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Microvascular reconstruction

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https://www.readbyqxmd.com/read/29775983/classification-and-microvascular-flap-selection-for-anterior-cranial-fossa-reconstruction
#1
James D Vargo, Wojciech Przylecki, Paul J Camarata, Brian T Andrews
BACKGROUND:  Microvascular reconstruction of the anterior cranial fossa (ACF) creates difficult challenges. Reconstructive goals and flap selection vary based on the defect location within the ACF. This study evaluates the feasibility and reliability of free tissue transfer for salvage reconstruction of low, middle, and high ACF defects. METHODS:  A retrospective review was performed. Reconstructions were anatomically classified as low (anterior skull base), middle (frontal bar/sinus), and high (frontal bone/soft tissue)...
May 18, 2018: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/29762453/microvascular-replantation-following-facial-dog-bites-in-children-systematic-review-and-management-algorithm
#2
Amanda J Williams, Jeremy M Powers, Jennifer L Rhodes, Andrea L Pozez
BACKGROUND: Pediatric dog bite injuries account for 1% of emergency department visits per year and represent an underrecognized and underreported public health problem. Reconstructive surgery is frequently utilized, and in the most extreme injuries, microvascular replantation may be considered. We sought to systematically review the available literature on microvascular replantation after facial dog bite injuries in children, with particular attention to perioperative morbidity and long-term follow-up...
May 14, 2018: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/29761514/mandibular-reconstruction-in-elderly-patients
#3
Shimpei Miyamoto, Takuya Higashino, Minoru Sakuraba
BACKGROUND AND OBJECTIVES: The choice of reconstructive technique for a segmental mandibular defect in elderly patients is controversial. The aim of this study was to establish an algorithm for selecting a method of mandibular reconstruction in elderly patients. METHODS: We retrospectively evaluated 121 patients aged ≥65 years who underwent immediate microvascular mandibular reconstruction after oncologic resection. Patients were divided into three groups based on method of reconstruction: vascularized bone graft (n = 49), mandibular reconstruction plate and soft tissue flap (n = 22), and soft-tissue flap (n = 50)...
May 14, 2018: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/29753503/novel-esophageal-reconstruction-technique-via-transmediastinal-route-from-posterior-to-anterior-mediastinum-after-esophagectomy
#4
Takushi Yasuda, Osamu Shiraishi, Mitsuru Iwama, Tomoki Makino, Hiroaki Kato, Yutaka Kimura
BACKGROUND: The incidence of metachronous esophageal squamous cell cancer (ESCC) after head and neck cancer (HNC) and in elderly patients has increased. Both elderly ESCC patients and ESCC patients after HNC surgery are at potential risk for dysphagia, and for the latter, surgery in the neck is difficult. An intrathoracic anastomosis that bypasses the cervical procedure is preferable to preserve swallowing function and reduce surgical risk. In gastrectomized patients, because the stomach cannot be used as a substitute, securing graft blood supply is critical, but microvascular anastomosis cannot be easily added in procedures for intrathoracic posterior mediastinal reconstruction...
April 13, 2018: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29750670/modern-postoperative-monitoring-of-free-flaps
#5
Minna Kääriäinen, Elina Halme, Jussi Laranne
PURPOSE OF REVIEW: Flap failure in microvascular reconstruction is a costly complication with total flap loss being the worst-case scenario. With the aim to rapidly identify a postoperative circulatory problem, some susceptible flaps can be saved by careful clinical monitoring or by various technical monitoring methods. In head and neck surgery, where the flaps are often buried and difficult to monitor clinically, a reliable technical monitoring method would be useful. A broad range of different techniques are in use varying according to practical and personal preferences among clinics and surgeons...
May 9, 2018: Current Opinion in Otolaryngology & Head and Neck Surgery
https://www.readbyqxmd.com/read/29747901/use-of-a-microvascular-coupler-device-for-end-to-side-venous-anastomosis-in-oral-and-maxillofacial-reconstruction
#6
W-M Wang, L Huang, X Gao, Y-X Yuan, X-Q Chen, X-C Jian
The aim of this study was to compare the use of a microvascular coupler device (MCD) for end-to-side venous anastomosis (ETS group) and phleboplasties combined with MCD for end-to-end venous anastomosis (ETE group) in free tissue transfer for oral and maxillofacial reconstruction, with regard to the anastomosis time and occurrence of postoperative vascular crisis. The ETS group included 22 patients and the ETE group included 40 patients. Patient demographic data, anastomotic time, coupler size, microvascular complications, and flap survival rates were collected and analyzed...
May 7, 2018: International Journal of Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/29747829/local-low-shear-stress-and-endothelial-dysfunction-in-patients-with-nonobstructive-coronary-atherosclerosis
#7
Gerasimos Siasos, Jaskanwal D Sara, Marina Zaromytidou, Kyoung H Park, Ahmet Umit Coskun, Lilach O Lerman, Evangelos Oikonomou, Charles C Maynard, Dimitris Fotiadis, Kostas Stefanou, Michail Papafaklis, Lampros Michalis, Charles Feldman, Amir Lerman, Peter H Stone
BACKGROUND: Local hemodynamic factors are important determinants of atherosclerotic plaque development and progression. OBJECTIVES: The goal of this study was to determine the association between low endothelial shear stress (ESS) and microvascular and epicardial endothelial dysfunction in patients with early atherosclerosis. METHODS: Sixty-five patients (mean age 52 ± 11 years) with nonobstructive coronary atherosclerosis (luminal diameter stenosis <30%) were included...
May 15, 2018: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/29746277/skin-paddles-improve-muscle-flap-salvage-rates-after-microvascular-compromise-in-lower-extremity-reconstruction
#8
John T Stranix, Adam Jacoby, Z-Hye Lee, Lavinia Anzai, Pierre B Saadeh, Vishal Thanik, Jamie P Levine
PURPOSE: Free tissue transfer after lower extremity trauma is associated with notoriously high complication rates. Theoretically, the inclusion of a cutaneous paddle on muscle free flaps may improve clinical flap monitoring. The effect of skin paddle presence on muscle free flap salvage outcomes after take-back was examined. METHODS: Retrospective query of our institutional free-flap registry (1979-2016) identified 362 muscle-based flaps performed for soft tissue coverage after below-knee trauma...
April 30, 2018: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/29736288/reconstruction-of-the-adult-hemifacial-microsomia-patient-with-temporomandibular-joint-total-joint-prosthesis-and-orthognathic-surgery
#9
Piero Cascone, Valentino Vellone, Valerio Ramieri, Emanuela Basile, Achille Tarsitano, Claudio Marchetti
Background: HFM patients' reconstruction has always been a challenge for maxillofacial surgeons, and numerous reconstructive techniques have been described. Surgical treatment depends on the patient's age and contemplates Temporomandibular Joint (TMJ) reconstruction in conjunction with orthognathic surgery, usually necessary following completion of growth to maximize the functional and esthetic results. Distraction osteogenesis had gained popularity as valid alternative in growing patients, but the two primary methods to reconstruct the TMJs involve the use of autogenous, using free or microvascular bone grafts, or alloplastic graft, but there is no widely accepted method...
2018: Case Reports in Surgery
https://www.readbyqxmd.com/read/29730061/computed-tomographic-angiographic-perforator-localization-for-virtual-surgical-planning-of-osteocutaneous-fibular-free-flaps-in-head-and-neck-reconstruction
#10
Kyle S Ettinger, Amy E Alexander, Kevin Arce
Virtual surgical planning (VSP), computer-aided design and computer-aided modeling, and 3-dimensional printing are 3 distinct technologies that have become increasingly used in head and neck oncology and microvascular reconstruction. Although each of these technologies has long been used for treatment planning in other surgical disciplines, such as craniofacial surgery, trauma surgery, temporomandibular joint surgery, and orthognathic surgery, its widespread use in head and neck reconstructive surgery remains a much more recent event...
April 10, 2018: Journal of Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/29730059/nasotracheal-intubation-the-preferred-airway-in-oral-cavity-microvascular-reconstructive-surgery
#11
Jordan Gigliotti, Godwin Cheung, Omar Suhaym, Ramanakumar V Agnihotram, Michel El-Hakim, Nicholas Makhoul
PURPOSE: We aimed to describe the safety and effectiveness of nasotracheal intubation (NTI) in a cohort of patients undergoing reconstruction of oral cavity defects with free tissue transfer (FTT). MATERIALS AND METHODS: We implemented a retrospective cohort study and enrolled a sample composed of consecutive patients undergoing FTT reconstruction of oral cavity, maxillary, or mandibular defects between 2013 and 2017. These patients were all subject to a newly developed enhanced recovery-after-surgery protocol...
April 11, 2018: Journal of Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/29729609/virtual-surgical-planning-and-three-dimensional-printing-in-multidisciplinary-oncologic-chest-wall-resection-and-reconstruction-a-case-report
#12
Basel Sharaf, M Diya Sabbagh, Aparna Vijayasekaran, Mark Allen, Jane Matsumoto
INTRODUCTION: Primary sarcomas of the sternum are extremely rare and present the surgical teams involved with unique challenges. Historically, local muscle flaps have been utilized to reconstruct the resulting defect. However, when the resulting oncologic defect is larger than anticipated, local tissues have been radiated, or when preservation of chest wall muscles is necessary to optimize function, local reconstructive options are unsuitable. PRESENTATION OF CASE: Virtual surgical planning (VSP) and in house three-dimensional (3D) printing provides the platform for improved understanding of the anatomy of complex tumours, communication amongst surgeons, and meticulous pre-operative planning...
April 30, 2018: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/29727515/microv-technology-to-improve-transcranial-color-coded-doppler-examinations
#13
Giovanni Malferrari, Giuseppe Pulito, Attilia Maria Pizzini, Nicola Carraro, Giorgio Meneghetti, Enzo Sanzaro, Patrizio Prati, Antonio Siniscalchi, Daniela Monaco
The purpose of this review is to provide an update on technology related to Transcranial Color Coded Doppler Examinations. Microvascularization (MicroV) is an emerging Power Doppler technology which can allow visualization of low and weak blood flows even at high depths, thus providing a suitable technique for transcranial ultrasound analysis. With MicroV, reconstruction of the vessel shape can be improved, without any overestimation. Furthermore, by analyzing the Doppler signal, MicroV allows a global image of the Circle of Willis...
May 4, 2018: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
https://www.readbyqxmd.com/read/29723399/outcomes-of-microvascular-flap-reconstruction-of-the-head-and-neck-in-patients-receiving-systemic-immunosuppressive-therapy-for-organ-transplantation
#14
Mark V Schaverien, Riley A Dean, Jeffrey N Myers, Lin Fang, Rene D Largo, Peirong Yu
BACKGROUND: For organ transplant recipients, cancer secondary to immunosuppressive therapy threatens long-term survival. The associated multiple comorbidities make major free flap reconstruction following cancer surgery a complicated event. This study evaluates the outcomes of free flap reconstruction in this population. METHODS: A retrospective chart review of all head and neck free flap cases in patients with a history of organ transplantation receiving systemic immunosuppressive therapy between 2005 and 2017 at a single-institution was conducted...
May 3, 2018: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/29706734/thoracoumbilical-flap-anatomy-technique-and-clinical-applications-in-upper-limb-reconstruction-in-the-era-of-microvascular-surgery
#15
Ravikiran Naalla, Moumita De, Rakesh Dawar, Shashank Chauhan, Maneesh Singhal
Purpose: Microvascular reconstruction is the standard of care for salvage of soft tissue defects in complex upper extremity due to their distinct advantages over the pedicled flaps. However, in the era of microsurgery, pedicled flaps have an acceptable significant role for reconstruction of complex soft tissue defects. The authors aim to demonstrate the versatility of pedicled thoracoumbilical flap (TUF) in selected clinical scenarios. Patients and Methods: Retrospective analysis of patients who underwent TUF for upper limb posttraumatic reconstruction was performed between January 2016 and October 2017...
April 2018: Journal of Hand and Microsurgery
https://www.readbyqxmd.com/read/29705732/treatment-and-reconstruction-of-a-complicated-infected-scalp-squamous-cell-carcinoma-with-cns-invasion
#16
Andreas Nørgaard Glud, Frantz Rom Poulsen, Jane Linnet, Jens Ahm Sørensen
A 60-year-old male patient with a large infected cranial apex lesion was admitted with lethargy and mental status changes. The patient underwent evaluation with imaging studies, a skin biopsy, cultures with microscopy and a diagnostic burr hole. MRI and positron emission tomography/CT scan revealed a squamous cell carcinoma with ingrowth in the midline of the brain and subdural empyema infected with Streptococcus anginosus and Staphylococcus aureus High dose intravenous antibiotic treatment was initiated and the patient subsequently underwent a surgical resection of the carcinoma with a 1 cm margin of surrounding skin and skull...
April 28, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29701760/optical-techniques-for-perfusion-monitoring-of-the-gastric-tube-after-esophagectomy-a-review-of-technologies-and-thresholds
#17
S M Jansen, D M de Bruin, M I van Berge Henegouwen, S D Strackee, D P Veelo, T G van Leeuwen, S S Gisbertz
Anastomotic leakage is one of the most severe complications after esophageal resection with gastric tube reconstruction. Impaired perfusion of the gastric fundus is seen as the main contributing factor for this complication. Optical modalities show potential in recognizing compromised perfusion in real time, when ischemia is still reversible. This review provides an overview of optical techniques with the aim to evaluate the (1) quantitative measurement of change in perfusion in gastric tube reconstruction and (2) to test which parameters are the most predictive for anastomotic leakage...
April 26, 2018: Diseases of the Esophagus: Official Journal of the International Society for Diseases of the Esophagus
https://www.readbyqxmd.com/read/29697628/mechanical-versus-hand-sewn-venous-anastomoses-in-free-flap-reconstruction-a-systematic-review-and-meta-analysis
#18
Zaiou Zhu, Xiang Wang, Jia Huang, Jialiang Li, Xu Ding, Heming Wu, Ye Yuan, Xiaomeng Song, Yunong Wu
BACKGROUND: Venous complications are the primary reason for flap loss in massive defect reconstructions; therefore, the quality and reliability of microvascular anastomoses are significant. The aim of this systematic review was to evaluate venous anastomotic time, the venous complication rate, and the flap failure rate with the mechanical anastomotic coupling device versus the hand-sewn technique in venous anastomoses of microvascular free flap operations. METHODS: Chinese and English databases were searched for eligible articles published between their inception and July of 2017...
May 2018: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/29689575/investigating-patients-perception-of-microvascular-free-toe-flap-for-reconstruction-of-amputated-thumbs-a-guide-for-surgeons-during-informed-consent
#19
Johnny Ionut Efanov, Christopher Wong, Clarence Guilbault, Joseph Bou-Merhi, Patrick G Harris, Ali Izadpanah, Michel Alain Danino
BACKGROUND:  After thumb amputations, restoration of function and aesthetic can be accomplished with microvascular free toe flaps. However, many patients in clinical practice do not choose this reconstruction despite positive reported outcomes. This study aims to determine patients' perceptions with respect to free toe flaps to improve areas of informed consent. METHODS:  A retrospective survey was administered to patients with thumb amputations. Participants were required to complete a questionnaire about patient demographics, the Brief Michigan Hand Questionnaire (bMHQ), the standard gamble/time trade-off questionnaires for utility scores, and a questionnaire investigating potential reasons for electing not to undergo a free toe transfer...
April 24, 2018: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/29672783/-smartphone-based-thermography-for-perforator-localisation-in-microvascular-breast-reconstruction
#20
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
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