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https://www.readbyqxmd.com/read/28812933/use-of-bilayer-matrix-wound-dressing-in-the-exenterated-socket
#1
Leon Rafailov, Roger E Turbin, Paul D Langer
To describe the novel use of a bilayer dermal substitute to reconstruct exenterated orbits. A retrospective chart review was performed in the practices of two surgeons (RET and PDL) of all patients who had undergone orbital exenteration between April 2014 and June 2016 and whose subsequent reconstruction included lining the socket with Integra bilayer. Patient demographics, pathologic diagnoses, surgical and post-operative complications, graft integrity, and patient acceptance were recorded. The charts of 7 patients (4 men and 3 women, ages 60-87 years) were reviewed...
August 16, 2017: Orbit
https://www.readbyqxmd.com/read/28807000/necrotizing-streptococcal-myositis-of-the-upper-extremity-a-case-report
#2
Johannes C Reichert, Götz Habild, Paul Simon, Ulrich Nöth, Jan B Krümpelmann
BACKGROUND: Necrotizing myositis is a rare but life-threatening soft-tissue infection characterized by rapidly spreading inflammation and subsequent necrosis of the affected tissue. The myositis is often caused by toxin-producing, virulent bacteria such as group A β-hemolytic streptococcus and associated with severe systemic toxicity. It is rapidly fatal unless diagnosed promptly and treated aggressively. However, necrotizing myositis is often initially misdiagnosed as a more benign soft-tissue infection as such fulminant, invasive muscle infections are rare with no more than 30 cases reported over the last century...
August 15, 2017: BMC Research Notes
https://www.readbyqxmd.com/read/28806291/revisiting-the-abdominal-donor-site-introducing-a-novel-nomenclature-for-autologous-breast-reconstruction
#3
Jason M Weissler, Frank P Albino, Martin J Carney, Liza C Wu
As abdominally-based free flaps for breast reconstruction continue to evolve, significant effort has been invested in minimizing donor-site morbidity. The impact on the donor-site remains a prevailing principle for breast reconstruction, and thus must be adequately reflected when classifying what is left behind following flap harvest. Although successful in describing the type of flap harvested, the existing nomenclature falls short of incorporating certain critical variables, such as degree of muscular preservation, fascial involvement, mesh implantation, and segmental nerve anatomy...
August 3, 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28806290/-clinical-and-quantitative-isokinetic-comparison-of-abdominal-morbidity-and-dynamics-following-diep-versus-muscle-sparing-free-tram-flap-breast-reconstruction
#4
Hirokazu Uda, Hideaki Kamochi, Syunji Sarukawa, Ataru Sunaga, Yasusih Sugawara, Kotaro Yoshimura
BACKGROUND: The deep inferior epigastric perforator (DIEP) flap, which is a modification of the muscle-sparing free transverse rectus abdominis musculocutaneous (msTRAM) flap, is being more frequently used in an effort to reduce postoperative abdominal morbidity. However, there is no consensus as to which of these flaps is superior. We aimed to compare quantitative measurements of abdominal function obtained with an isokinetic dynamometer after DIEP and msTRAM flap elevation. METHODS: Patients who underwent unilateral single-pedicled DIEP (n = 42) or msTRAM flap (n = 36) breast reconstruction performed by a single surgeon were included in this study...
August 3, 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28805958/large-orbital-defect-reconstruction-in-the-setting-of-globe-sparing-maxillectomy-the-titanium-hammock-and-layered-fibula-technique
#5
Samuel J Trosman, Timothy M Haffey, Rafael A Couto, Michael A Fritz
INTRODUCTION: The purpose of our study was to describe a novel technique for reconstruction of orbital defects after maxillectomy using a non-anatomic titanium mesh suspension of orbital contents for both support and volume correction. This construct is then articulated with a layered fibula osteocutaneous free flap that restores orbital rim, zygoma, and maxillary alveolus. We herein present our application of this technique, including refinements over time and long-term outcomes. METHODS: A retrospective review was performed on 12 patients who underwent reconstruction of Brown class III orbitopalatomaxillary defects with extensive orbital involvement (at minimum complete orbital floor and rim absent) with titanium mesh sling and a layered fibula free flap...
August 14, 2017: Microsurgery
https://www.readbyqxmd.com/read/28805282/autologous-breast-reconstruction-in-sickle-cell-trait-a-fine-line-between-success-failure
#6
Danny A Young-Afat, Marije J Hoornweg, Martine A van Huizum
Autologous breast reconstructions are increasingly being performed. While increased risks for flap loss after free tissue transfer (FTT) in sickle cell patients are known to most plastic surgeons, risks for patients with sickle cell trait (SCT) are less known. Unfortunately, recommendations to prevent complications after FTT in SCT are still scarce. We present additional and novel surgical measures that we took aiming to enhance probabilities for successful FTT in a SCT patient undergoing autologous breast reconstruction...
August 14, 2017: Breast Journal
https://www.readbyqxmd.com/read/28804686/a-comparative-study-of-tissue-expansion-and-free-parascapular-flaps-in-extensive-facial-burn-scar-reconstruction
#7
G S Kalra, Mitesh Bedi, Vipin Kumar Barala
BACKGROUND: Large post burn scars are a very difficult problem to treat. Available methods include skin grafts and tissue expansion. The reconstructive method used should be tailored according to individual patient rather than following a textbook approach in each. PATIENTS AND METHODS: A retrospective analysis was done of cases with extensive facial burn scars in whom secondary reconstruction was done with either free parascapular flap cover or tissue expansion and flap advancement following facial burn scar excision by a single surgeon (GSK) in Department of Burns, Plastic and reconstructive surgery...
2017: International Journal of Burns and Trauma
https://www.readbyqxmd.com/read/28803639/atrial-fibrillation-and-stroke-as-initial-manifestations-of-painless-type-a-aortic-dissection
#8
Claudia Stöllberger, Lilian Schäffl-Doweik, Maria Korn, Josef Finsterer
Aortic dissection is diagnostically challenging, especially in pain-free patients. Detection of acute ischemic stroke secondary to painless aortic dissection is a challenge for emergency physicians and neurologists. We report a previously healthy 58-years old female, admitted because of nausea, dizziness, somnolence, a left-sided hemiparesis and arterial hypotension. The electrocardiogram showed atrial fibrillation with ST-elevations and ST-depressions. Perfusion CT-imaging showed a dilatation of the aortic arch and intraluminal structures indicating an intima flap of aortic dissection...
July 21, 2017: Neurologia i Neurochirurgia Polska
https://www.readbyqxmd.com/read/28802984/free-grafts-and-microvascular-anastomoses
#9
REVIEW
Valery F Scharf
Skin grafts and free skin flaps are useful options for closure of wounds in which primary closure or use of traditional skin flaps is not feasible. Grafts are classified by their morphology and host-donor relationship. Free skin flaps with microvascular anastomoses are developed from previously described axial pattern flaps and have the added advantage of reestablishing robust vascular supply to the flap, but require specialized equipment and a high degree of technical expertise. Despite intensive perioperative care and the risk of graft or flap failure, skin grafts and free skin flaps can serve as rewarding methods of closing difficult wounds...
August 9, 2017: Veterinary Clinics of North America. Small Animal Practice
https://www.readbyqxmd.com/read/28802886/-lumbar-artery-perforator-flap-for-breast-reconstruction
#10
J-F Honart, N Leymarie, B Sarfati, H Alknashnam, K Rem, F Rimareix, F Kolb
Even though DIEP-SIEA flaps or latissimus dorsi musculocutaneous flap are the most frequently used, a wide variety of flaps have been described for autologous breast reconstruction. Concerning the choice of donor-site, the aim is to prevent and to limit the morbidity. That is why the donor-site should be carefully chosen, according to the morphology of the patient. Lumbar artery perforator flap (LAP) is an option for breast reconstruction, but it is not well known and its use is limited. This study summarizes the authors' early experience with free LAP flap for breast reconstruction...
August 9, 2017: Annales de Chirurgie Plastique et Esthétique
https://www.readbyqxmd.com/read/28802488/characterization-of-surgical-procedures-in-the-spanish-mohs-surgery-registry-regesmohs-for-2013-2015
#11
E de Eusebio Murillo, A Martín Fuentes, V Ruiz-Salas, J R Garcés, R Miñano Medrano, J L López-Estebaranz, T Alonso-Alonso, M Á Rodríguez-Prieto, Y Delgado Jiménez, V Morales, P Redondo Bellón, E Manubens-Mercadé, O Sanmartín-Jiménez, C Guillén Barona, R Cabeza, N Cano, A Toll-Abelló, R Navarro Tejedor, J L Artola Igarza, I Allende Markixana, A Alfaro Rubio, C Ciudad Blanco, H Vázquez-Veiga, L Barchino Ortiz, M A Descalzo, I García-Doval
INTRODUCTION: The Spanish Mohs Surgery Registry is used to collect data on the use and outcomes of Mohs micrographic surgery (MMS) in Spain. The aim of this study was to describe perioperative and intraoperative data recorded for MMS procedures performed between July 2013 (when the registry started) and January 2016. MATERIAL AND METHODS: Prospective cohort study of data from 18 hospitals. The data collected included type of anesthesia, surgical technique, hospital admission, number of Mohs stages, management of preoperative risk factors, additional treatments, previous treatments, type of tumor, operating time, and complications...
August 9, 2017: Actas Dermo-sifiliográficas
https://www.readbyqxmd.com/read/28799442/the-use-of-innervated-radial-artery-superficial-palmar-branch-perforator-free-flap-for-complex-digital-injuries-reconstruction
#12
Zhenglin Chi, Georgios Pafitanis, Luis Eduardo Parra Pont, Roshan Vijayan, Stefano Marcelli, Weiyang Gao, Zan Li, Xiao Zhou, Dajiang Song, Peng Yang
Loco-regional flaps have been widely used for the reconstruction of digital injuries without requiring microvascular anastomosis, however, they result in scarring and compromised functional outcomes. This study demonstrates our experience utilizing the innervated radial artery superficial palmar branch (RASPB) perforator free flap for complex digital injury reconstruction. From May 2007 to March 2014, the innervated RASPB perforator free flap was used to reconstruct 79 distal complex hand and digital soft tissue defects of which 14 were used to re-vascularise the distal digit in a flow-through fashion...
August 11, 2017: Journal of Plastic Surgery and Hand Surgery
https://www.readbyqxmd.com/read/28796101/use-of-the-ipsilateral-anteromedial-thigh-flap-for-immediate-rescue-of-nonviable-anterolateral-thigh-flaps-in-head-and-neck-cancer-reconstruction
#13
Hsu-Tang Cheng, Jin-Yi Tian, Yung-Chang Hsu, Hsin-Han Chen, Sophia Chia-Ning Chang
BACKGROUND: It is not always possible to use the anatomically variable free anterolateral thigh (ALT) flap for reconstructive surgery. An anteromedial thigh (AMT) flap serves as a good alternative, and shares the same vascular pedicle as the ALT flap. METHODS: Of 698 reconstructions performed in 2006 to 2013 following head and neck tumor ablation surgery, ALT flaps were used in 653 patients. Eighteen free AMT flaps were harvested to replace variant nonviable ALT flaps...
August 8, 2017: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/28796099/radiotherapy-and-smoking-history-are-significant-independent-predictors-for-osteosynthesis-associated-late-complications-in-vascular-free-fibula-reconstruction-of-mandible
#14
YiMing Chen, JiaLing Wu, Sandhya Gokavarapu, Qingcheng Shen, Tong Ji
BACKGROUND: The vascular fibula flap is an ideal choice for function and appearance reconstruction of mandible. Despite the high success rate, "late complications" such as Ti plate exposure and local infection related to osteosynthesis are not uncommon. PATIENTS AND METHOD: A retrospective cohort of patients who received vascular fibula reconstruction for mandible from January 2011 to December 2013 from the Department of Oral and Maxillofacial Oncology in a tertiary hospital were charted: clinical, pathological, and therapeutic factors were analyzed for late complications in univariate and multivariate analyses...
August 8, 2017: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/28796082/the-first-reported-case-of-primary-intestinal-type-adenocarcinoma-of-the-middle-ear-and-review-of-the-literature
#15
Marc-Elie Nader, Diana Bell, Lawrence Ginsberg, Franco DeMonte, G Brandon Gunn, Paul W Gidley
OBJECTIVE: Adenocarcinoma of the middle ear is a rare entity that must be distinguished from other adenomatous tumors of the temporal bone. We present the first patient of an intestinal-type adenocarcinoma originating from the middle ear. PATIENTS: A 58-year-old woman presented with an 8-year history of left otorrhea. Her middle ear effusions were quite thick and gummy. She underwent eight sets of pressure-equalization tubes within 3 years. In 2011, her physical examination identified a middle ear mass, and she underwent mastoidectomy...
August 8, 2017: Otology & Neurotology
https://www.readbyqxmd.com/read/28772277/factors-to-consider-when-deciding-on-the-type-of-free-flap-reconstruction-of-head-and-neck-soft-tissue-defects
#16
Mohammed Thabet Aladimi, Bo Han, Chunjie Li, Hussein Helal, Zhenjie Gao, Longjiang Li
OBJECTIVES: The aim of the study was to evaluate the functional and aesthetic outcomes on donor and recipient sites and to determine the effects of technical factors including flap thickness and vessel diameters measured by ultrasonography as well as the size of the defect and postoperative volume reduction of the flaps measured by magnetic resonance imaging (MRI). METHODS: In patients who had undergone soft tissue reconstructive surgery between March 2013 and March 2016 using 55 anterolateral thigh flaps (ALTFs), 30 radial forearm flaps (RFFs), and 18 latissimus dorsi flaps (LDFs), color Doppler ultrasonography was performed to measure the thickness of the flap at the site of the perforator...
August 4, 2017: ORL; Journal for Oto-rhino-laryngology and its related Specialties
https://www.readbyqxmd.com/read/28767568/three-dimensional-virtual-planning-in-precise-chimeric-fibula-free-flap-for-metacarpal-defects-a-case-report
#17
Hui Shen, Xiang-Qian Shen, Ying Lv, Hui Lu, Jing-Hong Xu, Shou-Cheng Wu
RATIONALE: Metacarpal and phalanx defects with soft tissue loss were suggested to be reconstructed by vascularized bone flap. The fibular osteocutaneous flap is a preferred method. Three-dimensional virtual planning has successfully applied in mandibular reconstruction with fibular free flap. We applied three-dimensional virtual planning in precise fibula flap harvest to maintain the continuity of the fibula and to achieve accurate metacarpal and phalanx reconstruction. PATIENT CONCERNS: A 35-year-old male presented with extensive soft tissue defects and first metacarpal defect involving the first metacarpophalangeal joint...
August 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28767176/sequential-chimeric-medial-femoral-condyle-and-anterolateral-thigh-flow-through-flaps-for-one-stage-reconstructions-of-composite-bone-and-soft-tissue-defects-report-of-three-cases
#18
Dominic Henn, Mohamed H Abouarab, Christoph Hirche, Jochen F Hernekamp, Volker J Schmidt, Ulrich Kneser, Thomas Kremer
Small recalcitrant non-unions with poor perfusion require reconstruction with vascularized bone flaps. Cases with concomitant large soft tissue defects are especially challenging, since vascularized soft tissue transfer is often indicated and distant microvascular anastomoses may be required. We introduce a sequential chimeric free flap composed of a medial femoral condyle corticoperiosteal flap anastomosed to an anterolateral thigh flow-through flap (MFC-ALT flap) and report its use for reconstruction of small non-unions with concomitant large soft tissue defects in three exemplary patients...
August 2, 2017: Microsurgery
https://www.readbyqxmd.com/read/28767168/the-possibility-of-free-tissue-transfer-as-a-nutrient-flap-for-critical-ischemic-foot-a-case-report
#19
Kentaro Tanaka, Kimihiro Igari, Mitsuhiro Kishino, Satoshi Usami, Tsutomu Homma, Takahiro Toyofuku, Yoshinori Inoue, Mutsumi Okazaki
Microsurgical procedure of free tissue transfer in critical limb ischemia patients with large ulceration has already been established. The nutrient flap concept was that transferred tissue functioned not only to cover the skin defect but also as a supplementary blood supply to the ischemic lower leg. This report showed the justification for this concept, which was rarely discussed. A 58-year-old male patient with progressive forefoot gangrene caused by arteriosclerosis obliterans was presented. The distal bypass procedure was performed as revascularization surgery, and a latissimus dorsi (LD) myocutaneous flap was transplanted to cover ulceration...
August 2, 2017: Microsurgery
https://www.readbyqxmd.com/read/28765185/a-delayed-presentation-of-ameloblastic-fibrosarcoma-in-an-african-patient
#20
Nkhensani Yvonne Chauke, Chrysis Sofianos, Dimitri Liakos, Elias Ndobe
A 24-year-old womanpresented with ameloblastic fibrosarcoma arising from ameloblastic fibroma. The delayed presentation accounted for the extensive destruction of the mandible and complete occlusion of her oral cavity. This resulted in an inability to eat and maintain oral hygiene. A multidisciplinary team management approach involved nutritional optimisation, segmental mandibulectomy, reconstruction with a reconstructive plate and a free anterolateral thigh flap to line the the floor of mouth. Functional and aesthetic outcome was acceptable, and the patient is planned for secondary free fibular flap bony reconstruction...
August 1, 2017: BMJ Case Reports
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