Microsurgery
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Unplanned readmissions are associated with decreased healthcare quality and increased costs. This nationwide study examines causes for unplanned readmission among head and neck cancer patients undergoing immediate microsurgical reconstruction. ⋯ Deep wound infection and wound dehiscence were independent predictors of unplanned readmission among head and neck cancer patients undergoing immediate microsurgical reconstruction. Institutions should focus efforts on improving wound surveillance, outpatient strategies for wound care, and optimization of discharge planning for this complex patient population.
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Comparative Study
Effect of fibrin sealant in positioning and stabilizing microvascular pedicle: A comparative study.
Fibrin sealants have had applications in hemostasis, cohesion, and promotion of healing in plastic surgery. In this article, we review cases where fibrin sealant was used to stabilize microvascular pedicles and compared with previous free flaps performed without fibrin sealant. ⋯ Fibrin sealant can be used to prevent vascular kinking and to position anastomosed vessels after successful micro-anastomosis and allow the reconstructive surgeon to overcome challenging situations of vascular pedicle related complications © 2016 Wiley Periodicals, Inc. Microsurgery 37:406-409, 2017.
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With complete plexus injuries or late presentation, free functional muscle transfer (FFMT) becomes the primary option of functional restoration. Our purpose is to review cases over a 10-year period of free functioning gracilis muscle transfer after brachial plexus injury to evaluate the effect of different donor nerves used to reinnervate the FFMT on functional outcome. ⋯ Intraplexal donor motor nerves if available will provide better transferred muscle function because they are higher quality donors closer to the muscle and can be done in one stage without a nerve graft. Otherwise, intercostal, rectus abdominis, or the distal accessory nerve should be used in a staged fashion. © 2016 Wiley Periodicals, Inc. Microsurgery 37:377-382, 2017.
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Case Reports
Free prepuce perforator flap: Ultra-thin superficial penile artery perforator flap for a dorsal finger defect.
Dorsal skin defect of the hand/digit requires thin and pliable skin for coverage. The prepuce skin, the second thinnest skin, can be a reconstructive option, but there is no previous report of a free prepuce flap for the reconstruction of the hand/digit. We report the first successful case of a free prepuce flap based on the superficial penile artery perforator (SPAP) for the treatment of dorsal soft tissue defect of the hand/digit. ⋯ The patient complained no postoperative discomfort of the donor penis, and was satisfied with functionally pleasing and esthetically acceptable results of the reconstructed finger and the donor site. Although only applicable for male patients without past history of penile trauma such as circumcision, a prepuce perforator flap may be an option for thin and pliable skin reconstruction with minimal donor site morbidity. © 2016 Wiley Periodicals, Inc. Microsurgery 37:252-255, 2017.
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A medial gastrocnemius muscle flap is useful for soft tissue reconstruction of the knee and proximal tibia but insufficient to cover defects involving the lateral aspect of the knee. The purpose of this report is to present the results of the use of a pedicled chimeric gastrocnemius-medial sural artery adipofascial flap for reconstruction of defects of the knee and lateral aspect of the knee. Six patients underwent soft tissue reconstruction of the knee by means of the described procedure. ⋯ Soft tissue reconstruction and infection control were successful without any additional surgical procedures. A pedicled chimeric gastrocnemius-medial sural artery adipofascial flap may be considered effective for soft tissue reconstruction of the knee as it reduces scars at the donor site and reconstructs the lateral knee defects not covered by the medial gastrocnemius muscle flap. © 2015 Wiley Periodicals, Inc. Microsurgery 37:206-211, 2017.