Subject(s)
Gracilis Muscle , Rectal Fistula , Urinary Fistula , Vaginal Fistula , Female , Humans , Rectovaginal Fistula/etiology , Rectovaginal Fistula/surgery , Gracilis Muscle/transplantation , Surgical Flaps , Vaginal Fistula/surgery , Urinary Fistula/surgery , Rectal Fistula/surgery , Muscle, Skeletal/transplantationABSTRACT
BACKGROUND: Skin-sparing mastectomy and prosthetic reconstruction can be complicated by poor surgical outcomes in large-breasted, obese women. This article describes a single surgeon's experience comparing conventional skin-sparing mastectomy (SSM) and skin-reduction mastectomy using an autologous vascularized inferior dermal/cutaneous sling (autoderm). METHODS: From July 2007 to May 2012, patients undergoing skin-sparing mastectomy were evaluated for surgical outcomes. After July 2009, the surgeon performed skin-reduction mastectomies with autoderm (SRM-AD) on all patients with macromastia or grade 3-4 ptosis. Remaining patients in this time period (SSM-cont) underwent conventional skin-sparing mastectomies while all previous patients (historical) also underwent skin-sparing mastectomies (SSM-hist). A predictive model was used to compare the large historical patients (who would have had reduction mastectomy if available) with the smaller historical patients to evaluate the effect of the procedure. RESULTS: Body mass index (BMI) and specimen weight were higher in both the SRM group and large historical group. The hazard ratio for having skin-reduction mastectomy was 0.53 (P = 0.51) compared with the historical group. There was a total of 16 complications for the whole study. Smoking was the only significant risk factor. CONCLUSIONS: This study shows that mastectomy with prosthetic reconstruction using a skin-reduction technique with autoderm can be done safely with a low complication rate and improved cosmetic outcomes in the traditionally "at-risk" group of women with high BMI and large ptotic breasts.
Subject(s)
Breast Neoplasms/surgery , Dermatologic Surgical Procedures , Hypertrophy/surgery , Mammaplasty , Mastectomy/rehabilitation , Plastic Surgery Procedures , Surgical Flaps , Breast/abnormalities , Breast/surgery , Breast Neoplasms/pathology , Choice Behavior , Female , Follow-Up Studies , Humans , Middle Aged , Neoplasm Staging , Postoperative Complications , Prognosis , Retrospective Studies , Skin TransplantationABSTRACT
Hydrogen sulfide is a colorless, noxious gas with the distinctive smell of rotten eggs. This compound is a powerful reducing agent that is encountered in a number of industrial processes. When hydrogen sulfide is present, it exposes workers to the potentially lethal effects of the rapid hypoxemia that results from exposure to this agent. The "warning sign" is the characteristic smell of rotten eggs; this smell should alert anyone in the area that a potentially serious risk exists. The immediate removal of the victim and administration of high-flow oxygen is essential. Neurologic sequelae may require anticonvulsants and care must be exercised to observe for cardiac, hepatic, and renal insufficiency. Depending on the concentration, hydrogen sulfide can rapidly overcome a potential victim.
