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Advances in microsurgery for upper and lower extremity reconstruction and limb preservation

Plastic and Aesthetic Research 2019年第10期6卷 1-14页

作者： Alberto Bolletta Rubino Corrado Hung-Chi Chen Department of Plastic Surgery China Medical University HospitalTaichung 404Taiwan Department of Medical Surgical and Experimental SciencesUHT of SassariPlastic Surgery UnitUniversity of SassariSassari 07100Italy

In the recent decades,microsurgical reconstruction has evolved from simple survival of the affected extremity to the improvement of functional and aesthetic *** review retraces the main contributions to the advances of microsurgery for reconstruction of upper and lower extremities and limb *** the upper extremity,it is important to restore fine motility,together with allowing prompt *** the lower limb,care must be taken in the reconstruction of weight-bearing areas and the aim must be proper ambulation and shoe *** perforator flaps can be considered for medium size *** provide thin coverage and can be performed in short operating *** use,though,is often limited by tissue *** flaps allow to overcome this problem and,thanks to the recent development in the study of perforator vessels,the microsurgeon can choose the flap with the most appropriate *** flaps can accomplish simultaneous reconstruction of different tissue components and large bone defects often require vascularized bone *** dealing with limb preservation it is very important to consider residual *** muscle transfer and targeted muscle re-innervation can be performed in these cases.A useful reconstructive tool in severely damaged limbs with limited blood supply is the use of cross-leg free *** conclusion,extremity reconstruction and limb preservation are reaching new heights thanks,not only to the work of plastic surgeons,but also to the new developments in other fields of study such as oncology,traumatology,radiology and medical engineering.

关键词： extremity reconstruction functional and aesthetic outcome limb salvage perforator flaps free flaps weight-bearing areas cross-leg flaps

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Sensory reinnervation of free flaps in reconstruction of the breast and the upper and lower extremities

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Neural Regeneration Research 2012年第29期7卷 2279-2285页

作者： Nektarios Sinis Androniki Lamia Helml Gudrun Thomas Schoeller Frank Werdin Department of Plastic Hand-and Reconstructive MicrosurgerySt.Marien Krankenhaus BerlinBerlin 12249 Germany Department of Handsurgery Microsurgery and Reconstructive Surgery of the Breast Marienhospital StuttgartStuttgart 70199Baden-Württemberg Germany Department of Handsurgery Microsurgery and Reconstructive Surgery of the Breast Marienhospital StuttgartStuttgart 70199Baden-Württemberg Germany

There is long-standing debate about sensate versus non-sensate free microvascular flaps among microsurgeons. The principle of connecting not only the vascular supply, but also sensitive nerves, in free tissue transfer is attractive. However, increased operating time and partial spontaneous innervation led to the common decision to restrict microsurgical tissue transfer to the vascular anastomosis and to leave the nerves ＂untreated＂. Nevertheless, in special cases such as breast reconstruction or extremity reconstruction, the question about sensory nerve coaptation of the flaps remains open. We present our experience with free microvascular tissue transfer for breast and extremity reconstruction and compare the data with previous literature and conclude that most free flap surgeries do not benefit from nerve coaptation.

关键词： free tissue flap mammaplasty dermatoplasty free tissue transfer flap free microvascular tissuetransfer breast reconstruction extremity reconstruction sensate flap non-sensate flap

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Experimental nerve transfer model in the neonatal rat

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Neural Regeneration Research 2022年第5期17卷 1088-1095页

作者： Matthias E.Sporer Martin Aman Konstantin D.Bergmeister Dieter Depisch Katharina M.Scheuba Ewald Unger Bruno K.Podesser Oskar C.Aszmann Christian Doppler Laboratory for the Restoration of extremity Function Department of SurgeryMedical University of ViennaViennaAustria Clinical Laboratory for Bionic extremity reconstruction Department of SurgeryMedical University of ViennaViennaAustria Division of Biomedical Research Medical University of ViennaViennaAustria Department of Plastic Aesthetic and Reconstructive SurgeryUniversity Hospital of St.PoeltenKarl Landsteiner University of Health SciencesSt.PoeltenAustria Center for Medical Physics and Biomedical Engineering Medical University of ViennaViennaAustria Division of Plastic and Reconstructive Surgery Medical University of ViennaViennaAustria

Clinically,peripheral nerve reconstructions in neonates are most frequently applied in brachial plexus birth *** surgical concepts,however,have investigated nerve reconstructions in adult animal *** immature neuromuscular system reacts differently to the effects of nerve lesion and surgery and is poorly investigated due to the lack of reliable experimental ***,we describe an experimental forelimb model in the neonatal rat,to study these effects on both the peripheral and central nervous *** 24 hours after birth,three groups were prepared:In the nerve transfer group,a lesion of the musculocutaneous nerve was reconstructed by selectively transferring the ulnar *** the negative control group,the musculocutaneous nerve was divided and not reconstructed and in the positive control group,a sham surgery was *** animal's ability to adapt to nerve lesions and progressive improvement over time were depict by the Bertelli test,which observes the development of *** weeks postoperatively,animals were fully matured and the nerve transfer successfully reinnervated their target muscles,which was indicated by muscle force,muscle weight,and cross sectional area *** the contrary,no spontaneous regeneration was found in the negative control *** the positive control group,reference values were *** labeling indicated that the motoneuron pool of the ulnar nerve was reduced following nerve *** to this post-axotomy motoneuron death,a diminished amount of motoneurons reinnervated the biceps muscle in the nerve transfer group,when compared to the native motoneuron pool of the musculocutaneous *** findings indicate that the immature neuromuscular system behaves profoundly different than similar lesions in adult rats and explains reduced muscle ***,pathophysiologic adaptations are *** maturing neuromuscular system,however,utilizes neonatal capacity of regener

关键词： brachial plexus birth injury experimental rat model extremity reconstruction methodological paper neonatal rat nerve reconstruction nerve regeneration nerve transfer neural plasticity peripheral nerve surgery

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Plastic surgeons: critical members of the mass casualty team

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Plastic and Aesthetic Research 2019年第7期6卷 1-2页

作者： Mario A.Aycart Simon G.Talbot Division of Plastic Surgery Department of SurgeryBrigham and Women's Hospital75 Francis StreetBostonMA 02115USA

Plastic and reconstructive surgeons are uniquely positioned to care for a variety of patients in all walks of *** routinely take part in the multidisciplinary care that ranges from prenatal consultation for congenital abnormalities such as cleft lip and palate to nuanced reconstructive care of our aging population after tumor extirpation.

关键词： Reconstructive Surgical Procedures blast injuries extremity reconstruction

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