Journal of reconstructive microsurgery
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J Reconstr Microsurg · Jul 2016
Lower Extremity Flap Salvage in Thrombophilic Patients: Managing Expectations in the Setting of Microvascular Thrombosis.
Background Undiagnosed thrombophilia is a risk factor for flap failure; however, its prevalence in patients undergoing microsurgical reconstruction is unknown. We present our experience with free tissue transfer (FTT) in a high-risk population of lower extremity patients with documented thrombophilia, identified through preoperative screening. Methods Between January 2012 and April 2014, 41 patients underwent 43 free flaps for nontraumatic, lower extremity reconstruction by a single surgeon. ⋯ On average, microvascular complications manifested later in the setting of thrombophilia (mean 4.8 days vs. 18 hours; p = 0.20) and were associated with a worse overall prognosis (salvage rate, 0 vs. 67%; p = 0.05). Conclusions Despite high success rates, thrombophilia appears to increase the risk of nonsalvageability following lower extremity FTT. This information should be used to help counsel patients regarding the risks and benefits of microsurgical reconstruction, as salvage rates following postoperative thrombotic events approach 0% in the presence of thrombophilia.
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Background Knowledge on the anatomical and morphological characteristics of the superficial peroneal nerve is amenable to further refinement. This cadaveric study aimed to further evaluate anatomical and morphological characteristics of the superficial peroneal nerve. Methods In this study, 10 lower limbs from five fresh cadavers were dissected. ⋯ Morphometric analyses revealed an average five nerve bundles at the broadest nerve diameter (2.6 mm). Conclusion The anatomical and morphometrical characteristics of the superficial peroneal nerve indicate that it may be a safe and useful donor for autologous graft treatment of peripheral nerve injuries. Our morphological study shows a median of five fascicles, and that the thickest diameter of the nerve was 2.6 mm at the emergence from the deep to the superficial compartment.
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J Reconstr Microsurg · Mar 2016
Regenerative Peripheral Nerve Interface for Prostheses Control: Electrode Comparison.
This study compared epimysial patch electrodes with intramuscular hook electrodes using monopolar and bipolar recording configurations. The purpose was to determine which strategy transduced muscle signals with better fidelity for control of myoelectric prostheses. ⋯ Epimysial patch electrodes outperform intramuscular hook electrodes during chronic skeletal muscle implantation.
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J Reconstr Microsurg · Mar 2016
Anastomosis Lapse Index (ALI): A Validated End Product Assessment Tool for Simulation Microsurgery Training.
Over the last decade, simulation has become a principal training method in microsurgery. With an increasing move toward the use of nonliving models, there is a need to develop methods for assessment of microvascular anastomosis skill acquisition substituting traditional patency rate. The authors present and validate a novel method of microvascular anastomosis assessment tool for formative and summative skills competency assessment. ⋯ Evaluation of anastomosis structural patency and quality in nonliving models is possible. The proposed error list showed construct and predictive validity. The anastomosis lapse index can serve as a formative and summative assessment tool during microvascular training.
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The objective of this study was to provide anatomical data on modified contralateral C7 (cC7) nerve root transfers by dissecting and measuring the separable lengths of the C7 root, trunk, and divisions. ⋯ The C7 division lengths can be prolonged by dissecting the epineuria at the division-cord junction of the C7 nerve root.