Resurfacing in Facial Burn Sequelae Using Parascapular Free Flap: A Long-Term Experience

2021 ◽  
Author(s):  
Gurdyal Singh Kalra ◽  
Sushrut Kalra ◽  
Samarth Gupta
Keyword(s):  
Tissue Expansion ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Surrounding Tissue ◽  
Parascapular Flap ◽  
Surgical Options ◽  
High Level ◽  
Flap Cover ◽  
Facial Burn

Abstract Background It is difficult to treat large post burn sequelae (scars and defects) over face. Available methods include skin grafts, local flaps, tissue expansion, and free flaps. These surgical options should be chosen wisely, depending upon individual patient requirements and area involved. In patients with large post burn scars and defects in which the surrounding tissue is also involved, use of free tissue transfer is extremely useful. Patients and Methods A retrospective analysis was done between 2011 and 2019 of fifty-two cases with extensive facial burn deformities in whom secondary reconstruction was done with free parascapular flap cover in or department. Outcome was assessed by direct questionnaire. Results There was no complete flap loss in the series. Two cases were re-explored for venous insufficiency and suffered partial marginal necrosis. Twenty patients had to undergo further debulking procedure. Forty-seven patients were satisfied by the final outcome. Conclusion Post burn facial deformities are difficult to treat, in many cases there are no local options and tissue from different regions is to be used for reconstruction. Free parascapular flaps can be used as an effective method in such cases with a high level of patient satisfaction.

scholarly journals Reconstruction of scalp with local axial flaps

2020 ◽  
Vol 6 (9) ◽  
pp. 1692
Author(s):  
Saket Srivastava ◽  
Pradeep Gupta
Keyword(s):  
Tissue Expansion ◽  
Free Tissue Transfer ◽  
Healing Time ◽  
Surrounding Tissue ◽  
Surgical Reconstruction ◽  
Local Flaps ◽  
Transposition Flap ◽  
Scalp Reconstruction ◽  
Scalp Defects ◽  
Scalp Defect

<p><strong>Background:</strong> The scalp is a unique part of the human body and various etiological factors, such as tumour extirpation, infection, burns, or trauma, can lead to scalp defects. Primary closure, skin grafting, local flaps, tissue expansion or free tissue transfer are modalities available for scalp reconstruction. In this article, the authors share their institutional experience using various local flaps concerning the size, location, depth of defect and the quality of surrounding tissue.</p><p><strong>Methods:</strong> From September 2017 to January 2020, 54 patients underwent scalp reconstruction with local flaps for a defect size of 5 to 150 cm<sup>2</sup> in the department of plastic surgery, SMS medical college, Jaipur. Patients were identified by age, sex, cause of the scalp defect; the location, size, and depth of the defect; condition of surrounding tissue and the type of reconstruction done.</p><p><strong>Results:</strong> The most common cause of scalp defect was excision of malignant tumour (50%). Thirty patients had a large sized defect (40-90 cm<sup>2</sup>) and 28 patients had 90-150 cm<sup>2</sup> defects. Surgical reconstruction was done using local flaps, transposition flap was the most used in 36 patients (66.7%) followed by rotation advancement flap in 11 patients (20.4%). The recovery was relatively quick. Minor complications happened in 5 patients (9.3%) that were managed conservatively.</p><p><strong>Conclusions</strong>: In the present era of microsurgical reconstruction, local options as axial flaps provide a simpler and safer method of scalp reconstruction. A carefully planned scalp flap gives healthy, robust, hair-bearing tissue coverage and requires a shorter healing time for the patients.</p>

Reconstruction Using Free Flaps for Diabetic Heel Defects: Outcomes and Risk Factor Analysis

2020 ◽  
Vol 36 (07) ◽  
pp. 494-500
Author(s):  
Hyung Bae Kim ◽  
Mehmet Altiparmak ◽  
Changsik John Pak ◽  
Hyunsuk Peter Suh ◽  
Joon Pio Hong
Keyword(s):  
Risk Factors ◽  
Limb Salvage ◽  
Diabetic Foot ◽  
Critical Role ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Free Flaps ◽  
Surrounding Tissue ◽  
Foot Reconstruction ◽  
High Level

Abstract Background Overall success rate after diabetic foot reconstruction using free flap has been acceptable, but certain parts of the foot like the heel remains more challenging. Patients and Methods This retrospective study reviewed 37 patients reconstructed with free flaps for diabetic foot ulcer on the heel region from 2008 to 2017. Flap outcome in addition to various risk factors were analyzed; arterial status on heel, the American Society of Anesthesiologists (ASA) physical status, smoking, hypertension, hypercholesterolemia, chronic renal failure patient, hemoglobin A1c level, C-reactive protein, and osteomyelitis. Results Overall flap survival was 73% and resulted in limb salvage and functional ambulation. Total flap loss was 27% and the majority ended up with high-level amputation. Among the risk factors evaluated, the arterial status of the heel and ASA status significantly increased the odds for failure. When both arterial branches to the heel were impaired, the odds of failure were 80 times higher to fail (p< 0.05). Conclusion The vascularity of the surrounding tissue of the defect plays a critical role in overall success of diabetic heel reconstruction. Aggressive debridement using the angiosome concept is necessary to assure surrounding tissue has a good circulation. Despite the high chance of failure, success will lead to limb salvage and to reasonable functional ambulation whereas failure to salvage the heel will lead to higher level amputation. This warrants microsurgeons to make an effort to perform reconstruction to the heel defect after obtaining maximal vascularity after angioplasty.

scholarly journals Free flaps in scar treatment

2017 ◽  
Vol 2 (4) ◽  
pp. 203-209
Author(s):  
Peter M. Vogt ◽  
Seyed Arash Alawi ◽  
Ramin Ipaktchi
Keyword(s):  
Treatment Algorithm ◽  
Tissue Expansion ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Individual Case ◽  
Surgical Approaches ◽  
Radical Excision ◽  
Surgical Measures ◽  
Scar Management ◽  
The Individual

AbstractIntroduction:Scar management needs defined concepts and an algorithm to restore functional and aesthetic units. After an unsuccessful conservative treatment, surgical measures provide a vast spectrum of possibilities for remediation. The spectrum of possibilities consists of excision and Z-plasty, regional flaps, vascularized pedicled flaps, tissue expansion, and finally free tissue transfer. Severe scarring and highly destructed tissues with inferior functional and aesthetic units can be effectively treated with radical excision and free flap reconstruction. The complexity of flap architecture and tissue qualities allows for an individualized approach. Specific attention should be paid to the long-term consequences of severe scarring with progressive loss of functionality.Materials and methods:We worked out the most common surgical approaches and treatment algorithm for a stepwise and effective approach. Part of this algorithm is a seven-step surgical approach.Results:This article provides modern plastic and reconstructive surgery concepts with an algorithm for scar management.Discussion:The treatment of scars follows an algorithm with the level of complexity of techniques adjusted to the individual case and the conditions. Disabilities induced by scarring can lead to further functional loss. In these cases, surgical strategies have to be considered.

scholarly journals Flap Decisions and Options in Soft Tissue Coverage of the Upper Limb

2014 ◽  
Vol 8 (1) ◽  
pp. 409-414 ◽  
Author(s):  
Michelle Griffin ◽  
Sandip Hindocha ◽  
Marco Malahias ◽  
Mohamed Saleh ◽  
Ali Juma
Keyword(s):  
Soft Tissue ◽  
Upper Limb ◽  
Free Flap ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Careful Consideration ◽  
Surrounding Tissue ◽  
Soft Tissue Coverage ◽  
Scapular Flap ◽  
Radial Forearm

Soft tissue deficiency in the upper limb is a common presentation following trauma, burns infection and tumour removal. Soft tissue coverage of the upper limb is a challenging problem for reconstructive surgeons to manage. The ultimate choice of soft tissue coverage will depend on the size and site of the wound, complexity of the injury, status of surrounding tissue, exposure of the vital structures and health status of the patient. There are several local cutaneous flaps that provide adequate soft tissue coverage for small sized defects of the hand, forearm and arm. When these flaps are limited in their mobility regional flaps and free flaps can be utilised. Free tissue transfer provides vascularised soft tissue coverage in addition to the transfer of bone, nerve and tendons. Careful consideration of free flap choice, meticulous intraoperative dissection and elevation accompanied by post-operative physiotherapy are required for successful outcomes for the patient. Several free flaps are available for reconstruction in the upper limb including the groin flap, anterolateral flap, radial forearm flap, lateral arm flap and scapular flap. In this review we will provide local, regional and free flap choice options for upper limb reconstruction, highlighting the benefits and challenges of different approaches.

Vivid Imagers Are Better at Detecting Salient Changes

2006 ◽  
Vol 27 (4) ◽  
pp. 218-228 ◽  
Author(s):  
Paul Rodway ◽  
Karen Gillies ◽  
Astrid Schepman
Keyword(s):  
Individual Differences ◽  
Change Detection ◽  
Visual Imagery ◽  
Detection Task ◽  
Level Of Detail ◽  
Detection Accuracy ◽  
Change Detection Task ◽  
Term Change ◽  
High Level

This study examined whether individual differences in the vividness of visual imagery influenced performance on a novel long-term change detection task. Participants were presented with a sequence of pictures, with each picture and its title displayed for 17  s, and then presented with changed or unchanged versions of those pictures and asked to detect whether the picture had been changed. Cuing the retrieval of the picture's image, by presenting the picture's title before the arrival of the changed picture, facilitated change detection accuracy. This suggests that the retrieval of the picture's representation immunizes it against overwriting by the arrival of the changed picture. The high and low vividness participants did not differ in overall levels of change detection accuracy. However, in replication of Gur and Hilgard (1975) , high vividness participants were significantly more accurate at detecting salient changes to pictures compared to low vividness participants. The results suggest that vivid images are not characterised by a high level of detail and that vivid imagery enhances memory for the salient aspects of a scene but not all of the details of a scene. Possible causes of this difference, and how they may lead to an understanding of individual differences in change detection, are considered.

Custom Presurgical Planning for Midfacial Reconstruction

2020 ◽  
Vol 36 (06) ◽  
pp. 696-702
Author(s):  
Nolan B. Seim ◽  
Enver Ozer ◽  
Sasha Valentin ◽  
Amit Agrawal ◽  
Mead VanPutten ◽  
...  
Keyword(s):  
Multidisciplinary Approach ◽  
Functional Performance ◽  
Three Dimensional ◽  
Free Tissue Transfer ◽  
Long Term Effects ◽  
Presurgical Planning ◽  
Dental Rehabilitation ◽  
Midface Reconstruction ◽  
Reconstructive Algorithm

AbstractResection and reconstruction of midface involve complex ablative and reconstructive tools in head and oncology and maxillofacial prosthodontics. This region is extraordinarily important for long-term aesthetic and functional performance. From a reconstructive standpoint, this region has always been known to present challenges to a reconstructive surgeon due to the complex three-dimensional anatomy, the variable defects created, combination of the medical and dental functionalities, and the distance from reliable donor vessels for free tissue transfer. Another challenge one faces is the unique features of each individual resection defect as well as individual patient factors making each preoperative planning session and reconstruction unique. Understanding the long-term effects on speech, swallowing, and vision, one should routinely utilize a multidisciplinary approach to resection and reconstruction, including head and neck reconstructive surgeons, prosthodontists, speech language pathologists, oculoplastic surgeons, dentists, and/or craniofacial teams as indicated and with each practice pattern. With this in mind, we present our planning and reconstructive algorithm in midface reconstruction, including a dedicated focus on dental rehabilitation via custom presurgical planning.

scholarly journals Long-term results of microvascular free-tissue transfer reanimation of the paralyzed face: Three cases

2008 ◽  
Vol 87 (4) ◽  
pp. 226-233
Author(s):  
John P. Leonetti ◽  
Chad A. Zender ◽  
Daryl Vandevender ◽  
Sam J. Marzo
Keyword(s):  
Facial Nerve ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Free Tissue Transfer ◽  
Long Term Results ◽  
Wide Field ◽  
Facial Movement ◽  
Tissue Transfer ◽  
Facial Reanimation

We conducted a retrospective case review at our tertiary care academic medical center to assess the long-term results of microvascular free-tissue transfer to achieve facial reanimation in 3 patients. These patients had undergone wide-field parotidectomy with facial nerve resection. Upper facial reanimation was accomplished with a proximal facial nerve–sural nerve graft, and lower facial movement was achieved through proximal facial nerve–long thoracic (serratus muscle) nerve anastomosis. Outcomes were determined by grading postoperative facial nerve function according to the House-Brackmann system. All 3 patients were able to close their eyes independent of lower facial movement, and all 3 had achieved House-Brackmann grade III function. We conclude that reanimating the paralyzed face with microvascular free-tissue transfer provides anatomic coverage and mimetic function after wide-field parotidectomy. Synkinesis is reduced by separating upper-and lower-division reanimation.

scholarly journals Free Tissue Transfer in Pressure Ulcer Reconstruction: A Systematic Review

2021 ◽  
Vol 06 (01) ◽  
pp. e35-e39
Author(s):  
Chelsi Robertson ◽  
Charles Patterson ◽  
Hugo St. Hilaire ◽  
Frank H. Lau
Keyword(s):  
Systematic Review ◽  
English Language ◽  
Free Tissue Transfer ◽  
Free Flaps ◽  
Final Analysis ◽  
The United States ◽  
Local Flap ◽  
Recurrence Rates ◽  
Tissue Transfer ◽  
Cochrane Database

Abstract Background Pressure ulcers (PUs) affect 2.5 million people in the United States annually and incur health-care costs of 11 billion dollars annually. Stage III/IV PU often require local flap reconstruction. Unfortunately, PU recurrence is common following reconstruction; recurrence rates as high as 82% have been reported. When local flap options are inadequate, free tissue transfer may be indicated but the indications have yet to be delineated. To develop evidence-based guidelines for the use of free flaps in PU reconstruction, we performed a systematic review. Methods A systematic review of the available English-language, peer-reviewed literature was conducted using PubMed/MEDLINE, Google Scholar, Scopus, EMBASE, and the Cochrane Database of Systematic Reviews. Articles were manually reviewed for relevance. Results Out of 272 articles identified, 10 articles were included in the final analysis. Overall, this systematic review suggests that free-flap PU reconstruction yields fewer recurrences compared with local flaps (0–20 vs. 13–82%). Further, several types of free flaps for PU reconstruction were identified in this review, along with their indications. Conclusion Free tissue transfer should be considered for recurrent PU. We offer specific recommendations for their use in PU reconstruction.

scholarly journals Review on Perioperative and Oncological Outcomes of Robotic Gastrectomy for Cancer

2021 ◽  
Vol 11 (7) ◽  
pp. 638
Author(s):  
Giuseppe Giuliani ◽  
Francesco Guerra ◽  
Lorenzo De Franco ◽  
Lucia Salvischiani ◽  
Roberto Benigni ◽  
...  
Keyword(s):  
English Language ◽  
Length Of Hospital Stay ◽  
Radical Gastrectomy ◽  
Robotic Gastrectomy ◽  
Relevant Evidence ◽  
Relative Paucity ◽  
Duration Of Surgery ◽  
High Level ◽  
Standard Laparoscopic Surgery

Background. Minimally invasive gastrectomy is currently considered a valid option to treat gastric cancer and is gaining increasing acceptance. Recent reports have suggested that the application of robots may confer some advantages over conventional laparoscopy, but the role of robotic surgery in clinical practice is still uncertain. We aimed to critically review the relevant evidence comparing robotic to standard laparoscopic surgery in performing radical gastrectomy. Methods. The Pubmed/Medline electronic databases were searched through February 2021. Paper conference and the English language was the only restriction applied to our search strategy. Results. According to the existing data, robotic gastrectomy seems to provide some benefits in terms of blood loss, rate of conversion, procedure-specific postoperative morbidity, and length of hospital stay. Robotic gastrectomy is also associated with a longer duration of surgery and a higher economic burden as compared to its laparoscopic counterpart. No significant differences have been disclosed in terms of long-term survivals, while the number of lymph nodes retrieved with robotic gastrectomy is generally higher than that of laparoscopy. Conclusions. The current literature suggests that robotic radical gastrectomy appears as competent as the conventional laparoscopic procedure and may provide some clinical advantages. However, due to the relative paucity of high-level evidence, it is not possible to draw definitive conclusions.

scholarly journals Mapping of affordability levels for photovoltaic-based electricity generation in the solar belt of sub-Saharan Africa, East Asia and South Asia

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sándor Szabó ◽  
Irene Pinedo Pascua ◽  
Daniel Puig ◽  
Magda Moner-Girona ◽  
Mario Negre ◽  
...  
Keyword(s):  
East Asia ◽  
South Asia ◽  
Electricity Generation ◽  
Sub Saharan Africa ◽  
Solar Photovoltaic ◽  
Term Operation ◽  
Sub Saharan ◽  
High Level ◽  
Do So

AbstractLack of access to modern forms of energy hampers efforts to reduce poverty. The provision of electricity to off-grid communities is therefore a long-standing developmental goal. Yet, many off-grid electrification projects neglect mid- and long-term operation and maintenance costs. When this is the case, electricity services are unlikely to be affordable to the communities that are the project’s primary target. Here we show that, compared with diesel-powered electricity generation systems, solar photovoltaic systems are more affordable to no less than 36% of the unelectrified populations in East Asia, South Asia, and sub-Saharan Africa. We do so by developing geo-referenced estimates of affordability at a high level of resolution (1 km2). The analysis illustrates the differences in affordability that may be found at the subnational level, which underscores that electrification investments should be informed by subnational data.

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