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Reconstruction of the postburn hand remains a challenge for surgeons. For cosmetic and functional requirements, the desired flap should be thin enough to ensure the flexibility of the hand. Conventional perforator flaps serve as a viable option when reconstructing the postburn hand to regain functionality. However, limitations include the discrepancy in tissue thickness and the difficulty with donor site closure. Thus, a preexpanded superthin skin perforator flap is an ideal choice for postburn hand reconstruction, with the trade-off being a longer treatment course (3-4 months), but with results that satisfy both patients and their surgeons., (Copyright © 2016 Elsevier Inc. All rights reserved.)

The deep inferior epigastric perforator (DIEP) flap can be used to cover large defects of the proximal lower extremity, abdominal wall, perineum, vulva, and buttock. Pre-expanding DIEP flaps cause a possible delay phenomenon improving vascularity, decrease donor site morbidity, and increase the area that can be covered. Pre-expansion requires staged procedures, has risk of extrusion and infection, causes temporary contour deformity during the expansion process, and requires a longer course. Pre-expanded DIEP flaps can be a useful flap with proper patient selection and planning., (Copyright © 2016 Elsevier Inc. All rights reserved.)

In case of failure of peripheral vascular access, classical alternatives are central venous or intraosseous access. We report a new site of vascular access necessitating no specific material. A 53-year-old patient with cirrhosis-induced coagulopathy, portal hypertension, and collateral abdominal portosystemic circulation required parenteral antibiotherapy. After failure of peripheral vein catheterization, he was addressed to our resuscitation room for central venous access. To avoid the risks associated with this invasive procedure, we chose an alternative approach. After skin preparation, a 20-gauge peripheral venous catheter was inserted in a dilated subcutaneous vein of abdominal wall. To our knowledge, it is the first human report of insertion of a catheter in a superficial vein of abdominal wall. It could be an alternative approach for vascular access after failure of peripheral venipuncture in patients with portal hypertension.

Identifying the position, course, and caliber of the dominant perforator is extremely valuable in the preoperative study for perforator surgery. Besides reliability, the ideal technique should offer low cost and high availability and reproducibility. It should be fast, easy to interpret, and free of morbidity. Multidetector-row computed tomography (MDTC) and magnetic resonance imaging (MRI) provide images that are easy to interpret, and assess the perforator's caliber and localization and its intramuscular course and anatomic relationships. Noncontrast MRI avoids radiation to the patient and eliminates the need for intravenous contrast medium. This article discusses this method and presents our experience., (Copyright © 2011. Published by Elsevier Inc.)

With technological advances in magnetic resonance angiography (MRA), spatial resolution of 1-mm perforating vessels can reliably be visualized and accurately located in reference to patients' anatomic landmarks without exposing patients to ionizing radiation or iodinated contrast, resulting in optimal perforator selection, improved flap design, and increased surgical efficiency. As their experience with MRA in breast reconstruction has increased, the authors have made changes to their MRA protocol that allow imaging of the vasculature in multiple donor sites (buttock, abdomen, and upper thigh) in one study. This article provides details of this experience with multiple donor site contrast-enhanced MRA., (Copyright © 2011 Elsevier Inc. All rights reserved.)

The clinical application of perforator-based flaps for microsurgical breast reconstruction has increased exponentially over the past 10 years. The benefits of the procedure are thought to be that it produces less postoperative pain, lowers abdominal morbidity, and allows for better preservation of muscles at the donor site compared with conventional musculocutaneous flaps. The disadvantages of perforator flaps are that they are more difficult to harvest, which can result in a longer operative time and higher costs. The vascular anatomy of the deep inferior epigastric artery and its perforating branches in the abdominal wall varies greatly not only among individuals but also from one side of the abdomen to the other. Perforator location, number, caliber, and the intramuscular trajectory of the branches all impact the design and harvest of the flap. The creation of a presurgical map of the vessels on the abdomen can facilitate surgical planning and could decrease operating room time, reduce intraoperative complications, and lead to improved outcomes. This article reviews the available techniques for preoperative planning with the currently available imaging modalities: hand-held Doppler, color Doppler (duplex) ultrasound, CT angiography, and MR angiography., (Copyright © 2010 Elsevier Inc. All rights reserved.)

The SAFELipo technique allows for safe, consistent liposuction that does not damage flap blood supply and is easily taught to, and reproducible by, other surgeons. The fat separation used in the SAFELipo technique is performed without suction, which prevents suction avulsion injury to blood vessels by the cannula. Blood vessels then remain intact while free, separated fat is aspirated with small diameter cannulas., (Copyright (c) 2010 Elsevier Inc. All rights reserved.)

Traditional abdominal plastic surgery results in a high rate of morbidity because of the necessity for a large undermining of the flap. In 2001, Saldanha, using the term "lipoabdominoplasty" for the first time, standardized a selective undermining, corresponding to 30% of the traditional undermining, between the medial borders of the rectus abdominal muscles. This procedure combines 2 traditional techniques, abdominoplasty and liposuction., (Copyright (c) 2010 Elsevier Inc. All rights reserved.)

Knowledge of abdominal anatomy is key to achieving optimal results in abdominoplasty. With adequate knowledge of the anatomy, the surgeon can tailor his or her techniques to fit the needs of the patient while still maximizing the blood supply to the abdominal flaps and minimizing complications., (Copyright (c) 2010 Elsevier Inc. All rights reserved.)

Abdominal wall defects pose a significant surgical challenge. The defect may result from trauma, infections, previous major surgery, or some combination of these etiologies. This article describes the Vacuum-Assisted Closure device (VAC, KCI, San Antonio, Texas) and how it can help in treating these defects.

An angiosome is a composite block of tissue that is supplied anatomically by source (segmental or distributing) vessels that span between the skin and bone. In addition to supplying the deep tissues, the source vessels of these angiosomes supply branches to the overlying skin, which pass either between the deep tissues or through the deep tissues, usually muscle, to pierce the outer layer of the deep fascia, usually at fixed skin sites. Hence, perforator flaps, when dissected to the underlying source vessels, involve tracing vessels either between the deep tissues, whether muscle tendon or bone, or through the deep tissues, usually muscle.