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microvascular free flap

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https://www.readbyqxmd.com/read/29452441/assessing-the-safety-and-efficacy-of-regional-anesthesia-for-lower-extremity-microvascular-reconstruction-enhancing-recovery
#1
Qing Zhao Ruan, Shawn Diamond, Scott Zimmer, Matthew L Iorio
BACKGROUND: Perioperative pain, increased sympathetic tone, and peripheral vasospasm may be safely managed with regional nerve blockade during microvascular reconstruction in the lower extremity. Limited reports exist in this setting; therefore, we evaluated our use of peripheral nerve catheters (PNCs) during microvascular limb salvage to determine safety and efficacy for both patient and flap. METHODS: A single-institution, retrospective review of a prospectively maintained database on all patients with lower extremity free tissue transfers between 2012 and 2017 was completed...
February 16, 2018: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/29452439/assessment-of-function-after-free-tissue-transfer-to-the-lower-extremity-for-chronic-wounds-using-the-lower-extremity-functional-scale
#2
Reuben A Falola, Chrisovalantis Lakhiani, Jocelyn Green, Siya Patil, Brandon Jackson, Rachel Bratescu, Ersilia Anghel, John S Steinberg, Paul J Kim, Christopher E Attinger, Karen K Evans
BACKGROUND: Free tissue transfer is one option for preservation of form and function in the native limb, in the setting of soft tissue paucity. However, the data on patient functionality after microvascular intervention is inconsistently reported. The Lower Extremity Function Scale (LEFS) measures patient-reported difficulty in carrying out 20 physical activities, on a Likert scale, the sum of which correlates with descriptive functional stages of 1-5. We assess limb functionality in this cohort of microvascular patients using the LEFS survey...
February 16, 2018: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/29447804/long-term-follow-up-with-mention-of-complications-in-pediatric-microvascular-mandibular-reconstruction
#3
Kenneth Akakpo, Christopher Iobst, Matthew Old, Jonathan Grischkan
The fibular free flap has become the gold standard for mandibular reconstruction. Despite its vast array of benefits, this procedure has the potential for several complications. In the pediatric setting, the immature skeleton sets the stage for an increased risk of future skeletal abnormalities, both in the jaw, and in the donor site. Herein we describe the case of a toddler who underwent mandibular reconstruction using a fibula free flap and, years later, subsequently developed ankle instability as a result of residual fibula migration...
February 2018: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/29406605/salvage-skull-base-reconstruction-in-the-endoscopic-era-vastus-lateralis-free-tissue-transfer
#4
Stephen Y Kang, Antoine Eskander, Ralph Abi Hachem, Enver Ozer, Theodoros N Teknos, Matthew O Old, Daniel M Prevedello, Ricardo L Carrau
BACKGROUND: When locoregional flaps fail to reconstruct the skull base, the microvascular surgeon faces several reconstructive challenges. We present our technique and results of salvage anterior skull base reconstruction utilizing the vastus lateralis free tissue transfer (VLFTT). METHODS: Four patients with anterior skull base defects after previous locoregional flap failure underwent free tissue transfer reconstruction with VLFTT. RESULTS: The success rate of free tissue transfer was 100%...
February 6, 2018: Head & Neck
https://www.readbyqxmd.com/read/29404244/skull-base-reconstruction-in-the-pediatric-patient
#5
REVIEW
Irit Duek, Alon Pener-Tessler, Ravit Yanko-Arzi, Arik Zaretski, Avraham Abergel, Ahmad Safadi, Dan M Fliss
Introduction  Pediatric skull base and craniofacial reconstruction presents a unique challenge since the potential benefits of therapy must be balanced against the cumulative impact of multimodality treatment on craniofacial growth, donor-site morbidity, and the potential for serious psychosocial issues. Objectives  To suggest an algorithm for skull base reconstruction in children and adolescents after tumor resection. Materials and Methods  Comprehensive literature review and summary of our experience...
February 2018: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/29395993/a-worldwide-comparison-of-the-management-of-surgical-treatment-of-advanced-oral-cancer
#6
Katinka Kansy, Andreas Albert Mueller, Thomas Mücke, Friederike Koersgen, Klaus Dietrich Wolff, Hans-Florian Zeilhofer, Frank Hölzle, Winnie Pradel, Matthias Schneider, Andreas Kolk, Ralf Smeets, Julio Acero, Piet Haers, G E Ghali, Jürgen Hoffmann
INTRODUCTION: Microvascular surgery following tumor resection has become an important field of oral and maxillofacial surgery (OMFS). Following the results from management of T1/T2 floor-of-mouth and tongue squamous cell carcinoma (SCC) in German-speaking countries, Europe, and worldwide, this paper presents specific concepts for the management of resection and reconstruction of T3/T4 SCC of the maxillary and mandibular alveolar process and tongue. METHODS: The DÖSAK questionnaire was distributed in three different phases to a growing number of maxillofacial units worldwide...
January 8, 2018: Journal of Cranio-maxillo-facial Surgery
https://www.readbyqxmd.com/read/29395583/rotational-pedicle-myocutaneous-forearm-fillet-flap-used-to-fill-forequarter-amputation-defect-indications-and-uses
#7
REVIEW
Sagar A Shah, Wendy H Wong, Dhaval Adhvaryu
A full-thickness fourth-degree burn to a large area of the upper extremity may require a forequarter amputation. Whereas our case describes a burn injury, forequarter amputations may more commonly be done in oncological surgery. In addition to the challenge of providing well-vascularized tissue coverage, the burn patient may also pose the complication of respiratory compromise in a systemically ill person. Fillet flaps have often been utilized as "spare part" reconstruction. Although previous forequarter amputations have been covered with free myocutanous forearm fillet flaps, we devised a rotational pedicle myocutaneous forearm fillet flap that might be less complex than a microvascular reconstruction...
January 25, 2018: Journal of Hand Surgery
https://www.readbyqxmd.com/read/29386704/negative-pressure-wound-therapy-in-the-management-of-mine-blast-injuries-of-lower-limbs-lessons-learnt-at-a-tertiary-care-center
#8
Sanjay Maurya, N Srinath, P S Bhandari
Background: Mine blast injuries of foot are devastating injuries that result in composite tissue loss or amputations. Negative pressure wound therapy has helped in the management of such combat-related wounds. The aim of this study was to report experiences gained in managing such injuries at a tertiary care center. Methods: 17 combatants who sustained mine blast injuries were included in this study. Severity of foot injury was assessed as per Foot and Ankle Severity Score...
October 2017: Medical Journal, Armed Forces India
https://www.readbyqxmd.com/read/29380039/olfactory-and-gustatory-functions-after-free-flap-reconstruction-and-radiotherapy-for-oral-and-pharyngeal-cancer-a-prospective-follow-up-study
#9
Markus Lilja, Mari Markkanen-Leppänen, Sanna Viitasalo, Kauko Saarilahti, Andrew Lindford, Patrik Lassus, Antti Mäkitie
BACKGROUND: The senses of smell and taste can be adversely affected by both tumour- and treatment-related factors amongst head and neck cancer patients. The consequences may negatively impact nutritional status as well as quality of life in this patient population. PATIENTS AND METHODS: This prospective longitudinal follow-up study is consisted of 44 patients treated for oral cavity, oropharyngeal or hypopharyngeal cancer with tumour resection and microvascular free tissue transfer reconstruction at the Helsinki University Hospital, Helsinki, Finland...
January 27, 2018: European Archives of Oto-rhino-laryngology
https://www.readbyqxmd.com/read/29369911/postoperative-hematoma-in-microvascular-reconstruction-of-the-head-and-neck
#10
Yi-Fan Chen, Tian-Hsiang Wang, Yen-Hao Chiu, Dun-Hao Chang
BACKGROUND: Free tissue transfer has become a safe and reliable means for repairing soft tissue and bony defects of the head and neck region. Although the success rate is high, the incidence of postoperative complications is common. One significant complication is postoperative hematoma formation. However, few published studies have addressed its incidence, etiology, or outcome. We performed a retrospective analysis to investigate this issue. METHODS: A retrospective review was conducted of 293 consecutive microvascular free tissue transfers in the head and neck region in a single institute from January 2013 to December 2015...
January 25, 2018: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/29369108/safety-of-microsurgery-under-loupes-versus-microscope-a-head-to-head-comparison-of-2-surgeons-with-similar-experiences
#11
Tosan Ehanire, Dhruv Singhal, Bruce Mast, Mark Leyngold
BACKGROUND: Microsurgery is performed using either the operating microscope or loupe magnification. Use of the operating microscope is considered the "criterion standard"; however, loupes are emerging as a safe and reliable technique to perform microsurgery. The purpose of this study was to analyze the safety of microsurgery under loupe magnification compared with the microscope. Previous studies discussing the safety of loupe magnification during microsurgery have been published; however, this is the first study to compare free flap outcomes from 2 surgeons at the same institution, each using their respective technique...
January 24, 2018: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/29367346/genetically-modified-lentiviruses-that-preserve-microvascular-function-protect-against-late-radiation-damage-in-normal-tissues
#12
Aadil A Khan, James T Paget, Martin McLaughlin, Joan N Kyula, Michelle J Wilkinson, Timothy Pencavel, David Mansfield, Victoria Roulstone, Rohit Seth, Martin Halle, Navita Somaiah, Jessica K R Boult, Simon P Robinson, Hardev S Pandha, Richard G Vile, Alan A Melcher, Paul A Harris, Kevin J Harrington
Improvements in cancer survival mean that long-term toxicities, which contribute to the morbidity of cancer survivorship, are being increasingly recognized. Late adverse effects (LAEs) in normal tissues after radiotherapy (RT) are characterized by vascular dysfunction and fibrosis causing volume loss and tissue contracture, for example, in the free flaps used for immediate breast reconstruction after mastectomy. We evaluated the efficacy of lentivirally delivered superoxide dismutase 2 (SOD2) overexpression and connective tissue growth factor (CTGF) knockdown by short hairpin RNA in reducing the severity of LAEs in an animal model of free flap LAEs...
January 24, 2018: Science Translational Medicine
https://www.readbyqxmd.com/read/29359295/impact-of-duration-of-perioperative-ischemia-on-outcomes-of-microsurgical-reconstructions
#13
Denis Ehrl, Paul I Heidekrueger, Milomir Ninkovic, P Niclas Broer
BACKGROUND:  Free tissue transfers have become routine for a variety of reconstructive purposes. During the time of transfer, some period of ischemia time is unavoidable, causing structural and metabolic changes. This study aimed to evaluate whether length of intraoperative ischemia affects the outcomes of microsurgical reconstructions. METHODS:  Within a 7-year period, 638 patients having undergone 690 microvascular free flap reconstructions fulfilled inclusion criteria for this study...
January 22, 2018: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/29328540/case-of-late-onset-relapsing-surgical-site-infection-related-to-a-venous-coupler-placed-during-free-flap-reconstruction-for-major-head-and-neck-cancer
#14
Yin Ren, Daniel G Deschler, Dipti Sajed, Marlene L Durand
BACKGROUND: Venous coupling devices are widely used during reconstructive surgery involving microvascular anastomosis but have not served as foreign bodies in head and neck surgical site infections. METHODS: We conducted a case report. RESULTS: A patient underwent resection and free flap reconstruction for recurrent tongue squamous cell carcinoma. She developed a neck abscess due to Streptococcus intermedius 7 weeks postoperatively, days after starting chemoradiotherapy...
January 12, 2018: Head & Neck
https://www.readbyqxmd.com/read/29322547/improvement-of-the-salvage-rate-of-flap-after-venous-thrombosis-with-intraparenchymatous-venous-pressure-monitoring
#15
Hajime Matsumine, Mariko Mogami, Osamu Fujiwara, Masahiro Hasegawa, Hiroshi Ito, Hiroyuki Sakurai
PURPOSE: Intraparenchymatous venous pressure (IVP) monitoring in flap can measure venous pressure with catheter placement. Among patients with IVP monitoring, this study reviewed postoperative microvascular complications for investigating the transplanted-tissue salvage-rate. PATIENTS AND METHODS: Two hundred and seventy-one patients (male, 132; female, 139; mean age, 52.3 years; age range, 9-82 years) underwent free flap transfer and postoperative continuous IVP monitoring, which performed as follows; a venous catheter was connected to a transducer, and venous pressure in the flap was recorded for three consecutive days postoperatively...
January 11, 2018: Microsurgery
https://www.readbyqxmd.com/read/29303857/reconstruction-of-a-compound-oromandibular-defect-by-means-of-chimeric-scapular-parascapular-free-flap-assisted-by-virtual-surgical-planning
#16
Josué Hernando, Antonio Aguilar-Salvatierra, Ignacio Osoitz Leizaola-Cardesa, Juan Antonio Rad, Amaya Vicuña, Rafael Gómez, Javier Martín, Gerardo Gómez-Moreno
BACKGROUND: Reconstruction of an oromandibular defect presents a considerable surgical challenge. But since the advent of microvascularized free flap reconstructive surgery, outcomes have improved significantly so that today almost any defect may be reconstructed. Recently, virtual surgical planning has reduced surgical time, the morbidity associated with surgery, and surgical precision. OBJECTIVE: This article reports a complex patient with a composite oromandibular defect...
January 4, 2018: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/29299526/chicken-thigh-microvascular-training-model-improves-resident-surgical-skills
#17
Francis X Creighton, Allen L Feng, Neerav Goyal, Kevin Emerick, Daniel Deschler
Objectives: Microsurgical techniques are essential for vessel anastomosis in free flap reconstructive surgery. However, teaching these skills intraoperatively is difficult. The chicken thigh microvascular model is a high-fidelity model that has been previously validated to differentiate between skill levels of surgeons. This study aims to determine if this model objectively improves microsurgical skills. Study Design: Validation study. Methods: Thirteen residents were given a tutorial on microvascular anastomosis and asked to perform anastomoses on the microvascular model...
December 2017: Laryngoscope Investigative Otolaryngology
https://www.readbyqxmd.com/read/29288289/anterolateral-thigh-flap-combined-with-reconstruction-plate-versus-double-free-flaps-for-composite-mandibular-reconstruction-a-propensity-score-matched-study
#18
Anaeze C Offodile, Jennifer An-Jou Lin, Kai-Ping Chang, Mohamed Abdelrahman, Hao-Wei Kou, Charles Yuen Yung Loh, Mario A Aycart, Huang-Kai Kao
OBJECTIVE: This study was designed to examine the comparative effectiveness of oromandibular defect reconstruction via anterolateral thigh flap and bridging plate (ALT only) versus simultaneous soft tissue and vascularized bone flap (DFF), with regards to long-term plate exposure and complications. METHODS: A propensity score-matched analysis of patients with an oncologic head and neck defect who underwent microvascular reconstruction was performed. Two surgical groups, i...
March 2018: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/29284902/elongated-miofascial-temporal-flap-in-comparison-with-standard-surgical-procedure-of-temporal-muscle-reconstruction
#19
Dino Dizdarevic, Tarik Masic, Edi Muslic
Introduction: Flap of the temporal muscle (m. temporalis) with its natural position, its mass and its length, compared with other bound and free microvascular flaps, is the method of choice for covering the middle part of the face after the removal of large tumor masses. Material: The study included a sample of 36 patients who were surgically treated due to malignant process at the middle face level with the performed partial, total or bilateral maxillectomy at the Clinic for Maxillofacial Surgery, University Clinical Center in Sarajevo...
October 2017: Medical Archives
https://www.readbyqxmd.com/read/29284163/geometric-three-dimensional-end-to-side-microvascular-anastomosis-a-simple-and-reproducible-technique
#20
Adrian S H Ooi, Daniel R Butz, Sean M Fisher, Zachary J Collier, Lawrence J Gottlieb
BACKGROUND:  End-to-side (ETS) anastomoses are useful when preservation of distal vascularity is critical. The ideal ETS microanastomosis should maintain a wide aperture and have a smooth take-off point to minimize turbulence, vessel spasm, and thrombogenicity of the suture line. We have developed a unique, dependable, and reproducible geometric technique for ETS anastomoses, and analyze its efficacy in our series of patients. METHODS:  The geometric ETS technique involves creating a three-dimensional (3D) diamond-shaped defect on the recipient vessel wall, followed by a slit incision of the donor vessel to create a "spatula" fitting this defect...
December 28, 2017: Journal of Reconstructive Microsurgery
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