Flap edema can often compromise an otherwise successful lower-extremity microsurgical reconstruction. To train a flap toward maturity, various wrapping and dangling protocols have been described. Mixed tissue oxygenation of a myocutaneous free flap for lower-extremity reconstruction is examined as measured by ViOptix with wrapping and unwrapping during dangling at different postoperative time points. The results are compared with the nonaffected lower extremity and additional healthy controls. Upon dangling a reconstructed lower extremity, the tissue oximetry recording of a free flap descended rapidly until the leg was reelevated and then continued at this low level with a gradual return to the predangling baseline. The extent of this drop in tissue oxygenation depended upon positioning, and the length of time to reach its baseline upon reelevation decreased as flap matured postoperatively. In addition, wrapping of a reconstructed lower extremity also decreased the overall drop in tissue oxygenation level and the time to recovery while having no effect on the control. Results of this prospective study can lead to an increased understanding of free flap physiology in lower-extremity reconstruction and can further validate and refine our postoperative management strategies regarding dependency and edema control.

Anatomical and clinical observations elucidated several technical points related to composite tissue transplantation of the midface. Careful graft harvest, appropriate selection of donor and recipient vessels, complete allograft revascularization, and restoration of sensory and motor function are critical to making face transplant surgery safe and functional.

Traditional microsurgery involves the use of bulky and expensive stereo microscopes that have limited portability. Recent advances in video technology have enabled the exploration of alternative visualization methods. The purpose of this study was to evaluate standard laparoscopic equipment for microvascular anastomoses. Eight surgeons completed anastomoses on rat femoral and synthetic vessels using stereo microsurgery and video microsurgery visualization systems. All surgeons had previous experience with stereo microsurgery and none had ever used video microsurgery. Data were collected on overall anastomosis and individual suture times. A sample of completed anastomoses was placed in a video database and evaluated by use of a quality rating scale (8 to 10, excellent; 6 to 7, adequate; less than 6, poor). All surgeons subjectively evaluated the video microsurgery system. A total of 48 anastomoses were completed. The average total anastomosis time for the stereo microsurgery was 1018.9 +/- 463.2 seconds versus 1738.9 +/- 460.1 seconds for the video microsurgery. The average individual suture placement time was 114.6 +/- 60.6 seconds for the stereo microsurgery versus 211.7 +/- 128.4 seconds for the video microsurgery (p < 0.05). Twenty-five of the anastomoses underwent quality review. The overall score of the stereo microsurgery group was 8.1 +/- 1.7, and the video microsurgery group had an overall score of 7.3 +/- 1.6. Survey results revealed that 75 percent of the participants thought that the video microsurgery would be useful for human operations and would improve surgeon comfort, but 87.5 percent would not use the present video microsurgery system over stereo microsurgery in their practice. Although significant differences exist in overall anastomosis and individual suture completion times, no difference was found in the overall quality. Video microsurgery could become a useful tool on the basis of surgeon ergonomics; however, optical parameters require further refinement.