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1.
J Craniofac Surg ; 2021 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-33464774

RESUMO

OBJECTIVE: The surgical flap delaying has been shown to be effective in preventing partial flap loss or in preparing larger flaps. However, there is no gold standard flap delay method in the literature. In this study, the authors aimed to compare 3 types of surgical delay methods to determine which model would increase more flap survival. The authors also investigated the effect of delay methods on circulating mononuclear leukocytes as a parameter of DNA damage. METHODS: Twenty-four Sprague-Dawley male rats were divided into 4 groups. All subjects had a 10 × 3 cm modified McFarlane flap. Surface area measurements, biopsies, and blood samples were taken on the day of sacrification; 7th day for the control group and 14th day for delay groups. RESULTS: Between incisional surgery delay groups, a significant difference was found in necrosis and apoptosis in the bipedicled group, and only necrosis in the tripedicled group compared to the control. In terms of DNA damage, it was found higher in all experimental groups than in the control group. CONCLUSIONS: Both incisional surgical delay procedures' results were meaningfully effective when only incisions were made without the elevation of flaps. In conclusion, bipedicled incisional surgical delay seems to be the most effective method in McFarlane experimental flap model whereas two-staged surgeries may increase the risk of systemic toxicity.

2.
Dermatol Ther ; 34(1): e14734, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33389778

RESUMO

We present hybrid reconstruction of distal lateral "through-and-through" nasal defects (skin, cartilage, and mucosa) due to resection of tumor and/or infection. Retrospective descriptive study. The study was performed in multicenter clinics between July 2011 and September 2016. 13 patients with full thickness distal nasal defects secondary to tumor and/or infection were included. Defects included dorsal and/or caudal septum, upper lateral cartilage, or inner/outer nasal valve. Caudal-based turn-in flaps were planned and used to repair inner lining of nasal cavity. Conchal and septal cartilages were used as cartilage grafts. Skin defects were reconstructed with lateral nasal artery perforator flaps. All flaps healed uneventfully, without flap loss. Nasal passage collapse, adhesion, or difficulty in breathing were not seen. No hematoma, infection, and deformity at cartilage graft donor areas was observed. During nasal reconstruction, it is mandatory to consider 3D complex and functional structure of nose. The repair of skin defects may not be enough for functional restoration. We believe that single step reconstruction of full thickness nasal defects through hybrid reconstruction may lead to anticipated successful results.

5.
J Hand Surg Asian Pac Vol ; 22(1): 59-64, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28205467

RESUMO

BACKGROUND: Penetrating upper extremity injury is a common encountered cause of significant loss of labor force and it is generally caused by sharp items. This article presents five rare cases of penetrating hand and forearm injury caused by blunt-edged items in conjunction with a detailed discussion of the mechanism and management of the injury. METHODS: Five patients with a mean age of 37.6 were treated for upper extremity trauma caused by "blunt-edged items" such as corrugated iron fence, garden wires, iron stick or iron safety fence between 2009 to 2014. All patients were operated under general anesthesia after performing detailed physical examination and x-ray imaging. RESULTS: The explorative surgery of the affected limbs revealed no nervous or vascular injury. In two patients, partial tear of the muscles bellies of intrinsic hand muscles (opponens pollicis and adductor pollicis); in two patients, partial extensor digitorum communis tendon laceration and in the remaining patient, partial tear of the third annular pulley were the only encountered injuries. The physical examinations performed in the last visit of each patient revealed, complete healing of the affected limb without any functional, vascular or sensorial deficiency in a mean follow-up period of 19.2 months. CONCLUSIONS: Despite their initial horrible appearance, injuries caused by "blunt-edged items" are quite harmless to the affected limb because they follow weak anatomic spaces of the extremity and cause minimal tissue damage leaving all vascular and nervous structures intact.


Assuntos
Traumatismos da Mão/diagnóstico , Procedimentos Ortopédicos/métodos , Ferimentos Penetrantes/diagnóstico , Adolescente , Adulto , Idoso , Feminino , Traumatismos da Mão/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Índices de Gravidade do Trauma , Ferimentos Penetrantes/cirurgia , Adulto Jovem
6.
Wounds ; 28(9): 328-333, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27701128

RESUMO

INTRODUCTION: Irregularly shaped wounds or flap borders usually require specified software or devices to measure their area and follow-up wound healing. In this study, an easy way of area measurement called histogram planimetry (HP) for wounds with irregular geometric shapes is defined and compared to conventional millimetric wound measurement. MATERIALS AND METHODS: Ten irregularly bordered geometric shapes were measured by 4 different individuals working as surgical assistants using both HP and manual millimetric measurement tools. The amount of time for each wound shape calculation as well as the measurements of the wound areas were noted. All measurements were compared for each method and between each individual using the Wilcoxon signed-rank test. RESULTS: There was no statistically significant difference between 2 measurement methods by means of measured areas; however, measurement time was significantly lower when the HP method was used. There also was no significant difference between the individuals' measurements and calculation times. These results indicated that HP is useful as a conventional millimetric square wound measurement technique with significantly lower measurement times. CONCLUSION: Due to the development of photo-editor software technologies, measurements in the surgical field have become more accurate and rapid than conventional manual methods without consuming the time and energy needed for other studies. A future study including comparisons between the presented method and complex computerized measurement methods, in terms of duration and accuracy, may provide additional supportive data for the authors' method.


Assuntos
Interpretação de Imagem Assistida por Computador , Fotografação , Software , Ferimentos e Lesões/patologia , Análise Custo-Benefício , Humanos , Variações Dependentes do Observador , Fotografação/economia , Fotografação/instrumentação , Fotografação/métodos , Reprodutibilidade dos Testes , Software/economia , Cicatrização , Ferimentos e Lesões/classificação
7.
Facial Plast Surg ; 32(4): 438-43, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27494589

RESUMO

The most important problem in fat transplantation is the unpredictable rates of resorption. Deferoxamine (DFO) is an iron-chelating agent with many useful functions including stimulating angiogenesis and antioxidant nature. The purpose of the study is to evaluate the effects of DFO on fat graft viability in rat model. A total of 24 Wistar rats were divided into three groups and 0.5 g of the left inguinal fat pad was extracted. In control group, fat grafts were implanted to the parascapular area without performing any procedure. In sham group, they were implanted in 0.2 mL saline solution followed by serial saline injections for 1 month. In the study group, fat grafts were implanted in 0.2 mL saline solution and 300 mg DFO followed by serial DFO injections for 1 month. At the postoperative second month, fat grafts were taken back and sent for histopathologic examination. The weight measurements of biopsy specimens in the study group demonstrated significantly higher than in the other two groups. Inflammation and fibrosis rates were also found to be significantly higher in the study group compared with the other groups; however, no significant difference in the apoptosis rates was detected between the groups. Fat grafts enriched with DFO showed significant increase in fatty tissue content in the study group compared with the control and sham groups. DFO increases the fat graft survival in rats and it may be a useful addition in autologous fat grafting procedures to increase fat graft viability and obtain maximal long-term durability.


Assuntos
Tecido Adiposo/transplante , Desferroxamina/uso terapêutico , Sobrevivência de Enxerto/efeitos dos fármacos , Sideróforos/uso terapêutico , Animais , Feminino , Ratos , Ratos Wistar
8.
Facial Plast Surg ; 32(4): 460-8, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27494592

RESUMO

Severe septal deviation is a challenging deformity usually treated using aggressive surgical methods, and extracorporeal septoplasty (ECS) is a commonly used method for this issue. However, this method has severe risks and complications such as the recurrent deformity or nasal saddling. In this article, we present an alternative solution to ECS procedure for the correction of severe septal deviation. Sixteen patients with severe c- or s-shaped septal deviation with a mean age of 26.5 years were included in the study. The entire deviated part of the septal cartilage was resected as a vertical block creating a full-thickness defect between the most cranial and caudal parts of the septal cartilage. After that, two spreader grafts were placed bilaterally facilitating the septal integrity and leaving the full-thickness septal defect unchanged. The surgical results were evaluated using the preoperative and postoperative facial photographs and patient satisfaction was determined using nine relevant questions of DAS-59 scale. The only complication observed in the follow-up period of 19 months was hanging columella deformity which was corrected at the postoperative first year. The mean length of the resected septal segment was 12.4 mm. The mean length of the resultant septal cartilage defect after the vertical resection was 5.9 mm. The mean length of the placed spreader grafts was 25.6 mm. The comparison of the preoperative and postoperative photographs showed significant improvement of the nasal contour and considerable correction of the septal deviation. The statistical evaluation of the answers given to the questions of the DAS-59 scale clearly demonstrates that a significant degree of patient satisfaction was achieved. Severe septal deviation may be successfully corrected by full-thickness resection of the deviated part and reconstruction with bilateral spreader grafts with a low risk of postoperative complications.


Assuntos
Septo Nasal/anormalidades , Septo Nasal/cirurgia , Rinoplastia/métodos , Adolescente , Adulto , Cartilagem/transplante , Feminino , Humanos , Masculino , Satisfação do Paciente , Rinoplastia/efeitos adversos , Adulto Jovem
10.
J Plast Reconstr Aesthet Surg ; 69(7): 944-51, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27085609

RESUMO

BACKGROUND: Botulinum toxin type-A (Bot-A) is a commonly used drug for both cosmetic and therapeutic purposes. The effects of Bot-A on skin and muscle flaps and the related mechanisms have been described previously. In this study, we used a rat transverse rectus abdominis musculocutaneous (TRAM) flap model to examine the effects of Bot-A on the skin island, which is perfused by the rectus abdominis muscle according to the angiosome concept. METHODS: Forty female rats were divided into five groups, including control and sham groups. In the control group, a TRAM flap was raised and sutured back after inserting a silicone sheath underneath the flap. In the sham group, the flap was raised 1 month after injecting saline into the muscle. In the chemical delay group, the flap was raised 1 month after injecting 10 IU of Bot-A. In the surgical delay group, the flap was raised 2 weeks after ligating the cranial epigastric artery. In the surgical and chemical delay group, a Bot-A injection was performed initially, a cranial epigastric artery was ligated after 2 weeks, and a TRAM flap was raised after the first month. In all groups, laser Doppler examination, photographic documentation, and analysis of the flap survival rates were performed. In the histopathological evaluation, the diameter measurements of the caudal epigastric vessels, vascular density measurements using CD31 stain, and apoptotic rate estimation using the Tunnel method were performed. RESULTS: The necrosis ratios, arterial cross-sectional diameters, and microvascular density measurements were significantly superior compared to those of control and sham groups; however, there was no significant difference between the delay groups. There was also no difference in the laser Doppler measurements between the groups and the zones of the TRAM flaps. CONCLUSION: An injection of Bot-A increases muscular circulation and flap survival of TRAM flaps in rats.


Assuntos
Toxinas Botulínicas Tipo A/farmacologia , Sobrevivência de Enxerto/efeitos dos fármacos , Mamoplastia , Retalho Miocutâneo/irrigação sanguínea , Animais , Artérias Epigástricas/diagnóstico por imagem , Feminino , Injeções , Fluxometria por Laser-Doppler/métodos , Mamoplastia/efeitos adversos , Mamoplastia/métodos , Modelos Anatômicos , Fármacos Neuromusculares/farmacologia , Ratos , Reto do Abdome/transplante , Resultado do Tratamento
11.
Indian J Dermatol ; 61(1): 118, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26955123

RESUMO

BACKGROUND: Glomus tumor is a common lesion of the subungual area of the hand fingers. However, glomus tumors located outside the hand region are rare and the diagnosis is often difficult due to their low incidence and lack of distinct clinical features in the physical examination. The presented article contains five cases of extradigital glomus tumors with a short review of the literature. PATIENTS AND METHODS: Five cases of extradigital glomus tumor were included in the study. All lesions were purple colored subcutaneous nodules with sharp pain by digital palpation. All lesions were examined with ultrasound imaging were operated under local anesthesia using loupe magnification. RESULTS: Among five patients, only one patient was female with a mean age of 35. Two lesions were located at the arm region, two at the crural region and one at the sternal area. The smallest nodule was 0.5 cm and the biggest lesion was 2 cm in diameter. In all the cases, the early postoperative period was uneventful without any surgical complication or acute recurrence. The postoperative 1(st) year examination of all patients revealed complete resolution of the pain and no recurrence was encountered. CONCLUSIONS: Glomus tumor should be kept in mind in the differential diagnosis of all painful subcutaneous lesions especially for those with purple reflection on the skin surface. In this manner, patients with extradigital glomus tumors may be diagnosed earlier and unnecessary and wrong treatments may be prevented.

12.
Ann Plast Surg ; 77(2): 178-82, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26207546

RESUMO

BACKGROUND: The aim of this study was to investigate the reliability and outcomes of the facial artery perforator and separately elevated depressor anguli oris (DAO) muscle chimeric flap for the reconstruction of partial or total lower lip defects. METHODS: Eleven patients with malignant skin tumors located at the lower lip were operated between 2013 and 2015. After the excision of the tumor with adequate clear margins using margin controlled excision technique, an appropriate flap fitting to the resultant defect based on the perforators of the facial artery and DAO muscle was prepared and placed into the defect. The DAO muscle activity was tested with electromyography in the postoperative first year examination. RESULTS: Besides 1 patient with transient venous insufficiency, all the flaps healed well without a partial or total flap loss. The mean follow-up period was 10 months. No new primary tumor or recurrence was observed. Although in 1 patient, transient asymmetric smiling and mild drooling was observed, the overall oral competence results were found to be quite satisfactory. The electromyography evaluation of DAO muscle of 5 patients who reached the postoperative first year examination showed action potential results in normal limits with a slight decrease. All patients were satisfied with the final esthetic and functional result. CONCLUSIONS: The facial artery perforator and depressor angel oris muscle chimeric flap is a valuable option for reconstruction of lower lip defects providing esthetically and functionally good results.


Assuntos
Músculos Faciais/cirurgia , Lábio/cirurgia , Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Idoso , Músculos Faciais/irrigação sanguínea , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Retalho Perfurante/irrigação sanguínea
13.
Ann Plast Surg ; 77(2): 169-72, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26418769

RESUMO

The treatment of flexor tenosynovitis in the hand and wrist due to tuberculosis is controversial. Although some authors recommend the antituberculous chemotherapy, the others recommend the surgical treatment. In this article, 12 patients with synovial tuberculosis of the flexor aspect of the hand and the wrist were evaluated with respect to diagnosis and treatment modalities. None of the patients had a history of tuberculosis, concomitant disease, immunosuppressive drug use, drug abuse, and human immunodefficiency virus positivity. A chest x-ray and family screening were performed in all of the cases, none had evidence of tuberculosis in the lung. The biopsy, histopathological examination, acid-fast bacillus staining, and BACTEC tuberculosis culture were performed. Antituberculous chemotherapy was initiated in patients diagnosed with tuberculosis by either histological or microbiological examinations. The patients did not undergo any further surgery after biopsy procedures. The lesions regressed totally in all patients after 3 months of treatment. Carpal tunnel syndrome symptoms and signs recruited at five months of treatment. In patients with flexor tuberculosis tenosynovitis, it is possible to achieve good results by applying only medical therapy after a biopsy, and without the need for further surgery.


Assuntos
Antituberculosos/uso terapêutico , Procedimentos Ortopédicos , Sinovectomia , Tendões/cirurgia , Tenossinovite/tratamento farmacológico , Tenossinovite/cirurgia , Tuberculose/complicações , Adulto , Quimioterapia Combinada , Feminino , Seguimentos , Mãos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tenossinovite/diagnóstico , Tenossinovite/microbiologia , Resultado do Tratamento , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Punho
14.
Aesthetic Plast Surg ; 40(1): 164-73, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26715576

RESUMO

OBJECTIVES: In recent studies, collagen organization was blamed for the formation of capsular contracture which is still a challenging problem after silicone implant-based breast operations. In this study, effects of different concentrations of collagenase enzyme derived from Clostridium histolyticum on the capsular tissue formation around the silicone implants were investigated. The injectable form of collagenase has a routine clinical use in the treatment of both Dupuytren's and Peyronie's diseases. MATERIALS AND METHODS: Thirty-two Wistar albino rats were randomized into four groups. A 2 × 1 × 0.3-cm-sized silicone block was inserted inside a dorsal subcutaneous pocket in all groups. After 2 months of insertion, capsule thicknesses around the implants were detected under ultrasonography. This was followed by injection of isotonic saline, 150, 300, and 600 IU in Gr-1, 2, 3, and 4, respectively. All the animals were sacrificed at the end of the first week for histologic sampling to determine fibroblast proliferation, vessel density of the tissue, necrosis, edema, inflammation, and capsule thickness. All the data were statistically analyzed using Kruskal-Wallis and Mann-Whitney U tests and compared for significance of the results. RESULTS: There was no significant difference in terms of capsule thinning between the 300 and 600 IU groups but in both groups thinning was significantly higher than the sham group. In the 150 IU group there was no significant thinning as compared to the sham group (p > 0.05). However, complications such as skin necrosis, infection, and seroma formation were seen only in the 600 IU injection group. The optimal safe and effective dose of the enzyme was accepted as 300 IU. The 300 IU injection provided up to 89 % thinning in the capsule tissue. There was thinning of the collagen bundles parallel to capsule thickness. In the 600 IU group, micro-pores were encountered at the thinnest points. CONCLUSION: However, the late results and recurrence rates of capsular contracture were not included in this study; collagenase seemed effective for the reduction of capsular tissue around the implants. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.


Assuntos
Implantes de Mama/efeitos adversos , Colagenases/administração & dosagem , Contratura Capsular em Implantes/tratamento farmacológico , Contratura Capsular em Implantes/etiologia , Géis de Silicone/efeitos adversos , Animais , Feminino , Injeções Intralesionais , Distribuição Aleatória , Ratos , Ratos Sprague-Dawley , Ratos Wistar
16.
Aesthetic Plast Surg ; 39(6): 1026-7, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26395093

RESUMO

UNLABELLED: In this study, an easy and useful method used for the drainage of seroma and hematoma formations occurring after operations requiring extensive tissue undermining is presented. The method utilizes the trocar of the conventional suprapubic urinary catheterization system in combination with the catheter of the negative pressure vacuum drainage system. It provides quick, safe, and painless seroma and hematoma evacuation and can easily be performed in office setting. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://www.springer.com/00266.


Assuntos
Hematoma/cirurgia , Complicações Pós-Operatórias/cirurgia , Seroma/cirurgia , Desenho de Equipamento , Humanos , Sucção/instrumentação , Sucção/métodos
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