Complete submuscular tissue expander coverage affords the best protection against implant exposure but restricts lower pole expansion. Techniques using acellular dermis as a pectoralis muscle extension can allow for more rapid fill of and better control inframammary fold. This study compares both techniques with regard to relevant outcomes.Results 100 consecutive breast reconstructions performed by two surgeons between 2004 2007 were retrospectively reviewed. Patient demographics, type,...

Free pedicled transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction is often advocated as the procedure of choice for autogenous tissue in high-risk patients, such smokers. However, whether use free TRAM a desirable option smokers still unclear. All patients undergoing with flaps at our institution between February 1989 and May 1998 were reviewed. Patients classified smokers, former (patients who had stopped smoking least 4 weeks before surgery), nonsmokers. Flap...

The purpose of this study was to assess the effect obesity on flap and donor-site complications in patients undergoing free transverse rectus abdominis myocutaneous (TRAM) breast reconstruction. All reconstruction with TRAM flaps at our institution from February 1, 1989, through May 31, 1998, were reviewed. Patients divided into three groups based their body mass index: normal (body index <25), overweight 25 29), obese > or =30). Flap compared. A total 936 reconstructions performed 718...

Current evidence indicates that endogenously produced peptide cytokines, most notably TNF-alpha and IL-1, mediate the lethality of experimental endotoxemia. Because circulating serum levels IFN-gamma can be detected soon after IL-1 in response to endotoxin, we investigated role endotoxin lethality. Specific neutralizing antibodies murine (anti-TNF-alpha Ab) or IFN gamma (anti-IFN-gamma our laboratory protected mice against Escherichia coli (LPS) administered 6 h later. Serum 2 i.v. LPS were...

Background: The use of polypropylene mesh in the reconstruction trunk defects increases complication rates when is placed directly over viscera or operative site has been irradiated contaminated with bacteria. An alternative AlloDerm (decellularized human cadaveric dermis), which becomes vascularized and remodeled into autologous tissue after implantation. When used for fascial reconstruction, forms a strong repair, causes minimal abdominal adhesions, resists infection. Methods: We did...

Background: Facial aging is a dynamic process involving the of soft-tissue and bony structures. In this study, authors demonstrate how facial skeleton changes with age in both male female subjects what impact these structural may have on overall aesthetics. Methods: bone computed tomographic scans were obtained from 60 Caucasian subjects. Twenty 20 placed three categories (20 to 40 years, 41 64 65 years older). Each scan underwent three-dimensional reconstruction volume rendering. Edentulous...

Local recurrence of cancer after mastectomy and immediate breast reconstruction is generally regarded as a poor prognostic indicator. This study was conducted to identify specific patterns local following determine their biological significance. The records all patients who had undergone at University Texas M. D. Anderson Cancer Center between June 1, 1988, December 31, 1998, were reviewed. tumor then carefully analyzed. During this 10-year period, found have developed in 39 1694 (2.3...

Background: Facial aging is a dynamic process involving the of soft-tissue and bony structures. In this study, authors demonstrate how specific aspects mandible change with age in both genders what impact these structural changes may have on overall facial aesthetics. Methods: bone three-dimensional computed tomographic scans were obtained from 120 Caucasian subjects (60 women 60 men). Our study population consisted 20 male female each three categories (20 to 40, 41 64, ≥65 years)....

In a review of the charts 158 patients who had undergone breast reconstruction with free transverse rectus abdominis musculocutaneous (TRAM) or deep inferior epigastric perforator (DIEP) flaps and were treated for postoperative pain morphine administered by patient-controlled analgesia pump, total dose during hospitalization flap transfer was measured. Patients whose treatment supplemented other intravenous narcotics excluded from study. The mean amount per kilogram required DIEP (0.74...

Tumor necrosis factor (TNF) is a peptide secreted by macrophages in response to endotoxin that can produce many of the changes seen septic shock. After cecal ligation and puncture (CLP) rats gradually develop tachycardia, hypotension, tachypnea, hypothermia. At 5 h post-CLP, have peak serum levels 60% blood cultures grow Gram-negative rods (Escherichia coli Klebsiella pneumonia). 20 post-CLP all positive cultures. Serum TNF are not reproducibly measurable following CLP. Rats undergoing CLP...

Total sacrectomies for cancer ablation often result in extensive defects that are challenging to reconstruct. In an effort elucidate the criteria select most effective reconstructive options, we reviewed our experience with management of large sacral wound defects. All patients who had a defect reconstruction after total sacrectomy at institution between January 1993 and August 1998 were reviewed. The size defect, type reconstruction, postoperative complications, functional outcome each...

Successful reconstruction after cranial base tumor ablation is paramount in preventing potentially life-threatening complications. The purpose of this study was to evaluate experiences and identify reconstructive management principles that may assist achieving successful reconstruction. All reconstructions performed by the Department Plastic Surgery at University Texas M. D. Anderson Cancer Center between January 1993 September 1999 were reviewed. Analyses assess impact location defect, type...

Abstract Studies were performed evaluating the role of Smad3, a transcription factor mediating canonical TGF‐β signaling, on scarring and adhesion formation using an established flexor digitorum longus (FDL) tendon repair model. In unoperated animals metatarsophalangeal (MTP) range motion (ROM) was similar in Smad3 −/− wild‐type (WT) mice while basal tensile strength tendons significantly (39%) lower than WT controls. At 14 21 days following MTP ROM reached approximately 50% level twice that...

Abstract Tumor cells release several factors that can help the progression of tumor by directly supporting growth and/or suppressing host antitumor immunity. Here, we report human primary breast not only express elevated levels heat shock protein 27 (Hsp27) at intracellular level but also extremely high Hsp27 compared with same patients' serum levels, predicting an acutely increased concentration soluble in microenvironment (HBTM). We demonstrate HBTM be as evidenced interstitial fluid....

Despite the now widespread experience with administration of chemotherapeutic agents in oncology, extravasation injuries still occur. Furthermore, most appropriate management such is not known. The authors examined current treatment options for injury and incidence this problem. All cases referred to plastic surgery service at one institution from 1994 through 1996 were examined. During a 6-year period there 44 identified 42 patients. Comparison previous study conducted 15 years before same...

Thrombolytic agents have been demonstrated to improve free flap salvage in animal models. However, clinical evidence regarding their efficacy has scant. The authors reviewed experience with using thrombolytic therapy 1,733 flaps from February 1990 July 1998. Patients intraoperative pedicle thrombosis were excluded this review. Forty-one of the 55 that reexplored emergently identified as having thrombosis. Of these 41 flaps, 28 salvaged (flap group, 68%) and 13 failed failure 32%). (urokinase...

This study compared the use of internal mammary and thoracodorsal recipient vessels in a uniform group patients who underwent delayed TRAM flap reconstruction after radiotherapy, focusing on usability rates outcomes. The authors identified 123 had undergone postmastectomy radiotherapy from prospective database (1990 to 2001). Recipient vessel unusability were calculated basis reports inspection vessel, either by direct intraoperative dissection or findings color Doppler examination (internal...

Immediate breast reconstruction is an attractive option for patients who undergo mastectomy. The purpose of this study was to qualitatively assess the effect immediate on design postmastectomy radiotherapy fields at our institution.We retrospectively reviewed records 152 treated institution with over a 1-year period. We identified 18 plans in setting prior reconstruction. By consensus, 2 board-certified radiation oncologists scored terms 4 outcomes: coverage chest wall breadth, ipsilateral...

Tendon reconstruction using grafts often results in adhesions that limit joint flexion. These are precipitated by inflammation, fibrosis, and the paucity of tendon differentiation signals during healing. In order to study this problem, we developed a mouse model which flexor digitorum longus (FDL) is reconstructed live autograft or freeze-dried allograft, identified growth factor 5 (Gdf5) as therapeutic target. have investigated potential rAAV-Gdf5 -loaded allografts "therapeutically...

Passive immunization against TNF allowed non-tumor-bearing C3H/HEN mice and tumor-bearing C57BL/6 to tolerate significantly more doses of IL-2 before death (p less than 0.005 p 0.001, respectively). The antitumor effect both 3-d 10-d pulmonary metastases was maintained in treated concurrently with neutralizing antibodies TNF. In one experiment metastases, increased administration made possible by passive improved the response compared equitoxic control antibody. results indicate that is a...