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Biologic collagen cylinder with skate flap technique for nipple reconstruction.

Tierney BP, Hodde JP, Changkuon DI - Plast Surg Int (2014)

Bottom Line: Average body mass index was 28.0.The only reported complications were extrusions (3.5%).Complications are infrequent and short-term projection measurements are encouraging.

View Article: PubMed Central - PubMed

Affiliation: Tierney Plastic Surgery, 2011 Church Street, Suite 805, Nashville, TN 37203, USA.

ABSTRACT
A surgical technique using local tissue skate flaps combined with cylinders made from a naturally derived biomaterial has been used effectively for nipple reconstruction. A retrospective review of patients who underwent nipple reconstruction using this technique was performed. Comorbidities and type of breast reconstruction were collected. Outcome evaluation included complications, surgical revisions, and nipple projection. There were 115 skate flap reconstructions performed in 83 patients between July 2009 and January 2013. Patients ranged from 32 to 73 years old. Average body mass index was 28.0. The most common comorbidities were hypertension (39.8%) and smoking (16.9%). After breast reconstruction, 68.7% of the patients underwent chemotherapy and 20.5% underwent radiation. Seventy-one patients had immediate breast reconstruction with expanders and 12 had delayed reconstruction. The only reported complications were extrusions (3.5%). Six nipples (5.2%) in 5 patients required surgical revision due to loss of projection; two patients had minor loss of projection but did not require surgical revision. Nipple projection at time of surgery ranged from 6 to 7 mm and average projection at 6 months was 3-5 mm. A surgical technique for nipple reconstruction using a skate flap with a graft material is described. Complications are infrequent and short-term projection measurements are encouraging.

No MeSH data available.


Related in: MedlinePlus

Intraoperative pictures. (a) Skate flap comprised of skin and fatty tissue is cut and lifted along the surgical markings; (b) the ends of the flap are brought together and sutured to allow for cylinder placement; (c) the cylinder is carefully placed inside the flap, (d) resulting in the cylinder being securely wrapped by vascularized skin tissue.
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Related In: Results  -  Collection


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fig3: Intraoperative pictures. (a) Skate flap comprised of skin and fatty tissue is cut and lifted along the surgical markings; (b) the ends of the flap are brought together and sutured to allow for cylinder placement; (c) the cylinder is carefully placed inside the flap, (d) resulting in the cylinder being securely wrapped by vascularized skin tissue.

Mentions: Nipple cylinder diameter (0.7 cm or 1.0 cm) and length (1 cm or 1.5 cm) were selected to closely match the contralateral nipple. If a contralateral nipple was not present, the overall size of the reconstructed breast, the presence or absence of a well-vascularized skin flap, and/or the patient's desired final appearance were considered when determining the cylinder size, allowing for some shrinkage following implant. The position of the nipple was determined with the patient seated in a relaxed position. Using a surgical marker, a skate-flap pattern (Figure 2) was drawn onto the patient's breast to guide the creation of the skin flaps. The NRC was allowed to rehydrate for no greater than 10 seconds before it was placed underneath the appropriate skin flaps, ensuring that an adequate blood supply reached the device. This placement allowed for maximum contact with healthy, well-vascularized tissue and encouraged cell in-growth and tissue remodeling (Figure 3). The cylinder was then secured into place with a combination of 3-0 Vicryl (Ethicon, Somerville, NJ) and 4-0 Monocryl (Ethicon, Somerville, NJ) sutures at the base of the nipple reconstruction to prevent migration of the cylinder into the subcutaneous region beneath the flaps. After reconstruction, incisions were closed with a combination of inverted dermal 3-0 Vicryl sutures and simple interrupted 4-0 Monocryl sutures. The reconstructed nipple was protected using a hard plastic shield, which was left in place for up to 4 weeks. Topical antibiotic cream was not routinely used following surgery, but patients were instructed to use triple antibiotic and return to the clinic if signs of infection were observed when cleansing the area. The areola was later pigmented by tattoo according to standard practice.


Biologic collagen cylinder with skate flap technique for nipple reconstruction.

Tierney BP, Hodde JP, Changkuon DI - Plast Surg Int (2014)

Intraoperative pictures. (a) Skate flap comprised of skin and fatty tissue is cut and lifted along the surgical markings; (b) the ends of the flap are brought together and sutured to allow for cylinder placement; (c) the cylinder is carefully placed inside the flap, (d) resulting in the cylinder being securely wrapped by vascularized skin tissue.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4120924&req=5

fig3: Intraoperative pictures. (a) Skate flap comprised of skin and fatty tissue is cut and lifted along the surgical markings; (b) the ends of the flap are brought together and sutured to allow for cylinder placement; (c) the cylinder is carefully placed inside the flap, (d) resulting in the cylinder being securely wrapped by vascularized skin tissue.
Mentions: Nipple cylinder diameter (0.7 cm or 1.0 cm) and length (1 cm or 1.5 cm) were selected to closely match the contralateral nipple. If a contralateral nipple was not present, the overall size of the reconstructed breast, the presence or absence of a well-vascularized skin flap, and/or the patient's desired final appearance were considered when determining the cylinder size, allowing for some shrinkage following implant. The position of the nipple was determined with the patient seated in a relaxed position. Using a surgical marker, a skate-flap pattern (Figure 2) was drawn onto the patient's breast to guide the creation of the skin flaps. The NRC was allowed to rehydrate for no greater than 10 seconds before it was placed underneath the appropriate skin flaps, ensuring that an adequate blood supply reached the device. This placement allowed for maximum contact with healthy, well-vascularized tissue and encouraged cell in-growth and tissue remodeling (Figure 3). The cylinder was then secured into place with a combination of 3-0 Vicryl (Ethicon, Somerville, NJ) and 4-0 Monocryl (Ethicon, Somerville, NJ) sutures at the base of the nipple reconstruction to prevent migration of the cylinder into the subcutaneous region beneath the flaps. After reconstruction, incisions were closed with a combination of inverted dermal 3-0 Vicryl sutures and simple interrupted 4-0 Monocryl sutures. The reconstructed nipple was protected using a hard plastic shield, which was left in place for up to 4 weeks. Topical antibiotic cream was not routinely used following surgery, but patients were instructed to use triple antibiotic and return to the clinic if signs of infection were observed when cleansing the area. The areola was later pigmented by tattoo according to standard practice.

Bottom Line: Average body mass index was 28.0.The only reported complications were extrusions (3.5%).Complications are infrequent and short-term projection measurements are encouraging.

View Article: PubMed Central - PubMed

Affiliation: Tierney Plastic Surgery, 2011 Church Street, Suite 805, Nashville, TN 37203, USA.

ABSTRACT
A surgical technique using local tissue skate flaps combined with cylinders made from a naturally derived biomaterial has been used effectively for nipple reconstruction. A retrospective review of patients who underwent nipple reconstruction using this technique was performed. Comorbidities and type of breast reconstruction were collected. Outcome evaluation included complications, surgical revisions, and nipple projection. There were 115 skate flap reconstructions performed in 83 patients between July 2009 and January 2013. Patients ranged from 32 to 73 years old. Average body mass index was 28.0. The most common comorbidities were hypertension (39.8%) and smoking (16.9%). After breast reconstruction, 68.7% of the patients underwent chemotherapy and 20.5% underwent radiation. Seventy-one patients had immediate breast reconstruction with expanders and 12 had delayed reconstruction. The only reported complications were extrusions (3.5%). Six nipples (5.2%) in 5 patients required surgical revision due to loss of projection; two patients had minor loss of projection but did not require surgical revision. Nipple projection at time of surgery ranged from 6 to 7 mm and average projection at 6 months was 3-5 mm. A surgical technique for nipple reconstruction using a skate flap with a graft material is described. Complications are infrequent and short-term projection measurements are encouraging.

No MeSH data available.


Related in: MedlinePlus