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Compromised flap

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https://www.readbyqxmd.com/read/27904753/skin-flap-complications-after-decompressive-craniectomy-and-cranioplasty-proposal-of-classification-and-treatment-options
#1
Alessandro Di Rienzo, Pier Paol Pangrazi, Michele Riccio, Roberto Colasanti, Ilaria Ghetti, Maurizio Iacoangeli
BACKGROUND: The list of complications reported after decompressive craniectomy (DC) and cranioplasty is progressively increasing. Nonetheless, the exact incidence of these events is still ill-defined. Problems affecting skin flaps after DC and cranioplasty have never been accurately analyzed in papers and their impact on patients' prognosis is largely underestimated. METHODS: In a 10-year time, we treated by DC 450 patients, 344 of whom underwent cranioplasty, either with autologous bone or artificial implants (hydroxyapatite, polyetheretherketone, titanium, polymethylmethacrylate)...
2016: Surgical Neurology International
https://www.readbyqxmd.com/read/27894916/reliability-of-extended-dorsal-intercostal-artery-perforator-propeller-flaps-for-reconstruction-of-large-myelomeningocele-defects
#2
Goktekin Tenekeci, Yavuz Basterzi
Reconstruction of large myelomeningocele defects using extended (elongated beyond the lateral margin of the latissimus dorsi muscle) dorsal intercostal artery perforator (DICAP) propeller flaps is not recommended by previous studies. However, to provide tension-free and successful closure of a defect, the DICAP propeller flaps must sometimes be elongated beyond this margin. Our experience and results in this issue are discussed. In this article, reconstruction of 11 consecutive cases, with large myelomeningocele defects in which standard DICAP propeller flaps were incapable to close the defect, was achieved using extended DICAP propeller flaps between June 2013 and November 2015...
November 15, 2016: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/27893628/watershed-areas-in-face-transplantation
#3
Bahar Bassiri Gharb, Russell S Frautschi, Brianna C Halasa, Gaby D Doumit, Risal S Djohan, Steven L Bernard, Brian R Gastman, Maria Z Siemionow, Francis A Papay, Antonio Rampazzo
BACKGROUND: Maxillary artery has traditionally been considered the main blood supply of the facial skeleton. However, the deep and concealed location makes the harvest of facial allografts based on this artery challenging, giving preference to the facial artery. There is growing evidence that the junction between the hard and soft palate may represent a watershed area in facial artery based allografts. The aim of this study was to review the occurrence of partial allograft necrosis and modify the available craniofacial techniques allowing for a reliable harvest of maxillary artery based facial allografts...
November 21, 2016: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/27860359/spectral-diffuse-reflectance-and-autofluorescence-imaging-can-perform-early-prediction-of-blood-vessel-occlusion-in-skin-flaps
#4
Shuo Chen, Caigang Zhu, Christopher Hoe-Kong Chui, Gyanendra Sheoran, Bien-Keem Tan, Quan Liu
Flap transfer has become a common technique in reconstructive surgery. However, a significant number of compromised skin flaps are not successfully salvaged because the current clinical method for flap assessment relies heavily on the clinician's experience. Vascular occlusion is the major reason for flap failure, thus the accurate and objective early prediction of blood vessel occlusion is vitally important. Our parallel point measurement study has demonstrated the great potential of joint diffuse reflectance and autofluorescence spectroscopy in the early detection and differentiation of venous and arterial occlusion in skin flaps...
November 17, 2016: Journal of Biophotonics
https://www.readbyqxmd.com/read/27826484/vermilion-only-cross-lip-flap-for-treating-whistle-deformity-in-secondary-bilateral-cleft-lip-repair
#5
Clifford C Sheckter, Robert M Menard
Bilateral cleft lip repairs can result in various secondary deformities. One more commonly seen deformity, the whistle deformity, is characterized by a reduced or absent tubercle, orbicularis muscle diastasis, and abnormalities of the philtrum with notched appearance of cupid's bow. Various techniques have been described to address these problems. One common procedure is the lip-switch flap originally described by Abbe in 1898, which has been modified by various surgeons. In these procedures, lower lip vermilion, mucosa, orbicularis, and lip skin are transposed to the upper lip on a pedicle that is later divided...
October 2016: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/27777799/new-possible-surgical-approaches-for-the-submammary-adipofascial-flap-based-on-its-arterial-supply
#6
Ehab M Elzawawy, Melad N Kelada, Ahmed F Al Karmouty
Introduction. Submammary adipofascial flap (SMAF) is a valuable option for replacement of the inferior portion of the breast. It is particularly useful for reconstruction of partial mastectomy defects. It is also used to cover breast implants. Most surgeons base this flap cranially on the submammary skin crease, reflecting it back onto the breast. The blood vessels supplying this flap are not well defined, and the harvest of the flap may be compromised due to its uncertain vascularity. The aim of the work was to identify perforator vessels supplying SMAF and define their origin, site, diameter, and length...
2016: Anatomy Research International
https://www.readbyqxmd.com/read/27771262/outcome-after-urgent-microvascular-revision-of-free-diep-siea-and-sgap-flaps-for-autologous-breast-reconstruction
#7
A Vanschoonbeek, G Fabre, L Nanhekhan, M Vandevoort
INTRODUCTION: Microvascular complications after free flap breast reconstruction are devastating, and revision of a compromised breast reconstruction is very challenging. The aim of this study was to review the different characteristics of urgent microvascular revision in DIEP, SIEA and SGAP flaps and to evaluate the final outcome after revision. MATERIALS AND METHODS: A retrospective chart review was performed for all patients who underwent an autologous breast reconstruction with a DIEP, SIEA or SGAP flap at the University Hospitals of Leuven between August 1997 and December 2013...
September 28, 2016: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/27757334/hand-allograft-saved-by-an-ultrathin-groin-flap
#8
Joseph Château, Aram Gazarian, Fabien Boucher, Lionel Badet, Fabienne Braye, Michel Saint-Cyr, Ali Mojallal
We report a case of a young double-hand allotransplant patient who presented with a full-thickness skin necrosis of the dorsum of the left hand after vascular compromise of the allotransplantation. Considering the lack of viable dorsal tissue overlying the extensor tendons and the need for early hand rehabilitation, an ultrathin pedicled groin flap was used for the coverage. This procedure resulted in salvaging the allotransplantation, and the patient was able to successfully return to work after his surgery...
September 2016: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/27756030/osseocutaneous-radial-forearm-flap-with-beavertail-modification-a-case-report-of-a-novel-single-reconstructive-free-flap-for-the-tongue-floor-of-mouth-and-mandible
#9
Alastair Henry, James A McCaul
INTRODUCTION: Complex hard and soft tissue defects produced as a result of ablative resection of head and neck malignancy can represent a reconstructive challenge, especially when patients are medically compromised. PRESENTATION OF CASE: We present the case of 72-year-old women presenting with an oral squamous cell carcinoma of the right floor of mouth invading the right mandible. Surgical management of the disease required ablative surgery with complex free tissue transfer reconstruction to provide restoration of form and function...
October 12, 2016: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/27741416/utility-of-superiorly-based-masseter-muscle-flap-for-postablative-retromaxillary-reconstruction
#10
Chandrashekhar R Bande, Akshay Mishra, M K Gupta, Manu Goel, Mayur J Gawande
PURPOSE: Resections in the posterior component of the oral cavity usually lead to severe functional compromise and lower quality of life for patients. Notable advances in reconstruction of the posterior part of the mouth and of the oropharynx have occurred in recent decades. The anatomic and physiologic rehabilitation of the defect to a reasonable outcome with low morbidity and mortality remains the founding basis of any surgical reconstruction, which also holds true for oral oropharyngeal and retromaxillary reconstructions...
September 17, 2016: Journal of Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/27730655/secondary-free-flap-reconstruction-following-ablation-for-acute-invasive-fungal-sinusitis
#11
Jordan J Allensworth, Scott H Troob, Tyler S Weaver, Javier D Gonzalez, Daniel Petrisor, Mark K Wax
OBJECTIVE: Acute invasive fungal sinusitis (AIFS) is a frequently fatal infection for which extensive and debilitating surgical debridement is a mainstay of therapy. Resulting defects are often composite in nature, mandating free tissue-transfer reconstruction. Outcomes data for free flap reconstruction are limited. The purpose of this study was to examine surgical outcomes and survival in patients undergoing free flap transfer following invasive fungal sinusitis. STUDY DESIGN: Retrospective case series...
October 12, 2016: Laryngoscope
https://www.readbyqxmd.com/read/27704608/direct-thrombectomy-as-a-salvage-technique-in-free-flap-breast-reconstruction
#12
Ki Yong Hong, Lan Sook Chang, Hak Chang, Kyung Won Minn, Ung Sik Jin
BACKGROUND: Breast reconstruction with microvascular free tissue transfer has become a widely used method. Despite a high rate of success, a compromised flap necessitating re-exploration can occur. Here, we introduce direct thrombectomy as a flap salvage technique, and compared the results with conventional thrombectomy. METHODS: A total of 488 patients who underwent breast reconstruction using a free transverse rectus abdominis myocutaneous flap between March 2009 and February 2014 were retrospectively analyzed...
October 5, 2016: Microsurgery
https://www.readbyqxmd.com/read/27695068/enhancing-predicted-efficacy-of-tumor-treating-fields-therapy-of-glioblastoma-using-targeted-surgical-craniectomy-a-computer-modeling-study
#13
Anders Rosendal Korshoej, Guilherme Bicalho Saturnino, Line Kirkegaard Rasmussen, Gorm von Oettingen, Jens Christian Hedemann Sørensen, Axel Thielscher
OBJECTIVE: The present work proposes a new clinical approach to TTFields therapy of glioblastoma. The approach combines targeted surgical skull removal (craniectomy) with TTFields therapy to enhance the induced electrical field in the underlying tumor tissue. Using computer simulations, we explore the potential of the intervention to improve the clinical efficacy of TTFields therapy of brain cancer. METHODS: We used finite element analysis to calculate the electrical field distribution in realistic head models based on MRI data from two patients: One with left cortical/subcortical glioblastoma and one with deeply seated right thalamic anaplastic astrocytoma...
2016: PloS One
https://www.readbyqxmd.com/read/27694304/preoperative-angiographic-criteria-for-predicting-free-flap-transfer-outcomes-in-patients-with-lower-extremity-peripheral-arterial-disease
#14
Sang Woo Park, Junhyung Kim, Jaehoon Choi, Jun Sik Kim, Jeong Hwan Lee, Young Sook Park
Patients scheduled for microsurgical reconstruction of the lower leg often receive preoperative assessment of recipient vessels using angiography. However, no clear standard is available for evaluating angiographic results to predict free-flap survival outcomes. We developed angiographic criteria for predicting surgical outcome in patients with lower-extremity peripheral arterial disease based on abnormality of the anterior tibial and posterior tibial arteries. We applied the criteria to a small number of patients scheduled for microsurgical reconstruction of the lower leg...
September 29, 2016: International Journal of Lower Extremity Wounds
https://www.readbyqxmd.com/read/27679947/single-transverse-extended-incision-for-radical-neck-dissection
#15
José Francisco Sales Chagas, Maria Beatriz Nogueira Pascoal, José Luís Braga Aquino, Luís Antônio Brandi, Evandro Von Zuben Previtale, Ana Sofia Pontes Trillo, Otávio Alberto Curioni, Abrão Rapoport, Rogério Aparecido Dedivitis
OBJECTIVE: to assess the efficacy of the single transverse extended cervical incision in radical neck dissection. METHOD: we conducted a prospective study, from January 2008 to January 2009, with 18 patients undergoing surgical treatment of malignant tumors of the upper aero-digestive tract. The primary lesion was located in the oral cavity in eight cases, in the oropharynx in three, in the hypopharynx in three, in the larynx in two, in the maxillary sinus, and in one case, the primary injury was hidden...
July 2016: Revista do Colégio Brasileiro de Cirurgiões
https://www.readbyqxmd.com/read/27679781/modified-skin-bridge-technique-for-ilio-inguinal-lymph-node-dissection-a-forgotten-technique-revisited
#16
REVIEW
Mukur Dipi Ray, Pankaj K Garg, Ashish Jakhetiya, Sunil Kumar, Durgatosh Pandey
Ilio-inguinal lymph node dissection (IILD) is a commonly performed surgical procedure for a number of malignant conditions involving mainly the male and female genitalia, and the skin; however the postoperative morbidity of IILD, due to high frequency of flap necrosis, wound infection and seroma formation, has always been a major concern for the surgeons. The aim of the study is to highlight a modified skin bridge technique of IILD using two parallel curvilinear incisions to minimize postoperative skin flap necrosis...
September 26, 2016: World Journal of Methodology
https://www.readbyqxmd.com/read/27661076/improvement-of-ischemic-or-congested-wound-conditions-by-reconstruction-with-microsurgical-flaps
#17
Jeong Tae Kim, Sang Wha Kim
BACKGROUND: Intractable chronic wounds share the basic problem of the environment being unfavorable for wound healing and prone to infection, inflammation, and recurrences. Microsurgical flap provides a healthy, well-vascularized normal tissue to compromised intractable environment, and promotes wound healing. In this report, we present the results of microsurgical flaps used for the reconstruction of chronic intractable conditions including chronic ulcer with an ischemic environment and pathologic lesions with a congestive environment...
September 23, 2016: Microsurgery
https://www.readbyqxmd.com/read/27651974/successful-deep-inferior-epigastric-perforator-flap-harvest-despite-preoperative-therapeutic-subcutaneous-heparin-administration-into-the-abdominal-pannus
#18
Joseph W Duncumb, Kana Miyagi, Parto Forouhi, Charles M Malata
Abdominal free flaps for microsurgical breast reconstruction are most commonly harvested based on the deep inferior epigastric vessels that supply skin and fat via perforators through the rectus muscle and sheath. Intact perforator anatomy and connections are vital for subsequent optimal flap perfusion and avoidance of necrosis, be it partial or total. The intraflap vessels are delicate and easily damaged and it is generally advised that patients should avoid heparin injection into the abdominal pannus preoperatively as this may compromise the vascular perforators through direct needle laceration, pressure from bruising, haematoma formation, or perforator thrombosis secondary to external compression...
2016: Case Reports in Surgery
https://www.readbyqxmd.com/read/27607130/oro-nasal-communication
#19
Nanda Kishore Sahoo, Ajay P Desai, Indranil Deb Roy, Vishal Kulkarni
Breach in the palatal vault leading to an abnormal communication between oral and nasal cavity is known as oro-nasal communication. It is an uncommon presentation in day-to-day clinical practice except in some patients of cleft lip and palate.Etiology may be congenital or acquired. Alveolar and palatal cleft defects are the most common etiological factor. The acquired causes may be trauma, periapical pathology, infections, neoplasms, postsurgical complications, and radio and chemo necrosis.Clinical features like nasal regurgitation of food, defective speech, fetid odor, bad taste, and upper respiratory tract and ear infection are associated with oro-nasal communication...
September 2016: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/27607121/arterio-venous-malformations-of-the-nose-combined-approach-for-a-successful-strategy
#20
Daria Almesberger, Francesco Manna, Gianni Franco Guarneri, Andrea Marchesi, Pier Camillo Parodi
BACKGROUND AND PURPOSE: The purpose of the present study is to evaluate the vascular malformations of the head and neck. They are uncommon lesions, but some areas have a significant potential for fatality, due to their massive bleeding. The vascular anatomy of the nose carries a high recurrence rate, due to the unique characteristic of the nose, especially if deep vascular connection is present. METHODS: The present article describes 2 patients of nasal dorsum arteriovenous malformations, both using a combined procedure: preoperative selective embolization, en-bloc tumor resection, and reconstruction with a forehead flap...
September 2016: Journal of Craniofacial Surgery
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