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Southern SJ, Sharpe DT. A reduction mammaplasty model for the trainee and patient. BRITISH JOURNAL OF PLASTIC SURGERY 1997; 50:142-3. [PMID: 9135434 DOI: 10.1016/s0007-1226(97)91329-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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27
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Malata CM, Feldberg L, Coleman DJ, Foo IT, Sharpe DT. Textured or smooth implants for breast augmentation? Three year follow-up of a prospective randomised controlled trial. BRITISH JOURNAL OF PLASTIC SURGERY 1997; 50:99-105. [PMID: 9135425 DOI: 10.1016/s0007-1226(97)91320-5] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Silicone breast implant surface texturing has been shown to reduce the short-term incidence of adverse (Baker III/IV) capsular contracture in augmentation mammaplasty in double-blind randomised controlled trials. It is, however, undetermined whether the textured surface merely delays the onset of severe contracture or its effect on capsular contraction is persistent. The current study reviewed, after three years, 49 of the 53 patients who had undergone subglandular breast augmentation mammaplasty in a randomised double-blind study with textured or smooth silicone gel-filled implants in 1989. The incidence of adverse capsular contracture was 59% for smooth implants and 11% for textured ones (P = 0.001; chi 2 = 10.60). Eight patients (31%) with smooth prostheses underwent breast implant exchange for severe capsular contracture between the one and three year assessments, compared with a revisional surgery rate of only 7.4% (2/27 patients) for the textured group (P < 0.04). These adverse capsular contracture and revisional breast implant surgery rates clearly demonstrate that the effect of textured implants in reducing capsular contracture in augmentation mammaplasty found at one year is maintained at three years, and suggest that it may be long lasting.
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Abstract
In this second article, the authors outline the process of reconstructive surgery using the tissue expansion technique described in the January 1995 issue of JWC.
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Abstract
A review of a surgical technique which uses the skin's ability to stretch to obtain tissue for reconstruction
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31
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Liston JC, Malata CM, Varma S, Scott M, Sharpe DT. The role of ultrasound imaging in the diagnosis of breast implant rupture: a prospective study. BRITISH JOURNAL OF PLASTIC SURGERY 1994; 47:477-82. [PMID: 7952818 DOI: 10.1016/0007-1226(94)90030-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Breast ultrasound to assess possible implant rupture was performed on 24 consecutive patients (43 breasts) by the same radiologist immediately before revisional breast implant surgery. Comparison of the clinical, ultrasound and operative findings showed ultrasound to be three times as sensitive as clinical judgement in predicting implant rupture. The sensitivity of ultrasound in predicting impaired implant integrity was 70% (versus 23% for clinical examination) with a specificity of 96%. The ultrasound features indicating leakage are outlined later. The positive predictive value of an abnormal scan was 90% and that of a normal scan 87%. It is concluded that breast ultrasound is a simple, quick, non-invasive method which contributes significantly to the assessment of patients with suspected breast implant rupture.
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Malata CM, Boot JC, Bradbury ET, Ramli AR, Sharpe DT. Congenital breast asymmetry: subjective and objective assessment. BRITISH JOURNAL OF PLASTIC SURGERY 1994; 47:95-102. [PMID: 8149066 DOI: 10.1016/0007-1226(94)90166-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
There is currently no standard objective method for the assessment of developmental breast asymmetry. The results of corrective surgery in 24 patients with congenital breast deformities were evaluated subjectively (symmetry scores by patients and panels of observers), and objectively (linear measurements of nipple position and stereophotogrammetrically determined breast volumes). The latter were obtained using a newly developed prototype computer based technique (Bodymap). This study is the first reported use of stereophotogrammetry in assessing results of surgery for the correction of congenital breast asymmetry. The results obtained, their clinical implications, and the usefulness of Bodymap in the objective measurement of breast asymmetry are discussed.
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Malata CM, Varma S, Scott M, Liston JC, Sharpe DT. Silicone breast implant rupture: common/serious complication? MEDICAL PROGRESS THROUGH TECHNOLOGY 1994; 20:251-260. [PMID: 7877570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Of the potential health risks of silicone breast implants it is the concern about implant durability, life span and the possible association with connective tissue disease which has attracted most attention. A prospective study addressing these factors was therefore undertaken over an 11 month period. 51 patients presenting with significant capsular contracture, suspected prosthesis rupture or unrelieved implant-induced anxiety underwent revisional breast surgery after biochemical, haematological and immunological screening. Of these 51 patients (83 breasts), 14 (19 breasts) had ruptured implants (23% incidence). These were all smooth prostheses belonging to a cohort manufactured more than 10 years ago; their mean in situ duration being 12 years vs. 5.5 years for the intact group (p = 0.0024; Kruskal-Wallis one-way ANOVA). There were no systemic complications from implant rupture and the mean blood silicon level was normal. One patient with pre-existing pernicious anaemia had elevated autoantibodies. The mean ESR in the ruptured implant group was 6 mm/hour. It is concluded that rupture of breast implants is not as uncommon as hitherto thought and is strongly correlated with their in situ duration. In this study implant gel leakage was not associated with serious systemic effects.
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Shuter ML, Malata CM, Duffy JS, Sharpe DT. Determination of relative contributions of 'mechanical' and 'biological' creep in tissue expansion using in vivo pressure monitoring: a preliminary report. Med Eng Phys 1994; 16:24-8. [PMID: 8162261 DOI: 10.1016/1350-4533(94)90006-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
This work outlines the theory underlying tissue deformation in response to an applied force and presents a model to evaluate relative contributions to tissue generation from mechanical and biological creep. Using in vivo pressure measurement, this model has been tested with clinical data generated from a heterogeneous series of 10 patients undergoing tissue expansion. Preliminary results indicate that the model proposed is able to fit accurately both in vitro and in vivo data. Extrapolation of the model, in time, may lead to a prediction of the relative contributions of 'biological' and 'mechanical' creep.
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35
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Coleman DJ, Sharpe DT, Naylor IL, Chander CL, Cross SE. The role of the contractile fibroblast in the capsules around tissue expanders and implants. BRITISH JOURNAL OF PLASTIC SURGERY 1993; 46:547-56. [PMID: 8252260 DOI: 10.1016/0007-1226(93)90104-j] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The occurrence, structure and contractility of myofibroblasts in the capsules around tissue expanders and static implants has been studied in the rat, pig and humans. The capsules showed a characteristic layered structure with myofibroblasts being the predominant cell type. Capsular strips contract in vitro in a manner characteristic of fibroblast contraction. The contractile ability decreased with the time since expander insertion; and increased with expander exposure, peri-expander infection and clinical evidence of adverse capsular contracture. An hypothesis is proposed that capsular contracture is analogous to wound contraction, and that intraimplant pressure usually inhibits capsular contraction. Evidence is shown from intraexpander pressure measurements to support this hypothesis. The clinical implications for tissue expansion and breast augmentation are discussed.
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36
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Slator RC, Wilson GR, Sharpe DT. Postburn breast reconstruction: tissue expansion prior to contracture release. Plast Reconstr Surg 1992; 90:668-71; discussion 672-4. [PMID: 1410006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Tissue expansion of the scarred chest following burns results in a poor breast mound shape with little projection or inframammary fold, since the expander, like normal developing breast tissue, is kept flat by the scarred skin envelope. We present a case that demonstrates that adequate projection of the breast and formation of an inframammary fold can be achieved by expansion if extensive release and skin grafting of contractures over the breast mound are performed after expansion. Maintained expansion will act as a stent reducing secondary contracture of the grafted-areas.
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Foo IT, Coleman DJ, Holmes JD, Palmer JH, Sharpe DT. Delay between expansion and expander/implant exchange in breast reconstruction--a prospective study. BRITISH JOURNAL OF PLASTIC SURGERY 1992; 45:279-83. [PMID: 1623343 DOI: 10.1016/0007-1226(92)90052-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
It has been suggested that delay between expansion and insertion of the definitive prosthesis in breast reconstruction reduces the incidence of adverse capsular contracture. We have carried out a prospective trial to examine this hypothesis. 65 patients were randomly allocated into two groups; in one, insertion of the definitive prosthesis was 2 weeks following expansion ("immediate") and in the other, 6 months ("delayed"). The incidence of adverse capsular contracture assessed both by the Baker Scale and a linear analogue scale showed no difference between the two groups. A new objective method for measuring ptosis using a specially designed template is described. The degree of ptosis was not affected by the delay.
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38
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Abstract
Lid loading with gold weights inserted into a submuscular pocket in the upper eyelid is a useful, simple, and effective method for the treatment of lagophthalmos in patients with temporary or permanent facial nerve palsy. The incidence of complications in our series was high. The reason for this are discussed, and methods of reducing the rate of complications are suggested.
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Coleman DJ, Foo IT, Sharpe DT. Textured or smooth implants for breast augmentation? A prospective controlled trial. BRITISH JOURNAL OF PLASTIC SURGERY 1991; 44:444-8. [PMID: 1933116 DOI: 10.1016/0007-1226(91)90204-w] [Citation(s) in RCA: 136] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
This study examines the hypothesis that textured surface silicone implants reduce the incidence of adverse capsular contracture in breast augmentation. A total of 53 patients were entered into a prospective study; they were randomly assigned to receive either smooth or textured implants which were placed in the submammary plane. Of these, 50 patients were assessed at 12 months by a panel of observers who did not know which type of implants had been used. Adverse capsular contracture (Baker grades 3 and 4) was found in 28 breasts augmented with smooth surface implants (58%) and in 4 breasts in the textured surface implant group (8%). This reduction in adverse contracture using textured surface implants was highly significant (p less than 0.0001). Careful trial design is essential in studies of this sort in order that we can obtain useful data regarding the causes and prevention of adverse capsular contracture.
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40
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Wilmshurst AD, Sharpe DT. Immediate placement of tissue expanders in the management of large excisional defects on the face. BRITISH JOURNAL OF PLASTIC SURGERY 1990; 43:150-3. [PMID: 2328375 DOI: 10.1016/0007-1226(90)90153-q] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Where excision of a facial lesion leaves a defect too large for local flap reconstruction, tissue expansion is frequently a more desirable option than a skin graft, providing as it does tissue which exactly matches that which has been lost. For malignant skin lesions where removal should not be delayed by preliminary expansion of the flap, the expander can be placed simultaneously with tumour excision thus keeping the reconstruction to two stages. A temporary skin graft is employed in the interim. Our experience with this approach in five patients with large facial malignancies is presented and discussed.
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41
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Abstract
This paper discusses the problems of handling major burns in disasters with particular reference to the disaster that occurred in Bradford. Several major features of the Bradford fire, in which 56 people died, made its management much simpler than might be expected in subsequent burns disasters; these are discussed. Lessons that have been learned from handling this disaster are indicated.
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42
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Sharpe DT. Management of burns in major disasters. NATNEWS 1989; 26:9-10. [PMID: 2628765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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43
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Brooks SG, Leveson SH, Sharpe DT. The use of a latissimus dorsi myocutaneous flap to cover an axillobifemoral vascular prosthetic graft. EUROPEAN JOURNAL OF VASCULAR SURGERY 1989; 3:367-8. [PMID: 2527762 DOI: 10.1016/s0950-821x(89)80076-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We describe a case of seroma formation with skin necrosis overlying an axillobifemoral dacron graft, which was treated by excision of the affected skin and closure using a latissimus dorsi myocutaneous flap.
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44
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Sharpe DT, Palmer JH. Tissue expander tube exteriorization using a stylet. Plast Reconstr Surg 1989; 84:363. [PMID: 2636859 DOI: 10.1097/00006534-198908000-00037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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45
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Sharpe DT, Burd RM. Tissue expansion in perspective. Ann R Coll Surg Engl 1989; 71:175-81. [PMID: 2589784 PMCID: PMC2498897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Tissue expansion is a recent advance in skin cover technique. Its empirical use has enabled many previously difficult reconstructions to be completed without recourse to distant flaps. Its high complication rate and lack of basic scientific understanding at present restrict its use to selected cases, but the quality of repairs possible by this method encourage further serious scientific study.
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46
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Roberts AC, Coleman DJ, Sharpe DT. Custom-made nipple-areola prostheses in breast reconstruction. BRITISH JOURNAL OF PLASTIC SURGERY 1988; 41:586-7. [PMID: 3207959 DOI: 10.1016/0007-1226(88)90165-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The nipple-areola prosthesis is a useful temporary or permanent adjunct to breast reconstruction. The commercially available prostheses, however, are unable to reflect the remarkable normal variation in this anatomical feature. We describe the production and use of custom-made prostheses using the remaining nipple-areola complex as a template. Their success in 72 patients has led us to adopt such prostheses as routine in breast reconstruction.
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47
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Kelly SA, Dickson MG, Sharpe DT. Calcium alginate as a temporary recipient bed dressing prior to the delayed application of split skin grafts. BRITISH JOURNAL OF PLASTIC SURGERY 1988; 41:445. [PMID: 3293681 DOI: 10.1016/0007-1226(88)90094-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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48
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49
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Dickson WA, Sharpe DT, Jackson IT. Experience with an external valve in small volume tissue expanders. BRITISH JOURNAL OF PLASTIC SURGERY 1988; 41:373-7. [PMID: 3395769 DOI: 10.1016/0007-1226(88)90077-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Tissue expansion has been a reconstructive technique for nearly 10 years. All published work has described serial expansion by percutaneous injection into a buried reservoir. This paper reviews a small series of patients who had tissue expansion using small volume expanders with an external valve. The complications with small expanders are discussed. The external valve is shown to be satisfactory and free from infection in this series.
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50
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Abstract
A case of osteogenic sarcoma of the tongue is described occurring 25 years following radiotherapy for a squamous cell carcinoma.
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