ABSTRACT: To evaluate skin sparing mastectomy(SSM) and immediate breast reconstruction(IBR) in terms of the survival, chances of recurrence, aesthetic restoration and prevention of psychosocial problems.
An interventional study.
The Department of Plastic and Reconstructive Surgery, CMH, Rawalpindi from November 1998 to November 2003.
Twenty-eight patients of breast cancer, included in the study, were discussed in a Multidisciplinary Breast Clinic. Detailed metastatic work-up was performed. In all patients SSM with en-bloc level II axillary clearance and IBR was done.
The patients' age ranged between 25-46 years. Two patients (7%) were nullipara. Tumor size was T1 in 10 (36%) and T2 in 18 patients (64%). In all the patients a circum-areolar incision was used. A contralateral uni-pedicled TRAM flap was used in 24 (86%) and latissimus dorsi flap in 4 patients (14%). All the flaps survived completely. There was marginal necrosis of native skin flaps in 03 (10.5%), infection in 03 (10.5%), axillary seroma in 03 (10.5%) and abdominal seroma in 01 patient (3.5%). As late complication 5 patients (19%) developed fat necrosis. Adjuvant chemotherapy was given in 6 (21%) and adjuvant radiotherapy in 4 patients (14%). No recurrence encountered in maximum follow-up . We found an excellent aesthetic restoration in 23 (82%), good in 1 (3.5%) and fair in 4 patients (14%).
SSM for patients with early breast cancer is an oncologically safe procedure. IBR can greatly reduce the psychological trauma associated with breast loss including diminished feelings of feminity, decreased libido, social behavior, sense of mutilation and depression.
Journal of the College of Physicians and Surgeons--Pakistan: JCPSP 09/2005; 15(8):467-71. · 0.34 Impact Factor
ABSTRACT: To emphasize the role and importance of multidisciplinary approach in the management of oral cavity cancers involving the mandible.
The Departments of Plastic and Reconstructive Surgery, ENT / Head and Neck Surgery and Radiation Oncology, Combined Military Hospital, Rawalpindi. Duration spans over a period of six years.
A total of 63 patients who had biopsy-proven oromandibular tumors, after thorough assessment / staging in Joint Head and Neck Oncology Clinic, underwent resection and reconstruction for malignant oral cavity tumors involving the mandible were included in the study. All the resected tumor specimen were sent for histopathology. All the post-resection defects were properly classified and reconstructed by the plastic surgery team. Postoperatively, all the patients underwent adjuvant full dose radiotherapy at the Department of Radiation Oncology. Complications were recorded and managed accordingly. At one year follow-up all the available patients were assessed for functional and aesthetic restoration and recurrences.
Out of 63 patients there were 40 males and 23 females (ratio 1.7 : 1) with an average age of 50 years. Tumor-free resection margins could be achieved in 56 patients. In 88% cases tumor was a Squamous cell carcinoma. Radical neck dissections were carried on in 27 patients. Radial forearm free flap was used in 27 patients, pectoralis major myocutaneous flap in 19, free fibula osteocutaneous flap in 10, rectus-abdominis myocutaneous free flap with Implant was used in 3 patients to reconstruct the post-resection defects. There was only one total flap loss and 3 partial flap losses. Implant exposure was encountered in 4 instances with 3 major and 5 minor fistulae. At one year follow-up, 56 patients were available. Thirty-seven patients had intelligible speech, 15 patients were taking normal diet and in 33 patients there was a satisfactory mandibular contour restoration. Seven patients had recurrences, 2 were not traceable and 5 patients had died by that time.
A multidisciplinary collaboration is the key to effectively manage this group of extremely debilitating malignancies.
Journal of the College of Physicians and Surgeons--Pakistan: JCPSP 02/2004; 14(1):29-34. · 0.34 Impact Factor
ABSTRACT: To study the use and effects of Karapandzic technique of lip reconstruction by long-term assessment.
A descriptive study.
CMH Rawalpindi from January 1994 to January 2002.
Thirty seven consecutive patients who underwent Karapandzic technique of lip reconstruction with a minimum follow-up period of two years have been included. The variables assessed were hemorrhage, wound infection, flap necrosis, microstomia, reconstruction time, hospital stay and dynamic lip functions. Results drawn were analyzed.
A total of 37 patients were included in the study. Thirteen (35%) patients were outdoor cases while 24 (65%) were in-patients. Average time of reconstruction was 40 minutes, which was done under general anesthesia in 21(57%) patients and under local anesthesia in 16 (43%) cases. Mean hospital stay of the indoor cases was 26 hours. There was no flap loss except for marginal necrosis in 04 (11%) patients. Wound infection and wound dehiscence was observed in 03 (08%) patients. Sensations were completely intact in 29 (78%) patients and aesthetically 28 (76%) patients gave normal look at the end of two years (2Y). Twenty-seven (74%) patients had no change in speech and only one (3%) patient had unsatisfactory speech after 2 years. Varying degree of microstomia was observed in all the cases at immediate postoperative stage of one month but 35 (95%) patients showed gradual improvement with active mouth opening and stretching by prosthetic splints over 2 years.
The Karapandzic technique of lip reconstruction is strongly recommended over the other techniques as it is a single stage, quick and safe procedure which gives cosmetically and functionally excellent results. Microstomia, occurring in early postoperative stage, shows gradual improvement on long-term follow-up.
Journal of the College of Physicians and Surgeons--Pakistan: JCPSP 05/2003; 13(4):219-22. · 0.34 Impact Factor
ABSTRACT: To compare the indications, ease of elevation, operative time, complications and durability of two fasciocutaneous flaps i.e. sensate medial plantar artery flap and distally based sural artery neurocutaneous flap, used for the coverage of weight bearing heel in young ambulant adults.
A comparative study.
CMH Rawalpindi and PIMS Islamabad during the period from May 1995 to April 2002.
All the patients fulfilling the inclusion criteria discussed later in the text were divided into two groups. Twenty patients underwent a medial plantar artery flap (MPAF) while 30 had their defects reconstructed by a sural artery neurocutaneous flap (SANF). The mode of presentation was noted in each case with a special note of the etiology. Postoperatively the patients were followed-up to evaluate any early or long-term complications.
The MPAF group consisted of 20 patients including 16 males and 4 females with a mean age of 28 years (range 22 to 37 years). The SANF group consisted of 30 patients including 29 males and only one female with a mean age of 30 years (range 23-38 years). In both groups a majority of patients presented with a history of road traffic accidents and was managed by delayed primary procedure. The duration of the operation was considerably less in SANF coverage i.e., 50-100 minutes compared to 120-190 minutes for the MPAF. Flap survival was 100% in both the groups. The postoperative complications were more in patients who underwent SANF. Complete weight-bearing was started at 6 weeks in medial plantar artery flap whereas the same started 6-8 weeks in sural artery neurocutaneous flap. Average time for return to work was 8 weeks in medial plantar artery flap but it was double (12 weeks) in sural artery neurocutaneous flap.
The medial plantar artery flap provides sensate and the same quality skin cover to the weight-bearing heel as compared to the distally based sural artery neurocutaneous artery flap. The medial plantar artery flap procedure is longer to perform but allows early weight-bearing with less complications than the distally based sural artery neurocutaneous flap.
Journal of the College of Physicians and Surgeons--Pakistan: JCPSP 05/2003; 13(4):216-8. · 0.34 Impact Factor