Reconstructive surgery in the complex treatment of breast cancer (10 years of experience)

The aim of the study is to improve the quality of life of women with breast cancer (BC) and a high risk of its development by performing one-stage or delayed reconstruction of the lost breast.The objectives of the study were: to clarify the criteria for selecting patients for prophylactic mastectomy; development of surgical tactics in the treatment of breast cancer and a high risk of its development; assessment of oncological safety of LME; clarification of the methods of reconstruction of the breast; analysis of postoperative complications, including the effect of neoadjuvant PCT during simultaneous breast reconstruction on their frequency, and determination of possible ways to prevent them.Material and methods. The prospective controlled study included 258 patients who underwent surgical treatment in our department between 2007 and 2016. The criteria for the inclusion of patients in the study were: carrying out radical surgical treatment for breast cancer, both in isolation and in combination with the reconstruction of the lost breast; carriage of germline mutations in the tumor suppressor genes BRCA1 and BRCA2, the presence of first-degree relatives suffering from breast cancer, previous BRCA-associated breast cancer; the desire of patients with multiple recurrent proliferative benign breast diseases that are not amenable to conservative and surgical treatment to use the surgical method of breast cancer prophylaxis with immediate restoration of the breast.Results. According to the Beck Depression Questionnaire, 72 % of patients in the first group of patients had a critical and high level of depression, while patients who underwent CME with one-stage reconstruction did not have such levels of depression. At the same time, a relatively favorable psychological state of patients with a low level of depression was observed in 17 of 21 patients in the RME + delayed reconstruction group (which amounted to 81% of the group), in 21 of 22 patients in the RME + simultaneous reconstruction group (95% of the group), and only in 5 of 43 patients in the RME group (12% of the group) (χ2 = 51.6; critical value 9.2 at p ≤ 0.01).Conclusions. When analyzing the results obtained, we once again became convinced of the oncological safety of LME with a one-stage reconstruction of the breast, subject to certain requirements. In the presence of appropriate conditions, it is possible to preserve the SAC during the LME. Preventive LME with simultaneous breast reconstruction is the method of choice in patients with a high risk of developing breast cancer, subject to the appropriate selection criteria and the patient's desire.

Ultrasound Examination and Navigation for Repeat/Delayed Reconstruction of the Ankle Extensor Tendons

Herein, we describe a 46-year-old woman with persistent pain and weakness in her left ankle/foot one year after surgical repair of all three ankle extensor tendons following a penetrating injury. This report presents a unique case whereby US imaging played a paramount role in the diagnosis and surgical management of a previous nonanatomic repair of the ankle extensor tendons after a penetrating injury one year prior. The above-quoted findings were subsequently corrected with end-to-end sutures. On the third postoperative month follow-up, the patient was free of any complaints or complications.

Facial Nerve Reconstruction with Free Vascularized Composite Nerve Flap from Intrapetrous Portion to Terminal Branches—Case Report

The case presented here is a delayed reconstruction of a facial nerve defect after radical parotidectomy without a useful nerve stump at the stylomastoid foramen. A composite free flap was used to reconnect the nerve’s intrapetrous portion to the peripheral branches and reconstruct the soft-tissue deficit.

EXPRESS: Grouping Effects in Immediate Reconstruction of Order and the Preconditions for Long-term Learning

One commonly acknowledged role of working memory is to set up conditions for new learning. Yet, it has long been understood that there is not a perfect correspondence between conditions leading to good immediate recall from working memory and conditions leading to good delayed recall from long-term memory. Here, in six experiments, we investigated the relation between grouping effects in immediate and delayed reconstruction of order for word lists. There has been a striking absence of tests of grouping effects in long-term memory. In the first four experiments, items within groups are presented concurrently, which encourages associations between items in a group. Despite that presumably favorable situation for group learning, in Experiments 1 and 2 we found effects of grouping only in immediate order reconstruction and not in delayed reconstruction. When more processing time was allowed (Experiments 3 & 4), grouping effects in both immediate and delayed order reconstruction were obtained. Experiment 5 showed that, with items presented one at a time, but with roughly the same amount of processing time and spatial separation as the previous two experiments, grouping effects were obtained neither in immediate order reconstruction nor in delayed reconstruction. However, in Experiment 6 with a more salient manipulation of grouping, effects of grouping were obtained in immediate order reconstruction, but not in delayed reconstruction. In sum, we demonstrated for the first time that there are mechanisms of temporal grouping that assist working memory but are relatively ineffective for long-term learning, in contrast to more effective, concurrent presentation.

A Novel “Shark-Fin” Pyramidal Achilles Bone-Tendon Allograft Surgical Technique for Delayed Reconstruction of Triceps Tendon Rupture and Review of the Literature

Introduction: Triceps tendon injuries are rare and often caused by direct trauma to the arm. There are no clear guidelines on the management of these and typically partial tears are treated conservatively whilst full thickness tears are treated with primary surgical repair. We aim to review the literature on the methods for triceps repair and propose a novel surgical technique. Methods: A “Medline” and “Embase” literature search of titles and abstracts combining “triceps brachii muscle,” “reconstruct/ed” or “reconstruction” alongside “reconstructive surgical procedures,” and further cross referenced with “repair/s/ed.” Excluded those related to brachial plexus injuries or general elbow trauma and removing duplicate results. 32 English results within 10 years were relevant and reviewed. Results: A 50-year-old gentleman with a 4-month-old full thickness triceps tear was repaired with a novel surgical technique of using an Achilles bone-tendon allograft fashioned into a “shark-fin” pyramidal shape and secured to the proximal ulnar in a lock and key type construct. The tendon was secured to the triceps remnant using a Krackow stitch. Complete radiological and clinical recovery was made by 18 months postoperatively with return to full physical activity. The literature review concluded no consensus in the method of treatment for delayed triceps reconstruction. Conclusion: The use of the bone-tendon allograft specifically shaped to fit congruently into an olecranon osteotomy site allows for direct bone-to-bone healing has not previously been mentioned in the literature. Results have been encouraging and the technique described is easily reproducible. Keywords: Triceps rupture, delayed, reconstruction, achilles allograft, surgical technique, literature review.

Modifications of Paramedian Forehead Flap

Introduction Paramedian forehead flap an interpolated flap based on supratrochlear vessels is considered as a workhorse for nasal and periorbital reconstruction however it re-quires modification’s to meet reconstruction requirement. Modifications includes islanded single stage forehead flap, expanded forehead flap, pre-fabricated with rib cartilage, folded forehead flap, split forehead flap and delayed flap, are associated with complications which can be minimized using different techniques. This article’s objective is to re-view indications for modification of Paramedian forehead flap, its complications and techniques of minimizing them. Methods: Twenty-three patients with facial defects reconstructed with modified Paramedian forehead flap were analysed by non-probability purposive sampling from September 2010 to August 2014, while traditional forehead flap reconstructions were excluded. Results: Nasal and periorbital region defects were present in twenty-one and two patients respectively.13 had full thickness nasal defects, 14 had BCC while SCC in 2 patients. Reconstruction was performed in multiple stages except in three patients. Expanded forehead flap was used in four, subcutaneously islanded pedicle forehead and flap prefabricated forehead flaps in three each, split forehead and delayed reconstruction in two patients each. No total loss of flap was observed except in one folded forehead flap where partial distal one cmnecrosed; one patient with expanded forehead flap required revision due to flap contraction. Conclusions: Modifications of Paramedian forehead flap appear reliable, versatile and excellent tool for nasal and periorbital reconstruction. Judicious modifications of flap de-sign as per indication can give satisfactory results with minimal complications by following the techniques mentioned in literature.

Exploring the Lived Experience of Undergoing an Immediate Versus Delayed Deep Inferior Epigastric Artery Perforator (DIEP) Flap Reconstruction in Women Who Require Post-Mastectomy Radiotherapy

Introduction Post-mastectomy radiotherapy (PMRT) is recommended to women at high risk of local recurrence. There is a paucity of published work on the experience of women who undergo deep inferior epigastric perforator (DIEP) flap breast reconstruction in the context of requiring PMRT. The aim of the study was to explore and understand the patient experience of these women. Methods Purposive sampling was used to identify patients who had undergone an immediate reconstruction with PMRT and women who had undergone a delayed reconstruction after PMRT. Purposive sampling was used to identify and invite women to participate in the study. Semi-structured interviews were conducted using a grounded theory approach with a topic guide which was derived from relevant literature. Results Twenty women participated in the study. Ten women had undergone immediate reconstruction followed by PMRT and 10 women had undergone delayed reconstruction after PMRT. The results suggest that, regardless of the surgical pathway or the consequences of treatment, overall women were satisfied with the treatment decision they had made. Patients described the challenges around decision-making and their post-operative experience. However, patients were grateful to have had a breast reconstruction and in the most part happy with the treatment pathway they underwent. Conclusion The findings of this study suggest that women are motivated by a variety of factors when presented with the choice of immediate versus delayed breast reconstruction and can justify the treatment path they have taken. This study highlights the importance of discussing reconstruction options in terms of context of a person’s life and coping strategies. Patients appeared to use self-regulation in their behaviour to cope with their illness threat and decision-making. The women who chose delayed reconstruction were motivated by the delayed gratification of having a reconstruction that had not been subjected to PMRT.

A Combined Surgical Approach for Extensor Hallucis Longus Reconstruction: Two Case Reports

The surgical management of foot tendon injuries is not well-represented in literature. To achieve excellent functional recovery of the extensor hallucis longus (EHL) tendon, we aimed at developing a reliable and feasible reconstructive technique.A surgical technique for delayed reconstruction of the EHL tendon, combining an elongation procedure with second toe extensor tendon transfer, is described in this article.The results of this combined approach for EHL tendon reconstruction were remarkable, since the patients of the two clinical cases reported regained active extension of the hallux after 6 months without any associated complication.This study represents a step forward in foot surgery, since it describes an alternative technique to manage EHL tendon lesions.