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Microvascular free tissue transfer

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...
October 4, 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
Altuğ Altınkaya, Şükrü Yazar, İbrahim Sağlam, Kaan Gideroğlu
BACKGROUND: Extensive scalp defects caused by various etiologies often require free-tissue transfer. We aimed to review our experience in the reconstruction of extensive scalp defects with free anterolateral flaps. METHODS: A retrospective analysis was performed on all patients with extensive scalp defects that were reconstructed with free anterolateral thigh flaps from November 2007 to April 2015. Eleven patients with a mean age of 44 years were included in this study...
July 2018: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
Patrik Pipkorn, Kelsey Rosenquist, Joseph Zenga
PURPOSE OF REVIEW: The treatment of oral cavity cancer may impair speech and swallowing function. Optimizing posttreatment function may lead to significant improvement of quality of life. RECENT FINDINGS: Although oncologic control remains the main goal of treatment for oral cavity cancer, posttreatment function for surviving patients has over the last decades been recognized as an important secondary outcome. Reconstruction of oral cavity defects range from primary closure to advanced microvascular reconstruction, including multiple tissue types...
October 2018: Current Opinion in Otolaryngology & Head and Neck Surgery
Silvia Gandolfi, Isabelle Auquit-Auckbur, Yoann Poirot, Albane Bonmarchand, Jordane Mouton, Raphael Carloni, Iad Nseir, Fabrice Duparc
INTRODUCTION: The elbow joint is particularly exposed to soft tissue injuries associated with fractures and dislocations. Different coverage options within the past decades for recovering loss of soft tissue defects around the elbow region have been proposed based on anatomical research. Our aim was to make an updated focus on the anatomical basis of different techniques of coverage of loss of tissues around the elbow. MATERIALS AND METHODS: The main procedures of flaps were defined: local random, axial fasciocutaneous, local muscle pedicle, propeller and free microvascular flaps...
July 10, 2018: Surgical and Radiologic Anatomy: SRA
Lee W T Alkureishi, Chad A Purnell, Patricia Park, Bruce S Bauer, Neil A Fine, Mark Sisco
INTRODUCTION: Whereas free tissue transfer has evolved to minimize morbidity in adults, less is known about outcomes after free flaps in children. This study sought to assess short- and long-term outcomes after microvascular reconstruction in the pediatric population. METHODS: Short- and long-term outcomes of free tissue transfer were assessed using chart-review and quality-of-life surveys. The Pediatric Outcomes Data Collection Instrument was used to evaluate overall health, pain, and ability to participate in normal daily and more vigorous activities...
October 2018: Annals of Plastic Surgery
Alberto Ruiz-Cases, Enrique Salmerón-González, Alberto Pérez-García, Juan R Esteban-Vico, Elena García-Vilariño
No abstract text is available yet for this article.
September 2018: Plastic and Reconstructive Surgery
Summer E Hanson, Patrick B Garvey
No abstract text is available yet for this article.
September 2018: Plastic and Reconstructive Surgery
Amir Inbal, Amanda K Silva, Laura S Humphries, Chad M Teven, Lawrence J Gottlieb
BACKGROUND: Successful free tissue transfer requires tension-free microvascular anastomosis. Vein grafts are used when this cannot be obtained, which increases microsurgical complexity and the chance of vessel thrombosis. Previous studies on vein grafts are limited to low numbers and selected techniques, making it difficult to draw conclusions. METHODS: A retrospective chart review was performed for all patients who underwent vein grafts in free flap reconstruction from 1995 to 2015...
September 2018: Plastic and Reconstructive Surgery
Eric J Formeister, A Sean Alemi, Ivan El-Sayed, Jonathan R George, Patrick Ha, P Daniel Knott, William R Ryan, Rahul Seth, Matthew L Tamplen, Chase M Heaton
PURPOSE: To evaluate how the interval between radiation and salvage surgery for advanced laryngeal cancer with free tissue transfer reconstruction influences complication rates. MATERIALS AND METHODS: This is a retrospective series of 26 patients who underwent salvage laryngectomy or laryngopharyngectomy with vascularized free tissue reconstruction (anterolateral thigh or radial forearm) following radiation or chemoradiation between 2012 and 2017 at a single academic center...
September 2018: American Journal of Otolaryngology
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