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Compromised flap

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https://www.readbyqxmd.com/read/28403069/using-a-pedicle-pectoralis-major-musculocutaneous-flap-in-head-and-neck-reconstruction-after-modified-radical-mastectomy-a-case-report
#1
Jen-Wu Huang, Nai-Yuan Wu, Yi-Ying Lin
RATIONALE: A pedicle pectoralis major musculocutaneous (PMMC) flap is one of the strategies for head and neck reconstruction. Seldom studies reported the case in which the skin area of previous modified radical mastectomy (MRM) had been used as a PMMC flap in head and neck reconstruction. PATIENT CONCERNS: An 84-year-old female who had suffered from left breast cancer and undergone a left modified radical mastectomy (MRM) more than 20 years earlier. DIAGNOSES: She had squamous cell carcinoma of the tongue and had undergone partial glossection and left modified radial neck dissection...
April 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28399607/surgeon-reported-needs-for-improved-training-in-identifying-and-managing-free-flap-compromise
#2
Catherine McMillan, Veerle D'Hondt, Alexandra H Marshall, Paul Binhammer, Joan Lipa, Laura Snell
Background This study examined the need for improved training in the identification and management of free flap (FF) compromise and assessed a potential role for simulated scenario training. Methods Online needs assessment surveys were completed by plastic surgeons and a subsample with expertise in microsurgery education participated in focus groups. Data were analyzed using descriptive statistics and mixed qualitative methods. Results In this study, 77 surgeons completed surveys and 11 experts participated in one of two focus groups...
April 11, 2017: Journal of Reconstructive Microsurgery
https://www.readbyqxmd.com/read/28392650/transoral-cross-lip-abb%C3%A3-estlander-flap-as-a-viable-and-effective-reconstructive-option-in-middle-lower-lip-defect-reconstruction
#3
Hyung Jin Hahn, Hyun Jee Kim, Jin Young Choi, Soo Young Lee, Young Bok Lee, Jin Wou Kim, Dong Soo Yu
The Abbé-Estlander flap surgery is a cross-lip procedure that is valuable in repairing a defect on the lower lip using a full-thickness flap, consisting of the skin, muscle and mucosa, from the upper lip. As usefulness and practicality of the flap in reconstruction of lower lip surgical defects in Asian ethnicity have not been documented, the authors present a case of successful lower lip reconstruction with a staged, Abbé-Estlander lip switching flap with commissuroplasty as an illustrative example. A 71-year-old male has presented with an ulcerating lip nodule in the middle one third of the lower lip, measuring about 1...
April 2017: Annals of Dermatology
https://www.readbyqxmd.com/read/28359353/guitar-string-suture-to-facilitate-closure-of-a-finger-like-flap-for-reconstruction-of-the-nose
#4
E Querol-Cisneros, P Redondo
INTRODUCTION: The basic principle of a lobed or finger-like transposition flap is that, after covering the defect with the transposed tissue, the donor site is closed primarily. With large defects, a second lobe may be added to the flap if primary closure of the area left by the first lobe is not possible. The flap can often be made to adapt to the defect, but this maneuver, in combination with primary closure of the adjacent tissue, can sometimes produce excessive tension and compromise the blood supply...
March 27, 2017: Actas Dermo-sifiliográficas
https://www.readbyqxmd.com/read/28356686/evaluating-the-use-of-octyl-2-cyanoacrylate-in-unilateral-cleft-lip-repair
#5
Vijaylaxmy Malhotra, J K Dayashankara Rao, Varun Arya, Shalender Sharma, Sushil Singh, Payal Luthra
BACKGROUND: Facial cosmetic results are one of the most concerning issues for the parents who get their children operated for cleft lip. Moreover, the postoperative care of the surgical site, the discomfort associated with the suture removal, and additional visit for suture removal are other reasons which encourages one to use any new technologies that may replace the need for suture placement. In this study, we used octyl-2-cyanoacrylate, a tissue adhesive which offers a viable alternative to traditional techniques without compromising optimal wound closure...
July 2016: National Journal of Maxillofacial Surgery
https://www.readbyqxmd.com/read/28352601/systematic-review-and-comparative-meta-analysis-of-outcomes-following-pedicled-muscle-versus-fasciocutaneous-flap-coverage-for-complex-periprosthetic-wounds-in-patients-with-total-knee-arthroplasty
#6
James M Economides, Michael V DeFazio, Kayvon Golshani, Mark Cinque, Ersilia L Anghel, Christopher E Attinger, Karen Kim Evans
BACKGROUND: In cases of total knee arthroplasty (TKA) threatened by potential hardware exposure, flap-based reconstruction is indicated to provide durable coverage. Historically, muscle flaps were favored as they provide vascular tissue to an infected wound bed. However, data comparing the performance of muscle versus fasciocutaneous flaps are limited and reflect a lack of consensus regarding the optimal management of these wounds. The aim of this study was to compare the outcomes of muscle versus fasciocutaneous flaps following the salvage of compromised TKA...
March 2017: Archives of Plastic Surgery
https://www.readbyqxmd.com/read/28350682/vasculature-of-a-medial-femoral-condyle-free-flap-in-intact-and-osteotomized-flaps
#7
Maciej Rysz, Wojciech Grabczan, Maciej Jan Mazurek, Romuald Krajewski, Dariusz Grzelecki, Bogdan Ciszek
BACKGROUND: A small size and difficulties with shaping a medial femoral condyle corticocancellous bone flap are factors limiting its use. The goal of this study was to evaluate range of vascular supply to a medial femoral condyle corticocancellous bone flap to determine whether harvesting of larger flaps and performing a flap osteotomy would compromise the vasculature of a flap's bone. METHODS: Twenty-four limbs were dissected and medial femoral condyle corticocancellous bone flaps were harvested with skin paddles...
April 2017: Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/28331365/mastectomy-skin-flap-necrosis-challenges-and-solutions
#8
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
#9
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
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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