Journal of reconstructive microsurgery
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J Reconstr Microsurg · Feb 2018
Review Meta AnalysisDoes Postoperative Anticoagulation Therapy Lead to a Higher Success Rate for Microvascular Free-Tissue Transfer in the Head and Neck? A Systematic Review and Meta-Analysis.
Due to limited evidence, it is unclear whether postoperative anticoagulation therapy may lead to higher success rates for microvascular free-flap surgery in the head and neck. This review evaluated whether postoperative anticoagulation therapy can lead to a better result in head and neck reconstruction. ⋯ The findings from our meta-analysis indicate that postoperative anticoagulation therapy barely decreases the risks of flap loss and thromboembolic events in free-flap surgery in the head and neck. However, it may significantly increase the risk of hematoma formation. Considering the limitations of this meta-analysis, additional high-quality, multicenter, prospective, randomized controlled studies are needed to confirm these findings.
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J Reconstr Microsurg · Jan 2015
ReviewFunctional abdominal wall reconstruction using an innervated abdominal wall vascularized composite tissue allograft: a cadaveric study and review of the literature.
Large, composite abdominal wall defects represent complex problems requiring a multidisciplinary approach for reconstruction. Abdominal wall vascularized composite allotransplantation (AW-VCA) has been successfully performed in 21 patients, already receiving solid organ transplants, to provide immediate abdominal closure. The current study aims to establish a novel anatomic model for AW-VCA that retains motor and sensory function in an effort to preserve form and function while preventing complications. ⋯ Motor function and sensory recovery is expected in other forms of vascularized composite allotransplantation, such as the hand or face; however, this has never been tested in AW-VCA. This study demonstrates feasibility for the transplantation of large, composite abdominal wall constructs that potentially retains movement, strength, and sensation through neurotization of both sensory and motor nerves.
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J Reconstr Microsurg · Jul 2013
Review Comparative StudyPerioperative fluid management and use of vasoactive and antithrombotic agents in free flap surgery: a literature review and clinical recommendations.
After reading this article, the participant should be able to (1) outline the rationale for different perioperative types of fluid therapy in free flap surgery and identify the methods considered best for flap survival; (2) understand the current views on the use of vasoactive agents and consider its possible safe use; (3) compare the most commonly used intraoperative and postoperative anticoagulant therapies and identify the risks and benefits associated with each. ⋯ Free flap surgery has become a reliable and efficient method for reconstruction of complex soft tissue and bony defects. Despite high success rates, free flap failure remains an important concern. A review of the literature was conducted on nonsurgical factors that may contribute to flap failure or success. Various anesthesiological and anticoagulant methods are applied in free flap surgery, but for the ideal approach there is no consensus. This article provides clinical recommendations on perioperative fluid management and the use of vasoactive and antithrombotic agents and offers a balanced view on the risks and benefits.
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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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Major burn injuries can be devastating for the patients and their carers both in terms of morbidity and mortality. Therefore, it is important to optimize the treatment of the injured patient. After initial resuscitation and physiological stabilization, thorough surgical débridement of the burn is necessary. ⋯ However, in a small percentage of cases free flap surgery is necessary. Free tissue transfer in burns surgery is rare, but is indicated in those patients in which there is loss of a vascularized surface suitable for grafting such as exposed tendon, or bone following surgical débridement, and in extreme cases for limb salvage. This review article discusses the rationale for free flap surgery in terms of types of burn injuries, perioperative considerations, and summarizes the literature in free tissue transfer in acute burns.