113,275 results on '"Surgical flaps"'
Search Results
302. Postoperative Urinary Complications in Head and Neck Free Flap Reconstructive Surgery.
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Chan, Kimberly, Keane, Allison, Pradhan, Sandeep, King, Tonya, Moroco, Annie, Goyal, Neerav, and Choi, Karen Y.
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NECK surgery , *HEAD surgery , *SURGICAL flaps , *POSTOPERATIVE care , *PLASTIC surgery , *RETROSPECTIVE studies , *FISHER exact test , *MANN Whitney U Test , *CATHETER-associated urinary tract infections , *URINARY catheters - Abstract
Objective: The purpose of this study is to evaluate the postoperative urinary complications and the optimal timing of foley catheter removal in patients who underwent free flap reconstructive surgery for head and neck pathology. Methods: A retrospective case-control study of head and neck patients who underwent free flap reconstructive surgery at a single institution between January 2009 and December 2021 was conducted. Patient risk factors for postoperative urinary retention (POUR) were analyzed. Fisher Exact and Wilcoxon Rank Sum tests were used to evaluate rates of foley replacement, straight catheterization, and catheter-associated urinary tract infection (CAUTI) and associated risk factors. Results: Two hundred and eleven patients were included in this study. Older age, lower BMI, lower intraoperative fluid volumes, and need for straight catheterization were statistically significant for POUR requiring foley replacement. Shorter total (P =.04) and postoperative (P =.01) foley duration showed statistical significance for POUR requiring straight catheterization. About 60% of patients who had straight catheterization required a foley replacement (P <.001). Only one patient (0.5%) developed a urinary tract infection (UTI). Conclusion: Foley catheter duration impacts the risk of POUR requiring straight catheterization and subsequently, foley replacement. Optimal timing for foley catheter removal in the postoperative period remains to be elucidated. Removal of catheters between 21 and 48 hours after surgery may decrease the risk of POUR without increasing the rate of CAUTI in patients with head and neck pathology undergoing free flap reconstructive surgery. [ABSTRACT FROM AUTHOR]
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- 2024
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303. A Pilot Study: Free Flap Atrophy in Tongue Reconstruction Using 3D Volumetric Analysis.
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Gewirtz, Jordan I., Zhao, Songzhu, Brock, Guy, Luttrull, Michael D., Sethuraman, Shruthi, Kang, Stephen Y., VanKoevering, Kyle K., and Seim, Nolan B.
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PILOT projects , *STATISTICS , *FOREARM , *OBESITY , *SURGICAL flaps , *THREE-dimensional imaging , *CROSS-sectional method , *PLASTIC surgery , *VOLUMETRIC analysis , *THIGH , *POSTOPERATIVE care , *ATROPHY , *RISK assessment , *DESCRIPTIVE statistics , *RESEARCH funding , *MEDICAL artifacts , *GLOSSECTOMY , *ADIPOSE tissues ,TONGUE surgery - Abstract
Objective: To identify factors influencing volume change in non-osseous oral free flap reconstruction using postoperative cross-sectional imaging and 3-dimensional segmentation of the free flap's muscular and adipose tissue content. Methods: Oral tongue free flap reconstruction cases (2014-2019) were reviewed with inclusion of patients with 3 postoperative, cross-sectional imaging studies with 1 within 6 months, 1 within 1 year, and 1 that spanned 2 years post-reconstruction. Exclusion criteria included recurrence, significant dental artifact, bony reconstruction, and flap failure. Demographics, risk factors, and surgical/clinical treatments were identified. Flap volumes were measured using Materialise MIMICS. Results: Twenty-two patients met strict inclusion criteria. Four flaps were anterolateral thighs and 18 radial forearms. Median percent volume loss greater than 2 years post-reconstruction was 53.2% overall, 58.1% for radial forearms, and 45.4% for ALTs (21.4% for adipose tissue and 57.4% for muscular tissue). Univariate analysis revealed glossectomy amount was associated with percent volume loss (P =.0417). Each successive postoperative month, the flap decreased by 1.54% (P <.0001). Checking for the interaction effect, the percent of flap loss across time was different for glossectomy amount (P =.0093), obesity status (P =.0431), and base of tongue involvement (P =.0472). Conclusion: Glossectomy type, and thus flap size, is a positive predictor for flap atrophy. Obesity and base of tongue involvement are negative predictors for flap atrophy. The amount of tissue loss may differ from classical teachings with median atrophy 53.2% greater than 2 years post-reconstruction. [ABSTRACT FROM AUTHOR]
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- 2024
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304. The Perfect Timing—Immediate versus Delayed Microvascular Reconstruction of the Mandible.
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Thiem, Daniel G. E., Siegberg, Fabia, Vinayahalingam, Shankeeth, Blatt, Sebastian, Krüger, Maximilian, Lethaus, Bernd, Al-Nawas, Bilal, Zimmerer, Rüdiger, and Kämmerer, Peer W.
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ADJUVANT treatment of cancer , *RETROSPECTIVE studies , *CANCER patients , *TREATMENT effectiveness , *DESCRIPTIVE statistics , *CHEMORADIOTHERAPY , *DECISION making in clinical medicine , *SURGICAL flaps , *SOCIAL integration , *QUALITY of life , *PLASTIC surgery , *SOCIODEMOGRAPHIC factors , *TIME , *ECONOMIC aspects of diseases ,MANDIBLE surgery - Abstract
Simple Summary: This study evaluated the clinical and economic impacts of immediate versus delayed reconstruction of the mandible in patients following resection. Data from two German oral and maxillofacial surgery university departments provided insights into patient demographics, surgical details, medical histories, and flap survival rates. Our analysis of 177 reconstructions (72 immediate, 105 delayed) revealed no significant difference in flap survival based on timing or radiotherapy. However, immediate reconstruction is less cost-intensive. The findings aim to inform surgical decision-making, balancing patient health and cost-effectiveness. Crucially, only 18% of patients achieved functional masticatory rehabilitation, underscoring the need for improved post-surgical care pathways. In this retrospective study, the clinical and economic implications of microvascular reconstruction of the mandible were assessed, comparing immediate versus delayed surgical approaches. Utilizing data from two German university departments for oral and maxillofacial surgery, the study included patients who underwent mandibular reconstruction following continuity resection. The data assessed included demographic information, reconstruction details, medical history, dental rehabilitation status, and flap survival rates. In total, 177 cases (131 male and 46 females; mean age: 59 years) of bony free flap reconstruction (72 immediate and 105 delayed) were included. Most patients received adjuvant treatment (81% with radiotherapy and 51% combined radiochemotherapy), primarily for tumor resection. Flap survival was not significantly influenced by the timing of reconstruction, radiotherapy status, or the mean interval (14.5 months) between resection and reconstruction. However, immediate reconstruction had consumed significantly fewer resources. The rate of implant-supported masticatory rehabilitation was only 18% overall. This study suggests that immediate jaw reconstruction is economically advantageous without impacting flap survival rates. It emphasizes patient welfare as paramount over financial aspects in clinical decisions. Furthermore, this study highlights the need for improved pathways for masticatory rehabilitation, as evidenced by only 18% of patients with implant-supported dentures, to enhance quality of life and social integration. [ABSTRACT FROM AUTHOR]
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- 2024
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305. Flap Closure in Neonatal Neural Tube Defects: Challenges in Flap Design and Lessons Learnt.
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Sharma, Nitin, Sharma, Shipra, and Sharma, Mini
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NEUROSURGERY , *HYDROCEPHALUS , *CEREBROSPINAL fluid leak , *SURGICAL wound dehiscence , *SPINA bifida , *DISEASE management , *NECROSIS , *NEONATAL diseases , *TREATMENT effectiveness , *WOUND infections , *DESCRIPTIVE statistics , *SURGICAL flaps , *SUTURING , *SEPSIS , *NEURAL tube defects , *TIME , *SURGICAL site , *CEREBROSPINAL fluid shunts , *EVALUATION - Abstract
Background: Management of neural tube defects (NTDs) is challenging and the outcome is demanding. Aims: To analyze the outcomes in operated cases of NTDs closed using various types of flaps. Materials and Methods: The data between June 2017 and May 2023 were analyzed. The mode of presentation, timing of intervention, type of flap, neurological status after closure, status of the wound, presence of hydrocephalous, flap blackening, flap necrosis, features of sepsis, and the outcome were recorded and analyzed. Covered NTD; closure done using primary closure or 'Z' Plasty (everywhere); incomplete data; lost to follow-up; and not giving consent were excluded from the study. Results: Out of 92 cases, 35 were operated using the rhomboid flap, 33 using dufourmentel modification of limberg flap, and 24 using keystone island flap. The mean age at presentation was 4 days (range: 0--28 days). The mean duration of surgery after presentation was 2 days (range: 1--3 days). Mean operating time was 1.15 h (range: 0.45--3.15 h). A ventriculoperitoneal shunt was required in 62 cases at various stages. The preoperative and the postoperative power were nearly the same in all. Wound infection was seen in 2, 3, and 1 cases in each group. Blackening of the flap was seen in 3, 2, and 1 cases in three groups. Cerebrospinal fluid (CSF) leak was seen in 2, 2, and 0 cases. Wound dehiscence was present in one case in each group and sepsis was present in 2, 3, and 2, respectively. Conclusion: The management of open NTD requires adequate planning. CSF shunting and flap closure are often required. [ABSTRACT FROM AUTHOR]
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- 2024
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306. VEGF and Other Gene Therapies Improve Flap Survival—A Systematic Review and Meta-Analysis of Preclinical Studies.
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Paskal, Wiktor, Gotowiec, Mateusz, Stachura, Albert, Kopka, Michał, and Włodarski, Paweł
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GENE therapy , *SURGICAL flaps , *SURVIVAL analysis (Biometry) , *PLASTIC surgery , *SURVIVAL rate , *GENETIC vectors - Abstract
Surgical flaps are basic tools in reconstructive surgery. Their use may be limited by ischemia and necrosis. Few therapies address or prevent them. Genetic therapy could improve flap outcomes, but primary studies in this field present conflicting results. This systematic review and meta-analysis aimed to appraise the efficacy of external gene delivery to the flap for its survival in preclinical models. This review was registered with PROSPERO (CRD42022359982). PubMed, Embase, Web of Science, and Scopus were searched to identify studies using animal models reporting flap survival outcomes following any genetic modifications. Random-effects meta-analysis was used to calculate mean differences in flap survival with accompanying 95% CI. The risk of bias was assessed using the SYRCLE tool. Subgroup and sensitivity analyses were performed to ascertain the robustness of primary analyses, and the evidence was assessed using the GRADE approach. The initial search yielded 690 articles; 51 were eventually included, 36 of which with 1576 rats were meta-analyzed. VEGF gene delivery to different flap types significantly improved flap survival area by 15.66% (95% CI 11.80–19.52). Other interventions had smaller or less precise effects: PDGF—13.44% (95% CI 3.53–23.35); VEGF + FGF—8.64% (95% CI 6.94–10.34); HGF—5.61% (95% CI 0.43–10.78); FGF 3.84% (95% CI 1.13–6.55). Despite considerable heterogeneity, moderate risk of bias, and low quality of evidence, the efficacy of VEGF gene therapy remained significant in all sensitivity analyses. Preclinical data indicate that gene therapy is effective for increasing flap survival, but further animal studies are required for successful clinical translation. [ABSTRACT FROM AUTHOR]
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- 2024
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307. Colgajo infrahioídeo: Reporte de un caso y revisión de la técnica quirúrgica.
- Author
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Chávez Raimann, Montserrat, Cordero García, Rebeca, and Pizarro Garay, Luis
- Abstract
Introduction: The infrahyoid flap (IF) is an alternative for reconstruction in defects of the oral cavity, oropharynx, and hypopharynx. It is a pedicled and innervated musculocutaneous flap that is usually well tolerated by patients. Clinical Case: We describe the surgical technique of IF with the description of the case of a 58-year-old patient with squamous cell carcinoma of the left tongue. He underwent wide resection and then reconstruction. We performed an IF achieving successful coverage with adequate postoperative course. Discussion: Regional and pedicled flaps are important reconstructive options for patients with oral cancer. The IF is a suitable option for medium defects with excellent aesthetic and functional results. Conclusion: IF is a simple and widely available reconstructive option. It requires adequate preoperative planning with a good selection of patients to obtain satisfactory results. [ABSTRACT FROM AUTHOR]
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- 2024
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308. Classification and reconstructive algorithm for nasal alar defect in Asians.
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Renpeng Zhou, Dongze Lyu, Chen Wang, and Danru Wang
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PLASTIC surgery , *OPERATIVE surgery , *POSTOPERATIVE care , *SURGICAL flaps , *ALGORITHMS - Abstract
Background: The nasal alar defect in Asians remains a challenging issue, as do clear classification and algorithm guidance, despite numerous previously described surgical techniques. The aim of this study is to propose a surgical algorithm that addresses the appropriate surgical procedures for different types of nasal alar defects in Asian patients. Methods: A retrospective case note review was conducted on 32 patients with nasal alar defect who underwent reconstruction between 2008 and 2022. Based on careful analysis and our clinical experience, we proposed a classification system for nasal alar defects and presented a reconstructive algorithm. Patient data, including age, sex, diagnosis, surgical options, and complications, were assessed. The extent of surgical scar formation was evaluated using standard photography based on a 4-grade scar scale. Results: Among the 32 patients, there were 20 males and 12 females with nasal alar defects. The predominant cause of trauma in China was industrial factors. The majority of alar defects were classified as type I C (n=8, 25%), comprising 18 cases (56.2%); there were 5 cases (15.6%) of type II defect, 7 (21.9%) of type III defect, and 2 (6.3%) of type IV defect. The most common surgical option was auricular composite graft (n=8, 25%), followed by bilobed flap (n=6, 18.8%), free auricular composite flap (n=4, 12.5%), and primary closure (n=3, 9.4%). Satisfactory improvements were observed postoperatively. Conclusion: Factors contributing to classifications were analyzed and defined, providing a framework for the proposed classification system. The reconstructive algorithm offers surgeons appropriate procedures for treating nasal alar defect in Asians. [ABSTRACT FROM AUTHOR]
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- 2024
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309. Immediate implant placement for chronic peri-apical periodontitis in the molar region: a randomised controlled trial.
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Yu, W., Luo, D., Yang, J., Yuan, M., Yang, Y., and Gao, Y.
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PERIAPICAL periodontitis ,TOOTH root planing ,RANDOMIZED controlled trials ,IMMEDIATE loading (Dentistry) ,MOLARS ,SURGICAL flaps ,CONE beam computed tomography - Abstract
The aim of this study was to evaluate the feasibility of immediate implantation for chronic peri-apical periodontitis in the molar region. Seventy-four molars were selected and allocated randomly to two groups. The experimental group (n = 38) received immediate implantation by flap surgery and the control group (n = 36) received delayed implantation. CBCT was performed immediately after surgery (T1) and 12 months after the permanent repair (T3). The implant survival rate at T3 was 100% in both groups. There was no significant difference in buccal or lingual vertical marginal bone loss between the groups (P = 0.515, P = 0.736). However, the buccal horizontal margin bone loss was significantly greater in the experimental group: 0.98 ± 0.34 mm vs 0.77 ± 0.27 mm in the control group (P = 0.003). In the experimental group, the highest point of buccal and lingual implant–bone contact increased at T3. The buccal and lingual jump gap widths were 3.21 ± 1.10 mm and 2.92 ± 1.01 mm at T1, and CBCT showed no jump gap around the implants at T3. The clinical outcomes showed immediate implantation to be feasible for chronic peri-apical periodontitis in the molar region. [ABSTRACT FROM AUTHOR]
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- 2024
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310. Right pulmonary artery compression following acute type A aortic dissection resulting in acute right ventricular heart failure: A case report.
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Alimi, Hedieh, Moud, Azadeh Izadi, and Yadollahi, Asal
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PULMONARY artery ,AORTIC dissection ,HEART failure ,SURGICAL flaps ,ECHOCARDIOGRAPHY ,DISEASE risk factors ,DISEASE complications - Abstract
Right ventricular failure is a mechanism of hemodynamic collapse in acute aortic dissection. Mostly RV failure happens as a result of coronary malperfusion secondary to compression of right coronary artery ostium by the false lumen of type A aortic dissection or the dissection flap involving this coronary artery. Another mechanism is compression of pulmonary artery and an acute rise of pulmonary pressure below the level of obstruction, which is rarely reported. Herein, we presented an 82-year-old man who was admitted with type A aortic dissection in whom echocardiographic examination revealed right pulmonary artery compression resulting in acute right ventricular failure. [ABSTRACT FROM AUTHOR]
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- 2024
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311. Comparative evaluation of nasolabial flap and buccal fat pad flap in the surgical management of oral submucous fibrosis: a systematic review and meta-analysis.
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Al-Madhoon, Hossam Waleed, Elkhateb, Amr, Asla, Moamen Mostafa, and Jaber, Mohamed
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ORAL submucous fibrosis ,SURGICAL flaps ,FAT ,PLASTIC surgery - Abstract
Purpose : Oral submucous fibrosis (OSMF) is a chronic, potentially malignant condition affecting any part of the oral cavity and is prevalent in Southeast Asia and the Indian subcontinent. The aim of this study is to compare the efficacy of buccal fat pad flap with the nasolabial flap in the management of OSMF. Methods: We systematically compared two commonly used constructive techniques in the management of OSMF: the buccal pad of fat flap and the nasolabial flap. We performed a comprehensive search in four databases for all articles published between 1982 and November 2021. We assessed the risk of bias using the Cochrane Handbook and Newcastle–Ottawa Scale. We used the mean difference (MD) for pooling the data with 95% confidence intervals (CIs) and evaluated the heterogeneity between pooled studies using χ
2 and I2 tests. Results: Out of 917 studies, six were included in this review. The meta-analysis significantly favored conventional nasolabial flap over buccal fat pad flap in improving the maximal mouth opening (MD, − 2.52; 95% CI, − 4.44 to − 0.60; P = 0.01; I2 = 0%) after OSMF reconstructive surgery. Conversely, when it comes to esthetic outcomes, these studies favored buccal fat pad flap. Conclusion: Our meta-analysis found that nasolabial flap was better than buccal fat pad flap in terms of mouth opening restoration after OSMF reconstructive surgery. Also, the included studies found better results, favoring nasolabial flap over buccal fat pad flap in terms of oral commissural width restoration. Also, these studies reported better outcomes in terms of esthetics, favoring buccal fat pad flap. Further studies with larger sample sizes and different populations/races are needed to confirm our findings. [ABSTRACT FROM AUTHOR]- Published
- 2024
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312. Temporalis Flap for Soft Palate Reconstruction - More than an Alternative for Patients Unsuitable for Microvascular Reconstructive Surgery.
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DUDDE, FLORIAN, BARBAREWICZ, FILIP, and HENKEL, KAI-OLAF
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SQUAMOUS cell carcinoma ,SOFT palate ,SURGICAL excision ,SURGICAL flaps ,MICROSURGERY - Abstract
Background/Aim: The treatment of squamous cell carcinoma (SCC) in the oral cavity for operable patients usually consists of surgical tumor resection, unilateral or bilateral neck dissection and defect reconstruction. In addition to local flaps, multiple, particularly microsurgical, distant flaps have been developed, which are mainly considered state of the art reconstruction. However, depending on previous operations and individual patient factors, microsurgical reconstruction is sometimes not suitable. Case Report: A 54-year-old male presented to the Department of Oral and Maxillofacial Surgery with leukoplakia-like changes in the area of the soft palate. Radiological and histopathological findings revealed SCC of the soft palate. Due to the patient's reduced general condition, pronounced vasosclerosis and the patient's negative opinion towards microsurgical reconstruction, the indication for tumor resection with simultaneous temporalis flap reconstruction was made. The temporalis flap showed sufficient healing throughout the follow up. Conclusion: For patients who are unsuitable for microsurgery (previous operations, radiation, patient's request), well-known local flaps such as the temporalis flap represent more than an alternative treatment for defect reconstruction. The temporalis flap is particularly suitable for defect reconstruction of the maxilla and palate due to its easy flap raising and low complication rates. This case report shows the step-by-step flap raising of temporalis flap for soft palate reconstruction. [ABSTRACT FROM AUTHOR]
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- 2024
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313. Applications of 3D Printed Biomaterials in Reconstructive Surgery of the Anterior Skull Base.
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MEIUS, ALEXANDRU DUMITRAS, VOIOSU, CATALINA, IONITA, IRINA GABRIELA, RUSESCU, ANDREEA, ALIUS, OANA RUXANDRA, PANEA, CRISTINA AURA, ZAINEA, VIOREL, and HAINAROSIE, RAZVAN
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BIOMATERIALS ,THREE-dimensional printing ,PLASTIC surgery ,PROSTHETICS ,SURGICAL flaps - Abstract
Anterior skull base reconstruction is a complex surgical procedure that requires careful evaluation of the patient's condition and the expertise of a skilled surgical team. Skull base reconstruction objectives focus on providing water-tight separation between the intracranial and extracranial contents, closing dead space, and returning reasonable form and function. Regarding the reconstruction options, the main categories are non-vascular grafts, loco-regional flaps, free tissue transfer or bony-free flaps. The major challenge in reconstructive surgery is the effective sealing of the defect due to its uneven edges and the conformation of the anterior skull base. Given this challenge, we are considering the possibility of designing a prosthetic for anterior skull base defects using the 3D printer. [ABSTRACT FROM AUTHOR]
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- 2024
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314. A IMPORTÂNCIA DA CIRURGIA PLÁSTICA REPARADORA EM SITUAÇÕES PÓS TRAUMÁTICAS.
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do Valle Varela, João Pedro, Silva Paes, Ian, Kallas Arantes, Nathália Machado, Amorim Barbosa, João Vitor, Giselle Batt, Jennifer, Godeline Essali, Genese Fairana, Vettorazzi Zambom, Gabriel, Lobato Ferreira, Juliana, Nogueira Domingues, Shayanne, and Teixeira Fully, Fabio Luiz
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TRAUMA surgery ,WOUNDS & injuries ,SKIN grafting ,BONES ,AESTHETICS ,BIBLIOGRAPHIC databases ,QUALITATIVE research ,BURNS & scalds ,TRAFFIC accidents ,MENTAL health ,BLOOD vessels ,FUNCTIONAL status ,FIREARMS ,BODY image ,CONFIDENCE ,EMOTIONAL trauma ,SURGICAL flaps ,SOCIAL integration ,REHABILITATION centers ,QUALITY of life ,CONVALESCENCE ,RESEARCH ,PERSONAL beauty ,PLASTIC surgery ,PATIENT satisfaction ,SELF-perception ,WELL-being ,MUSCLES ,ACTIVITIES of daily living - Abstract
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- Published
- 2024
315. Effects of systemically administered tramadol hydrochloride on random pattern skin flap survival in rats.
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Yildirim, Nadide Ors, Kadan, Elcin, Yildirim, Alperen Kutay, Aksoy, Okan Ali, Goksel, Berk Alp, Ozkan, Gokhan, Eskin, Mehmet Burak, and Yildirim, Vedat
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TRAMADOL ,DRUG administration ,SURGICAL flaps ,OPIOID receptors ,WOUND healing - Abstract
Aim: Tramadol is a weak centrally acting opioid analgesic with µ-opioid receptor agonist effects. It has been explored for its analgesic efficacy through various in-vitro and in-vivo studies. The skin, as the body's largest organ and the protector barrier, is vulnerable to injuries and wounds that can cause significant challenges due to pain, economic burdens and psychological implications. Successful healing of wound involves complex processes and it is influenced by factors such as angiogenesis and nitric oxide levels. This study investigates the effects of tramadol on wound healing in experimental ischemic wound models in rats. Material and Methods: Two 6 mm ischemic wound models were created on the backs of 30 male Wistar Albino rats, with wound areas cut along the long edges and a sterile silicone material placed between the panniculus carnosus fascia and paraspinosus muscle. Rats were randomized into Tramadol, Control, and Sham groups. The wounds were imaged using a "SONY ILCE-7" camera on days 0, 3, 6, 10, and 14. Wound areas and healing percentages were calculated from the images and recorded for statistical purposes. After 14 days, the animals were sacrificed under general anesthesia for histopathological examination of tissue samples. CD31 and VEGF antibodies were used to evaluate the density and morphology of vascular structures. Results: Tramadol administration accelerated the healing of wound surface area. Significant differences were found between groups in terms of inflammation, and data recorded in CD34, CD31, and VEGF-stained preparations. Conclusion: The study found that tramadol positively contributes to wound healing in the acute phase of ischemic wounds by affecting various processes. [ABSTRACT FROM AUTHOR]
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- 2024
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316. A rare case of a hard-to-heal ulcer caused by pulmonary Nocardia infection.
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Zhu, Wei, Shu, Ziqin, and Song, Huapei
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WOUND healing ,MICROBIAL sensitivity tests ,TREATMENT effectiveness ,SPUTUM ,LUNGS ,SURGICAL flaps ,NOCARDIOSIS ,NEEDLE biopsy ,MEDICAL drainage ,IMIPENEM ,WOUND care ,SURGICAL site infections ,DEBRIDEMENT ,MINOCYCLINE ,CHRONIC wounds & injuries ,DISEASE complications - Abstract
Nocardiosis is an acute purulent or granulomatous disease caused by Nocardia spp. infection that commonly invades the lungs and central nervous system. Hard-to-heal wounds caused by Nocardia spp. infection are rare. A 63-year-old female patient underwent puncture biopsy due to a mass in the right lung. Subsequently, dermal ulceration occurred on her back at the biopsy site, with no improvement following treatment at multiple hospitals. After admission to our department, bacterial culture of sputum and discharge from the deep wound sinus revealed Nocardia asteroides infection. The treatment regimen was developed by a multidisciplinary team at our department. The patient underwent debridement and vacuum sealing drainage (VSD) and was administered imipenem. The wound was then sealed by local flap transfer. The patient was discharged from the hospital after the wound had healed and continued to take minocycline for 2 months. At 3 months post-discharge, the symptoms of lung infection had resolved. Nocardiosis mainly affects the lungs, and its clinical symptoms are similar to those of pulmonary tuberculosis. Nocardia infections can extend to the chest wall and form abscesses or cellulitis. For hard-to-heal wounds caused by Nocardia spp., local debridement combined with systemic anti-infective therapy should be applied. In this case study, the diagnosis of pulmonary and wound nocardiosis was confirmed based on clinical manifestations, imaging, aetiological investigation and pathology. The treatment regimen was debridement combined with VSD, as well as a full course of antibiotics. The optimal treatment regimen for hard-to-heal wounds caused by Nocardia spp. includes effective debridement combined with VSD and long-course antibiotic therapy, which can improve the cure rate. Declaration of interest: The authors have no conflicts of interest. [ABSTRACT FROM AUTHOR]
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- 2024
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317. Assessment of clinical efficacy of 445 nm Diode laser as an adjunct to Kirkland flap surgery in the management of periodontitis – a split mouth randomized clinical trial.
- Author
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V., Vineet, SK, Balaji, Krishnakumar, Dhanadivya, Kumar, Divya, and Lavu, Vamsi
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LASER therapy , *SEMICONDUCTOR lasers , *SURGICAL flaps , *FEMTOSECOND lasers , *LASERS , *CLINICAL trials , *PERIODONTITIS , *PATIENT satisfaction - Abstract
Aim of this study is to assess the clinical efficacy of 445 nm Diode laser as an adjunct to Kirkland flap surgery in management of periodontitis. Type of study is a Split mouth clinical trial in which a total of 13 patients were recruited based on specific inclusion and exclusion criteria. In each participant, random allocation of selected sites into test and control in contralateral quadrants was done. Clinical parameters such as probing depth and clinical attachment loss was measured in control and test sites using occlusal stents. Flap surgery was carried out 6 weeks after phase I therapy and the selected contralateral sites with a probing depth of > 5mm were subjected to surgical therapy. In a test quadrant, 445 nm diode laser with a power of 0.8 W, CW mode, 320 µm fiber, in non-contact mode was used as an adjunct to flap surgery. Primary outcome variable assessed was change in PPD between baseline, pre-operative, 1-, 3- and 6-months post-surgery. Secondary outcomes variables assessed were Clinical attachment loss at baseline, pre-operative, 1, 3 and 6 months, visual analog scale at days 3 and 7 and patient satisfaction index at day 7 post surgery. Surgery for the second site (Test/control) in the contralateral quadrants was performed 1 week after the first surgery. A higher reduction in probing depth and gain in CAL was observed in test site at 1, 3 and 6 months follow up amongst all the included participants. VAS score was lower at the test site as compared to the control sites. PSI scores were similar in both the sites. The adjunctive use of 445nm diode laser to surgical periodontal therapy contributed to improved short term clinical outcomes as assessed at the end of 6 months post- surgery. VAS score indicative of post -surgical discomfort were also lower for the laser treated sites. Hence adjunctive use of laser (445 nm wavelength) can be recommended for achieving more predictable clinical outcomes. [ABSTRACT FROM AUTHOR]
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- 2024
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318. Extreme oncoplasty: past, present and future.
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da Costa Vieira, René Aloisio, Resende Paulinelli, Regis, and de Oliveira-Junior, Idam
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BREAST surgery ,PLASTIC surgery ,PERFORATOR flaps (Surgery) ,BREAST tumors ,LUMPECTOMY ,MAMMAPLASTY ,MASTECTOMY - Abstract
Breast surgery has evolved from mastectomy to breast-conserving surgery (BCS). Breast oncoplastic surgery later emerged with the inclusion and development of techniques used in plastic surgery for breast neoplasms. Recently, a new paradigm has been considered for mastectomy candidates with large multifocal and multicentric tumours, designated extreme oncoplasty (EO), which has allowed new techniques to be applied to tumours that would have been ineligible for BCS before. There are few publications and no uniform descriptions grouping all the technical possibilities and new indications together. We performed this a review with the objective of evaluating the indications and surgeries performed in the EO context, representing a new perspective for BCS. We observed new indications as extensive microcalcifications, locally advanced breast carcinoma with partial response to chemotherapy, small to moderatesized non-ptotic central tumours and extreme ptosis. Small breasts are able for EO since the presence of ptosis. New surgeries are reported as disguised geometric compensation, perforators flaps, local/regional flaps, latissimus dorsi miniflap and partial breast amputation. It is important to decrease barriers to oncoplastic surgery if we want to increase the use of EO and BCS rates. [ABSTRACT FROM AUTHOR]
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- 2024
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319. The sucker-like end-to-side arterial anastomosis for free flap in extremities reconstruction: a retrospective study of 78 cases.
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Cheng, Liangkun, Tan, Yuzhong, Cui, Liuchao, Zheng, Yun, Qin, Chenghe, and Tian, Lin
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EXTREMITIES (Anatomy) -- Surgery , *ARTERIAL surgery , *SURGICAL anastomosis , *SURGICAL flaps , *PLASTIC surgery , *RETROSPECTIVE studies , *ACQUISITION of data , *TREATMENT effectiveness , *MEDICAL records , *DESCRIPTIVE statistics , *POSTOPERATIVE period , *EVALUATION - Abstract
Background: The application of end-to-side (ETS) anastomosis for flap transfer poses challenges, particularly in cases of significant size discrepancy between the donor and flap arteries. Herein, a novel ETS anastomosis technique, termed "sucker-like ETS anastomosis", is developed to mitigate and rectify such vessel discrepancies. This study aims to evaluate the efficacy of this technique in tissue defect reconstruction through free flap transfer. Methods: Between September 2018 and March 2023, the medical records and follow-up data of 78 patients who underwent free flap transfer using sucker-like ETS anastomosis for significant artery size discrepancies were collected and retrospectively analyzed. Results: Among the 78 cases that received free flap transfer, the range of artery size discrepancy (flap artery vs donor artery) was 1:1.6–1:4 (mean: 1:2.5). Following anastomosis with the sucker-like ETS technique, 75 cases achieved flap survival without requiring additional surgical intervention, yielding a one-stage success rate of 96.2%. Three cases experienced post-operative venous crises, with two cases surviving after vein exploration and one case undergoing flap necrosis, necessitating a secondary skin graft. Seven cases faced delayed wound healing but eventually achieved complete healing following dressing changes. No arterial crisis was observed during hospitalization. With an average follow-up of 13 months, the surviving flaps exhibited excellent vitality without flap necrosis or pigment deposition. Overall, the application of sucker-like ETS arterial anastomosis for flap transfer resulted in a high overall surgical success rate of 98.7% (77/78). Conclusion: The application of sucker-like ETS anastomosis for free flap transfer is highly effective, particularly in cases with significant size discrepancy between the recipient and donor arteries. [ABSTRACT FROM AUTHOR]
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- 2024
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320. A retrospective propensity score-matched analysis of oncological and functional outcomes of submental island flap versus radial forearm free flap for oral cavity cancer reconstruction.
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Sittitrai, Pichit, Ruenmarkkaew, Donyarat, Kumkun, Chananchida, and Srivanitchapoom, Chonticha
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LENGTH of stay in hospitals ,MOUTH tumors ,SURGICAL flaps ,CONFIDENCE intervals ,MULTIVARIATE analysis ,PLASTIC surgery ,RETROSPECTIVE studies ,HOSPITAL costs ,METASTASIS ,MANN Whitney U Test ,TREATMENT effectiveness ,SURVIVAL analysis (Biometry) ,DESCRIPTIVE statistics ,KAPLAN-Meier estimator ,LOGISTIC regression analysis ,LONGITUDINAL method ,EVALUATION - Abstract
Background: This retrospective study aims to compare the oncological and functional outcomes of the submental island flap versus the radial forearm free flap used for oral cavity cancer reconstruction after minimizing differences in baseline characteristics. Methods: Propensity scores for each oral cavity cancer patient who underwent surgical resection and immediate reconstruction with a submental island flap or a radial forearm free flap with a flap size ≤ 60 cm
2 between October 2008 and December 2021 were generated based on the likelihood of being selected given their baseline characteristics. Patients were matched using a 1:1 nearest-neighbor approach. Results: The final matched-pair analysis included 51 patients in each group. The 5-year overall survival, disease-specific survival, and locoregional control rates were 70.1% and 64.8% (p = 0.612), 77.3% and 83.7% (p = 0.857), and 76.1% and 73.3% (p = 0.664), respectively, for the submental island flap group and the radial forearm free flap group. Speech and swallowing functions were comparable between groups. However, there were significantly lower rates of complication associated with both donor and recipient sites in the submental island flap group, and also the duration of hospital stays and hospital costs were significantly lower in these patients. A subgroup analysis of patients in which the reconstruction was carried out using the submental island flap procedure revealed that in selected cases, the presence of clinically and pathologically positive level I lymph nodes did not affect survival or locoregional control rates. Conclusions: Although this study was not randomized, the matched-pair analysis of surgically treated oral cavity cancer patients showed that submental island flap reconstruction is as effective as radial forearm free flap reconstruction with regard to oncological and functional outcomes with lower complication rates, hospital stay, and hospital costs. This flap can be safely and effectively performed in selected cases with a clinical level I lymph node smaller than 1.5 cm and no signs of extranodal extension. [ABSTRACT FROM AUTHOR]- Published
- 2024
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321. Selection of speech processor in cochlear implant patients: experience in a tertiary hospital.
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Park, Sung-Min, Chun, Yejun, and Choi, Byung Yoon
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COCHLEAR implants , *RESEARCH funding , *T-test (Statistics) , *RETROSPECTIVE studies , *TERTIARY care , *MANN Whitney U Test , *DESCRIPTIVE statistics , *SURGICAL flaps , *SURGICAL complications , *LONGITUDINAL method , *INNER ear , *REOPERATION , *SPEECH perception , *MAGNETS , *SURGICAL site infections , *CHILDREN - Abstract
There are two types of speech processors used in CI devices: behind-the-ear (BTE) and off-the-ear (OTE). This study aimed to investigate the characteristics of patients and revision cases in relation to the type of speech processors. A retrospective review of 452 ears that underwent CI was performed. Children with severe inner ear anomalies (91.7%) more frequently preferred BTE speech processors than those without severe inner ear anomalies (p =.000). The magnet strength used in OTE speech processor users was significantly higher than in BTE speech processor users (p =.002). In cochlear implantees who underwent surgery before 12 months of age, the magnet strength in the revision group was greater than in the non-revision group (p =.025). Overall, our findings suggest factors to consider when choosing the type of speech processor and modifying the magnet strength of the implant device. The choice between BTE and OTE speech processors led to different required magnet strengths, contributing to the occurrence of skin flap inflammation. [ABSTRACT FROM AUTHOR]
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- 2024
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322. Treatment of deep single RT2 and RT3 antero‐mandibular gingival recessions with a combination of surgical techniques: A case series study.
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Fernández‐Jiménez, A., García‐De‐La‐Fuente, A. M., Marichalar‐Mendia, X., Aguirre‐Zorzano, L. A., and Estefanía‐Fresco, R.
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PATIENT aftercare , *RESEARCH , *GINGIVAL recession , *SURGICAL flaps , *CONNECTIVE tissues , *RESEARCH methodology , *DISEASES , *TOOTH roots , *MEDICAL technology , *COMPARATIVE studies , *ROOT canal treatment , *DESCRIPTIVE statistics , *TEETH abnormalities , *STATISTICAL correlation , *TRANSPLANTATION of organs, tissues, etc. ,MANDIBLE surgery - Abstract
Objective: To evaluate root coverage (RC) in deep single antero‐mandibular RT2 and RT3 gingival recessions (GR) and to investigate the influence of several factors in RC. Materials and Methods: Fifteen single antero‐mandibular GR with a minimum depth of 3 mm were consecutively treated with a new one‐stage technique (laterally positioned flap with a tunnel access and a connective tissue graft). At baseline and at 12‐month follow‐up, the percentage of mean root coverage (%MRC), the recession reduction (RecRed), complete root coverage (CRC) and the gain of keratinized tissue width (KTW) were assessed. Descriptive, intergroup comparative and correlation analyses were performed. Results: At 12 months, a %MRC of 77.29 ± 21.48% with a mean RecRed of 4.10 ± 1.51 mm was achieved. The %MRC was 84.71 ± 21.08% in RT2, and 62.43 ± 14.17% in RT3. The mean gain of KTW was 2.10 ± 0.89 mm, with a mean gain of 2.0 ± 1.03 mm for RT2 and 2.3 ± 0.57 mm for RT3. CRC was observed in six cases, all of them being RT2. A positive association was found between the %MRC and the initial position of the tooth and of both papillae. Conclusions: This technique might be a valuable approach for the treatment of deep single antero‐mandibular RT2 and RT3 recessions, even in malpositioned teeth. Clinical Significance: A combination of different surgical techniques could provide greater vascularization to the CTG especially in malpositioned teeth in sextant V with a large avascular area to be covered. [ABSTRACT FROM AUTHOR]
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- 2024
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323. Reconstruction of Upper Third Defect of the Auricle by Conchal Cartilage Graft and Coverage by Postauricular Flap.
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Youssif, Sherif Hamdeno, Hamza, Fawzy Ahmed, Abdelaziz, Mohamed Ali, Nasef, Mahmoud Abdel Fattah, Omran, Ahmed Moustafa, Ismaiel, Wael F., Ibrahim, Ahmed A. M., Alsobky, Mahmoud E., Abdelazim, Ahmed H., El-Shiekh, Ahmed Mohamed, Youssef, Amr Hamdino, Alghamdi, Mohamed A., Habashi Hafez Issa, Sabry, and Abdelazim, Mohamed H.
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CARTILAGE transplantation , *AESTHETICS , *EXTERNAL ear , *SURGICAL flaps , *PLASTIC surgery , *PATIENT satisfaction , *ACQUISITION of data , *AUTOGRAFTS , *TREATMENT effectiveness , *MEDICAL records ,EXTERNAL ear abnormalities ,PREVENTION of surgical complications - Abstract
Background: The defects of the upper third of the auricle are considered significant reconstructive challenges, as they require frequent operations with a high risk of morbidity at the donor site and result in unacceptable cosmetic abnormalities. Objective: Is to perform the reconstruction of a full-thickness auricular defect located in the upper third of the ear using a conchal cartilage graft with postauricular flap coverage, aiming to minimize both donor and recipient morbidity. Patients and Methods: The current study included 20 patients with unilateral upper-third auricular defects. The repair involved 2 components: a cartilage graft from the concha to provide structural support and a flap for coverage. Follow-up was conducted for 6 months after the operation. Results: Successful outcomes were achieved in both subjective and doctors' assessments. Regarding subjective outcomes, 85% of the patients reported high satisfaction (P <.001). In terms of doctors' subjective assessment, 90% of the patients had excellent results (P <.001). Mild early and postoperative complications, if encountered, resolved spontaneously. Conclusion: The use of a combined conchal cartilage graft and postauricular flap in treating a full-thickness upper third auricular defect is safe and effective, with no major complications. The technique preserves the cosmetic and functional outcomes of the auricle, providing an excellent color match and minimal donor-site morbidity. [ABSTRACT FROM AUTHOR]
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- 2024
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324. Postoperative results of modified Karydakis flap method for primary sacrococcygeal pilonidal sinus disease: short and long‐term analysis.
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Erdoğrul, Güven
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PILONIDAL cyst , *SACROCOCCYGEAL region , *SURGICAL flaps , *POSTOPERATIVE period - Abstract
Background: Sacrococcygeal pilonidal sinus is a common surgical condition that requires various treatment options. This study aims to investigate the short and long‐term outcomes of the modified Karydakis flap method in patients with sacrococcygeal pilonidal sinus. Methods: A retrospective analysis was conducted on 175 patients who underwent the modified Karydakis flap method for sacrococcygeal pilonidal sinus by a single surgeon between September 2015 and February 2021. The patients' demographics, operative time, hospitalization time and complications were recorded. Results: Of the 175 patients, 125 (71.43%) were male and 50 (28.57%) were female, with a mean age of 24.93 ± 10.27 years. The mean operative time was 55.05 ± 12.33 min, the follow‐up time was 39.21 ± 17.58 months, and the mean hospitalization time was 3.4 ± 1.65 days. Complications were observed in 12 (6.85%) patients, including seroma (5.14%) and wound infection (1.71%), with no observed cases of flap necrosis or recurrence. Conclusion: The modified Karydakis flap method appears to be a safe and effective treatment option for sacrococcygeal pilonidal sinus, with an acceptable complication rate and no observed cases of recurrence. [ABSTRACT FROM AUTHOR]
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- 2024
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325. Our Experience at Tertiary Medical College—Intralesional Injection of Triamcinolone Acetonide Versus Injection Verapamil Following Keloidectomy with Fillet Flap in Auricular Keloids.
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Mane, Balaji Shankarrao and Gavali, Rushali Madhukar
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TRIAMCINOLONE acetonide , *KELOIDS , *MEDICAL schools , *VERAPAMIL , *PATIENT satisfaction , *SURGICAL flaps , *GALVANIC skin response - Abstract
Keloid, which forms as an excessive tissue response to trauma to the skin, is a benign, hyperproliferative, recurrent growth of dermal collagen without a quiescent or regressive period throughout the process of wound healing. The aim of this study was to evaluate patient satisfaction with treatment and to compare the efficacy of intralesional injection of triamcinolone acetonide against verapamil after keloidectomy with fillet flap in auricular keloids. Our study was Duration based prospective observational study with a Duration of two years from June 2021 till May 2023 with study population inclusive of 50 patients aged between 20 and 70 years having recurrent keloid(s) over the pinna of any size or site. Keloidectomy with fillet flap and intralesional injection of trimcinolone acetonide was performed on 25 patients (30 keloids) in Group A, and keloidectomy with fillet flap and intralesional injection of verapamil was performed on 25 patients (30 keloids) in Group B. With a recurrence rate of 27%, eight keloids in Group A patients had an early recurrence three months following surgery. At nine months, nine more mixed-type cases with a 30% recurrence rate resurfaced. Recurrence seen in eight keloids out of 28 showed a 28.57% recurrence rate 12 months following surgery. Three people in Group B with three sessile keloids experienced an early recurrence at three months after surgery, with a recurrence rate of 10%. At nine months, four more cases of mixed kind returned, with a recurrence rate of 13%. A recurrence rate of 14.28% was found in 4 of 28 keloids at 12 months postoperatively. The Patient and Observer Scar Assesment Scale scores (POSAS scores) were consistently higher than Beausang scores at 1 year, indicating high patient satisfaction compared to physician assessment in both groups A and B. A keloid recurrence-free interval of 11.36 months was obtained by the Kaplan–Meier survival test (p < 0.05) in group A. Keloid recurrence-free interval of 10.98 months was evaluated by the Kaplan–Meier survival test (p < 0.05) in group B. Among Keloidectomy with fillet flap surgery with intralesional injection of triamcinolone acetonide (group A) and keloidectomy with fillet surgery with intralesional injection of verapamil (group B), at each follow-up the success rate of group B was higher than group A indicating better trend of success in this group in terms of both absence of recurrence and absence of complications without statistically significant difference between them which shown both procedures more or less similar. [ABSTRACT FROM AUTHOR]
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- 2024
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326. The Infrahyoid Musculocutaneous Flap for the Reconstruction of Composite Oro-mandibular Defects.
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Manjula, B. V., Shilpa, M. J., Vidya Shree, K. M., and Asharaf, Amitha A.
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SPEECH evaluation , *MANDIBLE abnormalities , *SQUAMOUS cell carcinoma , *MOUTH tumors , *AESTHETICS , *VISUAL analog scale , *INTELLIGIBILITY of speech , *SURGICAL flaps , *ELECTRONIC health records , *PLASTIC surgery , *HEALTH outcome assessment , *DEGLUTITION , *TREATMENT failure , *PATIENT satisfaction , *TRISMUS , *DIET , *DISEASE risk factors , *DISEASE complications ,MANDIBLE surgery - Abstract
Resection of advanced gingivobuccal squamous cell carcinoma results in complex posterolateral mandible and soft tissue defects. Optimal reconstruction would include a single osteocutaneous free flap. However, free flaps are not feasible in certain situations where pectoralis major musculocutaneous flap is preferred. But it is very bulky and cannot be thinned, hence suitable only for repairing very large defects. For medium-sized composite oro-mandibular defects, we used infrahyoid musculocutaneous flap in select patients and evaluated the surgical outcomes. Patients who underwent infrahyoid musculocutaneous flap reconstruction for composite oro-mandibular defects at our center from 2016 to 2021 were included. Patient and defect characteristics were evaluated from our prospectively maintained electronic medical records. Assessment of speech and swallowing function was done by our therapist. Cosmesis was assessed by an independent observer using the visual analogue scale. In our series of 11 patients, none of the flaps was lost. Two patients had partial skin paddle loss. Most of these patients had mandibular drift but none of them developed postoperative trismus. All patients resumed normal oral or soft solid diet. Speech intelligibility was normal in all patients. All patients had satisfactory cosmetic outcome. Infrahyoid musculocutaneous flap is a reliable, quicker, and safe alternative technique in select patients for the reconstruction of composite oro-mandibular defects. In our small series of select patients, speech and swallowing outcomes were excellent with great patient satisfaction. [ABSTRACT FROM AUTHOR]
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- 2024
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327. Omentum Rotational Flap for Spleen Autotransplantation in Splenic Trauma — Experimental Study.
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Khoshmohabat, Hadi and Eslamian, Mohammad
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IMMUNOGLOBULIN analysis , *OMENTUM , *LEUKOCYTE count , *AUTOGRAFTS , *HEMOGLOBINS , *TREATMENT effectiveness , *DESCRIPTIVE statistics , *RADIOISOTOPES , *SURGICAL flaps , *SURGICAL complications , *RATS , *BLOOD platelets , *SPLENECTOMY , *ANIMAL experimentation , *RADIONUCLIDE imaging ,SPLEEN transplantation - Abstract
Intra-omental splenic autotransplantation is the only method described so far to preserve spleen function after splenectomy; however, it is associated with some postoperative complications. The present study aimed to compare the effectiveness and feasibility of an omentum rotational flap (ORF) with the spleen auto transplant in the omentum (SAO) for preserving splenic function. Forty male Wistar rats were equally divided into two ORF and SAO groups. White blood cell (WBC), hemoglobin (Hb), platelet, immunoglobulin A, M, and G (IgA, IgM, IgG), and complement levels (C3, C4) were measured before and 4 weeks after the surgery. Technetium-99 m scintigraphy was performed to assess the postoperative splenic function in both groups. There was no significant difference between the groups' preoperative hematological factors. The Hb, C3, C4, IgM, and IgA levels were significantly decreased after intervention in both groups (p < 0.05), and the WBC and platelet counts were significantly reduced after surgery in ORF and SAO groups, respectively. The postoperative level of WBC was significantly lower in ORF compared to the SAO group (p < 0.001). The radioisotope uptake was decreased after surgery in both groups (p < 0.05), and no significant difference was observed in terms of improving radioisotope uptake between the groups (p = 0.63). The duration of surgery was significantly higher in the SAO compared to the ORF group (p < 0.001). In splenic injuries, the omentum rotational flap technique instead of spleen auto transplant in the omentum seems to be an effective surgical method for preserving the function of the spleen, but the evaluation of its safety needs more clinical study. [ABSTRACT FROM AUTHOR]
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- 2024
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328. Pretreatment with platelet-rich plasma protects against ischemia–reperfusion induced flap injury by deactivating the JAK/STAT pathway in mice.
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Su, Linlin, Xie, Songtao, Li, Ting, Jia, Yanhui, and Wang, Yunchuan
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PLATELET-rich plasma , *MYOCARDIAL reperfusion , *SOFT tissue injuries , *SKIN injuries , *SURGICAL flaps - Abstract
Background: Ischemia–reperfusion (I/R) injury is a major cause of surgical skin flap compromise and organ dysfunction. Platelet-rich plasma (PRP) is an autologous product rich in growth factors, with tissue regenerative potential. PRP has shown promise in multiple I/R-induced tissue injuries, but its effects on skin flap injury remain unexplored. Methods: We evaluated the effects of PRP on I/R-injured skin flaps, optimal timing of PRP administration, and the involved mechanisms. Results: PRP protected against I/R-induced skin flap injury by improving flap survival, promoting blood perfusion and angiogenesis, suppressing oxidative stress and inflammatory response, and reducing apoptosis, at least partly via deactivating Janus kinase (JAK)-signal transducers and activators of transcription (STAT) signalling pathway. PRP given before ischemia displayed overall advantages over that given before reperfusion or during reperfusion. In addition, PRP pretreatment had a stronger ability to reverse I/R-induced JAK/STAT activation and apoptosis than AG490, a specific inhibitor of JAK/STAT signalling. Conclusions: This study firstly demonstrates the protective role of PRP against I/R-injured skin flaps through negative regulation of JAK/STAT activation, with PRP pretreatment showing optimal therapeutic effects. [ABSTRACT FROM AUTHOR]
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- 2024
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329. Long‐term stability of gingival margin and periodontal soft‐tissue phenotype achieved after mucogingival therapy: A systematic review.
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Carbone, Ana Claudia, Joly, Julio Cesar, Botelho, João, Machado, Vanessa, Avila‐Ortiz, Gustavo, Cairo, Francesco, and Chambrone, Leandro
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ONLINE information services , *MEDICAL databases , *WOUND healing , *GINGIVAL recession , *MEDICAL information storage & retrieval systems , *SURGICAL flaps , *CONNECTIVE tissues , *SYSTEMATIC reviews , *MULTIPLE regression analysis , *INDEPENDENT variables , *TOOTH roots , *TREATMENT effectiveness , *MEDLINE , *GINGIVA , *PHENOTYPES , *TRANSPLANTATION of organs, tissues, etc. - Abstract
Background: The aim of this systematic review was two‐fold: (i) to evaluate the long‐term (≥5 years) stability of the gingival margin position, keratinized tissue width (KTW) and gingival thickness (GT) in sites that underwent root coverage (RC) or gingival augmentation (GA); and (ii) to assess the influence of different local variables on the long‐term stability of dental and gingival tissues. Materials and Methods: Randomized controlled trials (RCTs) and non‐RCTs reporting short‐term (i.e., 6–12 months after baseline surgical intervention) and long‐term (≥5 years) follow‐up data after surgical treatment of adult patients presenting single or multiple mucogingival deformities, defined as sites presenting gingival recession defects (GRDs) and/or (KTW) deficiency (i.e., <2 mm), were considered eligible for inclusion. MEDLINE–PubMed, EMBASE and Cochrane Central Register of Controlled Trials databases were searched for articles published up to 15 May 2023. Mixed‐effects multiple linear regression was used to assess the association between KTW, type of surgical procedure and time (i.e., independent variables) on the stability of the gingival margin in sites that received RC or GA therapy. Results: Of the 2569 potentially eligible records, 41 (reporting 40 studies) met the eligibility criteria. Graphical estimates including data from all RC procedures found an upward trend in recession depth (RD) increase over time. Conversely, it was observed that in 63.63% of RC studies and in 59.32% of RC treatment arms KTW increased over time, particularly in sites treated with subepithelial connective tissue grafts (SCTGs). Conversely, sites that underwent GA procedures generally exhibited an overall reduction of KTW over time. However, sites treated with free gingival grafts (FGGs) showed a decrease in RD after 10 years of follow‐up. Three main findings derived from the pooled estimates were identified: (i) Gingival margin stability was associated with the amount of KTW present during short‐term assessment (i.e. the greater the KTW at 6–12 months after treatment, the more stable the gingival margin). (ii) The use of autogenous soft‐tissue grafts was associated with lower RD increase over time. (iii) Treatment approaches that contribute to the three‐dimensional enhancement of the gingival phenotype, as clearly demonstrated by FGG, were associated with gingival margin stability. Conclusions: The extent of apical migration of the gingival margin appears to be directly related to the amount of KTW and GT upon tissue maturation. Interventions involving the use of autogenous grafts, either SCTG or FGG, are associated with greater short‐term KTW gain and lower RD increase over time. [ABSTRACT FROM AUTHOR]
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- 2024
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330. Patient-Reported Outcomes Following Breast Reconstruction With the Transverse Myocutaneous Gracilis Flap Using the BREAST-Q and Lower Extremity Function Scale.
- Author
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Mahrhofer, Maximilian, Schwaiger, Karl, Fierdel, Frederic, Russe, Elisabeth, Hitzl, Wolfgang, Schoeller, Thomas, Wechselberger, Gottfried, and Weitgasser, Laurenz
- Abstract
Background The transverse myocutaneous gracilis (TMG) flap is a viable and safe option for breast reconstruction in patients with limited abdominal tissue or other contraindications for abdominal-based flaps. Although it is one of the most common flaps employed for breast reconstruction, data on patient-reported outcomes is limited. Objectives The authors seek to evaluate patient satisfaction and aesthetic outcome after breast reconstruction with the TMG flap. Methods All patients who underwent breast reconstruction with a TMG flap between March 2010 and October 2020 were identified. Invitation to a digital version of the BREAST-Q reconstructive module and the Lower Extremity Function Scale (LEFS) was sent to 105 patients. Patient demographics, complications, and surgical details were collected and retrospectively analyzed. BREAST-Q and LEFS scores were calculated and compared to the literature. Results Eighty-two patients participated in the study. Median follow-up was 5.9 years, with a mean patient age of 45.7 years. Most patients (90.2%) received treatment due to previous cancer of the breast, and 17.1% underwent immediate reconstruction. The mean score for "Satisfaction with Breast" was 66/100. Postoperative lower extremity function was high, with a median LEFS score of 78/80. A LEFS score below the median value was found to be significantly associated with active smoking (P =.049). Patients also reported high satisfaction with donor sites (8/11). Conclusions Patient satisfaction and aesthetic outcome after breast reconstruction with TMG flaps is high and comparable to other common techniques. Lower extremity function is not impaired after flap harvest. Level of Evidence: 3 [ABSTRACT FROM AUTHOR]
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- 2024
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331. Breast Reconstruction With Simultaneous Bilateral Lumbar Artery Perforator Flaps Improves Waistline Definition and Buttock Projection.
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Teotia, Sumeet S, Henn, Dominic, Lakatta, Alexis, Steppe, Cyrus, and Haddock, Nicholas T
- Abstract
Background The lumbar artery perforator (LAP) flap is a valuable secondary option for autologous breast reconstruction when abdominal donor sites are not available. Objectives The aim of this study was to determine how the LAP donor site affects waistline and gluteal proportions, and whether LAP flaps may produce potential secondary benefits concerning donor site aesthetics. Methods A retrospective review of 50 patients who underwent bilateral breast reconstruction with LAP flaps (100 flaps) between 2018 and 2022 was performed. Patient characteristics and postoperative complications were recorded. Pre- and postoperative standardized frontal and lateral patient photographs were analyzed to identify postoperative changes in waist-to-hip ratio (WHR) to assess waistline definition and buttock projection. The patients' individual perception of postoperative aesthetic changes to their waistline and buttocks was determined by an electronic survey. Results The patients had a mean age of 51 years (range, 24-63 years) and a mean BMI of 26.9 kg/m
2 (range, 19.3-37.4 kg/m2 ). Postoperative donor site complications included seroma (n = 10), wound dehiscence (n = 5), hematoma (n = 4), and wound infection (n = 2). Flap loss rate was 2%. After reconstruction, patients were found to have a more defined waistline, indicated by a significantly decreased WHR on frontal images (mean [standard error of the mean], 0.85 [0.05] vs 0.80 [0.05], P <.005) and a more projected buttocks indicated by a significant reduction in WHR on lateral images (0.92 [0.07] vs 0.87 [0.07], P <.0001). Among the patients who responded to the survey, 73% indicated that their waistline had aesthetically improved, 6.7% felt it had not changed, and 20% felt that it had worsened. An aesthetic improvement of the buttocks was reported by 53%, 40% felt their buttocks had not changed, and 6.7% felt their buttocks appearance had worsened. Conclusions Bilateral LAP flap breast reconstruction leads to improved waistline definition and buttock projection, bringing patients closer to ideal aesthetic proportions. This reconstructive approach is ideal for patients who are not candidates for abdominal free flaps, but who demonstrate excess flank tissue and seek a more defined waistline and projected buttocks. Level of Evidence: 4 [ABSTRACT FROM AUTHOR]- Published
- 2024
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332. Keystone Flap for Closure of Skin Cancer Defects on the Upper Extremity.
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Gordon, Travis, Golin, Andrew P., and Anzarut, Alexander
- Abstract
Copyright of Plastic Surgery is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2024
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333. Defect-Oriented Versus Back Scar-Oriented Flap Design in Breast Reconstruction with Latissimus Dorsi Musculocutaneous Flap: A Patient-Reported Satisfaction Outcome Comparison Using BREAST-Q.
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Rha, Eun Young, Jeon, Hui Hyung, Park, Seong Hyuk, and Lee, Jun Yong
- Abstract
Background: The design of the latissimus dorsi musculocutaneous flap in breast reconstruction has several options. To date, there have been no reports on the surgical outcomes with flap designed based on the defect shape of the mastectomy site and flap shape of the donor site. To compare patient satisfaction according to the flap design, we designed and conducted independent three sub-studies targeting fifty-three breast reconstruction patients using BREAST-Q
© scale. Methods: In study 1, there was no difference in patient satisfaction between the group with the flap designed according to the shape of mastectomy defect (defect-oriented group) that with the flap designed according to patient's wish regardless of defect shape (back scar-oriented group). In study 2, comparing the results based on the shape of the flap, vertically designed flap showed a statistically significant difference in the psychosocial well-being. In study 3, comparing the results based on the shape of the defect, no significant difference was noted. Results: Even though designing a donor flap based on the shape and orientation of the mastectomy defect has no statistical significance in patient satisfaction or quality of life compared with that based on the patient preference in placement of the donor site scar, the group with the vertical donor design showed better psychosocial well-being than the group with other shapes of the donor flap. By considering the advantages and disadvantages of each flap design, enhanced patient satisfaction and durability and natural aesthetic goal can be achieved. This is the first study to compare the differences in results according to the flap design method during breast reconstruction. Patient satisfaction according to the design of the flap was investigated in the form of a questionnaire survey, and the results were displayed. In addition to breast shape, donor scars and complications were also investigated. Level of Evidence IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]- Published
- 2024
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334. Modified Medial Incision Small Double-Opposing Z-Plasty for Treating Veau Type I Cleft Palate: Is the Early Result Reproducible?
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Denadai, Rafael, Seo, Hyung Joon, Go Pascasio, Dax Carlo, Sato, Nobuhiro, Murali, Srinisha, Lo, Chi-Chin, Chou, Pang-Yung, and Lo, Lun-Jou
- Subjects
SURGICAL flaps ,PTERYGOID muscles ,WORK ,CLEFT palate ,PLASTIC surgery ,RETROSPECTIVE studies ,MEDICAL personnel ,SURGICAL complications ,TREATMENT effectiveness ,ENTRY level employees ,EXPERIENTIAL learning ,DESCRIPTIVE statistics - Abstract
Objective: An inspiring early result with no oronasal fistula formation was recently described for a modified medial incision small double-opposing Z-plasty (MIsDOZ) for treating Veau type I cleft palate. This study describes an early single-surgeon experience in applying this newly proposed surgical approach. Design: Retrospective single-surgeon study. Patients: Consecutive nonsyndromic patients (n = 27) with Veau I cleft palate. Interventions: Topographic anatomical-guided MIsDOZ palatoplasty with pyramidal space dissection (releasing of the ligamentous fibers in the greater palatine neurovascular bundle and pyramidal process region, in-fracture of the pterygoid hamulus, and widening of space of Ernst) performed by a novice surgeon (RD). Mean Outcome Measures: Age at surgery, the presence of cleft lip, palatal cleft width, use of lateral relaxing incision, and 6-month complication rate (bleeding, dehiscence, fistula, and flap necrosis). A published senior surgeon-based outcome dataset (n = 24) was retrieved for comparison purposes. Results: Twenty-two (81.5%) and 5 (18.5%) patients received the medial incision only technique and lateral incision technique, respectively (P =.002). Age, presence of cleft lip, and cleft width were not associated (all P >.05) with the use of lateral incision. Comparative analysis between the novice surgeon- and senior surgeon-based datasets revealed no significant differences for sex (females: 74.1% vs 62.5%; P =.546), age (10.2 ± 1.7 vs 9.6 ± 1.2 months; P =.143), rate of lateral incision (18.5% vs 4.2%; P =.195), and postoperative complication rate (0% vs 0%). Conclusion: This modified DOZ palatoplasty proved to be a reproducible procedure for Veau I cleft palate closure, with reduced need for lateral incision and with no early complication. [ABSTRACT FROM AUTHOR]
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- 2024
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335. Application of maple leaf‐shaped flap combined with negative pressure wound therapy in the perianal circular skin defect reconstruction.
- Author
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Dai, Haiying, Wang, Yuchong, Xu, Jianguo, Lv, Chuan, Dong, Jie, Sun, Mengyan, Chen, Kexin, Xiao, Yuai, Wu, Minliang, and Xue, Chunyu
- Subjects
WOUND healing ,SURGICAL flaps ,SKIN grafting ,PLASTIC surgery ,RETROSPECTIVE studies ,NEGATIVE-pressure wound therapy ,TREATMENT effectiveness ,ANAL tumors ,SURGICAL site infections ,DESCRIPTIVE statistics ,COMBINED modality therapy ,SURGICAL dressings ,BANDAGES & bandaging ,DISEASE risk factors - Abstract
We aimed to explore the efficacy of maple leaf‐shaped flap in the repair of perianal circular skin defect. This study is a retrospective review of patients with perianal circular skin defect after skin tumour resection and repaired with maple leaf‐shaped flap. Patients included in this study were admitted in our department between January 2010 and January 2023. A standardized data collection template was used to collect related variables. The design and surgical procedures of maple leaf‐shaped flap are carefully described in this study. Negative pressure wound therapy (NPWT) was applied to assist wound healing postoperatively. Twenty‐seven patients were included in this study. The average wound size after tumour resection measured 4 × 5 cm2–10 × 10 cm2. The circular skin defect was repaired by maple leaf‐shaped flap, and NPWT was used after surgery. Twenty‐five patients achieved primary wound healing and flaps were well‐survived. Slight infection occurred in two patients, and both were cured after dressing change. During the follow‐up period of 6–24 months, no tumour recurrence occurred. The perianal morphology can be well‐restored by maple leaf‐shaped flap, and the defecation control function of anus was not impaired. The application of maple leaf‐shaped flap and NPWT is a promising way in the repair of perianal circular skin defect with little complication and satisfying outcomes. [ABSTRACT FROM AUTHOR]
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- 2024
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336. Evaluating the therapeutic and reconstructive efficacy of flap transplantation techniques in managing nasal tissue deficiency resulting from post‐rhinoplasty surgical infections.
- Author
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Song, Lei and Liu, Xiuyan
- Subjects
RHINOPLASTY ,AESTHETICS ,PROFESSIONAL practice ,SKIN grafting ,SURGICAL flaps ,RETROSPECTIVE studies ,PATIENT satisfaction ,ANTI-infective agents ,EVIDENCE-based medicine ,TREATMENT effectiveness ,NOSE ,NASAL mucosa ,DESCRIPTIVE statistics ,QUESTIONNAIRES ,DATA analysis software ,EVALUATION - Abstract
Rhinoplasty is a frequently performed aesthetic surgery with a high procedural volume. Despite the operational ease and safety profile of biocompatible materials such as silicone and inflatable prosthetics, postoperative complications like surgical site infections can lead to significant clinical challenges. These complications necessitate effective therapeutic and reconstructive interventions. This study aims to evaluate the efficacy of different flap transplantation techniques for early treatment of post‐rhinoplasty nasal tissue deficiencies. A retrospective study was conducted from May 2018 to May 2023, involving 38 patients divided into a control group receiving standard anti‐infective treatment and an observation group undergoing early flap grafting procedures. Efficacy was evaluated using objective metrics—namely, nasal appearance, function and flap condition—each assessed through a 10‐point scoring system, and subjective metrics such as patient satisfaction gauged through self‐administered questionnaires. Statistical analyses were performed using SPSS version 27.0. Both groups were statistically comparable in terms of demographics such as age, marital status and educational background. The observation group displayed significantly improved outcomes in terms of nasal aesthetics (mean score 7.92 ± 1.00), nasal function (mean score 8.47 ± 0.51) and flap condition (mean score 7.89 ± 1.12) compared to the control group. Flap transplantation techniques demonstrated superior therapeutic and reconstructive efficacy in the management of nasal tissue deficiencies arising from post‐rhinoplasty surgical infections. These findings contribute to evidence‐based recommendations for optimal clinical practice. [ABSTRACT FROM AUTHOR]
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- 2024
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337. Therapiestrategien bei frakturassoziierten Infektionen mit begleitendem Weichteilschaden.
- Author
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Alt, Volker, Rupp, Markus, Kerschbaum, Maximilian, Prantl, Lukas, and Geis, Sebastian
- Abstract
Copyright of Die Unfallchirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2024
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338. Efficacy of amniotic membrane with coronally advanced flap in the treatment of gingival recession: an updated systematic review and meta-analysis.
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Abdel-Fatah, Reham and Saleh, Wafaa
- Subjects
MEDICAL databases ,GINGIVAL recession ,SURGICAL flaps ,META-analysis ,MEDICAL information storage & retrieval systems ,AMNION ,SYSTEMATIC reviews ,CHORION ,TOOTH roots ,TREATMENT effectiveness ,DESCRIPTIVE statistics ,MEDLINE - Abstract
Objectives: This systematic review aims to evaluate the efficacy of combining the amniotic membrane (AM) with the coronally advanced flap (CAF) in the treatment of Miller class I and II gingival recession (GR). Methods: The protocol of this updated PRISMA-compliant systematic review was registered in PROSPERO (CRD42023431501). The following treatment outcomes were recorded; recession depth (RD), recession width (RW), width of keratinized gingiva (WKG), and clinical attachment level (CAL). We searched the following databases: MEDLINE, Cochrane Library, Google Scholar, EMBASE, Web of Science, and Science Direct. Results: Two independent reviewers screened the selected articles. Twenty-two eligible articles were extracted, with 689 sites of GR in 481 patients. No statistically significant difference was found in RD, RW, WKG, and CAL between (AM&CAF) in comparison to control groups. However, the subgroup analysis showed statistically significant differences in RD between the (AM & CAF) group v/s (CAF) alone (P = 0.004). Moreover, the subgroup analysis of the WKG showed statistically significant differences between (AM & CAF) v/s (CAF&CM) (p = 0.04). Additionally, a statistically significant difference was found in the subgroup analysis of CAL between both (AM & CAF) group v/s (CAF) alone (p = 0.0009). Conclusion: With the limitations of this meta-analysis due to short follow-up periods (6 months), the AM can be considered a viable treatment option for GR defects with satisfactory treatment outcomes comparable to other previously investigated treatment modalities. Clinical significance: While AM showed various beneficial properties as an ideal membrane for the coverage of GR, future studies are required to completely understand the potential application of AM in the treatment of GR. [ABSTRACT FROM AUTHOR]
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- 2024
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339. Algorithm for the reconstruction of the parotid region: a single institution experience.
- Author
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Dou, Chun-Bo, Ma, Si-Rui, Zhang, Shi-Long, Su, Heng, Yu, Zi-Li, and Jia, Jun
- Subjects
SALIVARY gland tumors ,SURGICAL flaps ,OSTEOSARCOMA ,PLASTIC surgery ,RETROSPECTIVE studies ,ACQUISITION of data ,CANCER relapse ,METASTASIS ,SOFT tissue tumors ,SURVIVAL rate ,SYMPTOMS ,RESEARCH funding ,MEDICAL records ,DESCRIPTIVE statistics ,PAROTID glands ,TUMORS ,BASAL cell carcinoma ,RADIOTHERAPY ,ALGORITHMS ,PAROTID gland tumors ,SQUAMOUS cell carcinoma - Abstract
Objective: This study aims to discuss the characteristics and treatment methods of malignant tumors in the parotid region, as well as the therapeutic effects of immediate free flap reconstruction of soft tissue for postoperative defects. Materials and methods: A retrospective review was conducted on 11 cases of soft tissue flap reconstruction for postoperative defects following the resection of malignant tumors in the parotid region. Statistical analysis was performed based on clinical data. Results: Among the 11 cases of malignant tumors in the parotid region, there were 2 cases of secretory carcinoma (SC) of the salivary gland, 2 cases of squamous cell carcinoma (SCC), 2 cases of carcinosarcoma, 1 case of mucoepidermoid carcinoma (MEC), 1 case of epithelial-myoepithelial carcinoma (EMC), 1 case of salivary duct carcinoma (SDC), 1 case of basal cell carcinoma (BCC), and 1 case of osteosarcoma. Among these cases, 4 were initial diagnoses and 7 were recurrent tumors. The defect repairs involved: 8 cases with anterolateral thigh free flap (ALTF), 2 cases with pectoralis major muscle flaps, and 1 case with forearm flap. The size of the flaps ranged from approximately 1 cm × 3 cm to 7 cm × 15 cm. The recipient vessels included: 4 cases with the facial artery, 4 cases with the superior thyroid artery, and 1 case with the external carotid artery. The ratio of recipient vein anastomosis was: 57% for branches of the internal jugular vein, 29% for the facial vein, and 14% for the external jugular vein. Among the 8 cases that underwent neck lymph node dissection, one case showed lymph node metastasis on pathological examination. In the initial diagnosis cases, 2 cases received postoperative radiotherapy, and 1 case received
125 I seed implantation therapeutic treatment after experiencing two recurrences. Postoperative follow-up revealed that 2 cases underwent reoperation due to local tumor recurrence, and there were 2 cases lost to follow-up. The survival outcomes after treatment included: one case of distant metastasis and one case of death from non-cancerous diseases. Conclusion: Immediate soft tissue flap reconstruction is an important and valuable option to address postoperative defects in patients afflicted with malignant tumors in the parotid region. [ABSTRACT FROM AUTHOR]- Published
- 2024
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340. In Situ Monitoring and Assessment of Ischemic Skin Flap by High-Frequency Ultrasound and Quantitative Parameters.
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Huang, Da-Ming and Wang, Shyh-Hau
- Subjects
- *
HUMAN skin color , *ULTRASONIC imaging , *DERMATOLOGIC surgery , *SURGICAL flaps , *SKIN injuries , *BACKSCATTERING - Abstract
Skin flap surgery is a critical procedure for treating severe skin injury in which post-surgery lesions must well monitored and cared for noninvasively. In the present study, attempts using high-frequency ultrasound imaging, quantitative parameters, and statistical analysis were made to extensively assess variations in the skin flap. Experiments were arranged by incising the dorsal skin of rats to create a skin flap using the chamber model. Measurements, including photographs, 30 MHz ultrasound B-mode images, skin thickness, echogenicity, Nakagami statistics, and histological analysis of post-surgery skin flap, were performed. Photograph results showed that color variations in different parts of the skin flap may readily correspond to ischemic states of local tissues. Compared to post-surgery skin flap on day 7, both integrated backscatter (IB) and Nakagami parameter (m) of the distal part of tissues were increased, and those of the skin thickness were decreased. Overall, relative skin thickness, IB, and m of the distal part of post-surgery skin flap varied from 100 to 67%, −66 to −61 dB, and 0.48 to 0.36, respectively. These results demonstrate that this modality and quantitative parameters can be feasibly applied for long-term and in situ assessment of skin flap tissues. [ABSTRACT FROM AUTHOR]
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- 2024
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341. Clinical Observations of a Surgical Method Comprising a Combination of Cross Flap and Autologous Auricular Cartilage Transplantation in the Treatment of Type I to III Congenital Concha-Type Microtia.
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Sun, Pengfei, Lu, Meng, Wang, Changchen, Pan, Bo, and Jiang, Haiyue
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- *
SURGICAL flaps , *EXTERNAL ear , *HUMAN abnormalities , *CARTILAGE diseases , *RETROSPECTIVE studies , *RESEARCH funding , *ARTICULAR cartilage ,EXTERNAL ear abnormalities - Abstract
Objectives: The present study attempted to investigate the clinical efficacy of a surgical method involving a combination of cross flap with autologous auricular cartilage transplantation in the treatment of type I to III congenital concha-type microtia. Methods: The present retrospective study was conducted on the clinical and postoperative data of 50 patients with unilateral type I to III concha-type microtia treated with a combination of cross flap and autologous auricular cartilage transplantation at the Plastic Surgery Hospital of Chinese Academy of Medical Sciences from January 2018 to December 2021. Results: The postoperative perimeters of malformed ears were significantly larger than the preoperative perimeters (P <.05). Of the total, 2 patients exhibited incision dehiscence, 3 patients exhibited incision infection, 2 patients exhibited flap hematoma, and 1 patient exhibited ischemic necrosis at the flap tip. The satisfaction rate of the patients and their families was 100%. Conclusions: The surgical method involving a combination of cross flap and autogenous auricular cartilage transplantation was effective in treating patients with type I to III congenital concha-type microtia, and therefore, this surgical approach can be applied widely to correct this deformity. [ABSTRACT FROM AUTHOR]
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- 2024
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342. Improved intraoperative identification of close margins in oral squamous cell carcinoma resections using a dual aperture fluorescence ratio approach: first in-human results.
- Author
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Rounds, Cody C., de Wit, Jaron G., Vonk, Jasper, Vorjohan, Jennifer, Nelson, Sophia, Trang, Allyson, Villinski, Brooke, Samkoe, Kimberley S., Brankov, Jovan G., Voskuil, Floris J., Witjes, Max J. H., and Tichauer, Kenneth M.
- Subjects
- *
SQUAMOUS cell carcinoma , *DUAL fluorescence , *RECEIVER operating characteristic curves , *SURGICAL margin , *SURGICAL excision , *SURGICAL robots , *SURGICAL flaps - Abstract
Significance: Surgical excision is the main treatment for solid tumors in oral squamous cell carcinomas, where wide local excision (achieving a healthy tissue margin of >5 mm around the excised tumor) is the goal as it results in reduced local recurrence rates and improved overall survival. Aim: No clinical methods are available to assess the complete surgical margin intraoperatively while the patient is still on the operating table; and while recent intraoperative back-bench fluorescence-guided surgery approaches have shown promise for detecting "positive" inadequate margins (<1 mm), they have had limited success in the detection of "close" inadequate margins (1 to 5 mm). Here, a dual aperture fluorescence ratio (dAFR) approach was evaluated as a means of improving detection of close margins. Approach: The approach was evaluated on surgical specimens from patients who were administered a tumor-specific fluorescent imaging agent (cetuximab-800CW) prior to surgery. The dAFR approach was compared directly against standard widefield fluorescence imaging and pathology measurements of margin thickness in specimens from three patients and a total of 12 margin locations (1 positive, 5 close, and 6 clear margins). Results: The area under the receiver operating characteristic curve, representing the ability to detect close compared to clear margins (>5 mm) was found to be 1.0 and 0.57 for dAFR and sAF, respectively. Improvements in dAFR were found to be statistically significant (p < 0.02). Conclusions: These results provide evidence that the dAFR approach potentially improves detection of close surgical margins. [ABSTRACT FROM AUTHOR]
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- 2024
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343. EFFECTS OF PIRFENIDONE ON ISCHEMIA-REPERFUSION INJURY IN RAT EPIGASTRIC ISLAND FLAP MODEL: EXPERIMENTAL STUDY.
- Author
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Sönmez, Mehmet, Yılmaz, Canan, Sungu, Nuran, Karakaş, Ebubekir, and Allı, İpek
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- *
ANTI-inflammatory agents , *SURGICAL flaps , *SMALL intestine , *HISTOPATHOLOGY , *MOLECULAR weights - Abstract
Objectives: Pirfenidone is a non-peptide synthetic low molecular weight substance with anti-inflammatory, antioxidant and antifibrotic effects. Its positive effects have been shown on ischemia-reperfusion injury in various tissues such as testis, kidney, liver, lung and small intestine. Our aim is to investigate the effects of Pirfenidone on ischemia-reperfusion injury in skin flaps. Materials and Methods: Eighteen Wistar male rats were divided randomly into three groups: Sham, IschemiaReperfusion (IR) and Pirfenidone plus Ischemia-Reperfusion (IR+Pirf). The epigastric island flap was elevated and returned to its place in the Sham group. In the second group (IR), the flap was elevated, and flap perfusion was interrupted with an avascular clamp for eight hours. In the third group (IR+Pirf), 300 mg/kg Pirfenidone was given orally before ischemia. Tissue samples were taken to evaluate biochemical substances (1st day) and histopathologic examination (7th day). On the seventh day, standardized photographs were taken to calculate the viable areas of the flap and all animals were sacrificed. Results: Tissue MPO levels were statistically higher in the IR+Pirf group than in the Sham and IR groups (p=0.006). Tissue MDA levels were statistically higher in the IR+Pirf group than in the IR group (p=0.026). The lymphocyte count was lower in the Sham group than in the IR and IR+Pirf groups (p=0.002). The reepithelization ratio was higher in the IR+Pirf group than in the IR and Sham groups p=0.010). Flap survival areas showed no significant difference between groups (p=0.194). Conclusion: As a conclusion, single dose treatment of Pirfenidone in rat skin flap ischemia-reperfusion model enhanced significantly re-epithelization and has no significant effect on flap survival. [ABSTRACT FROM AUTHOR]
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- 2024
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344. Safety and Feasibility of Steroid-Eluting Stent as a Bolster in Endoscopic Anterior Skull Base Reconstruction.
- Author
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Finlay, John B., Issa, Khalil, Ackall, Feras, Zomorodi, Ali, Codd, Patrick, Jang, David W., Goldstein, Bradley J., and Abi Hachem, Ralph
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- *
SUTURING , *CEREBROSPINAL fluid leak , *SURGICAL therapeutics , *CEREBROSPINAL fluid rhinorrhea , *SURGICAL flaps , *DRUG-eluting stents , *ENDOSCOPIC ultrasonography , *INFLAMMATION , *AGE distribution , *PLASTIC surgery , *DISEASE incidence , *SURGICAL complications , *RETROSPECTIVE studies , *ACQUISITION of data , *TERTIARY care , *SEX distribution , *SINUSITIS , *MEDICAL records , *DESCRIPTIVE statistics , *SKULL base , *ORAL mucosa , *BODY mass index , *PATIENT safety , *TRANSPLANTATION of organs, tissues, etc. , *COMORBIDITY , *INTRACRANIAL hypertension - Abstract
Background: With a rising incidence of cerebrospinal fluid (CSF) leaks, endoscopic endonasal CSF leak repair is increasingly performed. Current approaches utilize a variety of materials including free mucosal grafts and vascularized flaps, but post-op leaks continue to be reported. Steroid-eluting bioabsorbable stents (SES) are used during functional endoscopic sinus surgery for chronic rhinosinusitis to reduce inflammation and scarring while maintaining patency of sinus ostia. Objective: The aim of this study is to assess the feasibility of SES as a graft/flap bolster for endoscopic endonasal CSF leak repair. Methods: This is a retrospective review of patients undergoing endoscopic endonasal CSF leak repair with SES placed as part of the bolster technique at a tertiary care center between January 2019 and May 2022. Age, sex, BMI, comorbid idiopathic intracranial hypertension, pathology, location of CSF leak, intraoperative CSF leak flow, reconstruction type, and presence of post-op CSF leak were recorded. Results: Twelve patients (mean age 52, median BMI 30.9, 58% female) had SES placement as part of the bolster technique. The most common pathology was meningoencephalocele (75%). Reconstruction was performed with either a free mucosal graft (6), or a flap (6). No post-op CSF leaks occurred at a reconstruction site with a stent, and no known complications were reported. All sinusotomies were patent at the last follow-up visit. Conclusions: SES placement as an adjunct to graft and/or flap bolster appears to be safe and feasible during anterior skull base reconstruction and CSF leak repair providing longer term structural support and preserving sinus drainage patency. [ABSTRACT FROM AUTHOR]
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- 2024
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345. Frailty as a Predictor of Post-Surgical Outcomes in Patients With Cutaneous Malignancies of the Scalp and Neck Requiring Flap Reconstruction.
- Author
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Welch, Christopher, Kazim, Syed Faraz, Esce, Antoinette, Bowers, Christian, Syme, Noah, and Boyd, Nathan
- Subjects
- *
SURGICAL flaps , *FRAIL elderly , *EVALUATION of human services programs , *SCALP , *MULTIVARIATE analysis , *OPERATIVE surgery , *HEAD & neck cancer , *HEALTH status indicators , *PLASTIC surgery , *CANCER patients , *TREATMENT effectiveness , *RISK assessment , *CUTANEOUS malignant melanoma , *POSTOPERATIVE period , *DESCRIPTIVE statistics , *QUALITY assurance , *PREDICTION models , *RECEIVER operating characteristic curves , *BASAL cell carcinoma , *SQUAMOUS cell carcinoma - Abstract
Background: Investigate the ability of frailty status to predict post-surgical outcomes in patients with cutaneous malignancies of the scalp and neck undergoing flap reconstruction. Methods: National Surgical Quality Improvement Program database was used to isolate patients with cutaneous malignancies of the scalp and neck who underwent surgical resection between 2015 to 2019. Univariate and multivariate analyses were performed to determine if frailty score correlated with negative post-operative outcomes. Receiver operating characteristic (ROC) curves allowed testing of the discriminative performance of age versus frailty. Results: This study demonstrated an independent correlation between frailty and major complications as well as non-home discharge. In ROC curve analysis, frailty demonstrated superior discrimination compared to age for predicting major complications. Conclusion: Our study demonstrated an association between increasing frailty and major complications as well as the likelihood of a non-home discharge. When compared to age, frailty was also shown to be a better predictor of major complications. [ABSTRACT FROM AUTHOR]
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- 2024
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346. Use of Rectus Flaps in Reconstructive Surgery for Gynecologic Cancer.
- Author
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Dzyubak, Oleksandra, Salman, Lina, and Covens, Allan
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- *
PLASTIC surgery , *SURGICAL flaps , *GYNECOLOGIC cancer , *MUSCULOCUTANEOUS flaps , *ONCOLOGIC surgery , *SURGICAL site infections , *GYNECOLOGIC surgery - Abstract
The aim of this study was to explore the outcomes of pelvic reconstruction with a rectus abdominis myocutaneous (RAM) or rectus abdominis myoperitoneal (RAMP) flap following radical surgery for gynecologic malignancy. This is a retrospective case series of all pelvic reconstructions with RAM or RAMP flap performed in a gynecologic oncology service between 1998 and 2023. Reconstructions with other flaps were excluded. A total of 28 patients were included. Most patients had vulvar cancer (n = 15, 53.6%) and the majority had disease recurrence (n = 20, 71.4%). Exenteration was the most common procedure, being carried out in 20 (71.4%) patients. Pelvic reconstruction was carried out with a RAM flap in 24 (85.7%) cases and a RAMP flap in 4 (14.3%) cases. Flap-specific complications included cellulitis (14.3%), partial breakdown (17.9%), and necrosis (17.9%). Donor site complications included surgical site infection and necrosis occurring in seven (25.0%) and three (10.7%) patients, respectively. Neovaginal reconstruction was performed in 14 patients. Out of those, two (14.3%) had neovaginal stenosis and three (21.4%) had rectovaginal fistula. In total, 50% of patients were disease-free at the time of the last follow up. In conclusion, pelvic reconstruction with RAM/RAMP flaps, at the time of radical surgery for gynecologic cancer, is an uncommon procedure. In our case series, we had a significant complication rate with the most common being infection and necrosis. The development of a team approach, with input from services including Gynecologic Oncology and Plastic Surgery should be developed to decrease post-operative complications and improve patient outcomes. [ABSTRACT FROM AUTHOR]
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- 2024
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347. Two arterial variations of the hand and wrist present bilaterally (persistent median artery and superficial dorsal branch of the radial artery): ultrasound findings.
- Author
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Belbl, Miroslav, Steyerova, Petra, and Kachlik, David
- Subjects
- *
RADIAL artery , *COLOR Doppler ultrasonography , *SURGICAL flaps , *ARTERIES , *ULTRASONIC imaging - Abstract
Purpose: Arterial variations of the upper limb may bear high importance for many clinical procedures, including the use of flaps in plastic surgery. We present a feasible way for visualization and confirmation of presence of these variations. Methods: All variations were detected by ultrasonography and confirmed by Color Doppler Imaging. Proper documentation was taken in order to present our findings. Results: We report a case of a 19-year-old female who showed two concomitant arterial variations of the forearm and the hand bilaterally. These two variations were the persistent median artery and the superficial dorsal branch of the radial artery which both significantly contributed to the blood supply of the hand. All examinations were performed by the same investigator and all findings were reviewed by an experienced sonographist. Conclusion: An unusual arrangement of the arterial system can be easily detected. We present a feasible way to prevent iatrogenic injuries and increase utilization of anatomical variants knowledge in surgery by using ultrasound prior to planning surgical procedures. [ABSTRACT FROM AUTHOR]
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- 2024
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348. Reconstruction of the Anterior Skull Base Using the Nasoseptal Flap: A Review.
- Author
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Werner, Michael T., Yeoh, Desmond, Fastenberg, Judd H., Chaskes, Mark B., Pollack, Aron Z., Boockvar, John A., Langer, David J., D'Amico, Randy S., Ellis, Jason A., Miles, Brett A., and Tong, Charles C. L.
- Subjects
- *
SURGICAL flaps , *ENDOSCOPIC surgery , *CONVALESCENCE , *PLASTIC surgery , *PRODUCT design , *QUALITY assurance , *SKULL base , *ENDOSCOPY - Abstract
Simple Summary: Patients with pituitary tumors and other masses at the bottom of the skull are at risk of brain infection and leaks of the fluid surrounding the brain when the tumor is removed surgically. To prevent these types of complications, surgeons have developed techniques to patch the surgical area with normal tissue taken from other parts of the body. In the past, this tissue was taken from the head, neck, and shoulder regions. Newer techniques allow the entire surgery to occur within the nose, resulting in fewer side effects and faster recovery. This includes taking normal tissue from within the nose to repair the base of the skull where the mass is removed. The nasoseptal flap is the most common method for this type of intranasal repair. In this paper, we describe the development and evolution of this surgical technique and discuss the impact that it has had on patient outcomes. The nasoseptal flap is a workhorse reconstructive option for anterior skull base defects during endonasal surgery. This paper highlights the versatility of the nasoseptal flap. After providing a brief historical perspective, this review will focus on the relevant primary literature published in the last ten years. We will touch upon new applications of the flap, how the flap has been modified to expand its reach and robustness, and some of the current limitations. We will conclude by discussing what the future holds for improving upon the design and use of the nasoseptal flap in anterior skull base reconstruction. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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349. Extended arc of rotation of Latissimus Dorsi Musculocutaneous Flap providing well-vascularized tissue for reconstruction of complete defects of the sternum: An anatomical study of flap pedicle modification.
- Author
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Ernert, Carsten, Kielstein, Heike, Azatyan, Argine, Prantl, Lukas, and Kehrer, Andreas
- Subjects
- *
LATISSIMUS dorsi (Muscles) , *FREE flaps , *STERNUM , *MUSCULOCUTANEOUS flaps , *SURGICAL flaps , *PLASTIC surgery , *NEGATIVE-pressure wound therapy , *WOUND infections , *TISSUES - Abstract
BACKGROUND: Deep sternal wound infections (DSWI) following cardiothoracic surgery represent a life quality endangering sequelae and may lead to sternal osteomyelitis. Radical debridement followed by Negative Pressure Wound Therapy (NPWT) may achieve infection control, provide angiogenesis, and improve respiratory function. When stable wound conditions have been established a sustainable plastic surgical flap reconstruction should be undertaken. OBJECTIVE: This study analyses a method to simplify defect coverage with a single Latissimus Dorsi Myocutaneous Flap (LDMF). METHODS: Preparation of 20 LDMF in ten fresh frozen cadavers was conducted. Surgical steps to increase pedicle length were evaluated. The common surgical preparation of LDMF was compared with additional transection of the Circumflex Scapular Artery (CSA). RESULTS: Alteration of the surgical preparation of LDMF by sacrificing the CSA may provide highly valuable well-vascularized muscle tissue above the sensitive area of the Xiphisternum. All defects could be completely reconstructed with a single LDMF. The gain in length of flap tissue in the inferior third of the sternum was 3.86±0.9 cm (range 2.2 to 8 cm). CONCLUSIONS: By sacrificing the CSA in harvesting the LDMF a promising gain in length, perfusion and volume may be achieved to cover big sternal defects with a single flap. [ABSTRACT FROM AUTHOR]
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- 2024
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350. Case Report on Botulinum Toxin Treatment for Complex Regional Pain Syndrome in a Digit Reconstruction.
- Author
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RASHAAN, R., ARKOUMANIS, P. T., GAKIS, C., LYSSIOTIS, F. A., MICHALIS, J., ANAGNOSTOPOULOS, P., and STRATAKIS, K.
- Subjects
- *
BOTULINUM toxin , *COMPLEX regional pain syndromes , *BOTULINUM A toxins , *SURGICAL flaps - Abstract
Objective: To evaluate subcutaneous Botulinum toxin type A (BTX-A) efficacy in alleviating severe allodynia in complex regional pain syndrome (CRPS) type II post-digit reconstruction. Methods and methods: After surgical debridement and flap reconstruction for post-traumatic necrosis, a CRPS type II patient received subcutaneous BTX-A. Assessments tracked symptom changes and daily life improvements. Discussion: There are various CRPS management modalities, including rehabilitation and pharmacology. The limited efficacy of conventional non-steroidal antiinflammatory drugs contrasts with promising subcutaneous BTX-A, offering rapid pain relief. Conclusion: Our case underscores the efficacy of subcutaneous BTX-A in CRPS type II, prompting further research and safe outpatient protocol development. [ABSTRACT FROM AUTHOR]
- Published
- 2024
- Full Text
- View/download PDF
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