RESUMO
Innovation in surgery and pelvic oncology have redefined the boundaries of pelvic exenteration for CRC. However, surgical approaches and outcomes following repeat exenteration and reconstruction are not well described. The resulting defect from a second beyond Total Mesorectal Excision (TME) presents a challenge to the reconstructive surgeon. The aim of this study was to explore reconstructive options for patients undergoing repeat beyond TME for recurrent CRC following previous beyond TME and regional reconstruction. MEDLINE and Embase were searched for relevant articles, yielding 2353 studies. However, following full text review and the application of the inclusion criteria, all the studies were excluded. This study demonstrated the lack of reporting on re-do reconstruction techniques following repeat exenteration for recurrent CRC. Based on this finding, we conducted a point-by-point discussion of certain key aspects that should be taken into consideration when approaching this patient cohort.
RESUMO
We describe a technique using the reversed radial artery for distal revascularisation or replantation in the hand. This technique has been used for revascularisation following crush avulsion injuries associated with a large zone of trauma and polydigit replantation. The technique involves dividing the radial artery and venae comitantes proximally and mobilising it distally into the hand for anastomosis. Temporary 'syndactylisation' of adjacent digits is also described. This can be used to convert multiple digits into a single vascular unit and to provide a bed for the transposed radial vessels. These techniques are an option when there is extensive injury to distal vessels such that end-to-end anastomosis is not possible and interposition venous micrografting may be difficult or prone to failure due to poor quality recipient vessels and the need to place grafts in a traumatised bed.
