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1.	Taylor, Sam, et al. (author) Definitive coverage of distal vein graft in a case of early skin necrosis following popliteal to dorsalis pedis bypass 2023 In: Journal of Vascular Surgery Cases and Innovative Techniques. - : Elsevier. - 2468-4287. ; 9:4 Journal article (peer-reviewed)abstract Inframalleolar bypass is an effective intervention for chronic limb threatening ischemia. A successful outcome can be compromised by early pedal wound disruption with secondary bypass exposure. We describe the case of a 74-year-old man with a WIfI (wound, ischemia, foot infection) clinical stage 4 foot who underwent popliteal-dorsalis pedis bypass, complicated by early skin necrosis overlying the pedal anastomosis. This necessitated a multidisciplinary approach to obtain tissue coverage over the anastomosis. The wound healed within 28 days, and at 2 years, the patient was mobilizing independently. We outline the approach taken and discuss the management of this challenging limb salvage problem.
2.	Ade, Peter, et al. (author) The Simons Observatory : science goals and forecasts 2019 In: Journal of Cosmology and Astroparticle Physics. - : IOP Publishing. - 1475-7516. ; :2 Journal article (peer-reviewed)abstract The Simons Observatory (SO) is a new cosmic microwave background experiment being built on Cerro Toco in Chile, due to begin observations in the early 2020s. We describe the scientific goals of the experiment, motivate the design, and forecast its performance. SO will measure the temperature and polarization anisotropy of the cosmic microwave background in six frequency bands centered at: 27, 39, 93, 145, 225 and 280 GHz. The initial con figuration of SO will have three small-aperture 0.5-m telescopes and one large-aperture 6-m telescope, with a total of 60,000 cryogenic bolometers. Our key science goals are to characterize the primordial perturbations, measure the number of relativistic species and the mass of neutrinos, test for deviations from a cosmological constant, improve our understanding of galaxy evolution, and constrain the duration of reionization. The small aperture telescopes will target the largest angular scales observable from Chile, mapping approximate to 10% of the sky to a white noise level of 2 mu K-arcmin in combined 93 and 145 GHz bands, to measure the primordial tensor-to-scalar ratio, r, at a target level of sigma(r) = 0.003. The large aperture telescope will map approximate to 40% of the sky at arcminute angular resolution to an expected white noise level of 6 mu K-arcmin in combined 93 and 145 GHz bands, overlapping with the majority of the Large Synoptic Survey Telescope sky region and partially with the Dark Energy Spectroscopic Instrument. With up to an order of magnitude lower polarization noise than maps from the Planck satellite, the high-resolution sky maps will constrain cosmological parameters derived from the damping tail, gravitational lensing of the microwave background, the primordial bispectrum, and the thermal and kinematic Sunyaev-Zel'dovich effects, and will aid in delensing the large-angle polarization signal to measure the tensor-to-scalar ratio. The survey will also provide a legacy catalog of 16,000 galaxy clusters and more than 20,000 extragalactic sources.
3.	Adwall, Linda, et al. (author) Prospective Evaluation of Complications and Associated Risk Factors in Breast Cancer Surgery 2022 In: Journal of Oncology. - : Hindawi Publishing Corporation. - 1687-8450 .- 1687-8469. ; 2022 Journal article (peer-reviewed)abstract Background; Surgical site infection (SSI) is a well-known complication after breast cancer surgery. The primary aim was to assess risk factors for SSI. Risk factors for other wound complications were also studied.Materials and Methods: In this prospectively registered cohort study, patients who underwent breast-conserving surgery (BCS) or mastectomy between May 2017 and May 2019 were included. Data included patient and treatment characteristics, infection, and wound complication rates. Risk factors for SSI and wound complications were analyzed with simple and multiple logistic regression.Results: The study cohort consisted of 592 patients who underwent 707 procedures. There were 66 (9.3%) SSI and 95 (13.4%) wound complications. "BMI > 25, " "oncoplastic BCS, " "reoperation within 24 hour, " and "prolonged operative time " were risk factors for SSI with simple analysis. BMI 25-30 and > 30 remained as significant risk factors for SSI with adjusted analysis. Risk factors for "any wound complication " with adjusted analysis were "mastectomy with/without reconstruction " in addition to "BMI 25-30 " and "BMI > 30. "Conclusion: The only significant risk factor for SSI on multivariable analysis were BMI 25-30 and BMI > 30. Significant risk factors for "any wound complication " on multivariable analysis were "mastectomy with/without reconstruction " as well as "BMI 25-30 " and "BMI > 30. "
4.	Aguggia, Julieta P., et al. (author) Growth hormone secretagogue receptor signaling in the supramammillary nucleus targets nitric oxide-producing neurons and controls recognition memory in mice 2022 In: Psychoneuroendocrinology. - : Elsevier. - 0306-4530 .- 1873-3360. ; 139 Journal article (peer-reviewed)abstract Ghrelin is a stomach-derived hormone that acts via the growth hormone secretagogue receptor (GHSR). Recent evidence suggests that some of ghrelin's actions may be mediated via the supramammillary nucleus (SuM). Not only does ghrelin bind to cells within the mouse SuM, but ghrelin also activates SuM cells and intra-SuM ghrelin administration induces feeding in rats. In the current study, we aimed to further characterize ghrelin action in the SuM. We first investigated a mouse model expressing enhanced green fluorescent protein (eGFP) under the promoter of GHSR (GHSR-eGFP mice). We found that the SuM of GHSR-eGFP mice contains a significant amount of eGFP cells, some of which express neuronal nitric oxide synthase. Centrally-, but not systemically-, injected ghrelin reached the SuM, where it induced c-Fos expression. Furthermore, a 5-day 40% calorie restriction protocol, but not a 2-day fast, increased c-Fos expression in non-eGFP+ cells of the SuM of GHSR-eGFP mice, whereas c-Fos induction by calorie restriction was not observed in GHSR-deficient mice. Exposure of satiated mice to a binge-like eating protocol also increased c-Fos expression in non-eGFP+ cells of the SuM of GHSR-eGFP mice in a GHSR-dependent manner. Finally, intra-SuM-injected ghrelin did not acutely affect food intake, locomotor activity, behavioral arousal or spatial memory but increased recognition memory. Thus, we provide a compelling neuroanatomical characterization of GHSR SuM neurons and its behavioral implications in mice.
5.	Aristokleous, Iliana, et al. (author) Effect of standardised surgical assessment and shared decision-making on morbidity and patient satisfaction after breast conserving therapy : A cross-sectional study 2023 In: European Journal of Surgical Oncology. - : Elsevier. - 0748-7983 .- 1532-2157. ; 49:1, s. 60-67 Journal article (peer-reviewed)abstract Background: The role of oncoplastic breast conserving therapy (OPBCT) on physical function, morbidity and patient satisfaction has yet to be defined. Additionally, technique selection should be individualised and incorporate patient preference. The study aim was to investigate differences between "standard" (sBCT) and oncoplastic breast conservation (OPBCT) in patient-reported outcomes (PROs) when patients have been assessed in a standardised manner and technique selection has been reached through shared decision-making (SDM).Methods: This is a cross-sectional study of 215 women treated at a tertiary referral centre. Standardised surgical assessment included breast and lesion volumetry, definition of resection ratio, patient-related risk factors and patient preference. Postoperative morbidity and patient satisfaction were assessed by validated PROs tools (Diseases of the Arm, Shoulder and Hand-DASH and Breast-Q). Patient experience was assessed by semi-structured interviews.Results: There was no difference of the median values between OPBCT and sBCT in postoperative morbidity of the upper extremity (DASH 3.3 vs 5, p = 0.656) or the function of the chest wall (Breast-Q 82 vs 82, p = 0.758). Postoperative satisfaction with breasts did not differ either (Breast-Q 65 vs 61, p = 0.702). On the individual level, women that opted for OPBCT after SDM had improved satisfaction when compared to baseline (+3 vs -1, p = 0.001). Shared decision-making changed patient attitude in 69.8% of patients, leading most often to de-escalation from mastectomy.Conclusions: These findings support that a combination of standardised surgical assessment and SDM allows for tailored treatment and de-escalation of oncoplastic surgery without negatively affecting patient satisfaction and morbidity.
6.	Calì-Cassi, Lorenzo, et al. (author) The Anatomical Basis of the Lumbar Artery PerforatorFlap : A Cadaveric and Computer Tomography AngiogramStudy 2016 In: Clinics in Surgery Journal. - : Remedy Publications LLC. - 2474-1647. ; 1 Journal article (peer-reviewed)abstract Background: Lumbar skin flaps based on cutaneous perforators arising from the lumbar artery have been described for coverage of lumbosacral defects and as free flaps for autologous breast reconstruction. Thus, the purpose of this study is to clarify anatomical aspects of the lumbar artery perforator flaps pertaining improvement in utility and design of this flap. Methods: Five fresh human bodies were dissected and twenty three-dimensional computed tomographic (CT) angiographic previously used for the evaluation of the deep inferior epigastric perforator flap in patients that underwent breast reconstruction were evaluated. All cutaneous lumbar artery perforators were analyzed for total number, location, and external diameter. Results: The number of perforators observed per side was 1.6±0.84 in the CT angiography and 3±1.05 in the cadaver study. Data from CT angiographies showed a mean diameter of the pedicle of 2.76±0.74 mm. This perforators were located at the mean distance from the midline (spinal process) of 76.56±6.97 mm, the mean length pedicle were 19.88±7.57 mm. Data from the cadaveric dissection study the mean diameter of the pedicle were 1.96±0.57 mm, the mean distance from the midline were 69.6±22.5 mm. Conclusion: The lumbar artery perforator flap is based on a perforator that has a predictable location and presents a good caliber. Versatility of design of a pedicled flap as a propeller, bilobed or transposition flap based on this reliable perforator can be useful to reconstruct complex defects in the lumbar area. Preoperative planning with CT angiography is recommended to assess the location and caliber of the perforator allowing a better design of the flap
7.	Coelho, Ruben, et al. (author) Reconstruction of late esophagus perforation after anterior cervical spine fusion with an adipofascial anterolateral thigh free flap : A case report. 2017 In: Microsurgery. - : John Wiley & Sons. - 0738-1085 .- 1098-2752. ; 37:6, s. 684-688 Journal article (peer-reviewed)abstract Reconstruction of late esophageal perforation usually requires flap surgery to achieve wound healing. However, restoring the continuity between the digestive tract and retropharyngeal space to allow for normal swallowing remains a technical challenge. In this report, we describe the use of a thin and pliable free adipofascial anterolateral thigh (ALT) flap in a 47-year-old tetraplegic man with a history of C5-C6 fracture presented with a large posterior esophagus wall perforation allowing an easier flap insetting for a successful wound closure. The postoperative course was uneventful and mucosalization of the flap was confirmed by esophagoscopy 4 weeks postsurgery. The patient tolerated normal diet and maintained normal swallowing during a follow-up of 3 years postoperatively. The adipofascial ALT flap may provide easier insetting due to the thin and pliable layer of adipofascial tissue for reconstructing large defects of the posterior wall of the esophagus by filling the retroesophageal space.
8.	Cox, S, et al. (author) Neuronal Regeneration Potential of Facial Nerve for Compound Wound in an Elderly Patient, Review; Innovations in Tissue Engineering & Regenerative Medicine (ITERM) 2021 In: Crimson Publishers. Journal article (peer-reviewed)
9.	Cristóbal, Lara, et al. (author) Free anterolateral thigh flap and masseter nerve transfer for reconstruction of extensive periauricular defects : Surgical technique and clinical outcomes 2017 In: Microsurgery. - : John Wiley & Sons. - 0738-1085 .- 1098-2752. ; 37:6, s. 479-486 Journal article (peer-reviewed)abstract BACKGROUND: Radical tumor ablation in the periauricular area often results in extensive soft tissue defects, including facial nerve sacrifice, bone and/or dura defects. Reconstruction of these defects should aim at restoring facial reanimation, wound closure, and facial and neck contours. We present our experience using free anterolateral thigh flap (ALT) in combination with masseter nerve to facial nerve transfer in managing complex defects in the periauricular area.METHODS: Between 2011 and 2015 six patients underwent a combined procedure of ALT flap reconstruction and masseter nerve transfer, to reconstruct extensive, post tumor resection, periauricular defects. The ALT flap was customized according to the defect. For smile restoration, the masseter nerve was transferred to the buccal branch of the facial nerve. If the facial nerve stump was preserved, interposition of nerve grafts to the zygomatic and frontal branches was performed to provide separate eye closure. The outcomes were analyzed by assessing wound closure, contour deformity, symmetry of the face, and facial nerve function.RESULTS: There were no partial or total flap losses. Stable wound closure and adequate volume replacement in the neck was achieved in all cases, as well as good facial tonus and symmetry. The mean follow-up time of clinical outcomes was 16.8 months. Smile restoration was graded as good or excellent in four cases, moderate in one and fair in one.CONCLUSION: Extensive periauricular defects following oncologic resection could be adequately reconstructed in a combined procedure of free ALT flap and masseter nerve transfer to the facial nerve for smile restoration.
10.	D'Oria, Mario, et al. (author) An International Expert-Based CONsensus on Indications and Techniques for aoRtic balloOn occLusion in the Management of Ruptured Abdominal Aortic Aneurysms (CONTROL-RAAA) 2023 In: Journal of Endovascular Therapy. - : Sage Publications. - 1526-6028 .- 1545-1550. Journal article (peer-reviewed)abstract OBJECTIVE: To report on the recommendations of an expert-based consensus on the indications, timing, and techniques of aortic balloon occlusion (ABO) in the management of ruptured abdominal aortic aneurysms (rAAA).METHODS: Eleven facilitators created appropriate statements regarding the study issues that were voted on using a 4-point Likert scale with open-comment fields, by a selected panel of international experts (vascular surgeons and interventional radiologists) using a 3-round modified Delphi consensus procedure (study period: January-April 2023). Based on the experts' responses, only the statements reaching grade A (full agreement ≥75%) or B (overall agreement ≥80% and full disagreement <5%) were included in the final study report. The consistency of each round's answers was also graded using Cohen's kappa, the intraclass correlation coefficient, and, in case of double resubmission, Fleiss kappa.RESULTS: Sixty-three experts were included in the final analysis and voted on 25 statements related to indication and timing (n=6), and techniques (n=19) of ABO in the setting of rAAA. Femoral sheath or ABO should be preferably placed in the operating room, via a percutaneous transfemoral access, on a stiff wire (grade B, consistency I), ABO placement should be suprarenal and last less than 30 minutes (grade B, consistency II), postoperative peripheral vascular status (grade A, consistency II) and laboratory testing every 6 to 12 hours (grade B, consistency) should be assessed to detect complications. Formal training for ABO should be implemented (grade B, consistency I). Most of the statements in this international expert-based Delphi consensus study might guide current choices for indications, timing, and techniques of ABO in the management of rAAA. Clinical practice guidelines should incorporate dedicated statements that can guide clinicians in decision-making.CONCLUSIONS: At arrival and during both open or endovascular procedures for rAAA, selective use of intra-aortic balloon occlusion is recommended, and it should be performed preferably by the treating physician in aortic pathology.CLINICAL IMPACT: This is the first consensus study of international vascular experts aimed at defining the indications, timing, and techniques of optimal use of ABO in the clinical setting of rAAA. Aortic occlusion by endovascular means (or ABO) is a quick procedure in properly trained hands that may play an important role as a temporizing measure until the definitive aortic repair is achieved, whether by endovascular or open means. Since data on its use in hemodynamically unstable patients are limited in the literature, owing to practical challenges in the performance of well-conducted prospective studies, understanding real-world use by experts is of importance in addressing critical issues and identifying main gaps in knowledge.
11.	Driessen, Caroline, et al. (author) How should indocyanine green dye angiography be assessed to best predict mastectomy skin flap necrosis? : A systematic review 2020 In: Journal of Plastic, Reconstructive & Aesthetic Surgery. - : Elsevier BV. - 1748-6815 .- 1878-0539. ; 73:6, s. 1031-1042 Research review (peer-reviewed)abstract Introduction: The incidence of skin flap necrosis after mastectomies is as high as 11-24%. Laser-assisted indocyanine green (ICG) angiography seems to be a promising technique to assess skin flap perfusion. The aim of this systematic review is to assess the current methodology of ICG and its objective outcome measures ability to predict mastectomy skin flap necrosis.Methods: A PubMed search was conducted on the 31 December 2018 using ((("Fluorescein Angiography"[Mesh]) OR ("Indocyanine Green"[Mesh])) AND "Mastectomy"[Mesh]). This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included data about the study size, study design, skin flap necrosis, camera details and the objective outcome parameters.Results: Of 51 results, 22 abstracts were considered relevant of which nine were excluded secondarily. A reference check resulted in three extra inclusions. Sixteen papers were reviewed focusing on their methods and our primary endpoint which was the objective outcome measures of ICG. Objective outcome measures were reported in 8 of 16 studies. They mainly include absolute perfusion units and relative perfusion units (RPUs). All studies revealed a substantial decrease in skin necrosis when the ICG was used. The absolute number of units considered to be predictive for necrosis varies greatly; RPUs have been quite well established and are considered to be predictive for necrosis between 15.6% and 41.6%. However, consensus for methods, numbers and parameters is lacking.Conclusion: ICG evaluation of skin perfusion is a promising technique to aid in the surgeon's decision-making, and this seems to decrease skin flap necrosis after mastectomy.
12.	Driessen, Caroline, et al. (author) Usefulness of a template-based anterolateral thigh flap for reconstruction of head and neck defects. 2020 In: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 40:7, s. 776-782 Journal article (peer-reviewed)abstract BACKGROUND: One of the challenges in head and neck reconstruction is to have an adequate understanding of the three-dimensionalities of the defects created after resections due to the high variability of clinical scenarios. Consequently, it is essential to design the flap to match the requirements of the defect in order to facilitate the insetting and to achieve a successful outcome. The anterolateral thigh flap (ALT) is a robust and versatile flap commonly used in head and neck reconstruction. In this study the authors use a hand-made template as a tool to customize ALT flaps and its variations to fit more accurately the different shapes, volume, and components of the resulting defects. The aim of this study is to describe in detail this surgical approach and present the clinical experience in 100 consecutive cases using a template-based ALT flaps in head and neck reconstruction.METHODS: A retrospective review was performed on all microvascular head and neck reconstruction cases between January 2013 and December 2017 in our institution where a template-based ALT flap design was performed. We describe in detail the surgical technique used and present the clinical outcomes. In addition, we analyzed the use of different designs of the ALT flaps including different flap components in relation to the location of the defect.RESULTS: One hundred reconstructions for head and neck defects were performed in 97 patients. Seven types of ALT free flaps were performed: fasciocutaneous (46%), suprafascial (8%), adipofascial (9%), vastus lateralis muscle (3%), composite fasciocutaneous/adipofascial (9%), chimeric flaps (21%), and vascularized nerve grafts (4%). Oropharyngeal and periauricular defects were mostly reconstructed with fasciocutanoues design. In more complex three-dimensional defects such as skull base or midface defects, a chimeric flap was selected. In all cases the used of template facilitated the insetting of the free flap. The total flap loss was 2%.CONCLUSIONS: Customization of ALT flaps using intraoperative templates is a useful method for flap design which facilitates fitting of the flap to a variety of defects in head and neck reconstruction.
13.	Gümüscü, Rojda, et al. (author) National long-term patient-reported outcomes following mastectomy with or without breast reconstruction : The Swedish Breast Reconstruction Outcome Study Part 2 (SweBRO 2) 2024 In: BJS Open. - : Oxford University Press. - 2474-9842. ; 8:1 Journal article (peer-reviewed)abstract Background: The Swedish Breast Reconstruction Outcome Study (SweBRO) initiative is a nationwide study with the primary aim of assessing long-term outcomes after mastectomy with and without breast reconstruction (BR). The current part (SweBRO 2) is designed to evaluate health-related quality of life (HRQoL), with the hypothesis that BR has a positive impact on patient-reported HRQoL in the long-term.Methods: Women who underwent mastectomy in Sweden in 2000, 2005, or 2010 and were alive at the time of the survey were identified through the National Breast Cancer Registry. Eligible participants received formal invitation letters to take part in a survey evaluating their HRQoL at 5 , 10, or 15 years post-mastectomy. The EORTC QLQ-C30, EORTC QLQ-BR23, and EQ-5D-3L questionnaires were employed.Results: Of 2904 respondents (50% of 5853 invited), 895 (31%) had received BR. Among them, 516 (58%) were reconstructed with implants and 281 (31%) with autologous tissue. Women with BR scored significantly better in the EORCT QLQ-C30 physical functioning domain (mean 90 versus 81 points), fatigue (mean 21 versus 25), and dyspnoea (mean 16 versus 22) compared to non-reconstructed women. The EORTC QLQ-BR23 revealed that women with BR experienced favourable sexual functioning compared with non-reconstructed women (mean 26 versus 14). The EQ-5D-3L visual analogue scale score was similar between groups.Conclusion: The current study underscores the benefits of BR for long-term well-being, for example, in terms of physical and sexual functioning. These underline the importance of informing women undergoing mastectomy about BR alternatives and its potential benefits in enhancing long-term well-being. The Swedish Breast Reconstruction Outcome Study (SweBRO) initiative is a nationwide study with the primary aim of assessing long-term outcomes after mastectomy with and without breast reconstruction (BR). Women who had undergone mastectomy in Sweden in 2000, 2005, or 2010 and were alive at the time of the survey were identified through the National Breast Cancer Registry. The current study underscores the benefits of BR for long-term well-being, for example, in terms of physical and sexual functioning.
14.	Gösseringer, Nina, et al. (author) Benefits of Two or More Senior Microsurgeons Operating Simultaneously in Microsurgical Breast Reconstruction : Experience in a Swedish Medical Center 2017 In: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 37:5, s. 416-420 Journal article (peer-reviewed)abstract BACKGROUND:The aim of this study is to evaluate how the number of senior microsurgeons, performing autologous microvascular breast reconstruction together, influences operating time and postoperative complications.METHODS:A retrospective study was carried out in one hundred consecutive patients who underwent unilateral delayed deep inferior epigastric perforator flap reconstruction at a single institution. All patients followed our institution's surgical protocol and were divided into groups depending on the number of senior microsurgeons that simultaneously performed the procedure. Operating time and complications were compared between the groups.RESULTS:Sixteen of the patients were operated by one single microsurgically trained specialist, 64 by two and 20 by three specialists. The mean operating time for the one microsurgeon's group was 286 ± 84 min, for the two-microsurgeons' group 265 ± 57 min and for the three-microsurgeons' group 251 ± 59 min. There was a trend of decreasing operating times when more microsurgeons performed surgery together, however the difference between groups was not statistically significant (P = 0.251). Total flap failure rate was 2% (2/100). Both cases occurred in the group operated by one single microsurgeon (2/16) compared with two microsurgeon's group (0/64) and three microsurgeon's group (0/20; P < 0.005).CONCLUSIONS:By optimising the surgical experience available during microvascular breast reconstruction, operating time can be reduced and efficiency improved. In the current setting, two microsurgically trained surgeons achieved optimal operation flow with the lowest complication rate.
15.	Horna-Strand, A, et al. (author) Analysis of 28 Consecutive Cases of Severe Bullous Skin Diseases Over a 7-Year Period in One of Sweden's Two National Burn Centers and a Review of the Literature. 2016 Conference paper (other academic/artistic)
16.	Horna Strand, Angelica, et al. (author) Epidermal exfoliation of over 95% after a burn in an 18-month-old boy : Case report and review of the literature 2016 In: Burns. - : Elsevier BV. - 0305-4179 .- 1879-1409. ; 42:2, s. E18-E23 Research review (peer-reviewed)abstract This report concerns an 18-month-old boy who presented with a 6% total body surface area scald. The subject of this report is unique in that he developed the largest exfoliation described in literature. After 3 days an epidermal exfoliation with the appearance of a deliberately inflicted scald developed. As the exfoliation progressed to over 95% total body surface area the suspicion of child abuse or neglect could be abandoned. The diagnosis Staphylococcal scalded skin syndrome was set, due to the finding of Staphylococcus aureus on swabs, the lack of mucosal engagement, and the patient's age. The boy's skin healed within 3 weeks. The few reports published are all case reports and most frequently described visually infected burns with smaller epidermal exfoliations, and clinically based exfoliation diagnosis. S. aureus often cause burn wound infections that can lead to complications caused by cross-infection. It is important for burn surgeons and intensive care specialists to be aware of the increased possibility of Staphylococcal scalded skin syndrome occurring in patients who have a reduced barrier to infection such as burn patients and also, that the diagnosis can be difficult to make.
17.	Horna Strand, A, et al. (author) Epidermal exfoliation of over 95 % after a burn in an 18-month-old boy : a case report and a literature review. 2015 In: Annals of Burns and Fire Disasters. - 1121-1539 .- 1592-9558. ; 28 Journal article (peer-reviewed)
18.	Horna Strand, Angelica, et al. (author) EPIDERMAL EXFOLIATION OF OVER 95 % AFTER A BURN IN AN 18-MONTH-OLD BOY - A CASE REPORT AND A LITERATURE REVIEW 2015 In: Annals of Burns and Fire Disasters - vol. XXVIII – Supplement EBA - September 2015. Conference paper (peer-reviewed)
19.	Horna Strand, A, et al. (author) Långtidsmortalitet hos patienter med allvarlig bullös hudsjukdom. 2016 Conference paper (other academic/artistic)
20.	Jensson, David, et al. (author) Use of a pedicled fillet foot flap for knee preservation in severe lower extremity trauma : A case report and literature review 2015 In: Journal of Plastic Surgery and Hand Surgery. - : Informa UK Limited. - 2000-656X .- 2000-6764 .- 2332-0885. ; 2:3-4, s. 73-76 Journal article (peer-reviewed)abstract We report the sequential use of a pedicled fillet foot flap in a clinical case of complex bilateral lower extremity trauma to achieve stable wound closure, maximizing length preservation and gait rehabilitation. In addition, we perform a literature review of the use of fillet foot flaps in lower extremity trauma.
21.	Keijser, Klara, et al. (author) Photographic Measurements Partially Correlate to Nasal Function and Appearance among Adult Cleft Patients 2016 In: Plastic and reconstructive surgery. Global open. ; 4:5 Journal article (peer-reviewed)abstract BACKGROUND: Unilateral cleft lip and palate (UCLP) affects nasal function and appearance. There is a lack of objective measurements to evaluate these features. This study analyzes whether objective measurements on photographs correlate with nasal function and/or appearance among adults treated for UCLP.METHODS: All patients with UCLP born from 1960 to 1987 treated at the Uppsala University Hospital were invited (n = 109). Participation rate was 68% (n = 74); mean follow-up was 35 years. An age-matched control group (n = 61) underwent the same tests. Nostril area, nasal tip deviation angle, and width of the nostril were measured on photographs and were compared with functional tests and with appearance as assessed by self-assessment questionnaire, professional panel, or laymen panel.RESULTS: The photographically measured nostril area correlated with nasal volume (acoustic rhinometry) among UCLP patients, both cleft side and noncleft side, and controls (0.331, P = 0.005; 0.338, P = 0.004; and 0.420, P < 0.001, respectively). For the patients' noncleft side and controls, the area correlated inversely with airflow resistance at inspiration (noncleft side: -0.245, P = 0.043; controls: -0.226, P = 0.013). Laymen assessment of nasal appearance correlated with width ratio of the patients (0.27, P = 0.022) and with nasal tip deviation angle and area ratio of the controls (0.26, P = 0.041, and 0.31, P = 0.015, respectively).CONCLUSIONS: Photographic measurements correlate partially with both functional tests of the nose and panel ratings of appearance. No correlation was found with self-assessment of appearance. Evaluation of photographs needs to be combined with patient-reported outcome measures to be a valuable endpoint of nasal appearance.
22.	Konstantinou, Nikolaos, et al. (author) Revascularization of occluded renal artery stent grafts after complex endovascular aortic repair and its impact on renal function 2021 In: Journal of Vascular Surgery. - : Elsevier. - 0741-5214 .- 1097-6809. ; 73:5, s. 1566-1572 Journal article (peer-reviewed)abstract BACKGROUND: Acute occlusion of renal bridging stent grafts after fenestrated/branched endovascular aortic repair (F/B-EVAR) is an acknowledged complication with high morbidity that often results in chronic dialysis dependence. The feasibility and effect of timely or late (≥6 hours of ischemia) renal artery revascularization has not been adequately reported.METHODS: We performed a retrospective, multicenter study across 11 tertiary institutions of all consecutive patients who had undergone revascularization of renal artery stent graft occlusions after complex EVAR. The end points were technical success, association between ischemia time and renal function salvage, interventional complications, mortality, and mid-term outcomes.RESULTS: From 2009 to 2019, 38 patients with 46 target vessels (TVs; eight bilateral occlusions) were treated for renal artery occlusions after complex EVAR (mean age, 63.5 ± 10 years; 63.2% male). Six patients had a solitary kidney (15.8%). Of the 38 patients, 16 (42.1%) had undergone FEVAR and 22 (57.9%) had undergone BEVAR. The technical success rate was 95.7% (44 of 46 TVs). The recanalization technique used was sole aspiration thrombectomy in 5.3%, aspiration thrombectomy and stent graft relining in 52.6%, and sole stent graft relining in 36.8%. The median renal ischemia time was 27.5 hours (range, 4-720 hours; interquartile range, 4-36 hours). Most patients (94.4%) had been treated after ≥6 hours of renal ischemia time, and 55.6% had been treated after 24 hours. In 14 patients (36.8%), renal function had improved after intervention (mean glomerular filtration rate improvement, 14.2 ± 9 mL/min/1.73 m2). However, 24 patients (63.2%) showed no improvement. Improvement of renal function did not correlate with the length of renal ischemia time. Of the 14 patients with bilateral renal artery occlusion or a solitary kidney, 9 experienced partial recovery of renal function and no longer required hemodialysis. In-hospital mortality was 2.6%. The cause of renal stent graft occlusion could not be identified in 50% of the TVs (23 of 46). However, in 19 (41.3%), significant stenosis or a kink of the renal stent graft was found. The median follow-up was 11 months (interquartile range, 0-28 months). The estimated 1-year patient survival and patency rate of the renal stent grafts was 97.4% and 83.8%, respectively.CONCLUSIONS: Revascularization of occluded renal bridging stent grafts after F/B-EVAR is a safe and feasible technique and can lead to significant improvement of renal function, even after long ischemia times (>24 hours) of the renal parenchyma or bilateral occlusion, as long as residual perfusion of the renal parenchyma has been preserved. Also, the long-term patency rates justify aggressive management of renal artery occlusion after F/B-EVAR.
23.	Liu, Tianyi, et al. (author) Patients with abdominal-based free flap breast reconstruction a decade after surgery : A comprehensive long-term follow-up study 2018 In: Journal of Plastic, Reconstructive & Aesthetic Surgery. - : Elsevier BV. - 1748-6815 .- 1878-0539. ; 71:9, s. 1301-1309 Journal article (peer-reviewed)abstract Background: Abdominal-based free flap has increasingly become the gold standard for breast reconstruction, however long-term evidence of the aesthetic outcome and quality of life is lacking. The present study aims to gain an overview of patients with abdominal-based free flap breast reconstructions in a long-term perspective.Methods: Seventy-five patients who received abdominal-based free flap breast reconstructions between 2000-2007 in Uppsala, Sweden were invited back for photographs, 3D imaging and questionnaires. A retrospective chart review was conducted. Patient satisfaction with appearance and quality of life were assessed using the Breast-Q questionnaire. A layman panel and a professional panel rated the aesthetic appearance of the reconstructed breast from photographs and 3D images.Results: Fifty-five patients participated with a mean age of 52 +/- 8 years at the time of reconstruction and a mean follow-up time of 11.4 +/- 1.8 years completed the study. The majority of the patients had received unilateral (85%), delayed reconstructions (73%) with prior radiation (55%). There were 53 patients with DIEP flaps, one with free TRAM flap and one with SIEA flap. Breast-Q scores in the cohort were comparable to normative values of women without breast cancer (p < 0.001). There was a high level of agreement for the aesthetic results of the reconstructions between patient, professionals and layman panels (0.89 ICC, 95% CI: 0.83 - 0.93).Conclusion: Abdominal-based free flap reconstructions were effective in achieving a lasting positive aesthetic result and a high quality of life in patients a decade after surgery. (C) 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
24.	Mahajan, Anubha, et al. (author) Multi-ancestry genetic study of type 2 diabetes highlights the power of diverse populations for discovery and translation 2022 In: Nature Genetics. - : Springer Nature. - 1061-4036 .- 1546-1718. ; 54:5, s. 560-572 Journal article (peer-reviewed)abstract We assembled an ancestrally diverse collection of genome-wide association studies (GWAS) of type 2 diabetes (T2D) in 180,834 affected individuals and 1,159,055 controls (48.9% non-European descent) through the Diabetes Meta-Analysis of Trans-Ethnic association studies (DIAMANTE) Consortium. Multi-ancestry GWAS meta-analysis identified 237 loci attaining stringent genome-wide significance (P < 5 x 10(-9)), which were delineated to 338 distinct association signals. Fine-mapping of these signals was enhanced by the increased sample size and expanded population diversity of the multi-ancestry meta-analysis, which localized 54.4% of T2D associations to a single variant with >50% posterior probability. This improved fine-mapping enabled systematic assessment of candidate causal genes and molecular mechanisms through which T2D associations are mediated, laying the foundations for functional investigations. Multi-ancestry genetic risk scores enhanced transferability of T2D prediction across diverse populations. Our study provides a step toward more effective clinical translation of T2D GWAS to improve global health for all, irrespective of genetic background. Genome-wide association and fine-mapping analyses in ancestrally diverse populations implicate candidate causal genes and mechanisms underlying type 2 diabetes. Trans-ancestry genetic risk scores enhance transferability across populations.
25.	Mani, Maria, et al. (author) Bilateral breast reconstruction with deep inferior epigastric perforator flaps in slim patients. 2018 In: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 38:2, s. 143-150 Journal article (peer-reviewed)abstract BACKGROUND: Slim women are not always considered candidates for bilateral autologous breast reconstruction. The study aims to assess the volume considerations and complications of deep inferior epigastric perforator (DIEP) flap in bilateral breast reconstruction among slim patients.METHODS: All patients undergoing bilateral DIEP breast reconstruction at the Royal Marsden Hospital, London, September 2007-March 2015, were reviewed. Flap weight was compared to mastectomy weight (weight ratio) and complications were recorded. Subgroup analyses according to Body Mass Index (BMI) were performed.RESULTS: One-hundred seventy patients (340 flaps) were included. There were 42 in the slim-group (BMI <25) (84 flaps), 70 in the traditional (BMI = 25.0-29.9) (140 flaps), and 58 in the obese (BMI >30) (116 flaps). There were no significant differences in reconstruction weight ratio between the slim and the traditional groups (1.04 ± 0.31 versus 0.95 ± 0.38, p = .267). When comparing the slim to obese group the ratio was lower for the obese group, inferring that a larger reconstruction was performed (p = .016). Complications was less frequent in the slim group compared to the traditional and the obese groups (31% compared to 50% and to 53% (p = .060 and p = .021, respectively). Donor-site specific complications did not differ between groups (29% 26% and 29%; p = .823 and .830, respectively).CONCLUSION: The DIEP flaps may be a safe option for bilateral breast reconstruction among patients with BMI <25 without sacrifice in volume or increase in donor-site complications; low BMI does not in itself contraindicate bilateral DIEP breast reconstruction.
26.	Mani, Maria, et al. (author) Breast reconstruction with the deep inferior epigastric perforator flap is a reliable alternative in slim patients 2016 In: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 36:7, s. 552-558 Journal article (peer-reviewed)abstract INTRODUCTION: For slim patients eligible to breast reconstruction, clinical concerns exist on availability of adequate amount of donor tissue to restore breast volume and challenges in donor-site closure, when using the deep inferior epigastric perforator (DIEP) flap. The purpose of the current study is to analyze whether the DIEP flap can provide adequate volume for breast reconstruction in slim patients, without increased complication rates or prolonged hospital stay.PATIENTS AND METHODS: All patients receiving a unilateral DIEP breast reconstruction at the center 2007-2010 were included (n = 171). The patients were analyzed in subgroups of delayed and immediate reconstruction and of BMI. Complications were analyzed according to Clavien-Dindo. Flap weight was compared to mastectomy specimen weight among immediate reconstructions (n = 91).RESULTS: There was no difference in specimen to flap weight ratio between the different BMI-groups (BMI <25, 25-29.9 and >30: 0.81, 0.87 and 0.96 respectively, P = 0.360. Overall complication rate was 43.1% (BMI <25); 43.0% (BMI 25-29.9): and 70.0% (BMI >30) (P = 0.018). The results were similar for both the immediate and the delayed reconstructions. Length of hospital stay was similar in the different BMI groups. Delayed donor-site healing was higher in patients with BMI <25; 17.2%, compared to patients with BMI 25-29.9; 11.8%, but lower than for patients with BMI >30; 29.7% (P = 0.033).CONCLUSION: The DIEP flap provides adequate volume for unilateral breast reconstruction in slim patients, both in immediate and delayed settings. However, in delayed reconstructions slim patients need to be informed about the increased risk of donor-site complications.
27.	Mani, Maria, et al. (author) Factors Related to Quality of Life and Satisfaction with Nasal Appearance in Patients Treated for Unilateral Cleft Lip and Palate 2013 In: The Cleft Palate-Craniofacial Journal. - : SAGE Publications. - 1055-6656 .- 1545-1569. ; 50:4, s. 432-439 Journal article (peer-reviewed)abstract Objective: To identify factors related to Quality of Life (QoL) and satisfaction with nasal appearance among patients treated for unilateral cleft lip and palate (UCLP).Design: Cross sectional population study with long-term follow-up.Patients/Settings:All patients with UCLP born between 1960-1987, treated at Uppsala University Hospital, were invited (n=109), 86 (79%) participated. Mean follow-up time was 35 years.Main outcome measures:QoL was measured with Short Form-36 (SF-36) and analyzed using mental and physical cluster scores (MCS and PCS). Nasal appearance was self-assessed with "Satisfaction with Appearance" questionnaire and by panel judgment. Multivariate regression analyses explored endogenous factors (age, gender, infancy cleft width, nasal function, nasolabial appearance) and exogenous factors (marital status, number of children, education level, operation method, number of rhinoplasties performed).Results:A larger cleft width in infancy was associated with less satisfaction with nasal appearance as adults. A lower mental health QoL was associated with less satisfaction with nasal appearance. Despite female gender being linked to less satisfaction with nasal appearance, it was associated with higher mental health QoL. Higher resistance during nasal breathing was associated to lower physical health QoL.Conclusions:Gender and infant cleft width may affect QoL and satisfaction with nasal appearance among adults. They are potential predictive factors for satisfaction with nasal appearance and QoL during adulthood. The correlation of nasal function impairment and decreased physical health QoL underlines the importance of treatment of nasal symptoms in these patients.
28.	Mani, Maria, et al. (author) Nasolabial Appearance in Adults with Repaired Unilateral Cleft Lip and Palate : Relation between Professional and Lay Rating and Patients' Satisfaction 2010 In: Journal of plastic surgery and hand surgery. - : Informa UK Limited. - 2000-6764 .- 2000-656X. ; 44:4-5, s. 191-198 Journal article (peer-reviewed)abstract The aim of the current study was to evaluate the relation between professional and lay rating and patients' satisfaction with nasolabial appearance in adults with repaired unilateral cleft lip and palate (UCLP). A cross-sectional population study, long-term follow-up with controls matched for age and sex was performed. All patients with complete UCLP born between 1960 and 1987 (n = 109), treated at Uppsala University Hospital, Sweden were invited and 83 (76%) agreed to participate. Follow-up was 20-47 years after primary lip surgery. An age-and sex-matched control group of 65 people were evaluated in the same way. Ratings from professional and lay panels of cropped photographs using a 5 point categorical scale for 4 features of the nasolabial appearance and the satisfaction with appearance questionnaire (SWA) for self-assessment were used. Professional and lay ratings correlated positively but the professionals consistently rated nasolabial appearance as better than did the lay panel (p < 0.001). Self-assessment of nasolabial appearance with the SWA (by patients and controls) did not correlate with the judgement of lay or professional panels. Judgement of nasolabial appearance in adults with repaired UCLP differs among professionals, lay people, and patients. This should be considered when deciding about secondary surgical treatment of signs of clefts.
29.	Mani, Maria, et al. (author) Objective Assessment of Nasal Airway in Unilateral Cleft Lip and Palate : a Long-term Study 2010 In: The Cleft Palate-Craniofacial Journal. - : SAGE Publications. - 1055-6656 .- 1545-1569. ; 47:3, s. 217-224 Journal article (peer-reviewed)abstract OBJECTIVE: To objectively evaluate the nasal function in adults operated on for unilateral cleft lip and palate with one-stage or two-stage palate closure. DESIGN: The population consists of all unilateral cleft lip and palate patients born from 1960 to 1987 and treated at the Cleft Lip and Palate Center, Uppsala University Hospital, Sweden. The patients were treated according to the same protocol except for palate closure, which was performed in one stage until 1977 and in two stages thereafter. Eighty-three patients participated. Mean follow-up time after primary surgery was 32 years. An age-matched control group underwent the same examinations. MAIN OUTCOME MEASURES: Nasal minimum cross-sectional area (cm(2)) and volume (cm(3)) were assessed (acoustic rhinometry). Airflow resistance (Pa s/cm(3)) (rhinomanometry), peak inspiratory flow (L/min) (peak nasal inspiratory flow), and number of identified odors (Scandinavian Odor Identification Test) were determined. RESULTS: The cleft side of unilateral cleft lip and palate patients had significantly lower values for all parameters compared with controls (p < .001). No difference was found between one-stage and two-stage procedures in values for the cleft side. However, the nasal area and volume of the noncleft side were significantly larger in patients who underwent one-stage as compared with two-stage procedures (p < .05). CONCLUSION: The nasal airway of unilateral cleft lip and palate patients demonstrates a wide range of impairments that can be quantified by objective measurements. However, the measurements used did not differentiate between patients operated on with the one-stage and two-stage procedures except for values of the noncleft side.
30.	Mani, Maria, et al. (author) Quality of Life Varies with Gender and Age among Adults Treated for Unilateral Cleft Lip and Palate 2010 In: The Cleft Palate-Craniofacial Journal. - : SAGE Publications. - 1055-6656 .- 1545-1569. ; 47:5, s. 491-498 Journal article (peer-reviewed)abstract Objective: To evaluate health-related quality of life among adults treated for unilateral cleft lip and palate and to investigate whether patients were affected differently depending on gender and age. Design: Cross-sectional population study with long-term follow-up. Patients/Settings: All unilateral cleft lip and palate patients born 1960-1987 and treated at Uppsala University Hospital were invited (n = 109). Response rate was 79% (n = 86). Mean follow-up time was 35 years. Norm data matched for age and gender were used for comparison (n = 1385). Main Outcome Measures: Health-related quality of life measured with the SF-36 questionnaire. High values indicate good level of health-related quality of life. Results: The total patient group had lower values in the Mental Health subscale compared with norm data (p = .005). Values in all other subscales did not differ from norm data. Women had a higher positive difference than men in the subscale emotional role function compared with the matched norm population (p < .001). The younger age group (20 to 32 years old) consistently had a larger negative difference to matched norm data compared with the older age group (33 to 47 years old) in the subscales social function (p = .009), physical role function (p < .001), and emotional role function (p < .001). Conclusions: Unilateral cleft lip and palate affected health-related quality of life differently depending on gender and age of the patient. Younger patients were affected more negatively than older patients on several subscales. However, except for the mental health subscale, health-related quality of life was similar among unilateral cleft lip and palate patients and norm data.
31.	Mani, Maria (author) Rekonstruktiv och estetisk plastikkirurgi 2021. - 5 In: Kirurgi. - : Studentlitteratur AB. - 9789144134239 ; , s. 597-614 Book chapter (peer-reviewed)
32.	Mani, Maria (author) Unilateral Cleft Lip and Palate : Quality of Life and Nasal Form and Function among Adults 2010 Doctoral thesis (other academic/artistic)abstract Unilateral cleft lip and palate (UCLP) is a craniofacial malformation with functional and aesthetical impact on the face and the upper airways. The aims of the current thesis were to evaluate Quality of life (QoL) in adults treated for UCLP (I), to objectively evaluate nasal form and function and to search for possible differences in residual nasal deformity and impairment of function between patients operated according to one-stage and two-stage palate closure (II) as well as to evaluate the relationship between professional and lay rating and patient satisfaction with nasolabial appearance (III) and to identify factors associated with lower levels of QoL and less satisfaction with nasal appearance among adults treated for UCLP (IV). Analyses of data from a homogenous population of UCLP patients treated at Uppsala University Hospital form the basis of this thesis. The mean follow-up time after primary surgery was 35 years (20-47 years) and participation rate was 79% (n=86). An age and gender matched control group of 68 people without clefts were evaluated according to the same protocol. The evaluation protocol included the Short Form 36 questionnaire (SF-36), rhinomanometry, acoustic rhinometry, odor test, peak nasal inspiratory flow test and photographies of faces. For the SF-36 data, age- and gender-matched norm data of 1385 people from the Swedish population were used. Unilateral cleft lip and palate affected QoL differently depending on gender and age of the patient. Younger patients were affected more negatively than older patients in several subscales. However, except for lower values in the Mental Health subscale, QoL was similar among UCLP patients and norm data. Objectively measured nasal function was extensively affected among adults treated for UCLP. No difference in impairment of nasal function was found between one-stage and two-stage palate closure protocols on the cleft side. Judgment of nasolabial appearance differed between professionals, lay people and patients. Large infant cleft width was associated with less satisfaction with nasal appearance and male gender was associated with lower levels of mental QoL. Correlation between high nasal breathing resistance and low levels of physical QoL was found. In conclusion, this thesis provides a platform for future research for optimal evaluation of cleft treatment outcome.
33.	Manrique, Oscar J., et al. (author) Gastroepiploic vascularized lymph node transfer for the treatment of extremity lymphedema : comparison between middle and distal inset 2020 In: Gland surgery. - : AME PUBL CO. - 2227-684X .- 2227-8575. ; 9:2, s. 528-538 Journal article (peer-reviewed)abstract Background Middle and distal insets of gastroepiploic vascularized lymph node transfer (GE-VLNT) for extremity lymphedema have been described. However, there has been no prior comparison of surgical or patient-reported outcomes between these techniques. We analyzed the outcomes between both insets in patients with extremity lymphedema. Methods Retrospective review of patients with extremity-lymphedema who underwent GE-VLNT. Two groups were analyzed: middle and distal recipient inset. We analyzed 6-month surgical and patient-reported outcomes using the Lymphedema Life Impact Scale-v2 (LLISv2) and scar satisfaction utilizing the Patient Scar Assessment Questionnaire (PSAQ). Results Between 2017 and 2019, 26 patients with stage II unilateral extremity lymphedema underwent laparoscopically-harvested GE-VLNT (13 distal and 13 middle inset). There were no differences in patient demographics between groups. Mean hospital stay for patients with upper extremity lymphedema was 1.3 vs. 4.0 days (P<0.05), and for lower extremity lymphedema was 1.0 vs. 4.5 days (P<0.05), middle vs. distal inset, respectively. Mean return to daily activities for patients with upper extremity lymphedema was 13.4 vs. 33.4 days (P<0.05), and for lower extremity lymphedema was 16.0 vs. 29.5 days (P<0.05), middle vs. distal inset, respectively. Both middle and distal inset showed significant mean excess volume reduction at 6 months postoperatively for both upper and lower extremity lymphedema (upper extremity: middle inset 23.3%, distal inset: 22.0%; lower extremity: middle inset 23.3% and distal inset 13.3%). LLISv2 scores showed improved functional outcomes postoperatively in both upper and lower extremity lymphedema with both insets. Scar satisfaction with appearance and symptoms was higher with middle inset (P<0.05). Conclusions: GE-VLNT is an effective surgical treatment for extremity lymphedema. The middle placement showed shorter hospital stay, early return to work and higher patient satisfaction.
34.	Moren, Staffan, et al. (author) Nasal symptoms and clinical findings in adult patients treated for unilateral cleft lip and palate 2013 In: Journal of Plastic Surgery and Hand Surgery. - 2000-656X .- 2000-6764. ; 47:5, s. 383-389 Journal article (peer-reviewed)abstract The aim of the study was to investigate self-experienced nasal symptoms among adults treated for UCLP and the association to clinical findings, and to evaluate whether palate closure in one-stage or two-stages affected the symptoms or clinical findings. All people with UCLP born between 1960-1987, treated at Uppsala University Hospital, were considered for participation in this cross-sectional population study with long-term follow-up. Eighty-three patients (76% participation rate) participated, a mean of 37 years after the first operation. Fifty-two patients were treated with one-stage palate closure and 31 with two-stage palate closure. An age-matched group of 67 non-cleft controls completed the same study protocol, which included a questionnaire regarding nasal symptoms, nasal inspection, anterior rhinoscopy, and nasal endoscopy. Patients reported a higher frequency of nasal symptoms compared with the control group, e.g., nasal obstruction (81% compared with 60%) and mouth breathing (20% compared with 5%). Patients also rated their nasal symptoms as having a more negative impact on their daily life and physical activities than controls. Nasal examination revealed higher frequencies of nasal deformities among patients. No positive correlation was found between nasal symptoms and severity of findings at nasal examination. No differences were identified between patients treated with one-stage and two-stage palate closure regarding symptoms or nasal findings. Adult patients treated for UCLP suffer from more nasal symptoms than controls. However, symptoms are not associated with findings at clinical nasal examination or method of palate closure.
35.	Morén, Staffan, et al. (author) Speech in Adults Treated for Unilateral Cleft Lip and Palate : Long-Term Follow-Up After One- or Two-Stage Palate Repair 2017 In: The Cleft Palate-Craniofacial Journal. - : SAGE Publications. - 1055-6656 .- 1545-1569. ; 54:6, s. 639-649 Journal article (peer-reviewed)abstract OBJECTIVE: To evaluate speech in adults treated for unilateral cleft lip and palate with one-stage or two-stage palate closure and compare the speech of the patients with that of a noncleft control group.DESIGN: Cross-sectional study with long-term follow-up.PARTICIPANTS/SETTING: All unilateral cleft lip and palate patients born from 1960 to 1987 and treated at Uppsala University Hospital, Sweden, were invited (n = 109). Participation rate was 67% (n = 73) at a mean of 35 years after primary surgery. Forty-seven had been treated according to one-stage palate closure and 26 according to two-stage palate closure. Pharyngeal flap surgery had been performed in 11 of the 73 patients (15%). The noncleft control group consisted of 63 age-matched volunteers.MAIN OUTCOME MEASURE(S): Speech-language pathologists rated perceptual speech characteristics from blinded audio recordings.RESULTS: Among patients, seven (10%) presented with hypernasality, 12 (16%) had audible nasal emission and/or nasal turbulence, five (7%) had consonant production errors, one (2%) had glottal reinforcements/substitutions, and one (2%) had reduced intelligibility. Controls had no audible signs of velopharyngeal insufficiency and no quantifiable problems with the other speech production variables. No significant differences were identified between patients treated with one-stage and two-stage palate closure for any of the variables.CONCLUSIONS: The prevalence of speech outcome indicative of velopharyngeal insufficiency among adult patients treated for unilateral cleft lip and palate was low but higher compared with individuals without cleft. Whether palatal closure is performed in one or two stages does not seem to affect the speech outcome at a mean age of 35 years.
36.	Morén, Staffan, et al. (author) Speech in Adults Treated for Unilateral Cleft Lip and Palate as Rated by Naïve Listeners, Speech-Language Pathologists and Patients 2022 In: Journal of Plastic, Reconstructive & Aesthetic Surgery. - : Elsevier. - 1748-6815 .- 1878-0539. ; 75:10 Journal article (peer-reviewed)abstract Speech may be affected in patients with cleft lip and palate (CLP). Professional listeners, naïve listeners, and patients may perceive speech differently. The aim of the study was to assess speech among adults treated for unilateral CLP (UCLP) as rated by naïve listeners, speech-language pathologists (SLPs), and self-assessment and to evaluate how well these ratings correlate.All patients with complete UCLP treated at the Uppsala University Hospital, Uppsala, Sweden, in 1960–1987 were invited. A total of 73 of 109 patients (67%) participated, with a mean of 35 years since the initiation of treatment. The noncleft control group consisted of 55 volunteers. All participants answered questionnaires for self-rating of speech, and their speech was audio-recorded digitally. Fourteen naïve listeners and four SLPs rated the speech individually from blinded recordings.There were more speech abnormalities among patients compared to controls according to the ratings of naïve listeners and SLPs. In controls and patients, there were positive correlations between the speech ratings by naïve listeners and SLPs r = 0.44 to 0.71, p < 0.001, Spearman). The patients were less satisfied and rated to have more speech abnormalities than controls (p < 0.001).Although adults treated for UCLP considered their speech as fairly good, they were less satisfied than noncleft controls. The agreement between ratings by naïve listeners and SLPs were good, while the agreement between these ratings and self-assessment varied widely. When assessing speech in adults treated for UCLP, differences in perception of speech abnormalities by professionals, laymen, and patients should be considered.
37.	Morén, Staffan (author) Unilateral Cleft Lip and Palate : Speech, Voice and Nasal Function in Adults 2018 Doctoral thesis (other academic/artistic)abstract Cleft lip and palate (CLP) is the most common craniofacial malformation. Even after repair of the cleft there may be persistent symptoms affecting speech, voice, nasal breathing, dentition, appearance and quality of life. The aims of the thesis were to: (I) investigate subjective nasal function and nasal airway at clinical examination, (II) evaluate speech by perceptual evaluation, (III) assess voice quality by perceptual evaluation and acoustic analysis and (IV) compare ratings of speech by naïve listeners, speech-language pathologists (SLPs) and patients.All consecutive patients with complete unilateral CLP, born 1960-1987, and treated at Uppsala University Hospital were invited. A total of 83 (76%) (I) and 73 (67%) (II, III, IV) of the 109 eligible patients and non-cleft controls (n=63) participated. Patients had been treated in childhood with one- or two-stage palate closure. The participants underwent clinical examination, recording of speech and filled in questionnaires.The results showed that: (I) Patients earlier treated for UCLP suffer from more nasal symptoms than controls. However, nasal symptoms were not associated with clinical findings or method of palate closure. (II) Seven patients (10%) presented with hypernasality, 12 (16%) had audible nasal emission and/or nasal turbulence, five (7%) had consonant production errors, one (2%) had glottal reinforcements/substitutions, and one had reduced intelligibility. Controls had no quantifiable problems with speech. (III) Among patients, the mean values for the 12 perceptual voice variables on a visual analogue scale (0 = no abnormality, 100 = maximal abnormality) ranged between 1 and 22 and the mean for all was 6 mm. Voice variables were similar between patients and controls except “vocal fry”; this and total mean of all the perceptual voice variables were slightly lower among patients (p = 0.009 and p = 0.018 ). No clear association was found between velopharyngeal insufficiency and dysphonia. (IV). There were positive correlations between speech ratings by naïve listeners and SLPs (r =0.44 to 0.69, p always < 0.001, Spearman). The correlations between ratings of any of these groups and the patients’ self-ratings were weaker (r < 0.40). The patients were less satisfied with their speech and rated themselves to have more speech abnormalities than controls (p < 0.001). There were no statistically significant differences in any of the variables regarding speech, voice or nose between patients treated with one-stage and two-stage palate closure in any of the studies.This thesis shows that adults treated for unilateral CLP have more nasal symptoms and cleft related speech abnormalities compared to the controls, however the prevalence of speech abnormalities are relatively low. Voice quality is not affected. Speech quality is rated differently by naïve listeners, SLPs and patients.
38.	Morén, Staffan, et al. (author) Voice quality in adults treated for unilateral cleft lip and palate : Long-Term Follow-Up After One- or Two-Stage Palate Repair 2018 In: The Cleft Palate-Craniofacial Journal. - : SAGE Publications. - 1055-6656 .- 1545-1569. ; 55:8, s. 1103-1114 Journal article (peer-reviewed)abstract Objectives: The aim of the current study was to assess voice quality among adults treated for unilateral cleft lip and palate (UCLP), after 1- or 2-stage palate closure, and compare it to a noncleft control group.Study Design: Cross-sectional study in UCLP patients with long-term follow-up and noncleft controls.Participants: UCLP patients born 1960-1987, treated at Uppsala University Hospital, Sweden, were examined (n = 73) at a mean of 35 years after primary surgery. Forty-seven patients (64%) had been treated with 1-stage palate closure and 26 with 2-stage closure (36%). The noncleft control group consisted of 63 age-matched volunteers.Main Outcome Measure(s): Ratings of perceptual voice characteristics from blinded voice recordings with Swedish Voice Evaluation Approach (SVEA) method. Acoustic voice analysis including pitch and spectral measures.Results: Among the patients, the mean values for the 12 evaluated variables on a VAS scale (0 = no abnormality, 100 = maximal abnormality) ranged between 1 and 22 and the mean for all was 6 mm. Voice variables were similar between patients and controls except the total mean of all the perceptual voice variables, as well as “vocal fry”—both slightly lower among patients (P = .018 and P = .009). There was no difference in any variable between patients treated with 1-stage and 2-stage palate closure. No clear relationship was found between VPI and dysphonia.Conclusion: The voice characteristics among adults treated for UCLP in childhood are not different from those of individuals without cleft.
39.	Peroz, Roshan, et al. (author) Can objective measurements of the nasal form and function represent the clinical picture in unilateral cleft lip and palate? 2017 In: Journal of Plastic, Reconstructive & Aesthetic Surgery. - : Elsevier. - 1748-6815 .- 1878-0539. ; 70:5, s. 653-658 Journal article (peer-reviewed)abstract Background: The present study aimed to evaluate the potential correlations between objective measurements of nasal function and self-assessed nasal symptoms or clinical findings at nasal examination among adults treated for unilateral cleft lip and palate (UCLP), respectively. Methods: All UCLP patients born between 1960 and 1987 (n = 109) treated at a tertiary referring center were invited. Participation rate was 76% (n = 83) at a mean of 37 years after the initial surgery. All participants completed the same study protocol including acoustic rhinometry (AR), rhinomanometry (RM), anterior rhinoscopy, and questionnaires regarding self-experienced nasal symptoms. Results: A reduced volume of the anterior nasal cavity on the operated side (measured by AR) correlated to an expressed wish by the patient to change the function of the nose. A similar correlation was seen for the minimal cross-sectional area of anterior nasal cavity on the operated side. Furthermore, correlations were found between smaller volume and area of nasal cavity and a greater frequency of nasal obstruction. No further correlations were found. Conclusion: Objective measurements partly correlate to the clinical picture among adults treated for UCLP. However, these need to be combined with findings at clinical examination and patient self-assessment to represent the complete clinical picture. (C) 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
40.	Rangaiah, Pramod, et al. (author) Realization of a Portable Semi-Shielded Chamber for Evaluation of Fat-Intrabody Communication 2023 In: IEEE Access. - : IEEE. - 2169-3536. ; 11, s. 72743-72755 Journal article (peer-reviewed)abstract In this work, a customized portable semi-shielded chamber for torso phantoms to evaluatefat-intrabody communication (Fat-IBC) is presented. Fat-IBC is a technology where human fat tissue isused for microwave communication with intrabody medical devices. The potential clinical applications arevast including central nervous system (brain and spine) communication, cardiovascular disease monitoringand metabolic disorder control. However, validating this technology needs assurance that the signal leakagethrough undesired paths, particularly surface waves and reflections, does not occur. To solve this issue,an effective technique involving a modified design of a semi-shielded chamber is presented. The cross-section of the torso phantoms is about 25 cm × 35 cm and the height about 20 cm. As specified by ISO3745:2012, the maximum object volume that can be measured in a chamber is 5% of the chamber’s internalnet volume. Therefore, the dimensions of the semi-shielded chamber was set to 100 cm × 60 cm × 60 cm.The semi-shielded chamber was constructed out of a wooden crate, covered on the inside with microwaveabsorbers and with thin aluminum sheets on the outside. The experimental evaluation of the semi-shieldedchamber was validated according to standards such as EN 50147-1:1996, IEC 61000-4-3:2020, and IECCISPR 16-1-4:2019. The torso phantom was positioned at the center of the chamber, with a separation wallto ensure signal transmission solely through the phantoms interior and not its surface or chamber walls. Theseparation wall can be modified either to be conformal to the phantom sample or serve as a solid partitiondividing the chamber into two separate volumes for performance measurement. The separation wall wasfound to have a shielding attenuation of 30 dB to 60 dB for frequencies between 0.7 GHz and 18 GHz,respectively, while the corresponding values for the external walls were found to be 45 dB to 70 dB. Thesemi-shielded chamber realized in this work is useful for Fat-IBC technology, brain-computer interface,brain-machine interface, body area networks (BANs), and related applications.
41.	Reilly, Frank O. F., et al. (author) Implementation of robot-assisted lymphaticovenous anastomoses in a microsurgical unit 2024 In: European journal of plastic surgery. - : Springer. - 0930-343X .- 1435-0130. ; 47 Journal article (peer-reviewed)abstract Background: Numerous papers have been published evaluating the clinical benefits of robot-assisted microsurgery. In this study, we describe the incorporation of the MUSA-2 robot (Microsure, Eindhoven, The Netherlands) into a plastic surgery unit outside of its development centre. We aimed to assess robot implementation timeframes, areas of future development, and key learning points for centres considering the establishment of a robot-assisted microsurgery service.Methods: We identified 12 female patients with upper limb lymphoedema secondary to breast cancer treatment, who consented to have a robotic-assisted lymphaticovenous anastomosis (LVA) from September 2022 to March 2023. All patients had at least one robot-assisted LVA. Post operatively, a surgical evaluation of the robot's performance and of the surgeon's intraoperative workload was measured. Each patient completed a postoperative Likert scale, which measured their surgical experience.Results: The mean robot time per case was 60.25 min. The mean time taken for the first robot-assisted anastomosis was 32 min. The second robot anastomoses was 30% faster than the first, taking a mean of 22.5 min. The average anastomosis had 4.5 sutures placed robotically. Initial mean scores in the workload survey completed by the surgeon were highest for frustration and effort, both reduced with increasing volume of cases. In 91% of cases, physical intraoperative discomfort was reported by the surgeon but completely resolved following repositioning.Conclusions: The current technology can be readily incorporated into a microsurgical unit. We developed four key learning points from the implementation of robot-assisted LVA in our microsurgical unit.
42.	Reiser, Erika, et al. (author) Initial size of cleft does not correlate with size and function of nasal airway in adults with unilateral cleft lip and palate 2011 In: Journal of plastic surgery and hand surgery. - 2000-656X. ; 45:3, s. 129-135 Journal article (peer-reviewed)abstract The noses of patients with clefts are often functionally inadequate. The aim of the present study was to evaluate the correlation between size of the maxillary cleft in infancy and size and function of the nasal airway in adults with unilateral cleft lip and palate (UCLP). This is a long-term follow up study including 53 patients with UCLP born between 1960 and 1987 and treated at the Cleft Lip and Palate Centre, Uppsala University Hospital, Sweden. Lip repair was performed at 3--4 months of age followed by either a one-stage or a two-stage palatal closure. The size of the cleft was measured on infant maxillary dental casts. Nasal minimum cross-sectional area (cm
43.	Rodriguez-Lorenzo, Andres, et al. (author) Breast Reconstruction with the Innervated Deep Inferior Epigastric Free Flap 2020 In: Breast Reconstruction. - Springer Nature Switzerland AG : Springer. - 9783030346034 Book chapter (peer-reviewed)
44.	Rodriguez-Lorenzo, Andres, et al. (author) Endoscopic assisted insetting of free flaps in anterior skull base reconstruction : A preliminary report of five cases 2020 In: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 40:4, s. 460-467 Journal article (peer-reviewed)abstract IntroductionFree vascularized tissue may provide a robust reconstruction after anterior skull base surgery. We report our technique and outcomes of the endoscopic inset of free flaps in anterior skull base reconstructions.MethodsBetween 2016 and 2018, endoscopic tumor removal and reconstruction of anterior skull base pathology was performed in five patients aged 20–72 years old (four male, one female). The tumors included three neuroblastomas, a carcinoma, an adenoma, and a melanoma. The median size of the defect was 3.7 × 6.6 cm. Transmaxillary access was gained through the upper sulcus and an anterior and medial maxillectomy. The flap inset was facilitated by the endoscope. The donor vessels were tunneled through the sinus and through the cheek to the facial vessels without the use of the endoscope.ResultsIn three cases a vastus lateralis flap was used, in one case an adipofascial ALT flap and in one case an adipofascial radial forearm flap. Separation of intracranial and sinonasal spaces was confirmed by radiological and endoscopic examinations. There was no flap failure and one case with partial necrosis. One of the flaps needed to be trimmed as it obliterated the nasal cavity and in one of the cases the flap was repositioned postoperatively. Two cases had infectious complications. The mean follow‐up of the patients was 13.8 months.ConclusionsEndoscopic assisted inset of a free flap in the anterior skull base was feasible in the five cases we present. A dedicated, multidisciplinary approach is mandatory for surgical innovation like this.
45.	Rodriguez-Lorenzo, Andres, et al. (author) Fibula osteo-adipofascial flap for reconstruction of a cervical spine and posterior pharyngeal wall defect 2014 In: Microsurgery. - : Wiley. - 0738-1085 .- 1098-2752. ; 34:4, s. 314-318 Journal article (peer-reviewed)abstract When reconstructing combined defects of the cervical spine and the posterior pharyngeal wall the goals are bone stability along with continuity of the aerodigestive tract. We present a case of a patient with a cervical spine defect, including C1 to C3, associated with a posterior pharyngeal wall defect after excision of a chordoma and postoperative radiotherapy. The situation was successfully solved with a free fibula osteo-adipofascial flap. The reconstruction with a fibula osteo-adipofascial flap provided several benefits in comparison with a fibula osteo-cutaneous flap in our case, including an easier insetting of the soft tissue component at the pharyngeal level and less bulkiness of the flap allowing our patient to resume normal deglutition.
46.	Smeele, Hansje P., et al. (author) Breast reconstruction timing and modality in context : A cross-sectional study in Uppsala, Maastricht, and Rome 2023 In: European journal of plastic surgery. - : Springer. - 0930-343X .- 1435-0130. ; 47:1 Journal article (peer-reviewed)abstract BackgroundWith the development and refinement of techniques most mastectomy patients nowadays are candidates for breast reconstruction. No one surgical technique fits all, however. Treatment choices are driven by patient characteristics and preferences, alongside policy and operational factors. These, in turn, might be expected to differ on several levels of aggregation, for example, countries, regions, and hospitals. The aim of this study was to compare choices for breast reconstruction timing and modality in Uppsala (Sweden), Maastricht (the Netherlands), and Rome (Italy).MethodsIn this cross-sectional study, patients presenting for first-time post-mastectomy breast reconstruction in three teaching hospitals were included. The primary study outcomes were breast reconstruction timing and modality. Covariables were body habitus (i.e., body mass index, waist circumference, and mastectomy weight), health-related quality of life assessed with the BREAST-Q Reconstruction module, patient preferences assessed with a self-constructed questionnaire, and shared decision making assessed with the CollaboRATE questionnaire. Statistical tests were used to compare data across study sites.ResultsSixty-six participants were included. The most common choices for breast reconstruction timing and modality were delayed DIEP flaps in Uppsala (53%), immediate DIEP flaps in Maastricht (44%), and immediate prepectoral implants in Rome (92%). Participants in Rome were much slenderer than participants in Uppsala and Maastricht (mean body mass index 21.6, 26.2, and 26.3 kg/m2, respectively; p < 0.05). Participants in Uppsala and Maastricht highly valued material used for the reconstruction; participants in Rome were significantly more concerned with complications, scars, and recovery duration associated with the reconstruction.ConclusionsThis study shows large differences in choices for breast reconstruction timing and modality in Uppsala, Maastricht, and Rome. Possible reasons for the observed variation include differences in patient characteristics, patient preferences, reconstructive techniques available, and reimbursement.Level of evidenceLevel IV, Therapeutic study.
47.	Stefansdottir, Andrea B., et al. (author) Comparison of Pain Management Strategies to Reduce Opioid Use Postoperatively in Free Flap Breast Reconstruction : Pain Catheter versus Nerve Block in Addition to Refinements in the Oral Pain Management Regime 2024 In: ARCHIVES OF PLASTIC SURGERY-APS. - : Georg Thieme Verlag KG. - 2234-6163 .- 2234-6171. ; 51:02, s. 156-162 Journal article (peer-reviewed)abstract Background: Perioperative management in autologous breast reconstruction has gained focus in recent years. This study compares two pain management protocols in patients undergoing abdominal-based free flap breast reconstruction: a past protocol (PP) and a current protocol (CP)-both intended to reduce opioid consumption postoperatively. The PP entails use of a pain catheter in the abdominal wound and the CP consists of an intraoperative nerve block in addition to refinements in the oral pain management. We hypothesize that the CP reduces opioid consumption compared to PP.Methods: From December 2017 to January 2020, 102 patients underwent breast reconstruction with an abdominal-based free flap. Two postoperative pain management strategies were used during the period; from December 2017 to September 2018, the PP was used which entailed the use of a pain catheter with ropivacaine applied in the abdominal wound with continuous distribution postoperatively in addition to paracetamol orally and oxycodone orally pro re nata (PRN). From October 2018 to January 2020, the CP was used. This protocol included a combination of intraoperative subfascial nerve block and a postoperative oral pain management regime that consisted of paracetamol, celecoxib, and gabapentin as well as oxycodone PRN.Results: The CP group ( n = 63) had lower opioid consumption compared to the PP group ( n = 39) when examining all aspects of opioid consumption, including daily opioid usage in morphine milligram equivalents and total opioid usage during the stay ( p < 0.001). The CP group had shorter length of hospital stay (LOS).Conclusion: Introduction of the CP reduced opioid use and LOS was shorter.
48.	Svee, Andreas, 1984- (author) Deep inferior epigastric perforator flap breast reconstruction after mastectomy : An analysis of long-term outcomes and potential complications 2023 Doctoral thesis (other academic/artistic)abstract This thesis evaluated the long-term effects and satisfaction with outcomes following deep inferior epigastric perforator (DIEP)-based breast reconstruction after mastectomyPaper I is a retrospective cohort study of women who received a unilateral DIEP in 2000–2009 (n = 225) in Uppsala. These women were compared with individually matched women who underwent mastectomy without autologous reconstruction (n = 450). Recurrence and survival were primary endpoints. Both groups demonstrated a similar risk of recurrence. However, the DIEP group had a significant survival advantage not persisting after adjusting for tumor characteristics.Paper II examined whether breast reconstruction using a DIEP flap is associated with volume changes or arm lymphedema symptoms. It hypothesized that compared with DIEP reconstructions without using the cephalic vein (CV), that using CV is not associated with ipsilateral lymphedema. Patients completed the Lymphedema Quality of Life Inventory questionnaire to assess postoperative lymphedema symptoms. CV was found to be potentially useful as an extra venous outflow in DIEP breast reconstructions without increasing the risk of ipsilateral arm swelling or lymphedema symptoms.Paper III evaluated the aesthetic outcome and satisfaction with the appearance of abdominal-based breast reconstruction in the long-term. Patients responded to the postoperative BREAST-Q model, and their photographs were at a mean of 11 years postoperatively. The outcomes of the BREAST-Q and available normative scales were compared. The photographs were assessed by two panels, comprising eight professionals and lay individuals, respectively. According to patients, professionals, and lay observers, abdominal-based breast reconstructions yielded good term aesthetic outcomes.Paper IV is a retrospective study of long-term changes in the donor site after harvesting the DIEP flap. Patients were invited to complete BREAST-Q questionnaires regarding the abdomen. The follow-up period was >8 years. Most participants reported no abdominal pain and expressed satisfaction with their abdominal appearance. The outcomes were compared between women with DIEP and women who underwent mastectomy for breast cancer without abdominal-based breast reconstruction. DIEP breast reconstruction did not cause donor site morbidity and women with DIEP reconstruction were more likely satisfied with their abdominal appearance.Briefly, DIEP flap breast reconstruction yields long-lasting favorable outcomes for women undergoing mastectomy.
49.	Svee, Andreas, et al. (author) Long-term Donor Site-related Quality of Life after Deep Inferior Epigastric Perforator Flap Breast Reconstruction 2024 In: Plastic and Reconstructive Surgery - Global Open. - : Ovid Technologies (Wolters Kluwer Health). - 2169-7574. ; 12:7 Journal article (peer-reviewed)abstract Background:Current knowledge about patients' perceptions of the donor site following abdominal-based breast reconstruction and its effect on health-related quality of life (HRQoL) several years after breast reconstruction is limited. This study aimed to assess the long-term effects of deep inferior epigastric perforator (DIEP) flap breast reconstruction on HRQoL, specifically focusing on the abdomen and donor site aspects.Methods:This retrospective cohort study compared 66 women who underwent DIEP breast reconstruction between 2000 and 2007 with a matched control cohort of 114 women who underwent therapeutic mastectomies without reconstruction in the year 2005. The DIEP cohort of patients completed the BREAST-Q Reconstruction module during an outpatient visit in 2015-2016. The control cohort completed the same questionnaire online in 2016.Results:The follow-up time was at least 8 years (mean 11.4 +/- 1.6 years) postreconstruction for the DIEP cohort and 10 years postmastectomy (mean 11.0 +/- 0.3 years) for the control cohort. In the DIEP cohort, 93% reported no donor site pain, 89% had no difficulty sitting up, and 91% had no activity limitations 2 weeks before completing the survey. Patients undergoing DIEP were more satisfied with their abdominal appearance than the control group (adjusted OR, 5.7; 95% confidence interval 1.8-17.6).Conclusions:A decade postoperatively, DIEP breast reconstruction yields high abdominal donor site satisfaction, with comparable abdominal physical well-being to nonreconstructed women.
50.	Svee, Andreas, et al. (author) Survival and risk of breast cancer recurrence after breast reconstruction with deep inferior epigastric perforator flap 2018 In: British Journal of Surgery. - : Oxford University Press (OUP). - 0007-1323 .- 1365-2168. ; 105:11, s. 1446-1453 Journal article (peer-reviewed)abstract Background: Women who undergo autologous breast reconstruction have been reported to have an increased risk of breast cancer recurrence compared with those who have mastectomy alone. It has been suggested that more extensive surgery possibly activates dormant micrometastases. The aim of this study was to evaluate whether delayed unilateral deep inferior epigastric perforator (DIEP) flap reconstruction after mastectomy increases the risk of breast cancer recurrence or affects mortality among women previously treated for breast cancer. Methods: This was a matched retrospective cohort study including women with a previous unilateral invasive breast cancer who received a delayed DIEP flap breast reconstruction and a control cohort of individually matched women with unilateral breast cancer who underwent mastectomy but no autologous breast reconstruction. Matching criteria comprised: year of diagnosis (+/–3 years), age at diagnosis (+/–5 years), type of cancer and demographic region. The primary endpoints were local recurrence or distant metastasis, and overall mortality was a secondary endpoint. Absolute risk of recurrent disease and mortality was analysed, and relative risks were estimated using Cox proportional hazards analysis. Results: There were 225 women in the DIEP cohort and 450 in the no-DIEP cohort. The median follow-up time was 125 months. There was no difference in absolute risk of recurrence between the cohorts. The hazard ratio for breast cancer recurrence in DIEP versus no-DIEP cohorts was 0·76 (95 per cent c.i. 0·47 to 1·21). Conclusion: There is no increased risk in breast cancer recurrence after delayed DIEP flap reconstruction compared with mastectomy alone.

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