Abstract:
INTRODUCTION:Plastic surgeons are often asked to assist with the reconstruction of lower extremity wounds. These patients many times require free tissue transfer for coverage given paucity of soft tissue. Anecdotally, many orthopedic surgeons prefer muscle coverage--particularly in the setting of potentially infected bone. Today's surgeons now easily harvest and transfer fasciocutaneous flaps--a versatile option with less donor-site morbidity. We hypothesized that there would be no difference in outcomes between these 2 types of reconstruction. METHODS:We performed a single-institution retrospective review of lower extremity free flap reconstructions in the last 10 years. Demographics, preoperative and postoperative course, and the documented time to weight-bearing and bony union were collected. Major cohorts compared were muscle free flaps and fasciocutaneous free flaps, further divided into subgroups including acute trauma, tumor resection, osteomyelitis, and nonunion. Data comparisons were made using paired t test and Fischer exact tests. RESULTS:There were 121 patients who met inclusion criteria--86 in the muscle flap group, and 35 in the fasciocutaneous group and demographics were equal. Total complication rates were higher in smokers than nonsmokers (P < 0.03). There was no significant difference in major or minor complication rates between muscle and fasciocutaneous flaps in any subgroup. In both the acute fracture group and the infected nonunion group, there was a significantly faster return to weight bearing in the fasciocutaneous group (P < 0.03) although there was no difference in documented time to bony union. Patients who underwent fasciocutaneous reconstruction were more likely to require revisionary surgery for improved aesthetics (P < 0.001). CONCLUSIONS:Our data suggest that in essentially all clinical parameters, there is no difference between free flap type used for soft tissue coverage of the lower extremity. Patients undergoing reconstruction with a fasciocutaneous flap may return to weight bearing earlier--although they are more likely to require elective flap revisions. These results imply essentially equivalent outcomes regardless of flap type or operative indication, in contrast with some of the biases in the orthopedic community. The particular flap chosen for any reconstruction should remain solely at the discretion of the plastic surgeon.
journal_name
Ann Plast Surgjournal_title
Annals of plastic surgeryauthors
Paro J,Chiou G,Sen SKdoi
10.1097/SAP.0000000000000779subject
Has Abstractpub_date
2016-05-01 00:00:00pages
S213-5eissn
0148-7043issn
1536-3708journal_volume
76 Suppl 3pub_type
杂志文章abstract:BACKGROUND:A bilayered artificial dermis is widely applied for skin defects. Its collagen sponge is biodegraded and replaced with dermis-like tissue after application. There is no reliable method for quantitatively evaluating the blood flow of artificial dermis. In this study, we used laser Doppler imaging to evaluate ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0b013e3182590948
更新日期:2014-01-01 00:00:00
abstract::This study was performed to determine the degree of shrinkage over time in nipple projection after reconstruction. Nipple-areolar reconstruction was performed using the modified Anton-Hartrampf technique, and pigmentation was achieved with tattooing. This study looked at 28 consecutive patients with nipple reconstruct...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199911000-00001
更新日期:1999-11-01 00:00:00
abstract::Many procedures have been developed to correct the secondary cleft lip nasal deformity, including the depressed nasal tip, flaring nasal aperture, and a very short columella. The forked flap, cartilage graft, or strut and bony graft have been applied for many years. We propose the extended open-tip rhinoplasty with th...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199611000-00005
更新日期:1996-11-01 00:00:00
abstract::Millions of patients are treated annually in the United States with either acute or chronic wounds, costing billions of dollars. This is a retrospective study designed to quantify the directed education that medical students receive in their 4 years of training on 3 wound-related topics: physiology of tissue injury, p...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0b013e31802dd43b
更新日期:2007-07-01 00:00:00
abstract::One of the most common complications of double eyelid operations is asymmetry. To reduce asymmetry, we fixed the dermis to the tarsal plate at the same level as the skin incision, and objectively evaluated the symmetry of the height using photogrammetry.Of 30 patients who had double eyelid operations by the intratarsa...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0b013e3181b022e3
更新日期:2010-03-01 00:00:00
abstract::Breast reconstruction after nipple sparing mastectomy (NSM) plays, nowadays, a fundamental role in breast cancer management. There is no consensus on the best implant-based reconstruction technique, considering 2 stages (expander-prosthesis) or direct-to-implant (DTI). A retrospective review of consecutive adult femal...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000001893
更新日期:2019-10-01 00:00:00
abstract::To evaluate the management and outcome of acute facial powder burns, 10 patients admitted to a burn center (1980-1985) were reviewed. Facial burns resulted from black gun-powder in 7 and fireworks in 3 patients. Most burns occurred in teenage boys (6) and all but 1 were the result of carelessness on the part of the bu...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-198708000-00009
更新日期:1987-08-01 00:00:00
abstract::To investigate a 3-dimensional (3D) model of human brachial plexus including its topography of sensory and motor fascicles with the assistance of the computer technology, 2 brachial plexus were serially horizontally sliced. Each slice was stained by Karnovsky-Roots acetylcholinesterase histochemical method. The staine...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0b013e31822f677e
更新日期:2011-12-01 00:00:00
abstract::Five patients with avulsed scalps were treated with replantation between 1992 and 1998. All patients were women age 20 to 36 years. The percentage of the avulsed scalp ranged from 50% to 100% of the whole scalp. The vessels chosen for anastomosis were the superficial temporal artery, occipital artery, and superficial ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-200044040-00002
更新日期:2000-04-01 00:00:00
abstract:BACKGROUND:Exposure to the plastic surgery department is an important experience for medical students interested in the field. However, the impact of medical students in the plastic surgery operating room has not been previously examined. The aim of this study is to understand whether the presence of medical students i...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000001000
更新日期:2017-07-01 00:00:00
abstract::Many surgical procedures to improve mandibular contour have been introduced in East Asia. Despite consensus regarding mandible contouring surgery, surgery which includes angle ostectomy and lateral cortex excision, some patients require only mandibular angle ostectomy. The intraoral approach is a widely used method, b...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000000216
更新日期:2016-01-01 00:00:00
abstract::Transverse rectus abdominis musculocutaneous (TRAM) breast reconstruction in patients with advanced breast cancer is controversial. Management of these patients is often complex and consists of surgical extirpation, postoperative radiation, chemotherapy, and in some cases bone marrow transplantation. Few studies have ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/01.SAP.0000069075.27321.BC
更新日期:2003-06-01 00:00:00
abstract:BACKGROUND:Historically, dissection of the temporoparietal fascia immediately above the zygomatic arch has been avoided due to the risk of transection of the temporofrontal rami of the facial nerve. METHODS:A total of 8 fresh cadaveric hemi-faces have been dissected to investigate the relationship of the temporofronta...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0b013e318221b563
更新日期:2012-06-01 00:00:00
abstract::The Parkland formula is currently the most widely used protocol to guide fluid resuscitation of acute burns and has been adapted for pediatric use. We describe 3 novel graphic devices (a nomogram, slide rule, and disc calculator) based on this formula, which have significant advantages over existing graphic and electr...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0b013e3182586d4e
更新日期:2012-09-01 00:00:00
abstract:BACKGROUND:In most children with a unilateral cleft lip (UCL), because lateral lip tissue on the cleft side is congenitally short, the lateral lip element should be appropriately excised during primary cheiloplasty so that symmetric nasolabial features are obtained after surgery. The purpose of this study was to measur...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000002358
更新日期:2020-08-01 00:00:00
abstract:BACKGROUND:The surgical management of craniofacial fibrous dysplasia is controversial. The purpose of this study was to report the surgical outcomes of individualized management of craniofacial fibrous dysplasia of a single institution. METHODS:Data from patients (n = 20) with craniofacial fibrous dysplasia, who were ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000000640
更新日期:2016-08-01 00:00:00
abstract::The authors performed palatal mucoperiosteal grafting for contracture of the artificial eye socket in 4 patients. Mucoperiosteal grafts were collected from the paramedian area of the hard palate. After release of contracture, the grafts were sutured with absorbable thread to the defective areas on the conjunctival sid...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/01.SAP.0000068115.91989.A4
更新日期:2003-09-01 00:00:00
abstract::Endoscopic-assisted surgery allows remote incision placement and provides an illuminated, magnified operative field. We have applied these principles to perform neurolysis of the zygomaticotemporal nerve and removal of a fixation wire under endoscopic control in a patient with pain and tenderness at the site of a prev...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199608000-00012
更新日期:1996-08-01 00:00:00
abstract::Locoregional recurrent and distant metastases from squamous cell carcinomas, despite multimodality therapy, remain troublesome clinical realities. Discrepancies in success rates of various surgery and radiation treatment regimens dealing with these problems are confusing to the clinician attempting to recommend the mo...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199508000-00010
更新日期:1995-08-01 00:00:00
abstract::A semiautomatic anthropometric caliper was developed to accelerate and simplify anthropometric data acquisition. A technical slide caliper, connected via optical data cable interface to a standard PC, was amended with a data-input switch. A data sheet was filled in with consecutive measurements in 30 volunteers and co...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/01.sap.0000238344.15224.33
更新日期:2007-06-01 00:00:00
abstract::Myxoma of the jaw is a rare, benign bone tumor of odontogenic origin. Given the locally aggressive nature of the myxoma and the high rate of recurrence, there is a tendency to choose radical resection of the jaw segment containing the tumor mass as the treatment modality. As they appear to attain a considerable size p...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199707000-00016
更新日期:1997-07-01 00:00:00
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journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199701000-00010
更新日期:1997-01-01 00:00:00
abstract::Women over the age of 30 who had undergone single (N = 20) and multiple (N = 16) facial cosmetic surgery were compared with a control group (N = 49) on five personality measures. Cosmetic surgical patients were found to be more narcissistic (p = 0.05) and to have more problems with separation-individuation (p = 0.01) ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199709000-00001
更新日期:1997-09-01 00:00:00
abstract::A 16-year-old male with fibrous dysplasia, in which rapidly increasing proptosis of the left eye was induced by a mucocele behind the globe, is reported. The mucocele was removed and the expanded bone was completely recontoured back to normal dimensions with the aid of an acrylic skull replica fabricated preoperativel...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199802000-00015
更新日期:1998-02-01 00:00:00
abstract::Reconstruction of the damaged nasal vault is challenging. Limited available autologous tissue has lead surgeons to pursue alloplastic alternatives. A retrospective review comparing 18 patients who underwent secondary rhinoplasty with internal nasal valve reconstruction with spreader graft (SG) implants using either au...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0b013e3181d3ef8e
更新日期:2011-01-01 00:00:00
abstract::The repair of complex chest wall defects presents a challenging problem for the reconstructive surgeon. Although the majority of such defects could be repaired with the use of local and regional musculocutaneous flaps, more complicated cases require increasingly sophisticated reconstructive techniques. This study revi...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/01.sap.0000122653.09641.f8
更新日期:2004-05-01 00:00:00
abstract::Twenty patients with capillary/cavernous hemangiomas of the periorbital area (eyelid, eyebrow, nose extending to canthus) have been treated with a variety of techniques. Six patients were treated by yttrium-aluminum-garnet (YAG) laser photocoagulation and direct injection of steroids. Rapid shrinkage of the hemangioma...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199005000-00002
更新日期:1990-05-01 00:00:00
abstract::The onlay fascia-cartilage graft technique for malar or maxillary projections can be used for recontouring the middle third of the face. Covering onlay grafts with fascia achieves a smoother contour, concealing the edges in addition to obtaining a more natural anatomical look for the face. The technique has provided a...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-198705000-00006
更新日期:1987-05-01 00:00:00
abstract::There is an ongoing demand for surgeons to demonstrate that they can operate well, maintain their performance, and deliver acceptable results. Currently, surgeons are assessed by a series of subjective and peer-reviewed interviews, but at no stage is the objective assessment of surgical competence measured. The author...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/01.sap.0000037271.26659.f4
更新日期:2003-03-01 00:00:00
abstract:BACKGROUND:We compare the vascular territory of free muscle-sparing transverse rectus abdominis myocutaneous (MS-TRAM) flaps, deep inferior epigastric perforator (DIEP) flaps, and crossover anastomosis (CA) flaps using intraoperative ex vivo angiography. We also use ex vivo angiography to analyze the vascular architect...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000001859
更新日期:2019-12-01 00:00:00