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Journal of Reconstructive Microsurgery

Yoshichika Yasunaga, Daisuke Yanagisawa, Erika Ohata, Kiyoshi Matsuo, Shunsuke Yuzuriha
BACKGROUND:  Although lymphedema is fundamentally abnormal accumulation of excess water in the extracellular space, previous studies have evaluated the efficacy of physiological bypass surgery (lymphaticovenular anastomosis [LVA]) for lymphedema without measuring water volume. This study clarified the water reductive effect of LVA using bioelectrical impedance analysis (BIA). METHODS:  The efficacy of LVA for unilateral lower-limb lymphedema was evaluated using BIA in a retrospective cohort...
November 2, 2018: Journal of Reconstructive Microsurgery
Amro Harb, Maxwell Levi, Akio Kozato, Yelena Akelina, Robert J Strauch
BACKGROUND:  Torsion of vein grafts is a commonly cited reason for graft failure in clinical setting. Many microsurgery training courses have incorporated vein graft procedures in their curricula, and vein graft torsion is a common technical error made by the surgeons in these courses. To improve our understanding of the clinical reproducibility of practicing vein graft procedures in microsurgery training courses, this study aims to determine if torsion can lead to early vein graft failure in nonsurvival surgery rat models...
October 30, 2018: Journal of Reconstructive Microsurgery
Pobe Luangjarmekorn, Pravit Kitidumrongsook, Sittisak Honsawek
BACKGROUND:  Microsuture is an essential material for basic microsurgical training. However, it is consumable, expensive, and sometimes unavailable in the microsurgical laboratory. To solve this problem, we developed a microsuture made from human hair and needle gauge. METHODS:  Do-It-Yourself (DIY) microsuture is made from human hair and needle gauge 32G (BD Ultra-Fine Pen Needles 4 mm × 32G). Methods are explained step by step. This DIY microsuture (labeled as "test microsuture") and nylon 8-0 (Ethilon suture 8-0, labeled as "standard microsuture") were used for teaching orthopaedic residents to perform arterial anastomosis in chicken thighs...
October 26, 2018: Journal of Reconstructive Microsurgery
Rohini Kadle, Catherine C Motosko, George A Zakhem, John T Stranix, Timothy Rapp, Pierre B Saadeh
PURPOSE:  Limb-sparing treatment of extremity soft tissue sarcomas requires wide resections and radiation therapy. The resulting complex composite defects necessitate reconstructions using either muscle or fasciocutaneous flaps, often in irradiated wound beds. METHODS:  A retrospective chart review was performed of all limb-sparing soft tissue sarcoma resections requiring immediate flap reconstruction from 2012 through 2016. RESULTS:  Forty-four patients with 51 flaps were identified: 25 fasciocutaneous and 26 muscle-based flaps...
October 24, 2018: Journal of Reconstructive Microsurgery
Muhammet Uraloğlu, Alper Ural, İsmail Saygın, Murat Livaoğlu, Naci Karaçal
BACKGROUND:  Determining the extent of damage in vascular avulsion type injuries still represents a challenge for the microsurgeon. Excision of the damaged section is critical for the success of anastomosis. The purpose of this study was to determine which among vascular endothelial and adventitia damage findings is most effective in determining the extent of avulsion injury. METHODS:  Varying degrees of avulsion were applied to the aorta of 12 ( n  = 12) adult female New Zealand rabbits...
October 16, 2018: Journal of Reconstructive Microsurgery
Ashley L Howarth, Susan Hallbeck, Raman C Mahabir, Valerie Lemaine, Gregory R D Evans, Shelley S Noland
BACKGROUND:  Long surgical procedures with loupe magnification and microscopes may put microsurgeons at an increased risk of musculoskeletal discomfort. Identifying the prevalence and impact of work-related musculoskeletal discomfort may guide preventive strategies to prolong well-being, job satisfaction, and career duration. METHODS:  An online 29-question survey was designed to evaluate work-related musculoskeletal discomfort. The survey was created and distributed electronically through a private survey research center and was sent to the members of the American Society for Reconstructive Microsurgery...
October 16, 2018: Journal of Reconstructive Microsurgery
Michael V DeFazio, James M Economides, Ersilia L Anghel, Eshetu A Tefera, Karen K Evans
AIM:  No consensus exists regarding the optimal strategy for perioperative thromboprophylaxis in high-risk microsurgical populations. We present our experience with lower extremity free tissue transfer (FTT) in thrombophilic patients and compare outcomes between non-stratified and risk-stratified anticoagulation protocols. METHODS:  Between January 2013 and December 2017, 57 patients with documented thrombophilia underwent FTT for non-traumatic, lower extremity reconstruction by a single surgeon...
October 16, 2018: Journal of Reconstructive Microsurgery
Amir K Bigdeli, Emre Gazyakan, Volker J Schmidt, Christoph Bauer, Günter Germann, Christian A Radu, Ulrich Kneser, Christoph Hirche
BACKGROUND:  Vascular occlusion after free flap surgery has become a rare complication but still poses a major challenge. It necessitates urgent re-exploration, but the logistic challenge to provide sufficient resources for the emergency intervention remains. The aim of this study was to analyze the long-term outcome after successful lower extremity free flap salvage. METHODS:  A single-center retrospective study including long-term follow-up was approved by the local ethics committee...
October 16, 2018: Journal of Reconstructive Microsurgery
Zhongjie Wang, Xiaoping Yi, Jiqiang He, Liming Qing, Zhengbing Zhou, Youming Zhang, Zhiming Zhu, Chunhui Zhou, Hui Xie, Xuejun Li, Chishing Zee, Bihong T Chen
BACKGROUND:  During reconstructive surgery, anterolateral thigh (ALT) flap harvest is challenging due to variation and uncertainty in perforator distribution. We performed a pilot study to identify the predictive value of catheter-based computed tomography angiography (C-CTA) and traditional CTA (T-CTA) in ALT perforator mapping for patients whose ALT perforators were difficult to identify. METHODS:  Thirty-four consecutive T-CTA/C-CTA-mapped ALT flaps were evaluated for extremity reconstruction...
October 2, 2018: Journal of Reconstructive Microsurgery
Gunther Mangelsdorff, Pedro Cuevas, José Ramón Rodriguez, Nicolás Pereira, Enrica Ramirez, Ricardo Yañez
BACKGROUND:  Primary closure of the donor-site after harvest of a large anterolateral thigh flap (ALT) is associated with significant morbidity. Incisional negative pressure therapy (INPT) may decrease complications in high-risk incisions. This study assessed if the incidence of complications after primary closure of the ALT flap donor-site decreases with INPT. METHODS:  Retrospective cohort study of a prospectively maintained database including patients who underwent upper and lower limb reconstruction, using an ALT free flap with primary closure of the donor-site...
September 27, 2018: 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
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...
November 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...
November 2018: Journal of Reconstructive Microsurgery
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