BackgroundLymphatic malformation (LM) is a form of congenital vascular malformation with a low incidence. Although LM has been studied, no consensus has emerged regarding its cause or treatment.MethodsIn this study, we retrospectively evaluated 40 patients who visited our vascular anomalies center for the treatment of cervicofacial LM, which is a common manifestation of LM. The medical records of patients over a period of 12 years were reviewed and analyzed for commonalities regarding the diagnosis and the results of treatment.ResultsSuspected cervicofacial LM was confirmed through imaging studies. No difference in incidence was observed according to sex, and 73% of patients first presented with symptoms before the age of two years. The left side and the V2–V3 area were most commonly affected. No significant differences in incidence were observed among the macrocystic, microcystic, and combined types of LM. A total of 28 out of 36 patients received sclerotherapy as the first choice of treatment, regardless of the type of lesion. Complete resolution was achieved in only 25% of patients.ConclusionsLM is important to confirm the diagnosis early and to choose an appropriate treatment strategy according to the stage of the disease and each individual patient's symptoms. When treatment is delayed or an incorrect treatment is administered, patient discomfort increases as the lesion gradually spreads. Therefore, more so than is the case for most other diseases, a team approach on a case-by-case basis is important for the accurate and appropriate treatment of LM.
Background: Immediate partial breast reconstruction after breast-conserving surgery has become a new paradigm in treating breast cancer. Among the volume replacement techniques used for small to moderate-sized breasts, the perforator flap method has many advantages. The authors present anatomical studies and two surgical techniques using lateral intercostal artery perforator flaps. Methods: Data from 40 patients who underwent breast reconstruction using the lateral intercostal artery perforator flap between January of 2011 and June of 2016 were included. The authors conducted comparative analyses of the propeller flap and the turnover flap. They used three-dimensional computed tomography in lateral intercostal artery perforator flap anatomical studies, analyzing the distribution probability of the dominant perforator, the vertical distance from the axillary fold, and the horizontal distance from the anterior border of the latissimus dorsi. Results: The most dominant perforator used for lateral intercostal artery perforator flaps was the sixth lateral intercostal artery perforator (43.6 percent of cases), followed by the seventh lateral intercostal artery perforator (39.1 percent of cases); their mean distances from the latissimus dorsi and the axillary folds were determined and reported. Complications included three cases requiring additional treatment for fat necrosis (propeller method, two cases; turnover method, one case) and venous congestion in only two cases that used the propeller method. Cosmetic satisfaction was 90 percent or greater for both techniques, indicating that results were rated as either excellent or good. Conclusion: The authors believe that their study results can broaden the application of partial breast reconstruction by using the lateral intercostal artery perforator flap after breast-conserving surgery, with three-dimensional computed tomography for anatomical studies, and using one of the authors’ two described surgical techniques. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
BackgroundThe emergence of breast-conserving surgery combined with radiotherapy as the treatment of choice for early stage breast cancer has resulted in greater focus on oncoplastic breast surgery. The use of perforator flaps has particularly gained in reputation for its effectiveness in the reconstruction of partial breast defects in Korean women. Herein, we present our experience with the use of thoracodorsal artery perforator (TDAP) and lateral intercostal artery perforator (LICAP) flaps.MethodsThis study included 33 patients who underwent breast reconstruction using TDAP or LICAP flaps at our hospital from January 2011 to December 2014. Data from patient medical records, and patient satisfaction surveys, which were conducted 12 months postoperatively, were retrospectively evaluated.ResultsTDAP and LICAP flap-based reconstructions were performed in 14 and 19 patients, respectively. Five patients developed complications that required additional intervention. Overall patient satisfaction was observed to be excellent in 15 (46%) patients, and good in 12 (36%).ConclusionsBased on our experience, oncoplastic breast surgery using TDAP or LICAP flap is an effective remodeling technique for small-to-moderate breast defects in Korean women with smaller breasts.
The diagnosis and treatment of AVMs should be approached on a case-by-case basis by gathering opinions from specialists in each department using medical history, physical examination, and imaging results.
As the availability of breast reconstruction using implants is becoming widespread and many implant recipients undergo radiation therapy, there is an increasing interest in understanding the potential complications associated with capsule-tissue interactions in response to irradiation. Accordingly, our medical institution designed an animal experiment to investigate the effects of irradiation on capsular contracture. A total of 40 mice (C57BL6) were divided into four groups according to whether or not they received irradiation and the time from implantation to irradiation. After each mouse received a specially-fabricated, 1.5 cm semi-spherical silicone implant inserted into the area below the panniculus carnosus, half of the mice were irradiated using singe administration of a 10 Gy dose of radiation (6 MeV). Subsequently, data from gross inspection, histological analysis and immunohistochemical analysis were obtained at one and three months postoperatively and analyzed. Changes that occurred near the capsule led to the phenomenon of contracture subsequent to encapsulation. Our findings suggest that the inflammation reaction occurring near the implant becomes aggravated by 'radiation toxicity' and creates an environment conducive to capsular contracture. The present study demonstrated the process by which the complication of capsular contracture may occur during the treatment of human breast cancer via radiotherapy. These findings may serve as the basis for research and development of future treatments of capsular contracture.
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