BACKGROUND: Breast reconstruction following prophylactic mastectomy in women with ptotic or hypertrophic breasts often poses challenges. We describe a combined technique of large-volume fat grafting (>100 mL) and an inferior dermal flap, aiming to improve aesthetic outcomes and patient satisfaction. METHODS: We conducted a retrospective analysis of 21 patients undergoing immediate breast reconstruction with the described technique. All patients were asked to complete the BREAST-Q questionnaire preoperatively and at least 12 months postoperatively (median interval: 20 months). Statistical analysis (Wilcoxon signed-rank test) was used to assess changes in satisfaction and well-being; aesthetic outcomes were scored by an independent, multidisciplinary team. RESULTS: Among 13 patients with complete BREAST-Q data, satisfaction with the breasts increased significantly from a median score of 38-85 (p = 0.002), psychosocial well-being from 57-70 (p = 0.045), and physical well-being (chest) from 68 to 81 (p = 0.045). Sexual well-being rose from 47-63 (p = 0.023). Aesthetic evaluation by an independent panel showed notable improvements in breast symmetry, shape, and overall appearance. Minimal and asymptomatic fat necroses or oil liponecrotic pseudocysts were observed. CONCLUSIONS: Combining large-volume fat grafting with an inferior dermal flap appears promising for women with ptotic breasts, yielding high satisfaction and low complication rates. Despite requiring multiple operative stages, this autologous reconstruction technique may offer a less invasive alternative for high-risk patients seeking natural outcomes without implants.
- Klíčová slova
- Breast Reconstruction, Complications in Breast Surgery, Fat Grafting, Inferior Dermal Flap, Minimal Invasive Surgery, Prophylactic Mastectomy,
- MeSH
- chirurgické laloky * MeSH
- dospělí MeSH
- estetika MeSH
- kohortové studie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mamoplastika * metody MeSH
- nádory prsu * prevence a kontrola chirurgie MeSH
- profylaktická mastektomie * MeSH
- prsy chirurgie patologie MeSH
- průzkumy a dotazníky MeSH
- retrospektivní studie MeSH
- senioři MeSH
- spokojenost pacientů MeSH
- tuková tkáň * transplantace MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Identifying relevant perforators is crucial in planning a deep inferior epigastric perforator (DIEP) flap. Color Doppler ultrasonography (CDU) has gained popularity for localizing perforators; however, current evidence on its efficiency is still inconclusive. This study aimed to compare the efficiency of CDU with that of computed tomography angiography (CTA) in localizing and selecting the relevant perforators. METHODS: In this randomized controlled trial, 60 patients undergoing DIEP flap breast reconstruction (uni- or bilateral) were randomly assigned to the CDU group (i.e., CDU was performed to map and select the relevant perforators preoperatively) or the CTA+CDU group (i.e., mapping was based on CTA and supplemented by CDU). CDU was performed by the same surgeon with a well-defined sonography experience from our previous study. The reference XY coordinates of the dissected perforators were measured intraoperatively, and deviations from preoperatively deducted coordinates were calculated (ΔCDU or ΔCTA+CDU). The flaps were categorized according to the number of dissected perforators, and adherence to the preoperative strategy was evaluated. RESULTS: Overall, 22 patients (30 flaps) in the CTA+CDU group and 27 (39 flaps) patients in the CDU group were evaluated. The average ΔCDU (0.6 cm) was significantly lower than the average ΔCTA+CDU (1.0 cm) (p < 0.001). Adherence to the mapping-based dissection strategy was higher in the CDU group; however, the difference was insignificant (p = 0.092). CONCLUSION: CDU is not inferior to CTA + CDU in localizing and selecting relevant DIEA perforators. Therefore, CDU mapping is a possible complementary or substitute modality for CTA mapping.
- Klíčová slova
- Breast reconstruction, Color Doppler ultrasound, Computed tomographic angiography, DIEP flap perforator mapping, Localization of perforators, Perforator flaps,
- MeSH
- arteriae epigastricae diagnostické zobrazování chirurgie MeSH
- CT angiografie metody MeSH
- lidé MeSH
- mamoplastika * metody MeSH
- perforátorový lalok * chirurgie MeSH
- ultrasonografie dopplerovská barevná MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
BACKGROUND: Perforator mapping using diagnostic methods facilitates deep inferior epigastric perforator (DIEP) flap planning. Computed tomographic angiography (CTA) is a well-proven tool for perforator mapping. However, the benefits of color Doppler ultrasonography (CDU) are as follows: 1) CDU involves dynamic real-time examination and 2) does not use radiation. Comparing the accuracies of both methods in a cohort of patients, this study aimed to evaluate the learning curve of surgeon-conducted CDU perforator mapping. METHODS: Twenty patients undergoing DIEP flap breast reconstruction were enrolled in a cohort study. All patients underwent CTA perforator mapping preoperatively. XY coordinates of significant perforators were subtracted by a radiologist. A single surgeon (sonographer) with minimal experience with CDU performed CDU perforator mapping, including XY coordinates subtraction. The sonographer was blinded to the CTA data. The reference coordinates of dissected perforators were measured during surgery. Deviations from reference coordinates for both methods were compared, and CDU mapping learning curve was assessed using Joinpoint Regression. RESULTS: We included 20 women (32 DIEP flaps and 59 dissected perforators). The mean deviation between mapped and reference coordinates was 1.00 (0.50-1.12) cm for CDU and 0.71 (0.50-1.12) cm for CTA. The learning curve of CDU mapping showed the breaking point after the seventh patient (≈ 21 localized perforators). After the breaking point, no significant differences between the deviations of both methods were found (p = 0.980). CONCLUSION: A limited number of examinations were needed for the surgeon to learn CDU DIEA perforator mapping with accuracy similar to that of CTA mapping.
- Klíčová slova
- Color Doppler ultrasound, computed tomographic angiography, DIEP flap perforator mapping, Learning curve,
- MeSH
- arteriae epigastricae diagnostické zobrazování chirurgie MeSH
- chirurgové * MeSH
- kohortové studie MeSH
- křivka učení MeSH
- lidé MeSH
- mamoplastika * metody MeSH
- perforátorový lalok * krevní zásobení MeSH
- ultrasonografie dopplerovská barevná metody MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Excess of skin and fat in lower abdomen can be aesthetic and, in some patients, also medical problem. This article gives basic information about different types of abdominoplasty, the way how it is performed, about recovery time, risks and complications. Several patients pictures demonstrate pre and postoperative results. Abdominoplasty belongs to group of body contouring procedures and it is one of the most common aesthetic operations. Because of extension of the surgical field and the length of operation, there are possible risks of systemic complications and also complication with local healing. Under the specific condition, this operation can be covered by public health care resources. Keywords: abdominoplasty, miniabdominoplasty, floating abdominoplasty, circumferential body lift.
- Klíčová slova
- abdominoplasty, circumferential body lift, floating abdominoplasty, miniabdominoplasty,
- MeSH
- abdominoplastika * MeSH
- estetika MeSH
- lidé MeSH
- lipektomie * MeSH
- pooperační komplikace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Lipomodeling is a technique that uses the patient's own fat for tissue regeneration and augmentation. The extent of regenerative effect is reported to be determined by the numbers of adipose-derived stem cells and the viability of cells in processed adipose tissue which, together with other factors, influence the degree of graft retention. This study addresses whether differences exist in properties of fat graft obtained by three commonly used techniques. METHODS: Adipose tissue harvested from the hypogastric regions of 14 patients was processed by decantation, centrifugation, and membrane-based tissue filtration. The morphology of each preparation was assessed by electron microscopy and overall cell viability was assessed by live/dead assay. The number of adipose-derived stem cells was determined and their stem cell character was assessed by the presence of cell surface molecules (i.e., CD105, CD90, CD31, and CD45) and by their capacity to differentiate into adipogenic and osteogenic lineages. RESULTS: First, morphologies of processed fat samples obtained by individual procedures differed, but no preparation caused obvious damage to cellular or acellular components. Second, although the highest numbers of adipose-derived stem cells were contained in the upper fraction of centrifuged lipoaspirates, the difference between preparations was marginal. Third, the maximal concentration of adipose fraction (removal of watery component) of lipoaspirate was achieved by membrane-based tissue filtration. Finally, no significant differences in overall viability were detected. CONCLUSIONS: Properties of processed lipoaspirate were influenced by the preparation procedure. However, the differences were not dramatic; both centrifugation and membrane-based filtration are methods of choice whose selection depends on other criteria (e.g., practicality) for individual surgical settings.
- MeSH
- cytologické techniky MeSH
- dospělí MeSH
- kmenové buňky MeSH
- kultivované buňky MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- odběr tkání a orgánů metody MeSH
- tuková tkáň transplantace MeSH
- tukové buňky MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
UNLABELLED: Bilateral prophylactic mastectomy without reconstruction is not accepted by the majority of patients. Successful reconstruction is therefore a mandatory condition for prophylactic mastectomy. Of the many options for autologous breast reconstruction, the deep inferior epigastric perforator (DIEP) flap best meets requirements for bilateral reconstruction in selected patients. The goal of this study is to verify the feasibility of the procedure in our conditions and to find out how it is accepted by patients. We present 55 consecutive patients who were scheduled for bilateral DIEP flap reconstruction during a 4-year period. We reviewed medical charts, performed clinical assessments and processed anonymous questionnaires. There were 77 immediate and 33 delayed breast reconstructions. There was 100% flap survival and no microanastomoses revisions. In 11 patients (10%) the surgeon preferred to convert the DIEP into a mini transverse rectus abdominis muscle (miniTRAM) flap in order to provide adequate blood supply. COMPLICATIONS: revision for haematoma under the flap in four patients (7.2%), excessive blood loss in four patients (7.2%) and partial mastectomy skin flap necrosis in 10 immediate breast reconstructions (12.9%). Patients' evaluation of the aesthetic result was good or excellent in 96.2% of cases. In 33.9% of patients the postoperative quality of life was considered unchanged and 50.9% of them it even improved. The DIEP flap is recommended for bilateral breast reconstruction. Occasional conversion into a miniTRAM flap can increase the total flap survival rate. Bilateral prophylactic mastectomy and DIEP flap reconstruction are very well accepted by patients.
- MeSH
- chirurgické laloky * MeSH
- dospělí MeSH
- estetika MeSH
- kvalita života MeSH
- lidé středního věku MeSH
- lidé MeSH
- mamoplastika metody MeSH
- mastektomie metody MeSH
- nádory prsu prevence a kontrola MeSH
- pooperační komplikace MeSH
- retrospektivní studie MeSH
- spokojenost pacientů MeSH
- studie proveditelnosti MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- hodnotící studie MeSH
- MeSH
- kůže * MeSH
- lidé MeSH
- mamoplastika metody MeSH
- mastektomie metody MeSH
- prsní bradavky chirurgie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- dopisy MeSH
Out of 262 hands with total finger amputations treated by replantation of finger/fingers from January 2001 until January 2006, there were only 6 cases of type III ring avulsion injuries, all of which were replanted. Radical resection of the damaged part of the artery with primary vein grafting was used in each case; only 1 artery and 2 veins were anastomosed for each finger. The survival rate was 100%. Mean total active motion was 195 degrees (ranging from 175 degrees to 220 degrees ). Mean 2-point discrimination was 8.6 mm static (ranging from 4 to 11 mm) and 6.2 mm moving (ranging from 3 to 9 mm), and mean grip strength was 37.4 kg. We believe that liberal resection of the "zone of contusion" of vessels and primary vein grafting for arterial repair can improve the overall survival rate of replantation in type III ring avulsion injuries, and replantation can be attempted in majority of the cases; good hand function can be expected.
- MeSH
- časové faktory MeSH
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- poranění prstů ruky chirurgie MeSH
- prospektivní studie MeSH
- replantace * MeSH
- traumatická amputace chirurgie MeSH
- vény transplantace MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
