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Seminars in Plastic Surgery Aug 2020Since propeller flaps are elevated as island flaps and most often nourished by a single perforator nearby the defect, it is challenging to change the flap design... (Review)
Review
Since propeller flaps are elevated as island flaps and most often nourished by a single perforator nearby the defect, it is challenging to change the flap design intraoperatively when a reliable perforator cannot be found where expected to exist. Thus, accurate preoperative mapping of perforators is essential in the safe planning of propeller flaps. Various methods have been reported so far: (1) handheld acoustic Doppler sonography (ADS), (2) color duplex sonography (CDS), (3) perforator computed tomographic angiography (P-CTA), and (4) magnetic resonance angiography (MRA). To facilitate the preoperative perforator assessment, P-CTA is currently considered as the gold standard imaging tool in revealing the three-dimensional anatomical details of perforators precisely. Nevertheless, ADS remains the most widely used tool due to its low cost, faster learning, and ease of use despite an undesirable number of false-positive results. CDS can provide hemodynamic characteristics of the perforator and is a valid and safer alternative particularly in patients in whom ionizing radiation and/or contrast exposure should be limited. Although MRA is less accurate in detecting smaller perforators of caliber less than 1.0 mm and the intramuscular course of perforators at the present time, MRA is expected to improve in the future due to the recent developments in technology, making it as accurate as P-CTA. Moreover, it provides the advantage of being radiation-free with fewer contrast reactions.
PubMed: 33041683
DOI: 10.1055/s-0040-1715159 -
Seminars in Plastic Surgery Aug 2020Various types of propeller flaps from multiple donor sites can be used to reconstruct anterior trunk skin defects. The actual selection depends on the condition and... (Review)
Review
Various types of propeller flaps from multiple donor sites can be used to reconstruct anterior trunk skin defects. The actual selection depends on the condition and location of the recipient site, especially if it is to be the chest or abdomen that requires attention. Before surgery commences, it is always important to use an imaging analyses such as computed tomography angiography to examine and identify perforators that could perfuse a perforator-pedicled propeller flap (PPPF), as it is the most multifaceted imaging technique. Clusters of perforators that can be commonly used for the "workhorse" PPPFs for the thoracic and abdominal regions are the internal mammary artery perforator, the musculophrenic artery perforator, and the deep inferior epigastric perforator. These perforators are reliable and large enough to support long and large propeller flaps that will cover most defects in this region, while still allowing primary donor-site closure.
PubMed: 33041687
DOI: 10.1055/s-0040-1714270 -
Seminars in Plastic Surgery Aug 2020The reconstruction of complex posterior trunk defects remains challenging. But now with an increased knowledge of angiosomes and the practice of perforator flaps, the... (Review)
Review
The reconstruction of complex posterior trunk defects remains challenging. But now with an increased knowledge of angiosomes and the practice of perforator flaps, the posterior trunk offers a new plethora of options for reconstruction. Propeller flaps based on such perforator(s) offer an elegant solution for managing defects while achieving primary donor-site closure without significant morbidity. We will discuss the relevant anatomy and design principles for propeller flaps based on a review of the literature and our experience. Steps beginning with preoperative planning, perforator selection, and intraoperative surgical technique will be discussed, together with pearls on both avoiding and managing complications.
PubMed: 33041688
DOI: 10.1055/s-0040-1714086 -
Journal of the West African College of... 2022The risk of exposure to infections during surgery is partly mitigated by gloving. However, perforation can reduce the effectiveness of gloving as a barrier to exposure....
INTRODUCTION
The risk of exposure to infections during surgery is partly mitigated by gloving. However, perforation can reduce the effectiveness of gloving as a barrier to exposure. This study aimed at investigating the frequency of surgical glove perforation and factors predictive of these in our oral and maxillofacial surgical practice.
MATERIALS AND METHODS
The study was carried out at the National Hospital and the University of Abuja Teaching Hospital, Abuja, Nigeria. Consenting patients requiring oral surgical interventions were consecutively recruited into the study. Similarly, surgeons and their assistants who consented to the study were also enlisted in the study. At the end of every surgical procedure, gloves used by the surgeons and the assistants were tested for perforation. Variables investigated included the rate of perforations, the influence of the type of gloving, single versus double gloving, type of anaesthesia, and duration of surgery on rates.
RESULTS
At a minimum of three operators per procedure, a total of 154 participants were involved in the study and 895 gloves were used. The number of glove perforations was 117(13.1%) with 82 (70.1%) involving the surgeons. There were 58/117 (49.6%) cases of perforation involving the dominant hand. Forefinger glove perforation accounted for 62 (52.9%) cases. Wire-related perforations were 72 (61.5%). Overall, nine cases of percutaneous injury were recorded. Duration of operation and double gloving were the predictive factors for perforations.
CONCLUSION
Risk of sharps injury was relatively high due to the high incidence of glove perforation.
PubMed: 36590780
DOI: 10.4103/jwas.jwas_98_22 -
World Journal of Gastroenterology Jul 2023Using rat stomach perforation as a prototypic direct lesion applied in cytoprotection research, we focused on the first demonstration of the severe occlusion/...
BACKGROUND
Using rat stomach perforation as a prototypic direct lesion applied in cytoprotection research, we focused on the first demonstration of the severe occlusion/ occlusion-like syndrome induced by stomach perforation. The revealed stomach-induced occlusion/occlusion-like syndrome corresponds to the previously described occlusion/occlusion-like syndromes in rats suffering multicausal pathology and shared severe vascular and multiorgan failure. This general point was particularly reviewed. As in all the described occlusion/occlusion-like syndromes with permanent occlusion of major vessels, peripheral and central, and other similar noxious procedures that severely affect endothelium function, the stable gastric pentadecapeptide BPC 157 was resolving therapy.
AIM
To reveal the stomach perforation-induced general occlusion/occlusion-like syndrome and BPC 157 therapy effect.
METHODS
The procedure included deeply anesthetized rats, complete calvariectomy, laparotomy at 15 min thereafter, and stomach perforation to rapidly induce vascular and multiorgan failure occlusion/occlusion-like syndrome. At 5 min post-perforation time, rats received therapy [BPC 157 (10 µg or 10 ng/kg) or saline (5 mL/kg, 1 mL/rat) (controls)] into the perforated defect in the stomach). Sacrifice was at 15 min or 60 min post-perforation time. Assessment (gross and microscopy; volume) included: Brain swelling, peripheral vessels (azygos vein, superior mesenteric vein, portal vein, inferior caval vein) and heart, other organs lesions ( stomach, defect closing or widening); superior sagittal sinus, and peripherally the portal vein, inferior caval vein, and abdominal aorta blood pressures and clots; electrocardiograms; and bleeding time from the perforation(s).
RESULTS
BPC 157 beneficial effects accord with those noted before in the healing of the perforated defect (raised vessel presentation; less bleeding, defect contraction) and occlusion/occlusion-like syndromes counteraction. BPC 157 therapy (into the perforated defect), induced immediate shrinking and contraction of the whole stomach (unlike considerable enlargement by saline application). Accordingly, BPC 157 therapy induced direct blood delivery the azygos vein, and attenuated/eliminated the intracranial (superior sagittal sinus), portal and caval hypertension, and aortal hypotension. Thrombosis, peripherally (inferior caval vein, portal vein, abdominal aorta) and centrally (superior sagittal sinus) BPC 157 therapy markedly reduced/annihilated. Severe lesions in the brain (swelling, hemorrhage), heart (congestion and arrhythmias), lung (hemorrhage and congestion), and marked congestion in the liver, kidney, and gastrointestinal tract were markedly reduced.
CONCLUSION
We revealed stomach perforation as a severe occlusion/occlusion-like syndrome, peripherally and centrally, and rapid counteraction by BPC 157 therapy. Thereby, further BPC 157 therapy may be warranted.
Topics: Rats; Animals; Rats, Wistar; Syndrome; Stomach Diseases; Peptide Fragments; Hemorrhage; Anti-Ulcer Agents
PubMed: 37545637
DOI: 10.3748/wjg.v29.i27.4289 -
RoFo : Fortschritte Auf Dem Gebiete Der... Jul 2019Intracranial atherosclerotic stenosis (ICAS) causes 5 - 10 % of all ischemic strokes in the European population. Indication for endovascular treatment is a... (Review)
Review
BACKGROUND
Intracranial atherosclerotic stenosis (ICAS) causes 5 - 10 % of all ischemic strokes in the European population. Indication for endovascular treatment is a special challenge and the selection of material as well as interventional techniques essentially differs from the treatment of extracranial stenoses. According to recent studies patient selection became evidence based; however the method should not be abandoned. New technical approaches can contribute to avoid complications.
METHOD
We performed a review of the literature with regard to conservative as well as endovascular treatment of ICAS. Different technical approaches are discussed and strategies to avoid complications are stressed. Based on the treatment indication, the positions of the authorities and the professional societies are taken into account.
RESULTS AND CONCLUSION
A single self-expanding stent is approved for the treatment of ICAS. Balloon mounted and other self-expanding Stents are available for off-label use. Anatomical conditions and features of the stenosis determine the choice of material. Distal wire perforations causing intracranial bleedings may occur during exchange manoeuvres and constitute one of the technical complications in the treatment of ICAS. In contrast, there is hardly any efficient way to eliminate the risk of ischemia in the territory of perforating arteries arising from the intracranial posterior circulation and the middle cerebral artery. The results of the randomized prospective trials strengthen the conservative treatment of ICAS. Endovascular treatment should not be withheld from patients with either hemodynamic stenosis, recurrent ischemic events under best medical treatment in the territory of the stenosed vessel or acute occlusions of a stenosis.
KEY POINTS
· Medical therapy and risk reduction constitute the primary treatment of intracranial stenosis.. · Recurrence under best medical treatment and acute occlusions of intracranial stenosis are indications for endovascular treatment.. · Acute occlusions due to intracranial stenosis often are treated by stenting and angioplasty after mechanical thrombectomy.. · Exchange manoeuvres with distal wire perforation can cause intracranial hemorrhage.. · Basal ganglia and brain stem ischemia constitute a specific risk in treatment of vessel segments bearing perforators..
CITATION FORMAT
· Nordmeyer H, Chapot R, Haage P. Endovascular Treatment of Intracranial Atherosclerotic Stenosis. Fortschr Röntgenstr 2019; 191: 643 - 652.
Topics: Angioplasty, Balloon; Brain Ischemia; Endovascular Procedures; Intracranial Arteriosclerosis; Off-Label Use; Prospective Studies; Randomized Controlled Trials as Topic; Risk Assessment; Stents
PubMed: 30947351
DOI: 10.1055/a-0855-4298 -
JAAD Case Reports Feb 2021
PubMed: 33457481
DOI: 10.1016/j.jdcr.2020.12.003 -
Seminars in Plastic Surgery Aug 2020Reconstruction of the lower extremity is considered a major challenge due to frequent bone exposure and the absence of local tissue redundancy, as well as often due to... (Review)
Review
Reconstruction of the lower extremity is considered a major challenge due to frequent bone exposure and the absence of local tissue redundancy, as well as often due to the presence of vascular insufficiency. Many surgeons have preferred free flaps especially for reconstructing the more distal lower limb defects until the evolution of pedicled perforator flaps and propeller flaps in particular provided a like-with-like reconstruction of the lower extremity without affecting the main vessels of the limb or the underlying muscles, and without the risk of any microanastomosis especially in patients with multiple comorbidities. Perforator-pedicled propeller flaps as local flaps in the lower extremity are best suited for small- and medium-sized defects with minimal donor-site morbidity, regardless of the cause of the defect. Any of the three source vessels of the leg can provide reliable perforators for propeller flap coverage of the distal leg and foot. The three main risk factors that are relative contraindications may be advanced age, diabetes mellitus, and atherosclerotic peripheral vascular disease.
PubMed: 33041691
DOI: 10.1055/s-0040-1715154 -
Seminars in Plastic Surgery Aug 2020Propeller flaps are local flaps based either on a subcutaneous pedicle, a single perforator, or vessels entering the flap in such a way so as to allow the flap to rotate... (Review)
Review
Propeller flaps are local flaps based either on a subcutaneous pedicle, a single perforator, or vessels entering the flap in such a way so as to allow the flap to rotate on their axis. Depending on the kind of pedicle and the anatomical area, the preoperative investigation and the harvesting techniques may vary. An adequate knowledge of skin and subcutaneous tissue perfusion in the different areas of the body is very important to plan a propeller flap to be successful. The surgeon should begin by finding the most suitable perforators in the area surrounding the defect using available technology. The position, size, and shape of the flap are planned about this point. For perforator-pedicled propeller flaps, the procedure starts with an exploration from the margins of the defect or through a dedicated incision to visualize any perforators in the surroundings. The most suitable perforator is selected and isolated, the skin island is replanned, and the flap is harvested and rotated into the defect. The variations in surgical technique for other types of propellers and in specific anatomical areas are also described. Compared with free flaps, propeller flaps have the advantage of a simpler, shorter operation, without the need for a recipient vessel for microanastomosis. Yet, from a technical point of view, an adequate experience in dissecting perforators and the use of magnifying glasses are almost always required.
PubMed: 33041684
DOI: 10.1055/s-0040-1714271