Flap survival rate was 95%. Median follow-up period was 11 mTOR inhibitor months. Twelve patients were alive and free of disease at the end of the follow-up. Eighteen of 19 patients with oro-mandibular and glossectomy defects were able to resume
an oral diet within two months while one patient remained gastrostomy dependant till his death due to disease not related to cancer. This patient had a combination of free fibula flap with free ALT flap, for an extensive oro-mandibular defect. The associated large defect involving the tongue accounted for the swallowing difficulty. Simultaneous use of double free flap aided the reconstruction in certain large complex defects after head and neck oncologic resections. Such combination permits better complex multiaxial subunit reconstruction. An algorithm for choice of
flap combination for the appropriate indications is proposed. © 2012 Wiley Periodicals, Inc. Microsurgery, 2012. “
“Background:The internal mammary vein (IMV) is commonly used as a recipient vessel in the direction of antegrade flow for free flap breast reconstruction. Recent reports show that the distal IMV is valveless and can accommodate retrograde flow. We sought I-BET-762 molecular weight to quantify blood velocity and flow through the distal IMV following free tissue transfer. Methods:Ten free flap breast reconstructions were performed. The larger vena comitans of the DIEA was anastomosed to the antegrade internal mammary vein (AIMV). The smaller vena comitans was anastomosed to the retrograde internal mammary vein (RIMV) in five
free flaps, and the superficial inferior epigastric vein (SIEV) was anastomosed to the RIMV in five other free flaps.Results:The mean diameter of the larger vena comitans (3.4 ± 0.5 mm) was significantly greater than that of the smaller vena comitans (2.4 ± 0.4 mm; P = 0.003). Mean velocity in the AIMV after anastomosis was 10.13 ± 5.21 mm/s compared with 7.01 ± 2.93 mm/s in the RIMV (P = 0.12). Mean blood flow in the AIMV and the RIMV was unless 81.33 ± 52.81 mm3/s and 57.84 ± 45.11 mm3/s, respectively (P = 0.30). Mean blood flow in the RIMV was not significantly affected by whether the donor vein was the smaller vena comitans (70.78 ± 61.43 mm3/s) or the SIEV (44.90 ± 19.70 mm3/s; P = 0.40).Conclusions:Blood flow in the RIMV was less but not significantly different from flow in the AIMV. The difference is likely due to the smaller-sized donor vein anastomosed to the RIMV. The RIMV is a reliable, useful option when the antegrade vein is not available, or when a second recipient vein is needed. © 2011 Wiley Periodicals, Inc. Microsurgery, 2011. “
“Lymphatic supermicrosurgery, supermicrosurgical lymphaticovenular anastomosis (LVA), is becoming a useful option for the treatment of compression-refractory lymphedema.