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Mohammed H El Fahar
Oral chemical burn injuries induce more damage to the underlying tissues with extensive scarring. It is very well known that alkali causes severe liquefaction necrosis and injury to the deeper tissues. Pediatric facial burns must be managed thoroughly and always require complex reconstruction, which is a challenging process. So, any reconstructive surgeon must be aware of all the deformities that may have significant functional and aesthetic impact on the burn survivors especially children. Few medical studies addressed pediatric microsurgical reconstruction for oral burn injuries induced by chemical materials...
February 27, 2018: Annals of Plastic Surgery
Sang Won Seo, Kyu Nam Kim, Won Ha, Chi Sun Yoon
Performing a greater number of free flap procedures inevitably results in an increase in the number of cases that experience free flap failure. In cases that require a second free flap after the failure of the first, recipient vessel selection becomes difficult. Furthermore, recipient vessel selection can be complicated if the vessel is deep in the recipient site, or if there is an increased risk of vessel damage during the dissection. Thus, we present our experience where a subfascial vessel beneath the deep fascia was used as a recipient vessel for a second free flap in lower extremity reconstruction due to total or partial first flap failure...
February 2018: Medicine (Baltimore)
C Galmiche, J J Hidalgo Diaz, P Vernet, S Facca, G Menu, P Liverneaux
Many biological and non-biological simulators have been developed to reduce the length of the learning curve for supermicrosurgery. All of them have disadvantages. The goal of this study was to evaluate the feasibility of the new MicrochirSim® (0.5mm) non-biological procedural simulator by comparing it to the Anastomosis Training Kit® (2mm). After viewing a video of end-to-end anastomosis of a rat-tail artery, 10 residents in surgery reproduced the same technique on a procedural simulator: 5 on the MicroChirSim® (group 1) and 5 on the Anastomosis Training Kit® (group 2)...
February 2018: Hand Surgery and Rehabilitation
Stefano Gentileschi, Maria Servillo, Roberta Albanese, Francesca De Bonis, Girolamo Tartaglione, Marzia Salgarello
INTRODUCTION: Supermicrosurgical lymphatic-venous anastomosis (LVA) can improve limbs lymphedema. We describe a technique that we employ for preoperative lymphatic mapping of the upper limb (UL), when indocyanine green (ICG) lymphography shows only dermal backflow (DB) and no lymphatic vessel is detectable. PATIENTS AND METHODS: Sixteen patients undergoing LVA for unilateral UL lymphedema, showing "stardust" or "diffuse" DB pattern, were included. Demographic, clinical data, and limbs measurements were recorded...
September 27, 2017: Microsurgery
Georgios Pafitanis, Mitsunaga Narushima, Mitsunobu Harima, Ali Ghanem, Simon Myers, Isao Koshima
Supermicrosurgery is becoming a commonly used technique in various subspecialties of reconstructive surgery. However, there is a lack of standardization and validation in novel supermicrosurgical training. Current simulation training programs are not adequately focused on the challenges encountered during clinical supermicrosurgery practice. This article describes the authors' experience utilizing a supermicrosurgery competency-based training curriculum, in a simulation-based environment, toward safe clinical practice for lymphatic submillimeter supermicrovascular surgery...
June 2017: Plastic and Reconstructive Surgery. Global Open
Dajiang Song, Georgios Pafitanis, Peng Yang, Mitsunaga Narushima, Zan Li, Linfeng Liu, Zengtao Wang
INTRODUCTION: This study demonstrates the use of a modified free innervated DRAP flap utilizing the supermicrosurgery technique for fingertip reconstruction. MATERIALS AND METHODS: From January 2010 to February 2014, 20 cases of fingertip reconstruction were performed using a short pedicle mini innervated transverse DRAP flap. The patients demographics, the mechanism of injury, the defect size and anatomical location, the source of pedicle vessels, the recipient vessels, the nerve branch used for innervation, the follow-up and sensation outcomes are reported...
August 2017: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
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...
July 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...
September 2017: 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
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