venkat ramakrishnan - Academia.edu (original) (raw)

Papers by venkat ramakrishnan

Research paper thumbnail of One staged endoscopic graciloplasty for faecal incontinence

Research paper thumbnail of Aesthetic Surgery Practice Resumption in the United Kingdom During the COVID-19 Pandemic

Aesthetic Surgery Journal

Background The global COVID-19 pandemic has significantly impacted all aspects of healthcare, inc... more Background The global COVID-19 pandemic has significantly impacted all aspects of healthcare, including the delivery of elective aesthetic surgery practice. We carried out a national, prospective data collection of the first aesthetic plastic surgery procedures carried out during the COVID-19 pandemic in the United Kingdom. Objectives Our aim was to explore the challenges aesthetic practice is facing and to identify if any problems or complications arose from carrying out aesthetic procedures during the COVID-19 pandemic. Methods Over a 6-week period from June 15 th-August 2 nd, 2020, data was collected using a proforma for aesthetic plastic surgery cases. All patients had outcomes recorded for the audit period of 14 days post-surgery. Results Our results demonstrated that none of the 371 patients audited whom underwent aesthetic surgical procedures developed any symptoms of COVID-19-related illness and none required treatment for any subsequent respiratory illness. Conclusions We f...

Research paper thumbnail of Preliminary Report of a National Audit of Aesthetic Surgery Practice in the United Kingdom During the COVID-19 Pandemic

Aesthetic Surgery Journal

Research paper thumbnail of International microsurgery simulation society (IMSS) consensus statement on the minimum standards for a basic microsurgery course, requirements for a microsurgical anastomosis global rating scale and minimum thresholds for training

Research paper thumbnail of Enhancing breast projection in autologous reconstruction using the St Andrew's coning technique and 3D volumetric analysis

Gland surgery, 2017

An increasing number of women undergo mastectomy for breast cancer and post-mastectomy autologous... more An increasing number of women undergo mastectomy for breast cancer and post-mastectomy autologous breast reconstruction has been shown to significantly improve the psychosexual wellbeing of the patients. A goal of treatment is to achieve symmetry and projection to match the native breast, and/or the contralateral breast in the case of a unilateral reconstruction. Autologous reconstruction, particularly with the deep inferior epigastric artery perforator (DIEP) flap, is particularly advantageous as it can be manipulated to mimic the shape and turgor of the native breast. However, very few techniques of shaping the breast conus when insetting the DIEP flap to enhance aesthetic outcome have been reported to date. With the aide of three-dimension (3D) photography and 3D-printed mirrored image of the contralateral breast as a guide intraoperatively, we describe our St Andrew's coning technique to create a personalized flap projection. We report a prospective case series of 3 delayed ...

Research paper thumbnail of A systematic review of intraoperative process mapping in surgery

Gland surgery, 2017

Process mapping has been identified as a strategy to improve surgical efficiency but has been inc... more Process mapping has been identified as a strategy to improve surgical efficiency but has been inconsistently applied in the literature and underutilised in surgical practice. In this journal, we recently described our utilisation of these approaches when applied to breast reconstruction. We showed that in surgery as complex as autologous breast reconstruction, process mapping can improve efficiency, and may improve surgical teaching, education and audit. The intraoperative period specifically is an area that can be applied not only to breast reconstruction, but to a much broader range of surgical procedures. A systematic review was undertaken of the databases Ovid MEDLINE, Allied and Complementary Medicine Database, Embase and PsychINFO. Manual searching of the references from articles identified was also conducted. Data items relating to the review aims were extracted from articles' methods, applications, and outcomes. A descriptive analysis was carried out to synthesise the in...

Research paper thumbnail of Microsurgical refinements with the use of internal mammary (IM) perforators as recipient vessels in transverse upper gracilis (TUG) autologous breast reconstruction

Gland Surgery

Background: The transverse upper gracilis (TUG) flap is the senior authors' second choice for aut... more Background: The transverse upper gracilis (TUG) flap is the senior authors' second choice for autologous breast reconstruction when the DIEP flap is not available. It provides durable, pliable tissue with well hidden scars. The main criticism of this flap is the limited volume, donor site complications, short pedicle and vessel mismatch depending on which recipient vessels are used. We described methods of reducing vessel mismatch, complications of venous coupler and refinements to help give a more superior aesthetic outcome. Methods: We describe several maneuvers to help reduce vessel mismatch with the use of the internal mammary (IM) perforator vessels with a modification of the Harashina fish-mouth technique or the use of a vessel bifurcation to increase vessel diameter. We also describe the optimum method of perforator preparation and potential methods to prevent palpable venous couplers. The author's describe their case series of 14 TUG flaps to reconstruct 13 breasts in 12 patients. Results: Eight unilateral, 2 partial breast reconstruction, 1 bilateral and 1 bilateral TUG flap for a unilateral reconstruction was carried out. All flaps survived with one partial flap necrosis, one donor site seroma and two cases of palpable/tender venous couplers. The mean reconstructed breast was 320 grams. Conclusions: The TUG flap is a reconstructive challenge, but with correct planning a good aesthetic outcome is possible. The IM perforator is our first choice recipient vessel in TUG breast reconstructions. With meticulous preparation and by overcoming vessel mismatch the use of this recipient vessel is a reliable option.

Research paper thumbnail of Microsurgical Tissue Transfer in Breast Reconstruction

Clinics in plastic surgery, 2017

Autologous breast reconstructions have grown in popularity because of their durability, aesthetic... more Autologous breast reconstructions have grown in popularity because of their durability, aesthetic outcomes, symmetry, increase in external beam radiotherapy use, and potential aesthetic enhancement at the donor site. Increasing patient expectations for predictable high aesthetic outcomes with minimal complications or need for further procedures has been met by refinement in the use of flaps. The authors' microsurgical breast reconstruction center aims to provide this while delivering efficient service. The deep inferior epigastric flaps form 85% and transverse upper gracilis and profunda artery perforator flaps account for 10%; lumbar artery perforator flaps are a new addition to the authors' armamentarium.

Research paper thumbnail of Endoscopic join the dots!

British Journal of Plastic Surgery, Oct 1, 1998

Research paper thumbnail of Re: Breast Reconstruction After Mastectomy Without Additional Scarring: Application of Endoscopic Latissimus Dorsi Muscle Harvest

Research paper thumbnail of Re: Scarpa??s Adipofascial Flap for Repair of Wide Scalp Defects

Research paper thumbnail of 360� Microsurgical skills practice: a �round-the-clock� training device

J Plast Reconstr Aesthet Surg, 2008

No abstract is available. To read the body of this article, please view the Full Text online. ...... more No abstract is available. To read the body of this article, please view the Full Text online. ... © 2008 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved. ... Visit SciVerse ScienceDirect to see if you have access via your ...

Research paper thumbnail of The microvascular anastomotic coupler for venous anastomoses in free flap breast reconstruction improves outcomes

Gland surgery, 2016

Venous couplers are ubiquitous around the world and are a useful tool for the reconstructive micr... more Venous couplers are ubiquitous around the world and are a useful tool for the reconstructive microsurgeon. A systematic review of coupler performance studies demonstrated a thrombosis rate range of 0% to 3%, whilst the average time of using the device is 5 minutes. There is sparse published data on cost analysis and the impact of operator experience on the anastomotic coupler device success. Improvements in outcomes other than time benefits have also not been shown. This study aims to address these deficiencies in the literature. A retrospective clinical study was undertaken, aiming to compare equivalent groups of patients that had free flap surgery with venous micro-anastomoses with those that had sutured anastomoses. The cohort comprised all patients undergoing microsurgical breast reconstruction at the St Andrew's Centre for Plastic Surgery & Burns from January 2009 to December 2014. Between January 2010 to December 2014, 1,064 patients underwent 1,206 free flap breast recons...

Research paper thumbnail of Preoperative computed tomography angiography for planning DIEP flap breast reconstruction reduces operative time and overall complications

Gland surgery, 2016

The approach and operative techniques associated with breast reconstruction have steadily been re... more The approach and operative techniques associated with breast reconstruction have steadily been refined since its inception, with abdominal perforator-based flaps becoming the gold standard reconstructive option for women undergoing breast cancer surgery. The current study comprises a cohort of 632 patients, in whom specific operative times are recorded by a blinded observer, and aims to address the potential benefits seen with the use of computer tomography (CT) scanning preoperatively on operative outcomes, complications and surgical times. A prospectively recorded, retrospective review was undertaken of patients undergoing autologous breast reconstruction with a DIEP flap at the St Andrews Centre over a 4-year period from 2010 to 2014. Computed tomography angiography (CTA) scanning of patients began in September 2012 and thus 2 time periods were compared: 2 years prior to the use of CTA scans and 2 years afterwards. For all patients, key variables were collected including patient ...

Research paper thumbnail of Three routine free flaps per day in a single operating theatre: principles of a process mapping approach to improving surgical efficiency

Gland surgery, 2016

Breast reconstruction is a multi-stage process, involving many individual procedures and many hea... more Breast reconstruction is a multi-stage process, involving many individual procedures and many healthcare professionals which take the patient through from diagnosis of breast cancer to the completion of cancer treatment and ultimate breast reconstruction. With an experience of over 3,000 autologous breast reconstructions, we have refined both our surgical technique and overall approach to breast reconstruction to improve the efficiency in free flap based breast reconstruction surgery. Through a process mapping approach similar to that employed by large-scale industry, we have broken down free flap based breast reconstruction into multiple smaller processes. By looking at various steps as a simple component of the whole, we have improved our theatre efficiency to maximize patient throughput and improve our outcomes for breast reconstruction patients. Since beginning free flap breast reconstruction surgery, we have improved overall efficiency by applying a process mapping approach. In...

Research paper thumbnail of Stacked and bipedicled abdominal free flaps for breast reconstruction: considerations for shaping

Gland surgery, 2016

Stacked and bipedicled abdominal flaps are useful in women who require a large breast reconstruct... more Stacked and bipedicled abdominal flaps are useful in women who require a large breast reconstruction but have relative paucity of abdominal tissue. A new classification system is described to assist the surgeon in achieving the best possible aesthetic outcome. A retrospective review of 25 consecutive stacked and/or bipedicled deep inferior epigastric perforator (DIEP) flap reconstructions was assessed from 2009 to 2014. Demographic data and key variables were prospectively collected in our breast reconstruction database and an aesthetic classification devised. There are four main subtypes, (I) folded; (II) divided; (III) coned; and (IV) divided and folded. Each of these subtypes can be moulded in a symmetrically or asymmetrically fashion depending on the contralateral breast shape together with distribution and consistency of fat within the abdominal flap. Of the 25 patients, three-quarter were immediate reconstruction, with an average age of 48 years and a median follow-up of 2 yea...

Research paper thumbnail of Modern use of smartphone applications in the perioperative management in microsurgical breast reconstruction

Gland surgery, 2016

Advances in mobile telecommunication, improved mobile internet and affordability have led to a si... more Advances in mobile telecommunication, improved mobile internet and affordability have led to a significant increase in smartphone use within medicine. The capability of instant messaging, photography, videography, word processing, drawing and internet access allow significant potential in this small portable device. Smartphone use within medicine has grown tremendously worldwide given its affordability, improved internet and capabilities. We have searched for apps specifically helpful in the perioperative care of microsurgical breast reconstructive patients. The useful apps have been subdivided: (I) communication apps-multimedia messaging, WhatsApp, PicSafeMedi: allow efficient communication via text, picture and video messages leading to earlier assessment and definitive management of free flaps; (II) storage apps-Notability, Elogbook: electronic storage of patient notes and logbooks of case which can be shared with others if required; (III) educational apps-FlapApp, Touch Surgery,...

Research paper thumbnail of Increasing options in autologous microsurgical breast reconstruction: four free flaps for 'stacked' bilateral breast reconstruction

Gland surgery, 2016

For autologous breast reconstruction, there are cases where one free flap cannot provide the volu... more For autologous breast reconstruction, there are cases where one free flap cannot provide the volume of tissue required, and the concept of 'stacked' bilateral deep inferior epigastric artery (DIEP) flaps was developed, in which hemi-abdominal flaps are raised on each deep inferior epigastric artery (DIEA), and both flaps transferred to the chest. In cases of bilateral breast reconstruction, stacked flaps may be required to achieve volume replacement, however options are not described. We demonstrate the use of stacked free flaps for bilateral breast reconstruction, using one DIEP flap stacked with one transverse upper gracilis (TUG) flap for each side. A 49-year-old woman, with BRCA1 mutation, presented for risk reduction mastectomies. Flap design was planned to achieve maximal projection and primary nipple reconstruction. This was able to be achieved by using the DIEP flap de-epithelialised and completely buried, with the flap orientated with the pedicle on its superficial ...

Research paper thumbnail of Wnt5a Regulates the Assembly of Human Adipose Derived Stromal Vascular Fraction-Derived Microvasculatures

PloS one, 2016

Human adipose-derived stromal vascular fraction (hSVF) cells are an easily accessible, heterogene... more Human adipose-derived stromal vascular fraction (hSVF) cells are an easily accessible, heterogeneous cell system that can spontaneously self-assemble into functional microvasculatures in vivo. However, the mechanisms underlying vascular self-assembly and maturation are poorly understood, therefore we utilized an in vitro model to identify potential in vivo regulatory mechanisms. We utilized passage one (P1) hSVF because of the rapid UEA1+ endothelium (EC) loss at even P2 culture. We exposed hSVF cells to a battery of angiogenesis inhibitors and found that the pan-Wnt inhibitor IWP2 produced the most significant hSVF-EC networking decrease (~25%). To determine which Wnt isoform(s) and receptor(s) may be involved, hSVF was screened by PCR for isoforms associated with angiogenesis, with only WNT5A and its receptor, FZD4, being expressed for all time points observed. Immunocytochemistry confirmed Wnt5a protein expression by hSVF. To see if Wnt5a alone could restore IWP2-induced EC netwo...

Research paper thumbnail of Ossification of a Varicose Ulcer Bed: A Potential Pitfall in Skin Defect Reconstruction

Plastic Amp Reconstructive Surgery, Aug 1, 2003

Research paper thumbnail of One staged endoscopic graciloplasty for faecal incontinence

Research paper thumbnail of Aesthetic Surgery Practice Resumption in the United Kingdom During the COVID-19 Pandemic

Aesthetic Surgery Journal

Background The global COVID-19 pandemic has significantly impacted all aspects of healthcare, inc... more Background The global COVID-19 pandemic has significantly impacted all aspects of healthcare, including the delivery of elective aesthetic surgery practice. We carried out a national, prospective data collection of the first aesthetic plastic surgery procedures carried out during the COVID-19 pandemic in the United Kingdom. Objectives Our aim was to explore the challenges aesthetic practice is facing and to identify if any problems or complications arose from carrying out aesthetic procedures during the COVID-19 pandemic. Methods Over a 6-week period from June 15 th-August 2 nd, 2020, data was collected using a proforma for aesthetic plastic surgery cases. All patients had outcomes recorded for the audit period of 14 days post-surgery. Results Our results demonstrated that none of the 371 patients audited whom underwent aesthetic surgical procedures developed any symptoms of COVID-19-related illness and none required treatment for any subsequent respiratory illness. Conclusions We f...

Research paper thumbnail of Preliminary Report of a National Audit of Aesthetic Surgery Practice in the United Kingdom During the COVID-19 Pandemic

Aesthetic Surgery Journal

Research paper thumbnail of International microsurgery simulation society (IMSS) consensus statement on the minimum standards for a basic microsurgery course, requirements for a microsurgical anastomosis global rating scale and minimum thresholds for training

Research paper thumbnail of Enhancing breast projection in autologous reconstruction using the St Andrew's coning technique and 3D volumetric analysis

Gland surgery, 2017

An increasing number of women undergo mastectomy for breast cancer and post-mastectomy autologous... more An increasing number of women undergo mastectomy for breast cancer and post-mastectomy autologous breast reconstruction has been shown to significantly improve the psychosexual wellbeing of the patients. A goal of treatment is to achieve symmetry and projection to match the native breast, and/or the contralateral breast in the case of a unilateral reconstruction. Autologous reconstruction, particularly with the deep inferior epigastric artery perforator (DIEP) flap, is particularly advantageous as it can be manipulated to mimic the shape and turgor of the native breast. However, very few techniques of shaping the breast conus when insetting the DIEP flap to enhance aesthetic outcome have been reported to date. With the aide of three-dimension (3D) photography and 3D-printed mirrored image of the contralateral breast as a guide intraoperatively, we describe our St Andrew's coning technique to create a personalized flap projection. We report a prospective case series of 3 delayed ...

Research paper thumbnail of A systematic review of intraoperative process mapping in surgery

Gland surgery, 2017

Process mapping has been identified as a strategy to improve surgical efficiency but has been inc... more Process mapping has been identified as a strategy to improve surgical efficiency but has been inconsistently applied in the literature and underutilised in surgical practice. In this journal, we recently described our utilisation of these approaches when applied to breast reconstruction. We showed that in surgery as complex as autologous breast reconstruction, process mapping can improve efficiency, and may improve surgical teaching, education and audit. The intraoperative period specifically is an area that can be applied not only to breast reconstruction, but to a much broader range of surgical procedures. A systematic review was undertaken of the databases Ovid MEDLINE, Allied and Complementary Medicine Database, Embase and PsychINFO. Manual searching of the references from articles identified was also conducted. Data items relating to the review aims were extracted from articles' methods, applications, and outcomes. A descriptive analysis was carried out to synthesise the in...

Research paper thumbnail of Microsurgical refinements with the use of internal mammary (IM) perforators as recipient vessels in transverse upper gracilis (TUG) autologous breast reconstruction

Gland Surgery

Background: The transverse upper gracilis (TUG) flap is the senior authors' second choice for aut... more Background: The transverse upper gracilis (TUG) flap is the senior authors' second choice for autologous breast reconstruction when the DIEP flap is not available. It provides durable, pliable tissue with well hidden scars. The main criticism of this flap is the limited volume, donor site complications, short pedicle and vessel mismatch depending on which recipient vessels are used. We described methods of reducing vessel mismatch, complications of venous coupler and refinements to help give a more superior aesthetic outcome. Methods: We describe several maneuvers to help reduce vessel mismatch with the use of the internal mammary (IM) perforator vessels with a modification of the Harashina fish-mouth technique or the use of a vessel bifurcation to increase vessel diameter. We also describe the optimum method of perforator preparation and potential methods to prevent palpable venous couplers. The author's describe their case series of 14 TUG flaps to reconstruct 13 breasts in 12 patients. Results: Eight unilateral, 2 partial breast reconstruction, 1 bilateral and 1 bilateral TUG flap for a unilateral reconstruction was carried out. All flaps survived with one partial flap necrosis, one donor site seroma and two cases of palpable/tender venous couplers. The mean reconstructed breast was 320 grams. Conclusions: The TUG flap is a reconstructive challenge, but with correct planning a good aesthetic outcome is possible. The IM perforator is our first choice recipient vessel in TUG breast reconstructions. With meticulous preparation and by overcoming vessel mismatch the use of this recipient vessel is a reliable option.

Research paper thumbnail of Microsurgical Tissue Transfer in Breast Reconstruction

Clinics in plastic surgery, 2017

Autologous breast reconstructions have grown in popularity because of their durability, aesthetic... more Autologous breast reconstructions have grown in popularity because of their durability, aesthetic outcomes, symmetry, increase in external beam radiotherapy use, and potential aesthetic enhancement at the donor site. Increasing patient expectations for predictable high aesthetic outcomes with minimal complications or need for further procedures has been met by refinement in the use of flaps. The authors' microsurgical breast reconstruction center aims to provide this while delivering efficient service. The deep inferior epigastric flaps form 85% and transverse upper gracilis and profunda artery perforator flaps account for 10%; lumbar artery perforator flaps are a new addition to the authors' armamentarium.

Research paper thumbnail of Endoscopic join the dots!

British Journal of Plastic Surgery, Oct 1, 1998

Research paper thumbnail of Re: Breast Reconstruction After Mastectomy Without Additional Scarring: Application of Endoscopic Latissimus Dorsi Muscle Harvest

Research paper thumbnail of Re: Scarpa??s Adipofascial Flap for Repair of Wide Scalp Defects

Research paper thumbnail of 360� Microsurgical skills practice: a �round-the-clock� training device

J Plast Reconstr Aesthet Surg, 2008

No abstract is available. To read the body of this article, please view the Full Text online. ...... more No abstract is available. To read the body of this article, please view the Full Text online. ... © 2008 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved. ... Visit SciVerse ScienceDirect to see if you have access via your ...

Research paper thumbnail of The microvascular anastomotic coupler for venous anastomoses in free flap breast reconstruction improves outcomes

Gland surgery, 2016

Venous couplers are ubiquitous around the world and are a useful tool for the reconstructive micr... more Venous couplers are ubiquitous around the world and are a useful tool for the reconstructive microsurgeon. A systematic review of coupler performance studies demonstrated a thrombosis rate range of 0% to 3%, whilst the average time of using the device is 5 minutes. There is sparse published data on cost analysis and the impact of operator experience on the anastomotic coupler device success. Improvements in outcomes other than time benefits have also not been shown. This study aims to address these deficiencies in the literature. A retrospective clinical study was undertaken, aiming to compare equivalent groups of patients that had free flap surgery with venous micro-anastomoses with those that had sutured anastomoses. The cohort comprised all patients undergoing microsurgical breast reconstruction at the St Andrew's Centre for Plastic Surgery & Burns from January 2009 to December 2014. Between January 2010 to December 2014, 1,064 patients underwent 1,206 free flap breast recons...

Research paper thumbnail of Preoperative computed tomography angiography for planning DIEP flap breast reconstruction reduces operative time and overall complications

Gland surgery, 2016

The approach and operative techniques associated with breast reconstruction have steadily been re... more The approach and operative techniques associated with breast reconstruction have steadily been refined since its inception, with abdominal perforator-based flaps becoming the gold standard reconstructive option for women undergoing breast cancer surgery. The current study comprises a cohort of 632 patients, in whom specific operative times are recorded by a blinded observer, and aims to address the potential benefits seen with the use of computer tomography (CT) scanning preoperatively on operative outcomes, complications and surgical times. A prospectively recorded, retrospective review was undertaken of patients undergoing autologous breast reconstruction with a DIEP flap at the St Andrews Centre over a 4-year period from 2010 to 2014. Computed tomography angiography (CTA) scanning of patients began in September 2012 and thus 2 time periods were compared: 2 years prior to the use of CTA scans and 2 years afterwards. For all patients, key variables were collected including patient ...

Research paper thumbnail of Three routine free flaps per day in a single operating theatre: principles of a process mapping approach to improving surgical efficiency

Gland surgery, 2016

Breast reconstruction is a multi-stage process, involving many individual procedures and many hea... more Breast reconstruction is a multi-stage process, involving many individual procedures and many healthcare professionals which take the patient through from diagnosis of breast cancer to the completion of cancer treatment and ultimate breast reconstruction. With an experience of over 3,000 autologous breast reconstructions, we have refined both our surgical technique and overall approach to breast reconstruction to improve the efficiency in free flap based breast reconstruction surgery. Through a process mapping approach similar to that employed by large-scale industry, we have broken down free flap based breast reconstruction into multiple smaller processes. By looking at various steps as a simple component of the whole, we have improved our theatre efficiency to maximize patient throughput and improve our outcomes for breast reconstruction patients. Since beginning free flap breast reconstruction surgery, we have improved overall efficiency by applying a process mapping approach. In...

Research paper thumbnail of Stacked and bipedicled abdominal free flaps for breast reconstruction: considerations for shaping

Gland surgery, 2016

Stacked and bipedicled abdominal flaps are useful in women who require a large breast reconstruct... more Stacked and bipedicled abdominal flaps are useful in women who require a large breast reconstruction but have relative paucity of abdominal tissue. A new classification system is described to assist the surgeon in achieving the best possible aesthetic outcome. A retrospective review of 25 consecutive stacked and/or bipedicled deep inferior epigastric perforator (DIEP) flap reconstructions was assessed from 2009 to 2014. Demographic data and key variables were prospectively collected in our breast reconstruction database and an aesthetic classification devised. There are four main subtypes, (I) folded; (II) divided; (III) coned; and (IV) divided and folded. Each of these subtypes can be moulded in a symmetrically or asymmetrically fashion depending on the contralateral breast shape together with distribution and consistency of fat within the abdominal flap. Of the 25 patients, three-quarter were immediate reconstruction, with an average age of 48 years and a median follow-up of 2 yea...

Research paper thumbnail of Modern use of smartphone applications in the perioperative management in microsurgical breast reconstruction

Gland surgery, 2016

Advances in mobile telecommunication, improved mobile internet and affordability have led to a si... more Advances in mobile telecommunication, improved mobile internet and affordability have led to a significant increase in smartphone use within medicine. The capability of instant messaging, photography, videography, word processing, drawing and internet access allow significant potential in this small portable device. Smartphone use within medicine has grown tremendously worldwide given its affordability, improved internet and capabilities. We have searched for apps specifically helpful in the perioperative care of microsurgical breast reconstructive patients. The useful apps have been subdivided: (I) communication apps-multimedia messaging, WhatsApp, PicSafeMedi: allow efficient communication via text, picture and video messages leading to earlier assessment and definitive management of free flaps; (II) storage apps-Notability, Elogbook: electronic storage of patient notes and logbooks of case which can be shared with others if required; (III) educational apps-FlapApp, Touch Surgery,...

Research paper thumbnail of Increasing options in autologous microsurgical breast reconstruction: four free flaps for 'stacked' bilateral breast reconstruction

Gland surgery, 2016

For autologous breast reconstruction, there are cases where one free flap cannot provide the volu... more For autologous breast reconstruction, there are cases where one free flap cannot provide the volume of tissue required, and the concept of 'stacked' bilateral deep inferior epigastric artery (DIEP) flaps was developed, in which hemi-abdominal flaps are raised on each deep inferior epigastric artery (DIEA), and both flaps transferred to the chest. In cases of bilateral breast reconstruction, stacked flaps may be required to achieve volume replacement, however options are not described. We demonstrate the use of stacked free flaps for bilateral breast reconstruction, using one DIEP flap stacked with one transverse upper gracilis (TUG) flap for each side. A 49-year-old woman, with BRCA1 mutation, presented for risk reduction mastectomies. Flap design was planned to achieve maximal projection and primary nipple reconstruction. This was able to be achieved by using the DIEP flap de-epithelialised and completely buried, with the flap orientated with the pedicle on its superficial ...

Research paper thumbnail of Wnt5a Regulates the Assembly of Human Adipose Derived Stromal Vascular Fraction-Derived Microvasculatures

PloS one, 2016

Human adipose-derived stromal vascular fraction (hSVF) cells are an easily accessible, heterogene... more Human adipose-derived stromal vascular fraction (hSVF) cells are an easily accessible, heterogeneous cell system that can spontaneously self-assemble into functional microvasculatures in vivo. However, the mechanisms underlying vascular self-assembly and maturation are poorly understood, therefore we utilized an in vitro model to identify potential in vivo regulatory mechanisms. We utilized passage one (P1) hSVF because of the rapid UEA1+ endothelium (EC) loss at even P2 culture. We exposed hSVF cells to a battery of angiogenesis inhibitors and found that the pan-Wnt inhibitor IWP2 produced the most significant hSVF-EC networking decrease (~25%). To determine which Wnt isoform(s) and receptor(s) may be involved, hSVF was screened by PCR for isoforms associated with angiogenesis, with only WNT5A and its receptor, FZD4, being expressed for all time points observed. Immunocytochemistry confirmed Wnt5a protein expression by hSVF. To see if Wnt5a alone could restore IWP2-induced EC netwo...

Research paper thumbnail of Ossification of a Varicose Ulcer Bed: A Potential Pitfall in Skin Defect Reconstruction

Plastic Amp Reconstructive Surgery, Aug 1, 2003