| 1. |
- Acosta, Rafael, et al.
(författare)
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A Clinical Review of 9 Years of Free Perforator Flap Breast Reconstructions : An Analysis of 675 Flaps and the Influence of New Techniques on Clinical Practice
- 2011
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Ingår i: Journal of reconstructive microsurgery. - : Georg Thieme Verlag KG. - 0743-684X .- 1098-8947. ; 27:2, s. 91-98
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Forskningsöversikt (refereegranskat)abstract
- The aim of this study is to review our 9-year experience with deep inferior epigastric perforator (DIEP) breast reconstructions to help others more easily overcome the pitfalls we experienced. A chart review was conducted for all 543 patients who had 622 DIEP breast reconstructions in our clinic between January 2000 and January 2009. In this time, there were an additional 28 superior gluteal artery perforator and 25 superficial inferior epigastric artery reconstructions, bringing the total free flap reconstructions to 675. In the early years, the success rate was 90.7%, the average operative time was 7 hours and 18 minutes, and the complication rate was 33.3%; these have improved to 98.2%, 4 hours and 8 minutes, and 19.3%, respectively. We describe our selection criteria, preoperative vascular mapping, surgical techniques, and postoperative monitoring as they relate to these improvements in outcome, operative time, and complications. The DIEP flap is a safe and reliable option in breast reconstructions. By acquiring experience with the flap and introducing new and improving existing techniques we have improved the ease of the procedure and the success rate and have shortened the operative time.
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| 2. |
- Audolfsson, Thorir, et al.
(författare)
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A Reliable and Aesthetic Technique for Cephalic Vein Harvest in DIEP Flap Surgery
- 2009
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Ingår i: Journal of reconstructive microsurgery. - : Georg Thieme Verlag KG. - 0743-684X .- 1098-8947. ; 25:5, s. 319-321
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Tidskriftsartikel (refereegranskat)abstract
- The need for a secondary source of venous drainage in deep inferior epigastric artery perforator flaps is common, with the cephalic vein Commonly utilized as an alternative venous recipient vessel. In using the cephalic vein, previous studies have described the deltopectoral groove or the infraclavicular fossa as the site for harvest. We describe the use of an anterior axillary skin crease, which can improve aesthetic outcome, reduce the time needed for harvest, enable a greater length of vein to be transposed, and minimize surgical insult to the upper breast/chest wall. An anterior axillary-line skin fold can be used as the site for cephalic vein harvest, and using the methodology described, the technique can be fast and highly reliable and result in a final scar that is barely visible.
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| 3. |
- Brorson, Håkan
(författare)
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Liposuction in Lymphedema Treatment.
- 2016
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Ingår i: Journal of Reconstructive Microsurgery. - : Georg Thieme Verlag KG. - 1098-8947 .- 0743-684X. ; 32:1, s. 56-65
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Forskningsöversikt (refereegranskat)abstract
- Background Lymphedema leads to early deposition of adipose tissue. This may explain why conservative therapies such as complex decongestive therapy (CDT) and controlled compression therapy (CCT), as well as various forms of microsurgical reconstructions, cannot completely remove the excess volume in patients with a large chronic nonpitting lymphedema. Liposuction is therefore a logical and tempting treatment to reduce the adipose tissue volume excess. This article outlines the benefits of using liposuction and presents evidence to support its use. Methods The mechanism between adipose tissue depositions is described as well as the surgical technique, postoperative care, volume measurements, effects on the lymph transport, and follow-up. Results Fifteen years' follow-up shows complete reduction of the excess volume without recurrence following liposuction in patients with postmastectomy arm lymphedema. The same promising results can also be seen in patients with leg lymphedema. Conclusion Various types of treatment of lymphedema are under discussion and there has been some controversy regarding liposuction for lymphedema. Improvements in techniques, patient preparation, and patient follow-up have led to a greater and wider acceptance of liposuction as a treatment for lymphedema in patients with large chronic nonpitting extremity lymphedemas.
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| 4. |
- Danielsen, N, et al.
(författare)
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Characterization of neurotrophic activity in the silicone-chamber model for nerve regeneration
- 1995
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Ingår i: Journal of Reconstructive Microsurgery. - : Georg Thieme Verlag KG. - 0743-684X .- 1098-8947. ; 11:3, s. 231-235
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Tidskriftsartikel (refereegranskat)abstract
- In the present study, the authors reevaluated the temporal course and properties of neurotrophic activities present in the fluid accumulating in the silicone-chamber model for nerve regeneration. The fluid collected from silicone chambers was tested in four different dissociated neuronal cell cultures. Furthermore, the activity of the chamber fluid was examined, using a cell blot technique. There was one major peak of neurotrophic activity and this activity peaked early, about 3 to 6 hr after nerve injury. Results also indicate that the chamber fluid contains at least two types of neurotrophic activities, namely nerve growth factor and ciliary neurotrophic factor.
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| 5. |
- di Summa, Pietro G, et al.
(författare)
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Paper clip microretractor
- 2009
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Ingår i: Journal of reconstructive microsurgery. - : Thieme Medical Publishers. - 0743-684X .- 1098-8947. ; 25:4, s. 273-273
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 6. |
- Dimovska, Eleonora Olivera Felicity, et al.
(författare)
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Challenging the Orthodoxy of Mandibular Reconstructions Comparing Functional Outcomes in Osseous versus Soft Tissue Reconstructions of the Posterolateral Mandible.
- 2020
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Ingår i: Journal of reconstructive microsurgery. - : Georg Thieme Verlag KG. - 0743-684X .- 1098-8947. ; 36:1, s. 21-27
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Appropriate reconstruction of the posterolateral mandible remains controversial. Both osseous and soft tissues are vital components for an overall successful outcome and are often combined in complex defects. Their respective effect on oromandibular function in the reconstruction of different degrees of mandibular defects has been less evaluated. This study aimed to compare patient-perceived oromandibular function in osseous and soft tissue-only reconstructions following posterolateral mandibular defects, defined as limited or extended.PATIENTS AND METHODS: A 10-year retrospective review of consecutive patients undergoing mandibular reconstructions of the posterolateral mandible were identified. Limited defects were defined as reaching from the ipsilateral parasymphysis to anterior of the coronoid (sparing insertion of muscles of mastication). Extended defects were defined as reaching from the ipsilateral parasymphysis to posterior of the coronoid (sacrificing the muscle insertions). Functional outcomes were assessed using the University of Washington Quality of Life questionnaire, version 4.RESULTS: A total of 163 patients were identified, of which 41 patients had the particular posterolateral mandibular resections sought after. In 23 limited resections, there was no difference in functional outcome between osseous and soft tissue-only reconstructions. In 18 patients undergoing extended resections, osseous reconstructions demonstrated significantly better outcomes (p = 0.011). There were no significant differences in patient demographics between the groups.CONCLUSION: Our study highlights the interest of soft tissue-only reconstructions of the posterolateral mandible. Limited resections seem not to benefit from complex osseous reconstruction for adequate function. Conversely, there is a noteworthy positive impact on functional outcomes in extended posterolateral mandibulectomies reconstructed with osseous tissue, compared with soft tissue only. Although a larger study is needed to identify a stronger relationship, these preliminary results could aid reconstructive decisions, particularly when considering patient morbidity.
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| 9. |
- Kalbermatten, Daniel F, 1969-, et al.
(författare)
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New fibrin conduit for peripheral nerve repair
- 2009
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Ingår i: Journal of reconstructive microsurgery. - : Georg Thieme Verlag KG. - 0743-684X .- 1098-8947. ; 25:1, s. 27-33
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Tidskriftsartikel (refereegranskat)abstract
- An ideal substitute to treat a nerve gap has not been found. Initially, silicone conduits were employed. Later, conduits were fabricated from collagen or polyesters carbonates. More recently, it has been shown that a bioresorbable material, poly-3-hydroxybutyrate (PHB), can enhance nerve repair. The present investigation shows the use of fibrin as a conduit to guide nerve regeneration and bridge nerve defects. In this study we prepared and investigated a novel nerve conduit made from fibrin glue. Using a rodent sciatic nerve injury model (10-mm gap), we compared the extent of nerve regeneration through the new fibrin conduits versus established PHB conduits. After 2 and 4 weeks, conduits containing proximal and distal stumps were harvested. We evaluated the initial axon and Schwann cell stimulation using immunohistochemistry. The conduits presented full tissue integration and were completely intact. Axons crossed the gap after 1 month. Immunohistochemistry using the axonal marker PGP 9.5 showed a superior nerve regeneration distance in the fibrin conduit compared with PHB (4.1 mm versus 1.9 mm). Schwann cell intrusion (S100 staining) was similarly enhanced in the fibrin conduits, both from the proximal (4.2 mm versus 2.1 mm) and distal ends (3.2 mm versus 1.7 mm). These findings suggest an advantage of the new fibrin conduit for the important initial phase of peripheral nerve regeneration. The use of fibrin glue as a conduit is a step toward a usable graft to bridge peripheral nerve lesions. This might be clinically interesting, given the widespread acceptance of fibrin glue among the surgical community.
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| 10. |
- Lundborg, G, et al.
(författare)
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Trophism, tropism, and specificity in nerve regeneration
- 1994
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Ingår i: Journal of Reconstructive Microsurgery. - : Georg Thieme Verlag KG. - 0743-684X .- 1098-8947. ; 10:5, s. 54-345
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Tidskriftsartikel (refereegranskat)abstract
- Target-derived neurotrophic factors are of basic importance for survival of neurons. In the normal state, such neurotrophic factors, synthesized by the target tissues, are taken up by nerve terminals and transported by retrograde axonal transport in axons to the nerve-cell bodies to maintain their viability. After nerve injury, neurotrophic factors are synthesized by non-neuronal cells (Schwann cells and fibroblasts) in the nerve trunk, thereby supporting the outgrowth of axons. Neurite-outgrowth-promoting factors on cell surfaces (cell adhesion molecules, "recognition molecules") or in the extracellular matrix promote extension of the axons by providing an appropriate "adhesiveness" in the substrate. Both neurotrophic and neurite-outgrowth-promoting factors are essential for axonal growth after injury. Specificity in end-organ reinnervation is a complex phenomenon which may be based on physical factors at the zone of injury, as well as on molecular interaction between axons and substrate cells along the pathways and at the target level. Such processes may include molecular recognition of appropriate axons and maintenance of such axons by trophic mechanisms, as well as the pruning of inappropriate axons. The ultimate errors in target reinnervation are reflected in a cortical re-organization in the somatosensory cortex. The capacity of the brain to "reprogram" itself and adapt to this functional re-organization is critical for the ultimate recovery of functional sensory/motor function after nerve injuries.
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