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Alberto Franchi, Mathias Häfeli, Mario F Scaglioni, David Elliot, Thomas Giesen
INTRODUCTION: There is growing evidence of the superior ability of muscular tissue to clear bacterial bone infection. Unfortunately, in the hand, there are almost no small local muscular flaps, and muscular transfers to the hand are mainly microsurgical free transfers. In this report, we present the results of the use of a chimeric posterior interosseous flap including part(s) of the forearm muscles to treat osteomyelitis and soft tissue defect of hand from a series of patients. PATIENTS AND METHODS: Four male patients with an average age of 32 years (range 20-46 years), were affected by acute osteomyelitis in hand...
February 19, 2019: Microsurgery
Yi-Ting Chen, Shun-Chen Huang, Chien-Chang Chen, Lee-Moay Lim, Po-Liang Lu, Ya-Ping Hou, Yin-Chih Fu, Chia-Hsin Chen, Yur-Ren Kuo
Acute rejection is not uncommon after vascularized composite allotransplantation. We reported the effects of adjunctive topical immunosuppressant with topical tacrolimus (Protopic®) and steroid cream (Clobetasol®) in the management of acute rejection in two hand transplantation patients. Case 1 is a 45-year-old male with distal forearm deficit 4 years ago and Case 2 is a 30-year-old male with a proximal forearm deficiency 2 years ago, respectively. Both of them suffered from occupational accident and received hand allotransplantation...
February 15, 2019: Microsurgery
Nicolás Pereira, Álvaro Cámbara, Matías Kufeke, Ricardo Roa
Post-traumatic lymphedema is poorly understood. It is rarely considered in limb reconstruction decision-making approach. We report a case of a 41-year-old female who presented with right upper extremity lymphedema after degloving injury and split thickness skin graft, successfully treated with a superficial circumflex iliac artery perforator (SCIP) free flap restoring the lymphatic drainage. Right upper extremity had an excess of 258.7 mL or an excess volume of 27.86% compared to the healthy contralateral limb...
February 15, 2019: Microsurgery
Guido Giacalone, Takumi Yamamoto, Akitatsu Hayashi, Florence Belva, Mieke Gysen, Nobuko Hayashi, Nana Yamamoto, Isao Koshima
BACKGROUND: Lymphocele and lymphorrhea are frequent complications after lymph node excision. Recurrent lymphoceles and intractable lymphorrhea are particularly difficult to treat conservatively. We describe the outcomes of four patients with recurrent lymphocele and nine patients with persistent lymphorrhea that were treated by supermicrosurgery. METHODS: Four patients with recurrent lymphoceles with a size between 7 and 21 cm and located in the groin (n = 1) or upper leg (n = 3), were referred for surgical treatment between 2013 and 2017 after unsuccessful conservative therapy...
February 14, 2019: Microsurgery
Egemen Ayhan, Francisco Soldado, César G Fontecha, Jayme A Bertelli, Gursel Leblebicioglu
INTRODUCTION: Posttraumatic brachial plexus (BP) palsy was used to be treated by reconstruction with nerve grafts. For the last two decades, nerve transfers have gained popularity and believed to be more effective than nerve grafting. The aim of this systematic review was to compare elbow flexion restoration with nerve transfers or nerve grafting after traumatic BP injury. METHODS: PRISMA-IPD structure was used for 52 studies included. Patients were allocated as C5-C6 (n = 285), C5-C6-C7 (n = 150), and total BP injury (n = 245) groups...
February 13, 2019: Microsurgery
Cesar Casado-Sanchez, Luis Landin
No abstract text is available yet for this article.
February 11, 2019: Microsurgery
Shady Elmaraghi, Tzujane Jenny Chen, Jennifer E Heckman, Jonathan M Shiau, Daniel H Williams, E Jason Abel, Ahmed M Afifi
Penile amputation is a rare injury with significant posttraumatic ramifications. We present a case of successful immediate replantation after traumatic penile avulsion in a 52-year-old male patient. The patient reported his penis was caught in machinery during a boating accident, and avulsed at the level of the pubis. Immediate replantation of this proximal avulsion injury with no suitable proximal arterial stumps required transfer of the superficial inferior epigastric artery for arterial inflow. One artery and two veins were repaired...
February 3, 2019: Microsurgery
Maleka Ramji, Grace Y Kim, Alex Pozdnyakov, Mark H McRae
BACKGROUND: Restoration of nasal lining is essential in reconstruction of subtotal/total nasal defects. When local flaps are inadequate, a microvascular flap should be used. The purpose of this scoping review is to map the literature and identify the described flap options for subtotal/total nasal reconstruction. Further to that, we will summarize the stated advantages and disadvantages, evaluate functional and esthetic outcomes, and appraise the current body of literature. METHODS: An electronic literature search was completed...
January 31, 2019: Microsurgery
André C Nepomuceno, José C de Faria, Elisa L Politani, Eduardo G Silva, Raquel Salomone, Marco V Longo, Washington Lima, Alessandra G Salles, Rolf Gemperli
INTRODUCTION: Muscle contraction generated by electrical impulses simultaneously originating from two different neural sources may be an interesting treatment alternative for long term facial palsy. An experimental model was designed to compare single and dual innervation of the gastrocnemius muscle (GM) in rats. METHODS: Fifty adult Wistar rats underwent transection of their right peroneal nerve and were divided into five groups (n = 10): control (C), tibial nerve section (TS), tibial nerve primary end-to-end neurorrhaphy (PEE), tibial nerve primary repair associated with end-to-side peroneal-to-tibial nerve transfer (PRES), and tibial nerve repair by convergent end-to-end (CEE) neurorrhaphy between the proximal stumps of the tibial and peroneal nerves to the distal stump of the tibial nerve...
January 31, 2019: Microsurgery
Dominik Steiner, Raymund E Horch, Ingo Ludolph, Andreas Arkudas
Abdominal free flaps such as the muscle sparing transverse rectus abdominis myocutaneous (ms-TRAM) or deep inferior epigastric artery perforator (DIEP) flap represent the gold standard in autologous breast reconstruction. We describe a salvage procedure during bilateral free flap breast reconstruction due to insufficient venous drainage using a venous cross-over bypass. A 54-year-old woman with a thrombosis of the left subclavian port-system in the medical history was elected for simultaneous bilateral breast reconstruction with ms-TRAM and DIEP flaps...
January 28, 2019: Microsurgery
Milan Kral, Bohumil Zalesak, Daniel Stehlik, Zbynek Tudos, Sarka Kudlackova, Frantisek Hruska, Vladimir Student
No abstract text is available yet for this article.
January 25, 2019: Microsurgery
Dominic Henn, Amir K Bigdeli, Miriam Horsch, Christel Weiß, Clemens Kühner, Christoph Hirche, Volker J Schmidt, Ulrich Kneser
BACKGROUND: Limb salvage in patients with peripheral vascular disease (PVD) and soft tissue defects often requires both a restoration of blood flow to the lower extremity and soft tissue coverage. Outcomes of free tissue transfer may be affected by vein grafts, which can be used for the placement of an autologous venous bypass or an arteriovenous (AV) loop leading to different hemodynamic situations. The purpose of this study was to investigate whether free flap anastomosis to a bypass or an AV loop can be performed with comparable results...
January 24, 2019: Microsurgery
Raffi Gurunluoglu, James Gatherwright
BACKGROUND: Satisfaction with appearance, functional outcomes (speech, swallowing), work status after microsurgical reconstruction for maxillofacial gunshot wounds (GSW) remain largely unknown. The purpose of this study is to report these parameters. By investigating these outcomes, we also aimed to provide microsurgical algorithms for complex maxillofacial GSW. METHODS: Forty-two consecutive maxillofacial GSW patients between 2006 and 2014 were analyzed for outcomes...
January 24, 2019: Microsurgery
Z-Hye Lee, David A Daar, John T Stranix, Lavinia Anzai, Vishal D Thanik, Pierre B Saadeh, Jamie P Levine
PURPOSE: There is a dearth of literature dedicated to specifically evaluating the use of free flap reconstruction in pediatric lower extremity traumas. This study aims to identify specific risk factors for flap failure in pediatric lower extremity trauma reconstruction. METHODS: Retrospective review of 53 free flaps in our lower extremity database (1979-2017) identified all free flaps performed for traumatic reconstruction in children <18 years of age at our institution...
January 23, 2019: Microsurgery
Ali Yeniocak, Osman Kelahmetoglu, Ethem Guneren
No abstract text is available yet for this article.
January 22, 2019: Microsurgery
Alvaro B Cho, Gustavo Bersani Silva, Marina J Pisani, Jairo A Alves, Raquel B Iamaguchi, Teng H Wei, Marcelo R de Rezende
PURPOSE: Elbow flexion deficit is a frequent problem in traumatic brachial plexus injuries and reestablishment of this function is the primary treatment goal. When management is delayed, or the initial acute approach fails, free functional transfer of the gracilis muscle for elbow flexion is the treatment of choice. In this report, the authors present the results of a comparison study on different donor nerves (spinal accessory and ulnar) in elbow flexion reconstruction with gracilis flap for traumatic adult brachial plexus injuries...
January 22, 2019: Microsurgery
Pietro G di Summa, Gianluca Sapino, Mario Cherubino, Giorgio De Santis, Sebastien Durand, Patrice Zaugg, Olivier Bauquis, Wassim Raffoul
BACKGROUND: We evaluated composite anterolateral thigh (ALT) flaps including vascularized fascia lata (FL), for stable soft tissue coverage and tendons restoration at various joint levels in a one-stage procedure. METHODS: We performed a retrospective investigation including 21 "functional" ALT flaps between November 2006 and December 2016. In all patients included, FL was shaped to anatomical reproduce a tendon structure. Functional analysis included range of motion and force assessment...
January 22, 2019: Microsurgery
Hideki Kadota, Kenta Momii, Masuo Hanada, Kenichi Kamizono, Yusuke Inatomi, Kana Hisanaga, Sei Yoshida, Kippei Ogaki, Keijiro Kiyoshima
Fournier's gangrene is lethal necrotizing fasciitis that involves the perineum and external genitalia. We describe the case of a 52-year-old man with Fournier's gangrene who underwent reconstruction of an extensive perineoscrotal defect using three pedicled perforator flaps. Three debridement procedures resulted in a skin and soft tissue defect of 36 × 18 cm involving the perineum, scrotum, groin, medial thigh, buttocks, and circumferential perianal area and left the perforating arteries originating from these locations unavailable for reconstruction...
January 21, 2019: Microsurgery
Georgios Pafitanis, Rossella Elia, Robert Miller, Cho-Han Wu, Pedro Ciudad, Hung-Chi Chen
No abstract text is available yet for this article.
January 21, 2019: Microsurgery
Yosuke Niimi, Hajime Matsumine, Satoshi Fukuda, John R Salsbury, Yu Niimi, David N Herndon, Donald S Prough, Perenlei Enkhbaatar
BACKGROUND: The lack of a clinically relevant animal model for facial nerve research is a challenge. The goal of this study was to investigate the anatomy of the ovine facial and hypoglossal nerves to establish a clinically relevant facial nerve research model. MATERIALS AND METHODS: Six cadaver female Merino sheep (33.5 ± 3 kg, approximately 3 years old) and three anesthetized female Merino sheep (30 ± 3 kg, approximately 3 years old) were used. In cadaver sheep, a right side preauricular to submandibular incision was made...
January 21, 2019: Microsurgery
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