The Effect of Perioperative Blood Transfusions on Microvascular Anastomoses.

INTRODUCTION: Perioperative transfusions are associated with complications of free flaps. The purpose of the present study was to find out whether there is a significant relationship between the risk of developing complications in vascular anastomoses and the history of transfusions. METHODS: We studied 372 patients retrospectively with microsurgical reconstruction between 2009 and 2017 with regards to the number of red blood cell concentrates transfused. Complications were analyzed relative to flap loss and complications in microvascular anastomoses. RESULTS: 130 patients (34.9%) received blood transfusions. Some 55% of them were transfused between the day of the intervention and the first postoperative day. Ninety-six patients were reoperated on (25.7%). Of those, thirty-six patients (37.5%) corresponded to anastomosis failure. The percentage of patients transfused among those who required reoperation was 55.2%. The percentage of patients transfused among those who were reoperated on within the first 72 h due to an alteration in the anastomosis was 60.6%, while it was 25.6% (Chi square P = 0.0001) for the rest of the patients. CONCLUSIONS: Although there is a strong association between transfusion and vascular anastomosis failure, it is not possible to establish the causation between the two.

Outcomes in Vascularized Lymph Node Transplantation in Rabbits: A Reliable Model for Improving the Surgical Approach to Lymphedema.

Background: Conservative nonsurgical treatment has traditionally been applied to lymphedema. Early surgical procedures were invasive and disfiguring and their long-term success was often limited. In contrast, contemporary surgical techniques are much less invasive and have been shown to be effective in reducing excess limb volume, the risk of cellulitis, and the need for compression garments. Microsurgical procedures such as lymphovenous anastomosis and vascularized lymph node transfer can treat the excess fluid component of lymphedema and are gaining in popularity. In this study, we first evaluate the possibility of generating lymphedema in the hind limb of a rabbit and then describe its treatment with microsurgical lymph node transfer without lymph vessel transfer. Methods and Results: In experimental rabbit models, animals first underwent surgery in which the popliteal lymph node was removed to create lymphedema in the hind limb. After 15 days, another operation was performed to excise the contralateral popliteal lymph node and transfer it to the limb with lymphedema. Our model showed that lymph node transfer was able to reduce lymphedema in the rabbit's hind limb; intervened hind limb: basal volume (51.94 ± 11.23), volume day transfer (73.40 ± 26.47), and final volume (50.13 ± 12). Conclusion: We have developed a feasible model to microsurgically induce and treat lymphedema by lymph node transfer that shows promising results.

An Experimental Lymphedema Animal Model for Assessing the Results of Lymphovenous Anastomosis.

BACKGROUND: The lymphatic system is the least studied of the body's systems, and as a result its contribution to human health and diseases is not well known. The failure of the lymphatic system to drain extravasated fluid efficiently leads to accumulation of lymph in the interstitial tissue, thus causing lymphedema. Despite developments in microsurgery procedures, the results of lymphedema treatment remain disappointing. The aim of this study was to develop an experimental animal model that is able to reproduce the disease and to apply various surgical and therapeutic approaches. METHODS AND RESULTS: Lymphedema was induced in New Zealand white rabbits by a total skin denudation and destruction of the lymph channels via microsurgery in the right ear, leaving the left ear as control. Lymphedema generation was observed between days 7 and 15 after intervention. On day 15, a terminal venous lymphatic anastomosis was performed on the posterior edge of the right ear. Serial measurements of ear thickness were made during the study. Ear thickness was significantly (p < 0.05) increased after lymphedema induction compared to baseline (3.2 ± 0.4 vs. 1.3 ± 0.04 mm). After anastomosis, ear thickness was reduced (2 ± 0.26 mm). CONCLUSION: This animal model of lymphedema induction in the ear proved to be a reproducible alternative for studying new approaches to lymphedema treatment and for developing microsurgical skills.

Chimeric Superficial Circumflex Iliac Perforator Flap Including External Oblique Fascia: A Refinement of Conventional Harvesting.

The superficial circumflex iliac perforator (SCIP) flap is one of the most suitable flaps to cover distal extremity defects due to its lack of bulkiness and donor site concealment. However, it is less popular than other perforator flaps due to its anatomical variations, short pedicle length, and small caliber vessels. We describe a novel design for the SCIP flap, consisting of a chimeric flap with a piece of the external oblique muscle fascia. The purpose of this design is to cover and protect the vascular anastomosis in distal lower limb defects where recipient vessels are superficial and skin coverage is poor. In addition, lengthening the pedicle with this design makes the flap more versatile. The addition of a cuff of fascia in harvesting of the SCIP flap lengthens the pedicle, allowing easier insetting of the skin paddle and providing complete protection and coverage of the vessels. This procedure allows greater versatility in inset of the skin paddle and is particularly suitable in cases where recipient vessels are superficial or when skin coverage is poor.

[Pectoralis major flaps. Evolution of their use in the age of microvascularized flaps]. / Colgajo de pectoral mayor: evolución de su uso en la era de los colgajos microanastomosados.

INTRODUCTION: Oncological head and neck surgery has progressed with the possibility of adapting reconstruction to the surgery effected. In the last 30 years, two basic techniques have been developed: the pectoralis major myocutaneous flaps (PMMF) and microvascularized flaps. PMMF had a leading role in reconstruction surgery during the 1980s, but this has subsequently diminished in favour of microvascularized flaps. MATERIAL AND METHOD: A review was conducted on 351 reconstructive surgeries in 317 patients, of which 275 were PMMF and 76 free flaps. We analyzed age, gender, flap type, indication, and year of the surgery in all cases. RESULTS: 34 % of the revised flaps were used for reconstruction of the hypopharynx, 33 % for the oropharynx, 21 % for soft tissues, and 12 % for the repair of pharyngocutaneous fistulae. At our hospital, the introduction of the free flap technique from 2001 on has led to an increase in the use of reconstructive procedures as well as the replacement of PMMF by microvascularized flaps in a number of indications. CONCLUSIONS: In this age of microvascularized flaps, we believe that PMMF still has a privileged role in the repair of hypopharynx and cervical lesions. However, in such locations as the oral cavity or oropharynx and in facial soft- tissue reconstruction we prefer the use of microvascularized flaps.

Colgajo de pectoral mayor: evolución de su uso en la era de los colgajos microanastomosados / Pectoralis major flaps. Evolution of their use in the age of microvascularized flaps

Introducción: La cirugía oncológica de cabeza y cuello ha ido avanzando a medida que se ha podido ofrecer una reconstrucción adaptada al acto quirúrgico. En los últimos 30 años se han desarrollado 2 técnicas fundamentales: el colgajo pediculado de pectoral mayor (CMPM) y los colgajos microanastomosados. El CMPM tuvo un papel preeminente en los años ochenta, y con posterioridad su uso disminuyó de forma progresiva a favor de los colgajos microanastomosados. Material y método: Se realizó una revisión de 351 actos reconstructivos en 317 pacientes en los que se llevó a cabo 275 CMPM y 76 colgajos libres. Analizamos la edad, el sexo, el tipo de colgajo, la indicación y el año de la cirugía. Resultados: De los colgajos revisados: el 34 % fueron de reconstrucción de hipofaringe; el 33 %, de orofaringe; el 21 %, de reparación de partes blandas, y el 12 %, de reparación de fístulas faringocutáneas. La incorporación en el uso de colgajos libres a partir del año 2001 ha supuesto en nuestro centro el incremento en el uso de procedimientos reconstructivos, así como la sustitución para una serie de indicaciones del CMPM por colgajos microanastomosados. Conclusiones: En la era de los colgajos libres, creemos que el CMPM sigue manteniendo un lugar privilegiado para la reconstrucción de la hipofaringe y defectos de la región cervical. Sin embargo, actualmente, en determinadas localizaciones, como la cavidad oral y la orofaringe y en defectos de las partes blandas faciales, preferimos el uso de colgajos microanastomosados para la reconstrucción

Introduction: Oncological head and neck surgery has progressed with the possibility of adapting reconstruction to the surgery effected. In the last 30 years, two basic techniques have been developed: the pectoralis major myocutaneous flaps (PMMF) and microvascularized flaps. PMMF had a leading role in reconstruction surgery during the 1980s, but this has subsequently diminished in favour of microvascularized flaps. Material and method: A review was conducted on 351 reconstructive surgeries in 317 patients, of which 275 were PMMF and 76 free flaps. We analyzed age, gender, flap type, indication, and year of the surgery in all cases. Results: 34 % of the revised flaps were used for reconstruction of the hypopharynx, 33 % for the oropharynx, 21 % for soft tissues, and 12 % for the repair of pharyngocutaneous fistulae. At our hospital, the introduction of the free flap technique from 2001 on has led to an increase in the use of reconstructive procedures as well as the replacement of PMMF by microvascularized flaps in a number of indications. Conclusions: In this age of microvascularized flaps, we believe that PMMF still has a privileged role in the repair of hypopharynx and cervical lesions. However, in such locations as the oral cavity or oropharynx and in facial soft- tissue reconstruction we prefer the use of microvascularized flaps