Prospective, Randomized, Controlled Comparison of Bupivacaine versus Liposomal Bupivacaine for Pain Management after Unilateral Delayed Deep Inferior Epigastric Perforator Free Flap Reconstruction

Introduction: Poland syndrome is a rare, challenging combination of chest wall and breast deformities for reconstructive surgeons and selecting the treatment can prove difficult. This study aims to help surgeons in choosing the best viable option for treatment by sharing our institutional experience and proposing a guiding algorithm. Methods: A retrospective analysis of all patients with Poland syndrome undergoing treatment for breast and chest wall deformities at a single institution between December 2011 and May 2020 was performed. Medical charts were reviewed to allow for a description of patient demographics, treatment modalities and complications. A treatment algorithm to aid in selecting the adequate reconstructive option based on our institutional experience was formulated. Results: A total of 22 patients (six male, 16 female) were identified who received treatment for Poland Syndrome related deformities. Nine received microsurgical free flap reconstruction (three Deep Inferior Epigastric Perforator flaps, six Transverse Myocutaneous Gracilis flaps), two received reconstruction with a local flap (two Latissimus dorsi flaps), nine received implant based reconstruction, and two were treated with autologous free fat transfer only (17 in combination with other surgical methods). Conclusion: Free flap reconstruction with the TMG flap is a valid option for patients with low Body Mass Index (BMI), while Deep Inferior Epigastric Perforator flaps should be considered for patients with a higher BMI. Autologous free fat transfer proves to be a safe and efficient treatment option in mild cases of Poland syndrome for male and female patients, in combination with or without implant based reconstructive surgery. Multicentre studies should be conducted to achieve higher case numbers of this rare disease and support clinical decisions with more data.

Download Full-text

“Is dangling of the lower leg after a free flap reconstruction necessary? A study protocol for a large multicenter randomized controlled study.”

10.21203/rs.2.9340/v2 ◽

2019 ◽

Author(s):

David D. Krijgh ◽

Teun Teunis ◽

Pascal P.A. Schellekens ◽

Marc M.A. Mureau ◽

Antonius J.M. Luijsterburg ◽

...

Keyword(s):

Free Flap ◽

Primary Outcome ◽

Lower Leg ◽

Controlled Study ◽

Postoperative Phase ◽

Flap Reconstruction ◽

Infection Rates ◽

Free Flap Reconstruction ◽

Randomized Controlled ◽

Multicenter Randomized Controlled Trial

Abstract Background: Within the field of plastic surgery free tissue transfer is common practice for knee and lower leg defects. Usually, after such free flap reconstruction patients undergo a dangling protocol in the postoperative phase. A dangling protocol is designed to gradually subject the free flap to increased venous pressure resulting from gravitational forces. Worldwide there are multiple variations of dangling protocols. However, there is no evidence available in the literature that supports the use of a dangling protocol. Methods: This is a multicenter randomized controlled trial that includes patients with a free flap lower leg reconstruction. The primary outcome is to assess whether a no-dangling protocol is not inferior to a dangling protocol in terms of proportion of partial flap loss, six months after surgery. Secondary objectives are to identify differences in major and minor complications, length of stay, costs, and to objectify blood gaseous changes during dangling. Furthermore, at 2 years we will assess difference in physical function, infection rates and osseous union rates. Discussion: The primary outcome of this study will give a more decisive answer to the question whether a dangling protocol is necessary after a free flap reconstruction of the lower leg. The secondary outcomes of this study will provide a better insight into the physical functions, infection rates and union rates in these patients. Trial registration: Registered at the CCMO (Dutch Medical Research Ethics Commission) in the Netherlands on 11 July 2018: NL63146.041.17. Registered with the Dutch Trial Register (registration number NTR 7545).

Download Full-text

Is dangling of the lower leg after a free flap reconstruction necessary? Study protocol for a large multicenter randomized controlled study

Trials ◽

10.1186/s13063-019-3665-0 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

David D. Krijgh ◽

Teun Teunis ◽

Pascal P. A. Schellekens ◽

Marc A. M. Mureau ◽

Antonius J. M. Luijsterburg ◽

...

Keyword(s):

Free Flap ◽

Primary Outcome ◽

Lower Leg ◽

Controlled Study ◽

Postoperative Phase ◽

Flap Reconstruction ◽

Infection Rates ◽

Free Flap Reconstruction ◽

Randomized Controlled ◽

Multicenter Randomized Controlled Trial

Abstract Background Within the field of plastic surgery, free tissue transfer is common practice for knee and lower leg defects. Usually, after such free flap reconstruction, patients undergo a dangling protocol in the postoperative phase. A dangling protocol is designed to gradually subject the free flap to increased venous pressure resulting from gravitational forces. Worldwide there are multiple variations of dangling protocols. However, there is no evidence available in the literature that supports the use of a dangling protocol. Methods This is a multicenter randomized controlled trial that includes patients with a free flap lower leg reconstruction. The primary outcome is to assess whether a no-dangling protocol is not inferior to a dangling protocol, in terms of proportion of partial flap loss, 6 months after surgery. Secondary objectives are to identify differences in major and minor complications, length of stay, and costs, and to objectify blood gaseous changes during dangling. Furthermore, at 2 years we will assess difference in physical function, infection rates, and osseous union rates. Discussion The primary outcome of this study will give a more decisive answer to the question of whether a dangling protocol is necessary after a free flap reconstruction of the lower leg. The secondary outcomes of this study will provide a better insight into the physical functions, infection rates, and union rates in these patients. Trial registration Central Committee on Research Involving Human Subjects (CCMO), NL63146.041.17. Registered on 11 July 2018. Netherlands Trial Register, NTR7545. Registered on 10 October 2018.

Download Full-text

Is dangling of the lower leg after a free flap reconstruction necessary? A large multicenter randomized controlled study.

10.21203/rs.2.9340/v1 ◽

2019 ◽

Author(s):

David D. Krijgh ◽

Teun Teunis ◽

Pascal P.A. Schellekens ◽

Marc M.A. Mureau ◽

Antonius J.M. Luijsterburg ◽

...

Keyword(s):

Free Flap ◽

Primary Outcome ◽

Lower Leg ◽

Controlled Study ◽

Postoperative Phase ◽

Flap Reconstruction ◽

Infection Rates ◽

Free Flap Reconstruction ◽

Randomized Controlled ◽

Multicenter Randomized Controlled Trial

Abstract Background: Within the field of plastic surgery free tissue transfer is common practice for knee and lower leg defects. Usually, after such free flap reconstruction patients undergo a dangling protocol in the postoperative phase. A dangling protocol is designed to gradually subject the free flap to increased venous pressure resulting from gravitational forces. Worldwide there are multiple variations of dangling protocols. However, there is no evidence available in the literature that supports the use of a dangling protocol. Methods: This is a multicenter randomized controlled trial that includes patients with a free flap lower leg reconstruction. The primary outcome is to assess whether a no-dangling protocol is not inferior to a dangling protocol in terms of proportion of partial flap loss, six months after surgery. Secondary objectives are to identify differences in major and minor complications, length of stay, costs, and to objectify blood gaseous changes during dangling. Furthermore, at 2 years we will assess difference in physical function, infection rates and osseous union rates. Discussion: The primary outcome of this study will give a more decisive answer to the question whether a dangling protocol is necessary after a free flap reconstruction of the lower leg. The secondary outcomes of this study will provide a better insight into the physical functions, infection rates and union rates in these patients. Trial registration: Registered at the CCMO (Dutch Medical Research Ethics Commission) in the Netherlands on 11 July 2018: NL63146.041.17. Registered with the Dutch Trial Register (registration number NTR 7545).

Download Full-text