Annals of plastic surgery
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Annals of plastic surgery · May 2014
Fascia-only anterolateral thigh flap for extremity reconstruction.
The ability to use the anterolateral thigh (ALT) flap as a vascularized fascial flap, without skin or muscle, was first documented by Koshima et al in 1989. The authors mention the possibility of using the fascia alone for dural reconstruction. Despite its description more than 20 years ago, little literature exists on the application of the ALT flap as a vascularized fascial flap. In our experience, the ALT flap can be used as a fascia-only flap for thin, pliable coverage in extremity reconstruction. ⋯ The fascia-only ALT flap provides reliable, thin, and pliable coverage with improved contour and color over muscle and fasciocutaneous flaps. The fascia-only ALT is another excellent option for reconstructive surgery of the extremities.
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Annals of plastic surgery · May 2014
Randomized Controlled TrialThe Stanford Microsurgery and Resident Training (SMaRT) Scale: validation of an on-line global rating scale for technical assessment.
We previously reported results of our on-line microsurgery training program, showing that residents who had access to our website significantly improved their cognitive and technical skills. In this study, we report an objective means for expert evaluators to reliably rate trainees' technical skills under the microscope, with the use of our novel global rating scale. ⋯ Our SMaRT scale is valid and reliable in assessing the microsurgical skills of residents and other trainees. Current trainees are more likely to use self-directed on-line education because of its easy accessibility and interactive format. Our global rating scale can help ensure residents are achieving appropriate technical milestones.
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Annals of plastic surgery · May 2014
Case ReportsExtended reverse dorsal metacarpal artery flap for coverage of finger defects distal to the proximal interphalangeal joint.
Finger reconstruction distal to the proximal interphalangeal (PIP) joint is a challenging task for hand surgeons. Although extended reverse dorsal metacarpal artery (RDMA) flaps were described for coverage of finger defects, reports on repairs beyond the PIP joint are limited. The occurrence of venous congestion of the flaps and their treatments require further clarification. ⋯ Extended RDMA flaps can be effectively applied in the reconstruction of finger defects beyond PIP joint. Its advantages include a simple dissection, single-stage reconstruction, and preservation of digital artery and nerve. The donor site can be primarily closed if the flap width is less than 3 cm. Multiple subcutaneous heparin injection is a preferred solution in cases where venous congestion occurs in the flap.
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Annals of plastic surgery · May 2014
Outcomes of breast reconstruction in breast cancer patients with a history of mantle radiation for Hodgkin lymphoma.
Although mantle radiation (ie, extended field radiation) represented the standard of care in the past for Hodgkin disease, contemporary treatment of lymphoma consists of a multimodal approach with chemotherapy. Patients who were exposed to mantle radiation have a higher risk of breast cancer and are more susceptible to postoperative complications after breast reconstruction due to radiation. In this study, we present postoperative outcomes in patients with a history of mantle radiation who underwent mastectomy and breast reconstruction. ⋯ Although the risk of complications associated with preoperative radiation is well documented, physicians and patients should be cognizant of the increased risk of complications after mantle radiation as it represents a unique modality of radiation exposure.
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Annals of plastic surgery · May 2014
Transfusions in autologous breast reconstructions: an analysis of risk factors, complications, and cost.
Free tissue transfer requires lengthy operative times and can be associated with significant blood loss. The goal of our study was to determine independent risk factors for blood transfusions and transfusion-related complications and costs. ⋯ Prognostic/risk category, level III.