Jonatan Hernandez Rosa

Laparoscopic versus open inguinal hernia repair in octogenarians: A follow-up study

Aim:  The elderly population is the fastest growing demographic in developed countries. It is thus imperative to assess common medical procedures in this age group. Inguinal hernia repair is a commonly carried out operation in the USA with two methods of repair existing – laparoscopic and open. Although the advantages of laparoscopic inguinal hernia repair in the general population have been shown, its role in the elderly has yet to be elucidated.

Review of Maxillofacial Hardware Complications and Indications for Salvage.

From 2002 to 2006, more than 117,000 facial fractures were recorded in the U.S. National Trauma Database. These fractures are commonly treated with open reduction and internal fixation. While in place, the hardware facilitates successful bony union. However, when postoperative complications occur, the plates may require removal before bony union. Indications for salvage versus removal of the maxillofacial hardware are not well defined. A literature review was performed to identify instances when hardware may be salvaged. Articles considered for inclusion were found in the PubMed and Web of Science databases in August 2014 with the keywords maxillofacial trauma AND hardware complications OR indications for hardware removal. Included studies looked at human patients with only facial trauma and miniplate fixation, and presented data on complications and/or hardware removal. Fifteen articles were included. None were clinical trials. Complication data were presented by patient, fractures, and/or plate without consistency. The data described 1,075 fractures, 2,961 patients, and 2,592 plates, nonexclusive. Complication rates varied from 6 to 8% by fracture and 6 to 13% by patient. When their data were combined, 50% of complications were treated with plate removal; this was consistent across the mandible, midface, and upper face. All complications caused by loosening, nonunion, broken hardware, and severe/prolonged pain were treated with removal. Some complications caused by exposures, deformities, and infections were treated with salvage. Exposed plates were treated with flaps, plates with deformities were treated with secondary procedures including hardware revision, and hardware infections were treated with antibiotics alone or in conjunction with soft-tissue debridement and/or tooth extraction. Well-designed clinical trials evaluating hardware removal versus salvage are lacking. Some postoperative complications caused by exposure, deformity, and/or infection may be successfully treated with plate salvage. We propose an algorithm using this review and clinical expertise. We also propose that a national databank be created where surgeons can uniformly compile their patient information and examine it in a standardized format to further our understanding of clinical management.

Use of both antegrade and retrograde internal mammary vessels in the bipedicled deep inferior epigastric perforator flap for unilateral breast reconstruction

BACKGROUND Autologous abdominal tissue transfer is a well-established method of breast reconstruction. The deep inferior epigastric perforator (DIEP) flap has the additional benefit of minimal donor site morbidity as it spares the muscle and fascia. Conventional DIEP flaps may not provide adequate volume in cases where the patient is thin, has midline abdominal scars, and/or has a large volume of tissue to replace. One solution is to use a bipedicled DIEP flap, incorporating all the available abdominal tissue. Bipedicled DIEP flaps have been described in a number of different configurations. The literature appears to favor intra-flap anastomosis, with a minimal exposition of two recipient vessels. It has been demonstrated that both the antegrade internal mammary artery (aIMA) and retrograde internal mammary artery (rIMA) are adequate recipient vessels. Here, the authors present a single-center experience with bipedicled DIEP flaps to both the aIMA and rIMA, showing their feasibility and safety. METHODS A retrospective review of patients who underwent unilateral breast reconstruction using bipedicled DIEP flaps was performed to assess outcomes. RESULTS A total of 20 patients who underwent unilateral breast reconstruction using a bipedicled DIEP flap were selected for this study. All of them were previously diagnosed with cancer. There were zero flap failure and zero instance of abdominal hernia or issue with abdominal wall functionality following the surgeries. CONCLUSIONS The series of surgeries described in this study resulted in successful breast reconstruction in 20 women using a bipedicled DIEP flap. The results show that this approach allows for reconstruction in places where a conventional DIEP does not provide adequate volume, achieved safely, and does not increase morbidity. The bipedicled DIEP flap is a viable option for large-volume autologous breast reconstruction, providing ample tissue for successful reconstruction while also allowing for shorter recovery and limited donor site morbidity.

Risk Factors Associated with Free Flap Failure - An Analysis of 2103 Patients.

INTRODUCTION: The use of microvascular free tissue transfer has steadily increased over the years, due to the ability to reconstruct complex defects.1-4 Fortunately, failure rates have decreased over the past few years, with improvements in surgical technique combined with better preand post-operative assessments, including patient selection.5-7 The viability of free flaps depends upon various patient-based factors. The objective of this study was to further identify risk factors that are associated with increased incidence of flap failure, especially with regards to specific types of free flaps based on anatomic location.