Thomas Hayakawa

The Utility of near Infrared Imaging in Intra-Operative Prediction of Flap Outcome: A Reverse McFarlane Skin Flap Model Study

Skin flaps are complex procedures used extensively in reconstructive surgery that require post-operative monitoring to ensure that they do not fail. Near infrared (NIR) spectroscopic imaging is a convenient, non-invasive method for surgeons to examine flaps during surgery and in the early post-operative period. Using a reverse McFarlane skin flap model, we show that model-free chemometric methods as well as simple modified Beer-Lambert analysis of the NIR images provide insights into the blood supply to flaps and demonstrate that the technique can detect and localise perfusion-related complications as well as give real-time feedback to the surgeon as they try to resolve the complication. We also show that using estimates of tissue haemoglobin oxygen saturation, imaging measurements made during surgery and in the early post-operative period are highly predictive of the outcome of the flap tissue with specificities and sensitivities exceeding 85%.

Anastomosis to the common and proper digital vessels in free flap soft tissue reconstruction of the hand.

This study seeks to demonstrate the safety of anastomosing free flaps to the common or proper digital artery, and to the volar or dorsal digital vein in soft tissue reconstruction of the hand; as well, as to discuss the advantages of this technique.

Patient Reported Outcomes Following Lower Extremity Soft Tissue Sarcoma Resection with Microsurgical Preservation of Ambulation

Background Lower extremity soft tissue sarcoma treatment has evolved from primarily amputation procedures toward limb salvage. This series assesses whether soft tissue sarcoma tissue defects, extensive enough to require microsurgical reconstruction, can reliably result in preservation of ambulation, as well as objectively evaluate functional outcomes utilizing a patient‐reported validated scale. It will also look at whether immediate functional muscle reconstructions and tendon transfers can be successful at restoring ambulation, potentially expanding the indications for limb salvage procedures. Methods A retrospective review of all microsurgical reconstructions for limb salvage in lower extremity sarcoma patients was completed at our institution (2009‐2013). Patients were additionally asked to complete the Toronto Extremity Salvage Score(TESS) quality of life survey. Results Over a 5‐year period, 23 patients (mean age: 53 years) underwent free flap reconstructions for 23 sarcomas (mean follow‐up: 14 months). Seventy‐eight percent of patients received neoadjuvant radiation. The thigh was the most common tumor site (61%) and three muscles were resected on average. Perforator flaps were most frequently used (61%), and functional muscle transfers or immediate tendon transfers were used in four patients. There were no flap take‐backs or failures, and 22 patients achieved independent ambulation. Three patients in the series died, two from metastatic disease found postoperatively and one from local recurrence. A 74% response rate was achieved for the TESS survey, with a mean score of 83. Conclusion Microsurgical reconstruction of lower extremity sarcoma defects enables preservation of independent ambulation. Restoration of function utilizing immediate functional microsurgical reconstructions and tendon transfers should be considered.