查看更多>>摘要：Delayed pedicled flaps are a reliable reconstructive tool for limb salvage.Determining the optimal timing for pedicle division is critical for surgical success and minimizing complications.Assessment of optimal timing has traditionally relied on arbitrary timing or subjective measures.This study explores the use of indocyanine green(ICG)angiography in the office setting as an objective guide for timing the delayed pedicled flap pedicle division,aiming to improve surgical outcomes and resource efficiency.In the outpatient setting,ICG is administered intravenously while the flap pedicle is under tourniquet control.If the distal flap opacifies with the tourniquet still applied,appropriate revascularization has occurred,and the pedicle may be safely divided.We present the example of a 47-year-old male with multiple previous flap reconstructions who eventually required a reverse sural artery flap.Initial intraoperative ICG imaging on postoperative day(POD)23 revealed insufficient perfusion,prompting the postponement of pedicle division.Subsequent office-based imaging on POD 47 revealed a persistent lack of neovascularization.Adequate vascularization was demonstrated on POD 81,enabling successful pedicle division in the operating room on POD 121 without complications.ICG fluorescent angiography can guide the timing of division for delayed pedicled flaps.We recommend its use in the outpatient setting to decrease unnecessary operating room usage and anesthetic events and reduce the risk of wound healing complications from early pedicle division.
Peter C.FerrinBrynn HathawayJohanna WilsonBlair R.Peters...
8-17页
查看更多>>摘要：This article presents a comprehensive strategy for both the prevention and treatment of neuropathic pain at the radial forearm(RF)donor site.This strategy is presented within the framework of RF phalloplasty,based on the senior author's practice and the premise that of all RF reconstructions,phalloplasty holds the greatest potential for postoperative neuropathic pain due to flap size and the inherent division of multiple antebrachial cutaneous nerves to provide for flap sensation.This proposed protocol offers a thorough care pathway that integrates techniques in peripheral nerve surgery with perioperative clinical strategies to prevent and treat neuropathic pain.Specific technical recommendations for the prevention and treatment of postoperative neuromas,compression neuropathies,and hyperalgesia of each peripheral nerve involved in RF phalloplasty flap harvest are proposed.These strategies can be adapted and applied to RF flaps utilized in other reconstructive areas.
查看更多>>摘要：In autologous breast reconstruction,the deep inferior epigastric perforator(DIEP)flap is the most commonly used.For patients undergoing unilateral breast reconstruction who desire augmentation of the contralateral breast but wish to avoid using implants,augmentation of the contralateral breast using DIEP flaps is a reliable option.Preoperative evaluation requires assessing the patient's desired outcome and the amount of abdominal tissue available.CT angiography(CTA)helps facilitate the evaluation of abdominal perforator anatomy and the estimation of flap volumes for simultaneous reconstruction and contralateral augmentation.Flap design takes into consideration the perforators needed for a large flap for the primary reconstruction and the length of the pedicle needed to access contralateral recipient vessels for a smaller flap for augmentation.One set of recipient vessels[internal mammary artery(IMA)/internal mammary vein(IMV)]are used with antegrade anastomoses performed for primary reconstruction flaps and retrograde anastomoses for flaps used in augmentation.Augmentation flaps can be completely buried or include a skin paddle for monitoring.Subsequent secondary procedures are often needed to achieve the desired final breast shape and symmetry.Overall,patients who have undergone unilateral autologous breast reconstruction with simultaneous contralateral autologous augmentation report high levels of satisfaction postoperatively.
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