Publications (11)15.7 Total impact
- [Show abstract] [Hide abstract] ABSTRACT: Macrovascular bypass procedures and microvascular free tissue transfer have resulted in dramatic improvements in lower limb salvage. Although vascular steal is a well-documented phenomenon in the surgical literature, there is a paucity of information on its potential impact in microvascular surgery, particularly in relation to lower extremity reconstruction in the elderly patient with peripheral vascular disease. We report three cases of lower extremity reconstruction using microvascular free tissue transfer in which the free flap survived but the distal extremity suffered progressive ischemic necrosis. A retrospective analysis of these cases defines the conditions in which microvascular steal phenomenon may adversely influence lower limb salvage.
- [Show abstract] [Hide abstract] ABSTRACT: Vascular graft infections demand serious attention due to the potential for mortality or limb loss. Management modalities range from conservative wound debridement and drainage to graft resection and extra-anatomical revascularization. A retrospective chart review was conducted to evaluate wound complications in patients who underwent inguinal vascular bypass in an attempt to define the incidence of wound complications and guidelines for their management. Vascular operations involving femoral anastomoses were performed on 1,637 patients; 58 wound infections occurred in 57 patients (3.5%) over an 8-year period at our institution. There were 16 graft infections in 15 of these 57 patients (0.92%). Ten patients were treated with local muscle flaps, 1 with a fasciocutaneous thigh flap, and 5 with graft excision and either extra-anatomical bypass or amputation. Local flap coverage appears to be as effective as graft excision for the treatment of inguinal vascular graft infections. An algorithm for optimal management of these infections is presented.
- [Show abstract] [Hide abstract] ABSTRACT: Although denervated muscle and myocutaneous free flaps atrophy over a period of time, when used for surface coverage they may remain bulky, resulting in a less than optimal aesthetic result. With the availability of a number of donor sites, soft tissue defects can often be reconstructed with like tissue in a single stage. Even though the goal of all plastic surgeons is to achieve a good cosmetic result, special circumstances might dictate that need take precedence over form. We have had six cases where a bulky muscle was used to achieve well vascularised coverage. After wound closure had been successfully accomplished, a secondary debulking procedure was performed safely for a final acceptable aesthetic result.
- [Show abstract] [Hide abstract] ABSTRACT: A free radical forearm flap was salvaged from a nonreplantable amputated extremity and banked on the ipsilateral chest wall. Later, the flap was simply rotated to provide coverage of the proximal humeral stump, eliminating the need for a second microvascular procedure.
- [Show abstract] [Hide abstract] ABSTRACT: Using vein grafts to bypass sclerotic and occluded arterial segments is a well-established technique in vascular surgery. For infrapopliteal bypass, autogenous veins have better patency rates than synthetic grafts. Although not resolved, in situ bypasses seem to be better than reversed bypasses, especially for "far away" segments. Although the etiology is not understood, it is a well-known clinical finding that sclerosis affects arteries more than the veins and, as a whole, is more advanced in lower extremities compared with the trunk and upper extremities. Our experience with eight patients in whom critical soft-tissue defects were covered with free-tissue transfers in severely compromised lower extremities utilizing the in situ saphenous vein bypass as the inflow is presented. Simultaneous bypass and free-tissue transfers were performed in seven and delayed free-tissue transfer was done in one. Follow-up ranged from 6 months to 3 years. To date, two patients underwent amputations. Five patients are able to maintain bipedal ambulation. One patient is wheelchair-bound with intact lower extremities. In well-selected patients, this procedure may offer an alternative treatment to amputation. However, because of the complexity of these combined procedures, we strongly urge careful patient selection.
- [Show abstract] [Hide abstract] ABSTRACT: A series of 12 patients with deep burns resulting in exposed bones, joints, and tendons, in whom temporoparietal free flaps were used for reconstruction, are presented. Flap loss was 8.3%; good and satisfactory results were achieved in 91.7% of healed defects. Patients with large total body surface area burns are severely compromised, and the use of free flaps requiring prolonged periods of anesthesia and surgery should be a judicious decision. Prior to the availability of free flaps, most of these patients are left with chronic wounds and compromised functional results. Although our experience is limited, we think that in well-selected cases a one-stage reconstruction with free tissue transfer is expeditious, safe, and economical.
- [Show abstract] [Hide abstract] ABSTRACT: Vein-patch angioplasty is a well-established technique in vascular surgery to reduce the critical narrowing of the arteriotomy site. In microsurgical end-to-side anastomosis, although the arteriotomy is not closed, it is not known if anastomosis through a sclerotic segment contributes to narrowing at the anastomotic site. It is certainly technically difficult to perform a microanastomosis with fine sutures through a sclerotic segment. Two cases are illustrated in which vein-patch angioplasties were successfully used for microsurgical anastomoses.
- [Show abstract] [Hide abstract] ABSTRACT: Diffuse neurofibroma (paraneurofibroma) is an unusual variant of neurofibroma in which the tumor cells diffusely infiltrate beyond the usual well-circumscribed boundary. Histological features of the tumor include both typical and plexiform neurofibroma. Although benign, diffuse vascularity with the possibility of life-threatening hemorrhage dictates treatment. The combination of preoperative angiography, wide surgical excision, and resurfacing the defect with well-vascularized tissue offers one-stage reconstruction and possible cure.
- [Show abstract] [Hide abstract] ABSTRACT: Temporoparietal fascia free flap is an excellent source for resurfacing soft tissue defects of the hand and fingers. Because of the reliable anatomical bifurcation of the superficial temporal vessels, this flap can be very useful in simultaneous reconstruction of more than one digit without having to create a temporary syndactyly.
- [Show abstract] [Hide abstract] ABSTRACT: Polyurethane-coated breast implants are used more frequently in recent years both in augmentation and reconstruction. Postoperative infection may lead to serious complications with formation of foreign body granulomas. A case is presented with such a complication that required multiple operations and wide excision of reconstructed breasts necessitating major myocutaneous flaps to salvage the breasts.
Allentown CollegeAllentown, Pennsylvania, United States