Nicole Posch - Academia.edu (original) (raw)

Papers by Nicole Posch

Research paper thumbnail of Combined Free Partial Vastus Lateralis with Anterolateral Thigh Perforator Flap for Reconstruction of Extensive Composite Defects

Journal of Reconstructive Microsurgery, 2006

007-1226/$ see front matter q 20 i:10.1016/j.bjps.2005.04.022 * Corresponding author. Tel.: C31 1... more 007-1226/$ see front matter q 20 i:10.1016/j.bjps.2005.04.022 * Corresponding author. Tel.: C31 1 E-mail address: sophofer@hotmail. Summary Myocutaneous (MC) free flaps are useful for many reconstructive indications. Perforator flaps have become standard of care. The anterolateral thigh flap (ALT) donor site is popular. With the ALT flap varying sizes of vastus lateralis (VL) muscle can be harvested as a MC flap. The skin islands of these flaps have a great range of freedom when dissected on their perforator. It was hypothesised that the VL–ALT perforator flap would offer adequate tissue volume combining maximal freedom in planningwithminimal donor sitemorbidity. FromNovember 2001 to February 2003 a free partial VL with ALT perforator flap was used in 11 patients to reconstruct large defects. Indications for adding a muscular component were exposed bone, skull base, (artificial) dura, or osteosynthesis material, open sinuses, and lack of muscular bulk. Flaps were planned as standard ALT flaps, after which three types of dissection were performed: I. trueMCflap; II.muscleflapwitha skin islandononeperforator,whichcouldbe rotatedup to1808; III. chimera skin perforatorflapwithmuscle being harvestedona separatebranch from the source vessel or on a side branch of the skin perforator. Mean skin size of theMCALT flaps was 131 cm. Meanmuscle part size of the MC-ALT flaps was 268 cm. Muscular parts were custom designed for all defects. No total or partial flap failures were seen. Colourmismatchwas seen in6of8patients,whenskinwasused in the facial area in this all white population. Excessive flap bulk was found in 8 of 11 patients at 6 weeks, however, only in 2of 11patients after 6months. Patientswere satisfiedwith the functional result (8 of 11 patients) as well as the cosmetic result of their reconstruction (7 of 11 patients). All less satisfiedpatientshad receivedtheirflap forexternal facial skin reconstruction.Donor sitemorbiditywasminimal. The combined free partial VLwithALTperforator flapproved valuable as a (chimera type) MC flap with maximal freedom of planning to meet specific reconstructive demands and minimal donor site morbidity. q 2005 The British Association of Plastic Surgeons. Published by Elsevier Ltd. All rights reserved. British Journal of Plastic Surgery (2005) 58, 1095–1103

Research paper thumbnail of Anterolateral Thigh Flap Reconstruction of Large External Facial Skin Defects: A Follow-Up Study on Functional and Aesthetic Recipient- and Donor-Site Outcome

Plastic and Reconstructive Surgery, 2005

Background: The purpose of this study was to investigate the subjective and the objective functio... more Background: The purpose of this study was to investigate the subjective and the objective functional and aesthetic follow-up results of the recipient and donor sites after reconstruction of extensive facial defects with the anterolateral thigh flap. Methods: Between December of 2001 and April of 2003, the anterolateral thigh flap was used to reconstruct large facial skin defects after malignant tumor resection in 23 white patients. All patients had a standardized interview, physical examination, and clinical photographs. Results: The mean flap size was 108 cm 2. Fasciocutaneous anterolateral thigh flaps were used in 15 patients and musculocutaneous flaps were used in eight patients with exposed dura, open sinuses, or orbital defects. An extra free osteocutaneous fibula flap was necessary to reconstruct the affected mandible in 10 patients. The donor site was skin grafted in 18 patients. The flap survival rate was 96 percent. At follow-up, color mismatch (71 percent) and flap bulkiness (50 percent) were encountered most often. Four of five patients with speech problems had received an additional free osteocutaneous fibula flap.

Research paper thumbnail of The Facial Artery Perforator Flap for Reconstruction of Perioral Defects

Plastic and Reconstructive Surgery, 2005

Background: The concept of the facial artery perforator flap was developed to gain more freedom f... more Background: The concept of the facial artery perforator flap was developed to gain more freedom for reconstruction of perioral defects. Single perforators of the facial artery should supply a large area of facial skin for a pedicled perforator flap. Methods: Five fresh cadavers yielding 10 facial arteries were dissected after Microfil vascular injection to study distribution, number, length, and diameter of facial artery perforators. Five clinical cases with cancer-related perioral defects were reconstructed with facial artery perforator flaps. In two cases, additional regional flaps were used. Surgical technique was governed by the aesthetic unit principle and Doppler identification of the facial artery, which was used as a guideline for identification of suitable facial artery perforators. Results: Cadaver dissection showed a large number of evenly distributed facial artery perforators (average, 5.7; range, three to nine). The average perforator length was 25.2 mm (range, 13 to 51 mm). The average perforator diameter was 1.2 mm (range, 0.6 to 1.8 mm). In all clinical cases, a suitable facial artery perforator was identified to meet reconstructive demands. Flaps were rotated up to 180 degrees. Four flaps survived completely. One flap showed minor distal necrosis. Conclusions: The facial artery perforator flap offers a versatile tailor-made flap, because of the reliable presence of

Research paper thumbnail of Functional and Aesthetic Outcome and Survival after Double Free Flap Reconstruction in Advanced Head and Neck Cancer Patients

Plastic and Reconstructive Surgery, 2007

Extensive composite defects in the head and neck area may require the use of double free flap rec... more Extensive composite defects in the head and neck area may require the use of double free flap reconstructions. These reconstructions are not only surgically challenging but also challenging to patients. A realistic perspective on general outcome for the patient seems important. From January of 2002 to August of 2003, double free flap reconstructions were used in 12 patients with extensive composite head and neck defects following malignant tumor (n = 7) and osteoradionecrosis (n = 5) resection. Six patients had a standardized interview, physical examination, and clinical photographs. All reconstructions were performed using an osteocutaneous fibula flap in combination with an anterolateral thigh flap (n = 8), a radial forearm flap (n = 1), or a lateral thigh flap (n = 1). The total flap survival rate was 96 percent. Mean mandibular bone defects were 10 cm. Mean skin island sizes of osteocutaneous fibula flaps were 67 cm. Mean external skin reconstruction flap sizes were 117 cm. Mean overall survival time was 20 months in patients with malignant tumors. Patients with osteoradionecrosis reconstruction survived free of disease for an average period of 38 months. Three patients (50 percent) were very satisfied, one was neutral, and two were very dissatisfied with their functional and aesthetic results. Objective evaluation of function showed mainly deteriorated speech (83 percent) and oral incontinence (67 percent). Objective evaluation of aesthetics showed mainly color mismatch (67 percent) and flap contracture of external flaps (50 percent). Reconstruction of these major composite through-and-through defects will often result in a modest functional and aesthetic outcome. Because selected patients require these procedures, the authors give information that matches with realistic expectations.

Research paper thumbnail of Cold Intolerance in Upper Extremity Nerve Injury Patients

Journal of Reconstructive Microsurgery, 2006

Research paper thumbnail of The combined free partial vastus lateralis with anterolateral thigh perforator flap reconstruction of extensive composite defects

British Journal of Plastic Surgery, 2005

Myocutaneous (MC) free flaps are useful for many reconstructive indications. Perforator flaps hav... more Myocutaneous (MC) free flaps are useful for many reconstructive indications. Perforator flaps have become standard of care. The anterolateral thigh flap (ALT) donor site is popular. With the ALT flap varying sizes of vastus lateralis (VL) muscle can be harvested as a MC flap. The skin islands of these flaps have a great range of freedom when dissected on their perforator. It was hypothesised that the VL-ALT perforator flap would offer adequate tissue volume combining maximal freedom in planning with minimal donor site morbidity. From November 2001 to February 2003 a free partial VL with ALT perforator flap was used in 11 patients to reconstruct large defects. Indications for adding a muscular component were exposed bone, skull base, (artificial) dura, or osteosynthesis material, open sinuses, and lack of muscular bulk. Flaps were planned as standard ALT flaps, after which three types of dissection were performed: I. true MC flap; II. muscle flap with a skin island on one perforator, which could be rotated up to 1808; III. chimera skin perforator flap with muscle being harvested on a separate branch from the source vessel or on a side branch of the skin perforator. Mean skin size of the MC-ALT flaps was 131 cm 2. Mean muscle part size of the MC-ALT flaps was 268 cm 3. Muscular parts were custom designed for all defects. No total or partial flap failures were seen. Colour mismatch was seen in 6 of 8 patients, when skin was used in the facial area in this all white population. Excessive flap bulk was found in 8 of 11 patients at 6 weeks, however, only in 2 of 11 patients after 6 months. Patients were satisfied with the functional result (8 of 11 patients) as well as the cosmetic result of their reconstruction (7 of 11 patients). All less satisfied patients had received their flap for external facial skin reconstruction. Donor site morbidity was minimal. The combined free partial VL with ALT perforator flap proved valuable as a (chimera type) MC flap with maximal freedom of planning to meet specific reconstructive demands and minimal donor site morbidity.

Research paper thumbnail of Diminished thermoregulation in nerve injury patients: A reason for cold intolerance?

The Journal of Hand Surgery, 2003

Results and discussion: In the control group, the BDNFmRNA value was 38.16 fglmg in the muscle an... more Results and discussion: In the control group, the BDNFmRNA value was 38.16 fglmg in the muscle and 13.38 fg/mg in the skin. BDNFmRNA in the muscle at four weeks after nerve cutting was approximately four times that of the control value. In contrast to this, in the skin, no significant change was observed at one and two weeks, and then, BDNFmRNA was increased to about 2-fold at four weeks.

Research paper thumbnail of Differences in complexity of isolated brachydactyly type C cannot be attributed to locus heterogeneity alone

American Journal of Medical Genetics, 2001

Hereditary isolated brachydactyly type C (OMIM 113100) mostly follows an autosomal dominant patte... more Hereditary isolated brachydactyly type C (OMIM 113100) mostly follows an autosomal dominant pattern of inheritance with a marked variability in expression. This phenotype has been mapped to two different loci on chromosomes 12q24 and 20q11.2. The latter locus contains the cartilage-derived morphogenetic protein (CDMP)1 gene, in which a null mutation has been found in patients with malformations restricted to the upper limbs. A more complex brachydactyly type C phenotype has been mapped to chromosome 12q24. Differences in complexity of these phenotypes have been attributed to locus heterogeneity. Clinical subclassification based on the degree of complexity of the phenotype has therefore been suggested. We present patients with a complex brachydactyly type C phenotype in whom there is considerable intra-and interfamilial variability in expression. We show that clinical subclassification based on the complexity of the brachydactyly type C phenotype related to the genetic defect is not feasible. We present evidence that differences in complexity are not only due to locus heterogeneity, but that genetic modifiers and/or environmental factors must also play a role.

Research paper thumbnail of Combined Free Partial Vastus Lateralis with Anterolateral Thigh Perforator Flap for Reconstruction of Extensive Composite Defects

Journal of Reconstructive Microsurgery, 2006

007-1226/$ see front matter q 20 i:10.1016/j.bjps.2005.04.022 * Corresponding author. Tel.: C31 1... more 007-1226/$ see front matter q 20 i:10.1016/j.bjps.2005.04.022 * Corresponding author. Tel.: C31 1 E-mail address: sophofer@hotmail. Summary Myocutaneous (MC) free flaps are useful for many reconstructive indications. Perforator flaps have become standard of care. The anterolateral thigh flap (ALT) donor site is popular. With the ALT flap varying sizes of vastus lateralis (VL) muscle can be harvested as a MC flap. The skin islands of these flaps have a great range of freedom when dissected on their perforator. It was hypothesised that the VL–ALT perforator flap would offer adequate tissue volume combining maximal freedom in planningwithminimal donor sitemorbidity. FromNovember 2001 to February 2003 a free partial VL with ALT perforator flap was used in 11 patients to reconstruct large defects. Indications for adding a muscular component were exposed bone, skull base, (artificial) dura, or osteosynthesis material, open sinuses, and lack of muscular bulk. Flaps were planned as standard ALT flaps, after which three types of dissection were performed: I. trueMCflap; II.muscleflapwitha skin islandononeperforator,whichcouldbe rotatedup to1808; III. chimera skin perforatorflapwithmuscle being harvestedona separatebranch from the source vessel or on a side branch of the skin perforator. Mean skin size of theMCALT flaps was 131 cm. Meanmuscle part size of the MC-ALT flaps was 268 cm. Muscular parts were custom designed for all defects. No total or partial flap failures were seen. Colourmismatchwas seen in6of8patients,whenskinwasused in the facial area in this all white population. Excessive flap bulk was found in 8 of 11 patients at 6 weeks, however, only in 2of 11patients after 6months. Patientswere satisfiedwith the functional result (8 of 11 patients) as well as the cosmetic result of their reconstruction (7 of 11 patients). All less satisfiedpatientshad receivedtheirflap forexternal facial skin reconstruction.Donor sitemorbiditywasminimal. The combined free partial VLwithALTperforator flapproved valuable as a (chimera type) MC flap with maximal freedom of planning to meet specific reconstructive demands and minimal donor site morbidity. q 2005 The British Association of Plastic Surgeons. Published by Elsevier Ltd. All rights reserved. British Journal of Plastic Surgery (2005) 58, 1095–1103

Research paper thumbnail of Anterolateral Thigh Flap Reconstruction of Large External Facial Skin Defects: A Follow-Up Study on Functional and Aesthetic Recipient- and Donor-Site Outcome

Plastic and Reconstructive Surgery, 2005

Background: The purpose of this study was to investigate the subjective and the objective functio... more Background: The purpose of this study was to investigate the subjective and the objective functional and aesthetic follow-up results of the recipient and donor sites after reconstruction of extensive facial defects with the anterolateral thigh flap. Methods: Between December of 2001 and April of 2003, the anterolateral thigh flap was used to reconstruct large facial skin defects after malignant tumor resection in 23 white patients. All patients had a standardized interview, physical examination, and clinical photographs. Results: The mean flap size was 108 cm 2. Fasciocutaneous anterolateral thigh flaps were used in 15 patients and musculocutaneous flaps were used in eight patients with exposed dura, open sinuses, or orbital defects. An extra free osteocutaneous fibula flap was necessary to reconstruct the affected mandible in 10 patients. The donor site was skin grafted in 18 patients. The flap survival rate was 96 percent. At follow-up, color mismatch (71 percent) and flap bulkiness (50 percent) were encountered most often. Four of five patients with speech problems had received an additional free osteocutaneous fibula flap.

Research paper thumbnail of The Facial Artery Perforator Flap for Reconstruction of Perioral Defects

Plastic and Reconstructive Surgery, 2005

Background: The concept of the facial artery perforator flap was developed to gain more freedom f... more Background: The concept of the facial artery perforator flap was developed to gain more freedom for reconstruction of perioral defects. Single perforators of the facial artery should supply a large area of facial skin for a pedicled perforator flap. Methods: Five fresh cadavers yielding 10 facial arteries were dissected after Microfil vascular injection to study distribution, number, length, and diameter of facial artery perforators. Five clinical cases with cancer-related perioral defects were reconstructed with facial artery perforator flaps. In two cases, additional regional flaps were used. Surgical technique was governed by the aesthetic unit principle and Doppler identification of the facial artery, which was used as a guideline for identification of suitable facial artery perforators. Results: Cadaver dissection showed a large number of evenly distributed facial artery perforators (average, 5.7; range, three to nine). The average perforator length was 25.2 mm (range, 13 to 51 mm). The average perforator diameter was 1.2 mm (range, 0.6 to 1.8 mm). In all clinical cases, a suitable facial artery perforator was identified to meet reconstructive demands. Flaps were rotated up to 180 degrees. Four flaps survived completely. One flap showed minor distal necrosis. Conclusions: The facial artery perforator flap offers a versatile tailor-made flap, because of the reliable presence of

Research paper thumbnail of Functional and Aesthetic Outcome and Survival after Double Free Flap Reconstruction in Advanced Head and Neck Cancer Patients

Plastic and Reconstructive Surgery, 2007

Extensive composite defects in the head and neck area may require the use of double free flap rec... more Extensive composite defects in the head and neck area may require the use of double free flap reconstructions. These reconstructions are not only surgically challenging but also challenging to patients. A realistic perspective on general outcome for the patient seems important. From January of 2002 to August of 2003, double free flap reconstructions were used in 12 patients with extensive composite head and neck defects following malignant tumor (n = 7) and osteoradionecrosis (n = 5) resection. Six patients had a standardized interview, physical examination, and clinical photographs. All reconstructions were performed using an osteocutaneous fibula flap in combination with an anterolateral thigh flap (n = 8), a radial forearm flap (n = 1), or a lateral thigh flap (n = 1). The total flap survival rate was 96 percent. Mean mandibular bone defects were 10 cm. Mean skin island sizes of osteocutaneous fibula flaps were 67 cm. Mean external skin reconstruction flap sizes were 117 cm. Mean overall survival time was 20 months in patients with malignant tumors. Patients with osteoradionecrosis reconstruction survived free of disease for an average period of 38 months. Three patients (50 percent) were very satisfied, one was neutral, and two were very dissatisfied with their functional and aesthetic results. Objective evaluation of function showed mainly deteriorated speech (83 percent) and oral incontinence (67 percent). Objective evaluation of aesthetics showed mainly color mismatch (67 percent) and flap contracture of external flaps (50 percent). Reconstruction of these major composite through-and-through defects will often result in a modest functional and aesthetic outcome. Because selected patients require these procedures, the authors give information that matches with realistic expectations.

Research paper thumbnail of Cold Intolerance in Upper Extremity Nerve Injury Patients

Journal of Reconstructive Microsurgery, 2006

Research paper thumbnail of The combined free partial vastus lateralis with anterolateral thigh perforator flap reconstruction of extensive composite defects

British Journal of Plastic Surgery, 2005

Myocutaneous (MC) free flaps are useful for many reconstructive indications. Perforator flaps hav... more Myocutaneous (MC) free flaps are useful for many reconstructive indications. Perforator flaps have become standard of care. The anterolateral thigh flap (ALT) donor site is popular. With the ALT flap varying sizes of vastus lateralis (VL) muscle can be harvested as a MC flap. The skin islands of these flaps have a great range of freedom when dissected on their perforator. It was hypothesised that the VL-ALT perforator flap would offer adequate tissue volume combining maximal freedom in planning with minimal donor site morbidity. From November 2001 to February 2003 a free partial VL with ALT perforator flap was used in 11 patients to reconstruct large defects. Indications for adding a muscular component were exposed bone, skull base, (artificial) dura, or osteosynthesis material, open sinuses, and lack of muscular bulk. Flaps were planned as standard ALT flaps, after which three types of dissection were performed: I. true MC flap; II. muscle flap with a skin island on one perforator, which could be rotated up to 1808; III. chimera skin perforator flap with muscle being harvested on a separate branch from the source vessel or on a side branch of the skin perforator. Mean skin size of the MC-ALT flaps was 131 cm 2. Mean muscle part size of the MC-ALT flaps was 268 cm 3. Muscular parts were custom designed for all defects. No total or partial flap failures were seen. Colour mismatch was seen in 6 of 8 patients, when skin was used in the facial area in this all white population. Excessive flap bulk was found in 8 of 11 patients at 6 weeks, however, only in 2 of 11 patients after 6 months. Patients were satisfied with the functional result (8 of 11 patients) as well as the cosmetic result of their reconstruction (7 of 11 patients). All less satisfied patients had received their flap for external facial skin reconstruction. Donor site morbidity was minimal. The combined free partial VL with ALT perforator flap proved valuable as a (chimera type) MC flap with maximal freedom of planning to meet specific reconstructive demands and minimal donor site morbidity.

Research paper thumbnail of Diminished thermoregulation in nerve injury patients: A reason for cold intolerance?

The Journal of Hand Surgery, 2003

Results and discussion: In the control group, the BDNFmRNA value was 38.16 fglmg in the muscle an... more Results and discussion: In the control group, the BDNFmRNA value was 38.16 fglmg in the muscle and 13.38 fg/mg in the skin. BDNFmRNA in the muscle at four weeks after nerve cutting was approximately four times that of the control value. In contrast to this, in the skin, no significant change was observed at one and two weeks, and then, BDNFmRNA was increased to about 2-fold at four weeks.

Research paper thumbnail of Differences in complexity of isolated brachydactyly type C cannot be attributed to locus heterogeneity alone

American Journal of Medical Genetics, 2001

Hereditary isolated brachydactyly type C (OMIM 113100) mostly follows an autosomal dominant patte... more Hereditary isolated brachydactyly type C (OMIM 113100) mostly follows an autosomal dominant pattern of inheritance with a marked variability in expression. This phenotype has been mapped to two different loci on chromosomes 12q24 and 20q11.2. The latter locus contains the cartilage-derived morphogenetic protein (CDMP)1 gene, in which a null mutation has been found in patients with malformations restricted to the upper limbs. A more complex brachydactyly type C phenotype has been mapped to chromosome 12q24. Differences in complexity of these phenotypes have been attributed to locus heterogeneity. Clinical subclassification based on the degree of complexity of the phenotype has therefore been suggested. We present patients with a complex brachydactyly type C phenotype in whom there is considerable intra-and interfamilial variability in expression. We show that clinical subclassification based on the complexity of the brachydactyly type C phenotype related to the genetic defect is not feasible. We present evidence that differences in complexity are not only due to locus heterogeneity, but that genetic modifiers and/or environmental factors must also play a role.