Comparing patient satisfaction in bilateral and unilateral breast reconstruction.

BACKGROUND: Current literature in breast reconstruction continues to provide answers to questions regarding patient satisfaction in the areas of autologous vs alloplastic reconstruction and silicone vs saline implants. There are no studies, however, that specifi cally address patient satisfaction with bilateral vs unilateral breast reconstruction. Our goal was to assess patient satisfaction with bilateral compared with unilateral breast reconstruction. METHODS: Over a 4-year period, 108 patients completed either unilateral or bilateral breast reconstruction from a single surgeon. Patient satisfaction in these patients was assessed using a questionnaire developed focusing on clinical outcome measures of aesthetic and functional satisfaction. RESULTS: A total of 72 anonymous surveys were returned. Statistically significant differences were seen with respect to overall symmetry, aesthetics without clothing, and overall satisfaction between unilateral and bilateral reconstructions. In each of these categories, the average patient satisfaction score was higher for bilateral reconstructions. Furthermore, when comparing unilateral vs bilateral reconstruction in the different reconstruction types, parallel differences in patient satisfaction were noted. CONCLUSION: The results of this study suggest that patients were more satisfied with bilateral reconstruction because of improved symmetry, superior aesthetic appearance without clothing, and overall satisfaction with the reconstructive process. Future studies with larger subsets of patients are needed.

Avoiding pitfalls in craniofacial reconstruction using absorbable plates.

Rigid internal fixation devices are a mainstay in craniofacial surgery. The advent of absorbable plates has been a monumental advancement and has proven to be a safe and effective method of osteofixation. It has been proposed that many problems of the permanent metallic implants can be avoided by the use of resorbable plates. Exposure is thought to be secondary to tissue tension over the plates and breakdown of the overlying tissue envelope. This a report of 2 cases of craniosynostosis reconstruction with absorbable plate exposure through overlying skin incisions necessitating plate removal and revisionary surgery. This study proposes that imprudent plate placement traversing overlying skin incisions may more likely result in absorable hardware exposure. Careful preoperative planning of skin incisions and proposed hardware placement are a strategy to avoid absorbable plate exposure in craniosynostosis reconstruction.

Microvascular reconstruction of iatrogenic femoral artery thrombosis in an infant: a case report and review of the literature: infant femoral artery reconstruction.

OBJECTIVE: We present a case of femoral artery thrombosis and acute limb ischemia in an infant following attempted femoral venipuncture. Microsurgical reconstruction of the lesion and a review of the literature are described. METHODS: Insertion of intravascular catheters is a commonly performed procedure in neonatal and pediatric intensive care units. However, significant iatrogenic injuries to the peripheral vascular system can occur. Management ranges from anticoagulation and thrombolytics to surgical intervention. In this case, surgical therapy involved thrombectomy and microsurgical reconstruction of the femoral artery. RESULTS: Vascular inflow was reestablished and the limb was salvaged. CONCLUSIONS: We believe that microsurgical techniques are an important component for successful vascular reconstruction after iatrogenic artery thrombosis in an infant. Microvascular techniques allow for a controlled operating field with magnification, thereby assisting in the accuracy of vessel repair.

Adenocarcinoma of the gastroesophageal junction after bariatric surgery.

BACKGROUND: The development of upper gastrointestinal malignancies after bariatric surgery has not been well characterized. Our objective was to review the experience of patients with distal esophageal cancer that was diagnosed after bariatric surgery. METHODS: A retrospective review was conducted to identify patients who had undergone bariatric surgery (1999 to 2006) and who later developed high-grade dysplasia or adenocarcinoma of the distal esophagus. RESULTS: Three patients (of 2,875 [0.1%]) developed esophageal cancer: 2 after Roux-en-Y gastric bypass and 1 after vertical banded gastroplasty. All three patients had complaints of reflux, and two were treated with esophagectomy. The third patient presented with invasive carcinoma and died 2 years after diagnosis. CONCLUSIONS: Our findings emphasize the importance of precise endoscopic evaluation before bariatric surgery in patients with gastroesophageal reflux disease (GERD), of the necessity for continuing postsurgical surveillance in patients with known Barrett's esophagitis, and of early evaluation in patients who develop new symptoms of GERD after bariatric surgery.