Current practices remain exceedingly diverse. Key strategies to improve patient outcomes can be defined from the available literature. Key evidence-based guidelines included that normothermia should be maintained perioperatively to improve outcomes (level of evidence 2b), and volume replacement should be maintained between 3.5 and 6.0 ml/kg per hour (level of evidence 2b). Vasopressors do not harm outcomes and may improve flap flow (level of evidence 1b), with most evidence supporting the use of norepinephrine over other vasopressors (level of evidence 1b). Dextran should be avoided (level of evidence 1b), and pump systems for local anesthetic infusion are beneficial following free flap breast reconstruction (level of evidence 1b). Further prospective studies will improve the quality of available evidence.
Current practices remain exceedingly diverse and at times differ from best practices, which may be identified from the available literature. Key areas where patient care can be standardized and optimized include anesthesia, patient temperature, fluid management, the use of vasoactive agents, and analgesic medications. Standardized, evidence-based guidelines have the potential to further improve patient care and free flap outcomes.
146Findings related to artery, superfi cial and deep venous vessel diameter, vessel choice, and vascular-related complications were reviewed.
RESULTS:Sixty cases of distal VLN transfer were evaluated; 55% lower extremity, 45% upper extremity. In the lower extremity, a majority of transfers (94%) were placed around the ankle region, while two patients received transfers to the proximal leg. Vascular systems used included the posterior tibial (60.6%), the anterior tibial (33.3%), and the medial sural (6.1%) arteries. Average artery diameters were similar around the ankle (3.0mm), and were 2mm for the medial sural artery. The deep and superfi cial venous systems were used in equal portions, with a smaller proportion using combined systems. Vascular complications occurred in 27.3% of cases, but no sitespecifi c differences were found. In the upper extremity, distal forearm/wrist received a majority of transfers (89%), while three patients received transfers to the elbow region. Recipient vessels included the radial artery-deep branch (59.3%), ulnar artery (29.6%), and ulnar collateral artery (11.1%). Average artery (2.3mm) and vein diameter (2.5mm) were similar in the upper extremity transfers. When specifi cally evaluating select recipient sites, the volar wrist had a signifi cantly smaller average vein diameter (2.0mm) as compared to other sites (p=0.04) and less frequent use of the superfi cial venous system as outfl ow (p=0.02). Combined, these resulted in a signifi cantly greater occurrence of venous congestion (p=0.03).
CONCLUSIONS:Recipient vessels for distal VLN transfers are reliably and predictably present. In the setting of a lymphedematous extremity, deep arterial systems appear to be relatively unaffected, with medium caliber average vessel diameters. Regional differences appear to exist for the usability and selection of recipient veins in various locations.
BACKGROUND:Abdominal wall hernia is the most common complication after a laparotomy and cause for a reoperation. 1 More than 105, 000 ventral hernia repairs are performed annually. 2 Separation of the components is a widely used technique for closure of abdominal wall defects since the original studies by Ramirez in 1990. 3 We propose that adding scoring of transversalis fascia to component separation can provide additional midline advancement of the anterior rectus sheath. We have investigated the utility of this technique using a cadaver model.
Abstract-This study looks at the use of LinkedIn in the United Arab Emirates.In-depth interviews with representatives of five organisations and five recruitmen t companies based in the UAE were conducted to evaluate the use of LinkedIn as a recruitment tool. The study showed that LinkedIn is a cost effective recruitment tool. It is efficient when looking for candidates at the senior level or for those with specialized and unique skills. Recruitment agencies also see it as a competitor. The study concluded that to use LinkedIn effectively organisations should have a clear social media strategy.
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