Maximizing aesthetic outcome in autologous breast reconstruction with implants and lipofilling

Background

Free flap breast reconstruction is an option widely sought in postmastectomy breast reconstruction. However, the volume of autologous tissue from the patient is often not sufficient for symmetrical reconstruction. In these cases, flaps can be used in combination with implants or autologous fat injections to augment volume and achieve shape, symmetry, and contour.

Methods

A retrospective chart review was performed on patients who underwent postmastectomy free flap reconstruction with secondary augmentation using autologous fat grafting or implant from 2008 to 2011.

Results

Twenty-four patients (39 breasts) received further augmentation of autologous tissue reconstruction during this period. Sixteen patients (26 breasts) had fat graft augmentation only, four patients (eight breasts) had implant augmentation only, and three patients (five breasts) had both procedures. Among patients who had fat grafting, operative intervention was required twice for fat necrosis. Contrastingly, of patients who received implants, one patient required operative intervention for implant malpositioning. These differences were not significant (P?=?0.57). The group with both fat grafting and implant augmentation had significantly higher aesthetic scores regarding overall appearance, contour, and volume, but not projection, than the group with fat grafting only and the group with implant only.

Conclusions

Autologous fat grafting offers several contouring aesthetic advantages, including selectively augmenting areas of hollowness to improve contour and maximize symmetry. However, implant augmentation generally allows for a larger increase in projection in a single procedure, with similar rates of postaugmentation complications. Use of both autologous fat grafting and implant augmentation may allow for superior aesthetic results. Level of Evidence: Level IV, therapeutic study.     

A quantitative analysis of the spatial and temporal evolution patterns of the bluetongue virus outbreak in the island of Lesvos,Greece, in 2014

Bluetongue virus (BTV) causes an infectious disease called bluetongue, a vector‐borne viral disease of ruminants, which has major implications and causes severe economic damage due to its effect on livestock. These economic costs are mostly ascribed to the trade restrictions imposed during the epidemic period. In August 2014, an epidemic of bluetongue occurred in the island of Lesvos, Greece. The epidemic was severe and evolved over time, lasting until December 2014. The total cases of infected farms were 490, including a total number of 136,368 small ruminants. In this paper, we describe a bluetongue virus serotype 4 (BTV‐4) epidemic and utilize Bayesian epidemic models to capture the spatio‐temporal spread of the disease. Our study provides important insights into the drivers of BTV transmission and has implications for designing control strategies. The results showed strong spatial autocorrelations, with BTV being more likely to spread between farms located nearby. The spatial modelling results proposed a certain spatial radius (~12 km) around the onset of a similar epidemic for imposing restrictions on animal movement, which can be sufficient for the control of the disease and limit economic damage.     

Comparison of two screening bioassays, based on the frog sciatic nerve and yeast cells, for the assessment of herbicide toxicity

Two different test systems, one based on the isolated sciatic nerve of an amphibian and the other on a microbial eukaryote, were used for the assessment of herbicide toxicity. More specifically, we determined the deleterious effects of increasing concentrations of herbicides of different chemical classes (phenoxyacetic acids, triazines, and acetamides), and of 2,4-dichlorophenol (2,4-DCP), a degradation product of the herbicide 2,4-dichlorophenoxyacetic acid (2,4-D), on electrophysiological parameters and the vitality of the axons of the isolated sciatic nerve of the frog (Rana ridibunda) and on the growth curve of the yeast Saccharomyces cerevisiae based on microtiter plate susceptibility assays. The no-observed-effect-concentration (NOEC), defined as the maximum concentration of the tested compound that has no effect on these biological parameters, was estimated. In spite of the different methodological approaches and biological systems compared, the NOEC values were identical and correlated with the lipophilicity of the tested compounds. The relative toxicity established here, 2,4-DCP > alachlor, metolachlor > metribuzin > 2,4-D, 2-methyl-4-chlorophenoxyacetic acid (MCPA), correlates with the toxicity indexes reported in the literature for freshwater organisms. Based on these results, we suggest that the relatively simple, rapid, and low-cost test systems examined here may be of interest as alternative or complementary tests for toxicological assessment of herbicides.     

Synovial hemangioma of the interphalangeal joint: a case report

Among the differential diagnosis for lesions of the hand, synovial hemangioma of the articular surface and tendon sheath is often overlooked due to its rare nature. In comparison to more abundant reports describing their involvement of the knee joint, our literature review found only six cases involving the hand or wrist. We present our recent experience in treating a 17-year-old female diagnosed with synovial hemangioma of the long finger proximal interphalangeal joint. In addition, we have submitted pertinent imaging and pathological findings for review with the intent to increase awareness of synovial hemangioma during evaluation of hand lesions.     

Biomechanical analysis of knotless flexor tendon repair using large-diameter unidirection barbed suture

Purpose

In traditional flexor tendon repairs, suture knots can be sites of weakness, impair tendon healing, stimulate an inflammatory response, and increase the bulk of the tendon repair. Because of this, there has been an increased interest in knotless flexor tendon repair using barbed suture. Since knots are not required, it may be possible to increase the strength of the tendon repair by using a large-diameter barbed suture. The purpose of this study was to biomechanically compare a traditional four-strand tendon repair using 3-0 braided polyester with a similar knotless four-strand tendon repair using 0 unidirectional barbed suture.

Methods

Twenty-two matched cadaveric flexor digitorum profundus tendons were lacerated and assigned to repair by a four-strand modified Kirchmayr–Kessler technique using 3-0 braided polyester (n = 11) or knotless four-strand modified Kirchmayr–Kessler repair using 0 unidirectional barbed suture (n = 11). Repaired tendons were linearly distracted to failure at 20 mm/min after 1 N preload. Maximum load and load at 2-mm gap formation were recorded. Maximum load and load at 2-mm gap formation were compared with the Student’s t test, and p values ≤ 0.05 were considered significant.

Results

The mean maximum load of the barbed, knotless suture repair was higher than that of the traditional repair (52 vs. 42 N). There was no difference between the two groups in the mean load required to produce a 2-mm gap.

Conclusions

The four-strand knotless tendon repairs using a large-diameter unidirectional barbed suture were stronger than the traditional four-strand repairs using 3-0 braided polyester, and had similar 2-mm gap resistance.     

Bayesian epidemic models for spatially aggregated count data

Epidemic data often possess certain characteristics, such as the presence of many zeros, the spatial nature of the disease spread mechanism, environmental noise, serial correlation and dependence on time‐varying factors. This paper addresses these issues via suitable Bayesian modelling. In doing so, we utilize a general class of stochastic regression models appropriate for spatio‐temporal count data with an excess number of zeros. The developed regression framework does incorporate serial correlation and time‐varying covariates through an Ornstein–Uhlenbeck process formulation. In addition, we explore the effect of different priors, including default options and variations of mixtures of g‐priors. The effect of different distance kernels for the epidemic model component is investigated. We proceed by developing branching process‐based methods for testing scenarios for disease control, thus linking traditional epidemiological models with stochastic epidemic processes, useful in policy‐focused decision making. The approach is illustrated with an application to a sheep pox dataset from the Evros region, Greece. Copyright © 2017 John Wiley & Sons, Ltd.     

Comparison of calcium phosphate preparations for onlay cranial augmentation in a murine model

Calcium phosphate preparations are often employed for a variety of reconstructive tasks. The majority of existing data regarding these preparations relates to their use as an inlay implant. The present study aims to evaluate calcium phosphate preparations and their tissue characteristics related to onlay augmentation. Thirty-six research mice were divided into three groups of 12. Each animal underwent onlay augmentation with a calcium phosphate preparation. Group 1 members were subjected to hydroxyapatite (HA) paste while group 2 was treated with beta-tricalcium phosphate granules alone (TCP). Finally, group 3 was treated with a combined mixture of both substances (HA-TCP). The animals were harvested for histological analysis and data collection. Groups 2 (TCP) and 3 (HA-TCP) developed greater osteoneogenesis and tissue integration compared to Group 1 (HA). The results were found to be statistically significant (p?<?0.01). Calcium phosphate preparations including TCP alone or in combination with HA undergo greater osteoneogenesis and soft tissue integration compared with hydroxapatite alone when used as an onlay implant in the animal model. Therapeutic study — Level II.     

Combining muscle-sparing serratus flap with acellular dermal matrix in immediate breast reconstruction

Background

Submuscular placement of tissue expanders is a common method of reconstruction in the postmastectomy patient. Though the pectoralis muscle provides ample coverage of the expander superomedially, it is insufficient for complete coverage. Inferior coverage has been described using both local muscle and fascial flaps as well as the more recently introduced acellular dermal matrix (ADM). Each method possesses advantages and disadvantages, while the use of both in conjunction may serve to provide a superior, cost-effective result.

Methods

A retrospective review was undertaken of all patients undergoing immediate breast reconstruction from January 2008 to December 2011. Patients who underwent reconstruction with the use of combined ADM and muscle-sparing serratus flap were selected for further review. A total of 16 patients (27 reconstructed breasts) were identified. Data were collected regarding patient demographics, operative details, and complications.

Results

Of the 16 patients, 6 received postoperative radiation and 9 received perioperative chemotherapy. Mean follow-up was 20.8 months. A single 8?×?16-cm sheet of ADM was sufficient for bilateral reconstruction. Complications included infection (three patients), mastectomy flap necrosis (two patients), expander exposure (one patient), wound dehiscence (one patient), hematoma (one patient), and seroma (one patient). There were no cases of capsular contracture. All patients were noted to have sufficient lateral fullness and optimal contour.

Conclusions

Combined use of a muscle-sparing serratus anterior flap with ADM is a safe and viable method of complete inferior expander coverage in immediate breast reconstruction, which has not yet been described in the literature. Potential advantages include decreased donor site morbidity, improved lateral fullness, and greater efficiency in ADM use. Level of Evidence: Level IV, therapeutic study.