Different Modalities of Breast Reconstruction with Autologous Latissimus Dorsi Flap: Aesthetic Results and Complications
Hussein Fakhry,
Kassim Abdelazeem,
Hesham Hamza,
Badawy Ahmed,
Mahmod Mostafa,
Gamal Amira,
Arwa M. Ali
Issue:
Volume 3, Issue 5, October 2015
Pages:
44-49
Received:
27 July 2015
Accepted:
6 August 2015
Published:
19 August 2015
Abstract: Background. Use of an autologous latissimus dorsi (LD) flap in breast reconstruction accounts for a flexible and natural look of reconstructed breast and has maintained a strong popularity because of its ease of harvest, reliability, and ability to provide additional prosthetic coverage. Different complications (hematoma, seroma, flap necrosis, infection, hypertrophic scarring, and postoperative back pain) linked to this type of breast reconstruction. The aim of this study was to evaluate the complications and aesthetic outcome of (LD) flap breast reconstruction after breast cancer surgery. Materials and methods. forty patients underwent breast reconstruction using (LD) flap with a follow-up period ranged from 6 to 18 months. Patients with small to medium sized breasts underwent complete reconstruction by extended (LD) flap after mastectomy either subcutaneous or skin sparing mastectomy while patients with large pendulous breast underwent Augmentation by (LD) miniflap after conservative surgery by wide local excision (WLE) with safety margin. All patients gave their informed consent for the procedure and were aware of the potential complications and the possibility of secondary procedures. Results. The ages of the patients in our study ranged from 25 to 65 years old. 28 (70%) patients underwent (WLE) and reconstruction with (LD) miniflap while modified radical mastectomy, skin sparing mastectomy and subcutaneous mastectomy were done in 2(5%), 4(10%) and 6(15%) patients respectively with complete reconstruction by extended(LD) flap. The complication rates were noted as follows: partial flap necrosis in 4 patients (10%), wound breakdown in 2 patients (5%), lymphorrhea in 2 patients (5%), seroma in 6 patients (15%). Some of patients showed a minor deformity in the back, which disappeared with time and most patients, had temporary limitation of shoulder movements postoperatively but all recovered completely within few weeks. No patients underwent secondary nipple and areola reconstruction. No local recurrence or distant metastasis in any patient during the follow up period of our study. Evaluation of aesthetic results by patients revealed that 30 patients (75%) were deeply satisfied, 6 patients (15%) were satisfied and 4 patients (10%) were poorly satisfied. While, surgeon aesthetic evaluation was good in 28 patients (70%), satisfactory in 8 patients (20%) and fair in 4 patients (10%). Conclusion. (LD) flap breast reconstruction is a very versatile, safe and satisfactory technique with high success rate and is even suitable for high-risk patients. Donor site seroma is the most common complication and can be treated by repeated aspiration in outpatient clinic. Latissimus dorsi (LD) miniflap is the mainstay of breast reconstruction after partial mastectomy to repair defects in the lateral quadrants and the lower inner pole with low donor site morbidity and deep patient satisfaction
Abstract: Background. Use of an autologous latissimus dorsi (LD) flap in breast reconstruction accounts for a flexible and natural look of reconstructed breast and has maintained a strong popularity because of its ease of harvest, reliability, and ability to provide additional prosthetic coverage. Different complications (hematoma, seroma, flap necrosis, inf...
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Repair 0ptions Following Iatrogenic Bile Duct Injuries
Mohamed Salah Eldin Abdelhamid,
Ahmed Mohamed Sadat,
Ayman Hamdi Abouleid,
Amr Mohamed Aly Mohamed,
Mahmoud Ahmed Negida,
Ahmed Zaki Gharib,
Adel Morad Abdullah
Issue:
Volume 3, Issue 5, October 2015
Pages:
50-55
Received:
1 October 2015
Accepted:
13 October 2015
Published:
24 October 2015
Abstract: In the era of laparoscopic cholecystectomy there was a dramatic increase in the incidence of the bile duct injuries. It was estimated that major bile duct injury occurred in approximately 0.2% to 0.4% during open cholecystectomy opposed to 0.6% to 0.8% of patients undergoing laparoscopic cholecystectomy. The aim was to highlight the repair options for the happened injury. Included in the study were 22 patients, 19 sustained injury at our hospital and 3 referral cases between Feb. 1999 to Nov2014. The treatment options were end to end anastomosis over T-tube or straight stent and Roux-en Y hepaticojejunostomy with or without stenting the anastomosis. Regarding the injuries, according to Strasberg there were 2 A, 4 D, 8 E1, and 5 E2. The three referral cases were choledochodoudonostomy. They were treated through simple ligation of cystic duct in two cases, end to end anastomosis in seven cases (three of them over T-tube and four over straight stent). The remaining fifteen cases were treated with Roux-en Y hepaticojejunostomy with or without stenting the anastomosis (22 patients with 24 interventions due to 2 redo). We concluded that proximal bile ducts are at greater risk with laparoscopic cholecystectomy even with expert surgeon. Satisfactory results were obtained with end to end anastomosis over either T-tube or straight stent, however these two options cannot be applied to all cases as it is difficult to be done with non dilated ducts, so Roux-en-Y hepaticojejunostomy is the most feasible among all types of repairs as it can be applied to most cases even those with non dilated common bile duct.
Abstract: In the era of laparoscopic cholecystectomy there was a dramatic increase in the incidence of the bile duct injuries. It was estimated that major bile duct injury occurred in approximately 0.2% to 0.4% during open cholecystectomy opposed to 0.6% to 0.8% of patients undergoing laparoscopic cholecystectomy. The aim was to highlight the repair options ...
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