Approaches to the Nasopharynx and Eustachian Tube
John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed in Paediatrics, The Ear, Skull Base, 2018
A suitable mucosal flap is raised, hinged either laterally or inferiorly. The length of this flap varies according to the extent of the lesion being removed. The larger the flap, the better the chance of being able to approximate it at the end of the procedure (Figure 109.2c). If the lesion is submucosal, it is usually unnecessary to split the prevertebral fascia. But, if it is necessary to access the clivus, the prevertebral fascia and muscles have to be opened and this is best undertaken in the midline. The most helpful anatomical landmark is the anterior arch of the atlas, which is easily palpable. The narrow field afforded by this approach is insufficient for an en bloc resection of most tumours, so resection is usually performed in a piecemeal fashion.
Anorectal Abscess and Fistula
Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams in Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
As mentioned above, the use of this instrument has a detrimental effect on sphincter function and continence. In a randomised trial, Zimmerman et al. examined the impact of two different anal retractors on faecal continence in 30 patients. In 23 patients, a flap repair was performed. In the patients in whom a Parks retractor was used, anal resting pressure dropped significantly after the procedure. This was associated with an increase in the Rockwood faecal incontinence score. These findings were not observed in the patients who underwent fistula repair by using a Scott retractor.41
Skin, Fasciocutaneous, and Muscle Flap Anatomy Flaps: Classification, Form, and Function
Armstrong Milton B. in Lower extremity Trauma, 2006
A flap is a unit of tissue that is transferred or transplanted with intact circulation. This definition has arisen from many years of research involving the anatomy and circulation of the human body. The reconstructive surgeon possesses many options due to the vast number of techniques. This wide variety of flaps including microvascular composite tissue transfer has made possible the progression of plastic and reconstructive surgery. This knowledge of anatomy and physiology of skin and underlying structures allows the surgeon to safely and reliably restore form and function in most defects.
The association between surgical complications and the POSSUM score in head and neck reconstruction: a retrospective single-center study
Published in Journal of Plastic Surgery and Hand Surgery, 2018
Yohjiroh Makino, Katsuhiro Ishida, Keita Kishi, Hiroki Kodama, Takeshi Miyawaki
The breakdown of the primary disease was head and neck cancer (n = 687, includes multiple cancers), benign diseases/trauma (n = 24) and other (n = 7). All patients with head and neck cancer underwent reconstruction and tumor resection simultaneously. The detailed types of head and neck cancer were such as hypopharyngeal cancer oral cancer (n = 182), oropharyngeal cancer, maxillary sinus cancer and so on (Table 5). There were 626 patients who underwent reconstruction with one flap, and the types of flaps used include thigh, free jejunum, rectus abdominis, forearm, pectoralis major and fibula. Sixty-four patients underwent reconstruction with two flaps, and three patients underwent reconstruction with three flaps. Eighteen patients underwent reconstruction with local flaps alone (including nerve grafts) (Table 6).
Complications after pressure ulcer surgery – a study of 118 operations in spinal cord injured patients
Published in Journal of Plastic Surgery and Hand Surgery, 2020
Ebba K. Lindqvist, Pehr Sommar, Madeleine Stenius, Jakob F. Lagergren
Information on all post-operative complications, occurring within 30 days from surgery, was collected, as was information on healing status at the first post-operative visit to surgeon or specialized wound care nurse, usually 30–60 days post-operatively. Complications were graded according to Clavien–Dindo [37,38]. The criterion for local infection was administration of antibiotics for clinical symptoms of infection, such as redness, swelling or tenderness, at the surgical site. The criterion for systemic infection was administration of intravenous antibiotics, or a switch in antibiotic regime, due to fever, elevated infectious parameters, or investigations revealing distant infections such as pneumonia or urinary tract infection. Complications were regarded as flap-related if they occurred at the site of surgery, and included wound dehiscence, flap necrosis, bleeding/hematoma, and surgical site infections. These could occur concurrently in the same patient and all complications were counted.
Impact of patients’ gender on microvascular lower extremity reconstruction
Published in Journal of Plastic Surgery and Hand Surgery, 2022
Nicholas Moellhoff, P. Niclas Broer, Paul I. Heidekrueger, Milomir Ninkovic, Denis Ehrl
The data presented within this manuscript show no significant differences between the two groups of patients regarding the rate of major complications, including total flap loss and partial flap loss >10%, or surgical revision surgeries. Comparable literature on gender-related outcome of lower extremity free flap reconstruction is scarce and limited by small patient populations. While Wong et al. based their analysis on a total of 778 free flaps, only 36 of these were lower extremity reconstructions [28]. In accordance with our results, their study showed no association of flap failure with gender. Sanati-Mehrizy et al. included a subgroup of 127 extremity free flaps in their study and also reported no gender-related risk [20]. Conversely, in head and neck reconstructions, female gender is considered an independent risk factor for free tissue transfer, however, based on a limited number of only 94 flaps [19]. Gender has been evaluated as a risk factor in lower extremity reconstructions using perforator-based propeller flaps and free-style flaps [21,22], showing no significant differences between male and female patients and thus complying with our results. Recently, Yang et al. published risk factors for ALT flap failure in 128 lower-limb reconstructions and found no significant differences related to patients’ sex [29]. Accordingly, when analyzing all ALT- and gracilis muscle flaps separately, we observed no differences regarding the rate of major and minor surgical complications as well as of total and partial flap loss between male and female patients.
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