Use Of Microsurgical Reconstruction Research Articles

The use of microsurgical reconstruction in treatment of craniofacial defects in paediatric patients

Background: Reconstruction of craniofacial defects with the use of microvascular free flaps is currently a golden standard of reconstructive surgery in subjects with post-resection, post-traumatic and congenital tissue defects. Although microsurgical techniques are quite common in adult treatment, they are much less frequently used in paediatric patients. In juvenile patients, defects of skeleton and soft facial tissues are most frequently related to congenital defects (facial clefts, congenital applasias), resection of neoplastic tumours. The most serious include disorders in craniofacial growth and development resulting from damage to growth centres and loss of the main tissue mass. This leads to impaired ratio of facial to cerebral skull and to the remaining structures, which causes big difficulties during secondary reconstruction procedures and has a negative effect on the final functional and aesthetic effect. Additionally, defects of craniofacial tissue are very often related to impaired anatomy of the stomatognathic system (teeth, maxillary alveolar bones and bones of the alveolar part of the mandible, muscles of mastication and temporomandibular joints). The use of microsurgical techniques in craniofacial reconstruction procedures allows reconstruction of the oral cavity tissue base, which in turn enables rehabilitation of the stomatognathic system structure at the earliest possible time, also with the use of implantoprosthetic techniques. This creates proper growth impulses for further craniofacial development following a reconstruction procedure.

A literature review and meta-analysis of outcomes in microsurgical reconstruction using vasopressors.

There is a hesitancy to utilize vasopressors in microsurgical reconstruction due to fear of vessel spasm and subsequent flap compromise. Although there are large literature reviews analyzing vasopressor usage in head and neck reconstruction, this has not been extrapolated to all regions of the body. The goal of this study was to perform a meta-analysis examining vasopressor usage and risk of complications in microsurgical reconstruction for all recipient sites. A meta-analysis was conducted for articles discussing the utilization of vasopressors in microsurgical reconstruction. The primary endpoint was total flap failure. Secondary endpoints were necessity for operative take-back and hematoma requiring intervention. Odds ratios were calculated for each complication and for each study. Four prospective and six retrospective studies were analyzed yielding 6321 patients and 7526 flaps. 67.4% (966/1433) of patients received vasopressors and 80.8% (6080/7526) of flaps received vasopressors. There were 100 failures in the vasopressor group (100/6080 = 15.9%) and 39 failures in the non-vasopressor group (39/1456 = 26.8%) (O.R. 0.73; p = 0.12). There were 177 take-backs in the vasopressor group (177/5916 = 29.9%) and 64 take-backs in the non-vasopressor group (64/1404 = 4.6%) (O.R. 0.65; p < 0.05). There were 73 hematomas in the vasopressor group (73/5099 = 14/3%) and 14 hematomas in the non-vasopressor group (14/979 = 14.3%) (O.R. 1; p = 0.89). The odds ratio for total flaps failures in the breast and head/neck cohorts were 0.788 (p = 0.76) and 1.2761 (p = 0.77), respectively, with neither significantly increased in flaps receiving vasopressors. Our results suggest that vasopressor utilization does not directly result in increased complications. Flaps that received vasopressors had a statistically lower rate of take-back and failure. Due to the paucity of data available for analysis and limited reporting relating flap characteristics to outcomes, prospective, well-designed studies are necessary to verify the safety of vasopressor use in microsurgical reconstruction.

Perforator Flaps: History, Controversies, Physiology, Anatomy, and Use in Reconstruction

Perforator flaps have the advantages of reduced donor-site morbidity, versatility to accurately replace the components required at the recipient site, a longer pedicle than is achievable with the parent musculocutaneous flap, and freedom from orientation of the pedicle. Their development has followed our understanding of the blood supply from a source artery to the skin, which has been achieved because of landmark studies by Manchot, Salmon, Milton, Taylor, and others. Many articles now attest to the safety and reliability of perforator flaps. This review aims to outline the history and controversies surrounding perforator flaps and to describe the anatomy of the "workhorse" perforator flaps and their use in microsurgical reconstruction. These flaps include the deep inferior epigastric artery, the anterolateral thigh, the thoracodorsal artery, and the superior and inferior gluteal artery perforator flaps.

Hysterosalpingography in the 1990s.

All physicians involved in the evaluation and treatment of infertility rely heavily on the information provided by hysterosalpingography. For many years this study has provided images of the lumina of the fallopian tubes that are not available by other diagnostic means, and it also gives the most accurate outline of the uterine cavity. Hysterosalpingography will therefore continue to be a valuable study in the upcoming decade, and it is important now to take account of the many advances in technology that impinge on the execution and interpretation of this study. In this article we first update the continuing debate about elements of the study itself, involving techniques and the choice of contrast material. We also consider surgical advances, such as the widespread use of microsurgical reconstruction of the fallopian tube, that increase the demand for hysterosalpingography. Since radiologists are asked to evaluate the results of surgery, it is essential for them to be familiar with the postoperative appearances of the fallopian tube. Finally, we consider what must be by far the most important development of the 1990s, the continuing integration of hysterosalpingography with new interventional and imaging techniques. Fallopian tube catheterization expands the examination of the fallopian tube and offers new therapeutic applications. Transvaginal sonography and MR imaging have allowed noninvasive exploration of the female pelvis. Correlation of hysterosalpingography and MR imaging is particularly useful in the diagnosis of uterine myomas and congenital uterine duplication anomalies when surgery to preserve or enhance the reproductive capacity of the uterus is indicated. Sonography and MR imaging should be correlated with hysterosalpingography to provide a more efficient diagnostic and therapeutic approach to the common mechanical causes of infertility.