- Email: [email protected]
Segmental marking: A new technique to prevent pedicle twisting
Correspondence and communications
Conflict of interest None.
873
Segmental marking: A new technique to prevent pedicle twisting
Funding Dear Sir,
None.
Ethical approval This study was conducted under the University of Tokyo ethics committee-approved protocol.
Acknowledgments The first author (T.Y.) would like to thank Dr. Yoshichika Yasunaga for his kindness and valuable suggestion, and Nana and Rico for their kind support to manuscript preparation.
References 1. Yamamoto T, Narushima M, Kikuchi K, et al. Lambda-shaped anastomosis with intravascular stenting method for safe and effective lymphaticovenular anastomosis. Plast Reconstr Surg 2011;127(5):1987e92. 2. Yamamoto T, Narushima M, Yoshimatsu H, et al. Minimally invasive lymphatic supermicrosurgery (MILS): indocyanine green lymphography-guided simultaneous multi-site lymphaticovenular anastomoses via millimeter skin incisions. Ann Plast Surg 2014;72(1):67e70. 3. Yamamoto T, Yamamoto N, Azuma S, et al. Near-infrared illumination system-integrated microscope for supermicrosurgical lymphaticovenular anastomosis. Microsurgery 2014;34(1):23e7. 4. Yamamoto T, Narushima M, Doi K, et al. Characteristic indocyanine green lymphography findings in lower extremity lymphedema: the generation of a novel lymphedema severity staging system using dermal backflow patterns. Plast Reconstr Surg 2011;127(5):1979e86. 5. Yamamoto T, Yoshimatsu H, Koshima I. Navigation lymphatic supermicrosurgery for iatrogenic lymphorrhea: supermicrosurgical lymphaticolymphatic anastomosis and lymphaticovenular anastomosis under indocyanine green lymphography navigation. J Plast Reconstr Aesthet Surg 2014;67(11):1573e9 [epub ahead of print].
In performing free-flap transfer, some surgeons frequently change the position of the flap to achieve the best result, just as painters erase and re-draw some parts of pictures. The pedicle of a free flap can twist during such intraoperative trials. Such twisting is especially likely to occur and be left unnoticed if the pedicle of the flap is long. Once such twisting occurs, thrombosis can develop inside the pedicle vessels, subsequently leading to necrosis of the flap.1 To prevent this complication, we have developed an original technique. In our technique, marks are made segmentally on the pedicle of the flap at intervals of 7e8 mm (Figure 1). We usually use disinfection dyes (crystal violet) for the marking. When the pedicle is placed appropriately, all marks are aligned neatly (Figure 2 Above); when the pedicle twists, some of the marks move to the back side of the pedicle and disappear, presenting irregular patterns (Figure 2 Below). By looking for this change, we can know whether or not the pedicle is correctly placed. In performing free-flap transfer, surgeons should be very careful to avoid twisting the pedicle. Even if vascular anastomosis is successful, the operation ends in failure if the pedicle twists and thrombosis develops inside it. Furthermore, twisting of the pedicle can often go unnoticed, camouflaged by the branches of the arteries and veins. However, when marked with the present technique, the twist is easily recognized. The disinfection dye is usually available in most operation rooms, because it is used to draw the designs of flaps. Only ten to twenty seconds are needed to perform the present technique. Furthermore, this technique does no harm to the pedicle at all. By using
Takumi Yamamoto Ryohei Ishiura Motoi Kato Department of Plastic and Reconstructive Surgery, The University of Tokyo, Japan E-mail address: [email protected] ª 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bjps.2015.01.021
Figure 1 By using a toothpick as a pen (Red arrow), marks are made segmentally on the pedicle (Triangular arrows).
874
Correspondence and communications
Optimizing donor site outcomes after microsurgical proximal interphalangeal joint transfer using the bone-peg technique Dear Sir, Vascularised joint transfer is an option in patients who have had severe traumatic or osteoarthritic changes to their
Figure 2 (Above) When the pedicle is placed appropriately, the marks are aligned neatly. (Below) If the pedicle is twisted, the marks present an irregular pattern.
the present technique, twisting of the pedicle can effectively be prevented. For these advantages, we recommend the present technique as an effective technique for microsurgery.
Ethical approval N/A.
Conflict of interest None.
Funding None.
Reference 1. Lee HJ, Lim SY, Pyon JK, et al. The influence of pedicle tension and twist on perforator flap viability in rats. J Reconstr Microsurg 2011;27:433e8.
Yusuke Hamamoto Tomohisa Nagasao Toshiya Ensako Yoshio Tanaka Department of Plastic Surgery, Medical School of Kagawa University, Miki-Cho Ikenobe 1750-1, Kagawa Prefecture, Japan E-mail address: [email protected] ª 2015 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. http://dx.doi.org/10.1016/j.bjps.2015.01.020
Figure 1 Radiograph of second toe donor site at 1 year. Phalangeal length has been preserved without evidence of resorption.
Conflict of interest None.
873
Segmental marking: A new technique to prevent pedicle twisting
Funding Dear Sir,
None.
Ethical approval This study was conducted under the University of Tokyo ethics committee-approved protocol.
Acknowledgments The first author (T.Y.) would like to thank Dr. Yoshichika Yasunaga for his kindness and valuable suggestion, and Nana and Rico for their kind support to manuscript preparation.
References 1. Yamamoto T, Narushima M, Kikuchi K, et al. Lambda-shaped anastomosis with intravascular stenting method for safe and effective lymphaticovenular anastomosis. Plast Reconstr Surg 2011;127(5):1987e92. 2. Yamamoto T, Narushima M, Yoshimatsu H, et al. Minimally invasive lymphatic supermicrosurgery (MILS): indocyanine green lymphography-guided simultaneous multi-site lymphaticovenular anastomoses via millimeter skin incisions. Ann Plast Surg 2014;72(1):67e70. 3. Yamamoto T, Yamamoto N, Azuma S, et al. Near-infrared illumination system-integrated microscope for supermicrosurgical lymphaticovenular anastomosis. Microsurgery 2014;34(1):23e7. 4. Yamamoto T, Narushima M, Doi K, et al. Characteristic indocyanine green lymphography findings in lower extremity lymphedema: the generation of a novel lymphedema severity staging system using dermal backflow patterns. Plast Reconstr Surg 2011;127(5):1979e86. 5. Yamamoto T, Yoshimatsu H, Koshima I. Navigation lymphatic supermicrosurgery for iatrogenic lymphorrhea: supermicrosurgical lymphaticolymphatic anastomosis and lymphaticovenular anastomosis under indocyanine green lymphography navigation. J Plast Reconstr Aesthet Surg 2014;67(11):1573e9 [epub ahead of print].
In performing free-flap transfer, some surgeons frequently change the position of the flap to achieve the best result, just as painters erase and re-draw some parts of pictures. The pedicle of a free flap can twist during such intraoperative trials. Such twisting is especially likely to occur and be left unnoticed if the pedicle of the flap is long. Once such twisting occurs, thrombosis can develop inside the pedicle vessels, subsequently leading to necrosis of the flap.1 To prevent this complication, we have developed an original technique. In our technique, marks are made segmentally on the pedicle of the flap at intervals of 7e8 mm (Figure 1). We usually use disinfection dyes (crystal violet) for the marking. When the pedicle is placed appropriately, all marks are aligned neatly (Figure 2 Above); when the pedicle twists, some of the marks move to the back side of the pedicle and disappear, presenting irregular patterns (Figure 2 Below). By looking for this change, we can know whether or not the pedicle is correctly placed. In performing free-flap transfer, surgeons should be very careful to avoid twisting the pedicle. Even if vascular anastomosis is successful, the operation ends in failure if the pedicle twists and thrombosis develops inside it. Furthermore, twisting of the pedicle can often go unnoticed, camouflaged by the branches of the arteries and veins. However, when marked with the present technique, the twist is easily recognized. The disinfection dye is usually available in most operation rooms, because it is used to draw the designs of flaps. Only ten to twenty seconds are needed to perform the present technique. Furthermore, this technique does no harm to the pedicle at all. By using
Takumi Yamamoto Ryohei Ishiura Motoi Kato Department of Plastic and Reconstructive Surgery, The University of Tokyo, Japan E-mail address: [email protected] ª 2015 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.bjps.2015.01.021
Figure 1 By using a toothpick as a pen (Red arrow), marks are made segmentally on the pedicle (Triangular arrows).
874
Correspondence and communications
Optimizing donor site outcomes after microsurgical proximal interphalangeal joint transfer using the bone-peg technique Dear Sir, Vascularised joint transfer is an option in patients who have had severe traumatic or osteoarthritic changes to their
Figure 2 (Above) When the pedicle is placed appropriately, the marks are aligned neatly. (Below) If the pedicle is twisted, the marks present an irregular pattern.
the present technique, twisting of the pedicle can effectively be prevented. For these advantages, we recommend the present technique as an effective technique for microsurgery.
Ethical approval N/A.
Conflict of interest None.
Funding None.
Reference 1. Lee HJ, Lim SY, Pyon JK, et al. The influence of pedicle tension and twist on perforator flap viability in rats. J Reconstr Microsurg 2011;27:433e8.
Yusuke Hamamoto Tomohisa Nagasao Toshiya Ensako Yoshio Tanaka Department of Plastic Surgery, Medical School of Kagawa University, Miki-Cho Ikenobe 1750-1, Kagawa Prefecture, Japan E-mail address: [email protected] ª 2015 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. http://dx.doi.org/10.1016/j.bjps.2015.01.020
Figure 1 Radiograph of second toe donor site at 1 year. Phalangeal length has been preserved without evidence of resorption.