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Find video protocols related to scientific articles indexed in Pubmed.
Functional Abdominal Wall Reconstruction Using an Innervated Abdominal Wall Vascularized Composite Tissue Allograft: A Cadaveric Study and Review of the Literature.
J Reconstr Microsurg
PUBLISHED: 09-03-2014
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Background?Large, composite abdominal wall defects represent complex problems requiring a multidisciplinary approach for reconstruction. Abdominal wall vascularized composite allotransplantation (AW-VCA) has been successfully performed in 21 patients, already receiving solid organ transplants, to provide immediate abdominal closure. The current study aims to establish a novel anatomic model for AW-VCA that retains motor and sensory function in an effort to preserve form and function while preventing complications. Methods?Three fresh cadaver torsos were obtained. Dissection was started in the midaxillary line bilaterally through the skin and subcutaneous fascia until the external oblique was encountered. The thoracolumbar nerves were identified and measurements were obtained. A peritoneal dissection from the costal margin to pubic symphysis was performed and the vascular pedicle was identified for subsequent microsurgical anastomosis. Results?The mean size of the abdominal wall graft harvested was 615?±?120 cm(2). The mean time of abdominal wall procurement was ?150?±?12 minutes. The mean number of thoracolumbar nerves identified was 5?±?1.4 on each side. The mean length of the skeletonized thoracolumbar nerves was 7.8?±?1.7 cm. The cross-sectional diameter of all nerves as they entered the rectus abdominis was greater than 2 mm. Conclusions?Motor function and sensory recovery is expected in other forms of vascularized composite allotransplantation, such as the hand or face; however, this has never been tested in AW-VCA. This study demonstrates feasibility for the transplantation of large, composite abdominal wall constructs that potentially retains movement, strength, and sensation through neurotization of both sensory and motor nerves.
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Abdominal- versus thigh-based reconstruction of perineal defects in patients with cancer.
Dis. Colon Rectum
PUBLISHED: 05-09-2014
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An abdominoperineal resection is an invasive procedure that leaves the patient with vast pelvic dead space. Traditionally, the vertical rectus abdominus myocutaneous flap is used to reconstruct these defects. Oftentimes, this flap cannot be used because of multiple ostomy placements or previous abdominal surgery. The anterolateral thigh flap can be used; however, the efficacy of this flap has been questioned.
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Postmastectomy radiation therapy and immediate autologous breast reconstruction: Integrating perspectives from surgical oncology, radiation oncology, and plastic and reconstructive surgery.
J Surg Oncol
PUBLISHED: 04-23-2014
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The effect of postmastectomy radiation therapy (PMRT) on immediately reconstructed abdominal wall-based tissue remains imprecisely defined. We evaluated evidence from all fields involved in care of the breast cancer patient in order to advance a unified recommendation regarding this therapeutic sequence.
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Mesenteric calcification following abdominal stab wound.
Int J Surg Case Rep
PUBLISHED: 04-09-2014
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Heterotopic ossification (HO) refers to the formation of bone in non-ossifying tissue. Heterotopic mesenteric ossification is a rare form of HO that is characterized by the formation of an ossifying pseudotumour at the base of the mesentery, usually following abdominal surgery.
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A single institutional comparison of endoscopic and open abdominal component separation.
Surg Endosc
PUBLISHED: 03-17-2014
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The authors analyzed surgical factors and outcomes data in the largest single institutional study comparing endoscopic (ECS) and open component separation (OCS) in ventral hernia repairs (VHR).
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Using the dorsal, cavernosal, and external pudendal arteries for penile transplantation: technical considerations and perfusion territories.
Plast. Reconstr. Surg.
PUBLISHED: 03-14-2014
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Penile transplantation may provide improved outcomes compared with autogenous phalloplastic reconstruction. The optimal approach to vascularizing penile allografts is unknown. In penile replantation, typically only the dorsal arteries are repaired, but using the cavernosal and external pudendal arteries may improve erectile function and shaft skin perfusion, respectively. The authors sought to demonstrate the technical feasibility of using the dorsal, cavernosal, and external pudendal vessels for penile transplantation and to assess differences in their perfusion territories.
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Establishing cephalometric landmarks for the translational study of Le Fort-based facial transplantation in Swine: enhanced applications using computer-assisted surgery and custom cutting guides.
Plast. Reconstr. Surg.
PUBLISHED: 01-22-2014
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Le Fort-based, maxillofacial allotransplantation is a reconstructive alternative gaining clinical acceptance. However, the vast majority of single-jaw transplant recipients demonstrate less-than-ideal skeletal and dental relationships, with suboptimal aesthetic harmony. The purpose of this study was to investigate reproducible cephalometric landmarks in a large-animal model, where refinement of computer-assisted planning, intraoperative navigational guidance, translational bone osteotomies, and comparative surgical techniques could be performed.
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Bioprosthetic tissue matrices in complex abdominal wall reconstruction.
Plast Reconstr Surg Glob Open
PUBLISHED: 01-06-2014
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Complex abdominal defects are difficult problems encountered by surgeons in multiple specialties. Although current evidence supports the primary repair of these defects with mesh reinforcement, it is unclear which mesh is superior for any given clinical scenario. The purpose of this review was to explore the characteristics of and clinical relevance behind bioprosthetic tissue matrices in an effort to better clarify their role in abdominal wall reconstruction.
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A modified heterotopic swine hind limb transplant model for translational vascularized composite allotransplantation (VCA) research.
J Vis Exp
PUBLISHED: 10-23-2013
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Vascularized Composite Allotransplantation (VCA) such as hand and face transplants represent a viable treatment option for complex musculoskeletal trauma and devastating tissue loss. Despite favorable and highly encouraging early and intermediate functional outcomes, rejection of the highly immunogenic skin component of a VCA and potential adverse effects of chronic multi-drug immunosuppression continue to hamper widespread clinical application of VCA. Therefore, research in this novel field needs to focus on translational studies related to unique immunologic features of VCA and to develop novel immunomodulatory strategies for immunomodulation and tolerance induction following VCA without the need for long term immunosuppression. This article describes a reliable and reproducible translational large animal model of VCA that is comprised of an osteomyocutaneous flap in a MHC-defined swine heterotopic hind limb allotransplantation. Briefly, a well-vascularized skin paddle is identified in the anteromedial thigh region using near infrared laser angiography. The underlying muscles, knee joint, distal femur, and proximal tibia are harvested on a femoral vascular pedicle. This allograft can be considered both a VCA and a vascularized bone marrow transplant with its unique immune privileged features. The graft is transplanted to a subcutaneous abdominal pocket in the recipient animal with a skin component exteriorized to the dorsolateral region for immune monitoring. Three surgical teams work simultaneously in a well-coordinated manner to reduce anesthesia and ischemia times, thereby improving efficiency of this model and reducing potential confounders in experimental protocols. This model serves as the groundwork for future therapeutic strategies aimed at reducing and potentially eliminating the need for chronic multi-drug immunosuppression in VCA.
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Total heterotopic ossification of an acellular dermal matrix used for abdominal wall reconstruction.
BMJ Case Rep
PUBLISHED: 10-15-2013
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Heterotopic ossification is an observable phenomenon in the setting of abdominal wounds, estimated to effect 25% of all patients after midline abdominal surgery. The development of acellular dermal matrices has revolutionised the approach in repairing abdominal hernias, especially for potentially contaminated wounds. We describe a case of heterotopic bone formation incorporating the whole of an acellular dermal matrix in a patient on chronic steroid therapy.
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Current concepts and systematic review of vascularized composite allotransplantation of the abdominal wall.
Clin Transplant
PUBLISHED: 08-15-2013
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Abdominal wall vascularized composite allotransplantation (AW-VCA) is a rarely utilized technique for large composite abdominal wall defects. The goal of this article is to systematically review the literature and current concepts of AW-VCA, outline the challenges ahead, and provide an outlook for the future.
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CASE REPORT Spontaneous Forearm Compartment Syndrome in a Boy With Hemophilia A: A Therapeutic Dilemma.
Eplasty
PUBLISHED: 03-16-2013
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Objective: We present the case of a 14-year-old Factor VIII-deficient patient with no history of trauma, who developed acute spontaneous compartment syndrome of the volar forearm. We also suggest a treatment strategy. Methods: Fasciotomy with hematoma evacuation and ipsilateral carpal tunnel release was performed, and the wound was closed with vascular loops in "Jacobs ladder" fashion. Factor infusions were continued overnight. Results: The volar forearm compartment was successfully decompressed, and the patients coagulopathy was managed with appropriate clotting factors. Conclusions: Hemophilic patients warrant special consideration and multispecialty care; with replenished coagulation factors and timely surgical decompression, they can expect satisfactory recovery of muscular and neurological function.
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Near-infrared lymphography as a minimally invasive modality for imaging lymphatic reconstitution in a rat orthotopic hind limb transplantation model.
Transpl. Int.
PUBLISHED: 03-03-2013
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Wider application of vascularized composite allotransplantation (VCA) is limited by the need for chronic immunosuppression. Recent data suggest that the lymphatic system plays an important role in mediating rejection. This study used near-infrared (NIR) lymphography to describe lymphatic reconstitution in a rat VCA model. Syngeneic (Lewis-Lewis) and allogeneic (Brown Norway-Lewis) rat orthotopic hind limb transplants were performed without immunosuppression. Animals were imaged pre- and postoperatively using indocyanine green (ICG) lymphography. Images were collected using an NIR imaging system. Co-localization was achieved through use of an acrylic paint/hydrogen peroxide mixture. In all transplants, ICG first crossed graft suture lines on postoperative day (POD) 5. Clinical signs of rejection also appeared on POD 5 in allogeneic transplants, with most exhibiting Grade 3 rejection by POD 6. Injection of an acrylic paint/hydrogen peroxide mixture on POD 5 confirmed the existence of continuous lymphatic vessels crossing the suture line and draining into the inguinal lymph node. NIR lymphography is a minimally invasive imaging modality that can be used to study lymphatic vessels in a rat VCA model. In allogeneic transplants, lymphatic reconstitution correlated with clinical rejection. Lymphatic reconstitution may represent an early target for immunomodulation.
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Intraoperative laser angiography using the SPY system: review of the literature and recommendations for use.
Ann Surg Innov Res
PUBLISHED: 01-07-2013
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Inadequate tissue perfusion is a key contributor to early complications following reconstructive procedures. Accurate and reliable intraoperative evaluation of tissue perfusion is critical to reduce complications and improve clinical outcomes. Clinical judgment is the most commonly used method for evaluating blood supply, but when used alone, is not always completely reliable. A variety of other methodologies have been evaluated, including Doppler devices, tissue oximetry, and fluorescein, among others. However, none have achieved widespread acceptance. Recently, intraoperative laser angiography using indocyanine green was introduced to reconstructive surgery. This vascular imaging technology provides real-time assessment of tissue perfusion that correlates with clinical outcomes and can be used to guide surgical decision making. Although this technology has been used for decades in other areas, surgeons may not be aware of its utility for perfusion assessment in reconstructive surgery. A group of experts with extensive experience with intraoperative laser angiography convened to identify key issues in perfusion assessment, review available methodologies, and produce initial recommendations for the use of this technology in reconstructive procedures.
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Monocytes loaded with indocyanine green as active homing contrast agents permit optical differentiation of infectious and non-infectious inflammation.
PLoS ONE
PUBLISHED: 01-01-2013
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Distinguishing cutaneous infection from sterile inflammation is a diagnostic challenge and currently relies upon subjective interpretation of clinical parameters, microbiological data, and nonspecific imaging. Assessing characteristic variations in leukocytic infiltration may provide more specific information. In this study, we demonstrate that homing of systemically administered monocytes tagged using indocyanine green (ICG), an FDA-approved near infrared dye, may be assessed non-invasively using clinically-applicable laser angiography systems to investigate cutaneous inflammatory processes. RAW 264.7 mouse monocytes co-incubated with ICG fluoresce brightly in the near infrared range. In vitro, the loaded cells retained the ability to chemotax toward monocyte chemotactic protein-1. Following intravascular injection of loaded cells into BALB/c mice with induced sterile inflammation (Complete Freunds Adjuvant inoculation) or infection (Group A Streptococcus inoculation) of the hind limb, non-invasive whole animal imaging revealed local fluorescence at the inoculation site. There was significantly higher fluorescence of the inoculation site in the infection model than in the inflammation model as early as 2 hours after injection (p<0.05). Microscopic examination of bacterial inoculation site tissue revealed points of near infrared fluorescence, suggesting the presence of ICG-loaded cells. Development of a non-invasive technique to rapidly image inflammatory states without radiation may lead to new tools to distinguish infectious conditions from sterile inflammatory conditions at the bedside.
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Cutaneous collateral axonal sprouting re-innervates the skin component and restores sensation of denervated Swine osteomyocutaneous alloflaps.
PLoS ONE
PUBLISHED: 01-01-2013
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Reconstructive transplantation such as extremity and face transplantation is a viable treatment option for select patients with devastating tissue loss. Sensorimotor recovery is a critical determinant of overall success of such transplants. Although motor function recovery has been extensively studied, mechanisms of sensory re-innervation are not well established. Recent clinical reports of face transplants confirm progressive sensory improvement even in cases where optimal repair of sensory nerves was not achieved. Two forms of sensory nerve regeneration are known. In regenerative sprouting, axonal outgrowth occurs from the transected nerve stump while in collateral sprouting, reinnervation of denervated tissue occurs through growth of uninjured axons into the denervated tissue. The latter mechanism may be more important in settings where transected sensory nerves cannot be re-apposed. In this study, denervated osteomyocutaneous alloflaps (hind- limb transplants) from Major Histocompatibility Complex (MHC)-defined MGH miniature swine were performed to specifically evaluate collateral axonal sprouting for cutaneous sensory re-innervation. The skin component of the flap was externalized and serial skin sections extending from native skin to the grafted flap were biopsied. In order to visualize regenerating axonal structures in the dermis and epidermis, 50um frozen sections were immunostained against axonal and Schwann cell markers. In all alloflaps, collateral axonal sprouts from adjacent recipient skin extended into the denervated skin component along the dermal-epidermal junction from the periphery towards the center. On day 100 post-transplant, regenerating sprouts reached 0.5 cm into the flap centripetally. Eight months following transplant, epidermal fibers were visualized 1.5 cm from the margin (rate of regeneration 0.06 mm per day). All animals had pinprick sensation in the periphery of the transplanted skin within 3 months post-transplant. Restoration of sensory input through collateral axonal sprouting can revive interaction with the environment; restore defense mechanisms and aid in cortical re-integration of vascularized composite allografts.
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Anterolateral thigh flow-through flap in hand salvage.
Eplasty
PUBLISHED: 01-01-2013
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Objective: Hand salvage and reconstruction following trauma and oncologic resection often dictates the use of innovative reconstructive techniques. Preservation of functional anatomy is paramount to success in this clinical setting. Further constraints are placed on the reconstructive surgeon in the setting of the aging US population. We report a case of successful hand salvage in an elderly patient using a free anterolateral thigh flow-through flap. Methods: A retrospective chart review was performed on prospectively entered data to examine the case in detail. Indications, radiographs, and follow-up visits were reviewed. A free anterolateral thigh flap was harvested and used to provide soft tissue coverage as well as reconstruction of the palmar arch. Results: The free anterolateral thigh flap not only reconstructed the unique soft tissue envelope of the hand but also restored functional vascular anatomy by reconstituting the interrupted superficial palmar arch. The patient had an uneventful hospital course and was discharged without complications. Conclusions: The free anterolateral thigh flap is a versatile flap that can be used as an innovative solution for hand salvage where vascular anatomy and soft tissue need to be restored.
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Pelvic reconstruction with omental and VRAM flaps: anatomy, surgical technique, normal postoperative findings, and complications.
Radiographics
PUBLISHED: 11-16-2011
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Soft-tissue reconstruction of the pelvis with vascularized tissue flaps has become an increasingly common procedure. The types of flaps and the indications for their use vary, but all flap procedures are performed with the goal of transferring tissue from a donor site to a recipient site to restore form and function, obliterate dead space, and create an environment favorable to wound healing. Oncologic surgeries, including total pelvic exenteration and abdominoperineal resection, are the leading indications for pelvic reconstruction. The pedicle flaps most commonly used for pelvic reconstruction following these oncologic interventions are the vertical rectus abdominis myocutaneous flap (VRAM) and the omental pedicle flap. Familiarity with the surgical techniques used for pelvic reconstruction with these flaps is crucial for the accurate interpretation of cross-sectional imaging studies, allowing the radiologist to distinguish between normal postoperative findings and complications or recurrent disease.
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Reconstructive outcomes in patients undergoing contralateral prophylactic mastectomy.
Plast. Reconstr. Surg.
PUBLISHED: 10-28-2011
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As the rate of contralateral prophylactic mastectomy in breast cancer patients increases, more women are seeking immediate bilateral breast reconstruction. The authors evaluated complication rates in the index and prophylactic breasts in patients undergoing bilateral immediate reconstruction.
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An optimized dual-surgeon simultaneous orthotopic hind-limb allotransplantation model in rats.
J Reconstr Microsurg
PUBLISHED: 08-23-2011
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Composite tissue allograft (CTA) transplantation is a promising treatment in reconstructive surgery for complex tissue injuries in humans. However, continued research is required to optimize the risk to benefit ratios. In this study, we describe, in detail, an optimized simultaneous dual-surgeon orthotopic hind-limb transplantation model in direct comparison to a single-surgeon model. In this study 75 hind-limb CTAs were performed, employing either a dual-surgeon model (n?=?60) or a single-surgeon model (n?=?15) for the transplantation of two hind-limbs. Operative times, complication rates, and costs were compared. The dual-surgeon approach showed a significant reduction of 45.4% in overall operative time (p?
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Concomitant face and hand transplantation: perfect solution or perfect storm?
Ann Plast Surg
PUBLISHED: 08-13-2011
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Face and hand composite tissue allotransplantations have evolved into a promising subset of reconstructive transplant surgery due to recent advances in immunotherapy. Concomitant composite tissue allotransplantation, which involves a variable combination of facial (myocutaneous versus osteomyocutaneous) and upper extremity (ie, various levels) composite subtypes, has been performed infrequently at this time. In this review, we will describe many reasons as to why this field remains unexplored. Undoubtedly, future investigation is warranted to investigate the potential advantages and disadvantages of using this approach versus a staged manner for alloreconstruction and to identify the complexities of cortical reorganization and rehabilitation in this setting.
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Optimal timing of delayed free lower abdominal flap breast reconstruction after postmastectomy radiation therapy.
Plast. Reconstr. Surg.
PUBLISHED: 03-03-2011
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The purpose of this study was to determine the optimal timing of delayed abdominal free flap breast reconstruction following postmastectomy radiation therapy. The authors evaluated the association between timing of delayed abdominal free flap breast reconstruction following postmastectomy radiation therapy and postoperative complications.
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Reconstructive outcomes in patients with sarcoma of the breast.
Plast. Reconstr. Surg.
PUBLISHED: 08-11-2010
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Primary soft-tissue sarcomas account for less than 1 percent of all breast malignancies. Many of these are associated with prior radiation therapy. Few studies have evaluated this patient population. The purpose of this study was to examine reconstruction techniques and outcomes in a cohort of patients with breast sarcoma to elucidate the optimal type and timing of reconstruction.
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Malignant Mixed Tumor of the Lacrimal Gland in a Teenager.
J Pediatr Ophthalmol Strabismus
PUBLISHED: 03-10-2010
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A 17-year-old boy presented with a painless, right superotemporal orbital mass. Imaging demonstrated a lacrimal gland mass extending into the temporalis muscle through the lateral orbital wall. The patient underwent an orbital exenteration. Histopathology revealed malignant mixed tumor (carcinoma ex-pleomorphic adenoma) of the lacrimal gland with perineural and vascular invasion.
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Rib-sparing internal mammary vessel harvest for microvascular breast reconstruction in 100 consecutive cases.
Plast. Reconstr. Surg.
PUBLISHED: 05-02-2009
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Using the internal mammary vessels as recipient vessels in free-flap autologous breast reconstruction has become a common practice. However, these vessels are typically accessed by removing a costochondral segment. The purpose of this study was to describe the authors rib-sparing technique for accessing the internal mammary vessels that is efficient and reliable and limits chest wall morbidity.
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A model for functional recovery and cortical reintegration after hemifacial composite tissue allotransplantation.
Plast. Reconstr. Surg.
PUBLISHED: 02-03-2009
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The ability to achieve optimal functional recovery is important in both face and hand transplantation. The purpose of this study was to develop a functional rat hemifacial transplant model optimal for studying both functional outcome and cortical reintegration in composite tissue allotransplantation.
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Daily topical tacrolimus therapy prevents skin rejection in a rodent hind limb allograft model.
Plast. Reconstr. Surg.
PUBLISHED: 02-03-2009
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Skin is the most immunogenic component of a composite tissue allograft. Topical immunotherapy is an attractive therapeutic modality with which to provide local immunosuppression, with minimal systemic toxicity. The present study was performed to investigate the potential of topical tacrolimus to prolong survival of the skin component of a composite tissue allograft.
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The anterolateral thigh free flap for skull base reconstruction.
Otolaryngol Head Neck Surg
PUBLISHED: 01-14-2009
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To assess outcomes of patients undergoing reconstruction after resection of skull base tumors with the anterolateral thigh (ALT) free flap.
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Flap coverage of anterior abdominal wall defects.
Semin Plast Surg
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Reconstruction of complex defects of the anterior abdomen is both challenging and technically demanding for reconstructive surgeons. Advancements in the use of pedicle and free tissue transfer along with the use of bioprosthetic and synthetic meshes have provided for novel approaches to these complex defects. Accordingly, detailed knowledge of abdominal wall and lower extremity anatomy in combination with insight into the design, implementation, and limitations of various flaps is essential to solve these complex clinical problems. Although these defects can be attributed to a myriad of etiologic factors, the objectives in abdominal wall reconstruction are consistent and include the restoration of abdominal wall integrity, protection of intraabdominal viscera, and the prevention of herniation. In this article, the authors review pertinent anatomy and the various local, regional, and distant flaps that can be utilized in the reconstruction of these complex clinical cases of the anterior abdomen.
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Considerations in abdominal wall reconstruction.
Semin Plast Surg
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Reconstruction of complex defects of the central abdomen is both challenging and technically demanding for plastic surgeons. Advancements in the use of pedicle and free tissue transfer along with the use of bioprosthetic and synthetic meshes have provided for novel approaches to these complex defects. Accordingly, detailed knowledge of abdominal wall and lower extremity anatomy in combination with insight into the design, implementation, and limitations of various flaps is essential to solve these complex clinical problems. Although these defects can be attributed to a myriad of etiologic factors, the objectives in abdominal wall reconstruction are consistent and include the restoration of abdominal wall integrity, protection of intraabdominal viscera, and the prevention of herniation. In this article, it is our goal to review pertinent anatomy, pre- and postoperative care regimens, and the various local, regional, and distant flaps that can be utilized in the reconstruction of these complex clinical cases of the central abdomen.
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The use of acellular dermal matrices in chest wall reconstruction.
Plast. Reconstr. Surg.
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Surgeons are faced with increasingly complex and larger chest wall defects as a result of a variety of pathologies, the majority of which are oncologic. Skeletal reconstruction of these resulting defects and subsequent soft-tissue coverage remain a challenge for thoracic and plastic and reconstructive surgeons. A variety of techniques and grafts have been utilized to support the thoracic cage. This review focuses on the use of acellular dermal matrices in thoracic skeletal reconstruction, with a focus on the indications, published data, and surgical techniques for utilizing acellular dermal matrices in chest wall reconstruction.
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Fatal toxic leukoencephalopathy secondary to overdose of a new psychoactive designer drug 2C-E ("Europa").
Proc (Bayl Univ Med Cent)
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We present a case of a fatal toxic leukoencephalopathy following ingestion of a new psychoactive designer drug known as 2C-E or "Europa." Recreational drugs, particularly hallucinogenic substances, appear to be growing in popularity, with increasing amounts of information available via the Internet to entice potential users. In addition, some newer "designer" psychoactive substances are available for purchase online without adverse legal consequences, therefore adding to their popularity. We describe magnetic resonance imaging (MRI) findings to include selective diffuse toxic injury of the cerebral white matter with sparing of the cortex and most of the deep gray nuclei. To our knowledge, this is the first reported description of cerebral findings on MRI that are likely related to a lethal ingestion of 2C-E.
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Indocyanine green near-infrared laser angiography predicts timing for the division of a forehead flap.
Eplasty
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Introduction: Reconstruction with flaps requiring delayed division remains common, even with increasing use of free tissue transfer. Patient quality of life and function are significantly decreased during the delay period. Delay could be minimized by developing methods to reliably determine when the flap has developed sufficient vascular supply to undergo successful division. We report the use of laser angiography to determine the appropriate time for division of a forehead flap pedicle. Methods: The patient who had risk factors for microvascular disease underwent near-infrared laser angiography using indocyanine green on postoperative day 21 to assess vascular perfusion of the flap. Although traditional clinical examination indicated the flap was not adequately perfused, laser angiography revealed perfusion to all areas of the flap, so the pedicle was divided. Results: Pedicle division was successful, with no epidermolysis or necrosis. Conclusion: Near-infrared laser angiography with indocyanine green can assess perfusion status of the entire flap and inform the decision to divide the flap in an objective manner.
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Near-infrared laser-assisted indocyanine green imaging for optimizing the design of the anterolateral thigh flap.
Eplasty
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Objective: The anterolateral thigh flap is a versatile flap that can be used in a free or pedicled fashion. Because of the large amount of potential soft tissue, low donor site morbidity, and long pedicle lengths, many researchers consider it to be the perfect free flap. However, dissection of this and other perforator flaps can become an arduous experience with learning curves to overcome. Near-infrared laser angiography using indocyanine green provides a useful adjunctive tool to more predictably assess direct perforator perfusion zones. Laser-assisted angiography with SPY-Q analysis gives live localization of the flaps dominant perforator perfusion zones while quantifying the relative tissue perfusion for immediate skin paddle design. Methods: Fifteen patients with head and neck cancer defects were reconstructed with a free anterolateral thigh flap using laser-assisted near-infrared indocyanine green perforator mapping. The mid-point of a line between the anterior superior iliac spine and the patella was determined and the laser was centered over this. Indocyanine green (12.5 mg) was injected intravenously and fluorescence patterns were recorded. Optimal perforators were chosen using real-time imaging and SPY-Q analysis software. The anterolateral thigh skin paddle was centered over perforators based on best relative perfusion values. The hand-held Doppler was not used to identify perforators. All flaps were elevated in standard fashion. Patient demographics, defect characteristics, reconstructive techniques, and clinical outcomes were assessed. Results: All 15 free flaps were raised with the assistance of laser-assisted angiography. Cutaneous Doppler did not aid in the design of the skin paddle. There was only 1 flap loss due to venous congestion. All donor defects were closed primarily without the need for a skin graft. Conclusions: Laser-assisted indocyanine green angiography using SPY-Q analysis software provides robust, intraoperative, objective data to optimize anterolateral thigh skin paddle design while potentially minimizing patient morbidity. Future studies will be needed to further evaluate the use of this new technology.
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Amino acid concentrations in the hamster central auditory system and long-term effects of intense tone exposure.
J. Neurosci. Res.
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Exposure to intense sounds often leads to loss of hearing of environmental sounds and hearing of a monotonous tonal sound not actually present, a condition known as tinnitus. Chronic physiological effects of exposure to intense tones have been reported for animals and should be accompanied by chemical changes present at long times after the intense sound exposure. By using a microdissection mapping procedure combined with high-performance liquid chromatography (HPLC), we have measured concentrations of nine amino acids, including those used as neurotransmitters, in the cochlear nucleus, inferior colliculus, medial geniculate, and auditory cortex of hamsters 5 months after exposure to an intense tone, compared with control hamsters of the same age. No very large differences in amino acid concentrations were found between exposed and control hamsters. However, increases of glutamate and ?-aminobutyrate (GABA) in some parts of the inferior colliculus of exposed hamsters were statistically significant. The most consistent differences between exposed and control hamsters were higher aspartate and lower taurine concentrations in virtually all regions of exposed hamsters, which reached statistical significance in many cases. Although these amino acids are not considered likely neurotransmitters, they indirectly have roles in excitatory and inhibitory neurotransmission, respectively. Thus, there is evidence for small, widespread, long-term increases in excitatory transmission and decreases in inhibitory transmission after a level of acoustic trauma previously shown to produce hearing loss and tinnitus.
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Vertical rectus abdominis musculocutaneous flow-through flap to a free fibula flap for total sacrectomy reconstruction.
Microsurgery
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The purpose of this report of a small series was to describe the technique of total sacrectomy reconstruction using a pedicled vertical rectus abdominis musculocutaneous (VRAM) flow-through flap anastomosed to a free fibula flap.
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What is Visualize?

JoVE Visualize is a tool created to match the last 5 years of PubMed publications to methods in JoVE's video library.

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We use abstracts found on PubMed and match them to JoVE videos to create a list of 10 to 30 related methods videos.

Video X seems to be unrelated to Abstract Y...

In developing our video relationships, we compare around 5 million PubMed articles to our library of over 4,500 methods videos. In some cases the language used in the PubMed abstracts makes matching that content to a JoVE video difficult. In other cases, there happens not to be any content in our video library that is relevant to the topic of a given abstract. In these cases, our algorithms are trying their best to display videos with relevant content, which can sometimes result in matched videos with only a slight relation.