Spare Parts Surgery for Oncologic Reconstruction to Preserve Local Advancement Flap for Decubitus Ulcer Reconstruction: A Case Report

A 58-year-old male presented to our institution with synchronous large left thigh sarcoma and sacral decubitus ulcer requiring oncologic resection and reconstruction. Due to extensive tumor involvement, use of local flap for reconstruction was not feasible. Therefore, a spare parts free fillet flap from the disarticulated lower leg was utilized for reconstruction following oncologic resection. The benefits of this spare parts approach include no donor site morbidity, sufficient tissue padding for later use of prosthesis, and preservation of other flaps for future reconstruction of his sacral decubitus ulcer

Successful Latissimus Dorsi Free Flap Salvage using Intraoperative Vasopressors: A Case Report

Arterial thrombosis is a rare, but dreadful complication in microvascular surgery. Here we report on a case of recurrent arterial thrombosis in a latissimus dorsi (LD) free flap used for scalp reconstruction in an 18-year-old woman who sustained a gunshot wound (GSW) to the head. In the immediate postoperative period, internal and external doppler signals to the flap were lost. Emergent surgical exploration revealed arterial thrombosis, which was emergently explored and successfully repaired. Doppler signals were again lost and the flap was emergently explored for a second time. Following revision of the arterial anastomosis, flap perfusion decreased and appeared to correlate with the patient’s blood pressure. After administration of vasopressors to increase the Mean Arterial Pressure (MAP) to a goal of 70 or greater, flap perfusion and doppler signals were consistent. Here we describe a case of successful free flap salvage using both intraoperative and postoperative vasopressors for recurrent arterial thrombosis. Furthermore, vasopressor administration may be beneficial in select patients to maintain adequate flap perfusion in those who demonstrate intraoperative hypotension and no other identifiable causes of flap compromise, as in the present case

Intimate Partner Violence in Plastic Surgery Practice: Perceptions and Preparedness Amongst Practicing Plastic Surgeons

INTRODUCTION It is estimated that 4 of 10 women in the United States have experienced one or more forms of intimate partner violence (IPV) in their lifetime. The US Preventative Service Task Force recommends that clinicians screen women of reproductive age for IPV and refer women who screen positive to ongoing support services (B recommendation). We aim to identify the perceptions, attitudes, and preparedness of plastic surgeons regarding intimate partner violence METHODS An IRB approved survey was sent to members of the American Society of Plastic Surgeons. The survey contained three sections: (1) surgeon and practice demographics, (2) surgeon experience with intimate partner violence and preparedness of using protocols to screen for intimate partner violence, and (3) surgeon attitudes and perception of those experiencing and inflicting intimate partner violence. Four follow-up emails were sent to enhance response rate. RESULTS A total of 107 of 2,535 plastic surgeons responded (4.22% response rate), and 81 (75.7%) of them were men. Most surgeons, 57 (64.0%) respondents, estimate that intimate partner violence is rare (year) in their practice while 22 (24.7%) surgeons were unsure of the prevalence. Only 17 (37.8%) surgeons responded that they feel comfortable screening for intimate partner violence while 41 (43.2%) believe that screening protocols are likely to capture patients’ experiences. Most surgeons (71.6%) state they have no established protocol if a patient discloses intimate partner violence. CONCLUSIONS The prevalence of IPV is well understood, but educational efforts and adequate screening protocols are needed within the plastic surgery community to identify and treat patients experiencing intimate partner violence