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.
{"title":"Reconstruction of a Large Full-Thickness Alar Defect Using an Extended Free Composite Flap from the Pinna: A Case Report","authors":"Apostolos Vlachogiorgos, Titus Grecu, A. Salibi, D. Oudit","doi":"10.1055/s-0038-1675409","DOIUrl":"https://doi.org/10.1055/s-0038-1675409","url":null,"abstract":"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.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"03 1","pages":"e78 - e81"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1675409","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46589175","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}
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.
{"title":"Resurfacing of Two Separate Digital Defects Using a Single Fascial Free Flap with Neosyndactylization","authors":"F. Herrera, K. Horton, R. Brennan, G. Buncke, R. Buntic","doi":"10.1055/s-0038-1676773","DOIUrl":"https://doi.org/10.1055/s-0038-1676773","url":null,"abstract":"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.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"03 1","pages":"e87 - e90"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1676773","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47217884","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 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.
{"title":"Miniaturized Negative-Pressure Wound Therapy for Split-Thickness Skin Graft Donor Sites","authors":"Stuart L. Mitchell, E. Ray, P. Cordeiro","doi":"10.1055/s-0038-1668561","DOIUrl":"https://doi.org/10.1055/s-0038-1668561","url":null,"abstract":"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.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"3 1","pages":"e46 - e49"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1668561","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42259234","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}
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.
{"title":"Attempted Nose and Lip Replantation after Partial Animal Digestion","authors":"Trajan A. Cuellar, Catherine M. Westbom, D. Orgill, J. Pribaz, E. Caterson, S. Talbot","doi":"10.1055/s-0038-1676606","DOIUrl":"https://doi.org/10.1055/s-0038-1676606","url":null,"abstract":"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.","PeriodicalId":34024,"journal":{"name":"Journal of Reconstructive Microsurgery Open","volume":"03 1","pages":"e82 - e86"},"PeriodicalIF":0.0,"publicationDate":"2018-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1055/s-0038-1676606","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44363468","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 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.
{"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}
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.
{"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}
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.
{"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}
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.
{"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}
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.
{"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}
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.
{"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}
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