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microvascular free tissue

Steven M Schlichtemeier, Christopher B Nahm, Aiqun Xue, Anthony J Gill, Ross C Smith, Thomas J Hugh
BACKGROUND: Hepatocellular carcinoma (HCC) is a common cause of cancer death worldwide. Resection offers the best chance of long-term survival, but a consistent adverse prognostic factor is the presence of microvascular invasion (MVI). In this study, surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS), a high throughput method of analyzing complex samples, was used to explore differentially expressed proteins between HCC and adjacent nontumour liver tissue (ANLT)...
February 13, 2019: Journal of Surgical Research
Benjamin Thomas, Emre Gazyakan, Florian Falkner, Volker J Schmidt, Christoph Hirche, Ulrich Kneser, Amir K Bigdeli
BACKGROUND: Though technically feasible, free tissue transfer carries the risk of perioperative morbidity and mortality in elderly patients. To minimize the operative treatment time and complication rates, we choose the rectus abdominis muscle (RAM) flap. METHODS: Between 2012 and 2017, 34 patients (mean age: 74±7 years, range: 65-89 years) with comorbidities underwent defect reconstruction with a free RAM flap. Recipient-sites were: lower extremity (65%), trunk (18%), upper extremity (12%), and head and neck (6%)...
January 11, 2019: Journal of Plastic, Reconstructive & Aesthetic Surgery: JPRAS
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
G Siebenbürger, B Grabein, T Schenck, C Kammerlander, W Böcker, C Zeckey
BACKGROUND: Multi-drug-resistant bacteria (e.g. Carbapenem-resistant Acinetobacter baumannii, extended-spectrum betalactamase or carbapenemase-producing enterobacteriaceae) are emerging in early-onset infections. So far, there is no report describing the eradication of these bacteria in a osseous infection of an open proximal tibial fracture in combination with the hexapod technology to address both osseous consolidation and closed drop foot correction. CASE PRESENTATION: After sustaining a proximal tibial fracture (Gustilo 3B), a 41-year-old man was primarily treated with open reduction and internal fixation by a locking plate and split-thickness skin graft in the home country...
January 19, 2019: European Journal of Medical Research
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
Sanket Pattanaik, Chase Arbra, Heather Bainbridge, Sarah Grace Dennis, Stephen A Fann, Michael J Yost
Vascularization remains a substantial limitation to the viability of engineered tissue. By comparing in vivo vascularization dynamics of a self-assembled prevascular endothelial-fibroblast model to avascular grafts, we explore the vascularization rate limitations in implants at early time intervals, during which tissue hypoxia begins to affect cell viability. Scaffold-free prevascular endothelial-fibroblast constructs (SPECs) may serve as a modular and reshapable vascular bed in replacement tissues. SPECs, fibroblast-only spheroids (FOS), and silicone implants were implanted in 54 Sprague Dawley rats and harvested at 6, 12, and 24 h ( n  = 5 per time point and implant type)...
2019: BioResearch Open Access
Hedvig Komáromy, Mingchen He, Gábor Perlaki, Gergely Orsi, Szilvia Anett Nagy, Edit Bosnyák, David Kamson Olayinka, Flóra John, Anita Trauninger, Zoltán Pfund
BACKGROUND/AIM: Migraine-related intracerebral white matter lesions (WMLs) are likely to be microvascular in nature and can be found in all hemispheric lobes. The aim of this study was to investigate migraine patients with or without WMLs to see the effects of these tissue damages on cortical thickness and volume. The role of migraine characteristics (duration of headache, attack frequency, estimated lifetime attack number, aura) was also tested. METHODS: As study participants, 161 female migraine patients (63 with aura; 52 with WMLs) and 40 age-matched healthy female subjects were enrolled in the study...
January 10, 2019: Journal of Headache and Pain
Hani Sbitany, Rachel Lentz, Merisa Piper
BACKGROUND:  Deep inferior epigastric perforator (DIEP) flaps are routinely elevated on a single dominant perforator from the deep epigastric vascular system. However, the single perforator may not always perfuse an entire flap adequately, particularly suprascarpal tissue. We often perform "dual-plane" single perforator DIEP flaps by rerouting the superficial (SIEA/V) system directly into a branch of the deep (DIEA/V) vascular system pedicle, thus allowing both systems to contribute and enhance flap perfusion...
January 7, 2019: Journal of Reconstructive Microsurgery
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
R W Flower, Z Mirza, S R Thom
Fluorescence-mediated photoplethysmography (FM-PPG) is the first routine clinical methodology by which to quantifiably measure tissue blood perfusion in absolute terms (mL blood/sec ∗ mm2 tissue). The FM-PPG methodology has been described in detail previously in this journal (MVR 114, 2017, 92-100), along with initial proof-of-concept measurements of blood perfusion in both ocular and forearm skin tissues. The motivation for the current study was to investigate whether FM-PPG can be used readily and routinely under realistic clinical conditions...
December 24, 2018: Microvascular Research
Alberto Ballestín, Javier G Casado, Elena Abellán, F Javier Vela, Verónica Álvarez, Alejandra Usón, Esther López, Federica Marinaro, Rebeca Blázquez, Francisco Miguel Sánchez-Margallo
Ischemia reperfusion injury is associated with tissue damage and inflammation, and is one of the main factors causing flap failure in reconstructive microsurgery. Although ischemia-reperfusion (I/R) injury is a well-studied aspect of flap survival, its biological mechanisms remain to be elucidated. To better understand the biological processes of ischemia reperfusion injury, and to develop further therapeutic strategies, the main objective of this study was to identify the gene expression pattern and histological changes in an I/R injury animal model...
2018: PloS One
Salvatore Battaglia, Francesco Ricotta, Vincenzo Maiolo, Gabriella Savastio, Federico Contedini, Riccardo Cipriani, Barbara Bortolani, Laura Cercenelli, Emanuela Marcelli, Claudio Marchetti, Achille Tarsitano
INTRODUCTION: We present our pre-operative virtual planning of complex mandibular reconstruction with a microvascular fibular composite free flap and its harvesting using our novel cutaneous positioning guide based on the perforator vessels for our soft tissue reconstructive surgery. TECHNICAL REPORT: We applied our protocol to 42 consecutive patients needing mandibular composite reconstruction. All patients were preoperatively studied with a CTA scan to evaluate the fibular pattern of vascularization and the perforator vessels three-dimensional path and position...
November 28, 2018: Journal of Cranio-maxillo-facial Surgery
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
Theodor Burdyga, Lyudmyla Borysova
Microcirculation is the generic name for the finest level of the circulatory system and consists of arteriolar and venular networks located upstream and downstream of capillaries, respectively. Anatomically arterioles are surrounded by a monolayer of spindle-shaped smooth muscle cells (myocytes), while terminal branches of precapillary arterioles, capillaries and all sections of postcapillary venules are surrounded by a monolayer of morphologically different perivascular cells (pericytes). Pericytes are essential components of the microvascular vessel wall...
2018: Advances in Experimental Medicine and Biology
David Öhman, Christian Schaefer, Ulf Nannmark, Göran Kjeller, Johan Malmström
The purpose of this case report was to assess whether patient-specific implants (PSI: Xillocs) and soft tissue flaps contribute in reconstructing large mandibular defects. Five patients with a medical situation and history not suitable for free microvascular bone flaps were operated with PSI and evaluated. The mean follow-up time was 12 months. The excellent fit, convenient surgery, and esthetic outcome were seen as the major advantages. The PSI can, in the authors' experience, be considered as a useful alternative provided they are well embedded by viable tissue and attached to vital resection margins of the recipient bone...
January 2019: International Journal of Oral & Maxillofacial Implants
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