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1.
Lasers Med Sci ; 38(1): 45, 2023 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-36658259

RESUMO

Picosecond lasers have a very short pulse duration and a high peak power density. When fractional optical delivery systems are attached to picosecond lasers, they generate an array of concentrated microspots with a high fluence surrounded by areas with a low fluence. This article discusses the histologic characteristics and clinical applications of fractional picosecond laser treatment. Fractional picosecond laser produces laser-induced optical breakdown (LIOB) and laser-induced cavitation (LIC) in the epidermis and dermis respectively, and can encourage skin regeneration and dermal remodeling. It has been shown that fractional picosecond laser has a positive effect on facial photoaging, enlarged facial pores, dyspigmentation, wrinkles, and atrophic scars. Further research is still needed to confirm the benefits of fractional picosecond lasers.


Assuntos
Lasers de Estado Sólido , Transtornos da Pigmentação , Humanos , Lasers de Estado Sólido/uso terapêutico , Pele/patologia , Epiderme/patologia , Cicatriz/patologia , Transtornos da Pigmentação/patologia , Resultado do Tratamento
2.
Ann Plast Surg ; 90(2): 128-132, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36688855

RESUMO

BACKGROUND: The expanded forehead flap pedicled with superficial temporal vessel(s) is a common method to treat facial scar deformity. However, local bulkiness and hair retention have limited the use of this flap. METHODS: Five cadavers were used for anatomy to confirm the forehead "safety zone." A retrospective study was performed on 15 patients with facial scar deformity who were undergoing the expanded forehead superthin flap (without the expanded capsule, frontalis muscle, and with less hair follicles) pedicled with superficial temporal vessel(s) to transfer and repair the deformity. RESULTS: Through cadaver anatomy, the range where the subdermal vascular network laid superficial to the hair follicle level was named the "safety zone," whose average distance between the bilateral penetrating points was 10.2 cm (8.7-11.6 cm). Fifteen patients with facial scar deformity were treated with the superthin flap technique. The trimming size of the safety zone flap was (6-10) × (12-20) cm. The median time of thinning the safety zone was 35 minutes (range, 25-40 minutes). All flaps healed well. The median residual ratio of the hair follicle was 39.8% (29.9%-50.5%). All patients were satisfied with the contour of the flap. CONCLUSION: We firstly proposed a concept of forehead safety zone and used the superthin flap without the frontalis muscle and less hair follicles to treat facial scar deformity, and obtained an improved therapeutic effect. We think this is an appealing technique that can manifest facial concave and convex in the fine part, improve compliance of the flap, and reduce the times of laser hair removal.


Assuntos
Humanos , Testa/cirurgia , Folículo Piloso , Cicatriz/cirurgia , Estudos Retrospectivos , Transplante de Pele
3.
Plast Reconstr Surg ; 151(2): 325-328, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36696314

RESUMO

SUMMARY: Surgical treatments to the upper eyelid have evolved along with a better understanding of the aging upper eyelid anatomy and development of solutions that are aesthetically pleasing and that defy detection. It is not uncommon for patients to present before or after upper blepharoplasty with perceived deformities of the medial canthus. Epicanthal folds are sometimes a concern. Approaches to the varied presentations of epicanthal folds have derived from the belief that they relate to a dermal or orbicular (muscle) issue, and solutions have primarily involved traditional approaches to altering skin and muscle tension by means of complex flaps. Complications or unfavorable outcomes that relate to this approach mainly involve scarring or nonresolution. The author describes a novel and simple surgical approach for the treatment of mild to moderate epicanthal folds or medial canthal webbing that is in line with the goals of the balance of aesthetics, resolution, and undetectability.


Assuntos
Blefaroplastia , Humanos , Pálpebras/cirurgia , Pele , Cicatriz/etiologia , Cicatriz/prevenção & controle , Cicatriz/cirurgia , Resultado do Tratamento
5.
Int J Cardiovasc Imaging ; 39(1): 135-144, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36598693

RESUMO

The aim of this study was to investigate the diagnostic accuracy and reader confidence for late-gadolinium enhancement (LGE) detection of a novel free-breathing, image-based navigated 3D whole-heart LGE sequence with fat-water separation, compared to a free-breathing motion-corrected 2D LGE sequence in patients with ischemic and non-ischemic cardiomyopathy. Cardiac MRI patients including the respective sequences were retrospectively included. Two independent, blinded readers rated image quality, depiction of segmental LGE and documented acquisition time, SNR, CNR and amount of LGE. Results were compared using the Friedman or the Kruskal-Wallis test. For LGE rating, a jackknife free-response receiver operating characteristic analysis was performed with a figure of merit (FOM) calculation. Forty-two patients were included, thirty-two were examined with a 1.5 T-scanner and ten patients with a 3 T-scanner. The mean acquisition time of the 2D sequence was significantly shorter compared to the 3D sequence (07:12 min vs. 09:24 min; p < 0.001). The 3D scan time was significantly shorter when performed at 3 T compared to 1.5 T (07:47 min vs. 09:50 min; p < 0.001). There were no differences regarding SNR, CNR or amount of LGE. 3D imaging had a significantly higher FOM (0.89 vs. 0.78; p < 0.001). Overall image quality ratings were similar, but 3D sequence ratings were higher for fine anatomical structures. Free-breathing motion-corrected 3D LGE with high isotropic resolution results in enhanced LGE-detection with higher confidence and better delineation of fine structures. The acquisition time for 3D imaging was longer, but may be reduced by performing on a 3 T-scanner.


Assuntos
Meios de Contraste , Gadolínio , Humanos , Cicatriz , Água , Estudos Retrospectivos , Valor Preditivo dos Testes , Imageamento por Ressonância Magnética/métodos , Imageamento Tridimensional/métodos , Aumento da Imagem/métodos
6.
Artigo em Chinês | MEDLINE | ID: mdl-36603866

RESUMO

Objective: To investigate the feasibility of only surgical resection for nasal vestibular squamous cell carcinoma and the efficacy of perforator flap of ipsilateral nasolabial sulcus in repairing postoperative defects. Methods: The clinical data of 8 cases with squamous cell carcinoma of the nasal vestibule who admitted to Department of Facial Plastic and Reconstructive Surgery, Eye & ENT Hospital, Fudan University were analyzed, including 6 males and 2 females, aged from 38 to 75 years. The tumor of the nasal vestibule was eradicated in time after making definite diagnosis of lesions, then the perforators flap of the ipsilateral nasolabial sulcus was used for repairment, without performing further chemotherapy or radiotherapy after surgery. The tumor recurrence, facial appearance, nostril form, donor area scar, nasal ventilation function, and cutaneous sensation were evaluated after surgery. Descriptive analysis was used in this research. Results: There were 2 cases of stage T1 and 6 cases of stage T2 in 8 cases. After 32 to 45 months of following-up, no recurrence accurred and all the flaps survived well. However, there was about 2 mm necrosis of the transplanted flap in the lateral foot of the alar in one case, which was healed well by carrying out wound care after 10 d. And the dark color flap was occurred in another case, showing the flap's backflow trouble, yet it was improved with addressing timely during 5 d postoperation. Pincusion-like deformity of the transplanted flap occurred in 4 cases (50%), which subsided gradually after 6 months. The morphology of the anterior nostril was altered in 4 cases (50%), but there was no ventilation trouble and no need for addressment in any case. The postoperative facial appearance was rated as excellentor good with hidden scar in the donor site, and the sensation of the transplanted flaps was indistinct from the surrounding tissue after 3 months. Conclusions: Surgical resection of nasal vestibular squamous cell carcinoma with tumor stage T1-2 is a feasible treatment. And it is the one of the best reconstructive methods of the perforator flap of the ipsilateral nasolabial sulcus to repair the deformities after the surgery.


Assuntos
Carcinoma de Células Escamosas , Retalho Perfurante , Masculino , Feminino , Humanos , Retalho Perfurante/transplante , Cicatriz/cirurgia , Recidiva Local de Neoplasia/cirurgia , Carcinoma de Células Escamosas/cirurgia , Transplante de Pele/métodos , Resultado do Tratamento
7.
J Matern Fetal Neonatal Med ; 36(1): 2162818, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36597830

RESUMO

BACKGROUND: Cesarean scar pregnancy (CSP) is a long-term complication after cesarean section that can cause severe maternal morbidity and mortality. Although a variety of treatments have been described, there is no consensus as to the optimal management approach. Many grading systems for CSP have been proposed, among which the classification made by the consensus of Chinese experts in 2016 was shown to provide improved treatment guidance for clinical practice. The purpose of the present study was to analyze the success rate of different treatments for each type of CSP as classified according to the Chinese Expert's Consensus (2016), and to develop a management strategy for CSP. METHODS: A retrospective study was performed among patients diagnosed with CSP at Shandong Provincial Hospital between January 2009 and December 2019. We reviewed clinical characteristics, treatment methods, and subsequent outcomes; and analyzed these endpoints using the statistical software package SPSS 22.0 (SPSS, Inc., Chicago, IL). RESULTS: For type I CSP, systemic methotrexate (MTX) administration exhibited a success rate of 79.2% for type Ia and 14.3% for type Ib. Local and systemic MTX administration success rates were 88.9% for type Ia and 66.7% for type Ib. Dilation and curettage (D&C), curettage after uterine artery embolization (UAE + C), and hysteroscopic curettage (H + C) were 100% successful. For type II, UAE + C, H + C, and laparoscopy combined with hysteroscopic curettage (L + H+C) were 100% successful. D&C had a success rate of 97.0% for type IIa and 88.9% for type IIb. The success rate of systemic MTX administration was 52.0% for type IIa and 62.5% for type IIb. Both UAE + C and L + H+C had 100% success rates for type IIIa CSPs, while for type IIIb, the success rate was 87.9% for UAE + C vs. 96.6% for L + H+C. CONCLUSIONS: For type I CSPs, D&C was quick, easy, and safe; for type II, H + C was more suitable. For type III and some type II patients who wished to undergo simultaneous repair of the cesarean defect, L + H+C was the optimal method. UAE can be used as a complementary option instead of a prophylactic measure, and when difficulties with endoscopic surgeries were encountered, conversion to laparotomy was the ultimate treatment.


Assuntos
Gravidez Ectópica , Embolização da Artéria Uterina , Gravidez , Humanos , Feminino , Cesárea/efeitos adversos , Estudos Retrospectivos , Cicatriz/complicações , Cicatriz/terapia , Gravidez Ectópica/etiologia , Gravidez Ectópica/cirurgia , Metotrexato/uso terapêutico , Embolização da Artéria Uterina/métodos , Hospitais , Resultado do Tratamento
8.
J Drugs Dermatol ; 22(1): 29-34, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36607760

RESUMO

The treatment of primary scarring alopecias is challenging and patients may be susceptible to koebnerization. This predisposes cicatricial alopecia patients to worsening of their disease following procedural treatments or interventions. Research and recommendations surrounding the risk for koebnerization within scarring alopecias is extremely limited. Using a comprehensive literature review, we summarized the risks of procedures in potentially koebnerizing alopecias. We evaluated the risk not only with procedural treatments, but also with common elective cosmetic procedures and potentially trauma-inducing hairstyling techniques. Although additional studies are needed to better elucidate the risks of procedural treatments within primary scarring alopecia, we believe this review of the current evidence and expert insight will benefit healthcare providers and patients alike to help guide treatments in this challenging patient population. J Drugs Dermatol. 2023;22(1):29-34. doi:10.36849/JDD.6849.


Assuntos
Alopecia , Cicatriz , Humanos , Cicatriz/diagnóstico , Cicatriz/etiologia , Cicatriz/terapia , Alopecia/diagnóstico , Alopecia/etiologia , Alopecia/tratamento farmacológico , Pessoal de Saúde
9.
Planta ; 257(2): 33, 2023 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-36609883

RESUMO

MAIN CONCLUSIONS: Fully mature acorns of Quercus variabilis, Q. aliena, Q. mongolica, and Q. glandulifera are desiccation-sensitive. X-ray computer tomography showed that cotyledons shrink during drying, but embryos are protected. Information available on recalcitrant acorns of tropical and sub-tropical species of Quercus suggests that an impermeable pericarp, which limits the entry and loss of water only through the hilum (scar), is the underlying mechanism that prevents drying of the embryo axis following dispersal until the germination season. However, there is a lack of consensus supporting this proposition across species, and it is not well understood if such mechanisms occur in temperate Quercus species. This study investigated the significance of the acorn pericarp for temperate oak species and presents an ecological framework based on the post-dispersal climatic conditions. Using Quercus variabilis, Q. aliena, Q. mongolica, and Q. glandulifera acorns, the relationship between moisture content (MC) and germination was established, and X-ray computed tomography (X-ray CT) was used to understand the internal structural changes of cotyledons and embryonic axis occurring during desiccation. Water entry and exit routes through the scar, pericarp and apex were determined by imbibition and drying experiments. Climatic data and acorn morphological characteristics and germination were subjected to a principal component analysis (PCA). Freshly dispersed acorns of all species had a moisture content (MC) above 35% fresh weight (FW) basis, but drying to 15-10% MC resulted in complete loss of viability, implying recalcitrance behaviour. X-ray CT images suggested that the pericarp offers some protection to cotyledons and embryonic axis during desiccation, but it is contingent on MC. Extensive drying to a low MC with the scar and apex covered with vaseline resulted in internal tissues shrinkage, corresponding with viability loss. Water could enter or exit through the pericarp, albeit at a much slower rate than through the scar. A combination of factors including acorn anatomy, moisture content at the time of dispersal, microhabitat, the position of acorns in the soil prevent embryo desiccation below the critical MC and thus promotes survival of acorns on/in the soil during winter in temperate regions. Pericarp anatomy, to some extent, prevents excessive drying of the embryonic axis by slowing water movement, but prolonged drying or predatory pressure could result in pericarp cracks, favouring the absorption of water during sporadic rain. In the latter case, the survival of acorns possibly depends extensively on the continuous erratic rainfall, i.e. continuous wet-dry cycle, but in-situ experiments are yet to be performed to test this hypothesis.


Assuntos
Cotilédone , Quercus , Água , Sementes , Dessecação , Cicatriz
10.
J Orthop Surg Res ; 18(1): 50, 2023 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-36650521

RESUMO

OBJECTIVE: To investigate the clinical outcomes of a novel soft tissue repair patch (porcine small intestinal submucosa patch, SIS patch) in the treatment of full-thickness hand skin defects. METHODS: From January 2017 to July 2019, 80 patients with hand soft tissue defects, who met the inclusion criteria, were retrospectively reviewed and divided into two groups. After debridement, patients in group A were treated with the novel SIS patch to cover the wound, and patients in group B were treated with autologous skin graft. The dimensions of skin defect area and healing outcome were evaluated and recorded. Scar assessment was carried out using Scar Cosmesis Assessment and Rating Scale (SCAR scale) at the last follow-up postoperation, and the recovery of wound sensation was assessed at the same time using British Medical Research Council (BMRC) grading of sensorimotor recovery. All the data were collected and statistically analyzed. RESULTS: A total of 80 patients were enrolled in the study with 40 patients in each group. Four patients in group A and 5 patients in group B were excluded due to wound infection and lost to follow-up. There were 36 patients in group A and 35 patients in group B finally got follow-up postoperation with mean interval of 12.75 ± 5.61 months in group A and 14.11 ± 5.42 months in group B. The dimensions of skin defect area in group A ranged from 7.5 to 87.5 cm2 (mean 25.97 ± 18.66 cm2) and in group B ranged from 7.5 to 86.25 cm2 (mean 33.61 ± 19.27 cm2) which have no significant difference (P > 0.05). SCAR scale results of group A and group B were 10.98 ± 0.33 and 9.49 ± 0.35, respectively, and the difference was statistically significant (P < 0.05). BMRC grading results showed 6 cases of S4, 11 cases of S3+, 5 cases of S3, 6 cases of S2, 6 cases of S1 and 2 cases of S0 in group A, and 8 cases of S4, 10 cases of S3+, 7 cases of S3, 4 cases of S2, 5 cases of S1, and 1 case of S0 in group B, which had no significant difference between them (P > 0.05). CONCLUSIONS: The novel SIS patch is an applicable biological material in the treatment of hand skin defect, which could achieve a better cosmetic appearance of the newborn skin tissue.


Assuntos
Lesões dos Tecidos Moles , Animais , Suínos , Estudos Retrospectivos , Pele/lesões , Transplante de Pele/métodos , Cicatrização , Cicatriz , Resultado do Tratamento , Lesões dos Tecidos Moles/cirurgia
11.
Am J Dermatopathol ; 45(2): 137-141, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36669080

RESUMO

ABSTRACT: Eccrine syringofibroadenoma (ESFA) is a rare benign skin adnexal lesion of the acrosyringium of eccrine sweat ducts. Reactive ESFA, a subtype of ESFA, is usually associated with non-neoplastic cutaneous dermatoses or neoplastic skin tumors. Clinically, the lesions can be solitary or multiple, pink, or skin-colored coalescing papules or nodules of variable sizes. Histopathologically, this tumor is composed of numerous anastomosing cords of monomorphic cuboidal epithelial cells with eccrine duct formation. The association of reactive ESFA with benign conditions, such as psoriasis, diabetic polyneuropathy, scars, and leprosy, has been reported. However, the association of reactive ESFA with malignant tumors is extremely rare, with very few cases reported in the literature. We present a case of a 72-year-old woman who developed reactive ESFA associated with Merkel cell carcinoma excision scar. The ESFA tumors developed in the area of the surgical graft 10 months after the Merkel cell carcinoma had been excised. New ESFA tumors have continued to appear in the scar on a yearly basis while, so far, has been no recurrence of the original tumor. However, the presence of new tumor growths in the area suggested the possibility of recurrence of the Merkel cell carcinoma. That possibility was enhanced by the fact that PET scans revealed hypermetabolic activity in the ESFA papules.


Assuntos
Adenoma de Glândula Sudorípara , Carcinoma de Célula de Merkel , Poroma , Neoplasias Cutâneas , Neoplasias das Glândulas Sudoríparas , Feminino , Humanos , Idoso , Adenoma de Glândula Sudorípara/patologia , Poroma/patologia , Carcinoma de Célula de Merkel/cirurgia , Carcinoma de Célula de Merkel/patologia , Cicatriz/patologia , Glândulas Écrinas/patologia , Neoplasias das Glândulas Sudoríparas/cirurgia , Neoplasias das Glândulas Sudoríparas/patologia , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/patologia
12.
Am J Case Rep ; 24: e938607, 2023 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-36639861

RESUMO

BACKGROUND Abdominal scars can develop following abdominoplasty interventions and can cause severe functional and aesthetic disabilities. Surgery is almost no longer necessary thanks to the accessibility of more recent and sophisticated technology like lasers. Many ablative and non-ablative photothermolysis technologies and equipment have been developed, giving patients and medical professionals more alternatives but also complicating the system to be utilized and the methods to maximize the outcomes. The aim of the current study was to evaluate the volumetric action of 1540 wavelength and the efficacy and safety of the synergic sequential application of a new fractional ablative 10 600 nm CO2 and non-ablative 1540 nm lasers on abdominal postsurgical scar management. CASE REPORT We treated a female patient with an abdominal suprapubic scar following abdominoplasty. The patient underwent 3 treatment sessions (with a frequency of 1 session every 50 days) with 1 pass over the entire suprapubic area using 10 600 nm CO2 fractional laser emission and 1540 fractional laser emission in simultaneous modality. A photographic evaluation was made to monitor the effect of the treatment on the aesthetic appearance of the patient's suprapubic scar. After 6 months, the photographic assessment showed a significant improvement in scar texture and color. No patient pain or adverse effects were detected. CONCLUSIONS This case report describes the possibility of effectively treating abdominal suprapubic scars following abdominoplasty surgery with simultaneous and combined irradiation of 10 600 nm and 1540 nm wavelengths.


Assuntos
Terapia a Laser , Lasers de Gás , Terapia com Luz de Baixa Intensidade , Humanos , Feminino , Cicatriz/etiologia , Cicatriz/cirurgia , Resultado do Tratamento , Dióxido de Carbono , Lasers de Gás/uso terapêutico , Terapia com Luz de Baixa Intensidade/métodos , Terapia a Laser/efeitos adversos , Terapia a Laser/métodos
13.
Lasers Med Sci ; 38(1): 40, 2023 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-36633795

RESUMO

Early acne scar intervention is important. Oral isotretinoin is widely used in patients with moderate to severe acne. Picosecond laser has shown a promising effect on scar clearance. However, there is a lack of reports on the efficacy and safety of early acne scar management by using 1064-nm picosecond laser in patients receiving low-dose oral isotretinoin. Twenty-four patients with atrophic acne scars of Fitzpatrick skin type III to V were enrolled. All patients were receiving low-dose oral isotretinoin (0.12-0.22 mg/kg/day) during the treatment. The face of the participants was randomly assigned to receive 2 sessions of fractional picosecond 1064 nm Nd: YAG laser (FxPico) treatment and 2 follow-ups, with an interval of 1 month (month 0-3). Clinical efficacy and safety were assessed by photographs, ECCA grading scale, the number of scar lesions melanin and erythema indexes (MI and EI), TEWL, DLQI, and patient satisfaction and the adverse events were recorded on every visit. FxPico significantly decreased the ECCA score and showed higher improvement in the ECCA score. FxPico treated side achieved a significant reduction in all acne scar types, while only boxcar scars and rolling scars showed higher improvement. TEWL but not MI or EI were significantly improved. DLQI and patient satisfaction were higher with the FxPico-treated side than control side. No adverse effects were observed and all the side effects observed were temporary and tolerable. Early intervention by FxPico on patients receiving low-dose oral isotretinoin is a safe and effective modality to improve atrophic acne scars.


Assuntos
Acne Vulgar , Lasers de Estado Sólido , Humanos , Isotretinoína/uso terapêutico , Cicatriz/tratamento farmacológico , Cicatriz/etiologia , Projetos Piloto , Acne Vulgar/complicações , Acne Vulgar/terapia , Resultado do Tratamento , Lasers de Estado Sólido/uso terapêutico , Atrofia
14.
WIREs Mech Dis ; 15(1): e1584, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36634913

RESUMO

Myocardial infarction (MI) is defined as evidence of myocardial necrosis consistent with prolonged ischemia. In response to MI, the myocardium undergoes a series of wound healing events that initiate inflammation and shift to anti-inflammation before transitioning to tissue repair that culminates in scar formation to replace the region of the necrotic myocardium. The overall response to MI is determined by two major steps, the first of which is the secretion of proteases by infiltrating leukocytes to breakdown extracellular matrix (ECM) components, a necessary step to remove necrotic cardiomyocytes. The second step is the generation of new ECM that comprises the scar; and this step is governed by the cardiac fibroblasts as the major source of new ECM synthesis. The leukocyte component resides in the middle of the two-step process, contributing to both sides as the leukocytes transition from pro-inflammatory to anti-inflammatory and reparative cell phenotypes. The balance between the two steps determines the final quantity and quality of scar formed, which in turn contributes to chronic outcomes following MI, including the progression to heart failure. This review will summarize our current knowledge regarding the cardiac wound healing response to MI, primarily focused on experimental models of MI in mice. This article is categorized under: Cardiovascular Diseases > Molecular and Cellular Physiology Immune System Diseases > Molecular and Cellular Physiology.


Assuntos
Cicatriz , Infarto do Miocárdio , Camundongos , Animais , Cicatriz/metabolismo , Cicatrização/fisiologia , Infarto do Miocárdio/genética , Miocárdio , Miócitos Cardíacos/metabolismo
15.
BMC Surg ; 23(1): 4, 2023 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-36624485

RESUMO

BACKGROUND: Computer Assisted Design and Computer Assisted Manufacturing (CAD/CAM) have revolutionized oncologic surgery of the head and neck. A multitude of benefits of this technique has been described, but there are only few reports of donor site comorbidity following CAD/CAM surgery. METHODS: This study investigated comorbidity of the hip following deep circumflex iliac artery (DCIA) graft raising using CAD/CAM techniques. A cross-sectional examination was performed to determine range of motion, muscle strength and nerve disturbances. Furthermore, correlations between graft volume and skin incision length with postoperative donor site morbidity were assessed using Spearman's rank correlation, linear regression and analysis of variance (ANOVA). RESULTS: Fifteen patients with a mean graft volume of 21.2 ± 5.7 cm3 and a mean incision length of 228.0 ± 30.0 mm were included. Patients reported of noticeable physical limitations in daily life activities (12.3 ± 11.9 weeks) and athletic activities (38.4 ± 40.0 weeks in mean) following surgery. Graft volume significantly correlated with the duration of the use of walking aids (R = 0.57; p = 0.033) and impairment in daily life activities (R = 0.65; p = 0.012). The length of the scar of the donor-site showed a statistically significant association with postoperative iliohypogastric nerve deficits (F = 4.4, p = 0.037). Patients with anaesthaesia of a peripheral cutaneous nerve had a larger mean scar length (280 ± 30.0 mm) than subjects with hypaesthesia (245 ± 10.1 mm) or no complaints (216 ± 27.7 mm). CONCLUSIONS: Despite sophisticated planning options in modern CAD/CAM surgery, comorbidity of the donor site following  iliac graft harvesting is still a problem. This study is the first to investigate comorbidity after DCIA graft raising in a patient group treated exclusively with CAD/CAM techniques. The results indicate that a minimal invasive approach in terms of small graft volumes and small skin incisions could help to reduce postoperative symptomatology. Trial registration Retrospectively registered at the German Clinical Trials Register (DRKS-ID: DRKS00029066); registration date: 23/05/2022.


Assuntos
Cicatriz , Artéria Ilíaca , Humanos , Cicatriz/epidemiologia , Cicatriz/etiologia , Computadores , Estudos Transversais , Artéria Ilíaca/cirurgia , Mandíbula/cirurgia , Morbidade
16.
Cir Pediatr ; 36(1): 12-16, 2023 Jan 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-36629343

RESUMO

INTRODUCTION: Hypertrophic pyloric stenosis (HPS) is a frequent pathology in neonates, with extramucosal pyloromyotomy being a healing surgery. It may be performed through a transverse subcostal incision (TSI) or a transumbilical incision (TUI). OBJECTIVE: To compare complications, operating times, hospital stay, and esthetic results between both techniques. MATERIALS AND METHODS: A retrospective, descriptive study of patients undergoing HPS surgery between January 2010 and January 2020 was carried out. Qualitative variables (sex and complications) were expressed as absolute frequency and percentage, whereas quantitative variables (age at surgery, operating time, hospital stay, and scar esthetic assessment scales: MVSS [Modified Vancouver Scar Scale] and P-SAS [Patient Scar Assessment Scale]) were expressed as median and interquartile range. RESULTS: 107 patients were analyzed: TSI (60.7%, n = 65) vs. TUI (39.3%, n = 42). Male patients: 89.2%, n = 58 vs. 83.3%, n = 35; age (days): 31 (24.5-39.5) vs. 34.5 (29.5-47.25); operating time (minutes): 41 (33.75-60) vs. 46 (38.5-60); and hospital stay (days): 2 (2-4) vs. 3 (2-3). Clavien-Dindo grade II complications were more frequent in the TUI Group (1.54%, n = 1 vs. 23.81%, n = 10; p <0.001), with most of them being wound infections. The opinion regarding the scar according to the MVSS scale was better in the TUI Group (1.5 [0-4] vs. 0 [0-2]; p = 0.022). No significant differences were found in the P-SAS scale (10 (6-18) vs. 6 (6-9); p = 0.060). CONCLUSIONS: TUI is preferred from an esthetic point of view, and even though surgical wound infections are more frequent, it is not associated with longer operating times, longer hospital stay, or severe complications.


INTRODUCCION: La estenosis hipertrófica de píloro (EHP) es una patología frecuente en neonatos donde la piloromiotomía extramucosa es una cirugía curativa. Puede realizarse a través de una incisión transversa subcostal (IT) o una incisión transumbilical (ITU). OBJETIVO: Comparar complicaciones, tiempo quirúrgico y de hospitalización y resultado estético entre ambas técnicas. MATERIAL Y METODOS: Estudio descriptivo retrospectivo en pacientes intervenidos de EHP entre enero 2010-2020. Variables cualitativas (sexo y complicaciones) expresadas mediante frecuencia absoluta y porcentaje; y cuantitativas (edad en cirugía, tiempo operatorio, días de hospitalización y escalas de estética de cicatrices: MVSS (Modified Vancouver Scar Scale) y P-SAS (Patient Scar Assessment Scale)) expresadas mediante mediana y rango intercuartílico. RESULTADOS: Se analizaron 107 pacientes: IT (60,7%, n = 65) vs. ITU (39,3%, n = 42): varones (89,2%, n = 58 vs. 83,3%, n = 35), días de vida (31 [24,5-39,5] vs. 34,5 [29,5-47,25]), tiempo quirúrgico (41 [33,75-60] vs. 46 [38,5-60] minutos) y días de hospitalización (2 [2-4] vs. 3 [2-3]). Las complicaciones Clavien-Dindo II fueron más frecuentes en el grupo ITU (1,54%, n = 1 vs. 23,81%, n = 10; p <0,001), siendo la mayoría infecciones de la herida. En el grupo ITU presentaban una mejor opinión sobre la cicatriz en la escala MVSS (1,5 [0-4] vs. 0 [0-2]; p = 0,022). La escala P-SAS no alcanzó diferencias significativas (10 [6-18] vs. 6 [6-9]; p = 0,060). CONCLUSIONES: La ITU es mejor aceptada a nivel estético y, aunque presenta más infecciones de herida quirúrgica, no precisa más tiempo quirúrgico o de ingreso, ni asocia complicaciones graves.


Assuntos
Estenose Pilórica Hipertrófica , Piloromiotomia , Recém-Nascido , Humanos , Masculino , Lactente , Estenose Pilórica Hipertrófica/cirurgia , Cicatriz , Estudos Retrospectivos , Piloromiotomia/métodos , Infecção da Ferida Cirúrgica
17.
Zhonghua Yan Ke Za Zhi ; 59(1): 26-30, 2023 Jan 11.
Artigo em Chinês | MEDLINE | ID: mdl-36631054

RESUMO

Objective: To observe the clinical effect of free anterolateral femoral muscle flap and perforator flap transplantation for repair of the huge wound and after periorbital tumor resection and orbital enucleation. Methods: It was a retrospective case series study. Twelve patients with orbital tumors admitted to the Department of Burn and Plastic Surgery of the Affiliated Hospital of Zunyi Medical University from February 2017 to April 2021 were included. There were 4 males and 8 females, aged 48 to 87 years. Nine patients had cutaneous squamous cell carcinoma, and 3 had basal cell carcinoma. All patients underwent extended resection of the tumor, resection of orbital contents and wound repair.All patients had the lesion completely removed, chimeric anterolateral thigh flap of the anterolateral femoral flap and perforator flap were transplanted to repair the wound. The donor area of the flaps was closed with tension sutures. The size of intraoperative resection lesion,intraoperative resection flap and muscle flap and the depth of the wound cavity were summarized. The postoperative flap survival, wound healing, surgical area appearance, flap color, thickness and texture, scarring and sensation in the surgical area, and tumor recurrence were observed. Results: The surgical procedures were successfully completed in all the 12 patients. The intraoperative resection lesion ranged from 7.0 cm × 5.0 cm to 15.0 cm × 8.0 cm. The depth of the wound cavity was 4.0 to 5.0 cm. The intraoperative resection flap range was 7.0 cm × 5.0 cm to 19.0 cm × 8.0 cm. The muscle flap size ranged from 4.0 cm × 3.0 cm to 5.0 cm × 4.0 cm. All flaps completely survived after surgery, and the wounds healed. The sutures at the recipient area were removed at 5 to 7 days after surgery, while the sutures at the donor area were removed at 12 to 14 days. All of the patients were followed up for 3 to 30 months. The scar at the periorbital area was concealed, and the color, thickness and texture of the flaps were similar to those of the surrounding normal skin. The scarring in the flap supply area was not hypertrophic, with localized decreased skin sensation around it. None of the patients had any tumor recurrence during the follow-up period. Conclusion: The anterolateral femoral muscle flap and perforator flap transplantation could efficiently repair the huge wound after orbital content removal, achieving satisfactory therapeutic effects.


Assuntos
Carcinoma de Células Escamosas , Retalho Perfurante , Neoplasias Cutâneas , Lesões dos Tecidos Moles , Masculino , Feminino , Humanos , Retalho Perfurante/transplante , Transplante de Pele , Cicatriz/cirurgia , Recidiva Local de Neoplasia/cirurgia , Estudos Retrospectivos , Lesões dos Tecidos Moles/cirurgia , Músculos/transplante , Resultado do Tratamento
18.
Oncotarget ; 14: 23-39, 2023 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-36634224

RESUMO

The oral mucositis is a mucosal alteration that usually arises from oncological treatments, such as chemotherapy, and it is characterized as an inflammatory process. The aim of this study is to demonstrate the chromatographic constitution of Andiroba oil, comparing and evaluating Andiroba oil and laser scarring efficiency in treatments of oral mucositis in hamsters. These animals were submitted to 5-Fluorouracil. A total of 122 animals were used, randomized and divided into the following groups: (a) positive control; (b) laser associated to andiroba oil; (c) laser; (d) andiroba oil; (e) negative control; (f) cyclophosphamide (genotoxicity control). The induction of oral mucositis occurred by the administration of intraperitoneal Fluorouracila (60 mg/kg) and trauma to the mucosa. The laser protocol was performed once a day and the andiroba oil applied 3 times a day (1,5 ml/day). The mucosae were photographed and removed for clinical and histopathological analysis on day 4, 8, 12 and 15. The analysis was based in OM severity, in specific scoring for the clinical and histopathological aspect. Toxicity was evaluated on day 15 using comet assay and it was performed by variant DNA damage parameters. The data were analysed using analysis of variance (ANOVA) Tukey post-test and Kruskal-Wallis Dunn post-test. The "andiroba oil" and "laser" groups presented better results when compared to the control groups and the treatment associations. The andiroba oil presented the best scarring results, even considering its efficiency proximity to the laser treatment. Andiroba and laser, separately, did not present genotoxicity, however their association evidences damage to DNA.


Assuntos
Terapia com Luz de Baixa Intensidade , Estomatite , Animais , Cricetinae , Cicatriz , Fluoruracila/toxicidade , Terapia com Luz de Baixa Intensidade/métodos , Mesocricetus , Estomatite/induzido quimicamente
19.
Circ Arrhythm Electrophysiol ; 16(1): e011321, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36595639

RESUMO

BACKGROUND: Endocardial bipolar voltage amplitude is largely derived from endocardial and subendocardial wall layers. This may result in situations of low bipolar voltage amplitude despite the presence of mid-myocardial including epicardial (ie, intramural-epicardial) viable myocardium. This study examined the utility of endocardial unipolar voltage mapping for detection of viable intramural-epicardial atrial myocardium. METHODS: In 15 swine, an atrial intercaval ablation line with an intentional gap was created. Animals survived for 6 to 8 weeks before electroanatomical mapping followed by sacrifice. Gaps were determined by the presence of electrical conduction and classified based on the histopathologiclly layer(s) of viable myocardium into the following: (1) transmural, (2) endocardial, and (3) intramural-epicardial. Voltage data from healthy, scar, and gap points were exported into excel. The sensitivity and specificity of bipolar and unipolar voltage amplitude to detect intramural-epicardial gaps were compared using receiver operating characteristic analysis. RESULTS: In 9 of 15 (60%) swine, a focal ablation gap was detected in the intercaval line, while in the remainder 6 of 15 (40%), the line was complete without gaps. Gaps were classified into transmural (n=3), endocardial (n=3), or intramural-epicardial (n=3). Intramural-epicardial gaps were characterized by very low bipolar voltage amplitude that was similar to areas with transmural scar (P=0.91). In comparison, unipolar voltage amplitude in intramural-epicardial gaps was significantly higher compared to transmural scar (P<0.001). Unipolar voltage amplitude had higher sensitivity (93% versus 14%, respectively) and similar specificity (95% versus 98%, respectively) to bipolar voltage for detection of intramural-epicardial gaps. CONCLUSIONS: Atrial unipolar voltage mapping may be a useful technique for identifying viable intramural-epicardial myocardium in patients with endocardial scar.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Taquicardia Ventricular , Animais , Suínos , Cicatriz , Miocárdio/patologia , Endocárdio , Ablação por Cateter/métodos
20.
Circ Arrhythm Electrophysiol ; 16(1): e011369, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36595634

RESUMO

BACKGROUND: Pulsed field ablation (PFA) has recently been shown to penetrate ischemic scar, but details on its efficacy, risk of arrhythmias, and imaging insights are lacking. In a porcine model of myocardial scar, we studied the ability of ventricular PFA to penetrate scarred tissue, induce ventricular arrhythmias, and assess the influence of QRS gating during pulse delivery. METHODS: Of a total of 6 swine, 5 underwent coronary occlusion and 1 underwent radiofrequency ablation to create infarct scar and iatrogenic scar models, respectively. Two additional swine served as healthy controls. An 8 Fr focal PFA catheter was used to deliver bipolar, biphasic PFA (2.0 kV) lesions guided by electroanatomical mapping, fluoroscopy, and intracardiac echocardiography over both scarred and healthy myocardium. Swine underwent magnetic resonance imaging 2-7 days post-PFA. RESULTS: PFA successfully penetrated scar without significant difference in lesion depth between lesion at the infarct border (5.9±1.0 mm, n=41) and healthy myocardium (5.7±1.3 mm, n=26; P=0.53). PFA penetration of both infarct and iatrogenic radiofrequency abalation scar was observed in all examined sections. Sustained ventricular arrhythmias requiring defibrillation occurred in 4 of 187 (2.1%) ungated applications, whereas no ventricular arrhythmias occurred during gated PFA applications (0 of 64 [0%]). Dark-blood late-gadolinium-enhanced sequences allowed for improved endocardial border detection as well as lesion boundaries compared with conventional bright-blood late-gadolinium-enhanced sequences. CONCLUSIONS: PFA penetrates infarct and iatrogenic scar successfully to create deep lesions. Gated delivery eliminates the occurrence of ventricular arrhythmias observed with ungated porcine PFA. Optimized magnetic resonance imaging sequences can be helpful in detecting lesion boundaries.


Assuntos
Ablação por Cateter , Infarto do Miocárdio , Taquicardia Ventricular , Animais , Suínos , Cicatriz , Gadolínio , Arritmias Cardíacas/diagnóstico por imagem , Arritmias Cardíacas/cirurgia , Eletrofisiologia Cardíaca , Doença Iatrogênica , Ablação por Cateter/efeitos adversos , Ablação por Cateter/métodos , Taquicardia Ventricular/diagnóstico por imagem , Taquicardia Ventricular/cirurgia
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