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Microsurgical reconstruction

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https://www.readbyqxmd.com/read/28319440/markers-of-blood-coagulation-and-fibrinolysis-in-patients-with-early-and-delayed-microsurgical-reconstructions-in-the-lower-extremities
#1
Oliver Kloeters, Dalibor Vasilic, Pieter Hupkens, Dietmar Ulrich
BACKGROUND: In this study, markers of coagulation and fibrinolysis were assessed during early and delayed microsurgical reconstruction in patients with traumatic defects of their lower legs to analyse whether an imbalance of the hemostasis after trauma might predispose the development of vascular complications. METHODS: The prospective study included 70 patients. In 35 patients, surgery was performed within 72 hours after injury. In 35 other patients, delayed free flap transfer was performed between 14-21 days after trauma...
March 20, 2017: Journal of Plastic Surgery and Hand Surgery
https://www.readbyqxmd.com/read/28319277/the-systematic-review-and-meta-analysis-of-free-flap-safety-in-the-elderly-patients
#2
Galip Gencay Üstün, Ali Emre Aksu, Hakan Uzun, Ozan Bitik
BACKGROUND: Prolonged mean life expectancy gives rise to a more populated and older patient group. With increasing number of cases during the past decades, older patients are regarded as candidates for microsurgical interventions. Whether advanced patient age is an independent risk factor for microsurgical reconstruction is still an ongoing matter of debate. METHODS: The Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, CINAHL and EMBASE databases were screened for combination of the key words "elderly", "geriatric", "advanced age", "free flap", "microsurgery", free tissue transfer" by using time limits between 1989 and 2015...
March 20, 2017: Microsurgery
https://www.readbyqxmd.com/read/28319260/the-second-time-flap-from-the-previously-used-anterior-thigh-donor-site-for-head-and-neck-microsurgical-reconstruction
#3
Nidal Farhan Al Deek, Chun-Ta Liao, Shiang-Fu Huang, Chung-Jan Kan, Kai-Ping Chang, Ku-Hao Fang, Chung-Kan Tsao
BACKGROUND: Multiple free tissue transfer from the same donor site is not well described for microsurgical head and neck reconstruction. METHODS: Between (8/2011 and 11/2012), 103 patients received 103 free ALT flaps for head and neck reconstruction; flaps were called first-time ALT flaps. Intra-operative findings were used to assess the presence of a favorable anatomy for a future second flap from the same donor site. And, between 9/2009 and 12/2013, second-time flaps from previously used anterior thighs were attempted either freely or guided by the intra-operative data from the previous surgery...
March 20, 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28318741/neonatal-magnetic-resonance-imaging-without-sedation-correlates-with-injury-severity-in-brachial-plexus-birth-palsy
#4
Andrea S Bauer, Peter Y Shen, Anna E Nidecker, Paul S Lee, Michelle A James
PURPOSE: Which infants with brachial plexus birth palsy (BPBP) should undergo microsurgical plexus reconstruction remains controversial. The current gold standard for the decision for plexus reconstruction is serial clinical examinations, but this approach obviates the possibility of early surgical treatment. We hypothesize that a new technique using 3-dimensional volumetric proton density magnetic resonance imaging (MRI) without sedation can evaluate the severity of BPBP injury earlier than serial clinical examinations...
March 16, 2017: Journal of Hand Surgery
https://www.readbyqxmd.com/read/28302367/lateral-thigh-perforator-flap-for-breast-reconstruction-computed-tomographic-angiography-analysis-and-clinical-series
#5
Marco A Maricevich, Michael R Bykowski, M Asher Schusterman, Evan B Katzel, Michael L Gimbel
PURPOSE: Although abdominal-based flaps remain the first choice for autologous breast reconstruction, alternative donor sites are necessary when the abdomen is unavailable. Abdominal donor site suitability is determined, at times, according to deep inferior epigastric perforator (DIEP)-protocol computed tomographic angiography (CTA) results. CTA provides information about the pelvis/upper thigh that can be used to evaluate the suitability of other donor sites. This study aimed to examine the utility of DIEP-protocol CTA in the assessment of a lateral thigh perforator (LTP) flap...
February 20, 2017: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/28296715/evaluating-the-use-of-tissue-oximetry-to-decrease-intensive-unit-monitoring-for-free-flap-breast-reconstruction
#6
Joseph A Ricci, Christina R Vargas, Olivia A Ho, Samuel J Lin, Adam M Tobias, Bernard T Lee
BACKGROUND: Postoperative free flap care has historically required intensive monitoring for 24 hours in an intensive care unit. Continuous monitoring with tissue oximetry has allowed earlier detection of vascular compromise, decreasing flap loss and improving salvage. This study aims to identify whether a fast-track postoperative paradigm can be safely used with tissue oximetry to decrease intensive monitoring and costs. MATERIALS AND METHODS: All consecutive microsurgical breast reconstructions performed at a single institution were reviewed (2008-2014) and cases requiring return to the operating room were identified...
March 14, 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28293504/an-appraisal-of-internal-mammary-artery-perforators-as-recipient-vessels-in-microvascular-breast-reconstruction-an-analysis-of-515-consecutive-cases
#7
Felix H Vollbach, Christoph D Heitmann, Hisham Fansa
BACKGROUND: The usage of internal mammary artery perforators (IMAPs) has been described in autologous breast reconstruction although IMAPS are not yet considered standard recipient vessels. It remains unclear if these vessels can be safely used in large flaps after radiation therapy or in delayed breast reconstruction. METHODS: Over a 2-year period, 515 free flaps for autologous breast reconstruction were performed on 419 patients by 2 surgeons (S1 and S2). In a retrospective analysis, time of reconstruction, ischemia time, flap weight, diameter of couplers, and complications were analyzed...
December 2016: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/28280670/a-comprehensive-approach-to-lower-extremity-free-tissue-transfer
#8
Lee L Q Pu
BACKGROUND: The purpose of this study was to introduce a comprehensive approach to lower extremity free-tissue transfer and report the clinical outcome that has been achieved with this approach. METHODS: The comprehensive approach developed by the author includes patient selection, flap selection, selection of the recipient vessels, flap dissection, flap preparation, microvascular anastomosis, flap inset, immediate postoperative care, intermediate postoperative care, and further follow-up care...
February 2017: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/28280668/zygomatico-maxillary-reconstruction-with-computer-aided-manufacturing-of-a-free-dcia-osseous-flap-and-intraoral-anastomoses
#9
Andrée-Anne Roy, Johnny I Efanov, Geneviève Mercier-Couture, André Chollet, Daniel E Borsuk
Craniomaxillofacial reconstruction using virtual surgical planning, computer-aided manufacturing, and new microsurgical techniques optimizes patient-specific and defect-directed reconstruction. A 3D customized free deep circumflex iliac artery (DCIA) flap with intraoral anastomoses was performed on a 23-year-old man with a posttraumatic right zygomatico-maxillary defect with failure of alloplastic implant reconstruction. An osseous iliac crest flap was sculpted based on a customized 3D model of the mirror image of the patient's unaffected side to allow for perfect fit to the zygomatico-maxillary defect...
February 2017: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/28280662/avoiding-facial-incisions-with-midface-free-tissue-transfer
#10
Mark W Stalder, Michael Sosin, Leo J Urbinelli, James L Mayo, Amir H Dorafshar, Hugo St Hilaire, Daniel E Borsuk, Eduardo D Rodriguez
BACKGROUND: We have adopted an intraoral microsurgical anastomosis to the facial vessels to eliminate the need for any visible facial incisions. METHODS: Cadaveric dissection was used to demonstrate accessibility of the facial artery and vein through an intraoral approach. Additionally, 5 patients underwent free tissue transfer for reconstruction of major defects of the midface through an intraoral, transmucosal approach, obviating the need for visible skin incisions...
February 2017: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/28272279/preoperative-computed-tomography-angiogram-cta-measurement-of-abdominal-muscles-is-a-valuable-risk-assessment-for-bulge-formation-after-microsurgical-abdominal-breast-reconstruction
#11
Elisabeth A Kappos, Jeff Jaskolka, Kate Butler, Anne C O'Neill, Stefan Op Hofer, Toni Zhong
BACKGROUND: A major shortcoming associated with abdominal tissue breast reconstruction is the long-term abdominal wall morbidity. Although abdominal core muscle size on computed tomography angiogram (CTA) has been correlated with morbidity following many abdominal surgeries, it has not been studied for abdominal breast reconstruction. Therefore, we evaluated the association between preoperative CTA-derived measurements of abdominal core muscles and postoperative abdominal wall morbidity after abdominal tissue breast reconstruction...
March 6, 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28262373/nipple-reconstruction-using-rib-cartilage-strut-in-microsurgical-reconstructed-breast
#12
S Guerid, F Boucher, A Mojallal
Nipple areolar reconstruction is the very last step of breast reconstruction. It is of outmost importance because it gives final appearance of breast, which is then better integreated by the patient in her body image. A lot of techniques are described to recreate nipple projection, from trompe l'œil tattoo to local flap, nipple sharing or autologous tissue graft. Common drawback of these techniques is nipple flattening with time, due to tissue atrophy. We present here a technique to use rib cartilage graft as structural framework for nipple reconstruction...
March 2, 2017: Annales de Chirurgie Plastique et Esthétique
https://www.readbyqxmd.com/read/28259642/determining-the-best-recipient-vessel-site-for-autologous-microsurgical-breast-reconstruction-with-diep-flaps-an-anatomical-study
#13
Martin Lhuaire, Mikael Hivelin, Moustapha Dramé, Peter Abrahams, Reza Kianmanesh, Christian Fontaine, Laurent Lantieri
INTRODUCTION: The deep inferior epigastric perforator (DIEP) flap is a reliable and reproducible technique for autologous microsurgical breast reconstruction. Several recipient vessels sites for microvascular anastomosis have been described such as the internal thoracic vessels, the thoracodorsal vessels, and the circumflex scapular vessels. Nonetheless, the choice of the recipient site depends mainly on individual operator's experience and preferences, and currently the best recipient vessel site is under debate...
February 13, 2017: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/28255387/reverse-sural-flap-for-ankle-and-heel-soft-tissues-reconstruction
#14
R N Ciofu, D G Zamfirescu, S A Popescu, I Lascar
Introduction: The potential of the medial calf integument, as donor site for a free flap based on musculocutaneous branches of the medial sural artery, was first identified by Taylor and Daniel, following cadaver investigation. In 1981, Pontén described the fasciocutaneous sural flap as a reconstructive option for soft tissue loss of the lower extremity, particularly around the knee. Two years later, Donski and Fogdestram presented the distally based fasciocutaneous flap from the sural region followed by Montegut and Allen who considered the sural artery perforator flap as a viable alternative for the gastrocnemius myocutaneous flap...
January 2017: Journal of Medicine and Life
https://www.readbyqxmd.com/read/28250760/transfer-of-the-extensor-indicis-proprius-branch-of-posterior-interosseous-nerve-to-reconstruct-ulnar-nerve-and-median-nerve-injured-proximally-an-anatomical-study
#15
Pei-Ji Wang, Yong Zhang, Jia-Ju Zhao, Ju-Pu Zhou, Zhi-Cheng Zuo, Bing-Bing Wu
Proximal or middle lesions of the ulnar or median nerves are responsible for extensive loss of hand motor function. This occurs even when the most meticulous microsurgical techniques or nerve grafts are used. Previous studies had proposed that nerve transfer was more effective than nerve grafting for nerve repair. Our hypothesis is that transfer of the posterior interosseous nerve, which contains mainly motor fibers, to the ulnar or median nerve can innervate the intrinsic muscles of hands. The present study sought to investigate the feasibility of reconstruction of the deep branch of the ulnar nerve and the thenar branch of median nerve by transferring the extensor indicis proprius branch of the posterior interosseous nerve obtained from adult cadavers...
January 2017: Neural Regeneration Research
https://www.readbyqxmd.com/read/28230584/microsurgical-replantation-of-total-avulsed-scalp-extending-the-limits
#16
Yunbo Jin, Chen Hua, Xiaojie Hu, Hui Chen, Gang Ma, Yun Zou, Bin Chen, Dongze Lyu, Mathias Tremp, Xiaoxi Lin
BACKGROUND: Avulsion of the scalp is a rare but severe trauma and challenging to the reconstructive surgeon. It poses not only physical concussion but also significant persisting psychological distress to the patients. METHODS: Medical records from 5 patients who suffered scalp avulsion were reviewed retrospectively. The following data and methods were assessed: age, number of vessels repaired, method of replantation, vein grafts required, blood transfusion, ischemia time, total operating time, and percentage of scalp survival...
February 22, 2017: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/28219304/solitary-thoracic-intramedullary-spinal-neurofibroma-microsurgically-extirpated-via-recapping-t-saw-laminoplasty
#17
Mamer Soriano Rosario, Hideki Murakami, Satoshi Kato, Moriyuki Fujii, Noritaka Yonezawa, Hiroyuki Tsuchiya
We report the case of a 40-year-old female presenting with back pain that was complicated by a solitary intramedullary spinal cord mass at the T10-11 levels, confirmed by magnetic resonance imaging and computed tomography myelography. Microsurgical en bloc extirpation of the tumor approached through a recapping T-saw laminoplasty of T10 was done, and histopathology findings revealed a diagnosis of neurofibroma. Solitary spinal neurofibroma is one of the rarest tumors involving the spinal cord and is very adherent for the lack of a well-defined capsule, requiring careful dissection under microscope magnification for successful en bloc resection...
January 2017: Journal of Orthopaedic Surgery
https://www.readbyqxmd.com/read/28216827/distal-phalanx-amputation-with-delayed-presentation-and-successful-reconstruction-with-reposition-and-flap-after-2-weeks
#18
Jefferson Braga-Silva, Renato Franz Matta Ramos, Gabriela Meirelles Marchese, Pedro Salomao Piccinini
Traumatic finger amputations are common, causing significant functional and cosmetic deficits. Microsurgical replantation techniques are the mainstay of treatment for most such injuries although they require adequate conservation of the amputated segment for a successful result. In distal finger amputations, replantation is the procedure of choice, as long as the amputated fragment is viable. If replantation is not an option, reposition + flap using a neurovascular flap can be an efficient option, as this offers improved skin coverage...
September 2016: Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India
https://www.readbyqxmd.com/read/28201829/impact-of-continuous-two-team-approach-in-autologous-breast-reconstruction
#19
A J Bauermeister, A Zuriarrain, M Newman, S A Earle, M A Medina
Background Autologous breast reconstruction has been noted in the literature to provide superior aesthetic outcomes and patient satisfaction. Additionally, free perforator flap tissue transfer has the potential for lower abdominal donor site morbidity. However, it has been noted that the percentage of women who are undergoing autologous breast reconstruction in the United States is decreasing. Factors related to the technical difficulty, prolonged operative times, and decreasing reimbursement have been implicated as the causes...
February 15, 2017: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/28194796/the-utility-of-the-musculocutaneous-anterolateral-thigh-flap-in-pharyngolaryngeal-reconstruction-in-the-high-risk-patient
#20
Adrian S H Ooi, Chad M Teven, Amir Inbal, David W Chang
BACKGROUND AND OBJECTIVES: Prior radiotherapy leads to increased wound complication rates for microsurgical reconstruction of pharyngolaryngeal (PL) defects. Incorporating vastus lateralis muscle together with anterolateral thigh flap (ALT) skin in defect reconstruction is useful in protecting vital structures and reinforcing irradiated neck skin and suture lines. This study shows the utility of the musculocutaneous ALT (MC ALT) in PL reconstruction in previously irradiated patients. METHODS: A single-surgeon, retrospective chart review of all patients with defects of the PL region where an MC ALT was used for reconstruction from February 2014 to May 2016...
February 14, 2017: Journal of Surgical Oncology
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