Michelle M. Chang

Oral rehabilitation outcomes after free fibula reconstruction of the mandible without condylar restoration.

PurposeResection of the posterior mandible for tumor or osteonecrosis may include the mandibular condyle, an integral part of the temporomandibular joint (TMJ). Condylar reconstruction, including use of prostheses, the native condylar head, or part of the fibula, all have associated drawbacks including skull base erosion and the potential for ankylosis and TMJ dysfunction as well as the increased difficulty associated with trying to recapitulate the TMJ with high fidelity. We report our experience leaving a single side of the reconstructed mandible unsecured to the glenoid fossa, allowing the mandible to “hang.” We hypothesized that a good functional recovery may be achieved with this simple approach while avoiding the potential for ankylosis and TMJ dysfunction. MethodsA retrospective chart review of all patients undergoing free fibula reconstruction of the mandible with condylar removal was performed. Outcomes were determined by maximum interincisal opening, occlusion, and diet after full recovery. ResultsSix patients were studied. Two had condylar reconstruction with a contoured fibular head secured to the glenoid fossa. One of them had progressive postoperative trismus and ankylosis. One patient was reconstructed with the native condyle rigidly fixed to the fibula flap, complicated by avascular necrosis requiring condylar resection, with good function afterward. Three patients were left to “hang.” All 3 had either normal or improved function after surgery. Two had slight ipsilateral deviation on mouth opening. ConclusionsFunction can reliably be reestablished after segmental mandibulectomy and condylectomy with a vascularized fibula flap whose distal end is not precisely contoured or actively seated in the glenoid fossa, as a valid alternative to condylar reconstruction.

Oncoplastic Breast Reduction: Maximizing Aesthetics and Surgical Margins

Oncoplastic breast reduction combines oncologically sound concepts of cancer removal with aesthetically maximized approaches for breast reduction. Numerous incision patterns and types of pedicles can be used for purposes of oncoplastic reduction, each tailored for size and location of tumor. A team approach between reconstructive and breast surgeons produces positive long-term oncologic results as well as satisfactory cosmetic and functional outcomes, rendering oncoplastic breast reduction a favorable treatment option for certain patients with breast cancer.

Keeping it simple: Improving dental outcomes with osseointegrated implants after “single barrel” free fibula reconstruction of the mandible

PURPOSE: The free fibula flap has become the workhorse for reconstruction of the mandible after resection for tumor or osteonecrosis, with aesthetics and dental rehabilitation being the primary goals of reconstruction. A shortcoming of the fibula flap is its lack of height compared to the native mandible. As a result, osseointegrated implants placed into the fibula may be vertically short of the native occlusal plane. Approaches to address the fibula’s height deficiency have included the “double-barrel” fibula and vertical distraction osteogenesis. However, these confer additional complexity and risk to the reconstruction. Others have placed onlay bone graft, though this carries the risk of graft loss and infection. We hypothesized that mandible reconstruction using a single barrel fibula placed several millimeters above the inferior border of the native mandible would allow for improved dental rehabilitation without any untoward aesthetic consequences.

A Qualitative Study of Breast Reconstruction Decision-Making among Asian Immigrant Women Living in the United States.

Background: Despite research supporting improved psychosocial well-being, quality of life, and survival for patients undergoing postmastectomy breast reconstruction, Asian patients remain one-fifth as likely as Caucasians to choose reconstruction. This study investigates cultural factors, values, and perceptions held by Asian women that might impact breast reconstruction rates. Methods: The authors conducted semistructured interviews of immigrant East Asian women treated for breast cancer in the New York metropolitan area, investigating social structure, culture, attitudes toward surgery, and body image. Three investigators independently coded transcribed interviews, and then collectively evaluated them through axial coding of recurring themes. Results: Thirty-five immigrant East Asian women who underwent surgical treatment for breast cancer were interviewed. Emerging themes include functionality, age, perceptions of plastic surgery, inconvenience, community/family, fear of implants, language, and information. Patients spoke about breasts as a function of their roles as a wife or mother, eliminating the need for breasts when these roles were fulfilled. Many addressed the fear of multiple operations. Quality and quantity of information, and communication with practitioners, impacted perceptions about treatment. Reconstructive surgery was often viewed as cosmetic. Community and family played a significant role in decision-making. Conclusions: Asian women are statistically less likely than Caucasians to pursue breast reconstruction. This is the first study to investigate culture-specific perceptions of breast reconstruction. Results from this study can be used to improve cultural competency in addressing patient concerns. Improving access to information regarding treatment options and surgical outcomes may improve informed decision-making among immigrant Asian women.

Abstract 37: A Qualitative Study of Breast Reconstruction Decision-making Among Asians

34 sartorius flap option costing an additional

Risk factors of infected sternal wounds versus sterile wound dehiscence.

2,241.88. This lead to an incremental cost utility ratio (ICUR) of -

The Prevention and Genetics of Pancreatic Cancer: A Programmatic Approach

7,472.93/QALY favoring the rectus femoris flap. A substantial contribution to these results was due to the sartorius flap having a 13.68% major complication rate versus an 8.6% major complication rate for the rectus femoris flap. One-way sensitivity analysis showed that the sartorius flap became a cost-effective option if its major complication rate was less than or equal to 8.89%.