Theresa K. Webster, Sthefano Araya, Joseph G. Bartolacci, G. Amadio, J. Panichella, Joseph Costa, Sameer A. Patel
Abstract Background While sickle cell disease has long been considered a contraindication to breast free flap reconstruction, there have been less definitive decisions about the impact of sickle cell trait on these procedures. We sought to analyze the patients with sickle cell trait who underwent free deep inferior epigastric perforator (DIEP) flap and pedicled latissimus dorsi (LD) flap at a single institution to determine the reconstructive outcomes. Methods Patients with sickle cell trait who underwent breast free DIEP and pedicled LD reconstruction from 2007 to 2021 at a single institution by the lead surgeon were analyzed for demographics and surgical outcomes. Results Four patients were identified as having sickle cell trait and having undergone a breast flap reconstruction. The average age of the patients was 54 years, median body mass index was 25, and past medical history was notable for one patient being a current smoker, and one patient having hypertension. Two patients received a unilateral free DIEP flap, one received a bilateral free DIEP flap, and one received a unilateral pedicled LD flap for a total of five flaps in four patients. Three of the patients received prior hormone therapy, one received prior radiation therapy, and one received prior chemotherapy. There were no instances of flap failure, vessel thrombosis, pulmonary embolism, or deep venous thrombosis. One patient experienced wound dehiscence. Conclusion In this case series we present four patients with sickle cell trait who successfully underwent breast flap reconstruction without any instances of flap or systemic thrombosis. More work is needed to determine how to pre- and postoperatively optimize patients with sickle cell trait for favorable breast flap reconstruction outcomes.
{"title":"Should Sickle Cell Trait Be a Contraindication to Breast Reconstruction?—A Case Series Analysis","authors":"Theresa K. Webster, Sthefano Araya, Joseph G. Bartolacci, G. Amadio, J. Panichella, Joseph Costa, Sameer A. Patel","doi":"10.1055/s-0043-1769752","DOIUrl":"https://doi.org/10.1055/s-0043-1769752","url":null,"abstract":"Abstract Background While sickle cell disease has long been considered a contraindication to breast free flap reconstruction, there have been less definitive decisions about the impact of sickle cell trait on these procedures. We sought to analyze the patients with sickle cell trait who underwent free deep inferior epigastric perforator (DIEP) flap and pedicled latissimus dorsi (LD) flap at a single institution to determine the reconstructive outcomes. Methods Patients with sickle cell trait who underwent breast free DIEP and pedicled LD reconstruction from 2007 to 2021 at a single institution by the lead surgeon were analyzed for demographics and surgical outcomes. Results Four patients were identified as having sickle cell trait and having undergone a breast flap reconstruction. The average age of the patients was 54 years, median body mass index was 25, and past medical history was notable for one patient being a current smoker, and one patient having hypertension. Two patients received a unilateral free DIEP flap, one received a bilateral free DIEP flap, and one received a unilateral pedicled LD flap for a total of five flaps in four patients. Three of the patients received prior hormone therapy, one received prior radiation therapy, and one received prior chemotherapy. There were no instances of flap failure, vessel thrombosis, pulmonary embolism, or deep venous thrombosis. One patient experienced wound dehiscence. Conclusion In this case series we present four patients with sickle cell trait who successfully underwent breast flap reconstruction without any instances of flap or systemic thrombosis. More work is needed to determine how to pre- and postoperatively optimize patients with sickle cell trait for favorable breast flap reconstruction outcomes.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"08 1","pages":"e51 - e53"},"PeriodicalIF":0.0,"publicationDate":"2022-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42427334","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}
S. Denton, Conor McBride, Alexander P. Hammond, Anthony J LoGiudice
Abstract Background Traumatic amputees commonly experience residual limb pain (RLP) and phantom limb pain (PLP) which present major barriers to rehabilitation. An evolving treatment, targeted muscle reinnervation (TMR), shows promise in reducing these symptoms. While initial data are encouraging, existing studies are low power, and more research is needed to assess the long-term outcomes of TMR. We present the results of self-reported outcome surveys distributed to major-limb amputees more than 1 year post-TMR which were compared with similar data from a landmark randomized control trial for context. Methods Data was obtained from 17 adult traumatic amputees who were more than 1 year post-TMR using a numerical rating scale and the Patient-Reported Outcomes Measurement Information System survey tool. Results were compared with a 2019 randomized control trial by Dumanian et al which assessed TMR versus standard care (SC) after major limb amputation and demonstrated improvement in pain scores 1 year post-TMR. Results There was a statistically significant reduction in this cohort of TMR amputees' RLP worst pain scores relative to the comparison study's SC amputees (without TMR). In general, there was no significant difference in outcomes between TMR cohorts. However, PLP worst pain was significantly higher in this cohort relative to the comparison study's TMR group. Conclusion These findings support the use of TMR for reducing RLP in traumatic amputees. Relative to a similar group treated without TMR in the comparison study, this cohort's RLP was significantly improved. Future studies should aim to recruit more amputees to allow for analysis of functional outcomes, especially in upper limb amputees.
{"title":"Early Outcomes in Targeted Muscle Reinnervation for Traumatic Amputations","authors":"S. Denton, Conor McBride, Alexander P. Hammond, Anthony J LoGiudice","doi":"10.1055/a-2086-5446","DOIUrl":"https://doi.org/10.1055/a-2086-5446","url":null,"abstract":"Abstract Background Traumatic amputees commonly experience residual limb pain (RLP) and phantom limb pain (PLP) which present major barriers to rehabilitation. An evolving treatment, targeted muscle reinnervation (TMR), shows promise in reducing these symptoms. While initial data are encouraging, existing studies are low power, and more research is needed to assess the long-term outcomes of TMR. We present the results of self-reported outcome surveys distributed to major-limb amputees more than 1 year post-TMR which were compared with similar data from a landmark randomized control trial for context. Methods Data was obtained from 17 adult traumatic amputees who were more than 1 year post-TMR using a numerical rating scale and the Patient-Reported Outcomes Measurement Information System survey tool. Results were compared with a 2019 randomized control trial by Dumanian et al which assessed TMR versus standard care (SC) after major limb amputation and demonstrated improvement in pain scores 1 year post-TMR. Results There was a statistically significant reduction in this cohort of TMR amputees' RLP worst pain scores relative to the comparison study's SC amputees (without TMR). In general, there was no significant difference in outcomes between TMR cohorts. However, PLP worst pain was significantly higher in this cohort relative to the comparison study's TMR group. Conclusion These findings support the use of TMR for reducing RLP in traumatic amputees. Relative to a similar group treated without TMR in the comparison study, this cohort's RLP was significantly improved. Future studies should aim to recruit more amputees to allow for analysis of functional outcomes, especially in upper limb amputees.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"08 1","pages":"e54 - e59"},"PeriodicalIF":0.0,"publicationDate":"2022-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46424254","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}
Silvia Bernuth, A. Vater, Konrad F. Fuchs, R. Meffert, R. Jakubietz
Abstract Background To cover soft tissue defects, the perforator-based propeller flap offers the option to rotate healthy tissue into complex wounds. By rotating the flap, the perforator is torqued. As a result, perfusion changes are possible. Methods A retrospective data analysis of patients was done, who received a propeller flap to cover soft tissue defects of the lower extremity as well as a peri- and postoperative perfusion monitoring with a laser-Doppler-spectrophotometry system. Additionally, patient-specific data were collected. Results Seven patients were identified. Four patients experienced early complications, two epidermolysis of the distal flap areas, three wound healing disorders, and one partial flap necrosis. Intraoperative perfusion monitoring showed a decline of blood flow after incision of the flap, especially at distal flap site. In case of complications, there were prolonged blood flow declines up to the first postoperative day. Conclusion Torqueing the perforator by rotating the flap can cause an impairment in inflow and outflow. If the impairment is prolonged, perfusion-associated complications are possible. The identification of a viable perforator is particularly important. In addition, a conservative postoperative mobilization is necessary to compensate for the impaired and adapting outflow.
{"title":"Perfusion Changes in Perforator-Based Propeller Flaps","authors":"Silvia Bernuth, A. Vater, Konrad F. Fuchs, R. Meffert, R. Jakubietz","doi":"10.1055/a-2086-4988","DOIUrl":"https://doi.org/10.1055/a-2086-4988","url":null,"abstract":"Abstract Background To cover soft tissue defects, the perforator-based propeller flap offers the option to rotate healthy tissue into complex wounds. By rotating the flap, the perforator is torqued. As a result, perfusion changes are possible. Methods A retrospective data analysis of patients was done, who received a propeller flap to cover soft tissue defects of the lower extremity as well as a peri- and postoperative perfusion monitoring with a laser-Doppler-spectrophotometry system. Additionally, patient-specific data were collected. Results Seven patients were identified. Four patients experienced early complications, two epidermolysis of the distal flap areas, three wound healing disorders, and one partial flap necrosis. Intraoperative perfusion monitoring showed a decline of blood flow after incision of the flap, especially at distal flap site. In case of complications, there were prolonged blood flow declines up to the first postoperative day. Conclusion Torqueing the perforator by rotating the flap can cause an impairment in inflow and outflow. If the impairment is prolonged, perfusion-associated complications are possible. The identification of a viable perforator is particularly important. In addition, a conservative postoperative mobilization is necessary to compensate for the impaired and adapting outflow.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"08 1","pages":"e45 - e50"},"PeriodicalIF":0.0,"publicationDate":"2022-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46360907","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}
{"title":"Effective surgical approach for Breast cancer-related lymphedema using high-quality vein viewer","authors":"H. Mizuta, H. Motomura, T. Hatano","doi":"10.1055/a-1939-5512","DOIUrl":"https://doi.org/10.1055/a-1939-5512","url":null,"abstract":"<jats:p>none</jats:p>","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47440024","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}
Giovanna R. Pires, Whitney D. Moss, Jack D Sudduth, Jessica L. Marquez, Andrew M. Mills, E. Samlowski, Christopher E. Clinker, Devin Eddington, G. Hobson
Abstract Background The coronavirus disease 2019 (COVID-19) global pandemic prompted an unprecedented contraction in surgical volume. This utilizes the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) database to assess the impact of COVID-19 on breast reconstruction surgery volume and quality throughout 2020. Methods The NSQIP database was utilized to gather data from 2015 to 2020. We provide descriptive statistics in the form of mean (standard deviation), median (interquartile range), and range for continuous variables and counts (%) for categorical variables. A Kruskal–Wallis test was used to compare average age and a chi-squared test was used to compare other demographic categorical variables from 2019 to 2020. Results Breast reconstruction procedures decreased by 27% in Q2 2020 compared to Q2 of 2019. Immediate tissue-expander-based reconstruction was the only type of reconstruction that increased in comparison to Q2 2019 values (53.5 vs. 41.1%, p < 0.001). Rates of delayed direct to implant reconstruction was decreased (12.8 vs. 17.5%, p < 0.001) and free flap-based breast reconstruction decreased, including immediate free flap reconstruction (5.3 vs. 9%, p < 0.001) and delayed free flap reconstruction (5.7 vs. 9.1%, p < 0.001). Immediate direct to implant reconstruction rates were unchanged. In terms of surgical quality, there were no statistically significant increases in postoperative complications, readmissions, or reoperations. Conclusion Breast reconstruction surgery was heavily impacted in Q2 of 2020 with a 27% decrease in total surgical volume. There was an increase in immediate tissue-expander-based reconstruction and decrease in rates of both direct to implant and free-flap based reconstruction. Surgical quality and outcomes remained unchanged through the pandemic.
{"title":"The Impact of COVID-19 on Breast Reconstruction: A Nationwide Analysis Utilizing NSQIP","authors":"Giovanna R. Pires, Whitney D. Moss, Jack D Sudduth, Jessica L. Marquez, Andrew M. Mills, E. Samlowski, Christopher E. Clinker, Devin Eddington, G. Hobson","doi":"10.1055/s-0043-1771226","DOIUrl":"https://doi.org/10.1055/s-0043-1771226","url":null,"abstract":"Abstract Background The coronavirus disease 2019 (COVID-19) global pandemic prompted an unprecedented contraction in surgical volume. This utilizes the American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) database to assess the impact of COVID-19 on breast reconstruction surgery volume and quality throughout 2020. Methods The NSQIP database was utilized to gather data from 2015 to 2020. We provide descriptive statistics in the form of mean (standard deviation), median (interquartile range), and range for continuous variables and counts (%) for categorical variables. A Kruskal–Wallis test was used to compare average age and a chi-squared test was used to compare other demographic categorical variables from 2019 to 2020. Results Breast reconstruction procedures decreased by 27% in Q2 2020 compared to Q2 of 2019. Immediate tissue-expander-based reconstruction was the only type of reconstruction that increased in comparison to Q2 2019 values (53.5 vs. 41.1%, p < 0.001). Rates of delayed direct to implant reconstruction was decreased (12.8 vs. 17.5%, p < 0.001) and free flap-based breast reconstruction decreased, including immediate free flap reconstruction (5.3 vs. 9%, p < 0.001) and delayed free flap reconstruction (5.7 vs. 9.1%, p < 0.001). Immediate direct to implant reconstruction rates were unchanged. In terms of surgical quality, there were no statistically significant increases in postoperative complications, readmissions, or reoperations. Conclusion Breast reconstruction surgery was heavily impacted in Q2 of 2020 with a 27% decrease in total surgical volume. There was an increase in immediate tissue-expander-based reconstruction and decrease in rates of both direct to implant and free-flap based reconstruction. Surgical quality and outcomes remained unchanged through the pandemic.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"08 1","pages":"e73 - e80"},"PeriodicalIF":0.0,"publicationDate":"2022-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42639264","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}
L. Hruby, Matthias E. Sporer, I. Krusche-Mandl, V. Tereshenko, H. Platzgummer, S. Hajdu, O. Aszmann
Abstract Objective We report the case of a 40-year-old man with an inveterate ulnar nerve neuroma following a laceration injury of his left wrist twenty-three years ago. The patient presented with a typical ulnar claw-hand deformity and debilitating neuropathic pain in his hand (VAS 8.4). Pre-operative imaging revealed a neuroma of the ulnar nerve at the Guyon's canal. Moreover, a complete atrophy of all intrinsic hand muscles innervated by the ulnar nerve was present. Methods A Zancolli lasso procedure was performed to reduce the clawing effect. The neuroma was resected producing a nerve defect of five centimeters. Since the injury dated back more than two decades and any motor recovery was deemed impossible at that point, the motor fascicle of the ulnar nerve, i.e. the deep branch, was selectively neurolysed and harvested as an autologous nerve graft. Then the graft was shifted into the defect to be coapted with the superficial branch fascicle in an end-to-end fashion. Results The presented fascicular shift procedure resulted in satisfying and sustained pain reduction. At the six-month follow-up, the VAS decreased to 1.2, and two years post-operatively, the patient reported 2.5 on the VAS. Conclusion The fascicular shift procedure offers an alternative approach to conventional nerve grafts. If nerve grafting is required, using a locally harvested graft avoids additional donor site morbidity. Assuming the clinical scenario allows for fascicular grafting, we strongly suggest considering the fascicular shift procedure as a cost-effective alternative to expensive conduits and processed nerve allografts in sensory nerve reconstruction.
{"title":"Successful Treatment of a Painful Neuroma Using Fascicular Shifting in the Ulnar Nerve: A Case Report","authors":"L. Hruby, Matthias E. Sporer, I. Krusche-Mandl, V. Tereshenko, H. Platzgummer, S. Hajdu, O. Aszmann","doi":"10.1055/a-2039-1193","DOIUrl":"https://doi.org/10.1055/a-2039-1193","url":null,"abstract":"Abstract Objective We report the case of a 40-year-old man with an inveterate ulnar nerve neuroma following a laceration injury of his left wrist twenty-three years ago. The patient presented with a typical ulnar claw-hand deformity and debilitating neuropathic pain in his hand (VAS 8.4). Pre-operative imaging revealed a neuroma of the ulnar nerve at the Guyon's canal. Moreover, a complete atrophy of all intrinsic hand muscles innervated by the ulnar nerve was present. Methods A Zancolli lasso procedure was performed to reduce the clawing effect. The neuroma was resected producing a nerve defect of five centimeters. Since the injury dated back more than two decades and any motor recovery was deemed impossible at that point, the motor fascicle of the ulnar nerve, i.e. the deep branch, was selectively neurolysed and harvested as an autologous nerve graft. Then the graft was shifted into the defect to be coapted with the superficial branch fascicle in an end-to-end fashion. Results The presented fascicular shift procedure resulted in satisfying and sustained pain reduction. At the six-month follow-up, the VAS decreased to 1.2, and two years post-operatively, the patient reported 2.5 on the VAS. Conclusion The fascicular shift procedure offers an alternative approach to conventional nerve grafts. If nerve grafting is required, using a locally harvested graft avoids additional donor site morbidity. Assuming the clinical scenario allows for fascicular grafting, we strongly suggest considering the fascicular shift procedure as a cost-effective alternative to expensive conduits and processed nerve allografts in sensory nerve reconstruction.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"08 1","pages":"e60 - e65"},"PeriodicalIF":0.0,"publicationDate":"2022-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43205737","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}
Keith Sweitzer, Katherine Carruthers, P. Tiwari, E. Kocak
Background In recent years, there has been a shift toward nipple-sparing mastectomy (NSM) techniques which often negates the need for reconstruction with exposed cutaneous donor flap tissues. Although techniques for the monitoring of buried flaps have been proposed, none have been able to provide the benefits that come with cutaneous monitoring via near-infrared spectroscopy (NIRS). Therefore, we herein propose a novel method for monitoring deepithelialized flap tissues deep to the mastectomy flaps using NIRS technology. Methods An NSM with free flap reconstruction was performed. The flap was designed with a skin island for placement of a cutaneous NIRS probe. Next, a silicone NIRS probe was placed on a deepithelialized portion of the flap under the mastectomy flap. The readings from this tunneled device were then compared to the control measurements obtained from the cutaneous NIRS monitor. This procedure was performed on three consecutive patients. The changes in StO2 recorded from both devices were compared using a paired, two-tailed Student's t-test. Results During flap monitoring, there were no issues with probe dislodgement and signal quality averaged greater than 90. Furthermore, probe removal was easily accomplished at bedside. There was no harm to the mastectomy skin flaps by affixing the probe and the pocket which contained the probe quickly closed down after removal. Using the Student's t-test, a p-value of 0.995 was calculated indicating no statistically significant difference between the StO2 readings from the cutaneous and the tunneled probes. Conclusion By using this novel method, NIRS technology can reliably be applied to the monitoring of buried free flap tissues. The proposed technique could be applied to a variety of flaps beyond the realm of breast reconstruction and may prove to be particularly useful in the setting of head and neck reconstruction. The results of this study suggest that high quality postoperative flap monitoring is possible without compromising the aesthetic result.
{"title":"A Reliable Method for the Monitoring of Buried Free Flaps Using Near-Infrared Spectroscopy","authors":"Keith Sweitzer, Katherine Carruthers, P. Tiwari, E. Kocak","doi":"10.1055/s-0042-1757321","DOIUrl":"https://doi.org/10.1055/s-0042-1757321","url":null,"abstract":"\u0000 Background In recent years, there has been a shift toward nipple-sparing mastectomy (NSM) techniques which often negates the need for reconstruction with exposed cutaneous donor flap tissues. Although techniques for the monitoring of buried flaps have been proposed, none have been able to provide the benefits that come with cutaneous monitoring via near-infrared spectroscopy (NIRS). Therefore, we herein propose a novel method for monitoring deepithelialized flap tissues deep to the mastectomy flaps using NIRS technology.\u0000 Methods An NSM with free flap reconstruction was performed. The flap was designed with a skin island for placement of a cutaneous NIRS probe. Next, a silicone NIRS probe was placed on a deepithelialized portion of the flap under the mastectomy flap. The readings from this tunneled device were then compared to the control measurements obtained from the cutaneous NIRS monitor. This procedure was performed on three consecutive patients. The changes in StO2 recorded from both devices were compared using a paired, two-tailed Student's t-test.\u0000 Results During flap monitoring, there were no issues with probe dislodgement and signal quality averaged greater than 90. Furthermore, probe removal was easily accomplished at bedside. There was no harm to the mastectomy skin flaps by affixing the probe and the pocket which contained the probe quickly closed down after removal. Using the Student's t-test, a p-value of 0.995 was calculated indicating no statistically significant difference between the StO2 readings from the cutaneous and the tunneled probes.\u0000 Conclusion By using this novel method, NIRS technology can reliably be applied to the monitoring of buried free flap tissues. The proposed technique could be applied to a variety of flaps beyond the realm of breast reconstruction and may prove to be particularly useful in the setting of head and neck reconstruction. The results of this study suggest that high quality postoperative flap monitoring is possible without compromising the aesthetic result.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41508289","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}
J. McGraw, Corey M. Bascone, I. Jaimez, Carlos E. Barrero, J. Fosnot, D. Fraker, S. Kovach
Abstract Background Recurrent laryngeal nerve (RLN) injury carries significant morbidity. Microsurgical repair of the RLN has proven promising for enhancing patient recovery of vocal function; however, data remains limited. Methods This retrospective cohort study included patients who underwent RLN repair from 2007 to 2022. Demographics and medical history were collected. The location and etiology of RLN injury, as well as the repair technique, were collected. Follow-up data were collected at the initial postoperative visit, at 6 months and at 1 year. Hoarseness was classified as mild, moderate, or severe. Of patients who underwent nasopharyngolaryngoscopy (NPL) following repair, the glottic gap was measured. Vocal interventions performed were also recorded. This study utilized descriptive statistical methods. Results Eleven patients underwent RLN repair. All patients underwent immediate repair. Fifty-four percent ( n = 6) of RLN injuries resulted from tumor inflammation or nerve encasement. Eighty-two percent ( n = 9) underwent direct RLN coaptation, 9% ( n = 1) underwent vagus-RLN anastomosis, and 9% ( n = 1) underwent an interposition nerve graft. Technical success was 100%. Seventy-three percent ( n = 8) required otolaryngology referral, and of those, 50% ( n = 4) required intervention. At initial evaluation, 91% ( n = 10) suffered from mild to severe hoarseness, and of patients who underwent NPL, all had a glottic gap. At 1 year, 82% of patients ( n = 9) improved to having mild to no appreciable hoarseness. Of the patients who underwent NPL, 62% ( n = 5) had closure of the glottic gap. Conclusion Patients undergoing repair of the RLN following injury showed excellent recovery of vocal function and resolution of glottic gap at 1 year.
{"title":"Immediate Intraoperative Microsurgical Repair of the Recurrent Laryngeal Nerve: A Fifteen-Year Institutional Experience","authors":"J. McGraw, Corey M. Bascone, I. Jaimez, Carlos E. Barrero, J. Fosnot, D. Fraker, S. Kovach","doi":"10.1055/a-2004-0113","DOIUrl":"https://doi.org/10.1055/a-2004-0113","url":null,"abstract":"Abstract Background Recurrent laryngeal nerve (RLN) injury carries significant morbidity. Microsurgical repair of the RLN has proven promising for enhancing patient recovery of vocal function; however, data remains limited. Methods This retrospective cohort study included patients who underwent RLN repair from 2007 to 2022. Demographics and medical history were collected. The location and etiology of RLN injury, as well as the repair technique, were collected. Follow-up data were collected at the initial postoperative visit, at 6 months and at 1 year. Hoarseness was classified as mild, moderate, or severe. Of patients who underwent nasopharyngolaryngoscopy (NPL) following repair, the glottic gap was measured. Vocal interventions performed were also recorded. This study utilized descriptive statistical methods. Results Eleven patients underwent RLN repair. All patients underwent immediate repair. Fifty-four percent ( n = 6) of RLN injuries resulted from tumor inflammation or nerve encasement. Eighty-two percent ( n = 9) underwent direct RLN coaptation, 9% ( n = 1) underwent vagus-RLN anastomosis, and 9% ( n = 1) underwent an interposition nerve graft. Technical success was 100%. Seventy-three percent ( n = 8) required otolaryngology referral, and of those, 50% ( n = 4) required intervention. At initial evaluation, 91% ( n = 10) suffered from mild to severe hoarseness, and of patients who underwent NPL, all had a glottic gap. At 1 year, 82% of patients ( n = 9) improved to having mild to no appreciable hoarseness. Of the patients who underwent NPL, 62% ( n = 5) had closure of the glottic gap. Conclusion Patients undergoing repair of the RLN following injury showed excellent recovery of vocal function and resolution of glottic gap at 1 year.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"08 1","pages":"e32 - e37"},"PeriodicalIF":0.0,"publicationDate":"2022-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41905126","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}
Fernando Benedetti, Paola Kafury, Fabiola Reyes-Arceo, Carmelo Lizardo, Federico Reina, M. Zuluaga
Abstract Background This article describes the clinical results of the use of propeller flaps during reconstruction of coverage defects around the ankle. Methods A retrospective study of all patients with bone and soft tissue defects around the ankle reconstruction using propeller flap between January 2021 and December 2022 was conducted. Flap survival rate and complications were the outcomes variables. Results A total of 14 reconstructions in 13 patients (mean age: 45.8 ± 16.7 years) using propeller flaps were performed in the study period. The medial malleolus was the most affected area ( n = 5) and the defect size ranged from 12 to 33.7 cm 2 . The posterior tibial artery was used as a perforator in 11 flaps. Complications were identified in five flaps, four developed venous congestion and one case, reactivation of infection. Only one propeller flap presented complete failure associated with necrosis. Good soft tissue coverage was achieved in 13 of 14 flaps. Conclusion Propeller flaps proved to be a valid management option during reconstruction of bone and soft tissue defects around the ankle, offering adequate coverage in most cases. Adequate patient selection is important to decrease the risk of complications.
{"title":"Use of Propeller Flaps for the Reconstruction of Defects around the Ankle","authors":"Fernando Benedetti, Paola Kafury, Fabiola Reyes-Arceo, Carmelo Lizardo, Federico Reina, M. Zuluaga","doi":"10.1055/s-0043-1762894","DOIUrl":"https://doi.org/10.1055/s-0043-1762894","url":null,"abstract":"Abstract Background This article describes the clinical results of the use of propeller flaps during reconstruction of coverage defects around the ankle. Methods A retrospective study of all patients with bone and soft tissue defects around the ankle reconstruction using propeller flap between January 2021 and December 2022 was conducted. Flap survival rate and complications were the outcomes variables. Results A total of 14 reconstructions in 13 patients (mean age: 45.8 ± 16.7 years) using propeller flaps were performed in the study period. The medial malleolus was the most affected area ( n = 5) and the defect size ranged from 12 to 33.7 cm 2 . The posterior tibial artery was used as a perforator in 11 flaps. Complications were identified in five flaps, four developed venous congestion and one case, reactivation of infection. Only one propeller flap presented complete failure associated with necrosis. Good soft tissue coverage was achieved in 13 of 14 flaps. Conclusion Propeller flaps proved to be a valid management option during reconstruction of bone and soft tissue defects around the ankle, offering adequate coverage in most cases. Adequate patient selection is important to decrease the risk of complications.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"08 1","pages":"e38 - e44"},"PeriodicalIF":0.0,"publicationDate":"2022-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46736465","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}
P. Thoenissen, Andreas M. Bucher, A. Heselich, R. Sader, T. Vogl, S. Ghanaati
Abstract Objective Tumor resection and reconstruction in patients with oral squamous cell carcinoma often involves free flaps followed by radiation therapy. Volume loss of free flaps is common following transplantation and radiation therapy. Therefore, this study investigates the volume loss of free radial forearm flaps in the field of craniomaxillofacial surgery. Methods In a retrospective single-center clinical study, postsurgery magnetic resonance imaging (MRI) was analyzed in patients with a free radial forearm flap. Additional functional outcomes were observed. The size of transplants and volume shrinkage were measured over time. Additional functional outcomes were observed with a questionnaire at any follow-up. Transplant size and volume shrinkage were evaluated in 12 patients and showed a mean transplant volume loss in radial forearm free flaps of 33% within 100 weeks postsurgery. Results Depending on the site of transplantation, volume loss differed between the buccal region (38.33%), alveolar process (36.29%), and tongue (17.50%) and loss varied according to both radiation and chemotherapy (51.5%) or adjuvant radiotherapy (51.5%) compared with none of those (30%). Nine patients (75%) stated full functional satisfaction after this evaluation period. Conclusion MRI follow-up imaging is an adequate tool for measuring the volume shrinkage of free flaps. This study proves that overcorrection of flaps is necessary by expecting a loss of volume that depends on the site of transplantation and adjuvant therapy to reach a satisfying quality of life.
{"title":"Evaluation of Flap Shrinkage Using Magnetic Resonance Imaging Follow-up in the Treatment of Oral Cancer","authors":"P. Thoenissen, Andreas M. Bucher, A. Heselich, R. Sader, T. Vogl, S. Ghanaati","doi":"10.1055/s-0043-1760756","DOIUrl":"https://doi.org/10.1055/s-0043-1760756","url":null,"abstract":"Abstract Objective Tumor resection and reconstruction in patients with oral squamous cell carcinoma often involves free flaps followed by radiation therapy. Volume loss of free flaps is common following transplantation and radiation therapy. Therefore, this study investigates the volume loss of free radial forearm flaps in the field of craniomaxillofacial surgery. Methods In a retrospective single-center clinical study, postsurgery magnetic resonance imaging (MRI) was analyzed in patients with a free radial forearm flap. Additional functional outcomes were observed. The size of transplants and volume shrinkage were measured over time. Additional functional outcomes were observed with a questionnaire at any follow-up. Transplant size and volume shrinkage were evaluated in 12 patients and showed a mean transplant volume loss in radial forearm free flaps of 33% within 100 weeks postsurgery. Results Depending on the site of transplantation, volume loss differed between the buccal region (38.33%), alveolar process (36.29%), and tongue (17.50%) and loss varied according to both radiation and chemotherapy (51.5%) or adjuvant radiotherapy (51.5%) compared with none of those (30%). Nine patients (75%) stated full functional satisfaction after this evaluation period. Conclusion MRI follow-up imaging is an adequate tool for measuring the volume shrinkage of free flaps. This study proves that overcorrection of flaps is necessary by expecting a loss of volume that depends on the site of transplantation and adjuvant therapy to reach a satisfying quality of life.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"08 1","pages":"e12 - e17"},"PeriodicalIF":0.0,"publicationDate":"2022-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42957152","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}
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