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Reconstruction of a Large Full-Thickness Alar Defect Using an Extended Free Composite Flap from the Pinna: A Case Report 应用耳廓游离复合材料扩展皮瓣重建大面积全层Alar缺损1例
Pub Date : 2018-07-01 DOI: 10.1055/s-0038-1675409
Apostolos Vlachogiorgos, Titus Grecu, A. Salibi, D. Oudit
Abstract Alar reconstruction can pose a challenging task in reconstructive surgery. Herein, we describe a case of a large full-thickness alar defect (involving the full- thickness of the left ala, 50% of the tip of the nose and extending over the left nasal sidewall and cheek) that was reconstructed using a contralateral free composite pinna flap, which extended into the right temple. A 70-year-old man with a squamous cell carcinoma to the left ala underwent surgical excision and immediate reconstruction with an extended contralateral free composite pinna flap based on a branch of the right superficial temporal artery supplying the helical root and the skin paddle of the supra-auricular area. The patient had an uneventful recovery and the result was aesthetically pleasing without compromising the nostril or the external nasal valve. Based on this case, a free composite flap incorporating the contralateral root of helix and adjacent tissue from the temporal region is an option that could be used in a single-staged procedure for reconstruction of large full-thickness alar defects. One of the challenges of performing free flaps in this area is the paucity of suitable recipient veins. This can be reliably addressed with a vein graft.
摘要Alar重建在重建手术中可能是一项具有挑战性的任务。在此,我们描述了一例大的全厚度鼻翼缺损(涉及左鼻翼的全厚度,鼻尖的50%,延伸到左鼻侧壁和脸颊),该缺损是使用对侧游离复合耳廓皮瓣重建的,该皮瓣延伸到右太阳穴。一名患有左额鳞状细胞癌的70岁男子接受了手术切除,并立即用扩展的对侧游离复合耳廓皮瓣重建,该皮瓣基于供应耳上区域螺旋根和皮肤桨的右颞浅动脉分支。患者恢复顺利,在不影响鼻孔或外鼻瓣的情况下,结果美观。基于这种情况,结合对侧螺旋根和颞区相邻组织的自由复合皮瓣是一种可用于重建大的全层鼻翼缺损的单阶段手术的选择。在这个区域进行游离皮瓣的挑战之一是缺乏合适的受体静脉。这可以通过静脉移植可靠地解决。
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引用次数: 0
Resurfacing of Two Separate Digital Defects Using a Single Fascial Free Flap with Neosyndactylization 单筋膜游离皮瓣修复两个分离的指关节缺损
Pub Date : 2018-07-01 DOI: 10.1055/s-0038-1676773
F. Herrera, K. Horton, R. Brennan, G. Buncke, R. Buntic
Abstract We report a case of a 20-year-old patient who sustained a mutilating crush injury to the left-hand index and ring finger volar surface measuring 5 × 6 cm from the distal end of the proximal phalanx to the fingertips. After thorough debridement and stabilization of the skeletal injury, a radial forearm fascia only free flap measuring 6 × 7 cm was used to resurface the distal soft tissue volar defect of two adjacent fingers. Digital nerve grafting was also required, and this was done using autologous nerve graft from the lateral antebrachial cutaneous nerve. This thin fascia only flap allows for stable soft tissue coverage and provides a gliding surface for the underlying tendons. The neosyndactylized digits were safely divided at 3-month follow-up, and excellent functional and aesthetic results were achieved. The radial forearm fascia is a thin, durable, and pliable tissue that is based on the radial artery as a vascular pedicle. We consider this free fascial flap as a valuable option for coverage of multiple complex distal digit injuries using a single flap and highly recommend its use.
摘要我们报告了一例20岁的患者,他左手食指和无名指掌表面被挤压伤,面积为5 × 从近端指骨的远端到指尖6cm。在彻底清创并稳定骨骼损伤后,仅前臂桡侧筋膜的游离皮瓣测量为6 × 7cm用于重建两个相邻手指的远端软组织掌侧缺损。还需要指神经移植,这是使用前臂外侧皮神经的自体神经移植完成的。这种薄的筋膜瓣可以稳定地覆盖软组织,并为下面的肌腱提供滑动表面。在3个月的随访中,新并指手指被安全地分开,并取得了良好的功能和美学效果。前臂桡侧筋膜是一种薄、耐用、柔韧的组织,以桡动脉为血管蒂。我们认为这种游离筋膜瓣是一种有价值的选择,可以使用单一皮瓣覆盖多个复杂的远端手指损伤,并强烈建议使用。
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引用次数: 0
Miniaturized Negative-Pressure Wound Therapy for Split-Thickness Skin Graft Donor Sites 小尺寸负压创面治疗裂厚皮肤供区
Pub Date : 2018-07-01 DOI: 10.1055/s-0038-1668561
Stuart L. Mitchell, E. Ray, P. Cordeiro
Abstract Background Multiple therapeutic options exist for the treatment of split-thickness skin graft (STSG) donor sites, but there is no clear consensus among surgeons about the best option. Negative-pressure wound therapy (NPWT) has rapidly gained in popularity since its invention. Recently, several miniaturized, single-patient NPWT (SP-NPWT) devices have become available. Compared with traditional NPWT devices, SP-NPWT devices are associated with equal wound healing capability and reliability, but offer several advantages. We present a series of 10 consecutive patients whose STSG donor sites were treated with a commercially available SP-NPWT device. Methods We performed a retrospective review for 10 consecutive patients who underwent STSG procedures and were treated with SP-NPWT devices. Results From 2015 to 2017, 10 consecutive patients underwent oncologic reconstruction using STSG and had their donor sites treated with SP-NPWT devices. The SP-NPWT dressing had been left in place for 2 weeks after surgery. The average donor site area measured 80 cm2 (range: 76–106 cm2). In all 10 patients, the donor sites healed uneventfully and with no complications. Conclusion Off-the-shelf, miniaturized, SP-NPWT systems appear to be at least as effective as traditional dressings for STSG donor sites and require no maintenance (skilled nursing or dressing changes). Compared with larger and less portable standard NPWT devices, SP-NPWT dressing systems provide a potential cost benefit as well as enhanced convenience and portability.
背景裂厚皮肤移植(STSG)供区治疗存在多种治疗选择,但外科医生对最佳选择没有明确的共识。负压伤口治疗(NPWT)自发明以来迅速普及。最近,一些小型化的单患者NPWT (SP-NPWT)设备已经上市。与传统的NPWT设备相比,SP-NPWT设备具有相同的伤口愈合能力和可靠性,但具有几个优点。我们介绍了连续10例STSG供体部位用市售SP-NPWT装置治疗的患者。方法:我们对连续10例接受STSG手术并使用SP-NPWT装置治疗的患者进行回顾性研究。结果2015年至2017年,连续10例患者使用STSG进行肿瘤重建,并使用SP-NPWT装置治疗其供体部位。SP-NPWT敷料在手术后放置2周。平均供体面积为80 cm2(范围:76-106 cm2)。在所有10例患者中,供体部位均顺利愈合,无并发症。现成的、小型化的SP-NPWT系统对于STSG供体部位至少与传统敷料一样有效,并且无需维护(熟练的护理或更换敷料)。与体积更大、便携性更差的标准NPWT设备相比,SP-NPWT敷料系统提供了潜在的成本效益,并增强了便利性和便携性。
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引用次数: 0
Attempted Nose and Lip Replantation after Partial Animal Digestion 动物部分消化后尝试鼻唇再植
Pub Date : 2018-07-01 DOI: 10.1055/s-0038-1676606
Trajan A. Cuellar, Catherine M. Westbom, D. Orgill, J. Pribaz, E. Caterson, S. Talbot
Abstract We report a case of a 71-year-old female patient who sustained a severe midface soft tissue avulsion injury from a family canine. The removed tissue was recovered from the canine's digestive tract and transferred to the hospital where emergent microvascular replantation was performed. The tissue survived for 72 hours, but then developed vascular compromise. Despite aggressive revision of multiple anastomoses with extensive use of vein grafting, the replanted segment was lost. Reconstruction then proceeded along traditional lines with an acceptable cosmetic outcome and good functional outcomes.
摘要我们报告了一例71岁的女性患者,她遭受了一只家庭犬的严重面中部软组织撕脱伤。取出的组织从犬的消化道中回收,并转移到医院进行紧急微血管再植。该组织存活了72小时,但随后出现了血管损伤。尽管广泛使用静脉移植对多处吻合进行了积极的修复,但再植段还是丢失了。然后重建沿着传统路线进行,具有可接受的外观效果和良好的功能效果。
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引用次数: 0
Bladder Outlet Obstruction as a Cause for Late Total Flap Failure in Pelvic Reconstruction with a VRAM VRAM骨盆重建术中膀胱出口梗阻是导致晚期全皮瓣失败的原因
Pub Date : 2018-07-01 DOI: 10.1055/s-0038-1669453
Michael J. Stein, M. Momtazi
Abstract Background A 67-year-old man presented with abrupt failure of a pedicled vertical rectus abdominus myocutaneous (VRAM) flap 13 days postoperatively. Methods The patient underwent pelvic reconstruction with a pedicled VRAM flap following sacral chordoma and abdominoperineal resection. The flap remained well perfused and viable until postoperative day 13, at which point the patient was noted to become systemically unwell with fever, chills, and abdominal pain. This clinically coincided with prompt arterial and venous insufficiency of the VRAM flap. Results Computed tomography of the abdomen was ordered to rule out a pelvic collection and revealed an inflated Foley catheter in the bulbar urethra. This was associated with marked distention of the bladder and bilateral hydronephrosis. Direct compression of the deep inferior epigastric pedicle by the bladder neck was noted. Conclusion The case highlights the importance of considering bladder outlet obstruction and subsequent distention as a cause of pedicle compression and VRAM flap failure following pelvic reconstruction.
摘要背景 一位67岁的男性在术后13天出现带蒂垂直腹直肌肌皮瓣突然失效。方法 患者在骶骨脊索瘤和腹会阴切除术后接受了带蒂VRAM皮瓣的骨盆重建。皮瓣在术后第13天之前一直保持良好的灌注和存活,此时患者出现全身不适,伴有发烧、发冷和腹痛。这在临床上与VRAM皮瓣的即时动脉和静脉功能不全相吻合。后果 腹部的计算机断层扫描被要求排除骨盆集合,并显示球尿道中有一根膨胀的Foley导管。这与明显的膀胱扩张和双侧肾积水有关。膀胱颈直接压迫上腹部深部下蒂。结论 该病例强调了将膀胱出口梗阻和随后的扩张视为骨盆重建后椎弓根受压和VRAM皮瓣失败的原因的重要性。
{"title":"Bladder Outlet Obstruction as a Cause for Late Total Flap Failure in Pelvic Reconstruction with a VRAM","authors":"Michael J. Stein, M. Momtazi","doi":"10.1055/s-0038-1669453","DOIUrl":"https://doi.org/10.1055/s-0038-1669453","url":null,"abstract":"Abstract Background A 67-year-old man presented with abrupt failure of a pedicled vertical rectus abdominus myocutaneous (VRAM) flap 13 days postoperatively. Methods The patient underwent pelvic reconstruction with a pedicled VRAM flap following sacral chordoma and abdominoperineal resection. The flap remained well perfused and viable until postoperative day 13, at which point the patient was noted to become systemically unwell with fever, chills, and abdominal pain. This clinically coincided with prompt arterial and venous insufficiency of the VRAM flap. Results Computed tomography of the abdomen was ordered to rule out a pelvic collection and revealed an inflated Foley catheter in the bulbar urethra. This was associated with marked distention of the bladder and bilateral hydronephrosis. Direct compression of the deep inferior epigastric pedicle by the bladder neck was noted. Conclusion The case highlights the importance of considering bladder outlet obstruction and subsequent distention as a cause of pedicle compression and VRAM flap failure following pelvic reconstruction.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"3 1","pages":"e55 - e57"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1669453","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47111126","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}
引用次数: 0
Prediction of Flap Necrosis by Using Indocyanine Green Videoangiography in Cases of Venous Occlusion in the Epigastric Flap Model of the Rat 应用吲哚菁绿血管造影预测大鼠上腹部静脉闭塞皮瓣坏死
Pub Date : 2018-07-01 DOI: 10.1055/s-0038-1675408
L. Ritschl, Leonard H. Schmidt, A. Fichter, A. Hapfelmeier, A. Kanatas, K. Wolff, T. Mücke
Abstract Background A compromised free flap perfusion attributable to vascular occlusion requires immediate operative correction. Indocyanine green (ICG) videoangiography may reduce the risk of partial skin flap necrosis in high-risk free flaps in patients undergoing head and neck reconstruction. The purpose of this study was to determine the role of ICG in cases of venous congestion in a rat model. Methods A standardized epigastric flap was raised and repositioned in 35 rats. Full venous occlusion of the draining superficial inferior epigastric vein was temporarily applied for 4, 5, 6, or 7 hours. Blood flow measurements including simultaneous laser-Doppler flowmetry and tissue spectrophotometry (oxygen-to-see [O2C]) and ICG videoangiography with the FLOW 800 tool were performed before flap raising, after temporary venous stasis, and after clinical monitoring for 1 week. The Youden index computed from the receiver operating characteristic curve was used to define an optimal cutoff value for necrosis prediction after 4 and 6 hours of stasis. Results The ICG videoangiography with the FLOW 800 tool was found to be superior to O2C in the prediction of flap necrosis. The accuracy of prediction was moderate after an interval of 4 hours of stasis (area under the curve [AUC] = 0.661; 95% confidence interval [CI]: 0.489–0.834) and good after 6 hours of stasis (AUC = 0.787; 95% CI: 0.65–0.915). Conclusions The O2C does not reliably predict tissue necrosis in cases of venous congestion. ICG videoangiography is a valuable tool that can predict clinical outcome and provide guidance on whether to salvage a congested flap.
背景血管闭塞导致的游离皮瓣灌注受损需要立即手术纠正。吲哚菁绿(ICG)血管造影可降低头颈部重建术患者高危游离皮瓣部分皮瓣坏死的风险。本研究的目的是确定ICG在大鼠静脉充血模型中的作用。方法对35只大鼠进行标准化上腹部皮瓣的取出和复位。暂时对腹壁下浅静脉进行全静脉闭塞引流,持续4、5、6或7小时。血流测量包括同步激光多普勒血流测量和组织分光光度法(氧-视[O2C])以及使用flow 800工具进行ICG血管成像,分别在皮瓣抬高前、暂时静脉停滞后和临床监测1周后进行。根据受者工作特征曲线计算的约登指数用于确定4和6小时停滞后坏死预测的最佳临界值。结果使用FLOW 800工具进行ICG血管造影对皮瓣坏死的预测优于O2C。静息时间间隔4小时后,预测准确度为中等(曲线下面积[AUC] = 0.661;95%可信区间[CI]: 0.489-0.834),静息6小时后良好(AUC = 0.787;95% ci: 0.65-0.915)。结论O2C不能可靠地预测静脉充血患者的组织坏死。ICG血管造影是一种有价值的工具,可以预测临床结果,并为是否挽救充血皮瓣提供指导。
{"title":"Prediction of Flap Necrosis by Using Indocyanine Green Videoangiography in Cases of Venous Occlusion in the Epigastric Flap Model of the Rat","authors":"L. Ritschl, Leonard H. Schmidt, A. Fichter, A. Hapfelmeier, A. Kanatas, K. Wolff, T. Mücke","doi":"10.1055/s-0038-1675408","DOIUrl":"https://doi.org/10.1055/s-0038-1675408","url":null,"abstract":"Abstract Background A compromised free flap perfusion attributable to vascular occlusion requires immediate operative correction. Indocyanine green (ICG) videoangiography may reduce the risk of partial skin flap necrosis in high-risk free flaps in patients undergoing head and neck reconstruction. The purpose of this study was to determine the role of ICG in cases of venous congestion in a rat model. Methods A standardized epigastric flap was raised and repositioned in 35 rats. Full venous occlusion of the draining superficial inferior epigastric vein was temporarily applied for 4, 5, 6, or 7 hours. Blood flow measurements including simultaneous laser-Doppler flowmetry and tissue spectrophotometry (oxygen-to-see [O2C]) and ICG videoangiography with the FLOW 800 tool were performed before flap raising, after temporary venous stasis, and after clinical monitoring for 1 week. The Youden index computed from the receiver operating characteristic curve was used to define an optimal cutoff value for necrosis prediction after 4 and 6 hours of stasis. Results The ICG videoangiography with the FLOW 800 tool was found to be superior to O2C in the prediction of flap necrosis. The accuracy of prediction was moderate after an interval of 4 hours of stasis (area under the curve [AUC] = 0.661; 95% confidence interval [CI]: 0.489–0.834) and good after 6 hours of stasis (AUC = 0.787; 95% CI: 0.65–0.915). Conclusions The O2C does not reliably predict tissue necrosis in cases of venous congestion. ICG videoangiography is a valuable tool that can predict clinical outcome and provide guidance on whether to salvage a congested flap.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"3 1","pages":"e62 - e69"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1675408","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58064459","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}
引用次数: 1
A Novel Technique to Perform Microvascular Anastomosis Revisions without Clamps 一种无需夹钳进行微血管吻合修复的新技术
Pub Date : 2018-07-01 DOI: 10.1055/s-0038-1669451
Amro A Harb, Maxwell Levi, Y. Akelina, R. K. Kadiyala, J. Ascherman
Abstract Background For surgeons learning microsurgery, uneven spacing between sutures while performing microvascular arterial anastomoses is one of the most common technical errors made that can lead to leakage. Based on the previous surgical experience and training of these surgeons, the first option chosen to prevent bleeding is to place a vascular clamp proximal to the anastomosis and an additional suture at the site of the leak. Because this technique may have technical and thrombosis concerns, our study proposes an alternative technique of performing post-anastomotic revisions without the use of clamps. Methods Our technique involves placing a cotton-tipped applicator under the artery and lifting it to partially occlude flow within the vessel as an additional suture is placed at the leakage site to complete the revision. One-hundred eighty-four microvascular anastomoses were performed on the femoral arteries of 92 Sprague-Dawley rats, and of the 184 anastomoses, 147 had a leak and required a post-anastomotic revision. All revisions were completed using our technique, and no clamps were used during any of the revisions. Results Of the 147 post-anastomotic revisions completed using our technique, 141 (95.9%) were patent 2 hours post-revision. The mean operating time for the revisions was 5:03 minutes (range, 1:44–6:30 minutes). Conclusion Our technique of partially occluding an artery with a cotton-tipped applicator while performing a post-anastomotic revision is a safe and effective alternative to using vascular clamps. Our technique may also reduce technical errors and have a low risk of causing thrombosis when completing post-anastomotic revisions.
摘要背景 对于学习显微外科的外科医生来说,在进行微血管-动脉吻合时,缝线之间的不均匀间距是最常见的技术错误之一,可能导致渗漏。根据这些外科医生以前的手术经验和培训,预防出血的第一个选择是在吻合口附近放置血管夹,并在渗漏部位额外缝合。由于这项技术可能涉及技术和血栓形成问题,我们的研究提出了一种不使用夹子进行吻合后翻修的替代技术。方法 我们的技术包括在动脉下放置一个棉头敷贴器,并将其提起,以部分阻断血管内的流动,同时在渗漏部位放置一条额外的缝合线以完成翻修。对92只Sprague-Dawley大鼠的股动脉进行了184次微血管吻合,在184次吻合中,147次发生渗漏,需要进行吻合后翻修。所有修订都是使用我们的技术完成的,在任何修订过程中都没有使用夹具。后果 在使用我们的技术完成的147例吻合后翻修中,141例(95.9%)在翻修后2小时内获得专利。修订的平均操作时间为5:03分钟(范围为1:44-6:30分钟)。结论 我们的技术是在进行吻合口后翻修时使用棉头涂抹器部分闭塞动脉,这是使用血管夹的一种安全有效的替代方法。我们的技术还可以减少技术错误,并且在完成吻合口后翻修时导致血栓形成的风险很低。
{"title":"A Novel Technique to Perform Microvascular Anastomosis Revisions without Clamps","authors":"Amro A Harb, Maxwell Levi, Y. Akelina, R. K. Kadiyala, J. Ascherman","doi":"10.1055/s-0038-1669451","DOIUrl":"https://doi.org/10.1055/s-0038-1669451","url":null,"abstract":"Abstract Background For surgeons learning microsurgery, uneven spacing between sutures while performing microvascular arterial anastomoses is one of the most common technical errors made that can lead to leakage. Based on the previous surgical experience and training of these surgeons, the first option chosen to prevent bleeding is to place a vascular clamp proximal to the anastomosis and an additional suture at the site of the leak. Because this technique may have technical and thrombosis concerns, our study proposes an alternative technique of performing post-anastomotic revisions without the use of clamps. Methods Our technique involves placing a cotton-tipped applicator under the artery and lifting it to partially occlude flow within the vessel as an additional suture is placed at the leakage site to complete the revision. One-hundred eighty-four microvascular anastomoses were performed on the femoral arteries of 92 Sprague-Dawley rats, and of the 184 anastomoses, 147 had a leak and required a post-anastomotic revision. All revisions were completed using our technique, and no clamps were used during any of the revisions. Results Of the 147 post-anastomotic revisions completed using our technique, 141 (95.9%) were patent 2 hours post-revision. The mean operating time for the revisions was 5:03 minutes (range, 1:44–6:30 minutes). Conclusion Our technique of partially occluding an artery with a cotton-tipped applicator while performing a post-anastomotic revision is a safe and effective alternative to using vascular clamps. Our technique may also reduce technical errors and have a low risk of causing thrombosis when completing post-anastomotic revisions.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"3 1","pages":"e58 - e61"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1669451","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43632321","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}
引用次数: 2
Lymphatic Venous Anastomosis Can Release the Lymphedema-Associated Pain of Upper Limb after Breast Cancer Treatment 淋巴静脉吻合可缓解癌症治疗后上肢淋巴管相关疼痛
Pub Date : 2018-01-01 DOI: 10.1055/s-0037-1607306
M. Mihara, H. Hara, H. Zhou, S. Tange, K. Kikuchi, Yoshihisa Kawakami
Abstract Background Sometimes, chronic pain in the arm or chest could occur in postmastectomy patients. Although the pathology of the pain is unclear, the involvement of neurological mechanism, cicatricial contracture, or lymphedema is considered. The purpose of this study was to investigate the effectiveness of lymphaticovenous anastomosis (LVA) in reducing chronic pain in upper limb lymphedema patients. Patients and Methods This prospective study included consecutive 13 patients with upper limb lymphedema who received LVA. Preoperative lymphoscintigraphy and indocyanine green lymphography were performed. Pre- and postoperative pain scale were recorded using the visual analog scale (VAS). The number of cellulitis 1 year before and after LVA were compared. LVA was performed under local anesthesia, using a surgical microscope, and 12–0 nylon suture was used in the anastomosis. Results Two out of 13 patients were excluded from this study, and 11 patients were subjected to this study. All subjects were females with an average age of 64.3 years. The average lymphedema duration was 76.7 months. The average number of LVA sites was 5.7 per limb and the average follow-up period was 10.6 months. The average pre- and postoperative VAS scores were 3.5 and 0.59, respectively; the significant decrease was observed (p = 0.017). Three of the patients who had experienced cellulitis (once, twice, and four times, respectively) did not develop any cellulitis after LVA. Conclusion LVA was shown to be an effective surgical remedy for treating the lymphedema-associated pain of upper limb after breast cancer treatment.
摘要背景 有时,胸骨切除术后患者可能会出现手臂或胸部的慢性疼痛。虽然疼痛的病理学尚不清楚,但考虑了神经机制、瘢痕挛缩或淋巴水肿的影响。本研究的目的是探讨淋巴管静脉吻合术(LVA)在减轻上肢淋巴水肿患者慢性疼痛方面的有效性。患者和方法 这项前瞻性研究包括连续13例接受LVA治疗的上肢淋巴水肿患者。术前进行淋巴闪烁扫描和吲哚青绿淋巴造影。使用视觉模拟量表(VAS)记录术前和术后疼痛量表。比较LVA前后1年蜂窝组织炎的数量。LVA在局部麻醉下使用外科显微镜进行,吻合时使用12-0尼龙缝线。后果 13名患者中有2名被排除在本研究之外,11名患者接受了本研究。所有受试者均为女性,平均年龄64.3岁。淋巴水肿的平均持续时间为76.7个月。LVA部位的平均数量为每条肢体5.7个,平均随访期为10.6个月。术前和术后VAS评分平均值分别为3.5和0.59;观察到显著下降(p = 0.017)。三名经历过蜂窝组织炎的患者(分别为一次、两次和四次)在LVA后没有出现任何蜂窝组炎。结论 LVA是治疗乳腺癌症术后上肢淋巴水肿相关疼痛的有效手术方法。
{"title":"Lymphatic Venous Anastomosis Can Release the Lymphedema-Associated Pain of Upper Limb after Breast Cancer Treatment","authors":"M. Mihara, H. Hara, H. Zhou, S. Tange, K. Kikuchi, Yoshihisa Kawakami","doi":"10.1055/s-0037-1607306","DOIUrl":"https://doi.org/10.1055/s-0037-1607306","url":null,"abstract":"Abstract Background Sometimes, chronic pain in the arm or chest could occur in postmastectomy patients. Although the pathology of the pain is unclear, the involvement of neurological mechanism, cicatricial contracture, or lymphedema is considered. The purpose of this study was to investigate the effectiveness of lymphaticovenous anastomosis (LVA) in reducing chronic pain in upper limb lymphedema patients. Patients and Methods This prospective study included consecutive 13 patients with upper limb lymphedema who received LVA. Preoperative lymphoscintigraphy and indocyanine green lymphography were performed. Pre- and postoperative pain scale were recorded using the visual analog scale (VAS). The number of cellulitis 1 year before and after LVA were compared. LVA was performed under local anesthesia, using a surgical microscope, and 12–0 nylon suture was used in the anastomosis. Results Two out of 13 patients were excluded from this study, and 11 patients were subjected to this study. All subjects were females with an average age of 64.3 years. The average lymphedema duration was 76.7 months. The average number of LVA sites was 5.7 per limb and the average follow-up period was 10.6 months. The average pre- and postoperative VAS scores were 3.5 and 0.59, respectively; the significant decrease was observed (p = 0.017). Three of the patients who had experienced cellulitis (once, twice, and four times, respectively) did not develop any cellulitis after LVA. Conclusion LVA was shown to be an effective surgical remedy for treating the lymphedema-associated pain of upper limb after breast cancer treatment.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"03 1","pages":"e1 - e7"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0037-1607306","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42994397","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}
引用次数: 1
Free Functional Gracilis Muscle Transfer for Reconstruction during Forearm Reimplantation in a Patient with Deep Venous Thrombosis 游离功能性股薄肌移植在深静脉血栓患者前臂再植中的应用
Pub Date : 2018-01-01 DOI: 10.1055/s-0038-1642625
D. Morita, Hitoshi Nemoto, Kenta Miyabe, Seiko Nakae, T. Kuroki, T. Yasuda
Abstract Background Free muscle transfer is the gold standard procedure for functional upper extremity reconstruction. The gracilis muscle is one of the most commonly used donor muscles due to the reduced morbidity of its harvest. Case We performed a free gracilis muscle flap transfer for functional reconstruction of a forearm after reimplantation in a 62-year-old man with a known deep venous thrombosis (DVT). Result Perioperative DVT is a potentially fatal complication due to the risk of pulmonary embolism. There were many risk factors in this case for venous thromboembolism around the time of free flap transfer including the length of the operation, intraoperative position changes, and perioperative suspension of anticoagulants. We divided the operation into two stages to reduce operative times, chose a donor site that did not require intraoperative position changes, placed an indwelling temporary filter in the inferior vena cava preoperatively, and continued administration of anticoagulant intraoperatively. Conclusion With these measures, we safely and successfully performed free gracilis muscle transfer in a patient with DVT.
摘要背景 游离肌肉移植是上肢功能重建的黄金标准程序。股薄肌是最常用的供体肌肉之一,因为它可以降低收获时的发病率。案例 我们对一名患有已知深静脉血栓形成(DVT)的62岁男子进行了游离股薄肌皮瓣移植,以重建前臂的功能。后果 由于肺栓塞的风险,围手术期DVT是一种潜在的致命并发症。在这种情况下,在游离皮瓣转移时发生静脉血栓栓塞有许多风险因素,包括手术时间、术中位置变化和围手术期抗凝药物的暂停。我们将手术分为两个阶段,以减少手术时间,选择不需要术中位置改变的供体部位,术前在下腔静脉放置临时留置过滤器,并在术中继续使用抗凝剂。结论 通过这些措施,我们在一名DVT患者中安全成功地进行了股薄肌游离移植。
{"title":"Free Functional Gracilis Muscle Transfer for Reconstruction during Forearm Reimplantation in a Patient with Deep Venous Thrombosis","authors":"D. Morita, Hitoshi Nemoto, Kenta Miyabe, Seiko Nakae, T. Kuroki, T. Yasuda","doi":"10.1055/s-0038-1642625","DOIUrl":"https://doi.org/10.1055/s-0038-1642625","url":null,"abstract":"Abstract Background Free muscle transfer is the gold standard procedure for functional upper extremity reconstruction. The gracilis muscle is one of the most commonly used donor muscles due to the reduced morbidity of its harvest. Case We performed a free gracilis muscle flap transfer for functional reconstruction of a forearm after reimplantation in a 62-year-old man with a known deep venous thrombosis (DVT). Result Perioperative DVT is a potentially fatal complication due to the risk of pulmonary embolism. There were many risk factors in this case for venous thromboembolism around the time of free flap transfer including the length of the operation, intraoperative position changes, and perioperative suspension of anticoagulants. We divided the operation into two stages to reduce operative times, chose a donor site that did not require intraoperative position changes, placed an indwelling temporary filter in the inferior vena cava preoperatively, and continued administration of anticoagulant intraoperatively. Conclusion With these measures, we safely and successfully performed free gracilis muscle transfer in a patient with DVT.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"03 1","pages":"e21 - e24"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1642625","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43792385","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}
引用次数: 0
Digital Artery Massage for Improving Ischemia after Distal Digital Replantation Surgery 指动脉按摩改善指远端再植术后缺血
Pub Date : 2018-01-01 DOI: 10.1055/s-0038-1642627
Y. Niimi, Hiroshi Ito, K. Ikeda, M. Kirita, Junji Hishiyama, H. Sakurai
Abstract Distal digital replantation is frequently associated with arterial thrombosis and/or spasm, leading ischemia in the replanted tissue. This report introduced a rescue technique for ischemia after distal digital replantation without reanastomosis. Two males, 64 and 51 years old, underwent Ishikawa subzone II finger amputations. Microsurgical replantations with vein grafts were performed. Intraoperatively, heparin and urokinase through intra-arterial infusion were given for one week. At 40 to 48 hours after surgeries, the replanted digits developed ischemia; massaging digital arteries at the proximal phalanx regions with running warm water was immediately initiated and ischemia was improved. In both cases, the replanted tissues were rescued, though a partial necrosis requiring full-thickness skin grafting was found in one case. This massage was easily, safely, and effectively performed without complications and was applicable in cases with ischemia after distal digital replantation, especially where reanastomosis was unfeasible.
摘要指远端再植经常与动脉血栓形成和/或痉挛有关,导致再植组织缺血。本报告介绍了一种无需再吻合的指端再植术后局部缺血的抢救技术。两名男性,64岁和51岁,接受了石川Ⅱ区手指截肢手术。采用静脉移植物进行显微外科再植。术中通过动脉内输注肝素和尿激酶一周。术后40至48小时,再植指出现局部缺血;立即开始用流动的温水按摩指骨近端区域的指动脉,并且局部缺血得到改善。在这两个病例中,尽管在一个病例中发现了需要全层皮肤移植的部分坏死,但再植组织都得到了挽救。这种按摩简单、安全、有效,没有并发症,适用于指远端再植后的局部缺血病例,尤其是在无法再吻合的情况下。
{"title":"Digital Artery Massage for Improving Ischemia after Distal Digital Replantation Surgery","authors":"Y. Niimi, Hiroshi Ito, K. Ikeda, M. Kirita, Junji Hishiyama, H. Sakurai","doi":"10.1055/s-0038-1642627","DOIUrl":"https://doi.org/10.1055/s-0038-1642627","url":null,"abstract":"Abstract Distal digital replantation is frequently associated with arterial thrombosis and/or spasm, leading ischemia in the replanted tissue. This report introduced a rescue technique for ischemia after distal digital replantation without reanastomosis. Two males, 64 and 51 years old, underwent Ishikawa subzone II finger amputations. Microsurgical replantations with vein grafts were performed. Intraoperatively, heparin and urokinase through intra-arterial infusion were given for one week. At 40 to 48 hours after surgeries, the replanted digits developed ischemia; massaging digital arteries at the proximal phalanx regions with running warm water was immediately initiated and ischemia was improved. In both cases, the replanted tissues were rescued, though a partial necrosis requiring full-thickness skin grafting was found in one case. This massage was easily, safely, and effectively performed without complications and was applicable in cases with ischemia after distal digital replantation, especially where reanastomosis was unfeasible.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"03 1","pages":"e25 - e27"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1642627","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47307857","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}
引用次数: 0
期刊
Journal of Reconstructive Microsurgery Open
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