ICG angiography in immediate and delayed autologous breast reconstructions: peroperative evaluation and postoperative outcomes.

Postoperative complications in patients undergoing autologous breast reconstruction should be kept at the lowest possible level. Optimization of autologous breast reconstruction, especially techniques that can identify tissue perfusion and ischemia, will greatly benefit the patients and consequently society. Hence, the aim of this study was to evaluate the complication rates for autologous pedicle flap breast reconstructions, with and without the use of ICG-angiography. A single-institution retrospective review of mastectomy patients was performed. A total of 230 cases who underwent immediate or delayed, unilateral or bilateral pedicle autologous flap breast reconstruction between January 2013 and September 2016 was reviewed. Complication rates in the ICG-angiography and clinical assessment group were evaluated and compared. A total of 191 cases were identified of which 77 were evaluated with ICG-angiography, and 114 were evaluated clinically. There was no significant difference in overall complication rates between the two groups (ICG-angiography, 36.4%; Clinical assessment, 37.7%; p = .88). No significant difference was observed when stratifying for major or minor complications. However, when stratifying for the timing of the reconstruction, the rate of major complications was significantly lower in the ICG-angiography group (ICG-angiography, 0%; Clinical assessment 23.3%; p = .039). BMI was significantly associated with increased risk of minor complications (p = .018), whereas there was no correlation to age, prior smoking, chemotherapy, radiation, diabetes, or hypertension. Our study found that use of ICG-angiography was associated with a significant decrease in the rate of major complications for immediate autologous reconstructions.

Long-term evaluation of postmastectomy breast reconstruction with the pedicled transverse rectus abdominis musculocutaneous flap.

The transverse rectus abdominis musculocutaneus (TRAM) flap is ideal for unilateral breast reconstruction. It can produce a breast with a lasting natural look, soft feeling, and good resemblance to the opposite breast. The aim was to evaluate long-term results of the TRAM flap reconstruction in an homogenous study population and to examine the impact on abdominal competence, appearance, and function relative to patient satisfaction. The study included 123 women from the cohort of patients undergoing a postmastectomy breast reconstruction in the period from 1992-2005. Data was collected from patient charts, a study-specific questionnaire, and a clinical follow-up visit. The response to the questionnaire was 81% (100/123), and 78 of them participated in a clinical follow-up visit. Eighty-four per cent were satisfied with the overall results of their breast reconstruction, and the majority of the women were pleased with the overall appearance of their abdomen. A significant correlation existed between satisfaction with the abdominal appearance and donor site complications (p = 0.01). No association was determined between complications in the breast area and smoking. A BMI above 25 increased the risk of complications. Radiation therapy (RT) significantly increased the risk of severe complications (p = 0.04) and of an inferior aesthetic result (p = 0.03). In conclusion, after a median of 6 years, women reconstructed with a TRAM flap were pleased with the overall result, with the appearance and strength of their abdomen including the umbilicus. Breast reconstruction with the pedicled TRAM flap results in lasting good results and pleased patients.

Long-term evaluation of postmastectomy breast reconstruction.

BACKGROUND: Reconstructing a breast mound constitutes the basis of breast reconstruction. The breast can be reconstructed using autologous tissue, implants or a combination thereof. The number of women wishing a breast reconstruction has increased, but evaluation of the results is lacking. The current study examined the long-term results from three methods of breast reconstruction to assess the subjective and the objective outcome. PATIENTS AND METHODS: Patients undergoing first-time post mastectomy reconstruction, selected from the cohort of Danish women in the Central and North Region of Denmark, were evaluated. We included 363 women, reconstructed in 1990-2005. Data was collected from patient charts, a study specific questionnaire (to be found online at http://www.informahealthcare.com/doi/abs/10.3109/0284186X.2011.584554 ) and a clinical follow-up visit. The questionnaire included questions regarding demographic background and evaluation of the reconstructed breast and donor site. The clinical follow-up visit included an examination of the overall result and donor site. RESULTS: The questionnaire was answered by 263 women, of whom 137 had an implant, 26 had a latissimus dorsi musculocutaneus flap and 100 had a pedicled transverse rectus abdominis musculocutaneus flap. Women reconstructed with autologous tissue were significantly more pleased with the result of the breast reconstruction than women reconstructed with an implant. After a median of seven years, neither the patient's age nor the length of time since the reconstruction significantly affected the patients' opinion of the overall result. There was no difference in the incidences of minor complications among the different reconstructive methods. BMI, smoking and radiation therapy influenced the risk of complications. Objective evaluation of the 180 women participating in the follow-up visit was in agreement with data from the questionnaire. CONCLUSION: The type of reconstruction had a significant long-term influence on patient satisfaction and the objective result. Women reconstructed with autologous tissue were significantly more pleased, and the objective outcome was assessed as superior.

Intraoperative and postoperative evaluation of cavitation in mechanical heart valve patients.

BACKGROUND: Cavitation has been claimed partly responsible for the increased risk of thromboembolic complications, hemolysis, and fatal valve failure seen in mechanical heart valve patients. In vivo studies have investigated cavitation using high-pass filtering of the high-frequency pressure fluctuations with the root mean square values as an assessment of intensities. In vitro studies have shown that this well-known method may not be ideal owing to loss of data as a consequence of filtering, and because it requires a priori knowledge of the valve resonance pattern. Therefore, a new method has been developed, which decomposes the signal into nondeterministic (cavitation) and deterministic (valve resonance) signal components, and hence decreases data loss. This study aimed to evaluate cavitation in patients with mechanical, biological, and native heart valves both intraoperatively and postoperatively using the new method. METHODS: High-frequency pressure fluctuations were measured by a hydrophone intraoperatively and postoperatively in 14 patients with mechanical valves, 10 patients with normal aortic valves, and 5 patients with bioprosthesis. The total signal energy was evaluated as nondeterministic and deterministic energies. RESULTS: Nondeterministic energies were verified both intraoperatively and postoperatively in all patients who had a mechanical valve; this finding confirms the cavitation potential of mechanical valves. None of the data recorded in patients with bioprosthetic or native valves contained nondeterministic energy. CONCLUSIONS: The study confirms the presence of cavitation in mechanical heart valve patients using the nondeterministic energy of high-frequency pressure fluctuations as a quantitative measure of cavitation both intraoperatively and postoperatively.