RESUMO
An arteriovenous malformation (AVM) is a vascular developmental abnormality conditioned by impaired embryonic morphogenesis and characterized by the development of an abnormal connection between arteries and veins. More than 50% of the total number of patients suffering from this pathology are those having the pathological foci localizing in the area of the head and neck. At present, a combined method is both a generally accepted and the most radical one used for treatment for AVM. However, in the majority of cases, excision of the malformation leaves an extensive and complicated defect of tissues, whose direct closure leads to coarse cicatricious deformities. Over the period from 2004 to 2012, we followed up a total of 37 patients presenting with arteriovenous malformations of the head and neck. At admission the patients underwent preoperative examination including clinical tests, ultrasound duplex scanning, arteriography, MRT, and computed tomography. 24-72 hours prior to the operative intervention the patients were subjected to embolisation of the main vessels supplying the vascular malformation. Excision of the AVM was in 8 cases followed by primary closure of the postoperative wound, in 17 patients the defect was closed by transposition of the axial flaps, and 12 subjects underwent free transplantation of composite complexes of tissues. Relapse of the disease was revealed in 17 patients. In the majority of cases, relapses developed during the first year after the operative intervention (10 cases). The control of the disease's course was obtained in 20 patients. In 8 of the 12 patients with free transplantation of flaps we managed to obtain long-term control over the disease's course (more than 5 years). Hence, free microsurgical transplantation of compound complexes of tissues may be considered as a method of choice for closing the defect after excising an AVM in the area of the head and neck. Replacement of the defect with a well-vascularized tissue complex considerably improves regional haemodynamics, decreases tissue ischaemia, and is capable of providing longterm control over the disease's course.
Assuntos
Malformações Arteriovenosas/terapia , Embolização Terapêutica/métodos , Cabeça/irrigação sanguínea , Pescoço/irrigação sanguínea , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos , Procedimentos Cirúrgicos Vasculares/métodos , Adolescente , Adulto , Angiografia , Malformações Arteriovenosas/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Masculino , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto JovemRESUMO
First experience of the supraclavicular flap transposition for closure of superficial, but extended, defects of the soft tissues in the lower third of face and neck region in 6 patients is presented. In all the patients good functional and cosmetic result was achieved.
Assuntos
Face/cirurgia , Pescoço/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Retalhos Cirúrgicos , Adulto , Face/irrigação sanguínea , Feminino , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço/irrigação sanguínea , Necrose , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos/patologia , Resultado do Tratamento , Malformações Vasculares/cirurgiaRESUMO
Pathogenetically substantiated approach, using surgical, laser and echosclerosing methods, was applied for improvement of the treatment results in patients, suffering venous forms of the inborn vascular malformations of the lower extremities. The results of examination and treatment in 2006-2009 period were analyzed in 98 patients. The stem malformations with superficial venous system affection was diagnosed in 59 (60.2%) patients, the same with a deep venous system affection--in 27 (27.6%), the extrastem affections--in 7 (7.1%) and the combined malformations--in 5 (5.1%). There was differential tactics of the surgical treatment used together with combination of original surgical procedures, newest laser methods and sclerotherapy, which have permitted to achieve satisfactory late results in 73 (74.5%) patients. Poor results in 25 (25.5%) patients were caused by the pathological process spread and proliferative activity of malformation, what was confirmed by immunohistochemical and morphological investigations data.
Assuntos
Extremidade Inferior/irrigação sanguínea , Malformações Vasculares , Procedimentos Cirúrgicos Vasculares/métodos , Veias/anormalidades , Adolescente , Adulto , Criança , Endotélio Vascular/metabolismo , Endotélio Vascular/patologia , Procedimentos Endovasculares/métodos , Feminino , Humanos , Fotocoagulação a Laser/métodos , Extremidade Inferior/diagnóstico por imagem , Extremidade Inferior/cirurgia , Masculino , Músculo Liso Vascular/diagnóstico por imagem , Músculo Liso Vascular/patologia , Músculo Liso Vascular/cirurgia , Antígeno Nuclear de Célula em Proliferação/biossíntese , Fluxo Sanguíneo Regional/fisiologia , Escleroterapia/métodos , Resultado do Tratamento , Ultrassonografia , Receptor 2 de Fatores de Crescimento do Endotélio Vascular/biossíntese , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/patologia , Malformações Vasculares/cirurgia , Veias/diagnóstico por imagem , Veias/patologia , Veias/cirurgia , Adulto JovemRESUMO
Results of treatment of 19 patients, suffering vascular malformation of the head region, were analyzed. Application of a new highly informative diagnostic methods of surgical intervention differential methods have promoted significant clinical improvement.
Assuntos
Cabeça , Procedimentos de Cirurgia Plástica/métodos , Malformações Vasculares/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Embolização Terapêutica , Feminino , Cabeça/anormalidades , Cabeça/irrigação sanguínea , Cabeça/cirurgia , Humanos , Masculino , Microcirurgia , Pessoa de Meia-Idade , Retalhos Cirúrgicos , Resultado do Tratamento , Malformações Vasculares/diagnóstico , Malformações Vasculares/etiologiaRESUMO
Diagnosis and treatment of the inborn angiodysplasia constitutes the complex problem of vascular surgery. Of the multiple causes, conditioned by such the state of the issue, it is necessary to stress such as unsatisfactory knowledge of physician, the absence of strict diagnostic criterions, the attempts of the pathology elimination by specialists of various disciplines. The aim of the investigation was to determine the principal clinical and ultrasonographic criterions, permitting to reveal vascular malformation rapidly and objectively, to differentiate its type, the spreading, to characterize hemodynamical disorders.
Assuntos
Malformações Arteriovenosas/diagnóstico por imagem , Vasos Sanguíneos/diagnóstico por imagem , Hemodinâmica/fisiologia , Ultrassonografia Doppler em Cores , Adolescente , Adulto , Malformações Arteriovenosas/fisiopatologia , Circulação Sanguínea/fisiologia , Vasos Sanguíneos/anormalidades , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
The data on examination and surgical treatment of 35 patients, suffering severe forms of varicose disease in stage of trophic disorders occurrence and with an acute thrombophlebitis are adduced. The concept of an active surgical help, including thromboembolic complications prophylaxis, depending on thrombophlebitis localization, correction of the venous hemodynamics disorders and the staged closure of trophic ulcer is substantiated. Introduction of the proposed tactics had permitted to achieve satisfactory outcomes, including the trophic ulcer healing and the trophic disorders regression in all the patients operated on.
Assuntos
Tromboembolia/prevenção & controle , Tromboflebite/diagnóstico , Tromboflebite/cirurgia , Varizes/diagnóstico , Varizes/cirurgia , Procedimentos Cirúrgicos Vasculares , Doença Aguda , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Tromboflebite/complicações , Úlcera Varicosa/etiologia , Úlcera Varicosa/cirurgia , Varizes/complicaçõesRESUMO
Results have been analysed of comprehensive evaluation of 175 patients with discirculatory encephalopathy of atherosclerotic genesis, consisting of inspection of the neck vessels projection, study of neurological status, ultrasonic investigation of the major brain arteries structure and hemodynamics, their angiographic features. At stage I discirculatory encephalopathy subjective complaints predominated, being caused by syndrome of thoracic outlet, steal syndrome, stenosing lesions of brachiocephalic arteries. Encountered more frequently in the middle-aged and elderly patients were affections of several major brain arteries. Specific weight of correlation between ultrasonic investigation and angiography in stenosing lesions of brachiocephalic arteries in patients with discirculatory encephalopathy constituted 84-100%. Therefore patients with discirculatory encephalopathy of atherosclerotic genesis require ultrasonic investigation of brachiocephalic arteries with the purpose of finding out exactly the pathological process and choosing the tactics of treatment.