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1.
Surg Innov ; 29(5): 566-572, 2022 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34555944

RESUMEN

Background and Objectives. Lymph node status is the most important prognostic factor in cutaneous melanoma patients. Recent studies showed that indocyanine green (ICG) fluorescence lymphography helps locating sentinel nodes better. Sometimes, flap reconstruction is needed after wide excision of tumor. Indocyanine green fluorescence also simplifies the intraoperative design of flaps. This study investigates the use of ICG fluorescence in patients with cutaneous melanoma during operation. Methods. We performed a single-center, retrospective study of subjects with cutaneous melanoma using ICG lymphograhy and/or angiography during wide excision of tumor between 2015 and 2019. Patients received a dermal injection of ICG and patent blue (PB) dye. The positive node was excised. Indocyanine green angiography was utilized to visualize better skin paddle during flap reconstruction if needed. Results. A total of 37 sentinel lymph nodes (SLNs) were removed in 12 patients. Indocyanine green successful localization was found in 10 of the 12 patients (83%). Three patients were found with 6 metastatic nodes on final pathology. 100% of these 6 nodes were identified by ICG, while 83% (5/6) were positive PB. Three of the 12 patients received flap reconstruction after operation, and no major complications occurred. Conclusions. ICG dye lymphangiography is a good alternative for locating SLNs in patients with melanoma. It could also visualize well perfusion skin paddle during reconstruction. We reported a reproducible and simple method to utilize ICG fluorescence in cutaneous melanoma patients.


Asunto(s)
Melanoma , Neoplasias Cutáneas , Humanos , Verde de Indocianina , Melanoma/diagnóstico por imagen , Melanoma/cirugía , Melanoma/patología , Linfografía/métodos , Neoplasias Cutáneas/diagnóstico por imagen , Neoplasias Cutáneas/cirugía , Neoplasias Cutáneas/patología , Biopsia del Ganglio Linfático Centinela/métodos , Fluorescencia , Estudios Retrospectivos , Colorantes , Angiografía , Melanoma Cutáneo Maligno
2.
J Orthop Surg (Hong Kong) ; 28(3): 2309499020950262, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32840428

RESUMEN

Biomechanical factors play an extremely important role in regulating the function of articular chondrocytes. Understanding the mechanical factors that drive chondrocyte biological responses is at the heart of our interpretation of cascade events leading to changes in articular cartilage osteoarthritis. The mechanism by which mechanical load is transduced into intracellular signals that can regulate chondrocyte gene expression remains largely unknown. The mechanically sensitive ion channel (MSC) may be one of its specific mechanisms. This review focuses on four ion channels involved in the mechanotransduction of chondrocytes, exploring their properties and the main factors that activate the associated pathways. The upstream and downstream potential relationships between the protein pathways were also explored. The specific biophysical mechanism of the chondrocyte mechanical microenvironment is becoming the focus of research. Elucidating the mechanotransduction mechanism of MSC is essential for the research of biophysical pathogenesis and targeted drugs in cartilage injury-related diseases.


Asunto(s)
Cartílago Articular/diagnóstico por imagen , Mecanotransducción Celular/fisiología , Osteoartritis/diagnóstico , Animales , Fenómenos Biomecánicos , Cartílago Articular/cirugía , Condrocitos/patología , Humanos , Osteoartritis/fisiopatología , Osteoartritis/cirugía
3.
Dermatol Surg ; 45(12): 1605-1609, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-30829777

RESUMEN

BACKGROUND: The efficacy of botulinum toxin A (BTX-A) therapy in axillary hyperhidrosis has been documented; however, there are a few studies reporting the efficacy of BTX-A in treating axillary bromhidrosis. The histological changes occurring in sweat glands after BTX-A treatment are also unknown. OBJECTIVE: The authors report on the efficacy and safety of BTX-A in the treatment of axillary bromhidrosis and on the histological changes in sweat glands after BTX-A treatment. MATERIALS AND METHODS: Nineteen patients were included in this study. The patients were administered BTX-A injection in one axilla and sterile normal saline as placebo in the other axilla. The degree of malodor was evaluated subjectively by the patients before and 3 months after treatment. Sweat secretion was quantified by the gravimetric method. All patients underwent standard apocrinectomy in both axillary regions. RESULTS: The mean degree of malodor and mean sweat production in the BTX-A-treated axilla were significantly lower than those in the control axilla (2.42 vs 8.00; p < .0001 and 13.33 vs 33.75 mg/min; p = .0028, respectively) at 3 months after therapy. The histological studies showed apocrine sweat glands with atrophic changes and hypoplasia in treated axilla. CONCLUSION: BTX-A injection is an easy, fast, noninvasive method of treating axillary bromhidrosis.


Asunto(s)
Toxinas Botulínicas Tipo A/administración & dosificación , Hiperhidrosis/terapia , Fármacos Neuromusculares/administración & dosificación , Odorantes/prevención & control , Glándulas Sudoríparas/efectos de los fármacos , Adulto , Axila , Método Doble Ciego , Femenino , Humanos , Hiperhidrosis/complicaciones , Hiperhidrosis/diagnóstico , Inyecciones Intradérmicas , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Glándulas Sudoríparas/patología , Sudoración/efectos de los fármacos , Resultado del Tratamiento , Adulto Joven
4.
Wounds ; 31(3): 75-80, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30720445

RESUMEN

INTRODUCTION: Ischial pressure ulcers are considered the most difficult type of pressure ulcers (PUs) to treat. OBJECTIVE: The authors report the use of a pedicled anterolateral thigh (pALT) myocutaneous flap as an alternative for covering an ischial PU. MATERIALS AND METHODS: The authors retrospectively collected the data of 21 patients with an indurated recurrent ischial ulcer or a fresh ischial ulcer. A pALT myocutaneous flap was harvested without intramuscular dissection and skeletonization of the perforators for the ischial defect reconstruction. Two modified flap-insetting techniques, an open-route method and a subcutaneous tunnel method, were used for the ischial defect reconstruction. The open-route flap-insetting was used for a recurrent ulcer status after other surgical procedures, and the subcutaneous tunnel method was used for fresh ulcers. RESULTS: The mean follow-up period was 10 months (range, 4-14 months). During the postoperative follow-up, all open-route reconstructions resulted in flap take; however, poor healing with seroma was noted in 2 patients who had undergone pALT reconstruction with subcutaneous tunneling after other previous surgical reconstructions. CONCLUSIONS: In the authors' experience, because of constant blood supply, sufficient bulk, easy elevation, longer pedicle for the arc of rotation, primary closure of the donor site without morbidity, and a non-weightbearing flap donor site, the pALT myocutaneous flap for ischial ulcer reconstruction can serve as a primary treatment and secondary salvage.


Asunto(s)
Isquion/patología , Colgajo Miocutáneo , Procedimientos de Cirugía Plástica/métodos , Úlcera por Presión/patología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Úlcera por Presión/cirugía , Estudios Retrospectivos , Muslo , Resultado del Tratamiento
5.
Acta Orthop Traumatol Turc ; 53(2): 154-156, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30292474

RESUMEN

Intravascular papillary endothelial hyperplasia (IPEH), also known as Masson's tumor or vegetant intravascular hemangioendothelioma, is a reactive condition representing an exuberant organization and recanalization of a thrombus. It can occur in normal blood vessels or in vascular malformations, perhaps in response to blood vessel injury or thrombosis. In this report, we present the diagnostic and therapeutic courses of a 55 year-old woman and an 18 year-old man, who had a progressive protruding hand mass following a hand contusion. The pathological examination confirmed the diagnosis of IPEH in both patients.


Asunto(s)
Endotelio Vascular , Traumatismos de la Mano/complicaciones , Hemangioendotelioma/diagnóstico , Trombosis/diagnóstico , Adolescente , Biopsia/métodos , Diagnóstico Diferencial , Disección/métodos , Endotelio Vascular/patología , Endotelio Vascular/cirugía , Femenino , Humanos , Hiperplasia/diagnóstico , Hiperplasia/patología , Imagen por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento
6.
Int Wound J ; 15(5): 783-788, 2018 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-29797454

RESUMEN

The basic principle of donor site selection is to take skin from areas that will heal with minimal scarring while balancing the needs of the recipient site. For skin loss from the lower legs and feet, the most common harvest site for split-thickness skin grafts is the anterior or posterior thigh; grafts from the plantar areas have been mostly used to cover the volar aspect of digits and palms. Between September 2015 and September 2017, 42 patients with areas of skin loss on the legs or feet were treated with plantar skin grafts because of their cosmetic benefits and the convenience of the surgical procedure and postoperative wound care. Our technique of harvesting a single layer of split-thickness skin graft (0.014 in. thick) from a non-weight-bearing area of the foot of the injured leg is simple and provided good functional and cosmetic outcomes at both the donor and recipient sites. All patients were very satisfied with the recovery progress and final results. Therefore, in the management of skin defects in the lower legs or feet that comprise less than 1.5% of the total body surface area, our surgical method is a reliable alternative to anterior or posterior thigh skin grafting.


Asunto(s)
Traumatismos de los Pies/cirugía , Pie/cirugía , Traumatismos de la Pierna/cirugía , Procedimientos de Cirugía Plástica/métodos , Trasplante de Piel/métodos , Cicatrización de Heridas/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento
7.
Ostomy Wound Manage ; 64(2): 45-48, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29481327

RESUMEN

Many types of flaps are available if surgical reconstruction of a pressure ulcer is indicated, including a gluteus maximus flap, V-Y advancement flap, and superior gluteal artery perforator flap. Regional flap failure can complicate treatment, requiring additional flap surgery. An 80-year old woman with a 2-year history of being unconscious following a cerebrovascular accident presented with a Stage 4 sacral pressure ulcer of 2 months' duration with eschar and abscess formation. Because the wound measured 15 × 10 cm2, bilateral V-Y advancement flaps were used for surgical closure. However, 1 week later, ischemic change of the wound edges and wound dehiscence were observed. The wound was subsequently closed with an artery perforator (IGAP) flap, an approach that took into consideration religious preference of keeping the body intact. The patient was discharged with a healed wound 6 weeks postoperatively; long-term postoperative surveillance was hindered by the patient's distance from the care facility (she lived on an outlying island). This is the first case report to describe IGAP flap application in a patient with a sacral pressure ulcer after failed reconstruction using bilateral V-Y advancement flaps.


Asunto(s)
Procedimientos de Cirugía Plástica/normas , Úlcera por Presión/cirugía , Región Sacrococcígea/fisiopatología , Anciano de 80 o más Años , Femenino , Humanos , Colgajo Perforante/irrigación sanguínea , Colgajo Perforante/fisiología , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/cirugía , Úlcera por Presión/complicaciones , Procedimientos de Cirugía Plástica/métodos , Región Sacrococcígea/irrigación sanguínea
8.
Ann Plast Surg ; 80(2S Suppl 1): S59-S65, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29369098

RESUMEN

INTRODUCTION: Nipple-sparing mastectomy (NSM) and immediate breast reconstruction with gel implants have grown in popularity because of superior aesthetic outcomes. One risk of this procedure is overexcision of the flap leading to inadequate circulation in the breast envelope. METHODS: We investigated 17 cases of NSM and gel implant breast reconstruction. Patients were divided into an infra-areolar incision group and a supra-areolar incision group. Nipple-areolar complex perfusion was evaluated using the SPY imaging system after NSM and gel implant breast reconstruction. We aimed to discover any relationships between the incision method and nipple-areolar complex (NAC) circulation in NSM and gel implant breast reconstruction. RESULTS: For successful breast surgery, awareness of the blood supply to the breast, especially the NAC, is very important. In our study, with the indocyanine green SPY imaging system, most ingress (arterial inflow) and egress (venous outflow) rates in the infra-areolar incision group were better than those in the supra-areolar incision group (P < 0.005). CONCLUSIONS: We have shown that an infra-areolar incision provides better blood flow following NSM and gel implant breast reconstruction. In our experience, in order to prevent the possible ischemia of NAC, we used the smaller gel implants, which is approximately 10 to 20 mL smaller than the original implant size measured by the sizer, if the egress rate of NAC is lower than 0.2. These findings have implications in the clinical setting as surgeons have a choice to provide a better outcome for patients.


Asunto(s)
Implantes de Mama , Mamoplastia/métodos , Mastectomía Subcutánea/métodos , Pezones/irrigación sanguínea , Cirugía Asistida por Computador , Adulto , Anciano , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Estudios de Cohortes , Estética , Femenino , Humanos , Mamoplastia/instrumentación , Mastectomía Subcutánea/efectos adversos , Persona de Mediana Edad , Monitoreo Intraoperatorio/instrumentación , Monitoreo Intraoperatorio/métodos , Pezones/cirugía , Flujo Sanguíneo Regional , Estudios Retrospectivos , Medición de Riesgo , Estadísticas no Paramétricas , Resultado del Tratamiento
9.
Ann Plast Surg ; 80(2S Suppl 1): S55-S58, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-29369100

RESUMEN

INTRODUCTION: Plantar hyperkeratosis, such as corns and calluses, is common in older people and associated with pain, mobility impairment, and functional limitations. It usually develops on the palms, knees, or soles of feet, especially under the heels or balls. There are several treatment methods for plantar hyperkeratosis, such as salicylic acid plaster and scalpel debridement, and conservative modalities, such as using a shoe insert and properly fitting shoes. METHODS: We present an effective method of reconstructing the wound after corn excision using a split-thickness sole skin graft (STSSG). We harvested the skin graft from the arch of the sole using the dermatome with a skin thickness of 14/1000th inches. RESULTS: Because the split-thickness skin graft, harvested from the sole arch near the distal sole, is much thicker than the split-thickness skin graft from the thigh, it is more resistant to weight and friction. The healed wound with STSSG coverage over the distal sole was intact, and the donor site over the sole arch had healed without complication during the outpatient follow-up, 3 months after surgery. CONCLUSIONS: The recovery time of STSSG for corn excision is shorter than that with traditional treatment. Therefore, STSSG can be a reliable alternative treatment for recurrent palmoplantar hyperkeratosis.


Asunto(s)
Callosidades/cirugía , Enfermedades del Pie/cirugía , Placa Plantar/cirugía , Trasplante de Piel/métodos , Cicatrización de Heridas/fisiología , Anciano , Callosidades/diagnóstico , Estudios de Cohortes , Desbridamiento/métodos , Femenino , Enfermedades del Pie/diagnóstico , Supervivencia de Injerto , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Placa Plantar/fisiopatología , Pronóstico , Recurrencia , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Recolección de Tejidos y Órganos/métodos , Resultado del Tratamiento
10.
Microsurgery ; 38(4): 381-387, 2018 May.
Artículo en Inglés | MEDLINE | ID: mdl-28990692

RESUMEN

BACKGROUND: Loss of soft tissue in heel-calcaneal region is frequently caused by trauma, infection, or tumors. Limited availability of similar tissue becomes challenging, therefore, the use of free tissue transfer offers a solution. Our aim is to describe long term functional outcome of different free tissue transfers for these defects. PATIENTS AND METHODS: We retrospectively reviewed 24 consecutive cases of the heel-calcaneal defect between January 2009 and December 2014. The free fasciocutaneous perforator (FCP) flaps were performed in 14 cases and free muscle flaps with skin graft in 10 cases. The postoperative complications, range of motion and ability of ambulation or exercise were administered to evaluate functional results. RESULTS: The average follow-up period was 26.5 months. The survival of free flap was 100%. Early complication included venous thrombosis, infection and edge dehiscence was noted in 8 cases. Late complication with insensate ulcers developed in 3 cases (1 cases in FCP flap, 2 cases in muscle flap). All ulcers healed spontaneously without surgical intervention. The postoperative average range of motion of ankle regained 52.79 degree in FCP flap group and 56.4 degree in muscle flap group. The ability of ambulation or exercise returned in 13 cases in FCP group (13/14) and 9 cases in muscle flap group (9/10). No differences of complication rate (P = .403), ROM (P = .363) or functional evaluation (P = .803) could be found between these two groups. CONCLUSIONS: Both FCP flap and muscle flaps provided the similar and excellent functional results in resurfacing of heel-calcaneal defects after long term follow up.


Asunto(s)
Calcáneo , Colgajos Tisulares Libres , Talón , Procedimientos de Cirugía Plástica/métodos , Traumatismos de los Tejidos Blandos/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Rango del Movimiento Articular , Recuperación de la Función , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
11.
Int Wound J ; 14(6): 1170-1174, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-28736958

RESUMEN

Pressure sores are often observed in patients who are bedridden. They can be a severe problem not only for patients and their caregivers but also for plastic surgeons. Here, we describe a new method of superior gluteal artery perforator flap harvesting and anchoring with the assistance of intraoperative indocyanine green fluorescent angiography. In this report, we describe the procedure and outcomes for 19 patients with grades III and IV sacral pressure sores who underwent the operation between September 2015 and November 2016. All flaps survived, and two experienced wound-edge partial dehiscence. With the assistance of this imaging device, we were able to acquire a reliable superior gluteal artery perforator flap and perform modified operations with it that are safe, easy to learn and associated with fewer complications than are traditional.


Asunto(s)
Angiografía con Fluoresceína , Verde de Indocianina , Cuidados Intraoperatorios , Colgajo Perforante/irrigación sanguínea , Procedimientos de Cirugía Plástica , Úlcera por Presión/cirugía , Anciano , Anciano de 80 o más Años , Nalgas/irrigación sanguínea , Colorantes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Úlcera por Presión/diagnóstico por imagen , Estudios Retrospectivos , Sacro
12.
Ann Plast Surg ; 78(3 Suppl 2): S95-S101, 2017 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-28195894

RESUMEN

BACKGROUND: The use of implants is still the most common procedure for breast reconstruction because they are easy, less painful than tissue transplants, and do not need a donor site. However, it is challenging to find a suitable implant for patients with small breasts, and some women fear foreign bodies and possible complications or reoperations. Autologous breast reconstruction using the pedicled latissimus dorsi (LD) myocutaneous flap without an implant provides a good option for Asian women with small breasts. MATERIALS AND METHODS: Between June 1992 and December 2015, 31 patients underwent breast reconstruction with 33 LD flaps (29 unilateral and 2 bilateral). The skin paddle of the flap was designed with an oblique or transverse pattern depending on the mastectomy defect and the elasticity of skin. The thoracodorsal nerve was divided during flap harvesting to prevent a "twitching breast" postoperatively. Patients refused to have contralateral breast augmentation except for 2 with bilateral simultaneous augmentation after mastectomy bilaterally. Outcome measures were flap survival, shape and contour, symmetry of breast, complication of flap and donor site, patient satisfaction, and any local tumor recurrence or metastasis. RESULTS: The mean patient age was 46.7 years (range, 27-72), and the mean body mass index was 22.5 kg/m (range, 18.6-30). The mean size of the harvested skin paddle was 11.9 × 5.0 cm (range, 10 × 3 cm to 15 × 9 cm). Mean operative times were 200.8 minutes (range, 112-230 minutes) and 305 minutes (range, 300-310 minutes) for unilateral and bilateral reconstructions, respectively. Pathology reports showed a negative safety margin in all cases. Most cases were of invasive duct carcinoma (58%). All LD flaps survived, and the wounds healed satisfactorily over a mean follow-up of 49.9 months (range, 3-161 months). Donor sites were closed primarily with a hidden linear scar under the dorsal bra strap. Donor site morbidities were mainly seromas (15%), which were treated conservatively in most patients. CONCLUSIONS: The LD flap produced good autologous tissue for reconstruction, and no implants were needed for Asian women with small breasts. The reconstructed breasts showed good shape, contour, and symmetry. The results of donor site were acceptable and no significant functional loss. There were no major complications, and patient satisfaction was high.


Asunto(s)
Neoplasias de la Mama/cirugía , Mama/anatomía & histología , Mamoplastia/métodos , Colgajo Miocutáneo , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Satisfacción del Paciente , Taiwán , Trasplante Autólogo , Resultado del Tratamiento
13.
Ann Plast Surg ; 78(3 Suppl 2): S102-S107, 2017 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-28166138

RESUMEN

BACKGROUND: Although autogenous tissue-based breast reconstruction has been widely used in the past decade, implant-based breast reconstruction is more often used in Taiwan because Asian women are generally slender with small breasts. For patients with very small breasts, it is hard to achieve the goal of reconstructing a similar breast to the contralateral one, even with the smallest size implant available commercially. Therefore, these patients need not only breast reconstruction but also contralateral breast augmentation. Here we report the surgical outcomes and cosmetic results of breast reconstruction using cohesive gel implants combined with simultaneous contralateral breast augmentation. MATERIALS AND METHODS: A retrospective chart review was conducted to identify all patients with AA-sized to B-sized breast cups undergoing expander-implant reconstruction combined with contralateral breast augmentation between 2002 and 2015. Thirty patients were included. For each patient, patient profile (age, body mass index, and initial breast size), type and stage of breast cancer, surgical information (including implant sizes and the type of reconstruction and augmentation), and postoperative subjective pain scales were recorded. Outcomes were analyzed by identifying complications, the need for surgical revision, the presence of local or distant metastases, and patient satisfaction ratings. RESULTS: At a mean 2.3-year follow-up (range, 4 months to 12 years), problems occurred in 7 of the 30 patients, with 9 complications in 8 reconstructed breasts and in 1 augmented breast. Complications were mostly capsule contracture. Aesthetic satisfaction was rated as "excellent" or "good" by most of the patients, and only 1 commented "poor" on both overall and reconstructed results because of postoperative radiotherapy-associated skin necrosis. The total mean subjective pain scale was 1.9/10; a higher mean pain scale of 3.08 was noted in those patients undergoing augmentation with no extra incision. CONCLUSIONS: This is the first report of implant-based breast reconstruction with simultaneous contralateral augmentation in Taiwan, showing its efficacy, safety, and good cosmetic outcomes with relatively low complication and revision rates.


Asunto(s)
Implantes de Mama , Neoplasias de la Mama/cirugía , Mama/anatomía & histología , Mamoplastia/métodos , Mastectomía , Adulto , Anciano , Estética , Femenino , Humanos , Persona de Mediana Edad , Estudios Retrospectivos , Taiwán , Resultado del Tratamiento
14.
Int Wound J ; 14(5): 818-822, 2017 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-28052529

RESUMEN

Vibrio vulnificus can cause severe skin and soft tissue infection (SSTI). The pathogen is an opportunistic marine bacterium that is likely to infect patients with chronic liver disease, patients in an immunocompromised state, and those in end-stage renal disease. V. vulnificus gains entry through soft tissues by direct penetration of a wound by infected marine organisms, such as raw oysters, shellfish and other seafood, or by exposing a wound to contaminated water. Despite its ease of entry, V. vulnificus necrotising fasciitis with compartment syndrome has rarely been described. We report a case of an elderly patient with end-stage renal disease undergoing haemodialysis, who developed necrotising fasciitis following infection by V. vulnificus through a puncture injury while cleaning fish. A successful salvage and reconstruction surgery was performed using fenestrated-type artificial dermis followed by negative pressure wound therapy. This case presents a reasonable treatment option for threatening V. vulnificus necrotising fasciitis with compartment syndrome.


Asunto(s)
Fascitis Necrotizante/etiología , Fascitis Necrotizante/cirugía , Dedos/cirugía , Terapia de Presión Negativa para Heridas , Piel Artificial , Vibrio vulnificus/patogenicidad , Infección de Heridas/cirugía , Anciano de 80 o más Años , Femenino , Dedos/microbiología , Humanos , Fallo Renal Crónico , Resultado del Tratamiento
15.
Ostomy Wound Manage ; 62(3): 46-9, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26978859

RESUMEN

Salmonella can cause extra-intestinal focal infections as well as gastrointestinal problems. A few cases of Salmonella skin and soft tissue infection have been documented in immunocompromised patients such as persons with type 2 diabetes and poor glycemic control. A case study is presented of a 30-year-old man with a 10-year history of poorly controlled (HbA1C 11.7%) diabetes mellitus who presented with a ruptured nodule resulting in a wound with signs of infection over his anterior chest region of 1-month duration. He had been taking amoxycillin/clavulanate for the week previous to presentation at the authors' facility. Following sharp debridement, the ulcerative wound deteriorated and a chest wall abscess developed. Bacterial culture results were positive for Salmonella group D, resistant to ampicillin and susceptible to ceftriaxone and ciprofloxacin. The patient underwent surgical debridement, resulting in a wound 7 cm x 4 cm, and was provided ceftriaxone 2.0 g intravenously daily along with insulin therapy. After surgical debridement, a local rotational flap was created for wound closure and reconstruction. The patient was discharged 1 week later on oral antibiotic therapy for 1 week. His wound was completely healed without recurrence at his 4-month follow-up. For this patient, addressing glycemic issues, identifying the infectious organism, and providing appropriate therapy, radical debridement, and flap surgery helped heal an advanced soft tissue infection. In immunocompromised patients with skin or soft tissue infections, the presence of Salmonella should be considered.


Asunto(s)
Absceso/diagnóstico , Absceso/terapia , Diabetes Mellitus Tipo 2/complicaciones , Infecciones por Salmonella/diagnóstico , Infecciones por Salmonella/terapia , Úlcera Cutánea/microbiología , Absceso/etiología , Adulto , Diabetes Mellitus Tipo 2/terapia , Humanos , Masculino , Infecciones por Salmonella/etiología , Úlcera Cutánea/patología , Úlcera Cutánea/terapia , Pared Torácica
16.
Ostomy Wound Manage ; 62(1): 34-9, 2016 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-26779702

RESUMEN

Despite advances in reconstruction techniques, sacral pressure ulcers continue to present a challenge to the plastic surgeon. The flap from the gluteal crease derives blood supply from the inferior gluteal artery perforator (IGAP) and reliably preserves the entire contralateral side as a donor site. To incorporate the IGAP in the reconstruction of sacral pressure ulcers, a skin paddle over the gluteal crease was created and implemented by the authors. Data from 11 patients (8 men, 3 women; mean age 67 [range 44-85] years old) whose sacral ulcers were closed with an IGAP flap between June 2006 and May 2012 were retrieved and reviewed. All patients were bedridden; 1 patient in a vegetative state with a diagnosis of carbon monoxide intoxication was referred from a local clinic, 2 patients had Parkinson's disease, and 8 patients had a history of stroke. The average defect size was 120 cm(2) (range 88-144 cm(2)). The average flap size was 85.8 cm(2) (range 56-121 cm(2)). Only 1 flap failure occurred during surgery and was converted into V-Y advancement flap; 10 of the 11 flaps survived. After surgery, the patients' position was changed every 2 hours; patients remained prone or on their side for approximately 2 weeks until the flap was healed. After healing was confirmed, patients were discharged. Complications were relatively minor and included 1 donor site wound dehiscence that required wound reapproximation. No surgery-related mortality was noted; the longest follow-up period was 24 months. In this case series, flaps from the gluteal crease were successfully used for surgical closure of sacral pressure ulcers. This flap design should be used with caution in patients with hip contractures. Studies with larger sample sizes are needed to ascertain which type of flap is best suited to surgically manage extensive pressure ulcers in a variety of patient populations.


Asunto(s)
Colgajo Perforante , Procedimientos de Cirugía Plástica , Úlcera por Presión/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Nalgas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sacro
17.
Wounds ; 27(6): E12-5, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-26266282

RESUMEN

Ischial pressure ulcers are difficult ulcers to treat and have a low treatment success rate compared to sacral and trochanteric ulcers; regional flap failure further complicates the treatment. Reported here is a case of a 65-year-old man who experienced a spinal injury with paraplegia due to trauma 20 years ago. The patient experienced a recurrent ischial ulcer since 2007, and underwent several types of flap reconstruction with poor outcomes over a 7-year period. Therefore, the chosen intervention was a pedicled anterolateral thigh (pALT) fasciocutaneous flap reconstruction for the ischial ulcer via a subcutaneous route. Over the 10-month follow-up, the recurrent ischial ulcer healed without wound dehiscence. Island pALT reconstruction appears to be an alternative technique for treating recurrent ischial pressure ulcers. Though reconstruction of ischial ulcers via the pALT technique has been described previously, this may be the first case report to describe pALT flap in a patient with recurrent ischial ulcers after failed reconstructions using a gluteus maximus flap, V-Y advancement flap, and hatchet flap.Ischial pressure ulcers are difficult to treat and have a low treatment success rate1 compared to sacral and trochanteric ulcers. In addition, there are many different techniques that can be used to treat ischial pressure ulcers, including primary wound closure, gluteus maximus flaps, V-Y advancement flaps, or inferior gluteal artery perforator flaps. However, several experts have recently described using the pedicled anterolateral thigh (pALT) flap for reconstruction of recurrent ischial pressure ulcers.1,2 In the presented case, the authors followed a single patient with paraplegia with a recurrent ischial ulcer who had undergone several types of wound treatment over a 7-year period. The indurated ulcer was ultimately resolved by pALT reconstruction.


Asunto(s)
Isquion/cirugía , Paraplejía/complicaciones , Procedimientos de Cirugía Plástica , Úlcera por Presión/cirugía , Tejido Subcutáneo/cirugía , Colgajos Quirúrgicos/irrigación sanguínea , Muslo/cirugía , Anciano , Estudios de Seguimiento , Supervivencia de Injerto , Humanos , Isquion/patología , Masculino , Úlcera por Presión/etiología , Úlcera por Presión/patología , Recurrencia , Tejido Subcutáneo/irrigación sanguínea , Muslo/irrigación sanguínea , Resultado del Tratamiento , Cicatrización de Heridas
18.
Ostomy Wound Manage ; 61(2): 48-50, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-25654781

RESUMEN

Marjolin's ulcer is the malignant transformation of long-standing chronic pressure ulcers and requires prompt diagnosis and treatment. A 46-year-old man with an 8-year history of traumatic spinal injury with paraplegia presented with a recurrent ischial pressure ulcer. The initial ulcer, which developed 6 years earlier, was a Stage IV sacral ulcer. The wound was debrided and pathology showed epithelial hyperplasia, acanthosis, hyperkatosis accompanied by mild inflammation, and fibrosis without any malignant transformation. The lesion was covered with a fasciocutaneous bipedicled flap. Four years later, the patient presented with a similar ulcer in the same location. Histology showed the presence of a well-differentiated squamous cell carcinoma (SCC). Following a wide excision, the lesion was covered with a gluteal maximal V-Y musculocutaneous advancement flap. At last follow-up 14 months postoperatively, there was no evidence of recurrence or metastatic disease. Clinicians must be aware of known risk factors for the development of SCC.


Asunto(s)
Nalgas/patología , Carcinoma de Células Escamosas/etiología , Úlcera por Presión/complicaciones , Nalgas/irrigación sanguínea , Carcinoma de Células Escamosas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Paraplejía/complicaciones , Paraplejía/enfermería , Neoplasias Cutáneas/cirugía
19.
J Nanosci Nanotechnol ; 13(4): 2538-48, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23763127

RESUMEN

The decomposition of CO2 over oxygen deficient nickel ferrite nanoparticles (NFNs) and zinc ferrite nanoparticles (ZFNs) at 573 K was studied. The oxidation states with fine structure of Fe/Ni or Fe/Zn species were also measured in NFNs and ZFNs catalysts, respectively. Oxygen deficiency of catalysts was obtained by reduction in hydrogen. Decomposition of CO2 into carbon and oxygen has been carried out within few minutes when it comes into contact with oxygen deficient catalysts through incorporation of oxygen into ferrite nanoparticles. Oxygen and carbon rather than CO were produced in the decomposition process. The complete decomposition of CO2 was possible because of higher degree of oxygen deficiency andsurface-to-volume ratio of the catalysts. The pre-edge XANES spectra of Fe species in both catalysts exhibit an absorbance feature at 7114 eV for the 1s to 3d transition which is forbidden by the selection rule in case of perfect octahedral symmetry. The EXAFS data showed that the NFNs had two central Fe atoms coordinated by primarily Fe-O and Fe-Fe with bond distances of 1.871 and 3.051 angstroms, respectively. In case of ZFNs these values are 1.889 and 3.062 A, respectively. Methane gas was produced during the reactivation of NFNs by flowing hydrogen gas. Decomposition of CO2, moreover, recovery of valuable methane using heat energy of offgas produced from power generation plant or steel industry is an appealing alternative for energy recovery.

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