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Microvascular free tissue transfer

Kalvis Pastars, Janis Zarins, Juris Tars, Anna Ivanova, Andrejs Skagers
OBJECTIVE: Oral squamous cell carcinoma (OSCC) is a common type of cancer affecting people worldwide, with still large proportion of patients diagnosed with the disease in the advanced stage. Due to free vascularised tissue transfers, radical cancer treatment and immediate reconstruction are feasible as a one-stage procedure. The aim of this paper is to evaluate retrospectively our experience with free flap reconstruction of oral defects for patients with oral malignancies in advanced stages...
2018: Stomatologija
Kavitha Jayaram, Prasad Rao, Indira Gurajala, Gopinath Ramachandran
Objective: Multiple factors influence the success of microvascular free flap surgeries. Anaesthesia is an important factor to maximise the success rate of microvascular free flaps both by controlling haemodynamics and improving the perfusion of free vascularised tissue. The debate on the usefulness of regional and general anaesthesia for free tissue transfer is ongoing. This retrospective study was conducted to evaluate the effects of regional anaesthesia and other perioperative factors on outcomes of microvascular free flaps...
December 2018: Turkish Journal of Anaesthesiology and Reanimation
Madhubari Vathulya, Mohd Salahuddin Ansari
Introduction: The superficial veins of upper limbs are seldom talked about. They are always avoided quoting them to be variable in anatomy. Other than the cephalic and basilic veins, no other superficial vein has caught the eyes of anatomists and other health professionals significantly. This article tries to explain the importance of a superficial vein that closely traces the radial vessels and explains its possible use in microvascular reconstruction. Materials and Methods: The forelimbs of 26 upper limbs of fresh frozen cadavers were dissected out...
May 2018: Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India
Timo Rodi, Alexander Geierlehner, Afshin Mosahebi, Grigorios Tanos, Justin Conrad Rosen Wormald
BACKGROUND: A patent microvascular anastomosis is of paramount importance in free tissue transfer. Anastomotic coupler devices provide an alternative to technically demanding hand-sewn venous anastomosis. Various advantages of these devices have been discussed but previous systematic reviews had methodological flaws or did not perform a meta-analysis. This review aims to evaluate the quality of the evidence and quantify the efficacy and safety of venous couplers compared to hand-sewn anastomosis...
November 13, 2018: Systematic Reviews
J L McCarty, A S Corey, M W El-Deiry, H M Baddour, B M Cavazuti, P A Hudgins
Head and neck surgical reconstruction is complex, and postoperative imaging interpretation is challenging. Surgeons now use microvascular free tissue transfer, also known as free flaps, more frequently in head and neck reconstruction than ever before. Thus, an understanding of free flaps, their expected appearance on cross-sectional imaging, and their associated complications (including tumor recurrence) is crucial for the interpreting radiologist. Despite the complexity and increasing frequency of free flap reconstruction, there is no comprehensive head and neck resource intended for the radiologist...
November 8, 2018: AJNR. American Journal of Neuroradiology
Sanghoon Lee, Hye-Min Cho, Jin-Kyu Kim, Woong Nam
Background: Some of head and neck cancer patients are in compromised general condition after ablation surgery and chemoradiation therapy, which makes secondary free tissue transfer quite challenging. Elderly cancer patients also have some risk for microvascular surgery with lengthened general anesthesia. In those cases, the pedicled flap vascularized by supraclavicular artery could be considered as an alternative to free flap. Despite several authors have demonstrated the clinical reliability of supraclavicular artery island flap (SCAIF), to date, SCAIF has not been widely used among reconstructive surgeon...
December 2018: Maxillofacial Plastic and Reconstructive Surgery
Michael V DeFazio, James M Economides, Ersilia L Anghel, Eshetu A Tefera, Karen K Evans
AIM:  No consensus exists regarding the optimal strategy for perioperative thromboprophylaxis in high-risk microsurgical populations. We present our experience with lower extremity free tissue transfer (FTT) in thrombophilic patients and compare outcomes between non-stratified and risk-stratified anticoagulation protocols. METHODS:  Between January 2013 and December 2017, 57 patients with documented thrombophilia underwent FTT for non-traumatic, lower extremity reconstruction by a single surgeon...
October 16, 2018: Journal of Reconstructive Microsurgery
Alain Joe Azzi, Sarah Zhou, Tyler Safran, Liqin Xu, Nayif Alnaif, Teanoosh Zadeh
INTRODUCTION: Radiation therapy (RT) is recommended for appropriately selected sarcoma patients to minimize the risk of local recurrence and to maximize outcomes of disease-free survival and function. The purpose of this study was to confirm the safety of vascularized tissue reconstruction in recently irradiated sarcoma defects. METHODS: A retrospective review of all patients treated by the senior author for sarcoma reconstruction from January 2005 to July 2017 was performed...
January 2019: Annals of Plastic Surgery
D Zweifel, M G Bredell, H Essig, T Gander, M Lanzer, C Rostetter, M Rücker, S Studer
The Surgical reconstruction of defects of the face is challenging. Local and regional flaps have an important part to play, but large defects of bone and soft tissue are a greater problem. Microvascular tissue transfer has become the standard for such patients, and preoperative planning of bony reconstructions is now common. To use these preplanning tools best the implants should be placed in the prosthetically ideal place, and the bone positioned to surround the implants - that is, truly backward planning of the position of the bone...
November 2018: British Journal of Oral & Maxillofacial Surgery
Frederik W Fried, Justus P Beier, Christopher Bohr, Heinrich Iro, Raymund E Horch, Andreas Arkudas
Although free flap reconstruction has already gained widespread acceptance in pediatric patients, little is known about the outcome of free tissue transfer in head and neck reconstruction in pediatric patients. We present a case of a 6-month-old boy with a large volume deficit in the right temporal fossa after resection of a teratoma. This led to a large volume deficit with widely undermined skin margins. Therefore, we provided volume augmentation by microsurgical free latissimus dorsi myocutaneous flap transplantation...
October 2, 2018: Annals of Plastic Surgery
Mofiyinfolu Sokoya, Aurora G Vincent, Rohan Joshi, Sameep Kadakia, Scott Kohlert, Thomas S Lee, Masoud Saman, Yadranko Ducic
OBJECTIVES/HYPOTHESIS: Microvascular free tissue transfer is often employed to reconstruct significant facial defects from ballistic injuries. Herein, we present our comparison of complications between self-inflicted and non-self-inflicted gunshot wounds after microvascular free tissue transfer. STUDY DESIGN: Retrospective case review. METHODS: Approval was obtained from the JPS institutional review board. We performed a retrospective review of cases of ballistic facial injuries between October 1997 and September 2017 that underwent vascularized free tissue transfer for reconstruction...
September 24, 2018: Laryngoscope
Fares Samra, Christopher Bibbo, L Scott Levin, Stephen J Kovach
Introduction: The anterolateral thigh (ALT) flap allows for healthy, reliable, vascularized, soft-tissue coverage of extremity or axial defects of traumatic or acquired deformities. Indications & Contraindications: <AbstractText Label="Step 1 Positioning and Markings" NlmCategory="UNASSIGNED">Place the patient in the supine position, which allows for flap harvest and typically does not require any position changes (Fig. 1), and then mark the septum between the vastus lateralis and rectus femoris, which facilitates harvest of this flap (Video 1)...
September 28, 2017: JBJS Essential Surgical Techniques
Dmitry Zavlin, Vishwanath Chegireddy, Kevin T Jubbal, Nikhil A Agrawal, Aldona J Spiegel
BACKGROUND:  Maintaining optimal coagulation is vital for successful microvascular tissue transfer. The viscoelastic thromboelastography (TEG) is a modern and dynamic method to assess a patient's coagulation status. The aim of this study was to evaluate its diagnostic capabilities of identifying microvascular complications. METHODS:  A retrospective chart review was conducted for the most recent 100 cases of abdominal free flap breast reconstruction of a single surgeon...
September 19, 2018: Journal of Reconstructive Microsurgery
Eric I Chang, Carrie K Chu, Edward I Chang
The use of preoperative imaging has become routine for many reconstructive microsurgeons to help localize perforators for planning of microvascular free flaps. However, with advancements in imaging technology, perforator mapping represents only one potential benefit as virtual planning and medical modeling, and flap tissue perfusion are also rapidly becoming commonplace and the standard of care for many surgeons who perform high-volume free flap reconstruction for the breast, head and neck, torso, and the extremities...
October 2018: Journal of Surgical Oncology
Kevin J Kovatch, John E Hanks, Jayne R Stevens, Chaz L Stucken
OBJECTIVES/HYPOTHESIS: Despite major advances in the field of head and neck microvascular free tissue transfer (MFTT) over the past several decades, there are no standardized perioperative regimens for the care of patients undergoing free flap reconstructive surgery, and continued variation in practice exists. This study aimed to report current trends in the field of MFTT performed by otolaryngologists, including surgeon training, institutional operative practices, and perioperative management...
September 8, 2018: Laryngoscope
Jocelyn Lu, Michael V DeFazio, Chrisovalantis Lakhiani, Michel Abboud, Morgan Penzler, Tammer Elmarsafi, Paul J Kim, Christopher E Attinger, Karen K Evans
BACKGROUND:  Recent evidence documenting high success rates following microvascular diabetic foot reconstruction has led to a paradigm shift in favor of more aggressive limb preservation. The primary aim of this study was to examine reconstructive and functional outcomes in patients who underwent free tissue transfer (FTT) for recalcitrant diabetic foot ulcers (DFUs) at our tertiary referral center for advanced limb salvage. METHODS:  Between June 2013 and June 2016, 29 patients underwent lower extremity FTT for diabetic foot reconstruction by the senior author (K...
August 12, 2018: Journal of Reconstructive Microsurgery
Mark K Wax, James Azzi
Given the high stakes for microvascular reconstruction, the majority of reconstructive surgeons have developed paradigms for pre, intra, and postoperative management that have proven to result in individual high success rates. Much has been done to identify and avoid perioperative factors that could potentially increase flap failure rates. Two example of this practice has been the generalized use of anticoagulation in free tissue transfer and the prohibition against vasopressor use in patients that are undergoing free tissue transfer...
August 2018: Oral Oncology
T Mücke, C Wolff, A M Fichter, M von Düring, A Kanatas, L M Ritschl
Atherosclerosis is a systemic condition that is responsible for many diseases, and becomes a problem in cases where plaques form at several sites. The formation of a thrombotic embolus may jeopardise vascular operations, including microvascular anastomoses in replantation procedures or free tissue transfers. A mobile imaging tool for the detection of thrombosis preoperatively or intraoperatively would be valuable. An intimal injury, simulating removal of atherosclerotic plaques, was made microsurgically in 60 rat aortas, and results were analysed macroscopically, histologically, and with intraoperative indocyanine green (ICG) videoangiography immediately postoperatively...
October 2018: British Journal of Oral & Maxillofacial Surgery
Miguel de la Parra Marquez, Ricardo Fernandez-Riera
Currently, deep inferior epigastric perforator flap is undoubtedly the first choice for autologous breast reconstruction for most surgeons; however, there are instances where lower abdominal tissue is unavailable for microvascular transfer. In these cases, most surgeons choose gluteal or lower-extremity territories as donor sites.In the setting of morbid obesity, there is an increased risk of flap and donor site complications, as well as increased blood loss, surgical time, and risk of deep venous thrombosis, not to mention a more challenging surgical technique...
July 31, 2018: Annals of Plastic Surgery
Elliot Morse, Cara Henderson, Tracy Carafeno, Jacqueline Dibble, Peter Longley, Edwin Chan, Benjamin Judson, Wendell G Yarbrough, Clarence Sasaki, Saral Mehra
Objective To design and implement a postoperative clinical care pathway designed to reduce intensive care usage on length of stay, readmission rates, and surgical complications in head and neck free flap patients. Methods A postoperative clinical care pathway detailing timelines for patient care was developed by a multispecialty team. In total, 108 matched patients receiving free tissue transfer for reconstruction of head and neck defects in the year before (prepathway), year after (early pathway), and second year after (late pathway) pathway implementation were compared based on postoperative length of stay, 30-day readmission rate, intensive care unit (ICU) admission, and rates of medical/surgical complications...
July 31, 2018: Otolaryngology—Head and Neck Surgery
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