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1.
Handchir Mikrochir Plast Chir ; 51(5): 367-371, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31574551

RESUMO

Burn injuries of the hands happens very often. Up to 80 % of all severe burn victims suffer from a participation of their hands. A meticulous reconstruction of these areas is mandatory due to their important properties in form, function and aesthetic outcome. The treatment options actually are impressed by the efforts to reduce invasiveness, to increase the selectivity of necrectomy as well as the natural capacity of tissue regeneration.


Assuntos
Queimaduras , Traumatismos da Mão , Cicatrização/fisiologia , Queimaduras/cirurgia , Estética , Mãos , Traumatismos da Mão/cirurgia , Humanos
2.
Handchir Mikrochir Plast Chir ; 51(5): 372-376, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31574554

RESUMO

Hands are often affected from burns, due to their unprotected exposure to thermal injuries. Burn injuries also pose a major threat for hands as there is a high risk of severe functional and aesthetical disabilities. Bromelain-based enzymatic debridement is a novel treatment alternative for early surgical excision of burn eschar. This case study describes three patients who were treated with enzymatic debridement in deep thermal burns of the hand.


Assuntos
Bromelaínas/uso terapêutico , Queimaduras , Desbridamento/métodos , Traumatismos da Mão , Cicatrização/fisiologia , Adulto , Idoso , Queimaduras/terapia , Cicatriz/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transplante de Pele
3.
Niger J Clin Pract ; 22(9): 1189-1195, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31489852

RESUMO

Aim: The aim of the present study was to determine whether the use of advanced platelet rich fibrin based on the low speed+ centrifugation concept (A-PRF+) might improve the pain management and healing of delayed wound healing among cases of alveolar osteitis following mandibular third molar extraction. Materials and Methods: The patients (N = 40) with a complaint of alveolar osteitis following third molar extractions were divided into two groups: Group I (control; saline only); and Group II (use of A-PRF+). Pain was evaluated using the visual analogue scale (VAS). Soft tissue healing was assessed by the modified Index of Landry, Turnbull and Howley and bone density was assessed with the i-Dixel 2.1.8.2 software. Inter-group comparisons were analyzed by means of a student t-test and the Mann Whitney U test to identify group samples. Analysis of variance and the Friedman test were applied for repeated measurements. The Wilcoxon test and Bonferroni's test for multiple comparisons were conducted at the time-factor level. Yates Correction was used to compare qualitative data. Results: In regard to pain, A-PRF+ application demonstrated rapidly and continually reduced pain intensity at each respective time in comparison to the control. Statistically, the healing rates of epithelium and hard tissue were significantly faster in the A-PRF+ application group (p: 0.000, P < 0.05). Conclusions: The results show that A-PRF+ might represent an improved and accelerating therapeutic development for hard and soft tissue healing in management of alveolar osteitis that is also effective in reducing pain.


Assuntos
Alvéolo Seco/terapia , Adesivo Tecidual de Fibrina/administração & dosagem , Dente Serotino/cirurgia , Fibrina Rica em Plaquetas , Complicações Pós-Operatórias/terapia , Extração Dentária/efeitos adversos , Cicatrização/fisiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Mandíbula , Manejo da Dor , Estudos Prospectivos , Extração Dentária/métodos , Escala Visual Analógica
4.
Acta Cir Bras ; 34(7): e201900701, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31531536

RESUMO

PURPOSE: To compare the use of new cyanoacrylate surgical adhesive associated with macroporous tapes in cutaneous synthesis. METHODS: Male Wistar rats with a longitudinal incision of 4cm were used on the back, divided into four groups: GI used octyl-cyanoacrylate (Dermabond®), GII used N-2-butylcyanoacrylate, GIII used octyl-cyanoacrylate and macroporous tape and GIV used N-2-butyl cyanoacrylate and macroporous tape. On the fourteenth day, the rats were submitted to euthanasia, were divided in two parts, and a layer of skin subcutaneous tissue through an area of operative healing was removed. One part was submitted to the study of rupture strength with the use of tensiometer, and in the other part histological examination was performed. RESULTS: No force test was similar between groups I and II, being different from groups III and IV (P <0.001), which were identical to each other (P> 0.05). The units were compared among the studied groups, and they were different with the use of macroporous tapes (P> 0.05). CONCLUSIONS: The purpose of macroporous tapes is associated with CA adhesives in cutaneous tissues that provide more resistant scars. The use of a combination of macroporous tapes leads to complete re-epithelialization, without provoking foreign body reaction, has hemostatic properties and does not cause an absorptive reaction.


Assuntos
Embucrilato/farmacologia , Pele/efeitos dos fármacos , Deiscência da Ferida Operatória/prevenção & controle , Adesivos Teciduais/farmacologia , Cicatrização/fisiologia , Animais , Masculino , Ratos , Ratos Wistar , Técnicas de Sutura
5.
Acta Cir Bras ; 34(6): e201900608, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31432999

RESUMO

PURPOSE: To analyze the resistance to medial traction of abdominal wall muscles, before and after performing relaxing incisions. METHODS: Seventeen live pigs were used. After a median laparotomy, the handles were made in the rectus abdominis muscles (RAM) to fit the dynamometer. Step 1 (control phase): tensile strength measured without performing relaxant incisions. Step 2: A curvilinear relaxant incision was made on the anterior blade of the right RAM sheath and then the tensile strength was measured by the edge of the wound. The same procedure was adopted after incision of the left posterior blade. Step 3: Relaxing incisions were made in the right posterior and left anterior blade, so that both sides were left with a relaxing incision on both blades. Measurements of resistance were performed. RESULTS: There was no statistically significant difference between the sides. On the right and left side, all treatments reduced the tensile strength when compared to each other and to the control. There was a reduction of 12% and 9.8% after incision of the anterior and posterior blade, respectively. CONCLUSION: Relaxing incisions reduced tensile strength in the ventral abdominal wall.


Assuntos
Músculos Abdominais/cirurgia , Parede Abdominal/cirurgia , Laparotomia/métodos , Resistência à Tração/fisiologia , Músculos Abdominais/fisiologia , Animais , Técnicas de Sutura , Suínos , Cicatrização/fisiologia
6.
Nat Commun ; 10(1): 3027, 2019 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-31289275

RESUMO

Fibrosis accompanying wound healing can drive the failure of many different organs. Activated fibroblasts are the principal determinants of post-injury pathological fibrosis along with physiological repair, making them a difficult therapeutic target. Although activated fibroblasts are phenotypically heterogeneous, they are not recognized as distinct functional entities. Using mice that express GFP under the FSP1 or αSMA promoter, we characterized two non-overlapping fibroblast subtypes from mouse hearts after myocardial infarction. Here, we report the identification of FSP1-GFP+ cells as a non-pericyte, non-hematopoietic fibroblast subpopulation with a predominant pro-angiogenic role, characterized by in vitro phenotypic/cellular/ultrastructural studies and in vivo granulation tissue formation assays combined with transcriptomics and proteomics. This work identifies a fibroblast subtype that is functionally distinct from the pro-fibrotic αSMA-expressing myofibroblast subtype. Our study has the potential to shift our focus towards viewing fibroblasts as molecularly and functionally heterogeneous and provides a paradigm to approach treatment for organ fibrosis.


Assuntos
Fibroblastos/metabolismo , Infarto do Miocárdio/patologia , Miocárdio/patologia , Neovascularização Fisiológica/fisiologia , Cicatrização/fisiologia , Actinas/genética , Actinas/metabolismo , Animais , Transplante de Medula Óssea , Proteínas de Ligação ao Cálcio/metabolismo , Diferenciação Celular , Modelos Animais de Doenças , Fibroblastos/patologia , Fibrose/etiologia , Fibrose/patologia , Proteínas de Fluorescência Verde/genética , Células Endoteliais da Veia Umbilical Humana , Humanos , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/fisiopatologia , Miocárdio/citologia , Proteína A4 de Ligação a Cálcio da Família S100/genética , Proteína A4 de Ligação a Cálcio da Família S100/metabolismo , Quimeras de Transplante
7.
Zhonghua Shao Shang Za Zhi ; 35(6): 474-476, 2019 Jun 20.
Artigo em Chinês | MEDLINE | ID: mdl-31280545

RESUMO

Chronic wounds are with characteristics of long last time and cannot heal in time, which is a problem in clinic. Wound pH value plays an important role in the process of healing of chronic wounds. In this paper, we review the relative researches on wound pH value and wound microenvironment, summarize the potential relationship between wound pH value and healing of chronic wounds, as well as the method to change pH value of chronic wounds, thereby to provide theoretical basis for the treatment of chronic wounds in clinic.


Assuntos
Queimaduras/patologia , Queimaduras/terapia , Concentração de Íons de Hidrogênio , Cicatrização/fisiologia , Humanos , Resultado do Tratamento , Ferimentos e Lesões
8.
Graefes Arch Clin Exp Ophthalmol ; 257(9): 1915-1924, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31321523

RESUMO

PURPOSE: In vivo microenvironments are critical to tissue homeostasis and wound healing, and the cornea is regulated by a specific microenvironment complex that consists of cell-cell interactions, air-liquid interfaces, and fluid flow stimulation. In this study, we aimed to clarify the effects of and the correlations among these three component factors on the cell kinetics of corneal epithelial cells. METHODS: Human corneal epithelial-transformed (HCE-T) cells were cocultured with either primary rat corneal fibroblasts or NIH 3T3 fibroblasts. We employed a double-dish culture method to create an air-liquid interface and a gyratory shaker to create fluid flow stimulation. Morphometric and protein expression analyses were performed for the HCE-T cells. RESULTS: Both the primary rat fibroblasts and the NIH 3T3 cells promoted HCE-T cell proliferation, and the presence of fluid flow synergistically enhanced this effect and inhibited the apoptosis of HCE-T cells. Moreover, fluid flow enhanced the emergence of myofibroblasts when cocultured with primary rat fibroblasts or NIH 3T3 cells. Extracellular signal-regulated kinase and p38 signaling were regulated either synergistically or independently by both fluid flow and cellular interaction between the HCE-T and NIH 3T3 cells. CONCLUSION: The cell-cell interaction and fluid flow stimulation in the air-liquid interface synergistically or independently regulated the behavior of HCE-T cells. Fluid flow accelerated the phenotypic change from corneal fibroblasts and NIH 3T3 cells to myofibroblasts. Elucidation of the multicomponent interplay in this microenvironment will be critical to the homeostasis and regeneration of the cornea and other ocular tissues.


Assuntos
Lesões da Córnea/metabolismo , Epitélio Anterior/metabolismo , Células-Tronco Mesenquimais/citologia , Cicatrização/fisiologia , Animais , Western Blotting , Diferenciação Celular , Linhagem Celular , Proliferação de Células , Lesões da Córnea/patologia , Modelos Animais de Doenças , Células Epiteliais/metabolismo , Epitélio Anterior/patologia , Homeostase , Humanos , Imuno-Histoquímica , Ratos , Ratos Wistar , Transdução de Sinais
9.
Cornea ; 38(8): 951-954, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31276458

RESUMO

PURPOSE: To describe the outcomes of tuck-in tenon patch graft (TPG) in the management of corneal perforation up to 5-mm size. METHODS: Thirty-one cases of sterile corneal perforation (3-5 mm) underwent autologous TPG. The technique included, freshening of the edges, measuring the size of defect, creating a 360-degree stromal pocket around the perforation margin, harvesting the tenon graft followed by tucking into the stromal pocket, and application of cyanoacrylate glue or suturing the graft using 10-0 monofilament nylon suture. The main outcome measure was rate of healing (percentage of cases healed). RESULTS: The mean age was 52.3 ± 8.9 years with 22 male and 9 female patients. The various etiologies of corneal perforation included trauma (n = 10), neurotrophic keratitis (n = 11), and peripheral ulcerative keratitis (n = 10). The mean size of corneal perforation was 4.2 ± 0.6 mm (range 3-5 mm). The mean duration of epithelial healing was 25.7 ± 6.7 days. Best-corrected visual acuity improved from 1.8 ± 0.4 to 1.2 ± 0.4 logarithm of the minimum angle of resolution units at 4 weeks after surgery (P ≤ 0.01). Twenty-seven (87.1%) cases healed with formation of a leucomatous scar at 16.9 ± 2.7 weeks, whereas 4 cases had a flat anterior chamber. In three-fourths of the cases, a corneal graft was performed. In one case, graft resuturing was performed for post-op aqueous leak, which healed with the formation of a corneo-iridic scar. CONCLUSIONS: TPG is a safe, simple, inexpensive, and an effective technique for the management of corneal perforations. The advantages include the autologous nature of the graft, cost effectiveness, and easy availability.


Assuntos
Perfuração da Córnea/cirurgia , Úlcera da Córnea/cirurgia , Cápsula de Tenon/transplante , Adulto , Idoso , Perfuração da Córnea/fisiopatologia , Úlcera da Córnea/fisiopatologia , Cianoacrilatos/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Técnicas de Sutura , Adesivos Teciduais/uso terapêutico , Transplante Autólogo , Acuidade Visual/fisiologia , Cicatrização/fisiologia
10.
Int Braz J Urol ; 45(5): 916-924, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31268639

RESUMO

OBJECTIVE: This study aims to investigate the association of filamin A with the function and morphology of prostate cancer (PCa) cells, and explore the role of filamin A in the development of PCa, in order to analyze its significance in the evolvement of PCa. MATERIALS AND METHODS: A stably transfected cell line, in which filamin A expression was suppressed by RNA interference, was first established. Then, the effects of the suppression of filamin A gene expression on the biological characteristics of human PCa LNCaP cells were observed through cell morphology, in vitro cell growth curve, soft agar cloning assay, and scratch test. RESULTS: A cell line model with a low expression of filamin A was successfully constructed on the basis of LNCaP cells. The morphology of cells transfected with plasmid pSilencer-filamin A was the following: Cells were loosely arranged, had less connection with each other, had fewer tentacles, and presented a fibrous look. The growth rate of LNCap cells was faster than cells transfected with plasmid pSilencer-filamin A (P<0.05). The clones of LNCap cells in the soft agar cloning assay was significantly fewer than that of cells stably transfected with plasmid pSilencer-filamin A (P<0.05). Cells stably transfected with plasmid pSilencer-filamin A presented with a stronger healing and migration ability compared to LNCap cells (healing rate was 32.2% and 12.1%, respectively; P<0.05). CONCLUSION: The expression of the filamin A gene inhibited the malignant development of LNCap cells. Therefore, the filamin A gene may be a tumor suppressor gene.


Assuntos
Filaminas/análise , Filaminas/fisiologia , Neoplasias da Próstata/patologia , Western Blotting , Linhagem Celular Tumoral , Proliferação de Células , Células Cultivadas , Colorimetria/métodos , Filaminas/genética , Formazans , Humanos , Masculino , Plasmídeos , Neoplasias da Próstata/genética , Sais de Tetrazólio , Fatores de Tempo , Transfecção/métodos , Cicatrização/fisiologia
11.
Life Sci ; 232: 116594, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31233761

RESUMO

AIMS: Sleep deficiency has been reported to be associated with some oral health problems. Oral ulcers are very common lesions of the oral mucosa, which severely impact patients' quality of life. However, the association between sleep deficiency and the oral ulcer remains unknown. The present study aims to explore the effects of sleep deficiency on oral ulcers. MAIN METHODS: Rats were divided into normal control group (n = 30) and oral ulcer group (OU group, n = 50). Model rats with phenol-induced oral ulcers were deprived of sleep for 72 h by using the modified multiple platform technique. KEY FINDINGS: Sleep deprivation worsened oral ulcers and delayed healing process in rats. In addition, sleep deprivation increased the γ-aminobutyric acid (GABA, P < 0.01) and 5-hydroxytryptamine (5-HT, P < 0.05) levels in serum and brain, the corticotrophin (ACTH, P < 0.05), corticosterone (CORT, P < 0.01), immunoglobulin (Ig)M (P < 0.01), tumor necrosis factor-alpha (TNF-α) (P < 0.01), interleukin (IL)-1ß (P < 0.01), IL-6 (P < 0.01), IL-8 (P < 0.01), monocyte chemoattractant protein-1 (MCP-1) (P < 0.01), and 8-hydroxy-deoxyguanosine (8-OHdG, P < 0.01) levels in serum. Sleep deprivation also up-regulated malonaldehyde (MDA) (P < 0.05), TNF-α (P < 0.05), and IL-1ß (P < 0.01) levels in oral mucosa tissue and delayed superoxide dismutase (SOD, P < 0.05) activity recovery. SIGNIFICANCE: These data suggest that sleep deprivation impaired the oral ulcer healing in rat oral mucosa, and the mechanisms of this effect are probably related to neuro-immuno-endocrine system and oxidative stress.


Assuntos
Úlceras Orais/metabolismo , Privação do Sono/fisiopatologia , Cicatrização/fisiologia , Animais , Mucosa Gástrica/metabolismo , Interleucina-1beta/metabolismo , Interleucina-6/metabolismo , Masculino , Malondialdeído/metabolismo , Modelos Animais , Mucosa Bucal/metabolismo , Úlceras Orais/fisiopatologia , Estresse Oxidativo/efeitos dos fármacos , Ratos , Ratos Sprague-Dawley , Privação do Sono/metabolismo , Superóxido Dismutase/metabolismo , Fator de Necrose Tumoral alfa/metabolismo
12.
Khirurgiia (Mosk) ; (5): 52-56, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31169819

RESUMO

AIM: Experimental analysis of the strength properties of integration of muscle tissue, tendons and ligaments, bone tissue into titanium highly porous materials prepared by using of additive technologies. MATERIAL AND METHODS: The study included 9 mature rabbits of the Chinchilla breed. Both posterior paws and latissimus dorsi muscles (36 specimens) were used. Titanium models (Ti-6-Al-4-V, 'Rematitan', Germany) were made by additive technologies with preliminary prototyping, the prototypes had a highly porous mesh structure. RESULTS: It was developed experimental model of functional bone defect involving points of attachment of the muscle and ligaments. Strength of attachment of muscles to highly porous implants was 145 H vs. 31 H for standard models. Tensile strength for fixation to bone tissue was 84 H vs. 152 H in the main group. CONCLUSION: It was found integration of soft tissues and bones into highly porous titanium implants prepared with additive technologies. Fixation strength significantly exceeds that for standard models.


Assuntos
Osso e Ossos/cirurgia , Sistema Musculoesquelético/fisiopatologia , Osseointegração/fisiologia , Próteses e Implantes , Cicatrização/fisiologia , Animais , Materiais Biocompatíveis , Osso e Ossos/lesões , Osso e Ossos/fisiopatologia , Ligamentos/fisiopatologia , Ligamentos/cirurgia , Modelos Animais , Músculo Esquelético/fisiopatologia , Músculo Esquelético/cirurgia , Porosidade , Desenho de Prótese , Implantação de Prótese , Coelhos , Recuperação de Função Fisiológica , Reoperação , Telas Cirúrgicas , Tendões/fisiopatologia , Tendões/cirurgia , Titânio
13.
Medicine (Baltimore) ; 98(23): e15864, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169690

RESUMO

RATIONALE: Degloving injury of the upper limb often extends to underlying tendons and bone, which is at high risk of treatment failure if only simple reattachment of defatted avulsed skins was performed. Pelnac dermal regeneration template could be used as a treatment choice for necrosis of the reattached avulsed skins in a degloving injury. PATIENT CONCERNS: A 48-year-old woman with a degloving injury of the right forearm, wrist, and hand received initial treatment by reattachment of the defatted avulsed skins over the wound bed. However, 17 days postoperatively, the reattached skins developed complete necrosis, leaving large size of tissue defects and tendon/bone exposure. DIAGNOSIS: Failure to reconstruct the skin and soft-tissue envelop by reattachment of the defatted avulsed skins in a severe degloving injury of the upper limb. INTERVENTIONS: We decided to use a 2-stage procedure of Pelnac dermal regeneration template and secondary skin graft to solve this issue, in consideration of these conditions and the patient' demanding of limb function and aesthetic appearance. OUTCOMES: At the final follow-up, this patient obtained an excellent result, in term of scar quality, aesthetic appearance, and the ability to perform the daily activities. LESSONS: We believe this could become an interesting option in patients who needed revision procedure for management of complex wounds with tendon/bone exposure following the necrosis of reattached skins in degloving injuries.


Assuntos
Desenluvamentos Cutâneos/cirurgia , Derme/fisiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Regeneração/fisiologia , Tecidos Suporte , Bandagens , Desbridamento , Drenagem , Feminino , Humanos , Pessoa de Meia-Idade , Necrose , Transplante de Pele/efeitos adversos , Transplante de Pele/métodos , Cicatrização/fisiologia
14.
Altern Ther Health Med ; 25(4): 32-39, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31202209

RESUMO

Background and Context: Natural healing of bone lesions once incomplete or delayed bone regeneration represents an important clinical issue and plants possess compounds that may enhance bone healing, and avoid bone losses. Objective: The aim of this review is to evaluate the potential role of medicinal plants in the bone regenaration. Methods/Design: This review has included relevant studies available in MEDLINE-PubMed in the last three years that associated the role of plants in the bone regeneration. The descriptors used were "bone regeneration and plants" and "bone regeneration and medicinal plants". Results: We selected 59 articles, but only 15 studies dovetailed the study objectives of this review. These studies showed that plants have potential in increasing in the osseointegration once their components may downregulate biomarkers such as interleukin (IL)-1ß, IL-6, IL-8, Tumor Necrosis Factor-α, Metalloproteinase 2, and 3. They may also upregulate mediators such as Vascular Endothelial Growth Factor, Transforming-Growing Factor-ß1, Bone Morphogenetic Protein-2, osteocalcin, osteopontin, and type 1 collagen. The control in the production of these cytokines may help bone regeneration. Plant components such as curcumol, caffeic acid, resveratrol, luteolin, and many others may also be useful in bone health once may interfere in Nuclear Factor-κB and Mitogen Activated Protein Kinases, and may modulate Ca2+ signaling, inflammatory mediator genes, and inhibiting osteoclast-mediated bone resorption. Conclusion: Many plants possess components that are effective in promoting bone regeneration and new pharmaceutical technology and pharmacological researchers should be performed in order to establish the dose and the appropriate delivery vehicle of administration of the plant or its compounds.


Assuntos
Regeneração Óssea , Plantas Medicinais , Cicatrização/fisiologia , Humanos , Metaloproteinase 2 da Matriz , Fator A de Crescimento do Endotélio Vascular
16.
Plast Reconstr Surg ; 143(6): 1547-1556, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31136464

RESUMO

BACKGROUND: Direct-to-implant breast reconstruction offers the intuitive advantages of shortening the reconstructive process and reducing costs. In the authors' practice, direct-to-implant breast reconstruction has evolved from dual-plane to prepectoral implant placement. The authors sought to understand postoperative complications and aesthetic outcomes and identify differences in the dual-plane and prepectoral direct-to-implant subcohorts. METHODS: A retrospective review of a prospectively maintained database was conducted from November of 2014 to March of 2018. Postoperative complication data, reoperation, and aesthetic outcomes were reviewed. Aesthetic outcomes were evaluated by a blinded panel of practitioners using standardized photographs. RESULTS: One hundred thirty-four direct-to-implant reconstructions were performed in 81 women: 42.5 percent were dual-plane (n = 57) and 57.5 percent were prepectoral (n = 77). Statistical analysis was limited to patients with at least 1 year of follow-up. Total complications were low overall (8 percent), although the incidence of prepectoral complications [n = 1 (2 percent)] was lower than the incidence of dual-plane complications [n = 7 (12 percent)], with the difference approaching statistical significance (p = 0.07). Panel evaluation for aesthetic outcomes favored prepectoral reconstruction. Pectoralis animation deformity was completely eliminated in the prepectoral cohort. CONCLUSIONS: The authors present the largest comparative direct-to-implant series using acellular dermal matrix to date. Transition to prepectoral direct-to-implant reconstruction has not resulted in increased complications, degradation of aesthetic results, or an increase in revision procedures. Prepectoral reconstruction is a viable reconstructive option with elimination of animation deformity and potential for enhanced aesthetic results. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Derme Acelular , Implante Mamário/métodos , Implantes de Mama , Neoplasias da Mama/cirurgia , Adulto , Implante Mamário/efeitos adversos , Neoplasias da Mama/patologia , Estudos de Coortes , Bases de Dados Factuais , Estética , Feminino , Humanos , Mastectomia/métodos , Pessoa de Meia-Idade , Músculos Peitorais/cirurgia , Cuidados Pós-Operatórios/métodos , Falha de Prótese , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Cicatrização/fisiologia
17.
Plast Reconstr Surg ; 143(6): 1601-1604, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31136473

RESUMO

BACKGROUND: Autologous breast reconstruction using perforator flaps offers excellent outcomes, minimizes donor-site morbidity, and allows for precise donor-site selection. The deep inferior epigastric artery perforator, profunda artery perforator, and gluteal artery perforator flaps along with the stacked flap technique are the most common options. This study reports the first series of the stacked lateral thigh perforator flap. METHODS: A retrospective review of all stacked lateral thigh perforator flaps done by a single group of surgeons was performed. Demographics, flap weights, complications, indications, and surgical technique were tabulated for each patient. RESULTS: Eight female patients with a history of breast cancer underwent delayed unilateral breast reconstruction with stacked lateral thigh perforator flaps for a total of 16 flaps. Mean patient age, body mass index, flap weight, and stacked flap weight were 47.3 years, 26.2 kg/m, 333.1 g, and 666.1 g, respectively. Microsurgical revascularization was completed in anterograde and retrograde fashion to the internal mammary vasculature. Flap survival was 100 percent and one subsequent flap revision was performed. Two patients developed a seroma at the donor site. Indications included insufficient abdominal tissue, prominent lateral thigh lipodystrophy, prior abdominal surgery, and failed prior abdominally based autologous reconstruction. CONCLUSIONS: This series demonstrates that the lateral thigh perforator flap is a reliable and effective option for a stacked breast reconstruction. Its ease of harvest (stemming from reliable anatomy), straightforward dissection, and intraoperative positioning make it an appealing flap option. The stacked lateral thigh perforator flap allows the reconstructive surgeon to tailor breast reconstruction to the patient, focusing on body habitus and minimizing morbidity. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Mamoplastia/métodos , Retalho Perfurante/transplante , Coxa da Perna/irrigação sanguínea , Adulto , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Estudos de Coortes , Estética , Feminino , Seguimentos , Rejeição de Enxerto , Sobrevivência de Enxerto , Humanos , Mamoplastia/efeitos adversos , Mastectomia/métodos , Pessoa de Meia-Idade , Retalho Perfurante/irrigação sanguínea , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Coxa da Perna/cirurgia , Tempo para o Tratamento , Transplante Autólogo , Resultado do Tratamento , Cicatrização/fisiologia
18.
Plast Reconstr Surg ; 143(6): 1657-1664, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31136481

RESUMO

BACKGROUND: When frostbite thaws, reperfusion injury has a crucial impact on tissue injury, and production of free radicals induces further tissue damage. This study examined whether extract of Ginkgo biloba 761 could ameliorate frostbite injury as a free radical scavenger. METHODS: Seventy-five Fisher 344 rats were divided into five groups of 15, and frostbite injury was created in each animal by sandwiching the left hind foot between a frozen magnet (-78.5°C) and a room-temperature magnet. Group I received saline; groups II, III, and IV received extract of Ginkgo biloba 761 (200, 100, and 50 mg/kg, respectively); and group V received superoxide dismutase (12 mg/kg). All drugs were injected intraperitoneally three times at 24-hour intervals. The wound surface area was measured throughout the wound healing period. Wounds were also harvested at various times to count cells stained by monoclonal antibodies for 4-hydroxy-2-nonenal and 8-hydroxy-2'-deoxyguanosine. RESULTS: Compared to group I, the wound surface area was significantly smaller in groups II and III on days 1 and 3 after wound creation. Histologic examination revealed significantly more 4-hydroxy-2-nonenal-stained cells and 8-hydroxy-2'-deoxyguanosine-stained cells in group I compared to other groups on day 1. However, there was no difference in the total healing period among the groups. A higher dose test of extract of Ginkgo biloba 761 (300 mg/kg daily) induced animal death, probably because of toxicity. CONCLUSION: Extract of Ginkgo biloba 761 demonstrated a protective effect against frostbite in the present model and probably alleviated reperfusion injury by reducing tissue peroxidation.


Assuntos
Congelamento das Extremidades/prevenção & controle , Extratos Vegetais/administração & dosagem , Traumatismo por Reperfusão/tratamento farmacológico , Cicatrização/fisiologia , Administração Tópica , Animais , Biópsia por Agulha , Modelos Animais de Doenças , Feminino , Congelamento das Extremidades/tratamento farmacológico , Congelamento das Extremidades/patologia , Imuno-Histoquímica , Masculino , Distribuição Aleatória , Ratos , Ratos Endogâmicos F344 , Traumatismo por Reperfusão/prevenção & controle , Resultado do Tratamento
19.
J Coll Physicians Surg Pak ; 29(5): 476-477, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31036123

RESUMO

Here, we present the management of a patient, developing severe peritonitis due to laceration of the jejunum, involving sutures applied to facial layers after anterior resection for adenocarcinoma of the sigmoid colon. The patient, an 83-year woman, was operated by anterior resection, and relaparotomy was performed because the small bowel contents leaked from the incision. A compulsory stoma on the top of the incision was performed. Bilateral fasciocutaneous advancement flaps were carried out to treat the patient with severe intraabdominal sepsis via vacuum-assisted closure. The patient, with Apache-II score 12, open abdomen Bjorck score 2C, and Mannheim peritonitis index score 28, was monitored in the intensive care unit. Based on our experience, open abdomen management with vacuum-assisted closure might be successful for patients with intraabdominal sepsis because of uncontrollable primer sources. We propose that the technique defined for this patient is an innovative technique for primary source control of open abdomen patients.


Assuntos
Cavidade Abdominal/cirurgia , Jejuno/cirurgia , Laparotomia/efeitos adversos , Tratamento de Ferimentos com Pressão Negativa/métodos , Sepse/cirurgia , Cicatrização/fisiologia , Adenocarcinoma/cirurgia , Idoso de 80 Anos ou mais , Colo Sigmoide , Feminino , Humanos , Peritonite/complicações , Sepse/complicações , Sepse/diagnóstico , Neoplasias do Colo Sigmoide/cirurgia , Resultado do Tratamento , Técnicas de Fechamento de Ferimentos
20.
Fa Yi Xue Za Zhi ; 35(2): 136-142, 2019 Apr.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-31135105

RESUMO

Abstract: Objective To investigate the expression of cannabinoid type 2 receptor (CB2R) at different time points after brain contusion and its relationship with wound age of mice. Methods A mouse brain contusion model was established with PCI3000 Precision Cortical Impactor. Expression changes of CB2R around the injured area were detected with immunohistochemical staining, immunofluorescent staining and Western blotting at different time points. Results Immunohistochemical staining results showed that only a few cells in the cerebral cortex of the sham operated group had CB2R positive expression. The ratio of CB2R positive cells gradually increased after injury and reached the peak twice at 12 h and 7 d post-injury, followed by a decrease to the normal level 28 d post-injury. The results of Western blotting were consistent with the immunohistochemical staining results. Immunofluorescent staining demonstrated that the changes of the ratio of CB2R positive cells in neurons, CB2R positive cells in monocytes and CB2R positive cells in astrocytes to the total cell number showed a single peak pattern, which peaked at 12 h, 1 d and 7 d post-injury, respectively. Conclusion The expression of CB2R after brain contusion in neurons, monocytes and astrocytes in mice suggests that it is likely to be involved in the regulation of the biological functions of those cells. The changes in CB2R are time-dependent, which suggests its potential applicability as a biological indicator for wound age estimation of brain contusion in forensic practice.


Assuntos
Contusão Encefálica/metabolismo , Lesões Encefálicas , Músculo Esquelético/metabolismo , Receptor CB2 de Canabinoide/metabolismo , Cicatrização/fisiologia , Animais , Western Blotting , Patologia Legal , Camundongos , Músculo Esquelético/patologia , Receptores de Canabinoides , Fatores de Tempo
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