Journal of reconstructive microsurgery
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J Reconstr Microsurg · Feb 2011
Comparative StudyMild intraoperative hypothermia reduces free tissue transfer thrombosis.
Patients undergoing free tissue transfer are particularly susceptible to hypothermia. The goal was to investigate the impact of intraoperative core body temperature on free flap thrombosis. Two hundred twelve cases of free flap reconstruction at Yale-New Haven Hospital between 1992 and 2008 were reviewed. ⋯ The optimal temperature was calculated to be 36.2 °C, and maximum intraoperative temperatures between 36.0 °C and 36.4 °C showed lower thrombosis rates than super-warmed patients ( P < 0.03). Therefore, free flap patients should be mildly hypothermic at 36.0 °C to 36.4 °C, compared with normothermia at 37.5 °C, as measured in the bladder. A prospective randomized trial investigating thrombosis rates and intraoperative temperature should be undertaken.
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J Reconstr Microsurg · Feb 2011
Soft-tissue coverage of complex dorsal hand and finger defects using the turnover adipofascial flap.
Complex hand wounds with exposed tendon or bone often require free tissue transfer. We report results in 13 patients with complex dorsal hand or digital wounds who underwent soft-tissue reconstruction using a turnover adipofascial flap and skin grafting over a 35-month period. The mean patient age was 44 years. ⋯ One patient died of sepsis from unrelated medical conditions. All fractures were healed at follow-up, and there were no donor site complications. The adipofascial flap is a good alternative to free tissue transfer for the coverage of complex dorsal hand and finger soft-tissue defects and is associated with technical ease, good cosmetic results, and minimal donor site morbidity.
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J Reconstr Microsurg · Feb 2011
Short interposed pedicle of flow-through anterolateral thigh flap for reliable reconstruction of damaged upper extremity.
In microvascular reconstructive surgery, the recipient vessel in free flap transfer is often sacrificed to provide the vascular pedicle anastomosis. As the recipient vessel is likely to be necessary for distal circulation in the damaged upper extremity, preserving its patency is critical. Flow-through anastomosis is one method that preserves the recipient vessel's patency. ⋯ The flap's short vascular pedicle was interposed into a division of the radial artery and anastomosed on both sides of the pedicle's T-shaped arterial segment. The flow-through flap has various advantages, not only making it possible to reconstruct both vessels and soft tissues but also preserving recipient vessels and balancing the blood supply or pressure in the flap. In clinical situations that do not require reconstruction of the artery, the short interposed pedicle of the free anterolateral thigh flow-through flap offers a versatile and reliable option for microsurgical reconstruction of defects in the upper extremities.