Microsurgery
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Review Case Reports
Propeller flap reconstruction of abdominal defects: review of the literature and case report.
The abdominal wall is perfused anteriorly by the superior and deep epigastric vessels with a smaller contribution from the superficial system. The lateral abdominal wall is perfused predominantly from perforators arising from the intercostal vessels. Reconstruction of soft tissue defects involving the abdomen presents a difficult challenge for reconstructive surgeons. ⋯ A propeller flap was designed based on a perforator arising from the superior deep epigastric vessels and was rotated 90° into the defect allowing primary closure of the donor site. The patient healed uneventfully and was without recurrent disease 37 months following reconstruction. Perforator propeller flaps can be used successfully in reconstruction of abdominal defects and should be incorporated into the armamentarium of reconstructive microsurgeons already facile with perforator dissections.
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Case Reports
Free perforator flap transfer for reconstruction of skull base defects after resection of advanced recurrent tumor.
Skull base reconstruction is challenging due to its proximity to important anatomical structures. This report evaluates the use of perforator flaps for reconstruction of skull base defects after advanced recurrent tumor resection. ⋯ The use of perforator flaps may be a viable option for reconstruction of skull base defects after the resection of advanced recurrent tumor.
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This report describes a case of a patient who underwent secondary reconstruction of the maxilla using a combined scapular osseous and thoracodorsal artery perforator (TAP) flap, in which the pedicle of the scapular osseous flap was lengthened by reconnecting the angular branch of the thoracodorsal artery to the serratus branch. The patient was a 62-year-old man who had undergone left total maxillectomy for maxillary carcinoma and came for reconstruction of left deformity. A reconstructive procedure involving a vascularized scapular osseous and TAP flap transfer was planned. ⋯ We lengthened the pedicle of the scapular osseous flap by reconnecting the angular branch of the thoracodorsal artery to the serratus branch within the chimeric free flap and then anastomosed it to the contralateral facial vessels. The postoperative course was uneventful, and the left cheek deformity was well corrected. Using the technique of reconnection of branches within the blood supply system, a chimeric flap with a long pedicle may be elevated safely whilst avoiding the need for vein grafts.
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Transfusion with old red blood cells (RBCs) was associated with adverse clinical outcomes. The effect of perioperative transfusion of old RBCs on postoperative complications after free muscle sparing transverse rectus abdominis myocutaneous (TRAM) flap surgery was retrospectively investigated. ⋯ Perioperative transfusion of old RBCs can be associated with an increase in postoperative complications after free muscle sparing TRAM flap surgery.
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Case Reports
Pedicled superficial femoral artery perforator flaps for reconstruction of large groin defects.
Soft-tissue defects after wide resection of groin sarcomas have been reconstructed with well-characterized flaps, such as rectus abdominis, gracilis, and anterolateral thigh flaps. To our knowledge, the use of superficial femoral artery perforator (S-FAP) flaps for this purpose has not been reported. We report on three female patients in whom groin defects after sarcoma resection were reconstructed with pedicled S-FAP flaps. ⋯ The postoperative course was uneventful, and results were satisfactory in all patients. The main advantages of the S-FAP flap over more commonly used flaps are that it is easier to harvest and is associated with less donor-site morbidity. We believe that the S-FAP flap may be a versatile option for the coverage of groin defects.