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Breast Surgery
Published in Tjun Tang, Elizabeth O'Riordan, Stewart Walsh, Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Gaural Patel, Lucy Kate Satherley, Animesh JK Patel, Georgina SA Phillips
However, patients need to be aware that flap surgery is more complicated, more time consuming (hence, longer anaesthetic times), with longer stay in hospital and time to recovery, and associated with higher risk, especially in the context of free flap reconstruction.
Reconstruction in head and neck surgical oncology
Published in Neeraj Sethi, R. James A. England, Neil de Zoysa, Head, Neck and Thyroid Surgery, 2020
Kishan Ubayasiri, Andrew Foreman
The first 48 hours after free flap surgery are the most crucial. It is common practice for free flap patients to be nursed in the intensive care unit (ICU) or surgical high-dependency unit (SHDU), because of the enhanced facility for patient monitoring, higher nursing ratios and an increased burden of postoperative checks that nursing staff are required to undertake. Some advocate keeping the patient intubated in the intensive care unit (ICU) for a period of at least 12 hours to allow for the careful monitoring and maintenance of haemodynamic stability and regular flap checks, but this is by no means universal [14].
Limb trauma
Published in Ian Greaves, Military Medicine in Iraq and Afghanistan, 2018
The established principles of extremity reconstruction remain and are to establish a clean and non-contaminated wound through adequate debridement of both hard and soft tissues, to stabilise and rigidly fix associated fractures and to achieve early soft tissue closure so as to deliver a useful and functional limb. The body of evidence within the civilian literature suggests that early soft tissue coverage of open fractures reduces infective complications and flap loss and shortens the time to bony union. However, the time to definitive flap coverage remains controversial. During the 1980s Byrd, Cierny and Godina published studies looking at acute phase (within days), sub-acute phase (one to six weeks) and chronic phase (after six weeks) of flap coverage of complex lower limb fractures. The most frequent complications were identified in the subacute groups in all three papers. However, the papers were considered to have bias. Initially, patients were transferred to specialised centres late, and the authors suggested that there was a definite learning curve in undertaking the flap surgery. No account was made for patient comorbidities. Other papers have replicated the findings but have failed to focus on the timing of soft tissue cover.
Utilization of Perifascial Loose Areolar Tissue Grafting as an Autologous Dermal Substitute in Extremity Burns
Published in Journal of Investigative Surgery, 2023
Burak Özkan, Burak Ergün Tatar, Abbas Albayati, Cagri Ahmet Uysal
Deep extremity burns represent a major clinical challenge for reconstructive surgeons. The skin is thin, and tendons are more superficial in the distal extremities. Thus, deep extremity burns can lead to tendon or bone exposure [1]. Flap surgery is the most frequently used method to cover these structures. However, it is challenging to perform using local or free flaps when the patient has a high comorbidity burden, poor vascular condition, and diminished skin quality over surrounding tissues due to burn trauma. Skin grafting after settled granulation and dermal substitutes are other alternatives to flap surgery. However, these methods are associated with prolonged healing time and high costs [2]. Therefore, new options for covering exposed bones and tendons in extremity burns are needed.
Treatment approaches of stage III and IV pressure injury in people with spinal cord injury: A scoping review
Published in The Journal of Spinal Cord Medicine, 2023
Carina Fähndrich, Armin Gemperli, Michael Baumberger, Marco Bechtiger, Bianca Roth, Dirk J. Schaefer, Reto Wettstein, Anke Scheel-Sailer
After surgery, immobilization is required.11 Regarding the mattress, there is a weak recommendation of the EPUAP with a strength of evidence B1 to assess the relative benefits of using an air fluidized bed to facilitate healing while reducing skin temperature and excessive hydration in individuals with stage III or IV PIs.2 In contrast, the use of alternating pressure air mattresses varies.2 Moreover, the authors using the Basel Decubitus Concept describe different durations of immobilization after flap surgery. In the 90s, individuals were immobilized for six weeks. Since 2015, an immobilization period of six or four weeks has been used, depending on the person's condition, second reconstruction or diagnosed osteomyelitis.5,11,15,37 Neither the EPUAP nor the DMGP guideline contains recommendation on the duration of immobilization after flap surgery. This also applies to the duration of antibiotic treatment in people with and without osteomyelitis.2,4 New evidence suggests that the duration of antibiotic treatment should be adjusted to the severity of osteomyelitis to reduce the development of antibiotic resistance and avoid early postsurgical complication.38 Furthermore, in the Basel Decubitus Concept bone biopsies are meanwhile taken during the debridement to determine the antibiotic therapy for the specific bacteria.38
The Effect of Adipose Derived Stromal Vascular Fraction on Flap Viability in Experimental Diabetes Mellitus and Chronic Renal Disease
Published in Journal of Investigative Surgery, 2022
Burak Özkan, Atilla Adnan Eyüboğlu, Aysen Terzi, Eda Özturan Özer, Burak Ergün Tatar, Cagri A. Uysal
Diabetes mellitus (DM) is still considered one of the leading causes of foot ulcers in the world. Almost one quarter of diabetic patients develop foot ulcers during their life time [1]. The concurrence of diabetes mellitus and chronic renal diseases (CRD) increases the risk of development of diabetic foot compared to diabetic patients with normal renal function. The risk of lower limb amputation in patients with renal failure is 10 times greater than that of diabetic patients without uremia [2]. Reconstruction of chronic wounds in patients with diabetic nephropathy has been a challenge for surgeons due to impaired wound healing capacity and the complexity of the wound itself. Treatment modalities include skin graft, local skin flaps, local or distant muscle or skin flaps. Skin flap surgery is indicated to cover exposed bones or tendons, or to cover deep tissue defects on weight bearing areas under the foot where skin grafts might be thin to withstand the applied pressure by the weight. Success rates in flap surgery are low compared to normal population [3]. Several studies have discussed different strategies to enhance skin flap circulation in diabetic individuals, such as atorvastatin, all-trans retinoic acid and adipose derived stem cells (ADSCs) [4–6].