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Article: Introduction to "Advances in Microsurgical Breast Reconstruction".

Salibian, Ara A / Patel, Ketan M

2024 Volume 13, Issue 2, Page(s) 128–130

Language	English
Publishing date	2024-02-20
Publishing country	China (Republic : 1949- )
Document type	Editorial
ZDB-ID	3016969-0
ISSN	2227-8575 ; 2227-684X
ISSN (online)	2227-8575
ISSN	2227-684X
DOI	10.21037/gs-22-562
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Microsurgery in oncoplastic breast reconstruction.

Salibian, Ara A / Patel, Ketan M

Gland surgery

2023 Volume 12, Issue 4, Page(s) 527–534

Abstract: Oncoplastic breast reconstruction has allowed for the optimization of oncologic and reconstructive outcomes after breast-conserving surgery (BCS). Volume replacement procedures in oncoplastic reconstruction most commonly utilize regional pedicled flaps, ... ...

Abstract	Oncoplastic breast reconstruction has allowed for the optimization of oncologic and reconstructive outcomes after breast-conserving surgery (BCS). Volume replacement procedures in oncoplastic reconstruction most commonly utilize regional pedicled flaps, though several studies have reported benefits to free tissue transfer for oncoplastic partial breast reconstruction in the immediate, delayed-immediate and delayed settings. Microvascular oncoplastic breast reconstruction is a useful technique in the appropriate patients with small-to-medium size breasts and larger tumor-to-breast ratios who desire to preserve breast size, those with a paucity of regional breast tissue and patients that wish to avoid chest wall and back scars. Several free flap options for partial breast reconstruction exist, including superficially-based abdominal flaps, medial thigh-based flaps, deep inferior epigastric artery perforator (DIEP) flaps and thoracodorsal artery-based flaps. However, special consideration should be given to preserving donor sites for potential future total autologous breast reconstruction with any flap choice that should be tailored to individual recurrence risk. Aesthetically placed incisions should take recipient vessel access into consideration which include the internal mammary vessels and perforators medially, and then intercostal, serratus branch and thoracodorsal vessels laterally. The utilization of a thin strip of lower abdominal tissue based on the superficial abdominal circulation allows for a well-concealed donor site with minimal morbidity and preservation of the abdominal donor site if future total autologous breast reconstruction is needed. Optimizing outcomes requires a team-based approach to appropriately design recipient and donor-site considerations while individualizing tumor and patient-specific plans.
Language	English
Publishing date	2023-03-20
Publishing country	China (Republic : 1949- )
Document type	Journal Article ; Review
ZDB-ID	3016969-0
ISSN	2227-8575 ; 2227-684X
ISSN (online)	2227-8575
ISSN	2227-684X
DOI	10.21037/gs-22-561
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Outcomes, Concepts, Technical Refinements, and Challenges in the Microvascular Repair of Full-Thickness Nasal Defects.

Menick, Frederick J / Salibian, Arthur

Plastic and reconstructive surgery

2023 Volume 151, Issue 6, Page(s) 1002e–1014e

Abstract: Background: Repair of full-thickness nasal defects may require distant tissue, when local or regional donors are inadequate or unavailable. The authors' microvascular designs, technical details, and complications using a radial forearm flap to restore ... ...

Abstract	Background: Repair of full-thickness nasal defects may require distant tissue, when local or regional donors are inadequate or unavailable. The authors' microvascular designs, technical details, and complications using a radial forearm flap to restore nasal lining have been described in past publications. In this article, the authors review stages 2 through 5, using a forehead flap and rib grafts to resurface the nose and build a support framework. The authors examine their complications, long-term aesthetic and functional outcomes, clinical refinements, and continuing reconstructive challenges. Methods: Thirty-eight full-thickness nasal defects were repaired between 2001 and 2018. Records review identified the type and frequency of complications and their management. Patients were surveyed to determine their overall satisfaction, quality of life, restoration to a normal appearance, donor scars, the value of a late revision, airway function, and need for nasal stents. Postoperative results were classified by independent evaluators as very good, good, fair, and poor. Results: Repair was completed in 35 of 38 patients. Fifty percent of patients returned an anonymous survey; 85% were very satisfied; 75% declared excellent, very good, or good breathing; 75% used stents never/rarely; 95% appeared normal; and 95% would recommend to other patients. An independent review classified the aesthetic results as 94% very good to good, 3% fair, and 3% poor. Conclusion: A folded radial forearm lining flap, a three-stage full-thickness forehead flap for cover, and a late revision can repair difficult nasal defects, as shown in a large series of patients with long-term follow-up. Clinical question/level of evidence: Therapeutic, IV.
MeSH term(s)	Humans ; Rhinoplasty/methods ; Quality of Life ; Nose Neoplasms/surgery ; Nose/surgery ; Nose/blood supply ; Plastic Surgery Procedures
Language	English
Publishing date	2023-01-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	208012-6
ISSN	1529-4242 ; 0032-1052 ; 0096-8501
ISSN (online)	1529-4242
ISSN	0032-1052 ; 0096-8501
DOI	10.1097/PRS.0000000000010141
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Article ; Online: Modern Approaches to Implant-Based Breast Reconstruction.

Salibian, Ara A / Karp, Nolan S

Clinics in plastic surgery

2023 Volume 50, Issue 2, Page(s) 223–234

Abstract: The modern approach to implant-based breast reconstruction encompasses an evolution in surgical techniques, patient selection, implant technology, and use of support materials. Successful outcomes are defined by teamwork throughout the ablative and ... ...

Abstract	The modern approach to implant-based breast reconstruction encompasses an evolution in surgical techniques, patient selection, implant technology, and use of support materials. Successful outcomes are defined by teamwork throughout the ablative and reconstructive processes as well as appropriate and evidence-based utilization of modern material technologies. Patient education, focus on patient-reported outcomes, and informed and shared decision-making are the key to all steps of these procedures.
MeSH term(s)	Humans ; Female ; Acellular Dermis ; Mammaplasty/methods ; Breast Implants ; Plastic Surgery Procedures ; Mastectomy, Subcutaneous/methods ; Breast Neoplasms ; Breast Implantation/methods ; Retrospective Studies
Language	English
Publishing date	2023-01-02
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	193117-9
ISSN	1558-0504 ; 0094-1298
ISSN (online)	1558-0504
ISSN	0094-1298
DOI	10.1016/j.cps.2022.09.003
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Article: New strategies in ecotoxicology and toxicogenomics

Salibián, Alfredo

International journal of environment and health

2017 Volume 8, Issue 3, Page(s) 193

Language	English
Document type	Article
ZDB-ID	2383450-X
ISSN	1743-4955
Database	Current Contents Nutrition, Environment, Agriculture

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Article ; Online: Splitting the Difference: Using Synthetic and Biologic Mesh to Decrease Cost in Prepectoral Immediate Implant Breast Reconstruction.

Karp, Nolan S / Salibian, Ara A

Plastic and reconstructive surgery

2021 Volume 147, Issue 3, Page(s) 580–584

Abstract: Summary: Prepectoral breast reconstruction has minimized morbidity and dynamic deformities associated with submuscular implant-based breast reconstruction. However, reliance on implant coverage with acellular dermal matrix in immediate implant ... ...

Abstract	Summary: Prepectoral breast reconstruction has minimized morbidity and dynamic deformities associated with submuscular implant-based breast reconstruction. However, reliance on implant coverage with acellular dermal matrix in immediate implant reconstruction remains limited by high material costs. The authors describe a technique in which anterior implant coverage in prepectoral reconstruction is split into acellular dermal matrix inferolaterally and synthetic, absorbable mesh superiorly. Use of acellular dermal matrix inferiorly provides coverage and reinforces the inframammary fold, whereas the absorbable mesh is trimmed and sutured to the acellular dermal matrix at the appropriate tension to support the implant and relieve pressure on mastectomy flaps. A retrospective review was performed on all consecutive prepectoral one-stage breast reconstructions using this technique at a single institution. Patient demographics, mastectomy and reconstruction characteristics, reconstructive outcomes, and cost of support materials were queried and analyzed. Eleven patients (21 breasts) underwent prepectoral immediate implant reconstruction with Vicryl and acellular dermal matrix anterior coverage. Average mastectomy weight was 775.8 g. Smooth, round cohesive implants were used in all cases and average implant size was 514.5 ml. Overall complication rates were low and included one minor infection (4.8 percent) and one case of minor mastectomy flap and partial nipple necrosis each (4.8 percent). Calculated cost savings of Vicryl and acellular dermal matrix anterior coverage was up to $3415 in unilateral and $6830 in bilateral cases. Prepectoral breast reconstruction using acellular dermal matrix inferiorly and Vicryl mesh superiorly is a safe technique that decreases material costs associated with support materials and allows the surgeon to precisely control the implant pocket and position. Clinical question/level of evidence: Therapeutic, IV.
MeSH term(s)	Absorbable Implants/economics ; Acellular Dermis/economics ; Adult ; Breast Implantation/economics ; Breast Implantation/instrumentation ; Breast Implantation/methods ; Female ; Health Care Costs/statistics & numerical data ; Humans ; Middle Aged ; New York ; Outcome Assessment, Health Care ; Polyglactin 910/economics ; Postoperative Complications ; Retrospective Studies ; Surgical Mesh/economics
Chemical Substances	Polyglactin 910 (34346-01-5)
Language	English
Publishing date	2021-03-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	208012-6
ISSN	1529-4242 ; 0032-1052 ; 0096-8501
ISSN (online)	1529-4242
ISSN	0032-1052 ; 0096-8501
DOI	10.1097/PRS.0000000000007638
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Invited Discussion on: "Predictive Factors of Satisfaction Following Breast Reconstruction-Do They Influence Patients?"

Karp, Nolan S / Salibian, Ara A

Aesthetic plastic surgery

2021 Volume 46, Issue 2, Page(s) 619–620

MeSH term(s)	Breast Neoplasms/surgery ; Female ; Humans ; Mammaplasty ; Mastectomy ; Patient Satisfaction ; Personal Satisfaction ; Quality of Life ; Surveys and Questionnaires
Language	English
Publishing date	2021-10-08
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	532791-x
ISSN	1432-5241 ; 0364-216X
ISSN (online)	1432-5241
ISSN	0364-216X
DOI	10.1007/s00266-021-02620-w
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Zs.A 1296: Show issues

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Article ; Online: The cross-leg free flap: A systematic review of the literature.

Celie, Karel-Bart / Guo, Sarah / Raya, Jessica / Fahradyan, Artur / Carey, Joseph / Salibian, Ara A

Microsurgery

2024 Volume 44, Issue 2, Page(s) e31144

Abstract: Background: Free tissue transfer is a mainstay treatment for lower extremity soft tissue injuries. When the traditional cross-leg flap cannot provide enough coverage, a cross-leg free flap (CLFF) is a limb-saving alternative. The aim of this study is to ...

Abstract	Background: Free tissue transfer is a mainstay treatment for lower extremity soft tissue injuries. When the traditional cross-leg flap cannot provide enough coverage, a cross-leg free flap (CLFF) is a limb-saving alternative. The aim of this study is to conduct a systematic review of the literature published on the CLFF. Methods: We conducted a systematic review of articles describing the CLFF, according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Inclusion criteria included articles with primary data on the CLFF. Exclusion criteria included those describing pedicled cross-leg flaps or lacking complete data. Data analysis was performed using SPSS 29.0. Results: Our review included 28 articles encompassing 130 patients who underwent free tissue transfer. Most were male (63.8%) with a mean age of 32.4 years. Latissimus dorsi was the most common flap type (30.0%), followed by vertical rectus myocutaneous (20.0%). Average flap size was 301.8 cm Conclusion: The CLFF remains an excellent option for limb salvage when a suitable recipient vessel is unavailable. Our review demonstrates 1.4% flap failure and an acceptable complication rate. While most cases in our review describe muscle flaps, we report a complex case of limb salvage using an unusually large anterolateral thigh flap.
MeSH term(s)	Humans ; Male ; Adult ; Female ; Plastic Surgery Procedures ; Free Tissue Flaps/blood supply ; Leg/surgery ; Limb Salvage ; Lower Extremity/surgery ; Soft Tissue Injuries/surgery ; Treatment Outcome ; Skin Transplantation
Language	English
Publishing date	2024-02-11
Publishing country	United States
Document type	Systematic Review ; Journal Article ; Review
ZDB-ID	605524-2
ISSN	1098-2752 ; 0738-1085
ISSN (online)	1098-2752
ISSN	0738-1085
DOI	10.1002/micr.31144
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: The Free Superficially Based Low-Abdominal Mini Flap for Oncoplastic Breast Reconstruction.

Salibian, Ara A / Swerdlow, Mark A / Kondra, Katelyn / Patel, Ketan M

Plastic and reconstructive surgery

2023 Volume 152, Issue 5, Page(s) 959–962

Abstract: Summary: Volume replacement in oncoplastic breast reconstruction most commonly uses pedicled flaps. In thin patients with small breasts, free-tissue transfer may be better suited to preserve breast size. Evidence on microvascular oncoplastic ... ...

Abstract	Summary: Volume replacement in oncoplastic breast reconstruction most commonly uses pedicled flaps. In thin patients with small breasts, free-tissue transfer may be better suited to preserve breast size. Evidence on microvascular oncoplastic reconstruction is limited, and reconstruction has often required sacrifice of potential future donor sites. The free superficially based low-abdominal mini (SLAM) flap uses a narrow strip of lower abdominal tissue based on superficial perfusion of the abdominal wall that is anastomosed to chest wall perforators to preserve the ability to perform future abdominally based autologous breast reconstruction. Five patients underwent reconstruction with SLAM flaps for immediate oncoplastic reconstruction. Their mean age was 49.8 years, and their mean body mass index was 23.5. Tumor location was most commonly in the lower outer quadrant (40%). Average lumpectomy weight was 30 g. Two flaps were based on the superficial inferior epigastric artery, and three, on the superficial circumflex iliac artery. Recipient vessels included internal mammary perforators (40%), serratus branch (20%), lateral thoracic vessel branch (20%), and lateral intercostal perforators (20%). All patients underwent radiation therapy without delay and maintained volume, symmetry, and contour at an average period of 11.7 months after surgery. There were no cases of flap loss, fat necrosis, or delayed wound healing. The free SLAM flap allows for immediate oncoplastic breast reconstruction in thin, small-breasted patients with limited regional tissue without sacrificing future potential donor sites for autologous breast reconstruction. Clinical question/level of evidence: Therapeutic, IV.
MeSH term(s)	Humans ; Middle Aged ; Female ; Mammaplasty/adverse effects ; Surgical Flaps/blood supply ; Breast/surgery ; Mastectomy, Segmental ; Abdominal Wall/surgery ; Epigastric Arteries/surgery ; Perforator Flap/blood supply ; Breast Neoplasms/surgery ; Breast Neoplasms/etiology ; Retrospective Studies
Language	English
Publishing date	2023-03-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	208012-6
ISSN	1529-4242 ; 0032-1052 ; 0096-8501
ISSN (online)	1529-4242
ISSN	0032-1052 ; 0096-8501
DOI	10.1097/PRS.0000000000010466
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Extreme Limb Salvage: The Thin SCIP Flap for Distal Amputation Coverage in Highly Comorbid Patients.

Salibian, Ara A / Swerdlow, Mark A / Kondra, Katelyn / Patel, Ketan M

Plastic and reconstructive surgery

2023

Abstract: Introduction: Limb length preservation is correlated with overall survival. Successful free flap coverage of fore-, mid- and hind-foot amputations can prevent more proximal below-knee amputations but is challenging in patients with multiple ... ...

Abstract	Introduction: Limb length preservation is correlated with overall survival. Successful free flap coverage of fore-, mid- and hind-foot amputations can prevent more proximal below-knee amputations but is challenging in patients with multiple comorbidities. The thin superficial circumflex iliac artery perforator (SCIP) flap is well-suited for these patients as it provides thin, pliable tissue from a favorable donor site. Methods: A retrospective review of all patients with distal amputations requiring coverage with a thin SCIP flap between 2016 to 2022 was performed. Patient demographics, amputation levels, and wound characteristics as well as flap and microsurgery details were analyzed. The primary outcome was limb salvage. Secondary outcomes included partial flap necrosis, flap revision rate and additional postoperative complications. Results: Thirty-two patients (mean age 57.3) underwent reconstruction of fore-, mid- and hindfoot amputations with thin SCIP flaps (mean follow-up 36 months). Twenty-eight patients (87.5%) had diabetes, 27 (84.4%) had peripheral artery disease and 15 (46.9%) were dialysis-dependent. Average flap size was 59.5cm2 and average flap thickness was 5.7mm. Successful limb salvage was achieved in 27 patients (84.3%). Three cases (9.4%) had total flap loss. Twenty-one flaps (65.6%) had partial necrosis of which 12 (57.1%) healed with conservative management and seven (33.3 %) healed after late revision. Conclusion: The thin SCIP flap is a useful option for coverage of distal pedal amputations in patients with significant comorbidities. Despite higher rates of partial flap necrosis, free flap reconstruction allowed for high rates of limb salvage in a challenging patient population.
Language	English
Publishing date	2023-08-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	208012-6
ISSN	1529-4242 ; 0032-1052 ; 0096-8501
ISSN (online)	1529-4242
ISSN	0032-1052 ; 0096-8501
DOI	10.1097/PRS.0000000000011030
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