Arteriovenous Shunts: Their Location and Role in Physiology, Pathology, and Tissue Transfer. A Preliminary Report in the Upper Limb.

Background: Tiny arteriovenous (AV) shunts of 10-150 µm (0.01-0.15 mm) are documented in the hands and feet.

International consensus recommendations on face transplantation: A 2-step Delphi study.

Face transplantation is a viable reconstructive approach for severe craniofacial defects. Despite the evolution witnessed in the field, ethical aspects, clinical and psychosocial implications, public perception, and economic sustainability remain the subject of debate and unanswered questions. Furthermore, poor data reporting and sharing, the absence of standardized metrics for outcome evaluation, and the lack of consensus definitions of success and failure have hampered the development of a "transplantation culture" on a global scale.

Bipedicled Scrotal Flap for Penile Resurfacing.

Background: Acquired penile defects can be secondary to various pathologic conditions, including infection, scar, or complications following urologic procedures. Penis defects with skin deficit carry a distinct challenge for reconstructive surgeons. Scrotal flaps can provide reliable coverage and can restore distinct qualities of native penile skin.

Free Your Mind, Not Your Flap.

The pedicled flap has been a mainstay of soft tissue reconstruction since the earliest days of plastic surgery. Advances in surgical technology and skill have led to an erosion in the use of pedicled flaps in favor of increasingly popular free tissue transfers. Still, regional flaps without microvascular anastomosis remain a valuable reconstructive tool.

Chronic obstructive pulmonary disease is an independent risk factor for postoperative complications following operative treatment of distal radius fracture.

Purpose: This study aimed to investigate the relationship between chronic obstructive pulmonary disease (COPD) and postoperative complications for patients receiving distal radius fracture (DRF) open reduction internal fixation (ORIF).

Methods: From 2007 to 2018, patients undergoing operative treatment for distal radius fracture were identified in the National Surgical Quality Improvement Program database. Patients were separated into 2 cohorts: non-COPD and COPD patients.

Facial Transplantation: Nonimmune-Related Hyperacute Graft Failure-The Role of Perfusion Injury: A Case Report.

Background: The aim of this study was to report the first case of acute facial allograft transplantation (facial allograft transplantation) failure with allograft removal and autologous free-flap reconstruction.

Methods: A 49-year-old female patient affected by neurofibromatosis type 1 with a massive neurofibroma infiltrating the whole left hemiface was planned for FAT for the left hemiface including the auricle, all skin and soft tissues from the temporal region, periorbital and nasal region, and up to the perioral area. The maxillary process of the zygomatic bone, left hemimaxilla, and hemimandible from contralateral parasyphysis to the incisura mandibulae were also included.

All hands on deck: Hand replantation versus transplantation.

Objectives: Our hands play a remarkable role in our activities of daily living and the make-up of our identities. In the United States, an estimated 41,000 individuals live with upper limb loss. Our expanding experience in limb transplantation-including operative techniques, rehabilitation, and expected outcomes-has often been based on our past experience with replantation.

Bilobed Gracilis Flap: A Novel Alternative for Pelvic and Perineal Reconstruction.

Perineal reconstruction historically has been guided by the vertical rectus abdominis myocutaneous flap. In oncologic patients, because of prior surgical intervention, this donor site is often unavailable, the pelvis has been irradiated, and defects can be deep or irregularly contoured. Using plastic surgery principles of perforators, geometrically defined local tissue rearrangement, and flap inset, the authors have developed a modification of the gracilis flap to include a second soft-tissue arm similar to a bilobed flap.

Nasal Reconstruction: Current Overview.

The nose, with its conspicuous location, intricate convexities, and delicate 3-dimensional structure, continues to challenge the reconstructive surgeon. Today, there are a myriad of options available for reconstruction. The practitioner must take into account the location of the defect as well as the components needed to be restored.

Trismus in Face Transplantation Following Ballistic Trauma.

Background: Trismus can be a challenging consequence of ballistic trauma to the face, and has rarely been described in the setting of face transplantation. Almost half of all current face transplant recipients in the world received transplantation to restore form and function after a ballistic injury. Here we report our experience and challenges with long standing trismus after face transplantation.

Microsurgical Burn Reconstruction.

The treatment of burn-related wounds requires consideration of several factors, including defect size, available donor sites, exposure of critical structures, and the ultimate functional and aesthetic result of reconstruction. Although skin grafts and locoregional flaps are workhorses in burn reconstruction, they have inherent limitations that can directly impact reconstructive outcomes. Microsurgical free tissue transfer represents a viable option for the reconstruction of burn-related wounds in certain patients.

The Use of Prefabricated Flaps in Burn Reconstruction.

This article describes the use of prefabricated flaps in burn reconstruction. Several case examples are provided that demonstrate the versatility and power of this approach to restoration of form and function after burn injury.

Differentiation Between Pyogenic Flexor Tenosynovitis and Other Finger Infections.

Background: Hospital transfer decisions regarding pyogenic flexor tenosynovitis (PFT) are made difficult by emergency department presentations similar to other finger infections, with pain, redness, and functional limitation. Our objectives were to: (1) determine diagnostic sensitivity and specificity of Kanavel signs; and (2) identify existing factors most predictive of PFT during initial presentation.

Methods: Adult patients who underwent surgical consultation for concern of PFT over a 5-year period were identified retrospectively.

Management of Rhinophyma: Outcomes Study of the Subunit Method.

Background: Rhinophyma causes a nasal deformity and functional airway obstruction. Partial excision (eg, tangential) with secondary healing commonly removes hypertrophic soft tissues but does not improve nasal support. The subunit method for rhinophyma uses 6 nasal flaps to provide exposure for removal of rhinophymatous tissue and enhance structure.

The Sternum-Nipple Distance is Double the Nipple-Inframammary Fold Distance in Macromastia.

Background: Reduction mammaplasty is one of the most commonly performed plastic surgery operations. For a majority of techniques, the most common long-term complication is pseudoptosis. It has previously been proposed that upper breast suspensory ligaments (SL) are weaker than lower breast SL.

Impact of Prior Unilateral Chest Wall Radiotherapy on Outcomes in Bilateral Breast Reconstruction.

Background: The purpose of this study was to evaluate the impact of prior unilateral chest wall radiotherapy on reconstructive outcomes among patients undergoing bilateral immediate breast reconstruction.

Methods: A retrospective evaluation of patients with a history of unilateral chest wall radiotherapy was performed. In each patient, the previously irradiated and reconstructed breast was compared to the contralateral nonirradiated side, which served as an internal control.

Innovative Techniques for Maximizing Limb Salvage and Function.

Concurrent injuries to multiple extremities present unique challenges to the reconstructive surgeon. The primary goal in such scenarios is to optimize functional outcomes. The goal of this article is to present an overview of various techniques necessary to provide sufficient soft tissue and preserve amputation limb lengths and function.

Osteocutaneous Second-Toe Free Flap as Alternative Option for Repair of Anterior Oronasal Fistula: Long-Term Results in Selected Patients.

Introduction: Palatal fistulas anterior to the incisive foramen, generally seen as a complication of cleft lip and cleft palate repair, can be extremely difficult to repair. The requirements of the defect necessitate nasal lining, oral lining, and bone for maxillary arch continuity. Local pedicled flap has limited use in such patients with extensive scarring from previous surgeries.

Use of Video Clips to Assess the Outcomes of Bilateral Hand Transplantation.

Given the initial success of hand transplantation, there has been increased interest in determining functional independence and activities of daily living after hand transplantation. However, the metrics and methodologies used to study these outcomes have not yet been standardized. The goal of this article was to assess the role of video clips in assessing the outcomes of bilateral hand transplantation.

Functional Outcomes after Bilateral Hand Transplantation: A 3.5-Year Comprehensive Follow-Up.

Background: Since the first successful hand transplantation in 1998, 72 patients have been operated on for unilateral/bilateral hand transplantation across 13 countries. There have been multiple studies evaluating the outcomes of hand transplantation; however, there is considerable variability among the outcome measures evaluated in these studies.

Methods: This article reports functional outcomes in a patient with bilateral hand transplants at a mid-forearm level with serial follow-ups over 3.

Psychosocial Outcomes after Bilateral Hand Transplantation.

Unlabelled: Since the first successful hand transplantation in 1998, there have been multiple reports about surgical technique, transplant survival, and immunosuppression. However, very limited published data exist on psychosocial outcomes following hand transplantation.

Methods: We report psychosocial outcomes in a patient with bilateral hand transplants at the midforearm level with serial follow-ups over 3.

Use of Osteocutaneous Second-Toe Free Flap for Anterior Oronasal Fistulas.

Palatal fistula is a known complication of cleft lip-cleft palate repair. Fistulas anterior to the incisive foramen can be particularly difficult to repair because of the lack of available tissue. Adjacent tissue has inherent limitations, and multiple free-flap techniques have been described; however, there remains no single solution for this difficult problem.

Evolving options for breast reconstruction.

In summary, if the abdomen cannot be used for a donor site, alternative flap selection is based on individual patient anatomy and body habitus, targeting the buttocks and upper thigh. Intraoperative repositioning may be required for ease in flap harvest and donor site closure, adding time to the procedure. Flap dissection is performed in the subfascial plane to avoid injury to the perforator vessels.