Assessing the Safety and Efficacy of Regional Anesthesia for Lower Extremity Microvascular Reconstruction: Enhancing Recovery

Ruan, Qing; Diamond, Shawn; Zimmer, Scott; Iorio, Matthew L.

doi:10.1055/s-0037-1621726

Cited by 10 publications

(10 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…An enhanced recovery protocol was utilized for the majority of our patients including the use of regional anesthetic block [9] and an early limb dependency program [10] helped patients dangle early in their postoperative course expediting hospital stay, discharge to rehabilitation facilities, and return toward functional ambulation.…”

Section: Methodsmentioning

confidence: 99%

Skin grafting the vascular pedicle: a useful technique to avoid microvascular collapse in free tissue transfer for limb salvage

Kovar¹,

Diamond²,

Iorio³

2019

PAR

Self Cite

View full text Add to dashboard Cite

Aim: Free tissue transfer is essential for extremity reconstruction following traumatic injuries, oncologic resection, and diabetic complications. However, given the circumferential shape of the arm and leg, a small amount of ongoing edema can prevent a tension-free closure. Additionally, intraoperative thrombosis, vascular disease can lead to proximal exposure of the pedicle or vein grafts. This study evaluates the outcomes of microvascular transfers that utilized a skin graft for closure over the pedicle, in comparison with a matched cohort with a tension-free primary closure. Methods: A retrospective review was completed of all patients that underwent free flap reconstruction of an extremity defect from January 2014 to December 2017 at a single academic institution. Flaps that utilized skin grafting for closure were compared to those closed primarily. Adjunct operative procedures, demographics, and complications were evaluated. Results: A total of 71 patients fulfilled the inclusion criteria. The 11 flaps in 10 patients underwent skin grafting over the pedicle. The two cohorts were comparable in age, gender, BMI, and co-morbidities, excluding renal disease which was present in 40% (n = 4) of skin grafted group compared to 6.5% (n = 4) in the primary closure group. Flap area, operative time, and anastomosis technique were comparable between the two groups. There was no significant difference in the rates of post-operative complications including partial flap loss, complete flap loss, infection. Mean follow up time in the skin grafting group was 14.2 months and 20.2 months for the primary closure group. Conclusion: As per the principal, a tension-free closure is paramount to preventing tissue complications including direct compression of a microvascular pedicle. However, with ongoing tissue edema skin grafting should be considered as a reliable technique to ensure both protection of the pedicle as well as prevention of direct compression without additional complications and comparable post-operative outcomes.

show abstract

Section: Methodsmentioning

confidence: 99%

Skin grafting the vascular pedicle: a useful technique to avoid microvascular collapse in free tissue transfer for limb salvage

Kovar¹,

Diamond²,

Iorio³

2019

PAR

Self Cite

View full text Add to dashboard Cite

show abstract

“…An enhanced recovery protocol was utilized for the majority of our patients including the use of regional anesthetic block achieved via continuous peripheral nerve catheter placed in the popliteal region targeting the sciatic, tibial and peroneal nerves when appropriate. This achieved decreased rates of postoperative narcotic use and shorter post-anesthesia unit stays [21] . Additionally an early limb dependency program [22] helped patients dangle early in their post-operative course expediting hospital stay, discharge to rehabilitation facilities, and return toward functional ambulation.…”

Section: Reconstructive Techniquementioning

confidence: 96%

Limb preservation with suprafascial and thin perforator flaps: salvaging osteomyelitis, Charcot collapse and critical limb ischemia

Diamond¹,

Doval²,

Scott³

et al. 2019

PAR

Self Cite

View full text Add to dashboard Cite

Aim: There are limited reports in the United States demonstrating outcomes of primarily thinned fasciocutaneous flaps in the setting of critical limb ischemia, Charcot collapse and osteomyelitis. We hope to determine patient and flap related outcomes in advanced lower extremity disease. Methods:The authors conducted a retrospective review of fasciocutaneous free flaps of variable thickness for lower extremity salvage. Osteomyelitis and non-osteomyelitis patients were compared according to our primary outcome measures: functional ambulation, bone healing and complications to flap and patient. Subgroups with critical limb ischemia, Charcot collapse and diabetic foot were analyzed separately.Results: Fifty-nine patients underwent free flap reconstruction: osteomyelitis (n = 20, 34%), Charcot collapse (n = 22, 37%), and/or critical limb ischemia (n = 12, 20%). All patients underwent anterolateral thigh flaps tailored for defectspecific thicknesses: 17 superthin, 25 suprafascial, 17 subfascial. There were no significant differences between groups in terms of partial and complete flap loss (P = 1.000 and P = 0.108). Ninety-one percent of patients were ambulatory at follow up. Eighty-five percent of individuals with osteomyelitis cleared their infection demonstrating radiographic bone healing. Two patients developed recalcitrant deep space infections ultimately requiring amputation. Subgroup analysis did not show any differences in flap related complications within the diabetic Charcot population. In multivariate regression, preoperative revascularization was independently associated with failure of limb salvage. Conclusion:Primarily thinned perforator flaps performed well in the setting of lower extremity limb salvage, critical limb ischemia, osteomyelitis, and the Charcot foot -expanding their role in the armamentarium for lower extremity care.

show abstract

“…Numerous studies have demonstrated the efficacy of these blocks in reducing postoperative pain, opioid consumption, and length of hospital stay. 65 67 68 69 70 71 72 73 74 75 76 Transversus abdominis plane blocks in particular are incredibly effective at reducing postoperative abdominal pain and have increasingly become a recommended component of abdominally based autologous breast reconstruction flap enhanced recovery after surgery protocols. 77…”

Section: Breast Surgerymentioning

confidence: 99%

Applications of Ultrasound in the Postoperative Period: A Review

Long

Maselli

Barron

et al. 2022

J Reconstr Microsurg

View full text Add to dashboard Cite

Background Recent advances in ultrasound technology have further increased its potential for routine use by plastic and reconstructive surgeons. Methods An extensive literature review was performed to determine the most common applications of ultrasound in the postoperative care of plastic and reconstructive surgery patients. Results In contrast with other available imaging modalities, ultrasound is cost-effective, rapid to obtain, eliminates the need for ionizing radiation or intravenous contrast, and has virtually no contraindications. In addition to its diagnostic capabilities, ultrasound can also be used to facilitate treatment of common postoperative concerns conveniently at the bedside or in an office setting. Conclusion This article presents a review of the current applications of ultrasound imaging in the postoperative care of plastic and reconstructive surgery patients, including free flap monitoring following microsurgery, diagnosis and treatment of hematoma and seroma, including those associated with BIA-ALCL, and breast implant surveillance.

show abstract

Assessing the Safety and Efficacy of Regional Anesthesia for Lower Extremity Microvascular Reconstruction: Enhancing Recovery

Abstract: PNC utilization for lower extremity free flap transfer significantly reduced concurrent narcotic use and attained a shorter LOS. The technique provided for safe analgesia during lower extremity free flap reconstructions satisfying the microsurgeon and the anesthesiologist.

Cited by 10 publications

References 22 publications

Skin grafting the vascular pedicle: a useful technique to avoid microvascular collapse in free tissue transfer for limb salvage

Skin grafting the vascular pedicle: a useful technique to avoid microvascular collapse in free tissue transfer for limb salvage

Limb preservation with suprafascial and thin perforator flaps: salvaging osteomyelitis, Charcot collapse and critical limb ischemia

Applications of Ultrasound in the Postoperative Period: A Review

Contact Info

Product

Resources

About