An Algorithm for Labia Minora Reduction Based on a Review of Anatomical, Configurational, and Individual Considerations.

A variety of reduction labiaplasty techniques have been introduced to date, but no single technique will offer the optimal solution for every patient. Rather, the technique should be chosen based on anatomical, configurational, and technical considerations, as well as on patients' personal preferences regarded maintenance of the labial rim, maintenance of labial sensitivity, and prevention of iatrogenic thickening of the labium. We reviewed, defined, and assessed labial configurational variety, neurovascular supply, reduction techniques, and patient's preferences as the considerations relevant to the choice of labiaplasty technique.

Combined skin-sparing mastectomy and immediate implant-based breast reconstruction: Outcome following mantle field irradiation versus outcome following whole-breast irradiation.

Background: Mastectomy may be needed in the context of previous radiotherapy in cases of breast carcinoma following mantle field radiotherapy for Hodgkin lymphoma or in cases of local relapse or second primary tumours after breast conserving therapy including whole-breast irradiation (BCT). The outcome of combined skin-sparing mastectomy and immediate implant-based breast reconstruction (SSM-IIBR) has been reported to be unfavourable in these cases.

Purpose: To compare the outcome of SSM-IIBR after mantle field radiotherapy to that after BCT and to compare both to the outcome observed in non-irradiated breasts.

The ban of the ipsilateral limb as a skin graft donor site after melanoma excision: A critical review.

Split-thickness skin grafts are often applied in the management of primary cutaneous melanoma. It is routine surgical practice to use the contralateral limb because of the alleged risk of donor site metastases that may occur when the ipsilateral limb is used. The rationale and clinical evidence for this routine were assessed in light of current understanding of pathways of metastasis of melanoma.

Effect of latissimus dorsi flap breast reconstruction on the strength profile of the upper extremity.

Objective: Dissection of the latissimus dorsi (LD) flap may have a distinct impact on upper extremity function and strength. To date, insufficient differentiation has been made between loss of muscular strength and shoulder function by dissection of the LD muscle per se and loss of function resulting from all excisional surgery, radiation therapy, and reconstructive procedures at the donor site and the recipient site that may have been combined near the shoulder region.

Methods: This study determines the long-term effect of the LD breast reconstruction on the strength profiles of the upper extremity by measuring the isometric torque strength both in seven synergistic- and two contra-movement directions.

Can previous diagnostic examinations prevent preoperative angiographic assessment of the internal mammary perforators for (micro)surgical use?

Background And Aim: Preoperative assessment of the internal mammary artery perforating (IMAP) branches enhances IMAP-based reconstructive procedures. Conventionally, color-flow Doppler, selective catheter arteriography, or CT angiography is used for such assessment. We studied how often these examinations may be rendered superfluous by assessment of previously performed diagnostic examinations.

(Non-targeted) radioactive/fluorescent nanoparticles and their potential in combined pre- and intraoperative imaging during sentinel lymph node resection.

One clinical precedent for the use of nanosized imaging agents is the localization of the tumor draining sentinel lymph nodes. In this application, radiocolloids such as (99m)Tc-NanoColl are currently used to plan the surgical procedure and to provide acoustic guidance during the intervention. Additional injections of dyes are common to provide optical surgical guidance.

Tumor bracketing and safety margin estimation using multimodal marker seeds: a proof of concept.

Accurate tumor excision is crucial in the locoregional treatment of cancer, and for this purpose, surgeons often rely on guide wires or radioactive markers for guidance toward the lesion. Further improvement may be obtained by adding optical guidance to currently used methods, in the form of intra-operative fluorescence imaging. To achieve such a multimodal approach, we have generated markers that can be used in a pre-, intra-, and post-operative setting, based on a cocktail of a dual-emissive inorganic dye, lipids, and pertechnetate.

Dual-emissive quantum dots for multispectral intraoperative fluorescence imaging.

Fluorescence molecular imaging is rapidly increasing its popularity in image guided surgery applications. To help develop its full surgical potential it remains a challenge to generate dual-emissive imaging agents that allow for combined visible assessment and sensitive camera based imaging. To this end, we now describe multispectral InP/ZnS quantum dots (QDs) that exhibit a bright visible green/yellow exciton emission combined with a long-lived far red defect emission.

Validation of intratracheal instillation of lung tumour cells in mice using single photon emission computed tomography/computed tomography imaging.

In search of better predictive animal models for evaluating treatment response in lung cancer, orthotopic lung tumour models are a great step forward over traditional subcutaneous models. Crucial in the development of such orthotopic models is a reliable and reproducible instillation method. Because cells are instilled inside the thorax, the accuracy of the instillation and visualization of tumour growth demands the use of non-invasive imaging methods.

Skinning clitorectomy and skin replacement in women with vulvar intra-epithelial neoplasia.

Background And Aim: Partial or total clitoris amputation for vulvar intra-epithelial neoplasia (VIN) affects quality of life and sexual function and is likely to constitute over-treatment as superficial excision of only the involved, thinly cornified, stratified squamous clitoral epithelium would suffice. For this reason, we applied skinning clitorectomy and replacement of clitoral skin as an organ-sparing surgical therapy for clitoral VIN.

Methods: Seven consecutive patients presenting with VIN were treated from July 2003 to February 2008.

The design of the lateral thoracodorsal flap.

Although some of the aspects of the preoperative markings of the lateral thoracodorsal flap have been mentioned by its originators and subsequent authors, we get ongoing inquiries regarding the details of the design of the flap. These markings are made respecting the level of the contralateral nipple, with the convex inferior border of the flap extending up to the anterior axillary line, and with the straight superior border extending more medially over this line. We have used 200 lateral thoracodorsal flaps in 180 patients with no cases of more than marginal flap loss provided that the length of the flap was limited to a maximum of 17 cm.

Extended deepithelialization to secure double-breasted closure of the skin.

Double-breasted closure of the skin is achieved by deepithelialization of 1 edge of a wound and advancement of the opposite edge over this deepithelialized area. Such closure may prevent contamination or exposure of the implant in cases where immediate breast reconstruction with prosthetic material is obtained after skin sparing mastectomy. The deepithelialization routinely extends as far as the incision to be closed and, consequently, the skin suture at the end of the incision immediately overlies thedeep suture or implant in cases where the implant is not fully covered by muscle.