1
|
Kramer A, Lava CX, Li KR, Berger LE, Khayat E, Song DH. Indocyanine Green Angiography for Detecting Quantitative Perfusion Changes in Deep Inferior Epigastric Perforator Flap Breast Reconstruction With Second Venous Drainage. Ann Plast Surg 2024; 93:215-220. [PMID: 38896834 DOI: 10.1097/sap.0000000000003984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
BACKGROUND This study aims to compare perfusion dynamics using indocyanine green videoangiography before and after the creation of a second venous anastomosis between the superficial inferior epigastric vein and the retrograde internal mammary vein (IMV) in deep inferior epigastric perforator (DIEP) flap breast reconstructions. METHODS Indocyanine green videoangiography performed during DIEP flap reconstructions was analyzed prospectively. The areas of interest were above the perforators with the highest intensity (complete perfusion), the most distal lateral edge of the flap (partial perfusion), and the next lowest intensity (ischemic). We compared the zone intensities before and after the second venous anastomosis, assessing venous drainage patency and functionality. Patient characteristics, operative details, and complications were collected. RESULTS Seven patients (10 breasts) underwent DIEP reconstruction. Mean age was 54.5 ± 12.4 years. Mean operative duration was 575.5 ± 172.6 minutes. Donors included DIEV (n = 10, 100.0%), superficial inferior epigastric vein (n = 9, 90.0%), and superficial circumflex epigastric vein (n = 1, 10.0%). All DIEVs were anastomosed to the antegrade IMV (n = 10, 100.0%). Superficial inferior epigastric veins were anastomosed to the retrograde IMV (n = 10, 100.0%). Mean peak intensities of the complete perfusion zone before and after the second venous anastomosis were 160.7 ± 42.1 and 188 ± 42.1, respectively ( P = 0.163). Mean peak intensities of the partial perfusion zone were 100.8 ± 21.5 and 152 ± 31.5, respectively ( P < 0.001). Mean peak intensities of the ischemic zone were 90.4 ± 37.4 and 143.4 ± 45.3, respectively ( P = 0.012). CONCLUSION These findings highlight the potential benefits of the super drainage technique in enhancing perfusion and reducing complications, emphasizing the need for further investigation and consideration of this technique in clinical practice.
Collapse
Affiliation(s)
- Aviv Kramer
- From the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC
| | | | | | | | - Elias Khayat
- Georgetown University School of Medicine, Washington, DC
| | - David H Song
- From the Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC
| |
Collapse
|
2
|
Opyrchał J, Bula D, Dowgierd K, Pachuta B, Krakowczyk D, Raciborska A, Krakowczyk Ł. Case Series: Fibula Free Flap with Bone Allograft as the Gold Standard in Lower Limb-Salvage Surgery for Adolescent Patients with Primary Bone Tumors Located within Tibial Diaphysis: Technical Modifications and Short-Term Follow-Up. J Clin Med 2024; 13:4217. [PMID: 39064257 PMCID: PMC11277773 DOI: 10.3390/jcm13144217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 07/16/2024] [Accepted: 07/17/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Primary malignant bone tumors are most commonly associated with mutilating surgical procedures that can significantly disturb the motor development of a young patient and are frequently affiliated with major postoperative complications. Unfortunately, despite available autologous tissue donor sites, artificial materials are still most commonly used for the reconstruction of post-resection defects. Reconstructive microsurgery is increasingly recognized as an effective method of functional reconstruction, creating the possibility of performing limb-sparing surgery (LSS) with significant limitation of major postoperative complications at the same time. Methods: The study group consisted of 9 pediatric patients diagnosed with primary malignant bone tumor in the limb location. In order to perform microvascular reconstruction, 9 free fibula flaps were used in combination with a bone allograft (Capanna method). The functional outcome of the reconstruction was assessed on the basis of the MSTS (Musculoskeletal Tumor Society Scoring System) scale. Results: The presented analysis proves the effectiveness of this reconstructive procedure and the possibility of performing LSS with reasonable functional outcomes after appropriate patient qualification. In this study, all limbs included were spared. In all cases, the R0 surgical margins were achieved and no reports of local recurrences were reported during the follow-up. The average score on the MSTS scale was 27/30 points. Conclusions: Microvascular reconstructive surgery is an individually personalized and highly effective method of treating patients with primary bone tumors in the limb location and provides satisfactory functional outcomes.
Collapse
Affiliation(s)
- Jakub Opyrchał
- Department of Oncology and Surgical Oncology for Children and Youth, Institute of Mother and Child, 01-211 Warsaw, Poland
- 1st Department of Oncologic Surgery, Maria Sklodowska Curie Memorial National Cancer Center, 44-100 Gliwice, Poland
| | - Daniel Bula
- 1st Department of Oncologic Surgery, Maria Sklodowska Curie Memorial National Cancer Center, 44-100 Gliwice, Poland
| | - Krzysztof Dowgierd
- Department of Clinical Pediatrics, Head and Neck Surgery Clinic for Children and Young Adults, University of Warmia and Mazury, 10-709 Olsztyn, Poland
| | - Bartosz Pachuta
- Department of Oncology and Surgical Oncology for Children and Youth, Institute of Mother and Child, 01-211 Warsaw, Poland
| | - Dominika Krakowczyk
- Pediatric Surgery and Urological Department, Upper Silesian Child Health Center in Katowice, Silesian University of Medicine, 40-052 Katowice, Poland
| | - Anna Raciborska
- Department of Oncology and Surgical Oncology for Children and Youth, Institute of Mother and Child, 01-211 Warsaw, Poland
| | - Łukasz Krakowczyk
- Department of Oncology and Surgical Oncology for Children and Youth, Institute of Mother and Child, 01-211 Warsaw, Poland
- 1st Department of Oncologic Surgery, Maria Sklodowska Curie Memorial National Cancer Center, 44-100 Gliwice, Poland
- Department of Clinical Pediatrics, Head and Neck Surgery Clinic for Children and Young Adults, University of Warmia and Mazury, 10-709 Olsztyn, Poland
| |
Collapse
|
3
|
Moshal T, Lasky S, Roohani I, Jolibois MI, Manasyan A, Munabi NCO, Fahradyan A, Lee JA, Hammoudeh JA. The Forgotten Flap: The Pedicled Trapezius Flap's Utility in Pediatric Head and Neck Reconstruction-A Systematic Review. J Reconstr Microsurg 2024. [PMID: 38917840 DOI: 10.1055/s-0044-1787741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
BACKGROUND When free tissue transfer is precluded or undesired, the pedicled trapezius flap is a viable alternative for adults requiring complex head and neck (H&N) defect reconstruction. However, the application of this flap in pediatric reconstruction is underexplored. This systematic review aimed to describe the use of the pedicled trapezius flap and investigate its efficacy in pediatric H&N reconstruction. METHODS A systematic review was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles describing the trapezius flap for H&N reconstruction in pediatric patients were included. Patient demographics, surgical indications, wound characteristics, flap characteristics, complications, and functional outcomes were abstracted. RESULTS A systematic review identified 22 articles for inclusion. Studies mainly consisted of case reports (n = 11) and case series (n = 8). In total, 67 pedicled trapezius flaps were successfully performed for H&N reconstruction in 63 patients. The most common surgical indications included burn scar contractures (n = 46, 73.0%) and chronic wounds secondary to H&N masses (n = 9, 14.3%). Defects were most commonly located in the neck (n = 28, 41.8%). The mean flap area and arc of rotation were 326.4 ± 241.7 cm2 and 157.6 ± 33.2 degrees, respectively. Most flaps were myocutaneous (n = 48, 71.6%) and based on the dorsal scapular artery (n = 32, 47.8%). Complications occurred in 10 (14.9%) flaps. The flap's survival rate was 100% (n = 67). No instances of functional donor site morbidity were reported. The mean follow-up was 2.2 ± 1.8 years. CONCLUSION This systematic review demonstrated the reliability of the pedicled trapezius flap in pediatric H&N reconstruction, with a low complication rate, no reports of functional donor site morbidity, and a 100% flap survival rate. The flap's substantial surface area, bulk, and arc of rotation contribute to its efficacy in covering soft tissue defects ranging from the proximal neck to the vertex of the scalp. The pedicled trapezius flap is a viable option for pediatric H&N reconstruction.
Collapse
Affiliation(s)
- Tayla Moshal
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Sasha Lasky
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Idean Roohani
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Marah I Jolibois
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Artur Manasyan
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Naikhoba C O Munabi
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Artur Fahradyan
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California
| | - Jessica A Lee
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, California
| | - Jeffrey A Hammoudeh
- Division of Plastic and Maxillofacial Surgery, Children's Hospital Los Angeles, Los Angeles, California
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, California
| |
Collapse
|
4
|
Liu B, Su X, Chai H, Chen Q, Hu J, Wang Y. Three-point Method Nerve Block for Relieving Pain of Microbotox Injection in Middle and Upper Face. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5853. [PMID: 38841525 PMCID: PMC11150023 DOI: 10.1097/gox.0000000000005853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 04/01/2024] [Indexed: 06/07/2024]
Abstract
Background With the popularity of microbotox, pain caused by multiple microdroplets and subcutaneous injection of botulinum toxin is increasing. This study presents a new, refined, three-point nerve block technique that provides effective pain relief during minimally invasive injection therapy targeting the middle and upper face. Methods Fifty volunteers underwent facial ultrasonography to measure the locations of the supraorbital and infraorbital foramen. Following microdrop Botox injection of the middle and upper face, 100 patients underwent a self-controlled study to analyze whether a three-point nerve block surpasses topical anesthesia for reducing injection pain. The visual analog scale pain score, the time of the three-point method and botulinum toxin injection, and side effects were recorded. Results Among the volunteers, the location of the supraorbital and infraorbital foramen showed no statistical difference between the left and right sides. For the 100 patients (13 men, 87 women) who underwent the three-point nerve block, the visual analog scale pain scores on the experimental side were significantly lower than those on the control side, except in the frontotemporal region (2.46 ± 0.50, 2.42 ± 0.47, P > 0.05). The duration of the unilateral three-point nerve block was 74.8 ± 5.64 seconds. The total injection time was 189.86 ± 26.79 seconds (range 148-286 s). Conclusions The three-point method exerted prominent analgesic effects during middle and upper facial treatments, with benefits including a precise block region, high satisfaction, and simple operation technique. Therefore, clinicians can easily master and apply this method.
Collapse
Affiliation(s)
- Bing Liu
- From the Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xueshang Su
- From the Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongli Chai
- Department of Ultrasonography, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Chen
- The Second School of Clinical Medicine, Xinjiang Medical University, Xinjiang, China
| | - Jintian Hu
- Department of Cosmetic Injection Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yongqian Wang
- Department of Cleft Lip and Palate Treatment, Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
5
|
Yu VJ, Joseph JT, Kemp TL, Ortiz KJ, DeJesus RA. Successful Intraoperative Salvage of a Venous Congested Deep Inferior Epigastric Perforator Flap Using a Cross-thoracic Saphenous Vein Graft. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5830. [PMID: 38784833 PMCID: PMC11111392 DOI: 10.1097/gox.0000000000005830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/01/2024] [Indexed: 05/25/2024]
Abstract
For autologous breast reconstruction using the deep inferior epigastric perforator flap, the internal mammary vessels are a common choice for recipient vessels. However, if these vessels are discovered to be inadequate, this may require the utilization of alternative vessels for successful salvage. Here, we demonstrate the use of a venous conduit for flap salvage in a patient undergoing bilateral deep inferior epigastric perforator flap breast reconstruction. Intraoperative venous congestion was identified on the left side. A contributing factor was an unresolvable size discrepancy between the deep inferior epigastric and the internal mammary venae comitantes. A saphenous vein graft can be used to drain the donor inferior epigastric vein to the contralateral internal mammary venae comitantes. In this discussion, adequate venous drainage was obtained with this approach, and the flap remained viable with good Doppler signals without further complications over a year postoperatively.
Collapse
Affiliation(s)
- Victor J. Yu
- From the Division of Plastic and Reconstructive Surgery, Eastern Virginia Medical School, Norfolk, Va
| | - Jeremy T. Joseph
- From the Division of Plastic and Reconstructive Surgery, Eastern Virginia Medical School, Norfolk, Va
| | - Tamara L. Kemp
- From the Division of Plastic and Reconstructive Surgery, Eastern Virginia Medical School, Norfolk, Va
- Division of Plastic and Reconstructive Surgery, Naval Medical Center Portsmouth, Portsmouth, Va
| | - Kenneth J. Ortiz
- From the Division of Plastic and Reconstructive Surgery, Eastern Virginia Medical School, Norfolk, Va
- Division of Plastic and Reconstructive Surgery, Naval Medical Center Portsmouth, Portsmouth, Va
| | - Ramon A. DeJesus
- From the Division of Plastic and Reconstructive Surgery, Eastern Virginia Medical School, Norfolk, Va
- Division of Plastic and Reconstructive Surgery, Naval Medical Center Portsmouth, Portsmouth, Va
- Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, Md
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Va
| |
Collapse
|
6
|
Xie L, Kong X, Gao J. Unveiling Intricacies of DIEP Breast Reconstruction Post Early Breast Cancer: A Deep Dive into a Case of Unforeseen Complications. Cancer Manag Res 2024; 16:337-345. [PMID: 38650978 PMCID: PMC11034507 DOI: 10.2147/cmar.s429782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 03/03/2024] [Indexed: 04/25/2024] Open
Abstract
In the vast expanse of restorative surgical procedures, the Deep Inferior Epigastric Perforator (DIEP) flap, originating from the inferior epigastric artery, has emerged as the preferred method of breast reconstruction, attributable to its myriad advantages. The technique provides reliable vascular supply, robust tissue volume for excision, minimal invasiveness to the donor site, with direct closure and concealment of the said site. This paper embarks on an elaborate elucidation of the DIEP surgical procedure, pivoting on the analytical exploration of a particular instance where necrosis of the skin flap occurred following immediate DIEP breast reconstruction in a patient diagnosed with early-stage breast cancer. This patient had previously undergone Nipple Areola Complex Sparing Mastectomy (NSM). We endeavor to extrapolate insights from this singular case of post-NSM DIEP breast reconstruction failure and correlate our findings with current literature dedicated to similar instances of surgical failure in DIEP breast reconstruction.
Collapse
Affiliation(s)
- Li Xie
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, People’s Republic of China
| | - Xiangyi Kong
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, People’s Republic of China
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China
| | - Jidong Gao
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, People’s Republic of China
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, People’s Republic of China
| |
Collapse
|
7
|
Iskandarova A, Rao SJ, Yohe GJ, Shah AB, Giladi AM. Distal Upper Extremity Arterial Calcification as a Predictor for Subclinical Coronary Artery Disease by Coronary Artery Calcium Scoring. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5768. [PMID: 38660336 PMCID: PMC11042768 DOI: 10.1097/gox.0000000000005768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 03/18/2024] [Indexed: 04/26/2024]
Abstract
Several studies have linked calcification of the thoracic and lower extremity arterial trunks to an increased risk of developing coronary artery disease (CAD). Calcifications of the radial and/or ulnar artery are regularly identified in hand/wrist x-rays; however, the clinical relevance of these findings as related to identifying subclinical CAD is not well understood. Associations between CAD and upper extremity calcifications have been reported, but the timeline is unclear. The purpose of this study was to evaluate the association between upper extremity arterial calcifications on hand radiographs with CAD by coronary artery calcification (CAC) scoring in patients with no known history of CAD. This is a pilot single-center, prospective, matched cohort study. We included patients with no known history of CAD, related symptoms, or major risk factors. We recruited five patients with calcifications (cal+) and five patients matched by age, race, sex, and medical history but without calcifications (cal-). CAC scores were determined from computed tomography scanning, and lipid profile was evaluated. In the cal+ group, the mean CAC total score was 244.1; in the control (cal-) group, it was 85.2. The mean total cholesterol levels were 220.8 mg per dL and 167 mg per dL in the cal+ and cal- groups, respectively. Two cal+ patients with CAC scores of 937 and 669 died shortly after being enrolled in our study. Preliminary findings suggest that calcifications in the radial or ulnar artery in otherwise asymptomatic patients with no history of CAD may be an independent sign of CAD.
Collapse
Affiliation(s)
- Aygul Iskandarova
- From The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, Md
| | - Shiavax J. Rao
- Department of Medicine, MedStar Union Memoial Hospital, Baltimore, Md
| | - Gabriel J. Yohe
- From The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, Md
| | - Ankit B. Shah
- Cardiology, MedStar Union Memorial Hospital, Baltimore, Md
- Georgetown University School of Medicine, Washington D.C
| | - Aviram M. Giladi
- From The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, Md
| |
Collapse
|
8
|
Maier MA, Palines PA, Guidry RF, Stalder MW. Use of Flow-through Free Flaps in Head and Neck Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5588. [PMID: 38504941 PMCID: PMC10950194 DOI: 10.1097/gox.0000000000005588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 12/11/2023] [Indexed: 03/21/2024]
Abstract
Background Reconstructive obstacles in composite head and neck defects are compounded in reoperated, traumatized, irradiated, and vessel-depleted surgical fields. In cases that require multiple free flaps, recipient vessel accessibility and inset logistics become challenging. Strategic flow-through flap configurations mitigate these issues by supplying arterial inflow and venous outflow to a second flap in a contiguous fashion. This approach (1) permits the use of a singular native recipient vessel, (2) increases the reach of the vascular pedicle, avoiding the need for arteriovenous grafting, and (3) allows for a greater three-dimensional flexibility in configuring soft tissue and bony flap inset. Methods To demonstrate this technique, we conducted a retrospective review of all head and neck reconstruction patients presenting to us from March 2019 to April 2021. Results We present seven oncological and two traumatic patients (N = 9) who received flow-through free flaps for head and neck reconstruction. The most common flap used as the flow-through flap was the anterolateral thigh flap (N = 7), followed by the fibula flap (N = 2). Mean follow-up time was 507 days. No flap failures occurred. Conclusion In head and neck reconstruction, the use of the flow-through principle enables uninterrupted vascular flow for two distinct free flaps in single-stage reconstruction for patients with vessel-depleted, irradiated, and/or reoperated fields. We demonstrate that flow-through flaps in the head and neck may be used successfully for a variety of cases and flaps.
Collapse
Affiliation(s)
- Mark A. Maier
- From the School of Medicine, Louisiana State University Health Sciences Center, New Orleans, La
| | - Patrick A. Palines
- Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, La
| | - Richard F. Guidry
- Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, La
| | - Mark W. Stalder
- Division of Plastic and Reconstructive Surgery, Louisiana State University Health Sciences Center, New Orleans, La
- University Medical Center—LCMC Health, New Orleans, La
| |
Collapse
|
9
|
El Naggar ANM, Fathy Ibrahim M, Abdel Azeem KM, Ibrahim AHM, Mohamed Hawas E. Comparative Study between Gluteal Artery Perforator Flaps and Local Fasciocutaneous Flaps in Reconstruction of Gluteal Pressure Ulcers. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5671. [PMID: 38440364 PMCID: PMC10911522 DOI: 10.1097/gox.0000000000005671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/11/2024] [Indexed: 03/06/2024]
Abstract
Background Gluteal pressure ulcers are a common problem, associated with great morbidity and cost, and their surgical treatment includes debridement with complete bursectomy, followed by soft tissue coverage. Gluteal artery perforator flaps and gluteal fasciocutaneous flaps are commonly preferred for reconstruction because they preserve the gluteal muscle, allowing for revision in recurrent cases. The aim of this study was to evaluate the differences between these two flaps in the reconstruction of gluteal pressure ulcers regarding operative time, postoperative hospital stay, postoperative complications, and recurrence. Methods This prospective comparative study was conducted on 30 patients who presented with stage IV gluteal pressure ulcers. Patients were randomly allocated into two equal groups: each group consisted of 15 patients. Cases in group A were reconstructed using gluteal artery perforator flaps, and those in group B were reconstructed using local fasciocutaneous flaps. Results There was statistically significant long operative time and short postoperative hospital stay in gluteal artery perforator flaps when compared with local fasciocutaneous flaps. Also, the fasciocutaneous group reported a higher nonsignificant complication rate when compared with the gluteal perforator group. No recurrent cases were reported, and most patients had satisfactory outcomes in both groups. Conclusion Both techniques are safe, reliable, and effective and can be considered as a first-line option in the reconstruction of gluteal pressure ulcers.
Collapse
Affiliation(s)
- Abdel Nasser Mohamed El Naggar
- From the Department of Plastic and Reconstructive Surgery, Beni-suef University Hospital, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Mostafa Fathy Ibrahim
- From the Department of Plastic and Reconstructive Surgery, Beni-suef University Hospital, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Khaled Mohamed Abdel Azeem
- From the Department of Plastic and Reconstructive Surgery, Beni-suef University Hospital, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Ahmed Hamdy Mahmoud Ibrahim
- From the Department of Plastic and Reconstructive Surgery, Beni-suef University Hospital, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Emad Mohamed Hawas
- From the Department of Plastic and Reconstructive Surgery, Beni-suef University Hospital, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| |
Collapse
|
10
|
Alghamdi HG, Humaid HS, Alsaber NS, Almubarak FR, Alqifari FA, Makkawi MA, Alzamil AR. Prevalence of The Arterial Hand Dominance Using the Modified Allen Test and Pulse Oximetry among Plastic Surgery Patients. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5603. [PMID: 38375368 PMCID: PMC10876240 DOI: 10.1097/gox.0000000000005603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/28/2023] [Indexed: 02/21/2024]
Abstract
Background The ulnar and radial arteries are the major source of blood supply in the hand, as they form the superficial and deep palmar arches. Arterial hand circulation is one of the most complicated arterial trees and connections in the body, with tremendous variations in its structure. This study aimed to evaluate whether the ulnar artery or radial artery is the dominant artery in hand circulation among plastic surgery patients at King Khalid University Hospital and to correlate the arterial hand dominance with handedness and gender. Methods This is an analytical cross-sectional study conducted at King Khalid University Hospital in Riyadh, Saudi Arabia, on plastic surgery patients. The sampling method is purposive sampling. The calculated sample size is 28; however, 100 participants have been enlisted in the study. The data have been collected using the modified Allen test with a pulse oximeter. Results The collective prevalence of dual arterial dominance in our study was 69% compared with 56% and 30% for Little et al (P = 0.013) and Fuhrman et al (P < 0.001), respectively. With regard to gender, women were more likely to have a dual arterial blood supply than men, with the frequency values of 85% and 58.3% for women and men, respectively (P = 0.017). Conclusions Our study found that dual arterial supply is predominant among our participants, with 69% of our participants possessing a dual arterial supply, while 18% and 13% constitute the prevalence of radial and ulnar dominance, respectively. This contrasts with what has been reported previously in the literature.
Collapse
Affiliation(s)
- Hisham G Alghamdi
- From the Division of Plastic Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Hameed S Humaid
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Naif S Alsaber
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | | | | | | |
Collapse
|
11
|
El Danaf AA, Al-Ahmady HH, Eldanaf HA, Soliman HA, Elhelw MH, Khalil MF, Rizk IA, Donia MS. Alveolar Oral Layer Repair by Periosteal Grafts versus Maxillary Flaps and Gingivoperiosteoplasty: Techniques and Follow-up to Adolescence. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5633. [PMID: 38415103 PMCID: PMC10898659 DOI: 10.1097/gox.0000000000005633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 01/09/2024] [Indexed: 02/29/2024]
Abstract
Background Alveolar periosteoplasty during primary repair of cleft lip is still a topic of debate due to the fear exacerbating maxillary retrusion. The authors present their experience with early closure of alveolar clefts. The study aims to analyze gingivoperiosteoplasty (GPP) by comparing the use of locoregional flaps versus distant grafts for reconstruction of the lower layer of the primary palate cleft. Methods Seventeen infants underwent 22 alveolar cleft repairs. After nasal floor repair by nasal mucoperiosteum, the oral layer was repaired by maxillary or gingival periosteal flaps in seven patients with alveolar clefts less than or equal to 6 mm wide, and tibial or pericranial periosteal grafts in 10 patients with wider clefts. At teenage years, crossbites in three flap-GPP and three graft-GPP patients were compared with nine older adolescents without primary GPP. Results Alveolar clefts were perfectly sealed. Radiographs during the early 3 postoperative years showed new bone formation more posteriorly extended in patients who underwent graft-GPP. Teeth eruption and alveolar rigidity at the mixed dentition age eliminated the need for secondary bone grafting. The anterior crossbites in adolescent patients ranged between -2 and -14 mm; crossing was relatively smaller in patients with a younger age and without cleft palate. The mean crossbite was 7.2 mm in the six teenagers and 9.6 mm in the control cases. Conclusions Graft-GPP may be a good alternative to flap-GPP, particularly for wide alveolar cleft repair. Maxillary retrusion is aggravated in patients with cleft palate and older age at assessment. GPP may not increase crossbite.
Collapse
Affiliation(s)
- Ahmed A. El Danaf
- From the Plastic Surgery Department, Al Mataria Teaching Hospital, GOTHI, Cairo, Egypt
| | - Hatem H. Al-Ahmady
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Girls’ Branch, Al Azhar University, Cairo, Egypt
| | - Heba A. Eldanaf
- Restorative and Dental Materials Department, Oral and Dental Research Division, National Research Centre, Giza, Cairo, Egypt
| | - Helmy A. Soliman
- From the Plastic Surgery Department, Al Mataria Teaching Hospital, GOTHI, Cairo, Egypt
| | - Moustafa H. Elhelw
- From the Plastic Surgery Department, Al Mataria Teaching Hospital, GOTHI, Cairo, Egypt
| | - Maurice F. Khalil
- From the Plastic Surgery Department, Al Mataria Teaching Hospital, GOTHI, Cairo, Egypt
| | - Ibrahim A. Rizk
- From the Plastic Surgery Department, Al Mataria Teaching Hospital, GOTHI, Cairo, Egypt
| | - Mohamed S. Donia
- From the Plastic Surgery Department, Al Mataria Teaching Hospital, GOTHI, Cairo, Egypt
| |
Collapse
|
12
|
MacKenzie A, Dhoot A, Rehman U, Sohaib Sarwar M, Adebayo O, Brennan PA. Use of supermicrosurgery in craniofacial and head and neck soft tissue reconstruction: a systematic review of the literature and meta-analysis. Br J Oral Maxillofac Surg 2024; 62:140-149. [PMID: 38290861 DOI: 10.1016/j.bjoms.2023.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/28/2023] [Indexed: 02/01/2024]
Abstract
Supermicrosurgery is an evolving approach in the reconstruction of head and neck (HN) and craniofacial (CF) defects. This systematic review aims to evaluate the use of supermicrosurgery for arterial or combined arterial and venous anastomoses in the reconstruction of HN and CF soft tissue defects, and the associated success, total complication, and reoperation rates. A literature search was conducted on PubMed, Dynamed, DARE, EMBASE, Cochrane, and British Medical Journal (BMJ) electronic databases (PROSPERO ID: CRD42023476825). Nine studies fulfilled the inclusion criteria with 35 patients who underwent soft tissue reconstructive procedures using supermicrosurgery. Twenty-one flaps were performed on 20 patients (57.1%) with the remaining 15 patients (42.9%) undergoing supermicrosurgical replantation. The most common pathology requiring reconstruction was HN trauma (n = 16, 45.7%) followed by malignancy (n = 15, 42.9%). The pooled success rate for supermicrosurgery was 98% (95% CI 90 to 100, p = 1.00; I2 = 0%). The cumulative complication rate across all the studies was 46% (95% CI 13 to 80, p < 0.01; I2 = 0%), and the pooled rate of reoperation was 1% (95% CI 0 to 8, p = 0.23; I2 = 24%). The use of supermicrosurgery for HN and CF soft tissue reconstruction has an overall success rate of 98%, which is commensurate with traditional microsurgery for HN reconstruction. Complication and reoperation rates are comparable to previous literature. This study confirms the feasibility of supermicrosurgery as a safe and reliable reconstructive option for HN and CF defects.
Collapse
Affiliation(s)
| | - Amber Dhoot
- Department of Surgery, Queen Charlotte's and Chelsea Hospital, London, United Kingdom.
| | - Umar Rehman
- UCL Division of Surgery and Interventional Sciences, London, United Kingdom.
| | - Mohammad Sohaib Sarwar
- Department of Oral and Maxillofacial Surgery, The Queen Victoria Hospital, East Grinstead, United Kingdom.
| | | | - Peter A Brennan
- Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, United Kingdom.
| |
Collapse
|
13
|
Aksamitiene E, Heffelfinger RN, Hoek JB, Pribitkin ED. Standardized Pre-clinical Surgical Animal Model Protocol to Investigate the Cellular and Molecular Mechanisms of Ischemic Flap Healing. Biol Proced Online 2024; 26:2. [PMID: 38229030 DOI: 10.1186/s12575-023-00227-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 12/14/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Some of the most complex surgical interventions to treat trauma and cancer include the use of locoregional pedicled and free autologous tissue transfer flaps. While the techniques used for these reconstructive surgery procedures have improved over time, flap complications and even failure remain a significant clinical challenge. Animal models are useful in studying the pathophysiology of ischemic flaps, but when repeatability is a primary focus of a study, conventional in-vivo designs, where one randomized subset of animals serves as a treatment group while a second subset serves as a control, are at a disadvantage instigated by greater subject-to-subject variability. Our goal was to provide a step-by-step methodological protocol for creating an alternative standardized, more economical, and transferable pre-clinical animal research model of excisional full-thickness wound healing following a simulated autologous tissue transfer which includes the primary ischemia, reperfusion, and secondary ischemia events with the latter mimicking flap salvage procedure. RESULTS Unlike in the most frequently used classical unilateral McFarlane's caudally based dorsal random pattern skin flap model, in the herein described bilateral epigastric fasciocutaneous advancement flap (BEFAF) model, one flap heals under normal and a contralateral flap-under perturbed conditions or both flaps heal under conditions that vary by one within-subjects factor. We discuss the advantages and limitations of the proposed experimental approach and, as a part of model validation, provide the examples of its use in laboratory rat (Rattus norvegicus) axial pattern flap healing studies. CONCLUSIONS This technically challenging but feasible reconstructive surgery model eliminates inter-subject variability, while concomitantly minimizing the number of animals needed to achieve adequate statistical power. BEFAFs may be used to investigate the spatiotemporal cellular and molecular responses to complex tissue injury, interventions simulating clinically relevant flap complications (e.g., vascular thrombosis) as well as prophylactic, therapeutic or surgical treatment (e.g., flap delay) strategies in the presence or absence of confounding risk factors (e.g., substance abuse, irradiation, diabetes) or favorable wound-healing promoting activities (e.g., exercise). Detailed visual instructions in BEFAF protocol may serve as an aid for teaching medical or academic researchers basic vascular microsurgery techniques that focus on precision, tremor management and magnification.
Collapse
Affiliation(s)
- Edita Aksamitiene
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut St., 6Th floor, Philadelphia, PA, 19107, USA
- Present address: Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, 405 N. Mathews Ave | M/C 251, Room 4357, Urbana, IL, 61801, USA
| | - Ryan N Heffelfinger
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut St., 6Th floor, Philadelphia, PA, 19107, USA
| | - Jan B Hoek
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, 1020 Locust St, Room 527, Philadelphia, PA, 19107, USA
| | - Edmund deAzevedo Pribitkin
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, 925 Chestnut St., 6Th floor, Philadelphia, PA, 19107, USA.
- Sidney Kimmel Medical College, 31st Floor, 1101 Market Street, Philadelphia, PA, 19107, USA.
| |
Collapse
|
14
|
Sorotos M, Firmani G, Tornambene R, Marrella D, Paolini G, Santanelli di Pompeo F. DIEP flap perfusion assessment using microdialysis versus Doppler ultrasonography: A comparative study. Microsurgery 2024; 44:e31097. [PMID: 37538001 DOI: 10.1002/micr.31097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/03/2023] [Accepted: 07/21/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND The increasing number of buried free-tissue transfer procedures and the need for an objective method to evaluate vascular complications of free flaps has led to the development of new technologies. Microdialysis has been used to monitor free flaps using interstitial biological markers. Previous uses mainly focused on muscular flaps. Our aim is to compare external Doppler ultrasonography (EDU) evaluation versus microdialysis in the early follow-up of adipocutaneous flaps, and propose an efficient postoperative monitoring protocol. METHODS We retrospectively assessed 68 consecutive DIEP flaps (50 patients) performed between January 2019 and March 2021. All flaps received standardized post-operative monitoring using clinical signs, EDU and microdialysis. Glucose and lactate concentrations were assessed using glucose <1 mmol/L and lactate >6 mmol/L as ischemic trend thresholds. We calculated Glucose/Lactate ratio as a new parameter for the assessment of flap viability. RESULTS Among all the 68 flaps, two flaps returned to the operative theater when a combination of unsatisfactory microdialysis values and clinical/EDU signs identified vascular impairment; only one developed total flap necrosis. Reoperation rate was 2.94% with an overall flap success rate of 98.53%. External Doppler ultrasonography had 100% sensitivity and 82% specificity, while microdialysis had 100% sensitivity and 100% specificity. CONCLUSIONS Microdialysis values proved flap viability sooner than external Doppler ultrasonography, making it an excellent tool for post-operative monitoring. With the appropriate thresholds for glucose and lactate concentrations, and glucose/lactate ratio used as a new parameter, it can help potentially avoiding unnecessary re-explorations, and reducing flap ischemia times.
Collapse
Affiliation(s)
- Michail Sorotos
- Faculty of Medicine and Psychology, Sapienza University of Rome - Sant'Andrea Hospital, Rome, Italy
| | - Guido Firmani
- Faculty of Medicine and Psychology, Sapienza University of Rome - Sant'Andrea Hospital, Rome, Italy
| | - Roberta Tornambene
- Department of Human Pathology, Division and Residency Program in Plastic, Reconstructive and Aesthetic Surgery, University of Messina, Messina, Italy
| | - Domenico Marrella
- Department of Human Pathology, Division and Residency Program in Plastic, Reconstructive and Aesthetic Surgery, University of Messina, Messina, Italy
| | - Guido Paolini
- Faculty of Medicine and Psychology, Sapienza University of Rome - Sant'Andrea Hospital, Rome, Italy
| | - Fabio Santanelli di Pompeo
- Faculty of Medicine and Psychology, Sapienza University of Rome - Sant'Andrea Hospital, Rome, Italy
- Chair of Plastic Surgery, Faculty of Medicine and Psychology, Sapienza University of Rome - Sant'Andrea Hospital, Rome, Italy
| |
Collapse
|
15
|
Gentile P, Cervelli V, De Fazio D, Calabrese C, Scioli MG, Orlandi A. Mechanical and Enzymatic Digestion of Autologous Fat Grafting (A-FG): Fat Volume Maintenance and AD-SVFs Amount in Comparison. Aesthetic Plast Surg 2023; 47:2051-2062. [PMID: 37130992 DOI: 10.1007/s00266-023-03364-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 04/08/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Currently, several techniques for autologous fat graft (A-FG) preparation aimed at obtaining purified tissue exist. Both mechanical digestions via centrifugation, filtration, and enzymatic digestion were considered the most effective with different impacts in terms of adult adipose-derived stromal vascular fraction cells (AD-SVFs) amount that volume maintenance. OBJECTIVES This article aimed to report the in vivo and in vitro results, represented by fat volume maintenance and AD-SVFs amount, obtained by four different procedures of AD-SVFs isolation and A-FG purification based on centrifugation, filtration, centrifugation with filtration, and enzymatic digestion. METHODS A prospective, case-control study was conducted. In total, 80 patients affected by face and breast soft tissue defects were treated with A-FG and divided into four groups: n=20 were treated with A-FG enhanced with AD-SVFs obtained by enzymatic digestion (study group 1 [SG-1]); n=20 were treated with A-FG enhanced with AD-SVFs obtained by centrifugation with filtration (SG-2); n=20 were treated with A-FG enhanced with AD-SVFs obtained by only filtration (SG-3); n=20 were treated with A-FG obtained by only centrifugation according to the Coleman technique (control group [CG]). Twelve months after the last A-FG session, the volume maintenance percentage was analyzed by magnetic resonance imaging (MRI). Isolated AD-SVF populations were counted using a hemocytometer, and cell yield was reported as cell number/mL of fat. RESULTS Starting with the same amount of fat analyzed (20 mL), 50,000 ± 6956 AD-SVFs/mL were obtained in SG-1; 30,250 ± 5100 AD-SVFs/mL in SG-2; 33.333 ± 5650 AD-SVFs/mL in SG-3, while 500 AD-SVFs/mL were obtained in CG. In patients treated with A-FG enhanced with AD-SVFs obtained by automatic enzymatic digestion, a 63% ± 6.2% maintenance of fat volume restoring after 1 year was observed compared with 52% ± 4.6% using centrifugation with filtration, 39% ± 4.4% using only centrifugation (Coleman), and 60% ± 5.0% using only filtration. CONCLUSIONS In vitro AD-SVFs cell analysis indicated that filtration was the most efficient system-between mechanical digestion procedures-thanks to the highest amount of cells obtained with fewer cell structure damage, producing in vivo, the most volume maintenance after 1 year. Enzymatic digestion produced the best number of AD-SVFs and the best fat volume maintenance. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266 .
Collapse
Affiliation(s)
- Pietro Gentile
- Surgical Science Department, Plastic and Reconstructive Surgery, University of Rome "Tor Vergata", Via Montpellier 1, 00179, Rome, Italy.
| | - Valerio Cervelli
- Surgical Science Department, Plastic and Reconstructive Surgery, University of Rome "Tor Vergata", Via Montpellier 1, 00179, Rome, Italy
| | - Domenico De Fazio
- Plastic and Reconstructive Surgery, "Madonnina Clinic", 20122, Milan, Italy
| | | | - Maria Giovanna Scioli
- Department of Biomedicine and Prevention, Anatomic Pathology Institute, University of Rome Tor Vergata, 00133, Roma, Italy
| | - Augusto Orlandi
- Department of Biomedicine and Prevention, Anatomic Pathology Institute, University of Rome Tor Vergata, 00133, Roma, Italy
| |
Collapse
|
16
|
Morita Y, Sakata N, Kawakami R, Shimizu M, Yoshimatsu G, Wada H, Kodama S. Establishment of a Simple, Reproducible, and Long-lasting Hind Limb Animal Model of Lymphedema. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5243. [PMID: 37691702 PMCID: PMC10484367 DOI: 10.1097/gox.0000000000005243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/12/2023] [Indexed: 09/12/2023]
Abstract
Background Lymphedema is an intractable disease for which there is currently no established curative therapy. A reliable and long-lasting lymphedema model is essential for development of better treatments. In this study, we aimed to establish a simple, reproducible and long-lasting mouse model of lymphedema. Methods Our model is characterized by a combination of a circumferential skin incision in the femoral region, complete dissection of regional lymph nodes, and ablation of the inguinal route in the femoral region. The characteristics of the lymphedema were evaluated and compared with those of two other models. One of these models involved dissection of the subiliac, popliteal, and sciatic lymph nodes (model A) and the other excision of the subiliac, popliteal, and sciatic lymph nodes with cauterization of lymphatic vessels and closure without a skin excision (model B). Results Although the lymphedema in models A and B resolved spontaneously, that in the new model lasted for a month with increases in femoral circumference and hind limb volume, thickening of the skin, especially subcutaneous tissue, and congestion of peripheral lymphatic vessels. Furthermore, this model could be used for assessing the therapeutic effects of syngeneic mesenchymal stem cell transplantation. The average operation time for the new model was 14.4 ± 1.3 minutes. Conclusion Long-lasting lymphedema can be achieved by our new model, making it suitable for assessing therapies for lymphedema.
Collapse
Affiliation(s)
- Yuichi Morita
- From the Department of Regenerative Medicine & Transplantation, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
- Center for Regenerative Medicine, Fukuoka University Hospital, Fukuoka, Japan
- Department of Cardiovascular Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Naoaki Sakata
- From the Department of Regenerative Medicine & Transplantation, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
- Center for Regenerative Medicine, Fukuoka University Hospital, Fukuoka, Japan
- Research Institute for Regenerative Medicine, Fukuoka University, Fukuoka, Japan
| | - Ryo Kawakami
- From the Department of Regenerative Medicine & Transplantation, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
- Center for Regenerative Medicine, Fukuoka University Hospital, Fukuoka, Japan
- Research Institute for Regenerative Medicine, Fukuoka University, Fukuoka, Japan
| | - Masayuki Shimizu
- From the Department of Regenerative Medicine & Transplantation, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
- Center for Regenerative Medicine, Fukuoka University Hospital, Fukuoka, Japan
- Department of Cardiovascular Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Gumpei Yoshimatsu
- From the Department of Regenerative Medicine & Transplantation, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
- Center for Regenerative Medicine, Fukuoka University Hospital, Fukuoka, Japan
- Research Institute for Regenerative Medicine, Fukuoka University, Fukuoka, Japan
| | - Hideichi Wada
- Department of Cardiovascular Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
- Research Institute for Regenerative Medicine, Fukuoka University, Fukuoka, Japan
| | - Shohta Kodama
- From the Department of Regenerative Medicine & Transplantation, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
- Center for Regenerative Medicine, Fukuoka University Hospital, Fukuoka, Japan
- Research Institute for Regenerative Medicine, Fukuoka University, Fukuoka, Japan
| |
Collapse
|
17
|
Shi M, Lu Y, Mohyeddin A, Qi F, Pan Y. Preservation of Eschar Prevents Excessive Wound Healing by Reducing M2 Macrophages Polarization. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5238. [PMID: 37731728 PMCID: PMC10508428 DOI: 10.1097/gox.0000000000005238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/11/2023] [Indexed: 09/22/2023]
Abstract
Background Removal of the eschar has gradually become a consensus on treatments of deep dermal necrosis after skin trauma in recent years, whereas exaggerated scar contracture and tissue proliferation developed during healing have received little attention. Here, the authors investigated the effects of eschar on excessive wound healing of small dermal damage and focused on the role M2 macrophages played, hoping to offer a theoretical basis to improve patients' cosmetic satisfaction. Methods A mouse dorsal wound model (n = 12) was established by electric heating pads heating for 20 seconds on each side of the spine, and the left side was the preserved group. Macrophage numbers, expression of wound-healing-associated proteins, and inflammatory cytokine levels were assessed at different time points by immunohistochemistry and quantitative real-time polymerase chain reaction. A co-culture system of M2 macrophages and myofibroblasts was created in vitro. Immunohistochemistry, real-time polymerase chain reaction, and Western blot were performed to evaluate the proliferation, migration, and protein expression of myofibroblasts. Results Preserving eschar inhibited contraction-associated proteins (α-smooth muscle actin and vimentin) and collagen expression, inflammatory cytokine (IL-1β, IL-10, TFN-α, and IL-4) expression, and M2 macrophage infiltration. Mechanistically, M2 macrophages potentially contributed to excessive wound healing by promoting myofibroblasts proliferation, migration, and production of contraction-associated proteins. Conclusion Eschar preservation in wounds could reduce inflammation and negatively modulate myofibroblasts by inhibiting M2 macrophage polarization and infiltration, preventing excessive wound contraction and collagen deposition.
Collapse
Affiliation(s)
- Mingyue Shi
- From the Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yao Lu
- From the Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ali Mohyeddin
- From the Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Fazhi Qi
- From the Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuyan Pan
- From the Department of Plastic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| |
Collapse
|
18
|
Lim BJ, Shin JY, Roh SG, Lee NH, Chung YK. Clinical analysis of factors affecting the failure of free flaps used in head and neck reconstruction. Arch Craniofac Surg 2023; 24:159-166. [PMID: 37654235 PMCID: PMC10475704 DOI: 10.7181/acfs.2023.00325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/25/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Free tissue transfer is the preferred method of reconstructing head and neck defects, with a success rate of approximately 95%. Although flap failure is uncommon, it has a major impact on patient morbidity and diminishes quality of life, making it is important to investigate the causes of flap failure. METHODS This retrospective chart review analyzed patients who underwent free tissue transfer during head and neck reconstruction at a single institution between 2016 and 2021. RESULTS During the study period, 58 patients underwent 60 free flap procedures. Revision surgery was needed in 14 patients. Subsequent free flap surgery was performed in one patient, and three free flaps (5%) could not be salvaged. Cardiovascular disease was significantly associated with flap failure, and venous congestion (thrombosis) was the most common reason for revision surgery. CONCLUSION Cardiovascular disease clearly emerged as a factor related to the failure of free flap surgery, and this issue warrants particular attention in patients for whom free tissue transfer is planned.
Collapse
Affiliation(s)
- Beom Jin Lim
- Department of Plastic and Reconstructive Surgery, Jeonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Jin Yong Shin
- Department of Plastic and Reconstructive Surgery, Jeonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Si-Gyun Roh
- Department of Plastic and Reconstructive Surgery, Jeonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Nae-Ho Lee
- Department of Plastic and Reconstructive Surgery, Jeonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| | - Yoon Kyu Chung
- Department of Plastic and Reconstructive Surgery, Jeonbuk National University Medical School, Jeonju, Korea
- Research Institute of Clinical Medicine of Jeonbuk National University-Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Korea
| |
Collapse
|
19
|
Mishra JK, Sahu SA, Bodhey NK, Sindhuja A, V. A. Perforator-Based Propeller Flap with Additional Venous Pedicle for Lower Limb Reconstruction. Indian J Plast Surg 2023; 56:373-377. [PMID: 37705822 PMCID: PMC10497330 DOI: 10.1055/s-0043-1769113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023] Open
Abstract
Propeller flaps are effective reconstructive tools for small-to-medium sized defects of the lower limb and a reasonable alternative to free flaps. A major vessel of the lower limb remains undisturbed while raising the flap and the flap donor and recipient areas are addressed in the same operative field. Perforator-based propeller flaps are based on single perforator arising from a major vessel and during rotation of the larger paddle there is a possibility of kink in the venous component leading to congestion of flap. In our modification, one superficial vein of the lower limb namely the great saphenous or short saphenous vein was included in the flap territory to enhance the retrograde or antegrade venous drainage of the flap. We observed, no flap congestion or necrosis in the postoperative period. Also, the patency of the incorporated vein was confirmed using handheld and color Doppler.
Collapse
Affiliation(s)
- Jiten Kumar Mishra
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Shamendra Anand Sahu
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Narendra Kuber Bodhey
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Abi Sindhuja
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Abhijith V.
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| |
Collapse
|
20
|
Schäfer B, Bahm J, Beier JP. Nerve Transfers Using a Dedicated Microsurgical Robotic System. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5192. [PMID: 37583397 PMCID: PMC10424892 DOI: 10.1097/gox.0000000000005192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/29/2023] [Indexed: 08/17/2023]
Abstract
Microsurgical demands in peripheral nerve surgery are increasing. Because of the development of multiple simultaneous selective nerve transfers, the transposition of very small nerves and even single fascicles has evolved. Coaptation of these increasingly smaller structures require high skills in microsurgical techniques. In addition, the surgical situs often has very limited access and is difficult to reach with conventional microsurgical options. Robot technology, the Symani Surgical System (Medical Microinstruments, S.p.A, Calci, Pisa, Italy), was used for epineural coaptation of three donor nerves (intercostal nerves 4-6) to the long thoracic nerve and the thoracodorsal nerve as recipient nerves in a patient with brachial plexus palsy. The coaptations could be carried out successfully with the microsurgical robot technology. In combination with a high-magnification (up to 26×) 3D-exoscope, the epineural sutures could be placed very precisely and accurately. Using this new microsurgical robotic system, successful coaptation of very small nerve structures is possible. This opens possibilities for the microsurgeon to carry out even finer, more targeted and more complex nerve transfers, including procedures in anatomical regions that are difficult to reach.
Collapse
Affiliation(s)
- Benedikt Schäfer
- From the Department of Plastic Surgery, Hand Surgery - Burn Center, University Hospital RWTH Aachen, Aachen, Germany
- Division for Plexus Surgery,University Hospital RWTH Aachen, Aachen, Germany
| | - Jörg Bahm
- From the Department of Plastic Surgery, Hand Surgery - Burn Center, University Hospital RWTH Aachen, Aachen, Germany
- Division for Plexus Surgery,University Hospital RWTH Aachen, Aachen, Germany
| | - Justus P Beier
- From the Department of Plastic Surgery, Hand Surgery - Burn Center, University Hospital RWTH Aachen, Aachen, Germany
| |
Collapse
|
21
|
Puneky GA, Batchler KA, Kollapaneni SS, Blair JA, Davis JM. Simplified soft tissue coverage of the distal lower extremity: The reverse sural flap. OTA Int 2023; 6:e235. [PMID: 37448567 PMCID: PMC10337849 DOI: 10.1097/oi9.0000000000000235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/05/2022] [Indexed: 07/15/2023]
Abstract
Soft tissue defects involving the distal lower extremity present challenging problems for orthopaedic surgeons to manage. Historically, wounds not amenable to primary closure have necessitated assistance from multidisciplinary teams using plastic surgeons to obtain adequate soft tissue coverage through rotational flap or free tissue transfer procedures. Techniques related to soft tissue rearrangement and local rotational flap coverage have advanced over the years with a growing knowledge of local anatomy and vasculature. The reverse sural flap may be performed to cover soft tissue defects within 10 cm of the foot or ankle region, negating the need for microvascular intervention. The simplistic nature of the reverse sural flap is appealing to orthopaedic surgeons as a means to provide timely patient care without additional support because it does not require microvasculature work or the need for intraoperative microscopes and has been popularized among orthopaedic trauma surgeons as a necessary tool to possess. Here, we discuss the reverse sural flap to include history, relevant anatomy, clinical indications, and a description of the technique for application.
Collapse
Affiliation(s)
- George A. Puneky
- Department of Orthopedic Surgery, Medical College of Georgia, Augusta University, Augusta, GA
| | - Kathryn A. Batchler
- Medical Student, Medical College of Georgia at Augusta University, Augusta, GA
| | - Sai S. Kollapaneni
- Medical Student, Medical College of Georgia at Augusta University, Augusta, GA
| | - James A. Blair
- Department of Orthopedic Surgery, Medical College of Georgia, Augusta University, Augusta, GA
| | - Jana M. Davis
- Department of Orthopedic Surgery, Medical College of Georgia, Augusta University, Augusta, GA
| |
Collapse
|
22
|
Valença-Filipe R, Vardasca R, Magalhães C, Mendes J, Amarante J, Costa-Ferreira A. Use of Infrared Thermography for Abdominoplasty Procedures in Patients with Extensive Subcostal Scars: A Preliminary Analysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5149. [PMID: 37483894 PMCID: PMC10358803 DOI: 10.1097/gox.0000000000005149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 06/13/2023] [Indexed: 07/25/2023]
Abstract
Subcostal scars may increase the risk of healing complications in abdominoplasty. The authors evaluated the use of thermography as a potential tool for patient selection and surgery planning to avoid complications and improve abdominoplasty outcomes. Two candidates for abdominoplasty procedures who presented with extensive subcostal scars were submitted to an infrared thermography protocol at all phases of the procedure: preoperative, intraoperative, and postoperative at 1 and 6 months. The preoperative thermography for both patients revealed near-normal abdominal wall perfusion. The thermograms captured intraoperatively during flap elevation did not show perfusion deficits on the upper abdominal flap. At 1 month and 6 months postoperative, dynamic thermography for both patients showed normal to near-normal perfusion. The procedures had a complication-free course with a good aesthetic result. Plastic surgeons may be reluctant to perform a full abdominoplasty in patients with a previous subcostal incision. In this preliminary analysis, we raise the potential usefulness of thermography for patients with recent subcostal scars and/or important comorbidities as a strategy for adequate patient and technique selection, avoiding possible complications. Future studies, with an increased number of patients and adequate statistical analysis, may allow us to validate the utility of thermography in these cases and reassure that the presence of previous extensive subcostal scars may not be a contraindication for a full abdominoplasty, especially if they are not recent.
Collapse
Affiliation(s)
- Rita Valença-Filipe
- From the Department of Surgery and Physiology, Faculty of Medicine, Porto University (Universidade do Porto), Porto, Portugal
- FMR Clinic—Aesthetic Surgery, Porto, Portugal
| | - Ricardo Vardasca
- Plastic Surgery Division, FMR Clinic - Aesthetic Surgery, Porto, Portugal
- ISLA-Santarém, Santarém, Portugal
| | - Carolina Magalhães
- Plastic Surgery Division, FMR Clinic - Aesthetic Surgery, Porto, Portugal
- Faculty of Engineering, Porto University (Universidade do Porto), Porto, Portugal
| | - Joaquim Mendes
- Plastic Surgery Division, FMR Clinic - Aesthetic Surgery, Porto, Portugal
- Faculty of Engineering, Porto University (Universidade do Porto), Porto, Portugal
| | - José Amarante
- From the Department of Surgery and Physiology, Faculty of Medicine, Porto University (Universidade do Porto), Porto, Portugal
- Department of Plastic, Aesthetic and Reconstructive Surgery, São João University Hospital, Porto, Portugal
- Emeritus Professor, Porto University (Universidade do Porto), Porto, Portugal
| | - António Costa-Ferreira
- From the Department of Surgery and Physiology, Faculty of Medicine, Porto University (Universidade do Porto), Porto, Portugal
- Department of Plastic, Aesthetic and Reconstructive Surgery, São João University Hospital, Porto, Portugal
| |
Collapse
|
23
|
Kubo K, Kirita M, Hamahata A, Sakurai H. Continuous local intravenous heparin infusion after re-exploration for venous congestion in free-flap breast reconstruction: A case series. Clin Case Rep 2023; 11:e6858. [PMID: 36950674 PMCID: PMC10025250 DOI: 10.1002/ccr3.6858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/26/2022] [Accepted: 01/01/2023] [Indexed: 03/22/2023] Open
Abstract
We demonstrated local intravenous heparin infusion to salvage flaps after re-exploration for postoperative venous congestion after free-flap breast reconstruction. All flaps were salvaged using local intravenous heparin infusion without major complications. Local intravenous heparin infusion is an effective and safe procedure.
Collapse
Affiliation(s)
- Kazuyuki Kubo
- Division of Breast SurgerySaitama Cancer CenterSaitamaJapan
- Division of Plastic and Reconstructive SurgerySaitama Cancer CenterSaitamaJapan
| | - Miho Kirita
- Division of Plastic and Reconstructive SurgerySaitama Cancer CenterSaitamaJapan
| | - Atsumori Hamahata
- Division of Plastic and Reconstructive SurgerySaitama Cancer CenterSaitamaJapan
| | - Hiroyuki Sakurai
- Department of Plastic and Reconstructive SurgeryTokyo Women's Medical UniversityTokyoJapan
| |
Collapse
|
24
|
Yamashiro T, Kushibiki T, Mayumi Y, Tsuchiya M, Ishihara M, Azuma R. Negative-Pressure Wound Therapy: What We Know and What We Need to Know. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1436:131-152. [PMID: 36922487 DOI: 10.1007/5584_2023_773] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/17/2023]
Abstract
Negative-pressure wound therapy (NPWT) promotes wound healing by applying negative pressure to the wound surface. A quarter of a century after its introduction, NPWT has been used in various clinical conditions, although molecular biological evidence is insufficient due to delay in basic research. Here, we have summarized the history of NPWT, its mechanism of action, what is currently known about it, and what is expected to be known in the future. Particularly, attention has shifted from the four main mechanisms of NPWT to the accompanying secondary effects, such as effects on various cells, bacteria, and surgical wounds. This chapter will help the reader to understand the current status and shortcomings of NPWT-related research, which could aid in the development of basic research and, eventually, clinical use with stronger scientific evidence.
Collapse
Affiliation(s)
- Toshifumi Yamashiro
- Department of Plastic and Reconstructive Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Toshihiro Kushibiki
- Department of Medical Engineering, National Defense Medical College, Tokorozawa, Saitama, Japan.
| | - Yoshine Mayumi
- Department of Medical Engineering, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Masato Tsuchiya
- Department of Plastic and Reconstructive Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Miya Ishihara
- Department of Medical Engineering, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Ryuichi Azuma
- Department of Plastic and Reconstructive Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| |
Collapse
|
25
|
Simman R, Bach K. Role of Hyperbaric Oxygen Therapy in Cosmetic and Reconstructive Surgery in Ischemic Soft Tissue Wounds: A Case Series. EPLASTY 2022; 22:e61. [PMID: 36545638 PMCID: PMC9748824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Hyperbaric oxygen therapy (HBOT) is an effective primary and adjunctive treatment for a wide spectrum of conditions, ranging from carbon monoxide poisoning to nonhealing wounds. Although HBOT has been shown to improve morbidity and mortality rates when used as adjunctive therapy for compromised skin wounds, the strategy is still underutilized in practice, especially in the field of cosmetic and plastic reconstructive surgery. Methods Here we present 4 cases in which adjunctive HBOT was used to treat ischemic soft tissue wounds following facial fillers injectables, abdominoplasty, and compromise cutaneous flap after Mohs surgery reconstruction. Results In this report, we highlight the utility and implications of HBOT in the management of adverse outcomes following medical interventions. Conclusions The purpose of this case series is to add to the current existing literature examining the expanding role of HBOT as an adjunctive treatment for compromised skin and subcutaneous tissue wounds.
Collapse
Affiliation(s)
- Richard Simman
- Jobst Vascular Institute, ProMedica Toledo Hospital, Toledo, OH,University of Toledo, Department of Surgery, Toledo, OH,Correspondence: Richard Simman MD, FACS, FACCWS;
| | - Karen Bach
- University of Toledo College of Medicine and Life Sciences, Toledo, OH
| |
Collapse
|
26
|
Does Fitzpatrick Score Predict Flap Loss? Microsurgical Breast Reconstruction Outcomes of Varying Skin Color. Plast Reconstr Surg Glob Open 2022; 10:e4637. [PMID: 36381483 PMCID: PMC9640304 DOI: 10.1097/gox.0000000000004637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/08/2022] [Indexed: 01/25/2023]
Abstract
UNLABELLED The aim of this study was to seek evidence that patients with darker Fitzpatrick score skin tones are more susceptible to flap loss due to unsalvaged vascular compromise in autologous flap breast reconstruction. METHODS This is a retrospective study conducted on patients who underwent any type of autologous flap breast reconstruction performed by the two senior authors at an academic center between January 2010 and December 2021. The sole primary outcome variable was flap loss. Patient skin tone was assessed using the Fitzpatrick scale on clinical photographs of patients. RESULTS A total of 1115 pateints underwent autologous flap breast reconstruction, of which only 56 met both exclusion and inclusion criteria with 58 individual breasts being included in the final study population. The most common race of subjects was White (n = 33; 56.9%) while the most common Fitzpatrick score skin tone was type II (n = 22; 37.9%). The Cochran-Armitage test of trend showed a statistically significant linear trend, P = 0.006, with darker Fitzpatrick score skin tones associated with a higher proportion of flap loss in patients who had vascular compromise. A logistic regression showed that none of the predictor variables were significant. CONCLUSIONS Patients with darker Fitzpatrick skin tones were associated with flap loss after vascular compromise. To prevent flap loss in patients who have darker Fitzpatrick score skin tones, more aggressive flap monitoring should be taken into consideration in the immediate postoperative setting.
Collapse
|
27
|
Management of Artery-Only Digit Replantation: A Systematic Review of the Literature. Plast Reconstr Surg 2022; 150:105-116. [PMID: 35536774 DOI: 10.1097/prs.0000000000009185] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Artery-only replantation may be necessary in circumstances when venous repair cannot be performed due to their size or vessel injury. Venous congestion of the replanted part is inevitable. A systematic review was performed to identify techniques for mitigating congestion and analyze the outcomes of those techniques. METHODS A comprehensive literature search was performed to identify relevant articles related to artery-only replantation. An initial query identified 1286 unique articles. A total of 55 articles were included in the final review. Included studies were categorized by decongestive technique. Data from each article included the number of patients treated, level of amputation, graft use, anticoagulation or antiplatelet therapy, replant viability, and follow-up duration. Weighted averages were determined from studies that reported five or more digits. RESULTS A total of 1498 individual digital replantations were described. Very rarely did studies report artery-only replantation proximal to the distal interphalangeal joint. An overall survival rate of 78.5 percent was found irrespective of technique but was variable based on each particular study. Studies utilizing medicinal leech therapy were more likely to report use of intravenous anticoagulation, whereas surface bleeding techniques were more likely to report use of topical or local anticoagulant. CONCLUSIONS Lack of a vein for anastomosis should not be regarded as a contraindication to replantation. These digits instead require a method to establish reliable drainage sufficient to allow for low resistance inflow and maintain a physiologic pressure gradient across capillary beds. The surgeon should select a decongestive technique that best suits the patient and their specific injury.
Collapse
|
28
|
Baccarani A, Starnoni M, Pappalardo M, Lattanzi M, Blessent CGF, De Maria F, De Santis G. Early venous congestion after diep flap breast reconstruction: case report of a successful management. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022180. [PMID: 35671114 PMCID: PMC10510956 DOI: 10.23750/abm.v93is1.12898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/03/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND AIM More than 250 000 women estimated to be diagnosed with breast cancer in the USA every year. Mastectomy is primary treatment for more than a third of those with early-stage disease. Most of the patients undergoing mastectomy receive breast reconstruction. A number of. Surgical techniques have been described to reconstruct the breast. With autologous tissue breast reconstruction, the plastic surgeon uses patient's own tissues, taken from a different part of the body where there is an excess of fat and skin. Deep inferior epigastric perforator (DIEP) flap is the autologous breast reconstruction technique of choice in our department due to long lasting results, low donor site morbidity and positive patient reported outcomes have been described. Case Report: We present the case of a 42-year-old woman who underwent neoadjuvant chemotherapy followed by left breast simple mastectomy, axillary lymph-nodes dissection and later adjuvant radiation therapy (RT). After conclusion of RT a DIEP flap breast reconstruction was performed. Nine-hours after the operation, signs of acute venous congestion were noted. The venous congestion was treated by a combined surgical and medical approach based on pedicle discharge and ICU resuscitation protocol. After take back surgery, the patient was tightly monitored in the intensive care unit where intravenous heparin infusion and leech therapy were performed for 2 days. Flap congestion resolved completely, and the patient was discharged. Conclusions: Venous congestion is very difficult to treat due to its potential multifactorial nature. The most important step is to recognize this kind of emergency because irreversible microvascular damages will develop in 6-8 hours. Because of multiple causes of venous congestion a timely multidisciplinary approach is mandatory, to maximize flap salvage and success rates.
Collapse
Affiliation(s)
| | | | | | | | | | - Federico De Maria
- a:1:{s:5:"en_US";s:85:"Unit of Plastic Surgery, Policlinico di Modena, Università di Modena e Reggio Emilia";}.
| | | |
Collapse
|
29
|
Negative Pressure Wound Therapy as an Artificial Leech to Save a Congestive Flap: Case Report. Plast Reconstr Surg Glob Open 2022; 10:e4162. [PMID: 35265443 PMCID: PMC8901204 DOI: 10.1097/gox.0000000000004162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/06/2022] [Indexed: 11/29/2022]
Abstract
Historically, patients with lower limb defects have represented a challenge for plastic surgeons because of their higher rate of complications. One of the main complications is venous congestion. Recently, various studies have suggested the use of negative pressure wound therapy as a salvage flap therapy, showing promising results. In this case report, we will outline the case of an elderly patient with different comorbidities in whom we used negative pressure wound therapy (as an artificial leech) to reverse venous congestion in the flap, with a satisfactory clinical outcome and without any more surgical procedures.
Collapse
|