Technische innovaties bij autologe borstreconstructies

Contains fulltext : 187344.pdf (publisher's version ) (Open Access)Radboud University, 6 april 2018Promotores : Ulrich, D.J.O., Schultze Kool, L.J. Co-promotor : Hoogeveen, Y.L.137 p

Designing and utilizing 3D-printed skin incision guides during the first Dutch bilateral hand-arm transplantation

OBJECTIVE: To preoperatively plan skin incision in the case of the first Dutch bilateral hand-arm transplantation. BACKGROUND: A bilateral hand-arm transplantation has been performed for the first time in the Netherlands in 2019. In the context of preparation for this surgical procedure, the optimal patient-specific skin flap was determined. Skin flaps should be properly matched between donor and recipient to ensure sufficient tissue for the approximation of skin over the tendon anastomosis, adequate distal tip perfusion, and esthetics. METHODS: Preoperatively, stereophotogrammetry was obtained from the upper extremities of the patient and a volunteer with similar body physique. Skin flap dimensions were determined for each extremity, which resulted in patient-specific incision patterns. Combining this digital information yielded practical skin incision guides for both the donor and acceptor arms. Finally, the computer-aided designs were 3D printed. RESULTS: The 3D prints were convenient to utilize in both shaping the donor flaps as in preparing the acceptor extremities, taking only a few seconds during precious ischemia time. There was sufficient skin flap perfusion, and the wound-healing followed an uncomplicated course. No corrections were made to the initial skin incisions. CONCLUSIONS: Three-dimensional printed templates were successfully utilized in the first Dutch bilateral hand-arm transplantation. We believe its usage increased time efficiency, improved the match of skin flaps in donor and recipient arms, and allowed us to control the amount of skin surplus without skin flap tip necrosis. In these procedures where time is of the essence, we believe preoperative planning is imperative for its success

Displaying inguinal lymph nodes before transplantation in a deep inferior epigastric perforator flap breast reconstruction using an innovative projection method

Item does not contain fulltextINTRODUCTION: Lymphedema of the arm is a common postoperative complication as a result of breast cancer surgery. One of the surgical treatments comprises modification of a deep inferior epigastric perforator (DIEP) flap breast reconstruction to facilitate additional lymph node transplantation from the inguinal area. Using computed tomography angiography (CTA), the distribution of these lymph nodes can be assessed. A virtual planning based on this CTA created for the DIEP flap is presented, with the inguinal lymph nodes included, followed by preoperatively projecting this information on the patient's abdomen. METHODS: A total of 10 patients underwent the standard imaging protocol: A preoperative CTA to assess the vascular anatomy of the lower abdomen. A three-dimensional (3D) model of the blood vessels was produced, and the inguinal lymph nodes in this reconstruction were included. Preoperative projection of the 3D model onto the patients' abdomen and inguinal area was performed, followed by tracing of this image. Intraoperatively found lymph nodes were identified by touch and compared with the markings on the skin. RESULTS: In all 10 patients, all lymph nodes located preoperatively were found intraoperatively within a 1-cm radius of the marking on the skin; and these were more easily located by two operating surgeons. CONCLUSION: Virtual planning of lymph node transplantations in a deep inferior epigastric artery perforator flap breast reconstruction seems feasible and can be performed quickly. This additional visual support aids the surgeon in locating the lymph nodes in the inguinal area

Management of free flap salvage using thrombolytic drugs: A systematic review

BACKGROUND: Microvascular free tissue transfer is a reliable method for reconstructive surgery. However, pedicle thrombosis remains a serious complication following free tissue transfer as no consensus has been reached on the optimal management of failing flaps. The purpose of this systematic review is to examine the current evidence on the use of thrombolytic drugs and their effects on microvascular flap salvage rates. METHODS: A systematic literature search was performed using Medline, Embase, and, PubMed databases to identify scientific literature published between January 1987 and January 2019. This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles of English language studies reporting on free flap salvage procedures or protocols using thrombolytic drugs were included and reviewed by one author. RESULTS: Of 105 articles screened, 27 studies and case reports were included and qualified for data extraction. Overall, the level of evidence of the current literature is low. Thirteen retrospective studies tried to demonstrate a systemic approach for thrombolysis in flap salvage. The other 14 case reports presented clinical use of thrombolytic drugs to salvage free flaps. None of the thrombolytic agents presented had superior salvage outcomes. CONCLUSION: A review on the current literature did not provide satisfactory and consistent evidence for the optimal management of patients with microvascular thrombosis, since no consensus has been reached on the optimal management of failing flaps. Prospective randomized studies are needed regarding their indications, dosages, and methods of administration, efficacy, and safety

Applications and limitations of using patient-specific 3D printed molds in autologous breast reconstruction

Contains fulltext : 195860.pdf (Publisher’s version ) (Open Access

Development and Evaluation of a Remote Patient Monitoring System in Autologous Breast Reconstruction

Contains fulltext : 243843.pdf (Publisher’s version ) (Open Access