Seven of 11 patients had a functional tracheostoma with adequate stomal patency.

Combined use of free jejunum and pectoralis major muscle flap with skin graft provided secure wound closure even for complicated cases. © 2012 Wiley Periodicals, Inc. Microsurgery, 2013. “
“A delay procedure allows for reliable tissue transfer Pifithrin-�� in vitro in random pattern flaps and axial pattern flaps. However, delay procedures have not been studied in free flaps. In this report, we present a case involving the use of a free extended latissimus dorsi musculocutaneous flap (hemiback flap) that included half of the total back skin and was based on thoracodorsal vessels for reconstruction of an extensive soft tissue defect of the flank and waist. The flap was tailored in combination with a delay procedure. Intraoperative indocyanine green fluorescence angiography indicated profuse perfusion except for the most inferomedial part of the flap, which was discarded. The flap survived. A free hemiback flap may offer a valuable option for reconstruction of extensive soft tissue defects. To our knowledge, this is the first report to demonstrate a free flap made in combination with a delay procedure. © 2012 Wiley Periodicals, Inc. Microsurgery, 2013. “
“Microvascular surgeons always hold strong

belief against find more the use of vasopressors during free flap surgery. Our aim is to study the safety of intra-operative vasopressors on free jejunal flap reconstruction. A retrospective chart review was performed on patients undergoing free jejunal flap reconstruction, aiming at investigating the intra-operative use of vasopressors and the potential complications associated. Between 1984 and 2012, 110 free jejunal flaps were performed for reconstruction of circumferential pharyngeal defects created after resection of cancers of the hypopharynx. Intra-operative vasopressor was given in 81 (73.6%) patients. The most common vasopressors

used were ephedrine (42.7%), phenylephrine (14.5%) or both (42.8%). They were administered to the patients selleck chemical before the start of flap harvesting (n = 32, 29.1%), during the flap harvesting (n = 30, 27.3%), during microvascular anastomosis (n = 20, 18.2%), or they were given more than once during the whole operation (n = 28, 25.4%). The incidence of intra-operative re-anastomosis due to thrombosis was 4.5% and the post-operative flap failure rate was 5.4%. There was no significant relationship between the administration of vasopressor during surgery and the need for intra-operative re-anastomosis, post-operative flap failure and the timing of flap failure. Similarly, there was also no relationship between the timing of vasopressor administration and the above variables. The long-term stricture rate was 2.7%, the risk of which was not increased by the intra-operative use of vasopressors. The intra-operative use of vasopressors is safe in free jejunal flap reconstruction. © 2013 Wiley Periodicals, Inc. Microsurgery 33:358–361, 2013.