RESUMEN
BACKGROUND: The effect of neoadjuvant chemotherapy on immediate microvascular breast reconstruction is of concern because any complication might delay adjuvant treatment. We sought to determine whether the complication rate is increased and whether the interval between surgery and subsequent treatment is delayed compared with patients without neoadjuvant chemotherapy. METHODS: Complication rates and interval from surgery until adjuvant treatment of patients with mastectomy for locally advanced breast cancer followed by immediate microvascular breast reconstruction (deep inferior epigastric perforator (DIEP) flap, transverse rectus abdominis musculocutaneous (TRAM) flap, superior gluteal artery perforator (SGAP) flap, transverse musculocutaneous gracilis (TMG) flap, or superficial inferior epigastric artery (SIEA) flap) after neoadjuvant chemotherapy were compared with those of patients who underwent immediate breast reconstruction without neoadjuvant chemotherapy. RESULTS: Forty-seven patients with locally advanced breast cancers who underwent neoadjuvant chemotherapy before mastectomy and immediate microvascular reconstruction and 52 patients without neoadjuvant chemotherapy were identified. 36% of patients with neoadjuvant chemotherapy had one or more complications compared with 29% of patients without previous chemotherapy, but this difference was not statistically significant. The occurrence of complications in patients with neoadjuvant chemotherapy did not result in a delayed start of adjuvant treatment compared with patients without complications after neoadjuvant chemotherapy (43.6 vs. 44.6 days). CONCLUSIONS: Immediate microvascular breast reconstruction after neoadjuvant chemotherapy does not result in an increased complication rate or delay the start of adjuvant treatment even if complications occur and therefore can be performed safely in patients with locally advanced breast cancer.
Asunto(s)
Antineoplásicos/administración & dosificación , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/cirugía , Mamoplastia/métodos , Colgajos Quirúrgicos , Adulto , Anciano , Antineoplásicos/efectos adversos , Mama/cirugía , Neoplasias de la Mama/patología , Femenino , Humanos , Mastectomía , Persona de Mediana Edad , Terapia Neoadyuvante , Colgajos Quirúrgicos/irrigación sanguínea , Factores de TiempoRESUMEN
The efficacy of free fasciocutaneous flaps for the treatment of chronic osteomyelitis of the tibia was evaluated in a retrospective study. A series of 14 patients is reported who underwent soft-tissue reconstruction using different free fasciocutaneous flaps after radical debridement. Radical debridement and microvascular reconstruction were performed in two operative steps. The mean duration of disease was 14 years (range: 6 months to 37 years). At a mean follow-up of 31.4 (12 to 52) months, there was no evidence of recurrence of osteomyelitis. This retrospective study validates that fasciocutaneous flaps can be used for microsurgical soft-tissue reconstruction after radical debridement in the treatment of chronic osteomyelitis. The introduction of free fasciocutaneous flaps has challenged the dictum of the therapy of chronic osteomyelitis with muscle flaps.
Asunto(s)
Osteomielitis/cirugía , Colgajos Quirúrgicos , Tibia/cirugía , Adulto , Anciano , Enfermedad Crónica , Fístula Cutánea/cirugía , Desbridamiento , Fascia/trasplante , Estudios de Seguimiento , Humanos , Ilion/trasplante , Masculino , Persona de Mediana Edad , Necrosis/cirugía , Estudios Retrospectivos , Esclerosis/cirugía , Tibia/microbiología , Tibia/patología , Resultado del TratamientoRESUMEN
Circulating levels of calcitonin precursors (CTpr), including procalcitonin (ProCT), increase up to several thousand-fold in human sepsis, and immunoneutralization improves survival in two animal models of this disease. Herein, we analyzed inflammation-mediated calcitonin I gene (CALC I) expression in human adipocyte primary cultures and in adipose tissue samples from infected and noninfected patients with different levels of serum ProCT. In ex vivo differentiated adipocytes, the expression of CT mRNA increased 24-fold (P < 0.05) after the administration of Escherichia coli endotoxin (lipopolysaccharide) and 37-fold (P < 0.05) after IL-1beta administration by 6 h. ProCT protein secretion into culture supernatant increased 13.5-fold (P < 0.01) with lipopolysaccharide treatment and 15.2-fold (P < 0.01) with IL-1beta after 48 h. In coculture experiments, adipocyte CT mRNA expression was evoked by E. coli-activated macrophages in which CT mRNA was undetectable. The marked IL-1beta-mediated ProCT release was inhibited by 89% during coadministration with interferon-gamma (IFNgamma). In patients with infection and markedly increased serum ProCT, CT mRNA was detected in adipose tissue biopsies. Hence, we demonstrate that ProCT, which is suspected to mediate deleterious effects in sepsis and inflammation, is a novel product of adipose tissue secretion. The inhibiting effect of IFNgamma on IL-1beta-induced CT mRNA expression and on ProCT secretion might explain previous observations that serum ProCT concentrations increase less in systemic viral compared with bacterial infections.