scholarly journals The perforator-centralizing technique for super-thin anterolateral thigh perforator flaps: Minimizing the partial necrosis rate

2021 ◽  
Vol 48 (1) ◽  
pp. 121-126
Author(s):  
Young Chul Suh ◽  
Na Rim Kim ◽  
Dai Won Jun ◽  
Jung Ho Lee ◽  
Young Jin Kim
Keyword(s):  
Technical Difficulty ◽  
Necrotic Area ◽  
Perforator Flaps ◽  
Venous Anastomosis ◽  
Partial Necrosis ◽  
Anterolateral Thigh ◽  
Significant Difference ◽  
Extremity Reconstruction ◽  
Flap Thickness ◽  
The Mean

Background Despite the wide demand for thin flaps for various types of extremity reconstruction, the thin elevation technique for anterolateral thigh (ALT) flaps is not very popular because of its technical difficulty and safety concerns. This study proposes a novel perforatorcentralizing technique for super-thin ALT flaps and analyzes its effects in comparison with a skewed-perforator group.Methods From June 2018 to January 2020, 41 patients who required coverage of various types of defects with a single perforator-based super-thin ALT free flap were enrolled. The incidence of partial necrosis and proportion of the necrotic area were analyzed on postoperative day 20 according to the location of superficial penetrating perforators along the flap. The centralized-perforator group was defined as having a perforator anchored to the middle third of the x- and y-axes of the flap, while the skewed-perforator group was defined as having a perforator anchored outside of the middle third of the x- and y-axes of the flap.Results No statistically significant difference in flap thickness and dimension was found between the two groups. The arterial and venous anastomosis patterns of patients in both groups were not significantly different. Only the mean partial necrotic area showed a statistically significant difference between the two groups (centralized-perforator group, 3.4%±2.2%; skewed-perforator group, 15.8%±8.6%; P=0.022).Conclusions The present study demonstrated that super-thin ALT perforator flaps can be elevated safely, with minimal partial necrosis, using the perforator-centralizing technique.

Super-Thin and Suprafascial Anterolateral Thigh Perforator Flaps for Extremity Reconstruction

2017 ◽  
Vol 33 (07) ◽  
pp. 466-473 ◽  
Author(s):  
Akhil Seth ◽  
Matthew Iorio
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Reconstruction ◽  
Flap Reconstruction ◽  
Venous Anastomosis ◽  
Distal Extremity ◽  
Anterolateral Thigh ◽  
Effective Option ◽  
Tissue Reconstruction ◽  
Extremity Reconstruction ◽  
Alt Flap

Background The anterolateral thigh (ALT) flap remains a workhorse for soft tissue reconstruction. However, the traditional ALT flap is often too bulky for resurfacing shallow, distal extremity defects, prohibiting adequate function, or well-fitted orthotics. This study evaluates extremity reconstruction using ALT flaps elevated in the suprafascial or super-thin plane. Methods Retrospective review of ALT free flap reconstruction from October 2014 to July 2016 was performed. Suprafascial and super-thin flaps were those elevated just above the crural fascia and within the superficial scarpal plane, respectively. Adjunct operative procedures, demographics, and complications were recorded. Results A total of 25 patients underwent suprafascial (n = 14) or super-thin (n = 11) ALT flap reconstruction for primarily lower extremity wounds (n = 19), with an average age and body mass index of 53.8 years and 26.3 kg/m2, respectively. Follow-up was 6.3 months. Comorbidities included smoking (n = 7), diabetes (n = 8), peripheral vascular disease (n = 6), and hypertension (n = 8). The presence of hardware (n = 9), trauma (n = 10), and chronic infection (n = 12) were common risk factors. Average flap size was 8.2 × 21.5 cm, with 64% (n = 16) taken on one perforator. Forty-eight percent (n = 12) were end-to-side anastomoses and 62% (n = 13) utilized one venous anastomosis. Mean hospital stay was 7.8 days with a 24% (n = 6) complication rate. There were no partial or complete flap losses. Conclusion The ALT flap, elevated in a suprafascial or super-thin plane, is a safe, effective option for extremity soft tissue reconstruction. The decreased flap volume and bulk provides the improved contour and pliability necessary for appropriate distal extremity function. The potential versatility of super-thin flaps reinforces the importance of continued innovation by reconstructive microsurgeons.

scholarly journals Lower Extremity Reconstruction with Vascularized Free-Tissue Transfer: 20 Years of Experience in the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

2021 ◽  
Vol 73 (7) ◽  
pp. 462-470
Author(s):  
Nutthawut Akaranuchat
Keyword(s):  
Survival Rate ◽  
Lower Extremity ◽  
Free Flap ◽  
Free Tissue Transfer ◽  
Flap Surgery ◽  
Free Flap Surgery ◽  
Anterolateral Thigh ◽  
Lower Extremity Reconstruction ◽  
Extremity Reconstruction ◽  
The Mean

Objective: The reconstruction of extensive soft-tissue defects in the lower extremity still poses a great challenge to plastic and reconstructive surgeons. The ideal approach is to achieve a proper soft-tissue coverage with a well-vascularized flap, which results in a durable weight-bearing surface and permits normal joint motion. This study aims to retrospectively analyze the outcomes of lower-extremity reconstruction with vascularized free-tissue transfer performed at our plastic surgery division. Materials and Methods: A retrospective chart review was performed regarding 58 patients with defects in the lower extremity which were reconstructed with vascularized free-tissue transfers between 2000 and 2019. Forty-four of the patients were male, and 14 were female. The mean age was 44.4 years (range: 6-89 years). The most common indication for free-flap surgery was a secondary reconstruction after tumor eradication (23 cases, 39.7%), and 84.8% of the defects were exposed bare bones, tendons, or joints.Results: In our 58 reviewed cases, the foot was the most common area requiring reconstruction with a free flap (68.9%), and the mean defect size was 12.5 x 8.1 cm. The most commonly used free flap was the Anterolateral thigh free flap (39.7%), followed by the Gracilis free flap (29.3%), and the Superficial circumflex iliac artery-perforator free flap (10.4%). The recipient vessels most frequently used were posterior tibialis vessels (53.4%). The overall flap-survival rate was 75.9%, though there was an increased survival rate of up to 85.7% in the last five years of the period studied. The flap-salvage rate was 40.9%, and arterial thrombosis was the major cause of flap loss (50%). Factors associated with free-flap failure were re-exploration and free flap surgery after tumor or cancer eradication. The most common post-operative complication was flap-wound dehiscence (10.3%). Two patients received a flap correction due to bulkiness, and three had recurrence of ulceration. Conclusion: Microvascular free-tissue transfers for lower- extremity-defect reconstructions are reliable and valuable as a surgical technique. In over 20 years of experience in our division, we’ve had an overall flap-survival rate of 75.9%. Our flap of choice was the Anterolateral thigh free flap.

scholarly journals Anterolateral thigh free flaps with T-shaped pedicles and multiple venous anastomosis for extremity reconstruction

Medicine ◽  
2021 ◽  
Vol 100 (27) ◽  
pp. e26575
Author(s):  
Jun Ho Lee ◽  
Hwan Jun Choi ◽  
Si Hyun Kwak ◽  
Da Woon Lee ◽  
Min Sung Tak ◽  
...  
Keyword(s):  
Free Flaps ◽  
Venous Anastomosis ◽  
Anterolateral Thigh ◽  
Extremity Reconstruction

scholarly journals Prophylactic Mastectomy: Postoperative Skin Flap Thickness Evaluated by MRT, Ultrasound and Clinical Examination

2020 ◽  
Vol 27 (7) ◽  
pp. 2221-2228
Author(s):  
Rebecca Wiberg ◽  
Magnus N. Andersson ◽  
Johan Svensson ◽  
Anna Rosén ◽  
Freja Koch ◽  
...  
Keyword(s):  
Clinical Examination ◽  
Prophylactic Mastectomy ◽  
Skin Flap ◽  
Magnetic Resonance Tomography ◽  
Plastic Surgeon ◽  
General Surgeon ◽  
Skin Flaps ◽  
Significant Difference ◽  
Flap Thickness ◽  
The Mean

Abstract Background Women with an increased hereditary risk of breast cancer can undergo prophylactic mastectomy (PM), which provides a significant, but not total, risk reduction. There is an ongoing discussion about how much skin and subcutaneous tissue should be resected to perform an adequate PM while leaving viable skin flaps. Methods Forty-five women who had undergone PM were examined with magnetic resonance tomography (MRT), ultrasound (US) and clinical examination (CE) by a plastic surgeon and a general surgeon to estimate skin flap thickness. Results The estimated mean skin flap thickness after PM was 13.3 (± 9.6), 7.0 (± 3.3), 6.9 (± 2.8) and 7.4 (± 2.8) mm following MRT, US, and CE performed by a plastic surgeon and a general surgeon, respectively. The mean difference in estimated skin flap thickness was significant between MRT and the other measuring methods, while there was no significant difference between US and CE, nor between CE performed by the surgeons. The mean skin flap thickness was significantly affected by the age at PM. Following PM, necrosis was detected in 7/23 (30.4%) of the breasts in skin flaps ≤ 5 mm and in 5/46 (10.9%) of the breasts in skin flaps > 5 mm (OR 6.29; CI 1.20–32.94; p = 0.03). Conclusion The odds of getting postoperative necrosis was > 6 times higher in skin flaps ≤ 5 mm. Thus, if the degree of remaining glandular tissue is acceptably low, it is desirable to create skin flaps thicker than 5 mm to prevent wound healing problems after the PM procedure.

Vowel Recognition Threshold as a Function of Temporal Segmentations

1970 ◽  
Vol 13 (4) ◽  
pp. 715-724 ◽  
Author(s):  
Richard L. Powell ◽  
Oscar Tosi
Keyword(s):  
Normal Hearing ◽  
Recognition Threshold ◽  
Vowel Sound ◽  
Significant Difference ◽  
The Mean ◽  
Vowel Recognition ◽  
Temporal Segment

Vowels were segmented into 15 different temporal segments taken from the middle of the vowel and ranging from 4 to 60 msecs, then presented to 6 subjects with normal hearing. The mean temporal-segment recognition threshold of 15 msecs with a range from 9.3 msecs for the /u/ to 27.2 milliseconds for the /a/. Misidenti-fication of vowels was most often confused with the vowel sound adjacent to it on the vowel-hump diagram. There was no significant difference between the cardinal and noncardinal vowels.

Left Ventricular Dysfunction and Blood Glycohemoglobin Levels in Young Diabetics

1991 ◽  
Vol 30 (05) ◽  
pp. 183-188
Author(s):  
A. Aydrner ◽  
A. Oto ◽  
E. Oram ◽  
O. Gedik ◽  
C. F. Bekdik ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Left Ventricular ◽  
Diabetic Patients ◽  
Filling Fraction ◽  
Time To Peak ◽  
Significant Difference ◽  
The Mean ◽  
Hba1c Levels

Left ventricular function including regional wall motion (RWM) was evaluated by 99mTc first-pass and equilibrium gated blood pool ventriculography and glycohemoglobin (HbA1c) blood levels determined by a quantitative column technique in 25 young patients with insulin-dependent diabetes mellitus without clinical evidence of heart disease, and in healthy controls matched for age and sex. Phase analysis revealed abnormal RWM in 19 of 21 diabetic patients. The mean left ventricular global ejection fraction, the mean regional ejection fraction and the mean 1/3 filling fraction were lower and the time to peak ejection, the time to peak filling and the time to peak ejection /cardiac cycle were longer in diabetics than in controls. We found high HbA1c levels in all diabetics. There was no significant difference between patients with and without retinopathy and with and without peripheral neuropathy in terms of left ventricular function and HbA1c levels.

Detection of Circulating Tissue Factor and Factor VII in a Normal Population

1996 ◽  
Vol 75 (05) ◽  
pp. 772-777 ◽  
Author(s):  
Sybille Albrecht ◽  
Matthias Kotzsch ◽  
Gabriele Siegert ◽  
Thomas Luther ◽  
Heinz Großmann ◽  
...  
Keyword(s):  
Tissue Factor ◽  
Normal Population ◽  
Mean Value ◽  
Factor Vii ◽  
Significant Difference ◽  
Age Dependent ◽  
The Mean ◽  
Highly Correlated ◽  
And Gender

SummaryThe plasma tissue factor (TF) concentration was correlated to factor VII concentration (FVIIag) and factor VII activity (FVIIc) in 498 healthy volunteers ranging in age from 17 to 64 years. Immunoassays using monoclonal antibodies (mAbs) were developed for the determination of TF and FVIIag in plasma. The mAbs and the test systems were characterized. The mean value of the TF concentration was 172 ± 135 pg/ml. TF showed no age- and gender-related differences. For the total population, FVIIc, determined by a clotting test, was 110 ± 15% and the factor VIlag was 0.77 ± 0.19 μg/ml. FVII activity was significantly increased with age, whereas the concentration demonstrated no correlation to age in this population. FVII concentration is highly correlated with the activity as measured by clotting assay using rabbit thromboplastin. The ratio between FVIIc and FVIIag was not age-dependent, but demonstrated a significant difference between men and women. Between TF and FVII we could not detect a correlation.

Multi-Center Study of Thromboplastin Calibration Precision – Influence of Reagent Species, Composition, and International Sensitivity Index (ISI)

1993 ◽  
Vol 69 (01) ◽  
pp. 035-040 ◽  
Author(s):  
A M H P van den Besselaar ◽  
R M Bertina
Keyword(s):  
Oral Anticoagulants ◽  
International Normalized Ratio ◽  
The Other ◽  
World Health ◽  
Rabbit Brain ◽  
Sensitivity Index ◽  
Bovine Plasma ◽  
Significant Difference ◽  
The Mean ◽  
International Sensitivity Index

SummaryFour thromboplastin reagents were tested by 18 laboratories in Europe, North-America, and Australasia, according to a detailed protocol. One thromboplastin was the International Reference Preparation for ox brain thromboplastin combined with adsorbed bovine plasma (coded OBT/79), and the second was a certified reference material for rabbit brain thromboplastin, plain (coded CRM 149R). The other two thromboplastin reagents were another rabbit plain brain thromboplastin (RP) with a lower ISI than CRM 149R and a rabbit brain thromboplastin combined with adsorbed bovine plasma (RC). Calibration of the latter two reagents was performed according to methods recommended by the World Health Organization (W. H. O.).The purpose of this study was to answer the following questions: 1) Is the calibration of the RC reagent more precise against the bovine/combined (OBT/79) than against the rabbit/plain reagent (CRM 149R)? 2) Is the precision of calibration influenced by the magnitude of the International Sensitivity Index (ISI)?The lowest inter-laboratory variation of ISI was observed in the calibration of the rabbit/plain reagent (RP) against the other rabbit/plain reagent (CRM 149R) (CV 1.6%). The highest interlaboratory variation was obtained in the calibration of rabbit/plain (RP) against bovine/combined (OBT/79) (CV 5.1%). In the calibration of the rabbit/combined (RC) reagent, there was no difference in precision between OBT/79 (CV 4.3%) and CRM 149R (CV 4.2%). Furthermore, there was no significant difference in the precision of the ISI of RC obtained with CRM 149R (ISI = 1.343) and the rabbit/plain (RP) reagent with ISI = 1.14. In conclusion, the calibration of RC could be performed with similar precision with either OBT/79 or CRM 149R, or RP.The mean ISI values calculated with OBT/79 and CRM 149R were practically identical, indicating that there is no bias in the ISI of these reference preparations and that these reference preparations have been stable since their original calibration studies in 1979 and 1987, respectively.International Normalized Ratio (INR) equivalents were calculated for a lyophilized control plasma derived from patients treated with oral anticoagulants. There were small but significant differences in the mean INR equivalents between the bovine and rabbit thromboplastins. There were no differences in the interlaboratory variation of the INR equivalents, when the four thromboplastins were compared.

Incubation Temperature Influences the Duration of Egg Hatching and Early Development in the Boreal Digging Frog, Kaloula Borealis

2020 ◽  
Vol 3 (1) ◽  
pp. ACCEPTED
Author(s):  
Rho-Jeong Rae
Keyword(s):  
Water Temperature ◽  
Early Life ◽  
Rainy Season ◽  
Incubation Temperature ◽  
Life Stages ◽  
Early Life Stages ◽  
Egg Hatching ◽  
Significant Difference ◽  
The Mean ◽  
Hatching Rates

This study investigated the boreal digging frog, Kaloula borealis, to determine the egg hatching period and whether the hatching period is affected by incubation temperature. The results of this study showed that all the eggs hatched within 48 h after spawning, with 28.1% (±10.8, n=52) hatching within 24 h and 99.9% (±0.23, n=49) within 48 h after spawning. A significant difference was noted in the mean hatching proportion of tadpoles at different water temperatures. The mean hatching rates between 15 and 24 h after spawning was higher at a water temperature of 21.1 (±0.2) °C than at 24.1 (±0.2) °C. These results suggest that incubation temperature affected the early life stages of the boreal digging frog, since they spawn in ponds or puddles that form during the rainy season.

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