Publications (11)17.93 Total impact
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Article: A Simple Device to Prevent and Treat Umbilicus Stenosis.
Aesthetic Plastic Surgery 01/2013; · 1.41 Impact Factor -
Article: Total or subtotal glossectomy with microsurgical reconstruction: functional and oncological results.
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ABSTRACT: Management of patients after total or subtotal glossectomy presents challenging reconstruction of complex three-dimensional defects. Such defects can have a dramatic effect on respiration, speech, and nutrition, and may significantly impact quality of life. We present our experience with 39 patients submitted to total or subtotal glossectomy and reconstruction with microsurgical flaps. Functional results are reported in term of swallowing ability, decannulation, and intelligible speech. Oncological outcomes are described in terms of local disease control and overall survival rate. We carried out 24 total glossectomies and 15 subtotal glossectomies. Total glossectomy was associated with a total laryngectomy in eight patients. Reconstruction was performed using Taylor's myocutaneous extended deep inferior epigastric flap in 33 patients, and an anterolateral thigh perforator flap in six patients. A fibula osteocutaneous free flap was raised in two patients with an anterior segmental mandibulectomy. A second free flap was needed in three cases. Wound complications occurred in 17 patients: an orocutaneous fistula in eight patients and a dehiscence of the suture without fistulization in nine patients. Oral feeding was resumed in 33 patients (85%). In nonlaryngectomized patients, decannulation was achieved in 28 (90%) and speech was good or acceptable in 27 (87%). The 5-year adjusted survival for patients treated with total or subtotal glossectomy was 47%. Our results in a relatively large sample of patients who underwent total or subtotal glossectomy followed by reconstruction with microsurgical free flaps support the efficacy of this surgery as treatment for advanced oral and oral pharyngeal cancers.Microsurgery 09/2011; 31(7):517-23. · 1.61 Impact Factor -
Article: Extended deep inferior epigastric artery perforator flap for head and neck reconstruction: a clinical experience with 100 patients.
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ABSTRACT: The extended deep inferior epigastric perforator (DIEP) artery flap had been described in 1983. For head and neck reconstruction, we have been using a variation of this flap, namely a perforator free flap of the deep inferior epigastric system with a superolateral extension of the skin paddle. The purpose of this study was to present our 10-year experience in the performance of 102 soft tissue head and neck reconstructions with the extended DIEP flap in 100 patients. Depending on the reconstructive needs, we used the extended DIEP flap in 3 ways: as a cutaneous perforator flap (52.9%), as a chimeric perforator flap (6.9%), and as a myocutaneous perforator flap (40.2%). The overall flap survival rate was 97.1%. Three flaps (2.9%) totally necrosed. Partial flap loss occurred in 5.9% of the cases. The extended DIEP flap is reliable, has a safe vascular supply, and has a long pedicle. Its versatility makes it suitable for reconstruction of moderate to large head and neck reconstruction.Head & Neck 09/2011; 33(9):1328-34. · 2.40 Impact Factor -
Article: In search of the ideal method in perforator mapping: noncontrast magnetic resonance imaging.
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ABSTRACT: A reliable method for precise identification of the dominant perforator would be extremely valuable in perforator flap surgery. During the past 5 years, multidetector-row computed tomography has demonstrated excellent results in preoperative planning of abdominal free flap breast reconstruction, significantly reducing operative time and complications. The main drawbacks of computed tomography are unnecessary radiation to the patient and possible allergic reactions to intravenous contrast material. To circumvent these limitations, we performed noncontrast magnetic resonance imaging for abdominal perforator mapping. The aim of our study was to assess the accuracy and reliability of this technique in preoperative planning of breast reconstruction with deep inferior epigastric artery perforator flaps. From October 2007 to February 2009, noncontrast magnetic resonance preoperative mapping was performed in 56 female patients who underwent breast reconstruction after mastectomy with deep inferior epigastric artery perforator flaps. Imaging results were compared with the intraoperative clinical findings in all patients. Preoperative magnetic resonance imaging without the contrast showed no false-positive or false-negative results. In all cases, the perforator chosen as dominant according to magnetic resonance images corresponded with the perforator chosen intraoperatively (100% predictive value). Preoperative imaging techniques make perforator flap surgery safer for the patient. Noncontrast magnetic resonance imaging provides reliable information on the vascular anatomy of the abdominal wall, facilitating selection of the most appropriate deep inferior epigastric artery dominant perforator. It avoids radiation to the patient and also the need for intravenous contrast medium as required for the multidetector-row computed tomography. In our opinion, noncontrast magnetic resonance imaging is an ideal method for preoperative planning of breast reconstruction with deep inferior epigastric artery perforator flaps.Journal of Reconstructive Microsurgery 11/2009; 26(1):29-35. · 1.43 Impact Factor -
Article: Preoperative computed tomographic angiogram for deep inferior epigastric artery perforator flap breast reconstruction.
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ABSTRACT: Precision in preoperative evaluation of the abdominal wall vascular anatomy is of utmost importance in successful planning and execution of perforator flap surgery for breast reconstruction after mastectomy. We performed a study in 357 patients scheduled for deep inferior epigastric artery perforator (DIEAP) flap breast reconstruction to review our 5-year experience with the technique we developed based on our previous research confirming accuracy of a computed tomographic (CT) angiogram (multidetector row computed tomography [MDCT]) in preoperative planning of abdominal perforator flap surgery. Images obtained from the radiological study were used to create an accurate map of dominant abdominal perforators of the deep inferior epigastric artery, showing their location, size, and anatomic considerations of relevance for the preoperative flap design. Anatomic dissection of all perforators was performed in the first 36 cases to compare the data with preoperative MDCT findings. In the following 321 patients, the dominant perforator was chosen solely on the basis of MDCT and dissected directly. Exact correlation between surgical and radiological results was found in the first 36 cases. A significant reduction in average operating time and postoperative complications was noted in the following 321 patients. CT angiogram provides important preoperative information on inferior abdominal wall vascular anatomy, facilitating DIEAP flap harvest, saving operative time, and reducing complications and costs. It proved to be an invaluable tool in the preoperative algorithm for DIEAP flap breast reconstruction.Journal of Reconstructive Microsurgery 10/2009; 26(1):21-8. · 1.43 Impact Factor -
Article: MDCT in the preoperative planning of abdominal perforator surgery for postmastectomy breast reconstruction.
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ABSTRACT: This study aimed to evaluate the utility of MDCT in planning abdominal perforator surgery for breast reconstruction in patients who have undergone mastectomy. One hundred twenty-six consecutive patients scheduled for postmastectomy breast reconstruction using deep inferior epigastric perforator flaps underwent MDCT. The images were evaluated to identify, characterize, and map the dominant musculocutaneous perforator vessels of the deep inferior epigastric artery. In the first 36 patients, we compared the intraoperative findings with the preoperative MDCT findings. In the latter 90 patients, the dominant perforator vessels were directly selected on the basis of MDCT findings. We found an exact correlation between the intraoperative and radiologic findings in the first 36 cases. In the following 90 cases, the average operating time saved per patient was 1 hour 40 minutes and there was a significant reduction in postsurgical complications. The preoperative evaluation by MDCT confirmed the wide range of variability in the vascular anatomy of the abdominal wall previously described in anatomic studies. MDCT provides valuable information before surgery about the arterial anatomy of the inferior abdominal wall. It enables accurate identification of the most suitable dominant perforator vessel and makes surgical perforator flap procedures for breast reconstruction faster and safer.American Journal of Roentgenology 10/2008; 191(3):670-6. · 2.78 Impact Factor -
Article: Preoperative planning of the abdominal perforator flap with multidetector row computed tomography: 3 years of experience.
Plastic and reconstructive surgery 08/2008; 122(2):80e-1e. · 2.74 Impact Factor -
Article: [Larynx transplant: a therapeutic option for the 21st century? Literature review].
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ABSTRACT: The time and space devoted recently in the mass media to the transplantation of non-vital organs, such as the hands or the face, have raised questions in our patients regarding the possibility of transplanting the larynx, an essential organ for communication. The main barriers to larynx transplantation are tissue viability of the transplanted organ, immunological tolerance and functional restoration. This review of the literature aims to update the compendium of knowledge about this procedure and to explore the prospects of larynx transplantation as a viable therapeutic option.Acta Otorrinolaringológica Española 04/2008; 59(3):127-38. -
Article: The value of the multidetector row computed tomography for the preoperative planning of deep inferior epigastric artery perforator flap: our experience in 162 cases.
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ABSTRACT: A preoperative abdominal wall study was conducted using a multidetector scanner in 162 women who had undergone breast reconstruction with abdominal perforator flaps. A map of the abdominal perforator vessels dependent on the deep inferior epigastric artery was created. In the first 36 cases, anatomic dissection of all perforators was performed during surgery. The outcome was then compared with the radiologic findings. In the following 126 cases, the perforator vessel chosen preoperatively by the multidetector scanner was located and dissected directly. In the first 36 cases, an absolute correlation was observed between the radiologic information and intraoperative findings. In the following 126 cases, surgery time and the rate of postoperative complications decreased significantly. The multidetector scanner provides valuable preoperative information enabling identification of the most suitable perforator in view of its caliber, location, course, and anatomic relationships. Once located, we can proceed directly to its dissection during surgery, making it a faster and safer technique.Annals of Plastic Surgery 02/2008; 60(1):29-36. · 1.32 Impact Factor -
Article: Our experience in lower limb reconstruction with perforator flaps.
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ABSTRACT: The application of Taylor's concept about body angiosomes, referred to tissue transfers, has meant that the development of the perforator flaps and muscles is no longer needed as a carrier of skin flap vascularity. In this paper, we revise 59 lower limb reconstructions with local and free perforator flaps performed in the last 5 years, and a basic reconstructive algorithm is also suggested to help with the management of the lower limb soft tissue reconstruction with perforator flaps. The advantages of the perforator flaps are (1) muscles and their function are preserved; (2) the main vascular trunks are spared; (3) it is possible to make a more specific reconstruction, replacing "like with like" (even performing compound or chimeric flaps); (4) the donor site can often be closed primarily; (5) the general morbidity is reduced; (6) a better cosmetic result can be achieved.Annals of Plastic Surgery 06/2007; 58(5):507-12. · 1.32 Impact Factor -
Article: The 'propeller' distal anteromedial thigh perforator flap. Anatomic study and clinical applications.
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ABSTRACT: The leg and peripatellar region have always been known as a poor source of available flaps. One flap donor site that has proven to be adequate is the distal anteromedial half of the thigh. Due to the potential and plentiful vascular sources of this anatomic region we decided to study the distal anteromedial thigh and its clinical applications. ANATOMIC STUDY: Sixteen cryopreserved inferior limbs were latex-injected in the femoral artery and the skin perforators of the distal anteromedial thigh and their source vessels were studied. CLINICAL STUDY: In a period between December 2000 and June 2005, skin islands from the distal anteromedial aspect of the thigh of six patients were transferred, as local perforator flaps, to reconstruct the peripatellar region and upper leg soft tissue defects. Every flap was based on a single adequate perforator vessel. The tissue was rotated, as a 'propeller', through 180 degrees and the flap was named 'the propeller distal anteromedial thigh perforator flap'. In the distal anteromedial thigh the anatomic variability includes not only perforator vessels but also their source vessels. Skin perforators can come from each of the deep vessels. Our clinical results, with a follow up of 1-4 years, show no total flap losses. Partial necrosis > 20% happened in one diabetic patient. The propeller distal anteromedial thigh perforator flap can be reliably transferred based on only one adequate perforator vessel. It reduces the morbidity and improves the availability of the distal anteromedial thigh as a flap donor site and represents an additional reconstructive option for knee and upper leg defects.Journal of Plastic Reconstructive & Aesthetic Surgery 01/2007; 60(12):1323-30. · 1.49 Impact Factor
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2007–2013
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Hospital de la Santa Creu i Sant Pau
Barcelona, Catalonia, Spain
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