https://www.daisylouisespoer.com/home daily 1.0 2025-08-20 https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/cd758181-cd13-4a82-bc1b-f766eec93c68/IMG_A1F23B3910D0-1.jpeg home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/79e26247-5304-4082-a26f-a853092609d4/Screenshot+2025-10-19+at+19.08.14.png home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/be0936c7-b029-4082-9d8a-48c9e3cb06b1/Screenshot+2025-08-20+at+06.08.39.png home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/2348474c-2b0a-4e3e-93ed-b9be0a9ae13f/Picture1.png home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/8375a1e6-a95c-4a6e-8713-dcfaf272e89c/Screenshot+2023-10-04+at+4.54.49%E2%80%AFPM.png home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/1714091602684-PMZBUBPZHDKLFJ4SJNDZ/IMG_5371%2B2.jpg home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/1687909073324-OF2E6C2EZRUMNCU999O3/CY%2BNAC%2BFig%2B1%2Bcopy%2B4.jpg home C-Y Trilobe Nipple Reconstruction A series of figures illustrating the surgical technique for C-Y Trilobe Nipple Reconstruction. Created for Dr. David Song, Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital. Submitted to Annals of Plastic Surgery for publication in January 2023. Illustration of principle technique for C-Y Trilobed flap for nipple reconstruction. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/aa6564cb-a5a2-498c-baf4-dfdc0e50d61d/IMG_304C0F3CFA1F-1.jpeg home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/1a8f709b-f8aa-404c-8f19-0c8d23d5713b/Ideal%2Bflat%2Bchest.png home Aesthetic Flat Closure A series of figures illustrating the individual features contributing to the "ideal" aesthetic outcome following flat closure. Created for Dr. Kenneth Fan, Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital. Distributed for validation using MTurk. Ideal Flat Closure Together, these individual features contribute to the below "ideal" aesthetic outcome following flat closure https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/a8f69710-150b-420f-a686-267ba5a5c5c2/IMG_E17FCC6DA223-1.jpeg home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/97bb7643-4948-4e9d-a847-b21ae4a47ee6/Fig+3.png home Radiographic Evidence of Neo-vascularization of the Lower Abdominal Soft Tissues in Patients After Abdominoplasty and Previous Abdominal Free Flap Breast Reconstruction A series of figures illustrating the vascular anatomy apparent from imaging of patients after abdominally-based free flap and abdominal resections (abdominoplasty). Created for Dr. David Song, Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital. In-Press: European Journal of Plastic Surgery in June 2023 https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/42ab9a01-4f2b-428d-abfb-4e6e644ab6cd/body.jpg home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/5c0ae02d-fffc-44a7-b40f-cd23a88294af/Figure+1.jpg home Lymphovenous Coupler-Assisted Bypass (CAB) for Immediate Lymphatic Reconstruction Two figures illustrating the preoperative imaging and intraoperative technique for lymphovenous coupler-assisted bypass (CAB). Created for Dr. Laura Tom, Department of Plastic and Reconstructive Surgery, MedStar Washington Hospital Center. Submitted to the Journal of Reconstructive Microsurgery for publication in January 2023. Identification and Dissection of Lymphatic and Venous Targets Visual depiction of isolation of lymphatics and venous recipients. (A) Lymphatic visualized with ICG (white star) under near-infrared fluorescent imaging indicates continuity and drainage from the distal hand. (B) This intraoperative view demonstrates a lymphatic that is methylene blue positive and neighboring an appropriate venous recipient. Neighboring veins near branch points offer low flow conduits for bypass and are the ideal recipient for lymphatic drainage. The serratus branch is an optimal target for lymphovenous bypass as it is often near the transected lymphatics and does not preclude later autologous breast reconstruction. (C) Superimposed images of fluorescent and intraoperative target vessels. This view confirms that the lymphatic target is functional as it displays both ICG (white star) and blue dye positivity (blue star). (D) An anatomic illustration of the veins and lymphatics involved in prophylactic lymphovenous bypass. Named vessels include the following: axillary vein (ax); medial pectoral vein (not pictured) runs on the undersurface of the pectoralis major muscle; lateral thoracic vein (lt) runs of the lateral chest wall; thoracodorsal (td) vein, this vein is found deeper in the axilla generally posterior to the thoracoepigastric vein and anterior to the intercostal brachial nerve, proximally it will branch into the circumflex scapular vein and distally branches into the serratus branch; thoracoepigastric vein (te) sometimes referred to as the accessory vein, runs in a superficial plane that is deep to the clavipectoral fascia.9 https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/561a2ae5-855b-42ec-bac0-9d201cd13453/zscasc.png home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/6f390d9e-0f4c-45c5-9714-5a5e7546f900/Figure+3.jpg home Lymphoveonus Coupler Assisted Bypass (CAB) Technique, Key Steps Critical steps for lymphovenous coupler assisted bypass (CAB) technique. The procedure is presented in Video S1. (A) superimposed cartoon of the lasso stitch, which grasps the adventitia of the target lymphatic and gently pulls the lymphatic into the venous lumen. This is assisted by the coupler device, allowing for precision in implantation. (B) superimposed cartoon of an example final product following CAB. The resulting LVB will involve 2-3 implanted lymphatics into a single vein. Depending on the the equipment used and the surgeon's preference, the coupler can remain or be removed. A fat/soft tissue bolster can be placed to prevent theoretical damage from the coupler spikes and secure the LVB. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/ad7e8a84-1504-4fc6-9915-b01947dddff1/xxxx.png home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/1687911018897-SNBBC7L783WS359W3JPH/Picture1%2Bcopy%2B2.jpg home Surgical Techniques for Lymphovenous Bypass Three figures illustrating the pertinent anatomy and surgical technique for the various approaches to lymphovenous bypass. Created for Dr. Laura Tom, Department of Plastic and Reconstructive Surgery, MedStar Washington Hospital Center. Submitted to Plastic Aesthetic Research for invited editorial in January 2023 Overview of lymphatic and venous vasculature frequently used in LVB. Illustration of Koshima ICG lymphedema classification system Stage A-B Illustration of Koshima ICG lymphedema classification system Stage C-D Traditional E-E Traditional E-S Traditional S-S Overview of lymphatic and venous vasculature frequently used in LVB. The caliber of lymphatics varies in the published literature, although they have been categorized into initial lymphatics (0.01-0.06 mm), pre-collector (0.035–0.150 mm), and collector lymphatics (0.200 mm). Thus, we chose to illustrate a collector lymphatic as the relevant structure for LVB. (A) Collector lymphatics have tight “zipper-like” junctions, specialized muscle cells, and valves that coordinate directional flow of lymph via suction-derived diastolic filling. (B) The cutaneous vessels used in LVB generally include valved subdermal venules (0.3-0.6mm) or large cutaneous veins (>1mm). The microcirculatory venules and veins vary according to their ultrastructure, and anatomical location, and a venule with sparse smooth muscle cells is illustrated for generalizability. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/d50bdaa1-01ea-46e4-b437-2dbff11d3f4d/PNG+image+12.png home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/1687911096800-0MNFW9R77OZOZBPF9L36/Figure%2B2.jpg home Illustration of Koshima ICG lymphedema classification system Stage A-D (A) Stage 0: “Normal superficial lymphatic vessels appear as a “linear” pattern with no dermal backflow” (B) Stage 1: “Lymphatic vessels appear dilated and torturous with areas of ICG accumulation as a “splash” pattern” (C) Stage 2: “Contracted lymphatic vessels with loss of intraluminal diameter and thickening of the smooth muscle cell coverage Lymphatic vessels are disrupted, causing increased areas of ICG accumulation as a “stardust” pattern” (D) Stage 3: “No lymphatic vessels can be seen and there is ICG accumulation as a “diffuse” pattern.” Yamamoto T, Narushima M, Doi K, et al. Characteristic indocyanine green lymphography findings in lower extremity lymphedema: the generation of a novel lymphedema severity staging system using dermal backflow patterns. Plast Reconstr Surg 2011; 127: 1979-1986. DOI: 10.1097/PRS.0b013e31820cf5df. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/4154bcba-716e-4fe2-a80c-6ace82988ee5/PNG+image+11.png home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/cc34dbe6-03c5-4f67-a96c-52144952a3e5/Image+10-4-23+at+5.39%E2%80%AFPM+%281%29.jpeg home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/86e8c6fd-eb48-4aa1-846b-97e6187857a0/Image+10-4-23+at+5.37%E2%80%AFPM+%282%29.jpeg home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/dc175ee9-f6c1-464d-9927-e23b9c61c46e/Manuscript_Review+Final1024_1.jpg home Surgical Techniques for Lymphovenous Bypass Information and illustrations of LVB techniques as described in the published literature. The list is not comprehensive, and more options for LVB exist. Configurations are described by the direction of union including end-to-end (E-E), end-to-side (E-S), side-to-end (S-E), and side-to-side (S-S). Ratios of lymphatics:recipient veins (RV) comprise the number of individual, native lymphatics which were included in the LVB; lymphatics that were transected and employed the use of the proximal and distal ends were counted as 1 lymphatic. Ratios of 2:1 are described with λ-shaped, but the technique is described in the published literature as a method that involves two ends of a transected lymphatic rather than a method of 2:1 LVB. Because procedures involving RV outlets <0.8mm may require specialized equipment, techniques that included RV outlets <0.8mm were marked with “+,” if the procedure was described with RV <0.8 and RV>0.8 the procedure was marked with a “+/-.” Procedures that have been applied in the setting of immediate lymphatic reconstruction (ILR) were marked with a “+.” Illustrations are basic representations of the configurations, drawn according to the procedural descriptions or images in the referenced articles. Lymphatics, valves, and direction of lymphatic flow (arrows) are depicted in green. RV and direction of flow (arrows) are depicted in dark blue; venous valves are in pink. The directionality of lymphatic flow was based on the orientation described in the technical articles as both lymphatics and RV have directional valves which support flow in a distal to proximal manner. If the proximal or distal end of the lymphatic or vein was not otherwise specified, the directionality was depicted in the anatomical fashion, which would theoretically optimize flow. Modifications to the described approaches are listed with the procedures they are reportedly applied to. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/6d5bf5bd-36f4-45d7-8177-848510d35436/IMG_875ABDD013AA-1.jpeg home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/1687911126129-XM7WAC6QAGBM2D7IBQUB/Picture1%2Bcopy.jpg home Are We Misrepresenting SFA Stenting? High Rates of Restenosis and Limb Loss Are Seen in Patients with Chronic Wounds A figure illustrating the pertinent vascular and muscular anatomy of the lower extremity relevant for angiosome directed revascularization. Created for Dr. Cameron Akbari, Department of Vascular Surgery, MedStar Georgetown University Hospital Center. Presented at the Eastern Vascular Society 36th Annual Meeting; Philadelphia, PA; September 2022 Vascular Supply, Angiosomes, and Muscles of the Lower Extremity Visual depiction of the segmented arterial supply of the lower extremity, corresponding 21 cutaneous vascular territories (angiosomes), and lower extremity muscles. Colors correspond to the named vessel for the cutaneous angiosomes and dominant blood supply to the muscles. Illustrations reflect (A) an anterior view of the anatomy of the arteries, (B) an anterior view of angiosomes and muscles, and (C) a posterior view of angiosomes and muscles of the lower extremity. Named vessels have a corresponding angiosome pictured in color consistent with the vessel (A). Acronyms and associated muscles include the following list, due to the presence of anastomotic connections and dual blood supply, the colors of the muscles reflect the shade of the vessel which composes the dominant blood supply. (1) gluteal region: SGA: superior gluteal artery, IGA: inferior gluteal artery, (2) hip and thigh: SCIA: superficial circumflex iliac artery, FA: femoral artery (further segmented into the CFA (common), SFA1/2/3 (superficial, proximal, middle, and distal)), LCFA: lateral circumflex femoral artery, MCFA: medial circumflex femoral artery. (3) knee and leg: DGA: medial genicular artery, LSGA: lateral superior genicular artery, LIGA: lateral inferior genicular artery, MSGA: medial superior genicular artery, MIGA: medial superior genicular artery, PA: popliteal artery, PT: posterior tibial artery (1/2/3: proximal, middle, distal), ATA: anterior tibial artery (1/2/3: proximal, middle, distal), PEA: peroneal artery (4) ankle and foot: MCA: medial calcaneal artery, LCA: lateral calcaneal artery, LPA: lateral plantar artery, MPA: medial plantar artery, DPA: dorsalis pedis artery. Illustrations were adapted from Attinger, C. E. et al. (2006). "Angiosomes of the foot and ankle and clinical implications for limb salvage: reconstruction, incisions, and revascularization." Plast Reconstr Surg 117(7 Suppl): 261S-293S. Drake, R. L., Ph.D., FAAA, et al. (2021). Gray's Atlas of Anatomy, Third Edition, Elsevier. Wong, A. and S. Morris (2020). Vascular Anatomy of the Lower Extremity: A Practical Guide to Vascular Territories, Perforators, and Selection of Recipient Vessels. Lower Extremity Reconstruction: A Practical Guide. New York, Thieme. 1. Neligan, P. C., et al. (2012). Comprehensive lower extremity anatomy. Plastic Surgery E-Book: 6 - Volume Set: Expert Consult - Online, Elsevier Health Sciences, 2012.) https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/d4987654-237f-4cba-a768-9a82e12465c6/cf.png home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/3fa8a9bd-d905-4827-b4bb-a4f7bff979a4/Picture1.png home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/e09fbea8-8e91-4ecb-ab18-9f2c7a86f446/IMG_BD8950B42A2D-1.jpeg home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/583e898b-b4c0-482a-b380-3080342f5a7c/marking.jpg home Illustration of principle technique for C-Y Trilobed flap for nipple reconstruction. (A) The design is similar to C-V flaps but with square lateral extensions. Patient should be marked with lateral extensions measuring 1 cm x 1 cm and 3 cm in entirety. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/f1c137af-48aa-4b63-a4ae-9b704cd04478/asclawscmasc.png home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/a6815273-77ff-464e-9bfa-4aa09db52176/step+1.png home Illustration of principle technique for C-Y Trilobed flap for nipple reconstruction. (B) The initial incision and elevation were performed with a 15-blade. The lateral flaps are elevated with approximately 1 millimeter of fat on the dermis. When the central mound is reached, thickness is taken to about 5 millimeters of fat to provide adequate bulk; when complete, the flap should be able to stand up by itself. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/a3212b01-55a3-49c4-ab9e-375f588aec09/IMG_8251DF9D60DD-1.jpeg home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/802f339d-8398-438a-8e0a-f5b0eaafd3d5/step+2.png home Illustration of principle technique for C-Y Trilobed flap for nipple reconstruction. (C) The two corners are then approximated with deep dermal sutures. Next, the lateral triangular stitch should be placed to create the Y component in the flat. The triangular stitch should gather on all three sides of the donor site, making a Y. This is repeated on the opposite side. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/cd5e8e59-8213-4628-bda9-b317f04580fa/IMG_55A9CEFDD11B-1.jpeg home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/619179ca-fae5-462f-a501-c3ff85d20984/step+3.png home Illustration of principle technique for C-Y Trilobed flap for nipple reconstruction. (D) Following donor site closure, the remaining flaps are tacked together with deep dermal sutures. Initially, bringing together the lateral flaps and then securing them to the base. Lastly, a stitch securing the top flap fastening to the lateral flaps. The remaining incisions are closed with a running 5-0 Caprosyn. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/a96a7ca0-18c2-40f1-acc8-723278828409/Image+10-4-23+at+5.37%E2%80%AFPM+%281%29.jpeg home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/22dff564-cb3c-45d0-8a0d-075b5a96ab08/final.png home Illustration of principle technique for C-Y Trilobed flap for nipple reconstruction. (E) The donor scar length is short, and the nipple will have good projection. Tattooing of this nipple-areolar complex can occur postoperatively. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/408f8688-b73a-4e85-8e55-7b618d9cc3f8/Image+10-4-23+at+5.38%E2%80%AFPM+%281%29.jpeg home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/1fcd3c4a-eb38-4581-b488-2871c718e8a6/czcx.png home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/82627903-23aa-4e82-9dc6-a67b1328e6c7/IMG_5330.JPG home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/27df2f1c-a920-4a0f-bdc3-e35f38d158e4/IMG_5331.JPG home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/d19b135e-24e9-413a-b8ae-fded80177ee8/IMG_5332.JPG home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/5b573616-54b4-40ca-9ff7-703c92da0a6b/IMG_4BC2CE3A68D4-1.jpeg home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/801b7d0f-5f76-408e-b9c0-249b26d33a59/IMG_5329.JPG home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/cc6cde24-22ec-48ff-9dd7-895a72fca90c/Image+10-4-23+at+6.02%E2%80%AFPM.jpg home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/6dddf893-3602-45b3-8f69-71a867c69540/Image+10-4-23+at+6.02%E2%80%AFPM+%281%29.jpg home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/29f6dffa-18b9-4d8d-b83c-98a7b80ab23c/Picture1.png home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/3469e65d-a01e-44b3-af29-9a2ecbc4fd4e/sadvsdsad.png home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/cb26bf2c-550b-46ee-9993-f569b0b95cb2/asvmawlsd home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/a3c6b09a-590e-46af-b3a5-fd7836c4e9ea/IMG_4BC2CE3A68D4-1.jpeg home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/18f539a0-e19e-4329-ac59-891bd63eeebf/IMG_057C31F3AC30-1.jpeg home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/c9dbb97e-91b2-4473-b7d3-34f7c648e5b8/IMG_68F4568D5922-1.jpeg home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/4a9a7c6d-8f01-47a3-b62e-22e6e329f5bf/IMG_AF36972D9131-1.jpeg home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/5c37d8aa-5ac3-4b43-8664-bdcae1d65376/IMG_BAF96ED0057F-1.jpeg home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/c77ae5a2-194a-4dfa-bcc3-3533440d1c9d/IMG_B8B17F76A0A2-1.jpeg home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/d6502a0c-b49a-450c-8d5c-a72f89b3118c/IMG_BAF96ED0057F-1.jpeg home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/879e5327-bc2d-4ea5-a4ae-94c90be3a576/IMG_C4682336A7FD-1.jpeg home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/7329616a-94fd-47c6-8d54-c4467ba4291b/IMG_965210A83491-1.jpeg home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/53bc5c20-68c1-4194-aac8-014248e3a02f/IMG_8F4CEC3B2DDC-1.jpeg home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/53db25d9-033a-4d71-b2e7-826c2bc0d802/IMG_60E815E718AF-1.jpeg home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/6dd33d8f-01d7-4c2a-842c-2495356fcd7c/B551D5F2-DF9E-4095-8B30-99CED79C8721_1_105_c.jpeg home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/330aca05-ac00-4c4c-9d6e-8f84fb67de09/C8DF829A-2429-4265-8056-4AB80754A320_1_105_c.jpeg home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/1f139569-9f25-47f4-b162-454abfe25e94/B62E40C9-EDC9-4945-9D79-52D0BCFAC6A6_1_105_c.jpeg home https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/e12635d9-3115-4ed9-a08a-6aa264b037de/BBC22101-379B-44B3-BFA9-3D7AD0C36DB2_4_5005_c.jpeg home https://www.daisylouisespoer.com/about daily 0.75 2025-08-20 https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/8eb86480-d1b6-4c37-91ed-91a50ee0d138/headshot+copy.jpg https://www.daisylouisespoer.com/contact daily 0.75 2025-08-20 https://www.daisylouisespoer.com/graphics daily 0.75 2025-08-20 https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/fe89526d-3dd6-4fbd-bce5-0dec0381ba7d/Screenshot+2025-08-20+at+09.09.55.png https://www.daisylouisespoer.com/video daily 0.75 2025-08-20 https://www.daisylouisespoer.com/medical-illustrations daily 0.75 2025-08-20 https://www.daisylouisespoer.com/medical-illustrations/aestheticflatclosure monthly 0.5 2023-10-04 https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/1a8f709b-f8aa-404c-8f19-0c8d23d5713b/Ideal%2Bflat%2Bchest.png https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/44d5711c-05bb-4edd-8c2c-00acdae3d8b1/Screen%2Bshot%2B2022%2B11%2B21%2Bat%2B2.03.png medical illustrations - Aesthetic Flat Closure Aesthetic Inframammary fold (IMF) removal Ideal Outcome: 1. The IMF is the crease located at the bottom portion of the chest where the breast normally sits; the ideal outcome is for this crease to be completely removed. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/cda36b27-d23a-42d9-b7fb-4ff02b3e0e54/Screen%2Bshot%2B2022%2B11%2B21%2Bat%2B2.06.png medical illustrations - Aesthetic Flat Closure Aesthetic Feature: Side (lateral) chest wall contour. Ideal Outcome: 2. Each outer side of the chest wall should be smooth without extra skin, folds, wrinkles or bumps. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/e22d73cc-d526-4180-8fc0-15b1bc1c0fa0/Screen%2Bshot%2B2022%2B11%2B21%2Bat%2B2.09.png medical illustrations - Aesthetic Flat Closure Aesthetic Feature: Midline (medial) chest wall contour Ideal Outcome: 3. The midline (medial) portion of the chest wall should be smooth without extra skin, folds, wrinkles or bumps. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/9974c44d-1cb8-4ddd-a2d1-cb305430dba2/Screen%2Bshot%2B2022%2B11%2B21%2Bat%2B2.12.png medical illustrations - Aesthetic Flat Closure Aesthetic Feature: Concavity Ideal Outcome: 4. The chest wall should be flat or mildly curve outward (convex). The chest wall should not curve inward (no concavity). https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/a32b9a6b-4c3d-4afd-9204-2b20ea8ce7ee/Screen%2Bshot%2B2022%2B11%2B21%2Bat%2B2.27.png medical illustrations - Aesthetic Flat Closure Aesthetic Feature: Quality of incision closure. Ideal Outcome: 5. The incision should be as flat and smooth as possible with no bumps, rippling, or skin folds visible to the naked eye. Aesthetic Feature: Incision symmetry Ideal Outcome: 6. There should be minimal differences in incision size and shape without extra tissue on each side. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/0b4ddd51-3b70-4f54-8203-eae27f4364f9/Screen%2Bshot%2B2022%2B11%2B21%2Bat%2B2.17.png medical illustrations - Aesthetic Flat Closure Aesthetic Feature: Contour symmetry. Ideal Outcome: 7. There should be an equal distribution of overall skin thickness without puckering, rippling, bumps, or areas of extra tissue. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/8310d206-3a17-4fb5-bbf7-c8e31f732c59/Screen%2Bshot%2B2022%2B11%2B21%2Bat%2B2.21.png medical illustrations - Aesthetic Flat Closure Aesthetic Feature: Armpit & collarbone aesthetics. Ideal Outcome: 8. The armpit (axillary) and collarbone (clavicular) areas should be continuously smooth (tapered) from the chest, without divots or skin folds. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/c42a4655-224b-4086-8bbe-3066b353789f/Screen%2Bshot%2B2022%2B11%2B21%2Bat%2B2.28.png medical illustrations - Aesthetic Flat Closure Aesthetic Feature: Nipples: symmetry* Ideal Outcome: 11. Some patients want to keep their nipples. If retained, nipples should be as equal in size as possible and positioned along the same vertical and horizontal planes on each side. Aesthetic Feature: Nipples: position* Ideal Outcome:12. If retained, nipples should be positioned as close to the ideal position (shown here) as possible. https://www.daisylouisespoer.com/medical-illustrations/cynipplereconstruction monthly 0.5 2023-10-04 https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/b7f97bf5-fdf1-413a-bb63-f18b1d752629/untitled_artwork.jpg https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/be66881e-eefa-46fd-a277-5e35564ed695/untitled_artwork-1.jpg medical illustrations - C-Y Trilobe Nipple Reconstruction Illustration of principle technique for C-Y Trilobed flap for nipple reconstruction. (A) The design is similar to C-V flaps but with square lateral extensions. Patient should be marked with lateral extensions measuring 1 cm x 1 cm and 3 cm in entirety. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/b7f97bf5-fdf1-413a-bb63-f18b1d752629/untitled_artwork.jpg medical illustrations - C-Y Trilobe Nipple Reconstruction (B) The initial incision and elevation were performed with a 15-blade. The lateral flaps are elevated with approximately 1 millimeter of fat on the dermis. When the central mound is reached, thickness is taken to about 5 millimeters of fat to provide adequate bulk; when complete, the flap should be able to stand up by itself. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/d11b7a6e-40e6-4194-ae56-5056becb3b2d/step-2.png medical illustrations - C-Y Trilobe Nipple Reconstruction (C) The two corners are then approximated with deep dermal sutures. Next, the lateral triangular stitch should be placed to create the Y component in the flat. The triangular stitch should gather on all three sides of the donor site, making a Y. This is repeated on the opposite side. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/9382cdd4-05c1-4d59-b2e0-65a05edecbc0/step-3.png medical illustrations - C-Y Trilobe Nipple Reconstruction (D) Following donor site closure, the remaining flaps are tacked together with deep dermal sutures. Initially, bringing together the lateral flaps and then securing them to the base. Lastly, a stitch securing the top flap fastening to the lateral flaps. The remaining incisions are closed with a running 5-0 Caprosyn. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/783ebd6d-3378-404c-8a40-959db2ba0534/final.png medical illustrations - C-Y Trilobe Nipple Reconstruction (E) The donor scar length is short, and the nipple will have good projection. Tattooing of this nipple-areolar complex can occur postoperatively. https://www.daisylouisespoer.com/medical-illustrations/radiographicevidence monthly 0.5 2023-10-04 https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/e1947d2c-8e9e-4cde-9bf6-d0d553414294/238_2023_2076_Fig3_HTML+copy.jpg https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/82e1fb75-8c89-4225-aed4-fbbb56d6a5e8/Picture1.png medical illustrations - Radiographic Evidence of Neo-vascularization of the Lower Abdominal Soft Tissues Superior vessel dominance https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/767cb2a8-1561-4201-a8d8-9778c7ee63a5/Picture2.png medical illustrations - Radiographic Evidence of Neo-vascularization of the Lower Abdominal Soft Tissues Inferior vessel dominance https://www.daisylouisespoer.com/medical-illustrations/lvb-cab monthly 0.5 2025-08-20 https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/32525d82-810e-41af-9086-238b6ceaf705/cdjksnancsjdc.png https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/8f27464e-cdea-4094-b30e-7945a7419f38/Figure+1-1.png medical illustrations - Lymphovenous Coupler-Assisted Bypass (CAB) for Immediate Lymphatic Reconstruction Identification and Dissection of Lymphatic and Venous Targets Visual depiction of isolation of lymphatics and venous recipients. (A) Lymphatic visualized with ICG (white star) under near-infrared fluorescent imaging indicates continuity and drainage from the distal hand. (B) This intraoperative view demonstrates a lymphatic that is methylene blue positive and neighboring an appropriate venous recipient. Neighboring veins near branch points offer low-flow conduits for bypass and are the ideal recipient for lymphatic drainage. The serratus branch is an optimal target for lymphovenous bypass as it is often near the transected lymphatics and does not preclude later autologous breast reconstruction. (C) Image of neighboring vein and blue lymphatic in preparation for bypass (D) An anatomic illustration of the veins and lymphatics involved in prophylactic lymphovenous bypass. Named vessels include the following: axillary vein (ax); medial pectoral vein (not pictured) runs on the undersurface of the pectoralis major muscle; lateral thoracic vein (lt) runs of the lateral chest wall; thoracodorsal (td) vein, this vein is found deeper in the axilla generally posterior to the thoracoepigastric vein and anterior to the intercostal brachial nerve, proximally it will branch into the circumflex scapular vein and distally branches into the serratus branch; thoracoepigastric vein (te) sometimes referred to as the accessory vein, runs in a superficial plane that is deep to the clavipectoral fascia.9 (E) Demonstration of functional lymphatic via leakage of blue fluid following transection of lymphatic. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/03de34a7-8e0e-4f81-a54c-e73a5634e072/Figure+3.jpg medical illustrations - Lymphovenous Coupler-Assisted Bypass (CAB) for Immediate Lymphatic Reconstruction Lymphoveonus Coupler Assisted Bypass (CAB) Technique, Key Steps Critical steps for lymphovenous coupler assisted bypass (CAB) technique. The procedure is presented in Video S1. (A) superimposed cartoon of the lasso stitch, which grasps the adventitia of the target lymphatic and gently pulls the lymphatic into the venous lumen. This is assisted by the coupler device, allowing for precision in implantation. (B) superimposed cartoon of an example final product following CAB. The resulting LVB will involve 2-3 implanted lymphatics into a single vein. Depending on the the equipment used and the surgeon's preference, the coupler can remain or be removed. A fat/soft tissue bolster can be placed to prevent theoretical damage from the coupler spikes and secure the LVB. https://www.daisylouisespoer.com/medical-illustrations/surgicallvb monthly 0.5 2023-10-05 https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/8375a1e6-a95c-4a6e-8713-dcfaf272e89c/Screenshot+2023-10-04+at+4.54.49%E2%80%AFPM.png https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/496ce6dc-ec23-412d-a3ed-d6cacd63f9cf/Screenshot+2023-10-04+at+4.55.30%E2%80%AFPM.png medical illustrations - Surgical Techniques for Lymphovenous Bypass Overview of lymphatic and venous vasculature frequently used in LVB. The caliber of lymphatics varies in the published literature, although they have been categorized into initial lymphatics (0.01-0.06 mm), pre-collector (0.035–0.150 mm), and collector lymphatics (0.200 mm).[184, 185] Thus, we illustrated a collector lymphatic as the relevant structure for LVB. (A) Collector lymphatics have tight “zipper-like” junctions, specialized muscle cells, and valves that coordinate directional lymph flow via suction-derived diastolic filling.[3, 25, 174] (B) The cutaneous vessels used in LVB generally include valved subdermal venules (0.3-0.6mm) or large cutaneous veins (>1mm).[58] The microcirculatory venules and veins vary according to their ultrastructure and anatomical location, and a venule with sparse smooth muscle cells is illustrated for generalizability.[103, 186, 187] https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/03a961bb-f890-4007-94cb-394a1e5d5093/Screenshot+2023-10-04+at+4.55.10%E2%80%AFPM.png medical illustrations - Surgical Techniques for Lymphovenous Bypass Patient selection and preoperative evaluation. Illustration of Koshima ICG lymphedema classification system.[100] (A) Stage 0: “Normal superficial lymphatic vessels appear as a “linear” pattern with no dermal backflow” (B) Stage 1: “Lymphatic vessels appear dilated and torturous with areas of ICG accumulation as a “splash” pattern” (C) Stage 2: “Contracted lymphatic vessels with loss of intraluminal diameter and thickening of the smooth muscle cell coverage Lymphatic vessels are disrupted, causing increased areas of ICG accumulation as a “stardust” pattern” (D) Stage 3: “No lymphatic vessels can be seen and there is ICG accumulation as a “diffuse” pattern.”[100] https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/25cce4b5-c773-4810-86a2-136de8e785e7/Screenshot+2023-10-04+at+4.54.49%E2%80%AFPM.png medical illustrations - Surgical Techniques for Lymphovenous Bypass Selection of lymphatic and venous targets. (A) The lymphatic territories (lymphosomes) can be visualized with ICG. Lymphosomes superior to inferior 1) temporal, purple; 2) occipital, blue; 3) mental, tan; 4) supraclavicular, pink; 5) subscapular, not pictured; 6) axillary, dark teal; 7) pectoral, orange; 8) superior inguinal, red; 9) lateral inguinal, salmon; 10) inferior inguinal, magenta; 11) popliteal, not pictured. [illustration of lymphosomes adapted from Suami, et al.][188] (B) Pre-incision selection of target vessels will depend on location of obstruction and the presence of fluorescent lymphatics and neighboring veins. The incision should be placed over a junction between a lymphatic and vein (X and overlying circle). The incision can be made perpendicular to lymphatic. Selecting several possible sites for incision is ideal (C) lymphatic and vein in preparation for LVB. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/87abfc45-d5fd-44df-ad55-ca429f9535d7/Screenshot+2023-10-04+at+4.55.50%E2%80%AFPM.png medical illustrations - Surgical Techniques for Lymphovenous Bypass Operative techniques in LVB. (A) transection of the target lymphatic should demonstrate lymphatic function. This is facilitated by injection Isosulfan blue (Lymphazurin; United States Surgical Corp., Norwalk, CT) or methylene blue (American Reagent, Shirley, NY) subcutaneously along the fluorescent lymphatic pathway. (B) Intravascular stenting (IVaS) can be performed with nylon suture prior to LVB. (D) an implantation technique implants the lymphatic into the venous lumen, using a stitch to connect lymphatic adventitia to venous intima. (E) The success of the bypass can be determined by direct visualization of the unidirectional flow of fluorescence from lymphatic into the recipient vein (distal to proximal) under microscopy. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/3b1e7e7b-40d7-489f-a660-b89d864866d4/PNG+image+2.png medical illustrations - Surgical Techniques for Lymphovenous Bypass Traditional E-E LVB Configurations: Traditional Orientation: E-E Union: I-I or implantation Lymph :RV: 1:1 <0.8mm +/- ILR + Modifications: many https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/f872dbca-633a-4d06-8788-c5750e256fce/PNG+image+3.png medical illustrations - Surgical Techniques for Lymphovenous Bypass Traditional E-S LVB Configurations: Traditional Orientation: E-S Union: I-I or implantation Lymph :RV: 1:1 <0.8mm +/- ILR + https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/f3249bd8-c9e4-4186-826d-5181655deff9/PNG+image+4.png medical illustrations - Surgical Techniques for Lymphovenous Bypass Traditional S-S LVB Configurations: Traditional Orientation: S-S Union: I-I Lymph :RV: 1:1 <0.8mm - ILR - Modifications: Diamond-Shaped Fuse Y and Yamamoto T. Diamond-shaped anastomosis for supermicrosurgical side-to-side lymphaticovenular anastomosis. J Plast Reconstr Aesthet Surg 2015; 68: e209-210. 20150905. DOI: 10.1016/j.bjps.2015.08.033. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/98e96cc9-fc13-4955-85fb-ddc63e449238/PNG+image+5.png medical illustrations - Surgical Techniques for Lymphovenous Bypass Traditional S-E LVB Configurations: Traditional Orientation: S-E Union: I-I Lymph :RV: 1:1 <0.8mm + ILR - Modifications: "Modifed S-E," dilation (SEATTLE) Yamamoto T, Yoshimatsu H, Narushima M, et al. A modified side-to-end lymphaticovenular anastomosis. Microsurgery 2013; 33: 130-133. 20120914. DOI: 10.1002/micr.22040. Yamamoto T, Yoshimatsu H, Yamamoto N, et al. Side-to-End Lymphaticovenular Anastomosis through Temporary Lymphatic Expansion. Plos One 2013; 8: e59523. DOI: 10.1371/journal.pone.0059523. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/03374852-7ecb-4fbf-829f-38c0a834706b/PNG+image+8.png medical illustrations - Surgical Techniques for Lymphovenous Bypass T/Y shaped LVB Configurations: Alternative Combined Configurations Orientation: E-Ex2 Union: I-I Lymph :RV: 1:2 <0.8mm + ILR - Modifications: Half notching Visconti G, Hayashi A, Salgarello M, et al. Supermicrosurgical T-shaped lymphaticovenular anastomosis for the treatment of peripheral lymphedema: Bypassing lymph fluid maximizing lymphatic collector continuity. Microsurgery 2016; 36: 714-715. 20160105. DOI: 10.1002/micr.30019. Furuya M, Yamamoto T, Yamashita M, et al. The half notching method for Flow-through lymphaticovenular anastomosis. Microsurgery 2015; 35: 415-416. 20140920. DOI: 10.1002/micr.22332. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/de42665d-0239-43e8-b017-93acee2f1ccf/PNG+image+6.png medical illustrations - Surgical Techniques for Lymphovenous Bypass π-shaped LVB Configurations: Alternative Combined Configurations Orientation: E-Sx2 Union I-I Lymph :RV 1:1 <0.8mm + ILR - Ayestaray B and Bekara F. pi-shaped lymphaticovenular anastomosis: the venous flow sparing technique for the treatment of peripheral lymphedema. J Reconstr Microsurg 2014; 30: 551-560. 20140328. DOI: 10.1055/s-0034-1370356. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/1f8c65ca-932f-4058-b93e-e4c5150e1f65/PNG+image+15.png medical illustrations - Surgical Techniques for Lymphovenous Bypass λ-shaped LVB Configurations: Alternative Combined Configurations Orientation: E-S+E-E Union: I-I Lymph :RV: 1:2 <0.8mm + ILR - Modifications: Half notching Yamamoto T, Narushima M, Kikuchi K, et al. Lambda-shaped anastomosis with intravascular stenting method for safe and effective lymphaticovenular anastomosis. Plast Reconstr Surg 2011; 127: 1987-1992. DOI: 10.1097/PRS.0b013e31820cf5c6. Fuse Y and Yamamoto T. Half notching method for supermicrosurgical lambda-shaped lymphaticovenular anastomosis. J Plast Reconstr Aesthet Surg 2016; 69: e13-14. 20150905. DOI: 10.1016/j.bjps.2015.08.039. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/036af42f-628c-410a-8705-4959ba7e3ba3/PNG+image+13.png medical illustrations - Surgical Techniques for Lymphovenous Bypass Double barrel LVB Configurations: Alternative Combined Configurations Orientation: E-E Union: I-I Lymph :RV: 2:1, 2:2, 1:1 <0.8mm + ILR + Modifications: Walrus (2:2) elephant (1:1 with size mismatch) Masoodi Z, Steinbacher J, Tinhofer IE, et al. "Double Barrel" Lymphaticovenous Anastomosis: A Useful Addition to a Supermicrosurgeon's Repertoire. Plast Reconstr Surg Glob Open 2022; 10: e4267. 20220419. DOI: 10.1097/GOX.0000000000004267. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/d50bdaa1-01ea-46e4-b437-2dbff11d3f4d/PNG+image+12.png medical illustrations - Surgical Techniques for Lymphovenous Bypass Octopus LVB Configurations: Alternative Combined Configurations Orientation: E-E Union: Implantation Lymph :RV: multiple:1 <0.8mm - ILR - Chen WF, Yamamoto T, Fisher M, et al. The "Octopus" Lymphaticovenular Anastomosis: Evolving Beyond the Standard Supermicrosurgical Technique. J Reconstr Microsurg 2015; 31: 450-457. 20150413. DOI: 10.1055/s-0035-1548746. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/ef6f7ae7-2afc-4cc1-bc94-2ff280dddf90/PNG+image+10.png medical illustrations - Surgical Techniques for Lymphovenous Bypass MVLA LVB Configurations: Alternative Combined Configurations Orientation: E-E Union: I-I or implantation Lymph :RV: multiple:1 <0.8mm - ILR + Campisi CC, Ryan M, Boccardo F, et al. A Single-Site Technique of Multiple Lymphatic-Venous Anastomoses for the Treatment of Peripheral Lymphedema: Long-Term Clinical Outcome. J Reconstr Microsurg 2016; 32: 42-49. 20150601. DOI: 10.1055/s-0035-1549163. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/4154bcba-716e-4fe2-a80c-6ace82988ee5/PNG+image+11.png medical illustrations - Surgical Techniques for Lymphovenous Bypass Coupler Assisted Bypass LVB Configurations: Alternative Combined Configurations Orientation: E-E Union: implantation Lymph :RV: 2:1, 3:1 <0.8mm - ILR + Spoer D.L., Berger L.E., Towfighi P.N., Deldar R., Gupta N., Huffman S.S., Sharif-Askary B., Fan K.L., Parikh R.P. & Tom L.K.. Lymphovenous Coupler-Assisted Bypass (CAB) for Immediate Lymphatic Reconstruction. Journal of Reconstructive Microsurgery. Status: Submitted January 2023 https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/6cfb728f-916a-4675-ae27-268e4bd1cf1f/PNG+image+14.png medical illustrations - Surgical Techniques for Lymphovenous Bypass ladder-shaped LVB Configurations: Alternative Combined Configurations Orientation: S-S Union: I-I Lymph :RV: multiple:1 <0.8mm - ILR - Yamamoto T, Kikuchi K, Yoshimatsu H, et al. Ladder-shaped lymphaticovenular anastomosis using multiple side-to-side lymphatic anastomoses for a leg lymphedema patient. Microsurgery 2014; 34: 404-408. 20131226. DOI: 10.1002/micr.22215. https://www.daisylouisespoer.com/medical-illustrations/sfastent monthly 0.5 2023-10-05 https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/2e6f3b72-e76b-4741-8e52-d30cc4d6344e/SDC+2.png https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/2654477e-5ec0-47c1-add1-494b519d16fd/Figure+1.png medical illustrations - Are We Misrepresenting SFA Stenting? High Rates of Restenosis and Limb Loss Are Seen in Patients wit (A) Anterior view of vascular anatomy CFA: Common Femoral Artery; SFA: superficial femoral artery (SFA1/2/3: proximal, middle, distal 3rd); PA: popliteal artery (PA1/2/3: proximal, middle, distal 3rd); ATA: proximal 3 cm of the anterior tibial artery (ATA1/2/3: proximal, middle, distal 3rd); PEA: proximal 5 cm of the peroneal artery (PEA1/2/3: proximal, middle, distal 3rd); PTA: proximal 5 cm of the posterior tibial artery (PTA1/2/3: proximal, middle, distal 3rd); TPT: tibial-peroneal trunk. Proximal segment (SFA, PFA, and PA), distal segment (TPT, ATA 1/2/3, PEA 1/2/3, and PTA 1/2/3), pedal segment (DPA, MPA, LPA). MPA and LPA were not measured on angiography; labeling is provided in SDC 2. The proximal disease was defined as the involvement of the Common Femoral Artery (CFA), Superficial Femoral Artery (SFA 1/2/3 proximal, middle, distal 3rd), popliteal artery (PA1/2/3: proximal, middle, distal 3rd). The distal disease was defined as the involvement of the ATA: proximal 3 cm of the anterior tibial artery (ATA1/2/3: proximal, middle, distal 3rd); PEA: proximal 5 cm of the peroneal artery (PEA1/2/3: proximal, middle, distal 3rd); PTA: proximal 5 cm of the posterior tibial artery (PTA1/2/3: proximal, middle, distal 3rd); TPT: tibial-peroneal trunk. There were no significant differences between the lesion lengths between limb salvage and amputation cohorts (P = 0.645). (B) Distribution of lesions in patient pre-procedure angiograms. Percentages represent the proportion of individuals with a lesion present in the corresponding vascular segment. For the overall cohort, lesions traversed the CFA (5), SFA1 (33), SFA2 (36), SFA3 (41), PA1 (34), PA2 (25), and PA3 (20); We observed stenosis or occlusive disease of the AT (38) and PT (40). All % represents the ratio of lesions present per patient of the respective subgroup. The color denotes the frequency of occurrence for each anatomical segment, with a deeper red signifying a higher proportion of patients. https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/1696465194174-PILCQGS2MO5KBDZJAT5J/SDC%2B2.jpg medical illustrations - Are We Misrepresenting SFA Stenting? High Rates of Restenosis and Limb Loss Are Seen in Patients wit Vascular Supply, Angiosomes, and Muscles of the Lower Extremity. Visual depiction of the segmented arterial supply of the lower extremity, corresponding 21 cutaneous vascular territories (angiosomes), and lower extremity muscles. Colors correspond to the named vessel for the cutaneous angiosomes and dominant blood supply to the muscles. Illustrations reflect (A) an anterior view of the anatomy of the arteries, (B) an anterior view of angiosomes and muscles, and (C) a posterior view of angiosomes and muscles of the lower extremity. Named vessels have a corresponding angiosome pictured in color consistent with the vessel (A). Acronyms and associated muscles include the following list, due to the presence of anastomotic connections and dual blood supply, the colors of the muscles reflect the shade of the vessel which composes the dominant blood supply. (1) gluteal region: SGA: superior gluteal artery, IGA: inferior gluteal artery, (2) hip and thigh: SCIA: superficial circumflex iliac artery, FA: femoral artery (further segmented into the CFA (common), SFA1/2/3 (superficial, proximal, middle, and distal)), LCFA: lateral circumflex femoral artery, MCFA: medial circumflex femoral artery. (3) knee and leg: DGA: medial genicular artery, LSGA: lateral superior genicular artery, LIGA: lateral inferior genicular artery, MSGA: medial superior genicular artery, MIGA: medial superior genicular artery, PA: popliteal artery, PT: posterior tibial artery (1/2/3: proximal, middle, distal), ATA: anterior tibial artery (1/2/3: proximal, middle, distal), PEA: peroneal artery (4) ankle and foot: MCA: medial calcaneal artery, LCA: lateral calcaneal artery, LPA: lateral plantar artery, MPA: medial plantar artery, DPA: dorsalis pedis artery. Illustrations were adapted from Attinger, C. E. et al. (2006). "Angiosomes of the foot and ankle and clinical implications for limb salvage: reconstruction, incisions, and revascularization." Plast Reconstr Surg 117(7 Suppl): 261S-293S. Drake, R. L., Ph.D., FAAA, et al. (2021). Gray's Atlas of Anatomy, Third Edition, Elsevier. Wong, A. and S. Morris (2020). Vascular Anatomy of the Lower Extremity: A Practical Guide to Vascular Territories, Perforators, and Selection of Recipient Vessels. Lower Extremity Reconstruction: A Practical Guide. New York, Thieme. 1. Neligan, P. C., et al. (2012). Comprehensive lower extremity anatomy. Plastic Surgery E-Book: 6 - Volume Set: Expert Consult - Online, Elsevier Health Sciences, 2012.) https://www.daisylouisespoer.com/medical-illustrations/ets-ftt monthly 0.5 2025-08-20 https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/2348474c-2b0a-4e3e-93ed-b9be0a9ae13f/Picture1.png https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/ea9bf6dd-8c45-42b7-bd1c-bd2dafee0f99/Screenshot+2025-08-19+at+19.26.32.png medical illustrations - Longitudinal Slit Arteriotomy ETS for FTT in High-risk Limb Salvage Procedures https://www.daisylouisespoer.com/medical-illustrations/botox monthly 0.5 2025-08-20 https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/85f86309-c630-4b43-a8fd-4f8062eacc11/Screenshot+2025-08-20+at+06.08.39.png https://images.squarespace-cdn.com/content/v1/648e40951d4aa168b1174c2d/4002b77a-a8b8-4d1f-a40e-a4406662e255/Screenshot+2025-08-19+at+20.30.06.png medical illustrations - The effects of onabotulinumtoxinA on anxiety: A systematic review and quantitative analysis