The use of nuclear bone scanning after fibula free tissue transfer.

OBJECTIVES/HYPOTHESIS: To understand the role of nuclear bone scanning in the evaluation of threatened osteocutaneous free tissue transfers, identify patients who may benefit from nuclear bone scanning after head and neck reconstructive surgery, and be able to use nuclear bone scanning to help guide management of the threatened free flap. STUDY DESIGN: Retrospective case series design set in a tertiary referral center. METHODS: Records of patients undergoing bone scan in the context of threatened osteocutaneous free tissue transfer between July 1998 and December 2008 were reviewed. RESULTS: Over a 10-year period, 205 fibula free tissue transfers were performed, with an overall 94% success rate. Fifteen fibular free flaps in 14 patients were determined to be threatened in the late postoperative period, and nuclear bone scanning was performed. Seven of 15 flaps had regions of certain flap nonviability, with five flaps clearly appearing viable on bone scanning. No graft read as potentially viable eventually failed. All grafts read as nonviable underwent exploration and debridement, with confirmation of nonviability in all cases. In eight cases, bone scanning allowed preoperative planning for soft tissue flap reconstruction. CONCLUSIONS: In those instances in which the skin paddle dies in the late postoperative period and determination of bone viability is required, a bone scan can demonstrate whether or not the bone is alive. This information can help determine the future operative and reconstructive options available for the patient.

Interposition vein grafts in microvascular head and neck reconstruction.

OBJECTIVES/HYPOTHESIS: To understand when interposition vein grafting may be needed in head and neck reconstruction and become familiar with the factors associated with use of interposition grafts and their effect on free flap survival. STUDY DESIGN: Descriptive case-series design in a tertiary referral center. METHODS: Charts were reviewed in patients undergoing interposition vein grafts for microvascular reconstruction of head and neck defects between August 1998 and February 2009. RESULTS: In a 10-year period, interposition vein grafts were used in 20 free tissue transfers, representing 1.7% of all microvascular reconstruction cases (n = 1,143). Seventy percent of vein grafts were used in cases of secondary reconstruction or prior radiotherapy. Free flap survival in the interposition vein graft group was 95%, compared with 96% overall flap survival. CONCLUSIONS: Interposition vein grafts are used most often in cases involving a threatened flap, prior free flap, flap failure or radiation, and tumor recurrence. The use of interposition vein grafting in microvascular reconstruction is not associated with decreased flap survival.

Extending multidisciplinary management of cleft palate to the developing world.

The needs of patients with a cleft lip and/or palate (CL/P) extend beyond surgical repair. A multidisciplinary approach to the care of patients with CL/P is the widely accepted standard in most regions of the developed world. Patients with CL/P in developing countries have needs similar to those of patients in industrialized nations. However, the existing shortages of healthcare resources have precluded provision of the most basic care to those with a CL/P. Innovative applications of technology can facilitate the delivery of speech therapy, evaluation of audiometric data, and limited dental evaluation for these patients with a modest financial investment. One method by which this care might be provided is with the use of Internet-based modalities. This represents a near universally available method to fill a conspicuous gap in the preoperative evaluation and postoperative care of patients with CL/P in the developing world. With rapidly expanding access to the Internet, particularly with wireless-3G connectivity worldwide, it is time to expand our delivery of humanitarian care beyond surgery alone in treating patients with CL/P in medically underserved areas.

Model of functional cardiac aging: young adult mice with mild overexpression of serum response factor.

Serum response factor (SRF) is an important transcription factor that may have a role in the maintenance of cardiac structure and function. The level of SRF mRNA expression increases approximately 16% in the hearts of mice during adult aging. To model the effect of mild SRF elevation in the aging heart, transgenic mice with low levels of SRF overexpression were generated. By 6 mo of age, the transgenic mice had a 19% increase of heart-to-body weight ratio compared with nontransgenic mice. In addition, they had a 12% increase in myocyte size, a 6.7% increase in collagen deposition, and altered gene expression of a number of muscle-specific and cardiac genes. Doppler echocardiography revealed that these transgenic mice had increased left ventricular wall thickness and decreased left ventricular (LV) volumes, increased LV stiffness with 20% reduction in early diastolic LV filling (peak E), and 35% decline in peak E-to-peak A (late diastolic filling) ratio. The observed changes, especially those in the E/A ratio, are similar to those seen clinically in late life as a part of human adult myocardial aging.