Gemma Pons
Hospital de Sant Pau
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Featured researches published by Gemma Pons.
Annals of Plastic Surgery | 2008
Jaume Masia; Jose Larrañaga; Juan A. Clavero; Lorena Vives; Gemma Pons; Jose Maria Pons
A preoperative abdominal wall study was conducted using a multidetector scanner in 162 women who had undergone breast reconstruction with abdominal perforator flaps. A map of the abdominal perforator vessels dependent on the deep inferior epigastric artery was created. In the first 36 cases, anatomic dissection of all perforators was performed during surgery. The outcome was then compared with the radiologic findings. In the following 126 cases, the perforator vessel chosen preoperatively by the multidetector scanner was located and dissected directly. In the first 36 cases, an absolute correlation was observed between the radiologic information and intraoperative findings. In the following 126 cases, surgery time and the rate of postoperative complications decreased significantly. The multidetector scanner provides valuable preoperative information enabling identification of the most suitable perforator in view of its caliber, location, course, and anatomic relationships. Once located, we can proceed directly to its dissection during surgery, making it a faster and safer technique.
Journal of Plastic Reconstructive and Aesthetic Surgery | 2014
Gemma Pons; Jaume Masia; Pietro Loschi; Maria Luisa Nardulli; Joan Duch
Vascularised lymph node transfer is a promising technique to treat limb lymphoedema, especially when caused by lymph node dissection. The most common approach is the transfer of superficial inguinal lymph nodes using groin flaps or superficial circumflex iliac artery perforator flaps. Lower-limb lymphatic sequelae are unexpected as these lymph nodes should drain lymph from the lower abdominal wall. Recently, Vignes et al. described two cases out of 26 cases of chronic lymphoedema after superficial inguinal lymph node harvest. From a series of 42 vascularised lymph node transfers performed at our centre, only one patient developed swelling in the donor thigh. The features of this patient who underwent a lymph node-containing superficial circumflex iliac artery perforator flap are reported herein. We recommend maximal accuracy in selecting the appropriate lymph nodes for transfer and provide some tips from our experience.
Journal of Reconstructive Microsurgery | 2010
Jaume Masia; Damir Kosutic; Daniele Cervelli; Juan A. Clavero; Josep M. Monill; Gemma Pons
A reliable method for precise identification of the dominant perforator would be extremely valuable in perforator flap surgery. During the past 5 years, multidetector-row computed tomography has demonstrated excellent results in preoperative planning of abdominal free flap breast reconstruction, significantly reducing operative time and complications. The main drawbacks of computed tomography are unnecessary radiation to the patient and possible allergic reactions to intravenous contrast material. To circumvent these limitations, we performed noncontrast magnetic resonance imaging for abdominal perforator mapping. The aim of our study was to assess the accuracy and reliability of this technique in preoperative planning of breast reconstruction with deep inferior epigastric artery perforator flaps. From October 2007 to February 2009, noncontrast magnetic resonance preoperative mapping was performed in 56 female patients who underwent breast reconstruction after mastectomy with deep inferior epigastric artery perforator flaps. Imaging results were compared with the intraoperative clinical findings in all patients. Preoperative magnetic resonance imaging without the contrast showed no false-positive or false-negative results. In all cases, the perforator chosen as dominant according to magnetic resonance images corresponded with the perforator chosen intraoperatively (100% predictive value). Preoperative imaging techniques make perforator flap surgery safer for the patient. Noncontrast magnetic resonance imaging provides reliable information on the vascular anatomy of the abdominal wall, facilitating selection of the most appropriate deep inferior epigastric artery dominant perforator. It avoids radiation to the patient and also the need for intravenous contrast medium as required for the multidetector-row computed tomography. In our opinion, noncontrast magnetic resonance imaging is an ideal method for preoperative planning of breast reconstruction with deep inferior epigastric artery perforator flaps.
Journal of Reconstructive Microsurgery | 2010
Jaume Masia; Damir Kosutic; Juan A. Clavero; Jose Larrañaga; Lorena Vives; Gemma Pons
Precision in preoperative evaluation of the abdominal wall vascular anatomy is of utmost importance in successful planning and execution of perforator flap surgery for breast reconstruction after mastectomy. We performed a study in 357 patients scheduled for deep inferior epigastric artery perforator (DIEAP) flap breast reconstruction to review our 5-year experience with the technique we developed based on our previous research confirming accuracy of a computed tomographic (CT) angiogram (multidetector row computed tomography [MDCT]) in preoperative planning of abdominal perforator flap surgery. Images obtained from the radiological study were used to create an accurate map of dominant abdominal perforators of the deep inferior epigastric artery, showing their location, size, and anatomic considerations of relevance for the preoperative flap design. Anatomic dissection of all perforators was performed in the first 36 cases to compare the data with preoperative MDCT findings. In the following 321 patients, the dominant perforator was chosen solely on the basis of MDCT and dissected directly. Exact correlation between surgical and radiological results was found in the first 36 cases. A significant reduction in average operating time and postoperative complications was noted in the following 321 patients. CT angiogram provides important preoperative information on inferior abdominal wall vascular anatomy, facilitating DIEAP flap harvest, saving operative time, and reducing complications and costs. It proved to be an invaluable tool in the preoperative algorithm for DIEAP flap breast reconstruction.
American Journal of Roentgenology | 2008
Juan A. Clavero; Jaume Masia; Jose Larrañaga; Josep M. Monill; Gemma Pons; Sahyly Siurana; Xavier Alomar
OBJECTIVEnThis study aimed to evaluate the utility of MDCT in planning abdominal perforator surgery for breast reconstruction in patients who have undergone mastectomy.nnnSUBJECTS AND METHODSnOne hundred twenty-six consecutive patients scheduled for postmastectomy breast reconstruction using deep inferior epigastric perforator flaps underwent MDCT. The images were evaluated to identify, characterize, and map the dominant musculocutaneous perforator vessels of the deep inferior epigastric artery. In the first 36 patients, we compared the intraoperative findings with the preoperative MDCT findings. In the latter 90 patients, the dominant perforator vessels were directly selected on the basis of MDCT findings.nnnRESULTSnWe found an exact correlation between the intraoperative and radiologic findings in the first 36 cases. In the following 90 cases, the average operating time saved per patient was 1 hour 40 minutes and there was a significant reduction in postsurgical complications. The preoperative evaluation by MDCT confirmed the wide range of variability in the vascular anatomy of the abdominal wall previously described in anatomic studies.nnnCONCLUSIONnMDCT provides valuable information before surgery about the arterial anatomy of the inferior abdominal wall. It enables accurate identification of the most suitable dominant perforator vessel and makes surgical perforator flap procedures for breast reconstruction faster and safer.
Annals of Plastic Surgery | 2007
Jaume Masia; Fabrizio Moscatiello; Gemma Pons; Manuel Fernández; Susana Lopez; Pere Serret
The application of Taylors concept about body angiosomes, referred to tissue transfers, has meant that the development of the perforator flaps and muscles is no longer needed as a carrier of skin flap vascularity. In this paper, we revise 59 lower limb reconstructions with local and free perforator flaps performed in the last 5 years, and a basic reconstructive algorithm is also suggested to help with the management of the lower limb soft tissue reconstruction with perforator flaps. The advantages of the perforator flaps are (1) muscles and their function are preserved; (2) the main vascular trunks are spared; (3) it is possible to make a more specific reconstruction, replacing “like with like” (even performing compound or chimeric flaps); (4) the donor site can often be closed primarily; (5) the general morbidity is reduced; (6) a better cosmetic result can be achieved.
Annals of Plastic Surgery | 2014
Gemma Pons; Jaume Masia; Lídia Sanchez-Porro; Jose Larrañaga; Juan A. Clavero
&NA;One of the main steps in perforator flap surgery is to identify the dominant perforator. Using multidetector row computed tomography (MDCT) for the preoperative planning of deep inferior epigastric artery perforator (DIEAP) flap surgery, we identified a perforator with a large caliber, an excellent location in the middle abdominal region, and a totally extramuscular trajectory in a significant number of patients. We describe the frequency of this perforator and determine its characteristics. Patients and MethodsWe conducted a retrospective study of 482 patients who underwent 526 DIEAP flaps for breast reconstruction from October 2003 to October 2011. Mean age at surgery was 51.3 years old. A preoperative MDCT of abdominal vascularization was performed in all patients. ResultsMDCT identified a dominant perforator with a paramuscular course in 12.4% of abdominal walls. In all cases, it was located in the midline and emerged directly from the deep inferior epigastric system. Its mean caliber was 1.9 mm. The flap was harvested based on this perforator in all these patients, and mean harvest time was 51 minutes. The characteristics of this perforator made dissection easier and reduced morbidity at the donor site. There were no flap losses and the only complications were minor. ConclusionWe located a paramuscular perforator in 12.4% of patients undergoing breast reconstruction with abdominal perforator flaps. Its morphological features and extramuscular course make it the perforator of choice in DIEAP flap surgery.
Aesthetic Plastic Surgery | 2013
Gemma Pons; Pietro Loschi; Jaume Masia; Maria Luisa Nardulli; Lidia Sanchez Porro-Gil
Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of
Annals of Plastic Surgery | 2015
Gemma Pons
tion, after revision, March 16, 2015. Conflicts of interest and sources of funding: none declared. Reprints: Gemma Pons, MD, Department of Plastic and Reconstructive Surgery, Hospital de la Santa Creu i Sant Pau, Universitat Autòmoma deBarcelona, Sant Quintí 89, 08041 Barcelona, Spain. E-mail: [email protected]. Copyright
Acta otorrinolaringológica española | 2008
Xavier León; Albert Pujol; Montserrat López; Jacinto García; Gemma Pons; J. R. Sañudo; Jaume Masia; Miquel Quer
La presencia en los medios de comunicacion del trasplante de organos no vitales como las extremidades o la cara ha despertado el interes de nuestros pacientes, por la posibilidad de llevar a cabo el trasplante de un organo tan trascendente para la comunicacion como es la laringe. Los principales problemas que considerar para realizar un trasplante de la laringe son la viabilidad del organo trasplantado, la tolerancia inmunologica y la capacidad funcional. A partir de la revision de los estudios publicados, el presente trabajo pretende llevar a cabo una actualizacion de los conocimientos acumulados en relacion con el trasplante laringeo, asi como explorar la posibilidad de que en un futuro este procedimiento pueda llegar a ser una opcion terapeutica factible.