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microvascular surgery

Mitchell L Worley, Evan M Graboyes, Julie Blair, Suhael Momin, Kent E Armeson, Terry A Day, Andrew T Huang
Objective To describe swallowing outcomes in elderly patients undergoing microvascular reconstruction of the upper aerodigestive tract and identify risk factors for poor postoperative swallowing function. Study Design Case series with chart review. Setting Academic medical center. Subjects and Methods Sixty-six patients aged ≥70 years underwent microvascular reconstruction of the upper aerodigestive tract. The primary outcome measure was the Functional Oral Intake Scale (FOIS); preoperative and postoperative scores were dichotomized to define "good swallowing" and "poor swallowing...
March 1, 2018: Otolaryngology—Head and Neck Surgery
Hak Chang, SeungHwan Hwang, SooA Lim, SuRak Eo, Kyung Won Minn, Ki Yong Hong
BACKGROUND: Muscle flap is a valuable option in soft tissue reconstruction. Denervated skeletal muscle is known to undergo degeneration. However, information regarding histological and genetic changes in muscle free flap without reinnervation over long-term follow-up remains unclear. METHODS: We collected flap muscles obtained during secondary exploration surgery after more than 15 years of previous muscle free flap without reinnervation. Compared with normal muscle and fat, histomorphometric and gene expression analysis of flap muscle were performed...
March 16, 2018: Annals of Plastic Surgery
Shunta Hori, Mitsuru Tomizawa, Fumisato Maesaka, Takuya Owari, Yosuke Morizawa, Yasushi Nakai, Makito Miyake, Tatsuo Yoneda, Nobumichi Tanaka, Katsunori Yoshida, Kiyohide Fujimoto
BACKGROUND: Page kidney phenomenon is caused by strong renal parenchymal compression and leads to renal hypoperfusion and microvascular ischemia, resulting in renal dysfunction and hypertension. Although the development of Page kidney phenomenon in allograft is rare, most of its cases are induced by allograft biopsy or trauma. We observed a case of Page kidney phenomenon that was induced by unusual causes immediately after kidney transplantation. CASE PRESENTATION: A 66-year-old man, whose wife donated a kidney, underwent ABO-compatible living kidney transplantation...
March 13, 2018: BMC Nephrology
Hakushi Kim, Chie Inomoto, Takato Uchida, Hiroyuki Furuya, Tomoyoshi Komiyama, Hiroshi Kajiwara, Hiroyuki Kobayashi, Naoya Nakamura, Akira Miyajima
The aim of the present study was to evaluate the validity of potential prognostic parameters of clear cell renal cell carcinoma (ccRCC) recommended by the 2012 International Society of Urological Pathology (ISUP) Consensus Conference in the Japanese population. We reviewed 406 Japanese patients with localized or locally advanced ccRCC who underwent curative surgery during 2004-2014 at Tokai University Hospital (Isehara, Japan) and were followed up for >2 years after surgery. A single pathologist reviewed all the histological slides...
April 2018: International Journal of Oncology
Junyi Shen, Jun Wen, Chuan Li, Tianfu Wen, Lvnan Yan, Bo Li, Jiayin Yang, Changli Lu
BACKGROUND: Microvascular invasion (MVI) is well established as a negative prognostic factor for hepatocelluar carcinoma (HCC). However, its prognostic value in different subgroups of Barcelona Clinical Liver Cancer (BCLC) stages remains to be elucidated. METHODS: Four hundred fifty-eight MVI-negative and 204 MVI-positive patients who underwent hepatectomy were retrospectively analyzed. After propensity score matching (PSM) analysis, 187 pairs of matched patients were generated...
March 12, 2018: BMC Cancer
Yuka Matsunaga, Masataka Ishimura, Hazumu Nagata, Kiyoshi Uike, Tadamune Kinjo, Masayuki Ochiai, Kenichiro Yamamura, Hidetoshi Takada, Yoshihisa Tanoue, Masaki Hayakawa, Masanori Matsumoto, Toshiro Hara, Shouichi Ohga
BACKGROUND: Thrombotic microangiopathies (TMA) are microvascular occlusive disorders characterized by systemic or intrarenal platelet aggregation, thrombocytopenia, and red cell fragmentation. Post-operative TMA mostly occurs in adult patients with cardiovascular surgery, with the distinct pathophysiology from classical thrombotic thrombocytopenic purpura (TTP) although the exact pathophysiology remains unclear. CASE PRESENTATION: A one-month-old infant developed TMA after the initial surgery of double outlet right ventricle...
February 7, 2018: Pediatrics and Neonatology
E Haapio, I Kinnunen, J K E Airaksinen, H Irjala, T Kiviniemi
OBJECTIVE: Post-operative bleeding in the head and neck area is potentially fatal. This 'real world' study sought to assess factors that increase the risk of re-operation for post-operative bleeding in head and neck cancer surgery. METHODS: A total of 456 patients underwent surgery for head and neck cancer (591 operations). The primary endpoint was re-operation for bleeding. RESULTS: The rate of re-operation for bleeding was 5 per cent of all operations...
March 8, 2018: Journal of Laryngology and Otology
Jason Silvestre, Joseph Upton, Benjamin Chang, David R Steinberg
BACKGROUND: Hand surgery fellowship programs in the United States are predominately sponsored by departments or divisions of orthopaedic surgery or plastic surgery. This study compares the operative experiences of hand surgery fellows graduating from orthopaedic or plastic surgery hand surgery fellowships. METHODS: Operative case logs of 3 cohorts of hand surgery fellows graduating during the academic years of 2012-2013, 2013-2014, and 2014-2015 were analyzed. The median case volumes were compared by specialty via Mann-Whitney U tests...
March 7, 2018: Journal of Bone and Joint Surgery. American Volume
Luca Luzzi, Federico Franchi, Annarita Dapoto, Marco Ghisalberti, Roberto Corzani, Daniele Marrelli, Luca Marchetti, Piero Paladini, Sabino Scolletta
Background: In the treatment of malignant pleural mesothelioma the Hyperthermic Intra THOracic Chemotherapy (HITHOC) can improve the efficacy of pleurectomy and decortication with a local cytotoxic effect. However its biological impact in patient's hemodynamic and microcirculatory changes were rarely investigated. Aim of this study is to describe our experience with HITHOC after pleurectomy and decortication evaluating the role of sublingual video-microscopy in assessing the microcirculatory changes in the perioperative period...
January 2018: Journal of Thoracic Disease
N D Thimmappa, J V Vasile, C Y Ahn, J L Levine, M R Prince
Autologous breast reconstruction using muscle-sparing free flaps are becoming increasingly popular, although microvascular free flap reconstruction has been utilised for autologous breast reconstructions for >20 years. This innovative microsurgical technique involves meticulous dissection of artery-vein bundle (perforators) responsible for perfusion of the subcutaneous fat and skin of the flap; however, due to unpredictable anatomical variations, preoperative imaging of the donor site to select appropriate perforators has become routine...
February 27, 2018: Clinical Radiology
Amitesh Dubey, Nishtha Yadav, Shailendra Ratre, Vijay Singh Parihar, Yad Ram Yadav
BACKGROUND: Although most surgeons are employing endoscope as an adjunct to the microscope in microvascular decompression, a full endoscopic technique is less commonly performed. The present study is aimed to evaluate results of 230 patients of endoscopic vascular decompression. METHODS: A retrospective study was carried out in a tertiary care hospital. Patients with typical neuralgia, with or without preoperatively detected vascular compression, were advised to undergo vascular decompression...
February 24, 2018: World Neurosurgery
Vigdis Andersen Eidsvaag, Hans-Arne Hansson, Kjell Heuser, Erlend A Nagelhus, Per Kristian Eide
AIM: Idiopathic intracranial hypertension (IIH) is characterized by symptoms indicative of increased intracranial pressure (ICP), such as headache and visual impairment. We have previously reported that brain biopsies from IIH patients show patchy astrogliosis and increased expression of the water channel aquaporin-4 (AQP4) at perivascular astrocytic endfeet. METHODS: The present study was undertaken to investigate for ultrastructural changes of the cerebral capillaries in individuals with IIH...
February 22, 2018: Brain Research
Vadim Gospodarev, Vikram Chakravarthy, Casey Harms, Hannah Myers, Brett Kaplan, Esther Kim, Matthew Pond, Kenneth De Los Reyes
BACKGROUND: Trigeminal neuralgia (TGN) causes severe unilateral facial pain. The etiology is hypothesized to be segmental demyelination of the trigeminal nerve root via compression by the superior cerebellar artery (SCA). Microvascular decompression (MVD) allows immediate and long-term pain relief. Preoperative evaluation includes MRI (magnetic resonance imaging) and/or MRA (magnetic resonance angiography) of the brain. Having a pacemaker is a contraindication for MRI. There have been isolated reports of using computed tomography (CT) cisternography scans for radiation planning for TGN...
February 21, 2018: World Neurosurgery
Özlenen Özkan, Ömer Özkan, Anı Çinpolat, Mehmet Can Ubur, Gamze Bektaş, Adil Jumshudov, Hilmi Uysal
BACKGROUND: The repair of extensive lower lip defects is difficult due to the presence of both functional and esthetic requirements. This report describes functional lip repair using the partial latissimus dorsi free flap without nerve coaptation. METHODS: Reconstruction of the lower lip due to subtotal and total tissue defects was performed using latissimus dorsi free flap on twelve patients, between 2013 and 2017. The etiology was squamous cell carcinoma in six patients, malignant melanoma in one, firearm injury in three and microstomia in two...
February 23, 2018: Microsurgery
Shatha M Sulaiman, Abdulmalik A Alkhodair, Shahd M Sulaiman, Lama M Sulaiman, Ahmed S Elkafafy
Replantation is the reattachment of a severed body part, with attempts to restore neurovascular and musculoskeletal integrity, function, and aesthetics. On September 7, 1964, the first extremity replantation-a completely amputated hand-by vascular anastomosis technique was successfully performed.1 Soon after, the first replantation of a complete thumb amputation using microvascular anastomosis in a human was successfully conducted by Komatsu et al.2 in 1968. The overall success rate of limb replantation surgery is around 83...
January 2018: Plastic and Reconstructive Surgery. Global Open
Arezoo Astanehe, Claire Temple-Oberle, Markus Nielsen, William de Haas, Robert Lindsay, Jennifer Matthews, David C McKenzie, Justin Yeung, Christiaan Schrag
Background: The aim of this study was to develop, implement, and evaluate a standardized perioperative enhanced recovery after surgery (ERAS) clinical care pathway in microsurgical abdominal-based breast reconstruction. Methods: Development of a clinical care pathway was informed by the latest ERAS guideline for breast reconstruction. Key features included shortened preoperative fasting, judicious fluids, multimodal analgesics, early oral nutrition, early Foley catheter removal, and early ambulation...
January 2018: Plastic and Reconstructive Surgery. Global Open
Stephen Ali
Early year's plastic surgery trainees are faced with a large choice of microsurgery courses to select from. In the context of dwindling study budgets and busy on-call rotas, the pressure to select a high yield course that delivers value for money is of paramount importance.The Basic Microvascular Anastomosis Simulation Hub Microsurgery Course is a GBP £600 (US $790) 5-day 40-hour course based at Barts and The London School of Medicine and Dentistry increasing in popularity among junior trainees to fit this brief...
April 2018: Annals of Plastic Surgery
Sooneon Bae, Michael J DiBalsi, Nicole Meilinger, Chengqi Zhang, Erica Beal, Guzeliya Korneva, Robert O Brown, Konstantin G Kornev, Jeoung Soo Lee
The surgical connection of blood vessels, anastomosis, is a critical procedure in many reparative, transplantation, and reconstructive surgical procedures. However, effective restoration of circulation is complicated by pathological clotting (thrombosis) or progressive occlusion due to excess cell proliferation that often leads to additional surgeries and increases morbidity and mortality risk for patients. Pharmaceutical agents have been tested to prevent these complications, but many have unacceptable systemic side effects...
February 20, 2018: ACS Applied Materials & Interfaces
M Sindou, P Mercier
Over the last decades microvascular decompression (MVD) has been established as the curative treatment of the primary Hemifacial Spasm (HFS), proven to be linked in almost all cases to a neurovascular compression of the facial nerve. Because the disease is not life-threatening and MVD not totally innocuous, efficacy and safety have to be weighted before decision taken of indicating surgery. The authors have been charged by the French Speaking Society of Neurosurgery to conduct a detailed evaluation of the probability of relief of the spasm that MVD is able to obtain, together with its potential complications...
February 14, 2018: Neuro-Chirurgie
Kenneth Akakpo, Christopher Iobst, Matthew Old, Jonathan Grischkan
The fibular free flap has become the gold standard for mandibular reconstruction. Despite its vast array of benefits, this procedure has the potential for several complications. In the pediatric setting, the immature skeleton sets the stage for an increased risk of future skeletal abnormalities, both in the jaw, and in the donor site. Herein we describe the case of a toddler who underwent mandibular reconstruction using a fibula free flap and, years later, subsequently developed ankle instability as a result of residual fibula migration...
February 2018: International Journal of Pediatric Otorhinolaryngology
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