Tourniquet Use in Extremity-Based Microsurgery.

Background:  The use of tourniquets and their role in extremity-based microsurgery has not been thoroughly investigated. The purpose of this study was to investigate tourniquet use and its associated outcomes and complications. The authors hypothesize that tourniquets enhance visualization, bloodless approaches to vessel harvest, flap elevation, and anastomosis without added complications.

The use of abdominal wall tissue expansion prior to herniorrhaphy in massive ventral hernia defects.

Background: Massive ventral hernias pose a challenging reconstructive problem. In comparison to bridging mesh repair, the primary fascial repair is associated with significantly reduced rates of hernia recurrence. This study will review our experience with massive ventral hernia repairs using tissue expansion and anterior component separation as well as present the largest case series to date.

Predictors of Success following Microvascular Replantation Surgery of the Upper Extremity in Adult Patients.

Unlabelled: The purpose of this study is to ascertain which factors are associated with successful replantation in the upper extremity. Secondarily, the purpose was to determine patient factors that differentiate those patients who undergo initial replantation versus initial amputation.

Methods: Data gathered for this retrospective study were obtained from a custom subset of the 2015-2020 IBM Truven MarketScan Commercial and IBM Truven MarketScan Medicare Supplemental databases.

Targeted muscle reinnervation: A narrative review of a novel tool for the management of neuropathic pathology in major lower extremity amputations.

Objective: The purpose of this narrative review is to provide the vascular surgery community with updated recommendations and information regarding the use of Targeted Muscle Reinnervation (TMR) for both the prevention and treatment of chronic pain and phantom limb pain occurring in patients after undergoing lower extremity amputation for peripheral artery disease.

Methods: Current available literature discussing TMR is reviewed and included in the article in order to provide a succinct overview on the indications, clinical applications, and surgical technique for TMR. Additionally, early studies showing favorable long-term results after TMR are discussed.

The Current State of Targeted Muscle Reinnervation: A Systematic Review.

Background:  Targeted muscle reinnervation (TMR) is growing in popularity; however, literature evaluating patient characteristics and outcomes is limited.

Methods:  The EMBASE database was queried with the search terms "targeted muscle reinnervation" OR "TMR" AND "outcomes" OR "patient outcomes." Clinical human studies in English were eligible for inclusion, yielding 89 articles.

Brachial Plexus Birth Injury: Trends in Early Surgical Intervention over the Last Three Decades.

Unlabelled: Early surgical management of brachial plexus birth injury has advanced owing to targeted surgical techniques and increases in specialty-centers and multi-institutional collaboration. This study seeks to determine trends in the early surgical management of BPBI over the last 30 years.

Methods: A systematic review was performed through MEDLINE (PubMed) identifying studies limited to the early surgical management of BPBI from 1990 to current.

Technique of Abdominal Wall Tissue Expansion for the Treatment of Massive Complicated Ventral Hernias.

Abdominal wall tissue expansion is a unique technique that seeks to augment and expand both the fascial and subcutaneous tissues/skin layers to achieve durable closure of otherwise challenging ventral hernias. In addition to allowing primary fascial closure in a majority of cases, this technique enables reduced tension on the closure, potentially decreasing the recurrence rate. This article describes the senior author's surgical technique for abdominal wall tissue expansion in massive complicated ventral hernias.

A Call to Arms: Emergency Hand and Upper-Extremity Operations During the COVID-19 Pandemic.

Purpose: Limited data exist regarding volumetric trends and management of upper-extremity emergencies during periods of social restriction and duress, such as the coronavirus disease 2019 pandemic. We sought to study the effect of shelter-in-place orders on emergent operative upper-extremity surgery.

Methods: All patients undergoing emergent and time-sensitive operations to the finger(s), hand, wrist, and forearm were tracked over an equal number of days before and after shelter-in-place orders at 2 geographically distinct Level I trauma centers.

Neurotized Free Tissue Transfer for Foot Reconstruction: A Systematic Review.

Background:  Soft tissue reconstruction of the foot represents a complex reconstructive challenge given the unique anatomical properties of the glabrous plantar skin. For large soft tissue defects and/or complex injuries, free tissue transfer is often the optimal reconstructive modality. The decision to pursue a neurotized free flap remains controversial and an area of debate.

Venous Anastomoses in Anterolateral Thigh Flaps for the Lower Extremity: Vessel Selection In Lieu of Obligatory Number.

Background: Dual venous drainage for anterolateral thigh flaps has been proposed to protect against flap-related complications in head and neck applications. Here we report our experience with single vs dual venous anastomosis during lower extremity free-tissue transfer.

Methods: All free anterolateral thigh flaps for lower extremity reconstruction from 2011 to 2017 were retrospectively reviewed.

Assessing the Safety and Efficacy of Regional Anesthesia for Lower Extremity Microvascular Reconstruction: Enhancing Recovery.

Background:  Perioperative pain, increased sympathetic tone, and peripheral vasospasm may be safely managed with regional nerve blockade during microvascular reconstruction in the lower extremity. Limited reports exist in this setting; therefore, we evaluated our use of peripheral nerve catheters (PNCs) during microvascular limb salvage to determine safety and efficacy for both patient and flap.

Methods:  A single-institution, retrospective review of a prospectively maintained database on all patients with lower extremity free tissue transfers between 2012 and 2017 was completed.

Outcomes of Subfascial, Suprafascial, and Super-Thin Anterolateral Thigh Flaps: Tailoring Thickness without Added Morbidity.

Background:  Subfascial anterolateral thigh (ALT) flap thickness can be problematic with regards to bulk, oral competence, shoe-fit, or as a potential source of recurrent wound breakdown. We have utilized distinct upper thigh fascial planes to fashion thin (suprafascial) or super-thin (periscarpal) ALT flaps to improve surface topography. We compared outcomes based on ALT flap thickness to determine any significant differences in extremity coverage and reconstruction.

The early laparoscopic repair of a traumatic lumbar hernia: safe and successful.

Abdominal wall hernias are a rare but important consequence of blunt trauma. The optimal timing and the method of repair are not well described in the current surgical literature. Advances in laparoscopic techniques have offered new options for treatment of this problem.

National Outcomes after Pressure Ulcer Closure: Inspiring Surgery.

Over two million Americans receive treatment for pressure ulcers (PUs) annually, but national surgical outcomes are not well described. This study investigated rates and risk factors of postoperative complications in patients with PU. The 2011 and 2012 American College of Surgeons-National Surgical Quality Improvement Project database was queried and PU patients undergoing flap closure were identified.

Revising Recommendations and Outcome Measurements after Complex Open Abdominal Wall Reconstruction.

Grading systems developed by the Ventral Hernia Working Group (VHWG) for complex open abdominal wall reconstruction rely on limited outcomes: surgical site occurrence (SSO) and hernia recurrence. This does not account for the longitudinal restoration of a functional abdominal wall and the ability to correct complications. We performed a single-site, retrospective review of consecutive complex open abdominal wall reconstruction interventions with 24-month minimum follow-up to establish reoperation rates and compare long-term results to the VHWG.

The newborn butterfly project: a shortened treatment protocol for ear molding.

Background: Secondary to circulating maternal estrogens, a baby's ear cartilage is unusually plastic during the first few weeks of life, providing an opportunity to correct ear deformities by molding. If molding is initiated during the first days of life with a more rigid molding system than previously described in the literature, the authors hypothesized that treatment time would be reduced and the correction rate would increase.

Methods: An interdisciplinary team identified and assessed all infants born with ear deformities at New York-Presbyterian Hospital/Weill Cornell Medical Center.