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L S Levin - One of the best experts on this subject based on the ideXlab platform.
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From Autotransplantation to Allotransplantation: A Perspective on the Future of Reconstructive Microsurgery.
Journal of reconstructive microsurgery, 2018Co-Authors: L S LevinAbstract:It has been half a century since Susumu Tamai reported on the first thumb replantation. The evolution of Reconstructive microsurgery has continually added new applications of the operating microscope for Reconstructive surgery and has had profound impact on countless patients. From the time of Harold Gillies until today, the Reconstructive Ladder has evolved to a Reconstructive elevator with the "penthouse" floor being represented by vascularized composite allotransplantation.
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Reconstruction for All: The Case for Pediatric Hand Transplantation
Vascularized Composite Allotransplantation, 2015Co-Authors: David L. Colen, Jonathan Bank, Christine Mcandrew, L S LevinAbstract:The advent of vascularized composite allotransplantation (VCA) has ushered in a new era of Reconstructive surgery. Lower rungs on the Reconstructive Ladder rely on autologous tissue, alloplastic materials and pretreated biologics to reconstruct and mimic the functional and aesthetic components of human anatomy. VCA, however, uniquely provides the exact functional components in the appropriate anatomic configuration to restore both form and function together in a single unit. Following the first successful hand transplant in 1998, the medical community has progressively adopted VCA as a viable restorative option for a multitude of functional defects. Reconstructive Hand Transplantation (RHT) remains the most commonly practiced form of VCA and to date, 72 patients in 16 countries have undergone transplantation of 107 upper extremities over the past 17 y. As this field continues to gain traction and enjoy advances in transplant medicine, it is time we consider pediatric recipients who may have more to gain f...
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Management of soft tissue defects of the hand.
The Journal of hand surgery, 2015Co-Authors: Sarah M. Yannascoli, Stephanie Thibaudeau, L S LevinAbstract:Soft tissue coverage of the hand remains a challenging problem to the hand surgeon, but advances in the field of microsurgery have provided improved thin, pliable, durable flaps that offer cosmetic Reconstructive options. The Reconstructive elevator is poised to replace the Reconstructive Ladder, thereby allowing early reconstruction by the best available option. This reviews focus on the variety of pedicled, free fasciocutaneous, and venous flaps available for successful soft tissue coverage of the hand.
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The Reconstructive microsurgery Ladder in orthopaedics
Injury, 2013Co-Authors: Scott M. Tintle, L S LevinAbstract:Since the advent of the operating microscope by Julius Jacobson in 1960, Reconstructive microsurgery has become an integral part of extremity reconstruction and orthopaedics. During World War I, with the influx of severe extremity trauma Harold Gillies introduced the concept of the Reconstructive Ladder for wound closure. The concept of the Reconstructive Ladder goes from simple to complex means of attaining wound closure. Over the last half century microsurgery has continued to evolve and progress. We now have a microsurgical Reconstructive Ladder. The microsurgical reconstruction Ladder is based upon the early work on revascularization and replantation extending through the procedures that are described in this article.
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the Reconstructive Ladder an orthoplastic approach
Orthopedic Clinics of North America, 1993Co-Authors: L S LevinAbstract:The Reconstructive Ladder has many rungs. The Reconstructive surgeon may go from one level to another and, in many instances, simultaneously employ different aspects of the Ladder for different problems (i.e., a free-muscle transplant to a large lower extremity defect being covered by split-thickness skin grafts uses two rungs on the Ladder). Familiarly with local as well as distant tissue options ensures success when the soft-tissue envelope is treated using this Reconstructive Ladder.
L Vaienti - One of the best experts on this subject based on the ideXlab platform.
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Soft-tissue defects of the Achilles tendon region: Management and Reconstructive Ladder. Review of the literature.
Injury, 2016Co-Authors: A Marchesi, P C Parodi, M Brioschi, M Riccio, R E Perrotta, M Colombo, G M Calori, L VaientiAbstract:Defects of the Achilles tendon region represent a challenge for Reconstructive surgeons. Several options are available but there is still no Reconstructive Ladder for this specific and tricky area. An up-to-date Reconstructive Ladder according to local and general conditions is proposed based on our multicentre experience and an extensive review of the English literature on PubMed. An extensive review of the English literature was performed on PubMed using the following key-words: "Achilles region", "heel", "soft-tissue reconstruction", "flaps", "grafts" and "dermal substitutes". A total of 69 complete papers were selected, covering the last thirty years' literature. Although most of the studies were based on limited case-series, local and general conditions were always reported. A comprehensive Reconstructive Ladder of all the available Reconstructive techniques for the Achilles region has been created based on our personal multicentre experience and the results of the literature review. The Reconstructive Ladder is a concept that is still a mainstay in plastic surgery and guides decisions in the repair strategy for soft tissue defects. The optimal solution, according to the experience of the surgeon and the wishes of the patient, is the one that implies less sacrifice of the donor site. Perforator flaps should be the first-line option for small-to-moderate defects; the distally-based sural flap is the most reported for moderate-to-large defects of the Achilles region, and free flaps should be reserved mainly for complex and wide reconstructions. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Soft-tissue defects of the Achilles tendon region: Management and Reconstructive Ladder. Review of the literature
Injury-international Journal of The Care of The Injured, 2016Co-Authors: A Marchesi, P C Parodi, M Brioschi, M Riccio, M Colombo, G M Calori, Rosario Perrotta, L VaientiAbstract:Abstract Introduction Defects of the Achilles tendon region represent a challenge for Reconstructive surgeons. Several options are available but there is still no Reconstructive Ladder for this specific and tricky area. An up-to-date Reconstructive Ladder according to local and general conditions is proposed based on our multicentre experience and an extensive review of the English literature on PubMed. Materials and methods An extensive review of the English literature was performed on PubMed using the following key-words: “Achilles region”, “heel”, “soft-tissue reconstruction”, “flaps”, “grafts” and “dermal substitutes”. Results A total of 69 complete papers were selected, covering the last thirty years’ literature. Although most of the studies were based on limited case-series, local and general conditions were always reported. A comprehensive Reconstructive Ladder of all the available Reconstructive techniques for the Achilles region has been created based on our personal multicentre experience and the results of the literature review. Conclusions The Reconstructive Ladder is a concept that is still a mainstay in plastic surgery and guides decisions in the repair strategy for soft tissue defects. The optimal solution, according to the experience of the surgeon and the wishes of the patient, is the one that implies less sacrifice of the donor site. Perforator flaps should be the first-line option for small-to-moderate defects; the distally‐based sural flap is the most reported for moderate-to-large defects of the Achilles region, and free flaps should be reserved mainly for complex and wide reconstructions.
A Marchesi - One of the best experts on this subject based on the ideXlab platform.
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Soft-tissue defects of the Achilles tendon region: Management and Reconstructive Ladder. Review of the literature.
Injury, 2016Co-Authors: A Marchesi, P C Parodi, M Brioschi, M Riccio, R E Perrotta, M Colombo, G M Calori, L VaientiAbstract:Defects of the Achilles tendon region represent a challenge for Reconstructive surgeons. Several options are available but there is still no Reconstructive Ladder for this specific and tricky area. An up-to-date Reconstructive Ladder according to local and general conditions is proposed based on our multicentre experience and an extensive review of the English literature on PubMed. An extensive review of the English literature was performed on PubMed using the following key-words: "Achilles region", "heel", "soft-tissue reconstruction", "flaps", "grafts" and "dermal substitutes". A total of 69 complete papers were selected, covering the last thirty years' literature. Although most of the studies were based on limited case-series, local and general conditions were always reported. A comprehensive Reconstructive Ladder of all the available Reconstructive techniques for the Achilles region has been created based on our personal multicentre experience and the results of the literature review. The Reconstructive Ladder is a concept that is still a mainstay in plastic surgery and guides decisions in the repair strategy for soft tissue defects. The optimal solution, according to the experience of the surgeon and the wishes of the patient, is the one that implies less sacrifice of the donor site. Perforator flaps should be the first-line option for small-to-moderate defects; the distally-based sural flap is the most reported for moderate-to-large defects of the Achilles region, and free flaps should be reserved mainly for complex and wide reconstructions. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Soft-tissue defects of the Achilles tendon region: Management and Reconstructive Ladder. Review of the literature
Injury-international Journal of The Care of The Injured, 2016Co-Authors: A Marchesi, P C Parodi, M Brioschi, M Riccio, M Colombo, G M Calori, Rosario Perrotta, L VaientiAbstract:Abstract Introduction Defects of the Achilles tendon region represent a challenge for Reconstructive surgeons. Several options are available but there is still no Reconstructive Ladder for this specific and tricky area. An up-to-date Reconstructive Ladder according to local and general conditions is proposed based on our multicentre experience and an extensive review of the English literature on PubMed. Materials and methods An extensive review of the English literature was performed on PubMed using the following key-words: “Achilles region”, “heel”, “soft-tissue reconstruction”, “flaps”, “grafts” and “dermal substitutes”. Results A total of 69 complete papers were selected, covering the last thirty years’ literature. Although most of the studies were based on limited case-series, local and general conditions were always reported. A comprehensive Reconstructive Ladder of all the available Reconstructive techniques for the Achilles region has been created based on our personal multicentre experience and the results of the literature review. Conclusions The Reconstructive Ladder is a concept that is still a mainstay in plastic surgery and guides decisions in the repair strategy for soft tissue defects. The optimal solution, according to the experience of the surgeon and the wishes of the patient, is the one that implies less sacrifice of the donor site. Perforator flaps should be the first-line option for small-to-moderate defects; the distally‐based sural flap is the most reported for moderate-to-large defects of the Achilles region, and free flaps should be reserved mainly for complex and wide reconstructions.
Jeffrey B. Friedrich - One of the best experts on this subject based on the ideXlab platform.
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Soft Tissue Coverage of the Hand and Upper Extremity: The Reconstructive Elevator
The Journal of hand surgery, 2016Co-Authors: Erin A. Miller, Jeffrey B. FriedrichAbstract:Soft tissue reconstruction of the upper extremity is a complex topic because every defect has multiple potential solutions. Whereas the often-cited Reconstructive Ladder advised selection of the simplest reconstruction of the defect, the newer concept of the Reconstructive elevator allows freedom to choose a more complex reconstruction to account for specialized function and aesthetic outcome. An algorithm for assessment of the defect is presented and demonstrated in this review, using 6 case examples to highlight key concepts. Representative flaps are presented and a discussion of functional and aesthetic outcomes is undertaken to provide a framework for achieving the patient's and surgeon's goals of reconstruction.
Lawrence X. Webb - One of the best experts on this subject based on the ideXlab platform.
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Reply to Letter to the Editor: Negative Pressure Wound Therapy in Grade IIIB Tibial Fractures: Fewer Infections and Fewer Flap Procedures?
Clinical orthopaedics and related research, 2015Co-Authors: Daniel R. Schlatterer, Adam G. Hirschfeld, Lawrence X. WebbAbstract:W e would like to support the interesting conclusions from a systematic review recently presented by Schlatterer and colleagues [1]. Their study addresses treatment for Grade IIIB tibial fractures and points to negative pressure wound therapy as an option that is changing the way many traumatologists think about the treatment of these difficult-to-manage wounds. As Schlatterer and colleagues point out, some clinicians support wound closure or stable muscle flap coverage within 72 hours to limit complications. The authors, however, found evidence to suggest that negative pressure wound therapy can be performed safely beyond 72 hours without increasing the risk of infection. These complex wounds can cause terrible morbidity and constitute a public health problem for many centers [2]. Through the years, researchers have devised a hierarchy of procedures within a hypothetical Reconstructive Ladder to guide the surgical treatment of wounds. This traditional Reconstructive Ladder, in its various iterations, subsequently has become a paradigm that helps to inform the choice of closure method across an array of defects. Currently, the increased availability of negative pressure wound therapy has illuminated its key benefits, including faster granulation tissue formation, less periwound edema, decreased closure time, less-frequent dressing changes, control of bacterial proliferation, and potential cost reduction. Although Janis et al. [3] have now incorporated negative pressure wound therapy as a new step in the traditional Reconstructive Ladder, we are advocating a different approach. In our experience, a descent in the usual Reconstructive Ladder (that is, from flaps to skin grafts or primary closure) is feasible if neoadjuvant negative pressure wound therapy is applied in the course of treating some complex wounds. This downscaled approach was taken in 106 patients with complex wounds seen between February 2011 and August 2014. All patients were initially subjected to negative pressure wound therapy via VAC system (Kinetic Concepts Inc, San Antonio, TX, USA). In 90 patients whose wounds were measured, the average wound area was 87 cm. (RE: Schlatterer DR, Hirschfeld AG, Webb LX. Negative pressure wound therapy in grade IIIB tibial fractures: Fewer infections and fewer flap procedures? Clin Orthop Relat Res. 2015;473:1802–1811). The authors certify that they, or any member of their immediate families, have no commercial associations (eg, consultancies, stock ownership, equity interest, patent/ licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR or The Association of Bone and Joint Surgeons. J. A. Farina Jr MD, PhD (&), C. E. F. de Almeida MD, PhD, E. G. S. C. Marques MD, J. L. G. Jorge MD, R. V. K. S. Lima MD Division of Plastic Surgery of Department of Surgery and Anatomy, Ribeirao Preto Medical School of University of Sao Paulo-Brazil, Av. Bandeirantes, 3900 Monte Alegre, Ribeirao Preto, Sao Paulo 14049-900, Brazil e-mail: jafarinajr@fmrp.usp.br Letter to the Editor Published online: 21 August 2015 The Association of Bone and Joint Surgeons1 2015
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Soft-tissue management after trauma: initial management and wound coverage
Instructional course lectures, 2011Co-Authors: Nirmal C. Tejwani, Lawrence X. Webb, Edward J. Harvey, Philip R WolinskyAbstract:Before proceeding with treatment, it is necessary to recognize that bony injuries are always associated with soft-tissue disruption and damage. A good soft-tissue envelope is essential to fracture healing and overall extremity function. Injury management begins by recognizing and classifying the injury. Wound debridement with irrigation fluid at low pressure and the administration of antibiotics are essential aspects of treatment. Wound treatment starts with applying dressing material using negative suction and can be guided by the tenets of an algorithm modeled on the Reconstructive Ladder.