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To shorten the reconstructive process, improve results, and provide additional options for women seeking mastectomy, we used an acellular cryopreserved dermal matrix (AlloDerm) sling to reestablish the lower pole of the pectoralis major muscle. This technique creates a subpectoral-sub-AlloDerm pocket that completely encloses the breast implant. By tailoring the width of the AlloDerm, we can precisely control the degree of lower-pole fullness. This technique shortens or eliminates the need for tissue expansion and provides an additional option for single-stage breast reconstruction with implants. We have selectively used this technique as a reconstructive option for 10 women undergoing bilateral mastectomy (20 breasts).

Appearance of heparin-binding EGF-like growth factor in wound fluid as a response to injury (epidermal growth Communicated by Judah Folkman, January 4, 1993 (received for review January 3, 1992) ABSTRACTWound fluid was obtained from porcine partial-thickness excisional wounds and analyzed for heparinbinding growth factors. Two heparin-binding growth factor activities were detected, a relatively minor one that was eluted from a heparin affinity column with 0.65 M NaCi and a major one that was eluted with 1.1 M NaCI. These activities were not present in wound fluid 1 hr after injury but appeared 1 day after injury, were maximal 2-3 days after injury, and were not detectable by 8 days after injury. The heparin-binding growth factor eluted with 0.65 M NaCl was identified as a plateletderived growth factor (PDGF)-like activity by the use ofspecific anti-PDGF neutralizing antibodies. The heparin-binding growth factor eluted with 1.1 M NaCl was shown to be structurally related to heparin-binding epidermal growth factor (EGF)-like growth factor (HB-EGF) by several criteria, including binding to heparin affinity columns and elution with 1.1 M NaCl, competition with the binding of 125I-EGF to the EGF receptor, triggering phosphorylation of the EGF receptor, immunodetection on a Western blot, and stimulation of fibroblast and keratinocyte growth. It was concluded that HB-EGF is a major growth factor component of wound fluid and, since it is mitogenic for fibroblasts and keratinocytes, that it might play an important role in wound healing.

Implant reconstruction with an inferolateral AlloDerm hammock facilitates positioning of the implant in immediate or revisional breast reconstruction and simplifies expander-implant reconstruction. This safe technique is easy to learn and should be considered a viable option for breast reconstruction.

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In 28 porcine partial thickness excisional wounds, the presence of several growth factors was first studied by enzyme-linked immunoadsorbent assay on wound fluid collected in sealed wound chambers. Basic fibroblast growth factor (bFGF) peaked on day 1 at 31.4 pg/ml; platelet derived growth factor (PDGF)-AB on day 3 reached 45.2 pg/ml, and transforming growth factor-beta (TGF-beta) on day 7 was 726.1 pg/ml. The same chamber system was used in 48 partial thickness excisional wounds for delivery of nanogram doses of bFGF, PDGF-AB, insulin-like growth factor (IGF)-1, epidermal growth factor (EGF), and cholera toxin. PDGF and EGF accelerated healing (1.1 days and 0.3 days, respectively), whereas bFGF and IGF-1 had no effect. Cholera toxin retarded healing by 1.9 days. Furthermore, in 100 excisional wounds EGF in the concentration range of 10 to 1,000 ng/ml had the same stimulating effect on healing. EGF at 10,000 ng/ml significantly delayed healing. The wound chamber model is useful for detecting of endogenous growth factors as well as for delivering exogenous factors.

The lips are a complex laminated structure. When lost through injury or disease, they present a complex reconstructive challenge. The facial artery musculomucosal (FAMM) flap is a composite flap with features similar to those of lip tissue. In this article, the anatomy, dissection, and clinical applications for the use of the FAMM flap in lip and vermilion reconstruction are discussed. A series of 16 FAMM flaps in 13 patients is presented. Seven patients had upper-lip reconstruction and six had lower-lip reconstruction. Superiorly based FAMM flaps were used in eight patients, and eight inferiorly based flaps were performed in five patients. Three patients had bilateral, inferiorly based flaps. In summary, the FAMM flap is a local flap that can be used for lip and vermilion reconstruction. Although not identical to the lip, it has many similar features, which make it an excellent option for lip reconstruction.