Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · Jan 2006
ReviewRadiation effects on the cosmetic outcomes of immediate and delayed autologous breast reconstruction: an argument about timing.
To conduct a systematic review to gather the available evidence on the optimum timing of the radiotherapy in relation to autologous breast reconstruction. ⋯ Despite the paucity of the published data, the current evidence suggests that the radiation has a deleterious effect on autologous flap reconstruction. Until better methods of radiation delivery can be devised to minimise the long term radiation sequelae in the irradiated tissue, delayed reconstruction seems to be a safe option in most of the cases. However, the findings from these studies should be interpreted with great caution before generalising from their results.
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J Plast Reconstr Aesthet Surg · Jan 2006
ReviewThe influence of radiotherapy on capsule formation and aesthetic outcome after immediate breast reconstruction using biodimensional anatomical expander implants.
Capsular contracture occurs more frequently when immediate breast reconstruction (IBR) is associated with radiotherapy (RT) in a post-mastectomy field. The aim of this study was to investigate the impact of RT on surgical outcome after IBR using a single implant type. ⋯ The mean age of the 114 patients studied was 45 (range, 20-77) years. Forty-four reconstructed breasts received RT. Capsule formation was detected in 13/92 (14.1%) reconstructed breasts with no RT and in 17/44 (38.6%) reconstructed breasts with RT. On univariate analysis, RT was the only variable related to capsule formation (p<0.001). Significant differences in geometric measurements of symmetry were identified in patients with capsules compared with those without capsules. Photographic assessments were worse in the capsule group: mean photo score 8 (95% CI 8, 8.5) compared with the no capsule group 6.5 (95% CI 5, 7.5), p<0.001. Persistent pain two years or more after surgery was present in 8/30 patients with capsules and 1/106 with no capsule group, p<0.01. Capsule formation is three times more likely to occur after IBR in association with an RT field. However, as more than 60% of patients do not get capsules despite RT at four years, implant-assisted tissue expansion techniques using a biodimensional device is a viable breast reconstructive option in selected cases.
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J Plast Reconstr Aesthet Surg · Jan 2006
Soft-tissue reconstruction of the distal lower leg and foot: are free flaps the only choice? Review of 215 cases.
Free flaps are the first choice procedure to manage soft-tissue defect of the lower limb for many authors, but loco-regional pedicled flaps are an alternative since they were described in the 1980s. We analysed the changes in our practice to reconstruct soft-tissue defects of the distal third of the leg. A retrospective chart review identified 215 cases of distal leg soft-tissue defect treated in the department during 15 years. ⋯ Moreover, complications of local and regional flaps are less severe. Our practice has changed to make pedicled flaps our first choice to cover soft-tissue defects of the lower limb. However, we still use free flaps as a first choice for wide or composite defects, when pedicled flaps are not feasible or for cosmetic considerations to avoid additional scarring of the leg.
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J Plast Reconstr Aesthet Surg · Jan 2006
Case ReportsSympathetic paraganglioma presenting with Horner's syndrome in a child.
Paragangliomas of the head and neck arise from collections of cells from the neural crest associated with cranial or sympathetic nerves. Such lesions are rare in children. The majority of paragangliomas in the paediatric age groups have been familial, occurring in association with an adrenal pheochromocytoma. ⋯ Sympathetic chain paragangliomas are very rare tumours in the head and neck but should be considered in the differential diagnosis when clinical and radiographic evidence suggest a paraganglioma. The presentation is typically of a slow-growing neck mass with the presence of an ipsilateral Horner's syndrome. To our knowledge, this is the first reported case of a sympathetic chain paraganglioma in a child.
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J Plast Reconstr Aesthet Surg · Jan 2006
Case ReportsAcute exacerbation of macroglossia leading to necrosis of the anterior third of the tongue.
Macroglossia is defined as an enlarged tongue that protrudes beyond the teeth or the alveolar ridge in the resting position. Macroglossia may be classified into generalised and localised based on the extent of tongue involvement. Each of these groups can be subdivided into congenital, inflammatory, traumatic, metabolic and neoplastic lesions [Myer III CM, Hotaling AJ, Reilly JS. ⋯ The congenital causes are vascular anomalies such as haemangioma and lymphovenous malformations. We report the case of a large lymphovenous malformation of the tongue in a 17 month old child who developed an acute exacerbation of macroglossia following trauma. This eventually led to necrosis of the anterior third of his tongue requiring a partial glossectomy.