ABSTRACT
BACKGROUND: The aim was to carry out phase 4 international field-testing of the European Organisation for Research and Treatment of Cancer (EORTC) breast reconstruction (BRECON) module. The primary objective was finalization of its scale structure. Secondary objectives were evaluation of its reliability, validity, responsiveness, acceptability and interpretability in patients with breast cancer undergoing mastectomy and reconstruction. METHODS: The EORTC module development guidelines were followed. Patients were recruited from 28 centres in seven countries. A prospective cohort completed the QLQ-BRECON15 before mastectomy and the QLQ-BRECON24 at 4-8 months after reconstruction. The cross-sectional cohort completed the QLQ-BRECON24 at 1-5 years after reconstruction, and repeated this 2-8 weeks later (test-retest reliability). All participants completed debriefing questionnaires. RESULTS: A total of 438 patients were recruited, 234 in the prospective cohort and 204 in the cross-sectional cohort. A total of 414 reconstructions were immediate, with a comparable number of implants (176) and donor-site flaps (166). Control groups comprised patients who underwent two-stage implant procedures (72, 75 per cent) or delayed reconstruction (24, 25 per cent). Psychometric scale validity was supported by moderate to high item-own scale and item-total correlations (over 0·5). Questionnaire validity was confirmed by good scale-to-sample targeting, and computable scale scores exceeding 50 per cent, except nipple cosmesis (over 40 per cent). In known-group comparisons, QLQ-BRECON24 scales and items differentiated between patient groups defined by clinical criteria, such as type and timing of reconstruction, postmastectomy radiotherapy and surgical complications, with moderate effect sizes. Prospectively, sexuality and surgical side-effects scales showed significant responsiveness over time (P < 0·001). Scale reliability was supported by high Cronbach's α coefficients (over 0·7) and test-retest (intraclass correlation more than 0·8). One item (finding a well fitting bra) was excluded based on high floor/ceiling effects, poor test-retest and weak correlations in factor analysis (below 0·3), thus generating the QLQ-BRECON23 questionnaire. CONCLUSION: The QLQ-BRECON23 is an internationally validated tool to be used alongside the EORTC QLQ-C30 (cancer) and QLQ-BR23 (breast cancer) questionnaires for evaluating quality of life and satisfaction after breast reconstruction.
Subject(s)
Health Status Indicators , Mammaplasty , Quality of Life , Adult , Aged , Cross-Sectional Studies , Europe , Female , Humans , Mastectomy , Middle Aged , Outcome Assessment, Health Care , Patient Satisfaction , Prospective Studies , Psychometrics , Reproducibility of ResultsABSTRACT
Introducción y objetivos: Existe una enorme variedad de colgajos cutáneos empleados para la reparación de defectos quirúrgicos faciales tras la extirpación de tumores. El objetivo del estudio fue consensuar una guía práctica de los colgajos más útiles para cada una de las distintas unidades estéticas faciales. Material y métodos: Estudio multicéntrico donde 10 dermatólogos de larga experiencia quirúrgica reconstructiva eligieron sus técnicas preferidas para cada unidad estética. La elección de estos colgajos se fundamentó en la experiencia personal de cada dermatólogo basándose en factores como la idoneidad de la técnica reconstructiva para ese defecto, el resultado estético final, la facilidad de ejecución y la baja probabilidad de complicaciones, entre otros. Eligieron 2 colgajos por orden de preferencia para cada subunidad estética y se le asignaron 10 puntos al primer colgajo y 5 al segundo. Resultados: Con la suma obtenida de todas las opciones aportadas por los dermatólogos encuestados se obtuvo una relación de los 3 mejores colgajos para cada localización. Destacar la unanimidad de criterio por parte de la mayoría de los dermatólogos para técnicas reconstructivas como el colgajo glabelar para defectos de canto interno del ojo, el colgajo de avance bilateral en bandera o H para frente, el colgajo en puerta giratoria para concha auricular, el colgajo pangeniano para mejilla infraorbitaria, el colgajo de rotación O-Z para cuero cabelludo, el colgajo de Tenzel para párpado inferior y el colgajo en isla para labio superior. Conclusiones: Los resultados de este estudio son de utilidad para ofrecer una guía práctica para la elección de las mejores técnicas reconstructivas en cada una de las distintas subunidades estéticas faciales (AU)
Background and objectives: A broad range of skin flaps can be used to repair facial surgical defects after the excision of a tumor. The aim of our study was to develop a practical guideline covering the most useful skin grafts for each of the distinct facial cosmetic units. Material and methods: This was a multicenter study in which 10 dermatologists with extensive experience in reconstructive surgery chose their preferred technique for each cosmetic unit. The choice of flaps was based on personal experience, taking into account factors such as suitability of the reconstruction technique for the specific defect, the final cosmetic result, surgical difficulty, and risk of complications. Each dermatologist proposed 2 flaps in order of preference for each cosmetic subunit. A score of 10 was given to the first flap and a score of 5 to the second. Results: The total score obtained for each of the options proposed by the participating dermatologists was used to draw up a list of the 3 best grafts for each site. There was notable unanimity of criteria among most of the dermatologists for reconstructive techniques such as the glabellar flap for defects of the medial canthus of the eye, the bilateral advancement flag flap or H flap for the forehead, the rotary door flap for the auricle of the ear, the Mustarde flap for the infraorbital cheek, the O-Z rotation flap for the scalp, the Tenzel flap for the lower eyelid, and the island flap for the upper lip. Conclusions: The results of this study will be useful as a practical guide to choosing the best reconstruction technique for each of the facial cosmetic units (AU)
Subject(s)
Humans , Plastic Surgery Procedures/methods , Facial Injuries/surgery , Surgical Flaps , Face/surgery , Esthetics , Practice Patterns, Physicians'ABSTRACT
BACKGROUND AND OBJECTIVES: A broad range of skin flaps can be used to repair facial surgical defects after the excision of a tumor. The aim of our study was to develop a practical guideline covering the most useful skin grafts for each of the distinct facial cosmetic units. MATERIAL AND METHODS: This was a multicenter study in which 10 dermatologists with extensive experience in reconstructive surgery chose their preferred technique for each cosmetic unit. The choice of flaps was based on personal experience, taking into account factors such as suitability of the reconstruction technique for the specific defect, the final cosmetic result, surgical difficulty, and risk of complications. Each dermatologist proposed 2 flaps in order of preference for each cosmetic subunit. A score of 10 was given to the first flap and a score of 5 to the second. RESULTS: The total score obtained for each of the options proposed by the participating dermatologists was used to draw up a list of the 3 best grafts for each site. There was notable unanimity of criteria among most of the dermatologists for reconstructive techniques such as the glabellar flap for defects of the medial canthus of the eye, the bilateral advancement flag flap or H flap for the forehead, the rotary door flap for the auricle of the ear, the Mustarde flap for the infraorbital cheek, the O-Z rotation flap for the scalp, the Tenzel flap for the lower eyelid, and the island flap for the upper lip. CONCLUSIONS: The results of this study will be useful as a practical guide to choosing the best reconstruction technique for each of the facial cosmetic units.
Subject(s)
Facial Neoplasms/surgery , Plastic Surgery Procedures/methods , Surgical Flaps/surgery , Esthetics , Humans , Portugal , Practice Guidelines as Topic , Practice Patterns, Physicians' , Retrospective Studies , Scalp/surgery , Skin Neoplasms/surgery , Skin Transplantation/methods , SpainABSTRACT
We report a patient with an unusual anal ulceration. The biopsy of an anal lesion and subsequent studies revealed a disseminated form of paracoccidioidomycosis, observed in the lungs, small and large bowel. The anorectal disease frequently represents a secondary site of disease, and the patient must be better evaluated.
