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1.
Plast Reconstr Surg ; 146(6): 1331-1339, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33234964

RESUMO

BACKGROUND: For the cleft surgeon, palatal fistulae after cleft palate repair remain a difficult problem, with a paucity of local tissue options to aid closure. Small clinical series have described the use of the buccal fat pad flap to repair palatal fistulae; however, there is no literature detailing the anatomical coverage of the flap. This study delineates the anatomy of the buccal fat pad flap to guide surgeons in patient selection and examines the residual buccal fat after flap harvest to provide new information with regard to possible effects on the donor site. METHODS: Buccal fat pad flaps were raised in 30 hemicadavers. The reach of the flap across the midline, anteriorly and posteriorly, was recorded. In 18 hemicadavers, the entire buccal fat pad was then exposed to determine the effects of flap harvest on movement and volume of the residual fat. RESULTS: All buccal fat pad flaps provided coverage from the soft palate to the posterior third of the hard palate and all across the midline. Approximately three-fourths of flaps would cover the mid hard palate. The flap constitutes 36 percent of the total buccal fat pad on average, and a series of retaining ligaments were identified that may prevent overresection. CONCLUSIONS: The buccal fat pad flap is a useful tool for coverage of fistulae in the soft palate to the posterior third of the hard palate. In most cases, it will also reach the middle third; however, it is not suitable for more anterior defects. On average, two-thirds of the buccal fat pad remains within the cheek after flap harvest, which may protect against unwanted alteration in aesthetics.


Assuntos
Bochecha/cirurgia , Fístula/cirurgia , Procedimentos Cirúrgicos Bucais/efeitos adversos , Coleta de Tecidos e Órgãos/efeitos adversos , Sítio Doador de Transplante/cirurgia , Tecido Adiposo/transplante , Cadáver , Bochecha/anatomia & histologia , Estética , Estudos de Viabilidade , Fístula/patologia , Humanos , Procedimentos Cirúrgicos Bucais/métodos , Palato Duro/patologia , Palato Duro/cirurgia , Palato Mole/patologia , Palato Mole/cirurgia , Seleção de Pacientes , Retalhos Cirúrgicos/efeitos adversos , Retalhos Cirúrgicos/transplante , Coleta de Tecidos e Órgãos/métodos , Sítio Doador de Transplante/anatomia & histologia
2.
BMC Neurol ; 7: 21, 2007 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-17683543

RESUMO

BACKGROUND: The Contact Heat Evoked Potential Stimulator (CHEPS) rapidly stimulates cutaneous small nerve fibres, and resulting evoked potentials can be recorded from the scalp. We have studied patients with symptoms of sensory neuropathy and controls using CHEPS, and validated the findings using other objective measures of small nerve fibres i.e. the histamine-induced skin flare response and intra-epidermal fibres (IEF), and also quantitative sensory testing (QST), a subjective measure. METHODS: In patients with symptoms of sensory neuropathy (n = 41) and healthy controls (n = 9) we performed clinical examination, QST (monofilament, vibration and thermal perception thresholds), nerve conduction studies, histamine-induced skin flares and CHEPS. Skin punch biopsies were immunostained using standard ABC immunoperoxidase for the nerve marker PGP 9.5 or the heat and capsaicin receptor TRPV1. Immunoreactive IEF were counted per length of tissue section and epidermal thickness recorded. RESULTS: Amplitudes of Adelta evoked potentials (muV) following face, arm or leg stimulation were reduced in patients (e.g. for the leg: mean +/- SEM - controls 11.7 +/- 1.95, patients 3.63 +/- 0.85, p = 0.0032). Patients showed reduced leg skin flare responses, which correlated with Adelta amplitudes (rs = 0.40, p = 0.010). In patient leg skin biopsies, PGP 9.5- and TRPV1-immunoreactive IEF were reduced and correlated with Adelta amplitudes (PGP 9.5, rs = 0.51, p = 0.0006; TRPV1, rs = 0.48, p = 0.0012). CONCLUSION: CHEPS appears a sensitive measure, with abnormalities observed in some symptomatic patients who did not have significant IEF loss and/or QST abnormalities. Some of the latter patients may have early small fibre dysfunction or ion channelopathy. CHEPS provides a clinically practical, non-invasive and objective measure, and can be a useful additional tool for the assessment of sensory small fibre neuropathy. Although further evaluation is required, the technique shows potential clinical utility to differentiate neuropathy from other chronic pain states, and provide a biomarker for analgesic development.


Assuntos
Potenciais Somatossensoriais Evocados/fisiologia , Fibras Nervosas/fisiologia , Doenças do Sistema Nervoso Periférico/patologia , Limiar Sensorial/fisiologia , Pele/inervação , Adulto , Idoso , Biópsia/métodos , Eletroencefalografia/métodos , Feminino , Histamina/farmacologia , Humanos , Masculino , Pessoa de Meia-Idade , Fibras Nervosas/efeitos da radiação , Doenças do Sistema Nervoso Periférico/fisiopatologia , Tempo de Reação/fisiologia , Limiar Sensorial/efeitos dos fármacos , Pele/fisiopatologia , Estatísticas não Paramétricas , Canais de Cátion TRPV/metabolismo , Ubiquitina Tiolesterase/metabolismo
3.
J Plast Reconstr Aesthet Surg ; 69(7): 1003-7, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27039219

RESUMO

INTRODUCTION: Fistula formation following closure of palatal clefts remains a difficult clinical complication. A significant recurrence rate has also been reported following attempted closure. We present our results of fistula closure augmented with Bio-Gide(®), a purified porcine collagen membrane designed to promote guided tissue regeneration. METHODS: We reviewed the records of 263 patients operated between 1993 and 2011 for closure of palatal fistula. The patients selected comprised 61 who underwent fistula closure augmented with Bio-Gide and 202 with other techniques in the absence of Bio-Gide. We reviewed the age at surgery, sex, location of fistula, cleft type and outcome. Operation success was defined as an asymptomatic patient along with visible confirmation of closure of the fistula. RESULTS: The overall fistula closure rate was 75% in the Bio-Gide group and 63% in the non-Bio-Gide group (p = 0.070) and 86% versus 61% in the unilateral cleft palate patients (p = 0.027). DISCUSSION: Bio-Gide has improved the success rate in fistula closure in this study. Using this technique, fistula closure can be performed as a day case procedure and does not need to transgress any original suture lines; an additional advantage is that this procedure does not require harvesting of any autologous tissue to augment the repair.


Assuntos
Fissura Palatina/cirurgia , Colágeno/uso terapêutico , Regeneração Tecidual Guiada/métodos , Fístula Bucal , Procedimentos de Cirurgia Plástica/efeitos adversos , Complicações Pós-Operatórias , Materiais Biocompatíveis/uso terapêutico , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Membranas Artificiais , Fístula Bucal/diagnóstico , Fístula Bucal/etiologia , Fístula Bucal/cirurgia , Fístula Bucal/terapia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Complicações Pós-Operatórias/terapia , Procedimentos de Cirurgia Plástica/métodos , Resultado do Tratamento , Reino Unido
4.
J Orthop Surg (Hong Kong) ; 21(1): 122-4, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23630005

RESUMO

We report on a 79-year-old woman who underwent salvage of the knee and lower leg using a Whichita Fusion Nail for knee arthrodesis, combined with a medial gastrocnemius muscle flap for a 3% contact burn that resulted in loss of the extensor mechanism. This provided an alternative to above-knee amputation when extensor mechanism reconstruction was not feasible.


Assuntos
Queimaduras/cirurgia , Salvamento de Membro , Extremidade Inferior/lesões , Extremidade Inferior/cirurgia , Idoso , Pinos Ortopédicos , Feminino , Humanos , Procedimentos Ortopédicos/instrumentação , Procedimentos Ortopédicos/métodos , Retalhos Cirúrgicos
5.
Plast Reconstr Surg ; 126(6): 1960-1966, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21124134

RESUMO

BACKGROUND: Reconstruction following pharyngolaryngectomy presents a complex reconstructive challenge, and a single-stage, reliable reconstruction allowing prompt discharge from the hospital and return of swallowing and speech function is required. The authors present their 10-year experience of 43 jejunal free flaps for pharyngolaryngectomy reconstruction by a single team and outline their operative algorithm to minimize postoperative morbidity. METHODS: The data for patients who underwent jejunal free flap reconstruction of circumferential pharyngoesophageal defects between March of 2000 and September of 2009 were reviewed retrospectively. All cases were included for analysis. RESULTS: There were 31 male patients and 12 female patients, with 100 percent acute flap survival. The authors' overall benign pharyngocutaneous fistula rate was two of 43 (5 percent), with two of 29 (7 percent) occurring in the group without a prophylactic pectoralis muscle flap and zero of 14 occurring in the group that had a prophylactic pectoralis muscle flap. No fistulas occurred when the anastomosis was performed with the gastrointestinal stapler (zero of 48). The authors' overall benign stricture rate was six of 43 (14 percent). Thirty-six patients received either a primary or secondary tracheoesophageal puncture; of these, 28 of 36 (78 percent) used their tracheoesophageal puncture as their primary mode of communication. CONCLUSION: The authors' recommendations for minimizing fistulas and stricture rate, following free jejunal reconstruction, include the gastrointestinal stapler for bowel anastomosis whenever possible, and the use of a prophylactic pedicled pectoralis major muscle flap for patients exposed to previous radiotherapy.


Assuntos
Retalhos de Tecido Biológico/fisiologia , Jejuno/transplante , Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Neoplasias Faríngeas/cirurgia , Faringectomia/métodos , Procedimentos de Cirurgia Plástica/métodos , Complicações Pós-Operatórias/prevenção & controle , Idoso , Algoritmos , Esôfago/cirurgia , Feminino , Seguimentos , Sobrevivência de Enxerto/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Voz Esofágica , Grampeamento Cirúrgico
6.
J Hand Surg Eur Vol ; 33(2): 155-62, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18443055

RESUMO

Painful nerves are a difficult and complex clinical problem. We describe the result of treatment by proximal relocation of 51 painful end neuromas and scarred nerves of the forearm in 33 patients. The relocated nerves included 29 superficial radial nerves, 16 lateral antebrachial cutaneous nerves, two medial cutaneous nerves and four posterior cutaneous nerves. These relocations achieved no, or only mild, pain in 100% of nerves at the original site and 94% of nerves at the relocation site. It also achieved no, or only mild, hypersensitivity in 96% of nerves at the original site and 98% of nerves at the relocation site. The technical difficulties encountered in this region, in particular on the radial aspect of the wrist, are discussed.


Assuntos
Antebraço/inervação , Mãos/inervação , Transferência de Nervo/métodos , Neuroma/cirurgia , Neoplasias do Sistema Nervoso Periférico/cirurgia , Adulto , Idoso , Dissecação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/inervação , Músculo Esquelético/cirurgia , Medição da Dor , Nervo Radial/cirurgia , Estudos Retrospectivos
7.
J Hand Surg Eur Vol ; 33(2): 186-91, 2008 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18443061

RESUMO

Forty-nine children with distal upper limb nerve injury were studied at a mean follow-up of 2 years 3 months. Patients who were aged 5 years or younger at the time of nerve injury (15/49) had no chronic neuropathic pain symptoms or allodynia. Patients with allodynia on quantitative sensory testing but no spontaneous pain (8/49) were all older than 5 years and those reporting spontaneous chronic neuropathic pain (5/49) were all older than 12 years at the time of injury. Previous studies of adults with similar nerve injuries report chronic hyperaesthesia in up to 40% of cases. Semmes-Weinstein monofilament testing showed a positive correlation between age at injury and abnormal sensory threshold (r = 0.60, P<0.0001). These findings indicate that young children show better sensory recovery and are less likely to develop long-term chronic neuropathic pain syndromes than adults following nerve injury.


Assuntos
Extremidade Superior/inervação , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Humanos , Hiperestesia/epidemiologia , Lactente , Masculino , Medição da Dor , Limiar da Dor , Pancreatite Crônica , Doenças do Sistema Nervoso Periférico
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