Notes

Catabolism of strigolactones by the carboxylesterase.
CONCLUSION  The objective limb function of the affected hindlimb improved continuously after surgery and reached a near normal value at 6 months after surgery. It was suggested that TPLO for small breed dogs had good outcomes based on force plate gait analysis. Georg Thieme Verlag KG Stuttgart · New York.BACKGROUND  The versatile application of local perforator flaps for coverage throughout the lower extremity has already been well proven. Often a "free-style" approach has been used to design these flaps, as conventional imaging devices for perforator identification may be too expensive or unavailable. The recent adaptation of Smartphone thermal digital imaging may now prove to be a cheaper and more readily available means for identifying the requisite perforators that will sustain these local flaps. METHODS  Over the past year, a prospective study was undertaken of all patients having a local perforator flap for coverage of a lower extremity defect. Twenty-eight local perforator flaps involving all subtypes were utilized in 25 patients. Smartphone thermography was used in all patients preoperatively to identify preferable perforator or vascular network "hot spots" that allowed appropriate flap design. Intraoperative and postoperative monitoring was similarly done for all flaps to determine outcomes. RESULTS ted. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.BACKGROUND  In the pediatric population, bony defects of the extremities pose a significant challenge for which free vascularized fibular grafts (FVFGs) represent a valuable reconstructive option. The purpose of this study was to explore surgical outcomes, complications, and long-term functionality of FVFG for this patient group. METHODS  Using MEDLINE and PubMed databases, studies were identified of pediatric extremity reconstruction using FVFG which reported functional outcomes and/or complications. The operative logs at a tertiary pediatric center were then reviewed for cases of FVFG between January 2000 and 2017. Demographic characteristics, surgical indications, operative details, graft survival, bony union, complications, and functionality of the reconstruction were recorded. RESULTS  A total of 366 studies were identified with 23 ultimately meeting inclusion criteria in the systematic review. In the institutional series, 29 patients were included with mean age of 9.7 years (1-17 years). Indications for counseled regarding this expectation. Though technically challenging, excellent long-term graft viability and functional recovery can be achieved in the large majority of patients. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.BACKGROUND  This study aims to directly compare measurements of tissue oxygenation obtained using the Intra.Ox (Vioptix Inc., Fremont, CA) near infrared spectrometer with the perfusion assessment of the indocyanine green (ICG)-based SPY Elite imaging system (Stryker Co., Kalamazoo, MI) in a porcine bowel model. METHODS  Two live minipigs underwent laparotomy and isolation of a 30-cm segment of a large bowel. Standardized oximetry measurements were taken along the segment of bowel immediately before, after, and serially for 30 minutes following transection. A 0.5 mg/kg dose of ICG was then injected intravenously and the SPY Elite system was used to visualize and quantify tissue perfusion. Pearson's correlation coefficients were calculated using the outcomes. RESULTS  Transected and ligated bowel yielded mean Intra.Ox measurements of 61% oxygenation at the proximal base of the limb and 27.8% at the distal edges. Analysis of the relative ICG fluorescence using the SPY Elite's proprietary software yielded perfusion estimates of 64.8% proximally and 6.8% distally. Intra.Ox and SPY Elite measurements demonstrate a Pearson product-moment correlation of 0.929. Repeat measurements at 15-mm intervals along the tissue yielded decreasing Intra.Ox measurements along the length of the flap that correlate to SPY Elite measurements (r = 0.645). CONCLUSION  Both the Intra.Ox and the SPY detected clinically relevant changes in bowel oxygenation following transection and ligation. The use of intravenous ICG dye did not appear to affect measurements of tissue oxygenation obtained using the Intra.Ox. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.BACKGROUND  As deep inferior epigastric artery perforator (DIEP) flaps have gained popularity in breast reconstruction, the postoperative care of these patients, including the appropriate hospital length-of-stay and the need for intensive care unit (ICU) admission, has become a topic of debate. At our institution, we have adopted a pathway that aims for discharge on postoperative day 3, utilizing continuous tissue oximetry without ICU admission. This study aims to evaluate outcomes with this pathway to assess its safety and feasibility in clinical practice. METHODS  A retrospective review was performed of patients undergoing DIEP flap breast reconstruction between January 2013 and August 2014. Data of interest included patient demographics and medical history as well as complication rates and date of hospital discharge. RESULTS  In total, 153 patients were identified undergoing 239 DIEP flaps. The mean age was 50 years (standard deviation [SD] = 10.2) and body mass index (BMI) 29.4 kg/m2 (SD = 5.2). Over the study period, the flap failure rate was 1.3% and reoperation rate 3.9%. Seventy-one percent of patients were discharged on postoperative day 3. Nine patients required hospitalization beyond 5 days. Theoretical cost savings from avoiding ICU admissions were $1,053 per patient. CONCLUSION  A pathway aiming for hospital discharge on postoperative day 3 without ICU admission following DIEP flap breast reconstruction can be feasibly implemented with an acceptable reoperation and flap failure rate. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.BACKGROUND  Given the national trends in obesity, reconstructive surgeons are faced with an increasing number of overweight and obese women interested in postmastectomy breast reconstruction. While the link between obesity and adverse postoperative outcomes is well established, few studies have explored the relationship between body mass index (BMI) and the vasculature of the anterior abdominal wall. METHODS  A radiographic review was conducted on female patients who underwent computed tomographic angiography (CTA) of the anterior abdominal wall. CTA studies were evaluated for perforator caliber and quantity. Patients were stratified by BMI. The relationship between BMI and the diameter and number of deep inferior epigastric artery (DIEA) perforators was analyzed using analysis of variance using Minitab software with α of 0.05. RESULTS  There were a total of 916 hemiabdomens included in this study. There was no statistically significant correlation between BMI and DIEA diameter or mean diameter of major (≥ 1 mm) DIEA perforators. There was a statistically significant negative correlation between BMI and the number of major DIEA perforators (p  less then  0.01). CONCLUSION  Despite the increased demands of excess abdominal adiposity, DIEA perforator caliber was not correlated with BMI on CTA. The number of major DIEA perforators visualized on CTA decreased with increasing body weight may indicate a limitation of CTA for presurgical planning of abdominal free flaps in obese patients. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.BACKGROUND  Sarcopenia has been implicated as a positive predictor of postsurgical complications. click here Its role in head and neck (H&N) free flap reconstruction has yet to be examined. Our study aimed to determine the clinical impact of sarcopenia on postoperative outcomes in patients receiving autologous free tissue reconstruction for H&N cancer (HNC). METHODS  A retrospective case-control study was conducted at our tertiary referral center. Patients with HNC who received oncologic resection followed by autologous free tissue reconstruction were included. Preoperative abdominal computed tomography (CT) imaging was analyzed at the third lumbar vertebra (L3) to calculate skeletal muscle cross-sectional area (CSA, cm2). Skeletal muscle index (SMI, cm2/m2) was calculated by normalizing CSA to patient height. Sarcopenia at L3 was defined as SMI ≤ 41.6 cm2/m2 for males and ≤ 32.0 cm2/m2 for females. Data analyses were performed to compare postoperative outcomes. RESULTS  Of the 168 patients who met inclusion criteria, 4in H&N free flap reconstruction, signifying its value as a negative prognostic factor in surgical outcomes. This study reflects level of evidence IV. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.BACKGROUND  During a subcutaneous mastectomy, nerves are severed and patients lose sensation on the breast skin. The aim of this study is to investigate factors that have impact on the sensation of the mastectomy flaps and patients' own perception regarding overall breast skin sensation. PATIENTS AND METHODS  Patients who have undergone skin sparing or nipple sparing mastectomy with immediate reconstruction with either an implant or autologous tissue were included. Sensory assessment was performed at least 12 months after surgery using Semmes-Weinstein monofilaments (Aesthesio, San Jose, CA). The breast envelope was divided into four quadrants, and one measurement from each quadrant was recorded. Patients were also asked to fill out a questionnaire before the examination. RESULTS  A total of 59 breasts in 40 women were examined. In lower medial quadrant, significantly more patients reported "no sensation" in the radiated group than the nonradiated group. In upper medial quadrant and lower lateral quadrant, patients with NSM reported better sensation than patients with skin sparing mastectomy (SSM). CONCLUSION  Vascularized tissue did not improve sensory recovery. There was no relationship between sensation and the preoperative cup size and the number of revision surgeries. Irradiation was associated with higher sensory thresholds in lower medial quadrant. Nipple sparing mastectomy was associated with lower sensory thresholds in two quadrants compared to SSM. Independent of all variables none of the patients reported normal sensation. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.BACKGROUND  Transversus abdominis plane (TAP) blocks have been shown to significantly reduce pain and narcotic consumption following major abdominal surgeries. This study investigates the literature on their use in microsurgical breast reconstruction. PATIENTS AND METHODS  A systematic review of TAP blocks in autologous breast reconstruction was performed. RESULTS  Across 10 included studies, 174 patients (5 studies) received an intraoperative TAP block injection, 185 patients (4 studies) received a TAP catheter for intermittent postoperative analgesia, and 325 patients served as controls for a total of 684 included patients. The majority of TAP block delivery techniques were ultrasound guided (7/10 studies). Liposomal bupivacaine (LB) was the most commonly used analgesic (4 studies and139 patients) followed by conventional bupivacaine (3 studies and 105 patients). Eight studies found a significant reduction in oral, intravenous, and/or total morphine requirements in the TAP group when either the daily average and/or total inpatient consumption was compared with the control.
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