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microvascular free flap

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https://www.readbyqxmd.com/read/28438396/the-versatile-use-of-revisited-de-epithelialization-concept-in-superficial-circumflex-iliac-and-anterolateral-thigh-perforator-free-flap-for-head-and-neck-reconstructions
#1
Jong Woo Choi, Young Chul Kim, Tae Suk Oh, Kyung S Koh, Woo Shik Jeong
BACKGROUND: Although the perforator free flap is now a standard choice for head and neck reconstruction, problems such as microvascular complications, insufficient volume support for the defect, and fistula formation occur. We revisited a de-epithelialized concept for superficial circumflex iliac artery and anterolateral thigh perforator free flap to overcome these problems. METHODS: We applied the de-epithelized perforator free flaps in 35 cases among 761 microsurgical head and neck reconstructions and investigated flap characteristics (length gain of pedicle, flap size, and volumetric analysis) and outcomes (flap failure, partial flap necrosis, hematoma, infection, and fistula)...
February 20, 2017: Journal of Cranio-maxillo-facial Surgery
https://www.readbyqxmd.com/read/28419812/defining-quality-in-head-and-neck-reconstruction
#2
Peter M Vila, Jason T Rich, Shaun C Desai
Microvascular free flap reconstruction has now become the standard of care in the reconstruction of selected head and neck defects. Although uncommon, flap failure is a catastrophic event that results in significant patient morbidity, extended length of hospitalization, and increased cost. However, there is currently no gold standard for measuring the quality of a reconstructive center. Structure and process outcomes have recently been developed, but outcome measures are still lacking. Areas for future research include preoperative nutrition, preoperative flap planning, intraoperative fluid management, appropriate thromboembolism prophylaxis, consistent perioperative antibiotic regimens, skilled ancillary staff, and clear outcome measures for performance measurement...
April 1, 2017: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/28400133/perioperative-serum-levels-of-procalcitonin-c-reactive-protein-and-leukocytes-in-head-and-neck-free-flaps
#3
S Koerdt, N Rommel, N H Rohleder, S Sandig, G Frohwitter, T Steiner, K D Wolff, M R Kesting
Microvascular free flaps are considered to be the gold standard in reconstructive head and neck surgery. However, reduced postoperative transplant perfusion is one of the serious postoperative complications and calls for close and reliable monitoring. Procalcitonin, C-reactive protein, and leukocytes are closely associated with local and systemic inflammatory reactions and might have prognostic capacity concerning tissue necrosis. This study aimed to evaluate perioperative serum levels of these three biomarkers to assess their potential in postoperative flap monitoring...
April 8, 2017: International Journal of Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/28397565/local-intraluminal-irrigation-with-argatroban-during-free-flap-repair-in-a-patient-with-heparin-induced-thrombocytopenia
#4
David Macias, Daniel I Kwon, Paul C Walker, Nathaniel R Peterson
OBJECTIVE: This study describes a case of a successful free flap repair using argatroban for local intraluminal irrigation as a substitute to heparin in a patient with heparin-induced thrombocytopenia. METHODS: Case report and review of literature. RESULTS: The patient had an uneventful postoperative course, and the free flap survived without complications. CONCLUSIONS: The use of argatroban during microvascular surgery is likely to be safe and simple and may be effective in preventing micro-thrombotic complications during microvascular surgery, and it should be considered as an alternative to heparinized saline for local intraluminal irrigation...
May 2017: Annals of Otology, Rhinology, and Laryngology
https://www.readbyqxmd.com/read/28365396/use-of-the-3d-surgical-modelling-technique-with-open-source-software-for-mandibular-fibula-free-flap-reconstruction-and-its-surgical-guides
#5
L Ganry, B Hersant, J Quilichini, P Leyder, J P Meningaud
INTRODUCTION: Tridimensional (3D) surgical modelling is a necessary step to create 3D-printed surgical tools, and expensive professional software is generally needed. Open-source software are functional, reliable, updated, may be downloaded for free and used to produce 3D models. Few surgical teams have used free solutions for mastering 3D surgical modelling for reconstructive surgery with osseous free flaps. We described an Open-source software 3D surgical modelling protocol to perform a fast and nearly free mandibular reconstruction with microvascular fibula free flap and its surgical guides, with no need for engineering support...
March 29, 2017: Journal of Stomatology, Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/28363300/microsurgical-reconstruction-of-the-burned-hand-and-upper-extremity
#6
REVIEW
Mauricio De la Garza, Michael Sauerbier, Germann Günter, Curtis L Cetrulo, Reuben A Bueno, Robert C Russell, Michael W Neumeister
Improvements in critical care and burn victim resuscitation have led to increased survival of burned patients. Initial resuscitation, early excision of burned tissues, prevention of burn wound sepsis, and wound coverage remain mainstays of care. Many burn wounds require complex reconstruction. This is particularly important in the hand. Coverage of tendons, ligaments, joints, vessels, nerves, and bones of the hand requires healthy vascularized tissue to maintain viability and function. Local flaps or regional flaps may be within the burn zone of injury...
May 2017: Hand Clinics
https://www.readbyqxmd.com/read/28293504/an-appraisal-of-internal-mammary-artery-perforators-as-recipient-vessels-in-microvascular-breast-reconstruction-an-analysis-of-515-consecutive-cases
#7
Felix H Vollbach, Christoph D Heitmann, Hisham Fansa
BACKGROUND: The usage of internal mammary artery perforators (IMAPs) has been described in autologous breast reconstruction although IMAPS are not yet considered standard recipient vessels. It remains unclear if these vessels can be safely used in large flaps after radiation therapy or in delayed breast reconstruction. METHODS: Over a 2-year period, 515 free flaps for autologous breast reconstruction were performed on 419 patients by 2 surgeons (S1 and S2). In a retrospective analysis, time of reconstruction, ischemia time, flap weight, diameter of couplers, and complications were analyzed...
December 2016: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/28285013/use-of-revascularized-artery-as-a-recipient-in-microvascular-reconstruction-of-the-lower-leg-an-analysis-of-62-consecutive-free-flap-transfers
#8
Hyung Min Hahn, Yeon Seong Jeong, You Sun Hong, Je Hwan Won, Sang Hyun Lim, Jinoo Kim, Myong Chul Park, Dong Ha Park, Il Jae Lee
BACKGROUND: This study aimed to demonstrate the safety and reliability of combined preoperative angioplasty and free flap transfer in patients with peripheral arterial occlusive disease (PAOD) by analyzing the surgical outcomes. METHODS: Between October 2011 and October 2015, patients who had undergone lower extremity angiography and subsequent free flap transfer were retrospectively reviewed. Data collected included demographics, perioperative data, and postoperative outcomes...
May 2017: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/28280670/a-comprehensive-approach-to-lower-extremity-free-tissue-transfer
#9
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/28280668/zygomatico-maxillary-reconstruction-with-computer-aided-manufacturing-of-a-free-dcia-osseous-flap-and-intraoral-anastomoses
#10
Andrée-Anne Roy, Johnny I Efanov, Geneviève Mercier-Couture, André Chollet, Daniel E Borsuk
Craniomaxillofacial reconstruction using virtual surgical planning, computer-aided manufacturing, and new microsurgical techniques optimizes patient-specific and defect-directed reconstruction. A 3D customized free deep circumflex iliac artery (DCIA) flap with intraoral anastomoses was performed on a 23-year-old man with a posttraumatic right zygomatico-maxillary defect with failure of alloplastic implant reconstruction. An osseous iliac crest flap was sculpted based on a customized 3D model of the mirror image of the patient's unaffected side to allow for perfect fit to the zygomatico-maxillary defect...
February 2017: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/28280662/avoiding-facial-incisions-with-midface-free-tissue-transfer
#11
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/28267121/current-techniques-for-postoperative-monitoring-of-microvascular-free-flaps
#12
Nasir Khatri, Shuhao Zhang, Santosh S Kale
Free tissue transfer (FTT) is used in patients with complicated reconstructive needs; it can provide stable wound coverage, improved aesthetic appearance, and restore functional deficits. Despite the high success rates of free flaps, vascular occlusion is a significant risk leading to flap failure. Many studies have demonstrated that the salvage rate for flaps is inversely related to the time between onset of a vascular problem and its surgical correction. As a result, ongoing postoperative monitoring of free flaps for adequate perfusion is imperative to allow timely and accurate diagnosis of vascular compromise...
March 2017: Journal of Wound, Ostomy, and Continence Nursing
https://www.readbyqxmd.com/read/28259113/surgeon-based-3d-printing-for-microvascular-bone-flaps
#13
Erin M Taylor, Matthew L Iorio
Background Three-dimensional (3D) printing has developed as a revolutionary technology with the capacity to design accurate physical models in preoperative planning. We present our experience in surgeon-based design of 3D models, using home 3D software and printing technology for use as an adjunct in vascularized bone transfer. Methods Home 3D printing techniques were used in the design and execution of vascularized bone flap transfers to the upper extremity. Open source imaging software was used to convert preoperative computed tomography scans and create 3D models...
March 4, 2017: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/28259112/end-to-end-versus-end-to-side-microvascular-anastomosis-a-meta-analysis-of-free-flap-outcomes
#14
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
#15
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
#16
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/28226373/microvascular-flaps-in-nasal-reconstruction
#17
Irene A Kim, Kofi D O Boahene, Patrick J Byrne, Shaun C Desai
Nasal reconstruction for subtotal and total rhinectomy defects is a challenging endeavor, which requires technical finesse, a keen artistic eye, and the ability to anticipate long-term changes that accompany postoperative healing. While local and regional flaps have traditionally been utilized to reconstitute missing nasal elements, certain situations may not provide sufficient or acceptable tissue for optimal reconstruction. In these situations, the three major components of the nose-lining, structural support, and external skin-may require reconstruction with tissues harvested from distant sites through microvascular free tissue transfer...
February 2017: Facial Plastic Surgery: FPS
https://www.readbyqxmd.com/read/28199294/flow-induced-microvascular-network-formation-of-therapeutic-relevant-arteriovenous-av-loop-based-constructs-in-response-to-ionizing-radiation
#18
Volker J Schmidt, Jennifer M Covi, Christoph Koepple, Johannes G Hilgert, Elias Polykandriotis, Amir K Bigdeli, Luitpold V Distel, Raymund E Horch, Ulrich Kneser
BACKGROUND The arteriovenous (AV) loop model enables axial vascularization to gain a functional microcirculatory system in tissue engineering constructs in vivo. These constructs might replace surgical flaps for the treatment of complex wounds in the future. Today, free flaps are often exposed to high-dose radiation after defect coverage, according to guideline-oriented treatment plans. Vascular response of AV loop-based constructs has not been evaluated after radiation, although it is of particular importance...
February 15, 2017: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/28177337/free-flap-loss-caused-by-heparin-induced-thrombocytopenia-and-thrombosis-hitt-a-case-report-and-literature-review
#19
E Segna, A R Bolzoni, C Baserga, A Baj
Heparin-induced thrombocytopenia and thrombosis (HITT) represents a dramatic condition that is difficult to diagnose because of nuanced clinical presentation. Therefore, in every case of microvascular thrombosis during heparin-therapy prompt suspicion about HITT is necessary to avoid flap necrosis. We present a case of HITT which, as the 8 other articles reviewed, clearly shows that HITT is difficult to diagnose and complex to manage. Microvascular reconstruction is the first choice in head and neck reconstruction; unfortunately, dramatic outcomes in free flap surgery due to unpredictable thrombotic events are still reported in the English literature...
December 2016: Acta Otorhinolaryngologica Italica
https://www.readbyqxmd.com/read/28177328/head-and-neck-reconstruction-with-pedicled-flaps-in-the-free-flap-era
#20
R Mahieu, G Colletti, P Bonomo, G Parrinello, A Iavarone, G Dolivet, L Livi, A Deganello
Nowadays, the transposition of microvascular free flaps is the most popular method for management of head and neck defects. However, not all patients are suitable candidates for free flap reconstruction. In addition, not every defect requires a free flap transfer to achieve good functional results. The aim of this study was to assess whether pedicled flap reconstruction of head and neck defects is inferior to microvascular free flap reconstruction in terms of complications, functionality and prognosis. The records of consecutive patients who underwent free flap or pedicled flap reconstruction after head and neck cancer ablation from 2006 to 2015, from a single surgeon, in the AOUC Hospital, Florence Italy were analysed...
December 2016: Acta Otorhinolaryngologica Italica
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