For all 5 aesthetic parameters evaluated, the ADM group scored significantly higher than the TSR group by 18 blinded evaluators. These consistent findings suggest that the use of ADM in breast reconstruction does confer a significant advantage in aesthetic outcomes for breast reconstruction. This is likely at the cost of a higher infection rate when using ADM; however, that may be offset by the advantage of a lower rate of capsular contracture in patients with ADM.

General anesthesia induces hypotension and this is commonly treated intraoperatively with administering vasopressors. Microsurgeons are hesitant to use vasopressors due to the potential risk of inducing vasoconstriction and flap necrosis. The aim of this study was to determine the frequency of intraoperative vasopressor utilization in patients undergoing free tissue transfer reconstruction and to determine its impact on patient outcomes. An IRB-approved retrospective review was performed for 47 consecutive patients undergoing free tissue transfer for head, neck, and extremity reconstruction at Wake Forest Baptist Health over a 3-year period. Free flap survival was 97%, with 3% of patients having total flap necrosis and 17% with partial flap necrosis. The frequency of intraoperative vasopressor use was 53.2%. There was no significant difference in the frequency of total or partial flap necrosis between patients who received intraoperative vasopressors and those who did not. Similarly, there was no statistical significance in the rate of arterial or venous thrombosis between the 2 groups (P = 0.095 and P = 0.095, respectively). The use of vasopressors did not significantly increase postoperative complications. The timing of vasopressor administration did not affect outcomes. Intraoperative vasopressors are used more frequently than previously realized during free tissue transfer for reconstructive surgery. The use of intraoperative vasopressors does not appear to adversely affect outcomes of free tissue transfer. Further investigation and larger study size are needed to analyze the timing of drug administration, dose, and type of vasopressor to better understand the impact of intraoperative vasopressor use in free tissue transfer outcomes.

Background: Tibial tubercle transfer (TTT) and medial patellofemoral ligament (MPFL) reconstruction have both shown, either in isolation or in combination, to provide improved patellofemoral joint (PFJ) stability. There are few studies that provide evidence that this remains true in the long term. Purpose: To compare the long-term results of patellar instability after TTT with and without MPFL reconstruction in 2 randomized groups. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 34 patients (36 knees) were randomized to 2 groups. The first group underwent lateral release (LR) and TTT for confirmed maltracking of the patella (control group). The second group underwent MPFL reconstruction in addition to TTT and LR (reconstruction group). Patients were followed up with validated questionnaires (Kujala score, Tegner activity score), a visual analog scale (VAS) assessing their insecurity, and a clinical assessment at a minimum of 5 years postoperatively. Participants also underwent quantitative computed tomography (CT) at 1 year for comparison. Two patients in the control group and 1 patient in the reconstruction group were lost to follow-up at 5 years. Results: There were no significant differences in the Kujala ( P = .75), Tegner ( P = .36), or VAS ( P = .75) scores at any time period. One patient in the control group sustained a patellar redislocation at 3 years. Five patients in the control group and 2 in the reconstruction group had functional failures and required reoperations; however, this was not statistically significant ( P = .30). There were no significant differences between groups in the time to return to school or work ( P = .65) or sports ( P = .38) after surgery. Overall patient satisfaction was higher in the reconstruction group compared with the control group ( P = .04), and quantitative CT scans showed that the reconstruction group had a statistically significant improvement in the mean patellar tilt (6° vs −8°, respectively; P = .03) and mean congruence angle (13° vs −11°, respectively; P = .03) in the quadriceps-contracted state compared with the control group. Conclusion: Reconstruction of the MPFL in addition to TTT and LR resulted in improved alignment parameters (congruence angle, patellar tilt angle) as well as patient satisfaction. The Kujala and Tegner scores were no different between the 2 groups at any time period. There was insufficient evidence to conclude that the addition of MPFL reconstruction to TTT results in fewer redislocations or reoperations. This study concludes that MPFL reconstruction improves PFJ alignment and patient satisfaction; however, further studies with larger patient numbers are required to satisfy its significance with respect to redislocation rates and functional scores in the long term.

Integra is an effective method to treat complex hand wounds with exposed bone, joints, and/or tendons. This technique can be used in the office, lessens the need for local or free flap coverage, and provides an excellent aesthetic outcome. Integra should be considered a viable option in hand reconstruction algorithm.

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