An abdominal bulge is an often-underreported complication of abdominally based breast reconstruction (ABBR) with no gold standard treatment. A bulge confers substantial morbidity to patients through compromised core function and poor esthetic contour. Here, we present a new technique for bulge repair that addresses both aspects through an open transversus abdominis release (TAR) with a well-fixed, polypropylene mesh. An electronic data warehouse query was initiated using keywords "bulge" and "TAR" for the senior author's (GAD) patients from 2020-2025 for bulge repair after ABBR. A total of 11 patients were included in the final analysis; their medical and surgical history, operative details, and clinic follow-up were collected. The average age was 58 years with a mean BMI of 29.3 kg/m2 (max 38.2 kg/m2). The average interval time between ABBR and bulge development was 127 days. Five patients failed a previous bulge repair, either planar mesh onlay with plication (n=3) or plication only (n=2). All patients endorsed complete resolution of bulge symptoms after TAR intervention with no clinical recurrences during an average follow-up of 379 days. Average width of the polypropylene mesh was 17.6 cm. A postoperative seroma and an incidence of focal, superficial delayed wound healing that resolved spontaneously were reported. Clinical photography is presented to demonstrate the resulting esthetic contour of the abdomen. The described open TAR uses a large, well-fixed polypropylene mesh that targets and re-tensions the attenuated inferior abdominal wall after ABBR. It is well-tolerated and reproducible across common permutations of postoperative bulge anatomy. (c) 2026 The Authors. Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Background: Poland syndrome in female patients is frequently associated with complex breast and chest wall asymmetry and requires individualized reconstructive strategies to achieve satisfactory symmetry while minimizing morbidity. Methods: A retrospective observational study was conducted on female patients with Poland syndrome who underwent two-stage alloplastic breast reconstruction between 2012 and 2023. Customized positioning of anatomical tissue expanders was used to reshape the skin envelope of the affected hemithorax and correct vertical and horizontal nipple-areola complex malposition. Anthropometric measurements, including sternal notch-to-nipple and midsternal line-to-nipple distances, were collected preoperatively and postoperatively. Statistical analyzes were used to evaluate symmetrical outcomes and correlations with some variables, including body mass index (BMI). Results: Twenty-four patients were included. Mean sternal notch-to-nipple distance on the affected side improved from 16.04 +/- 1.47 preoperatively to 19.10 +/- 1.32 cm postoperatively, whereas midsternal line-to-nipple distance improved from 8.77 +/- 1.20 to 11.06 +/- 0.98 cm. Higher BMI was associated with greater residual postoperative sternal notch-to-nipple asymmetry in an exploratory analysis. Conclusions: The proposed two-stage alloplastic algorithm achieved measurable anthropometric improvement in nipple-areola complex positioning in female patients with Poland syndrome. By combining customized expander orientation with staged implant reconstruction, this approach provides a reproducible strategy for reshaping the skin envelope and facilitating final breast symmetry while limiting donor-site morbidity. Level of Evidence: Therapeutic, IV. (c) 2026 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
OBJECTIVE:The main objective of this study was to confirm the consistency of the transverse cervical artery anterior perforator (TCAP) and describe its anatomical landmarks. The secondary objective was to define the role of TCAP flap in the head and neck reconstruction strategy. MATERIALS AND METHODS:Twenty-one flaps were dissected from 11 formalin-embalmed and 2 fresh cadavers. Flaps were raised distally to proximally, the TCAP was isolated and then injected with watercolor dye to delineate its vascular territory. One fresh cadaver underwent contrast injection, followed by angiography and cone beam computed tomography. In parallel, an in vivo Doppler ultrasonography study was conducted on 50 volunteers to measure the diameter and origin of TCAP. RESULTS:This anatomical study found that anterior thoracic perforator artery consistently originated from the transverse cervical artery with a median diameter of 1.6 mm, as confirmed using cone beam computed tomography. Anterior thoracic perforator artery was located between the clavicle (inferiorly), anterior scalene muscle (deeply), sternocleidomastoid muscle (medially), and omohyoid muscle (laterally). The median vascularized skin territory was 201.1 cm². the Doppler study identified the anterior thoracic perforator artery in 75 of 100 cases, with 98% of them arising from the transverse cervical artery in its scalenic section. CONCLUSION:The TCAP exhibits consistent anatomical landmarks that originate mainly from the transverse cervical artery in its scalenic section. Preoperative identification using Doppler ultrasonography can help to determine its course, diameter, and accessibility.
Background: Toe-to-hand transfer exemplifies the "like-with-like" principle and remains a reliable option for digit reconstruction. Here, we describe a modified technique to improve esthetic and functional outcomes in distal digit reconstruction. Methods: From January 2021 to March 2024, 103 patients with 114 injured digits underwent reconstruction using a great toe wrap-around flap combined with iliac bone grafting. Indications included thumb injuries distal to the metacarpophalangeal (MCP) joint and other digit injuries distal to the proximal interphalangeal (PIP) joint. Donor sites were closed using full-thickness skin grafts. Outcomes were assessed based on sensory recovery, function, and esthetics. Results: The cohort's mean age was 30.4 +/- 15.5 yr and included 54% men. The thumb was the most commonly reconstructed digit (n = 43; 37.7%). Five patients (4.9%) required re-exploration for vascular compromise; one had partial flap loss. All other flaps survived. The mean iliac bone graft length was 17.7 +/- 6.7 mm, with resorption in one case. Mean follow-up was 28.0 +/- 11.7 months. At 6 months postoperatively, average static two-point discrimination was 8 mm (range: 7-10 mm), and the Semmes-Weinstein monofilament score averaged 2.83. All reconstructed digits achieved stable pinching and grasping. No significant donor-site complications, including no wound ulceration, delayed healing, persistent pain, cold intolerance, or gait disturbance, were observed. Conclusions: The modified great toe wrap-around flap with iliac bone grafting provides effective distal digit reconstruction with favorable functional and esthetic outcomes. It preserves toe integrity, minimizing donor-site morbidity while offering a viable option for microsurgical reconstruction.
Background: Postoperative octreotide is known to reduce lymphorrhea after axillary node dissection in breast cancer and other gynecological malignancies with varying efficacy. However, the effect of octreotide on the development of lymphedema after axillary node dissection has not been explored. We sought to evaluate the role of octreotide in preventing lymphedema in patients who underwent axillary lymphadenectomy. Methods: This retrospective review of the TriNetX Analytics Network queried the Global Collaborative Network with over 170 million patients to identify patients undergoing complete axillary lymphadenectomy or radical, modified radical, or partial mastectomy with axillary node dissection. Then, the patients who received octreotide after surgery were identified. Patients with a history of octreotide use prior to surgery or hereditary lymphedema were excluded. Patients were identified using diagnosis and procedure codes. Occurrence of postoperative lymphedema was compared between 1:1 propensity score matched cohorts. Patients were matched for age, body mass index (BMI), gender, race, radiation therapy, and smoking among others. Risk ratios, t-tests, and Z-tests were used to compare outcomes. Results: A total of 222 patients who underwent axillary lymphadenectomy and received octreotide postoperatively were matched to 222 patients who did not receive octreotide from an original pool of 69,955 patients. Prior to matching, the standardized mean difference between the two groups was greater than 0.1 for age, BMI, and several race categories. After matching, all standardized mean differences were less than 0.1. Patients who received octreotide were at significantly lesser risk of developing lymphedema (p < 0.0001) when compared to patients who did not receive octreotide. Patients who received octreotide required fewer manual therapy techniques including lymphatic massage/drainage (p < 0.05). Additionally, patients who received octreotide were less likely to undergo plastic surgical consultation or surgical correction of their lymphedema (p < 0.05). Patients who received octreotide were not at increased risk of bradycardia (p > 0.05) or hypothyroidism (p > 0.05). Conclusions: Patients who underwent axillary lymphadenectomy and received octreotide postoperatively were associated with significantly less risk of developing lymphedema and undergoing surgical lymphedema correction without increased risk of hypothyroidism or bradycardia. This study establishes the potential role of octreotide for lymphedema prevention in patients undergoing axillary lymphadenectomy.
