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Arash Momeni, Suhail K Kanchwala
BACKGROUND: Autologous breast reconstruction is associated with long-term patient satisfaction that is superior to implant-based approaches. Occasionally, however, patients who desire autologous reconstruction present with inadequate donor-site volume. A hybrid approach, combining free flap reconstruction with simultaneous implant placement, is a solution. We present our experience with the use of mesh for improved pocket control using this reconstructive modality. METHODS: A retrospective analysis of a prospectively maintained database of patients undergoing autologous breast reconstruction was performed...
October 22, 2016: Microsurgery
Filip B J L Stillaert, Casper Sommeling, Salvatore D'Arpa, David Creytens, Koenraad Van Landuyt, Herman Depypere, Rudy Van den Broecke, Stan Monstrey, Phillip N Blondeel, Wayne A Morrison
BACKGROUND: Breast reconstruction involves the use of autologous tissues or implants. Occasionally, microsurgical reconstruction is not an option because of insufficient donor tissues. Fat grafting has become increasingly popular in breast surgery. The challenge with this technique is how to reconstruct a stable and living "scaffold" that resembles a breast. METHODS: Breast reconstruction (n = 7) was performed using intratissular expansion with serial deflation-lipofilling sessions...
September 27, 2016: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Ravinder Bamba, Thanapong Waitayawinyu, Ratnam Nookala, David Colton Riley, Richard B Boyer, Kevin W Sexton, Chinnakart Boonyasirikool, Sunyarn Niempoog, Nathaniel D Kelm, Mark D Does, Richard D Dortch, Robert Bruce Shack, Wesley P Thayer
BACKGROUND: Peripheral nerve injury can have a devastating impact on our military and veteran population. Current strategies for peripheral nerve repair include techniques such as nerve tubes, nerve grafts, tissue matrices, and nerve growth guides to enhance the number of regenerating axons. Even with such advanced techniques, it takes months to regain function. In animal models, polyethylene glycol (PEG) therapy has shown to improve both physiologic and behavioral outcomes after nerve transection by fusion of a portion of the proximal axons to the distal axon stumps...
November 2016: Journal of Trauma and Acute Care Surgery
Aaron L Grant, Claire Temple-Oberle
OBJECTIVE: The purpose of this study is to determine the utility of self-assessment in microsurgical training using a previously validated rating scale. DESIGN: A prospective study of surgical residents taking a hands-on 5-day microsurgical training course. Learners completed multiple self-assessments of their technical skills using the University of Western Ontario Microsurgical Acquisition/Assessment instrument. Simultaneously, preceptors assessed the learners using the same scale...
October 17, 2016: Journal of Surgical Education
Hyung-In Yoon
OBJECTIVE: This report is to present the treatment procedure and clinical considerations of prosthodontic management of a patient who had undergone a partial mandibulectomy and fibular free flap surgery. DESIGN: A 59-year-old man with a squamous cell carcinoma received a partial mandibular resection. Microsurgical reconstruction with a fibular free flap surgery and implant-supported zirconia-fixed prosthesis produced by computer-aided manufacturing led to successful results for the oral rehabilitation of mandibular defects...
October 2016: Journal of Craniofacial Surgery
Yu-Chi Wang, Chi-Cheng Chuang, Kuo-Chen Wei, Cheng-Nen Chang, Shih-Tseng Lee, Chieh-Tsai Wu, Yung-Hsin Hsu, Tzu-Kan Lin, Peng-Wei Hsu, Yin-Cheng Huang, Chen-Kan Tseng, Chun-Chieh Wang, Yao-Liang Chen, Pin-Yuan Chen
Atypical and malignant meningiomas are rare. Our aim was to examine the treatment outcomes following surgical resection, and analyze associations between clinical characteristics and overall survival (OS) or relapse free survival (RFS). 102 patients with atypical or malignant meningiomas underwent microsurgical resection between June 2001 and November 2009 were analyzed retrospectively. We compared demographics, clinical characteristics, treatment, and complications. The five-year and ten-year overall survival rates were 93...
October 20, 2016: Scientific Reports
P Li, H X Chen, Y H Huang, E L Zhi, R H Tian, H Zhao, F Yang, H F Sun, Y H Gong, Z J Zhu, Y Hong, Y D Liu, S J Xia, Z Li
Objective: To evaluate the efficacy and safety of microsurgical crossover vasovasostomy in treating complicated obstructive azoospermia. Methods: The data of 14 patients with complicated obstructive azoospermia treated with microsurgical crossover vasovasostomy were reviewed from October 2012 to March 2016.Ten of them underwent microsurgical crossover vasovasostomy. Intraoperative exploration revealed that 2 patients had vas deferens injury and contralateral testicular atrophy or epididymal obstruction due to previous hernia repair; 7 patients had obstruction of intracorporeal vas deferens on one side and epididymal obstruction on the other side; the other 1 patient had unilateral vasal obstruction with contralateral epididymal obstruction...
September 27, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Minyan Zhang, Xiaochen Tian, Jun Shi, Huxian Liu, Ning Liu, Zhengjun Cui
OBJECTIVE: This study aims to observe the efficacies of microsurgical technique combined with the Zhuang's skin soft tissue expander in treating Hunter type III congenital microtia. METHODS: Fifty-eight patients (61 ears) were enrolled from 2003 to 2012; the skin tissue expander was embedded subepidermally in the first stage via the intrahairline longitudinal incision in the postauricular mastoid area, the diseased-side rib cartilage was then taken for preparing the ear bracket in the second stage, and the tragus was surgically reconstructed in the third stage...
October 17, 2016: Annals of Plastic Surgery
Nidal Farhan Al Deek, Donald H Lalonde
Fu-Chan Wei is a world-renowned plastic and reconstructive surgeon. He is clearly one of the most influential and innovative surgeons in the history of plastic surgery. The Taiwanese legend is the innovator of the osteoseptocutaneous fibula flap, which revolutionized the reconstruction of composite bone and soft tissue defects in the jaw and extremities. He has pioneered several perforator flaps, including the free style variety. He has taken toe-to-hand microsurgical transplantation to a whole new level. He is not only recognized for his surgical skills and clinical innovations, but also for his vision, leadership, and teaching...
September 2016: Plastic and Reconstructive Surgery. Global Open
Kevin Phan, Joshua Xu, Rajesh Reddy, Piyush Kalakoti, Anil Nanda, Jacob Fairhall
BACKGROUND: The pituitary adenoma causing acromegaly is typically resected through a transsphenoidal approach and visualised with an operating microscope or endoscope. We undertook a systematic review and meta-analysis examining the clinical efficacy of endoscopic and microsurgical approaches. METHODS: Relevant studies using either endoscopic or microscopic transphenoid approaches for growth-hormone pituitary adenomas were identified up to Feb 2016. Data were extracted and analyzed according to predefined clinical endpoints...
October 15, 2016: World Neurosurgery
V Kakkassery, K U Loeffler, M Sand, K R Koch, A M Lentzsch, A C Nick, I A Adamietz, L M Heindl
The treatment options for basal cell carcinoma (BCC) have recently been augmented with the introduction of novel chemotherapeutic drugs. New S2 guidelines on the disease have also been published. The aim of this article is to present a comprehensive state of the art description of the features of ocular BCC and an overview of the various therapeutic options. Particular emphasis is placed on the clinical signs, the diagnostic tools to identify periocular BCC and interpretation of the different histopathological subtypes...
October 17, 2016: Der Ophthalmologe: Zeitschrift der Deutschen Ophthalmologischen Gesellschaft
Marine Hitier, Jean-Luc Cracowski, Cynthia Hamou, Christian Righini, Georges Bettega
OBJECTIVE: We evaluated the feasibility and the tolerance of repeated fluorescent indocyanine green angiography in free flap monitoring, and determined the intraoperative predictive values of flap vitality. BACKGROUND: The free flap failure rate has been significantly reduced, but free flap loss still occurs and remains a costly disaster. Repeated clinical examinations are commonly used for flap monitoring, but they can be unreliable because of their subjectivity...
September 10, 2016: Journal of Cranio-maxillo-facial Surgery
S Rosahl, D Eßer
BACKGROUND: The experience of the medical team, interdisciplinarity, quality of the physician-patient relationship, sensible use of modern technology, and a sound knowledge about the long-term results of observation and interventions all influence treatment quality in patients with vestibular schwannomas. OBJECTIVES: Compilation of findings regarding the results of observation and microsurgical treatment of patients with these tumors. Deduction of strategies for the medical management from these data...
October 14, 2016: HNO
Sung-Pil Joo, Seung-Hoon Jung, Sung-Hyun Kim, Tae-Sun Kim
BACKGROUND: Preservation of the superficial Sylvian veins (SSV) is essential to prevent neurological deficits during Sylvian dissection. We describe an appropriate surgical approach for unruptured middle cerebral artery (MCA) aneurysms to preserve these veins by using indocyanine green videoangiography (ICG-VA). METHODS: Between August 2014 and August 2015, we performed microsurgical clipping for 37 unruptured MCA aneurysms in 36 patients. We classified all the cases into 3 types according to the location between the Sylvian fissure and the SSV...
October 11, 2016: World Neurosurgery
Pierre R Bourque, Gabrielle Bourque, William Miller, John Woulfe, Jodi Warman Chardon
Perineural invasion is a targeted cellular proliferation guided by neurotrophins, rather than a simple diffusion of tumor in a path of least resistance. Invasion of cranial nerves by squamous cell carcinoma can represent an important diagnostic dilemma. It commonly presents as a distinct clinical neurological syndrome of combined isolated trigeminal and facial neuropathies. The focal cancer source may have been overlooked or remain occult. This case series illustrates diverse clinical presentations and neuroimaging challenges in four patients with squamous cell carcinoma of the cranial nerves...
October 11, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Jason M Davies, Michael T Lawton
OBJECTIVE Treatment of cerebrovascular malformations has grown in complexity with the development of multimodal approaches, including microsurgery, endovascular treatments, and radiosurgery. In spite of this changing standard of care, the provision of care continues across a variety of settings. The authors sought to determine the risk of adverse outcome after treatment of patients with vascular malformations in the US. Patient, surgeon, and hospital characteristics, including volume, were tested as potential outcome predictors...
October 14, 2016: Journal of Neurosurgery
Yasuhiro Shibata, Sota Kurihara, Seiji Arai, Haruo Kato, Tomomi Suzuki, Yoshiyuki Miyazawa, Hidekazu Koike, Kazuto Ito, Tetsuya Nakamura, Kazuhiro Suzuki
OBJECTIVES: Microsurgical subinguinal varicocelectomy is one of the best treatment modalities for varicoceles related to male infertility and scrotal pain. However, the difficulty in identifying testicular arteries, which should be spared, is a limitation of this technique. To visualize and identify the testicular arteries in spermatic cord during the operation, we examined the efficacy of intraoperative indocyanine green angiography (ICGA), which is regularly used in microsurgical neurosurgery...
October 13, 2016: Journal of Investigative Surgery: the Official Journal of the Academy of Surgical Research
V D'Orazi, A Panunzi, E Di Lorenzo, Al Ortensi, M Cialini, S Anichini, A Ortensi
AIM: The use of microsurgical technique and loupes magnification as a support to traditional surgery can help surgical performance and prevent complications in thyroid surgery. PATIENTS AND METHODS: Between January 2004 and December 2014, 782 patients with thyroid diseases were operated by our team with microsurgical technique and loupes magnification 4.5x. All patients had pre and postoperative vocal cords assessment and calcemia and the collected data were analysed...
May 2016: Il Giornale di Chirurgia
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
Maurizio Calcagni, Simon Zimmermann, Mario F Scaglioni, Thomas Giesen, Pietro Giovanoli, Richard M Fakin
INTRODUCTION: None of the existing treatments in the management of painful end-neuromas of the superficial branch of the radial nerve (SBRN) has been proven superior due to high levels of pain relapse. Fat grafts enriched with the stromal vascular fraction (SVF) could act as a mechanic barrier with biological effects decreasing the resorption rate and boosting the graft's regenerative potential. This study describes the novel surgical treatment technique of SVF-enriched fat grafting. PATIENTS AND METHODS: In this clinical study, five consecutive patients treated for painful end-neuromas of the SBRN between 2012 and 2013 were analyzed retrospectively...
October 12, 2016: Microsurgery
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