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Journal of Reconstructive Microsurgery

Jae Hoon Lee, Duke Whan Chung, Jong Hun Baek, Young Jun Kim, So Young Park
Background Although proximal fibular flaps have been widely applied in wrist arthroplasty, controversy remains regarding which side of the proximal fibula is better for reconstruction of the distal radius. If the articular surface of the proximal fibula shows dorsal tilting, the ipsilateral (right) proximal fibula should be harvested in right wrist arthroplasty because the articular surface of the distal radius normally has volar tilt. This study investigated anatomical similarities between the proximal fibular articular surface and the distal radius articular surface based on morphologic analysis of the proximal fibula using computed tomography (CT)...
October 21, 2016: Journal of Reconstructive Microsurgery
Collin W Blackburn, Sarah R Vossoughi, Bukola Ojo, Prakash Gorroochurn, Charles C Marboe, Yelena Akelina, Robert J Strauch
Background During microvascular anastomosis, needle placement is facilitated by inserting the tips of the forceps into the lumen of the vessel, rather than grasping and everting the luminal wall, to minimize trauma to the vessel. This study examines whether the vessel wall can be grasped and everted during microvascular anastomosis without compromising surgical outcomes. Methods A total of 20 Sprague-Dawley rats weighing between 252 and 483 g were used. Bilateral anastomoses of the animals' femoral arteries (mean size: 0...
October 21, 2016: Journal of Reconstructive Microsurgery
Stanislaw Sobotka, Jingming Chen, Themba Nyirenda, Liancai Mu
Background Our recent work has demonstrated that the native motor zone (NMZ) within a given skeletal muscle is the best site for muscle reinnervation. This study was designed to explore the outcomes of direct nerve implantation (DNI) into the NMZ of denervated sternomastoid (SM) muscle in a rat model. Methods The right SM muscle was experimentally denervated by transecting its innervating nerve. The proximal stump of the severed SM nerve was immediately implanted into a small muscle slit made in the NMZ of the muscle where denervated motor endplates were concentrated...
October 13, 2016: Journal of Reconstructive Microsurgery
Emilio Trignano, Nefer Fallico, Gino Zingone, Luca Andrea Dessy, Gian Vittorio Campus
Background Microsurgery is very challenging, requiring a high degree of dexterity and manual skills that should be fully trained outside of the operating room. Common microsurgery courses usually follow a stepwise training approach beginning practice on nonliving models and proceeding with live rats. However, training on live rats raises certain issues, including ethical concerns as well as the associated costs. As such, there is an increasing drive toward alternative models. The current article describes a three-step training approach (latex glove-endovascular prosthesis-human placenta), which aims to prepare trainees for the clinical direct application...
October 12, 2016: Journal of Reconstructive Microsurgery
Brady R Still, Laura W Christianson, Julie M Mhlaba, Ian P O'Malley, David H Song, Alexander J Langerman
Background A key avoidable expense in the surgical setting is the wastage of disposable surgical items, which are discarded after cases even if they go unused. A major contributor to wastage of these items is the inaccuracy of surgeon preference cards, which are rarely examined or updated. The authors report the application of a novel technique called cost heatmapping to facilitate standardization of preference cards for microvascular breast reconstruction. Methods Preference card data were obtained for all surgeons performing microvascular breast reconstruction at the authors' institution...
October 12, 2016: Journal of Reconstructive Microsurgery
Atsumori Hamahata, Takeshi Beppu, Takao Tokumaru, Takashi Yamaki, Hiroyuki Sakurai
Background For soft palate defects of more than two-thirds, we previously described the bent anterolateral thigh (ALT) method in which the pharyngeal isthmus was reconstructed as a tunnel structure. In this study, we compared the new "tunnel structure" reconstruction in our bent ALT flap method and the traditional "port structure" reconstruction. Methods From April 2010 to March 2015, 25 patients in Saitama Cancer Center (Saitama, Japan) underwent oropharyngeal tumor resection including soft palate resection...
October 3, 2016: Journal of Reconstructive Microsurgery
Matthew R Kaufman, Andrew I Elkwood, David Brown, John Cece, Catarina Martins, Thomas Bauer, Jason Weissler, Kameron Rezzadeh, Reza Jarrahy
Background Phrenic nerve reconstruction has been evaluated as a method of restoring functional activity and may be an effective alternative to diaphragm plication. Longer follow-up and a larger cohort for analysis are necessary to confirm the efficacy of this procedure for diaphragmatic paralysis. Methods A total of 180 patients treated with phrenic nerve reconstruction for chronic diaphragmatic paralysis were followed for a median 2.7 years. Assessment parameters included: 36-Item Short Form Health Survey (SF-36) physical functioning survey, spirometry, chest fluoroscopy, electrodiagnostic evaluation, a five-item questionnaire to assess specific functional issues, and overall patient-reported outcome...
September 25, 2016: Journal of Reconstructive Microsurgery
Jacob Rinkinen, Eric G Halvorson
Background Topical vasodilators are frequently used during free tissue transfer to prevent and treat vasospasm and microvascular thrombosis. A variety of agents have been studied and are available, yet most microsurgeons select an agent based on anecdotal evidence or personal training. Our aim was to review the literature on topical vasodilators so microsurgeons can make more informed decisions about which agent to use. Methods A systemic review of the literature was performed on PubMed, EMBASE, and Google Scholar using keywords "topical vasodilator," "antispasmodic," "vasospasm," "free flaps," and "microsurgery...
September 16, 2016: Journal of Reconstructive Microsurgery
Alexis T Laungani, Jodie Christner, Jason A Primus, Nirusha Lachman, Karla V Ballman, Anita Mohan, Michel Saint-Cyr
Background Perforator flaps remain challenging in their design, especially as free flaps. We used a cadaveric model to help refine the design of perforator flaps by studying their vascular features. We define the angle of perfusion of a perforator as a tool to achieve safer flap designs. Methods A total of 83 flaps were designed from 20 fresh cadaveric anterolateral thigh flaps. The most dominant perforator larger than 0.5 mm was used as the reference point on the midline of the flap, and the tip of the flap was set at 5 cm (n = 10), 2 cm (n = 5), or 10 cm (n = 5) from this perforator...
September 16, 2016: Journal of Reconstructive Microsurgery
Blair A Wormer, Nicholas W Clavin, Jean-Francois Lefaivre, Jason M Korn, Edward Teng, Anthony S Aukskalnis, J Michael Robinson
Background The purpose of this study was to evaluate the use of a biosynthetic mesh onlay on reducing postoperative abdominal bulge following deep inferior epigastric perforator (DIEP) flap breast reconstruction. Methods All patients undergoing DIEP reconstructions from January, 2010 to January, 2014 at a tertiary center were reviewed. Patients were divided into two groups for comparison based on whether a biosynthetic mesh onlay (Phasix [monofilament poly-4-hydroxybutyrate], Bard Inc., Warwick, RI) was used for reinforcement of the anterior rectus fascia...
September 5, 2016: Journal of Reconstructive Microsurgery
Mark L Smith, Bianca J Molina, Erez Dayan, Julie N Kim, Alexander Kagen, Joseph H Dayan
Background The medial sural vessels have been used extensively as donor vessels in free tissue transfer; however, there is sparse literature detailing their use as recipient vessels. The few existing reports involve small numbers of patients and describe operative approaches that are unnecessarily cumbersome. We explored our experience in free tissue transfer to the medial sural vessels and share a simplified operative approach to this recipient site. Methods A retrospective review was performed of all patients who underwent free tissue transfers to the medial sural vessels between December 2012 and December 2015 at a single institution...
September 5, 2016: Journal of Reconstructive Microsurgery
Masashi Ono, Keisuke Takanari, Kazuhiro Toriyama, Shunjiro Yagi, Katsumi Ebisawa, Hisashi Sawamura, Miki Kambe, Kenta Murotani, Yuzuru Kamei
Background A successful free flap transfer is achieved, in part, by having a thorough understanding of vascular anatomy and blood flow dynamics. We previously reported that vascular resistance differs by type of free flap. To test the hypothesis that the difference reflects the proportion of tissue components within free flaps, we calculated blood flow and vascular resistance for free flaps in which we determined the volume of each tissue component. Methods Measurements and calculations were made for 40 free flap transfers performed at our hospital: 7 radial forearm flaps, 14 anterolateral thigh flaps, and 19 rectus abdominis myocutaneous flaps...
September 5, 2016: Journal of Reconstructive Microsurgery
Yong Seok Nam, Young Joon Jun, In-Beom Kim, Sung Hun Cho, Hyun Ho Han
Background There are a few previous studies of the vascular anatomy of the fingertips. The aim of this study was to evaluate this anatomy and the distribution of fingertip arteries. Patients and Methods A total of 31 cadaveric hands were used for evaluation of the vascular pattern of the fingertips on X-ray images obtained using a radiopaque material. We analyze the anatomy of the fingertip arteries, and classified it into three types in Tamai zone I. If only one dominant artery branched off from the distal transverse palmar arch, it was classified as type I...
September 5, 2016: Journal of Reconstructive Microsurgery
Jian-Hua Zhu, Jiang Deng, Xiao-Jing Liu, Jing Wang, Yu-Xing Guo, Chuan-Bin Guo
No abstract text is available yet for this article.
September 5, 2016: Journal of Reconstructive Microsurgery
Joo Myong Paik, Jai-Kyong Pyon
Background Freestyle propeller flaps have been widely used as a reconstructive option for both trunk and extremities. It offers the advantage of "like-with-like" reconstruction with an adjacent tissue with no dissection to the source vessels. However, there is the risk of vascular complications. In the present study, the authors investigated the incidence of vascular complications and their risk factors following freestyle propeller flap in the trunk and extremities. Methods The authors conducted a retrospective review of 50 patients who underwent soft tissue reconstruction of the trunk and the extremities with 55 freestyle propeller flaps from 2004 to 2015...
August 19, 2016: Journal of Reconstructive Microsurgery
Satoshi Onoda, Kiyoshi Yamada, Kumiko Matsumoto, Yoshihiro Kimata
Background To date, only a few reports have been published on idiopathic lymphedema, and most of these are case reports. In this time, we performed a retrospective review of idiopathic lymphedema patients. Methods Forty patients presented with idiopathic lymphedema that was unrelated to surgery, injury, and medical conditions such as circulatory disease, kidney disease, and thrombotic venous disease. For these patients, we performed a retrospective review for edema-onset age, sex, location and stage of the edema, presence of cellulitis, episode related to edema onset, therapeutic intervention, and follow-up duration in the 33 patients whom we followed up...
August 19, 2016: Journal of Reconstructive Microsurgery
Jonathon Bryce Olenczak, Daniel Murariu, Keita Ikeda, Robert H Thiele, Chris A Campbell
Background Flap monitoring with near-infrared spectroscopy (NIRS) facilitates early detection of vascular compromise. However, standard NIRS devices that employ two wavelengths of light to assess tissue oxygenation (StO2) are susceptible to artifact from background noise and demonstrate significant variability in the clinical setting. As the number of wavelengths detected by a NIRS device is increased, the precision of StO2 measurements can be improved and additional chromophores other than oxyhemoglobin and deoxyhemoglobin can be measured...
August 19, 2016: Journal of Reconstructive Microsurgery
Thomas Mücke, Constantin Wolff, Monika von Düring, David A Mitchell, Lucas M Ritschl, Andreas M Fichter
Background Atherosclerosis is a known risk factor for flap loss in microsurgery. Several microsurgical techniques, like plaque removal, have been proposed for atherosclerotic vessels, but these techniques often induce intimal injuries. The aim of this study was to investigate the impact of various endothelial defects on the risk of thrombosis in a rat acute intimal injury model. Methods Endothelial defects of various forms and sizes were created in the abdominal aorta of 30 male Wistar rats following a strict protocol...
August 19, 2016: Journal of Reconstructive Microsurgery
Jonas Kolbenschlag, Johanna Schneider, Kamran Harati, Ole Goertz, Jochen Frederik Hernekamp, Reiner Kempf, Marcus Lehnhardt, Tobias Hirsch
Background Free tissue transfer has become a safe and reliable procedure and is routinely used in a variety of settings. However, it is associated with lengthy operating times and a high potential for blood loss and consecutive red blood cell transfusions (RBCTs). Methods To assess the risk for RBCTs, we retrospectively identified 398 patients undergoing free tissue transfer between 2005 and 2014. Based on a multivariate model of risk factors and their respective odds ratio, a risk score was developed to predict the likelihood of the need for intraoperative RBCT...
August 19, 2016: Journal of Reconstructive Microsurgery
Ignacio J Cifuentes, José R Rodriguez, Ricardo A Yañez, María C Salisbury, Álvaro J Cuadra, Julian E Varas, Bruno L Dagnino
Background Supermicrosurgery is a technique used for dissection and anastomosis of submillimeter diameter vessels. This technique requires precise hand movements and superb eye-hand coordination, making continuous training necessary. Biological in vivo and ex vivo models have been described for this purpose, the latter being more accessible and cost-effective. The aim of this study is to present a new ex vivo training model using a chicken leg. Methods In 28 chicken legs, an anatomical study was performed...
August 19, 2016: Journal of Reconstructive Microsurgery
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