770 Welch Rd Suite 400
Palo Alto CA 94304
Medical School: Other - Unknown
Accepts Medicare: No
Participates In eRX: No
Participates In PQRS: No
Participates In EHR: No
License #: RT 1250
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Transverse tensor fascia lata myocutaneous flap for microvascular breast reconstruction: case report and review of the literature. - Annals of plastic surgery
The transverse tensor fascia lata (TTFL) flap is an important alternative flap for autologous breast reconstruction. It is a horizontal variant of the tensor fascia lata myocutaneous flap and contains fat from the prominence of the upper lateral thigh (saddle bag). We present the surgical management of a woman with trochanteric lipodystrophy, who underwent staged bilateral mastectomy and autologous breast reconstruction with TTFL flaps. We discuss technical points in TTFL flap design and harvest. Breast reconstruction was successful and the thigh donor sites had excellent aesthetic contour. There were no complications at either recipient or donor sites. The TTFL flap is an important alternative flap for autologous breast reconstruction when other options are less optimal, and has a secondary benefit of thigh donor site closure with lateral thigh lift techniques. The TTFL flap should be presented as an option for autologous breast reconstruction in women with prominent trochanteric lipodystrophy of the upper lateral thighs.
Vertical island trapezius myocutaneous flap for cervical esophagoplasty: case report and review of the literature. - Annals of plastic surgery
Reconstruction of the cervical esophagus can be fraught with a variety of complications, such as fistula formation or stricture. Additional complicating factors may include local tumor recurrence, failed prior reconstruction, partial or total flap necrosis, and compromised tissues in an irradiated field. Once complications occur, the chance of a successful reconstruction in subsequent operations is greatly reduced. We report a case of a patient who had local tumor recurrence despite chemoradiotherapy necessitating cervical esophagectomy. Reconstruction of the esophagus was initially performed with a tubed anterolateral thigh flap, which was complicated by partial flap necrosis and salivary fistula. Since the patient was elderly and already had a pectoralis flap used in a previous operation, we elected to perform a vertical island trapezius myocutaneous flap as a salvage procedure to restore esophageal continuity. Postoperatively, the patient had no evidence of further fistula and was able to tolerate a regular diet.
Free flap scalp reconstruction in a 91-year-old patient under local-regional anesthesia: case report and review of the literature. - Journal of reconstructive microsurgery
In the elderly population with significant medical comorbidities, the safety of general anesthesia is often in question. In the head and neck, where regional and extradural anesthesia are not options, reconstruction of defects requiring free tissue transfer becomes a particular challenge for patients in whom general anesthesia is contraindicated. We present a case of a scalp reconstruction utilizing a latissimus dorsi free flap in a 91-year-old man performed entirely under local and regional anesthesia. General anesthesia was contraindicated secondary to the patient's multiple medical comorbidities. A paravertebral block was used for the harvest of the latissimus dorsi muscle and skin grafts. The microvascular portion of the procedure and the inset were performed under local anesthesia alone. The patient tolerated the procedure, and the operation was successful. This case is unique in that there are no published reports of head and neck free tissue transfer being performed entirely under local-regional anesthesia. We conclude that despite the medical challenges of performing complex reconstruction in elderly patients, expedient free tissue transfer can offer patients access to successful reconstruction.Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Early delayed amputation: a paradigm shift in the limb-salvage time line for patients with major upper-limb injury. - Journal of rehabilitation research and development
Patients with major injuries to the upper limbs sometimes fail to achieve successful limb salvage. During the attempt to fashion a functional limb, multiple painful procedures may be ventured. Despite the best efforts of surgeons and therapists, a nonfunctioning or painful upper limb may remain in place for many months or years before late delayed amputation and progression to productive rehabilitation occur. We present three patient cases that illustrate failed upper-limb salvage. In each case, patients expressed a desire for amputation at 6 months after their injury. To reduce the pain and suffering that patients with failed limb salvage endure, we propose a paradigm shift in the limb-salvage time line. We suggest that patients be evaluated for early delayed amputation 6 months after their injury.
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770 Welch Rd Suite 400 Palo Alto, CA 94304
3801 Miranda Ave Department Of Psychiatry (151-Y), Vapahcs
3801 Miranda Ave Domiciliary Service 180D Menlo Park Division
300 Pasteur Dr Grant S101