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RISS 인기검색어
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- 저자 : Neil A. Fine (검색결과 3 건)
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Armando A. Davila,Akhil K. Seth,Edward Wang,Philip Hanwright,Karl Bilimoria,Neil Fine,John YS Kim 대한성형외과학회 2013 Archives of Plastic Surgery Vol.40 No.1
Background Acellular dermal matrix (ADM) allografts and their putative benefits have been increasingly described in prosthesis based breast reconstruction. There have been a myriad of analyses outlining ADM complication profiles, but few large-scale, multi-institutional studies exploring these outcomes. In this study, complication rates of acellular dermis-assisted tissue expander breast reconstruction were compared with traditional submuscular methods by evaluation of the American College of Surgeon’s National Surgical Quality Improvement Program (NSQIP) registry. Methods Patients who underwent immediate tissue expander breast reconstruction from 2006-2010 were identified using surgical procedure codes. Two hundred forty tracked variables from over 250 participating sites were extracted for patients undergoing acellular dermisassisted versus submuscular tissue expander reconstruction. Thirty-day postoperative outcomes and captured risk factors for complications were compared between the two groups. Results A total of 9,159 patients underwent tissue expander breast reconstruction; 1,717 using acellular dermis and 7,442 with submuscular expander placement. Total complications and reconstruction related complications were similar in both cohorts (5.5% vs. 5.3%, P=0.68 and 4.7% vs. 4.3%, P=0.39, respectively). Multivariate logistic regression revealed body mass index and smoking as independent risk factors for reconstructive complications in both cohorts (P<0.01). Conclusions The NSQIP database provides large-scale, multi-institutional, independent outcomes for acellular dermis and submuscular breast reconstruction. Both thirty-day complication profiles and risk factors for post operative morbidity are similar between these two reconstructive approaches.
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Davila, Armando A.,Seth, Akhil K.,Wang, Edward,Hanwright, Philip,Bilimoria, Karl,Fine, Neil,Kim, John Y.S. Korean Society of Plastic and Reconstructive Surge 2013 Archives of Plastic Surgery Vol.40 No.1
Background Acellular dermal matrix (ADM) allografts and their putative benefits have been increasingly described in prosthesis based breast reconstruction. There have been a myriad of analyses outlining ADM complication profiles, but few large-scale, multi-institutional studies exploring these outcomes. In this study, complication rates of acellular dermis-assisted tissue expander breast reconstruction were compared with traditional submuscular methods by evaluation of the American College of Surgeon's National Surgical Quality Improvement Program (NSQIP) registry. Methods Patients who underwent immediate tissue expander breast reconstruction from 2006-2010 were identified using surgical procedure codes. Two hundred forty tracked variables from over 250 participating sites were extracted for patients undergoing acellular dermis-assisted versus submuscular tissue expander reconstruction. Thirty-day postoperative outcomes and captured risk factors for complications were compared between the two groups. Results A total of 9,159 patients underwent tissue expander breast reconstruction; 1,717 using acellular dermis and 7,442 with submuscular expander placement. Total complications and reconstruction related complications were similar in both cohorts (5.5% vs. 5.3%, P=0.68 and 4.7% vs. 4.3%, P=0.39, respectively). Multivariate logistic regression revealed body mass index and smoking as independent risk factors for reconstructive complications in both cohorts (P<0.01). Conclusions The NSQIP database provides large-scale, multi-institutional, independent outcomes for acellular dermis and submuscular breast reconstruction. Both thirty-day complication profiles and risk factors for post operative morbidity are similar between these two reconstructive approaches.
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Nima Khavanin,Sumanas Jordan,Francis Lovecchio,Neil A. Fine,John Kim 한국유방암학회 2013 Journal of breast cancer Vol.16 No.4
Purpose: Prosthetic-based breast reconstruction is performedwith increasing frequency in the United States. Major mastectomyskin flap necrosis is a significant complication with outcomesranging from poor aesthetic appearance to reconstructivefailure. The present study aimed to explore the interactionsbetween intraoperative fill and other risk factors on the incidenceof flap necrosis in patients undergoing mastectomy with immediateexpander/implant-based reconstruction. Methods: A retrospectivereview of 966 consecutive patients (1,409 breasts) whounderwent skin or nipple sparing mastectomy with immediatetissue expander reconstruction at a single institution was conducted. Age, body mass index, hypertension, smoking status,premastectomy and postmastectomy radiation, acellular dermalmatrix use, and application of the tumescent mastectomy techniquewere analyzed as potential predictors of flap necrosis bothindependently and as synergistic variables with high intraoperativefill. The following three measures of interaction were calculated:relative excess risk due to interaction, attributable proportionof risk due to interaction, and synergy index (SI). Results: Intraoperativetissue expander fill volume was high (≥66.7% of themaximum volume) in 40.9% (576 of 1,409 breasts) of cases. Theunadjusted flap necrosis rate was greater in the high intraoperativefill cohort than in the low fill cohort (10.4% vs. 7.1%, p=0.027). Multivariate logistic regression did not identify high intraoperativefill volume as an independent risk factor for flap necrosis(odds ratio 1.442, 95% confidence interval 0.973-2.137, p=0.068). However, four risk factors were identified that interactedsignificantly with intraoperative fill volume, namely tumescence,age, hypertension, and obesity. The SI, or the departure from additiverisks, was largest for tumescence (SI, 25.3), followed byhypertension (SI, 2.39), obesity (SI, 2.28), and age older than 50years (SI, 1.17). Conclusion: In the postmastectomy, hypovascularmilieu, multiple risk factors decreasing flap perfusion interactwith high intraoperative fill volume to cross a threshold and synergisticallyincrease the risk of flap necrosis.
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