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Compromised flap

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https://www.readbyqxmd.com/read/28062176/characteristics-and-surgical-management-of-flap-compromise-caused-by-thrombosis-of-the-internal-jugular-vein
#1
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
#2
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
#3
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...
November 29, 2016: Journal of Pediatric Urology
https://www.readbyqxmd.com/read/28039007/pedicle-orientation-in-free-flap-microvascular-maxillofacial-reconstruction
#4
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. Often, surgical reconstruction is preferred for patient quality of life and definitive restoration. Surgical reconstruction also avoids the difficulties encountered with fabricating an obturator in an irradiated field with the often-resultant microstomia...
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
#5
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
https://www.readbyqxmd.com/read/28018904/3d-volumetric-modeling-and-microvascular-reconstruction-of-irradiated-lumbosacral-defects-after-oncologic-resection
#6
Emilio Garcia-Tutor, Marco Romeo, Michael P Chae, David J Hunter-Smith, Warren Matthew Rozen
BACKGROUND: Locoregional flaps are sufficient in most sacral reconstructions. However, large sacral defects due to malignancy necessitate a different reconstructive approach, with local flaps compromised by radiation and regional flaps inadequate for broad surface areas or substantial volume obliteration. In this report, we present our experience using free muscle transfer for volumetric reconstruction, in such cases, and demonstrate three-dimensional (3D) haptic models of the sacral defect to aid preoperative planning...
2016: Frontiers in Surgery
https://www.readbyqxmd.com/read/28011323/intensive-care-unit-monitoring-after-pharyngeal-flap-surgery-is-it-necessary
#7
Sashank Reddy, Srinivas Susarla, Nance Yuan, Gurjot Walia, Danielle Rochlin, Richard Redett
PURPOSE: To assess the incidence of perioperative complications and the utility of intensive care monitoring in patients undergoing posterior pharyngeal flap surgery for velopharyngeal dysfunction (VPD). MATERIALS AND METHODS: This study was a retrospective evaluation of patients who underwent posterior pharyngeal flap surgery for treatment of VPD and an assessment of the incidence of perioperative complications. Descriptive statistics were computed. RESULTS: Over an 18-year period, 145 patients underwent pharyngeal flap surgery for VPD; 133 (91...
December 1, 2016: Journal of Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/28005651/columellar-reconstruction-a-new-technique-for-median-cleft-lip-repair
#8
Murat Livaoğlu, Yasemin Imamoğlu
Median cleft lip (MCL), failure of the fusion of the medial nasal prominences in the midline resulting in vertical cleft through the center of the upper lip, can be repaired by various columellar reconstruction approaches depending on the nature of patient. The main drawback of these surgical techniques is the use of healthy neighboring structures that may compromise the process. In this report, the authors present a new approach for repairing MCL which involves simultaneous columellar reconstruction without damaging any nasal units...
December 21, 2016: Journal of Craniofacial Surgery
https://www.readbyqxmd.com/read/27995120/tonsillectomy-as-prevention-and-treatment-of-sleep-disordered-breathing-a-report-of-23-cases
#9
Jae-Man Woo, Jin-Young Choi
BACKGROUND: The paradigm of tonsillectomy has shifted from a treatment of recurrent throat infection to one of multi-discipline management modalities of sleep-disordered breathing (SDB). While tonsillectomy as a treatment for throat problems has been performed almost exclusively by otorhinolaryngologists, tonsillectomy as a part of the armamentarium for the multifactorial, multidisciplinary therapy of sleep-disordered breathing needs a new introduction to those involved in treating SDB patients...
December 2016: Maxillofacial Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/27977824/soft-tissue-closure-of-grafted-extraction-sockets-in-the-anterior-maxilla-a-modified-palatal-pedicle-connective-tissue-flap-technique
#10
Edgard El Chaar, Sarah Oshman, Giuseppe Cicero, Alejandro Castano, Cinzia Dinoi, Leila Soltani, Yoonjung Nicole Lee
Localized ridge resorption, the consequence of socket collapse, following tooth extraction in the anterior maxilla can adversely affect esthetics, function, and future implant placement. Immediate grafting of extraction sockets may help preserve natural ridge contours, but a lack of available soft tissue can compromise the final esthetic outcome. The presented modified rotated palatal pedicle connective tissue flap is a useful technique for simultaneous soft tissue coverage and augmentation of grafted sockets to improve esthetic outcome...
January 2017: International Journal of Periodontics & Restorative Dentistry
https://www.readbyqxmd.com/read/27975015/implantable-doppler-probes-for-postoperatively-monitoring-free-flaps-efficacy-a-systematic-review-and-meta-analysis
#11
Tzu-Yen Chang, Yao-Chou Lee, You-Cheng Lin, Stanley Thian-Sze Wong, Yuan-Yu Hsueh, Yao-Lung Kuo, Shyh-Jou Shieh, Jing-Wei Lee
BACKGROUND: Although clinical assessment remains the gold standard for monitoring the circulation of free flaps, several adjunct techniques promote timely salvage by detecting circulation compromise early. The objective of this systematic review was to evaluate the efficacy of an implantable Doppler probe for postoperatively monitoring free flaps. MATERIALS AND METHODS: English-language articles evaluating the efficacy of implantable Doppler probes compared with clinical assessment for postoperatively monitoring free flaps were analyzed...
November 2016: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/27975014/the-nipple-areola-preserving-mastectomy-the-value-of-adding-a-delay-procedure
#12
Carlos A Martinez, Scott M Reis, Sean G Boutros
BACKGROUND: Conservative mastectomy procedures, such as the nipple-sparing mastectomy (NSM), present appealing options for patients with small invasive or noninvasive malignancies and those needing prophylactic mastectomies. Despite outstanding postoperative cosmetic results, nipple-areola complex (NAC) and mastectomy skin flap (MSF) survival remains a concern. We present our two-stage nipple-areola preserving (NAP) mastectomy, which aims to decrease the rate of NAC loss and MSF necrosis after conservative mastectomies...
November 2016: Plastic and Reconstructive Surgery. Global Open
https://www.readbyqxmd.com/read/27966506/versatility-of-nasolabial-flaps-for-the-management-of-severe-trismus-in-oral-submucous-fibrosis
#13
S M Balaji
BACKGROUND: Oral submucous fibrosis (OSMF) is a chronic insidious disease affecting any part of the oral cavity and sometimes the pharynx. It is a collagen-related disorder predominantly associated with tobacco/areca nut chewing habit and characterized by progressive hyalinization of the submucosa. Prevalence of OSMF is 2.01%, and malignant transformation rate of 2.3%-7.6% has been reported in the literature. Measures such as forcing the mouth open and cutting the fibrotic bands have resulted in more fibrosis and disability...
September 2016: Indian Journal of Dental Research: Official Publication of Indian Society for Dental Research
https://www.readbyqxmd.com/read/27935547/flap-design-and-perfusion-are-keys-of%C3%A2-success-axial-fasciocutaneous-posterior-thigh-flaps-for-deep-small-pelvic-defect-reconstruction
#14
Andreas Kehrer, Philipp Lamby, Benjamin H Miranda, Lukas Prantl, Juergen H Dolderer
BACKGROUND AND OBJECTIVES: Radical excisions of the rectum often result in large perineal and intrapelvic defects. Compromised wound healing can delay adjuvant therapies and limit the patient's prognosis. With current treatment, integrity of the abdominal wall may be maintained. The defect geometry is unique and requires extensive volume for reconstruction. This study describes the surgical technique and reports clinical outcomes of fasciocutaneous posterior thigh flaps as preliminary data for this indication...
December 8, 2016: Clinical Hemorheology and Microcirculation
https://www.readbyqxmd.com/read/27904753/skin-flap-complications-after-decompressive-craniectomy-and-cranioplasty-proposal-of-classification-and-treatment-options
#15
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
#16
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...
January 2017: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/27893628/watershed-areas-in-face-transplantation
#17
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
#18
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
#19
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
#20
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
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