Use of Iliac Allograft from Cadaveric Donor as a Rescue Technique in Living Donor Kidney Transplant: Two Case Reports.

BACKGROUND: A short right renal vein (RRV) remains a challenge for renal transplant surgery, especially in the living donor. Different techniques exist to obtain an RRV with a suitable length in cadaveric donor; however, in living donors the options are limited. MATERIAL AND METHODS: We present 2 living kidney transplants in which we obtained a very short RRV, making the implantation very difficult. We describe our technique to overcome this problem by using cadaveric iliac vessels retrieved from previous cadaveric donations and preserved at 4°C in histidine-tryptophan-ketoglutarate (HTK) solution, without intraoperative or postoperative complications. We complied with the Helsinki Congress and the Istanbul Declaration regarding the donor source. RESULTS: In both cases, kidney grafts had optimal primary function, with good creatinine clearance after transplant and good patency of vascular anastomosis by Doppler ultrasounds. CONCLUSIONS: We believe the use of cadaveric vessel grafts in living donor kidney transplant is a valuable resource as a rescue tool in emergency situations like the ones being presented in this article in order to avoid discarding a kidney graft with damage or short vessels. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Post-traumatic lymphedema treatment with superficial circumflex iliac artery perforator lymphatic free flap: A case report.

Post-traumatic lymphedema is poorly understood. It is rarely considered in limb reconstruction decision-making approach. We report a case of a 41-year-old female who presented with right upper extremity lymphedema after degloving injury and split thickness skin graft, successfully treated with a superficial circumflex iliac artery perforator (SCIP) free flap restoring the lymphatic drainage. Right upper extremity had an excess of 258.7 mL or an excess volume of 27.86% compared to the healthy contralateral limb. A SCIP free flap including lymphatic vessels (SCIP-L) was performed to replace the skin graft in order to restore the lymphatic flow. Flap size was 19 × 8 cm and pedicle length was 4 cm. No lymph nodes were included and no lymphatic or lymphovenous anastomoses were performed. The surgery was uneventful, and there were no postoperative complications. Fourteen days after free tissue transfer, lymphedema showed clear improvement. At a 4-month follow-up, 55.6% reduction of excess volume was obtained. Indocyanine green lymphography performed at that time showed a restitution of lymph flow through the flap. Lymphedema improvements persisted at a 6-month follow-up. A successful treatment of post-traumatic lymphedema can be performed by using the SCIP-L free flap for soft tissue reconstruction of critical lymphatic drainage areas.

Resultados quirúrgicos de puentes extraanatómicos en pacientes de alto riesgo con enfermedad aorto-iliaca o infección inguinal / Surgical results in extra-anatomic by-pass for high risk patients with aorto-iliac disease or groin infection

Con el proposito de informar los resultados quirúrgicos, analizar las indicaciones, y comunicar la morbilidad y mortalidad, permeabilidad de los puentes extraanatómicos se revisó la experiencia de cinco años durante los que se realizaron 23 puentes en 20 pacientes. El 61 por ciento eran fumadores, 55 por ciento con cardiopatía isquémica, 39 por ciento diabéticos y 20 por ciento con infarto agudo del miocardio. Se indicó la operación para salvamento de una extremidad en 79 por ciento. En 13 por ciento se realizó el puente a través del agujero obturado como consecuencia de una infección inguinal. Las complicaciones en los primeros 30 días fueron: obstrucción del puente en cuatro . infección de gherida en dos, choque por sangrado del tubo digestivo alto en uno, y accidente vascular cerebral en otro. Ocurrieron dos fallecimientos, uno por sepsis y otro por infarto agudo del miocardio. Se logróel salvamemtp inmediato de la extremidad en 78 por ciento de los casos. La permeabilidad a 30 días, 1,2,3,4 y 5 años fue de 82,71,71,65,65, y 51 por ciento respectivamente. La supervivencia a 30 días, 1,2,3,4 y 5 años fue de 90,80,80,74,74 y 60 por ciento respectivamente

A revascularizaçäo renal com artérias autógenas

Os autores apresentam 10 casos de derivaçäo aorto-renal com artérias autógenas realizados para tratamento de lesöes obstrutivas das artérias renais. Seis pacientes tinham dosplasia fibromuscular, três tinham doença aterosclerótica e um único apresentava arterite. Em sete pacientes foram realizadas reconstruçöes arteriais "in ssitu" e em três o autotransplante renal com cirurgia ex-vivo. Houve um óbito. Todas as reconstruçöes arteriais funcinaram bem e houve alívio da hipertensäo arterial em 8/9 pacientes que sobreviveram a operaçäo