Abstract:
:Pedicled flaps and microsurgical free tissue transfers are increasingly being used for reconstruction in the elderly and poorer risk patient. The use of systemically administered vasoactive agents to date has been avoided because of the fear that systemic levels of these agents perioperatively (particularly the vasopressors) might decrease blood flow and compromise the viability of the flap. There are no large-animal, real-time hemodynamic studies that support or disprove this belief. The objectives of this study were to (1) develop a musculocutaneous flap model in the pig that allows accurate, simultaneous monitoring of systemic and flap hemodynamic parameters such as flow and resistance and (2) identify the effects of commonly used vasoactive substances (dopamine, dobutamine, and phenylephrine) at clinically used levels on systemic and flap pressure/flow relationships. Vertically based rectus abdominis musculocutaneous flaps were raised in 8 anesthetized, 50- to 55-kg pigs, and a flow probe was placed around the artery. Catheters within the pulmonary artery and aorta were used to measure cardiac output and aortic root pressures. Measures of arterial blood pressure, cardiac output, and musculocutaneous flap flow were obtained at baseline and during the administration of varying doses of dopamine dobutamine and phenylephrine. Cardiac output increased significantly with low and high doses of dopamine and dobutamine, but decreased with increasing doses of phenylephrine. Flap flow, on the other hand, is increased only with dobutamine but remains unchanged with dopamine despite increased cardiac output. Flap flow decreases with high doses of phenylephrine. Flap flow also decreases relative to cardiac output with both dopamine and dobutamine. We conclude that (1) phenylephrine clearly affects flap flow adversely in a large-animal musculocutaneous model and therefore should be avoided, (2) dopamine does not affect total flap flow at either low or high doses despite increasing cardiac output, (3) dobutamine increases both flap flow and cardiac output, and (4) both dopamine and dobutamine should still be used with caution because the flap flow is not equally increased relative to total cardiac output. Possible changes in systemic and flap metabolic demand induced by these vasopressor drugs may therefore still be injurious to the flaps.
journal_name
Ann Plast Surgjournal_title
Annals of plastic surgeryauthors
Cordeiro PG,Santamaria E,Hu QY,Heerdt Pdoi
10.1097/00000637-199711000-00013subject
Has Abstractpub_date
1997-11-01 00:00:00pages
524-31issue
5eissn
0148-7043issn
1536-3708journal_volume
39pub_type
杂志文章abstract::Lateral malleolus avulsion is uncommon, and fusion of the syndesmosis of the ankle joint is usually performed in such cases. Others have reported successful reconstruction of the lateral malleolus with a vascularized fibular head. A case of reconstruction in a 17-year-old girl, with a free scapular apophysis flap, is ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-200109000-00018
更新日期:2001-09-01 00:00:00
abstract::Forearm and wrist injuries can result in a nonfunctional hand caused by loss of motor and sensory functions. Psychological stress is known to accompany traumatic hand injuries and may therefore affect functional outcome. The authors conducted a retrospective study of 107 patients diagnosed with a median, ulnar, or com...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-200207000-00013
更新日期:2002-07-01 00:00:00
abstract::Our understanding of muscle, fascia, and skin flap physiology is based largely on data obtained from rodent, rabbit, or canine models. The presence of a well-developed panniculus carnosus confounds the extrapolation of data from these animals to humans. This study attempted to define microsurgically applicable musculo...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-199805000-00005
更新日期:1998-05-01 00:00:00
abstract::Loss of pinch power associated with loss of coordinated movement of thumb and index fingers is the major disability in patients with ulnar nerve paralysis. Several tendon transfer methods utilizing different donor muscles have been used to restore adductor pollicis muscle function in ulnar nerve paralysis. In this pap...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/01.sap.0000209028.11153.be
更新日期:2006-07-01 00:00:00
abstract::We present a case of a nail defect, which was reconstructed by free composite nail combined with the palmar pocket method without vascular anastomoses. A 40-year-old man lost his nail of the right middle finger by trauma 1 year ago. A total nail composite graft, composed of germinal and sterile matrices, and proximal ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/01.sap.0000164731.99795.fe
更新日期:2005-06-01 00:00:00
abstract::Limited access to hand surgical care in the emergency room appears to be a problem in north Florida and probably other parts of the country, as well. In this study, hand surgeons in 3 major cities were contacted to determine what on-call services they provide for hospital emergency departments in their areas. Addition...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/01.sap.0000237636.37714.bb
更新日期:2007-02-01 00:00:00
abstract::Anophtalmic socket reconstruction is a challenging problem in plastic surgery. We had described a prefabricated superficial temporal fascia island flap and used this technique in >50 enucleation patients with severe socket contraction ending in excellent or good results for 28 years (Altindas- 1 procedure). However, t...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0b013e3181c9dd17
更新日期:2010-08-01 00:00:00
abstract::We report the use of topic negative pressure for seromas resulting from mobilization of tensor fascia lata miocutaneous flap in the trochanteric areas for pressure sores. In 5 consecutive patients we successfully treated seroma with the use of external and internal topic subatmospheric pressure. ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0b013e31819adf94
更新日期:2009-12-01 00:00:00
abstract::Craniofacial surgical techniques have yielded better methods of treating severe craniofacial trauma. In this paper surgical techniques are discussed in principle and specifically presented through case reports. We conclude that the most important factors for successful reconstruction after craniofacial trauma are to d...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-198612000-00012
更新日期:1986-12-01 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::Although the etiology of nonsyndromic forms of craniosynostosis remains uncertain, recent experiments from our laboratory have demonstrated that fetal head constraint induces cranial suture fusion in mice through a process associated with altered patterns of transforming growth factor beta (TGF-beta) isoform expressio...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-200105000-00015
更新日期:2001-05-01 00:00:00
abstract:INTRODUCTION:Breast cancer in women under 40 years of age is rare, accounting for approximately 5% of cases. The disease tends to be more aggressive in younger women. Younger age has been shown to be an independent predictive of breast reconstruction after total mastectomy. Treatment by total mastectomy and reconstruct...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0b013e318216b648
更新日期:2011-05-01 00:00:00
abstract::Metacarpal fractures are a relatively common hand injury that may require operative intervention to ensure adequate reduction and stabilization. The use of permanent hardware, although acceptable, may lead to complications and an increased number of surgical procedures. The use of resorbable hardware such as poly-L-la...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-200208000-00015
更新日期:2002-08-01 00:00:00
abstract:BACKGROUND:This study of stage III (locally advanced) breast cancer patients evaluated the survival improvement conferred by immediate breast reconstruction by transverse rectus abdominis musculocutaneous (TRAM) flap reconstruction after modified radical mastectomy (MRM) in comparison with MRM alone. METHODS:This retr...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000000251
更新日期:2014-09-01 00:00:00
abstract:INTRODUCTION:Over time, the operative treatment of extra-articular and intra-articular fractures of the first metacarpal base has gained significant importance, and at present, there are many operative strategies available because of the different osteosynthesis procedures in practice today. PURPOSE:In this retrospect...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000001293
更新日期:2018-05-01 00:00:00
abstract::Microcirculatory changes were monitored in 20 deep inferior epigastric artery perforator (DIEAP) flaps during unilateral breast reconstruction until the seventh postoperative day using laser Doppler perfusion imaging. Measurements were recorded according to the zonal classification by Scheflan and Dinner. The cutaneou...
journal_title:Annals of plastic surgery
pub_type: 临床试验,杂志文章
doi:10.1097/SAP.0b013e3181f3e39b
更新日期:2011-08-01 00:00:00
abstract::Deeply invading tumors of the scalp present numerous extirpative and reconstructive problems requiring the combined expertise and skills of both medical and surgical disciplines. We have employed a combined multidisciplinary approach to recurrent tumors of the scalp and calvarium. Intraoperatively, a fresh-tissue mapp...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:
更新日期:1980-03-01 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::Avulsion fractures can pose technical difficulties for surgical fixation. The fragments are often small and around finger joints with access being difficult due to attachment of ligaments or tendons. Traditionally, these have been treated using K wires, lag screws, or pullout sutures.Hook plates were originally descri...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000001119
更新日期:2017-09-01 00:00:00
abstract::Tattooing is increasingly common in Western society. The aim of the study was to create an overview of the surgical options when a tattoo is present in the operative site and to present an algorithm for the surgical plan.A literature-based study was conducted, using the Pubmed database. The following search terms have...
journal_title:Annals of plastic surgery
pub_type: 杂志文章,评审
doi:10.1097/SAP.0b013e3181b1429f
更新日期:2010-01-01 00:00:00
abstract::Activator protein 1 (AP-1) is thought to play an important role in the expression of genes expressed in response to ischemia-reperfusion injury. In this report, the activation of AP-1 in rat skeletal muscle during reperfusion after a 4-hour ischemic period was studied. AP-1 activation displayed a biphasic pattern, sho...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-200212000-00016
更新日期:2002-12-01 00:00:00
abstract::Pseudoaneurysms resulting from vascular impingement by osteochondromas are extremely rare. The authors detail the case of a 19-year-old man who represents the third known report in the English literature of a brachial artery pseudoaneurysm associated with a humeral osteochondroma. In patients presenting with a painful...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/01.sap.0000099818.70078.2b
更新日期:2004-04-01 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
abstract:INTRODUCTION:The traditions of surgical education have changed little over the years. However, the increasing focus on patient safety and duty hour restrictions mandates that residents start developing complex skill sets earlier to ensure they graduate with procedural competency. Surgical training is poised to exploit ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000002265
更新日期:2021-02-01 00:00:00
abstract:PURPOSE:This study aims to review the incidence and outcomes for children with superficial spreading melanomas (SSM) using population-based data. METHODS:The Surveillance, Epidemiology, and End Results database (1974-2009) was analyzed for all patients less than 20 years of age diagnosed with SSM. RESULTS:Overall, 72...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000000141
更新日期:2015-09-01 00:00:00
abstract::Whether operating on soft tissue, bony tissue, or both, as in major craniofacial procedures, patient safety is enhanced by better understanding of the anatomical details of the orbit. The myth and mystery of the optic nerve is made clear here, especially by our magnification techniques. ...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/00000637-198004000-00001
更新日期:1980-04-01 00:00:00
abstract:INTRODUCTION:The purpose of this article was to discuss about the use of corticosteroids in head and neck hemangioma as one of the safest noninvasive therapy, focusing on intralesional steroid injection, including perilesional and infusion, for curing or reducing tumor size. METHODS:A systematic review was done by mea...
journal_title:Annals of plastic surgery
pub_type: 杂志文章,评审
doi:10.1097/SAP.0b013e3181d49f52
更新日期:2011-01-01 00:00:00
abstract:OBJECTIVE:This study aimed to present the results of a series of forequarter amputations (FQAs) and to evaluate the reconstructive methods used. SUMMARY BACKGROUND DATA:Although FQA has become a rare procedure in the era of limb-sparing treatment of extremity malignancies, it is a useful option when resection of a sho...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000002204
更新日期:2020-06-01 00:00:00
abstract::Transverse facial clefts (macrostomia) are rare disorders that result when the embryonic mandibular and maxillary processes of the first branchial arch fail to fuse properly to form the corners of the mouth. Macrostomia may be seen alone or in association with other anomalies. It may be unilateral, extending along a l...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0b013e3181e6cfc1
更新日期:2011-04-01 00:00:00
abstract::Adipose-derived stem cells (ADSCs) are a promising new therapeutic modality for several diseases and have been applied to various clinical fields because of their multidifferentiation potential and capacity for growth-factor secretion. Recently, 2 in vivo studies showed ADSCs to have potential applications in lymphede...
journal_title:Annals of plastic surgery
pub_type: 杂志文章
doi:10.1097/SAP.0000000000000084
更新日期:2015-06-01 00:00:00