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Background: This study investigated the association between silicone breast implants and health symptoms believed to be related to breast implant illness (BII) in women who underwent implant-based breast reconstruction after breast cancer. Although there is increasing evidence of an association between BII and breast augmentation cases, it is unclear in women with implant-based breast reconstruction., Methods: This retrospective cohort study involved 254 women who underwent implant-based reconstruction after breast cancer treatment and a control group comprising 487 women who underwent breast-conservation therapy or simple mastectomy. We linked Dutch Breast Implant Registry data (2015-2019) and general practice electronic health records data (2014-2022) to study the occurrence of 13 BII-related health symptoms in general practice and number of consultations for these symptoms 1 year before to 3 years after breast surgery., Results: Over the 3 years following implantation, no significant differences in symptom occurrence were observed when comparing the data from year before implantation and the control group. Women with breast implants did not have more consultations in general practice compared to the control group during follow-up. However, there was an increased likelihood of having ≥3 consultations in the first and second years post-implantation compared to that before implantation., Conclusions: This is the first study on BII focusing solely on women who underwent implant-based reconstruction after breast cancer. We found no evidence for BII in this patient group. However, BII symptoms may not manifest within the 3-year timeframe but could emerge later, which warrants further research with longer follow-up., (Copyright © 2025 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: There has been a growing concern about a possible causal relationship between silicone breast implants (SBIs) and health symptoms, referred to as breast implant illness. This study assessed the association between SBIs for cosmetic augmentation and health symptoms., Methods: This retrospective cohort study used the data from the Dutch Breast Implant Registry and Nivel Primary Care Database. A total of 688 women with cosmetic SBIs were age-matched with 1301 women without SBIs. The occurrence of 13 health symptoms presented in general practice was assessed 1 year before implantation until 3 years after implantation. Comparisons were made regarding the number of symptoms and general practice consultations, before and after implantation and between the two groups., Results: Women with SBIs were more likely to experience three or more distinct health symptoms and a combination of multiple symptoms with multiple consultations during follow-up than women without SBIs (adjusted OR 1.44, 95% CI 1.06 to 1.96; adjusted OR 1.44, 95% CI 1.04 to 2.00, respectively). Women with SBIs also had more than twice the likelihood of manifesting these outcomes in the second year after implantation compared to the first year before implantation (OR 2.13, 95% CI 1.27 to 3.57; OR 2.13, 95% CI 1.22 to 3.72, respectively)., Conclusions: Women with cosmetic SBIs had increased odds of developing health symptoms after implantation compared to those before implantation and to women without SBIs. These results suggest an association between health symptoms and cosmetic SBIs that needs further research to explore whether there is causality or residual confounding., Competing Interests: Conflict of interest The authors declared no potential conflicts of interest with respect to the research, authorship and publication of this article., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Competing Interests: Conflict of interest The Department of Plastic & Reconstructive Surgery of the Erasmus MC received funding from POLYTECH Health & Aesthetics GmbH in the form of financial support for personnel costs for one PhD candidate (no grant number available) from July 2018 until July 2021. Three authors are affiliated to the Dutch Institute for Clinical Auditing (DICA), a non-profit organization, which facilitates the Dutch Breast Implant Registry (DBIR). MRDM is the data processor of data in DBIR and the Patient Access Tool described in this paper. All remaining authors have declared no conflicts of interest.

Ulnar artery revascularization in hypothenar hammer syndrome has repeatedly been shown to reduce ischaemic symptoms, however with varying graft patency percentages. This study prospectively assesses the effect of revascularization surgery with a vein graft using validated questionnaires in seven patients. The Disabilities of the Arm, Shoulder and Hand (DASH) and the Cold Intolerance Symptom Severity (CISS) questionnaires have been used to compare the preoperative and postoperative functionality and cold intolerance. All patients showed improvement in either functionality, or cold intolerance, or both from disabled to nearly normalized levels and resumed their occupation at final follow-up (mean of 28 months). Strikingly this was also the case in a patient with graft stenosis. Patients with the highest preoperative questionnaire scores showed most postoperative improvement. In conclusion, revascularization surgery seems to improve the symptomatology irrespective of graft patency. Questionnaires can be a valuable contribution to quantify and to follow the symptomatology in hypothenar hammer syndrome., Competing Interests: Declaration of Competing Interest The authors declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article., (Copyright © 2020 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Although the use of breast implants is generally considered to be safe, breast implants are associated with short- and long-term complications. To evaluate and improve the quality of breast implant surgery, and increase our knowledge of implant performance, the national Dutch Breast Implant Registry (DBIR) was established in 2015. DBIR is one of the first up-and-running breast implant registries worldwide and follows an opt-out structure., Objective: This article provides an overview of the first outcomes and experiences of the DBIR., Methods: The national coverage of DBIR was studied using data from the Dutch Health and Youth Care Inspectorate. The incidence rate of breast implants was calculated for 2016 and 2017, and patient, device, and surgery characteristics were compared between cosmetic breast augmentations or reconstructive indications. Four infection control, measures were selected to demonstrate the variation in the Dutch clinical practice., Results: In 2016, 95% of the hospitals and 78% of the private clinics participated in DBIR. Between 2015 and 2017, a total of 15,049 patients and 30,541 breast implants were included. A minimum breast implant incidence rate of 1 per 1,691 women could be determined for 2017. The majority of devices were inserted for a cosmetic indication (85.2%). In general, patient, device, and surgery characteristics differed per indication group. Substantial variation was seen in the use of infection control measures (range 0-100%)., Conclusion: Preliminary results obtained from DBIR show high national participation rates and support further developments toward the improvement of breast implant surgery and patient safety., (Copyright © 2019. Published by Elsevier Ltd.)

Background: Surgical resection of skin tumors in the medial canthal area may damage the lacrimal duct and can result in chronic epiphora. Postoncologic reconstruction of the lacrimal duct has not been studied extensively. The current study discusses the anatomical and functional features of the lacrimal duct. It describes short-term functional outcomes after monocanalicular reconstruction of the lacrimal duct in a case series of 10 patients., Methods: From February 2015 to October 2017, all patients with a postoncological lacrimal duct defect were analyzed to make an anatomical classification. The functional outcomes of patients after monocanalicular reconstruction were measured with the Munk scale up to 3 months after stent removal., Results: Twelve patients had lacrimal duct defects after Mohs resection. Anatomical characteristics were used to create a clinical classification for lacrimal duct defects. This classification divides the upper (U) and lower (L) proximal lacrimal duct into two sections which can be damaged: the punctum and pars verticalis (1), the canaliculus horizontalis (2), or combined (3). The Common lacrimal duct (C) is the distal part of the lacrimal duct and can also be affected. Ten patients were analyzed after lacrimal duct reconstruction. Three months after stent removal, none of the patients suffered from epiphora., Conclusions: This article proposes an anatomical classification for lacrimal duct defects in the proximal lacrimal drainage system. The classification can be applied in comparing cases and determining reconstructive strategies after oncologic skin tumor resection. Short-term results are promising for future efforts to reconstruct the lacrimal duct., (Copyright © 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Infections of the hand can result in significant limitation of the function of the hand, and may even require partial amputation of a digit. A felon is an abscess of the distal pulp of the fingertip, which can spread rapidly through the flexor tendon sheath when not treated appropriately. Knowledge of the anatomy and the correct method of physical examination are essential when assessing a patient suspected of having a felon or flexor tendon sheath infection. Here we present two patients with a complicated felon resulting in palmar necrosis of the distal phalanx of the thumb, in which a groin flap was used to reconstruct the thumb. This article describes the relevant anatomy, physical examination and treatment of a felon and flexor tendon sheath infection to prevent a complicated course.

Background: Breast reconstruction with deep inferior epigastric perforator (DIEP) flaps is typically a three-stage procedure, but additional operations may be required to deal with complications or to improve the aesthetic result. The purpose of this study was to evaluate the total number of operations needed after DIEP flap breast reconstruction to achieve a satisfactory end result for the patient., Patients and Methods: From December 2002 to October 2006, 99 DIEP flap breast reconstructions obtained an end result in 72 patients. Data were collected in a structured database. Additional operations and complications were evaluated for the entire group. A study-specific questionnaire was used to evaluate patient satisfaction., Results: The mean number of additional operations was 1.4 per patient. Patients with complications required more operations than patients without complications. Women who chose nipple reconstruction were younger than women who did not and were more likely to have had a primary or secondary than a tertiary reconstruction. The number of additional aesthetic operations was neither related to the occurrence of complications during the initial reconstruction, nor to patient satisfaction. Overall, patients were very satisfied with the end result., Conclusions: Completion of DIEP flap breast reconstruction involved the initial reconstruction and an average of 1.4 additional operations. Patients were generally very satisfied with the end result.

Purpose: Evaluation of objective and subjective functional follow-up results of intraoral radial forearm free flap reconstructions., Methods: A total of 149 patients had received radial forearm free flaps between January 1996 and December 2005. Seventy-two patients completed a European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-H&N35 (EORTC H&N35) in the follow-up study. Patients were divided according to location of defect (anterior or posterior) or irradiation. Thirty-nine patients with anterior positioned flaps received standardised physical examinations., Results: Flap survival was 99.3%. Complications were divided in early (<2 weeks; 23%) and late complications (20%). Most common complications were dehiscence or fistula, responding well to conservative treatment. Analysis of questionnaire subscales showed no statistically significant differences between anterior and posterior defects. Irradiation showed significant impairment for the ability to smell and taste. No important donor site impairment was found., Conclusion: The radial forearm free flap is an adequate method for reconstructions after resection of intraoral malignancies. Subjective functional outcome seemed to be defined by adjuvant radiotherapy, patient coping and, to a lesser extent, flap bulk for anterior defects.

New techniques for reconstructing large defects of the floor of the mouth include the use of cultured mucosal substitutes. The purpose of this study was to compare dispase and thermolysin for keratinocyte isolation. Keratinocyte yield per surface area of rabbit buccal mucosa was assessed by histology, cytokeratin 13 (CK13) staining, seeding efficiency analysis and cell diameter quantification. Surface areas of cultured mucosa were calculated. Histology showed that treatment by thermolysin resulted in incomplete separation of epidermis from dermis. Also, the absolute number of keratinocytes/cm(2) isolated mucosa, cell yield, cell size and seeding efficiencies was higher in the dispase group. A 3.45-fold larger graft could be reconstituted using dispase. The use of dispase, rather than thermolysin, to isolate cells from buccal mucosa is concluded to be favourable.