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Microsurgical reconstruction

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https://www.readbyqxmd.com/read/28092334/is-enhanced-recovery-the-new-standard-of-care-in-microsurgical-breast-reconstruction
#1
Anoushka Afonso, Sabine Oskar, Kay See Tan, Joseph J Disa, Babak J Mehrara, Jihan Ceyhan, Joseph H Dayan
BACKGROUND: Enhanced recovery pathways (ERPs) have been shown to aid in patient recovery and improve outcomes in many surgical settings. At present, there is limited data available regarding the use and feasibility of ERPs for patients undergoing microsurgical breast reconstruction. We sought to assess patient outcomes before and after the introduction of an ERP that was adopted by multiple surgeons at a single cancer center. METHODS: A multidisciplinary ERP was developed for patients undergoing deep inferior epigastric perforator (DIEP) or muscle-sparing free transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction...
January 12, 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28061519/does-a-standalone-cancer-center-improve-head-and-neck-microsurgical-outcomes
#2
Matthew L Tamplen, Jesse Tamplen, Vanessa Torrecillas, Rahul Seth, Santo Ricceri, Shirin Hemmat, Chase Heaton, William R Ryan, P Daniel Knott
Objectives To evaluate the role of hospital setting (standalone cancer center vs. large multidisciplinary hospital) on free tissue transfer (FTT) outcomes for head and neck reconstruction. Methods Medical records were reviewed of 180 consecutive patients undergoing FTT for head and neck reconstruction. Operations occurred at either a standalone academic cancer center (n = 101) or a large multidisciplinary academic medical center (n = 79) by the same surgeons. Patient outcomes, operative comparisons, and hospital costs were compared between the hospital settings...
January 6, 2017: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/28057874/pregnancy-and-live-birth-rates-after-microsurgical-vasoepididymostomy-for-azoospermic-patients-with-epididymal-obstruction
#3
Jing Peng, Zhichao Zhang, Yiming Yuan, Wanshou Cui, Weidong Song
STUDY QUESTION: Can microsurgical vasoepididymostomy (MVE) be an effective treatment for azoospermic men with epididymal obstruction? SUMMARY ANSWER: MVE is an effective treatment for epididymal obstruction, with overall patency and live birth rates of 76.3% and 34.8%, respectively. WHAT IS KNOWN ALREADY: We showed that MVE was an effective treatment for non-vasectomized patients with epididymal obstruction and prior failed sperm retrieval for ICSI...
January 5, 2017: Human Reproduction
https://www.readbyqxmd.com/read/28056334/immediate-microsurgical-bone-and-nerve-reconstruction-in-the-irradiation-treated-patient-a-case-report
#4
Ramzey Tursun, J Marshall Green
Microsurgical reconstructive techniques have revolutionized the treatment of large head and neck defects. These defects were once forever life altering because of the considerable morbidity to both the form and function of the patient. As time has progressed, microsurgical technique has improved dramatically and has become institutionalized in our training programs. Free flap outcomes in head and neck reconstruction have improved dramatically, and optimization of these outcomes is now key. One overlooked area has been neurosensory reconstruction...
December 11, 2016: Journal of Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/28052381/the-lateral-calcaneal-artery-as-an-alternative-recipient-vessel-option-for-heel-and-lateral-foot-reconstruction
#5
Kyong-Je Woo, Jin-Woo Park, Goo-Hyun Mun
BACKGROUND: Clinical outcomes of consecutive use of the lateral calcaneal artery (LCA) as a recipient vessel for microsurgical reconstruction have not been reported. This study aimed to evaluate the feasibility and safety of the LCA as a recipient vessel for microsurgical foot reconstruction based on anatomical study of CT angiography and clinical results of using this vessel as the recipient. METHODS: Anatomic study was performed using CT angiography of 61 lower extremities (31 patients)...
January 4, 2017: Microsurgery
https://www.readbyqxmd.com/read/28045814/recalcitrant-invasive-skin-cancer-of-the-scalp-combined-extirpation-and-microsurgical-reconstruction-without-cranioplasty
#6
Gerald J Cho, Frederick Wang, Steven M Garcia, Jennifer Viner, William Y Hoffman, Michael W McDermott, Jason H Pomerantz
BACKGROUND: Recurrent invasive skin cancer of the scalp and calvarium is a difficult problem for which universally accepted treatment protocols have not been established. The authors present their 10-year experience with treatment of this specific subset of scalp reconstruction patients and present a successful treatment algorithm that is well suited to this patient population. METHODS: The authors retrospectively reviewed all patients of microsurgical scalp reconstruction performed from 2005 to 2015 that involved invasive cutaneous malignancies of the scalp and calvarium...
December 30, 2016: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/28027177/the-visor-flap-a-novel-design-for-scalp-wound-closure
#7
Lisa Hwang, Ni-Ka Ford, Jamie Spitz, Marco Ellis
Full-thickness scalp defects pose a reconstructive problem in the setting of infection, radiation, and underlying calvarial defects. Current options include dermal matrices, skin grafts, and local fasciocutaneous flaps. Free tissue transfer is frequently required when scalp-based flaps fail or the wound is significantly large or complex. The authors present 7 patients of complex scalp defect reconstruction using the novel visor flap. The visor flap is a bipedicled advancement flap with a triangular posterior extension...
December 23, 2016: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/28007078/re-abdelaziz-o-sallam-k-mostafa-m-elansary-a-amin-a-hybrid-microsurgical-reconstruction-and-percutaneous-endovascular-stent-placement-for-management-of-dissected-graft-hepatic-artery-during-living-donor-liver-transplantation-j-vasc-interv-radiol-2015-26-916
#8
https://www.readbyqxmd.com/read/28002282/microsurgical-reconstruction-of-traumatic-lower-extremity-defects-in-the-pediatric-population
#9
Arash Momeni, Michael Lanni, L Scott Levin, Stephen J Kovach
BACKGROUND: Very few reports focus exclusively on microsurgical reconstruction of traumatic lower extremity defects in children. As such, we felt it prudent to contribute to this area of clinical research. We hypothesized that reconstructive success would be comparable to success rates reported in adults and that young age or concerns regarding vessel size or behavior do not negatively impact surgical outcome. METHODS: A retrospective review of microsurgical lower extremity reconstruction cases at two academic medical centers (University of Pennsylvania and Duke University) was performed...
December 16, 2016: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/27977494/microsurgical-forehead-reconstruction
#10
Denis Ehrl, P Niclas Broer, Paul I Heidekrueger, Milomir Ninkovic
Reconstruction of the forehead remains challenging. Especially in cases of large or even complete forehead defects, local flaps and skin grafting may not be an option, necessitating free flap coverage. The aim of this retrospective case series was to develop an algorithmic surgical approach as well as to evaluate surgical and aesthetic outcomes of microvascular-based forehead reconstructions, using gracilis muscle or anterolateral thigh flaps in 15 cases. The mean size of the defects was 84.6 (range: 25-160, ±44...
December 13, 2016: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/27973959/three-dimensional-digitalized-virtual-planning-for-saphenous-artery-flap-a-pilot-study
#11
Yuan Z Zhang, Shu Z Wen, Hui Q Zhang, Ya G Li, Jian M Zhao, Yong Yang
OBJECTIVE: Since the 1970s, research and applications on flap and muscle flap had solved many problems in microsurgical reconstruction. However, the traditional flap design is completely dependent on two-dimensional (2D) images. The purpose of this study was to discuss the methods in the visualization of saphenous artery flap by digitalized technique and its applications by digitalized technique. METHODS: Two adult fresh cadaver specimens, one male and one female, were subject to radiographic computerized tomography (CT) scanning before and after perfused with lead oxide-gelatine mixture, whose collimation are 0...
December 2016: Comput Assist Surg (Abingdon)
https://www.readbyqxmd.com/read/27919113/analysis-of-flap-weight-and-postoperative-complications-based-on-flap-weight-in-patients-undergoing-microsurgical-breast-reconstruction
#12
Gretl Lam, Katie E Weichman, Patrick L Reavey, Stelios C Wilson, Jamie P Levine, Pierre B Saadeh, Robert J Allen, Mihye Choi, Nolan S Karp, Vishal D Thanik
Background Higher body mass index (BMI) has been shown to increase postoperative complications in autologous breast reconstruction. However, the correlation with flap weight is unknown. Here, we explore the relationship of flap weights and complication rates in patients undergoing microvascular breast reconstruction. Methods Retrospective chart review identified all patients undergoing microvascular breast reconstruction with abdominally based flaps at a single institution between November 2007 and April 2013...
December 5, 2016: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/27898199/microsurgical-reconstruction-in-patients-greater-than-80-years-old
#13
Paul I Heidekrueger, Albrecht Heine-Geldern, Milomir Ninkovic, Frank Herter, Daniel Schmauss, Thiha Aung, P Niclas Broer
BACKGROUND: Demographic change implies that the human population is getting older and the elderly are living longer. Consequently, achieving good functional and aesthetic outcomes in microvascular procedures, especially in very old patients with higher incidence of atherosclerosis and vessel calcifications, constitutes a microsurgical challenge. This study evaluates the feasibility of microsurgical procedures in a very old patient cohort. PATIENTS AND METHODS: Between 2009 and 2015, 754 patients underwent 838 free flap reconstructions...
November 29, 2016: Microsurgery
https://www.readbyqxmd.com/read/27898195/cost-effectiveness-of-microsurgical-reconstruction-for-head-and-neck-defects-after-oncologic-resection
#14
Lin Lin Gao, Marten Basta, Suhail K Kanchwala, Joseph M Serletti, David W Low, Liza C Wu
BACKGROUND: Microvascular free tissue transfer has become the main technique used for head and neck reconstruction. We assessed the cost-effectiveness of free flap reconstruction for head and neck defects after oncologic resection for squamous cell carcinoma (SCC). METHODS: We developed a Markov model of the cost, quality of life, survival, and incremental cost-effectiveness of reconstruction with free tissue transfer compared with locoregional flaps. Health state probabilities and quality of life scores were determined from literature...
November 29, 2016: Head & Neck
https://www.readbyqxmd.com/read/27894916/reliability-of-extended-dorsal-intercostal-artery-perforator-propeller-flaps-for-reconstruction-of-large-myelomeningocele-defects
#15
Goktekin Tenekeci, Yavuz Basterzi
Reconstruction of large myelomeningocele defects using extended (elongated beyond the lateral margin of the latissimus dorsi muscle) dorsal intercostal artery perforator (DICAP) propeller flaps is not recommended by previous studies. However, to provide tension-free and successful closure of a defect, the DICAP propeller flaps must sometimes be elongated beyond this margin. Our experience and results in this issue are discussed. In this article, reconstruction of 11 consecutive cases, with large myelomeningocele defects in which standard DICAP propeller flaps were incapable to close the defect, was achieved using extended DICAP propeller flaps between June 2013 and November 2015...
January 2017: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/27894155/increased-lower-extremity-venous-stasis-may-contribute-to-deep-venous-thrombosis-formation-after-microsurgical-breast-reconstruction-an-ultrasonographic-study
#16
Arash Momeni, Michael G Tecce, Michael A Lanni, Shagun Aggarwal, Christopher Pannucci, Stephen J Kovach, Suhail K Kanchwala, Liza C Wu, Joseph M Serletti
Background Despite guideline-compliant prophylaxis, an increased rate of deep venous thrombosis (DVT) formation has been reported following autologous versus implant-based breast reconstruction. We hypothesized that tight abdominal fascia closure might decrease lower extremity venous return and promote venous stasis. Methods An observational crossover study of patients who underwent autologous breast reconstruction using transverse rectus abdominis musculocutaneous/deep inferior epigastric artery perforator flaps was conducted...
November 28, 2016: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/27893637/timing-of-presentation-of-pediatric-compartment-syndrome-and-its-microsurgical-implication-a-retrospective-review
#17
Natalia I Ziolkowski, Leanne Zive, Emily Ho, Ronald Zuker
BACKGROUND: Forearm compartment syndrome in the pediatric population can lead to severe functional disability. Although it is known that earlier presentation with decompression leads to better outcomes, it is not known when presentation post-injury leads to significant loss of function requiring microsurgical intervention. AIM: To describe the rate of microsurgical reconstruction after forearm compartment syndrome in pediatric patients as related to timing of presentation...
November 21, 2016: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/27892447/a-study-on-variations-of-nutrient-foramen-of-humerus-with-its-clinical-implications
#18
D I Mansur, P Manandhar, M K Haque, D K Mehta, S Duwal, B Timalsina
Background Nutrient foramen is an opening into shaft of humerus which gives passage to the blood vessels of medullary cavity. The knowledge of nutrient foramen is important in surgical procedures like bone grafting and more recently in microsurgical vascularized bone transplantation. Objective To determine the number, location and direction of nutrient foramen and whether the nutrient foramens obey the rule of ossification, that is directed away from the growing end of the bone or not. Method The present study consisted of 253 (108 right and 145 left) dried humeri excluding any fracture or pathological abnormalities during the period of 15th December 2014 - 14th February 2015...
January 2016: Kathmandu University Medical Journal (KUMJ)
https://www.readbyqxmd.com/read/27889116/total-phallic-reconstruction-using-radial-forearm-free-flap-after-iatrogenic-penile-amputation
#19
J C Angulo, I Arance, C Gómez-Llorens, C Esquinas, C Gómez-Martín, J L Fernández-Cañamaque
INTRODUCTION: The iatrogenic loss of the penis is a rare situation. We present a challenging case of deferred total penile reconstruction in a genetic male. MATERIAL AND METHODS: A 57-year-old man with the loss of the penis due to a penile abscess and necrosis secondary to penile curvature surgery. The reconstruction was performed over several operations using a radial forearm free flap (RFFF) and placement of a customised inflatable prosthesis a year later. RESULTS: During the first operation, the penile abscess was drained, the necrotic residues were debrided and placement of hypogastric drainage...
November 23, 2016: Actas Urologicas Españolas
https://www.readbyqxmd.com/read/27878799/microsurgery-robots-addressing-the-needs-of-high-precision-surgical-interventions
#20
Leonardo S Mattos, Darwin G Caldwell, Giorgio Peretti, Francesco Mora, Luca Guastini, Roberto Cingolani
Robotics has a significant potential to enhance the overall capacity and efficiency of healthcare systems. Robots can help surgeons perform better quality operations, leading to reductions in the hospitalisation time of patients and in the impact of surgery on their postoperative quality of life. In particular, robotics can have a significant impact on microsurgery, which presents stringent requirements for superhuman precision and control of the surgical tools. Microsurgery is, in fact, expected to gain importance in a growing range of surgical specialties as novel technologies progressively enable the detection, diagnosis and treatment of diseases at earlier stages...
2016: Swiss Medical Weekly
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