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

RESUMO

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


Assuntos
Microcirurgia , Procedimentos Cirúrgicos Reconstrutivos , Cirurgia Plástica , Internato e Residência , Mamoplastia/economia , Microcirurgia/economia , Microcirurgia/métodos , Nervos Periféricos/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/economia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Suíça
2.
Unfallchirurg ; 2019 Aug 19.
Artigo em Alemão | MEDLINE | ID: mdl-31428806

RESUMO

BACKGROUND: Needlestick injuries (NSI) are potentially infectious injuries from sharp or pointed medical instruments and through contact with blood on mucous membranes or nonintact skin. Although the European Union (EU) Council directive 2010/32/EU on the prevention of NSI was implemented in EU countries in 2013, information on the effectiveness of the measures is limited. OBJECTIVE: The aim of this study was to evaluate the effectiveness of a safety concept according to the EU Council Directive 2010/32/EU on prevention of NSI. MATERIAL AND METHODS: In 2016 the NSI safety concept at a large regional hospital was improved according to 2010/32/EU, specifically by an update of blood screening profiles and standard operating procedures (SOP), better dissemination of information to employees and complete conversion to safety cannulas and scalpels. The medical records of all NSIs from 2015-2017 were retrospectively anonymized and evaluated and a cost analysis was performed. RESULTS: The number of NSIs in 2017 was significantly reduced by 48.4% as compared to 2016 and NSIs with scalpels were completely prevented. The proportion of employees with NSIs who were adequately immunized against hepatitis B was significantly increased to 84.1% in 2017. Furthermore, identification of the index patient was significantly increased to 82.5% in 2017. The cost of avoiding NSIs increased by a total of 24.1% in 2017 as compared to 2015 before introduction of the safety concept. CONCLUSION: Implementation of the EU Council directive 2010/32/EU, resulted in an almost 50% reduction in NSIs over 1 year, including the complete prevention of NSIs due to scalpels. In addition, the anamnestic presence of immunization against hepatitis B and index patient identification were significantly increased.

3.
Sci Rep ; 9(1): 5437, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30932006

RESUMO

Implementation of tubular endothelial cell networks is a prerequisite for 3D tissue engineering of constructs with clinically relevant size as nourishment of cells is challenged by the diffusion limit. In vitro generation of 3D networks is often achieved under conditions using serum containing cell culture medium and/or animal derived matrices. Here, 3D endothelial cell networks were generated by using human umbilical vein endothelial cells (HUVECs) in combination with human adipose tissue derived stromal cells (hASCs) employing human collagen I as hydrogel and decellularized porcine small intestinal submucosa as starter matrix. Matrigel/rat tail collagen I hydrogel was used as control. Resulting constructs were cultivated either in serum-free medium or in endothelial growth medium-2 serving as control. Endothelial cell networks were quantified, tested for lumen formation, and interaction of HUVECs and hASCs. Tube diameter was slightly larger in constructs containing human collagen I compared to Matrigel/rat tail collagen I constructs under serum-free conditions. All other network parameters were mostly similar. Thereby, the feasibility of generating 3D endothelial cell networks under serum-free culture conditions in human collagen I as hydrogel was demonstrated. In summary, the presented achievements pave the way for the generation of clinical applicable constructs.

4.
J Burn Care Res ; 39(4): 516-526, 2018 06 13.
Artigo em Inglês | MEDLINE | ID: mdl-29596600

RESUMO

The effect of the "Patient and Observer Scar Assessment Scale" (POSAS) and "Vancouver Scar Scale" (VSS) on patients' quality of life and their correlation with objective scar assessment tools, such as the Cutometer®, is not fully elucidated. In addition, long-term results of the dermal substitute Matriderm® used in combination with split-thickness skin grafting (STSG) remain unclear. We evaluated burn scars of 45 patients at least 2 years postburn injury using the Cutometer® MPA 580, the VSS, and the POSAS with three additional questions regarding quality of life and correlated the results. Study groups were: 1) scars following conservative treatment, 2) scars following STSG, and 3) scars following STSG in combination with Matriderm®. Cutometer® measurements demonstrated better elastic qualities in the Matriderm® group compared with the STSG group. VSS and extended POSAS were rated best for the conservative group, followed by the STSG group and the Matriderm® group. There was a significant correlation between POSAS and VSS, quality of life and the objective Cutometer® measurements. Conservatively treated superficial dermal burns do not reach the elastic qualities of healthy skin, and the use of Matriderm® significantly improves the long-term elastic qualities of STSG in deep dermal and full-thickness burns 2 years post injury. Results from the VSS and the POSAS correlate with restrictions in the quality of life of patients and also with objective Cutometer® measurements and are therefore useful tools in scar evaluation following burn injury.


Assuntos
Queimaduras/patologia , Queimaduras/psicologia , Cicatriz/patologia , Cicatriz/psicologia , Qualidade de Vida , Adulto , Idoso , Idoso de 80 Anos ou mais , Queimaduras/terapia , Cicatriz/terapia , Colágeno , Elastina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
6.
Ann Plast Surg ; 77(4): 401-5, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27387468

RESUMO

INTRODUCTION: Increased evaporative water loss (EWL) in burn patients leads to dehydration and hypothermia. Early clinical studies performed with outdated hygrometers suggested a 17 to 75 times increased EWL in burns with contradicting results for the different burn depths.Our study proposals were: (1) obtain reliable data of the EWL of all burn depths, (2) compare these results with findings from earlier studies, (3) evaluate the usefulness of the EWL in differentiating between superficial and deep partial thickness burns, (4) determine the effect of Biobrane on the EWL of superficial partial thickness burns in vivo, and (5) evaluate the effect of the sterile incision foil Opraflex on the EWL in split skin graft donor sites. METHODS: We measured the EWL of all burn depths in 28 patients under stable and recorded conditions regarding room temperature and humidity with a modern digital evaporimeter (Tewameter TM 300). For the first time in vivo, we also determined the effect of Biobrane on the EWL of burns and evaluated the EWL in split skin graft donor sites covered with Opraflex. RESULTS: The EWL in all burn depths was significantly increased (P < 0.001) compared with unburned skin. There was no significant difference (P > 0.05) in the EWL of superficial compared with deep partial thickness burns, whereas full thickness burns had a significantly lower EWL (P < 0.05) compared with superficial and deep partial thickness burns. Biobrane significantly reduced the EWL (P < 0.05) of superficial partial thickness burns. The EWL of Opraflex covered skin graft donor sites was significantly reduced compared with uncovered donor sites (P < 0.05). CONCLUSIONS: Our data suggest that the actual EWL in burns is approximately 3 times higher in full thickness burns and approximately 4 times higher in superficial and deep partial thickness burns compared with normal skin and therefore much lower than suggested previously.Because there was no significant difference in the EWL of superficial compared with deep partial thickness burns, the EWL cannot be used to differentiate between these burn depths.Biosynthetic wound dressings can significantly reduce the EWL of superficial partial thickness burns and sterile incision foil protects split skin graft donor sites from an increased EWL.


Assuntos
Queimaduras/fisiopatologia , Perda Insensível de Água/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Queimaduras/diagnóstico , Queimaduras/patologia , Queimaduras/terapia , Materiais Revestidos Biocompatíveis/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curativos Oclusivos , Transplante de Pele , Índices de Gravidade do Trauma , Resultado do Tratamento , Adulto Jovem
7.
J Plast Reconstr Aesthet Surg ; 69(2): e27-34, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26565080

RESUMO

INTRODUCTION: We investigated the application of the validated portable Kinect camera for three- and four-dimensional breast assessment in female life models. METHOD: Breast images from six life models were captured using the Kinect camera. Capture was conducted with taking three different arm positions while standing upright: with the arms straight down, straight up to the side at 90° and straight all the way up. Images of the volunteers were superimposed on each other. Digital linear distances between sternal notch and nipple-areola complexes were obtained and compared. The views of plastic and breast surgeons to arm positions were questioned. An example for clinical application was provided. RESULTS: Successful capture of images of the female life breast models was achieved. Digital breast measurements at the three different arm positions revealed considerable variation in linear distances measured on the images obtained with the Kinect camera. The dynamic of breast movements could be demonstrated by image overlay and the first ever four-dimensional breast assessment was demonstrated. Fourteen plastic and breast surgeons were found to have nine different opinions regarding their favoured arm positions for breast capture. Even though precision of image sharpness still needs improvement, the images were satisfactory for clinical patient use. The Kinect data were shown to be applicable to surgery planning by designing a planar flap from the 3D mesh. CONCLUSION: The portable and low-cost Kinect camera proved to be easy to use for the first application in life models for three- and four-dimensional breast assessment.


Assuntos
Mama/anatomia & histologia , Imagem Tridimensional/instrumentação , Postura , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Tamanho do Órgão , Reprodutibilidade dos Testes , Software
9.
Thorac Cardiovasc Surg Rep ; 3(1): 38-41, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25798359

RESUMO

Ectopia cordis (EC) is characterized by a complete or partial malposition of the heart outside the thorax. Despite the interdisciplinary treatment, the repair of EC is still very difficult and offers new surgical challenges because of its complexity and various combinations with other anomalies. We report the successful outcome after using a pedicled latissimus dorsi flap in reconstructive surgery in the setting of chronic wound dehiscence in an 8-month-old female infant born with a thoracic EC and omphalocele.

10.
J Reconstr Microsurg ; 27(2): 127-32, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21108182

RESUMO

The aim of this study was to evaluate the relevant conditions for safe free flap transfers. The authors retrospectively studied the data from 150 patients who received free flaps at a single institution. Many parameters were analyzed to reveal if there was a correlation with respect to surgical or medical complications. Regarding safety of free tissue transfer, we found a worse prognosis in flaps where a revision of the microanastomosis had to be performed. Platelet count and leukocyte count had an impact on the prognosis. Patients older than 60 years did not have an increased rate of surgical complications. Apart from active osteomyelitis, the presence of comorbid conditions did not significantly impair the outcome of flap transfer, although smoking and diabetes correlated with minor surgical complications like wound breakdown or hematoma, respectively. Besides one case of lethal heart failure of an octogenarian patient, no severe medical complications occurred in this series of patients. Microvascular free tissue transfer is not significantly impaired by age and most comorbidities. Osteomyelitis as well as elevated leukocytes and lowered platelets may increase the complication rate and worsen the surgical prognosis. Smoking and diabetes might prolong the hospital course of the patients.


Assuntos
Comorbidade , Retalhos de Tecido Biológico/irrigação sanguínea , Microcirurgia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Cicatrização/fisiologia , Adulto , Idoso , Estudos de Coortes , Feminino , Seguimentos , Retalhos de Tecido Biológico/efeitos adversos , Rejeição de Enxerto , Sobrevivência de Enxerto , Humanos , Masculino , Microcirurgia/efeitos adversos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento
11.
J Trauma ; 69(4): 928-33, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20924319

RESUMO

BACKGROUND: Although explosion injuries caused by terror attacks or in war are evaluated in many studies, limited information about civil explosion injuries can be found in the literature. METHODS: In a retrospective study of 71 civil gas explosion injuries treated in a single burn center during a 16-year period, we evaluated trauma mechanisms, patterns of injury, and clinical outcome. RESULTS: More than 50% of all gas explosions injuries occurred in private households. The mortality correlated significantly with higher burned total body surface area (TBSA), higher abbreviated burn severity index (ABSI) score, accompanying inhalation injuries, and lung contusions. Although mean ABSI score and burned TBSA were similar in men and women (6 vs. 7 and 22% vs. 21%), the female mortality from gas explosions was noticeably higher, albeit not statistically significant due to small patient numbers (32% vs. 17%). Although mean burned TBSA, ABSI scores, and intensive care unit lengths of stay in patients with burns from gas explosions were comparable and not significantly different compared with all burn patients treated in our burn center (TBSA: 22% vs. 17%; ABSI: 6 vs. 6; and intensive care unit lengths of stay: 12 vs. 11 days), the mortality from gas explosions was significantly higher (21% vs. 12%, p = 0.04). CONCLUSIONS: The mortality from gas explosion-related burns correlated significantly with burned TBSA, ABSI score, accompanying inhalation injuries, and lung contusions. Despite comparable ABSI scores, the mortality from gas explosion-related burns was significantly higher than the mortality for all burn victims.


Assuntos
Traumatismos por Explosões/epidemiologia , Traumatismos por Explosões/etiologia , Queimaduras/epidemiologia , Queimaduras/etiologia , Explosões , Combustíveis Fósseis/efeitos adversos , Acidentes Domésticos/estatística & dados numéricos , Acidentes de Trabalho/estatística & dados numéricos , Adulto , Fatores Etários , Traumatismos por Explosões/mortalidade , Superfície Corporal , Unidades de Queimados/estatística & dados numéricos , Queimaduras/mortalidade , Queimaduras por Inalação/epidemiologia , Queimaduras por Inalação/etiologia , Queimaduras por Inalação/mortalidade , Contusões/epidemiologia , Contusões/etiologia , Contusões/mortalidade , Estudos Transversais , Feminino , Combustíveis Fósseis/estatística & dados numéricos , Alemanha , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Lesão Pulmonar/epidemiologia , Lesão Pulmonar/etiologia , Lesão Pulmonar/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Risco , Fatores Sexuais , Análise de Sobrevida , Índices de Gravidade do Trauma
12.
Oper Orthop Traumatol ; 22(4): 440-51, 2010 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-20931323

RESUMO

OBJECTIVE: Soft-tissue defect closure of the volar and dorsal aspect of the hand and lower arm with a maximum defect size of 10 × 25 cm. INDICATIONS: Soft-tissue defects of the entire palm and dorsum of the hand and lower arm with a maximum defect size of 10 × 25 cm. CONTRAINDICATIONS: Polytraumatized patients presenting with concomitant life-threatening injuries. In these cases one should perform the definite defect closure secondary after cardiovascular stabilization. Scars and vascular injury at the donor site. Lack of vascularity and necrosis of implantation site. Poorly vascularized recipient site (e.g. after radiation) Infection and necrosis at the donor and/or recipient site. Prior operations of the groin with impairment of the vasculature. Noncompliant patient. SURGICAL TECHNIQUE: Landmarks are the femoral artery, inguinal ligament, anterior superior iliac spine, and sartorius muscle. The superior and inferior border of the flap should be orientated parallel to the inguinal ligament. The longitudinal axis of the flap is parallel to the superficial circumflex iliac artery, which is partially located superior to the inguinal ligament. One third of the flap is located superior, and two thirds inferior, to the inguinal ligament. Flap dissection starts at the lateral border without including the fascia. Identification of the lateral border of the sartorius muscle, incision of its fascia and inclusion of the fascia into flap dissection in order to preserve the vessel. If a long flap pedicle is favored, flap dissection is continued to the source of the superficial circumflex iliac artery. Primary closure of the donor site and, finally, inset of the flap. A tubed pedicle protects the vessels and simplifies the ischemic preconditioning during the postoperative phase. According to the flap size, the donor site closure is either primary or split-thickness skin grafting is necessary at the lateral aspect of the donor site. The mean duration of the procedure is 120 min in a teaching hospital (own data). POSTOPERATIVE MANAGEMENT: The patient should be mobilized as early as possible. Dressings and flap monitoring should be performed daily. Ischemic preconditioning by applying a tourniquet starts after 10-14 days. The ischemic period is increased continuously from 3 × 5 min/d in the beginning to 3 × 1 h/d before flap dissection. Flap dissection of the pedicle is performed after 3 weeks. The residual donor site is closed, while the distal pedicle is left untrimmed and closed secondarily a few days later to allow for sufficient venous drainage. Finally, defect closure can be completed after demarcation of the pedicle. RESULTS: In a 3-year period, defect closure with a pedicled groin flap was performed in 14 patients. Indications for this procedure were the following: thumb reconstruction for lengthening and defect closure after amputation and burn injury, soft-tissue reconstruction of the dorsum of the hand after decollement and infection, soft-tissue reconstruction of the distal part of the lower arm, wrist and palm after complex and combined trauma, and plastic reconstructive preservation of multiple fingers with subsequent phalangealization and syndactyly release, respectively. In all patients, complete soft-tissue coverage and flap survival could be achieved. The functional and aesthetic result was satisfactory in all cases.


Assuntos
Traumatismos da Mão/cirurgia , Mãos/cirurgia , Retalhos Cirúrgicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Virilha , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
13.
Aesthetic Plast Surg ; 34(1): 96-9; discussion 100-1, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-20043157

RESUMO

BACKGROUND: Gluteal ptosis may result from sagging of redundant skin and fat below the infragluteal fold. The correction of gluteal ptosis and the definition of gluteal prominence can be obtained by several gluteal lifting techniques. We present a new technique to correct gluteal ptosis using deepithelialized dermal flaps. METHODS: Eight female patients (39 + or - 4 years old) with gluteal ptosis were included in the study. Six patients had been previously operated on elsewhere (liposuction, body lift). Gluteal lifting is performed using a crescent-shaped deepithelialized flap. The cranial two-thirds of the flap is sutured to the gluteal fascia, thus creating the new gluteal curvature and the position of the new infragluteal fold. The lower third of the flap is then sutured back toward the two-thirds flap within the first suture line, resulting in a doubling of the deepithelialized area. RESULTS: The mean operating time was 100 + or - 20 min (range = 75-110 min). There were no complications in the study group. An analysis of postoperative results revealed a very good aesthetic aspect in all patients. All patients showed an improved definition of the infragluteal fold, with a symmetric shape of the gluteal region. All patients judged the outcome as very good. CONCLUSION: The use of a deepithelialized double dermal flap is a safe and new way to obtain excellent results in rejuvenation of the gluteal region. Our technique allows for the creation of a stable and long-lasting infragluteal fold with an aesthetic buttock curvature and a defined border to the thigh region.


Assuntos
Nádegas/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos , Adulto , Feminino , Humanos , Satisfação do Paciente , Resultado do Tratamento
14.
J Burn Care Res ; 30(4): 747-51, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19506511

RESUMO

The definition of heparin-induced thrombocytopenia (HIT) has been modified over time; however, most definitions require a relative or absolute thrombocytopenia after exposure to heparin. Therefore, routine platelet count monitoring has been recommended for screening. We present the case of a 26-year-old male patient with toxic epidermal necrolysis who developed a rapid and fatal clinical presentation of HIT, without thrombocytopenia at the time of diagnosis. Because our patient did not present a relative or absolute thrombocytopenia at the time of serological and clinical confirmation of HIT, routine platelet count monitoring failed to detect HIT in our patient. As a result of the here presented case of rapid and fatal HIT, it may be prudent to consider if thrombocytopenia, although it is still a common and important hallmark of HIT, should be an absolute requirement for the definition of HIT. In cases of HIT without any thrombocytopenia, screening for HIT antibodies may be the only way to detect HIT early enough to react. Because there is a high incidence of HIT antibodies in the general population, which are not always associated with HIT, screening for HIT antibodies cannot be recommended for every patient receiving heparin. However, prospective studies may be useful in determining if routine screening for HIT antibodies can decrease the morbidity and mortality of HIT in critically ill patients receiving therapeutic doses of unfractionated heparin on the intensive care unit.


Assuntos
Antimaníacos/efeitos adversos , Carbamazepina/efeitos adversos , Heparina/efeitos adversos , Síndrome de Stevens-Johnson/etiologia , Trombocitopenia/induzido quimicamente , Adulto , Transtorno Bipolar/tratamento farmacológico , Evolução Fatal , Humanos , Masculino
15.
Ann Plast Surg ; 59(4): 423-7, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17901735

RESUMO

Local treatment of burn injuries with conventional anti-infective preparations does not provide the moist environment that promotes fast wound healing. In a randomized controlled trial the effects of liposome polyvinyl-pyrrolidone-iodine (PVP-I) hydrogel, a novel formulation of PVP-I in a liposome hydrogel with high water-binding capacity, were investigated in 43 patients with partial-thickness burn wounds in an intraindividual comparison with a conventional silver-sulfadiazine cream. Treatment with liposome PVP-I hydrogel resulted in significantly faster complete healing of the burn wounds compared with silver-sulfadiazine cream (9.9 +/- 4.5 days versus 11.3 +/- 4.9; P < 0.015). The cosmetic result (smoothness, elasticity, appearance) was rated as excellent for 37.0% of study wounds with liposome PVP-I hydrogel compared with 13.0% of wounds treated with silver-sulfadiazine cream. Local tolerability was good; handling and change of dressing were rated as easy. Local treatment with liposome PVP-I hydrogel thus provides fast wound healing with a favorable cosmetic result.


Assuntos
Anti-Infecciosos Locais/administração & dosagem , Queimaduras/tratamento farmacológico , Hidrogel de Polietilenoglicol-Dimetacrilato/administração & dosagem , Povidona-Iodo/administração & dosagem , Cicatrização/efeitos dos fármacos , Adulto , Feminino , Humanos , Lipossomos , Masculino , Pessoa de Meia-Idade , Povidona-Iodo/uso terapêutico , Sulfadiazina de Prata/uso terapêutico , Resultado do Tratamento
16.
World J Surg Oncol ; 5: 15, 2007 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-17280612

RESUMO

BACKGROUND: Elastofibromas are benign soft tissue tumours mostly of the infrascapular region between the thoracic wall, the serratus anterior and the latissimus dorsi muscle with a prevalence of up to 24% in the elderly. The pathogenesis of the lesion is still unclear, but repetitive microtrauma by friction between the scapula and the thoracic wall may cause the reactive hyperproliferation of fibroelastic tissue. METHODS: We present a series of seven cases with elastofibroma dorsi with reference to clinical findings, further clinical course and functional results after resection, as well as recurrence. Data were obtained retrospectively by clinical examination, phone calls to the patients' general practitioners and charts review. Follow-up time ranged from four months to nine years and averaged 53 months. RESULTS: The patients presented with swelling of the infrascapular region or snapping scapula. In three cases, the lesion was painful. The ratio men/women was 2/5 with a mean age of 64 years. The tumor sizes ranged from 3 to 13 cm. The typical macroscopic aspect was characterized as poorly defined fibroelastic soft tissue lesion with a white and yellow cut surface caused by intermingled remnants of fatty tissue. Microscopically, the lesions consisted of broad collagenous strands and densely packed enlarged and fragmented elastic fibres with mostly round shapes. In all patients but one, postoperative seroma (which had to be punctuated) occurred after resection; however, at follow-up time, no patient reported any decrease of function or sensation at the shoulder or the arm of the operated side. None of the patients experienced a relapse. CONCLUSION: In differential diagnosis of soft tissue tumors located at this specific site, elastofibroma should be considered as likely diagnosis. Due to its benign behaviour, the tumor should be resected only in symptomatic patients.


Assuntos
Fibroma/patologia , Neoplasias de Tecidos Moles/patologia , Neoplasias Torácicas/patologia , Parede Torácica/patologia , Idoso , Biópsia por Agulha , Diagnóstico Diferencial , Feminino , Fibroma/cirurgia , Seguimentos , Humanos , Imuno-Histoquímica , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Amostragem , Neoplasias de Tecidos Moles/cirurgia , Neoplasias Torácicas/cirurgia , Resultado do Tratamento
17.
J Reconstr Microsurg ; 22(7): 513-8, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17048133

RESUMO

The success of a free microvascular tissue transfer is based on a sufficient microanastomosis which meets the following requirements: a pedicle placed without kinking or twisting, good drainage, a well-defined recipient vessel, integrity of the endothelium, and duration of ischemia. The extent of skin and muscle necrosis increases significantly with increases in ischemia time. Reperfusion of ischemic tissue results in local and systemic damage associated with the release of oxygen free radicals, polymorphonuclear leucocytes, and such endothelial hormones as endothelin-1, EDRF (endothelial-derived relaxing factor), thromboxane, complement, and cytokines. Ischemia-reperfusion disrupts the delicate balance that maintains homeostasis in the microcirculation. This review discusses the clinical and therapeutic aspects of such injury, concentrating on perioperative management in free flap transfer. It points out the possible influence of endothelin-1 on vasospasm at the site of anastomosis, and emphasizes the importance of the endothelium as a highly dynamic network. Finally, future diagnostic and therapeutical aspects are discussed.


Assuntos
Endotélio Vascular/fisiologia , Microcirculação/fisiologia , Traumatismo por Reperfusão/fisiopatologia , Retalhos Cirúrgicos/fisiologia , Anastomose Cirúrgica , Endotelina-1/fisiologia , Fatores Relaxantes Dependentes do Endotélio/fisiologia , Humanos , Neutrófilos/fisiologia , Retalhos Cirúrgicos/irrigação sanguínea
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