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Microvascular free tissue transfer

Larissa Sweeny, Eben L Rosenthal, Tyler Light, Jessica Grayson, Daniel Petrisor, Scott H Troob, Benjamin J Greene, William R Carroll, Mark K Wax
BACKGROUND: Critical review of current head and neck reconstructive practices as related to free flap donor sites and their impact on clinical outcomes and cost. METHODS: Retrospective multicenter review of free tissue transfer reconstruction of head and neck defects (n = 1315). Variables reviewed: defect, indication, T classification, operative duration, and complications. A convenience sample was selected for analysis of overall (operative and inpatient admission) charges per hospitalization (n = 400)...
February 9, 2019: Head & Neck
Ulrike Maria Hamscha, Wolfgang Josef Weninger, Christian Freystätter, Chieh-Han Tzou, Christine Radtke
BACKGROUND:  Functional restoration in reconstructive surgery can require complex and adaptable approaches. In this anatomical study, the combined angiosome of the septofasciomyocutaneous vessels originating from the fibular artery was defined as basis for a chimeric flap of the lateral lower leg. METHODS:  Methylene blue injection into the fibular artery was performed in 10 legs of fresh cadavers for visualization of the angiosome on the skin, fibula, and adjacent muscles as the lateral hemisoleus (HS) muscle...
January 31, 2019: Journal of Reconstructive 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
Rosmarie Adelsberger, Richard Fakin, Sophia Mirtschink, Natasha Forster, Pietro Giovanoli, Nicole Lindenblatt
After microvascular tissue transfer, free flaps require meticulous postoperative surveillance. The purpose of this study was to evaluate the effect and applicability of indocyanine green fluorescence angiography (ICG-FA) in bedside monitoring of free flaps postoperatively, especially considering its role in correctly identifying vascular thromboses. Between February 2012 and October 2015, 210 free flaps used for defect reconstruction were analyzed. The flaps were monitored bedside for flap perfusion compromise by clinical examination and by ICG-FA in a standardized procedure in the first 3 postoperative days...
January 24, 2019: Journal of Plastic Surgery and Hand Surgery
Islam Abdelrahman, Moustafa Elmasry, Ingrid Steinvall, Pia Olofsson, Hans Nettelblad, Johann Zdolsek
Background: Reconstruction of complex defects in the lower leg is a challenge. Although microvascular free tissue transfer is a popular technique, experience and available resources limit its use. Furthermore, free tissue transfer is not always required in the reconstruction of small lower leg defects, as many of them can be reconstructed with local alternatives such as an extensor digitorum brevis flap (EDB). Our aim was to describe our experience of the last 20 years with the EDB as a local muscle flap to cover small complex lower leg defects to establish its clinical feasibility and to document its associated complications...
December 2018: Plastic and Reconstructive Surgery. Global Open
L C Boyd, G A Bond, A Hamidian Jahromi, S D Kozusko, Zinon Kokkalis, P Konofaos
While free tissue transfer has long been established as a reliable microsurgical technique in the adult population, its application in pediatric reconstruction is a relatively recent phenomenon. Despite initial concerns regarding minute vessel diameters, increased propensity for vasospasm, and limited tissue availability, pediatric free tissue transfer is now a widely used technique that has demonstrated an acceptable level of donor and recipient site morbidity in children. Five flaps commonly used in the reconstruction of lower extremity trauma are discussed in this paper: the latissimus dorsi, rectus abdominis, anterolateral thigh, gracilis, and the subscapular and parascapular flaps...
January 16, 2019: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Daniel Richard van Gijn, Jacob D'Souza, Wendy King, Michael Bater
Microsurgical free tissue transfer represents the mainstay of care in both ablative locoregional management and the simultaneous reconstruction of a defect. Advances in microsurgical techniques have helped balance the restoration of both form and function-decreasing the significant morbidity once associated with large ablative, traumatic, or congenital defects-while providing immediate reconstruction enabling early aesthetic and functional rehabilitation. There are a multitude of perioperative measures and considerations that aim to maximize the success of free tissue transfer...
December 2018: Facial Plastic Surgery: FPS
Mitchell L Worley, Evan M Graboyes, Julie Blair, Suhael Momin, Terry A Day, Joshua D Hornig, Judith Skoner, Andrew T Huang
BACKGROUND: Following salvage total laryngectomy (STL) with microvascular-free tissue transfer (MFTT), patients are at high risk for swallowing dysfunction, but risk factors for persistent gastrostomy tube (G-tube) dependence are unknown. METHODS: Retrospective review of 33 patients who underwent STL with MFTT. RESULTS: A total oral diet was achieved by 81% of patients with ≥6 months of postoperative follow-up. Approximately 27% of patients were G-tube dependent preoperatively with 67% achieving a total oral diet postoperatively...
December 14, 2018: Head & Neck
Kalvis Pastars, Janis Zarins, Juris Tars, Anna Ivanova, Andrejs Skagers
OBJECTIVE: Oral squamous cell carcinoma (OSCC) is a common type of cancer affecting people worldwide, with still large proportion of patients diagnosed with the disease in the advanced stage. Due to free vascularised tissue transfers, radical cancer treatment and immediate reconstruction are feasible as a one-stage procedure. The aim of this paper is to evaluate retrospectively our experience with free flap reconstruction of oral defects for patients with oral malignancies in advanced stages...
2018: Stomatologija
Kavitha Jayaram, Prasad Rao, Indira Gurajala, Gopinath Ramachandran
Objective: Multiple factors influence the success of microvascular free flap surgeries. Anaesthesia is an important factor to maximise the success rate of microvascular free flaps both by controlling haemodynamics and improving the perfusion of free vascularised tissue. The debate on the usefulness of regional and general anaesthesia for free tissue transfer is ongoing. This retrospective study was conducted to evaluate the effects of regional anaesthesia and other perioperative factors on outcomes of microvascular free flaps...
December 2018: Turkish Journal of Anaesthesiology and Reanimation
Madhubari Vathulya, Mohd Salahuddin Ansari
Introduction: The superficial veins of upper limbs are seldom talked about. They are always avoided quoting them to be variable in anatomy. Other than the cephalic and basilic veins, no other superficial vein has caught the eyes of anatomists and other health professionals significantly. This article tries to explain the importance of a superficial vein that closely traces the radial vessels and explains its possible use in microvascular reconstruction. Materials and Methods: The forelimbs of 26 upper limbs of fresh frozen cadavers were dissected out...
May 2018: Indian Journal of Plastic Surgery: Official Publication of the Association of Plastic Surgeons of India
Timo Rodi, Alexander Geierlehner, Afshin Mosahebi, Grigorios Tanos, Justin Conrad Rosen Wormald
BACKGROUND: A patent microvascular anastomosis is of paramount importance in free tissue transfer. Anastomotic coupler devices provide an alternative to technically demanding hand-sewn venous anastomosis. Various advantages of these devices have been discussed but previous systematic reviews had methodological flaws or did not perform a meta-analysis. This review aims to evaluate the quality of the evidence and quantify the efficacy and safety of venous couplers compared to hand-sewn anastomosis...
November 13, 2018: Systematic Reviews
J L McCarty, A S Corey, M W El-Deiry, H M Baddour, B M Cavazuti, P A Hudgins
Head and neck surgical reconstruction is complex, and postoperative imaging interpretation is challenging. Surgeons now use microvascular free tissue transfer, also known as free flaps, more frequently in head and neck reconstruction than ever before. Thus, an understanding of free flaps, their expected appearance on cross-sectional imaging, and their associated complications (including tumor recurrence) is crucial for the interpreting radiologist. Despite the complexity and increasing frequency of free flap reconstruction, there is no comprehensive head and neck resource intended for the radiologist...
November 8, 2018: AJNR. American Journal of Neuroradiology
Sanghoon Lee, Hye-Min Cho, Jin-Kyu Kim, Woong Nam
Background: Some of head and neck cancer patients are in compromised general condition after ablation surgery and chemoradiation therapy, which makes secondary free tissue transfer quite challenging. Elderly cancer patients also have some risk for microvascular surgery with lengthened general anesthesia. In those cases, the pedicled flap vascularized by supraclavicular artery could be considered as an alternative to free flap. Despite several authors have demonstrated the clinical reliability of supraclavicular artery island flap (SCAIF), to date, SCAIF has not been widely used among reconstructive surgeon...
December 2018: Maxillofacial Plastic and Reconstructive Surgery
Michael V DeFazio, James M Economides, Ersilia L Anghel, Eshetu A Tefera, Karen K Evans
AIM:  No consensus exists regarding the optimal strategy for perioperative thromboprophylaxis in high-risk microsurgical populations. We present our experience with lower extremity free tissue transfer (FTT) in thrombophilic patients and compare outcomes between non-stratified and risk-stratified anticoagulation protocols. METHODS:  Between January 2013 and December 2017, 57 patients with documented thrombophilia underwent FTT for non-traumatic, lower extremity reconstruction by a single surgeon...
October 16, 2018: Journal of Reconstructive Microsurgery
Alain Joe Azzi, Sarah Zhou, Tyler Safran, Liqin Xu, Nayif Alnaif, Teanoosh Zadeh
INTRODUCTION: Radiation therapy (RT) is recommended for appropriately selected sarcoma patients to minimize the risk of local recurrence and to maximize outcomes of disease-free survival and function. The purpose of this study was to confirm the safety of vascularized tissue reconstruction in recently irradiated sarcoma defects. METHODS: A retrospective review of all patients treated by the senior author for sarcoma reconstruction from January 2005 to July 2017 was performed...
January 2019: Annals of Plastic Surgery
D Zweifel, M G Bredell, H Essig, T Gander, M Lanzer, C Rostetter, M Rücker, S Studer
The Surgical reconstruction of defects of the face is challenging. Local and regional flaps have an important part to play, but large defects of bone and soft tissue are a greater problem. Microvascular tissue transfer has become the standard for such patients, and preoperative planning of bony reconstructions is now common. To use these preplanning tools best the implants should be placed in the prosthetically ideal place, and the bone positioned to surround the implants - that is, truly backward planning of the position of the bone...
November 2018: British Journal of Oral & Maxillofacial Surgery
Frederik W Fried, Justus P Beier, Christopher Bohr, Heinrich Iro, Raymund E Horch, Andreas Arkudas
Although free flap reconstruction has already gained widespread acceptance in pediatric patients, little is known about the outcome of free tissue transfer in head and neck reconstruction in pediatric patients. We present a case of a 6-month-old boy with a large volume deficit in the right temporal fossa after resection of a teratoma. This led to a large volume deficit with widely undermined skin margins. Therefore, we provided volume augmentation by microsurgical free latissimus dorsi myocutaneous flap transplantation...
October 2, 2018: Annals of Plastic Surgery
Mofiyinfolu Sokoya, Aurora G Vincent, Rohan Joshi, Sameep Kadakia, Scott Kohlert, Thomas S Lee, Masoud Saman, Yadranko Ducic
OBJECTIVES/HYPOTHESIS: Microvascular free tissue transfer is often employed to reconstruct significant facial defects from ballistic injuries. Herein, we present our comparison of complications between self-inflicted and non-self-inflicted gunshot wounds after microvascular free tissue transfer. STUDY DESIGN: Retrospective case review. METHODS: Approval was obtained from the JPS institutional review board. We performed a retrospective review of cases of ballistic facial injuries between October 1997 and September 2017 that underwent vascularized free tissue transfer for reconstruction...
September 24, 2018: Laryngoscope
Fares Samra, Christopher Bibbo, L Scott Levin, Stephen J Kovach
Introduction: The anterolateral thigh (ALT) flap allows for healthy, reliable, vascularized, soft-tissue coverage of extremity or axial defects of traumatic or acquired deformities. Indications & Contraindications: <AbstractText Label="Step 1 Positioning and Markings" NlmCategory="UNASSIGNED">Place the patient in the supine position, which allows for flap harvest and typically does not require any position changes (Fig. 1), and then mark the septum between the vastus lateralis and rectus femoris, which facilitates harvest of this flap (Video 1)...
September 28, 2017: JBJS Essential Surgical Techniques
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