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- Persson, Anna A. E., et al.
(author)
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Treatment of orbital fractures - a critical analysis of ophthalmic outcomes and scenarios for re-intervention
- 2023
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In: Journal of Plastic Surgery and Hand Surgery. - : Medical Journals Sweden. - 2000-656X .- 2000-6764. ; 58, s. 1-7
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Journal article (peer-reviewed)abstract
- BACKGROUND: Malplaced implants in orbital reconstruction may lead to serious complications and necessitate re-intervention. The aim of this study was to describe outcomes, complications and scenarios of re-intervention in a historical case series of orbital fractures treated with free-hand orbital wall reconstruction. The main hypothesis was that early re-interventions are mainly because of malplaced implants in the posterior orbit.METHODS: Retrospective review of 90 patients with facial fractures involving the orbit, reconstructed with radiopaque orbital wall implants, from 2011 to 2016. Data were obtained from medical records and computed tomography images. Recorded parameters were fracture type, ocular injury, ocular motility, diplopia, eye position, complications and re-interventions. Secondary reconstructions because of enophthalmos were volumetrically evaluated.RESULTS: Early complications requiring re-intervention within 1 month were seen in 12 (13%) patients, where all except two were because of malplaced implants. The implant incongruence was without exception found in the posterior orbit. Late complications consisted of four (4%) cases of ectropion and five (5%) cases of entropion that needed corrective surgery. The majority of the patients with eye-lid complications had undergone repeated surgeries. Secondary orbital surgeries were performed in nine (10%) patients. Five of these patients had secondary reconstruction for enophthalmos and associated diplopia. None of these patients became completely free from either enophthalmos or diplopia after the secondary surgery.CONCLUSION: Re-intervention after orbital reconstruction is mainly related to malplaced implants in the posterior orbit. Incomplete results in patients requiring secondary surgery for enophthalmos infer the importance of accurate restoration of the orbit at primary surgery.
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| 2. |
- Svee, Andreas, 1984-
(author)
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Deep inferior epigastric perforator flap breast reconstruction after mastectomy : An analysis of long-term outcomes and potential complications
- 2023
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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.
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| 3. |
- Svee, Andreas, et al.
(author)
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Use of the Cephalic Vein in DIEP Breast Reconstruction Does Not Increase Risk of Lymphedema of the Ipsilateral Arm
- 2023
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In: Plastic and reconstructive surgery (1963). - : Lippincott Williams & Wilkins. - 0032-1052 .- 1529-4242. ; 151:1, s. 195-201
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Journal article (peer-reviewed)abstract
- Flap failure is a rare but devastating complication in deep inferior epigastric perforator (DIEP) flap reconstructions. Common causes of partial or complete flap failure are related to venous congestion. Although the cephalic vein is usually a safe and reliable recipient vein for additional venous outflow, there is a hypothesized risk of donor-arm lymphedema secondary to lymphatic vessel damage in the vicinity of the cephalic vein or related to scarring and reduced venous backflow of the arm. The aim was to assess whether the cephalic vein as an additional recipient vessel, by means of the superficial inferior epigastric vein in DIEP flap breast reconstruction, was associated with long-term volume changes of the arm and/or symptoms of lymphedema. Arm volume was assessed preoperatively in patients scheduled to undergo unilateral delayed DIEP flap breast reconstruction at Uppsala University Hospital, Sweden, between 2001 and 2007. Long-term postoperative assessments were performed in 2015 to 2016. Water displacement and circumferential measurement were assessed preoperatively and postoperatively by the same lymphedema therapists. Patients were divided into two groups: DIEP reconstruction with the cephalic vein or without. Fifty-four patients fulfilled the inclusion criteria and completed the study, with a mean follow-up time of 136 months. There was no increased occurrence of lymphedema in the group undergoing DIEP flap reconstruction with the cephalic vein as extra venous drainage, based on an analysis of change from baseline in arm volume difference.This study shows that the cephalic vein can be used for secondary venous outflow in DIEP breast reconstruction without long-term risk of ipsilateral arm volume increase or symptoms of lymphedema.
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