Medical Student Research Fellowship for Summer 2007
Mentor: Michel St. Cyr, MD
Department: Plastic Surgery
Room number: WA4.230
Mail Code: 9132
Phone number: 214.645.3115
E-mail: Michel.Saint-cyr@UTSouthwestern.edu
Project I title:
1. Outcomes of Implant-Based Breast Reconstruction using Subserratus and Subpectoral Fascia
Human subjects IRB approved project number (where applicable):
1. Serratus/subpectoral fascia study: 042007-017 - approved
Animal subjects IACUC approved project number (where applicable):
Project Type (patient-based research, animal-based research, or basic research; this characterization is only to permit a general classification for grouping similar types of projects)
Patient-based
Brief Description of Project:
1. Outcomes of Implant-Based Breast Reconstruction using Subserratus and Subpectoral Fascia
Implant-based breast reconstruction requires complete muscular coverage of
the implant to prevent capsular contracture and visible implant rippling. The
use of subserratus and subpectoral fascia is a novel method for obtaining vascularised
lateral implant coverage. The purpose of this study is to evaluate the outcomes
of novel implant coverage technique during breast reconstruction using subserratus
and subpectoral fascia.
A retrospective case note analysis of outcomes for patients who underwent implant-based
breast reconstruction in whom subserratus and subpectoral fascia will be used.
Outcome measures include duration of hospital stay, perioperative complications,
and wound complications including infection, to evaluate the safety of this
technique. An anatomical dissection of the subpectoral fascia and serratus fascia
will also be performed to better elucidate the blood supply to both these fascial
systems.
Hypothesis:
We hypothesize that use of subpectoral fascia and serratus fascia results in less morbidity when compared to harvesting slips of serratus muscle for lateral expander coverage. This hypothesis will be tested by performing an analysis of all clinical, and functional results of our patient case series and comparing this with historical case series using slips of serratus muscle for lateral expander coverage.
Medical student involvement:
The medical students working on this project will be involved in anatomical dissections of the subpectoral and serratus fascia looking at the anatomical landmarks and vascular supplies. They will also be involved in analyzing all of the results of our series so far. The end points measured will include all complications, and functional assessment with the help of a certified hand occupational therapist. These results will be compared to historical cases series reported in the literature.
Project II title: Use of the muscle sparing latissimus dorsi flap in immediate and delayed breast reconstruction: anatomical and clinical study
Human subjects IRB approved project number (where applicable):
1. Muscle-sparing latissimus study: 072006-072 - approved
Animal subjects IACUC approved project number (where applicable):
Project Type (patient-based research, animal-based research, or basic research; this characterization is only to permit a general classification for grouping similar types of projects)
Patient-based
Brief Description of Project:
1. Use of the muscle sparing latissimus dorsi flap in immediate and delayed breast reconstruction: anatomical and clinical study
The latissimus dorsi flap is one of the workhorses in reconstructive plastic surgery. Originally described in the 1950's, the flap was popularized for use in breast reconstruction by Bostwick and the group from Emory in the late 1970's. In the mid-1990's, Angrigiani described the thoracodorsal artery perforator (TAP) flap. This new technique employed the same skin paddle and arterial pedicle as the traditional latissimus dorsi, however, this functionally-important muscle was spared. The arterial pedicle is long and reliable, and the flap offers the opportunity for harvesting very thin flaps for surfacing large defects.
Although this flap is a creative, less-morbid alternative to the latissimus dorsi, it still has some disadvantages. The dissection is very intense and time consuming, as the surgeon must follow the perforator down through the latissimus muscle. There is still a wide dissection of the flap, and seroma formation is still seen. A new possible alternative to this perforator flap is the muscle-sparing latissimus dorsi flap. This technique offers us the ability to employ this same reliable skin paddle and vascular pedicle, yet at the same time, the dissection is not as involved, leading to less intraoperative time for the patient, and possibly a less traumatic dissection within the donor site.
We have been using the muscle sparing latissimus dorsi flap in some of our breast reconstruction patients in whom it is indicated. We would like to examine our case series and explore whether this flap is indeed the perfect middle ground between the more invasive latissimus dorsi flap, and the time-consuming TAP flap.
The study will be in two parts: part one is an anatomical study using latex and barium sulphate injections into the flap arterial system, as well as a novel 3D CTA imaging technique that we have recently described, to better understand flap anatomy and perfusion; part 2 is a mainly case-note based analysis to record operating time, incidence of flap necrosis, seroma formation, and wound dehiscence, as well as functional donor site morbidity, functional status, and also the aesthetics of the posterior axillary fold, retrospectively examined from records from past operations performed at UT Southwestern by the primary investigator, and for which we have IRB approval.
Hypothesis:
We hypothesize that use of the muscle sparing latissimus dorsi flap results in a lower complication rate and better functional outcome when compared to the traditional latissimus dorsi flap. This hypothesis will be tested by performing an analysis of all clinical, aesthetic and functional results of our patient case series and comparing this with historical case series using the traditional latissimus dorsi flap.
Medical student involvement:
The medical students working on this project will be involved in anatomical dissections looking at the anatomical landmarks and vascular supply of the muscle sparing latissimus dorsi flap. They will also be involved in analyzing all of the results of our series so far. The end points measured will include all complications, aesthetic results, and a full functional assessment with the help of a certified hand occupational therapist. These results will be compared to historical cases series reported in the literature.
Previous Research Activities or Publications with Medical Students:
I have 6 years experience with teaching medical students prior to recent appointment
at UTSW.
Return to Medical Student Research Page