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1.
Spinal Cord ; 2020 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-31911622

RESUMO

STUDY DESIGN: Interventional feasibility study. OBJECTIVES: To evaluate safety and effects of local heat preconditioning on skin physiology using water-filtered infrared-A radiation (wIRA) or warm water therapy (wWT) in individuals with spinal cord injury (SCI). SETTING: Acute and rehabilitation center, specialized in SCI. METHODS: A convenience sample of 15 individuals (3 women, 12 men) with complete paraplegia from thoracic levels ranging between T2 and T12 received local heat applications either with wIRA or wWT on the thigh (paralyzed area) and on the upper arm (non-paralyzed area). Local heat was applied during three 30-min cycles, each separated by 30 min rest; thus, the treatment lasted for 180 min. Temperature, blood perfusion, and skin redness were measured at baseline, before and after heat application and 24 h after the last application. RESULTS: Heat applications with wIRA and wWT were well-tolerated. No burns or any other side effects were detected. Skin temperature (p ≤ 0.008) and blood perfusion (p ≤ 0.013) significantly increased after heat application. Local skin temperature (arm p = 0.004/leg p < 0.001) and blood perfusion (arm p = 0.011/leg p = 0.001) after the first and the second application cycle, respectively, were significantly higher during heat application with wIRA than with wWT. However, skin redness did not change significantly (p = 0.1). No significant differences were observed between the paralyzed and non-paralyzed areas for all parameters immediately, as well as 24 h after the treatment. CONCLUSIONS: Although both heating methods have been confirmed as safe treatments in this study, further investigations with regard to their efficacy in the context of preconditioning are warranted. SPONSORSHIP: The use of the instruments Hydrosun® 750 Irradiator (Hydrosun Medizintechnik, Germany) and Hilotherm-Calido 6 (Hilotherm GmbH, Germany) was sponsored by the Dr. med. h. c. Erwin Braun Foundation and by Hilotherm GmbH, respectively.

2.
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
3.
Crit Rev Oncol Hematol ; 144: 102828, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31710955

RESUMO

Granular cell tumors are rare soft tissue tumors; they are almost never malignant, but can mimic a carcinoma clinically, radiologically and microscopically. The finding of a suspicious lump often entails subsequent diagnostic procedures that can pose significant anxiety on patients before reaching a challenging differential diagnosis. The physical and psychological burden is even more significant when such findings occur during the follow up of a previous oncologic condition. Sometimes the fear for a potential local or distant recurrence can be responsible for a misdiagnosis and lead to patient overtreatment.

4.
Burns ; 2019 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-31645294

RESUMO

INTRODUCTION: The burn comb model is a well-established model for studying secondary burn progression. It creates four rectangular burn surfaces intercalated by three unburned zones prone to secondary burn progression. While burn progression is a tri-dimensional phenomenon, of which the vertical extension from the superficial to deeper tissue layer is clinically most relevant, the models initial focus was mainly on the horizontal surface extension within interspaces. The aim of this study is to evaluate the correlation between horizontal surface and vertical depth burn progression. METHODS: 24 large (400-450 g) Wistar male rats underwent standardized burn injuries using a burn comb. Laser Doppler flowmetry to assess perfusion, planimetric evaluation of burn progression within interspaces and histological analyses assessing burn depth were performed before burn induction (baseline; BL) and after 1 h, as well as after 1, 4, and 7 days. Histological burn depth was graded from superficial (1) to the subcutaneous layer (5). Furthermore, final scarring time and contracture rate were also assessed. RESULTS: The burn comb resulted in consistent and uniform superficial burns (mean ± SEM burn depth score: 2 ± 0; hour 1) separated by intact but critically perfused interspaces (63 ± 1% of BL; p < 0.05 vs. BL). Tissue damage significantly progressed to the deep dermis within the first day (burn depth score 4.3 ± 0.2; p < 0.05 vs. hour 1), while significant interspace necrosis at the surface did not develop within this time period (4 ± 3% of interspace necrosis; p n.s vs. hour 1). However, interspace necrosis was observed at day 4 (83 ± 3%; p < 0.05 vs. hour 1) and further progressed until day 7 (94 ± 2%; p < 0.05 vs. hour 1). CONCLUSION: This study shows the limits of the burn comb model originally described with a discrepancy between horizontal surface and vertical depth progression of the burn injury. We herein propose a necessary refinement of this model to adequately evaluate vertical depth progression using a histological score. This revisited approach focusing on assessment of depth progression of the burn will allow a better evaluation of experimental burn treatments in future.

5.
Handchir Mikrochir Plast Chir ; 51(6): 424-433, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31067594

RESUMO

Secondary lymphedema is a complex and devastating disease including chronic inflammation and reduced immunofunction, lymphatic fluid and protein accumulation due to misdirected lymphatic transport, and secondary fat deposition followed by fibrosis. While the domain of treatment still is lifelong complex decongestive therapy, it is more and more widespread to treat the disease with a surgical focus on physiologic, reconstructive strategies or debulking surgery. Lymphovenous Anastomosis (LVA) and Vascularized lymph node transplantation (VLNT) are the mostly frequently applied, reconstructive techniques which address restoration or improvement of physiologic lymph clearance. The article summarizes and discusses the recommendations of an expert panel on the diagnostic, indication and therapy of LVA and VLNT in secondary lymphedema during the 40th Meeting of the Germanspeaking Society of Microsurgery in Lugano, Switzerland, 2018. The expert panel addressed the basic diagnostics prior to lymphoreconstructive surgery, including the inevitable application of Indocyanine Green (ICG) based fluorescence lymphangiography and navigation for both techniques including reverse mapping to reduce the rate of donor-site lymphedema for VLNT as well as the use of lymphedema-specific quality of life questionnaires. Both LVA and VLNT are elaborately described, including tips and tricks on identifying functional lymphatic collectors, equipment, types of anastomosis and documentation for LVA and choice of donor and recipient site, number of includable lymph nodes and management of specific donor sites, e. g. jejunal mesenteric for VLNT. The synchronous and sequential application of LVA, VLNT and/or ablative liposuction is discussed against the background of the effectivity and morbidity of both reconstructive, physiologic techniques. Finally, recommendations on post-operative treatment and diagnostics are discussed. The present consensus paper intends to improve the level of standardization for further multicenter studies in the germanspeaking countries in this aspiring field of lymphedema treatment.


Assuntos
Anastomose Cirúrgica , Vasos Linfáticos/cirurgia , Linfedema , Microcirurgia , Consenso , Humanos , Linfonodos , Linfedema/cirurgia , Qualidade de Vida , Suíça
6.
Plast Reconstr Surg ; 143(4): 1099-1107, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30921129

RESUMO

BACKGROUND: Several methods to prepare the recipient site in fat grafting have been proposed in recent decades. However, to date, these procedures have never been reviewed exhaustively. The purpose of the present study is to provide a comprehensive overview of the different techniques to prepare the recipient site for fat grafting as they were investigated in preclinical studies, with resulting outcomes and underlying mechanisms of action. METHODS: The PubMed/MEDLINE database was queried to search for preclinical investigations on the preparation of the recipient site in fat grafting using the following algorithm: ((recipient site) AND (fat grafting) OR (lipofilling) OR (lipograft)). A priori criteria were applied to review the resulting articles. RESULTS: Thirteen animal studies met inclusion criteria. Overall, five techniques were identified: external volume expansion, implantation of alloplastic material (silicone sheets), administration of cell-proliferation factors (i.e., vascular endothelial growth factor, adipose tissue-derived stromal vascular fraction, and interleukin-8), ischemia, and microneedling. A positive effect on cellular activity (cell proliferation and angiogenesis) was demonstrated by all studies and achieved with all techniques. Seven of the eight authors who examined this aspect reported enhancement of fat graft survival. CONCLUSIONS: Improvement of fat grafting surgical outcomes is documented preclinically using different recipient-site preparation techniques, particularly through enhancement of vascularization and soft-tissue expansion. This understanding will lead to further clinical research, especially for those cases where improvement of the recipient site is recommended, such as contracted scars or preirradiated tissues.


Assuntos
Tecido Adiposo/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Animais , Proliferação de Células/fisiologia , Sobrevivência de Enxerto , Humanos , Neovascularização Fisiológica/fisiologia , Expansão de Tecido/métodos , Fatores de Crescimento do Endotélio Vascular/administração & dosagem
7.
J Plast Reconstr Aesthet Surg ; 72(4): 590-599, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30733080

RESUMO

It has been shown that pre- and postconditioning of ischemically challenged tissue with erythropoietin (EPO) is able to reduce necrosis in a dose-dependent manner. The aim of this study was to determine the tissue-protective effects of different EPO dosages and administration regimes. Three groups of six C57Bl/6-mice each were analyzed: (1) pre- and postconditioning with initial high doses of EPO (starting at 2500 I.U./kg bw i.p.) followed by low doses of EPO (125 I.U./kg bw i.p.) (EPO-high-dose); (2) pre- and postconditioning with low doses of EPO (125 I.U./kg bw i.p.) (EPO-low-dose); and (3) untreated control group. Randomly perfused musculocutaneous flaps were mounted on dorsal skinfold chambers undergoing acute persistent ischemia and developing ∼50% necrosis without treatment. Intravital epifluorescence microscopy was performed at days 1, 3, 5, 7, and 10 after surgery, assessing flap necrosis, microcirculation, and angiogenesis. The hematocrit was measured at days 0, 3, 7, and 10. Only the EPO-low-dose regimen was associated with a significant reduction of necrosis when compared to untreated controls. EPO-low-dose showed a higher increase in both arteriolar diameter and velocity, thereby resulting in a significantly increased arteriolar blood flow and a hence higher functional capillary density (FCD) of the critically perfused zone. EPO-induced angiogenesis was significantly increased in EPO-low-dose at days 7 and 10. Only EPO-high-dose reached a significant hematocrit increase by day 10. Tissue pre- and postconditioning with low doses of EPO protects the critically perfused musculocutaneous tissue by maintaining capillary perfusion because of increased arteriolar blood flow mediated by nitric oxide (NO) expression.


Assuntos
Eritropoetina/uso terapêutico , Retalho Miocutâneo/irrigação sanguínea , Animais , Eritropoetina/administração & dosagem , Camundongos , Camundongos Endogâmicos C57BL , Microcirculação/efeitos dos fármacos , Microscopia de Fluorescência , Retalho Miocutâneo/transplante , Necrose/prevenção & controle , Perfusão
9.
Breast Cancer Res Treat ; 172(3): 523-537, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30182349

RESUMO

PURPOSE: Indications for nipple-sparing mastectomy (NSM) have broadened to include the risk reducing setting and locally advanced tumors, which resulted in a dramatic increase in the use of NSM. The Oncoplastic Breast Consortium consensus conference on NSM and immediate reconstruction was held to address a variety of questions in clinical practice and research based on published evidence and expert panel opinion. METHODS: The panel consisted of 44 breast surgeons from 14 countries across four continents with a background in gynecology, general or reconstructive surgery and a practice dedicated to breast cancer, as well as a patient advocate. Panelists presented evidence summaries relating to each topic for debate during the in-person consensus conference. The iterative process in question development, voting, and wording of the recommendations followed the modified Delphi methodology. RESULTS: Consensus recommendations were reached in 35, majority recommendations in 24, and no recommendations in the remaining 12 questions. The panel acknowledged the need for standardization of various aspects of NSM and immediate reconstruction. It endorsed several oncological contraindications to the preservation of the skin and nipple. Furthermore, it recommended inclusion of patients in prospective registries and routine assessment of patient-reported outcomes. Considerable heterogeneity in breast reconstruction practice became obvious during the conference. CONCLUSIONS: In case of conflicting or missing evidence to guide treatment, the consensus conference revealed substantial disagreement in expert panel opinion, which, among others, supports the need for a randomized trial to evaluate the safest and most efficacious reconstruction techniques.


Assuntos
Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Mastectomia Subcutânea/métodos , Consenso , Feminino , Humanos , Mastectomia Subcutânea/efeitos adversos , Necrose , Mamilos/patologia , Retalhos Cirúrgicos/patologia
10.
Eur Surg Res ; 59(3-4): 255-264, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30244240

RESUMO

BACKGROUND: Flap procedures are widely used in clinical reconstructive surgery. Since ische-mia-associated complications, e.g., wound breakdown or tissue necrosis, are still a great challenge in flap surgery, experimental flap models are widely used to study flap physiology and to evaluate treatment strategies to prevent these complications. SUMMARY: Since rodents in general, and mice and rats in particular, are widely used in experimental flap models, we give an overview of the most common flap models in rodents, including the cremaster flap, the osteomyocutaneous flap, the McFarlane flap, the ear flap, and the dorsal skinfold chamber. Key Messages: Rodent flap models in experimental surgery are manifold and have a long history. These models play an important role in training surgical techniques, understanding flap physiology, defining flap anatomy and vascularity, and developing treatment regimens to prevent the necrosis of ischemically challenged tissue. However, it is important to be aware of the advantages and disadvantages of the single flap models concerning the possible time span of the experiment, the degree of difficulty, and the reproducibility and the translation of the results in humans.


Assuntos
Retalhos Cirúrgicos , Animais , Camundongos , Ratos , Reprodutibilidade dos Testes
11.
Handchir Mikrochir Plast Chir ; 50(4): 248-255, 2018 08.
Artigo em Alemão | MEDLINE | ID: mdl-30130834

RESUMO

The most common donor-site for autologous breast reconstruction is the abdomen. Over the past several decades technical advances have resulted in the development of flaps that have been associated with a progressive decrease in abdominal wall morbidity. However, controversy exists related to the differences between muscle-sparing (MS)-TRAM and deep inferior epigastric perforator (DIEP) flaps. Hence, the question which approach should be considered standard of care remains unanswered. To address this question the current literature and published evidence was critically reviewed and discussed by an expert panel at the 39th Annual Meeting of the German-speaking Society for Micro surgery of the Peripheral Nerves and Vessels (DAM). Based on this discussion a consensus statement was developed that incorporates contemporary data regarding postoperative complication rate, donor site morbidity, as well as expert opinion regarding technical details in autologous breast reconstruction with free TRAM and DIEP flaps.


Assuntos
Mamoplastia , Microcirurgia , Retalho Perfurante , Consenso , Feminino , Humanos , Complicações Pós-Operatórias , Reto do Abdome
12.
Handchir Mikrochir Plast Chir ; 50(2): 118-125, 2018 04.
Artigo em Alemão | MEDLINE | ID: mdl-29045998

RESUMO

During the last two decades, understanding and experience of microsurgical reconstruction have increased. This is linked to improved instruments and technical devices, as well as to the increased number of available donor sites for microvascular flap transfer. If the indication is appropriate, it is now possible to perform personalised, safe and successful microsurgical reconstructions, almost independently of the patients' age. Despite these constant developments, there is little specific literature on microsurgery related to the specific problems of the elderly patient. During two consensus workshops organised by the DAM (German Speaking Working Group for Microsurgery of the Peripheral Nerves and Vessels), the latest findings and experience with microsurgical reconstruction in the elderly patient were presented by a group of experts and current recommendations were formulated. On the basis of these consensus workshops and the current literature, this article discusses important issues in this area.


Assuntos
Microcirurgia , Procedimentos Cirúrgicos Reconstrutivos , Cirurgia Plástica/métodos , Idoso , Consenso , Humanos , Nervos Periféricos/cirurgia
13.
Z Evid Fortbild Qual Gesundhwes ; 125: 23-29, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28711421

RESUMO

OBJECTIVES: To identify the spectrum of patient safety issues in office-based surgery and anaesthesia in Switzerland. METHODS: Purposive sample of 23 experts in surgery and anaesthesia and quality and regulation in Switzerland. Data were collected via individual qualitative interviews using a researcher-developed semi-structured interview guide between March 2016 and September 2016. Interviews were transcribed and analysed using conventional content analysis. Issues were categorised under the headings "structure", "process", and "outcome". RESULTS: Experts identified two key overarching patient safety and regulatory issues in relation to office-based surgery and anaesthesia in Switzerland. First, experts repeatedly raised the current lack of data and transparency of the setting. It is unknown how many surgeons are operating in offices, how many and what types of operations are being done, and what the outcomes are. Secondly, experts also noted the limited oversight and regulation of the setting. While some standards exists, most experts felt that more minimal safety standards are needed regarding the requirements that must be met to do office-based surgery and what can and cannot be done in the office-based setting are needed, but they advocated a self-regulatory approach. CONCLUSION: There is a lack of empirical data regarding the quantity and quality office-based surgery and anaesthesia in Switzerland. Further research is needed to address these research gaps and inform health policy in relation to patient safety in office-based surgery and anaesthesia in Switzerland.


Assuntos
Assistência Ambulatorial/normas , Anestesia/normas , Segurança do Paciente , Procedimentos Cirúrgicos Operatórios/normas , Alemanha , Humanos , Pesquisa Qualitativa , Suíça
14.
Breast Cancer Res Treat ; 165(1): 139-149, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28578506

RESUMO

PURPOSE: To obtain consensus recommendations for the standardization of oncoplastic breast conserving surgery (OPS) from an international panel of experts in breast surgery including delegates from the German, Austrian and Swiss societies of senology. METHODS: A total of 52 questions were addressed by electronic voting. The panel's recommendations were put into context with current evidence and the report was circled in an iterative open email process until consensus was obtained. RESULTS: The panelists considered OPS safe and effective for improving aesthetic outcomes and broadening the indication for breast conserving surgery (BCS) towards larger tumors. A slim majority believed that OPS reduces the rate of positive margins; however, there was consensus that OPS is associated with an increased risk of complications compared to conventional BCS. The panel strongly endorsed patient-reported outcomes measurement, and recommended selected scales of the Breast-Q™-Breast Conserving Therapy Module for that purpose. The Clough bi-level classification was recommended for standard use in clinical practice for indicating, planning and performing OPS, and the Hoffmann classification for surgical reports and billing purposes. Mastopexy and reduction mammoplasty were the only two recognized OPS procedure categories supported by a majority of the panel. Finally, the experts unanimously supported the statement that every OPS procedure should be tailored to each individual patient. CONCLUSIONS: When implemented into clinical practice, the panel recommendations may improve safety and effectiveness of OPS. The attendees agreed that there is a need for prospective multicenter studies to optimize patient selection and for standardized criteria to qualify and accredit OPS training centers.


Assuntos
Neoplasias da Mama/cirurgia , Medicina Baseada em Evidências/normas , Mastectomia Segmentar/normas , Neoplasias da Mama/patologia , Consenso , Feminino , Humanos , Cooperação Internacional , Mastectomia Segmentar/efeitos adversos , Mastectomia Segmentar/métodos , Resultado do Tratamento
15.
Aesthet Surg J ; 37(5): 560-569, 2017 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-28203698

RESUMO

Background: Many studies of gluteal augmentation techniques have been published in recent decades, including case reports, retrospective and prospective case series, and multicenter survey reviews. However, to date, there has been no study of the overall complications or satisfaction rates associated with the broad spectrum of techniques. Objectives: The authors performed a comprehensive literature review to determine outcomes and complications of gluteoplasty techniques, including patient satisfaction. Methods: A search on PubMed/Medline was performed for clinical studies involving gluteal augmentation techniques. A priori criteria were used to review the resulting articles. Results: Fifty-two studies, published from 1969 through 2015, were included - representing 7834 treated patients. Five gluteal augmentation techniques were identified from these studies: gluteal augmentation with implants (n = 4781), autologous fat grafting (n = 2609), local flaps (n = 369), hyaluronic acid gel injection (n = 69), and local tissue rearrangement (n = 6). The overall complication rates of the most commonly utilized techniques were: 30.5% for gluteal augmentation with implants, 10.5% for autologous fat grafting, and 22% for local flaps. Patients' satisfaction was reported as consistently high for all the five techniques. Conclusions: Implant-based gluteal augmentation is associated with high patients' satisfaction despite a high complication rate, while autologous fat grafting is associated with the lowest complication rate yet including serious major complications such as fat embolism. Local flaps and local tissue rearrangements are the ideal procedures in case of massive weight loss patients. A paucity of data is available for hyaluronic acid gel injections, which appear to be effective but temporary and expensive.


Assuntos
Tecido Adiposo/transplante , Autoenxertos/transplante , Nádegas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Cirurgia Plástica/métodos , Retalhos Cirúrgicos/transplante , Estudos Clínicos como Assunto , Embolia Gordurosa/epidemiologia , Géis/administração & dosagem , Humanos , Ácido Hialurônico/administração & dosagem , Lipectomia , Satisfação do Paciente , Próteses e Implantes , Cirurgia Plástica/efeitos adversos , Resultado do Tratamento
18.
J Foot Ankle Surg ; 55(2): 368-72, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-25724471

RESUMO

Soft tissue tumors of the foot are rare, and the diagnosis is often difficult. Surgery is indicated if pain, discomfort, or functional impairment is present or to rule out malignancy. We present the case of a 14-year-old female with a painless swelling at the lateral aspect of her right foot. After radiologic imaging, including ultrasonography and magnetic resonance imaging (MRI), we performed a subtotal resection of the abductor digiti minimi muscle, preserving its motor nerve. Four months later, recurrence of the soft tissue mass was observed. MRI revealed hypertrophy of the small muscles of the foot, including the abductor digiti minimi, quadratus plantae, and flexor digiti minimi brevis. Functional impairment resulted in complete excision of the remnant abductor digiti minimi muscle and partial excision of the flexor digiti minimi brevis muscle another 7 months later. Twelve months after the secondary surgery, neither clinical nor radiologic signs of a second recurrence were found. At the last follow-up visit, the patient was satisfied with the contour of her foot and not hindered at all during sporting activities. Our findings demonstrate that subtotal resection of a bulky muscle, preserving its motor nerve, can result in reactive hypertrophy of the remnant muscle part. The patient must be informed that partial excision of an innervated muscle could result in reactive hypertrophy and must be contrasted with radical muscle excision that might be more likely to result in functional impairment.


Assuntos
Deformidades Adquiridas do Pé/cirurgia , Pé/cirurgia , Músculo Esquelético/patologia , Músculo Esquelético/cirurgia , Adolescente , Feminino , Pé/inervação , Deformidades Adquiridas do Pé/diagnóstico por imagem , Deformidades Adquiridas do Pé/patologia , Humanos , Hipertrofia , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/inervação
19.
Front Surg ; 2: 71, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26835456

RESUMO

Breast cancer is the leading cause of cancer death in women worldwide. Its surgical approach has become less and less mutilating in the last decades. However, the overall number of breast reconstructions has significantly increased lately. Nowadays, breast reconstruction should be individualized at its best, first of all taking into consideration not only the oncological aspects of the tumor, neo-/adjuvant treatment, and genetic predisposition, but also its timing (immediate versus delayed breast reconstruction), as well as the patient's condition and wish. This article gives an overview over the various possibilities of breast reconstruction, including implant- and expander-based reconstruction, flap-based reconstruction (vascularized autologous tissue), the combination of implant and flap, reconstruction using non-vascularized autologous fat, as well as refinement surgery after breast reconstruction.

20.
J Burn Care Res ; 36(3): e176-89, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25094011

RESUMO

After a burn injury, superficial partial-thickness burn wounds may progress to deep partial-thickness or full-thickness burn wounds, if kept untreated. This phenomenon is called secondary burn wound progression or conversion. Burn wound depth is an important determinant of patient morbidity and mortality. Therefore, reduction or even the prevention of secondary burn wound progression is one goal of the acute care of burned patients. The objective of this study was to review preclinical approaches evaluating therapies to reduce burn wound progression. A systematic review of experimental approaches in animals that aim at reducing or preventing secondary burn wound progression was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) guidelines. The selected references consist of all the peer-reviewed studies performed in vivo in animals and review articles published in English, German, Italian, Spanish, or French language relevant to the topic of secondary burn wound progression. We searched MEDLINE, Cochrane Library, and Google Scholar including all the articles published from the beginning of notations to the present. The search was conducted between May 3, 2012 and December 26, 2013. We included 29 experimental studies in this review, investigating agents that maintain or increase local perfusion conditions, as well as agents that exhibit an anti-coagulatory, an anti-inflammatory, or an anti-apoptotic property. Warm water, simvastatin, EPO, or cerium nitrate may represent particularly promising approaches for the translation into clinical use in the near future. This review demonstrates promising experimental approaches that might reduce secondary burn wound progression. Nevertheless, a translation into clinical application needs to confirm the results compiled in experimental animal studies.


Assuntos
Antibacterianos/uso terapêutico , Queimaduras/terapia , Modelos Animais de Doenças , Infecção dos Ferimentos/prevenção & controle , Animais , Antibioticoprofilaxia/métodos , Queimaduras/complicações , Queimaduras/patologia , Sobrevivência de Enxerto , Sulfadiazina de Prata/uso terapêutico , Pele/patologia , Cicatrização , Infecção dos Ferimentos/induzido quimicamente
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