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1.
Plast Reconstr Surg ; 145(4): 829e-838e, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32221235

RESUMO

BACKGROUND: Intrathoracic fistulas pose unique challenges for thoracic and reconstructive surgeons. To decrease the incidence of fistula recurrence, pedicled flaps have been suggested to buttress the repair site. The authors aimed to report their experience with muscle flap transposition for the management of intrathoracic fistulas. METHODS: A retrospective review of all patients who underwent intrathoracic muscle flap transposition for the management of intrathoracic fistulas from 1990 to 2010 was conducted. Patient demographics, surgical characteristics, and complication rates were abstracted and analyzed. RESULTS: A total of 198 patients were identified. Bronchopleural fistula was present in 156 of the patients (79 percent), and 48 had esophageal fistula (24 percent). A total of 238 flaps were used, constituting an average of 1.2 flaps per patient. After the initial fistula repair, bronchopleural fistula complicated the course of 34 patients (17 percent), and esophageal fistula occurred in 13 patients (7 percent). Partial flap loss was identified in 11 flaps (6 percent), and total flap loss occurred in four flaps (2 percent). Median follow-up was 27 months. At the last follow-up, 182 of the patients (92 percent) had no evidence of fistula, 175 (89 percent) achieved successful chest closure, and 164 (83 percent) had successful treatment. Preoperative radiation therapy and American Society of Anesthesiologists score of 4 or greater were identified as risk factors for unsuccessful treatment. CONCLUSIONS: Intrathoracic fistulas remain a source of major morbidity and mortality. Reinforcement of the fistula closure with vascularized muscle flaps is a viable option for preventing dehiscence of the repair site and can be potentially life-saving. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

2.
Anticancer Res ; 40(3): 1463-1466, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32132044

RESUMO

BACKGROUND/AIM: Radiotherapy for soft tissue sarcomas (STS) of the hand is thought to be associated with poor function. The aim of this study was to compare the long-term functional outcome in patients with and without radiotherapy. PATIENTS AND METHODS: At long-term follow-up (mean 10±5 years), 33 (13 males, 20 female) patients, were alive for review. The mean patient age at surgery was 33±17 years and 13 (39%) patients received radiotherapy (mean dose 55±6 Gy). RESULTS: Postoperatively, the mean QuickDASH and MSTS93 were 7±8 and 92±8%, respectively. Comparing patients with and without radiotherapy, there was no difference (p>0.05) between the mean QuickDASH (5±5 vs. 8±9) or MSTS93 (93±9% vs. 91±8%). Surgical complication occurred more commonly in patients with radiotherapy (46% vs. 15%, p=0.10). CONCLUSION: The use of radiotherapy was associated with a higher rate of complications, however, was not associated with a worse long-term functional outcome in patients with hand STS.


Assuntos
Mãos/patologia , Sarcoma/radioterapia , Neoplasias de Tecidos Moles/radioterapia , Adulto , Feminino , Mãos/cirurgia , Humanos , Masculino , Terapia Neoadjuvante , Radioterapia Adjuvante , Estudos Retrospectivos , Sarcoma/cirurgia , Neoplasias de Tecidos Moles/cirurgia
3.
Hand (N Y) ; : 1558944719900565, 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-32036680

RESUMO

Background: The frequency, pattern, and treatment of pediatric hand fractures are rarely reported. We sought to review our institution's experience in the management of pediatric hand fractures. Methods: A retrospective review of children and adolescents (younger than 18 years) treated for hand fractures between January 1990 and June 2017 was preformed. Fractures were categorized into metacarpal, proximal/middle phalanx, distal phalanx, or intra-articular metacarpophalangeal (MCP)/proximal interphalangeal (PIP)/distal interphalangeal (DIP) fractures. Patients were categorized into 3 age groups (0-5, 6-11, and 12-17 years). Results: A total of 4356 patients were treated for hand fractures at a mean ± SD age of 12.2 ± 3.5 years. Most fractures occurred in patients aged 12 to 17 years (n = 2775, 64%), followed by patients aged 6 to 11 years (n = 1347, 31%). Only 234 (5%) fractures occurred in children younger than 5 years. Most fractures occurred in the proximal/middle phalanx (48%), followed by metacarpal (33%), distal phalangeal (12%), and intra-articular MCP/PIP/DIP joints (7%). Proximal/middle phalangeal fractures were the most common in all age groups. About 58% of intra-articular MCP/PIP/DIP fractures in patients aged between 0 and 5 years required open reduction ± fixation, and the remaining 42% fractures were amenable to closed reduction. In patients older than 5 years, about 70% of these fractures were amenable to closed reduction. All age groups included, most metacarpal (93%), proximal/middle phalangeal (92%), and distal phalangeal (86%) fractures were amenable to closed reduction alone. Conclusions: The frequency, pattern, and treatment of hand fractures vary among different age groups. Understanding the pattern of these fractures helps making the right diagnosis and guides choosing the appropriate treatment.

4.
J Orthop Res ; 2020 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-31930553

RESUMO

Flexor tendon injuries and tendinopathy are very common but remain challenging in clinical treatment. Exosomes-based cell-free therapy appears to be a promising strategy for tendon healing, while limited studies have evaluated its impacts on tenocyte biology. The objective of this study was to characterize a novel purified exosome product (PEP) derived from plasma, as well as to explore its cellular effects on canine tenocyte biology. The transmission electron microscope revealed that exosomes of PEP present cup-shaped structures with the diameters ranged from 80 to 141 nm, and the NanoSight report presented that their size mainly concentrated around 100 nm. The enzyme-linked immunosorbent assay kits analysis showed that PEP was positive for CD63 and AChE expression, and the cellular uptake of exosomes internalized into tenocyte cytoplasm was observed. The cell growth assays displayed that tenocyte proliferation ability was enhanced by PEP solution in a dose-dependent manner. Tenogenic phenotype was preserved as is evident by that tendon-related genes expression (SCX, COL1A, COL3A1, TNMD, DCN, and MKX) were expressed insistently in a high level, while tenocytes were treated with 5% PEP solution. Furthermore, migration capability was maintained and total collagen deposition was increased. More interesting, dexamethasone-induced cellular apoptosis was attenuated during the incubation of tenocytes with a 5% PEP solution. These findings will provide the basic understandings about the PEP, and support the potential use of this biological strategy for tendon healing.

5.
Plast Reconstr Surg ; 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31929454

RESUMO

BACKGROUND: Intrathoracic fistulas pose unique challenges for thoracic and reconstructive surgeons. To decrease the incidence of fistula recurrence, pedicled flaps have been suggested to buttress the repair site. We aimed to report our experience with muscle flap transposition for the management of intrathoracic fistulas. METHODS: A retrospective review of all patients who underwent intrathoracic muscle flap transposition for the management of intrathoracic fistulas from 1990 to 2010 was conducted. Patient demographics, surgical characteristics, and complication rates were abstracted and analyzed. RESULTS: A total of 198 patients were identified. Bronchopleural fistula (BPF) was present in 79% of the patients (n=156), while 24% had esophageal fistula (EF) (n=48). A total of 238 flaps were used, constituting an average of 1.2 flaps per patient. After the initial fistula repair, BPF complicated the course of 34 patients (17%), and EF occurred in 13 patients (7%). Partial flap loss was identified in 11 flaps (6%), and total flap loss occurred in 4 flaps (2%). Median follow-up was 27 months. At the last follow-up, 92% of the patients (n=182) had no evidence of fistula, 89% (n=175) achieved successful chest closure, and 83% (n=164) had successful treatment. Preoperative radiation and ASA ≥ 4 were identified as risk factors for unsuccessful treatment. CONCLUSION: Intrathoracic fistulas remain a source of major morbidity and mortality. The reinforcement of the fistula closure with vascularized muscle flaps is a viable option for preventing dehiscence of the repair site and can be potentially life-saving.

6.
J Hand Surg Am ; 2020 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-31924437

RESUMO

PURPOSE: The radial artery is becoming the vessel of choice for performing cardiac catheterization. Transradial catheterization can impose risks on the upper extremity, and hand surgeons should be aware of the most frequent complications. The purpose of this study was to determine the frequency, timing, and scope of upper-limb complications shortly after transradial catheterization. METHODS: A retrospective review was conducted of the medical records of patients who underwent catheterization between 2009 and 2016. Complications were assessed for up to 60 days. The Cox model was used to assess risk factors for complications. RESULTS: A total of 10,540 patients were included in the analysis (68.5% male), median age 67 years. There were 79 patients who experienced at least one complication within 60 days (0.84% of procedures; 95% confidence interval, 0.65% to 1.02%). The most common complications were hematoma (n = 39) and radial artery occlusion (n = 28). Other complications included pseudoaneurysm (n = 7), arteriovenous fistula (n = 3), carpal tunnel syndrome (n = 4), arterial perforation (n = 3), persistent vasospasm (n = 2), and compartment syndrome (n = 1). The complications were diagnosed a median of 1 day after catheterization. Female sex was at increased risk for developing a complication. Diabetes, age, body mass index, and catheter size were not associated with an increased risk for developing a complication. Ten patients underwent surgical management of a complication. Reasons for surgery included symptomatic radial artery occlusions, pseudoaneurysm formation, arteriovenous fistulas, and compartment syndrome. No identifiable risk factors were associated with patients who underwent surgical intervention. CONCLUSIONS: The frequency of upper-limb complications after radial artery catheterization is small. They include arterial occlusion, bleeding, compartment syndrome, arteriovenous fistula, and pseudoaneurysm. Most complications presented within 1 week of the procedure and occurred more frequently in the female sex. Operative management of complications was infrequent. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

7.
Ann Plast Surg ; 2020 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-31913893

RESUMO

BACKGROUND: There is little written about the scope of rural plastic surgery within the United States. Approximately 25 million people do not have immediate access to a plastic surgeon. Most areas are designated as rural, and this lack of specialty care can result in suboptimal care. Physicians are more likely to move to a rural area if they have prior life experience with rural areas, but exposure to rural plastic surgery in residency training is scarce. We attempted to examine the practice characteristics of rural plastic surgeons within the United States to (a) to better define the average rural plastic surgery practice and (b) to highlight the broad scope of practice of the rural plastic surgeon to educate both hospital administrators and our physician colleagues of the impact and benefit a plastic surgeon can have on a health system. METHODS: A survey was e-mailed to surgeons identified as rural plastic surgeons who practiced in communities with fewer than 50,000 people not located in a metropolitan area. Thirty-four surgeons were identified and 12 responded to the survey. RESULTS: Respondents on average were 56 years old and had practiced for 14.3 years. At the time of the survey, 33% practiced in a hospital-employed group practice, and 33% operated in a hospital that is part of a health system. Seventy-five percent did not complete fellowship training, but 67% believed that fellowship training would be beneficial to someone interested in rural plastic surgery. Seventy-five percent recommended hand surgery as the most beneficial fellowship. Eighty-three percent had prior experiences with rural surgery before starting their practice. Average case volume ranged from 150 to more than 1000 cases per year and spanned the spectrum of plastic surgery. Potential barriers to practicing rural plastic surgery included call responsibility and facility limitations. CONCLUSIONS: A career in rural plastic surgery offers great variety encompassing the spectrum of plastic surgery. Most agreed that hand fellowship would be the most beneficial fellowship. Most had prior experience with rural surgery before seeking a career in rural plastic surgery, highlighting the importance of increasing awareness of these opportunities.

8.
J Plast Reconstr Aesthet Surg ; 73(2): 242-254, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31703941

RESUMO

INTRODUCTION: Hemipelvectomy procedures result in massive soft tissue defects. The standard approach is to reconstruct the defect with anterior or posterior hemipelvectomy flaps. Certain situations preclude the use of local tissue flaps, and an alternative is the use of leg fillet flaps, circumferential pedicled or free flaps harvested from the amputated part. The purpose of this study is to present our institution's experience with using pedicled and free fillet flaps to reconstruct hemipelvectomy soft tissue defects. METHODS: We performed a retrospective chart review of patients who underwent hemipelvectomy and fillet flap reconstruction from 2001 to 2018. Demographics, clinical and surgical characteristics, postoperative outcomes, and complications of patients were reviewed. RESULTS: Ten patients were identified and included. Their mean age was 51 ± SD 12.4 years. Six patients underwent standard external hemipelvectomy and 4 patients underwent extended external hemipelvectomy. Seven lower extremity fillet flaps were performed as free tissue transfers, and 3 were pedicled flaps. The mean flap size was 1,153 ± SD 1137 cm2. The mean follow-up was 5 months (range: 1-24 months). Five patients developed postoperative complications; none of them required operative intervention. There were no partial or total flap losses postoperatively. CONCLUSION: Reconstruction with pedicled or free lower extremity fillet flaps is a valuable reconstructive approach, for managing large soft tissue defects following hemipelvectomy when the standard anterior and posterior thigh flaps are unavailable or inadequate for complete soft tissue coverage. This useful technique mitigates donor site morbidity, while simultaneously achieving massive soft tissue coverage with an acceptable complication profile.

9.
Microsurgery ; 40(2): 258-260, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31328294

RESUMO

Nerve repair and nerve transfer are the optimal approaches to restore function to denervated muscle. When the distal-most portion of the nerve entering the muscle is compromised, these are not possible and direct muscle neurotization (DMN) is considered. We describe the first reported case of DMN with acellular nerve allograft. The patient is a 25 year old male who sustained a blast injury to the patient's proximal leg with segmental injury to the deep peroneal nerve resulting in complete foot drop with 0/5 dorsiflexion and toe extension. Given complete obliteration of the distal nerve, we performed direct neurotization of the tibialis anterior muscle with a 7 cm acellular nerve allograft coapted to the proximal stump of the deep peroneal nerve. At 3 years after surgery, the patient regained 5/5 strength with dorsiflexion and toe extension and normal gait. This case supports the use of acellular nerve allografts to restore function to denervated muscle when the distal nerve stump is not available for nerve repair or transfer and there is a desire to avoid the morbidity of autologous nerve graft harvest.

10.
J Plast Reconstr Aesthet Surg ; 73(2): 255-268, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757686

RESUMO

BACKGROUND: Following the excision of sacral tumors, plastic surgeons are often faced with a large soft tissue defect that necessitates flap coverage to promote wound healing and obliterate the resulting dead space. We aimed to evaluate the outcomes and complications following soft tissue reconstruction of sacrectomy defects. METHODS: Applying the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA), a comprehensive search of several databases was performed from 1950 to 2019 for articles reporting outcomes of soft tissue flap reconstruction after sacrectomy. Demographics, surgical characteristics, and complication rates were abstracted and analyzed. RESULTS: A total of 544 articles were identified in the initial search, out of which 26 met our inclusion criteria. Gluteal-based flap was the most commonly used (50%), followed by the vertical rectus abdominis myocutaneous (VRAM) flap (38%) and free latissimus dorsi (5%). Patients who underwent high sacrectomy had significantly higher local complications than those who underwent low sacrectomy [OR: 2.57(1.12,5.92); p = 0.03]. Patients who received preoperative radiation had a significantly higher complication rate than those who did not [OR: 2.91(1.25,6.79); p = 0.01]. The pooled local complication rate was 37% in the gluteal-based flap group and 50% in the VRAM flap group. Total flap loss was identified in 1 gluteal and 2 VRAM flaps. CONCLUSION: Gluteal-based and VRAM flaps are the two most common options for soft tissue reconstruction after sacrectomy. Both flaps demonstrate a high complication rate after this morbid procedure; however, total flap loss seems to be a rare occurrence. Most patients can achieve good functional outcome following reconstruction.

11.
Hand (N Y) ; 15(1): 125-130, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30009627

RESUMO

Background: Distal radius fractures are common, and the trend in fixation has included the use of locked volar plating. The duration of splinting required after surgery and the effect splinting has upon outcome of the wrist are not clear. Our aim was to compare outcome of patients treated with early versus late motion protocol after volar plating. Methods: Thirty-three patients with distal radius fractures were prospectively and randomly enrolled into an early versus late motion study including volar plating of the distal radius fracture. Early motion included an active and passive wrist motion protocol by 14 days after surgery and delayed motion was initiated at 5 weeks. Fractures were defined as intra-articular and extra-articular, and those with, and without, ulnar styloid fracture. Motion and outcome scores (Disabilities of the Arm, Shoulder and Hand [DASH]/patient-rated wrist evaluation [PRWE]), and strength were measured through 1 year. Results: Wrist motion, DASH, and PRWE scores were only significantly different at 6 weeks with no significant differences at any later time points up to 1 year. One patient had complex regional pain syndrome (CRPS) and one had adhesive capsulitis in the late motion group. Conclusions: Following locked volar plating of distal radius fractures, early motion favored earlier return of motion along with lower DASH, PRWE, and pain scores within first 6 weeks. Although the late motion group had delayed recovery, there were no long-term significant differences in motion, strength, outcome, or pain scores. The 2 cases with complications (CRPS and adhesive capsulitis) did occur in the late motion group and may implicate late motion with these problems.

12.
Microsurgery ; 40(1): 19-24, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30178520

RESUMO

INTRODUCTION: Reconstruction of abdominal wall defects with enterocutaneous fistulas (ECF) remains challenging. The purpose of this report is to describe a single-stage approach using combined microscopic enterolysis, pedicle seromuscular bowel flaps, mesh, fasciocutaneous, and myocutaneous flaps. METHODS: Between 1990 and 2016 a retrospective review identified a total of 18 patients with an average age of 39 years (ranging 26-59 years). Thirteen cases were associated with trauma, four were complication of previous mesh repair, and one was after an aortic dissection. Average diameter of defect size was 22 cm (ranging 20-24 cm). Surgical technique involved enterolysis using microscope magnification, a pedicle seromuscular bowel flap to reinforce the bowel anastomosis, mesh, musculocutaneous, and fasciocutaneous flaps to reconstruct the abdominal wall. RESULTS: Fifteen patients required rotational flaps with an average skin paddle area of 442.7 cm2 (ranging 440 cm2 -260 cm2 ) and 10 patients required a serosal patch with an average length of 5 cm (ranging 4-6 cm). Complications included three wound dehiscence and one abdominal wall bulging. Flap survival was 100%. The majority of patients (12 out of 18) were able to resume normal activities, and the remaining (n = 6) were able to resume most activities. Functional outcome as assessed by 36-Item Short Form Survey (SF-36) physical function component questionnaire at 18-24 months follow up was 67.8% (ranging from 59 to 72%). Mean length of hospital stay was 2.2 weeks (ranging 1.4-2.7 weeks). Mean follow-up was 24 months (ranging 22-26 months) with clinical examination. CONCLUSION: Microscopically assisted intra-abdominal dissection with resection of diseased bowel, replacement with well-vascularized tissue at the anastomosis site in, and reinforcement with mesh combined with pedicle musculocutaneous and fasciocutaneous flaps may be an alternative when other local reconstructive options have failed.

13.
J Plast Reconstr Aesthet Surg ; 73(4): 633-637, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31862267

RESUMO

BACKGROUND: Nonunion is a common complication following a fracture in the setting of previous radiotherapy; however, currently there is a paucity of data describing treatment for these nonunions in the upper extremity. Free vascularized fibular (FVF) flaps successfully treat bone defects; however, their efficacy with respect to treatment of radiated nonunions is limited. The purpose of the study was to assess the outcome following FVF for radiation-associated upper extremity nonunions. METHODS: Seven patients underwent FVF for the treatment of radiation-associated upper extremity nonunion between 1998 and 2016. RESULTS: There were 5 male and 2 female patients, with a mean age and follow-up of 44 years and 4 years, respectively. Mean total radiation dose was 41.3 Gy, given at a mean of 11 years prior to FVF. The average FVF length was 15 cm. First time union rate was 71%, however, following repeat bone grafting all patients healed. The median time to union was 10 months. Musculoskeletal Tumor Society scores improved from 57% preoperatively to 89% at latest follow-up (p < 0.0001). CONCLUSIONS: FVF is a reliable treatment option for radiation-associated nonunions of the upper extremity, providing an overall union rate of 100% and an improvement in functional outcome.

14.
J Surg Oncol ; 121(3): 465-473, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31853992

RESUMO

BACKGROUND AND OBJECTIVES: The purpose of this study is to present our experience using free fillet flaps to reconstruct massive oncologic defects of the upper and lower extremity. METHODS: A retrospective chart review was performed to include patients who underwent oncologic resection followed by reconstruction using free fillet flaps from July 2001 to October 2018. Patient demographics, clinical and surgical characteristics, and postoperative complications were reviewed. RESULTS: In total, 12 patients were identified and included in this study. Mean age was 48.9 years old. Five patients had extended forequarter amputations and seven patients had external hemipelvectomies, all for locally advanced tumors. Mean tumor size was 15 ± SD 6.4 cm, and negative tumor margins were achieved in all the patients. Mean flap size was 1028 ± SD 869 cm2 . The mean follow-up was 13 months. There were no partial or total flap losses in the postoperative period. Two patients had flap-related postoperative complications, including flap bleeding and wound dehiscence. Median survival was 18 months. CONCLUSION: The free fillet flap is a safe, reliable, and valuable approach for reconstructing oncological defects. It offers the advantage of avoiding donor site morbidity, while providing extensive soft-tissue coverage as a one-step solution for massive oncologic defects.


Assuntos
Retalhos de Tecido Biológico/estatística & dados numéricos , Extremidade Inferior/cirurgia , Neoplasias/mortalidade , Neoplasias/cirurgia , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos/estatística & dados numéricos , Adulto , Feminino , Hemipelvectomia/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Procedimentos Cirúrgicos Reconstrutivos/mortalidade , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
15.
J Surg Orthop Adv ; 28(3): 196-200, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31675296

RESUMO

Pisiform pathology may be a source of ulnar-sided wrist pain. This study reviews the long-term outcomes of patients treated with pisiformectomy. A retrospective study approved by the institutional review board was performed over a 27-year period of patients undergoing pisiformectomy. Range of motion, grip strength, complications, and need for revision surgery were recorded. The series includes 61 wrists (60 patients) with an average age at surgery of 46 years. Two complications were noted (3%): a postoperative ulnar nerve palsy and symptomatic retained suture. At final follow-up, average flexion-extension arc was 81% (expressed as percent of contralateral), radioulnar deviation arc was 88%, and average grip strength was 89%. Pisiformectomy is a reliable, motion-preserving procedure with low complication rates for patients with chronic ulnar-sided wrist pain. In this series, 93% of patients did not require further procedures at an average of 8.2 years follow-up. (Journal of Surgical Orthopaedic Advances 28(3):196-200, 2019).


Assuntos
Osteoartrite , Punho , Seguimentos , Humanos , Pessoa de Meia-Idade , Osteoartrite/complicações , Osteoartrite/cirurgia , Dor , Amplitude de Movimento Articular , Estudos Retrospectivos , Punho/cirurgia , Articulação do Punho
16.
Anticancer Res ; 39(10): 5611-5615, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31570457

RESUMO

BACKGROUND/AIM: Chemotherapy is the mainstay treatment of osteosarcoma. The purpose of this study was to elucidate the factors that affect the rate of chemotherapy treatment of osteosarcoma patients. MATERIALS AND METHODS: We queried the National Cancer Database for bone cancer patients. We included patients diagnosed with osteosarcoma of the upper extremities regardless of age and sex. With bivariate and multivariate models, we analyzed the demographic, facility, and tumor-specific characteristics, comparing the group that received chemotherapy with those that did not. RESULTS: Female patients (OR=0.567; 95%CI=0.337-0.955), non-White patients (OR=0.485; 95%CI=0.25-0.939), and patients with government insurance (OR=0.506; 95%CI=0.285-0.9) had lower odds of receiving chemotherapy treatment than male, white, and privately insured patients. Patients with stages II (OR=4.817; 95%CI=2.594-8.946) and IV disease (OR=0.457; 95%CI=1.931-10.286) had higher odds of receiving chemotherapy than those with stage I disease. CONCLUSION: Age, sex, race and insurance affected the rate of chemotherapy treatment in patients with upper limb osteosarcoma.


Assuntos
Antineoplásicos/uso terapêutico , Neoplasias Ósseas/tratamento farmacológico , Osteossarcoma/tratamento farmacológico , Extremidade Superior/patologia , Adulto , Quimioterapia Adjuvante/métodos , Terapia Combinada/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
17.
Anticancer Res ; 39(10): 5663-5668, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31570464

RESUMO

BACKGROUND/AIM: Osteosarcoma of the upper extremities is rare, and characteristics in this location have not been described before. We aimed to analyze the characteristics and survival rate of osteosarcoma of the upper extremities. MATERIALS AND METHODS: A retrospective cohort study was performed by querying the National Cancer Database. Statistical analysis was performed using a multivariate logistic regression model and Kaplan-Meier log-rank tests for survival. RESULTS: A total of 991 patients were diagnosed with osteosarcoma of the upper extremities. Most tumors were osteogenic and osteoblastic (66.8%), larger than 8 cm (47.9%), high grade (64.3%), lymph node-negative (7.9%), and without metastasis to lungs (39.0%). Osteosarcomas of the hand and wrist were less likely to be high-grade when compared to osteosarcomas of the forearm, arm, and shoulder. CONCLUSION: The results of this study help us to approach patients promptly and avoid total amputation, increasing functionality and prognosis of the disease.


Assuntos
Osteossarcoma/patologia , Extremidade Superior/patologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoblastos/patologia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
18.
J Hand Surg Am ; 44(11): 928-938, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31543293

RESUMO

PURPOSE: The purpose of this study was to investigate the intraosseous vascular anatomy of the scaphoid using recent advances in micro-computed tomography (micro-CT) imaging and 3-dimensional reconstruction. We also studied the effect of scaphoid shape and screw position on the intraosseous vascular structure. METHODS: Thirteen upper extremities were injected with a contrast agent. The scaphoid bones were extracted and scanned using a micro-CT scanner. The vascular impact of screw insertion at various axes through the scaphoid was calculated and compared using the generated 3-dimensional models. The specimens were 3-dimensionally-printed and the morphology was assessed according to bone dimensions. A relationship between the internal vascular patterns and these morphological features was determined. RESULTS: All specimens received vascular inflow from the dorsal ridge forming a vascular network that supplied an average of 83% of the bone's volume. This network was supplemented in 4 specimens with volar vessels entering at the waist. Another network was identified, created by vessels entering volarly at the tubercle, which supplied the remainder of the scaphoid. One specimen did not receive any vessels at the tubercle. With regards to screw placement, screws placed in the central axis were the least disruptive to the internal vascularity, followed by the antegrade (dorsal) insertion axis. Two morphological bone types were identified: type I or full scaphoids and type II or slender scaphoids. Type I possessed a more robust internal vascular network than type II scaphoids. CONCLUSIONS: This study identifies 2 distinct types of scaphoid morphology with 1 of them having a less robust blood supply, which may prove to be related to development of nonunion, avascular necrosis, or Preiser disease. Central axis and antegrade (dorsal) screw fixation may be least disruptive to the internal blood supply. CLINICAL RELEVANCE: Safer fixation of the scaphoid bone may be achieved by knowledge of intraosseous vascular patterns.

19.
Anticancer Res ; 39(9): 5027-5031, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31519610

RESUMO

AIM: The purpose of this study was to identify patient-, facility-, disease-, and treatment-specific characteristics that increase mortality in patients with upper limb osteosarcoma. PATIENTS AND METHODS: The National Cancer Data Base (NCDB) was queried for bone cancer. With Cox regression, the demographic, facility, tumor-specific and treatment characteristics were analyzed to identify factors that increased mortality. RESULTS: Cox regression model showed that patients older than 40 years had a significantly higher likelihood of dying from upper limb osteosarcoma than those aged 0-14 years [hazard ratio (HR)=4.12, 95% confidence interval (CI)=2.261-7.508]. Patients with an income of $38,000-47,999 (HR=3.335, 95%CI=1.694-657) or less than $38,000 (HR=2.41, 95%CI=1.098-5.288) were also at greater risk of dying from their tumor. Patients who received radiation therapy (HR=2.457, 95%CI=1.056-5.717) had a higher likelihood of dying than patients who did not undergo this therapy. CONCLUSION: Age, gender, income, education, stage at diagnosis, radiation therapy and type of surgery seem to increase mortality from upper limb osteosarcoma.


Assuntos
Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/patologia , Osteossarcoma/mortalidade , Osteossarcoma/patologia , Extremidade Superior/patologia , Adolescente , Adulto , Neoplasias Ósseas/epidemiologia , Neoplasias Ósseas/terapia , Criança , Pré-Escolar , Terapia Combinada , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estadiamento de Neoplasias , Osteossarcoma/epidemiologia , Osteossarcoma/terapia , Prognóstico , Modelos de Riscos Proporcionais , Fatores de Risco , Fatores Socioeconômicos , Carga Tumoral , Estados Unidos/epidemiologia , Adulto Jovem
20.
J Shoulder Elbow Surg ; 28(12): 2364-2370, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31371161

RESUMO

BACKGROUND: Recalcitrant clavicular nonunion is a rare but complicated problem of clavicular fracture fixation. Nonunion is most often treated with clavicular shortening or in extreme cases vascularized bone grafting. Herein we describe our experience using the vascularized medial femoral condyle (MFC) free flap for the reconstruction of segmental defects in cases of recalcitrant clavicular nonunion. METHODS: A retrospective chart review was conducted of patients with symptomatic recalcitrant nonunion of the clavicle who underwent reconstruction with the vascularized MFC free flap from June 2003 to January 2018. Patients' demographics, time to union, and postoperative complications were collected. RESULTS: A total of 7 patients (6 women; 39.8 ± 9.01 years old) underwent clavicular reconstruction after an average of 3.7 ± 1.3 previous surgical procedures. Average preoperative visual analog scale score for pain was 4.1. The graft size ranged from 2 to 5 cm in length with approximately 1 cm in width and depth. The average time of total nonunion was 66 ± 48.2 months before surgery. All flaps survived and all clavicles healed with an average time to radiographic union of 15 ± 6.7 months. Patients regained full shoulder motion, and average postoperative visual analog scale score was 1.6 ± 1.8. All patients returned to their preoperative employment status. Donor site morbidity from the knee was minimal. CONCLUSION: The MFC free flap is a good option for recalcitrant bone nonunion of the clavicle where larger vascularized flaps are not warranted. It is effective and offers minimal donor site morbidity.


Assuntos
Transplante Ósseo/métodos , Clavícula/cirurgia , Fêmur/transplante , Fraturas não Consolidadas/cirurgia , Retalhos de Tecido Biológico/transplante , Adulto , Clavícula/lesões , Epífises/transplante , Feminino , Fixação Interna de Fraturas , Fraturas não Consolidadas/complicações , Retalhos de Tecido Biológico/irrigação sanguínea , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/etiologia , Medição da Dor , Procedimentos Cirúrgicos Reconstrutivos , Reoperação , Estudos Retrospectivos
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