Assuntos
Corticosteroides/administração & dosagem , Antibacterianos/efeitos adversos , Anti-Inflamatórios/administração & dosagem , Úlcera de Buruli/tratamento farmacológico , Úlcera de Buruli/imunologia , Síndrome Inflamatória da Reconstituição Imune/induzido quimicamente , Síndrome Inflamatória da Reconstituição Imune/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Biópsia , Criança , Feminino , Histocitoquímica , Humanos , Masculino , Pessoa de Meia-Idade , Mycobacterium ulcerans/patogenicidade , Pele/patologia , Resultado do Tratamento , Adulto JovemRESUMO
The Cook-Swartz implantable Doppler probe (Cook Medical(®), Cook Ireland Ltd., Limerick, Ireland) has evolved as a useful option for postoperative free flap monitoring. For placement, the probe either is left unattached around the venous pedicle or is secured. In our experience with over 300 applications, we typically secure the cuff with two small microclips, or use fibrin glue. These techniques require redundant silicone cuff for apposition; however, we have encountered some vessels that are of sufficiently large diameter as to not provide enough cuff to employ these methods. The first technique comprises the application of two interrupted sutures through the cuff ends to mimic the technique of microclips. The sutures can be tightened to the desired tension and can be used in cases where the cuff ends are not in direct apposition. A second technique is to excise a segment of silicone cuff and either clip or suture the excised segment to the cuff ends, effectively elongating the cuff diameter. All four techniques (nonattachment, microclip fixation, suture fixation, silicone cuff elongation) have been used effectively, and none have resulted in any complications. Of note, the technique of nonattachment was associated with an increased rate of false-positive results, as migration away from the vessel was postulated to have occurred. There are a range of techniques for attachment of the implantable Doppler probe, and each contributes to the range of options for cuff attachment in difficult cases, with each technique worthwhile in particular settings.
Assuntos
Retalhos de Tecido Biológico/irrigação sanguínea , Monitorização Fisiológica/instrumentação , Procedimentos de Cirurgia Plástica/instrumentação , Ultrassonografia Doppler/instrumentação , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Feminino , Retalhos de Tecido Biológico/efeitos adversos , Rejeição de Enxerto , Sobrevivência de Enxerto , Humanos , Cuidados Intraoperatórios/instrumentação , Cuidados Intraoperatórios/métodos , Masculino , Microcirculação/fisiologia , Microcirurgia/instrumentação , Microcirurgia/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/prevenção & controle , Próteses e Implantes , Procedimentos de Cirurgia Plástica/métodos , Sensibilidade e Especificidade , Técnicas de Sutura , VitóriaRESUMO
We present the first clinical descriptions of immune-mediated paradoxical reactions to effective antibiotic treatment for Mycobacterium ulcerans infection, which result in clinical deterioration after initial improvement. Recognition of this phenomenon could prevent unnecessary changes to antibiotic regimens, and might obviate the need for, or reduce the extent of, further surgery.