Abstract:
BACKGROUND:The need for preoperative imaging as well as anastomotic technique (ie, end-to-side [ETS] vs end-to-end [ETE]) are areas of controversy in microsurgical lower-extremity reconstruction. The objective of this study was to (1) investigate whether preoperative imaging is mandatory and (2) to elicit if the type of anastomosis impacts clinical outcomes. METHODS:A retrospective review of all patients who underwent microvascular lower-extremity reconstruction between 2007 and 2015 by a single surgeon was performed. Patients were categorized into groups based on anastomotic technique, that is, ETE versus ETS anastomosis. Patients in the ETE group were further subclassified into those who had preoperative imaging (computed tomography angiography [CTA]+) versus those who did not (CTA-). Parameters of interest included flap type, thrombosis rate, flap loss, length of stay (LOS), return to ambulation, and rate of secondary amputation. Two-sided statistical analysis was performed using Kruskal-Wallis rank-sum test and Fisher exact test. RESULTS:One hundred twenty-eight patients were analyzed: ETE (n = 40) and ETS (n = 88). Mean follow-up for both groups was 20 ± 19 months. Anterolateral thigh flaps were most commonly performed (71%). Overall flap loss rate was 3.1% without any significant differences noted with respect to thrombosis (arterial, P = 0.09; venous, P = 0.56), flap loss (P = 0.33), LOS (P = 0.28), amputation (P = 1.00), or return to ambulation (P = 0.77). Furthermore, the availability of preoperative imaging (CTA+: N = 11 vs CTA-: N = 29) did not impact rates of thrombosis (arterial, P = 0.29; venous, P = 0.31), flap loss (P = 1.00), LOS (P = 0.26), or return to mobility (P = 0.62). CONCLUSIONS:In light of similar reconstructive outcomes, we prefer to preserve distal extremity perfusion via ETS anastomoses whenever possible. Furthermore, preoperative vascular imaging angiography might not be necessary in patients with palpable pedal pulses on preoperative examination. An actionable algorithm for determining ETS versus ETE anastomosis in lower-extremity reconstruction is presented.
journal_name
Ann Plast Surgjournal_title
Annals of plastic surgeryauthors
Carney MJ,Samra F,Momeni A,Bauder AR,Weissler JM,Kovach SJdoi
10.1097/SAP.0000000000002227subject
Has Abstractpub_date
2020-04-01 00:00:00pages
425-430issue
4eissn
0148-7043issn
1536-3708journal_volume
84pub_type
杂志文章abstract::A bayonet-shaped airway allowing free respiration and undisturbed deglutition was reconstructed in 2 young women who had undergone tracheotomy and radiotherapy for thyroid carcinoma. The laryngeal vestibule, glottis, and subglottis had been destroyed, and the air passages were closed. An external gutter and an anterio...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-198605000-00010
更新日期:1986-05-01 00:00:00
abstract::Crushing injuries, including electrical burns on the dorsum of the foot, result in extensive tissue loss and exposure of bone and tendon. Debridement and covering of the wound with richly vascularized tissue are necessary at an early date. Flaps for the dorsum of the foot should be thin and the donor tissue to be sacr...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-198509000-00011
更新日期:1985-09-01 00:00:00
abstract:INTRODUCTION:The most effective management of a patient with sarcoma is surgical resection. Often the resection is performed, the wound is irradiated, adjuvant chemotherapy is administered, and the wound is closed without plastic surgery consultation. Wound complications, after these treatment protocols, often require ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0b013e31827c7973
更新日期:2013-09-01 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::The morphology of macrostomia and a method of myoplasty and commissuroplasty are described. The important operative considerations are accurate commissure positioning, muscle reconstruction, obliteration of the lateral subdermal groove, placement of a vermilion flap across the commissure, and Z-plasty of skin in the n...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-198108000-00010
更新日期:1981-08-01 00:00:00
abstract::Prostaglandin E1 has been proven to be useful in the treatment of vascular diseases of the lower leg. Plastic surgeons have been aware of its usefulness in augmenting flap survival and have used it intraarterially or intravenously. We attempted to enhance the effect of prostaglandin E1 with heparin by local continuous...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199302000-00010
更新日期:1993-02-01 00:00:00
abstract:INTRODUCTION:Plantar hyperkeratosis, such as corns and calluses, is common in older people and associated with pain, mobility impairment, and functional limitations. It usually develops on the palms, knees, or soles of feet, especially under the heels or balls. There are several treatment methods for plantar hyperkerat...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000001304
更新日期:2018-02-01 00:00:00
abstract::We have developed a new in vivo model for the study of fetal wound healing. Fetal ICR mice (total gestation, 21 days) received a full-thickness incisional wound in the hind limb at gestational day 14 (N = 100). The wound was made with a 28.5-gauge needle that was passed transplacentally into the amniotic cavity. The w...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199710000-00008
更新日期:1997-10-01 00:00:00
abstract::Seroma formation is a common postoperative complication in plastic surgery, resulting in notable patient morbidity and expense. In this study the authors investigated the efficacy of a synthetic glutaraldehyde-based tissue adhesive (BioGlue; Cryolife, Inc., Kennesaw, GA) in seroma prevention in the rat mastectomy sero...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/01.SAP.0000054182.47311.17
更新日期:2003-06-01 00:00:00
abstract::Since 1993, a total of 41 free osteofasciocutaneous fibular flaps with an extended skin island (average dimensions, 16.9 cm long [range, 12-22 cm] x 10.7 cm wide [range, -16 cm], or 180.8 cm [range, 112-352 cm ]) have been used in by the authors in various clinical applications. To evaluate donor site morbidity, the 4...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-200208000-00005
更新日期:2002-08-01 00:00:00
abstract::Acquired digital fibrokeratomas are benign, rare tumors that develop most commonly on the fingers. They can have an appearance of a rudimentary supernumerary digit or be misdiagnosed as a more common condition, such as verruca vulgaris. There are no case reports described in the plastic surgery literature. We are repo...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0b013e3182996ee6
更新日期:2015-03-01 00:00:00
abstract:BACKGROUND:Patients with unilateral cleft lip and palate (CLP) deformities commonly develop nasal airway obstruction, necessitating septoplasty at the time of definitive rhinoplasty. We assessed the contribution of the bony septum to airway obstruction using computed tomography (CT) and cone beam CT (CBCT). METHODS:A ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000000027
更新日期:2015-07-01 00:00:00
abstract::The efficacy of tissue expanders in providing additional skin and muscle for breast reconstruction has been demonstrated convincingly and repeatedly. This had led to the increasing use of this technique for certain women desiring reconstruction of the breast following mastectomy for cancer. We report on the psychologi...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:
更新日期:1988-09-01 00:00:00
abstract:BACKGROUND:Despite their widespread use, there are no evidence-based guidelines on the management of closed-suction drains or antibiotics in postmastectomy breast reconstruction. The purpose of this study was to assess consensus and variation in postoperative care among plastic surgeons. METHODS:The authors designed a...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0b013e31820c0593
更新日期:2011-05-01 00:00:00
abstract::Cytokines are peptide mediators of inflammation that are being extensively studied in several aspects of disease. I provide an introduction to the general features of cytokine biology. Cytokines may be considered as either proinflammatory or anti-inflammatory compounds, and they also have potent hematopoietic effects....
journal_title:Annals of plastic surgery
pub_type: 杂志文章,评审
doi:10.1097/00000637-199511000-00021
更新日期:1995-11-01 00:00:00
abstract::Although microsurgery has rapid expanded, problems related to microarterial anastomosis continue. Cigarette smoking is one of the major risks for anastomosis by increasing platelet adhesion, and its effects on endothelial cells. Aim of this article is to study the negative effects of cigarettes on microarterial anasto...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0b013e3181b404fa
更新日期:2010-07-01 00:00:00
abstract::To reconstruct medial orbital wall fractures with a clear, least dissection, an alternative method, precaruncular approach, has been performed. We reviewed 36 patients with medial blowout fractures treated with this technique. The incision was made between the caruncle and medial canthal skin at the mucocutaneous junc...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0b013e31826a1a75
更新日期:2014-01-01 00:00:00
abstract:UNLABELLED:Due to the importance of hand functions, fingertip injuries should be reconstructed by flap coverage. Although reverse homodigital island flap is an option that is widely used, the classical homodigital flap, which includes a skin graft for the donor site, leads to many donor-site problems such as maceration...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000000137
更新日期:2015-08-01 00:00:00
abstract::Reconstruction of large congenital spinal defects remains a challenge. We present our experience in closure of difficult spinal defects following repair of tethered cord, using paravertebral fascial or myofascial turnover flaps. Between 1996 and 2005, 23 patients were operated using paravertebral turnover flaps for cl...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/01.sap.0000235424.26158.e5
更新日期:2006-12-01 00:00:00
abstract::Endothelin-1, a peptide isolated from vascular endothelial cells, facilitates the constriction of vascular smooth muscle and various pharmacological actions including vasodilation, the proliferation of smooth muscle cells and fibroblasts, and the stimulation of arachidonic acid metabolism. In this study, plasma, urine...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199609000-00012
更新日期:1996-09-01 00:00:00
abstract::Reconstruction of the lower and upper lips, commissure, and full-thickness cheek defects using a composite radial forearm palmaris longus free flap with secondary commissuroplasty is described. This flap is useful for reconstruction of the total lower lip as well as larger defects that include full-thickness cheek and...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199411000-00013
更新日期:1994-11-01 00:00:00
abstract:BACKGROUND:Conjoined twinning is a rare congenital malformation, and the resultant huge body wall defects after separation of conjoined twins represent a real challenge to surgeons. METHODS:From 2004 to 2009, authors performed body wall reconstruction for 2 pairs of thoraco-omphalopagus twins and 1 pair of ischiopagus...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000001609
更新日期:2018-12-01 00:00:00
abstract::Congenital segmental amputations are difficult to correct. Free interposition bone grafts with growth centers were tried experimentally by many investigators even at the beginning of this century. Attempts at clinical application of this principle, however, were mostly failures. More recently, with the advent of micro...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199210000-00010
更新日期:1992-10-01 00:00:00
abstract::The purpose of this study is to objectively evaluate donor-site morbidity of the inferior gluteal musculocutaneous flap in teenagers. All cases of breast reconstruction performed between 1996 and 2005 using an inferior gluteal flap were reviewed. Flap size, weight, and pedicle origin were noted. Donor-site morbidity w...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/01.sap.0000259595.65804.2f
更新日期:2007-12-01 00:00:00
abstract::Several experimental studies have demonstrated that granulocytes have an important role in causing the necrosis of ischemic tissue by capillary plugging and superoxide radical formation. Adenosine is spontaneously released by ischemic cells and inhibits the granulocytic superoxide radical formation. 5-Aminoimidazole-4...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199106000-00008
更新日期:1991-06-01 00:00:00
abstract:BACKGROUND:Pulmonary complications are common among patients who have undergone major oral cancer surgery with microvascular reconstruction. Current literatures focused on early-onset pneumonia in the postoperative acute stage. In contrast, we are aiming to identify the clinical importance and the risk factors associat...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000002170
更新日期:2020-01-01 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::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
abstract::Disciplines using human body surface dimensions require accurate, repeatable measurements. This study presents a design for the analysis of repeatability, precision, and validation of a new anthropometric device. This model enables estimation of the proportion of the total variation attributable to each level of data ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199504000-00004
更新日期:1995-04-01 00:00:00
abstract::The purpose of this pilot study was to compare proliferation, collagen synthesis, and growth factor production, which are important contributing factors for wound healing, of the bone marrow stromal cells (BSCs) with those of dermal fibroblasts in vitro. Cultured human BSCs and dermal fibroblasts from the same patient...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/01.sap.0000178809.01289.10
更新日期:2005-10-01 00:00:00