Closure of the osteocutaneous fibula flap donor site with a tonearm (propeller) flap: Anatomic considerations and surgical indications.

Background: Skin graft is frequently used for donor site closure after osteocutaneous fibula free flap (OCFFF) harvest when primary closure is not possible. Partial skin graft loss requiring wound care is a common complication. The purposes of this prospective study were to investigate the perforator anatomy for local propeller or tonearm flap closure and compare the outcomes to those of skin graft closure.

Effects of changing farming practices in African agriculture.

Information on the effects of changing agricultural management on crop and livestock performance is critical for developing evidence-based policies, investments, and programs. Evidence for Resilient Agriculture (ERA) v1.0.

Free fibula mandible reconstruction for osteoradionecrosis is more challenging than for primary cancer.

Introduction: Osteoradionecrosis (ORN) of the mandible is an unfortunate potential sequela of radiotherapy for head and neck cancer. In advanced cases of ORN, mandibulectomy, and free fibula flap reconstruction are required. We hypothesized that patients undergoing fibula free flap reconstruction and mandibulectomy for ORN pose unique challenges and experience more complications than patients undergoing fibula free flaps after oncologic mandibulectomy.

Premastectomy Radiotherapy and Immediate Breast Reconstruction: A Randomized Clinical Trial.

Importance: Premastectomy radiotherapy (PreMRT) is a new treatment sequence to avoid the adverse effects of radiotherapy on the final breast reconstruction while achieving the benefits of immediate breast reconstruction (IMBR).

Objective: To evaluate outcomes among patients who received PreMRT and regional nodal irradiation (RNI) followed by mastectomy and IMBR.

Design, Setting, And Participants: This was a phase 2 single-center randomized clinical trial conducted between August 3, 2018, and August 2, 2022, evaluating the feasibility and safety of PreMRT and RNI (including internal mammary lymph nodes).

The Full Continuum of Robotic Breast Surgery: Robotic-assisted Mastectomy, Robotic DIEP Flap, and Robotic Supermicrosurgery.

In recent years, robotic surgery has rapidly expanded to improve surgical outcomes in a variety of surgical subspecialties. Although plastic surgery has taken longer to integrate robotic surgery into practice, the advantages of robotic-assisted surgery, including improved visualization and resolution, minimally invasive approaches, and the ability to surpass human precision and scale, have driven its more recent adoption into plastic surgery. Currently, procedures performed with robotic assistance that are considered part of the continuum of surgical treatment of breast cancer include robotic-assisted nipple-sparing mastectomy, reconstruction with the robotic latissimus dorsi flap or the deep inferior epigastric artery perforator flap, and robotic microsurgery for the flap anastomosis and/or the surgical treatment of lymphedema.

Outcomes for 160 Consecutive Lateral Arm Free Flaps for Head and Neck Reconstruction.

Objective: Examine outcomes for lateral arm autologous tissue transfer in head and neck reconstruction.

Study Design: Retrospective cohort study.

Setting: Tertiary cancer center.

Evolution of Medical Modeling and 3D Printing in Microvascular Midface Reconstruction: Literature Review and Experience at MD Anderson Cancer Center.

Reconstruction of the midface represents a challenge for reconstructive microsurgeons given the formidable task of restoring both aesthetics and functionality. In particular, preservation of proper globe positioning and maintaining normal vision are as important as restoring the proper projection of the midface and enabling a patient to speak and eat as normally as possible. The introduction of virtual surgical planning (VSP) and medical modeling has revolutionized bony reconstruction of the craniofacial skeleton; however, the overwhelming majority of studies have focused on mandibular reconstruction.

Innovative Strategies in Microvascular Head and Neck Reconstruction.

The field of reconstructive microsurgery has witnessed considerable advancements over the years, driven by improvements in technology, imaging, surgical instruments, increased understanding of perforator anatomy, and experience with microsurgery. However, within the subset of microvascular head and neck reconstruction, novel strategies are needed to improve and optimize both patient aesthetics and post-operative function. Given the disfiguring defects that are encountered following trauma or oncologic resections, the reconstructive microsurgeon must always aim to innovate new approaches, reject historic premises, and challenge established paradigms to further achieve improvement in both aesthetic and functional outcomes.

The lateral forearm flap versus traditional upper extremity flaps: A comparison of donor site morbidity and flap thickness.

Introduction: The lateral forearm flap (LFF) is a thin fasciocutaneous flap with a donor site that can be closed primarily.

Methods: A retrospective analysis of donor site morbidity and hand function was performed in patients who underwent a radial forearm flap (RFF), ulnar artery perforator flap (UAPF), or LFF. Flap thickness was evaluated radiographically in 50 control patients.

Subpectoral Implant Placement Is Not Protective against Postmastectomy Radiotherapy-Related Complications Compared to Prepectoral Placement.

Background: Postmastectomy radiotherapy (PMRT) is associated with altered cosmetic outcomes and higher complication rates in implant-based breast reconstruction (IBR). Conventional wisdom suggests that muscle coverage is somewhat protective against PMRT-related complications. In this study, the authors compared surgical outcomes in patients who underwent two-stage prepectoral versus subpectoral IBR in the setting of PMRT.

Surgical and Patient-Reported Outcomes of 694 Two-Stage Prepectoral versus Subpectoral Breast Reconstructions.

Background: Opinion regarding the optimal plane for prosthetic device placement in breast reconstruction patients has evolved. The purpose of this study was to assess the differences in complication rates and patient satisfaction between patients who underwent prepectoral and subpectoral implant-based breast reconstruction (IBR).

Methods: The authors conducted a retrospective cohort study of patients who underwent two-stage IBR at their institution from 2018 to 2019.

Down with the Bean Bag: A Multi-institutional Experience with Total Latissimus Muscle Free Flap Harvest in the Supine Position.

The latissimus muscle continues to be a head to toe workhorse in free tissue transfer for coverage of large defects. Traditional full muscle harvest is performed in the lateral decubitus position which is frequently suboptimal or requires position change based on the recipient site and laterality. We present a multi-institutional case series of full muscle flap harvest from the supine position for a range of defects in 32 patients.

Vascularized Condyle Reconstruction with Free Medial Femoral Trochlea and Fibular Flow-through Flaps.

The free fibula flap is the gold standard in reconstruction of oncologic mandibular defects. When the mandibular condyle is resected, reconstruction of the temporomandibular joint (TMJ) continues to pose a unique challenge to the reconstructive surgeon. Several conventional methods have been described, including costochondral grafts, bone grafts, and alloplastic prostheses.

The Medial Femoral Condyle Flap: A Novel Versatile Tool for Complex Microvascular Maxillofacial Reconstruction.

Summary: The medial femoral condyle flap is well-described for reconstruction of small bone defects of the upper and lower extremities. There are limited case reports of its use in other anatomic sites, particularly for reconstruction of complex head and neck defects. In the setting of previous radiation and contaminated fields, vascularized bone is generally preferred to bone grafts, cadaveric allografts, or synthetic implants.

Prospective Pilot Study of Robotic-Assisted Harvest of the Latissimus Dorsi Muscle: A 510(k) Approval Study with U.S. Food and Drug Administration Investigational Device Exemption.

Background: There are no U.S. Food and Drug Administration (FDA)-approved indications for robotic plastic surgery.

Robotic DIEP Patient Selection: Analysis of CT Angiography.

Background: Preoperative CTA is widely used and extensively studied for planning of DIEP flap breast reconstruction. However, its utility in planning robotic DIEP harvest is undescribed.

Methods: The authors conducted a retrospective study of consecutive patients presenting to the clinics of select plastic surgeons between 2017 and 2021 for abdominally based autologous breast reconstruction.

Free Lateral Forearm Flap in Head and Neck Reconstruction: An Attractive Alternative to the Radial Forearm Flap.

The lateral forearm flap-a thin, fasciocutaneous flap harvested over the lateral epicondyle based on the terminal anterior branch of the posterior radial collateral artery-is an attractive alternative to the radial forearm flap. The authors hypothesized that it is safe and effective for head and neck reconstruction. They conducted a retrospective review of all lateral forearm flap reconstructions performed between 2016 and 2018.

Is Our Effort Appropriately Valued? An Analysis of Work Relative Value Units in Immediate Breast Reconstruction.

Background: The work relative value units system was developed as a quantifier of physician labor, technical skill, and training time required to complete surgical procedures. Thus, more complex surgical procedures that require greater technical skills and are more time consuming should yield a greater compensation. It is known that prosthetic breast reconstruction reimburses more per hour than autologous breast reconstruction.

The Effect of Positive Postdebridement Cultures on Local Muscle Flap Reconstruction of the Lower Extremity.

Background: Local muscle flaps are a reconstructive option for wound coverage in the distal lower extremity, particularly in high-risk patients who are poor candidates for free tissue transfer. At our institution, chronic and infected wounds are managed with serial debridement before definitive reconstruction. There is a paucity of data on optimal timing for reconstruction in this patient population.

A critical look at the effect of hyperbaric oxygen on the ischemic nipple following nipple sparing mastectomy and implant based reconstruction: a case series.

Background: Nipple preservation provides superior aesthetic results as well as patient satisfaction in patients treated with both therapeutic and prophylactic mastectomy. Post-operative nipple ischemia and necrosis presents a unique clinical challenge that may be treated with hyperbaric oxygen therapy or conservative measures alone. To date, the efficacy of hyperbaric oxygen on post-operative nipple ischemia has yet to be evaluated.