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Microsurgical Reconstruction (microsurgical + reconstruction)
Selected AbstractsMicrosurgical reconstruction of brachial artery injuries in displaced supracondylar fracture humerus in childrenMICROSURGERY, Issue 7 2006Hassan H. Noaman M.D. Between March 2000 and March 2005, 840 children with grade III supracondylar humeral fractures presented for treatment, consecutively at our hospital. One hundred twenty had absent or diminished (detected by Doppler but not palpable) radial pulse on initial examination. Eighty-nine of these 120 children recovered pulse (palpable) after closed reduction and percutaneous pinning of the fracture. The remaining 31 children had persistent absent radial pulse. Twenty-two of the 31 children had median nerve signs. Each of these 31 children was explored. The intraoperative findings were intact median nerve in all cases (neuropraxia), traumatic aneurysm with thrombus formation in 17 cases, complete injury of the brachial artery in 8 cases (loss of continuity), thrombosis in 3 cases, partial tear in 2 cases, and brachial artery entrapment in the fracture site in 1 case. Microsurgical reconstruction of the 31 brachial arteries was done as the following: reversed vein graft for 8 cases, excision and repair in 17 cases, partial repair in 2 cases, thrombectomy in 3 cases, and release of the brachial artery from the fracture site in 1 case. The average follow up was 26 months range (6,60) months. All children had excellent to good functional and cosmetic outcome except one who had Volkman's ischemic contracture, treated later by free functioning gracilis muscle transfer. © 2006 Wiley-Liss, Inc. Microsurgery, 2006. [source] Total obstetric brachial plexus palsy: Results and strategy of microsurgical reconstructionMICROSURGERY, Issue 3 2010Tarek A. El-gammal M.D. From 2000 to 2006, 35 infants with total obstetric brachial plexus palsy underwent brachial plexus exploration and reconstruction. The mean age at surgery was 10.8 months (range 3,60 months), and the median age was 8 months. All infants were followed for at least 2.5 years (range 2.5,7.3 years) with an average follow-up of 4.2 years. Assessment was performed using the Toronto Active Movement scale. Surgical procedures included neurolysis, neuroma excision and interposition nerve grafting and neurotization, using spinal accessory nerve, intercostals and contralateral C7 root. Satisfactory recovery was obtained in 37.1% of cases for shoulder abduction; 54.3% for shoulder external rotation; 75.1% for elbow flexion; 77.1% for elbow extension; 61.1% for finger flexion, 31.4% for wrist extension and 45.8% for fingers extension. Using the Raimondi score, 18 cases (53%) achieved a score of three or more (functional hand). The mean Raimondi score significantly improved postoperatively as compared to the preoperative mean: 2.73 versus 1, and showed negative significant correlation with age at surgery. In total, obstetrical brachial plexus palsy, early intervention is recommended. Intercostal neurotization is preferred for restoration of elbow flexion. Tendon transfer may be required to improve external rotation in selected cases. Apparently, intact C8 and T1 roots should be left alone if the patient has partial hand recovery, no Horner syndrome, and was operated early (3- or 4-months old). Apparently, intact nonfunctioning lower roots with no response to electrical stimulation, especially in the presence of Horner syndrome, should be neurotized with the best available intraplexal donor. © 2010 Wiley-Liss, Inc. Microsurgery, 2010. [source] Is the recipient vein really the main concern?MICROSURGERY, Issue 8 2009A cohort study of head, neck reconstruction The aim of this study was to verify the role of the venous drainage system in the pathogenesis of complications in microsurgical head and neck reconstruction. In a nonrandomized cohort study, 52 consecutive cases of complex head and neck microsurgical reconstruction were evaluated. The patients were divided in two groups based on the treatment: the deep (DVDG; n = 30) and superficial (SVDG; n = 22) venous drainage groups. The complications evaluated included vascular obstruction with partial or total loss of the microsurgical flap, inadequate healing (fistulas or suture dehiscence), and infections. The arterial anastomotic site, neoplastic recurrence, use of medications and neoadjuvant radiotherapy, flap selection, tumor histology, smoking/alcoholism, and systemic diseases had no effect on postoperative complications, while the venous component influenced the overall complication rate (chi-square test, P = 0.006). A protective effect was achieved in the DVDG when the overall complication rate was considered,relative risk (RR) 0.65, 95% confidence interval (CI) 0.45,0.94. The recipient vein should be the surgeon's main concern as it influenced the outcomes of patients undergoing complex microsurgical head and neck reconstruction. A protective effect was observed when the internal jugular vein drainage system was used for this purpose. © 2009 Wiley-Liss, Inc. Microsurgery 2009. [source] Clinical evaluation of a hyaluronan-based gel following microsurgical reconstruction of peripheral nerves of the hand,MICROSURGERY, Issue 1 2007Andrea Atzei M.D. A controlled clinical trial was performed to investigate the safety and efficacy of the hyaluronate-based gel polymer Hyaloglide® after microsurgical reconstruction of peripheral nerves of the hand. Thirty patients were randomized to receive either no postsurgical treatment (n = 16) or Hyaloglide® (n = 14) and were clinically evaluated at various intervals for 1 year. The application of Hyaloglide® posed no safety concerns. Efficacy was assessed by the recovery of sensitivity, measurement of pain, and progression of Tinel's sign. The Hyaloglide®-treated group showed better improvement in recovery from pain, approaching statistical significance during the first 3 months postsurgery. Likewise, recovery of sensitivity was also higher in the Hyaloglide®-treated group throughout the entire follow-up period, and the distance of Tinel's sign was longer in the Hyaloglide®-treated group (P < 0.05 at day 30). The application of Hyaloglide® may improve recovery of sensitivity and decrease pain following microsurgical repair of the peripheral nerves of the hand. © 2007 Wiley-Liss, Inc. Microsurgery 27, 2007. [source] Extremity salvage with a free musculocutaneous latissimus dorsi flap and free tendon transfer after resection of a large congenital fibro sarcoma in a 15-week-old infant.MICROSURGERY, Issue 6 2006A case report A case of complex microsurgical reconstruction of the dorsum of the foot, including tendon transfer following tumor resection, in a 15-week-old male infant is presented. After birth, a 5.5 × 4 cm large tumor was observed on the dorsum of the right foot. Biopsy showed a congenital malignant fibro sarcoma. After initial chemotherapy a radical excision of the tumor at the age of 14 weeks was followed. To cover the defect a musculocutaneous latissimus dorsi flap was taken, the cutaneous part being large enough to cover the defect. Extensor tendons were reconstructed with free tendon transplants. Amputation is usually indicated in these cases. To the best of our knowledge, microsurgical reconstruction in infants at this age with congenital malignant tumors has not yet been reported. The case shows that Plastic surgery can play an important role in pediatric oncology and should routinely be integrated into the multi-modal treatment concepts. © 2006 Wiley-Liss, Inc. Microsurgery, 2006. [source] Management of flaps with compromised venous outflow in head and neck microsurgical reconstructionMICROSURGERY, Issue 8 2002Tateki Kubo M.D. Microvascular tissue transfer has become an indispensable procedure for head and neck reconstruction. Although remarkable progress has been made technically, anastomosed vessel occlusion is still a serious complication. Even with technically skilled microsurgeons, anastomosed vessel occlusion occurs because the technique is not the sole prophylaxis against thrombosis in microsurgery. Therefore, to minimize the possibility of an unfavorable result in microsurgery, microsurgeons must be familiar with management options for a vascular compromised flap. Most investigators have agreed that venous obstruction occurs more often than arterial obstruction. Here, we reviewed the published literature on the salvage of venous compromised flaps from the viewpoints of surgical correction, including reanastomosis and catheter thrombectomy, and nonsurgical procedures, such as a medicinal leech, hyperbaric oxygen, and thrombolytic therapy. © 2002 Wiley-Liss, Inc. MICROSURGERY 22:391,395 2002 [source] Reconstruction of seminal ducts in obstructive azoospermiaANDROLOGIA, Issue 4 2001G. Popken Summary. Depending on the localization of the obstruction of the seminal ducts, either a microsurgical reconstruction (tubulovasostomy, vasovasostomy) or a transurethral resection of the ejaculatory ducts is carried out. We have compared the effectiveness and economic advantages of reconstructive microsurgery of the epididymis and vas deferens with standard procedures in animal experiments. Microsurgical invagination techniques in tubulovasostomy are equal to the standard procedure from the point of view of the patency and fertility rates. They are also easier to learn and carry out. Less time is required for the invagination technique, and also less microsurgical suture material. The double-layer technique in vasovasostomy is equal to the one-layer microsurgical technique from the point of view of patency and fertility rates. The one-layer technique requires less time and suture material. It seems that the discrepancy between the patency and the fertility rate is related to immunological processes after reconstruction of the seminal ducts. In cases of obstructive azoospermia it is necessary to investigate the individual conditions and possibilities of the infertile couple. As a result of the high success rate obtainable today by surgical reconstruction of the seminal ducts, this must constitute the first type of treatment to be considered, before any of the procedures of reproductive medicine are undertaken. [source] | ||||||||||