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https://www.readbyqxmd.com/read/28331365/mastectomy-skin-flap-necrosis-challenges-and-solutions
#1
REVIEW
Stuart A Robertson, Johann A Jeevaratnam, Avi Agrawal, Ramsey I Cutress
INTRODUCTION: Mastectomy skin flap necrosis (MSFN) has a reported incidence of 5%-30% in the literature. It is often a significant and underappreciated problem. The aim of this article was to review the associated challenges and possible solutions. METHODS: A MEDLINE search was performed using the search term "mastectomy skin flap necrosis". Titles and abstracts from peer-reviewed publications were screened for relevance. RESULTS: MSFN is a common complication and may present as partial- or full-thickness necrosis...
2017: Breast Cancer: Targets and Therapy
https://www.readbyqxmd.com/read/28296715/evaluating-the-use-of-tissue-oximetry-to-decrease-intensive-unit-monitoring-for-free-flap-breast-reconstruction
#2
Joseph A Ricci, Christina R Vargas, Olivia A Ho, Samuel J Lin, Adam M Tobias, Bernard T Lee
BACKGROUND: Postoperative free flap care has historically required intensive monitoring for 24 hours in an intensive care unit. Continuous monitoring with tissue oximetry has allowed earlier detection of vascular compromise, decreasing flap loss and improving salvage. This study aims to identify whether a fast-track postoperative paradigm can be safely used with tissue oximetry to decrease intensive monitoring and costs. MATERIALS AND METHODS: All consecutive microsurgical breast reconstructions performed at a single institution were reviewed (2008-2014) and cases requiring return to the operating room were identified...
March 14, 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28274072/versatility-of-tongue-flaps-for-closure-of-palatal-defects-case-report
#3
Vishnu Mohan, Roopesh U Nair, Arjun Madhu Usha
Palatal defects following congenital anomalies, traumatic injuries, benign and malignant pathologies frequently require resection and reconstruction. Reconstruction of these defects is challenging and complex due to the amount of tissue left for primary closure after excision, compromised vasculature as on repaired cleft palate and limited pedicled flaps around the lesion. Tongue flap though doesn't fulfil all the ideal requirements of a flap, however because of its flexibility, good blood supply and position it can be considered as the best among other flaps for reconstruction of oral and palatal defects...
January 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28272856/macromastia-and-gigantomastia-efficacy-of-the-superomedial-pedicle-pattern-for-breast-reduction-surgery
#4
V Chetty, E Ndobe
BACKGROUND: Reduction mammoplasty procedures in patients with macromastia and gigantomastia can prove a major challenge to the plastic surgeon. Although several techniques have been described to reduce very large breasts, they can often result in vascular compromise to the nipple-areola complex (NAC) and skin flaps, decrease in NAC sensation and inability to breast-feed. The superomedial pedicle (SMP) procedure is often used in patients with moderate to large breast reductions. For extremely large breast reductions, macromastia and gigantomastia breast amputation with a free nipple graft is often recommended...
November 2016: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28267121/current-techniques-for-postoperative-monitoring-of-microvascular-free-flaps
#5
Nasir Khatri, Shuhao Zhang, Santosh S Kale
Free tissue transfer (FTT) is used in patients with complicated reconstructive needs; it can provide stable wound coverage, improved aesthetic appearance, and restore functional deficits. Despite the high success rates of free flaps, vascular occlusion is a significant risk leading to flap failure. Many studies have demonstrated that the salvage rate for flaps is inversely related to the time between onset of a vascular problem and its surgical correction. As a result, ongoing postoperative monitoring of free flaps for adequate perfusion is imperative to allow timely and accurate diagnosis of vascular compromise...
March 2017: Journal of Wound, Ostomy, and Continence Nursing
https://www.readbyqxmd.com/read/28257218/modified-double-papillae-flap-technique-with-subepithelial-connective-tissue-graft-for-root-coverage-in-the-esthetic-zone-case-report
#6
Gustavo Javier Salazar Littuma, Leonardo Bez, Camilo Andres Villabona Lopez, Cesar Augusto Magalhães Benfatti, Ricardo de Souza Magini
Gingival recession can compromise the esthetic appearance, leading to functional problems, hypersensitivity, and root caries. Several techniques have been implicated for root coverage, which includes pedicle grafts, free gingival grafts, connective tissue grafts, and guided-tissue regeneration. The double-papillae flap associated with subepithelial connective tissue is a predictable technique to cover isolated areas with insufficient attached gingiva apical to a recession. This case report demonstrates a surgical alternative to the technique using a sling periosteal suture to stabilize the connective tissue and pedicle flap during the initial phase of healing, increasing the potential of this periodontal procedure for gingival recession coverage...
March 2017: Compendium of Continuing Education in Dentistry
https://www.readbyqxmd.com/read/28198770/should-immediate-autologous-breast-reconstruction-be-considered-in-women-who-require-post-mastectomy-radiation-therapy-a-prospective-analysis-of-outcomes
#7
Jessica Billig, Reshma Jagsi, Ji Qi, Jennifer B Hamill, Hyungjin M Kim, Andrea L Pusic, Edward Buchel, Edwin G Wilkins, Adeyiza O Momoh
BACKGROUND: In women who require post-mastectomy radiation therapy, immediate autologous breast reconstruction is often discouraged. We aim to prospectively evaluate postoperative morbidity and satisfaction reported by women undergoing delayed or immediate autologous breast reconstruction in the setting of post-mastectomy radiation therapy. METHODS: Patients enrolled in the Mastectomy Reconstruction Outcomes Consortium Study, who received post-mastectomy radiotherapy and had immediate or delayed free abdominal-based autologous breast reconstruction were identified...
February 13, 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28166137/vascular-complications-and-free-flap-salvage-in-head-and-neck-reconstructive-surgery-analysis-of-150-cases-of-reexploration
#8
Yen-Hao Chiu, Dun-Hao Chang, Cherng-Kang Perng
INTRODUCTION: Despite the excellent reliability of free tissue transfer, flap failure is devastating, and in addition to patient morbidity, it may increase hospital stay and associated costs. Previous studies have evaluated factors related to flap salvage, regarding the operative strategy for flap salvage surgery. The present study aimed to share our experience of reexploration and describe operative standards dealing with vascular thrombosis. METHODS: We retrospectively reviewed 150 (of 1258) free flaps for head and neck reconstruction that showed signs of vascular compromise at our institution during a 13-year period between 2002 and 2015...
March 2017: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/28163885/flies-compensate-for-unilateral-wing-damage-through-modular-adjustments-of-wing-and-body-kinematics
#9
Florian T Muijres, Nicole A Iwasaki, Michael J Elzinga, Johan M Melis, Michael H Dickinson
Using high-speed videography, we investigated how fruit flies compensate for unilateral wing damage, in which loss of area on one wing compromises both weight support and roll torque equilibrium. Our results show that flies control for unilateral damage by rolling their body towards the damaged wing and by adjusting the kinematics of both the intact and damaged wings. To compensate for the reduction in vertical lift force due to damage, flies elevate wingbeat frequency. Because this rise in frequency increases the flapping velocity of both wings, it has the undesired consequence of further increasing roll torque...
February 6, 2017: Interface Focus
https://www.readbyqxmd.com/read/28152218/tailored-approach-to-oromandibular-reconstruction-in-patients-with-compromised-lower-limb-vessels
#10
Conor P Barry, James Brown, Rebecca Hanlon, Richard Shaw
BACKGROUND: The purpose of this study was to compare outcomes for segmental reconstruction of the mandible between patients who underwent reconstruction with a fibula flap (group 1), and those with an alternative osseous free flap in which the fibula flap was unsuitable either for defect reasons (group 2) or in which the fibula flap could not safely be harvested because of compromised leg vessels (group 3). METHODS: One hundred fifty-two patients who underwent osseous free flap reconstruction of a mandibular segmental defect between January 2008 and June 2014 were identified from operating records...
February 2, 2017: Head & Neck
https://www.readbyqxmd.com/read/28143976/calvarial-metastasis-of-renal-cell-carcinoma
#11
Tabrez Suffee, Mohamed Derder, Julien Quilichini, Edouard Dezamis, Laurent Lantieri
The calvarium is an extremely unusual site of metastasis of renal cell carcinoma. We report a 62-year-old man who was enrolled for palliative medical management for an exophytic calvarial metastasis. His quality of life was greatly compromised with everyday local care and bandages due to recurrent events of infection and bleeding, limiting his social life. Surgical palliative surgery was carried out to improve the patient's quality of life. After tumour resection, the resultant defects of the calvarium and the scalp were covered by a muscular latissimus dorsi free flap and a fascia lata graft as dural substitute...
January 31, 2017: BMJ Supportive & Palliative Care
https://www.readbyqxmd.com/read/28140669/surgical-repositioning-of-the-premaxilla-using-a-minimally-invasive-endonasal-approach
#12
Nicolas E Sierra, Ada Ferrer-Fuertes, Bárbara Salazar-Perez, Gui-Youn Cho-Lee, Carles Martí-Pages, Alejandro Rivera-Baró, Josep Rubio Palau, Eloy M García-Diez
OBJECTIVE:   The aim of this study was to evaluate a technique for the surgical repositioning of the premaxilla using a minimally invasive endonasal approach. DESIGN:   Retrospective review of clinical records. SETTING:   Tertiary care, University Hospital, pediatric maxillofacial surgery unit. PATIENTS:   Twenty-one patients (12 boys and 9 girls), ages ranging from 6 to 21 years, with BCLP+A and premaxillary malposition (PM)...
January 31, 2017: Cleft Palate-craniofacial Journal
https://www.readbyqxmd.com/read/28116225/hyperbaric-oxygen-therapy-for-the-compromised-graft-or-flap
#13
REVIEW
Ashish Francis, Richard C Baynosa
Significance: Tissue grafts and flaps are used to reconstruct wounds from trauma, chronic disease, tumor extirpation, burns, and infection. Despite careful surgical planning and execution, reconstructive failure can occur due to poor wound beds, radiation, random flap necrosis, vascular insufficiency, or ischemia-reperfusion (IR). Traumatic avulsions and amputated composite tissues-compromised tissue-may fail from crush injury and excessively large sizes. While never intended, these complications result in tissue loss, additional surgery, accrued costs, and negative psychosocial patient effects...
January 1, 2017: Advances in Wound Care
https://www.readbyqxmd.com/read/28114212/the-anterolateral-thigh-flap-as-the-flap-of-choice-for-scalp-reconstruction
#14
Gregory A Lamaris, Rebecca Knackstedt, Rafael A Couto, Nasim Abedi, Paul Durand, Brian Gastman
INTRODUCTION: Large scalp soft tissue defects can present difficulties with reconstruction. The ideal flap for scalp reconstruction has yet to be described although the latissimus dorsi flap is frequently referred to as the first choice in this setting. PATIENTS AND METHODS: Following institutional review board approval, the authors reviewed their experience in scalp reconstruction for the past 4 years. Patient demographics, reconstruction indication, flap choice, complications, and outcomes were recorded...
March 2017: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/28105589/maxillary-segmental-osteoperiosteal-flap-with-simultaneous-placement-of-dental-implants-case-report-of-a-novel-technique
#15
Tibebu Tsegga, Thomas Wright
Dental restorative space from the opposing dentition requires adequate distance for restorative material for an acceptable restoration. Typically, long-standing edentulous alveolar ridges will have vertical and or horizontal defects that require alveolar ridge augmentation for ideal dental implant restorations. Along with these defects, one will see the opposing dentition supra erupt which can obliterate the restorative space. Multiple surgical techniques have been described to address these dilemmas. The use of osteoperiosteal flaps has been described to address vertical height deficiencies...
December 2017: International Journal of Implant Dentistry
https://www.readbyqxmd.com/read/28062176/characteristics-and-surgical-management-of-flap-compromise-caused-by-thrombosis-of-the-internal-jugular-vein
#16
Bin Yang, Yi Qu, Ming Su, Jinzhong Li, Hua Li, Rudong Xing, Zhengxue Han
BACKGROUND: A principal reason for flap compromise in oral and maxillofacial head and neck surgery, and failure of a free flap transfer, is thrombosis of a drainage vein such as the internal jugular vein. This study characterized flap compromise caused by internal jugular vein thrombosis after a free flap transfer, and its management. PATIENTS AND METHODS: A retrospective clinical study was conducted of 306 consecutive microvascular free flaps performed for 305 patients with head and neck cancer from March 2003 to March 2013 at the Department of Oral and Maxillofacial Surgery at Beijing Stomatological Hospital, Capital Medical University...
December 18, 2016: Journal of Cranio-maxillo-facial Surgery
https://www.readbyqxmd.com/read/28050439/rotation-flap-closure-of-moderate-size-scalp-defects-technique-and-outcome
#17
Philip Umman, Vinod G Pillai, Pradip M Abraham, Roshan G Varkey
Many patients present to general surgeons with scalp lesions which require wide local excision with margin, following which the defect is too large to be closed primarily. These lesions can be benign or malignant. Skin grafting of these defects gives poor cosmetic outcome. Knowledge of basic flaps will enable the general surgeon to close these defects to heal by primary intention. Also, the margin of excision will not be compromised because of anticipated difficulty in closing the wound. We present a series of three cases who underwent excision of scalp lesions resulting in moderate size scalp defects...
November 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28040322/mucosectomy-impairs-ileal-microcirculation-and-results-in-flap-contraction-after-experimental-ileocystoplasty
#18
Raimondo M Cervellione, Daniel Hajnal, Gabreilla Varga, George Rakoczy, Jozsef Kaszaki, David Keene, Anju Goyal, Alan Dickson, Tamas Cserni
INTRODUCTION: Bladder augmentation with demucosalized ileal flap is a promising alternative approach for mucus free bladder augmentation; however, the contraction of the flap is still a major concern. It has been hypothesized that mucosectomy causes ischemic damage, but no direct histological evidence has been found and attention is now focused on the urothelium cover to prevent the exposure of the denuded surface to urine or the use of balloons to keep the flaps distended. OBJECTIVE: Our aim was to study the effect of mucosectomy on the microcirculation of ileal flaps during reverse clam ileocystoplasty using direct intraoperative imaging of the ileum...
February 2017: Journal of Pediatric Urology
https://www.readbyqxmd.com/read/28039007/pedicle-orientation-in-free-flap-microvascular-maxillofacial-reconstruction
#19
Daniel M Cummins, Beomjune Kim, Arshad Kaleem, Waleed Zaid
Oncologic and traumatic defects of the maxilla can pose a challenge to patients, reconstructive surgeons, and maxillofacial prosthodontists in an attempt to provide satisfactory treatment. Oral-nasal and oral-antral fistulas are frequently treated with soft tissue flaps, osteocutaneous flaps, or a maxillofacial obturator. The free fibula microvascular osteocutaneous flap has proved the workhorse of these maxillary and mandibular reconstructions. The success of microvascular reconstruction often hinges on flap viability in the immediate postoperative period...
December 10, 2016: Journal of Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/28039005/reconstruction-of-through-and-through-oromandibular-defects-with-combined-fibula-flap-and-anterolateral-thigh-flap
#20
Zhao-Jian Gong, Shuai Zhang, Sheng Zhang, Jiang Liu, Yu-Ming Xu, Han-Jiang Wu
PURPOSE: The reconstruction of massive through-and-through oromandibular defects is still a challenge because no single adequate candidate for a donor site of vascularized bone and a large amount of soft tissue has yet been found. The aim of this study was to evaluate the feasibility and reconstructive efficacy of the combined fibula flap and anterolateral thigh (ALT) flap in tandem for the reconstruction of such defects. PATIENTS AND METHODS: We performed a retrospective case series of patients who had undergone reconstruction of through-and-through oromandibular defects with the combined fibula flap and ALT flap in tandem from January 2012 through December 2014 at the Second Xiangya Hospital...
December 13, 2016: Journal of Oral and Maxillofacial Surgery
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