Arterial Pressure Management in a Reconstructive Microsurgery Patients by Dopamine Infusion in a Nonintensive Care Ward

Free flap perfusion and arterial pressure management have always had a crucial role in free flap reconstruction. Blood pressure values requested can be reached either by using vasoactive agents or fluid replacement or the combination of both.1,2 In contrast to the most frequently tested phenylephrine, norepinephrine, and dobutamine,3,4 this work evaluates dopamine efficacy in perioperative blood pressure management. In our institution, dopamine infusion is the only vasoactive agent authorized in a non-intensive care unit department. This drug stimulates \u3b1- and \u3b2-adrenergic receptors with positive chronotropic and inotropic effects and reduces peripheral vascular resistance helping in this way to achieve an increase of blood pressure and free flap perfusion.

Suture anchors to fix free flaps in oral and oropharyngeal reconstruction

The Mitek\uae suture anchors (Depuy Mitek Surgical Products,Inc.Raynham, Massachusetts) are produced in a number of differentsizes(micro, mini, GII, and Super) but we use the mini. It is composed of a body and two wings, the body being made oftitaniumalloy, and the wings of nickel-titaniumalloy, which benefits from superelasticity and its memory of shape. The packaging includes both the anchor and the insertion device, in which the anchor is already preloaded. The bottom of the anchor has a loop that contains the suture, which is charged on to the insertion device

Elastofibroma Dorsi. Our experience with 11 lesions

Elastofibroma is a rare benign lesion that typically arises on the posterior chest wall beneath the scapula. The etiopathogenesis is still unclear and the knowledge about its diagnosis and management mainly comes from small case series. We collected all the data related to 11 Elastofibroma Dorsi treated at our institution between January 2003 and July 2014. The definitive diagnosis was made by histological examination of the mass. We analyzed the characteristic of the patients, (i.e. age, sex, dominant hand, and occupation), the presenting symptoms and signs, the preoperative investigations, surgical management and complications comparing our findings with the current medical literature on the subject. We found that preoperative investigations are of limited value and when clinical presentation is typical the diagnosis could be made presumptively. Surgery should be performed under general anaesthesia since local anaesthetic infiltration and sedation are often inadequate to reduce intraoperative discomfort

Clinical use of semiliquid dermal substitute: A case report

Nowadays Integra\u2122 is an integral part of the "reconstructive ladder", recently the new Integra\u2122 Flowable Dermal Regeneration has appeared on the market. This is a semiliquid compound, malleable and those characteristics widen the indication for its use. In this report we describe two cases in which we used this product to repair undermined and tunnelled wounds. We believe that this product can be useful for treatment of tunnelled wounds of small dimensions reducing the need for major procedures

Limb and Flap Salvage in Gustilo IIIC Injuries Treated by Vascular Repair and Emergency Free Flap Transfer

BACKGROUND: Gustilo classification system defines IIIC fractures as open fractures associated with an arterial injury that requires repair. The aim of our study was to analyze the early outcome in terms of limb and flap salvage, early amputation, and early complication rate in patients with Gustilo IIIC open fractures treated in an emergency setup. METHODS: We retrospectively reviewed 20 patients with Gustilo IIIC injuries treated by the \u201cfix and flap\u201d principle during the first surgical procedure in the first 24 hours after injury (emergency free flap transfer). All patients underwent surgery with radical debridement, wound irrigation, skeletal stabilization, vascular repair, and immediate free flap coverage. RESULTS: In this study, 18 patients were men (90%) and 2 were women (10%). In all patients, a vascular repair was performed and in 17 cases (85%), the lower limb/foot was avascular and limb salvage was performed. Three patients had one vessels injured (15%) and 17 had two or three vessels injured (85%). In 9 out of 20 (45%), a revision surgery was needed for arterial (10%, 2 patients), arterial\u2013venous (15%, 3 patients), and venous thrombosis (20%, 4 patients), while 4 patients required an early amputation (20%) and 1, a late one (5%). In three patients (15%), a flap loss occurred. Superficial infection occurred in seven cases (35%) and deep infection (osteomyelitis) in one (5%). CONCLUSION: A single-stage procedure performed in an emergency operating room could lead to an effective outcome with a high rate of limb salvage and satisfying long-term results

Is the LICOX\uae PtO2 system reliable for monitoring of free flaps? Comparison between two cohorts of patients

Background: Licox\uae PtO2 is a minimally invasive monitoring system for continuous measurement of tissue oxygen tension in all types of free tissue transfers. Our study compares two consecutive series of patients undergoing microsurgical reconstruction monitored with standard clinical bedside surveillance and with the Licox\uae PtO2 system regarding flap loss and flap salvage, the sensitivity, specificity, and cost-effectiveness. Methods: We performed a longitudinal observational prospective study of all patients undergoing microsurgical reconstructions between 2016 and 2017. Group 1 included 43 patients that underwent standard clinical bedside postoperative flap monitoring whereas group 2 included 44 consecutive patients also monitored with Licox\uae PtO2 system. Flap complications such as return to theater for vascular compromise, partial and total flap loss and flap salvage rate were analyzed. Results: We recorded no significant difference between the two groups regarding the rate of vascular complications (P = .31), return to the theater (P = .31), flap salvage (P = .9), partial and total flap loss (P = .36 and P = .49, respectively). When analyzing the Licox\uae PtO2 system monitoring group, we documented six false-positive results (13.6%) and 0 false negatives with an accuracy of 0.86, a sensibility of 1.00, and a specificity of 0.85. Conclusions: This is the first study that provides statistical data about the comparison of postoperative free flap monitoring by standard clinical bedside method and Licox\uae PtO2 system. For the monitoring of buried flaps, the Licox\uae PtO2 monitoring can be used only as a supplement to other systems. Its use, compared to near-infrared spectroscopy or clinical bedside monitoring, was not found cost-efficient

How we fix free flaps to the bone in oral and oropharyngeal reconstructions

Purpose: The use of suture anchors has been described in orthopedic, hand, oculoplastic, temporomandibular joint and in aesthetic surgery, but no study reports the use of the Mitek\uae anchors (Depuy Mitek Surgical Products, Inc. Raynham, Massachusetts) for fixing the free flaps used in oncologic oral and oropharyngeal reconstruction. Materials and Methods: In this prospective non-randomized study, 9 patients underwent surgical resection of oral or oropharyngeal cancer followed by a free flap reconstruction; mini anchors were used to fix the flap directly to the bone. We collected data regarding the patients, the tumor stage, the surgical procedure, the radiotherapy and the number of anchors used. Results: The average follow-up was 28 months (range 24\u201338).We observed no complications with trans-oral, sub-mandibular and trans-mandibular approach in both oral and oropharyngeal reconstructions. All anchors became osteo-integrated and no complications occurred after radiotherapy. Conclusions: In our opinion this device favors free flap adhesion to the bone. We registered no postoperative complications related to the use of the device which looks suitable for use in irradiated tissues. The radiotherapy did not cause any long-term complications related to the use of Mitek\uae mini bone anchors