The future of free flap monitoring by laser continuous doppler flowmetry: A prospective assessment in consecutive 71 patients.

Objective: This study evaluated the effectiveness of laser Doppler flowmetry (LDF) in detecting perfusion disturbances during microvascular free tissue transfer.

Methods: Conducted at a single centre from December 2020 to September 2022, this prospective study involved 71 patients mainly undergoing head and neck free flap reconstructions, using the Pocket LDF™ for continuous perfusion monitoring.

Results: Out of the 71 cases, data from 69 cases were analysed after excluding those with significant noise or sensor detachment.

Percutaneous Needle Fasciotomy Versus Limited Fasciectomy for Dupuytren Disease: A Linear Model Assessment of Short-term Efficacy.

Background: There is no consensus about the best treatment for Dupuytren contracture in the hand. In particular, whether to use a percutaneous needle fasciotomy (PCNF) in preference to a limited fasciectomy (LF).

Methods: We performed a retrospective review of the outcomes of 74 joints treated with either PCNF or LF.

Salvage of anterolateral thigh (ALT) flap with indocyanine green assessment of a flap pedicle and subsequent perforator-to-perforator anastomosis.

Indocyanine green (ICG) fluorescence angiography has emerged as an intraoperative method to accurately assess real-time tissue vascularity, perfusion and anastomotic patency in flap surgery. We illustrate a complex case of elbow reconstruction in an elderly patient with a free anterolateral thigh flap, which relied on intraoperative ICG to evaluate the flap pedicle and map the site of arterial occlusion. Supermicrosurgical instrumentation was employed to perform complex perforator-to-perforator anastomosis following resection of the vascular site of the lesion.

Patient satisfaction using wide-awake local anaesthesia no tourniquet (WALANT) in adults undergoing elective hand surgery: A systematic review and meta-analysis.

Background: Wide-awake local anaesthesia no tourniquet (WALANT) is increasing in popularity within hand surgery. However, evidence is unclear on patient satisfaction rates when WALANT is compared against more traditional anaesthetic techniques where pneumatic tourniquets are used. The present study aimed to evaluate the satisfaction rates of patient with the WALANT technique.

Evolution and Adaptations of Robotic DIEP Flap Surgery: A Systematic Review.

Background: The integration of robotic technology into surgical procedures has gained considerable attention for its promise to enhance a variety of clinical outcomes. Robotic deep inferior epigastric perforator (DIEP) flap harvest has emerged as a novel approach for autologous breast reconstruction. This systematic review aims to provide a comprehensive overview of the current techniques, outcomes, and complications of robotic DIEP flap surgery.

Clinical, Preclinical, and Educational Applications of Robotic-Assisted Flap Reconstruction and Microsurgery: A Systematic Review.

Introduction: Microsurgery and super-microsurgery allow for highly technical reconstructive surgeries to be performed, with repairs of anatomical areas of less than 1 mm. Robotic-assisted surgery might allow for further advances within microsurgery, providing higher precision, accuracy, and scope to operate in previously inaccessible anatomical areas. However, robotics is not well-established within this field.

Non-operative management of metacarpal II-IV fractures: A retrospective study from a tertiary hand unit.

Metacarpal fractures produce significant hand disability, and non-operative management of these fractures can produce satisfactory functional outcomes with few complications. However, most studies assessing non-operative outcomes of metacarpal fractures revolves around metacarpals I and V, which possess different anatomy. Therefore, further investigation into outcomes after non-operative treatment of metacarpals II-IV is required to inform management decisions and allow modification of the rehabilitation protocols to specific fracture patterns.

ALT in combination with triple-rolled TFL for reconstruction of a complex tendoachilles defect: technical details and rehabilitation regime.

A fit man in his 60s presented with an infected Achilles tendon (AT) following two failed repairs for a traumatic rupture. Initial debridement of necrotic tissue resulted in a large soft tissue defect requiring robust coverage. Following aggressive wound management, an anterolateral thigh flap was elevated with tensor fasciae latae (TFL) which was triple-rolled to provide soft tissue coverage and tendon reconstruction.

The transverse upper gracilis flap for autologous breast reconstruction: patient satisfaction outcomes from a single centre experience.

Background: The transverse upper gracilis (TUG) flap procedure is an alternative procedure for autologous breast reconstruction, that is indicated in patients with a low body mass index (BMI) and small to moderate sized breasts. We investigated patient satisfaction of all TUG flap breast reconstructions at Royal Free Hospital.

Methods: A retrospective review of all patients who had undergone a TUG flap procedure was performed using Electronic Patient Records between October 2010 and October 2021 in Royal Free Hospital.

Prolonged operative time is a risk factor for adverse postoperative outcomes in the unilateral deep inferior epigastric perforator (DIEP) flap surgery: A retrospective cohort study.

Background: Currently, one published study documented operative time (OT) as a predictor for postoperative outcomes in bilateral deep inferior epigastric perforator (DIEP) flap breast reconstructions. No literature has investigated this in unilateral DIEP flaps. We aimed to determine the relationship between unilateral OT, postoperative complications, unplanned reoperations (UR), and extended length-of-stay (eLOS).

Uses of Smartphone Thermal Imaging in Perforator Flaps as a Versatile Intraoperative Tool: The Microsurgeon's Third Eye.

Introduction: In this study, we evaluate the versatility of smartphone thermal imaging technology as a valuable intraoperative modality in different stages of perforator flap surgery aiming to minimize the complications and achieve the best postoperative outcome.

Patients And Methods: Thermography was performed in 20 perforator flaps in 20 patients at different surgical stages in three different ways to identify the most dominant perforator: first, by measuring the surface temperature of the skin; second, by using the dynamic infrared thermography technique; and third, by assessing the perfusion pattern when the flap was supplied by each perforator separately. Thermography was used to help in discarding the least perfused area of the flap.

WAFER trial: a study protocol for a feasibility randomised controlled trial comparing wide-awake local anaesthesia no tourniquet (WALANT) to general and regional anaesthesia with tourniquet for flexor tendon repair.

Introduction: Flexor tendons are traditionally repaired under either general anaesthesia (GA) or regional anaesthesia (RA), allowing for the use of an arm tourniquet to minimise blood loss and establish a bloodless surgical field. However, the use of tourniquets exposes the patient to certain risks, including skin, muscle and nerve injuries. A recent advancement in anaesthesia delivery involves the use of a wide-awake approach where no sedation nor tourniquets are used (wide-awake local anaesthesia no tourniquet (WALANT)).

Management of capitate avascular necrosis in an adult with a free medial femoral condyle flap.

The treatment of the extremely uncommon avascular necrosis of the capitate with a medial femoral condyle corticocancellous free flap has been described previously by one group reporting on outcomes in a paediatric patient. However, no literature to-date has detailed results of this procedure in an adult. We illustrate the case of a 53-year-old man who sustained capitate avascular necrosis and tendon rupture of traumatic aetiology.

The free Thenar flap for thumb pulp reconstruction: A case report.

The thumb is acknowledged to contribute significantly to hand function, accounting for up to 40% of its overall capability. Consequently, injuries affecting the thumb can have a profound impact on the quality of life experienced by patients. When it comes to the surgical reconstruction of thumb injuries, the primary objective is to promptly provide coverage of the affected area with glabrous skin, thus preserving both the length and functionality of the thumb.

A Single-center Comparison of Unipedicled and Bipedicled Diep Flap Early Outcomes in 98 Patients.

Unlabelled: The deep inferior epigastric perforator (DIEP) flap is the gold standard for autologous breast reconstruction. One or two pedicles may be used. Our study is the first to compare unipedicled and bipedicled DIEP flaps on donor and recipient site outcomes in the same patient cohort.

Radiographic views for hand fractures - call for three-view national UK guidelines - a quality improvement study.

A three-view radiographic examination (comprising of antero-posterior, oblique and lateral views) is crucial for the accurate assessment and subsequent decision-making in hand fracture management. The superiority of a three-view examination, compared to only two views, has been demonstrated by multiple studies, citing increased diagnostic accuracy and reduced rates of misdiagnosis. As such, the American College of Radiology (ACR) now recommends a standard three-view examination for finger and hand injuries; despite this, no formal guidance exists in the United Kingdom.