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Partial Flap Loss (partial + flap_loss)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Omental free flap reconstruction in complex head and neck deformities,

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 4 2002
Albert Losken MD
Abstract Background Microvascular free flaps continue to revolutionize coverage options in head and neck reconstruction. This article reviews our 25-year experience with omental free tissue transfers. Methods All patients who underwent free omental transfer to the head and neck region were reviewed. Results Fifty-five patients were included with omental transfers to the scalp (25%), craniofacial (62%), and neck (13%) region. Indications were tumor resections, burn wound, hemifacial atrophy, trauma, and moyamoya disease. Average follow-up was 3.1 years (range, 2 months,13 years). Donor site morbidities included abdominal wound infection, gastric outlet obstruction, and postoperative bleeding. Recipient site morbidities included partial flap loss in four patients (7%) total flap loss in two patients (3.6%), and three hematomas. Conclusions The omental free flap has acceptable abdominal morbidity and provides sufficient soft tissue coverage with a 96.4% survival. The thickness \and versatility of omentum provide sufficient contour molding for craniofacial reconstruction. It is an attractive alternative for reconstruction of large scalp defects and badly irradiated tissue. © 2002 Wiley Periodicals, Inc. Head Neck 24: 326,331, 2002; DOI 10.1002/hed.10082 [source]

Microvascularly augmented transverse rectus abdominis myocutaneous flap for breast reconstruction,Reappraisal of its value through clinical outcome assessment and intraoperative blood gas analysis

MICROSURGERY, Issue 8 2008
Jing-Wei Lee M.D.
Our experience with 73 transverse rectus abdominis myocutaneous (TRAM) flap transfers was reviewed to see the variance in the incidence of complications among three groups of patients undergoing different types of surgical techniques. The TRAM flap was transferred as a free flap in 26 patients, a unipedicled flap in 25 patients, and a microvascularly augmented pedicled flap in 22 patients. Our data demonstrated that the incidence of partial flap loss and fat necrosis in the microvascularly augmented group was significantly lower than that in the unipedicled flap group (P < 0.01), and also lower than that in the free flap group with a statistically marginal significance (P = 0.055). Supplemental surgery is less often required in the microvascularly augmented group than in the conventional TRAM group (P = 0.002). Substantial increase in venous O2 concentration (P = 0.03), O2 saturation level (P = 0.007), and pH value (P = 0.002) was noticed following supercharge, and this very fact testifies to the perfusion-promoting effect of the microvascular augmentation maneuver. © 2008 Wiley-Liss, Inc. Microsurgery, 2008. [source]

Improved survival of rat ischemic cutaneous and musculocutaneous flaps after VEGF gene transfer

MICROSURGERY, Issue 5 2007
Andrea 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]

Reconstruction of foot defects with free lateral arm fasciocutaneous flaps: Analysis of fifty patients

MICROSURGERY, Issue 8 2005
Betul Gozel Ulusal M.D.
In this article, long-term outcomes of foot reconstruction with free lateral arm fasciocutaneous flaps were retrospectively analyzed in 50 patients. The patients, 38 men and 12 women, ranged in age from 7,73 years (mean, 43.5 years). Indications for surgery included trauma (32 patients), diabetes mellitus (7 patients), burns (7 patients), chronic ulcers (3 patients), and tumor (1 patient). The locations of defects were the dorsum (n = 21), ankle (n = 12), medial (n = 6), lateral (n = 6), posterior heel (n = 2), and distal sole (n = 3) Concomitant bone injury occurred in 5 cases, and the weight-bearing surface of the foot was involved in 5 patients. Defects ranged in size from 27,76 cm2 (mean, 36.4 cm2). Successful reconstructions were accomplished in 46 cases (92%). Flap complications included total flap loss and below-knee amputation (1 patient) and partial flap loss (3 patients); 75% (3/4) of these cases had diabetes as a comorbid factor, and 25% (1/4) had a concomitant bone injury. Six patients with dorsum defects required debulking of the flap (11.1%). None of the patients required modified shoes. In the majority of cases, flaps provided stable coverage and a gain in protective deep-pressure sensation. In long-term follow-up (up to 4 years), patients regained their ambulation, free of pain. Even in weight-bearing areas, none of the cases experienced ulceration or skin breakdown. Free lateral arm flaps provided excellent durability, with solid bony union and successful restoration of the contour of the foot in moderate-sized foot defects. © 2005 Wiley-Liss, Inc. Microsurgery 25:581,588, 2005. [source]

Monitoring free flaps using laser-induced fluorescence of indocyanine green: A preliminary experience

MICROSURGERY, Issue 7 2002
C. Holm M.D.
In a prospective, clinical study, the clinical utility of indocyanine green for intraoperative monitoring of free tissue transfer was evaluated. The study comprised 20 surgical patients undergoing elective microsurgical procedures. Indocyanine green angiography was performed intraoperatively, immediately after flap inset, and the operating team was blind to the fluoremetric findings. Thereafter, postoperative monitoring was done exclusively by clinical examination (color, temperature, time for recapillarization, and bleeding after puncture). Final outcome was compared with results of perioperative indocyanine (ICG)-imaging, and classified either as total flap loss, partial flap loss, or successful tissue transplantation. A total of 2 (10%) complications was recorded, and included one partial and one total flap loss. Both complications were detected by intraoperative ICG imaging. Another case of intraoperative subclinical arterial spasm at the place of microvascular anastomosis was revealed by dynamic ICG-videography. This flap did not develop postoperative complications. In conclusion, evaluation of perfusion by ICG imaging is feasible in all kinds of microsurgical flaps, irrespective of the type of tissue. Even though not meeting all the criteria of an ideal monitoring device, significant additional information can be obtained. In this study, cases with arterial spasm, venous congestion, and regional hypoperfusion were revealed by intraoperative ICG-videography. There was a strong correlation between intraoperative findings and clinical outcome. © 2002 Wiley-Liss, Inc. MICROSURGERY 22:278,287 2002 [source]