Cases Of Venous Congestion Research Articles

Le lambeau sural désépidermisé : technique originale de fiabilisation du lambeau neurocutané sural

The neurocutaneous sural flap is useful to cover defects of the distal quarter of the lower limb. Nevertheless, severe complications occur in 14% of the cases, and venous congestion is reported in 75% of these cases. This congestion can lead to total necrosis of the flap and a failure of the procedure. We describe a new surgical method aiming to reduce the risk of venous congestion occurrence and failure of the defect coverage. We realized a retrospective study of patients who undergone a de-epidermized distally based neurocutaneous sural flap in our surgery department from 2015 to 2020. The following data were collected: sex, age, vascular risk factors, size of the wound, defect area, etiology, delay between the surgery of the flap and the split-thickness skin graft and complications. The cohort is composed of 5 cases. We reported no failure of the coverage of the defect. There were no cases of venous congestion. The de-epidermized distally based neurocutaneous sural flap could increase the reliability of these flaps by reducing the risk of venous congestion. A larger study comparing the classic technique to the de-epidermized sural flap could confirm these data on a greater number of cases and position this technique in the therapeutic arsenal.

The PAP Flap Breast Reconstruction: A Practical Option for Slim Patients.

The posterior thigh-based profunda artery perforator (PAP) flap has been an emerging option as a secondary choice in breast reconstructions. However, whether a PAP flap could consistently serve as the secondary option in slim patients has not been investigated. Records of immediate unilateral breast reconstructions performed from May 2017 to June 2019 were reviewed. PAP flap breast reconstructions were compared with standard deep inferior epigastric perforator (DIEP) flap breast reconstructions, and were grouped into single or stacked PAP flaps for further analysis. Overall, 43 PAP flaps were performed to reconstruct 32 breasts. Eleven patients underwent stacked PAP flap reconstruction, while 17 patients underwent 21 single PAP flap reconstruction. The average body mass index (BMI) of the patients was 22.2 ± 0.5 kg/m2. The results were as follows: no total loss, one case of venous congestion (2.3%), two donor site wound dehiscence cases (4.7%), and one case of fat necrosis from partial flap loss (2.3%). When compared with 192 DIEP flap reconstructions, the final DIEP flap supplied 98.1 ± 1.7% of mastectomy weight, while the final PAP flap supplied 114.1 ± 6.2% of mastectomy weight (p < 0.005), demonstrating that PAP flaps can successfully supply final reconstruction volume. In a separate analysis, single PAP flaps successfully supplied 104.2% (84.2-144.4%) of mastectomy weights, while stacked PAP flaps supplied 103.7% (98.8-115.2%) of mastectomy weights. In our series of PAP flap reconstructions performed in low-to-normal BMI patients, we found that PAP flaps, as single or stacked flaps, provide sufficient volume to reconstruct mastectomy defects.

Nasolabial propeller perforator flap: Anatomical study and case series.

The previous cadaveric studies of facial artery perforators have frequently reported high variability, and those results remain to be validated in the Colombian population. Thus, we aimed to describe the vascular anatomy of the lateral nasal artery cutaneous branches and their clinical applications using Colombian cadavers. Nine hemifaces from six fresh cadavers were included in the study. Terminal branches of the facial artery and cutaneous perforators of the lateral nasal artery were dissected. The quality, number, and distribution of the perforators were assessed. In addition, we present results of seven clinical cases for nasal alar reconstruction. Cutaneous perforators were found in all hemifaces, and zone 2 was the most common location. In our clinical case series, all flaps used to reconstruct the nasal alar defects survived. There were two cases of venous congestion but no additional procedures were needed. Although nasal alar reconstruction continues to be a challenging plastic surgery procedure, the nasolabial propeller perforator flap is an excellent choice for such because it allows a precise skin island design, is less bulky, has a wide arc of rotation, and facilitates one-staged reconstruction without increasing the rate of complications.

Abstract: Thin Patients are at Higher Risk for Venous Congestion During DIEP Reconstruction

INTRODUCTION: Venous congestion occurs in 2–15% of deep inferior epigastric perforator (DIEP) flaps and often requires superficial inferior epigastric vein (SIEV) salvage.1,2 We previously showed thicker suprascarpal fat pads (>23 mm) are associated with increased SIEV caliber.3 We hypothesize that patients with thicker suprascarpal fat pads have a dominant superficial venous system and are more likely to suffer venous congestion. METHODS: An IRB-approved retrospective study was performed at New York-Presbyterian Hospital/Weill Cornell. Subjects included female patients who underwent unilateral or bilateral DIEP flap reconstruction from 2011- 2015. Radiographic measurements of suprascarpal fat pad thickness and SIEV diameter were collected per hemi-abdomen from pre-operative abdominal CT angiogram (CTA) imaging. Clinical outcomes recorded included: intra-operative venous congestion and SIEV usage. Statistical analysis explored if suprascarpal fat pad thickness was associated with clinical outcomes. RESULTS: 94 patients underwent 164 DIEP flaps. Mean suprascarpal fat pad thickness was 20.7mm ± 10.8 (4.9–65.4) and mean SIEV diameter was 2.8mm ± 0.7 (1.5–5.7). Five (3.0%) flaps exhibited venous congestion, with three (1.8%) requiring intra-operative SIEV salvage. All four cases of venous congestion in patients with pre-operative CTA occurred in flaps with suprascarpal fat pad thickness less than 18mm (p=0.041). CONCLUSIONS: There is a significantly increased risk of venous congestion with thinner suprascarpal fat pads (<18mm), suggesting that venous congestion is not related to superficial draining system dominance or increased SIEV caliber. We recommend SIEV dissection with suprascarpal fat pad thickness <18 mm. DISCLOSURE/FINANCIAL SUPPORT:None of the Authors has a financial interest in any of the products, devices or drugs mentioned in the manuscript. REFERENCES: 1. Sbitany H, Mirzabeigi MN, Kovach SJ, et al. Strategies for recognizing and managing intraoperative venous congestion in abdominally based autologous breast reconstruction. Plast Reconst Surg 129(4):809–815. 2012. 2. Granzow JW, Levine JL, Chiu ES, Allen RJ. Breast reconstruction with the deep inferior epigastric perforator flap: History and an update on current technique. Journal of Plastic, Reconstructive, and Aesthetic Surgery 59:571–579, 2006. 3. Bast J, Pitcher AA, Small K, Otterburn DM. Suprascarpal fat pad thickness may predict venous drainage patterns in abdominal wall flaps. Microsurgery 2016;36(2):99–103.

Anastomosis to the common and proper digital vessels in free flap soft tissue reconstruction of the hand.

This study seeks to demonstrate the safety of anastomosing free flaps to the common or proper digital artery, and to the volar or dorsal digital vein in soft tissue reconstruction of the hand; as well, as to discuss the advantages of this technique. Retrospective review of all patients who underwent free flap reconstruction of the hand in two institutions over a period of 5 years. A total of 29 free flaps (9 great toe pulp, 7 anterolateral thigh, 6 second toe pulp, 4 radial artery perforator, 2 partial medial rectus, 1 lateral arm) in 28 patients met our inclusion criteria. All recipient vessels were the proper or common digital artery and the volar or dorsal digital vein. There was one case of venous congestion that resolved with leeching. There was no partial or total loss of any of the flaps. Anastomosing soft tissue free flaps to the common or proper digital artery, and the volar or dorsal digital vein is a safe and effective approach with numerous advantages that should be considered in the reconstruction of soft tissue defects of the hand. © 2016 Wiley Periodicals, Inc. Microsurgery, 38:21-25, 2018.

Abstract P2-19-05: Oncoplastic breast conserving surgery with perforator flap in breast cancer patients

Abstract Purpose : Oncoplastic breast surgery has been used widely as a treatment protocol for breast cancer. Thoracodorsal artery perforator (TDAP) flap and intercostal artery perforator (ICAP) flap can provide adequate cover without sacrificing any muscle and allow closing of the donor sites in inconspicuous sites. Therefore, among the oncoplastic volume replacement techniques indicated using local flap that can adequately cover the volume of breast, TDAP and ICAP are especially suggested. This study describes the use of TDAP and ICAP flap techniques after breast conserving surgery. Methods : From March 2010 to August 2012, 38 patients with breast cancer received breast reconstruction. All patients who were selected had small- to moderate-sized defects on breasts, middle aged, and were not sensitive to scars. The TDAP flap is the first choice for performing the surgery, but if the perforator of the TDAP flap is not found, a dissection toward the anterior area to find an adequate perforator is made and the serratus anterior artery perforator is normally used. Otherwise after the dissection is performed more anterior, ICAP can be used. If the perforator penetrates the LD muscle, the TDAP flap can be used. The perforator that penetrates from the serratus anterior muscle is also used in the anterior area. Otherwise, ICAP can be used in partial breast reconstruction. The TDAP flap can be applied to any defect site regardless of the size of the defect area. Results : The mean age was 44.9 years and the average follow-up interval was 6 months. The average specimen weight was 98g. Complications developed in 4 cases including 3 cases of venous congestion, though self-limited, and 1 case of wound disruption on the inframammary fold suture area. Majority of the patients were satisfied with the cosmetic result. Conclusion : Thoracodorsal artery perforator flap (TDAP) and intercostal artery perforator flap (ICAP) techniques can be reliable and useful in correcting breast deformity after breast conservation surgery, especially in patients with small- to moderate-sized defects on breasts. Key Words : intercostal artery perforator flap, thoracodorsal artery perforator flap Oncoplastic surgery, ICAP, TDAP. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-19-05.

Free deep inferior epigastric artery perforator flap for reconstruction of soft‐tissue defects in extremities of children

The deep inferior epigastric artery perforator (DIEP) flap has been a valuable tool in breast reconstruction, but seldom in extremity reconstruction. The aim of this report is to present our experience on the use of the DIEP flap for reconstruction of soft-tissue defects in the extremities of pediatric patients. From January 2007 to February 2011, 22 consecutive free DIEP flap transfers were performed for reconstruction of complex soft-tissue defects in the extremities of children with a mean age of 5.7 years old (ranging 2-10 years old). The flap design included transverse, oblique, and irregular DIEP flaps, containing one to three perforators in the flap. The flap size ranged from 7 × 4 cm to 18 × 17 cm. Primary donor-site closure was accomplished in all of patients. The postoperative course was uneventfully in most of cases. The venous congestion was observed in two cases. One case of venous congestion was caused by flap inset with tension. The other case with venous thrombosis ended with partial loss of the flap after salvage procedure. There was one total flap loss due to the arterial thrombosis. The flap survival rate was 95.5%. The mean follow-up was 12 months (ranging 6-36 months). All reconstructed extremities had satisfactory aesthetic and functional outcomes except two cases undergoing the secondary debulking procedures. The donor sites healed well in all cases without complications. Our experience showed that the free DIEP flap could be an alternative for reconstruction of soft-tissue defects in the extremities of children.

Perioperative management of antithrombotic medication in head and neck reconstruction—a retrospective analysis of 137 patients

PurposeVarious protocols exist to prevent thrombosis after free flap surgery in the head and neck. This study reviews the outcome and incidence of perioperative complications in patients undergoing head and neck reconstruction, simply using subcutaneous low-molecular-weight heparin. Materials and methodsA total of 137 free tissue transfers performed between 2007 and 2010 were reviewed. All patients received a general thrombosis prophylaxis with subcutaneous low-molecular-weight enoxaparin. No aspirin, dextran, or additional antithrombotic medication was administered. ResultsOverall flap survival was 97.1%. A total of 3 complete and 1 partial flap loss occurred, all due to venous thrombosis. Five cases of venous congestion were successfully revised. ConclusionThe free flap survival rate using simple subcutaneous heparin seems to be equivalent to other management regimens. Therefore, we suggest that no additional antithrombotic treatment is needed for patients who undergo head and neck reconstruction with free tissue transfer.

Versatility of Venous Flap for Coverage of Proximal and Middle Phalanges of Fingers

Owing to paucity of soft tissue in the fingers, the trauma to fingers can cause exposure of tendons, joints, and bone. Several flaps have been used to cover soft tissue defects of the fingers. From 2007 to 2010, we have operated on 18 male patients with skin defects of dorsal phalanges of fingers. We used reverse distally based venous flap with perivenous tissue to cover the defects. Their mean age was 30.6±8.6 (15 to 40). The etiology in all cases was severe trauma. Ten had defect in dorsal aspect of proximal phalanges and in 8 the defect was in the middle phalanges. One of our patients experienced superficial necrosis at the distal margin of the flap that was successfully treated with local wound care and dressing changes. There was 1 case of venous congestion that resolved itself. There were no postoperative wound infections. There were no serious complications. The venous flap with preservation of perivenous areolar network is a good option for coverage of soft tissue defects of proximal and middle phalanges of fingers.

거머리 요법에 대한 연구동향

Objective : To review the trend of the study related to Leech therapy and to establish the hereafter direction for the study on Leech therapy. Methods : I reviewed and analyzed all the theses published in Domestic and Foreign research institution from 1990 to 2009. Results : The following results were obtained in this study. 1. Analyzed number of theses published, there was no significance per year. 2. Classified by theme of journal, journals related to surgery were most(41 journals, 75.92%) among 54 kinds. 3. Classified by theses by research method and thesis types, case report accounted for nearly twothirds (52 pieces, 68.42%) of all theses and consideration of document was next(9 pieces, 11.84%). 4. With the most case of venous congestion after plastic and reconstructive surgery(33 pieces, 63.46%), leech therapy was effective on illnesses such as haematoma, macroglossia, purpura, varicous vein, avulsion injury, neurovascular compression, diabetic neuropathy, penoscrotal oedema, buerger`s disease, rheumatoid arthritis. 5. Two most appeared adverse effects were anemia and infection. Immediate blood transfusion was done for recovering anemia and prophylactic 3rd generation antibiotics to infection were emphasized in more than half of case reports. 6. All of consideration of documents was retrospective study of cases related leech therapy and 3 pieces of them emphasized prophyratic antibiotic treatment for preventing infection. 7. The study of clinical trail type started first in 2002 and osteoarthritis of knee and carpometacarpal joint were main target. As see above result, Leech therapy was effective cure and could be used in disease induced by venous congestion. And I think that it is necessary to perform additional study related to solution of problems about leech therapy and protocol for using in clinical practice.

Incidence and Treatment of Complications, Suboptimal Outcomes, and Functional Deficiencies After Pollicization

To evaluate the incidence and treatment of complications, suboptimal outcomes, and functional deficiencies after pollicization, and the need for additional surgical procedures. A total of 73 index finger pollicizations performed by a single surgeon were identified. We retrospectively evaluated all available patient records for perioperative complications, suboptimal outcomes, and functional deficiencies of the pollicized digit. There were 8 complications in the perioperative period (including 3 cases of venous congestion, 4 cases of marginal necrosis, and 1 infection), requiring 12 surgical procedures; 1 pollicized digit was removed owing to nonviability. There were 8 suboptimal outcomes, including 7 cases of scar contracture and 1 with redundant skin, requiring 3 surgical procedures. Additional procedures related to functional deficiencies were performed in 26 total patients, 19 for poor opposition and 15 for limited extension. Most perioperative complications and suboptimal outcomes after pollicization are minor when an experienced surgeon is involved. Venous congestion, although uncommon, is a major viability risk and should be treated aggressively. In addition, a substantial number of pollicized digits have functional deficiencies related to anatomical limitations that can be addressed with muscle and tendon transfers. Therapeutic IV.

Augmentation of Venous Drainage by a Venous Anastomosis for Pedicled Flaps

Recently several studies have addressed the venous problem and confirmed that venous ischemia is more injurious to tissue viability than arterial ischemia of equivalent duration. There are different methods of managing venous-compromised pedicled flaps. Between June 1996 and November 2003, our center treated two submental, five Becker, nine posterior interosseous, three distally based sural, and three colon pedicled flaps (22 flaps in total), which had venous congestion either at the time of flap elevation or immediately after inset of the flap. These cases of venous congestion were managed with an immediate additional venous anastamosis. After vein anastomosis, venous congestion reduced gradually, then improved, and finally disappeared completely in the postoperative follow-up days with all flaps surviving in their entirety. Reexploration was not required for the microsurgical venous anastomosis. In conclusion, flap necrosis resulting from venous congestion causes prolonged hospitalization, multiple debridements, and additional procedures to cover the exposed structures. Additional vein anastomosis, which is a simple, rapid, and reliable auxiliary procedure, may increase complete flap survival and lead to successful end results, both functional and cosmetic.

Specific Complications Associated with Different Types of Intrinsic Pedicle Flaps of the Hand

One hundred eight pedicle flaps intrinsic to the hand were performed in 98 male and 10 female patients averaging 36 years of age for digit-level trauma in 19 thumbs, 27 index, 50 long, 8 ring, and 4 small fingers. Specific flaps employed were 79 antegrade proper digital artery, 10 reverse proper digital artery, 6 reverse second dorsal metacarpal artery, 5 antegrade first dorsal metacarpal artery, 6 reverse dorsal ulnar artery of thumb, and 2 dorsal middle phalangeal flaps. The final average total active motion in the fingers was 235 degrees. Complications in 42 cases (39% actively smoking) included 10 partial flap losses, 13 cases of superficial epidermolysis, 4 cases of venous congestion, 4 superficial infections, 3 deep infections, and 8 cases of delayed healing at the wound margin. Second surgeries required were 3 debridements of deep wound infections, 3 revisions of the distal fingertip, and 9 full-thickness skin grafts. Specific associations of complications with flap type were between antegrade proper digital artery flaps and partial flap loss, epidermolysis, delayed wound healing, and infections at the distal margin but no cases of venous congestion. Reverse-flow flaps experienced venous congestion and epidermolysis but no partial flap losses or infection.

Reverse Homodigital Flap

The objectives in fingertip reconstruction surgery are to preserve functional length and sensibility, prevent neuroma formation and articular stiffness, and minimize aesthetic deformities. The reverse homodigital flap technique, first described by Weeks and Wray in 1973, consists of a single stage procedure that maintains finger length and creates a skin cover similar to the native fingertip, thus avoiding long-term immobilization, maintaining the protective sensibility of the finger, and providing a good aesthetic and functional outcome. The authors attempted to analyze the aesthetic and functional outcomes obtained with the reverse homodigital flap technique for fingertip reconstruction. Twenty-seven patients with 28 distal finger injuries were reconstructed using the reverse homodigital flap in the Hospital del Trabajador de Santiago between January 2001 and December 2003. Clinical records were analyzed for tabulation of data regarding: age, sex, injury mechanism, affected finger, donor-site closure, flap laterality, surgical time, and complications. The follow-up ended in May 2004, when ROM, sensibility, and aesthetic satisfaction were evaluated. In all patients, the flap remained vital and no necrosis was found. There where 5 cases of superficial infection and venous congestion, treated with frequent dressing changes, antibiotics, and i.v. Dextran 40 in the cases of venous congestion. Most patients reached an S3 or S3 + sensibility, according to BMRC. ROM was good or excellent in 90% of the patients (ROM>#x2009;90%); the aesthetic outcome, on a 0–10 scale, obtained an average of 8 points, and was considered good. The authors believe that the use of the reverse homodigital flap for fingertip reconstruction is an excellent solution, as it avoids finger amputation, allows a good fingertip skin coverage, avoids long-term immobilization, conserves the protective sensibility of the finger, and allows a good functional and aesthetic outcome.