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Francesco Giuseppe Mazzei, Francesco Gentili, Susanna Guerrini, Nevada Cioffi Squitieri, Duccio Guerrieri, Paolo Gennaro, Michele Scialpi, Luca Volterrani, Maria Antonietta Mazzei
We propose a practical approach for performing high-resolution MR lymphangiography (MRL). We shall discuss and illustrate the technical approach for the visualization of lymphatic vessels in patients suffering from lymphedema, how to distinguish lymphatic vessels from veins, and MRL role in supermicrosurgery treatment planning. A brief review of literature, from a technical point of view, is also reported.
2017: BioMed Research International
Can Emre Bas, Joanna Cwykiel, Maria Siemionow
Background This study aimed to confirm the feasibility and reliability of saphenous artery (SA) and great saphenous vein (GSV) anastomosis as a new supermicrosurgery training model and to compare the one-way-up anastomosis with the currently used end-to-end anastomosis technique. Methods Twenty supermicrosurgical anastomoses were performed in 10 Sprague Dawley rats. The external diameters of SA and GSV were measured using Leica LAS EZ software. The right-side SA and GSV anastomoses were performed using the standard end-to-end anastomosis technique...
March 10, 2017: Journal of Reconstructive Microsurgery
R Vijayan, F Al-Aswad, R Y Kannan
The centre ground in the world of flaps have over time, gradually shifted from tubed pedicled, random-pattern, axial-pattern, pedicled, free and currently, to free-styled flaps. These concepts are broadly based on the angiosome-perforasome concept. In this case report, we illustrate how the concept of venosome capture can be transposed onto reverse-flow flaps with the aid of venous supercharging. Moreover, if this is seen from the free-styled flap perspective, it requires supermicrosurgical expertise. This case report hence, serves as a fusion of all the above concepts...
February 2017: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Julie E Park, David W Chang
LEARNING OBJECTIVES: After reading this article, the participant should be able to: 1. summarize the evolution of perforator, chimeric, and free style flaps; 2. define and give examples of supermicrosurgery as well as understand its application in treatment of lymphedema; and 3. appreciate the development and advancements of composite tissue allotransplantation. SUMMARY: Although microsurgery may seem like a highly specialized niche within plastic surgery, it is more than just a discipline that focuses on small anastomoses...
November 2016: Plastic and Reconstructive Surgery
Hyun Suk Suh, Tae Suk Oh, Ho Seung Lee, Seung Hwan Lee, Yong Pil Cho, Joong Ryul Park, Joon Pio Hong
BACKGROUND: Major vessels in the diabetic foot are often calcified and inadequate for use as recipient vessels. Thus, a supermicrosurgery technique using small branches or perforators from other collateral vessels with an adequate pulse may be an alternative method. This study evaluated outcome using the supermicrosurgery concept and the risk factors involved. METHODS: Ninety-five cases of diabetic foot reconstruction were reviewed; the average patient age was 57 years; average follow-up was 43...
October 2016: Plastic and Reconstructive Surgery
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...
November 2016: Journal of Reconstructive Microsurgery
Makoto Mihara, Hisako Hara, Shuichi Tange, Han Peng Zhou, Mari Kawahara, Yohei Shimizu, Noriyuki Murai
BACKGROUND: The impact of lymphaticovenous anastomosis on lymphedema has yet to be defined. The authors investigated the clinical evidence regarding the effectiveness of lymphaticovenous anastomosis in lower limb lymphedema. METHODS: Eighty-four patients (162 limbs; 73 female and 11 male patients) with lower limb lymphedema who underwent multisite lymphaticovenous anastomosis in the authors' clinic between August of 2010 and May of 2014 were included in this retrospective study...
July 2016: Plastic and Reconstructive Surgery
Seung Woo Cho, Ji Ung Park, Sung Tack Kwon
INTRODUCTION: Various methods have been used for the coverage of soft-tissue defects, such as local and free flaps, as well as perforator flaps performed using even supermicrosurgery. However, the techniques have some limitations regarding flap size and location when used to reconstruct small defects. We introduced the lateral calcaneal region as a donor site for free flaps in order to overcome these disadvantages and presented the results from a series of cases. PATIENTS AND METHODS: A retrospective chart review was performed on 10 patients with small soft-tissue defects who underwent reconstruction with a lateral calcaneal free flap between January 2011 and May 2014...
March 18, 2016: Microsurgery
Hyun Suk Suh, Tae Suk Oh, Joon Pio Hong
The treatment of diabetic foot ulceration is complex with multiple factors involved, and it may often lead to limb amputation. Hence, a multidisciplinary approach is warranted to cover the spectrum of treatment for diabetic foot, but in complex wounds, surgical treatment is inevitable. Surgery may involve the decision to preserve the limb by reconstruction or to amputate it. Reconstruction involves preserving the limb with secure coverage. Local flaps usually are able to provide sufficient coverage for small or moderate sized wound, but for larger wounds, soft tissue coverage involves flaps that are distantly located from the wound...
January 2016: Diabetes/metabolism Research and Reviews
Igor Stupka, Zdenek Dvorak, Jiri Vesely, Pavel Novak, Rosario E Perrotta, Giuseppe A G Lombardo
The nose is one of the most important aesthetic units of the face. After a traumatic amputation, replantation is undoubtedly the procedure of choice, although, technically, very challenging. We report the 10-year follow-up of a partially digested nose replantation after a dog-bite in an 11-year-old boy using supermicrosurgery technique. Our report confirms that the microsurgical replantation of the nose can lead to an acceptable aesthetic result, with the sufficient growth of the replanted part in the following years...
December 2015: Annals of Plastic Surgery
Sang Won Seo, Kyu Nam Kim, Chi Sun Yoon
BACKGROUND: The advantages of the peroneal perforator flap include a short harvesting time, thinness, and pliability. Due to the presence of a short pedicle and small vessel diameter, without peroneal vessel sacrifice, this flap is commonly used for distal limb reconstruction, but is rarely used for knee and proximal and middle lower leg reconstruction. We describe our experience with the application of a versatile peroneal perforator free flap for knee and proximal and middle lower leg reconstruction through supermicrosurgery...
November 2015: Journal of Reconstructive Microsurgery
Seong Yoon Lim, Matthew Sze-Wei Yeo, Fabio Nicoli, Pedro Ciudad, Joannis Constantinides, Kidakorn Kiranantawat, Stamatis Sapountzis, Ambrose Chung-Wai Ho, Hung-Chi Chen
BACKGROUND: Although perforator-to-perforator anastomosis in supermicrosurgery may be used in transferring free flaps with small vessels, it is still difficult in certain situations that include potentially infected wounds. Moreover, it is limited to smaller flaps. Anastomosis of large vessels is still safer for transfer of a large flap for most surgeons. The harvesting of a patch of the parent artery together with the perforator supplying the flap allows the surgeon to perform an anastomosis between the vessel ends of larger caliber, and possibly with greater anastomotic success...
April 2015: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Takumi Yamamoto, Nana Yamamoto, Akitatsu Hayashi, Isao Koshima
Lymphatic supermicrosurgery or supermicrosurgical lymphaticovenular anastomosis (LVA) is becoming popular for the treatment of compression-refractory upper extremity lymphedema (UEL) with its effectiveness and minimally invasiveness. In conventional LVA, superficial lymphatic vessels are used for anastomosis, but its treatment efficacy would be minimum when superficial lymphatic vessels are severely sclerotic. Theoretically, deep lymphatic vessels can be used for LVA, but no clinical case has been reported regarding deep lymphatic vessel-to-venous anastomosis (D-LVA)...
February 2017: Microsurgery
Benoit Ayestaray, Farid Bekara
Microscope-integrated lymphangiography is a useful method in the field of lymphatic supermicrosurgery. Fluorescence based on indocyanine green (ICG) is the most commonly used. Fluorescein sodium is a fluorescent tracer used for retinal and neurosurgical angiography but not yet for lymphatic supermicrosurgery. In this report, we present a case in which the fluorescein sodium fluorescence microscope-integrated lymphangiography was used for assessment of lymphatic drainage pathway and patency in a patient treated for secondary lymphedema by lymphaticovenular anastomoses...
July 2015: Microsurgery
Q Qassemyar, M Gianfermi
INTRODUCTION: As a technique of anastomosis for vessels of less than 0.8mm in diameter, supermicrosurgery has aroused renewed interest on account of its potential clinical applications. The technical difficulty of surgery at such a small scale necessitates exploration of new methods likely to render the anastomoses accessible and reliable. The aim of this article is to present the results of an experimental study on the feasibility of anastomoses (arterial diameter ≤0.5mm), assisted by the injection of hyaluronic acid (HA)...
February 2015: Annales de Chirurgie Plastique et Esthétique
Theddeus Oh Prasetyono, Kristaninta Bangun, Frank B Buchari, Putri Rezkini
BACKGROUND: A thin perforator flap is one of the best methods for covering defects. This study aimed to revisit and further test the rapidly advancing field of flap thinning techniques. METHODS: We performed two cadaveric studies to test the known flap thinning methods, and then applied these methods to a clinical series. In the first study, five cadavers were used to observe the anatomical relation of the perforator with the subdermal plexuses and the subcutaneous fat layer by injecting a colored latex solution...
November 2014: Archives of Plastic Surgery
Takumi Yamamoto, Nana Yamamoto, Marie Yamashita, Megumi Furuya, Akitatsu Hayashi, Isao Koshima
BACKGROUND: Lymphaticovenular anastomosis (LVA) is becoming a choice of treatment for compression-refractory lymphedema. However, LVA requires highly sophisticated microsurgical technique called supermicrosurgery, and no training model for LVA has been developed. This study aimed to develop and evaluate feasibility of a new LVA model using rat thigh lymphatic vessels. METHODS: Ten Sprague-Dawley rats were used for the study. After preoperative indocyanine green (ICG) lymphography, lymphatic vessels in posteromedial aspect of the thigh were dissected...
January 2017: Microsurgery
Ran Ito, Hiroo Suami
Recent articles report that surgery can effectively treat secondary lymphedema. Lymphovenous anastomosis with supermicrosurgery technique has become popular for surgical intervention for lymphedema and has an advantage of minimal morbidity. Lymphovenous anastomosis is effective for treating early-stage lymphedema before fibrosis occurs but has limited outcomes in advanced lymphedema. Lymph node transfer is an emerging physiologic surgical treatment for lymphedema that shows promise. The mechanisms of lymph node transfer have been discordant between publications...
September 2014: Plastic and Reconstructive Surgery
Takumi Yamamoto, Hidehiko Yoshimatsu, Isao Koshima
BACKGROUND: Lymphorrhea can occur after surgical intervention to the lymphatic system. Most cases with lymphorrhea can be treated conservatively, but some cases are refractory to conservative treatments and require further surgical treatments. METHODS: Eight patients developed inguinal lymphorrhea after surgical intervention in the groin region. Navigation lymphatic supermicrosurgery (NLS) was performed for the treatment of iatrogenic lymphorrhea refractory to conservative treatments...
November 2014: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
B O Mofikoya, A O Ugburo, O B Bankole
OBJECTIVE: The anastomosis of sub-millimeter vessels is fraught with significant technical challenges even for the experienced microsurgeon. The supermicrosurgery era is increasing the demand for repair of very small vessels. Our study aims to ascertain whether the open guide suture technique provides a superior patency rate compared with conventional technique when anastomosing rat artery less than a millimeter. METHODS: Anastomosis of transected rat femoral, superficial femoral and central tail arteries were done in 24 in bred albino rats...
April 2014: Handchirurgie, Mikrochirurgie, Plastische Chirurgie
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