Daria Jokinen, M. Kuuskeri, M. Helminen, M. Kääriäinen
Abstract Background Free flap reconstruction is the gold standard in head and neck reconstructions. The current article analyzes failed free flaps in the head and neck region during an 11-year period in a single center aiming to discover factors that could be influenced in order to reduce the risk for flap failure. Methods During the 11-year study period, 336 patients underwent free flap reconstruction at Tampere University Hospital, Tampere, Finland. The patients' average age was 62 years (range 14–92 years). Note that 201 (61.5%) of the patients were women and 135 (38.5%) men. Medical records were reviewed for demographics, comorbidities, neoadjuvant and adjuvant therapies, free flap type, area of reconstruction, and intraoperative and postoperative complications. Statistical analyses were performed. Results Ten (3%) of the 336 free flaps failed. Patients' age, comorbidities, smoking, dosage of anticoagulation, free flap type, or the location of the defect did not influence the risk of flap failure. All lost flaps were postoperatively followed by clinical monitoring only. In contrast, 89% of all flaps had both Licox (Integra LifeSciences Corp, NJ) and clinical follow-up postoperatively. In six (60%) of the failed cases, a second free flap surgery was performed as a salvage procedure, with a survival rate of 83.3%. Conclusion Our free flap success rate of 97% is in accordance with that of other centers that perform head and neck reconstructions. According to our findings, free flap reconstructions can be successfully performed on elderly patients and patients with comorbidities. Smoking did not increase the flap loss rate. We encourage the use of other methods in addition to clinical monitoring to follow the flaps after head and neck free flap reconstructions. All flap types used have high success rates, and reconstruction can be conducted with the most suitable flaps for the demands of the defect.
{"title":"Analysis of Flap Failures in Microvascular Head and Neck Reconstructions: 11-Year Single-Center Results","authors":"Daria Jokinen, M. Kuuskeri, M. Helminen, M. Kääriäinen","doi":"10.1055/a-2003-9976","DOIUrl":"https://doi.org/10.1055/a-2003-9976","url":null,"abstract":"Abstract Background Free flap reconstruction is the gold standard in head and neck reconstructions. The current article analyzes failed free flaps in the head and neck region during an 11-year period in a single center aiming to discover factors that could be influenced in order to reduce the risk for flap failure. Methods During the 11-year study period, 336 patients underwent free flap reconstruction at Tampere University Hospital, Tampere, Finland. The patients' average age was 62 years (range 14–92 years). Note that 201 (61.5%) of the patients were women and 135 (38.5%) men. Medical records were reviewed for demographics, comorbidities, neoadjuvant and adjuvant therapies, free flap type, area of reconstruction, and intraoperative and postoperative complications. Statistical analyses were performed. Results Ten (3%) of the 336 free flaps failed. Patients' age, comorbidities, smoking, dosage of anticoagulation, free flap type, or the location of the defect did not influence the risk of flap failure. All lost flaps were postoperatively followed by clinical monitoring only. In contrast, 89% of all flaps had both Licox (Integra LifeSciences Corp, NJ) and clinical follow-up postoperatively. In six (60%) of the failed cases, a second free flap surgery was performed as a salvage procedure, with a survival rate of 83.3%. Conclusion Our free flap success rate of 97% is in accordance with that of other centers that perform head and neck reconstructions. According to our findings, free flap reconstructions can be successfully performed on elderly patients and patients with comorbidities. Smoking did not increase the flap loss rate. We encourage the use of other methods in addition to clinical monitoring to follow the flaps after head and neck free flap reconstructions. All flap types used have high success rates, and reconstruction can be conducted with the most suitable flaps for the demands of the defect.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"08 1","pages":"e18 - e22"},"PeriodicalIF":0.0,"publicationDate":"2022-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49319278","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. Copeland-Halperin, Prashanthi Divakar, Talia Stewart, Falen Demsas, Joshua J Levy, John F. Nigriny, J. Paydarfar
Abstract Background Head and neck cancer is a leading cause of cancer. Treatment often requires surgical resection, free-flap reconstruction, radiation, and/or chemotherapy. Tumor burden and pain may limit swallowing and impair nutrition, increasing complications and mortality. Patients commonly require gastrostomy tubes (G-tube), but predicting which patients are in need remains elusive. This study identifies predictors of G-tube among head and neck cancer patients undergoing immediate free-flap reconstruction. Methods Institutional Review Board approval was obtained. Retrospective database review was performed of patients at 18 years of age or older with head and neck cancer who underwent resection with immediate free-flap reconstruction from 2011 to 2019. Patients who underwent nonfree-flap or delayed reconstruction or with mortality within 7 days postoperatively were excluded. Patient demographics and comorbidities, tumor/treatment characteristics, and need for G-tube were analyzed to identify univariate and multivariate predictors. Results In total, 107 patients were included and 72 required G-tube placement. On multivariate analysis, tracheostomy (odds ratio [OR]: 81.78; confidence interval [CI]: 7.43–1,399.92; p < 0.01), anterolateral thigh flap reconstruction (OR: 16.18; CI: 1.14–429.66; p = 0.04), and age 65 years or younger (OR: 9.35; CI: 1.47–89.11; p = 0.02) were predictors of G-tube placement. Conclusion Head and neck cancer treatment commonly involves extensive resection, reconstruction, and/or chemoradiation. These patients are at high risk for malnutrition and need G-tube. Determining who requires a pre- or postoperative G-tube remains a challenge. In this study, the need for tracheostomy or ALT flap reconstruction and age 65 years or younger were predictive of postoperative G-tube placement. Future research will guide a multidisciplinary perioperative pathway to facilitate the optimization of nutrition management.
{"title":"Predictors of Gastrostomy Tube Placement in Head and Neck Cancer Patients at a Rural Tertiary Care Hospital","authors":"L. Copeland-Halperin, Prashanthi Divakar, Talia Stewart, Falen Demsas, Joshua J Levy, John F. Nigriny, J. Paydarfar","doi":"10.1055/s-0043-1760757","DOIUrl":"https://doi.org/10.1055/s-0043-1760757","url":null,"abstract":"Abstract Background Head and neck cancer is a leading cause of cancer. Treatment often requires surgical resection, free-flap reconstruction, radiation, and/or chemotherapy. Tumor burden and pain may limit swallowing and impair nutrition, increasing complications and mortality. Patients commonly require gastrostomy tubes (G-tube), but predicting which patients are in need remains elusive. This study identifies predictors of G-tube among head and neck cancer patients undergoing immediate free-flap reconstruction. Methods Institutional Review Board approval was obtained. Retrospective database review was performed of patients at 18 years of age or older with head and neck cancer who underwent resection with immediate free-flap reconstruction from 2011 to 2019. Patients who underwent nonfree-flap or delayed reconstruction or with mortality within 7 days postoperatively were excluded. Patient demographics and comorbidities, tumor/treatment characteristics, and need for G-tube were analyzed to identify univariate and multivariate predictors. Results In total, 107 patients were included and 72 required G-tube placement. On multivariate analysis, tracheostomy (odds ratio [OR]: 81.78; confidence interval [CI]: 7.43–1,399.92; p < 0.01), anterolateral thigh flap reconstruction (OR: 16.18; CI: 1.14–429.66; p = 0.04), and age 65 years or younger (OR: 9.35; CI: 1.47–89.11; p = 0.02) were predictors of G-tube placement. Conclusion Head and neck cancer treatment commonly involves extensive resection, reconstruction, and/or chemoradiation. These patients are at high risk for malnutrition and need G-tube. Determining who requires a pre- or postoperative G-tube remains a challenge. In this study, the need for tracheostomy or ALT flap reconstruction and age 65 years or younger were predictive of postoperative G-tube placement. Future research will guide a multidisciplinary perioperative pathway to facilitate the optimization of nutrition management.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"08 1","pages":"e1 - e11"},"PeriodicalIF":0.0,"publicationDate":"2022-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45236794","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}
Reuben A. Falola, N. Rodriguez-Unda, R. Probe, H. Papaconstantinou, M. Saint-Cyr, Andrew M. Altman
Background Closed-loop communication is essential for managing a diverse surgical team. When new or unfamiliar members are present, as is common in shift-based perioperative care, challenges to effective communication can arise. Methods We introduced the Surgical Flight Plan (SFP), a novel communication tool that informs surgical team members on procedural details in advance of surgery, at our tertiary academic center. The tool was made available in the electronic health record prior to surgery. The primary outcome assessed after application of the SFP was “patient-in-room to incision time.” The secondary outcome was “improvement of communication in surgical teams” as assessed by a standardized (10-item) preintervention survey and a follow-up postintervention survey, given 3 months later. Data were gathered using Redcap software and statistical analysis was performed using SAS 9.4, significance was set at p-value less than 0.05 Results Thirty-six first-start, operative plastic surgery cases were included for the analysis (20 pre- and 16 postintervention). The average time from patient-in-room to surgical time out were 59.15 and 48.69 minutes pre-/postintervention respectively (p < .0437). Sixty-one members of the surgical team responded to the survey, with the majority citing improved team communication. Conclusion The SFP significantly improved first case on-time starts (FCOTS) and may improve surgical team communication, efficiency, safety, and overall patient care. Expanding the use of the instrument into other surgical specialties is needed to further validate its efficacy.
{"title":"Improving Preoperative Communication and First Case On-Time Starts with the Surgical Flight Plan: A Pilot Study","authors":"Reuben A. Falola, N. Rodriguez-Unda, R. Probe, H. Papaconstantinou, M. Saint-Cyr, Andrew M. Altman","doi":"10.1055/s-0042-1742468","DOIUrl":"https://doi.org/10.1055/s-0042-1742468","url":null,"abstract":"\u0000 Background Closed-loop communication is essential for managing a diverse surgical team. When new or unfamiliar members are present, as is common in shift-based perioperative care, challenges to effective communication can arise.\u0000 Methods We introduced the Surgical Flight Plan (SFP), a novel communication tool that informs surgical team members on procedural details in advance of surgery, at our tertiary academic center. The tool was made available in the electronic health record prior to surgery. The primary outcome assessed after application of the SFP was “patient-in-room to incision time.” The secondary outcome was “improvement of communication in surgical teams” as assessed by a standardized (10-item) preintervention survey and a follow-up postintervention survey, given 3 months later. Data were gathered using Redcap software and statistical analysis was performed using SAS 9.4, significance was set at p-value less than 0.05\u0000 Results Thirty-six first-start, operative plastic surgery cases were included for the analysis (20 pre- and 16 postintervention). The average time from patient-in-room to surgical time out were 59.15 and 48.69 minutes pre-/postintervention respectively (p < .0437). Sixty-one members of the surgical team responded to the survey, with the majority citing improved team communication.\u0000 Conclusion The SFP significantly improved first case on-time starts (FCOTS) and may improve surgical team communication, efficiency, safety, and overall patient care. Expanding the use of the instrument into other surgical specialties is needed to further validate its efficacy.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45998064","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}
Karen E M Massada, Meagan Wu, Theresa K. Webster, J. Panichella, Michael C. Coronado, Lindsay Talemal, Nicholas Elmer, Sthefano Araya, Rohan Brebion, P. Baltodano, Sameer A. Patel
Background Breast reconstruction using deep inferior epigastric perforator (DIEP) and latissimus dorsi (LD) flaps following mastectomy are associated with seroma formation, most commonly at the donor site. We sought to perform an updated systematic review and meta-analysis on the effects of fibrin sealant on donor-site complications following DIEP and LD flap breast reconstruction. Methods A comprehensive literature search was conducted (March 2021) in PubMed, OVID, and Cochrane databases. Articles analyzing the efficacy of fibrin glue in reducing donor-site morbidity in DIEP and LD breast reconstruction were included. The outcomes assessed were seroma formation and duration of drainage. Results A total of 17,265 articles were screened, and 9 articles were selected for analysis, which comprised 632 surgical sites in 611 patients. Comparing fibrin glue and quilting to quilting alone showed no significant difference in seroma formation (pooled risk ratio [RR]: 0.51; 95% confidence interval [CI]: 0.12, 2.25). Similarly, comparing fibrin glue alone to no fibrin glue showed no significant difference in seroma formation (pooled RR: 1.03; 95% CI: 0.66, 1.61) or duration of drain (pooled RR: −0.85; 95% CI: −4.09, 2.40); there was however a difference in duration of drain in those who received fibrin glue and quilting versus quilting alone (pooled RR: −2.13; 95% CI: −3.27, −0.99). Conclusion The existing literature supports that the use of fibrin glue is not associated with a decrease in seroma formation in DIEP and LD flaps and is weakly associated with a reduction in the drainage duration only if used in conjunction with quilting.
{"title":"Fibrin Sealants Do Not Reduce the Rate of Seroma Formation in Postmastectomy Breast Reconstruction: A Systematic Review and Meta-analysis","authors":"Karen E M Massada, Meagan Wu, Theresa K. Webster, J. Panichella, Michael C. Coronado, Lindsay Talemal, Nicholas Elmer, Sthefano Araya, Rohan Brebion, P. Baltodano, Sameer A. Patel","doi":"10.1055/s-0042-1748885","DOIUrl":"https://doi.org/10.1055/s-0042-1748885","url":null,"abstract":"\u0000 Background Breast reconstruction using deep inferior epigastric perforator (DIEP) and latissimus dorsi (LD) flaps following mastectomy are associated with seroma formation, most commonly at the donor site. We sought to perform an updated systematic review and meta-analysis on the effects of fibrin sealant on donor-site complications following DIEP and LD flap breast reconstruction.\u0000 Methods A comprehensive literature search was conducted (March 2021) in PubMed, OVID, and Cochrane databases. Articles analyzing the efficacy of fibrin glue in reducing donor-site morbidity in DIEP and LD breast reconstruction were included. The outcomes assessed were seroma formation and duration of drainage.\u0000 Results A total of 17,265 articles were screened, and 9 articles were selected for analysis, which comprised 632 surgical sites in 611 patients. Comparing fibrin glue and quilting to quilting alone showed no significant difference in seroma formation (pooled risk ratio [RR]: 0.51; 95% confidence interval [CI]: 0.12, 2.25). Similarly, comparing fibrin glue alone to no fibrin glue showed no significant difference in seroma formation (pooled RR: 1.03; 95% CI: 0.66, 1.61) or duration of drain (pooled RR: −0.85; 95% CI: −4.09, 2.40); there was however a difference in duration of drain in those who received fibrin glue and quilting versus quilting alone (pooled RR: −2.13; 95% CI: −3.27, −0.99).\u0000 Conclusion The existing literature supports that the use of fibrin glue is not associated with a decrease in seroma formation in DIEP and LD flaps and is weakly associated with a reduction in the drainage duration only if used in conjunction with quilting.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43070697","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 As phalloplasty becomes more routinely performed, there is a growing need for an evidence base to guide surgical decision-making. Recent reviews have suggested that flap type and number of stages may affect the high rates of urethral complications seen with phalloplasty, but no rigorous comparison of both has been performed. Methods A systematic review was conducted across PubMed, Google Scholar, and ScienceDirect (PROSPERO #158722). All included studies examined urethral complications following gender-affirming phalloplasty in transgender men. Data were extracted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations system. All searches, extractions, and grading were completed by two authors. Results Twenty-five studies were included with a total of 1,674 patients. Identified flap types included radial forearm, anterolateral thigh, abdominal, and fibular flaps. Surgical techniques varied widely within the flap types. Number of stages ranged from one to four. Stricture and fistula were the most frequently reported complications with considerable variation in the reported rates between studies, even within singular flap types. Data extraction indicated serious quality issues with the published literature, with the majority of studies at high risk of bias due to short follow-up times, inconsistent and incomplete reporting of outcomes, and inconsistent reporting of surgical technique. Conclusion To date, there is insufficient data to support a preferred flap type to minimize the urethral complication rates of phalloplasty. Further high-quality literature is required to determine the impact of potential factors affecting complications of gender-affirming phalloplasty. Improved literature quality may be facilitated by a standardized set of reporting guidelines.
{"title":"A Systematic Review of Staging and Flap Choice in Gender-Affirming Phalloplasty","authors":"Catherine A. Wu, D. Jolly, E. Boskey, O. Ganor","doi":"10.1055/s-0042-1748884","DOIUrl":"https://doi.org/10.1055/s-0042-1748884","url":null,"abstract":"Abstract Background As phalloplasty becomes more routinely performed, there is a growing need for an evidence base to guide surgical decision-making. Recent reviews have suggested that flap type and number of stages may affect the high rates of urethral complications seen with phalloplasty, but no rigorous comparison of both has been performed. Methods A systematic review was conducted across PubMed, Google Scholar, and ScienceDirect (PROSPERO #158722). All included studies examined urethral complications following gender-affirming phalloplasty in transgender men. Data were extracted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations system. All searches, extractions, and grading were completed by two authors. Results Twenty-five studies were included with a total of 1,674 patients. Identified flap types included radial forearm, anterolateral thigh, abdominal, and fibular flaps. Surgical techniques varied widely within the flap types. Number of stages ranged from one to four. Stricture and fistula were the most frequently reported complications with considerable variation in the reported rates between studies, even within singular flap types. Data extraction indicated serious quality issues with the published literature, with the majority of studies at high risk of bias due to short follow-up times, inconsistent and incomplete reporting of outcomes, and inconsistent reporting of surgical technique. Conclusion To date, there is insufficient data to support a preferred flap type to minimize the urethral complication rates of phalloplasty. Further high-quality literature is required to determine the impact of potential factors affecting complications of gender-affirming phalloplasty. Improved literature quality may be facilitated by a standardized set of reporting guidelines.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"07 1","pages":"e13 - e26"},"PeriodicalIF":0.0,"publicationDate":"2021-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45198601","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 The extent of functional recovery induced in healthy patients by sensory nerve grafts, the clinical “gold standard” technique for repairing peripheral nerves with a gap, is significantly limited by increasing gap length, time between trauma and repair, and patient age. When the values of any two, or all three, variables increase simultaneously, there is little to no recovery. For diabetic patients, even under the best of conditions and without any large variables, the extent of axon regeneration and functional recovery is significantly less, but generally none. Therefore, novel techniques are required that enhance recovery in diabetic patients. Methods A 12-cm long median nerve gap in the wrist/palm of a 71-year-old male long-term diabetic patient was bridged 1.3 years post nerve injury with a sural nerve graft within a platelet-rich plasma-filled collagen tube. Results By 2 months post-repair, the patient's level 6 chronic neuropathic pain was permanently eliminated. By 6.75 months, the palm had recovered good sensitivity to stimuli of all sensory modalities, including 4.56 g pressure and less than 15 mm two-point discrimination. Each finger had good motor function of M3–5, with partial to complete sensitivity to stimuli of all sensory modalities and an overall recovery of S3. Conclusion This technique permanently eliminates severe chronic neuropathic pain while simultaneously inducing good motor and sensory recovery in a long-term diabetic patient, under conditions where recovery is rarely, if ever, seen, even in non-diabetic patients. This technique holds great promise of restoring function to diabetic patients, for whom it is otherwise not possible.
{"title":"A Novel Technique Restores Function while Eliminating Intractable Neuropathic Pain in a 71-Year-Old Diabetic Patient under Challenging Injury Conditions","authors":"W. Micheo, C. Foy, D. Kuffler","doi":"10.1055/s-0042-1757323","DOIUrl":"https://doi.org/10.1055/s-0042-1757323","url":null,"abstract":"Abstract Background The extent of functional recovery induced in healthy patients by sensory nerve grafts, the clinical “gold standard” technique for repairing peripheral nerves with a gap, is significantly limited by increasing gap length, time between trauma and repair, and patient age. When the values of any two, or all three, variables increase simultaneously, there is little to no recovery. For diabetic patients, even under the best of conditions and without any large variables, the extent of axon regeneration and functional recovery is significantly less, but generally none. Therefore, novel techniques are required that enhance recovery in diabetic patients. Methods A 12-cm long median nerve gap in the wrist/palm of a 71-year-old male long-term diabetic patient was bridged 1.3 years post nerve injury with a sural nerve graft within a platelet-rich plasma-filled collagen tube. Results By 2 months post-repair, the patient's level 6 chronic neuropathic pain was permanently eliminated. By 6.75 months, the palm had recovered good sensitivity to stimuli of all sensory modalities, including 4.56 g pressure and less than 15 mm two-point discrimination. Each finger had good motor function of M3–5, with partial to complete sensitivity to stimuli of all sensory modalities and an overall recovery of S3. Conclusion This technique permanently eliminates severe chronic neuropathic pain while simultaneously inducing good motor and sensory recovery in a long-term diabetic patient, under conditions where recovery is rarely, if ever, seen, even in non-diabetic patients. This technique holds great promise of restoring function to diabetic patients, for whom it is otherwise not possible.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"08 1","pages":"e23 - e27"},"PeriodicalIF":0.0,"publicationDate":"2021-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44246559","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 Chronic groin neuralgia is a life-debilitating condition that plagues patients worldwide. While groin neuralgia is usually traced to iatrogenic causes (inguinal hernia repairs, vasectomy, and hysterectomy), there is a unique subset of patients that present with noniatrogenic groin neuralgia. The diagnosis and treatment of these patients present a particular challenge. Methods A total of 30 patients (current mean age, 46.5 [range: 19–72] years) who presented with noniatrogenic groin neuralgia and received neurectomies on the iliohypogastric, ilioinguinal, and genitofemoral nerves between 2008 and 2017 were identified. A retrospective review of preoperative and immediate postoperative pain scores was compared with prospectively collected current pain on a Likert's scale (0–10). Additionally, patients were asked to complete a Short Form (SF)-20 and identify current pain medications. A two-sided Wilcoxon–Mann–Whitney test was used to analyze the data. Results Of the 30 patients identified, 16 could participate (mean follow-up = 61 months). The average pain reduction for the entire group was 62.7%. When using an established 30% reduction pain as a marker for clinical significance, 12 successful and 4 unsuccessful patients had an average reduction of 81.1 and 7.68%, respectively (success rate of 75%). Patients with successful group showed a statistically significant increased social functioning (p = 0.012) and near-significant increase in mental health (p = 0.063). Improvements, albeit nonsignificant, in mean scaled scores for every other SF-20 quality of life (QoL) category were observed when comparing both groups. Conclusion Neurectomy is a potentially beneficial surgery that can assuage pain and improve quality of life for patients with noniatrogenic groin neuralgia.
{"title":"Use of Groin Neurectomies for Noniatrogenic Testicular and Groin Pain","authors":"Sanchit Sachdeva, A. Chhabra, J. Reisch, S. Rozen","doi":"10.1055/s-0041-1736421","DOIUrl":"https://doi.org/10.1055/s-0041-1736421","url":null,"abstract":"Abstract Background Chronic groin neuralgia is a life-debilitating condition that plagues patients worldwide. While groin neuralgia is usually traced to iatrogenic causes (inguinal hernia repairs, vasectomy, and hysterectomy), there is a unique subset of patients that present with noniatrogenic groin neuralgia. The diagnosis and treatment of these patients present a particular challenge. Methods A total of 30 patients (current mean age, 46.5 [range: 19–72] years) who presented with noniatrogenic groin neuralgia and received neurectomies on the iliohypogastric, ilioinguinal, and genitofemoral nerves between 2008 and 2017 were identified. A retrospective review of preoperative and immediate postoperative pain scores was compared with prospectively collected current pain on a Likert's scale (0–10). Additionally, patients were asked to complete a Short Form (SF)-20 and identify current pain medications. A two-sided Wilcoxon–Mann–Whitney test was used to analyze the data. Results Of the 30 patients identified, 16 could participate (mean follow-up = 61 months). The average pain reduction for the entire group was 62.7%. When using an established 30% reduction pain as a marker for clinical significance, 12 successful and 4 unsuccessful patients had an average reduction of 81.1 and 7.68%, respectively (success rate of 75%). Patients with successful group showed a statistically significant increased social functioning (p = 0.012) and near-significant increase in mental health (p = 0.063). Improvements, albeit nonsignificant, in mean scaled scores for every other SF-20 quality of life (QoL) category were observed when comparing both groups. Conclusion Neurectomy is a potentially beneficial surgery that can assuage pain and improve quality of life for patients with noniatrogenic groin neuralgia.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"06 1","pages":"e70 - e78"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49118459","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}
Dewi Aisiyah Mukarramah, Irena Sakura Rini, R. Sofyan, M. Kiat, I. Iskandar, Azmi Ritana, B. Brahma
Abstract Background Head and neck cancer is one of the leading cancers worldwide. Complex head and neck procedures are potentially aerosol-generating and considered high risk for coronavirus disease 2019 (COVID-19) transmission between the patients, surgeons, and other health-care workers (HCWs). Several adjustments in the microsurgery procedure were needed. The COVID-19 protocol was developed and applied to minimize the COVID-19 transmission. The study objectives were to describe the preoperative, intraoperative, and postoperative protocols applied and the characteristics of patients who underwent head and neck reconstructive microsurgery during the COVID-19 pandemic in Dharmais Cancer Hospital-National Cancer Center. Methods This study was a retrospective descriptive study of patients who underwent head and neck reconstructive microsurgery between March 2020 and December 2020 in the plastic surgery department and surgical oncology department, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia. The patients' characteristics including sex, age, location of the defects, the flap type, flap survival, and complications were obtained from medical records and analyzed using SPSS version 23. Results There were 55 patients, 30 (54.54%) patients were female, and 25 (45.45%) patients were male. The mean age at the time of surgery was 51.32 ± 1.85 years. The most common cancer type was squamous cell carcinoma for 49.09% (n = 27/55). The most frequent location was tongue for 25.45% (n = 14/55). Anterolateral thigh flap was also the most used flap in this study for 50.91% (n = 14/55). The overall survival rate of this study was 83.64% (n = 46/55). There were nine patients (16.36%) who were found with postoperative complications. There was no nosocomial infection with COVID-19 for patients, surgeons, and other HCWs. Conclusion Microsurgery can be performed even in the COVID-19 pandemic as the gold standard for oncologic head and neck reconstruction by applying protocols to protect the patients, surgeons, and other HCWs.
{"title":"Oncologic Head and Neck Reconstructive Microsurgery during the COVID-19 Pandemic in Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia","authors":"Dewi Aisiyah Mukarramah, Irena Sakura Rini, R. Sofyan, M. Kiat, I. Iskandar, Azmi Ritana, B. Brahma","doi":"10.1055/s-0041-1736420","DOIUrl":"https://doi.org/10.1055/s-0041-1736420","url":null,"abstract":"Abstract Background Head and neck cancer is one of the leading cancers worldwide. Complex head and neck procedures are potentially aerosol-generating and considered high risk for coronavirus disease 2019 (COVID-19) transmission between the patients, surgeons, and other health-care workers (HCWs). Several adjustments in the microsurgery procedure were needed. The COVID-19 protocol was developed and applied to minimize the COVID-19 transmission. The study objectives were to describe the preoperative, intraoperative, and postoperative protocols applied and the characteristics of patients who underwent head and neck reconstructive microsurgery during the COVID-19 pandemic in Dharmais Cancer Hospital-National Cancer Center. Methods This study was a retrospective descriptive study of patients who underwent head and neck reconstructive microsurgery between March 2020 and December 2020 in the plastic surgery department and surgical oncology department, Dharmais Cancer Hospital-National Cancer Center, Jakarta, Indonesia. The patients' characteristics including sex, age, location of the defects, the flap type, flap survival, and complications were obtained from medical records and analyzed using SPSS version 23. Results There were 55 patients, 30 (54.54%) patients were female, and 25 (45.45%) patients were male. The mean age at the time of surgery was 51.32 ± 1.85 years. The most common cancer type was squamous cell carcinoma for 49.09% (n = 27/55). The most frequent location was tongue for 25.45% (n = 14/55). Anterolateral thigh flap was also the most used flap in this study for 50.91% (n = 14/55). The overall survival rate of this study was 83.64% (n = 46/55). There were nine patients (16.36%) who were found with postoperative complications. There was no nosocomial infection with COVID-19 for patients, surgeons, and other HCWs. Conclusion Microsurgery can be performed even in the COVID-19 pandemic as the gold standard for oncologic head and neck reconstruction by applying protocols to protect the patients, surgeons, and other HCWs.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"06 1","pages":"e79 - e86"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44913522","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 Various phalloplasty methods have been reported; however, a consensus has not been reached. Therefore, we suggest an alternative algorithm for an ideal phalloplasty considering the factors that affect flap selection. Methods We retrospectively examined 32 phalloplasty cases of female-to-male transgender. Flaps used for phalloplasty were classified into three groups as follows: (1) radial forearm (RF) group, (2) anterolateral thigh (ALT) group, and (3) flap combination (FC) group. Statistical analyses were performed to determine the significance of age and body mass index (BMI) as well as differences in the rates of postoperative complication, reoperation, esthetic acceptability, tactile or erogenous sensibility, and the ability to urinate while standing. Results Ten cases were included in the RF group and 7 and 15 cases in the ALT and FC groups, respectively. With respect to BMI, the RF group (mean [standard deviation (SD)] = 25.9 [3.3]) showed significantly higher BMI than the ALT (21.7 [0.9]) or FC group (22.2 [4.5]). The RF (mean [SD] = 3.7 [0.4]) and ALT groups (3.5 [0.9]) had significantly higher esthetic acceptability evaluation scores (from 1 to 4) than the FC group (2.5 [1.2]). Moreover, the RF and ALT groups were superior than the FC group in terms of tactile or erogenous sensibility rates. Conclusion BMI effected flap choices for phalloplasty because of the correlation between BMI and skin thickness. FC becomes an option between ALT flap and RF flap in terms of flap choice based on BMI. Our alternative algorithm for an ideal phalloplasty based on BMI will be useful for objective flap choices.
{"title":"Flap Selection Algorithm Based on the Body Mass Index for Phalloplasty in Female-to-Male Transgender: Techniques and Outcomes","authors":"Toshiyuki Watanabe, Yuzaburo Namba, Y. Kimata","doi":"10.1055/s-0041-1732373","DOIUrl":"https://doi.org/10.1055/s-0041-1732373","url":null,"abstract":"Abstract Background Various phalloplasty methods have been reported; however, a consensus has not been reached. Therefore, we suggest an alternative algorithm for an ideal phalloplasty considering the factors that affect flap selection. Methods We retrospectively examined 32 phalloplasty cases of female-to-male transgender. Flaps used for phalloplasty were classified into three groups as follows: (1) radial forearm (RF) group, (2) anterolateral thigh (ALT) group, and (3) flap combination (FC) group. Statistical analyses were performed to determine the significance of age and body mass index (BMI) as well as differences in the rates of postoperative complication, reoperation, esthetic acceptability, tactile or erogenous sensibility, and the ability to urinate while standing. Results Ten cases were included in the RF group and 7 and 15 cases in the ALT and FC groups, respectively. With respect to BMI, the RF group (mean [standard deviation (SD)] = 25.9 [3.3]) showed significantly higher BMI than the ALT (21.7 [0.9]) or FC group (22.2 [4.5]). The RF (mean [SD] = 3.7 [0.4]) and ALT groups (3.5 [0.9]) had significantly higher esthetic acceptability evaluation scores (from 1 to 4) than the FC group (2.5 [1.2]). Moreover, the RF and ALT groups were superior than the FC group in terms of tactile or erogenous sensibility rates. Conclusion BMI effected flap choices for phalloplasty because of the correlation between BMI and skin thickness. FC becomes an option between ALT flap and RF flap in terms of flap choice based on BMI. Our alternative algorithm for an ideal phalloplasty based on BMI will be useful for objective flap choices.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"06 1","pages":"e57 - e62"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0041-1732373","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48707178","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 Objective This study aimed to evaluate the safety of microvascular free tissue transfer in the elderly patient population. Methods We performed a 20-year retrospective review at a tertiary care private practice of patients of ≥ 90 years of age who underwent microvascular free tissue transfer and had at least 6 months of follow-up. Similarly, we reviewed patients aged 70 to 89 years who underwent free tissue transfer between 2018 and 2020 as a control group. Records were examined for type of flap, defect site, pathology, and occurrence of complications. Results Overall 77 patients of 90 years or older met the inclusion criteria and 77 sequential patients aged 70 to 89 years were identified to serve as a control group. The overall complication rate among patients of ≥ 90 years of age was 18%, with flap-related complications in 4% (two partial flap loss and one total loss). The mortality rate was 1.3%. All patients of ≥ 90 years of age undergoing osteocutaneous reconstruction for osteoradionecrosis experienced complications, but only one was a flap complication (partial loss). Among patients aged 70 to 89 years, the overall complication rate was also 18%, with flap-related complications in 4% (two complete flap failures and one partial loss). The mortality rate in the control group was 2.6%. Conclusion Soft tissue free flaps are a safe option in the elderly patient population and should be offered to patients who are medically optimized prior to surgery, regardless of age. Osteocutaneous reconstruction for osteoradionecrosis must be undertaken with caution. This study reflects level of evidence 4.
{"title":"Safe Free Tissue Transfer in Patients Older than 90 Years","authors":"M. Hohman, A. Vincent, Abdul R. Enzi, Y. Ducic","doi":"10.1055/s-0041-1736419","DOIUrl":"https://doi.org/10.1055/s-0041-1736419","url":null,"abstract":"Abstract Objective This study aimed to evaluate the safety of microvascular free tissue transfer in the elderly patient population. Methods We performed a 20-year retrospective review at a tertiary care private practice of patients of ≥ 90 years of age who underwent microvascular free tissue transfer and had at least 6 months of follow-up. Similarly, we reviewed patients aged 70 to 89 years who underwent free tissue transfer between 2018 and 2020 as a control group. Records were examined for type of flap, defect site, pathology, and occurrence of complications. Results Overall 77 patients of 90 years or older met the inclusion criteria and 77 sequential patients aged 70 to 89 years were identified to serve as a control group. The overall complication rate among patients of ≥ 90 years of age was 18%, with flap-related complications in 4% (two partial flap loss and one total loss). The mortality rate was 1.3%. All patients of ≥ 90 years of age undergoing osteocutaneous reconstruction for osteoradionecrosis experienced complications, but only one was a flap complication (partial loss). Among patients aged 70 to 89 years, the overall complication rate was also 18%, with flap-related complications in 4% (two complete flap failures and one partial loss). The mortality rate in the control group was 2.6%. Conclusion Soft tissue free flaps are a safe option in the elderly patient population and should be offered to patients who are medically optimized prior to surgery, regardless of age. Osteocutaneous reconstruction for osteoradionecrosis must be undertaken with caution. This study reflects level of evidence 4.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"06 1","pages":"e87 - e92"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46422435","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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