Nicholas G. Cuccolo, R. Cauley, Brady A. Sieber, S. Hussain, Laurel K. Chandler, Ahmed M. S. Ibrahim, Samuel J. Lin
Abstract Reconstruction of large nasal septal perforations can be a considerable challenge for surgeons. Reconstructive modalities are often determined by the size of the defect and the quality of local tissue and vasculature. Local and regional flaps may not provide enough tissue to achieve successful closure in patients with large perforations and those with baseline compromise of the nasal mucosa and blood supply from prior intervention or underlying medical condition. Microvascular free tissue transfer is a possible approach to reconstruction in these patients. We report a case of a 30-year-old man who presented with a large, symptomatic, 4 × 3.5 cm perforation as a result of prior functional septoplasty at an outside hospital. Reconstruction of the defect was accomplished in this setting with a free temporoparietal fascia (TPF) flap anastomosed to the columellar branch of the labial artery and the angular vein. Postoperative follow-up visits showed successful closure of the perforation without complications. As illustrated by this case, TPF flap is a versatile tool for complex nasal reconstructions. With minimal donor-site morbidity and rich vascularity capable of promoting remucosalization without the need for prelamination, the TPF flap may be suited for the repair of large nasoseptal perforations.
{"title":"Temporoparietal Fascia Free Flap for a Large Nasal Septal Perforation","authors":"Nicholas G. Cuccolo, R. Cauley, Brady A. Sieber, S. Hussain, Laurel K. Chandler, Ahmed M. S. Ibrahim, Samuel J. Lin","doi":"10.1055/s-0039-1692145","DOIUrl":"https://doi.org/10.1055/s-0039-1692145","url":null,"abstract":"Abstract Reconstruction of large nasal septal perforations can be a considerable challenge for surgeons. Reconstructive modalities are often determined by the size of the defect and the quality of local tissue and vasculature. Local and regional flaps may not provide enough tissue to achieve successful closure in patients with large perforations and those with baseline compromise of the nasal mucosa and blood supply from prior intervention or underlying medical condition. Microvascular free tissue transfer is a possible approach to reconstruction in these patients. We report a case of a 30-year-old man who presented with a large, symptomatic, 4 × 3.5 cm perforation as a result of prior functional septoplasty at an outside hospital. Reconstruction of the defect was accomplished in this setting with a free temporoparietal fascia (TPF) flap anastomosed to the columellar branch of the labial artery and the angular vein. Postoperative follow-up visits showed successful closure of the perforation without complications. As illustrated by this case, TPF flap is a versatile tool for complex nasal reconstructions. With minimal donor-site morbidity and rich vascularity capable of promoting remucosalization without the need for prelamination, the TPF flap may be suited for the repair of large nasoseptal perforations.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"04 1","pages":"e42 - e46"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0039-1692145","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47988011","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}
G. Alexopoulos, L. Pavlidis, M. Tsagarakis, A. Delimpaltas, Antonios Tsimponis, A. Papalois, A. Batistatou, A. Papoudou-Bai, D. Barritault, E. Demiri, G. Spyropoulou
Abstract Background The purpose of this study was to use artery grafts filled with CACIPLIQ20 and see if they promote nerve regeneration. Methods Sixty male Wistar rats were used. The rats were randomly divided into four experimental groups (n = 15): transected control group (negative control group [NCG]), sham-operated group (positive control group [SO]) artery graft group filled with saline (AG/NS), and CACIPLIQ20-treated group (AG/CACIPLIQ20). Fifteen rats were used as artery graft donors. In the SO group, the sciatic nerve was dissected from the surrounding tissues and left intact. In the NCG, AG/NS and AG/CACIPLIQ20) groups, a 10-mm gap was created in the left sciatic nerve. In the NCG group, the gap was not bridged with a graft. In the AG/NS group, the gap was bridged with a graft filled with saline. In the AG/CACIPLIQ20 group, the graft was filled with CACIPLIQ20. Walking track analysis was performed at 4, 8, 12, and 16 weeks after surgery. At 16 weeks postoperatively, the rats were sacrificed, nerve sections were harvested for histopathology analysis, and the weight ratio of the gastrocnemius muscle was measured. Results There was no significant difference in myelin sheath thickness between the AG/NS and AG/CACIPLIQ20 groups. Muscle weight in the AG/CACIPLIQ20 group was higher but not statistically significant (p = 0.168) compared with the AG/NS group. Also, AG/CACIPLIQ20 mean was better than AG/NS mean, although there was no statistically significant difference (p = 0.605). Conclusion There could be an indication that CACIPLIQ20 improves functional recovery of a transected peripheral nerve through a nerve gap bridged with an artery graft.
{"title":"Can ReGeneraTing Agents Improve Functional Recovery of Transected Peripheral Nerve through a Nerve Gap Bridged with an Artery Graft?","authors":"G. Alexopoulos, L. Pavlidis, M. Tsagarakis, A. Delimpaltas, Antonios Tsimponis, A. Papalois, A. Batistatou, A. Papoudou-Bai, D. Barritault, E. Demiri, G. Spyropoulou","doi":"10.1055/s-0039-1692453","DOIUrl":"https://doi.org/10.1055/s-0039-1692453","url":null,"abstract":"Abstract Background The purpose of this study was to use artery grafts filled with CACIPLIQ20 and see if they promote nerve regeneration. Methods Sixty male Wistar rats were used. The rats were randomly divided into four experimental groups (n = 15): transected control group (negative control group [NCG]), sham-operated group (positive control group [SO]) artery graft group filled with saline (AG/NS), and CACIPLIQ20-treated group (AG/CACIPLIQ20). Fifteen rats were used as artery graft donors. In the SO group, the sciatic nerve was dissected from the surrounding tissues and left intact. In the NCG, AG/NS and AG/CACIPLIQ20) groups, a 10-mm gap was created in the left sciatic nerve. In the NCG group, the gap was not bridged with a graft. In the AG/NS group, the gap was bridged with a graft filled with saline. In the AG/CACIPLIQ20 group, the graft was filled with CACIPLIQ20. Walking track analysis was performed at 4, 8, 12, and 16 weeks after surgery. At 16 weeks postoperatively, the rats were sacrificed, nerve sections were harvested for histopathology analysis, and the weight ratio of the gastrocnemius muscle was measured. Results There was no significant difference in myelin sheath thickness between the AG/NS and AG/CACIPLIQ20 groups. Muscle weight in the AG/CACIPLIQ20 group was higher but not statistically significant (p = 0.168) compared with the AG/NS group. Also, AG/CACIPLIQ20 mean was better than AG/NS mean, although there was no statistically significant difference (p = 0.605). Conclusion There could be an indication that CACIPLIQ20 improves functional recovery of a transected peripheral nerve through a nerve gap bridged with an artery graft.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"04 1","pages":"e47 - e53"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0039-1692453","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42869982","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}
Jourdain D. Artz, Daniel Yoo, Juan José Gilbert-Fernández, R. Walvekar, W. Risher, C. Dupin
Abstract Acquired tracheoesophageal fistulas are rare but associated with significant morbidity and mortality. The majority of cases are due to prolonged or complicated endotracheal intubation, tracheostomy, or esophageal malignancy, or subsequent to radiation or chemotherapy for treatment of the latter. Other etiologies include esophageal stenting and complications secondary to endoscopic procedures. The pathophysiology involves chronic inflammation of the esophagus or posterior wall of the trachea, ultimately promoting fistulization between these two structures. Risk factors primarily depend on the etiology; however, excessive balloon pressures and prolonged intubation are among the strongest predictors of acquired tracheoesophageal fistula. In two reported cases, intubation with persistent air leaks resulted in fistulization. Patients present with refractory pneumonia, aspiration, hypoxemia, acute respiratory distress, enteral feed in endotracheal aspirate, or gastric distention following extubation. It can be difficult to distinguish normal functional deterioration from deterioration secondary to intubation. Up to 51% of patients intubated for at least 48 hours may experience dysphagia following extubation. Ultimately, the diagnostic algorithm includes an esophagogram, followed by imaging with computed tomography (CT) scan, and, more recently, CT scan with three-dimensional reconstructions, a bronchoscopy, and an esophagoscopy. Spontaneous closure rarely occurs, and the primary treatment modalities include interventional therapy with stenting via bronchoscopy, esophagoscopy, or surgical correction. Surgical intervention is associated with higher risks due to surrounding vital anatomy and, often, technical challenges requiring multispecialty care. Our case study presents a novel and effective method of repairing a benign acquired tracheoesophageal fistula utilizing the transverse cervical artery flap.
{"title":"Transverse Cervical Artery Flap Repair of Benign Acquired Tracheoesophageal Fistula","authors":"Jourdain D. Artz, Daniel Yoo, Juan José Gilbert-Fernández, R. Walvekar, W. Risher, C. Dupin","doi":"10.1055/s-0039-1678576","DOIUrl":"https://doi.org/10.1055/s-0039-1678576","url":null,"abstract":"Abstract Acquired tracheoesophageal fistulas are rare but associated with significant morbidity and mortality. The majority of cases are due to prolonged or complicated endotracheal intubation, tracheostomy, or esophageal malignancy, or subsequent to radiation or chemotherapy for treatment of the latter. Other etiologies include esophageal stenting and complications secondary to endoscopic procedures. The pathophysiology involves chronic inflammation of the esophagus or posterior wall of the trachea, ultimately promoting fistulization between these two structures. Risk factors primarily depend on the etiology; however, excessive balloon pressures and prolonged intubation are among the strongest predictors of acquired tracheoesophageal fistula. In two reported cases, intubation with persistent air leaks resulted in fistulization. Patients present with refractory pneumonia, aspiration, hypoxemia, acute respiratory distress, enteral feed in endotracheal aspirate, or gastric distention following extubation. It can be difficult to distinguish normal functional deterioration from deterioration secondary to intubation. Up to 51% of patients intubated for at least 48 hours may experience dysphagia following extubation. Ultimately, the diagnostic algorithm includes an esophagogram, followed by imaging with computed tomography (CT) scan, and, more recently, CT scan with three-dimensional reconstructions, a bronchoscopy, and an esophagoscopy. Spontaneous closure rarely occurs, and the primary treatment modalities include interventional therapy with stenting via bronchoscopy, esophagoscopy, or surgical correction. Surgical intervention is associated with higher risks due to surrounding vital anatomy and, often, technical challenges requiring multispecialty care. Our case study presents a novel and effective method of repairing a benign acquired tracheoesophageal fistula utilizing the transverse cervical artery flap.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"04 1","pages":"e9 - e13"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0039-1678576","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43908913","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 Malignant bone tumors of the distal tibia or fibula in children are rare. Quality of functional outcome following limb salvage surgery is still controversial. This is a retrospective review of the functional outcome of ankle arthrodesis using vascularized fibular flap. Methods A total of seven patients were reviewed. The diagnosis was osteosarcoma in five and Ewing's sarcoma in two patients. The primary tumor site was the distal tibia in six patients and the distal fibula in one patient. The average age at presentation was 10.6 years (range, 6.7–14 years). The average follow-up period was 24.5 months (range, 13–69 years). A pedicled fibular graft was harvested from the ipsilateral leg in two patients and a free vascularized osteocutaneous fibular flap from the contralateral leg in five patients. External fixation was used in five and internal fixation in two patients. Patients were allowed full weight bearing following radiographic evidence of complete bone union. Results The mean time to complete bone union and full weight bearing was 7.1 months (range, 4–13 months). One patient developed nonunion at graft-host junction and one patient had stress fracture of the fibular graft. The mean limb length inequality was 0.57 cm (range, 0–3 cm). The average Musculoskeletal Tumor Society (MSTS) score was 84.5% (range, 73–100%). Conclusion Skeletally immature patients treated by ankle arthrodesis using vascularized fibular flap can return to full weight bearing within the first year following surgery. A contralateral fibular flap has the advantage of preserving the contour of the ankle and reserving the ipsilateral fibula for initial stability at the fusion site. This study is of level IV evidence.
{"title":"Limb Salvage for Primary Malignant Bone Tumors of the Distal Leg in Skeletally Immature Patients: Ankle Arthrodesis Using Vascularized Ipsilateral or Contralateral Fibular Flap","authors":"A. E. El Ghoneimy, M. Sokar, Nehal Kamal","doi":"10.1055/s-0039-1688762","DOIUrl":"https://doi.org/10.1055/s-0039-1688762","url":null,"abstract":"Abstract Background Malignant bone tumors of the distal tibia or fibula in children are rare. Quality of functional outcome following limb salvage surgery is still controversial. This is a retrospective review of the functional outcome of ankle arthrodesis using vascularized fibular flap. Methods A total of seven patients were reviewed. The diagnosis was osteosarcoma in five and Ewing's sarcoma in two patients. The primary tumor site was the distal tibia in six patients and the distal fibula in one patient. The average age at presentation was 10.6 years (range, 6.7–14 years). The average follow-up period was 24.5 months (range, 13–69 years). A pedicled fibular graft was harvested from the ipsilateral leg in two patients and a free vascularized osteocutaneous fibular flap from the contralateral leg in five patients. External fixation was used in five and internal fixation in two patients. Patients were allowed full weight bearing following radiographic evidence of complete bone union. Results The mean time to complete bone union and full weight bearing was 7.1 months (range, 4–13 months). One patient developed nonunion at graft-host junction and one patient had stress fracture of the fibular graft. The mean limb length inequality was 0.57 cm (range, 0–3 cm). The average Musculoskeletal Tumor Society (MSTS) score was 84.5% (range, 73–100%). Conclusion Skeletally immature patients treated by ankle arthrodesis using vascularized fibular flap can return to full weight bearing within the first year following surgery. A contralateral fibular flap has the advantage of preserving the contour of the ankle and reserving the ipsilateral fibula for initial stability at the fusion site. This study is of level IV evidence.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"04 1","pages":"e36 - e41"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0039-1688762","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42202983","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 Present study was conducted to identify common mastectomy patterns and autologous skin paddle designs, to identify patient characteristics that influence these patterns, and assess aesthetic outcomes associated with each pattern. Methods Autologous breast reconstructions over 5 years were reviewed. Mastectomy type and resultant skin paddle were categorized into four mastectomy type/skin paddle design groups based on the amount of native “Skin Spared” after mastectomy and the resultant flap skin paddle designed. Groups were designated as skin-sparing mastectomy 1 (SS1)/large elliptical skin paddle, skin-sparing mastectomy 2 (SS2)/small elliptical skin paddle, skin-sparing mastectomy 3 (SS3)/areola skin paddle, and skin-sparing mastectomy 4 (nipple-sparing mastectomy, SS4)/no skin paddle. Surveys were performed to validate the classification system and critique aesthetic outcomes. Results A total of 89 autologous breast reconstructions were included. Radiotherapy was used in 45.6% of SS1 patients versus 29.2% in SS2 and 12.5% in SS3/SS4. Mean body mass index (BMI) was 30 in SS1/SS2 and 26 in SS3/SS4 mastectomy types (p = 0.045). Delayed reconstruction was performed in 96.5% SS1 versus 62.5% in SS2 and only 25% of SS3/SS4 (p < 0.0001). Physicians and Non-MD personnel correctly categorized 85.8 and 76.1% of skin paddle designs, respectively. Over 75% of those surveyed rated the reconstruction aesthetic outcome as “good-excellent” regardless of the pattern group. Conclusions Patients in SS1/SS2 groups had a higher incidence of radiotherapy, delayed reconstruction, and higher BMI compared with the SS3/SS4 groups. The classification system is recognizable and may provide improved patient education and communication between healthcare providers. All mastectomy type/skin paddle designs received high aesthetic ratings.
{"title":"Autologous Breast Reconstruction Skin Paddle Designs: Classification and Aesthetic Outcomes","authors":"I. Pestana, N. Walker","doi":"10.1055/s-0039-1688725","DOIUrl":"https://doi.org/10.1055/s-0039-1688725","url":null,"abstract":"Abstract Objective Present study was conducted to identify common mastectomy patterns and autologous skin paddle designs, to identify patient characteristics that influence these patterns, and assess aesthetic outcomes associated with each pattern. Methods Autologous breast reconstructions over 5 years were reviewed. Mastectomy type and resultant skin paddle were categorized into four mastectomy type/skin paddle design groups based on the amount of native “Skin Spared” after mastectomy and the resultant flap skin paddle designed. Groups were designated as skin-sparing mastectomy 1 (SS1)/large elliptical skin paddle, skin-sparing mastectomy 2 (SS2)/small elliptical skin paddle, skin-sparing mastectomy 3 (SS3)/areola skin paddle, and skin-sparing mastectomy 4 (nipple-sparing mastectomy, SS4)/no skin paddle. Surveys were performed to validate the classification system and critique aesthetic outcomes. Results A total of 89 autologous breast reconstructions were included. Radiotherapy was used in 45.6% of SS1 patients versus 29.2% in SS2 and 12.5% in SS3/SS4. Mean body mass index (BMI) was 30 in SS1/SS2 and 26 in SS3/SS4 mastectomy types (p = 0.045). Delayed reconstruction was performed in 96.5% SS1 versus 62.5% in SS2 and only 25% of SS3/SS4 (p < 0.0001). Physicians and Non-MD personnel correctly categorized 85.8 and 76.1% of skin paddle designs, respectively. Over 75% of those surveyed rated the reconstruction aesthetic outcome as “good-excellent” regardless of the pattern group. Conclusions Patients in SS1/SS2 groups had a higher incidence of radiotherapy, delayed reconstruction, and higher BMI compared with the SS3/SS4 groups. The classification system is recognizable and may provide improved patient education and communication between healthcare providers. All mastectomy type/skin paddle designs received high aesthetic ratings.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"04 1","pages":"e29 - e35"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0039-1688725","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48543400","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 We performed soft tissue augmentation using free flap and secondary cranioplasty combined with soft tissue augmentation for cases with artificial or autologous skull exposure after neurosurgery. We evaluated operative result and the relationship between the cause of infection and the infected site. Methods Twenty-four patients were included. Data included age, sex, indications for neurosurgery, causes of infection, infection sites, medical comorbidities, time between last neurosurgery and reconstruction, types of reconstruction, and types of secondary cranioplasty. Results The causes of neurosurgery were subarachnoid hemorrhage (n = 9), trauma (n = 5), brain tumor (n = 5), brain hemorrhage (n = 3), and meningioma (n = 3). The mean size of infected bone was 67.3 cm2. The mean duration between last neurosurgery and reconstruction was 5.2 years. Types of infected bone were artificial bone (n = 19) and autologous skull (n = 6). The soft tissue augmentation was performed using latissimus dorsi myocutaneous flap (n = 14) and anterolateral thigh flap (n = 10). The infection sites were the frontal (n = 13), temporal (n = 4), parietal (n = 4), and occipital regions (n = 4). Bone defects included the frontal sinus in all patients who had infections in the frontal region. The patients who had infections in non-frontal region received multiple surgeries (n = 7). Nine patients received secondary cranioplasty using custom-made hydroxyapatite block. Conclusion To achieve good results during soft tissue augmentation, the cause of infection should be eliminated.
{"title":"Soft Tissue Augmentation Using Free Tissue Transfer for Artificial Bone Infection or Skull Bone Sequestration after Neurosurgery","authors":"Masayuki Okochi, H. Okochi, Takao Sakaba, K. Ueda","doi":"10.1055/s-0039-1678702","DOIUrl":"https://doi.org/10.1055/s-0039-1678702","url":null,"abstract":"Abstract Background We performed soft tissue augmentation using free flap and secondary cranioplasty combined with soft tissue augmentation for cases with artificial or autologous skull exposure after neurosurgery. We evaluated operative result and the relationship between the cause of infection and the infected site. Methods Twenty-four patients were included. Data included age, sex, indications for neurosurgery, causes of infection, infection sites, medical comorbidities, time between last neurosurgery and reconstruction, types of reconstruction, and types of secondary cranioplasty. Results The causes of neurosurgery were subarachnoid hemorrhage (n = 9), trauma (n = 5), brain tumor (n = 5), brain hemorrhage (n = 3), and meningioma (n = 3). The mean size of infected bone was 67.3 cm2. The mean duration between last neurosurgery and reconstruction was 5.2 years. Types of infected bone were artificial bone (n = 19) and autologous skull (n = 6). The soft tissue augmentation was performed using latissimus dorsi myocutaneous flap (n = 14) and anterolateral thigh flap (n = 10). The infection sites were the frontal (n = 13), temporal (n = 4), parietal (n = 4), and occipital regions (n = 4). Bone defects included the frontal sinus in all patients who had infections in the frontal region. The patients who had infections in non-frontal region received multiple surgeries (n = 7). Nine patients received secondary cranioplasty using custom-made hydroxyapatite block. Conclusion To achieve good results during soft tissue augmentation, the cause of infection should be eliminated.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"04 1","pages":"e1 - e8"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0039-1678702","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43722434","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 76-year-old woman presented with rheumatoid lymphedema (RL) distal to the left elbow after 20 years of affliction with rheumatoid arthritis (RA). Although the RA was controlled by medication, the patient could not receive full-scale compression therapy for her edema with a medium-pressure compression sleeve (pressure: 20–25 mm Hg) due to hand dysfunction caused by long-term RA. Methods Lymphaticovenular anastomosis (LVA) was performed after compression therapy with a low-pressure sleeve (14–18 mm Hg) proved ineffective for edema relief. Two anastomoses were created in a side-to-end fashion at the cubital fossa. Results The edema improved rapidly after LVA and was maintained with a low-pressure compression sleeve. Conclusion LVA represents a treatment option for remaining RL in RA treatment. As some RL patients are ineligible for full-scale compression therapy due to hand dysfunction caused by RA, LVA may help to reduce RL and enable edema management using a low-pressure compression garment without concern for hand dysfunction.
摘要背景一名76岁女性在患类风湿关节炎(RA) 20年后出现左肘远端类风湿淋巴水肿(RL)。虽然药物控制了RA，但由于长期RA引起的手部功能障碍，患者无法接受中压压套(压力:20-25 mm Hg)对其水肿的全面压迫治疗。方法采用低压套筒(14 ~ 18 mm Hg)加压治疗，对水肿缓解无效后，行淋巴小囊吻合。在肘窝处以侧对端方式创建两个吻合口。结果LVA术后水肿迅速改善，采用低压压套维持。结论LVA是RA治疗中剩余RL的一种治疗选择。由于一些RL患者由于RA引起的手部功能障碍而不适合进行全面的压迫治疗，LVA可能有助于减少RL并使用低压压迫服进行水肿管理，而无需担心手部功能障碍。
{"title":"Rheumatoid Lymphedema Successfully Treated with Lymphaticovenular Anastomosis: A Case Report","authors":"Y. Ichinose, Y. Yasunaga, S. Yuzuriha","doi":"10.1055/s-0039-1688763","DOIUrl":"https://doi.org/10.1055/s-0039-1688763","url":null,"abstract":"Abstract Background A 76-year-old woman presented with rheumatoid lymphedema (RL) distal to the left elbow after 20 years of affliction with rheumatoid arthritis (RA). Although the RA was controlled by medication, the patient could not receive full-scale compression therapy for her edema with a medium-pressure compression sleeve (pressure: 20–25 mm Hg) due to hand dysfunction caused by long-term RA. Methods Lymphaticovenular anastomosis (LVA) was performed after compression therapy with a low-pressure sleeve (14–18 mm Hg) proved ineffective for edema relief. Two anastomoses were created in a side-to-end fashion at the cubital fossa. Results The edema improved rapidly after LVA and was maintained with a low-pressure compression sleeve. Conclusion LVA represents a treatment option for remaining RL in RA treatment. As some RL patients are ineligible for full-scale compression therapy due to hand dysfunction caused by RA, LVA may help to reduce RL and enable edema management using a low-pressure compression garment without concern for hand dysfunction.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"04 1","pages":"e24 - e28"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0039-1688763","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47428732","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}
Shuhei Yoshida, I. Koshima, S. Nagamatsu, K. Yokota, Shuji Yamashita, M. Harima, K. Tashiro
Abstract Background Island pedicle flaps often have the problem of limited reach. In such cases, free flaps are useful for reconstruction but often have the issue of unavailability of suitable recipient vessels. Therefore, it would be helpful if the pedicle of an island flap could be extended as far as necessary. Methods Here, we describe the use of interpositional vein grafts to extend island pedicle flaps for the reconstruction of an ischemic above-knee amputation stump in one case and to seal an intractable fistula on the buttock after radiation therapy in another case. In the patient with the ischemic stump, a deep inferior epigastric perforator flap was extended by 6 cm using the great saphenous vein harvested from the contralateral side, allowing successful coverage of the stump. In the patient with an intractable fistula on the buttock, a thoracodorsal artery and vein graft that was extended by 25 cm using the cephalic vein harvested from the right forearm to upper arm allowed successful sealing of the fistula. Results Circulation was satisfactory in both cases and both flaps survived. The operative procedure was straightforward. Conclusion Interpositional vein grafts may be a feasible option for the extension of island pedicle flaps to include the features of an island pedicle flap and a free flap.
{"title":"Novel Interpositional Vein Grafting for Pedicle Extension of Island Pedicle Flaps","authors":"Shuhei Yoshida, I. Koshima, S. Nagamatsu, K. Yokota, Shuji Yamashita, M. Harima, K. Tashiro","doi":"10.1055/s-0038-1669452","DOIUrl":"https://doi.org/10.1055/s-0038-1669452","url":null,"abstract":"Abstract Background Island pedicle flaps often have the problem of limited reach. In such cases, free flaps are useful for reconstruction but often have the issue of unavailability of suitable recipient vessels. Therefore, it would be helpful if the pedicle of an island flap could be extended as far as necessary. Methods Here, we describe the use of interpositional vein grafts to extend island pedicle flaps for the reconstruction of an ischemic above-knee amputation stump in one case and to seal an intractable fistula on the buttock after radiation therapy in another case. In the patient with the ischemic stump, a deep inferior epigastric perforator flap was extended by 6 cm using the great saphenous vein harvested from the contralateral side, allowing successful coverage of the stump. In the patient with an intractable fistula on the buttock, a thoracodorsal artery and vein graft that was extended by 25 cm using the cephalic vein harvested from the right forearm to upper arm allowed successful sealing of the fistula. Results Circulation was satisfactory in both cases and both flaps survived. The operative procedure was straightforward. Conclusion Interpositional vein grafts may be a feasible option for the extension of island pedicle flaps to include the features of an island pedicle flap and a free flap.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"3 1","pages":"e50 - e54"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1669452","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49384228","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. Hayashi, K. Kawamura, Naoki Maegawa, Akito Nakanishi, Yasushi Mizutani, Akinori Okuda, Shinpei Kurata, Takamasa Shimizu, T. Kira, S. Omokawa, Yasuhito Tanaka
Abstract Background Deep venous thrombosis (DVT) of the lower leg is a widespread medical problem and is associated with hypercoagulable states. Although spontaneous thrombosis of the peroneal vein of a fibula flap is theoretically possible, few cases of asymptomatic DVT of the peroneal vein encountered during fibula flap harvest have been reported. Case Report A 45-year-old man presented with segmental bone defects of the tibia resulting from a fall. Treatment with a free vascularized osteocutaneous fibula flap from the contralateral lower leg was scheduled. Intraoperatively, diffuse thrombi were found in the peroneal venous system. After removal of thrombi, the fibula was grafted with anastomosis of the peroneal vessels to the recipient posterior tibial vessels. The skin paddle of the flap became congested after surgery; exsanguination of the skin paddle was performed with multiple skin incisions to relieve congestion. Despite treatment, the skin paddle became partially necrotic and additional skin grafting was performed. Bone union of the grafted fibula was achieved 5 months after initial surgery. Conclusions To the best of our knowledge, only six cases of pre-existing DVT in the peroneal vein of a free osteocutaneous fibula flap have been reported. In three of these cases, the fibula flap was successfully grafted. Although successful free osteocutaneous fibula flap surgery might be possible in patients with peroneal venous thrombosis, careful preoperative evaluation is recommended for high-risk patients.
{"title":"A Rare Case of Pre-Existing Deep Venous Thrombosis in the Peroneal Vein of a Free Osteocutaneous Fibula Flap","authors":"S. Hayashi, K. Kawamura, Naoki Maegawa, Akito Nakanishi, Yasushi Mizutani, Akinori Okuda, Shinpei Kurata, Takamasa Shimizu, T. Kira, S. Omokawa, Yasuhito Tanaka","doi":"10.1055/s-0038-1675410","DOIUrl":"https://doi.org/10.1055/s-0038-1675410","url":null,"abstract":"Abstract Background Deep venous thrombosis (DVT) of the lower leg is a widespread medical problem and is associated with hypercoagulable states. Although spontaneous thrombosis of the peroneal vein of a fibula flap is theoretically possible, few cases of asymptomatic DVT of the peroneal vein encountered during fibula flap harvest have been reported. Case Report A 45-year-old man presented with segmental bone defects of the tibia resulting from a fall. Treatment with a free vascularized osteocutaneous fibula flap from the contralateral lower leg was scheduled. Intraoperatively, diffuse thrombi were found in the peroneal venous system. After removal of thrombi, the fibula was grafted with anastomosis of the peroneal vessels to the recipient posterior tibial vessels. The skin paddle of the flap became congested after surgery; exsanguination of the skin paddle was performed with multiple skin incisions to relieve congestion. Despite treatment, the skin paddle became partially necrotic and additional skin grafting was performed. Bone union of the grafted fibula was achieved 5 months after initial surgery. Conclusions To the best of our knowledge, only six cases of pre-existing DVT in the peroneal vein of a free osteocutaneous fibula flap have been reported. In three of these cases, the fibula flap was successfully grafted. Although successful free osteocutaneous fibula flap surgery might be possible in patients with peroneal venous thrombosis, careful preoperative evaluation is recommended for high-risk patients.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"3 1","pages":"e74 - e77"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1675410","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47070856","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 Aim of this study was to determine the feasibility of using the saphenous artery (SA) and great saphenous vein (GSV) as recipient vessels, combined with anterolateral thigh (ALT) flap, in the treatment of skin defects after lower limb amputation. Methods From June 2015 to June 2017, 12 patients (average age, 33.5 years; range, 14–56 years; males, 9; female, 3) with large skin defects and symptoms of bone exposure in the proximal lower extremity were included in our study. The patients underwent emergency treatment and multiple debridement combined with vacuum sealing drainage therapy, followed by free flap surgery using the SA and GSV as recipient vessels, and ALT to cover the wound. Results All 12 patients who underwent free flap surgery survived, but two patients had distal flap necrosis, which, however, was salvaged with conservative measures. All patients were satisfied with the postoperative outcome at the 3 and 6-month follow-up. Conclusion The SA and GSV can be used as recipient vessels, combined with ALT, to treat skin defects after lower limb amputation.
{"title":"Using the Saphenous Artery and Great Saphenous Vein Combined with Anterolateral Thigh Flap to Treat Skin Defects after Amputation","authors":"L. Kong, H. Cheng, Tao Nie, Min Dai","doi":"10.1055/s-0038-1675407","DOIUrl":"https://doi.org/10.1055/s-0038-1675407","url":null,"abstract":"Abstract Background Aim of this study was to determine the feasibility of using the saphenous artery (SA) and great saphenous vein (GSV) as recipient vessels, combined with anterolateral thigh (ALT) flap, in the treatment of skin defects after lower limb amputation. Methods From June 2015 to June 2017, 12 patients (average age, 33.5 years; range, 14–56 years; males, 9; female, 3) with large skin defects and symptoms of bone exposure in the proximal lower extremity were included in our study. The patients underwent emergency treatment and multiple debridement combined with vacuum sealing drainage therapy, followed by free flap surgery using the SA and GSV as recipient vessels, and ALT to cover the wound. Results All 12 patients who underwent free flap surgery survived, but two patients had distal flap necrosis, which, however, was salvaged with conservative measures. All patients were satisfied with the postoperative outcome at the 3 and 6-month follow-up. Conclusion The SA and GSV can be used as recipient vessels, combined with ALT, to treat skin defects after lower limb amputation.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"3 1","pages":"e70 - e73"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1675407","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47109425","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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