Pedicle complex tissue flap transfer for reconstruction of duplicated thumbs with unequal size

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.

Download Full-text

Microsurgery in the Sickle Cell Trait Population: Is It Actually Safe?

Surgical Case Reports ◽

10.31487/j.scr.2020.04.02 ◽

2020 ◽

pp. 1-2

Author(s):

Michael Alperovich ◽

Eric Park ◽

Michael Alperovich ◽

Omar Allam ◽

Paul Abraham

Keyword(s):

Sickle Cell Disease ◽

Sickle Cell ◽

Free Flap ◽

Near Infrared ◽

Sickle Cell Trait ◽

Cell Disease ◽

Flap Transfer ◽

Free Flap Transfer ◽

Patient Reported ◽

Deep Inferior Epigastric Perforator

Although sickle cell disease has long been viewed as a contraindication to free flap transfer, little data exist evaluating complications of microsurgical procedures in the sickle cell trait patient. Reported is the case of a 55-year-old woman with sickle cell trait who underwent a deep inferior epigastric perforator (DIEP) microvascular free flap following mastectomy. The flap developed signs of venous congestion on postoperative day two but was found to have patent arterial and venous anastomoses upon exploration in the operating room. On near-infrared indocyanine green angiography, poor vascular flow was noted despite patent anastomoses and strong cutaneous arterial Doppler signals. Intrinsic microvascular compromise or sickling remains a risk in the sickle cell trait population as it does for the sickle cell disease population. Just like in sickle cell disease patients, special care should be taken to optimize anticoagulation and minimize ischemia-induced sickling for patients with sickle cell trait undergoing microsurgery.

Download Full-text

Evidence of Browning of White Adipocytes in Poorly Survived Fat Grafts in Patients

Aesthetic Surgery Journal ◽

10.1093/asj/sjab165 ◽

2021 ◽

Author(s):

Tong Liu ◽

Su Fu ◽

Qian Wang ◽

Hao Cheng ◽

Dali Mu ◽

...

Keyword(s):

Gene Expression ◽

Uncoupling Protein ◽

Fold Increase ◽

Fat Grafting ◽

Electronic Microscopy ◽

Uncoupling Protein 1 ◽

Fat Transfer ◽

Flap Transfer ◽

Fat Grafts ◽

White Adipocytes

Abstract Background Browning adipocytes induced by burn and cancer were assumed less viable and more prone to necrosis for their hypermetabolic properties. Recent studies have shown browning of white adipose after fat engraftment in mice. Objectives We tend to evaluate whether fat transfer could induce browning biogenesis in fat grafts in humans and if it is associated with graft necrosis. Methods Necrotic adipose grafts were excised from 11 patients diagnosed with fat necrosis after fat grafting or flap transfer. Non-necrotic fat grafts were from 5 patients undergoing revisionary surgeries after flap transfer. Histology and electronic microscopy, protein and gene expression of browning related marker analyses were performed. Results Fat grafts with necrosis demonstrated a higher gene expression level of uncoupling protein-1 (>5-fold increase, **p<0.01), a master beige adipocyte marker, than non-necrotic fat grafts. Electronic microscopy and histology showed that browning adipocytes were presented in necrotic adipose in patients. Conclusions Fat transfer induced browning adipocytes in patients and was evident in patients with post grafting necrosis.

Download Full-text