Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · Sep 2015
Perfusion dynamics in lower limb reconstruction: Investigating postoperative recovery and training using combined white light photospectroscopy and laser Doppler (O2C(®)).
Postoperative regimes designed to acclimatise lower limb free flaps to the changing flow dynamics of standing (flap training exercises) are widely employed despite a paucity of evidence for their use. This study utilises non-invasive monitoring of perfusion parameters to investigate flap training at the microcirculatory level. ⋯ Prior to flap training, lower limb dependency causes reduced oxygenation, increased venous pooling and decreased flow consistent with venous congestion. Following a three day training regime, flap perfusion begins to accommodate for these changes. These findings provide a rationale for flap training, although further work is required to explain the mechanisms.
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J Plast Reconstr Aesthet Surg · Sep 2015
Management of perioperative microvascular thrombotic complications - The use of multiagent anticoagulation algorithm in 395 consecutive free flaps.
Thrombotic complications remain a major barrier to successful microsurgical reconstruction, but their effective management remains controversial. ⋯ Thrombophilia uncovered by microvascular procedures can be effectively treated with anticoagulation upon discovery and prevent postoperative free flap thrombotic events. High free flap salvage can be achieved with the early intervention combined with thrombolysis and multiagent anticoagulation and antiplatelet therapy.
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J Plast Reconstr Aesthet Surg · Sep 2015
Second intercostal internal mammary artery perforator (IMAP) fasciocutaneous flap as an alternative choice for the treatment of deep sternal wound infections (DSWI).
Sternal wound infections after sternotomy are associated with high morbidity, high mortality and escalating treatment costs. Repeated radical debridement - with the removal of any hardware - and wound conditioning are the prerequisites for reconstruction. Muscle and, less frequently, omentum flaps are usually used for reconstruction. ⋯ Our experience reveals that a fasciocutaneous flap based on the second intercostal perforator of the internal mammary artery can be an alternative, quick-to-prepare flap for covering sternal defects. In adipose patients, it has sufficient bulk, and it is large enough to cover common sternal wounds. It also has low complication and morbidity rates, and it achieves an aesthetically pleasing result.
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The palmar and digital volar skin is unique because of its glabrous nature, texture and light colour in all races. Any defect on the palmar surface not suitable for a homodigital or thenar flap remains a challenge for reconstructive surgeons. Various skin flaps have been described in the literature for palmar resurfacing. ⋯ It provides glabrous, potentially sensate, hairless skin with a better colour and texture match compared to conventional pedicled or free flaps in all cases. This paper describes our refined flap raising technique, the possibility of a neurotisation and discusses the role of the free instep flap for idealised digital and palmar resurfacing. It can provide a truly cosmetic microsurgical reconstructive option.
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J Plast Reconstr Aesthet Surg · Sep 2015
Free tissue transfer to the traumatized upper extremity: Risk factors for postoperative complications in 282 cases.
Complex traumatic upper extremity injuries frequently possess compromised local vasculature or extensive defects that are not amenable to local flap reconstruction. Free tissue transfer is required to provide adequate soft tissue coverage. The present study aimed to evaluate risk factors that contribute to postoperative complications and flap loss in complex upper extremity reconstruction. ⋯ This study supports the safety of early free tissue transfer for reconstruction of traumatized upper extremities. Injuries proximal to the elbow and open fracture were associated with a significantly higher infection rate. Gustilo grade IIIC fractures, need for interpositional vein grafts, and anastomotic revision at index operation resulted in significantly higher risk of flap loss, whereas the presence of fracture, fracture fixation, and injury location were not predictors of flap failure.