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Pedicle
Kinds of Pedicle Terms modified by Pedicle Selected AbstractsMaximizing Breast Projection with Combined Free Nipple Graft Reduction Mammaplasty and Back-folded Dermaglandular Inferior PedicleTHE BREAST JOURNAL, Issue 3 2007Metin Gorgu MD Abstract:, Standard technique for free nipple reduction mammoplasty was described by Thorek in 1922 (1). In contrast to its effectiveness, late postoperative results included insufficient projection of the breast and the nipple,areola region. We describe a modification of this well recognized technique in order to increase central mound projection and improve nipple,areola projection by suturing the dermaglandular flap to the pectoralis major muscle by back-folding the pedicle. Twenty macromastia patients were subjected to free-nipple-graft reduction mammoplasty in combination with inferior pedicled dermaglandular reduction mammaplasty of a total of 40 breasts with this technique between years 2000 and 2004. Preoperative planning for inferior pedicled dermaglandular flap was made using the "Wise" pattern for large breasts. The variation of the technique comes from using the back-folded deepithelialized inferior pedicled dermaglandular flap for increasing the breast mound projection by fixating the demaglandular flap with absorbable sutures to the underlying pectoralis major muscle fascia and the costal cartilage pericondrium. By applying this technique, increased projection during the early preoperative and late postoperative periods are achieved, compared with patients who only underwent free-nipple- graft reduction mammoplasty. [source] Subcutaneous Pedicle Limberg Flap for Facial ReconstructionDERMATOLOGIC SURGERY, Issue 8 2005Li Jun-Hui MD Background. A residual dog-ear arising from the traditional Limberg flap transposition sometimes influences the cosmetic outcomes, and the Limberg flap with a subcutaneous pedicle is an innovation applicable to a variety of facial defects and free from the dog-ear. Objective. To investigate the outcome of the subcutaneous pedicle Limberg flap for the reconstruction of medium-sized facial skin defects. Materials and Methods. From August 2002 to June 2004, the subcutaneous pedicle Limberg flap was designed to repair facial skin defects in 17 patients (19 flaps), and the size of the lesions ranged from 2.0 × 1.9 cm to 5.0 × 4.5 cm. Results. All flaps survived with primary healing postoperatively. The patients were followed up from 1 to 22 months, and functionally and cosmetically satisfactory outcomes were achieved. Conclusions. This subcutaneous pedicle Limberg flap provides a competitive repair alternative for the treatment of medium-sized skin defects in the face. [source] First record of the brachiopod Lingulella waptaensis with pedicle from the Middle Cambrian Burgess ShaleACTA ZOOLOGICA, Issue 2 2010Sandra Pettersson Stolk Abstract Pettersson Stolk, S., Holmer, L. E. and Caron, J -B. 2010. First record of the brachiopod Lingulella waptaensis with pedicle from the Middle Cambrian Burgess Shale. ,Acta Zoologica (Stockholm) 91: 150,162 The organophosphatic shells of linguloid brachiopods are a common component of normal Cambrian,Ordovician shelly assemblages. Preservation of linguloid soft-part anatomy, however, is extremely rare, and restricted to a few species in Lower Cambrian Konservat Lagerstätten. Such remarkable occurrences provide unique insights into the biology and ecology of early linguloids that are not available from the study of shells alone. Based on its shells, Lingulella waptaensis Walcott, was originally described in 1924 from the Middle Cambrian Burgess Shale but despite the widespread occurrence of soft-part preservation associated with fossils from the same levels, no preserved soft parts have been reported. Lingulella waptaensis is restudied herein based on 396 specimens collected by Royal Ontario Museum field parties from the Greater Phyllopod Bed (Walcott Quarry Shale Member, British Columbia). The new specimens, including three with exceptional preservation of the pedicle, were collected in situ in discrete obrution beds. Census counts show that L. waptaensis is rare but recurrent in the Greater Phyllopod Bed, suggesting that this species might have been generalist. The wrinkled pedicle protruded posteriorly between the valves, was composed of a central coelomic space, and was slender and flexible enough to be tightly folded, suggesting a thin chitinous cuticle and underlying muscular layers. The nearly circular shell and the long, slender and highly flexible pedicle suggest that L. waptaensis lived epifaunally, probably attached to the substrate. Vertical cross-sections of the shells show that L. waptaensis possessed a virgose secondary layer, which has previously only been known from Devonian to Recent members of the Family Lingulidae. [source] The immunocytochemical localization of connexin 36 at rod and cone gap junctions in the guinea pig retinaEUROPEAN JOURNAL OF NEUROSCIENCE, Issue 11 2003Eun-Jin Lee Abstract Connexin 36 (Cx36) is a channel-forming protein found in the membranes of apposed cells, forming the hexameric hemichannels of intercellular gap junction channels. It localizes to certain neurons in various regions of the brain including the retina. We characterized the expression pattern of neuronal Cx36 in the guinea pig retina by immunocytochemistry using specific antisera against Cx36 and green/red cone opsin or recoverin. Strong Cx36 immunoreactivity was visible in the ON sublamina of the inner plexiform layer and in the outer plexiform layer, as punctate labelling patterns. Double-labelling experiments with antibody directed against Cx36 and green/red cone opsin or recoverin showed that strong clustered Cx36 immunoreactivity localized to the axon terminals of cone or close to rod photoreceptors. By electron microscopy, Cx36 immunoreactivity was visible in the gap junctions as well as in the cytoplasmic matrices of both sides of cone photoreceptors. In the gap junctions between cone and rod photoreceptors, Cx36 immunoreactivity was only visible in the cytoplasmic matrices of cone photoreceptors. These results clearly indicate that Cx36 forms homologous gap junctions between neighbouring cone photoreceptors, and forms heterologous gap junctions between cone and rod photoreceptors in guinea pig retina. This focal location of Cx36 at the terminals of the photoreceptor suggests that rod photoreceptors can transmit rod signals to the pedicle of a neighbouring cone photoreceptor via Cx36, and that the cone in turn signals to corresponding ganglion cells via ON and OFF cone bipolar cells. [source] Efficacy and limitation of bone marrow transplantation in the treatment of acute and subacute liver failure in ratsHEPATOLOGY RESEARCH, Issue 11 2009Hirotaka Tokai Aim:, Recent reports have shown that bone marrow cells (BMC) retain the potential to differentiate into hepatocytes. Thus, the BMC have been recognized as an attractive source for liver regenerative medicine. However, it has not been clarified whether BMC transplantation can be used to treat liver damage in vivo. In the present study, we explored whether BMC possess therapeutic potential to treat acute and/or subacute liver failure. Methods:, Fulminant hepatic failure (FHF) was induced by 70% hepatectomy with ligation of the right lobe pedicle (24% liver mass), followed by transplantation of BMC into the spleen. Dipeptidyl peptidase IV-positive (DPPIV+) BMC were then transplanted into DPPIV-negative (DPPIV - ) recipients following hepatic irradiation (HIR) in which 70% of the liver was resected and the remnant liver irradiated. Results:, There was no benefit of BMC transplantation towards survival in the FHF model. DPPIV+ hepatocytes appeared in the liver tissues of the DPPIV - HIR model rats, but DPPIV+ hepatocytes replaced less than 13% of the recipient liver. Conclusion:, BMC transplantation may have limitations in the treatment of fulminant or acute liver failure because they do not have sufficient time to develop into functional hepatocytes. Preparative HIR may be beneficial in help to convert the transplanted BMC into host hepatocytes, and provide a survival benefit. Although, However, the precise mechanism warrants further studies. [source] Radiofrequency ablation partial nephrectomy: A new method of nephron-sparing surgery in selected patientsINTERNATIONAL JOURNAL OF UROLOGY, Issue 11 2006MAREK SALAGIERSKI Abstract, From July 2002 to April 2005, seven radiofrequency ablation partial nephrectomies have been carried out in seven selected patients. A cool-tip Tyco radiofrequency device under intraoperative ultrasound guidance was used. After intervention, tumors were removed and their tissue with their margins were verified histopathologically. Procedure efficacy was assessed by multidetector computed tomography and by ultrasound. Complications included urine leakage in three cases. Histopathologically, in every case renal cell carcinoma was detected. There is no need for dialysis and there has been no tumor recurrence. No bleeding without clamping renal pedicle, easy tumor extraction and, we hope, reduced risk of recurrence are the major advantages of this intervention. [source] Harvesting of the Radial Artery: Subfasciotomy or Full Skeletonization: A Comparative StudyJOURNAL OF CARDIAC SURGERY, Issue 4 2008Nezihi Kucukarslan M.D. We compared the early results of this technique with those of the RA graft harvested as a pedicle in the conventional fashion. Methods: The study patients have been selected from the patients who underwent coronary artery bypass grafting (CABG) using the RA graft harvested either with a long posterior fasciotomy (group 1) or as a whole with a pedicle in the classical manner (group 2). Only the patients with a flow study have been included. The flow index was described as the bleeding amount of the RA in a minute per body surface area (mL/m2 min). The flow index has been performed before and after fasciotomy in group 1, and after full skeletonization in group 2. The clinical and demographic parameters and flow indices were measured and compared between the groups, and in group 1, before and after fasciotomy. Results: From 218 patients with CABG using the RA between January 1998 and August 2005, a total of 57 patients were recruited into the study. Group 1 consisted of 25 patients. Thirty-two patients constituted group 2. Subfascial dissection of the RA increased the blood flow index from 48 ± 20 mL/m2 min to 51 ± 19 mL/m2 min (p < 0.001). The comparison of the clinical, perioperative characteristics of the patients was not different between the groups. Conclusions: The necessity of total skeletonization of the RA should not be the only option when the aim is to reduce the spasm. While subfascial dissection (sympathectomy) of the pediculed RA alone provides a satisfactory increase in the blood flow index, it also reduces the manipulation time as well as the risk of injury to the graft. [source] Subcutaneous angioleiomyomas: Gray-scale and color Doppler sonographic appearancesJOURNAL OF CLINICAL ULTRASOUND, Issue 2 2006Vanesa Gomez-Dermit MD Abstract Purpose: To describe the gray-scale Doppler and sonographic features of a series of subcutaneous angioleiomyomas. Methods: The sonographic appearances of 10 pathologically proven angioleiomyomas were retrospectively reviewed; 4 in women and 6 in men, with an age range from 33 to 77 years. We evaluated size, shape, echo pattern, margins, location, relationships with adjacent structures, and vascularity. Examinations were performed using a multifrequency linear array transducer (9,11 MHz) connected to a Logiq 500 scanner (GE, Milwaukee, Wl). Results: All tumors were subcutaneous and located in the extremities (7 in the lower extremities, 3 in the upper extremities). The sizes ranged from 0.6 to 6.4 cm, with an average size of 2 cm. All of the lesions were hypoechoic with well-defined margins, and 9 were oval. Intratumoral calcifications were observed in two patients. Vascularity was easily detected in all of them, and 4 tumors had a clear vascular pedicle. The spectral Doppler analysis performed in 5 cases, revealing a low-resistance arterial waveform in 4 patients. Conclusions: Although angioleiomyomas are uncommon soft tissue tumors, the presence of a well-defined, hypoechoic, vascular subcutaneous tumor in the extremities should raise the possibility of such a diagnosis. © 2006 Wiley Periodicals, Inc. J Clin Ultrasound 34:50,54, 2006 [source] Spinal somatosensory evoked potential evaluation of acute nerve-root injury associated with pedicle-screw placement procedures: An experimental studyJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 2 2003I-Ming Jou Pedicle screws for spinal fixation risk neural damage because of the proximity between screw and nerve root. We assessed whether spinal somatosensory evoked potential (SSEP) could selectively detect pedicle-screw-related acute isolated nerve injury. Because pedicle screws are too large for a rat's spine, we inserted a K-wire close to the pedicle in 32 rats, intending not to injure the nerve root in eight (controls), and to injure the L4 or L5 root in 24. We used sciatic-nerve-elicited SSEP pre- and postinsertion. Radiologic, histologic, and postmortem observations confirmed the level and degree of root injury. Sciatic (SFI), tibial (TFI), and peroneal function indices (PFI) were calculated and correlated with changes in potential. Although not specific for injuries to different roots, amplitude reduction immediately postinsertion was significant in the experimental groups. Animals with the offending wire left in place for one hour showed a further non-significant deterioration of amplitude. Electrophysiologic changes correlated with SFI and histologic findings in all groups. SSEP monitoring provided reliable, useful diagnostic and intraoperative information about the functional integrity of single nerve-root injury. These findings are clinically relevant to acute nerve-root injury and pedicle-screw insertion. If a nerve-root irritant remains in place, a considerable neurologic deficit will occur. © 2002 Orthopaedic Research Society. Published by Elsevier Science Ltd. All rights reserved. [source] Autologous diaphragm reconstruction with the pedicled latissimus dorsi flapJOURNAL OF SURGICAL ONCOLOGY, Issue 3 2006M.O. McConkey BSc Abstract The latissimus dorsi (LD) muscle has been previously described to repair diaphragmatic defects, but as a "reverse" flap, relying on secondary blood supply from the perforating lumbar vessels rather than primary inflow from the dominant thoracodorsal artery. We report resection of a retroperitoneal synovial sarcoma, with reconstruction of the hemidiaphragm using the LD rotated on its primary neurovascular bundle. By using the dominant pedicle, the vascularity of the flap is improved, minimizing the chance of flap tip loss. Maintaining an intact nerve supply prevents atrophy. As the distal origin of the LD is broad and flat, it is ideally suited for diaphragm repair. A latissimus-sparing thoracotomy incision is required to enable this method of diaphragm reconstruction. J. Surg. Oncol. 2006;94:248,251. © 2006 Wiley-Liss, Inc. [source] A gregarious lingulid brachiopod Longtancunella chengjiangensis from the Lower Cambrian, South ChinaLETHAIA, Issue 1 2007ZHIFEI ZHANG Longtancunella chengjiangensis, one of the sparse lingulid brachiopods from the Early Cambrian Chengjiang Lagerstätten of southwestern China, is characterized by a sub-circular shell shape, stout pedicle, and notably by gregarious occurrences in the fossils. This brachiopod form was briefly reported in 1999, but its detailed description, however, remains to be done. The material in our collection is remarkably well preserved and allows accounts of the shell morphology and of valve interiors, including lophophores, mantle canals, and a digestive tract. When compared with the coeval lingulid brachiopod Xianshanella haikouensis Zhang & Han, 2004, L. chengjiangensis exhibits some distinct features, notably tenuous marginal setae and distinguishable mantle canals and a relative short pedicle tapering posteriorly. [source] The bipedicled latissimus dorsi myocutaneous free flap: Clinical experience with 53 patientsMICROSURGERY, Issue 3 2010Mehmet Veli Karaaltin M.D. The Latissimus dorsi musculocutaneous flap is a valuable workhorse of the microsurgeon, especially in closing large body defects. One of the pitfalls in harvesting the flap, is particularly in its inferior aspect which may be unreliable. Here we report a series of 53 patients who were undergone bipedicled free latissimus dorsi musculocutaneous free flaps for extensive tissue defects. The age of patients were between 5 and 64 and all of them were males. The wound sizes in these patients ranged between 31,35 × 10,12 cm and flap dimensions were between 38,48 × 6,8 cm. Perforator branches of the 10th intercostal vessels were dissected and supercharged to the flaps to reduce the risk of ischemia of the inferior cutaneous extensions. The secondary pedicles were anastomosed to recipient vessels other than the primary pedicles. Recipient areas were consisted of lower extremities. Four patients suffered of early arterial failure in the major pedicle and all revisions were successfully attempted. Neither sign of venous congestion nor arterial insufficiency were observed at the inferior cutaneous extensions of the flaps, and all defects were reconstructed successfully. All donor sites were primarily closed, only two patients suffered from a minor area of superficial epidermal loss at the donor site, without suffering any adjunct complications. In conclusion coverage of large defects can be safely performed with extending the skin paddle of latissimus dorsi flap as a bipedicled free flap. © 2009 Wiley-Liss, Inc. Microsurgery, 2010. [source] Reverse flow facial artery as recipient vessel for perforator flapsMICROSURGERY, Issue 6 2009D.D.S., Frank Hölzle M.D., Ph.D. In perforator flaps, anastomosis between flap and recipient vessels in the neck area is often difficult due to small vessel diameter and short pedicle. The aim of this study was to investigate whether the retrograde flow of the distal, paramandibular part of the facial artery would provide sufficient pressure and size to perfuse perforator flaps. Before and after occlusion of the contralateral facial artery, retrograde and anterograde arterial pressure was measured on both sides of the facial artery in 50 patients. The values were compared with the mean systemic arterial pressure. Diameters of facial arteries in the paramandibular region and perforator flap vessels were evaluated by morphometry. Arterial pressure in the distal facial artery with retrograde flow was 76% of the systemic arterial pressure. The latter equaled approximately the anterograde arterial pressure in the proximal end of the facial artery. Mean arterial pressure of the facial arteries decreased after proximal occlusion of the contralateral facial artery, which was not significant (P = 0.09). Mean diameter of the distal facial arteries in the mandibular region was 1.6 mm (range 1.3,2.2 mm; standard deviation 0.3 mm; n = 50), that of the perforator flap arteries 1.3 mm (0.9,2.6 mm; 0.4 mm; n = 20). Facial arteries, based on reverse flow, successfully supported all 20 perforator flaps. Retrograde pulsatile flow in the distal facial artery sustains perforator flaps even if the contralateral facial artery is occluded. Proximity of the distal facial arteries to the defect compensates for short pedicles. Matching diameters of the arteries are ideal for end-to-end anastomosis. © 2009 Wiley-Liss, Inc. Microsurgery, 2009. [source] Use of the arcade vessels after disruption of the vascular pedicle of pedicled jejunum transfer for a recurrent esophageal cancer patientMICROSURGERY, Issue 6 2009Akira Saito M.D., Ph.D. [source] Microvascular surgery in the previously operated and irradiated neck,MICROSURGERY, Issue 1 2009Matthew M. Hanasono M.D. Microvascular reconstruction of head and neck defects can be extremely challenging in patients with a history of prior neck dissection and/or irradiation. We reviewed of 261 head and neck free flaps performed between 2004 and 2007 at a tertiary cancer center. One hundred twenty-four (52%) free flaps were performed in patients with a history of prior neck dissection and/or irradiation. The ipsilateral external carotid artery or one of its branches was not available in 43 (19%) cases: 13 with no history of prior neck dissection or irradiation, and 30 with a history of prior neck dissection and/or irradiation (P = 0.03). The ipsilateral internal/external jugular veins (IJ/EJ) were not available in 37 (16%) cases: 11 with no history of prior neck dissection or irradiation, and 26 with a history of prior neck dissection and/or irradiation (P = 0.002). Strategies for dealing with lack of a recipient vessels included anastomosis to contralateral neck vessels, transverse cervical vessels, internal mammary vessels, the cephalic vein, and the pedicle of another free flap. We propose an algorithm for locating recipient vessels adequate for microvascular anastomosis should the ipsilateral external carotid arterial and/or the internal/external jugular venous systems not be available, such as in the setting of prior neck dissection or irradiation. © 2008 Wiley-Liss, Inc. Microsurgery, 2009. [source] Autologous fat grafting: A technique for stabilization of the microvascular pedicle in DIEP flap reconstructionMICROSURGERY, Issue 7 2008Eran D. Bar-Meir M.D. Proper orientation of the microvascular pedicle is essential to ensure a high success rate in microvascular surgery. The inset of a deep inferior epigastric perforator (DIEP) flap breast reconstruction can sometimes be problematic given the long vascular pedicle, the acute takeoff from an internal mammary anastomosis, and the positioning of the flap on top of the vascular pedicle. In the postoperative period, the flap can also shift as the patient's activity level increases. We present a technique where nonvascularized autologous fat grafts are used to stabilize and cushion the vascular pedicle. Over a 14-month period, 117 consecutive DIEP flaps were performed to the internal mammary vessels with autologous fat grafting to the microvascular pedicle. Six flaps (5.1%) were explored during the immediate postoperative period for anastomotic compromise. Only one total flap failure (0.8%) was observed during this time. We had no direct complications related to the fat grafts. The use of nonvascularized autologous fat grafts is a simple and safe technique for stabilization of a microvascular pedicle. It should be considered in DIEP flap breast reconstruction and other microvascular cases where the vascular pedicle might be compressed by adjacent structures. © 2008 Wiley-Liss, Inc. Microsurgery, 2008. [source] Transplantation of a vascularized rabbit femoral diaphyseal segment: Mechanical and histologic properties of a new living bone transplantation modelMICROSURGERY, Issue 4 2008Goetz A. Giessler M.D. A new vascularized bone transplantation model is described, including the anatomy and surgical technique of isolating a rabbit femoral diaphyseal segment on its nutrient vascular pedicle. The histologic and biomechanical parameters of pedicled vascularized femoral autotransplants were studied following orthotopic reimplantation in the resulting mid-diaphyseal defect. Vascularized femur segments were isolated in 10 rabbits on their nutrient pedicle, and then replaced orthotopically with appropriate internal fixation. Postoperative weightbearing and mobility were unrestricted, and the contralateral femora served as no-treatment controls. After 16 weeks, the bone flaps were evaluated by x-ray (bone healing), mechanical testing (material properties), microangiography (quantification of intraosseous vasculature), histology (bone viability), and histomorphometry (bone remodeling). Bone healing occurred by 2 weeks, with further callus remodeling throughout the survival period. Eight transplants healed completely, while two had a distal pseudarthrosis. Microangiography demonstrated patent pedicles in all transplants. Intraosseous vessel densities were comparable to nonoperated (control) femora. We found ultimate strength and elastic modulus to be significantly reduced when compared to normal controls. Viable bone, increased mineral apposition rate, and bone turnover were demonstrated in all transplants. The method described, and the data provided will be of value for the further study of isolated segments of living bone, and in particular, for investigations of reconstruction of segmental bone loss in weight-bearing animal models. This study also provides important normative data on living autologous bone flap material properties, vascularity, and bone remodeling. We intend to use this method and data for comparison in subsequent studies of large bone vascularized allotransplantation. © 2008 Wiley-Liss, Inc. Microsurgery, 2008. [source] Improved survival of rat ischemic cutaneous and musculocutaneous flaps after VEGF gene transferMICROSURGERY, Issue 5 2007Andrea Antonini M.D. When harvesting microsurgical flaps, the main goals are to obtain as much tissue as possible based on a single vascular pedicle and a reliable vascularization of the entire flap. These aims being in contrast to each other, microsurgeons have been looking for an effective way to enhance skin and muscle perfusion in order to avoid partial flap loss in reconstructive surgery. In this study we demonstrate the efficacy of VEGF 165 delivered by an Adeno-Associated Virus (AAV) vector in two widely recognized rat flap models. In the rectus abdominis miocutaneous flap, intramuscular injection of AAV- VEGF reduced flap necrosis by 50%, while cutaneous delivery of the same amount of vector put down the epigastric flap's ischemia by >40%. Histological evidence of neoangiogenesis (enhanced presence of CD31-positive capillaries and ,-Smooth Muscle Actin-positive arteriolae) confirmed the therapeutic effect of AAV- VEGF on flap perfusion. © 2007 Wiley-Liss, Inc. Microsurgery, 2007. [source] Perfusion, viability, and pedicle dependence in acute and delayed rat island skin flapsMICROSURGERY, Issue 2 2007Ewa Komorowska-Timek M.D. Purpose: Although surgical delay phenomenon has been widely investigated, its pathophysiology has not been fully elucidated. Methods: In 25 Spraque,Dawley rats, an 8 × 8 cm2 epigastric skin flap consisting of 4 vertical zones A through D (farthest from vascular pedicle) was outlined. All animals were perfused twice with colored fluorescent microspheres: immediately before and after flap elevation (Acute, n = 10) and before and after pedicle ligation on POD 8 (Delayed, n = 15). Results: After acute flap elevation, peripheral perfusion dropped significantly in zone C (0.29 ± 0.01 vs. 0.19 ± 0.04 ml g,1 min,1; P < 0.01) and zone D (0.33 ± 0.09 vs 0.01 ± 0.01 ml g,1 min,1; P < 0.01), while global flap perfusion remained unchanged. Total and regional blood flow did not change in the Delayed group after pedicle ligation. Conclusions: Elevation of a pedicled flap caused significant decrease in distal flap perfusion while maintaining proximal and total flap perfusion. Eight-day delay was adequate to establish sufficient flap perfusion independent of the vascular pedicle. © 2007 Wiley-Liss, Inc. Microsurgery, 2007. [source] Repair of buccal defects with anterolateral thigh flapsMICROSURGERY, Issue 3 2006Ömer Özkan M.D. The ideal reconstructive method for the buccal mucosa should provide durable, stable coverage and a natural contour, while simultaneously minimizing morbidity of both the defect and donor sites. Since the first report of the anterolateral thigh flap in 1984, it has become one of the most commonly used flaps for the reconstruction of various soft-tissue defects. From March 2004,April 2005, 24 free anterolateral thigh flaps were used to reconstruct buccal defects, including the retromolar trigone and as far as the oral commissure, and in some cases with extension to the neighboring palatal region and tongue. The study comprised 1 female and 23 male patients, with ages ranging from 26,63 years (mean age, 45.8 years). Two flaps required reoperation due to vascular compromise, and both were salvaged with arterial and venous anastomosis revisions, giving an overall success rate of 100%. Primary thinning of the flap was performed in 10 cases. In 2 cases, additional vastus lateralis muscle was included in the flap to fill the large defect. In 2 cases, marginal necrosis with dehiscence of the flap was observed, one of these patients having a history of atherosclerosis and diabetes mellitus (marginal skin necrosis and infection of the donor area were also observed in this patient). In 2 patients, seroma collection was observed in the neck at the dissection site. Chart reviews showed that most patients had a history of betel-nut chewing (95.8%) or a combination of smoking and betel-nut chewing (79.2%). During the follow-up period of 4,12 months, a sufficient level of mouth-opening with interincisal distances of 34 mm, 44 mm, and 48 mm was achieved in all 3 cases reconstructed after release of the trismus. Although it has some variations in the vascular pedicle, irregularity in derivation from the main vessels, and minimal morbidity of the donor site, the anterolateral thigh flap, with its evident functional, structural, and cosmetic advantages, can be considered an excellent and ideal flap option, and a first choice for most buccal defects. © 2006 Wiley-Liss, Inc. Microsurgery, 2006. [source] Cross-leg free anterolateral thigh perforator flap: A case reportMICROSURGERY, Issue 3 2006Serel M.D. The purpose of this report is to introduce the cross-leg anterolateral thigh perforator flap for closure of a defect on the dorsum of the foot, and to show that the anterolateral thigh perforator flap is a safe option for a cross-bridge microvascular anastomosis in defects of the extremity. The free anterolateral thigh perforator flap was used for a patient with an unhealed wound on the dorsum of the foot. The flap was revascularized by end-to-side anastomosis between the flap's artery and the posterior tibial artery of the other leg, since there was no available recipient artery on the same leg. After a 4-week neovascularization period, the pedicle was cut. To the best of our knowledge, this is the first report of the use of a free anterolateral thigh perforator flap for a cross-bridge microvascular anastomosis. © 2006 Wiley-Liss, Inc. Microsurgery, 2006. [source] Penile resurfacing with vascularized fascia lataMICROSURGERY, Issue 6 2005Andreas I. Gravvanis M.D., Ph.D. Penis resurfacing is a challenging procedure, and should simultaneously ensure erectile function, tactile sensibility, sexual satisfaction, and aesthetic integrity. This article presents three cases with penile skin defects treated by means of a pedicled fascia lata attached either to the tensor fascia lata (one case) or an anterolateral thigh flap (two cases). The cause of the wounds included electrical burn, Fournier's gangrene, and self-mutilation. The size of flaps ranged from 10,13 cm in width and 15,30 cm in length. All flaps included vascularized fascia lata, which covered part or the circumference of the penis. All flaps survived completely. The lateral cutaneous nerve of the thigh was included in the designed flaps in all instances, and normal protective sensation was recorded postoperatively. The patients reported normal erectile function and ability to perform intercourse. The flaps, though relatively bulky and hairy, had a good color and texture match with the penis and suprapubic region. Based on our limited experience, we believe that the anterolateral thigh flap has greater dimensions with a longer pedicle, and allows for greater flexibility in flap design compared to the tensor fascia lata flap. An anterolateral thigh flap can be safely thinned in a second stage, and it is our flap of choice for penis resurfacing. © 2005 Wiley-Liss, Inc. Microsurgery 25:462,468, 2005 [source] Incidence and significance of microscopic pathological lesions found in pedicle and recipient vessels used in microsurgical breast reconstructionMICROSURGERY, Issue 1 2003H.H. El-Mrakby M.D. The purpose of this study was to assess the incidence of abnormal vascular histology and to determine whether or not this was correlated with the incidence of postoperative microvascular problems. The microvascular histology of both donor and recipient vessels was studied in 38 patients (40 flaps) undergoing breast reconstruction with free TRAM flaps. Preoperative risk factors were assessed and correlated with histological changes in vessels, and both were tested against anastomotic complications. Thrombosis of either the artery or the vein of the flap was seen in 6 cases (15%), and of these, two flaps failed completely and one suffered partial necrosis. The occlusion affected the arterial anastomosis in 3 patients, and the venous anastomosis in 2 patients, while both the artery and the vein were thrombosed in one case. Preoperative risk factors such as smoking, obesity, radiotherapy, and chemotherapy were not associated with a significantly higher incidence of thrombosis or with significant histological abnormalities in vessels (P value varied between 0.3,0.06). Microvascular histology showed variable degrees of pathological changes in six flaps (15%); nevertheless, in this group, only one flap suffered a venous thrombosis, which ended in total flap loss. Among those with one or more risk factors (24 patients), only 2 had some evidence of histological abnormality of the blood vessels used for the microvascular anastomosis (P = 0.2). © 2003 Wiley-Liss, Inc. MICROSURGERY 23:6,9 2003 [source] Acute remote ischemic preconditioning on a rat cremasteric muscle flap modelMICROSURGERY, Issue 6 2002Markus V. Küntscher M.D. A previous study showed, in a rat adipocutaneous flap model, that acute ischemic preconditioning (IP) can be achieved not only by preclamping of the flap pedicle, but also by a brief extremity ischemia prior to flap ischemia. The purpose of this study was to determine whether remote IP is also effective in other tissues such as muscle flaps. Twenty male Wistar rats were divided into three experimental groups. The rat cremaster flap in vivo microscopy model was used for assessment of ischemia/reperfusion injury. In the control group (CG, n = 8), a 2-hr flap ischemia was induced after preparation of the cremaster muscle. In the "classic" IP group (cIP, n = 6), a brief flap ischemia of 10 min was induced by preclamping the pedicle, followed by 30 min of reperfusion. A 10-min ischemia of the contralateral hindlimb was induced in the remote IP group (rIP, n = 6). The limb was then reperfused for 30 min. Flap ischemia and the further experiment were performed as in the CG. In vivo microscopy was performed after 1 hr of flap reperfusion in each animal. A significantly higher red blood cell velocity in the first-order arterioles and capillaries, a higher capillary flow, and a decreased number of leukocytes adhering to the endothelium of the postcapillary venules were observed in both preconditioned groups by comparison to the control group (P < 0.05). The differences within the preconditioned groups were not significant for these parameters. Our data show that ischemic preconditioning and improvement of flap microcirculation can be achieved not only by preclamping of the flap pedicle, but also by induction of an ischemia/reperfusion event in a body area distant from the flap prior to elevation. These findings indicate that remote IP is a systemic phenomenon, leading to an enhancement of flap survival. Our data suggest that remote IP could be performed simultaneously with flap elevation in the clinical setting without prolongation of the operation and without invasive means. © 2002 Wiley-Liss, Inc. MICROSURGERY 22:221,226 2002 [source] Acute remote ischemic preconditioning II: The role of nitric oxideMICROSURGERY, Issue 6 2002Markus V. Küntscher M.D. The purpose of this study was to determine whether nitric oxide (NO) plays a role in the mechanism of acute "classic" as well as acute remote ischemic preconditioning (IP). Thirty-two male Wistar rats were divided into five experimental groups. The rat cremaster flap in vivo microscopy model was used for assessment of ischemia/reperfusion injury. In the control group (CG, n = 8), a 2-hr flap ischemia was induced after preparation of the cremaster muscle. The animals of group NO (n = 6) received 500 nmol/kg of the NO-donor spermine/nitric oxide complex (Sper/NO) intravenously 30 min prior to ischemia. The group LN + P (L-NAME + preclamping, n = 6) received 10 mg/kg N,-nitro-L-arginine methyl ester (L-NAME) intravenously before preclamping of the flap pedicle (10-min cycle length, 30-min reperfusion). L-NAME (10 mg/kg) was administered in group LN + T (L-NAME + tourniquet, n = 6) before ischemia of the right hindlimb was induced, using a tourniquet for 10 min after flap elevation. The limb was then reperfused for 30 min. Thereafter, flap ischemia was induced in each group as in group CG. In vivo microscopy was performed after 1 hr of flap reperfusion in each animal. Group NO demonstrated a significantly higher red blood cell velocity (RBV) in the first-order arterioles and capillaries, a higher capillary flow, and a decreased number of leukocytes adhering to the endothelium (stickers) of the postcapillary venules by comparison to all other groups (P < 0.05). The average capillary RBV and capillary flow were still higher in the CG than in the groups receiving L-NAME (P < 0.05). The data show that NO plays an important role in the mechanism of both acute "classic" as well as acute remote IP, since the administration of a NO-donor previous to ischemia simulates the effect of IP, whereas the nonspecific blocking of NO synthesis by L-NAME abolishes the protective effect of flap preconditioning. © 2002 Wiley-Liss, Inc. MICROSURGERY 22:227-231 2002 [source] Anterior versus posterior approach in reconstruction of infected nonunion of the tibia using the vascularized fibular graft: potentialities and limitationsMICROSURGERY, Issue 3 2002Sherif M. Amr M.D. The potentialities, limitations, and technical pitfalls of the vascularized fibular grafting in infected nonunions of the tibia are outlined on the basis of 14 patients approached anteriorly or posteriorly. An infected nonunion of the tibia together with a large exposed area over the shin of the tibia is better approached anteriorly. The anastomosis is placed in an end-to-end or end-to-side fashion onto the anterior tibial vessels. To locate the site of the nonunion, the tibialis anterior muscle should be retracted laterally and the proximal and distal ends of the site of the nonunion debrided up to healthy bleeding bone. All the scarred skin over the anterior tibia should be excised, because it becomes devitalized as a result of the exposure. To cover the exposed area, the fibula has to be harvested with a large skin paddle, incorporating the first septocutaneous branch originating from the peroneal vessels before they gain the upper end of the flexor hallucis longus muscle. A disadvantage of harvesting the free fibula together with a skin paddle is that its pedicle is short. The skin paddle lies at the antimesenteric border of the graft, the site of incising and stripping the periosteum. In addition, it has to be sutured to the skin at the recipient site, so the soft tissues (together with the peroneal vessels), cannot be stripped off the graft to prolong its pedicle. Vein grafts should be resorted to, if the pedicle does not reach a healthy segment of the anterior tibial vessels. Defects with limited exposed areas of skin, especially in questionable patency of the vessels of the leg, require primarily a fibula with a long pedicle that could easily reach the popliteal vessels and are thus better approached posteriorly. In this approach, the site of the nonunion is exposed medial to the flexor digitorum muscle and the proximal and distal ends of the site of the nonunion debrided up to healthy bleeding bone. No attempt should be made to strip the scarred skin off the anterior aspect of the bone lest it should become devitalized. Any exposed bone on the anterior aspect should be left to granulate alone. This occurs readily when stability has been regained at the fracture site after transfer of the free fibula. The popliteal and posterior tibial vessels are exposed, and the microvascular anastomosis placed in an end-to-side fashion onto either of them, depending on the length of the pedicle and the condition of the vessels themselves. To obtain the maximal length of the pedicle of the graft, the proximal osteotomy is placed at the neck of the fibula after decompressing the peroneal nerve. The distal osteotomy is placed as distally as possible. After detaching the fibula from the donor site, the proximal part of the graft is stripped subperiosteally, osteotomized, and discarded. Thus, a relatively long pedicle could be obtained. To facilitate subperiosteal stripping, the free fibula is harvested without a skin paddle. In this way, the use of a vein graft could be avoided. Patients presenting with infected nonunions of the tibia with extensive scarring of the lower extremity, excessively large areas of skin loss, and with questionable patency of the anterior and posterior tibial vessels are not suitable candidates for the free vascularized fibular graft. Although a vein graft could be used between the recipient popliteal and the donor peroneal vessels, its use decreases flow to the graft considerably. These patients are better candidates for the Ilizarov bone transport method with or without free latissimus dorsi transfer. © 2002 Wiley-Liss, Inc. MICROSURGERY 22:91,107 2002 [source] Beneficial effect of hyperbaric oxygen on island flaps subjected to secondary venous ischemia,MICROSURGERY, Issue 2 2002Thomas J. Gampper M.D. The potential for hyperbaric oxygen therapy (HBO) to decrease the untoward effects of a secondary ischemic event was studied in the rat superficial epigastric flap model. The secondary venous ischemic flap was created by cross-clamping the vascular pedicles for 2 h. Twenty-four hours later, the flap was reelevated and the venous pedicle was occluded for 5 h. Thirty-two rats were divided into three groups. In experimental group 1, animals received HBO treatment immediately prior to the initial flap elevation and ischemia at 2 atmosphere pressures for 90 min. In experimental group 2, the rats underwent a similar course except for a second 90-min HBO course immediately prior to the secondary venous occlusion. The rats without HBO therapy were used as controls. The results showed that all control flaps were nonviable at 1 week by clinical inspection and fluorescein injection. Complete flap survival occurred in 20% of group 1 flaps and 30.8% of group 2 flaps. Partial flap survival occurred in the rest of the flaps in these two groups, with mean survival areas of 48% and 55%, respectively. In conclusion, HBO treatments significantly increase the survival of flaps subjected to a secondary ischemia, even if administered before the primary ischemia. Administering HBO prior to secondary venous ischemia was marginal, which may be due to the effect of O2 given by HBO not lasting longer than 5 h. © 2002 Wiley-Liss, Inc. MICROSURGERY 22:49,52 2002 [source] Effects of some pharmacological agents on the survival of unipedicled venous flaps: an experimental studyMICROSURGERY, Issue 8 2001Ibrahim Askar M.D. Clinical and experimental studies have been conducted to improve the survival of venous flaps. As a result of these studies, although various survival mechanisms were raised, none obtained satisfactory information. Venous stasis, and the resultant venous thrombosis, is a factor that decreases the survival of venous flaps. In this study, we evaluated the effects of two antiinflammatory agents, etodolac and etofenamate, on the survival of unipedicled venous flaps. In this study, 35 male New Zealand white rabbits (3,500,4,000 g) (70 ears) were used. Perichondrocutaneous flaps, 3 × 4.5 cm in size, were designed and raised, keeping the central veins intact in the middle of venous flap. Central arteries and nerves were ligated and transected both proximally and distally, to prepare unipedicled venous flaps. A silicone sheet was placed between the cartilage tissue and flap, to prevent blood flow and revascularization beneath. The subjects were divided into seven groups, consisting of five rabbits (10 ears). In the negative control group (group I), the single vascular pedicle of venous flaps, central veins were ligated and flaps sutured into their own place as the composite graft. In the positive control group (group II), after venous flaps were prepared, normal saline, 0.2 mL, was given subcutaneously. In the first of five experimental groups (group III), unfractionated heparin (100 U/day) was given subcutaneously. In the second experimental group (group IV), etodolac (5 mg/kg/day) was given subcutaneously. In the third experimental group (group V), etophenamate (5 mg/kg/day) was given orally through a feeding tube. In the fourth experimental group (group VI), parnaparin (5 anti-Xa U/kg/day) was given subcutaneously. In the fifth experimental group (group VII), nadroparin (5 anti-Xa U/kg/day) was given subcutaneously, about 7 days postoperatively. At the eighth postoperative day, surviving areas of venous flaps were measured, and the results were evaluated by Kruskal-Wallis ANOVA and Mann-Whitney U-test (P < 0.05). Biopsies were also taken from the flaps for histological evaluation of border of necrotic tissue. Surviving areas of unipedicled venous flaps were larger in experimental groups than those in negative and positive control group (P < 0.05). However, comparison of the experimental groups demonstrated no statistically significant difference (P > 0.05). We concluded that all pharmacological agents used in the experimental groups succeeded in increasing the survival of unipedicled venous flaps. Survival of the unipedicled venous flap was higher in venous flaps than that of composite graft, clearly showing the importance of the venous pedicle. © 2001 Wiley-Liss Inc. MICROSURGERY 21:350--356, 2001 [source] Experimental study of vascularized nerve graft: Evaluation of nerve regeneration using choline acetyltransferase activityMICROSURGERY, Issue 2 2001Makoto Iwai M.D. A comparative study of nerve regeneration was performed on vascularized nerve graft (VNG) and free nerve graft (FNG) in Fischer strain rats. A segment of the sciatic nerve with vascular pedicle of the femoral artery and vein was harvested from syngeneic donor rat for the VNG group and the sciatic nerve in the same length without vascular pedicle was harvested for the FNG group. They were transplanted to a nerve defect in the sciatic nerve of syngeneic recipient rats. At 2, 4, 6, 8, 12, 16, and 24 weeks after operation, the sciatic nerves were biopsied and processed for evaluation of choline acetyltransferase (CAT) activity, histological studies, and measurement of wet weight of the muscle innervated by the sciatic nerve. Electrophysiological evaluation of the grafted nerve was also performed before sacrifice. The average CAT activity in the distal to the distal suture site was 383 cpm in VNG and 361 cpm in FNG at 2 weeks; 6,189 cpm in VNG and 2,264 cpm in FNG at 4 weeks; and 11,299 cpm in VNG and 9,424 cpm in FNG at 6 weeks postoperatively. The value of the VNG group was statistically higher than that of the FNG group at 4 weeks postoperatively. Electrophysiological and histological findings also suggested that nerve regeneration in the VNG group was superior to that in the FNG group during the same period. However, there was no significant difference between the two groups after 6 weeks postoperatively in any of the evaluations. The CAT measurement was useful in the experiments, because it was highly sensitive and reproducible. © 2001 Wiley-Liss, Inc. MICROSURGERY 24:43,51 2001 [source] Maximizing Breast Projection with Combined Free Nipple Graft Reduction Mammaplasty and Back-folded Dermaglandular Inferior PedicleTHE BREAST JOURNAL, Issue 3 2007Metin Gorgu MD Abstract:, Standard technique for free nipple reduction mammoplasty was described by Thorek in 1922 (1). In contrast to its effectiveness, late postoperative results included insufficient projection of the breast and the nipple,areola region. We describe a modification of this well recognized technique in order to increase central mound projection and improve nipple,areola projection by suturing the dermaglandular flap to the pectoralis major muscle by back-folding the pedicle. Twenty macromastia patients were subjected to free-nipple-graft reduction mammoplasty in combination with inferior pedicled dermaglandular reduction mammaplasty of a total of 40 breasts with this technique between years 2000 and 2004. Preoperative planning for inferior pedicled dermaglandular flap was made using the "Wise" pattern for large breasts. The variation of the technique comes from using the back-folded deepithelialized inferior pedicled dermaglandular flap for increasing the breast mound projection by fixating the demaglandular flap with absorbable sutures to the underlying pectoralis major muscle fascia and the costal cartilage pericondrium. By applying this technique, increased projection during the early preoperative and late postoperative periods are achieved, compared with patients who only underwent free-nipple- graft reduction mammoplasty. [source] | |||||||||||||