Nuestra experiencia en reconstrucción autóloga mamaria con colgajo latissimus dorsi e injerto de tejido adiposo tras mastectomía y radioterapia / Our experience in autologous breast reconstruction with latissimus dorsi flap and lipofilling after mastectomy and radiotherpay

Introducción y Objetivo: El colgajo de Latisimus Dorsi (LAT) es uno de los pilares en la reconstrucción mamaria; si bien el colgajo TRAM (transverse rectus abdominis myocutaneous flap) y en los últimos años el auge del colgajo de perforantes de la arteria epigástrica inferior profunda (DIEAP: deep inferior epigastric artery perforator flap) disminuyó su uso, continúa siendo una herramienta básica de la reconstrucción mamaria que incrementa su aplicación al asociarlo al injerto de tejido adiposo (ITA) prescindiendo del uso de prótesis. Presentamos y analizamos nuestros resultados con el uso del colgajo LAT asociado al ITA como alternativa en reconstrucción mamaria autóloga. Material y método: Recogemos de forma retrospectiva 35 casos de reconstrucción mamaria mediante colgajo pediculado LAT y varias sesiones de ITA en un periodo de 5 años en el Servicio de Cirugía Plástica del Hospital Clínico Universitario de Valencia (España). Resultados: La edad media de las pacientes fu 49.17 años. Todas habían sufrido mastectomía radical o subcutánea y recibido radioterapia posterior. El número medio de sesiones para lograr el volumen deseado fue de 3.23, siendo también 3 el número más frecuente de sesiones necesarias (15 pacientes, 42.86% del total). El volumen de injerto osciló entre 30 y 365 cc (media de 177.52 cc de injerto por sesión). El tiempo de espera medio entre sesiones fue de 5 meses. El resultado estético final ha sido muy satisfactorio, con mejoría evidente en las secuelas de la radioterapia. No registramos complicaciones mayores reseñables. Conclusiones: El empleo de ITA asociado al colgajo pediculado LAT permite, en nuestra experiencia, alcanzar un volumen final adecuado en la mama reconstruida y mejora la calidad de los tejidos radiados, suponiendo una alternativa comparable a los colgajos microquirúrgicos abdominales, y minimizando la complejidad quirúrgica del procedimiento

Background and Objective: The Latissimus Dorsi (LAT) flap represents one of the pillars in breast reconstruction; although TRAM (transverse rectus abdominis myocutaneous) flap and, in recent years, the rise of deep inferior epigastric perforator (DIEP) flap has decreased its use, it continues to constitute a basic tool of breast reconstruction, which increases its application when associated with the adipose tissue graft, not needing the use of breast implants. We present and analyze our results in the use of the LAT flap associated with the adipose tissue graft (ATG) as an alternative to other techniques of autologous reconstruction. Methods: We retrospectively collected 35 cases of patients with LAT flap reconstruction followed by several ATG sessions over a period of 5 years at the Plastic Surgery Department of the Hospital Clínico Universitario de Valencia (Spain). Results: Patients' average age was 49.17 years. All of them have undergone a radical or subcutaneous mastectomy and subsequent radiotherapy. The average number of adipose tissue graft sessions to achieve the desired volume was 3.23, with 3 being the most frequent number of sessions required (15 patients, 42.86% of the total). The graft volume ranged between 30 and 365 cc per session, with an average of 177.52 cc of graft per session. The average waiting time between sessions was 5 months. The final aesthetic result has been very satisfactory, obtaining an evident improvement in the sequels of radiotherapy. No major complications were reported. Conclusions: In our experience, the use of ATG associated with the LAT flap achieves an adequate final volume in the breast and improves the quality of the radiated tissues, assuming an alternative comparable to abdominal microsurgical flaps and minimizing surgical complexity of the procedure

Post-extraction mesio-distal gap reduction assessment by confocal laser scanning microscopy - a clinical 3-month follow-up study.

AIM: The aim of this 3-month follow-up study is to quantify the reduction in the mesio-distal gap dimension (MDGD) that occurs after tooth extraction through image analysis of three-dimensional images obtained with the confocal laser scanning microscopy (CLSM) technique. MATERIALS AND METHODS: Following tooth extraction, impressions of 79 patients 1 month and 72 patients 3 months after tooth extraction were obtained. Cast models were processed by CLSM, and MDGD changes between time points were measured. RESULTS: The mean mesio-distal gap reduction 1 month after tooth extraction was 343.4 µm and 3 months after tooth extraction was 672.3 µm. The daily mean gap reduction rate during the first term (between baseline and 1 month post-extraction measurements) was 10.3 µm/day and during the second term (between 1 and 3 months) was 5.4 µm/day. CONCLUSIONS: The mesio-distal gap reduction is higher during the first month following the extraction and continues in time, but to a lesser extent. When the inter-dental contacts were absent, the mesio-distal gap reduction is lower. When a molar tooth is extracted or the distal tooth to the edentulous space does not occlude with an antagonist, the mesio-distal gap reduction is larger. The consideration of mesio-distal gap dimension changes can help improve dental treatment planning.

Confocal laser scanning microscopy for the study of the morphological changes of the postextraction sites.

A better understanding of the remodeling process of postextraction sockets is essential in dental treatment planning. The aim of this study was to evaluate whether confocal laser scanning microscopy (CLSM) can be applied to imaging contour changes of postextraction sites, as well as to its quantification with image analysis of obtained three-dimensional images. This work describes a new application of the CLSM technique. The system used was the OLS3100-USS, LEXT model (Olympus®). CLSM was used for the surface analysis of the extraction site. The measurements taken with CLSM were: (1) mesio-distal distance, (2) alveolar ridge thickness, and (3) vestibular and lingual alveolar ridge height. Results of study cast scanning at baseline, 1 and 3 months after tooth extraction, with CLSM are well-detailed images of postextraction areas. The CLSM technique used in study casts is a valid method to measure the dimensional changes that happen in the edentulous area after tooth extraction. This technique allows the evaluation of changes in mesio-distal distance, thickness of the alveolar ridge and alveolar ridge height based on the measurements on the alveolar contours.

Evaluation of bleeding risk and measurement methods in dental patients

Objective: The present study explores bleeding manifestations in routine dental surgical procedures, evaluates the influence of antithrombotic drugs upon bleeding risk, and validates the efficiency of a clinical method for the measurement of bleeding.Material and method: A prospective observational study was made involving a cohort of 99 patients in the setting of normal clinical practice, with the added conduction of prior hematological tests including baseline hemostasis and platelet function, based on a new method (Multiplate System(R). For evaluation of the bleeding manifestations,a clinical method was selected that evaluates bleeding on the basis of its duration and the hemostatic measures needed to resolve the problem.Results: Almost one-third of the patients (27.3%) were receiving treatment with oral antiplatelet drugs, while 19.2% received oral anticoagulants and 9% received combined therapy with acetylsalicylic acid plus clopidogrel. In turn, an 8% incidence of moderate bleeding episodes was detected correlated to the ASPI platelet function testand to advanced patient age.Conclusion: The incorporation of platelet function tests increases the safety of oral surgery in elderly patients subjected to antiplatelet treatment, particularly with acetylsalicylic acid and clopidogrel (AU)

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Evaluation of bleeding risk and measurement methods in dental patients.

OBJECTIVE: The present study explores bleeding manifestations in routine dental surgical procedures, evaluates the influence of antithrombotic drugs upon bleeding risk, and validates the efficiency of a clinical method for the measurement of bleeding. MATERIAL AND METHOD: A prospective observational study was made involving a cohort of 99 patients in the setting of normal clinical practice, with the added conduction of prior hematological tests including baseline hemostasis and platelet function, based on a new method (Multiplate System®). For evaluation of the bleeding manifestations, a clinical method was selected that evaluates bleeding on the basis of its duration and the hemostatic measures needed to resolve the problem. RESULTS: Almost one-third of the patients (27.3%) were receiving treatment with oral antiplatelet drugs, while 19.2% received oral anticoagulants and 9% received combined therapy with acetylsalicylic acid plus clopidogrel. In turn, an 8% incidence of moderate bleeding episodes was detected correlated to the ASPI platelet function test and to advanced patient age. CONCLUSION: The incorporation of platelet function tests increases the safety of oral surgery in elderly patients subjected to antiplatelet treatment, particularly with acetylsalicylic acid and clopidogrel.