Abstract Background Microvascular compromise from arterial or venous occlusion is a common cause of free flap failure. The salvage rate following a microvascular compromise is dependent on detecting the problem early and intervening quickly. Methods The ViOptix tissue oximeter measures tissue oxygen saturation using the near-infrared spectroscopy technology. The ViOptix device has an alarm capability to warn of potential compromise to tissue perfusion. The tissue oximetry readings are visible on the bedside monitor and are relayed to a webpage link, which is accessible on a personal computer or mobile device, allowing real-time monitoring. This article presents a case where real-time monitoring allowed almost immediate detection of inadvertent pedicle compromise allowing flap salvage by repositioning without surgical intervention. Results In the case presented, the patient's nurse inadvertently positioned a pillow under the location of the vascular pedicle likely causing microvascular compression. The ViOptix reading dropped and for this reason the nurse contacted the Plastic Surgery team. The drop was confirmed remotely and the flap was urgently evaluated in person. Once the pillow was removed, the ViOptix readings normalized and Doppler signals strengthened in the flap. Discussion While tissue oximetry monitoring does not by itself ensure flap survival, it provides critical information than conventional flap monitoring would allow giving the microsurgeon the opportunity to make a quicker decision. ViOptix tissue oximeters are able to detect vascular compromise even before conventional clinical symptoms are present. Alas in several cases by the time clinical symptoms develop the flap may be beyond salvage.
{"title":"Detecting Microsurgical Complications with ViOptix Tissue Oximetry in a Pediatric Myocutaneous Free Flap: Case Presentation and Literature Review","authors":"Steven D Kozusko, U. B. Gbulie","doi":"10.1055/s-0038-1626728","DOIUrl":"https://doi.org/10.1055/s-0038-1626728","url":null,"abstract":"Abstract Background Microvascular compromise from arterial or venous occlusion is a common cause of free flap failure. The salvage rate following a microvascular compromise is dependent on detecting the problem early and intervening quickly. Methods The ViOptix tissue oximeter measures tissue oxygen saturation using the near-infrared spectroscopy technology. The ViOptix device has an alarm capability to warn of potential compromise to tissue perfusion. The tissue oximetry readings are visible on the bedside monitor and are relayed to a webpage link, which is accessible on a personal computer or mobile device, allowing real-time monitoring. This article presents a case where real-time monitoring allowed almost immediate detection of inadvertent pedicle compromise allowing flap salvage by repositioning without surgical intervention. Results In the case presented, the patient's nurse inadvertently positioned a pillow under the location of the vascular pedicle likely causing microvascular compression. The ViOptix reading dropped and for this reason the nurse contacted the Plastic Surgery team. The drop was confirmed remotely and the flap was urgently evaluated in person. Once the pillow was removed, the ViOptix readings normalized and Doppler signals strengthened in the flap. Discussion While tissue oximetry monitoring does not by itself ensure flap survival, it provides critical information than conventional flap monitoring would allow giving the microsurgeon the opportunity to make a quicker decision. ViOptix tissue oximeters are able to detect vascular compromise even before conventional clinical symptoms are present. Alas in several cases by the time clinical symptoms develop the flap may be beyond salvage.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"03 1","pages":"e8 - e12"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1626728","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47287528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Coverage of hands with degloving injuries is currently being investigated, but it typically involves combinations of free flap operations to cover wide dimensions. In this study, the deep inferior epigastric perforator (DIEP) flap was successfully used to salvage a severely injured hand. After performing an open wound coverage with a flap operation, we did several minimal division operations under local anesthesia, which is a logical surgical option when the patient suffers from general deterioration immediately following significant trauma. We believe that this application of DIEP flap allows for a shorter operation time, decreased rates of infection for one-step coverage, and a higher chance of functional digit division compared with conventional methods.
{"title":"From Mitten Hand to Five Individual Fingers: One-Stage Coverage Using a Deep Inferior Epigastric Perforator Free Flap for an Extensive Degloving Hand Injury","authors":"Min Ji Kim, B. Park","doi":"10.1055/s-0038-1649490","DOIUrl":"https://doi.org/10.1055/s-0038-1649490","url":null,"abstract":"Abstract Coverage of hands with degloving injuries is currently being investigated, but it typically involves combinations of free flap operations to cover wide dimensions. In this study, the deep inferior epigastric perforator (DIEP) flap was successfully used to salvage a severely injured hand. After performing an open wound coverage with a flap operation, we did several minimal division operations under local anesthesia, which is a logical surgical option when the patient suffers from general deterioration immediately following significant trauma. We believe that this application of DIEP flap allows for a shorter operation time, decreased rates of infection for one-step coverage, and a higher chance of functional digit division compared with conventional methods.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"03 1","pages":"e28 - e31"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1649490","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44567882","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jocelyn Lu, Tammer Elmarsafi, J. Steinberg, P. Kim, C. Attinger, P. Cooper, K. Evans
Abstract Background Postoperative complications of total ankle arthroplasty (TAA) include anterior surgical site dehiscence, hardware failure, infection, and amputation. Early intervention with free flap may provide TAA salvage. We report the largest series of failed TAA require microsurgical free tissue transfer, identify risk factors, and examine the long-term post-free flap outcomes. Materials and Methods This is a case series of consecutive patients from a single institution dedicated to limb salvage. Inclusion criteria included patients who underwent TAA with complications related to the index surgery and underwent microsurgical free tissue transfer. Nine patients were identified within the inclusion parameters. Results Patients presented with osteomyelitis 4 (44%), soft tissue infections 4 (44%), and wound dehiscence 1 (11%) following TAA. Three (33%) radial forearm free flaps and six (67%) anterolateral thigh flaps were used, with a 100% microsurgical success rate. Preoperative angiography revealed six (67%) patients with anterior tibial artery occlusion at the level of the ankle or below. Patients required an average of 2.7 ± 1 (range 1–4) operative débridements prior to free flap, with successful flap outcome and return to full weight bearing status in nine (100%) patients. The mean long-term lower extremity functional scale score was 62 out of 80 points. Conclusion Microsurgical free tissue transfer is an effective and favorable strategy to attain a stable soft tissue envelope for patients presenting with surgical site complications following TAA. We recommend early involvement with plastic surgery and endovascular angiography to evaluate the integrity of the anterior tibial artery.
{"title":"Free Flap Reconstruction after Complications of Total Ankle Arthroplasty: Case Series and Review of the Literature","authors":"Jocelyn Lu, Tammer Elmarsafi, J. Steinberg, P. Kim, C. Attinger, P. Cooper, K. Evans","doi":"10.1055/s-0038-1641733","DOIUrl":"https://doi.org/10.1055/s-0038-1641733","url":null,"abstract":"Abstract Background Postoperative complications of total ankle arthroplasty (TAA) include anterior surgical site dehiscence, hardware failure, infection, and amputation. Early intervention with free flap may provide TAA salvage. We report the largest series of failed TAA require microsurgical free tissue transfer, identify risk factors, and examine the long-term post-free flap outcomes. Materials and Methods This is a case series of consecutive patients from a single institution dedicated to limb salvage. Inclusion criteria included patients who underwent TAA with complications related to the index surgery and underwent microsurgical free tissue transfer. Nine patients were identified within the inclusion parameters. Results Patients presented with osteomyelitis 4 (44%), soft tissue infections 4 (44%), and wound dehiscence 1 (11%) following TAA. Three (33%) radial forearm free flaps and six (67%) anterolateral thigh flaps were used, with a 100% microsurgical success rate. Preoperative angiography revealed six (67%) patients with anterior tibial artery occlusion at the level of the ankle or below. Patients required an average of 2.7 ± 1 (range 1–4) operative débridements prior to free flap, with successful flap outcome and return to full weight bearing status in nine (100%) patients. The mean long-term lower extremity functional scale score was 62 out of 80 points. Conclusion Microsurgical free tissue transfer is an effective and favorable strategy to attain a stable soft tissue envelope for patients presenting with surgical site complications following TAA. We recommend early involvement with plastic surgery and endovascular angiography to evaluate the integrity of the anterior tibial artery.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"03 1","pages":"e13 - e20"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1641733","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42256303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Background In sciatic nerve neuropathies, when direct nerve repair is impossible due to a large gap, nerve grafting can be performed. However, the diameters of traditional autologous nerve grafts are too small to cover the whole cross-sectional area of the sciatic nerve. The aim of this study is to present the outcome of common peroneal nerve grafting to repair the tibial nerve in eight patients with sciatic nerve injuries, showing long defects of more than 10 cm. Methods Between 2007 and 2013, the common peroneal nerve was used as an autograft to repair the tibial nerve in eight patients with complete high sciatic nerve injury with long defects. There were 6 men and 2 women with an average age of 31 years (range: 17–44 years). Muscle strength was evaluated using the British Medical Research Council scale. The Semmes–Weinstein monofilament test was used for sensory evaluation. Results The follow-up time for patients ranged from 36 to 60 months, with an average of 48.75 months. Tibial nerve motor function was “good” or “very good” (M3–M4) in five out of eight patients (55.6%). Plantar flexion was not adequate in the rest of the patients. Sensory recovery was “good” or “very good” (S2–S3) in six patients and “inadequate” (S4) in two patients. Conclusion In cases where there were extensive gaps in the sciatic nerve, using the common peroneal nerve as an autograft to repair the tibial nerve provides an alternative to traditional nerve graft repair.
{"title":"Common Peroneal Nerve Grafting to Repair the Tibial Nerve as a Salvage Procedure in the Treatment of Sciatic Nerve Injury with Long-Segment Defects","authors":"Haodong Lin, De-song Chen, C. Hou","doi":"10.1055/s-0038-1653951","DOIUrl":"https://doi.org/10.1055/s-0038-1653951","url":null,"abstract":"Abstract Background In sciatic nerve neuropathies, when direct nerve repair is impossible due to a large gap, nerve grafting can be performed. However, the diameters of traditional autologous nerve grafts are too small to cover the whole cross-sectional area of the sciatic nerve. The aim of this study is to present the outcome of common peroneal nerve grafting to repair the tibial nerve in eight patients with sciatic nerve injuries, showing long defects of more than 10 cm. Methods Between 2007 and 2013, the common peroneal nerve was used as an autograft to repair the tibial nerve in eight patients with complete high sciatic nerve injury with long defects. There were 6 men and 2 women with an average age of 31 years (range: 17–44 years). Muscle strength was evaluated using the British Medical Research Council scale. The Semmes–Weinstein monofilament test was used for sensory evaluation. Results The follow-up time for patients ranged from 36 to 60 months, with an average of 48.75 months. Tibial nerve motor function was “good” or “very good” (M3–M4) in five out of eight patients (55.6%). Plantar flexion was not adequate in the rest of the patients. Sensory recovery was “good” or “very good” (S2–S3) in six patients and “inadequate” (S4) in two patients. Conclusion In cases where there were extensive gaps in the sciatic nerve, using the common peroneal nerve as an autograft to repair the tibial nerve provides an alternative to traditional nerve graft repair.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"03 1","pages":"e41 - e45"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1653951","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48499237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Khalil, M. Kalkat, M. Malahias, S. Rhobaye, T. Ashour, Tahir Faroq, A. Shimal, M. Tsalic, B. Naidu
Abstract Background The internal mammary lymph node (IMLN) basin is considered the second most important regional nodal basin in breast cancer. IMLNs are often not detected radiologically and left untreated, with symptomatic recurrence being 0.1%. Challenges in accessibility have been an obstacle in achieving a comprehensive treatment plan, especially with undetermined and radiologically enlarged IMLN. Free autologous tissue breast reconstruction is considered the gold standard, and the familiarity of microvascular surgeons in using the internal mammary vessels (IMVs) puts them in a unique position to shed more light on the natural pathological process of IMLN metastases. Materials and Methods A retrospective data analysis study was conducted evaluating 270 patients who underwent 307 free flaps for breast reconstruction using the IMV in the period between 2009 and 2017. Patient's demographics and clinicopathological data including IMLN harvest, radiological, operative details, adjuvant therapy, postoperative morbidity, and follow-up outcome data were analyzed. Results Eighty-nine enlarged IMLNs were surgically retrieved from 30.7% (83/270) of the patients (73 delayed, 10 immediate breast reconstructions) with an age range of 29 to 77 years (mean: 45). Eighty six were incidentally encountered during surgery, whereas in three, the enlarged IMLN was preoperatively, radiologically determined and biopsied during computed tomography (CT) scan staging and was retrieved subsequently during surgery. IMLN metastases were confirmed in 8.4% (7/83) of the patients in whom IMLNs were retrieved with subsequent modification of the proposed adjuvant therapy. The follow-up period ranged from 3 to 84 months (mean: 42) for the involved IMLN patients. Two patients (28% [2/7]) showed signs of disease progression with mortality. Conclusion Microvascular surgeons in a multidisciplinary setting would provide a valuable role in improving outcomes of patients with IMLN metastases through better diagnosis and staging of incidentally enlarged metastatic IMLN and provision of an effective approach for locoregional disease control.
{"title":"Impact of Surgically and Radiologically Detected Incidental Internal Mammary Lymph Node Enlargement in Breast Cancer Patients Undergoing Free-Flap Breast Reconstruction","authors":"H. Khalil, M. Kalkat, M. Malahias, S. Rhobaye, T. Ashour, Tahir Faroq, A. Shimal, M. Tsalic, B. Naidu","doi":"10.1055/s-0038-1642626","DOIUrl":"https://doi.org/10.1055/s-0038-1642626","url":null,"abstract":"Abstract Background The internal mammary lymph node (IMLN) basin is considered the second most important regional nodal basin in breast cancer. IMLNs are often not detected radiologically and left untreated, with symptomatic recurrence being 0.1%. Challenges in accessibility have been an obstacle in achieving a comprehensive treatment plan, especially with undetermined and radiologically enlarged IMLN. Free autologous tissue breast reconstruction is considered the gold standard, and the familiarity of microvascular surgeons in using the internal mammary vessels (IMVs) puts them in a unique position to shed more light on the natural pathological process of IMLN metastases. Materials and Methods A retrospective data analysis study was conducted evaluating 270 patients who underwent 307 free flaps for breast reconstruction using the IMV in the period between 2009 and 2017. Patient's demographics and clinicopathological data including IMLN harvest, radiological, operative details, adjuvant therapy, postoperative morbidity, and follow-up outcome data were analyzed. Results Eighty-nine enlarged IMLNs were surgically retrieved from 30.7% (83/270) of the patients (73 delayed, 10 immediate breast reconstructions) with an age range of 29 to 77 years (mean: 45). Eighty six were incidentally encountered during surgery, whereas in three, the enlarged IMLN was preoperatively, radiologically determined and biopsied during computed tomography (CT) scan staging and was retrieved subsequently during surgery. IMLN metastases were confirmed in 8.4% (7/83) of the patients in whom IMLNs were retrieved with subsequent modification of the proposed adjuvant therapy. The follow-up period ranged from 3 to 84 months (mean: 42) for the involved IMLN patients. Two patients (28% [2/7]) showed signs of disease progression with mortality. Conclusion Microvascular surgeons in a multidisciplinary setting would provide a valuable role in improving outcomes of patients with IMLN metastases through better diagnosis and staging of incidentally enlarged metastatic IMLN and provision of an effective approach for locoregional disease control.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"03 1","pages":"e32 - e40"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1642626","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45421281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael Trostler, Johnathan Shih, Gabriel M. Klein, A. Dagum, D. Bui, Mark A. Gelfand
Abstract Background Distal lower extremity reconstruction presents many challenges due to the suboptimal vascular supply, the weight-bearing necessity, movement, and multiple tissue types that can be easily damaged by trauma, from bones, tendons, ligaments, muscle, and soft tissue loss. The anterolateral thigh flap provides a reconstructive option for large defects with good coverage and minimal donor-site morbidity. Methods After a chart review of all anterolateral thigh flaps, the patients were contacted to take a survey regarding their satisfaction and functional ability and to meet for measurements of their feet after debulking procedures. Results A total of 13 patients were included in the study, with traumatic injuries comprising 84% of cases. There was a significant difference in sizes of the midfoot (mean: 10.27 vs. 9.53, p = 0.004) and the hindfoot (mean: 12.92 vs. 12.2, p = 0.023) when comparing the affected side to the unaffected side. The majority, 77%, of our patients underwent debulking procedures. Overall, 75% of traumatic injury patients had > 90% maximum functionality score. All posttraumatic reconstruction results were rated satisfied to very satisfied by the patients. All posttraumatic patients were able to walk after their procedures, although three patients did require custom-made shoes with inserts or braces. Conclusion The anterolateral thigh flap is a versatile reconstructive option that can be used in the distal lower extremity and is especially useful after a traumatic injury as it allows for functional recovery and high patient satisfaction after debulking.
下肢远端重建面临着许多挑战，因为血管供应欠佳、负重需要、运动以及多种组织类型容易因创伤而受损，包括骨骼、肌腱、韧带、肌肉和软组织的损失。股骨前外侧皮瓣为大面积缺损提供了一种重建选择，具有良好的覆盖和最小的供区发病率。方法对所有大腿前外侧皮瓣的图表进行回顾后，联系患者进行满意度和功能能力的调查，并在减压手术后进行足部测量。结果共纳入13例患者，其中外伤性损伤占84%。患侧与未患侧比较，中足尺寸(平均:10.27 vs. 9.53, p = 0.004)和后足尺寸(平均:12.92 vs. 12.2, p = 0.023)差异有统计学意义。77%的患者接受了减体积手术。总体而言，75%的创伤性损伤患者的最大功能评分为bbb90 %。所有创伤后重建结果均被患者评价为满意至非常满意。所有创伤后患者在手术后都能行走，尽管有三名患者确实需要定制带植入物或背带的鞋子。结论股前外侧皮瓣是一种多用途的重建选择，可用于下肢远端，特别适用于创伤性损伤后的功能恢复和术后患者满意度高。
{"title":"Role of Anterolateral Thigh Flaps in Distal Lower Extremity Reconstruction: Assessment of Functionality, Aesthetics, and Patient Satisfaction","authors":"Michael Trostler, Johnathan Shih, Gabriel M. Klein, A. Dagum, D. Bui, Mark A. Gelfand","doi":"10.1055/s-0037-1603941","DOIUrl":"https://doi.org/10.1055/s-0037-1603941","url":null,"abstract":"Abstract Background Distal lower extremity reconstruction presents many challenges due to the suboptimal vascular supply, the weight-bearing necessity, movement, and multiple tissue types that can be easily damaged by trauma, from bones, tendons, ligaments, muscle, and soft tissue loss. The anterolateral thigh flap provides a reconstructive option for large defects with good coverage and minimal donor-site morbidity. Methods After a chart review of all anterolateral thigh flaps, the patients were contacted to take a survey regarding their satisfaction and functional ability and to meet for measurements of their feet after debulking procedures. Results A total of 13 patients were included in the study, with traumatic injuries comprising 84% of cases. There was a significant difference in sizes of the midfoot (mean: 10.27 vs. 9.53, p = 0.004) and the hindfoot (mean: 12.92 vs. 12.2, p = 0.023) when comparing the affected side to the unaffected side. The majority, 77%, of our patients underwent debulking procedures. Overall, 75% of traumatic injury patients had > 90% maximum functionality score. All posttraumatic reconstruction results were rated satisfied to very satisfied by the patients. All posttraumatic patients were able to walk after their procedures, although three patients did require custom-made shoes with inserts or braces. Conclusion The anterolateral thigh flap is a versatile reconstructive option that can be used in the distal lower extremity and is especially useful after a traumatic injury as it allows for functional recovery and high patient satisfaction after debulking.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"02 1","pages":"e83 - e89"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0037-1603941","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44546582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Iglesias, F. Salazar-Hernández, M. Ramírez-Berumen, P. Butrón, J. Alberú-Gómez, R. Leal-Villalpando, J. Zamudio-Bautista, V. Acosta, L. Jauregui-Flores, V. Espinosa-Cruz, J. Vázquez-Lamadrid, J. González-Sánchez, C. Hinojosa, H. Laparra-Escareño, J. Montejo-Vargas, J. Macías-Gallardo
Abstract Background Arm transplantations are performed less frequently than forearm and hand transplantations. We present the surgical and microsurgical technique and its relationship with the clinical results in a patient with bilateral arm transplantation. Methods A 51-year-old male patient underwent bilateral arm transplantation in October 2015. The right arm was transplanted at the glenohumeral joint. The vascular repair was at the axillary level, and the nerves were repaired at their origin. The total ischemia time was 3 hours and 48 minutes. The left arm was transplanted at the midhumeral level; all muscles were completely transplanted. The nerves were repaired at the distal third of the arm. Additionally, terminolateral neurorrhaphy was performed from the donor musculocutaneous nerve to the recipient radial nerve. The total ischemia time was 6 hours and 35 minutes. Results At 15 months posttransplantation, the right shoulder had an abduction of 90 degrees and muscle strength of M4; flexion of 100 degrees and M4; internal and external rotation of M1; elbow flexion of 120 degrees and M3; elbow extension of M5; pronosupination of M2; and wrist extension of M2. There was no mobility in the fingers. The left transplanted limb had total elbow flexion and extension of M5, pronosupination of M2, wrist extension of M4, and finger flexion of M2. Both extremities had thermal sensitivity that allowed discrimination of cold and heat with residual deep pressure. Conclusion Although the functional results of arm transplantation are so far unknown, they may be considered beneficial compared with the devastating disability caused by arm amputation.
{"title":"Anatomical and Microsurgical Implications in Total and Midarm Transplantation","authors":"M. Iglesias, F. Salazar-Hernández, M. Ramírez-Berumen, P. Butrón, J. Alberú-Gómez, R. Leal-Villalpando, J. Zamudio-Bautista, V. Acosta, L. Jauregui-Flores, V. Espinosa-Cruz, J. Vázquez-Lamadrid, J. González-Sánchez, C. Hinojosa, H. Laparra-Escareño, J. Montejo-Vargas, J. Macías-Gallardo","doi":"10.1055/s-0037-1604342","DOIUrl":"https://doi.org/10.1055/s-0037-1604342","url":null,"abstract":"Abstract Background Arm transplantations are performed less frequently than forearm and hand transplantations. We present the surgical and microsurgical technique and its relationship with the clinical results in a patient with bilateral arm transplantation. Methods A 51-year-old male patient underwent bilateral arm transplantation in October 2015. The right arm was transplanted at the glenohumeral joint. The vascular repair was at the axillary level, and the nerves were repaired at their origin. The total ischemia time was 3 hours and 48 minutes. The left arm was transplanted at the midhumeral level; all muscles were completely transplanted. The nerves were repaired at the distal third of the arm. Additionally, terminolateral neurorrhaphy was performed from the donor musculocutaneous nerve to the recipient radial nerve. The total ischemia time was 6 hours and 35 minutes. Results At 15 months posttransplantation, the right shoulder had an abduction of 90 degrees and muscle strength of M4; flexion of 100 degrees and M4; internal and external rotation of M1; elbow flexion of 120 degrees and M3; elbow extension of M5; pronosupination of M2; and wrist extension of M2. There was no mobility in the fingers. The left transplanted limb had total elbow flexion and extension of M5, pronosupination of M2, wrist extension of M4, and finger flexion of M2. Both extremities had thermal sensitivity that allowed discrimination of cold and heat with residual deep pressure. Conclusion Although the functional results of arm transplantation are so far unknown, they may be considered beneficial compared with the devastating disability caused by arm amputation.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"02 1","pages":"e94 - e102"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0037-1604342","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46455450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Kolk, S. Haidari, K. Wolff, A. Fichter, V. Kehl, C. Götz, M. Kesting, J. Weitz
Abstract Background The free fibular flap (FFF) is established for mandibular reconstruction. Some complications, such as non-union, fistulas, and complete graft loss, are sometimes unavoidable. There are no clinically relevant data regarding the optimum selection of osteosynthesis and risk analysis prior to reconstruction. Methods Eighty-three FFFs with up to four osteotomies were analyzed for possible complications during the course of a longitudinal analysis. Forty-one patients underwent simultaneous mandibular reconstruction after tumor resection, and another 42 subjects received FFFs due to infected osteoradionecrosis (ORN). Patients who experienced transplant losses due to vascular occlusion in the grafts were excluded from the study. Results The most common complications were fistulas, bony non-union, and failure of osteosynthesis material. Major contributing risk factors were radiotherapy (p = 0.004), number of osteosynthesis plates >6 (p = 0.002), length of the harvested fibula (p = 0.027), the size of the skin island (p = 0.002), and the number of osteotomies (p = 0.001). Conclusion For the success of FFF, there are many influencing factors. If the mentioned risk factors are considered, the number of osteotomies, size of the skin paddle, and fibula are as small as possible, and a suitable osteosynthesis material is chosen, the FFF is a safe solution for mandibular reconstruction.
{"title":"The Osteocutaneous Fibular Flap for Mandibular Replacement—Which Factors Influence Long-Term Success?","authors":"A. Kolk, S. Haidari, K. Wolff, A. Fichter, V. Kehl, C. Götz, M. Kesting, J. Weitz","doi":"10.1055/s-0037-1604343","DOIUrl":"https://doi.org/10.1055/s-0037-1604343","url":null,"abstract":"Abstract Background The free fibular flap (FFF) is established for mandibular reconstruction. Some complications, such as non-union, fistulas, and complete graft loss, are sometimes unavoidable. There are no clinically relevant data regarding the optimum selection of osteosynthesis and risk analysis prior to reconstruction. Methods Eighty-three FFFs with up to four osteotomies were analyzed for possible complications during the course of a longitudinal analysis. Forty-one patients underwent simultaneous mandibular reconstruction after tumor resection, and another 42 subjects received FFFs due to infected osteoradionecrosis (ORN). Patients who experienced transplant losses due to vascular occlusion in the grafts were excluded from the study. Results The most common complications were fistulas, bony non-union, and failure of osteosynthesis material. Major contributing risk factors were radiotherapy (p = 0.004), number of osteosynthesis plates >6 (p = 0.002), length of the harvested fibula (p = 0.027), the size of the skin island (p = 0.002), and the number of osteotomies (p = 0.001). Conclusion For the success of FFF, there are many influencing factors. If the mentioned risk factors are considered, the number of osteotomies, size of the skin paddle, and fibula are as small as possible, and a suitable osteosynthesis material is chosen, the FFF is a safe solution for mandibular reconstruction.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"02 1","pages":"e103 - e110"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0037-1604343","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45042298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Kawamura, S. Omokawa, Takamasa Shimizu, Tadanobu Onishi, S. Hayashi, Naoki Maegawa, Yasuhito Tanaka
Abstract Background The osteocutaneous fibula flap is an established method for reconstruction of bone and soft tissue defects in the lower extremity. The vascularity of the fibula and overlying skin paddle is usually provided by a single pedicle composed of the peroneal artery. In rare situations, the fibula is supplied by the peroneal artery, whereas the overlying skin paddle is supplied by perforators originating from the posterior tibial artery. Case Report A 28-year-old man presented with osteomyelitis of the tibia that was scheduled to be treated with a free vascularized osteocutaneous fibula flap from the contralateral lower leg. Intraoperatively, it was found that perforators supplying the skin paddle originated not from the peroneal artery but from the posterior tibial artery. A fibula flap nourished by the peroneal vessels was harvested and the skin paddle was returned to the lower leg. The fibula was fixed at the recipient site, and peroneal vessels were anastomosed to the recipient posterior tibial vessels. The skin defect was successfully managed with a perforator-based propeller flap nourished by the recipient artery. Conclusion To the best of our knowledge, only five authors have reported this variant vascularity of the osteocutaneous fibula flap. They harvested two independent flaps, one a skin flap and the other a fibula flap, and performed two separate vascular anastomoses at the recipient site. In comparison to previously reported cases, the salvage procedure using a perforator-based propeller flap is easy and reliable because there is no need for additional anastomosis of the perforator vessels.
{"title":"Salvage of an Osteocutaneous Fibula Flap with a Variant Perforator of Skin Paddle in Lower Leg Reconstruction","authors":"K. Kawamura, S. Omokawa, Takamasa Shimizu, Tadanobu Onishi, S. Hayashi, Naoki Maegawa, Yasuhito Tanaka","doi":"10.1055/s-0037-1604340","DOIUrl":"https://doi.org/10.1055/s-0037-1604340","url":null,"abstract":"Abstract Background The osteocutaneous fibula flap is an established method for reconstruction of bone and soft tissue defects in the lower extremity. The vascularity of the fibula and overlying skin paddle is usually provided by a single pedicle composed of the peroneal artery. In rare situations, the fibula is supplied by the peroneal artery, whereas the overlying skin paddle is supplied by perforators originating from the posterior tibial artery. Case Report A 28-year-old man presented with osteomyelitis of the tibia that was scheduled to be treated with a free vascularized osteocutaneous fibula flap from the contralateral lower leg. Intraoperatively, it was found that perforators supplying the skin paddle originated not from the peroneal artery but from the posterior tibial artery. A fibula flap nourished by the peroneal vessels was harvested and the skin paddle was returned to the lower leg. The fibula was fixed at the recipient site, and peroneal vessels were anastomosed to the recipient posterior tibial vessels. The skin defect was successfully managed with a perforator-based propeller flap nourished by the recipient artery. Conclusion To the best of our knowledge, only five authors have reported this variant vascularity of the osteocutaneous fibula flap. They harvested two independent flaps, one a skin flap and the other a fibula flap, and performed two separate vascular anastomoses at the recipient site. In comparison to previously reported cases, the salvage procedure using a perforator-based propeller flap is easy and reliable because there is no need for additional anastomosis of the perforator vessels.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"02 1","pages":"e90 - e93"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0037-1604340","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42882775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The Deep Inferior Epigastric Perforator (DIEP) fl ap is the preferred method of autogenous breast reconstruction as it provides an ideal replacement for the absent breast tissue with minimal donor site morbidity and improved abdominal contour. When a single hemiabdomen is inadequate for unilateral reconstruction the volume and projection can be augmented with an implant, or the experienced microsur-geon may offer stacked DIEP fl aps. 1 An additional considera-tion would be the use of both hemiabdominal fl aps in addition to an implant. This hybrid combination could max-imize the autogenous contribution to the reconstruction allowing the use of a smaller implant. Additionally, total implant coverage with stacked DIEP fl aps could help prevent rippling, improve projection, and lessen implant palpability. We describe two cases of hybrid reconstruction combining stacked DIEP fl aps with immediate silicone implantation to improve reconstructive outcomes.
{"title":"Stacked DIEP and Implant for Unilateral Breast Reconstruction","authors":"Elsie M. Rodebeck, Craig A. Blum, F. Dellacroce","doi":"10.1055/s-0037-1606355","DOIUrl":"https://doi.org/10.1055/s-0037-1606355","url":null,"abstract":"The Deep Inferior Epigastric Perforator (DIEP) fl ap is the preferred method of autogenous breast reconstruction as it provides an ideal replacement for the absent breast tissue with minimal donor site morbidity and improved abdominal contour. When a single hemiabdomen is inadequate for unilateral reconstruction the volume and projection can be augmented with an implant, or the experienced microsur-geon may offer stacked DIEP fl aps. 1 An additional considera-tion would be the use of both hemiabdominal fl aps in addition to an implant. This hybrid combination could max-imize the autogenous contribution to the reconstruction allowing the use of a smaller implant. Additionally, total implant coverage with stacked DIEP fl aps could help prevent rippling, improve projection, and lessen implant palpability. We describe two cases of hybrid reconstruction combining stacked DIEP fl aps with immediate silicone implantation to improve reconstructive outcomes.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"02 1","pages":"e124 - e125"},"PeriodicalIF":0.0,"publicationDate":"2017-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0037-1606355","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49394105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：