Management of Flap Necrosis in Cochlear Implantation

1992 ◽  
Vol 101 (1) ◽  
pp. 38-41 ◽  
Author(s):  
Thomas J. Haberkamp ◽  
Mitchell K. Schwaber
Keyword(s):  
Cochlear Implantation ◽  
Skin Flap ◽  
Surgical Techniques ◽  
Electrode Array ◽  
Skin Flaps ◽  
Flap Necrosis ◽  
Healthy Skin ◽  
Local Skin ◽  
Cochlear Implant Surgery

Skin flap complications are the most commonly reported problems in cochlear implant surgery when the anteriorly based C-shaped flap is used for the incision. If the prosthesis is exposed by flap necrosis, local skin flaps may be used to obtain coverage. Unfortunately, the long-term viability of such flaps may be compromised by the pressure exerted by the transmitter. Two cases of flap necrosis severe enough to expose the prosthesis have been successfully managed by relocating the device to a position superior to the auricle, under healthy skin. In one case the receiver was removed owing to infection and reimplanted at a later date. In this case, the electrode array was left in place at explantation in order to stent the cochlea. The surgical techniques and flap designs for this procedure are presented. No further surgical complications have developed in either case. The devices are performing well for both patients at this time. We have found relocation of the implant a useful technique in the management of major flap necrosis. This technique may also be useful to prevent flap necrosis should excessive flap thinning occur during the implant operation.

A Model for Training in Elevation of Local Skin Flaps in the Hand

1994 ◽  
Vol 19 (6) ◽  
pp. 794-795 ◽  
Author(s):  
H. D. SKOFF
Keyword(s):  
Skin Flap ◽  
Three Dimensional ◽  
Skin Flaps ◽  
Dimensional Model ◽  
Surgical Experience ◽  
Three Dimensional Model ◽  
Local Skin ◽  
Practice Models ◽  
Flap Design

Appropriate skin flap design is crucial for success in surgery of the hand. Practice models are useful in acquiring surgical experience. The author describes a three-dimensional model composed of readily available materials which has been useful for practice in elevation of local skin flaps in the hand

scholarly journals Standard Programming of Retrograde Electrode Insertion via Middle-Turn Cochleostomy in Labyrinthitis Ossificans

2020 ◽  
pp. 014556132097486
Author(s):  
Mounika Reddy Y ◽  
Anjali Lepcha ◽  
Ann Mary Augustine ◽  
Ajay Philip ◽  
Philip Thomas
Keyword(s):  
Patient Preference ◽  
Cochlear Implantation ◽  
Surgical Techniques ◽  
Electrode Array ◽  
Labyrinthitis Ossificans ◽  
Electrode Insertion

Successful cochlear implantation in the setting of labyrinthitis ossificans is challenging. Various surgical techniques are described to circumvent the region of ossification and retrograde insertion of the electrode array is one such option. While reverse programming is often recommended in the case of retrograde electrode insertion, we present our experience of retrograde electrode insertion for labyrinthitis ossificans, where standard programming was adopted due to patient preference and provided satisfactory outcomes.

scholarly journals The First Stage of Acquired Syndactyly Reconstruction - A Rare Case Report

2022 ◽  
Vol 12 (1) ◽  
pp. 87-91
Author(s):  
Lucretya Yeniwati Tanuwijaya ◽  
Agus Roy Rusly Hariantana Hamid ◽  
I Gusti Putu Hendra Sanjaya
Keyword(s):  
Case Report ◽  
Skin Graft ◽  
Skin Flap ◽  
Donor Site ◽  
Surgical Techniques ◽  
Operation Time ◽  
Donor Site Morbidity ◽  
Reconstruction Procedure ◽  
Local Skin ◽  
And Function

Background: Acquired syndactyly is a very rare disorder on the interdigital area. Syndactyly with only soft tissue involvement can be a sequela of trauma, such as burn, inflammation or infection in the interdigital area, resulting in bony fusion following crush injury. Case Report: An 8-year-old boy came to our department with fusion from the base to the tip of the first to fourth right toes since the accidental step on burnt plastic 5 years ago. He complained of a poor appearance and discomfort when walking. Then we performed zigzag incision for first to second toes and third to fourth toes. Skin graft closure was performed to cover the defect on third to fourth toes. The second reconstruction surgery will be scheduled 6 months later. Discussion: The surgical techniques for foot syndactyly were derived from those for hand syndactyly, which are to separate the digital fusion by creating local skin flap. Additionally, skin graft might be necessary when recent surgeons avoid the use of skin graft for open treatment, primary closure by defatting, or intricate local flaps. These can shorten the operation time and minimize donor site morbidity. However, surgeons should consider the free tension closure of the wound by combining the skin graft after the flap. Conclusion: Reconstruction procedure for foot syndactyly aims to improve the appearance and function of the toes as well as to avoid progressive deformity through development. The skin graft addition in combination of skin flap shows promising outcome. Key words: acquired syndactyly, syndactyly reconstruction, zigzag flap, skin graft.

scholarly journals Capsaicin on the viability of random-pattern skin flaps in rats

2010 ◽  
Vol 25 (5) ◽  
pp. 440-443 ◽  
Author(s):  
Gustavo Roberto de Godoy ◽  
Richard Eloin Liebano ◽  
Juliana Barbosa Corrêa ◽  
Bernardo Hochman ◽  
Lydia Masako Ferreira
Keyword(s):  
Surgical Procedure ◽  
Wistar Rats ◽  
Skin Flap ◽  
Donor Site ◽  
Control Group ◽  
Random Pattern ◽  
Skin Flaps ◽  
Flap Necrosis ◽  
Group A

PURPOSE: To evaluate the effects of capsaicin on the viability of ischemic random-pattern skin flaps in rats. METHODS:Forty EPM1-Wistar rats were randomized into two groups of 20 animals each, the capsaicin group and the control group. A random-pattern skin flap measuring 10 x 4cm was raised and a plastic barrier was placed between the flap and the donor site. After the surgical procedure, the control group was treated with an inert vehicle in the form of a cream applied uniformly to a rayon bandage which, in turn, was applied to the surface of the skin flap. The capsaicin group was treated in the same way, but in this case capsaicin was added to the cream. This procedure was repeated for two consecutive days. RESULTS: There was a significantly smaller amount of flap necrosis in the capsaicin group (35.07%) than in the control group (44.75%) (p=0.035). CONCLUSION:Topical administration of capsaicin improved the viability of ischemic random-pattern skin flaps in rats.

scholarly journals Cochlear Implant Surgical Technique: Our Experience

2018 ◽  
Vol 01 (01) ◽  
pp. 007-010
Author(s):  
Milind Kirtane ◽  
Kashmira Chavan
Keyword(s):  
Surgical Technique ◽  
Cochlear Implant ◽  
Cochlear Implantation ◽  
Electrode Array ◽  
Surgical Approaches ◽  
Implant Surgery ◽  
Original Technique ◽  
Cortical Mastoidectomy ◽  
Cochlear Implant Surgery ◽  
Posterior Tympanotomy

Abstract Introduction Different surgical approaches have been adopted for cochlear implantation, with cortical mastoidectomy–posterior tympanotomy being the most commonly followed technique. Method In this article, we describe the surgical technique for cochlear implant followed at our center, which has been successfully implemented in more than 2,500 cochlear implant surgeries. Cochlear implant surgery using the cortical mastoidectomy–posterior tympanotomy technique has been performed in more than 2,500 cases with some modifications to the original technique over a period of time. Results In spite of not using tie-down holes and securing down the receiver–stimulator with sutures, no cases of receiver–stimulator displacement or outward electrode migration have been noted with the current technique of creating a snug-fitting subperiosteal pocket along with a hook for the electrode array. Conclusion Adhering to a strict intraoperative surgical protocol plays an extremely important role in carrying out successful cochlear implant surgeries with minimal complications.

Phalloplasty With a Free Scapular Flap Improves Postoperative Sensation in Penile Reconstruction

2021 ◽  
pp. 229255032110555
Author(s):  
Qi Wu ◽  
Zhe Yang ◽  
Ning Ma ◽  
Weixin Wang ◽  
Yangqun Li
Keyword(s):  
Patient Reported Outcomes ◽  
Donor Site ◽  
Surgical Techniques ◽  
Flap Necrosis ◽  
Patient Reported ◽  
Sensory Recovery ◽  
Scapular Flap ◽  
Residual Tissue ◽  
Patients Experience

Objective We aimed to evaluate both the long-term surgical outcomes and patient-reported outcomes of free scapular flap (FSF) phalloplasty. MethodThe same surgical team performed phalloplasty in 66 patients using a FSF between March 2000 and September 2018. All patients had at least 24 months of follow-up. The surgical techniques used, complications observed, and surgical and patient-reported outcomes were retrospectively described. ResultA total of 66 patients with indications of penile trauma (n = 19), micropenis (n = 42), and self-amputation (n = 5) underwent FSF phalloplasty. Two patients (3%) had total flap necrosis and 1 (1.5%) had partial flap necrosis. The urethral complication rate was 18.2% (12/66 patients). All patients were able to void while standing after revision procedures or urethroplasty. We found that an FSF is a reliable donor site for penile reconstruction.ConclusionThe FSF phalloplasty creates an esthetically pleasing penis and allows voiding while standing. Most patients can engage in sexual activity. The main drawbacks of using this method are that patients experience different degrees of sensory recovery, and patients undergoing surgery with the “tube-in-tube” technique may find they are be limited by the thickness of the flap. However, by making full use of residual tissue, such as the micropenis glans or scrotal skin, patients can obtain good tactile and erogenous sensation. We believe that using an FSF complements the existing phalloplasty techniques.

Another reason for intra-operative imaging during cochlear implantation

2008 ◽  
Vol 122 (4) ◽  
Author(s):  
M Viccaro ◽  
E De Seta ◽  
E Covelli ◽  
V Marvaso ◽  
R Filipo
Keyword(s):  
Cochlear Implant ◽  
Semicircular Canal ◽  
Cochlear Implantation ◽  
Electrode Array ◽  
Neural Response ◽  
Radiological Assessment ◽  
Implant Surgery ◽  
Stimulation Intensity ◽  
Cochlear Implant Surgery ◽  
The Right

AbstractObjective:We report a case of a rare cochlear implant complication: the introduction of the electrode array into the superior semicircular canal, with intra-operative measurements of neural response reactions suggesting reasonable functioning of the implant.Case report:A two-year old patient affected by congenital, profound, sensorineural deafness underwent bilateral cochlear implantation at the ENT clinic of the ‘La Sapienza’ University of Rome. Two Clarion 90k devices were implanted, and electrophysiological and radiological checks were performed. After the introduction of the array in the right side, neural response imaging was performed, and a neural potential was found only on two apical electrodes, at a stimulation intensity of 431 clinical units. The situation differed on the left side, where neural response imaging was present at a stimulation intensity of 300 clinical units on the two electrodes tested (one apical electrode (number three), and one middle electrode (number nine)). Intra-operative radiological assessment with a transorbital plain films was performed as usual in order to assess the position of the electrodes inside the cochlea. This radiography showed the electrode array to be in the superior semicircular canal in the right ear.Conclusion:Intra-operative monitoring tests during cochlear implant surgery play different roles; measurement of impedances and neural response imaging can evaluate the integrity of implant electrodes and the status of the electrode–cochlea interface, but it must not be the sole way in which correct positioning of the array is confirmed. In our opinion, intra-operative radiological assessment is mandatory during cochlear implant surgery.

scholarly journals Intraoperative Perfusion Assessment in Mastectomy Skin Flaps: How Close are We to Preventing Complications?

2019 ◽  
Vol 35 (07) ◽  
pp. 471-478 ◽  
Author(s):  
Nima Khavanin ◽  
Cecil Qiu ◽  
Halley Darrach ◽  
Franca Kraenzlin ◽  
George Kokosis ◽  
...  
Keyword(s):  
Skin Flap ◽  
Future Research ◽  
Skin Flaps ◽  
Review Of The Literature ◽  
Flap Necrosis ◽  
Perfusion Assessment ◽  
Considerable Morbidity ◽  
Mastectomy Flap ◽  
Flap Perfusion ◽  
Time Assessment

Abstract Background Mastectomy flap necrosis is the source of considerable morbidity and cost following breast reconstruction. A great deal of effort has been put forth to predicting and even preventing its incidence intraoperatively. Methods A review of the literature was performed evaluating the evidence of mastectomy skin flap perfusion technologies. Results Multiple technologies have leveraged spectroscopy and/or angiography to provide real-time assessment of flap perfusion, including indocyanine green, fluorescein, and light-based devices. Conclusion This manuscript endeavors to review the evidence on mastectomy skin flap perfusion analysis, highlighting the benefits, and downsides of the current technologies and identifying exciting areas of future research and development.

Skin flaps

2021 ◽  
pp. 39-50
Author(s):  
Donald Dewar
Keyword(s):  
Blood Supply ◽  
Subcutaneous Tissue ◽  
Skin Flap ◽  
Donor Site ◽  
Pedicled Flap ◽  
Local Flaps ◽  
Skin Flaps ◽  
Local Skin ◽  
Recipient Vessel ◽  
Composite Defect

Flaps can reconstruct defects of the integument, resurface mucosal defects, as well as contribute to contour. They are used where grafting is not feasible because of the nature of the defect and/or where the aims of reconstruction would be better served by vascularized tissue with both cutaneous and subcutaneous components. A skin flap can also be combined with fascia, muscle, or bone to reconstruct a complex or composite defect, and to provide tissue to restore function. Flaps may be classified according to the origin of the flap: local skin flaps are raised from tissue adjacent to the defect (usually deriving their blood supply from the subcutaneous tissue and subdermal plexus), and distant flaps are raised on dedicated vascular pedicles from a non-contiguous region. A distant flap may be moved to the defect maintaining the continuity of the pedicle (a ‘regional’ or ‘pedicled’ flap) or as a free flap, where the flap is elevated from its remote donor site and the pedicle is divided to allow the flap to be transported ‘free’ to the defect and then the vascular continuity is re-established by anastomosis to a recipient vessel in the defect. This chapter focuses on local flaps.

Long-term results of cochlear implantation in children

2005 ◽  
Vol 132 (3) ◽  
pp. 456-458 ◽  
Author(s):  
JAN Haensel ◽  
Jan-Christian Engelke ◽  
Wiebke Ottenjann ◽  
Martin Westhofen
Keyword(s):  
Psychosocial Development ◽  
Cochlear Implantation ◽  
Surgical Techniques ◽  
University Hospital ◽  
Long Term Results ◽  
Deaf Children ◽  
Test Results ◽  
Speech Test ◽  
Prelingually Deaf

OBJECTIVES: Since the first implantation of a multichannel cochlear implant over 15 years ago there have been improvements in implant devices, surgical techniques, speech coding strategies and rehabilitation matters. There also have been concerns, whether the first implanted systems are stable and the benefit for the patients is constant over a long time. This study analyzes long-term results of prelingually deaf children who were implanted at Aachen University Hospital. STUDY DESIGN AND SETTING: We examined 16 prelingually deaf children, who underwent cochlear implantation at our department between 1990 and 1993 over a time period of 10 to 13 years. The indication, perioperative complications, technical parameters, speech test results as well as the psychosocial development of the children were analyzed. A questionnaire containing questions about the daily use, expectations and the personal evaluation of the procedure was sent to all patients. RESULTS: The mean age of all patients was 9 years at time of implantation. In two cases we saw postoperative complications which needed an intervention. The speech test results remained stable after reaching a plateau after 5 years. Eighty-eight percent of all patients would undergo the procedure again and 94% would recommend cochlear implantation to others. CONCLUSION: Cochlear implantation in cases of prelingual deafness is feasible without severe complications and leads to an increasing quality of life demonstrated by long-term observation.

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