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Microvascular anastomosis

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https://www.readbyqxmd.com/read/28280670/a-comprehensive-approach-to-lower-extremity-free-tissue-transfer
#1
Lee L Q Pu
BACKGROUND: The purpose of this study was to introduce a comprehensive approach to lower extremity free-tissue transfer and report the clinical outcome that has been achieved with this approach. METHODS: The comprehensive approach developed by the author includes patient selection, flap selection, selection of the recipient vessels, flap dissection, flap preparation, microvascular anastomosis, flap inset, immediate postoperative care, intermediate postoperative care, and further follow-up care...
February 2017: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/28280662/avoiding-facial-incisions-with-midface-free-tissue-transfer
#2
Mark W Stalder, Michael Sosin, Leo J Urbinelli, James L Mayo, Amir H Dorafshar, Hugo St Hilaire, Daniel E Borsuk, Eduardo D Rodriguez
BACKGROUND: We have adopted an intraoral microsurgical anastomosis to the facial vessels to eliminate the need for any visible facial incisions. METHODS: Cadaveric dissection was used to demonstrate accessibility of the facial artery and vein through an intraoral approach. Additionally, 5 patients underwent free tissue transfer for reconstruction of major defects of the midface through an intraoral, transmucosal approach, obviating the need for visible skin incisions...
February 2017: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/28259642/determining-the-best-recipient-vessel-site-for-autologous-microsurgical-breast-reconstruction-with-diep-flaps-an-anatomical-study
#3
Martin Lhuaire, Mikael Hivelin, Moustapha Dramé, Peter Abrahams, Reza Kianmanesh, Christian Fontaine, Laurent Lantieri
INTRODUCTION: The deep inferior epigastric perforator (DIEP) flap is a reliable and reproducible technique for autologous microsurgical breast reconstruction. Several recipient vessels sites for microvascular anastomosis have been described such as the internal thoracic vessels, the thoracodorsal vessels, and the circumflex scapular vessels. Nonetheless, the choice of the recipient site depends mainly on individual operator's experience and preferences, and currently the best recipient vessel site is under debate...
February 13, 2017: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/28259112/end-to-end-versus-end-to-side-microvascular-anastomosis-a-meta-analysis-of-free-flap-outcomes
#4
Iraj Ahmadi, Pradyumna Herle, George Miller, David J Hunter-Smith, James Leong, Warren Matthew Rozen
Background Optimal outcomes in microsurgery have been attributed to a range of factors, with performing of end-to-end (ETE) versus end-to-side (ETS) influencing anastomotic complications and flap outcomes. Methods A systematic review of the literature and meta-analysis was undertaken to evaluate the relative risks of anastomotic complications with ETE versus ETS approaches, for arterial and venous anastomoses looking at risk ratios (RRs) for thrombosis and overall flap failure. Results RRs of thrombosis and flap failure in ETS versus ETE venous anastomosis groups were 1...
March 4, 2017: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/28236793/complications-and-cost-analysis-of-intraoperative-arterial-complications-in-head-and-neck-free-flap-reconstruction
#5
Catherine S Chang, Michael W Chu, Jonas A Nelson, Marten Basta, Patrick Gerety, Suhail K Kanchwala, Liza C Wu
Background Microvascular anastomotic patency is fundamental to head and neck free flap reconstructive success. The aims of this study were to identify factors associated with intraoperative arterial anastomotic issues and analyze the impact on subsequent complications and cost in head and neck reconstruction. Methods A retrospective review was performed on all head and neck free flap reconstructions from 2005 to 2013. Patients with intraoperative, arterial anastomotic difficulties were compared with patients without...
February 25, 2017: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/28231374/mechanical-venous-anastomosis-in-head-and-neck-microvascular-reconstruction-as-an-equivalent-to-the-gold-standard
#6
Eric Thorpe, Yash Patil
To define the most successful and efficient manner to perform venous microvascular anastomoses, the effectiveness of mechanical venous anastomosis in head and neck microvascular reconstruction is reviewed. Head and neck reconstruction with free flap techniques has become the norm and gold standard for large defects. This retrospective, multicenter case series of a single microvascular surgeon's experience with mechanical venous anastomoses specifically assessed the effectiveness of head and neck reconstruction and the complications associated with it...
February 2017: Ear, Nose, & Throat Journal
https://www.readbyqxmd.com/read/28230584/microsurgical-replantation-of-total-avulsed-scalp-extending-the-limits
#7
Yunbo Jin, Chen Hua, Xiaojie Hu, Hui Chen, Gang Ma, Yun Zou, Bin Chen, Dongze Lyu, Mathias Tremp, Xiaoxi Lin
BACKGROUND: Avulsion of the scalp is a rare but severe trauma and challenging to the reconstructive surgeon. It poses not only physical concussion but also significant persisting psychological distress to the patients. METHODS: Medical records from 5 patients who suffered scalp avulsion were reviewed retrospectively. The following data and methods were assessed: age, number of vessels repaired, method of replantation, vein grafts required, blood transfusion, ischemia time, total operating time, and percentage of scalp survival...
February 22, 2017: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/28194342/comprehensive-analysis-of-chicken-vessels-as-microvascular-anastomosis-training-model
#8
Bo Young Kang, Byung-Joon Jeon, Kyeong-Tae Lee, Goo-Hyun Mun
BACKGROUND: Nonliving chickens are commonly used as a microvascular anastomosis training model. However, previous studies have investigated only a few types of vessel, and no study has compared the characteristics of the various vessels. The present study evaluated the anatomic characteristics of various chicken vessels as a training model. METHODS: Eight vessels-the brachial artery, basilic vein, radial artery, ulnar artery, ischiatic artery and vein, cranial tibial artery, and common dorsal metatarsal artery-were evaluated in 26 fresh chickens and 30 chicken feet for external diameter (ED) and thicknesses of the tunica adventitia and media...
January 2017: Archives of Plastic Surgery
https://www.readbyqxmd.com/read/28151027/end-to-end-versus-end-to-side-anastomoses-in-free-flap-reconstruction-single-centre-experiences
#9
Paul I Heidekrueger, Milomir Ninkovic, Albrecht Heine-Geldern, Frank Herter, P Niclas Broer
BACKGROUND: The choice of microsurgical anastomotic technique, end-to-end (ETE) or end-to-side (ETS), is a relevant point in free tissue transfer. The decision-making process of choosing ETE or ETS technique depends on several clinical and perioperative factors. This study evaluates the outcomes of microvascular procedures in a large single centre patient series, focusing on ETE vs ETS arterial anastomoses. MATERIALS AND METHODS: Between January 2009 and June 2015, 838 patients underwent free flap surgery for reconstruction after trauma, infection, or malignancies...
February 2, 2017: Journal of Plastic Surgery and Hand Surgery
https://www.readbyqxmd.com/read/28112411/medial-sural-artery-as-a-salvage-recipient-vessel-for-complex-post-traumatic-microvascular-lower-limb-reconstruction
#10
Amresh Baliarsing, Shivprasad Date, Pedro Ciudad
BACKGROUND: Complex lower extremity trauma still poses a formidable challenge for micro vascular reconstruction. The extensive surrounding zone of trauma can make it difficult to find a suitable recipient pedicle for anastomosis. A need was felt for exploration of newer recipient vessels in lower extremity which could be harnessed for reliable and tension free micro anastomosis. The purpose of the present report is to highlight the possibility of using medial sural artery for safe micro vascular anastomosis in selected scenarios like vessel depleted extremity...
January 23, 2017: Microsurgery
https://www.readbyqxmd.com/read/28089863/prevention-of-thrombosis-in-hypercoagulable-patients-undergoing-microsurgery-a-novel-anticoagulation-protocol
#11
Jonas A Nelson, Cyndi U Chung, Andrew R Bauder, Liza C Wu
BACKGROUND: Hypercoagulable conditions are often considered relative contraindications to free flap reconstruction. This paper presents and critically examines a novel anticoagulation regimen developed to address this disease state. METHODS: Hypercoagulable patients who underwent free tissue transfer between 2007 and 2015 were identified. From 2011, all such patients were subjected to a novel anticoagulation protocol involving an intravenous bolus of 2000 U of unfractionated heparin prior to microvascular pedicle anastomosis, followed by a heparin infusion at 500 U/h, which was postoperatively increased to therapeutic levels...
December 18, 2016: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/28089170/iliolumbar-artery-a-useful-pedicle-for-the-iliac-crest-free-flap-in-maxillofacial-reconstruction
#12
T Singh, K Andi
The iliac crest free flap is commonly used in maxillofacial reconstruction, and is typically supplied by the deep circumflex iliac artery (DCIA). However, the iliolumbar artery is an alternative blood supply that can potentially be used in such reconstructions. We describe the anatomy of the iliolumbar artery and review publications about its clinical use. We raised four cadaveric iliac crest free flaps using both the DCIA and the iliolumbar artery to illustrate its use in reconstructing maxillofacial defects...
January 11, 2017: British Journal of Oral & Maxillofacial Surgery
https://www.readbyqxmd.com/read/28062176/characteristics-and-surgical-management-of-flap-compromise-caused-by-thrombosis-of-the-internal-jugular-vein
#13
Bin Yang, Yi Qu, Ming Su, Jinzhong Li, Hua Li, Rudong Xing, Zhengxue Han
BACKGROUND: A principal reason for flap compromise in oral and maxillofacial head and neck surgery, and failure of a free flap transfer, is thrombosis of a drainage vein such as the internal jugular vein. This study characterized flap compromise caused by internal jugular vein thrombosis after a free flap transfer, and its management. PATIENTS AND METHODS: A retrospective clinical study was conducted of 306 consecutive microvascular free flaps performed for 305 patients with head and neck cancer from March 2003 to March 2013 at the Department of Oral and Maxillofacial Surgery at Beijing Stomatological Hospital, Capital Medical University...
December 18, 2016: Journal of Cranio-maxillo-facial Surgery
https://www.readbyqxmd.com/read/28059901/conservative-surgery-for-laryngeal-chondrosarcoma-a-review-of-the-most-recently-proposed-approaches
#14
Cesare Piazza, Alberto Paderno, Piero Nicolai
PURPOSE OF REVIEW: The aim of this study was to describe the most recent technical nuances for resection and reconstruction of Grade 1 and 2 laryngeal chondrosarcomas, with a special emphasis on those located at the level of the cricoid plate, which is the site of origin of the vast majority of these rare tumours. RECENT FINDINGS: Even though inherently based on retrospective small clinical series or anecdotal case reports, a number of studies have been recently published focusing on conservative transoral and open-neck surgical procedures aimed at an oncologically sound removal of the tumour together with organ and function preservation...
January 3, 2017: Current Opinion in Otolaryngology & Head and Neck Surgery
https://www.readbyqxmd.com/read/28039007/pedicle-orientation-in-free-flap-microvascular-maxillofacial-reconstruction
#15
Daniel M Cummins, Beomjune Kim, Arshad Kaleem, Waleed Zaid
Oncologic and traumatic defects of the maxilla can pose a challenge to patients, reconstructive surgeons, and maxillofacial prosthodontists in an attempt to provide satisfactory treatment. Oral-nasal and oral-antral fistulas are frequently treated with soft tissue flaps, osteocutaneous flaps, or a maxillofacial obturator. Often, surgical reconstruction is preferred for patient quality of life and definitive restoration. Surgical reconstruction also avoids the difficulties encountered with fabricating an obturator in an irradiated field with the often-resultant microstomia...
December 10, 2016: Journal of Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/27995558/is-there-benefit-to-free-over-pedicled-vascularized-grafts-in-augmenting-tibial-intercalary-allograft-constructs
#16
Marco Manfrini, Srimanth Bindiganavile, Ferhat Say, Marco Colangeli, Laura Campanacci, Massimiliano Depaolis, Massimo Ceruso, Davide Donati
BACKGROUND: Intercalary reconstruction of tibial sarcomas with vascularized fibula autografts and massive bone allografts is reliable with predictable long-term results. However, inadequate data exist comparing free and pedicled vascularized fibula autografts in combination with a massive bone allograft in patients undergoing intercalary tibia reconstructions. QUESTIONS/PURPOSES: Among patients undergoing large-segment intercalary allografting, we sought to compare supplemental free vascularized fibular autografts with supplemental pedicled vascularized fibular autografts, in terms of (1) oncologic results, (2) complications associated with surgery, (3) Musculoskeletal Tumor Society (MSTS) scores, and (4) surgical time...
December 19, 2016: Clinical Orthopaedics and related Research
https://www.readbyqxmd.com/read/27975009/effect-of-previous-irradiation-on-vascular-thrombosis-of-microsurgical-anastomosis-a-preclinical-study-in-rats
#17
Sergi Barrera-Ochoa, Irene Gallardo-Calero, Alba López-Fernández, Cleofe Romagosa, Ramona Vergés, Marius Aguirre-Canyadell, Francisco Soldado, Roberto Velez
BACKGROUND: The objective of the present investigation was to compare the effect of neoadjuvant irradiation on the microvascular anastomosis in cervical bundle using an experimental model in rats. METHODS: One hundred forty male Sprague-Dawley rats were allocated into 4 groups: group I, control, arterial microanastomosis; group II, control, venous microanastomosis; group III, arterial microanastomosis with previous irradiation (20 Gy); and group IV, venous microanastomosis with previous irradiation (20 Gy)...
November 2016: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/27939908/sutureless-microvascular-anastomosis-with-the-aid-of-heparin-loaded-poloxamer-407
#18
Fırat Özer, Mustafa Nişancı, Çetin Taş, Jayakumar Rajadas, Doğan Alhan, Yalçın Bozkurt, Armağan Günal, Serdar Demirtaş, Selçuk Işık
BACKGROUND: Anastomosis with tissue adhesives is an alternative method for conventional anastomosis. However, this method has several technical challenges. It requires the use of suture to prevent leakage into lumen and precise application onto all surfaces of the anastomosis site. To solve these problems, poloxamer 407 (P 407) was previously used as a stent. In this study, we made heparinized P 407 (h-P 407) as a new formula. We aimed to successfully use h-P 407 as a stent in sutureless anastomosis in a rat abdominal aorta model...
February 2017: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/27930679/reconstruction-of-the-foot-and-ankle-using-pedicled-or-free-flaps-perioperative-flap-survival-analysis
#19
Xiucun Li, Jianli Cui, Suraj Maharjan, Laijin Lu, Xu Gong
OBJECTIVE: The purpose of this study is to determine the correlation between non-technical risk factors and the perioperative flap survival rate and to evaluate the choice of skin flap for the reconstruction of foot and ankle. METHODS: This was a clinical retrospective study. Nine variables were identified. The Kaplan-Meier method coupled with a log-rank test and a Cox regression model was used to predict the risk factors that influence the perioperative flap survival rate...
2016: PloS One
https://www.readbyqxmd.com/read/27929602/facial-reanimation-according-to-the-postresection-defect-during-lateral-skull-base-surgery
#20
John P Leonetti, Sahar Nadimi, Sam J Marzo, Douglas Anderson, Darl Vandevender
The vast majority of benign tumors of the cerebellopontine angle, temporal bone, and parotid gland can be successfully resected without permanent injury to the facial nerve. Malignant tumors or recurrent disease may require facial nerve sacrifice, especially if preoperative facial paresis is present. This article will present case examples of the various methods to reconstruct facial animation after lateral skull base resections that require sacrifice of cranial nerve VII, and the associated mimetic facial musculature...
December 2016: Ear, Nose, & Throat Journal
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