Free Graft Research Articles

Free Radical-Mediated Grafting of Natural Polysaccharides Such as Chitosan, Starch, Inulin, and Pectin with Some Polyphenols: Synthesis, Structural Characterization, Bioactivities, and Applications-A Review.

Polyphenols and polysaccharides are very important natural products with special physicochemical properties and extensive biological activities. Recently, polyphenol-polysaccharide conjugates have been synthesized to overcome the limitations of polysaccharides and broaden their application range. Grafted copolymers are produced through chemical coupling, enzyme-mediated, and free radical-mediated methods, among which the free radical-induced grafting reaction is the most cost-effective, ecofriendly, safe, and plausible approach. Here, we review the grafting reactions of polysaccharides mediated by free radicals with various bioactive polyphenols, such as gallic acid (GA), ferulic acid (FA), and catechins. A detailed introduction of the methods and their mechanisms for free radical-mediated grafting is given. Structural characterization methods of the graft products, including thin-layer chromatography (TLC), ultraviolet-visible (UV-vis) spectroscopy, Fourier transform infrared (FT-IR) spectroscopy, nuclear magnetic resonance (NMR) analysis, and X-ray diffraction (XRD) are introduced. Furthermore, the biological properties of polyphenol-polysaccharide conjugates are also presented, including antioxidant, antibacterial, antidiabetic, and neuroprotection activities, etc. Moreover, the potential applications of polyphenol-polysaccharide conjugates are described. Finally, the challenges and research prospects of graft products are summarized.

Surgical Interventions for Chronic Ulnar Collateral Ligament Injuries of the Thumb: A Systematic Review.

Background: There is no consensus for the appropriate surgical management of symptomatic chronic ulnar collateral ligament (UCL) injuries of the thumb. The aim of this study is to systematically review the treatment of chronic thumb metacarpophalangeal (MCP) joint UCL injuries to determine the optimal approach to treatment. Methods: A systematic review of PubMed, Medline, Embase and ePub Ahead of Print was performed in accordance with Preferred Reporting of Items in Systematic Review and Meta-Analysis (PRISMA) guidelines. Results: Data from 11 studies using various surgical techniques in 245 thumbs were heterogenous and meta-analysis of results not possible. These data were qualitatively assessed. Direct repair, reconstruction with free tendon grafts and arthrodesis all demonstrated favourable outcomes with patient-reported outcome measures (PROMs). Conclusions: Direct repair can be safely performed more than 2 months following injury. Arthrodesis may be considered in heavy manual labourers or those with osteoarthrosis. Tendon grafting is safe, yet the optimal type and configuration are yet to be determined for reconstructive methods. Level of Evidence: Level III (Therapeutic).

Investigating Weekend Effect in the Management of Upper and Lower Extremity Degloving Injuries.

Weekend presentation has been associated with adverse outcomes in emergent conditions, including stroke, myocardial infarction, and critical limb ischemia. We examine whether a weekend effect exists in the management of and outcomes after extremity degloving injuries. The cohort included adults presenting with open extremity degloving injuries to a tertiary level one trauma center between June 2018 and May 2022. We collected demographics, comorbidities, injury information, interventions, and complications. Propensity score weighting was used to minimize confounding differences between those presenting on weekends (Sat-Sun) versus weekdays (Mon-Fri). Weighted regressions were used to examine differences in interventions by day of presentation. Multivariable weighted regressions accounting for differences in interventions received were used to examine whether weekend presentation was associated with amputation risk, complications, or functional deficits. Ninety-five patients with 100 open extremity degloving injuries were included. In total, 39% of injuries were weekend-presenting. There was a higher rate of noninsulin-dependent diabetes among patients presenting on weekends (P = 0.03). Weekend-presenting injuries had higher median Injury Severity Scores (P = 0.04). Propensity-weighted regression analysis revealed differences in interventions received on weekends, including lower rates of pedicled and free flaps and bone graft, and increased rates of negative-pressure wound therapy (P ≤ 0.02). Multivariable regression analysis revealed weekend presentation was a significant independent risk factor for amputation of the affected extremity [odds ratio 2.27, 95% CI (1.01-5.33), P = 0.05]. Weekend presentation may impact interventions received and amputation risk in patients presenting with open extremity degloving injuries.

Biomaterials derived from hard palate mucosa for tissue engineering and regenerative medicine.

Autologous materials have superior biosafety and are widely used in clinical practice. Due to its excellent trauma-healing ability, the hard palate mucosa (HPM) has become a hot spot for autologous donor area research. Multiple studies have conducted an in-depth analysis of the healing ability of the HPM at the cellular and molecular levels. In addition, the HPM has good maneuverability as a donor area for soft tissue grafts, and researchers have isolated various specific mesenchymal stem cells (MSCs) from HPM. Free soft tissue grafts obtained from the HPM have been widely used in the clinic and have played an essential role in dentistry, eyelid reconstruction, and the repair of other specific soft tissue defects. This article reviews the advantages of HPM as a donor area and its related mechanisms, classes of HPM-derived biomaterials, the current status of clinical applications, challenges, and future development directions.

Gingival Recession Treatment by Free Graft Fixed with Silk Sutures vs Vicryl Plus

Gingival Recession Treatment by Free Graft Fixed with Silk Sutures vs Vicryl Plus

Insertion of orthodontic temporary anchorage devices with free gingival grafting for phenotype modification of the peri-implant mucosa

BackgroundMini Implants are widely used in contemporary orthodontics, they provide skeletal anchorage even in non-compliant patients, facilitate orthodontic tooth movement, are easy to place and are relatively inexpensive. Their failure is multifactorial, and the quality of the soft tissue can present a risk limitation for the insertion of TADS. Orthodontic Mini Implants inserted in keratinized gingiva present fewer tissue-related complications and higher survival rate, than those inserted in non-keratinized mucosa. The purpose of this report is to present and describe this novel technique to modify and enhance the peri-implant mucosa of Orthodontic Mini Implants inserted in nonkeratinized gingiva. MethodsA free gingival graft was harvested from the palate in combination with a buccal recipient site preparation in the alveolar mucosa and a TAD insertion procedure. ResultsAfter twenty-one days of healing, graft integration was observed. One hundred and eighty days after insertion and twelve weeks of loading, none to mild signs of clinical inflammation were documented, and the patient reported no pain or discomfort. ConclusionWithin the limitations of this report, free gingival grafting for phenotype modification of the peri-implant mucosa, can benefit patients who need insertion of orthodontic mini-implants in non-keratinized mucosa for orthodontic tooth movement.

Evaluation of platelet derived growth factor-BB levels in injectable platelet rich fibrin coated graft using gingival pedicle split thickness tunnel technique for isolated gingival recession: A randomized controlled trial

BackgroundUse of injectable-platelet rich fibrin (i-PRF) in the field of periodontal regeneration is quite well known due to its efficacy. The study was aimed to evaluate the platelet derived growth factor-BB (PDGF-BB) levels in cases of isolated gingival recession using gingival pedicle split thickness tunnel technique (GPST) and de-epithelialized gingival graft (DGG) with or without coating it with i-PRF. Methodology20 patients exhibiting Miller’s class I/II isolated gingival recession were selected for this parallel arm randomized controlled trial. Recipient site was prepared using GPST technique, free gingival graft was harvested and de-epithelialized, further graft was coated with i-PRF and wound fluid samples from surgical site were collected at baseline, 3rd day and 7th day for group A. The same procedure without coating the graft in i-PRF was carried out for group B. Clinical parameters like probing depth, recession depth, recession width, width of keratinized gingiva, wound healing index (WHI), complete root coverage was recorded at baseline and after 4 months. ResultsSignificant intergroup difference was seen in WHI and the levels of PDGF-BB from baseline to the last estimated time point (p < 0.05). ConclusionThe study emphasizes on the use of novel GPST technique in conjunction with DGG coated with liquid PRF, which has shown sustained release of PDGF-BB resulting in better wound healing.

Combined superior and inferior dermoglandular flaps for projection enhancement in giantic breast amputation and free nipple areola graft

Giantomastia has been a pathological condition in which excised breast tissue weighs more than1.5 kg per breast or when breast weight surpasses three percent of body weight. epidermis &amp; Cooper's ligaments, which support breast tissue, expand as a result of breasts becoming heavier &amp; larger, which causes breast ptosis. Numerous methods for correcting gigantomastia have been discovered. amputation for decreased studied cases who complain of gigantomastia &amp; severe ptosis (space among nipple &amp; inframammary fold exceeds twenty-five cm) are only eligible for mammaplasty with free nipple-areola grafting. purpose of that surgery is to achieve breast shape size that is acceptable while also relieving pain &amp; suffering brought on by excessive breast tissue hypertrophy. flat, boxy breasts with poor projection is the main drawback of that treatment. Several flaps, including superior, inferior, medial, superomedial,&amp; lateral-based flaps combined with wise-pattern skin excision, are employed to address this drawback.

Covalent and non-covalent interaction of myofibrillar protein and cyanidin-3-O-glucoside: focus on structure, binding sites and in vitro digestion properties.

The aim of this study was to investigate the effects of covalent and non-covalent interactions between myofibrillar protein (MP) and cyanidin-3-O-glucoside (C3G) on protein structure, binding sites, and digestion properties. Four methods of inducing covalent cross-linking were used in the preparation of MP-C3G conjugates, including tyrosinase-catalyzed oxidation, alkaline pH shift treatment, free radical grafting, and ultrasonic treatment. A comparison was made between MP-C3G conjugates and complexes, and the analysis included sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), C3G binding ratio, liquid chromatography-tandem mass spectrometry (LC-MS/MS), protein side-chain amino acids, circular dichroism spectroscopy, three-dimensional fluorescence, particle size, and in vitro simulated digestion. Covalent bonding between C3G and amino acid side chains in MP was confirmed by LC-MS/MS. In covalent bonding, tryptophan residues, free amino groups and sulfhydryl groups were all implicated. Among the 22 peptides covalently modified by C3G, 30 modification sites were identified, located in lysine, histidine, tryptophan, arginine and cysteine. In vitro simulated digestion experiments showed that the addition of C3G significantly reduced the digestibility of MP, with the covalent conjugate showing lower digestibility than the non-covalent conjugate. Moreover, the digestibility of protein decreased more during intestinal digestion, possibly because covalent cross-linking of C3G and MP further inhibited trypsin targeting sites (lysine and arginine). Covalent cross-linking of C3G with myofibrillar proteins significantly affected protein structure and reduced protein digestibility by occupying more trypsin binding sites. © 2023 Society of Chemical Industry.

Repigmentation of the Nipple-Areola Complex following Free Nipple Grafting.

Free nipple grafting (FNG) is a technique historically used during breast reduction and top surgery for treatment of gender dysphoria to minimize nipple-areola complex (NAC) hypoperfusion and subsequent loss. One drawback of this approach is NAC hypopigmentation. The authors sought to quantify long-term pigmentation changes in the NAC after FNG. A retrospective review of patients who underwent reduction mammaplasty or simple mastectomy with FNG from 2000 through 2020 at the authors' institution was conducted. Patients were included if they had preoperative, early, and late postoperative images. Images were analyzed using the National Institutes of Health's Image J software for pigmentation changes over time. Of the 151 patients identified, 56 patients (111 breasts) had complete imaging (macromastia, n = 47; oncologic, n = 4; gender dysphoria, n = 5). All patients had NAC hypopigmentation on early imaging, with 25.5% (SD 18.1%) of the NACs affected. On late imaging, 83 NACs (74.7%) experienced repigmentation, with only 8.7% (SD 7.3%) of the NAC area remaining hypopigmented. This represents a 67.2% resolution of pigmentation ( P < 0.001). Ten NACs (9.0%) had progression of hypopigmentation, and 17 NACs (15.3%) had no change. In a subset analysis by race, White patients had significantly greater area of NAC hypopigmentation on early postoperative imaging (White, 29.3% [SD 18.8%] versus Black, 18.3% [SD 14.0%]; P < 0.01). However, resolution of hypopigmentation was similar between the groups. Although partial hypopigmentation of the NAC is nearly universal after FNG, a majority of patients experience repigmentation, with low residual hypopigmentation at 1 year. These findings are useful for counseling patients with early pigmentation changes in addition to guiding surgical decisions about breast surgery with FNG. Therapeutic, IV.

Ultrasound and enzyme assisted preparation of novel lactoferrin-cereal phenolic acid conjugates: structural, physicochemical and functional properties

The effects of covalent binding of protocatechuic acid (PA) and gallic acid (GA) to lactoferrin (LF) on the structure, functional, and antioxidant properties of the protein conjugate were investigated. These protein–phenolic conjugates were produced by laccase cross-linking and ultrasound-assisted free radical grafting, which were characterized using turbidity, particle size, and sodium dodecyl sulfate–polyacrylamide gel electrophoresis (SDS-PAGE) analyses. Structural changes in conjugates were monitored by endogenous fluorescence spectroscopy, fourier transform infrared spectroscopy (FTIR), and circular dichroism (CD). The antioxidant capacities and pH stability were determined using DPPH, ABTS, FRAP, and potentiometric analysis. The enzymatic cross-linking and free radical grafting yielded LF-PA/GA conjugates with altered hydrodynamic diameter and zeta-potential. Spectroscopic and chromatographic analyses revealed that binding to PA/GA altered the molecular structure of LF, with a decrease in LF isoelectric point post binding to PA/GA, without affecting antioxidant activities. In conclusion, LF-PA/GA conjugates present potential applications in the food industry.

Highly Ozonated Sunflower Oil Dose May Cause Oxidative Stress and Impact the Quality of Life After Palatal Graft Removal: Secondary Endpoints of a Randomized Controlled Clinical Trial

ABSTRACT The aim of this study was to evaluate the effect of highly ozonated sunflower oil on postoperative pain and quality of life in patients undergoing removal of a free gingival graft (FGG) in the donor area of the palate. After graft removal, the palatal wound was treated with highly ozonated sunflower oil with a peroxide index between 510 and 625 meq/kg in the test group (n = 14) and with non-ozonated sunflower oil in the control group (n = 14). These are the secondary endpoints of a randomized clinical trial. Questionnaires assessing oral health impact on quality of life (OHIP-14) and postoperative pain (VAS scale) were applied to all participants at day 7. The results did not reveal a statistically significant difference in the postoperative pain between groups in all periods (P>0.05). There was a significant positive correlation in both groups for pain and amount of analgesic consumption (P<0.0001). It was found that participants in the test group showed a higher overallscore for OHIP-14 than the control group (P < 0.05), with impact on unsatisfactory diet, meal interruptions and irritability (P < 0.05). MDA levels measured 7 days post-treatment were higher in the test group compared to those of the control group (P < 0.05). It can be concluded that high dose and overapplication of the ozonated sunflower oil had a negative impact on the quality of life of individuals after palatal graft removal, which might have been aggravated by oxidative stress. Trial Registration number NCT05620550/Date of registration: November 16, 2022

Preparation of strong and mildew-resistant soybean meal adhesives with self-assembled core-shell structured nanospheres

Preparation of soybean meal adhesives offering good water resistance, prepressing adhesion as well as antimildew properties through a green and simple strategy remains challenging. In the present study, a self-assembled nanostructure-based filling enhancement strategy was proposed. Tannic acid (TA) is grafted onto the chitosan framework through free radical grafting, followed by ultrasound induced self-assembly into nanospheres. Chitosan based nanospheres (CS@TA) and ferric chloride (FeCl3) complexing with nanospheres are combined to modify soybean meal (SM) based wood adhesives synergistically. CS@TA enables interaction with protein chains through hydrogen bonding and Schiff base reactions, which in combination with its nanostructure allows for a more homogeneous dispersion in the SM system. At the same time the Fe (III) ions chelate with the catechol, forming ionic bonds and obtaining a denser structure. The results showed that the dry and wet shear strength (DWSS) of SM/1,2,3-propanetriol triglycidyl ether (GTE) /5%CS@TA/Fe increased by 79% and 693% to 2.28 MPa and 1.27 MPa. At the same time, the residual rate (RD) increased by 9.3–72.5% and prepressing adhesion now reaches 0.71 MPa compared with SM adhesives. And CS@TA nanospheres as well as Fe (III) ions act on the cell membrane of bacteria to provide stronger antibacterial effect, the anti- mildew time has been extended from the initial 2 d to more than 15 d. The construction of multi-network reinforcement strategies through self-assembled nanostructures improves the application potential of SM adhesives and provides ideas for the reinforcement of other engineering materials.

Does the systemic rise in serum lactate levels correlate to free flap failure in head and neck reconstructive surgeries—series of cases

BackgroundHead and neck reconstructive surgeries needs free tissue transfer but it fails sometimes. As most of the flap failure occurs in first 24 h. Local rise in lactate level or glucose lactate ratio provides clear indicator of tissue ischemia and further recovery. The question is about systemic rise in lactate levels with failing flap. Hence, we aimed to use systemic lactate levels to indicate free flap failure. To correlate the systemic rise in serum lactate levels to free flap failure in head and neck reconstructive surgeries. The series of cases were targeted undergoing free fibular graft, posted electively for head and reconstructive surgery operated by same surgeon. Record of blood loss, need of blood transfusion and use of microspan was also done. Monitoring of arterial blood gas values mainly lactate and vitals were done.ResultsOut of 15 patients studied, only 2(13.3%) patients had flap re-exploration (group F). Twelve (80%) patients were of ASA class I. Lactate, pH, blood sugars, base deficits and hemoglobin and vitals studied over 24 h in two groups had no statistically significant difference in the two groups. Lactate rise was noted in all cases for first few hours after starting surgery but elevated values were not observed during hours of flap re-exploration.ConclusionsWe could not establish relation between systemic rise in lactate levels and flap re-exploration or flap failure but continuous acidosis can impact outcome. We need to be vigilant and need to have individualized approach for management.

Clinicopathologic Profile and Surgical Modalities in Mandibular Ameloblastoma: A Descriptive Study.

Ameloblastoma is a benign neoplasm composed of epithelial tissue with invasive and infiltrative behavior at the local level and a high recurrence rate, with various histopathologic patterns and clinical forms. Approximately 85% of conventional ameloblastomas occur in the mandible, most often in the body, angle, and ascending ramus area. The treatment modalities include both conservative and radical treatments. Postoperative follow-up is most important in the treatment of ameloblastoma. To describe the clinicopathologic profile of mandibular ameloblastoma in patients undergoing different surgical modalities. The primary objective was to describe the clinicopathologic profile and surgical management of mandibular ameloblastoma in patients aged ≥18 years, who had reported to a tertiary dental care center for follow-up during the study period. The secondary objective was to describe the distribution of comorbidities associated with different surgical modalities and reconstructive methods. A total of 34 patients with mandibular ameloblastoma who underwent various surgical modalities between 2011 and 2021 were studied. Information was collected using a predesigned proforma and statistically analyzed. Thirty-four review cases of ameloblastoma were included in the study. The patients were analyzed concerning age, sex, site, size, clinical presentation, radiographic pattern, histopathologic subtype, type of surgery, and associated comorbidities. Most cases of mandibular ameloblastoma involve the age of 16 to 55 years. The mean age of occurrence was found to be 35.5±13.2. A female preponderance, a tumor size range of 2 to 4cm, a multicystic variant, involvement of the mandibular body in the premolar-molar area, root resorption, cortical perforation, and a follicular type of histopathologic pattern were the common presentations. Isolated anterior tumors restricted to the incisor/canine region were not found. The common surgical modalities undertaken were conservative methods such as enucleation, and chemical cauterization, and radical methods such as marginal mandibulectomy and segmental resection. Reconstruction using a titanium plate or free fibular graft was performed in the indicated cases. The common comorbidities included difficulty in chewing and loss of facial contour. Recurrence after surgical treatment was rare. Only 9% of cases developed a recurrence within 5 years. No recurrence was noted in cases treated with radical treatment, whereas 50% of cases treated with conservative methods showed recurrence. The age of occurrence, site, and size of the tumor, cortical perforation, root resorption, histopathologic type, and radiographic patterns are widely considered factors in devising a treatment plan for mandibular ameloblastoma. However, there may be rare instances where these tumors behave differently regardless of their innocuous clinicopathologic presentation. Surgical procedures such as segmental resection and marginal mandibulectomy were found to be promising for the eradication of the tumor, and prevention of recurrences and metastasis. However, conservative measures such as enucleation and chemical cauterization were fraught with an increased risk of tumor recurrence and metastasis. Future studies with a larger sample size should focus on the clinicopathologic characteristics of ameloblastoma to elucidate its varied behavior and develop newer and advanced treatment modalities that would provide better surgical and postsurgical outcomes in affected patients.

Nipple-Preserving Inferior-Ellipse Mastectomy: A New Technique for Gender-Affirming Top Surgery.

The 2 most common techniques for gender-affirming mastectomy are the double-incision free nipple graft and periareolar techniques. However, some patients are not well suited for either technique. When the nipples are high and on the pectoralis muscle, but there is marked breast tissue and skin redundancy, a double-incision free nipple graft would land the incision above the pectoral shadow, but a periareolar approach would not adequately remove the excess skin. In these patients, a nipple-preserving inferior-ellipse incision allows for appropriate chest contouring, leaving the nipple position unchanged and placing the incision in the pectoralis muscle shadow. A retrospective review identified all consecutive patients undergoing nipple-preserving inferior-ellipse mastectomy by the senior author (R.B.-L.). Indications were patients with moderate glandular tissue, skin excess, and a high nipple-areola complex (NAC) above the inferior border of the pectoralis major. Sixteen patients underwent inferior-ellipse mastectomy and were included. Mean follow-up was 203 days. Two patients (14%) required revision of the NAC. There was no partial or complete NAC loss. One patient (7%) developed postoperative seroma, which resolved with aspiration. For patients with moderate glandular tissue, excess skin in the inferior pole, and NAC position above the inferior border of the pectoralis major, the nipple-preserving inferior-ellipse mastectomy technique achieves excellent chest contour.

Targeted Nipple Reinnervation in Gender-affirming Mastectomy Using Autologous Nerve Graft.

Our team recently described targeted nipple reinnervation (TNR) during female-to-male gender-affirming mastectomy with free nipple grafting using either direct nerve coaptation or nerve allograft. The goals of TNR are to improve sensation (including erogenous sensation) and prevent numbness, paresthesias, chronic pain, and phantom sensation. Here, we describe our modified technique, which has evolved to use autologous intercostal nerve branches as donor nerves for reinnervation if direct nerve coaptation cannot be achieved. During TNR, the T3-T5 sensory branches are preserved and coapted to the repositioned nipple-areolar complex (NAC). In patients with donor nerves that were not adequate in length to allow for direct coaptation, autologous intercostal nerve branches were not used for coaptation (branches present along the chest wall that would otherwise be lost) or one of the T3-T5 branches were harvested. An end-to-end nerve repair between the autograft and donor nerves was done, and the donor nerve/autograft complex was coapted to the NAC. Targeted muscle reinnervation was performed after autograft harvest to prevent neuroma formation. TNR with intercostal nerve autograft is technically feasible in female-to-male gender-affirming mastectomy with free nipple grafting when direct coaptation is not possible. Chest reinnervation using autologous intercostal nerve branches as donor nerves is another option for reinnervation when the nerves are too short for direct coaptation. Because the collection of long-term data is ongoing, the effectiveness of NAC reinnervation using our technique will be described in a future publication.

Addressing the Gray Zone in Affirmative Mastectomy: An Analysis of Fischer 2 Patients.

Surgical decision making in gender-affirming mastectomy (GAM) is based on a patient's classification using the Fischer scale. Fischer 1 patients are excellent candidates for periareolar (PA) approach and Fischer 3 patients almost exclusively undergo double incision with free nipple grafting (DIFNG). Fischer 2 patients are in a gray zone in which decision making is more challenging. In this patient population, periareolar approaches can lead to increased complication and revision rates but free grafting procedures seem excessive. We have created a treatment algorithm to address Fischer 2 patients and additionally developed a novel technique, the batwing, to provide patients with more options. A retrospective chart review was undertaken to analyze the Fischer classification of all patients undergoing top surgery by a single surgeon at an academic institution from 2014 to 2021. The choice of surgical technique used as well as the outcomes of GAM among Fischer 2 patients was analyzed. Four hundred four patients underwent GAM, and 51 (11%) had Fischer 2 classification. The surgical techniques used were PA (27%), batwing (39%), nipple-sparing double incision (NSDI, 24%), and DIFNG (10%). Of those, 10% had major complications and 20% requested revision for contour irregularities. Major complication rates for PA, batwing, NSDI, and DIFNG were as follows: 2 of 14 patients (14%), 1 of 20 patients (5%), 1 of 12 patients (8%), and 1 of 5 patients (20%), respectively. The revision rate by technique was PA (36%), batwing (15%), NSDI (17%), and DIFNG (0%). For Fischer 2 patients, batwing and NSDI techniques avoid the need for free nipple graft while providing better exposure, improved control of nipple-areolar complex position, and decreased rate of revision as compared with the PA technique. The complication rate was not significantly different. We present an algorithm accounting for Fischer grade, unique patient characteristics, and patient desires.

Primary Regenerative Peripheral Nerve Interfaces Using Devascularized Vastus Lateralis Muscle in Sensate Anterolateral Thigh Flap Donor Sites.

Sensate flaps are increasingly used in diverse areas of plastic surgery. Concurrently, modern techniques in neuroma prevention have emerged, such as regenerative peripheral nerve interface (RPNI). Despite increasing use of sensate flaps, the combined use of donor-site neuroma prevention techniques has yet to be described. We report on the use of primary donor-site RPNI at the time of sensate anterolateral thigh (ALT) reconstructions. In ALT flaps, the vastus lateralis muscle can be segmentally devascularized from perforator dissection. These segments of devascularized vastus lateralis muscle can easily be used and repurposed as the free muscle grafts needed for RPNI, providing a physiologic target for the regenerating neurons. Donor-site neuroma has not been shown to be a significant issue at standard ALT flap donor sites. Sensate ALT flaps involve harvest of the lateral femoral cutaneous nerve and/or additional femoral sensory branches at a more proximal location close to the level of the anterior superior iliac spine, where injury to the lateral femoral cutaneous nerve may be associated with pain. In this series, eight patients underwent senate ALT flaps with the use of primary RPNI at the sensate ALT donor site. At a mean follow-up of 16.3 months (range 5-25 months), there was minimal to no nerve pain and no clinical evidence of donor-site neuroma. As sensate flap reconstructions are increasingly performed in plastic surgery and data on neuroma prevention techniques continue to grow, we propose consideration of their combined use.

Free jejunum transfers in oncologic reconstruction

Methods of pharyngoesophageal reconstruction include gastric pull-up, colon or jejunal interposition, and transfer of a free anterolateral thigh flap. The most popular method at our institution is transfer of a free jejunal graft. The free jejunum transfer was first described in 1957 by Seidenberg. The advantage of this procedure is a decreased risk of fistula, because the pharyngoesophagus is physiologically reconstructed with bowel-type reconstruction material. There are few reports about the operative methods of free jejunum transfer in detail and the operative methods vary greatly by institution. We performed free jejunum transfers for several hundred patients in the past and reported the characteristics and intraoperative and postoperative matters that require attention. Here, we summarize free jejunum transfer in oncologic reconstruction with relation to the points of safety, recipient vessels and microsurgical anastomosis, intestinal anastomosis and postoperative complications based on our experience and published reports.