27 results on '"Ehud Arad"'
Search Results
2. Comparing Efficacy of Common Pocket Irrigation Protocols in an Infected Breast Implant Model
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Dina Gofstein Hayuth, MD, Yoav Barnea, MD, Anat Lerner, PhD, Jonathan Lellouche, PhD, Zack Shiloah, MD, Gal Bracha, MD, Yehuda Carmeli, PhD, Eyal Gur, MD, Nir Shani, PhD, and Ehud Arad, MD
- Subjects
Surgery ,RD1-811 - Published
- 2020
- Full Text
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3. Treatment Algorithm of Postsurgical Fat Necrosis of the Breast-Revisited
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Oriana Haran, Carolina Legarda, Dina Gofstein, Dana Adelson, Roei Singolda, Ehab Madah, Ehud Arad, Andrew E. Grush, and Yoav Barnea
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Surgery - Abstract
Fat necrosis is a common complication of breast surgery, with the potential to cause both functional and aesthetic repercussions that can affect patient satisfaction. Although several fat necrosis classification systems have been proposed, fat necrosis management varies widely across institutions, requiring revisiting of existing treatment protocols. We evaluated the postoperative outcomes on 335 breasts following either breast reduction or reconstruction with deep inferior epigastric perforator (DIEP) flaps at our institution between 2016 and 2020, with particular attention to the development of fat necrosis and the need for subsequent surgical intervention. Fat necrosis was diagnosed in 36 (10.74%) breasts, of which 16 (44.4%) were surgically removed and 20 (55.5%) were conservatively managed. Time of fat necrosis diagnosis: early (≤one-month after breast surgery) or late (>1 month) was the only variable associated with surgical intervention. Fat necrosis management should be approached on a case-by-case basis. Whenever possible, conservative management with regular clinical and radiological follow-up, and patient reassurance, should be pursued even for large masses, in the absence of concomitant complications.
- Published
- 2023
4. Breast Implant–associated Anaplastic Large Cell Lymphoma Diagnosis 6 Years After Implant Removal
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Yoav Barnea, Ehud Arad, Ehab Madah, Jonathan Ben-Ezra, Mark W. Clemens, and Oriana Haran
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medicine.medical_specialty ,Breast Implants ,Implant removal ,law.invention ,law ,hemic and lymphatic diseases ,medicine ,Humans ,Breast Implantation ,Anaplastic large-cell lymphoma ,Device Removal ,business.industry ,Guideline ,Middle Aged ,medicine.disease ,Surgery ,body regions ,Left breast ,Seroma ,surgical procedures, operative ,Breast implant ,Lymphoma, Large-Cell, Anaplastic ,Female ,Primary treatment ,business - Abstract
We present a case report of a 48-year-old woman with a late-onset seroma of her left breast, 6 years after removal of her textured breast implants. At that time, she also had a late-onset seroma of her left breast, and capsulectomy was performed along with removal of the implants. The current late seroma presentation, which followed 6 years of uneventful healing, was treated with en bloc excision of the encapsulated seroma. Pathology results were concordant with locally invasive anaplastic large cell lymphoma (ALCL). Review of her previous seroma cytology from 6 years ago was performed given the current updated guideline standards on breast implant-associated ALCL (BIA-ALCL). Evidence of BIA-ALCL confirmed the patient had the diagnosis 6 years ago. The disease persisted and remained indolent for 6 years and manifested clinically as a late seroma of the left breast. This case report emphasizes the high degree of suspicion that is required in late seroma cases involving textured breast implants or a history of textured breast implants, along with the need for en bloc capsulectomy as a primary treatment for diagnosed BIA-ALCL to avoid incomplete capsulectomy and recurrence of the disease.
- Published
- 2021
5. Postirradiation Capsular Contracture in Implant-Based Breast Reconstruction: Management and Outcome
- Author
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Ehab Madah, Ehud Arad, Alon Tiosano, Yoav Barnea, Eyal Gur, Oriana Haran, Gal Bracha, and Tehillah Menes
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Reoperation ,medicine.medical_specialty ,Breast Implants ,medicine.medical_treatment ,Breast surgery ,Breast Neoplasms ,030230 surgery ,Transplantation, Autologous ,Surgical Flaps ,Time-to-Treatment ,03 medical and health sciences ,0302 clinical medicine ,Implant Capsular Contracture ,medicine ,Humans ,Acellular Dermis ,Breast ,Prospective cohort study ,Breast Implantation ,Device Removal ,Mastectomy ,Retrospective Studies ,business.industry ,Chemoradiotherapy, Adjuvant ,Capsular contracture ,Surgery ,Radiation therapy ,Transplantation ,Treatment Outcome ,Adipose Tissue ,030220 oncology & carcinogenesis ,Capsulotomy ,Female ,Implant ,business ,Breast reconstruction ,Follow-Up Studies - Abstract
Background Implant-based breast reconstruction is commonly avoided in the setting of radiation therapy, mainly because of risks of capsular contracture. Nevertheless, as breast reconstruction is becoming more available, more patients undergo both implant-based breast reconstruction and radiotherapy. The dilemma is how to manage capsular contracture if it does occur. The goal of this study was to examine the outcome of patients with implant-based breast reconstruction who developed postirradiation capsular contracture and were treated with capsulotomy or capsulectomy, with or without fat grafting. Methods The authors reviewed charts of patients who developed capsular contracture following alloplastic breast reconstruction followed by radiation therapy, between 2008 and 2018. The surgical treatment methods for capsular contracture were evaluated along with their outcomes. A follow-up of at least 1 year was required. Results Forty-eight breasts with postirradiation capsular contracture underwent surgical implant exchange with capsular release, of which 15 had combined fat grafting and 33 did not. Overall, 35 breasts (72.9 percent) showed long-term resolution of capsular contracture; 24 underwent a single procedure and 11 required an additional fat grafting procedure. Some patients [six breasts (12.5 percent)] were offered a consecutive round of fat grafting, and some [seven breasts (14.5 percent)] were offered autologous reconstruction because of lack of improvement. Fat grafting increased the success rate by more than 30 percent when it was initially and consecutively used. Conclusions Postirradiation capsular contracture may be treated successfully by secondary procedures, sustaining implant-based breast reconstruction in over 70 percent of breasts. Fat grafting may elevate resolution rates even further, to 86 percent. Larger prospective studies are required to validate these findings. Clinical question/level of evidence Therapeutic, III.
- Published
- 2020
6. Reply: Postirradiation Capsular Contracture in Implant-Based Breast Reconstruction: Management and Outcome
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Oriana Haran, Yoav Barnea, and Ehud Arad
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Contracture ,Mammaplasty ,Implant Capsular Contracture ,Humans ,Surgery - Published
- 2021
7. Immediate breast reconstruction in high-risk cases using an anatomically shaped permanent expandable implant
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Eyal Gur, Ehud Arad, Daniel J. Kedar, Amir Inbal, and Yoav Barnea
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Adult ,medicine.medical_specialty ,Permanent implant ,Time Factors ,Breast Implants ,Mammaplasty ,Salvage therapy ,030230 surgery ,Surgical Flaps ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,In patient ,Breast Implantation ,Aged ,Retrospective Studies ,Salvage Therapy ,Implant technique ,business.industry ,Large series ,Retrospective cohort study ,Skin Transplantation ,Middle Aged ,Surgery ,030220 oncology & carcinogenesis ,Female ,Implant ,Breast reconstruction ,business - Abstract
Summary Background Anatomically shaped permanent expandable implants are dual-chambered devices, which allow their postoperative expansion for the adjustment of volume. Their use is optional when 1-stage immediate breast reconstruction (IBR) direct to permanent implant is not feasible. The aim of this study is to present one center's long-term experience with the anatomical Becker expandable implant in a large series of patients who underwent either IBR or a salvage procedure for IBR with the device. Methods The records of 141 patients (a total of 161 breasts) who underwent IBR with the Becker implant were retrospectively reviewed. Patient demographics and surgical outcomes were analyzed. Indications for this procedure included reduced skin envelopes, compromised skin flaps, salvage procedures, and single-stage procedures in patients with major comorbidities. Results One hundred twenty-three devices (76%) involved IBR and 38 devices (24%) were salvage cases after direct-to-implant IBR. The device was used in a previously radiated breast in 36 cases (22%). Long-term follow-up demonstrated that 99 devices (61.5%) had been exchanged or removed and that only 62 devices (38.5%) remained as permanent implants. Removal of the device was associated with prior breast radiation and advanced age. Conclusions The use of the Becker device in high-risk IBR cases had a low retention rate as a permanent implant. Favorable indications for the use of this device in IBR cases include contralateral breast augmentation and patients with major comorbidities, which demonstrated a higher retention rate. Other indications for high-risk IBR cases could probably benefit using a 2-stage tissue-expander and implant technique.
- Published
- 2019
8. Correction to: Superiomedial Pedicle Breast Reduction for Gigantic Breast Hypertrophy: Experience in 341 Breasts and Suggested Safety Modifications
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Roei Singolda, Gal Bracha, Tariq Zoabi, Arik Zaretski, Amir Inbal, Eyal Gur, Yoav Barnea, and Ehud Arad
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Surgery - Published
- 2022
9. Comparing Efficacy of Common Pocket Irrigation Protocols in an Infected Breast Implant Model
- Author
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Jonathan Lellouche, Ehud Arad, Nir Shani, Zack Shiloah, Eyal Gur, Dina Gofstein Hayuth, Gal Bracha, Anat Lerner, Yehuda Carmeli, and Yoav Barnea
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Irrigation ,law ,business.industry ,Breast implant ,lcsh:Surgery ,Dentistry ,Medicine ,Surgery ,lcsh:RD1-811 ,business ,Research & Technology Abstracts ,law.invention - Published
- 2020
10. Incomplete Facial Paralysis
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Yoav Barnea, Daniel J. Kedar, Benjamin Meilik, Ravit Yanko, Eyal Gur, Arik Zaretski, Ronald M. Zuker, Ehud Fliss, Ehud Arad, and David Leshem
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Facial Paralysis ,Aftercare ,030230 surgery ,Free Tissue Flaps ,Neurosurgical Procedures ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,In patient ,Gracilis muscle ,Child ,Rest (music) ,Retrospective Studies ,business.industry ,Middle Aged ,Plastic Surgery Procedures ,medicine.disease ,Nasolabial fold ,Facial nerve ,Facial paralysis ,Surgery ,Facial Nerve ,Treatment Outcome ,medicine.anatomical_structure ,Facial reanimation ,Child, Preschool ,Gracilis Muscle ,030220 oncology & carcinogenesis ,Female ,business ,Facial symmetry - Abstract
Background The reconstructive approach for incomplete facial paralysis is not yet determined. In this article, the authors present a new surgical approach for patients with incomplete facial paralysis in which residual, ineffective movement is detected preoperatively in the ipsilateral buccozygomatic territory of the paretic facial nerve. Methods Sixteen patients with incomplete facial paralysis were found eligible for the procedure and underwent one-stage facial reanimation performed by the senior author (E.G.). Reanimation was performed using free gracilis muscle transfer with neural coaptation to an active facial nerve branch(es) responsible for the predetected buccozygomatic residual movement. Patients were reviewed in a systematic fashion using a combined still photographic and video scoring scale for symmetry at rest and at dynamic states. Results Following surgery, improved symmetry was observed in the majority of observations of the mouth region at rest and while smiling and of the nasolabial fold region while smiling. There was no significant change in symmetry in the majority of observations of the eye region at rest and while smiling and the nasolabial fold region at rest. Video assessment of dynamic facial symmetry while smiling demonstrated improved symmetry in 91 percent of the observations (n = 191 observations). Comparison of mean scores for dynamic smile symmetry produced a statistically significant improvement of 1.68 points following surgery (p Conclusion Based on this series, the authors recommend that use of the ipsilateral facial nerve buccozygomatic residual branch be considered as a donor nerve for facial reanimation using a free gracilis muscle transfer in patients with incomplete facial paralysis with residual preoperative movement in the midface. Clinical question/level of evidence Therapeutic, IV.
- Published
- 2018
11. Superomedial Pedicle Vertical Scar Breast Reduction: Objective and Subjective Assessment of Breast Symmetry and Aesthetics
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Ofir Ron, Eyal Gur, Amir Inbal, Yoav Barnea, Arik Zaretski, David Leshem, Ravit Yanko, and Ehud Arad
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Adult ,Reoperation ,medicine.medical_specialty ,Databases, Factual ,Esthetics ,Mammaplasty ,medicine.medical_treatment ,030230 surgery ,Surgical Flaps ,Cicatrix ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Patient satisfaction ,Quality of life ,medicine ,Humans ,Breast ,Prospective cohort study ,Retrospective Studies ,Wound Healing ,business.industry ,Graft Survival ,Hypertrophy ,Evidence-based medicine ,Middle Aged ,Plastic surgery ,Otorhinolaryngology ,Patient Satisfaction ,030220 oncology & carcinogenesis ,Multivariate Analysis ,Linear Models ,Physical therapy ,Female ,Surgery ,Breast reduction ,business - Abstract
The superomedial vertical scar breast reduction (SVBR) described by Hall-Findlay is gaining popularity among surgeons worldwide. The aim of this study was to evaluate its long-term aesthetic outcome, the extent of quality of life improvement and the factors that influence patient satisfaction and reviewers’ evaluation of aesthetic/surgical outcome. In this historical prospective study, we included women who underwent SVBR at least one year prior to enrollment and responded to a quality of life questionnaire. Their breasts were photographed, measured and evaluated by the plastic surgery staff. A total of 40 patients responded to the questionnaire, and the breasts of 31 of them were measured and photographed. All 31 patients had good breast symmetry according to objective breast measurements. There was a clear correlation between the patients’ and the reviewers’ scores of breast symmetry, scar appearance and breast shape (r = 0.4–0.65, r = 0.432–0.495 and r = 0.335–0.403, respectively). The factor that most influenced reviewers’ and patients’ satisfaction with the overall aesthetic outcome was the breast-to-body proportion. The proportions between the breast size and the patient’s body habitus are pivotal to patient satisfaction and should be taken into consideration when planning a reduction mammaplasty. The SVBR technique for breast reduction provided good cosmetic outcome and symmetry over a long-term follow-up. 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 .
- Published
- 2017
12. An Oncoplastic Breast Augmentation Technique for Immediate Partial Breast Reconstruction following Breast Conservation
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David Leshem, Ehud Arad, Amir Inbal, Yoav Barnea, Or Friedman, Eyal Gur, Tehillah Menes, Arik Zaretski, and Daphna Barsuk
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Adult ,medicine.medical_specialty ,Time Factors ,Mammaplasty ,medicine.medical_treatment ,Breast Neoplasms ,030230 surgery ,Mastectomy, Segmental ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Patient satisfaction ,medicine ,Humans ,skin and connective tissue diseases ,Breast augmentation ,Retrospective Studies ,Breast conservation ,business.industry ,Lumpectomy ,Capsular contracture ,Middle Aged ,Partial breast ,Surgery ,Radiation therapy ,Clinical question ,030220 oncology & carcinogenesis ,Female ,business - Abstract
BACKGROUND Patients with a small breast volume and a relative large lumpectomy volume are at risk of developing severe breast deformity and asymmetry following breast conservation, presenting a unique surgical challenge. METHODS A series of patients undergoing immediate reconstruction by means of an oncoplastic breast augmentation technique following breast conservation are described. The technique includes local tissue rearrangement and bilateral subpectoral breast augmentation with implants of different sizes and shapes, immediately after lumpectomy for a malignant tumor. RESULTS Twenty-one consecutive patients underwent the oncoplastic breast augmentation technique (mean follow-up, 23 months; range, 12 to 48 months). Three patients (14.3 percent) had tumor-positive surgical margins. Postoperative complications included grade III/IV capsular contracture in five patients (23.8 percent) and breast infection in two patients (10 percent). All patients received postoperative radiation therapy. The cosmetic outcome was evaluated at least 6 months after radiation therapy, and it was favorable according to the reported high patient satisfaction (81 percent) and independent observers' evaluation scores (76 percent). CONCLUSIONS The oncoplastic breast augmentation technique described in this article is an acceptable option in small-breasted patients with a relatively large lumpectomy volume who elect to undergo breast conservation. This technique allows conservation of the affected breast and minimizes potential breast deformation and asymmetry following radiation therapy. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
- Published
- 2017
13. Laser pretreatment for the attenuation of planned surgical scars: A randomized self-controlled hemi-scar pilot study
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Dina Gofstein, Eli Sprecher, Or Friedman, Ofir Artzi, Ehud Arad, and Eyal Gur
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Adult ,Male ,medicine.medical_specialty ,Scar assessment ,medicine.medical_treatment ,Scars ,Pilot Projects ,Lasers, Solid-State ,law.invention ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Cicatrix ,0302 clinical medicine ,Pharmacotherapy ,law ,Preoperative Care ,medicine ,Humans ,Israel ,Surgical scar ,Aged ,Wound Healing ,business.industry ,Cosmesis ,Middle Aged ,Laser ,Surgery ,Radiation therapy ,Incision Site ,Patient Satisfaction ,030220 oncology & carcinogenesis ,Female ,Laser Therapy ,Lipoma ,medicine.symptom ,business - Abstract
Summary Background Nonsurgical scar attenuation options include compression garments, silicone gel, intralesional drug therapy, radiation therapy, laser, and light therapies. Laser application preceding surgical intervention has been shown to modify the wound-healing process and affect subsequent scar formation. The objective of this study was to evaluate the safety, efficacy, and final cosmesis of a single presurgical laser treatment on surgical scar formation. Methods This was a randomized, controlled, intraindividual split-scar pilot study with blinded assessments of treated versus untreated planned incision sites. One half of each planned scar was treated by means of an Erbium glass, 1540 nm laser, 24 h before surgery, and the other half was not treated and served as the control. Clinical evaluations and the measurements of patient and physician POSAS scales were done at 1 and 12 months following surgery. Results Eleven patients completed the study and were included in the analyses. Laser pretreatment showed a significant beneficial effect compared with no treatment. Both the patient and physician mean Patient and Observer Scar Assessment Scale scores were significantly lower for the laser-treated half of the scars compared with the control side (1.55 to 3.00, p = 0.02 and 2.28 to 4.42, p = 0.03). There was a highly significant interobserver correlation in the evaluation of the overall posttreatment changes (r = 0.904, p Conclusion A single presurgical laser treatment of a planned incision site is a simple, safe, and painless strategy to significantly improve the final scar appearance.
- Published
- 2019
14. Oncoplastic partial breast reconstruction improves patient satisfaction and aesthetic outcome for central breast tumours
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Shirley Shechter, Daphna Barsuk, Amir Inbal, Ehud Arad, Or Friedman, Tehillah Menes, Eyal Gur, and Yoav Barnea
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medicine.medical_specialty ,Esthetics ,Settore MED/18 - CHIRURGIA GENERALE ,medicine.medical_treatment ,Mammaplasty ,Breast Neoplasms ,Mastectomy, Segmental ,Outcome (game theory) ,Resection ,03 medical and health sciences ,Breast cancer ,0302 clinical medicine ,Patient satisfaction ,Surveys and Questionnaires ,Oncoplastic surgery ,Treatment ,medicine ,Humans ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,General surgery ,Lumpectomy ,Breast tumours ,General Medicine ,Middle Aged ,Partial breast ,Surgery ,Oncoplastic Surgery ,Treatment Outcome ,Patient Satisfaction ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Female ,business ,Breast reconstruction - Abstract
Background Patients with centrally located tumours involving the nipple-areolar complex (NAC) who undergo breast-conserving treatment (BCT) are at high risk for breast deformity and asymmetry. Immediate oncoplastic breast reconstruction (OBR) can have a favourable impact on surgical outcome. Methods We retrospectively compared aesthetic outcomes and patient satisfaction among women treated with NAC lumpectomy and immediate OBR with patients treated with BCT alone. Aesthetic outcome was evaluated by independent observers, and patient satisfaction was assessed by the BREAST-Q questionnaire. Results A total of 24 patients were studied, 12 in each group. Demographics and oncological staging were similar in both groups, apart from mean age, hypertension and tumour size/lumpectomy weight. Patients in the OBR group had higher scores for aesthetic outcome and a higher degree of patient satisfaction from the surgical outcome compared to the patients in the BCT-alone group. Conclusions The immediate OBR approach in the treatment of centrally located tumours with NAC resection has clear advantages over BCT alone. This approach should be considered for and offered to suitable patients.
- Published
- 2018
15. DIEP Flap Breast Reconstruction Complication Rate in Previously Irradiated Internal Mammary Nodes
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Yoav Barnea, Amir Inbal, Or Friedman, Ehud Arad, Shirley Shechter, and Eyal Gur
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Adult ,Graft Rejection ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Mammaplasty ,Breast Neoplasms ,Free flap ,030230 surgery ,Anastomosis ,03 medical and health sciences ,0302 clinical medicine ,Breast cancer ,Postoperative Complications ,DIEP flap ,medicine ,Humans ,Fat necrosis ,Fat Necrosis ,Mastectomy ,Retrospective Studies ,business.industry ,Middle Aged ,medicine.disease ,Surgery ,Radiation therapy ,Treatment Outcome ,030220 oncology & carcinogenesis ,Female ,Radiotherapy, Adjuvant ,Lymph Nodes ,Breast reconstruction ,business ,Perforator Flap ,Follow-Up Studies - Abstract
Background Postmastectomy radiation therapy (PMRT) is a widely accepted treatment for locally advanced breast cancer. Some patients require additional boost radiation to the internal mammary nodes as the part of regional nodal irradiation (RNI). Delayed breast reconstruction with an autologous free flap using the internal mammary vessels for microvascular flap anastomosis is a common practice for these patients. The aim of our study was to evaluate the effect of RNI on autologous microvascular breast reconstruction. Patients and Methods A retrospective study was performed on 57 patients (69 flaps) undergoing deep inferior epigastric perforator (DIEP) flap for delayed breast reconstruction after radiation therapy. The study group included 37 patients (65%) who received PMRT and RNI to the internal mammary nodes. The control group included 20 patients (35%) who received PMRT alone. Early and delayed surgical complications, including wound complications, fat necrosis, and flap loss, were compared between the groups. Results The patient demographics in both groups were similar. Complication rate showed a higher trend in the study group for flap loss (8.3% versus 0%) and vascular anastomosis failure (5.6% versus 0%), but with no statistical difference (p = 0.54, 0.53, respectively). The control group showed a higher trend in fat necrosis (25% versus 8.3%, p = 0.11). Conclusions DIEP flap breast reconstructions with internal mammary vessels anastomosis should be performed with cautious in patients who had received RNI to internal mammary nodes because of potential added risk for surgical complications.
- Published
- 2018
16. The Role of Botulinum Toxin A in the Establishment of Symmetry in Pediatric Paralysis of the Lower Lip
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Carolyn Lai, Siba Haykal, Ronald M. Zuker, Gregory H. Borschel, Ehud Arad, Shaghayegh Bagher, Tessa A. Hadlock, and Marc H. Hohman
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Male ,Adolescent ,Facial Paralysis ,Lower lip ,Clostridium difficile toxin A ,Botulinum toxin a ,Paralysis ,medicine ,Humans ,Botulinum Toxins, Type A ,Child ,Retrospective Studies ,business.industry ,medicine.disease ,Botulinum toxin ,Lip ,Facial paralysis ,Facial Expression ,Treatment Outcome ,Neuromuscular Agents ,Multicenter study ,Synkinesis ,Child, Preschool ,Anesthesia ,Female ,Surgery ,medicine.symptom ,business ,medicine.drug - Abstract
Botulinum toxin A has been described as an effective adjunct treatment for achieving symmetry in adults with facial paralysis. Few investigators have described the use of botulinum toxin A in pediatric patients with facial paralysis.To present our preliminary experience with botulinum toxin A in pediatric patients presenting with asymmetry of the lower lip.We performed a retrospective medical record review of all pediatric patients (age range, 4-17 years; mean [SD] age, 11.2 [4.7] years) with facial paralysis who were treated with botulinum toxin A injections from January 1, 2004, through December 31, 2012. Patients presented for treatment at The Hospital for Sick Children, Toronto, Ontario, Canada, or the Massachusetts Eye and Ear Infirmary, Boston.Using facial analysis software, we measured lower lip asymmetry in the patients' photographs before and after treatment, at rest, and in a dynamic state. We performed analysis of variance to assess for improvement in symmetry.We identified 18 patients with the following 3 primary indications for treatment: focal lip asymmetry (n = 11), extensive hemifacial asymmetry (n = 5), and focal synkinesis (n = 2). We found no complications related to botulinum toxin A treatment. The mean (SD) dynamic deviation before the injection was 3.5 (1.7) mm, whereas the mean dynamic deviation after the injection was 1.5 (0.8) mm. The mean (SD) deviation correction was evaluated at 61% (6%) and was statistically significant (P = .04).Botulinum toxin A injection is a safe procedure for improving localized asymmetry in pediatric patients with facial paralysis. Preliminary results indicate that botulinum toxin A may be an effective treatment for lower lip asymmetry in children and adolescents.4.
- Published
- 2015
17. The Shifting Paradigm in the Management of Giant Congenital Melanocytic Nevi
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Ronald M. Zuker and Ehud Arad
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Pathology ,medicine.medical_specialty ,Quality of life ,business.industry ,MEDLINE ,Medicine ,Nevus ,Surgery ,skin and connective tissue diseases ,business ,Surgical treatment ,medicine.disease ,Dermatology - Abstract
SUMMARY Congenital melanocytic nevi remain a subject of controversy with respect to risk of malignant transformation and recommended management. Recent studies indicate a lower malignant risk (0.7 to 2.9 percent) than had previously been estimated. Surgery has not been proven to reduce malignant risk or improve quality of life, and may result in undesirable aesthetic and functional outcomes. In this article, the authors review key controversial issues in the management of congenital melanocytic nevi and re-evaluate indications for surgical treatment. An updated review of controversial topics in the management of congenital melanocytic nevi is presented, and clinical applications are demonstrated through clinical cases. Updates regarding the risks and outcomes of congenital melanocytic nevi patients open a renewed debate with respect to the indications for surgery as well as the extent of surgery that may be suitable. Treatment should be tailored to achieve optimal aesthetic results whereby complete nevus excision is not the goal. As such, nonsurgical management and incomplete nevus excision should be integrated as legitimate parts of any treatment algorithm.
- Published
- 2014
18. Anatomic Sites of Origin of the Suprascapular and Lateral Pectoral Nerves within the Brachial Plexus
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Anne Agur, Thomas J. Sitzman, Ehud Arad, Zhi Li, and Howard M. Clarke
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Male ,Shoulder ,Dissection (medical) ,medicine.nerve ,Upper trunk ,Cadaver ,Humans ,Medicine ,Brachial Plexus ,Brachial Plexus Neuropathies ,Aged ,Thoracic Nerves ,Lateral pectoral nerve ,business.industry ,Dissection ,Torso ,Anatomy ,Lateral cord ,Suprascapular nerve ,medicine.disease ,Trunk ,medicine.anatomical_structure ,Cervical Vertebrae ,Female ,Surgery ,Spinal Nerve Roots ,business ,Brachial plexus - Abstract
Background The goal of this study was to clarify the anatomical origins of the suprascapular and lateral pectoral nerves from the brachial plexus as an aid to surgical exploration. Methods Both nerves were studied in 100 adult cadaver specimens. Topographic points of origin were described as distance from the bifurcation of the upper trunk or distance from the formation point of the lateral cord, using visual anatomical models. Results The suprascapular nerve originated from (1) the posterior division of the upper trunk distal to the bifurcation of the upper trunk (61 specimens); (2) the point of upper trunk bifurcation (29 cases); (3) the upper trunk proximal to the bifurcation point (six cases); and (4) directly from the C5 root (four cases). The lateral pectoral nerve originated from (1) the anterior division of the upper trunk proximal to the point of lateral cord formation (88 cases); (2) the point of lateral cord formation (five cases); (3) the lateral cord distal to the lateral cord formation point (four cases); and (4) the anterior division of the middle trunk (three cases). Eighty-two cases had origins from both the anterior upper trunk and the anterior middle trunk. Conclusions The suprascapular nerve most frequently originates from the posterior division of the upper trunk, and the lateral pectoral nerve from the anterior divisions of the upper and middle trunks. This information can be used to guide the surgeon in identifying the key landmarks of the supraclavicular brachial plexus at surgical exploration.
- Published
- 2014
19. Novel Rat Model of Methicillin-Resistant Staphylococcus aureus–Infected Silicone Breast Implants
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Daphna Frenkiel-Krispin, Yoav Barnea, Shiri Navon-Venezia, Rivka Glick, Eyal Kramer, Yehuda Carmeli, Eyal Gur, Boris Kuzmenko, and Ehud Arad
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Methicillin-Resistant Staphylococcus aureus ,Pathology ,medicine.medical_specialty ,Prosthesis-Related Infections ,Breast Implants ,Rat model ,medicine.disease_cause ,Microbiology ,Rats, Sprague-Dawley ,Silicone Gels ,Pathogenesis ,chemistry.chemical_compound ,Silicone ,medicine ,Animals ,skin and connective tissue diseases ,business.industry ,Biofilm ,Staphylococcal Infections ,biochemical phenomena, metabolism, and nutrition ,Methicillin-resistant Staphylococcus aureus ,Rats ,Sprague dawley ,Disease Models, Animal ,chemistry ,Biofilms ,Female ,Surgery ,business - Abstract
Clinical infection of breast implants occurs in 7 to 24 percent of breast reconstructions. It may persist over time in the form of biofilm without overt manifestation and is extremely difficult to eradicate. The authors' aim was to establish a novel model for biofilm infection of silicone breast implants in rats.Fifty-six rats underwent implantation of miniature silicone breast implants and/or methicillin-resistant Staphylococcus aureus (MRSA) bacteria. Group A received implants covered with MRSA biofilm. Group B received implants and free planktonic MRSA. Group C received free planktonic MRSA without implants. A control group received sterile implants without MRSA. Each group was divided to receive either saline or vancomycin injections between days 4 and 11. Clinical evaluation, bacterial counts, and scanning electron microscopy were performed.The mortality rate in group B (implants infected with free planktonic MRSA) was significantly higher than that in all other groups [37 percent versus groups A and D (0 percent) and group C (7 percent)]. Treatment with vancomycin lowered temperature in groups B and C (p0.05) and improved wound healing in group B (p0.01). Vancomycin treatment reduced wound bacterial counts in free planktonic MRSA groups B and C but had no significant effect on biofilm MRSA-infected group A.The model successfully induced persistent breast implant infection. Free planktonic MRSA produced in situ biofilm on silicone implants. Biofilm infection has milder manifestations than free planktonic MRSA infection, which has higher rates of systemic infections and death when compared with either isolated biofilm infection or free planktonic MRSA infection without implant. Vancomycin has limited effect against mature biofilm.
- Published
- 2013
20. Comparison of Surgical Complications Between Immediate Breast Reconstruction and Mastectomy: The Impact on Delivery of Chemotherapy
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Toni Zhong and Ehud Arad
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Reconstructive surgery ,medicine.medical_specialty ,Chemotherapy ,business.industry ,Adjuvant chemotherapy ,medicine.medical_treatment ,medicine.disease ,Surgery ,Breast cancer ,Time frame ,medicine ,Clinical significance ,skin and connective tissue diseases ,Breast reconstruction ,business ,Mastectomy - Abstract
A variety of immediate breast reconstructive techniques coupled with skin-sparing mastectomies has resulted in superior aesthetic outcomes with minimal disruption to the patient’s lifestyle. Immediate breast reconstruction (IBR) is an important alternative for women diagnosed with early-stage breast cancer, and one that should be considered when contemplating between breast conservation therapy versus mastectomy. The authors discuss immediate breast reconstruction (IBR) postoperative complications and the effects of delay of adjuvant chemotherapy. Most studies suggest a delay of approximately 1–2 weeks in administration of chemotherapy following immediate breast reconstructive surgery, probably due to a slightly higher rate of postoperative complications. Nevertheless, this may not be of clinical significance as most patients still receive chemotherapy within the recommended 8–12-week time frame, with no evidence of impairment of oncologic outcomes.
- Published
- 2016
21. Reply
- Author
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Ronald M. Zuker and Ehud Arad
- Subjects
medicine.medical_specialty ,business.industry ,Medicine ,Surgery ,business ,Dermatology ,Malignant transformation - Abstract
Summary:Congenital melanocytic nevi remain a subject of controversy with respect to risk of malignant transformation and recommended management. Recent studies indicate a lower malignant risk (0.7 to 2.9 percent) than had previously been estimated. Surgery has not been proven to reduce malignant ris
- Published
- 2014
22. Comprehensive Approach in Surgical Reconstruction of Facial Nerve Paralysis: A 10-year Perspective
- Author
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Eyal Shapira, Jerry Weiss, Arik Zaretski, Eyal Gur, David Leshem, Yoav Barnea, Beni Meilik, Ehud Miller, Shy Stahl, Aharon Amir, Amin Abu Jabel, and Ehud Arad
- Subjects
Adult ,Male ,medicine.medical_specialty ,Facial Paralysis ,Treatment outcome ,Neurological disorder ,Surgical Flaps ,Postoperative Complications ,medicine ,Paralysis ,Humans ,Cranial nerve disease ,Child ,Intraoperative Complications ,Muscle, Skeletal ,Facial expression ,business.industry ,Anastomosis, Surgical ,Perspective (graphical) ,Plastic Surgery Procedures ,medicine.disease ,Facial nerve ,Facial paralysis ,Surgery ,Facial Expression ,Treatment Outcome ,Facial Asymmetry ,Thigh ,Female ,medicine.symptom ,business ,Algorithms - Abstract
Facial paralysis presents diverse functional and aesthetic abnormalities. Reconstruction may be achieved by several methods. We reviewed the management and outcome of facial paralysis patients to establish principles on which a comprehensive reconstructive approach may be based. Records were reviewed of all patients operated for facial paralysis at our institution between 1998 and 2007. Ninety-five patients were included, of which 15 patients had static reconstruction alone, and 80 patients had dynamic reconstruction. Presented is our experience in reconstruction of facial paralysis over the past decade, delineating a comprehensive approach to this condition. Various surgical techniques are described.
- Published
- 2009
23. Botulinum toxin for the treatment of motor imbalance in obstetrical brachial plexus palsy
- Author
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Christine G. Curtis, Howard M. Clarke, Ehud Arad, and Derek Stephens
- Subjects
Male ,Shoulder ,Contracture ,Elbow ,Shoulder movement ,Injections, Intramuscular ,Birth Injuries ,Medicine ,Humans ,Brachial Plexus ,Botulinum Toxins, Type A ,Range of Motion, Articular ,Elbow flexion ,Brachial Plexus Neuropathies ,Child ,Palsy ,business.industry ,Recovery of Function ,medicine.disease ,Botulinum toxin ,medicine.anatomical_structure ,Muscle imbalance ,Anesthesia ,Child, Preschool ,Surgery ,Female ,business ,Range of motion ,Brachial plexus ,medicine.drug - Abstract
BACKGROUND Residual muscle imbalance is a common problem affecting obstetrical brachial plexus palsy patients. The goal of this study was to examine the efficacy of botulinum toxin type A (Botox) in improving this muscle imbalance. METHODS The authors retrospectively reviewed obstetrical brachial plexus palsy patients treated with Botox for muscle imbalance as an isolated procedure. Outcomes were the change in Active Movement Scale scores from pre-Botox scores to scores at 1 month after Botox and 1 year after Botox. RESULTS Twenty-seven patients were included, 19 treated for shoulder imbalance and eight treated for elbow imbalance. Active Movement Scale scores (mean±SD) for shoulder external rotation improved from 0.6±1.0 before Botox to 2.6±2.14 (p
- Published
- 2013
24. Facial Paralysis Reconstruction: Focus on Long-lasting Facial Paralysis, Cross-face Nerve Grafting and Free Gracilis Muscle Transfer
- Author
-
Eyal Gur, Ron Zuker, and Ehud Arad
- Subjects
Nerve grafting ,Long lasting ,medicine.medical_specialty ,Focus (computing) ,business.industry ,medicine ,Gracilis muscle ,Anatomy ,medicine.disease ,business ,Facial paralysis ,Surgery - Published
- 2013
25. Body Builder’s Nightmare
- Author
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Oded Ben Amotz, Or Friedman, and Ehud Arad
- Subjects
Steroid injection ,medicine.medical_specialty ,biology ,Athletes ,business.industry ,medicine.medical_treatment ,010401 analytical chemistry ,Surgical debridement ,biology.organism_classification ,01 natural sciences ,0104 chemical sciences ,Nightmare ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Trenbolone ,medicine ,030212 general & internal medicine ,Black market ,medicine.symptom ,Gluteal area ,business ,Anabolic steroid ,medicine.drug - Abstract
In the pursuit of success in sports, some athletes are not deterred by health risks associated with the (mis)use of black market preparations of dubious origin as performance-enhancing agents. Several studies published in the recent years demonstrated that anabolic-androgenic steroids, but also stimulants and growth hormones, are misused by numerous recreational athletes from all over the world. Trenbolone is an anabolic steroid routinely used in the finishing phase of beef production to improve animal performance and feed efficiency. A 35-year-old male patient presented to our plastic surgery clinic after self-intramuscular administration of Trenbolone to the superior gluteal area bilaterally, which led to a full-thickness defect in a cone-like distribution. The wounds underwent surgical debridement and were treated locally with mafenide acetate irrigation and wound dressings. Closure was achieved by secondary intention healing. In this report, we discuss the first documented case of full-thickness skin and subcutaneous tissue necrosis after black market anabolic steroid injection. This illustrates a plastic complication and resolution of a widespread but seldom reported problem.
- Published
- 2016
26. Skin necrosis after self-administered intramuscular diclofenac
- Author
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Ofir Uri and Ehud Arad
- Subjects
Male ,medicine.medical_specialty ,Necrosis ,Diclofenac ,Pain relief ,Self Administration ,Injections, Intramuscular ,Pathogenesis ,medicine ,Humans ,Surgical Wound Infection ,Skin ,Superficial femoral artery ,business.industry ,Anti-Inflammatory Agents, Non-Steroidal ,Nicolau Syndrome ,Cellulitis ,Middle Aged ,Staphylococcal Infections ,Surgery ,stomatognathic diseases ,Thigh ,Back Pain ,Anesthesia ,Tissue necrosis ,medicine.symptom ,Complication ,business ,medicine.drug - Abstract
Intramuscular diclofenac is used extensively for pain relief in medical practice. Tissue necrosis is a rare but serious complication of intramuscular injections. The pathogenetic mechanism is still not completely understood. A case of tissue necrosis following self-administration of diclofenac inadvertently injected into an arterial perforator branch of the superficial femoral artery is reported, supporting a vascular pathogenesis.
- Published
- 2008
27. Paravertebral turnover flaps for closure of large spinal defects following tethered cord repair
- Author
-
Liana Beny, Ehud Arad, Jerry Weiss, Yoav Barnea, David Leshem, Eyal Gur, Shimon Rochkind, Shlomi Constantini, Aharon Amir, and Arik Zaretski
- Subjects
Adult ,medicine.medical_specialty ,Adolescent ,Spina Bifida Occulta ,Surgical Flaps ,Cerebrospinal fluid ,Lumbar ,Medicine ,Humans ,Tethered Cord ,Child ,Retrospective Studies ,business.industry ,Infant ,Spinal cord ,Surgery ,Plastic surgery ,medicine.anatomical_structure ,Spinal Cord ,Anesthesia ,Child, Preschool ,business ,Suture line ,Sacral defects ,Lumbosacral joint - Abstract
Reconstruction of large congenital spinal defects remains a challenge. We present our experience in closure of difficult spinal defects following repair of tethered cord, using paravertebral fascial or myofascial turnover flaps. Between 1996 and 2005, 23 patients were operated using paravertebral turnover flaps for closure of large spinal defects associated with tethered cord. Fifteen (65%) patients had lipomyelomeningoceles. Eleven (48%) patients had sacral defects, 10 (43%) had lumbosacral defects, and 2 (9%) had lumbar defects. Fourteen (61%) patients underwent closure using fascial turnover flaps. Myofascial turnover flaps were used in 9 (39%) patients. Following surgery, none of the patients developed cerebrospinal fluid (CSF) leaks, pseudomeningoceles, or subcutaneous infection. One patient suffered superficial necrosis and infection of the skin suture line, which healed secondarily. We conclude that fascial or myofascial paravertebral turnover flaps provide reliable coverage of difficult defects of the spinal CNS.
- Published
- 2006
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