Vascularized fibular grafting following tumor resection demonstrates acceptable long-term outcomes in Denmark: a national retrospective cohort study.

Background And Purpose:  Vascularized fibular grafting following tumor resection is an essential treatment option in limb salvage surgery. We aimed to evaluate: (I) bone healing, (II) complications and reoperations, (III) limb salvage, and (IV) survival.

Methods:  We present a retrospective evaluation of a national cohort comprising 27 patients.

[Not Available].

Preoperative virtual surgical planning and the use of 3D-printed patient-specific models and cutting guides are increasingly being used in the reconstruction of mandibular defects with a free bone flap. This technology offers several advantages over conventional surgery, such as reduced operating time, reduced bone flap ischaemia time, and the ability to perform more complex and precise reconstructions. This review presents the evidence supporting 3D-assisted surgery for mandibular defect reconstruction and discusses the utilisation of commercial vendors versus in-house 3D-printing solutions.

Implementation of In-house Computer-aided Design and Manufacturing for Accelerated Free Fibula Flap Reconstruction of Mandibular Defects in Cancer Patients.

Background: Computer-aided design and manufacturing (CAD/CAM) is widely adopted for optimizing microsurgical reconstruction of mandibular defects. However, commercial solutions are hampered by costs and lengthy lead times, with the latter being problematic in cancer surgery. This study aimed to investigate the efficiency of an in-house CAD/CAM service for expeditious planning and execution of free fibula mandibular reconstruction in head and neck cancer patients.

[Not Available].

Chronic fistulas are a dreaded complication to surgery. They are often persistent to treatment and involve several negative side effects and a significant reduction in quality of life. We present a case report of a 36-year-old male with a deep chronic fistula in the pelvis after pouch surgery.

Improving Visualization of Intramuscular Perforator Course: Augmented Reality Headsets for DIEP Flap Breast Reconstruction.

Background: Augmented reality (AR) technology, exemplified by devices such as the Microsoft HoloLens 2, has gained interest for its potential applications in preoperative guidance. This study explores the use of AR technology for perforator identification during deep inferior epigastric artery perforator (DIEP) flap breast reconstruction.

Methods: A case series of five patients where an AR device was used to identify perforators during DIEP flap breast reconstruction is presented.

Severe midface necrosis after liver failure induced fungal infection: A case report on the outcome after reconstruction.

Introduction: Reconstruction of the complex anatomy of the midface is challenging and requires meticulous preparation. Immunosuppression therapy increases patient susceptibility to infection and can compromise wound healing.

Presentation Of Case: A 22-year-old male presented with acute hepatic failure and underwent liver transplantation.

Effect of Remote Ischemic Conditioning on Bleeding Complications in Surgery: A Systematic Review and Meta-Analysis.

Remote ischemic conditioning (RIC) is administered with an inflatable tourniquet by inducing brief, alternating cycles of limb ischemia and reperfusion. RIC possibly impacts the hemostatic system, and the intervention has been tested as protective therapy against ischemia-reperfusion injury and thrombotic complications in cardiac surgery and other surgical procedures. In the present systematic review, we aimed to investigate the effect of RIC on intraoperative and postoperative bleeding complications in meta-analyses of randomized controlled trials including adult patients undergoing surgery.

Oncological results and morbidity following intended curative resection and free jejunal graft reconstruction of cervical esophageal cancer: a retrospective Danish consecutive cohort study.

Background: The role of surgery in treatment of locally advanced cervical esophageal cancer (CEC) remains debated. In the European and American treatment guidelines, definitive chemoradiotherapy (dCRT) is preferred over surgery, while in the Danish guidelines, the two treatment modalities are equally recommended. Surgical treatment of CEC is centralized at our center in Denmark.

Novel Technique with Double Free Flap Design for Advanced Mandibular Osteoradionecrosis: A Case Series.

Advanced mandibular osteoradionecrosis is arguably among the most challenging cases for reconstructive head and neck surgeons. Several reconstructive methods for complex mandibular defects have been reported; however, for advanced mandibular osteoradionecrosis, a safe option that minimizes the risk of renewed fistulation and infections is needed. For this purpose, we present a new technique using a fascia-sparing vertical rectus abdominis musculocutaneous flap as protection for a vascularized free fibula graft (FFG).

Remote ischemic preconditioning does not influence lectin pathway protein levels in head and neck cancer patients undergoing surgery.

Background: Cancer patients who undergo tumor removal, and reconstructive surgery by transfer of a free tissue flap, are at high risk of surgical site infection and ischemia-reperfusion injury. Complement activation through the lectin pathway (LP) may contribute to ischemia-reperfusion injury. Remote ischemic preconditioning (RIPC) is a recent experimental treatment targeting ischemia-reperfusion injury.

[Orthopaedic treatment of malignant bone tumours in children].

The treatment of malignant bone tumours in children has improved significantly over the past 50 years. Previously, the only curative treatment was amputation, but today the surgical treatment has changed towards limb salvage surgery. However, there is not consensus regarding choice of surgical procedure, and it is mainly based upon the surgeon's previous experience.

Remote Ischemic Preconditioning in Microsurgical Head and Neck Reconstruction: A Randomized Controlled Trial.

Unlabelled: The free flap failure rate is 5% in head and neck microsurgical reconstruction, and ischemia-reperfusion injury is an important mechanism behind this failure rate. Remote ischemic preconditioning (RIPC) is a recent intervention targeting ischemia-reperfusion injury. The aim of the present study was to investigate if RIPC improved clinical outcomes in microsurgical reconstruction.

Effect of remote ischemic preconditioning on hemostasis and fibrinolysis in head and neck cancer surgery: A randomized controlled trial.

Introduction: The aim of this randomized controlled trial was to investigate if remote ischemic preconditioning (RIPC) reduced platelet aggregation and increased fibrinolysis in cancer patients undergoing surgery and thereby reduced the risk of thrombosis.

Materials And Methods: Head and neck cancer patients undergoing tumor resection and microsurgical reconstruction were randomized 1:1 to RIPC or sham intervention. RIPC was administered intraoperatively with an inflatable tourniquet by four cycles of 5-min upper extremity occlusion and 5-min reperfusion.

Intracortical Bone Mechanics Are Related to Pore Morphology and Remodeling in Human Bone.

During aging and in osteoporosis, cortical bone becomes more porous, making it more fragile and susceptible to fractures. The aim of this study was to investigate the intracortical compression- induced strain energy distribution, and determine whether intracortical pores associated with high strain energy density (SED) in the surrounding bone matrix have a different morphology and distribution, as well as different remodeling characteristics than matrix with normal SED. Fibular diaphyseal specimens from 20 patients undergoing a jaw reconstruction (age range 41 to 75 years; 14 men and 6 women) were studied.

Local and systemic coagulation marker response to musculocutaneous flap ischemia-reperfusion injury and remote ischemic conditioning: An experimental study in a porcine model.

Background: Remote ischemic conditioning (RIC) administered by non-lethal periods of extremity ischemia and reperfusion attenuates ischemia-reperfusion injury. We aimed to investigate the local and systemic coagulation marker response to flap ischemia-reperfusion injury, and the effects of RIC on coagulation markers following flap ischemia-reperfusion injury.

Methods: A musculocutaneous latissimus dorsi flap was subjected to 4 h of ischemia followed by 7 h of reperfusion in 16 female Danish Landrace pigs (39 kg).

[Microsurgery in reanimation, lymphoedema and hand surgery].

Microsurgery is defined as surgery performed with the aid of ocular magnification. In Denmark, this is undertaken by four units. This review describes the history of microsurgery which evolved during the 1960s.

[Microsurgery in plastic surgery].

The most common indication for free flap surgery is breast reconstruction. Deep inferior epigastric perforator flaps are safe, quick and provide excellent cosmetic results. The reconstruction in head and neck cancer patients is more complex.

Remote ischemic perconditioning attenuates acute inflammation of experimental musculocutaneous flaps following ischemia-reperfusion injury.

Background: In free flap reconstruction and replantation surgery, prolonged ischemia time may lead to flap or replantation failure. The aim of the study was to investigate the effects of hypothermic flap ischemia or remote ischemic perconditioning (RIPER) during normothermic ischemia on acute inflammation of musculocutaneous flaps subjected to ischemia-reperfusion injury.

Materials And Methods: In 24 pigs, a musculocutaneous latissimus dorsi flap was dissected and subjected to 4 hours of arterial ischemia and 7 hours of reperfusion.

Direct comparison of postoperative monitoring of free flaps with microdialysis, implantable cook-swartz Doppler probe, and clinical monitoring in 20 consecutive patients.

Background: There is an increasing demand for successful free tissue transfer, with postoperative monitoring of flaps a key to early salvage. Monitoring methods have ranged from clinical techniques to invasive options, of which two are particularly applicable to buried flaps (Cook-Swartz Doppler probe and microdialysis). The evidence for these options has been represented largely in separate cohort studies, with no single study comparing these three techniques.

Postoperative monitoring of free flaps in autologous breast reconstruction: a multicenter comparison of 398 flaps using clinical monitoring, microdialysis, and the implantable Doppler probe.

Many techniques for flap monitoring following free tissue transfer have been described; however, there is little evidence that any of these techniques allow for greater rates of flap salvage over clinical monitoring alone. We sought to compare three established monitoring techniques across three experienced microsurgical centers in a comparable cohort of patients. A retrospective, matched cohort study of 398 consecutive free flaps in 347 patients undergoing autologous breast reconstruction was undertaken across three institutions during the same 3-year period, with a single form of postoperative monitoring used at each institution: clinical monitoring alone, the Cook-Swartz implantable Doppler probe, or microdialysis.

The lumbar artery perforators: a cadaveric and clinical anatomical study.

Background: The lumbar region has been scarcely explored as a donor site for free tissue transfer or as a free flap recipient site. The lumbar integument provides a versatile prospective flap site, with a potentially well-concealed scar. Similarly, defects of this region can require recipient vessels that may be difficult to identify.

Preserving the neurovascular supply in the Hall-Findlay superomedial pedicle breast reduction: an anatomical study.

Background: The Hall-Findlay superomedial pedicle technique is widely used for breast reduction, and, despite low complication rates, nipple-areola complex (NAC) necrosis and denervation are still the two most common complications, particularly when resection volumes exceed 600g. An understanding of the anatomy of the neurovascular pedicle of the NAC is paramount in avoiding these complications.

Methods: An anatomical study was undertaken on 11 female cadaveric breast specimens (nine fresh and two embalmed).

Avoiding denervation of rectus abdominis in DIEP flap harvest II: an intraoperative assessment of the nerves to rectus.

Background: The deep inferior epigastric artery perforator (DIEP) flap aims to reduce donor-site morbidity by minimizing rectus muscle damage; however, damage to motor nerves during perforator dissection may denervate rectus muscle. Although cadaveric research has demonstrated that individual nerves do not arise from single spinal cord segments and are not distributed segmentally, the functional distribution of individual nerves remains unknown. Using intraoperative nerve stimulation, the current study describes the motor distribution of individual nerves supplying the rectus abdominis, providing a guide to nerve dissection during DIEP flap harvest.

Anatomical variations in the harvest of anterolateral thigh flap perforators: a cadaveric and clinical study.

Background: The anterolateral thigh (ALT) flap has become increasingly popular due to its versatility and minimal donor site morbidity. Its major limitation has been uncertainty in predicting perforator anatomy, with the occasional absence of suitable perforators and high variability in their size and course. The variability of this anatomy has not been adequately explored previously.