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Free-tissue Transfer (free-tissue + transfer)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Simplifying head and neck microvascular reconstruction

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 11 2004
Eben Rosenthal MD
Abstract Background. Free-tissue transfer has become the preferred method of head and neck reconstruction but is a technique that is considered to use excessive hospital resources. Methods. This study is a retrospective review of 125 consecutive free flaps in 117 patients over a 16-month period at a tertiary care university hospital. Results. Defects of the oral cavity/oropharynx (60%), midface (9%), hypopharynx (15%), or cervical and facial skin (16%) were reconstructed from three donor sites: forearm (70%), rectus (11%), and fibula (19%). Microvascular anastomoses were performed with a continuous suture technique or an anastomotic coupling device for end-to-end venous anastomoses. A single vein was anastomosed in 97% of tissue transfers. There were five flaps (4%) requiring exploration for vascular compromise, and the overall success rate was 97.6%. The major complication rate was 13%. Mean hospital stay was 7 days for all patients and 5 days for those with cutaneous defects. Combined ablative and reconstructive operative times were 6 hours 42 minutes, 7 hours 40 minutes, and 8 hours 32 minutes for forearm, rectus, and fibular free grafts, respectively. A subset of this patient series with oral cavity and oropharynx defects (76 patients; 58%) available for follow-up (74 patients) was assessed for deglutition. Forty-three patients (58%) had a regular diet, 22 patients (30%) had a limited diet or required supplemental tube feedings, and nine patients (12%) were dependent on tube feedings with a severely limited diet. Conclusions. This series suggests that most head and neck defects can be reconstructed by use of a simplified microvascular technique and a limited number of donor sites. Analysis of operative times and length of stay suggest improved efficiency with this approach to microvascular reconstruction. Complications and functional results are comparable to previously published results. © 2004 Wiley Periodicals, Inc. Head Neck26: 930,936, 2004 [source]

Anterior cranial base reconstruction using free tissue transfer: Changing trends,

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 2 2003
Joseph Califano MD
Abstract Introduction. A consecutive series of 135 patients undergoing resection for malignant tumors involving the anterior cranial base between 1976 and 1999 was reviewed. Patient and Methods. In the years from 1976,1991, free-tissue transfer was used in 5 of 76 or 6.6% of cases, whereas free-tissue reconstruction was used in 24 of 59 or 40% of cases in the years 1992,1999. Of those cases reconstructed with free-tissue transfer in 1976,1991, 60% (three of five) underwent a complex resection defined as involving dura, brain, or more than one major structure adjacent to skull base. Of those patients reconstructed with conventional (pericranial or pericranial/galeal) pedicled flaps in this time period, 35% (25 of 71) underwent a complex resection. From 1992,1999, 75% (18 of 24) of patients reconstructed with free-tissue transfer received a complex resection, whereas only 6% (2 of 35) of patients reconstructed by other means received a complex resection. Outcomes. For those patients reconstructed by free-tissue transfer, there were no instances of flap loss. Comparison of these two time periods was notable for a similar patient composition in terms of age, histologic findings, and extent of resection. Major complication rates for patients who are reconstructed with free-tissue transfer for anterior cranial base resections (31%) are similar compared with patients who have been reconstructed with conventional pedicled flaps (35%). This was noted despite an increased extent and complexity of resection in those patients who underwent free-tissue transfer reconstruction (72%) compared with those patients reconstructed by more conventional means (26%) p < .001. Conclusion. In our institution, the use of vascularized, free-tissue transfer has replaced pedicled flaps as the preferred modality for reconstructing complex anterior cranial base defects involving resection of dura, brain, or multiple major structures adjacent to local skull base, including the orbit, palate, and other structures. Complication rates for patients reconstructed with free-tissue transfer techniques is similar to those patients reconstructed by conventional techniques, despite an increase in complexity of resection in this group. © 2002 Wiley Periodicals, Inc. Head Neck 24: 000,000, 2002 [source]

Late free-flap salvage with catheter-directed thrombolysis

MICROSURGERY, Issue 4 2008
Andrew P. Trussler M.D.
Introduction: Despite high success rates with free-tissue transfer, flap loss continues to be a devastating event. Flap salvage is often successful if vascular complications are recognized and treated early. However, delayed presentation of flap compromise is an ominous predictor of flap loss. Late free-flap salvage has been described with poor long-term results. Catheter-directed thrombolysis (CDT) has only been described in context with free-tissue transfer in a case of distal bypass salvage. Objectives: The authors examined the efficacy of highly selective CDT in late salvage of free-flaps with vascular compromise. Methods: Two patients underwent highly selective CDT after delayed presentation (>5 days) of flap compromise. Patient 1 is a 59-year-old woman who underwent delayed breast reconstruction with a free TRAM flap and presented with arterial thrombosis 12 days postoperatively. Patient 2 is a 53-year-old man who underwent fibular osteocutaneous free-flap reconstruction of a floor of mouth defect who developed venous thrombosis 6 days postoperatively. Patient 2 underwent two attempted operative anastamotic revisions with thrombectomies and local thrombolysis prior to CDT. Results: The average time of presentation was 9 days, with the average time to CDT being 9.5 days. Patient 1 had an arterial thrombosis, whereas Patient 2 had a venous thrombosis. Both patients underwent successful thrombolysis after super-selective angiograms. Continuous infusions of thrombolytic agents were used in both patients for ,24 h. Average length of stay postCDT was 7 days with no perioperative complications. Long-term follow-up demonstrated complete flap salvage with no soft tissue loss. Conclusion: Despite extremely delayed presentation, aggressive CDT was successful in both breast, and head and neck reconstructions with excellent long-term flap results. CDT appears to be a useful modality in managing difficult cases of free-flap salvage. © 2008 Wiley-Liss, Inc. Microsurgery, 2008. [source]

Preoperative planning for free-tissue transfer

MICROSURGERY, Issue 5 2005
Anthony A. A. Smith M.D.
Preoperative planning is of paramount importance in the surgical teaching of free-tissue transfer. Preoperative planning begins with the initial patient evaluation and continues to the point of successful free-tissue transfer. A detailed preoperative plan allows even the neophyte microsurgeon to anticipate operative difficulties before they occur, and to have contingency plans for nearly all intraoperative scenarios. © 2005 Wiley-Liss, Inc. Microsurgery 25:365,372, 2005. [source]

Salvage operations of free tissue transfer following internal jugular venous thrombosis: A review of 4 cases

MICROSURGERY, Issue 3 2005
Muneo Miyasaka M.D.
The internal jugular vein (IJV) is used as the optimal recipient for free-tissue transfer in reconstruction following modified radical neck dissection. Some reports documented rare cases of flap compromise following IJV thrombosis, but large sample studies are few. We present cases of emergent exploration and an analysis of factors to improve salvage rates of compromise due to IJV thrombosis. From a survey of 756 patients, four developed congestion due to IJV thrombosis and returned to the operating room. A restrospective analysis was made from the case records. This represents a rate of 0.5% for the entire series. Three flaps survived,and one failed. Detection of compromise ranged from 7,25 h postoperatively. All four IJVs recovered to provide adequate drainage after thrombectomy. While flap compromise following IJV thrombosis is rare, careful observation and early exploration are crucial for salvage, as in other microvascular venous crises. © 2005 Wiley-Liss, Inc. Microsurgery 25:00,00 2005. [source]

Reliability of free-flap coverage in diabetic foot ulcers

MICROSURGERY, Issue 2 2005
Ömer Özkan M.D.
As microsurgery advances, microsurgical free-tissue transfers have become the reconstructive method of choice over staged or primary amputation, and enabling independent ambulation in difficult lower-extremity wounds. In this report, we present our experiences with free-tissue transfer for the reconstruction of soft-tissue defects in 13 diabetic foot ulcers. Following radical debridement, soft-tissue reconstruction was achieved in the following ways: anterolateral thigh fasciocutaneous flap in 5 patients, radial forearm fasciocutaneous flap in 3 patients, lateral arm fasciocutaneous flap in 1 patient, gracilis musculocutaneous flap in 1 patient, tensor fascia latae flap in 1 patient, deep inferior epigastric perforator flap in 1 patient, and a parascapular flap in the remaining patient. In 8 cases, diabetic wounds were in the foot, while wounds were at the level of the lower leg in the remaining patients. In all patients, vascular patency was confirmed by the Doppler technique. In suspicious cases, arteriography was then performed. While all flaps survived well in the postoperative period, one patient died from cardiopulmonary problems on postoperative day 16 in an intensive care unit. Amputation was necessary in the early postoperative period because of healing problems. In the remaining 10 cases, all flaps survived intact. In one case, arterial revision was performed successfully. The ultimate limb salvage rate was 83% for the 12 patients. Independent ambulation was achieved in these cases. During the follow-up period of 8 months to 2 years, no ulcer recurrence was noted, and no revascularization or vascular bypass surgery was needed before or after the free-tissue transfers. The authors conclude that free-tissue transfer for diabetic foot ulcers is a reliable procedure, despite pessimistic opinions regarding the flap survival and low limb salvage rates. It should be considered a useful reconstructive option for serious defects in well-selected cases. © 2005 Wiley-Liss, Inc. Microsurgery 25:107,112, 2005. [source]

A new type of magnification system in free microvascular tissue transfer: Varioscope M5

MICROSURGERY, Issue 6 2007
Ph.D., Stefano Chiummariello M.D.
Free microvascular tissue transfers have become today a key instrument for the surgical treatment of wide loss of tissue. These procedures can provide definitive treatment in a single operation but they are expensive and require specialized practitioners. The operating microscope traditionally has provided this requirement; our study is focusing on the prospect of using a new visual system,Varioscope M5,in the reconstructive microsurgery field. Varioscope M5 (Life Optics, Vienna, Austria) has been employed in 21 microvascular anastomoses, where different free flaps were used in head and neck reconstruction. The necessity to operate in a different department, not provided with an operating microscope, brought along the idea of exploring an alternative procedure to classical visualization systems. Specific advantages such as reduced cost, freedom of movement, autofocus, minimal upkeep, a variable range of magnification from 2× to 9× are some of the reasons that convinced the authors to use this new type of magnification system. Increasing interest in microsurgery magnification highlights the need for further technical development in that field. We consider Varioscope M5 a future mean of anastomotic magnification in most free-tissue transfers with specific characteristics that combine the microscope and loupe philosophies. © 2007 Wiley-Liss, Inc. Microsurgery, 2007. [source]

Guidelines for the optimization of microsurgery in atherosclerotic patients

MICROSURGERY, Issue 5 2006
F.A.C.S., Hung-Chi Chen M.D.
We review the pathogenesis of atherosclerosis and the issues that must be taken into consideration when performing microsurgery in atherosclerotic patients. Atherosclerosis is a systemic disease, and may affect the success of microsurgery. Atherosclerotic patients have a tendency toward thrombosis, because the nature of the arteries is changed. Such patients are usually old and have additional medical problems. To increase the success rate of microsurgery in atherosclerotic patients, special precautions should be considered. Patients must be evaluated properly for the suitability of microsurgery. The microsurgical technique requires a meticulous approach, and various technical tricks can be used to avoid thrombosis. Recipient-vessel selection, anastomotic technique, and the use of vein grafts are all important issues. Prophylactic anticoagulation is recommended in severely atherosclerotic patients. Close monitoring of the patient and flap is necessary after the operation, as with routine microvascular free-tissue transfers. We conclude that atherosclerosis is not a contraindication for microsurgery. If the microsurgeon knows how to deal with the difficulties in atherosclerotic patients, microsurgery can be performed safely. © 2006 Wiley-Liss, Inc. Microsurgery, 2006. [source]

Postoperative monitoring of free flaps in UK plastic surgery units

MICROSURGERY, Issue 6 2005
Ch.B. (Hons.), M.R.C.S. (Eng.), N. Jallali B.Sc.
Monitoring free-tissue transfers in the postoperative period is valuable for detection of failing flaps. As well as conventional methods, a myriad of sophisticated techniques have been reported in the literature. Using a postal questionnaire, a survey was conducted to delineate current protocols employed in UK plastic surgery units. Data were received from 148 plastic surgeons in 51 units. All surgeons used clinical assessment, although there was significant disparity in the duration and frequency of postoperative monitoring. Adjuvant techniques such as laser Doppler flowmetry were routinely used by less than 20% of surgeons. We conclude that there is considerable variation in postoperative monitoring of free flaps, with significant clinical and resource implications. A protocol based on robust evidence is thus recommended. © 2005 Wiley-Liss, Inc. Microsurgery 25:469,472, 2005. [source]

Use of varioscope in free microvascular tissue transplants,,

MICROSURGERY, Issue 3 2005
E.B.O.P.R.A.S., Petros K. Spyriounis M.D., Ph.D.
Since July 2002, the author has performed 12 consecutive free flaps using a new device, the Varioscope AF3, in order to evaluate its efficacy. The Varioscope is a world-patent novelty by Life Optics (Vienna, Austria) that combines the philosophy of microscopes and loupes. Specific advantages such as reduced cost, freedom of movement, portability, and a magnification range between 3.6,7,2× are some of the reasons that convinced the author to use the Varioscope initially. The overall success rate is similar to that obtained with a microscope or high-power loupes. The results show that the Varioscope AF3 could be safely employed in the majority of free-tissue transfers as sole means of magnification. However, for digital replantations or vessels with a diameter of less than 1 mm, a microscope might be necessary. © 2005 Wiley-Liss, Inc. Microsurgery 25:00,00 2005. [source]