{"title":"Free Abdominal Tissue Transfer and Utilization of the Umbilical Stalk for “Tubular” Reconstruction in Ear, Nose, and Throat Defects","authors":"J. Laun, J. Pribaz","doi":"10.1055/s-0040-1716370","DOIUrl":"https://doi.org/10.1055/s-0040-1716370","url":null,"abstract":"head and neck burns and cancer-related defects","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"05 1","pages":"e69 - e73"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1716370","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48839126","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 Injuries of the hand often require free flap reconstruction. To minimize flap loss, evidence exists to surgically syndactylize digits when repairing multiple injuries, with delayed flap division, or desyndactylization. However, evidence suggests that division of the flap at the time of inset can be accomplished with minimal negative effect. The purpose of this study was to evaluate outcomes, following hand reconstruction with free flaps utilizing either acute or staged desyndactylization techniques. Methods A systematic review utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. Articles that described the use of a free flap for surgically syndactylized digits or multilobed flaps for coverage of multiple digits were included. Results One hundred sixty-one articles were reviewed with 34 fulfilling inclusion criteria. One hundred seventeen patients underwent 145 free flap reconstructions. Traumatic avulsions (49%) were the most common injuries, followed by burns (11%). Twenty-one (62%) papers described surgical syndactylization of digits, which were later desyndactylized and five (15%) papers included reconstruction of more than one digit with multilobed free flaps. Eight papers (24%) described both techniques. Overall, 100% of included flaps survived. Total complication rate was 6%, with six complications (67%) occurring in flaps with primary syndactylization. Conclusion Hand defects often require free flaps for reconstruction. Although free flaps for the reconstruction of digital defects is technically demanding, they result in better outcomes. With available evidence indicating complications rates less than those of staged desyndactylization, multidigit reconstruction with multilobed free flaps may be a more desirable technique.
{"title":"Evaluation of Primary and Secondary Free Flap Desyndactylization Techniques in Hand and Digit Reconstruction: A Systematic Review","authors":"Michael B. Gehring, M. Iorio","doi":"10.1055/s-0040-1721705","DOIUrl":"https://doi.org/10.1055/s-0040-1721705","url":null,"abstract":"Abstract Objective Injuries of the hand often require free flap reconstruction. To minimize flap loss, evidence exists to surgically syndactylize digits when repairing multiple injuries, with delayed flap division, or desyndactylization. However, evidence suggests that division of the flap at the time of inset can be accomplished with minimal negative effect. The purpose of this study was to evaluate outcomes, following hand reconstruction with free flaps utilizing either acute or staged desyndactylization techniques. Methods A systematic review utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed. Articles that described the use of a free flap for surgically syndactylized digits or multilobed flaps for coverage of multiple digits were included. Results One hundred sixty-one articles were reviewed with 34 fulfilling inclusion criteria. One hundred seventeen patients underwent 145 free flap reconstructions. Traumatic avulsions (49%) were the most common injuries, followed by burns (11%). Twenty-one (62%) papers described surgical syndactylization of digits, which were later desyndactylized and five (15%) papers included reconstruction of more than one digit with multilobed free flaps. Eight papers (24%) described both techniques. Overall, 100% of included flaps survived. Total complication rate was 6%, with six complications (67%) occurring in flaps with primary syndactylization. Conclusion Hand defects often require free flaps for reconstruction. Although free flaps for the reconstruction of digital defects is technically demanding, they result in better outcomes. With available evidence indicating complications rates less than those of staged desyndactylization, multidigit reconstruction with multilobed free flaps may be a more desirable technique.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"05 1","pages":"e107 - e114"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1721705","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48706188","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 Despite efforts of head and neck functional reconstruction, anatomic restoration has been used until now. This article describes our experience of using a chimeric free fibular osteocutaneous flap conjoined with a functional muscle free flap, defined as dynamic oromandibular reconstruction. Methods Through a retrospective chart review, four consecutive patients who underwent reconstruction with a total fibular free flap were included. The former two patients underwent reconstruction using a conventional osteocutaneous free fibular flap. The latter two patients had an oromandibular defect after cancer resection and underwent dynamic oromandibular reconstruction with a chimeric free fibular flap conjoined with a gracilis free flap or vastus lateralis muscle free flap. Results In the speech analysis, the dynamic group revealed a satisfactory tongue movement. Protrusion and lateralization were the most different movement changes. The tongue range of motion score was 62.5 in the dynamic group and 25.0 in the control group. On the dynamic magnetic resonance imaging, the contact of the soft palate with the tongue was excellent, and the epiglottis closure during deglutition was complete. In the three-dimensional volumetric analysis of mandibular aesthetic contouring, the dynamic group showed a much smaller difference in hemifacial volume, with a difference of 73.7 mL in the dynamic group and 101.76 mL in the control group. Conclusion This study is a preliminary trial of dynamic oromandibular reconstruction using chimeric free fibular flaps with functional muscle transfer. We demonstrated the possibility of dynamic oromandibular reconstruction, which enhanced more functional aspects in the patients in this study.
{"title":"Dynamic Oromandibular Reconstructions Using Chimeric Fibular and Gracilis or Vastus Lateralis Free Flaps","authors":"Min Wook Kim, J. Choi, W. Jeong, S. Nam, S. Choi","doi":"10.1055/s-0040-1713801","DOIUrl":"https://doi.org/10.1055/s-0040-1713801","url":null,"abstract":"Abstract Background Despite efforts of head and neck functional reconstruction, anatomic restoration has been used until now. This article describes our experience of using a chimeric free fibular osteocutaneous flap conjoined with a functional muscle free flap, defined as dynamic oromandibular reconstruction. Methods Through a retrospective chart review, four consecutive patients who underwent reconstruction with a total fibular free flap were included. The former two patients underwent reconstruction using a conventional osteocutaneous free fibular flap. The latter two patients had an oromandibular defect after cancer resection and underwent dynamic oromandibular reconstruction with a chimeric free fibular flap conjoined with a gracilis free flap or vastus lateralis muscle free flap. Results In the speech analysis, the dynamic group revealed a satisfactory tongue movement. Protrusion and lateralization were the most different movement changes. The tongue range of motion score was 62.5 in the dynamic group and 25.0 in the control group. On the dynamic magnetic resonance imaging, the contact of the soft palate with the tongue was excellent, and the epiglottis closure during deglutition was complete. In the three-dimensional volumetric analysis of mandibular aesthetic contouring, the dynamic group showed a much smaller difference in hemifacial volume, with a difference of 73.7 mL in the dynamic group and 101.76 mL in the control group. Conclusion This study is a preliminary trial of dynamic oromandibular reconstruction using chimeric free fibular flaps with functional muscle transfer. We demonstrated the possibility of dynamic oromandibular reconstruction, which enhanced more functional aspects in the patients in this study.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"05 1","pages":"e36 - e42"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1713801","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43922695","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}
T. Eldahshoury, Shuhei Yoshida, I. Koshima, Hirofumi Imai, Toshio Uchiki, Ayano Sasaki, S. Nagamatsu, K. Yokota
Abstract Background A surgical line production system using loupes to dissect lymphatics and veins is a cost-effective way of performing multiple lymphaticovenular anastomoses. There is an art to successful dissection of lymphatics under loupes, and selection of the correct loupe magnification is important. Therefore, the aim of this study was to provide a detailed description of how to dissect lymphatics under loupes. Patients and Methods Dissection of lymphatics under loupes was performed for a series of 13 patients. Lymphatics are transparent threadlike structures that are arranged longitudinally and may be oriented with feeding capillary vessels. At the start of dissection, it is helpful to have a reference scale in the field of vision when operating to appreciate the size of the structures seen under loupes. It is also helpful to be able to separate lymphatics from fat tissue in the background. Results Mean time for exploration under loupes was 25 ± 7 minutes; lymphatics were successfully found in 27 sites (90%) of the 30 attempted with failure to identify lymphatics in three sites (10%) and failure to identify veins in three sites (10%); the average size of the lymphatics was found to be 0.5 ± 0.2 mm. No lymphatics could be found by the microscopes after loupes exploration in two sites. Discussion Even a novice surgeon can identify lymphatics based on knowledge of the visual characteristics of these structures. However, a higher magnification is likely necessary for accurate discrimination.
{"title":"How to Dissect Lymphatics under Loupes for Line Production System for Multiple Lymphaticovenular Anastomosis","authors":"T. Eldahshoury, Shuhei Yoshida, I. Koshima, Hirofumi Imai, Toshio Uchiki, Ayano Sasaki, S. Nagamatsu, K. Yokota","doi":"10.1055/s-0040-1714660","DOIUrl":"https://doi.org/10.1055/s-0040-1714660","url":null,"abstract":"Abstract Background A surgical line production system using loupes to dissect lymphatics and veins is a cost-effective way of performing multiple lymphaticovenular anastomoses. There is an art to successful dissection of lymphatics under loupes, and selection of the correct loupe magnification is important. Therefore, the aim of this study was to provide a detailed description of how to dissect lymphatics under loupes. Patients and Methods Dissection of lymphatics under loupes was performed for a series of 13 patients. Lymphatics are transparent threadlike structures that are arranged longitudinally and may be oriented with feeding capillary vessels. At the start of dissection, it is helpful to have a reference scale in the field of vision when operating to appreciate the size of the structures seen under loupes. It is also helpful to be able to separate lymphatics from fat tissue in the background. Results Mean time for exploration under loupes was 25 ± 7 minutes; lymphatics were successfully found in 27 sites (90%) of the 30 attempted with failure to identify lymphatics in three sites (10%) and failure to identify veins in three sites (10%); the average size of the lymphatics was found to be 0.5 ± 0.2 mm. No lymphatics could be found by the microscopes after loupes exploration in two sites. Discussion Even a novice surgeon can identify lymphatics based on knowledge of the visual characteristics of these structures. However, a higher magnification is likely necessary for accurate discrimination.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"05 1","pages":"e43 - e48"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1714660","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47861765","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}
Brianne Sullivan, Michael Zoppo, A. Yao, P. Henderson
Abstract Background Microsurgical anastomosis is a delicate, highly nuanced procedure that can be done in several different ways; the most basic approach to performing microsurgical anastomoses is by using simple interrupted sutures, but even within that approach, there are different sequences by which the sutures can be placed. To date, there is no review of these sequences and the advantages and disadvantages of each. Methods A PubMed search was performed in October 2019 that sought all published descriptions of simple interrupted microsurgery techniques. Keywords included were “microvascular anastomosis,” “microvascular anastomosis technique,” “simple interrupted,” and “microsurgery.” Results Four simple interrupted microsurgery techniques were identified: triangulation, 12 o'clock to 6 o'clock, posterior-wall-first, and 3 o'clock to 9 o'clock-side-side. Additionally, there is no uniform nomenclature that describes the techniques for simple interrupted microvascular anastomoses. Conclusion This study identified four distinct sequences for the placement of simple interrupted sutures for microsurgical anastomosis and the advantages and disadvantages of each, and for the first time described them utilizing standardized nomenclature.
{"title":"Simple Interrupted Microvascular Anastomosis: Review of Four Sutures Placement Sequences","authors":"Brianne Sullivan, Michael Zoppo, A. Yao, P. Henderson","doi":"10.1055/s-0040-1719152","DOIUrl":"https://doi.org/10.1055/s-0040-1719152","url":null,"abstract":"Abstract Background Microsurgical anastomosis is a delicate, highly nuanced procedure that can be done in several different ways; the most basic approach to performing microsurgical anastomoses is by using simple interrupted sutures, but even within that approach, there are different sequences by which the sutures can be placed. To date, there is no review of these sequences and the advantages and disadvantages of each. Methods A PubMed search was performed in October 2019 that sought all published descriptions of simple interrupted microsurgery techniques. Keywords included were “microvascular anastomosis,” “microvascular anastomosis technique,” “simple interrupted,” and “microsurgery.” Results Four simple interrupted microsurgery techniques were identified: triangulation, 12 o'clock to 6 o'clock, posterior-wall-first, and 3 o'clock to 9 o'clock-side-side. Additionally, there is no uniform nomenclature that describes the techniques for simple interrupted microvascular anastomoses. Conclusion This study identified four distinct sequences for the placement of simple interrupted sutures for microsurgical anastomosis and the advantages and disadvantages of each, and for the first time described them utilizing standardized nomenclature.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"05 1","pages":"e101 - e106"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1719152","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46190709","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}
Y. Yasunaga, Daisuke Yanagisawa, Erika Ohata, S. Yuzuriha, S. Kondoh, K. Matsuo
Abstract Background We have newly developed a novel “grip-type” gun-shaped microsurgical needle holder that requires only finger twisting between the thumb and index finger for needle advancement. This study aimed to objectively assess whether this grip-type needle holder could reduce forearm muscle movement during microsurgical suturing as compared with a conventional pen-type needle holder by means of surface electromyography (sEMG). Methods Extensor carpi ulnaris (ECU) muscle and flexor carpi ulnaris muscle (FCU) sEMG measurements were taken during needle advancement in a microvascular anastomosis model for calculation of root mean square (RMS) values. The summed ECU and FCU RMS values were employed as indicators of forearm muscle movement and compared between the pen-type and grip-type instruments. Analyses of eight subjects and suturing in five directions by one subject were conducted. Results The summed ECU and FCU RMS values of the grip-type holder were significantly smaller than those of the pen-type holder in comparisons of eight subjects (p < 0.05). Similarly, the summed RMS values of the grip-type holder in each of the five suturing directions were remarkably lower than those of the pen-type holder. Conclusion The grip-type needle holder could significantly reduce forearm muscle movement as compared with a conventional pen-type holder based on objective sEMG measurements. The grip-type device appears more ideally suited for delicate microsurgical suturing, such as lymphaticovenular anastomosis or finger replantation, since the reduced forearm movement may mitigate the risk of coarse motion and hand shaking.
{"title":"A Novel Grip-Type Microsurgical Needle Holder: Introduction and Electromyographic Evaluation","authors":"Y. Yasunaga, Daisuke Yanagisawa, Erika Ohata, S. Yuzuriha, S. Kondoh, K. Matsuo","doi":"10.1055/s-0040-1715582","DOIUrl":"https://doi.org/10.1055/s-0040-1715582","url":null,"abstract":"Abstract Background We have newly developed a novel “grip-type” gun-shaped microsurgical needle holder that requires only finger twisting between the thumb and index finger for needle advancement. This study aimed to objectively assess whether this grip-type needle holder could reduce forearm muscle movement during microsurgical suturing as compared with a conventional pen-type needle holder by means of surface electromyography (sEMG). Methods Extensor carpi ulnaris (ECU) muscle and flexor carpi ulnaris muscle (FCU) sEMG measurements were taken during needle advancement in a microvascular anastomosis model for calculation of root mean square (RMS) values. The summed ECU and FCU RMS values were employed as indicators of forearm muscle movement and compared between the pen-type and grip-type instruments. Analyses of eight subjects and suturing in five directions by one subject were conducted. Results The summed ECU and FCU RMS values of the grip-type holder were significantly smaller than those of the pen-type holder in comparisons of eight subjects (p < 0.05). Similarly, the summed RMS values of the grip-type holder in each of the five suturing directions were remarkably lower than those of the pen-type holder. Conclusion The grip-type needle holder could significantly reduce forearm muscle movement as compared with a conventional pen-type holder based on objective sEMG measurements. The grip-type device appears more ideally suited for delicate microsurgical suturing, such as lymphaticovenular anastomosis or finger replantation, since the reduced forearm movement may mitigate the risk of coarse motion and hand shaking.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"05 1","pages":"e50 - e56"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1715582","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45273890","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}
C. I. Verret, Meridith P. Pollie, Jona Kerluku, S. Dhulipala, D. Fufa
Abstract Background Flap loss is a catastrophic complication following lower extremity reconstructions. Close monitoring can detect circulatory changes, particularly when introducing gravity through dangle protocols. Noninvasive near-infrared spectroscopy (NIRS) tissue oximetry is one such method used for continuous monitoring of tissue perfusion. Recently, negative pressure wound therapy (NPWT) has been for compromised flaps salvage. We used NIRS to study the impact of leg positioning and NPWT on lower extremity perfusion during a mock dangle protocol. Methods A tissue oximeter transcutaneous probe was placed on each lower limb of five normal patients at the location of the highest density of peroneal artery perforators along the distal one-third fibula. The experimental leg probe was covered with NPWT at 100 mm Hg. The contralateral leg served as control. Tissue oxygen saturation (StO2) was measured continuously for 140 minutes. Leg position was changed in every 20 minutes to mimic a dangle protocol. Results Our results showed higher StO2 with leg elevation, and lower StO2 in dependent positions in the control limb. StO2 was consistently higher in the limb with NPWT, which had a slower rate of deoxygenation with introduction of gravity. In both conditions, on returning to neutral position from the dependent, StO2 returned to levels close to baseline. Conclusion These data provide further information on hemodynamic changes introduced by gravity, and how NPWT might modulate these changes.
{"title":"Evaluating the Effect of Leg Position and Negative Pressure Wound Therapy on Lower Extremity Oxygenation Measured by Noninvasive Tissue Oximetry: A Pilot Study","authors":"C. I. Verret, Meridith P. Pollie, Jona Kerluku, S. Dhulipala, D. Fufa","doi":"10.1055/s-0040-1717110","DOIUrl":"https://doi.org/10.1055/s-0040-1717110","url":null,"abstract":"Abstract Background Flap loss is a catastrophic complication following lower extremity reconstructions. Close monitoring can detect circulatory changes, particularly when introducing gravity through dangle protocols. Noninvasive near-infrared spectroscopy (NIRS) tissue oximetry is one such method used for continuous monitoring of tissue perfusion. Recently, negative pressure wound therapy (NPWT) has been for compromised flaps salvage. We used NIRS to study the impact of leg positioning and NPWT on lower extremity perfusion during a mock dangle protocol. Methods A tissue oximeter transcutaneous probe was placed on each lower limb of five normal patients at the location of the highest density of peroneal artery perforators along the distal one-third fibula. The experimental leg probe was covered with NPWT at 100 mm Hg. The contralateral leg served as control. Tissue oxygen saturation (StO2) was measured continuously for 140 minutes. Leg position was changed in every 20 minutes to mimic a dangle protocol. Results Our results showed higher StO2 with leg elevation, and lower StO2 in dependent positions in the control limb. StO2 was consistently higher in the limb with NPWT, which had a slower rate of deoxygenation with introduction of gravity. In both conditions, on returning to neutral position from the dependent, StO2 returned to levels close to baseline. Conclusion These data provide further information on hemodynamic changes introduced by gravity, and how NPWT might modulate these changes.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"05 1","pages":"e79 - e81"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1717110","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41484207","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}
E. Fliss, A. Zaretski, Eyal D. Maoz-Halevy, E. Gur, R. Yanko
Abstract Background Approximately 70,000 Israelis underwent scalp irradiation for tinea capitis infection during their childhood, as did many other children worldwide. Long-term follow-up data showed that these children had an increased risk of aggressive and multiple nonmelanoma skin cancers, meningiomas, and other malignancies. Resection of these lesions creates a defect of soft tissue, bone, and dura, and requires scalp and skull reconstruction with local or free flaps in the irradiated field. Methods Sixteen patients with a history of childhood scalp irradiation underwent scalp and skull reconstruction in our department (2000–2018). Data on demographics, oncological status, operative details, and postoperative outcome were retrospectively collected and analyzed. Results The study group included 11 males and 5 females (average age at surgery, 70 years). The most common lesions were meningiomas (n = 9) and basal cell carcinomas (n = 8), and the most common indication for reconstruction was chronic exposure of deep structures (skull, dura, brain tissue, and titanium mesh; n = 9). Thirteen patients underwent primary free flap reconstruction and three underwent primary local flap reconstruction. Flap failure requiring reoperation occurred in one patient of the free flap reconstruction group (7%) and in all three patients of the local flap reconstruction group. Conclusion Long-term consequences of childhood depilatory treatments of the scalp by irradiation are now surfacing. Our experience showed that in such cases, surgeons should aim for a more aggressive approach with wide resection and primary free flap reconstruction, and that favorable long-term functional and aesthetic results can safely be achieved using this reconstruction approach.
{"title":"Scalp and Skull Reconstruction in Patients Irradiated for Tinea Capitis in Childhood: The Scalp Exchange Procedure","authors":"E. Fliss, A. Zaretski, Eyal D. Maoz-Halevy, E. Gur, R. Yanko","doi":"10.1055/s-0040-1716418","DOIUrl":"https://doi.org/10.1055/s-0040-1716418","url":null,"abstract":"Abstract Background Approximately 70,000 Israelis underwent scalp irradiation for tinea capitis infection during their childhood, as did many other children worldwide. Long-term follow-up data showed that these children had an increased risk of aggressive and multiple nonmelanoma skin cancers, meningiomas, and other malignancies. Resection of these lesions creates a defect of soft tissue, bone, and dura, and requires scalp and skull reconstruction with local or free flaps in the irradiated field. Methods Sixteen patients with a history of childhood scalp irradiation underwent scalp and skull reconstruction in our department (2000–2018). Data on demographics, oncological status, operative details, and postoperative outcome were retrospectively collected and analyzed. Results The study group included 11 males and 5 females (average age at surgery, 70 years). The most common lesions were meningiomas (n = 9) and basal cell carcinomas (n = 8), and the most common indication for reconstruction was chronic exposure of deep structures (skull, dura, brain tissue, and titanium mesh; n = 9). Thirteen patients underwent primary free flap reconstruction and three underwent primary local flap reconstruction. Flap failure requiring reoperation occurred in one patient of the free flap reconstruction group (7%) and in all three patients of the local flap reconstruction group. Conclusion Long-term consequences of childhood depilatory treatments of the scalp by irradiation are now surfacing. Our experience showed that in such cases, surgeons should aim for a more aggressive approach with wide resection and primary free flap reconstruction, and that favorable long-term functional and aesthetic results can safely be achieved using this reconstruction approach.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"05 1","pages":"e61 - e68"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1716418","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42654569","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 A 36-year-old male was involved in a motor vehicle accident, presenting with a Guistillo's IIIB crush injury to the upper extremity. A severely comminuted ulnar fracture resulted in a 10-cm bone defect with significant overlying soft tissue injury. Methods The injury resulted in a wide zone of injury with inadequate collateral vascularity at the level of the elbow and distal viability dependent on the brachial artery. An osteocutaneous free fibular flap and fasciocutaneous anterolateral thigh flap were used to reconstruct the defect with both flaps anastomosed in an end-to-side fashion to the brachial artery. Results The upper extremity was successfully salvaged, and the patient discharged from hospital at postoperative day 10. Both free flaps survived with no donor or recipient site complications at a follow-up period of 2 years. Conclusion The case illustrates the challenges inherent to significant Guistillo's IIIB injuries with insufficient recipient vessels over a large zone of injury. While performing anastomoses outside the zone of injury is preferred, this case demonstrates the success of performing multiple anastomoses to the brachial artery in an end-to-side fashion within the zone of injury.
{"title":"Single Artery Upper Extremity Salvage with Two Free Flap End-to-Side Brachial Artery Anastomoses","authors":"Michael J. Stein, Jing Zhang","doi":"10.1055/s-0040-1715863","DOIUrl":"https://doi.org/10.1055/s-0040-1715863","url":null,"abstract":"Abstract Background A 36-year-old male was involved in a motor vehicle accident, presenting with a Guistillo's IIIB crush injury to the upper extremity. A severely comminuted ulnar fracture resulted in a 10-cm bone defect with significant overlying soft tissue injury. Methods The injury resulted in a wide zone of injury with inadequate collateral vascularity at the level of the elbow and distal viability dependent on the brachial artery. An osteocutaneous free fibular flap and fasciocutaneous anterolateral thigh flap were used to reconstruct the defect with both flaps anastomosed in an end-to-side fashion to the brachial artery. Results The upper extremity was successfully salvaged, and the patient discharged from hospital at postoperative day 10. Both free flaps survived with no donor or recipient site complications at a follow-up period of 2 years. Conclusion The case illustrates the challenges inherent to significant Guistillo's IIIB injuries with insufficient recipient vessels over a large zone of injury. While performing anastomoses outside the zone of injury is preferred, this case demonstrates the success of performing multiple anastomoses to the brachial artery in an end-to-side fashion within the zone of injury.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"05 1","pages":"e57 - e60"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1715863","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47098066","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}
Tarek Zayid, M. Ouf, Amr M. Elbatawy, Serag M. Zidan, Abdelnaser Hamdy, Hany M. Ismail, Khallad Sholkamy, H. Dahshan, W. Ayad
Abstract Background Postcircumcision penile gangrene is a devastating complication that may lead to total or subtotal penile loss requiring penile reconstruction. Pediatric penile reconstruction poses diverse challenges for most plastic surgeon. Patients and Methods Retrospective cohort study of 12 children ranged from 6 to 36 months old suffered from total or partial penile loss secondary to electrocautery burn during circumcisions. Reconstruction was done by island groin flap for phallus in first stage and urethral reconstruction by tubularized scrotal flap 6 months later. The outcome was evaluated by assessment of flap survival, the esthetic appearance, urethral competence and rate of complication. Results Follow-up was ranged from 6 to 24 months. A new phallus of satisfactory dimensions was achieved in all cases. Complications included partial necrosis of the flap in two cases, fistulas in two cases, and stenosis of the urethral anastomosis in one case. These complications were successfully resolved by corrective surgery. Good satisfactory result regarded as shape and urination stream. Conclusion Penile reconstruction can be performed in children with good results and low complication rate. The use of island groin flap for phallus reconstruction followed by urethral reconstruction by tubularized scrotal flap 6 months later was found effective, time saving, and with minor complication.
{"title":"Two-Stage Pediatric Penile Reconstruction after Postcircumcision Gangrene","authors":"Tarek Zayid, M. Ouf, Amr M. Elbatawy, Serag M. Zidan, Abdelnaser Hamdy, Hany M. Ismail, Khallad Sholkamy, H. Dahshan, W. Ayad","doi":"10.1055/s-0040-1718717","DOIUrl":"https://doi.org/10.1055/s-0040-1718717","url":null,"abstract":"Abstract Background Postcircumcision penile gangrene is a devastating complication that may lead to total or subtotal penile loss requiring penile reconstruction. Pediatric penile reconstruction poses diverse challenges for most plastic surgeon. Patients and Methods Retrospective cohort study of 12 children ranged from 6 to 36 months old suffered from total or partial penile loss secondary to electrocautery burn during circumcisions. Reconstruction was done by island groin flap for phallus in first stage and urethral reconstruction by tubularized scrotal flap 6 months later. The outcome was evaluated by assessment of flap survival, the esthetic appearance, urethral competence and rate of complication. Results Follow-up was ranged from 6 to 24 months. A new phallus of satisfactory dimensions was achieved in all cases. Complications included partial necrosis of the flap in two cases, fistulas in two cases, and stenosis of the urethral anastomosis in one case. These complications were successfully resolved by corrective surgery. Good satisfactory result regarded as shape and urination stream. Conclusion Penile reconstruction can be performed in children with good results and low complication rate. The use of island groin flap for phallus reconstruction followed by urethral reconstruction by tubularized scrotal flap 6 months later was found effective, time saving, and with minor complication.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"05 1","pages":"e95 - e100"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0040-1718717","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45202788","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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