Vascular grafts and flow-through flaps for microsurgical lower extremity reconstruction

Background: The use of vascular grafts is indicated in case of insufficient pedicle length or for complex defects involving both soft tissues and vessels. Venous grafts (for both venous and arterial reconstructions) and arterial grafts (arterial reconstruction) can be used. This study retrospectively evaluated the needs for vascular reconstruction and its results in a clinical series of lower limb reconstructions with microsurgical free flaps. Materials and Methods: From 2010 to 2015, a total of 16 vascular grafts or flow-through flaps were used in 12 patients out of a total of 150 patients undergoing microsurgical reconstruction (8%). Arterial reconstruction was performed in seven cases (six flow-through flaps, one arterial graft), combined arterial and venous reconstruction in four cases (three vein grafts, one combined venous/arterial graft), and venous reconstruction in one case (one venous graft). The rate of complications and donor-site morbidity related to vascular graft harvest were evaluated. Results: Reconstruction was successful in all cases, despite an overall complication rate of 17 and 8% of surgical revision. Donor-site morbidity, subjectively evaluated, was minimal with respect to functional deficits and aesthetic outcome. Indications for the different types of grafts are discussed. Conclusion: The use of vascular grafts is needed in a relevant percentage of microsurgical reconstruction cases. Venous and arterial vascular grafts, transient arteriovenous fistulas, and flow-through microsurgical flaps showed a safe reconstruction comparable to microsurgical reconstructions without the use of grafts. Donor-site morbidity secondary to vascular graft harvest is minimal, and in almost 70% of cases no additional scars are needed

Retrospective analysis in lower limb reconstruction : propeller perforator flaps versus free flaps

Background: Technical advancements and increasing experience in the management of soft tissue defects in lower extremities have led to the evolution of decisional reconstructive algorithms. Both propeller perforator flaps (PPFs) and free flaps (FFs) proved to be useful methods of reconstruction for lower extremities defects, offering alternative reconstructive tools. We present a case series of PPFs and FFs for reconstruction of lower limbs defects, analyzing and comparing treatment and outcomes. Methods: Through a retrospective analysis, we report our experience in performing PPFs or FFs for reconstruction of soft tissue defects of the lower extremities, in patients admitted between 2010 and 2015 at the Department of Plastic and Reconstructive Surgery, University of Palermo. In these patients, we evaluated location and causes of defects, types of flaps used, recipient vessels, complications, time to healing, and aesthetic outcome. Results: A primary healing rate was obtained in 13 patients for PPF and 16 cases for FF. Revision surgery for partial skin necrosis was required in eight cases (PPF: four and FF: four). Recovery time and hospitalization period were eventually shorter in patients with FFs, due to lower rate of complications and revision surgery. Conclusion: In the past years, our indications for reconstruction with PPFs in the lower limb have become more restricted, while we favor reconstruction with FFs. Recommendations are provided to orient surgical treatment in small, medium, and large lower limb defects

IMPIANTO PERISUTURALE DI TESSUTO NERVOSO AUTOLOGO DOPO RIPARAZIONE DI UN NERVO PERIFERICO CON AUTOINNESTO DI NERVO A POLARITA’ INVERTITA.

Molti studi scientifici utilizzano cellule di Schwann e fattori di crescita per cercare di migliorare sempre più il processo rigenerativo assonale. Tutt’oggi l’unica fonte autologa di cellule di Schwann deriva dalla processazione del tessuto nervoso e dall’amplificazione di queste così ottenute in coltura. Questo processo richiede molto tempo e notevoli risorse umane ed economiche e per tali motivi non è ancora possibile il loro utilizzo routinario ed immediato durante un intervento di riparazione nervosa. Le cellule di Schwann prodotte mediante differenziazione in coltura da cellule staminali (embrionali o adulte) non possono essere impiegare nella pratica clinica per motivi di ordine etico-legale. Dalla constatazione scientifica del ruolo chiave svolto delle cellule di Schwann nei meccanismi di rigenerazione nervosa prende spunto questo studio il cui scopo è di valutare l’utilità dell’impianto di cellule di Schwann autologhe in sede perisuturale distale di un innesto a polarità invertita nella rigenerazione nervosa

The face lift SMAS plication flap for reconstruction of large temporofrontal defects : reconstructive surgery meets cosmetic surgery

Reconstruction of large defects in the temporal region can be performed with skin grafts or pedicled or free flaps. Results are often not optimal because of the patch of a skin graft, lack of availability of local flaps, and distant skin from free flaps. A technique for reconstruction of these defects with local tissue is presented in this article that uses superficial musculoaponeurotic system (SMAS) plication to allow wide advancement of a cervicofacial flap

INFLUENCE OF CAROTID AND PERIPHERAL ATHEROSCLEROSIS ON THE OUTCOME OF PATIENTS WITH ACUTE CORONARY SYNDROME

INFLUENCE OF CAROTID AND PERIPHERAL ATHERLSCLEROSIS IN THE OUTCOME OF PATIENTS WITH ACUTE CORONARY SYNDROM

Seeding nerve sutures with minced nerve-graft (MINE-G): a simple method to improve nerve regeneration in rats

Background: The aim of this study was to assess the effect of seeding the distal nerve suture with nerve fragments in rats. Methods: On 20 rats, a 15 mm sciatic nerve defect was reconstructed with a nerve autograft. In the Study Group (10 rats), a minced 1 mm nerve segment was seeded around the nerve suture. In the Control Group (10 rats), a nerve graft alone was used. At 4 and 12 weeks, a walking track analysis with open field test (WTA), hystomorphometry (number of myelinated fibers (n), fiber density (FD) and fiber area (FA) and soleus and gastrocnemius muscle weight ratios (MWR) were evaluated. The Student t-test was used for statistical analysis. Results: At 4 and 12 weeks the Study Group had a significantly higher n and FD (p =.043 and.033). The SMWR was significantly higher in the Study Group at 12 weeks (p =.0207). Conclusions: Seeding the distal nerve suture with nerve fragments increases the number of myelinated fibers, the FD and the SMWR. The technique seems promising and deserves further investigation to clarify the mechanisms involved and its functional effects