Objective:The"July effect,"a theory that the beginning of the academic year has worse operative outcomes and complication rates,remains controversial.We evaluated the"July effect"as a risk factor f...Objective:The"July effect,"a theory that the beginning of the academic year has worse operative outcomes and complication rates,remains controversial.We evaluated the"July effect"as a risk factor for negative operative outcomes in head and neck microvascular reconstruction.Methods:Multi-institutional retrospective review at three academic tertiary care centers from January 2010 to August 2021.Free flaps were stratified by the academic quarter.Patient factors,operative variables,length of stay(LOS),flap failures,and postoperative complications and adverse events were compared between academic quarters 1 and 4.Results:We identified 2897 free flaps:749 quarter 1(Q1),693 quarter 2(Q2),770 quarter 3(Q3),and 685 quarter 4(Q4).Overall flap failure rate was 4.9%(n=143),and the most common postoperative complications were wound infection(12.8%,n=370)and dehiscence(7.6%,n=221).There were no significant differences between quarters in overall complication rate,flap failures,partial flap necrosis,wound infection,fistula,or hematoma(p>0.05).There were also no significant differences in LOS or rates of 30-day readmission or reoperation(p>0.05).Q1 had significantly more dehiscences(p=0.04)and longer operative times(p=0.001)than Q4.Conclusion:Although Q1 surgeries had significantly longer operative times and higher dehiscence rates,we found no other differences in postoperative complications,flap failures,or adverse events by the academic quarter.While a"July effect"may exist due to the integration of new trainees into the surgical workflow,this effect does not translate into meaningful differences in overall free flap or patient outcomes.展开更多
Microvascular free flap reconstruction based on the subscapular system is an established and versatile method of reconstructing complex head and neck defects.Since the first published description in the mid-1980s,adva...Microvascular free flap reconstruction based on the subscapular system is an established and versatile method of reconstructing complex head and neck defects.Since the first published description in the mid-1980s,advances have been made to the harvest technique,positioning,use of virtual surgical planning,and endosseous implants.Here,the most recent literature is reviewed for innovations related to the subscapular system.Microvascular head and neck surgeon preferences related to the subscapular system are surveyed and discussed.The concordance between virtual surgical plans using scapula cutting guides and pre-contoured plates with the postoperative result is assessed,and novel applications of the scapula free flap are presented.Subscapular system free flaps are an established and essential component of the reconstructive armamentarium for head and neck defects with minimal limitations and low donor site morbidity.展开更多
Head and neck reconstruction has evolved substantially in the last three decades to rely heavily on microvascular free tissue transfer,including bony composite flaps that improve form and functional outcomes.The techn...Head and neck reconstruction has evolved substantially in the last three decades to rely heavily on microvascular free tissue transfer,including bony composite flaps that improve form and functional outcomes.The technologies available for planning and executing bony reconstruction have undergone concurrent innovation,leaving the modern surgeons with a host of options to consider.In this review,the techniques of external fixation,virtual surgical planning and rapid prototyping are discussed with the aim of familiarizing surgeons and comparing these approaches.External fixation,though not new to head and neck surgery,has seen a revival and has considerable utility in vascularized bony reconstruction with the potential for improved efficiency and cost control.We explore the clinical situations in which virtual surgical planning is best employed,and the varying levels to which it can be applied throughout the reconstructive process.The ever-expanding realm of rapid prototyping,or 3D printing,is also examined to explore potential applications for surgical modeling,tissue engineering and even clinical training.Finally,we present a discussion of the cost-effectiveness of the technologies and future directions for research in the field.展开更多
Thumb reconstruction following a traumatic injury challenge depends on the extent of the injury. Ideally, reconstruction should restore thumb length and position and retain thumb stability, mobility, and strength, whi...Thumb reconstruction following a traumatic injury challenge depends on the extent of the injury. Ideally, reconstruction should restore thumb length and position and retain thumb stability, mobility, and strength, while preserving sensation and aesthetics. Achieving these outcomes can be especially challenging in severe cases of soft tissue and bony loss. The authors present a case of a 20-year-old right-hand dominant female involved in a motor vehicle accident who sustained severe crush injuries and burns to her right hand. Her injuries included soft tissue and bony defects extending from the thumb to the distal radius, namely avulsion of the thumb and significant loss of the distal radial and carpal column, resulting in severe wrist instability. We employed a three-segment vascularized osteocutaneous fibula flap to reconstruct the thumb and wrist to restore bony construct, carpal support, and soft tissue coverage. Thumb motion could not be achieved, but this technique offered a sensate, functional post for opposition and the appearance of an anatomic hand. Because of this surgery, the patient was enabled to graduate from college and pursue full-time employment. The authors hope that this report will add to the fund of knowledge and surgeon armamentarium for similar devastating injuries demanding thumb and wrist reconstruction.展开更多
Congenital aneurysms of the palm are uncommon in the pediatric population compared to aneurysms in adults.A seven-month-old boy presented with a true aneurysm of the ulnar artery with reconstruction with surgical exci...Congenital aneurysms of the palm are uncommon in the pediatric population compared to aneurysms in adults.A seven-month-old boy presented with a true aneurysm of the ulnar artery with reconstruction with surgical excision and end-to-end microvasculer anastomosis using a superficial vein of the dorsal foot.To our knowledge,there have been only 15 reports of congenital aneurysms of the palm.展开更多
文摘Objective:The"July effect,"a theory that the beginning of the academic year has worse operative outcomes and complication rates,remains controversial.We evaluated the"July effect"as a risk factor for negative operative outcomes in head and neck microvascular reconstruction.Methods:Multi-institutional retrospective review at three academic tertiary care centers from January 2010 to August 2021.Free flaps were stratified by the academic quarter.Patient factors,operative variables,length of stay(LOS),flap failures,and postoperative complications and adverse events were compared between academic quarters 1 and 4.Results:We identified 2897 free flaps:749 quarter 1(Q1),693 quarter 2(Q2),770 quarter 3(Q3),and 685 quarter 4(Q4).Overall flap failure rate was 4.9%(n=143),and the most common postoperative complications were wound infection(12.8%,n=370)and dehiscence(7.6%,n=221).There were no significant differences between quarters in overall complication rate,flap failures,partial flap necrosis,wound infection,fistula,or hematoma(p>0.05).There were also no significant differences in LOS or rates of 30-day readmission or reoperation(p>0.05).Q1 had significantly more dehiscences(p=0.04)and longer operative times(p=0.001)than Q4.Conclusion:Although Q1 surgeries had significantly longer operative times and higher dehiscence rates,we found no other differences in postoperative complications,flap failures,or adverse events by the academic quarter.While a"July effect"may exist due to the integration of new trainees into the surgical workflow,this effect does not translate into meaningful differences in overall free flap or patient outcomes.
文摘Microvascular free flap reconstruction based on the subscapular system is an established and versatile method of reconstructing complex head and neck defects.Since the first published description in the mid-1980s,advances have been made to the harvest technique,positioning,use of virtual surgical planning,and endosseous implants.Here,the most recent literature is reviewed for innovations related to the subscapular system.Microvascular head and neck surgeon preferences related to the subscapular system are surveyed and discussed.The concordance between virtual surgical plans using scapula cutting guides and pre-contoured plates with the postoperative result is assessed,and novel applications of the scapula free flap are presented.Subscapular system free flaps are an established and essential component of the reconstructive armamentarium for head and neck defects with minimal limitations and low donor site morbidity.
文摘Head and neck reconstruction has evolved substantially in the last three decades to rely heavily on microvascular free tissue transfer,including bony composite flaps that improve form and functional outcomes.The technologies available for planning and executing bony reconstruction have undergone concurrent innovation,leaving the modern surgeons with a host of options to consider.In this review,the techniques of external fixation,virtual surgical planning and rapid prototyping are discussed with the aim of familiarizing surgeons and comparing these approaches.External fixation,though not new to head and neck surgery,has seen a revival and has considerable utility in vascularized bony reconstruction with the potential for improved efficiency and cost control.We explore the clinical situations in which virtual surgical planning is best employed,and the varying levels to which it can be applied throughout the reconstructive process.The ever-expanding realm of rapid prototyping,or 3D printing,is also examined to explore potential applications for surgical modeling,tissue engineering and even clinical training.Finally,we present a discussion of the cost-effectiveness of the technologies and future directions for research in the field.
文摘Thumb reconstruction following a traumatic injury challenge depends on the extent of the injury. Ideally, reconstruction should restore thumb length and position and retain thumb stability, mobility, and strength, while preserving sensation and aesthetics. Achieving these outcomes can be especially challenging in severe cases of soft tissue and bony loss. The authors present a case of a 20-year-old right-hand dominant female involved in a motor vehicle accident who sustained severe crush injuries and burns to her right hand. Her injuries included soft tissue and bony defects extending from the thumb to the distal radius, namely avulsion of the thumb and significant loss of the distal radial and carpal column, resulting in severe wrist instability. We employed a three-segment vascularized osteocutaneous fibula flap to reconstruct the thumb and wrist to restore bony construct, carpal support, and soft tissue coverage. Thumb motion could not be achieved, but this technique offered a sensate, functional post for opposition and the appearance of an anatomic hand. Because of this surgery, the patient was enabled to graduate from college and pursue full-time employment. The authors hope that this report will add to the fund of knowledge and surgeon armamentarium for similar devastating injuries demanding thumb and wrist reconstruction.
文摘Congenital aneurysms of the palm are uncommon in the pediatric population compared to aneurysms in adults.A seven-month-old boy presented with a true aneurysm of the ulnar artery with reconstruction with surgical excision and end-to-end microvasculer anastomosis using a superficial vein of the dorsal foot.To our knowledge,there have been only 15 reports of congenital aneurysms of the palm.
