Plastic Surgery Reconstruction of Sarcoma Resection Defects: Form and Function.

Surgical wide resection is the mainstay of treatment of sarcomas, but the advent of multimodality therapy has improved outcomes and the rates of limb-sparing resection. Often, wounds are unable to be closed primarily and require plastic surgical reconstruction. Following adequate oncologic resection, reconstruction should focus on maintaining functional and esthetic outcomes with minimal postoperative complications.

Broad-Spectrum Antibiotics for Breast Expander/Implant Infection: Treatment-Related Adverse Events and Outcomes.

Background: Despite best practices, infection remains the most common complication after breast reconstruction with expanders and implants, ranging from 2% to 29%. Empiric broad-spectrum antibiotics are frequently used in nonsurgical treatment of implant-associated infections in an effort to salvage the reconstruction. Pitfalls of antibiotherapy include adverse events, vascular access site complications, and drug resistance.

Bilateral immediate two-stage breast reconstruction in patients with unilateral breast cancer: Outcomes analysis and risk assessment.

Introduction: Contralateral prophylactic mastectomy has the potential to decrease the occurrence of cancer and reduce psychological burden. However, it is known that complications after bilateral mastectomy are higher compared with unilateral mastectomy. Our goal was to evaluate outcomes of immediate breast reconstruction in patients undergoing bilateral mastectomy and to compare complication rates between therapeutic and prophylactic sides.

Management of Expander- and Implant-Associated Infections in Breast Reconstruction.

Background: Periprosthetic infection remains the most common complication after implant-based breast reconstruction. Objectives of the study were to (1) describe our clinical approach and treatment protocol for managing patients with suspected periprosthetic infection, (2) identify the microorganisms causing periprosthetic infections at our institute, and (3) report on outcomes of implant salvage versus explantation.

Methods: A retrospective chart review of patients who were treated with parenteral antibiotics for periprosthetic infection was carried out.

Expander/Implant Removal After Breast Reconstruction: Analysis of Risk Factors and Timeline.

Introduction: Removal of tissue expanders (TE) or implants is a dire consequence of breast reconstruction, and has the potential to halt the reconstructive efforts. Our goals were to characterize a cohort of patients with TE/implant removal, to perform a time-based analysis, and to review the bacteriology associated with explanted devices.

Materials And Methods: Review of a prospectively maintained database was performed to identify patients who underwent TE/implant removal.

Free vascularized lymph node transfer for treatment of lymphedema: A systematic evidence based review.

Background: Free vascularized lymph node transfer (VLNT) is a relatively novel technique for treatment of lymphedema. The purpose of this systematic review was to evaluate the current evidence on VLNT and to determine if there is objective data concerning improved outcomes.

Methods: A literature search of PubMed, EMBASE and CENTRAL electronic databases was conducted to identify articles written in the English language on VLNT for treatment of lymphedema.

An Analysis of Current Techniques Used for Intraoperative Flap Evaluation.

Background: Over the last decade, microsurgeons have used a greater variety of more complex flaps. At the same time, microsurgeons have also become more interested in technology, such as indocyanine green (ICG) angiography, dynamic infrared thermography (DIRT), and photospectrometry, for preoperative planning and postoperative monitoring. These technologies are now migrating into the operating room, and are used to optimize flap design and to identify areas of hypoperfusion or problems with the anastomoses.

Predicting skin flap viability using a new intraoperative tissue oximetry sensor: a feasibility study in pigs.

Background:  Operations for soft-tissue reconstruction, orthopedic, vascular, and other types of surgery can be complicated by unexpected skin flap necrosis. At present, surgeons utilize subjective clinical judgment and physical findings to estimate the potential for tissue compromise. As the validity of these subjective methods is questionable, there is a need for objective, quantitative tools to determine the risk of flap necrosis during surgery.

A prospective randomized trial comparing subatmospheric wound therapy with a sealed gauze dressing and the standard vacuum-assisted closure device: a supplementary subgroup analysis of infected wounds.

Introduction: Subatmospheric pressure wound therapy (SAWT) is commonly used to manage infected wounds. However, this practice remains controversial because the safety and efficacy of the technique has not been carefully documented.

Methods: The authors assessed the safety and efficacy of a sealed gauze dressing with wall suction applied (GSUC) compared to vacuum assisted-closure (VAC), both soaked with topical antimicrobials.

A prospective analysis of free flap monitoring techniques: physical examination, external Doppler, implantable Doppler, and tissue oximetry.

No universally accepted method of flap monitoring exists, and several techniques are in use. Repeated physical examination is most popular and is often supplemented with a handheld, external Doppler, and/or implantable Doppler probes; near-infrared spectroscopy is less commonly used. We investigated the nursing and resident house staff's experience and confidence with physical exam for flap monitoring.

Microsurgery in the hypercoagulable patient: review of the literature.

Improved techniques in microvascular surgery over the last several decades have led to the increased use of free tissue transfers as a mode of reconstructing difficult problems with a high success rate. However, undiagnosed thrombophilias have been associated with microsurgery free flap failures. We present a case of successful free tissue transfer in a patient with lupus anticoagulant and review the literature.

A prospective randomized trial comparing subatmospheric wound therapy with a sealed gauze dressing and the standard vacuum-assisted closure device.

Objective: Two methods of subatmospheric pressure wound therapy--wall suction applied to a sealed gauze dressing (GSUC) and the vacuum-assisted closure device (VAC)--were compared in hospitalized patients at University of Chicago Medical Center.

Summary Of Background Data: VAC therapy is widely used, but can be expensive and difficult to apply; it also fails in some patients.

Methods: A randomized prospective study of 87 patients (N = 45 in the GSUC arm and N = 42 in the VAC arm) was undertaken between October 2006 and May 2008.

Ethical considerations in the first American face transplant.

Background: Before performing the first face transplant in the United States, the authors addressed several ethical considerations: subject selection, adequacy of informed consent, and risk-to-benefit analysis.

Methods: Destruction of the patient's midface, including its bony architecture, had impaired the ability of the authors' patient to speak, eat, smell, and socialize. These functional impairments and the inability of conventional reconstruction to reconstruct this deformity justified considering this patient for face transplantation.

Considerations surrounding reconstruction after resection of musculoskeletal sarcomas.

The defects left by resection of bone and soft-tissue sarcomas often require reconstructive surgery to provide adequate wound coverage, preserve limb function, and optimize cosmetic results. Immediate reconstruction should always be considered after resection with a negative margin, and should be attempted whenever possible. The choice of reconstructive method and tissue flap depends on multiple factors, including body site, donor site morbidity, functional requirements, size of the vascular pedicle, and aesthetics.

The technical and anatomical aspects of the World's first near-total human face and maxilla transplant.

Objective: To discuss the technical and anatomical analysis and design of an osteocutaneous allograft transplant incorporating the donor maxilla and the execution of the operative protocol during the transplant.

Methods: The Cleveland Clinic reported the world's first successful combined face and maxilla transplant in December 2008. Unlike the 3 prior face transplants, this surgical procedure was done as a salvage operation in a patient who had undergone 23 major reconstructive procedures.

First U.S. near-total human face transplantation: a paradigm shift for massive complex injuries.

Background: Severe complex facial injuries are difficult to reconstruct and require multiple surgical procedures. The potential of performing complex craniofacial reconstruction in one surgical procedure is appealing, and composite face allograft transplantation may be considered an alternative option. The authors describe establishment of the Cleveland Clinic face transplantation program that led them to perform the first U.

The impact of topical lidocaine on pain level assessment during and after vacuum-assisted closure dressing changes: a double-blind, prospective, randomized study.

Background: Vacuum-assisted closure dressing changes are frequently painful. The authors hypothesized that administering topical lidocaine into the vacuum-assisted closure sponge would decrease pain during dressing changes.

Methods: A double-blind, randomized, prospective study was performed on patients (n = 70) undergoing vacuum-assisted closure dressing changes at a single institution between October of 2003 and June of 2005.

Near-total human face transplantation for a severely disfigured patient in the USA.

Background: Multiple reconstructive procedures are common for the reconstruction of complex facial deformities of skin, soft tissues, bony structures, and functional subunits, such as the nose, lips, and eyelids. However, the results have been unsatisfactory. An innovative approach entailing a single surgical procedure of face allograft transplantation is a viable alternative and gives improved results.

Metachronous giant brachial artery pseudoaneurysms: a case report and review of the literature.

Brachial artery pseudoaneurysms secondary to intravenous drug abuse represent a limb-threatening problem to patients and a technical challenge to the vascular surgeon. Here information is reported about a patient with metachronous bilateral giant brachial artery pseudoaneurysms secondary to intravenous drug use that were successfully treated with excision of the aneurysm and ligation of the brachial artery. Furthermore, a review of the current literature on the treatment of brachial artery aneurysm is presented.

Proximal vascular pedicle preservation for sartorius muscle flap transposition.

Background: A variety of muscle flaps have been described to treat complex groin wounds associated with infected and/or exposed femoral vessels or vascular grafts and persistent lymphatic leaks, and for prophylaxis against wound breakdown following inguinal lymphadenectomy. The sartorius muscle flap has several advantages over other muscle flaps: it is immediately adjacent to the groin, it is easy to prepare, and the harvest causes no functional morbidity. Despite these advantages, the flap's reliability has been questioned because of the segmental blood supply to the muscle and the flap's limited arc of rotation.

Vacuum-assisted closure for sternal wounds: a first-line therapeutic management approach.

Background: Vacuum-assisted closure therapy has gained widespread use since its introduction in 1997. Previous studies have attributed significant benefit to its use for treatment of sternal wounds with or without mediastinitis. Management of sternal wounds with this therapy has been shown to decrease the number of dressing changes, reduce the time between débridement and definitive closure, and reduce costs associated with a protracted course of in-hospital dressing changes.

Primary sternal plating in high-risk patients prevents mediastinitis.

Objective: Sternal wound infection leading to post-operative mediastinitis is a devastating complication of cardiac surgery carrying nearly a 15% mortality rate despite current treatment methods. Instability of bone fragments pre-disposes a patient to have non-union, mal-union and can subsequently lead to deep sternal wound infections progressing to mediastinitis. Rigid plate fixation has been utilized for acquired and surgically created fractures of virtually every bone in the body to prevent instability.