RESUMEN
In many centres, the myocutaneous transverse upper gracilis (TUG) flap represents an alternative choice in autologous breast reconstruction when abdominal tissue is unavailable. However, a single TUG flap may be volume deficient, particularly in the upper pole. We describe the application of simultaneous lipofilling to the pectoralis major muscle at the index procedure and present our decision-making algorithm, technique and outcomes. A retrospective review of all TUG flaps between January 2011 and May 2021 was conducted. Patient demographics, volume of primary and any subsequent fat grafting and complications were recorded. A total of 183 patients (242 TUG flaps) were included in this study. Of these; 130 patients were reconstructed with single TUG flaps, 16 patients received a single TUG flap with immediate lipofilling, and 37 patients underwent stacked, double TUG flap reconstructions. Of the 242 flaps, there were 2 flap losses (<1%), neither of which occurred in the immediate lipofilling cohort. Among the 130 single TUG patients, 28 (21.5%) required a cumulative total of 40, and a mean of 1.4, secondary lipofilling procedures. The immediate lipofilling patients were injected with a mean of 42 ml fat (range: 20-80 ml). In this group, only 2 of 16 patients required secondary lipofilling. The mean follow-up was 67 months (17-141). Primary lipofilling may reduce the need for secondary revisional procedures and appears safe at the index operation, adds little operative time and has negligible donor site morbidity. In patients where a second (stacked) flap would add unnecessary volume and complexity, it can be considered a useful adjunct.
Asunto(s)
Neoplasias de la Mama , Músculo Grácil , Mamoplastia , Colgajo Miocutáneo , Humanos , Femenino , Mamoplastia/métodos , Colgajo Miocutáneo/trasplante , Estudios Retrospectivos , Músculo Grácil/trasplante , Complicaciones Posoperatorias/cirugía , Neoplasias de la Mama/cirugíaRESUMEN
INTRODUCTION: This study evaluates COVID-19 related patient risk, when undergoing management within one of the largest specialist centres in Europe, which rapidly implemented national COVID-19 safety guidelines. METHOD: A prospective cohort study was undertaken in all patients who underwent surgical (nâ¯=â¯1429) or non-operative (nâ¯=â¯191) management during the UK COVID-19 pandemic peak (April-May 2020); all were evaluated for 30-day COVID-19 related death. A representative sample of elective/trauma/burns patients (surgery group, nâ¯=â¯729) were selected and also sub-analysed within a controlled cohort study design. Comparison was made to a random selection of non-operatively managed (non-operative group, nâ¯=â¯100) or waiting list (control group, nâ¯=â¯250) patients. These groups were prospectively followed-up and telephoned from the end of June (control group) or at 30 days post-first assessment (non-operative group)/post-operatively (surgery group). RESULTS: Complex general (9.2%, 136/1483) or regional (5.0%, 74/1483) anaesthesia cases represented 14.2% (210/1483) of operations undertaken. There were no 30-day post-operative (0/1429)/first assessment (0/191) COVID-19 related deaths. Neither the three sub-speciality plastic surgery, or non-operative groups, displayed increases in post-operative/first assessment symptoms in comparison to each other, or to control. The proportion of COVID-19 positive tests were: 7.1% (1/14) (non-operative), 5.9% (2/34) (burns) and 3.0% (3/99) (trauma); there were however no significant differences between these groups, the elective (0%, 0/54) and control (0%, 0/24) groups (pâ¯=â¯0.236). CONCLUSION: We demonstrate that even heterogeneous sub-speciality patient groups, who required operative/non-operative management, did not incur an increased COVID-19 risk compared to each other or to control. These highly encouraging results were achieved with described, rapidly implemented service changes that were tailored to protect each patient group and staff.
Asunto(s)
Quemaduras/cirugía , COVID-19 , Procedimientos Quirúrgicos Electivos , Procedimientos de Cirugía Plástica , Heridas y Lesiones/cirugía , Adulto , Anciano de 80 o más Años , Inglaterra , Femenino , Hospitales , Humanos , Masculino , Persona de Mediana Edad , Seguridad del Paciente , Estudios Prospectivos , Medición de RiesgoRESUMEN
Bilateral below knee amputation following septicaemic foot gangrene may be avoided by limited amputation and bilateral immediate free flap reconstruction. This technique results in reduction in morbidity and early mobilisation.
Asunto(s)
Pie/patología , Pie/cirugía , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos , Adulto , Amputación Quirúrgica , Femenino , Gangrena/etiología , Gangrena/cirugía , Humanos , Recuperación del Miembro/métodos , Masculino , Persona de Mediana Edad , Sepsis/complicacionesRESUMEN
A technique of nipple reconstruction using two local flaps is described. The central 'core' flap is surrounded by a peripheral 'wrap' flap, producing a natural nipple. Results of 24 nipple reconstructions in 22 cases are presented. This technique is useful when the neo-nipple location falls on the mastectomy scar.