Enhancing breast projection in autologous reconstruction using the St Andrew’s coning technique and 3D volumetric analysis

Immediate obturation of the patient undergoing maxillectomy who is not undergoing formal autologous reconstruction is important for immediate form and function of the patient. Exophytic tumors, that are large in dimension can make pre-operative obturator formation challenging. Traditional methods of obturator fabrication involve a physical or digital impression. Preoperative virtual surgical planning for tumor resection and reconstruction using free tissue transfer has become a mainstay in head and neck reconstruction. We describe a variation of this for a patient unable to undergo free tissue transfer where the authors used preoperative virtual surgical planning and CAD/CAM technologies to perform tumor resection, and fabricated an obturator based on the CT imaging alone.

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Comparative Assessment of Autogenous Cancellous Bone Graft and Bovine-Derived Demineralized Bone Matrix for Secondary Alveolar Bone Grafting in Patients With Unilateral Cleft Lip and Palate

The Cleft Palate-Craniofacial Journal ◽

10.1177/10556656211025197 ◽

2021 ◽

pp. 105566562110251

Author(s):

Vijay Kumar ◽

Vidya Rattan ◽

Sachin Rai ◽

Satinder Pal Singh ◽

Jai Kumar Mahajan

Keyword(s):

Bone Graft ◽

Iliac Crest ◽

Demineralized Bone Matrix ◽

Bone Matrix ◽

Volumetric Analysis ◽

Group I ◽

Alveolar Bone Grafting ◽

Group Ii ◽

Demineralized Bone

Objective: Comparison between bovine-derived demineralized bone matrix (DMBM) and iliac crest graft over long term for secondary alveolar bone grafting (SABG) in patients with unilateral cleft lip and palate (UCLP) in terms of radiological and clinical outcomes. Design: Prospective, randomized, parallel groups, double-blind, controlled trial. Setting: Unit of Oral and Maxillofacial Surgery, Oral Health Science Centre, Postgraduate Institute of Medical Education & Research, Chandigarh. Participants: Twenty patients with UCLP. Interventions: Patients were allocated into group I (Iliac crest bone graft) and group II (DMBM) for SABG. Outcomes were assessed at 2 weeks, 6 months, and then after mean follow-up period of 63 months. Outcomes Measures: Volumetric analysis of the grafted bone in the alveolar cleft site was done through cone beam computed tomography using Cavalieri principle and modified assessment tool. Clinical assessment was performed in terms of pain, swelling, duration of hospital stay, cost of surgery, alar base symmetry, and donor site morbidity associated with iliac crest harvesting. Results: Volumetric analysis through Cavalieri principle revealed comparable bone uptake at follow-up of 6 months between group I (70%) and group II (69%). Modified assessment tool showed no significant difference between horizontal and vertical bone scores over short- and long-term follow-up. In group II, there was higher cost of surgery, but no donor site morbidity unlike group I. Conclusions: Demineralized bone matrix proved analogous to iliac crest bone graft as per volumetric analysis over shorter period. However, although statistically insignificant, net bone volume achieved was lower than the iliac crest graft at longer follow-up.

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Breast Reconstruction Completion in the Obese: Does Reconstruction Technique Make a Difference in Its Achievement?

Journal of Reconstructive Microsurgery ◽

10.1055/s-0041-1726031 ◽

2021 ◽

Author(s):

Christine Velazquez ◽

Robert C. Siska ◽

Ivo A. Pestana

Keyword(s):

Breast Reconstruction ◽

Perioperative Complications ◽

Major Complication ◽

Normal Body Mass Index ◽

Reconstruction Technique ◽

Autologous Reconstruction ◽

Obese Women ◽

Areolar Complex ◽

Obese Female ◽

Increased Risk

Abstract Background Breast mound and nipple creation are the goals of the reconstructive process. Unlike in normal body mass index (BMI) women, breast reconstruction in the obese is associated with increased risk of perioperative complications. Our aim was to determine if reconstruction technique and the incidence of perioperative complications affect the achievement of reconstruction completion in the obese female. Methods Consecutive obese women (BMI ≥30) who underwent mastectomy and implant or autologous reconstruction were evaluated for the completion of breast reconstruction. Results Two hundred twenty-five women with 352 reconstructions were included. Seventy-four women underwent 111 autologous reconstructions and 151 women underwent 241 implant-based reconstructions. Chemotherapy, radiation, and delayed reconstruction timing was more common in the autologous patients. Major perioperative complications (requiring hospital readmission or unplanned surgery) occurred more frequently in the implant group (p ≤ 0.0001). Breast mounds were completed in >98% of autologous cases compared with 76% of implant cases (p ≤ 0.001). Nipple areolar complex (NAC) creation was completed in 57% of autologous patients and 33% of implant patients (p = 0.0009). The rate of successfully completing the breast mound and the NAC was higher in the autologous patient group (Mound odds ratio or OR 3.32, 95% confidence interval or CI 1.36–5.28 and NAC OR 2.7, 95% CI 1.50–4.69). Conclusion Occurrence of a major complication in the implant group decreased the rate of reconstruction completion. Obese women who undergo autologous breast reconstruction are more likely to achieve breast reconstruction completion when compared with obese women who undergo implant-based breast reconstruction.

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Quadricuspid Aortic Valve Repair Facilitated by Geometric Ring Annuloplasty

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/15569845211003095 ◽

2021 ◽

pp. 155698452110030

Author(s):

Joseph A. McGuire ◽

Heather K. Hayanga ◽

Jeremiah W. Hayanga ◽

Daniel Sloyer ◽

Matthew Ellison ◽

...

Keyword(s):

Aortic Valve ◽

Patient Outcomes ◽

Systematic Approach ◽

Aortic Insufficiency ◽

Aortic Valve Repair ◽

Autologous Reconstruction ◽

Quadricuspid Aortic Valve ◽

Valve Repair ◽

Ring Annuloplasty ◽

Annular Geometry

Quadricuspid aortic valve (QAV) is a rare congenital anomaly often associated with aortic insufficiency. The exact anatomy of QAV is variable, and most cases have undergone aortic valve replacement. With the recognition that aortic valve repair achieves superior patient outcomes as compared to replacement, a systematic approach to autologous reconstruction of QAV is needed. This article reports 2 cases having successful repair utilizing geometric aortic annuloplasty rings, and describes a proposed scheme for repairing most QAV defects, based on relative leaflet and commissural characteristics. Using either tri-leaflet or bicuspid ring annuloplasty, the normal sub-commissural triangles can be remodeled into a 120° or 180° configuration, respectively, and then the leaflets can be sutured and plicated to fit annular geometry. With this approach, most quadricuspid valves potentially could undergo autologous reconstruction.

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Retraining Convolutional Neural Networks for Specialized Cardiovascular Imaging Tasks: Lessons from Tetralogy of Fallot

Pediatric Cardiology ◽

10.1007/s00246-020-02518-5 ◽

2021 ◽

Author(s):

Animesh Tandon ◽

Navina Mohan ◽

Cory Jensen ◽

Barbara E. U. Burkhardt ◽

Vasu Gooty ◽

...

Keyword(s):

Tetralogy Of Fallot ◽

Hausdorff Distance ◽

Volumetric Analysis ◽

Dice Similarity Coefficient ◽

Algorithm Performance ◽

Comprehensive Method ◽

Combined Use ◽

Median Error ◽

Structural Abnormalities ◽

Testing Data

AbstractVentricular contouring of cardiac magnetic resonance imaging is the gold standard for volumetric analysis for repaired tetralogy of Fallot (rTOF), but can be time-consuming and subject to variability. A convolutional neural network (CNN) ventricular contouring algorithm was developed to generate contours for mostly structural normal hearts. We aimed to improve this algorithm for use in rTOF and propose a more comprehensive method of evaluating algorithm performance. We evaluated the performance of a ventricular contouring CNN, that was trained on mostly structurally normal hearts, on rTOF patients. We then created an updated CNN by adding rTOF training cases and evaluated the new algorithm’s performance generating contours for both the left and right ventricles (LV and RV) on new testing data. Algorithm performance was evaluated with spatial metrics (Dice Similarity Coefficient (DSC), Hausdorff distance, and average Hausdorff distance) and volumetric comparisons (e.g., differences in RV volumes). The original Mostly Structurally Normal (MSN) algorithm was better at contouring the LV than the RV in patients with rTOF. After retraining the algorithm, the new MSN + rTOF algorithm showed improvements for LV epicardial and RV endocardial contours on testing data to which it was naïve (N = 30; e.g., DSC 0.883 vs. 0.905 for LV epicardium at end diastole, p < 0.0001) and improvements in RV end-diastolic volumetrics (median %error 8.1 vs 11.4, p = 0.0022). Even with a small number of cases, CNN-based contouring for rTOF can be improved. This work should be extended to other forms of congenital heart disease with more extreme structural abnormalities. Aspects of this work have already been implemented in clinical practice, representing rapid clinical translation. The combined use of both spatial and volumetric comparisons yielded insights into algorithm errors.

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