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microvascular free flap

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https://www.readbyqxmd.com/read/29672783/-smartphone-based-thermography-for-perforator-localisation-in-microvascular-breast-reconstruction
#1
Leonard Walle, Hisham Fansa, Onno Frerichs
BACKGROUND: Thermography permits non-invasive examination and presentation of cutaneous temperature differences. When planning microvascular flaps, thermography may illustrate these differences and may portray patterns of blood circulation near to perforators. As an additional tool, thermography may enhance quality and diversity in free flaps. PATIENTS AND METHODS: In this prospective study, we examined 10 patients with 13 free DIEP-flaps for breast reconstruction...
April 2018: Handchirurgie, Mikrochirurgie, Plastische Chirurgie
https://www.readbyqxmd.com/read/29672777/diep-flap-breast-reconstruction-complication-rate-in-previously-irradiated-internal-mammary-nodes
#2
Shirley Shechter, Ehud Arad, Amir Inbal, Or Friedman, Eyal Gur, Yoav Barnea
BACKGROUND:  Postmastectomy radiation therapy (PMRT) is a widely accepted treatment for locally advanced breast cancer. Some patients require additional boost radiation to the internal mammary nodes as the part of regional nodal irradiation (RNI). Delayed breast reconstruction with an autologous free flap using the internal mammary vessels for microvascular flap anastomosis is a common practice for these patients. The aim of our study was to evaluate the effect of RNI on autologous microvascular breast reconstruction...
April 19, 2018: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/29661662/multimodal-analysis-using-flowmeter-analysis-laser-doppler-spectrophotometry-and-indocyanine-green-videoangiography-for-the-detection-of-venous-compromise-in-flaps-in-rats
#3
Lucas M Ritschl, Leonard H Schmidt, Andreas M Fichter, Alexander Hapfelmeier, Klaus-Dietrich Wolff, Thomas Mücke
Venous congestion results in tissue damage and remains the most common failure of free microvascular transfer if it is not recognized early. The purpose of this experimental study was to evaluate venous congestion and describe the findings with two different monitoring tools. A standardized epigastric flap was raised, and total occlusion of the draining vein was temporarily applied for 4, 5, 6, or 7 h. Blood flow measurements, including laser-Doppler flowmetry, and tissue spectrophotometry (O2C) and indocyanine green (ICG) videoangiography using the FLOW® 800 tool, were performed systematically after each surgical step, an interval of venous occlusion, and 1 week of clinical observation...
March 30, 2018: Journal of Cranio-maxillo-facial Surgery
https://www.readbyqxmd.com/read/29606583/cost-analysis-of-enhanced-recovery-after-surgery-in-microvascular-breast-reconstruction
#4
Christine Oh, James Moriarty, Bijan J Borah, Kristin C Mara, William S Harmsen, Michel Saint-Cyr, Valerie Lemaine
BACKGROUND: Enhanced recovery after surgery (ERAS) pathways have been shown in multiple surgical specialties to decrease hospital length of stay (LOS) after surgery. ERAS in breast reconstruction has been found to decrease hospital LOS and inpatient opioid use. ERAS protocols can facilitate a patient's recovery and can potentially increase the quality of care while decreasing costs. METHODS: A standardized ERAS pathway was developed through multidisciplinary collaboration...
March 2, 2018: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/29605953/does-cigarette-smoking-harm-microsurgical-free-flap-reconstruction
#5
Denis Ehrl, Paul I Heidekrueger, Elisabeth M Haas, Michaela Coenen, Riccardo Giunta, Milomir Ninkovic, P Niclas Broer
BACKGROUND:  Free tissue transfers can successfully address a wide range of reconstructive requirements. While the negative influence of cigarette smoking is well documented, its effects in the setting of microsurgical free flap reconstruction remain debated. This study evaluates the impact of cigarette smoking on microsurgical reconstructions. METHODS:  Over a 7-year period, 897 patients underwent 969 microvascular free flap reconstructions at a single surgical center...
April 1, 2018: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/29595720/5000-free-flaps-and-counting-a-10-year-review-of-a-single-academic-institution-s-microsurgical-development-and-outcomes
#6
Martin J Carney, Jason M Weissler, Michael G Tecce, Michael N Mirzabeigi, Ari M Wes, Peter F Koltz, Suhail K Kanchwala, David W Low, Stephen J Kovach, Liza C Wu, Joseph M Serletti, Joshua Fosnot
BACKGROUND: The establishment of an effective clinical and academic culture within an institution is a multifactorial process. This process is cultivated by dynamic elements such as recruitment of an accomplished and diverse faculty, patient geographic outreach, clinical outcomes research, and fundamental support from all levels of an institution. This study reviews the academic evolution of a single academic plastic surgery practice, and summarizes a 10-year experience of microsurgical development, clinical outcomes, and academic productivity...
April 2018: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/29577940/vascular-architecture-in-free-flaps-analysis-of-vessel-morphology-and-morphometry-in-murine-free-flaps
#7
Andreas Max Pabst, Peer Wolfgang Kämmerer, Maximilian Krüger, Lukas Jäger, Maximilian Ackermann
The aim of this study was to analyze the development of vascular architecture as well as vascular morphometry and morphology of anastomosed microvascular free flaps. Free pectoral skin flaps were raised in 25 rats and anastomosed to the femoral vessels in the groin region. CD31 immunohistology was performed after 3, 7 and 12 d (each 5 animals each) to analyze microvessel density (MVD), microvessel area (MVA) and microvessel size (MVS). Microvascular corrosion casting was performed after 7 and 12 d (5 animals each) to analyze vessel diameter (VD), intervascular distance (IVD), interbranching distance (IBD), and branching angle (BA)...
March 22, 2018: Microvascular Research
https://www.readbyqxmd.com/read/29576961/clinical-impact-of-albumin-in-advanced-head-and-neck-cancer-patients-with-free-flap-reconstruction-a-retrospective-study
#8
Ming-Hsien Tsai, Hui-Ching Chuang, Yu-Tsai Lin, Hui Lu, Wei-Chih Chen, Fu-Min Fang, Chih-Yen Chien
Background: Poor nutritional status among patients with advanced stage head and neck squamous cell carcinoma (HNSCC) is common. Albumin is a common indicator of nutritional status and has been shown to be a predictor of oncological outcomes and perioperative morbidity. This study aims to determine the prognostic value of the serum albumin level among patients with advanced HNSCC undergoing surgery with simultaneous free flap reconstruction. Methods: A total of 233 patients with advanced head and neck cancer undergoing tumor resection and immediate microvascular free flap reconstruction in a tertiary referral center were enrolled retrospectively between January 2009 and December 2011...
2018: PeerJ
https://www.readbyqxmd.com/read/29566750/predicting-complications-of-major-head-and-neck-oncological-surgery-an-evaluation-of-the-acs-nsqip-surgical-risk-calculator
#9
Peter S Vosler, Mario Orsini, Danny J Enepekides, Kevin M Higgins
BACKGROUND: The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) universal surgical risk calculator is an online tool intended to improve the informed consent process and surgical decision-making. The risk calculator uses a database of information from 585 hospitals to predict a patient's risk of developing specific postoperative outcomes. METHODS: Patient records at a major Canadian tertiary care referral center between July 2015 and March 2017 were reviewed for surgical cases including one of six major head and neck oncologic surgeries: total thyroidectomy, total laryngectomy, hemiglossectomy, partial glossectomy, laryngopharyngectomy, and composite resection...
March 22, 2018: Journal of Otolaryngology—Head & Neck Surgery
https://www.readbyqxmd.com/read/29555139/influence-of-venous-stasis-on-survival-of-epigastric-flaps-in-rats
#10
T Mücke, L H Schmidt, A M Fichter, K-D Wolff, L M Ritschl
Venous congestion results in tissue damage and remains the most common reason for failure of transfer of microvascular free flaps if it is not recognised early. The purpose of this study was to measure the critical duration of venous congestion and the resultant survival of flaps according to the duration of venous stasis. A standard epigastric flap was raised and repositioned in 35 rats, seven of which acted as controls. The superficial inferior epigastric vein was fully occluded for four, five, six, or seven hours in the rest (n=7 each group)...
March 16, 2018: British Journal of Oral & Maxillofacial Surgery
https://www.readbyqxmd.com/read/29554345/the-role-of-the-visor-flap-in-scalp-reconstruction-a-case-series-of-21-patients
#11
Marco Ellis, Lisa Hwang, Ni-Ka Ford, Konstantin Slavin
BACKGROUND: Full-thickness scalp defects pose a reconstructive problem, especially in the setting of infection, chemotherapy/radiation, and underlying cranial defects. Current options include dermal matrices, skin grafts, and local flaps. Local flaps often fail, requiring subsequent microvascular free flap reconstruction. OBJECTIVE: To describe the visor flap, a novel bipedicled advancement flap design, and its role in reconstruction of scalp defects. METHODS: A retrospective review of 21 adult patients who developed scalp defects reconstructed using the visor flap from 2013 to 2017...
March 14, 2018: Operative Neurosurgery (Hagerstown, Md.)
https://www.readbyqxmd.com/read/29553977/long-term-fate-of-denervated-skeletal-muscle-after-microvascular-flap-transfer
#12
Hak Chang, SeungHwan Hwang, SooA Lim, SuRak Eo, Kyung Won Minn, Ki Yong Hong
BACKGROUND: Muscle flap is a valuable option in soft tissue reconstruction. Denervated skeletal muscle is known to undergo degeneration. However, information regarding histological and genetic changes in muscle free flap without reinnervation over long-term follow-up remains unclear. METHODS: We collected flap muscles obtained during secondary exploration surgery after more than 15 years of previous muscle free flap without reinnervation. Compared with normal muscle and fat, histomorphometric and gene expression analysis of flap muscle were performed...
March 16, 2018: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/29543679/repair-of-large-full-thickness-scalp-defects-using-biomaterial-and-skin-grafting
#13
Sheng Yan, Hangyan Shi, Da Chen, Jincai Guo, Yi Sun, Sufan Wu
The reconstruction of large full-thickness scalp defects remains a surgical challenge, especially when the skull is exposed completely without periosteum. Surgical technique options for wound coverage have included tissue expansion, skin grafting, local or regional flaps, and microvascular free tissue transfer. In recent years, some authors have reported to use biological material as an alternative for repairing complex wounds. The authors report the successful reconstruction of a large defect with bare skull in bilateral temporal regions of a 3-year-old child...
March 14, 2018: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/29499911/mra-of-the-skin-mapping-for-advanced-breast-reconstructive-surgery
#14
REVIEW
N D Thimmappa, J V Vasile, C Y Ahn, J L Levine, M R Prince
Autologous breast reconstruction using muscle-sparing free flaps are becoming increasingly popular, although microvascular free flap reconstruction has been utilised for autologous breast reconstructions for >20 years. This innovative microsurgical technique involves meticulous dissection of artery-vein bundle (perforators) responsible for perfusion of the subcutaneous fat and skin of the flap; however, due to unpredictable anatomical variations, preoperative imaging of the donor site to select appropriate perforators has become routine...
February 27, 2018: Clinical Radiology
https://www.readbyqxmd.com/read/29476562/functional-lower-lip-reconstruction-with-the-partial-latissimus-dorsi-muscle-free-flap-without-nerve-coaptation
#15
Özlenen Özkan, Ömer Özkan, Anı Çinpolat, Mehmet Can Ubur, Gamze Bektaş, Adil Jumshudov, Hilmi Uysal
BACKGROUND: The repair of extensive lower lip defects is difficult due to the presence of both functional and esthetic requirements. This report describes functional lip repair using the partial latissimus dorsi free flap without nerve coaptation. METHODS: Reconstruction of the lower lip due to subtotal and total tissue defects was performed using latissimus dorsi free flap on twelve patients, between 2013 and 2017. The etiology was squamous cell carcinoma in six patients, malignant melanoma in one, firearm injury in three and microstomia in two...
February 23, 2018: Microsurgery
https://www.readbyqxmd.com/read/29465485/enhanced-recovery-pathway-in-microvascular-autologous-tissue-based-breast-reconstruction-should-it-become-the-standard-of-care
#16
Christodoulos Kaoutzanis, Nishant Ganesh Kumar, Dillon O'Neill, Blair Wormer, Julian Winocour, John Layliev, Matthew McEvoy, Adam King, Stephane A Braun, K Kye Higdon
BACKGROUND: Enhanced Recovery Pathway (ERP) programs have demonstrated improved perioperative care and shorter length of hospital stay (LOS) in several surgical disciplines. The purpose of this study was to compare outcomes of patients undergoing autologous tissue-based breast reconstruction (ABR) before and after the implementation of an ERP program. METHODS: We retrospectively reviewed consecutive patients who underwent ABR by two surgeons before and after the implementation of the ERP at a university center over a three-year period...
February 9, 2018: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/29464172/free-flap-survival-despite-internal-jugular-vein-thrombosis-in-head-and-neck-reconstruction
#17
Koichiro Kiya, Tateki Kubo, Shien Seike, Ko Hosokawa
Microvascular free tissue transfer is one of the most common techniques of reconstruction for complex head and neck surgical defects. Generally, venous thrombosis is more likely to occur than arterial thrombosis in vascular anastomosis. Thus, recipient veins must be chosen carefully. Although the internal jugular vein is preferred as a recipient vein by many microsurgeons, internal jugular vein thrombosis is a potential complication, as shown in our report. Therefore, we consider that the external jugular vein still is an option as a recipient for venous anastomosis and that it is better to perform multiple vein anastomoses with 2 different venous systems, such as the internal and external jugular systems, than anastomoses within the same venous system...
January 2018: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/29461377/total-lower-lip-reconstruction-with-functional-gracilis-free-muscle-flap
#18
Mehmet Akif Cakmak, Hakan Cinal, Ensar Zafer Barin, Muhammed Sedat Sakat, Harun Karaduman, Onder Tan
Free flaps based on static slings principles cannot provide esthetic and functional outcomes at a desired level in total or close to total lip loss. Therefore, dynamic methods have become a current issue in recent years and especially the idea of functional gracilis free muscle flap has been suggested. In this study, we present a case of a successful total lower lip repair with this flap.In a 78-year-old female patient who was diagnosed with squamous cell carcinoma involving the entire lower lip, bilateral modified radical neck dissection and full-thickness total resection with 1 cm surgical margin so as to include both commissures of the tumor were performed and then a free gracilis muscle flap was transferred from the same side...
February 14, 2018: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/29452441/assessing-the-safety-and-efficacy-of-regional-anesthesia-for-lower-extremity-microvascular-reconstruction-enhancing-recovery
#19
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
#20
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
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