| Microvascular free-tissue transfer for traumatic defects of the upper extremity: a 25-year experience. | |
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MedLine Citation:
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PMID: 14634908 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Microvascular free-tissue transfer has been a major advance in the treatment of complex traumatic defects of the upper extremity. One hundred and fifty microvascular free-tissue transfers were performed in 133 patients with complex traumatic upper extremity defects at Bellevue Hospital Center from 1976 to 2000. The indication for microvascular free tissue transfers was exposure of vital structure (81 percent), bone defect (11 percent), and functional deficit (8 percent). The parascapular region was the most common donor site used (26 percent). Microvascular free-tissue transfer was performed either emergently at the time of injury (9.3 percent), during days 1 to 5 post injury (19.3 percent), during days 6 to 21 (19.3 percent), or after day 21 (52 percent). The overall flap failure rate was 9 percent. A decreased incidence of flap failure was observed in patients treated from 6 to 21 days post injury (3 percent p<0.05). The most common acute complication was infection at the recipient site, observed in 14 percent of patients overall. A decreased incidence of recipient-site infection was seen in patients who received free flaps at days 6 to 21 (3 percent; p<0.05). In long-term follow-up, the incidences of osteomyelitis and nonunion were lowest in patients treated from 6 to 21 days post injury (0.0 percent and 11 percent, respectively; p<0.05). During the last 10 years, the timing of reconstruction has been altered, and now preferentially microvascular free flaps are performed 6 to 21 days post injury. The treatment algorithm has been simplified and now only four different flaps are used in the majority of patients (70 percent). With this, the authors have witnessed a decrease in failure rates from 11 percent to 4 percent, a decrease in recipient-site infections from 16 percent to 10 percent and a decrease in osteomyelitis from 12 percent to 4 percent. The preferred timing for microvascular free-tissue transfers to the upper extremity is concluded to be 6 to 21 days post injury. |
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Authors:
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Christopher A Derderian; Wendy-Ann M Olivier; Germania Baux; Jamie Levine; Geoffrey C Gurtner |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Journal of reconstructive microsurgery Volume: 19 ISSN: 0743-684X ISO Abbreviation: J Reconstr Microsurg Publication Date: 2003 Oct |
Date Detail:
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Created Date: 2003-11-24 Completed Date: 2004-02-18 Revised Date: 2011-02-16 |
Medline Journal Info:
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Nlm Unique ID: 8502670 Medline TA: J Reconstr Microsurg Country: United States |
Other Details:
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Languages: eng Pagination: 455-62 Citation Subset: IM |
Affiliation:
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Institute of Reconstructive Plastic Surgery, New York University Medical Center, New York, NY 10016, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Arm Injuries / surgery* Child Female Humans Male Microsurgery Middle Aged Reconstructive Surgical Procedures* Retrospective Studies Surgical Flaps* / blood supply |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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