Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · Jun 2015
One-stage dual latissimus dorsi muscle flap transfer with a pair of vascular anastomoses and double nerve suturing for long-standing facial paralysis.
Various types of neurovascular free-muscle transfers have been reported as surgical treatments for long-standing facial paralysis. Among one-stage methods, two approaches, that is, latissimus dorsi transfer with nerve suturing to the contralateral facial nerve and gracilis transfer with nerve suturing to the ipsilateral masseteric nerve, have recently become popular. The former method has the advantage of making spontaneous smiling possible, but the contraction strength of the transferred muscle varies, whereas the latter approach has the advantage of guaranteeing voluntary contraction of the transferred muscle, but makes spontaneous smiling difficult. Recently, dual innervation methods have also been reported, but uncertainty remains about the utility of such approaches. To overcome these drawbacks, we devised a hybrid method combining the two previously established techniques. ⋯ Our novel one-stage method, which involves a combination of two previously established methods, guarantees early voluntary smiling, and spontaneous smiling becomes possible later. In addition, it is free from the uncertainty associated with double innervation and does not require nerve grafts. So, stable results can be expected in most patients with long-standing facial paralysis.
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J Plast Reconstr Aesthet Surg · Jun 2015
Vein grafting your way out of trouble: Examining the utility and efficacy of vein grafts in microsurgery.
There is limited data on the indications, outcomes, and associated complications with use of interpositional vein grafts (IVG) in microsurgery. This study sought to critically examine and update the utility of this microsurgical technique. ⋯ prognostic/risk category, level II.
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J Plast Reconstr Aesthet Surg · Jun 2015
Intercostal artery perforator propeller flap for reconstruction of trunk defects following sarcoma resection.
Trunk defects following soft tissue sarcoma resection are usually managed by myocutaneous flaps or free flaps. However, harvesting muscle will cause functional morbidities and some trunk regions lack reliable recipient vessels. The intercostal arteries give off multiple perforators, which distribute widely over the trunk and can supply various pedicle flaps. ⋯ All intercostal artery perforator flaps survived completely, except for marginal necrosis in one flap harvested close to the previous flap donor site. The intercostal artery perforator propeller flap provides various and valuable options in our reconstructive armamentarium for trunk oncologic reconstruction. To our knowledge, this is the first case series of using intercostal artery perforator propeller flaps for trunk oncologic reconstruction and clinical application of dorsolateral intercostal artery perforator flaps.
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J Plast Reconstr Aesthet Surg · Jun 2015
Descending genicular artery free flaps: Multi-purpose tissue transfers in limb reconstruction.
The descending genicular artery supplies skin, muscle, tendon, and bone structures in the medial knee area. Three types of skin perforator including musculocutaneous perforators through the vastus medialis (descending genicular artery perforator (DGAP)-vm), direct cutaneous perforators (DGAP), and saphenous artery perforators (SAP) can be elevated for the skin flap component. ⋯ The descending genicular artery flap offers a wide range of simple and composite flaps. Recognition of all types of skin perforators should enhance the options, the chance of success, and the popularity of the flap.