Reconstructive Plastic Surgery - San Francisco
Time 2021-10-24 11:10:58Web Name: Reconstructive Plastic Surgery - San Francisco
WebSite: http://reconplasticsurgsf.blogspot.com
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Plastic,Reconstructive,Surgery,Francisco,San,Description:
keywords: description:This site is dedicated to educating patients about Reconstructive Plastic Surgery, its history, options, and relevance to Medicine and Surgery. Key words: Wounds, Trauma, Cancer, Breast Reconstruction, Infection, Osteomyelitis, Limb Salvage, Lymphedema, Hand Surgery, Microsurgery, Flaps, Skin Grafts, Negative Pressure
The TRAM (Transverse Rectus Abdominis Muscle) flap procedure requires taking the entire Rectus Muscle (1 set of the 6-pack abdominal muscles) to reconstruct the breast. It can be done as a Pedicle Flap (as shown here, the blood vessel and muscle is still attached), or as a free TRAM flap requiring microsurgery to reconnect the tissue to blood vessels in the chest area. The DIEP flap procedure has evolved from the free TRAM flap where the muscle is preserved and the skin and fat is removed from the abdomen with only the blood vessels. 9 comments: Saturday, December 27, 2014 Exparel in postoperative pain managment after reconstructive breast and abdominal surgeryTaking Great Pains: EXPAREL helps improve postop pain after breast reconstruction
The past decade has brought major treatment advances in breast reconstruction surgery. Most notably, autologous flap procedures have vastly improved the patient experience. But despite significant strides on the surgical front, one constant that continues to diminish the quality of life of patients undergoing breast surgery is postsurgical pain. Inadequate pain control after surgery has been correlated with long-term chronic pain,1which affects between 27% and 48% of patients following breast surgery.2,3
Enter EXPAREL
References
- See more at: http://www.plasticsurgerypractice.com/2014/09/taking-great-pains-exparel-helps-improve-postop-pain-breast-reconstruction/#sthash.esDmyv6B.dpuf5 comments: Tuesday, May 27, 2014 Infected Mesh is an Infected Implant -- It must be removed. Prosthetic mesh is often used in hernia repair surgery, with over 20 million such procedures done annually around the world. Mesh is used to augment tissue repair in hernias to reduce tension at the suture line where the "weakness" is strengthened or plugged to hold back internal structures (such as intestine or omentum) that want to bulge through these areas. The mesh can be made of various materials, such as Polypropelene, Gortex, and other plastic materials which allows the body to grow scar tissue around it. The thing remember about prosthetic mesh, is that it is NOT alive or biologically active. Your body recognizes it as a foreign substance, and because of that, there are inherent risks.
For the most part, prosthetic mesh works and does its job; however, when it becomes a problem, it usually becomes a BIG problem. The worst problem of all is when the mesh becomes infected. In that situation, with rare exception, the mesh must be removed--completely. It must be completely removed because any portion that remains may harbor bacteria which the body cannot clear away (even with the most powerful antibiotics), leading to a chronic wound, deeper infection, absesses, or systemic infection.
The treatment of infected mesh requires a step-wise approach with the first step in removing the mesh and debriding (cleaning) the wound. This step may be repeated multiple times until the area is clean. Once deemed clean, the area that the mesh covered will need to be reconstructed, preferably with your own tissue (flaps), or in combination with a Biologic mesh that can grow with your tissues and that your body ultimately recognizes as "self" tissue. It will take at least 6 weeks from the time of the final reconstruction to fully heal, and depending on the complexity of the wound, infection, and anatomy of the infected mesh, several months in total.
Far too often, I have seen patients who have lived with this problem for too long. A small, chronic wound, may be a sign of a much bigger problem deep down below. Appropriate evaluation, diagnosis, and management is critical, but just as importantly, it is important to first recognize and know that you may have mesh in your body. If it is close to an area that is draining or infected, the mesh must be ruled out as a potential source of problem. Afterward, it may be necessary to find a team of surgeons, including a general surgeon and plastic surgeon, to work together to solve this difficult problem.5 comments: Thursday, January 23, 2014 Where can the lymph nodes be taken for a lymph node transplant for Lymphedema surgery?There are several accessible areas around the body where lymph nodes may be harvested with its blood vessels to be transplanted in an arm or leg for lymphedema treatment. This includes the groin area (the area near the hip bone (Groin Flap)), the subaxillary region (arm pit region(Subaxillary Flap), and the neck/collar bone area (Transverse Cervical Flap)). Each area contains a lymph node basin which can be harvested with the flap tissue. Careful dissection and evaluation of the area needs to be done prior to using the tissues from each specific area.
Be sure to have a thorough discussion with your surgeon regarding your "donor site" options for lymph nodes when considering lymph node transplant to treat lymphedema.7 comments: Wednesday, May 15, 2013 Angelina Jolie and Breast Cancer ReconstructionI applaud Angelina Jolie's candid approach to her recenttreatment for breast cancer. Because ofher star status, she is able to put a significant spotlight upon currentissues in breast cancer treatment today. This includes the BRCA gene, which places herat high risk for breast cancer, that many people may not know much about. It also highlights her approach to thissituation with her getting prophylacticbilateral mastectomies and immediate breast reconstruction with tissue expanderimplants.
It is very common now for me to see patients who seek toundergo prophylactic mastectomies and immediate breast reconstruction. It allows the patient to be treated at anearlier stage stage in a proactiveway, based on genetic information or earlydiagnosis. Our team of breast surgeons, oncologists,pathologists, and plastic surgeons can treat women in the same, proactive waythat Angelina Jolie sought with outstanding results.
I thank and applaud Angelina Jolies courage in sharing thisdeep and personal part of her life to help others. She is a super star in my book.
Lymphatic venous anastomosis has been a treatment option for over 30 years. It has waxed and waned in terms of treatment efficacy and therein lies the controversy. Only more recently, with the advent of super microsurgical techniques and instruments, have higher rates of success with vessels and lymphatics at 0.5 mm and less, become the norm. There have been significantly improved outcomes since the early days of microsurgery. Dr. Isao Koshima in Tokyo, Japan has been pushing the envelope for decades with advanced super microsurgery techniques. He is a pioneer in super microsurgery and has some of the most extensive experience and long-term follow-up of lymphatic patients in the world.
Lymphatico Venous Anastomsis as seen under the Operating Microscope(Performed by Dr. Charles K. Lee at St.Mary's Medical Center, San Francisco, CA, October 2012)
I was fortunate to learn from Dr. Isao Koshima directly on his techniques and share knowledge and experience with colleagues from around the world about the latest treatments for lymphedema. I am fortunate to have both Drs. Koshima and Dr. David Chang at M.D. Anderson Cancer Center as my mentors in this regard.
With Drs. David Chang (Left) and Dr. Isao Koshima (Center)at Tokyo University, Tokyo, Japan, September 2012.
In combination with lymph node transplantation as a free tissue transfer from the groin, abdomen, axilla, shoulder, or neck (large lymph node basins) with additional lymphatic venous anastomosis, this two-pronged approach to addressing improved lymphatic flow has likely made the greatest advances in the treatment for lymphedema to this date. This two-pronged approach allows to redirect lymphatic flow from the interstitial space in the subcutaneous layer to the venous system and helps regenerate lymphatics in areas where they may have been removed.
Liposuction to address lymphedema has also been described. It is more of a cosmetic treatment for lymphedema as the patient is still is left with permanent lifelong compression and reaccumulation of lymph as soon as the compression garment is removed. Liposuction does not treat the cause of lymphedema and therefore does not cannot be a long-term solution.
The power of Lymphatic Venous Anastomosis (LVA) and Lymph Node Transplant (LNT) lies in its ability to treat the causal pathway to lymphedema; it is a physiologic and long-term solution to improving lymphatic flow and ultimately, patient's quality of life. I have personally seen and treated patients with dramatic improvements, that can range from 40% to 80% reduction in circumference, 60%-80% reduction in pain and swelling, with improved range of motion, wound healing, and improved quality of life by not having to wear compression or decrease the amount of time in compression.
I encourage patients who are trying to learn more about the latest treatments for lymphedema contact our office for more information and to continue learning more about the most advanced treatments for this difficult condition.28 comments: Saturday, June 30, 2012 Exparel for Post Surgical Pain Relief in Reconstructive Surgery
Exparel is a high-tech new form of a commonly used localanesthetic (bupivicaine/marcine). It isFDA approved and is catching on quickly with surgeons who want the best fortheir patients in post surgical pain relief.I have been fortunate to have been one of the first plastic surgeon inthe Bay Area to have used Exparel since April 2012. Patients who have undergone both cosmeticplastic (breast augmentation, tummy tuck) and reconstructive plastic surgery(breast reconstruction, hand and leg surgery) have benefited from thismedication. It is currently also being used in general surgery (eg: hernia), orthopedics, and other procedures.
Typically, Marcine/Bupivicaine lasts only 6-8 hours after itis injected in the surgical area. WithExparel-- Marcaine + Depofoam technology-- it can last up 72 hours. The most painful time after surgery iswithin the first 48-72 hours, so the timing is excellent to address thiscritical time. In addition, my patientscan avoid the use of the "pain pump" which basically infuses marcaineover a period of time, but the inconvenience of the additional tubing and bulbs,and the possibility of this tubing sitting near an implant, is avoided.
Ultimately, using this medication can help significantlywith pain relief and decrease the use of narcotics which come with significantside effects -- nausea, vomiting, constipation, mood changes, etc.
Exparel is an excellent addition to my practice and I amfortunate to be able to offer this high-tech pain reliever to my patients. Ask your surgeon if you might benefit from Exparel for your next procedure.
TAGS:Plastic Reconstructive Surgery Francisco San
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