Wiley-Liss, Inc. Microsurgery, 2011. “
“Perforator flaps as an innovative method for soft tissue transfer that maximizes check details function preservation, were originally introduced primarily as free flaps. Their reliability and versatility has been found to not differ from other sources of free flaps where total failure is an uncommon event. Partial failure should also be recognized as a possible dilemma that is perhaps more of a unique untoward sequela of perforator flaps. A retrospective review of our flap experience over the past decade included 310 perforator free flaps. Partial perforator flap failure that required a second free flap for salvage was selected in 6 patients. All perforator free flaps in our experience that had some form of partial failure were anterolateral thigh [ALT] free flaps. Clinically initially unrecognizable but ultimately distal flap ischemia could be attributed to poor flap design, and was the cause of immediate partial flap necrosis in 2 cases. Delayed difficulties were complications not specific to perforator flaps. In all cases, a free flap was considered the best option, and a second perforator free flap proved to resolve all reconstructive
objectives. The root cause of partial failure of a perforator free flap was found to be either iatrogenic or de novo in origin. The proper design requires an awareness of the correct topographic axis and an understanding of the perforasome concept to better insure adequate flap perfusion. If a free flap is still BMN 673 chemical structure considered the best solution after a partial failure, the advantages and benefit of a second perforator free flap should not be overlooked. © 2013 Wiley Periodicals, Inc. Microsurgery 34:177–182, click here 2014. “
“Ultrasound (US) has been used in the management of carpal tunnel syndrome since the 1980s. The first report of US-guided carpal tunnel release (CTR) was published in 1997, with cadaver and clinical reports confirming the safe navigation of surgical tools
with US for division of the transverse carpal ligament. The MANOS CTR device was recently reported as a minimally invasive tool for CTR, and may be well suited for use with US guidance. The authors report three cases of US-guided CTR using the MANOS CTR device. The MANOS device was inserted in a blunt configuration into the safe zone, and the cutting surface was deployed with a thumb-activated trigger that simultaneously ejected a sharp through the palm. The transverse carpal ligament was divided safely and confirmed with US. US allowed for clear identification of the median nerve, safe zones, transverse carpal ligament, and the MANOS CTR device in relation to all pertinent structures of the carpal tunnel. Complete division of the transverse carpal ligament was confirmed in all three cases.