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  • 1.
    Agrogiannis, Nikolaos
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Rozen, Shai
    Reddy, Gangadasu
    Audolfsson, Thorir
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Rodriguez Lorenzo, Andres
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Vastus lateralis vascularized nerve graft in facial nerve reconstruction: An anatomical cadaveric study and clinical implications2015In: Microsurgery, ISSN 0738-1085, E-ISSN 1098-2752, Vol. 35, no 2, p. 135-139Article in journal (Refereed)
  • 2. Audolfsson, Thorir
    et al.
    Rodríguez-Lorenzo, Andrés
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Wong, Corrine
    Cheng, Angela
    Kildal, Morten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Nowinski, Daniel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Rozen, Shai
    Nerve Transfers for Facial Transplantation: a cadaveric study for motor and sensory restoration2013In: Plastic and reconstructive surgery (1963), ISSN 0032-1052, E-ISSN 1529-4242, Vol. 131, no 6, p. 1231-1240Article in journal (Refereed)
    Abstract [en]

    BACKGROUND

    Restoration of facial animation and sensation are highly important for the outcome after facial allotransplantation. The identification of healthy nerves for neurotization, through recipient to donor nerve coaptation, is of particular importance for successful nerve regeneration within the allograft. However, due to the severity of the initial injury and resultant scar formation, a lack of healthy nerve stumps in the recipient is a commonly encountered problem. In this study, we evaluate the technical feasibility of performing nerve transfers in facial transplantation for both sensory and motor neurotization.

    METHODS

    Fifteen fresh cadaver heads were used in this study. The study was divided in two parts. First, the technical feasibility of nerve transfer from the cervical plexus (CP) to the mental nerve (MN) and the masseter nerve (MaN) to the buccal branches of the facial nerve (BBFN) was assessed. Next, we performed nerve transfers in simulated face transplants to describe the surgical technique focusing on sensory restoration of the midface and upper lip by neurotization of the infraorbital nerve (ION), sensory restoration of the lower lip by neurotization of the MN, and smile reanimation by neurotization of the BBFN.

    RESULTS

    In all specimens coaptation of at least one of branches of the CP to the mental nerve was possible as well as between the masseter nerve to the buccal branch of the facial nerve. In simulated face transplant procedures nerve transfers of the supraorbital nerve (SON) to the infraorbital nerve (ION), cervical plexus branches to the mental nerve, and masseter nerve to facial nerve are all technically possible.

    CONCLUSION

    Nerve transfers are a technically feasible option that could theoretically be used in face transplantation either as a primary nerve reconstruction when there are no available healthy nerves, or as a secondary procedure for enhancement of functional outcomes. The supraorbital nerve, branches of the cervical plexus and the masseter nerve are nerves usually located out of the zone of injury and can be selected as neurotizers for the infraorbital nerve, mental nerve and buccal branch of the facial nerve respectively.

  • 3.
    Blache, Ludovic
    et al.
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology.
    Nysjö, Fredrik
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Computerized Image Analysis and Human-Computer Interaction.
    Malmberg, Filip
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Division of Visual Information and Interaction.
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Rodriguez-Lorenzo, Andres
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Nyström, Ingela
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Division of Visual Information and Interaction.
    SoftCut:: A Virtual Planning Tool for Soft Tissue Resection on CT Images2018In: Medical Image Understanding and Analysis / [ed] Mark Nixon; Sasan Mahmoodi; Reyer Zwiggelaar, Cham: Springer, 2018, Vol. 894, p. 299-310Conference paper (Refereed)
    Abstract [en]

    With the increasing use of three-dimensional (3D) models and Computer Aided Design (CAD) in the medical domain, virtual surgical planning is now frequently used. Most of the current solutions focus on bone surgical operations. However, for head and neck oncologic resection, soft tissue ablation and reconstruction are common operations. In this paper, we propose a method to provide a fast and efficient estimation of shape and dimensions of soft tissue resections. Our approach takes advantage of a simple sketch-based interface which allows the user to paint the contour of the resection on a patient specific 3D model reconstructed from a computed tomography (CT) scan. The volume is then virtually cut and carved following this pattern. From the outline of the resection defined on the skin surface as a closed curve, we can identify which areas of the skin are inside or outside this shape. We then use distance transforms to identify the soft tissue voxels which are closer from the inside of this shape. Thus, we can propagate the shape of the resection inside the soft tissue layers of the volume. We demonstrate the usefulness of the method on patient specific CT data.

  • 4.
    Bylund, Nina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Jensson, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Enghag, Sara
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Berg, T
    Marsk, E
    Hultcrantz, M
    Hadziosmanovic, Nermin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Rodriguez-Lorenzo, Andres
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Jonsson, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Synkinesis in Bell's palsy in a randomised controlled trial2017In: Clinical Otolaryngology, ISSN 1749-4478, E-ISSN 1365-2273, Vol. 42, no 3, p. 673-680Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To study the development of synkinesis in Bell's palsy. Frequency, severity, gender aspects and predictors were analysed.

    DESIGN: Data from the randomised controlled Scandinavian Bell's palsy trial including 829 patients.

    MAIN OUTCOME MEASURES: Frequency and severity of synkinesis at 12 months were the main outcome measures. Mean Sunnybrook synkinesis scores, voluntary movement scores and composite scores between 6 and 12 months were compared.

    RESULTS: In 743 patients with a 12-month follow-up, synkinesis frequency was 21.3%. There was no gender difference. Synkinesis was moderate to severe in 6.6% of patients. Those with synkinesis at 6 months had a synkinesis score of 4.1 (±2.8 sd), which increased to 4.7 (±3.2) (P = 0.047) at 12 months (n = 93). Sunnybrook composite score at 1 month was the best predictor for synkinesis development with receiver operating characteristics and area under the curve (AUC) 0.87. Risk for synkinesis increased with a lower Sunnybrook composite score. Furthermore, at 1 month, symmetry of voluntary movement had higher predictive value for synkinesis than resting symmetry with AUC 0.87 and 0.77, respectively. Gentle eye closure and open-mouth smile were the only independent significant predictive items (AUC 0.86).

    CONCLUSIONS: Moderate-to-severe synkinesis was present in 6.6% of patients. The mean synkinesis score increased between 6 and 12 months, and outcome should therefore be evaluated after at least 12 months. Sunnybrook composite score and symmetry of voluntary movement at 1 month were good predictors for synkinesis.

  • 5.
    Calì-Cassi, Lorenzo
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Rozen, Shai M.
    Mani, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Thorir, Audolfsson
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Gangadasu, Reddy
    Rodríguez-Lorenzo, Andrés
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    The Anatomical Basis of the Lumbar Artery PerforatorFlap: A Cadaveric and Computer Tomography AngiogramStudy2016In: Clinics in Surgery Journal, ISSN 2474-1647, Vol. 1, article id 1270Article in journal (Refereed)
    Abstract [en]

    Background: Lumbar skin flaps based on cutaneous perforators arising from the lumbar artery have been described for coverage of lumbosacral defects and as free flaps for autologous breast reconstruction. Thus, the purpose of this study is to clarify anatomical aspects of the lumbar artery perforator flaps pertaining improvement in utility and design of this flap. Methods: Five fresh human bodies were dissected and twenty three-dimensional computed tomographic (CT) angiographic previously used for the evaluation of the deep inferior epigastric perforator flap in patients that underwent breast reconstruction were evaluated. All cutaneous lumbar artery perforators were analyzed for total number, location, and external diameter. Results: The number of perforators observed per side was 1.6±0.84 in the CT angiography and 3±1.05 in the cadaver study. Data from CT angiographies showed a mean diameter of the pedicle of 2.76±0.74 mm. This perforators were located at the mean distance from the midline (spinal process) of 76.56±6.97 mm, the mean length pedicle were 19.88±7.57 mm. Data from the cadaveric dissection study the mean diameter of the pedicle were 1.96±0.57 mm, the mean distance from the midline were 69.6±22.5 mm. Conclusion: The lumbar artery perforator flap is based on a perforator that has a predictable location and presents a good caliber. Versatility of design of a pedicled flap as a propeller, bilobed or transposition flap based on this reliable perforator can be useful to reconstruct complex defects in the lumbar area. Preoperative planning with CT angiography is recommended to assess the location and caliber of the perforator allowing a better design of the flap

  • 6. Cheng, Angela
    et al.
    Audolfsson, Thorir
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Rodriguez-Lorenzo, Andres
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Wong, Corrine
    Rozen, Shai
    A reliable anatomic approach for identification of the masseteric nerve2013In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1532-1959, Vol. 66, no 10, p. 1438-1440Article in journal (Refereed)
  • 7.
    Coelho, Ruben
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Ekberg, Thomas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Svensson, Malin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Mani, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Rodriguez-Lorenzo, Andres
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Reconstruction of late esophagus perforation after anterior cervical spine fusion with an adipofascial anterolateral thigh free flap: A case report.2017In: Microsurgery, ISSN 0738-1085, E-ISSN 1098-2752, Vol. 37, no 6, p. 684-688Article in journal (Refereed)
    Abstract [en]

    Reconstruction of late esophageal perforation usually requires flap surgery to achieve wound healing. However, restoring the continuity between the digestive tract and retropharyngeal space to allow for normal swallowing remains a technical challenge. In this report, we describe the use of a thin and pliable free adipofascial anterolateral thigh (ALT) flap in a 47-year-old tetraplegic man with a history of C5-C6 fracture presented with a large posterior esophagus wall perforation allowing an easier flap insetting for a successful wound closure. The postoperative course was uneventful and mucosalization of the flap was confirmed by esophagoscopy 4 weeks postsurgery. The patient tolerated normal diet and maintained normal swallowing during a follow-up of 3 years postoperatively. The adipofascial ALT flap may provide easier insetting due to the thin and pliable layer of adipofascial tissue for reconstructing large defects of the posterior wall of the esophagus by filling the retroesophageal space.

  • 8.
    Cristóbal, Lara
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Linder, Sora
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Lopez, Beatriz
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Mani, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Rodriguez-Lorenzo, Andres
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Free anterolateral thigh flap and masseter nerve transfer for reconstruction of extensive periauricular defects: Surgical technique and clinical outcomes2017In: Microsurgery, ISSN 0738-1085, E-ISSN 1098-2752, Vol. 37, no 6, p. 479-486Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Radical tumor ablation in the periauricular area often results in extensive soft tissue defects, including facial nerve sacrifice, bone and/or dura defects. Reconstruction of these defects should aim at restoring facial reanimation, wound closure, and facial and neck contours. We present our experience using free anterolateral thigh flap (ALT) in combination with masseter nerve to facial nerve transfer in managing complex defects in the periauricular area.

    METHODS: Between 2011 and 2015 six patients underwent a combined procedure of ALT flap reconstruction and masseter nerve transfer, to reconstruct extensive, post tumor resection, periauricular defects. The ALT flap was customized according to the defect. For smile restoration, the masseter nerve was transferred to the buccal branch of the facial nerve. If the facial nerve stump was preserved, interposition of nerve grafts to the zygomatic and frontal branches was performed to provide separate eye closure. The outcomes were analyzed by assessing wound closure, contour deformity, symmetry of the face, and facial nerve function.

    RESULTS: There were no partial or total flap losses. Stable wound closure and adequate volume replacement in the neck was achieved in all cases, as well as good facial tonus and symmetry. The mean follow-up time of clinical outcomes was 16.8 months. Smile restoration was graded as good or excellent in four cases, moderate in one and fair in one.

    CONCLUSION: Extensive periauricular defects following oncologic resection could be adequately reconstructed in a combined procedure of free ALT flap and masseter nerve transfer to the facial nerve for smile restoration.

  • 9. Fernández Gómez, E
    et al.
    Castro Torre, M
    González-Herranz, P
    Delgado Sotorrío, C
    Rodríguez Lorenzo, Andres
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    [Early reconstruction of congenital pseudoarthrosis of the tibia with free vascularized fibular grafts]2012In: Cirugía pediátrica : organo oficial de la Sociedad Española de Cirugía Pediátrica, ISSN 0214-1221, Vol. 25, no 2, p. 113-116Article in journal (Refereed)
    Abstract [es]

    Congenital pseudoarthrosis of the tibia (CPT) is an uncommon disease presenting a tibial nonunion since birth and frequently associated to neurofibromatosis type 1. Surgical management by wide excision of the pseudoarthrosis and sustitution of the defect with vascularized bone in an early stage has proven to be the most effective technique in terms of bone consolidation. We present a clinical case of a 22-month-old patient with CPT treated successfully by reconstruction with a free vascularized fibula graft with an excellent functional result.

  • 10. Galeiras, R.
    et al.
    Álvarez, L.
    Rodriguez Lorenzo, Andres
    University Hospital A Coruna, Spain.
    García, J.
    Martelo, F.
    Pneumonia in Burn Patients2010In: Current Respiratory Medicine Reviews, ISSN 1573-398X, Vol. 6, no 3, p. 175-187Article in journal (Other academic)
    Abstract [en]

    Previous studies have indicated an increased susceptibility to pneumonia in burn injury patients [1-5]. Despite numerous advances in understanding it, its incidence is still quite high and represents a significant cause of morbidity and mortality in this population. In the last few years numerous articles have been published on diagnosis, treatment and prevention. In this review, we have selected those articles that could potentially lead to changes in the clinical practice and handling of pneumonia in adult patients with burn injuries.

  • 11. García Barreiro, J
    et al.
    Rodriguez Lorenzo, Andres
    Cal, M
    Alvarez, A
    Martelo Villar, F
    Treatment of postoperative pain for burn patients with intravenous analgesia in continuous perfusion using elastomeric infusors2005In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 31, no 1, p. 67-71Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Postoperative pain after surgery with patients suffering from burns tends to be moderate or severe, and its treatment requires a combination of high-strength analgesics (opioids) with others having different action mechanisms according to the concept of multimodal analgesia.

    AIMS: In this article we propose the use of continuous intravenous analgesia with morphine using elastomeric infusors at fixed dose for the treatment of this kind of pain. An evaluation is made of its analgesic efficacy, side effects and level of satisfaction.

    MATERIAL AND METHODS: A study was made of 17 burn patients operated on in our unit who received continuous intravenous analgesia during the postoperative period, with morphine at 1mg/h, using elastomeric infusors for a period of 24h. Its analgesic efficacy was analysed using the visual analogical scale (VAS) at different moments; side effects and the level of acceptance by the patient was also evaluated.

    RESULTS: The results confirm a good analgesic effect after 2h from starting perfusion (VAS < 3). The side effects reveal a similar or lesser incidence to the use of morphine in bolus or using the PCA system, and in no cases did they require treatment to be halted. The level of acceptance of the procedure by patients was good.

    CONCLUSION: This method reveals a high level of analgesic efficacy in the postoperative period with burn patients in this study. However, it is important to note the lower results obtained in the first hours of perfusion, and proposing a heavy initial dose of analgesics when starting perfusion. This is presented as an efficient analgesic method that is easy to apply, has a low cost, and the possibility of extending its indications to ambulatory treatment.

  • 12.
    Gösseringer, Nina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Mani, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Cali-Cassi, Lorenzo
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Papadopoulos, Antonia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Rodriguez-Lorenzo, Andres
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Benefits of Two or More Senior Microsurgeons Operating Simultaneously in Microsurgical Breast Reconstruction: Experience in a Swedish Medical Center2017In: Microsurgery, ISSN 0738-1085, E-ISSN 1098-2752, Vol. 37, no 5, p. 416-420Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The aim of this study is to evaluate how the number of senior microsurgeons, performing autologous microvascular breast reconstruction together, influences operating time and postoperative complications.

    METHODS:

    A retrospective study was carried out in one hundred consecutive patients who underwent unilateral delayed deep inferior epigastric perforator flap reconstruction at a single institution. All patients followed our institution's surgical protocol and were divided into groups depending on the number of senior microsurgeons that simultaneously performed the procedure. Operating time and complications were compared between the groups.

    RESULTS:

    Sixteen of the patients were operated by one single microsurgically trained specialist, 64 by two and 20 by three specialists. The mean operating time for the one microsurgeon's group was 286 ± 84 min, for the two-microsurgeons' group 265 ± 57 min and for the three-microsurgeons' group 251 ± 59 min. There was a trend of decreasing operating times when more microsurgeons performed surgery together, however the difference between groups was not statistically significant (P = 0.251). Total flap failure rate was 2% (2/100). Both cases occurred in the group operated by one single microsurgeon (2/16) compared with two microsurgeon's group (0/64) and three microsurgeon's group (0/20; P < 0.005).

    CONCLUSIONS:

    By optimising the surgical experience available during microvascular breast reconstruction, operating time can be reduced and efficiency improved. In the current setting, two microsurgically trained surgeons achieved optimal operation flow with the lowest complication rate.

  • 13.
    Jensson, David
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Enghag, Sara
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Bylund, Nina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Jonsson, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Wikström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Grindlund, Margareta E
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Clinical Neurophysiology.
    Flink, Roland
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Clinical Neurophysiology.
    Rodriguez-Lorenzo, Andres
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Cranial Nerve Coactivation and Implication for Nerve Transfers to the Facial Nerve.2018In: Plastic and reconstructive surgery (1963), ISSN 0032-1052, E-ISSN 1529-4242, Vol. 141, no 4, p. 582e-585eArticle in journal (Refereed)
    Abstract [en]

    In reanimation surgery, effortless smile can be achieved by a nonfacial donor nerve. The underlying mechanisms for this smile development, and which is the best nonfacial neurotizer, need further clarification. The aim of the present study was therefore to further explore the natural coactivation between facial mimic muscles and muscles innervated by the most common donor nerves used in smile reanimation. The study was conducted in 10 healthy adults. Correlation between voluntary facial muscle movements and simultaneous electromyographic activity in muscles innervated by the masseter, hypoglossal, and spinal accessory nerves was assessed. The association between voluntary movements in the latter muscles and simultaneous electromyographic activity in facial muscles was also studied. Smile coactivated the masseter and tongue muscles equally. During the seven mimic movements, the masseter muscle had fewer electromyographically measured coactivations compared with the tongue (two of seven versus five of seven). The trapezius muscle demonstrated no coactivation during mimic movements. Movements of the masseter, tongue, and trapezius muscles induced electromyographically recorded coactivation in the facial muscles. Bite resulted in the strongest coactivation of the zygomaticus major muscle. The authors demonstrated coactivation between voluntary smile and the masseter and tongue muscles. During voluntary bite, strong coactivation of the zygomaticus major muscle was noted. The narrower coactivation pattern in the masseter muscle may be advantageous for central relearning and the development of a spontaneous smile. The strong coactivation between the masseter muscle and the zygomaticus major indicates that the masseter nerve may be preferred in smile reanimation.

  • 14.
    Liu, Tianyi
    et al.
    Uppsala Univ Hosp, Uppsala, Sweden.
    Freijs, Christoffer
    Uppsala Univ Hosp, Uppsala, Sweden.
    Klein, Holger J.
    Uppsala Univ Hosp, Uppsala, Sweden; Zurich Univ Hosp, Zurich, Switzerland.
    Feinbaum, Anna
    Uppsala Univ Hosp, Uppsala, Sweden.
    Svee, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery. Uppsala Univ Hosp, Uppsala, Sweden.
    Rodriguez-Lorenzo, Andres
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery. Uppsala Univ Hosp, Uppsala, Sweden.
    Liss, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences. Uppsala Univ Hosp, Uppsala, Sweden.
    Acosta, Rafael
    Deakin Univ, Geelong, Vic, Australia.
    Mani, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery. Uppsala Univ Hosp, Uppsala, Sweden.
    Patients with abdominal-based free flap breast reconstruction a decade after surgery: A comprehensive long-term follow-up study2018In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1532-1959, Vol. 71, no 9, p. 1301-1309Article in journal (Refereed)
    Abstract [en]

    Background: Abdominal-based free flap has increasingly become the gold standard for breast reconstruction, however long-term evidence of the aesthetic outcome and quality of life is lacking. The present study aims to gain an overview of patients with abdominal-based free flap breast reconstructions in a long-term perspective.

    Methods: Seventy-five patients who received abdominal-based free flap breast reconstructions between 2000-2007 in Uppsala, Sweden were invited back for photographs, 3D imaging and questionnaires. A retrospective chart review was conducted. Patient satisfaction with appearance and quality of life were assessed using the Breast-Q questionnaire. A layman panel and a professional panel rated the aesthetic appearance of the reconstructed breast from photographs and 3D images.

    Results: Fifty-five patients participated with a mean age of 52 +/- 8 years at the time of reconstruction and a mean follow-up time of 11.4 +/- 1.8 years completed the study. The majority of the patients had received unilateral (85%), delayed reconstructions (73%) with prior radiation (55%). There were 53 patients with DIEP flaps, one with free TRAM flap and one with SIEA flap. Breast-Q scores in the cohort were comparable to normative values of women without breast cancer (p < 0.001). There was a high level of agreement for the aesthetic results of the reconstructions between patient, professionals and layman panels (0.89 ICC, 95% CI: 0.83 - 0.93).

    Conclusion: Abdominal-based free flap reconstructions were effective in achieving a lasting positive aesthetic result and a high quality of life in patients a decade after surgery. (C) 2018 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  • 15.
    Lorenzo, Andres Rodriguez
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Batti Söfteland, Madiha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Audolfsson, Thorir
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Acute transfer of superficial radial nerve to the medial nerve: Case Report2012In: Annals of Plastic Surgery, ISSN 0148-7043, E-ISSN 1536-3708, Vol. 69, no 5, p. 547-549Article in journal (Refereed)
    Abstract [en]

    Distal nerve transfers have proven to be an important addition to the armamentarium for reconstruction of peripheral nerve injuries. As new nerve transfer procedures are developed, the indications for their use continue to broaden. We report a case of a 77 year-old male who had a 9 centimeters long gap of the median nerve after suffering from an avulsion injury to his right forearm. This was successfully treated by transferring superficial radial nerve to the median nerve at the carpal tunnel level, thus restoring thumb, index and first web sensation. Our report emphasizes that nerve transfers in the emergency setting may be the treatment of first choice in cases were conventional nerve grafting is known to result in poorer outcomes such as in long nerve gaps or in the elderly patient population.

  • 16. Lorenzo, Andrés R
    et al.
    Alvarez, Angel
    Garcia-Barreiro, Juan
    Centeno, Alberto
    Lopez, Eduardo
    Martelo, Francisco
    Design and creation of an experimental program of advanced training in reconstructive microsurgery2006In: Microsurgery, ISSN 0738-1085, E-ISSN 1098-2752, Vol. 26, no 6, p. 421-428Article in journal (Refereed)
    Abstract [en]

    In this study, we design an experimental protocol for the purpose of enhancing performance in training in microsurgery. It is based on five free tissue transfer exercises in rat (epigastric cutaneous flap, saphenous fasciocutaneous flap, epigastric neurovascular flap, saphenous muscular flap, and hindlimb replantation), which simulate the principal clinical procedures of reconstructive microsurgery. The first part of the study consists of an anatomical review of the flaps of 5 rats and in the second part we have carried out the free transfer of flaps on 25 rats divided into 5 groups. To differentiate between them, we have created a mathematical function, referred to as difficulty in a microsurgical exercise, which has enabled us to establish a scale of progression for training, ranging form the easiest to the most difficult. As a conclusion, we believe that this protocol is a useful instrument as it allows for a more precise assessment of microsurgical capacity due to enhanced accuracy in the reproduction of global procedures and the fact that the quantification of progress in training is based on clinical monitoring after 7 days.

  • 17.
    Marcos, Pedro J.
    et al.
    Neumology, A Coruna University Hospital.
    Rodríguez Lorenzo, Andrés
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Sternal Mass Presenting as a First Manifestation of Lung Cancer2013In: The American journal of surgery, ISSN 0002-9629, E-ISSN 1538-2990, Vol. 346, no 5, p. 420-Article in journal (Refereed)
  • 18.
    Natghian, Hamidreza
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Fransén, Jian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Rozen, Shai M.
    Univ Texas Southwestern Med Ctr Dallas, Dept Plast Surg, Dallas, TX, USA.
    Rodriguez-Lorenzo, Andres
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Qualitative and Quantitative Analysis of Smile Excursion in Facial Reanimation: A Systematic Review and Meta-analysis of 1- versus 2-stage Procedures2017In: Plastic and reconstructive surgery (1963), ISSN 0032-1052, E-ISSN 1529-4242, Vol. 5, no 12, article id e1621Article, review/survey (Refereed)
    Abstract [en]

    Background: Free functional muscle transfer has become a common treatment modality for smile restoration in long-lasting facial paralysis, but the selection of surgical strategy between a 1-stage and a 2-stage procedure has remained a matter of debate. The aim of this study was to compare the quantitative and qualitative outcomes of smile excursion between 1-stage and 2-stage free muscle transfers in the literature.

    Methods: A comprehensive review of the published literature between 1975 and end of January 2017 was conducted.

    Results: The abstracts or titles of 2,743 articles were screened. A total of 24 articles met our inclusion criteria of performing a quantitative or qualitative evaluation of a free-functioning muscle transfer for smile restoration. For the purpose of meta-analysis, 7 articles providing quantitative data on a total of 254 patients were included. When comparing muscle excursion between 1-stage and 2-stage procedures, the average range of smile excursion was 11.5 mm versus 6.6 mm, respectively. For the purpose of systematic review, 17 articles were included. The result of the systematic review suggested a tendency toward superior functional results for the 1-stage procedure when comparing the quality of smile.

    Conclusions: The results of this review must be interpreted with great caution. Quantitative analysis suggests that 1-stage procedures produce better excursion than 2-stage procedures. Qualitative analysis suggests that 1-stage procedures might also produce superior results when based on excursion and symmetry alone, but these comparisons do not include one important variable dictating the quality of a smile—the spontaneity of the smile. The difficulty in comparing published results calls for a consensus classification system for facial palsy.

  • 19.
    Olsson, Pontus
    et al.
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Division of Visual Information and Interaction. Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Computerized Image Analysis and Human-Computer Interaction.
    Nysjö, Fredrik
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Division of Visual Information and Interaction. Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Computerized Image Analysis and Human-Computer Interaction.
    Rodríguez-Lorenzo, Andrés
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Hirsch, Jan-Michaél
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Carlbom, Ingrid B.
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Division of Visual Information and Interaction. Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Computerized Image Analysis and Human-Computer Interaction.
    Haptics-assisted Virtual Planning of Bone, Soft Tissue, and Vessels in Fibula Osteocutaneous Free Flaps2015In: Plastic and Reconstructive Surgery - Global Open, ISSN 2169-7574, Vol. 3, no 8, article id e479Article in journal (Refereed)
    Abstract [en]

    Background: Virtual surgery planning has proven useful for reconstructing head and neck defects by fibula osteocutaneous free flaps (FOFF). Benefits include improved healing, function, and aesthetics, as well as cost savings. But available virtual surgery planning systems incorporating fibula in craniomaxillofacial reconstruction simulate only bone reconstruction without considering vessels and soft tissue.

    Methods: The Haptics-Assisted Surgery Planning (HASP) system incorporates bone, vessels, and soft tissue of the FOFF in craniomaxillofacial defect reconstruction. Two surgeons tested HASP on 4 cases they had previously operated on: 3 with composite mandibular defects and 1 with a composite cervical spine defect. With the HASP stereographics and haptic feedback, using patient-specific computed tomography angiogram data, the surgeons planned the 4 cases, including bone resection, fibula design, recipient vessels selection, pedicle and perforator location selection, and skin paddle configuration.

    Results: Some problems encountered during the actual surgery could have been avoided as they became evident with HASP. In one case, the fibula reconstruction was incomplete because the fibula had to be reversed and thus did not reach the temporal fossa. In another case, the fibula had to be rotated 180 degrees to correct the plate and screw placement in relation to the perforator. In the spinal case, difficulty in finding the optimal fibula shape and position required extra ischemia time.

    Conclusions: The surgeons found HASP to be an efficient planning tool for FOFF reconstructions. The testing of alternative reconstructions to arrive at an optimal FOFF solution preoperatively potentially improves patient function and aesthetics and reduces operating room time.

  • 20. Pan, CH
    et al.
    Chuang, DC
    Rodriguez Lorenzo, Andres
    Chang Gung Memorial Hospital , Chang Gung University.
    Outcomes of Nerve Reconstruction for Radial Nerve Injuries Based on the Level of Injury in 244 operative cases2010In: Journal of Hand Surgery, European Volume, ISSN 1753-1934, E-ISSN 2043-6289, Vol. 35, no 5, p. 385-391Article in journal (Refereed)
    Abstract [en]

    We report a single surgeon series of 244 patients with radial nerve injuries who had nerve repair, neurolysis, or nerve graft over a 17-year period. 44 patients had a Level I or infraclavicular injury, 37 had a Level II injury within the spiral groove of the humerus, 104 had a Level III injury from the lateral arm to antebrachial fossa and 64 had a Level IV injury affecting the posterior interosseous nerve. Nerve grafting was used most frequently in all groups, and was the only method of reconstruction for level II injury. At 21.5 months follow up, Level IV injuries had significantly better outcome of finger and thumb extension, while wrist extension recovered in at least 80% of the patients irrespective of the level of injury. The radial nerve recovered better if repaired or reconstructed within 5 months of injury.

  • 21.
    Rodriguez Lorenzo, Andres
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Principles, Techniques and Applications in Microsurgery2009In: Annals of Plastic Surgery, ISSN 0148-7043, E-ISSN 1536-3708, Vol. 62, no 6, p. 600-Article, book review (Other academic)
  • 22.
    Rodriguez Lorenzo, Andres
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Audolfsson, Thorir
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Rozen, Shai Michael
    University of Texas Southwestern Medical Center, US.
    Kildal, Morten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Nowinski, Daniel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Supraorbitary to infraorbitary nerve transfer for restoration of midface sensation in face transplantation: cadaver feasibility study2012In: Microsurgery, ISSN 0738-1085, E-ISSN 1098-2752, Vol. 32, no 4, p. 309-313Article in journal (Refereed)
    Abstract [en]

    Background:

    The collected experience from facial allotransplantations has shown that the recovery of sensory function of the face graft is unpredictable. Unavailability of healthy donor nerves, especially in central face defects may contribute to this fact. Herein, the technical feasibility of transferring the supraorbitary nerve (SO) to the infraorbitary nerve (IO) in a model of central facial transplantation was investigated.

    Methods:

    Five heads from fresh cadavers were dissected with the aid of 3× loupe magnification. Measurements of the maximum length of dissection of the SO nerve through a supraciliary incision and the IO nerve from the skin of the facial flap to the infraorbital foramen were performed. The distance between supraorbital and infraorbital foramens and the calibers of both nerves were also measured. In all dissections, we simulated a central allotransplantation procedure and assessed the feasibility of directly transferring the SO to the IO nerve.

    Results:

    The average maximum length of dissection for the IO and SO nerve was 1.4 ± 0.3 cm and 4.5 ± 1.0 cm, respectively. The average distance between the infraorbital and supraorbital foramina was 4.6 ± 0.3 cm. The average calibers of the nerves were of 1.1 ± 0.2 mm for the SO nerve and 2.9 ± 0.4 mm for the IO nerve. We were able to perform tension-free SO to IO nerve coaptations in all specimens.

    Conclusion:

    SO to IO nerve transfer is an anatomically feasible procedure in central facial allotransplantation. This technique could be used to improve the restoration of midfacial sensation by the use of a healthy recipient nerve in case of the recipient IO nerves are not available secondary to high-energy trauma.

  • 23.
    Rodriguez Lorenzo, Andres
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery. Institute of Surgical Sciences.
    Audolfsson, Thorir
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences.
    Wong, Corrine
    Cheng, Angela
    Arbique, Gary
    Nowinski, Daniel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Rozen, Shai
    Influence of using a single facial vein as outflow in full-face transplantation: A Three-Dimensional Computed Tomographic Study2015In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1532-1959, Vol. 68, no 10, p. 1358-1363Article in journal (Refereed)
    Abstract [en]

    Background

    The purpose of this study is to evaluate the contribution of a single unilateral facial vein in the venous outflow of total face allograft using three-dimensional computed tomographic imaging techniques to further elucidate the mechanisms of venous complications following total face transplant.

    Methods

    Full-face soft tissue flaps were harvested from fresh adult human cadavers. A single facial vein was identified and injected distally to the submandibular gland with radiopaque contrast (barium sulfate/gelatin mixture) in every specimen. Following vascular injections, three-dimensional computed tomographic venographies of the faces were performed. Images were viewed using TeraRecon Software allowing analysis of the venous anatomy and perfusion in different facial subunits by observing radiopaque filling venous patterns.

    Results

    Three-dimensional computed tomographic venographies demonstrated a venous network with different degree of perfusion in subunits of the face in relation to the facial vein injection side: 100% of ipsilateral and contralateral forehead units, 100% of ipsilateral and 75% of contralateral periorbital units, 100% of ipsilateral and 25% of contralateral cheek units, 100% of ipsilateral and 75% of contralateral nose units, 100% of ipsilateral and 75% of contralateral upper lip units, 100% of ipsilateral and 25% of contralateral lower lip units and 50% of ipsilateral and 25% of contralateral chin units.

    Conclusion

    Venographies of the full-face grafts revealed better perfusion in the ipsilateral hemifaces from the facial vein in comparison with the contralateral hemifaces. Reduced perfusion was observed mostly in the contralateral cheek unit and contralateral lower face including lower lip and chin units.

  • 24.
    Rodriguez Lorenzo, Andres
    et al.
    Chang Gung Memorial Hospital, TLinkou-Taipei, Taiwan.
    Chuang, David C
    Chang Gung Memorial Hospital, TLinkou-Taipei, Taiwan.
    Chen, KT
    Chang Gung Memorial Hospital, TLinkou-Taipei, Taiwan.
    Lyu, RK
    Chang Gung Memorial Hospital, TLinkou-Taipei, Taiwan.
    Ko, YS
    Chang Gung Memorial Hospital, Linkou-Taipei, Taiwan.
    Comparative study of single-, double-, and triple-nerve transfer to a common target: experimental study of rat brachial plexus2011In: Plastic and reconstructive surgery (1963), ISSN 0032-1052, E-ISSN 1529-4242, Vol. 127, no 3, p. 1155-1162Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The purpose of this study was to investigate the recovery of a common target motor function after different single and combined motor nerve transfers in rat brachial plexus model.

    METHODS:

    The musculocutaneous nerve and biceps muscle were chosen as the target for neurotization. The phrenic, pectoral, and suprascapular nerves were selected as the neurotizers. Forty-two Sprague-Dawley rats were randomly assigned to seven groups (six rats in each group): single-neurotizer transfer (three groups), double-neurotizer transfer (three groups), and triple-neurotizer transfer (one group). The contralateral intact forelimb was used as a control. Functional outcomes were measured by grooming test, electrophysiological study, muscle contraction strength, muscle weight, and axon counts.

    RESULTS:

    At 12 weeks, 40 operative rats were studied (two had died). In the single-neurotizer transfer, all three transfers showed no significant difference in motor recovery of the biceps. In the double-neurotizer transfer groups, the worst results were seen in group 6 (combined pectoral and suprascapular nerve transfer) despite increasing axon counts.

    CONCLUSIONS:

    This study may potentially suggest: (1) single-neurotizer transfer will not have synergistic or antagonistic effects; (2) two neurotizers with functional antagonism will significantly downgrade motor recovery of the neurotized muscle despite increasing axon counts; (3) multiple motor neurotizer transfers may not always provide a better outcome, although increasing axons may outweigh antagonistic effects; and (4) phrenic nerve transfer alone did not upgrade the functional outcome despite its automatic discharge. Any nerve transfer combined with phrenic nerve transfer, however, showed improved functional results.

  • 25.
    Rodriguez Lorenzo, Andres
    et al.
    university Hospital A Coruna, Spain.
    Lin, C.H.
    Tensor fasciae latae perforator free flap as a backup procedure for an anterolateral thigh flap2009In: Cirugía Plástica Ibero-Latinoamericana, ISSN 0376-7892, E-ISSN 1989-2055Article in journal (Refereed)
  • 26.
    Rodriguez Lorenzo, Andres
    et al.
    Chang Gung Memorial Hospital , Chang Gung University.
    LIn, CH
    LIn, CH
    Ching, WC
    LIn, YT
    Favorable Outcomes of Replantation of a Totally Degloved Hand with added Arteriovenous Anastomosis: Report of 2 Cases2009In: Journal of Hand Surgery-American Volume, ISSN 0363-5023, E-ISSN 1531-6564, Vol. 34, no 10, p. 1864-1867Article in journal (Refereed)
    Abstract [en]

    Revascularization of the degloved skin is generally accepted as the best option for the management of totally degloved hands. Nevertheless, the selection of vessels for anastomoses is usually difficult in this situation, and insufficient perfusion of the degloved hand skin is common after arterial repair. We present 2 cases of patients who sustained totally degloved hand injuries. Favorable outcomes of replantation were achieved with added arteriovenous anastomoses between the dorsal veins of the degloved hand skin and the digital arteries.

  • 27. Rodriguez Lorenzo, Andres
    et al.
    Lin, Cheng-Hung
    Chang Gung Memorial Hospital, Linkou-Taipei, Taiwan.
    Lin, Chuh-Hung
    Chang Gung Memorial Hospital, Linkou-Taipei, Taiwan.
    Nguyen, A
    Chang Gung Memorial Hospital, Linkou-Taipei, Taiwan.
    Chen, CT
    Chang Gung Memorial Hospital, Linkou-Taipei, Taiwan.
    Wei, Fu-Chan
    Chang Gung Memorial Hospital, Linkou-Taipei, Taiwan.
    Selection of the recipient vein in microvascular flap reconstruction of the lower extremity: analysis of 362 free-tissue transfers2011In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1532-1959, Vol. 64, no 5, p. 649-655Article in journal (Refereed)
    Abstract [en]

    Venous insufficiency is the most common cause of re-exploration in free-tissue transfers to the lower extremity. There is currently no consensus regarding the best approach to recipient vein selection. This study was designed to evaluate whether the type of venous system or the number of recipient veins would impact flap outcomes after microsurgical lower-extremity reconstruction. A retrospective study was conducted in 362 free-tissue transfers for lower-extremity reconstruction between 2003 and 2008. Flap outcomes were evaluated according to the selection of recipient vein system and number of veins. The deep venous system (80.4%) was more frequently selected than the superficial venous system (12.1%) or the combination of both systems (7.5%). In addition, one vein (65.5%) was more commonly used for anastomosis than two veins (34.5%). A total of 26 flaps (7.2%) presented with postoperative venous insufficiency. Male patients, composite defects including bones and the use of bone flaps presented higher rates of venous insufficiency with statistical significance. However, no significant differences were found among the different groups related to the age of patients, co-morbidities, aetiology, location of the defects or timing of reconstruction after trauma. The superficial venous system group was associated with a higher rate of venous insufficiency and partial flap loss compared with the deep venous system group (p = 0.036 and 0.018, respectively). One-vein-anastomosis flaps were associated with statistically significant fewer complete flap failure in comparison with two-vein-anastomosis flaps (p = 0.014). In conclusion, the assessment of recipient vein parameters by surgeon's experience is the best predictor of flap outcome in lower-extremity reconstruction. In our cohort of patients, the deep venous system was more reliable than the superficial venous system, but the use of more than one vein for anastomosis did not correlate with better flap outcomes.

  • 28.
    Rodriguez Lorenzo, Andres
    et al.
    University Hospital A Coruna, Spain.
    Martelo Villar, F.
    Acute renal failure in a young male with cellulitis in the lower leg2008In: Anales de Medicina Interna, ISSN 0212-7199, Vol. 25, no 2Article in journal (Refereed)
  • 29.
    Rodriguez Lorenzo, Andres
    et al.
    Glasgow University.
    Morley, S.
    Payne, A.P.
    Tollan, C.J.
    Soutar, D.S.
    Anatomy of the motor nerve to the gracilis muscle and its implications in a one-stage microneurovascular gracilis transfer for facial reanimation2010In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1532-1959, Vol. 63, no 1, p. 54-58Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The present study was conducted to investigate the anatomy of the motor nerve to the gracilis muscle (MNG) to provide the anatomical basis for harvesting a one-stage gracilis transfer with a long nerve for re-animation of the paralysed face.

    METHODS:

    An anatomical study was performed on 24 lower-limb specimens (from the pelvis down to the knee) from 12 embalmed cadavers. The MNG was dissected from the surface of the muscle to the obturator foramen. Two anatomical regions were defined in the course of the nerve. The first region includes the part of the nerve that can easily be reached through a standard incision in the medial aspect of the thigh, that is, from the surface of the muscle to the posterior border of the adductor brevis muscle and the second region from there to the obturator foramen. Measurements of both anatomical regions and the maximum length of the nerve were taken with a calliper. The anatomical relations of the nerve were also noted and photo-documented.

    RESULTS:

    The median maximum length of the MNG from the surface of gracilis to the posterior border of adductor brevis ('first anatomical region') was 7.7 cm (Range 6.3-10.5 cm); from there to the obturator foramen ('second anatomical region') the length was 3.7 cm (Range 2-6 cm), giving a median length of dissection of the nerve as 11.5 cm (Range 9.9-13.6 cm). Intraneural dissection of the MNG has to be performed proximally in the course of the nerve (the part corresponding to the second anatomical region), just where it runs inside the fascia over the obturator externus muscle.

    CONCLUSIONS:

    Over 10-cm length of the MNG can be obtained when dissected along the course of the nerve up to the obturator foramen. To achieve the maximum length, intraneural dissection must normally be performed after the nerve passes the posterior border of the adductor brevis. An endoscopic approach or extended proximal incision is recommended to easily reach the proximal part of the nerve as far as the obturator foramen.

  • 30.
    Rodriguez Lorenzo, Andres
    et al.
    University Hospital A Coruna, Spain.
    Morris, S.F.
    Carrera Burgaya, A.
    Martelo Villar, F.
    Arterial anatomy of the extensor carpi radialis longus and extensor carpi radialis brevis muscle flaps related to its use in free functioning muscle transfer2008In: Cirugía Plástica Ibero-Latinoamericana, ISSN 0376-7892, E-ISSN 1989-2055, Vol. 34, no 3, p. 167-174Article in journal (Refereed)
  • 31.
    Rodriguez Lorenzo, Andres
    et al.
    University Hospital A Coruna, Spain.
    Pérez-Fontán, F.J
    Fernández, P.
    Álvarez, A.
    Midón, J.
    Martelo, F.
    Pyogenic Flexor Tenosynovitis of the hand: sonographic findings2007In: Cirugía Plástica Ibero-Latinoamericana, ISSN 0376-7892, E-ISSN 1989-2055, Vol. 33, no 3, p. 189-194Article in journal (Refereed)
  • 32.
    Rodriguez Lorenzo, Andres
    et al.
    University Hospital A Coruna, Spain.
    Pérez-Fontán, F.J.
    Fernández, P.
    Álvarez, A.
    Midón, J.
    Martelo, F.
    Streptococcal toxic shock syndrome after necrotizing fascitis due to streptococcus pyogenes2007In: Cirugía Plástica Ibero-Latinoamericana, ISSN 0376-7892, E-ISSN 1989-2055, Vol. 33, no 3, p. 189-194Article in journal (Refereed)
  • 33.
    Rodriguez Lorenzo, Andres
    et al.
    University Hospital A Coruna, Spain.
    Villar, FM
    Nail-splinting technique for injured nails: a simple device made of a surgical glove2007In: Annals of Plastic Surgery, ISSN 0148-7043, E-ISSN 1536-3708, Vol. 59, no 4, article id 477Article in journal (Refereed)
  • 34.
    Rodriguez Lorenzo, Andres
    et al.
    University Hospital A Coruna, Spain.
    Álvarez, J.
    Martelo Villar, F.
    Temporal Artery Biopsy: Review of indications and surgical technique for  plastic surgeons2007In: Cirugía Plástica Ibero-Latinoamericana, ISSN 0376-7892, E-ISSN 1989-2055, Vol. 33, no 2, p. 177-122Article in journal (Refereed)
  • 35.
    Rodriguez-Lorenzo, Andres
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Arufe, Maria C.
    de la Fuente, Alexandre
    Fernandez, Fernando
    Blanco, Francisco
    Influence of Flap Prefabrication on Seeding of Subcutaneously Injected Mesenchymal Stem Cells in Microvascular Beds in Rats2014In: Annals of Plastic Surgery, ISSN 0148-7043, E-ISSN 1536-3708, Vol. 73, no 2, p. 234-238Article in journal (Refereed)
    Abstract [en]

    Background: In this article, the authors investigated whether the prefabrication of an autologous pedicled flap by isolation from the surrounding with artificial skin substitutes would increase mesenchymal stem cell (MSC) seeding. Methods: Mesenchymal stem cells were isolated from human umbilical cords and were cultured and characterized by fluorescence-activated cell sorting. Oxacarbocyanine and its green fluorescence emission were used to label the MSCs population. Sixteen adult Wistar rats were randomized in 4 groups (n = 4 animals per group). In group 1, a prefabricated groin flap (GF) with skin substitutes was harvested without cell injection; in group 2, 1 million MSCs were injected subcutaneously in the area corresponding to the GF without flap harvesting; in Group 3, a prefabricated GF with skin substitutes was harvested and 1 million MSCs were injected subcutaneously; and in Group 4, a prefabricated GF with skin substitutes was harvested and 2 million MSCs were injected subcutaneously. All procedures were performed bilaterally in each animal. Animals were sacrificed 2 weeks after the surgery. Flap viability was then assessed by clinical inspection and histology, and seeding of MSCs was observed. Results: All flaps survived 2 weeks after the surgery. Oxacarbocyanine-labeled cells were found in all prefabricated flaps injected (Groups 3 and 4) in higher number in comparison with the group where subcutaneous injection without flap harvesting was performed (Group 2). This difference was statistically significant (P < 0.05). Conclusions: Prefabricated skin flaps with skin substitutes may provide a useful vehicle for the implantation of MSCs to serve as an autologous microvascular bioscaffold.

  • 36.
    Rodriguez-Lorenzo, Andres
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Gago, Bruno
    Pineda, Andres F.
    Bhatti, Madiha
    Audolfsson, Thorir
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Superficial peroneal and sural nerve transfer to tibial nerve for restoration of plantar sensation after complex injuries of the tibial nerve: Cadaver feasibility study2011In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1532-1959, Vol. 64, no 11, p. 1512-1516Article in journal (Refereed)
    Abstract [en]

    Background: Nerve reconstruction following lower-extremity nerve injuries usually leads to worse outcomes in comparison with upper-extremity injuries due to the long distances of nerve regeneration. This study was performed to consider the clinical application of distal nerve transfer for the treatment of long gaps of the tibial nerve (TN) and in established compartment syndrome. It aimed to determine the anatomic suitability of transferring the sural nerve (SN) in combination with the superficial peroneal nerve (SPN) to the TN at the level of the tarsal tunnel for restoration of plantar sensation. Methods: Nine fresh above-knee amputated limbs were dissected with the aid of loupe magnification. We focussed on the detailed anatomy of the course of the SN and the SPN from its emergence proximally at the knee level to the foot. Two different regions, suprafascial and subfascial, were described for each nerve. The maximum length of dissection and the length of the nerves in each region were measured. In all dissections, we assessed the feasibility of directly transferring the SN and SPN to the TN at the level of the tarsal tunnel. Results: The average length of the course of the SN was 20.6 cm (SD +/- 2.3 cm) subfascially and 16.4 cm (SD +/- 0.9 cm) suprafascially. For the SPN, the average length was 19.4 cm (SD +/- 1.9 cm) subfascially and 18 cm (SD +/- 2.5 cm) suprafascially. The point of emergence of the nerve from the subfascial course to the suprafascial course was defined as the pivot point for its transfer to the TN. Both the SN and the SPN reached the TN comfortably at the level of the tarsal tunnel, allowing direct co-aptation. Conclusion: Distal nerve transfer using the SN in combination with the SPN is an anatomically reliable procedure, being a potential alternative to the use of nerve grafts in reconstruction of long gaps of the TN. In addition, selected patients with compartment syndrome may also benefit from this transfer to restore plantar sensation.

  • 37. Rodriguez-Lorenzo, Andres
    et al.
    Pineda, Andres F.
    Complejo Hospitalario Universitario A Coruna, Spain.
    Nonvascularized transfer of DIP to PIP joint as a backup procedure for vascularized heterotopic joint replantation2011In: European journal of plastic surgery, ISSN 0930-343X, E-ISSN 1435-0130, Vol. 34, no 1, p. 69-70Article in journal (Refereed)
  • 38.
    Rodriguez-Lorenzo, Andres
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Rydevik Mani, Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Thor, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Oral and Maxillofacial Surgery.
    Gudjonsson, Olafur
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
    Marklund, Niklas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
    Olerud, Claes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics.
    Ekberg, Tomas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Otolaryngology and Head and Neck Surgery.
    Fibula osteo-adipofascial flap for reconstruction of a cervical spine and posterior pharyngeal wall defect2014In: Microsurgery, ISSN 0738-1085, E-ISSN 1098-2752, Vol. 34, no 4, p. 314-318Article in journal (Refereed)
    Abstract [en]

    When reconstructing combined defects of the cervical spine and the posterior pharyngeal wall the goals are bone stability along with continuity of the aerodigestive tract. We present a case of a patient with a cervical spine defect, including C1 to C3, associated with a posterior pharyngeal wall defect after excision of a chordoma and postoperative radiotherapy. The situation was successfully solved with a free fibula osteo-adipofascial flap. The reconstruction with a fibula osteo-adipofascial flap provided several benefits in comparison with a fibula osteo-cutaneous flap in our case, including an easier insetting of the soft tissue component at the pharyngeal level and less bulkiness of the flap allowing our patient to resume normal deglutition.

  • 39.
    Rodríguez Lorenzo, Andrés
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Audolfsson, Thorir
    Wong, Corrine
    Saiepour, Daniel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Nowinski, Daniel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Rozen, Shai
    Vascular Perfusion of the Facial Skin: Implications in Allotransplantation of Facial Aesthetic Subunits2016In: Plastic and reconstructive surgery (1963), ISSN 0032-1052, E-ISSN 1529-4242, Vol. 138, no 5, p. 1073-1079Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: As the field of face transplantation develops, it may be possible to transplant segments of facial skin to replace facial aesthetic subunits in selected cases. The aim of this study was to identify the more reliable vascular pedicles of each facial aesthetic subunit for its use in transplantation METHODS:: Six full facial soft-tissue flaps were harvested, and the external carotid artery was identified and cannulated proximal to the facial artery. Next, radiopaque contrast was injected through the facial artery into three of the facial flaps and through the superficial temporal artery in the other three facial flaps. After vascular injections, three-dimensional computed tomographic arteriographs of the faces were obtained, allowing analysis of the arterial anatomy and perfusion in different facial aesthetic subunits.

    RESULTS: The chin, lower lip, upper lip, medial cheek, nose, and periorbital units were perfused in all facial flaps where the facial artery was injected and in none of those where the superficial temporal artery was injected. The lateral cheek was perfused in 100 percent of the superficial temporal artery flaps and in 67 percent of the facial artery flaps. The lateral forehead contained contrast in 100 percent of the superficial temporal artery-injected flaps and in none of the facial artery-injected flaps, and the medial foreheads contained contrast in 67 percent of the facial artery-injected flaps and in 67 percent of the superficial temporal artery-injected flaps.

    CONCLUSION: The majority of the facial subunits can be harvested based on the facial artery pedicle, with the exception of the lateral forehead, which is based on the superficial temporal artery.

  • 40.
    Rodríguez-Lorenzo, Andres
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Jensson, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Weninger, Wolfgang J.
    Schmid, Melanie
    Meng, Stefan
    Tzou, Chieh-Han John
    Platysma Motor Nerve Transfer for Restoring Marginal Mandibular Nerve Function2016In: Journal of Plastic, Reconstructive & Aesthetic Surgery, ISSN 1748-6815, E-ISSN 1532-1959, Vol. 4, no 12, p. e1164-Article in journal (Refereed)
    Abstract [en]

    Background: Injuries of the marginal mandibular nerve (MMN) of the facial nerve result in paralysis of the lower lip muscle depressors and an asymmetrical smile. Nerve reconstruction, when possible, is the method of choice; however, in cases of long nerve gaps or delayed nerve reconstruction, conventional nerve repairs may be difficult to perform or may provide suboptimal outcomes. Herein, we investigate the anatomical technical feasibility of transfer of the platysma motor nerve (PMN) to the MMN for restoration of lower lip function, and we present a clinical case where this nerve transfer was successfully performed.

    Methods: Ten adult fresh cadavers were dissected. Measurements included the number of MMN and PMN branches, the maximal length of dissection of the PMN from the parotid, and the distance from the anterior border of the parotid to the facial artery. The PMN reach for direct coaptation to the MMN at the level of the crossing with the facial artery was assessed. We performed histomorphometric analysis of the MMN and PMN branches.

    Results: The anatomy of the MMN and PMN was consistent in all dissections, with an average number of subbranches of 1.5 for the MMN and 1.2 for the PMN. The average maximal length of dissection of the PMN was 46.5 mm, and in every case, tension-free coaptation with the MMN was possible. Histomorphometric analysis demonstrated that the MMN contained an average of 3,866 myelinated fiber counts per millimeter, and the PMN contained 5,025. After a 3-year follow-up of the clinical case, complete recovery of MMN function was observed, without the need of central relearning and without functional or aesthetic impairment resulting from denervation of the platysma muscle.

    Conclusions: PMN to MMN transfer is an anatomically feasible procedure for reconstruction of isolated MMN injuries. In our patient, by direct nerve coaptation, a faster and full recovery of lower lip muscle depressors was achieved without the need of central relearning because of the synergistic functions of the PMN and MMN functions and minimal donor-site morbidity.

  • 41. Rozen, Shai
    et al.
    Rodriguez Lorenzo, Andres
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Audolfsson, Thorir
    Wong, Corrine
    Cheng, Angela
    Obturator nerve anatomy and relevance to one-stage facial reanimation: limitations of a retroperitoneal approach2013In: Plastic and reconstructive surgery (1963), ISSN 0032-1052, E-ISSN 1529-4242, Vol. 131, no 5, p. 1057-1064Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Single-stage facial reanimation with a partial gracilis muscle coapted to the contralateral facial nerve seems an optimal surgical solution yet has not supplanted the two-stage approach. Insufficient obturator nerve length may limit reach to sizable contralateral facial nerve branches (possibly necessitating interposition nerve grafting), compromise optimal muscle positioning, or risk nerve coaptation under tension. This study evaluates whether retroperitoneal obturator nerve dissection would effectively lengthen the nerve, thus obviating the aforementioned limitations.

    METHODS:

    Ten hemifaces and obturator nerves of five cadavers were dissected. Facial measurements included modiolus to contralateral facial nerve branches of sufficient size at the vertical line of the lateral orbital rim. Obturator nerve measurements included gracilis neurovascular hilum to (1) obturator canal entry point (ab), (2) intraobturator canal point where additional adductor branches are inseparable by internal neurolysis (ac), and (3) retroperitoneal point of separation between anterior and posterior obturator branches (ad). Obturator nerve reach for cross-facial nerve coaptation was assessed.

    RESULTS:

    Successful coaptation was achieved with obturator nerve dissection to point b approximately 20 percent of the time, to point c 60 to 70 percent of the time, and to retroperitoneal point d 90 to 100 percent of the time

    CONCLUSIONS:

    Successful coaptation to large contralateral facial nerve branches is feasible in 90 to 100 percent of cases if the entire anterior obturator branch is harvested. However, the increased risk of retroperitoneal dissection and sacrifice of additional adductor branches decreases the viability of this approach. Obturator canal dissection (point c) provides reach in 60 to 70 percent of cases, but short interposition nerve grafting may prove necessary.

  • 42.
    Zabojova, Jorga
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Thrikutam, Nikhitha
    Univ Texas Southwestern Med Ctr Dallas, Dept Plast & Reconstruct Surg, Dallas, TX 75390 USA.
    Tolley, Philip
    Univ Texas Southwestern Med Ctr Dallas, Dept Plast & Reconstruct Surg, Dallas, TX 75390 USA.
    Perez, Justin
    Univ Texas Southwestern Med Ctr Dallas, Dept Plast & Reconstruct Surg, Dallas, TX 75390 USA.
    Rozen, Shai M.
    Univ Texas Southwestern Med Ctr Dallas, Dept Plast & Reconstruct Surg, Dallas, TX 75390 USA.
    Rodriguez-Lorenzo, Andres
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Relational Anatomy of the Mimetic Muscles and Its Implications on Free Functional Muscle Inset in Facial Reanimation2018In: Annals of Plastic Surgery, ISSN 0148-7043, E-ISSN 1536-3708, Vol. 81, no 2, p. 203-207Article in journal (Refereed)
    Abstract [en]

    Background: The human smile is a complex coordinated activity of mimetic muscles predominantly recognizable by a superolateral pull at the commissure and elevation of the upper lip. The aim of this study was to revisit the muscles of facial expression responsible for these motions, evaluate their relational anatomy and orientation, and relate this to optimal positioning of free muscle transfer in smile reanimation.

    Methods: Nineteen hemifaces from fresh cadaveric specimens were dissected. A subsuperficial muscular aponeurotic system skin flap was elevated to expose the zygomaticus major, zygomaticus minor, levator labii superioris, and levator labii superioris alaeque nasi. Muscle location, length, width, angle of pull, and any anatomic variation were noted.

    Results: All specimens had zygomaticus major, levator labii superioris, and levator labii superioris alaeque nasi muscles present bilaterally. Conversely, the zygomaticus minor was present in only 10 of 19 hemifaces. There was no significant difference in muscle length, width, or line of pull between specimen sides. Of all the assessed muscles, the zygomaticus minor had the most transverse line of pull, at 31.6 degrees; the zygomaticus major was more oblique with a line of pull of 55.5 degrees; and the levator labii superioris and levator labii superioris alaeque nasi were oriented almost vertically with angles of 74.7 degrees and 79.0 degrees, respectively.

    Conclusions: The mimetic muscle vector is quite vertical in comparison to the angle obtained by traditional dynamic smile reconstruction surgeries. A more vertical vector, especially at the upper lip, should be considered in smile reconstruction.

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