Microvascular Autologous Breast Reconstruction in the Context of Radiation Therapy

Patel, Ketan M.; Albino, Frank P.; Fan, Kenneth L.; Liao, Eileen; Nahabedian, Maurice Y.

doi:10.1097/prs.0b013e31829586e2

Cited by 39 publications

(47 citation statements)

References 16 publications

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“…Results from Nouri et al suggest that lithium improves sciatic nerve regeneration after a traumatic lesion [72]. Additional evidence indicates that lithium exhibits synergistic effects in combined therapies with glial-derived neurotrophic factor in a model of rat sciatic nerve injury [23] and enhances the regenerative capacity of spinal motorneurons in a rat model of brachial plexus root avulsion [73]. To conclude, lithium’s pharmacology and biological effects in human patients have been extensively documented and its benefits on the central and peripheral nervous systems are seemingly clear.…”

Section: Discussionmentioning

confidence: 99%

“…Additional benefits of lithium therapy include neuroprotective [14,15], anti-inflammatory [16] and anti-apoptotic effects [17], which have been exploited to treat central nervous system trauma [18,19] and chronic neurodegenerative diseases, such as Huntington’s disease, amyotrophic lateral sclerosis and Parkinson’s disease [20,21]. In the peripheral nervous system, it has been shown that lithium administration can foster functional recovery and re-myelination after injury [22,23]. Evidence from in vitro studies has been provided indicating that lithium enhances SC proliferation [24] and myelin gene expression [25,22].…”

Section: Introductionmentioning

confidence: 99%

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Lithium Reversibly Inhibits Schwann Cell Proliferation and Differentiation Without Inducing Myelin Loss

et al. 2016

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This study was undertaken to examine the bioactivity, specificity and reversibility of lithium’s action on the growth, survival, proliferation and differentiation of cultured Schwann cells (SCs). In isolated SCs, lithium promoted a state of cell cycle arrest that featured extensive cell enlargement and c-Jun downregulation in the absence of increased expression of myelin-associated markers. In addition, lithium effectively prevented mitogen-induced S-phase entry without impairing cell viability. When lithium was administered together with differentiating concentrations of cAMP analogs, a dramatic inhibition of the expression of the master regulator of myelination Krox-20 was observed. Likewise, lithium antagonized the cAMP-dependent expression of various myelin markers such as protein zero, periaxin and galactocerebroside and allowed SCs to maintain high levels of expression of immature SC markers even in the presence of high levels of cAMP and low levels of c-Jun. Most importantly, the inhibitory action of lithium on SC proliferation and differentiation was shown to be dose dependent, specific and reversible upon removal of lithium compounds. In SC-neuron cultures, lithium suppressed myelin sheath formation while preserving axonal integrity, SC-axon contact and basal lamina formation. Lithium was unique in its ability to prevent the onset of myelination without promoting myelin degradation or SC dedifferentiation. To conclude, our results underscored an unexpected antagonistic action of lithium on SC mitogenesis and myelin gene expression. We suggest that lithium represents an attractive pharmacological agent to safely and reversibly suppress the onset of SC proliferation, differentiation and myelination while maintaining the integrity of pre-existing myelinated fibers.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Lithium Reversibly Inhibits Schwann Cell Proliferation and Differentiation Without Inducing Myelin Loss

et al. 2016

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“…For each group, half was euthanized at 6 weeks, and the other at 12 weeks. We used postmortem histomorphometric analysis as a reference to justify results derived from the CatWalk system since histomorphometric analysis is widely used in current studies as a gold standard for evaluating recovery following sciatic nerve injury (Gan et al, 2016; Kabiri et al, 2015; Lin et al, 2013). We have described the methods of histomorphometric analysis in past studies (Johnson et al, 2015).…”

Section: Methodsmentioning

confidence: 99%

Establishing a reliable gait evaluation method for rodent studies

Chen

Zhang

et al. 2017

Journal of Neuroscience Methods

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BACKGROUND CatWalk is one of the most popular tools for evaluating gait recovery in preclinical research, however, there is currently no consensus on which of the many gait parameters captured by CatWalk can reliably model recovery. There are conflicting interpretations of results, along with many common but seldom reported problems such as heel walking and poor compliance. NEW METHOD We developed a systematic manual classification method that overcomes common problems such as heel walking and poor compliance. By correcting automation errors and removing inconsistent gait cycles, we isolated stretches of recordings that are more reliable for analysis. Recovery outcome was also assessed by quantitative histomorphometric analysis of myelinated axons. RESULTS While 40–60% of runs were erroneously classified without manual intervention, we corrected all errors with our new method, and showed that Stand Time, Duty Cycle, and Swing Speed are able to track significant differences over time and between experimental groups (all p<0.05). The usability of print area and intensity parameters requires further validation beyond the capabilities of CatWalk. COMPARISON WITH EXISTING METHOD(S) There is currently no strategy that addresses problems such as heel walking and poor compliance, and therefore no standard set of parameters that researchers can rely on to report their findings. CONCLUSION Manual classification is a crucial step to generate reliable CatWalk data, and Stand Time, Duty Cycle, and Swing Speed are suitable parameters for evaluating gait recovery. Static parameters such as print area and intensity should be used with extreme caution.

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“…However, the impact of prior implant reconstruction on outcomes of autologous conversion remains unclear. Planned autologous conversion after immediate tissue expander reconstruction and adjuvant radiotherapy, termed delayed-immediate reconstruction, has been described by several studies as a method of preserving the tissue envelope while avoiding deleterious effects of radiation on the flap [31][32][33] . In a series of 16 delayedimmediate reconstructions, Kronowitz et al…”

Section: Discussionmentioning

confidence: 99%

Microsurgical restoration of failed or unsatisfactory breast reconstruction: a systematic review and pooled-analysis of outcomes

El‐Sabawi¹,

Howell²,

Patel³

2017

PAR

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Aim: Autologous tissue transfer to salvage breast reconstruction following a previously failed or unsatisfactory reconstruction has been described by previous studies to be an effective strategy to optimize outcomes. The purpose of this systematic review is to assimilate the relevant literature to evaluate surgical and aesthetic outcomes following autologous breast reconstruction in the setting of a prior unsuccessful reconstruction. Methods: A systematic review of the English literature was performed on Pubmed/MEDLINE to identify all manuscripts reporting surgical outcomes, aesthetic outcomes, or patient satisfaction of autologous breast reconstruction in the setting of a previously failed or unsatisfactory breast reconstruction. Results: Nineteen studies met the criteria for inclusion. Of these, 15 studies reported outcomes following autologous conversion of unsuccessful prosthetic reconstruction (778 breasts). Pooled-analysis of these studies demonstrated total flap loss in 1.6%, microsurgical revision in 3.2%, total complications in 21.7%, and revision surgery in 26.5%. Review of these studies demonstrated high rates of positive aesthetic outcomes and patient satisfaction. Five studies (54 patients) evaluated outcomes following autologous salvage of prior unsuccessful autologous breast reconstruction. Pooled-analysis of these studies demonstrated no instances of microsurgical revision, total complications in 42.2%, and revision surgery in 70.0%. Total flap failure following tertiary reconstruction utilizing microsurgical free flaps occurred in 9.5%. Data describing aesthetic outcomes or patient satisfaction was lacking in these studies. Conclusion: Autologous conversion in the setting of unsuccessful prosthetic breast reconstruction appears to be valuable option to improve outcomes. There is little evidence to suggest that prior prosthetic reconstruction negatively impacts outcomes of autologous breast reconstruction. Data describing autologous breast reconstruction following prior flap loss is limited but suggests it is viable method to salvage breast reconstruction in appropriate patients. ABSTRACT

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Microvascular Autologous Breast Reconstruction in the Context of Radiation Therapy

Abstract: Therapeutic, III.

Cited by 39 publications

References 16 publications

Lithium Reversibly Inhibits Schwann Cell Proliferation and Differentiation Without Inducing Myelin Loss

Lithium Reversibly Inhibits Schwann Cell Proliferation and Differentiation Without Inducing Myelin Loss

Establishing a reliable gait evaluation method for rodent studies

Microsurgical restoration of failed or unsatisfactory breast reconstruction: a systematic review and pooled-analysis of outcomes

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