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Journal of Reconstructive Microsurgery

Akiko Sakakibara, Junya Kusumoto, Shunsuke Sakakibara, Takumi Hasegawa, Masaya Akashi, Tsutomu Minamikawa, Shungo Furudoi, Kazunobu Hashikawa, Takahide Komori
OBJECTIVE:  Musculocutaneous flap reconstruction surgery is one of the standard procedures following head and neck cancer resection. However, no previous studies have classified flaps in terms of muscle and fat or examined them after long-term follow-up. The purpose of this study was to estimate the fat and muscle volume changes in musculocutaneous flaps during long-term follow-up. METHODS:  We conducted a retrospective analysis of 35 patients after musculocutaneous flap reconstruction...
September 21, 2018: Journal of Reconstructive Microsurgery
John P Brosious, Shawna R Kleban, Joshua J Goldman, Adnan G Mohsin, Shelly J Williams, Wei Z Wang, John M Menezes, Richard C Baynosa
BACKGROUND:  The purpose of this study was to evaluate learning curves for an existing microsurgical training model. We compared efficiency and amount of training needed to achieve proficiency between novice microsurgeons without operative experience versus those who had completed a surgical internship. METHODS:  Ten novice microsurgeons anastomosed a silastic tube model. Time to perform each anastomosis, luminal diameter, and number of errors were recorded...
September 21, 2018: Journal of Reconstructive Microsurgery
Dmitry Zavlin, Vishwanath Chegireddy, Kevin T Jubbal, Nikhil A Agrawal, Aldona J Spiegel
BACKGROUND:  Maintaining optimal coagulation is vital for successful microvascular tissue transfer. The viscoelastic thromboelastography (TEG) is a modern and dynamic method to assess a patient's coagulation status. The aim of this study was to evaluate its diagnostic capabilities of identifying microvascular complications. METHODS:  A retrospective chart review was conducted for the most recent 100 cases of abdominal free flap breast reconstruction of a single surgeon...
September 19, 2018: Journal of Reconstructive Microsurgery
Ahmet Hamdi Sakarya, Hakan Uzun, Ayten Türkkanı, Ayşe Nur Çakar, Yun-Huan Hsieh, Galip Gencay Üstün, Tunç Şafak
BACKGROUND:  The use of caffeine is not recommended prior to elective microsurgery due to its demonstrated negative effects on vessel anastomosis by the presumed sympathomimetic induction of vasoconstriction. In this study, we aimed to elucidate the systemic and local effects of caffeine on vessel diameter, anastomosis patency, and degree of intimal hyperplasia during the healing process. METHODS:  Twenty-five rats were randomly assigned to five groups: (1) negative control, (2) preoperative systemic caffeine, (3) postoperative systemic caffeine, (4) perioperative systemic caffeine, and (5) a local caffeine group...
September 19, 2018: Journal of Reconstructive Microsurgery
Theodore A Kung, Kelley M Kidwell, Kelly A Speth, Judy C Pang, Reshma Jagsi, Lisa A Newman, Edwin G Wilkins, Adeyiza O Momoh
BACKGROUND:  Delayed autologous breast reconstruction is commonly recommended in patients requiring postmastectomy radiation. This study examines gross and histologic changes in the breast skin of patients who have undergone postmastectomy radiation to help determine when radiation-induced skin changes begin to stabilize. METHODS:  A prospective pilot study was conducted on eight patients with invasive breast cancer who required mastectomy and radiotherapy. At the time of mastectomy and 2, 4, 6, 8, and 12 months after completion of radiotherapy, a punch biopsy was taken from the radiated mastectomy skin of each patient...
September 19, 2018: Journal of Reconstructive Microsurgery
Max Stewart, Cecilia Brassett, Ahid Abood
BACKGROUND:  The anterolateral thigh (ALT) perforator flap is one of the most widely used flaps in reconstructive microsurgery. This study investigated a previously unexplored and clinically relevant aspect of perforator anatomy: the "box junction" (BxJn), the point at which the perforator arises from its source vessel. Negotiating the BxJn can be a challenging and time-consuming step in flap harvest, due to the neurovascular structures in the area which must be protected from injury...
September 15, 2018: Journal of Reconstructive Microsurgery
Juan Jose Gilbert Fernandez, Roberto Gilbert Febres-Cordero, Roger L Simpson
BACKGROUND:  In 1964, faced with the challenge of traumatic amputation, a team of surgeons at Clinica Guayaquil was convinced that the transplantation of a hand could significantly improve function and quality of life for the recipient. With a current but basic understanding of immunosuppression, the surgeons identified a recipient and waited for the correct donor. A human hand transplant had never been performed to date. METHODS:  The surgeons' criteria for the recipient included a young healthy individual who had sustained a traumatic amputation at the distal forearm level with full motion of the proximal joints...
August 31, 2018: Journal of Reconstructive Microsurgery
Akito Nakanishi, Kenji Kawamura, Shohei Omokawa, Takamasa Shimizu, Akio Iida, Yasuhito Tanaka
BACKGROUND:  Microsurgical replantation of the thumb and digits has become an increasingly familiar technique in clinical practice worldwide. However, successful digit replantation does not always provide better hand function than revision amputation. Little information is available regarding predictors of motor skill activities of replanted hands. Therefore, we retrospectively evaluated hand dexterity after single-digit replantation at a minimum follow-up of 1 year and analyzed the factors influencing dexterity...
August 28, 2018: Journal of Reconstructive Microsurgery
Linden K Head, Katie Hicks, Gerald Wolff, Kirsty U Boyd
BACKGROUND:  Given the unsatisfactory outcomes with traditional treatments, there is growing interest in nerve transfers to reestablish ankle dorsiflexion in peroneal nerve palsy. The objective of this work was to perform a systematic review and meta-analysis of the primary literature to assess the effectiveness of nerve transfer surgery in restoring ankle dorsiflexion in patients with peroneal nerve palsy. METHODS:  Methodology was registered with PROSPERO, and PRISMA guidelines were followed...
August 22, 2018: Journal of Reconstructive Microsurgery
Melissa A Mueller, Navid Pourtaheri, Gregory R D Evans
BACKGROUND:  Given emerging focus on competency-based surgical training and work-hour limitations, surgical skills laboratories play an increasingly important role in resident education. This study was designed to investigate educational opportunities in microsurgery across integrated residency programs. METHODS:  Senior residents (PGY 4-6) at integrated plastic surgery programs were surveyed during the 2016 to 2017 academic year to determine each program's access to: training microscopes and anastomosis models, video-based skills assessment, pre-requisite skills exams, flap courses, or a formal microsurgical training curriculum...
August 18, 2018: Journal of Reconstructive Microsurgery
Ian R MacArthur, Colin W McInnes, Kim R Dalke, Mohamed Akra, Shantanu Banerji, Edward W Buchel, Thomas J Hayakawa
BACKGROUND:  Lower extremity soft tissue sarcoma treatment has evolved from primarily amputation procedures toward limb salvage. This series assesses whether soft tissue sarcoma tissue defects, extensive enough to require microsurgical reconstruction, can reliably result in preservation of ambulation, as well as objectively evaluate functional outcomes utilizing a patient-reported validated scale. It will also look at whether immediate functional muscle reconstructions and tendon transfers can be successful at restoring ambulation, potentially expanding the indications for limb salvage procedures...
August 18, 2018: Journal of Reconstructive Microsurgery
Ahmed Mohamed El Ghoneimy, Magdy El Sherbiny, Nehal Kamal
BACKGROUND:  Most reports on skeletal reconstruction using vascularized fibular free flap include patients with varying age groups and anatomic locations. This study has limited the inclusion criteria to pediatric and adolescent patients diagnosed with bone sarcoma of the femoral shaft. METHODS:  Forty-one patients, diagnosed with a malignant bone tumor of the femoral shaft (21 Ewing's sarcomas and 20 osteosarcomas), were locally treated by joint sparing wide resection and reconstruction using a vascularized fibular free flap...
August 18, 2018: Journal of Reconstructive Microsurgery
Weifeng Zeng, Nikita O Shulzhenko, Aaron M Dingle, Samuel O Poore
No abstract text is available yet for this article.
August 18, 2018: Journal of Reconstructive Microsurgery
Akhil K Seth, Pieter G L Koolen, Steven M Sultan, Bernard T Lee, Heather A Erhard, David T Greenspun
BACKGROUND:  The abdomen remains the most popular and reliable donor site for autologous breast reconstruction. Some patients, however, lack sufficient tissue to recreate an aesthetic breast mound using a single-pedicle, deep inferior epigastric perforator (DIEP) flap, particularly when matching a contralateral native breast. The amount of abdominal skin and/or soft tissue reliably supplied by one vascular pedicle is frequently insufficient to adequately restore the breast skin envelope and "footprint...
August 15, 2018: Journal of Reconstructive Microsurgery
Marco Innocenti, Mariella Santini, Emanuela Dreassi, Robin Martin, Dario Melita, Barbara Colombini, Alessandro Innocenti
INTRODUCTION:  The creation of skin flaps based on small perforator vessels is an increasingly popular procedure nowadays; the optimization of their blood supply enhances surgical success. This study evaluates the effects on the flowmetries of 7 days' negative pressure application on the skin surface overlying the muscle fascia emergence of periumbilical perforators of the deep inferior epigastric artery (DIEA). METHODS:  Ten volunteer participants were enrolled...
August 15, 2018: Journal of Reconstructive Microsurgery
Shantanu N Razdan, Hina Panchal, Claudia R Albornoz, Andrea L Pusic, Colleen C McCarthy, Peter G Cordeiro, Joseph J Disa, Babak J Mehrara, Evan Matros
BACKGROUND:  One aim of unilateral postmastectomy breast reconstruction (BR) is to restore symmetry with the contralateral breast. As such, unilateral prosthetic reconstruction often requires a contralateral symmetry procedure (CSP). There is sparse literature on the impact of CSPs on long-term patient-reported outcomes (PROs) such as satisfaction and health-related quality of life (HRQoL). This study aims to describe PROs following CSPs, using a validated PRO tool, BREAST-Q. The hypothesis is that CSPs are associated with greater patient-reported satisfaction and HRQoL...
August 12, 2018: Journal of Reconstructive Microsurgery
Kumiko Matsumoto, Akira Shinaoka, Kiyoshi Yamada, Yoshihiro Kimata
BACKGROUND:  Indocyanine green (ICG) fluorescence lymphography (ICGLG) that can visualize the lymphatic vessel and its flow noninvasively and dynamically was developed in 2007. It is frequently used to observe the function and pathway of the lymphatic vessels. ICGLG is simple and easy to perform, and it is useful for understanding the condition of the lymphatic system in real time. However, its protocol is not standardized. In addition, the lymphatic flow is enhanced by an exercise load such as walking...
August 12, 2018: Journal of Reconstructive Microsurgery
Jocelyn Lu, Michael V DeFazio, Chrisovalantis Lakhiani, Michel Abboud, Morgan Penzler, Tammer Elmarsafi, Paul J Kim, Christopher E Attinger, Karen K Evans
BACKGROUND:  Recent evidence documenting high success rates following microvascular diabetic foot reconstruction has led to a paradigm shift in favor of more aggressive limb preservation. The primary aim of this study was to examine reconstructive and functional outcomes in patients who underwent free tissue transfer (FTT) for recalcitrant diabetic foot ulcers (DFUs) at our tertiary referral center for advanced limb salvage. METHODS:  Between June 2013 and June 2016, 29 patients underwent lower extremity FTT for diabetic foot reconstruction by the senior author (K...
August 12, 2018: Journal of Reconstructive Microsurgery
Charles Anton Fries, Carole Yasay Villamaria, Jerry Richard Spencer, Shari Lawson, Lin Wang, Thomas Raj, E George Wolf, Bijaya Kumar Parida, Vijay Saradhi Gorantla, Rory Frederick Rickard, Michael Robert Davis
BACKGROUND:  Ischemia-reperfusion injury (IRI) precipitates acute rejection of vascularized composite allografts (VCA). Hyperbaric preservation of tissues ex vivo, between harvest and revascularization, may reduce IRI and mitigate acute rejection of VCA. METHODS:  A porcine heterotopic musculocutaneous gracilis flap model was used. In phase 1, control autografts ( n  = 5) were infused with University of Wisconsin Solution (UWS) and stored at 4°C for 3 hours...
August 12, 2018: Journal of Reconstructive Microsurgery
Andreas M Fichter, Lucas M Ritschl, Rali Georg, Andreas Kolk, Marco R Kesting, Klaus-Dietrich Wolff, Thomas Mücke
BACKGROUND:  Indocyanine green (ICG) videoangiography is routinely used to evaluate skin and organ perfusion and to assess patency rates of microvascular anastomoses. This study uses ICG angiography as a novel approach to qualitatively and quantitatively evaluate bone perfusion of microvascular fibula grafts intraoperatively and to assess the effect of fibula segment length and number of osteotomies on bone perfusion. METHODS:  All patients planned for mandible reconstruction using a microvascular fibula graft between January 2013 and May 2017 were considered for this study...
August 12, 2018: Journal of Reconstructive Microsurgery
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