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Meshed acellular dermal matrix:technique and application in implant based breast reconstruction

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Plastic and Aesthetic Research 2016年第1期3卷 254-256页

作者： Dino Zammit jonathan kanevsky Fan-Yi Meng Tassos Dionisopoulos Plastic Surgery Faculty of MedicineMcGill UniversityMontrealQuebec H3G 1A4Canada Montreal General Hospital McGill UniversityMontrealQuebec H3G 1A4Canada Jewish General Hospital McGill UniversityMontrealQuebec H3G 1A4Canada

Alloderm was the first acellular dermal matrix used and remains a popular choice among plastic ***,while the overall surgical outcome of breast reconstruction using alloderm has been a success,the economic burden on the health care system makes it a subject of frequent re-evaluations in *** by the high price of$3,700 USD for a 6 cm×16 cm area,our group proposes the meshing of AlloDerm to decrease the total amount needed for breast reconstruction,while achieving comparable surgical outcomes as using unmeshed alloderm.

关键词： Alloderm acellular dermal matrix breast reconstruction meshing breast cancer

Fat injection to correct contour deformities of the reconstructed breast:a single surgeon experience

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Plastic and Aesthetic Research 2015年第1期2卷 115-119页

作者： Youssef Tahiri jonathan kanevsky Joshua Vorstenbosch James Lee Karl Schwarz Department of Surgery Division of Plastic and Reconstructive SurgeryRiley Hospital for ChildrenIndiana UniversityIndianapolisIN 46202USA Department of Surgery Division of Plastic and Reconstructive SurgeryMcGill University Health CentreMontrealQC H3G 1B3Canada Department of Surgery Section of Plastic SurgeryUniversity of ManitobaWinnipegMB R3T 2N2Canada Schwarz Plastic Surgery MontrealQC H3G 1B9Canada

Aim:Autologous fat grafting has gained acceptance as a technique to improve aesthetic outcomes in breast *** purpose of this study was to share our clinical experience using autologous fat injection to correct contour deformities during breast ***:A single surgeon,prospectively maintained database of patients who underwent autologous fat injection during breast reconstruction from January 2008 to November 2013 at McGill University Health Center was *** characteristics,breast history,type of breast reconstruction,volume of fat injected,and complications were ***:One hundred and twenty-four patients benefited from autologous fat injection from January 2008 to November 2013,for a total of 187 treated *** patients were on average 49.3 years old(±8.9 years).Fat was harvested from the medial thighs(20.5%),flanks(39.1%),medial thighs and flanks(2.9%),trochanters(13.3%),medial knees(2.7%),and abdomen(21.9%).An average of 49.25 mL of fat was injected into each reconstructed breast.A total of 187 breasts in 124 patients were lipo-infiltrated during the second stage of breast *** breasts(in 12 separate patients)were injected several years after having undergone lumpectomy and *** the 187 treated breasts,118 were reconstructed with expanders to implants,45 with deep inferior epigastric perforator flaps,9 with latissimus dorsi flaps with implants,4 with transverse rectus abdominis myocutaneous flaps,and 13 had previously undergone lumpectomy and *** complications were noted in the entire series,for a rate of 3.2%.All were in previously radiated *** follow-up time was 12 months(range:2-36 months).Conclusion:Fat injection continues to grow in popularity as an adjunct to breast *** experience demonstrates a low complication rate as compared to most surgical interventions of the breast and further supports its safety in breast ***

关键词： Breast contour deformities fat injection

Free deep inferior epigastric perforator flap after abdominal liposuction:reconsidering a contraindication

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Plastic and Aesthetic Research 2015年第1期2卷 311-314页

作者： Peter James Mankowski jonathan kanevsky Anne‑Sophie Lessard Teanoosh Zadeh Division of Plastic and Reconstructive Surgery McGill University Health CentreMontrealQuebec H3G 1B3Canada

Autologous breast reconstruction with perforators has been previously avoided in tissues that have undergone *** present a case series and literature review of breast reconstruction with deep inferior epigastric perforator(DIEP)flaps after abdominal wall *** MEDLINE search was performed for all relevant articles describing breast reconstruction with DIEP flap technique following the abdominal wall *** search words used included“DIEP”,“DIEAP”,“deep inferior epigastric perforator”,“liposuction”and“free flap”.All published data on the topic from 1965 to December 2014 were *** were assessed for reports of clinical cases,complications,age,liposuction amount,time since liposuction and number of perforators for *** have also presented 2 patients who underwent a DIEP procedure with a previous history of *** cases of autologous breast reconstruction using a DIEP flap after liposuction were identified in the literature in addition to the presented *** preoperative and postoperative course was uneventful in all cases except one patient who had a mild cellulitis managed with antibiotics and a second patient with a drainable *** average age was 52 years±6.4 years old,one perforator was used in all cases except one where 2 were used,and the average amount of total liposuction was 1,084 *** major complications were *** liposuction is not an absolute contraindication for free-flap breast *** management should include evaluation of suitable perforators by duplex ultrasound or computed tomography *** case series are needed to better understand the safety of perforator flaps after liposuction.

关键词： Breast reconstruction deep inferior epigastric perforator flap liposuction

Development and assessment of a cutaneous tissue stretch device as a novel scar therapy

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Plastic and Aesthetic Research 2016年第1期3卷 351-358页

作者： jonathan kanevsky Joshua Vorstenbosch Julian Diaz-Abele Tyler Safran Markus Prinz Youssef Tahiri Mirko Gilardino Satya Prakash Division of Plastic and Reconstructive Surgery McGill University Health CentreMontrealQC H3G 1B3Canada Section of Plastic and Reconstructive Surgery University of ManitobaWinnipegMB R3T 2N2Canada McGill Medical School McGill UniversityMontrealQC H3G 2M1Canada Division of General Surgery University of SherbrookeSherbrookeQC J1K 2R1Canada Division of Plastic and Reconstructive Surgery Indiana UniversityIndianapolisIN 46202USA Biomedical Engineering Department Artificial Cells and Organs Research CentreMontrealQC H3A 2B4Canada

Aim:Scar prevention and reduction is an area of therapeutic opportunity and unmet medical *** no current effective scar therapy,patients are often disappointed in their appearance post surgery and re-present to surgeons,only to be turned *** purpose of this study was to develop and test a device that produces intermittent parallel stretch on new scars and to analyze its potential to reduce ***:Mice were randomized into 5 scar stretch treatment groups:1 control,1 sham,and 3 stretch models(0.5×,1×,or 2×device strength)and treated for 10 *** were scored using the Vancouver Scar *** tissue samples were compared by histology and transforming growth factor beta 1(TGF-β1)expression between control and treatment ***:Scar scores of 0.5×and 1×groups were significantly lower than the control group(P<0.05).Scar scores from the 1×treatment group were also significantly lower than the 0.5×group(P<0.05).Sham,control scar and 2×groups showed more collagen deposition and a thicker dermal scar than the 0.5×and 1×*** scars had fewer fibroblasts with more collagen deposition than the 0.5×and 2×***-β1 levels were significantly lower in the 0.5×(342.1±9.2)and 1×(254.1±3.1)groups than in the control group(P<0.05).TGF-β1 levels in the 1×treatment group were also significantly lower than the 0.5×treatment group(P<0.05).Conclusion:Intermittent cutaneous tissue stretch parallel to scars during the proliferative phase of wound healing decreases fibrosis on a macroscopic,microscopic and biochemical level.

关键词： Mechanotransduction scar therapy hypertrophic scar skin stretch