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Microvascular reconstruction

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https://www.readbyqxmd.com/read/29146958/third-repeat-microvascular-reconstruction-in-head-and-neck-cancer-patients-aged-65-years-and-older-a-longitudinal-and-sequential-analysis
#1
Jonas Löfstrand, Kai-Ping Chang, Jennifer An-Jou Lin, Charles Yuen Yung Loh, Hsuan-Yu Chou, Huang-Kai Kao
Performing a sequential third free flap for reconstruction of a head and neck defect after cancer resection can be challenging, and the problem is further compounded in elderly patients. The outcomes in this clinical scenario are currently unknown and this study aims to compare the results in elderly patients with younger patients in a high-volume microsurgical unit. A retrospective review of 126 consecutive patients who had undergone three sequential free flap reconstructions after head and neck cancer was performed...
November 16, 2017: Scientific Reports
https://www.readbyqxmd.com/read/29137568/first-dorsal-metatarsal-artery-perforator-flap-to-cover-great-toe-defect
#2
Roongsak Limthongthang, Perajit Eamsobhana
BACKGROUND: There were very few options available for distal foot and toe defects that required a vascularized flap for coverage. As such, the use of a free flap was often justified in this region of the foot. The use of perforator flaps has created a new subset of local tissue transfer alternatives that increases the potential that the difficulties associated with microvascular tissue transfers could be avoided. The first dorsal metatarsal artery (FDMA) perforator flap was one variant of this new type of tissue transfer...
September 2017: Journal of Orthopaedic Surgery
https://www.readbyqxmd.com/read/29132790/ulnar-thumb-pulp-reconstruction-using-the-anterograde-homodigital-neurovascular-island-flap
#3
REVIEW
Valeriy Shubinets, River M Elliott
The thumb ulnar pulp is a critical component of key pinch and precision manipulation. Injuries to this area should be reconstructed with robust, sensate tissue that restores bulk and contour. The existing reconstructive options, however, have substantial risks and drawbacks. We describe an anterograde homodigital neurovascular island flap that provides both sensate and durable coverage of the ulnar thumb pulp. The flap uses innervated glabrous tissue, limits donor site morbidity to the thumb and first web space, and does not require microvascular anastomoses or nerve coaptation...
November 11, 2017: Journal of Hand Surgery
https://www.readbyqxmd.com/read/29130554/sensory-recovery-of-myomucosal-flap-oral-cavity-reconstructions
#4
Olindo Massarelli, Luigi Angelo Vaira, Andrea Biglio, Roberta Gobbi, Giovanni Dell'aversana Orabona, Giacomo De Riu
BACKGROUND: Sensory restoration of the oral cavity is a primary aim of reconstructive surgery in posttraumatic or postablative defects. Sensitivity plays a key role in oral function, whose impairment strongly affects the patient's quality of life. Cheek myomucosal flaps provide a reliable and tissue-like reconstruction of these regions but their sensitive recovery, which we still know little about, deserves thorough assessment. METHODS: In this retrospective study, the myomucosal cheek flaps were tested for different aspects of sensory recovery: touch; 2-point discrimination; pain; sharp/smooth discrimination; ability to feel hot/cold stimulus; stereognosis; and taste...
November 11, 2017: Head & Neck
https://www.readbyqxmd.com/read/29128255/patients-experience-of-the-monitoring-of-free-flaps-after-reconstruction-for-oral-cancer
#5
H Nazir, D Lowe, S N Rogers
Regular monitoring of free flaps is essential after microvascular free tissue transfer, but the frequency and duration of the observations vary between units and there is no consensus nationally. Best practice can be informed by the feedback of patients, but as we know of no such studies, we did a cross-sectional survey of a consecutive group of patients after free tissue transfer to find out what they thought about monitoring. We designed a study-specific questionnaire after consultation with the patient and carer forum, and sent it to 150 patients who had had free tissue transfer in the maxillofacial department at Aintree University Hospital during 2015 and 2016...
November 8, 2017: British Journal of Oral & Maxillofacial Surgery
https://www.readbyqxmd.com/read/29127507/influence-of-coupler-size-on-revision-rate-and-timing-of-revision-after-free-flap-tissue-transfer-in-the-head-and-neck
#6
Ulrich Kisser, Christine Adderson-Kisser, Philipp Baumeister, Maximilian Reiter
OBJECTIVE: Microvascular coupler devices have been proven an effective alternative to standard hand-sutured anastomoses in reconstructive surgery. Until now, the influence of the coupler size on the revision rate after free flap tissue transfer in head and neck surgery has not been investigated. Neither has its influence on the timing of venous revisions. MATERIALS AND METHODS: A retrospective mono-center cohort study was performed in order to analyze the influence of coupler size on timing and revision rate of microvascular procedures...
November 10, 2017: European Archives of Oto-rhino-laryngology
https://www.readbyqxmd.com/read/29126769/cardiovascular-complications-in-head-neck-microvascular-flap-reconstruction-a-retrospective-risk-stratification-and-outcomes-assessment
#7
Naseem Ghazali, Steven Caldroney, Donita Dyalram, Joshua E Lubek
BACKGROUND: To determine the incidence and predictors of cardiac complications (CC) in head & neck microvascular flap reconstruction. METHODS: A series of 216 microvascular flaps performed between 2012 and 2015 were analyzed using the Revised Cardiac Risk Index (CRCI) and the Charlson Comorbidity Index (CCI). Multivariate regression analysis was undertaken for predictive factors of outcomes. RESULTS: Twenty patients developed CC (9.7%) with transient cardiac arrhythmia (6...
October 12, 2017: Journal of Cranio-maxillo-facial Surgery
https://www.readbyqxmd.com/read/29124365/change-in-reimbursement-and-costs-in-german-oncological-head-and-neck-surgery-over-the-last-decade-ablative-tongue-cancer-surgery-and-reconstruction-with-split-thickness-skin-graft-vs-microvascular-radial-forearm-flap
#8
Sebastian Hoefert, Oliver Lotter
OBJECTIVES: Defects after ablative tongue cancer surgery can be reconstructed by split-thickness skin grafts or free microvascular flaps. The different surgical options may influence costs, reimbursement, and therefore possible profits. Our goal was to analyze the development of these parameters for different procedures in head and neck reconstruction in Germany over the last decade. MATERIALS AND METHODS: After tumor resection and neck dissection of tongue cancer, three different scenarios were chosen to calculate costs, reimbursement, length of stay (LoS), and profits...
November 9, 2017: Clinical Oral Investigations
https://www.readbyqxmd.com/read/29122486/trapezius-flaps-for-reconstruction-of-head-and-neck-defects-following-oncological-resection-a-systematic-review
#9
Conor M Sugrue, Grainne Rooney, Ryan M Sugrue
OBJECTIVE: Head and neck (H&N) reconstruction after cancer resection is challenging. Myocutaneous trapezius flaps provide an alternative reconstruction for patients not suitable for microvascular free tissue transfer. METHODS: A systematic review was performed on studies involving trapezius flaps for H&N reconstruction post oncological resection between the years 1985-2015. Data extracted included patient numbers and demographics, operative technique and complications...
October 10, 2017: Journal of Cranio-maxillo-facial Surgery
https://www.readbyqxmd.com/read/29117833/management-of-the-pediatric-patient-following-upper-extremity-replantation-or-revascularization-a-suggested-protocol
#10
Alec Sundet, Kyros Ipaktchi, Claudia Kunrath, Rodrigo N Banegas
BACKGROUND: Traumatic pediatric amputations of the hand and upper extremity can have long-term financial, psychological, developmental, and functional consequences that readily extend beyond the realm of that which is normally encountered in comparatively injured adults. These factors, along with a paucity of medical comorbidities, have guided a more liberal and aggressive approach to treating pediatric amputations in hopes of optimizing psychosocial, aesthetic, and developmental outcomes...
December 2017: Journal of Hand Surgery Asian-Pacific Volume
https://www.readbyqxmd.com/read/29108534/-lengthening-temporalis-myoplasty-in-treatment-of-chronical-facial-paralysis
#11
EDITORIAL
Alexander Bonde, Mette Stueland Wolthers
Introducing the lengthening temporalis myoplasty (LTM), a newly implemented surgical treatment of chronic facial paralysis. LTM is a single-stage operation where the temporalis muscle is transposed for dynamic smile reconstruction, hereby serving as an alternative to the more complex two-stage microvascular functional muscle transplantation. This case report demonstrates how LTM can be used to treat patients, who are not motivated or suitable for extensive surgery. The introduction of this technique aims to help a larger number of patients with chronic facial paralysis...
November 6, 2017: Ugeskrift for Laeger
https://www.readbyqxmd.com/read/29095187/defining-the-role-of-free-flaps-for-transoral-robotic-surgery
#12
Kyle M Hatten, Robert M Brody, Gregory S Weinstein, Jason G Newman, Andres M Bur, Ara A Chalian, Bert W OʼMalley, Christopher H Rassekh, Steven B Cannady
BACKGROUND: Transoral surgical techniques for oropharyngeal tumors have been widely accepted, yet often results in a significant functional deficit. Current reports on the safety, feasibility, and swallowing performance after microvascular reconstruction are limited to small volume case series. MATERIALS AND METHODS: Retrospective review of 42 consecutive patients, between December 2013 and May 2016, who underwent transoral robotic surgery oropharyngectomy followed by microvascular reconstruction...
October 31, 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/29083525/antibiotic-prophylaxis-in-clean-contaminated-head-and-neck-cases-with-microvascular-free-flap-reconstruction-a-systematic-review-and-meta-analysis
#13
REVIEW
Yarah M Haidar, Prem B Tripathi, Tjoson Tjoa, Sartaaj Walia, Lishi Zhang, Yanjun Chen, Danh V Nguyen, Hossein Mahboubi, William B Armstrong, Julie A Goddard
BACKGROUND: Optimal antibiotic prophylaxis duration in head and neck clean-contaminated free-flap cases is unknown. METHODS: A systematic review/meta-analysis was conducted using PubMed/MEDLINE, Cochrane Library, Web-of-Science, and Scopus databases. RESULTS: Of the 3755 searched articles, 5 articles were included for a total of 861 patients. The recipient surgical site infection risk was significantly higher in patients receiving prophylactic antibiotics for ≤24 hours compared to >24 hours (relative risk [RR] 1...
October 30, 2017: Head & Neck
https://www.readbyqxmd.com/read/29080960/protocol-for-mandibular-reconstruction-with-zygomatic-implants-zygomatic-mandibular-implant
#14
Ruben Muñoz, Golaszewski Gajos, Jose Bladimir, Diaz Carvajal, Alvaro Luis, Grace Del Valle Speranza
INTRODUCTION: This study describes a modified protocol using transmandibular zygomatic implants with immediate occlusal loading for the comprehensive dental rehabilitation of previously reconstructed mandibular defects and reports preliminary results of this modified protocol. MATERIALS AND METHODS: Fifteen patients (6 female and 9 male), with a mean of age 40.26 years (range 12 to 68 years), had previously undergone immediate mandibular reconstruction using either autologous bone grafting, bone transport, or microvascular free-flap reconstruction for a variety of diagnoses...
October 28, 2017: Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/29076317/salvage-of-unilateral-complete-ear-amputation-with-continuous-local-hyperbaric-oxygen-platelet-rich-plasma-and-polydeoxyribonucleotide-without-micro-revascularization
#15
Sang Keon Lee, Yoon Min Lim, Dae Hyun Lew, Seung Yong Song
In many cases of complete ear amputation, microvascular surgery is required for tissue perfusion and organ survival. However, microvascular reconstruction is not always feasible in the absence of suitable vessels. Here, we present the case of a 76-year-old man who underwent complete amputation of the left ear after a collapse at home because of cardiogenic syncope. He was treated with primary replantation and underwent a postoperative salvage course including continuous local hyperbaric oxygen therapy (HBOT), platelet-rich plasma (PRP) injections, and polydeoxyribonucleotide (PDRN) injections...
October 27, 2017: Archives of Plastic Surgery
https://www.readbyqxmd.com/read/29075158/locoregional-and-microvascular-free-tissue-reconstruction-of-the-lateral-skull-base
#16
REVIEW
Demetri Arnaoutakis, Sameep Kadakia, Manoj Abraham, Thomas Lee, Yadranko Ducic
The goals of reconstruction following any oncologic extirpation are preservation of function, restoration of cosmesis, and avoidance of morbidity. Anatomically, the lateral skull base is complex and conceptually intricate due to its three-dimensional morphology. The temporal bone articulates with five other cranial bones and forms many sutures and foramina through which pass critical neural and vascular structures. Remnant defects following resection of lateral skull base tumors are often not amenable to primary closure...
November 2017: Seminars in Plastic Surgery
https://www.readbyqxmd.com/read/29069877/is-robot-assisted-surgery-really-scarless-surgery-immediate-reconstruction-with-a-jejunal-free-flap-for-esophageal-rupture-after-robot-assisted-thyroidectomy
#17
Seong Hoon Park, Joo Hyun Kim, Jun Won Lee, Hii Sun Jeong, Dong Jin Lee, Byung Chun Kim, In Suck Suh
Esophageal perforation is a rare but potentially fatal complication of robot-assisted thyroidectomy (RAT). Herein, we report the long-term outcome of an esophageal reconstruction with a jejunal free flap for esophageal rupture after RAT. A 33-year-old woman developed subcutaneous emphysema and hoarseness on postoperative day1 following RAT. Esophageal rupture was diagnosed by computed tomography and endoscopy, and immediate surgical exploration confirmed esophageal rupture, as well as recurrent laryngeal nerve injury...
October 26, 2017: Archives of Plastic Surgery
https://www.readbyqxmd.com/read/29068920/five-steps-to-internal-mammary-vessel-preparation-in-less-than-15-minutes
#18
Nicholas T Haddock, Sumeet S Teotia
BACKGROUND: Modern breast reconstruction often involves microvascular reconstruction. The most common recipient vessels are the internal mammary artery and vein. Recently, there has been great focus on efficiency, but much of this emphasis has been directed to faster flap harvest or recovery protocols for expeditious discharge. An equally important aspect is internal mammary vessel preparation. METHODS: Breast reconstruction was performed in 415 patients (715 breasts) using autologous tissue (850 flaps) from 2012 to 2016...
November 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/29059111/pedicled-rotational-medial-and-lateral-gastrocnemius-flaps-surgical-technique
#19
Zeke Walton, Milton Armstrong, Sophia Traven, Lee Leddy
Gastrocnemius flaps have been used for decades to reconstruct defects of the proximal tibia and knee. They have proven to be useful in the soft-tissue reconstruction of defects caused by trauma, tumors, and infections about the knee, and the reconstruction of extensor mechanism discontinuity with and without total joint arthroplasty. The flaps have low failure rates and a distinct proximally based blood supply that allows them to be elevated and rotated up to 15 cm above the level of the knee joint. The vascular anatomy is reproducible because rotational flaps do not require microvascular anastomosis...
November 2017: Journal of the American Academy of Orthopaedic Surgeons
https://www.readbyqxmd.com/read/29045998/-plastic-reconstructive-microsurgery-in-the-elderly-patient-consensus-statement-of-the-german-speaking-working-group-for-microsurgery-of-the-peripheral-nerves-and-vessels
#20
Ingo Ludolph, Marcus Lehnhardt, Andreas Arkudas, Ulrich Kneser, Gerhard Pierer, Yves Harder, Raymund E Horch
During the last two decades, understanding and experience of microsurgical reconstruction have increased. This is linked to improved instruments and technical devices, as well as to the increased number of available donor sites for microvascular flap transfer. If the indication is appropriate, it is now possible to perform personalised, safe and successful microsurgical reconstructions, almost independently of the patients' age. Despite these constant developments, there is little specific literature on microsurgery related to the specific problems of the elderly patient...
October 18, 2017: Handchirurgie, Mikrochirurgie, Plastische Chirurgie
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