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- Mobargha, Nathalie, et al.
(author)
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Scapular osseous free flap in head and neck reconstruction : An assessment of the postoperative function of the donor site
- 2022
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In: Journal of Plastic, Reconstructive and Aesthetic Surgery. - : Elsevier BV. - 1748-6815. ; 75:2, s. 753-760
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Journal article (peer-reviewed)abstract
- Background: The scapular osseous free flap (SOFF) has become an important reconstructive option for complex head and neck defects. Postoperative donor site function is, however, an important consideration. The objective of this study was to prospectively investigate SOFF donor site morbidity and to relate the findings to hand dominance and neck dissection. Methods: Objective assessment included bilateral measurement of shoulder, elbow, and hand range of motion (ROM), hand strength, and distal nerve function in consecutive patients with head and neck cancer SOFF reconstruction at a tertiary referral center in Sweden between 2016 and 2019. The subjective function was assessed by the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Results: Sixteen of 20 consecutive patients were evaluated (median follow-up 10 months [range 3–17]). Significant side differences in shoulder range of motion (ROM) (flexion, abduction, external and internal rotation) were observed for patients where the SOFF had been harvested from the same side as their dominant hand (n = 9; Ps ≤ 0.04). For patients where the SOFF was harvested from the non-dominant hand side, no significant shoulder ROM side differences were observed (n = 7; Ps ≥ 0.08). There were significant side differences in shoulder ROM for patients who underwent neck dissections (n = 12; Ps ≤ 0.03), not for the other four patients. Patients reported low but varying DASH scores (median 2.5, range 0–57). Conclusion: Postoperative donor site morbidity seems to be quite acceptable after SOFF surgery. The results indicate possible benefits of choosing the non-dominant hand side for the SOFF and that a neck dissection affects postoperative shoulder outcome. Further studies are however needed.
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| 2. |
- Tallroth, Linda, et al.
(author)
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Assessment of local tissue water in breasts following breast reconstruction with an expander prosthesis or DIEP flap
- 2022
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In: Journal of Plastic Surgery and Hand Surgery. - 2000-656X. ; 56:4, s. 217-223
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Journal article (peer-reviewed)abstract
- The role of breast oedema in breast reconstruction is unknown. Therefore, our aim was to investigate local tissue water (LTW) and breast oedema-related symptoms in breasts reconstructed with either an expander prosthesis (EP) or with a deep inferior epigastric perforator (DIEP) flap at a minimum of one year postoperatively. Sixty-eight patients randomised to breast reconstruction with an EP or DIEP flap completed follow-up. Objective evaluation was performed at a mean of 25 (standard deviation, SD 9.5) months following breast reconstruction, and included measurements of breast volume and LTW with the MoistureMeterD® instrument. The patients completed the BREAST-Q questionnaire pre- and postoperatively. No significant differences in LTW were found when comparing EP and DIEP flap reconstructed breasts. The reconstructed breasts had an increase in LTW compared with the non-operated contralateral breasts. The BREAST-Q responses related to breast oedema symptoms were overall low and the median responses ranged from 1 to 2. A score of 1 indicated that symptoms were experienced 'None of the time'. Our findings indicate that mastectomy followed by breast reconstruction inflicts damage on the lymphatic system, shown as an increase in LTW. However, no breast oedema-related symptoms were reported in the BREAST-Q questionnaire, and therefore, we consider our objective results to be below a potential threshold for symptomatic breast oedema. A threshold for clinical indication of breast oedema remains to be defined.
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| 3. |
- Tallroth, Linda, et al.
(author)
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Breast softness in patients randomised to postmastectomy breast reconstruction with an expander prosthesis or DIEP flap
- 2021
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In: European Journal of Plastic Surgery. - : Springer Science and Business Media LLC. - 0930-343X .- 1435-0130. ; , s. 1-8
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Journal article (peer-reviewed)abstract
- Background Objectively measured breast softness in reconstructed breasts and its relation to patients’ subjective satisfactionwith breast softness has not yet been investigated. The aim of this study was to evaluate breast softness in patients 1 yearfollowing delayed breast reconstruction with an expander prosthesis (EP) or deep inferior epigastric perforator (DIEP) fap,using objective and subjective methods.Methods Seventy-three patients were randomised to breast reconstruction with an EP or DIEP fap between 2012 and 2018.Of these, 69 completed objective evaluation at a mean of 25 (standard deviation, SD 9.4) months following breast reconstruction. Objective evaluation included measurements of breast volume, jugulum-nipple distance, clavicular-submammary folddistance, ptosis and Baker scale grading. Breast softness was assessed with applanation tonometry. Subjective evaluationwas performed using the BREAST-Q questionnaire.Results Objectively, DIEP faps were signifcantly softer than EP breast reconstructions. Non-operated contralateral breastswere signifcantly softer compared with reconstructed breasts. In the subjective evaluation, the median score on the question(labelled 1.h) “How satisfed or dissatisfed have you been with the softness of your reconstructed breast (s)?” was higher inthe DIEP fap group corresponding to greater satisfaction in this group. A fair correlation was found between the applanationtonometry and the patient-reported satisfaction with the reconstructed breast’s softness (rs=0.37).Conclusions In terms of breast softness, breast reconstructions with DIEP faps result in more satisfed patients. Concerningapplanation tonometry as an objective tool for
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| 4. |
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| 5. |
- Tallroth, Linda, et al.
(author)
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Evaluation of an assessment scale for aesthetic outcome in breast reconstructions based on digital photos in both 2D and 3D format
- 2023
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In: Journal of Plastic Surgery and Hand Surgery. - 2000-656X. ; 57:1-6, s. 427-433
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Journal article (peer-reviewed)abstract
- The aesthetic outcome is crucial in a breast reconstruction. Our aim was to evaluate the intra- and interrater reliability of an aesthetic outcome assessment scale with digital photos of breast reconstructions in two-dimensional (2D) and three-dimensional (3D) format. Thirty-three women with delayed breast reconstructions, consecutively participating in a five-year follow-up between November 2019 and June 2021, were included in the study. Of these, 14 were reconstructed with an expander prosthesis (EP) and 19 with a deep inferior epigastric perforator (DIEP) flap. Photos of the breasts were assessed in 2D and 3D format by expert, layman and patient panels. Data were analysed with the weighted kappa (wk) statistics. The intrarater agreements were moderate to substantial, with wk between 0.66 and 0.73 for the panels. Within the panels, the interrater agreements were 0.46–0.62. Moderate agreements were found between the matched 2D and 3D format photos (wk 0.62–0.66). The patient panel graded scar appearance worse in 3D compared with 2D format. In all panels, there was a tendency towards DIEP flap reconstructions receiving higher aesthetic outcome grades compared with EP. Thus, the aesthetic outcome assessment scale demonstrated acceptable agreements between the individual panellists and within the panels. Scars captured in 3D format may provide a greater resemblance to the reality compared with 2D. Implications for clinics remain to be further studied.
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| 6. |
- Tallroth, Linda, et al.
(author)
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Expander prosthesis and DIEP flaps in delayed breast reconstruction : Sensibility, patient-reported outcome, and complications in a five-year randomised follow-up study
- 2023
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In: Journal of Plastic Surgery and Hand Surgery. - 2000-656X. ; 58, s. 101-109
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Journal article (peer-reviewed)abstract
- Breast reconstruction is a given choice for many women following mastectomy. There are a multitude of methods available today, and thus, comparative studies are essential to match patients with suitable methods. The aim of this study was to compare 5-year outcomes following delayed breast reconstruction with expander prosthesis (EP) and with deep inferior epigastric perforator (DIEP) flaps. Seventy-three patients, previously randomised to either a permanent EP or a DIEP flap breast reconstruction, were invited for a 5-year follow-up. Assessments included symmetry measurements, breast sensibility with Semmes-Weinstein monofilaments and patient-reported outcome (PRO) with the BREAST-Q. Complications within the first 5 postoperative years were recorded. Additionally, BREAST-Q questionnaires were collected from non-randomised patients with an EP breast reconstruction. Between 2019 and 2022, 65 patients completed the follow-ups. Symmetry and PRO were significantly higher in the DIEP flap group. However, EP-reconstructed breasts were significantly more sensate and demonstrated areas with protective sensibility, unlike the DIEP flap breasts. The overall complication rates were comparable between the two groups (p = 0.27). Regression analysis identified body mass index as a risk factor for reoperation in general anaesthesia and for wound infection. No significant differences were found in a comparison of the randomised and the non-randomised EP groups' BREAST-Q results. This randomised 5-year follow-up study found PRO to be favourable following a DIEP flap reconstruction and sensibility to be better in EP reconstructions. The complication rates were comparable; however, longer follow-ups are warranted to cover the complete lifespans of the two breast reconstruction methods.
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