Medicine › Surgery

Reconstructive Surgery and Microvascular Techniques

Works Count: 93288

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Description

This cluster of papers focuses on advancements in microsurgical reconstruction techniques, particularly in the areas of head and neck reconstruction, breast reconstruction, and mandibular reconstruction. The papers cover topics such as free flap and perforator flap surgeries, vascular anatomy, donor-site complications, and surgical outcomes.

Keywords

Microsurgical Reconstruction; Free Flap; Perforator Flap; Head and Neck Reconstruction; Vascular Anatomy; Donor-Site Complications; Mandibular Reconstruction; Breast Reconstruction; Surgical Outcomes; Complications

Free Flap Reexploration: Indications, Treatment, and Outcomes in 1193 Free Flaps

2007-05-23

Duc T. Bui , Peter G. Cordeiro , Qunying Hu +3 more

Background: Microvascular free tissue transfer is a reliable method for reconstruction of complex surgical defects. However, there is still a small risk of flap compromise necessitating urgent reexploration. A comprehensive … Background: Microvascular free tissue transfer is a reliable method for reconstruction of complex surgical defects. However, there is still a small risk of flap compromise necessitating urgent reexploration. A comprehensive study examining the causes and methods of avoiding or treating these complications has not been performed. The purpose of this study was to review the authors' experience with a large number of microvascular complications over an 11-year period. Methods: This was a retrospective review of all free flaps performed from 1991 to 2002 at Memorial Sloan-Kettering Cancer Center. All patients who required emergent reexploration were identified, and the incidence of vascular complications and methods used for their management were analyzed. Results: A total of 1193 free flaps were performed during the study period, of which 6 percent required emergent reexploration. The most common causes for reexploration were pedicle thrombosis (53 percent) and hematoma/bleeding (30 percent). The overall flap survival rate was 98.8 percent. Venous thrombosis was more common than arterial thrombosis (74 versus 26 percent) and had a higher salvage rate (71 versus 40 percent). Salvaged free flaps were reexplored more quickly than failed flaps (4 versus 9 hours after detection; p = 0.01). There was no significant difference in salvage rate in flaps requiring secondary vein grafting or thrombolysis as compared with those with anastomotic revision only. Conclusions: Microvascular free tissue transfer is a reliable reconstructive technique with low failure rates. Careful monitoring and urgent reexploration are critical for salvage of compromised flaps. The majority of venous thromboses can be salvaged. Arterial thromboses can be more problematic. An algorithm for flap exploration and salvage is presented.

THE USE OF TUBES CONSTRUCTED FROM VINYON “N” CLOTH IN BRIDGING ARTERIAL DEFECTS A PRELIMINARY REPORT

1952-03-01

Arthur B. Voorhees , Alfred Jaretzki , Arthur H. Blakemore

Voorhees, Arthur B. JR. M.D.; Jaretzki, Alfred III M.D.; Blakemore, Arthur H. M.D. Author Information Voorhees, Arthur B. JR. M.D.; Jaretzki, Alfred III M.D.; Blakemore, Arthur H. M.D. Author Information

The Vascular Anatomy of Rectus Abdominis Musculocutaneous Flaps Based on the Deep Superior Epigastric System

1988-11-01

Harry K. Moon , G. Ian Taylor

Radiographie studies of the deep superior epigastric artery (DSEA) and its connections within the soft tissues of the abdominal wall were performed in 64 fresh cadavers. The patterns of anastomosis … Radiographie studies of the deep superior epigastric artery (DSEA) and its connections within the soft tissues of the abdominal wall were performed in 64 fresh cadavers. The patterns of anastomosis between the deep superior epigastric artery and the deep inferior epigastric artery (DIEA) were noted. Type I (29 percent) revealed a single deep superior epigastric artery and deep inferior epigastric artery, type II (57 percent) revealed a double-branched system of each vessel, and type III (14 percent) revealed a system of three or more major branches. In each case, the two systems were united by choke vessels in the segment of muscle above the umbilicus. The supply to the various transverse and vertical skin flaps from the deep superior epigastric artery was defined as a series of captured anatomic territories bounded by choke vessels. The upper transverse and vertical flaps had the best supply, and the TRAM flap had the most tenuous supply. Midline crossover occurs predominantly in the subdermal plexus and on the surface of the rectus sheath. Modifications of the design of the TRAM flap, the case for a delay procedure, the wisdom of including a strip of anterior rectus sheath, and the risks of splitting the muscle with respect to its nerve supply and vascular patterns are discussed on an anatomic basis.

Consensus Statement on the Classification and Terminology of Neck Dissection

2008-05-01

K. Thomas Robbins , Ashok R. Shaha , Jesús E. Medina +5 more

<h3>Objective</h3> To update the guidelines for neck dissection terminology, as previously recommended by the American Head and Neck Society. <h3>Participants</h3> Committee for Neck Dissection Classification, American Head and Neck Society; … <h3>Objective</h3> To update the guidelines for neck dissection terminology, as previously recommended by the American Head and Neck Society. <h3>Participants</h3> Committee for Neck Dissection Classification, American Head and Neck Society; representation from the Committee for Head and Neck Surgery and Oncology, American Academy of Otolaryngology–Head and Neck Surgery (T.A.D.). <h3>Evidence</h3> Review of current literature on neck dissection classification. <h3>Consensus Process</h3> Semiannual face-to-face meetings of the Committee for Neck Dissection Terminology and e-mail correspondence. <h3>Conclusions</h3> Standardization of terminology for neck dissection is important for communication among clinicians and researchers. New recommendations have been made regarding the following: boundaries between levels I and II and between levels III/IV and VI; terminology of the superior mediastinal nodes; and the method of submitting surgical specimens for pathologic analysis.

Superiority of the Deep Circumflex Iliac Vessels as the Supply for Free Groin Flaps Clinical Work

1979-12-01

G. Ian Taylor , P.L.G. Townsend , Russell J. Corlett

Taylor, G. Ian F.R.A.C.S.; Townsend, Paul F.R.C.S.; Corlett, Russell F.R.A.C.S. Author Information Taylor, G. Ian F.R.A.C.S.; Townsend, Paul F.R.C.S.; Corlett, Russell F.R.A.C.S. Author Information

The vascular territories (angiosomes) of the body: experimental study and clinical applications

1987-03-01

G. Ian Taylor , John H. Palmer

Fibular Osteoseptocutaneous Flap: Anatomic Study and Clinical Application

1986-08-01

Fu‐Chan Wei , Hung‐Chi Chen , Chwei‐Chin Chuang +1 more

Wei, Fu-Chan M.D.; Chen, Hung-Chi M.D.; Chuang, Chwei-Chin M.D.; Noordhoff, M Samuel M.D., F.A.C.S. Author Information Wei, Fu-Chan M.D.; Chen, Hung-Chi M.D.; Chuang, Chwei-Chin M.D.; Noordhoff, M Samuel M.D., F.A.C.S. Author Information

Angiosomes of the Foot and Ankle and Clinical Implications for Limb Salvage: Reconstruction, Incisions, and Revascularization

2006-06-01

Christopher E. Attinger , Karen K. Evans , Erwin J. Bulan +2 more

Background: Ian Taylor introduced the angiosome concept, separating the body into distinct three-dimensional blocks of tissue fed by source arteries. Understanding the angiosomes of the foot and ankle and the … Background: Ian Taylor introduced the angiosome concept, separating the body into distinct three-dimensional blocks of tissue fed by source arteries. Understanding the angiosomes of the foot and ankle and the interaction among their source arteries is clinically useful in surgery of the foot and ankle, especially in the presence of peripheral vascular disease. Methods: In 50 cadaver dissections of the lower extremity, arteries were injected with methyl methacrylate in different colors and dissected. Preoperatively, each reconstructive patient's vascular anatomy was routinely analyzed using a Doppler instrument and the results were evaluated. Results: There are six angiosomes of the foot and ankle originating from the three main arteries and their branches to the foot and ankle. The three branches of the posterior tibial artery each supply distinct portions of the plantar foot. The two branches of the peroneal artery supply the anterolateral portion of the ankle and rear foot. The anterior tibial artery supplies the anterior ankle, and its continuation, the dorsalis pedis artery, supplies the dorsum of the foot. Blood flow to the foot and ankle is redundant, because the three major arteries feeding the foot have multiple arterial-arterial connections. By selectively performing a Doppler examination of these connections, it is possible to quickly map the existing vascular tree and the direction of flow. Conclusions: Detailed knowledge of the vascular anatomy of the foot and ankle allows the plastic surgeon to plan vascularly sound reconstructions, the foot and ankle surgeon to design safe exposures of the underlying skeleton, and the vascular surgeon to choose the most effective revascularization for a given wound.

The Pectoralis Major Myocutaneous Flap A Versatile Flap for Reconstruction in the Head and Neck

1979-01-01

Stephan Ariyan

New Haven, Conn. Section of Plastic and Reconstructive Surgery of the Yale University School of Medicine. New Haven, Conn. Section of Plastic and Reconstructive Surgery of the Yale University School of Medicine.

Inferior epigastric artery skin flaps without rectus abdominis muscle

1989-11-01

Isao Koshima , Shugo Soeda

Early Microsurgical Reconstruction of Complex Trauma of the Extremities

1986-09-01

Marko Godina

Five hundred and thirty-two patients underwent microsurgical reconstruction following trauma to their extremities. They were divided into three groups for the purpose of review. Group 1 underwent free-flap transfer within … Five hundred and thirty-two patients underwent microsurgical reconstruction following trauma to their extremities. They were divided into three groups for the purpose of review. Group 1 underwent free-flap transfer within 72 hours of the injury, group 2 between 72 hours and 3 months of the injury, and group 3 between 3 months and 12.6 years, with a mean of 3.4 years. The results were analyzed with respect to flap failure, infection, bone-healing time, length of hospital stay, and number of operative procedures. The flap failure rate was 0.75 percent in group 1, 12 percent in group 2, and 9.5 percent in group 3 (p less than 0.0005 early versus delayed; p less than 0.0025 early versus late). Postoperative infection occurred in 1.5 percent of group 1, 17.5 percent of group 2, and 6 percent of group 3. Bone-healing time was 6.8 months in group 1, 12.3 months in group 2, and 29 months in group 3. The average length of total hospital stay was 27 days for group 1, 130 days for group 2, and 256 days for group 3. The number of operations averaged 1.3 for group 1, 4.1 for group 2, and 7.8 for group 3.

The free thigh flap: a new free flap concept based on the septocutaneous artery

1984-04-01

Yeguang Song , Guo-zhang Chen , Yeliang Song

Complications in Postmastectomy Breast Reconstruction: Two-Year Results of the Michigan Breast Reconstruction Outcome Study

2002-06-01

Amy K. Alderman , Edwin G. Wilkins , Hyungjin Myra Kim +1 more

In this study, the effects of procedure type, timing, and other clinical variables on complication rates in mastectomy reconstruction were prospectively evaluated. Using a prospective cohort design, women undergoing firsttime, … In this study, the effects of procedure type, timing, and other clinical variables on complication rates in mastectomy reconstruction were prospectively evaluated. Using a prospective cohort design, women undergoing firsttime, immediate or delayed breast reconstruction were recruited from 12 centers and 23 plastic surgeons. Complication data for expander/implant, pedicle transverse rectus abdominis musculocutaneous (TRAM) flap, and free TRAM flap procedures were evaluated 2 years after surgery in 326 patients. For each patient, the total number of complications was recorded and the complication data were dichotomized in two ways: (1) total complications and (2) major complications (those requiring reoperation, rehospitalization, or nonperioperative intravenous antibiotic treatment). The effects of procedure type, timing, radiotherapy, chemotherapy, age, smoking, and body mass index on complication rates were analyzed using logistic regression. Immediate reconstructions had significantly higher total as well as major complication rates, compared with delayed procedures (p = 0.011 and 0.005, respectively). Furthermore, higher body mass indexes were associated with significantly higher total and major complication rates (p = 0.005 and p < 0.001, respectively). No significant effects on complication rates were noted for procedure type or for the other independent variables, although there was evidence of trends for higher total and major complication rates in implant patients who received radiotherapy and a trend for higher major complication rates in TRAM flap patients who received chemotherapy. It was concluded that (1) immediate reconstructions were associated with significantly higher complication rates than delayed procedures, and (2) procedure type had no significant effect on complication rates. (Plast. Reconstr. Surg. 109: 2265, 2002.)

Skin Island Flaps Supplied by the Vascular Axis of the Sensitive Superficial Nerves

1992-06-01

A. C. Masquelet , Maria Claudia Romaña , G. Wolf

An anatomic study performed on 64 fresh injected legs has shown the role of the vascular axis that follows the superficial sensitive nerves in supplying the skin. Three nerves were … An anatomic study performed on 64 fresh injected legs has shown the role of the vascular axis that follows the superficial sensitive nerves in supplying the skin. Three nerves were studied: the saphenous nerve, the superficial peroneal nerve, and the sural nerve. Conclusions are the same for the three nerves: The vascular axis, which can be either a true artery or an interlacing network, ensures the vascularization of the nerves, gives off several cutaneous branches in the suprafascial course of the nerve, and anastomoses with the septocutaneous arteries issuing from a deep main vessel. The superficial nerves that course the leg can therefore be considered as vascular relays owing to their neurocutaneous arteries. The concept of a neuroskin island flap has been developed and applied to six clinical cases for coverage of some specific areas of the knee and of the lower part of the limb.

One hundred free DIEP flap breast reconstructions: a personal experience

1999-03-01

Phillip Blondeel

Breast Reconstruction with a Transverse Abdominal Island Flap

1982-02-01

Carl R. Hartrampf , Michaël Scheflan , Paul W. Black

Michael Scheflan, M.D. Medical College of Virginia P.O. Box 154, MCV Station Richmond, Va. 2329, Atlanta, Ga., and Richmond, Va. From the Atlanta Plastic Surgery Clink, P.A., the Division of … Michael Scheflan, M.D. Medical College of Virginia P.O. Box 154, MCV Station Richmond, Va. 2329, Atlanta, Ga., and Richmond, Va. From the Atlanta Plastic Surgery Clink, P.A., the Division of Plastic Surgery at the Emory University School of Medicine, and the Department of Surgery. Division of Plastic Surgery, at the Medical College of Virginia.

Subepithelial Connective Tissue Graft Technique for Root Coverage

1985-12-01

Burton Langer , Laureen Langer

This article describes the use of the subepithelial connective tissue graft as a donor source for root coverage. The success of these grafts has been attributed to the double-blood supply … This article describes the use of the subepithelial connective tissue graft as a donor source for root coverage. The success of these grafts has been attributed to the double-blood supply at the recipient site from the underlying connective tissue base and the overlying recipient flap. Four cases have been illustrated to demonstrate the versatility of this procedure for areas of single or multiple root coverage especially in the maxillary arch, coverage of existing crown margins and areas requiring a combination of ridge augmentation and root coverage. An increase of 2 to 6 mm of root coverage has been achieved in 56 cases over 4 years with minimal sulcus depth and no recurrence of recession. The donor site is a closed wound which produces less postoperative discomfort.

Deep Inferior Epigastric Perforator Flap for Breast Reconstruction

1994-01-01

Robert J. Allen , Penny Treece

The ideal material for reconstruction of a breast is fat and skin. Most current methods of autogenous reconstruction use myocutaneous flaps. We investigated the feasibility of transfer of skin and … The ideal material for reconstruction of a breast is fat and skin. Most current methods of autogenous reconstruction use myocutaneous flaps. We investigated the feasibility of transfer of skin and fat from the lower abdomen without muscle sacrifice. The flap is based on one, two, or three perforators of the deep inferior epigastric vessels. The study will demonstrate both experimentally and clinically this original technique for breast reconstruction. Fifteen breasts have been successfully reconstructed with this technique. This technique has all of the advantages of the free transverse rectus abdominis myocutaneous flap with decreased possibility of ventral hernia or muscle weakness.

Neck Dissection Classification Update

2002-07-01

K. Thomas Robbins , Garry Clayman , Paul A. Levine +5 more

Since the first description of the radical neck dissection by George Crile almost a century ago, many variations and modifications of the procedure have been added. These include the functional … Since the first description of the radical neck dissection by George Crile almost a century ago, many variations and modifications of the procedure have been added. These include the functional neck dissection, the modified radical neck dissection, and various selective neck dissections. In response to the need for an organized approach in describing these operations, the Committee for Head and Neck Surgery and Oncology of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) in 1988 initiated an effort to develop a standardized classification system for neck dissection (Table 1). During this process, input was obtained from the Education Committee of the American Society for Head and Neck Surgery (ASHNS) and its Council. The final product, endorsed by the ASHNS and the AAO-HNS, was published in the ARCHIVES 1 and as a monograph 2 by the AAO-HNS in 1991.

Have We Found an Ideal Soft-Tissue Flap? An Experience with 672 Anterolateral Thigh Flaps

2002-06-01

Fu‐Chan Wei , Vivek Jain , Naci Çelik +3 more

The free anterolateral thigh flap is becoming one of the most preferred options for soft-tissue reconstruction. Between June of 1996 and August of 2000, 672 anterolateral thigh flaps were used … The free anterolateral thigh flap is becoming one of the most preferred options for soft-tissue reconstruction. Between June of 1996 and August of 2000, 672 anterolateral thigh flaps were used in 660 patients at Chang Gung Memorial Hospital. Four hundred eighty-four anterolateral thigh flaps were used for head and neck region recontruction in 475 patients, 58 flaps were used for upper extremity reconstruction in 58 patients, 121 flaps were used for lower extremity reconstruction in 119 patients, and nine flaps were used for trunk reconstruction in nine patients. Of the 672 flaps used in total, a majority (439) were musculocutaneous perforator flaps. Sixty-five were septocutaneous vessel flaps. Of these 504 flaps, 350 were fasciocutaneous and 154 were cutaneous flaps. Of the remaining 168 flaps, 95 were musculocutaneous flaps, 63 were chimeric flaps, and the remaining ten were composite musculocutaneous perforator flaps with the tensor fasciae latae. Total flap failure occurred in 12 patients (1.79 percent of the flaps) and partial failure occurred in 17 patients (2.53 percent of the flaps). Of the 12 flaps that failed completely, five were reconstructed with second anterolateral thigh flaps, four with pedicled flaps, one with a free radial forearm flap, one with skin grafting, and one with primary closure. Of the 17 flaps that failed partially, three were reconstructed with anterolateral thigh flaps, one with a free radial forearm flap, five with pedicled flaps, and eight with primary suture, skin grafting, and conservative methods. In this large series, a consistent anatomy of the main pedicle of the anterolateral thigh flap was observed. In cutaneous and fasciocutaneous flaps, the skin vessels (musculocutaneous perforators or septocutaneous vessels) were found and followed until they reached the main pedicle, regardless of the anatomic position. There were only six cases in this series in which no skin vessels were identified during the harvesting of cutaneous or fasciocutaneous anterolateral thigh flaps. In 87.1 percent of the cutaneous or fasciocutaneous flaps, the skin vessels were found to be musculocutaneous perforators; in 12.9 percent, they were found as septocutaneous vessels. The anterolateral thigh flap is a reliable flap that supplies a large area of skin. This flap can be harvested irrespective of whether the skin vessels are septocutaneous or musculocutaneous. It is a versatile soft-tissue flap in which thickness and volume can be adjusted for the extent of the defect, and it can replace most soft-tissue free flaps in most clinical situations.

A Prospective Study of Microvascular Free-Flap Surgery and Outcome

1998-09-01

Roger K. Khouri , Brian C. Cooley , Allen R. Kunselman +6 more

Over a 6-month period, 23 members of the International Microvascular Research Group participated in a prospective survey of their microvascular free-flap practice. Data were recorded with each case for 60 … Over a 6-month period, 23 members of the International Microvascular Research Group participated in a prospective survey of their microvascular free-flap practice. Data were recorded with each case for 60 variables covering patient characteristics, surgical technique, pharmacologic treatment, and postoperative outcome. A total of 493 free flaps were reported with a representative demographic distribution for age, sex, indications for surgery, risk factors, flap type, surgical technique, and pharmacologic intervention. Mixed effects logistic regression modeling was used to determine predictors of flap failure and associated complications. The overall incidence of flap failure was 4.1 percent (20 of 493). Reconstruction of an irradiated recipient site and the use of a skin-grafted muscle flap were the only statistically significant predictors of flap failure, with increased odds of failure of 4.2 (p = 0.01) and 11.1 (p = 0.03), respectively. A postoperative thrombosis requiring re-exploration surgery occurred in 9.9 percent of the flaps. The incidence of this complication was significantly higher when the flap was transferred to a chronic wound and when vein grafts were needed, with increased odds of failure of 2.9 (p = 0.02) and 2.5 (p = 0.02), respectively. There was a lower incidence of postoperative thrombosis when rectus/transverse rectus abdominis muscle (TRAM) flaps were used, where odds of failure decreased by 0.36 (p = 0.04), and when subcutaneous heparin was administered in the postoperative period, where odds decreased by 0.27 (p = 0.04). There was an overall 69-percent salvage rate for flaps identified with a postoperative thrombosis. Intraoperative thrombosis occurred in 41 cases (8.3 percent) and was observed more frequently in myocutaneous flaps or when vein grafts were needed (5.5 and 5.0 greater odds, respectively; p < 0.001) but was not associated with higher flap failure (2 of 41 cases; 4.9-percent failure rate). The incidence of a hematoma and/or hemorrhage was increased in obese patients and when vein grafts were needed [2.7 (p = 0.02) and 2.6 (p = 0.03) greater odds, respectively], whereas this complication was significantly decreased in muscle flaps (myocutaneous or skin-grafted muscle), in tobacco users, when a heparinized solution was used for general wound irrigation, and when the attending surgeon performed the arterial anastomosis (in contrast to the resident or fellow on staff) (p < 0.05 for each factor). With the multivariable analysis, many factors were found not to have a significant effect on flap outcome, including the recipient site (e.g., head/neck, breast, lower limb, etc.); indications for surgery (trauma, cancer, etc.); flap transfer in extremes of age, smokers, or diabetics; arterial anastomosis with an end-to-end versus end-to-side technique; irrigation of the vessel without or with heparin added to the irrigation solution; and a wide spectrum of antithrombotic drug therapies. These results present a current baseline for free-flap surgery to which future advances and improvements in technique and practice may be compared. (Plast. Reconstr. Surg. 102: 711, 1998.)

THE FREE VASCULARIZED BONE GRAFT

1975-05-01

G. Ian Taylor , GRAEME D. H. MILLER , FRANK J. HAM

For the common problem of lower limb injury with extensive. Loss of skin and bone, a new method of free vascularized bone grafting has been used and integrated with an … For the common problem of lower limb injury with extensive. Loss of skin and bone, a new method of free vascularized bone grafting has been used and integrated with an appropriate soft tissue flap repair. The technique was developed to salvage two legs which would otherwise have been amputated. The preliminary result in Case 2 is encouraging. This case would appear to be the first successful distant transfer of a composite fibular graft by microvascular anastomoses to be reported in man.

The groin flap

1972-01-01

Ian A. McGregor , Ian T. Jackson

Iliac Crest Bone Graft Harvest Donor Site Morbidity

1995-05-01

J Christopher Banwart , Marc A. Asher , Ruth S. Hassanein

Study Design. This study analyzed the cause, rate, and risk factors of iliac crest bone graft donor site morbidity. Objectives. All complications or problems, no matter how small, were sought … Study Design. This study analyzed the cause, rate, and risk factors of iliac crest bone graft donor site morbidity. Objectives. All complications or problems, no matter how small, were sought to develop strategies of prevention. Summary of Background Data. A wide range of major, 0.76% (Keller et al) to 25% (Summers et al) and minor complications, 9.4% (Keller et al) to 24% (Summers et al) has been reported. Methods. A consecutive series of 261 patients, whose bone graft harvest was done by one surgeon, was studied by chart review and a mail survey that was not conducted by the operating surgeon. The survey presented specific open-ended questions designed to uncover any complication/problem, no matter how small. Complications then were categorized as major or minor and subcategorized as acute or chronic. Statistical analysis was done using chi-squared and multiple logistical regression. Results. None of the 261 patients had a severe perioperative complication—e.g., superior gluteal artery injury, sciatic nerve injury, or deep wound infection. None of the 225 patients with long term follow-up (average, 66 months; range, 32-105 months) had a severe late complication—e.g., donor site herniation, meralgia paresthetica, pelvic instability, or fracture. Of the 180 patients meeting the qualifications for statistical analysis, major complications occurred in 18 (10% ), only three of which affected function (pain). Minor complications occurred in 70 (39% ). Conclusions. The results indicated that severe complications from iliac crest bone graft harvest can be avoided and major complications affecting functioning are uncommon, but minor complications are common. The findings suggest that procedural refinements of limiting subcutaneous dissection and providing layered tension-free incision closure may improve results.

The Vascular Territories of the Superior Epigastric and the Deep Inferior Epigastric Systems

1984-01-01

J. Brian Boyd , G. Ian Taylor , Russell J. Corlett

Boyd, J. Brian F.R.C.S., F.R.C.S.(C); Taylor, G. Ian F.R.C.S., F.R.A.C.S.; Corlett, Russell F.R.A.C.S. Author Information Boyd, J. Brian F.R.C.S., F.R.C.S.(C); Taylor, G. Ian F.R.C.S., F.R.A.C.S.; Corlett, Russell F.R.A.C.S. Author Information

Outcome of Salvage Total Laryngectomy Following Organ Preservation Therapy

2003-01-01

Randal S. Weber , Brian Berkey , Arlene A. Forastiere +7 more

<h3>Objective</h3> To evaluate the incidence of morbidity, mortality, and disease control for patients requiring salvage total laryngectomy (TL) following organ preservation therapy. <h3>Design</h3> Patients entered into a 3-arm randomized prospective … <h3>Objective</h3> To evaluate the incidence of morbidity, mortality, and disease control for patients requiring salvage total laryngectomy (TL) following organ preservation therapy. <h3>Design</h3> Patients entered into a 3-arm randomized prospective multi-institutional trial for laryngeal preservation who required TL following initial treatment. <h3>Setting</h3> The Radiation Therapy Oncology Group 91-11 trial for laryngeal preservation. <h3>Patients</h3> From 1992 to 2000, 517 evaluable patients were randomized to receive chemotherapy followed by radiation therapy (arm 1), concomitant chemotherapy and radiation therapy (arm 2), or radiation therapy alone (arm 3). <h3>Results</h3> Overall, TL was required in 129 patients. The incidence was 28%, 16%, and 31% in arms 1, 2, and 3, respectively (<i>P</i>= .002). Of these, 7 patients (5%) required TL for aspiration or necrosis. Following TL, the incidence of major and minor complications ranged from 52% to 59% and did not differ significantly among the 3 arms. Pharyngocutaneous fistula was lowest in arm 3 (15%) and highest in arm 2 (30%) (<i>P</i>>.05). There was 1 perioperative death. Local-regional control following salvage TL was 74% for arms 1 and 2 and 90% for arm 3. At 24 months, the overall survival was 69% (arm 1), 71% (arm 2), and 76% (arm 3) (<i>P</i>>.73). <h3>Conclusions</h3> Laryngectomy following organ preservation treatment is associated with acceptable morbidity. Perioperative mortality is low but up to one third of patients will develop a pharyngocutaneous fistula. Local-regional control is excellent for this group of patients. Survival following salvage TL was not influenced by the initial organ preservation treatment.

The fasciocutaneous flap: its use in soft tissue defects of the lower leg

1981-04-01

Bengt Pontén

The Osteocutaneous Scapular Flap for Mandibular and Maxillary Reconstruction

1986-04-01

William M. Swartz , Joseph C. Banis , E. Douglas Newton +3 more

Microfil injections in 8 cadavers and clinical experience with 26 patients have demonstrated a reliable blood supply to the lateral border of the scapula based on branches of the circumflex … Microfil injections in 8 cadavers and clinical experience with 26 patients have demonstrated a reliable blood supply to the lateral border of the scapula based on branches of the circumflex scapular artery. This tissue has been used successfully for reconstruction of a variety of defects resulting from maxillectomy and mandibular defects from cancer and benign tumor excisions. Advantages of this tissue over previous reconstructive methods include the ability to design multiple cutaneous panels on a separate vascular pedicle from the bone flap allowing improvement in three-dimensional spatial relationships for complex mandibular and maxillary reconstructions. The lateral border of the scapula provides up to 14 cm of thick, straight corticocancellous bone that can be osteotomized where desired. The thin blade of the scapula provides optimum tissues for palate and orbital floor reconstruction. There have been no flap failures and minimal donor-site complications.

The Perforasome Theory: Vascular Anatomy and Clinical Implications

2009-10-21

Michel Saint‐Cyr , Corrine Wong , Mark V. Schaverien +2 more

Background: A clear understanding of the vascular anatomy of an individual perforator relative to its vascular territory and flow characteristics is essential for both flap design and harvest. The authors … Background: A clear understanding of the vascular anatomy of an individual perforator relative to its vascular territory and flow characteristics is essential for both flap design and harvest. The authors investigated the three-dimensional and four-dimensional arterial vascular territory of a single perforator, termed a “perforasome,” in major clinically relevant areas of the body. Methods: A vascular anatomy study was performed using 40 fresh cadavers. A total of 217 flaps and arterial perforasomes were studied. Dissection of all perforators was performed under loupe magnification. Perforator flaps on the anterior trunk, posterior trunk, and extremities were studied. Flaps underwent both static (three-dimensional) and dynamic (four-dimensional) computed tomographic angiography to better assess vascular anatomy, flow characteristics, and the contribution of both the subdermal plexus and fascia to flap perfusion. Results: The perfusion and vascular territory of perforators is highly complex and variable. Each perforasome is linked with adjacent perforasomes by means of two main mechanisms that include both direct and indirect linking vessels. Vascular axis follows the axiality of linking vessels. Mass vascularity of a perforator found adjacent to an articulation is directed away from that same articulation, whereas perforators found at a midpoint between two articulations, or midpoint in the trunk, have a multidirectional flow distribution. Conclusions: Each perforator holds a unique vascular territory (perforasome). Perforator vascular supply is highly complex and follows some common guidelines. Direct and indirect linking vessels play a critical part in perforator flap perfusion, and every clinically significant perforator has the potential to become either a pedicle or free perforator flap.

Standardizing Neck Dissection Terminology: Official Report of the Academy's Committee for Head and Neck Surgery and Oncology

1991-06-01

K. Thomas Robbins , Jesús E. Medina , G. T. Wolfe +3 more

The emergence of the multitude of modified techniques for neck dissection procedure has resulted in a nomenclature system that is nonuniform. To eliminate potential misinterpretation, overlap, and lack of standardization, … The emergence of the multitude of modified techniques for neck dissection procedure has resulted in a nomenclature system that is nonuniform. To eliminate potential misinterpretation, overlap, and lack of standardization, the Academy's Committee for Head and Neck Surgery and Oncology, with input from the Education Committee of the American Society of Head and Neck Surgery, has developed a classification system for these procedures. This has now been adopted by the American Academy of Otolaryngology-Head and Neck Surgery. The classification is based on the following concepts: (1) radical neck dissection is the fundamental procedure with which all other neck dissections are compared, (2) modified radical neck dissection denotes preservation of one or more nonlymphatic structure(s), (3) selective neck dissection denotes preservation of one or more group(s) of lymph nodes, and (4) extended radical neck dissection denotes removal of one or more additional lymphatic and/or nonlymphatic structure(s). Adherence to the principles of this classification system to describe neck dissection techniques should provide an improved method of communication. Furthermore, the system provides a rational framework on which subsequent terminology can be added.

Anatomic Variations and Technical Problems of the Anterolateral Thigh Flap: A Report of 74 Cases

1998-10-01

Yoshihiro Kimata , Kiyotaka Uchiyama , Satoshi Ebihara +2 more

We have transferred 74 free or pedicled anterolateral thigh flaps, including those combined with other flaps, for reconstruction of various types of defects. We report several anatomic variations of the … We have transferred 74 free or pedicled anterolateral thigh flaps, including those combined with other flaps, for reconstruction of various types of defects. We report several anatomic variations of the lateral circumflex arterial system and discuss some technical problems with this flap. Septocutaneous perforators were found in 28 of 74 cases (37.8 percent), and no perforators were found in 4 cases (5.4 percent). In the 70 cases with perforators, 171 tiny cutaneous perforators (an average of 2.31 per case) were found. Musculocutaneous perforators (81.9 percent) were much more common than septocutaneous perforators (18.1 percent). Perforators were concentrated near the midpoint of the lateral thigh, and the selection of perforators as nutrient vessels for the anterolateral thigh flap was related to the length of the pedicle and the thickness of the skin flap. Anatomic variations of the branching pattern of perforators were classified into eight types. Flaps with perforators that arise directly from the profunda femoris artery are difficult to combine with other free flaps. Because the perforators are extremely small and tend to thrombose soon after congestion develops, these flaps are difficult to salvage with recirculation surgery. Therefore, several perforators should be included with the flap, if possible. The descending artery of the lateral circumflex femoral artery was always accompanied by two veins with different back-flow strengths. Therefore, veins for microsurgical anastomosis must be chosen carefully. Because it is nourished by several perforators arising from the descending artery, the vastus lateralis muscle can be combined with the anterolateral thigh flap. However, splitting the muscle longitudinally without harvesting its blood supply is complicated because its fibers are oblique. The rectus femoris muscle can also be combined with the anterolateral thigh flap, but its pedicle is short and its origin is very near the site of anastomosis. When the anterolateral thigh flap is combined with the tensor fasciae latae musculocutaneous flap, the large skin area of the lateral part of thigh can be transferred to repair the massive defects. The anterolateral thigh flap has many advantages and can be used to reconstruct many types of defect. However, anatomic variations must be considered if the flap is to be used safely and reliably. (Plast. Reconstr. Surg. 102: 1517, 1998.)

SUCCESSFUL REPLANTATION OF A COMPLETELY CUT-OFF THUMB

1968-10-01

SHIGEO KOMATSU , Susumu Tamai

cLassificaTion of The VascULar anaTomy of mUscLes: experimenTaL and cLinicaL correLaTion 1981

2014-10-09

Stephen J. Mathes , Foad Nahai

Five patterns of muscle circulation, based on studies of the vascular anatomy of muscle, are described. Clinical and experimental correlation of this classification is determined by the predictive value of … Five patterns of muscle circulation, based on studies of the vascular anatomy of muscle, are described. Clinical and experimental correlation of this classification is determined by the predictive value of the vascular pattern of each muscle currently useful in reconstructive surgery in regard to the following parameters: arc of rotation, skin territory, distally based flaps, microvascular composite tissue transplantation, and design of muscle-delay experimental models. This classification is designed to assist the surgeon both in choice and design of the muscle and musculocutaneous flap for its use in reconstructive surgery.

Historical Review and Present Status of Free Fat Graft Autotransplantation in Plastic and Reconstructive Surgery

1989-02-01

Edmund Billings , James W. May

Boston, Mass. Division of Plastic and Reconstructive Surgery and the Hand Surgery Service, Department of General Surgery, at Massachusetts General Hospital and Harvard Medical School. Boston, Mass. Division of Plastic and Reconstructive Surgery and the Hand Surgery Service, Department of General Surgery, at Massachusetts General Hospital and Harvard Medical School.

A 10-Year Retrospective Review of 758 DIEP Flaps for Breast Reconstruction

2004-03-19

Paul Singh Gill , John P. Hunt , Aldo Benjamin Guerra +6 more

This study examined 758 deep inferior epigastric perforator flaps for breast reconstruction, with respect to risk factors and associated complications. Risk factors that demonstrated significant association with any breast or … This study examined 758 deep inferior epigastric perforator flaps for breast reconstruction, with respect to risk factors and associated complications. Risk factors that demonstrated significant association with any breast or abdominal complication included smoking (p = 0.0000), postreconstruction radiotherapy (p = 0.0000), and hypertension (p = 0.0370). Ninety-eight flaps (12.9 percent) developed fat necrosis. Associated risk factors were smoking (p = 0.0226) and postreconstruction radiotherapy (p = 0.0000). Interestingly, as the number of perforators increased, so did the incidence of fat necrosis. There were only 19 cases (2.5 percent) of partial flap loss and four cases (0.5 percent) of total flap loss. Patients with 45 flaps (5.9 percent) were returned to the operating room before the second-stage procedure. Patients with 29 flaps (3.8 percent) were returned to the operating room because of venous congestion. Venous congestion and any complication were observed to be statistically unrelated to the number of venous anastomoses. Overall, postoperative abdominal hernia or bulge occurred after only five reconstructions (0.7 percent). Complication rates in this large series were comparable to those in retrospective reviews of pedicle and free transverse rectus abdominis musculocutaneous flaps. Previous studies of the free transverse rectus abdominis musculocutaneous flap described breast complication rates ranging from 8 to 13 percent and abdominal complication rates ranging from 0 to 82 percent. It was noted that, with experience in microsurgical techniques and perforator selection, the deep inferior epigastric perforator flap offers distinct advantages to patients, in terms of decreased donor-site morbidity and shorter recovery periods. Mastery of this flap provides reconstructive surgeons with more extensive options for the treatment of postmastectomy patients.

VAGINAL RECONSTRUCTION WITH GRACILIS MYOCUTANEOUS FLAPS

1976-08-01

John B. McCraw , Fred M. Massey , KENNETH D. SHANKLIN +1 more

MCCRAW, JOHN B. M.D.; MASSEY, FRED M. M.D.; SHANKLIN, KENNETH D. M.D.; HORTON, CHARLES E. M.D. Author Information MCCRAW, JOHN B. M.D.; MASSEY, FRED M. M.D.; SHANKLIN, KENNETH D. M.D.; HORTON, CHARLES E. M.D. Author Information

Latissimus Dorsi Musculocutaneous Flap Without Muscle

1995-12-01

Claudio Angrigiani , Daniel Grilli , John W. Siebert

The possibility of raising the cutaneous island of the latissimus dorsi musculocutaneous flap without muscle based on only one cutaneous perforator is presented in this paper. An anatomic study performed … The possibility of raising the cutaneous island of the latissimus dorsi musculocutaneous flap without muscle based on only one cutaneous perforator is presented in this paper. An anatomic study performed in 40 fresh cadaver specimens injected with colored latex demonstrated that the vertical intramuscular branch of the thoracodorsal artery gives off two to three cutaneous branches (perforators) that are consistently present. The largest one, measuring approximately 0.4 to 0.6 mm in diameter, provides the blood supply to a 25 x 15 cm cutaneous island. The incorporation of the proximal trunk of the thoracodorsal artery lengthens the pedicle, facilitating the anastomosis or the arc of rotation (in the case of island flaps) but does not increase the amount of tissue transferable. Five clinical cases were done with this technique without tissue necrosis or flap loss.

Reconstruction of the maxilla and midface: introducing a new classification

2010-10-01

James S. Brown , Richard Shaw

Analysis of Outcome and Complications in 400 Cases of Microvascular Head and Neck Reconstruction

2004-08-01

Jeffrey D. Suh , Joel A. Sercarz , Elliot Abemayor +4 more

To determine the incidence and causes of perioperative complications in patients who undergo microvascular free flap procedures for reconstruction of the head and neck.Academic tertiary care medical center.A total of … To determine the incidence and causes of perioperative complications in patients who undergo microvascular free flap procedures for reconstruction of the head and neck.Academic tertiary care medical center.A total of 400 consecutive microvascular free flap procedures were performed for reconstruction of the head and neck, with 95% of the defects arising after the treatment of malignancies. Flap donor sites included radial forearm (n = 183), fibula (n = 145), rectus abdominis (n = 38), subscapular system (n = 28), iliac crest (n = 5), and a jejunal flap. Patient-related characteristics (age; sex; diagnosis; comorbidity level; tumor stage; defect site; primary vs secondary reconstruction; and history of surgery, radiation therapy, or chemotherapy) and the incidence of perioperative complications were recorded prospectively over a 7-year period.The perioperative mortality was 1.3%. Overall, perioperative complications occurred in 36.1% of all cases. Free flaps proved to be extremely reliable, with a 0.8% incidence of free flap failure and a 3% incidence of partial flap necrosis. Perioperative medical complications occurred in 20.5% of cases, with pulmonary, cardiac, and infectious complications predominating. Multivariate statistical analysis showed significant relationships between the incidence of perioperative complications and preoperative comorbidity level as indicated by American Society of Anesthesiologists (ASA) status (P =.02).The present study confirms that free flaps are extremely reliable in achieving successful reconstruction of the head and neck. The incidence of perioperative complications is related to preoperative comorbidity level.

Breast Reconstruction with the Free TRAM or DIEP Flap: Patient Selection, Choice of Flap, and Outcome

2002-08-01

Maurice Y. Nahabedian , Bahram Momen , Gregory M. Galdino +1 more

Recent reports of breast reconstruction with the deep inferior epigastric perforator (DIEP) flap indicate increased fat necrosis and venous congestion as compared with the free transverse rectus abdominis muscle (TRAM) … Recent reports of breast reconstruction with the deep inferior epigastric perforator (DIEP) flap indicate increased fat necrosis and venous congestion as compared with the free transverse rectus abdominis muscle (TRAM) flap. Although the benefits of the DIEP flap regarding the abdominal wall are well documented, its reconstructive advantage remains uncertain. The main objective of this study was to address selection criteria for the free TRAM and DIEP flaps on the basis of patient characteristics and vascular anatomy of the flap that might minimize flap morbidity. A total of 163 free TRAM or DIEP flap breast reconstructions were performed on 135 women between 1997 and 2000. Four levels of muscle sparing related to the rectus abdominis muscle were used. The free TRAM flap was performed on 118 women, of whom 93 were unilateral and 25 were bilateral, totaling 143 flaps. The DIEP flap procedure was performed on 17 women, of whom 14 were unilateral and three were bilateral, totaling 20 flaps. Morbidities related to the 143 free TRAM flaps included return to the operating room for 11 flaps (7.7 percent), total necrosis in five flaps (3.5 percent), mild fat necrosis in 14 flaps (9.8 percent), mild venous congestion in two flaps (1.4 percent), and lower abdominal bulge in eight women (6.8 percent). Partial flap necrosis did not occur. Morbidities related to the 20 DIEP flaps included return to the operating room for three flaps (15 percent), total necrosis in one flap (5 percent), and mild fat necrosis in two flaps (10 percent). Partial flap necrosis, venous congestion, and a lower abdominal bulge were not observed. Selection of the free TRAM or DIEP flap should be made on the basis of patient weight, quantity of abdominal fat, and breast volume requirement, and on the number, caliber, and location of the perforating vessels. Occurrence of venous congestion and total flap loss in the free TRAM and DIEP flaps appears to be independent of the patient age, weight, degree of muscle sparing, and tobacco use. The occurrence of fat necrosis is related to patient weight (p < 0.001) but not related to patient age or preservation of the rectus abdominis muscle. The ability to perform a sit-up is related to patient weight (p < 0.001) and patient age (p < 0.001) but not related to preservation of the muscle or intercostal nerves. The incidence of lower abdominal bulge is reduced after DIEP flap reconstruction (p < 0.001). The DIEP flap can be an excellent option for properly selected women. (Plast. Reconstr. Surg. 110: 466, 2002.)

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The donor site morbidity of free DIEP flaps and free TRAM flaps for breast reconstruction

1997-07-01

Phillip Blondeel , Guy Vanderstraeten , Stan Monstrey +5 more

Augmentation procedures for the rehabilitation of deficient edentulous ridges with oral implants

2006-09-01

Matteo Chiapasco , Marco Zaniboni , Maurizio Boisco

Abstract Objectives: To analyze publications related to augmentation procedures and to evaluate the success of different surgical techniques for ridge reconstruction and the survival/success rates of implants placed in the … Abstract Objectives: To analyze publications related to augmentation procedures and to evaluate the success of different surgical techniques for ridge reconstruction and the survival/success rates of implants placed in the augmented areas. Material and methods: Clinical investigations published in English involving at least 5 patients and with a minimum follow‐up of 6 months were included. The following procedures were considered: a) Guided bone regeneration (GBR); 2) Onlay bone grafts; 3) Inlay grafts; 4) Bone splitting for ridge expansion (RE); 5) Distraction osteogenesis (DO); and 6) Revascularized flaps. Success rates of augmentation procedures and related morbidity, as well as survival and success rates of implants placed in the augmented sites were analyzed. Results: Success rates of surgical procedures ranged from 60% to 100% for GBR, from 92% to 100% for onlay bone grafts, from 98% to 100% for ridge expansion techniques, from 96,7% to 100% for DO, and was 87.5% for revascularized flaps, whereas survival rates of implants ranged from 92% to 100% for GBR, from 60% to 100% for onlay bone grafts, from 91% to 97.3% for RE, from 90.4% to 100% for DO, and, finally, was 88.2% for revascularized flaps. Conclusion: On the basis of available data it was shown that it was difficult to demonstrate that a particular surgical procedure offered better outcome as compared to another. The main limit encountered in this review has been the overall poor methodological quality of the published articles. Therefore larger well‐designed long term trials are needed.

Fibula free flap: A new method of mandible reconstruction

1990-02-01

H. Tideman

Optical and electro-optical information processing

1966-06-01

E. B. Brown

The forearm flap.

1982-01-01

R Song , Yuguang Gao , Yingna Song +1 more

Classification of the Vascular Anatomy of Muscles

1981-02-01

Stephen J. Mathes , Foad Nahai

San Francisco, Calif., and Atlanta, Ga. From the Division of Plastic and Reconstructive Surgery at the University of California, San Francisco, and the Division of Plastic and Reconstructive Surgery at … San Francisco, Calif., and Atlanta, Ga. From the Division of Plastic and Reconstructive Surgery at the University of California, San Francisco, and the Division of Plastic and Reconstructive Surgery at Emory University Clinic, Atlanta, Ga.

A Prospective Study of Microvascular Free-Flap Surgery and Outcome

1998-09-01

Roger K. Khouri , Brian C. Cooley , Allen R. Kunselman +6 more

Fibula Free Flap

1989-07-01

David A. Hidalgo

The fibula was investigated as a donor site for freeflap mandible reconstruction. It has the advantages of consistent shape, ample length, distant location to allow a two-team approach, and low … The fibula was investigated as a donor site for freeflap mandible reconstruction. It has the advantages of consistent shape, ample length, distant location to allow a two-team approach, and low donor-site morbidity. It can be raised with a skin island for composite-tissue reconstruction. Twelve segmental mandibular defects (average 13.5 cm) were reconstructed following resection for tumor, most commonly epidermoid carcinoma. Five defects consisted of bone alone, and four others had only a small amount of associated intraoral soft-tissue loss. Eleven patients underwent primary reconstructions. At least two osteotomies were performed on each graft, and mini-plates were used for fixation in 11 patients. Six patients received postoperative radiation, and two patients received postoperative chemotherapy. The flaps survived in all patients. All osteotomies healed primarily. The septocutaneous blood supply was generally not adequate to support a skin island for intraoral soft-tissue replacement. The aesthetic result of the reconstruction was excellent in most patients, particularly in "bone only" defects. There was no long-term donor-site morbidity.

The Forearm Flap

1982-01-01

Ruyao Song , Yuzhi Cao , Yeguang Song +2 more

Spreader Graft

1984-02-01

Jack H. Sheen

Los Angeles, Calif. From the Department of Surgery, Division of Plastic Surgery, at the UCLA School of Medicine. 9201 Sunset Boulevard, Suite 814 Los Angeles, Calif. 90069 Los Angeles, Calif. From the Department of Surgery, Division of Plastic Surgery, at the UCLA School of Medicine. 9201 Sunset Boulevard, Suite 814 Los Angeles, Calif. 90069

Evaluation and Management of Fingertip Injuries in Plastic Surgery Department in Nepal Medical College: A Retrospective Study

2025-06-25

Sunil Singh Thapa , Niraj Acharya , Baburam Dixit Thapa +1 more | Nepal Medical College Journal

Our daily activities to professional handicrafts require the use of fingertips one way or other and such important anatomical parts are prone to significant injuries either at home or at … Our daily activities to professional handicrafts require the use of fingertips one way or other and such important anatomical parts are prone to significant injuries either at home or at work. The injuries if not managed properly can lead to devastating consequences with significant disability. The aim of this study was to identify the incidence of such injuries and the causes behind them along with the treatment options. A retrospective, hospital based study evaluating fingertip injuries at Nepal Medical College Teaching Hospital was conducted from April of 2023 to September 2024. Patients with fingertip injuries presenting to outpatient departments and emergencies were enrolled in this study. Total of 117 patients were enrolled with mean age of 27.37 years and 81.2% were males. Most of the injuries had occurred at workplace (64.1%) and most common mode of injury was cut injury (74.1%). Long finger was most commonly injured finger (25.6%) followed closely by index finger (23.9%) and thumb (16.2%). Allens type 2 was the most common grade of injury (78.6%). Primary repair was successfully performed in most of the patients (82.9%). Some patients required thenar flap (8.5%), V-Y flap (3.4%), cross finger flap (1.7%), FDMA flap (0.9%) and amputation (2.6%). Cut injuries were the most common mode of injury primarily affecting adult males in industrial settings so workplace safety protocols should be implemented to reduce the incidence of these injuries. Different patients and different grades of injuries require different approaches so as to approach each case uniquely.

Anatomical Mapping of Temporalis Muscle Arterial Origins Relative to Cranial Landmarks: A Cadaveric Study

2025-06-25

Necati Salman , Si̇mel Kendi̇r , Mehmet Yılmaz +4 more | Bratislavské lekárske listy/Bratislava medical journal

Abstract Background The temporalis muscle receives a dual blood supply from the maxillary artery (anterior “ADTA” and posterior deep temporal artery “PDTA” branches) and the superficial temporal artery “STA” (middle … Abstract Background The temporalis muscle receives a dual blood supply from the maxillary artery (anterior “ADTA” and posterior deep temporal artery “PDTA” branches) and the superficial temporal artery “STA” (middle temporal artery “MTA” branch). This study aims to map the origin points of these arteries using fixed cranial bony landmarks to improve anatomical understanding and enhance surgical safety in the temporal region. Method The study was conducted on 19 hemifaces from 10 embalmed cadavers, in which the arteries were filled with a latex-based liquid material. Reference axes were established based on posterior corner of the zygomatic arch to localize the arterial origins systematically. Measurements were obtained for the origins of the STA, MTA, ADTA, and PDTA. These coordinates were transferred to millimetric paper for visual mapping. Statistical analysis assessed differences based on sex, side, and cranial dimensions. Results Morphometric analysis confirmed consistent anatomical points across specimens, with no significant differences related to sex or laterality. Arterial origins followed predictable patterns along the defined reference axes. The STA bifurcated superior to the horizontal reference line corresponding to the anatomical location of the zygomatic arch, and the deep temporal arteries followed a posterior-to-anterior sequence. The mean distances to this line were 18.89 ± 9.40 mm superior for the STA bifurcation, 22.79 ± 8.84 mm inferior for the MTA, 23.15 ± 3.14 mm inferior for the PDTA, and 28.01 ± 6.59 mm inferior for the ADTA. Conclusion Arterial origins in the anterior third of the zygomatic region were fewer and positioned more distally. This area is considered safer for surgical dissections compared to the middle and posterior thirds.

Propeller Flap Based on the Ulnar Artery Perforator for the Closure of Defects Following the Harvesting of a Radial Forearm Free Flap

2025-06-25

F. Javier Salazar , Paolo Cariati , Fernando Monsalve Iglesias +3 more | Journal of Craniofacial Surgery

The reconstruction of skin defects in the forearm following radial forearm free flap harvesting is challenging due to the limited availability of local soft tissue. Traditional skin grafts often lead … The reconstruction of skin defects in the forearm following radial forearm free flap harvesting is challenging due to the limited availability of local soft tissue. Traditional skin grafts often lead to complications such as partial or total graft loss and suboptimal aesthetic outcomes. The perforator-based propeller flap, utilizing the ulnar artery perforator, has emerged as an effective solution for such reconstructions. This fasciocutaneous rotational flap, designed in a helix shape, provides stable coverage without compromising the vascular pedicle. Its advantages include aesthetic outcomes, functional recovery, and primary closure of the donor site, eliminating the need for additional grafts. The surgical technique involves careful preoperative planning, identification of robust perforators, and precise flap elevation while preserving vascular structures. Although the technique requires meticulous dissection and presents anatomical variability, its reliability in covering tendinous and neural structures of the forearm has been well established. The authors present 2 clinical cases of patients with squamous cell carcinoma, who underwent tumor resection and defect reconstruction using a radial forearm free flap. The propeller flap provided excellent defect coverage, with satisfactory functional and aesthetic results. Close monitoring of flap perfusion in the postoperative period is essential. These outcomes suggest that the propeller flap is a preferred option for forearm defect reconstruction following radial forearm flap harvesting. In conclusion, the ulnar artery perforator-based propeller flap is an innovative and effective technique that offers significant benefits in reconstructive surgery.

Preoperative Imaging Review Predicts the Complex Venous Anatomy of the Submental Island Flap

2025-06-25

Abigale R. Aldrich , Ashley M. Dorneden , Nathan H. Boyd +2 more | Annals of Otology Rhinology & Laryngology

Objectives: The submental island flap is a dependable option for head and neck reconstruction. Venous drainage depends on the submental vein, which typically drains into the facial vein and, subsequently, … Objectives: The submental island flap is a dependable option for head and neck reconstruction. Venous drainage depends on the submental vein, which typically drains into the facial vein and, subsequently, the internal jugular vein. Variations in venous anatomy often involve drainage into the anterior jugular or external jugular venous systems. This study evaluates the likelihood of encountering submental venous anatomy variants and the accuracy of preoperative imaging in identifying them. Methods: Twenty-two patients who underwent a submental island flap procedure at the University of New Mexico Hospital from 2015 through 2023 with defined submental venous anatomy were analyzed. Three surgeons, blinded to intraoperative findings, predicted venous anatomy from preoperative imaging, with inter-rater reliability assessed using Fleiss Kappa. Results: Fifteen patients exhibited typical venous anatomy. Four patients’ submental venous vasculature showed drainage into the external jugular vein, and 3 into the anterior jugular vein. Imaging reviews showed accuracy rates of 72.23%, 90.91%, and 86.36%, respectively. Analysis of cases with CT scans yielded k = 0.46 ( P < .001). Conclusion: The submental island flap is versatile and reliable but demonstrates common variant venous anatomy. Accurate imaging-based predictions can optimize surgical efficiency and outcomes.

Discussion: A Critical Analysis of Randomized Controlled Trial Quality in Plastic and Reconstructive Surgery

2025-06-25

Isabella Churchill , Lucas Gallo , Cameron F. Leveille +1 more | Plastic & Reconstructive Surgery

Discussion: Does Dangling the Lower Extremity after Free Flap Reconstruction Reduce Partial Flap Loss? A Multicenter Randomized Controlled Trial

2025-06-25

Eric I. Chang | Plastic & Reconstructive Surgery

Multiple Segmental DCIA Flap for the Reconstruction of Extensive Defect in Symphyseal Area of Mandible Using VSP

2025-06-24

C. Zheng | International Journal of Oral and Maxillofacial Surgery

Advanced three-dimensional anatomical mapping of cutaneous perforators in the fibula free flap

2025-06-24

P. Yu , Annalina Lombardi , Harun S Bola +4 more | International Journal of Oral and Maxillofacial Surgery

Submental Island Flap: Is it the Right Choice?

2025-06-24

S. Jaigirdar , Sarika Shivji , Sukhpreet Singh Dubb +1 more | International Journal of Oral and Maxillofacial Surgery

Oncologic Outcomes Following Computer-Aided Reconstructive Jaw Surgery

2025-06-24

Yang Ying , J. Le , Anthony B. Morlandt | International Journal of Oral and Maxillofacial Surgery

Mandibular Symphysis Graft for Vertical and Horizontal Bone Augmentation: A Case Report

2025-06-24

Sevda Yılmaz | International Journal of Oral and Maxillofacial Surgery

Survival Rates of Lateral Buttress Plates in Reconstruction of the Lateral Middle Third

2025-06-24

C. Boutros , Simon Holmes | International Journal of Oral and Maxillofacial Surgery

Reconstruction of Small-Sized Defects of the Maxilla and Mandible – Role of the Medial Femoral Condyle Flap

2025-06-24

V. Ramani , K. Balaraman | International Journal of Oral and Maxillofacial Surgery

The Coronal Flap: Challenging Existing Techniques

2025-06-24

Richard Malík , Hemant Bansal , Noor ul aain Bhatti | International Journal of Oral and Maxillofacial Surgery

Epidemiology of Patients with Facial Soft Tissue Injuries in Central India: An Ambi-Directional Study

2025-06-24

Ramakrishna Shenoi | International Journal of Oral and Maxillofacial Surgery

Adverse Events in Helmet Moulding Therapy for Positional Head Deformities

2025-06-24

Jan Gaessler , Michael Schwaiger | International Journal of Oral and Maxillofacial Surgery

A Pilot Study Evaluating HoloLens for Precision-Guided Segmental Resection in Oral and Maxillofacial Surgery: A Comparison with Freehand Resections

2025-06-24

Shu‐Yam Wong | International Journal of Oral and Maxillofacial Surgery

Innovative Solutions for Complex Maxillofacial Wound Care: The Role of Accessible and Cost-Effective Negative Pressure Wound Therapy

2025-06-24

Sonia S. Hassan | International Journal of Oral and Maxillofacial Surgery

Augmented Reality Three-Jaw Vessel Eversion Microclamps vs. Doppler Acland Microclamps in End-to-End Anastomosis for ALT Flap Head and Neck Reconstruction: A Randomized Controlled Trial

2025-06-24

Amit Kohli | International Journal of Oral and Maxillofacial Surgery

The Short Scar Facelift Access for Aesthetically Refined Outcomes in TMJ Replacement Surgery

2025-06-24

M. Halsnad | International Journal of Oral and Maxillofacial Surgery

Considerations & Challenges of Free Tissue Transfer in Mid-Facial Reconstructive Surgery for Massive Maxillary Tumours on Board Mercy Ships in West Africa

2025-06-24

M. Dhillon , L. Cheng , Gary Parker +1 more | International Journal of Oral and Maxillofacial Surgery

Concomitant Use of TJR, Patient-specific Implant and Microvascular Fibula in Mandibular Reconstruction

2025-06-24

Ravi Veeraraghavan , J. Painatt , G. Manimangalath +1 more | International Journal of Oral and Maxillofacial Surgery

Virtual Planning of Concomitant Fibula Free Flap and Orthognathic Surgery for the Reconstruction of Dentomaxillofacial Deformity Secondary to a Long-term Mandibular Defect

2025-06-24

Jie Cao , Xiaoxia Wang | International Journal of Oral and Maxillofacial Surgery

Transforming Mandibular Reconstruction: Coen's Procedure with Non-Vascularized Autogenous Bone Grafts as a Cutting-edge innovation

2025-06-24

Ameliana Nuraeni | International Journal of Oral and Maxillofacial Surgery

Fibula Free Flap Reconstruction of the Jaws - Peri-Prosthetic Soft Tissue Management

2025-06-24

Tricia Tan , Bobby K. W. Ng , Muhammad M. Rahmat | International Journal of Oral and Maxillofacial Surgery

AI and AR-Assisted Free Flap Harvest for Head and Neck Reconstruction: A Clinical Pilot Study

2025-06-24

Pu Jiang , Yu‐Xiong Su | International Journal of Oral and Maxillofacial Surgery

Temporomandibular Joint Reconstruction with the Ortho Baltic Group Patient-Specific Total Joint Prosthesis: A Multidisciplinary Case Report

2025-06-24

T. Kivimaa , O. Ivask | International Journal of Oral and Maxillofacial Surgery

Comparison of Submental Island Flap and Free Radial Forearm Flap in Head and Neck Cancer Reconstruction: A Meta-Analysis

2025-06-24

Kexin Chen | International Journal of Oral and Maxillofacial Surgery

Jaw in a Day for Segmental and Total Mandibulectomy Defects. How Does Prosthetic-Driven Jaw Reconstruction Change the Game Plan?

2025-06-24

Camilo Mosquera , Hisham Marwan | International Journal of Oral and Maxillofacial Surgery

Osteomyocutaneous Sumental Flap for Premaxila Reconstruction

2025-06-24

Richard Pink , Petr Heinz , Petr Michl +2 more | International Journal of Oral and Maxillofacial Surgery

Non-Vascularized Grafts for Mandibular Reconstruction in More than 6 cm Defects: Pushing Beyond Boundaries

2025-06-24

Zainab Chaudhary | International Journal of Oral and Maxillofacial Surgery

Indication Patterns and Outcomes of Double Flap Technique in Head and Neck Reconstruction

2025-06-24

Y. Ghantus | International Journal of Oral and Maxillofacial Surgery

Continuous-Interrupted Suture—A Superior Suturing Method for Microvascular Anastomosis in Head and Neck Free Flap Reconstruction

2025-06-24

J. Chen , J Chen | International Journal of Oral and Maxillofacial Surgery

Comparison of Skin Substitutes for H&N Skin Cancer Reconstruction

2025-06-24

I. Dimasi , A. Jephcote , V. Pettis +2 more | International Journal of Oral and Maxillofacial Surgery

Evaluating Non-Invasive Methods for Collateral Circulation Assessment in Radial Forearm Free Flap Surgery

2025-06-24

Arati A. Inamdar | International Journal of Oral and Maxillofacial Surgery

Utility of the Submental Flap for Reconstruction of Orofacial Defects after Cancer Ablation

2025-06-24

H N Pak | International Journal of Oral and Maxillofacial Surgery

Usefulness of Sublingual Gland Flap for Soft-Tissue Reconstruction after Cancer Ablations

2025-06-24

Tadashi Eguchi | International Journal of Oral and Maxillofacial Surgery

Application of Microvascular Stenting Technology in the Anastomosis of Vascularized Flaps for Oral and Maxillofacial Reconstruction

2025-06-24

Yan Shi , J. Zhang | International Journal of Oral and Maxillofacial Surgery

A Review of Outcomes of Multidisciplinary Mandibular Reconstruction with Fibula Free Flaps in a Singapore Healthcare Institution

2025-06-24

G. Teoh , X. Dyeo , Bobby K. W. Ng +1 more | International Journal of Oral and Maxillofacial Surgery

Evaluation of A Mixed Reality Technology Approach for Locating Perforators in Anterolateral Thigh Flap Reconstruction

2025-06-24

Hongjian Zhu , Peng Xie | International Journal of Oral and Maxillofacial Surgery

Complementary PEEK Prosthesis for Fibula Flap in Mandible Reconstruction

2025-06-24

Hui Xin Ong , C. Huentequeo , Xiaoli Qu | International Journal of Oral and Maxillofacial Surgery

Analysis of the Influence From Tough Neck Status and Other Risk Factors to Vascularized Free Flap Loss in Head and Neck Reconstruction: A Retrospective Cohort Study

2025-06-24

Pengfei Ma , Li Li , Chenyang Li | International Journal of Oral and Maxillofacial Surgery

Head and Neck Microvascular Reconstruction the Elderly Patient

2025-06-24

Gregorio Sánchez Aniceto , E. Seco , P. Caballero Pedrero +2 more | International Journal of Oral and Maxillofacial Surgery

Cosmetic reconstruction of extensive maxillary defects with cerclage wire alone or in combination with polypropylene mesh in 25 dogs (2017‐2023)

2025-06-24

Federico Massari , Lavinia E. Chiti , Dario Drudi | Journal of Small Animal Practice

This study aimed to describe the use of cerclage wires with or without polypropylene mesh for the reconstruction of maxillectomies with or without concurrent orbitectomy and report the surgical outcomes. … This study aimed to describe the use of cerclage wires with or without polypropylene mesh for the reconstruction of maxillectomies with or without concurrent orbitectomy and report the surgical outcomes. Dogs presented for resection of a maxillary/orbital neoplasia and reconstruction were retrospectively enrolled. Data retrieved from medical records included signalment, tumour site and size, type of maxillectomy and reconstruction, results of histological examination, surgical time and surgical complications. Twenty-five dogs were included. Central-caudal, caudal and rostral maxillectomies were performed in 11, 9 and 5 dogs, respectively. Eight dogs (32%) received a ventral orbitectomy concurrently. Mean surgical time was 70 minutes. No intraoperative complications occurred. Minor early (<48 hours) postoperative complications occurred in 22 dogs (88%) and were oedema of the muzzle (n = 21), rhinorrhagia (n = 11) and pain causing difficulty in eating (n = 2). Five dogs (20%) had minor late postoperative (>48 hours) complications: partial intraoral dehiscence at 10 days that healed by second intention (n = 2), reverse sneezing (n = 2) and antibiotic-respondent infection (n = 1). Five dogs (20%) developed oronasal fistula as a major late postoperative complication. All the dogs were able to eat autonomously 48 hours after surgery; visual function was normal and appearance was restored. The technique that we report relies on readily available, cost-effective materials and can be successfully used for customised reconstruction of maxillary defects in dogs. Rate of complications should be compared to the standard reconstructive technique to determine if the use of maxillary implants results in higher risk of complications.

Assessment of Aesthetic Outcomes in Autologous Breast Reconstruction Using Profunda Femoris Artery Perforator Flap

2025-06-24

Chison Gon , Ryo Karakawa , Hidehiko Yoshimatsu +3 more | Microsurgery

ABSTRACT Background While autologous breast reconstruction using the profunda femoris artery perforator ( PAP ) flap is becoming increasingly popular, no aesthetic evaluation has been reported. The aim of this … ABSTRACT Background While autologous breast reconstruction using the profunda femoris artery perforator ( PAP ) flap is becoming increasingly popular, no aesthetic evaluation has been reported. The aim of this study is to evaluate the reconstructed breast using the PAP flap quantitatively and to clarify which factors contribute to the aesthetically favorable results. Methods We identified 127 patients who underwent breast reconstructions using the vertically designed PAP flap for unilateral breast cancer between April 2018 and December 2021. The PAP flap was elevated vertically to avoid disrupting lymphatic pathways and was inserted between the pectoralis major muscle and the subcutaneous fat after the anastomoses. We classified cases into two groups: the “Favorable cosmesis group” and the “Unfavorable cosmesis group” based on aesthetic evaluations using the vectra three‐dimensional ( 3D ) imaging system. Patient characteristics and outcomes between two groups were compared. Results Of the 127 patients, 15 were excluded: three with stacked PAP flaps, two with flap necrosis, and 10 with missing aesthetic outcome data. Among the remaining 112 patients, 18 were classified in the “Favorable cosmesis group” and 94 in the “Unfavorable cosmesis group.” Comparative analysis revealed that the “Favorable cosmesis group” showed significantly higher ratio with small volume in the upper pole of the unaffected side (21% vs. 72%, p < 0.01) and had a smaller final inset flap weight (147 vs. 190 g, p = 0.028) compared to the “Unfavorable cosmesis group.” All 112 patients were evaluated using vectra 3D system at 12 months postoperatively, and their postoperative flap courses were uneventful. Conclusions In our study, inherent small volume of the upper pole and smaller flap inset weight contribute to more favorable outcomes.

The Autologous Free Dermal Fat Graft for Midface Reshaping in Orthognathic Surgery: An Innovative Proposal

2025-06-24

Roberta Magliulo | International Journal of Oral and Maxillofacial Surgery

Assessment of surgical outcomes and oncological safety for submental artery perforator flap reconstruction after ablation of oral cancer

2025-06-24

Zhuqing Rao , Nan Li | International Journal of Oral and Maxillofacial Surgery

Immediate Implants in Maxillo-Mandibular Reconstruction: Advancing Patient Outcomes in Oncology

2025-06-24

Sayed Azher | International Journal of Oral and Maxillofacial Surgery

Comparative Analysis of Quality of Life Outcomes Following Glossectomy and Primary Closure, Radial Forearm and Anterolateral Thigh Flap Reconstructions

2025-06-24

O. Bar , Y. Ghantus | International Journal of Oral and Maxillofacial Surgery

Immediate Prosthodontic Rehabilitation in Head and Neck Oncology and Free Flap Reconstruction: A Case Series Discussing Possible Workflows and Pitfalls

2025-06-24

Michel Bila | International Journal of Oral and Maxillofacial Surgery