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Awaida CJ, Bernier C, Bou-Merhi JS, Trabelsi NO, Gagnon A, El-Khatib A, Harris PG, Odobescu A. Staged Mastopexy before Nipple-Sparing Mastectomy: Improving Safety and Appearance in Breast Reconstruction. Plast Reconstr Surg 2024; 153:864e-872e. [PMID: 37335584 DOI: 10.1097/prs.0000000000010823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
BACKGROUND Breast reconstruction following nipple-sparing mastectomy (NSM) in patients with large or ptotic breasts remains challenging because of the risk of ischemic complications and the difficulty in managing the redundant skin envelope. Staged mastopexy or breast reduction before the mastectomy/reconstruction has been shown to decrease the risk of complications and improve clinical outcomes. METHODS A retrospective analysis was conducted of patients with a genetic predisposition to breast cancer who underwent staged breast reduction/mastopexy before NSM and reconstruction in the authors' institution. In patients with in situ disease or invasive cancer, the first stage consisted of lumpectomy and oncoplastic reduction/mastopexy. Breast reconstruction at the second stage was performed with free abdominal flaps or breast implants and acellular dermal matrix. Data regarding the ischemic complications were recorded. RESULTS In total, 47 patients (84 breasts) underwent this staged approach. All patients had a genetic predisposition to breast cancer. The time interval between the two stages was 11.5 months (range, 1.3 to 23.6 months). Twelve breasts (14.3%) were reconstructed with free abdominal flaps, six (7.1%) with tissue expanders, and 66 (78.6%) with permanent subpectoral implants and acellular dermal matrix. There was one case of postoperative superficial nipple-areola complex epidermolysis (1.2%), and two cases of partial mastectomy skin flap necrosis (2.4%). The mean follow-up time after completion of reconstruction was 8.3 months. CONCLUSION Mastopexy or breast reduction before NSM and reconstruction is a safe procedure with a low risk of ischemic complications. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Cyril J Awaida
- From the Division of Plastic and Reconstructive Surgery, University of Montreal Hospital Center
| | - Christina Bernier
- From the Division of Plastic and Reconstructive Surgery, University of Montreal Hospital Center
| | - Joseph S Bou-Merhi
- From the Division of Plastic and Reconstructive Surgery, University of Montreal Hospital Center
| | | | - Alain Gagnon
- From the Division of Plastic and Reconstructive Surgery, University of Montreal Hospital Center
| | - Arij El-Khatib
- From the Division of Plastic and Reconstructive Surgery, University of Montreal Hospital Center
| | - Patrick G Harris
- From the Division of Plastic and Reconstructive Surgery, University of Montreal Hospital Center
| | - Andrei Odobescu
- Department of Plastic Surgery, University of Texas Southwestern
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Cordoba T, Awaida C, Delisle É, Cordoba C, Odobescu A. Triple Barrel Free Fibula Flap for Sternal Stabilization: A Case Report. Ann Burns Fire Disasters 2024; 37:79-82. [PMID: 38680839 PMCID: PMC11042043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 12/01/2022] [Indexed: 05/01/2024]
Abstract
Sternal non-union is a rare complication of median sternotomies following cardiac surgery. It results in sternal instability and is associated with a high rate of morbidity. Patients with sternal non-union usually complain of pain and sternal clicking with movement of the chest wall. Diagnosis is confirmed on computed tomography showing a gap between two sternal halves. Surgical correction of sternal instability is challenging. The key objective is to reconstruct a thoracic cage that allows for biomimesis and preserves normal physiologic cardiac and pulmonary functions all whilst achieving an aesthetically pleasing result. In this article, we describe a novel technique for sternal instability reconstruction using a triple-barrel vascularized free fibula flap fixed with rib titanium plates. This approach provides rigid long-lasting stability while preserving chest wall biomechanics.
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Affiliation(s)
- T. Cordoba
- University of Montreal, Montreal, Quebec, Canada
| | - C. Awaida
- Division of Plastic and Reconstructive Surgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - É. Delisle
- University of Montreal, Montreal, Quebec, Canada
| | - C. Cordoba
- Division of Plastic and Reconstructive Surgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - A. Odobescu
- Department of Plastic and Reconstructive Surgery, University of Texas-Southwestern, Dallas, Texas, United States
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3
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Awaida C, Aribert M, Weger N, Keck K, Odobescu A. Venous Free Flap with Interposition Bypass Graft for Arteriovenous Fistula Preservation: A Case Report. Arch Plast Surg 2023; 50:568-572. [PMID: 38143846 PMCID: PMC10736209 DOI: 10.1055/a-2122-6029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 06/27/2023] [Indexed: 12/26/2023] Open
Abstract
Cutaneous squamous cell carcinoma (CSCC) overlying an arteriovenous fistula (AVF) is rare and presents unique challenges. This case report describes a method of fistula preservation after CSCC excision using a flow-through venous free flap. The saphenous vein of the venous flap was used as flow-through segment for AVF preservation. The flap was inserted along the dorsal aspect of the forearm wound and microvascular anastomosis of the arterial inflow was completed using a vein just proximal to the radiocephalic fistula anastomosis. Venous outflow was established by creating an end-to-end vascular anastomosis between the cephalic vein and the greater saphenous vein. A separate subcutaneous vein was used to provide a low-pressure outflow for the flap to avoid congestion. This case demonstrates an option for AVF preservation that has not been previously described. It also highlights the importance of a multidisciplinary approach for the safe treatment of CSCCs overlying AVFs.
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Affiliation(s)
- Cyril Awaida
- Division of Plastic and Reconstructive Surgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Marion Aribert
- Division of Plastic and Reconstructive Surgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Natalie Weger
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Kendall Keck
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Andrei Odobescu
- Department of Plastic Surgery, University of Texas-Southwestern, Dallas, Texas
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4
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Papas Y, Bou-Merhi J, Odobescu A, Retchkiman M, Danino MA. Partial DIEP flap loss in a patient with history of abdominal liposuction. ANN CHIR PLAST ESTH 2020; 66:257-260. [PMID: 32948374 DOI: 10.1016/j.anplas.2020.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/23/2020] [Accepted: 08/30/2020] [Indexed: 11/25/2022]
Abstract
Classically, history of prior abdominal liposuction has been considered a relative contraindication for breast reconstruction using deep inferior epigastric perforator (DIEP) flap. The rationale for this is based on the fact that liposuction can possibly damage perforating vessels, which could compromise flap survival. However, multiple recently published reports have shown that imaging using CT angiography or colour Duplex ultrasonography could be used to accurately assess the adequacy of the perforating vessels before DIEP flap harvest. This contraindication is currently being reconsidered in the scientific literature. We present a case of partial DIEP flap loss in a patient with history of abdominal liposuction that happened despite preoperative identification of adequate perforators using CT angiography and intraoperative clear evidence of patent anastomoses. This occurrence reopens in our view the question of whether DIEP flaps can be safely performed on patients with a history of abdominal liposuction, even in the presence of adequate perforators on regular CT angiography or Doppler ultrasonography. While abdominal liposuction may not injure perforating vessels, its detrimental effect on linking micro-vessels within the flap cannot be fully evaluated using CT Angiography. Therefore, the use of another imaging modality, such as the indocyanine green laser angiography, to assess perfusion before DIEP flap harvesting is performed and could be considered in patients with history of abdominal liposuction.
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Affiliation(s)
- Y Papas
- Centre hospitalier universitaire de Montréal, Montréal, Québec, Canada
| | - J Bou-Merhi
- Centre hospitalier universitaire de Montréal, Montréal, Québec, Canada
| | - A Odobescu
- Centre hospitalier universitaire de Montréal, Montréal, Québec, Canada
| | - M Retchkiman
- Centre hospitalier universitaire de Montréal, Montréal, Québec, Canada
| | - M A Danino
- Centre hospitalier universitaire de Montréal, Montréal, Québec, Canada.
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5
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Odobescu A, Dawson D, Goodwin I, Harris PG, BouMerhi J, Danino MA. High-Fidelity Microsurgical Simulation: The Thiel Cadaveric Nerve Model and Evaluation Instrument. Plast Surg (Oakv) 2019; 27:289-296. [PMID: 31763328 DOI: 10.1177/2292550319876660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
With surgical education moving from a time-based to a competency-based model, developing high-fidelity simulation models has become a priority. The Thiel cadaveric model has previously been used for a number of medical and surgical simulations, including microvascular simulation. We aim to investigate the use of the Thiel model in peripheral nerve simulation and validate a novel evaluation instrument. Sixteen residents ranging from postgraduate years 1 to 6 participated in the study. Their nerve coaptations using Thiel cadaveric nerves were video recorded and evaluated by 5 fellowship-trained microsurgeons using the Micro-Neurorrhaphy Evaluation Scale (MNES). The intraclass correlation among the 5 evaluators was 0.75, revealing excellent interrater reliability. The Cronbach α was .77, underlining the internal consistency of the test items. Bivariate analysis revealed a significant association between the MNES scores and the participants' self-declared level of experience. This correlation was confirmed by mixed modeling. Our results validate the MNES and underscore the utility of the Thiel nerve tissue for peripheral nerve surgical simulation.
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Affiliation(s)
- Andrei Odobescu
- Department of Surgery, University of Iowa.,Department of Surgery, University of Montreal Hospital Center
| | - Deborah Dawson
- Department of Surgery, University of Iowa.,College of Dentistry, University of Iowa
| | | | | | - Joseph BouMerhi
- Department of Surgery, University of Montreal Hospital Center
| | - Michel A Danino
- Department of Surgery, University of Montreal Hospital Center
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Hosein R, Odobescu A, Goodwin I. A Novel Technique for Microsurgery on Calcified Arteries: Venous Interposition Grafting. Eplasty 2019; 19:pb3. [PMID: 31341527 PMCID: PMC6625752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Ray Christopher Hosein
- aDivision of Plastic & Reconstructive Surgery, University of Utah Health, Salt Lake City, UT
| | - Andrei Odobescu
- bDivision of Plastic & Reconstructive Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Isak A. Goodwin
- aDivision of Plastic & Reconstructive Surgery, University of Utah Health, Salt Lake City, UT,Correspondence:
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Odobescu A, Goodwin I, Berbiche D, BouMerhi J, Harris PG, Danino MA. High Fidelity Microsurgical Simulation: The Thiel Model and Evaluation Instrument. Plast Surg (Oakv) 2019; 27:118-124. [PMID: 31106168 DOI: 10.1177/2292550318800324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background The Thiel embalmment method has recently been used in a number of medical simulation fields. The authors investigate the use of Thiel vessels as a high fidelity model for microvascular simulation and propose a new checklist-based evaluation instrument for microsurgical training. Methods Thirteen residents and 2 attending microsurgeons performed video recorded microvascular anastomoses on Thiel embalmed arteries that were evaluated using a new evaluation instrument (Microvascular Evaluation Scale) by 4 fellowship trained microsurgeons. The internal validity was assessed using the Cronbach coefficient. The external validity was verified using regression models. Results The reliability assessment revealed an excellent intra-class correlation of 0.89. When comparing scores obtained by participants from different levels of training, attending surgeons and senior residents (Post Graduate Year [PGY] 4-5) scored significantly better than junior residents (PGY 1-3). The difference between senior residents and attending surgeons was not significant. When considering microsurgical experience, the differences were significant between the advanced group and the minimal and moderate experience groups. The differences between minimal and moderate experience groups were not significant. Based on the data obtained, a score of 8 would translate into a level of microsurgical competence appropriate for clinical microsurgery. Conclusions Thiel cadaveric vessels are a high fidelity model for microsurgical simulation. Excellent internal and external validity measures were obtained using the Microvascular Evaluation Scale (MVES).
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Affiliation(s)
- Andrei Odobescu
- Division of plastic surgery, University of Montreal Hospital Center, Montreal, Québec, Canada.,Division of plastic surgery, University of Iowa, Iowa City, IA, USA
| | - Isak Goodwin
- Division of plastic surgery, University of Utah, Salt Lake City, UT, USA
| | | | - Joseph BouMerhi
- Division of plastic surgery, University of Montreal Hospital Center, Montreal, Québec, Canada
| | - Patrick G Harris
- Division of plastic surgery, University of Montreal Hospital Center, Montreal, Québec, Canada
| | - Michel A Danino
- Division of plastic surgery, University of Montreal Hospital Center, Montreal, Québec, Canada
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8
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Odobescu A, Moubayed SP, Danino MA. Thiel Cadaveric Nerve Tissue: A Model for Microsurgical Simulation. J Brachial Plex Peripher Nerve Inj 2017; 11:e18-e20. [PMID: 28077956 DOI: 10.1055/s-0036-1580626] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 02/08/2016] [Indexed: 10/21/2022] Open
Affiliation(s)
- Andrei Odobescu
- Department of Plastic and Reconstructive Surgery Service, Université de Montréal Hospital Center, Montreal, Canada
| | - Sami P Moubayed
- Department of Otolaryngology-Head and Neck Surgery Service, Université de Montréal Hospital Center, Montreal, Canada
| | - Michel Alain Danino
- Department of Plastic and Reconstructive Surgery Service, Université de Montréal Hospital Center, Montreal, Canada
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9
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Moubayed SP, Giot JP, Odobescu A, Guertin L, Harris PG, Danino MA. Arteriovenous fistulas for microvascular head and neck reconstruction. Plast Surg (Oakv) 2015; 23:167-70. [PMID: 26361623 DOI: 10.4172/plastic-surgery.1000925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In head and neck cancer patients, multiple surgeries and radiation can leave the neck depleted of recipient vessels appropriate for microvascular reconstruction. The creation of temporary arteriovenous fistulas using venous interposition for subsequent microvascular reconstruction has rarely been reported in the head and neck. The authors report the largest series of temporary arteriovenous loops for head and neck reconstruction in vessel-depleted necks. METHODS The authors performed a case series of major head and neck reconstructions using temporary arteriovenous fistulas with a saphenous vein graft. A subclavian surgical approach was used. All reconstructions were performed at least two weeks after the creation of the initial fistula. RESULTS The authors have performed nine reconstructive cases for malignancy using five different free flaps. The subclavian and transerve cervical arteries were used, and the subclavian, internal jugular and cephalic veins were used for microanastomosis. Two cases of flap hematoma and one case of venous pedicle compression were recorded. No cases of flap failure were reported. CONCLUSIONS Reconstruction using temporary arteriovenous fistulas is a reliable technique that can be used in the vessel-depleted neck, with excellent outcomes in experienced hands.
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Affiliation(s)
- Sami P Moubayed
- Otolaryngology-Head and Neck Surgery Service, Université de Montréal Hospital Center (CHUM), Montreal, Quebec
| | - Jean-Philippe Giot
- Plastic Surgery Service, Department of Surgery, Université de Montréal Hospital Center (CHUM), Montreal, Quebec
| | - Andrei Odobescu
- Plastic Surgery Service, Department of Surgery, Université de Montréal Hospital Center (CHUM), Montreal, Quebec
| | - Louis Guertin
- Otolaryngology-Head and Neck Surgery Service, Université de Montréal Hospital Center (CHUM), Montreal, Quebec
| | - Patrick G Harris
- Plastic Surgery Service, Department of Surgery, Université de Montréal Hospital Center (CHUM), Montreal, Quebec
| | - Michel Alain Danino
- Plastic Surgery Service, Department of Surgery, Université de Montréal Hospital Center (CHUM), Montreal, Quebec
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10
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Abstract
Background In head and neck cancer patients, multiple surgeries and radiation can leave the neck depleted of recipient vessels appropriate for microvascular reconstruction. The creation of temporary arteriovenous fistulas using venous interposition for subsequent microvascular reconstruction has rarely been reported in the head and neck. The authors report the largest series of temporary arteriovenous loops for head and neck reconstruction in vessel-depleted necks. Methods The authors performed a case series of major head and neck reconstructions using temporary arteriovenous fistulas with a saphenous vein graft. A subclavian surgical approach was used. All reconstructions were performed at least two weeks after the creation of the initial fistula. Results The authors have performed nine reconstructive cases for malignancy using five different free flaps. The subclavian and transerve cervical arteries were used, and the subclavian, internal jugular and cephalic veins were used for microanastomosis. Two cases of flap hematoma and one case of venous pedicle compression were recorded. No cases of flap failure were reported. Conclusions Reconstruction using temporary arteriovenous fistulas is a reliable technique that can be used in the vessel-depleted neck, with excellent outcomes in experienced hands.
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Affiliation(s)
- Sami P Moubayed
- Otolaryngology-Head and Neck Surgery Service, Université de Montréal Hospital Center (CHUM), Montreal, Quebec
| | - Jean-Philippe Giot
- Plastic Surgery Service, Department of Surgery, Université de Montréal Hospital Center (CHUM), Montreal, Quebec
| | - Andrei Odobescu
- Plastic Surgery Service, Department of Surgery, Université de Montréal Hospital Center (CHUM), Montreal, Quebec
| | - Louis Guertin
- Otolaryngology-Head and Neck Surgery Service, Université de Montréal Hospital Center (CHUM), Montreal, Quebec
| | - Patrick G Harris
- Plastic Surgery Service, Department of Surgery, Université de Montréal Hospital Center (CHUM), Montreal, Quebec
| | - Michel Alain Danino
- Plastic Surgery Service, Department of Surgery, Université de Montréal Hospital Center (CHUM), Montreal, Quebec
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Abstract
OBJECTIVE To evaluate the horizontal mattress technique in microvascular anastomosis for size-mismatched vessels. METHODS The present study involved cadaveric simulation using size-mismatched (1.5:1) Thiel-embalmed cadaveric arteries. The authors performed horizontal mattress anastomoses using 9-0 nylon suture and recorded the procedure. Vessel patency was evaluated by saline infusion. Vessels were cut open and photographed; histological slides were prepared and stained with hematoxylin and eosin. RESULTS Four anastomoses were performed. Vessels were found to be patent in all cases, with grade 0 leaks. Intima-on-intima apposition with no intraluminal exposure of muscularis nor adventitia were observed. CONCLUSION The present cadaveric study supports the technical feasibility of using horizontal mattress sutures in size-mismatched end-toend anastomoses.
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Affiliation(s)
| | - Sami P Moubayed
- Otolaryngology-Head and Neck Surgery Service, Notre-Dame Hospital, University of Montréal Hospital Center (CHUM)
| | - Eugene Daniels
- Department of Anatomy, McGill University, Montreal, Quebec
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12
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El-Diwany M, Odobescu A, Bélanger-Douet M, Berbiche D, Arsenault J, Bou-Merhi J, Harris P, Danino A. Replantation vs revision amputation in single digit zone II amputations. J Plast Reconstr Aesthet Surg 2015; 68:859-63. [DOI: 10.1016/j.bjps.2015.02.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 12/23/2014] [Accepted: 02/26/2015] [Indexed: 11/27/2022]
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Abstract
Objective To evaluate the horizontal mattress technique in microvascular anastomosis for size-mismatched vessels. Methods The present study involved cadaveric simulation using size-mismatched (1.5:1) Thiel-embalmed cadaveric arteries. The authors performed horizontal mattress anastomoses using 9-0 nylon suture and recorded the procedure. Vessel patency was evaluated by saline infusion. Vessels were cut open and photographed; histological slides were prepared and stained with hematoxylin and eosin. Results Four anastomoses were performed. Vessels were found to be patent in all cases, with grade 0 leaks. Intima-on-intima apposition with no intraluminal exposure of muscularis nor adventitia were observed. Conclusion The present cadaveric study supports the technical feasibility of using horizontal mattress sutures in size-mismatched end-to-end anastomoses.
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Affiliation(s)
| | - Sami P Moubayed
- Otolaryngology-Head and Neck Surgery Service Notre-Dame Hospital University of Montréal Hospital Center (CHUM)
| | - Eugene Daniels
- Department of Anatomy, McGill University, Montreal, Quebec
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Efanov JI, Odobescu A, Giroux MF, Harris PG, Danino MA. Intra-arterial Thrombolysis for Postoperative Digital Ischemia: A Case Report. Eplasty 2014; 14:e26. [PMID: 25165495 PMCID: PMC4102140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Surgical repair of digital flexion deformities can result in vascular injuries threatening the viability of the affected digit. While uncommon, these injuries are reported to have a rate as high as 0.8% following palmo-digital fasciectomy for Dupuytren's disease. Late presentation of such vascular events pose a challenge, since taking the patient to the operating room does not guarantee success. METHODS We report a case of subacute digital ischemia that presented 10 days following correction of a boutonniere deformity treated with intra-arterial thrombolysis. There were no particular intraoperative complications. The thrombolytic regimen consisted of Alteplase (Roche, Mississauga, Canada) 2 mg bolus and 1 mg per hour (total 30 mg received over 28 hours) and intravenous heparin with a subtherapeutic target partial thromboplastin time of 40 to 50 seconds. RESULTS Thirty hours after the initiation of thrombolysis, an angiography confirmed complete reperfusion of the digital arteries at the distal interphalangeal joint that correlated with the clinical appearance of the digit. Thrombolysis was interrupted and therapeutic intravenous heparin was maintained. Bridging to warfarin was started 6 days postthrombolysis with a target international normalized ratio of 2 to 3. Unfortunately, she was weaned from the heparin while her international normalized ratio was not yet in the therapeutic range and the vessels rethrombosed. This was confirmed by angiography, and intra-arterial thrombolysis was performed with successful revascularization. The patient was restarted on therapeutic dose of heparin and carefully bridged to Coumadin. CONCLUSIONS For traction injuries, thrombolytic therapy can be a viable option although we should keep in mind that it could provoke severe adverse events.
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Affiliation(s)
- Johnny I. Efanov
- aPlastic and Reconstructive Surgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Andrei Odobescu
- aPlastic and Reconstructive Surgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Marie-France Giroux
- bDivision of Interventional Radiology, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Patrick G. Harris
- aPlastic and Reconstructive Surgery, University of Montreal Hospital Center, Montreal, Quebec, Canada
| | - Michel A. Danino
- aPlastic and Reconstructive Surgery, University of Montreal Hospital Center, Montreal, Quebec, Canada,Correspondence:
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15
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Karam E, Lévesque M, Jacquemin G, Delure A, Robidoux I, Laramée M, Odobescu A, Harris P, Danino A. Building a multidisciplinary team for burn treatment - Lessons learned from the Montreal tendon transfer experience. Ann Burns Fire Disasters 2014; 27:3-7. [PMID: 25249840 PMCID: PMC4150479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Indexed: 06/03/2023]
Abstract
Multidisciplinary teams (MDTs) represent a recognized component of care in the treatment of complex conditions such as burns. However, most institutions do not provide adequate support for the formation of these teams. Furthermore, the majority of specialists lack the managerial skills required to create a team and have difficulties finding the proper tools. Our objective is to provide an insight for health care professionals, who wish to form a MDT for burn treatment, on the challenges that are likely to be faced, and to identify key elements that may facilitate the establishment of such a project. The setting for this was a plastic surgery department and rehabilitation center at a national reference center. A qualitative analysis was performed on all correspondences related to our tetraplegia project, from 2006 to 2008. To guide our thematic analysis, we used a form of systems theory known as the complexity theory. The qualitative analysis was performed using the NVivo software (Version 8.0 QSR International Melbourne, Australia). Lastly, the data was organized in chronologic order. Three main themes emerged from the results: knowledge acquisition, project organizational setup and project steps design. These themes represented respectively 24%, 50% and 26% of all correspondences. Project steps design and knowledge acquisition correspondences increased significantly after the introduction of the mentor team to our network. We conclude that an early association with a mentor team is beneficial for the establishment of a MDT.
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Affiliation(s)
- E. Karam
- Centre Hospitalier de l’Université de Montréal, Université de Montréal, Service de Chirurgie plastique, Hôpital Notre Dame, Montréal, Québec, Canada
| | | | - G. Jacquemin
- Institut de Réadaptation Gingras-Lindsay de Montréal, Montréal, Québec, Canada
| | - A. Delure
- Institut de Réadaptation Gingras-Lindsay de Montréal, Montréal, Québec, Canada
| | - I. Robidoux
- Institut de Réadaptation Gingras-Lindsay de Montréal, Montréal, Québec, Canada
| | - M.T. Laramée
- Institut de Réadaptation Gingras-Lindsay de Montréal, Montréal, Québec, Canada
| | - A. Odobescu
- Centre Hospitalier de l’Université de Montréal, Université de Montréal, Service de Chirurgie plastique, Hôpital Notre Dame, Montréal, Québec, Canada
| | - P.G.. Harris
- Centre Hospitalier de l’Université de Montréal, Université de Montréal, Service de Chirurgie plastique, Hôpital Notre Dame, Montréal, Québec, Canada
| | - A.M. Danino
- Centre Hospitalier de l’Université de Montréal, Université de Montréal, Service de Chirurgie plastique, Hôpital Notre Dame, Montréal, Québec, Canada
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Odobescu A, Ferland Caron G, Danino MA, Gagnon AR. Alar rotation flap for full thickness medial alar defects. J Plast Reconstr Aesthet Surg 2014; 67:866-8. [PMID: 24461553 DOI: 10.1016/j.bjps.2013.12.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/19/2013] [Accepted: 12/23/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Andrei Odobescu
- Plastic Surgery Service, University of Montreal Hospital Center, Montreal, Canada
| | | | - Michael Alain Danino
- Plastic Surgery Service, University of Montreal Hospital Center, Montreal, Canada
| | - Alain R Gagnon
- Plastic Surgery Service, University of Montreal Hospital Center, Montreal, Canada.
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Odobescu A, Moubayed SP, Harris PG, Bou-Merhi J, Daniels E, Danino MA. A new microsurgical research model using Thiel-embalmed arteries and comparison of two suture techniques. J Plast Reconstr Aesthet Surg 2013; 67:389-95. [PMID: 24507964 DOI: 10.1016/j.bjps.2013.12.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 12/20/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the utility of the Thiel arterial model in microsurgical research, we compared interrupted horizontal mattress (HM) sutures to simple interrupted (SI) sutures in human vessels. METHODS A microsurgical set-up using an operating microscope and Thiel-embalmed arteries was used to practice ten SI and HM anastomoses. Vessel patency, leak and stricture were evaluated using angiography, and vessel wall architecture was evaluated using light microscopy and scanning electron microscopy (SEM). The technique speed was also assessed. RESULTS We have successfully evaluated all outcomes. All anastomoses were patent. The stricture rate was higher with HM than with SI (60% vs. 35% surface area reduction). Three minor leaks occurred with HM sutures versus one with SI sutures. Edges were evenly everted without any intimal flaps with HM compared to SI. The anastomoses were performed faster using HM than SI sutures (7:58 min vs. 12:41 min, respectively). CONCLUSION This is the first study to evaluate the feasibility of a Thiel-embalmed artery model for research purposes. The HM microvascular suture is a promising technique that requires further in vivo validation.
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Affiliation(s)
- Andrei Odobescu
- Department of Surgery, University of Montreal, Montreal, QC, Canada
| | - Sami P Moubayed
- Department of Surgery, University of Montreal, Montreal, QC, Canada
| | - Patrick G Harris
- Plastic and Reconstructive Surgery Service, Department of Surgery, Notre-Dame Hospital, University of Montréal Hospital Center (CHUM), Montreal, QC, Canada
| | - Joseph Bou-Merhi
- Plastic and Reconstructive Surgery Service, Department of Surgery, Notre-Dame Hospital, University of Montréal Hospital Center (CHUM), Montreal, QC, Canada
| | - Eugene Daniels
- Department of Anatomy and Cell Biology, McGill University, Montreal, QC, Canada
| | - Michel Alain Danino
- Plastic and Reconstructive Surgery Service, Department of Surgery, Notre-Dame Hospital, University of Montréal Hospital Center (CHUM), Montreal, QC, Canada.
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L'Heureux-Lebeau B, Odobescu A, Harris P, Guertin L, Danino A. Chimaeric subscapular system free flap for complex oro-facial defects. J Plast Reconstr Aesthet Surg 2013; 66:900-5. [DOI: 10.1016/j.bjps.2013.02.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Revised: 02/22/2013] [Accepted: 02/25/2013] [Indexed: 11/29/2022]
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Odobescu A, Williams H, Gilardino M. Description of a communication between the facial and zygomaticotemporal nerves. J Plast Reconstr Aesthet Surg 2012; 65:1188-92. [DOI: 10.1016/j.bjps.2012.03.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 03/14/2012] [Accepted: 03/21/2012] [Indexed: 10/28/2022]
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Dionyssopoulos A, Odobescu A, Foroughi Y, Harris P, Karagergou E, Guertin L, Ferraro P, Danino AM. Monitoring buried jejunum free flaps with a sentinel: A retrospective study of 20 cases. Laryngoscope 2012; 122:519-22. [DOI: 10.1002/lary.22382] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 06/04/2011] [Accepted: 06/14/2011] [Indexed: 11/10/2022]
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L'Heureux-Lebeau B, Odobescu A, Moser T, Harris PG, Danino MA. Ulnar subluxation of the median nerve following carpal tunnel release: a case report. J Plast Reconstr Aesthet Surg 2012; 65:e99-e101. [PMID: 22227502 DOI: 10.1016/j.bjps.2011.11.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 11/25/2011] [Indexed: 12/31/2022]
Abstract
Complications of carpal tunnel release, while infrequent, include incomplete release resulting in persistent symptoms or recurrence due to postoperative scarring, as well as iatrogenic damage to nerves and vessels. We present the case of a patient who underwent carpal tunnel release with resolution of symptoms in the immediate postoperative period. At one and a half years post release he started to experience numbness and tingling in a median nerve distribution triggered by repetitive ulnar to radial deviation of the wrist, with no symptoms at rest. Dynamic ultrasound showed a subluxation of the median nerve from one side of the palmaris longus tendon to the other. The patient's symptoms were triggered as the median nerve squeezed in between the palmaris longus and flexor digitorum superficialis tendons.
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Affiliation(s)
- B L'Heureux-Lebeau
- Division of Plastic and Reconstructive Surgery, University of Montréal Hospital Center, University of Montréal, Montréal, Canada
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Odobescu A, Servant JM, Danino IW, Danino MA. Nostril alar rim threshold flap for columellar reconstruction. J Plast Reconstr Aesthet Surg 2011; 64:929-33. [PMID: 21316321 DOI: 10.1016/j.bjps.2011.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 01/07/2011] [Accepted: 01/11/2011] [Indexed: 11/16/2022]
Abstract
The reconstruction of the columella poses a significant challenge to the plastic surgeon. A multitude of techniques have been developed to address this issue; however, the end result is often unsatisfactory or comes at too high a morbid cost. Gillies described an alar margin flap in 1949 that never gained significant popularity. This technique had been refined by Servant over the past two decades in his work on Noma noses in Africa. We describe a two-stage columella reconstruction technique with a nostril alar rim threshold flap and provide the results of our case series. Under local anaesthesia, a full-thickness alar flap is raised by placing an incision along the alar-facial groove and carrying it around the lateral crus. This flap is then rotated on its medial pedicle and inserted into the nasal tip. Three weeks after the first stage, the flap is divided to the desired columellar length and the remaining ala relocated to the alar-facial groove. At the same time, the contralateral ala can be adjusted to match the donor side. We performed a retrospective study of all our columellar reconstructions using this local flap. Our case series consisted of seven patients, and satisfactory cosmetic results were obtained in all cases. The nostril alar rim threshold flap is a useful technique for columellar reconstruction, producing near-anatomic results that can be performed as a two-stage outpatient procedure under local anaesthesia. This technique is particularly well suited for columellar reconstruction in patients of African descent.
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Affiliation(s)
- A Odobescu
- University of Montreal Health Center, Montreal, Canada
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Abstract
We describe a variation in the A4 pulley reconstruction technique using one slip of the flexor digitorum superficialis insertion and report the results of a biomechanical analysis of this reconstruction in cadavers. While conserving the distal bony insertion, one slip of flexor digitorum superficialis is transferred over the flexor digitorum profundus tendon and sutured to the contralateral superficialis slip insertion. This creates a new pulley at the base of the original A4 pulley that can be adjusted to accommodate an FDP repair of increased bulk. We found a 57% reduction in excess excursion due to bowstringing when compared with no repair. Furthermore the repairs were sturdy, 94% of specimens maintaining their integrity when a proximally directed force of 50 N was applied.
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Affiliation(s)
- A Odobescu
- Division of Plastic and Reconstructive Surgery, McGill University Health Center, Montreal, Canada
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