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Vascularized flap

Mathew Geltzeiler, Ana Carolina Igami Nakassa, Meghan Turner, Pradeep Setty, George Zenonos, Andrea Hebert, Eric Wang, Juan Fernandez-Miranda, Carl Snyderman, Paul Gardner
BACKGROUND: Vascularized intranasal flaps are the primary reconstructive option for endoscopic skull base defects. Flap vascularity may be compromised by injury to the pedicle or prior endonasal surgery. There is currently no validated technique for intraoperative evaluation of intranasal flap viability. OBJECTIVE: To evaluate the efficacy of indocyanine green (ICG) near-infrared angiography in predicting the viability of pedicled intranasal flaps during endoscopic skull base surgery through a pilot study...
March 14, 2018: Operative Neurosurgery (Hagerstown, Md.)
Aderaldo Costa Alves Junior, Pedro Tadao Hamamoto Filho, Marcelo Pacheco Gonçalves, Aristides Augusto Palhares Neto, Marco Antonio Zanini
Cranioplasty is a common procedure in neurosurgical practice, but associated with high complication rates. In the current study, the authors describe surgical characteristics and results of cranioplasty performed in a tertiary teaching hospital in Brazil. Data were obtained from electronic medical records of cranioplasties performed between January 2013 and November 2016. The sample comprised of 33 patients, and the mean follow-up time was 16 months. Patients presented most of the times a good preoperative status, with 84...
March 16, 2018: Journal of Craniofacial Surgery
Stephen L Viviano, Farrah C Liu, Paul J Therattil, Edward S Lee, Jonathan D Keith
BACKGROUND: Thinning of anterolateral thigh (ALT) flaps has been described to achieve optimal contouring. Previous studies caution against thinning large flaps owing to the risk of vascular compromise leading to partial or total flap necrosis. This study aims to demonstrate a reliably safe method for thinning extra-large (>240 cm) flaps. METHODS: A retrospective review of 53 consecutive ALT flaps performed at a single institution was completed. Of these flaps, 18 (34%) were thinned primarily by sharp excision of sub-Scarpa's fat along the periphery of the flap using loupe magnification...
March 16, 2018: Annals of Plastic Surgery
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
Ruifu Yang, Mingwu Zhou, Chaofeng Xing, Shimin Li, Li Song, Jia Chen, Yingjie Xiong, Kai Zhang
Objective: To expound the clinical effect of a new operation by transplanting double segment triangular fibula flap with vascular pedicle to repair the forefoot with lateral bone defect, and to study how to improve the operation method in the following stage. Methods: The inclusion criteria: More than 2 phalangeal and metatarsal bones defects of the lateral forefoot, widespread skin and soft tissue defects on pelma and dorsal foot, and destruction of the anterior aspect of foot arch, which seriously affects the foot function...
December 2017: Saudi Journal of Biological Sciences
Hin-Lun Liu, Suet-Ying Pang, Chung-Ching Lee, Melody Man-Kuen Wong, Hon-Ping Chung, Yu-Wai Chan
INTRODUCTION: Vascularized lymph node transfer (VLNT) has become very popular in the treatment of secondary lymphedema. However, the mechanism has not been clearly elucidated. The purpose of this study was (1) to evaluate the outcome of vascularized groin lymph node (VGLN) transfer using axilla as a recipient site in patients with breast cancer-related lymphedema (BCRL) and (2) to provide radiological evidence of lymphangiogenesis in VLNT. METHODS: Between August 2013 and June 2016, 30 consecutive patients with a mean age of 60 years underwent VGLN transfer for BCRL...
February 28, 2018: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
Rebecca Shirley, Janka Fazekas, Martin McNally, Alex Ramsden
Aim : This study aimed to define the costs of surgical management of chronic osteomyelitis where free tissue transfer was required in addition to debridement of bone, particularly the increased costs incurred by a return to theatre. We hypothesised that there would be a significantly greater cost when patients required re-exploration for vascular compromise. Method : We retrospectively analysed the costs of a consecutive series of sixty patient episodes treated at the Bone Infection Unit in Oxford from 2012 to 2015...
2018: Journal of Bone and Joint Infection
Jun Li, Yi Shen, Liang Wang, Jin-Bing Wang, Jian Sun, Thorsen W Haugen
PURPOSE: The aims of this study are to review our surgical experience in maxillary and midface reconstruction using free vascularized tissue and to compare the postoperative outcomes based on superficial temporal versus cervical recipient vessels. MATERIALS AND METHODS: We performed a retrospective review of patients who underwent maxillary and midface reconstruction with free vascularized tissue from March 2001 to July 2014. Two groups were analyzed: those in whom superficial temporal vessels were used as the recipient vessels and those in whom cervical vessels were used as the recipient vessels...
February 20, 2018: Journal of Oral and Maxillofacial 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
R Cuthbert, C Deutsch, A Roy, P Stimpson, H Patel
Introduction The free jejunal flap represents the gold standard for circumferential defects in upper digestive tract reconstruction. It is a technically demanding procedure with significant failure rates. Unrecognised failure leads to flap necrosis and potentially fatal sequelae, including sepsis and carotid artery bleed. Despite these catastrophic consequences, however, there remains no consensus on an optimum method for postoperative flap monitoring. Our unit has pioneered the use of external colour duplex ultrasound to monitor flap vascularity...
March 15, 2018: Annals of the Royal College of Surgeons of England
Daniele Alberti, Laura Righetti, Adrian Bianchi, Gian Luigi de'Angelis, Giovanni Boroni
BACKGROUND: Bowel dilatation is a common adaptive mechanism after intestinal resection. The symptomatic dilated dysmotile duodenum is difficult to manage, since conventional bowel tailoring and lengthening techniques are potentially hazardous because of the anatomy of the duodenal blood supply, the proximity to the pancreas, and the risk of injury to the common bile duct. METHODS: A 2-month-old child with short bowel and a symptomatic massively dilated duodenum was treated with a Transverse Flap Duodenoplasty (TFD)...
March 14, 2018: Pediatric Surgery International
Aaron M Rutman, Justin E Vranic, Mahmud Mossa-Basha
Blunt cerebrovascular injury (BCVI) is a relatively rare but potentially devastating finding in patients with high-energy blunt force trauma or direct cervical and/or craniofacial injury. The radiologist plays an essential role in identifying and grading the various types of vascular injury, including minimal intimal injury, dissection with raised intimal flap or intraluminal thrombus, intramural hematoma, pseudoaneurysm, occlusion, transection, and arteriovenous fistula. Early identification of BCVI is important, as treatment with antithrombotic therapy has been shown to reduce the incidence of postinjury ischemic stroke...
March 2018: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Kohei Okuyama, Masashi Yamashiro, Atsushi Kaida, Aya Kawamata, Miho Mizutani, Yasuyuki Michi, Narikazu Uzawa, Tomoyuki Yano, Rei Tohyama, Satoshi Yamaguchi
For young growing children before the end of skeletal maturity, the growth activity of the grafted bone after hemimandibulectomy is not well-known. After an adolescence, such a patient may have facial deformity because the anterior growth point of the mandible is in the condylar neck. A 13-year-old boy was performed hemimandibulectomy with immediate mandibular reconstruction by fibula free flap (FFF) because of a huge ameloblastic fibroma. The authors evaluated the length of FFF on the images of computed tomography (CT) at 5 and 60 months after the operation and compared them by calculating growth rates...
March 8, 2018: Journal of Craniofacial Surgery
Daniele Marchioni, Angelo Musumeci, Cristoforo Fabbris, Stefano De Rossi, Davide Soloperto
BACKGROUND: The clivus is a region characterized by complex anatomy, with vascular and neural structures that are located in close proximity. Different pathologies can affect this area, and traditional surgical approaches were open approaches. Recently, the endoscopic transnasal technique has been introduced, and currently represents a good alternative for the surgical management of these lesions. This is a preliminary report on patients treated endoscopically for clival lesions by the authors' Skull Base Team...
March 8, 2018: European Archives of Oto-rhino-laryngology
Rafi Sheikh, Khashayar Memarzadeh, Christian Torbrand, Jonas Blohmé, Sandra Lindstedt, Malin Malmsjö
Purpose: The eyelid is commonly dissected and divided in the process of, for example, blepharotomy, entropion repair, or when preparing a full-thickness eyelid flap to reconstruct a tumor defect. No study has yet been conducted to examine how perfusion in an eyelid is affected by dissection, using modern imaging techniques. Methods: The eyelid was divided with a 10-mm vertical incision, 5 mm from the medial canthus, and the incision was extended horizontally by 30 mm to provide a full-thickness eyelid. Blood perfusion was measured along the length of the free dissected eyelid using both laser Doppler velocimetry and laser speckle contrast imaging...
2018: Eplasty
Ömer Özkan, Özlenen Özkan, Anı Çinpolat, Nasuh Utku Doğan, Gamze Bektaş, Kemal Dolay, Alihan Gürkan, Cumhur Arıcı, Selen Doğan
Although vaginal reconstructions with intestinal segments require particularly complex surgical procedures, this technique has become popular with respect to fairly good functional and esthetic outcomes. This study describes cases of vaginal reconstruction performed using a modified rectosigmoid colon held in an ischemic state in order to reduce secretion and denervated in order to prevent defecation problems. Vaginal reconstructions with rectosigmoid colon were performed on 43 patients. In this retrospective study, 34 patients had Müllerian agenesis, while nine had undergone male to female sex reassignment surgery in which adequate vaginal depth had not been achieved...
March 8, 2018: Journal of Plastic Surgery and Hand Surgery
Elizabeth O Kenworthy, Jonas A Nelson, Richa Verma, JeanJacques Mbabuike, Babak J Mehrara, Joseph H Dayan
BACKGROUND AND OBJECTIVES: Orthotopic vascularized lymph node transplant has been successfully used to treat lymphedema. A second, heterotopic lymph node transplant in the distal extremity may provide further improvement. The vascularized omentum lymphatic transplant (VOLT) provides adequate tissue for two simultaneous flap transfers to one limb. The purpose of this study was to review our experience with this technique. METHODS: We conducted a retrospective study of patients who underwent VOLT, with a subgroup analysis of patients who underwent double VOLT...
March 8, 2018: Journal of Surgical Oncology
Cimara Fortes Ferreira, Edival Barreto de Magalhães Junior, Barbara Zini
Achieving excellence in anterior rehabilitations requires close cooperation between the periodontist and the prosthodontist. Many techniques can be used to restore the lost alveolar hard and soft tissues. The more severe the peri-implant defect, the higher the challenge and lower the predictability of the procedure. The present case consists of Seibert class III with mal-aligned implants in the esthetic zone resolved with a cost-modified treatment plan to re-establish esthetics in the anterior maxilla using rotated palatal flap...
March 8, 2018: Journal of Oral Implantology
Sarina K Mueller, Suzanne K Freitag, Daniel R Lefebvre, Nahyoung G Lee, Benjamin S Bleier
BACKGROUND: Endoscopic dacryocystorhinostomies (eDCRs) show patency rates between 81% and 94%. However, dacryocystorhinostomy (DCR) failure and the need for revision remain a significant challenge. One of the principal challenges in revision eDCR is the need to surgically identify the correct osteotomy site and maintain long-term patency in the setting of previously instrumented and potentially scarred tissue. At the same time, the surgeon must assume that the blood supply to the commonly described anterior and posteriorly pedicled flaps has been compromised...
March 8, 2018: Orbit
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
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