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1.
Zhonghua Shao Shang Za Zhi ; 35(7): 532-536, 2019 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-31357824

RESUMO

Objective: To explore the clinical effect of negative pressure wound therapy (NPWT) in emergency limb-salvage operation of destructive injury of limb. Methods: From July 2014 to December 2017, 43 patients with destructive injury of limb in one side conformed to the inclusion criteria were admitted to our hospital. The patients were divided to NPWT group of 24 patients [ 21 males and 3 females, aged (38±10) years] and routine dressing change group of 19 patients [ 17 males and 2 females, aged (37±10) years] according to their treatment methods. After the emergency debridement, fracture external fixation, neurovascular exploration, and microsurgical repair were performed, NPWT were applied on wounds of patients in NPWT group and routine dressing change treatment on wounds of patients in routine dressing change group. On 7 to 10 days after the emergency operation, incidence of arterial embolism of patients in the two groups were calculated, and condition of wound infection of patients in the two groups were observed. Complete wound healing time and survival condition of limb were recorded. Data were processed with independent sample t test or chi-square test. Results: Incidence of arterial embolism of patients in NPWT group on 7 to 10 days after the emergency operation was 6.67% (3/45), which was close to 5.56% (2/36) of patients in routine dressing change group (χ(2)=0.043, P>0.05). There was 1 patient with wound infection in NPWT group on 7 to 10 days after the emergency operation, obviously less than 6 patients in routine dressing change group (χ(2)=5.847, P<0.05). Complete wound healing time of patients in NPWT group was (30±4) d, significantly shorter than (36±8) d of patients in routine dressing change group (t=2.813, P<0.01). Limbs of 24 patients in NPWT group survived, which was close to 18 patients in routine dressing change group (χ(2)=1.293, P>0.05). Conclusions: NPWT can significantly reduce tthe wound infection rate and shorten the time of wound healing of limb with destructive injury after emergency operation, which is worthy of popularization in clinic.


Assuntos
Extremidades/lesões , Tratamento de Ferimentos com Pressão Negativa , Terapia de Salvação , Adulto , Bandagens , Desbridamento , Extremidades/cirurgia , Feminino , Fixação de Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Cicatrização , Infecção dos Ferimentos/prevenção & controle
2.
Bone Joint J ; 101-B(6): 739-744, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31154835

RESUMO

AIMS: The aim of this study was to identify factors that determine outcomes of treatment for patients with chondroblastic osteosarcomas (COS) of the limbs and pelvis. PATIENTS AND METHODS: The authors carried out a retrospective review of prospectively collected data from 256 patients diagnosed between 1979 and 2015. Of the 256 patients diagnosed with COS of the pelvis and the limbs, 147 patients (57%) were male and 109 patients (43%) were female. The mean age at presentation was 20 years (0 to 90). RESULTS: In all, 82% of the patients had a poor response to chemotherapy, which was associated with the presence of a predominantly chondroblastic component (more than 50% of tumour volume). The incidence of local recurrence was 15%. Synchronous or metachronous metastasis was diagnosed in 60% of patients. Overall survival was 51% and 42% after five and ten years, respectively. Limb localization and wide surgical margins were associated with a lower risk of local recurrence after multivariable analysis, while the response to chemotherapy was not. Local recurrence, advanced patient age, pelvic tumours, and large volume negatively influenced survival. Resection of pulmonary metastases was associated with a survival benefit in the limited number of patients in whom this was undertaken. CONCLUSION: COS demonstrates a poor response to chemotherapy and a high incidence of metastases. Wide resection is associated with improved local control and overall survival, while excision of pulmonary metastases is associated with improved survival in selected patients. Cite this article: Bone Joint J 2019;101-B:739-744.


Assuntos
Neoplasias Ósseas/cirurgia , Condrossarcoma/cirurgia , Extremidades/cirurgia , Osteossarcoma/cirurgia , Neoplasias Pélvicas/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/patologia , Criança , Pré-Escolar , Condrossarcoma/patologia , Terapia Combinada , Extremidades/patologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Osteossarcoma/patologia , Neoplasias Pélvicas/patologia , Estudos Retrospectivos , Resultado do Tratamento
3.
J Surg Oncol ; 120(3): 332-339, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31172536

RESUMO

OBJECTIVE: Our aim was to compare outcomes in patients who underwent unplanned excisions (UE) of soft-tissue sarcomas (STS) against patients with planned excisions (PE). METHODS: The retrospective 7-institution US Sarcoma Collaborative database was used. Patients with curative-intent resection of truncal/extremity STS between 2000 and 2016 were included. Propensity score weighting analysis (PSWA) was performed. Endpoints were locoregional recurrence-free survival (LRFS), distant metastasis-free survival (DMFS), and disease-specific survival (DSS). RESULTS: One thousand five hundred and ninety-six patients were included. Eighty-two percent (n = 1315) underwent PE and 18% (n = 281) underwent UE. Compared with PE, patients with UE were younger with smaller tumors with similar tumor grade. Unmatched analysis revealed PE was associated with worse DMFS (hazard ratio [HR] 1.95, P = .009) and DSS (HR 1.78, P = .039), but not LRFS compared with UE. On PSWA, UE had earlier LRFS (3-year LRFS: 80.5% vs 89.8%, P = .039), but not DMFS or DSS. By grade, patients with high-grade tumors and UE had worse LRFS (1-year LRFS: 90% vs 94%, P = .015), but similar DMFS and DSS compared with PE. In low-grade patients, UE and PE had similar LRFS, DMFS, or DSS. CONCLUSIONS: UE of STS is not associated with worse prognosis compared to PE, though UE is associated with earlier locoregional recurrence in patients with high-grade tumors. Multimodality therapy is needed to achieve improved outcomes in these patients.


Assuntos
Sarcoma/cirurgia , Estudos de Coortes , Procedimentos Cirúrgicos de Citorredução/métodos , Extremidades/patologia , Extremidades/cirurgia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Sarcoma/patologia , Tronco/patologia , Tronco/cirurgia , Resultado do Tratamento
4.
J Surg Oncol ; 120(3): 366-375, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31236956

RESUMO

BACKGROUND: Desmoid tumors are rare locally invasive, benign neoplasms that develop along aponeurotic structures. Current treatment is complicated by associated morbidity and high recurrence rates. METHODS: A retrospective, single-institution review identified 23 patients (age: 16-77) with extra-abdominal desmoid tumors who received CT-guided percutaneous cryoablation as either a first-line (61%) or salvage (39%) treatment in 30 sessions between 2014 and 2018. Median maximal lesion diameter was 69 mm (range: 11-209). Intent was curative in 52% and palliative in 48%. Contrast-enhanced cross-sectional imaging was obtained before and after treatment in addition to routine clinical follow-up. RESULTS: Technical success was achieved in all patients. The median follow-up was 15.4 months (3.5-43.4). Symptomatic improvement was demonstrated in 89% of patients. At 12 months, the average change in viable volume was -80% (range -100% to + 10%) and response by modified response evaluation criteria in solid tumors (mRECIST) was CR 36%, PR 36%, and SD 28% No rapid postablation growth or track seeding was observed. Four patients underwent repeat cryoablation for either residual or recurrent disease. Two patients sustained a major procedural complication consisting of significant neuropraxia. CONCLUSION: Cryoablation for desmoid tumors demonstrates a high degree of symptom improvement and local tumor control on early follow-up imaging with relatively low morbidity.


Assuntos
Criocirurgia/métodos , Fibromatose Agressiva/cirurgia , Parede Abdominal/diagnóstico por imagem , Parede Abdominal/patologia , Parede Abdominal/cirurgia , Adolescente , Adulto , Idoso , Extremidades/diagnóstico por imagem , Extremidades/patologia , Extremidades/cirurgia , Feminino , Fibromatose Agressiva/diagnóstico por imagem , Fibromatose Agressiva/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Parede Torácica/diagnóstico por imagem , Parede Torácica/patologia , Parede Torácica/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
5.
BMC Musculoskelet Disord ; 20(1): 166, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975128

RESUMO

BACKGROUND: Schwannomas are well-encapsulated, benign neoplasms, and enucleation is a standard operation procedure. The incidence of neurological complications after surgical treatment for schwannomas of the extremities varies, and there is no consensus concerning predictive factors for complications. The aim of this study was to elucidate predictive factors for complications after surgical treatment of schwannomas that develop in the major nerves of the extremities. METHODS: A total of 139 patients with 141 schwannomas arising in major nerves were retrospectively analyzed. Data regarding preoperative clinical features, the postoperative neurological complications, and clinical course of complications, with a median follow-up period of 2 months (range, 0.5-96), were obtained. Predictive factors for complications were statistically analyzed. RESULTS: Postoperative complications occurred in 49 lesions (34.8%), including 42 with sensory disturbance and 8 with motor weakness. In univariate analysis, older age, tumors originating from the upper extremity, and major motor nerve involvement were associated with a higher complication rate (p = 0.03, p = 0.003, and p = 0.001, respectively). In multivariate analysis, major motor nerve involvement was an independent predictive factor for postoperative complications (p = 0.03). Almost all complications gradually improved, but 6 out of 8 patients with motor weakness did not show full recovery at the final follow-up. CONCLUSIONS: Schwannomas originating from major motor nerves can lead to a higher risk for postoperative complications.


Assuntos
Doenças do Sistema Nervoso/diagnóstico , Neurilemoma/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Extremidades/inervação , Extremidades/cirurgia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/etiologia , Neurilemoma/patologia , Nervos Periféricos/patologia , Nervos Periféricos/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
6.
BMJ Case Rep ; 12(3)2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30898966

RESUMO

Purpura fulminans (PF) is a rare but serious complication of septic shock in adults. The complex disease course makes it challenging to manage the condition. Here, we present the case of a healthy young woman who presented with sepsis and new-onset erythematous lesions 4 days after the vaginal delivery of a healthy baby. The infectious source could not be identified, and the patient was started on antibiotics and resuscitated. However, her condition worsened, and she developed disseminated intravascular coagulation and PF. The septic episode slowly decreased in severity, but she sustained extensive ischaemic injuries to her extremities, for which she underwent four-limb amputation.


Assuntos
Coagulação Intravascular Disseminada/complicações , Púrpura Fulminante/etiologia , Choque Séptico/etiologia , Adulto , Amputação , Deficiência de Ácido Ascórbico/complicações , Extremidades/cirurgia , Feminino , Humanos , Gravidez , Púrpura Fulminante/cirurgia
7.
Bone Joint J ; 101-B(3): 266-271, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30813783

RESUMO

AIMS: The purpose of this study was to investigate the potential for achieving local and systemic control after local recurrence of a chondrosarcoma of bone. PATIENTS AND METHODS: A total of 126 patients with local recurrence (LR) of chondrosarcoma (CS) of the pelvis or a limb bone were identified from a prospectively maintained database, between 1990 and 2015 at the Royal Orthopaedic Hospital, Birmingham, United Kingdom. There were 44 female patients (35%) and 82 male patients (65%) with a mean age at the time of LR of 56 years (13 to 96). The 126 patients represented 24.3% of the total number of patients with a primary CS (519) who had been treated during this period. Clinical data collected at the time of primary tumour and LR included the site (appendicular, extremity, or pelvis); primary and LR tumour size (in centimetres); type of operation at the time of primary or LR (limb-salvage or amputation); surgical margin achieved at resection of the primary tumour and the LR; grade of the primary tumour and the LR; gender; age; and oncological outcomes, including local recurrence-free survival and disease-specific survival. A minimum two years' follow-up and complete histopathology records were available for all patients included in the study. RESULTS: For patients without metastases prior to or at the time of local recurrence, the disease-specific survival after local recurrence was 62.5% and 45.5% at one and five years, respectively. After univariable analysis, significant factors predicting disease-specific survival were grade (p < 0.001) and surgical margin (p = 0.044). After multivariable analysis, grade, increasing age at the time of diagnosis of local recurrence, and a greater time interval from primary surgery to local recurrence were significant factors for disease-specific survival. A secondary local recurrence was seen in 26% of patients. Wide margins were a good predictor of local recurrence-free survival for subsequent recurrences after univariable analysis when compared with intralesional margins (p = 0.002) but marginal margins did not reach statistical significance when compared with intralesional margins (p = 0.084). CONCLUSION: In cases of local recurrence of a chondrosarcoma of bone, we have shown that if the tumour is non-metastatic at re-staging, an increase in disease-specific survival and in local recurrence-free survival is achievable, but only by resection of the local recurrence with a wide margin. Cite this article: Bone Joint J 2019;101-B:266-271.


Assuntos
Neoplasias Ósseas/cirurgia , Condrossarcoma/cirurgia , Recidiva Local de Neoplasia/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/patologia , Condrossarcoma/mortalidade , Condrossarcoma/patologia , Extremidades/patologia , Extremidades/cirurgia , Feminino , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Gradação de Tumores , Metástase Neoplásica , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Ossos Pélvicos/patologia , Ossos Pélvicos/cirurgia , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Adulto Jovem
8.
Injury ; 50(3): 777-783, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30772050

RESUMO

INTRODUCTION: This is a retrospective study that evaluate the outcome of patients with extremity sarcoma between extramedullary plate and intramedullary nailing for the biological reconstruction after tumor resection. METHODS: 58 patients (40 treated with plate fixation and 18 with intramedullary nailing, IM group) with sarcomas of the lower and upper extremity who received biological reconstruction at our bone tumor center from November 2003 to November 2015 were reviewed for the study. There were 29 male and 29 female patients with a mean age of 20.8 years (range, 5-72 years). The mean follow-up duration was 90.8 months (range, 12.2-244.4 months). All data were obtained from the clinical, radiograph records and follow-up information. The analysis of outcome, survival, local recurrence, function and complications of patients in the plate group and IM group was performed. RESULTS: 28 cases in the plate group lived at the last follow-up, of which 26 had no evidence of disease, 2 lived with the pulmonary metastasis, whereas 15 in the IM group lived at the last follow-up, of which all had no evidence of disease and no lived with the pulmonary metastasis. There was no significant difference between the two groups for the prognosis. Meanwhile, there was no significant difference of incidence of nonunion, graft fracture and fixation breakage between the two groups, whereas the time to diaphysis union in the plate group (11.6 ± 2.7 months) was shorter than that in IM group (14.7 ± 4.8 months, P = 0.015). It had the tendency that the time to mechanical complications in the intramedullary nailing group (38.1 ± 39.6 months) was longer than that in the plate group (15.7 ± 13.4 months, P = 0.058,95% CI,-45.6-0.8). Furthermore, the infection occurred in 12 cases and five grafts of them developed the deep infection and the mean time to deep infection was 14.8 ± 20.5 months. Furthermore, the incidence of local recurrence for the patients who had plate fixation was similar to the incidence of patients who had nailing fixation. At the last follow-up, the functional evaluation was performed for 39 patients. There was no significant difference in MSTS and VAS functional score for patients between in the plate group (n = 32) and IM group (n = 7). CONCLUSIONS: The findings of the present study showed that intramedullary nailing does not improve the union rate or decrease the incidence of mechanical complications for patients with extremity sarcoma after biological reconstruction. However, intramedullary nailing may have potential advantages on the service life for the biological reconstruction after extremity sarcoma resection.


Assuntos
Extremidades/cirurgia , Fixação Intramedular de Fraturas/métodos , Consolidação da Fratura/fisiologia , Fraturas Espontâneas/cirurgia , Sarcoma/cirurgia , Adolescente , Adulto , Idoso , Pinos Ortopédicos , Placas Ósseas , Criança , Extremidades/diagnóstico por imagem , Extremidades/patologia , Feminino , Seguimentos , Fixação Intramedular de Fraturas/efeitos adversos , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Radiografia , Estudos Retrospectivos , Sarcoma/diagnóstico por imagem , Sarcoma/patologia , Resultado do Tratamento , Adulto Jovem
9.
Vet Comp Orthop Traumatol ; 32(2): 149-157, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30736091

RESUMO

OBJECTIVES: The purpose of this study was to report the clinical outcomes of traumatic appendicular bone injuries treated with supercutaneous plating. METHODS: We conducted a retrospective case series of medical records following fracture fixation using locking implants with a supercutaneous plating technique. Inclusion criteria comprised a complete clinical and radiographical follow-up until implant removal. Patient history and signalment as well as fracture configuration were recorded. RESULTS: Five appendicular long bone fractures (3 radii, 2 tibiae) were included in the study and they were all treated using conical coupling locking plates. The patient mean age was 2.3 years (range: 0.3-5.8 years) and the mean body weight 16.5 kg (range: 3-27 kg).One major (implant failure) and minor complications (delayed bone union and iatrogenic recurvatum deformity) were detected. The removal of the plates was quick and did not require general anaesthesia. All five fractures treated healed and patients were sound at final follow-up. Neither discomfort nor pain were noticed during the postoperative patient management. CLINICAL SIGNIFICANCE: The advantages related to the minimally invasive approach and implant removal could make the supercutaneous plating (SCP) an alternative to the traditional external skeletal fixation.Further clinical investigations are required before definitive treatment recommendations using this technique can be made. In consideration of some of the complications detected, the use of fluoroscopy is recommended to support the surgeon at the beginning of their SCP learning curve.


Assuntos
Placas Ósseas/veterinária , Doenças do Cão/cirurgia , Extremidades/cirurgia , Fixação de Fratura/veterinária , Animais , Parafusos Ósseos/veterinária , Cães/lesões , Fixação de Fratura/instrumentação , Fixação de Fratura/métodos , Complicações Pós-Operatórias/veterinária , Estudos Retrospectivos
10.
Acta Oncol ; 58(4): 456-462, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30632859

RESUMO

BACKGROUND: The incidence of surgery due to metastatic bone disease in the extremities (MBDex) and postoperative survival remain uninvestigated in the population. The aim of the current study was: to identify (1) incidence, demographics and survival of a population-based cohort of patients having surgery for MBDex (2) rate of referrals and referral pattern to a musculoskeletal tumour centre (MTC). MATERIAL AND METHOD: A prospective study of a consecutive population-based cohort of patients having surgery for MBDex from 2014 to 2016. Patient demographics, indication for surgery, oncological status, and postoperative survival was obtained from patient interviews, surveillance scans and patient records. RESULTS: We identified 164 patients treated for 175 bone lesions resulting in an incidence of MBDex surgery of 48.6 lesions/million inhabitants/year and a 10% risk of undergoing surgery for MBDex for every year liven with metastatic bone disease. The most common primary cancers were breast, lung, renal, prostate and myeloma. Twenty-nine lesions represented debut of cancer and 22 lesions debut of relapse of a previous cancer. Overall one-year survival was 41% (95% C.I.: 33%-48%). Fifty-nine percent of patients were referred for treatment at MTC. Patients referred had better prognostic baseline characteristic than patients treated at secondary surgical centres (SSC) (lower ASA score (p < .001), no visceral metastasis (p < .001), lower age (p < .001) and less aggressive primary cancer (p < .001)). The one-year probability of overall survival was higher for MTC patients compared to SSC patients (p < .001). CONCLUSIONS: Present study describes a prospective population-based cohort of patients having surgery for MBDex identifying incidence and postoperative survival. Referral of patient is biased by selection where 'long-term survivors' are referred for treatment at MTC. We can, however, not exclude that treatment centre influences chance of survival after surgery for MBDex although our study was not designed to identify any potential influence.


Assuntos
Neoplasias Ósseas/epidemiologia , Neoplasias Ósseas/mortalidade , Neoplasias/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/secundário , Neoplasias Ósseas/cirurgia , Dinamarca/epidemiologia , Extremidades/patologia , Extremidades/cirurgia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Neoplasias/patologia , Neoplasias/cirurgia , Prognóstico , Estudos Prospectivos , Taxa de Sobrevida
11.
Comput Methods Biomech Biomed Engin ; 22(3): 243-250, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30596510

RESUMO

In this study, the effects of medial collateral ligament (MCL) release and the limb correction strategies with pre-existing MCL laxity on tibiofemoral contact force distribution after high tibial osteotomy (HTO) were investigated. The medial and lateral contact forces of the knee were quantified during simulated standing using computational modeling techniques. MCL slackness had a primary influence on contact force distribution of the knee, while there was little effect of simulated limb correction. Anterior and middle bundle release, which involved the partial release of two-thirds of the superficial MCL, was shown to be an optimal surgical method in HTO, achieving balanced contact distribution in simulated weight-bearing standing.


Assuntos
Simulação por Computador , Extremidades/cirurgia , Instabilidade Articular/patologia , Articulação do Joelho/cirurgia , Ligamento Colateral Médio do Joelho/cirurgia , Osteotomia , Tíbia/cirurgia , Idoso , Fenômenos Biomecânicos , Feminino , Humanos
12.
Rev. Asoc. Argent. Ortop. Traumatol ; 83(3): 157-166, set. 2018. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-976766

RESUMO

Introducción: El objetivo de este artículo es comunicar los resultados obtenidos con el uso del colgajo paraescapular para cubrir defectos severos postraumáticos de tejidos blandos en las extremidades. Materiales y Métodos: Estudio retrospectivo, descriptivo, de una serie de 20 pacientes a los que se les realizó un colgajo libre paraescapular para cubrir lesiones masivas combinadas postraumáticas de tejidos blandos en las extremidades, entre 2006 y 2017. La edad de los pacientes promedió 30 años (18 hombres, 2 mujeres). La localización de las lesiones fue: 10 en antebrazo y muñeca, una en la región inguinal, siete en la pierna y dos en tobillo/pie. Resultados: El seguimiento promedio fue de 3.6 años. Se logró la cobertura exitosa en 17 casos. El tamaño de los colgajos promedió 24,8 x 10,7 cm. Seis casos presentaron lesiones vasculonerviosas que necesitaron injerto, seis se asociaron a pérdidas óseas, 11 requirieron injerto de piel y cuatro, reconstrucciones tendinosas. En todos los pacientes, el área donante cerró en forma primaria y sin secuelas funcionales. Dicho colgajo se combinó con el escapular en tres casos y con colgajo de dorsal ancho en tres casos. Dos colgajos fallaron y debió amputarse la extremidad lesionada; un paciente falleció por embolia masiva al séptimo día de la cirugía. Conclusiones: El colgajo paraescapular permitió salvar y reconstruir satisfactoriamente defectos masivos extensos en 17 de 20 extremidades, sin morbilidad para la zona donante del colgajo, pero su uso no está exento de complicaciones, y un abordaje multidisciplinario es necesario para disminuir esta morbilidad. Nivel de Evidencia: IV


Introduction: The aim of this paper is to present the results after the use of parascapular free flaps to cover severe softtissue defects at the extremities. Methods: A retrospective, descriptive study of 20 patients who received parascapular free flaps to cover massive combined soft-tissue lesions at the extremities as a salvage procedure from 2006 to 2017 was performed. Patients' age averaged 30 years (18 men, 2 women). Sites of lesions were: ten at the forearm and wrist, one at the inguinal region, seven at the leg and two at the ankle/foot. Results: Follow-up averaged 3.6 years. Successful coverage was achieved in 17 cases. Flap size averaged 24.8 x 10.7 cm. There were six cases with neurovascular lesions that needed grafting, six cases had associated bone loss, eleven patients needed skin graft and four required tendon reconstructions. Donor area closed primarily without functional limitations in all patients. In three cases the flap was combined with a scapular flap and in three cases with a latissimus dorsi flap. Two flaps failed and the injured limb was amputated; one patient died due to massive embolism seven days after surgery. Conclusions: Parascapular free flaps allowed salvage and reconstruction of 17 out of 20 severely injured limbs, without morbidity for the donor area. But its use is not free of complications, and a multidisciplinary approach is necessary to reduce this morbidity. Level of Evidence: IV


Assuntos
Adulto , Retalhos Cirúrgicos , Lesões dos Tecidos Moles/cirurgia , Extremidades/cirurgia , Estudos Retrospectivos , Seguimentos , Resultado do Tratamento
13.
Rev. Asoc. Argent. Ortop. Traumatol ; 83(3): 167-178, set. 2018. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-976767

RESUMO

Introducción: El colgajo libre anterolateral de muslo es actualmente una de las opciones reconstructivas más útiles. Su versatilidad se debe a la inclusión de distintos tipos de tejido en diferentes combinaciones, una anatomía local confiable y un pedículo largo con un calibre adecuado. El objetivo de este estudio es revisar nuestra experiencia y evaluar la versatilidad del colgajo en defectos de los miembros superiores e inferiores. Materiales y Métodos: Estudio retrospectivo. Se consideraron pacientes tratados por defectos en las extremidades. Se analizaron variables preoperatorias, intraoperatorias y posoperatorias. Resultados: Se incluyeron 12 pacientes (7 hombres y 5 mujeres) con una edad promedio de 44 años. La causa del defecto fue resección oncológica (9 casos) y trauma (3 casos). La localización fue el miembro superior en cuatro casos y el miembro inferior en ocho pacientes. El tiempo promedio entre el defecto y la cirugía fue de 8 días. La tasa de supervivencia del colgajo fue del 92%, con falla en un caso. El sitio donante no presentó complicaciones, el cierre fue primario en 10 pacientes y con injerto de piel en dos. Conclusiones: El colgajo libre anterolateral de muslo es un recurso válido y de gran utilidad para la cobertura de defectos de diferentes etiologías tanto en los miembros superiores como en los miembros inferiores, ya que su versatilidad permite que se adapte con éxito en defectos de localización y tamaño variados. Nivel de Evidencia: IV


Introduction: The anterolateral thigh free flap is currently one of the most useful reconstructive options. A long pedicle with suitable vessel diameter, reliable anatomy and the availability of different tissues with large amounts of skin make this flap versatile. The purpose of this study was to evaluate the flap versatility in a series of patients with coverage defects in both, the upper and lower limbs. Methods: A retrospective study was performed. Inclusion criteria were patients with defects in the limbs to whom this flap was made as a reconstructive treatment. Preoperative, intraoperative and postoperative variables were analyzed. Results: Twelve patients (7 men and 5 women) with an average age of 44 years were included. Defects were caused by oncological resection (9 patients) and trauma (3 cases). In 4 cases the defect was in the upper limb and in 8 cases in the lower limb. The average time from the defect to the reconstructive surgery was 8 days. The survival rate of the flap was 92%, with only one failure. Donor site presented no complications and primary closure was performed in all cases, except for two requiring closure with skin graft. Conclusions: Anterolateral thigh free flap is a valid and very useful resource to cover defects of different etiologies in the upper and lower limbs since its versatility allows its successful adaptation in defects of varied location and size. Level of Evidence: IV


Assuntos
Adulto , Retalhos Cirúrgicos , Coxa da Perna , Procedimentos Cirúrgicos Reconstrutivos/métodos , Extremidades/cirurgia , Estudos Retrospectivos
14.
J Surg Oncol ; 118(3): 403-406, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30098306

RESUMO

In the morbidly obese population (BMI > 35), distal extremity defects are difficult to reconstruct. Traditional skin flaps are several centimeters in thickness in obese patients; however, a new plane superficial to the scarpal plane has demonstrated success in these patients. In this report, we present a 62-year-old female (BMI = 44.81) with a chronic lower extremity wound. A suprascarpal thin flap (approximately 1 cm in thickness) was harvested from the thigh and transferred successfully with no wound-healing issues.


Assuntos
Extremidades/cirurgia , Retalhos de Tecido Biológico , Obesidade Mórbida/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Transplante de Pele , Coxa da Perna/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Coxa da Perna/irrigação sanguínea , Resultado do Tratamento
15.
Medicine (Baltimore) ; 97(25): e11114, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29924008

RESUMO

INTRODUCTION: The Pacman flap is a novel modality for repairing round soft-tissue defects after tumor resection. This modality provides a robust blood supply without microsurgical tissue rearrangement. This article reviews the authors' experience with Pacman flap for reconstruction of round soft-tissue defects. The safety and effectiveness of the Pacman flap are investigated. METHODS: Here, we describe a method for oncologic reconstruction of round soft-tissue defects with a Pacman flap after tumor resection. Fourteen consecutive patients (6 males and 8 females, median age of 60 years, range, 18-87 years) who received Pacman flaps for oncologic reconstruction during the period from April 2015 to April 2017 were included in the present study. RESULTS: In total, 15 Pacman flaps (including 1 bilateral Pacman flap) were created to provide coverage after resection of a tumor from the face (n = 11), chest (n = 1), or extremities (n = 2). One patient had twice previously undergone tumor resection. Median defect size was 25.5 × 25 mm (range, 9 × 9-100 × 90 mm). Median flap size was 35 × 27 mm (range, 12 × 10-120 × 110 mm). Median duration of follow-up was 10 months (range, 6-22 months). No local or distal tumor was observed during the follow-up period. All flaps survived without partial or complete necrosis, infection, or other complications. All patients were satisfied with their aesthetic outcomes. A hematoma formed in 1 patient and was successfully treated with debridement. CONCLUSIONS: The Pacman flap enables the surgeon to achieve tension-free round defect closure after tumor resection, with good functional and aesthetic outcomes. This modality is a reliable and effective reconstructive surgical technique for oncologic reconstruction of round soft-tissue defects.


Assuntos
Neoplasias/cirurgia , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Extremidades/cirurgia , Face/cirurgia , Feminino , Humanos , Lábio/cirurgia , Masculino , Pessoa de Meia-Idade , Neoplasias/patologia , Estudos Retrospectivos , Adulto Jovem
16.
J Ayub Med Coll Abbottabad ; 30(2): 155-158, 2018 Apr-Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29938409

RESUMO

BACKGROUND: To assess the outcome of Medial Sural Artery Perforator Flap (MSAP Flap) as an option for the soft tissue reconstruction of head and neck and limbs. METHODS: This descriptive case series was conducted at Jinnah Burn and Reconstructive Surgery Center, Lahore during October 2016 to August 2017. All patients in whom MSAP flap (free and pedicled) was performed for reconstruction are included. Patients were followed at one week and one month after the discharge and data was entered into the proformas. RESULTS: In total, 18 patients were operated with this flap. Free and pedicled MSAP flap were performed for reconstruction of soft tissue defects in the head and neck and the lower limb. The maximum dimensions of the flap were 14 cm length and 10 cm width. The maximum pedicle length was 16cm. All flaps survived and showed good outcome. There was necrosis of the distal margin of a pedicled flap, but no case of venous congestion and flap failure was observed. The flap donor site was closed primarily in 7 patients while split skin graft was used in the rest of the patients. CONCLUSIONS: The MSAP flap provides a thin skin paddle and has minimal donor site morbidity as compared to the other options. It is a good addition to the armamentarium of perforator flaps which are thin and pliable, can be harvested by two team approaches, under the tourniquet and has a hidden donor site.


Assuntos
Artérias/cirurgia , Extremidades , Neoplasias de Cabeça e Pescoço/cirurgia , Retalho Perfurante/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos de Coortes , Extremidades/irrigação sanguínea , Extremidades/cirurgia , Humanos
17.
Arch Orthop Trauma Surg ; 138(7): 929-937, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29633075

RESUMO

INTRODUCTION: Chondroid lesions are very common bone tumors. In most cases, they are benign enchondromas (EC) and, in a minor percentage, chondrosarcomas (CSs), the malignant counterpart. In the latter cases, surgery is the mainstay treatment, because they are chemo- and radio-resistant unless dedifferentiation occurs. If resection is recognized as the gold standard for intermediate-, high-grade tumors, and for low-grade chondrosarcoma (LG-CS) located in the spine and pelvis to reduce the risk of local recurrence, there is still no consensus in literature on the treatment of central low-grade chondrosarcoma (cLG-CS) located in the limbs. Our aim is to perform a review of literature on evidence supporting this approach or not. MATERIALS AND METHODS: An electronic research of the medical archives was carried out in March 2017 seeking papers evaluating the results of curettage and resection in cLG-CS. RESULTS: We selected 13 studies corresponding to our criteria. Unfortunately, they were descriptive, retrospective, non-randomized studies. We identified a population of 471 patients for a total of 473 low-grade chondrosarcomas. Two hundred and ninety-nine lesions were treated with curettage and 174 with wide surgery. The two groups were not homogeneous for diagnosis, size and staging, so no comparison between resection and curettage was possible. The global weighted average percentage of local recurrence was 6.7% (20 cases) and 10.9% (19 cases) after curettage and resection, respectively. No cases of metastasis were reported in the group treated with intralesional surgery, compared to five cases reported in the group treated with resection. Indications for surgery were given in most cases based on symptoms and imaging. CONCLUSIONS: The absence of a preoperative histological diagnosis and the lack of a scientific method to conduct the studies do not sufficiently support curettage for low-grade chondrosarcomas. In the absence of this, resection must be considered a general rule for every malignancy. In our opinion, based on the low biological growth rate of low-grade chondrosarcoma, every chondromatous lesion can be followed-up. Biopsies must be performed based on clinical and radiological suspicions such as pain, scalloping or increase in size, rather than on performing a PET scan to evidence more informative high metabolic areas.


Assuntos
Neoplasias Ósseas/cirurgia , Condrossarcoma/cirurgia , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/patologia , Condrossarcoma/diagnóstico por imagem , Condrossarcoma/patologia , Curetagem , Extremidades/diagnóstico por imagem , Extremidades/patologia , Extremidades/cirurgia , Humanos , Gradação de Tumores , Recidiva Local de Neoplasia , Radiografia , Resultado do Tratamento
18.
J Surg Oncol ; 117(7): 1479-1486, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29633281

RESUMO

BACKGROUND AND OBJECTIVES: The purpose of this investigation was to determine the effect of hospital volume on treatment decisions, treatment results, and overall patient survival in extremity soft tissue sarcoma. METHODS: The National Cancer Database was used to identify patients ≥18 years of age with non-metastatic soft tissue sarcoma of the extremity treated with surgery. Patients in high- and low-volume centers were matched by propensity score and placed into two equal comparative groups of 2437 patients each. RESULTS: Chemotherapy was used at a higher rate in high-volume centers (22% vs 17%, P < 0.001) and external beam radiation usage was similar (55% vs 52%, P = 0.108). There was a lower incidence of positive margins in high-volume centers (12% vs 17%, P < 0.001). There was no significant difference in the rates of limb salvage surgery or readmissions at high-volume hospitals compared to low-volume. In a multivariate Cox proportional hazards model, low-volume facilities demonstrated diminished overall survival at all time points (hazard ratio at 5 years = 1.24, 95%CI 1.10-1.39). CONCLUSIONS: Treatment at high-volume hospitals was associated with fewer positive margins and increased overall survival at 2, 5, and 10 years. Continued efforts should focus on optimizing the balance between patient access to specialty care and experience of the treating center.


Assuntos
Extremidades/cirurgia , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Salvamento de Membro/mortalidade , Sarcoma/mortalidade , Estudos de Coortes , Bases de Dados Factuais , Extremidades/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Pontuação de Propensão , Sarcoma/patologia , Sarcoma/cirurgia , Taxa de Sobrevida , Resultado do Tratamento
19.
Mol Pain ; 14: 1744806918766745, 2018 Jan-Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29592780

RESUMO

Neuroligin1 is an important synaptic cell adhesion molecule that modulates the function of synapses through protein-protein interactions. Yet, it remains unclear whether the regulation of synaptic transmission in the spinal cord by neruoligin1 contributes to the development of postoperative pain. In a rat model of postoperative pain induced by plantar incision, we conducted Western blot study to examine changes in the expression of postsynaptic membrane of neuroligin1, postsynaptic density 95 (PSD-95), and α-amino-3-hydroxy-5-methyl-4-isoxazole propionate (AMPA) receptor GluA1 and GluA2 subunits in the spinal cord dorsal horn after injury. The interaction between neuroligin1 and PSD-95 was further determined by using coimmunoprecipitation. Protein levels of neuroligin1 and GluA1, but not GluA2 and PSD-95, were significantly increased in the postsynaptic membrane of the ipsilateral dorsal horn at 3 h and 1 day after incision, as compared to that in control group (naïve). A greater amount of PSD-95 was coimmunoprecipitated with neuroligin1 at 3 h after incision than that in the control group. Intrathecal administration of small interfering RNAs (siRNAs) targeting neuroligin1 suppressed the expression of neuroligin1 in the spinal cord. Importantly, pretreatment with intrathecal neuroligin1 siRNA2497, but not scrambled siRNA or vehicle, prevented the upregulation of GluA1 expression at 3 h after incision, inhibited the enhanced neuroligin1/PSD-95 interaction, and attenuated postoperative pain. Together, current findings suggest that downregulation of spinal neuroligin1 expression may ameliorate postoperative pain through inhibiting neuroligin1/PSD-95 interaction and synaptic targeting of GluA1 subunit. Accordingly, spinal neuroligin1 may be a potential new target for postoperative pain treatment.


Assuntos
Moléculas de Adesão Celular Neuronais/metabolismo , Proteína 4 Homóloga a Disks-Large/metabolismo , Regulação para Baixo , Dor Pós-Operatória/metabolismo , Subunidades Proteicas/metabolismo , Receptores de AMPA/metabolismo , Corno Dorsal da Medula Espinal/metabolismo , Sinapses/metabolismo , Animais , Extremidades/cirurgia , Injeções Espinhais , Masculino , Dor Pós-Operatória/etiologia , Ligação Proteica , RNA Interferente Pequeno/metabolismo , Ratos Sprague-Dawley , Reprodutibilidade dos Testes , Corno Dorsal da Medula Espinal/patologia , Regulação para Cima
20.
Mol Pain ; 14: 1744806918767508, 2018 Jan-Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29592783

RESUMO

Background Intense nociceptive signaling arising from ongoing injury activates primary afferent nociceptive systems to generate peripheral sensitization. ERK1/2 phosphorylation in dorsal root ganglion can be used to visualize intracellular signal activity immediately after noxious stimulation. The aim of this study was to investigate spatiotemporal characteristics of ERK1/2 phosphorylation against tissue injury in the primary afferent neurons. Methods Plantar incisions were made in the hind paws of Sprague-Dawley rats (n =150). Levobupivacaine was injected into the plantar aspect of the paws and ankles, Mitogen-activated protein kinase kinase (MEK) inhibitor was injected into the paw, and carbenoxolone, dual inhibitor of the gap junction and pannexin channel, was intraperitoneally injected. Pain hypersensitivity was investigated by a behavioral study, while phosphorylated ERK1/2 was detected in dorsal root ganglion and hind paw using immunohistochemistry and Western blot. Results Phosphorylated ERK1/2 was induced in dorsal root ganglion (26.8 ± 2.9% at baseline, 65.6 ± 3.6% at 2 min, and 26.3 ± 3.4% at 2 h) after the incision. NF-200 positive A-fiber neurons and satellite glial cells were positive for phosphorylated ERK1/2. Injury-induced pain hypersensitivity was abolished by MEK inhibitor. Levobupivacaine treatment inhibited phosphorylated ERK1/2 induction, carbenoxolone treatment inhibited glial phosphorylated ERK1/2 at 2 min after the injury, and carbenoxolone inhibited pain hypersensitivity and neuronal phosphorylated ERK1/2 at 1 h after the injury. Conclusion ERK1/2 phosphorylation in A-fiber neurons and satellite glial cells immediately after injury contributes to the generation of pain hypersensitivity. Signal communication between neurons and satellite glial cells expands the duration of neuronal ERK1/2 phosphorylation and pain hypersensitivity at 1 h after tissue injury.


Assuntos
MAP Quinases Reguladas por Sinal Extracelular/metabolismo , Extremidades/patologia , Gânglios Espinais/enzimologia , Gânglios Espinais/patologia , Neuroglia/enzimologia , Neurônios/enzimologia , Dor/enzimologia , Analgésicos/farmacologia , Animais , Bupivacaína/farmacologia , Bupivacaína/uso terapêutico , Ativação Enzimática , Extremidades/cirurgia , Hipersensibilidade/enzimologia , Hipersensibilidade/patologia , Masculino , Quinases de Proteína Quinase Ativadas por Mitógeno/antagonistas & inibidores , Quinases de Proteína Quinase Ativadas por Mitógeno/metabolismo , Dor/tratamento farmacológico , Dor/patologia , Inibidores de Proteínas Quinases/farmacologia , Ratos Sprague-Dawley
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