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1.
Curr Urol Rep ; 22(3): 15, 2021 Feb 03.
Artículo en Inglés | MEDLINE | ID: mdl-33534013

RESUMEN

PURPOSE OF REVIEW: Patients with congenital urologic conditions present unique challenges as adults. Herein, we review the literature relevant to the adult reconstructive urologist confronted with complex surgical concerns affecting their patients with a history of hypospadias, spina bifida, and other syndromes affecting the genitourinary tract. RECENT FINDINGS: Urethral stricture disease related to hypospadias is complex, but successful urethroplasty and penile curvature correction can be achieved with an anatomically minded approach. Multiple urinary diversion techniques can be considered in a patient-centered approach to bladder management in the adult spina bifida patient, but complications are common and revision surgeries are frequently required. Strong evidence is lacking for most surgical techniques in this population, but experiences reported by pediatric and adult urologists with genitourinary reconstruction training can help foster consensus in decision-making. Urologists trained in genitourinary reconstruction may be uniquely positioned to care for the transitional urology patient as they enter adolescence and adulthood.


Asunto(s)
Rol del Médico , Procedimientos Quirúrgicos Reconstructivos , Disrafia Espinal/complicaciones , Transición a la Atención de Adultos , Anomalías Urogenitales/cirugía , Procedimientos Quirúrgicos Urológicos , Adolescente , Adulto , Niño , Femenino , Humanos , Hipospadias/cirugía , Masculino , Reoperación , Estrechez Uretral/etiología , Estrechez Uretral/cirugía , Sistema Urinario/cirugía , Anomalías Urogenitales/terapia , Enfermedades Urológicas/etiología , Enfermedades Urológicas/cirugía , Urólogos
2.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(2): 200-205, 2021 Feb 15.
Artículo en Chino | MEDLINE | ID: mdl-33624474

RESUMEN

Objective: To explore the feasibility of using indocyanine green (ICG) angiography to detect brachial artery perforators, and the clinical application of brachial artery perforator propeller (BAPP) flaps to repair soft tissue defects of the trunk and upper limbs. Methods: Between August 2016 and February 2019, ICG angiography was used to detect the perforating vessels of the brachial artery muscle septum, and the BAPP flaps were cut out with the detected perforating vessels as the pedicle to repair 19 cases of trunk and upper limb soft tissue defects. There were 12 males and 7 females, with an average age of 28.6 years (range, 5-66 years). Etiologies included the post-burn scar in 10 cases, soft-tissue sarcoma in 5 cases, congenital melanocytic nevi in 2 cases, chronic chest wall ulcer in 1 case, and malignant melanoma in 1 case. Defects located in axilla in 8 cases, chest wall in 4 cases, elbow in 5 cases, and shoulder in 2 cases. The area of the defect ranged from 15 cm×3 cm to 20 cm×8 cm. Pre-transfer tissue expansion was used in 11 patients. Thirteen flaps were pedicled with 1 perforator vessel, and 6 flaps were pedicled with 2 perforator vessels. The length of the vascular pedicle was 2.5-4.5 cm, with an average of 3.08 cm. The area of the skin flap ranged from 11 cm×5 cm to 22 cm×10 cm. The flap rotation angle was 110° in 1 case, 120° in 1 case, and 180° in 17 cases. Except for one donor site repaired by skin graft, the other donor sites were directly sutured. Results: A total of 24 perforating vessels of the brachial artery muscle septum were detected by ICG angiography, 26 were identified during the operation, with an accuracy rate of 92.31%. Eighteen flaps survived without arteriovenous crisis. Venous congestion was observed in the distal 3-cm of one flap and the flap survived after conservative management. Intraoperative analysis showed that the blood perfusion of the distal 4-cm of one flap was poor, the relative value was less than 32%, the flap survived after removing the poor perfusion area. All the patients were followed up 3 to 23 months (mean, 8.6 months). The color and texture of the flap were similar to those of the recipient area. Flap debulking was not needed in all patients owing to the thinness of the flap. The contracture symptoms of patients with scar contracture on the medial of the elbow joint and axilla were significantly improved; a patient with malignant melanoma underwent tumor resection at 1 year and 5 months after operation due to tumor recurrence, and additional surgery was done to remove the recurrent tumor. No tumor recurrence was found in other patients. Conclusion: The ICG angiography technique can be used to explore the perforating vessels of the brachial artery muscle septum. The BAPP flap pedicled with the perforating vessels can be used for the repair of skin and soft tissue defects in the chest wall, axilla, shoulder, and elbow joint.


Asunto(s)
Procedimientos Quirúrgicos Reconstructivos , Traumatismos de los Tejidos Blandos , Adolescente , Adulto , Anciano , Angiografía , Arteria Braquial , Niño , Preescolar , Femenino , Humanos , Verde de Indocianina , Masculino , Persona de Mediana Edad , Traumatismos de los Tejidos Blandos/cirugía , Extremidad Superior , Adulto Joven
3.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(2): 252-257, 2021 Feb 15.
Artículo en Chino | MEDLINE | ID: mdl-33624483

RESUMEN

Objective: To review the research progress of indication and treatment of graft in shoulder superior capsular reconstruction (SCR) for rotator cuff tear (RCT). Methods: The literature related to shoulder SCR in recent years was extensively reviewed, and the anatomy, biomechanics, surgical indications, and treatment of graft in SCR were summarized. Results: Superior capsule plays a role as a functional complex with rotator cuff, ligament, and whole capsule. SCR can effectively restore the superior stability of the shoulder. The indications of SCR include the irreparable massive RCT, massive RCT combined with pseudoparalysis shoulder, medium/large RCT with severe degenerative rotator cuff tissue, and dual-layer RCT. In order to achieve a better healing of tendon-bone in graft and decrease the rate of long-term graft retearing, it is essential to select an appropriate thickness graft, fix the graft in right intensity, and get a better capsular continuity. Conclusion: The technique of SCR advanced to SCR for reinforcement and it is indicated from substantial massive RCT to severe degeneration of rotator cuff tissue. Graft treatment is the key step for a successful SCR.


Asunto(s)
Procedimientos Quirúrgicos Reconstructivos , Lesiones del Manguito de los Rotadores , Articulación del Hombro , Humanos , Manguito de los Rotadores/cirugía , Lesiones del Manguito de los Rotadores/cirugía , Hombro/cirugía , Articulación del Hombro/cirugía
4.
Acta Cir Bras ; 36(2): e360201, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33624718

RESUMEN

PURPOSE: The spleen is relevant in blood purification, hematopoiesis, metabolism, and immune response to antigens, in addition to the storage and control on the release of metals and amino acids. Its functions concerning reproduction characteristics are still unknown. The objective was to study the influence of splenectomies on reproduction. METHODS: This study analyzed 25 mice couples, distributed into five groups: group 1 - control, no surgery: group 2 - control, submitted to laparotomy and laparorrhaphy only; group 3 - splenectomy in male mice; group 4 - splenectomy in female mice; group 5 - splenectomy in male and female mice. The animals were studied as regards the number of gestations and offspring generated in each gestation. RESULTS: A decrease in both the number of gestations and the number of offspring was verified in the male mice that had received a splenectomy when coupled with normal female mice. It is important to emphasize lower reproduction level when paired asplenic males with normal females, otherwise, the couples in which both mice had been splenectomized did not present change in the reproduction pattern. CONCLUSIONS: A reduction in the number of pregnancies and litters occurs in mice couples when the male mice were previously splenectomized.


Asunto(s)
Procedimientos Quirúrgicos Reconstructivos , Esplenectomía , Animales , Femenino , Masculino , Ratones , Embarazo , Bazo
5.
Int J Oral Maxillofac Implants ; 36(1): Ie1-e6, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33600540

RESUMEN

This case report demonstrates the use of dynamic navigation guidance for bone reduction. Information about smile line position incorporated in a virtual plan and accurate transfer to the surgical field enhances the predictability of the treatment. A virtual wax-up was made, and implant positions along with bone reduction were planned accordingly. Residual teeth in the maxilla were extracted, and bone reduction and zygomatic implant placement were assisted by surgical navigation, while conventional implants were placed using the surgical template, followed by immediate loading. When surgical navigation is used for implant placement, navigated bone reduction can easily be incorporated in the workflow. The accuracy of bone reduction was evaluated together with the accuracy of two zygomatic implants assisted by a navigation system and four conventional implants assisted by a static template. The mean deviation between planned and performed bone reduction was 1.3 ± 0.39 mm (range: 0.8 to 1.7 mm). The accuracy of this procedure corresponds to the accuracy of guided implant placement and can be considered reliable after confirmation through clinical trials.


Asunto(s)
Implantes Dentales , Procedimientos Quirúrgicos Reconstructivos , Cirugía Asistida por Computador , Implantación Dental Endoósea , Humanos , Maxilar/diagnóstico por imagen , Maxilar/cirugía , Flujo de Trabajo
6.
BMC Surg ; 21(1): 90, 2021 Feb 18.
Artículo en Inglés | MEDLINE | ID: mdl-33602207

RESUMEN

BACKGROUND: Primitive neuroectodermal tumours are clinically rare. Here, we report a case of a large peripheral primitive neuroectodermal tumour of the abdominal wall. The defect was reconstructed with the longest lateral circumflex femoral artery musculocutaneous flap reported to date. CASE PRESENTATION: A 15-year-old male suffered rupture and bleeding of an abdominal wall mass with a volume of approximately 23*18*10 cm3, involving the whole layer of the abdominal wall. Pathological examination revealed a peripheral primitive neuroectodermal tumour. The tumour was removed via oncologic resection, and the abdominal wall was reconstructed with a bilateral 44*8 cm2 lateral circumflex femoral artery musculocutaneous flap combined with a titanium polypropylene patch. The patient had smooth recovery postoperative, and the functions of the donor and recipient areas of the flap were not significantly affected. CONCLUSION: In this case report, we describe a rare primitive neuroectodermal tumour of the abdominal wall, which invaded almost the entire abdominal wall due to delay of treatment. After thoroughly removing the tumour, we immediately reconstructed the abdominal wall with an ultra-long lateral circumflex femoral artery musculocutaneous flap and achieved better appearance and function after the operation. This case suggests that we should adopt an integrated scheme of surgery combined with radiotherapy and chemotherapy in the treatment of peripheral primitive neuroectodermal tumours. Under the premise of determining the blood supply, the lateral circumflex femoral artery musculocutaneous flap can be cut to a sufficient length.


Asunto(s)
Neoplasias Abdominales , Tumores Neuroectodérmicos Primitivos , Procedimientos Quirúrgicos Reconstructivos , Neoplasias Abdominales/cirugía , Pared Abdominal/cirugía , Adolescente , Arteria Femoral/cirugía , Humanos , Masculino , Colgajo Miocutáneo , Tumores Neuroectodérmicos Primitivos/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos
7.
Khirurgiia (Mosk) ; (2): 14-19, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33570349

RESUMEN

OBJECTIVE: To study the immediate results of pancreatoduodenectomy depending on digestive reconstruction procedure. MATERIAL AND METHODS: We analyzed 242 patients who underwent pancreatoduodenectomy for the period from January 2013 to December 2019. There were 32 combined procedures: 28 (11.6%) with portal vein resection and 8 (3.3%) simultaneous operations (right-sided hemicolectomy - 4, right-sided adrenalectomy - 2, gastrectomy with splenectomy - 2). Pancreatic stump was inserted into the jejunum in 156 (64.5%) patients, into the stomach - in 86 (35.5%) cases. RESULTS: Postoperative period was uneventful in 180 (74.4%) patients. Eighty postoperative complications were observed in 62 (25.6%) patients; 221 (91.3%) patients were discharged, 21 (8.7%) patients died. Pancreatic necrosis was the most common postoperative event and provoked 65 (82.5%) various complications (38 (72.1%) in patients with pancreaticojejunostomy and 20 (71.5%) in those with pancreaticogastrostomy). Incidence of complications was similar in both groups. However, pancreaticojejunostomy was followed by severe pancreatic fistula type C in 12 (23.1%) patients, type B in 24 (46.1%) cases. In case of pancreaticogastrostomy, pancreatic fistula type C occurred in 4 (14.3%) cases, type B - in 8 (28.6%) patients. CONCLUSION: Pancreatic necrosis was the most common postoperative event after pancreatoduodenectomy. Fewer severe pancreatic fistulae (type C) were recorded after pancreaticogastrostomy although these patients had lower density of the pancreas and unclear pancreatic duct. Choice of pancreatic-digestive anastomosis should be determined by features of pancreatic parenchyma, pancreatic duct diameter. Nevertheless, final decision is a prerogative of surgeon. Pancreaticogastrostomy is especially advisable in minimally invasive PDEs that will simplify inclusion of the pancreas into digestive system and reduce the incidence of complications and mortality.


Asunto(s)
Pancreaticoduodenectomía , Pancreatoyeyunostomía , Procedimientos Quirúrgicos Reconstructivos/métodos , Anastomosis Quirúrgica/efectos adversos , Anastomosis Quirúrgica/métodos , Humanos , Yeyuno/cirugía , Necrosis/etiología , Necrosis/prevención & control , Páncreas/patología , Páncreas/cirugía , Fístula Pancreática/etiología , Pancreaticoduodenectomía/efectos adversos , Pancreaticoduodenectomía/métodos , Procedimientos Quirúrgicos Reconstructivos/efectos adversos , Estómago/cirugía , Resultado del Tratamiento
8.
Khirurgiia (Mosk) ; (2): 40-47, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33570353

RESUMEN

OBJECTIVE: To identify the risk factors associated with non-closure of defunctioning stoma in patients with rectal cancer. MATERIAL AND METHODS: A retrospective analysis included patients who underwent surgical treatment at the Ryzhikh National Medical Research Centre of Coloproctology for the period from March 2017 to August 2019. Inclusion criterion was anterior or low anterior resection followed by anastomosis and preventive stoma. Univariate and multivariate analysis enrolled 28 factors for identifying the risk factors of non-closure of defunctioning stoma. RESULTS: There were 246 patients with rectal cancer. Intraoperative fluorescence angiography was applied in 145 cases to assess blood supply within the anastomosis and reduce the risk of anastomotic leakage. According to multivariate analysis, only two factors had significant influence on non-closure of preventive stoma - any grade of anastomotic leakage (OR 6.5; 95% CI 2.2-18.8, p=0.001) and rectal cancer stage IV (OR 7.2; 95% CI 1.9-27.6, p=0.004). CONCLUSION: According to our data, permanent stoma is observed in 15% of patients.


Asunto(s)
Proctectomía/métodos , Neoplasias del Recto , Estomas Quirúrgicos , Análisis de Varianza , Anastomosis Quirúrgica/efectos adversos , Fuga Anastomótica/diagnóstico , Fuga Anastomótica/etiología , Contraindicaciones de los Procedimientos , Humanos , Análisis Multivariante , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/patología , Proctectomía/efectos adversos , Procedimientos Quirúrgicos Reconstructivos , Neoplasias del Recto/patología , Neoplasias del Recto/cirugía , Estudios Retrospectivos , Factores de Riesgo , Estomas Quirúrgicos/efectos adversos
9.
Khirurgiia (Mosk) ; (2): 48-52, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33570354

RESUMEN

OBJECTIVE: To improve treatment outcomes in patients with anorectal malformations via research of morphological criteria and differentiated approach to surgical correction. MATERIAL AND METHODS: There were 37 children with various types of anorectal malformations for the period 2000-2019. We analyzed morphological features of atretic rectum wall, fistula, anastomosis with adjacent organs and skin of the perineum. RESULTS: Morphological research of anorectal malformations made it possible to differentiate treatment strategy and explain the causes of unsatisfactory results after perineal and abdominal-perineal proctoplasty. Incidence and severity of complications, as well as early disability were reduced that significantly improved postoperative quality of life. CONCLUSION: According to the morphological criteria, deeper mobilization of atretic rectum within at least 2.5-3 cm of the rectal «cone¼ with intact muscular wall is necessary. This approach was valuable to ensure adequate closure function of the rectum, prevent anal incontinence and restore normal appearance of the perineum. These achievements contributed to decrease in the incidence of admissions, redo surgeries and improvement of social adaptation in children.


Asunto(s)
Malformaciones Anorrectales , Incontinencia Fecal , Procedimientos Quirúrgicos Reconstructivos , Canal Anal/anomalías , Canal Anal/cirugía , Malformaciones Anorrectales/patología , Malformaciones Anorrectales/cirugía , Niño , Incontinencia Fecal/etiología , Incontinencia Fecal/prevención & control , Incontinencia Fecal/cirugía , Humanos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Calidad de Vida , Procedimientos Quirúrgicos Reconstructivos/efectos adversos , Procedimientos Quirúrgicos Reconstructivos/métodos , Recto/anomalías , Recto/cirugía
10.
Medicine (Baltimore) ; 100(5): e24357, 2021 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-33592883

RESUMEN

ABSTRACT: Although it is well recognized that other surgical specialties perform various procedures related to trauma care, there is a lack of analyses focusing on the role of plastic surgical management in trauma centers. This retrospective study was designed to investigate the scope of plastic surgery services in acute trauma care, using clinical data obtained from a single, regional, level I trauma center.This study included patients who presented to a single, regional, level I trauma center between March 1, 2016 and February 28, 2018. Patients with acute trauma to the facial soft tissue and skeleton, soft tissue of the upper and lower limbs, trunk and perineum, and other areas requiring plastic surgical procedures were included in the analysis. Cases requiring consultation for the correction of posttraumatic deformity or secondary deformity and trauma sequelae, such as scars, were excluded. Data on patients' demographics and detailed surgical procedures were acquired from electronic medical records. The reviewed cases were categorized by the primary anatomical region requiring surgery and the primary procedure performed.A total of 1544 patients underwent surgery, and 2217 procedures were recorded during the 2-year study period. In 2016, 1062 procedures on 690 patients, and, in 2017, 1155 procedures on 787 patients were registered. The average age of the patients who underwent plastic surgical procedure due to a trauma-related cause was 38.4 years (range, 2 days to 91 years), and 1148 patients (77.7%) were male. The head and neck region was the most commonly observed anatomical area that was operated on. The facial bone requiring the largest degree of surgical intervention was the mandible, followed by the zygomatic bone, nasal bones, orbital floor, and maxilla. Microsurgical procedures, such as flap surgery and microsurgery, were performed in 121 cases. The most commonly elevated free flap was the ALT flap (n = 69).Plastic surgeons play various roles in level I trauma centers, such as in the management of facial injury, performing limb-saving free tissue transfers, and complex wound reconstruction with flaps or skin grafts. Thus, plastic surgeons are an essential part of trauma centers.


Asunto(s)
Utilización de Instalaciones y Servicios/estadística & datos numéricos , Procedimientos Quirúrgicos Reconstructivos/estadística & datos numéricos , Cirugía Plástica/estadística & datos numéricos , Centros Traumatológicos/estadística & datos numéricos , Heridas y Traumatismos/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Medicina/estadística & datos numéricos , República de Corea , Estudios Retrospectivos , Adulto Joven
11.
BMC Surg ; 21(1): 73, 2021 Feb 04.
Artículo en Inglés | MEDLINE | ID: mdl-33541322

RESUMEN

BACKGROUND: Intestinal failure (IF) is a rare but severe form of organ failure. The condition is defined as body's inability to absorb adequate fluids, macronutrients and minerals for growth and development, so that intravenous supplementation is necessary. A broad spectrum of diseases, trauma and complications of surgery might eventually end up with intestinal failure. Nowadays, intestinal failure patients are preferably cared for in intestinal rehabilitation units (IRU). Autologous gastrointestinal reconstruction (AGIR) refers to non-transplant operative management of IF patients designed to improve enteral tolerance and gut absorptive capacity. CASE PRESENTATION: Herein we present five cases with complications of surgeries due to peptic ulcer bleeding, blunt abdominal trauma, obesity and gastric tumor. The surgeries were complicated by anastomotic leak, peritonitis and fistula formation. By adopting multidisciplinary decisions and special care for each complication, all the five patients were successfully managed and discharged. DISCUSSION AND CONCLUSIONS: As presented, re-anastomosis in presence of abdominal contamination will probably fail. In patients with intestinal failure, PN should start as soon as possible to increase the success rate of future surgeries and prevent potential need for intestinal transplantation. We suggest referring patients with complicated outcomes of gastrointestinal surgeries to the IRUs to reduce morbidity and mortality.


Asunto(s)
Gastrectomía , Derivación Gástrica , Enfermedades Intestinales/cirugía , Fístula Intestinal/cirugía , Intestino Delgado/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Adulto , Fuga Anastomótica , Humanos , Enfermedades Intestinales/complicaciones , Masculino , Persona de Mediana Edad , Insuficiencia del Tratamiento
12.
Bone Joint J ; 103-B(2): 391-397, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33517732

RESUMEN

AIMS: Hip reconstruction after resection of a periacetabular chondrosarcoma is complex and associated with a high rate of complications. Previous reports have compared no reconstruction with historical techniques that are no longer used. The aim of this study was to compare the results of tantalum acetabular reconstruction to both historical techniques and no reconstruction. METHODS: We reviewed 66 patients (45 males and 21 females) with a mean age of 53 years (24 to 81) who had undergone acetabular resection for chondrosarcoma. A total of 36 patients (54%) underwent acetabular reconstruction, most commonly with a saddle prosthesis (n = 13; 36%) or a tantalum total hip arthroplasty (THA) (n = 10; 28%). Mean follow-up was nine years (SD 4). RESULTS: There was no difference in the mean age (p = 0.63), sex (p = 0.110), tumour volume (p = 0.646), or type of resection carried out (p > 0.05) between patients with and without reconstruction. Of the original 66 patients, 61 (92%) were ambulant at final follow-up. There was no difference in the proportion of patients who could walk in the reconstruction and 'no reconstruction' groups (p = 0.649). There was no difference in the mean Musculoskeletal Tumor Society (MSTS) score between patients who were reconstructed and those who were not (61% vs 56%; p = 0.378). Patients with a tantalum THA had a significantly (p = 0.015) higher mean MSTS score (78%) than those who were reconstructed with a saddle prosthesis (47%) or who had not been reconstructed (56%). Patients who had undergone reconstruction were more likely to have complications (81% vs 53%; p = 0.033). CONCLUSION: Reconstruction after resection of the acetabulum is technically demanding. In selected cases, reconstruction is of benefit, especially when reconstruction is by tantalum THA; however, the follow-up for these patients remains mid-term. When not feasible, patients with no reconstruction have an acceptable functional outcome. Level of Evidence: Level III Therapeutic. Cite this article: Bone Joint J 2021;103-B(2):391-397.


Asunto(s)
Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/métodos , Neoplasias Óseas/cirugía , Condrosarcoma/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo de Cadera/instrumentación , Femenino , Estudios de Seguimiento , Prótesis de Cadera , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Procedimientos Quirúrgicos Reconstructivos/instrumentación , Estudios Retrospectivos , Tantalio , Resultado del Tratamiento
13.
Bone Joint J ; 103-B(2): 382-390, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33517736

RESUMEN

AIMS: There is an increased risk of dislocation of the hip after the resection of a periacetabular tumour and endoprosthetic reconstruction of the defect in the hemipelvis. The aim of this study was to determine the rate and timing of dislocation and to identify its risk factors. METHODS: To determine the dislocation rate, we conducted a retrospective single-institution study of 441 patients with a periacetabular tumour who had undergone a standard modular hemipelvic endoprosthetic reconstruction between 2003 and 2019. After excluding ineligible patients, 420 patients were enrolled. Patient-specific, resection-specific, and reconstruction-specific variables were studied using univariate and multivariate analyses. RESULTS: The dislocation rate was 9.3% (n = 41). Dislocation was most likely to occur in the first three months after surgery. Four independent risk factors were found, one of which was older age at operation (p = 0.039). The odds ratios (ORs) of those aged ≥ 60 years and 30 to 60 years were 8.50 and 4.64, respectively, compared with those aged < 30 years. The other three risk factors were resection of gluteus maximus (p = 0.010, OR = 5.8), vertical shift of the centre of rotation (COR) of the hip by ≥ 20 mm (p = 0.008, OR = 3.60), and a type I+II+III pelvic resection (p = 0.014, OR = 3.04). CONCLUSION: Hemipelvic endoprosthetic reconstruction after resection of a periacetabular tumour has a dislocation rate of 9.3% (n = 41). Patients are most likely to dislocate in the first three months after surgery. The risk is increased for older patients (especially those aged > 60 years) and for those with gluteus maximus resection, vertical shift of the COR ≥ 20 mm, and a type I+II+III pelvic resection. Cite this article: Bone Joint J 2021;103-B(2):382-390.


Asunto(s)
Acetábulo/cirugía , Neoplasias Óseas/cirugía , Articulación de la Cadera/cirugía , Luxaciones Articulares/etiología , Complicaciones Posoperatorias/etiología , Procedimientos Quirúrgicos Reconstructivos/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Tumor Óseo de Células Gigantes/cirugía , Prótesis de Cadera , Humanos , Luxaciones Articulares/diagnóstico , Luxaciones Articulares/epidemiología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/epidemiología , Procedimientos Quirúrgicos Reconstructivos/instrumentación , Estudios Retrospectivos , Factores de Riesgo , Sarcoma/cirugía , Resultado del Tratamiento
14.
Quintessence Int ; 0(0): 0, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33533237

RESUMEN

OBJECTIVES: In-vitro data have shown that cross-linked hyaluronic acid (HA) enhances the proliferative and migratory properties of cells involved in periodontal wound healing/regeneration, stabilizes the blood clot, reduces the inflammatory response, and facilitates angiogenesis. The aim of this study was to histologically evaluate the effects of cross-linked HA alone or combined with a collagen matrix (CM) on the periodontal wound healing/regeneration in intrabony defects. METHOD AND MATERIALS: Two-wall intrabony defects (5 mm wide, 5 mm deep) were surgically created at the distal and mesial aspects of mandibular premolars in six beagle dogs. The 24 defects were randomly treated as follows: open flap debridement (OFD) + HA, OFD + CM, OFD + HA + CM (HA/CM), and OFD alone (control). At 2 months, the animals were euthanized for histologic evaluation. RESULTS: The HA (2.43 ±â€¯1.25 mm) and HA/CM (2.60 ±â€¯0.99 mm) groups yielded statistically significantly (P < .05) greater formation of new attachment (ie, linear length of new cementum adjacent to newly formed bone, with inserting collagen fibers) compared with the OFD (0.55 ± 0.99 mm) group. Among the four treatment groups, the HA/CM group demonstrated the highest amount of regenerated tissues, although no statistically significant differences in any of the histometric parameters were observed between the HA and HA/CM groups. CONCLUSION: Within their limits, it can be concluded that cross-linked HA alone or combined with CM promotes periodontal wound healing/regeneration in two-wall intrabony defects in dogs.


Asunto(s)
Pérdida de Hueso Alveolar , Procedimientos Quirúrgicos Reconstructivos , Pérdida de Hueso Alveolar/cirugía , Animales , Regeneración Ósea , Colágeno , Perros , Regeneración Tisular Guiada Periodontal , Ácido Hialurónico , Cicatrización de Heridas
15.
BMC Pregnancy Childbirth ; 21(1): 95, 2021 Jan 29.
Artículo en Inglés | MEDLINE | ID: mdl-33514327

RESUMEN

BACKGROUND: A bicornuate uterus often results in infertility. While reconstructive procedures may facilitate pregnancy, spontaneous abortion or serious pregnancy complications may occur. We present a case of a bicornuate uterus with spontaneous conception after Strassman metroplasty; however, life-threatening complications during pregnancy occurred. CASE PRESENTATION: A 38-year-old woman with a history of infertility presented for prenatal care at 6 weeks of gestation. She had conceived spontaneously after four failed in vitro fertilization and embryo transfer (IVF-ET) procedures, Strassman metroplasty for a complete bicornuate uterus, and two postoperative IVF-ET pregnancies that ended in embryo arrest. This pregnancy was uneventful until the patient presented with massive vaginal bleeding at 28 weeks of gestation and was diagnosed with placenta previa and placenta percreta. Bleeding was controlled after emergency Caesarean section and delivery of a healthy neonate. However, severe adhesions were noted as well as a rupture along the metroplasty scar. Two days later, on removal of the intrauterine gauze packing, severe hemorrhage resumed, and the uterus did not respond to oxytocin, hemabate, or carbetocin. Emergency hysterectomy was required. CONCLUSIONS: Reconstructive surgical procedures for complete bicornuate uterus may allow patients to achieve spontaneous pregnancies. However, potential intrapartum complications include placenta implantation and postpartum hemorrhage, and the latter may be exacerbated as the uterus does not contract or respond to oxytocin or prostaglandin drugs. Patients should be counseled on the risks associated with pregnancy after Strassman metroplasty, and clinicians must be aware of potential severe complications.


Asunto(s)
Placenta Accreta/cirugía , Complicaciones del Embarazo/cirugía , Anomalías Urogenitales/cirugía , Hemorragia Uterina/diagnóstico , Útero/anomalías , Útero/cirugía , Aborto Espontáneo/etiología , Adulto , Cesárea/efectos adversos , Femenino , Edad Gestacional , Humanos , Histerectomía , Recién Nacido , Placenta Previa/cirugía , Embarazo , Resultado del Embarazo , Segundo Trimestre del Embarazo , Procedimientos Quirúrgicos Reconstructivos/efectos adversos , Hemorragia Uterina/etiología , Hemorragia Uterina/cirugía
16.
Mymensingh Med J ; 30(1): 101-105, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33397858

RESUMEN

Free flap reconstruction after surgical ablation of head & neck cancer greatly improve the surgical outcome. Microvascular anastomosis is an important part of Microsurgery and it is not widely practiced in every center. A retrospective review was conducted in the Head & Neck Division of Otolaryngology-Head & Neck Surgery Department, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from May 2016 to June 2017. Total 20 patients with head & neck cancer had been treated surgically between this period and 14 patients were reconstructed with free flap. The focus of this study is to establish the surgical outcome, which is more with free flap reconstruction in the patients previously diagnosed as head & neck cancer. We reconstructed 14 cases of oral cavity carcinoma (Stage IV) with the free flap. Majority cases were carcinoma involving the buccal mucosa with retromolar trigone (36%) followed by buccal mucosa (22%), buccal mucosa with lower alveolus (21%), carcinoma tongue with floor of the mouth (14%) and floor of the mouth (7%). Radial forearm freflap (RFFF) were commonly used in 10 cases (71.4%) and Anterolateral thigh flap (ALT) used in four cases (21.5%). Partial flap loss was seen in one case and wound infection occurred in another case but both were managed successfully with postoperative dressing and debridement. Microvascular free flap reconstruction can be a good choice after surgical removal of the head & neck cancer diseases and it should be practiced in every well-equipped tertiary medical center with the help of properly trained surgeon.


Asunto(s)
Colgajos Tisulares Libres , Neoplasias de Cabeza y Cuello , Procedimientos Quirúrgicos Reconstructivos , Bangladesh , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Estudios Retrospectivos , Universidades
17.
Zhonghua Wai Ke Za Zhi ; 59(1): 32-39, 2021 Jan 01.
Artículo en Chino | MEDLINE | ID: mdl-33412631

RESUMEN

Objective: To evaluate the feasibility and efficacy of total hilar en bloc resection and reconstruction(THERR) and portal vein resection and reconstruction(PVRR) in treatment of perihilar cholangiocarcinoma(PHC). Methods: Data of a total of 101 consecutive patients with PHC who underwent bile duct resection with various types of hepatectomies from June 2013 to December 2019 at Department of Hepatopancreatobiliary,Lihuili Hospital were retrospectively analyzed. Patients who underwent PHC resection combined with THERR or PVRR were identified and grouped accordingly. Fourteen patients(6 males, 8 females, aged (64.3±9.7)years old) underwent hepatectomy combined with THERR, 19 patients(11 males, 8 females, aged (63.8±8.6)years old) underwent hepatectomy combined with PVRR. Indications and surgical procedures of THERR and PVRR were reported. The clinicopathological characteristics and operation data, as well as the short and long-term outcomes of patients of the two groups were compared by Student's t-test and the χ2 test or Fisher exact test, respectively. The actual survivals rates were calculated by using the Kaplan-Meier method, and compared using the Log-rank test. Results: There were no statistically significant differences between the two groups in respect to age,sex and whether they had preoperative biliary drainage or not. The types of combined hepatectomy carried out predominately between the two groups were statistically different with the left side being predominant in the THERR group(10/14,P=0.010) and right side in PVRR group(12/19,P=0.001). There were no significant differences between the two groups in respect to whether they received preoperative portal vein embolization,intraoperative blood loss,curative degree,number of lymph node dissections, and whether there was lymphatic metastasis or not. However, both the times of operation and continuous Pringle maneuver were statistically longer in the THERR group((586±158)minutes and (32.5±7.3)minutes)than those in the PVRR group((453±88)minutes and (12.4±3.8)minutes),respectively(t=3.087,P=0.004;t=10.325,P<0.01). One patient in the THERR group died of liver failure 9 days postoperative, the cumulative 1-, 3- and 5-year survival rates were 84.9%, 57.1% and 37.0% for the THERR group and 81.9%, 37.8% and 30.2% for the PVRR group, respectively. There was no statistically significant differences between the two groups(χ²=0.150,P=0.698). Conclusions: Compared to the role of PVRR in the treatment of PHC, THERR is a novel and technically demanding procedure that is feasible in selected patients for the treatment of advanced PHC with invasion of both the hepatic artery and portal vein. However,due to the small size of this primary study,the value of THERR needs further evaluation.


Asunto(s)
Neoplasias de los Conductos Biliares , Procedimientos Quirúrgicos del Sistema Biliar , Colangiocarcinoma , Hepatectomía , Tumor de Klatskin , Procedimientos Quirúrgicos Vasculares , Anciano , Neoplasias de los Conductos Biliares/cirugía , Conductos Biliares Intrahepáticos/cirugía , Procedimientos Quirúrgicos del Sistema Biliar/métodos , Colangiocarcinoma/cirugía , Estudios de Factibilidad , Femenino , Hepatectomía/métodos , Arteria Hepática/cirugía , Humanos , Tumor de Klatskin/cirugía , Masculino , Persona de Mediana Edad , Vena Porta/cirugía , Procedimientos Quirúrgicos Reconstructivos , Estudios Retrospectivos , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/métodos
18.
Anticancer Res ; 41(1): 453-458, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33419843

RESUMEN

BACKGROUND AND AIM: Anastomotic leakage, the most common major complication after esophagectomy, is an important early postoperative complication that results in reoperation, delayed discharge, and psychological and financial distress. The current study focused on gastric conduit blood flow and investigated the relationship between gastric conduit temperature and anastomotic leakage. PATIENTS AND METHODS: Between July 2015 and December 2017, a total of 51 patients aged 38 to 84 years who underwent esophagectomy followed by esophagogastric anastomosis with gastric conduit reconstruction were enrolled. Thermography was then used to measure the temperature of the intact stomach and gastric conduit before anastomosis. RESULTS: The temperature of the planned site of gastric conduit anastomosis was significantly inversely correlated with anastomotic leakage, with the receiver operator characteristic curve showing a cutoff point of 27.6°C for predicting anastomotic leakage. CONCLUSION: The temperature of the planned gastric tube anastomosis line should be kept at 27.6°C or higher to reduce anastomotic leakage.


Asunto(s)
Fuga Anastomótica/diagnóstico , Fuga Anastomótica/etiología , Neoplasias Esofágicas/complicaciones , Esofagectomía/efectos adversos , Complicaciones Posoperatorias/diagnóstico , Procedimientos Quirúrgicos Reconstructivos , Estómago/cirugía , Termografía , Adulto , Anciano , Anciano de 80 o más Años , Temperatura Corporal , Neoplasias Esofágicas/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Pronóstico , Procedimientos Quirúrgicos Reconstructivos/métodos , Estudios Retrospectivos , Termografía/métodos
19.
BMC Surg ; 21(1): 41, 2021 Jan 18.
Artículo en Inglés | MEDLINE | ID: mdl-33461533

RESUMEN

BACKGROUND: Scalp reconstruction is a common challenge for surgeons, and there are many different treatment choices. The "crane principle" is a technique that temporarily transfers a scalp flap to the defect to deposit subcutaneous tissue. The flap is then returned to its original location, leaving behind a layer of soft tissue that is used to nourish a skin graft. Decades ago, it was commonly used for forehead scalp defects, but this useful technique has been seldom reported on in recent years due to the improvement of microsurgical techniques. Previous reports mainly used the crane principle for the primary defects, and here we present a case with its coincidental application to deal with a complication of a secondary defect. CASE REPORT: We present a case of a 75-year-old female patient with a temporoparietal scalp squamous cell carcinoma (SCC). After tumor excision, the primary defect was reconstructed using a transposition flap and the donor site was covered by a split-thickness skin graft (STSG). Postoperatively, the occipital skin graft was partially lost resulting in skull bone exposure. For this secondary defect, we applied the crane principle to the previously rotated flap as a salvage procedure and skin grafting to the original tumor location covered by a viable galea fascia in 1.5 months. Both the flap and skin graft healed uneventfully. CONCLUSIONS: Currently, the crane principle is a little-used technique because of the familiarity of microsurgery. Nevertheless, the concept is still useful in selected cases, especially for the management of previous flap complications.


Asunto(s)
Procedimientos Quirúrgicos Reconstructivos/métodos , Cuero Cabelludo/cirugía , Neoplasias Cutáneas/cirugía , Trasplante de Piel/métodos , Colgajos Quirúrgicos , Anciano , Femenino , Humanos , Procedimientos Quirúrgicos Reconstructivos/efectos adversos , Cuero Cabelludo/anomalías , Neoplasias Cutáneas/patología , Cráneo , Resultado del Tratamiento
20.
Khirurgiia (Mosk) ; (1): 5-14, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33395506

RESUMEN

OBJECTIVE: To analyze the long-term postoperative outcomes in patients with cicatricial tracheal stenosis and to determine the indications for various surgical strategies. MATERIAL AND METHODS: There were 976 patients with benign cicatricial tracheal stenosis for the period 2001-2017. Tracheal stenosis occurred after mechanical ventilation and tracheostomy in 910 (93.2%) patients. Other causes were neck trauma, burns, previous surgery or tuberculosis. Idiopathic stenosis was observed in 41 (4.2%) patients. Multiple-stage reconstructive treatment was possible due to benign nature of disease. There were 2.4 operations per a patient, and 976 patients underwent 2327 procedures. Circular tracheal resection was preferred (n=396). RESULTS: Surgical complications occurred in 107 (4.6%) cases, mortality rate - 0.3%. In long-term period, 42 patients died for various causes. In most cases (n=34, 80.9%), mortality was associated with concomitant diseases or consequences of trauma rather cicatricial tracheal stenosis or its treatment. Eight patients died from cicatricial tracheal stenosis or its treatment (7 patients after staged repair, 1 after circular tracheal resection). Four patients died due to asphyxia following T-tube obturation with a tracheobronchial secret or unjustified decannulation. For various reasons, 41 (6.2%) patients continued their treatment in other hospitals (4 patients died). Mortality rate in this group was 9.8%. Favorable long-term outcome was observed in 90.1% of patients, good and unsatisfactory results - in 7.2% and 1.8% of patients, respectively. Circular tracheal resection ensured better functional outcome. CONCLUSION: Surgical treatment of cicatricial tracheal stenosis is associated with low incidence of postoperative complications and mortality. However, further improvement in long-term results is associated with advanced rehabilitation programs for concomitant diseases. Treatment of cicatricial tracheal stenosis should be carried out at specialized hospitals.


Asunto(s)
Cicatriz/cirugía , Procedimientos Quirúrgicos Reconstructivos , Estenosis Traqueal , Cicatriz/etiología , Constricción Patológica/etiología , Constricción Patológica/cirugía , Humanos , Procedimientos Quirúrgicos Reconstructivos/métodos , Tráquea/cirugía , Estenosis Traqueal/diagnóstico , Estenosis Traqueal/etiología , Estenosis Traqueal/cirugía , Traqueostomía/efectos adversos , Resultado del Tratamiento
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