Current Issue : July - September Volume : 2015 Issue Number : 3 Articles : 5 Articles
The outcomes of free tissue transfers combined with vein grafts have been inconsistent, and discussions continue regarding their\nappropriate use.Of the 142 free tissue transfers that we performed from January 2004 toDecember 2011, we retrospectively analyzed\n15 consecutive patients who underwent free tissue transfers in combination with vein grafts. Etiologies included trauma (8 patients),\ninfection (4), and tumor (3). Types of free tissue transfers were fibula (4), anterolateral thigh (3), groin (3), jejunum (3), latissimus\ndorsi (1), and dorsal pedis (1). Vein grafts were used for the artery (6), vein (2), or both (7).Thedonor veins were the saphenous vein\n(12) and the external jugular vein (3).Themean length of the grafted veins was 10.8 cm (range: 4ââ?¬â??18 cm). Even though complications\nof congestion occurred in 2 patients, these flaps survived by reexploration. The flap success rate was 15 of 15 (100%) of vein grafted\nfree flaps versus 124 of 127 (97.6%) of free flaps not requiring vein grafts. To improve the success rate of free tissue transfers combined\nwith vein grafts, securing healthy recipient vessels, meticulous surgical handling, a reliable vascular anastomosis technique, and\nstrict postoperative monitoring are crucial....
Background. Lipomas are benign tumors of mature fat cells. They can be removed by liposuction, yet this technique is seldom\nemployed because of concerns that removal may be incomplete and recurrence may be more frequent than after conventional\nexcision. Objectives.We assessed the short- and long-term clinical outcomes and recurrence of combined liposuction and limited\nsurgical excision of subcutaneous lipomas. Methods. From 2003 to 2012, 25 patients with 48 lipomas were treated with liposuction\nfollowed by direct excision through the same incision to remove residual lipomatous tissue. Initial postoperative follow-up ranged\nfrom 1 week to 3 months, and long-term outcomes, complications, and recurrence were surveyed 1 to 10 years postoperatively.\nResults. Lipomas on the head, neck, trunk, and extremities ranged from 1 to 15 cm in diameter. Early postoperative hematoma and\nseromas were managed by aspiration. Among 23 survey respondents (92%), patients were uniformly pleased with the cosmetic\nresults; none reported recurrent lipoma. Conclusions.The combination of liposuction and excision is a safe alternative for lipoma\nremoval; malignancy and recurrence are uncommon. Liposuction performed through a small incision provides satisfactory\naesthetic results in most cases. Once reduced in size, residual lipomatous and capsular tissue can be removed without expanding\nthe incision. These favorable outcomes support wider application of this technique in appropriate cases....
Intense pulsed light (IPL) has been used extensively in aesthetic and cosmetic dermatology. To test whether IPL could change the\ntissue vascularity and improve wound healing, mice were separated into 4 groups. Mice in Group I were not treated with IPL,\nwhereas, dorsal skins of mice in Groups II, III, and IV were treated with 35 J/cm2, 25 J/cm2, and 15 J/cm2 IPL, respectively. After 2\nweeks, dorsal island skin flaps were raised, based on the left deep circumflex iliac vessels as pedicles; then, survival rate was assessed.\nFlaps in Group IV (treated with lowest dose of IPL) have a survival rate significantly higher than other groups. Counting blood\nvessels did not demonstrate any significant differences; however, vessel dilation was found in this group. The results show that IPL\nat the therapeutic doses which are usually applied to humans is harmful to mouse dorsal skin and did not enhance wound healing,\nwhereas, IPL atmuch lower dose could improve wound healing.Thepossible mechanism is the dilation of tissue vasculature thanks\nto the electromagnetic character of IPL. Another mechanism could be the heat-shock protein production....
The selection of recipient vessels is crucial when reconstructing traumatized lower extremities using a free flap.When the dorsalis\npedis artery and/or posterior tibial artery cannot be palpated, we utilize computed tomography angiography to verify the site of\nvascular injury prior to performing free flap transfer. For vascular anastomosis, we fundamentally performend-to-side anastomosis\nor flow-through anastomosis to preserve the main arterial flow. In addition, in open fracture of the lower extremity, we utilize the\nanterolateral thigh flap for moderate soft tissue defects and the latissimus dorsi musculocutaneous flap for extensive soft tissue\ndefects.Thefree flaps used in these two techniques are long and include a large-caliber pedicle, and reconstruction can be performed\nwith either the anterior or posterior tibial artery. The preparation of recipient vessels is easier during the acute phase early after\ninjury, when there is no influence of scarring. A free flap allows flow-through anastomosis and is thus optimal for open fracture of\nthe lower extremity that requires simultaneous reconstruction of main vessel injury and soft tissue defect from the middle to distal\nthirds of the lower extremity....
Deformities in the craniofacial region are of great social and functional importance. Several surgical techniques have been used\nto treat such pathologies often with high morbidity and lacking the ability to address smaller contour defects. The minimally\ninvasive technique of fat transplantation has evolved rapidly within the last few decades. The objective of this paper is to present\nthe versatility and applicability of fat transplantation in a wide range of contour deformities in the craniofacial region.We share our\nexperiences in treating 13 patients with autoimmune disorders, congenitalmalformations, and acquired defects. Future perspectives\nof fat transplantation in the field of craniofacial reconstruction are discussed....
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