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1.
Acta Chir Plast ; 61(1-4): 10-15, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32380837

RESUMO

INTRODUCTION: The bilobed flap was first described by Esser in 1918. He used it to reconstruct the defects of the nose. It has been used in the reconstructions of trunk and feet defects by many authors since then. Its principle is also advantageous in reconstructions of larger facial defects. Successful reconstruction of problematic suborbital area using the bilobed flap was reported by Yenidunya in 2007. The design of the flap can be successfully used in other atypical facial defects. MATERIAL AND METHODS: The bilobed flap was used to cover facial defects of 199 patients who underwent 203 tissue reconstructions from 1st January 2007 to 31st December 2016 at the Department of Plastic and Aesthetic Surgery St. Anne´s University Hospital in Brno. RESULTS: The flaps were equally distributed between the genders, men 101 and women 98. Ages of patients ranged from 39 to 98 years (mean 76 years). It was used in the reconstruction of the tip and alars defects of the nose 159 times, in the reconstruction of periorbital defects 16 times and in other atypical facial areas 28 times. The excision of malignant tumours of the face (basal cell carcinoma, squamous cell carcinoma, SSM) were usually the causes of the defects (89.7%). There were 80 cases with defects of the nasal tip and ala in men and 79 cases in women. Complications occurred 41 times of all reconstructions (20.2%). The most common complication was abundance of the flap (4.9%). The postoperative results were favourable due to the preservation of colour, texture and function of the reconstructed areas. CONCLUSION: Bilobed flap in different modifications should always be considered in the reconstruction of extensive defects of the face, because unlike other techniques, it preserves good texture and colour of facial skin with minimal donor site morbidity.


Assuntos
Face/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias Cutâneas/cirurgia , Retalhos Cirúrgicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Cutâneas/patologia
2.
Ceska Gynekol ; 84(3): 177-183, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31324106

RESUMO

INTRODUCTION: A successful embryo implantation is crucial for a positive outcome of in vitro fertilization. But there is only a short period during which the endometrium is receptive for embryo, this so called implantation window can be detected by a molecular diagnostic method endometrial receptivity analysis (ERA). OBJECTIVE: To find out the percentage of patients with a non-receptive endometrium in the time of ERA and to learn what part of them got pregnant after the identification of their personalized implantation window. DESIGN: A retrospective study. SETTING: REPROMEDA Biology Park, Centre of Reproductive Medicine and Preimplantation Genetic Diagnosis, Brno. METHODS: A cohort of 85 patients undergoing ERA from August 2015 to October 2018 was studied. 74 patients experienced a previous implantation failure, the average number of preceding unsuccessful frozen embryo transfers was 2,5 in this group, 11 women went through ERA due to the preventive reason before the first FET. In all women one euploid embryo was transferred. 48 patients were prepared either for ERA or FET in a natural menstrual cycle, 37 women in HRT cycle. We were interested in a percentage of non-receptive patients in the time of ERA and wanted to discover what part of non-receptive women got pregnant after the identification of their personal implantation window. The average number of frozen embryo transfers needed to achieve the pregnancy was also calculated. RESULTS: 31 of 85 patients (36.5%) were found to have a non-receptive endometrium. In the natural cycle 13 of 48 (27.1%) were non-receptive: five were pre-receptive, three early receptive, two late receptive and three post-receptive. In the HRT cycle 18 of 37 patients (48.6%) were non-receptive: 12 were pre-receptive, four early receptive, one late receptive, one post-receptive. Personalized FET was done in 26 of total 31 initially non-receptive patients, 18 of them got pregnant (69.2%). In the natural cycle 6 of 11 (54.5%) achieved the pregnancy, in the HRT cycle 12 of 15 women (80.0%) got pregnant. To achieve the clinical pregnancy 1.5 frozen embryo transfer in average was needed. CONCLUSION: A displaced implantation window was found in more than 1/3 of patients undergoing an assisted reproductive treatment. After the personalized FET the clinical pregnancy was noticed in 69.2% of them. This result supports an individual approach to patients in IVF programme besides other at the timing of embryo transfer after the identification of pWOI.


Assuntos
Implantação do Embrião , Transferência Embrionária/métodos , Endométrio/fisiologia , Fertilização In Vitro/métodos , Infertilidade Feminina/terapia , Implantação do Embrião/fisiologia , Feminino , Humanos , Infertilidade Feminina/fisiopatologia , Gravidez , Taxa de Gravidez , Estudos Retrospectivos
3.
Org Biomol Chem ; 15(43): 9071-9076, 2017 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-29083001

RESUMO

An asymmetric organocatalytic addition of fluorinated phenylsulfonylnitromethane to isatin-derived ketimines was developed. The reaction was efficiently catalyzed by a chiral tertiary amine, cinchonine. This methodology provides a new type of optically active compound with two adjacent quaternary carbon stereocenters in good yield (up to 96%), with moderate diastereoselectivity (up to 5.7 : 1 dr) and excellent enantioselectivity (up to 98/96% ee).


Assuntos
Benzenossulfonatos/química , Iminas/química , Isatina/química , Metano/química , Nitrilas/química , Estereoisomerismo
4.
Acta Chir Plast ; 59(2): 72-81, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29446306

RESUMO

BACKGROUND: The latissimus dorsi flap is a reliable and one of the most commonly used methods of both immediate and delayed breast reconstruction. Its disadvantage is the limited volume of transferred tissue. The authors present their experience with the use of extended latissimus dorsi flap associated with immediate fat grafting into the pectoralis and latissimus dorsi muscles for secondary breast reconstruction. METHODS: From 2013 to 2016, 14 patients underwent secondary unilateral total breast reconstruction with extended latissimus dorsi flap associated with primary fat grafting into the pectoralis major and latissimus dorsi muscles. Fat was injected under visual control between muscle fibers. Fat injected into the pectoralis muscle formed an apparent bulging - autoprosthesis. RESULTS: Mean patient age was 48.2 years (range, 34 to 64 years). Mean injected fat volume was 86.4 ml (range, 50 to 160 ml) and majority of this volume was injected into the pectoralis muscle. All flaps healed uneventfully and no fat grafting-related complications were observed. The most common complication was donor site seroma, which occurred in 57.1%. Results of postoperative ultrasound examination were evaluated. Incidence and the size of oil cysts and fat necroses were significantly lower in muscular layer in comparison with the subcutaneous layer of the reconstructed breast. CONCLUSIONS: Immediate fat transfer into the pectoralis and latissimus dorsi muscle increases the breast volume during the reconstruction with extended latissimus dorsi flap avoiding implant-related complications when abdominal tissue is not available. Pectoralis and latissimus dorsi muscles were shown as reliable and safe recipients for fat grafting.


Assuntos
Neoplasias da Mama , Mamoplastia , Músculos Superficiais do Dorso , Mama , Feminino , Humanos , Mamoplastia/métodos , Músculos Peitorais , Retalhos Cirúrgicos
5.
Bratisl Lek Listy ; 117(10): 577-582, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27826972

RESUMO

BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by chronic thromboembolic obstruction in the pulmonary bed. The definitive pathogenesis remains incompletely explained, although multiple risk factors of CTEPH have been identified. The purpose of the study was to evaluate the risk profile of patients with CTEPH and the representativeness of risk factors, identify possible new CTEPH risk factors and specify the epidemiology of CTEPH in our country. METHODS: In 81 patients with CTEPH, well known risk factors were analyzed, and a detailed analysis of selected hematological parameters was investigated at a specialized hematology laboratory. RESULTS: CTEPH risk factors were identified as follows: pulmonary embolism (PE), deep vein thrombosis (DVT), thyreopathy, blood type other than "0", inflammatory bowel disease, malignancy, splenectomy, pacemaker. When compared to healthy controls, the following was observed: a significant decrease in platelet count, higher mean platelet volume, higher spontaneous platelet aggregation, increase in von Willebrand factor and fibrinogen. The median of risk factors representativeness was 3 (PE, DVT, blood type other than "0"). The prevalence of CTEPH in adult population in our country is estimated to be 1.8 per 100,000 inhabitants. CONCLUSION: In the study we confirmed multiple established risk factors of CTEPH, set their representativeness, identified some platelet abnormalities which could be a potential new risk marker and specified the prevalence of CTEPH (Tab. 5, Ref. 35).


Assuntos
Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/etiologia , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico , Adulto , Idoso , Anticoagulantes , Doença Crônica , Feminino , Fibrinogênio , Humanos , Pulmão , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Prevalência , Fatores de Risco , Trombose Venosa/complicações , Trombose Venosa/diagnóstico
6.
Acta Chir Plast ; 58(2): 64-69, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28079391

RESUMO

BACKGROUND: The abdominal tissue is an ideal source for autologous breast reconstruction. We propose a new approach for intramuscular dissection of a DIEP flap in this paper. METHODS: A total of 84 women underwent breast reconstruction after mastectomy. From this group, 49 patients were treated with traditional DIEP flap of which 21 had unilateral procedure and 28 had bilateral procedure. This new type of dissection was performed in 35 women, with unilateral approach in 14 cases and bilateral approach in 21 cases. RESULTS: The statistical differences are not significant in the two groups with regards to complications (p > 0.1). Mean operative time in this new approach was 3 hours and 10 minutes per flap. Mean operative time in the traditional dissection of DIEP was 3 hours and 41 minutes per flap. The operative time of the new approach is significantly shorter than the dissection of the traditional DIEP flap (p < 0.01). CONCLUSION: The approach to DIEP flap dissection proposed by the authors is a new concept in autologous breast reconstruction. In this type of dissection no fascia is resected and it is more reliable than a traditional DIEP flap for the ease of dissection and for the presence of a small protective cuff of muscle around the vessel with a lower risk of perforator injury.It is a reproducible option of dissection, useful also in less experienced hands and it is a time reducing technique compared with the traditional DIEP flap.


Assuntos
Dissecação/métodos , Retalho Perfurante , Feminino , Humanos , Mamoplastia , Duração da Cirurgia , Estudos Retrospectivos
7.
Acta Chir Plast ; 58(2): 70-76, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28079392

RESUMO

A variety of surgical techniques has been used to correct hypoplastic breast malformations and deformities, including tissue expanders, breast implants, custom chest wall implants, mammary gland remodelling, as well as locoregional or free flap. Case series of successful breast reconstruction using lipomodelling technique in one patient with severe Polands syndrome and two patients with tuberous breasts are reported together with literature review. No surgical complications were observed and ultrasound examination did not reveal any pathology in breast tissue other than oil pseudocysts postoperatively. In both malformations, submammary fold was moved downwards. Moreover, the lower part of the breast and areolar herniation was corrected in tuberous breast, and in Polands syndrome, the areolar complex was significantly shifted downwards and laterally. In comparison with other reconstructive techniques, lipomodelling allows for the breast correction to begin in early adolescence. Further growth of the unaffected breast may be effectively corrected by subsequent lipomodelling session. This technique appears to change the overall approach to the management of hypoplastic breast and chest wall malformations.


Assuntos
Tecido Adiposo/transplante , Mama/cirurgia , Mamoplastia/métodos , Síndrome de Poland/cirurgia , Adolescente , Mama/anormalidades , Feminino , Humanos , Adulto Jovem
8.
Acta Chir Plast ; 58(2): 77-81, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28079393

RESUMO

The reconstruction of complex craniofacial and orbital defects should satisfactorily restore functional and aesthetic integrity. Autologous reconstruction of nasal, periorbital and auricular facial subunits as a whole using a locoregional or a free flap is very challenging and the results are not sometimes ideal. With advanced technologies that are currently available it is possible to plan and produce authentic facial prosthesis that can satisfactory substitute these facial subunits. We demonstrate an alternative reconstructive concept for complex craniofacial defects based on a free flap combined with a facial prosthesis for the replacement of periorbital or auricular facial subunits. This approach was used in two patients with very satisfactory results. Combination of a free flap with a facial prosthesis may become a preferable approach for the reconstruction of complex craniofacial defects. Clinical outcomes of the reconstructions may be enhanced respecting the principle of aesthetic facial subunits.


Assuntos
Orelha Externa/cirurgia , Olho Artificial , Retalhos de Tecido Biológico , Implantes Orbitários , Próteses e Implantes , Neoplasias Cutâneas/cirurgia , Carcinoma Basocelular/cirurgia , Enucleação Ocular , Neoplasias Palpebrais/cirurgia , Neoplasias Faciais/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
9.
Klin Onkol ; 29 Suppl 1: S93-9, 2016.
Artigo em Tcheco | MEDLINE | ID: mdl-26691949

RESUMO

BACKGROUND: Assisted reproduction, as well as pregnancy itself, in patients with breast cancer or other hereditary type of cancer, is a widely discussed topic. In the past, patients treated for breast cancer were rarely involved in the discussion about reproductive possibilities or infertility treatment. However, current knowledge suggests, that breast cancer is neither a contraindication to pregnancy, nor to assisted reproduction techniques. On the contrary, assisted reproduction and preimplantation genetic diagnosis methods might prevent the transmission of genetic risks to the fetus. AIM: In this review we summarize data concerning pregnancy risks in patients with increased risk of breast cancer. In addition, we introduce current possibilities and approaches to fertility preservation prior to assisted reproduction treatment as well as novel methods improving the safety of fertility treatment. In the second part of this review, we focus on karyomapping--an advanced molecular genetic tool for elimination of germinal mutations in patients with predisposition to cancer. Moreover, the rapid development of preimplantation genetic diagnosis methods contributes to detection of both chromosomal aneuploidy and causal mutations in a relatively short time-span.


Assuntos
Neoplasias da Mama/genética , Predisposição Genética para Doença , Testes Genéticos , Diagnóstico Pré-Implantação , Técnicas de Reprodução Assistida , Neoplasias da Mama/diagnóstico , Feminino , Humanos
10.
Acta Chir Plast ; 57(1-2): 9-12, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26650107

RESUMO

The rat's femoral artery is definitely the most frequently used model in microsurgical training for its easy dissection. Our model, consisting in the creation of several anastomoses in a row, helps the novice surgeon to assess his microsurgical level and to improve his capacity. Indeed, this leads to an amplification of the trainee surgeon's mistakes, which add up to each other as the anastomoses are performed. We propose a simple method to evaluate the surgeon microsurgical skills during the training.


Assuntos
Anastomose Cirúrgica/educação , Artéria Femoral/cirurgia , Curva de Aprendizado , Microcirurgia/educação , Animais , Modelos Animais , Ratos Wistar
11.
Acta Chir Plast ; 57(1-2): 13-6, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26650108

RESUMO

BACKGROUND: Replantation is a complicated procedure in avulsion injuries in majority of the cases. When replantation of an avulsed thumb is not feasible, it is mandatory to find an appropriate reconstruction choice as soon as possible due to the importance of the thumb function in the dynamics of the handgrip. MATERIALS AND METHODS: Three patients with skin avulsion injury underwent immediate reconstruction by twisted lateral arm flap in our department since 2004. RESULTS: No infection, hematoma, partial or complete flap necrosis were observed after the procedure. All of the flaps healed without complications. CONCLUSION: Although the gold standard in reconstruction of these trauma defects is the use of local skin flaps or distant inguinal flap, these reconstructive choices have multiple drawbacks such as the loss of sensibility and they are thicker. In thispaper we propose a modification of distally planned lateral arm flap design and a new technique of its spiral shaping for immediate thumb reconstruction.


Assuntos
Retalhos Cirúrgicos , Polegar/lesões , Polegar/cirurgia , Adulto , Amputação Traumática/cirurgia , Braço , Humanos , Masculino , Pessoa de Meia-Idade
12.
Acta Chir Plast ; 57(1-2): 24-6, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26650110

RESUMO

The deep inferior epigastric artery perforator (DIEAp) flap is becoming a widely used method of autologous breast reconstruction. Despite the huge use of the DIEAp flap in reconstructive field, an evidenced based approach in perforator selection has not yet been developed. Unfortunately there is no clear evidence about the relation between the number and dimension of the perforator vessel and the prediction of flap survival in a living model. An old technique like the vascular delay could be extremely useful as a lifeboat procedure when the vascularization of the flap after the dissection is inadequate.


Assuntos
Mamoplastia , Retalho Perfurante/irrigação sanguínea , Adulto , Feminino , Humanos , Tempo para o Tratamento
13.
J Mech Behav Biomed Mater ; 45: 101-8, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25700260

RESUMO

In the present study, inflation tests with free axial extension of 15 human vena saphena magna were conducted ex vivo to obtain data suitable for multi-axial constitutive modeling at overloading conditions (pressures up to approximately 15kPa). Subsequently the data were fitted with a hyperelastic, nonlinear and anisotropic constitutive model based on the theory of the closed thick-walled tube. It was observed that initial highly deformable behavior (up to approximately 2.5kPa) in the pressure-circumferential stretch response is followed by progressive large strain stiffening. Contrary to that, samples were much stiffer in longitudinal direction, where the observed stretches were in the range 0.98-1.03 during the entire pressurization in most cases. The effect of possible residual stress was evaluated in a simulation of the intramural stress distribution with the opening angle prescribed to 0°, 10°, 20°, 30°, 40°, and 50°. The result suggests that the optimal opening angle making the stress distribution through the wall thickness uniform is about 40°. The material parameters presented here are suitable for use in mechanobiological simulations describing the adaptation of the autologous vein wall after bypass surgery.


Assuntos
Modelos Biológicos , Pressão , Veia Safena/fisiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Teste de Materiais , Pessoa de Meia-Idade , Veia Safena/anatomia & histologia , Estresse Mecânico , Suporte de Carga
14.
Org Biomol Chem ; 13(10): 2884-9, 2015 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-25642993

RESUMO

The alkynylation of various nitrogen- and/or sulphur-containing heterocyclic compounds using hypervalent iodine TMS-EBX by utilization of tertiary amines under mild conditions is described. The developed metal-free methodology furnishes the corresponding alkynylated heterocycles bearing quaternary carbon in high yields.


Assuntos
Produtos Biológicos/química , Compostos Heterocíclicos/química , Iodetos/química , Iodo/química , Acetileno/química , Alquilantes/química , Carbono/química , Desenho de Fármacos , Ligação de Hidrogênio , Indicadores e Reagentes , Indóis/química , Lactonas/química , Espectroscopia de Ressonância Magnética , Modelos Químicos , Modelos Moleculares , Conformação Molecular , Estrutura Molecular , Compostos Orgânicos/química , Oxindóis , Rodanina/química , Solventes/química , Temperatura
15.
Acta Chir Plast ; 57(3-4): 75-8, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26853584

RESUMO

Osseous reconstruction of the thumb following traumatic bone loss can be approached through a variety of techniques. The use of a silicone spacer with secondary bone grafting is a valid therapeutic option. In case of combined injuries, simultaneous immediate reconstruction of missing soft tissues over the spacer by well-vascularised skin cover is essential. Dorsoradial forearm flap has recently been described as distally based cutaneous pedicled flap on the dorsoradial artery, a constant branch of the radial artery. A case of a 52-year-old male patient with a combined injury of the thumb with bone loss of the proximal phalanx and with the loss of dorsal skin reconstructed primarily with bone silicon spacer and together with emergency dorsoradial forearm flap is reported together with a brief literature review.


Assuntos
Falanges dos Dedos da Mão/cirurgia , Retalhos de Tecido Biológico , Próteses e Implantes , Polegar/cirurgia , Falanges dos Dedos da Mão/lesões , Retalhos de Tecido Biológico/irrigação sanguínea , Humanos , Masculino , Pessoa de Meia-Idade , Silicones , Polegar/lesões
16.
Acta Chir Plast ; 56(1-2): 3-11, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25484270

RESUMO

BACKGROUND: An experimental model for testing vasodilating drugs on vasospasm caused by standardized traumatisation of a pedicle has not been described yet. The aim of this study was to develop such model and to compare the effects of different types of surgical manipulations that can provoke vasospasm during flap dissection. MATERIAL AND METHODS: The pedicled groin flap was dissected in 185 male Wistar rats under standardised conditions. The blood perfusion curves of the flap were obtained using the Laser Doppler flow-meter. The vasospasm was provoked by the following manoeuvres: pulling on the pedicle; compression of the pedicle by vascular clamps; dissection of the vessels and by presence of blood around the pedicle. The perfusion recording curves were processed and two important time periods describing the progress of spasm were extracted. Combined non-parametrical ANOVA and WILCOXON tests were used to compare the time parameters between the groups. On the basis of statistical evaluation, we divided the factors responsible for vasospasm into categories labelled as strong and weak. The strong stimuli included dissection of the vessels; pulling on the pedicle using 15g, 20g and 25g weights and presence of blood around the pedicle. The weak stimuli included compression of the pedicle using vascular clamps and pulling on the pedicle using 10g weight. Pulling on the pedicle using 15g weight was chosen as the most appropriate stimulus for the experimental model. RESULTS: A new experimental model for studying vasospasm caused by tension on the pedicle was developed. This model is well defined, easily repeatable and reproducible, produces vasospasm of appropriate duration and permits standardized topical application of vasodilating drugs. DISCUSSION AND CONCLUSION: The finding that certain kind of surgical traumatisation causes vasospasm that is longer than the others may help microsurgeons to review their methods of surgical manipulation.


Assuntos
Retalhos Cirúrgicos/irrigação sanguínea , Vasoconstrição , Análise de Variância , Animais , Constrição Patológica , Masculino , Microcirurgia , Modelos Animais , Músculo Liso Vascular , Ratos Wistar
17.
Acta Chir Plast ; 56(1-2): 23-6, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25484274

RESUMO

Replantation of amputated fingertip is a technical challenge to the microsurgeons. The success rate depends directly on the availability and the size of preserved vessels and on the degree of their damage. In distal digital amputations, veins are usually not easily recovered or even absent, and thus high number of replantation procedures fails because of the venous congestion. The use of medicinal leeches is a treatment option for venous congestion of replanted fingers. A case report of a 4-year-old patient after fingertip replantation without venous anastomosis when temporary venous drainage was provided by an application of medicinal leeches is reported together with literature review. We observed an unusually short duration of venous congestion (48 hours) and there was no need of blood transfusion.


Assuntos
Amputação Traumática/cirurgia , Traumatismos dos Dedos/cirurgia , Aplicação de Sanguessugas , Reimplante , Animais , Pré-Escolar , Humanos , Masculino
18.
Org Biomol Chem ; 12(28): 5071-6, 2014 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-24911945

RESUMO

The highly stereoselective allylic alkylation of Morita-Baylis-Hillman carbonates with ß-ketoesters catalysed by ß-ICD is described. The corresponding products containing two adjacent quaternary and tertiary carbon centers were obtained in good yields with high diastereoselectivity (up to 10 : 1 dr) and enantioselectivity (up to 95% ee).

19.
J Hand Surg Eur Vol ; 38(4): 399-404, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23151351

RESUMO

We describe our experience and outcome with the 'Proximal first dorsal metacarpal artery free flap'. Ten consecutive cases utilizing the proximal first dorsal metacarpal artery free flap for complex digital defects were studied. Surgical technique, patient demographics, and flap outcome data were collected. Patient satisfaction was analysed using a questionnaire. All defects healed successfully with no loss of free flaps. The short-pedicle proximal first dorsal metacarpal artery free flap enables primary closure of the donor site up to 2 cm of width (in nine of the ten donor sites). The flap is a reliable and versatile alternative in selected cases of complex digital injuries.


Assuntos
Traumatismos dos Dedos/cirurgia , Retalhos de Tecido Biológico/irrigação sanguínea , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adolescente , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Inquéritos e Questionários , Resultado do Tratamento
20.
Acta Chir Orthop Traumatol Cech ; 79(4): 367-9, 2012.
Artigo em Tcheco | MEDLINE | ID: mdl-22980937

RESUMO

PURPOSE OF THE STUDY: Two tendons, i.e., the extensor indicis proprius (EIP) and the extensor carpi radialis longus (ECRL), are commonly used to reconstruct the function of a ruptured extensor pollicis longus (EPL) tendon. We reviewed a group of patients with EPL ruptures treated by ECRL tendon transfer to the EPL tendon, which was the method of choice. The aim was to evaluate the results and to assess the effect of ECRL detachment on hand function. MATERIAL AND METHODS: Twenty patients were treated surgically for a subcutaneous rupture of the EPL tendon between 2003 and 2007. Each patient was examined at 2 years after surgery. The range of motion (ROM) of both the injured and the contralateral hand was recorded and evaluated with a modified Geldmacher scoring system; a response to the DASH questionnaire was obtained. The mean follow-up was 24 months (19-31 months). RESULTS: For the ROM of the operated hand, the mean Total Active Motion (TAM) of 98.75 degrees (60-140, SD 22.74) was calculated. The mean extension lag at the interphalangeal (IP) joint was 5.42 degrees (0-25, SD 8.77) and the mean IP flexion was 65.8 degrees (40-80, SD 13.2). In order to evaluate body side differences, the ROM of the contralateral thumb was recorded. The values were as follows: mean TAM, 141.3 degrees (115-190, SD 20.43); mean IP extension lag, 0 degrees (0-0, SD 0); mean IP flexion, 68.8 degrees (50-80, SD 9.6). DISCUSSION: The extension lag at the IP joint was detected in both the operated and the contralateral hands. The patients examined at a longer interval after surgery showed an increase in extension lag. This may have been caused by undesired adaptation of the donor muscle, the presence of adhesions or suture loosening. CONCLUSIONS: The results showed increased adaptation of thumb motion to the extension lag at the IP joint, which had a mild effect on the patient's hand function. The difference in wrist extension between the operated and the contralateral hand corresponded to the pre-operative condition.


Assuntos
Traumatismos dos Tendões/cirurgia , Transferência Tendinosa , Polegar/lesões , Adulto , Idoso , Dedos , Humanos , Pessoa de Meia-Idade , Ruptura , Transferência Tendinosa/métodos , Adulto Jovem
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