49 research outputs found
Introduction to Lower Extremity Reconstruction: Historical Perspectives, Advances in the Field, and the Future
No full textFibroblast Growth Factor Receptor 2 (<i>FGFR2</i>) Mutation Related Syndromic Craniosynostosis
No full textCultured Epidermal Autograft for Total Scalp Reconstruction in a Neonate Following Necrotizing Fasciitis
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Attributes of Perforator Flaps for Prophylatic Soft Tissue Augmentation Prior to Definitive Total Knee Arthroplasty.
No full textBACKGROUND: As our population ages, the demand for total knee arthroplasty (TKA) will dramatically increase to ensure an independent lifestyle with unimpeded and pain-free ambulation. Complications will be inevitable, especially in that patient with preexisting soft tissue deficits or extensive scarring in the knee region. Under these circumstances, prophylactic soft tissue augmentation should be strongly considered and be extremely beneficial.
METHODS: A retrospective review of all TKA procedures at our institutions over the past two decades revealed seven patients who specifically had soft tissue augmentation prior to their definitive TKA. Each had a single perforator flap used to achieve this. In no cases was a muscle flap used for this purpose. Excluded were all patients who had a flap of any kind for coverage of an exposed prosthesis or to accomplish wound healing after the TKA.
RESULTS: Seven perforator flaps were utilized in seven patients for soft tissue replacement prior to the ultimate TKA. For smaller defects in three patients, a local island medial sural artery perforator flap was used. For larger defects in four patients, an anterolateral thigh perforator free flap was necessary. All flaps were successful. The only complication was an implant infection after one anterolateral thigh free flap that required a revision arthroplasty that eventually allowed salvage. Unrestricted ambulation was possible in all patients except for one who had a preexisting contralateral below-knee amputation.
CONCLUSION: As the number of TKA procedures in the near future increases, prevention of the absolute number of complications becomes even more important. An awareness that any knee region suboptimal soft tissue base can lead to wound breakdown and then periprosthetic infection should alert all involved that prevention of this sequela can be best achieved by prior soft tissue augmentation. Preferably, this may be possible by capturing the assets of local and free perforator flaps
Quantitative reverse transcription polymerase chain reaction-based detection of thyroid-specific gene expression in fine-needle aspirate for thyroid cancer recurrence evaluation: a case report and review of the literature.
No full textBACKGROUND: Despite improved surveillance for patients after total thyroidectomy for cancer, there has yet to be a diagnostic method that detects recurrence with 100% accuracy.
METHODS: A 60-year-old woman with a family history of papillary thyroid cancer (PTC) underwent total thyroidectomy and radioactive iodine ablation. On postoperative surveillance, ultrasound examination of the neck demonstrated a focus concerning for recurrence and a fine-needle aspirate (FNA) was performed. The cytology report was nondiagnostic and, hence, RNA was extracted from the specimen followed by reverse transcription (cDNA), and quantitative real-time polymerase chain reaction (qRT-PCR) to detect thyroid-specific gene expression (thyroglobulin =Tg; sodium-iodide symporter = NIS; thyroperoxidase = TPO).
RESULTS: Expression of select thyroid-specific genes was demonstrated, and given the patient\u27s remarkable cancer and family history, surgical resection was elected. Final pathology demonstrated follicular adenoma.
CONCLUSION: This case demonstrates a novel approach used in the evaluation for recurrent thyroid cancer as an adjunct to FNA cytology
Soft-tissue management and reconstruction of lower-extremity trauma
No full textSoft-tissue management and subsequent salvage of the lower extremity following trauma has long presented difficult challenges to the plastic surgeon. Trauma to the lower extremity can produce long-term sequelae consisting of psychological trauma, functional deficits, and increased costs to the healthcare system. Avoiding incorrect management is important, and is compounded by the fact that few guidelines exist on appropriate treatment and patient counseling. This study aims to describe the authors’ experience at a large limb salvage center in order to further delineate management strategies
Expanding the top rungs of the extremity reconstructive ladder: targeted muscle reinnervation, osseointegration, and vascularized composite allotransplantation
No full textOsseointegration (OI), targeted muscle reinnervation (TMR), and vascularized composite allotransplantation (VCA) are just a few ways by which our reconstructive ladder is evolving. It is important to recognize that amputation does not necessarily denote failure, but surgeons should strive to find ways to provide these patients with means for obtaining better satisfaction and quality of life postoperatively. TMR and OI have added options for mutilating lower extremity injuries that necessitate amputation. More recently, the senior author (Levin LS) described the “penthouse” floor of the reconstructive ladder being VCA. Despite the advances in VCA over the last 20 years, there are many challenges that face this discipline including indications for patient selection, minimizing immunosuppressive regimens, standardizing outcome measures, establishing reliable protocols for monitoring, and diagnosing and managing rejection. Herein, the authors review TMR, OI, and VCA as additional higher rungs of the reconstructive ladder
