Skin sparing mastectomy with preservation of nipple areola complex and immediate breast reconstruction in patients with breast cancer: a single centre prospective study.

Background. Skin and nipple areola sparing mastectomy (NASM) has recently gained popularity as the management of breast cancer. This study aims to evaluate the aesthetic outcome, patient satisfaction, and oncological safety of NASM. Methods. The study prospectively analyzes the results of NASM and immediate breast reconstruction in 34 women with breast cancer. The criteria for inclusion were core biopsy-proven, peripherally located breast cancer of any tumor size and with any "N" status, with documented negative intraoperative frozen section biopsy of retroareolar tissue, and distance from the nipple to tumor margin >2 cm on mammography. Results. The median age of the patients was 45 years. The majority had either stage II or stage III breast cancer. The median mammographic distance of tumor from nipple areola complex (NAC) was 3.8 cm. The overall operative morbidity was minimal. The NAC could be preserved in all the patients. There was no local recurrence of tumor at median follow-up of 28.5 months. The aesthetic outcomes were satisfactory. Conclusion. NASM and immediate breast reconstruction can be successfully achieved with minimal morbidity and very low risk of local recurrence in appropriately selected breast cancer patients, with acceptable aesthetic results and good patient satisfaction.

Paraspinal transposition flap for reconstruction of sacral soft tissue defects: a series of 53 cases from a single institute.

STUDY DESIGN: Case series. PURPOSE: To describe paraspinal transposition flap for coverage of sacral soft tissue defects. OVERVIEW OF LITERATURE: Soft tissue defects in the sacral region pose a major challenge to the reconstructive surgeon. Goals of sacral wound reconstruction are to provide a durable skin and soft tissue cover adequate for even large sacral defects; minimize recurrence; and minimize donor site morbidity. Various musculocutaneous and fasciocutanous flaps have been described in the literature. METHODS: The flap was applied in 53 patients with sacral soft tissue defects of diverse etiology. Defects ranged in size from small (6 cm×5 cm) to extensive (21 cm×10 cm). The median age of the patients was 58 years (range, 16-78 years). RESULTS: There was no flap necrosis. Primary closure of donor sites was possible in all the cases. The median follow up of the patients was 33 months (range, 4-84 months). The aesthetic outcomes were acceptable. There has been no recurrence of pressure sores. CONCLUSIONS: The authors conclude that paraspinal transposition flap is suitable for reconstruction of large sacral soft tissue defects with minimum morbidity and excellent long term results.

Revisiting Gavello's procedure for single-stage reconstruction of the earlobe: The vascular basis, technique and clinical uses.

BACKGROUND: Deformities or loss of the earlobe may be congenital, or acquired due to trauma, bites, burns or tumour excision. A variety of single-stage and two-stage procedures have been described for earlobe reconstruction, of which Gavello's procedure was one of the earliest. OBJECTIVE: To revisit Gavello's procedure with reference to the vascular supply of the flap, and discuss the relevance of the technique in current practice. METHODS: The authors discuss the vascular basis of Gavello's flap, and describe the clinical application of the single-stage Gavello's procedure in diverse clinical situations, including congenital absence of earlobe, post-burn earlobe deformity and traumatic amputation of the earlobe. RESULTS: Excellent cosmetic results have been achieved in all different clinical situations in the authors' experience, with preservation of earlobe shape and volume, good colour match and a well-concealed scar in the donor area. DISCUSSION: Gavello's procedure is a simple, one-stage procedure that relies entirely on local tissue for earlobe reconstruction; the flap has a predictable vascular supply, skin grafting is not required and the procedure can be used for large defects. An intact donor area over the postauricular mastoid region is a prerequisite. CONCLUSION: The simple, century-old Gavello's procedure is still of great value for reconstruction of earlobe defects of diverse etiology.

HISTORIQUE: Les anomalies ou la perte du lobe de l'oreille peuvent être d'origine congénitale ou être acquises en raison d'un traumatisme, de morsures, de brûlures ou d'excision d'une tumeur. Diverses interventions en une ou deux étapes ont été décrites pour reconstruire le lobe de l'oreille. L'intervention de Gavello est l'une des plus anciennes. OBJECTIF: Examiner l'intervention de Gavello compte tenu de la capacité vasculaire du lambeau et exposer la pertinence de cette technique dans la pratique actuelle. MÉTHODOLOGIE: Les auteurs abordent la base vasculaire du lambeau de Gavello et décrivent l'application clinique de l'intervention de Gavello en une étape dans diverses situations, y compris l'absence congénitale de lobe d'oreille, une malformation du lobe de l'oreille après une brûlure et une amputation traumatique du lobe de l'oreille. RÉSULTATS: Les auteurs ont remarqué d'excellents résultats esthétiques dans toutes sortes de situations cliniques, qui permettent de préserver la forme et le volume du lobe de l'oreille ainsi que d'obtenir une bonne correspondance de la couleur et une cicatrice bien cachée au foyer du donneur. EXPOSÉ: L'intervention de Gavello est une intervention simple en une étape qui fait entièrement appel à des tissus locaux pour reconstruire le lobe de l'oreille. Le lambeau a une capacité vasculaire prévisible, la greffe de peau est inutile et l'intervention peut être utilisée pour des anomalies importantes. La région de la mastoïde postauriculaire du donneur doit être intacte. CONCLUSION: L'intervention de Gavello, qui est simple et existe depuis un siècle, est toujours très précieuse pour la reconstruction d'anomalies du lobe de l'oreille d'étiologies variées.