Journal of plastic, reconstructive & aesthetic surgery : JPRAS
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J Plast Reconstr Aesthet Surg · Jul 2019
Prophylactic incisional negative pressure wound therapy shows promising results in prevention of wound complications following inguinal lymph node dissection for Melanoma: A retrospective case-control series.
Inguinal lymphadenectomy (ILND) for melanoma is associated with a number of complications including seroma, surgical site infection (SSI), and lymphedema. Incisional negative pressure wound therapy (iNPWT) has shown promising results in preventing postoperative morbidity across a wide variety of surgical procedures, but these results are yet to be investigated in patients undergoing ILND for melanoma. ⋯ The use of prophylactic iNPWT significantly reduced seroma formation following ILND. These promising results, however, need to be confirmed in a future prospective randomized trial.
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J Plast Reconstr Aesthet Surg · Jul 2019
Case ReportsSequential chimeric deep circumflex iliac artery perforator flap and flow-through anterolateral thigh perforator flap for one-stage reconstruction of complex tissue defects.
Simultaneous reconstruction of composite bone and large soft-tissue defect areas is challenging for reconstructive surgeons. This study presents a microsurgical sequential chimeric flap composed of a flow-through anterolateral thigh perforator (ALTP) flap and a deep circumflex iliac artery perforator (DCIAP) chimeric flap for one-stage reconstruction of a complex tissue defect in limbs. ⋯ The sequential chimeric ALTP-DCIAP flap is a valuable alternative for one-stage reconstruction of composite bone and large soft-tissue defects in limbs. This approach is flexible and provides a large cutaneous area with primary closure of the donor site.
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J Plast Reconstr Aesthet Surg · Jul 2019
Case ReportsVein conduit for end-to-side anastomosis of a calcified vessel in lower extremity free flap reconstruction.
As the microsurgical and interventional revascularization techniques are evolving, traditionally amputated limbs are now challenged to salvage. However, a calcified recipient vessel is a common but challenging problem encountered in lower extremity reconstruction. ⋯ A total of 18 free flaps (10 ALT cases, 4 TDAP cases, 2 PAP cases, and 2 SCIP cases) were anastomosed with a bridge vein graft to the heavily calcified recipient vessels (7 ATA cases, 3 PTA cases, 7 DPA cases, and 1 MPA case). Overall flap survival rate was 83.3%. Limb salvage rate was 93.7%, and anastomosis patency rate was 94.4% CONCLUSION: Vein conduit in an end-to-side anastomosis of severely calcified recipient vessels shows a reasonable limb salvage rate. It acts as a buffer, which makes microscopic vessel manipulation easier. If vessel calcification is the only drawback for a free flap reconstruction, then a vein graft needs to be prepared instead of an amputation. This method may extend the surgical option to more high-risk patients in lower extremity microsurgical reconstruction and increase the limb salvage rate.
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J Plast Reconstr Aesthet Surg · Jul 2019
Delayed breast reconstruction with transverse latissimus dorsi myocutaneous flap using Becker expander implants in patients submitted to radiotherapy: A series of cases.
Breast reconstruction with a latissimus dorsi myocutaneous flap associated with a breast implant is a well-established procedure. However, there are few published articles regarding latissimus association with expanders and radiotherapy. This study assess data of breast reconstructions using a latissimus dorsi myocutaneous flap associated with Becker expander implant (TLDMF/E) in patients submitted to radiotherapy. ⋯ Delayed breast reconstruction with TLDMF/E is a reliable option to selected patients with mastectomy and radiotherapy sequel.
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J Plast Reconstr Aesthet Surg · Jun 2019
Preoperative planning of lymphaticovenous anastomosis: The use of magnetic resonance lymphangiography as a complement to indocyanine green lymphography.
Lymphaticovenous anastomosis (LVA) is a surgical treatment for lymphedema that requires identification and mapping of functional lymphatic channels. This technique was performed blindly for years because of the lack of suitable methods of study. Progress in imaging techniques and the introduction of Indocyanine green lymphography (ICG-L) represented a significant advancement in lymphedema management. Magnetic resonance lymphangiography (MRL) has also helped improve knowledge about lymphedema anatomy and pathophysiology. We now present our protocol based on both ICG-L and MRL for optimal LVA preoperative planning. ⋯ ICG-L and MRL are noninvasive techniques that provide images of the lymphatic system with sufficient temporal and spatial resolution to depict functional lymphatic vessels. Such knowledge is essential for preoperative planning of LVA microsurgery. We present our protocol for the approach of surgical treatment of lymphedema. This protocol represents a step forward in unifying patient selection criteria and achieving safe, effective, and rational surgery.