Can't have one without the other: component separation plus mesh for repairing difficult incisional hernias.

BACKGROUND: Incisional hernia recurrence after repair continues to be a persistent complication. The purpose of this study was to investigate the association between patient-specific factors, surgeon-specific factors, and hernia recurrence in patients undergoing repair of an incisional hernia in whom the component separation technique was used. METHODS: All patients undergoing incisional herniorrhaphy with component separation from October 2006 to May 2013 were reviewed. Data collected included demographics, comorbidities, postoperative complications, and factors related to mesh implantation. Computed tomography images were used to evaluate the size of the hernia and dimensions of the linea alba. RESULTS: The 85 patients were followed for a mean of 14.4 months, and 12 (14.1%) recurrent hernias were diagnosed. More than 91% of the herniorrhaphies were performed after a previous repair failed. The recurrence rate decreased to 11.1% when, in addition to the component separation, a mesh was used to reinforce the repair. There were no differences between the group who developed a recurrence and those who did not in terms of sex, age, race, body mass index, preoperative comorbidities, or type of mesh used. CONCLUSION: In this case series of complex abdominal wall herniorrhaphies using component separation, the recurrence rate was 14.1% overall and 11.1% when a mesh was used to reinforce the repair. Recurrent hernia was not associated with patient demographics, comorbidities, thickness or width of the linea alba, presence of a contaminated wound, or postoperative surgical-site occurrences.

A comparison of full and split thickness skin grafts in radial forearm donor sites.

To formally evaluate the functional and aesthetic outcomes between full versus split thickness skin graft coverage of radial forearm free flap donor sites. A retrospective chart review of 47 patients who underwent pedicled or free radial forearm free flap reconstruction from May 1997 to August 2004 was performed. Comparisons were made between patients who had donor site coverage with split thickness skin grafts (STSG) or full thickness skin grafts (FTSG). There was no statistically significant difference between the STSG and FTSG in the number of post-operative dressings, incidence of tendon exposure, time to healing at the skin graft donor site, and time to healing at the skin graft recipient site. The questionnaire data showed there was a trend toward higher scores with the radial forearm scar aesthetics and satisfaction in the FTSG group. Full thickness skin graft coverage of radial forearm free flap donor site is superior to split thickness skin graft coverage in terms of aesthetic outcome, and has no statistically significant difference in terms of tendon exposure, time to healing at the skin graft donor site, time to healing at the skin graft recipient site, or post operative pain.

Intermeshing breast reconstruction and postmastectomy radiation.

In women with advanced breast cancer or those with early-stage cancer for whom there is a contraindication for breast-conserving therapy, mastectomy is the primary surgical treatment. This is often followed by breast reconstruction in either an immediate or delayed fashion. There is a great psychological and emotional benefit for the patient to have immediate reconstruction at the time of initial mastectomy. Recently, evidence has demonstrated that postmastectomy radiation therapy (PMRT) administered in conjunction with systemic therapy improves not only locoregional control but also survival. This has increased the number of women receiving PMRT and resulted in much debate in the literature regarding the timing of radiation therapy and the types of reconstructive options. In this article, the authors review the literature for controversies and currently accepted practices for intermeshing PMRT and breast reconstruction following mastectomy. We also summarize the key issues related to the integration of breast reconstruction with PMRT and detail the experience and complications arising from this integration.

Prediction of postoperative seroma after latissimus dorsi breast reconstruction.

BACKGROUND: The latissimus dorsi flap has become a first-line option in reconstruction of the breast cancer patient. Donor-site seroma is a commonly described postoperative complication of the latissimus dorsi flap. METHODS: A retrospective chart review from 1998 to 2003 of all patients undergoing latissimus dorsi breast reconstruction was performed (n = 50). Age of the patients, timing of breast reconstruction, type of nodal dissection (axillary versus sentinel versus none), and chemotherapy status of the patients were examined. RESULTS: The overall incidence of seroma formation was 47 percent. Those patients who had undergone prior or concurrent nodal dissection at the time of breast reconstruction were found to have a higher incidence of seroma formation than patients who had no nodal dissection (52 percent versus 25 percent) (p = 0.15). Age also was a risk factor for seroma formation, as 63 percent of patients older than 50 had formed seroma as compared with 39 percent of those younger than age 50 (p = 0.08). CONCLUSION: The authors conclude that advanced age and the presence of nodal disruption before or concurrent with latissimus dorsi breast reconstruction are predictors of donor-site seroma formation.

The use of free tissue transfers in acute thermal and electrical extremity injuries.

BACKGROUND: This article presents a retrospective analysis of a case series of patients requiring free tissue transfers for acute thermal and electrical injuries in a single burn center. METHODS: Eight patients, in the period between 1997 and 2001, were referred for evaluation of extensive thermal injury to one or more extremities, which required free tissue transfer to achieve coverage. A total of 12 flaps were performed on eight patients. Data including flap type, flap viability, complications, hospital stays, length of rehabilitation, and time until return to work were collected. RESULTS: Twelve flaps were performed on eight patients. One patient died. We report a flap failure rate of 9% (1 of 12) and two postoperative infections. Follow-up ranged from 3 months to 4 years. Flap types included lateral arm, radial forearm, rectus abdominis, posterior lateral thigh, and omentum and temporoparietal fascia. Mean hospital stay was 22 days, with a mean rehabilitation time of 9.7 months. Sixty-two percent of patients returned to work. CONCLUSION: Free tissue transfer is a safe and efficacious method of early surgical management of thermal and electrical burns. Electrical burns account for a disproportionate number of injuries requiring free tissue transfers. These injuries frequently necessitate the use of multiple free flaps. Postoperative complications and length of stay can be minimized by the use of split donor flaps during one operative session.