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1.
Medicine (Baltimore) ; 100(14): e25395, 2021 Apr 09.
Artículo en Inglés | MEDLINE | ID: mdl-33832132

RESUMEN

ABSTRACT: Skin grafts are not suitable for closing tendon- or bone-exposing wounds, which require flap surgery. Dermal regeneration templates have value for closing such wounds, but the disadvantages of the technique include implantation failures because of infection, hematoma formation, or inappropriate immobilization. Negative-pressure wound therapy was reported to increase graft acceptance in difficult wounds.This retrospective case series of 65 patients evaluated negative-pressure therapy combined with artificial dermis for the treatment of acute or chronic tendon- or bone-exposing wounds. The artificial dermis was placed after adequate wound-bed preparation, with simultaneous application of a vacuum-assisted closure system. Split-thickness skin grafting was performed after the implanted artificial dermis had become established.The overall success rate was 88.1% (59/67): 88.6% (39/44) in the chronic wounds group and 87% (20/23) in the acute-trauma group separately. The overall mean survival time of artificial dermis in success cases was 13.24 ±â€Š7.14 days. In separately, the survival time of artificial dermis had no statistically difference in chronic wound group (13.64 ±â€Š7.53 vs 12.60 ±â€Š5.86. P = .943), but had significant statistical difference in acute trauma group (12.45 ±â€Š6.44 days vs 23.33 ±â€Š4.04 days, P = .018). Also, comorbidity of PAOD was found a strong risk factor of failure in chronic wound group (100% vs 23.1%, P < 0.001).We concluded that artificial dermis combined with negative-pressure therapy followed by split-thickness skin grafting might be a reliable and effective option for surgical reconstruction of tendon- or bone-exposing wounds, and could decreasing waiting periods of autologous skin graft.


Asunto(s)
Terapia de Presión Negativa para Heridas/métodos , Trasplante de Piel/métodos , Piel Artificial/normas , Heridas y Traumatismos/cirugía , Adulto , Anciano , Arteriopatías Oclusivas/complicaciones , Arteriopatías Oclusivas/epidemiología , Autoinjertos/trasplante , Estudios de Casos y Controles , Terapia Combinada/efectos adversos , Terapia Combinada/métodos , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Terapia de Presión Negativa para Heridas/efectos adversos , Enfermedad Arterial Periférica/complicaciones , Enfermedad Arterial Periférica/epidemiología , Procedimientos Quirúrgicos Reconstructivos/métodos , Estudios Retrospectivos , Factores de Riesgo , Trasplante de Piel/efectos adversos , Piel Artificial/efectos adversos , Colgajos Quirúrgicos/trasplante , Tendones/patología , Tendones/cirugía , Resultado del Tratamiento , Cicatrización de Heridas/fisiología , Heridas y Traumatismos/complicaciones , Heridas y Traumatismos/patología
2.
Khirurgiia (Mosk) ; (4): 5-14, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33759462

RESUMEN

OBJECTIVE: To develop the algorithm for correction of defects following high-voltage electrical trauma with revascularized autografts, to assess the incidence and risk factors of postoperative complications. MATERIAL AND METHODS: Surgical interventions were performed in 16 men. Autografts were selected considering localization of defect and preoperative ultrasound data on perfusion of donor and recipient areas. We applied a sample with temporary compression of the vessels and ultrasound scanning of arteries and veins (a small-sized Doppler sound indicator of blood flow velocity - MINIDOP, BIOSS). RESULTS: Nine patients underwent microsurgical transplantation of revascularized flaps. Six patients with electrical trauma of the upper extremities underwent transplantation of free skin autografts and transposition of flexor and extensor muscles of the fingers in various combinations. In 1 patient, simultaneous microsurgical graft transplantation and plasty with local tissues were carried out. Microsurgical transplantation of thoracodorsal flap was performed in 2 patients with maxillofacial defect (with preliminary deepidermization of the flap in one case). In 3 patients with traumatic amputation of the penis, 2 patients underwent phalloplasty with a thoracodorsal flap and prefabrication of a radial forearm graft at the first stage. At the next stage, urethroplasty with a prefabricated radial forearm graft was performed. In 1 patient, closure of the penis defect was carried out using scrotal flaps. CONCLUSION: An integrated surgical approach, the use of free revascularized autografts and adequate postoperative management ensure high-quality aesthetic and functional restoration, improvement of the quality of life and social adaptation of patients with defects and deformations following high-voltage electrical injury.


Asunto(s)
Traumatismos por Electricidad/cirugía , Procedimientos Quirúrgicos Reconstructivos , Colgajos Quirúrgicos , Quemaduras por Electricidad/diagnóstico por imagen , Quemaduras por Electricidad/cirugía , Traumatismos por Electricidad/diagnóstico por imagen , Humanos , Incidencia , Masculino , Microcirculación , Microcirugia , Calidad de Vida , Procedimientos Quirúrgicos Reconstructivos/efectos adversos , Factores de Riesgo , Trasplante de Piel/métodos , Colgajos Quirúrgicos/irrigación sanguínea , Colgajos Quirúrgicos/trasplante , Trasplante Autólogo , Resultado del Tratamiento , Ultrasonografía Doppler , Heridas y Traumatismos/diagnóstico por imagen , Heridas y Traumatismos/cirugía
3.
Int. j. med. surg. sci. (Print) ; 8(1): 1-7, mar. 2021. ilus
Artículo en Inglés | LILACS | ID: biblio-1151627

RESUMEN

Basal cell carcinoma (BCC) is the most common type of nonmelanoma skin cancer (NMSC). It grows slowly and very rarely metastasizes but can cause substantial morbidity due to its tendency to relapse and locally invasive nature, especially when located on the face. Excision surgery is still the gold standard treatment for primary BCC and is usually followed by reconstruction procedure. Skin flap techniques vary widely, one of which is flap advancement technique. The main benefit of flap advancement technique is the ability to hide the excision line, thus resulting in an aesthetically sound outcome. We report a case of 72-year-old female with hyperpigmented plaque brownish lump on the left lateral cheek. A diagnosis of igmented basal cell carcinoma had been confirmed through histopathological examination. The patient was treated with wide excision surgery and the defectwas closed by multiple advancement flaps. Follow-up after three months showed excellent cosmetic and functional outcome.


El carcinoma basocelular (CBC) es el tipo más común de cáncer de piel no melanoma. Crece lentamente y rara vez hace metástasis, pero puede causar una morbilidad sustancial debido a su ubicación en la cara, tendencia a la recidiva y su comportamiento invasivo local. La cirugía de escisión sigue siendo el tratamiento estándar de oro para el CBC primario y generalmente se acompañan de procedimientos reconstructivos. Las técnicas de flap varían ampliamente, una de las cuales es la técnica de avance del colgajo. El principal beneficio de la técnica de avance es la capacidad de ocultar la línea de escisión y, por lo tanto, se obtiene un resultado más estético. En este artículo reportamos el caso de una mujer de 72 años con placa hiperpigmentada y abultada en su mejilla lateral izquierda. Se había confirmado un diagnóstico de carcinoma de células basales pigmentadas mediante un examen histopatológico. El paciente fue tratado con una amplia cirugía de escisión y el defecto fue cerrado por múltiples colgajos de avance. El seguimiento después de tres meses mostró un excelente resultado cosmético y funcional.


Asunto(s)
Humanos , Femenino , Anciano , Neoplasias Cutáneas/complicaciones , Neoplasias Cutáneas/rehabilitación , Procedimientos Quirúrgicos Reconstructivos/métodos , Colgajos Quirúrgicos/trasplante , Carcinoma Basocelular/complicaciones , Resultado del Tratamiento
4.
Dermatol Surg ; 47(2): 162-166, 2021 02 01.
Artículo en Inglés | MEDLINE | ID: mdl-33565771

RESUMEN

BACKGROUND: Although many repair methods for postsurgical lip defects have been described, the literature lacks a comprehensive review of these methods. OBJECTIVE: To perform a systematic review of lip defect repair methods after Mohs surgery or excisions. MATERIALS AND METHODS: Terms related to perioral anatomy, Mohs surgery and excision, and reconstruction were used to search 8 databases. Articles were included if they reported postsurgical lip repair data for 4 or more patients, were in English, and were published from 2004 onward. Two reviewers screened all titles and abstracts, followed by the full texts of the remaining articles. Data were then extracted including author specialties, study design, demographic, tumor, and defect information, surgical procedures, outcomes, and complications. RESULTS: Forty-two studies were eligible, including a randomized trial, 25 case series, and 16 cohort studies. Most were written by dermatologic or plastic surgeons, and most studies were small, with an average subject number of 61. Very few studies used structured outcome measures. Many repair methods were described, the most common of which were linear closures and various flaps. CONCLUSION: Many repair methods for lip defects have been published, but overall, the quality of the available evidence is low.


Asunto(s)
Carcinoma de Células Escamosas/cirugía , Neoplasias de los Labios/cirugía , Cirugía de Mohs/efectos adversos , Colgajos Quirúrgicos/trasplante , Herida Quirúrgica/cirugía , Humanos , Labio/cirugía , Herida Quirúrgica/etiología , Técnicas de Cierre de Heridas
6.
J Laryngol Otol ; 135(2): 173-175, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33568237

RESUMEN

BACKGROUND: Despite advances in endoscopic techniques, there are still instances when the frontal sinus must be approached externally. Given its variable anatomy, the frontal sinus continues to present a challenge to the surgeon. Our rule of thumb capitalises on the consistent embryological development of the frontal sinus, aiding safe external access. METHODS AND RESULTS: The presented stepwise approach includes trephination, fenestration, an osteoplastic flap and obliteration. The obliteration procedure has produced good results in managing those patients with disabling symptoms despite multiple endoscopic procedures.


Asunto(s)
Endoscopía/métodos , Seno Frontal/cirugía , Colgajos Quirúrgicos/trasplante , Endoscopía/estadística & datos numéricos , Seno Frontal/anatomía & histología , Seno Frontal/embriología , Heurística , Humanos , Cirujanos/estadística & datos numéricos , Trepanación/métodos
7.
BMJ Case Rep ; 14(1)2021 Jan 26.
Artículo en Inglés | MEDLINE | ID: mdl-33500305

RESUMEN

Nasal reconstruction following a total or subtotal resection presents a challenging clinical scenario. Ample external skin coverage is readily available using the paramedian forehead flap (PMFF), but restoring adequate internal lining of sufficient size and pliability is a major limitation. Intranasal mucosal flaps or free tissue transfer is often employed for this purpose, each with their own sets of limitations. Prelamination of the PMFF with a skin graft prior to transfer is a method to create a composite flap with both internal and external lining. Another challenge in subtotal nasal reconstruction centres around restoring adequate dimensions to the nose without an existing template to work from. Three-dimensional (3D) printing has become an increasingly popular tool in reconstructive surgery as it captures precise patient-specific dimensions to guide reconstruction. Herein, we describe a case of subtotal nasal reconstruction using a prelaminated PMFF using a patient-specific 3D printed model as a template for reconstruction.


Asunto(s)
Procedimientos Quírurgicos Nasales/métodos , Procedimientos Quirúrgicos Reconstructivos/métodos , Trasplante de Piel/métodos , Colgajos Quirúrgicos/trasplante , Anciano , Carcinoma Basocelular/cirugía , Frente , Humanos , Masculino , Neoplasias Nasales/cirugía , Impresión Tridimensional , Neoplasias Cutáneas/cirugía
8.
BMJ Case Rep ; 14(1)2021 Jan 12.
Artículo en Inglés | MEDLINE | ID: mdl-33436363

RESUMEN

Successful surgical management of chest wall tumours relies on extensive chest wall resection with adequate margins. In large complex tumours, return to form and function is determined by appropriate skeletal and soft tissue reconstruction of the chest wall defect. We report an original case of a large 11×16×3 cm ulcerative basosquamous carcinoma of the anterior chest wall. Soft tissue reconstruction was performed with a unilateral pedicled latissimus dorsi flap. A multidisciplinary approach between thoracic and plastic surgeons was used in the planning, intraoperative and follow-up periods. This case highlights a good long-term functional and cosmetic outcome in complex chest wall reconstruction as a result of successful cross-specialty collaboration.


Asunto(s)
Procedimientos Quirúrgicos Reconstructivos/métodos , Colgajos Quirúrgicos/trasplante , Neoplasias Torácicas/cirugía , Anciano , Humanos , Masculino , Músculos Superficiales de la Espalda , Pared Torácica/cirugía
9.
Am J Otolaryngol ; 42(1): 102834, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33229129

RESUMEN

PURPOSE: Near infrared spectroscopy (NIRS) measures tissue oximetry and perfusion of free tissue transfer with the advantage of remote wireless monitoring for free tissue transfer. It has been widely used in breast and extremity reconstruction but has had limited adoption in the head and neck. MATERIALS AND METHODS: A retrospective review of head and neck microvascular reconstruction by three different surgical services over 15 months at one tertiary care hospital was performed. Demographics, flap type, monitoring technique, complications, and flap outcomes were recorded. Monitoring techniques were (1) implantable/handheld Doppler or (2) NIRS. Flap monitoring outcomes were evaluated using multivariate analysis. RESULTS: 119 flaps were performed by four surgeons with a success rate of 92% (109/119). Flaps were monitored with Doppler (40%) or NIRS (60%). There was no difference in flap success based on monitoring technique. An ROC analysis identified that the optimal cutoff in immediate StO2 for classifying flap success at discharge was 68%. CONCLUSIONS: NIRS was successfully implemented in a high-volume head and neck reconstructive practice. NIRS remote monitoring allowed for flap surveillance without requiring in-hospital presence and was able to identify both arterial and venous compromise.


Asunto(s)
Neoplasias de Cabeza y Cuello/cirugía , Microvasos/cirugía , Monitoreo Fisiológico/métodos , Oximetría/métodos , Perfusión/métodos , Procedimientos Quirúrgicos Reconstructivos/métodos , Tecnología de Sensores Remotos/métodos , Espectroscopía Infrarroja Corta , Colgajos Quirúrgicos/fisiología , Colgajos Quirúrgicos/trasplante , Procedimientos Quirúrgicos Vasculares/métodos , Anciano , Femenino , Neoplasias de Cabeza y Cuello/irrigación sanguínea , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
10.
Plast Reconstr Surg ; 147(1): 38-45, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-33370047

RESUMEN

BACKGROUND: Despite advances in skin envelope reduction techniques and experienced nipple-sparing mastectomy flap procedures, the rate of nipple malposition and secondary revision in these patients remains high and eligible candidates are limited. In this article, the authors present a novel technique combining skin reduction nipple-sparing mastectomy surgery with single-stage skin-only mastopexy and direct-to-implant reconstruction. METHODS: A retrospective review was performed at a single institution from 2015 to 2018. All patients were operated on using this technique consecutively, by a breast and plastic surgeon team (A.F. and A.M.). Surgical technique and outcomes were compared with the currently accepted literature. RESULTS: Twenty-six patients (40 breasts) underwent this technique; all were single-stage direct-to-implant reconstructions. The average body mass index was 31 kg/m2. A Wise pattern was used in 35 breasts (87.5 percent) and prepectoral placement was used in 25 breasts (62.5 percent). Overall complications included seroma [n = 6 (15 percent)], vertical/T-junction dehiscence [n = 4 (10 percent)], skin necrosis [n = 4 (10 percent)], superficial or partial nipple necrosis [n = 4 (10 percent)], with no total nipple-areola complex lost and no reconstructive failures at 18.7 months' average follow-up. CONCLUSIONS: In this article, the authors share a novel reconstructive technique in which the skin envelope is reduced, the nipple-areola complex is repositioned, and a direct-to-implant reconstruction is performed in a single stage at the time of mastectomy. Consideration of pearls and pitfalls accompanies a review of the authors' experienced complication profile, and is discussed in the context of current literature. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Asunto(s)
Mamoplastia/efectos adversos , Mastectomía Subcutánea/efectos adversos , Pezones/cirugía , Complicaciones Posoperatorias/epidemiología , Colgajos Quirúrgicos/efectos adversos , Tejido Adiposo/trasplante , Adulto , Anciano , Implantes de Mama , Neoplasias de la Mama/cirugía , Femenino , Estudios de Seguimiento , Humanos , Mamoplastia/instrumentación , Mamoplastia/métodos , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Reoperación/métodos , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Colgajos Quirúrgicos/trasplante , Resultado del Tratamiento
11.
Plast Reconstr Surg ; 147(1): 127-129, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-33370056

RESUMEN

SUMMARY: Pollicization can be performed for secondary thumb reconstruction after traumatic injury or for primary thumb construction in cases of congenital thumb hypoplasia. Given the complexity of this operation, intimate familiarity with the involved anatomy and surgical principles is key to successful surgical outcomes. In this Video Plus article, the authors present a step-by-step approach to pollicization in case of Blauth type IIIB thumb hypoplasia.


Asunto(s)
Dedos/trasplante , Deformidades de la Mano/cirugía , Colgajos Quirúrgicos/trasplante , Pulgar/anomalías , Niño , Femenino , Humanos , Pulgar/cirugía , Resultado del Tratamiento
12.
Plast Reconstr Surg ; 147(1): 94e-97e, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-33370062

RESUMEN

SUMMARY: Large oronasal palatal fistulas can be challenging to reconstruct. The authors present a modified buccal myomucosal flap repair technique and review intermediate-term outcomes. In this technique, large anterior palatal fistulas are closed in two layers. First, apposing nasal turnover flaps of vomer mucosa medially and nasal wall mucosa laterally are approximated. Second, a posteriorly based buccal flap incorporating full-thickness buccinator muscle and overlying mucosa is transposed with interposition of the flap in the retromolar trigone and lateral palate to preserve dental occlusion. Consecutive patient cases performed in low-resource settings were reviewed and outcomes reported. Among eight subjects aged 3 to 22 years, with average defect size of 2.5 cm2 (range, 0.8 to 3.5 cm2), the flap was viable in all cases and required revision or pedicle division in only two patients (25 percent); all patients showed symptom improvement. The modified buccal myomucosal flap shows promising intermediate-term results as a single-stage reconstruction suitable to a wide patient age range, low airway/anesthetic risk, reliable functional outcomes, and low comorbidity.


Asunto(s)
Fisura del Paladar/cirugía , Deformidades Adquiridas Nasales/cirugía , Fístula Oral/cirugía , Procedimientos Quirúrgicos Ortognáticos/efectos adversos , Complicaciones Posoperatorias/cirugía , Colgajos Quirúrgicos/trasplante , Adolescente , Niño , Preescolar , Estética , Músculos Faciales/trasplante , Femenino , Humanos , Masculino , Mucosa Bucal/trasplante , Deformidades Adquiridas Nasales/etiología , Fístula Oral/etiología , Paladar (Hueso)/cirugía , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Resultado del Tratamiento , Adulto Joven
13.
Plast Reconstr Surg ; 147(1): 111e-122e, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-33370068

RESUMEN

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Understand the available donor sites for autologous breast reconstruction. 2. Describe the advantages and limitations of each donor site. 3. Provide a rational, algorithmic preoperative evaluation and approach for patients seeking autologous breast reconstruction. 4. Develop an effective postoperative monitoring system to minimize complications and maximize salvage of microvascular thromboses. SUMMARY: Breast reconstruction remains at the heart of the field of plastic and reconstructive surgery, and it is continuously evolving. Tremendous advances in breast implant technology and supplemental products, particularly acellular dermal matrices, have revolutionized breast reconstruction in the modern era. However, microvascular free flap breast reconstruction has also witnessed profound advancements with exceptionally high success rates, with the ability to provide the most durable and natural breast reconstruction. Although the pendulum oscillates between prosthesis-based reconstruction and autologous tissue, the present synopsis will focus on autologous free flap breast reconstruction from an historical perspective, recent advancements in microsurgery, and the future of autologous breast reconstruction.


Asunto(s)
Mamoplastia/métodos , Complicaciones Posoperatorias/prevención & control , Guías de Práctica Clínica como Asunto , Colgajos Quirúrgicos/trasplante , Recolección de Tejidos y Órganos/normas , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/genética , Neoplasias de la Mama/cirugía , Femenino , Asesoramiento Genético , Humanos , Mamoplastia/efectos adversos , Mamoplastia/normas , Mastectomía/efectos adversos , Anamnesis , Recurrencia Local de Neoplasia/diagnóstico , Recurrencia Local de Neoplasia/epidemiología , Recurrencia Local de Neoplasia/genética , Obesidad/epidemiología , Selección de Paciente , Examen Físico/normas , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Cuidados Preoperatorios/métodos , Cuidados Preoperatorios/normas , Medición de Riesgo/métodos , Medición de Riesgo/normas , Factores de Riesgo , Colgajos Quirúrgicos/efectos adversos , Tiempo de Tratamiento/normas , Recolección de Tejidos y Órganos/efectos adversos , Recolección de Tejidos y Órganos/métodos , Resultado del Tratamiento
14.
Plast Reconstr Surg ; 147(1): 123e-134e, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-33370069

RESUMEN

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Describe the risks, benefits, and safety profile of oncoplastic procedures for partial breast reconstruction, and how they compare to breast conservation-therapy alone. 2. Have a working knowledge of oncoplastic techniques and how they are addressed from the multidisciplinary perspective. 3. Understand the limitations of oncoplastic techniques and how to avoid unfavorable results. SUMMARY: Oncoplastic surgical techniques have expanded indications for breast conservation and have improved both oncologic and reconstructive outcomes. This article will focus on some of the barriers to adoption and discuss ways to improve safety through streamlining the process, understanding the oncologic concerns, and evaluating unfavorable outcomes that might interfere with the appropriate delivery of breast cancer care.


Asunto(s)
Neoplasias de la Mama/terapia , Mamoplastia/efectos adversos , Mastectomía Segmentaria/efectos adversos , Recurrencia Local de Neoplasia/prevención & control , Complicaciones Posoperatorias/prevención & control , Mama/diagnóstico por imagen , Mama/patología , Mama/cirugía , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/patología , Quimioterapia Adyuvante , Femenino , Humanos , Mamoplastia/métodos , Mastectomía Segmentaria/métodos , Oncología Médica/métodos , Oncología Médica/organización & administración , Recurrencia Local de Neoplasia/diagnóstico , Recurrencia Local de Neoplasia/epidemiología , Recurrencia Local de Neoplasia/etiología , Planificación de Atención al Paciente/organización & administración , Grupo de Atención al Paciente/organización & administración , Selección de Paciente , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Mejoramiento de la Calidad , Radioterapia Ayuvante , Reoperación/estadística & datos numéricos , Medición de Riesgo/métodos , Cirugía Plástica/métodos , Cirugía Plástica/organización & administración , Colgajos Quirúrgicos/trasplante , Factores de Tiempo , Tiempo de Tratamiento
15.
Rev. cuba. ortop. traumatol ; 34(2): e302, jul.-dic. 2020. tab, graf
Artículo en Español | LILACS, CUMED | ID: biblio-1156593

RESUMEN

RESUMEN Introducción: La cobertura de dispositivos ortopédicos expuestos y las infecciones en el hueso con colgajos es un tema controvertido. No existe un consenso claro sobre el tratamiento de esta complicación. En los últimos años se aprecia una tendencia a mantener el material de osteosíntesis y a controlar la infección aportando tejido bien vascularizado en forma de colgajo muscular o fasciocutáneo. Objetivo: Evaluar el éxito reconstructivo con colgajos de defectos de partes blandas en miembros que han precisado de una osteosíntesis, en función de la presencia de infección y el estado de los dispositivos de implante en el momento de la reconstrucción. Métodos: Estudio retrospectivo de una serie de 15 casos con un defecto de partes blandas en las extremidades inferiores secundario a la implantación de dispositivos ortopédicos en el hueso. Todos los casos recibieron cobertura con un colgajo muscular o fasciocutáneo con o sin retirada de los implantes. Se estudió la presencia o ausencia de infección previa a la reconstrucción (signos clínicos, resultado del cultivo microbiológico y exposición del material ortopédico), la retirada o mantenimiento del implante durante la reconstrucción, y la presencia de complicaciones posoperatorias. Se relacionaron estas variables con el éxito reconstructivo posoperatorio. El análisis de las variables se realizó con los estadísticos chi cuadrado, Wilcoxon y U de Mann Whitney, según el tipo de variable, y para una significación de 0,05. Resultados: La frecuencia de éxito reconstructivo fue mayor en aquellos pacientes con cultivo negativo sin exposición de material óseo (p = 0,038). Se encontró menor tasa de complicaciones en los pacientes que presentaban infección antes de la reconstrucción (p = 0,039), y en aquellos con cultivo positivo y exposición del material previos a la cirugía, cuyos implantes habían sido retirados durante la reconstrucción (p = 0,032). Conclusiones: El aporte de tejido bien vascularizado en forma de colgajo permite el mantenimiento del material ortopédico con una frecuencia de éxito de 66,67 %, y resultados favorables de mediano a largo plazo. La exposición y el resultado del cultivo son indicadores predictivos de los resultados de la cirugía(AU)


ABSTRACT Introduction: The covering of exposed orthopedic devices and bone infections with flaps are a controversial issue. There is no clear consensus concerning the treatment of this complication. In recent years, there has been a trend to maintain the osteosynthesis material and to control the infection by providing well vascularized tissue in the form of a muscular or fasciocutaneous flap. Objective: To assess the reconstructive success with flaps of soft tissue defects in limbs that have required osteosynthesis, based on the presence of infection and the status of the implant devices at the time of reconstruction. Methods: Retrospective study of a series of 15 cases with soft tissue defect in the lower limbs after implantation of orthopedic devices to the bone. All the cases were covered with muscle or fasciocutaneous flap, with or without removal of the implants. The presence or absence of infection prior to reconstruction (clinical signs, results of microbiological culture, and exposure of the orthopedic material), removal or maintenance of the implant during reconstruction, and the presence of postoperative complications were studied. These variables were associated with postoperative reconstructive success. The analysis of the variables was performed using the chi-square, as well as Wilcoxon and Mann Whitney U tests, according to the type of variable, and for a significance of 0.05. Results: The frequency of reconstructive success was higher in those patients with negative culture and without exposure of bone material (P=0.038). A lower rate of complications was found in patients with infection before reconstruction (P=0.039), and in those with positive culture and exposure of the material prior to surgery, whose implants had been removed during reconstruction (P=0.032). Conclusions: The provision of well vascularized tissue in the form of flap allows maintenance of the orthopedic material with a success rate of 66.67%, as well as favorable outcomes in the mid to long terms. The results of exposure and culture are predictive indicators of surgery outcomes(AU)


Asunto(s)
Humanos , Artroplastia/efectos adversos , Colgajos Quirúrgicos/trasplante , Extremidad Inferior/cirugía , Fijación Interna de Fracturas/efectos adversos , Estudios Retrospectivos
16.
Medicine (Baltimore) ; 99(50): e23080, 2020 Dec 11.
Artículo en Inglés | MEDLINE | ID: mdl-33327231

RESUMEN

BACKGROUND: Head and neck tissue defects cause great physical and psychological damage to patients. Therefore, accurate positioning of perforating vessels before operation is of great significance for improving the success rate of flap preparation and avoiding unnecessary incision injury. METHODS/DESIGN: A total of 60 patients with laryngeal cancer in otolaryngology, Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Southwest Medical University and the Third People's Hospital of Mianyang city from October 2020 to October 2021 will be selected and randomly divided into CT angiogram (CTA) group (n=20), mimics group (n = 20) and CTA + mimics group (n = 20) according to the numerical table. Patients in the CTA group will receive CTA examination of lower extremities. Patients in mimics group will receive digital technology in the positioning of perforator. Patients in CTA + mimics group will receive CTA + digital technology. All the patients will receive the flap cutting and the flap making; the doctor will determine the perforation branch of the flap with 3-D visual positioning, measure the preoperative indicators intraoperatively and complete the wound repair. Finally, the survival rate, sensitivity, specificity and accuracy of the flap will be measured. DISCUSSION: The anterolateral thigh flap has been widely used to repair various tissue defects and has obtained good clinical results. The extensive clinical application mainly focuses on 2 aspects, namely the study of vascular anatomy of lateral flap and the exploration of preoperative flap design technology. Perforator is the direct blood supply source of anterolateral thigh flap, so it is particularly important to study the anatomy of perforator. Therefore, this study will reveal CTA combined with digital technology in the vascular anatomy of the anterior external femoral flap and the design of the flap before and during surgery, so as to provide help for the repair of tissue defects. TRIAL REGISTRATION: It has been registered at http://www.chictr.org.cn/listbycreater.aspx (Identifier: ChiCTR2000038951), Registered on October 10th, 2020.


Asunto(s)
Neoplasias de Cabeza y Cuello/cirugía , Neoplasias Laríngeas/complicaciones , Traumatismos de los Tejidos Blandos/cirugía , Muslo/cirugía , Adulto , Anciano , China/epidemiología , Angiografía por Tomografía Computarizada/métodos , Femenino , Neoplasias de Cabeza y Cuello/patología , Humanos , Imagenología Tridimensional/métodos , Neoplasias Laríngeas/patología , Neoplasias Laríngeas/cirugía , Extremidad Inferior/irrigación sanguínea , Extremidad Inferior/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Colgajo Perforante , Procedimientos Quirúrgicos Reconstructivos/métodos , Trasplante de Piel/métodos , Colgajos Quirúrgicos/trasplante , Tasa de Supervivencia , Muslo/irrigación sanguínea , Resultado del Tratamiento
17.
Medicine (Baltimore) ; 99(50): e23545, 2020 Dec 11.
Artículo en Inglés | MEDLINE | ID: mdl-33327304

RESUMEN

It is difficult to repair large skull and dural defects. We observed the therapeutic effects of anterolateral thigh flaps with vascular fascia lata for repairing large skull and dural defects.From December 2008 to June 2019, we repaired large skull and dural defects for 28 cases including 12 cases with scalp malignant tumor and 16 cases requiring removal of titanium mesh which had been once placed due to craniocerebral trauma. The scalp malignant tumor invaded full-thickness skull in 12 cases; and invaded cervical lymph nodes, dura mater or brain tissue in 3 cases. In the 12 cases with scalp malignant tumor, the scalp defects of 12 cm × 9 cm to 22 cm × 18 cm and skull defects of 9 cm × 7 cm to 15 cm × 12 cm after radical tumor resection were repaired using anterolateral thigh flaps of 14 cm × 11 cm to 23 cm × 19 cm with fascia lata of 10 cm × 8 cm to 16 cm × 12 cm. Postoperative radiotherapy and chemotherapy were also performed in the 3 cases with tumor metastasis. In the 16 cases requiring removal of titanium mesh, the skull and dural defects of 8 cm × 7 cm to 15 cm × 11 cm after removal of titanium mesh were repaired using anterolateral thigh flaps of 10 cm × 8 cm to 16 cm × 12 cm.In all cases, the transplanted anterolateral thigh flap with fascia lata survived after surgery and no vascular crisis occurred. During the followup of 8 months to 9 years, the flap appearance in the head-repaired area was fine, no external hernia of brain tissue occurred, the appearance of the femoral donor site was acceptable, and femoral muscle strength and movements were normal in all cases. The 12 cases with scalp malignant tumor had no local recurrence or distant metastasis.Repairing the skull and dural defects caused by radical surgery for scalp malignant tumor or removal of titanium mesh using anterolateral thigh flaps with vascular fascia lata, is effective. The appearance in the head-repaired area is fine without external hernia of brain tissue.


Asunto(s)
Duramadre/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Cráneo/cirugía , Colgajos Quirúrgicos/trasplante , Muslo/cirugía , Adulto , Anciano , Lesiones Encefálicas/cirugía , Carcinoma Basocelular/cirugía , Carcinoma de Células Escamosas/cirugía , Duramadre/lesiones , Femenino , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Masculino , Persona de Mediana Edad , Cuero Cabelludo/cirugía , Neoplasias Cutáneas/cirugía , Cráneo/lesiones , Mallas Quirúrgicas , Titanio , Adulto Joven
18.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artículo en Inglés | MEDLINE | ID: mdl-33370984

RESUMEN

An open sternal wound is a dreaded complication after open heart surgery for neonatal congenital cardiac anomalies. Vascularised muscle flap reconstruction of sternal wound defects, to prevent life-threatening mediastinal infections, is the standard of care in adults and children. However, there is paucity of published literature regarding the safety of this technique in neonates. We describe a successful operative technique for complex reconstruction of an open heart sternal defect on a neonatal male patient. On 6 months postoperative follow-up, we identified an issue with sternal instability. Patient underwent a subsequent operation for reinforcement of the sternal wound repair with Vicryl mesh. The authors report safety of using three separate vascularised muscle flaps in a single neonatal operation. Long-term follow-up of the sternal wound reconstruction is warranted to determine need for secondary procedures.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Reconstructivos/métodos , Síndrome de Cimitarra/terapia , Esternotomía/efectos adversos , Herida Quirúrgica/terapia , Procedimientos Quirúrgicos Cardíacos/métodos , Oxigenación por Membrana Extracorpórea , Humanos , Recién Nacido , Masculino , Terapia de Presión Negativa para Heridas , Músculos Pectorales/trasplante , Procedimientos Quirúrgicos Reconstructivos/efectos adversos , Reoperación/métodos , Esternón/cirugía , Colgajos Quirúrgicos/efectos adversos , Colgajos Quirúrgicos/trasplante , Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/prevención & control
19.
Zhonghua Nan Ke Xue ; 26(5): 431-435, 2020 May.
Artículo en Chino | MEDLINE | ID: mdl-33354952

RESUMEN

Objective: To summarize the experience in the surgical treatment of hypospadias by analyzing the operation features and clinical effects of two different routes for transferring the pedicled preputial island flap. METHODS: This retrospective study included 122 cases of hypospadias treated by transferring the pedicled preputial island flap, 80 from one side of the penis (the control group) and the other 42 through the middle orifice of the vascular pedicle (the observation group). We recorded the intra- and postoperative data and compared them between the two groups. RESULTS: The operation time was significantly longer in the observation group than in the control (ï¼»164.43 ± 25.03ï¼½ vs ï¼»134.71 ± 32.37ï¼½ min, P < 0.01), but the catheter-indwelling time was dramatically shorter in the former than in the latter group (ï¼»2.93 ± 0.97ï¼½ vs ï¼»3.68 ± 0.73ï¼½ wk, P < 0.01). There was no statistically significant difference in the length of the reconstructed urethra between the two groups (ï¼»2.86 ± 0.71ï¼½ vs ï¼»2.83 ± 0.82ï¼½ cm, P = 0.863). A 6- to 12-month follow-up showed a significantly lower incidence of postoperative complications in the observation than in the control group (9.52% vs 25.00%, P < 0.05). CONCLUSIONS: Transferring the pedicled preputial island flap through the middle orifice of the vascular pedicle, though taking a longer time than that from one side of the penis, has the advantages of a shorter catheter-indwelling time and a lower incidence rate of postoperative complications, and therefore deserves wide clinical application.


Asunto(s)
Hipospadias , Pene/cirugía , Colgajos Quirúrgicos/trasplante , Uretra/cirugía , Niño , Prepucio/cirugía , Humanos , Hipospadias/cirugía , Masculino , Estudios Retrospectivos
20.
Pan Afr Med J ; 37: 48, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33209175

RESUMEN

In the COVID-19's crisis, elective surgery and non-emergent cases were postponed; all other procedures have to be minimized. A 17-year male patient with severe crush and degloving injury over the thigh, gluteal, sacral, and perineum areas was admitted to our Department on the 16th of March 2020. The patient presented soft tissue skin and muscle loss. A double Latissimus Dorsi and Anterolateral Thigh free flaps were indicated. However, due to the particular circumstance of the COVID-19 crisis, we applied domestic negative wound therapy (NPWT) using gauzes and wall suction. We obtained suitable granulation tissue after 17 consecutive days with this treatment. The raw area was then covered with an expanded split-thickness skin graft. The wound healed at 95%, and the patient was discharged on 25th of April 2020. He was followed up in an outpatient setting with wound care and physiotherapy. This case showed that in a limited-resource setting, with available wall suction, the domestic NPWT is a versatile tool to promote granulation tissue.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Lesiones por Aplastamiento/cirugía , Lesiones por Desenguantamiento/cirugía , Terapia de Presión Negativa para Heridas/métodos , Neumonía Viral/epidemiología , Colgajos Quirúrgicos/trasplante , Accidentes de Tránsito , Adolescente , Vendajes , Nalgas/lesiones , Desbridamiento , Humanos , Masculino , Músculo Esquelético/lesiones , Pandemias , Perineo/lesiones , Muslo/lesiones , Cicatrización de Heridas , Infección de Heridas/tratamiento farmacológico , Infección de Heridas/microbiología
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