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Microvascular reconstruction

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https://www.readbyqxmd.com/read/28918934/reconstructive-microsurgical-approach-for-the-treatment-of-pyoderma-gangrenosum
#1
Karl Schwaiger, Elisabeth Russe, Hassan Kholosy, Michaela Hladik, Klemens Heinrich, Laurenz Weitgasser, Thomas Schoeller, Gottfried Wechselberger
INTRODUCTION: Pyoderma gangrenosum (PG) is a rare type of autoimmune disease that results in progressive ulcers with or without previous trauma. However, PG is not well understood to date, and its treatment therefore remains a challenge. Because of the disease's systemic characteristic and the unpredictability of the clinical course, no gold standard treatment is available, especially concerning the surgical procedures to treat pyodermic lesions. Often, PG is not recognized during routine clinical practice, and standard ulcer treatment (conservative wound care, debridement, skin grafting, and local flap coverage) is initiated; this induces an autoinflammatory response, resulting in disastrous ulcers, thereby making free flap coverage necessary...
August 16, 2017: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/28913317/reconstruction-of-a-complex-scalp-defect-after-the-failure-of-free-flaps-changing-plans-and-strategy
#2
Youn Hwan Kim, Gyeong Hoe Kim, Sang Wha Kim
The ideal scalp reconstruction involves closure of the defect with similar hair-bearing local tissue in a single step. Various reconstructions can be used including primary closure, secondary healing, skin grafts, local flaps, and microvascular tissue transfer. A 53-year-old female patient suffered glioblastoma, which had recurred for the second time. The neurosurgeons performed radial debridement and an additional resection of the tumor, followed by reconstruction using a serratus anterior muscle flap with a split-thickness skin graft...
June 2017: Arch Craniofac Surg
https://www.readbyqxmd.com/read/28910897/-the-application-of-microvascular-anastomotic-coupler-in-vascular-anastomosis-of-free-tissue-flap-for-reconstruction-of-defect-after-head-and-neck-cancer-resection
#3
Y J Zhang, Z H Wang, C H Li, J Chen
Objective: To investigate the application and operation skills in vein anastomosis by microvascular anastomotic coupler (MAC) in reconstruction of defects after head and neck cancer resection. Methods: From August 2015 to July 2016, in Department of Head and Neck Surgery, Sichuan Cancer Hosipital, 17 cases underwent the reconstruction of defects after head and neck cancer resection with free tissue flaps, including forearm flaps in 11 casess, anterolateral flaps in 4 casess and fibula flaps in 2 casess. Totally 17 MAC were used, including 14 MAC for end-to-end anastomosis and 3 MAC for end-to-side anastomosis...
September 7, 2017: Zhonghua Er Bi Yan Hou Tou Jing Wai Ke za Zhi, Chinese Journal of Otorhinolaryngology Head and Neck Surgery
https://www.readbyqxmd.com/read/28894667/dual-vascular-free-anterolateral-thigh-flap
#4
Toshiaki Numajiri, Daiki Morita, Shoko Tsujiko, Hiroko Nakamura, Yoshihiro Sowa, Akihito Arai, Matsui Masahiro, Hiroshi Nakano, Shigeru Hirano
BACKGROUND: The optimum number of microvascular anastomoses for safe free tissue transfer is controversial. Although the case for 2 venous anastomoses versus 1 anastomosis has been argued, the use of an additional arterial anastomosis has not been examined in detail. METHODS: Twelve patients who underwent 2 arterial anastomoses for a free flap transfer were identified retrospectively from the medical records of patients undergoing reconstruction for head and neck cancer...
August 2017: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/28894665/late-arterial-thrombosis-after-microvascular-head-and-neck-reconstruction-due-to-combined-factors-of-pedicle-artery-loop-and-submandibular-gland-swelling
#5
Yu Kagaya, Masaki Arikawa, Shimpei Miyamoto
Late arterial thrombosis of a free flap is rare and usually unsalvageable because it is hard to detect. We herein report 2 cases of arterial thrombosis of a free flap after microvascular head and neck reconstruction due to the combined factors of pedicle artery loop and compression by a swollen submandibular gland, the occurrence of thrombosis in both of which was > 72 hours after the operation. In case 1, the arterial thrombosis was undetectable, and it was too late for a successful take-back operation, so the flap was lost...
August 2017: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/28892943/reconstruction-of-maxilla-with-titanium-mesh-and-fascia-lata-a-case-report
#6
Devkumar Rengaraja, Mohan Jagade, Karthik Rao, Radhika Sonate, Arpita Singhal
Maxillary defect reconstruction has been a grave challenge which unfortunately has stopped many ENT surgeons from attempting maxillectomy due to the fear of reconstruction. With our technique of reconstructing the maxillary defect with titanium mesh and fascia lata, the need for microvascular assistance is obviated. Here we describe a revision case of ameloblastoma of maxilla in a 33-year-old female for which total maxillectomy with reconstruction was done without the aid of microvascular tissue transfer. The aim of this article is to encourage and alleviate the fear among the ENT surgeons, in attempting maxillectomy and its reconstruction for delivering an equally good aesthetic and functional outcome especially at the centres where the facility of plastic assistance is not readily available...
July 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28885383/application-of-a-modified-pedicled-adipofascial-lateral-arm-flap-in-the-prevention-and-treatment-of-radial-nerve-injuries
#7
Steven M Koehler, Andrew P Matson, Suhail K Mithani
The fasciocutaneous lateral arm flap is a workhorse flap in upper extremity reconstruction. However, its adipofascial variant is not widely used. The technique can be used in various clinical scenarios. The adipofascial flap can be transposed to circumferentially wrap the radial nerve with a pliable, vascularized fat and fascial envelope, mimicking the natural fatty environment of peripheral nerves. This technique has the advantage of providing a scar tissue barrier, a barrier to hardware irritation and a milieu for vascular regeneration of the nerve...
September 6, 2017: Techniques in Hand & Upper Extremity Surgery
https://www.readbyqxmd.com/read/28882491/anatomic-and-high-resolution-computed-tomographic-angiography-study-of-the-lateral-femoral-condyle-flap-implications-for-surgical-dissection
#8
Mohamed Morsy, Yoo Joon Sur, Osman Akdag, Amr Eisa, Tarek A El-Gammal, Nirusha Lachman, Steven L Moran
BACKGROUND: The lateral femoral condyle (LFC) flap is a vascularized bone flap based on the superior lateral genicular artery (SLGA). Harvest technique for this flap has not yet been demonstrated. The purpose of this study was to better delineate the blood supply to the bone and skin of this flap to allow for a safe and effective harvest. MATERIALS AND METHODS: Twenty-three lower extremities were injected with latex or a mixture of latex and barium sulfate. The SLGA was identified and dissected, documenting the course, diameter, anatomical relations, length, and branches...
August 16, 2017: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/28877384/exosomes-secreted-from-mutant-hif-1%C3%AE-modified-bone-marrow-derived-mesenchymal-stem-cells-attenuate-early-steroid-induced-avascular-necrosis-of-femoral-head-in-rabbit
#9
Haile Li, Danping Liu, Chen Li, Shanjian Zhou, Dachuan Tian, Dawei Xiao, Huan Zhang, Feng Gao, Jianhua Huang
Mesenchymal stem cells (MSCs)-derived exosomes exhibit protective effects on damaged or diseased tissues. Hypoxia-inducible factor 1α (HIF-1α) plays a critical role in bone development. However, HIF-1α is easily biodegradable under normoxic conditions. The bone-marrow-derived mesenchymal stem cells (BMSCs) were transfected with adenovirus carrying triple point-mutations (amino acids 402, 564, and 803) in the HIF-1α coding sequence (CDS). The mutant HIF-1α can efficiently express functional proteins under normoxic conditions...
September 6, 2017: Cell Biology International
https://www.readbyqxmd.com/read/28843005/reconstruction-of-midface-defects-with-the-osteocutaneous-radial-forearm-flap-evaluation-of-long-term-outcomes-including-patient-reported-quality-of-life
#10
Timothy M Connolly, Larissa Sweeny, Benjamin Greene, Anthony Morlandt, William R Carroll, Eben L Rosenthal
BACKGROUND: Maxillectomy defects significantly impair quality of life. Prosthetics can overcome some of these issues, but has limitations. The role of the osteocutaneous radial forearm free flap (OC-RFFF) has been established for reconstruction of smaller maxillectomy defects, but its role in larger defects is not well defined. We aim to evaluate outcomes after midface reconstruction utilizing the OC-RFFF. METHODS: Retrospective review of prospective database collected between 2005 and 2014 of midface reconstruction using OC-RFFF in a tertiary care centre...
August 26, 2017: Microsurgery
https://www.readbyqxmd.com/read/28842095/functional-outcomes-after-heel-pad-reconstruction-a-review-of%C3%A2-7%C3%A2-cases
#11
Koh Khai Luen, Wan Azman Wan Sulaiman
Sensate, durable heel pad reconstruction is challenging. The present study assessed the functional outcomes after heel pad reconstruction using various flap techniques at our institution. From June 2011 to June 2016 (5-year period), 7 consecutive patients underwent heel pad reconstruction for various etiologies, with 3 microvascular free flaps (42.9%; 2 musculocutaneous flaps [66.7%] and 1 contralateral medial plantar flap [33.3%]) and 4 local pedicle flaps (57.1%; 3 instep medial plantar artery flaps [75.0%] and 1 distally based reverse sural flap [25...
September 2017: Journal of Foot and Ankle Surgery: Official Publication of the American College of Foot and Ankle Surgeons
https://www.readbyqxmd.com/read/28838837/osteomyocutaneous-fibular-flap-harvesting-computer-assisted-planning-of-perforator-vessels-using-computed-tomographic-angiography-scan-and-cutting-guide
#12
Salvatore Battaglia, Vincenzo Maiolo, Gabriella Savastio, Maurizio Zompatori, Federico Contedini, Elisa Antoniazzi, Riccardo Cipriani, Claudio Marchetti, Achille Tarsitano
INTRODUCTION: Mandibular reconstruction performed after virtual planning has become more common during recent years. The gold standard for extensive mandibular reconstruction is of course a fibular free flap. In designing an osteomyocutaneous fibula flap, poor planning, aberrant anatomy and/or inadequate perforator vessels are the most frequent causes of complications and may force the surgeon to modify the flap design, explore the contralateral leg or harvest an additional microvascular flap...
July 29, 2017: Journal of Cranio-maxillo-facial Surgery
https://www.readbyqxmd.com/read/28838451/hepatic-artery-reconstruction-using-3-in-1-segmental-resection-in-pediatric-living-donor-liver-transplantation-a-case-report-and-literature-review
#13
Y Luo, D Zhao, M Zhang, T Zhou, B-J Qiu, J-J Zhang, Q Xia
We report a transplant of the left lateral liver segments with 3 arteries for a pediatric recipient from a living donor. A 6-month-old female infant was diagnosed with liver cirrhosis secondary to biliary atresia and scheduled for living donor liver transplantation (LDLT; mother as donor). Left lateral hepatectomy was performed at the donor site. The dissection of the left hepatic artery (HA), which was divided immediately after its origin, showed 3 branches for segments II, III, and IV. The arteries for segment II, segment III, and segment IV were anastomosed to the recipient HA...
September 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28836485/the-vascularization-pattern-of-acellular-nerve-allografts-after-nerve-repair-in-sprague-dawley-rats
#14
Zhaowei Zhu, Yanyan Huang, Xiaoyan Zou, Canbin Zheng, Jianghui Liu, Longhai Qiu, Bo He, Qingtang Zhu, Xiaolin Liu
OBJECTIVE: We have demonstrated that angiogenesis in acellular nerve allografts (ANAs) can promote neuroregeneration. The present study aimed to investigate the microvascular regeneration pattern of ANAs in Sprague-Dawley (SD) rats. METHODS: Sixty male SD rats were randomly divided into an autologous group and a rat acellular nerve allograft group (rANA), and 10-mm sciatic nerve defects were induced in these rats. On the 7th, 14th and 21st days after surgery, systemic perfusion with Evans Blue (EB) or lead oxide was performed on the rats through carotid intubation...
August 24, 2017: Neurological Research
https://www.readbyqxmd.com/read/28833281/a-vascularized-preputial-free-flap-for-labial-reconstruction-in-a-dog
#15
Chi-Hsin Liu, Lih-Seng Yeh
OBJECTIVE: To describe the clinical application of a vascularized preputial free flap in the reconstruction of a large facial-labial defect. STUDY DESIGN: Case report. ANIMALS: An adult neutered male mongrel dog with a large left facial-labial defect. METHODS: A preputial free flap was created by elevating the cranial part of the prepuce, using the ipsilateral caudal superficial epigastric vessels as a vascular pedicle...
August 22, 2017: Veterinary Surgery: VS
https://www.readbyqxmd.com/read/28831362/autologous-latissimus-dorsi-breast-reconstruction-flap-salvage-microvascular-anastomosis-with-serratus-branch
#16
Victoria Kuta, Martin LeBlanc
Autologous breast reconstruction has become a standard option during the recovery of breast cancer survivors. Although pedicle damage is a rare complication of this procedure, extensive torsion or tension can lead to partial or total flap failure. We report a case of partial flap salvage after accidental transection of the pedicled blood supply within the intramuscular course of a latissimus dorsi musculocutaneous flap. This salvage technique involved microvascular anastomosis between the remaining vasculature of the latissimus dorsi pedicle and the serratus branch of the thoracodorsal artery and vein...
July 2017: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/28820839/smaller-diameter-anastomotic-coupling-devices-have-higher-rates-of-venous-thrombosis-in-microvascular-free-tissue-transfer
#17
Summer E Hanson, Matthew B Mitchell, Nihanth Palivela, S Andrew Peng, Lei Feng, Rene D Largo, Charles E Butler, Patrick B Garvey
BACKGROUND: Smaller anastomotic coupling devices may increase the risk of complications in free flap reconstructions; however, the relationship between coupler size and venous thrombosis rates has not been adequately evaluated. We hypothesized that smaller-diameter coupling devices are associated with higher rates of venous thrombosis than larger diameter devices in free tissue transfer. METHODS: We retrospectively reviewed data prospectively entered into a central departmental database for all patients who underwent microsurgical free tissue transfer at our institution in 2001-2013...
August 8, 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28799442/the-use-of-innervated-radial-artery-superficial-palmar-branch-perforator-free-flap-for-complex-digital-injuries-reconstruction
#18
Zhenglin Chi, Georgios Pafitanis, Luis Eduardo Parra Pont, Roshan Vijayan, Stefano Marcelli, Weiyang Gao, Zan Li, Xiao Zhou, Dajiang Song, Peng Yang
Loco-regional flaps have been widely used for the reconstruction of digital injuries without requiring microvascular anastomosis, however, they result in scarring and compromised functional outcomes. This study demonstrates our experience utilizing the innervated radial artery superficial palmar branch (RASPB) perforator free flap for complex digital injury reconstruction. From May 2007 to March 2014, the innervated RASPB perforator free flap was used to reconstruct 79 distal complex hand and digital soft tissue defects of which 14 were used to re-vascularise the distal digit in a flow-through fashion...
August 11, 2017: Journal of Plastic Surgery and Hand Surgery
https://www.readbyqxmd.com/read/28796082/the-first-reported-case-of-primary-intestinal-type-adenocarcinoma-of-the-middle-ear-and-review-of-the-literature
#19
Marc-Elie Nader, Diana Bell, Lawrence Ginsberg, Franco DeMonte, G Brandon Gunn, Paul W Gidley
OBJECTIVE: Adenocarcinoma of the middle ear is a rare entity that must be distinguished from other adenomatous tumors of the temporal bone. We present the first patient of an intestinal-type adenocarcinoma originating from the middle ear. PATIENTS: A 58-year-old woman presented with an 8-year history of left otorrhea. Her middle ear effusions were quite thick and gummy. She underwent eight sets of pressure-equalization tubes within 3 years. In 2011, her physical examination identified a middle ear mass, and she underwent mastoidectomy...
October 2017: Otology & Neurotology
https://www.readbyqxmd.com/read/28767176/sequential-chimeric-medial-femoral-condyle-and-anterolateral-thigh-flow-through-flaps-for-one-stage-reconstructions-of-composite-bone-and-soft-tissue-defects-report-of-three-cases
#20
Dominic Henn, Mohamed H Abouarab, Christoph Hirche, Jochen F Hernekamp, Volker J Schmidt, Ulrich Kneser, Thomas Kremer
Small recalcitrant non-unions with poor perfusion require reconstruction with vascularized bone flaps. Cases with concomitant large soft tissue defects are especially challenging, since vascularized soft tissue transfer is often indicated and distant microvascular anastomoses may be required. We introduce a sequential chimeric free flap composed of a medial femoral condyle corticoperiosteal flap anastomosed to an anterolateral thigh flow-through flap (MFC-ALT flap) and report its use for reconstruction of small non-unions with concomitant large soft tissue defects in three exemplary patients...
August 2, 2017: Microsurgery
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