Robot-Assisted Capsulectomy with Immediate Reimplantation in Breast Reconstruction.

SUMMARY: Recent reports have introduced robotic breast surgery for immediate breast reconstruction with an implant. However, relevant reports of robot-assisted breast reconstruction including capsulectomy are limited. Although capsulectomy lowers risk of capsular contracture and thus contributes to better aesthetic outcomes, total capsulectomy may have complications, such as injury to axillary structures or chest wall and overlying skin devascularization. To minimize the risk of injury, the authors used a robotic system with Da Vinci SP, which has freely movable arms and clear, magnified three-dimensional vision, for total capsulectomy. Compared with conventional procedures, robotic surgery has the critical advantage of minimal incision and concealed scars, contributing to positive aesthetic outcomes. This study suggests that robot-assisted capsulectomy is technically feasible and safe for patients undergoing breast reconstruction with immediate reimplantation.

Analysis of Perfusion in the DIEP Flap: Role of the Location of the Perforator, Umbilicus, and Midline Crossing-Over Vessel.

BACKGROUND: During breast reconstruction, predicting contralateral perfusion of the deep inferior epigastric artery perforator flap can help minimize tissue necrosis. This study aimed to quantify the area of contralateral perfusion and identify the factors affecting it. METHODS: A retrospective study was conducted on unilateral breast reconstructions with a single perforator-based deep inferior epigastric artery perforator flap, for the period of 2017 to 2019. Data on the distance between the perforator and the umbilicus, and the grade of the midline crossing-over vessel (G0, no vessel; G1, suspicious vessel; G2, definite vessel), were collected. Contralateral perfusion was estimated using intraoperative indocyanine green angiography, and the degree of contralateral circulation based on perforator location was assessed using a response surface methodology analysis. RESULTS: The study included 143 patients (G0, 62; G1, 45; and G2, 36). The average length of transverse contralateral flap perfusion (contralateral circulation area/vertical height of the flap) increased as the crossing-over vessel grade increased (G0, 62.96 ± 20.33 mm; G1, 71.69 ± 20.66 mm; and G2, 81.1 ± 19.32 mm; P = 0.0002). In the response surface methodology analysis, contralateral perfusion was the least when the perforator was located near the umbilicus (G0, within a 10-mm radius; G1, <10-mm transverse distance and 16- to 22-mm vertical distance; and G2, within a 20-mm radius). CONCLUSIONS: The umbilicus can interfere with contralateral perfusion; thus, a definite presence of a midline crossing-over vessel ensures robust contralateral perfusion. The results of this study can help surgeons select the optimal single perforator before surgery. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Effect of Acellular Dermal Matrix on Long-Term Speech Outcomes in Primary Palatoplasty with Radical Intravelar Veloplasty.

OBJECTIVE: This study investigates whether the use of acellular dermal matrix (ADM) affects the long-term speech outcomes in patients undergoing primary palatoplasty with radical intravelar veloplasty. DESIGN: Retrospective cohort study. SETTING: Tertiary university-affiliated hospital. PARTICIPANTS: A consecutive cohort of 112 patients who underwent primary palatoplasty with radical intravelar veloplasty from August 2014 to March 2018 were included. MAIN OUTCOME MEASURES: A 2 × 2 cm-sized ADM was incorporated as an interpositional graft between the oral and nasal lining at the soft-hard palate junction. The perceptual analysis of hypernasality and articulation was performed when the age of the patient reached at least 36 months. Cleft-related characteristics and surgical factors affecting the speech outcomes were investigated. RESULTS: The ADM was applied in 57 patients with a mean follow-up of45.76 months (SD, 10.69), while no ADM was used in 55 patients with a mean follow-up of 48.43 months (SD, 14.98). Regarding the hypernasality outcome, 33.3% (19 of 57 patients) of the ADM group and 27.3% (15 of 55 patients) of the control group showed a greater than mild-to-moderate degree. The distribution of hypernasality and articulation grade showed no significant difference between the two groups. After controlling for potential risk factors that may affect the speech outcomes, the use of ADM showed no significant relationship with velopharyngeal insufficiency. CONCLUSION: The use of ADM use in primary palatoplasty with radical intravelar veloplasty is not associated with the alteration of speech function in early childhood.