In the management of giant incisional hernias with loss of domain several surgical obstacles have... more In the management of giant incisional hernias with loss of domain several surgical obstacles have to be addressed. Adequate coverage of the defect using mesh, sufficient local tissue advancement and prevention of wound and mesh infections are prerequisites for success. We present a case of a complicated giant incisional hernia repair after oncologic surgery, in which we chose for an intraabdominal mesh repair using a composite mesh. The patient developed a wound dehiscence and mesh infection, successfully treated with negative pressure therapy followed by a free ALT perforator flap. Several surgical techniques are discussed to manage these complicated hernias, such as progressive pneumoperitoneum, the component separation technique and the importance of soft tissue coverage (e.g. anterolateral thigh flap). In cases of wound complications, negative pressure therapy and new soft tissue coverage are discussed.
Currently available mammary implants filled with either silicone gel, saline, or both are radiopa... more Currently available mammary implants filled with either silicone gel, saline, or both are radiopaque on x-ray film and make mammographic screening less reliable. In women who have had augmentation mammaplasty, modifications of the mammography technique are necessary to maximize the amount of breast tissue visualized.1 These special techniques require additional effort, expertise, and x-ray views, adding to the expense of the procedure. A new implant (Trilucent, Lipomatrix, Inc., Neufchateau, Switzerland), filled with medicalgrade triglycerides derived from 100% USP soybean oil, recently became available on the market. The filler has a radiolucency equal to that of breast tissue and is reported to greatly simplify mammography in patients who have undergone augmentation.2– 4 Because breast cancer is expected to develop in about 10 percent of women who have undergone breast implantation and because mammography is the best diagnostic tool to detect breast carcinoma in its earliest stage (before the mass becomes palpable), this new filler might become increasingly important, even more so with the aging of women who have undergone breast augmentation.5,6 Although silicone gel and saline have been traditionally used as implant fillers, triglycerides are by no means a novel material. In fact, they have a much longer history of use in human medicine (as intravenous nutrition and intramuscular drug carriers), and their biocompatibility has been demonstrated in several animal experiments.2 The manufacturer states that the triglyceride filler of the Trilucent implant has several properties that make it even more desirable than normal saline as an implant filler: It is biodegradable, excretable, a lubricant, a normal dietary component, more viscous than saline, osmotically neutral, as radiolucent as breast fat, and nonallergenic. However, little is known about the effects of aging on the content of the breast implant in a biological environment, which may be associated with oxidation of the fatty acid moiety. To our knowledge, this report is the first to describe what happens when late deflation of a triglyceride-filled implant occurs.
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2006
Perforator flaps are widely used in our unit for breast reconstruction. They provide ample tissue... more Perforator flaps are widely used in our unit for breast reconstruction. They provide ample tissue with minimal donor site morbidity together with long lasting aesthetic results. Increasing number of patients may have liposuction procedure which may jeopardise areas such as the abdomen and the buttock which are the donor sites for perforator-free flaps in breast reconstruction. Therefore, liposuction has been considered as a relative contraindication of raising perforator flaps. Six patients who had previous liposuction of the donor sites underwent autologous breast reconstruction with perforator-free flaps. Colour Duplex imaging was obtained in all cases preoperatively in order to evaluate the blood supply to the flap and to map the perforators. There were five deep inferior epigastric artery flaps (DIEP) and one superior gluteal artery perforator (SGAP) flap used. Total flap survival was obtained in all cases. Postoperative course was uneventful. Our results showed that raising perforator flaps after liposuction of the donor sites is possible. Preoperative radiological evaluation of the perforators is mandatory for such difficult cases.
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2009
Pedicled superior epigastric artery perforator (SEAP) flaps can be raised to cover challenging th... more Pedicled superior epigastric artery perforator (SEAP) flaps can be raised to cover challenging thoracic defects. We present an anatomical study based on multidetector computerized tomography (MDCT) scan findings of the SEA perforators in addition to the first reported clinical series of SEAP flaps in anterior chest wall reconstruction. (a) In the CT scan study, images of a group of 20 patients who underwent MDCT scan analysis were used to visualise bilaterally the location of musculocutaneous SEAP. X- and Y-axes were used as landmarks to localise the perforators. The X-axis is a horizontal line at the junction of sternum and xyphoid (JCX) and the Y-axis is at the midline. (b) In the clinical study, seven pedicled SEAP flaps were performed in another group of patients. MDCT images revealed totally 157 perforators with a mean of 7.85 perforators per patient. The dominant perforators (137 perforators) were mainly localised in an area between 1.5 and 6.5 cm from the X-axis on both sides and between 3 and 16 cm below the Y-axis. The calibre of these dominant perforators was judged as 'good' to 'very good' in 82.5% of the cases. The average dimension of the flap was 21.7x6.7 cm. All flaps were based on one perforator. Mean harvesting time was 110 min. There were no flap losses. Minor tip necrosis occurred in two flaps. One of them was treated with excision and primary closure. Our clinical experience indicates that the SEAP flap provides a novel and useful approach for reconstruction of anterior chest wall defects. CT-based imaging allows for anatomical assessment of the perforators of the superior epigastric artery (SEA).
In the management of giant incisional hernias with loss of domain several surgical obstacles have... more In the management of giant incisional hernias with loss of domain several surgical obstacles have to be addressed. Adequate coverage of the defect using mesh, sufficient local tissue advancement and prevention of wound and mesh infections are prerequisites for success. We present a case of a complicated giant incisional hernia repair after oncologic surgery, in which we chose for an intraabdominal mesh repair using a composite mesh. The patient developed a wound dehiscence and mesh infection, successfully treated with negative pressure therapy followed by a free ALT perforator flap. Several surgical techniques are discussed to manage these complicated hernias, such as progressive pneumoperitoneum, the component separation technique and the importance of soft tissue coverage (e.g. anterolateral thigh flap). In cases of wound complications, negative pressure therapy and new soft tissue coverage are discussed.
Currently available mammary implants filled with either silicone gel, saline, or both are radiopa... more Currently available mammary implants filled with either silicone gel, saline, or both are radiopaque on x-ray film and make mammographic screening less reliable. In women who have had augmentation mammaplasty, modifications of the mammography technique are necessary to maximize the amount of breast tissue visualized.1 These special techniques require additional effort, expertise, and x-ray views, adding to the expense of the procedure. A new implant (Trilucent, Lipomatrix, Inc., Neufchateau, Switzerland), filled with medicalgrade triglycerides derived from 100% USP soybean oil, recently became available on the market. The filler has a radiolucency equal to that of breast tissue and is reported to greatly simplify mammography in patients who have undergone augmentation.2– 4 Because breast cancer is expected to develop in about 10 percent of women who have undergone breast implantation and because mammography is the best diagnostic tool to detect breast carcinoma in its earliest stage (before the mass becomes palpable), this new filler might become increasingly important, even more so with the aging of women who have undergone breast augmentation.5,6 Although silicone gel and saline have been traditionally used as implant fillers, triglycerides are by no means a novel material. In fact, they have a much longer history of use in human medicine (as intravenous nutrition and intramuscular drug carriers), and their biocompatibility has been demonstrated in several animal experiments.2 The manufacturer states that the triglyceride filler of the Trilucent implant has several properties that make it even more desirable than normal saline as an implant filler: It is biodegradable, excretable, a lubricant, a normal dietary component, more viscous than saline, osmotically neutral, as radiolucent as breast fat, and nonallergenic. However, little is known about the effects of aging on the content of the breast implant in a biological environment, which may be associated with oxidation of the fatty acid moiety. To our knowledge, this report is the first to describe what happens when late deflation of a triglyceride-filled implant occurs.
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2006
Perforator flaps are widely used in our unit for breast reconstruction. They provide ample tissue... more Perforator flaps are widely used in our unit for breast reconstruction. They provide ample tissue with minimal donor site morbidity together with long lasting aesthetic results. Increasing number of patients may have liposuction procedure which may jeopardise areas such as the abdomen and the buttock which are the donor sites for perforator-free flaps in breast reconstruction. Therefore, liposuction has been considered as a relative contraindication of raising perforator flaps. Six patients who had previous liposuction of the donor sites underwent autologous breast reconstruction with perforator-free flaps. Colour Duplex imaging was obtained in all cases preoperatively in order to evaluate the blood supply to the flap and to map the perforators. There were five deep inferior epigastric artery flaps (DIEP) and one superior gluteal artery perforator (SGAP) flap used. Total flap survival was obtained in all cases. Postoperative course was uneventful. Our results showed that raising perforator flaps after liposuction of the donor sites is possible. Preoperative radiological evaluation of the perforators is mandatory for such difficult cases.
Journal of Plastic, Reconstructive & Aesthetic Surgery, 2009
Pedicled superior epigastric artery perforator (SEAP) flaps can be raised to cover challenging th... more Pedicled superior epigastric artery perforator (SEAP) flaps can be raised to cover challenging thoracic defects. We present an anatomical study based on multidetector computerized tomography (MDCT) scan findings of the SEA perforators in addition to the first reported clinical series of SEAP flaps in anterior chest wall reconstruction. (a) In the CT scan study, images of a group of 20 patients who underwent MDCT scan analysis were used to visualise bilaterally the location of musculocutaneous SEAP. X- and Y-axes were used as landmarks to localise the perforators. The X-axis is a horizontal line at the junction of sternum and xyphoid (JCX) and the Y-axis is at the midline. (b) In the clinical study, seven pedicled SEAP flaps were performed in another group of patients. MDCT images revealed totally 157 perforators with a mean of 7.85 perforators per patient. The dominant perforators (137 perforators) were mainly localised in an area between 1.5 and 6.5 cm from the X-axis on both sides and between 3 and 16 cm below the Y-axis. The calibre of these dominant perforators was judged as 'good' to 'very good' in 82.5% of the cases. The average dimension of the flap was 21.7x6.7 cm. All flaps were based on one perforator. Mean harvesting time was 110 min. There were no flap losses. Minor tip necrosis occurred in two flaps. One of them was treated with excision and primary closure. Our clinical experience indicates that the SEAP flap provides a novel and useful approach for reconstruction of anterior chest wall defects. CT-based imaging allows for anatomical assessment of the perforators of the superior epigastric artery (SEA).
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Papers by K. Van Landuyt