Journal of reconstructive microsurgery
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Just what is the S&T lecture? In the beginning it appeared to be a dubious distinction, another task thrust upon me but different in that I had absolutely no idea what was wanted or would be appropriate. At the least, it seemed reasonable to recite a simple introductory story for what would be an extraordinary conclave. First, an appreciation was due to our dedicated leaders of World Society of Reconstructive Microsurgery (WSRM), who this year (2017) have put together the most extravagant meeting ever, intended to include not just the glamorous but the entire scope of rudimentary reconstructive microsurgery. ⋯ The WSRM here today is a great international forum where we can then mingle with all of our colleagues to help dictate the present, but also define the future role of all specialities here where the ultimate goal is to help those most in need. This S&T lecture will just be a history story, subject to your interpretation. Enjoy!
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J Reconstr Microsurg · Jul 2018
Meta AnalysisFree-Flap Lower Extremity Reconstruction: A Cohort Study and Meta-Analysis of Flap Anastomotic Outcomes between Perforator and Nonperforator Flaps.
Free-flap outcomes in lower extremity reconstruction carry the lowest anastomotic success rates compared with other anatomical sites. Despite their advantages over traditional nonperforator flaps, free perforator flaps have only recently become established in this area due to the additional challenges faced. It is therefore crucial to assess the anastomotic outcomes of perforator and nonperforator free flaps. ⋯ Our meta-analysis is the first reported study and serves as an indication that free perforator flaps in lower extremity are as reliable as their traditional nonperforator counterparts. This does come with the prerequisite appreciation of the anatomical variations, the delicate handling of these flaps, and a low threshold for reexploration.
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J Reconstr Microsurg · Jun 2018
ReviewProximal versus Distal Recipient Vessels in Lower Extremity Reconstruction: A Retrospective Series and Systematic Review.
Recipient vessels proximal to the zone of injury have traditionally been preferred for lower extremity reconstruction. However, more recent data have shown mixed outcomes when performing anastomoses distal to the zone of injury. We investigated the impact of recipient vessel location on free flap outcomes. ⋯ Our results are congruent with the current lower extremity literature and demonstrate no difference in perioperative complication rates between anastomoses performed proximal or distal to the zone of injury. These findings suggest that anastomotic location choice should be based primarily on recipient vessel quality/flow and ease of access/exposure rather than orientation relative to the zone of injury.
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J Reconstr Microsurg · Jun 2018
Immunohistochemical Detection of Motor Endplates in the Long-Term Denervated Muscle.
We have demonstrated that the native motor zone (NMZ) within a muscle is an ideal target for performing nerve-muscle-endplate band grafting (NMEG) to restore motor function of a denervated muscle. This study was designed to determine spatiotemporal alterations of the myofibers, motor endplates (MEPs), and axons in the NMZ of long-term denervated muscles for exploring if NMEG-NMZ technique would have the potential for delayed reinnervation. ⋯ Persistence of MEPs in the long-term denervated SM suggests that some surgeries targeting the MEPs such as NMEG-NMZ technique should be effective for delayed reinnervation. However, more work is needed to develop strategies for preservation of muscle mass and MEPs after denervation.
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J Reconstr Microsurg · Mar 2018
Use of Incisional Negative Pressure Wound Therapy in Skin-Containing Free Tissue Transfer.
Negative pressure wound therapy (NPWT) was initially introduced for wound management, but its benefits have stimulated the investigation of its use in new clinical scenarios. Most recently, incisional NPWT has been shown to be a benefit. Incisional NPWT applied to skin-containing free tissue transfer has not been well defined. This may originate from concerns of dressing material obscuring frequent examination of the newly transferred tissue or risk of pedicle compression and potential for increased risk of tissue loss. We aim to describe incisional NPWT in cutaneous free tissue transfer. ⋯ NPWT may be employed in a fashion similar to the standard incisional application. With this technique, serial flap examination remains possible and is not associated with pedicle compression or increased rates of flap loss. Interestingly, no splints were utilized with the VAC device which itself may serve as a relative immobilizer of an extremity.