Annals of plastic surgery
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Annals of plastic surgery · Jul 2003
Treatment of painful neuroma by resection and nerve stump transplantation into a vein.
Twenty-three patients (14 men, 9 women) with 24 painful neuromas underwent resection of neuroma and transposition of the nerve stump into an adjacent vein. The neuromas resulted from amputations (N = 7), tumor excision (N = 5), laceration injuries (N = 4), different types of wrist surgery (N = 3), vein-stripping procedures (N = 2), open fracture of the radius (N = 1), and toe harvest for thumb reconstruction (N = 1). The duration of painful symptoms averaged 66.7 weeks at the time of operation. ⋯ Two patients experienced moderate pain, and pain recurred unchanged 2 months postoperatively in 1 patient. The results presented are consistent with results of animal experiments demonstrating that typical neuroma does not develop in nerve stumps transposed into veins. Further clinical use of this approach is encouraged.
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Annals of plastic surgery · Jun 2003
Case Reports Comparative StudySentinel lymph node biopsy for the T1 (thin) melanoma: is it necessary?
The use of sentinel lymph node biopsy for the T1 melanoma is controversial. Recent reports have demonstrated that certain T1 melanomas are at increased risk for early regional metastases and late recurrence when compared with all thin melanomas. The purpose of this study was to review the authors' experience with wide excision and sentinel lymph node biopsy for certain patients with T1 melanoma. ⋯ Current indications for sentinel lymph node biopsy for patients with T1 melanoma include tumors associated with Clark level IV or V invasion, ulceration, regression, a positive deep margin on initial biopsy, or previous melanoma. Acral lentiginous melanoma associated with at least a Clark level III invasion warrant sentinel lymph node biopsy. Superficial spreading or nodular melanoma larger than 0.9 mm should include sentinel lymph node biopsy regardless of other associated histological factors.
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Annals of plastic surgery · Jun 2003
TRAM flap breast reconstruction for patients with advanced breast disease.
Transverse rectus abdominis musculocutaneous (TRAM) breast reconstruction in patients with advanced breast cancer is controversial. Management of these patients is often complex and consists of surgical extirpation, postoperative radiation, chemotherapy, and in some cases bone marrow transplantation. Few studies have attempted to examine patient long-term survival and overall satisfaction with the surgical procedure. ⋯ Patients with advanced breast cancer can be considered appropriate candidates for TRAM reconstruction. The results of this study indicate that patients with advanced breast cancer do not have an increased rate of postoperative complications, and they recover within a reasonable time from their surgical procedure despite adjuvant radiation and chemotherapy. Furthermore, the majority of patients are satisfied with their reconstructed breast and postoperative course, and would choose this reconstructive option again.
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Annals of plastic surgery · Jun 2003
Comparative StudyBreast reconstruction in the elderly: preserving excellent quality of life.
There is a paucity of information in the literature that focuses on quality-of-life issues after mastectomy with breast reconstruction in elderly women. The purpose of this study was to review the authors' experience with breast reconstruction after mastectomy in women older than 65 years of age. Emphasis was placed on the types of reconstructions, outcomes, and evaluation of issues related to quality of life. ⋯ Specifically, study patients reported dramatic increases (better outcomes) in the subscales that are strongly influenced by one's mental health. However, when compared with prior data for younger patients undergoing mastectomy and reconstruction, the older patients scored lower (worse outcomes) in the areas related to physical function. The older patients maintained superior scores (better outcomes) over the younger patients in the subscales influenced by one's mental health.