342 results on '"Flap failure"'
Search Results
2. Flap Monitoring
- Author
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Strohl, Madeleine P., Patel, Rusha, Nicolli, Elizabeth A., Quimby, Anastasiya, editor, Parmar, Sat, editor, and Fernandes, Rui, editor
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- 2023
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3. Re-exploration, Complications and Flap Salvage
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Caine, Paul, Jeevaratnam, Johann A., Misky, Adam, Nikkhah, Dariush, Nikkhah, Dariush, editor, Rawlins, Jeremy, editor, and Pafitanis, Georgios, editor
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- 2023
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4. Strategies Following Free Flap Failure in Lower Extremity Trauma: A Systematic Review
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Isabelle T.S. Koster, Marieke P. Borgdorff, Faridi S. Jamaludin, Tim de Jong, Matthijs Botman, and Caroline Driessen
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Lower extremity ,Traumatic injuries ,Free flap ,Flap failure ,Microsurgery ,Treatment outcome ,Surgery ,RD1-811 - Abstract
ABSTRACT: Background: Free flap reconstructions are an important reconstructive option for soft tissue defects in mangled lower extremities. Microsurgery facilitates soft tissue coverage of defects that otherwise would result in amputation. However, the success rates of traumatic lower extremity free flap reconstructions remain lower than those in other locations. Nevertheless, post-free flap failure salvage strategies have rarely been addressed. Therefore, the current review aims to provide an overview of post-free flap failure strategies in lower extremity trauma and their subsequent outcomes. Methods: A search of Pubmed, Cochrane, and Embase databases was performed on June 9, June 2021 using the following medical subject headings (MeSH) search terms: ‘lower extremity’, ‘leg injuries’, ‘reconstructive surgical procedures’, ‘reoperation’, ‘microsurgery’ and ‘treatment failure’. This review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Partial and total free flap failures after traumatic reconstruction were included. Results: Twenty-eight studies with a total of 102 free flap failures fulfilled the eligibility criteria. Following the total failure, a second free flap is the predominant reconstructive strategy (69%). In comparison to the failure rate of a first free flap (10%), the fate of a second free flap is less favorable with a failure rate of 17%. The amputation rate following flap failure is 12%. The risk of amputation increases between primary and secondary free flap failures. After partial flap loss, the preferred strategy is a split skin graft (50%). Conclusion: To our knowledge, this is the first systematic review on the outcome of salvage strategies after free flap failure in traumatic lower extremity reconstruction. This review provides valuable evidence to take into consideration in the decision-making regarding post-free flap failure strategies.
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- 2023
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5. Vasopressors improve outcomes in autologous free tissue transfer: A systematic review and meta-analysis.
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Noori, Omar, Pereira, Jose L, Stamou, Despoina, Ch'ng, Sydney, and Varey, Alexander HR
- Abstract
Vasopressor use in patients undergoing autologous free tissue transfer is generally discouraged by surgeons perioperatively. This stems from concerns about the increased risk of flap failure with their use. The aim of this systematic review was to investigate the evidence and quantify any harm or benefits associated with vasopressor use. A systematic review of the literature was undertaken using OVID Medline to search 13 databases. The search strategy used Boolean operators, text word searches, truncation symbols, and adjacency searching. Terms such as "free flap," "free tissue graft," and "free tissue transfer" were used along with a list of appropriate vasopressors. The primary outcome was free flap failure, on which a meta-analysis was performed. The search initially identified 1029 unique articles, which after title and abstract screening was reduced to 112, of which 15 remained after full-text screening for inclusion in the review and analysis. We analyzed data from 8427 flaps, with 6695 having received a vasopressor. Meta-analysis demonstrated that vasopressor use reduced the relative risk (RR) of free flap failure (RR: 0.70; 95% CI: 0.50–0.97; p = 0.03) but did not affect rates of other adverse events (RR: 0.81; 95% CI: 0.63–1.05; p = 0.11). Vasopressor use appears beneficial for autologous free tissue transfer, with evidence that it reduced the risk of flap failure without impacting the rates of other adverse events. The use of vasopressors should, therefore, be encouraged on a case-by-case basis, depending upon the general physiological needs of the patient. [ABSTRACT FROM AUTHOR]
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- 2023
- Full Text
- View/download PDF
6. Outcome comparison between muscle and fasciocutaneous flaps after secondary orthopedic procedures.
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Guo, Meng, Thomas, Bejoy, Goyal, Samita, Rivedal, David, Mehdi, Maahum, Schmeling, Gregory J., Neilson, John C., Martin, Jill, Harkin, Elizabeth A., Wooldridge, Adam, King, David M., Hackbarth, Donald A., Doren, Erin L., Hettinger, Patrick, and LoGiudice, John A.
- Abstract
Lower extremity wounds associated with fractures and bony defects often require secondary orthopedic procedures after flap coverage has been performed. In this study, we compare complications between muscle and fasciocutaneous flaps after secondary orthopedic procedures. A retrospective chart review study of all lower extremity soft tissue reconstructions by a single surgeon over seven years yielded a subgroup of patients who underwent secondary orthopedic procedures, including hardware removal, hardware revision, and bone grafting after flap reconstruction. Of 355 lower extremity, soft tissue reconstructions for orthopedic coverage performed in the time period studied, 102 patients underwent secondary orthopedic procedures after flap reconstruction. Of these, 54 received muscle flaps (52.94%), and 48 received fasciocutaneous flaps (47.06%). Using this subgroup of 102 patients, we compared muscle and fasciocutaneous flaps using three categories of wound complications following these secondary procedures: There were no superficial wounds requiring local wound care only in the muscle flap group (0%, n = 0) versus 4.17% (n = 2; p = 0.130) in the fasciocutaneous flap group. There were 2 lost flaps requiring surgical debridement and additional skin grafting in the muscle flaps group (3.70%) versus 2 (4.17%; p = 0.904) in the fasciocutaneous flap group. In the third category, flap loss requiring additional soft tissue reconstruction was 18.52% (n = 10) in the muscle group versus 2.08% (n = 1; p = 0.008) in the fasciocutaneous flap group. Our data support the existing literature indicating that fasciocutaneous flaps can tolerate secondary procedures better than muscle flaps and should initially be considered in patients with higher probability of needing additional orthopedic procedures after reconstruction. [ABSTRACT FROM AUTHOR]
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- 2023
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7. Does anticoagulation improve outcomes of microvascular free flap reconstruction following head and neck surgery: a systematic review and meta-analysis.
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Dawoud, B.E.S., Kent, S., Tabbenor, O., Markose, G., Java, K., and Kyzas, P.
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FREE flaps ,LOW-molecular-weight heparin ,VENOUS thrombosis ,FIBRINOLYTIC agents ,ANTICOAGULANTS - Abstract
The commonest cause of microvascular free flap failure is thrombosis at the anastomosis. Pharmacological antithrombotic therapies have been used to mitigate this risk, but they carry the risk of bleeding and haematoma formation. To justify any intervention, it is necessary to evaluate the benefits and balance of risks. This meta-analysis aims to quantify the value of systemic anticoagulation during head and neck free tissue reconstruction. We performed a systematic review on the impact of additional prophylactic antithrombotic therapy on head and neck (H&N) free tissue transfer (on top and above the use of low molecular weight heparin to prevent deep vein thrombosis). We carried a PRISMA-guided literature review, following registration with PROSPERO. All studies analysing the possible impact of prophylactic anticoagulants on free flap surgery in the head and neck were eligible. The primary outcome was perioperative free flap complications (perioperative thrombosis, partial or total free flap failure, thrombo-embolic events, or re-exploration of anastomosis). Secondary outcomes included haematoma formation or bleeding complications requiring further intervention. We identified eight eligible studies out of 454. These included 3531 free flaps for H&N reconstruction. None of the assessed interventions demonstrated a statistically significant improvement in free flap outcomes. Accumulative analysis of all anti-coagulated groups demonstrated an increased relative risk of free flap complications [RR 1.54 (0.73–3.23)] compared to control albeit not statistically significant (p = 0.25). Pooled analysis from the included studies showed that the prophylactic use of therapeutic doses of anticoagulants significantly (p = 0.003) increased the risk of haematoma and bleeding requiring intervention [RR 2.98 (1.47-6.07)], without reducing the risk of free flap failure. Additional anticoagulation does not reduce the incidence of free flap thrombosis and failure. Unfractionated heparin (UFH) consistently increased the risk of free flap complications. The use of additional anticoagulation as 'prophylaxis' in the perioperative setting, increases the risk of haematoma and bleeding. [ABSTRACT FROM AUTHOR]
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- 2022
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8. Late Free Flap Failure in Head and Neck Reconstruction: Unusual Etiology in Two Case Studies and Literature Review.
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Zahran, Mohamed, Hoffman, Gary, Eisenberg, Robert, Tan, Andrew, and Youssef, Ahmed
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OPERATIVE surgery , *FREE flaps , *LITERATURE reviews , *ETIOLOGY of diseases , *POSTOPERATIVE period , *NECK , *THORACIC outlet syndrome - Abstract
The development of modern microvascular surgical techniques has enabled the reliable transfer of free vascularized tissue. This allowed for predictable reconstruction outcomes with excellent surgical success rates. However, devastating consequences of partial or total flap failure and subsequent loss may occur. This usually occurs in the first 48–72 h post-operatively. It is rare for flaps to fail in the late post-operative period and it remains poorly understood why flaps fail after day seven. We presented two patients in whom flap failure occurred after the seventh post-operative day (POD). Complete flap failure occurred after POD 9 and 27 in our cases. During the postoperative period, there was no evidence of early occlusion or insult to the vascular integrity such as venous/arterial compression. The cause of late flap failure was due to thrombophlebitis secondary to infection from the tracheostomy-neck fistula. This assumption was supported by recurrent failure of anastomoses revision. [ABSTRACT FROM AUTHOR]
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- 2022
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9. Microsurgical Strategies after Free Flap Failure in Soft Tissue Reconstruction of the Lower Extremity: A 17-Year Single-Center Experience.
- Author
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Struebing, Felix, Xiong, Lingyun, Bigdeli, Amir K., Diehm, Yannick, Kneser, Ulrich, Hirche, Christoph, and Gazyakan, Emre
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FREE flaps , *PERFORATOR flaps (Surgery) , *LIMB salvage , *SKIN grafting , *NEGATIVE-pressure wound therapy , *VENOUS insufficiency - Abstract
Background: There is no clear consensus on the optimal surgical strategy for providing safe coverage in salvage free flap surgery after total free flap failure. Methods: A retrospective study was conducted to evaluate patients with total failure of the primary free flap in lower extremity reconstruction between 2000 and 2017. Results: In a cohort of 1.016 patients, we identified 43 cases of total flap failure (4.2%). A total of 30 patients received a salvage free flap with a success rate of 83.3% (25/30). One patient received a secondary salvage free flap. Overall limb salvage after primary free flap loss was 83.7% (36/43). Conclusions: Microsurgical management of free flap loss in the lower extremity is challenging and requires a decisive re-evaluation of risk factors and alternative strategies. This should include reconsidering the flap choice with a tendency towards traditional and safe workhorse flaps, a low-threshold switch to different recipient vessels, including arteriovenous (AV) loops, bypasses (especially in case of venous insufficiency) and back-up procedures, such as negative pressure wound therapy or dermal regeneration templates with skin grafting in cases of lower demand and critically ill patients. We derived one suggestion from our previous practice: replacing perforator flaps with axial pattern flaps ("safe workhorses"). [ABSTRACT FROM AUTHOR]
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- 2022
- Full Text
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10. Outcomes of anastomotic venous flow couplers in head and neck free flap reconstruction – five-year experience in a single centre.
- Author
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Bowe, C.M., Twigg, J., Salker, A.M., Doumas, S., and Ho, M.W.
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FREE flaps ,MAXILLOFACIAL surgery ,ORAL surgery ,NECK ,POSTOPERATIVE period ,SURGICAL anastomosis - Abstract
Flow couplers for venous anastomosis, which enable the invasive monitoring of free flaps during the postoperative period with a continuous venous signal audible immediately after completion of the anastomosis, have been reported to be reliable, sensitive, and specific as anastomotic flap monitoring adjuncts. The purpose of this study was to evaluate the reliability, sensitivity, specificity, and outcomes of surgical exploration, and the impact on free-flap survival of the venous anastomotic flow coupler for microvascular head and neck reconstruction in a consecutive series of patients. This is a retrospective review of consecutive patients treated in the department of oral and maxillofacial surgery who underwent reconstruction of a head and neck defect using venous anastomosis with a flow coupler-vascularised free flap between October 2015 and December 2020. A total of 189 patients had free-flap reconstruction of head and neck defects. We compared the venous flow coupler group (n = 72) with patients who had free flaps with hand-sewn anastomoses over the same period (n = 117). There were no false positive/negatives associated with the flow coupler as an implantable flap monitor. The flow coupler cohort had a significantly higher flap salvage rate compared with free flaps that were monitored clinically (p = 0.04). The venous flow coupler has been shown to be a reliable microvascular anastomotic and invasive flap monitor that enables accurate and timely detection of flap compromise and prompt, successful free-flap salvage. [ABSTRACT FROM AUTHOR]
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- 2022
- Full Text
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11. Risk factors for surgical site infection in head and neck cancer.
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Gan, Chengwen, Wang, Yannan, Tang, Yan, Wang, Kai, Sun, Bincan, Wang, Mengxue, and Zhu, Feiya
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PREOPERATIVE risk factors , *HEAD & neck cancer , *NECK dissection , *SURGICAL site infections , *MAXILLOFACIAL surgery , *LOGISTIC regression analysis ,TUMOR surgery - Abstract
Purpose: Surgical site infection (SSI) frequently occurs in patients with head and neck cancer (HNC) after tumor resection and can lead to death in severe cases. Moreover, there is no definitive conclusion about the risk factors of SSI. Therefore, it is of great clinical significance to study the factors affecting the SSI. Methods: The HNC patients included in this study were all from the Department of Oral and Maxillofacial Surgery of the Second Xiangya Hospital of Central South University (CSU), and these patients received surgical treatment in the department from January 2018 to December 2019. The cross tabulation with chi-squared testing and multivariate regression analysis were applied to determine the risk factors of SSI. To identify the key risk factors of SSI, the caret package was used to construct three different machine learning models to investigate important features involving 26 SSI-related risk factors. Results: Participants were 632 HNC patients who underwent surgery in our department from January 2018 to December 2019. During the postoperative period, 82 patients suffered from SSI, and surgical site infection rate (SSIR) was about 12.97%. Multivariate logistic regression analysis shows that diabetes mellitus, primary tumor site (floor of mouth), preoperative radiotherapy, flap failure, and neck dissection (bilateral) are risk factors for SSI of HNC. Machine learning indicated that diabetes mellitus, primary tumor site (floor of mouth), and flap failure were consistently ranked the top three in the 26 SSI-related risk factors. Conclusion: Diabetes mellitus, primary tumor site (floor of mouth), flap failure, preoperative radiotherapy, and neck dissection (bilateral) are risk factors for SSI of HNC. [ABSTRACT FROM AUTHOR]
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- 2022
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12. Implantable Doppler Removal After Free Flap Monitoring Among Head and Neck Microvascular Surgeons.
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Ong, Adrian A., Ducic, Yadranko, Pipkorn, Patrik, and Wax, Mark K.
- Abstract
Objective: Investigate current practice patterns of head and neck microvascular reconstructive surgeons when removing an implantable Doppler after free flap surgery. Study Design: Cross‐sectional survey study. Methods: Survey distributed to head and neck microvascular reconstructive surgeons. Data regarding years performing free tissue transfer, case numbers, management of implantable Doppler wire, and complications were collected. Results: Eighty‐five responses were analyzed (38,000 cases). Sixty‐six responders (77.6%) use an implantable Doppler for postoperative monitoring, with 97% using the Cook‐Swartz Doppler Flow Monitoring System. Among this group, 65.2% pull the wire after monitoring was complete, 3% cut the wire, and 31.8% have both cut and pulled the wire. Of those who have cut and pulled the wire, 48% report cutting and pulling the wire with equal frequency, 43% formerly pulled the wire and now cut the wire, and 9% previously cut the wire but now pull the wire. Of those who pull the wire, there were two injuries to the pedicle requiring return to the operating for flap salvage, and one acute venous congestion. Of the nine who previously pulled the wire, six (67%) cited concerns with major bleeding/flap compromise as the reason for cutting the wire. Conclusion: In this study, most surgeons use an implantable Doppler for monitoring of free flaps postoperatively. In extremely rare instances, pulling the implantable Doppler wire has resulted in flap compromise necessitating revision of the vascular anastomosis. Cutting the wire and leaving the proximal portion in the surgical site has been adopted as a management option. Level of Evidence: 4 Laryngoscope, 132:554–559, 2022 [ABSTRACT FROM AUTHOR]
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- 2022
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13. Impact of Periosteal Branches and Septo-Cutaneous Perforators on Free Fibula Flap Outcome: A Retrospective Analysis of Computed Tomography Angiography Scans in Virtual Surgical Planning.
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Knitschke, Michael, Baumgart, Anna Katrin, Bäcker, Christina, Adelung, Christian, Roller, Fritz, Schmermund, Daniel, Böttger, Sebastian, Streckbein, Philipp, Howaldt, Hans-Peter, and Attia, Sameh
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FREE flaps ,COMPUTED tomography ,ANGIOGRAPHY ,CARDIOVASCULAR system ,SURGICAL flaps ,RETROSPECTIVE studies ,PERFORATOR flaps (Surgery) - Abstract
Background: Virtual surgical planning (VSP) for jaw reconstruction with free fibula flap (FFF) became a routine procedure and requires computed tomography angiography (CTA) for preoperative evaluation of the lower limbs vascular system and the bone. The aim of the study was to assess whether the distribution and density of periosteal branches (PB) and septo-cutaneous perforators (SCP) of the fibular artery have an impact on flap success. Method: This retrospective clinical study assessed preoperative CTA of the infra-popliteal vasculature and the small vessel system of 72 patients who underwent FFF surgery. Surgical outcome of flap transfer includes wound healing, subtotal, and total flap loss were matched with the segmental vascular supply. Result: A total of 72 patients (28 females, 38.9 %; 44 males, 61.1 %) fulfilled the study inclusion criteria. The mean age was 58.5 (± 15.3 years). Stenoses of the lower limbs' vessel (n = 14) were mostly detected in the fibular artery (n = 11). Flap success was recorded in n = 59 (82.0%), partial flap failure in n = 4 (5.5%) and total flap loss in n = 9 (12.5%). The study found a mean number (± SD) of 2.53 ± 1.60 PBs and 1.39 ± 1.03 SCPs of the FA at the donor-site. The proximal FFF segment of poly-segmental jaw reconstruction showed a higher rate of PB per flap segment than in the distal segments. Based on the total number of prepared segments (n = 121), 46.7% (n = 7) of mono-, 40.4% (n = 21) of bi-, and 31.5 % (n = 17) of tri-segmental fibula flaps were at least supplied by one PB in the success group. Overall, this corresponds to 37.2% (45 out of 121) of all successful FFF. For total flap loss (n = 14), a relative number of 42.9% (n = 6) of distinct supplied segments was recorded. Wound healing disorder of the donor site was not statistically significant influenced by the detected rate of SCP. Conclusion: In general, a correlation between higher rates of PB and SCP and the flap success could not be statistically proved by the study sample. We conclude, that preoperative PB and SCP mapping based on routine CTA imaging is not suitable for prediction of flap outcome. [ABSTRACT FROM AUTHOR]
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- 2022
- Full Text
- View/download PDF
14. Intraoperative Vasopressor Usage in Free Tissue Transfer: Should We Be Worried?
- Author
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Munro, Samuel P., Chang, Chad, Tinker, Rory J., Anderson, Iain B., Bedford, Geoff C., Ragbir, Maniram, and Ahmed, Omar A.
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FREE flaps , *HYPEREMIA , *FISHER exact test , *SURGICAL complications - Abstract
Background The role of vasopressors has long been a subject of debate in microsurgery. Conventional wisdom dictates the avoidance of vasopressor use, due to concerns such as peripheral vasoconstriction, inducing vasospasm of the anastomoses, and leading to failure in perfusion. It has since become common practice in some centers to avoid intraoperative vasopressor use during free tissue transfer surgery. Recent studies have suggested that this traditional view may not be supported by clinical evidence. However, none of these studies have separated vasopressor use by method of administration. Methods We conducted a retrospective review of our experience of vasopressor use in free flap surgery at a single high-volume center. The outcome measures were flap failure, flap-related complications and overall postoperative complications (reported using the Clavien–Dindo classification). Groups were compared using Chi-square or Fisher's Exact test where appropriate. Results A total of 777 cases in 717 patients were identified. 59.1% of these had vasopressors administered intraoperatively. The overall failure rate was 2.2%, with 9.8% experienced flap-related complications. There was no difference in flap loss when vasopressors were administered, but an increased rate of microvascular thrombosis was noted (p = 0.003). Continuous administration of vasopressors was associated with reduced venous congestion, whereas intermittent boluses increased risk of microvascular thrombosis. Conclusion Our study confirms previous findings that intraoperative vasopressor use in free flap surgery is not associated with increased failure rate. Administering vasopressors continuously may be safer than via repeated boluses. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF
15. Impact of Periosteal Branches and Septo-Cutaneous Perforators on Free Fibula Flap Outcome: A Retrospective Analysis of Computed Tomography Angiography Scans in Virtual Surgical Planning
- Author
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Michael Knitschke, Anna Katrin Baumgart, Christina Bäcker, Christian Adelung, Fritz Roller, Daniel Schmermund, Sebastian Böttger, Philipp Streckbein, Hans-Peter Howaldt, and Sameh Attia
- Subjects
virtual surgical planning ,jaw reconstruction ,CTA ,flap failure ,head and neck tumor ,fibula free flap ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
BackgroundVirtual surgical planning (VSP) for jaw reconstruction with free fibula flap (FFF) became a routine procedure and requires computed tomography angiography (CTA) for preoperative evaluation of the lower limbs vascular system and the bone. The aim of the study was to assess whether the distribution and density of periosteal branches (PB) and septo-cutaneous perforators (SCP) of the fibular artery have an impact on flap success.MethodThis retrospective clinical study assessed preoperative CTA of the infra-popliteal vasculature and the small vessel system of 72 patients who underwent FFF surgery. Surgical outcome of flap transfer includes wound healing, subtotal, and total flap loss were matched with the segmental vascular supply.ResultA total of 72 patients (28 females, 38.9 %; 44 males, 61.1 %) fulfilled the study inclusion criteria. The mean age was 58.5 (± 15.3 years). Stenoses of the lower limbs’ vessel (n = 14) were mostly detected in the fibular artery (n = 11). Flap success was recorded in n = 59 (82.0%), partial flap failure in n = 4 (5.5%) and total flap loss in n = 9 (12.5%). The study found a mean number (± SD) of 2.53 ± 1.60 PBs and 1.39 ± 1.03 SCPs of the FA at the donor-site. The proximal FFF segment of poly-segmental jaw reconstruction showed a higher rate of PB per flap segment than in the distal segments. Based on the total number of prepared segments (n = 121), 46.7% (n = 7) of mono-, 40.4% (n = 21) of bi-, and 31.5 % (n = 17) of tri-segmental fibula flaps were at least supplied by one PB in the success group. Overall, this corresponds to 37.2% (45 out of 121) of all successful FFF. For total flap loss (n = 14), a relative number of 42.9% (n = 6) of distinct supplied segments was recorded. Wound healing disorder of the donor site was not statistically significant influenced by the detected rate of SCP.ConclusionIn general, a correlation between higher rates of PB and SCP and the flap success could not be statistically proved by the study sample. We conclude, that preoperative PB and SCP mapping based on routine CTA imaging is not suitable for prediction of flap outcome.
- Published
- 2022
- Full Text
- View/download PDF
16. Microsurgical Strategies after Free Flap Failure in Soft Tissue Reconstruction of the Lower Extremity: A 17-Year Single-Center Experience
- Author
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Felix Struebing, Lingyun Xiong, Amir K. Bigdeli, Yannick Diehm, Ulrich Kneser, Christoph Hirche, and Emre Gazyakan
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lower extremity ,free flap ,flap failure ,secondary free flap ,tertiary free flap ,orthoplastic ,Medicine - Abstract
Background: There is no clear consensus on the optimal surgical strategy for providing safe coverage in salvage free flap surgery after total free flap failure. Methods: A retrospective study was conducted to evaluate patients with total failure of the primary free flap in lower extremity reconstruction between 2000 and 2017. Results: In a cohort of 1.016 patients, we identified 43 cases of total flap failure (4.2%). A total of 30 patients received a salvage free flap with a success rate of 83.3% (25/30). One patient received a secondary salvage free flap. Overall limb salvage after primary free flap loss was 83.7% (36/43). Conclusions: Microsurgical management of free flap loss in the lower extremity is challenging and requires a decisive re-evaluation of risk factors and alternative strategies. This should include reconsidering the flap choice with a tendency towards traditional and safe workhorse flaps, a low-threshold switch to different recipient vessels, including arteriovenous (AV) loops, bypasses (especially in case of venous insufficiency) and back-up procedures, such as negative pressure wound therapy or dermal regeneration templates with skin grafting in cases of lower demand and critically ill patients. We derived one suggestion from our previous practice: replacing perforator flaps with axial pattern flaps (“safe workhorses”).
- Published
- 2022
- Full Text
- View/download PDF
17. Postoperative management of antithrombotic medication in microvascular head and neck reconstruction: a comparative analysis of unfractionated and low-molecular-weight heparin.
- Author
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Sievert, Matti, Goncalves, Miguel, Tamse, Rosalie, Mueller, Sarina K., Koch, Michael, Gostian, Antoniu-Oreste, Iro, Heinrich, and Scherl, Claudia
- Subjects
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FREE flaps , *MEDICATION therapy management , *HEPARIN , *NECK , *COMPARATIVE studies , *SURGICAL complications - Abstract
Purpose: Free flap reconstruction is a valuable technique to preserve function in oncological head and neck surgery. Postoperative graft thrombosis is a dreaded risk. This study aims to compare low-dose unfractionated heparin (UFH) and low-molecular-weight heparin (LMWH) in perioperative thrombosis prophylaxis. Methods: This is a retrospective analysis of 266 free flaps performed at our academic center. A comparison was made between 2 patient groups, based on their respective postoperative prophylaxis protocols either with UFH (n = 87) or LMWH (n = 179). Primary endpoints were the frequency of transplant thrombosis and the number of flap failures. Secondary endpoints were the occurrence of peri- and postoperative complications. Results: The flap survival rate was 96.6% and 93.3% for the groups UFH and LMWH, respectively (P = 0.280). The rate of postoperative bleeding requiring revision was 4.6% and 6.7% for each group, respectively (P = 0.498). We found a hematoma formation in 4.6% and 3.9% (P = 0.792). Conclusion: The free-flap survival rate using low-dose UFH seems to be equivalent to LMWH regimens without compromising the postoperative outcome. Consequently, for risk-adapted thrombosis prophylaxis, either LMWH or UFH can be administrated. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
18. Management of Craniomaxillofacial Injuries
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Abu-Sittah, Ghassan Soleiman, Baroud, Joe S., Hakim, Christopher Alain, Abu-Sittah, Ghassan Soleiman, editor, Hoballah, Jamal J., editor, and Bakhach, Joseph, editor
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- 2017
- Full Text
- View/download PDF
19. Predicting risk factors that lead to free flap failure and vascular compromise: A single unit experience with 565 free tissue transfers.
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Lese, Ioana, Biedermann, Raphael, Constantinescu, Mihai, Grobbelaar, Adriaan O., and Olariu, Radu
- Abstract
Even though the benefit of free tissue transfer is uncontested in complex reconstructive cases, vascular compromise and/or flap failure remain a challenge for the surgeon and identification of possible risk factors can aid in the preoperative planning. The aim of this study was to identify the individual risk factors leading to flap failure and/or vascular compromise in free tissue transfers in a single institution over a period of 10 years and to create an index predicting these problems, as well as finding predictors of other postoperative complications. Data from all the patients undergoing free tissue transfers between 2009 and 2018 were retrospectively analyzed (demographics, comorbidities, flap failure, vascular compromise, and other complications). The results from the univariate and multivariate analyses were used to create an index. A predictability index with three classes (low, moderate, and high risk) was calculated for each patient, based on defect etiology and the presence of coronary heart disease, diabetes, smoking, peripheral arterial vascular disease, and arterial hypertension. A patient with moderate-risk index had 9.3 times higher chances of developing vascular compromise than those in the low-risk group, while a high-risk index had 18.6 higher odds (p =0.001). American Society of Anesthesiologists (ASA) classification was found to be a predictor of complications in free tissue transfer (p =0.001). If patients at a high risk of vascular compromise could be identified preoperatively through this predictability index, patient counseling could be improved and the surgeon might adapt the reconstructive plan and choose an alternative reconstructive strategy. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
20. Near-Infrared Spectroscopy (NIRS) versus Hyperspectral Imaging (HSI) to Detect Flap Failure in Reconstructive Surgery: A Systematic Review
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Anouk A. M. A. Lindelauf, Alexander G. Saelmans, Sander M. J. van Kuijk, René R. W. J. van der Hulst, and Rutger M. Schols
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free flap ,near-infrared spectroscopy ,hyperspectral imaging ,flap failure ,flap loss ,tissue oxygenation ,Science - Abstract
Rapid identification of possible vascular compromise in free flap reconstruction to minimize time to reoperation improves achieving free flap salvage. Subjective clinical assessment, often complemented with handheld Doppler, is the golden standard for flap monitoring; but this lacks consistency and may be variable. Non-invasive optical methods such as near-infrared spectroscopy (NIRS) and hyperspectral imaging (HSI) could facilitate objective flap monitoring. A systematic review was conducted to compare NIRS with HSI in detecting vascular compromise in reconstructive flap surgery as compared to standard monitoring. A literature search was performed using PubMed and Embase scientific database in August 2021. Studies were selected by two independent reviewers. Sixteen NIRS and five HSI studies were included. In total, 3662 flap procedures were carried out in 1970 patients using NIRS. Simultaneously; 90 flaps were performed in 90 patients using HSI. HSI and NIRS flap survival were 92.5% (95% CI: 83.3–96.8) and 99.2% (95% CI: 97.8–99.7). Statistically significant differences were observed in flap survival (p = 0.02); flaps returned to OR (p = 0.04); salvage rate (p < 0.01) and partial flap loss rate (p < 0.01). However, no statistically significant difference was observed concerning flaps with vascular crisis (p = 0.39). NIRS and HSI have proven to be reliable; accurate and user-friendly monitoring methods. However, based on the currently available literature, no firm conclusions can be drawn concerning non-invasive monitoring technique superiority
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- 2022
- Full Text
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21. A UK based multi-centre prospective study of microvascular free-flap surgery.
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Room, Hywel, Sawyer, Oliver, Sethu, Claire, Taha, Hisham, Pikturnaite, Jurga, Gujral, Sameer, and Hughes, Juliana
- Subjects
- *
FREE flaps , *PLASTIC surgery , *SURVIVAL analysis (Biometry) , *LONGITUDINAL method , *SURGERY , *LEG - Abstract
Background: Studies carried out in 1998 by Khouri et al. established a benchmark for free flap survival. Whilst individual factors related to free flap survival have been examined since, there has been little contemporaneous data re-examining overall flap survival rates and factors related to complications to assess progress in the field and specifically European or UK practice. Methods: Six plastic surgery units from four regions within the South West UK regional collaboration group prospectively collected data on all free flap surgery performed in a 6-month period between October 2013 and April 2014. Results: Data on 264 free flaps were prospectively collected. Total flap failure was 2.7% and partial flap failure was 4.5%. Regression analysis identified obesity and previous recipient site radiotherapy as the most important factors in flap failure. The rate of intra-operative and post-operative flap thrombosis was 3.8% and 6.4%, respectively, and was associated with lower limb recipient site and surgeon grade. Post-operative haematoma occurred in 4.2%, associated with recipient site radiotherapy. Conclusions: Our study establishes a UK baseline for standards in free flap surgery. With the recent introduction of a UK Free Flap Surgery Registry, this baseline will support unit audit and improvements in free flap surgery. Level of evidence: Level III, risk/prognostic study. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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22. Failure of pedicled flap reconstruction in the head and neck area: A case report of a bilateral subclavian artery stenosis.
- Author
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Sievert, Matti, Koch, Michael, Mantsopoulos, Konstantinos, Traxdorf, Maximilian, Mueller, Sarina K., Iro, Heinrich, and Scherl, Claudia
- Abstract
• Pedicled flap reconstruction in the head and neck is still an alternative if free flaps are not possible. • Angiography of the subclavian artery is not a standard procedure in the surgical planning of pedicle flap harvesting. • In exceptional cases, we recommend angiography of the neck and thoracic vessels. • The application of a temporary pharyngostoma is still an option in extraordinary circumstances. Pedicled flap reconstruction still plays an essential role in head and neck surgery as an alternative to free grafts. Two standard methods are the pectoralis major and the deltopectoral flap, which are generally characterized by their reliable perfusion. This case describes bilateral arteriosclerosis of the subclavian artery as a possible cause of flap failure. We report on a 65-year-old patient with a multilevel carcinoma of the right pharynx. Due to the unique patient history, a free flap reconstruction was not possible. After resection of the primary, we performed reconstruction with a pedicled pectoralis major flap. Postoperatively, we observed necrosis of the pectoralis major flap. Secondary defect reconstructions were performed with a deltopectoral flap first from the right and then, in the case of necrosis, from the left side. Stenosing arteriosclerotic plaques of the subclavian artery on both sides were the cause of flap failure. Preoperative angiography of the subclavian artery is not a standard diagnostic procedure in the surgical planning of pedicled flap reconstruction in the head and neck region. In exceptional cases, we recommend angiographic imaging of the supplying vessels to make a more precise flap selection and avoid complications. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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23. Analysis of Selection of Recipient Vein, Number of Outflows, Style and Technique in Head and Neck Venous Anastomosis and a Proposed Algorithm.
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Acartürk, Tahsin Oğuz and Bengür, Fuat Barış
- Abstract
Surgeons have preferential ways of performing venous anastomosis in head and neck microsurgery. However, controversies exist regarding the superiority of each method. This study aims to determine the effects of these variables on the rates of thrombosis and flap failure, and propose an algorithm to be used as a facilitator in the decision-making process. A total of 208 microsurgical reconstructions on 199 patients from a single surgeon's data were evaluated. Selection of recipient vein (superficial vs. deep), style of anastomosis (end-to-end vs. end-to-side), number of outflows (one vs. two) and technique of anastomosis (hand-sewn vs. coupler) were compared. Selection was done according to the pre- and intraoperative plan, as well as, surgeon's clinical judgement. Outcomes were determined as rates of venous thrombosis and flap failure. Five patients (2.4%) had venous problems, leading to two partial and three total flap failures. Selection of the recipient vein, style and number of outflows did not affect the outcomes, whereas coupler use decreased the rates of venous thrombosis and flap failure (p=0.008). Although it is difficult to set dogmatic criteria to achieve consistent outcomes, coupler use in this study prevented flap failure. An algorithmic approach was proposed with the results of the data and literature to increase the success in microsurgical anastomosis. Surgeons should use algorithms and sound judgement with adherence to microsurgical principles to obtain the best results for each patient. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
24. Management of free flap salvage using thrombolytic drugs: A systematic review.
- Author
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Brouwers, Kaj, Kruit, Anne Sophie, Hummelink, Stefan, and Ulrich, Dietmar J.O.
- Abstract
Microvascular free tissue transfer is a reliable method for reconstructive surgery. However, pedicle thrombosis remains a serious complication following free tissue transfer as no consensus has been reached on the optimal management of failing flaps. The purpose of this systematic review is to examine the current evidence on the use of thrombolytic drugs and their effects on microvascular flap salvage rates. A systematic literature search was performed using Medline, Embase, and, PubMed databases to identify scientific literature published between January 1987 and January 2019. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles of English language studies reporting on free flap salvage procedures or protocols using thrombolytic drugs were included and reviewed by one author. Of 105 articles screened, 27 studies and case reports were included and qualified for data extraction. Overall, the level of evidence of the current literature is low. Thirteen retrospective studies tried to demonstrate a systemic approach for thrombolysis in flap salvage. The other 14 case reports presented clinical use of thrombolytic drugs to salvage free flaps. None of the thrombolytic agents presented had superior salvage outcomes. A review on the current literature did not provide satisfactory and consistent evidence for the optimal management of patients with microvascular thrombosis, since no consensus has been reached on the optimal management of failing flaps. Prospective randomized studies are needed regarding their indications, dosages, and methods of administration, efficacy, and safety. [ABSTRACT FROM AUTHOR]
- Published
- 2020
- Full Text
- View/download PDF
25. Management of Flap Failure After Head and Neck Reconstruction: A Systematic Review and Meta-analysis
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Craig A. Bollig, Ryan S. Jackson, Evan M. Graboyes, Sidharth V. Puram, Joseph Zenga, Patrik Pipkorn, Amit Walia, Angela Hardi, and Jake J. Lee
- Subjects
medicine.medical_specialty ,business.industry ,Flap failure ,Free flap failure ,Plastic Surgery Procedures ,Free Tissue Flaps ,Tissue transfer ,Surgery ,Postoperative Complications ,Otorhinolaryngology ,Head and Neck Neoplasms ,Meta-analysis ,Medicine ,Humans ,business ,Head and neck ,Head ,Neck ,Retrospective Studies - Abstract
To systematically review management of flap loss in head and neck construction with free tissue transfer as compared with locoregional flap or conservative management.Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov were searched up to October 2019.Candidate articles were independently reviewed by 2 authors. Articles were considered eligible if they included adequate reporting of flap management after flap loss and outcomes for survival of reconstruction, length of hospitalization, and perioperative complications.A total of 429 patients had acute flap failure in the perioperative period. The overall success with a secondary free flap was 93% (95% CI, 0.89-0.97; n = 26 studies,Salvage reconstruction with free tissue transfer has a high success rate. Second free flaps following flap failure had a similar length of hospitalization and lower overall complication rate than locoregional reconstruction or conservative management. A second free tissue transfer, when feasible, is likely a more reliable and effective procedure for salvage reconstruction.
- Published
- 2023
26. A Better Understanding of Hypercoagulability in the Microsurgical Setting
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Sezgin, Billur and Shiffman, Melvin A., editor
- Published
- 2016
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27. Importance of Postoperative Use of External Warming Devices in Flap Reconstructive Surgery
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Ahmed Emam and Mohamed Maklad
- Subjects
medicine.medical_specialty ,Reconstructive surgery ,business.industry ,Vascular compromise ,MEDLINE ,Flap failure ,030230 surgery ,Surgery ,Review article ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,Flap survival ,business - Abstract
Flap failure, partial or complete, can have great negative impact on the patient and the reconstructive outcome. The effect of thermal regulation on flap survival is well recognized. This article focuses on the importance of external warming devices as a standard on postoperative flap care to avoid any temperature-related vascular compromise. PubMed, Medline, and EMBASE search had been performed. More than 60 papers have been reviewed. Out of them, that 29 references have been included in this review. The authors emphasize on the importance of strict postoperative flap temperature control with active warming devices as a standard of practice to minimize any related microcirculatory changes.
- Published
- 2022
28. Bladder Outlet Obstruction as a Cause for Late Total Flap Failure in Pelvic Reconstruction with a VRAM
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Michael J. Stein and Moein Momtazi
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pelvic reconstruction ,perineal reconstruction ,pelvic exenteration ,vram ,abdominoperineal resection ,flap failure ,Surgery ,RD1-811 - Abstract
Abstract Background A 67-year-old man presented with abrupt failure of a pedicled vertical rectus abdominus myocutaneous (VRAM) flap 13 days postoperatively. Methods The patient underwent pelvic reconstruction with a pedicled VRAM flap following sacral chordoma and abdominoperineal resection. The flap remained well perfused and viable until postoperative day 13, at which point the patient was noted to become systemically unwell with fever, chills, and abdominal pain. This clinically coincided with prompt arterial and venous insufficiency of the VRAM flap. Results Computed tomography of the abdomen was ordered to rule out a pelvic collection and revealed an inflated Foley catheter in the bulbar urethra. This was associated with marked distention of the bladder and bilateral hydronephrosis. Direct compression of the deep inferior epigastric pedicle by the bladder neck was noted. Conclusion The case highlights the importance of considering bladder outlet obstruction and subsequent distention as a cause of pedicle compression and VRAM flap failure following pelvic reconstruction.
- Published
- 2018
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29. Primary thrombolysis for free flap surgery in head and neck reconstruction: a case report and review
- Author
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Steven Liben Zhang and Hui Wen Ng
- Subjects
medicine.medical_specialty ,RD1-811 ,business.industry ,medicine.medical_treatment ,Pediatric/Craniomaxillofacial/Head&Neck ,Flap failure ,Case Report ,Thrombolysis ,medicine.disease ,Thrombosis ,Surgery ,reconstructive surgical procedures ,fibrinolytic agents ,medicine ,free tissue flaps ,Recombinant tissue plasminogen activator ,Complication ,Head and neck ,Free flap surgery ,business ,Fibrinolytic agent ,thrombolytic therapy ,surgery, plastic - Abstract
The use of free flaps is an essential and reliable method of reconstruction in complex head and neck defects. Flap failure remains the most feared complication, the most common cause being pedicle thrombosis. Among other measures, thrombolysis is useful when manual thrombectomy has failed to restore flap perfusion, in the setting of late or established thrombosis, or in arterial thrombosis with distal clot propagation. We report a case of pedicle arterial thrombosis with distal clot propagation which occurred during reconstruction of a maxillectomy defect, and was successfully treated with thrombolysis using recombinant tissue plasminogen activator. We also review the literature regarding the use of thrombolysis in free flap surgery, and propose an algorithm for the salvage of free flaps in head and neck reconstruction.
- Published
- 2021
30. Objective photographic assessments and comparisons of immediate bilateral breast reconstruction using deep inferior epigastric perforator flaps and implants
- Author
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Jin Mi Choi, Jin Sup Eom, and Hyun Ho Han
- Subjects
medicine.medical_specialty ,RD1-811 ,business.industry ,Flap failure ,Bilateral breast reconstruction ,Body weight ,Breast implants ,Surgery ,medicine.anatomical_structure ,Perforator flaps ,Clavicle ,DIEP flap ,medicine ,Original Article ,Breast reconstruction ,Breast/Trunk ,Free tissue flap ,Implant ,Breast neoplasms ,business - Abstract
Background The increasing number of bilateral breast cancer patients has been accompanied by a growing need for bilateral mastectomy with immediate reconstruction. However, little research has investigated the complications and aesthetic outcomes related to bilateral reconstruction. Therefore, we analyzed retrospective data comparing the outcomes of bilateral reconstruction using deep inferior epigastric perforator (DIEP) flaps or implants. Methods This study included 52 patients (24 DIEP group and 28 implant group) who underwent bilateral mastectomy with immediate reconstruction between 2010 and 2020. Patient demographics, surgical characteristics, and complications were recorded. The difference between the left and right position of the nipple-areolar complex with respect to the sternal notch point at the clavicle was measured, and breast symmetry was evaluated. Results The average weight of breasts reconstructed with DIEP flaps (417.43±152.50 g) was higher than that of breasts with implants. The hospitalization period and operation time were significantly longer in the DIEP group. Early complications were significantly more common in the implant group (36.53%) than in the DIEP group. The angles between the nipples and the horizontal line were 1.09°±0.71° and 1.75°±1.45° in the DIEP and implant groups, respectively. Conclusions Although the surgical burden is lower, breast reconstruction using implants requires greater attention with respect to implant positioning, asymmetry, and complications than DIEP flap reconstruction. DIEP flap reconstruction has a prolonged operation time and a high risk of flap failure, but yields excellent cosmetic results and does not require intensive follow-up. Patients should be consulted to determine the most suitable option for them.
- Published
- 2021
31. Performance of infrared thermography and thermal stress test in perforator mapping and flap monitoring: A meta-analysis of diagnostic accuracy
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Nakul G. Patel, Djamila Rojoa, and Firas Raheman
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medicine.medical_specialty ,Reconstructive surgery ,Computed Tomography Angiography ,Infrared Rays ,Early detection ,Diagnostic accuracy ,030230 surgery ,Free Tissue Flaps ,03 medical and health sciences ,0302 clinical medicine ,Monitoring, Intraoperative ,Preoperative Care ,Humans ,Medicine ,Monitoring, Physiologic ,Ultrasonography ,business.industry ,Graft Survival ,Flap failure ,Plastic Surgery Procedures ,Reference Standards ,Surgery ,Regional Blood Flow ,Thermography ,030220 oncology & carcinogenesis ,Meta-analysis ,Operative time ,Radiology ,business ,Perforator Flap - Abstract
Summary Background Accurate mapping of perforators prior to flap reconstruction and early detection of poor flap perfusion reduces the risk of flap failure. Infrared thermography (IRT) has recently regained popularity within reconstructive surgery to aid flap design, reduce operative time and assess flap viability based on surface temperature changes. The aim of this review is to quantify the diagnostic ability of IRT in perforator mapping preoperatively and monitor flap perfusion perioperatively. Methods We conducted a systematic review of literature and included all studies that evaluated the use of IRT for perforator mapping and flap perfusion monitoring. We used a mixed-effects logistic regression bivariate model to estimate the summary sensitivity and specificity and constructed hierarchical summary receiver operative characteristic (HSROC) curves. Outcome We identified 18 studies and observed IRT to have sensitivities of 99.6% and 89.6% with specificities of 99.9% and 96.0% for perforator mapping and flap monitoring, respectively. Moreover, IRT recognises patterns of perfusion within interperforator zones through visualisation of angiosomal rewarming and may improve flap outcomes.
- Published
- 2021
32. Microvascular free flaps from the lower abdomen for preservation of amputation length in the lower extremity
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Manfred Schmidt, Maximilian Zaussinger, Georg M. Huemer, Dominik Duscher, Raphael Wenny, and Isabel Zucal
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Physiology ,medicine.medical_treatment ,Free flap ,030230 surgery ,Free Tissue Flaps ,Amputation, Surgical ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Physiology (medical) ,Abdomen ,medicine ,Humans ,Rectus abdominis muscle ,Aged ,Retrospective Studies ,Rehabilitation ,business.industry ,Deep Inferior Epigastric Artery ,Flap failure ,Hematology ,Middle Aged ,Surgery ,medicine.anatomical_structure ,Lower Extremity ,Amputation ,030220 oncology & carcinogenesis ,Microvessels ,Female ,Traumatic amputation ,Cardiology and Cardiovascular Medicine ,business - Abstract
BACKGROUND: The length of the amputation stump is crucial for optimal prosthetic fitting and rehabilitation. Especially in traumatic amputation, direct closure of the stump may be challenging, and bone shortening is frequently needed. To avoid excessive bone shortening, coverage of exposed bone with free flaps is a versatile option. OBJECTIVE: Here we present our experience with the utilization of free flaps from the lower abdomen for the coverage of amputations stumps of the lower extremity. METHODS: Between March 2008 and October 2010, five patients (three female, two male) with complex wounds on amputation stumps of the lower extremity were treated with a mean age of 50 years (range: 15–72 years). Six abdominal free flaps were performed in five patients (one bilateral case), including four deep inferior epigastric artery (DIEP-) and two muscle-sparing transverse rectus abdominis muscle (ms-TRAM-) flaps. Patient’s and operative data were collected retrospectively. RESULTS: One complete flap failure occurred (overall success rate: 83.3%). Three of five patients gained full ambulatory status. CONCLUSIONS: Due to the low donor site morbidity a long vascular pedicle and the large amount of available tissue, abdominal based free flaps represent our first choice for microsurgical reconstruction of lower extremity stumps.
- Published
- 2021
33. The ideal flap for reconstruction of circumferential pharyngeal defects: A systematic review and meta-analysis of surgical outcomes
- Author
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Gabriel Bouhadana, Mirko S. Gilardino, and Alain J. Azzi
- Subjects
medicine.medical_specialty ,Fistula ,medicine.medical_treatment ,Prospective data ,030230 surgery ,Free Tissue Flaps ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Pharyngectomy ,medicine ,Humans ,Radial forearm ,business.industry ,Flap failure ,Plastic Surgery Procedures ,Microsurgery ,Anterolateral thigh ,medicine.disease ,Surgery ,Forearm ,Jejunum ,Thigh ,030220 oncology & carcinogenesis ,Meta-analysis ,Pharynx ,business ,Systematic search - Abstract
There is a lack of consensus regarding the superiority of the common free flaps for the reconstruction of circumferential pharyngeal defects.A systematic literature search was conducted to identify studies reporting the complications of circumferential pharyngeal reconstruction between 2005 and 2020. Anterolateral thigh free flaps (ALTFF), jejunal free flaps (JFF), and radial forearm free flaps (RFFF) were compared. Various complications were compared by meta-analysis. Primary endpoints were fistula and stricture rates.Forty studies were included (2230 patients). Stricture rate was similarly low with tubed ALTFF (13.3%, n = 36/270) and JFF (13.2%, n = 176/1334). Fistula rate was the lowest with JFF (9.2%, n = 58/634). ALTFF was associated with the lowest rates of partial and complete flap failure (3.8%, n = 6/157, and 2.8%, n = 5/178), infection (2.8%, n = 3/106), donor site morbidity (3.9%, n = 5/130), and mortality (0%, n = 0/101) within 30 days. A meta-analysis demonstrated that there was no statistically significant difference in stricture and fistula rates between ALTFF and JFF. Moreover, JFF was associated with a significantly lower fistula rate than that of RFFF (p 0.001). ALTFF was associated with a significantly lower infection rate than that of JFF (p = 0.013).The data suggest the use of ALTFF for circumferential pharyngeal defects. In the absence of randomized, prospective data, the authors hope the results presented can be used as an evidence-based reference.
- Published
- 2021
34. Informed Consent for Facial Transplantation
- Author
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Bramstedt, Katrina A. and Siemionow, Maria Z., editor
- Published
- 2011
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35. Results of flap reconstruction: categorisation to reflect outcomes and process in the management of head and neck defects.
- Author
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Ho, M.W., Nugent, M., Puglia, F., Shaw, R.J., Blackburn, T.K., Parmar, S., Dhanda, J., Fry, A.M., Brennan, P., Barry, C.P., and McMahon, J.
- Subjects
NOTOCHORD ,NECK ,FREE flaps - Abstract
The reporting of the outcomes of flap reconstruction is often based on numerical success rates. Whilst this remains a useful variable with which to measure success, it is limited in its ability to reflect the complex processes involved. The lack of consistency in the categorisation of outcomes of flap reconstruction in the head and neck could potentially lead us to lose the opportunity to fully capture the implications of its success or failure, or both. We propose a classification that moves away from primarily reporting the results of its binary nature, and focuses more on the process of reconstruction, particularly in the head and neck. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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36. Intraoperative Use of Vasopressors Does Not Increase the Risk of Free Flap Compromise and Failure in Cancer Patients.
- Author
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Lin Fang, Jun Liu, Cuicui Yu, Hanasono, Matthew M., Gang Zheng, and Peirong Yu
- Abstract
Objective: To examine the effects of vasopressors on free flap outcomes. Background: Most micro-surgeons avoid the use of vasopressors during free flap surgery due to concerns of vasoconstriction, which could potentially lead to vascular thrombosis and flap failure. Previous studies lack the statistical power to draw meaningful conclusions. Methods: All free flaps between 2004 and 2014 from a single institution were reviewed retrospectively. Vasopressors were given intraoperatively as an intravenous bolus when blood pressure dropped >20% from baseline. The timing of intraoperative vasopressor administration was divided into 3 phases: from anesthesia induction to 30 minutes before the start of flap ischemia (P1); end of P1 to 30 minutes after revascularization (P2); end of P2 to end of surgery (P3). Agents included phenylephrine, ephedrine and calcium chloride. Results: A total of 5671 free flap cases in 4888 patients undergoing head and neck, breast, trunk, or extremity reconstruction were identified. Vasopressors were used intraoperatively in 85% of cases. The overall incidence of pedicle compromise was 3.6%, with a flap loss rate of 1.7%. A propensity score matching analysis showed that intraoperative use of any agents at any time of surgery was not associated with increased overall pedicle compromise [51/ 1584 (3.2%) vs 37/792 (4.7%); P = 0.074] or flap failure rates [26/1584 (1.6%) vs 19/792 (2.4%); P = 0.209]. Rather, there was less risk of venous congestion [33/1584 (2.1%) vs 31/792 (3.9%); P = 0.010]. Conclusions: Intraoperative use of phenylephrine, ephedrine, or calcium chloride as an intravenous bolus does not increase flap compromise and failure rates in cancer patients. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
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37. Literature Review of Criteria for Defining Recipient-Site Infection after Oral Oncologic Surgery with Simultaneous Reconstruction.
- Author
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Akashi, Masaya, Kusumoto, Junya, Sakakibara, Akiko, Hashikawa, Kazunobu, Furudoi, Shungo, and Komori, Takahide
- Subjects
- *
ORAL cancer risk factors , *ORAL surgery , *SURGICAL site infections , *ORAL fistula , *SURGICAL site , *DISEASES , *DISEASE risk factors , *FISTULA , *SURGICAL flaps , *MOUTH tumors , *SKIN diseases , *PLASTIC surgery , *ANTIBIOTIC prophylaxis , *DIAGNOSIS , *PREVENTION - Abstract
Background: The lack of uniformity of criteria for defining recipient-site infection after oral oncologic surgery with simultaneous reconstruction is problematic despite numerous studies on this issue. This study aimed to investigate the difference in the criteria for defining recipient-site infection after oral oncologic surgery with reconstruction.Methods: A Medline search was performed via PUBMED using the following combinations of key terms that were tagged in the title, abstract, or both: "surgical site infection-head neck," "surgical site infection-oral cancer," "antibiotic prophylaxis-head neck," and "surgical site infection-oral carcinoma." Search results were filtered between 2005 and 2017. Articles in which there was no mention of the criteria for definition of surgical-site infection were excluded.Results: The number of articles that met the inclusion criteria was 24. The lack of uniformity in the criteria for defining recipient-site infection in each article appeared to be attributable mainly to differences in whether an orocutaneous fistula and superficial incisional infection were regarded as recipient-site infection.Conclusion: Reconsideration of the categorization of orocutaneous fistula as infection, regardless of the etiology, and differentiation of superficial and deep incisional infections are necessary for correct assessment of recipient-site infection in oral oncologic surgery. [ABSTRACT FROM AUTHOR]- Published
- 2017
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38. Thrombophilia and Preoperative Deep Venous Thrombosis and Their Effect on Free Flap Survival: A Scoping Review
- Author
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Lorraine Harry, Mariia Gultiaeva, and Ahmed Hagiga
- Subjects
medicine.medical_specialty ,Preoperative planning ,business.industry ,Preoperative screening ,Flap failure ,Free flap ,030230 surgery ,medicine.disease ,Thrombophilia ,Surgery ,03 medical and health sciences ,Venous thrombosis ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,business - Abstract
Background: A proper preoperative planning is essential to prevent flap failure. However, venous workup for flaps has not been commonly performed or utilized as a preoperative screening tool. A scoping review was conducted to explore preoperative venous system screening, including deep vein thrombosis diagnosis, and its effect on flap survival rate. This review identified existing gaps of knowledge and emphasized potential research areas for future studies. Methods: Two independent reviewers searched 3 electronic databases from inception to September 2020. Retrieved appropriate articles were selected systematically by title, abstract, and full review of the article. Studies were included if they enrolled patients who had thrombophilia or deep venous thrombosis (DVT) preoperatively and had undergone a free flap reconstruction. For eligible studies, the following information was extracted: basic demographics (sex, age, comorbidities), preoperative scans type, free flap type, clotting mode (causes), wound type, and flap survival. Results: Seventeen articles were found eligible for this review. Traumatic aetiology was found in 63 (33.6%) patients, while 124 (66.3%) patients had a non-traumatic aetiology. Preoperative screening for patients with non-traumatic aetiology was reported in 119 patients. In these patients, the flap survived in 107 (89.91%) patients. Four studies investigating patients with traumatic DVT aetiology, 60 patients (out of 63) had a preoperative computed tomography angiography or duplex. Those patients had 100% flap survival rates. Conclusion: Further investigations are required to identify venous thrombosis incidence in patients with non-traumatic thrombosis aetiology as this cohort of patients is at high risk of flap failure. Finally, the prognostic validity of available preoperative screening tools to identify high-risk patients should be assessed, such as imaging techniques, which would include venous duplex scanning, may prevent failure in free flap surgery.
- Published
- 2021
39. New Technique for the Proximal Leg Reconstruction: Medial Sural Artery-Based Cross-leg Flap
- Author
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Burak Yaşar, Ramazan Erkin Ünlü, Ahmet Kaplan, Çağdaş Duru, Hasan Murat Ergani, and İpek Allı
- Subjects
030222 orthopedics ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Local flap ,Flap failure ,Soft tissue ,030229 sport sciences ,Free flap ,eye diseases ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,Orthopedic surgery ,Angiography ,medicine ,Orthopedics and Sports Medicine ,Surgical Technique ,business ,Sural arteries ,Leg region - Abstract
Reconstruction of the lower extremity, especially the proximal lower leg, is known to be a challenge for reconstructive surgeons. When there is extensive vascular damage, the use of local flaps and microsurgical methods will be limited, so there are few reconstructive options available. We want to define the use of medial sural artery-based cross-leg flap for the reconstruction of the proximal lower leg. A 51-year-old male had a soft tissue defect on the proximal leg region because of a gun-shot injury. We observed that there was no chance of a local flap as a result of CT angiography. We considered free flap to be risky because of extensive vascular damage and medial sural artery-based cross-leg flap was planned. 12*20-cm-sized medial sural artery-based cross-leg flap was elevated from the contralateral leg and adapted to the defect without tension. Medial sural artery-based flap is mostly used as a vascular island for the reconstruction of knee defects. However, its use as a cross-leg flap has not been found in the literature. We believe that it is a safe option to consider in challenging cases such as after flap failure or patients not suitable for a free flap.
- Published
- 2021
40. Flap Failure and Salvage in Head and Neck Reconstruction
- Author
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Adrian A. Ong, Yadranko Ducic, Aurora G. Vincent, Weitao Wang, Britney Scott, and Tom Shokri
- Subjects
Reconstructive surgery ,medicine.medical_specialty ,business.industry ,Flap failure ,Free flap failure ,Free flap ,Tissue transfer ,Review article ,Surgery ,medicine ,Ablative surgery ,Head and neck ,business - Abstract
With advanced head and neck ablative surgery comes the challenge to find an ideal reconstructive option that will optimize functional and aesthetic outcomes. Contemporary microvascular reconstructive surgery with free tissue transfer has become the standard for complex head and neck reconstruction. With continued refinements in surgical techniques, larger surgical volumes, and technological advancements, free flap success rates have exceeded 95%. Despite these high success rates, postoperative flap loss is a feared complication requiring the surgeon to be aware of potential options for successful salvage. The purpose of this article is to review free flap failure and ways to optimize surgical salvage in the scenario of flap compromise.
- Published
- 2020
41. Noninvasive Monitoring of Deep Tissue Oxygenation in Buried Flaps by Time-Resolved Near-Infrared Spectroscopy in Pigs
- Author
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Rodolphe Lartizien, Michel Berger, Jean-Luc Coll, Anne Planat-Chrétien, Maxime Henry, Audrey Dot, and Georges Bettega
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Graft Rejection ,Oxygenation monitoring ,Sus scrofa ,Arterial Occlusive Diseases ,030230 surgery ,Veins ,Diagnosis, Differential ,03 medical and health sciences ,0302 clinical medicine ,Deep tissue ,Animals ,Humans ,Medicine ,Monitoring, Physiologic ,Spectroscopy, Near-Infrared ,Venous occlusion ,business.industry ,Near-infrared spectroscopy ,Flap failure ,Arteries ,Oxygenation ,Plastic Surgery Procedures ,Myocutaneous Flap ,Arterial occlusion ,Inferior pedicle ,Disease Models, Animal ,Oxyhemoglobins ,030220 oncology & carcinogenesis ,Surgery ,Nuclear medicine ,business - Abstract
Background Flap monitoring in reconstructive surgery is particularly important because flap failure is a dramatic event for the patient and for the medical team. Noninvasive deep tissue oxygenation monitoring is a challenge. The aim of this experimental study was to assess the performance of time-resolved near-infrared spectroscopy compared with continuous-wave near-infrared spectroscopy and with invasive oxygen partial pressure measurement in pigs. Methods Thirty fasciocutaneous flaps based on the superficial epigastric inferior pedicle were harvested and buried under the transcutaneous dorsal muscle (approximately 1 cm thick). An optical probe was placed on the skin above each buried flap. For each pig, two buried flaps were performed, one submitted to arterial occlusion and one to venous occlusion. Oxyhemoglobin and deoxyhemoglobin concentrations were observed for over 40 minutes before clamping, almost 20 minutes during clamping and during a period of release of approximately 20 minutes. Variations in time-resolved near-infrared spectroscopy were compared to the oxygen partial pressure and continuous-wave near-infrared spectroscopy variations. Results All vascular events were detected by the time-resolved near-infrared spectroscopy. During arterial clamping, oxyhemoglobin decreased rapidly, whereas deoxyhemoglobin increased moderately. The divergence of oxyhemoglobin and deoxyhemoglobin curves indicated arterial occlusion. During venous clamping, deoxyhemoglobin increased, whereas oxyhemoglobin increased briefly then remained stable or decreased moderately. The initial increases in the oxyhemoglobin and deoxyhemoglobin curves indicated venous occlusion. Oxygen partial pressure failed to detect vascular events in three cases. Continuous-wave near-infrared spectroscopy could not clearly identify vascular occlusions. Conclusions Thus, the authors demonstrated the relevance of time-resolved near-infrared spectroscopy to buried flap monitoring. Time-resolved near-infrared spectroscopy could differentiate between arterial occlusion and venous occlusion.
- Published
- 2020
42. Near-Infrared Spectroscopy (NIRS) versus Hyperspectral Imaging (HSI) to Detect Flap Failure in Reconstructive Surgery: A Systematic Review
- Subjects
flap loss ,TISSUE OXYGEN-SATURATION ,near-infrared spectroscopy ,hyperspectral imaging ,VASCULAR COMPROMISE ,SALVAGE ,OXIMETRY ,VIABILITY ,DOPPLER ,flap failure ,non-invasive monitoring ,PERFUSION ,tissue oxygenation ,free flap - Abstract
Rapid identification of possible vascular compromise in free flap reconstruction to minimize time to reoperation improves achieving free flap salvage. Subjective clinical assessment, often complemented with handheld Doppler, is the golden standard for flap monitoring; but this lacks consistency and may be variable. Non-invasive optical methods such as near-infrared spectroscopy (NIRS) and hyperspectral imaging (HSI) could facilitate objective flap monitoring. A systematic review was conducted to compare NIRS with HSI in detecting vascular compromise in reconstructive flap surgery as compared to standard monitoring. A literature search was performed using PubMed and Embase scientific database in August 2021. Studies were selected by two independent reviewers. Sixteen NIRS and five HSI studies were included. In total, 3662 flap procedures were carried out in 1970 patients using NIRS. Simultaneously; 90 flaps were performed in 90 patients using HSI. HSI and NIRS flap survival were 92.5% (95% CI: 83.3-96.8) and 99.2% (95% CI: 97.8-99.7). Statistically significant differences were observed in flap survival (p = 0.02); flaps returned to OR (p = 0.04); salvage rate (p < 0.01) and partial flap loss rate (p < 0.01). However, no statistically significant difference was observed concerning flaps with vascular crisis (p = 0.39). NIRS and HSI have proven to be reliable; accurate and user-friendly monitoring methods. However, based on the currently available literature, no firm conclusions can be drawn concerning non-invasive monitoring technique superiority
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- 2022
43. Is long-term post-operative monitoring of microsurgical flaps still necessary?
- Author
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Zoccali, Giovanni, Molina, Alexandra, and Farhadi, Jian
- Abstract
Summary Autologous microsurgical flap reconstruction has become commonplace in most plastic surgery units, and the success rates of this procedure have markedly increased over recent years. However, the possibility of flap failure still needs to be considered. A review of the literature reveals that the critical period for flap-threatening complications is the first 24–48 post-operative hours; however, the window for the onset of these complications remains open for up to 7 days post-operatively. In this study, we focus on the timing of flap complications, aiming to elucidate the time period over which meticulous flap monitoring can positively contribute to flap salvage rates. The relevant literature on the study topic was collated and reviewed in conjunction with the senior author's case series, which consisted of a total of 335 free flaps used during a 2-year period for breast and head and neck reconstruction or limb trauma. Patients' series were then divided into groups according to the complications timing. The correlation between the timing of complications and the flap salvage rate was investigated among the groups. Overall analysis of both the literature and our own data on 335 free flaps showed a progressive reduction in flap salvage rate during post-operative days; the correlations between the times of complication onset and the flap salvage rates in all groups were significant up to the third post-operative day. The correlations between salvage rates and later complications were not significant. Our results suggest that hourly flap monitoring should be compulsory during the first 48 post-operative hours, but clinical monitoring four times daily should be sufficient thereafter. [ABSTRACT FROM AUTHOR]
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- 2017
- Full Text
- View/download PDF
44. Thrombose genähter vs. gekoppelter Anastomosen bei mikrovaskulären Kopf- und Halsrekonstruktionen
- Author
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Heinrich Iro, Miguel Goncalves, Uli Harréus, Michael Koch, Maximilian Traxdorf, Rosalie Tamse, Matti Sievert, Daniel Richter, Antoniu-Oreste Gostian, and Sarina K. Mueller
- Subjects
Gynecology ,medicine.medical_specialty ,business.industry ,Flap failure ,030230 surgery ,Anastomosis ,medicine.disease ,Thrombosis ,03 medical and health sciences ,0302 clinical medicine ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Medicine ,Free flap reconstruction ,Venous anastomosis ,business ,Head and neck - Abstract
Zusammenfassung Hintergrund Die Kupplungsvorrichtung für mikrovaskuläre Anastomosen hat in der freien Gewebetransplantation weite Verbreitung gefunden. Ziel der Arbeit ist der Vergleich der Thromboserate und des Transplantatversagens in Abhängigkeit von der Anastomosentechnik an einem großen Kopf-Hals-Tumorzentrum. Material und Methoden Retrospektive Auswertung von allen Patienten, die im Zeitraum von 2001–2019 eine freie Lappenrekonstruktion erhalten haben. Rekonstruktionstyp, Empfängergefäße, Anzahl an Venenanastomosen, Coupler-Größe und Operationszeit wurden untersucht. Wir verglichen die Raten an Venenthrombosen zwischen handgenähten und gekoppelten Anastomosen sowie die Rate des Transplantatversagens. Ergebnisse Insgesamt wurden 403 freie Lappenrekonstruktionen über einen Zeitraum von 17 Jahren durchgeführt. Die venöse Anastomose wurde bei 113 Lappen in Einzelknopftechnik genäht und in 290 Fällen mittels Coupler durchgeführt. Die Rate der Venenthrombosen, die eine umgehende chirurgische Revision erforderten, betrug in der genähten Gruppe 6,2 % (7/113), verglichen mit 7,6 % in der gekoppelten Gruppe (22/290; p = 0,627). Bei einer allgemeinen Erfolgsrate von 95,0 % (383/403) lag die Rate des Transplantatversagens jeweils bei 3,6 % (4/113) und 5,5 % (16/290; p = 0,421). Die Operationszeit war mit 680 ± 144 Minuten in der handgenähten Gruppe und 688 ± 167 Minuten in der Coupler-Gruppe vergleichbar (p = 0,678). Schlussfolgerungen Bei ähnlichen Erfolgsraten ist der Coupler als wirksame Alternative zur venösen Anastomose in Einzelnahttechnik zu sehen. Aufgrund der allgemein niedrigen Rate an Stielthrombosen in beiden Gruppen können wir den Einfluss der Anastomosentechnik nicht von möglichen Störvariablen trennen.
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- 2020
45. Safety and effectiveness of early compression of free flaps following lower limb reconstruction: A systematic review
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Luke Geoghegan, Luigi Troisi, Abhilash Jain, Jagdeep Nanchahal, Patrick Will, and Juan Enrique Berner
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medicine.medical_specialty ,Compression Bandage ,business.industry ,MEDLINE ,Flap failure ,Hyperemia ,Context (language use) ,Free flap ,Compression (physics) ,Free Tissue Flaps ,Lower limb ,Surgery ,Postoperative Complications ,Lower Extremity ,Compression Bandages ,medicine ,Edema ,Humans ,Postoperative outcome ,business - Abstract
Introduction Early postoperative compression of free flaps for lower limb reconstruction remains controversial. It may reduce venous congestion and promote the resolution of oedema. However, concerns remain regarding inadvertent pedicle compression, which may lead to flap failure. The aim of this systematic review was to determine the safety and effectiveness of this intervention. Methods A systematic review was designed in compliance with PRISMA. MEDLINE and EMBASE databases were searched. Parallel screening, selection of eligible studies, and data gathering were carried out by two independent authors. A formal risk of bias assessment was included along with the appraisal of outcomes. Results A total of 847 abstracts were retrieved and 262 free flaps for lower limb reconstruction were identified in ten eligible articles. The overall flap failure rate for patients who underwent early postoperative compression was 1.6%. Apart from flap failure rates, there were no other outcomes consistently reported and none of the studies included a no-compression group for comparison. Discussion All included studies had methodological flaws, resulting in a high risk of bias. Nevertheless, there was consistent reporting of flap failure as a postoperative outcome. Compression of free flaps in the context of lower limb reconstruction does not appear to be associated with a higher flap failure rate compared with other series. Compression bandages may reduce the pain associated with dangling regimes. However, there is no evidence to support that free flap compression in the context of lower limb reconstruction is associated with any other clinical benefit.
- Published
- 2020
46. Donor site grading after six autologous breast reconstructions for one single patient
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Alessia M. Lardi, Nicole E. Speck, and Jian Farhadi
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medicine.medical_specialty ,business.industry ,Flap failure ,030230 surgery ,Site evaluation ,Autologous tissue ,Surgery ,Single patient ,03 medical and health sciences ,Plastic surgery ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Superior gluteal artery ,medicine.artery ,Medicine ,business ,Breast reconstruction ,Grading (tumors) - Abstract
Few studies exist comparing patient-reported donor site morbidity after autologous microsurgical breast reconstruction. We report a case of a 53-year-old patient who underwent three consecutive bilateral autologous breast reconstructions due to serial flap failure. Donor site morbidity after bilateral transverse myocutaneous gracilis (TMG), superior gluteal artery perforator (SGAP) and deep inferior epigastric perforator (DIEP) flap harvest was evaluated by the patient according to different variables. While the three donor sites were graded differently regarding postoperative pain, wound healing and aesthetics, no functional deficit was reported. Taking into account all variables, the DIEP donor site was rated most favourably and the TMG donor site was graded least favourably. To our knowledge, this is the first case report providing donor site evaluation after three consecutive bilateral breast reconstructions with autologous tissue in a single patient. If all three above-mentioned donor sites are available and suitable for breast reconstruction, and the patient has no preference, the DIEP donor site might be preferred by the plastic surgeon. Level of evidence: Level V, therapeutic study.
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- 2020
47. Three End-to-End Techniques for Microvascular Anastomosis of Vessels With Different Size Discrepancy
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Ying Liu, Tingliang Wang, Hua Xu, Jiasheng Dong, Jinguang He, and Yi Zhang
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Microsurgery ,medicine.medical_specialty ,medicine.medical_treatment ,Free flap ,030230 surgery ,Anastomosis ,Free Tissue Flaps ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,medicine ,Humans ,Sutures ,business.industry ,Anastomosis, Surgical ,Reproducibility of Results ,Flap failure ,Superficial temporal artery ,Surgery ,Caliber ,030220 oncology & carcinogenesis ,Replantation ,Microvascular anastomosis ,business - Abstract
Background Size discrepancy in microvascular anastomosis is a common issue in free flap transfer and replantation surgery. A number of different techniques have been described to overcome the problem, but optimal method continues to be defined. Methods Since June 2015 to May 2018, clinical courses of 103 microvascular cases performed by one senior surgeon were reviewed. Three end-to-end techniques including mechanical dilation, single-mattress suture, and wedge resection were applied in 364 anastomoses with caliber ratio between 1:1 and 1:1.5, 1:1.5 and 1:2, and 1:2 and 1: 3, respectively. Results A total of 112 flaps were incorporated in this study. The incidence of anastomotic failure was 3.0% (11/364), and the overall flap failure rate was 3.6% (4/112). The failure cases included 2 replanted scalps, 1 replanted ear, and 1 superficial temporal artery flap for nasal reconstruction. Conclusions Our results depicted operational convenience and reliability of the 3 end-to-end anastomotic techniques in addressing mild-to-large vessel discrepancy.
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- 2020
48. Superficial Circumflex Iliac Artery Perforator Flap as a Workhorse Flap: Systematic Review and Meta-analysis
- Author
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Hyunsuk Peter Suh, Joon Pio Hong, Mehmet Altiparmak, and Han Gyu Cha
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medicine.medical_specialty ,business.industry ,Reproducibility of Results ,Flap failure ,Plastic Surgery Procedures ,030230 surgery ,Iliac Artery ,Surgery ,Vessel diameter ,03 medical and health sciences ,0302 clinical medicine ,Lower Extremity ,030220 oncology & carcinogenesis ,medicine.artery ,Meta-analysis ,medicine ,Humans ,Complication rate ,Small vessel ,business ,Cadaveric spasm ,Perforator Flap ,Superficial circumflex iliac artery - Abstract
Background There are various advantages and disadvantages attributed to superficial circumflex iliac artery perforator (SCIP) flap. The aim of this study is to evaluate the versatility and reliability of free SCIP flap by performing a systematic review and meta-analysis of the literature in terms of flap characteristics, pedicle types, and outcomes, including the different types of flap elevations. Methods PubMed, Embase OVID, and Cochrane CENTRAL were searched up to January 2019. All original articles and case reports published in English were included in the analysis. Anatomic descriptions, cadaveric studies, conference presentations, letter to the editors, local SCIP flaps, and review articles were excluded. Results A total of 36 articles including 907 SCIP flaps were available for the analysis. The most frequent causes of defects were tumors (38.2%) and lower extremities were the most common recipient areas (62.7%). The average flap dimension was 73.3 ± 23.0 cm2 with a pedicle length of 5.0 ± 0.6 cm. Vessel diameter average was 0.67 ± 0.12 mm. The average number of deep branch and superficial branch used per study was 14.4 ± 8.7 (18%) and 93.3 ± 75.0 (84%), respectively. Flap failure rate and complication rate were 2.7 and 4.2%, respectively. Conclusion SCIP flaps have been shown to be versatile in various aspects of reconstruction. The attributed disadvantages such as having short pedicle and small vessel diameter do not seem to limit the variable usage of this flap. Therefore, SCIP flap should be considered a workhorse flap.
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- 2020
49. Flap demise reversed after central venous access device removal: A case report
- Author
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Michael G. Moore, Cyrus C. Rabbani, Michael W. Sim, and Morgan M. Sandelski
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medicine.medical_specialty ,lcsh:Medicine ,Case Report ,Case Reports ,030204 cardiovascular system & hematology ,Venous stenosis ,03 medical and health sciences ,0302 clinical medicine ,Port (medical) ,Device removal ,medicine ,head and neck oncology ,Head and neck ,lcsh:R5-920 ,microvascular reconstruction ,Potential risk ,business.industry ,lcsh:R ,Flap failure ,General Medicine ,eye diseases ,Venous access ,Surgery ,030220 oncology & carcinogenesis ,Free flap reconstruction ,lcsh:Medicine (General) ,business - Abstract
Patients undergoing head and neck free flap reconstruction should be evaluated for radiation‐induced venous stenosis and presence of central venous port as a potential risk for flap failure.
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- 2020
50. Anti-thrombin III deficiency in free flap transfer: a case report
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Dean Trotter and Nicholas Tang
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medicine.medical_specialty ,business.industry ,Free flap breast reconstruction ,Flap failure ,Anti-thrombin III deficiency ,Free flap ,Guideline ,medicine.disease ,Thrombosis ,Surgery ,Plastic surgery ,medicine ,Significant risk ,business - Abstract
Thrombosis in the free flap patient poses potentially the most significant risk factor for either partial or total flap failure. While prevention of thromboembolic complications can be achieved through careful vessel handling and the use of adjunctive pharmacological anti-coagulants, other risk factors including coagulopathic disorders are more difficult to control for. Of these, hereditary anti-thrombin III deficiency is well established to confer the highest risk for thromboembolic events among the documented hereditary thrombophilias. We present the first reported case of bilateral free flap breast reconstruction in a patient with a known history of anti-thrombin III deficiency. We discuss our approach to this case, including a suggested guideline for the management of the free flap patient with anti-thrombin III deficiency. Level of evidence: Level V, therapeutic study.
- Published
- 2020
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