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1.
Dermatol Surg ; 50(1): 52-58, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-37994437

RESUMO

BACKGROUND: There are many different autologous grafts used for lip augmentation, such as fat, fascia, or dermofat grafts (DFG). However, filling with synthetic materials such as hyaluronic acid (HA) fillers is the most preferred method. OBJECTIVE: The authors aimed to compare DFG with HA fillers regarding cost, permanence, complication rate, gained volume, and satisfaction rate. The authors investigated the effect of tie-over dressings on the viability of DFG. PATIENTS AND METHODS: Patients who received hyaluronic acid fillers were referred to as Group H. Patients who received grafts without tie-over and with tie-over dressings formed Groups D1 and D2, respectively. The lip index (LI) was used for volume comparisons. The viable area of the grafts was measured using ultrasound imaging. RESULTS: At postoperative month 6, the only significant difference was found between Group D1 and Group D2 ( p < .05). At the postoperative first year, Groups D1 and D2 had a statistically higher LI value compared with Group H. Group D2 had a higher viable area than Group D2 ( p < .05). Group H and Group D2 showed higher satisfaction scores than Group D1 ( p < .05). CONCLUSION: Dermofat grafts with or without tie-over dressings can be considered a reliable and inexpensive choice for patients who seek a more permanent procedure. Tie-over dressings increase the predictability of DFG and reduce the need for overcorrection.


Assuntos
Técnicas Cosméticas , Preenchedores Dérmicos , Humanos , Bandagens , Ácido Hialurônico , Lábio
2.
J Maxillofac Oral Surg ; 22(4): 961-965, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-38105851

RESUMO

Among the rare congenital malformations, congenital nasal sinuses with blind end are extremely unusual. To the best of our knowledge, a sinus located in the midcolumellar region has not been reported yet. Since there is no consensus about the treatment of midcolumellar sinus, to manage the case as individually as possible was our priority. Considering the patient's age, aesthetic concerns, and requirement of septorhinoplasty in the future, the known inverted V incision was modified to provide surgical excision without any extra scar in the midcolumellar line. This report emphasizes a patient-specific treatment of a 15-year-old female patient presented for congenital sinus in the midcolumellar area. Supplementary Information: The online version contains supplementary material available at 10.1007/s12663-023-02032-0.

3.
Artigo em Inglês | MEDLINE | ID: mdl-37578466

RESUMO

Background: There are several factors affecting the results of rhinoplasty, and the predictability of outcomes still remains insufficient. Objective: To associate the rhinoplasty results with patients' age by anthropometric measurements. Methods: Retrospective chart review of patients undergoing rhinoplasty who were divided into decades of age. Anthropometric measurements were carried out using Rhinobase® Software. Wilcoxon t test was used for the postoperative 3 months and 2 years analysis. p values of <0.05 were considered statistically significant. Results: A total of 243 patients (median age: 37.1; M:F = 68:175) were included in the study: group I (19-29 years) n: 80; group II (30-39 years) n:71; group III (40-49 years) n: 48; and group IV (50-61 years) n: 44. In group IV, the highest value of difference (Δ) was seen in the midfacial height with the number of 5.5 ± 1.1 (mm) (<0.001). The values of nasal length, tip projection, and midfacial height parameters showed significant differences in both group III and group IV. Conclusions: Unfavorable age-related changes in long-term postoperative period following rhinoplasty can occur in patients above 40 years of age.

4.
Eur J Trauma Emerg Surg ; 49(5): 2113-2120, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37367969

RESUMO

PURPOSE: One of the most common causes of a failure after replantation and revascularization surgeries is 'no reflow' from proximal artery that occurs, especially following crush and avulsion injuries. In this study, we aimed to evaluate the effect of dobutamine treatment on salvage of replanted and revascularized digits. METHODS: The patients with no reflow phenomenon detected in the salvage operations of replanted/revascularized digits between the years 2017 and 2020 were included in the study. Dobutamine treatment was infused at a rate of 4 µg·kg-1·min-1 intraoperatively and of 2 µg·kg-1 min-1 postoperatively. Demographic data (age, sex), digit survival rate, ischemia time, and level of injury were retrospectively analysed. Pre-infusion, intraoperative and postoperative values of cardiac index (CI), mean arterial pressure (MAP), and heart rate (HR) were recorded. RESULTS: The phenomenon of 'no reflow' was encountered in 35 digits of 22 patients who underwent salvage surgery due to vascular compromise. The survival rate in the revascularization group was 75%, while it was 42.1% in the replanted digits. Metaphysis level of proximal phalanx was the most common localization for 'no reflow' phenomenon. The least values of CI, MAP and HR to obtain sufficient perfusion in salvaged digits were as follows: 4.2 l.min-1.m-2, 76 mm Hg, and 83 beat·min-1, respectively. CONCLUSIONS: It was demonstrated that dobutamine infusion at a rate of 4 µg·kg-1·min-1 intraoperatively and at 2 µg·kg-1·min-1 postoperatively has favorable effects on the vascular compromise derived from no reflow of proximal artery.


Assuntos
Amputação Traumática , Traumatismos dos Dedos , Humanos , Dedos/irrigação sanguínea , Dedos/cirurgia , Amputação Traumática/cirurgia , Dobutamina/uso terapêutico , Traumatismos dos Dedos/tratamento farmacológico , Traumatismos dos Dedos/cirurgia , Estudos Retrospectivos , Reimplante
5.
Ann Plast Surg ; 90(4): 356-362, 2023 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-36921330

RESUMO

PURPOSE: The treatment of Fournier's gangrene (FG) includes aggressive debridement of the affected necrotic area, broad-spectrum antibiotic therapy, and reconstructive procedures, respectively. One of the main reasons of unfavorable outcomes in FG surgery is that the dead space occurs in the perianal region because of destruction of fascias and soft tissues. In this study, we aimed to evaluate the results of gracilis muscle flap transposition to fill the FG-associated perianal dead spaces. METHODS: Patients treated for FG-associated dead spaces in their perianal region between the years 2017 and 2021 were included in the study. The patients who underwent the pedicled gracilis muscle flap surgery were included in group 1, whereas group 2 consisted of the patients with no additional surgical procedure for dead spaces but only the reconstruction of the soft tissue defects. Demographic data (age, sex), comorbid diseases, localization and length of perianal dead space, and management method for the soft tissue defects and complications were noted. The length of hospital stay and discharge day after surgery were also recorded. RESULTS: In group 1, the mean duration of hospital stay was 23.5 ± 5.0 (range, 14-48) days, whereas the mean period between the surgery and discharge was 5.1 ± 2.2 (range, 3-12) days. These numbers were 31 ± 8.3 (range, 19-58) days and 12.7 ± 6.1 (range, 7-22) days in group 2, respectively. Statistical comparison of the periods between the surgery and discharge was found to be significantly different ( P = 0.022). The duration of hospital stay was also shorter in the patients with gracilis muscle flap ( P = 0.039). CONCLUSIONS: Perianal dead spaces accompanying many of the patients with FG provide appropriate conditions for bacterial colonization. Filling these pouches by the gracilis muscle flap prevented the progression of infection and enabled the patients to return to their normal life earlier.


Assuntos
Gangrena de Fournier , Músculo Grácil , Masculino , Humanos , Gangrena de Fournier/microbiologia , Gangrena de Fournier/cirurgia , Tempo de Internação , Períneo , Desbridamento/métodos , Hospitais
6.
Int J Low Extrem Wounds ; 22(2): 339-344, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33939494

RESUMO

Reconstruction of soft tissue defects in the lower extremity due to different etiologies can be a challenging process for surgeons. Compelling reasons for reconstruction include the anatomy of the lower extremity, limited mobility of soft tissues especially the presence of bone, tendon, and neurovascular structures under the defect, and the exposed fixation materials make these defects more complicated. Local fasciocutaneous and muscle flaps are frequently used for the reconstruction of these defects. The patients in our study were with multiple comorbidities such as diabetes mellitus, hypertension, atherosclerosis, and peripheral vascular disease. In this study, with a clinic series consisting of 42 patients (29 male and 13 female), we present a reconstruction with a bipedicled flap as a safe, simple, and efficient reconstructive modality in the treatment of lower extremity soft tissue defects. Except for 1 total flap loss, all defects were successfully reconstructed without any major complications. When reconstruction is performed with a bipedicled flap, the main neurovascular structures are not damaged, free flap and other locoregional flaps can be used as a salvage protocol.


Assuntos
Retalhos de Tecido Biológico , Procedimentos de Cirurgia Plástica , Lesões dos Tecidos Moles , Humanos , Masculino , Feminino , Lesões dos Tecidos Moles/diagnóstico , Lesões dos Tecidos Moles/etiologia , Lesões dos Tecidos Moles/cirurgia , Extremidade Inferior/cirurgia , Extremidade Inferior/lesões , Estudos Retrospectivos , Resultado do Tratamento
7.
Wounds ; 34(10): 245-249, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36219710

RESUMO

INTRODUCTION: Wide excision of affected skin tissue and the apocrine glandular region is the standard treatment for advanced HS. Various flap types have been used for coverage. OBJECTIVE: This study was conducted to assess the use and outcomes of propeller parascapular flaps for unilateral or bilateral axillary defects after excision in patients with advanced axillary HS. MATERIALS AND METHODS: This retrospective case series reports on 11 patients with unilateral (7 patients) or bilateral (4 patients) advanced HS treated with propeller parascapular flap surgery between July 1, 2016, and December 31, 2018. Flap dimensions were measured. Patients were evaluated in terms of 2 main postoperative complications: postoperative recurrence and flap viability. In addition, other complications such as bleeding, infection, dehiscence, contracture, and hypertrophic scarring were noted. RESULTS: The average flap area was 160 cm2. One flap dehisced; no infection, partial necrosis, or total flap loss occurred, and no recurrence was observed. The mean follow-up period was 18 months. At final follow-up, no patient had contractures that caused restricted movement of the shoulder joint. CONCLUSION: Parascapular flaps should be the first choice in patients with advanced HS owing to low donor area morbidity, low recurrence rate, wide rotation arc, and sufficient flap size.


Assuntos
Contratura , Hidradenite Supurativa , Retalho Perfurante , Procedimentos de Cirurgia Plástica , Axila/cirurgia , Contratura/cirurgia , Hidradenite Supurativa/cirurgia , Humanos , Procedimentos de Cirurgia Plástica/métodos , Estudos Retrospectivos , Transplante de Pele/métodos , Retalhos Cirúrgicos
8.
J Hand Surg Asian Pac Vol ; 27(3): 570-573, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35808881

RESUMO

Rubber band syndrome is a condition that usually affects children because of wearing a rubber band on the wrist or the ankle. Depending on the degree of pressure caused by the band, patients may present acutely with ischemia and necrosis of the tissues distal to the bands or chronically with change in shape, oedema, loss of function, sensation and rarely amputation. This condition is very rare in adults and most reports in literature are in patients with cognitive impairment or psychiatric illness. We report 62-year-old lady with a background of a psychiatric illness who presented with an acquired constriction band syndrome affecting multiple digits of both hands. Level of Evidence: Level V (Therapeutic).


Assuntos
Mãos , Punho , Criança , Constrição , Constrição Patológica/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Síndrome
9.
Indian J Plast Surg ; 55(1): 58-65, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-35444759

RESUMO

Aim Several health problems have been reported to be triggered or facilitated by prolonged mask usage during the coronavirus disease 2019 (COVID-19) pandemic. While wearing a face mask, people tend to push their jaws forward and downward in a repetitive manner to hold their masks in the right position; these jaw motions may induce temporomandibular joint disorder (TMD). In this study, we aimed to investigate these repetitive jaw movements while wearing face masks and their effects on TMD. Patients and Methods Patients who applied with TMD signs between June 2020 and May 2021 were evaluated prospectively. A survey using a questionnaire was conducted to define patients with TMD that caused only by mask-related repetitive jaw movements. Demographic data (age and gender), mean duration of daily mask usage, mask type, and magnetic resonance imaging results were recorded. Results Prolonged daily mask usage (≥8 hours/day) was significantly higher in patients with mask-related habits (group a) with a rate of 40.4% ( p ≈ 0.001). Also, in this group, the disc displacement with reduction rate (54.6%) was higher compared with other groups ( p ≈ 0.010). On the contrary, patients with no underlying risk factor (group c) showed an unexpected high osteoarthritis rate ( p ≈ 0.029). Conclusions In this study, we demonstrate that correcting the position of a face mask by repetitive jaw movements can increase the occurrence of TMD. Informing individuals wearing face masks about the risk of TMD and the importance of choosing the appropriate mask size according to the face shape are important issues to be addressed in the near future.

10.
Eur J Trauma Emerg Surg ; 48(5): 3997-4003, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35226113

RESUMO

PURPOSE: Several experimental studies have investigated the effects of hyperbaric oxygen therapy (HBOT) on peripheral nerve regeneration. However, to the best of our knowledge, clinical studies to evaluate the effects of HBOT on peripheral nerve recovery are seldom performed. The aim of our study was to investigate the efficacy of HBOT following primary nerve repair in patients with upper extremity nerve injuries. METHODS: Patients admitted to our hospital between 2015 and 2019 with ulnar and median nerve injuries were included in the study. Patients were randomized based on their application dates and divided into two different groups. Patients who received HBOT following standard epineural nerve repair were included in group 1, while patients who only underwent epineural nerve repair were included in group 2. All patients were followed up at 3, 6, and 12 months post-treatment and evaluated through electroneuromyography analysis of the traumatized nerve, injured nerve-related muscle strength, and two-point discrimination test. RESULTS: Impulse transmission of injured nerves to the end organ was faster in group 1. Further, ENMG parameters demonstrated that injured nerves of patients in group 1 recovered faster. Patients in group 1 also reached higher power score and had significantly more rapid motor recovery than patients in group 2. CONCLUSION: This prospective study of upper extremity injuries demonstrated the favorable effects of HBOT on nerve recovery both clinically and electrophysiologically following nerve repair. One HBOT session each day for 5 days after surgical treatment can decrease morbidity and facilitate recovery.


Assuntos
Traumatismos do Braço , Oxigenoterapia Hiperbárica , Humanos , Nervo Mediano/lesões , Nervo Mediano/cirurgia , Nervos Periféricos/cirurgia , Estudos Prospectivos , Extremidade Superior
11.
J Plast Surg Hand Surg ; 56(2): 103-110, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34151711

RESUMO

Nerve conduits could be used to provide a bridge between both nerve endings. In this study, the tuba uterina of female rats were prepared in a vascularized pedicled flap model and it used as a nerve conduit. The aim was to investigate the effectiveness of a vascularized pedicle nerve conduit and its ciliated epithelium in a sciatic nerve defect. The study was conducted between May and August 2018, and used a total of 60, 14-16-week-old female Wistar albino rats. Six groups were created; Cut and Unrepaired Group, Nerve Graft Group, Flap-Forward Group (Tuba uterina tubular flap, forward direction), Flap-Reversed Group (Tuba uterina tubular flap, reverse direction), Graft-Forward Group (Tuba uterina tubular graft, forward direction) and Graft-Reverse Group (Tuba uterina tubuler graft, reverse direction). Nerve regeneration was evaluated 3 months (90 days) after the surgery by the following methods: (1) Sciatic Functional Index (SFI) measurement, (2) Electromyographic (EMG) assessment, (3) Microscopic assessment with the light microscope and (4) Microscopic assessment with the electron microscope. According to the SFI, EMG and microscopic assessments with the light and electron microscope, it was observed that the transfer of tuba uterina tubular conduit as a graft was statistically better in its effect on nerve regeneration than flap transfer, but also indicated that the direction of the ciliated structures had no significant effect. We believe that as this model is improved with future studies, it will shed light on new models, ideas and innovations about nerve conduits.


Assuntos
Regeneração Nervosa , Nervo Isquiático , Animais , Feminino , Regeneração Nervosa/fisiologia , Ratos , Ratos Sprague-Dawley , Ratos Wistar , Nervo Isquiático/fisiologia , Nervo Isquiático/cirurgia , Retalhos Cirúrgicos
12.
J Hand Surg Am ; 47(7): 686.e1-686.e6, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-34454778

RESUMO

PURPOSE: This study describes the results of the ring finger transfer technique for thumb reconstruction. METHODS: Five fingers of 4 patients aged 23-57 years who presented to our clinic with an amputated thumb between 2017 and 2019 were included in this study. The results were assessed using Disabilities of Arm, Shoulder, Hand (DASH) scoring. Active range of motion, grip and pinch strengths, Kapandji scores, and static 2-point discrimination were measured. RESULTS: The mean age of the patients (3 men, 1 woman) was 37 years (23-57 years). The level of amputation was the proximal phalanx in 3 digits and metacarpal in 2 digits. The average procedure time of was 89 ± 12 minutes. The average follow-up duration was 13 months (12-16 months). There was no total or partial digit necrosis in any patient. The mean preoperative shortened DASH score was 52.5 ± 6.7, and the mean postoperative score was 5.3 ± 6.5. The mean preoperative DASH Work Module score was 81.2 ± 18.8 and the mean postoperative score was 13.8 ± 7.5. Two-point discrimination was normal. CONCLUSIONS: Transfer of the ring finger to reconstruct the amputated thumb is an alternative reconstruction method for patients who do not accept toe-to-thumb and pollicization techniques. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.


Assuntos
Amputação Traumática , Procedimentos de Cirurgia Plástica , Adulto , Amputação Traumática/cirurgia , Anastomose Cirúrgica , Feminino , Dedos/cirurgia , Humanos , Masculino , Procedimentos de Cirurgia Plástica/métodos , Polegar/cirurgia
13.
Skin Appendage Disord ; 7(4): 322-325, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34307483

RESUMO

Primary intraosseous vascular malformations (PIVMs) are rare intraosseous lesions, accounting for approximately 0.5-1% of all intraosseous tumours. In this case report, we aimed to present a rare case of intraosseous vascular malformation causing a large lytic area in the parietal bone. A 25-year-old male patient was admitted to the clinic with a mass on the parietal bone. On physical examination, it was observed that the hair density on the mass was decreased, the mass had a soft consistency, and there was no pain on palpation. The patient was operated under local anaesthesia with a provisional diagnosis of a trichilemmal cyst. However, intraoperative diagnosis was a vascular malformation. There was a 3-cm full-thickness defect on the parietal bone caused by the lesion. The mass was excised completely while preserving the integrity of the dura. The resulting defect was reconstructed with bilateral rotation advancement flaps. The calvarial defect was not reconstructed due to equipment inadequacy. No complications were encountered in the postoperative period. Ninety-three PIVM cases have been reported in the skull since 1845. In very few of these cases, the mass is located in the parietal bone. The pathogenesis of PIVMs is not completely understood. The definitive diagnosis is made by histopathological examination. The therapeutic gold standard is surgery. Surgeons should keep in mind that radiological examination before the operation could prevent undesirable complications.

15.
J Craniofac Surg ; 32(8): e708-e710, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34172677

RESUMO

ABSTRACT: Tessier 30 cleft is a more rare anomaly comparing the other clefts and has variable clinical presentations. According to the literature, there were only 66 cases with Tessier 30 cleft reported since 2007. Furthermore, because of the rarity and variable clinical presentation of this condition, there is no consensus on the mode of management and timing of surgical procedures. In this case, we demonstrated the earlier treatment method of a newborn case with Tessier 30 cleft.


Assuntos
Fenda Labial , Anormalidades Maxilomandibulares , Procedimentos de Cirurgia Plástica , Fenda Labial/cirurgia , Humanos , Recém-Nascido
16.
Aesthet Surg J ; 41(11): NP1421-NP1426, 2021 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-34031694

RESUMO

BACKGROUND: During septorhinoplasty, many different surgical procedures are employed to bring the nose to the desired shape and solve breathing complaints. As a matter of course, intraoperative pain response occurs due to these procedures. OBJECTIVES: With this study, the authors aimed to evaluate the intraoperative pain formed during septorhinoplasty surgery with numerical values and to determine which stage of surgery is more painful. METHODS: Between April 2019 and March 2020, a total of 30 female patients who were planned to undergo septorhinoplasty were included in this prospective study. Standard anesthesia and analgesia were applied to all patients. During surgery, state entropy measure was utilized to evaluate the depth of anesthesia, and Surgical Pleth Index was employed to evaluate the response of the central nervous system to pain "nociception." RESULTS: The age of the patients ranged from 18 to 42 years (average, 25.3 ±â€…6.1 years). The average value of state entropy recorded during the surgery for all patients was found to be 45.43 ±â€…5.37. The mean beginning Surgical Pleth Index value recoded from all of the patients was 23.4 ±â€…8.84 compared with the beginning value; the values recorded during periost dissection, lateral osteotomy, and lower turbinate lateralization were statistically significantly higher (P < 0.005). CONCLUSIONS: Although sufficient depth of anesthesia and standard protocol of analgesia were applied, pain response was found to be significantly higher at some procedures during septorhinoplasty. The authors think that increasing the depth of anesthesia during these procedures will increase the comfort of this operation by inhibiting pain response.


Assuntos
Dor Pós-Operatória , Rinoplastia , Adolescente , Adulto , Feminino , Humanos , Nociceptividade , Manejo da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Estudos Prospectivos , Rinoplastia/efeitos adversos , Adulto Jovem
17.
Wounds ; 33(3): 65-69, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33793411

RESUMO

BACKGROUND: Fournier's gangrene (FG) is a rarely encountered necrotizing fasciitis principally affecting skin and subcutaneous tissues of the genital region, perineum, and abdominal wall. The overall incidence of FG is 1.6 cases per 100 000 per year; the incidence in males is higher. Management techniques described in the literature have both advantages and disadvantages, and there is no gold standard treatment technique. OBJECTIVE: This study evaluated whether the Limberg flap can be used reliably in scrotal defects with fewer complications than are seen with traditional techniques. The results of unilateral or bilateral Limberg flaps for scrotal reconstruction after FG were assessed. MATERIALS AND METHODS: This retrospective, single-center study analyzed records from 29 male patients with scrotal defects after multiple debridements who were treated from January 2013 to January 2018. Twenty-one patients (72.4%) with hemiscrotal defects and 8 patients (27.6%) with defects involving greater than 50% of the scrotal surface were included in this study. Demographic data that were analyzed included smoking history, comorbid conditions, time of surgery, and time of follow-up. Flap dimensions were measured. Patients were evaluated in terms of flap viability and postoperative complications. RESULTS: Mean age was 64 years (range, 47-80 years). The mean follow-up period was 16 months (range, 12-26 months). Dehiscence with seroma were detected in 4 patients (13.7%) on postoperative days 4 and 5. The average size of the flaps was 11 cm × 15 cm. Seroma and dehiscence were encountered in 4 patients (13.7%) during postoperative follow-ups. No postoperative infection was observed in any patient, and no partial or total flap loss was reported. CONCLUSIONS: These results suggest that use of the Limberg flap technique for scrotal reconstruction following FG has the important benefits of being easily harvested while providing tension-free repair and acceptable cosmetic results.


Assuntos
Gangrena de Fournier , Gangrena de Fournier/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Períneo/cirurgia , Estudos Retrospectivos , Escroto/cirurgia , Retalhos Cirúrgicos
18.
Microsurgery ; 41(4): 348-354, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33590499

RESUMO

BACKGROUND: Good sensory outcome in fingertip replantation is a major part of the success of reconstruction and using the finger. Although some sensorial outcomes have been reported in various series in the literature, there is no controlled study, which demonstrates the anatomical levels where nerve repair should or should not be performed. We aimed to assess sensorial outcomes of fingertip amputations with or without nerve coaptation according to amputation level. METHODS: Between January 2013 and July 2018, patients with Tamai Zone 1 and Zone 2 amputations underwent replantation. The patients were divided two main groups. Patients underwent nerve coaptation were grouped as Group 1, and those coaptation not performed as Group 2. In addition, subgroups were designed according to level of the amputation. Tamai zone 1 amputations were grouped as groups 1a and 2a. Tamai zone 2 amputations were grouped as groups 1b and 2b. The mean age was 30.8 ± 30.8 years in Group 1a, 33.2 ± 12.6 years in Group 1b, 34.1 ± 13.6 years in Group 2a, 34.3 ± 11.1 years in Group 2b. Type of injury were evaluated as clean cut (with knife, saw etc.), moderately crushed, and severely crushed and/or avulsion. In Group 1a, one prominent branch of the nerve was repaired, and in Group 1b, the nerve in both side was repaired. The mean duration of replantation in Group 1a was 1 h and 40 min (1 h and 15 min-2 h), whereas this time was 1 h and 15 min (1 h - 1 h and 35 min) in Group 2a. Then, 2 h 15 min (1 h and 55 min-2 h and 50 min) in Group 1b, and 2 h (1 h and 45-2 h 25 min) in Group 2b. Mean age, type of injury and length of follow-up were statistically compared. Sensorial outcome was evaluated by 2-point discrimination test and the Semmes-Weinstein test. RESULTS: According to the Semmes-Weinstein test, 33% of the fingers tested were normal, 58% had diminished light touch, 8% had diminished protective sensation, and 0% had loss of protective sensation in Group 1a; In Group 1b, these values were 35% (7/20), 55% (11/20), 10% (2/20), 0%; in Group 2a, 38% (6/16), 56% (9/16), 6% (1/16), 0%; in Group 2b, 25% (4/16), 44% (7/16), %25 (4/16), 6% (1/16), respectively Mean static two-point discriminations in Groups 1a, 1b, 2a, and 2b were 4.17 ± 0.58, 4.55 ± 0.69, 4.25 ± 0.68, and 5.9 ± 1.26 mm, respectively. The mean follow-up duration was 24 months in Group 1a, 24 months in Group 1b, 26 months in Group 2a, 21 months in Group 2b. Then, 17 (3 in Group 1a, 6 in Group 1b, 4 in Group 2a, 4 in Group 2b) of the 64 fingers were clean cut amputation, 45 (9 in Group 1a, 14 in Group 1b, 11 in Group 2a, 11 in Group 2b) were moderately crushed amputation, and 2 (1 in Group 2a, 1 in Group 2b) were severely crushed and/or avulsion injury. There was no statistically significant difference between groups 1a and 2a (p = .71). On the other hand, there was a statistically significant increase in sensory outcomes of patients in Group 1b compared to Group 2b (p = .009). There was no statistically significant between the groups in terms of mean age, type of injury and length of follow-up. CONCLUSION: We think that nerve repair does not have a positive effect on sensorial recovery in Tamai Zone 1 amputations, but nerve coaptation should be performed in Tamai Zone 2 replantations if possible for better sensorial result.


Assuntos
Amputação Traumática , Traumatismos dos Dedos , Adulto , Amputação Cirúrgica , Amputação Traumática/cirurgia , Traumatismos dos Dedos/cirurgia , Dedos/cirurgia , Humanos , Reimplante , Estudos Retrospectivos
19.
J Plast Surg Hand Surg ; 55(2): 118-122, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33176522

RESUMO

BACKGROUND: In general, capsular contracture is the underlying cause of complications such as pain, stiffening, breast asymmetry, and animation deformity that are seen in the late postoperative period due to the use of silicone breast prostheses. Considering the positive effects of HBO therapy on wound healing, the objective of this study was to investigate the effect of HBO therapy on capsule reaction occurring due to silicone implants. MATERIAL AND METHODS: Rats were divided into four groups. 1 cm × 1 cm silicone implants with rough surface were inserted in subcutaneous plane on the m spinotrapezius muscle fascia at just right of the dorsal region midline in rats in Group 1, while implants with same properties were inserted beneath m spinotrapezius muscle in rats in Group 2.Implants with the same properties were inserted in the subcutaneous area on the m spinotrapezius muscle in rats in Group 3 and into the area under the muscle in rats in Group 4. Beginning from the first postoperative day, rats in Groups 3 and 4 received HBO therapy for 90 min under 2.5 ATM pressure as one session a day over 15 days. RESULTS: The mean capsule thickness was statistically significantly lower in the groups treated with HBO compared to the control groups. Fibroblast, neutrophil and macrophage counts were statistically significantly lower in the groups treated with HBO compared to the control groups. CONCLUSION: We believe that HBO therapy can be used as an adjuvant treatment options to decrease capsule contraction occurring after silicone implant application.


Assuntos
Implantes de Mama/efeitos adversos , Oxigenoterapia Hiperbárica , Contratura Capsular em Implantes/terapia , Animais , Contagem de Células , Modelos Animais de Doenças , Feminino , Fibroblastos/metabolismo , Macrófagos/metabolismo , Neutrófilos/metabolismo , Ratos Wistar , Géis de Silicone
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