Partial Flap Loss in Gender Affirming Phalloplasty

2021 ◽  
Author(s):  
Isabel Cylinder ◽  
Aaron Heston ◽  
Jourdan Carboy ◽  
Breanna Jedrzejewski ◽  
Blair Peters ◽  
...  
Keyword(s):  
Donor Site ◽  
Skin Grafting ◽  
Flap Loss ◽  
Physical Status Classification ◽  
Thickness Skin ◽  
Radial Forearm ◽  
Site Design ◽  
Patient Variables ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract Background Flaps used in phalloplasty are larger than described for other indications, with a design that is tubularized up to two times. While the incidence of partial flap loss (PFL) is well described, current literature lacks granularity comparing donor sites and techniques with minimal discussion of etiology and management. The purpose of this study was to review our experience with PFL in phalloplasty. Methods This was a retrospective cohort study of patients who underwent phalloplasty by a single surgeon at a single institution between 2016 and 2020. PFL was defined as any patient requiring sharp excision of necrotic tissue and reconstruction. Patient variables (demographics, body mass index, American Society of Anesthesiologists physical status classification, comorbidities), flap variables (donor site, design, dimensions, perforator number) and intraoperative variables (use of vasopressors, intraoperative fluid volume) were collected. Results Of 76 phalloplasties, 6 patients suffered PFL (7.9%). 5/6 patients were radial forearm free flap tube-within-tube (TWT) and 1/5 patients were pedicled anterolateral thigh TWT. 4/6 cases involved the shaft only and were treated with excision ± Integra and full-thickness skin grafting. 2 cases of PFL involved the urethral extension requiring excision of the necrotic segment. Conclusion PFL occurred in 7.9% of cases and was solely found in the TWT cohort. The majority of cases involved the shaft, sparing the urethral segment. Cases in the acute postoperative period appeared to be related to macrovascular venous congestion, while cases in the subacute period appeared to be due to microvascular arterial ischemia.

A Comparison of Colectomy Outcomes Utilizing Open, Laparoscopic, and Robotic Techniques

2020 ◽  
pp. 000313482097338
Author(s):  
Elizabeth McCarthy ◽  
Benjamin L. Gough ◽  
Michael S. Johns ◽  
Alexandra Hanlon ◽  
Sachin Vaid ◽  
...  
Keyword(s):  
Postoperative Recovery ◽  
Logistic Regression Models ◽  
Community Institution ◽  
Physical Status Classification ◽  
Estimated Blood Loss ◽  
Comparative Review ◽  
Significant Difference ◽  
American Society ◽  
The Individual ◽  
American Society Of Anesthesiologists

Introduction Robotic colectomy could reduce morbidity and postoperative recovery over laparoscopic and open procedures. This comparative review evaluates colectomy outcomes based on surgical approach at a single community institution. Methods A retrospective review of all patients who underwent colectomy by a fellowship-trained colon and rectal surgeon at a single institution from 2015 through 2019 was performed, and a cohort developed for each approach (open, laparoscopic, and robotic). 30-day outcomes were evaluated. For dichotomous outcomes, univariate logistic regression models were used to quantify the individual effect of each predictor of interest on the odds of each outcome. Continuous outcomes received a similar approach; however, linear and Poisson regression modeling were used, as appropriate. Results 115 patients were evaluated: 14% (n = 16) open, 44% (n = 51) laparoscopic, and 42% (n = 48) robotic. Among the cohorts, there was no statistically significant difference in operative time, rate of reoperation, readmission, or major complications. Robotic colectomies resulted in the shortest length of stay (LOS) (Kruskal-Wallis P < .0001) and decreased estimated blood loss (EBL) (Kruskal-Wallis P = .0012). Median age was 63 years (interquartile range [IQR] 53-72). 54% (n = 62) were female. Median American Society of Anesthesiologists physical status classification was 3 (IQR 2-3). Median body mass index was 28.67 (IQR 25.03-33.47). A malignant diagnosis was noted on final pathology in 44% (n = 51). Conclusion Among the 3 approaches, there was no statistically significant difference in 30-day morbidity or mortality. There was a statistically significant decreased LOS and EBL for robotic colectomies.

scholarly journals Comparison of Train of Four Measurements with Kinemyography NMT DATEX and Accelerography TOFscan

2021 ◽  
Vol 9 (2) ◽  
pp. 21
Author(s):  
Cyrus Motamed ◽  
Migena Demiri ◽  
Nora Colegrave
Keyword(s):  
Neuromuscular Blockade ◽  
Lower Limit ◽  
Elective Surgery ◽  
Orotracheal Intubation ◽  
Neuromuscular Blocking ◽  
Physical Status Classification ◽  
Train Of Four ◽  
Surgery First ◽  
American Society ◽  
American Society Of Anesthesiologists

Introduction: This study was designed to compare the Datex neuromuscular transmission (NMT) kinemyography (NMTK) device with the TOFscan (TS) accelerometer during the onset and recovery of neuromuscular blockade. Patients and methods: This prospective study included adult patients who were scheduled to undergo elective surgery with general anesthesia and orotracheal intubation. The TS accelerometer was randomly placed at the adductor pollicis on one hand, and the NMTK was placed on the opposite arm. Anesthesia was initiated with remifentanil target-controlled infusion (TCI) and 2.0–3.0 mg/kg of propofol. Thereafter, 0.5 mg/kg of atracurium or 0.6 mg/kg of rocuronium was injected. If needed, additional neuromuscular blocking agents were administered to facilitate surgery. First, we recorded the train of four (TOF) response at the onset of neuromuscular blockade to reach a TOF count of 0. Second, we recorded the TOF response at the recovery of neuromuscular blockade to obtain a T4/T1 90% by both TS and NMTK. Results: There were 32 patients, aged 38–83 years, with the American Society of Anesthesiologists (ASA) Physical Status Classification I–III included and analyzed. Surgery was abdominal, gynecologic, or head and neck. The Bland and Altman analysis for obtaining zero responses during the onset showed a bias (mean) of 2.7 s (delay) of TS in comparison to NMTK, with an upper/lower limit of agreement of [104; −109 s] and a bias of 36 s of TS in comparison to NMTK, with an upper/lower limit of agreement of [−21.8, −23.1 min] during recovery (T4/T1 > 90%). Conclusions: Under the conditions of the present study, the two devices are not interchangeable. Clinical decisions for deep neuromuscular blockade should be made cautiously, as both devices appear less accurate with significant variability.

Validation of the Tokyo guideline 2018 treatment proposal for acute cholecystitis from a single-center retrospective analysis

2019 ◽  
Author(s):  
Tomoaki Bekki ◽  
Tomoyuki Abe ◽  
Hironobu Amano ◽  
Keiji Hanada ◽  
Tsuyoshi Kobayashi ◽  
...  
Keyword(s):  
Blood Transfusion ◽  
Acute Cholecystitis ◽  
Treatment Strategy ◽  
Early Laparoscopic Cholecystectomy ◽  
Physical Status Classification ◽  
Severity Grading ◽  
Hospital Stays ◽  
Comorbidity Index ◽  
American Society ◽  
American Society Of Anesthesiologists

Abstract Background Based on the revised Tokyo guideline 2018 (TG18), early laparoscopic cholecystectomy (LC) is recommended in patients who satisfy the Charlson Comorbidity Index (CCI) criteria and the American Society of Anesthesiologists Physical Status Classification (ASA-PS). Our study aims to determine the efficacy of TG18 treatment strategy. Methods We enrolled 324 patients with acute cholecystitis (AC) diagnosed by TG18 who underwent cholecystectomy between 2010 and 2018. Perioperative variables and surgical outcomes were analyzed according to the TG18 treatment strategy and severity grading. Results ASA-PS scores and CCI were significantly higher in patients with Grade II (GII) and GIII AC. Higher severity grading resulted in failed LC, requiring blood transfusion and bailout surgery. The TG18 within group showed a higher proportion of GI and GII AC and their ASA-PS scores were also significantly lower. TG18 within group demonstrated significant differences in the achievement of LC, bailout surgery, postoperative hospital stays, and 90-day mortality rates. Intraoperative blood loss and blood transfusion were significantly higher in the TG18 outside group than that in the TG18 within group. Conclusions Our study shows that the TG18 treatment strategy is well-designed and efficacious. Novel findings Our study established the feasibility and efficacy of TG18. The usefulness of performing aggressive surgery beyond the TG18 strategy requires further study.

Full Thickness Skin Graft for Nail Unit Reconstruction

2005 ◽  
Vol 30 (2) ◽  
pp. 194-198 ◽  
Author(s):  
A. LAZAR ◽  
P. ABIMELEC ◽  
C. DUMONTIER
Keyword(s):  
Skin Graft ◽  
Simple Procedure ◽  
Donor Site ◽  
Skin Grafting ◽  
Malignant Tumour ◽  
Donor Site Morbidity ◽  
Full Thickness ◽  
Full Thickness Skin Graft ◽  
Full Thickness Skin ◽  
Thickness Skin

A retrospective study of 13 patients assessed the use of a full thickness skin graft for nail unit reconstruction after total nail unit removal for nail bed malignancies. No failures of the graft were observed and no patient had recurrence of the malignant tumour at 4 year follow-up. Full thickness skin grafting is a simple procedure which provides a good cosmetic outcome and does not produce significant donor site morbidity.

scholarly journals Are Intoxicated Trauma Patients at an Increased Risk for Intraoperative Anesthetic Complications? A Retrospective Study

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Brian D. Wolf ◽  
Swapna Munnangi ◽  
Raymond Pesso ◽  
Charles McCahery ◽  
Madhu Oad
Keyword(s):  
Intraoperative Complications ◽  
Final Analysis ◽  
Trauma Patients ◽  
Urine Toxicology ◽  
Physical Status Classification ◽  
Increased Risk ◽  
Toxicology Screening ◽  
Anesthetic Complications ◽  
American Society ◽  
American Society Of Anesthesiologists

Background. The purpose of this study was to correlate intraoperative anesthetic complications of trauma patients with their respective urine toxicology results. Methods. This retrospective, single-center cohort study at a Level 1 trauma center included patients with the following criteria: (1) trauma admission between January 1, 2010, and December 31, 2016, (2) required surgical intervention, (3) are age 18 and older, and (4) urine toxicology screening was completed. Anesthetic records were evaluated for intraoperative complications. Results. The final analysis included 847 patients. The mean anesthesia time, American Society of Anesthesiologists physical status classification scores, change in body temperature, anesthetic complication rate, and mortality were not significantly different between urine toxicology positive and negative patients. Of note, a significantly lower proportion of the urine toxicology positive patients were extubated postoperatively in comparison to urine toxicology negative patients (57.32% vs 63.83%). Conclusions. Trauma patients who presented with a positive urine toxicology screening are not at an increased risk for intraoperative anesthetic complications compared to those with a negative urine toxicology screening. However, our results indicated that the need for postoperative mechanical ventilation increased in the acutely intoxicated trauma patients when compared to those without preinjury intoxication.

Suprafascial Harvest of the Radial Forearm Free Flap Decreases the Risk of Postoperative Tendon Exposure

2017 ◽  
Vol 126 (3) ◽  
pp. 224-228 ◽  
Author(s):  
David C. Shonka ◽  
Nikita V. Kohli ◽  
Benjamin M. Milam ◽  
Mark J. Jameson
Keyword(s):  
Free Flap ◽  
Donor Site ◽  
Retrospective Chart Review ◽  
Split Thickness Skin Graft ◽  
Radial Forearm Free Flap ◽  
Tourniquet Time ◽  
Exact Test ◽  
Harvest Technique ◽  
Thickness Skin ◽  
Radial Forearm

Objective: To determine if suprafascial harvest of the radial forearm free flap improves postoperative donor site outcomes compared to subfascial harvest. Methods: Retrospective chart review. Results: Forty-six patients underwent reconstruction of a head and neck defect with a radial forearm free flap (RFFF). Subfascial harvest of the RFFF was performed in 25 (53%) patients and suprafascial harvest performed in 22 (47%) patients. All donor sites were covered with a split thickness skin graft and a bolster that remained in place for 6 days. Postoperative tendon exposure at the donor site occurred in 5 (20%) of the patients in the subfascial group and in 0 (0%) of the patients in the suprafascial group ( P = .05; Fisher’s exact test). Average tourniquet time was 117 minutes in the subfascial group and 102 minutes in the suprafascial group. Hematoma formation occurred at the donor site in 2 (8%) and 1 (5%) patients in the subfascial and suprafascial groups, respectively. There were no complete or partial flap losses in either group. Conclusions: Suprafascial harvest of the RFFF decreases the risk of postoperative tendon exposure. The suprafascial harvest technique does not increase harvest time or donor site complications, nor does it negatively impact flap vascularity.

Sign in / Sign up

Export Citation Format

Share Document