Aim:Autologous tissue is considered the“gold standard”for breast reconstruction today.However,little is known about deep inferior epigastric perforator(DIEP)flap reconstruction in combination with tissue expander(TE...Aim:Autologous tissue is considered the“gold standard”for breast reconstruction today.However,little is known about deep inferior epigastric perforator(DIEP)flap reconstruction in combination with tissue expander(TE)/implant.The authors describe a series of combined DIEP flap/TE reconstruction,including its indications and technique to ensure protection of the pedicle during the expansion process.Methods:Between January 2009 and December 2012,patients undergoing immediate DIEP with TE reconstruction were retrospectively reviewed.Oncologic,comorbid conditions,intraoperative,postoperative expansion,complications,and technique data points were collected.Photographs were taken postoperatively and patient’s satisfaction surveys were obtained to assess overall satisfaction.Results:Five patients underwent immediate DIEP flap/TE reconstruction utilizing our alloderm sling technique.There were no complications to the pedicle,flap,expander,or mastectomy skin perioperatively or postoperatively.All patients describe being very satisfied,often with improved breast volume and projection as compared to their preoperative appearance.Conclusion:The results of this study suggest that DIEP flap/TE reconstruction is safe,in particular when utilizing the alloderm sling technique,and should be considered in patients who lack sufficient abdominal tissue,have existing breast asymmetries,or do not desire the scar deformity of latissimus dorsi.展开更多
Objectives: To describe the versatility of acellular fetal bovine dermal matrix as an alternative to human cadaveric allograft for head and neck reconstructive procedures in children. Study Design: Case series with ch...Objectives: To describe the versatility of acellular fetal bovine dermal matrix as an alternative to human cadaveric allograft for head and neck reconstructive procedures in children. Study Design: Case series with chart review. Methods: A database of pediatric operative procedures was queried for the use of acellular fetal bovine dermal matrix over a 16-month period. Indications for reconstruction were assessed and initial parental and surgeon satisfaction with the product were noted. Results: During the time period of 3/2012 and 7/2013 a total of 8 reconstructive procedures were performed on pediatric patients using acellular fetal bovine dermal matrix. Indications for use varied and included open and transnasal endoscopic repair of encephaloceles and soft tissue reconstructions including lateral pharyngeal wall repair, cleft palate repair, and facial recontouring operations. Acellular fetal bovine dermal matrix had a subjectively increased ease of use as compared to the surgeon’s prior experience with human cadaveric acellular dermis. Every parent vocalized a greater comfort level with the use of a bovine product over the alternative of human cadaveric tissue. The cost of acellular fetal bovine dermal matrix is slightly lower than the cost of human cadaveric acellular dermis. Conclusions: Acellular fetal bovine dermal matrix appears to be an acceptable alternative to human cadaveric acellular dermis for various forms of head and neck soft tissue reconstruction in children. Further prospective studies are warranted to assess for any differences in the long-term efficacy of this product as compared to other forms of allograft reconstruction.展开更多
Macrophages have recently been characterized as having an M1 or M2 phenotype based on receptor expression, mechanism of activation and function. The effects of macrophage phenotype upon tissue remodeling following imp...Macrophages have recently been characterized as having an M1 or M2 phenotype based on receptor expression, mechanism of activation and function. The effects of macrophage phenotype upon tissue remodeling following implantation of an acellular dermal matrix (ADM) is largely unknown. The purpose of this study was to compare the macrophage phenotype and tissue remodeling elicited by four different ADMs (DermaMatrix, AlloDerm, Integra and Der mACELL). ADM samples were wrapped around the inferior epigastric vessels of a rat and were harvested on 7, 14, 21 and 42 days post implantation. Immunohistologic methods were used to identify macrophage surface markers CD68 (pan macrophage), CCR7 (M1 profile), and CD206 (M2 profile). All human derived ADMs showed a bell shaped curve for distribution of CD68+ macrophages with peaks for DermaMatrix occurring at day 14 and peak influx for AlloDerm occurring on day 21. In contrast, bovine derived Integra showed an increasing trend of macrophages with time. DermACELL had the highest influx of macro- phages while Integra had the lowest. A quantitative analysis of phenotype of macrophages in AlloDerm showed that the cells were predominantly M1 at 7, 14, 21 and 42 days post implantation. In contrast, Integra showed a mixed M1/M2 population of macrophages at all time points. The histopathologic evaluation showed that a predominantly M1 macrophage response was associated with a more inflamematory type tissue remodeling outcome in AlloDerm while a mixed M1/M2 macrophage response was associated with a more constructive tissue remodeling response seen in the other substrates.展开更多
Alloderm was the first acellular dermal matrix used and remains a popular choice among plastic surgeons.However,while the overall surgical outcome of breast reconstruction using alloderm has been a success,the economi...Alloderm was the first acellular dermal matrix used and remains a popular choice among plastic surgeons.However,while the overall surgical outcome of breast reconstruction using alloderm has been a success,the economic burden on the health care system makes it a subject of frequent re-evaluations in cost-effectiveness.Prompted by the high price of$3,700 USD for a 6 cm×16 cm area,our group proposes the meshing of AlloDerm to decrease the total amount needed for breast reconstruction,while achieving comparable surgical outcomes as using unmeshed alloderm.展开更多
The utility of the internal bra for breast support,reconstruction,and in revision breast surgery has been recognized and various materials have been introduced for this application.As clinical experience has grown and...The utility of the internal bra for breast support,reconstruction,and in revision breast surgery has been recognized and various materials have been introduced for this application.As clinical experience has grown and new products have been developed,the roles of these materials are becoming better defined.This paper reviews the use of the internal bra concept to date.展开更多
文摘Aim:Autologous tissue is considered the“gold standard”for breast reconstruction today.However,little is known about deep inferior epigastric perforator(DIEP)flap reconstruction in combination with tissue expander(TE)/implant.The authors describe a series of combined DIEP flap/TE reconstruction,including its indications and technique to ensure protection of the pedicle during the expansion process.Methods:Between January 2009 and December 2012,patients undergoing immediate DIEP with TE reconstruction were retrospectively reviewed.Oncologic,comorbid conditions,intraoperative,postoperative expansion,complications,and technique data points were collected.Photographs were taken postoperatively and patient’s satisfaction surveys were obtained to assess overall satisfaction.Results:Five patients underwent immediate DIEP flap/TE reconstruction utilizing our alloderm sling technique.There were no complications to the pedicle,flap,expander,or mastectomy skin perioperatively or postoperatively.All patients describe being very satisfied,often with improved breast volume and projection as compared to their preoperative appearance.Conclusion:The results of this study suggest that DIEP flap/TE reconstruction is safe,in particular when utilizing the alloderm sling technique,and should be considered in patients who lack sufficient abdominal tissue,have existing breast asymmetries,or do not desire the scar deformity of latissimus dorsi.
文摘Objectives: To describe the versatility of acellular fetal bovine dermal matrix as an alternative to human cadaveric allograft for head and neck reconstructive procedures in children. Study Design: Case series with chart review. Methods: A database of pediatric operative procedures was queried for the use of acellular fetal bovine dermal matrix over a 16-month period. Indications for reconstruction were assessed and initial parental and surgeon satisfaction with the product were noted. Results: During the time period of 3/2012 and 7/2013 a total of 8 reconstructive procedures were performed on pediatric patients using acellular fetal bovine dermal matrix. Indications for use varied and included open and transnasal endoscopic repair of encephaloceles and soft tissue reconstructions including lateral pharyngeal wall repair, cleft palate repair, and facial recontouring operations. Acellular fetal bovine dermal matrix had a subjectively increased ease of use as compared to the surgeon’s prior experience with human cadaveric acellular dermis. Every parent vocalized a greater comfort level with the use of a bovine product over the alternative of human cadaveric tissue. The cost of acellular fetal bovine dermal matrix is slightly lower than the cost of human cadaveric acellular dermis. Conclusions: Acellular fetal bovine dermal matrix appears to be an acceptable alternative to human cadaveric acellular dermis for various forms of head and neck soft tissue reconstruction in children. Further prospective studies are warranted to assess for any differences in the long-term efficacy of this product as compared to other forms of allograft reconstruction.
文摘Macrophages have recently been characterized as having an M1 or M2 phenotype based on receptor expression, mechanism of activation and function. The effects of macrophage phenotype upon tissue remodeling following implantation of an acellular dermal matrix (ADM) is largely unknown. The purpose of this study was to compare the macrophage phenotype and tissue remodeling elicited by four different ADMs (DermaMatrix, AlloDerm, Integra and Der mACELL). ADM samples were wrapped around the inferior epigastric vessels of a rat and were harvested on 7, 14, 21 and 42 days post implantation. Immunohistologic methods were used to identify macrophage surface markers CD68 (pan macrophage), CCR7 (M1 profile), and CD206 (M2 profile). All human derived ADMs showed a bell shaped curve for distribution of CD68+ macrophages with peaks for DermaMatrix occurring at day 14 and peak influx for AlloDerm occurring on day 21. In contrast, bovine derived Integra showed an increasing trend of macrophages with time. DermACELL had the highest influx of macro- phages while Integra had the lowest. A quantitative analysis of phenotype of macrophages in AlloDerm showed that the cells were predominantly M1 at 7, 14, 21 and 42 days post implantation. In contrast, Integra showed a mixed M1/M2 population of macrophages at all time points. The histopathologic evaluation showed that a predominantly M1 macrophage response was associated with a more inflamematory type tissue remodeling outcome in AlloDerm while a mixed M1/M2 macrophage response was associated with a more constructive tissue remodeling response seen in the other substrates.
文摘Alloderm was the first acellular dermal matrix used and remains a popular choice among plastic surgeons.However,while the overall surgical outcome of breast reconstruction using alloderm has been a success,the economic burden on the health care system makes it a subject of frequent re-evaluations in cost-effectiveness.Prompted by the high price of$3,700 USD for a 6 cm×16 cm area,our group proposes the meshing of AlloDerm to decrease the total amount needed for breast reconstruction,while achieving comparable surgical outcomes as using unmeshed alloderm.
文摘The utility of the internal bra for breast support,reconstruction,and in revision breast surgery has been recognized and various materials have been introduced for this application.As clinical experience has grown and new products have been developed,the roles of these materials are becoming better defined.This paper reviews the use of the internal bra concept to date.
