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Compromised flap

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
Mark L Urken, Ansley M Roche, Kimberly J Kiplagat, Eliza H Dewey, Cathy Lazarus, Ilya Likhterov, Daniel Buchbinder, Devin J Okay
BACKGROUND: Palatomaxillary defects were historically restored with a prosthetic obturator; however, advances in local and free tissue transfer has provided a viable alternative for appropriately selected patients with palatomaxillary defects. METHODS: A retrospective chart review of patients who underwent palatomaxillary reconstruction by the lead author between 1998 and 2016 was conducted. Patients who were restored with a palatal obturator were excluded. RESULTS: One hundred forty patients were reconstructed with a total of 159 local, regional, and free flaps with a 96...
March 14, 2018: Head & Neck
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
Ian R Wisecarver, Gerhard S Mundinger, Michael S Tarakji, Hugo St Hilaire
Squamous cell carcinoma (SCC) of the head and neck affects a significant number of people around the world every year. Treatment generally entails surgical resection, radiotherapy, chemotherapy, or some combination of the three. Following resection, microsurgical reconstruction can provide definitive coverage, replace many tissue types simultaneously, and bring healthy tissue to irradiated wound beds. Microsurgical engineering, the manipulation and reorganization of native vascular tissue, can further augment the adaptability of free tissue transfer to complex, compromised wound beds...
January 2018: Plastic and Reconstructive Surgery. Global Open
Necmettin Tutuncu, Goktekin Tenekeci, Sakir Unal, Necat Yilmaz, Celal Bagdatoglu
AIM: Whether the macular lesions associated with spinal dysraphism should be preserved is controversial. This area is usually excised during reconstruction. This study aims to characterize the macular lesions associated with spinal dysraphism and to determine the outcomes of cases in which macular lesions are not excised. MATERIAL AND METHODS: The patient cohort comprised 17 patients with spinal dysraphism who were treated at Mersin University Hospital from 2005 through 2007...
December 17, 2017: Turkish Neurosurgery
S Christianto, A Lau, K Y Li, W F Yang, Y X Su
Venous compromise is still the most common cause of free flap failure. The use of two venous anastomoses has been advocated to reduce venous compromise. However, the effectiveness of this approach remains controversial. A systematic review and cumulative meta-analysis was performed to assess the effect of one versus two venous anastomoses on venous compromise and free flap failure in head and neck microsurgical reconstruction. A total of 27 articles reporting 7389 flaps were included in this study. On comparison of one versus two venous anastomoses, the odds ratio (OR) for flap failure was 1...
January 29, 2018: International Journal of Oral and Maxillofacial Surgery
Sagar A Shah, Wendy H Wong, Dhaval Adhvaryu
A full-thickness fourth-degree burn to a large area of the upper extremity may require a forequarter amputation. Whereas our case describes a burn injury, forequarter amputations may more commonly be done in oncological surgery. In addition to the challenge of providing well-vascularized tissue coverage, the burn patient may also pose the complication of respiratory compromise in a systemically ill person. Fillet flaps have often been utilized as "spare part" reconstruction. Although previous forequarter amputations have been covered with free myocutanous forearm fillet flaps, we devised a rotational pedicle myocutaneous forearm fillet flap that might be less complex than a microvascular reconstruction...
January 25, 2018: Journal of Hand Surgery
Sabarish Babu Malli Sadhasivan, Mohamed Shafiuzama, Mala Shammi, Ganne Venkata Sudhakar Rao, Nitin J D Souza, Hemalatha Senthilnayagam, Ravi Sundar George, P Manoj Prabhakar
Aim: The main objective of the study was to describe the use of skin fold advancement flaps (SFAFs) and other reconstructive techniques for closure of large skin defects following mammary tumor excision in dogs. Materials and Methods: Twelve dogs underwent reconstruction of large ventral skin defects following mammary tumor excision with wide margins. Skin fold flaps (flank fold flap and elbow fold flap) were elevated from the flank and elbow region, respectively, and transposed and sutured onto the large ventral skin defect following mastectomy in all the dogs...
December 2017: Veterinary World
Ido Badash, Karen E Burtt, Hyuma A Leland, Daniel J Gould, Alexis D Rounds, Beina Azadgoli, Ketan M Patel, Joseph N Carey
Traumatic lower extremity fractures with compromised arterial flow are limb-threatening injuries. A retrospective review of 158 lower extremities with traumatic fractures, including 26 extremities with arterial injuries, was performed to determine the effects of vascular compromise on flap survival, successful limb salvage and complication rates. Patients with arterial injuries had a larger average flap surface area (255.1 vs 144.6 cm2, P = 0.02) and a greater number of operations (4.7 vs 3.8, P = 0.01) than patients without vascular compromise...
October 1, 2017: American Surgeon
J Riggs, J F Ladlow, L J Owen, J L Hall
Internal obturator and/or semitendinosus muscle flaps were used to reinforce primary appositional rectal wall repair in three dogs and one cat in this case series. All three dogs incurred rectal wall compromise during surgical excision of anal sac tumours. The cat sustained bite wounds to the perianal region resulting in abscessation and a rectal tear. Our results indicate that application of an internal obturator and/or semitendinosus muscle flap can reduce the risk of rectal wall dehiscence after primary repair, and consequently the risk of pararectal abscess or rectocutaneous fistula formation...
January 29, 2018: Journal of Small Animal Practice
Junjiang Fu, Xiaohui Liu, Wei Shyy, Huihe Qiu
In the current study, we experimentally investigated the flexibility effects on the aerodynamic performance of flapping wings and the correlation with aspect ratio at angle of attack α = 45<sup>o</sup>. The Reynolds number based on the chord length and the wing tip velocity is maintained at Re = 5.3x10<sup>3</sup>. Our result for compliant wings with an aspect ratio of 4 shows that wing flexibility can offer improved aerodynamic performance compared to that of a rigid wing. Flexible wings are found to offer higher lift-to-drag ratios; in particular, there is significant reduction in drag with little compromise in lift...
January 26, 2018: Bioinspiration & Biomimetics
Yi-Fan Chen, Tian-Hsiang Wang, Yen-Hao Chiu, Dun-Hao Chang
BACKGROUND: Free tissue transfer has become a safe and reliable means for repairing soft tissue and bony defects of the head and neck region. Although the success rate is high, the incidence of postoperative complications is common. One significant complication is postoperative hematoma formation. However, few published studies have addressed its incidence, etiology, or outcome. We performed a retrospective analysis to investigate this issue. METHODS: A retrospective review was conducted of 293 consecutive microvascular free tissue transfers in the head and neck region in a single institute from January 2013 to December 2015...
January 25, 2018: Annals of Plastic Surgery
Aadil A Khan, James T Paget, Martin McLaughlin, Joan N Kyula, Michelle J Wilkinson, Timothy Pencavel, David Mansfield, Victoria Roulstone, Rohit Seth, Martin Halle, Navita Somaiah, Jessica K R Boult, Simon P Robinson, Hardev S Pandha, Richard G Vile, Alan A Melcher, Paul A Harris, Kevin J Harrington
Improvements in cancer survival mean that long-term toxicities, which contribute to the morbidity of cancer survivorship, are being increasingly recognized. Late adverse effects (LAEs) in normal tissues after radiotherapy (RT) are characterized by vascular dysfunction and fibrosis causing volume loss and tissue contracture, for example, in the free flaps used for immediate breast reconstruction after mastectomy. We evaluated the efficacy of lentivirally delivered superoxide dismutase 2 (SOD2) overexpression and connective tissue growth factor (CTGF) knockdown by short hairpin RNA in reducing the severity of LAEs in an animal model of free flap LAEs...
January 24, 2018: Science Translational Medicine
Akshay Kapoor, Malay Karmakar, Collin Roy, Kaushal Priya Anand
Objective: To detect venous or arterial obstruction in the pedicle of a free flap we can monitor resistance in the flap bed which is reflected in Pulsatility Index (PI) Therefore if we detect change in the values of the PI in these flaps then we can detect complications in flap due to vascular insufficiency early. Materials and Methods: Seven patients of Free Fibular Flap Reconstruction and ten patients of Free Radial Forearm Flap reconstruction were evaluated over a period of 18 months...
May 2017: Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India
Mohit Sharma, Subramania Iyer, P Kishore, Jimmy Mathew, Raghuveer Reddy, Janarthanan Ramu, Sundeep Vijayaraghavan, Abhijeet Wakure, S M Mali Chetan, Visakh Varma, Ashish Chaudhari, Swapnil Dhake, Akshay Omkumar, Jerry Paul, Sunil Rajan, Ayyappan Nair, Druvan Shaji
Introduction: This article deals with two patients who underwent bilateral hand transplantation following amputation of both upper limbs at the distal third of the foream. Materials and Methods: The first patient had a history of loss of hands in a train accident , with possiblity of a run over element during the injury. The second patient lost his both hands in a mine blast. The preoperative work up included detailed clinical and psychological evaluation. The donor retrieval was similar in both the cases and the donors were housed in our own instittution...
May 2017: Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India
Harvey Chim, Yasmina Zoghbi, Ajani George Nugent, Wrood Kassira, Morad Askari, Christopher John Salgado
BACKGROUND: Free muscle flaps are a mainstay for reconstruction of distal third leg wounds and for large lower extremity wounds with exposed bone. However a major problem is the significant postoperative flap swelling, which may take months to resolve. We studied the efficacy and safety of immediate application of a vacuum assisted closure (VAC) dressing after a free muscle flap to the lower extremity. METHODS: Over a 19 months period, all consecutive free muscle flaps for lower extremity reconstruction at a Level I trauma center were evaluated prospectively for postoperative flap thickness, complications and flap survival...
January 2018: Archives of Plastic Surgery
Melissa Berthelot, Guang-Zhong Yang, Benny Lo
In fasciocutaneous free flap surgery, close postoperative monitoring is crucial for detecting flap failure, as around 10% of cases require additional surgery due to compromised anastomosis. Different biochemical and biophysical techniques have been developed for continuous flap monitoring, however, they all have shortcoming in terms of reliability, elevated cost, potential risks to the patient, and inability to adapt to the patient's phenotype. A wearable wireless device based on near infrared spectroscopy has been developed for continuous blood flow and perfusion monitoring by quantifying tissue oxygen saturation ()...
January 2018: IEEE Journal of Biomedical and Health Informatics
Rene D Largo, Jesse C Selber, Patrick B Garvey, Edward I Chang, Matthew M Hanasono, Peirong Yu, Charles E Butler, Donald P Baumann
BACKGROUND: Extensive flap salvage attempts are routinely performed in patients with late-onset flap vascular crisis despite low flap survival rates. A knowledge gap exists in management of compromised free flaps in patients who present with perfusion-related complications after hospital discharge. METHODS: A retrospective review of 7443 free flaps used in 7128 cancer patients at a single institution from January of 2001 to March of 2015 was performed. RESULTS: Of 7443 free flap reconstructions, 856 patients (12 percent) were taken back to the operating room...
January 2018: Plastic and Reconstructive Surgery
Seung Yup Lee, Julia M Pakela, Michael C Helton, Karthik Vishwanath, Yooree G Chung, Noah J Kolodziejski, Christopher J Stapels, Daniel R McAdams, Daniel E Fernandez, James F Christian, Jameson O'Reilly, Dana Farkas, Brent B Ward, Stephen E Feinberg, Mary-Ann Mycek
In reconstructive surgery, the ability to detect blood flow interruptions to grafted tissue represents a critical step in preventing postsurgical complications. We have developed and pilot tested a compact, fiber-based device that combines two complimentary modalities-diffuse correlation spectroscopy (DCS) and diffuse reflectance spectroscopy-to quantitatively monitor blood perfusion. We present a proof-of-concept study on an in vivo porcine model (n=8). With a controllable arterial blood flow supply, occlusion studies (n=4) were performed on surgically isolated free flaps while the device simultaneously monitored blood flow through the supplying artery as well as flap perfusion from three orientations: the distal side of the flap and two transdermal channels...
December 2017: Journal of Biomedical Optics
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