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Background Reports of synchronous bilateral giant (>10 cm) phyllodes tumors of the breast are scant in the literature. Reconstruction of the two large defects created after bilateral mastectomies is a challenge. Our patient, a 45-year-old woman, had a borderline phyllodes tumor measuring 15.5×15×7.3 cm in the right breast and a malignant phyllodes tumor measuring 16×10×9.8 cm in the left breast. After bilateral mastectomy, the following two huge defects remained: a 15×15 cm defect in the right breast and a 18×15-cm defect in the left breast. Methods We used one donor site with two separated deep inferior epigastric perforator flaps for postmastectomy breast reconstruction. This is the first case of bilateral giant phyllodes tumor in which mastectomy was followed immediately by autologous tissue reconstruction. Results Large flap reconstruction conferred adequate leverage for wide excision of giant phyllodes tumors, and no local recurrence or distal metastatic lesions were observed over a follow-up period of 4 years. Conclusions This method caused less donor site morbidity than did methods involving other types of flaps, and good functional and cosmetic results were achieved.

BACKGROUND This study is a retrospective review to compare combining progressive tension sutures, closed drain, and fibrin sealant effects on seroma formation, postoperative drainage volume, and hospital stay for abdominoplasty after deep inferior epigastric artery perforator (DIEP) flap. We ever published a 0% seroma rate in abdominoplasty after DIEP flap using progressive tension sutures and closed drain. Massive abdominal wound drainage caused delayed drain removal and increased hospital stay and medical costs. METHODS We retrospectively evaluated 54 abdominoplasty patients between December 2013 and September 2017; 43 patients used fibrin glue and 11 used progressive tension sutures and closed drain. RESULTS Abdominal drainage for the first 3 postoperative days was 84.65 ± 52.95 mL in the fibrin group, with total drainage of 127.70 ± 125.50 mL and 214.45 ± 104.35 mL in the no fibrin group, with total drainage of 350.45 ± 213.58 mL. Drains were removed on postoperative day 6.21 ± 1.44 in the fibrin group and day 9.64 ± 1.96 in the no fibrin group. The association of the first 3 days and total drainage volumes with the drain removal day significantly differed in the fibrin and no fibrin groups. Hospital stay was 9.88 ± 3.55 and 12.45 ± 5.22 days in the fibrin and no fibrin group, respectively, with borderline significant differences. CONCLUSIONS Donor site abdominoplasty after DIEP flap combining progressive tension sutures, closed drainage, and fibrin glue can prevent seroma occurrence, reduce postoperative abdominal drainage and need for blood transfusion, and achieve early removal of the abdominal drain, shorter hospital stay, and lower medical cost.

Autologous breast reconstructions using deep inferior epigastric perforator (DIEP) flaps create a large incision, presenting an opportunity for surgical site complications. In this pilot study, we aimed to examine outcomes in DIEP donor site incisions managed with standard dressings (control; n = 5) or closed incision negative pressure therapy (ciNPT; n = 5). We observed no significant differences between group age, body mass index, and past medical history. Both treatment groups had a similar duration of hospital stay, the number of blood transfusions, and pain scores on postoperative day 2 (P > .05). There was a trend of higher drainage (P = .251) and shorter time to incision healing (P = .067) in the ciNPT group than the control though the difference was not statistically significant. We did observe a significant improvement in scar pigmentation, vascularity, and pliability at 3, 6, and 12 months post‐surgery in the ciNPT group compared with control (P

We report a rare case that after rapid recurrence there was pathological transition from a fibroadenoma and benign phyllodes tumor to borderline and malignant phyllodes tumor. Another rare finding included tumor dissemination in the pleural cavity via reconstructed deep inferior epigastric perforator flap edge and internal mammary vessel bundle. Hence, we eliminated the use of internal mammary vessel bundle as the recipient vessel for free-flap reconstruction to avoid recurrence in the pleural cavity. Remarkably, we achieved successful reconstruction of 2 huge defects (reconstruction of breast following mastectomy and that of chest wall following en bloc excision of recurrence) using 2 different free flaps.

Background First rib fractures and traumatic Horner's syndrome are both quite rare, which can make it difficult to properly diagnose the combination of these 2 conditions in the emergency department. These conditions may be associated with severe medical emergencies, such as ongoing carotid dissection. Case Report We present the case of a 33-year-old man who sustained fractures to his right second, third, and fourth ribs and a delay in the diagnosis of left Horner's syndrome after he was involved in a traffic accident. Left Horner's syndrome was caused by a left transverse fracture of the first rib. This fracture was not detected on chest radiographs and required a 3-dimensional reconstructed neck computed tomography scan for detection. Why Should an Emergency Physician Be Aware of This? In the diagnosis of carotid artery dissection, conventional angiography is the criterion standard but is considered invasive. CTA is less invasive, time-saving, and can show more anatomic structures in the neck in addition to the carotid arteries. It is a good screening diagnostic modality in the traumatology department. Although the treatments for Horner's syndrome and first rib fracture are conservative, the early diagnosis of both conditions can resolve the anxiety and uncertainty experienced by both doctors and patients.

Introduction: Breast reconstruction using silicone implants is a widespread choice, however, breast capsular contracture (BCC), a response of the immune system to foreign materials, is the most affliction and frustration fibrosis complications after silicone implantation. Chronic inflammation-associated fibrosis is regarded as a main cause of BCC. Hyaluronic acid (HA) is an effective anti-adhesive and anti-fibrotic agent. Furthermore, 1,4-butanediol diglycidyl ether-cross-linked hyaluronan hydrogel (cHA) is a non-resorbable cross-linked hyaluronan-derived polymer with no cytotoxicity and high stability. This study aims to evaluate the potential of cHA on preventing BCC in breast surgery using silicone implants. Methods: The effect of cHA on BCC will be examined in breast BCC rat model. Results: Our study showed that cHA decreased fibrosis-regulated factors transforming growth factor beta 1 (TGF-β1) and tissue inhibitor of metalloproteinase (TIMP) expressions and increased metalloproteinase (MMP) MMP-9 expression in capsule tissue. cHA significantly decreased inflammatory mediators tumor necrosis factoralpha (TNF-α), interleukin IL-6, nitric oxide (NO), as well as inducible nitric oxide synthase (iNOS) expressions. In addition, cHA significantly decreased transcription factor nuclear factor kappa B (NF-κB) activation in silicone surrounded tissue. Conclusions: cHA showed prevention in BCC formation through inhibiting NF-κB -associated inflammation in rats with silicone implantation.

Phyllodes tumors of the breast are the rarest of all breast neoplasms. Giant phyllodes tumors (>10 cm) of the breast have been less discussed in the literature. Reconstruction of the large defect created after wide excision (safety margin >1 cm) is a challenge in these patients. We present one technique using a bi-pedicled deep inferior epigastric perforator flap for post-mastectomy breast reconstruction for giant phyllodes tumors. We treated three patients with giant phyllodes tumors between 2013 and 2016. The histological characteristics were benign and borderline; tumor sizes were 18 × 13 × 12, 20 × 16 × 9.5, and 18 × 15 × 9 cm. Immediate post-mastectomy reconstruction was performed using bi-pedicled deep inferior epigastric perforator flaps. Flap sizes measured 30 × 11, 28 × 12, and 28 × 13 cm. Total operative time, including that for mastectomy, was 285, 425, and 410 min. The duration of hospital stay was 12, 13, and 9 days. No local recurrence or distant metastasis occurred in the first two patients over a follow-up period of 3 years and in the third patient over a follow-up period of 6 months. A higher local recurrence rate was associated with positive margins, histological grade, tumor size, and necrosis. Immediate post-mastectomy breast reconstruction may become the preferred option for treatment of giant phyllodes tumors. A bi-pedicled deep inferior epigastric perforator flap conferred adequate leverage for wide excision and resolved scar contracture of the axilla. Good functional and cosmetic results were achieved. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .