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Journal of Reconstructive Microsurgery

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https://www.readbyqxmd.com/read/27894155/increased-lower-extremity-venous-stasis-may-contribute-to-deep-venous-thrombosis-formation-after-microsurgical-breast-reconstruction-an-ultrasonographic-study
#1
Arash Momeni, Michael G Tecce, Michael A Lanni, Shagun Aggarwal, Christopher Pannucci, Stephen J Kovach, Suhail K Kanchwala, Liza C Wu, Joseph M Serletti
Background Despite guideline-compliant prophylaxis, an increased rate of deep venous thrombosis (DVT) formation has been reported following autologous versus implant-based breast reconstruction. We hypothesized that tight abdominal fascia closure might decrease lower extremity venous return and promote venous stasis. Methods An observational crossover study of patients who underwent autologous breast reconstruction using transverse rectus abdominis musculocutaneous/deep inferior epigastric artery perforator flaps was conducted...
November 28, 2016: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/27894154/perfusion-controlled-mobilization-after-lower-extremity-free-flaps-pushing-the-limits-of-time-and-intensity
#2
Ulf Dornseifer, Charlotte Kleeberger, Lukas Kargl, Markus Schönberger, Daniel Rohde, Milomir Ninkovic, Arndt Schilling
Background The current standard to gradually adapt the fragile perfusion in lower extremity free flaps to an upright posture is the dangling maneuver. This type of flap training neither fits the orthostatic target load of an upright posture, nor does it assist in mobilizing the patients effectively. In this study, we quantitatively analyzed training effects of an early and full mobilization on flap perfusion. Methods A total of 15 patients with gracilis flaps for distal lower extremity reconstruction were included...
November 28, 2016: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/27894153/painless-indocyanine-green-lymphography
#3
Giuseppe Visconti, Roberta Albanese, Marzia Salgarello
No abstract text is available yet for this article.
November 28, 2016: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/27894152/surgical-decompression-in-the-treatment-of-diabetic-peripheral-neuropathy-a-systematic-review-and-meta-analysis
#4
Yiji Tu, William Charles Lineaweaver, Zenggan Chen, Junda Hu, Fred Mullins, Feng Zhang
Background Over the last decade, surgical decompression procedures have been commonly used in the treatment of diabetic peripheral neuropathy. However, the effectiveness of them remains to be proved. Methods A comprehensive literature search of databases including PubMed-Medline, Ovid-EMBASE, and Cochrane Library was performed to collect the related literatures. The Medical Subject Headings used were "diabetic neuropathy," "surgical decompression," and "outcomes." The methodological index for nonrandomized studies was adopted for assessing the studies included in this review...
November 28, 2016: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/27855468/prefabricated-flaps-identification-of-microcirculation-structure-and-supercharging-technique-improving-survival-area
#5
Yixin Zhang, Heng Xu, Shaoqing Feng, Yimeng Xia, Zvi Steinberger, Wenjing Xi, Hongwei Fang, Zhiwei Li, Yixin Xie
Background Microcirculation is an important factor frequently overlooked when studying the survival of prefabricated flaps. In the current study, we use different prefabrication techniques for characterizing microcirculation within the flap, with the goal of finding an effective way to improve its survival area. Methods An abdominal prefabricated flap rodent model was created using a two-stage operation. All rats were randomly divided into six groups (n = 10/group): group A, prefabricated femoral vessels; group B, prefabricated femoral artery with a connected superficial inferior epigastric vein (SIEV); group C, connected superficial inferior epigastric artery (SIEA) with a prefabricated femoral vein; group D was similar to group A along with a prefabricated SIEA, and group E was similar to group A along with a prefabricated SIEV; and group F acted as a control group and consisted of an axial flap nourished by superficial inferior epigastric vessels...
November 17, 2016: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/27855467/less-is-more-impact-of-single-venous-anastomosis-on-the-intrinsic-transit-time-of-free-flaps
#6
Ulf Dornseifer, Charlotte Kleeberger, Michael Kimelman, Lukas Kargl, Charlotte Holm, Philipp Moog, Milomir Ninkovic
Background The number of venous anastomoses advisable for a free flap continues to be controversial. Intrinsic transit time (ITT) is the time it takes dye during indocyanine green (ICG) microangiography to travel from the arterial to the venous anastomosis. ITT provides information on blood flow velocity and can predict postoperative circulatory complications. This study investigated the effect of the number of venous anastomoses on ITT. Methods The study enrolled 126 patients who had undergone microsurgical reconstruction and intraoperative ICG microangiography...
November 17, 2016: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/27798949/impact-of-time-interval-between-radiation-and-free-autologous-breast-reconstruction
#7
Aaron B Mull, Ali A Qureshi, Ema Zubovic, Yuan J Rao, Imran Zoberi, Ketan Sharma, Terence M Myckatyn
BACKGROUND: To evaluate whether the timing of surgery after radiation in autologous breast reconstruction affects major complications. METHODS: We performed a retrospective review of 454 free flaps (331 patients) for breast reconstruction at a single institution from 2003 to 2014. Charts were reviewed for age, BMI, laterality, flap type (TRAM, msTRAM, DIEP), surgeon, donor vessels (IMA, TD), chemotherapy, smoking, diabetes, hypertension, DVT, venous anastomoses, vein size, and time from radiation (none, < 12 months, or ≥ 12 months)...
October 31, 2016: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/27798948/optimizing-outcomes-following-total-and-subtotal-tongue-reconstruction-a-systematic-review-of-the-contemporary-literature
#8
Oscar J Manrique, Hyuma A Leland, Claude-Jean Langevin, Alex Wong, Joseph N Carey, Pedro Ciudad, Hung-Chi Chen, Ketan M Patel
BACKGROUND: More than 45,000 Americans are diagnosed with oropharyngeal cancer annually and multimodal treatment often requires wide excision, lymphadenectomy, chemotherapy, and radiation. Total and subtotal lingual resection severely impairs speech, swallow, and quality of life (QoL). This study investigates functional outcomes and QoL following subtotal and total tongue resection with free tissue transfer reconstruction. MATERIALS AND METHODS: A systematic review of the English language literature was performed using PubMed, Ovid, Embase, and Cochrane databases based on predetermined inclusion/exclusion criteria...
October 31, 2016: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/27798947/laser-assisted-indocyanine-green-angiography-aids-in-the-reconstruction-of-gustilo-grade-iiib-open-lower-limb-fractures
#9
Seijiro Koshimune, Akira Shinaoka, Tomoyuki Ota, Satoshi Onoda, Yoshihiro Kimata
BACKGROUND: Worldwide obesity has more than doubled since 1980. Given this epidemic change, surgical and medical care has become more complex as obesity is a known risk factor for complications. Consequently, one could expect a higher prevalence of medical and surgical complications in an obese patient collective in the setting of free tissue transfer. Goal of this study was to evaluate whether this assumption holds true. MATERIAL AND METHODS: Between January 2009 and June 2015, 838 patients underwent free tissue transfers at a single institution...
October 31, 2016: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/27798946/extending-the-limits-of-microsurgical-reconstruction-in-patients-with-moderate-to-very-severe-obesity-single-center-6-year-experiences
#10
Paul I Heidekrueger, Albrecht Heine-Geldern, Milomir Ninkovic, Frank Herter, Camillo Mueller, P Niclas Broer
Background Worldwide obesity has more than doubled since 1980. Given this epidemic change, surgical and medical care has become more complex as obesity is a known risk factor for complications. Consequently, one could expect a higher prevalence of medical and surgical complications in an obese patient collective in the setting of free tissue transfer. Goal of this study was to evaluate whether this assumption holds true. Material and Methods Between January 2009 and June 2015, 838 patients underwent free tissue transfers at a single institution...
October 31, 2016: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/27769095/morphological-study-of-the-proximal-fibular-articular-surface-using-computed-tomography-which-side-is-preferred-for-proximal-fibular-flap-in-wrist-arthroplasty
#11
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
https://www.readbyqxmd.com/read/27769094/a-comparison-of-the-minimal-touch-technique-and-the-eversion-technique-for-microvascular-anastomosis-in-a-rat-model
#12
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
https://www.readbyqxmd.com/read/27737470/outcomes-of-muscle-reinnervation-with-direct-nerve-implantation-into-the-native-motor-zone-of-the-target-muscle
#13
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
https://www.readbyqxmd.com/read/27733004/microsurgical-training-with-the-three-step-approach
#14
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
https://www.readbyqxmd.com/read/27733003/standardization-of-disposable-instruments-in-microvascular-breast-reconstruction-a-case-study-in-cost-reduction
#15
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
https://www.readbyqxmd.com/read/27699727/a-comparison-of-large-soft-palate-defect-reconstruction-using-the-new-tunnel-structure-and-traditional-port-structure-methods
#16
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
https://www.readbyqxmd.com/read/27665114/long-term-follow-up-after-phrenic-nerve-reconstruction-for-diaphragmatic-paralysis-a-review-of-180-patients
#17
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
https://www.readbyqxmd.com/read/27636540/topical-vasodilators-in-microsurgery-what-is-the-evidence
#18
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
https://www.readbyqxmd.com/read/27636539/study-of-the-impact-of-the-location-of-a-perforator-in-the-perfusion-of-a-perforator-flap-the-concept-of-angle-of-perfusion
#19
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
https://www.readbyqxmd.com/read/27595188/reducing-postoperative-abdominal-bulge-following-deep-inferior-epigastric-perforator-flap-breast-reconstruction-with-onlay-monofilament-poly-4-hydroxybutyrate-biosynthetic-mesh
#20
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
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