RESUMO
BACKGROUND: Hypoxia-inducible factor-1α (HIF-1α), regulated by prolyl hydroxylase, plays a central role in tissue adaptation to ischemia. This study investigates the impact of HIF-1α on angiogenesis in the Choke II zone of multiterritory perforator flaps. METHODS: Ninety male Wistar rats were allocated into 3 groups, with 30 rats in each group: the dimethyloxalylglycine (DMOG) group, the 3-(5-hydroxymethyl-2-furyl)-1-benzylindazole (YC-1) group, and the normal saline (NS) group. All rats underwent multiterritory perforator flap surgeries on their dorsal side. Subsequently, they received intraperitoneal injections of DMOG (40 mg/kg), YC-1 (10 mg/kg), and normal saline on postoperative days 1, 2, and 3, respectively. After treatment, angiogenesis in the Choke II zone of the flap on day 7 was observed through transillumination tests and lead oxide/gelatin x-ray angiography. Histological features were determined using hematoxylin and eosin staining, and the expression of HIF-1α and vascular endothelial growth factor (VEGF) in the Choke II region of the flap was assessed via immunohistochemistry and western blotting. RESULTS: Compared to the YC-1 and NS groups, the DMOG group exhibited significant angiogenesis, resulting in a denser vascular network in the Choke II zone of the flap. The DMOG group showed significantly higher microvessel density in the Choke II zone than the YC-1 and NS groups (7.10 ± 0.99 vs 24.30 ± 3.65; 14.30 ± 2.40 vs 24.30 ± 3.65, both P<0.05). Additionally, the DMOG group demonstrated higher expression of VEGF and HIF-1α in the flaps than the other groups (P < 0.05). CONCLUSIONS: In summary, HIF-1α enhances the expression of VEGF, promoting angiogenesis in the Choke II zone of the multiterritory perforator flap, thus increasing the survival area.
Assuntos
Sobrevivência de Enxerto , Subunidade alfa do Fator 1 Induzível por Hipóxia , Neovascularização Fisiológica , Retalho Perfurante , Ratos Wistar , Fator A de Crescimento do Endotélio Vascular , Animais , Masculino , Retalho Perfurante/irrigação sanguínea , Retalho Perfurante/transplante , Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Ratos , Fator A de Crescimento do Endotélio Vascular/metabolismo , Neovascularização Fisiológica/efeitos dos fármacos , Aminoácidos Dicarboxílicos/farmacologia , Indazóis/farmacologia , Distribuição AleatóriaRESUMO
BACKGROUND: To evaluate the feasibility and safety of the superficial circumflex iliac perforator flap (SCIP) for maxillary reconstruction with intraoral anastomosis, pedicle elongation, and super-microsurgery techniques to overcome its anatomical shortcomings due to the attractive merits of the flap. METHODS: Patients who underwent reconstruction of maxillary defects with SCIPs from July 2020 to December 2022 were included. Intraoral anastomosis, pedicle elongation, and super-microsurgery were performed during surgery with or without a neck incision. The sizes, pedicle lengths, inner calibres of vessels, complications and flap survival statuses were recorded. RESULTS: A total of 12 patients were included, with 3 males and 9 females, and the median age was 45 years, ranging from 14 to 74 years. There were 5 class IIa and 7 class IIb defects, 6 cases underwent maxillary defect reconstruction via SCIPs with intraoral anastomosis, and the other 6 cases with distally design and/or de-epidermis pedicle elongation. Super-microsurgery interventions were needed in 5 patients. The size ranged from 3 cm×4 cm to 6 cm×8 cm. The pedicle length ranged from 4 cm to 12 cm, with a median of 6 cm. The inner caliber of the arteries ranged from 0.7 mm to 2 mm, with a median of 1 mm, and the veins ranged from 1.5 mm to 4 mm, with a median of 2.5 mm. All the flaps survived, and no donor site complications occurred. CONCLUSION: Superficial circumflex iliac perforator flaps can be regarded as feasible and safe choices for maxillary defects with the support of intraoral anastomosis, pedicle elongation and super-microsurgery.
Assuntos
Anastomose Cirúrgica , Maxila , Retalho Perfurante , Procedimentos de Cirurgia Plástica , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Anastomose Cirúrgica/métodos , Maxila/cirurgia , Idoso , Adolescente , Retalho Perfurante/irrigação sanguínea , Retalho Perfurante/transplante , Procedimentos de Cirurgia Plástica/métodos , Adulto Jovem , Microcirurgia/métodos , Estudos de Viabilidade , Ílio/transplante , Ílio/cirurgia , Artéria Ilíaca/cirurgia , Artéria Ilíaca/transplanteRESUMO
BACKGROUND: The lower extremities are the largest donor sites in the body for perforator flap reconstruction. Multislice row computed tomography angiography allows for a multiplanar assessment of perforators using a large number of three-dimensional images with high resolution. In this study, the effect of leg dominance on perforator flap donor site preference was investigated radiologically to increase preoperative perforator mapping precision and surgical success. PATIENTS AND METHODS: The study included 40 patients. Superior gluteal artery perforator (SGAP) flap, inferior gluteal artery perforator (IGAP) flap, superficial circumflex iliac artery perforator flap, anterolateral thigh (ALT) flap, profunda artery perforator (PAP) flap, medial sural artery perforator (MSAP) flap, peroneal artery perforator (PP) flap, and posterior tibial artery perforator (PTAP) flap were analyzed according to their number of perforators (> 0.8-mm perforators counted, number of larger perforators [nLP]), dominant perforator diameter (DPD), related muscle thickness (RMT), and related subcutaneous tissue thickness (RSTT) in each leg. RESULTS: Of these 40 patients, 35 (87.5%) were right-leg dominant and 5 (12.5%) were left-leg dominant. The dominant leg had higher DPD for MSAP, PTAP, and PP than the nondominant leg (p = 0.08, p = 0.06, and p = 0.06, respectively). The dominant leg had a significantly higher nLP (> 0.8 mm) in MSAP, PTAP, and PP flaps than the nondominant leg (p < 0.05). Except for the PAP flap (adductor magnus muscle; p > 0.05), RMT of all other perforator flaps (SGAP, IGAP, ALT, MSAP, PTAP, and PP) was statistically higher in the dominant leg (p < 0.05). There was no statistically significant difference in RSTT between any of the two groups (p > 0.05). CONCLUSION: According to findings, the dominant leg could be considered a donor site preference to improve surgical outcomes and reduce microsurgical complications due to an increased nLP, perforator diameter, and RMT.
Assuntos
Extremidade Inferior , Retalho Perfurante , Procedimentos de Cirurgia Plástica , Humanos , Retalho Perfurante/irrigação sanguínea , Retalho Perfurante/transplante , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Extremidade Inferior/cirurgia , Extremidade Inferior/irrigação sanguínea , Procedimentos de Cirurgia Plástica/métodos , Idoso , Angiografia por Tomografia Computadorizada , Perna (Membro)/irrigação sanguínea , Estudos Retrospectivos , Adulto Jovem , Tomografia Computadorizada MultidetectoresRESUMO
Near-total to total lower lip defects present significant challenges for reconstructive surgeons, requiring restoration of oral competency, maximization of oral aperture, and cosmetic appearance. This report explores a novel reconstructive option addressing all three needs. Traditionally, local flap options restore cosmesis and oral competency by recruiting local tissue of similar thickness, pliability, and appearance, but often result in microstomia. Conversely, free flaps prevent microstomia but can lead to bulky and cosmetically unacceptable reconstructions. We present the first case of using a super-thin superficial circumflex iliac artery perforator (SCIP) free flap for near-total, full-thickness lower lip reconstruction. The patient was a 66-year-old female with recurrent squamous cell carcinoma of the lower lip, requiring wide local excision and resulting in an 80% full-thickness defect with unilateral oral commissure loss. An 8 cm × 5 cm × 5 mm SCIP flap was raised with a 4.5-cm pedicle length and anastomosed to the facial artery and vein. Clear fluids were commenced 7 days postoperatively, wounds healed 2 weeks postoperatively, and a normal diet was resumed at this time. The SCIP flap offers an excellent additional option for managing full-thickness near-total to total lower lip defects. Its thin, pliable nature and minimal donor site morbidity help restore oral competency, maximize oral aperture, and achieve a pleasing cosmetic result.
Assuntos
Carcinoma de Células Escamosas , Retalhos de Tecido Biológico , Artéria Ilíaca , Neoplasias Labiais , Retalho Perfurante , Procedimentos de Cirurgia Plástica , Humanos , Feminino , Idoso , Neoplasias Labiais/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Artéria Ilíaca/cirurgia , Artéria Ilíaca/transplante , Retalho Perfurante/irrigação sanguínea , Retalho Perfurante/transplante , Carcinoma de Células Escamosas/cirurgia , Retalhos de Tecido Biológico/transplante , Retalhos de Tecido Biológico/irrigação sanguínea , Lábio/cirurgiaRESUMO
BACKGROUND: With the rising popularity of the deep inferior epigastric perforator (DIEP) flap in breast reconstruction, use of the superficial inferior epigastric vein (SIEV) to augment venous outflow has been proposed as a strategy to prevent venous congestion, a complication positively associated with flap volume. This study evaluated the impact of routine SIEV venous augmentation on the risk of vascular complications or operative fat necrosis in the context of flap size and operating time. METHODS: A retrospective cohort study compared complication rates of patients with SIEV-augmented DIEP flaps to controls over a 3-year period. Outcomes assessed included vascular complications, defined as venous congestion or compromise requiring take-back, partial flap necrosis, total flap loss, as well as operative fat necrosis. Relative risk was modeled by Cox proportional hazard regression analysis. Sensitivity analysis was performed to assess for an interaction effect by flap mass. RESULTS: The study sample included 197 patients with 316 flaps. The mean mass of the SIEV-augmented flaps was significantly greater than in the control group (832.9 vs. 653.9 g; p = 0.0007). After adjustment for flap characteristics, patient demographic factors, and comorbidities, pooled risk of vascular complication and operative fat necrosis was found to be significantly lower in the SIEV-augmented group compared to controls (hazard ratio = 0.33, 95% CI [0.11-1.00]; p = 0.0489). Sensitivity analysis demonstrated no effect interaction by flap weight (p = 0.5139). CONCLUSION: Routine venous outflow augmentation via anastomosis of SIEV to the internal mammary vein perforator at the second intercostal space significantly reduced the risk of vascular complications and operative fat necrosis, regardless of flap weight. No significant increase in operative time was observed among cases in which augmentation was performed.
Assuntos
Artérias Epigástricas , Mamoplastia , Retalho Perfurante , Complicações Pós-Operatórias , Humanos , Mamoplastia/métodos , Mamoplastia/efeitos adversos , Feminino , Estudos Retrospectivos , Retalho Perfurante/irrigação sanguínea , Retalho Perfurante/transplante , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/etiologia , Adulto , Necrose Gordurosa/etiologia , Necrose Gordurosa/epidemiologia , Necrose Gordurosa/prevenção & controle , Veias/cirurgia , Hiperemia/etiologia , Hiperemia/prevenção & controleRESUMO
BACKGROUND: Vascularized lymphnode transfer (VLNT) is one of the most common surgical treatments for moderate and severe lymphedema. Various techniques have been described for harvesting lymph nodes from different donor sites. However, a standardized harvest procedure is still lacking. The transplantation of inguinal lymph nodes using the perforator-to-perforator technique may represent a significant advancement in this context. This approach relies always on the same vascular pedicle, offers a lower morbidity, and allows for a more superficial inset at the recipient site. PATIENTS AND METHODS: Between 2019 and 2022, 12 patients received a perforator-to-perforator VLNT for the treatment of late stage (Late II) lymphedema, both primary and secondary. In all cases, the lymphnodes were harvested from the groin supplied by the superficial circumflex iliac artery perforator (SCIP) vessels. The average age was 62.2 years old (range 47-73 years old); nine patients were females and three were males. In 11 cases, the lower limb was affected, and in one case, the upper limb was affected. Eight patients received additional lymphovenous anastomosis. RESULTS: All the patients reported an improvement of the symptoms after surgery in terms of tissue quality (tenderness, lymphangiectasia, and pain), and no cases of recurrent cellulitis were reported. Postoperative lymphoscintigraphy was performed at 6 months, and in all cases, the function of transplanted lymphnodes was confirmed. No complications were encountered, neither at donor nor at recipient site. The follow-up was at least 12 months in all patients. CONCLUSIONS: Despite being more technically demanding, the systematic implementation of the perforator-to-perforator technique for the transfer of SCIP-based inguinal lymphnodes can be a valuable evolution of VLNT. The aim of this study is to present how this technical approach may become a standardized procedure for inguinal-based VLNT, offering a reduced donor and recipient site morbidity and potentially enhancing the lymph draining effects due to a more superficial inset.
Assuntos
Linfonodos , Linfedema , Retalho Perfurante , Humanos , Feminino , Pessoa de Meia-Idade , Masculino , Linfedema/cirurgia , Idoso , Linfonodos/transplante , Linfonodos/irrigação sanguínea , Retalho Perfurante/irrigação sanguínea , Retalho Perfurante/transplante , Resultado do Tratamento , Artéria Ilíaca/cirurgia , Artéria Ilíaca/transplante , Estudos RetrospectivosRESUMO
BACKGROUND: Augmented reality (AR - augmented reality) is the addition of digital information to one or more senses, which allows the user to perform tasks more efficiently. This can be achieved by overlaying images, videos, or computer models. OBJECTIVE: The aim the study is to study the use of AR for preoperative planning of perforant flaps and compare the results of visualization accuracy of various research methods. MATERIALS AND METHODS: 3 patients with oncological diseases were examined, who were planned to lift and transplant a SCIP flap (in two cases) and a propeller flap on the perforant branch of the peroneal artery (in one case). All patients underwent a high-frequency ultrasound of 75 GHz examination of the donor zone and marking along it in the area of the planned flap lift. A CT scan of the donor area was also performed, followed by the superimposition of a segmentation image using HoloLens 2 virtual reality glasses. 7 measurements were obtained. RESULTS: AR for microsurgical planning was performed in two inguinal regions and was 100% correlated with the results of high-frequency ultrasound, in the case of perforant vessels of the peroneal artery, a discrepancy of 5 mm was noted for the X and Y axes in three perforant vessels. CONCLUSION: Augmented reality allows the reconstructive surgeon to see the anatomy of the area of interest in a particular patient before the incision. This area of medicine is certainly in demand, promising and requires further research with larger patient samples and randomization.
Assuntos
Realidade Aumentada , Humanos , Projetos Piloto , Masculino , Pessoa de Meia-Idade , Retalho Perfurante/transplante , Retalho Perfurante/irrigação sanguínea , Feminino , Procedimentos de Cirurgia Plástica/métodos , Cuidados Pré-Operatórios/métodos , Microcirurgia/métodos , Ultrassonografia , IdosoAssuntos
Artéria Ilíaca , Retalho Perfurante , Procedimentos de Cirurgia Plástica , Lesões dos Tecidos Moles , Polegar , Humanos , Masculino , Retalho Perfurante/irrigação sanguínea , Retalho Perfurante/transplante , Polegar/lesões , Polegar/cirurgia , Adolescente , Procedimentos de Cirurgia Plástica/métodos , Artéria Ilíaca/cirurgia , Artéria Ilíaca/lesões , Artéria Ilíaca/transplante , Lesões dos Tecidos Moles/cirurgia , Retalhos de Tecido Biológico/transplante , Retalhos de Tecido Biológico/irrigação sanguíneaRESUMO
INTRODUCTION: The use of free-style and propeller perforator-based flaps has been popularized for the reconstruction of moderate size defects in the trunk and extremities, while their application in the field of abdominal reconstruction is seldom reported. The purpose of this report is to describe the authors experience with the use of pedicled perforator-based flaps in abdominal wall reconstruction, presenting the innovative concept of transition from angiosomal to bi-angiosomal and extra-angiosomal perforator flaps and showing applications of the different flap designs according to the multiple clinical scenarios. PATIENTS AND METHODS: A total of 15 patients underwent abdominal wall reconstruction with angiosomal, bi-angiosomal, and extra-angiosomal pedicled perforator-based flaps harvested from the surrounding abdominal subunits for superficial or full thickness defects of the abdominal wall of moderate and large dimensions. The defects were consequent to soft-tissue sarcomas (STS) and non-melanoma skin cancer (NMSC) resection in 11 and 4 cases, respectively. Operative data, post-operative course, and complications were recorded. Moreover, at 12 months follow-up, patients were asked to rate the esthetic and functional outcomes of the reconstructive procedure on a 5-point Likert scale. RESULTS: Ten angiosomal perforator flaps (4 DIEP, 4 SCIP, 1 SEAP, and 1 LICAP flaps) and 5 bi-angiosomal and extra-angiosomal conjoined perforator flaps including different vascular territories (3 bilateral DIEP, 1 bilateral SEAP, and 1 ipsilateral DIEP-SEAP flap) were successfully transferred in 15 patients. In two patients, microsurgical anastomoses were performed to guarantee proper vascularization of the additional cutaneous territory. Mean age was 59.3 years. Defect sizes ranged from 98 to 408 cm2 (mean size was 194.7 cm2). Mean operative time was 280 min. Flap surface ranged from 108 to 336 cm2 (mean surface was 209.3 cm2). No major complications were registered. One bi-angiosomal bilateral DIEP flap suffered from partial necrosis and required an additional flap reconstruction. All patients underwent a 12-month follow-up except one, who did not show for clinical follow-up but responded at the Likert scale at clinical follow-up at 9 months. Overall patients' satisfaction was high, with mean esthetic and functional ratings of 4.27 and 3.87. CONCLUSION: The use of local tissues is an under-utilized solution in the field of abdominal wall reconstruction. Angiosomal, bi-angiosomal, and extra-angiosomal perforator flaps proved to be a reliable option to provide the transfer of a significant amount of tissue and offer like with like reconstruction while maximizing flap survival.
Assuntos
Parede Abdominal , Retalho Perfurante , Procedimentos de Cirurgia Plástica , Humanos , Retalho Perfurante/irrigação sanguínea , Retalho Perfurante/transplante , Parede Abdominal/cirurgia , Pessoa de Meia-Idade , Procedimentos de Cirurgia Plástica/métodos , Masculino , Feminino , Idoso , Adulto , Neoplasias Cutâneas/cirurgia , Resultado do Tratamento , Seguimentos , Estudos Retrospectivos , Sarcoma/cirurgiaRESUMO
INTRODUCTION: Facial artery perforator (FAP) flap is a versatile and reliable one-step facial reconstruction technique. However, its full potential remains underutilized due to a lack of clear guidelines and rigorous technique requirements. This study report the use of FAP flaps in our centre for the management of perioral and nasal oncologic defects, focusing on surgical technique performed and post-operative management. METHODS: We conducted a retrospective review of all patients who underwent reconstruction with a perioral or perinasal FAP flap only following tumor resection over a 4-year period (n = 29). Parameters measured included flap survival, complication rates, surgical technique performed, and the need for touch-up procedures. Patients were grouped based on age, defect size, and location and outcomes were compared across these groups. RESULTS: The mean histological tumor defect area was 331 mm2. During at least 6 months of follow-up, no local recurrence was observed. Twenty-seven (93.1%) flaps survived completely. Major postsurgical complications occurred in seven (23.8%) patients, including complete flap necrosis (1), partial flap necrosis (1), flap collapse (1), venous congestion (1), wound dehiscence (1), and local infection (2). A higher complication rate was associated with nose tip defects (80.0% vs. 12.5%, p = 0.007). Touch-up procedures were more frequently required for reconstructions involving the nasal sidewall and dorsum (53.8% vs. 13.3%, p = 0.04). CONCLUSION: Based on our experience, the FAP flap is highly effective for the reconstruction of the upper lip, nasolabial fold, and certain oncologic nasal defects. However, specific defect locations, such as the nose tip, may be associated with higher complication rates, necessitating careful patient selection and surgical planning.
Assuntos
Neoplasias Nasais , Retalho Perfurante , Procedimentos de Cirurgia Plástica , Complicações Pós-Operatórias , Humanos , Estudos Retrospectivos , Retalho Perfurante/irrigação sanguínea , Retalho Perfurante/transplante , Masculino , Feminino , Pessoa de Meia-Idade , Procedimentos de Cirurgia Plástica/métodos , Idoso , Adulto , Neoplasias Nasais/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Neoplasias Bucais/cirurgia , Face/cirurgia , Idoso de 80 Anos ou mais , Sobrevivência de Enxerto , Artérias/cirurgia , SeguimentosRESUMO
To improve the use of sensate anterolateral thigh (ALT) flaps for foot and ankle reconstruction, we employed a thinned nerve-selective harvesting technique. The data of 31 patients in whom sensate ALT perforator flaps were transferred for reconstruction of soft-tissue defects in the foot and ankle were reviewed. Flaps were elevated with 2 refinements. The first is the initial selection of the "true" sensory branch in the medial incision on the suprafascial plane. The second is flap thinning by keeping a cuff of thin deep fat surrounding the point where the perforator or nerve branch inserts into the superficial fat layer. The recipient site assessment consisted of complications, monofilament touch perception, sharp-blunt discrimination, axial circumference, and American Orthopedic Foot and Ankle Society score. After a mean follow-up of 31.7 months, all flaps survived uneventfully, except for marginal necrosis in 1 patient, infection in 1 patient, ulceration in 2 patients, and secondary thinning in 3 patients. The sensation of each flap was restored. A total of 87% and 90% of the patients exhibited 5 or more positive response points in the Semmes-Weinstein monofilament touch and sharp-blunt discrimination testings, respectively. The mean axial circumference of the reconstructed foot was 27.4 cm (the unaffected side was 25.8 cm). All patients achieved mobility in ordinary shoes with a mean functional score of 74.6. The thinned nerve-selective sensate ALT perforator flap can be a favorable option for foot and ankle reconstruction. This method also offers the possibility of preserving the nerve branch at the donor thigh.
Assuntos
Tornozelo , Pé , Retalho Perfurante , Procedimentos de Cirurgia Plástica , Coxa da Perna , Humanos , Masculino , Estudos Retrospectivos , Feminino , Retalho Perfurante/transplante , Pessoa de Meia-Idade , Adulto , Procedimentos de Cirurgia Plástica/métodos , Coxa da Perna/cirurgia , Pé/cirurgia , Tornozelo/cirurgia , Lesões dos Tecidos Moles/cirurgia , Idoso , Traumatismos do Pé/cirurgia , Adulto Jovem , Resultado do TratamentoRESUMO
OBJECTIVE: Defect reconstruction of the hand by means of the free medial sural artery perforator (MSAP) flap. INDICATIONS: Reconstruction of full-thickness defects on the hand with a thin non-bulky flap in cases of exposure of functional structures or in combination with simultaneous osteosynthetic procedures. CONTRAINDICATIONS: Prior surgery at the donor site or progressive peripheral artery occlusive disease. Defect size that exceeds the maximum width of the free MSAP flap for primary closure of the donor site. Lack of patient consent or compliance. SURGICAL TECHNIQUE: Suitable perforators are identified through a medial incision on the calf. The vascular pedicle is then completely followed subfascially along the gastrocnemius muscle until its source vessel the medial sural artery is reached. Subsequently, the flap design is adapted to the perforator anatomy and the flap is completely elevated. Indocyanine green fluorescence angiography can be used to identify the size of the reliable angiosome. POSTOPERATIVE MANAGEMENT: Close monitoring of the flap is required for the first 48â¯hours after surgery. Anticoagulation with low-molecular weight heparin should be administered for thrombosis prophylaxis. The hand can be mobilized on the first day after surgery. RESULTS: Between May 2017 and March 2022 a total of 16 free MSAP flaps were carried out for hand defect reconstruction. All donor sites were primarily closed. The reconstruction was successful in all cases. In one patient venous thrombosis occurred postoperatively, which was successfully revised. In two flaps, surgical hematoma evacuation was necessary within 24â¯hours after surgery. Complications or wound healing disorders at the donor site were not observed.
Assuntos
Traumatismos da Mão , Retalho Perfurante , Procedimentos de Cirurgia Plástica , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Retalhos de Tecido Biológico/transplante , Retalhos de Tecido Biológico/irrigação sanguínea , Traumatismos da Mão/cirurgia , Retalho Perfurante/irrigação sanguínea , Retalho Perfurante/transplante , Procedimentos de Cirurgia Plástica/métodos , Adulto Jovem , Idoso de 80 Anos ou maisAssuntos
Músculos Abdominais , Anestésicos Locais , Bupivacaína , Mamoplastia , Bloqueio Nervoso , Dor Pós-Operatória , Retalho Perfurante , Humanos , Mamoplastia/métodos , Bloqueio Nervoso/métodos , Bupivacaína/administração & dosagem , Feminino , Músculos Abdominais/inervação , Anestésicos Locais/administração & dosagem , Retalho Perfurante/irrigação sanguínea , Retalho Perfurante/transplante , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/etiologia , Lipossomos , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: Hand injuries pose challenges due to complexity and aesthetic-functional concerns. Dorsum of hand injuries are difficult to treat due to thin skin cover and increased propensity to exposure of underlying structures. Perforator-based flaps can provide better outcomes with minimal donor site morbidity. This study aims to bridge the gap in anatomical knowledge and explore the potential benefits of dorsal carpal artery perforator flap. MATERIALS AND METHODS: A prospective study was done from July 2021 to June 2023, focused on study of dorsal carpal artery perforators on 12 fresh frozen cadaveric hands. Anatomical study involved injection of red latex into arteries at the wrist, followed by dissection and measurements. During the clinical phase, we used the inferences gained from the anatomical study to identify and mark perforator of dorsal carpal arteries. We performed V-Y advancement flap based on the DCPs in 5 patients who had dorsum of hand defects due to trauma. RESULTS: The study was carried out on 6 fresh frozen cadavers (12 hands). Anatomical findings revealed the anatomical location, caliber, and consistent number of dorsal carpal artery perforators supplying the dorsum of the hand arranged in 2 rows. Clinically, we applied this insight to create V-Y flaps in 5 patients with successful outcomes, thus, offering DCP-based flap as an alternative to distant flaps. CONCLUSION: DCP-based flaps offer an efficient solution for reconstructing proximal hand defects over the dorsum, with minimal complications, enhancing our understanding of hand reconstruction options. The study's comprehensive anatomical insights and clinical outcomes contribute to improving hand defect management and surgical techniques.
Assuntos
Cadáver , Traumatismos da Mão , Retalho Perfurante , Procedimentos de Cirurgia Plástica , Humanos , Retalho Perfurante/irrigação sanguínea , Retalho Perfurante/transplante , Estudos Prospectivos , Traumatismos da Mão/cirurgia , Masculino , Procedimentos de Cirurgia Plástica/métodos , Adulto , Feminino , Pessoa de Meia-Idade , Artérias/anatomia & histologiaRESUMO
INTRODUCTION: The deep inferior epigastric perforator (DIEP) flap is currently one of the main options in breast reconstruction. The information about this surgery is critical for the patient, in order to choose the breast reconstruction method. Our study aims to analyze and compare the quality and accuracy of the information related to the DIEP flap reconstruction method provided by social media platforms (SMPs) and the new large language models (LLMs). MATERIALS AND METHODS: A total of 50 videos in English and Spanish were selected from the main SMPs (YouTube, Instagram, and Facebook) using the keywords "DIEP flap" and "colgajo DIEP." The duration, number of likes, dislikes, number of visits, upload date, author, and the video category (institutional video, media, patient experience, academic, and surgery) were analyzed. 3 specific questions were asked to 2 new LLMs (ChatGPT and Google Bard). The quality of information in SMPs and LLMs was analyzed and compared by 2 independent board-certified plastic surgeons using the Journal of American Medical Association and DISCERN scales. RESULTS: LLMs showed a statistically significant higher quality of information when compared with SMPs based on the DISCERN scores. The average DISCERN scores for answers given by ChatGPT and Google Bard were 54 ± 6.841 and 61.17 ± 6.306, respectively (good quality). In SMPs, the average scores were 2.31 ± 0.67 (insufficient quality) and 32.87 ± 9.62 (low quality) for the Journal of American Medical Association and DISCERN scales respectively. Thirty-eight percent of the videos in SMPs were performed by nonmedical authors. CONCLUSIONS: The quality of information for breast reconstruction using DIEP flaps from LLMs was considered good and significantly better than in SMPs. The information found in SMPs was insufficient and of low quality. Academic plastic surgeons have an opportunity to provide quality content on this type of reconstruction in LLM and SMPs.
Assuntos
Artérias Epigástricas , Mamoplastia , Retalho Perfurante , Mídias Sociais , Gravação em Vídeo , Humanos , Mamoplastia/métodos , Retalho Perfurante/irrigação sanguínea , Retalho Perfurante/transplante , Feminino , Artérias Epigástricas/transplante , IdiomaRESUMO
This article illustrates the use of locoregional perforator and pedicled flaps from the 2 main vascular systems of the head and neck area. The 2 authors combine their experiences and research findings to highlight clinical scenarios for these useful refined reconstructions and discuss their pros and cons.
Assuntos
Face , Retalho Perfurante , Procedimentos de Cirurgia Plástica , Retalhos Cirúrgicos , Humanos , Retalho Perfurante/irrigação sanguínea , Retalho Perfurante/transplante , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos/irrigação sanguínea , Face/cirurgia , Face/irrigação sanguínea , Artérias Temporais/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgiaRESUMO
BACKGROUND: The neurocutaneous flap was developed based on the understanding that every superficial cutaneous nerve includes vessels, also known as vasa nervorum or paraneural vessels, which run around and inside the nerves and deliver blood to the skin above. A cutaneous perforator connected to paraneural vessels that vascularize the skin and nerves is referred to as a neurocutaneous perforator. The lateral antebrachial cutaneous nerve (LACN), the most dependable blood supply from the primary underlying veins of the neurocutaneous flap, is the subject of this study. METHODS: We reviewed the results of 30 flap coverage procedures in 10 children. The applied flap was based distally along the radial aspect of the hand and wrist. The pivot point of the flap was located dorsally. This study considered patients with posttraumatic tissue loss, vital structure exposure, or hand contractures with an LACN flap. There was a case-by-case assessment. RESULTS: Thirteen male patients were included; their ages ranged from 6 to 65 years. Demographic data, preoperative cause of trauma, and postoperative complications were collected. Statistically significant improvements were observed after flap healing. CONCLUSIONS: The LACN flap is a more versatile flap with less morbidity than other alternative flaps for coverage of soft tissue defect restoration around the hand, wrist, and distal forearm.
Assuntos
Procedimentos de Cirurgia Plástica , Humanos , Masculino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Procedimentos de Cirurgia Plástica/métodos , Idoso , Adulto Jovem , Estudos Retrospectivos , Lesões dos Tecidos Moles/cirurgia , Retalho Perfurante/irrigação sanguínea , Retalho Perfurante/transplante , Retalho Perfurante/inervação , Resultado do Tratamento , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos/inervação , Retalhos Cirúrgicos/transplante , Traumatismos da Mão/cirurgiaRESUMO
BACKGROUND: Colorectal cancer is a significant cause of cancer-related death in the United States with abdominoperineal resection (APR) remaining a necessary procedure for many patients. The resultant defects of this radical operation are complex and characterized by significant tissue voids. Pedicled vertical profunda artery perforator flaps (vPAP) can be used to obliterate these defects in patients receiving minimally invasive APR or when the abdominal donor site is unavailable. METHODS: After receiving local institutional review board approval, a single center, retrospective cohort study from January 2020 to December 2021 was performed assessing pedicled vPAP flap reconstruction of APR defects. Age, sex, body mass index, primary diagnosis, comorbidities, concomitant oncologic procedures, radiation, timing, incorporation of gracilis flaps, follow-up, and complications were compared. RESULTS: Ten patients (70% male) with an average age of 56.2 years and BMI of 27.6 were included in the study. Rectal adenocarcinoma (50%) was the most common indication for APR, followed by rectal squamous cell carcinoma (30%), vulvar squamous cell carcinoma (10%), and Crohn disease (10%). Eighty percent of the patients received radiation, and 70% of reconstructions were delayed after the initial resection. The average length of clinical follow-up was 26.1 months. Concerning major complications, 2 patients were required to return to the operating room due to venous congestion (20%), and 2 patients suffered partial flap failure (20%). Minor complications were perineal dehiscence (50%), abscess requiring percutaneous drainage by interventional radiology (30%), and infection requiring antibiotics (20%). Twenty percent of patients developed fistulas requiring surgical excision. There were no instances of donor site dehiscence, and there was no complete flap loss, indicating successful reconstruction in all included cases. CONCLUSIONS: vPAP flaps are a reliable method to reconstruct perineal defects with less donor-site morbidity than previous reconstructive options. vPAP flaps should be considered in the setting of delayed reconstruction, minimally invasive APRs, and when the abdominal donor site is unavailable.
Assuntos
Retalho Perfurante , Períneo , Procedimentos de Cirurgia Plástica , Humanos , Pessoa de Meia-Idade , Masculino , Feminino , Retalho Perfurante/transplante , Retalho Perfurante/irrigação sanguínea , Estudos Retrospectivos , Períneo/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Idoso , Adulto , Protectomia/métodos , Neoplasias Retais/cirurgiaRESUMO
Soft tissue injuries of the hand or forearm often results in exposure of tendon or bone which needs coverage with a suitable flap. This prospective observational study was carried out in National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR), Dhaka, Bangladesh from February 2019 to January 2020, to evaluate the use of the pedicled paraumbilical perforator flaps as a reliable flap to cover such defects. Total 34 patients having soft tissue defects in the hand and forearm with exposed tendons, bones or implant were included in this study. All the defects were covered by paraumbilical perforator flap. The defects were caused by road traffic accident (n=22), machinery injury (n=10) and burn injury (n=2). Sixteen patients had defects involving the forearm, six over dorsum of hand, another two over first web space and the rest had defects over two or more areas of forearm, hand and wrist. Lateral extent of flaps was upto anterior axillary line in 41.18% cases and upto mid-axillary line in 55.88% cases. Flap division and final inset was done in second stage after 3 weeks. Donor site closed primarily in all cases, except in two cases where it was covered by skin graft. All the flaps survived with no incidence of flap necrosis, dehiscence or infection after first stage. However, after the division of the flap, two patients developed marginal necrosis of the proximal margin which healed spontaneously by conservative treatment. The mean flap surface area utilized was 108 cm2. Donor area healed well without any major complications. Three patients developing scar hypertrophy were treated with intra-lesional triamcinolone injections. The paraumbilical perforator flap is a reliable option to cover soft tissue defects of hand and forearm due to easier planning and harvesting of the flap, adequate skin paddle and minimum donor site morbidity.
Assuntos
Traumatismos da Mão , Retalho Perfurante , Lesões dos Tecidos Moles , Humanos , Retalho Perfurante/transplante , Masculino , Lesões dos Tecidos Moles/cirurgia , Feminino , Adulto , Estudos Prospectivos , Traumatismos da Mão/cirurgia , Pessoa de Meia-Idade , Antebraço/cirurgia , Adolescente , Traumatismos do Antebraço/cirurgia , Adulto Jovem , Procedimentos de Cirurgia Plástica/métodos , CriançaRESUMO
BACKGROUND: This study aims to compare perfusion dynamics using indocyanine green videoangiography before and after the creation of a second venous anastomosis between the superficial inferior epigastric vein and the retrograde internal mammary vein (IMV) in deep inferior epigastric perforator (DIEP) flap breast reconstructions. METHODS: Indocyanine green videoangiography performed during DIEP flap reconstructions was analyzed prospectively. The areas of interest were above the perforators with the highest intensity (complete perfusion), the most distal lateral edge of the flap (partial perfusion), and the next lowest intensity (ischemic). We compared the zone intensities before and after the second venous anastomosis, assessing venous drainage patency and functionality. Patient characteristics, operative details, and complications were collected. RESULTS: Seven patients (10 breasts) underwent DIEP reconstruction. Mean age was 54.5 ± 12.4 years. Mean operative duration was 575.5 ± 172.6 minutes. Donors included DIEV (n = 10, 100.0%), superficial inferior epigastric vein (n = 9, 90.0%), and superficial circumflex epigastric vein (n = 1, 10.0%). All DIEVs were anastomosed to the antegrade IMV (n = 10, 100.0%). Superficial inferior epigastric veins were anastomosed to the retrograde IMV (n = 10, 100.0%). Mean peak intensities of the complete perfusion zone before and after the second venous anastomosis were 160.7 ± 42.1 and 188 ± 42.1, respectively ( P = 0.163). Mean peak intensities of the partial perfusion zone were 100.8 ± 21.5 and 152 ± 31.5, respectively ( P < 0.001). Mean peak intensities of the ischemic zone were 90.4 ± 37.4 and 143.4 ± 45.3, respectively ( P = 0.012). CONCLUSION: These findings highlight the potential benefits of the super drainage technique in enhancing perfusion and reducing complications, emphasizing the need for further investigation and consideration of this technique in clinical practice.