Journal of reconstructive microsurgery
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J Reconstr Microsurg · May 2008
Anatomic variance in common vascular pedicle of the gracilis and adductor longus muscles: feasibility of double functioning free muscle transplantation with single pedicle anastomosis.
Fifty thighs from fresh human cadavers were studied to evaluate the feasibility of a double functioning free muscle transfer of the gracilis and adductor longus with single common vascular pedicle anastomosis. Methylene blue intra-arterial injection and loupe-magnified dissection were used to demonstrate three groups of vascular patterns in these two muscles. The common vascular pedicles of 88% of our specimen muscles were long enough for possible anastomosis. ⋯ If only one pedicle of this type is harvested during a free gracilis muscle transfer, it may cause inadequate flap perfusion. Four specimens were studied using contrast media angiography to confirm both are Mathes and Nahai type II muscle flaps. In summary, this study typed the common vascular pedicle of our sample of gracilis and adductor longus muscles and confirmed the feasibility of double functioning free muscle transfer of the gracilis and adductor longus with single vascular anastomosis.
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J Reconstr Microsurg · May 2008
Case ReportsEarly free tissue transfer for extremity reconstruction following high-voltage electrical burn injuries.
We compared the effectiveness of free tissue transfer in repairing high-voltage electrical extremity injuries with conventional multistage procedures. Patients were matched for age, sex, level of injury, voltage, and burn surface area; results were compared using the paired Student T test. Free tissue transfer was performed a mean of 19.1 +/- 10.6 days after the injury occurred, and definitive wound closure and limb salvage were achieved in 87.5% of patients after a mean of 23.0 +/- 9.1 days after the injury. ⋯ Both patients required upper and lower proximal ipsilateral limb amputations. One upper-extremity flap failed after pedicle avulsion 4 days after surgery, but a second free tissue transfer was successful in salvaging this limb 4 days later. The number of surgeries, time required to achieve wound closure, and length of hospitalization were all statistically significantly lower in the free flap group compared with those in the conventional treatment group.
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J Reconstr Microsurg · Apr 2008
A ten-year experience of multiple flaps in head and neck surgery: how successful are they?
Ablative surgery in the head and neck often results in defects that require free flap reconstruction. With improved ablation/reconstructive and adjuvant techniques, improved survival has led to an increase in the number of patients undergoing multiple free flap reconstruction. We retrospectively analyzed a single institution's 10-year experience (August 1993 to August 2003) in free flap reconstruction for malignant tumors of the head and neck. ⋯ For primary free flap surgery, success was 481/506 (95%), compared with 44/50 (88%) for a second free flap reconstruction and 9/12 (75%) for a third free flap reconstruction ( P < 0.05). Eight extensive defects were reconstructed with 16 flaps, all of which were successful. More than one free flap may be required for reconstruction of head and neck defects, although success decreases as the number of reconstructive procedures increases.
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J Reconstr Microsurg · Apr 2008
Bridging critical nerve defects through an acellular homograft seeded with autologous schwann cells obtained from a regeneration neuroma of the proximal stump.
Over the last decade, several models have investigated the usefulness of different biologic and/or synthetic matrices as alternatives to conventional nerve grafts. Still, axonal regeneration did not occur over longer (> 3 cm) distances. One problem may be that a growth-promoting environment not only includes physical cues but also a rich spectrum of different growth factors only provided by reactive Schwann cells. ⋯ The present experiment sought to create a hybrid graft where the proximal stump neuroma is used as a biological resource for autologous Schwann cells that are seeded unto an acellular matrix, thus providing both physical and chemical support to regenerating axons. The results are encouraging in that successful regeneration was observed over the entire distance; however, only sensory axons had enough regenerative potential to also make end-organ contact. For motor axons, further refinements in conduit preparation have to be done.
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J Reconstr Microsurg · Nov 2007
Metabolic response in microvascular flaps during partial pedicle obstruction and hypovolemic shock.
To investigate tissue metabolism during suboptimal blood perfusion, we used in situ microdialysis in an experimental model of myocutaneous flaps. We assessed concentrations of glucose, lactate, and pyruvate in flaps subjected to partial pedicle obstruction and to hemorrhagic shock. When the arterial flow was restricted, the glucose concentration decreased in the flap muscle, and the lactate concentration increased in all flap components. ⋯ During hypovolemic shock, the lactate production increased and the glucose concentration decreased or remained normal. The metabolic changes occurring during partial pedicle obstruction and hypovolemic shock are moderate and different from those seen in total pedicle obstruction. Microdialysis is a feasible method for assessing local tissue metabolism and can be used to monitor flap ischemia.