The Use of the Sternocleidomastoid Flap Helps Reduce Complications After Free Jejunal Flap Reconstructions in Total Laryngectomy and Cervical Esophagectomy Defects.
Annals of plastic surgery
2016; 76: S209-12
Superior Gluteal Artery Perforator Flap: The Beauty of the Buttock.
Annals of plastic surgery
2016; 76: S191-5
Esophageal reconstruction after tumor extirpation or ingestion injury is a difficult problem for the reconstructive plastic surgeon. Free tubed fasciocutaneous flaps and intestinal flaps have become the mainstay for reconstruction. The free jejunal flap has the advantage of replacing like-with-like tissue and having lower fistula rates. Additionally, the "mesenteric wrap" modification and prophylactic pectoralis major muscle have been described to further decrease anastomotic leaks and fistulae. The purpose of this study was to describe the use of the prophylactic pedicled sternocleidomastoid (SCM) flap for prevention of anastomotic leaks and fistulae.A retrospective review of patients who underwent reconstruction of circumferential pharyngoesophageal defects with a free jejunal flap by a single surgeon from 2008 to 2012 was performed. Those who received a prophylactic pedicled SCM flap to reinforce one of their jejunal anastomoses were selected for this study, and their outcomes were analyzed. Patients' demographics, comorbidities, complications, and clinical outcomes were collected and analyzed.Three patients underwent reinforcement of one jejunal anastomosis with a pedicled SCM flap. The mean age was 60 years, and average follow-up was 27 months. Two patients received postoperative radiation, and one patient received both preoperative and postoperative radiation. The recipient vessels included the facial artery, internal jugular vein, and facial vein. The flap survival rate was 100%. There was 1 stricture and 1 fistula that occurred at the anastomoses without the SCM muscle reinforcement. There were no complications at the jejunal anastomotic sites that were reinforced with the SCM muscle. Of the 6 anastomotic sites in 3 patients, there was a 0% fistula rate and 0% stricture rate at the sites reinforced with the SCM muscle versus a 33% fistula rate and a 33% stricture rate at the sites without the SCM muscle flap. One patient was diagnosed with local tumor recurrence and eventually succumbed to the progression of their disease. All patients were able to tolerate an oral diet without supplemental feeds. All patients were able to achieve intelligible speech via an electrolarynx or esophageal speech.Reconstruction of pharyngoesophageal defects can be technically challenging and requires extensive planning and careful execution. The free jejunal flap restores alimentary continuity with good functional outcomes. Fistula rates may be decreased with the use of a prophylactic SCM flap to reinforce the jejunal anastomosis.
View details for DOI 10.1097/SAP.0000000000000724
View details for PubMedID 26849282
Reconstruction of First Web Space Contractures.
journal of hand surgery
2015; 40 (9): 1892-1895
Treatment of an unusual trans-scaphoid perilunate avulsion fracture dislocation: a case report.
Hand (New York, N.Y.)
2015; 10 (2): 328-332
The superior gluteal artery perforator (SGAP) flap is a useful technique for breast reconstruction. This perforator flap allows for the transfer of the patient's own skin and subcutaneous tissue with minimal donor-site morbidity. Despite its usefulness, the SGAP flap is not widely used among reconstructive surgeons. The challenging perforator dissection and need for microsurgery may contribute to the reluctant use of the flap by many reconstructive surgeons. The ability to perform a single-stage breast reconstruction with buttock tissue when abdominal or thigh tissue are unavailable provides a significant service to the patient desiring an autologous breast reconstruction.The authors performed a retrospective review and outcomes analysis of a single surgeon's surgical technique and experience. Consecutive patients, who underwent SGAP flaps for breast reconstruction during a 7-year period from 2007 to 2014, were compared to a matched cohort of consecutive patients undergoing deep inferior epigastric perforator (DIEP) flaps and clinical outcomes were analyzed.Thirteen patients underwent SGAP flap breast reconstruction for a total of 16 flaps during the study period compared to 34 consecutive DIEP flaps for breast reconstruction. There was no significant difference in flap or donor-site complications between the 2 groups. There was no statistically significant difference between the average operative time for unilateral breast reconstruction in the SGAP and DIEP flap groups. In 4 patients, a bipedicled SGAP flap was used due to perforator anatomy. All SGAP patients returned to full activity. Average follow-up time was 1 year.Although utilization of buttock tissue for breast reconstruction can be challenging and requires microsurgical expertise, in the hands of experienced microsurgeons the SGAP flap is a safe and reliable option for autologous breast reconstruction with minimal donor-site morbidity and excellent aesthetic results.
View details for DOI 10.1097/SAP.0000000000000723
View details for PubMedID 26808742
Indications for sentinel lymph node biopsy in multifocal and multicentric breast cancer
2012; 152 (3): 389-396
We describe an unusual case of trans-scaphoid perilunate injury where the proximal half of the scaphoid avulsed from all attaching ligaments and extruded into the forearm. Treatment involved anatomic reduction and internal fixation of the fracture, scapholunate (SL) ligament repair, temporary K-wire fixation, and prolonged immobilization. At 19-month follow-up, the fracture healed, SL ligament remained intact, and the patient recovered much of his hand function.
View details for DOI 10.1007/s11552-014-9634-x
View details for PubMedID 26034454
Multifocal and multicentric breast cancers have been regarded as relative contraindications for sentinel lymph node (SLN) biopsy, because initial validation studies noted an association with greater false-negative rates. The purpose of this study is to perform a meta-analysis of the literature evaluating the feasibility and accuracy of SLN biopsy in multifocal and multicentric breast cancer.A PubMed search retrieved original articles published between 2000 and 2010 in which the authors evaluated the accuracy of SLN biopsy in multifocal and multicentric breast cancer. Sixteen original articles were included in our meta-analysis.Nine-hundred thirty-two patients with multifocal and multicentric breast cancer underwent SLN biopsy followed by axillary lymph node dissection. The overall accuracy rate and false-negative rate are 96% and 7.7%, respectively. Of the 37 false-negative biopsies, 7 patients had an additional relative contraindication for SLN biopsy. If we exclude these patients with additional known relative contraindication to SLN biopsy, the accuracy and false-negative rates are 96.7% and 6.3%, respectively.When a multifocal or multicentric breast cancer has an additional relative contraindication to performing SLN biopsy, such as neoadjuvant chemotherapy or T > 5 cm, the false-negative rate increases.
View details for DOI 10.1016/j.surg.2012.06.017
View details for Web of Science ID 000308623500013
View details for PubMedID 22938899