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Microsurgical reconstruction

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https://www.readbyqxmd.com/read/29464176/latissimus-dorsi-and-immediate-fat-transfer-lift-for-complete-autologous-breast-reconstruction
#1
James M Economides, David H Song
Background: Despite the popularity of latissimus dorsi (LD) flap in breast reconstruction, a breast implant is often necessary to achieve sufficient volume. Prior reports describe fat grafting to the LD flap as a secondary procedure to correct contour deformities and improve volume. Our institution has instituted autologous breast reconstruction with an LD flap and immediate fat transfer (LIFT). Methods: A retrospective review of all patients undergoing the LIFT procedure was undertaken...
January 2018: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/29464164/an-enhanced-recovery-after-surgery-pathway-for-microvascular-breast-reconstruction-is-safe-and-effective
#2
Arezoo Astanehe, Claire Temple-Oberle, Markus Nielsen, William de Haas, Robert Lindsay, Jennifer Matthews, David C McKenzie, Justin Yeung, Christiaan Schrag
Background: The aim of this study was to develop, implement, and evaluate a standardized perioperative enhanced recovery after surgery (ERAS) clinical care pathway in microsurgical abdominal-based breast reconstruction. Methods: Development of a clinical care pathway was informed by the latest ERAS guideline for breast reconstruction. Key features included shortened preoperative fasting, judicious fluids, multimodal analgesics, early oral nutrition, early Foley catheter removal, and early ambulation...
January 2018: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/29464149/microsurgical-engineering-bilateral-deep-inferior-epigastric-artery-perforator-flap-with-flow-through-intraflap-anastomosis
#3
Ian R Wisecarver, Gerhard S Mundinger, Michael S Tarakji, Hugo St Hilaire
Squamous cell carcinoma (SCC) of the head and neck affects a significant number of people around the world every year. Treatment generally entails surgical resection, radiotherapy, chemotherapy, or some combination of the three. Following resection, microsurgical reconstruction can provide definitive coverage, replace many tissue types simultaneously, and bring healthy tissue to irradiated wound beds. Microsurgical engineering, the manipulation and reorganization of native vascular tissue, can further augment the adaptability of free tissue transfer to complex, compromised wound beds...
January 2018: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/29452441/assessing-the-safety-and-efficacy-of-regional-anesthesia-for-lower-extremity-microvascular-reconstruction-enhancing-recovery
#4
Qing Zhao Ruan, Shawn Diamond, Scott Zimmer, Matthew L Iorio
BACKGROUND: Perioperative pain, increased sympathetic tone, and peripheral vasospasm may be safely managed with regional nerve blockade during microvascular reconstruction in the lower extremity. Limited reports exist in this setting; therefore, we evaluated our use of peripheral nerve catheters (PNCs) during microvascular limb salvage to determine safety and efficacy for both patient and flap. METHODS: A single-institution, retrospective review of a prospectively maintained database on all patients with lower extremity free tissue transfers between 2012 and 2017 was completed...
February 16, 2018: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/29443832/one-barrel-microsurgical-fibula-flap-for-reconstruction-of-large-defects-of-the-femur
#5
Jung Eun Lee, Min Bom Kim, Do Hwan Han, Sung Hee Pyo, Young Ho Lee
Various methods for reconstructing large femur bone defects after tumor resection have been introduced. In this study, we reviewed the clinical outcomes of using a 1-barrel free vascularized fibular graft (FVFG) protected by a lateral locking plate for large femoral defects not involving the knee joint.Between August 2007 and August 2013, we treated 7 patients with large femoral bone defects after tumor resection. The mean age of the patients was 19 years (range, 12-36 years), and 3 were women. All defects were free of infection before the procedure...
February 13, 2018: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/29401129/early-ambulation-after-microsurgical-reconstruction-of-the-lower-extremity
#6
Michael J Orseck, Christopher Robert Smith, Sean Kirby, Manuel Trujillo
Successful outcomes after microsurgical reconstruction of the lower extremity include timely return to ambulation. Some combination of physical examination, ViOptix tissue oxygen saturation monitoring, and the implantable venous Doppler have shown promise in increasing sensitivity of current flap monitoring. We have incorporated this system into our postoperative monitoring protocol in an effort to initiate earlier dependency protocols. A prospective analysis of 36 anterolateral thigh free flap and radial forearm flaps for lower extremity reconstruction was performed...
February 2, 2018: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/29396982/use-of-social-media-and-an-online-survey-to-discuss-complex-reconstructive-surgery-a-case-of-upper-lip-reconstruction-with-402-responses-from-international-microsurgeons
#7
Soo-Ha Kwon, Che-Hsiung Lee, Angela Ting-Wei Hsu, Mark Shafarenko, Usama Farghaly Omar, Chieh-Han John Tzou, Julia Roka-Palkovits, Aldo G Beltrán P, Dimitri Liakos, Tommy Nai-Jen Chang
BACKGROUND: The best reconstructive strategy for upper lip defects is still in debate. The purpose of this study was to analyze the decisions made by international microsurgeons, who were participated through online questionnaire, distributed by email and social media network. MATERIALS AND METHODS: A case of a two-thirds upper lip oncologic defect was presented via an online questionnaire and 402 microsurgeons replied their treatment options. The data were then analyzed according to the geographic area, microsurgical fellowship, seniority, and subspecialty...
February 2, 2018: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/29395670/one-versus-two-venous-anastomoses-in-microsurgical-head-and-neck-reconstruction-a-cumulative-meta-analysis
#8
REVIEW
S Christianto, A Lau, K Y Li, W F Yang, Y X Su
Venous compromise is still the most common cause of free flap failure. The use of two venous anastomoses has been advocated to reduce venous compromise. However, the effectiveness of this approach remains controversial. A systematic review and cumulative meta-analysis was performed to assess the effect of one versus two venous anastomoses on venous compromise and free flap failure in head and neck microsurgical reconstruction. A total of 27 articles reporting 7389 flaps were included in this study. On comparison of one versus two venous anastomoses, the odds ratio (OR) for flap failure was 1...
January 29, 2018: International Journal of Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/29369171/microdissected-thin-anterolateral-thigh-perforator-flaps-with-multiple-perforators-a-series-of-case-reports
#9
Jiu-Long Liang, Xiao-Yan Liu, Tao Qiu, Zhi-Qiang Fu, Hong-Yi Wang, Xu Kong, Kai Tao
INTRODUCTION: The study aimed to explore the effect of microdissected thin anterolateral thigh (MTALT) perforator flap with multiple perforators on patients with complex defects on the hand, elbow, heel, or knee. METHODS: From March 2012 to February 2013, 5 patients with complex defects on the hand, elbow, heel, or knee were included. During the flap preparation, 2 to 3 perforators penetrating the fascia of the anterolateral femoral area were initially detected, and the deep fascia was incised...
January 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29369105/monitoring-of-myocutaneous-flaps-by-measuring-capillary-glucose-and-lactate-levels-experimental-study
#10
David Guillier, Vivien Moris, Sarra Cristofari, Brice Gerenton, Anna Hallier, Philippe Rizzi, Benoit Henault, Narcisse Zwetyenga
INTRODUCTION: In surgery, certain defects require reconstruction with a microsurgical flap. The free flap failure rate varies between 2% and 5%. Vascular thrombosis is the most frequent complication and represents 15% to 73% of failures. The success rate of salvage therapy is greater when salvage surgery is early. Currently, clinical monitoring is the criterion standard but many noninvasive or minimally invasive techniques have been developed to improve early diagnosis of complications of vascular thrombosis...
January 24, 2018: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/29366529/use-of-medial-upper-arm-free-flap-in-oral-cavity-reconstruction-a-preliminary-study
#11
P Saenthaveesuk, S-E Zhang, G-S Zheng, Y-J Liang, Y-X Su, G-Q Liao
The medial upper arm has previously been proposed as a potential free flap donor site, but the clinical application of such flaps in head and neck reconstruction has not been popular. The preliminary results of the clinical application of medial upper arm free flaps in oral cavity reconstruction are reported here. Five patients with oral cancer underwent surgical resection and neck dissection, with simultaneous reconstruction using a medial upper arm free flap. Functional outcomes were investigated using the University of Washington Quality of Life Questionnaire...
January 20, 2018: International Journal of Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/29359295/impact-of-duration-of-perioperative-ischemia-on-outcomes-of-microsurgical-reconstructions
#12
Denis Ehrl, Paul I Heidekrueger, Milomir Ninkovic, P Niclas Broer
BACKGROUND:  Free tissue transfers have become routine for a variety of reconstructive purposes. During the time of transfer, some period of ischemia time is unavoidable, causing structural and metabolic changes. This study aimed to evaluate whether length of intraoperative ischemia affects the outcomes of microsurgical reconstructions. METHODS:  Within a 7-year period, 638 patients having undergone 690 microvascular free flap reconstructions fulfilled inclusion criteria for this study...
January 22, 2018: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/29341294/topical-nitroglycerin-for-the-treatment-of-intraoperative-microsurgical-vasospasm
#13
Joseph A Ricci, Dhruv Singhal, Eugene Y Fukudome, Adam M Tobias, Samuel J Lin, Bernard T Lee
BACKGROUND: Papaverine remains a popular agent to treat intraoperative microsurgical vasospasm. However, the recent shortage has forced surgeons to trial antispasmodic agents unproven in microsurgery, but commonly used in other areas. During this shortage we have trialed topical nitroglycerin to break intraoperative vasospasm. This study aims to analyze the outcomes of this medication on flap complications compared with papaverine. METHODS: All consecutive free flaps performed for breast reconstruction at a single institution were reviewed...
January 17, 2018: Microsurgery
https://www.readbyqxmd.com/read/29331084/baus-consensus-document-for-the-management-of-male-genital-emergencies-penile-amputation
#14
REVIEW
C J Shukla, G Brown, T Dorkin, M Lucky, R Pearcy, R W Rees, M Shabbir, D J Summerton, A Muneer
Male genital emergencies relating to the penis and scrotum are rare and require prompt investigation and surgical intervention. Clinicians are often unfamiliar with the management of these conditions and may not work in a specialist centre with on-site expertise in genitourethral surgery available. A series of consensus statements have been developed by an expert consensus comprising BAUS Section of Andrology and Genitourethral Surgery together with experts from units throughout the UK. Penile amputation is a rare gentile emergency and requires prompt intervention and microsurgical reconstruction...
January 13, 2018: BJU International
https://www.readbyqxmd.com/read/29319579/how-big-is-too-big-pushing-the-obesity-limits-in-microsurgical-breast-reconstruction
#15
Jamie A Spitz, Perry S Bradford, Frank Aguilar, Sergey Y Turin, Marco F Ellis
PURPOSE: Obesity is a major public health concern in the United States, affecting nearly 79 million people. There have been promising results performing microvascular breast reconstruction in patients with obesity; however, the definition of obesity is often poorly defined or does not extend above a body mass index (BMI) of 35. Our goal was to examine outcomes of microvascular breast reconstruction in this questionably more risky population. METHODS: A retrospective review from 2013 to 2016 was performed of 2 surgeons' experience with abdominally based microvascular breast reconstructions...
February 2018: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/29306525/cricoarytenoid-joint-ankylosis-classification-and-transoral-laser-microsurgical-treatment
#16
Ihab Atallah, Manjunath Mk, Ahmad Al Omari, Christian Adrien Righini, Paul F Castellanos
OBJECTIVE: This study aimed to describe a graduated approach for effective transoral mobilization of cricoarytenoid joint ankylosis (CJA) in the context of the Bogdasarian system of classifying posterior glottic web-based stenosis (PGWS). STUDY DESIGN: This is a retrospective cohort study through data from medical records and operative notes. A consecutive series of 23 patients who underwent reconstructive transoral laser microsurgery for PGWS with a significant degree of CJA (Bogdasarian grade III-IV) was included in the study...
January 4, 2018: Journal of Voice: Official Journal of the Voice Foundation
https://www.readbyqxmd.com/read/29299526/chicken-thigh-microvascular-training-model-improves-resident-surgical-skills
#17
Francis X Creighton, Allen L Feng, Neerav Goyal, Kevin Emerick, Daniel Deschler
Objectives: Microsurgical techniques are essential for vessel anastomosis in free flap reconstructive surgery. However, teaching these skills intraoperatively is difficult. The chicken thigh microvascular model is a high-fidelity model that has been previously validated to differentiate between skill levels of surgeons. This study aims to determine if this model objectively improves microsurgical skills. Study Design: Validation study. Methods: Thirteen residents were given a tutorial on microvascular anastomosis and asked to perform anastomoses on the microvascular model...
December 2017: Laryngoscope Investigative Otolaryngology
https://www.readbyqxmd.com/read/29289988/rerouting-the-internal-thoracic-pedicle-a-novel-solution-for-maxillofacial-reconstruction-in-vessel-depleted-situations-a-preliminary-anatomic-study
#18
François Morel, Frédéric Crampon, Jérôme Adnot, Pierre-Yves Litzler, Fabrice Duparc, Olivier Trost
PURPOSE: Microsurgical reconstruction in a vessel-depleted neck is a challenge due to the lack of reliable vessels in or nearby the host site. The use of the internal thoracic pedicle (ITP) by rib section or sparring is a limited option due to the small length of the pedicle of some flaps. However, in cardiac surgery, the internal thoracic artery (ITA) is widely used for myocardial revascularization, providing a long and versatile pedicle. We aimed at determining precise anatomical bases for the use of the ITP, approached by sternotomy and rerouted in the neck, as recipient vessels for free-flap facial reconstructions...
December 30, 2017: Surgical and Radiologic Anatomy: SRA
https://www.readbyqxmd.com/read/29285664/pectoralis-minor-transfer-for-elbow-flexion-restoration-in-late-obstetric-brachial-plexus-palsy
#19
Vanessa Costil, Claudia Romana, Frank Fitoussi
PURPOSE: Obstetric brachial plexus palsy (OBPP) may result in a severe impairment of upper limb function, especially when major motor functions do not recover with or without early microsurgical reconstruction. Various methods to restore elbow flexion have been described. The aim of this study was to report the results after pectoralis minor transfer for elbow flexion restoration in late OBPP. METHODS: Nineteen patients were included. Mean age at surgery was six years (range, 2...
December 28, 2017: International Orthopaedics
https://www.readbyqxmd.com/read/29282507/recovery-of-voice-after-reconstruction-of-the-recurrent-laryngeal-nerve-and-adjuvant-nimodipine
#20
P Mattsson, A Frostell, G Björck, J K E Persson, R Hakim, J Zedenius, M Svensson
BACKGROUND: Transection injury to the recurrent laryngeal nerve (RLN) has been associated with permanent vocal fold palsy, and treatment has been limited to voice therapy or local treatment of vocal folds. Microsurgical repair has been reported to induce a better function. The calcium channel antagonist nimodipine improves functional recovery after experimental nerve injury and also after cranial nerve injury in patients. This study aims to present voice outcome in patients who underwent repair of the RLN and received nimodipine during regeneration...
December 28, 2017: World Journal of Surgery
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