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Microvascular reconstruction

Mitchell L Worley, Evan M Graboyes, Julie Blair, Suhael Momin, Kent E Armeson, Terry A Day, Andrew T Huang
Objective To describe swallowing outcomes in elderly patients undergoing microvascular reconstruction of the upper aerodigestive tract and identify risk factors for poor postoperative swallowing function. Study Design Case series with chart review. Setting Academic medical center. Subjects and Methods Sixty-six patients aged ≥70 years underwent microvascular reconstruction of the upper aerodigestive tract. The primary outcome measure was the Functional Oral Intake Scale (FOIS); preoperative and postoperative scores were dichotomized to define "good swallowing" and "poor swallowing...
March 1, 2018: Otolaryngology—Head and Neck Surgery
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.)
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
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
Michael P Veve, Joshua B Greene, Amy M Williams, Susan L Davis, Nina Lu, Yelizaveta Shnayder, David X Li, Salem I Noureldine, Jeremy D Richmon, Lawrence O Lin, Matthew M Hanasono, Patrik Pipkorn, Ryan S Jackson, Joshua D Hornig, Tyler Light, Mark K Wax, Yin Yiu, James Bekeny, Matthew Old, David Hernandez, Urjeet A Patel, Tamer A Ghanem
Objective To characterize and identify risk factors for 30-day surgical site infections (SSIs) in patients with head and neck cancer who underwent microvascular reconstruction. Study Design Cross-sectional study with nested case-control design. Setting Nine American tertiary care centers. Subjects and Methods Hospitalized patients were included if they underwent head and neck cancer microvascular reconstruction from January 2003 to March 2016. Cases were defined as patients who developed 30-day SSI; controls were patients without SSI at 30 days...
March 1, 2018: Otolaryngology—Head and Neck Surgery
Jason Silvestre, Joseph Upton, Benjamin Chang, David R Steinberg
BACKGROUND: Hand surgery fellowship programs in the United States are predominately sponsored by departments or divisions of orthopaedic surgery or plastic surgery. This study compares the operative experiences of hand surgery fellows graduating from orthopaedic or plastic surgery hand surgery fellowships. METHODS: Operative case logs of 3 cohorts of hand surgery fellows graduating during the academic years of 2012-2013, 2013-2014, and 2014-2015 were analyzed. The median case volumes were compared by specialty via Mann-Whitney U tests...
March 7, 2018: Journal of Bone and Joint Surgery. American Volume
Dimitra Kotsougiani, Caroline A Hundepool, Liselotte F Bulstra, Patricia F Friedrich, Alexander Y Shin, Allen T Bishop
INTRODUCTION: In prior small animal studies, we maintained vascularized bone allotransplant viability without long-term immunotherapy. Instead, an autogenous neoangiogenic circulation is created from implanted vessels, sufficient to maintain bone viability with only 2 weeks immunosupression. Blood flow is maintained despite rejection of the allogeneic vascular pedicle thereafter. We have previously described a large animal (swine) pre-clinical model, reconstructing tibial defects with vascularized tibial allotransplants...
March 5, 2018: Microsurgery
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
Craig A Bollig, Claire S Spradling, Laura M Dooley, Tabitha L Galloway, Jeffrey B Jorgensen
BACKGROUND: The effects of perioperative hyperglycemia on complications and outcomes in microvascular reconstruction have not been reported in the literature. METHODS: A retrospective cohort of 203 patients undergoing microvascular reconstruction was generated. Perioperative glucose levels and clinical factors were tested for associations with complications using simple and multivariate analyses. RESULTS: Hyperglycemia (blood glucose ≥ 180 mg/dL) occurred in 91 patients (44...
March 1, 2018: Head & Neck
Evan M Graboyes, Travis P Schrank, Mitchell L Worley, Suhael R Momin, Terry A Day, Andrew T Huang
BACKGROUND: Characteristics of 30-day unplanned readmissions after head and neck microvascular reconstruction remain poorly understood. METHODS: We conducted a retrospective cohort of patients who underwent head and neck microvascular reconstruction between 2010 and 2015. RESULTS: The 30-day unplanned readmission rate was 13.0% (64/493). The most common readmission diagnoses were dehiscence, surgical site infection, or fistula (45.3%; n = 29)...
March 1, 2018: Head & Neck
Shujing Yao, Jiashu Zhang, Yining Zhao, Yuanzheng Hou, Xinghua Xu, Zhizhong Zhang, Ron Kikinis, Xiaolei Chen
OBJECTIVE: To address the feasibility and predictive value of multimodal image-based virtual reality in detecting and assessing features of neurovascular confliction (NVC), particularly regarding the detection of offending vessels, degree of compression exerted on the nerve root, in patients who underwent microvascular decompression (MVD) for non-lesional trigeminal neuralgia (TN) and hemi-facial spasm (HFS). METHODS: This prospective study includes 42 consecutive patients who underwent MVD for classic primary TN or HFS...
February 21, 2018: World Neurosurgery
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
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
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
Arezoo Astanehe, Claire Temple-Oberle, Markus Nielsen, William de Haas, Robert Lindsay, Jennifer Matthews, David C McKenzie, Justin Yeung, Christiaan Schrag
Background: The aim of this study was to develop, implement, and evaluate a standardized perioperative enhanced recovery after surgery (ERAS) clinical care pathway in microsurgical abdominal-based breast reconstruction. Methods: Development of a clinical care pathway was informed by the latest ERAS guideline for breast reconstruction. Key features included shortened preoperative fasting, judicious fluids, multimodal analgesics, early oral nutrition, early Foley catheter removal, and early ambulation...
January 2018: Plastic and Reconstructive Surgery. Global Open
Yun-Min Kook, Hyerim Kim, Sujin Kim, Chan Yeong Heo, Min Hee Park, Kangwon Lee, Won-Gun Koh
New blood vessel formation is essential for tissue regeneration to deliver oxygen and nutrients and to maintain tissue metabolism. In the field of tissue engineering, in vitro fabrication of new artificial vessels has been a longstanding challenge. Here we developed a technique to reconstruct a microvascular system using a polycaprolactone (PCL)/gelatin nanofibrous structure and a co-culture system. Using a simple electrospinning process, we fabricated three-dimensional mesh scaffolds to support the sprouting of human umbilical vein endothelial cells (HUVECs) along the electrospun nanofiber...
February 18, 2018: Nanomaterials
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
Sooneon Bae, Michael J DiBalsi, Nicole Meilinger, Chengqi Zhang, Erica Beal, Guzeliya Korneva, Robert O Brown, Konstantin G Kornev, Jeoung Soo Lee
The surgical connection of blood vessels, anastomosis, is a critical procedure in many reparative, transplantation, and reconstructive surgical procedures. However, effective restoration of circulation is complicated by pathological clotting (thrombosis) or progressive occlusion due to excess cell proliferation that often leads to additional surgeries and increases morbidity and mortality risk for patients. Pharmaceutical agents have been tested to prevent these complications, but many have unacceptable systemic side effects...
February 20, 2018: ACS Applied Materials & Interfaces
Nagarajesh Gorlamandala, Jasneet Parmar, Amanda J Craig, John M Power, Andrew J Moorhouse, Arun V Krishnan, Gary D Housley
It is generally accepted that the cerebellum is particularly vulnerable to ischaemic injury, and this may contribute to the high mortality arising from posterior circulation strokes. However, this has not been systematically examined in an animal model. This study compared the development and resolution of matched photothrombotic microvascular infarcts in the cerebellar and cerebral cortices in adult 129/SvEv mice of both sexes. The photothrombotic lesions were made using tail vein injection of Rose Bengal with a 532 nm laser projected onto a 2 mm diameter aperture over the target region of the brain (with skull thinning)...
February 17, 2018: Translational Stroke Research
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
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