The delay procedure in deep inferior epigastric artery perforator flap breast reconstruction.

BACKGROUND: The delay procedure in DIEP flap breast reconstruction, in which the reduced-caliber choke vessels play a major role, can provide more well-perfused tissue than a standard DIEP flap. The aim of this study was to review our experience with this technique, to evaluate the indications, and to analyze the surgical outcomes. METHODS: A retrospective study was conducted of all consecutive DIEP delay procedures performed between March 2019 and June 2021. Patient demographics, operative details, and complications were registered. Patients had preoperative imaging by MRA to select dominant perforators. The surgical technique involves a two-stage operation. During the first operation the flaps were pedicled on a dominant perforator and a lateral skin bridge extending towards the lateral flank and lumbar fat, and in a second stage the flap is harvested and transferred. RESULTS: A total of 82 extended DIEP delay procedures were performed to reconstruct 154 breasts. The majority were bilateral breast reconstructions (87.8%). The delay procedure was used for 38 primary reconstructions (46.3%) and 32 tertiary reconstructions (39.0%). The primary indication was the need for additional volume (79.3%), followed by extensive abdominal scarring and liposuction. After the first operation seroma was the most frequently observed complication (7.3%). After the second operation three total flap losses (1.9%) were observed. CONCLUSIONS: The delay procedure in DIEP flap breast reconstruction results in the harvest of a good amount of abdominal tissue by adding a preliminary procedure. This technique can convert patients previously considered unsuitable into suitable candidates for abdominal-based breast reconstruction.

Algae as nutritional and functional food sources: revisiting our understanding.

Global demand for macroalgal and microalgal foods is growing, and algae are increasingly being consumed for functional benefits beyond the traditional considerations of nutrition and health. There is substantial evidence for the health benefits of algal-derived food products, but there remain considerable challenges in quantifying these benefits, as well as possible adverse effects. First, there is a limited understanding of nutritional composition across algal species, geographical regions, and seasons, all of which can substantially affect their dietary value. The second issue is quantifying which fractions of algal foods are bioavailable to humans, and which factors influence how food constituents are released, ranging from food preparation through genetic differentiation in the gut microbiome. Third is understanding how algal nutritional and functional constituents interact in human metabolism. Superimposed considerations are the effects of harvesting, storage, and food processing techniques that can dramatically influence the potential nutritive value of algal-derived foods. We highlight this rapidly advancing area of algal science with a particular focus on the key research required to assess better the health benefits of an alga or algal product. There are rich opportunities for phycologists in this emerging field, requiring exciting new experimental and collaborative approaches.

Prospects and challenges for industrial production of seaweed bioactives.

Large-scale seaweed cultivation has been instrumental in globalizing the seaweed industry since the 1950s. The domestication of seaweed cultivars (begun in the 1940s) ended the reliance on natural cycles of raw material availability for some species, with efforts driven by consumer demands that far exceeded the available supplies. Currently, seaweed cultivation is unrivaled in mariculture with 94% of annual seaweed biomass utilized globally being derived from cultivated sources. In the last decade, research has confirmed seaweeds as rich sources of potentially valuable, health-promoting compounds. Most existing seaweed cultivars and current cultivation techniques have been developed for producing commoditized biomass, and may not necessarily be optimized for the production of valuable bioactive compounds. The future of the seaweed industry will include the development of high value markets for functional foods, cosmeceuticals, nutraceuticals, and pharmaceuticals. Entry into these markets will require a level of standardization, efficacy, and traceability that has not previously been demanded of seaweed products. Both internal concentrations and composition of bioactive compounds can fluctuate seasonally, geographically, bathymetrically, and according to genetic variability even within individual species, especially where life history stages can be important. History shows that successful expansion of seaweed products into new markets requires the cultivation of domesticated seaweed cultivars. Demands of an evolving new industry based upon efficacy and standardization will require the selection of improved cultivars, the domestication of new species, and a refinement of existing cultivation techniques to improve quality control and traceability of products.

Polar lipids from the marine macroalga Palmaria palmata inhibit lipopolysaccharide-induced nitric oxide production in RAW264.7 macrophage cells.

The EtOAc soluble fraction of a MeOH/CHCl3 extract of Palmaria palmata showed strong nitric oxide (NO) inhibitory activity against lipopolysaccharide (LPS)-induced NO production in murine RAW264.7 cells. NO inhibition-guided isolation led to identification of three new polar lipids including a sulfoquinovosyl diacylglycerol (SQDG) (2S)-1-O-eicosapentaenoyl-2-O-myristoyl-3-O-(6-sulfo-α-D-quinovopyranosyl)-glycerol (1) and two phosphatidylglycerols, 1-O-eicosapentaenoyl-2-O-trans-3-hexadecenoyl-3-phospho-(1'-glycerol)-glycerol (3) and 1-O-eicosapentaenoyl-2-O-palmitoyl-3-phospho-(1'-glycerol)-glycerol (4) from the EtOAc fraction. Seven known lipids were also isolated including a SQDG (2), a phospholipid (5) and five galactolipids (6-10). Structures of the isolated lipids were elucidated by spectral analyses. The isolated SQDGs, phosphatidylglycerols and phospholipid possessed strong and dose-dependent NO inhibitory activity compared to N(G)-methyl-L-arginine acetate salt (L-NMMA), a well-known NO inhibitor used as a positive control. Further study suggested that these polar lipids suppressed NO production through down-regulation of inducible nitric oxide synthase (iNOS).

Perforator flaps: recent experience, current trends, and future directions based on 3974 microsurgical breast reconstructions.

Perforator flap breast reconstruction is an accepted surgical option for breast cancer patients electing to restore their body image after mastectomy. Since the introduction of the deep inferior epigastric perforator flap, microsurgical techniques have evolved to support a 99 percent success rate for a variety of flaps with donor sites that include the abdomen, buttock, thigh, and trunk. Recent experience highlights the perforator flap as a proven solution for patients who have experienced failed breast implant-based reconstructions or those requiring irradiation. Current trends suggest an application of these techniques in patients previously felt to be unacceptable surgical candidates with a focus on safety, aesthetics, and increased sensitization. Future challenges include the propagation of these reconstructive techniques into the hands of future plastic surgeons with a focus on the development of septocutaneous flaps and vascularized lymph node transfers for the treatment of lymphedema.

Simultaneous bilateral breast reconstruction with in-the-crease inferior gluteal artery perforator flaps.

The inferior gluteal artery perforator (IGAP) free flap represents an alternative technique for autogenous breast reconstruction in patients with insufficient abdominal donor tissue. Historically, patients underwent a staged approach for bilateral breast reconstruction with the IGAP because it is technically demanding and can be time consuming. The bilateral simultaneous IGAP can be performed effectively with 2 microsurgeons operating together. This is a retrospective study of 22 patients (44 flaps) who underwent bilateral breast reconstruction with bilateral IGAP flaps in one operation between January 2005 and December 2007. The following parameters were evaluated and compared to our published data with unilateral IGAP flap reconstruction: operating time, blood loss, flap weight, hospital length of stay, and perioperative complications. A follow-up patient survey was also conducted to gauge patient's satisfaction with the donor site and procedure. The flap survival rate was 100%. Complications included 1 patient with 1 flap with partial fat necrosis, 2 patients who required reoperation for venous congestion, 1 patient with a hematoma, 2 patients with delayed buttock wound healing, 2 patients requiring resuturing for buttock wound dehiscence, and 1 patient with resolved paresthesias. The majority of patients were satisfied with the procedure and donor site. In this study, we detail our experience with the inferior gluteal region as a reliable source of donor tissue and the simultaneous bilateral IGAP flap as an efficient method of breast reconstruction.

Transplantation in identical twins: another option for breast reconstruction.

BACKGROUND: Deriving their name from the Greek word plastikos, meaning related to molding, plastic surgeons have made their reputation by transplanting tissues from one area of the body to another to "remold" defects caused by trauma, congenital anomaly, or disease. Dr. Joseph Murray, a plastic surgeon, performed the first successful kidney transplant between identical twins in 1954. The authors present three cases involving the transplantation of perforator flaps from one identical twin to another for breast reconstruction, including cases using both deep inferior epigastric perforator and superficial inferior epigastric artery flaps. METHODS: Three sets of recipient monozygotic twins that had breasts treated with mastectomies underwent reconstruction using transplanted tissue from their donor monozygotic twins. All sets of twins underwent DNA testing to determine that they were monozygotic; therefore, no immunosuppressive therapy was indicated. RESULTS: The three sets of recipient monozygotic twins underwent successful breast reconstruction using perforator flap transplants from their donor monozygotic twins. The operations included two unilateral reconstructions (one using a deep inferior epigastric perforator flap and the other using a superficial inferior epigastric artery flap) and one bilateral deep inferior epigastric perforator reconstruction. Their hospital courses were unremarkable. CONCLUSIONS: Transplant surgery continues to evolve in the twenty-first century. The authors present three cases of breast reconstruction using skin flap transplantation as a new option for breast reconstruction.

Autogenous breast reconstruction with the deep inferior epigastric perforator flap.

Muscle-sparing autogenous breast reconstruction has enhanced the multidisciplinary care that is available to patients who have breast cancer. The DIEP flap has proven reliability, a low complication rate, and is applicable to many clinical scenarios (Figs. 8-12). Avoidance of muscle sacrifice in the abdomen ultimately translates into greater patient satisfaction. The increased demands, in terms of surgical expertise, are more than offset by decreased postoperative pain and decreased donor site morbidity. The methods that were used to innovate the DIEP flap have been applied to other donor sites and the available options for patients have been expanded.