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Microsurgical reconstruction

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https://www.readbyqxmd.com/read/28820839/smaller-diameter-anastomotic-coupling-devices-have-higher-rates-of-venous-thrombosis-in-microvascular-free-tissue-transfer
#1
Summer E Hanson, Matthew B Mitchell, Nihanth Palivela, S Andrew Peng, Lei Feng, Rene D Largo, Charles E Butler, Patrick B Garvey
BACKGROUND: Smaller anastomotic coupling devices may increase the risk of complications in free flap reconstructions; however, the relationship between coupler size and venous thrombosis rates has not been adequately evaluated. We hypothesized that smaller-diameter coupling devices are associated with higher rates of venous thrombosis than larger diameter devices in free tissue transfer. METHODS: We retrospectively reviewed data prospectively entered into a central departmental database for all patients who underwent microsurgical free tissue transfer at our institution in 2001-2013...
August 8, 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28820822/the-impact-of-two-operating-surgeons-on-microsurgical-breast-reconstruction
#2
Hazim Sadideen, Judith Hunter, Francis Henry, Simon Wood, Navid Jallali
No abstract text is available yet for this article.
August 9, 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28820820/reply-the-impact-of-two-operating-surgeons-on-microsurgical-breast-reconstruction
#3
Vishal Thanik, Katie Weichman
No abstract text is available yet for this article.
August 9, 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28820303/rapid-ventricular-pacing-for-clip-reconstruction-of-complex-unruptured-intracranial-aneurysms-results-of-an-interdisciplinary-prospective-trial
#4
Juergen Konczalla, Johannes Platz, Stephan Fichtlscherer, Haitham Mutlak, Ulrich Strouhal, Volker Seifert
OBJECTIVE To date, treatment of complex unruptured intracranial aneurysms (UIAs) remains challenging. Therefore, advanced techniques are required to achieve an optimal result in treating these patients safely. In this study, the safety and efficacy of rapid ventricular pacing (RVP) to facilitate microsurgical clip reconstruction was investigated prospectively in a joined neurosurgery, anesthesiology, and cardiology study. METHODS Patients with complex UIAs were prospectively enrolled. Both the safety and efficacy of RVP were evaluated by recording cardiovascular events and outcomes of patients as well as the amount of aneurysm occlusion after the surgical clip reconstruction procedure...
August 18, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28792429/glabrous-flow-through-flaps-for-simultaneous-resurfacing-revascularization-and-reinnervation-of-digits
#5
Chao Chen, Liwen Hao, Wenhai Sun, Zengtao Wang, Zihai Ding, Shizhen Zhong
INTRODUCTION: Composite injuries of the volar surfaces of fingers are frequently associated with digital vessel and nerve damage. Flow-through glabrous flaps can provide esthetic tissue coverage as well as revascularization, and using a neurovascular flap, allows primary reconstruction of the digital nerve. METHODS: Between June 2010 and August 2014, we prospectively studied the use of Microsurgical flow-through glabrous flaps to achieve simultaneously digital revascularization and soft tissue coverage in 13 fingers of 12 patients who experienced volar injuries, comprising 6 great toe fibular flaps, 3 medial plantar flaps, 1 pedis medialis flap, and 3 hypothenar flaps...
November 2016: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28766056/-anesthesia-management-in-microsurgical-reconstructions
#6
A Rand, M Ayoub, C H Meyer-Frießem, P K Zahn, M Bauer
Microsurgical procedures for construction of anastomoses present new challenges for anesthetists in the perioperative setting. Despite their increasing importance, so far no perioperative management guidelines for these patients existed. Anesthetists can influence the success of surgery (e. g. successful perfusion of a flap) via an optimal preoperative, intraoperative and postoperative approach. Patients should be carefully evaluated preoperatively for increased risks to avoid poor postoperative outcomes...
August 1, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28758229/time-dependent-factors-in-diep-flap-breast-reconstruction
#7
Rosaria Laporta, Benedetto Longo, Michail Sorotos, Alessio Farcomeni, Vittoria Amorosi, Fabio Santanelli di Pompeo
BACKGROUND: The process of harvesting and performing microsurgical anastomosis may lengthen deep inferior epigastric artery perforator (DIEP) flap breast reconstruction affecting results and patient safety. The aim of the study was to investigate the associations between predictors and operative time (OT). METHODS: Between 2004 and 2016, 336 immediate and 68 delayed unilateral reconstructions were performed in 404 patients. Age, weight, height, body mass index (BMI), nulliparity, or pluriparity condition were collected to determine the impact of patient characteristics on OT...
July 24, 2017: Microsurgery
https://www.readbyqxmd.com/read/28754750/postoperative-gluteal-compartment-syndrome-following-microsurgical-free-flap-hand-reconstruction-the-importance-of-early-recognition-and-treatment
#8
Umran Sarwar, Jason Ting
Compartment syndrome, a surgical emergency, is caused by an increase in pressure within a closed osseofascial space, often due to trauma. This causes a decrease in tissue perfusion and ultimately tissue necrosis and multiorgan failure if not treated in a timely fashion. Gluteal compartment syndrome is a rare variant and often caused by a period of immobilisation secondary to intoxication with alcohol or drugs or during long operations, typically in the supine position. We report on a case of gluteal compartment syndrome developing in a patient postoperatively following a long microsurgical procedure to a hand, which has not been documented before...
July 27, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28750798/functional-pectoralis-minor-myocutaneous-flap-transplantation-for-reconstruction-of-thumb-opposition-an-anatomic-study-with-clinical-applications
#9
Yong-Qing Zhuang, Hong-Tao Xiong, Qiang Fu, Xuan Zhang, Hao-Li Jiang, Xi-Chi Fang
OBJECTIVE: To develop a myocutaneous flap for reconstruction of thumb opposition function in patients with loss of the thenar muscles and skin. METHODS: An anatomic experiment on the dimensions of the pectoralis minor muscle and its neurovascular supply in 10 adult human cadavers was conducted to evaluate the feasibility of microsurgical transplantation using part of the muscle for thumb opposition reconstruction. Based on these results, we performed surgical thenar reconstruction with a pectoralis minor myocutaneous flap in seven patients (34...
July 24, 2017: Asian Journal of Surgery
https://www.readbyqxmd.com/read/28746282/outcomes-of-muscle-brachialis-transfer-to-restore-finger-flexion-in-brachial-plexus-palsy
#10
Brent R DeGeorge, Hillary A Becker, John H Faryna, Robert J Spinner, Allen T Bishop, Alexander Y Shin
BACKGROUND: In adults with lower trunk brachial plexus injury, proximal nerve surgery for restoration of prehension demonstrates poor outcomes secondary to long distances required for nerve regeneration and time-dependent degradation of motor endplates. Options for reconstruction are limited to distal tendon or nerve transfers and free-functioning muscle transfers. In this article, the authors describe the long-term outcomes of brachialis muscle-to-flexor digitorum profundus transfer to restore prehension in patients with traumatic lower trunk brachial plexus injuries...
August 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28746269/transversus-abdominis-plane-blocks-with-single-dose-liposomal-bupivacaine-in-conjunction-with-a-nonnarcotic-pain-regimen-help-reduce-length-of-stay-following-abdominally-based-microsurgical-breast-reconstruction
#11
Eric M Jablonka, Andreas M Lamelas, Julie N Kim, Bianca Molina, Nathan Molina, Michelle Okwali, William Samson, Mark R Sultan, Joseph H Dayan, Mark L Smith
BACKGROUND: Side effects associated with use of postoperative narcotics for pain control can delay recovery after abdominally based microsurgical breast reconstruction. The authors evaluated a nonnarcotic pain control regimen in conjunction with bilateral transversus abdominis plane blocks on facilitating early hospital discharge. METHODS: A retrospective analysis was performed of consecutive patients who underwent breast reconstruction using abdominally based free flaps, with or without being included in a nonnarcotic protocol using intraoperative transversus abdominis plane blockade...
August 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28738446/single-stage-versus-two-stage-arteriovenous-loop-microsurgical-reconstruction-a-meta-analysis-of-the-literature
#12
REVIEW
Rebecca Knackstedt, Rachel Aliotta, James Gatherwright, Risal Djohan, Brian Gastman, Graham Schwarz, Mark Hendrickson, Raffi Gurunluoglu
BACKGROUND: Arteriovenous (AV) loops can be utilized in a single- or two-stage approach in free flap reconstruction when proper vessels are not available. However, there exists no consensus on which method leads to superior microsurgical and patient outcomes. The purpose of this article was to review single- versus two-stage AV loops utilized in free flap reconstruction with a focus on complications and overall outcomes. METHODS: A systematic review of AV loops for autologous free tissue transfer was conducted...
July 24, 2017: Microsurgery
https://www.readbyqxmd.com/read/28688657/umbilical-necrosis-rates-after-abdominal-based-microsurgical-breast-reconstruction
#13
Joseph A Ricci, Parisa Kamali, Babette E Becherer, Daniel Curiel, Winona Wu, Adam M Tobias, Samuel J Lin, Bernard T Lee
BACKGROUND: Umbilical stalk necrosis represents a rare, yet important complication after abdominal-based microsurgical breast reconstruction, which is both underrecognized and understudied in the literature. Once identified, umbilical reconstruction can be an extremely challenging problem. METHODS: All consecutive breast free flaps at a single institution from February 2004 to February 2016 were reviewed, excluding non-abdominal-based flaps. Patients were divided based on the development of umbilical necrosis postoperatively...
July 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28673620/microsurgical-flaps-in%C3%A2-repair-and-reconstruction-of-the-hand
#14
REVIEW
Shimpei Ono, Sandeep J Sebastin, Hiroyuki Ohi, Kevin C Chung
The authors' strategy for soft-tissue coverage of the hand is presented. The concept of replacing like with like and reconstruction with similar adjacent tissue enhances functional and aesthetic outcomes. In this viewpoint, the pedicle perforator flap is an ideal flap. A decision-making algorithm to select an ideal flap for a particular hand defect is challenging, requiring experiential consideration of functional outcome, appearance, donor-site morbidity, and patient satisfaction. To assist surgeons in determining the most appropriate flap with more evidence, studies are necessary to compare the outcomes of each flap by evaluating hand function, aesthetics, donor site morbidity, and patient satisfaction...
August 2017: Hand Clinics
https://www.readbyqxmd.com/read/28657946/reconstruction-repair-of-iatrogenic-biliary-injuries-is-the-robot-offering-a-new-option-short-clinical-report
#15
Pier Cristoforo Giulianotti, Pablo Quadri, Samarth Durgam, Francesco Maria Bianco
OBJECTIVE: The aim of this study is to analyze perioperative outcomes of robotic reconstruction of iatrogenic biliary injuries and describe the surgical technique in detail. BACKGROUND: Iatrogenic bile duct injuries (BDIs) continue to be a major concern in open and laparoscopic cholecystectomy. In the past decade, robotic surgery has been applied to many different procedures showing technical advantages, especially in microsurgical fields. Few cases of robotic BDI reconstructions have been described in the literature so far...
June 27, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28657669/does-the-use-of-arteriovenous-loops-increase-complications-rates-in-posttraumatic-microsurgical-lower-extremity-reconstruction-a-matched-pair-analysis
#16
Arash Momeni, Michael A Lanni, Lawrence S Levin, Stephen J Kovach
INTRODUCTION: The use of arteriovenous (AV) loops in microsurgical lower extremity reconstruction is a controversial topic. The objective of the present study was to assess the impact of AV loops on complication rates following microsurgical reconstruction of posttraumatic lower extremity defects. PATIENTS AND METHODS: Patients who underwent free flap coverage of posttraumatic defects in combination with an AV loop (Group 1) were identified and matched for age, body mass index (BMI), tobacco use, defect location, and flap type with patients who underwent reconstruction without vein grafts (Group 2)...
June 28, 2017: Microsurgery
https://www.readbyqxmd.com/read/28648581/is-long-term-post-operative-monitoring-of-microsurgical-flaps-still-necessary
#17
Giovanni Zoccali, Alexandra Molina, Jian Farhadi
Autologous microsurgical flap reconstruction has become commonplace in most plastic surgery units, and the success rates of this procedure have markedly increased over recent years. However, the possibility of flap failure still needs to be considered. A review of the literature reveals that the critical period for flap-threatening complications is the first 24-48 post-operative hours; however, the window for the onset of these complications remains open for up to 7 days post-operatively. In this study, we focus on the timing of flap complications, aiming to elucidate the time period over which meticulous flap monitoring can positively contribute to flap salvage rates...
June 1, 2017: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/28648003/-curative-effect-analysis-of-15-cases-of-cervical-intra-and-extra-spinal-tumors-by-microsurgical-resection
#18
Y Han, X L Zheng, L Li, Z Q Jiang, F Y Lou, S J Zhang
Objective: To explore the curative effect of microsurgical treatment of cervical intra- and extra-spinal tumors. Methods: The clinical data of 15 patients with cervical intra-and extra-spinal tumors in Department of Neurosurgery, the First Affiliated Hospital of Bengbu Medical College from January 2013 to February 2017 were retrospectively analyzed. According to Shaw's tumor stage: 6 cases in stage Ⅰ, 5 cases in stage Ⅱ, 3 cases in stage Ⅲ, and 1 case in stage Ⅳ. About the surgical methods: 9 cases were treated via posterior median semi-laminectomy approach, of which were internal fixation in 2 cases, and via posterior median approach spinous process and vertebral plate complex orthotopic replantation to spinal canal plasty in 3 cases, other 3 cases were operated via anterior cervical approach, including internal fixation in 1 case...
June 20, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/28611938/anatomic-study-of-the-vascular-perfusion-of-the-sternum-and-its-clinical-relevance-in-deep-sternal-wound-infection
#19
Nick Spindler, Florian Kaatz, Christine Feja, Christian Etz, Friedrich-Wilhelm Mohr, Ingo Bechmann, Christoph Josten, Stefan Langer, Sabine Loeffler
Introduction: Deep sternal wound infections (DSWI) are a rare but devastating complication after median sternotomy. Minor perfusion in bone and soft tissue, especially after recruiting the internal mammary artery for bypass supports the development of wound infection and nonunion of the sternal bone. The aim of the study was the macroscopic and radiological presentation of the vascular system supplying the sternum, in particular the compensating blood supply routes in the event that the internal mammary artery is no longer available after use as a bypass vessel...
2017: GMS Interdisciplinary Plastic and Reconstructive Surgery DGPW
https://www.readbyqxmd.com/read/28607852/microsurgical-hepatic-artery-reconstruction-using-ikuta-a-ii-double-clamp
#20
Masayuki Okochi, Hiromi Okochi, Takao Sakaba, Masanori Momiyama, Kazuki Ueda
We performed hepatic artery (HA) reconstruction on 24 patients between January 2010 and October 2016. Six of 24 patients used an Ikuta type A-II vascular clamp (A-II group). The mean age was 38.0 years (range, 1-61 years). There was no blood leakage at the anastomosed site in any of the patients. No patients required an additional vascular clamp, and none developed HA thrombosis. Eighteen of 24 patients used a conventional vascular clamp. The mean age was 36.1 years (range, 1-65 years; conventional group). Sixteen of 18 patients required an additional vascular clamp due to blood leakage from the HA...
May 2017: Plastic and Reconstructive Surgery. Global Open
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