Background: The use of perforator flaps has allowed for the transfer large amounts soft tissue with decreased morbidity. For breast reconstruction, deep inferior epigastric flap, superior and gluteal artery flaps, transverse upper gracilis flap are all options. authors present an alternative source using posterior thigh based on profunda perforators, termed flap. Methods: Preoperative imaging helps identify perforators from femoris artery. These marked, elliptical skin paddle, approximately...

Background: The tear trough and the lid/cheek junction become more visible with age. These landmarks are adjacent, forming in some patients a continuous indentation or groove below infraorbital rim. Numerous, often conflicting procedures have been described to improve appearance of region. purpose this study was evaluate anatomy underlying designed correct them. Methods: Twelve fresh cadaver lower lid midface dissections were performed (six heads). orbital regions dissected layers, medical...

Background: This study aims to elucidate the important predicting factors for fat necrosis and abdominal morbidity in patient undergoing deep inferior epigastric artery perforator flap reconstruction. Methods: The authors conducted a retrospective review of 866 free-flap breast reconstructions performed at one institution from 2010 2016. Twenty-eight potential predictors were included multivariable analyses control possible confounding interactions. Results: Four hundred nine total flaps...

Abstract Introduction : The profunda artery perforator (PAP) flap is a new addition to our reconstructive armamentarium. In effort better understand patient candidacy for the PAP we characterized perforators on preoperative imaging. Methods: A retrospective review was completed of 40 posterior thigh computed tomography angiographies and magnetic resonance by four plastic surgeons. positioning patient, type study, number perforators, size were documented. location documented an x – y ‐axis....

Background: Free and local flaps based on the profunda artery perforators were first used for reconstruction of pressure sores, burn contractures, extremity wounds. Recently, a revised perforator flap was introduced breast reconstruction. However, despite increasing reports use flap, it remains rarely option. The authors present their early experience with 101 at institution. Methods: conducted retrospective review Patient demographics, perioperative data, postoperative complications...

Abstract Introduction Current research within other surgical specialties suggests that a co‐surgeon approach may reduce operative times and complications associated with complex bilateral procedures, possibly leading to improved patient outcomes. We sought evaluate the role of co‐surgery team its development in free flap breast reconstruction. Methods A retrospective review free‐flap reconstruction by two surgeons from 2011 2016 was conducted. analyzed 128 patients who underwent...

Background: This study aims to characterize the effect of laser-assisted indocyanine green fluorescence angiography on fat necrosis and flap failure in deep inferior epigastric artery perforator (DIEP) breast reconstruction. Methods: A retrospective review was performed 1000 free flaps for reconstruction at a single center from 2010 2017. Indocyanine used after completion recipient-site anastomoses subjectively assess areas hypoperfusion. multivariable logistical analysis conducted with 24...

Background: In deep inferior epigastric perforator (DIEP) flap breast reconstruction, many surgeons use preoperative imaging for mapping as a method to plan the operation, reduce operative times, and potentially limit morbidity. This study compared times specific portions of DIEP harvest with without computed tomographic angiography imaging. Methods: Two patient groups undergoing reconstruction were studied prospectively. experimental group, harvesting surgeon was blinded scan; in control...

The DIEP flap is considered the gold standard in autologous breast reconstruction. Despite benefit of a lifelong natural reconstruction, some argue that potential drawbacks, specifically operative time and recovery, are significant. We recently focused on process analysis our practice present comprehensive efficient reconstructions.Fifty consecutive bilateral flaps were prospectively tracked (100 flaps). procedure was divided into segments (recipient site preparation, dissection/harvest,...

Background: As free breast reconstruction options evolve, a patient- and body-centric approach can distinguish refined aesthetic outcomes. Although deep inferior epigastric perforator (DIEP), profunda artery (PAP), lumbar (LAP) flaps are all safe effective for reconstruction, head-to-head analysis of these 3 has not been performed. The authors aim to compare based on outcomes, BREAST-Q scores, results. Methods: After institutional review board approval, retrospective in Research Electronic...

The senior author routinely performs primary nasal reconstruction with every cleft lip repair. This addresses the tip asymmetry and simplifies definitive secondary rhinoplasty in adolescence.A retrospective chart review was completed of all unilateral rhinoplasties performed by author. indications for were examined, anatomical features nose at time operation documented, reconstructive techniques used recorded.From 2001 to 2009, 116 patients a previously repaired lip. 44 initial repairs...

As breast reconstructive microsurgeons increase their available flap techniques with experience, the need for stacked and multiple flaps may generate an improved aesthetic outcome. The authors present institutional experience of using single versus free reconstruction.ONE THOUSAND SEVENTY: were performed on 509 patients from 2010 to 2018 by two senior surgeons at a university hospital. Three hundred eighty-eight either profunda artery perforator (PAP) flaps, four-flap [bilateral PAP plus...

The ideal form of breast reconstruction provides total permanent restoration the mound. When a deep inferior epigastric (DIEP) flap is not an option or does provide significant volume, secondary source must be considered. In our practice, profunda artery perforator (PAP flap) from thigh has emerged as second choice. We present experience with first 265 PAP flaps used for at institution. specifically focus on refinements, satisfaction, and functional outcomes.We conducted retrospective review...

The free fibula flap is the standard of care in mandibular reconstruction; however, procedural nuances continue to optimize results. More accurate and efficient osteotomies for graft insetting can be envisioned, which address difficulty obtaining a perfect match between cut ends mandible subsequent giving up maximal bone contact. We propose method complementary offset osteotomies. angled cuts were virtually planned using three-dimensional computed tomographic images. Optimal maximized...

The foot and ankle area has a tenuous blood supply that can easily be damaged with trauma or open exposures. navicular talus are susceptible to avascular necrosis, making arthrodesis difficult. In addition, in this region, large bone gaps occur as result of trauma, infection. Often, vascularized flaps required for reconstruction salvage.A retrospective review all the performed by senior surgeon (L.S.L) from July 2006 2012 was performed. Twelve cases were identified (seven fibula five medial...

Background: Avascular necrosis (AVN) or persistent nonunion occurs in situations of poor vascular supply. Some specific that plague the foot and ankle surgeon are talus nonunion, AVN, navicular failed arthrodesis with bone loss. The medial femoral condyle (MFC) flap has emerged as a popular source vascularized corticocancelous bone. We present series cases demonstrating versatility MFC complex pathology. Methods: A retrospective review was completed all flaps used over past 5 years. Five...

Background: Recently, the profunda artery perforator flap has become one of popular choices for patients who desire autologous breast reconstruction but are not optimal candidates deep inferior epigastric (DIEP) surgery. These ideal DIEP surgery because having poor perforators, previous abdominal operations, low body mass index, or previously used/failed flap. In their institution, authors have performed stacked flaps these to provide full volumetric and aesthetic reconstruction. Methods: A...

Background: With advances in technology and technique, the goal of microvascular breast reconstruction has transitioned from flap success to minimizing complications maximizing aesthetic outcome efficiency. In an effort evaluate efficiency, authors implemented a rigorous process analysis their practice deep inferior epigastric perforator (DIEP) reconstruction. Methods: A prospective implementation was instituted on 147 DIEP flaps. The eight critical maneuvers for are (1) skin identification,...

The lumbar artery perforator (LAP) flap is a useful alternative for patients who are not candidate breast reconstruction using the deep inferior epigastric flap. Due to positioning and concerns prolonged ischemia time, bilateral LAP flaps frequently performed in separate stages. We present our early experience performing simultaneous reconstruction.We retrospective review of all underwent with from December 2018 September 2019. Demographics, data, complication data were collected. Surgical...

Background: The rising popularity of prepectoral tissue expander placement with acellular dermal matrices in immediate breast reconstruction has prompted many studies on the safety this technique. However, a comprehensive propensity-matched, historically controlled trial comparing perioperative outcomes following versus partial subpectoral (dual-plane) expanders is lacking. Methods: Retrospective propensity-matched cohort analysis was performed all patients two senior reconstructive surgeons...

Enhanced recovery after surgery (ERAS) includes multiple interventions that have yielded positive outcomes in a number of surgical fields. The authors evaluated whether an ERAS protocol and the subsequent addition liposomal bupivacaine affect patient specifically deep inferior epigastric perforator (DIEP) flap breast reconstruction.All patients treated with DIEP flaps from January 2016 to December 2019 were reviewed retrospectively. was implemented midway through 2017; halfway 2018,...

Background: Flaps based on the profunda artery perforators were first used for reconstruction of pressure sores, burn contractures, and extremity wounds. Recently, a revised perforator flap was introduced breast reconstruction. However, is rarely despite interesting reports its use. The authors present their experience with flap, describing versatile applications in Methods: conducted retrospective review all patients lead author who underwent flaps before January 2015. Patient demographics,...