RESUMO
BACKGROUND: While autologous fat grafting of the face is considered a generally safe procedure, severe complications such as arterial embolism (AE) have been reported. OBJECTIVE: To summarize data on injection-related visual compromise, stroke, and death caused by arterial embolism after facial fat transplantation. MATERIALS AND METHODS: Plastic surgery societies were contacted for reports on AE after autologous facial fat injection. In addition, a systematic literature review was performed. Data extracted included study design, injection site/technique, symptoms, management, outcome, and etiology. RESULTS: 61 patients with a mean age of 33.56 ± 11.45 years were reported. Injections targeted the glabella or multiple facial regions (both n = 16/61, 26.2%) most commonly, followed by injections in the temples (n = 10/61, 16.4%) and the forehead (n = 9/61, 14.8%). The mean volume injected was 21.5 ± 21.5 ml. Visual symptoms were described most frequently (n = 24/58, 41.4%) followed by neurological symptoms (n = 20/58, 34.5%), or both (n = 13/58, 22.4%). Ophthalmic artery (OA, n = 26/60, 43.3%), anterior or middle cerebral artery (CA, n = 11/60, 18.3%) or both (n = 14/60, 23.3%) were most frequently occluded. Outcome analysis revealed permanent vision loss in all patients with OA occlusion (n = 26/26, 100%), neurological impairment in most patients with CA occlusion (n = 8/10, 80%), and vision loss in most patients suffering from both OA and CA occlusion (n = 7/11, 63.6%). Six patients died following embolisms. CONCLUSIONS: AE causes severe complications such as blindness, stroke, and death. Due to a lack of high-quality data, no evidence-based treatment algorithms exist. To increase patient safety, a database collecting cases and complications should be established. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Assuntos
Tecido Adiposo , Embolia , Face , Transplante de Tecidos , Adulto , Humanos , Pessoa de Meia-Idade , Adulto Jovem , Tecido Adiposo/transplante , Cegueira , Embolia/etiologia , Face/cirurgia , Testa/cirurgia , Estudos Retrospectivos , Acidente Vascular Cerebral/etiologia , Resultado do Tratamento , Transplante de Tecidos/efeitos adversosAssuntos
Tecido Adiposo/transplante , Mamoplastia , Mastectomia/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Transplante de Tecidos , Dissidências e Disputas , Feminino , Humanos , Mamoplastia/efeitos adversos , Mamoplastia/métodos , Mamoplastia/estatística & dados numéricos , Mastectomia/métodos , Avaliação de Resultados em Cuidados de Saúde/métodos , Avaliação de Resultados em Cuidados de Saúde/normas , Transplante de Tecidos/efeitos adversos , Transplante de Tecidos/métodos , Transplante de Tecidos/estatística & dados numéricosRESUMO
INTRODUCTION: The gold standard reconstruction for facial reanimation is the functional muscle transfer. The reinnervation of a muscle is never complete, and clinical results are variable with 20% not achieving a satisfactory outcome. We hypothesise that this may be due to a mismatch between the characteristics of the donor nerve and transferred muscle. METHOD: 81 YFP-16 and 14 YFP-H mice were studied in three intervention groups over three time periods. Two parameters were investigated: the number and surface area of reinnervated neuromuscular junctions and regenerating axons. An assessment was made of motor unit proportions. RESULTS: All cases of nerve repair and nerve graft, the neuromuscular junctions (NMJ) were completely reinnervated by regenerating axons. The number and calibre of the regenerating axons were significantly different from controls for both intervention groups. The motor units were smaller in both intervention groups. DISCUSSION: Reinnervation occurs after nerve repair or graft; however, the arbour was reinnervated by large numbers of much smaller axons. These axons showed some evidence of remodelling in the repair group, but not in the graft group. Neither group achieved the parameters of the control group. There were persistent qualitative changes to the morphology of both axons and junctions. Imaging documented both synkinesis and alterations that resemble those seen in ageing. CONCLUSION: Overall, the efficacy of reinnervation is very high with all NMJ reoccupied by regenerating axons. The way small axons are remodelled is different in the nerve repairs compared with the nerve grafts.
Assuntos
Músculos Faciais , Regeneração Nervosa/fisiologia , Tecido Nervoso/transplante , Transferência de Nervo , Transplante de Tecidos , Animais , Axônios/fisiologia , Músculos Faciais/inervação , Músculos Faciais/cirurgia , Camundongos , Neurônios Motores/fisiologia , Transferência de Nervo/efeitos adversos , Transferência de Nervo/métodos , Condução Nervosa/fisiologia , Junção Neuromuscular/fisiologia , Projetos de Pesquisa , Cirurgia Plástica/métodos , Sincinesia , Transplante de Tecidos/efeitos adversos , Transplante de Tecidos/métodosRESUMO
This historical retrospective explores the study of the freemartin condition and its impact on the discovery of immunologic tolerance and the field of transplant surgery-from the ancient Romans, to early modern anatomists Valsalva, Scarpa, and Hunter, to contemporary immunologists Owen, Medawar, and Billingham, and to legendary transplant surgeon Joseph Murray. The legacy of freemartin cattle in the understanding of acquired tolerance and transplant immunology represents generations of scientific inquiry guided by careful observation and occasional serendipity, and the present-day immunologists and surgeons exploring immune transplant tolerance owe much to the history of the freemartin, several millennia in the making.
Assuntos
Rejeição de Enxerto/imunologia , Infertilidade Feminina/veterinária , Transplante de Órgãos/história , Transplante de Tecidos/história , Tolerância ao Transplante , Animais , Pesquisa Biomédica/história , Bovinos/imunologia , Feminino , Rejeição de Enxerto/prevenção & controle , História do Século XVII , História do Século XVIII , História do Século XIX , História do Século XX , História do Século XXI , História Antiga , Humanos , Infertilidade Feminina/imunologia , Transplante de Órgãos/efeitos adversos , Transplante de Tecidos/efeitos adversosRESUMO
In the late 1800s, the concept of iatrogenic implantation of cancer cells during surgery was put forth. The most dramatic example is a recurrence in a donor graft site, which is often distant to the primary site of excision. This eliminates the possibility of incomplete removal as the etiology of recurrence. However, in addition to direct transplantation to the graft site via gloves or instruments, several other possibilities exist, including de novo lesions of squamous cell carcinoma in the graft, as well as systemic metastases. This article reviews 15 published case reports of cancer recurrence in graft donor sites in which the authors considered seeding via gloves or instruments. Viewing these cases in the context of a 2018 study demonstrates the varying opinions of surgeons on the possibility of cancer seeding. This article strongly advises the changing of gloves and instruments following resection of any suspicious or established cancerous tumors.
Assuntos
Luvas Cirúrgicas , Doença Iatrogênica , Inoculação de Neoplasia , Neoplasias/cirurgia , Instrumentos Cirúrgicos , Carcinoma de Células Escamosas , Humanos , Doença Iatrogênica/prevenção & controle , Recidiva Local de Neoplasia , Transplante de Tecidos/efeitos adversos , Sítio Doador de TransplanteRESUMO
RESUMEN Introducción: La recesión periodontal es un problema mucogingival frecuente, de origen multifactorial que usualmente se asocia a hipersensibilidad dentinaria, caries radicular y problemas estéticos. La cobertura radicular es parte integral de su tratamiento quirúrgico. Las técnicas bilaminares con injerto de tejido conectivo subepitelial son las más predecibles. Objetivo: Describir los resultados clínicos obtenidos al realizar en recesiones periodontales múltiples, injerto de tejido conectivo subepitelial cubierto por colgajo reposicionado coronal modificado. Presentación del caso: Paciente masculino, blanco, obrero, de 43 años, con antecedentes personales y familiares de salud que acudió al Servicio de Periodoncia de la Clínica Estomatológica "III Congreso del PCC", Matanzas, Cuba, por "cambio de posición de la encía en algunos dientes". Clínicamente existía exposición radicular en los dientes 13, 53 y 14, ausencia del 12, higiene bucal adecuada, no presencia de bolsas periodontales. Se diagnosticó recesión periodontal clase I de Miller localizada en dichos dientes. Para su tratamiento quirúrgico se realizó injerto de tejido conectivo subepitelial y colgajo desplazado coronal sin incisiones verticales de 11 a 15. A la semana, se retiró sutura de zona donante, se observó buena cicatrización. Se citó a los siete días para retirar cemento quirúrgico y sutura de la zona injertada; existía discreto edema, materia alba, biopelícula y cobertura radicular completa del 13, 53 y 14. Al año del procedimiento, las superficies expuestas estaban completamente cubiertas con tejido gingival posicionado en 13 y 53, ganancia de encía insertada y armonía de color entre sitio injertado y área adyacente. El 14 mostró 1 mm de raíz expuesta. Conclusiones: La técnica empleada, cubrió totalmente la superficie radicular del 13, del 53 y parcialmente la raíz del 14. Se obtuvo incremento de encía queratinizada, óptimo aspecto estético y buena evolución posoperatoria(AU)
ABSTRACT Introduction: periodontal recession is a frequent mucogingival problem, of multifactorial origin that is usually associated to dentin hypersensibility, radicular caries and esthetic problems. Root coverage is an integral part of its surgical treatment, considering bilaminar techniques with subepithelial connective tissue graft as the most predictable ones. Objective: to describe the clinical results obtained when making a sub epithelial connective tissue graft covered by a modified coronal repositioned flap, in multiple periodontal recessions. Case presentation: a male, white, worker patient, aged 43 years, with health personal and family antecedents, who assisted the Periodontics service of the Dental Clinic "III Congreso del Partido", of Matanzas, Cuba, for "a change of the gum position in some teeth". Clinically, there it was a root exposition of the 13, 53 and 14 teeth, lack of the 12 one, adequate oral hygiene and absence of periodontal´s pockets. A Miller´s Class I periodontal recession located in those teeth was diagnosed. A subepithelial connective tissue graft and coronally advanced flap was performed without vertical incisions from 11 to 15 teeth. After a week, the suture of the donor zone was retired, showing good healing. He was cited at the seventh day to retire surgical cement and suture form the grafted zone, observing a discrete edema, debris, biofilm and complete root coverage of the 13, 53 and 14 teeth. At the year after the procedure, the exposed surface was completely covered with gingival tissue positioned in the 13 and 53 teeth, with a gaining of inserted gum and color harmony between the grafted site and adjacent areas. The 14 tooth showed 1 mm of exposed root. Conclusions: the used technique totally covered the root of the 13 and the 53, and most of the root of the 14 tooth, reaching an increase of the keratinized gum, and optimal esthetic aspect and post-surgery evolution(AU)
Assuntos
Humanos , Masculino , Adulto , Retalhos Cirúrgicos/cirurgia , Transplante de Tecidos/efeitos adversos , Retração Gengival/diagnóstico por imagemRESUMO
PURPOSE: The best surgical method for the management of adhesive otitis media is controversial. The aim of the study was to explore the feasibility and effectiveness of tympanoplasty combined with fascia grafting catheterization in the treatment of adhesive otitis media. METHODS: This was a retrospective study of patients with adhesive otitis media and who underwent tympanoplasty combined with fascia grafting and catheterization between April 2015 and December 2016 at the Eye-Ear-Nose-Throat Hospital Affiliated to Fudan University. All injured ears were examined by pure tone audiometry at 0.5, 1 and 2 kHz before and at 3 months after operation. RESULTS: Thirty-five patients (35 ears) were followed for 12-44 months. The air-conduction pure tone average was 31.7 ± 12.3 dBnHL. Hearing of 28 patients (80%) was improved to a practical level within 40 dBnHL, but 2 patients (6%) had no change in postoperative hearing. Numbers of patients with spontaneous prolapse, artificial removal of tympanic membrane ventilation tube, and unobstructed in place were 15, 12, and 8, respectively. Twenty-seven patients had perforations left after the prolapse and removal of tympanic membrane ventilation tubes, of which 22 (81%) had perforations healing by themselves. All patients had dry ears after operation, without recurrence. Thirty-three patients (94%) had dry ears within 3 months and only 2 patients (6%) for more than 6 months. CONCLUSION: Tympanoplasty combined with fascia grafting catheterization is effective in the treatment of adhesive otitis media.
Assuntos
Fáscia/transplante , Otite Média , Complicações Pós-Operatórias , Transplante de Tecidos , Membrana Timpânica/cirurgia , Timpanoplastia , Adulto , Audiometria de Tons Puros/métodos , Cateterismo/métodos , Doença Crônica , Feminino , Humanos , Masculino , Otite Média/fisiopatologia , Otite Média/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Transplante de Tecidos/efeitos adversos , Transplante de Tecidos/métodos , Resultado do Tratamento , Timpanoplastia/efeitos adversos , Timpanoplastia/métodosRESUMO
Fecal microbiota transplantation (FMT) represents a promising management modality for Clostridium difficile infection (CDI). In immunocompromised patients, FMT is utilized for CDI as well as emerging non-CDI indications such as inflammatory bowel disease and graft versus host disease. PURPOSE OF REVIEW: This review aims to shed light on the safety and efficacy of FMT in immunocompromised patients, including patients suffering for human immunodeficiency virus infection, solid organ and hematopoietic stem cell transplant recipients, cancer patients, and patients on immunosuppressive therapies. RECENT FINDINGS: Though the body of evidence concerning the use of FMT in immunocompromised is growing, no clinical trials exist to date. Present literature weighs in favor of FMT in immunocompromised patients, with an acceptable adverse effect profile and minimal risk of infectious adverse events. Further large scale studies and randomized controlled trials to validate the utility of FMT in immunocompromised individuals will be a welcomed endeavor.
Assuntos
Infecções por Clostridium/terapia , Transplante de Microbiota Fecal/métodos , Hospedeiro Imunocomprometido , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Infecções Oportunistas Relacionadas com a AIDS/terapia , Infecções por Clostridium/imunologia , Transplante de Microbiota Fecal/efeitos adversos , Humanos , Imunossupressores/efeitos adversos , Transplante de Tecidos/efeitos adversosRESUMO
OBJECTIVE: To demonstrate the technical advances since the time we reported the first successful case in 2000 and our modern approach to autologous transplantation of frozen-thawed human ovarian tissue. DESIGN: A step-by-step video demonstration of three surgical approaches was created by editing the surgical footage obtained during ovarian transplantation procedures. SETTING: Academic. PATIENT(S): Three patients who previously underwent ovarian tissue harvesting and cryopreservation before gonadotoxic cancer treatments or radical cancer surgery are presented. INTERVENTION(S): The illustrated techniques include robot-assisted orthotopic (technique 1) and heterotopic (technique 2) approaches using the da Vinci Xi (Intuitive Surgical) robotic system and a decellularized human extracellular tissue matrix (Alloderm; LifeCell Corp.) as a tissue scaffold, as well as a percutaneous autotransplantation approach (technique 3). MAIN OUTCOME MEASURE(S): Successful completion of procedures without complications and ovarian graft function with demonstration of E2 production and follicle development. RESULT(S): All cases were completed without complications. Ovarian graft function was confirmed by E2 production, follicle growth by 10-14 weeks after transplantation, and later embryo development. CONCLUSION(S): Since our first report of successful restoration of ovarian function after orthotopic transplantation of frozen-banked ovarian tissue in 2000 (1), followed by our first reports of subcutaneous heterotopic transplantation techniques (2, 3), ovarian tissue cryopreservation followed by subsequent transplantation has become a promising fertility preservation option for young women with cancer who do not have sufficient time to undergo oocyte or embryo cryopreservation and for prepubertal girls (4, 5). The same approach also has the advantage of restoring ovarian endocrine function and fertility without a need for assisted reproduction (6, 7). In the very first successful procedure that we reported in 2000, we used conventional laparoscopy, and the tissues were reconstructed and mounted on a polycellulose scaffold (Surgicel) (1, 7). Since then, we have made significant modifications in our surgical approach with potential improvements in outcomes. Here we illustrate three main techniques of ovarian tissue transplantation resulting in the restoration of ovarian function in all cases. In the first two cases, we illustrated the robot-assisted orthotopic and heterotopic approaches using Alloderm. Robotic ovarian transplantation may increase precision, provide more delicate graft handling, and reduce the time from tissue thawing to transplantation (6, 8). Alloderm is regenerated de-epithelized human cadaver skin, which consists of several extracellular matrix components. It has been safely used in the surgery and dentistry fields for enhancing tissue regeneration and vascularization (9, 10). Furthermore, our earlier laboratory work indicated the critical role of extracellular matrix in primordial follicle growth initiation and preantral follicle growth (11, 12). Prior to our use of Alloderm as part of ovarian transplant procedures, we tested it in human ovarian xenograft models and found Alloderm to incorporate well with ovarian tissue (8). Only after that test did we adopt it for use in ovarian transplants. The utility of the extracellular tissue matrix may thus enhance our ovarian autotransplantation techniques by facilitating ovarian reconstruction and potentially improving neovascularization. In fact, we have seen improved follicle growth and response to ovarian stimulation with the use of Alloderm in our first cases (8). We use heterotopic ovarian transplantation when the pelvis is not suitable for autotransplantation due to past radiation or scarring or when there are other medical contraindications for transplantation in the pelvis. The third technique we illustrated was percutaneous heterotopic ovarian autotransplantation. This is a simple approach that can be used in surgically high-risk patients, as it is done with local anesthesia or IV sedation and without entering abdominal cavity. Additionally, same approach can be utilized when there is heightened concern that the ovarian tissue may harbor a disease that can recur, requiring close surveillance and easier removal of the ovarian graft. While ovarian endocrine function and follicle growth are restored with efficiency using the percutaneous ovarian transplants, our initial experience suggests that oocyte quality may be impaired in SC locations (2, 3, 13). Hence that technique may be more suitable when the only purpose is restoration of ovarian endocrine function. However, we have encountered recurrent live births from spontaneous conceptions following SC ovarian transplants, prompting the question of whether the grafted tissue can augment the function of in situ menopausal ovary (13, 14). While ovarian cryopreservation and transplantation may no longer be considered experimental, there are many exciting questions remaining to be answered on the full potential of this procedure.
Assuntos
Preservação da Fertilidade/tendências , Ovário/transplante , Procedimentos Cirúrgicos Robóticos/tendências , Transplante de Tecidos/tendências , Biomarcadores/sangue , Criopreservação/tendências , Estradiol/sangue , Feminino , Preservação da Fertilidade/efeitos adversos , Preservação da Fertilidade/métodos , Humanos , Folículo Ovariano/diagnóstico por imagem , Ovário/diagnóstico por imagem , Ovário/metabolismo , Gravidez , Técnicas de Reprodução Assistida/tendências , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Fatores de Tempo , Transplante de Tecidos/efeitos adversos , Transplante de Tecidos/métodos , Transplante Heterotópico/tendências , Resultado do TratamentoRESUMO
In recent years, gluteal fat augmentation has exhibited some of the most significant growth among all plastic surgery procedures. However, as the popularity of and media attention to gluteal fat augmentation continue to rise, reports of fatalities, largely attributed to fat embolism, have raised valid concerns. Many plastic surgeons inject fat in the intramuscular plane and claim better graft take in the muscles and the possibility of injecting more volume in the gluteal region. Because of the large caliber of vessels, subcutaneous fat augmentation has been a preference of many. However, the long-term outcome of fat injected into the subcutaneous layer has been questionable, and there is a lack of prospective quantitative studies of subcutaneous-only fat grafting. Therefore, the authors evaluated the long-term maintenance of gluteal adipose thickness when fat was injected only subcutaneously. Fifty consecutive female patients were evaluated in this prospective clinical study. All patients underwent gluteal fat augmentation in the subcutaneous plane only. Ultrasound analysis of the adipose tissue thickness of the gluteal region was performed preoperatively, immediately postoperatively, and at 12 months postoperatively. Immediate postoperative measurements revealed an average increase in gluteal subcutaneous layer thickness of 56.51 percent (range, 39.5 to 108.6 percent) (p < 0.0001). At 12 months postoperatively, the gluteal adipose tissue thickness decreased by an average of 18.16 percent (range, 6.8 to 24.8 percent) (p < 0.0001). Subcutaneous-only gluteal fat augmentation is shown to be as effective as previous studies reporting intramuscular fat injection with regard to long-term fat retention in the buttocks. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.
Assuntos
Tecido Adiposo/transplante , Nádegas/cirurgia , Gordura Subcutânea/transplante , Transplante de Tecidos/métodos , Ultrassonografia Doppler/métodos , Tecido Adiposo/diagnóstico por imagem , Adolescente , Adulto , Idoso , Estudos de Coortes , Estética , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Medição de Risco , Tempo , Transplante de Tecidos/efeitos adversos , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVES: To compare the amount of tissue loss using different FUE punches. MATERIALS AND METHODS: The study was conducted in 5 patients undergoing hair restoration surgery by FUE. Four different kinds of punches were used, that is, sharp, blunt, serrated, and new "A-design." All the punches had a total cutting edge of 0.8 mm. In each patient, 4 punches were used to make insertion at right angle with the skin. Immediately after the punch use, the diameter of the hole was measured. The same areas were also measured after 24 hours and after 1 month. The data were collected and analyzed by Multiple t test (with Bonferroni's correction). RESULTS: The average size of the wound immediately at the end of the procedure was 0.826 mm for sharp, 0.858 mm for blunt, 0.892 mm for serrated, and 0.932 mm for A-design. Similarly, the wounds decreased to 0.752, 0.778, 0.774, and 0.696 mm for sharp, blunt, serrated, and A-design, respectively, after 24 hours. The final wound/scar size was 0.640 mm for punch, 0.660 mm for blunt punch, 0.668 mm for serrated punch, and 0.598 mm for A-design punch after 1 month. CONCLUSION: The new A-design resulted in the minimum scar size after 1 month.
Assuntos
Desenho de Equipamento , Folículo Piloso/transplante , Transplante de Tecidos/instrumentação , Cicatriz/etiologia , Humanos , Transplante de Tecidos/efeitos adversosRESUMO
BACKGROUND: External volume expansion improves the survival of adipose tissue grafts by preoperatively conditioning ("preconditioning") tissues that will receive the graft. External volume expansion's mechanisms of action (induction of angiogenesis and of adipogenesis) could improve graft survival also when applied postoperatively ("postconditioning"). METHODS: Fifty-six 8-week-old athymic (nu/nu) mice received dorsal subcutaneous grafts of human lipoaspirate (0.3 ml each) bilaterally before undergoing external volume expansion (left dorsum) or no treatment (right dorsum, controls). External volume expansion was started either on the same day of (immediate group), 2 days after (early group), or 1 week after surgery (delayed group). At follow-up, grafts were analyzed for tissue survival, remodeling, adipogenesis, and angiogenesis using histology. The authors subsequently assessed the effects of the delayed application of external volume expansion adopting a foam-shaped interface to deliver the treatment. RESULTS: At 28-day follow-up, delayed postconditioning with external volume expansion significantly improved the survival of grafts (18 percent) compared with controls (viable graft thickness ratio, 58 ± 15 percent versus 49 ± 13 percent) and increased the density of blood vessels within the graft (63 percent; blood vessels per 10× magnification field, 44 ± 12 versus 27 ± 11). Other groups did not experience significant changes. Adoption of external volume expansion with a foam-shaped interface similarly improved outcomes and further reduced fibrosis within the grafts. CONCLUSIONS: Postoperative delayed application of external volume expansion modestly improves the survival of adipose tissue grafts by inducing adipogenesis and angiogenesis. Use of a foam-shaped interface decreases the fibrosis induced in the grafts.
Assuntos
Tecido Adiposo/transplante , Sobrevivência de Enxerto/fisiologia , Pós-Condicionamento Isquêmico/métodos , Gordura Subcutânea/transplante , Tecido Adiposo/irrigação sanguínea , Animais , Modelos Animais de Doenças , Feminino , Seguimentos , Camundongos , Camundongos Nus , Neovascularização Fisiológica , Distribuição Aleatória , Valores de Referência , Gordura Subcutânea/irrigação sanguínea , Fatores de Tempo , Expansão de Tecido/métodos , Transplante de Tecidos/efeitos adversos , Transplante de Tecidos/métodosRESUMO
BACKGROUND: Deaths secondary to gluteal lipoinjection are relatively recent events of major importance. However, little is known in relation to their behavior and clinical evolution. Therefore, an analysis was performed of case records from clinical cases that encountered this problem, correlating the results with the findings during autopsies. METHODS: An analysis was performed of records from patients who died secondary to gluteal lipoinjection. Patient-specific data, surgical procedure, clinical picture, evolution, and outcome were analyzed. The findings of the autopsies and the involvement of other organs were also analyzed and correlated. RESULTS: From 2000 to 2009, 16 files were obtained that fulfilled the indicated requirements. There were no statistically significant differences in the general characteristics of the patients, such as age, body mass index, or volume lipoinjected or liposuctioned. The clinical pictures were similar in all cases, and the autopsy findings showed the presence of microembolism in all cases and macroembolism in the most severe cases. CONCLUSIONS: The most significant parameter of severity in patients who undergo gluteal lipoinjection is the presence of fat in macroscopic form in the circulation. The volumes of liposuctioned or lipoinjected fat have little influence. Hypoxemia, hypotension, and bradycardia are the characteristic clinical features. Although there is no specific treatment, immediate aggressive vital support to attempt to stabilize the patient is crucial. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.
Assuntos
Tecido Adiposo/transplante , Embolia Gordurosa/etiologia , Adulto , Autopsia , Contorno Corporal/efeitos adversos , Nádegas , Embolia Gordurosa/mortalidade , Humanos , Injeções Intramusculares , Estudos Retrospectivos , Transplante de Tecidos/efeitos adversos , Transplante de Tecidos/mortalidade , Adulto JovemRESUMO
INTRODUCTION: Hair transplant surgery is a minimally invasive surgery, where hair follicle is transplanted from donor area of patient's own body to the desired area. METHODS: Patient with hair transplant surgery from a clinic were followed up for one year. The patients were asked for their complications within 2 days, 7 days, one month, 2 to 6 months and one year for assessment of results, side effects. At the end of one-year, subjective evaluation was done with patient's satisfaction to growth as- poor growth, satisfactory and good growth. RESULTS: Out of 152 patients, maximum patients 74 (48.6%) were in age group 21-30, followed by 61 (40.01%) in age group 31-40, mean age was 31.79, youngest being 21 years and oldest being 70 years of age. Among the complications, swelling of forehead was in more than two- thirds of the patients 106 (69.74%), followed by temporary hair fall noted in 65 (42.76%) of patients. Clients' remarks noted at the end on one-year revealed 86.18% as excellent results, 11.84% as satisfactory and 1.97% as poor results. CONCLUSIONS: Hair transplant sugary by FUE is a relatively safe surgery with optimum results and minimum complications, which can be useful to patients with androgenetic alopecia.
Assuntos
Alopecia/cirurgia , Folículo Piloso/transplante , Transplante de Tecidos , Adulto , Alopecia/diagnóstico , Feminino , Humanos , Masculino , Nepal , Satisfação do Paciente , Transplante de Tecidos/efeitos adversos , Transplante de Tecidos/métodos , Transplante de Tecidos/estatística & dados numéricos , Resultado do TratamentoRESUMO
Metastasis to the thyroid is uncommon. Mostly, they are tumors that originate in the lung or head or neck. Metastases from breast or kidney carcinomas and metastatic melanoma have also been reported. Autotransplantation of benign thyroid tissue is a surgical procedure designed to achieve normal thyroid hormonal status following surgery. Metastasis into autotransplanted thyroid tissue has not been reported earlier. We report a case of squamous cell carcinoma (SCC) metastatic to autotrasplanted thyroid diagnosed on fine-needle aspiration. Further workup revealed a primary oral cavity SCC.
Assuntos
Carcinoma de Células Escamosas/diagnóstico , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias Bucais/patologia , Metástase Neoplásica , Segunda Neoplasia Primária , Glândula Tireoide/transplante , Biópsia por Agulha Fina , Carcinoma de Células Escamosas/etiologia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/radioterapia , Feminino , Neoplasias de Cabeça e Pescoço/etiologia , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Pessoa de Meia-Idade , Mucosa Bucal/patologia , Pescoço/diagnóstico por imagem , Carcinoma de Células Escamosas de Cabeça e Pescoço , Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Transplante de Tecidos/efeitos adversos , Tomografia Computadorizada por Raios XRESUMO
To evaluate the safety and efficacy of the surgical use of plasma rich in growth factors fibrin membrane (mPRGF) in different ocular surface pathologies.Fifteen patients with different corneal and conjunctival diseases were included in the study. Patients were grouped according to the use of mPRGF as graft (corneal and/or conjunctival) or dressing; they were also grouped according to the surgical subgroup of intervention (persistent corneal ulcer [PCU], keratoplasty, superficial keratectomy, corneal perforation, and pterygium). Best corrected visual acuity, intraocular pressure (IOP), inflammation control time (ICT), mPRGF AT (PRGF membrane absorption time), and the healing time of the epithelial defect (HTED) were evaluated throughout the clinical follow-up time. Safety assessment was also performed reporting all adverse events.mPRGF showed a total closure of the defect in 13 of 15 patients (86.7%) and a partial closure in 2 patients (13.3%). The mean follow-up time was 11.1â±â4.2 (4.8-22.8) months, the mean ICT was 2.5â±â1.1 (1.0-4.0) months, the mean mPRGF AT was 12.4â±â2.0 (10.0-16.0) days, and for the global HTED the mean was 2.9â±â1.2 (1-4.8) months. Results showed an improvement in BCVA in all patients, with an overall improvement of 2.9 in Vision Lines. The BCVA significantly improved (Pâ<â.05) in the groups of corneal graft and dressing. In the PCU subgroup (6 patients), the healing time of epithelial defect was significantly reduced (Pâ<â.05) in patients treated only with the mPRGF in comparison to those which mPRGF therapy was associated to the amniotic membrane. The IOP remained stable (Pâ>â.05) throughout the clinical follow-up time. No adverse events were reported after mPRGF use.The mPRGF is effective and safe as coadjuvant treatment in surgeries related with ocular surface disorders, being an alternative to the use of amniotic membrane. The mPRGF accelerates tissue regeneration after ocular surface surgery thus minimizing inflammation and fibrosis.
Assuntos
Curativos Biológicos , Oftalmopatias/cirurgia , Fibrina/uso terapêutico , Peptídeos e Proteínas de Sinalização Intercelular/uso terapêutico , Procedimentos Cirúrgicos Oftalmológicos/métodos , Transplante de Tecidos/métodos , Idoso , Idoso de 80 Anos ou mais , Âmnio , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Oftalmológicos/efeitos adversos , Plasma Rico em Plaquetas , Estudos Retrospectivos , Transplante de Tecidos/efeitos adversos , Acuidade VisualAssuntos
Engenharia Celular/métodos , Regeneração Tecidual Guiada/métodos , Medicina Regenerativa/métodos , Transplante de Células-Tronco/métodos , Imunologia de Transplantes/imunologia , Humanos , Transplante de Órgãos/efeitos adversos , Transplante de Órgãos/métodos , Transplante de Células-Tronco/efeitos adversos , Transplante de Tecidos/efeitos adversos , Transplante de Tecidos/métodos , Transplante Autólogo/métodos , Transplante Homólogo/efeitos adversos , Transplante Homólogo/métodosRESUMO
STUDY QUESTION: Is transplantation of cryopreserved ovarian tissue from patients with borderline ovarian tumors (BOTs) a safe procedure? SUMMARY ANSWER: BOT cells were found in frozen-thawed and xenografted ovarian tissue in 1 of 11 BOT patients. WHAT IS KNOWN ALREADY: The risk of reintroducing malignant cells upon ovarian tissue transplantation has been subject of debate for many years. Reimplantation of cryopreserved ovarian tissue from leukemia patients is unsafe, while results from studies of cryopreserved ovarian tissue from other forms of cancer, such as Hodgkin's lymphoma, are reassuring. STUDY DESIGN, SIZE, DURATION: Prospective experimental study conducted in an academic research unit using ovarian tissue from 11 patients undergoing cryopreservation for BOTs. PARTICIPANTS/MATERIALS, SETTING, METHODS: Histology, immunohistochemistry (IHC) for mucin 1 (MUC1) and cytokeratin 7 (CK7) and molecular analysis by reverse transcription quantitative polymerase chain reaction (RT-qPCR) for CK7 and MUC1 were performed on frozen-thawed ovarian tissue from 11 patients. Long-term (5 months) xenografting of ovarian tissue in immunodeficient mice was performed. The xenografts were analyzed by histology, IHC and RT-qPCR, furthermore IHC for CD10, a marker of endometriosis, was performed on a selected sample. MAIN RESULTS AND THE ROLE OF CHANCE: Analysis by histology, IHC and RT-qPCR indicated 10 of the ovarian tissue samples were negative. Analysis of the xenograft samples indicated nine were negative for malignant cells but in two xenografts glandular lesions were detected by histology. In these two xenografts, CK7 and MUC1 markers were demonstrated by IHC and CK7 expression also by RT-qPCR. A BOT was confirmed in the xenograft in which the original ovarian tissue was positive, while in the other case IHC demonstrated expression of endometriosis marker CD10. LIMITATIONS, REASONS FOR CAUTION: Cryopreserved ovarian fragments cannot be tested before transplantation, therefore the preimplantation analysis cannot guarantee that all cryopreserved fragments will be free of BOT cells. WIDER IMPLICATIONS OF THE FINDINGS: BOT cells can be found in cryopreserved ovarian tissue from BOT patients, therefore preimplantation analysis is an absolute prerequisite. Endometriosis can also be detected in cryopreserved ovarian tissue and caution should also be exercised in this scenario. STUDY FUNDING/COMPETING INTEREST(S): This study was supported by grants from the Fonds National de la Recherche Scientifique de Belgique (FNRS-PDR Convention T.0077.14, Télévie Grant 7.4590.16 awarded to Rossella Masciangelo, and Grant 5/4/150/5 awarded to Marie-Madeleine Dolmans), the Fonds Speciaux de Recherche, and the Foundation Against Cancer. None of the authors have any conflicting interests to declare.
Assuntos
Preservação da Fertilidade/efeitos adversos , Preservação da Fertilidade/métodos , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Ovário/patologia , Ovário/transplante , Transplante de Tecidos/efeitos adversos , Transplante de Tecidos/métodos , Adulto , Animais , Criopreservação , Feminino , Humanos , Imuno-Histoquímica , Queratina-7/genética , Queratina-7/metabolismo , Camundongos , Camundongos SCID , Mucina-1/genética , Mucina-1/metabolismo , Neoplasias Ovarianas/metabolismo , Ovário/metabolismo , Estudos Prospectivos , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Segurança , Transplante HeterólogoRESUMO
BACKGROUND: Fat grafting is a commonly performed procedure not only for augmenting the soft tissue but also for regeneration in esthetic and reconstructive plastic surgery.However, unpredictable fat survival rate because of high resorption rate is remained as the main problem. The purpose of this study was to investigate the effect of pretreatment of the recipient site to the fat survival using fractional carbon dioxide (CO2) laser. METHODS: The rats were divided to 2 groups. Inguinal fat pads of rats were transplanted to the dorsum without pretreatment in the control group. The study group was preconditioned by fractional CO2 laser to the recipient site 1 week before fat graft.The pulse energy was set to 100 mJ. Transplanted fat tissues were harvested at postoperative days 1, 3, 7, 14, and 28 and were analyzed morphologically, histologically, and immunohistochemically. RESULTS: Weight and volume in the control group was more decreased than in the study group at postoperative day 28. Histological evaluation showed less inflammation, less fibrosis, less vacuolization, and better integrity of adipocytes. Immunohistologically, microvessel density in the study group was higher than in the control group (P < 0.05) at postoperative day 1. Survival rate in the study group was higher than in the control group at postoperative days 1, 3, 7, and 14 (P < 0.05). CONCLUSIONS: Pretreatment of recipient site using fractional CO2 laser helped vascularization in the early stage in fat graft and solved the ischemic condition, so it improved fat survival rate.
Assuntos
Tecido Adiposo/transplante , Rejeição de Enxerto/prevenção & controle , Terapia com Luz de Baixa Intensidade/métodos , Procedimentos de Cirurgia Plástica/métodos , Tecido Adiposo/efeitos da radiação , Animais , Modelos Animais de Doenças , Sobrevivência de Enxerto , Lasers de Gás/uso terapêutico , Masculino , Cuidados Pré-Operatórios/métodos , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Valores de Referência , Estatísticas não Paramétricas , Transplante de Tecidos/efeitos adversos , Transplante de Tecidos/métodos , Cicatrização/fisiologiaRESUMO
OBJECTIVE: The purpose of this study was to compare the outcomes of the buccal mucosa and lingual mucosa used in children who received multiple failed hypospadias surgeries. METHOD: We conducted a retrospective study of 62 children who received buccal or lingual mucosa graft urethroplasty in our hospital between 2012 and 2015. The ages ranged from 3.5-11 y. All cases included multiple failed hypospadias procedures, and the subjects received previous operations 2-3 times. All patients underwent one-stage operations. Thirty-three cases were treated with lingual mucosa grafts. The patient ages ranged from 3.5 to 11 y (median 7.5 y), and they had previous operations 2-3 times (mean 2.8±0.7). Grafts ranged from lengths of 2-6 cm (mean 5.1±0.46 cm) and widths of 0.5-1.5 cm (mean 1.2± 0.16 cm). Our follow-up was 5 to 12 m (mean 8.3±1.2 m). Twenty-nine cases were treated with buccal mucosa grafts. The patient ages ranged from 4 to 9.2 y (median 7.0 y), and they had previous operations 2-3 times (mean 2.5±0.2). Grafts ranged from lengths of 2-5.3 cm (mean 4.9± 0.28 cm) and widths of 0.5-1.5 cm (mean 1.0±0.11 cm). Our follow-up was 5 to 12 m (mean 7.9±0.5 m). The results were tested with SPSS 18.0. The rates of complications were compared by a chi-square test, and pre-operative conditions were compared by t test. RESULTS: For the outcomes of the two groups, there was no significant difference between the groups in terms of age, preoperative surgery time, and the length and width of the grafts (p>0.05). For the lingual mucosa graft group, fistula: 2/33 (6.0%), stricture: 1/33(3.0%), ventral curvature: 2/33(6.0%), complications: 5/33(15.0%), success rate: 28/33(84.8%), Hose score: 14.34±0.95, peak flow: 6.5 ml/s-12.0 ml/s, and mean peak flow: 9.3±0.4 ml/s. For the buccal mucosa graft group, fistula: 2/29(6.8%), stricture: 2/29(6.8%), ventral curvature: 1/29 (3.4%), complication rate: 5/29(17.0%), success rate: 24/29 (83.0%), Hose score: 14.28±1.03, peak flow: 6.5 ml/s-12.0 ml/s, and mean peak flow: 9.2±0.2 ml/s. There were no differences between the two groups for overall success, complication rates, peak flow, and the Hose scores(P>0.05). CONCLUSION: The lingual mucosal graft and the buccal mucosa graft both achieved good outcomes, and the lingual mucosa graft made up for the shortcomings of the buccal mucosa graft, which provided a reliable way to treat the multiple failed hypospadias surgeries in pre-pubertal boys.