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https://www.readbyqxmd.com/read/29343893/assessment-of-perfusion-of-free-flaps-used-in-head-and-neck-reconstruction-using-pulsatility-index
#1
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
https://www.readbyqxmd.com/read/29343890/first-two-bilateral-hand-transplantations-in-india-part-2-technical-details
#2
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
https://www.readbyqxmd.com/read/29316773/immediate-application-of-vacuum-assisted-closure-dressing-over-free-muscle-flaps-in-the-lower-extremity-does-not-compromise-flap-survival-and-results-in-decreased-flap-thickness
#3
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 month 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 10, 2018: Archives of Plastic Surgery
https://www.readbyqxmd.com/read/29300699/a-self-calibrated-tissue-viability-sensor-for-free-flap-monitoring
#4
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
https://www.readbyqxmd.com/read/29280859/outcome-analysis-of-free-flap-salvage-in-outpatients-presenting-with-microvascular-compromise
#5
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
https://www.readbyqxmd.com/read/29243415/compact-dual-mode-diffuse-optical-system-for-blood-perfusion-monitoring-in-a-porcine-model-of-microvascular-tissue-flaps
#6
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
https://www.readbyqxmd.com/read/29224825/head-and-neck-free-flap-reconstruction-what-is-the-appropriate-post-operative-level-of-care
#7
Varun V Varadarajan, Hassan Arshad, Peter T Dziegielewski
Patients undergoing head and neck reconstruction require complex, multidisciplinary postoperative care which may include wound care, flap monitoring, tracheostomy management, and management of comorbid conditions. Historically, patients undergoing major resection of a head and neck or aerodigestive tract malignancy with regional or free flap reconstruction were routinely admitted to the ICU. Although head and neck cancer patients may have multiple medical comorbidities that may require postoperative critical care, the current trend in many institutions is to transfer stable and less medically complex patients to non-intensive care-level units with specialty trained nursing staff...
December 2017: Oral Oncology
https://www.readbyqxmd.com/read/29209513/can-we-predict-necrosis-intra-operatively-real-time-optical-quantitative-perfusion-imaging-in-surgery-study-protocol-for-a-prospective-observational-in-vivo-pilot-study
#8
Sanne M Jansen, Daniel M de Bruin, Mark I van Berge Henegouwen, Simon D Strackee, Denise P Veelo, Ton G van Leeuwen, Suzanne S Gisbertz
Background: Compromised perfusion as a result of surgical intervention causes a reduction of oxygen and nutrients in tissue and therefore decreased tissue vitality. Quantitative imaging of tissue perfusion during reconstructive surgery, therefore, may reduce the incidence of complications. Non-invasive optical techniques allow real-time tissue imaging, with high resolution and high contrast. The objectives of this study are, first, to assess the feasibility and accuracy of optical coherence tomography (OCT), sidestream darkfield microscopy (SDF), laser speckle contrast imaging (LSCI), and fluorescence imaging (FI) for quantitative perfusion imaging and, second, to identify/search for criteria that enable risk prediction of necrosis during gastric tube and free flap reconstruction...
2017: Pilot and Feasibility Studies
https://www.readbyqxmd.com/read/29208785/use-of-a-partial-thickness-flap-for-guided-bone-regeneration-in-the-upper-jaw
#9
Gianluca Porcaro, Alberto Busa, Edoardo Bianco, Gianluigi Caccianiga, Marcello Maddalone
INTRODUCTION: Guided bone regeneration (GBR) aims to restore adequate bone volume for the placement of implants in an ideal location. In this article, we analyze different surgical techniques for tissue management during GBR and a modified partial-thickness surgical approach. MATERIALS AND METHODS: In a year's time span, five patients were enrolled in the study: Four women and one man (aged 44-59 years). In four patients, a GBR with simultaneous implant placement was adopted, whereas in another patient, a delayed implant placement was done...
December 1, 2017: Journal of Contemporary Dental Practice
https://www.readbyqxmd.com/read/29201370/salvage-of-mangled-upper-extremity-using-the-masquelet-technique-in-a-child-a-case-report
#10
Nabil Alassaf, Amro Alhoukail, Abdullah Alsahli, Ghazi Althubaiti
Aim: To report our experience with the Masquelet concept in a pediatric upper extremity following an open injury to the elbow. Methods: A case report and literature review. Results: An 11-year-old boy was transferred to our institution after a motor vehicle collision. There was a primary loss of the ulnohumeral articulation and the surrounding soft tissues as well as the ulnar nerve. Reconstruction used the Masquelet-induced membrane technique and a soft tissue flap...
2017: SAGE Open Medical Case Reports
https://www.readbyqxmd.com/read/29175135/a-systematic-review-of-near-infrared-spectroscopy-in-flap-monitoring-current-basic-and-clinical-evidence-and-prospects
#11
REVIEW
Yu Kagaya, Shimpei Miyamoto
BACKGROUND: Near-infrared spectroscopy (NIRS) has been reported to be a reliable non-invasive modality for free flap monitoring; however, the history of its application in flap monitoring is short, and there is no definite consensus regarding its use at present. OBJECTIVES: The aim of this review is to clarify the evidence related to post-operative flap monitoring using NIRS and examine its appropriateness and usability. MATERIALS AND METHODS: The PubMed and Web of Science databases were searched using the strings "flap monitoring AND near-infrared spectroscopy" and "flap monitoring AND tissue oxygen saturation," with a study period from inception to December 31, 2016...
November 22, 2017: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/29175133/rectus-femoris-branch-an-alternative-blood-supply-for-a-distally-based-anterolateral-thigh-flap
#12
Shanshan Li, Yuanbo Liu, Mengqing Zang, Shengji Yu, Wei Guo, Rongli Yang
Successful raising of a distally based anterolateral thigh (dALT) flap mainly depends on a well-developed lateral circumflex femoral artery (LCFA) descending branch and an intact vascular connection between the descending branch and the vascular network of the knee. However, in some clinical scenarios, the descending branch is hypoplastic or the vascular connection of the knee is compromised. We present six cases of using dALT flaps in soft tissue defect reconstruction of the knee with either of the above-mentioned conditions...
November 2, 2017: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
https://www.readbyqxmd.com/read/29165417/-pterygium-etiology-pathogenesis-treatment
#13
S A Malozhen, S V Trufanov, D A Krakhmaleva
Pterygium is a degenerative condition characterized by fibrovascular outgrowth of conjunctiva over the cornea. Many theories exist that try to explain its pathogenesis. The current belief is that this disease is multifactorial with ultraviolet radiation being the most important trigger. Attention is also paid to such factors as tear film changes, cytokines and growth factors disbalance, immunologic disturbances, genetic mutations, and viral infections. Modern classifications consider the rate of fibrovascular growth, its progressive potential, and histological features...
2017: Vestnik Oftalmologii
https://www.readbyqxmd.com/read/29162941/aerobic-performance-in-tinamous-is-limited-by-their-small-heart-a-novel-hypothesis-in-the-evolution-of-avian-flight
#14
Jordi Altimiras, Isa Lindgren, Lina María Giraldo-Deck, Alberto Matthei, Álvaro Garitano-Zavala
Some biomechanical studies from fossil specimens suggest that sustained flapping flight of birds could have appeared in their Mesozoic ancestors. We challenge this idea because a suitable musculoskeletal anatomy is not the only requirement for sustained flapping flight. We propose the "heart to fly" hypothesis that states that sustained flapping flight in modern birds required an enlargement of the heart for the aerobic performance of the flight muscles and test it experimentally by studying tinamous, the living birds with the smallest hearts...
November 21, 2017: Scientific Reports
https://www.readbyqxmd.com/read/29140581/comparison-of-long-term-outcomes-between-pull-through-resection-and-mandibular-lip-split-surgery-for-t4a-tongue-floor-of-mouth-cancers
#15
Shih-Jung Cheng, Hui-Hsin Ko, Jang-Jaer Lee, Sang-Heng Kok
BACKGROUND: The purpose of this study was to determine whether the pull-through resection is better than the mandibular lip-split for advanced tongue/floor of mouth (FOM) cancers, which remains inconclusive. METHODS: A retrospective cohort study was performed on 91 patients with T4a tongue/FOM cancers from 2009 to 2014. Cases with mandibular resection were excluded. The pull-through resection was used when the mouth opening was ≥15 mm; otherwise the mandibular lip-split was used...
January 2018: Head & Neck
https://www.readbyqxmd.com/read/29126421/peroneal-artery-perforator-flap-for-the-treatment-of-chronic-lower-extremity-wounds
#16
Liang Cheng, Xiaqing Yang, Tingxiang Chen, Zhijie Li
BACKGROUND: Reconstruction of chronic lower extremity wounds remains challenging. These wounds are mainly associated with diabetes mellitus, infections, and osteomyelitis. Although several reconstructive techniques are available, the peroneal artery perforator flap has unique advantages. METHODS: In this study, we discuss our experiences with peroneal artery perforator flaps in 55 patients who had suffered from chronic lower limb wounds. The size of the defect, comorbidities, etiology, flap size, and complications were recorded and analyzed based on a retrospective chart review...
November 10, 2017: Journal of Orthopaedic Surgery and Research
https://www.readbyqxmd.com/read/29108918/donor-site-morbidity-of-the-anterolateral-thigh-flap
#17
Hannes Weise, Andreas Naros, Gunnar Blumenstock, Michael Krimmel, Sebastian Hoefert, Susanne Kluba, Stefan Hofer, Siegmar Reinert
INTRODUCTION: The purpose of this study was to investigate donor site morbidity after reconstruction of defects in the head and neck region with an anterolateral thigh (ALT) flap. METHODS: From 07/2006 to 12/2015 the anterolateral thigh flap was used for reconstruction of large intra- or extraoral defects in 138 patients. The donor sites were available to examine for morbidity in 51 patients (36.7%). All patients completed a standardized questionnaire, received a physical examination, and underwent isokinetic muscle exercises of the lower extremity with a Dynamometer...
September 30, 2017: Journal of Cranio-maxillo-facial Surgery
https://www.readbyqxmd.com/read/29024491/surgical-morbidity-and-mortality-in-patients-after-microvascular-reconstruction-for-head-and-neck-cancer
#18
Y-H Joo, K-J Cho, J-O Park, S-Y Kim, M-S Kim
OBJECTIVES: The aim was to evaluate the importance of clinical factors in the prediction of postoperative complications in patients with microvascular reconstruction for head and neck squamous cell cancer (HNSCC). DESIGN: A retrospective review of case notes was performed. SETTING: Patients treated at a single institute. PARTICIPANTS: This study included 259 patients with HNSCC treated with radical surgery and microvascular reconstruction between 1993 and 2014...
October 11, 2017: Clinical Otolaryngology
https://www.readbyqxmd.com/read/28988465/outcomes-and-reliability-of-the-flow-coupler-in-postoperative-monitoring-of-head-and-neck-free-flaps
#19
Rance J T Fujiwara, Jacqueline M Dibble, Scott V Larson, Matthew L Pierce, Saral Mehra
OBJECTIVES/HYPOTHESIS: To assess the accuracy and reliability of the flow coupler relative to the implantable arterial Doppler probe in postoperative monitoring of head and neck free flaps. STUDY DESIGN: Retrospective single-institution study, April 2015 to March 2017. METHODS: Both the venous flow coupler and arterial Doppler were employed in 120 consecutive head and neck free flap cases. When Doppler signal loss occurred, flaps were evaluated by physical exam to determine whether signal loss was a true positive necessitating operating room takeback...
October 8, 2017: Laryngoscope
https://www.readbyqxmd.com/read/28978276/a-novel-rodent-excision-model-for-ischemia-impaired-wound-healing
#20
Anna Theresa Hofmann, Sabine Neumann, James Crawford Ferguson, Heinz Redl, Rainer Mittermayr
Delayed wound healing and the potentially resulting chronic wounds are a challenging clinical problem. Available therapeutic strategies are limited in both number and efficacy. For developing and establishing novel treatment approaches appropriate clinical relevant animal models are essential. The aim of the study was to establish a reliable and reproducible delayed wound healing model which simulates the clinical scenario of compromised vascular tissue perfusion (hypoxia/ischemia). Therefore a standard rodent ischemic flap model was modified by challenging the tissue with ascending degrees of ischemia using different surgical approaches (minimal, mild, moderate and severe ischemic invasive approach)...
October 5, 2017: Tissue Engineering. Part C, Methods
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