Plastic and reconstructive surgery
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Plast. Reconstr. Surg. · Mar 2011
Comparative StudyUse of vascularized free fibular head grafts for upper limb oncologic reconstruction.
Transfer of a vascularized fibular graft is the method of first choice for reconstruction of defects of long bones. In particular, the vascularized fibula head graft is preferred for patients with bone defects of the upper limb involving the distal radius or the proximal humerus. The aim of the present study was to analyze the operative results, complications, and postoperative function after vascularized fibula head graft transfer and the indications for this procedure. ⋯ The authors believe that the vascularized fibula head graft transfer is a safe and reliable method for reconstructing the upper limb, especially for patients with a defect of the distal radius or the proximal humerus. This procedure is also useful for pediatric patients, in whom bone growth is expected after transplantation, and for salvage procedures after reconstructive materials of an artificial joint have failed.
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Plast. Reconstr. Surg. · Mar 2011
Comparative StudyThe keystone island flap: use in large defects of the trunk and extremities in soft-tissue reconstruction.
Microsurgical perforator flaps are useful in an array of reconstructive scenarios, but their technical complexity, steep learning curves, and prolonged operative times may limit their widespread adoption. Alternatively, the keystone island flap combines perforator-based vascularity with relative simplicity of nonmicrosurgical tissue rearrangement. This article reviews the authors' reconstructive experience using the keystone flap to reconstruct large trunk and extremity defects. ⋯ The keystone flap can be applied to large defects of the trunk and extremities, obviating the need for either microsurgical techniques or extensive operative time while achieving primary wound healing. Despite minor complications, the 97 percent reconstructive success rate compares well to published rates of microsurgical tissue transfers but has several advantages: short operative times, high reproducibility, ease of use, and favorable aesthetic outcome. The authors conclude that the keystone flap is a reliable and effective reconstructive surgical technique for reconstruction of soft-tissue defects.
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Systematic reviews and meta-analyses are important research tools in modern medicine. They serve to condense and clarify large amounts of data into resources that can educate clinicians, enhance patient care, help formulate clinical guidelines, and guide future research endeavors. ⋯ Using clinical examples and published guidelines, a framework is presented to help the reader properly conduct a systematic review. These guidelines also help the reader conduct a critical appraisal of systematic reviews published in the scientific literature. Even more importantly, principles regarding application of systematic review results to individual patients are addressed.