| 1. |
- Doria Medina, Roberto, et al.
(författare)
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fMRI after Phalloplasty with Nerve Anastomosis in a Trans-Man Patient
- 2017
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Ingår i: Plastic and Reconstructive Surgery-Global Open. - : Ovid Technologies (Wolters Kluwer Health). - 2169-7574. ; 5:6
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Tidskriftsartikel (refereegranskat)abstract
- We report on a case of a trans-man patient, who underwent penile reconstruction with the use of a radial forearm flap, urethroplasty, vaginectomy and scrotoplasty, insertion of testicle implants, and penile erection implants, similar to previously described methods. One of the requirements for an ideal phalloplasty is the preservation of erogenous sensitivity, which is often demanded by the patients for fulfilling their sexual well-being. For the first time known to us, we use a functional magnetic resonance imaging following radial forearm flap phalloplasty with nerve anastomosis to assess the cortical activation after clitoral stimulation. The patient was poked with a plastic pen on the neophallus and the groin. Regular block design with T1 and BOLD-T2* images were used. The results contradict the classic Penfield and Rasmussen homunculus, that is, the activations in the primary somatosensory cortex (S1) were bilateral with a left-sided dominance in the lateral parts of the medial postcentral gyrus (same region as the groin), and no activations were observed in the mesial parts of the postcentral gyrus. We also reported bilateral activations with a left-sided dominance in the secondary somatosensory cortex (S2) and near Broca's area at the sylvian fissure just posterior to ramus ascendens. Our findings are similar to previous studies reporting on imaging related to genital sensitivity.
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| 2. |
- Lewin, Richard, 1976, et al.
(författare)
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Prospective Evaluation of Health After Breast Reduction Surgery Using the Breast-Q, Short-Form 36, Breast-Related Symptoms Questionnaire, and Modified Breast Evaluation Questionnaire.
- 2019
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Ingår i: Annals of plastic surgery. - 1536-3708. ; 83:2, s. 143-151
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Tidskriftsartikel (refereegranskat)abstract
- Breast hypertrophy is a condition associated with physical, psychological, and psychosocial problems. The primary aims of this study were to determine the impact of breast hypertrophy and the effects of breast reduction, performed on the basis of well-described inclusion criteria, on general and breast-related health, using both general and diagnosis-specific validated questionnaires. We used a prospective, longitudinal paired study design. A secondary aim was to analyze the relationship between preoperative breast volume, body mass index, sternal notch-to-nipple distance and the weight of resected tissue on the one hand and improvements in health on the other.Three hundred forty-eight consecutive patients undergoing breast reduction were included and the Short-Form 36 (SF-36), Breast-Related Symptoms Questionnaire (BRSQ), Modified Breast Evaluation Questionnaire (mBEQ) and BREAST-Q were distributed preoperatively and 1 year postoperatively.A total of 284 (83%) patients answered the questionnaires either preoperatively or postoperatively, or both, and 159 (46%) patients answered both. The breast hypertrophy patients had significantly lower scores preoperatively than the matched normal population when it came to all dimensions of the SF-36 and mBEQ. The preoperative scores for both the BRSQ and BREAST-Q were low.After breast reduction, there were significant improvements in all dimensions of the BRSQ, mBEQ, and Breast-Q and in several dimensions of the SF-36.Breast reduction reduces or removes disease-associated pain. It improves or normalizes perceived health and psychosocial self-esteem in slightly obese women or women of normal weight with preoperative breast volumes around 1000 mL. Women with higher preoperative breast volumes and longer sternal notch-to-nipple distances appear to be more satisfied with the cosmetic result postoperatively.
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| 3. |
- Lewin, Richard, 1976, et al.
(författare)
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A Randomized Prospective Study of Prophylactic Cloxacillin in Breast Reduction Surgery.
- 2015
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Ingår i: Annals of plastic surgery. - 1536-3708. ; 74:1, s. 17-21
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Tidskriftsartikel (refereegranskat)abstract
- Postoperative infection after breast reduction surgery is a common complication, with the most commonly involved pathogen being Staphylococcus aureus. Previous studies of antibiotic prophylaxis in breast reduction surgery have been inconclusive. The aim of the present study was to clarify the role of prophylactic antibiotics in breast reduction surgery.
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| 4. |
- Lewin, Richard, 1976, et al.
(författare)
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Validation of the breast evaluation questionnaire for breast hypertrophy and breast reduction.
- 2018
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Ingår i: Journal of plastic surgery and hand surgery. - 2000-6764. ; 52:5, s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- There is a lack of published, validated questionnaires for evaluating psychosocial morbidity in patients with breast hypertrophy undergoing breast reduction surgery.To validate the breast evaluation questionnaire (BEQ), originally developed for the assessment of breast augmentation patients, for the assessment of psychosocial morbidity in patients with breast hypertrophy undergoing breast reduction surgery.Validation study Subjects: Women with macromastia Methods: The validation of the BEQ, adapted to breast reduction, was performed in several steps. Content validity, reliability, construct validity and responsiveness were assessed.The original version was adjusted according to the results for content validity and resulted in item reduction and a modified BEQ (mBEQ) that was then assessed for reliability, construct validity and responsiveness. Internal and external validation was performed for the modified BEQ. Convergent validity was tested against Breast-Q (reduction) and discriminate validity was tested against the SF-36. Known-groups validation revealed significant differences between the normal population and patients undergoing breast reduction surgery. The BEQ showed good reliability by test-re-test analysis and high responsiveness.The modified BEQ may be reliable, valid and responsive instrument for assessing women who undergo breast reduction.
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| 5. |
- Lidén, Mattias, 1973
(författare)
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Breast reduction and complications
- 2010
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Ingår i: Nordisk Plastikkirurgisk Förenings XXXIII kongress 10-12 juni 2010, Reykjavik, Island.
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Konferensbidrag (refereegranskat)
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| 6. |
- Lidén, Mattias, 1973
(författare)
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Long-term studies after primary and revision Anterior Cruciate Ligament reconstruction using different types of autograft - with special emphasis on the clinical, radiographic, histological and ultrastructural results
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Long-term studies after primary and revision Anterior Cruciate Ligament reconstruction using different types of autograft? with special emphasis on the clinical, radiographic, histological and ultrastructural results Mattias Lid?n Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, G?teborg, Sweden The aim of this study was to evaluate the long-term outcome after primary ACL reconstruction surgery using either BPTB or HT autografts and, in addition, ACL revision surgery using re-harvested patellar tendon autografts. Clinical and standard radiographic assessments were made of both the primary ACL-reconstructed knees and the patients who underwent ACL revision surgery using re-harvested patellar tendon autografts. Furthermore, in the revised knees, the patellar tendon underwent radiographic evaluations using MRI two and ten years after the index operation and histological and ultrastructural evaluations using a light and transmission electron microscope at ten years. In 14 patients, who were examined two and ten years after the re-harvesting procedure for revision ACL surgery, the clinical results were poor and the patellar tendon at the donor site had not normalised, as seen on MRI at both two and ten years. No differences in terms of the MRI assessments were registered between the two- and ten-year assessments. In a prospective, randomised seven-year follow-up study, 71 patients underwent primary ACL reconstruction using either BPTB or HT autografts. The objective and subjective outcomes were similar between the groups and a significant improvement compared with the pre-operative values was seen in most clinical assessments. No difference in terms of donor-site morbidity was found. One hundred and twenty-four patients who underwent an ACL reconstruction using either BPTB or HT autografts were included in a retrospective study comparing the radiographic OA findings seven years after ACL reconstruction. No significant differences between the graft types in terms of OA findings classified according to the Ahlb?ck and Fairbank rating systems were found between the study groups. Associated meniscal injuries increased the prevalence of OA. Specimens from the patellar tendon of 12 patients were obtained using an ultrasonography-guided biopsy procedure ten years after re-harvesting the central third of the patellar tendon at revision ACL surgery. The histological evaluation using the light microscope revealed a deterioration in fibre structure with increased cellularity and increased vascularity in both the central and peripheral parts of the index patellar tendon specimens compared with normal control tendon. The ultrastructural evaluation using the electron microscope revealed pathological cell morphology and a change in fibril size class distribution compared with the normal control tendon. Key words: anterior cruciate ligament, surgery, radiology, biopsy, osteoarthritis, histology, ultrastructure
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| 7. |
- Lidén, Mattias, 1973, et al.
(författare)
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Patellar tendon or semitendinosus tendon autografts for anterior cruciate ligament reconstruction: a prospective, randomized study with a 7-Year follow-up
- 2007
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Ingår i: Am J Sports Med. - : SAGE Publications. - 0363-5465. ; 35:5, s. 740-8
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The aim of the study was to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using central-third bone-patellar tendon-bone (BTB) autografts and triple/quadruple semitendinosus (ST) autografts. HYPOTHESIS: In the long-term, ACL reconstruction using BTB autografts will render more donor-site problems than ST autografts. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: A randomized series of 71 patients (22 women and 49 men) with a unilateral ACL rupture who underwent reconstructive surgery were included in the study. The BTB graft was used in 34 patients (BTB group) and the ST-tendon graft was used in 37 patients (ST group). The patients were examined a median of 86 months (range, 68 to 114 months) after the reconstruction. RESULTS: Sixty-eight of 71 patients (96%) were examined at follow-up. The clinical assessments at follow-up revealed no significant differences between the BTB group and the ST group in terms of the Lysholm score, Tegner activity level, International Knee Documentation Committee evaluation system, 1-legged hop test, KT-1000 arthrometer laxity measurements, manual Lachman test, and range of motion. A significant improvement was seen in both groups compared with the preoperative values in terms of most clinical assessments. Donor-site morbidity in the form of knee-walking ability, kneeling ability, and area of disturbed anterior knee sensitivity revealed no significant differences between the groups. CONCLUSION: Seven years after ACL reconstruction, the subjective and objective outcomes were similar after using the central-third BTB autograft and triple/quadruple ST autograft. Furthermore, no difference in terms of donor-site morbidity was found between the 2 groups.
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| 8. |
- Lidén, Mattias, 1973, et al.
(författare)
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The course of the patellar tendon after reharvesting its central third for ACL revision surgery: a long-term clinical and radiographic study
- 2006
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Ingår i: Knee Surg Sports Traumatol Arthrosc. - 0942-2056. ; 14:11, s. 1130-8
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Tidskriftsartikel (refereegranskat)abstract
- The choice of the optimal graft for anterior cruciate ligament (ACL) revision surgery is still controversial. Reharvesting the patellar tendon has been suggested as one graft alternative. Our hypothesis was that in the long-term, ACL revision surgery using reharvested patellar tendon autografts would render a good clinical outcome and a normal patellar tendon at the donor site as seen on magnetic resonance imaging (MRI). Fourteen consecutive patients (five women, nine men), who underwent ACL revision surgery using reharvested ipsilateral patellar tendon grafts, were included in the study. They underwent bilateral MRI evaluations of the patellar tendon and were tested for clinical outcome 26 (20-35) and 115 months (102-127) after the revision procedure. On the second occasion, they also underwent standard weight-bearing X-ray examinations.The serial MRI evaluations revealed that the thickness of the patellar tendon at the donor site was significantly increased compared with the non-harvested, normal contralateral side and that the donor-site gap was still visible after 10 years. No significant differences were seen between the 2- and 10-year MRI evaluations. Standard weight-bearing X-ray examinations revealed signs of mild degenerative changes in all patients. Clinical results in terms of the Lysholm score, IKDC evaluation system, one-leg-hop test, KT-1000 laxity test and the knee-walking test revealed no significant differences between the 2- and 10-year assessments. In overall terms, the clinical results were considered to be poor on both occasions. The patellar tendon at the donor site had not normalised 10 years after the reharvesting procedure, as seen on MRI. Furthermore, the clinical results were poor after ACL revision surgery using reharvested patellar tendon autograft.
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| 9. |
- Löfstrand, Jonas, 1981, et al.
(författare)
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Comparison of patient-reported achievements of goals and core outcomes with delayed breast reconstruction in irradiated patients: latissimus dorsi with an implant versus DIEP.
- 2023
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Ingår i: Journal of plastic surgery and hand surgery. - 2000-6764. ; 58, s. 74-81
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Tidskriftsartikel (refereegranskat)abstract
- Different women's individual goals with a breast reconstruction vary, and few studies compare techniques in light of the different goals. This study aimed to compare patient-reported core outcomes in patients reconstructed with deep inferior epigastric artery perforator (DIEP) flaps and latissimus dorsi (LD) flaps. Second, breast-related factors that the patients were particularly satisfied/dissatisfied with were analyzed.This was a retrospective cross-sectional study, which includes women who had undergone mastectomy and radiation, followed by delayed breast reconstructions with either LD flap and implant or DIEP flap during 2007-2017. The patient-reported core outcomes of overall breast-specific quality of life, normality, women's cosmetic satisfaction, self-esteem, emotional well-being, and physical well-being were analyzed using BREAST-Q.The patients were divided into LD and implant (n = 135 patients) and DIEP (n = 118 patients) groups, and both were demographically similar. The median follow-up was 8 years. The DIEP group scored significantly higher than the LD and implant group in five out of six domains. A high satisfaction was reported in questions regarding the feeling or appearance when having clothes on, whereas the greatest dissatisfaction was reported regarding questions entailing symmetry and the appearance without clothes.After 7 years, patients' breast-specific quality of life, normality, women's cosmetic satisfaction, self-esteem, emotional well-being, and physical well-being seem to be higher in irradiated patients who have been reconstructed with DIEP flap as compared to patients reconstructed with LD flap and implant. In both groups, patient satisfaction is high regarding their appearance when clothed, whereas the lowest satisfaction scores were reported in situations without clothing.
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| 10. |
- Löfstrand, Jonas, 1981, et al.
(författare)
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Long-term patient-reported back and shoulder function after delayed breast reconstruction with a latissimus dorsi flap: case-control cohort study.
- 2024
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Ingår i: The British journal of surgery. - 1365-2168. ; 111:1
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Tidskriftsartikel (refereegranskat)abstract
- Sacrifice of the latissimus dorsi (LD) muscle might entail donor site morbidity when used in delayed breast reconstruction. Previous studies are small, have short follow-up, and demonstrate diverging results. The aims of this study were to evaluate long-term patient-reported effects on shoulder and back function following LD flap harvest, and to investigate predictors for a worse outcome.This is a retrospective observational case-control cohort study. Cases were all patients who had undergone an LD flap reconstruction during the years 2007-2017. Controls were patients reconstructed with a deep inferior epigastric perforator (DIEP) flap during the same time period. Participants completed two validated questionnaires; the BREAST-Q reconstruction LD domains and the Western Ontario Shoulder Osteoarthritis Index (WOOS).A total of 135 cases (75 per cent) and 118 controls (60 per cent) responded to the questionnaires. The mean follow-up time was 7 years. Patients reconstructed with a LD flap were significantly less satisfied with their back and shoulder function when compared to the DIEP controls, as measured with BREAST-Q and WOOS. Predictors for a poor patient-reported back and shoulder function included axillary surgery and axillary radiotherapy, especially when combined, as well as higher age at reconstruction.Patients who have undergone LD flap for delayed breast reconstruction had a lower satisfaction with back and shoulder function, when compared to patients who had undergone a DIEP reconstruction. Delayed LD reconstruction should be used with care, especially in patients who have undergone axillary surgery and axillary radiotherapy.
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