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  1. Article ; Online: A History of the Frenchay Hospital Plastic Surgery Unit, Bristol, United Kingdom.

    Davies, Alex J / Pleat, Jonathon M / Wilson, Sherif M

    Annals of plastic surgery

    2019  Volume 83, Issue 4, Page(s) 373–378

    Abstract: Frenchay Hospital has long since been established as the center for plastic surgery in Bristol, providing care to the city and its surrounding catchment area. From humble origins in the Second World War when the site took on the role of a large military ... ...

    Abstract Frenchay Hospital has long since been established as the center for plastic surgery in Bristol, providing care to the city and its surrounding catchment area. From humble origins in the Second World War when the site took on the role of a large military hospital providing reconstructive surgery for the victims of war to a busy modern-day National Health Service establishment, the plastic surgery unit at Frenchay Hospital has grown and developed through in parallel with the genesis and development of the specialty. Recent centralization of care in Bristol has seen a massive reorganization of services, and with it the closure of Frenchay Hospital. Because the plastic surgery unit establishes a new home at Southmead Hospital, this review documents the foundations of reconstructive surgery in Bristol and the South West United Kingdom.
    MeSH term(s) History, 20th Century ; Hospitals/history ; Humans ; State Medicine/history ; Surgery Department, Hospital/history ; Surgery, Plastic/history ; United Kingdom
    Language English
    Publishing date 2019-09-30
    Publishing country United States
    Document type Historical Article ; Journal Article
    ZDB-ID 423835-7
    ISSN 1536-3708 ; 0148-7043
    ISSN (online) 1536-3708
    ISSN 0148-7043
    DOI 10.1097/SAP.0000000000001843
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Seeing White: Management of TIVA during autologous breast reconstruction.

    Vigneswaran, Piranavhan / Clancy, Rachel / Choo, S Y / Love-Jones, Sarah / Jackson, Philippa C / Wilson, Sherif M

    Journal of plastic, reconstructive & aesthetic surgery : JPRAS

    2021  Volume 74, Issue 9, Page(s) 2392–2442

    Abstract: Total IntraVenous Anaesthesia is frequently the anaesthetic of choice for enhanced recovery after surgery pathways during breast reconstruction free flap surgery. This relies upon the continuous intravenous infusion of propofol. We describe our ... ...

    Abstract Total IntraVenous Anaesthesia is frequently the anaesthetic of choice for enhanced recovery after surgery pathways during breast reconstruction free flap surgery. This relies upon the continuous intravenous infusion of propofol. We describe our experience of two patients where augmentation of a venously congested DIEP flap with a cephalic vein transposition procedure, risked interruption of the intravenous delivery of anaesthesia to the patient. We also share our steps taken to mitigate this risk going forward.
    MeSH term(s) Anesthesia, Intravenous ; Epigastric Arteries ; Free Tissue Flaps/blood supply ; Humans ; Mammaplasty/methods
    Language English
    Publishing date 2021-04-01
    Publishing country Netherlands
    Document type Letter
    ZDB-ID 2217750-4
    ISSN 1878-0539 ; 1748-6815 ; 0007-1226
    ISSN (online) 1878-0539
    ISSN 1748-6815 ; 0007-1226
    DOI 10.1016/j.bjps.2021.03.048
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Predicting venous congestion before DIEP breast reconstruction by identifying atypical venous connections on preoperative CTA imaging.

    Davis, Christopher R / Jones, Lyn / Tillett, Rachel L / Richards, Helen / Wilson, Sherif M

    Microsurgery

    2018  Volume 39, Issue 1, Page(s) 24–31

    Abstract: Background: Venous congestion is the principle cause of flap failure after microsurgical breast reconstruction. We aim to correlate preoperative computed tomography angiography (CTA) findings with postoperative venous congestion to predict patients at ... ...

    Abstract Background: Venous congestion is the principle cause of flap failure after microsurgical breast reconstruction. We aim to correlate preoperative computed tomography angiography (CTA) findings with postoperative venous congestion to predict patients at risk of congestion.
    Methods: All patients undergoing deep inferior epigastric perforator (DIEP) breast reconstruction between August 2009 and August 2013 underwent preoperative CTA and prospectively entered the study. Patients with postoperative venous congestion were matched with a similar cohort of complication-free patients. Preoperative CTAs were randomized and re-interpreted by a radiologist, blinded to the subsequent clinical outcome. Inter-group comparisons were performed.
    Results: Two hundred and forty DIEP flaps were performed in 202 patients over the 4-year study. Venous congestion affected 15 flaps (6.3%). Preoperative CTA showed significantly more atypical venous connections between deep and superficial systems in congested flaps compared to controls (66.7% vs. 8%; P < .0001), with a positive predictive value of 83%. Atypical connections were narrow, tortuous, or incomplete. Patients with congestion-free flaps had more normal connections (80% vs. 26.7%; P < .001) and more cranial perforators (P = .02). Similar CTA findings between groups included perforator size and lateral position, superficial inferior epigastric vein size, crossing of midline, and absent connections (P > .05).
    Conclusions: Preoperative CTA identifies atypical venous connections between deep and superficial systems that increase the risk of postoperative DIEP congestion five-fold. Identifying atypical venous connections maximizes the chances of flap survival and minimizes complications for patients considering DIEP breast reconstruction.
    MeSH term(s) Adult ; Breast Neoplasms/diagnostic imaging ; Breast Neoplasms/surgery ; Cohort Studies ; Computed Tomography Angiography ; Epigastric Arteries ; Female ; Humans ; Hyperemia/etiology ; Mammaplasty/adverse effects ; Mastectomy ; Middle Aged ; Perforator Flap ; Postoperative Complications/etiology ; Predictive Value of Tests
    Language English
    Publishing date 2018-09-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 605524-2
    ISSN 1098-2752 ; 0738-1085
    ISSN (online) 1098-2752
    ISSN 0738-1085
    DOI 10.1002/micr.30367
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Time to re-group and save: Do we routinely need to perform group-and-save in patients undergoing free deep inferior epigastric perforator (DIEP) flap breast reconstruction?

    Ali, Stephen R / Chetwynd-Stapylton, Rachel / Holmes, Will J M / Vermaak, Liam / Wilson, Sherif M

    Journal of plastic, reconstructive & aesthetic surgery : JPRAS

    2018  Volume 71, Issue 5, Page(s) 780–781

    MeSH term(s) Epigastric Arteries/transplantation ; Erythrocyte Transfusion/standards ; Female ; Graft Survival ; Humans ; Mammaplasty/methods ; Perforator Flap/blood supply ; Retrospective Studies
    Language English
    Publishing date 2018-02-03
    Publishing country Netherlands
    Document type Letter
    ZDB-ID 2217750-4
    ISSN 1878-0539 ; 1748-6815 ; 0007-1226
    ISSN (online) 1878-0539
    ISSN 1748-6815 ; 0007-1226
    DOI 10.1016/j.bjps.2018.01.014
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Microvascular lifeboats: a stepwise approach to intraoperative venous congestion in DIEP flap breast reconstruction.

    Davies, Alex / O'Neill, Jennifer K / Wilson, Sherif M

    Plastic and reconstructive surgery

    2014  Volume 135, Issue 3, Page(s) 638e–639e

    MeSH term(s) Female ; Humans ; Hyperemia/prevention & control ; Intraoperative Complications/prevention & control ; Mammaplasty/methods ; Perforator Flap/blood supply
    Language English
    Publishing date 2014-12-29
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 208012-6
    ISSN 1529-4242 ; 0032-1052 ; 0096-8501
    ISSN (online) 1529-4242
    ISSN 0032-1052 ; 0096-8501
    DOI 10.1097/PRS.0000000000001045
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Salvage of the failed implant-based breast reconstruction using the Deep Inferior Epigastric Perforator Flap: A single centre experience with tertiary breast reconstruction.

    Holmes, Will J M / Quinn, Marcus / Emam, Ahmed T / Ali, Stephen R / Prousskaia, Elena / Wilson, Sherif M

    Journal of plastic, reconstructive & aesthetic surgery : JPRAS

    2019  Volume 72, Issue 7, Page(s) 1075–1083

    Abstract: Background: The longevity and durability of implant-based reconstruction is limited and many patients who develop complications seek alternative reconstruction. Recent studies have shown tertiary reconstruction with autologous tissue to be safe in the ... ...

    Abstract Background: The longevity and durability of implant-based reconstruction is limited and many patients who develop complications seek alternative reconstruction. Recent studies have shown tertiary reconstruction with autologous tissue to be safe in the short term. But no study has looked in-depth at the motivation for seeking referral and its long-term outcome.
    Methods: This was a retrospective study using patient case-notes and a prospectively-collated database. One hundred and fifteen patients underwent tertiary breast reconstruction with a Deep Inferior Epigastric Perforator (DIEP) flap between 1998 and 2016.
    Results: Mean age was 49 (23-67). The predominant initial reconstruction was expander (71%). Twenty nine percent received a definitive reconstruction (implant with acellular dermal matrix or pedicled latissimus dorsi). The proportion of patients who received post-mastectomy radiotherapy (PMRT) to their implant was 72%. Thirty four percent underwent surgical salvage prior to referral for autologous tissue and this was significantly higher in the group that did not receive PMRT (29% vs 40, p = 0.04). Predominant motivation for autologous reconstruction was poor cosmesis (62%) and/or grade III/IV capsular contracture (27%). Mean time from implant to DIEP was 4 years 5 months. Ten percent had complications requiring re-operation. Flap loss was 0.7%. Fifty five percent required an additional ipsilateral procedure and 47% required symmetrization. Median follow-up was 20-months (6-months to 7-years).
    Conclusions: We present the largest UK series of tertiary breast reconstruction. Tertiary reconstruction is safe with a surgical outcome comparable to delayed autologous reconstruction. Patients with implant complications often had multiple failed attempts at salvage prior to referral. We advocate careful consideration of implants in the setting of PMRT and early referral for autologous tissue once complications become apparent.
    MeSH term(s) Acellular Dermis ; Adult ; Aged ; Breast Implantation/instrumentation ; Breast Implantation/methods ; Breast Implants ; Breast Neoplasms/surgery ; Carcinoma, Ductal, Breast/surgery ; Carcinoma, Intraductal, Noninfiltrating/surgery ; Carcinoma, Lobular/surgery ; Epigastric Arteries ; Female ; Follow-Up Studies ; Humans ; Middle Aged ; Perforator Flap/blood supply ; Postoperative Complications/epidemiology ; Postoperative Complications/surgery ; Reoperation/statistics & numerical data ; Retrospective Studies ; Salvage Therapy/methods ; Superficial Back Muscles/transplantation ; Tertiary Care Centers ; Tissue Expansion/instrumentation ; Tissue Expansion/methods ; Tissue Expansion Devices ; Treatment Failure
    Language English
    Publishing date 2019-03-22
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 2217750-4
    ISSN 1878-0539 ; 1748-6815 ; 0007-1226
    ISSN (online) 1878-0539
    ISSN 1748-6815 ; 0007-1226
    DOI 10.1016/j.bjps.2019.03.003
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Tertiary Breast Reconstruction for Salvage of the Failed Implant-Based Reconstruction Using the Deep Inferior Epigastric Perforator Flap.

    Ali, Stephen R / Holmes, Will J M / Quinn, Marcus / Emam, Ahmed T / Prousskaia, Elena / Wilson, Sherif M

    Journal of reconstructive microsurgery

    2019  Volume 34, Issue 9, Page(s) e1–e2

    Language English
    Publishing date 2019-02-21
    Publishing country United States
    Document type Letter
    ZDB-ID 605983-1
    ISSN 1098-8947 ; 0743-684X ; 0743-684X
    ISSN (online) 1098-8947 ; 0743-684X
    ISSN 0743-684X
    DOI 10.1055/s-0039-1679885
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: The superficial outside-flap shunt (SOS) technique for free deep inferior epigastric perforator flap salvage.

    Davies, Alex J / O'Neill, Jennifer K / Wilson, Sherif M

    Journal of plastic, reconstructive & aesthetic surgery : JPRAS

    2014  Volume 67, Issue 8, Page(s) 1094–1097

    Abstract: A common cause for loss of a deep inferior epigastric perforator (DIEP) flap is venous congestion secondary to inadequate outflow via the deep perforating vessels. Further anastomosis of the superficial venous system provides effective outflow and ... ...

    Abstract A common cause for loss of a deep inferior epigastric perforator (DIEP) flap is venous congestion secondary to inadequate outflow via the deep perforating vessels. Further anastomosis of the superficial venous system provides effective outflow and salvage of the congested DIEP. Multiple methods have been described requiring dissection of additional recipient venous systems or around the perforating vessels in order to provide a vein onto which the superficial system may be anastomosed. These are potentially associated with increased morbidity and risk of damage to the pedicle. We describe an alternative technique of harvesting an additional length of deep inferior epigastric pedicle cranial to the perforator onto which an anastomosis may be performed. This avoids the need for additional dissection of recipient vessels or further handling of the perforator, its venae comitantes and the main pedicle of the flap thus reducing the risk of damage.
    MeSH term(s) Algorithms ; Anastomosis, Surgical/methods ; Female ; Graft Survival ; Humans ; Mammaplasty ; Perforator Flap/blood supply ; Salvage Therapy/methods ; Veins/surgery
    Language English
    Publishing date 2014-08
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 2217750-4
    ISSN 1878-0539 ; 1748-6815 ; 0007-1226
    ISSN (online) 1878-0539
    ISSN 1748-6815 ; 0007-1226
    DOI 10.1016/j.bjps.2014.04.034
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Improving the accuracy of intraoperative perforator location in DIEP flaps.

    Tillett, Rachel L / Rees Lee, Jacqueline E / Jones, Lyn / Wilson, Sherif M

    Journal of plastic, reconstructive & aesthetic surgery : JPRAS

    2014  Volume 67, Issue 2, Page(s) e60–1

    MeSH term(s) Abdomen/anatomy & histology ; Abdomen/diagnostic imaging ; Angiography ; Arteries/anatomy & histology ; Arteries/diagnostic imaging ; Humans ; Mammaplasty ; Perforator Flap/blood supply ; Sensitivity and Specificity ; Tomography, X-Ray Computed ; Ultrasonography, Doppler
    Language English
    Publishing date 2014-02
    Publishing country Netherlands
    Document type Letter
    ZDB-ID 2217750-4
    ISSN 1878-0539 ; 1748-6815 ; 0007-1226
    ISSN (online) 1878-0539
    ISSN 1748-6815 ; 0007-1226
    DOI 10.1016/j.bjps.2013.09.034
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  10. Article: Tertiary Breast Reconstruction for Salvage of the Failed Implant-Based Reconstruction Using the Deep Inferior Epigastric Perforator Flap

    Ali, Stephen R. / Holmes, Will J. M. / Quinn, Marcus / Emam, Ahmed T. / Prousskaia, Elena / Wilson, Sherif M.

    Journal of Reconstructive Microsurgery

    2018  Volume 34, Issue 09, Page(s) e1–e2

    Language English
    Publishing date 2018-11-01
    Publisher Thieme Medical Publishers
    Publishing place Stuttgart ; New York
    Document type Article
    ZDB-ID 605983-1
    ISSN 1098-8947 ; 0743-684X ; 0743-684X
    ISSN (online) 1098-8947 ; 0743-684X
    ISSN 0743-684X
    DOI 10.1055/s-0039-1679885
    Database Thieme publisher's database

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