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1.
BMC Surg ; 21(1): 226, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33933053

RESUMO

BACKGROUND: Forearm autotransplantation after parathyroidectomy has turned into the standard method for secondary hyperparathyroidism (SHPT) treatment in chronic kidney disease patients. Our study aimed to explore the effects of three methods including muscle, subcutaneous and muscle + subcutaneous transplant methods on SHPT. METHODS: Seventy five SHPT patients were enrolled and assigned into the muscle + subcutaneous (M + S) (n = 26), muscle (M) (n = 35), and subcutaneous (S) (n = 14) groups. The operation efficacy evaluation included preoperative and postoperative biological characteristics such as parathyroid hormone (PTH), serum phosphorus, serum calcium and alkaline phosphatase (ALP). The data were recorded from pre-operation time point to 1, 2, 3, 6, 12, 18, 24 month (mo) postoperation periods. After operation, short-form health survey (SF-36) scores was made for life quality identification at 1, 2, 3, 6, 12, 24 time points. Symptoms about SHPT including bone pain, fracture, pruritus, and coronary artery calcification were followed-up based on the scale. RESULTS: Compared with the preoperative record, all the M + S, M, and S groups showed postoperative decreased levels of PTH, serum phosphorus, serum calcium, calcium-phosphorus. In M + S group, the PTH and serum calcium level kept more steady compared with the M and S groups during a 24 mo duration observation. After this, a SF-36 score scale which represents the life quality show M + S group got more scores at 3, 6, 12, 18 and 24 mo points. At last, the incidence of SHPT associated symptoms including Bone pain, Fracture, Pruritus, and Coronary artery calcification in M + S group were decreased compared with M and S groups at 1, 3, 6, 12 and 24 mo post-operation time points. CONCLUSION: M + S seems to be an efficient method for medical treatment of SHPT patients in the control of PTH and serum calcium. This mixed transplant strategy improves the biochemical characterizes compared with M and S groups in SHPT patients. Furthermore, the M + S method make beneficial on clinical outcomes and life quality of patients.


Assuntos
Hiperparatireoidismo Secundário , Paratireoidectomia , Cálcio , Antebraço/cirurgia , Humanos , Hiperparatireoidismo Secundário/etiologia , Hiperparatireoidismo Secundário/cirurgia , Músculos , Glândulas Paratireoides , Hormônio Paratireóideo , Transplante Autólogo
2.
Ned Tijdschr Geneeskd ; 1652021 03 18.
Artigo em Holandês | MEDLINE | ID: mdl-33793125

RESUMO

BACKGROUND: Compartment syndrome is a rare but serious entity with various causes. Timely diagnosis and treatment are essential. CASE DESCRIPTION: We present a case of a 14-year-old boy with a crush injury of the forearm including a fracture of the radius and ulna. In addition, a traction injury of the brachial plexus was present. Despite the absence of pain, a fasciotomy was performed because of excessive swelling of the forearm with obvious bulging of the muscles intra-operatively. CONCLUSION: Compartment syndrome can develop at several places in the body, including the forearm. Disproportional pain is the most relevant symptom which can however be absent due to concurrent neurological injury. Surgical exploration is always warranted in case of a clinical suspicion of compartment syndrome to prevent severe complications.


Assuntos
Plexo Braquial/lesões , Síndromes Compartimentais/cirurgia , Lesões por Esmagamento/complicações , Traumatismos do Antebraço/complicações , Antebraço/irrigação sanguínea , Adolescente , Síndromes Compartimentais/etiologia , Lesões por Esmagamento/cirurgia , Fasciotomia , Antebraço/cirurgia , Traumatismos do Antebraço/cirurgia , Humanos , Masculino
3.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(4): 483-487, 2021 Apr 15.
Artigo em Chinês | MEDLINE | ID: mdl-33855834

RESUMO

Objective: To investigate the effectiveness of retrograde muscle release in treatment of mild to moderate type ischemic muscle contracture of forearm classified by Tsuge. Methods: Between March 2010 and September 2018, 11 patients with mild to moderate ischemic muscle contracture of forearm were treated with retrograde muscle release. There were 6 males and 5 females with an average age of 24 years (range, 16-29 years). According to Tsuge classification, 6 cases were mild type and 5 cases were moderate type. The interval between injury and operation was 9 months to 25 years, with a median of 17 years. The scar cords in the muscle of the middle one-third of the forearm was released firstly. If the standard of sufficient release was not reached, further releasing the scar cords in the muscle and the tense tendon structure in the proximal one-third of the forearm and the origins of the flexor muscles was necessary. If the standard was still not reached, the origins of the flexor muscles can be released and slid. The effectiveness was evaluated from six aspects of the range of motion of the hand and wrist, dexterity, grip strength, sensation, subjective function scores [quick-disability of the arm, shoulder, and hand questionnaire (Quick-DASH) and the patient-related wrist/hand evaluation (PRWHE)] and satisfaction. Results: All the incisions healed by first intention. Eight patients were followed up 1-106 months (median, 13 months). The range of motion of the hand and wrist was significantly improved, the results were excellent in 3 cases, good in 3 cases, and fair in 2 cases, with an excellent and good rate of 75%. The patient's dexterity evaluation scored a perfect score of 12, which was close to the normal hand dexterity. At last follow-up, the grip strength on the affected side was 37.6%-95.5% of the contralateral side, with an average of 77.6%. Seven patients had normal sensation before and after operation, and the two-point discrimination of median nerve and ulnar nerve was 4-5 mm at last follow-up; 1 patient with forearm mechanical crush injury still felt numb after operation, and the two-point discrimination of median nerve and ulnar nerve was 8 mm and 7 mm, respectively. The Quick-DASH score was 0-15.9, with an average of 4.5, and the PRWHE score was 0-23.0, with an average of 6.6. All the patients were satisfied with the surgery and the effectiveness. Conclusion: A targeted retrograde muscle release method for mild to moderate type ischemic contracture of forearm can achieve satisfactory effectiveness.


Assuntos
Contratura , Contratura Isquêmica , Adulto , Contratura/etiologia , Contratura/cirurgia , Feminino , Antebraço/cirurgia , Humanos , Masculino , Músculos , Amplitude de Movimento Articular , Resultado do Tratamento , Articulação do Punho , Adulto Jovem
4.
J Craniomaxillofac Surg ; 49(5): 403-414, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33741237

RESUMO

The purpose of this study was to compare the clinical, aesthetic, and functional outcomes between amniotic membrane (test group) and split-thickness skin grafts (control group) used for radial forearm free flap defect closure. The primary outcome measurement for both groups was assessment of the defect closure healing process. In addition, aesthetic (Vancouver Scar Scale) and functional outcomes (skin sensitivity, hand/wrist functionality, grip strength) were evaluated. Fifty eligible patients with radial forearm free flap donor site defects were randomly assigned to two groups receiving either amniotic membrane (test group; n = 25) or split-thickness skin graft (control group; n = 25) for defect covering. Forty-seven of the 50 patients (n = 47) were able to be followed up for 6 months and showed a significantly longer healing process (p < 0.001) with amniotic membrane (64.5 ± 38.4 days; n = 24) than with split-thickness skin grafts (29.2 ± 8.9 days; n = 23); however, there were no differences in the prevalence of healing defects/dehiscence and/or wound infections. Forty-two of the 47 patients (21 in each group) were able to be continually followed up for 12 months, and showed no differences in terms of clinical outcome as well as the subjective and objective aesthetic and functional results evaluated. With regard to the clinical, aesthetic, and functional outcomes evaluated for radial forearm free flap defects, coverage with amniotic membrane offers an excellent alternative treatment approach, avoiding secondary induced donor site morbidity.


Assuntos
Retalhos de Tecido Biológico , Procedimentos Cirúrgicos Reconstrutivos , Âmnio , Estética Dentária , Antebraço/cirurgia , Humanos , Estudos Prospectivos , Transplante de Pele
5.
Am J Sports Med ; 49(5): 1152-1159, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33635730

RESUMO

BACKGROUND: The proximity of the posterior interosseous nerve (PIN) to the bicipital tuberosity is clinically important in the increasingly popular anterior single-incision technique for distal biceps tendon repair. Maximal forearm supination is recommended during tendon reinsertion from the anterior approach to ensure the maximum protective distance of the PIN from the bicipital tuberosity. PURPOSE: To compare the location of the PIN on magnetic resonance imaging (MRI) relative to bicortical drill pin instrumentation for suspensory button fixation via the anterior single-incision approach in varying positions of forearm rotation. STUDY DESIGN: Descriptive laboratory study. METHODS: Axial, non-fat suppressed, T1-weighted MRI scans of the elbow were obtained in positions of maximal supination, neutral, and maximal pronation in 13 skeletally mature individuals. Distances were measured from the PIN to (1) the simulated path of an entering guidewire (GWE-PIN) and (2) the cortical starting point of the guidewire on the bicipital tuberosity (CSP-PIN) achievable from the single-incision approach. To radiographically define the location of the nerve relative to constant landmarks, measurements were also made from the PIN to (3) the prominent-most point on the bicipital tuberosity (BTP-PIN) and (4) a perpendicular plane trajectory from the bicipital tuberosity exiting the opposing radial cortex (PPT-PIN). All measurements were subsequently compared between positions of pronation, neutral, and supination. In supination only, BTP-PIN and PPT-PIN measurements were made and compared at 3 sequential axial levels to evaluate the longitudinal course of the nerve relative to the bicipital tuberosity. RESULTS: Of the 13 study participants, mean age was 38.77 years, and mean body mass index was 25.58. Five participants were female, and 5 left and 8 right elbow MRI scans were reviewed. The GWE-PIN was significantly greater in supination (mean ± SD, 16.01 ± 2.9 mm) compared with pronation (13.66 ± 2.5 mm) (P < .005). The mean CSP-PIN was significantly greater in supination (16.20 ± 2.8 mm) compared with pronation (14.18 ± 2.4 mm) (P < .013).The mean PPT-PIN was significantly greater in supination (9.00 ± 3.0 mm) compared with both pronation (1.96 ± 1.2 mm; P < .001) and neutral (4.73 ± 2.6 mm; P < .001). The mean BTP-PIN was 20.54 ± 3.0, 20.81 ± 2.7, and 20.35 ± 2.9 mm in pronation, neutral, and supination, respectively, which did not significantly differ between positions. In supination, the proximal, midportion, and distal measurements of BTP-PIN did not significantly differ. The proximal PPT-PIN distance (9.08 ± 2.9 mm) was significantly greater than midportion PPT-PIN (5.85 ± 2.4 mm; P < .001) and distal BTP-PIN (2.27 ± 1.8 mm; P < .001). CONCLUSION: This MRI study supports existing evidence that supination protects the PIN from the entering guidewire instrumentation during anterior, single-incision biceps tendon repair using cortical button fixation. The distances between the entering guidewire trajectory and PIN show that guidewire-inflicted injury to the nerve is unlikely during the anterior single-incision approach. CLINICAL RELEVANCE: When a safe technique is used, PIN injuries during anterior repair are likely the result of aberrant retractor placement, and we recommend against the use of retractors deep to the radial neck. Guidewire placement as close as possible to the anatomic footprint of the biceps tendon is safe from the anterior approach. MRI evaluation confirms that ulnar and proximal guidewire trajectory is the safest technique when using single-incision bicortical suspensory button fixation.


Assuntos
Antebraço , Rádio (Anatomia) , Adulto , Cadáver , Feminino , Antebraço/diagnóstico por imagem , Antebraço/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/cirurgia , Rotação , Supinação
6.
Ann Plast Surg ; 86(3): 308-316, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33555685

RESUMO

BACKGROUND: Because the tongue consists of 26 intrinsic and extrinsic muscles, even hemiglossectomy, which preserves some of the tongue and its muscles, leads to functional morbidity in speech and swallowing. Subsequent reconstruction using a conventional fasciocutaneous flap results in limited functional recovery. This study compared the functional recovery of patients who underwent hemiglossectomy based on the fasciocutaneous free flap with or without dynamic gracilis muscle flap reconstruction. METHODS: Twenty-three patients were included in the study. Reconstruction was achieved using radial forearm and gracilis conjoined flaps (n = 7), gracilis flaps (n = 7), and radial forearm flaps (RFFFs) (n = 9) between 2014 and 2019. Functional outcome data were collected via videofluoroscopic swallowing, speech analysis, and a tongue movement scale. RESULTS: In the conjoined flap group, the lingual range of motion in terms of elevation and defect-side lateralization was superior to that of the RFFF group. Furthermore, the conjoined flap was associated with superior protrusion, elevation, and lateralization (on both sides) than the gracilis-only flap. Patients who underwent conjoined-flap reconstruction had better articulation, intelligence, and dysphagia outcomes than patients who underwent reconstruction with RFFFs or gracilis-only flaps. CONCLUSIONS: Although this was a preliminary study, the findings suggest that using a conjoined free flap with an RFFF and a functional gracilis muscle flap for dynamic hemitongue reconstructions could improve postoperative tongue function.


Assuntos
Retalhos de Tecido Biológico , Músculo Grácil , Procedimentos Cirúrgicos Reconstrutivos , Neoplasias da Língua , Antebraço/cirurgia , Glossectomia , Humanos , Neoplasias da Língua/cirurgia
7.
J Hand Surg Asian Pac Vol ; 26(1): 17-23, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33559563

RESUMO

Background: Previous reports on schwannomas of the upper extremities have mainly focused on proximal involvement. This study aimed to evaluate pre- and peri-operative findings in schwannomas of the distal upper extremities and assess the accuracy of diagnosis and surgical outcome. Methods: We identified 24 patients with isolated tumors. Seven patients had schwannomas located in the forearm, eleven in the hand, and six in the digits. We collected the following data: preoperative clinical and magnetic resonance imaging findings, provisional diagnosis, surgical findings and procedures, tumor volume, and postoperative clinical findings. Data were compared between tumors of different locations. Results: The mean age of our cohort at the time of surgery was 48.0 years and the mean follow-up period was 10.6 months. All patients with forearm schwannomas were diagnosed preoperatively by the presence of the Tinel-like sign and suggestive magnetic resonance imaging findings. In contrast, schwannomas in the hands and digits often lacked these diagnostic features; only five patients with hand schwannomas and one with digit schwannoma were correctly diagnosed. Microsurgical enucleation was the most common treatment. Ten patients reported newly acquired paresthesia after operation, which resolved within the follow-up period in nine patients. Three of the four patients with preoperative paresthesia and one patient who underwent enucleation with surgical loupes still had paresthesia at the final follow-up. Conclusions: In schwannomas of the distal upper extremities, a more distal location is associated with a lower occurrence of the Tinel-like sign and fewer suggestive magnetic resonance imaging findings, resulting in lower diagnostic accuracy. However, intra-operative diagnosis is usually straightforward and microsurgical enucleation does not cause iatrogenic nerve deficit. When treating soft tissue tumors in the hand and digits that present without specific or suggestive findings, the possibility of schwannoma should be considered.


Assuntos
Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Neoplasias do Sistema Nervoso Periférico/diagnóstico por imagem , Neoplasias do Sistema Nervoso Periférico/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Dedos/cirurgia , Seguimentos , Antebraço/cirurgia , Mãos/cirurgia , Humanos , Imageamento por Ressonância Magnética , Masculino , Microcirurgia , Pessoa de Meia-Idade , Parestesia/etiologia , Parestesia/cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos , Adulto Jovem
8.
Ann Plast Surg ; 86(2): 162-170, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33346547

RESUMO

INTRODUCTION: The reconstruction of the hand and forearm targets the restoration of their function and aesthetic appearance. Inferiorly based abdominal flaps are reliable and versatile flaps that can cover large defects of the forearm and hand. Here we present a modified abdominal flap design based exclusively on the superficial inferior epigastric artery (SIEA) to reconstruct the hand and forearm's extensive defects. The donor site is closed primarily. METHODS: This is a retrospective study of the patients who underwent reconstruction of hand and forearm defects with SIEA flap from 2006 to 2018. The flap was designed on the ipsilateral hemiabdomen with a narrow pedicle based on the SIEA. We describe the anatomical basis and the outcomes of SIEA flap for reconstruction of the hand and forearm's extensive defects. RESULTS: Forty-eight soft tissue defects of the hand and forearm were reconstructed with the SIEA-based abdominal flap. Twenty-nine (60.41%) dorsal defects, 4 (8.33%) volar defects, 4 (8.33%) circumferential defects, 6 (12.5%) hand amputation stump, and 5 (10.41%) finger and thumb defects were covered using the SIEA flap. Forty-seven (97.91%) flaps had complete survival, whereas 1 (2.08%) flap had distal necrosis at the time of division. One (2.08%) flap had marginal necrosis, and 1 (2.08%) flap had distal necrosis after the division. The donor site was closed primarily in all patients. One (2.08%) patient had wound dehiscence at the abdominal donor site. All flaps gave excellent coverage with a satisfactory contour. CONCLUSION: Abdominal flap based on SIEA is a safe, reliable, and versatile flap for the reconstruction of extensive soft-tissue defects of the hand and forearm. An ability to provide a large amount of skin and soft tissue and the abdominal donor site's primary closure make it a favorable option for upper limb reconstruction in regions with limited resources and technical expertise.


Assuntos
Artérias Epigástricas , Antebraço , Artérias Epigástricas/cirurgia , Antebraço/cirurgia , Mãos/cirurgia , Humanos , Estudos Retrospectivos , Retalhos Cirúrgicos
9.
Medicine (Baltimore) ; 99(43): e22739, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120774

RESUMO

OBJECTIVES: It was recently proposed that a costoclavicular (CC) approach can be used in ultrasound (US)-guided infraclavicular brachial plexus block (BPB). In this study, we hypothesized that triple injections in each of the 3 cords in the CC space would result in a greater spread in the 4 major terminal nerves of the brachial plexus than a single injection in the CC space without increasing the local anesthetic (LA) volume. METHODS: Sixty-eight patients who underwent upper extremity surgery randomly received either a single injection (SI group, n = 34) or a triple injection (TI group, n = 34) using the CC approach. Ten milliliters of 2% lidocaine, 10 mL of 0.75% ropivacaine, and 5 mL of normal saline were used for BPB in each group (total 25 mL). Sensory-motor blockade of the ipsilateral median, radial, ulnar, and musculocutaneous nerves was assessed by a blinded observer at 5 minutes intervals for 30 minutes immediately after LA administration. RESULTS: Thirty minutes after the block, the blockage rate of all 4 nerves was significantly higher in the TI group than in the SI group (52.9% in the SI group vs 85.3% in the TI group, P = .004). But there was no significant difference in the anesthesia grade between the 2 groups (P = .262). The performance time was similar in the 2 groups (3.0 ±â€Š0.9 minutes in the SI group vs 3.2 ±â€Š1.2 minutes in the TI group, respectively; P = .54). DISCUSSION: The TI of CC approach increased the consistency of US-guided infraclavicular BPB in terms of the rate of blocking all 4 nerves without increasing the procedure time despite administering the same volume of the LA.


Assuntos
Anestésicos Locais/administração & dosagem , Bloqueio do Plexo Braquial/métodos , Antebraço/cirurgia , Mãos/cirurgia , Lidocaína/administração & dosagem , Ropivacaina/administração & dosagem , Adulto , Clavícula , Feminino , Humanos , Injeções/métodos , Injeções/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Resultado do Tratamento
12.
Plast Reconstr Surg ; 146(4): 446e-450e, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32590516

RESUMO

The lateral forearm flap-a thin, fasciocutaneous flap harvested over the lateral epicondyle based on the terminal anterior branch of the posterior radial collateral artery-is an attractive alternative to the radial forearm flap. The authors hypothesized that it is safe and effective for head and neck reconstruction. They conducted a retrospective review of all lateral forearm flap reconstructions performed between 2016 and 2018. Patient demographics, defect characteristics, adjuvant therapies, and postoperative complications were recorded. Swallowing and diet were assessed in patients undergoing intraoral reconstruction. The Disabilities of the Arm, Shoulder and Hand questionnaire was completed prospectively preoperatively and postoperatively. Flap and pedicle dimensions were recorded. Twenty-five lateral forearm flap reconstructions were performed; 23 were for intraoral defects. There were no partial or complete flap losses, one venous thrombosis, and one hematoma requiring reoperation. Preoperative and postoperative Disabilities of the Arm, Shoulder and Hand questionnaire scores were equivalent (p = 0.78). In the intraoral cohort, 22 patients (96 percent) resumed an oral diet following reconstruction. The average pedicle length was 11.8 cm (range, 9 to 16 cm); skin paddle length and width were 6.6 cm (range, 4 to 12 cm) and 4.7 cm (range, 4 to 12 cm), respectively; arterial diameter was 1.5 mm (range, 1.4 to 2.5 mm); and venous diameter was 2.8 mm (range, 2.4 to 3.6 mm). All donor sites were closed primarily; one superficial dehiscence was reported. In summary, the authors found that the free lateral forearm flap provided an excellent alternative to the radial forearm flap in head and neck reconstruction. It is a thin, pliable fasciocutaneous flap with excellent pedicle length, and the donor site can be closed primarily with minimal morbidity. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.


Assuntos
Retalhos de Tecido Biológico , Neoplasias de Cabeça e Pescoço/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Idoso , Idoso de 80 Anos ou mais , Antebraço/cirurgia , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
BMC Surg ; 20(1): 132, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32532274

RESUMO

BACKGROUND: Radial free forearm flaps is indicated patients with total or near-total defects in their lower lip. The purpose of our study was to evaluate a simple and effective barrel-shaped design of the radial free forearm flap for lower lip reconstruction and to compare its clinical outcomes with those of a conventional rectangular shaped free forearm flap. METHODS: Twenty-two patients with a lower lip carcinoma who underwent radial forearm free flap reconstructive surgery were enrolled in this study between January 1, 2012, and December 31, 2017. A barrel-shaped design of radial forearm free flap for reconstruction was used in 8 patients (case group), and a rectangular design was used in 14 patients (control group). The patients' quality of life was evaluated preoperatively and postoperatively in all the patients using the European Organization for Research and Treatment of Cancer Quality of Life (EORTC-HN35) questionnaire. We analyzed the differences in the EORTC QLQ-HN35 scores pre- and postoperatively between the case and control group. RESULTS: The patients in the case group had better outcomes in swallowing, speech, social eating, social contact, and dry mouth than the control group at 1-year follow-up (P < 0.05). CONCLUSIONS: The use of a barrel-shaped design free forearm flap for lower lip reconstruction is an effective procedure and can achieve better results than the use of rectangular free forearm flap.


Assuntos
Retalhos de Tecido Biológico , Neoplasias Labiais/cirurgia , Lábio/cirurgia , Idoso , Estudos de Casos e Controles , Feminino , Antebraço/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Qualidade de Vida , Procedimentos Cirúrgicos Reconstrutivos/métodos
14.
J Oral Maxillofac Surg ; 78(9): 1639-1644, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32504562

RESUMO

PURPOSE: Our goal was to compare the clinical results and quality-of-life (QoL) in tongue cancer patients undergoing submental island pedicled (SIP) flap and radial forearm free (RFF) flap reconstruction. MATERIALS AND METHODS: Patients undergoing SIP or RFF flap reconstruction for primary tongue squamous cell carcinoma were prospectively enrolled and were asked to complete the University of Washington Quality-of-Life (UW-QOL) questionnaire, version 4, at 12 months after the operation. The study's main interest was QoL as well as locoregional recurrence control. RESULTS: A total of 190 patients were enrolled for analysis, and the SIP and RFF groups showed significant differences in patient age, American Society of Anesthesiologists classification, and hospital cost. In the survival analysis, locoregional recurrence occurred in 35 patients in the SIP group and 48 patients in the RFF group; the difference was not significant (P = .440). In the QoL analysis, compared with patients in the SIP group, those in the RFF group had higher scores in the domains of activity and recreation. No significant differences were found with respect to the other domains. CONCLUSIONS: The SIP flap and RFF flap have comparable survival control in tongue squamous cell carcinoma patients. The RFF flap might lead to better QoL, but the SIP flap imposes fewer limitations on patients' health status and is associated with lower hospital cost.


Assuntos
Retalhos de Tecido Biológico , Procedimentos Cirúrgicos Reconstrutivos , Neoplasias da Língua , Antebraço/cirurgia , Humanos , Recidiva Local de Neoplasia , Qualidade de Vida , Neoplasias da Língua/cirurgia
15.
Am J Otolaryngol ; 41(4): 102536, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32487337

RESUMO

LEARNING OBJECTIVES: Identify factors associated with skin graft take in fibula free flaps (FFF) and radial forearm free flaps (RFFF) donor sites. STUDY OBJECTIVES: To determine which factors are associated with decreased skin graft take at the donor site in FFF and RFFF in head and neck patients. DESIGN: Retrospective Chart Review Case Series. SETTING: Multicenter Tertiary Care. METHODS: A multicenter retrospective review was performed at three institutions identifying patients who underwent free tissue transfer, specifically either FFF or RFFF, between 2007 and 2017. Patient demographics, medical history, and social history were examined including age, gender, BMI, smoking status, diabetes and preoperative anticoagulation use. Preoperative, intraoperative data, and postoperative data were also examined including tourniquet use, type of flap, area of skin graft, if the skin graft had a donor site or if it was taken from the flap, wound NPWT use, cast use, use of physical therapy, DVT prophylaxis, limb ischemia, heparin drip, and postoperative aspirin use. Statistical analysis was used to determine which factors were significantly associated with skin graft take. RESULTS: 1415 patients underwent a forearm or fibula flap and 938 patients underwent split-thickness skin graft. Of these, 592 patients had sufficient information and were included in the final analysis. There were 371 males and 220 females. The average age was 55.7. Complete skin graft take was seen in 480 patients (81.1%). On univariate analysis, patients with diabetes (p = .003), type of flap (fibula p < .001), skin graft area (p = .006), tourniquet use (p = .003), DVT prophylaxis (p = .008) and casting (p = .003) were significantly associated with decreased skin graft take rate. In a multivariate analysis, diabetes (OR 2.17 (95%CI 1.16-3.98)), fibula flaps (OR 2.86 (95%CI 1.79-4.76)), an increase in skin graft area (OR 1.01 (95%CI 1.01-1.01)), post-operative aspirin (OR 2.63 (95%CI 1.15-5.88), and casting (OR 2.94 (95%CI 1.22-7.14)) were associated with poor rates of skin graft take. CONCLUSION: Several factors affect skin graft take rate and should be considered when performing a skin graft for a donor site defect.


Assuntos
Fíbula/cirurgia , Antebraço/cirurgia , Retalhos de Tecido Biológico/transplante , Transplante de Pele/métodos , Coleta de Tecidos e Órgãos/métodos , Transplantes , Adulto , Idoso , Aspirina/administração & dosagem , Surdez , Diabetes Mellitus Tipo 2 , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Mitocondriais , Estudos Retrospectivos , Torniquetes , Trombose Venosa/prevenção & controle
16.
Int J Oral Maxillofac Surg ; 49(11): 1402-1407, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32402690

RESUMO

The radial forearm free flap (RFFF) and ulnar forearm free flap (UFFF) are used in head and neck reconstruction because they provide a thin and pliable skin paddle as well as a long vascular pedicle. However, in spite of several studies showing the safety of the UFFF, the RFFF is more popular among reconstructive surgeons based on concerns about hand ischaemia. A prospective study was designed in which 10 UFFF and 11 RFFF surgeries were performed in 20 patients undergoing oral cavity reconstruction between January 2017 and July 2018. Hand vascular parameters were evaluated preoperatively and postoperatively using Doppler ultrasound and plethysmography. The preoperative and postoperative diameters of the radial and ulnar arteries, and the flow velocities through the remainder of the forearm artery were measured preoperatively and at 3 months postoperative. Additionally, a comparison was performed between the preoperative and postoperative fingertip perfusion values according to impedance plethysmography. The preoperative mean diameter of the radial artery (2.89±0.47mm) was significantly greater than that of the ulnar artery (2.35±0.48mm) at the level of the wrist; however, 3 months after the surgery, the mean diameters of the two arteries did not differ significantly. There were no differences in digital perfusion when a UFFF was used compared with an RFFF.


Assuntos
Retalhos de Tecido Biológico , Procedimentos Cirúrgicos Reconstrutivos , Antebraço/cirurgia , Humanos , Boca , Estudos Prospectivos , Artéria Radial/diagnóstico por imagem
18.
Plast Reconstr Surg ; 145(5): 1267-1274, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332551

RESUMO

BACKGROUND: The forearm is a common donor site, providing thin, pliable workhorse flaps for head and neck reconstruction. There are no prospective studies comparing the donor-site morbidity of the radial forearm flap to the ulnar artery perforator flap. METHODS: All patients undergoing forearm free flaps were included for analysis and followed for a minimum of 1 year. Grip strength, sensation to light touch, temperature sensation, and wound healing were assessed. RESULTS: A total of 98 patients were enrolled (radial forearm flap, n = 50; ulnar artery perforator flap, n = 48). There were three osteocutaneous radial forearm flaps performed. The donor site was closed primarily in one radial forearm flap patient and four ulnar artery perforator flap patients. The majority of donor sites were resurfaced with full-thickness skin grafts (radial forearm flap, n = 40; ulnar artery perforator flap, n = 44), and the remaining were closed with split-thickness skin grafts. Average grip strength compared to baseline measured at 1, 3, 6, and 12 months after surgery demonstrated no significant differences. All patients returned to baseline sensation to light touch with no long-term sensory deficits at 1 year. No patients suffered significant changes in temperature sensation or cold intolerance. Seven patients suffered partial skin graft loss (radial forearm flap, n = 5; ulnar artery perforator flap, n = 2); all of them healed secondarily with local wound care. There were no flap losses in the study. CONCLUSIONS: The radial forearm and ulnar artery perforator flaps are equivalent in terms of success and donor-site morbidity. Selection of flap should be based on need for pedicle length, flap bulk, concerns with radial or ulnar dominance, and surgeon comfort. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Assuntos
Retalhos de Tecido Biológico/transplante , Retalho Perfurante/transplante , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Coleta de Tecidos e Órgãos/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Antebraço/irrigação sanguínea , Antebraço/fisiopatologia , Antebraço/cirurgia , Retalhos de Tecido Biológico/efeitos adversos , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Retalho Perfurante/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Prospectivos , Artéria Radial/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Coleta de Tecidos e Órgãos/métodos , Sítio Doador de Transplante/fisiopatologia , Sítio Doador de Transplante/cirurgia , Artéria Ulnar/cirurgia
19.
J Craniofac Surg ; 31(5): e465-e469, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32310873

RESUMO

BACKGROUND: Oral cancer is a common and life threatening disease that requires interdisciplinary treatment and often necessitates complex facial reconstruction. Standard care includes tumor resection, while reconstruction is routinely performed with free radial forearm flaps. As esthetic results are crucial for quality of life, flap size, flap volume, and flap composition have to be considered. To date no standardized measurement of flap volume and shrinkage has been established for routine use. The purpose of this study was therefore to evaluate the transplant volume of radial forearm flaps in craniomaxillofacial reconstruction using magnetic resonance imaging (MRI) volumetry. MATERIAL AND METHODS: Ten postoperative MR sequences of 5 patients were included. All patients had received transplantation of radial forearm flaps after tumor resection and radiation therapy. Evaluated parameters were: sex, age, type of flap, flap volume. Two different observers (1 surgeon and 1 radiologist) segmented transplant volume at three different time points in a postoperative MRI independently and in consensus, using both axial and coronal slices. A nonfat saturated T1 spin echo sequence was used. Mean transplant volume was calculated. RESULTS: A total of 90 volumetric measurements were included. Overall Tvolm was 24.83 cm from axial sections and 27.25 cm from coronal sections. Measurements for axial and coronal orientations differed significantly. Results showed excellent intra- and inter-rater correlation, coefficient for rater A and rater B were 0.91 (axial) and 0.96 (coronal). CONCLUSION: MRI volumetry is a noninvasive reproducible method to quantify volume of free radial forearm flaps in situ but should follow specific considerations for best results.


Assuntos
Antebraço/diagnóstico por imagem , Neoplasias Bucais/cirurgia , Idoso , Feminino , Antebraço/cirurgia , Humanos , Imageamento Tridimensional , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/diagnóstico por imagem , Qualidade de Vida , Procedimentos Cirúrgicos Reconstrutivos , Retalhos Cirúrgicos/cirurgia
20.
Orthopade ; 49(11): 1006-1012, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32266431

RESUMO

This is a report of the reconstructive surgery of a patient with chondrosarcoma in the proximal radius. After extensive resection of the proximal radius that contained the tumor, the skeleton of the forearm was reconstructed by ulnar translocation. This patient was followed for 2 years, no recurrence of the tumor was found and the function of the forearm was nearly normal. This case is reported and discussed and a literature review is presented.


Assuntos
Neoplasias Ósseas/cirurgia , Condrossarcoma/secundário , Antebraço/cirurgia , Rádio (Anatomia)/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/patologia , Condrossarcoma/diagnóstico por imagem , Condrossarcoma/patologia , Antebraço/patologia , Humanos , Recidiva Local de Neoplasia , Radiografia , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/patologia , Resultado do Tratamento
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