Objective To introduce the treatment experiences about the skin-sparing mastectomy and immediate breast reconstruction. Methods The skin-sparing mastectomy and immediate breast reconstruction by using transverse rectus abdominis myocutaneous （TRAM） flat were performed in 10 patients with early-stage breast cancer from May 2008 to December 2011 in our hospital. The patients’ data were retrospectively analyzed. Results There were postoperative complications after skin-sparing mastectomy and immediate breast reconstruction， including TRAM flat necrosis in 1 case， papillary necrosis in 1 case and fat necrosis in the reconstructed breast with oxter wound infection in 1 case. There was no incision hernia of abdominal wall or necrosis of all TRAM flat in any case. The patients’ satisfaction that evaluation for the breast shapes of reconstructed breasts was very satisfaction in 5 cases， part satisfaction in 4 cases， and dissatisfaction in 1 case， respectively. Conclusions Because of the minimal access approach and good breast shape， the skin-sparing mastectomy and immediate TRAM flat breast reconstruction is a safe and effective way for treating early-stage breast cancer.
ObjectiveTo screen the current optimal evidence for early removal of urinary catheters in patients after gastrointestinal surgery both domestically and internationally. MethodsWe systematically searched the following databases or website, including the UpToDate, the British Medical Journal Best Practice, the Jonna Briggs Institute Evidence-Based Healthcare Center, the Guidelines International Network, the National Institute for Health and Clinical Excellence Guidelines, the Registered Nurses’ Association of Ontario, the Scottish Intercollegiate Guidelines Network, the European Association of Urology Nurses, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, ClinicalKey, Embase, PubMed, Web of Science, CNKI, Wanfang, and VIP. The literature was evaluated, and the evidence was extracted and summarized. ResultsA total of 27 articles were included, including 3 clinical decisions, 4 guidelines, 18 systematic reviews, 1 practice recommendation, and 1 expert consensus. The 23 evidence items were classified into five categories: pre-catheterization assessment (6 items), institutional and personnel requirements (2 items), strategies to shorten catheter indwelling time (8 items), bladder recovery strategies (5 items), and timing of catheter removal (2 items). These items were classified 5 evidence levels ccording to the 2014 JBI Evidence-Based Healthcare System Evidence Pre-Grading and Recommendation Level System: level 1 (6 items), level 2 (8 items), level 3 (1 item), level 4 (0 items), and level 5 (8 items). Recommendation grades: grade A (strong recommendation, 14 items) and grade B (weak recommendation, 9 items). ConclusionsThe high-quality evidence identified in this study regarding early urinary catheter removal can be effectively applied in the clinical management of patients after gastrointestinal surgery. However, there are few studies on this in China. These best evidence should be adaptively implemented according to the specific situation after gastrointestinal surgery in China.