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Journal of Reconstructive Microsurgery

Ahmad Eweida, Olga Rosenbauer, Oliver Frisch, Frank A Giordano, Jens Fleckenstein, Frederik Wenz, Stephanie Kirschner, Marc A Brockmann, Matthias Schulte, Ulrich Kneser, Leila Harhaus
BACKGROUND:  Regenerative medicine is still deficient in the reconstruction after cancer due to impaired vascularization after radiotherapy and due to the need to substitute larger defects after tumor excision. Aiming at introducing regenerative medicine for reconstruction after cancer, we tested an axially vascularized bone construct in an experimental setting that mimics the clinical situation after tumor resection and adjuvant radiotherapy. METHODS:  Twenty bone constructs were axially vascularized using microsurgically created arteriovenous loops and were implanted subcutaneously in Lewis rats...
July 11, 2018: Journal of Reconstructive Microsurgery
Lilli Cooper, Katia Sindali, Karthik Srinivasan, Martin Jones, Nora Nugent
BACKGROUND:  Microsurgery is increasingly relevant, and is difficult to learn. Simulation is relied upon ever more in microvascular training. While living models provide the ultimate physiological feedback, we are ethically obliged to optimize non-living models to replace, refine, and reduce the use of animals in training. There is currently no three-layered synthetic vessel available for microsurgical training. METHODS:  A three-layered synthetic vessel was designed with a simulation company...
July 11, 2018: Journal of Reconstructive Microsurgery
Magdy Ahmed Abd-Al-Moktader
BACKGROUND:  Peroneus brevis muscle flap is a distinguished, distally based safe flap that can be manipulated to cover small defects in the leg and ankle. For large-sized defects, a more distal, larger flap is required either locally or distantly. METHODS:  Forty-two distally based peroneus brevis muscle flaps were elevated in 42 patients (30 males and 12 females) with major lower leg, ankle, and proximal foot defects of 6 to 15 cm in length and 6 to 12 cm in width...
June 28, 2018: Journal of Reconstructive Microsurgery
Krishna S Vyas, Anita T Mohan, Shane D Morrison, Duy C Tran, Samir Mardini
BACKGROUND:  Dendritic cells (DCs) are bone marrow-derived, professional antigen-presenting cells with tolerogenic function. The ability of DCs to regulate alloantigen-specific T cell responses and to promote tolerance has aligned them ideally for a role in vascularized composite allotransplantation (VCA). In this study, we summarize the current evidence for DC therapies for tolerance induction to alleviate the requirement for chronic immunosuppression. METHOD:  A comprehensive and structured review of manuscripts published on VCA was performed using the MEDLINE and PubMed databases...
June 26, 2018: Journal of Reconstructive Microsurgery
Zaher Jandali, Martin C Lam, Benedikt Merwart, Bernd Möhring, Stephanie Geil, Klaus Müller, Mihai Ionac, Lucian P Jiga
BACKGROUND:  The composite anterolateral thigh flap with vascularized fascia lata (ALT-FL flap) for covering complex soft tissue defects involving the Achilles tendon has shown promising results. The age and body mass index (BMI) are important predictors of clinical outcome after surgical treatment of Achilles tendon ruptures. In this study, we investigate whether these also influence the outcome of patients after Achilles tendon reconstruction using the ALT-FL flap. METHODS:  Twenty patients (mean age: 55...
June 26, 2018: Journal of Reconstructive Microsurgery
Daniel Panchik, Sarah Masco, Patrice Zinnikas, Brooke Hillriegel, Tori Lauder, Erica Suttmann, Vernon Chinchilli, Maureen McBeth, William Hermann
BACKGROUND:  Breast cancer-related lymphedema (BCRL) affects many areas of daily living. Individuals with lymphedema may experience chronic and progressive swelling, recurrent skin infections, and decreased self-image and quality of life. For many years, it was considered best practice for this population to avoid exercise; however, in recent years, research has begun to challenge this belief. This systematic review and meta-analyses examined the recent literature on the effects of exercise for patients with, or at risk for, BCRL to inform best practice...
June 23, 2018: Journal of Reconstructive Microsurgery
Kimberley Hughes, Derek Neoh
BACKGROUND:  Locally advanced breast cancer (LABC) is traditionally treated with a multimodal approach of chemotherapy, surgery, and postmastectomy radiotherapy (PMRT). The advantages of immediate breast reconstruction (IBR) are well described and include improved aesthetic outcomes, fewer surgical procedures, shorter treatment period, and a higher quality of life. However, this sequence makes immediate free autologous reconstruction more challenging as PMRT can have deleterious and unpredictable effects on the flap...
June 16, 2018: Journal of Reconstructive Microsurgery
John T Stranix, William J Rifkin, Z-Hye Lee, Lavinia Anzai, Adam Jacoby, Daniel J Ceradini, Vishal Thanik, Pierre B Saadeh, Jamie P Levine
BACKGROUND:  Microvascular reconstruction of the lower extremity has the highest reported complication and flap failure rates of any anatomical region. Despite widespread adoption of the mechanical anastomotic venous coupler and encouraging results in other anatomical regions, there are limited reports examining its use in the lower extremity. This study compares outcomes between coupled and hand-sewn venous anastomoses in traumatic lower extremity reconstruction. METHODS:  Retrospective review of our institutional flap registry from 1979 to 2016 identified soft tissue free flaps performed for the reconstruction of Gustilo type IIIB/IIIC open tibial fractures...
June 15, 2018: Journal of Reconstructive Microsurgery
Emily A Van Kouwenberg, Alan Yan, Ashit Patel, Rick L McLaughlin, Patricia Northrup, Melanie Cintron, Richard L Agag
BACKGROUND:  The radial forearm free flap (RFFF) remains a workhorse flap but can have significant donor site morbidity. The authors developed a novel technique for endoscopic-assisted RFFF (ERFFF) harvest and hypothesized improved donor site morbidity. METHODS:  A retrospective cohort study was conducted evaluating patients who underwent ERFFF or RFFF by a single surgeon for head and neck reconstruction between November 2011 and July 2016; outcomes and complications were compared...
June 12, 2018: Journal of Reconstructive Microsurgery
Vincent Hunsinger, Martin Lhuaire, Kevin Haddad, Francesco-Saverio Wirz, Samah Abedalthaqafi, Déborah Obadia, Mohamed Derder, Alexandre Marchac, Marc David Benjoar, Mikael Hivelin, Laurent Lantieri
BACKGROUND:  The volume of the profunda femoris artery perforator (PAP) flap limits its indications to small- and medium-sized breast reconstructions after modified radical mastectomy for cancer. We report a modified PAP flap design, including not only a vertical extension that increases its volume but also the skin surface, which suits larger breasts requiring immediate or delayed breast reconstructions and compare the results with our horizontal skin paddle PAP flap experience. PATIENTS AND METHODS:  In our center between November 2014 and November 2016, 51 consecutive patients underwent a PAP flap breast reconstruction following breast cancer...
June 2, 2018: Journal of Reconstructive Microsurgery
Corinne M Bertolaccini, Ann Marie B Prazak, Jayant Agarwal, Isak A Goodwin, W Bradford Rockwell, Christopher J Pannucci
BACKGROUND:  In microvascular surgery, patients often receive unfractionated heparin infusions to minimize risk for microvascular thrombosis. Patients who receive intravenous (IV) heparin are believed to have adequate prophylaxis against venous thromboembolism (VTE). Whether a fixed dose of IV heparin provides detectable levels of anticoagulation, or whether the "one size fits all" approach provides adequate prophylaxis against VTE remains unknown. This study examined the pharmacodynamics of fixed-dose heparin infusions and the effects of real-time, anti-factor Xa (aFXa) level driven heparin dose adjustments...
May 22, 2018: Journal of Reconstructive Microsurgery
James D Vargo, Wojciech Przylecki, Paul J Camarata, Brian T Andrews
BACKGROUND:  Microvascular reconstruction of the anterior cranial fossa (ACF) creates difficult challenges. Reconstructive goals and flap selection vary based on the defect location within the ACF. This study evaluates the feasibility and reliability of free tissue transfer for salvage reconstruction of low, middle, and high ACF defects. METHODS:  A retrospective review was performed. Reconstructions were anatomically classified as low (anterior skull base), middle (frontal bar/sinus), and high (frontal bone/soft tissue)...
May 18, 2018: Journal of Reconstructive Microsurgery
Hemin Oathman Sheriff, Kawa Abdullah Mahmood, Nzar Hamawandi, Aram Jamal Mirza, Jawad Hawas, Esther Granell Moreno, Juan Antonio Clavero, Christopher Hankins, Jaume Masia
BACKGROUND:  The supraclavicular artery flap is an excellent flap for head and neck reconstruction. The aim of this study is to assess imaging techniques to define the precise vascular boundaries of this flap. METHODS:  Six imaging techniques were used for supraclavicular artery mapping in 65 cases; handheld Doppler, triplex ultrasound, computed tomography angiography, magnetic resonance angiography, digital subtraction angiography, and indocyanine green angiography...
May 18, 2018: Journal of Reconstructive Microsurgery
W P Andrew Lee, Jaimie T Shores, Gerald Brandacher
AIM:  To achieve a favorable risk-benefit balance for hand transplantation, an immunomodulatory protocol was developed in the laboratory and translated to clinical application. METHODS:  Following donor bone marrow infusion into transplant recipients, hand and arm allografts have been maintained on low-dose tacrolimus monotherapy. RESULTS:  Good-to-excellent functional recovery has been achieved in patients compliant with medication and therapy, thus restoring autonomous and productive lives...
May 18, 2018: Journal of Reconstructive Microsurgery
Oscar J Manrique, Sarah N Bishop, Pedro Ciudad, Kian Adabi, Jorys Martinez-Jorge, Steven L Moran, Tony Huang, Aparna Vijayasekaran, Shih-Heng Chen, Hung-Chi Chen
BACKGROUND:  Lower extremity salvage following significant soft tissue loss can be complicated by lack of recipient vessel for free tissue transfer. We describe our experience in lower limb salvage for patients with no recipient vessels with the use of pedicle, free and cable bridge flaps. METHODS:  A retrospective review from 1985 to 2017 of patients undergoing lower limb salvage using a contralateral pedicle cross leg (PCL) flaps, free cross leg (FCL) flaps, or free cable bridge (FCB) flaps was conducted...
May 16, 2018: Journal of Reconstructive Microsurgery
David Chwei-Chin Chuang
BACKGROUND:  Nerve transfer can be broadly separated into two categories: proximal nerve graft and/or transfer and distal nerve transfer. The superiority of proximal nerve graft/transfer over distal nerve transfer strategy has been debated extensively, but which strategy is the best has not yet been defined. Each technique has its own advantages and disadvantages. However, proximal nerve graft/transfer is still the main reconstructive procedure based on the principle of "no diagnosis, then no treatment...
May 16, 2018: Journal of Reconstructive Microsurgery
Giuseppe Visconti, Marzia Salgarello, Akitatsu Hayashi
BACKGROUND:  Venules have been usually neglected in the literature on lymphaticovenular anastomosis (LVA). The aim of this study was to analyze the flow dynamic of recipient venules in LVA and their impact on the surgical outcomes. PATIENTS AND METHODS:  Data from 128 patients affected by extremity lymphedema, who underwent LVA, were collected in two institutions from August 2014 to May 2016. Recipient venules were classified according to their flow dynamic into backflow, slack, and outlet (BSO classification)...
May 12, 2018: Journal of Reconstructive Microsurgery
Hidehiko Yoshimatsu, Takuya Iida, Takumi Yamamoto, Akitatsu Hayashi
BACKGROUND:  The superficial circumflex iliac artery (SCIA)-based iliac bone flap has yet to be widely used. The purpose of this article is to validate the feasibility of SCIA-based iliac bone flap transfers for reconstruction of small to moderate-sized bony defects. Retrospective outcome comparisons between SCIA-based iliac bone flaps and fibula flaps were made. METHODS:  Twenty-six patients with bony tissue defects underwent reconstructions using either free SCIA-based iliac bone flaps (13) or fibula flaps (13)...
May 12, 2018: Journal of Reconstructive Microsurgery
Ruya Zhao, Bao Ngoc N Tran, Andres F Doval, Gloria Broadwater, Kate J Buretta, Jonah P Orr, Bernard T Lee, Scott T Hollenbeck
BACKGROUND:  Breast implant placement is the most common method for postmastectomy reconstruction. For patients who develop complications associated with implant-based reconstruction, additional surgeries may be challenging. This study examined implant-based reconstruction failure in patients undergoing salvage with abdominal free tissue transfer. METHODS:  We conducted an Institutional Review Board approved, multicenter retrospective study of patients with implant-based primary breast reconstruction followed by implant removal and subsequent abdominal free tissue transfer between 2006 and 2016...
May 7, 2018: Journal of Reconstructive Microsurgery
Geoffrey G Hallock
Just what is the S&T lecture? In the beginning it appeared to be a dubious distinction, another task thrust upon me but different in that I had absolutely no idea what was wanted or would be appropriate. At the least, it seemed reasonable to recite a simple introductory story for what would be an extraordinary conclave. First, an appreciation was due to our dedicated leaders of World Society of Reconstructive Microsurgery (WSRM), who this year (2017) have put together the most extravagant meeting ever, intended to include not just the glamorous but the entire scope of rudimentary reconstructive microsurgery...
May 3, 2018: Journal of Reconstructive Microsurgery
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