Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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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.
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J Plast Reconstr Aesthet Surg · May 2015
Clinical TrialFlexor tendon repairs in children: Outcomes from a specialist tertiary centre.
We evaluate the functional outcomes of early active mobilization (EAM) after paediatric flexor tendon repair at one centre from 2006 to 2013. A generic rehabilitation protocol was used for the first four to six weeks: boxing glove immobilization (<5 years), dorsal blocking splint and cage (5-10 years) or dorsal blocking splint ± cage (10-16 years). Outcomes were assessed using the Total Active Mobilization (TAM) method of the American Society for Surgery of the Hand and original Strickland criteria (OSC). ⋯ Complications included: one rupture, one post-operative infection requiring washout and three contractures, two requiring re-operation. EAM is a practical and safe way to rehabilitate children after flexor tendon repair, without increasing ruptures or adhesions. Most children under five are managed effectively in a bulky bandage.
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Microvascular surgery plays an important reconstructive role in the pediatric population. Successful outcomes rely on surgical technique as well as anesthesia. Regional anesthesia contributes to successful free tissue transfer through sympathetic blockade, postoperative pain control, and elimination of risks and costs associated with general anesthesia. ⋯ The average duration of anesthesia was 3-4 h (anterolateral thigh (ALT) and gracilis) and 6-8 h (toe transfer and fibula). No anesthesia-related complications or flap failures occurred. We conclude that regional anesthesia has important benefits in pediatric microsurgery and it is a safe and cost-effective alternative to general anesthesia.