Background Postoperative monitoring is crucial in the care of free flap breast reconstruction patients. Tertiary care facilities (TCFs) provide postoperative monitoring in an ICU after surgery. Specialty surgery hospitals (SSHs) do not have ICUs, but these facilities perform free flap breast reconstruction as well. Are outcomes comparable between the 2 facilities in terms of flap reexploration ...

Background We examined the associations of surgeon and hospital volume with total cost, length of stay (LOS), and cost per day for free tissue transfer (FTT) surgeries. Evidence demonstrates a higher likelihood of success for FTT in higher volume hospitals. Little, however, is known about volume-outcome associations for surgical costs and LOS. We hypothesized that higher provider volume is asso...

OBJECTIVE To determine the efficacy of free flap reconstruction in patients 90 years and older. DESIGN Retrospective medical chart review. SETTING Academic medical center. PATIENTS Patients 90 years and older who underwent a free flap reconstruction from 2002 through 2011 were identified. MAIN OUTCOME MEASURES Clinical, demographic, and procedural data were recorded. Complications of su...

OBJECTIVE To present a 1-stage technique for orbital reconstruction after exenteration with the use of myocutaneous rectus abdominis free flap in children. SURGICAL TECHNIQUE After orbital exenteration, a myocutaneous rectus abdominis free flap with long vascular pedicle is harvested from the abdomen. The flap is transferred to the orbit and the vascular pedicle is passed through an opening m...

Amputation by crush injuries generally represents a contraindication for replantation, and especially when the lesion is caused by the summation of multiple concomitant traumatic mechanisms. We present the case of a 22 year- old female who arrived in our service with a crush/torsion amputation of all long fingers at the metacarpo-phalangeal level of the right hand. After the unsuccessful attemp...

BACKGROUND Case payment mechanisms have become the principal means of remunerating hospitals in most developed countries. Our purpose was to analyse the reimbursement for different types of tissue transfer in five European countries. METHODS We looked at common surgical options for pedicled and free flaps. The recipient site of a flap and the principal diagnosis were systematically modified a...

BACKGROUND Current teaching suggests increased perfusion in free transverse rectus abdominis myocutaneous (TRAM) flaps over pedicled TRAM flaps, broadening indications for its use in high risk patients. This study compared perfusion analysis of free muscle-sparing versus pedicle TRAM flaps in vivo in the peri-operative and late post-operative periods. METHODS The SPY-Elite system using indocy...

Abstract Anterolateral thigh (ALT) free flap is a commonly used for reconstruction of circumferential laryngopharyngeal defects. The harvested as an ellipse and tubed along its length. We would like to present design modification the ALT where tubing done width flap. This has advantages it allows two-layered closure without harvest additional tissue provides skin neck coverage also. After inset...

This study compared the deep inferior epigastric perforator (DIEP) flap and the free transverse rectus abdominis myocutaneous (TRAM) flap in postmastectomy reconstruction using a cost-effectiveness analysis. A decision analytic model was used. Medical costs associated with the two techniques were estimated from the Ontario Ministry of Health Schedule of Benefits for 2002. Hospital costs were ob...

The collaboration of surgeons, radiation oncologists, chemotherapists, dentists, oral surgeons, prosthodontists, and speech therapists has led to major advances in the management of the difficult cancers of the head and neck area. The advent of myocutaneous flaps and the facilitation of microsurgical free flaps have ushered in an era of one-stage reconstructions to shorten the hospital stay and...