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1.
Zhonghua Shao Shang Za Zhi ; 36(2): 91-96, 2020 Feb 20.
Artigo em Chinês | MEDLINE | ID: mdl-32114725

RESUMO

Objective: To explore the clinical application effects of portable visual retractor in superficial temporal fascia flap harvesting. Methods: From January 2010 to June 2019, 27 patients meeting the inclusion criteria and planning to perform operation of superficial temporal fascia flap harvesting were admitted to the Department of Plastic and Reconstructive Surgery of the First Clinical Medical Center of the People's Liberation Army General Hospital. The patients were divided into traditional surgical method group [6 males and 3 females, aged (34±14) years], cold light source retractor group [6 males and 4 females, aged (35±16) years], and portable visual retractor group [7 males and 1 female, aged (30±14) years] according to way of superficial temporal fascia flap harvesting. The superficial temporal fascia flaps of patients in traditional surgical method group were resected by traditional way of resection, and the superficial temporal fascia flaps of patients in cold light source retractor group and portable visual retractor group were resected at assistance of cold light source retractor and portable visual retractor, respectively. Length of incision, operation time, intraoperative blood loss volume, postoperative drainage volume, and postoperative complication of patients in 3 groups were observed and recorded. Data were processed with Fisher's exact probability test, one-way analysis of variance, least significant difference test, Kruskal-Wallis H test, and Bonferroni correction. Results: The length of incision of patients in visual retractor group was (3.6±0.8) cm, significantly shorter than (12.6±1.6) cm in traditional surgical method group and (5.8±0.9) cm in cold light source retractor group (P<0.05). The incision length of patients in traditional surgical method group was significantly longer than that in cold light source retractor group (P<0.05). The operation time of patients in visual retractor group was 24.0 (23.3, 25.8) min, significantly shorter than 35.0 (30.5, 36.5) min in traditional surgical method group and 28.5 (26.8, 30.5) min in cold light source retractor group (H=16.5, 9.8, P<0.05). The operation time of patients in traditional surgical method group was significantly longer than that in cold light source retractor group (H=6.6, P<0.05). The intraoperative blood loss volume was (26±3) mL of patients in visual retractor group, significantly less than (34±4) mL in traditional surgical method group and (30±6) mL in cold light source retractor group (P<0.05). The intraoperative blood loss volume of patients in traditional surgical method group was significantly more than that in cold light source retractor group (P<0.05). The postoperative drainage volumes of patients in visual retractor group, cold light source retractor group, and traditional surgical method group were (33±4), (34±6), and (31±7) mL, respectively, and there were no significantly statistical differences in postoperative drainage volumes among patients in the three groups (F=0.3, P>0.05). There were no severe complications such as ischemia and necrosis of superficial temporal fascia flaps in patients of the three groups. One patient in cold light source retractor group had subcutaneous hematoma after operation, which was improved by removing stitches and hematoma. Conclusions: Superficial temporal fascia flap harvesting at the assistance of portable visual retractor has the advantages of clear visual field, simple operation, short operation time, small incision, and less intraoperative blood loss.


Assuntos
Retalhos Cirúrgicos , Adolescente , Adulto , Fáscia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos , Transplante de Pele , Tela Subcutânea , Resultado do Tratamento , Adulto Jovem
2.
Khirurgiia (Mosk) ; (1): 40-45, 2020.
Artigo em Russo | MEDLINE | ID: mdl-31994498

RESUMO

OBJECTIVE: To improve the results of treatment of patients undergoing laparotomy by using of a new method of aponeurosis suturing after laparotomy. MATERIAL AND METHODS: Training process for a new method of aponeurosis suturing after laparotomy was organized on the patented medical simulator for learning the technique of laparotomy closure. The method was introduced into surgical practice later. The study involved 130 patients who underwent emergency abdominal surgery through median laparotomy. The main group consisted of 70 patients (laparotomy closure using the proposed method (RF patent No.2644846 dated 02/14/18). Interrupted sutures were applied for aponeurosis suturing in the control group. RESULTS: Duration of laparotomy closure was similar in both groups. Postoperative ventral hernias in 1 year after surgery occurred in 5 (8%) patients of the main group and in 11 (18%) patients of the control group. CONCLUSION: The proposed method of aponeurosis suturing after laparotomy is mastered by students and serves as effective method for prevention of postoperative ventral hernias and eventration.


Assuntos
Técnicas de Fechamento de Ferimentos Abdominais/educação , Aponeurose/cirurgia , Hérnia Ventral/prevenção & controle , Hérnia Incisional/prevenção & controle , Laparotomia/efeitos adversos , Técnicas de Sutura/educação , Fáscia , Hérnia Ventral/etiologia , Humanos , Hérnia Incisional/etiologia , Laparotomia/educação , Modelos Anatômicos
3.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(1): 83-86, 2020 Jan 15.
Artigo em Chinês | MEDLINE | ID: mdl-31939240

RESUMO

Objective: To explore the feasibility and effectiveness of using auricular cartilage multi-point suspension fixed on deep craniofacial fascia in correcting mild to moderate cupped ear malformation. Methods: Between January 2014 and March 2016, 22 patients (12 males and 10 females) with mild to moderate cupped ear malformation were admitted, aged from 6 to 28 years, with an average age of 15 years. Sixteen cases were unilateral and 6 cases were bilateral. According to Tanzer classification, there were 18 sides of type Ⅰ and 10 sides of type Ⅱ. The otocranial groove incision was selected to expose and release the posterior auricular muscles and ligaments. The abnormal structure of auricle subunits was remolded. The auricle cartilage was suspended and fixed on the deep craniofacial fascia with non absorbable line to remodel the shape and position of auricle. Results: The incision healed by first intention, without hematoma, infection, and skin necrosis. All the patients were followed up 3-48 months, with an average of 12 months. In addition to 1 case of slippage of the fixed line knot, the effect was good after being suspended and fixed again, the auricles of the other patients were not drooping and tilted forward, the shape of the outer ear was good, the ear boat was obvious, the shape of the upper and lower feet of the ear wheel and the pair of ears was natural, the bilateral symmetry was good, and the patients and their families were satisfied. Conclusion: Auricular cartilage multi-point suspension fixed on deep craniofacial fascia is effective in the treatment of mild to moderate cupped ear malformation.


Assuntos
Pavilhão Auricular , Cartilagem da Orelha , Procedimentos Cirúrgicos Reconstrutivos , Adolescente , Adulto , Criança , Fáscia , Fasciotomia , Feminino , Humanos , Masculino , Retalhos Cirúrgicos , Adulto Jovem
4.
Ann Otol Rhinol Laryngol ; 129(2): 135-141, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31559861

RESUMO

OBJECTIVE: To report the rate of major soft tissue complications after cochlear implantation and to describe the use of the temporoparietal fascia (TPF) flap for such complications. STUDY DESIGN: Retrospective case series. SETTING: Tertiary care, University Hospital. SUBJECTS AND METHODS: Chart review of all patients who underwent cochlear device implantation over a 5-year period to identify patients and to determine the rate of soft tissue complications. Five patients with major soft tissue complications underwent TPF flap with device salvage or explantation/reimplantation. RESULTS: The rate of major skin complications was 6 out of 281 (2.1%) over 5 years, with 5 patients undergoing TPF flap. The average follow-up was 25.8 months (range, 5-58 months). TPF flap represented the definitive, successful solution for all 5 patients. One postoperative hematoma occurred after TPF flap, with no long-term sequelae. The average hospital length of stay was 2.2 nights (range, 1-5 nights). One patient required IV antibiotics for 4 weeks; the remaining patients were treated with a postoperative course of oral antibiotics. The original device remained in place for 4 patients, while one case required device explantation and staged re-implantation. Post-TPF flap hearing results were equal to if not superior to their preoperative results. CONCLUSION: Major soft tissue complications following cochlear device implantation are rare. The temporoparietal fascia flap is an excellent option for reconstruction of device site soft tissue dehiscences when local wound care and primary closure are not sufficient, and can potentially prevent explantation of a functional implant.


Assuntos
Implante Coclear , Complicações Pós-Operatórias/cirurgia , Retalhos Cirúrgicos , Idoso , Idoso de 80 Anos ou mais , Fáscia , Feminino , Humanos , Masculino , Reoperação , Estudos Retrospectivos , Deiscência da Ferida Operatória/cirurgia , Resultado do Tratamento
6.
Nature ; 576(7786): 215-216, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31822827
7.
Medicine (Baltimore) ; 98(52): e18428, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31876720

RESUMO

RATIONALE: The plantar fascia (PF) is an important anatomical structure that stabilizes the longitudinal arch of the foot. While plantar fasciitis is a common pathology affecting the foot, tears of the PF are uncommon injuries characterized by acute pain in the plantar aspect of the foot. The main purpose of this paper was to describe, in detail, how the ultrasonographic pattern of PF rupture can be combined with the clinical features to define the prognosis and promptly plan the therapeutic approach. PATIENT CONCERNS: In the first case, a 39-year-old male patient was seen due to acute pain in the mid plantar foot which appeared 3 days after a tennis match. The pain was accompanied by a "snap" noise and intense pain. In the second case, a 44-year-old male patient was seen due to pain in the heel region which appeared 2 days after a running session. DIAGNOSIS: One case of noninsertional complete tear of the central bundle of the PF with retraction of the 2 stumps and 1 case of partial tear of the central bundle of the PF at the level of the insertional region. INTERVENTIONS: Both patients were treated with conservative therapies including load management, oral nonsteroidal anti-inflammatory drugs, foot orthosis, and restriction of sport activities. OUTCOMES: At follow-up, the patient with spontaneous complete tear of the PF (noninsertional area) showed a small fibrous bridge between the 2 stumps, with partial alignment of the proximal and distal portions, the ability to walk for a medium to long-distance, and difficulty going up and downstairs. The patient with the spontaneous partial tear (insertional area) showed complete fibrous scar tissue with restoration of the fascial continuity, and the ability to walk for a long-distance and go up and downstairs without pain. LESSONS: Based on the clinical and ultrasonographic findings, we suggest that partial tear of the PF in the insertional region presents a favorable prognosis with complete recovery, both clinically and anatomically, while a complete tear in the noninsertional region is associated with partial functional and histological recovery when managed with a conservative approach. Therefore, coupling the clinical findings with the sonohistologic pattern is a valuable approach to plan the most suitable treatment for patients with spontaneous PF tear.


Assuntos
Fáscia/lesões , Traumatismos do Pé/terapia , Ruptura/terapia , Adulto , Tratamento Conservador/métodos , Fáscia/diagnóstico por imagem , Traumatismos do Pé/diagnóstico por imagem , Humanos , Masculino , Ruptura/diagnóstico por imagem , Ultrassonografia
8.
Medicine (Baltimore) ; 98(46): e18018, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725676

RESUMO

BACKGROUND: Cavus foot is a deformity represented by an increased and rigid medial longitudinal arch, and it is often associated with persistent pain and gait disturbances. None of the conservative conventional treatments for cavus foot have shown conclusive evidence of effectiveness, and so further is research needed to understand how to manage this condition better. This study aimed to assess the immediate and short-term radiological changes after combining static stretching and transcutaneous electrical stimulation of the plantar fascia in adults with idiopathic cavus foot. METHODS: A randomized, single-blinded clinical trial was conducted. Sixty-eight participants with idiopathic cavus foot, as determined by an internal Moreau-Costa-Bertani angle (MCBA) less than 125° in a lateral weight-bearing foot radiograph, were equally distributed into a neuromuscular stretching group (NSG) or a control group (no intervention). The NSG underwent a single session, combining transcutaneous electrical nerve stimulation with static stretching of the plantar fascia. Primary measurements of 3 angles were taken using a lateral weight-bearing foot radiograph: the internal MCBA; the calcaneal pitch angle (CPA); and the first metatarsal declination angle (FMDA). Outcomes were collected at baseline, immediately postintervention, and 1 week after intervention. RESULTS: Analysis of variance revealed a significant group effect for all angles (all, P < .05). NSG participants showed a significant increase in the internal MCBA (P = .03), and a significant decrease in the CPA (P = .01) and FMDA (P = .04) from baseline to immediately postintervention. These changes remained statistically significant 1 week after the intervention (all, P < .05). CONCLUSION: The combination of static stretching and transcutaneous electrical stimulation of the plantar fascia, compared with no treatment, achieved immediate and short-term changes in the internal MCBA, the CPA, and the FMDA, which resulted in flattening the medial longitudinal plantar arch in adults with idiopathic cavus foot.


Assuntos
Exercícios de Alongamento Muscular/métodos , Pé Cavo/terapia , Estimulação Elétrica Nervosa Transcutânea/métodos , Adulto , Terapia Combinada , Fáscia/fisiopatologia , Feminino , Humanos , Masculino , Método Simples-Cego , Pé Cavo/diagnóstico por imagem , Suporte de Carga , Adulto Jovem
9.
Acta Clin Croat ; 58(Suppl 1): 108-113, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31741568

RESUMO

Anterior section of the hip joint capsule is innervated by femoral nerve and obturator nerve, and posterior section is innervated by the nerve to quadratus femoris muscle and occasionally by the superior gluteal (posterolateral region) and sciatic nerve (posterosuperior region). One of the regional anesthesia options for hip surgery is the fascia iliaca compartment block (FICB) that affects nerves important for hip innervation and sensory innervation of the thigh - femoral, obturator and lateral femoral cutaneous nerve. FICB can be easily performed and is often a good solution for management of hip fractures in emergency departments. Its use reduces morphine pre-operative requirement for patients with femoral neck fractures and can also be indicated for hip arthroplasty, hip arthroscopy and burn management of the region. Quadratus lumborum block (QLB) is a block of the posterior abdominal wall performed exclusively under ultrasound guidance, with still unclarified mechanism of action. When considering hip surgery and postoperative management, the anterior QLB has shown to reduce lengthy hospital stay and opioid use, it improves perioperative analgesia in patients undergoing hip and proximal femoral surgery compared to standard intravenous analgesia regimen, provides early and rapid pain relief and allows early ambulation, thus preventing deep vein thrombosis and thromboembolic complications etc. However, some nerve branches responsible for innervation of the hip joint are not affected by QLB, which has to be taken into consideration. QLB has shown potential for use in hip surgery and perioperative pain management, but still needs to be validated as a reliable treatment approach.


Assuntos
Músculos Abdominais , Anestesia por Condução/métodos , Fáscia , Articulação do Quadril/cirurgia , Bloqueio Nervoso/métodos , Dor Pós-Operatória/prevenção & controle , Fraturas do Quadril/cirurgia , Articulação do Quadril/inervação , Humanos , Procedimentos Ortopédicos/efeitos adversos , Manejo da Dor/métodos , Dor Pós-Operatória/etiologia
10.
Am Surg ; 85(11): 1213-1218, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31775961

RESUMO

The best method for fascial closure during hernia repair remains unknown. This study evaluates the impact of fascial closure techniques on short-term outcomes. All patients undergoing open ventral hernia repair were queried using the Americas Hernia Society Quality Collaborative database. Analysis was stratified by suture type (absorbable and permanent) and technique (figure-of-eight, running, and interrupted). Outcome measures included SSI, surgical site occurrence (SSO), SSO requiring intervention, recurrence rate, and quality of life. Descriptive statistics and logistic regression were used. The study included 6544 patients. Two-thirds of surgeons closed fascia during ventral hernia repair with absorbable suture and one-third with permanent suture. In the absorbable group, 17 per cent used figure-of-eight, 46 per cent running, and 4 per cent interrupted suture. In the permanent group, 13 per cent used figure-of-eight, 8 per cent running, and 11 per cent interrupted suture. There was no significant association between SSO and closure technique (P = 0.2). However, SSO and suture type were significant (P < 0.001) with the odds of SSO for closure with absorbable suture being 62 per cent higher than the odds of permanent. Fascial closure technique and suture type had no significant association (P > 0.5) with SSI, SSO requiring intervention, hernia recurrence rate, or HerQLes or NIH PROMIS 3a scores at 30 days or 6 months. Fascial closure technique and suture material do not have a major impact on outcomes in ventral hernia repair. Despite a significantly higher rate of SSO for absorbable sutures than permanent, this did not increase the rate of interventions.


Assuntos
Fasciotomia/métodos , Hérnia Ventral/cirurgia , Hérnia Incisional/cirurgia , Técnicas de Sutura/estatística & dados numéricos , Técnicas de Fechamento de Ferimentos , Adulto , Idoso , Fáscia , Fasciotomia/estatística & dados numéricos , Feminino , Herniorrafia/métodos , Herniorrafia/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica , Qualidade de Vida , Recidiva , Suturas/estatística & dados numéricos , Técnicas de Fechamento de Ferimentos/estatística & dados numéricos
11.
Handchir Mikrochir Plast Chir ; 51(6): 464-468, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31698492

RESUMO

BACKGROUND: Dorsal complex cutaneotendinous lesions of the hand represent a reconstructive challenge. The use of composite microvascular flaps and vascularized tendon grafts represent the gold-standard. The radial anti-brachial region can still represent an excellent donor site, to the detriment of the possible sacrifice of the radial artery. The reverse radial anti-brachial flap can be either perforator-based, thus saving the radial artery or raised as an adipo-fascial flap, to spare the skin. PATIENTS AND METHODS: A case of post-traumatic highly contaminated dorsal cutaneotendinous defect of the second ray of the hand was reported. An original surgical reconstructive technique with a Revers Radial Teno-Adipo-Fascial Flap (RRTAFF) plus vascularized Palmaris Longus was described, preserving the radial artery. A simple partial thickness skin graft was performed a second time to complete dorsal cutaneous coverage. A subsequent infection was managed by trusting the complete vascularization of the tissues used for the reconstruction. RESULTS: The hand healed well with containment of the infection. The dorsal healed skin appeared elastic and pliable enough. Passive and active motion of interphalangeal and metacarpofalangeal joints were very satisfying. The donor site was well healed, with almost no morbidity. CONCLUSIONS: This reconstructive strategy provides a quick and straightforward single-stage option for the reconstruction of complex cutaneotendinous defects of the dorsum of the hand. Such a reconstruction, with a completely vascularized procedure, is particularly indicated in cases of high contamination or infection of the recipient site.


Assuntos
Traumatismos da Mão , Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Fáscia , Traumatismos da Mão/cirurgia , Humanos , Transplante de Pele
12.
Eur. j. anat ; 23(6): 479-481, nov. 2019. ilus
Artigo em Inglês | IBECS | ID: ibc-185092

RESUMO

The claim made in this publication of the existence of a hitherto unknown interstitial space is based on studies with sample-based confocal laser endo-microscopy (pCLM). Due to postings on various web portals (New Cellvizio, EurekAlert, Google Scholar,...) the alleged discovery has found great resonance. Nevertheless, there are several critical issues in this publication, the most important being that this is not the discovery of an "unrecognized" interstitium as it has, in fact, been known for a long time


No disponible


Assuntos
Humanos , Fáscia/anatomia & histologia , Fáscia/ultraestrutura , Pele/ultraestrutura , Espaço Extracelular , Fibroblastos/ultraestrutura , Pele/anatomia & histologia , Derme/anatomia & histologia , Derme/ultraestrutura , Imagem Tridimensional
13.
Eur. j. anat ; 23(6): 483-485, nov. 2019.
Artigo em Inglês | IBECS | ID: ibc-185093

RESUMO

We appreciate the time and attention paid to our paper by Prof. Mestres-Ventura and similarly appreciate the opportunity to respond to his concerns. We would like to address what we believe are several fundamental misunderstandings in his commentary.1. Scale: The most significant misunderstanding is one of scale. The schematic (Fig. 1) provided by Prof. Mestres-Ventura is (per personal communication) at the nano scale, while in vivo microscopy of extrahepatic bile duct and dermis shows that the collagen bundles we report are at the micron scale, each containing many individual fibrils at the nanometer scale. Indeed, examining the tissues described in our paper - submucosae, dermis and subcutaneous fascia - fresh in resected specimens or intraoperatively, we find that the structures we describe are visible at the macroscopic level (if one leans in closely enough). In other words, they are macroscopic, not microscopic. Prof. Mestres-Ventura, in summarizing the prior pCLE work of Wallace and Fockens, which he notes is similar to ours, states "the 'holes' shown under intravital microscopy and in cryofixed samples are huge (over 20 µm)" This is exactly our point - we were surprised as well at the scale of these structures, as this has not been well appreciated in the past


No disponible


Assuntos
Humanos , Ducto Colédoco/anatomia & histologia , Ducto Colédoco/ultraestrutura , Derme/ultraestrutura , Fáscia/ultraestrutura , Microscopia/métodos , Derme/anatomia & histologia , Fáscia/anatomia & histologia , Antígenos CD34 , Proteoglicanas
14.
Am Surg ; 85(9): 998-1000, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31638513

RESUMO

Tension is one of the most discussed terms related to hernia surgery and repair. Despite the universally accepted opinion that tension and reduction of tension are important concepts in hernia repair, there is very little known about the physiologic tension of the abdominal wall related to ventral hernia repair. The purpose of this project was to attempt to measure physiologic tension in patients without hernia repair and help determine a normal baseline tension. Patients were enrolled in a prospective institutional review board-approved protocol to measure abdominal wall tension from February 2014 to present. Patients undergoing abdominal surgery without hernia repair were included. Demographic information and operative details were documented. Abdominal wall tensions were measured using scales attached to Kocher clamps that are clamped to the fascia and then brought together in the midline. Total tension, surgeon's estimation of tension, and grading of the fascia were recorded. Descriptive statistics were calculated. Eleven patients met the inclusion criteria and had tension measurements performed during surgery. The average age was 58 years, with 55 per cent of them being white and 82 per cent being male, with an average BMI of 27. Operations included exploratory laparotomy for small bowel pathology in six patients, colorectal surgery in three patients, and splenectomy in a trauma patient. Average tension measurements for these patients were 1.9 lbs. Surgeon grading of tension was an average of 2.2 (range, 1-5). Obtaining tension measurements is feasible during abdominal surgery. Physiologic tension seems to be approximately 2 pounds. Further study is needed with a larger sample of patients.


Assuntos
Parede Abdominal/fisiologia , Tono Muscular/fisiologia , Adulto , Idoso , Fáscia/fisiologia , Feminino , Hérnia Ventral/fisiopatologia , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Humanos , Período Intraoperatório , Laparotomia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Valores de Referência
17.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(10): 920-925, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31630487

RESUMO

The theory of membrane surgery actually holds the same concepts as that of traditional cancer surgery, which believes that tumor spread is regarded as an isotropic process but the tumor is confined by the block of the membrane. Therefore, the radical resection can be achieved by complete mesentery excision along the membrane plane. The surgical practice derived from these conceptions is extended excision and lays emphasis on tumor-free margins. But the theory is controversial in the view of the existence of mesorectal fascial envelope and the feasibility of complete excision of mesorectum along the "holy plane". Based on ontogenetic anatomy, the compartment theory suggeststhat tumor spread is not isotropic, and it is locally confined within the ontogenetic compartment derived from a common primordium for a relatively long phase during their natural course. Local tumor is suppressed by the boundary instead of fascia. The anatomical territory developing from each anlage primordium may be separated morphologically. Consequently, ontogenetic compartment theory states that optimal local control of cancer is achieved by whole compartment resection, irrespective of margin width. The compartment model of tumor spread provides explanations for total mesorectal excision (TME) which excises the complete rectum compartment including the rectum and its surrounding vascular and ligamentous mesenteries. The compartment theory may set up the new principles for surgical tumor treatment, namely the resection of the tumor bearing compartment rather than target organ.


Assuntos
Mesentério/patologia , Mesentério/cirurgia , Protectomia/métodos , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Colectomia/métodos , Colectomia/normas , Fáscia/patologia , Humanos , Margens de Excisão , Mesocolo/patologia , Mesocolo/cirurgia , Invasividade Neoplásica , Metástase Neoplásica , Protectomia/normas , Reto/anatomia & histologia , Reto/patologia
18.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(10): 937-942, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31630490

RESUMO

The anorectum is a complex region, whose anatomic structure is the basis and premise of intersphincteric resection (ISR) for low rectal cancer. With the development of pelvic surgery and minimally invasive surgery, the anatomic approaches, surgical planes, extent of excision and reconstruction strategies of ISR have been better understood. Surgeons can furthest preserve anal function as well as adhere to the principles of radical resection. However, the anatomy of the anorectum has not been fully understood. We hope further exploration of the anal canal anatomy, including the perirectal fascia, rectourethral muscle, anococcygeal ligament, hiatal ligament, levator ani muscle, internal and externals phincter, intersphincteric nerves, conjointed longitudinal muscle, intersphincteric spaces and the surgical approaches, by reviewing relevant literatures combined with the experiences of our clinical practice and applied anatomy, will help to improve the accuracy of the surgeries and increase the oncologic and functional outcomes of ISR.


Assuntos
Canal Anal/patologia , Canal Anal/cirurgia , Pelve/cirurgia , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Canal Anal/anatomia & histologia , Canal Anal/inervação , Fáscia/anatomia & histologia , Humanos , Diafragma da Pelve/anatomia & histologia , Diafragma da Pelve/patologia , Diafragma da Pelve/cirurgia , Pelve/anatomia & histologia , Pelve/patologia
19.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(10): 943-948, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31630491

RESUMO

The neurovascular bundle (NVB) starts at the lateral angle of the seminal vesicle (the initial part), passes posterolateral of the prostate gland (the main part), and ends at the cavernous body of the penis (the cavernous part). In low rectal surgery, different transabdominal and transanal perspectives result in different NVB injury risks. In the perspective of transabdominal operation, the separation between the initial part of NVB and Denonvilliers fascia and the anatomical variation of the two lateral sides of Denonvilliers fascia increases the risk of NVB injury, and conformation separation may take into account the convenience of separationand the protection of NVB. In the perspective of transanal operation, when separating the main part with NVB and mesorectum, the perspective of the transanal, unidirection traction and excessive dissection increase the risk of NVB main exposure. Clear anatomical identification helps the protection of NVB in the transanal operation. At present, the medical evidence on the difference of NVB injury in different perspectives of transabdominal and transanal approach is still in need of relevant clinical researches.


Assuntos
Mesentério/cirurgia , Protectomia/métodos , Neoplasias Retais/cirurgia , Reto/cirurgia , Colectomia/métodos , Dissecação , Fáscia/anatomia & histologia , Humanos , Masculino , Mesentério/anatomia & histologia , Mesentério/irrigação sanguínea , Mesentério/inervação , Neoplasias Retais/patologia , Reto/anatomia & histologia , Reto/irrigação sanguínea , Reto/inervação
20.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(10): 949-954, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31630492

RESUMO

Objective: To perform an anatomical observation on the extension of the mesocolon to the mesorectum and the continuity of the fasciae lining the abdomen and pelvis, in order to clarify the appropriate surgical plane of total mesorectal excision. Methods: This is an descriptive study. The operation videos of 61 cases (28 males, 33 females, median age of 61) were collected. All the patients underwent laparoscopic colorectal surgery from January 2018 to December 2018 in Yangpu Hospital, including low anterior resection for rectal cancer in 25 cases, left hemicolectomy for descending colon cancer in 15 cases, and subtotal resection of the colon for intractable constipation in 21 cases. Among these 21 constipation patients, 8 received additional modified Duhamel surgeries. Gross anatomy was performed on 24 adult cadavers provided by Department of Anatomy, Shanghai Jiaotong University School of Medicine, including 23 formalin-fixed and 1 fresh cadaver (12 males, 12 females). Sixty-one patients and 24 cadavers had no previous abdominal or pelvic surgical history. The anatomy and extension of fasciae related to descending colon, sigmoid colon and rectum, especially the morphology of Toldt fascia, and the continuities of mesocolon and mesorectum were observed carefully. The distribution characteristics of the fasciae and anatomical landmarks during laparoscopic surgery were recorded and described. Results: The anatomical study on 24 cadavers showed that visceral fascia was the densest connective tissue in the pelvic, posterolateral to the rectum, and stretched as a hammock to lift all pelvic organs. Among 61 patients undergoing laparoscopic surgery, 36 (59.0%) needed to free the left colon during operation, and Toldt fascia in the descending colon segment presented as potential, avascular and extensible loose connective tissue plane between the mesocolon and posterior Gerota fascia; 33 (54.1%) needed to free the rectum during operation, and Toldt fascia extended downward to pelvis as loose connective tissue between the fascia propria of the rectum and visceral fascia; the fascia propria of the rectum exposed completely in 32 (32/33, 97.0%) cases, which ran downward and fused with visceral fascia at the level of the fourth sacral vertebra. The anatomy of 24 cadavers also showed that fascia propria of the rectum fused with visceral fascia at the level of Waldeyer fascia. The fusion line of these two fasciae was supposed to be the extension of Waldeyer fascia. There were two avascular planes behind the rectum: one between the fascia propria of the rectum and visceral fascia, and the other between the visceral fascia and parietal fascia. In 8 constipation cases undergoing laparoscopic subtotal colon resection plus modified Duhamel operation, both mesocolon and mesorectum needed to be mobilized. It was obvious that the mesocolon of descending colon extended and became the mesocolon of sigmoid colon, and ran further into the pelvic and became the mesorectum. The colon fascia of descending colon served as the natural boundary of mesocolon extended downward as the fascia of sigmoid colon and the fascia propria of the rectum, respectively. Toldt fascia locating between mesocolon of descending colon and Gerota fascia extended to pelvis as the 'presacral space' between the fascia propria of the rectum and visceral fascia. Gerota fascia in descending colon segment extended as urogenital fascia in sigmoid colon segment and visceral fascia in the pelvis, respectively. In the cadaver anatomy study, the visceral fascia served as a corridor carrying the hypogastric nerve, and ureter was observed in 23 (23/24, 95.8%) cases. The visceral fascia passed from posterior to anterior lateral of rectum, fusing with Denonvilliers fascia in a fan shape. The pelvic plexus located exactly external to the junction of visceral fascia and Denonvilliers fascia. Pelvic splanchnic nerves went through the parietal fascia toward to the inferolateral of the pelvic plexus. Conclusion: Fascia propria of the rectum and the visceral pelvic fascia are two independent layers of fascia, and the TME surgical plane is between the fascia propria of the rectum and visceral pelvic fascia instead of between the visceral and the parietal pelvic fascia.


Assuntos
Fáscia/anatomia & histologia , Mesentério/anatomia & histologia , Pelve/anatomia & histologia , Protectomia/métodos , Neoplasias Retais/cirurgia , Reto/anatomia & histologia , Abdome/anatomia & histologia , Cadáver , Colectomia/métodos , Feminino , Humanos , Laparoscopia , Masculino , Mesocolo/anatomia & histologia , Pessoa de Meia-Idade
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