Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.352
Filtrar
2.
Bone Joint J ; 102-B(6_Supple_A): 176-180, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32475267

RESUMO

AIMS: The integrity of the soft tissue envelope is crucial for successful treatment of infected total knee arthroplasty (TKA). The purpose of this study was to evaluate the rate of limb salvage, infection control, and clinical function following microvascular free flap coverage for salvage of the infected TKA. METHODS: We retrospectively reviewed 23 microvascular free tissue transfers for management of soft tissue defects in infected TKA. There were 16 men and seven women with a mean age of 61.2 years (39 to 81). The median number of procedures performed prior to soft tissue coverage was five (2 to 9) and all patients had failed at least one two-stage reimplantation procedure. Clinical outcomes were measured using the Knee Society Scoring system for pain and function. RESULTS: In all, one patient was lost to follow-up prior to 12 months. The remaining 22 patients were followed for a mean of 46 months (12 to 92). At latest follow-up, four patients (18%) had undergone amputation for failure of treatment and persistent infection. For the other 18 patients, 11 patients (50%) had maintained a knee prosthesis in place while seven patients had undergone resections for persistent infection but retained their limbs (32%). Reoperations were common following coverage and reimplantation. The median number of additional procedures was two (0 to 6). Clinical function was poor in patients who underwent reimplantation and retained a knee prosthesis following free flap coverage with a mean KSS score for pain and function of 44 (0 to 70) and 30 (0 to 65), respectively. All patients required an assistive device. Extensor mechanism problems and extensor lag requiring bracing were common following limb salvage and prosthesis reimplantation. CONCLUSION: Microvascular tissue transfer for management of infected TKA can be successful in limb salvage (82%) but clinical outcomes in salvaged limbs were poor. Cite this article: Bone Joint J 2020;102-B(6 Supple A):176-180.


Assuntos
Artroplastia do Joelho , Retalhos de Tecido Biológico/irrigação sanguínea , Prótese do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Terapia de Salvação/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Microvasos , Pessoa de Meia-Idade , Estudos Retrospectivos
3.
J Plast Reconstr Aesthet Surg ; 73(7): 1232-1238, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32414702

RESUMO

Clavicle non-union is a challenging problem. Open reduction with internal fixation and autologous bone grafting is usually the first line treatment. In case of failure, the medial femoral condyle corticoperiosteal flap in association with a non-vascularized bone graft is one of the therapeutic options, which is well adapted to the clavicle anatomical characteristics. We performed a retrospective study of all patients treated with this technique in our department. Between 2014 and 2017, five patients with recalcitrant post traumatic clavicle non-unions received this surgical treatment. The average nonunion time period was 50.2 month (range 10 to 108 months), and the mean defect length was 3.4 cm (between 2 and 5 cm), defects were all located in the medial third of the clavicle Three patients achieved full consolidation with an average time of consolidation of 8,7 months (range 6 to12 months). Patients with radiological consolidation had better functional improvement and pain reduction with an average DASH score improved from 53,6 before surgery to 19,6 after consolidation (at the last follow up visit). There was one donor site complications (hematoma). The medial femoral condyle corticoperiosteal flap with non-vascularized iliac crest graft is a good option for the management of recalcitrant clavicle non-union, especially when the bone defect is small.


Assuntos
Clavícula/lesões , Clavícula/cirurgia , Osso Cortical/transplante , Fêmur/transplante , Fraturas não Consolidadas/cirurgia , Retalhos de Tecido Biológico/irrigação sanguínea , Ílio/transplante , Periósteo/transplante , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
4.
Clin Hemorheol Microcirc ; 75(4): 457-466, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32417763

RESUMO

BACKGROUND: Acute normovolemic hemodilution (ANH) has been proposed as a microsurgical technique to improve blood flow in free flaps. OBJECTIVE: Here, we present the first systematic review of clinical and experimental studies on the effect of ANH. METHODS: We performed a systematic literature search of PubMed, Medline, the Cochrane Library, Google Scholar, and ClinicalTrials.gov using search strategies and a review process in agreement with the PRISMA statement and the Cochrane Handbook for systematic reviews of interventions. PICO criteria were defined before bibliometric processing of the retrieved articles, which were analyzed with the SYRCLE RoB tool for risk of bias and the GRADE scale for level of evidence. RESULTS: We retrieved 74 articles from the literature search, and after processing according to PICO criteria, only four articles remained, all of which were experimental. The rating for risk of bias was uncertain according to SYRCLE RoB results, and the level of evidence was low according to GRADE evaluation. CONCLUSIONS: There is no clinical evidence for the effect of ANH on microcirculation in free flaps, and experimental studies provide weak evidence supporting the use of hemodilution in reconstructive microsurgery.


Assuntos
Retalhos de Tecido Biológico/irrigação sanguínea , Hemodiluição/métodos , Humanos
5.
J Craniofac Surg ; 31(5): 1441-1444, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32224778

RESUMO

The most serious complication of free flap transfer is total flap necrosis, which is usually due to a microvascular problem. The development of a microsurgical instrument has greatly lowered the prevalence of postoperative vascular trouble to a rate of 1% to 3%. However, necrosis of the transferred flap in head and neck reconstruction can cause serious complications and postoperative functional deficiency. Therefore, for blood circulation disorder of the flap following free flap transfer, it is necessary to perform re-operation, as soon as possible, in order to attempt salvaging the flap after the disorder has been diagnosed.The goal of this study was to analyze the microsurgery for head and neck reconstruction. The author, with an experience of more than 500 microsurgical anastomoses, discusses microsurgery in head and neck reconstruction through the choices of recipient vessels, aspects that require attention in order to prevent vascular complications, and correspondence when complications occur.


Assuntos
Cabeça/cirurgia , Microcirurgia , Pescoço/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Anastomose Cirúrgica , Retalhos de Tecido Biológico/irrigação sanguínea , Retalhos de Tecido Biológico/cirurgia , Cabeça/irrigação sanguínea , Humanos , Pescoço/irrigação sanguínea , Complicações Pós-Operatórias , Reoperação
6.
J Plast Reconstr Aesthet Surg ; 73(8): 1442-1447, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32209324

RESUMO

BACKGROUND: Postoperative hematoma and venous congestion after free tissue transfer may occur independently or concurrently. We aimed to explore the association between these two events. METHODS: All free flap reconstructions for head and neck (HN) and breast from a single institution between 2004 and 2014 were retrospectively reviewed for reoperation for venous congestion and/or hematoma. RESULTS: There were 2985 free flap cases for HN reconstruction and 2345 cases for breast reconstruction. In HN, 100 patients developed a hematoma (3.4%) and 84 patients developed venous congestion (2.8%). The prevalence of hematoma was 17.8% and 2.9% in the presence and absence of congestion, respectively (p<0.001). Among the 15 patients who had both hematoma and venous congestion were separate events that occurred from 1 to 9 days apart in 8 patients. Hematoma caused the compression of the pedicle vein in 4 patients, while venous congestion possibly caused hematoma in 3 patients. In breast, 56 patients developed a hematoma (2.4%) and 64 patients developed venous congestion (2.7%). The prevalence of hematoma was 12.5% and 2.1% in the presence and absence of congestion, respectively (p<0.001). In the 8 patients who developed both, hematoma and congestion were separate events in 4 patients. Venous congestion caused hematoma in 3 patients, and hematoma caused venous congestion in 1 patient. CONCLUSIONS: Although postoperative hematoma and venous congestion often present concurrently, most events are not causally associated. When related, however, venous congestion leading to hematoma is more common in breast reconstruction, while hematoma preceding venous congestion is more common in HN reconstruction.


Assuntos
Retalhos de Tecido Biológico/irrigação sanguínea , Hematoma/etiologia , Hiperemia/etiologia , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/cirurgia , Feminino , Neoplasias de Cabeça e Pescoço/cirurgia , Hematoma/cirurgia , Humanos , Hiperemia/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/cirurgia , Reoperação , Estudos Retrospectivos , Fatores de Risco
7.
J Craniofac Surg ; 31(4): 1042-1045, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32168126

RESUMO

BACKGROUND: Nasolabial flap is a work-horse flap for coverage of many facial units. However, these flaps have limited mobility and these limit their use in many instances. Facial artery with its numerous small cutaneous perforators can be a source for free-style skin flaps that can be islanded and have greater reach, one of which is nasolabial perforatory flap. METHODS: The authors present a case series of 35 patients with central facial unit defects reconstructed by a single flap harvested from the nasolabial sulcus. RESULTS: In our series, we did not encounter any significant flap loss and patient satisfaction was high both functionally and aesthetically. Main drawbacks were temporary venous congestion and hair bearing flaps in male patients. CONCLUSION: The authors think with its reliability and versatility nasolabial perforator flaps, based on the same donor area as the traditional nasolabial flap can be a valuable addition to our arsenal in reconstruction of central facial unit defects.


Assuntos
Face/cirurgia , Retalho Perfurante/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Face/irrigação sanguínea , Retalhos de Tecido Biológico/irrigação sanguínea , Retalhos de Tecido Biológico/cirurgia , Humanos , Hiperemia , Masculino , Retalho Perfurante/irrigação sanguínea
8.
Plast Reconstr Surg ; 145(3): 507e-513e, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32097299

RESUMO

BACKGROUND: Fat necrosis following microsurgical breast reconstruction is common and problematic for patients and surgeons alike. Indocyanine green angiography provides a means of evaluating flap perfusion at the time of surgery to inform judicious excision of hypoperfused tissue. The authors hypothesized that incorporation of protocolized indocyanine green-informed flap débridement at the time of surgery would decrease the incidence of fat necrosis. METHODS: A retrospective study of two cohorts was performed evaluating patients before and after implementation of protocolized indocyanine green-guided flap excision. Variables included demographics, procedural details, and complications. Multivariable analysis was used to determine significant differences between the cohorts and evaluate for meaningful changes in fat necrosis. RESULTS: Eighty patients were included, accounting for 137 flaps. Flap type was the only significant difference between the two groups, with the indocyanine green group more likely to be deep inferior epigastric perforator flaps (43.1 percent versus 25.3 percent; p = 0.038). The overall postoperative incidence of fat necrosis was 14.6 percent (20 of 137 flaps). Comparing by cohort, the standard débridement group showed 18 of 79 flaps with fat necrosis (22.8 percent), whereas the indocyanine green-informed débridement group showed only two of 58 flaps with fat necrosis (3.4 percent; odds ratio, 0.11; 95 percent CI, 0.02 to 0.60; p = 0.011). There were no other significant differences in complication profile. CONCLUSIONS: Intraoperative use of indocyanine green angiography was associated with significantly lower odds of fat necrosis. This technology may reduce additional revision operations and improve patient satisfaction. Additional studies are needed to determine whether this innovation is cost-effective and generalizable to the entire autologous breast reconstruction population. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Angiografia/métodos , Necrose Gordurosa/epidemiologia , Mamoplastia/efeitos adversos , Microcirurgia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Administração Intravenosa , Adulto , Corantes/administração & dosagem , Artérias Epigástricas/diagnóstico por imagem , Artérias Epigástricas/cirurgia , Necrose Gordurosa/etiologia , Necrose Gordurosa/prevenção & controle , Feminino , Retalhos de Tecido Biológico/efeitos adversos , Retalhos de Tecido Biológico/irrigação sanguínea , Retalhos de Tecido Biológico/transplante , Humanos , Incidência , Verde de Indocianina/administração & dosagem , Cuidados Intraoperatórios/métodos , Mamoplastia/métodos , Microcirurgia/métodos , Pessoa de Meia-Idade , Satisfação do Paciente , Retalho Perfurante/efeitos adversos , Retalho Perfurante/irrigação sanguínea , Retalho Perfurante/transplante , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos , Resultado do Tratamento
10.
Otolaryngol Head Neck Surg ; 162(3): 277-282, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31986974

RESUMO

OBJECTIVE: To compare morbidity and aesthetic outcomes of full-thickness skin grafts (FTSGs) and split-thickness skin grafts (STSGs) in the reconstruction of the forearm free flap donor site. STUDY DESIGN: Case series, retrospective chart review. SETTING: Institutional microvascular database. SUBJECTS AND METHODS: Subjects who underwent forearm free flaps and FTSGs for donor site reconstruction from April 2016 to November 2017 were included. FTSGs were obtained from the donor forearm with a proximal S-shaped incision, thereby avoiding additional wound creation. Morbidity outcomes were compared to 68 consecutive patients with STSG reconstruction from January 2009 to May 2010. Complications, including tendon exposure, subjective functional impairment, complete graft loss, partial graft loss, infection, paresthesias, and hematoma/seroma, were evaluated, as were aesthetic outcomes. RESULTS: Sixty-eight patients underwent FTSG reconstruction. No significant differences between FTSGs and STSGs were demonstrated in terms of graft loss ≥40% (4% vs 4%, P = 1.000), partial graft loss (<40%) (29% vs 40%, P = .207), tendon exposure (9% vs 12%, P = .573), infection (15% vs 13%, P = .805), paresthesias (12% vs 7%, P = .382), subjective functional impairment (0% vs 2%, P = .316), or hematoma/seroma (2% vs 0%, P = .316). Aesthetic outcomes were better in the FTSG group compared to the STSG group, as determined by both patients (P = .004) and surgeon (P < .001). CONCLUSIONS: Our results advocate for the consideration of FTSGs in the reconstruction of the forearm free flap donor site given superior aesthetic results without additional donor site morbidity or additional wound creation when compared to STSGs.


Assuntos
Antebraço/irrigação sanguínea , Antebraço/cirurgia , Retalhos de Tecido Biológico/irrigação sanguínea , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Idoso , Estética , Feminino , Rejeição de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estudos Retrospectivos
11.
J Plast Reconstr Aesthet Surg ; 73(5): 885-892, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31924534

RESUMO

BACKGROUND: Diabetes mellitus may have a negative effect on free flap perfusion in patients undergoing reconstructive surgery. Little is known of the effects of lipo-prostaglandin E1 (lipo-PGE1) on flap blood flow in diabetes. This study investigated the effects of lipo-PGE1 on maximal blood flow velocity of the free flap arterial pedicle in patients with diabetes. METHODS: This prospective observational study assessed maximal blood flow velocity in the arterial pedicle before and 30 min after infusion of 0.4 µg/h lipo-PGE1 in 40 patients with diabetes who received a free flap for lower extremity reconstruction. Multivariate logistic regression analysis was performed to determine whether age, hemoglobin A1c concentration, duration of diabetes, and flap type were significantly associated with increased maximal blood flow velocity after lipo-PGE1 infusion or not. RESULTS: The maximal blood flow velocity of the free flap did not differ significantly before and 30 min after lipo-PGE1 infusion. Multivariate logistic regression analysis showed that age <65 years was the only independent factor associated with increased maximal blood flow velocity after lipo-PGE1 infusion (odds ratio = 5.344; p = 0.022). CONCLUSION: Assessments of all patients with diabetes undergoing free flap surgery, when age was not taken into consideration, found that lipo-PGE1 did not significantly increase the maximal blood flow velocity of the free flap arterial pedicle. However, when age was taken into consideration, lipo-PGE1 increased blood flow velocity in patients <65 years old, suggesting that age influences the effect of lipo-PGE1 on the blood flow velocity.


Assuntos
Alprostadil/administração & dosagem , Velocidade do Fluxo Sanguíneo/efeitos dos fármacos , Complicações do Diabetes/cirurgia , Retalhos de Tecido Biológico/irrigação sanguínea , Extremidade Inferior/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Vasodilatadores/administração & dosagem , Fatores Etários , Pé Diabético/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/cirurgia , Estudos Prospectivos
12.
J Plast Surg Hand Surg ; 54(1): 19-23, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31448658

RESUMO

Microvascular anastomosis is mandatory for free flap surgery, but free flap transfer can be challenging because of vascular diameter discrepancies during microsurgery. Different methods have been described for preventing vascular discrepancies. The aim of this study was to test a simple technique using a hemostatic clip to taper the vessels. In 12 patients who had free tissue transfer with diameter discrepancies between donor and recipient vessels, tapering with a hemostatic clip technique was used. After key sutures were placed on the vessels, a hemostatic clip was placed in an oblique fashion on the vessel with a larger diameter. After the vessel was tapered and the same diameters in the donor and recipient vessels were achieved, anastomosis was completed. This technique was used in head and neck reconstruction and lower extremity reconstruction. The luminal diameters of arteries, and veins of the flap and recipient differed by 1.6- to 3.0-fold and 1.5- to 2.6-fold, respectively. All the flaps survived without complications. Tapering with a hemoclip technique is a rapid procedure that can be considered for managing vascular diameter discrepancies in free tissue transfers.


Assuntos
Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Retalhos de Tecido Biológico/irrigação sanguínea , Técnicas Hemostáticas/instrumentação , Microcirurgia/métodos , Adulto , Feminino , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade
13.
J Surg Res ; 245: 377-382, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31425879

RESUMO

BACKGROUND: Vessel size discrepancy is one of the major risk factors for anastomotic failure in free flap transfer. The situation becomes challenging for reconstructive microsurgeons when the recipient vein is much smaller than the flap vein. We investigated the feasibility of large-to-small end-to-side venous anastomosis for such cases. MATERIALS AND METHODS: The subjects were 16 consecutive patients who underwent a free flap transfer for oncologic defects with a large-to-small end-to-side venous anastomosis. The larger flap vein was anastomosed to the side slit of the smaller recipient vein under an operating microscope. Surgical details and postoperative outcome were investigated retrospectively. RESULTS: An anterolateral thigh flap was used in five patients, a superficial inferior epigastric artery flap in four, a thoracodorsal artery perforator flap in three, and a latissimus dorsi musculocutaneous flap and a fibular osteocutaneous flap in two patients each. The internal mammary vein and the anterior tibial vein were most frequently used as a recipient vein (four patients each), followed by the deep inferior epigastric vein (three patients). The extent of vessel size discrepancy ranged from 1.3- to 3.3-fold, and the mean discrepancy was 1.9-fold. No anastomotic failure occurred postoperatively, and the flap survived in all patients. CONCLUSIONS: Large-to-small end-to-side venous anastomosis can be a versatile option when only a small vein is available as a recipient vein. Internal mammary, deep inferior epigastric, and anterior tibial veins are good candidates for this technique.


Assuntos
Anastomose Cirúrgica/métodos , Retalhos de Tecido Biológico/irrigação sanguínea , Procedimentos Cirúrgicos Vasculares/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Retalhos de Tecido Biológico/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
14.
J Foot Ankle Surg ; 59(1): 128-130, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31882136

RESUMO

Damage to the weightbearing surface of the foot is a challenge for the reconstructive surgeon. The aim is to reconstruct the skeletal tripod and soft tissue, allowing the patient to walk normally. We report the case of a patient admitted with an acute right foot open fracture of the second, third, fourth, and fifth metatarsal bones. After debridement of all nonvital tissues, the patient required reconstruction of the metatarsal heads (third, fourth, and fifth) plus soft tissue coverage. We then performed a reconstruction with a free osteocutaneous fibular flap, insetting the bone perpendicular to the long axis of the metatarsal bones. This configuration allowed the reconstruction of the foot skeletal tripod. A second free flap, a thin radial forearm flap, was added during the revision surgery to improve the venous drainage of the skin paddle of the fibular flap and avoid tension after skin closure. At 1-year follow-up, the patient was able to walk entirely weightbearing on the forefoot, returning to her previous employment with no limitation in physical and recreational activities. To our knowledge, this is the first description of the use of a chimeric osteocutaneous fibular flap, oriented transversely, to reconstruct a complex bone/soft tissue defect after a traumatic loss of multiple metatarsal heads.


Assuntos
Fíbula/transplante , Traumatismos do Pé/cirurgia , Fraturas Expostas/cirurgia , Retalhos de Tecido Biológico/irrigação sanguínea , Ossos do Metatarso/cirurgia , Lesões dos Tecidos Moles/cirurgia , Transplante Ósseo , Desbridamento , Feminino , Seguimentos , Traumatismos do Pé/diagnóstico por imagem , Fraturas Cominutivas/diagnóstico por imagem , Fraturas Cominutivas/cirurgia , Fraturas Expostas/diagnóstico por imagem , Retalhos de Tecido Biológico/cirurgia , Humanos , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/lesões , Rádio (Anatomia)/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recuperação de Função Fisiológica , Lesões dos Tecidos Moles/diagnóstico por imagem , Suporte de Carga , Adulto Jovem
15.
Plast Reconstr Surg ; 145(1): 164e-171e, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31881626

RESUMO

BACKGROUND: Although venous thrombosis is a leading cause of flap failure, the majority of lower extremity free flap planning is centered on arterial system evaluation. Preoperative identification of relevant abnormality in lower extremity venous systems by means of duplex ultrasound may aid in the diagnosis of clinically important abnormality that could affect lower extremity flap outcomes. METHODS: Between November of 2014 and August of 2017, 57 patients underwent preoperative lower extremity venous duplex imaging and free tissue transfer for lower extremity wounds. A retrospective review was performed to describe lower extremity venous pathologic findings, relevant patient demographic data, comorbid conditions, and outcomes. Discovery of venous abnormality helped guide recipient vein selection. RESULTS: Fifty-seven consecutive patients underwent 59 free flap operations to treat chronic lower extremity wounds. Venous duplex ultrasonography detected venous insufficiency (defined as >0.5 second of reflux) in 23 patients (39.0 percent), including 16 (27.2 percent) with deep thigh reflux, six (10.2 percent) with superficial calf reflux, and four (6.78 percent) with deep calf reflux. Deep venous thrombosis was found in four patients (6.78 percent) and treated with anticoagulation. The flap success rate was 98.3 percent. Five patients (8.47 percent) progressed to amputation. At a mean follow-up time of 15.1 ± 9.51 months (range, 1.67 to 35.2 months), 53 patients (89.8 percent) were able to continue community ambulation. CONCLUSIONS: Lower extremity venous duplex testing before free tissue transfer may be useful for optimizing flap recipient vessel selection and for detecting potentially unknown venous abnormality. Development of free flap planning protocols incorporating preoperative vascular imaging is important to achieving good functional outcomes in this comorbid patient population. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, IV.


Assuntos
Rejeição de Enxerto/prevenção & controle , Traumatismos da Perna/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Insuficiência Venosa/diagnóstico , Trombose Venosa/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Retalhos de Tecido Biológico/irrigação sanguínea , Retalhos de Tecido Biológico/transplante , Rejeição de Enxerto/epidemiologia , Rejeição de Enxerto/etiologia , Humanos , Incidência , Perna (Membro)/irrigação sanguínea , Perna (Membro)/diagnóstico por imagem , Perna (Membro)/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Ultrassonografia Doppler Dupla , Veias/diagnóstico por imagem , Insuficiência Venosa/complicações , Insuficiência Venosa/epidemiologia , Trombose Venosa/complicações , Trombose Venosa/epidemiologia , Adulto Jovem
16.
J Plast Reconstr Aesthet Surg ; 73(4): 633-637, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31862267

RESUMO

BACKGROUND: Nonunion is a common complication following a fracture in the setting of previous radiotherapy; however, currently there is a paucity of data describing treatment for these nonunions in the upper extremity. Free vascularized fibular (FVF) flaps successfully treat bone defects; however, their efficacy with respect to treatment of radiated nonunions is limited. The purpose of the study was to assess the outcome following FVF for radiation-associated upper extremity nonunions. METHODS: Seven patients underwent FVF for the treatment of radiation-associated upper extremity nonunion between 1998 and 2016. RESULTS: There were 5 male and 2 female patients, with a mean age and follow-up of 44 years and 4 years, respectively. Mean total radiation dose was 41.3 Gy, given at a mean of 11 years prior to FVF. The average FVF length was 15 cm. First time union rate was 71%, however, following repeat bone grafting all patients healed. The median time to union was 10 months. Musculoskeletal Tumor Society scores improved from 57% preoperatively to 89% at latest follow-up (p < 0.0001). CONCLUSIONS: FVF is a reliable treatment option for radiation-associated nonunions of the upper extremity, providing an overall union rate of 100% and an improvement in functional outcome.


Assuntos
Fraturas não Consolidadas/cirurgia , Retalhos de Tecido Biológico/irrigação sanguínea , Lesões por Radiação/cirurgia , Extremidade Superior , Adulto , Feminino , Fíbula/transplante , Fraturas não Consolidadas/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Lesões por Radiação/complicações , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
17.
Oral Oncol ; 101: 104482, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31862546

RESUMO

OBJECTIVE: Interposition vein grafting in free flap reconstruction is often viewed as a risky procedure, but is necessary in cases of inadequate pedicle length. MATERIALS AND METHODS: Two tertiary care centers retrospectively.reviewed 3008 head and neck free flap reconstructions from 2008 to 2017 91 patients were identified requiring interposition vein grafting during reconstruction. Pre and perioperative characteristics were recorded Univariate and multivariate analyses were conducted with a p value <0.05 indicating statistical significance. RESULTS: Of the 91 patients 75% had undergone reconstruction for cancer, 66% of these cases were in the setting of recurrence or complication, 33% had a previous free flap, and 52% had prior radiation therapy. Surgical site was primarily craniofacial (36%) or oral cavity (26%). The majority of vein grafts were saphenous (64%), average graft length 18 cm (SD 11 cm). Half were used for both artery and vein anastomosis. Flap survival was 85% overall and only prior free flap was predictive of failure on multivariate analysis. No other peri-operative or graft variable assessed in this study were predictive of flap failure. CONCLUSION: In a multi-institutional study of head and neck free flap reconstructions using interposition vein grafts, we identified an overall 85% success rate with no significant difference between soft tissue and osteocutaneous flaps despite the complicated nature of these cases.


Assuntos
Retalhos de Tecido Biológico/irrigação sanguínea , Retalhos de Tecido Biológico/transplante , Sobrevivência de Enxerto , Procedimentos Cirúrgicos Reconstrutivos , Veias/transplante , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Resultado do Tratamento , Adulto Jovem
18.
Oral Oncol ; 101: 104506, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31863964

RESUMO

OBJECTIVES: In this study, we presented a novel hybrid perfusion mode in an attempt to provide a new strategy to improve the survival of an extended large flap and discuss its possible mechanisms. MATERIALS AND METHODS: A 14 × 10 cm flap was designed on the rabbit abdomen. Ninety-six rabbits were randomly divided into three groups based on the flap perfusion mode: control group I (CON 1, physiological perfusion mode with bilateral deep inferior epigastric vascular pedicles intact), control group II (CON 2, physiological perfusion mode with single deep inferior epigastric vascular pedicle intact), hybrid nourished group (physiological perfusion as in CON 2 combined with arterialized venous nonphysiological perfusion mode, referred to as a hybrid perfusion mode). Flap survival, status of vascular perfusion, microvasculature, histopathology, expression of CD34, eNOs, VEGF and metabolic status of the flaps by LC-MS were assessed in each group. RESULTS: The results of "hybrid nourished" flaps were similar to the traditional flaps in terms of flap survival, level of vascular perfusion and microvasculature except the status of metabolites. CONCLUSIONS: The feasibility of this novel hybrid perfusion mode will greatly extend the indications of flap transfer and efficiently improve the survival reliability of large flaps. In a sense, this mode will be an ideological emancipation for the field of flap surgery.


Assuntos
Retalhos de Tecido Biológico/irrigação sanguínea , Sobrevivência de Enxerto , Microvasos , Modelos Biológicos , Perfusão , Animais , Biomarcadores , Biópsia , Biologia Computacional/métodos , Diagnóstico por Imagem , Imuno-Histoquímica , Masculino , Metaboloma , Coelhos , Reação em Cadeia da Polimerase Via Transcriptase Reversa
19.
J Craniomaxillofac Surg ; 47(12): 1973-1979, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810844

RESUMO

The Cook-Swartz-Doppler probe is an easy to handle and reliable tool for free flap monitoring. In the head and neck region different confounders can affect the read out. We therefore analyzed the use of the Doppler probe regarding these potential difficulties and to compare the diagnostic accuracy in arterial or venous monitoring of free flaps in the head and neck region. A retrospective study was performed in which all patients were included who underwent free flap surgery in the head and neck region in the Department of Plastic Surgery and the Department of Maxillofacial Surgery of our institution between 2010 and 2018 and were monitored with an implanted Doppler probe. 147 free tissue transfers were included. No significance was found for arterial and venous placement of the Doppler probe for sensitivity (artery 83.3%; vein 84.6%; p = 0.87), specificity (artery 89.2%; vein 96.1%; p = 0.17) and negative predictive value (artery 96.7%; vein 94.2%; p = 0.55). A better positive predictive value for placing the Doppler probe around the artery (82.7%) than the vein (61.1%) was found in our study (p = 0.056). The better positive predictive value in arterial monitoring suggests that this is the more reliable measuring method to assess flap perfusion in the head and neck region.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Retalhos de Tecido Biológico , Neoplasias de Cabeça e Pescoço/cirurgia , Monitorização Ambulatorial/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Retalhos de Tecido Biológico/irrigação sanguínea , Retalhos de Tecido Biológico/fisiologia , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Fluxometria por Laser-Doppler/instrumentação , Microcirurgia/métodos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Estudos Retrospectivos
20.
J Craniomaxillofac Surg ; 47(12): 1980-1985, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31810850

RESUMO

INTRODUCTION: Radial forearm free flaps (RFFF) are often used to replace tissue removed in head and neck surgery. In recent years, many attempts have been made to reduce donor-site morbidity and to prevent common complications such as infection, skin-graft necrosis, tendon exposure and subsequent impairment of hand function. One promising option is the use of vacuum-assisted-closure wound therapy (VAC). The objective of this study was to evaluate the effectiveness of VAC compared with a conventional bolster dressing (CBD). MATERIAL AND METHODS: A randomized controlled trial was enrolled. Our study was prospective in design and included patients with a skin-grafted forearm defect after harvesting of RFFF. Patients who met the inclusion criteria were randomly assigned into two study arms. The predictor variable was the type of wound therapy (VAC therapy compared with CBD) and the outcome variables were (1) the size of the wound area, (2) wrist movement and (3) grip strength. Outcome variables were assessed 12 days, three weeks and eight weeks after surgery. RESULTS: Fifty patients (33 males, mean age 61.7 years [SD 15.5]; 17 females, mean age 54.7 years [SD 10.5]) were included consecutively in the study. Patients in the VAC group experienced a faster postsurgical reduction of wound area and had better wrist movement; nonetheless, the differences between the VAC group and CBD group did not reach statistical significance. In contrast, the recovery of postsurgical grip strength was significantly faster in the VAC group. CONCLUSIONS: Our study failed to prove that VAC therapy is significantly superior to CBD for all the variable studied. Because VAC therapy has some positive effects, however, we recommend further development of this negative-pressure wound treatment, rather than the termination of its use.


Assuntos
Antebraço/irrigação sanguínea , Retalhos de Tecido Biológico/irrigação sanguínea , Tratamento de Ferimentos com Pressão Negativa , Transplante de Pele , Coleta de Tecidos e Órgãos/métodos , Cicatrização/fisiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Transplante de Pele/métodos , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA