Journal of reconstructive microsurgery
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J Reconstr Microsurg · Oct 2011
Cost analysis of near-infrared spectroscopy tissue oximetry for monitoring autologous free tissue breast reconstruction.
Free flap monitoring typically requires specialized nursing that can increase medical costs. This study uses near-infrared spectroscopy (NIRS) tissue oximetry to monitor free tissue breast reconstruction. We hypothesize this practice will reduce medical costs by eliminating the need for specialized nursing. ⋯ Comparison of hospital costs showed an average reduction of $1937 per patient when monitored on the surgical floor (P = 0.036). NIRS tissue oximetry is a sensitive and reliable monitoring tool, eliminating the need for specialized nursing care. The effect is decreased cost structure and increased hospital contribution margin for autologous free tissue breast reconstruction.
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J Reconstr Microsurg · Oct 2011
ReviewChemical and mechanical alternatives to leech therapy: a systematic review and critical appraisal.
Although leech therapy is a well-established, effective method of relieving venous congestion, it is associated with complications such as wound infection and leech migration. To minimize these risks, efforts to reproduce their effects have been developed and investigated. A search string using (chemical OR mechanical OR alternative) AND (Leeches OR HIRUDO MEDICINALIS) in Boolean format was used across the major electronic databases to cover the past 10 years. ⋯ The studies infer evidence at Grade B level that current device prototypes show proof of concept by providing suction and chemical anticoagulation following a surgically created wound. Although progress had been made to replicate leech action, there are still areas to address in future research. This article represents the current state of play in clinical translation of these concepts, providing efficacious devices without the drawbacks of traditional leech therapy.
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J Reconstr Microsurg · Jul 2011
Case ReportsReconstruction of large traumatic segmental defects of the femur using segmental allograft with vascularized fibula inlay.
Segmental defects of the distal femur following trauma pose a reconstructive challenge. A stable reconstruction capable of withstanding high forces while allowing early mobility is paramount. The Capanna technique of reconstruction combining allograft with vascularized bone graft provides such a construct and has been described for oncological resection. ⋯ This reconstruction provides early mechanical stability, protecting the fibula from fracturing and allowing axial loading of healing bone. The inlay assembly allows a large area of bony contact between allograft and vascularized bone, optimizing bony healing. It is a good alternative to other established techniques of managing significant segmental defects of the distal femur.
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J Reconstr Microsurg · Jul 2011
Biography Historical ArticleBenjamin Alcock and the pudendal canal.
The anatomy of the pudendal nerve is complex and difficult to visualize. Entrapment of the pudendal nerve is believed to occur in a canal, the pudendal canal or Alcock's canal, yet in the literature this term is used to refer to several different anatomic locations. ⋯ It is concluded that Alcock's canal for the pudendal nerve, as Alcock described it related to the pudendal artery, should be that portion of the pudendal nerve within the obturator internus fascia. This definition now permits future medical and surgical approaches to use the appropriate terminology for this anatomic location.
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J Reconstr Microsurg · May 2011
Scalp reconstruction with inverted myocutaneous latissimus free flap and unmeshed skin graft.
Limited skin paddle size, peripheral thinning, or lack of cerebral expansion after radiotherapy may necessitate secondary sculpting after latissimus free flap reconstruction of large scalp defects. This series presents a novel modification of the myocutaneous latissimus dorsi free flap for use in large scalp defects. After superficial artery isolation, titanium mesh is placed into the calvarial defect to recapitulate the inner table. ⋯ Cosmesis was most notably limited by skin graft joint lines. No patients underwent secondary surgical revision. The inverted myocutaneous latissimus free flap is a safe and effective method for reconstructing large or irradiated scalp defects.