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superior capsular reconstruction

Christopher R Adams, Patrick J Denard, Paul C Brady, Robert U Hartzler, Stephen S Burkhart
In a subset of patients with rotator cuff tears, the glenohumeral joint has minimal degenerative changes and the rotator cuff tendon is either irreparable or very poor quality and unlikely to heal. Reverse shoulder arthroplasty (RSA) is often considered for these patients despite the lack of glenohumeral arthritis. However, due to the permanent destruction of the glenohumeral articular surfaces, complication rates, and concerns about implant longevity with RSA, we believe the superior capsular reconstruction (SCR) is a viable alternative...
July 2016: American Journal of Orthopedics
Joseph Liu, Alexander S McLawhorn, Alexander B Christ, Peteris Dzenis, John H Healey
BACKGROUND: The posterolateral approach is one of the most common approaches used during hip arthroplasty. A posterior soft tissue repair is necessary to limit the risk of postoperative dislocation. For a trapezoidal capsulotomy, the proximal limb divides the superior band of the iliofemoral ligament (Bigelow's ligament). A transosseous repair frequently leaves a defect in this region, which may elevate the risk for dislocation. The purpose of this article is to describe a simple, rational technique for reinforcing the posterior capsular repair...
July 2016: HSS Journal: the Musculoskeletal Journal of Hospital for Special Surgery
Maximilian Petri, Joshua A Greenspoon, Peter J Millett
Massive irreparable rotator cuff tears in young patients are a particular challenge for the orthopaedic surgeon. Surgical treatment options include debridement, partial rotator cuff repair, patch-augmented rotator cuff repair, bridging rotator cuff reconstruction with graft interposition, tendon transfer, and reverse total shoulder arthroplasty. Recently, reconstruction of the superior glenohumeral capsule using a fascia lata autograft has been suggested to reduce superior glenohumeral translation and restore superior stability...
December 2015: Arthroscopy Techniques
Robert Thorsness, Anthony Romeo
Compared with smaller tears, massive rotator cuff tears present significant clinical management dilemmas for the treating surgeon because they are often fraught with structural failure and poor outcomes. To optimize healing, current surgical methods look to optimize footprint coverage and enhance the biological environment for healing. Double-row techniques have demonstrated clear biomechanical advantages in controlled cadaveric studies, but have yet to demonstrate clear clinical efficacy over more simple repair techniques...
May 1, 2016: Orthopedics
C Garusi, A Manconi, G Lanni, G Lomeo, P Loschi, M C Simoncini, L Santoro, M Rietjens, J Y Petit
OBJECTIVES: The latissimus dorsi (LD) flap is well-known in breast reconstruction especially in previously-irradiated patients, in order to have a low capsular contraction rate whenever an implant is associated. The aim of this study is to closely evaluate the effect of LD flap harvesting on shoulder function as well as specific movements related to the LD, both objectively and subjectively. MATERIALS AND METHODS: We retrospectively collected data on 86 patients who underwent pedicled LD muscle flap for breast reconstruction at the European Institute of Oncology between September 1995 until March 2011...
June 2016: Breast: Official Journal of the European Society of Mastology
Michael J Rossi
Biomechanical study of superior capsular reconstruction for irreparable supraspinatus tears has lower subacromial contact pressures with a thicker graft placed in 15° to 45° of shoulder abduction. Whether this translates to the clinical situation of massive rotator cuff insufficiency remains to be determined.
March 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
Teruhisa Mihata, Michelle H McGarry, Timothy Kahn, Iliya Goldberg, Masashi Neo, Thay Q Lee
BACKGROUND: Patients with irreparable rotator cuff tears have a defect of the superior capsule, which creates discontinuity of the shoulder capsule in the transverse direction (anterior-posterior direction). This effect is one of the causes underlying shoulder instability after rotator cuff tears. PURPOSE/HYPOTHESIS: The purpose of this study was to assess the effects of anterior and posterior continuity on shoulder biomechanics after superior capsule reconstruction (SCR)...
June 2016: American Journal of Sports Medicine
Alan M Hirahara, Christopher R Adams
Massive irreparable rotator cuff tears have been troublesome entities to treat, especially in younger patients. Few good options exist, leaving most patients in recent years receiving a reverse total shoulder arthroplasty. Reverse shoulder arthroplasty carries serious risks, a limited lifespan, and no other viable options should it fail. Recent biomechanical studies have shown that the superior capsule is critical to containing the glenohumeral joint reduced, allowing the larger muscles like the deltoid and pectoralis major to function properly...
December 2015: Arthroscopy Techniques
Wei-Lin Wang, Song Ye, Sheng Yan, Yan Shen, Min Zhang, Jian Wu, Shu-Sen Zheng
BACKGROUND: With the development of new surgical techniques, pancreaticoduodenectomy (PD) with portal vein or superior mesenteric vein (PV/SMV) resection has been used in the treatment of patients with borderline resectable pancreatic cancer. However, opinions of surgeons differ in the effectiveness of this surgical technique. This study aimed to investigate the effectiveness of this approach in patients with pancreatic cancer. METHODS: Follow-up visits and retrospective analysis were carried out of 208 patients with pancreatic cancer who had undergone PD (PD group) and PD combined with PV/SMV resection and reconstruction (PDVR group) from June 2009 to May 2013 at our center...
August 2015: Hepatobiliary & Pancreatic Diseases International: HBPD INT
Kurt E Jacobson, Matthew D Longacre
Posterolateral rotatory instability of the knee causes significant morbidity if unrecognized and left untreated. With both acute and chronic injuries, restoration of the normal anatomy is crucial for a good outcome. During capsular repairs, detailed knowledge of the anatomy will help the surgeon repair the pathoanatomy. To complement the direct approach, an osteotomy of the lateral femoral condyle that includes the attachments of the fibular collateral ligament and popliteal tendon allows superior visualization of the lateral meniscus and its attachments, as well as the associated deep structures...
March 2015: Sports Medicine and Arthroscopy Review
Louis Wessels, Siun Murphy, Steven Merten
UNLABELLED: A well-defined inframammary fold (IMF) is essential in providing an aesthetically pleasing and stable result in breast procedures. The position of the IMF on the chest wall determines the "footprint" of the breast, and hence the breast and chest aesthetic as a whole. Implant malposition is reported in the literature to occur in 5-8 % of primary breast augmentation patients. This occurs most commonly in a caudal direction, which is the most difficult problem to correct, as reported by Tebbett (Clin Plast Surg 28:425-434, 2001)...
April 2014: Aesthetic Plastic Surgery
L Franklyn Elliott, Carrie K Chu, Jarrod Daniel, Garrett Harper, Patricia Bergey
Prior breast augmentation in patients desiring post-mastectomy reconstruction provides a unique opportunity for capsular preservation and immediate, single-step implant reconstruction. We report a case series of a single-surgeon experience with immediate implant reconstruction after skin-sparing mastectomy in patients with prior subpectoral augmentation. Final implant volumes, complications, and outcomes were examined. Twenty patients (15 bilateral, total 35 breasts) were included. Eighteen (90%) patients were treated for cancer...
2014: Annals of Plastic Surgery
Andrew Kornstein
INTRODUCTION: Patients who present for augmentation mammoplasty with poor quality mammary soft-tissue support may be at increased risk for post-operative complications. Non-crosslinked intact porcine-derived acellular dermal matrix (Strattice™ Reconstructive Tissue Matrix, LifeCell Corp., Branchburg, NJ, USA) may enhance soft-tissue support in such patients and reduce implant-related complications, including capsular contracture, rippling, palpability, and malposition. The objective of this case report series was to describe the outcomes of three patients with poor quality mammary soft-tissue support who underwent primary cosmetic breast augmentation with pre-emptive implantation of porcine-derived acellular dermal matrix...
2013: Journal of Medical Case Reports
Clay G Forsberg, David A Kelly, Benjamin C Wood, Stephanie L Mastrangelo, Anthony J DeFranzo, James T Thompson, Lisa R David, Malcolm W Marks
INTRODUCTION: Tissue expander and implant-based breast reconstruction after mastectomy is the most common method of breast reconstruction. Modifications of the traditional total submuscular reconstruction (TSR) have been made using acellular dermal matrix (ADM) to create an inferolateral sling and a more natural implant pocket for superior aesthetic results. The objective of this study was to assess aesthetic outcomes when using ADM in breast reconstruction. METHODS: A retrospective chart review identified all patients who underwent implant-based breast reconstruction from 2005 to 2009 at our institution...
2014: Annals of Plastic Surgery
Eric C Burdge, James Yuen, Matthew Hardee, Pranjali V Gadgil, Chandan Das, Ronda Henry-Tillman, Daniela Ochoa, Soheila Korourian, V Suzanne Klimberg
BACKGROUND: Skin-sparing mastectomy (SSM) or nipple skin-sparing mastectomy (NSSM) are procedures commonly offered as part of the surgical treatment for breast cancer. Each involves a mastectomy with preservation of the skin overlying the breast (in SSM) and often also the skin overlying the nipple-areolar complex (NSSM). At the time of mastectomy, immediate reconstruction with a tissue expander or implant is performed for a more favorable cosmetic outcome. Until now, these procedures have been reserved for low-risk patients and are rarely offered to patients with advanced disease where neoadjuvant chemotherapy and postmastectomy radiation are a planned part of the treatment...
October 2013: Annals of Surgical Oncology
Katie E Weichman, Peter Niclas Broer, Neil Tanna, Stelios C Wilson, Anna Allan, Jamie P Levine, Christina Ahn, Mihye Choi, Nolan S Karp, Robert Allen
BACKGROUND: Autologous breast reconstruction offers higher rates of patient satisfaction, but not all patients are ideal candidates, often due to inadequate volume of donor sites. Although autologous fat grafting is frequently used to augment volume and contour abnormalities in implant-based breast reconstruction, its clear utility in microsurgical breast reconstruction has yet to be defined. Here, we examined patients undergoing autologous microsurgical breast reconstruction with and without the adjunct of autologous fat grafting to clearly define utility and indications for use...
July 2013: Annals of Plastic Surgery
Magelia Kitcat, Alexandra Molina, Charlotte Meldon, Nagham Darhouse, Jon Clibbon, Charles M Malata
INTRODUCTION: Immediate small breast reconstruction poses challenges including limited potential donor site tissues, a thinner skin envelope, and limited implant choice. Few patients are suitable for autologous reconstruction while contralateral symmetrization surgery that often offsets the problem of obvious asymmetry in thin and small-breasted patients is often unavailable, too expensive, or declined by the patient. METHODS: We reviewed 42 consecutive patients with mastectomy weights of 350 g or less (the lowest quartile of all reconstructions)...
2012: Eplasty
L S Paek, J O Tétreault-Paquin, S St-Jacques, M Nelea, M A Danino
PURPOSE: Scanning electron microscopy (SEM) is a powerful analytical tool that allows the study of interactions between commonly used biomaterials and the human body. In conventional SEM (HiVac), hydrated biological samples cannot be analyzed in their natural state and must be dried and metallized. The primary goal of this study is to present recent developments in SEM, notably Environmental SEM (ESEM). The secondary objective is to define the potential utility of these new technologies in the study of periprosthetic breast capsules...
June 2013: Annales de Chirurgie Plastique et Esthétique
Scott L Spear, Sarah R Sher, Ali Al-Attar
Prosthetic-based breast reconstruction commonly involves device placement in either a total submuscular pocket or a partial subpectoral position for just superior pole coverage, with various possible strategies for inferior pole coverage. Historically, the pectoralis major muscle is managed either by suturing the muscle to the inferior flap or with marionette sutures; alternatively, the device is placed under total muscle/fascia coverage (under the pectoralis major, plus the serratus anterior and rectus abdominis muscles or fascia)...
November 2012: Plastic and Reconstructive Surgery
K Hanada, H Fukuda, K Hamada, T Nakajima
Shoulder problems are common in patients with paraplegia because of long-term weight bearing that occurs when crutches or wheelchairs are used and when transfers are done. Two moderate and two large rotator cuff tears in three patients with paraplegia were operated on and evaluated with the use of our shoulder assessment system. A special roentgenographic projection designated as a "push-up view" was used after the operation for evaluation. It is an anteroposterior projection of both shoulders on a large casette and is done while the patient lifts himself or herself up with extended elbows off the seat of an armchair...
March 1993: Journal of Shoulder and Elbow Surgery
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