scholarly journals The importance of a lifeboat-median artery forearm flap in Goldenhar Syndrome

2021 ◽  
Author(s):  
Anna M. Jaźwiec ◽  
Ewa D. Komorowska Timek
Keyword(s):  
Radial Artery ◽  
Free Tissue Transfer ◽  
Goldenhar Syndrome ◽  
Level Of Evidence ◽  
Flap Transfer ◽  
Free Flap Transfer ◽  
Flap Design ◽  
Median Artery ◽  
Therapeutic Study ◽  
Left Radial Artery

AbstractWe present a case of a 32-year-old male with left-sided Goldenhar Syndrome and delta phalanx of the thumb, who was offered free tissue transfer from the forearm to address an intra-oral soft tissue deficiency. Despite the presence of appropriately developed right radial artery, used in previous facial reconstruction, the left radial artery occurred to be hypoplastic. He ultimately underwent free flap transfer based on the anomalous persistent left median artery. We suggest that in face of an unusual hand anatomy, flexible flap creation techniques that allow a lifeboat strategy of adjusting flap design should be considered preoperatively. Level of evidence: Level V, therapeutic study.

Gracilis Muscle Free Flap Transfer Using a Radial Artery/Venae Comitantes Composite Vascular Pedicle

2001 ◽  
Vol 108 (1) ◽  
pp. 156-161 ◽  
Author(s):  
Samir M. Sukkar ◽  
Joseph A. Daw ◽  
James Chandler ◽  
Gregory A. Dumanian
Keyword(s):  
Radial Artery ◽  
Free Flap ◽  
Gracilis Muscle ◽  
Vascular Pedicle ◽  
Flap Transfer ◽  
Free Flap Transfer

scholarly journals Use of the Retrograde Recipient Vein for Additional Outflow in Free Tissue Transfer

2020 ◽  
Vol 05 (01) ◽  
pp. e1-e6
Author(s):  
Tetsuji Uemura ◽  
Mamoru Kikuchi ◽  
Hidetaka Watanabe ◽  
Tetsu Yanai
Keyword(s):  
Head And Neck ◽  
Free Tissue Transfer ◽  
Blood Perfusion ◽  
Free Flaps ◽  
Successful Outcome ◽  
Venous Anastomosis ◽  
Venous Flow ◽  
Flap Transfer ◽  
Tissue Transfer ◽  
Free Flap Transfer

Abstract Background The selection of appropriate recipient vessels is essential to the successful outcome of free flap transfer. To improve blood perfusion after reconstruction and reduce the risk of postoperative obstruction of flap vessels, multiple vessels should be chosen as candidate recipients. Methods For certainty of venous drainage, we have been performing venous anastomosis to the distal end of the recipient vein to utilize the reverse venous flow. Results A total of 48 cases of reconstruction of the head and neck or breast region with free flaps using retrograde venous anastomosis were performed. The method possibly improves flap circulation and the success rate of the free tissue transfer and reduces the need to extend surgery to search for multiple recipient veins. Conclusion We emphasized that retrograde limb of vein is useful as a second and/or rescued recipient in free tissue transfer. Retrograde venous anastomosis is a fine and reasonable option when appropriate recipient vessels cannot be found near the defect in the head and neck such as frozen neck or breast region.

Clinical application of a free radial artery superficial palmar branch flap for soft-tissue reconstruction of digital injuries

2016 ◽  
Vol 42 (2) ◽  
pp. 151-156 ◽  
Author(s):  
S. H. Lee ◽  
S. J. Cheon ◽  
Y. J. Kim
Keyword(s):  
Soft Tissue ◽  
Clinical Application ◽  
Radial Artery ◽  
Soft Tissue Reconstruction ◽  
Flap Reconstruction ◽  
Level Of Evidence ◽  
Finger Injuries ◽  
Flap Transfer ◽  
Tissue Reconstruction ◽  
Poor Outcomes

Unsuccessful reconstruction of injured fingers can lead to poor outcomes. The aim of this article was to investigate the clinical application of the radial artery superficial palmar branch flap for soft-tissue reconstruction of the finger. We treated 125 patients with various finger injuries who underwent free radial artery superficial palmar branch flap reconstruction between October 2010 and March 2015. There were 46 distal finger injuries, 25 distal finger amputation following failed replantation and 54 palmar digital injuries with tendon, bone or joint exposure requiring soft-tissue reconstruction. Of the 125 cases, 114 flap reconstructions were considered successful. We believe that a free radial artery superficial palmar branch flap transfer is credible and useful for reconstructing various finger injuries. Level of Evidence: III

Assessing the Safety and Efficacy of Regional Anesthesia for Lower Extremity Microvascular Reconstruction: Enhancing Recovery

2018 ◽  
Vol 34 (04) ◽  
pp. 293-299 ◽  
Author(s):  
Qing Ruan ◽  
Shawn Diamond ◽  
Scott Zimmer ◽  
Matthew Iorio
Keyword(s):  
Lower Extremity ◽  
Free Flap ◽  
Free Tissue Transfer ◽  
Microvascular Reconstruction ◽  
Safety And Efficacy ◽  
Flap Transfer ◽  
Pain Scores ◽  
Patient Morbidity ◽  
Free Flap Transfer ◽  
The Mean

Background Perioperative pain, increased sympathetic tone, and peripheral vasospasm may be safely managed with regional nerve blockade during microvascular reconstruction in the lower extremity. Limited reports exist in this setting; therefore, we evaluated our use of peripheral nerve catheters (PNCs) during microvascular limb salvage to determine safety and efficacy for both patient and flap. Methods A single-institution, retrospective review of a prospectively maintained database on all patients with lower extremity free tissue transfers between 2012 and 2017 was completed. Patients were matched into groups based on PNC utilization. The use of intravenous narcotics including patient-controlled analgesia (PCA), oral narcotics, antiemetics, length of stay (LOS), associated pain scores, flap-related performance, and patient morbidity was recorded. Results Of 48 patients who underwent lower extremity free tissue transfer, 35 satisfied criteria for comparison. Of these, PNC was utilized in 83%. The mean pain score in the immediate postoperative period was 3.84 ± 2.47 (10-point Likert scale). PCA and narcotic use were decreased in the PNC group, and no adverse effects of the catheter were identified. Microsurgical outcomes were not adversely affected in comparison. Conclusion PNC utilization for lower extremity free flap transfer significantly reduced concurrent narcotic use and attained a shorter LOS. The technique provided for safe analgesia during lower extremity free flap reconstructions satisfying the microsurgeon and the anesthesiologist.

Tissue Expansion for Closure of the Donor Site of a Distant Pedicle Flap

1994 ◽  
Vol 2 (4) ◽  
pp. 155-158
Author(s):  
Ronald M Zuker ◽  
Craig Fielding ◽  
Steve Beatty
Keyword(s):  
Donor Site ◽  
Tissue Expansion ◽  
Free Tissue Transfer ◽  
Pedicle Flap ◽  
Direct Closure ◽  
Flap Transfer ◽  
Free Flap Transfer ◽  
Specialized Tissue ◽  
Donor Defect ◽  
Pedicle Flaps

RM Zuker, C Fielding, S Beatty. Tissue expansion for closure of the donor site of a distant pedicle flap. Can J Plast Surg 1994; 2(4):155-158. Tissue expansion continues to provide new and exciting applications in reconstructive surgery. Tissue expansion has allowed for an increase in size of specialized tissue, particularly about the head and neck. It has also been demonstrated that the blood supply of pedicle flaps can be augmented, thus extending the surviving length of expanded flaps. Recently tissue expansion has been used with free flap transfer to expand the amount of tissue to be transferred and to facilitate donor site closure. In certain situations free tissue transfer may not be recommended and pedicle flap and particularly cross leg and cross thigh flaps are required. In addition to the prolonged unnatural positioning of the patient, the donor defect of these flaps has been harshly criticized. In this report tissue expansion is used to provide adequate tissue for direct closure of the donor defect thus minimizing the deformity.

Microvascular Flaps in Nasal Reconstruction

2017 ◽  
Vol 33 (01) ◽  
pp. 074-081 ◽  
Author(s):  
Kofi Boahene ◽  
Patrick Byrne ◽  
Shaun Desai ◽  
Irene Kim
Keyword(s):  
Free Flap ◽  
Free Tissue Transfer ◽  
Nasal Reconstruction ◽  
Flap Transfer ◽  
Structural Support ◽  
Tissue Transfer ◽  
Free Flap Transfer ◽  
Long Term Changes ◽  
Optimal Reconstruction

AbstractNasal reconstruction for subtotal and total rhinectomy defects is a challenging endeavor, which requires technical finesse, a keen artistic eye, and the ability to anticipate long-term changes that accompany postoperative healing. While local and regional flaps have traditionally been utilized to reconstitute missing nasal elements, certain situations may not provide sufficient or acceptable tissue for optimal reconstruction. In these situations, the three major components of the nose—lining, structural support, and external skin—may require reconstruction with tissues harvested from distant sites through microvascular free tissue transfer. Our objective in this article is to discuss the general approach to nasal reconstruction and present the considerations for free tissue transfer with regard to each nasal component. The virtues of free flap transfer as well as its shortcomings and potential complications are discussed.

Methods of Assessing the Viability of Free Flap Transfer During the Postoperative Period

1983 ◽  
Vol 10 (1) ◽  
pp. 21-36 ◽  
Author(s):  
Douglas H. Harrison ◽  
Marjorie Girling ◽  
Godfrey Mott
Keyword(s):  
Free Flap ◽  
Postoperative Period ◽  
Flap Transfer ◽  
Free Flap Transfer

Upper Extremity Free Flap Transfers: An Analysis of the National Surgical Quality Improvement Program Database

2020 ◽  
Author(s):  
George A. Beyer ◽  
Karan Dua ◽  
Neil V. Shah ◽  
Joseph P. Scollan ◽  
Jared M. Newman ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Upper Extremity ◽  
Free Flap ◽  
Quality Improvement Program ◽  
Readmission Rates ◽  
Improvement Program ◽  
Surgical Quality ◽  
Flap Transfer ◽  
Free Flap Transfer ◽  
Reoperation Rates

Abstract Introduction We evaluated the demographics, flap types, and 30-day complication, readmission, and reoperation rates for upper extremity free flap transfers within the National Surgical Quality Improvement Program (NSQIP) database. Materials and Methods Upper extremity free flap transfer patients in the NSQIP from 2008 to 2016 were identified. Complications, reoperations, and readmissions were queried. Chi-squared tests evaluated differences in sex, race, and insurance. The types of procedures performed, complication frequencies, reoperation rates, and readmission rates were analyzed. Results One-hundred-eleven patients were selected (mean: 36.8 years). Most common upper extremity free flaps were muscle/myocutaneous (45.9%) and other vascularized bone grafts with microanastomosis (27.9%). Thirty-day complications among all patients included superficial site infections (2.7%), intraoperative transfusions (7.2%), pneumonia (0.9%), and deep venous thrombosis (0.9%). Thirty-day reoperation and readmission rates were 4.5% and 3.6%, respectively. The mean time from discharge to readmission was 12.5 days. Conclusion Upper extremity free flap transfers could be performed with a low rate of 30-day complications, reoperations, and readmissions.

Range of Motion after the Sauvé–Kapandji and Darrach Procedures without Extensor Tendon Rupture

2020 ◽  
Author(s):  
Tomoyuki Kato ◽  
Taku Suzuki ◽  
Makoto Kameyama ◽  
Masato Okazaki ◽  
Yasushi Morisawa ◽  
...  
Keyword(s):  
Range Of Motion ◽  
Tendon Rupture ◽  
Extensor Tendon ◽  
Distal Radioulnar Joint ◽  
Wrist Flexion ◽  
Level Of Evidence ◽  
Radioulnar Joint ◽  
The Mean ◽  
Therapeutic Study ◽  
Loss Of Motion

Abstract Background Previous study demonstrated that distal radioulnar joint (DRUJ) plays a biomechanical role in extension and flexion of the wrist and suggested that fixation of the DRUJ could lead to loss of motion of the wrist. Little is known about the pre- and postoperative range of motion (ROM) after the Sauvé–Kapandji (S-K) and Darrach procedures without tendon rupture. To understand the accurate ROM of the wrist after the S-K and Darrach procedures, enrollment of patients without subcutaneous extensor tendon rupture is needed. Purpose This study aimed to investigate the pre- and postoperative ROM after the S-K and Darrach procedures without subcutaneous extensor tendon rupture in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). Methods This retrospective study included 36 patients who underwent the S-K procedure and 10 patients who underwent the Darrach procedure for distal radioulnar joint disorders without extensor tendon rupture. Pre- and postoperative ROMs after the S-K and Darrach procedures were assessed 1 year after the surgery. Results In the S-K procedure, the mean postoperative ROM of the wrist flexion (40 degrees) was significantly lower than the mean preoperative ROM (49 degrees). In wrist extension, there were no significant differences between the mean preoperative ROM (51 degrees) and postoperative ROM (51 degrees). In the Darrach procedure, the mean postoperative ROM of the wrist flexion and extension increased compared with the mean preoperative ROM; however, there were no significant differences. Conclusion In the S-K procedure, preoperative ROM of the wrist flexion decreased postoperatively. This study provides information about the accurate ROM after the S-K and Darrach procedures. Level of Evidence This is a Level IV, therapeutic study.

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