1,721,019 research outputs found
Microcirculation in DIEP flaps: a study of the haemodynamics using laser Doppler flowmetry and lightguide reflectance spectrophotometry
No full textThe deep inferior epigastric perforator (DIEP) flap is ideally suited for breast reconstruction. The DIEP flap reduces abdominal wall morbidity when compared to a transverse rectus abdominis (TRAM) flap, however, there maybe a compromise of the flap vascularity. Early venous problems and late fat necrosis in DIEP flaps can occur. There is a limited literature on the haemodynamic and microcirculation of the DIEP flap. Sixteen consecutive patients who underwent immediate breast reconstruction with DIEP flap were prospectively monitored during the post-operative time for a minimum period of 48 h using laser Doppler flowmetry (LDF) and lightguide reflectance spectrophotometry (LRS) to analyse blood flow and oxygenated haemoglobin percentage in the cutaneous microcirculation of the flap. LDF demonstrated an increase of capillary flow in comparison to the pre-operative levels. LRS showed an initial decrease of the values and a varying pattern of increase in relation to time, to reach the pre-operative levels. A correlation between lower values of post-operative LDF and LRS measurements and late fat necrosis and early venous congestion was demonstrable in this series. This study demonstrates a change in the cutaneous microcirculation of the lower anterior abdominal wall following its elevation as a DIEP flap. These findings could explain the clinical phenomenon occurring in this flap in the early post-operative period. Significant correlation between longer harvesting time and re-exploration and between longer ischaemia time and localised fat necrosis was found. © 2006 The British Association of Plastic Surgeons
Stacked free siea/diep flap for unilateral breast reconstruction in a thin patient with an abdominal vertical midline scar
No full textA New Abductor Pollicis Longus Suspension Arthroplasty
No full textPurpose: Surgical treatment of osteoarthritis of the first carpometacarpal joint aims to achieve complete pain relief with restoration of thumb strength and stability. The aim of this study was to introduce a variation of the abductor pollicis longus (APL) sling arthroplasty and to determine its efficacy in comparison with other tendon sling arthroplasty procedures. Methods: Between January 1999 and December 2003, 104 trapeziectomies in 74 consecutive patients (30 bilateral cases) were performed using a new APL sling arthroplasty. Patients were evaluated at 6 and 12 months after surgery. The outcomes were analyzed subjectively by questionnaire and objectively by clinical and radiographic evaluation. Results: After 6 months, excellent results in terms of pain relief were achieved in 95 thumbs (91%) of 65 patients. The remaining 9 thumbs had ongoing pain and had a secondary surgery performed between 6 and 12 months after the initial surgery. Pain relief was achieved in 1 thumb by scaphotrapezoid arthrodesis and in the other 8 thumbs by excision of the osteophyte on the ulnar-volar surface of the base of the first metacarpal, which was impinging on the base of the second metacarpal or the trapezoid. The gap was filled with a palmaris tendon anchovy. After 12 months, the 65 patients with successful trapeziectomies and APL sling remained pain-free. In these patients tip pinch, key pinch, and power grip strength increased by 46%, 19%, and 41%, respectively, from the preoperative values. In the 35 unilateral cases, tip pinch, key pinch, and power grip strength increased from 53%, 77%, and 65% of the contralateral hand strength before surgery to 82%, 89%, and 90%, respectively. Conclusions: This modified APL sling arthroplasty is a new and effective way of creating a suspension sling with the APL tendon after trapeziectomy, with results comparable or better than other published methods, for the treatment of osteoarthritis of the first carpometacarpal joint. Type of study/level of evidence: Therapeutic, Level IV. © 2007 American Society for Surgery of the Hand
Subacute nerve compressions after trauma and surgery of the hand
No full textBACKGROUND: It is accepted that major injuries of the upper limb may require not only fasciotomies but also nerve decompressions. That nerve compression(s) may occur after less dramatic injuries and "routine" surgery distal to the elbow is less well documented in the literature but well known to experienced clinicians. The aim of this study was to identify a possible link between injuries or elective surgery to the distal upper limb and "subacute nerve compressions." METHODS: Over a 5-year period, data of patients who developed clinical symptoms of nerve compressions distal to the elbow within 6 months after trauma or elective surgery to the same upper limb that affected postoperative management were collected prospectively. RESULTS: This study identified 91 patients (49 after trauma and 42 after elective surgery). Compression of the median nerve in the carpal tunnel was the most common syndrome (73 cases). Fasciectomy for Dupuytren's disease was the most frequent operation involved (23 cases). The average time from injury or surgery to diagnosis of nerve compression(s) was 8 weeks (range, 1 to 24 weeks). Surgical decompression of the involved nerves was performed in 43 patients (47.2 percent), with an average time from diagnosis to surgery of 30.4 weeks (range, 28 to 44 weeks). In the carpal tunnel syndrome group (47 men and 26 women), mean age was 49 years (men, 48 years; women, 50 years) and the male-to-female ratio was 1.8:1. CONCLUSION: Subacute nerve compressions should be considered as a complication during the recovery period after injury and surgery of the upper limb. ©2007American Society of Plastic Surgeons
Hemodynamic changes in the microcirculation of DIEP flaps
No full textPerforator flaps are widely used in reconstructive surgery, but little is known about the hemodynamic changes within these flaps. Recently, the blood velocity in the perforator artery was shown to be higher than that at the source vessel. This study was carried out to demonstrate the effect of this increased velocity within the perforators in the cutaneous microcirculation of the perforator flap. Twenty-six consecutive patients who underwent unilateral immediate breast reconstruction with deep inferior epigastric perforator (DIEP) flaps were selected. A 3-stage prospective study using 2 laser Doppler probes was carried out. Stage 1: preoperative measurements; Stage 2: immediate postoperative measurements; Stage 3: postoperative measurements after 3 months. Statistically significant increase of blood velocity in the microcirculation of DIEP flaps was demonstrated in stages 2 and 3 when compared with stage 1 (P < 0.01, Friedman and Wilcoxon tests). The higher blood velocity within the perforator flap microcirculation may be a favorable rheologic feature of perforator flaps. © 2008 by Lippincott Williams & Wilkins
Squamous cell carcinoma of the lateral nail fold
No full textThe digital nail complex is occasionally involved by squamous cell carcinoma. The published literature has either been indiscriminating of the site of origin of this tumour within the nail complex or has concentrated attention on the nail bed as the site of pathology. Tumours originating in the lateral nail fold can be clearly differentiated from those of the nail bed itself. This study identifies six cases of squamous cell carcinoma arising in the lateral nail fold. While surgical convention remains to amputate the digital tip for squamous cell carcinoma of any part of the nail complex, the dermatological literature identifies that local surgery can be curative for these tumours, when presenting early and without bone involvement, although offering no discussion of reconstruction. Reconstruction is desirable and methods of achieving this following local excision of lateral nail fold tumours are illustrated in this series. © 2005 The British Society for Surgery of the Hand. Published by Elsevier Ltd. All rights reserved
Comment on: Patel SA and Keller A "A theoretical model describing arterial flow in the DIEP flap related to number and size of perforator vessels" <i>J Plast Reconstr Aesthet Surg</i> 2008;61:1316-20
No full textWe read with much interest the article entitled "A theoretical model describing arterial flow in the DIEP flap related to number and size of perforator vessels" by Patel and Keller. We really appreciate the efforts of the authors in trying to investigate the perfusion factors of perforator flaps. As we already reported and supported by the wide experience of several colleagues who internationally have developed this kind of surgical flap, the deep inferior epigastric artery perforator (DIEAP) flap arterial flow is becoming more and more clear. Without any doubts, from a haemodynamic point of view, perforator flaps and particularly the DIEAP flap represent peculiar entities compared to the conventional arterial tree structure of the myocutaneous flaps and the normal circulation
Contralateral DIEV as an interpositional vein graft for venous supercharge in the salvage of a congested DIEP flap
No full textBreast reconstruction using the Profunda Artery Perforator (PAP) flap: technical refinements and evolution, outcomes and patient satisfaction based on 116 consecutive flaps
Full text linkIntroduction: When a deep inferior epigastric artery flap is not suitable, the profunda artery perforator (PAP) flap can be a good alternative for autologous breast reconstruction. Popularity of the PAP flap is expanding, but it is still only slowly being adopted worldwide. We report our experience with 116 consecutive PAP flaps showing refinements and evolution of the technique towards improvement in outcomes and patients’ satisfaction. Methods: We prospectively collected data from consecutive PAP flap breast reconstructions performed from 2016 to 2019. Patients’ demographics, pre-, intra-, postoperative data, and revision procedures were analyzed. The BREAST-Q and a specific questionnaire investigating outcomes at the donor site were completed preoperatively and 12 months postoperatively. Results: One-hundred and sixteen PAP flaps were performed in 86 patients, 64 unilateral and 22 bilateral breast reconstructions. Mean body mass index was 24.72 kg/m 2 (range 18.9–29.2) and mean flap weight was 251.30 g (range 152–455 g). Complications included donor site hematoma (1.7%), seroma (2.6%), fat necrosis (1.7%), and wound dehiscence (2.6%). No arterial/venous thrombosis nor flap losses were recorded. Patients reported high satisfaction in all BREAST-Q domains, with mean postoperative scores being higher than preoperative ones, suggesting a positive effect in quality of life and satisfaction. Scores were significant in the satisfaction with breast domain (p = 0.0016). Conclusions: Breast reconstruction with PAP flap yields a high success, low complications, and excellent cosmetic outcomes in the breast and donor sites. It improves patients’ satisfaction and quality of life; hence, it can be considered an excellent option for autologous breast reconstruction
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