Single stage reconstruction of circumferential pharyngo-esophageal defects using the free jejunum flap produces excellent functional results with minimal morbidity and mortality. The most serious complication with thi...Single stage reconstruction of circumferential pharyngo-esophageal defects using the free jejunum flap produces excellent functional results with minimal morbidity and mortality. The most serious complication with this flap is vascular compromise, usually within the first 24 - 48 hours after surgery. Compromised flaps are frequently diagnosed late often making their salvage impossible, so close postoperative monitoring of tissue perfusion is critical. Rapid identification and salvage of the failing flap increases the chance of a successful outcome.展开更多
Sometimes in free flap there is a venous congestion without an obstruction of the venous anastomosis or other organic causes of reduction venous drainage (haematoma, seroma compressing the pedicle). In these cases the...Sometimes in free flap there is a venous congestion without an obstruction of the venous anastomosis or other organic causes of reduction venous drainage (haematoma, seroma compressing the pedicle). In these cases the authors suggest the application of nitroglycerine patch in the congested area of the flap few hours before the surgical exploration of the anastomosis. If there is a fast improvement of the clinical feature of the flap, the surgical exploration could be avoided. The authors underline that applying the nitroglycerin patch should not be regarded in any way as a therapy of a free flap venous thrombosis but only as an useful device, an option to be taken only when the surgeon is undecided whether to revisit the anastomosis or not.展开更多
Background:Several surgeons have described studies of free-tissue transfers using veins instead of arteries.These innovative microsurgical techniques can offer several advantages,such as an easier dissection during fl...Background:Several surgeons have described studies of free-tissue transfers using veins instead of arteries.These innovative microsurgical techniques can offer several advantages,such as an easier dissection during flap harvesting,and represent an alternative during an accidental surgical mistake or development of new surgical procedures.The purpose of this study was to describe and explore different constructs of vascularized lymph node transfer(VLNT)only based on venous blood flow in a mouse model,evaluate their blood flow microcirculation through indocyanine green(ICG)angiography and investigate the lymphatic drainage function and the lymph nodes’structures.Methods:Five types of venous lymph node flaps(LNF)were created and investigated:Types IA,IB,IC,IIA and IIB were developed by ICG intraoperatively(with videos in the article).Seven weeks later,by applying methylene blue,the recanalization of the lymphatic vessels between the LNF and the recipient site was detected.Lymph nodes were collected at the same time and their structures were analyzed by hematoxylin and eosin staining analysis.Results:All of the venous LNFs developed except Type IC.Seven weeks later,methylene blue flowed into Types IA,IB,IIA and IIB from recipient sites.When comparing with arteriovenous lymph node,the medullary sinus was diffusely distributed in venous lymph nodes.The proportion of cells was significantly reduced(p<0.05).The artery diameters were significantly smaller(p<0.05).The veins diameters and lymphatic vessels output in Types IA,IB,IIA and IIB were more dilated(p<0.05).Conclusions:This research demonstrated that Type IA,IB,IIA and IIB venous LNFs can retrogradely receive venous blood supply;they can survive,produce a lymphatic recanalization and integrate with the surrounding tissue,despite lymph node structural changes.Our results will improve the understanding of the survival mechanism of venous LNFs and will help researchers to design new studies or lymphatic models and eventually find an alternative procedure for the surgical treatment of lymphedema.展开更多
New developments in regenerative medicine are bound to revolutionize the way we approach loss of function and form in human organisms. Especially in the field of reconstructive plastic surgery new biotechnologies find...New developments in regenerative medicine are bound to revolutionize the way we approach loss of function and form in human organisms. Especially in the field of reconstructive plastic surgery new biotechnologies find their way from bench to bed. Biofabrication is an evolving field that aims to combine natural biologic processes with bioartificial constructs with the scope of reconstituting tissue without having to rely on autotransplantation. In this brief review we present the concepts of intrinsic vs. extrinsic neovascularization and we discuss the use of neovascularization in three dimensional matrices. In a clinical context matrix flaps for application in reconstructive surgery can be fabricated this way.展开更多
Aim: Computed tomography angiography (CTA) using three-dimensional (3D) virtual reconstruction has been increasingly used in planning deep inferior epigastric artery perforator (DIEP) breast reconstruction. Although t...Aim: Computed tomography angiography (CTA) using three-dimensional (3D) virtual reconstruction has been increasingly used in planning deep inferior epigastric artery perforator (DIEP) breast reconstruction. Although the most common complication associated with this surgery is diffuse venous congestion, its origin remains unclear. The aim of this study was to assess the anatomical characteristics of the anterior abdominal wall vessels that could predict venous congestion, using CTA with 3D virtual reconstruction. Methods: A retrospective case-control study was conducted and a total of 169 DIEP flaps were reviewed. An abdominal CTA with 3D virtual reconstruction was analyzed with regard to anatomical features of the abdominal wall vessels. Seven venous congestive cases were identified. For each case, 3 controls that had not exhibited any vascular complications were randomly selected. Results: The global venous congestion rate was 4.14%. No statistically significant differences were found between the groups' superficial inferior epigastric vein (SIEV) diameter (P = 0.915), number of branches of SIEV (P = 0.371), number of perforators per flap (P = 0.255), flap subcutaneous tissue thickness (P = 0.652), direct communications between SIEV-perforators (P = 0.418), and communications of both SIEVs across the abdominal midline (P = 0.371). Conclusion: The present study provided new information concerning the identification of the controversial anatomical features associated with venous congestion in DIEP flaps. CTA and 3D virtual reconstruction were useful tools for evaluating the abdominal wall anatomy and for planning DIEP breast surgery, but neither for predicting nor preventing the diffuse congestive phenomenon.展开更多
文摘Single stage reconstruction of circumferential pharyngo-esophageal defects using the free jejunum flap produces excellent functional results with minimal morbidity and mortality. The most serious complication with this flap is vascular compromise, usually within the first 24 - 48 hours after surgery. Compromised flaps are frequently diagnosed late often making their salvage impossible, so close postoperative monitoring of tissue perfusion is critical. Rapid identification and salvage of the failing flap increases the chance of a successful outcome.
文摘Sometimes in free flap there is a venous congestion without an obstruction of the venous anastomosis or other organic causes of reduction venous drainage (haematoma, seroma compressing the pedicle). In these cases the authors suggest the application of nitroglycerine patch in the congested area of the flap few hours before the surgical exploration of the anastomosis. If there is a fast improvement of the clinical feature of the flap, the surgical exploration could be avoided. The authors underline that applying the nitroglycerin patch should not be regarded in any way as a therapy of a free flap venous thrombosis but only as an useful device, an option to be taken only when the surgeon is undecided whether to revisit the anastomosis or not.
基金The national natural science foundation of China(Grant Number:81772098)Clinical Multi-Disciplinary Team Research Program of 9th People’s Hospital,Shanghai Jiao Tong University School of Medicine(Grant Number:2017-1-007)+3 种基金Clinical Research Program of 9th People’s Hospital,Shanghai Jiao Tong University School of Medicine(Grant Number:JYLJ027)Shanghai Municipal Education Commission Gaofeng Clinical Medicine Grant Support(Grant Number:20152227)The national natural science foundation of China(Grant Number:82000456)Scientific research foundation of Shanghai Municipal Commission of Health and Family Planning(Grant Number:20154Y0023).
文摘Background:Several surgeons have described studies of free-tissue transfers using veins instead of arteries.These innovative microsurgical techniques can offer several advantages,such as an easier dissection during flap harvesting,and represent an alternative during an accidental surgical mistake or development of new surgical procedures.The purpose of this study was to describe and explore different constructs of vascularized lymph node transfer(VLNT)only based on venous blood flow in a mouse model,evaluate their blood flow microcirculation through indocyanine green(ICG)angiography and investigate the lymphatic drainage function and the lymph nodes’structures.Methods:Five types of venous lymph node flaps(LNF)were created and investigated:Types IA,IB,IC,IIA and IIB were developed by ICG intraoperatively(with videos in the article).Seven weeks later,by applying methylene blue,the recanalization of the lymphatic vessels between the LNF and the recipient site was detected.Lymph nodes were collected at the same time and their structures were analyzed by hematoxylin and eosin staining analysis.Results:All of the venous LNFs developed except Type IC.Seven weeks later,methylene blue flowed into Types IA,IB,IIA and IIB from recipient sites.When comparing with arteriovenous lymph node,the medullary sinus was diffusely distributed in venous lymph nodes.The proportion of cells was significantly reduced(p<0.05).The artery diameters were significantly smaller(p<0.05).The veins diameters and lymphatic vessels output in Types IA,IB,IIA and IIB were more dilated(p<0.05).Conclusions:This research demonstrated that Type IA,IB,IIA and IIB venous LNFs can retrogradely receive venous blood supply;they can survive,produce a lymphatic recanalization and integrate with the surrounding tissue,despite lymph node structural changes.Our results will improve the understanding of the survival mechanism of venous LNFs and will help researchers to design new studies or lymphatic models and eventually find an alternative procedure for the surgical treatment of lymphedema.
文摘New developments in regenerative medicine are bound to revolutionize the way we approach loss of function and form in human organisms. Especially in the field of reconstructive plastic surgery new biotechnologies find their way from bench to bed. Biofabrication is an evolving field that aims to combine natural biologic processes with bioartificial constructs with the scope of reconstituting tissue without having to rely on autotransplantation. In this brief review we present the concepts of intrinsic vs. extrinsic neovascularization and we discuss the use of neovascularization in three dimensional matrices. In a clinical context matrix flaps for application in reconstructive surgery can be fabricated this way.
文摘Aim: Computed tomography angiography (CTA) using three-dimensional (3D) virtual reconstruction has been increasingly used in planning deep inferior epigastric artery perforator (DIEP) breast reconstruction. Although the most common complication associated with this surgery is diffuse venous congestion, its origin remains unclear. The aim of this study was to assess the anatomical characteristics of the anterior abdominal wall vessels that could predict venous congestion, using CTA with 3D virtual reconstruction. Methods: A retrospective case-control study was conducted and a total of 169 DIEP flaps were reviewed. An abdominal CTA with 3D virtual reconstruction was analyzed with regard to anatomical features of the abdominal wall vessels. Seven venous congestive cases were identified. For each case, 3 controls that had not exhibited any vascular complications were randomly selected. Results: The global venous congestion rate was 4.14%. No statistically significant differences were found between the groups' superficial inferior epigastric vein (SIEV) diameter (P = 0.915), number of branches of SIEV (P = 0.371), number of perforators per flap (P = 0.255), flap subcutaneous tissue thickness (P = 0.652), direct communications between SIEV-perforators (P = 0.418), and communications of both SIEVs across the abdominal midline (P = 0.371). Conclusion: The present study provided new information concerning the identification of the controversial anatomical features associated with venous congestion in DIEP flaps. CTA and 3D virtual reconstruction were useful tools for evaluating the abdominal wall anatomy and for planning DIEP breast surgery, but neither for predicting nor preventing the diffuse congestive phenomenon.