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BACKGROUND: Capsular contracture is a known complication of breast augmentation and is among the top reasons for revisional breast augmentation procedures. The use of acellular dermal matrix (ADM) has been shown to reduce the rate of capsular contracture in breast reconstruction and augmentation, theorizing that it acts as a protective barrier between the implant capsule and inflammatory process responsible for capsular contracture. The role of ADM in treatment of capsular contracture has been investigated in numerous studies, with a variety of ADMs. OBJECTIVES: The aim of this study was to perform a systematic review of existing literature on the use of ADM for treatment of capsular contracture in aesthetic breast augmentation patients to investigate differences in efficacy of ADM types. METHODS: The PubMed, Embase, and CINAHL databases were systematically reviewed for articles pertaining to capsular contracture, acellular dermal matrices, and breast augmentation. Number of patients, type of ADM, Baker grade, follow-up time, complication rate, and capsular contracture rate were recorded from identified articles. Data was pooled from studies to calculate a capsular contracture rate for each ADM type, with a chi-squared test performed for analysis. Identified studies with a comparative group were included in a meta-analysis utilizing risk ratio (RR) to assess the efficacy of ADM. RESULTS: Nine articles including ADM for treatment of capsular contracture in breast augmentation met criteria for inclusion, with a total of 481 breasts. Strattice was the most commonly utilized ADM (n = 391), followed by AlloDerm (n = 57). There was a statistically significant difference in efficacy of ADM among the studied ADM types (P < .001). AlloDerm, FlexHD, and DermaMatrix had the lowest capsular contracture rates (0%). NeoForm and SurgiMend had the highest capsular contracture rates (each 25%, but with n = 4 and n = 8, respectively). Strattice had a capsular contracture rate of 1.53% in the pooled data, and meta-analysis showed that Strattice reduced the risk of capsular contracture (RR 0.14 [95% CI 0.06, 0.31]) compared with conventional treatment. CONCLUSIONS: Acellular dermal matrices appear to be effective at treating capsular contracture after breast augmentation while maintaining a low complication rate. Overall capsular contracture rates are low with the use of ADM. There is a statistically significant difference in efficacy among ADM types. Meta-analysis shows that Strattice is effective at reducing the risk of capsular contracture in breast augmentation patients when compared to conventional treatment. Future research, especially in the form of randomized controlled trials, is needed to further investigate the efficacy of various ADMs in the treatment of capsular contracture.
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Derme Acelular , Implante Mamário , Implantes de Mama , Contratura , Mamoplastia , Humanos , Implante Mamário/efeitos adversos , Implante Mamário/métodos , Mamoplastia/métodos , Implantes de Mama/efeitos adversos , Contratura/etiologia , Contratura/cirurgia , Contratura Capsular em Implantes/etiologia , Contratura Capsular em Implantes/cirurgia , Estudos RetrospectivosRESUMO
Amphibians are becoming increasingly reliant on captive breeding programs for continued survival. Assisted reproductive technologies including gamete cryopreservation and IVF can help reduce costs of breeding programs, provide insurance against extinction and assist genetic rescue in wild populations. However, the use of these technologies to produce reproductively mature offspring has only been demonstrated in a few non-model species. We aimed to optimise sperm cryopreservation in the threatened frog Litoria aurea and generate mature offspring from frozen-thawed spermatozoa by IVF. We tested three concentrations (1.4, 2.1 and 2.8M) of the cryoprotectants dimethylsulfoxide (DMSO) and glycerol with 0.3M sucrose. Using DMSO was more likely to result in recovery of sperm motility, vitality and acrosome integrity than glycerol, regardless of concentration, with forward progressive motility being most sensitive to damage. The lowest concentrations of 1.4 and 2.1M provided the best protection regardless of cryoprotectant type. Spermatozoa cryopreserved in 2.1M DMSO outperformed spermatozoa cryopreserved in equivalent concentrations of glycerol in terms of their ability to fertilise ova, resulting in higher rates of embryos hatching and several individuals reaching sexual maturity. We have demonstrated that sperm cryopreservation and subsequent offspring generation via IVF is a feasible conservation tool for L. aurea and other threatened amphibians.
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Prepectoral breast reconstruction has rapidly gained attention as a new technique for implant-based breast reconstruction. It is essentially a modernization of an old technique made possible by the use of marketable products, primarily dermal matrices and cohesive silicone gel implants. The rapid dissemination of its benefits, not only to physicians, but also to the general public and referring physicians, leading to widespread adoption, is in part due to a combination of marketing and social media/Internet influences. This review will summarize the recent peer-reviewed literature to provide facts for the reconstructive surgeon to decide whether this technique is a fad or a useful option in implant-based breast reconstruction.
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Derme Acelular , Implante Mamário , Implantes de Mama , Neoplasias da Mama , Mamoplastia , Neoplasias da Mama/cirurgia , Humanos , Géis de SiliconeRESUMO
Massive localized lymphedema (MLL) is rare, but as the prevalence of obesity in adults rises, it can be foreseen that cases will increase in prevalence. These patients are unable to ambulate and have uncontrollable rash and skin breakdown. Operative management for MLL is offered when nonsurgical measures are ineffective. The surgery can be difficult with ambiguous tissue planes saturated with lymphatic fluid, ill-defined margins, large arteries and dilated veins, and extensive intraoperative fluid and blood loss. We performed a retrospective chart review and analysis with a focus on the intraoperative findings and management in order to provide improved awareness and recommendations for preoperative care. We reviewed the charts of 15 patients with MLL undergoing a total of 17 surgical resections at our institution. Patients were morbidly obese with an average body mass index of 63 kg/m and 5.5 other medical comorbidities. Average operative time was 4.5 hours. Operative time showed a moderate correlation with increased blood loss. Operative transfusion averaged approximately 1 U per case, with 12% (2/17) of cases needing additional transfusions following surgery. An increase in operative time correlated with an increase in crystalloid infusion. In conclusion, we recommend close communication between the surgery and anesthesia teams regarding the extent of the resection and potential for fluid resuscitation and transfusions. Preoperative laboratory tests are recommended, as well as type and cross-match prior to the operation to obtain a baseline for intraoperative and postoperative monitoring. Recommendations for intraoperative management include strict input and output monitoring and aggressive fluid resuscitation with appropriate arterial and venous access.
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Transfusão de Sangue/métodos , Linfedema/cirurgia , Obesidade Mórbida/cirurgia , Assistência Perioperatória/métodos , Adulto , Feminino , Humanos , Linfedema/fisiopatologia , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/fisiopatologia , Duração da CirurgiaRESUMO
BACKGROUND: Use of dermal regeneration template (DRT) is well documented in the literature for complex wounds ranging from the scalp, trunk, and lower extremity. METHODS: A retrospective cohort study was performed of the use of dermal regeneration template and skin grafting. A literature review was performed of all studies where DRT was used for scalp reconstruction. RESULTS: Patients in the DRT cohort had an average age of 70, with wounds averaging 108âcm in size. These patients also had a relatively low rate of complications (0.4), a short hospital stay (average 2 days), and a relatively short operating room time (114âminutes). CONCLUSION: This study demonstrates dermal regeneration template to be an effective and reliable option for soft tissue reconstruction with minimal morbidity and complications in patients with extensive medical comorbidities. Emerging applications include radiation exposure and hypercoaguable states.
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Derme/cirurgia , Procedimentos de Cirurgia Plástica , Couro Cabeludo , Transplante de Pele , Análise Custo-Benefício , Humanos , Complicações Pós-Operatórias , Procedimentos de Cirurgia Plástica/economia , Procedimentos de Cirurgia Plástica/métodos , Regeneração , Estudos Retrospectivos , Couro Cabeludo/lesões , Couro Cabeludo/cirurgia , Transplante de Pele/economia , Transplante de Pele/métodosRESUMO
Diabetic mastopathy is a benign condition of the breast that typically manifests in patients with diabetes mellitus. Lymphocytic mastopathy is the term used to describe this condition in patients without diabetes mellitus. Most patients undergo excisional biopsy, but the use of mastectomy, even in cases of diffuse, bilateral disease, is rarely reported. We present a 32-year-old female patient with type 1 diabetes and bilateral diabetic mastopathy. Because of pain, and concern for limitations in future cancer detection, she underwent bilateral nipple-sparing mastectomies with immediate direct-to-implant reconstruction. A systematic literature review was performed to examine the treatment options for this disease, particularly from a plastic surgery perspective. Sixty articles were reviewed which contained information regarding 313 patients. Of these patients, only 4 underwent mastectomy. This case is the first report of bilateral nipple sparing mastectomy and immediate implant reconstruction for a patient with bilateral, symptomatic diabetic mastopathy.
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Diabetes Mellitus Tipo 1/complicações , Mamoplastia/métodos , Mastectomia Subcutânea/métodos , Mastite/diagnóstico por imagem , Mastite/cirurgia , Adulto , Biópsia por Agulha , Implantes de Mama , Diabetes Mellitus Tipo 1/diagnóstico , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Mamografia/métodos , Mastite/etiologia , Medição da Dor , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Wounds are dynamic environments in which dead tissue, exudate, and the bacterial bioburden interact in a complex manner among themselves and with the tissue of the host. Bacteria organize into biofilms, reducing their susceptibility to elimination by the host immune response and antimicrobials. Early detection of biofilms in wounds is crucial to successful chronic wound management; and although many techniques have developed to identify planktonic counterparts in viable wounds, few have been able to quickly and accurately identify bacterial biofilms. Future studies are needed to find means of identifying and monitoring biofilm colonization at the bedside to permit timely initiation of treatment. In this review, we examine some promising new technologies that hope to identify and quantify the process of biofilm formation in chronic wounds.
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Antibacterianos/farmacologia , Biofilmes/efeitos dos fármacos , Biofilmes/crescimento & desenvolvimento , Infecção dos Ferimentos/tratamento farmacológico , Infecção dos Ferimentos/microbiologia , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/microbiologia , Doença Crônica , Contagem de Colônia Microbiana , Meios de Cultura , Diagnóstico Precoce , Escherichia coli/efeitos dos fármacos , Escherichia coli/crescimento & desenvolvimento , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/crescimento & desenvolvimento , Medição de Risco , Sensibilidade e Especificidade , Infecção dos Ferimentos/diagnósticoRESUMO
PURPOSE: The management of occult tumor involvement of the nipple during total skin-sparing mastectomy (TSSM) and immediate reconstruction is not well addressed in the literature. We reviewed our experience with positive nipple core biopsies, comparing outcomes of different management options. METHODS: Mastectomy and implant/expander reconstructions over a 5-year period were reviewed. Patient characteristics, type of mastectomy, and complications were analyzed. Patients were grouped by type of mastectomy/immediate reconstruction and delayed reconstruction to compare outcomes. Positive intraoperative core nipple biopsy cases formed a subset of the TSSM group. RESULTS: Forty-four of 240 (18%) cases were TSSMs performed through inferolateral incisions. All were reconstructed immediately, 24 with tissue expanders and 20 with implants. Major complications (necrosis, infection, seroma) were significantly lower than for skin-sparing mastectomies, but higher than delayed reconstruction. One case of full thickness nipple necrosis occurred. Seven of the TSSM group had positive core nipple biopsies (16%). Three of these patients underwent nipple excision and tissue expander placement at the initial surgery, of which 2 developed subsequent mastectomy skin flap necrosis requiring explantation. A third patient underwent staged nipple excision without complication. The remaining 3 patients underwent delayed nipple resection at the time of tissue expander replacement without complication. Pathology in the nipple core was invasive ductal carcinoma and ductal carcinoma in situ. No TSSM patients have developed local recurrence at follow-up. CONCLUSIONS: Concurrent excision of the nipple and an inferolateral incision increase the incidence of skin flap necrosis. Delaying nipple excision may prove to be a safer option.
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Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/patologia , Carcinoma Intraductal não Infiltrante/patologia , Mamoplastia/métodos , Mastectomia Subcutânea , Mamilos/patologia , Adulto , Idoso , Biópsia , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/cirurgia , Carcinoma Intraductal não Infiltrante/cirurgia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Mamilos/cirurgia , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
OBJECTIVES: Intraoperative management of hemodynamic instability during microvascular flap reconstruction is often based on anecdotal experience. Randomized controlled trials are difficult to perform when overall success rates are high. This study seeks to determine current practices for management of intraoperative hypotension during microsurgical free tissue transfer. METHODS: An anonymous, 17-question, multiple choice, and open response online survey was distributed to university surgeons identified from the American Society of Plastic Surgeons and American Society of Reconstructive Microsurgeons online membership listing. Responses were collected from April 1, 2012, to May 1, 2012. Questions included number of years of microsurgery experience, number of flaps performed yearly, acceptable lower limits of blood pressure, preferences for treatment of hypotension, intraoperative conditions (hemodilution, temperature, and regional anesthesia), preferred methods of postoperative flap monitoring, and timing/method of prophylaxis of thromboembolic complications. Anonymous responses were analyzed individually as well as per respondent's experience. RESULTS: The response rate was 26.7% (145/544), with 88.3% performing microsurgery. Sixty-two percent performed 24 or less free flaps per year (low volume). Thirty-seven percent performed greater than 24 per year (high volume). The acceptable lower limit (SD) of systolic blood pressure was 92.6 (11.3) mm Hg for the low-volume group and 86.9 (16.2) for the high volume group (P = 0.035). The treatment of choice for hypotension was fluid administration (94.5%). Vasopressors were used by 50.0% of low-volume respondents and 38.1% of high-volume respondents (P = 0.312). Twenty-two respondents (23.2%) stated they had a flap loss due to administration of vasopressors. There was no significant difference between high- and low-volume surgeons' responses. CONCLUSIONS: A national survey of microsurgeons demonstrates that many would not use vasopressors to treat intraoperative hypotension regardless of their experience. Although subject to responder bias, this report, nevertheless, outlines current practice. The need to develop a scientific basis for these practices is evident.
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Hipotensão/tratamento farmacológico , Complicações Intraoperatórias/tratamento farmacológico , Retalhos de Tecido Biológico , Humanos , Padrões de Prática Médica , Vasoconstritores/uso terapêutico , Trombose Venosa/prevenção & controleRESUMO
BACKGROUND: Acellular dermal matrix (ADM) has been associated with an increased incidence of complications after implant-based breast reconstruction. Recently, sterile ADM has been introduced in an attempt to minimize these complications. To analyze the impact of this product on patient outcomes, we created a database of patients undergoing implant-based breast reconstruction. METHODS: Patients undergoing implant-based breast reconstruction at the University of Kentucky Medical Center from January 1, 2011, to December 31, 2011 were identified. A database of patient characteristics and outcomes was created. Outcomes investigated included mastectomy flap necrosis, dehiscence, infection, red breast, capsular contracture, hematoma, and seroma. Statistical analysis was performed. RESULTS: Fifty-eight patients underwent breast reconstruction with implants or tissue expanders. Of the 58 patients, 9 had the sterile form of ADM placed, 25 had the original aseptic but not sterile ADM, and 24 were not reconstructed with ADM. The most frequent complication noted was seroma, occurring in 6/9 patients with sterile ADM as compared to 2/25 with the aseptic ADM. This was statistically significant (P = 0.003). CONCLUSIONS: The use of sterile ADM is associated with a statistically significant increase in seroma formation. The etiology of this increased incidence remains unknown, but it correlates with the introduction of the sterile form of ADM at our institution. A different preparation or sterilization process, or some other variable as yet unknown, may be responsible. Further studies comparing the different forms of ADM in an animal model may serve to clarify this issue.
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Derme Acelular , Implante Mamário/instrumentação , Colágeno , Mastectomia , Complicações Pós-Operatórias/etiologia , Seroma/etiologia , Esterilização , Adulto , Assepsia , Implante Mamário/métodos , Implantes de Mama , Neoplasias da Mama/cirurgia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Seroma/epidemiologia , Seroma/prevenção & controle , Dispositivos para Expansão de TecidosRESUMO
BACKGROUND: The use of acellular dermal matrix (ADM) has become a routine practice in implant-based breast reconstruction. Bilateral mastectomy is becoming more popular in cases of unilateral breast cancer. ADM has been associated with an increased incidence of complications. METHODS: We identified cases of bilateral implant-based breast reconstruction over a 5-year period. Data collection included medical comorbities, details of operative management, and details of postoperative cancer treatment. RESULTS: On univariate analysis, the use of ADM (31% vs. 7%, P = 0.018), smoking (37% vs. 13%, P = 0.045), and open wound (55% vs. 13%, P = 0.006) were significantly associated with increased risk of infection. Multivariate analysis revealed open wound as the strongest predictor of infection. CONCLUSIONS: The use of ADM is associated with an increased risk of infection in bilateral implant-based breast reconstruction. However, it does not appear to be an independent risk factor by itself.
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Materiais Biocompatíveis/efeitos adversos , Implante Mamário/instrumentação , Infecção da Ferida Cirúrgica/etiologia , Adulto , Idoso , Materiais Biocompatíveis/administração & dosagem , Derme , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Infecção da Ferida Cirúrgica/epidemiologiaRESUMO
BACKGROUND: In 1994, Mackinnon advocated that plastic surgery residents should have accessible child care to promote a productive return to work. Decades later, lack of adequate child care remains a dilemma for trainees. The authors' survey aims to evaluate childrearing during plastic surgery training. METHODS: An anonymous, voluntary survey was sent to plastic surgery residents. It evaluated demographics, childcare accommodations, and attitudes/issues surrounding childrearing during residency. RESULTS: There were 32 respondents: 66 percent women and 34 percent men. Seventy-five percent were married, and 38 percent were parents. Seventy-five percent of male parents compared to 12 percent of female parents reported that their spouse was the primary childcare source. One hundred percent of respondents with children reported that child care creates a financial burden. Three percent of respondents felt their institution provided services to arrange adequate child care. Sixty-three percent of residents felt their program did not allow flexibility to accommodate childcare needs. Female residents missed work twice as often and were twice as likely to require a co-resident to cover clinical duties because of childcare difficulties when compared to male residents (p = 0.296 and p = 0.145). Sixty-seven percent of women agreed with the statement, "If you had to pick a residency program today, the availability of on-site child care would influence your decision," compared to only 9 percent of men (p = 0.002). CONCLUSIONS: Training institutions are not meeting the childcare needs of plastic surgery trainees. If the specialty wishes to recruit and retain the top applicants, it must improve the childcare accommodations for residents. All institutions with plastic surgery residency programs should provide affordable, accessible child care that accommodates the 24-hour natures of both patient care and parenthood.
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Internato e Residência , Cirurgia Plástica , Feminino , Humanos , Masculino , Poder Familiar , Pais , Cirurgia Plástica/educação , Inquéritos e QuestionáriosRESUMO
SUMMARY: Insufficient blood flow causes mastectomy skin flap necrosis in 5 to 30 percent of cases. Fluorescence angiography with the injection of indocyanine green dye has shown high sensitivities (90 to 100 percent) but moderate specificities (72 to 50 percent) in predicting mastectomy skin flap necrosis. However, a number of challenging issues limit its wide acceptance in clinical settings, including allergic reaction, short time-window for observation, and high cost for equipment and supplies. An emerging inexpensive speckle contrast diffuse correlation tomography technology enables noninvasive, noncontact, and continuous three-dimensional imaging of blood flow distributions in deep tissues. This preliminary study tested the hypothesis that speckle contrast diffuse correlation tomography and indocyanine green-fluorescence angiography measurements of blood flow distributions in mastectomy skin flaps are consistent. Eleven female patients undergoing skin-sparing or nipple-sparing mastectomies were imaged sequentially by the dye-free speckle contrast diffuse correlation tomography and dye-based commercial fluorescence angiography (SPY-PHI). Resulting images from these two imaging modalities were co-registered based on the ischemic areas with the lowest blood flow values. Because the ischemic areas have irregular shapes, a novel contour-based algorithm was used to compare three-dimensional images of blood flow distribution and two-dimensional maps of indocyanine green perfusion. Significant correlations were observed between the two measurements in all contours from a selected area of 10 × 10 mm 2 with the lowest blood flow ( r ≥ 0.78; p < 0.004), suggesting that speckle contrast diffuse correlation tomography provides the information for identifying ischemic tissues in mastectomy skin flaps. With further optimization and validation in large populations, speckle contrast diffuse correlation tomography may ultimately be used as a noninvasive and inexpensive imaging tool for intraoperative assessment of skin flap viability to predict mastectomy skin flap necrosis. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, II.
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Neoplasias da Mama , Mamoplastia , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/cirurgia , Feminino , Humanos , Verde de Indocianina , Isquemia , Mamoplastia/métodos , Mastectomia/métodos , Necrose , Imagem Óptica , Complicações Pós-Operatórias/diagnósticoRESUMO
Laser-assisted lipoplasty has potential attractive advantages over traditional liposuction, though review of the literature reveals some variation in outcomes. The patient's perspective regarding the procedure and outcome is described from the results of a survey administered to sequential patients undergoing laser-assisted lipoplasty in an office setting. The average perception of reduction in size is 3.94 on a scale of 1 to 5, with 5 being the most noticeable. The average perception of improvement in skin appearance is 3.1 (1-5, with 5 being most noticeable). The overall satisfaction is 3.78 (1-5, with 5 being very satisfied). Return to normal activity was 1.5 days. Of all the respondents, 75% took only 0 to 1 pain pills after the procedure. Though we found a positive patient response to the technique, further study is needed to answer remaining questions.
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Terapia a Laser/métodos , Lasers de Estado Sólido/uso terapêutico , Lipectomia/métodos , Satisfação do Paciente/estatística & dados numéricos , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Medição de Risco , Inquéritos e Questionários , Resultado do TratamentoRESUMO
INTRODUCTION: Tissue injuries are often associated with abnormal blood flow (BF). The ability to assess BF distributions in injured tissues enables objective evaluation of interventions and holds the potential to improve the acute management of these injuries on battlefield. MATERIALS AND METHODS: We have developed a novel speckle contrast diffuse correlation tomography (scDCT) system for noncontact 3D imaging of tissue BF distributions. In scDCT, a galvo mirror was used to remotely project near-infrared point light to different source positions and an electron multiplying charge-coupled-device was used to detect boundary diffuse speckle contrasts. The normalized boundary data were then inserted into a modified Near-Infrared Fluorescence and Spectral Tomography program for 3D reconstructions of BF distributions. This article reports the first application of scDCT for noncontact 3D imaging of BF distributions in burn wounds. RESULTS: Significant lower BF values were observed in the burned areas/volumes compared to surrounding normal tissues. CONCLUSIONS: The unique noncontact 3D imaging capability makes the scDCT applicable for intraoperative assessment of burns/wounds, without risk of infection and without interfering with sterility of the surgical field. The portable scDCT device holds the potential to be used by surgeons in combat surgical hospitals to improve the acute management of battlefield burn injuries.
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Abdome/irrigação sanguínea , Queimaduras/complicações , Análise de Variância , Queimaduras/fisiopatologia , Hemodinâmica/fisiologia , Humanos , Kentucky , Tomografia Computadorizada por Raios X/métodosRESUMO
Pyridine-phosphaalkene (PN) ligands 2a-e were prepared in an E-selective fashion using phospha-Wittig methodology. Treatment of these five ligands, varying only in their 6-substituent with RuCl2(PPh3)3, produced four distinct types of coordination complexes: pyridine-phosphaalkene-derived 3b,d, cyclized 4e, and six-coordinate 5a and 6c. Prolonged heating of 3b,d in THF resulted in C-H activation of the Mes* group and cyclization to give 4b,d featuring a bidentate pyridine-phospholane ligand bound to the metal center. Complex 5a, also possessing a newly formed phospholane ring, contained a different spatial arrangement of donors to Ru(II) with an agostic Ru-H-C interaction serving as the sixth donor to the transition metal center. Ligands 2b,d,e and Ru(II) complexes 3b, 4b,e and 5a were all characterized by X-ray crystallography. Six-coordinate 6c featured a structure similar to 4b,d,e, but with the CF3 substituent acting as a weakly bound sixth ligand to the Ru(II) center, as observed by 31P{1H} and19F NMR spectroscopy. The calculated structure of 6c established that the closest Ru- - -F contact was at 2.978 Å.
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BACKGROUND: Microcystic adnexal carcinoma (MAC) is a rare infiltrative cutaneous tumor, but with its locally aggressive nature, high rate of recurrence, and rare metastatic potential, it is an important clinical entity to consider when faced with a nipple lesion. These tumors are frequently misdiagnosed based on superficial biopsy alone. CASE REPORT: This case of a 15-year-old girl with MAC of the nipple demonstrates the importance of having a high index of suspicion in order to obtain a diagnosis, to determine the extent of disease, and to achieve adequate resection before reconstruction. Close clinical observation is recommended due to the possibility of future recurrences. CONCLUSIONS: Between the confusing nomenclature, indolent course, and inadequacy of superficial biopsy to achieve an accurate diagnosis, MAC is a clinical entity that the plastic surgeon must be aware of in order to facilitate proper diagnosis and treatment.
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Carcinoma de Apêndice Cutâneo/diagnóstico , Mamoplastia/métodos , Mastectomia/métodos , Mamilos/patologia , Neoplasias Cutâneas/diagnóstico , Adolescente , Carcinoma de Apêndice Cutâneo/radioterapia , Carcinoma de Apêndice Cutâneo/cirurgia , Feminino , Humanos , Recidiva Local de Neoplasia , Radioterapia , Neoplasias Cutâneas/radioterapia , Neoplasias Cutâneas/cirurgia , Resultado do TratamentoRESUMO
A noncontact electron multiplying charge-coupled-device (EMCCD)-based speckle contrast diffuse correlation tomography (scDCT) technology has been recently developed in our laboratory, allowing for noninvasive three-dimensional measurement of tissue blood flow distributions. One major remaining constraint in the scDCT is the assumption of a semi-infinite tissue volume with a flat surface, which affects the image reconstruction accuracy for tissues with irregular geometries. An advanced photometric stereo technique (PST) was integrated into the scDCT system to obtain the surface geometry in real time for image reconstruction. Computer simulations demonstrated that a priori knowledge of tissue surface geometry is crucial for precisely reconstructing the anomaly with blood flow contrast. Importantly, the innovative integration design with one single-EMCCD camera for both PST and scDCT data collection obviates the need for offline alignment of sources and detectors on the tissue boundary. The in vivo imaging capability of the updated scDCT is demonstrated by imaging dynamic changes in forearm blood flow distribution during a cuff-occlusion procedure. The feasibility and safety in clinical use are evidenced by intraoperative imaging of mastectomy skin flaps and comparison with fluorescence angiography.
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Interpretação de Imagem Assistida por Computador/métodos , Fluxo Sanguíneo Regional/fisiologia , Tomografia Óptica/métodos , Feminino , Antebraço/irrigação sanguínea , Antebraço/diagnóstico por imagem , Humanos , Mastectomia/métodos , Necrose/diagnóstico por imagem , Necrose/prevenção & controle , Retalhos Cirúrgicos/irrigação sanguíneaRESUMO
A 41-year-old man with past medical history of kidney-liver transplantation requiring chronic immunosuppression presented 2 years posttransplant with a necrotizing soft tissue infection of his right thigh. Serial debridement to remove necrotic tissue was performed, and a Matrix HD Allograft Fenestrated (RTI Surgical, Alachua, FL) was applied. At 5-months post grafting, the patient demonstrated fully vascularized and intact skin. Under normal circumstances, a cadaveric allograft sloughs over several weeks and is not usually considered a permanent solution for wound closure. A systematic review of transplant patients on chronic immunosuppression with skin allografts demonstrates the potential for the indefinite survival of an allograft. Necrotizing soft tissue infections can definitively be treated using serial debridement and allograft transplantation in the chronically immunosuppressed.
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Aloenxertos/imunologia , Sobrevivência de Enxerto , Hospedeiro Imunocomprometido/imunologia , Terapia de Imunossupressão/métodos , Necrose/cirurgia , Transplante de Pele , Infecções dos Tecidos Moles/cirurgia , Transplante Homólogo , Adulto , Cadáver , Desbridamento/métodos , Sobrevivência de Enxerto/imunologia , Humanos , Transplante de Rim , Transplante de Fígado , Masculino , Necrose/imunologia , Necrose/fisiopatologia , Transplante de Pele/métodos , Infecções dos Tecidos Moles/imunologia , Infecções dos Tecidos Moles/fisiopatologia , Coxa da Perna/patologia , Fatores de Tempo , Transplante Homólogo/métodos , Resultado do TratamentoRESUMO
A new advanced technology, noncontact diffuse correlation spectroscopy, has been recently developed for the measurement of tissue blood flow through analyzing the motions of red blood cells in deep tissues. This technology is portable, inexpensive, and noninvasive, and can measure up to 1.5-cm tissue depth. In this prospective study, the authors aimed to explore the use of this novel device in the prediction of mastectomy skin flap necrosis. The noncontact diffuse correlation spectroscopy device was used to measure mastectomy skin flap flow in patients undergoing mastectomy and immediate implant-based breast reconstruction before and immediately after mastectomy, and after placement of the prosthesis. Patients were tracked for the development of complications, including skin necrosis and the need for further surgery. Nineteen patients were enrolled in the study. Four patients (21 percent) developed skin necrosis, one of which required additional surgery. The difference in relative blood flow levels immediately after mastectomy in patients with or without necrosis was statistically significant, with values of 0.27 ± 0.11 and 0.66 ± 0.22, respectively (p = 0.0005). Relative blood flow measurements immediately after mastectomy show a significant high accuracy in prediction of skin flap necrosis, with an area under the receiver operating characteristic curve of 0.95 (95 percent confidence interval, 0.81 to 1). The noncontact diffuse correlation spectroscopy device is a promising tool that provides objective information regarding mastectomy skin flap viability intraoperatively, allowing surgeons early identification of those compromised and ischemic flaps with the hope of potentially salvaging them. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.