RESUMO
The breast is a variable organ and as such reconstructive surgeons need to use a variety of reconstructive techniques. Prosthetic reconstruction is a good technique for women who are either unsuitable for or not accepting of autogenous tissue reconstruction. We reviewed the last five years' experience at Monash Medical Centre with permanent tissue expander breast reconstruction. Forty patients underwent reconstruction of 54 breasts. Immediate reconstruction was performed in 70% with an overall average patient age of 45 years. The selection criteria, advantages, and disadvantages of this technique are discussed. Inflation of expanders took an average of 71 days and creation of breast mound (excluding nipple/areolar reconstruction) took an average of 2.3 operations. Overall aesthetic results have been judged to be good to excellent in 81%. Symmetry was more easily achieved in bilateral reconstructions. Capsular contracture rate was Baker Grade I or II in 83%. Minor complications occurred in 17% of patients. We believe that there still exists a significant number of women who are either unsuitable for or not accepting of autogenous tissue reconstruction. It is this group of women who, if well selected, can be reconstructed safely and efficiently by the use of permanent tissue expander breast prosthesis.
Assuntos
Implantes de Mama , Mama/cirurgia , Mamoplastia , Dispositivos para Expansão de Tecidos , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Seleção de Pacientes , Complicações Pós-OperatóriasRESUMO
Large scalp defects in aplasia cutis congenita present a management dilemma. In these lesions, prolonged conservative treatment may cause as much risk as does operative treatment. As a result of our experience, we suggest that one should be prepared to undertake early surgical intervention, rather than prolonged conservative treatment, for larger defects. Decreasing the size of the defect should decrease the risk of complications, since these appear to be related. The management of this condition should be a compromise of both operative and conservative modalities.
Assuntos
Procedimentos Cirúrgicos Dermatológicos , Couro Cabeludo/anormalidades , Couro Cabeludo/cirurgia , Anormalidades da Pele , Bandagens , Humanos , Recém-NascidoRESUMO
This experimental study in the rabbit establishes a reliable model for the production of skin necrosis analogous to intravenous extravasation injuries in humans. The effectiveness of hyaluronidase in reducing the extent of tissue injury is examined, using several different toxic agents.
Assuntos
Extravasamento de Materiais Terapêuticos e Diagnósticos , Hialuronoglucosaminidase/uso terapêutico , Pele/efeitos dos fármacos , Animais , Cloreto de Cálcio/efeitos adversos , Doxorrubicina/efeitos adversos , Alimentos Formulados/efeitos adversos , Necrose , Coelhos , Pele/patologia , Fatores de TempoRESUMO
Morbidity following 104 bone graft harvesting operations (60 iliac, 44 rib) in 72 patients is documented. Early morbidity of iliac donor sites was found, as expected, to be far greater than that of rib donor sites. However, long-term follow-up reveals that while hip symptoms largely resolve, a significant number of chest-wall sites cause persistent, unpleasant pain. Technical ways of minimizing problems are also discussed. When procuring an iliac graft, a lateral skin incision and a medial bony approach are used if possible. If full-thickness ilium is required, the crest should be left intact or raised and replaced as a trapdoor .
