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Free flaps

Cécile Philandrianos, Jean-Camille Mattei, Alexandre Rochwerger, Baptiste Bertrand, Charlotte Jaloux, Dominique Casanova
BACKGROUND: Infection is a common complication of major lower limb-sparing surgery with massive total knee prosthesis (MTKP) reconstruction after extensive tumour resection. When free tissue transfer is required to cover the prosthesis, musculo-cutaneous flaps are usually preferred based on proven efficacy when used in both one-stage and two-stage procedures. The use of a free fascio-cutaneous antero-lateral thigh (FC-ALT) flap in 3 patients with infected knee reconstructions is reported here...
June 18, 2018: Orthopaedics & Traumatology, Surgery & Research: OTSR
Manuel Robustillo, Luis Parra Pont, Georgios Pafitanis, Pedro Ciudad, Daniel Grandes, Israel Iglesias
DIEP flap has become the gold standard method for patients undergoing autologous breast reconstruction; however, previous surgery or scars in the abdominal area have been considered a relative contraindication for the use of abdominal tissue. Longitudinal midline abdominal scars may be specially problematic because of the poor midline crossover of blood and the high risk of necrosis of the distal flap. Patients with small breast may be easily reconstructed with hemi-DIEP flap; however, patients with large breast need more tissue available...
January 2018: Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India
Jammula S Srinivas, Prakash Panagatla, Mukunda Reddy Damalacheru
Introduction: Reconstruction of complex abdominal wall defects is both challenging and technically demanding for plastic surgeon. Objectives in abdominal wall reconstruction are consistent and include restoration of abdominal wall integrity, protection of intra abdominal viscera and prevention of herniation. Materials: We conducted a retrospective study on five patients in whom lateral thigh flaps such as anterolateral thigh (ALT) flaps and tensor fascia lata (TFL) myocutaneous flaps as pedicled or free flaps were used for complex abdominal wall Type II defects over a 5- years period between 2007 and 2012...
January 2018: Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India
Ravi Kumar Mahajan, Krishnan Srinivasan, Abhiskek Bhamre, Mahipal Singh, Prakash Kumar, Ankush Tambotra
Background: Many flaps have been described for reconstruction of lower extremity defects, including, Latissimus Dorsi, Rectus abdominis, Anterolateral thigh perforator flaps, each having advantages and disadvantages. The defect location, size and specific geometric pattern of defect influences the type of flap that can be used. In this case series, we describe the specific situations where the use of chimeric latissimus dorsi-serratus anterior (LD + SA) free flaps are of advantage in providing complete wound cover...
January 2018: Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India
Mosaad Abdel-Aziz, Mohamed Fawaz, Mohamed Kamel, Ahmed Kamel, Talal Aljeraisi
Oroantral fistula (OAF) is a pathologic communication between the oral cavity and the maxillary sinus. It is usually associated with maxillary sinusitis, where drainage of sinus infection is a mandatory step during closure of the fistula. The flap used for closure of OAF should be tension free, broadly based and well vascularized. The aim of this study was to assess the effectiveness of closure of OAF using buccal fat pad (BFP) flap with concomitant endoscopic middle meatal antrostomy for maxillary sinus drainage...
June 20, 2018: Journal of Craniofacial Surgery
Katelyn G Bennett, Ji Qi, Hyungjin M Kim, Jennifer B Hamill, Andrea L Pusic, Edwin G Wilkins
Importance: In breast reconstruction, it is critical for patients and surgeons to have comprehensive information on the relative risks of the available options. However, previous studies that evaluated complications were limited by single-center designs, inadequate follow-up, and confounding. Objective: To assess 2-year complication rates across common techniques for postmastectomy reconstruction in a multicenter patient population. Design, Setting, and Participants: This longitudinal, multicenter, prospective cohort study conducted from February 1, 2012, through July 31, 2015, took place at the 11 study sites associated with the Mastectomy Reconstruction Outcomes Consortium study...
June 20, 2018: JAMA Surgery
Jiqiang He, Ding Pan, Panfeng Wu, Juyu Tang
A 37-year-old man complained of a refractory posterior malleolar ulceration on his left ankle. He was diagnosed with Werner syndrome according to the progeroid clinical features and genetic testing. To approach the ulceration, a free flow-through right anterolateral thigh perforator flap with anterolateral thigh cutaneous nerve was harvested. One year later, he was readmitted due to a new ulceration on his right ankle. We harvested the left anterolateral thigh perforator flap with anterolateral thigh cutaneous nerve to reconstruct the defect...
June 2018: Anais Brasileiros de Dermatologia
Guangxue Li, Lan Mu, Ye Bi, Kai Yang, Yan Liu, Zhe Peng, Yi Zhu, Huiran Zang, Saisai Cao, Peiyang Zhang, Youlei Qian
INTRODUCTION: The Pacman flap is a novel modality for repairing round soft-tissue defects after tumor resection. This modality provides a robust blood supply without microsurgical tissue rearrangement. This article reviews the authors' experience with Pacman flap for reconstruction of round soft-tissue defects. The safety and effectiveness of the Pacman flap are investigated. METHODS: Here, we describe a method for oncologic reconstruction of round soft-tissue defects with a Pacman flap after tumor resection...
June 2018: Medicine (Baltimore)
Philipp Schoenle, Emre Gazyakan, Thomas Kremer, Leila Harhaus, Ulrich Kneser, Christoph Hirche
Traumatic soft tissue and bone defects are demanding challenges for the reconstructive microsurgeons. Common and safe workhorses for these reconstructions are free microvascular flaps based on the subscapular system. In this article, we want to demonstrate the versatility of the serratus anterior muscle combined with other components of the subscapular system for reconstruction of complex lower extremity defects. Three patients with traumatic soft tissue and bone defects of the lower extremity were planned for reconstruction...
May 2018: Plastic and Reconstructive Surgery. Global Open
Haitham H Khalil, Maninder Kalkat, Marco N Malahias, Saif Rhobaye, Tarek Ashour, Madava G Djearaman, Babu Naidu
Background: Tenets of chest wall reconstruction for malignancy are well known; however, the insertion of synthetic prosthetic material to achieve rigid and nonrigid skeletal reconstruction could be associated with more complications including infection and extrusion especially in high risk patients. This includes fungating, infected tumors, previous radiotherapy, scars, smoking, diabetes, and morbid obesity. Bioprosthesis Acelluar Dermal Matrix Strattice would be a substitute to resist infection and provide stable coverage...
May 2018: Plastic and Reconstructive Surgery. Global Open
Mario F Scaglioni, Andrè A Barth, Yen-Chou Chen
INTRODUCTION: The primary closure of the vertical posteromedial thigh (vPMT) free flap donor site is very important to minimize donor site morbidity and maximize cosmetic appearance. However, sometimes due to the dimension of the defect, a vPMT flap is wider than the 8-10 cm requirement. The authors report their experience with the third perforator of the profunda femoris artery (PFA) during the vPMT free flap donor-site closure. PATIENTS AND METHODS: Between January 2016 and December 2017, 5 patients underwent reconstruction of lower extremity (2 pts...
June 19, 2018: Microsurgery
Vinay V Kumar, Murali Srinivasan
OBJECTIVES: The aim of this split-mouth study was to evaluate the masticatory efficiency in patients with segmentally reconstructed mandibles using free fibula flaps, with and without stabilizing osteosynthesis material in-situ during implant placement for rehabilitation with implant-supported removable partial dental prostheses (ISRPDPs). METHODS: Ten participants (n = 10; ♀ = 2, ♂ = 8; mean age = 38.1 years) consented to participate in this study...
June 19, 2018: Clinical Oral Implants Research
Robert C Rennert, Kristine Ravina, Ben A Strickland, Joshua Bakhsheshian, Joseph Carey, Jonathan J Russin
BACKGROUND: Surgical innovation is critical for the management of challenging cerebrovascular pathology. Flow-through free flaps are versatile composite grafts that combine viable tissue with a revascularization source. Neurosurgical experience with these flaps is limited. OBJECTIVE: To provide an in-depth technical description of the radial artery fascial (and fasciocutaneous) flow-through free flap (RAFF and RAFCF, respectively) for complex cerebral revascularizations...
June 16, 2018: Operative Neurosurgery (Hagerstown, Md.)
Elodie Gautier-Veyret, Magnus Bäck, Claire Arnaud, Elise Belaïdi, Renaud Tamisier, Patrick Lévy, Nathalie Arnol, Marion Perrin, Jean-Louis Pépin, Françoise Stanke-Labesque
AIMS: Obstructive sleep apnea (OSA) characterized by nocturnal intermittent hypoxia (IH) is associated with atherosclerosis and cysteinyl-leukotrienes (CysLT) pathway activation. We aimed to identify the determinants of CysLT pathway activation and the role of CysLT in OSA-related atherosclerosis. METHODS AND RESULTS: Determinants of the urinary excretion of LTE4 (U-LTE4 ) including history of cardiovascular events, polysomnographic and biological parameters were studied in a cohort of 170 OSA patients and 29 controls, and in a subgroup of OSA patients free of cardiovascular event (n = 136)...
June 16, 2018: Pharmacological Research: the Official Journal of the Italian Pharmacological Society
Loreto Castellon, Daniel Jerez, Jaime Mayorga, Alejandra Gallego, Carlos Fuenzalida, German Laissle
: Mandibular reconstruction in pediatric patients is controversial. The scant pediatric experience and the infrequent occurrence of this type of pathology in children complicate therapeutic decisions. The literature contains different treatment protocols and describes the bone graft alternatives to be used. MATERIALS AND METHOD: This is a retrospective review of patients under the age of 15 who were subjected to resection and reconstruction. RESULTS: A total of 18 patients were included in the study: 8 women and 10 men...
June 18, 2018: Journal of Craniofacial Surgery
Arvind Krishnamurthy
The main goals of reconstruction of nasal defects are to restore the topographic subunit outline, thereby maintaining the aesthetic three-dimensional facial contours and more importantly ensuring a patent airway. Wide excision of tumours of the external nose can at times result in complex defects causing significant facial disfigurement and this poses a significant reconstructive challenge. Nasal reconstruction with only micro-vascular free flaps can at times produce poor aesthetic outcomes as distant skin often appears as a mismatched patch within the surrounding normal facial skin...
April 2018: Indian Journal of Surgery
Amitabh Thacoor, Muholan Kanapathy, Jana Torres-Grau, Jagdeep Chana
BACKGROUND: The deep inferior epigastric perforator (DIEP) flap is widely regarded as the Gold Standard in autologous breast reconstruction. Although drain-free abdominoplasty is performed in many centres, there is a paucity of evidence comparing outcomes when applied to DIEP breast reconstruction. METHOD: A retrospective review of patients who underwent DIEP breast reconstruction without abdominal drain insertion at Royal Free Hospital between Jan 2012-Nov 2016 was undertaken...
May 22, 2018: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Stephen Y Kang, Antoine Eskander, Krupal Patel, Theodoros N Teknos, Matthew O Old
While the lateral arm free flap has been well described, there is a relative paucity in its use compared to other free flaps and regional flaps. The lateral arm free flap is a unique soft tissue free flap that provides several reconstructive advantages in head and neck reconstruction: excellent contour and color match to facial skin, well compartmentalized fat, donor nerves for nerve grafting, and the ability to two-team harvest and close the donor site without a skin graft. A detailed anatomic and harvest technique is described, along with indications and advantages of using lateral free flap for head and neck reconstruction...
July 2018: Oral Oncology
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...
June 6, 2018: American Journal of Otolaryngology
Lawrence J Gottlieb
The radial forearm free flap phalloplasty provides a thin, potentially sensate, minimally hair-bearing cutaneous flap. Since its initial description, several modifications of the technique have emerged. The earliest dimensions described needed to be increased because of the increase amount of subcutaneous fat in the Western population. Incorporating a centrally placed neo-urethra with a distal extension that gets folded over to create a semblance of a neoglans eliminates the distal/meatal stenosis. Performing a urethral extension at a preliminary surgery and extending the neourethra proximally has improved the position of the neophallus and minimized proximal urethral strictures and fistulas in transgender men...
July 2018: Clinics in Plastic Surgery
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