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Christopher J Salgado

Publications and source records attributed to Christopher J Salgado.

18 recordsLinked to original sources
PubMed2006

Free microvascular transfer of the reverse ileo-colon flap with ileocaecal valve valvuloplasty for reconstruction of a pharyngoesophageal defect: Indication and usage of the 'funnel flap'.

The authors have designed a method of reconstruction for high pharyngeal and oesophageal defects that potentially avoids many of the disadvantages related to size mismatch at the proximal and distal end of oesophageal defects that are encountered with the use of free jejunal and colon flaps, respectively. An ileo-colon flap was used to reconstruct this type of defect where the ascending colon was anastomosed to the pharyngeal end and the ileum was anastomosed to the oesophageal end. Both sides were perfectly matched in circumference and minimal manipulation was necessary at both ends of the flap. A detailed description of the surgical technique is depicted and a case presented. While this procedure solves some of the problems encountered when dealing with this type of defect, it nevertheless does have some disadvantages and technical nuisances that are detailed and discussed in this report.

Colon↗
PubMed2006

Guidelines for the optimization of microsurgery in atherosclerotic patients.

We review the pathogenesis of atherosclerosis and the issues that must be taken into consideration when performing microsurgery in atherosclerotic patients. Atherosclerosis is a systemic disease, and may affect the success of microsurgery. Atherosclerotic patients have a tendency toward thrombosis, because the nature of the arteries is changed. Such patients are usually old and have additional medical problems. To increase the success rate of microsurgery in atherosclerotic patients, special precautions should be considered. Patients must be evaluated properly for the suitability of microsurgery. The microsurgical technique requires a meticulous approach, and various technical tricks can be used to avoid thrombosis. Recipient-vessel selection, anastomotic technique, and the use of vein grafts are all important issues. Prophylactic anticoagulation is recommended in severely atherosclerotic patients. Close monitoring of the patient and flap is necessary after the operation, as with routine microvascular free-tissue transfers. We conclude that atherosclerosis is not a contraindication for microsurgery. If the microsurgeon knows how to deal with the difficulties in atherosclerotic patients, microsurgery can be performed safely.

Anticoagulants↗
PubMed2006

Posterior tibial artery flap in poliomyelitis patients with lower extremity paralysis.

BACKGROUND: Poliomyelitis is a disease that can render affected individuals incapacitated to a variable degree. A normal lifespan is expected and therefore the patients deserve every effort at curative cancer resection and reconstruction. Those with lower extremity paralysis rely heavily on their upper limbs and torso for ambulation; therefore, their compromised limbs may be a better donor site for flaps. METHODS: All poliomyelitis patients with lower extremity paralysis over a 20-month period who underwent head and neck reconstruction were selected for a retrospective review. Perioperative complications were noted and outpatient follow-up was performed. RESULTS: Three patients underwent reconstruction of defects using the posterior tibial artery flap. Two patients required reconstruction of a buccal defect and one patient required soft palate reconstruction. All patients healed without complications and none required reexploration. At a mean follow-up of 10 months, there was no incidence of donor limb vascular compromise, cold intolerance, or long-term paresthesias. CONCLUSIONS: The posterior tibial artery free flap has been used successfully in the past; however, its popularity has been limited because of sacrifice of the posterior tibial artery. Nevertheless, in patients with lower extremity paralysis, this flap may fulfill the requirements of a thin, pliable flap with minimal hair that has a long pedicle and a reliable blood supply. Most importantly, the use of this flap obviates the need to use flaps that fulfill the same requirement, such as forearm flaps, that would be taken from patients' functioning limbs.

Adult↗
PubMed2006

Muscle versus nonmuscle flaps in the reconstruction of chronic osteomyelitis defects.

BACKGROUND: Surgical treatment of chronic osteomyelitis requires aggressive debridement followed by wound coverage and obliteration of dead space with vascularized tissue. Controversy remains as to the effectiveness of different tissue types in achieving these goals and in the eradication of disease. METHODS: Chronic osteomyelitis was induced in 26 goat tibias using Staphylococcus aureus as an infecting inoculum. In a single stage, debridement followed by reconstruction using either a muscle flap (n = 13) or a fasciocutaneous flap (n = 13) was performed. Flap donor sites were closed primarily and antibiotics were given for 5 days postoperatively. Daily clinical evaluation for 1 year was performed and monthly radiographs were obtained for 9 months and 1 year after the reconstruction. RESULTS: Twenty-five flaps survived completely, and one nonmuscle flap underwent partial flap loss following a period of venous congestion. There were no postoperative complications in the muscle flap group. Two goats (15 percent) in the nonmuscle group developed superficial wounds in the immediate postoperative period that resolved with conservative management. No limbs had recurrent osteomyelitis wounds at 1 year of clinical follow-up examination. Radiographic evidence of osteomyelitis was present in two goats (15 percent) in the muscle group and one goat (8 percent) in the nonmuscle group. There was no statistically significant difference in the incidence of recurrent osteomyelitis between the groups by clinical and radiographic assessment. CONCLUSIONS: The findings in this study demonstrate that vascularized tissue flaps in the form of muscle or nonmuscle flaps provide viable options for wound coverage of osteomyelitis defects following adequate surgical debridement.

Animals↗
PubMed2006

Corrective otoplasty for symptomatic prominent ears in U.S. soldiers.

The purpose of this investigation was to evaluate U.S. Army soldiers who presented to the plastic surgery service with the inability to properly wear a government-issued Kevlar field helmet because of their prominent ear deformity. Between September 2000 and April 2002, four patients with prominent ears and helical rim skin abrasions with breakdown attributable to abutment from their helmets underwent open otoplasty with conchal bowl resection via a posterior approach. Symptomatic relief and cosmetic improvement were obtained, with no incidence of complications or recurrence during the follow-up period, which ranged from 9 to 22 months. All patients were able to wear their Army-issued Kevlar helmets without difficulty after surgery. Otoplasty is an effective, reliable procedure that has now been performed to alleviate symptoms in an otherwise asymptomatic patient population.

Adult↗
PubMed2005

Mastodynia refractory to medical therapy: is there a role for mastectomy and breast reconstruction?

BACKGROUND: Mastodynia is among the most frequently reported symptoms in women with breast complaints; it is usually classified as cyclic, noncyclic, or nonbreast in origin. A useful response with medical or conservative therapy is obtained in the majority of these patients. There is a subset of patients, however, who have exhausted every medical effort and psychiatric counseling and will desire mastectomy with breast reconstruction in the hope of alleviating their chronic pain. METHODS: Three patients with noncyclical, bilateral mastodynia referred for breast reconstruction options from December of 2000 to March of 2004 are presented in this article. Daily breast pain charts with a visual analogue scale for pain assessment were analyzed and recorded for all patients throughout the study period. RESULTS: Two patients underwent delayed reconstruction and had complete resolution of pain 6 to 8 weeks after bilateral mastectomy, with no recurrence of mastalgia after reconstruction. One patient underwent bilateral mastectomy with immediate reconstruction and achieved complete resolution of her pain 3 months postoperatively. Histopathologic findings of all breast specimens revealed benign breast tissue with proliferative breast disease consistent with mastodynia. CONCLUSIONS: This modality, which includes mastectomy with or without reconstruction, is a viable alternative after exhaustion of all other nonsurgical options and when quality of life is significantly affected. Although mastectomy for the treatment of mastodynia refractory to medical therapy does not guarantee alleviation of chronic breast pain, it should be considered in these often desperate patients.

Adult↗
PubMed2005

A model for chronic osteomyelitis using Staphylococcus aureus in goats.

Animal models of osteomyelitis traditionally have been characterized by inherent weaknesses related to animal size, differences in clinical findings compared with humans, aggressive behavior, high complication rate, and high cost. In this experiment, a model of tibial osteomyelitis was established in 28 goats with a very low complication rate and a consistent clinical, radiographic, and histologic disease course. The infecting Staphylococcus aureus organism was isolated in all but five of 28 animals (82%), in which there was no growth of bacteria at 24 and 72 hours. All five of these specimens had histologic evidence of osteomyelitis. Twenty-seven of the 28 animals (96%) had radiographic and histologic evidence of osteomyelitis. Clinical progression of the disease was observed by draining wounds, a postoperative limp that subsided in all goats, and varied periods of anorexia despite an average increase in body weight. There were no complications or mortalities related to the establishment of the animal model. This large animal model will provide a practical method of studying osteomyelitis and comparing treatment protocols.

Animals↗
PubMed2005

Intussusception of a transferred jejunal flap in cervical esophagus reconstruction.

Although jejunal flaps have been used frequently for esophageal reconstruction, and the techniques for transfer, as well as subsequent modification, have been well described, a variety of complications still poses problems for both physicians and patients. The challenge exists in avoidance and management of complications. The purpose of this report is to present an unusual but severe complication involving a jejunal flap that was transferred to the neck for esophageal reconstruction. Intussusception of the jejunal flap occurred 1 year after flap transfer due to redundancy of the transferred segment. The patient was a child who had esophageal reconstruction for severe dysphagia that was due to a previous history of radiation injury. The disorder was successfully treated surgically with manual reduction of the intussuscepted segment, followed by shortening of the jejunal flap to prevent future recurrence. One should keep in mind that redundancy of the reconstructed esophagus may cause dysphagia due to kinking or, in this case, intussusception, which may result in necrosis of a segment of the transferred jejunum. One of the measures that should be taken during the initial reconstruction to prevent these serious complications is to perform the final inset of the jejunal flap after revascularization. This allows for proper assessment of jejunal length, which undergoes a significant change after restoration of the vascular supply.

Child↗
PubMed2005

Tubed deltopectoral flap for creation of a controlled esophagocutaneous fistula in patients with persistent choking following esophageal reconstruction with free diversionary jejunum.

Esophageal reconstruction in patients with abnormal pharyngeal muscles or epiglottis may result in episodes of choking. The jejunal flap has been used to prevent choking by insetting the proximal end into the gingivobuccal sulcus and separating the digestive tract from the airway. A technique has been developed to deal with patients with aspiration due to collection of food near the nonfunctioning epiglottis. Between 1997 and 2004, 25 patients underwent reconstruction with jejunal flaps inset into the gingivobuccal sulcus. Postoperatively, 5 patients presented with episodes of choking. All patients underwent creation of an esophagocutaneous fistula using a deltopectoral flap. All flaps survived. Choking resolved and vocal performance was preserved in all patients. The jejunum, inset proximally into the gingivobuccal sulcus, has been successful in reconstructing patients unable to separate the airway from the digestive tract. The deltopectoral flap provides tissue for creation of a tubed flap and allows for the creation of a long fistula that prevents aspiration and can divert oral fluids away from a tracheostomy or a fresh wound.

Airway Obstruction↗
PubMed2005

Intracranial space, brain, and cerebrospinal fluid volume measurements obtained with the aid of three-dimensional computerized tomography in patients with and without Crouzon syndrome.

OBJECT: The authors attempt to provide a standard for volumes of the intracranial space, brain, and cerebrospinal fluid (CSF) in healthy control individuals by using in vivo three-dimensional (3D) computerized tomography (CT) data and to compare these data with those obtained from a group with Crouzon syndrome. METHODS: Fifty-seven individuals underwent 3D head CT scanning for nonintracranial-related disease to produce a set of normal volumes for the intracranial space, brain, and CSF. Prediction limits of 95% were obtained to provide a range of acceptable volumes throughout the growing period and early adulthood. Eleven patients (seven boys and four girls, age range 2.2 months-13.4 years) with Crouzon syndrome underwent identical measurements, which were compared with those of the control patients. The control group comprised 35 boys and 22 girls who ranged in age from 0.26 months to 24.4 years. Intracranial space and brain volume showed a progressive increase with age, with three different slopes from birth to adulthood. Male patients were found to have larger volumes than female patients in the same age group. Volume patterns for CSF were not significantly different within a given age or sex. Six patients with Crouzon syndrome had intracranial and brain volumes within the 95% prediction limit, three patients measured above the limit, and two measured below. CONCLUSIONS: A standard for volumes of intracranial space and structures provides a guideline for the evaluation of patients with intracranial disease. Volumes in patients with Crouzon syndrome can be matched to their normal age- and sex-matched counterparts.

Adolescent↗
PubMed2004

Extended trapezius myocutaneous free flap for the reconstruction of a foot defect lacking adjacent recipient vessels.

Foot reconstruction requires tissue that is durable and can withstand the extremes of pressure and stress. The trapezius myocutaneous flap has not been used previously as a free flap for foot reconstruction. In this report, the trapezius was used as an extended myocutaneous free flap for the reconstruction of a foot wound lacking adjacent and adequate recipient vessels. The extended trapezius flap may be one of the longest free flaps that can be harvested. The indications for the use of this flap are limited. In an extremity that lacks adequate recipient vessels adjacent to the defect, this flap can be extended such that more proximal vessels in the leg can be used as the recipient vessels without the need for vein grafts to bridge the distance. The donor-site morbidity of this flap is minimal when the superior fibers of the trapezius muscle and its innervation are preserved.

Accidents, Traffic↗
PubMed2004

Periareolar approach for the correction of congenital symmastia.

This report elucidates the continued and relatively rare problem of congenital symmastia and its surgical repair without concomitant bilateral breast reduction. This case highlights the use of suction-assisted lipectomy techniques to address the excess fat in the presternal web and a periareolar approach for access to the intermammary space. The periareolar incision allows for the use of a concealed approach and the avoidance of a central scar that could result in hypertrophy or keloid formation, especially in this patient who is more prone to hypertrophic scarring. Furthermore, plication of the central web dermis to the sternal periosteum in a more superior position serves to not only correct the symmastia but also redrape the excess skin and restore the blunted inframammary folds.

Adult↗
PubMed2004

Free tissue transfer in patients with renal disease.

Several authors have cited renal disease as a risk factor for free flap failure. The authors performed a retrospective analysis of all patients who underwent free tissue transfer with concomitant renal disease, including acute renal failure, end-stage renal disease, chronic renal insufficiency, and functional kidney transplants, to determine what effect renal disease has on flap survival and overall reconstructive outcome. More than 1053 free flaps were examined. Renal disease was identified in 32 patients who underwent 33 free tissue transfers. Average patient age was 57 years (range, 36 to 80 years). Twelve patients (38 percent) were on chronic dialysis (end-stage renal disease), 18 patients (56 percent) had chronic renal insufficiency, and three patients (9 percent) had the diagnosis of acute renal failure at the time of surgery. Three patients in the chronic renal insufficiency group had a functioning renal transplant. Average follow-up was 16 months. Immediate postoperative complications occurred in 14 patients (42 percent of the 33 flaps). Overall perioperative mortality was 3 percent. Within the first 30 days there were two cases (6 percent) of primary flap failure; an additional four legs were lost as the result of complications related to their bypass grafts. There were no primary flap failures after 30 days; however, within the first year after surgery an additional seven limbs were lost as the result of progressive ischemia or infection, and an additional three patients died. This resulted in a 52 percent incidence of major morbidity or mortality during the first year and a 55 percent reconstructive success rate in survivors at 1 year. No significant difference was seen in postoperative morbidity or mortality when comparing the end-stage renal disease group to the chronic renal insufficiency group; however, patients with renal disease and diabetes tended to have poorer outcomes. Renal disease, especially renal disease associated with diabetes and peripheral vascular disease, can be a strong indicator of possible reconstructive failure. The surgeon and patient should be aware of the medical and surgical complications associated with this procedure at the outset.

Acute Kidney Injury↗
PubMed2004

Bowel preparation before microvascular free colon transfer for head and neck reconstruction: is it necessary?

Mechanical bowel preparation before any intestinal operation, especially when the large intestine is involved, is routine practice for most surgeons. This practice has been questioned by many colorectal surgeons, with convincing data showing the lack of benefit of preoperative mechanical bowel preparation. Free microvascular transfer of the large intestine is occasionally performed for reconstruction of the upper esophagus, as it provides a better size match for the oropharynx than other visceral organs. Nine patients underwent reconstruction of the cervical esophagus and voice tube using a segment of ileocolon. In all patients, the cervical esophagus was reconstructed using the ascending colon and the voice tube was reconstructed using the ileal segment. Both were transferred as one free flap. All patients underwent the procedure without any form of preoperative mechanical bowel preparation. The patients were able to tolerate a solid diet at the end of the mean follow-up period of 7 months, and all esophagograms showed no evidence of stricture formation. One patient developed a fistula at the recipient site that was treated with a regional flap, one patient developed a superficial wound infection of the abdominal wall, and one patient developed a postoperative abdominal wound dehiscence after several episodes of excessive coughing. Microvascular transfer of a large intestinal segment without preoperative mechanical bowel preparation for the reconstruction of the esophagus is a safe procedure. It can avoid the discomfort and complications associated with mechanical bowel preparation. If preoperative mechanical bowel preparation is preferred, the results of this study, which are based on nine patients, demonstrate the safety of this practice in cases where the patient did not follow proper instructions or in cases where the use of the colon was not anticipated preoperatively.

Aged↗
PubMed2003

Critical oropharyngocutaneous fistulas after microsurgical head and neck reconstruction: indications for management using the "tissue-plug" technique.

Despite advances in head and neck reconstruction with free-tissue transfer techniques, oropharyngocutaneous fistulas continue to present challenging and potentially lethal complications. The authors present a system for prioritizing these fistulas and the surgical management of nine patients in whom critical fistulas developed after microsurgical head and neck reconstruction. The indications for aggressive management of these fistulas were primarily dependent on their location. Three peristomal and six midneck fistulas were considered critical because of the risk of aspiration pneumonia and carotid artery blowout, respectively. Fistulas located in the submental and/or submandibular region were considered noncritical and were managed conservatively. Using the concept of a "tissue plug" for fistula repair, a dermal component (i.e., a deltopectoral or pectoralis major pedicled flap) is guided through the fistula, and with external traction the tissue "plugs" the tract. No sutures are placed directly in the surrounding friable tissue. There were no partial or total flap losses. There were two fistula recurrences in patients who had received postoperative radiation therapy. One of these recurrences was due to tumor recurrence within the previous fistula and was managed with palliative measures. The other fistula recurrence was closed with a local-flap procedure on an outpatient basis. All patients resumed oral feeding, except for the patient in whom tumor recurrence was suspected. This tissue-plug technique can be used in the management of critical peristomal and/or midneck oropharyngocutaneous fistulas not only to obliterate the tract but also to augment volume and vascularity in already damaged, ischemic, and deficient tissue.

Cutaneous Fistula↗
PubMed2002

Effects of late loss of arterial inflow on free flap survival.

Greater than 80 percent of free flap thromboses have been shown to occur within the first three postoperative days, warranting immediate re-exploration and restoration of adequate vessel patency. The infrequency of thromboses beyond this period is reflected in the lack of reported cases in the literature and the absence of accepted guidelines for the treatment of such delayed complications. A single study reported free flap survival in vessel thromboses only when encountered after postoperative day (POD) 7 in a pig model. Since 1990, over 800 free tissue transfers have been done at the University of Rochester. A total of ten cases of late (defined as after POD 7) arterial inflow loss were identified and examined. A retrospective chart review recorded patient demographics, site of tissue defect, free tissue transferred, major co-morbidities, preoperative XRT, timing of arterial inflow loss, nature of inflow loss, and flap survival. The mean POD of arterial inflow loss was 53 days (range: 8 to 166). The mean age of patients was 58 years. No major co-morbidities correlated with late arterial inflow loss. Loss of inflow occurred as anastomotic rupture (5), occlusion of recipient bypass graft in lower extremity cases (3), primary donor arterial thrombosis (1), and pedicle avulsion during re-exploration for seroma (1). Five flaps survived, one sustained partial necrosis, and four were completely lost. Of the five surviving flaps, three were inset into healthy recipient sites. One was utilized on a dysvascular lower extremity, and another was used in an irradiated neck defect. Of the four failed flaps, all were placed in recipient beds compromised by radiation, ischemia, or scarring. Two exemplary case reports are presented. The timing of late loss of arterial inflow does not appear to be the primary determinant of free tissue survival. The condition and quality of the recipient site plays a large role in survival of these flaps. Ischemic, irradiated, and scarred beds are inadequate in providing late flap neovascularization, compared to healthy recipient sites. When encountering late loss of arterial inflow in flaps placed on such compromised beds, the microsurgeon should not anticipate survival based on surrounding vessel ingrowth. More aggressive salvage attempts may be warranted.

Adult↗