Abdominal-Based Microsurgical Breast Reconstruction: How to Inset the Flap to Maximize the Aesthetic Result-A Systematic Review.

Nowadays, the ultimate goal of microsurgical breast reconstruction is not merely the effective transfer of vascularized tissue but the achievement of a natural, symmetric appearance. The aim of this present study was to systematically summarize the published evidence on abdominal-based free flap inset for breast reconstruction in order to provide principles and classification that could guide the surgeon in choosing the most appropriate inset technique based on patient and flap characteristics. A comprehensive review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, looking for articles on the insetting technique for free flap breast reconstruction.

Limiting the fascia incision length in a DIEP flap: Repercussion on abdominal wall morbidity.

Background: The evolution from free muscle-sparing transverse rectus abdominis myocutaneous flap to deep inferior epigastric perforator (DIEP) flap leads to less donor-site morbidity. However, rectus fascia is usually incised longitudinally from perforator(s) to iliac vessels, often exceeding 15 cm when including longitudinal muscle spreading. By using a limited fascia incisional (LFI-) technique, we try to diminish abdominal wall functional decrease.

Survival analysis of segmental mandibulectomy with immediate vascularized fibula flap reconstruction in stage IV oral squamous cell carcinoma patients.

Purpose: This study aims to assess the survival rate of oral squamous cell carcinoma (OSCC) patients following immediate mandibular reconstruction with vascularized fibula flap (VFF) and to identify risk factors influencing the overall survival rate and postoperative outcomes.

Patients And Methods: Patients suitable for the inclusion criterion diagnosed and treated between January 1996 till June 2019 for OSCC were retrospectively reviewed (n = 74). Potential risk factors and postoperative outcomes were recorded and analyzed.

Fibula Free Flap in Head and Neck Reconstruction: Identifying Risk Factors for Flap Failure and Analysis of Postoperative Complications in a Low Volume Setting.

The fibula free flap (FFF) has been a workhorse in maxillofacial reconstruction. High success rates of this technique are reported. However, identifying risk factors for flap failure and analyzing complications can open the way to better patient care.

Immediate versus delayed autologous breast reconstruction: A retrospective matched cohort study of irradiated patients.

Background: The impact of radiotherapy on breast reconstructions is not completely understood. The purpose of this study was to evaluate long-term effects of radiation therapy in relation to timing of autologous breast reconstruction.

Methods: A total of 1247 patients undergoing autologous breast reconstruction at the University Hospitals of Leuven between August 1997 and October 2013 were subjected to a retrospective matched cohort study.

Regions of ilium and fibula providing clinically usable bone for mandible reconstruction: "A different approach to bone comparison".

A variety of donor sites are available for mandibular reconstruction. We present here a different way of comparing two commonly-used bone flaps. The lengths of the usable parts in a total of 241 coxal bones, 91 mandibles and 60 fibulas were measured.

Histopathological Differences of the Pedicle Artery in Commonly Used Free Flaps: The Influence of Age, Gender, and Side.

Purpose: The increasing use of vascularized free flaps has increased the demand for a specified flap selection. This study investigated histologic differences in the arterial wall of the pedicle for commonly used free flaps and the effect of age, gender, and anatomic side on these differences.

Materials And Methods: Light microscopic examinations of vessel walls were performed on 245 specimens of the nourishing artery of commonly used free vascularized flaps in preserved cadavers.

Immediate debridement of road rash injuries with Versajet® hydrosurgery: traumatic tattoo prevention?

Unlabelled: Traumatic tattoos can result from accidental deposition of foreign particles in the dermis. These pigmented particles become permanently lodged in the dermis after re-epithelialization of the wound and can give rise to irregular black or blue discoloration of the skin. Different methods for tattoo removal exist.

Factors influencing the necessity for preoperative vascular imaging before harvesting a vascularized fibular flap.

Objective: This study was carried out to identify groups of patients who would benefit from this angiography. The angiographic images of a random group of patients were studied; the correlations between the vascular state of the lower extremities and vessel pathology were investigated; and the possible links of these findings with certain medical conditions were explored.

Study Design: Three experienced observers independently evaluated the angiograms of 185 patients.

Surgical management of auricular defect depending on the size, location, and tissue involved.

Purpose: Auricular reconstruction is a challenging surgical intervention that requires perfect surgical skills, exact planning, and esthetic knowledge. It is necessary to use a suitable method of reconstruction for each patient. From 10 years of experience, the authors have developed a general concept for auricular reconstruction.

New approach to shaping a ptotic breast in secondary autologous breast reconstruction.

Unlabelled: Breast ptosis in women is mostly perceived as unattractive. It is associated with aging, breastfeeding, and multiple pregnancies. However, women who undergo radical mastectomy are the exception.

The unilateral deep inferior epigastric perforator flap: comparing university to community hospital.

The deep inferior epigastric perforator (DIEP) flap is considered to be the gold standard for autologous breast reconstruction. This study evaluates the outcome of unilateral DIEP flap reconstructions, comparing university with a community hospital setting. A total of 77 unilateral DIEP flaps were performed at one university hospital and two community hospitals by the same two surgeons.

Fat necrosis in deep inferior epigastric perforator flaps: an ultrasound-based review of 202 cases.

Background: In autologous breast reconstruction after mastectomy, fat necrosis is a rather common complication that may lead to secondary corrective surgery. The understanding of fat necrosis until now has been limited because previous studies were based exclusively on physical examination and used diverse definitions.

Methods: The authors retrospectively reviewed the incidence of fat necrosis and the correlation of several risk factors in 202 deep inferior epigastric perforator (DIEP) flaps for breast reconstruction.

Minimizing limb amputations in meningococcal sepsis by early microsurgical arteriolysis.

Purpose: Surgical treatment of children with meningococcal sepsis has mainly involved debridement of necrotic skin and amputation of limbs. This resulted in major functional impairment. On the contrary, when early microsurgical arteriolysis was performed, freeing up the blood vessels, the impaired blood flow could be restored, thereby significantly reducing the amputation levels.

Initial reconstruction of sustained neck and facial burns.

Approximately 50% of burn injuries involve the neck and head region. Because both appearance and function must be taken into account with burns of this area, several consecutive reconstructions will be performed. With a focus on improving outcome after burn injury, we underline the method of grafting as a very important element in primary surgery.

The role of free flaps in the treatment of persistent scalp osteomyelitis.

Objective: To evaluate the efficacy of the combination of an extensive surgical debridement and simultaneous free flap repair in case of troublesome cranial osteomyelitis.

Methods: Five patients with persistent, frontal bone osteomyelitis were treated with surgical debridement of the infected bone and reconstruction with a free flap. In all patients, osteomyelitis occurred after neurosurgical procedures and lasted from 1 to 7 years.

Preservation of rat cremaster muscle microcirculation after prolonged cold storage and transplantation.

Background: Microvascular surgery for the reconstruction of complex defects involves an ischemic period, which may cause flap failure as the result of ischemia/reperfusion injury. We assessed the microvascular consequences of rat cremaster muscle transplantation after prolonged periods of cold storage in HTK-Bretschneider solution (HTK).

Materials And Methods: Cremaster muscle transplantations were performed immediately or after 8 or 24 h of cold storage (4 degrees C) in HTK or saline.

Microcirculatory hemodynamics of the rat cremaster muscle flap in reduced blood flow states.

Recent studies revealed that muscle and musculocutaneous flaps have the lowest peripheral resistance and best flap survival. The critical values of flow rates responsible for this survival have not been established. The authors evaluated the effect of prolonged arterial flow reduction on flow hemodynamics and muscle flap survival, independent of neovascularization using the rat cremaster muscle island flap model for microcirculatory studies.