-
Plastic and Reconstructive Surgery Mar 2024Prosthetic-based postmastectomy breast reconstruction in patients with large or pendulous breasts remains challenging because of inelastic and redundant skin, with...
BACKGROUND
Prosthetic-based postmastectomy breast reconstruction in patients with large or pendulous breasts remains challenging because of inelastic and redundant skin, with various approaches to skin reduction at the time of mastectomy. This study describes the authors' experience with a Wise-pattern inferior dermal sling approach to skin-sparing mastectomy.
METHODS
Retrospective chart review was performed on patients who underwent immediate prosthetic-based breast reconstruction after mastectomy from 2009 to 2021. A total of 240 patients who underwent Wise-pattern skin-sparing mastectomy (WSSM) were compared with a cohort of patients who had traditional elliptical skin-sparing mastectomy (ESSM), matched for mastectomy weight, prior radiation therapy, and smoking. Ninety-day postsurgical outcomes were examined.
RESULTS
The WSSM cohort had a significantly higher body mass index (30.3 kg/m 2 versus 26.9 kg/m 2 ; P < 0.0001) and mastectomy weight (831 g versus 607 g; P < 0.0001). After propensity score matching, there was no significant difference in complication or treatment rates between WSSM and ESSM breasts except for mastectomy flap necrosis (11.6% versus 5.0%; P = 0.0082). WSSM patients who had mastectomy flap necrosis did not have significantly different treatment rates of admission, return to the operating room, or explantation compared with ESSM patients.
CONCLUSIONS
In the largest reported series to date, WSSM was associated with a higher rate of mastectomy flap necrosis, but this did not translate into statistically significant differences in treatment. The inferior dermal flap likely acts as a protective layer of vascularized tissue, which appears to prevent evolution of mastectomy skin flap necrosis into more serious adverse outcomes.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, III.
Topics: Humans; Female; Mastectomy; Breast Neoplasms; Retrospective Studies; Mammaplasty; Postoperative Complications; Necrosis; Treatment Outcome
PubMed: 37166048
DOI: 10.1097/PRS.0000000000010622 -
Advances in Radiation Oncology Jan 2024Moist desquamation (MD) is a concerning acute side effect of radiation therapy for breast cancer, often seen in skin folds for patients having large or pendulous...
PURPOSE
Moist desquamation (MD) is a concerning acute side effect of radiation therapy for breast cancer, often seen in skin folds for patients having large or pendulous breasts. In vivo skin dosimetry, clinical assessments, and patient-reported skin reactions were used to determine a relationship between dose-area metrics and the development of MD, to lend insight into skin tolerances and possibly guide future treatment planning dose constraints.
METHODS AND MATERIALS
Skin dose was measured using GafChromic film on the inner surface of an early prototype carbon-fiber accessory for breast support to remove the inframammary fold in 20 patients at high risk of developing MD undergoing adjuvant whole breast radiation therapy. Prescribed doses were 42.5 Gray (Gy) in 16 fractions or 50 Gy in 25 fractions using 6 to 15 MV x-rays. To account for fraction size differences, analysis was performed using the equivalent dose in 2 Gy fractions using α/β = 11 (EQD2). MD was assessed out to 2 weeks post radiation therapy by trained therapists and by a patient-reported outcome questionnaire.
RESULTS
Statistically significant differences in areas receiving 30 to 48 Gy (EQD2) were observed between patients who did and did not develop MD in the inframammary area. Patients receiving EQD2 maximum dose ≤ 46 Gy and ≥ 38 Gy to ≤ 50 cm of their breast skin did not develop MD.
CONCLUSIONS
The findings of this study offer insight into the relationship between skin toxicity and areas of skin irradiated to doses up to 50 Gy. Potential skin dose constraints to test in future studies to prevent MD are suggested.
PubMed: 38260224
DOI: 10.1016/j.adro.2023.101318 -
PeerJ 2021, a new species of Phyllanthaceae from Southeast Yunnan Province, China, is described. The phylogenetic position of the new species within the genus was analyzed based...
, a new species of Phyllanthaceae from Southeast Yunnan Province, China, is described. The phylogenetic position of the new species within the genus was analyzed based on nuclear ribosomal Internal Transcribed Spacer (nrITS) and plastid sequence data. The results show that is highly supported to be the sister of (P. T. Li) Voronts. & Petra Hoff., a species endemic to western Guangxi Province, China. Morphologically, the new species can be distinguished from all known congeneric taxa by its long and slim branches usually pendulous or procumbent, some of its leaf laminas up to 15 cm long and 7 cm wide. It further differs from its sister species by its hirsute stems, leaves and pedicel of female flowers, longer pedicel of male flowers, 3-locular ovary and three styles. A key to all 10 accepted species is provided.
PubMed: 34513329
DOI: 10.7717/peerj.11989 -
Dalton Transactions (Cambridge, England... Aug 2020Novel crystalline covalent organic polymers (COPs) were constructed by reacting 1,4-diaminoanthraquinone with 1,3,5-triformylphloroglucinol or tris(4-formylphenyl)amine...
Novel crystalline covalent organic polymers (COPs) were constructed by reacting 1,4-diaminoanthraquinone with 1,3,5-triformylphloroglucinol or tris(4-formylphenyl)amine (TPDA or TADA). After they were covalently bonded to amine-functionalized graphene oxides, the resulting mesoporous COPs@graphene composites demonstrated efficient capacitance storage performance in both alkaline and acidic media. In particular, the as-synthesized TPDA@graphene displayed a reversible specific capacitance of 522 F g-1 in a 6.0 mol L-1 aqueous KOH electrolyte, superior to the previously reported COPs with inconspicuous capacitance storage properties in alkaline media. Its specific capacitance also reached 390 F g-1 in 2.0 mol L-1 H2SO4. The impressive capacitance storage properties of this composite can be ascribed to its unique structure with abundant pendulous anthraquinone redox groups and better electrical conductivity enhanced by the coupled graphenes.
PubMed: 32785318
DOI: 10.1039/d0dt02279a -
Sensors (Basel, Switzerland) Oct 2022In the field of ultra high accuracy inertial measurement unit (IMU), pendulous integrating gyroscopic accelerometer (PIGA) has become a research hot spot due to its...
In the field of ultra high accuracy inertial measurement unit (IMU), pendulous integrating gyroscopic accelerometer (PIGA) has become a research hot spot due to its high-end performance. However, PIGA is sensitive to angular velocity, and the calibration process of PIGA-based IMU will be very complicated, which makes online self-calibration difficult to implement. To solve the above problems, we proposed an online self-calibration method utilizing angular velocity observation. The main contributions of this study are twofold: (1) An error analysis of PIGA is conducted in this paper, and the error model has also been simplified to suit the self-calibration model. (2) An improved online self-calibration method utilizing angular observation based on a simplified PIGA error model is proposed in this study. Experimental results show that the self-calibration method proposed in this study can improve the PIGA online calibration accuracy effectively (with the accuracy within 0.02 m/s/pulse), which can improve the dynamic accuracy of the PIGA.
PubMed: 36365833
DOI: 10.3390/s22218136 -
Clinical Nuclear Medicine May 2020An 85-year-old asymptomatic man with suspected biochemical recurrence of prostate cancer underwent an F-fluciclovine PET/CT scan, which revealed a solitary suspicious...
An 85-year-old asymptomatic man with suspected biochemical recurrence of prostate cancer underwent an F-fluciclovine PET/CT scan, which revealed a solitary suspicious tracer uptake in the dorsal right corporal body of the proximal pendulous penis. The patient underwent ultrasound-guided fine-needle aspiration of the penile lesion, which revealed metastatic prostate cancer. The patient had definitive external beam radiation therapy 3 years before the examination. At the time of scan, the prostatic-specific antigen (PSA) was only 1.0 ng/mL, although the PSA doubling time was 2.6 months. It is unusual to detect a solitary penile metastasis in a patient with a low level of PSA.
Topics: Aged, 80 and over; Carboxylic Acids; Cyclobutanes; Humans; Male; Penile Neoplasms; Positron Emission Tomography Computed Tomography; Prostate-Specific Antigen; Prostatic Neoplasms
PubMed: 32149799
DOI: 10.1097/RLU.0000000000002987 -
The Journal of the Acoustical Society... Feb 2020Elastic wave propagation experiments were performed on a thin bar sample composed of Texas "moss" sandstone in order to study nonlinear elastic effects in the time...
Elastic wave propagation experiments were performed on a thin bar sample composed of Texas "moss" sandstone in order to study nonlinear elastic effects in the time domain. The present experiments utilized a pendulous hammer to produce axially propagating transient signals with strain amplitude between 15 and 130 microstrain in the mid-audio band. Particle velocity along the bar axis was measured with a laser Doppler vibrometer, focused at various locations along the bar. Nonequilibrium dynamics and nonlinear elasticity effects were observed on the propagating pulse as it reflected between the ends of the bar. The same effects were also observed at a single location along the mid-length of the bar using a continuous-wave 1 MHz probe signal, propagating transverse to the bar axis. The results demonstrate larger strain amplitudes and greater reduction in the Young's modulus than in previously reported measurements that employed narrowband excitation. Nonlinear attenuation of the axial pulse is also observed, which increases with excitation amplitude. The present results indicate significant conditioning of the sandstone, particularly "softening" of the Young's modulus of up to 20%, primarily during the tensile phase of propagation, with a "slow dynamic" memory that is similar to that reported in previous investigations.
PubMed: 32113298
DOI: 10.1121/10.0000512