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Caroline A Hundepool, Liselotte F Bulstra, Dimitra Kotsougiani, Patricia F Friedrich, Steven E R Hovius, Allen T Bishop, Alexander Y Shin
BACKGROUND: A bridging nerve autograft is the gold standard for the repair of segmental nerve injury that cannot be repaired directly. However, limited availability and donor site morbidity remain major disadvantages of autografts. Here, a nerve allograft decellularized with elastase was compared with an autograft regarding functional motor outcome in a rat sciatic segmental nerve defect model. Furthermore, the effect of storage on this allograft was studied. METHODS: Sixty-six Lewis rats (250-300 g) underwent a 10-mm sciatic nerve reconstruction using either a cold- (n = 22) or frozen-stored (n = 22) decellularized nerve allograft or an autograft (n = 22)...
September 19, 2018: Microsurgery
Beniamino Brunetti, Stefania Tenna, Mauro Barone, Gabriella Cassotta, Manuele Casale, Paolo Persichetti
INTRODUCTION: Many techniques have been described to treat full thickness nasal defects. The authors introduce the bipaddle chimaeric forehead flap (BCFF), a new alternative technique to achieve simultaneous lining and cutaneous reconstruction in case of full thickness hemi-nasal defects, presenting surgical details and applications for its clinical use. PATIENTS AND METHODS: From June 2015 to April 2017, 10 patients presenting with oncological full thickness defects involving nasal sidewall and/or nasal ala were reconstructed with the BCFF technique...
September 16, 2018: Microsurgery
Kensuke Tashiro, Masaki Arikawa, Yutaka Fukunaga, Fumihiko Nakatani, Eisuke Kobayashi, Akira Kawai, Shimpei Miyamoto
INTRODUCTION: External hemipelvectomy is one of the most extensive surgical procedures for locally advanced pelvic tumors. Stump coverage with the local tissues can be difficult in recurrent cases. Herein, we report our experience with immediate stump coverage using a free latissimus dorsi musculocutaneous (LDMC) flap after external hemipelvectomy for recurrent pelvic malignancies. METHODS: Six patients underwent external hemipelvectomy and immediate reconstruction using a free LDMC flap between November 2012 and June 2017...
September 6, 2018: Microsurgery
Oscar Ochoa, Michael Metzner, Constantine Theoharis, Minas Chrysopoulo, Steven Pisano, Chet Nastala, Peter Ledoux, Gary Arishita, Ramon Garza, Ted Snider
INTRODUCTION: Breast cancer-related extremity lymphedema is a potentially devastating condition. Vascularized lymph node transfer (VLNT) has shown benefit in lymphedema treatment. Due to concerns over potential iatrogenic complications, various donor sites have been described. The current study aims at defining the deep inferior epigastric lymph node basin as a novel donor site for VLNT. METHODS: A retrospective study was performed on patients undergoing routine abdominal-based breast reconstruction...
September 5, 2018: Microsurgery
Christopher R Davis, Lyn Jones, Rachel L Tillett, Helen Richards, Sherif M Wilson
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...
September 5, 2018: Microsurgery
Yoon Jae Lee, Seung Eun Baek, Junho Lee, Deuk Young Oh, Jong Won Rhie, Suk-Ho Moon
BACKGROUND: The reconstruction of complex defects in the posterior trunk is a challenging problem. Various surgical methods using local flap, propeller flap, and muscle flap have been reported. However, in case where a free flap is inevitable, due to the absence of usable recipient vessels, eventually it may fail to perform or the use of long vessel graft is mandatory. To overcome this problem, we investigated use of perforator as recipient vessel in posterior trunk region and here we report satisfactory outcomes of the cases...
September 5, 2018: Microsurgery
Kian Adabi, Oscar J Manrique, Aparna Vijayasekaran, Steven L Moran, Pedro Ciudad, Tony C T Huang, Fabio Nicoli, Sarah Bishop, Hung-Chi Chen
INTRODUCTION: Reconstruction of abdominal wall defects with enterocutaneous fistulas (ECF) remains challenging. The purpose of this report is to describe a single-stage approach using combined microscopic enterolysis, pedicle seromuscular bowel flaps, mesh, fasciocutaneous, and myocutaneous flaps. METHODS: Between 1990 and 2016 a retrospective review identified a total of 18 patients with an average age of 39 years (ranging 26-59 years). Thirteen cases were associated with trauma, four were complication of previous mesh repair, and one was after an aortic dissection...
September 3, 2018: Microsurgery
Natalie A Krane, Scott H Troob, Mark K Wax
We report a case during which a new method of reconstruction for a nasopharyngeal and skull base defect was successfully performed. A 45-year-old female with granulomatosis with polyangiitis presented with computed tomography (CT) findings demonstrative of chronic clival and cervical spine osteomyelitis secondary to nasopharyngeal destruction. The posterior nasopharyngeal defect, evident as a wide area of mucosal erosion exposing the clivus centrally, was successfully reconstructed with an anterior serratus muscle-free tissue transfer via both transcervical and endoscopic transnasal approaches utilizing a laparoscopic fixation device, a previously unreported method for free flap inset, to secure the free flap...
September 3, 2018: Microsurgery
David Mattos, Jason H Ko, Matthew L Iorio
BACKGROUND: Osteomyelitis of the wrist is rare but destructive. Subsequent bone defects often require vascularized bone for successful healing. Recent literature has pointed to the successful use of the medial femoral condylar (MFC) flap for difficult non-unions, yet it has not been specifically described for wrist fusion. We present our experience with this technique for limited and complete wrist arthrodesis. PATIENTS AND METHODS: We reviewed 4 cases of radiocarpal bone loss from osteomyelitis...
September 3, 2018: Microsurgery
Sebastian Fischer, Yannick Diehm, Miguel I Dorante, Dimitra Kotsougiani, Maximilian Kueckelhaus, Muayyad Alhefzi, Ericka M Bueno, Bohdan Pomahac
INTRODUCTION: Assessment of outcomes after face transplantation (FT) is necessary to provide sound evidence on the benefits of this life-giving surgery. Current methods for outcomes assessment, however, are imprecise or prone to subjectivity. Software-based video analysis may allow fast, objective and retrospective assessment of restoration of facial movements and functions after FT. PATIENTS AND METHODS: We recorded videos of 7 subjects before as well as every 3-6 months after facial transplantation...
August 29, 2018: Microsurgery
Carsten Rendenbach, Friedemann Goehler, Lara Hansen, Carsten Kohlmeier, Michael Amling, Henning Hanken, Benedicta Beck-Broichsitter, Max Heiland, Bjoern Riecke
PURPOSE: Free flap surgery can be associated with donor-site morbidity. The purpose of this study was to analyze long-term functional outcomes at the donor site after deep circumflex iliac artery (DCIA) bone flap harvesting. METHODS: Fourteen patients (8 men and 6 women, mean age 53.9 years; range 22-87 years) with mandible resection (8 carcinomas, 4 ameloblastomas, 1 osteonecrosis, and 1 myxofibroma) and DCIA flap reconstruction were included in an observational study...
August 29, 2018: Microsurgery
Tateki Kubo, Tomoyuki Kurita, Hiroki Tashima, Motoyuki Suzuki, Hirokazu Uemura, Takashi Fujii, Shien Seike, Hidenori Inohara, Ko Hosokawa
BACKGROUND: "Window" resection of the trachea is sometimes performed to remove tumors invading the trachea. Here, we present a novel reconstructive procedure to this end. METHODS: Eleven patients (mean age, 64 years; range, 46-80 years) were included. Primary diagnoses included thyroid cancer and adenoid cystic carcinoma of the trachea. All defects were partial and located in the neck (mean width and length, 3/5 circle and 7.5 rings; range, 1/2-2/3 circle and 5-9 rings)...
August 29, 2018: Microsurgery
Tateki Kubo, Tomoyuki Kurita, Hiroki Tashima, Shien Seike, Takashi Fujii, Masahiko Yano, Makoto Yamasaki, Yuichiro Doki, Ko Hosokawa
BACKGROUND: When pharyngoesophagectomy is performed in conjunction with anterior mediastinal tracheostomy, reconstructing both the trachea and alimentary tract is extremely difficult. We developed a novel 1-stage reconstructive procedure using a single free jejunal flap containing multiple vascular pedicles to decrease postoperative morbidity and mortality. Free jejunal flap transfer with multiple vascular pedicles could offer a viable option for reducing associated life-threatening complications...
August 27, 2018: Microsurgery
Felix F Strübing, Amir K Bigdeli, Volker J Schmidt, Spyridoula Maraka, Ulrich Kneser, Dimitra Kotsougiani
Late free flap failures due to pedicle obstruction are rare adverse events. The purpose of this report is to present a case in which the near-infrared indocyanine green video angiography (ICG-NIR-VA) was used to evaluate the perfusion in a compromised fasciocutaneous flap in the late postoperative period. A 55-year-old male patient, who initially suffered from an open tibial fracture, developed concurrent osteomyelitis with fistulae of the proximal tibia requiring excision. Reconstruction was achieved using a parascapular flap of 25 × 8 cm, anastomosed to an arterio-venous (AV) Loop in the adductor canal...
August 24, 2018: Microsurgery
Rebecca Knackstedt, James Gatherwright, Raffi Gurunluoglu
INTRODUCTION: There is a hesitancy to utilize vasopressors in microsurgical reconstruction due to fear of vessel spasm and subsequent flap compromise. Although there are large literature reviews analyzing vasopressor usage in head and neck reconstruction, this has not been extrapolated to all regions of the body. The goal of this study was to perform a meta-analysis examining vasopressor usage and risk of complications in microsurgical reconstruction for all recipient sites. MATERIALS AND METHODS: A meta-analysis was conducted for articles discussing the utilization of vasopressors in microsurgical reconstruction...
July 29, 2018: Microsurgery
Georgette Oni, William Nabulyato, Charles Malata
No abstract text is available yet for this article.
July 23, 2018: Microsurgery
Pedro Ciudad, Oscar J Manrique, Mouchammed Agko, Chieh-Ting Huang, Wei-Ling Chang, Ricardo Delgado B, César Reynaga, Bulent Sacak, Hung-Chi Chen
No abstract text is available yet for this article.
July 4, 2018: Microsurgery
Travis J Miller, Jarom N Gilstrap, Katsuhide Maeda, Stanley Rockson, Dung H Nguyen
Thoracic duct injury can be a devastating injury with disruption of lymphatic flow leading to potentially chylothorax and/or severe lymphedema. Standard treatment modalities include thoracic duct ligation or embolization for chylothorax, but treatment options to date are few for resultant lymphedema. In this case report, we describe lymphaticovenous bypass of the thoracic duct to the jugular venous system in a 21-year-old male with secondary lymphedema after iatrogenic thoracic duct injury. The patient experienced improvement of lymphedema symptoms including decreased weight and limb girth as well as normalization of serum markers indicating improved lymphatic delivery to the venous system...
July 4, 2018: Microsurgery
Mario F Scaglioni, Gabriele Giunta
BACKGROUND: Complex defects resulting in ablation of the scalp, the calvaria, the dura, and the underlying brain are still challenging. These defects require cranioplasty to restore the bone cosmetic and functional roles and free-flap soft tissue reconstruction to prevent cranioplasty exposure and further infection. Different materials have been used in cranioplasty, while different free flaps have been proposed in those cases. In this article, we present a case series of cranioplasty reconstruction with thoracodorsal artery perforator flap (TDAP)...
July 3, 2018: Microsurgery
Osman Kelahmetoglu, Direnc Ozlem Aksoy, Selma Sonmez Ergun, Ethem Guneren
No abstract text is available yet for this article.
July 3, 2018: Microsurgery
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