Correction of regional defects in the breast with acellular allogeneic dermis after removal of polyacrylamide hydrogel / 中华医学美学美容杂志

Objective When implantation of a prosthesis is performed for patients with a local defect of the breast after the removal of polyacrylamide hydrogel,incomplete coverage of the surface of the prosthesis occurs in these cases.The aim of this study was to explore the effectiveness of acellular allogeneic dermis in the repair of defects after prosthesis implantation.Methods Breast prosthesis implantation together with acellular allogeneic dermis repair was performed in 46 cases.Acellular allogeneic dermis was applied to cover the surface of the prosthesis,and interrupted suture was used between the margin of the dermis and the incisional margin of the gland,while appropriate tension was maintained.Results There were no complications occurred postoperatively.Correction of local depression in the breast was excellent in all cases.Histological examination showed the implanted acellular allogeneic dermis was integrated into the peripheral tissue.Conclusions Acellular allogeneic dermis can be used for repairing breast and muscle defects,in order to cover the prosthesis.Although it cannot significantly increase the thickness of the subcutaneous tissue,it can maintain the integrity of the peripheral tension around the prosthesis.In this way,it can avoid bulging of the prosthesis caused by a sudden reduction of local tension.Moreover,donor site injury is avoided.Acellular allogeneic dermis is an effective method for the repair of local breast defects.

Hemodynamic effect of different kinds of venous augmentation in a pig transmidline flap model of DIEP flap.

BACKGROUND: Venous augmentation enhances the viability of the deep inferior epigastric perforator (DIEP) flap. We compared the efficacy of three venous superdrainage procedures on survival area and hemodynamics of the DIEP flap model. METHODS: In 24 castrated Yorkshire pigs, a true abdominal perforator-based flap was created based on four perforators arising from the deep superior epigastric vessels. Three remaining venous tracts were alternated to represent different venous augmentations of the DIEP flap. Analyzed were flap perfusion, venous blood pressure, and venous blood gas. In control animals, all three supplemental veins were ligated; the ipsilateral superficial superior epigastric vein (SSEV) was retained in the IS (ipsilateral SSZV augmented) group, the contralateral SSEV in the CS (contralateral SSZV augmented) group and the contralateral deep superior epigastric vein (DSEV) in the CD (contralateral DSZV augmented) group. The flap was then returned to its bed, and animals sacrificed on the seventh day postoperatively. DIEP flap survival was then recorded. RESULTS: All four intraoperative parameters showed improved perfusion of the distal flap area under distal venous augmentation. Efficacy was CDSEV > CSSEV > ISSEV > none. Skin islands of the CD and CS groups survived completely. In the IS and control groups, 96.33 ± 3.16% and 84.00 ± 7.55% of skin islands survived, respectively. Test groups were statistically significantly different from the control group but not from each other. CONCLUSIONS: Venous superdrainage effectively enhances DIEP flap survival. Benefit was relatively the same for all procedures. An additional venous route should be preserved with large or multiterritory flaps to improve venous congestion.

Autologous fat transfer augmentation using external tissue expansion / 中华医学美学美容杂志

Objective To observe the clinical effects of autologous fat injection augmentation with external tissue expander.Methods 26 cases wore the Brava device,a bra-like vacuum-based external tissue expander for 4 weeks before autologous fat injection augmentation.Patients resumed Brava wear for 14 more days after fat injection.Results 26 women had a mean augmentation volume at 3 months of 76 ml per breast after single fat injection.Follow-up ranged from 1 month to 12 months.There were no complications such as nodules,masses,or cysts occurred.Patient satisfaction was as sessed:25 cases (95.6 ％) were satisfied with the cosmetic results.Conclusions The addition of Brava expansion before autologous fat grafting leads to significantly larger breast augmentations,with more fat graft placement,higher graft survival rates,and minimal graft necrosis or complications,demonstrating high safety and efficacy for the procedure.

Transmidline abdominal skin flap model in pig: refinements and advancements.

Abdominal flaps have recently gained considerable popularity in breast reconstruction, and their importance and advantages have been widely accepted. Given the unreliability of the distal parts in these flaps and the advancement of microsurgery, many modifications and improvements have been made. To get a better understanding of these flaps, researchers have encouraged the search for a suitable flap model. The purpose of this study was to clarify the anatomical and physiological features of the transmidline abdominal flap model in pig. We included 16 white female Yorkshire pigs in this study. In six pigs, the vascular anatomy of the abdominal region was studied by multidetector row computed tomographic angiography and anatomic dissection. In the remaining 10 pigs, three kinds of transmidline abdominal flap models were established. The pigs were scanned on the abdominal flap to evaluate the perfusion zones after the true abdominal transmidline flap was created, and then they were sacrificed to determine the flap survival area 7 days after surgery. The results of the study were as follows. (1) The pig's deep inferior epigastric vessels were smaller than deep superior epigastric vessels both in length and diameters. (2) The deep superior epigastric artery always bifurcates into two groups; each group gives off five or six branches. (3) The superficial superior epigastric veins were present, while the superficial epigastric arteries were absent in all the animals included. (4) The linea alba abdominis was tough and lack of vascular structures. The average perfusion units were 197.0 ± 24.2, 103.2 ± 36.4, 138.8 ± 25.4, and 30.2 ± 11.8 from zone I to zone IV. All the flaps underwent partial necrosis. The flap survival area percentage was 85.9 ± 4.1%. The transmidline abdominal skin flap in pig is a reliable and true abdominal flap model for future physiological studies, especially the circulatory dynamics in transmidline abdominal flaps.

Breast reconstruction after mastectomy: a preoperative evaluation system / 中华医学美学美容杂志

Objective To establish a preoperative evaluation system for breast reconstruction,and to simplify the selection of surgical methods for breast reconstruction in a standard way.Methods We investigated respectively 192 successful cases that underwent breast reconstruction from July 2003 to July 2009.The factors influencing selection of methods for breast reconstruction were studied.The results presented in more than 50 ％ were collected.Results A special table of the preoperative evaluation system for breast reconstruction was established by analyzing statistical results. Conclusions The selection of methods for breast reconstruction is simplified according to this preoperative evaluation system.

The value of multidetector-row CT angiography for pre-operative planning of breast reconstruction with deep inferior epigastric arterial perforator flaps.

The deep inferior epigastric artery perforator (DIEP) flap has recently become the first option for breast reconstruction. However, the anatomy of the deep inferior epigastric artery varies greatly from one individual to another and even from one hemiabdomen to the other. An optimal pre-operative evaluation method that adequately maps the underlying vasculature has been lacking. The advent of multidetector-row CT (MDCT) angiography has proven highly accurate at detailing the vasculature, but no reports have documented its value during pre-operative planning. From December 2006 to May 2008, 22 consecutive patients who underwent MDCT angiography before breast reconstruction using DIEP flaps were selected as the test group, and 22 former patients who did not undergo MDCT before the same procedure were selected as the control group. The two groups were evaluated for the ratio of pre-operative redesign, intra-operative method changes, time spent on flap harvest and the ratio of flap-associated complications. The pre-operative redesign ratio was 22.7% in the test group and 0% in the control group. The intra-operative method change ratio was 0% in the test group and 13.6% in the control group. The mean time spent on flap harvest was 2.8 +/- 0.2 h in the test group and 4.4 +/- 0.2 h in the control group (p<0.05). The flap complication rate was 1/22 in the test group and 3/22 in the control group (p _ 0.04). In conclusion, use of MDCT angiography during pre-operative planning promotes a significant reduction in operating time and complication rate.

Three-dimensional reconstruction technique in breast volume measurement and its artificial influencing factors / 中华医学美学美容杂志

Objective To set up a method of three-dimensional breast volume measurement, to observe the effect of the artificial influencing factors on the final data, which are used for 3-D reconstruction of breast volume. Methods The CT data were used to reconstruct a digital prototype of the breast implant and the chest. The 3-D models were established firstly, and then the model was reasonablly cut to get single breast volume, breast implant volume, differences of the both sides of chest and breast volume. These methods were put up by the repeated test when the reference frame and the ranges were fixed. And the analysis of the artificial influencing factors was performed on 10 women whose breasts were unsym-metrical. The effects of the artificial influencing factors were analyzed by moving the coordinate axis, revolving the chest around the coordinate axis and changing the selected area. Results The repeatable test showed that the error was less than 4. 08 ml. The average volume differences between both sides of the breast before and after the given influencing factors were set, were 10. 339 ml and 7. 73 ml, as moved ± 4mm along the axis X; as revolving ±2° along the axis Z, that were 8. 654 ml and 7. 971 ml; as increasing or decreasing of the selected diameter of ± 4 mm, that were 6. 764 ml and 4. 267 ml, respectively. Conclusion Using the 3-D reconstruction technique for breast volume measurement is more simple, accurate and repeatable.

Breast reconstruction with superficial inferior epigastric artery flap / 中华医学美学美容杂志

Objective To present a method for breast reconstruction with the superficial inferior epigastric artery (S1EA) flap and to summarize the operative experiences. Methods The diameter and distribution were evaluated with multipledetector-row computed tomography (MDCT) angiography and doppler perfusion flowmeter. Bipedicle superficial inferior epigastric artery flap was designed below umbilicus. Superficial inferior epigastric artery and vein were anastomosed to the internal mammary artery and vein. Results Since 2007, we have used the superficial inferior epigastric artery flap in 4 cases of breast reconstruction. Four flaps survived completely. With the follow-up of 6-12 months, the reconstructed breasts were well-shaped and there were no complications such as abdominal hernia, bulge and weakness in donor sites. Conclusions Breast reconstruction using the superficial inferior epigastric artery flaps can not only preserve the advantages of the traditional method using the deep inferior epigastric perforator flaps, but also retain the maximal function of the fascia and the rectus abdominal muscle and prevent the occurrence of abdominal weakness and hernia. It is an ideal alternative method of breast reconstruction on condition that definitive preoperative assessment of vessels and skilled surgical technique are provided.

Correction of secondary deformity after removal of polyacrylamide hydrogel in breast / 中华医学美学美容杂志

Objective To evaluate the methods of correction for secondary deformity after removal of polyacrylamide hydrogel in breast.Methods From June 2006 to December 2007,the Center of Breast Plastic and Reconstruction at Chinese Academy of Medical Sciences admitted and treated 36 patients who experienced deformity after polyacrylamide hydrogel remoral in breasts.The average age of the patients was 27.5 years,and the time of consultation for the correction was from 6 months postoperatively.The patients who had preoperative MRI examinations showed that no visible polyacrylamide hydrogel remained in the breast were included in the study.The patients were classified according to the deformity of the breast and the chest wall tissue.Autologous fat injection grafting,silicon gel implant augmentation,and dermis grafting were performed for treating the deformity of the breasts after polyacrylamide hydrogel removal.Results During 3 to 18 months follow-up,the shape of the breast was improved and no complications such as infection,the sclerotic nodules,implant exposure occurred.35(97.2%) patients were satisfied with the result of the operations.Conclusions The correction for secondary deformity of breast after removal of PAHG should be performed at least 6 months after removal of polyacrylamide hydrogel.The optimal and nature contour of the breast may be recovered by combination of various surgical methods which are carefully selected according to the individual situation.

Overlapping tissue expansion techniques and its clinical applications / 中华整形外科杂志

<p><b>OBJECTIVE</b>To improve the results of the soft tissue expansion technique.</p><p><b>METHODS</b>Two expanders were buried in the same soft tissue pocket in an overlapping pattern. The inflation process was carried out routinely.</p><p><b>RESULTS</b>19 cases of various tissue defects were treated with the overlapping tissue expansion technique since March 1999. Good results have been achieved.</p><p><b>CONCLUSION</b>The overlapping tissue expansion technique can provide much more expanded tissue and reduce complications compared with the traditional expansion technique. It is especially suitable for repair of the defects at the facial and cervical region.</p>

Clinical study of the hemodynamics of both ends (proximal and distal) of internal mammary artery and its following-up / 中华整形外科杂志

<p><b>OBJECTIVE</b>To verify the value of retrograde flow of Internal Mammary Artery (IMA) used as one of the supplying arteries and to develop a new method of applying IMA in breast reconstruction.</p><p><b>METHODS</b>During breast reconstruction with free bilateral transverse rectus abdominis myocutaneous (TRAM) flap, the pressures and velocities of the two ends (proximal and distal) of internal mammary artery as well as the according perfusion unit (PU) of TRAM were measured in two patients who suffered from mammectomy because of carcinoma.</p><p><b>RESULTS</b>The pressure at distal end was 66 or/and 58 mmHg, the pressure at proximal end was 88 or/and 75 mmHg, the former is 75%-77% of the later. The immediate rate of blood flow of distal anastomotic stoma was 74 or/and 52 ml/min, that of proximal was 94 or/and 70 ml/min, the former is 74%-78% of the later after anastomosed to the two sides of deep inferior epigastric arteries (DIEA) separately. Under condition that both ends (proximal and distal) of IMA contributing as the supplying blood vessels simultaneously, the PU of TRAM was the best. The rates of blood flow at the two anastomotic stomas are similar to each other in late stage (evaluated at the fifth year follow-up).</p><p><b>CONCLUSION</b>The distal end of internal mammary artery can supply blood flow in a considerable level, similar with the proximal end.</p>

A hemodynamic animal model of distal ends of internal mammary artery and vein / 中华医学美学美容杂志

Objective To verify the ability of distal ends of internal mammary artery and vein used as recipient vessels on breast and chest wall reconstruction. Methods Four bilateral (left 2 and right 2) scent pig buttock island flaps pedicled circle deep iliac artery and vein were used by comparing the different hemodynamic parameters (pressure; flux volume; perfusion unions) between the original pedicl artery (deep iliac artery), proximal and distal ends of internal mammary artery. The free flaps were transplantated by anastomosed end-end to the distal-ends of internal mammary artery and vein after the proximal ends were ligated. Results The pressure of distal end of internal mammary artery was 61%-65% of the pressure with original pedicl artery (deep iliac artery), the immediate volume of anastomasis stoma was a little lower than that of original pedicl artery. The flap, 15 cm?30 cm?2 cm in size, completely survived more than 14 days after operation. Conclusion The slightly decreased distal arterial pressure does not compromise flap survival. Bilateral scent pig buttock island flap pedicled circle deep iliac artery and vein is an ideal animal flap model. This hymodynamic model can be widely used .