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Microvascular reconstruction

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https://www.readbyqxmd.com/read/29333783/-application-of-preoperative-vascular-localization-techniques-for-perforator-flaps
#1
Wu Lianjun, Wang Huiming
With the development of microvascular technology, perforator flaps have gradually become a good alternative for reconstruction of tissue defects. However, the major limitations of perforator flaps include uncertainty in predicting anatomical location of perforators and high variability in perforator size and course, which require preoperative localization techniques. Recently, as one of the preoperative localization techniques, computed tomography angiography was used to determine the number, size, course, and exact emerging point of perforator flaps...
December 1, 2017: Hua Xi Kou Qiang Yi Xue za Zhi, Huaxi Kouqiang Yixue Zazhi, West China Journal of Stomatology
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
#2
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/29319579/how-big-is-too-big-pushing-the-obesity-limits-in-microsurgical-breast-reconstruction
#3
Jamie A Spitz, Perry S Bradford, Frank Aguilar, Sergey Y Turin, Marco F Ellis
PURPOSE: Obesity is a major public health concern in the United States, affecting nearly 79 million people. There have been promising results performing microvascular breast reconstruction in patients with obesity; however, the definition of obesity is often poorly defined or does not extend above a body mass index (BMI) of 35. Our goal was to examine outcomes of microvascular breast reconstruction in this questionably more risky population. METHODS: A retrospective review from 2013 to 2016 was performed of 2 surgeons' experience with abdominally based microvascular breast reconstructions...
February 2018: Annals of Plastic Surgery
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
#4
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
#5
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
#6
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...
December 30, 2017: Annals of Surgical Oncology
https://www.readbyqxmd.com/read/29284902/elongated-miofascial-temporal-flap-in-comparison-with-standard-surgical-procedure-of-temporal-muscle-reconstruction
#7
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/29284164/current-practices-in-the-management-of-postoperative-arterial-vasospasm-in-microsurgery
#8
Sergey Y Turin, Robert L Walton, Gregory A Dumanian, John B Hijjawi, John A LoGiudice, Mohammed Alghoul
BACKGROUND:  Postoperative microvascular arterial vasospasm is a rare clinical entity. There are no published management algorithms and also the pathophysiology of this phenomenon has not been elucidated. METHODS:  An email survey of American Society for Reconstructive Microsurgery (ASRM) and World Society for Reconstructive Microsurgery (WSRM) members regarding their experiences with postoperative arterial vasospasm was conducted, returning 116 responses. A comprehensive literature search was conducted regarding the current body of knowledge on this entity...
December 28, 2017: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/29284163/geometric-three-dimensional-end-to-side-microvascular-anastomosis-a-simple-and-reproducible-technique
#9
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
https://www.readbyqxmd.com/read/29283939/rabdomyosarcoma-of-the-mandible-an-uncommon-clinical-presentation
#10
Cleverton Roberto de Andrade, Guilherme Dos Santos Trento, Fabiano Jeremias, Elisa Maria Aparecida Giro, Marisa Aparecida Cabrini Gabrielli, Mario Francisco Real Gabrielli, Oslei Paes de Almeida, Valfrido Antonio Pereira-Filho
Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in children and adolescents. Most patients present with a mass in the head and neck region, urogenital region, or with distal extremity involvement. The authors describe a challenging case of a 6-year-old male patient presenting with mandibular RMS. The clinical/radiographic/tomographic evaluations classified the tumor as an advanced stage (stage IV), with a mass of 6.0 cm involving the left side of the mandible and parotid region. The biopsy revealed round, spindled, and pleomorphic cells with hyperchromatic nuclei and rare larger rhabdomyoblasts with eosinophilic cytoplasm...
December 27, 2017: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/29280859/outcome-analysis-of-free-flap-salvage-in-outpatients-presenting-with-microvascular-compromise
#11
Rene D Largo, Jesse C Selber, Patrick B Garvey, Edward I Chang, Matthew M Hanasono, Peirong Yu, Charles E Butler, Donald P Baumann
BACKGROUND: Extensive flap salvage attempts are routinely performed in patients with late-onset flap vascular crisis despite low flap survival rates. A knowledge gap exists in management of compromised free flaps in patients who present with perfusion-related complications after hospital discharge. METHODS: A retrospective review of 7443 free flaps used in 7128 cancer patients at a single institution from January of 2001 to March of 2015 was performed. RESULTS: Of 7443 free flap reconstructions, 856 patients (12 percent) were taken back to the operating room...
January 2018: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/29258778/effects-of-deep-sedation-under-mechanical-ventilation-on-cognitive-outcome-in-patients-undergoing-surgery-for-oral-and-maxillofacial-cancer-and-microvascular-reconstruction
#12
Y Terada, S Inoue, M Konda, J Egawa, J Ueda, T Kirita, M Kawaguchi
OBJECTIVE: Cognitive impairment after intensive care unit (ICU) admission is becoming increasingly recognized. High-dose deep sedation has been suggested to play an important role in the development of cognitive impairment. However, the impact of heavy sedation as a single cause in the development of cognitive impairment in ICU patients remains unclear. In this study we investigated whether a three-day deep sedation protocol could reduce cognitive function in mechanically ventilated non-critical patients...
December 16, 2017: Medicina Intensiva
https://www.readbyqxmd.com/read/29243415/compact-dual-mode-diffuse-optical-system-for-blood-perfusion-monitoring-in-a-porcine-model-of-microvascular-tissue-flaps
#13
Seung Yup Lee, Julia M Pakela, Michael C Helton, Karthik Vishwanath, Yooree G Chung, Noah J Kolodziejski, Christopher J Stapels, Daniel R McAdams, Daniel E Fernandez, James F Christian, Jameson O'Reilly, Dana Farkas, Brent B Ward, Stephen E Feinberg, Mary-Ann Mycek
In reconstructive surgery, the ability to detect blood flow interruptions to grafted tissue represents a critical step in preventing postsurgical complications. We have developed and pilot tested a compact, fiber-based device that combines two complimentary modalities-diffuse correlation spectroscopy (DCS) and diffuse reflectance spectroscopy-to quantitatively monitor blood perfusion. We present a proof-of-concept study on an in vivo porcine model (n=8). With a controllable arterial blood flow supply, occlusion studies (n=4) were performed on surgically isolated free flaps while the device simultaneously monitored blood flow through the supplying artery as well as flap perfusion from three orientations: the distal side of the flap and two transdermal channels...
December 2017: Journal of Biomedical Optics
https://www.readbyqxmd.com/read/29239686/recurrent-posterior-circulation-infarcts-secondary-to-vertebral-artery-external-compression-treated-with-endovascular-deconstruction
#14
Aldo Fabrizio Berti, Atif Zafar, Asad Ikram, Christopher S Calder, Danielle Eckart Sorte
When multiple, recurrent infarcts occur in spite of maximal medical management, the level of suspicion for atypical vascular injury should be heightened. We present a case of a patient who presented with recurrent posterior circulation infarcts despite optimized medical management. On imaging, he was found to have external anatomical vertebral artery muscular and/or osseous compression leading to repetitive vascular injury and strokes. Recurrent intimal injury and vertebral artery to intracranial emboli despite anticoagulation and subsequent dual antiplatelet therapy necessitated definitive operative management...
January 1, 2017: Interventional Neuroradiology
https://www.readbyqxmd.com/read/29233698/ex-corpore-linguae-a-cohort-analysis-after-a-unique-surgical-technique-in-oral-cancer-resection
#15
Jan-Falco Wilbrand, Daniel Schmermund, Michael Knitschke, Philipp Streckbein, Christopher Kähling, Heiko Kerkmann, Heidrun Schaaf, Hans-Peter Howaldt, Sebastian Böttger
OBJECTIVE: Resection of posteriorly located oral squamous cell carcinomas (OSCCs) remains challenging for head and neck surgeons. However, several surgical techniques, such as lip and mandibular splitting, as well as submental "visor drop-down" of intraoral soft tissues, have been proposed for this purpose. Merrick et al. suggested that a pedicled genial drop-down surgical approach should be used to resect dorsally located OSCCs. Our study investigated patient outcomes following this surgical procedure, as no previous study has analyzed long-term follow-up data...
November 21, 2017: Journal of Cranio-maxillo-facial Surgery
https://www.readbyqxmd.com/read/29230869/microvascular-replantation-of-a-composite-facial-avulsion-in-a-24-month-old-child-after-dog-bite
#16
David Macias, Daniel I Kwon, Paul C Walker, Nathaniel R Peterson
Dog bite injuries are common sources of morbidity with an estimated incidence of 4.5 million bites per year with over 350,000 requiring treatment in the emergency room. Children under the age of 14 are most likely to be affected with a peak age of 5-9 years old. We report a case of a 24-month-old female who sustained a large composite facial avulsion injury from a pit bull dog bite. The avulsed tissue involved a substantial portion of the patient's mid-face, including the entire soft tissue of the nose, upper lip, part of the left cheek, and left oral commissure...
December 12, 2017: Microsurgery
https://www.readbyqxmd.com/read/29224810/utilization-of-a-pre-bent-plate-positioning-surgical-guide-system-in-precise-mandibular-reconstruction-with-a-free-fibula-flap
#17
Tingwei Bao, Jianfeng He, Changyang Yu, Wenquan Zhao, Yi Lin, Huiming Wang, Jianhua Liu, Huiyong Zhu
OBJECTIVES: We evaluated the effects of three-dimensional virtual planning and the use of a plate-embedded surgical guide in mandibular reconstruction with microvascular fibula flaps. MATERIALS AND METHODS: We retrospectively reviewed 35 patients who underwent primary mandibular reconstruction with a free fibula flap. They were divided into three groups according to the therapy they received. In group A, 12 patients underwent reconstruction using the modified surgical guide system, including virtual surgeries, pre-bent titanium plates, screw-predesignated cutting guides for mandibular and fibular osteotomies, and plate-embedded shaping guides...
December 2017: Oral Oncology
https://www.readbyqxmd.com/read/29218804/impact-of-diabetes-on-free-flap-surgery-of-the-head-and-neck-a-nsqip-analysis
#18
Jacob S Brady, Aparna Govindan, Meghan M Crippen, Andrey Filimonov, Jean Anderson Eloy, Soly Baredes, Richard Chan Woo Park
OBJECTIVE: Diabetes is associated with microvascular pathology and may predispose patients undergoing microvascular surgery to complications. This study assesses diabetes as a risk factor for complications following free flap surgery of the head and neck. PATIENTS AND METHODS: In this retrospective cohort study, data on free flap surgeries of the head and neck between 2005 and 2014 was collected from the National Surgical Quality Improvement Program (NSQIP) database...
December 8, 2017: Microsurgery
https://www.readbyqxmd.com/read/29205328/quantitative-analysis-of-hepatic-macro-and-microvascular-alterations-during-cirrhogenesis-in-the%C3%A2-rat
#19
Geert Peeters, Charlotte Debbaut, Adrian Friebel, Pieter Cornillie, Winnok H De Vos, Kasper Favere, Ingrid Vander Elst, Tim Vandecasteele, Tim Johann, Luc Van Hoorebeke, Diethard Monbaliu, Dirk Drasdo, Stefan Hoehme, Wim Laleman, Patrick Segers
Cirrhosis represents the end-stage of any persistent chronically active liver disease. It is characterized by the complete replacement of normal liver tissue by fibrosis, regenerative nodules, and complete fibrotic vascularized septa. The resulting angioarchitectural distortion contributes to an increasing intrahepatic vascular resistance, impeding liver perfusion and leading to portal hypertension. To date, knowledge on the dynamically evolving pathological changes of the hepatic vasculature during cirrhogenesis remains limited...
December 4, 2017: Journal of Anatomy
https://www.readbyqxmd.com/read/29192315/clinical-factors-associated-with-reoperation-and-prolonged-length-of-stay-in-free-tissue-transfer-to-oncologic-head-and-neck-defects
#20
William W Thomas, Jason Brant, Jinbo Chen, Orly Coblens, John P Fischer, Jason G Newman, Ara A Chalian, Rabie M Shanti, Steven B Cannady
Importance: Prolonged hospitalization and reoperation after free tissue transfer may be associated with certain clinical factors. Objective: To determine patient and surgical factors associated with length of stay (LOS) and reoperation following surgical procedures for malignant neoplasm of the head and neck involving microvascular free tissue transfer reconstruction. Design, Setting, and Participants: This was a retrospective review of American College of Surgeons National Surgical Quality Improvement Program data from 2012 to 2014 using International Classification of Diseases, Ninth Revision (ICD-9), codes for malignant neoplasms of the head and neck...
November 30, 2017: JAMA Facial Plastic Surgery
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