Microsurgery
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Vascularized composite allotransplantation (VCA) is a new dimension in reconstructive surgery. Generally, these procedures are offered for quality of life and functional indications rather than life-saving indications. Controversy exists, therefore, over the indications and risk/benefit ratios of VCA. ⋯ A substantial but not significant failure rate was observed in cases performed without institutional review (36.4%). These findings suggest that institutional, professional, social, and ethical standards applied to VCA should require clarification of perioperative risk managements for any clinical VCA program, because such managements can be critical factors in determining outcome. The special character of these transplantation procedures suggest the concept of identity-defining vascularized composite allotransplantation (IVCA), for which psychological screening and third-party supervision is recommended.
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This study addresses the "pre-expanded perforator flap concept" by demonstrating a case series of relevant reconstructive procedures and evaluate the perforator vessel diameter changes that happen during the pre-expansion procedure. ⋯ Suprafascial pre-expansion of the perforator flaps seems to provide a solution to achieve broader and thinner perforator flaps with larger perforator arteries.