Journal of reconstructive microsurgery
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J Reconstr Microsurg · May 2013
ReviewPerioperative interventions to reduce chronic postsurgical pain.
Approximately 10% of patients following a variety of surgeries develop chronic postsurgical pain. Reducing chronic postoperative pain is especially important to reconstructive surgeons because common operations such as breast and limb reconstruction have even higher risk for developing chronic postsurgical pain. ⋯ Recent clinical trial data show that there is an opportunity during the perioperative period to dramatically reduce the incidence and severity of chronic postsurgical pain. The surgeon, working with the anesthesiologist, has the ability to modify both early and chronic postoperative pain by implementing an evidence-based preventative analgesia plan.
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J Reconstr Microsurg · May 2013
Comparative StudyA paradigm shift in flap selection protocols for zones of the lower extremity using perforator flaps.
Significant lower limb wounds often require soft tissue coverage using vascularized flaps. Traditionally, local muscles have been used for the proximal lower extremity and free flaps for the distal leg and foot, but perforator flaps over the past decade have been shown to be a reliable alternative. ⋯ Perforator flaps can be another soft tissue choice for all zones of the lower extremity, recognizing that function preservation is their major asset as no muscle need be included. Peninsular, propeller, or advancement perforator flaps proved to be valuable local nonmicrosurgical flap alternatives.
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J Reconstr Microsurg · May 2013
Case ReportsPrefabricated neck expanded skin flap with the superficial temporal vessels for facial resurfacing.
The achievement of a normal-appearing face after surgical resurfacing remains an elusive goal. This is due in part to insufficient color matching, restoration of contours, and the persistence of visible scars. Flap prefabrication is a staged procedure that provides an independent axial blood supply to local expanded tissues. We describe a new reconstructive alternative with superior reconstructive surgical options for facial resurfacing that better matches damaged or discarded facial tissues. ⋯ Prefabricated neck-expanded skin flap demonstrated an excellent color and texture match with facial skin that surrounded the repair sites, and optimal aesthetic results were obtained. Importantly, facial expression was completely maintained due to thinness and pliability of the rotated skin.
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J Reconstr Microsurg · May 2013
Case ReportsSplit and thinned pedicle deep inferior epigastric perforator (DIEP) flap for vulvar reconstruction.
Vulvar defects following tumor extirpation are most commonly closed primarily by the gynecologist but larger and/or radiated defects often require reconstruction with flaps for adequate coverage and wound healing. Recurrence of vulvar carcinomas remains a challenge, so secondary reconstruction becomes increasingly problematic where locoregional flaps (i.e., gracilis, rectus, anterolateral thigh, and gluteal flaps) may have already been utilized, radiated, or have resulted in unacceptable cosmetic or functional morbidity. ⋯ Previous authors have reported the use of thinned and split flaps, but we combine these techniques to split and thin a transversely oriented deep interior epigastric artery perforator (DIEP) flap to maximize aesthetic results and minimize donor-site morbidity. The DIEP flap is commonly performed by microsurgeons for autologous free-tissue transfer in breast reconstruction but also serves as a useful option for large vulvar or perineal defects, either in primary or secondary reconstruction.