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26건 · 최신순-
Lower Extremity Free Tissue Transfer in the Setting of Severe Medial Arterial Calcification: Limb Salvage Is Possible, But at What Cost?
[BACKGROUND] Medial arterial calcification (MAC) is emerging as a tool to predict adverse limb events, but its effects on microsurgery are unknown. This study evaluates the effects of MAC on microsurgical limb salvage outcomes. [METHODS] P…
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Clostridium difficile induced coagulopathy: Implications for microsurgery in the setting of limb salvage.
[BACKGROUND] Studies have demonstrated a correlation between Clostridium difficile infection (CDI) and hypercoagulability. This study evaluates CDI in patients undergoing lower extremity (LE) free tissue transfer (FTT) and quantifies its im…
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Early Functional Outcomes After Single-Stage Achilles Tendon Reconstruction Using Free Anterolateral Thigh Flap With Tubularized Fascia Lata.
[BACKGROUND] Achilles tendon injury with extensive soft tissue loss presents challenges to lower extremity (LE) reconstruction with functionally favorable results. The use of a free anterolateral thigh (ALT) flap incorporating a tubularized…
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Lower Extremity Free Tissue Transfer in Peronea Arteria Magna: An Observational Retrospective Cohort Study of Anatomic and Microsurgical Considerations.
[BACKGROUND] Patients with only peroneal artery blood supply to the foot, known as peronea arteria magna (PAM), represent a rare cohort and a unique challenge in the setting of complex lower free (LE) tissue transfer (FTT). The present stud…
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Optimal Timing and Duration of Flap-Frame Immobilization: A Podoplastic Case Series.
[BACKGROUND] Flap-based and podoplastic limb salvage in the foot and ankle is difficult due to the presence of biomechanical forces that can impact flap healing and complication rates and, in turn, limb salvage rates. For this reason, exter…
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Intraoperative Vasopressor Use Does Not Adversely Impact Free Flap Outcomes in Lower Extremity Limb Salvage Procedures in a Highly Comorbid Atraumatic Wound Population.
The use of vasopressors during microsurgical reconstruction is debated. Their effect on the comorbid lower extremity (LE) wound population is unstudied. This study characterizes the impact of intraoperative vasopressor use in LE free tissue…
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A Combined "Vasculoplastic" Approach to the Vasculopathic Patient Undergoing Limb Salvage: Understanding the Role of Endovascular Revascularization for Lower Extremity Free Tissue Transfer.
Multidisciplinary care with vascular surgery and plastic surgery is essential for lower extremity free flap (LEFF) success in the chronic wound population with diabetes and peripheral vascular disease. There is a lack of understanding on pe…
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Preoperative Deep and Superficial Venous Thrombosis in Limb Salvage Candidates: A Contraindication to Microsurgical Free Flap Reconstruction? Lessons Learned from Our 13-year Institutional Experience.
Although arterial inflow considerations dominate microsurgical planning, venous outflow is equally vital for flap survival. Patients requiring free tissue transfer (FTT) for lower extremity (LE) reconstruction frequently present with occult…
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Clinical utility of the modified frailty index in predicting adverse outcomes in patients undergoing lower extremity free flap reconstruction.
[BACKGROUND] Identifying at-risk patients for complications remains challenging in patients with chronic lower extremity (LE) wounds receiving free tissue transfer (FTT) for limb salvage. The modified-5 frailty index (mFI-5) has been utiliz…
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The Use of Flap Techniques to Preserve Limb Length in Patients with Transmetatarsal Amputations.
[BACKGROUND] Chronic lower extremity wounds affect up to 13% of the US population. Transmetatarsal amputation (TMA) is frequently performed in patients with chronic forefoot wounds. TMA allows limb salvage and preserves functional gait, wit…
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Muscle versus Fascia Free Tissue Transfer for Treatment of Chronic Osteomyelitis in the Comorbid Population.
[BACKGROUND] In patients with chronic lower extremity (LE) wounds, chronic osteomyelitis confers additional complexity to achieving adequate treatment. Previous reviews demonstrate increased rates of osteomyelitis recurrence in patients wh…
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Feasibility of Obtaining Patient-Reported Outcome Measures in a High-Volume Multidisciplinary Surgical Limb Salvage Center.
[BACKGROUND] Completion of patient-reported outcome measures (PROMs) is labor-intensive but paramount in improving patient-centered care, allowing for advancement of techniques and scrutinization of outcomes. We report the feasibility of PR…
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Long-Term Outcomes in Patients With Peripheral Arterial Disease Who Undergo Free Flap Reconstruction for Chronic Lower Extremity Wounds.
[BACKGROUND] Free tissue transfer (FTT) is critical for limb salvage of chronic lower extremity (LE) wounds. In patients with peripheral arterial disease (PAD), FTT LE reconstruction can be challenging due to limited vessel selection for an…
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A comparative analysis of fasciocutaneous versus muscle free flaps in peripheral vascular disease patients.
[OBJECTIVE] Chronic lower extremity (LE) wounds are common in patients with peripheral vascular disease (PVD). Free tissue transfer (FTT) provides healthy soft tissue for wound coverage and additional blood supply to promote wound healing. …
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Comparison of Charlson Comorbidity Index and Modified 5-Factor Frailty Index as Clinical Risk Stratification Tools in Predicting Adverse Outcomes in Patients Undergoing Lower Extremity Free-Flap Reconstruction.
[BACKGROUND] Free tissue transfer (FTT) reconstruction is associated with a high rate of limb salvage in patients with chronic lower extremity (LE) wounds. Studies have shown perioperative risk stratification tools (e.g., 5-factor modified…
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Can Mentorship Shatter the Glass Ceiling in Academic Microsurgery? A National Survey of Microsurgery Fellowship-Trained Women.
[BACKGROUND] The "leaky pipeline" phenomenon has caused women to remain underrepresented at higher levels of academic plastic surgery. No study has considered the availability of mentorship within any subset of academic plastic surgery. The…
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Should Antiplatelet Therapy Be Withheld Perioperatively? The First Study Examining Outcomes in Patients Receiving Dual Antiplatelet Therapy in the Lower Extremity Free Flap Population.
[BACKGROUND] Antiplatelet agents are typically withheld perioperatively because of bleeding concerns. Dual antiplatelet therapy, such as aspirin and clopidogrel, has significant morbidity and mortality benefits in patients with ischemic hea…
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A single-center experience with head-to-toe microsurgical reconstruction in bloodless medicine patients.
Patients who decline blood transfusions, including members of the Jehovah's Witness faith, often face challenges when they require or desire prolonged operations such as free tissue transfer (FTT). This study aims to outline our institution…
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Free flap reconstruction of plantar weight-bearing heel defects: Long-term functional and patient-reported outcomes.
[PURPOSE] Non-healing plantar weight-bearing heel ulcers are a challenging problem to treat. Free tissue transfer (FTT) reconstruction of the heel is an opportunity for limb salvage to preserve gait and ambulation. The aim of this study is …
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Intensive care unit versus floor admission following lower extremity free flap surgery: Is there a difference in outcomes?
[BACKGROUND] Free tissue transfer (FTT) lower limb salvage requires costly multidisciplinary care. Traditionally, patients who undergo FTT reconstruction for lower extremity (LE) wounds were admitted to the intensive care unit (ICU) in the …
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Amputation versus Free Flap: Long-Term Outcomes of Microsurgical Limb Salvage and Risk Factors for Amputation in the Diabetic Population.
[BACKGROUND] Reconstructive microsurgery is an effective limb-saving option for nonhealing lower extremity wounds in diabetic patients. However, the ability to predict the future need for amputation is unclear. This article seeks to identif…
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Free Tissue Transfer for Patients with Chronic Lower Extremity Wounds.
Chronic lower extremity wounds are defined as wounds that fail to heal within 3 months of defect onset. Free tissue transfer offers an opportunity for limb salvage and length preservation. Preoperative optimization includes a medical and nu…
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Microsurgical vascular clamp injury causing arterial stenosis and subsequent free flap necrosis: A case report.
During microanastomosis, the recipient artery must be controlled both proximally and distally, so that the donor flap artery may be anastomosed. Bulldog vascular clamps are often used; however, these clamps may fail to occlude heavily calci…
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Composite Cutaneous Anterolateral Thigh Flap with Rolled Fascia Lata for Tibialis Anterior Tendon Reconstruction.
[UNLABELLED] Rupture of the tibialis anterior tendon (TAT) is a rare phenomenon with limited therapeutic options derived from sparse case reports. Without proper anchoring of the tibialis anterior, dorsiflexion and inversion of the foot bec…
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Intraoperative Utility of the Implantable Doppler in Lower Extremity Reconstruction: A Matched Case-control Study.
[UNLABELLED] Patients with diabetes mellitus and peripheral vascular disease have high rates of thrombogenic vessels. The implantable (Cook) Doppler in lower extremity reconstruction can optimize microsurgical outcomes in this population. …
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Survey on ventral hernias: surgeon indications, contraindications, and management of large ventral hernias.
Repair of ventral hernias constitutes one of the most common surgical procedures. Although an abundance of data exists on objective outcome measures, very little information exists on subjective measures of surgeon preference and patient sa…