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1.
Handchir Mikrochir Plast Chir ; 51(6): 418-423, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31698485

RESUMO

The profitability of medical treatment has gained increasing importance in health politics and likewise has become a considerable part of a microsurgeon's daily practice. The resulting cost pressure leads to microsurgeons having to justify their often complex and expensive treatments against hospital providers and health insurances. In this position paper of the German Speaking Group for Microsurgery of Peripheral Nerves and Vessels, we analyze the current status of profitability of microsurgical extremity and breast reconstruction, and its impact on choice of therapy and residency training. We specifically highlight the available literature, that shows often reduced long-term treatment costs after microsurgical reconstruction in comparison to cheaper initial treatments. The statements are based on a consensus workshop on the 40th meeting of the DAM in Lugano, Switzerland.


Assuntos
Microcirurgia , Procedimentos Cirúrgicos Reconstrutivos , Cirurgia Plástica , Internato e Residência , Mamoplastia/economia , Microcirurgia/economia , Microcirurgia/métodos , Nervos Periféricos/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/economia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Suíça
2.
Artigo em Alemão | MEDLINE | ID: mdl-31533154

RESUMO

The aim of this study was to describe our results and experience with end-to-side venous anastomosis using a coupler device in microvascular free flaps.

3.
Plast Reconstr Surg Glob Open ; 7(3): e2148, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31044119

RESUMO

In autologous breast reconstruction, the internal mammary artery (IMA) and internal mammary vein (IMV) are the standard recipient vessels. Recently, the perforator vessels of the IMA and IMV were found to be a safe alternative as recipient vessels cause less morbidity and allow adequate flap. We describe 2 cases in which the IMA and IMV perforators were used as additional recipient vessels to overcome intraoperatively occurred complications. The IMA and IMV perforators have some advantages over the IMA/IMV: (1) the dissection is done superficially and directly from the mastectomy site. Flap positioning is facilitated. (2) There is no need to remove a rib, which reduces postoperative pain and possible contour deformities. (3) Possible injuries to the pleura are avoided. (4) The IMA is spared for possible cardiac revascularization. Disadvantages can be that (1) the IMA perforators are not always present with the required caliber, (2) the position of the perforators is not suitable to adequately position the flap, and (3) dissection of the IMA perforators and their anastomoses has a learning curve. In the presented cases, the IMA and IMV perforators have proven to offer a simple solution to avoid complications. The additional dissection is done from the same recipient site, and there is no further dissection or incision necessary at the axilla or to explore the cephalic vein. This keeps morbidity and operation time low. Therefore, we suggest keeping the IMA and IMV perforators in mind not only as primary recipient vessels but also as a possible solution for intraoperatively occurred complications.

4.
Handchir Mikrochir Plast Chir ; 50(2): 111-117, 2018 04.
Artigo em Alemão | MEDLINE | ID: mdl-29672783

RESUMO

BACKGROUND: Thermography permits non-invasive examination and presentation of cutaneous temperature differences. When planning microvascular flaps, thermography may illustrate these differences and may portray patterns of blood circulation near to perforators. As an additional tool, thermography may enhance quality and diversity in free flaps. PATIENTS AND METHODS: In this prospective study, we examined 10 patients with 13 free DIEP-flaps for breast reconstruction. With smartphone-based thermography, we analysed preoperative abdominal "hot spots" of skin circulation (entrance of perforators). The results were compared with preoperative computed tomographic angiography (CTA) and intraoperative anatomical findings. RESULTS: Thermography was succesfully performed on all patients. Areas of perfusion were reliably shown in the raised area ("hot spot"). Each perforator selected by thermography was also selected for the DIEP free flap on the basis of intraoperative findings. Moreover, the identified main perforators were identical to perforators found at the CTA. CONCLUSION: Smartphone-based thermography provides an easy, rapid and non-invasive method to present cutaneous differences in temperature. "Hot spots" can reliably illustrate the entrance of perforators. When selecting a suitable perforator, thermography provides additional information for imaging perforator-based flaps.


Assuntos
Mamoplastia , Retalho Perfurante , Smartphone , Termografia , Feminino , Humanos , Estudos Prospectivos , Termografia/métodos , Tomografia Computadorizada por Raios X
6.
Dtsch Arztebl Int ; 113(15): 269, 2016 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-27151465
7.
Exp Ther Med ; 11(5): 1685-1699, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-27168790

RESUMO

The present study was conducted to investigate the effects of minocycline on the expression of selected transcriptional and translational profiles in the rat spinal cord following sciatic nerve (SNR) transection and microsurgical coaptation. The mRNA and protein expression levels of B cell lymphoma-2 (Bcl-2), Bcl-2-associated X protein (Bax), caspase-3, major histocompatibility complex I (MHC I), tumor necrosis factor-α (TNF-α), activating transcription factor 3 (ATF3), vascular endothelial growth factor (VEGF), matrix metalloproteinase 9 (MMP9), and growth associated protein-43 (GAP-43) were monitored in the rat lumbar spinal cord following microsurgical reconstruction of the sciatic nerves and minocycline treatment. The present study used semi-quantitative reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry. As a PCR analysis of spinal cord tissue enabled the examination of the expression patterns of all cell types including glia, the motorneuron-like NSC-34 cell line was used to investigate expression level changes in motorneurons. As stressors, oxygen glucose deprivation (OGD) and lipopolysaccharide (LPS) treatment were performed. SNR did not induce significant degeneration of ventral horn motorneurons, whereas microglia activation and synaptic terminal retraction were detectable. All genes were constitutively expressed at the mRNA and protein levels in untreated spinal cord and control cells. SNR significantly increased the mRNA expression levels of all genes, albeit only temporarily. In all genes except MMP9 and GAP-43, the induction was seen ipsilaterally and contralaterally. The effects of minocycline were moderate. The expression levels of MMP9, TNF-α, MHC I, VEGF, and GAP-43 were reduced, whereas those of Bax and Bcl-2 were unaffected. OGD, but not LPS, was toxic for NSC-34 cells. No changes in the expression levels of Bax, caspase-3, MHC I or ATF3 were observed. These results indicated that motorneurons were not preferentially or solely responsible for SNR-mediated upregulation of these genes. MMP9, TNF-α, VEGF and Bcl-2 were stress-activated. These results suggest that a substantial participation of motorneurons in gene expression levels in vivo. Minocycline was also shown to have inhibitory effects. The nuclear factor-κB signalling pathway may be a possible target of minocycline.

8.
Plast Reconstr Surg Glob Open ; 4(12): e1144, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28293504

RESUMO

BACKGROUND: The usage of internal mammary artery perforators (IMAPs) has been described in autologous breast reconstruction although IMAPS are not yet considered standard recipient vessels. It remains unclear if these vessels can be safely used in large flaps after radiation therapy or in delayed breast reconstruction. METHODS: Over a 2-year period, 515 free flaps for autologous breast reconstruction were performed on 419 patients by 2 surgeons (S1 and S2). In a retrospective analysis, time of reconstruction, ischemia time, flap weight, diameter of couplers, and complications were analyzed. All 515 flaps were compared in a subset with regard to the 2 surgeons: S1 who always used the IMA as a recipient vessel and S2 who attempted IMAP use if possible. RESULTS: Of all 515 flaps, 424 were abdominal flaps and 91 flaps were from the upper thigh. Three hundred six cases were immediate reconstructions, and 112 were delayed reconstructions. In 97 cases, implants were converted to autologous tissue. In 112 cases, the IMAPs were used; of these, 82 were immediate and 17 were delayed reconstructions, and in 13 cases, implants were removed. Thirty-five percent of all anastomoses to IMAPs had previous radiation therapy. The flap failure rate was 1.9%. In none of these cases, the IMAPs were used. S1 never used the IMAP, and S2 used the IMAP in 37% of all of his flaps. CONCLUSIONS: IMAPs were safely used in all kinds of reconstructions and after radiation therapy, with no flap failure or negative effects on mastectomy skin flap perfusion. Using the IMAPs as recipient vessels is a further step toward simplifying microsurgical breast reconstruction.

9.
Exp Cell Res ; 327(2): 234-55, 2014 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-24997385

RESUMO

Although the peripheral nervous system is capable of regeneration, this capability is limited. As a potential means of augmenting nerve regeneration, the effects of cerebrolysin (CL)--a proteolytic peptide fraction--were tested in vitro on the motor-neuron-like NSC-34 cell line and organotypic spinal cord cultures. Therefore, NSC-34 cells were subjected to mechanical stress by changing media and metabolic stress by oxygen glucose deprivation. Afterwards, cell survival/proliferation using MTT and BrdU-labeling (FACS) and neurite sprouting using ImageJ analysis were evaluated. Calpain-1, Src and α-spectrin protein expression were analyzed by Western blot. In organotypic cultures, the effect of CL on motor neuron survival and neurite sprouting was tested by immunohistochemistry. CL had a temporary anti-proliferative but initially neuroprotective effect on OGD-stressed NSC-34 cells. High-dosed or repeatedly applied CL was deleterious for cell survival. CL amplified neurite reconstruction to limited extent, affected calpain-1 protein expression and influenced calpain-mediated spectrin cleavage as a function of Src expression. In organotypic spinal cord slice cultures, CL was not able to support motor neuron survival/neurite sprouting. Moreover, it hampered astroglia and microglia activities. The data suggest that CL may have only isolated positive effects on injured spinal motor neurons. High-dosed or accumulated CL seemed to have adverse effects in treatment of spinal cord injury. Further experiments are required to optimize the conditions for a safe clinical administration of CL in spinal cord injuries.


Assuntos
Aminoácidos/farmacologia , Diferenciação Celular/efeitos dos fármacos , Neurônios Motores/efeitos dos fármacos , Fármacos Neuroprotetores/farmacologia , Medula Espinal/efeitos dos fármacos , Animais , Western Blotting , Calpaína/metabolismo , Proliferação de Células/efeitos dos fármacos , Células Cultivadas , Imunofluorescência , Técnicas Imunoenzimáticas , Camundongos , Neurônios Motores/citologia , Neurônios Motores/metabolismo , Regeneração Nervosa/efeitos dos fármacos , Neuritos/metabolismo , Técnicas de Cultura de Órgãos , Espectrina/metabolismo , Medula Espinal/citologia , Medula Espinal/metabolismo , Quinases da Família src/metabolismo
10.
Acta Histochem ; 116(5): 820-30, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24636538

RESUMO

Although the peripheral nervous system (PNS) is capable of regeneration, these processes are limited. As a potential means to augment PNS regeneration, the effects of cerebrolysin (CL), a proteolytic peptide fraction, were tested in vitro on Schwann cell (SC) proliferation, stress resistance, phagocytic and cluster-forming capacity. Primary SC/fibrocyte co-cultures were prepared from dorsal root ganglia of 5-7-day-old rats. SCs were subjected to mechanical stress by media change and metabolic stress by serum glucose deprivation (SGD). Cell survival was assessed using MTT test. SC proliferation was determined by counting BrdU-labeled cells. SC clustering was studied by ImageJ analysis of S100 immunostaining. Wallerian degeneration (WD) was evaluated by measuring acetylcholine-esterase staining within sciatic nerves in vitro. It was found that CL caused no effect on MTT turnover in the tested doses. CL inhibited SC proliferation in a dose-dependent manner. Media change and additional SGD stress inhibited SC clustering. CL enhanced the reorganization of SC clusters and was able to counteract SGD-induced cluster defects. Moreover, CL accelerated WD in vitro. CL was able to enhance the functions of SCs that are relevant to nerve regeneration. Thus, our findings suggest that CL may be suitable for therapeutic usage to enhance PNS regeneration/reconstruction.


Assuntos
Aminoácidos/farmacologia , Células de Schwann/efeitos dos fármacos , Animais , Proliferação de Células/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Células Cultivadas , Fármacos Neuroprotetores/farmacologia , Ratos , Estresse Mecânico
11.
PLoS One ; 8(9): e74704, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24058622

RESUMO

INTRODUCTION: Diabetic foot ulcers occur in approximately 2,5% of patients suffering from diabetes and may lead to major infections and amputation. Such ulcers are responsible for a prolonged period of hospitalization and co- morbidities caused by infected diabetic foot ulcers. Small, superficial ulcers can be treated by special conservative means. However, exposed bones or tendons require surgical intervention in order to prevent osteomyelitis. In many cases reconstructive surgery is necessary, sometimes in combination with revascularization of the foot. There are studies on non surgical treatment of the diabetic foot ulcer. Most of them include patients, classified Wagner 1-2 without infection. Patients presenting Wagner 3D and 4D however are at a higher risk of amputation. The evolution of microsurgery has extended the possibilities of limb salvage. Perforator based flaps can minimize the donorsite morbidity. PATIENTS AND METHODS: 41 patients were treated with free tissue transfer for diabetic foot syndrome and chronic defects. 44 microvascular flaps were needed. The average age of patients was 64.3 years. 18 patients needed revascularization. 3 patients needed 2 microvascular flaps. In 6 cases supramicrosurgical technique was used. RESULTS: There were 2 flap losses leading to amputation. 4 other patients required amputation within 6 months postoperatively due to severe infection or bypass failure. Another 4 patients died within one year after reconstruction. The remaining patients were ambulated. DISCUSSION: Large defects of the foot can be treated by free microvascular myocutaneous or fasciocutaneous tissue transfer. If however, small defects, exposing bones or tendons, are not eligible for local flaps, small free microvascular flaps can be applied. These flaps cause a very low donor site morbidity. Arterialized venous flaps are another option for defect closure. Amputation means reduction of quality of life and can lead to an increased mortality postoperatively.


Assuntos
Amputação , Pé Diabético/cirurgia , Microcirurgia , Úlcera/cirurgia , Procedimentos Cirúrgicos Vasculares , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Humanos , Cuidados Intraoperatórios , Masculino , Microcirurgia/efeitos adversos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Retalhos Cirúrgicos/irrigação sanguínea , Procedimentos Cirúrgicos Vasculares/efeitos adversos
12.
PLoS One ; 8(8): e73422, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23967343

RESUMO

BACKGROUND: Minocycline, a second-generation tetracycline antibiotic, exhibits anti-inflammatory and neuroprotective effects in various experimental models of neurological diseases, such as stroke, Alzheimer's disease, amyotrophic lateral sclerosis and spinal cord injury. However, conflicting results have prompted a debate regarding the beneficial effects of minocycline. METHODS: In this study, we analyzed minocycline treatment in organotypic spinal cord cultures of neonatal rats as a model of motor neuron survival and regeneration after injury. Minocycline was administered in 2 different concentrations (10 and 100 µM) at various time points in culture and fixed after 1 week. RESULTS: Prolonged minocycline administration decreased the survival of motor neurons in the organotypic cultures. This effect was strongly enhanced with higher concentrations of minocycline. High concentrations of minocycline reduced the number of DAPI-positive cell nuclei in organotypic cultures and simultaneously inhibited microglial activation. Astrocytes, which covered the surface of the control organotypic cultures, revealed a peripheral distribution after early minocycline treatment. Thus, we further analyzed the effects of 100 µM minocycline on the viability and migration ability of dispersed primary glial cell cultures. We found that minocycline reduced cell viability, delayed wound closure in a scratch migration assay and increased connexin 43 protein levels in these cultures. CONCLUSIONS: The administration of high doses of minocycline was deleterious for motor neuron survival. In addition, it inhibited microglial activation and impaired glial viability and migration. These data suggest that especially high doses of minocycline might have undesired affects in treatment of spinal cord injury. Further experiments are required to determine the conditions for the safe clinical administration of minocycline in spinal cord injured patients.


Assuntos
Antibacterianos/farmacologia , Minociclina/farmacologia , Neurônios Motores/efeitos dos fármacos , Neuroglia/efeitos dos fármacos , Neuroglia/metabolismo , Medula Espinal/efeitos dos fármacos , Animais , Antibacterianos/toxicidade , Técnicas de Cultura de Células , Movimento Celular/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Técnicas de Cocultura , Minociclina/toxicidade , Técnicas de Cultura de Órgãos , Ratos , Fatores de Tempo
13.
Ann Plast Surg ; 71(5): 533-7, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22868328

RESUMO

The internal mammary artery (IMA) is the standard recipient vessel for autologous breast reconstruction. To save the IMA for bypass surgery, to keep flap pedicles short, and to allow better flap positioning, the IMA perforators were used. Forty-six flaps for immediate breast reconstructions were performed in 39 patients. In the first 22 patients, the decision to use the perforators was clinically based. In the second group of 17 patients, all patients received a thoracic computed tomographic angiography (CTA) to determine the perforators. In 13 flaps (6 deep inferior epigastric artery perforator, 3 superficial inferior epigastric artery, and 4 transverse myocutaneous gracilis), the perforators were used as recipient vessels. Of these flaps, 5 were anastomosed to perforators before the CTA was applied and 8 after the CTA was established. The CTA revealed the IMA and the perforators in detail. In immediate reconstructions, the IMA perforators can be used as recipient vessels. They allow better flap positioning for superficial inferior epigastric artery and transverse myocutaneous gracilis flaps in particular; moreover, it decreases donor site and recipient site morbidity. After introducing the CTA, the perforators were used more frequently for anastomosis.


Assuntos
Mamoplastia/métodos , Artéria Torácica Interna/diagnóstico por imagem , Artéria Torácica Interna/cirurgia , Retalho Perfurante/irrigação sanguínea , Adulto , Angiografia/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Transplante Autólogo , Resultado do Tratamento , Cicatrização/fisiologia
14.
Restor Neurol Neurosci ; 30(6): 463-79, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22596354

RESUMO

PURPOSE: The regeneration of adult peripheral nerves is a complex, multi-step process that is often incomplete, resulting in pain and/or loss of muscle innervation. Success is based on a fine-tuned interplay of neurons, Schwann cells, fibrocytes and macrophages realizing Wallerian degeneration, fiber regrowth and revascularization. Following trauma, the nerves distal to the injury site undergo Wallerian degeneration, an event that includes the phagocytosis of debris and the formation of Schwann cell scaffolds that guide the sprouting nerve fibers. The actin cytoskeleton is critical to all of these processes; therefore, activators of the cytoskeleton such as Rho GTPases and RhoGEFS such as Vav2 and Vav3 represent attractive targets for therapeutic intervention. METHODS: Sciatic nerve segments were surgically resected and reconstructed, and the degenerative/regenerative outcomes were compared in wild-type and Vav2/3 double knockout mice. RESULTS: Vav2/3 knockout nerves showed delayed Wallerian degeneration and revascularization, a broadly control-like morphometry of the regenerated nerves including remyelination, and contradictory motor function recovery, whereby impaired toe spreading was accompanied by enhanced muscle weight recreation. CONCLUSIONS: The data suggest that Vav2 and Vav3 are required for normal peripheral nerve degeneration/regeneration, revascularization and functional recovery. Functional redundancy, compensatory mechanisms, and muscle (pseudo)hypertrophy, however, impede the understanding of and intervention in Vav-mediated processes.


Assuntos
Regeneração Nervosa/fisiologia , Proteínas Proto-Oncogênicas c-vav/genética , Neuropatia Ciática/genética , Neuropatia Ciática/fisiopatologia , Animais , Feminino , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Placa Motora/fisiologia , Destreza Motora/fisiologia , Músculo Esquelético/irrigação sanguínea , Músculo Esquelético/inervação , Músculo Esquelético/fisiologia , Neovascularização Fisiológica/fisiologia , Fibras Nervosas Mielinizadas/fisiologia , Proteínas Proto-Oncogênicas c-vav/deficiência , Recuperação de Função Fisiológica/fisiologia , Nervo Isquiático/irrigação sanguínea , Nervo Isquiático/fisiopatologia , Nervo Isquiático/cirurgia , Neuropatia Ciática/cirurgia , Degeneração Walleriana/genética , Degeneração Walleriana/fisiopatologia , Degeneração Walleriana/cirurgia
15.
BMC Neurosci ; 13: 32, 2012 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-22439862

RESUMO

BACKGROUND: Magnetic nanoparticles (MNPs) offer a large range of applications in life sciences. Applications in neurosciences are one focus of interest. Unfortunately, not all groups have access to nanoparticles or the possibility to develop and produce them for their applications. Hence, they have to focus on commercially available particles. Little is known about the uptake of nanoparticles in primary cells. Previously studies mostly reported cellular uptake in cell lines. Here we present a systematic study on the uptake of magnetic nanoparticles (MNPs) by primary cells of the nervous system. RESULTS: We assessed the internalization in different cell types with confocal and electron microscopy. The analysis confirmed the uptake of MNPs in the cells, probably with endocytotic mechanisms. Furthermore, we compared the uptake in PC12 cells, a rat pheochromocytoma cell line, which is often used as a neuronal cell model, with primary neuronal cells. It was found that the percentage of PC12 cells loaded with MNPs was significantly higher than for neurons. Uptake studies in primary mixed neuronal/glial cultures revealed predominant uptake of MNPs by microglia and an increase in their number. The number of astroglia and oligodendroglia which incorporated MNPs was lower and stable. Primary mixed Schwann cell/fibroblast cultures showed similar MNP uptake of both cell types, but the Schwann cell number decreased after MNP incubation. Organotypic co-cultures of spinal cord slices and peripheral nerve grafts resembled the results of the dispersed primary cell cultures. CONCLUSIONS: The commercial MNPs used activated microglial phagocytosis in both disperse and organotypic culture systems. It can be assumed that in vivo application would induce immune system reactivity, too. Because of this, their usefulness for in vivo neuroscientific implementations can be questioned. Future studies will need to overcome this issue with the use of cell-specific targeting strategies. Additionally, we found that PC12 cells took up significantly more MNPs than primary neurons. This difference indicates that PC12 cells are not a suitable model for natural neuronal uptake of nanoparticles and qualify previous results in PC12 cells.


Assuntos
Microglia/citologia , Nanopartículas , Neurônios/citologia , Animais , Células Cultivadas , Técnicas de Cocultura , Magnetismo , Microscopia Confocal , Células PC12 , Ratos
18.
Head Neck Oncol ; 3: 14, 2011 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-21385421

RESUMO

Defects in head and neck after tumor resection often provide significant functional and cosmetic deformity. The challenge for reconstruction is not only the aesthetic result, but the functional repair. Cancer may involve composite elements and the in sano resection may lead to an extensive tissue defect. No prospective randomized controlled studies for comparison of different free flaps are available. There are many options to cover defects and restore function in the head and neck area, however we conclude from experience that nearly all defects in head and neck can be closed by 5 different free flaps: radial forearm flap, free fibula flap, anterior lateral thigh flap, lateral arm flap and parascapular flap.


Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Tomada de Decisões , Humanos , Retalhos Cirúrgicos
19.
Plast Reconstr Surg ; 122(5): 1326-33, 2008 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-18971715

RESUMO

BACKGROUND: Autologous breast reconstruction is predominantly performed using free transverse rectus abdominis musculocutaneous or deep inferior epigastric perforator flaps. However, some patients are not suitable candidates for flaps from the lower abdomen. The transverse skin island of the gracilis muscle presents an additional option, as it includes tissue from the posterior upper thigh/lower buttock and thus delivers the amount of tissue necessary for breast reconstruction. METHODS: In 2007, the authors' unit performed 73 free flaps for breast reconstruction subsequent to carcinoma, implant-related capsular fibrosis, and breast asymmetry. The transverse myocutaneous gracilis flap was used 32 times. The ventral margin was the greater saphenous vein, and the posterior margin was the midline of the inferior gluteal fold. The skin island could be harvested to a width of up to 30 cm and a height of up to 10 cm. The donor site was closed primarily. RESULTS: Thirty-two flaps were performed in 20 patients. Mean follow-up was 6 months. Mean operating time was 220 minutes for unilateral and 325 minutes for bilateral cases. All flaps and donor sites healed uneventfully. An initially described "tight feeling" at the thigh ceased after 2 to 3 weeks. Persistent hypesthesia of the dorsal thigh was not noted. A major asymmetry of the thigh in unilateral transplantations was not apparent. After 6 months, all flaps were soft. CONCLUSIONS: The transverse myocutaneous gracilis flap is a safe, fast flap for reconstruction after benign and malignant breast disease. It combines a constant vascular pedicle with soft subcutaneous tissue that has breast-like characteristics.


Assuntos
Neoplasias da Mama/cirurgia , Carcinoma Ductal/cirurgia , Mamoplastia/métodos , Retalhos Cirúrgicos , Adulto , Idoso , Mama/patologia , Mama/cirurgia , Implantes de Mama/efeitos adversos , Carcinoma in Situ/cirurgia , Feminino , Seguimentos , Humanos , Mamoplastia/normas , Mastectomia , Pessoa de Meia-Idade , Coxa da Perna/cirurgia
20.
Exp Neurol ; 212(1): 189-200, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18501894

RESUMO

Minocycline, a broad-spectrum antimicrobial tetracycline, acts neuroprotectively in ischemia. Recently, however, minocycline has been revealed to have ambiguous effects on nerve regeneration. Thus its effects in a rat sciatic nerve transplantation model and on cultivated Schwann cells stressed by oxygen glucose deprivation (OGD) were studied. The negative effect of minocycline on Wallerian degeneration, the essential initial phase of degeneration/regeneration after nerve injury, that was recently demonstrated, was excluded by using predegenerated nerve and Schwann cell-enriched muscle grafts, both free of Wallerian degeneration. They were compared with common nerve grafts. The principle findings were that in vitro minocycline provided protective effects against OGD-induced death of Schwann cells by preventing permeability of the mitochondrial membrane. It suppressed the OGD-mediated induction of HIF-1alpha and BAX, and stabilized/induced BCL-2. Cytochrome c release and cleavage of procaspase-3 were diminished; release and translocation of AIF and cytotoxic cleavage of actin into fractin were stopped. In common nerve grafts, minocycline, besides its direct anti-ischemic effect, hampered revascularization by down-regulation of MMP9 and VEGF prolonging ischemia and impeding macrophage recruitment. In bioartificial nerve grafts that were free of Wallerian degeneration and revealed lower immunogenicity, minocycline aided the regeneration process. Here, the direct anti-ischemic effect of minocycline on Schwann cells, which are mandatory for successful peripheral nerve regeneration, dominated the systemic anti-angiogenic/pro-ischemic effects. In common nerve grafts, however, where Wallerian degeneration is a prerequisite, the anti-angiogenic and macrophage-depressing effect is an obstacle for regeneration.


Assuntos
Cones de Crescimento/efeitos dos fármacos , Isquemia/tratamento farmacológico , Minociclina/farmacologia , Regeneração Nervosa/efeitos dos fármacos , Nervos Periféricos/efeitos dos fármacos , Células de Schwann/efeitos dos fármacos , Animais , Apoptose/efeitos dos fármacos , Apoptose/fisiologia , Proteínas Reguladoras de Apoptose/efeitos dos fármacos , Proteínas Reguladoras de Apoptose/metabolismo , Órgãos Bioartificiais , Células Cultivadas , Cones de Crescimento/metabolismo , Isquemia/fisiopatologia , Isquemia/prevenção & controle , Masculino , Metaloproteinase 9 da Matriz/efeitos dos fármacos , Metaloproteinase 9 da Matriz/metabolismo , Potencial da Membrana Mitocondrial/efeitos dos fármacos , Potencial da Membrana Mitocondrial/fisiologia , Músculo Esquelético/efeitos dos fármacos , Músculo Esquelético/metabolismo , Músculo Esquelético/transplante , Neovascularização Fisiológica/efeitos dos fármacos , Regeneração Nervosa/fisiologia , Fármacos Neuroprotetores/farmacologia , Nervos Periféricos/metabolismo , Nervos Periféricos/transplante , Ratos , Ratos Wistar , Células de Schwann/metabolismo , Neuropatia Ciática/tratamento farmacológico , Neuropatia Ciática/metabolismo , Neuropatia Ciática/fisiopatologia , Fator A de Crescimento do Endotélio Vascular/efeitos dos fármacos , Fator A de Crescimento do Endotélio Vascular/metabolismo , Degeneração Walleriana/tratamento farmacológico , Degeneração Walleriana/fisiopatologia , Degeneração Walleriana/prevenção & controle
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