Tissue expander/implant breast reconstructions by 5 surgeons at a single institution from 2005 to 2008 were retrospectively identified and divided into 2 cohorts: use of acellular dermal matrix (ADM, n = 75) versus standard submuscular placement (n = 52). The ADM group had a statistically significant higher rate of infection (28.9% vs. 12.0%, P = 0.022), reoperation (25.0% vs. 8.0%, P = 0.011), expander explantation (19.2% vs. 5.3%, P = 0.020), and overall complications (46.2% vs. 22.7%, P = 0.007). When stratifying by breast size, a higher complication rate was not observed with the use of ADM in breasts less than 600 g, whereas ADM use in breasts larger than 600 g was associated with a statistically significant higher rate of infection when controlling for the occurrence of skin necrosis. The ADM cohort had a significantly higher mean initial tissue expander fill volume (256 mL vs. 74 mL, P < 0.001) and a significantly higher mean initial tissue expander fill ratio (49% vs. 17%, P < 0.001). Further work is needed to define the ideal patient population for ADM use in tissue expander/implant breast reconstruction.

ICG angiography can detect venous congestion in a rat lower extremity model reliably at occlusion rates ≥ 85%. This method may offer surgeons an intraoperative diagnostic tool to identify venous congestion at extremely early time points, allowing for immediate intervention. Further investigation and characterization is warranted in a larger animal model before clinical adaptation.

Needle localized breast biopsy is commonly used to diagnose and remove non-palpable breast lesions. We present the first case of cardiac injury resulting from needle localized breast biopsy. A hooked-end monofilament wire penetrated the pericardium and myocardium overlying the left ventricle. The wire was pulled and the patient managed non-operatively with close monitoring that included plain chest radiographs, electrocardiography, and echocardiography. The literature regarding complications of the procedure was reviewed.

The Asher-McDade scale has been used to evaluate cleft lift repairs but is limited due to its subjective nature. The basal view scale grades these repairs by using a scale of progressive columellar shortening and alar flaring/slumping, which provides an opportunity for quantification and standardization. Our results show that the basal view correlates with the Asher-McDade scale among raters, thus providing an objective and validated measure of cleft lip repair.

PurPose: Venous Congestion is the top cause for free flap failure. Postoperative diagnosis of a congested flap still relies on clinical observation as the gold standard. We hypothesized that in a rat lower limb venous congestion model, Indocyanine Green (ICG) Angiography can detect venous congestion and differentiate between a congested and non-congested limb more reliably than clinical observation. Methods:A severe venous congestion model was created by bilateral amputation of the lower extremities of male Sprague Dawley rats at the level of the proximal femur leaving only the femoral vessels and femur intact. The femoral vein was occluded at the inguinal ligament while the contralateral limb served as sham control. Complete venous occlusion was achieved by suture ligature (n=11) whereas partial occlusion was achieved by surrounding the vein with a synthetic microtube to achieve 75% (n=6), 85% (n=11) and 92% (n=11) occlusions respectively. Analysis was performed at 10mins post occlusion and consisted of observation (blinded plastic surgeon), temperature, tissue oximetry (VIOPtix Inc.), ICG Angiography and measurement of TNFα and HMGB1 (by qPCR). results:Clinical assessment identified all congested limbs in the 100%, 92% and 85% groups as being congested but only 1/7 animals in the 75% occlusion group was diagnosed with congestion. However, the decision to operate on a congested limb, a corollary for the severity of occlusion, was made in 11/11 (100% group) 10/11 (92% group), 9/11 (85% group) and 0/7 (75% group). Temperature and tissue oximetry showed no significant difference between limbs in any group. By comparison, ICG Angiography was able to detect statistically significant differences in limb perfusion within the first 2 minutes of ICG injection (12mins from occlusion) in all animals in the 100%, 92% and 85% groups (paired t-test p=0.001, p=0.040 and p=0.030 respectively). ICG Angiogrpahy did not show a significant difference in limb perfusion in the 75% occlusion group. TNFα and HMGB-1 showed up-regulation as occlusion increased and the latter demonstrated >3-fold increase in the 100% occlusion group compared to the 75% occlusion group (1.49±0.48 vs. 0.44±0.22). ConClusion:We demonstrate that LAICGA is able to detect venous congestion in a rat lower extremity model reliably at occlusion rates greater than 75%. However, clinical judgment is less reliable in determining the severity of congestion. Our model serves as a basis to further study varying venous occlusion levels and their long term effects