BACKGROUND: The integration of robotic technology into surgical procedures has gained considerable attention for its promise to enhance a variety of clinical outcomes. Robotic deep inferior epigastric perforator (DIEP) flap harvest has emerged as a novel approach for autologous breast reconstruction. This systematic review aims to provide a comprehensive overview of the current techniques, outcomes, and complications of robotic DIEP flap surgery. METHODS: A systematic literature search was conducted after PRISMA 2020 guidelines across databases including PubMed, Embase, Google Scholar, and Web of Science from 2000 to 2023. Articles exploring robotic DIEP flap harvest for breast reconstruction were assessed to compare operative techniques, clinical outcomes, and complications. The risk of bias was evaluated using ROBINS-I and the Newcastle-Ottawa scale. RESULTS: Fourteen studies involving 108 patients were included. Three studies used a totally extraperitoneal (TEP) technique, whereas 11 studies used a transabdominal preperitoneal (TAPP) approach. Preoperative planning utilized computed tomography angiography and magnetic resonance angiography imaging. The mean robotic operative time was 64 minutes, with total operative times averaging 574 minutes for TAPP and 497 minutes for TEP. The mean length of stay was 5 days, and the mean fascial incision length was 3 cm. Overall complication rate was 14.9%, with no significant difference compared with conventional DIEP flap procedures. CONCLUSION: Robotic DIEP flap harvest is a promising technique that may reduce postoperative pain and limiting abdominal donor site morbidity. Potential limitations include longer operative times, variable hospital stays, and increased costs.
- MeSH
- Epigastric Arteries * transplantation MeSH
- Operative Time * MeSH
- Length of Stay MeSH
- Humans MeSH
- Mammaplasty * methods MeSH
- Tissue and Organ Harvesting methods MeSH
- Perforator Flap * blood supply MeSH
- Postoperative Complications prevention & control MeSH
- Robotic Surgical Procedures * methods MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Systematic Review MeSH
BACKGROUND: Modern trends in reconstructive surgery involve the use of free perforator flaps to reduce the donor site morbidity. The course of perforator vessels has a great anatomic variability and demands detailed knowledge of the anatomical relationships and the variability of the course of the perforators. The numerous modifications to perforator nomenclature proposed by various authors resulted in confusion rather than simplification. In our study, we focused on the hypothesis that a septocutaneous perforator traverses from the given source vessel to the deep fascia adherent to but not to within the septum itself. METHODS: Sixty-nine septocutaneous perforators from three different limb donor sites (lateral arm flap, anterolateral thigh flap, and radial forearm free flap) were collected from the gross pathology specimens of 14 fresh cadavers. The gross picture and the cross-sections with the histological cross-sections on different levels were examined to determine the position of the vessel to the septal tissue. RESULTS: Of the observed 69 septal perforators, 61 (88.5%) perforators were adherent to but not within the septum. The remaining eight (12.5%) perforators passed through the septum. All these eight perforators were found in multiple different cross-section levels (2 of 19 in lateral arm flap, 3 of 27 in anterolateral thigh flap, and 3 of 23 in radial forearm free flap). CONCLUSION: Although septocutaneous vessels appear identical macroscopically, microscopically two types of vessels with paraseptal and intraseptal pathways are observed. The majority of these vessels are merely adherent to the septum having a paraseptal pathway, while a minority are within the septum and are "true" septocutaneous perforators. It is advisable to dissect with a piece of the septum in order to avoid damage or injury to the perforator.
- MeSH
- Humans MeSH
- Cadaver MeSH
- Perforator Flap * blood supply MeSH
- Forearm blood supply surgery MeSH
- Thigh blood supply MeSH
- Free Tissue Flaps * blood supply MeSH
- Plastic Surgery Procedures * methods MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Male genital lymphedema (MGL) is a debilitating condition that may require surgical intervention. Lymphaticovenous anastomosis (LVA) can be ineffective in primary and advanced cases because of lymphatic disruption, whereas vascularized lymph node transfer (VLNT) can overcome this limitation by promoting neolymphangiogenesis but traditionally carries some risk of donor site complications. Gastroepiploic vascularized lymph node transfer (GEVLNT) has recently emerged as an effective treatment option for upper and lower limb lymphedema, with negligible complications. However, its role in genital lymphedema remains unexplored. This is the first short series reporting the use of GEVLNT in MGL. Three male patients (44, 61, and 52 years old) with GL underwent GEVLNT. The first patient had idiopathic disease, which relapsed after previous treatment with LVA; the other two had secondary lymphedema due to cancer treatment and hydrocele surgery, respectively. In all patients, the right gastroepiploic lymphosome was harvested laparoscopically, with flap sizes of 14 × 5 cm, 15 × 4 cm, and 12 × 4 cm, respectively. The recipient vessels were the deep inferior epigastric artery and vein in the first case, and the superficial external pudendal vessels in the other two. Post-operative courses were uneventful for all patients, with no complications reported. Follow-up periods were 36, 23, and 12 months, respectively. In all cases, GEVLNT resulted in significant clinical improvements and reductions in genital lymphedema severity (GLS) scores (7-1, 9-4, and 8-4). Our preliminary experience suggests that GEVLNT could be a viable and effective option for treating male genital lymphedema with minimal donor site morbidity and stable results over time. However, further research with larger patient cohorts, comparative studies, and long-term follow-up is needed to fully establish its efficacy.
- MeSH
- Gastroepiploic Artery * transplantation MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Lymph Nodes * transplantation blood supply MeSH
- Lymphedema * surgery etiology MeSH
- Genital Diseases, Male * surgery MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
Background: The surgical procedure of feminizing genitoplasty aims at restoration of normal anatomy and function in various cases of disorders of sexual development with ambiguous genitalia. Material and methods: Between April 2021 and May 2023, 23 patients underwent a single stage feminizing genitoplasty procedure at the department of plastic and reconstructive surgery. All the patients underwent clitoroplasty with partial glans preservation, omega flap vaginoplasty and labioplasty. Cases with only clitoroplasty were excluded from the study. Of these 23 patients, 17 had congenital adrenal hyperplasia and the rest 6 had varying degrees of androgen insensitivity syndrome. The age of the patients ranged from 4 to 23 years and all were raised as females. The mean operating time was around 120 to 150 minutes and average hospitalization period was 7 to 8 days. At follow-up evaluation, no major complications were observed. In all cases the vaginal introitus was located in the physiological position and was of varying size and elastic. Conclusion: This procedure of single stage feminizing genitoplasty enables reconstruction with good cosmetic and functional results not only in children but also in adults presenting with ambiguous genitalia.
- Keywords
- feminizující genitoplastika,
- MeSH
- Child MeSH
- Gynecologic Surgical Procedures * methods MeSH
- Adrenal Hyperplasia, Congenital surgery physiopathology MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Disorders of Sex Development * surgery physiopathology MeSH
- Androgen-Insensitivity Syndrome surgery physiopathology MeSH
- Plastic Surgery Procedures methods MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Female MeSH
- Publication type
- Clinical Study MeSH
Introduction: Venous thrombosis is a common cause of flap failure. Performing a second vein anastomosis provides a backup channel for draining. However, this may not be useful in circumstances of vessel kinking and compression. When a flap is compromised, there is a decrease in glucose levels and an increase in anabolic metabolites like lactate. In our study, we measured the ratio of flap/peripheral sugar levels (glucose index – GI) as a metabolic indicator and assessed flap perfusion after the second vein anastomosis. Materials and methods: This was a single-centre prospective cohort study. Based on the inclusion criteria, eligible patients reconstructed with a free flap (anterolateral thigh flap / radial forearm flap / fibula flap) were included in the study. Results: In our series, the mean flap sugar levels after the first and the second vein anastomoses were 116.60 mg/dL and 131.5 mg/dL, respectively. There was an increase in the flap sugar level after the second vein anastomosis. This increase was found statistically significant (P = 0.009), suggestive of better perfusion. In this study, the flap/peripheral glucose level (GI) ratios after the first and the second vein anastomoses were 0.90 and 0.99, respectively. The increase in this ratio after the second vein anastomosis indicated better flap perfusion after a double vein anastomosis. Conclusion: The study concluded that there is a better perfusion after a double vein anastomosis.
- MeSH
- Anastomosis, Surgical methods MeSH
- Surgical Flaps * surgery blood supply statistics & numerical data MeSH
- Adult MeSH
- Blood Glucose * analysis MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Perfusion MeSH
- Prospective Studies MeSH
- Veins surgery metabolism MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Publication type
- Clinical Study MeSH
Background: Complex nasal defects most often arise due to oncological resection or severe trauma. Traditional methods of two-stage nose reconstruction using a forehead flap with a skin graft have often resulted in collapse and deformity of the nose with a very compromised outcome over time. These techniques were gradually replaced by new procedures consistently reconstructing the intranasal lining, most often with flaps from the nasal septum. These methods reconstruct the cartilaginous and bony support of the nose as well, while the skin cover of the nose is, nowadays, in large defects, reconstructed in three stages. Evaluation of the topic: The options for intranasal lining reconstruction are as follows: a composite graft, a turnover flap covered with a local flap, advancement of the residual lining (bipedicle vestibular mucosa flap), a folded forehead flap, a prelaminated forehead flap, the use of another local flap (a forehead, nasolabial, facial artery myomucosal flap), a hinged turnover flap, a septal mucoperichondrial hinged flap, a composite septal chondromucosal pivot flap, a turbinate flap and microvascular free flaps (a radial forearm flap, a helix free flap, a kite flap, a dorsalis pedis free flap, a temporoparietal free flap, a postauricular free flap). Thanks to the abundant vascular supply of the face, the risk of ischemia and infection is mitigated, allowing most complex nasal defects to be reconstructed by using local flaps to restore all layers of the nose. Local tissues retain ideal quality, coloration, and texture, are reliable, and usually result in esthetically acceptable morbidity of the donor area. If the inner lining defect is extensive, it must be reconstructed by free microvascular tissue transfer. If other than intranasal flaps are used in the reconstruction of the internal lining, it is preferable to postpone the reconstruction of the supporting framework until the second stage while thinning the flaps used; otherwise, there is a high risk of obturation of the nasal airways. Conclusion: The results of modern reconstruction dramatically improved after the introduction of three-stage nasal reconstruction and emphasizing the reconstruction of all layers of the nose. Therefore, a quality inner lining is the basis for the construction of the new nose.
BACKGROUND: Hormonal therapy (HT) is pivotal in managing hormone receptor-positive breast cancer. However, in autologous microvascular breast reconstructions (AMBRs), HT raises concerns, particularly regarding venous thromboembolic (VTE) risk and its potential impact on flap viability. This systematic review and meta-analysis aimed to evaluate the impact of HT on complications of AMBR. METHODS: We performed a systematic review and meta-analysis of all comparative studies reporting postoperative complications of AMBR in patients receiving HT in comparison with a control group. All types of free flaps were included. Complications were categorized and compared. Odds ratios and 95% confidence intervals were calculated using a random-effects model. RESULTS: Eight studies, encompassing 4776 flaps performed on 3796 patients undergoing AMBR with or without HT, were included. Patients undergoing HT were treated with either selective estrogen receptor modulators (SERMs) or aromatase inhibitors. Five studies compared both treatments to a control group, whereas 3 studies focused on tamoxifen. Only studies with retrospective design could be included. There was no statistically significant difference between the 2 groups in terms of overall flap complication rates, partial and total flap loss, flap fat necrosis, flap pedicle arterial and/or venous thrombosis, or systemic VTE. Subgroup analysis revealed a significantly higher risk of systemic VTE in the SERMs group compared with controls, while other complications were not significant. CONCLUSIONS: Our results show that HT does not increase the risk of flap complications in the context of AMBR, whereas SERMs increase the risk of systemic VTE. Further research with prospective studies is warranted to confirm these findings.
- Publication type
- Journal Article MeSH
Volné laloky jsou považovány za zlatý standard v rekonstrukčních operacích anatomicky i funkčně složitých defektů v oblasti hlavy a krku. Jedná se o časově, technicky i logisticky náročné operace vyžadující multioborovou spolupráci. Materiál a metodika: Do retrospektivní klinické studie byli zahrnuti pacienti, kteří podstoupili rekonstrukci onkochirurgického defektu v oblasti hlavy a krku volným lalokem na Klinice otorinolaryngologie a chirurgie hlavy a krku FN u sv. Anny v Brně v letech 2000–2022. Výsledky: Do studie bylo zařazeno celkem 158 pacientů, u nichž bylo provedeno 162 rekonstrukčních operací volným lalokem. Typ laloku: fasciokutánní předloketní lalok 62 (38,3 %); fasciokutánní laterální pažní lalok 16 (9,9 %); muskulokutánní lalok z širokého zádového svalu 79 (48,8 %), jiný: 5 (3,1 %). Komplikace: Revize pro poruchu prokrvení laloku: 30 (18,5 %); parciální nekróza laloku: 5 (3,12 %); totální nekróza laloku: 2 (1,2 %). Úspěšnost přihojení laloku 98,8 %. Závěr: Úspěšnost přihojení volných laloků je srovnatelná s předními zahraničními centry zabývajícími se komplexní onkochirurgickou péčí o nádory hlavy a krku. Předpokladem úspěšného programu je kvalitní mezioborová spolupráce, vhodná selekce pacientů, vysoká erudice chirurgického týmu a standardizované postupy pooperační péče.
Free flaps are considered as the gold standard in reconstructive surgery for anatomically and functionally complex defects in the head and neck region. These surgeries are time-consuming and technically demanding, requiring interdisciplinary cooperation. Materials and methods: The retrospective clinical study included patients who underwent free flap reconstruction of oncological defects in the head and neck region at the Department of Otorhinolaryngology and Head and Neck Surgery, St. Anne’s University Hospital in Brno, between 2000 and 2022. Results: A total of 158 patients underwent 162 free flap reconstructive surgeries. Flap types: radial forearm fasciocutaneous flap 62 (38.3%); lateral arm fasciocutaneous flap 16 (9.9%); latissimus dorsi musculocutaneous flap 79 (48.8%); and other 5 (3.1%). Complications: Revision for vascular compromise: 30 (18.5%); partial flap necrosis: 5 (3.12%); total flap necrosis: 2 (1.2%); and flap survival rate 98.8%. Conclusion: The flap survival rate is comparable to leading international centers for head and surgery. Key factors for a successful program include high-quality interdisciplinary cooperation, appropriate patient selection, high level of surgical skills, and standardized postoperative care protocols.
- MeSH
- Surgical Flaps surgery classification transplantation MeSH
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Head and Neck Neoplasms * surgery diagnosis MeSH
- Otorhinolaryngologic Surgical Procedures methods MeSH
- Retrospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Free Tissue Flaps * surgery classification transplantation MeSH
- Treatment Outcome MeSH
- Plastic Surgery Procedures methods MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
Volné laloky jsou dnes zlatým standardem pro rekonstrukci onkologických defektů hlavy a krku. Lokální laloky mají díky své barvě a struktuře nezastupitelnou úlohu při rekonstrukci menších defektů, defektů nosu, očních víček a uší. Regionální stopkované laloky se obvykle používají při rekonstrukci hlavy a krku jako laloky druhé volby. Rutinně používané lokální laloky jsou V-Y posuvný lalok, transpoziční lalok, rotační lalok a jeho forma Bilobed flap. Z regionálních laloků se nejčastěji používají submentální lalok, supraklavikulární lalok, infrahyoidní myokutánní lalok, FAMM flap, stopkovaný pektorální lalok, stopkovaný lalok svalu latissimus dorsi, trapézový myokutánní lalok a paramediánní lalok čela. Lokální a regionální laloky by měly být zvažovány za primární metodu rekonstrukce hlavy a krku u pacientů s přidruženými komorbiditami, s deplecí cév na krku nebo je lze použít v kombinaci s volnými laloky či jako záchrannou rekonstrukci po selhání volného laloku. Stejně tak je lze užít jako záchrannou rekonstrukci v důsledku recidivy onkologického onemocnění. Stále však patří k základnímu vybavení chirurga hlavy a krku.
Free flaps are now the gold standard for reconstruction of oncological defects of the head and neck. Local flaps have an irreplaceable role due to their colour and texture in the reconstruction of smaller defects, and defects of the nose, eyelids, and ears. Regional pedicled flaps are usually used in head and neck reconstruction as second choice flaps. Routinely used local flaps are V-Y advancement flap, transposition flap, rotation flap, and its form bilobed flap. Of the regional flaps, the most commonly used are the submental flap, supraclavicular flap, infrahyoid myocutaneous flap, facial artery musculomucosal flap (FAMM), pedicled pectoralis major flap, pedicled latissimus dorsi flap, trapezius myocutaneous flap, and paramedian forehead flap. Local and regional flaps should be considered as a primary method of head and neck reconstruction in patients with associated comorbidities and neck vascular depletion or they can be used in combination with free flaps or as salvage reconstruction following free flap failure. Similarly, they can be used as a salvage reconstruction due to recurrence of oncological dis ease. However, they still belong to the basic armentarium of the head and neck surgeon,
- MeSH
- Surgical Flaps * surgery classification transplantation MeSH
- Head surgery MeSH
- Neck surgery MeSH
- Humans MeSH
- Otorhinolaryngologic Surgical Procedures * methods MeSH
- Free Tissue Flaps surgery classification transplantation MeSH
- Plastic Surgery Procedures methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
- Review MeSH
The feasibility of a pedicled flexor digitorum superficialis muscle flap was studied in 10 fresh cadavers. The number, length and distance from the flexion wrist crease of muscular branches from the ulnar artery in the distal 10 cm of the forearm were recorded. The mean number of muscular branches was 2.7 (range 1-4). The mean distance of the most distal branch was 35 mm (range 26-40) from the proximal wrist flexion crease. Its mean length was 20 mm (range 16-26). A partial muscle flap was raised on the most distal branch and transposed over the median nerve in the distal forearm. Dissection and transposition of this flap were feasible in all specimens. The reliable pattern of muscular branches to the flexor digitorum superficialis allows the elevation of a pedicled partial muscle flap that can cover the median nerve in the distal forearm.Level of evidence: V.
- MeSH
- Ulnar Artery * surgery MeSH
- Surgical Flaps * blood supply MeSH
- Muscle, Skeletal * blood supply MeSH
- Humans MeSH
- Cadaver * MeSH
- Median Nerve surgery MeSH
- Forearm * surgery blood supply MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
