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  1. Article ; Online: Modern Approaches to Alternative Flap-Based Breast Reconstruction: Transverse Upper Gracilis Flap.

    Blough, Jordan T / Saint-Cyr, Michel H

    Clinics in plastic surgery

    2023  Volume 50, Issue 2, Page(s) 313–323

    Abstract: The transverse upper/myocutaneous gracilis is a medial thigh-based flap primarily reserved as a secondary choice for autologous reconstruction of small to moderate-sized breasts in women without a suitable abdominal donor site. Its consistent and ... ...

    Abstract The transverse upper/myocutaneous gracilis is a medial thigh-based flap primarily reserved as a secondary choice for autologous reconstruction of small to moderate-sized breasts in women without a suitable abdominal donor site. Its consistent and reliable anatomy based on the medial circumflex femoral artery permits expedient flap harvest with relatively low donor site morbidity. The primary disadvantage is the limited achievable volume, often necessitating augmentation such as extended flap modifications, autologous fat grafting, flap stacking, or even implant placement.
    MeSH term(s) Female ; Humans ; Mammaplasty ; Myocutaneous Flap/surgery ; Myocutaneous Flap/transplantation ; Breast/surgery ; Transplantation, Autologous ; Thigh/surgery
    Language English
    Publishing date 2023-01-25
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 193117-9
    ISSN 1558-0504 ; 0094-1298
    ISSN (online) 1558-0504
    ISSN 0094-1298
    DOI 10.1016/j.cps.2022.11.001
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  2. Article ; Online: Propeller Flaps in Lower Extremity Reconstruction.

    Blough, Jordan T / Saint-Cyr, Michel H

    Clinics in plastic surgery

    2021  Volume 48, Issue 2, Page(s) 173–181

    Abstract: Propeller flaps represent an outstanding alternative to conventional pedicled and free flap options in lower extremity reconstruction, offering significant advantages over the latter. An understanding of the perforasome concept, hot and cold perforator ... ...

    Abstract Propeller flaps represent an outstanding alternative to conventional pedicled and free flap options in lower extremity reconstruction, offering significant advantages over the latter. An understanding of the perforasome concept, hot and cold perforator locations, and basic flap design enable the surgeon to readily harvest flaps based on any clinically relevant perforator in freestyle fashion. The purpose of this article is to review fundamentals of propeller flap design and harvest in the lower extremity and discuss reconstructive strategies by level of injury.
    MeSH term(s) Humans ; Lower Extremity/injuries ; Lower Extremity/surgery ; Perforator Flap ; Reconstructive Surgical Procedures/methods
    Language English
    Publishing date 2021-02-24
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 193117-9
    ISSN 1558-0504 ; 0094-1298
    ISSN (online) 1558-0504
    ISSN 0094-1298
    DOI 10.1016/j.cps.2021.01.002
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  3. Article ; Online: Flaps Based on the Dorsal Metacarpal Artery.

    Webster, Nicholas / Saint-Cyr, Michel

    Hand clinics

    2019  Volume 36, Issue 1, Page(s) 75–83

    Abstract: Dorsal metacarpal artery flaps have evolved with our knowledge of vascular anatomy of the hand. Since the description of the first transposition flap likely based on the first dorsal metacarpal artery in the 1950s until today, the indications and ... ...

    Abstract Dorsal metacarpal artery flaps have evolved with our knowledge of vascular anatomy of the hand. Since the description of the first transposition flap likely based on the first dorsal metacarpal artery in the 1950s until today, the indications and modifications of these flaps have greatly expanded. Reverse flow flaps have allowed coverage of the dorsum of each digit with vascularized tissue with minimal donor site morbidity and harvest of veins, bone, and tendon with them. This article reviews the history, anatomy, indications, and surgical techniques of this class of flaps and its numerous permutations.
    MeSH term(s) Arteries/anatomy & histology ; Contraindications, Procedure ; Finger Injuries/surgery ; Fingers/blood supply ; Fingers/surgery ; Humans ; Surgical Flaps/blood supply
    Language English
    Publishing date 2019-11-19
    Publishing country United States
    Document type Journal Article ; Review ; Video-Audio Media
    ZDB-ID 1315374-2
    ISSN 1558-1969 ; 0749-0712
    ISSN (online) 1558-1969
    ISSN 0749-0712
    DOI 10.1016/j.hcl.2019.09.001
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  4. Article ; Online: Recent Advances in Microsurgery: An Update in the Past 4 Years.

    Mohan, Anita T / Saint-Cyr, Michel

    Clinics in plastic surgery

    2020  Volume 47, Issue 4, Page(s) 663–677

    Abstract: Microsurgery has broad applications in reconstructive surgery. As techniques, diagnostics, and advancing technology rapidly evolve, reconstructive microsurgeons can adapt to address new challenges and push the frontiers to achieve optimal functional and ... ...

    Abstract Microsurgery has broad applications in reconstructive surgery. As techniques, diagnostics, and advancing technology rapidly evolve, reconstructive microsurgeons can adapt to address new challenges and push the frontiers to achieve optimal functional and aesthetic reconstruction, and minimize donor site morbidity. This article briefly outlines some of the recent advances and innovations in microsurgery within the last 5 years in perforator flaps, breast, lymphedema surgery, extremity reconstruction, targeted muscle reinnervation, head and neck reconstruction, composite tissue allotransplantation, and robotic surgery.
    MeSH term(s) Breast/surgery ; Esthetics ; Extremities/surgery ; Female ; Humans ; Male ; Microsurgery/methods ; Perforator Flap/surgery ; Reconstructive Surgical Procedures/methods ; Surgery, Computer-Assisted
    Language English
    Publishing date 2020-08-15
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 193117-9
    ISSN 1558-0504 ; 0094-1298
    ISSN (online) 1558-0504
    ISSN 0094-1298
    DOI 10.1016/j.cps.2020.07.002
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  5. Article ; Online: Microsurgery: Global Perspectives: An Update.

    Tang, Jin Bo / Saint-Cyr, Michel

    Clinics in plastic surgery

    2020  Volume 47, Issue 4, Page(s) xiii

    Language English
    Publishing date 2020-08-12
    Publishing country United States
    Document type Editorial
    ZDB-ID 193117-9
    ISSN 1558-0504 ; 0094-1298
    ISSN (online) 1558-0504
    ISSN 0094-1298
    DOI 10.1016/j.cps.2020.07.003
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  6. Article ; Online: Decreasing Opioids in Outpatient Breast Surgery with an Enhanced Recovery after Surgery Program and Preoperative Education.

    Wong, Stacy / Lombana, Nicholas F / Falola, Reuben A / Park, Peter / Saint-Cyr, Michel H

    Plastic and reconstructive surgery

    2022  Volume 151, Issue 5, Page(s) 941–947

    Abstract: Background: Enhanced recovery after surgery (ERAS) programs have been detailed in the literature predominantly in the inpatient setting. The purpose of this study was to determine the effect of an ERAS protocol with a preoperative educational class on ... ...

    Abstract Background: Enhanced recovery after surgery (ERAS) programs have been detailed in the literature predominantly in the inpatient setting. The purpose of this study was to determine the effect of an ERAS protocol with a preoperative educational class on opioid prescribing and patient outcomes for outpatient breast surgery.
    Methods: An ERAS protocol was formulated focusing on preoperative education, multimodal pain control, and an intraoperative block. The study was conducted as an institutional review board-approved retrospective review. Women undergoing breast reconstruction revision, breast reduction, delayed insertion of prosthesis, tissue expander to implant exchange, and matching procedures were included. The patients were separated into pre-ERAS and ERAS cohorts. Data on demographic characteristics, postanesthesia care unit (PACU) length of stay, PACU oral morphine equivalent (OME) consumption, outpatient OME prescriptions, major and minor complications, and need for additional opioid prescriptions were collected. Analysis was performed with the Fisher exact test or chi-square test as appropriate.
    Results: Group 1 (pre-ERAS) and group 2 (ERAS) each included 68 patients. The cohorts had similar age, body mass index, diabetes status, and tobacco use. Group 1 was prescribed an average of 216 OMEs, compared with 126.4 OMEs for group 2, a 41.5% decrease ( P < 0.0001). The pre-ERAS group consumed an average of 23.3 OMEs in the PACU versus 16.6 OMEs in the ERAS group ( P = 0.005). Fewer patients in the ERAS group required additional prescriptions for narcotic pain medication at postoperative follow-up ( P = 0.116). No differences were seen in major or minor complications.
    Conclusion: An ERAS protocol that uses a multimodal approach to pain control and preoperative patient education is useful in the outpatient setting and can help decrease opioid consumption.
    Clinical question/level of evidence: Therapeutic, III.
    MeSH term(s) Humans ; Female ; Analgesics, Opioid/therapeutic use ; Outpatients ; Enhanced Recovery After Surgery ; Pain, Postoperative/drug therapy ; Pain, Postoperative/etiology ; Pain, Postoperative/prevention & control ; Practice Patterns, Physicians' ; Retrospective Studies ; Morphine/therapeutic use ; Breast Neoplasms/complications ; Length of Stay
    Chemical Substances Analgesics, Opioid ; Morphine (76I7G6D29C)
    Language English
    Publishing date 2022-12-19
    Publishing country United States
    Document type Journal Article
    ZDB-ID 208012-6
    ISSN 1529-4242 ; 0032-1052 ; 0096-8501
    ISSN (online) 1529-4242
    ISSN 0032-1052 ; 0096-8501
    DOI 10.1097/PRS.0000000000010069
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  7. Article: Updates on Enhanced Recovery after Surgery protocols for plastic surgery of the breast and future directions.

    Lombana, Nicholas F / Mehta, Ishan M / Zheng, Caiwei / Falola, Reuben A / Altman, Andrew M / Saint-Cyr, Michel H

    Proceedings (Baylor University. Medical Center)

    2023  Volume 36, Issue 4, Page(s) 501–509

    Abstract: Introduction: Perioperative pain control is an important component of any plastic surgery practice. Due to the incorporation of Enhanced Recovery after Surgery (ERAS) protocols, reported pain level, opioid consumption, and hospital length of stay ... ...

    Abstract Introduction: Perioperative pain control is an important component of any plastic surgery practice. Due to the incorporation of Enhanced Recovery after Surgery (ERAS) protocols, reported pain level, opioid consumption, and hospital length of stay numbers have decreased significantly. This article provides an up-to-date review of current ERAS protocols in use, reviews individual aspects of ERAS protocols, and discusses future directions for the continual improvement of ERAS protocols and control of postoperative pain.
    Eras components: ERAS protocols have proven to be excellent methods of decreasing patient pain, opioid consumption, and postanesthesia care unit (PACU) and/or inpatient length of stay. ERAS protocols have three phases: preoperative education and pre-habilitation, intraoperative anesthetic blocks, and a postoperative multimodal analgesia regimen. Intraoperative blocks consist of local anesthetic field blocks and a variety of regional blocks, with lidocaine or lidocaine cocktails. Various studies throughout the surgical literature have demonstrated the efficacy of these aspects and their relevance to the overall goal of decreasing patient pain, both in plastic surgery and other surgical fields. In addition to the individual ERAS phases, ERAS protocols have shown promise in both the inpatient and outpatient sectors of plastic surgery of the breast.
    Conclusion: ERAS protocols have repeatedly been shown to provide improved patient pain control, decreased hospital or PACU length of stay, decreased opioid use, and cost savings. Although protocols have most commonly been utilized in inpatient plastic surgery procedures of the breast, emerging evidence points towards similar efficacy when used in outpatient procedures. Furthermore, this review demonstrates the efficacy of local anesthetic blocks in controlling patient pain.
    Language English
    Publishing date 2023-05-23
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2703932-8
    ISSN 1525-3252 ; 0899-8280
    ISSN (online) 1525-3252
    ISSN 0899-8280
    DOI 10.1080/08998280.2023.2210036
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  8. Article: How Fat Grafting Works.

    Evans, Brogan G A / Gronet, Edward M / Saint-Cyr, Michel H

    Plastic and reconstructive surgery. Global open

    2020  Volume 8, Issue 7, Page(s) e2705

    Abstract: Fat grafting has been shown to improve diseased soft issue. Although the mechanism behind fat grafting's regenerative properties is currently debated, published studies agree that there is an associated vasculogenic effect. A systematic literature review ...

    Abstract Fat grafting has been shown to improve diseased soft issue. Although the mechanism behind fat grafting's regenerative properties is currently debated, published studies agree that there is an associated vasculogenic effect. A systematic literature review was conducted to elucidate the biochemical pathways responsible for establishing neo-vasculature to grafted fat.
    Methods: A systematic literature review was conducted by searching PubMed for current basic science and clinical research relating to fat grafting. In total, 144 of 269 (54%) articles met the inclusion criteria for our literature review. These 144 articles were summarized, with 86 of them (60%) used to construct this article at the authors' discretion.
    Results: Fat grafting-induced neovascularization can be divided into 3 parts. First, tissue trauma induced via fat injection activates a host inflammatory response necessary for cellular recruitment. Recruited cells promote the formation of connective tissue and neo-vasculature at the graft site. Second, cellular elements within the lipoaspirate contribute to neovascularization through a cytokine burst. Third, a synergistic relationship is established between recruited inflammatory cells and the cytokine burst of grafted fat. The end product of these processes is the differentiation of progenitor cells and the creation of neo-vasculature at the graft site.
    Conclusions: Establishing neovasculature is paramount for the survival of grafted fat. Fat graft take can be divided into 2 steps: imbibition and neovascularization. We believe this process occurs through 3 distinct concepts: host inflammation via graft injection, hypoxic response of lipoaspirate-derived cellular elements, and a synergistic relationship between host inflammation and grafted fat.
    Language English
    Publishing date 2020-07-14
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2851682-5
    ISSN 2169-7574 ; 2169-7574
    ISSN (online) 2169-7574
    ISSN 2169-7574
    DOI 10.1097/GOX.0000000000002705
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  9. Article ; Online: Keystone and Perforator Flaps in Reconstruction: Modifications and Updated Applications.

    Rodriguez-Unda, Nelson A / Abraham, Jasson T / Saint-Cyr, Michel

    Clinics in plastic surgery

    2020  Volume 47, Issue 4, Page(s) 635–648

    Abstract: Pedicle perforator flaps and keystone perforator island flaps provide additional tools for the reconstructive surgeon's armamentarium. Advances in understanding of vascular anatomy, dynamic nature of perforator perfusion, interperforator flow, and "hot ... ...

    Abstract Pedicle perforator flaps and keystone perforator island flaps provide additional tools for the reconstructive surgeon's armamentarium. Advances in understanding of vascular anatomy, dynamic nature of perforator perfusion, interperforator flow, and "hot spot" principle have led to reconstructive methods that allow for autologous tissue transfer, while limiting donor site morbidity. Further modifications in pedicle perforator flap enabled the propeller flap and freestyle perforator free flap for soft tissue reconstruction. Modifications in keystone perforator island flap increased degrees of freedom the reconstructive surgeon has for soft tissue coverage of large defects, with significant reliability, aesthetically pleasing results, and reduced donor site morbidity.
    MeSH term(s) Esthetics ; Female ; Humans ; Male ; Perforator Flap/blood supply ; Reconstructive Surgical Procedures/methods
    Language English
    Publishing date 2020-08-13
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 193117-9
    ISSN 1558-0504 ; 0094-1298
    ISSN (online) 1558-0504
    ISSN 0094-1298
    DOI 10.1016/j.cps.2020.06.014
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  10. Article ; Online: Autologous Breast Reconstruction in Low Body Mass Index Patients: Strategies for Maximizing Skin Envelope and Breast Volume.

    Mohan, Anita T / Zhu, Lin / Vijayasekaran, Aparna / Saint-Cyr, Michel

    Clinics in plastic surgery

    2020  Volume 47, Issue 4, Page(s) 611–619

    Abstract: Pure autologous breast reconstruction in thin patients creates challenges. This review highlights techniques to optimize the scarce donor tissue available, approaches to reconstruction, and microsurgical techniques. A systematic approach to maximize ... ...

    Abstract Pure autologous breast reconstruction in thin patients creates challenges. This review highlights techniques to optimize the scarce donor tissue available, approaches to reconstruction, and microsurgical techniques. A systematic approach to maximize breast volume and the skin envelope in patients who underwent pure autologous breast reconstruction by a single senior surgeon is presented with a clinical case series. Included in the study were 125 patients (217) with autologous breast reconstructions. Although DIEP flaps were the commonest flap used overall (79%), within in the low body mass index (<22) group, there was a greater use of Latissimus (32%), and thigh-based flaps (>50%).
    MeSH term(s) Adipose Tissue/transplantation ; Adult ; Aged ; Algorithms ; Autografts ; Body Mass Index ; Breast Implants ; Breast Neoplasms/surgery ; Female ; Humans ; Mammaplasty/methods ; Mastectomy/methods ; Middle Aged ; Perforator Flap ; Retrospective Studies ; Surgical Flaps ; Thinness ; Tissue Expansion
    Language English
    Publishing date 2020-08-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 193117-9
    ISSN 1558-0504 ; 0094-1298
    ISSN (online) 1558-0504
    ISSN 0094-1298
    DOI 10.1016/j.cps.2020.07.001
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