breast deformities treated with lipofilling technique. Fat harvest was performed by conventional lipoaspiration with 3 mm cannulas, centrifuged at 2000 rpm for 2 minutes and injected in the breast were was needed with 1.9 mm blunt cannulas. RESULTS: The patient's average age was 24 year old with a BMI of 23.4 kg/m2. Volumes between 80 and 250 ml per breast were injected in every session, requiring a total volume of 413 ml per breast. Most patients required up to two procedures to achieve the complete breast correction. The mean follow-up was 29.7 months. All patients had good aesthetics results with minimal complications. CONCLUSION: Natural breast mound with excellent cosmetic result can be achieved with fat grafting. Fat grafting main advantage is to respond to physiological changes in weight over time. In addition, lipofilling do not carry the inherent complications of implants. We strongly believe it is a safe and easy technique to reproduce in properly selected patients and with minimal morbidity it can cause the best natural result.

Breast Cancer Recurrence Is not Increased With Lipofilling Reconstruction: A Case-Controlled Study.

BACKGROUND: Lipofilling use has become a revolutionary technique for the correction of breast defect including breast cancer sequelae. The potential risk that progenitor cells included in fat graft tissue may contribute to disease progression by stimulation of residuary breast cancer cells in a tumor bed has set alarms regarding its safety. The aim of this study was to identify lipofilling interference over breast recurrence in patients with cancer history. METHODS: We reviewed 205 patients with fat grafting reconstruction after breast cancer surgery performed in our institution between the years 2007 and 2015. For comparative analysis, we selected 2 matched control patients with similar characteristics who did not undergo any lipofilling procedure. RESULTS: No significant differences in recurrence were observed in patients who had lipofilling compared with controls, local (2.4% vs 3.2%, P = 0. 485), regional (1.0 vs 0.7, P = 0.968), and distant (3.4% vs 3.9%, P = 0.590) recurrence. An increased risk of locoregional recurrence (P = 0.014) was detected when lipofilling took place within the first 36 months after cancer surgery. CONCLUSIONS: This study provides patients and surgeons with the confidence to keep using lipofilling reconstruction in women with breast cancer history when it is performed in a hospital setting by trained surgeons.

The efficacy of intralesional cryosurgery in the treatment of small- and medium-sized basal cell carcinoma: A pilot study.

BACKGROUND: Cryotherapy has been used in treatment of basal cell carcinoma (BCC). In 1993, Weshahy described his technique for applying cryotherapy in depth, i.e. intralesional cryosurgery (ILC), using Weshahy's cryoneedles. OBJECTIVE: To assess the clinical efficacy of ILC using Weshahy cryoneedles in the treatment of small- and medium-sized BCC with >5-year follow-up. PATIENTS AND METHODS: This pilot study included 43 patients with histopathologically proven BCCs of the nodular and superficial type. All BCCs were treated by Intralesional cryosurgery (Weshahy's technique) using specially designed angled or hook shaped needles. RESULTS: The study included 22 men (51.2%) and 21 women (48.8%). Out of 46 lesions, 45 lesions (97.8%) showed a cure in one session, and only 1 nodular lesion showed a small recurrence in a marginal region of the site treated. In relation to the cosmetic outcome, 32 (69.6%) lesions showed a good to excellent outcome, 11 (23.9%) a moderate to good outcome and 3 (6.5%) a poor cosmetic outcome. The cosmetic outcome was better in females (p = 0.578), with small lesions (p = 0.048), and between 40 and 70 years old (p = 0.046). CONCLUSION: Cryotherapy is an alternative treatment for a small- to medium-sized BCC in selected patients.