Ian Valerio - Academia.edu (original) (raw)

Papers by Ian Valerio

Research paper thumbnail of Use of a bioartificial dermal regeneration template for skin restoration in combat casualty injuries

Regenerative Medicine, 2016

Military personnel who survive combat injuries frequently have large soft tissue wounds complicat... more Military personnel who survive combat injuries frequently have large soft tissue wounds complicated by concomitant injuries and contamination. These devastating wounds present a therapeutic challenge to not only restore the protective skin barrier but also to preserve tendon and muscle excursion, provide protective padding around nerves and restore adequate joint motion. Accordingly, regenerative medicine modalities that can accomplish these goals are of great interest. The use of bioartificial dermal regeneration templates (DRT), such as Integra DRT (Integra Lifesciences Corporation, Plainsboro, NJ, USA), in the management of complex soft tissue injuries has an important role in the reconstruction of war wounds. These DRTs provide initial wound coverage and help establish a well-vascularized wound bed suitable for definitive soft tissue coverage.

Research paper thumbnail of Bioartificial dermal substitutes in the severely traumatized wounded warrior

Research paper thumbnail of Bioartificial dermal regenerate substitutes in severely traumatized wounded warrior

Research paper thumbnail of The Changing and Challenging Patterns of Extremity War Trauma: The Afghanistan Experience

Research paper thumbnail of Advancements in existing and emerging therapies: Selected collaborative efforts among military and civilian centers

Research paper thumbnail of Advanced Cranial Reconstructions in the War Wounded: Indications and Applications for an Intracranial Free Flap

Research paper thumbnail of Light-Activated Sealing of Nerve Graft Coaptation Sites Improves Outcome following Large Gap Peripheral Nerve Injury

Plastic and reconstructive surgery, 2015

Nerve repair using photochemically bonded human amnion nerve wraps can result in superior outcome... more Nerve repair using photochemically bonded human amnion nerve wraps can result in superior outcomes in comparison with standard suture. When applied to nerve grafts, efficacy has been limited by proteolytic degradation of bonded amnion during extended periods of recovery. Chemical cross-linking of amnion before bonding may improve wrap durability and efficacy. Three nerve wraps (amnion, cross-linked amnion, and cross-linked swine intestinal submucosa) and three fixation methods (suture, fibrin glue, and photochemical bonding) were investigated. One hundred ten Lewis rats had 15-mm left sciatic nerve gaps repaired with isografts. Nine groups (n = 10) had isografts secured by one of the aforementioned wrap/fixation combinations. Positive and negative control groups (n = 10) were repaired with graft and suture and no repair, respectively. Outcomes were assessed using sciatic function index, muscle mass retention, and histomorphometry. Statistical analysis was performed using analysis of...

Research paper thumbnail of The use of urinary bladder matrix in the treatment of trauma and combat casualty wound care

Regenerative Medicine, 2015

Treatment of combat injuries and resulting wounds can be difficult to treat due to compromised an... more Treatment of combat injuries and resulting wounds can be difficult to treat due to compromised and evolving tissue necrosis, environmental contaminants, multidrug resistant microbacterial and/or fungal infections, coupled with microvascular damage and/or hypovascularized exposed vital structures. Our group has developed surgical care algorithms with identifiable salvage techniques to achieve stable, definitive wound coverage often with the aid of certain regenerative medicine biologic scaffold materials and advanced wound care to facilitate tissue coverage and healing. This case series reports on the role of urinary bladder matrix scaffolds in the wound care and reconstruction of traumatic and combat wounds. Urinary bladder matrix was found to facilitate definitive soft tissue reconstruction by establishing a neovascularized soft tissue base acceptable for second stage wound and skin coverage options within traumatic and combat-related wounds.

Research paper thumbnail of Subtotal Nasal Reconstruction

Plastic and Reconstructive Surgery - Global Open, 2015

Military plastic surgeons perform reconstructive surgeries for various congenital, oncologic, and... more Military plastic surgeons perform reconstructive surgeries for various congenital, oncologic, and traumatic craniofacial injuries or deformities. Recently, our Walter Reed National Military Medical Center Plastic Surgery team was tasked to care for a woman who bravely sought a new and better life in the United States after she suffered amputation of her nose and bilateral ears while in her home country of Afghanistan. A military-civilian team collaborated throughout her reconstructive planning, treatment, and postoperative course to create both an aesthetically acceptable and functional subtotal nasal reconstruction. This case report details the patient's unique journey, her reconstructive course, and highlights her reintegration into a new life and society.

Research paper thumbnail of 64: Choosing the Right DVT Prophylaxis in the Massive Weight Loss Patient

Plastic and Reconstructive Surgery, 2006

Research paper thumbnail of Vascularized osseous flaps and their bipartate perfusion: Real-time objective assessment and perfusion-related complication reduction via intra-operative fluorescence angiography

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2014

Background Large segmental bone and composite tissue defects often require vascularized osseous f... more Background Large segmental bone and composite tissue defects often require vascularized osseous flaps for definitive reconstruction. However, failed osseous flaps due to inadequate perfusion can lead to significant morbidity. Utilization of indocyanine green (ICG) fluorescence angiography has been previously shown to reliably assess soft tissue perfusion. Our group will outline the application of this useful intraoperative tool in evaluating the perfusion of vascularized osseous flaps. Methods A retrospective review was performed to identify those osseous and/or osteocutaneous bone flaps, where ICG angiography was employed. Data analyzed included flap types, success and failure rates, and perfusion-related complications. All osseous flaps were evaluated by ICG angiography to confirm periosteal and endosteal perfusion. Results Overall 16 osseous free flaps utilizing intraoperative ICG angiography to assess vascularized osseous constructs were performed over a 3-year period. The flaps consisted of the following: nine osteocutaneous fibulas, two osseous-only fibulas, two scapular/parascapular with scapula bone, two quadricep-based muscle flaps, containing a vascularized femoral bone component, and one osteocutaneous fibula revision. All flap reconstructions were successful with the only perfusion-related complication being a case of delayed partial skin flap loss. Conclusions Intraoperative fluorescence angiography is a useful adjunctive tool that can aid in flap design through angiosome mapping and can also assess flap perfusion, vascular pedicle flow, tissue perfusion before flap harvest, and flap perfusion after flap inset. Our group has successfully extended the application of this intraoperative tool to assess vascularized osseous flaps in an effort to reduce adverse outcomes related to preventable perfusion-related complications.

Research paper thumbnail of Intraoperative fluorescence angiography: a review of applications and outcomes in war-related trauma

Military medicine, 2015

In the recent Iraq and Afghanistan conflicts, survival rates from complex battlefield injuries ha... more In the recent Iraq and Afghanistan conflicts, survival rates from complex battlefield injuries have continued to improve. The resulting war-related wounds are challenging, with confounding issues making assessment of tissue perfusion subjective and variable. This review discusses the utility of intraoperative fluorescence angiography, and its usefulness as an objective tool to evaluate the perfusion of tissues in the face of complex war-related injuries. A retrospective review of all war-related traumatic and reconstructive cases employing intraoperative indocyanine green laser angiography (ICGLA) was performed. Data analyzed included indication for use, procedure success/failure rates, modifications performed, and perfusion-related complications. Anatomical regions assessed were extremity, head and neck, truncal, and intra-abdominal viscera. The endpoint of specific interest involved the decision for additional debridement of poorly perfused tissue, as based on the ICGLA findings. ...

Research paper thumbnail of Refinement of the myocutaneous anterolateral thigh flap for the reconstruction of frontonasal fistula defects

Head & neck, Jan 19, 2015

Frontonasal fistulae can lead to life-threatening intracranial infections. Our refinement of the ... more Frontonasal fistulae can lead to life-threatening intracranial infections. Our refinement of the myocutaneous anterolateral thigh (MC-ALT) flap for treating these fistulae is described. A retrospective review of the microsurgical treatment of frontonasal fistulae is presented. Demographics, etiologies, outcomes, and complications were evaluated Results: Ten MC-ALT flaps were used to reconstruct frontonasal fistulae. The mean follow-up was 35 ± 2.5 months. Nine fistulae were secondary to oncologic resections, and 1 was due to a traumatic origin. Complications included a recurrent abscess in 1 case (10%); there were no cases of CSF leak or flap loss. Preoperative intracranial infections were present in 7 cases, with 6 successfully resolving their infection after surgical intervention and flap obliteration of their fistulae. Refinements in the MC- ALT flap design have been illustrated to provide robust dead-space obliteration with vascularized muscle and reliable simultaneous scalp cov...

Research paper thumbnail of Abstract P22

Plastic and Reconstructive Surgery, 2015

Research paper thumbnail of Abstract P29

Plastic and Reconstructive Surgery, 2015

Research paper thumbnail of Ballistic Trauma: Lessons Learned from Iraq and Afghanistan

Seminars in Plastic Surgery, 2015

Management of upper extremity injuries secondary to ballistic and blast trauma can lead to challe... more Management of upper extremity injuries secondary to ballistic and blast trauma can lead to challenging problems for the reconstructive surgeon. Given the recent conflicts in Iraq and Afghanistan, advancements in combat-casualty care, combined with a high-volume experience in the treatment of ballistic injuries, has led to continued advancements in the treatment of the severely injured upper extremity. There are several lessons learned that are translatable to civilian trauma centers and future conflicts. In this article, the authors provide an overview of the physics of ballistic injuries and principles in the management of such injuries through experience gained from military involvement in Iraq and Afghanistan.

Research paper thumbnail of Near-infrared laser-assisted indocyanine green imaging for optimizing the design of the anterolateral thigh flap

Eplasty, 2012

The anterolateral thigh flap is a versatile flap that can be used in a free or pedicled fashion. ... more The anterolateral thigh flap is a versatile flap that can be used in a free or pedicled fashion. Because of the large amount of potential soft tissue, low donor site morbidity, and long pedicle lengths, many researchers consider it to be the perfect free flap. However, dissection of this and other perforator flaps can become an arduous experience with learning curves to overcome. Near-infrared laser angiography using indocyanine green provides a useful adjunctive tool to more predictably assess direct perforator perfusion zones. Laser-assisted angiography with SPY-Q analysis gives live localization of the flap's dominant perforator perfusion zones while quantifying the relative tissue perfusion for immediate skin paddle design. Fifteen patients with head and neck cancer defects were reconstructed with a free anterolateral thigh flap using laser-assisted near-infrared indocyanine green perforator mapping. The mid-point of a line between the anterior superior iliac spine and the p...

Research paper thumbnail of TXA in Combat Casualty Care-Does It Adversely Affect Extremity Reconstruction and Flap Thrombosis Rates?

Military medicine, 2015

Tranexamic acid (TXA) is an antifibrinolytic that competitively inhibits the activation of plasmi... more Tranexamic acid (TXA) is an antifibrinolytic that competitively inhibits the activation of plasminogen to plasmin. In recent years, the military has adapted TXA's use in combat casualties suffering severe hemorrhagic injuries. The purpose of this study is to examine the association between TXA on complications such as venous thromboembolic events (VTEs) and flap-related thrombosis in combat trauma patients undergoing tissue transfer for extremity reconstruction. A retrospective chart review of war wounded undergoing extremity reconstructions from 2003 to 2012 at Walter Reed National Military Medical Center was completed. Data collected included patient demographics and administration of TXA. Outcomes measured included VTE rates and flap complications in TXA and non-TXA cohorts. From 2003 to 2012, 173 extremity flap procedures were performed (100 pedicle, 73 free flaps). TXA was used in 11% of all patients reviewed. The overall VTE rate was 23.7%; however, there were no documente...

Research paper thumbnail of Military-Led Novel Regenerative Medicine Case Study: Spray Skin Epidermal Regenerate in Conjunction with Dermal Regenerate for Reconstruction of Full Thickness Traumatic Soft Tissue Injuries

Research paper thumbnail of Vascularized Osseous Flaps and Assessing Their Bipartate Perfusion Pattern via Intraoperative Fluorescence Angiography

Journal of Reconstructive Microsurgery, 2014

Large segmental bone and composite tissue defects often require vascularized osseous flaps for de... more Large segmental bone and composite tissue defects often require vascularized osseous flaps for definitive reconstruction. However, failed osseous flaps due to inadequate perfusion can lead to significant morbidity. Utilization of indocyanine green (ICG) fluorescence angiography has been previously shown to reliably assess soft tissue perfusion. Our group will outline the application of this useful intraoperative tool in evaluating the perfusion of vascularized osseous flaps. A retrospective review was performed to identify those osseous and/or osteocutaneous bone flaps, where ICG angiography was employed. Data analyzed included flap types, success and failure rates, and perfusion-related complications. All osseous flaps were evaluated by ICG angiography to confirm periosteal and endosteal perfusion. Overall 16 osseous free flaps utilizing intraoperative ICG angiography to assess vascularized osseous constructs were performed over a 3-year period. The flaps consisted of the following: nine osteocutaneous fibulas, two osseous-only fibulas, two scapular/parascapular with scapula bone, two quadricep-based muscle flaps, containing a vascularized femoral bone component, and one osteocutaneous fibula revision. All flap reconstructions were successful with the only perfusion-related complication being a case of delayed partial skin flap loss. Intraoperative fluorescence angiography is a useful adjunctive tool that can aid in flap design through angiosome mapping and can also assess flap perfusion, vascular pedicle flow, tissue perfusion before flap harvest, and flap perfusion after flap inset. Our group has successfully extended the application of this intraoperative tool to assess vascularized osseous flaps in an effort to reduce adverse outcomes related to preventable perfusion-related complications.

Research paper thumbnail of Use of a bioartificial dermal regeneration template for skin restoration in combat casualty injuries

Regenerative Medicine, 2016

Military personnel who survive combat injuries frequently have large soft tissue wounds complicat... more Military personnel who survive combat injuries frequently have large soft tissue wounds complicated by concomitant injuries and contamination. These devastating wounds present a therapeutic challenge to not only restore the protective skin barrier but also to preserve tendon and muscle excursion, provide protective padding around nerves and restore adequate joint motion. Accordingly, regenerative medicine modalities that can accomplish these goals are of great interest. The use of bioartificial dermal regeneration templates (DRT), such as Integra DRT (Integra Lifesciences Corporation, Plainsboro, NJ, USA), in the management of complex soft tissue injuries has an important role in the reconstruction of war wounds. These DRTs provide initial wound coverage and help establish a well-vascularized wound bed suitable for definitive soft tissue coverage.

Research paper thumbnail of Bioartificial dermal substitutes in the severely traumatized wounded warrior

Research paper thumbnail of Bioartificial dermal regenerate substitutes in severely traumatized wounded warrior

Research paper thumbnail of The Changing and Challenging Patterns of Extremity War Trauma: The Afghanistan Experience

Research paper thumbnail of Advancements in existing and emerging therapies: Selected collaborative efforts among military and civilian centers

Research paper thumbnail of Advanced Cranial Reconstructions in the War Wounded: Indications and Applications for an Intracranial Free Flap

Research paper thumbnail of Light-Activated Sealing of Nerve Graft Coaptation Sites Improves Outcome following Large Gap Peripheral Nerve Injury

Plastic and reconstructive surgery, 2015

Nerve repair using photochemically bonded human amnion nerve wraps can result in superior outcome... more Nerve repair using photochemically bonded human amnion nerve wraps can result in superior outcomes in comparison with standard suture. When applied to nerve grafts, efficacy has been limited by proteolytic degradation of bonded amnion during extended periods of recovery. Chemical cross-linking of amnion before bonding may improve wrap durability and efficacy. Three nerve wraps (amnion, cross-linked amnion, and cross-linked swine intestinal submucosa) and three fixation methods (suture, fibrin glue, and photochemical bonding) were investigated. One hundred ten Lewis rats had 15-mm left sciatic nerve gaps repaired with isografts. Nine groups (n = 10) had isografts secured by one of the aforementioned wrap/fixation combinations. Positive and negative control groups (n = 10) were repaired with graft and suture and no repair, respectively. Outcomes were assessed using sciatic function index, muscle mass retention, and histomorphometry. Statistical analysis was performed using analysis of...

Research paper thumbnail of The use of urinary bladder matrix in the treatment of trauma and combat casualty wound care

Regenerative Medicine, 2015

Treatment of combat injuries and resulting wounds can be difficult to treat due to compromised an... more Treatment of combat injuries and resulting wounds can be difficult to treat due to compromised and evolving tissue necrosis, environmental contaminants, multidrug resistant microbacterial and/or fungal infections, coupled with microvascular damage and/or hypovascularized exposed vital structures. Our group has developed surgical care algorithms with identifiable salvage techniques to achieve stable, definitive wound coverage often with the aid of certain regenerative medicine biologic scaffold materials and advanced wound care to facilitate tissue coverage and healing. This case series reports on the role of urinary bladder matrix scaffolds in the wound care and reconstruction of traumatic and combat wounds. Urinary bladder matrix was found to facilitate definitive soft tissue reconstruction by establishing a neovascularized soft tissue base acceptable for second stage wound and skin coverage options within traumatic and combat-related wounds.

Research paper thumbnail of Subtotal Nasal Reconstruction

Plastic and Reconstructive Surgery - Global Open, 2015

Military plastic surgeons perform reconstructive surgeries for various congenital, oncologic, and... more Military plastic surgeons perform reconstructive surgeries for various congenital, oncologic, and traumatic craniofacial injuries or deformities. Recently, our Walter Reed National Military Medical Center Plastic Surgery team was tasked to care for a woman who bravely sought a new and better life in the United States after she suffered amputation of her nose and bilateral ears while in her home country of Afghanistan. A military-civilian team collaborated throughout her reconstructive planning, treatment, and postoperative course to create both an aesthetically acceptable and functional subtotal nasal reconstruction. This case report details the patient's unique journey, her reconstructive course, and highlights her reintegration into a new life and society.

Research paper thumbnail of 64: Choosing the Right DVT Prophylaxis in the Massive Weight Loss Patient

Plastic and Reconstructive Surgery, 2006

Research paper thumbnail of Vascularized osseous flaps and their bipartate perfusion: Real-time objective assessment and perfusion-related complication reduction via intra-operative fluorescence angiography

Journal of Plastic, Reconstructive & Aesthetic Surgery, 2014

Background Large segmental bone and composite tissue defects often require vascularized osseous f... more Background Large segmental bone and composite tissue defects often require vascularized osseous flaps for definitive reconstruction. However, failed osseous flaps due to inadequate perfusion can lead to significant morbidity. Utilization of indocyanine green (ICG) fluorescence angiography has been previously shown to reliably assess soft tissue perfusion. Our group will outline the application of this useful intraoperative tool in evaluating the perfusion of vascularized osseous flaps. Methods A retrospective review was performed to identify those osseous and/or osteocutaneous bone flaps, where ICG angiography was employed. Data analyzed included flap types, success and failure rates, and perfusion-related complications. All osseous flaps were evaluated by ICG angiography to confirm periosteal and endosteal perfusion. Results Overall 16 osseous free flaps utilizing intraoperative ICG angiography to assess vascularized osseous constructs were performed over a 3-year period. The flaps consisted of the following: nine osteocutaneous fibulas, two osseous-only fibulas, two scapular/parascapular with scapula bone, two quadricep-based muscle flaps, containing a vascularized femoral bone component, and one osteocutaneous fibula revision. All flap reconstructions were successful with the only perfusion-related complication being a case of delayed partial skin flap loss. Conclusions Intraoperative fluorescence angiography is a useful adjunctive tool that can aid in flap design through angiosome mapping and can also assess flap perfusion, vascular pedicle flow, tissue perfusion before flap harvest, and flap perfusion after flap inset. Our group has successfully extended the application of this intraoperative tool to assess vascularized osseous flaps in an effort to reduce adverse outcomes related to preventable perfusion-related complications.

Research paper thumbnail of Intraoperative fluorescence angiography: a review of applications and outcomes in war-related trauma

Military medicine, 2015

In the recent Iraq and Afghanistan conflicts, survival rates from complex battlefield injuries ha... more In the recent Iraq and Afghanistan conflicts, survival rates from complex battlefield injuries have continued to improve. The resulting war-related wounds are challenging, with confounding issues making assessment of tissue perfusion subjective and variable. This review discusses the utility of intraoperative fluorescence angiography, and its usefulness as an objective tool to evaluate the perfusion of tissues in the face of complex war-related injuries. A retrospective review of all war-related traumatic and reconstructive cases employing intraoperative indocyanine green laser angiography (ICGLA) was performed. Data analyzed included indication for use, procedure success/failure rates, modifications performed, and perfusion-related complications. Anatomical regions assessed were extremity, head and neck, truncal, and intra-abdominal viscera. The endpoint of specific interest involved the decision for additional debridement of poorly perfused tissue, as based on the ICGLA findings. ...

Research paper thumbnail of Refinement of the myocutaneous anterolateral thigh flap for the reconstruction of frontonasal fistula defects

Head & neck, Jan 19, 2015

Frontonasal fistulae can lead to life-threatening intracranial infections. Our refinement of the ... more Frontonasal fistulae can lead to life-threatening intracranial infections. Our refinement of the myocutaneous anterolateral thigh (MC-ALT) flap for treating these fistulae is described. A retrospective review of the microsurgical treatment of frontonasal fistulae is presented. Demographics, etiologies, outcomes, and complications were evaluated Results: Ten MC-ALT flaps were used to reconstruct frontonasal fistulae. The mean follow-up was 35 ± 2.5 months. Nine fistulae were secondary to oncologic resections, and 1 was due to a traumatic origin. Complications included a recurrent abscess in 1 case (10%); there were no cases of CSF leak or flap loss. Preoperative intracranial infections were present in 7 cases, with 6 successfully resolving their infection after surgical intervention and flap obliteration of their fistulae. Refinements in the MC- ALT flap design have been illustrated to provide robust dead-space obliteration with vascularized muscle and reliable simultaneous scalp cov...

Research paper thumbnail of Abstract P22

Plastic and Reconstructive Surgery, 2015

Research paper thumbnail of Abstract P29

Plastic and Reconstructive Surgery, 2015

Research paper thumbnail of Ballistic Trauma: Lessons Learned from Iraq and Afghanistan

Seminars in Plastic Surgery, 2015

Management of upper extremity injuries secondary to ballistic and blast trauma can lead to challe... more Management of upper extremity injuries secondary to ballistic and blast trauma can lead to challenging problems for the reconstructive surgeon. Given the recent conflicts in Iraq and Afghanistan, advancements in combat-casualty care, combined with a high-volume experience in the treatment of ballistic injuries, has led to continued advancements in the treatment of the severely injured upper extremity. There are several lessons learned that are translatable to civilian trauma centers and future conflicts. In this article, the authors provide an overview of the physics of ballistic injuries and principles in the management of such injuries through experience gained from military involvement in Iraq and Afghanistan.

Research paper thumbnail of Near-infrared laser-assisted indocyanine green imaging for optimizing the design of the anterolateral thigh flap

Eplasty, 2012

The anterolateral thigh flap is a versatile flap that can be used in a free or pedicled fashion. ... more The anterolateral thigh flap is a versatile flap that can be used in a free or pedicled fashion. Because of the large amount of potential soft tissue, low donor site morbidity, and long pedicle lengths, many researchers consider it to be the perfect free flap. However, dissection of this and other perforator flaps can become an arduous experience with learning curves to overcome. Near-infrared laser angiography using indocyanine green provides a useful adjunctive tool to more predictably assess direct perforator perfusion zones. Laser-assisted angiography with SPY-Q analysis gives live localization of the flap's dominant perforator perfusion zones while quantifying the relative tissue perfusion for immediate skin paddle design. Fifteen patients with head and neck cancer defects were reconstructed with a free anterolateral thigh flap using laser-assisted near-infrared indocyanine green perforator mapping. The mid-point of a line between the anterior superior iliac spine and the p...

Research paper thumbnail of TXA in Combat Casualty Care-Does It Adversely Affect Extremity Reconstruction and Flap Thrombosis Rates?

Military medicine, 2015

Tranexamic acid (TXA) is an antifibrinolytic that competitively inhibits the activation of plasmi... more Tranexamic acid (TXA) is an antifibrinolytic that competitively inhibits the activation of plasminogen to plasmin. In recent years, the military has adapted TXA's use in combat casualties suffering severe hemorrhagic injuries. The purpose of this study is to examine the association between TXA on complications such as venous thromboembolic events (VTEs) and flap-related thrombosis in combat trauma patients undergoing tissue transfer for extremity reconstruction. A retrospective chart review of war wounded undergoing extremity reconstructions from 2003 to 2012 at Walter Reed National Military Medical Center was completed. Data collected included patient demographics and administration of TXA. Outcomes measured included VTE rates and flap complications in TXA and non-TXA cohorts. From 2003 to 2012, 173 extremity flap procedures were performed (100 pedicle, 73 free flaps). TXA was used in 11% of all patients reviewed. The overall VTE rate was 23.7%; however, there were no documente...

Research paper thumbnail of Military-Led Novel Regenerative Medicine Case Study: Spray Skin Epidermal Regenerate in Conjunction with Dermal Regenerate for Reconstruction of Full Thickness Traumatic Soft Tissue Injuries

Research paper thumbnail of Vascularized Osseous Flaps and Assessing Their Bipartate Perfusion Pattern via Intraoperative Fluorescence Angiography

Journal of Reconstructive Microsurgery, 2014

Large segmental bone and composite tissue defects often require vascularized osseous flaps for de... more Large segmental bone and composite tissue defects often require vascularized osseous flaps for definitive reconstruction. However, failed osseous flaps due to inadequate perfusion can lead to significant morbidity. Utilization of indocyanine green (ICG) fluorescence angiography has been previously shown to reliably assess soft tissue perfusion. Our group will outline the application of this useful intraoperative tool in evaluating the perfusion of vascularized osseous flaps. A retrospective review was performed to identify those osseous and/or osteocutaneous bone flaps, where ICG angiography was employed. Data analyzed included flap types, success and failure rates, and perfusion-related complications. All osseous flaps were evaluated by ICG angiography to confirm periosteal and endosteal perfusion. Overall 16 osseous free flaps utilizing intraoperative ICG angiography to assess vascularized osseous constructs were performed over a 3-year period. The flaps consisted of the following: nine osteocutaneous fibulas, two osseous-only fibulas, two scapular/parascapular with scapula bone, two quadricep-based muscle flaps, containing a vascularized femoral bone component, and one osteocutaneous fibula revision. All flap reconstructions were successful with the only perfusion-related complication being a case of delayed partial skin flap loss. Intraoperative fluorescence angiography is a useful adjunctive tool that can aid in flap design through angiosome mapping and can also assess flap perfusion, vascular pedicle flow, tissue perfusion before flap harvest, and flap perfusion after flap inset. Our group has successfully extended the application of this intraoperative tool to assess vascularized osseous flaps in an effort to reduce adverse outcomes related to preventable perfusion-related complications.