vascular pedicle
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2021 ◽  
Vol 5 (4) ◽  
pp. 09-12
Author(s):  
Solomon Bekele Abebe ◽  
◽  
Yonas Ademe Teferi ◽  
Henok T/Silassie Zeleke

Wandering spleen is a rare clinical occurrence characterized by the absence of spleen in its normal anatomic place. Patients may present with acute abdomen, abdominal mass, and chronic abdominal pain. Prompt diagnosis and intervention are necessary. Here, we report a case of a woman who presented with acute abdominal pain secondary to a wandering spleen complicated by torsion of its vascular pedicle. Keywords: Wandering spleen; torsion; splenectomy


Cancers ◽  
2021 ◽  
Vol 13 (24) ◽  
pp. 6198
Author(s):  
Dimitrios Dionyssiou ◽  
Alexandros Sarafis ◽  
Antonios Tsimponis ◽  
Asterios Kalaitzoglou ◽  
Georgios Arsos ◽  
...  

Background: This retrospective study aimed to assess the impact of certain flap characteristics on long-term outcomes following microsurgical treatment in Breast Cancer-Related Lymphedema (BCRL) patients. Methods: Sixty-four out of 65 BCRL patients, guided by the “Selected Lymph Node” (“SeLyN”) technique, underwent Vascularized Lymph Node Transfer (VLNT) between 2012 and 2018. According to their surface size, flaps were divided into small (<25 cm2, n = 32) and large (>25 cm2, n = 32). Twelve large and six small flaps were combined with free abdominally based breast reconstruction procedures. Lymphedema stage, flap size, vascular pedicle and number of lymph nodes (LNs) were analyzed in correlation with long-term Volume Differential Reduction (VDR). Results: At 36-month follow-up, no major complication was recorded in 64 cases; one flap failure was excluded from the study. Mean flap size was 27.4 cm2, mean LNs/flap 3.3 and mean VDR 55.7%. Small and large flaps had 2.8 vs. 3.8 LNs/flap (p = 0.001), resulting in 49.6% vs. 61.8% VDR (p = 0.032), respectively. Lymphedema stage and vascular pedicle (SIEA or SCIA/SCIP) had no significant impact on VDR. Conclusion: In our series, larger flaps included a higher number of functional LNs, directly associated with better outcomes as quantified by improved VDR.


2021 ◽  
Vol 43 (2) ◽  
pp. 38-41
Author(s):  
V. I. Popov ◽  
V. I. Filin

The experience of the General Surgery Clinic of the Military Medical Academy showed that the function of an artificial esophagus created from the large intestine is quite satisfactory. For six years in the General Surgery Clinic of the Military Medical Academy, colonic esophagoplasty for diseases of various parts of the esophagus was performed in 85 patients. For cicatricial (10 patients) or tumor (4 patients) lesions of the cervical esophagus, the large intestine on the vascular pedicle was used as a plastic material in 14 patients.


2021 ◽  
Author(s):  
Nan Hou ◽  
Die Lv ◽  
XiaoLi Xu ◽  
YanQing Lu ◽  
JingZhi Li ◽  
...  

Abstract Background: Hypopharynx reconstruction after hypopharyngectomy is still a great challenge. Perfusion decellularization is for extracellular matrix (ECM) scaffolding and had been used in organ reconstruction. Our study aimed to prepare an acellular, natural, three-dimensional (3D) biological hypopharynx with vascular pedicle scaffold as the substitute materials to reconstruct hypopharynx. Result: Scanning electron microscope (SEM) and immuno showed that the decellularized hypopharynx with vascular pedicle scaffold retained intact native anatomical ECM structure. Myoblasts were observed on the recellularized scaffolds with bone marrow mesenchyml stem cells (BMSCs) induced by 5-azacytidine implanted in the rabbit greater omentum by immunohistochemical analysis. conclusion: the decellularized hypopharynx with vascular pedicle scaffold prepared by detergent perfusion in our study has an potential to be an alternative material to pharynx reconstruction.


2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Amr Abdelhamid AbouZeid

Abstract Background The colon is among the best options to substitute the oesophagus; it is well known for its durability and good function that makes it most suitable for paediatric patients. The steps of the procedure, postoperative complications, and outcome assessment were thoroughly discussed in previous reports. However, in this report, we have tried to focus on one basic and essential step of the operation, which is fashioning of the colonic flap used to substitute the oesophagus. Results The study included 50 consecutive paediatric cases who underwent colonic replacement of the oesophagus during the period 2010 through 2020. The indication for oesophageal replacement was either oesophageal atresia (27 cases) or corrosive strictures (23 cases). Our standard technique was using a middle segment of the colon (transverse colon) based on the left colic vessels (vascular pedicle) after ligation of middle colic vessels. Variations of the middle colic vessels were encountered that included single, double, or absent vessels. In a single case (2%), the middle colic vessels were multiple, short, and non-branching with interrupted continuity of marginal vessels at that point. In the latter situation, we had to use a different technique by fashioning a right colonic flap based on the middle colic vessels. Conclusion In colonic replacement of the oesophagus, preparing a pedicled flap from the transverse colon based on the left colic vessels was almost always feasible owing to the stable collateral marginal vessels. On a rare occasion, the marginal vessels were interrupted by disturbed anatomy of the middle colic vessels when we had to shift to another technique using a right colonic flap.


QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Mohamed Lotfy Hamed ◽  
Amir Samir Elbarbary ◽  
Abd El Rahman Mohamed Sayed ◽  
Ahmed Mohamed Abdel Salam ◽  
Dalia Mohamed Galal

Abstract Background The propeller perforator flap is a variant of perforator flaps in which complete skeletonization of the perforator with venae commitantes is done to transfer the islanded flap on its pedicle with up to 180 degrees of twisting that predispose to its gradual occlusion by time. These flaps have been recently advocated for lower extremity reconstruction. However, reconstruction of the lower extremity especially in the distal third of the leg quite often involves multistage procedures that might necessitate flap re-elevation and little knowledge is available about postoperative patency of these flaps. Aim of the work The aim of this study is to assess the postoperative patency and flow pattern in twisted vascular pedicle of propeller perforator flaps used in lower extremity reconstruction. Materials and methods A Prospective study was conducted on 15 patients 18 years or older of both genders undergoing lower extremity soft tissue reconstruction by propeller perforator flaps rotated from 90 to 180 degrees at Ain Shams University Hospitals and Nasser Institute between 1st February and 31th December 2019. With exclusion of smoking, peripheral vascular diseases and diabetes mellitus, each patient was evaluated preoperatively in regards to age, gender, comorbidities, bacterial contamination or infection, cause of tissue loss. The flap size, source vessel, arc of rotation, donor site closure was analyzed. The flow pattern was evaluated by handheld Doppler device and used as a control for the study. Postoperatively, the same handheld Doppler device was used to localize the vascular pedicle, evaluate its patency and assess the flow pattern at a minimum follow up period of 3 months postoperatively in all patients. Results The mean age of the fifteen patients included was 35.3 years old. Six patients lost tissue was caused by unstable scar, while post-traumatic in the remaining. Preoperatively, four patients had osteomyelitis and four had wound infection. The rest of patients did not report any infection. Eight out of fifteen patients used perforators from peroneal vessel source, while seven patients used posterior tibial artery source. Forty percent of included participants had a 180 degrees arc of rotation, while 26.7% of participants had an arc rotation angle of 120 degrees, and 33.3% had 90 degrees. Five patients had early post-operative congestion that improved by conservative methods without de-rotation of the flap, one patient had skin graft loss over the donor site of the flap, and another patient suffered in addition to skin graft loss distal congestion leading to superficial skin necrosis. Eight patients had no complications. All patients had patent vessels with biphasic flow pattern postoperatively at a minimum of 3 months postoperatively. Conclusion The perforator propeller flaps are safe, reliable procedures and are considered as an ideal option in reconstructing small-medium defects of the middle and distal third of the leg providing similar skin texture with low rate of vascular obstruction. The present study documented patent vascular pedicle of propeller perforator flaps at three months postoperatively.


2021 ◽  
Vol 8 (10) ◽  
pp. 3211
Author(s):  
Surya Rao Venkata Mahipathy ◽  
Alagar Raja Durairaj ◽  
Narayanamurthy Sundaramurthy ◽  
Anand Prasath Jayachandiran ◽  
Suresh Rajendran

In the current scenario, propeller flaps are an attractive choice for single stage coverage of a large number of defects. They have a more reliable vascular pedicle than traditional flap and allow for greater freedom in design and wide mobilization and minimal donor-site morbidity. Harvesting of a propeller flap requires appropriate patient selection, preoperative planning, and meticulous dissection and these techniques greatly reduce the complication rates. Here, we present a case of a post burn raw area of the right axilla which was debrided and covered with a brachial artery perforator propeller flap.


2021 ◽  
Author(s):  
Weibin Du ◽  
Fangbing Zhu ◽  
Qiao Hou ◽  
Shenghu Hong ◽  
Guohua Ren ◽  
...  

Abstract Objective: To investigate the surgical method and therapeutic effect of retrograde island flap bridge transfer of adjacent phalangeal artery combined with vascular pedicle tubular skin grafting to repair finger pulp defect.Methods: From June 2008 to May 2020, 14 patients (16 fingers) with severe contusion of proximal and middle phalangeal body combined with finger pulp defect, and 5 patients (5 fingers) with finger pulp defect more than distal interphalangeal joint were repaired by retrograde island flap bridge transfer of adjacent phalangeal artery combined with vascular pedicle tubular skin grafting. The dorsal branch of digital nerve was carried in the skin flap for anastomosis with the proper nerve at the stump of the injured finger. The donor area was covered with medium thickness skin of abdominal or elbow transverse stripes, and the vascular pedicle was wrapped with tubular skin. The pedicle was severed 16-22 days after surgery. The survival rate and complications of postoperative flaps were observed. The finger function was evaluated by the Michigan functional questionnaire and Dagan functional criteria, and the clinical effect was evaluated. Result: All flaps survived and all patients were followed up for a period of 6 to 46 months. The skin flap of the affected finger was of good texture, and the appearance was naturally not bloated. The two-point discrimination was 7 ~ 11mm, and no obvious complications were observed in the donor area. Evaluation of the Michigan Hand Function Questionnaire: Nineteen patients were satisfied with the overall appearance and function of the hand. Finger joint Dargan function evaluation: excellent in 15 cases, good in 4 cases.Conclusions: It is a safe and effective operation to repair finger pulp defect with the retrograde island flap of adjacent finger artery combined with vascular pedicle tubular skin grafting. the skin flap has the advantages of simple cutting, good texture and concealed donor area, which is convenient for the early functional exercise of the finger body.


2021 ◽  
Vol 10 (17) ◽  
pp. 3863
Author(s):  
José Luis del Castillo Pardo de Vera ◽  
Carlos Navarro Cuéllar ◽  
Ignacio Navarro Cuéllar ◽  
José Luis Cebrián Carretero ◽  
Sandra Bacián Martínez ◽  
...  

Microsurgical scalp reconstruction is indicated in patients with large scalp defects. The aim of this study was to compare the outcomes of scalp reconstruction in oncologic patients reconstructed with latissimus dorsi (LD), anterolateral thigh (ALT), and omental (OM) free flaps. Thirty oncologic patients underwent scalp reconstruction with LD (10), ALT (11), and OM (9) flaps. The length of the vascular pedicle, the operation time, the possibility of a two-team approach, the length of hospital stays, the complications, and the aesthetic results were evaluated. The OM flap was the flap with the shortest vascular pedicle length with a mean of 6.26 ± 0.16 cm, compared to the LD flap, which was 12.34 ± 0.55 cm and the ALT flap with 13.20 ± 0.26 cm (p < 0.05). The average time of surgery was 6.6 ± 0.14 h in patients reconstructed with OM, compared to the LD flap, which was 8.91 ± 0.32 h and the ALT flap with 7.53 ± 0.22 h (p < 0.05). A two-team approach was performed in all patients for OM flaps and ALT flaps, but only in two patients reconstructed with the LD flap (p < 0.001). In patients reconstructed with the OM flap, a very satisfactory or satisfactory result was reported in seven patients (77.8%). Eight patients reported a very unsatisfactory or unsatisfactory result with LD flap (80%) and 10 patients with ALT flap (90.9%) (p = 0.002). The mean hospital stay after surgery was not statistically significant (p > 0.05). As for complications, two patients reconstructed with OM flap, five LT flaps, and two ALT flaps developed complications, not statistically significant (p = 0.235). Omental flap, latissimus dorsi flap, and anterolateral thigh flap fulfill most of the characteristics for complex scalp reconstruction. The decision on which flap to use should be based on clinical aspects of the patients taking into account that the three flaps show similar rates of complications and length of hospital stay. Regarding the aesthetic outcome, OM flap or LD flap should be considered for reconstruction of extensive scalp defects.


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