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Compromised flap

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https://www.readbyqxmd.com/read/29788679/delayed-bipedicled-nasolabial-flap-in-facial-reconstruction
#1
Cindy Siaw-Lin Goh, Joshua Guy Perrett, Manzhi Wong, Bien-Keem Tan
BACKGROUND: The nasolabial flap is ideal for reconstruction of the nasal alar subunit due to its proximity, color and contour match, and well-placed donor scar. When raised as a random-pattern flap, there is a risk of vascular compromise to the tip with increased flap length and aggressive flap thinning. Surgical delay can greatly improve the chances of tip survival, allowing the harvest of longer flaps with greater reach. METHODS: We describe our technique of lengthening the nasolabial flap through multiple delay procedures...
May 2018: Archives of Plastic Surgery
https://www.readbyqxmd.com/read/29775983/classification-and-microvascular-flap-selection-for-anterior-cranial-fossa-reconstruction
#2
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/29763940/simultaneous-septal-perforation-repair-with-septorhinoplasty-a-31-year-experience
#3
Russell W H Kridel, Sean William Delaney
Septal perforation repair and septorhinoplasty (SRP) each present unique surgical challenges. However, in many instances, these procedures may be performed together successfully. In this study, the authors aim to determine the safety and effectiveness of combining primary or revision SRP and septal perforation repair via an open approach. A retrospective review was carried out of all consecutive patients who had SRP and septal perforation repair via an open approach between 1986 and 2017 in the senior author's practice...
May 15, 2018: Facial Plastic Surgery: FPS
https://www.readbyqxmd.com/read/29751944/radial-forearm-flaps-with-venous-compromise-correlations-between-salvage-techniques-and-their-rates-of-success
#4
Z Qin-Kai, G Bing, D Wei, T Xue-Xin, S Jian, Z Chen-Ping, X-J Qin
We retrospectively analysed the reliability of anastomosis of the deep venous system as a salvage technique for a free radial forearm flap that has developed venous compromise. The primary predictors were the salvage techniques, which comprised anastomosis of the deep venous system and a repeat of the original anastomosis, and the primary outcome measure was the rate of success. The potential confounders included original venous outflow, the original causes of the venous compromise, and the number of venous anastomoses...
May 8, 2018: British Journal of Oral & Maxillofacial Surgery
https://www.readbyqxmd.com/read/29746277/skin-paddles-improve-muscle-flap-salvage-rates-after-microvascular-compromise-in-lower-extremity-reconstruction
#5
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/29744524/-defect-coverage-using-gluteal-flaps
#6
REVIEW
T R Mett, M K Boyce, R Ipaktchi, P M Vogt
OBJECTIVE: Gluteal skin, fasciocutaneous and myocutaneous flaps can be used to cover decubitus ulcers in the sacral and ischiocrural area. INDICATIONS: Decubitus ulcers in the sacral or ischial area that do not heal after exhausted conservative therapy. CONTRAINDICATIONS: Moribund patients who are very likely to suffer a life-threatening complication. Non-cooperative patients who cannot follow the postoperative recommendations. The presence of extensive scars after previous operations in the donor area or irradiation of the donor area which may compromise the flap perfusion...
May 9, 2018: Operative Orthopädie und Traumatologie
https://www.readbyqxmd.com/read/29734567/random-flap-survival-with-hyperbaric-oxygen-daily-versus-twice-daily-treatments
#7
Rachel Weber, Andrew Silver, Shelley J Williams, Linda Stephenson, Phillip C Usera, Fan Zhang, Honglin Tian, Wei Yang, Wei Z Wang, Xin Hua Fang, William A Zamboni, Richard Baynosa
Purpose: Hyperbaric oxygen (HBO₂) therapy is used to improve the survival of compromised flaps. Compromised flaps are complications encountered postsurgically, or in traumatic degloving or avulsion injuries. Failed flaps lead to persistence of the defect, requirement of another donor site, and psychosocial sequelae. Although evidence of the benefit of HBO₂ therapy is significant, there is no consensus on the optimal treatment regimen. The purpose of this study is to examine whether twice-daily treatments (BID HBO₂) provide additional benefit compared to daily treatments (QD HBO₂) in a rat compromised random flap model...
March 2018: Undersea & Hyperbaric Medicine: Journal of the Undersea and Hyperbaric Medical Society, Inc
https://www.readbyqxmd.com/read/29723950/use-of-a-contralateral-nasoseptal-flap-for-sino-orbital-fistula-closure
#8
Mohammad K Hararah, Jameson K Mattingly, Vijay R Ramakrishnan
Sino-orbital fistulas can occur after orbital exenteration. Chronic nonhealing fistulas lead to bothersome symptoms including malodorous discharge, hypernasal speech, crusting, wound breakdown, or inability to wear an ocular prosthesis. Reconstruction can be difficult due to the complexity of the defects and the multitude of treatments patients often undergo for the management of the primary disease. Prior radiation, lack of available local tissue, or compromised blood supply are some of the issues that make successful fistula closure problematic...
May 2018: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/29697629/forty-years-of-lower-extremity-take-backs-flap-type-influences-salvage-outcomes
#9
John T Stranix, Z-Hye Lee, Adam Jacoby, Lavinia Anzai, Josh Mirrer, Tomer Avraham, Vishal Thanik, Jamie P Levine, Pierre B Saadeh
BACKGROUND: Considering that muscle has higher metabolic demand than fasciocutaneous tissue and can be more difficult to monitor clinically, the authors compared take-back salvage rates between fasciocutaneous and muscle free flaps for lower extremity trauma reconstruction. METHODS: The authors conducted a retrospective review of 806 free flaps (1979 to 2016); 481 soft-tissue flaps performed for below-knee trauma met inclusion criteria. Primary outcome measures were perioperative complications, specifically, take-backs and flap salvage rates...
May 2018: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/29676309/safety-and-efficacy-of-fibrin-glue-versus-infinity-suture-in-sics-with-extended-scleral-flap
#10
Anita Ambastha, Rakhi Kusumesh, Gyan Bhasker, Bibhuti Prassan Sinha
Purpose: To study the safety and efficacy of biologic fibrin glue (FG) in comparison with infinity suture in SICS with compromised scleral flap. Methods: A retrospective comparative study of patients who were treated with FG (Group A) with 10-0 nylon (Group B) as sealing agent for intraoperative compromised tunnels in SICS. Parameters noted were postoperative inflammation, wound integrity, anterior chamber (AC) depth, intraocular pressure (IOP), and surgically induced astigmatism (SIA) at postoperative day 1, 4 weeks, 6 weeks, and 6 months, respectively...
May 2018: Indian Journal of Ophthalmology
https://www.readbyqxmd.com/read/29661662/multimodal-analysis-using-flowmeter-analysis-laser-doppler-spectrophotometry-and-indocyanine-green-videoangiography-for-the-detection-of-venous-compromise-in-flaps-in-rats
#11
Lucas M Ritschl, Leonard H Schmidt, Andreas M Fichter, Alexander Hapfelmeier, Klaus-Dietrich Wolff, Thomas Mücke
Venous congestion results in tissue damage and remains the most common failure of free microvascular transfer if it is not recognized early. The purpose of this experimental study was to evaluate venous congestion and describe the findings with two different monitoring tools. A standardized epigastric flap was raised, and total occlusion of the draining vein was temporarily applied for 4, 5, 6, or 7 h. Blood flow measurements, including laser-Doppler flowmetry, and tissue spectrophotometry (O2C) and indocyanine green (ICG) videoangiography using the FLOW® 800 tool, were performed systematically after each surgical step, an interval of venous occlusion, and 1 week of clinical observation...
March 30, 2018: Journal of Cranio-maxillo-facial Surgery
https://www.readbyqxmd.com/read/29620551/practical-applications-of-delayed-immediate-autologous-breast-reconstruction-a-flexible-and-safe-operative-strategy
#12
Gloria R Sue, Arhana Chattopadhyay, Chao Long, Eva A Huis in 't Veld, Gordon K Lee
BACKGROUND: Timing is an important consideration in patients undergoing mastectomy for breast cancer. While immediate reconstruction results in superior aesthetic outcomes, the need for postmastectomy radiation can often only be ascertained after review of surgical pathology. Delayed-immediate autologous reconstruction (DIAR) is a reconstructive approach that consists of mastectomy with tissue expander placement in the first stage and flap-based breast reconstruction in the second stage...
May 2018: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/29596192/soft-tissue-reconstruction-of-the-complicated-knee-arthroplasty-principles-and-predictors-of-salvage
#13
David L Colen, Martin J Carney, Valeriy Shubinets, Michael A Lanni, Tiffany Liu, L Scott Levin, Gwo-Chin Lee, Stephen J Kovach
BACKGROUND: Total knee arthroplasty is a common orthopedic procedure in the United States and complications can be devastating. Soft-tissue compromise or joint infection may cause failure of prosthesis requiring knee fusion or amputation. The role of a plastic surgeon in total knee arthroplasty is critical for cases requiring optimization of the soft-tissue envelope. The purpose of this study was to elucidate factors associated with total knee arthroplasty salvage following complications and clarify principles of reconstruction to optimize outcomes...
April 2018: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/29596090/using-mesh-to-reinforce-the-abdominal-wall-in-abdominal-free-flaps-for-breast-reconstruction-is-there-a-benefit-what-are-the-risks
#14
Daniel Sotelo Leon, Rahim Nazerali, Gordon Kwanlyp Lee
INTRODUCTION: Abdominal wall integrity may be compromised after abdominal flap harvest for breast reconstruction, leading to bulging or herniation due to weakening of the abdominal wall and dissection through the rectus muscle. Mesh can be used to reinforce the abdominal wall to reduce the risk of hernia formation postoperatively, especially in patients who may be at high risk. In this study, we describe this institution's experience with the use of mesh in the abdominal wall and critically evaluate its impact on patient outcomes and complications...
May 2018: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/29595720/5000-free-flaps-and-counting-a-10-year-review-of-a-single-academic-institution-s-microsurgical-development-and-outcomes
#15
Martin J Carney, Jason M Weissler, Michael G Tecce, Michael N Mirzabeigi, Ari M Wes, Peter F Koltz, Suhail K Kanchwala, David W Low, Stephen J Kovach, Liza C Wu, Joseph M Serletti, Joshua Fosnot
BACKGROUND: The establishment of an effective clinical and academic culture within an institution is a multifactorial process. This process is cultivated by dynamic elements such as recruitment of an accomplished and diverse faculty, patient geographic outreach, clinical outcomes research, and fundamental support from all levels of an institution. This study reviews the academic evolution of a single academic plastic surgery practice, and summarizes a 10-year experience of microsurgical development, clinical outcomes, and academic productivity...
April 2018: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/29555139/influence-of-venous-stasis-on-survival-of-epigastric-flaps-in-rats
#16
T Mücke, L H Schmidt, A M Fichter, K-D Wolff, L M Ritschl
Venous congestion results in tissue damage and remains the most common reason for failure of transfer of microvascular free flaps if it is not recognised early. The purpose of this study was to measure the critical duration of venous congestion and the resultant survival of flaps according to the duration of venous stasis. A standard epigastric flap was raised and repositioned in 35 rats, seven of which acted as controls. The superficial inferior epigastric vein was fully occluded for four, five, six, or seven hours in the rest (n=7 each group)...
May 2018: British Journal of Oral & Maxillofacial Surgery
https://www.readbyqxmd.com/read/29554360/evaluation-of-intranasal-flap-perfusion-by-intraoperative-indocyanine-green-fluorescence-angiography
#17
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.)
https://www.readbyqxmd.com/read/29554345/the-role-of-the-visor-flap-in-scalp-reconstruction-a-case-series-of-21-patients
#18
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.)
https://www.readbyqxmd.com/read/29553978/peripheral-pruning-a-safe-approach-to-thinning-extra-large-anterolateral-thigh-flaps
#19
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...
April 2018: Annals of Plastic Surgery
https://www.readbyqxmd.com/read/29545991/costs-and-renumeration-of-osteomyelitis-treatment-involving-free-flaps-implications-of-return-to-theatre
#20
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
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