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1.
Breast J ; 2023: 6688466, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37205012

RESUMEN

Purpose: In modern breast cancer treatment, a growing role has been observed for breast reconstruction together with an increase in clinical indications for postmastectomy radiotherapy (PMRT). Choosing the optimum type of reconstructive technique is a clinical challenge. We therefore conducted a national multicenter study to analyze the impact of PMRT on breast reconstruction. Methods: We conducted a retrospective case-control multicenter study on women undergoing breast reconstruction. Data were collected from 18 Italian Breast Centres and stored in a cumulative database which included the following: autologous reconstruction, direct-to-implant (DTI), and tissue expander/immediate (TE/I). For all patients, we described complications and surgical endpoints to complications such as reconstruction failure, explant, change in type of reconstruction, and reintervention. Results: From 2001 to April 2020, 3116 patients were evaluated. The risk for any complication was significantly increased in patients receiving PMRT (aOR, 1.73; 95% CI, 1.33-2.24; p < 0.001). PMRT was associated with a significant increase in the risk of capsular contracture in the DTI and TE/I groups (aOR, 2.24; 95% CI, 1.57-3.20; p < 0.001). Comparing type of procedures, the risk of failure (aOR, 1.82; 95% CI, 1.06-3.12, p=0.030), explant (aOR, 3.34; 95% CI, 3.85-7.83, p < 0.001), and severe complications (aOR, 2.54; 95% CI, 1.88-3.43, p < 0.001) were significantly higher in the group undergoing DTI reconstruction as compared to TE/I reconstruction. Conclusion: Our study confirms that autologous reconstruction is the procedure least impacted by PMRT, while DTI appears to be the most impacted by PMRT, when compared with TE/I which shows a lower rate of explant and reconstruction failure. The trial is registered with NCT04783818, and the date of registration is 1 March, 2021, retrospectively registered.


Asunto(s)
Neoplasias de la Mama , Mamoplastia , Femenino , Humanos , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , Neoplasias de la Mama/etiología , Radioterapia Adyuvante/efectos adversos , Radioterapia Adyuvante/métodos , Mastectomía/métodos , Estudios Retrospectivos , Resultado del Tratamiento , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Mamoplastia/efectos adversos , Mamoplastia/métodos
2.
Pathologica ; 114(2): 111-120, 2022 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-35414723

RESUMEN

Phyllodes tumors (PT) are fibroepithelial neoplasms of the breast showing a peculiar leaf-like appearance. They account for 0.3 to 1% of all primary breast tumors and 2.5% of all fibroepithelial breast tumors. PT are classified into benign, borderline and malignant based upon their stromal morphology with a distribution of 60%, 20%, and 20%, respectively. Malignant PT of the breast constitute an uncommon challenging group of fibroepithelial neoplasms. They have a relatively high tendency to recur, although distant metastasis is uncommon, and nearly exclusive to malignant PT. Adequate surgical resection remains the standard approach to achieve maximal local control. Giant malignant PT are rare and a pose a diagnostic dilemma for pathologists, especially when comprised of sarcomatous elements. This review highlights the morphological features of PT detected in cytology and histology specimens and discusses diagnostic pitfalls and differential diagnosis.


Asunto(s)
Neoplasias de la Mama , Neoplasias Fibroepiteliales , Tumor Filoide , Mama/diagnóstico por imagen , Mama/patología , Mama/cirugía , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Femenino , Humanos , Recurrencia Local de Neoplasia/patología , Neoplasias Fibroepiteliales/patología , Tumor Filoide/diagnóstico , Tumor Filoide/patología , Tumor Filoide/cirugía
3.
Medicina (Kaunas) ; 57(2)2021 Feb 08.
Artículo en Inglés | MEDLINE | ID: mdl-33567574

RESUMEN

Surgical site infection in implant-based breast reconstruction is a complication with variable incidence reported in the literature. Due to potential loss of implant and reconstruction, it can have a strong psychological impact on patients. Background and objectives: This study aimed primarily at analyzing the current status of the surgical site infection (SSI), (type, time of onset, clinical presentation, pathogens and management) in patients who underwent implant-based breast reconstruction at our Breast Unit. Secondarily, we wanted to establish whether introduction of a new, updated evidence-based protocol for infection prevention can reduce SSI in implant-based breast reconstruction. Materials and Methods: A single-center retrospective study was performed primarily to evaluate the incidence and features of SSI after implant-based breast reconstruction from 2007 to 2020. In June 2020, a protocol for prevention of SSI in implant-based breast reconstruction was introduced in clinical practice. Secondarily, a data analysis of all patients who underwent implant-based breast reconstruction in compliance with this protocol was performed after preliminarily assessing its efficacy. Results: 756 women were evaluated after mastectomy and implant-based breast reconstruction for breast cancer. A total of 26 surgical site infections were detected. The annual incidence of SSI decreased over time (range 0-11.76%). Data relating to infections' features, involved pathogens and implemented treatments were obtained. Since the introduction of the protocol, 22 patients have been evaluated, for a total of 29 implants. No early infections occurred. Conclusions: Surgical site infection rates at our Breast Unit are comparable to those reported in the literature. The SSI rates have shown a decreasing trend over the years. No SSI has occurred since the introduction of the prevention protocol for surgical site infection in June 2020.


Asunto(s)
Neoplasias de la Mama , Mamoplastia , Neoplasias de la Mama/cirugía , Femenino , Humanos , Mamoplastia/efectos adversos , Mastectomía , Estudios Retrospectivos , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/prevención & control
4.
J Foot Ankle Surg ; 59(1): 128-130, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31882136

RESUMEN

Damage to the weightbearing surface of the foot is a challenge for the reconstructive surgeon. The aim is to reconstruct the skeletal tripod and soft tissue, allowing the patient to walk normally. We report the case of a patient admitted with an acute right foot open fracture of the second, third, fourth, and fifth metatarsal bones. After debridement of all nonvital tissues, the patient required reconstruction of the metatarsal heads (third, fourth, and fifth) plus soft tissue coverage. We then performed a reconstruction with a free osteocutaneous fibular flap, insetting the bone perpendicular to the long axis of the metatarsal bones. This configuration allowed the reconstruction of the foot skeletal tripod. A second free flap, a thin radial forearm flap, was added during the revision surgery to improve the venous drainage of the skin paddle of the fibular flap and avoid tension after skin closure. At 1-year follow-up, the patient was able to walk entirely weightbearing on the forefoot, returning to her previous employment with no limitation in physical and recreational activities. To our knowledge, this is the first description of the use of a chimeric osteocutaneous fibular flap, oriented transversely, to reconstruct a complex bone/soft tissue defect after a traumatic loss of multiple metatarsal heads.


Asunto(s)
Peroné/trasplante , Traumatismos de los Pies/cirugía , Fracturas Abiertas/cirugía , Colgajos Tisulares Libres/irrigación sanguínea , Huesos Metatarsianos/cirugía , Traumatismos de los Tejidos Blandos/cirugía , Trasplante Óseo , Desbridamiento , Femenino , Estudios de Seguimiento , Traumatismos de los Pies/diagnóstico por imagen , Fracturas Conminutas/diagnóstico por imagen , Fracturas Conminutas/cirugía , Fracturas Abiertas/diagnóstico por imagen , Colgajos Tisulares Libres/cirugía , Humanos , Huesos Metatarsianos/diagnóstico por imagen , Huesos Metatarsianos/lesiones , Radio (Anatomía)/trasplante , Procedimientos de Cirugía Plástica/métodos , Recuperación de la Función , Traumatismos de los Tejidos Blandos/diagnóstico por imagen , Soporte de Peso , Adulto Joven
5.
Microsurgery ; 39(5): 423-427, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30512215

RESUMEN

BACKGROUND: Licox® PtO2 is a minimally invasive monitoring system for continuous measurement of tissue oxygen tension in all types of free tissue transfers. Our study compares two consecutive series of patients undergoing microsurgical reconstruction monitored with standard clinical bedside surveillance and with the Licox® PtO2 system regarding flap loss and flap salvage, the sensitivity, specificity, and cost-effectiveness. METHODS: We performed a longitudinal observational prospective study of all patients undergoing microsurgical reconstructions between 2016 and 2017. Group 1 included 43 patients that underwent standard clinical bedside postoperative flap monitoring whereas group 2 included 44 consecutive patients also monitored with Licox® PtO2 system. Flap complications such as return to theater for vascular compromise, partial and total flap loss and flap salvage rate were analyzed. RESULTS: We recorded no significant difference between the two groups regarding the rate of vascular complications (P = .31), return to the theater (P = .31), flap salvage (P = .9), partial and total flap loss (P = .36 and P = .49, respectively). When analyzing the Licox® PtO2 system monitoring group, we documented six false-positive results (13.6%) and 0 false negatives with an accuracy of 0.86, a sensibility of 1.00, and a specificity of 0.85. CONCLUSIONS: This is the first study that provides statistical data about the comparison of postoperative free flap monitoring by standard clinical bedside method and Licox® PtO2 system. For the monitoring of buried flaps, the Licox® PtO2 monitoring can be used only as a supplement to other systems. Its use, compared to near-infrared spectroscopy or clinical bedside monitoring, was not found cost-efficient.


Asunto(s)
Colgajos Tisulares Libres/irrigación sanguínea , Monitoreo Fisiológico/instrumentación , Pruebas en el Punto de Atención , Complicaciones Posoperatorias/diagnóstico , Flujo Sanguíneo Regional/fisiología , Adulto , Femenino , Colgajos Tisulares Libres/trasplante , Rechazo de Injerto , Supervivencia de Injerto , Humanos , Estudios Longitudinales , Masculino , Microcirugia/efectos adversos , Microcirugia/métodos , Persona de Mediana Edad , Consumo de Oxígeno/fisiología , Cuidados Posoperatorios/métodos , Estudios Prospectivos , Medición de Riesgo , Sensibilidad y Especificidad , Espectroscopía Infrarroja Corta/métodos
6.
J Craniofac Surg ; 30(8): 2416-2420, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31274819

RESUMEN

Integra is a dermal regeneration template used in the reconstruction of burns, traumatic injuries, or excision lesions in patients who present particular risk factors for traditional surgical procedures. A multidisciplinary advisory board of expert dermatologists and plastic surgeons have discussed the use of Integra in the reconstruction of scalp defects after tumor excision, focusing on the evidence derived from literature and on their experience in the treatment of approximately 400 patients. In this position paper, the authors summarize the main evidence discussed during the board, and the common practice guidelines proposed by the experts. The use of Integra is recommended in elderly patients with multiple comorbidities who have a higher risk for potential complications in traditional surgery; these patients may in fact benefit from a lower anesthetic risk, a less complicated postsurgical care and limited morbidity at the donor site obtained with the dermal template. Integra should also be used in the reconstruction of large and complex wounds and in case of bone exposure, as it helps to overcome the challenges related to wound healing in difficult areas. Notably, Integra has proven to be effective in patients who have undergone previous surgical procedures or adjuvant radiation therapy, in which previous incisions, scarring and radiation damages may hamper the effectiveness of traditional procedures. Finally, Integra is recommended in patients with recurrent and aggressive tumors who need closer tumor surveillance, as it gives easy access to the tumor site for oncologic follow-up examination.


Asunto(s)
Neoplasias de Cabeza y Cuello/cirugía , Procedimientos de Cirugía Plástica , Cuero Cabelludo/cirugía , Cicatriz/cirugía , Humanos , Trasplante de Piel/métodos , Piel Artificial , Cicatrización de Heridas
7.
Proc Natl Acad Sci U S A ; 111(11): 4209-14, 2014 Mar 18.
Artículo en Inglés | MEDLINE | ID: mdl-24591625

RESUMEN

We have previously shown that C1q is expressed on endothelial cells (ECs) of newly formed decidual tissue. Here we demonstrate that C1q is deposited in wound-healing skin in the absence of C4 and C3 and that C1q mRNA is locally expressed as revealed by real-time PCR and in situ hybridization. C1q was found to induce permeability of the EC monolayer, to stimulate EC proliferation and migration, and to promote tube formation and sprouting of new vessels in a rat aortic ring assay. Using a murine model of wound healing we observed that vessel formation was defective in C1qa(-/-) mice and was restored to normal after local application of C1q. The mean vessel density of wound-healing tissue and the healed wound area were significantly increased in C1q-treated rats. On the basis of these results we suggest that C1q may represent a valuable therapeutic agent that can be used to treat chronic ulcers or other pathological conditions in which angiogenesis is impaired, such as myocardial ischemia.


Asunto(s)
Complemento C1q/fisiología , Células Endoteliales/efectos de los fármacos , Neovascularización Fisiológica/genética , Cicatrización de Heridas/genética , Animales , Proliferación Celular/efectos de los fármacos , Complemento C1q/genética , Complemento C1q/farmacología , Cartilla de ADN/genética , Células Endoteliales/fisiología , Ensayo de Inmunoadsorción Enzimática , Células Endoteliales de la Vena Umbilical Humana , Humanos , Immunoblotting , Inmunohistoquímica , Hibridación in Situ , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Neovascularización Fisiológica/fisiología , Ratas , Ratas Wistar , Reacción en Cadena en Tiempo Real de la Polimerasa , Cicatrización de Heridas/fisiología
10.
Am J Otolaryngol ; 36(2): 166-72, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25467297

RESUMEN

PURPOSE: The use of suture anchors has been described in orthopedic, hand, oculoplastic, temporomandibular joint and in aesthetic surgery, but no study reports the use of the Mitek® anchors (Depuy Mitek Surgical Products, Inc. Raynham, Massachusetts) for fixing the free flaps used in oncologic oral and oropharyngeal reconstruction. MATERIALS AND METHODS: In this prospective non-randomized study, 9 patients underwent surgical resection of oral or oropharyngeal cancer followed by a free flap reconstruction; mini anchors were used to fix the flap directly to the bone. We collected data regarding the patients, the tumor stage, the surgical procedure, the radiotherapy and the number of anchors used. RESULTS: The average follow-up was 28months (range 24-38).We observed no complications with trans-oral, sub-mandibular and trans-mandibular approach in both oral and oropharyngeal reconstructions. All anchors became osteo-integrated and no complications occurred after radiotherapy. CONCLUSIONS: In our opinion this device favors free flap adhesion to the bone. We registered no postoperative complications related to the use of the device which looks suitable for use in irradiated tissues. The radiotherapy did not cause any long-term complications related to the use of Mitek® mini bone anchors.


Asunto(s)
Colgajos Tisulares Libres/trasplante , Neoplasias de la Boca/cirugía , Neoplasias Orofaríngeas/cirugía , Procedimientos de Cirugía Plástica/métodos , Anclas para Sutura , Anciano , Femenino , Estudios de Seguimiento , Colgajos Tisulares Libres/irrigación sanguínea , Rechazo de Injerto , Supervivencia de Injerto , Humanos , Masculino , Mandíbula/cirugía , Persona de Mediana Edad , Neoplasias de la Boca/patología , Invasividad Neoplásica/patología , Estadificación de Neoplasias , Neoplasias Orofaríngeas/patología , Estudios Prospectivos , Procedimientos de Cirugía Plástica/efectos adversos , Medición de Riesgo , Factores de Tiempo , Resultado del Tratamiento
12.
J Tissue Viability ; 24(4): 180-4, 2015 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-26243676

RESUMEN

Nowadays Integra™ is an integral part of the "reconstructive ladder", recently the new Integra™ Flowable Dermal Regeneration has appeared on the market. This is a semiliquid compound, malleable and those characteristics widen the indication for its use. In this report we describe two cases in which we used this product to repair undermined and tunnelled wounds. We believe that this product can be useful for treatment of tunnelled wounds of small dimensions reducing the need for major procedures.


Asunto(s)
Sulfatos de Condroitina/uso terapéutico , Colágeno/uso terapéutico , Trasplante de Piel/métodos , Piel Artificial , Traumatismos de los Tejidos Blandos/terapia , Adulto , Traumatismos del Tobillo/terapia , Femenino , Frente/lesiones , Humanos , Masculino , Persona de Mediana Edad , Repitelización , Colgajos Quirúrgicos , Adulto Joven
15.
Life Sci Alliance ; 7(11)2024 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-39191487

RESUMEN

Helicobacter pylori infection predisposes carriers to a high risk of developing gastric cancer. The cell-of-origin of antral gastric cancer is the Lgr5+ stem cell. Here, we show that infection of antrum-derived gastric organoid cells with H. pylori increases the expression of the stem cell marker Lgr5 as determined by immunofluorescence microscopy, qRT-PCR, and Western blotting, both when cells are grown and infected as monolayers and when cells are exposed to H. pylori in 3D structures. H. pylori exposure increases stemness properties as determined by spheroid formation assay. Lgr5 expression and the acquisition of stemness depend on a functional type IV secretion system (T4SS) and at least partly on the T4SS effector CagA. The pharmacological inhibition or genetic ablation of NF-κB reverses the increase in Lgr5 and spheroid formation. Constitutively active Wnt/ß-catenin signaling because of Apc inactivation exacerbates H. pylori-induced Lgr5 expression and stemness, both of which persist even after eradication of the infection. The combined data indicate that H. pylori has stemness-inducing properties that depend on its ability to activate NF-κB signaling.


Asunto(s)
Infecciones por Helicobacter , Helicobacter pylori , FN-kappa B , Receptores Acoplados a Proteínas G , Neoplasias Gástricas , Vía de Señalización Wnt , Animales , Ratones , Antígenos Bacterianos/metabolismo , Antígenos Bacterianos/genética , Proteínas Bacterianas/metabolismo , Proteínas Bacterianas/genética , Mucosa Gástrica/metabolismo , Mucosa Gástrica/microbiología , Infecciones por Helicobacter/metabolismo , Infecciones por Helicobacter/microbiología , Células Madre Neoplásicas/metabolismo , Células Madre Neoplásicas/microbiología , FN-kappa B/metabolismo , Organoides/metabolismo , Organoides/microbiología , Receptores Acoplados a Proteínas G/metabolismo , Receptores Acoplados a Proteínas G/genética , Células Madre/metabolismo , Estómago/microbiología , Estómago/patología , Neoplasias Gástricas/microbiología , Neoplasias Gástricas/metabolismo , Neoplasias Gástricas/genética , Neoplasias Gástricas/patología , Sistemas de Secreción Tipo IV/metabolismo , Sistemas de Secreción Tipo IV/genética , Vía de Señalización Wnt/genética
16.
Clin Breast Cancer ; 24(4): e226-e231, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38503614

RESUMEN

INTRODUCTION: Skin-sparing mastectomy (SSM) entails complete removal of the breast tissue and the nipple and areola complex (NAC) with preservation of as much of the overlying skin as possible. The preservation of the natural skin envelope during SSM improves the aesthetic outcome of immediate breast reconstruction, but the lack of NAC determines that the reconstructed breast remains anatomically incomplete with not always satisfactory final results. For this purpose, the aim of the present study was to investigate and evaluate the impact of nipple reconstruction after skin sparing and skin reducing mastectomy on the patients' perception and intimate life. MATERIALS AND METHOD: This was a comparative single-center prospective study that involved 42 patients underwent NAC reconstruction after SSM. A pre- and postoperative quality-of-life and psychological questionnaires Breast-Q questionnaire (Breast Conserving therapy module) were given to all the patients before the surgery and 6 months after. The statistical analysis with chi-square test was performed. RESULTS: After 6 months a prevalence of patients reported to be very satisfied in regard to shape, appearance, naturalness, projection, position and symmetry. The study shows an overall improvement in all the psychological items analyzed with statistically significant difference regarding: "patient's satisfaction," "self-confidence," "appearance of the breast." CONCLUSION: The authors believe that the NAC reconstruction has useful functional and aesthetic results particularly appreciated by patients who feel demoralized after breast demolition surgery.


Asunto(s)
Neoplasias de la Mama , Mamoplastia , Pezones , Satisfacción del Paciente , Calidad de Vida , Colgajos Quirúrgicos , Humanos , Femenino , Pezones/cirugía , Mamoplastia/métodos , Mamoplastia/psicología , Neoplasias de la Mama/cirugía , Neoplasias de la Mama/psicología , Estudios Prospectivos , Persona de Mediana Edad , Adulto , Encuestas y Cuestionarios , Anciano , Mastectomía/psicología , Estudios de Seguimiento , Resultado del Tratamiento
17.
J Clin Med ; 13(9)2024 May 06.
Artículo en Inglés | MEDLINE | ID: mdl-38731255

RESUMEN

Background: Cervical esophageal reconstruction is vital to improve the quality of life in cancer surgery patients. Microsurgery is crucial in providing vascularized tissue for defect repair, particularly in secondary cases with a higher risk of failure due to larger defects and damage from previous surgery and radiotherapy. The purpose of this study was to describe the clinical characteristics of a series of patients who underwent secondary repair of esophageal defects and provide practical information for the management and treatment of such cases based on the authors' experience and the literature review. Methods: We retrospectively reviewed the electronic medical records of the Plastic Surgery Clinic at the University of Trieste to identify cases of patients who underwent secondary esophageal microsurgical reconstructions following oncological surgery. Patient demographics, the etiology of esophageal defects, previous surgical history, and preoperative assessments were collected from medical records. Surgical techniques utilized for reconstruction, such as pedicled flaps or free tissue transfers, were documented along with intraoperative information. Postoperative outcomes, including complications, graft viability, and functional outcomes, were evaluated during follow-up. Results: We treated 13 cases of secondary esophageal reconstructions between 2011 and 2022. Most commonly, Antero-Lateral Thigh (ALT) flaps were used in 10 cases, while 2 cases employed a radial forearm flap (RFF), and 1 case employed a chimeric parascapular flap. No flap failures occurred during a median 50-month follow-up. One ALT flap patient experienced postop stricture but maintained swallowing ability. A single tracheoesophageal fistula occurred in an RFF patient with a history of radiotherapy and complete lymph node dissection. Conclusions: Cervical esophageal reconstruction significantly impacts patients' quality of life by restoring oral feeding and phonation. When local flaps fall short, microsurgical reconstruction with intestinal flaps is valuable but is burdened by limitations. For challenging secondary cases, ALT or RFF flaps emerge as safer options due to their robust pedicles, yielding low complication rates and positive functional outcomes.

18.
Cancers (Basel) ; 16(13)2024 Jul 02.
Artículo en Inglés | MEDLINE | ID: mdl-39001499

RESUMEN

BACKGROUND: With the rise in the mastectomy rate, the number of patients who choose to undergo postmastectomy reconstruction has been increasing, and implant-based procedures are the most performed methods for postmastectomy breast reconstruction. Among the possible complications, the most feared is the loss of reconstruction. It can be related to several reasons, but one of the most common is infection of the implant, which can lead to prolonged antibiotic treatment, undesired additional surgical procedures, increased incidence of capsular contracture, and unsatisfactory aesthetics results, with a huge psychological impact on patients. AIMS: The primary intent of this study is to analyze the status of infection rates at our institution and evaluate the effectiveness of our prevention protocol since its introduction. Secondly, we compared data of the surgical site infections (SSIs) after implant-based breast reconstruction at Trieste Hospital, where the protocol has been employed since 2020, and in another center, where plastic surgeons of our team are involved, with different prevention procedures. METHODS AND RESULTS: We enrolled 396 female patients, who underwent implant-based breast reconstruction, using definitive mammary implants or breast tissue expanders, with or without ADM (acellular dermal matrix), both for breast cancer and risk-reducing surgery in BRCA1/2 patients. Patients treated at the Hospital of Trieste, with the use of the prevention protocol, were considered the experimental group (group 1), while patients treated in Gorizia by the same breast team with standardized best-practice rules, but without the use of the prevention protocol, were considered the control group (group 2). Infected patients were 5 in the first group (1.7%) and 8 in the second one (7.9%), with a global infection rate of 3.2%. CONCLUSION: After the introduction of our prevention protocol, we faced a lower incidence of infection after breast surgery with implants or tissue expanders.

19.
Infez Med ; 32(2): 138-147, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38827836

RESUMEN

Infected skin ulcers represent a frequent and intricate clinical challenge, necessitating prompt and comprehensive multidisciplinary interventions to avert complications. Anti-infective therapy constitutes a cornerstone in the therapeutic paradigm. This manuscript delineates our approach to anti-infective management of infected ulcers, encompassing insights into clinical classifications, diagnostic features, exampless of early clinical decision-making in anti-infective treatment, comprehensive evaluation of infectious diseases encompassing host clinical considerations and potential interventions, determination of antibiotic therapy duration, methodologies for assessing clinical response, identification of potential causes for lack of clinical response, as well as strategies for outpatient parenteral antibiotic therapy and a diagnostic and therapeutic algorithm.

20.
Int J Surg Case Rep ; 112: 108939, 2023 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-37866017

RESUMEN

INTRODUCTION AND RELEVANCE: Microsurgical revascularization stands as the preferred method for addressing erectile dysfunction (ED) resulting from traumatic penile arterial insufficiency. Traditional microarterial bypass surgery (MABS) techniques have typically relied on utilizing the inferior epigastric artery (IEA) as the graft vessel. However, issues such as endothelial dysfunction in the vessel and alterations in abdominal tissue can negatively impact surgical outcomes. MABS using the descending branch of the lateral circumflex artery of the femur (DLCFA) should be proposed as a surgical option for penile arterial revascularization. CASE PRESENTATION: A 29-year-old who experienced ED after a pelvic bone fracture with hypogastric vascular injury was referred to our center. Preoperatory penile Doppler ultrasound (PDU) examination documented the presence of arterial insufficiency. Selective hypogastric angiography pointed out the interruption of arterial blood flow at the level of the distal right internal pudendal artery. CASE DISCUSSION: Access to the dorsal penile artery was gained through an infrapubic incision, the DLCFA pedicle was isolated through an incision along the anterolateral right thigh. After its transposition, the arterial bundle was anastomosed to the dorsal penile artery in an end-to-end fashion. Intraoperative PDU has been used to verify the patency of the anastomosis. At 6 months follow-up, optimal flow parameters on PDU were persistently registered, and the patient had consistent clinical improvement on the IIEF-5 score. CONCLUSION: DLCFA grafting for penile revascularization is a suitable therapeutic option in traumatic ED due to its size and accessibility. Further experience is necessary to compare clinical outcomes among different revascularization techniques.

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