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PURPOSE: Abdominal wall reconstruction is challenging, which demands adequate skin coverage and structural support. The anterolateral thigh (ALT) flap including fascial portion can be useful in such cases. METHODS: Retrospective chart review of five patients that underwent complex abdominal wall defects reconstruction with ALT free flaps with fascia lata was conducted. Patient age ranged from 49 to 69 years (average: 57.4). The etiology of defects was infected liposuction site, small bowel perforation, esophageal cancer, diverticulum perforation, and Hartmann operation. The average size of the defect was 17.4 × 10 cm (9 × 9 ~ 21 × 18). Single-stage reconstruction using ALT flaps based on the lateral circumflex femoral artery was done in all patients. Exposed intestines were successfully covered and reinforced utilizing fascial component. RESULTS: The average size of the flap was 17.4 × 8 cm (9 × 9 cm ~25 × 10 cm). One partial flap necrosis, venous congestion, and infection occurred. These complications were treated successfully. During the follow-up (12-96 months, mean: 63), all patients achieved functional stabilization and returned to normal activities. CONCLUSION: ALT flap combined with its fascial component is useful for abdominal wall. It can be a reliable option in cases of intestinal exposure.
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Pared Abdominal/cirugía , Colgajos Tisulares Libres , Procedimientos de Cirugía Plástica/métodos , Anciano , Fascia Lata/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Muslo/cirugíaRESUMEN
With growing number of cases in recent years, composite tissue allotransplantation (CTA) has been improving the quality of life of patient who seeks reconstruction and repair of damaged tissues. Composite tissue allografts are heterogeneous. They are composed of a variety of tissue types, including skin, muscle, vessel, bone, bone marrow, lymph nodes, nerve, and tendon. As a primary target of CTA, skin has high antigenicity with a rich repertoire of resident cells that play pivotal roles in immune surveillance. In this regard, understanding the molecular mechanisms involved in immune rejection in the skin would be essential to achieve successful CTA. Although scientific evidence has proved the necessity of immunosuppressive drugs to prevent rejection of allotransplanted tissues, there remains a lingering dilemma due to the lack of specificity of targeted immunosuppression and risks of side effects. A cumulative body of evidence has demonstrated T regulatory (Treg) cells have critical roles in induction of immune tolerance and immune homeostasis in preclinical and clinical studies. Presently, controlling immune susceptible characteristics of CTA with adoptive transfer of Treg cells is being considered promising and it has drawn great interests. This updated review will focus on a dominant form of Treg cells expressing CD4+CD25+ surface molecules and a forkhead box P3 transcription factor with immune tolerant and immune homeostasis activities. For future application of Treg cells as therapeutics in CTA, molecular and cellular characteristics of CTA and immune rejection, Treg cell development and phenotypes, Treg cell plasticity and stability, immune tolerant functions of Treg cells in CTA in preclinical studies, and protocols for therapeutic application of Treg cells in clinical settings are addressed in this review. Collectively, Treg cell therapy in CTA seems feasible with promising perspectives. However, the extreme high immunogenicity of CTA warrants caution.
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Linfocitos T Reguladores/inmunología , Alotrasplante Compuesto Vascularizado , Animales , Plasticidad de la Célula/inmunología , Ensayos Clínicos como Asunto , Rechazo de Injerto/inmunología , Humanos , Tolerancia Inmunológica , FenotipoRESUMEN
INTRODUCTION: Reconstruction of a nose deformity with a full-thickness defect is not an easy procedure because the nose is highly noticeable, being located at the center of the face, and plays an important role in breathing. Esthetics and functionality are equally important. Local flap reconstruction is an option but it has limitations for reconstruction of large defects because of the following the scar and the deformity at the recipient site. Chondrocutaneous preauricular free flaps can be used to provide grafts with satisfactory esthetics. Since the chondrocutaneous preauricular free flap has a short pedicle for anastomosis with the facial artery and vein, in some patients there is a need for extra vessel grafts. The authors have had several successful results using chondrocutaneous free flaps aided by interposition vascular grafts with the descending branch of the lateral circumflex femoral artery and the accompanying vein. PATIENTS AND METHODS: A total of 6 patients with full thickness defects of the nose participated in chondrocutaneous preauricular free flap operations from 2011 to 2015. Operations were performed under general anesthesia. After dissection around the tissue and scar removal, the flap was designed to be a few centimeters size wide to include cartilage from the helical loop and preauricular skin. After finding the superficial temporal vein by dissection, the incision was extended to the proximal part of the flap and dissection was done below the superficial temporal vessels. To elongate the pedicle of the flap, the descending branch of the lateral circumflex femoral artery, used as a pedicle for the anterolateral femoral flap, and the accompanying vein were harvested together. The harvested descending branch of the lateral circumflex femoral artery and the accompanying vein were placed on the subcutaneous tunnel. End-to-end anastomosis between the pedicle of the flap and the vessel graft as well as between the vessel graft and the facial vessels was done. During flap inset, even though remnant parts were trimmed, sufficient tissue should be left cautiously, and the donor site was closed primarily. RESULTS: All 6 operations were successful. Despite the different etiologies in each patient, the nose defects were not different and the operations were not different either. The operative time varied from 3.5 to 6âhours. No major complications were reported. After the operation, necrosis and donor site complications did not occur, and scarring and deformity of the donor site were minimal. The patients were mostly satisfied with the results. CONCLUSION: Use of the chondrocutaneous preauricular free flap is not only effective for large defects of the nose, but also makes a good donor if the 3-floor structure and subunit structures of the nose are taken into consideration. Since the pedicle of the flap was short, the authors recruited the descending branch of the lateral circumflex femoral artery and the accompanying vein as a vessel graft. A year after surgery, all of the patients were satisfied with the results.
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Colgajos Tisulares Libres/irrigación sanguínea , Nariz/cirugía , Procedimientos de Cirugía Plástica/métodos , Adulto , Anciano , Cartílago/trasplante , Cicatriz/etiología , Disección , Estética Dental , Femenino , Arteria Femoral/trasplante , Vena Femoral/trasplante , Colgajos Tisulares Libres/efectos adversos , Humanos , Masculino , Persona de Mediana Edad , Muslo/cirugíaRESUMEN
BACKGROUND: Posttraumatic enophthalmos is a relatively common problem following orbitozygomatic fractures. However, inadequate long-term results are frequently observed due to the difficulty of performing intraoperative fine adjustments to soft-tissue volume and orbital size and gradual absorption of some grafted materials. Here, the authors describe an efficient method of enophthalmos correction using sliced costochondral bone and cartilage combination grafts. METHODS: From 2005 to 2011, the authors corrected enophthalmos in 12 patients using sliced costochondral grafts. The mean follow-up period was 13 months. For costochondral graft harvest, an approximately 5-cm skin incision was made directly above the seventh costal cartilage, the perichondrium was peeled back, and a small piece of rib bone and costal cartilage was harvested from the anterior part of the seventh rib bone and cartilage and cut into 2-mm-thick slices. A subciliary and/or transcaruncular incision was made in the affected side eyelid to expose the operating field, subperiosteal dissection was performed in the orbit and orbital floor. The cartilage chips were gradually grafted onto the dissected areas from the posterior orbit. RESULTS: Aesthetically satisfactory results were obtained in all patients. No complications in the donor area were observed. Furthermore, no patients experienced a recurrence or deterioration of diplopia over the follow-up period. One patient experienced temporary high intraocular pressure, which spontaneously resolved with medication and eye drops. CONCLUSION: The costochondral graft is adequate for the reconstruction of the fracture, easy to obtain, easily adaptable to the orbital walls, and has minimal morbidity at the donor site.
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Cartílago Costal/trasplante , Enoftalmia , Procedimientos Quirúrgicos Oftalmológicos/métodos , Órbita , Fracturas Orbitales/complicaciones , Adulto , Enoftalmia/etiología , Enoftalmia/cirugía , Párpados/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Órbita/lesiones , Órbita/patología , Órbita/cirugía , Satisfacción del Paciente , Costillas/trasplante , Cirugía Plástica/métodosRESUMEN
Face allotransplantation represents a novel frontier in complex human facial defect reconstruction. To develop more refined surgical techniques and yield fine results, it is first imperative to make a suitable animal model. The development of a composite facial allograft model in swine is more appealing: the facial anatomy, including facial nerve and vascular anatomy, is similar to that of humans. Two operative teams performed simultaneously, one assigned to harvest the donor and the other to prepare the recipient in efforts to shorten operative time. The flap was harvested with the common carotid artery and external jugular vein, and it was transferred to the recipient. After insetting the maxilla, mandible, muscles, and skins, the anastomosis of the external jugular vein, external carotid artery, and facial nerve were performed. The total mean time of transplantation was 7âhours, and most allografts survived without vascular problems. The authors documented that this model is well qualified to be used as a standard transplantation training model and future research work, in every aspect.
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Cara/cirugía , Trasplante Facial/métodos , Colgajos Quirúrgicos , Animales , Masculino , Modelos Animales , Porcinos , Trasplante HomólogoRESUMEN
Severely disfiguring facial injuries can have a devastating impact on the patient's quality of life. During the past decade, vascularized facial allotransplantation has progressed from an experimental possibility to a clinical reality in the fields of disease, trauma, and congenital malformations. This technique may now be considered a viable option for repairing complex craniofacial defects for which the results of autologous reconstruction remain suboptimal. Vascularized facial allotransplantation permits optimal anatomical reconstruction and provides desired functional, esthetic, and psychosocial benefits that are far superior to those achieved with conventional methods. Along with dramatic improvements in their functional statuses, patients regain the ability to make facial expressions such as smiling and to perform various functions such as smelling, eating, drinking, and speaking. The ideas in the 1997 movie "Face/Off" have now been realized in the clinical field. The objective of this article is to introduce this new surgical field, provide a basis for examining the status of the field of face transplantation, and stimulate and enhance facial transplantation studies in Korea.
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Cara/cirugía , Traumatismos Faciales/cirugía , Trasplante Facial/métodos , Procedimientos de Cirugía Plástica/métodos , Colgajos Quirúrgicos/tendencias , Medicina Basada en la Evidencia , Trasplante Facial/tendencias , Predicción , Humanos , Procedimientos de Cirugía Plástica/tendencias , Resultado del TratamientoRESUMEN
Regenerative medicine using stem cells has progressed significantly over the last decade. Plastic surgeons historically have used tissues of human being to restore various defect sites and utilized a single cell lines for the tissue regeneration. The cell sources (autologous or allogeneic), cell types (embryonic stem cell or adult stem cell), and source of tissues (bone marrow, muscle, adipose, cartilage, or blood) are very important for stem cell-based tissue coverage. Embryonic stem cells are pluripotent precursors obtained from the inner cell mass of the blastocyst and reported to be used for preventing muscle atrophy after peripheral nerve injury. Multipotent adult stem cells are easily accessed for plastic surgeons during many routine procedures. This article briefly review the current state of overall stem cell research and clinical applications in the plastic surgical field.
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Células Madre Embrionarias , Células Madre Pluripotentes Inducidas , Medicina Regenerativa/métodos , Cirugía Plástica/métodos , Ingeniería de Tejidos/métodos , Rechazo de Injerto/prevención & control , Humanos , Procedimientos de Cirugía Plástica , Cicatrización de HeridasRESUMEN
Attempts at tongue replantation are rare, possibly because of the friable nature of the tongue vasculature. We describe the successful replantation of the tongue in a patient with schizophrenia who attempted self-mutilation. Anastomosis of the right deep lingual artery and vein was performed under microscopy. To ensure that the patient did not make another mutilation attempt, he was kept under sedation in the intensive care unit, and a Denhardt mouth gag was placed for 5 days. Currently, his pronunciation is close to normal, and he has recovered some degree of somatic and gustatory sensation. It may be argued that the amputated tongue should be discarded; however, successful replantation can be achieved with high satisfaction for the patient and family, especially in a psychiatric patient.
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Amputación Traumática/etiología , Amputación Traumática/cirugía , Reimplantación/métodos , Esquizofrenia Paranoide/complicaciones , Automutilación/etiología , Lengua/lesiones , Lengua/cirugía , Adolescente , Adulto , Aripiprazol , Humanos , Masculino , Cumplimiento de la Medicación , Piperazinas/administración & dosificación , Quinolonas/administración & dosificación , Esquizofrenia Paranoide/tratamiento farmacológico , Adulto JovenRESUMEN
PURPOSE: Frontal sinus fractures are relatively common injuries presenting to trauma units. The optimal treatment of frontal sinus fractures remains controversial. Bicoronal approach is commonly used to obtain full exposure of both frontal bones and to repair any intracranial trauma; however, this approach requires long operative time and could lead to a long-lasting visible scar, alopecia, and paresthesias. In addition, patients have to stay in hospital for several days with this method. Endoscopic approach, less invasive than bicoronal method, has a steep learning curve. In this article, we suggest a simple reduction method in frontal sinus anterior wall fracture using the tapper instrument. METHODS: Between 2005 and 2011, a transcutaneous reduction of closed anterior table frontal sinus fracture using a tapper instrument was performed in 13 patients. This group consists of 10 men and 3 women, and the mean age was 27.5 years. Under general anesthesia, the point that the tapper would be placed is marked considering the fracture site shown on computed tomographic scan and the clinically depressed area. A 3-mm slit incision was made just above the marked point. After drilling through this incision, the tapper device was applied to the depressed bone segment. Simply pulling out the tapper, the depressed frontal sinus anterior wall segment was reduced. RESULTS: Contour deformities were restored completely in all patients without any recurrent displacement, and all patients were satisfied with the results. There were no complications such as infection and uncontrollable sinus bleeding, but pneumocephalus had occurred in 1 patient owing to the posterior table injury that happened during the tapper-applying procedure. We treated him with preventive antibiotics, and he completely recovered after 1 week. CONCLUSIONS: This method has better aesthetic results, shorter operative time, and minimal hospital stay than other surgical approaches. Although it contains minimal risk of posterior wall injury, considering not only surgical results but also patients' satisfaction, the authors suggest that this simple percutaneous reduction method using the tapper instrument would be the treatment of choice in the frontal sinus anterior wall fractures.
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Traumatismos en Atletas/cirugía , Fijación Interna de Fracturas/instrumentación , Seno Frontal/lesiones , Seno Frontal/cirugía , Fracturas Craneales/cirugía , Instrumentos Quirúrgicos , Adulto , Traumatismos en Atletas/diagnóstico por imagen , Femenino , Seno Frontal/diagnóstico por imagen , Humanos , Masculino , Fracturas Craneales/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVE: Ketamine is used intramuscularly or intravenously as a sedative when repairing the skin lacerations of children in many emergency departments (EDs). Nitrous oxide (N(2)O) has the advantages of being a sedative agent that does not require a painful injection and that offers shallower levels of sedation and a rapid recovery of mental state. We evaluated the clinical usefulness of N(2)O compared with intravenous ketamine when used for the repair of lacerations in children in the ED. METHODS: From January to December 2009, we performed a prospective, randomized study at a single academic ED enrolling pediatric patients aged 3 to 10 years who needed primary repair of a laceration wound. The primary outcome was recovery time, which was defined as the time from completion of procedure to recovery of mental state. Other outcomes were sedation depth, pain scale, adverse effects, and satisfaction with sedation. RESULTS: There were 32 children who were randomly assigned. Recovery times were shorter in the N(2)O group compared with those in the ketamine group (median [interquartile range (IQR)], 0.0 minutes, [0.0-4.0 minutes] vs 21.5 minutes [12.5-37.5 minutes], P < 0.05). Sedation levels were deeper in the ketamine group than in the N2O group, but pain scales were comparable between groups. No difference was observed in the satisfaction scores by physicians, parents, or nurses. CONCLUSIONS: Nitrous oxide inhalation was preferable to injectable ketamine for pediatric patients because it is safe, allows for a faster recovery, maintains sufficient sedation time, and does not induce unnecessarily deep sedation.
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Analgésicos no Narcóticos/uso terapéutico , Anestesia por Inhalación , Anestesia Intravenosa , Sedación Consciente , Hipnóticos y Sedantes/uso terapéutico , Ketamina/uso terapéutico , Laceraciones/terapia , Óxido Nitroso/uso terapéutico , Dolor/prevención & control , Técnicas de Cierre de Heridas , Administración por Inhalación , Analgésicos no Narcóticos/administración & dosificación , Analgésicos no Narcóticos/efectos adversos , Analgésicos no Narcóticos/farmacocinética , Periodo de Recuperación de la Anestesia , Anestésicos por Inhalación/administración & dosificación , Anestésicos por Inhalación/efectos adversos , Anestésicos por Inhalación/farmacocinética , Anestésicos Intravenosos/administración & dosificación , Anestésicos Intravenosos/efectos adversos , Anestésicos Intravenosos/farmacocinética , Niño , Preescolar , Mareo/inducido químicamente , Antagonistas de Aminoácidos Excitadores/administración & dosificación , Antagonistas de Aminoácidos Excitadores/uso terapéutico , Femenino , Humanos , Hipnóticos y Sedantes/administración & dosificación , Hipnóticos y Sedantes/efectos adversos , Hipnóticos y Sedantes/farmacocinética , Infusiones Intravenosas , Ketamina/administración & dosificación , Ketamina/efectos adversos , Ketamina/farmacocinética , Laceraciones/complicaciones , Masculino , Náusea/inducido químicamente , Óxido Nitroso/administración & dosificación , Óxido Nitroso/efectos adversos , Óxido Nitroso/farmacocinética , Dolor/tratamiento farmacológico , Dolor/etiología , Estudios Prospectivos , Técnicas de Cierre de Heridas/efectos adversosRESUMEN
Several approaches to the management of subcondylar fractures have been used, including the submandibular approach, the preauricular approach, and the retromandibular approach. Although they provide excellent access to repair fractures of body, ramus, and condyle, we have found it difficult to manage subcondylar fractures using either of these approaches. We describe a novel approach for subcondylar fractures that provides direct access to the fracture site. A total of 17 consecutive patients underwent open reduction and internal fixation of their subcondylar fractures using this technique. The incision line is located just anterior and posterior to the ear lobe, and is comprised of lower part preauricular and upper retroauricular incisions. Intraoperatively, the method applied shortened the time necessary for and simplified the procedure of reduction and osteosynthesis. The postoperative course was uneventful in most patients. Radiologic follow-up revealed correct reduction and fixation in all the cases. There were no occlusal disturbances, no trismus, no lateral deviations of the mandible, and no nerve lesions. Our findings indicate that the short perilobe approach is an easy and safe technique for displaced subcondylar fractures.
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Tornillos Óseos , Fijación Interna de Fracturas/métodos , Cóndilo Mandibular/cirugía , Fracturas Mandibulares/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Fijación Interna de Fracturas/instrumentación , Humanos , Masculino , Cóndilo Mandibular/lesiones , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/instrumentación , Resultado del Tratamiento , Adulto JovenRESUMEN
Corrective rhinoplasty for functional and aesthetic recovery relies much on the use of grafts. This may be effectively accomplished with alloplastic materials; however, certain circumstances mandate the use of autologous grafts. Septal and auricular cartilages are inadequate for dorsal augmentation of the Asian nose. Here, we present our experiences with the correction of nasal deformities using chondro-osseous rib grafts, aiming at anatomic and functional reconstruction of the nose dorsum, especially the keystone area. The deformity was the result of trauma in 16 patients, postrhinoplastic deformities in 7, and congenital deformities in 5 patients. All the patients underwent reconstructive rhinoplasty using the sixth or seventh rib complex graft. Overall, functional and aesthetic outcome was satisfactory in all patients. Rigid bony union, good nasal projection, and symmetry were obtained. Graft exposure, displacement, warping, and significant bone absorption were not observed. The seventh or sixth rib provided not only the greatest overall available length and thickness, but also less donor-site morbidity. In conclusion, using rib bone and cartilage combination graft as a single unit allowed more predictable and reliable reconstruction of the nose deformity than did the conventional dorsal grafts.
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Pueblo Asiatico , Nariz/anomalías , Nariz/lesiones , Rinoplastia/métodos , Costillas/trasplante , Adolescente , Adulto , Femenino , Humanos , Imagenología Tridimensional , Masculino , Persona de Mediana Edad , Nariz/diagnóstico por imagen , Dolor Postoperatorio/tratamiento farmacológico , Tomografía Computarizada por Rayos X , Trasplante AutólogoRESUMEN
Facial composite tissue allograft transplantation represents a novel frontier in the reconstruction of complex human facial defects. To develop more refined surgical techniques and yield fine results, it is definite to make a suitable animal model. Rabbit is a medium-sized animal and considered to have many advantages than any other animal, but published reports are very few and contain less detailed description. We made an easy and accessible facial transplantation approach and tried to ascertain its virtue of use as an appropriate transplantation model. The facial-scalp flap including ipsilateral ear was harvested and transferred as a single unit with unilateral common carotid artery and external jugular vein. Most allografts survived with perfect viability without vascular problems in the early postoperative period, and rejection response was also identified by clinical and histopathologic analysis. The total mean time of transplantation was 2 hours +/- 10 minutes. We documented that this model is well qualified for use as a standard transplantation training model and future research work in every aspect.
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Trasplante Facial/métodos , Trasplante de Piel/métodos , Colgajos Quirúrgicos , Animales , Estudios de Factibilidad , Supervivencia de Injerto , Modelos Animales , Conejos , Cuero Cabelludo/trasplante , Trasplante HomólogoRESUMEN
Hand transplantation is the most common form of modern composite tissue allotransplantation, with 89 cases reported worldwide since 1998. The procedure is a treatment option for complex injuries that leave patients with structural, functional, and aesthetic deficits that cannot be addressed by other means. Successful application of this technology requires a multidisciplinary approach, incorporating not only skilled hand surgeons, transplant surgeons, and transplant immunologists, but also hand therapists, psychiatrists, medical specialists, anesthesiologists, and so on. Its long-term results depend on proper patient selection, a technically successful operation, postoperative rehabilitation, and an immunotherapy protocol that prevents rejection. Recent advances in transplant immunology are shifting the focus from immunosuppression to immunoregulation. Despite the enormous antigen load associated with composite tissue allografts, hand transplant has become a clinical reality, with immunosuppression comparable to that of solid-organ transplants. Our understanding of hand transplantation is still evolving, and ongoing research is needed to improve functional outcomes and to decrease the morbidity associated with long-term immunosuppression. This review discusses the current protocols for upper extremity donation, transplant receipt, surgical techniques, postoperative rehabilitation and immunosuppression, nerve regeneration, functional outcomes, ethical issues, and financial considerations.
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Rechazo de Injerto/prevención & control , Supervivencia de Injerto/efectos de los fármacos , Mano/cirugía , Inmunosupresores/uso terapéutico , Trasplante de Órganos/métodos , Amputación Quirúrgica , Toma de Decisiones Clínicas , Rechazo de Injerto/inmunología , Humanos , Inmunosupresores/efectos adversos , Trasplante de Órganos/efectos adversos , Selección de Paciente , Recuperación de la Función , Factores de Riesgo , Factores de Tiempo , Resultado del TratamientoRESUMEN
The evolution and success of intestinal and multi-visceral transplantation over the past 20 years have raised the issue of difficult or even impossible abdominal closure, a topic rarely encountered in other fields of transplantation. Different techniques have been proposed to address this topic. The choice depends on the transplant team's expertise and/or the availability of a plastic surgery service. Abdominal wall transplant is a type of composite tissue allograft that can be utilized to reconstitute the abdominal domains of patients who undergo intestinal transplant, and the results are encouraging. It is an effective option to achieve primary abdominal closure after intestinal transplant. In its full-thickness form, it may be useful for monitoring rejection or viability of visceral organs. Our aim is to review the role of abdominal wall transplant in achieving tension-free closure of the abdomen.
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Pared Abdominal/cirugía , Aloinjertos Compuestos/cirugía , Intestinos/trasplante , Trasplante de Órganos/métodos , Alotrasplante Compuesto Vascularizado/métodos , Técnicas de Cierre de Heridas , Pared Abdominal/irrigación sanguínea , Aloinjertos Compuestos/irrigación sanguínea , Aloinjertos Compuestos/inmunología , Rechazo de Injerto/inmunología , Rechazo de Injerto/prevención & control , Supervivencia de Injerto/efectos de los fármacos , Humanos , Inmunosupresores/administración & dosificación , Trasplante de Órganos/efectos adversos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Alotrasplante Compuesto Vascularizado/efectos adversos , Técnicas de Cierre de Heridas/efectos adversosRESUMEN
As reconstructive transplantation is gaining popularity as a viable alternative for upper limb amputees, it is becoming increasingly important for plastic surgeons to renew surgical skills and knowledge of this area. Forelimb allotransplantation research has been performed previously in rodent and swine models. However, preclinical canine forelimb allotransplantation studies are lacking in the literature. The purpose of this paper is to provide an overview of the surgical skills necessary to successfully perform forelimb transplantation in canines as a means to prepare for clinical application. A total of 18 transplantation operations on canines were performed. The recipient limb was shortened at the one-third proximal forearm level. The operation was performed in the following order: bones (two reconstructive plates), muscles and tendons (separately sutured), nerves (median, ulnar, and radial nerve), arteries (two), and veins (two). The total mean time of transplantation was 5 hours ± 30 minutes. All of the animals that received transplantation were treated with FK-506 (tacrolimus, 2 mg/kg) for 7 days after surgery. Most allografts survived with perfect viability without vascular problems during the early postoperative period. The canine forelimb allotransplantation model is well qualified to be a suitable training model for standard transplantation and future research work.
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Aloinjertos Compuestos/patología , Aloinjertos Compuestos/trasplante , Miembro Anterior/trasplante , Supervivencia de Injerto , Tempo Operativo , Alotrasplante Compuesto Vascularizado/métodos , Animales , Perros , Modelos Animales , Técnicas de Cultivo de Órganos/métodos , Resultado del TratamientoRESUMEN
Two pediatric patients with internal device exposure of cochlear implant (CI) were treated successfully using vascularized temporalis myofascial flaps. The visible scarring was minimal, and the CI function was excellent. Although we used temporalis myofascial flaps for late complications of an implanted ear, it can also be used in a primary case to provide flap reinforcement. In conclusion, the temporalis myofascial flap technique is an ultimate surgical option that offers advantages for CI patients with flap-related problems.
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Implantes Cocleares , Fascia/trasplante , Colgajos Quirúrgicos , Músculo Temporal/trasplante , Niño , Implantación Coclear , Femenino , Humanos , Lactante , Masculino , ReoperaciónRESUMEN
BACKGROUND: To refine facial transplantation techniques and achieve sound results, it is essential to develop a suitable animal model. Rat is a small animal and has many advantages over other animals that have been used as transplantation models. The purpose of this study was to describe a rat hemifacial transplantation model and to verify its convenience and reproducibility. METHODS: Animals used in this study were Lewis rats (recipients) and Lewis-Brown Norway rats (donors). Nine transplantations were performed, requiring 18 animals. The hemifacial flap that included the ipsilateral ear was harvested based on the unilateral common carotid artery and external jugular vein and was transferred as a single unit. Cyclosporine A therapy was initiated 24 hours after transplantation and lasted for 2 weeks. Signs of rejection responses were evaluated daily. RESULTS: The mean transplantation time was 1 hour 20 minutes. The anatomy of common carotid artery and external jugular vein was consistent, and the vessel size was appropriate for anastomosis. Six of nine allografts remained good viable without vascular problems at the conclusion of study (postoperative 2 weeks). CONCLUSION: The rat hemifacial transplantation model is suitable as a standard transplantation training model.
RESUMEN
BACKGROUND: The limb-threatening large soft tissue defects that occur on the feet of type 2 diabetic patients have complex causes and are less likely to be corrected by free flap reconstruction compared to those in non-diabetic patients. We retrospectively analysed factors affecting the success of free flap transfer for necrotising soft tissue defects of the lower extremities in patients with type 2 diabetes. METHODS: This study included 33 diabetic patients whose feet were treated with free flap transfers. All patients had limb-threatening large soft tissue defects with tendon or bone exposure. The operative results were divided into three groups at 1 month post-operatively: the complete healing group, and the complication group, with either partial necrosis requiring additional simple procedures or flap failure with total necrosis. Nine preoperative factors were analysed: (1) ankle brachial index, (2) HbA1c, (3) BMI, (4) the smoking factor, (5) atherosclerotic calcifications (6) serum creatinine levels (>1.28 mg dL(-1) vs. <1.28 mg dL(-1)), (7) GFR, (8) wound infection and (9) wound defect size. RESULTS: Of the 33 patients, 15 showed complete healing and 18 showed complications of the free flap (eight partial necrosis and 10 flap failure). No atherosclerotic calcifications were found in the patients in the complete healing group, although they were found in 12 patients in the complication group, and this difference was significant (p = 0.002). Patients with serum creatinine levels >1.28 mg dL(-1) had significantly higher free flap transfer complication rates than those with serum creatinine levels <1.28 mg dL(-1) (p = 0.038). CONCLUSIONS: This study analysed the risk factors of free flap reconstruction for limb-threatening large soft tissue defects on the feet of type 2 diabetic patients. Serum creatinine levels >1.28 mg dL(-1) and atherosclerotic calcifications were confirmed as risk factors for flap survival.