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1.
Medicine (Baltimore) ; 100(9): e24972, 2021 Mar 05.
Artículo en Inglés | MEDLINE | ID: mdl-33655964

RESUMEN

INTRODUCTION: Vaginal agenesis is a congenital disorder, which can be managed by nonsurgical dilation or surgical reconstruction of the vagina. The sigmoid vaginoplasty procedure is a popular approach, which pulls down part of the sigmoid colon to form a neovagina. One complication of this procedure is introital stenosis. PATIENT CONCERNS: A 55-year-old woman presented to the outpatient general surgery department with severe, persistent abdominal pain. The patient was diagnosed with congenital absence of uterus and vagina, and a sigmoid vaginoplasty was performed 34 years ago. DIAGNOSIS: A pelvic MRI and an abdominal enhanced CT scan were performed, finding that the uterus was absent, and the os of the vagina was closed, forming a closed loop full of fluid. Introital atresia and closed loop of neovaginal colon conduit were diagnosed. INTERVENTIONS: Based on our conclusions and the patient's consent we surgically removed the neovagina. OUTCOMES: After surgery, the abdominal pain was relieved, and the patient reported full recovery during a 6-month follow-up appointment. CONCLUSION: Introital stenosis is one of the long-term complications of sigmoid vaginoplasty procedure. Introital stenosis, leading to introital atresia, is rare but may occur. Surgical removal of neovagina can relieve the pain in patients who do not have the demand of sexual intercourse.


Asunto(s)
Colon Sigmoide/cirugía , Anomalías Congénitas/cirugía , Procedimientos Quirúrgicos Ginecológicos/métodos , Procedimientos Quirúrgicos Reconstructivos/métodos , Estructuras Creadas Quirúrgicamente , Vagina/anomalías , Anomalías Congénitas/diagnóstico , Femenino , Humanos , Imagen por Resonancia Magnética/métodos , Persona de Mediana Edad , Vagina/cirugía
2.
BMC Surg ; 21(1): 140, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33740923

RESUMEN

BACKGROUND: Proximal gastrectomy with double-tract reconstruction (DTR) has been used for upper third gastric cancer as a function-preserving procedure. However, the safety and feasibility of laparoscopic proximal gastrectomy (LPG) with DTR remain uncertain. This study compared open proximal gastrectomy (OPG) with DTR and LPG with DTR for proximal gastric cancer. METHODS: Sixty-four patients who had undergone OPG with DTR and forty-six patients who had undergone LPG with DTR were enrolled in this case-control study. The clinical characteristics, surgical outcomes and postoperative nutrition index were analysed retrospectively. RESULTS: The operation time was significantly longer in the LGP group than in the OPG group (258.3 min vs 205.8 min; p = 0.00). However, the time to first flatus and postoperative hospital stay were shorter in the LPG group [4.0 days vs 3.5 days (p = 0.00) and 10.6 days vs 9.2 days (p = 0.001), respectively]. No significant difference was found between the two groups in the number of retrieved lymph nodes, complications or reflux oesophagitis. The nutrition status was assessed using the haemoglobin, albumin, prealbumin and weight levels from pre-operation to six months after surgery. No significant difference was found between the groups. CONCLUSION: LPG with DTR can be safely performed for proximal gastric cancer patients by experienced surgeons.


Asunto(s)
Gastrectomía , Laparoscopía , Procedimientos Quirúrgicos Reconstructivos , Neoplasias Gástricas , Anciano , Estudios de Casos y Controles , Femenino , Gastrectomía/métodos , Humanos , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Reconstructivos/métodos , Estudios Retrospectivos , Neoplasias Gástricas/cirugía , Resultado del Tratamiento
3.
Ann R Coll Surg Engl ; 103(4): 245-249, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33682428

RESUMEN

Soft tissue reconstruction remains a continuing challenge for plastic and reconstructive surgeons. Standard methods of reconstruction such as local tissue transfer and free autologous tissue transfer are successful in addressing soft tissue cover, yet they do not come without the additional morbidity of donor sites. Autologous fat transfer has been used in reconstruction of soft tissue defects in different branches of plastic surgery, specifically breast and facial defect reconstruction, while further maintaining a role in body contouring procedures. Current autologous fat transfer techniques come with the drawbacks of donor-site morbidity and, more significantly, resorption of large amounts of fat. Advancement in tissue engineering has led to the use of engineered adipose tissue structures based on adipose-derived stem cells. This enables a mechanically similar reconstruct that is abundantly available. Cosmetic and mechanical similarity with native tissue is the main clinical goal for engineered adipose tissue. Development of novel techniques in the availability of natural tissue is an exciting prospect; however, it is important to investigate the potential of cell sources and culture strategies for clinical applications. We review these techniques and their applications in plastic surgery.


Asunto(s)
Tejido Adiposo/trasplante , Trasplante de Células Madre Mesenquimatosas , Células Madre Mesenquimatosas , Procedimientos Quirúrgicos Reconstructivos/métodos , Ingeniería de Tejidos/métodos , Tejido Adiposo/citología , Humanos
4.
Ann R Coll Surg Engl ; 103(4): 278-281, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33682450

RESUMEN

INTRODUCTION: Microvascular reconstruction is the gold standard for reconstruction in oral cavity cancers. Age and comorbidities determine the type of reconstruction. We aimed to analyse the impact of high-risk comorbidities on perioperative morbidity. METHODS: This is a retrospective study of 317 patients undergoing microvascular reconstruction from January 2014 to December 2017. High risk patients were based on age, American Society of Anaesthesiologists (ASA) grade (III/IV) and Charlson comorbidity index (CCI) score >4; overall, 73 out of 317 patients were evaluated. RESULTS: Median age was 59 years. Five patients (6.8%) had complete flap failures and seven (9.5%) had minor complications (wound breakdown, bleeding, wound dehiscence, partial flap loss). ASA score of IV was significantly associated with morbidity while age >65 years and CCI >4 was not associated. The overall flap success rate was 93.2%. CONCLUSIONS: A high-risk population has nearly similar outcomes for microvascular reconstruction as a younger age group. High ASA score adversely affects surgery-related outcomes.


Asunto(s)
Neoplasias de Cabeza y Cuello/cirugía , Microcirugia/métodos , Procedimientos Quirúrgicos Reconstructivos/métodos , Carcinoma de Células Escamosas de Cabeza y Cuello/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Colgajos Quirúrgicos , Resultado del Tratamiento
5.
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
6.
Medicine (Baltimore) ; 100(12): e24330, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761633

RESUMEN

ABSTRACT: This study aimed to investigate the therapeutic effects of osteotomy combined with lateral ligament reconstruction on the osteochondral lesion of patients with talar injuries and varus ankles.Seventy five patients with talar injuries and varus ankles who received osteotomy combined with lateral ligament reconstruction for the osteochondral lesions from June 2008 to December 2014 were retrospectively reviewed. Patients were followed up for 32.4 ±â€Š15.3 months after surgeries, and the AOFAS-AH score, VAS score and SF36 score were determined preoperatively and postoperatively. The iconographic data were compared preoperatively and postoperatively, including tibial anterior surface angle (TAS), TTS, TT, and tibial lateral surface angle (TLS) angles.After surgeries, the AOFAS-AF score increased from 43.2 ±â€Š8.1 to 82.1 ±â€Š5.6, the VAS score decreased from 6.9 ±â€Š2.3 to 1.8 ±â€Š1.5, and the SF36 score increased from 48.7 ±â€Š9.4 to 83.5 ±â€Š6.2. TAS increased from 83.3 ±â€Š5.1 to 90.3 ±â€Š6.1, TTS increased from 70.3 ±â€Š6.1 to 82.5 ±â€Š5.4, TT decreased from 12.9 ±â€Š6.1 to 6.9 ±â€Š5.7, and TLS increased from 76.5 ±â€Š4.1 to 81.2 ±â€Š3.3 (P < .05).Osteotomy combined with lateral ligament reconstruction is effective for the treatment of talar osteochondral lesion with varus ankle, which could relieve the arthritic symptoms induced by cartilage lesions. By correcting the force line on lower limbs and metapedes with osteotomy completely, the treatments on talar osteochondral lesion and lateral ligament reconstruction are the critical factors with better results.


Asunto(s)
Articulación del Tobillo/anomalías , Ligamentos Colaterales/cirugía , Osteotomía/métodos , Procedimientos Quirúrgicos Reconstructivos/métodos , Astrágalo/lesiones , Articulación del Tobillo/cirugía , Cartílago Articular/lesiones , Cartílago Articular/cirugía , Terapia Combinada/efectos adversos , Terapia Combinada/métodos , Desbridamiento/efectos adversos , Desbridamiento/métodos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Osteotomía/efectos adversos , Procedimientos Quirúrgicos Reconstructivos/efectos adversos , Estudios Retrospectivos , Astrágalo/cirugía , Resultado del Tratamiento
7.
BMC Surg ; 21(1): 167, 2021 Mar 28.
Artículo en Inglés | MEDLINE | ID: mdl-33775250

RESUMEN

BACKGROUND: Reconstructions the soft-tissue defects of the distal lower extremities in the elderly patients (≥ 60 years old) are full of challenges because of many comorbidities. The purpose of this study was to report the clinical application of the distally based sural flap in the elderly patients, and to verify the reliability of this flap in the elderly patients. METHODS: Between March of 2005 and December of 2019, 53 patients aged over 60-year-old and 55 patients aged 18 to 30-year-old who underwent the procedure have been included in this study. The reconstruction outcomes, medical-related complications, flap viability-related complications and potential risk factors are compared between the group A (≥ 60 years old) and group B (ranging from 18 to 30 years old). RESULTS: The partial necrosis rate in group A (9.43%) is higher than group B (9.09%), but the difference is not significant (P > 0.05). The constitute ratio of the defects that were successfully covered using the sural flap alone or combining with simple salvage method (i.e., skin grafting) is 96.22% and 98.18% in group A and B, respectively (P > 0.05). The differences of the risk flaps factors that affected the survival of distally based sural flap were not significant between group A and B (P > 0.05). CONCLUSIONS: The distally based sural flap can be effectively used to repair the soft-tissue defect of the lower extremity in the elderly patients. It is safe and reliable to harvest and transfer the flap in one stage, and the delay surgery is not necessary.


Asunto(s)
Extremidad Inferior , Procedimientos Quirúrgicos Reconstructivos , Nervio Sural , Colgajos Quirúrgicos , Adolescente , Adulto , Anciano , Humanos , Extremidad Inferior/lesiones , Extremidad Inferior/cirugía , Persona de Mediana Edad , Procedimientos Quirúrgicos Reconstructivos/métodos , Reproducibilidad de los Resultados , Traumatismos de los Tejidos Blandos/cirugía , Adulto Joven
8.
Bone Joint J ; 103-B(3): 456-461, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33641428

RESUMEN

AIMS: To clarify the effectiveness of the induced membrane technique (IMT) using beta-tricalcium phosphate (ß-TCP) for reconstruction of segmental bone defects by evaluating clinical and radiological outcomes, and the effect of defect size and operated site on surgical outcomes. METHODS: A review of the medical records was conducted of consecutive 35 lower limbs (30 males and five females; median age 46 years (interquartile range (IQR) 40 to 61)) treated with IMT using ß-TCP between 2014 and 2018. Lower Extremity Functional Score (LEFS) was examined preoperatively and at final follow-up to clarify patient-centered outcomes. Bone healing was assessed radiologically, and time from the second stage to bone healing was also evaluated. Patients were divided into ≥ 50 mm and < 50 mm defect groups and into femoral reconstruction, tibial reconstruction, and ankle arthrodesis groups. RESULTS: There were ten and 25 defects in the femur and tibia, respectively. Median LEFS improved significantly from 8 (IQR 1.5 to 19.3) preoperatively to 63.5 (IQR 57 to 73.3) at final follow-up (p < 0.001). Bone healing was achieved in all limbs, and median time from the second stage to bone healing was six months (IQR 5 to 10). Median time to bone healing, preoperative LEFS, or postoperative LEFS did not differ significantly between the defect size groups or among the treatment groups. CONCLUSION: IMT using ß-TCP provided satisfactory clinical and radiological outcomes for segmental bone defects in the lower limbs; surgical outcomes were not influenced by bone defect size or operated part. Cite this article: Bone Joint J 2021;103-B(3):456-461.


Asunto(s)
Trasplante Óseo/métodos , Fosfatos de Calcio/farmacología , Fémur/cirugía , Ilion/trasplante , Procedimientos Quirúrgicos Reconstructivos/métodos , Tibia/cirugía , Adulto , Artrodesis , Desbridamiento , Femenino , Fémur/lesiones , Fémur/patología , Humanos , Japón , Masculino , Persona de Mediana Edad , Polimetil Metacrilato , Estudios Retrospectivos , Tibia/lesiones , Tibia/patología , Cicatrización de Heridas/efectos de los fármacos
9.
J Plast Reconstr Aesthet Surg ; 74(1): 199-202, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33645504

RESUMEN

Coronavirus disease-2019 (COVID-19) is the infectious disease caused by the recently discovered coronavirus, SARS-CoV2. This new virus and disease were unknown before the outbreak began in Wuhan, China, in December 2019. The number of publications with regard to COVID-19-related information is exponentially increasing, but there are also some retracted papers appearing on PubMed, including those retracted from The Lancet Global Health and the New England Journal of Medicine. In a PubMed search for "COVID," there were 1595 articles by April 1, 2020. As of June 30, the number of articles has now reached 25,913. In this editorial, 4 specific areas of information are looked at but the principles apply to many other areas of medicine. The specifics looked at are PPE for tracheostomy, testing for COVID-19, pregnancy and COVID-19, and surgical expectations during redeployment. We must make no mistake that we are seeing a disease that modern medicine has never encountered before. This article is not aimed at belittling or dismissing any of the advice of the Royal Colleges' or PHE advice, but it demonstrates the tsunami of information and the ambiguity that surgeons are experiencing throughout the UK right now. This is unlikely to be the end of progression regarding healthcare planning and development for unencountered viruses9. In the next few months and beyond, there are likely to be adaptions and revisions of more documents advising on various aspects of healthcare with regard to COVID-19 management and for possible future viruses not yet seen by the modern world before.


Asunto(s)
Control de Infecciones , Procedimientos Quirúrgicos Reconstructivos , Servicio de Cirugía en Hospital , /epidemiología , Humanos , Control de Infecciones/instrumentación , Control de Infecciones/métodos , Control de Infecciones/organización & administración , Difusión de la Información , Innovación Organizacional , Procedimientos Quirúrgicos Reconstructivos/métodos , Procedimientos Quirúrgicos Reconstructivos/tendencias , Servicio de Cirugía en Hospital/organización & administración , Servicio de Cirugía en Hospital/tendencias
10.
BMC Surg ; 21(1): 120, 2021 Mar 08.
Artículo en Inglés | MEDLINE | ID: mdl-33685447

RESUMEN

BACKGROUND: Most of the head and neck cancers are time-critical and need urgent surgical treatment. Our unit is one of the departments in the region, at the forefront in treating head and neck cancers in Pakistan. We have continued treating these patients in the COVID-19 pandemic with certain modified protocols. The objective of this study is to share our experience and approach towards head and neck reconstruction during the COVID-19 pandemic. RESULTS: There were a total of 31 patients, 20 (64.5%) were males and 11 (35.4%) patients were females. The mean age of patients was 52 years. Patients presented with different pathologies, i.e. Squamous cell carcinoma n = 26 (83.8%), mucoepidermoid carcinoma n = 2 (6.4%), adenoid cystic carcinoma n = 2 (6.4%) and mucormycosis n = 1 (3%). The reconstruction was done with loco-regional flaps like temporalis muscle flap n = 12 (38.7%), Pectoralis major myocutaneous flap n = 8 (25.8%), supraclavicular artery flap n = 10 (32.2%) and combination of fore-head, temporalis major and cheek rotation flaps n = 1 (3%). Defects involved different regions like maxilla n = 11 (35.4%), buccal mucosa n = 6 (19.3%), tongue with floor of mouth n = 6 (19.3%), mandible n = 4 (12.9%), parotid gland, mastoid n = 3 (9.6%) and combination of defects n = 1 (3%). Metal reconstruction plate was used in 3 (9.6%) patients with mandibular defects. All flaps survived, with the maximum follow-up of 8 months and minimum follow-up of 6 months. CONCLUSION: Pedicled flaps are proving as the workhorse for head and neck reconstruction in unique global health crisis. Vigilant use of proper PPE and adherence to the ethical principles proves to be the only shield that will benefit patients, HCW and health system.


Asunto(s)
Neoplasias de Cabeza y Cuello , Procedimientos Quirúrgicos Reconstructivos , Femenino , Neoplasias de Cabeza y Cuello/cirugía , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Reconstructivos/métodos , Colgajos Quirúrgicos
11.
Orv Hetil ; 162(10): 392-398, 2021 03 07.
Artículo en Húngaro | MEDLINE | ID: mdl-33683219

RESUMEN

Összefoglaló. Bevezetés: Az orrmelléküreg-daganatok kezelésében a legfrissebb nemzetközi ajánlások alapján továbbra is a sebészi reszekció az elsodlegesen választandó módszer. Bár az endoszkópos technikák fejlodésével a külso feltárással járó mutétek bizonyos esetekben háttérbe szorultak, napjainkban még mindig a Weber-Fergusson-féle metszést tartják a legszélesebb feltárást biztosító technikának, annak ellenére is, hogy a módszer stigmatizáló hegeket és deformitásokat hagy a páciensek arcán. Módszer: A "facial degloving" eljárást mint alternatív, hegmentes technikát eloször az 1970-es években publikálták, azóta számos módosítását írták le. A szerzok az orrmelléküregi tumorok eltávolítására már 8 éve kizárólag az általuk módosított technikát alkalmazzák. 2012 és 2019 között Klinikánkon 34 beteg esett át a módosított "facial degloving" mutéten. A módszer alapja egy felso szájpitvari behatolásból a középarc területén kialakított oszteoplasztikus lebeny, melynek felemelésével széles rálátás nyílik az orrüregre és melléküregeire, valamint az elülso koponyaalapra is. A mutéti terület a daganat eltávolítását követoen jó kozmetikai eredménnyel rekonstruálható. Eredmények: A szerzok akusztikus rinometriai vizsgálatokkal és az arckifejezéseket ábrázoló posztoperatív képi dokumentációval támasztották alá eredményeiket. Az operált oldalon sem az orrbemenet beszukülését (orrlégzés gátoltsága), sem pedig az arcmozgás zavarait, az arc aszimmetriáját nem észlelték. Betegeik túlélését Kaplan-Meier-görbén ábrázolták. Megbeszélés, következtetés: Habár az eredeti "facial degloving" technikának számos módosítását publikálták, az itt bemutatott módszer (oszteoplasztikus lebeny, melyben a középarc lágy részeinek integritása megtartott) rövidebb hospitalizációs idot és kevesebb komplikációt eredményezett. A bemutatott módosított "facial degloving" technika véleményünk szerint megfelelo és biztonságos sebészi reszekciót biztosít orrmelléküregi rosszindulatú daganatok esetén, továbbá kombinálható endoszkópos technikákkal, és szükség esetén nyitott mutétté alakítható, akár orbitalis kiterjesztéssel. Orv Hetil. 2021; 162(10): 392-398. INTRODUCTION: The widely used external approach (Weber-Fergusson's incision) for the removal of maxillo-ethmoidal tumors leaves stigmatizing scars and deformities on the patient's face. As an alternative technique, the scarless facial degloving approach was first described in the 1970's, and since then, several modifications have been developed. METHOD: We have been using our modified facial degloving technique for eight years now with maxillo-ethmoidal tumors. Between 2012 and 2019, 34 consecutive patients have been operated with our modified facial degloving approach at the Department of Oto-Rhino-Laryngology and Head-Neck Surgery, University of Szeged, Hungary. We describe our method which provides a wide surgical approach via an osteoplastic flap for the whole nasal and paranasal region, with good cosmetic results. RESULTS AND CONCLUSION: We have evaluated our results with acoustic rhinometry and photo-documentation of the facial mimic postoperatively. Neither narrowing of the nasal cavity on the operated side (loss of nasal breathing function), nor facial movement dysfunction was visible in our patients. We represent our patients' survival in Kaplan-Meier curve. Although several modifications of the original facial degloving approach have been published, in our technique, the novel osteoplastic flap and the intact soft tissue of the nasal and midfacial region results in shorter hospitalization time and fewer complications. Our modified facial degloving technique offers proper and safe surgical resection for tumors of the maxillo-ethmoid region. It can be routinely combined with endoscopic techniques, and, if necessary, can be converted to an open approach. Orv Hetil. 2021; 162(10): 392-398.


Asunto(s)
Cara , Procedimientos Quirúrgicos Reconstructivos , Cara/cirugía , Humanos , Hungría , Procedimientos Quirúrgicos Reconstructivos/métodos , Resultado del Tratamiento
12.
Magy Seb ; 74(1): 3-13, 2021 Mar 16.
Artículo en Inglés | MEDLINE | ID: mdl-33729994

RESUMEN

Összefoglaló. Complex aortaaneurysmáról beszélünk, ha az több, egymástól anatómiailag nem elválasztható aortaszegmentumra terjed, és/vagy az aneurysma egy vagy több életfontosságú mellékág szájadékát is magában foglalja. Kettos vagy többszörös aortaaneurysmák egymástól sebészileg jól szeparálható elváltozásokat jelentenek. Míg a complex elváltozások egy ülésben vagy idoben, egymást néhány nappal követo beavatkozással kezelendok, addig a kettos/többszörös aneurysmák szeparált megoldásokkal uralhatók. E kiterjedt elváltozások kezelése jelentos javallati és technikai kihívásokkal társul. A kezelési lehetoségek széles spektrumával rendelkezünk. Korábban a nagy sebészi traumával, jelentos morbiditással és mortalitással járó nyitott mutétek nagy rizikóval terhelt betegeken siker reményében nem voltak elvégezhetok. Napjainkban a sebészi és endograft technikákkal végzett hybrid mutétek, illetve a tisztán endovascularis megoldások a kiterjedt elváltozások kezelésének javallatát jelentosen kiszélesítették. Dolgozatunkban ismertetjük a lehetséges, és az általunk már alkalmazott technikákat, valamint azokat a lehetoségeket, amelyeket a rohamos technikai fejlodés kínál. Summary. Complex aortic aneurysms extend to more aortic segments, and/or include one or more orifices of highly important side branches. Meanwhile complex aneurysms need reconstructive solutions in one sitting or hybrid procedures timely close to each other, multiple aneurysms can be treated technically and timely separated. Previously, open surgery was the only opportunity to intervene, which was associated with significant surgical trauma and was not suitable for high risk patients when devastating complications were likely. Recently combination of lower risk surgery with endovascular treatment options - the so called hybrid techniques - resulted in that indications for treatment remarkably widened. In addition, permanent technical progress made available pure endovascuar solutions, so a wide range of surgical procedures provide number of options for treatment. In this paper we report on the treatment options of complex aortic aneurysms, and present our own relevant experience.


Asunto(s)
Aneurisma de la Aorta/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Procedimientos Endovasculares , Humanos
13.
Ann R Coll Surg Engl ; 103(3): e106-e108, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33645268

RESUMEN

Transposition scalp flaps are a versatile solution for soft-tissue cover in a multitude of scalp defects. They are frequently used to reconstruct larger skin cancers that involve the outer table of the cranium in addition to covering neurosurgical bony defects and hardware. The transposition flap requires the donor site to be grafted using a split-thickness graft, which results in a secondary wound elsewhere on the body, commonly the lateral thigh. Although quite routine in such surgery, this procedure does require another body area to be prepared and draped. We sought to streamline this procedure with an adjustment to the location of the donor site. In harvesting the graft from the skin of the flap itself, we localised all surgery to one area, which has a number of logistical and patient-care advantages. Our experience has shown significant benefits from this technique and this is now our chosen and recommended donor site for these reconstructions.


Asunto(s)
Neoplasias de Cabeza y Cuello/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Cuero Cabelludo/cirugía , Neoplasias Cutáneas/cirugía , Trasplante de Piel/métodos , Colgajos Quirúrgicos , Sitio Donante de Trasplante , Humanos , Masculino
14.
J Surg Oncol ; 123(5): 1316-1327, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33523514

RESUMEN

Symptomatic peri-acetabular metastatic lesions are often treated with open surgery such as modified Harrington procedures. In an effort to avoid surgical complications inherently associated with open surgical approaches, we developed and recently reported a novel Tripod percutaneous screw technique. The tripod technique is minimally invasive and was found to yield excellent outcomes regarding both pain control and functionality. The procedure is performed in a standard operative theater using fluoroscopic guided percutaneous screws. Despite the simplicity of intraoperative set-up and instrumentation, it is technically demanding. Obtaining the correct fluoroscopic views and troubleshooting intraoperative hurdles can be challenging for even an experienced orthopedic surgeon. The technique and bony conduits were previously described in the trauma literature, however, there are key points of difference in the setting of metastatic disease. Here we provide a compilation of a stepwise graphic guide for the tripod model in the setting of metastatic peri-acetabular lesions, as well as the tips and tricks based on our own experience. These encompass preoperative preparation, operating room settings, intraoperative fluoroscopic guidance, postoperative care, and subsequent conversion to a cemented total hip arthroplasty, if needed.


Asunto(s)
Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/métodos , Neoplasias Óseas/cirugía , Tornillos Óseos , Fijación Interna de Fracturas/métodos , Neoplasias/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Neoplasias Óseas/secundario , Fluoroscopía , Humanos , Neoplasias/patología , Pronóstico
15.
J Surg Oncol ; 123(5): 1304-1315, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33559165

RESUMEN

BACKGROUND: The aims of this study are to evaluate the rate of wrist joint preservation, allograft retention, factors associated with reoperation and to report the patient reported outcomes after osteoarticular allograft reconstruction of the distal radius. METHODS: Retrospective chart review identified 33 patients who underwent distal radius resection followed by osteoarticular allograft reconstruction, including 27 giant cell tumors and 6 primary malignancies. Ten patients with a preserved wrist joint completed the QuickDASH, PROMIS-CA physical function, and Toronto extremity salvage score (TESS) at a median of 13 years postoperatively. RESULTS: The allograft retention rate was 89%, and an allograft fracture predisposed to conversion to wrist arthrodesis. The reoperation rate was 55% and 36% underwent wrist arthrodesis at a median of 4.2 years following index surgery. The use of locking plate fixation was associated with lower reoperation and allograft fracture rates. Patients reported a median QuickDASH of 10.2 (range: 0-52.3), a mean PROMIS physical function of 57.8 (range: 38.9-64.5) and the median TESS was 95.5 (range: 67.0-98.4). CONCLUSION: Osteoarticular allograft reconstruction results in acceptable long-term patient reported outcomes, despite a high revision rate. Allograft fixation with locking plates seems to reduce the number of reoperations and allograft fractures, along with reduction in wrist arthrodesis rates.


Asunto(s)
Neoplasias Óseas/cirugía , Tumor Óseo de Células Gigantes/cirugía , Medición de Resultados Informados por el Paciente , Radio (Anatomía)/cirugía , Procedimientos Quirúrgicos Reconstructivos/métodos , Reoperación/métodos , Articulación de la Muñeca/cirugía , Adulto , Aloinjertos , Artroplastia , Neoplasias Óseas/patología , Femenino , Estudios de Seguimiento , Tumor Óseo de Células Gigantes/patología , Humanos , Masculino , Radio (Anatomía)/trasplante , Estudios Retrospectivos , Articulación de la Muñeca/patología , Adulto Joven
16.
Medicine (Baltimore) ; 100(7): e24693, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-33607809

RESUMEN

RATIONALE: Crouzon syndrome is a craniofacial malformation caused by premature fusion of fibrous sutures in infants. It is one of the most common craniosynostosis syndromes, and surgery is the only effective treatment for correcting it. Postoperative complications such as encephalocele, infections, hematoma have been reported. We herein report a case of a 62-month-old boy with Crouzon syndrome who underwent fronto-orbital advancing osteotomy, cranial vault remolding, and extensive osteotomy and subsequently developed left proptosis and severe chemosis, these complications are rare and we believe it will be of use to clinicians, physicians, and researchers alike. PATIENT CONCERNS: The patient's skull had been malformed since birth, and he had been experiencing paroxysmal headaches coupled with vomiting for 4 months. Having never received prior treatment, he underwent fronto-orbital advancement at our clinic; afterward, left proptosis and severe chemosis occurred. DIAGNOSIS: The patient was diagnosed with Crouzon syndrome, and the complications included left proptosis and severe chemosis, confirmed by the clinical manifestations, physical examination, and computed tomography (CT). INTERVENTION: We carried out cranial vault remodeling and fronto-orbital advancement. We applied ophthalmic chlortetracycline ointment on the conjunctivae, elevated the patient's head, evacuated the hematoma, and carried out a left blepharorrhaphy. OUTCOMES: The proptosis and chemosis resolved with no recurrence. No other complications occurred during the follow-up period (12 months), and CT scans revealed that the hematoma had disappeared. The calvarial vault reshaping was satisfactorily performed, and the patient's vision was not impaired. LESSONS: Severe proptosis and chemosis are rare complications that can occur after fronto-orbital advancement for Crouzon syndrome. A detailed preoperative examination (including magnetic resonance imaging and CT) is essential for diagnosis. Complete hemostasis, evacuation of hematoma, and placement of a periorbital drainage tube during surgery all contribute to an effective treatment plan. An ophthalmic ointment should be administered, and the patient's head should be elevated during the procedure. Evacuation of retrobulbar epidural hematoma and blepharorrhaphy could also help relieve proptosis and chemosis. Our report describes 2 rare complications associated with the treatment for Crouzon syndrome, and we believe it will be of use to clinicians, physicians, and researchers alike.


Asunto(s)
Disostosis Craneofacial/cirugía , Exoftalmia/etiología , Hueso Frontal/cirugía , Procedimientos Quirúrgicos Oftalmológicos/efectos adversos , Órbita/cirugía , Procedimientos Quirúrgicos Reconstructivos/efectos adversos , Preescolar , Disostosis Craneofacial/diagnóstico , Disostosis Craneofacial/patología , Enfermedades de los Párpados/patología , Enfermedades de los Párpados/cirugía , Hueso Frontal/anomalías , Humanos , Masculino , Procedimientos Quirúrgicos Oftalmológicos/métodos , Órbita/anomalías , Osteotomía/métodos , Procedimientos Quirúrgicos Reconstructivos/métodos , Hemorragia Retrobulbar/diagnóstico por imagen , Hemorragia Retrobulbar/cirugía , Cráneo/cirugía , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Trastornos de la Visión/cirugía
17.
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
18.
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
19.
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
20.
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
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