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1.
Urol Clin North Am ; 48(1): 11-23, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33218585

RESUMO

Radical prostatectomy has undergone many adaptations since its inception, including the Retzius-sparing robotic-assisted radical prostatectomy approach. In this article, we review the origins of radical prostatectomy, the theoretic basis for Retzius-sparing robotic-assisted radical prostatectomy, and outline the key steps of the procedure. To date, there have been 9 studies comparing the outcomes of Retzius-sparing robotic-assisted radical prostatectomy with standard robotic-assisted radical prostatectomy, which have demonstrated improved continence outcomes for Retzius sparing robotic assisted radical prostatectomy within the first year and equivalent oncologic efficacy out to 18 months. Further research is needed to evaluate sexual function outcomes as well as long-term oncologic outcomes.


Assuntos
Prostatectomia/métodos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Fáscia , Fasciotomia , Previsões , História do Século XX , História do Século XXI , Humanos , Masculino , Próstata/cirurgia , Prostatectomia/efeitos adversos , Prostatectomia/história , Prostatectomia/tendências , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/história , Procedimentos Cirúrgicos Robóticos/tendências , Incontinência Urinária/etiologia , Incontinência Urinária/prevenção & controle
2.
J Spec Oper Med ; 20(4): 47-52, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33320312

RESUMO

BACKGROUND: Expedient resuscitation and emergent damage control interventions remain critical tools of modern combat casualty care. Although fortunately rare, the requirement for life and limb salvaging surgical intervention prior to arrival at traditional deployed medical treatment facilities may be required for the care of select casualties. The optimal employment of a surgical resuscitation team (SRT) may afford life and limb salvage in these unique situations. METHODS: Fifteen years of after-action reports (AARs) from a highly specialized SRTs were reviewed. Patient demographics, specific details of encounter, team role, advanced emergent life and limb interventions, and outcomes were analyzed. RESULTS: Data from 317 casualties (312 human, five canines) over 15 years were reviewed. Among human casualties, 20 had no signs of life at intercept, with only one (5%) surviving to reach a Military Treatment Facility (MTF). Among the 292 casualties with signs of life at intercept, SRTs were employed in a variety of roles, including MTF augmentation (48.6%), as a transport capability from other aeromedical platforms, critical care transport (CCT) between MTFs (27.7%), or as an in-flight damage control capability directly to point of injury (POI) (18.2%). In the context of these roles, the SRT performed in-flight life and limb preserving surgery for nine patients. Procedures performed included resuscitative thoracotomy (7/9; 77.8%), damage control laparotomy (1/9; 11.1%) and extremity fasciotomy for acute lower extremity compartment syndrome (1/11; 11%). Survival following in-flight resuscitative thoracotomy was 33% (1/3) when signs of life (SOL) were absent at intercept and 75% (3/4) among patients who lost SOL during transport. CONCLUSION: In-flight surgery by a specifically trained and experienced SRT can salvage life and limb for casualties of major combat injury. Additional research is required to determine optimal SRT utilization in present and future conflicts.


Assuntos
Extremidades/cirurgia , Animais , Cuidados Críticos , Cães , Fasciotomia , Humanos , Medicina Militar , Militares , Ressuscitação , Estudos Retrospectivos
3.
Harefuah ; 159(11): 781-782, 2020 Nov.
Artigo em Hebraico | MEDLINE | ID: mdl-33210845

RESUMO

INTRODUCTION: A 16 years old girl presented with gradual foot pain after running 2 kilometers. Conservative treatment that consisted of rest and high dose of analgesia had no effect. An MRI scan revealed a partial tear of the abductor hallucis muscle with diffuse edema in the compartment. Under general anesthesia compartmental pressure was measured. The involved compartment's pressure was 130 mm/hg while the contralateral foot measured 10 mm/hg. Immediate fasciotomy was performed with instant pain relief. No analgesics were needed following surgery. Compartment syndrome usually develops following trauma. In unusual cases the syndrome can appear due to other causes, such as muscle tear and present with different clinical signs and rates of presentation. Exertional compartment syndrome presents in the pediatric population, but can rarely present in the foot. High clinical suspicion and awareness can help the diagnosis in challenging cases.


Assuntos
Síndromes Compartimentais , Corrida , Adolescente , Criança , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/terapia , Fasciotomia , Feminino , , Humanos , Dor/diagnóstico , Dor/etiologia
4.
Bone Joint J ; 102-B(10): 1354-1358, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32993329

RESUMO

AIMS: In the UK, fasciectomy for Dupuytren's contracture is generally performed under general or regional anaesthetic, with an arm tourniquet and in a hospital setting. We have changed our practice to use local anaesthetic with adrenaline, no arm tourniquet, and perform the surgery in a community setting. We present the outcome of a consecutive series of 30 patients. METHODS: Prospective data were collected for 30 patients undergoing open fasciectomy on 36 digits (six having two digits affected), over a one-year period and under the care of two surgeons. In total, 10 ml to 20 ml volume of 1% lidocaine with 1:100,000 adrenaline was used. A standard postoperative rehabilitation regime was used. Preoperative health scores, goniometer measurements of metacarpophalangeal (MCP), proximal interphalangeal (PIP) contractures, and Unité Rheumatologique des Affections de la Main (URAM) scores were measured pre- and postoperatively at six and 12 weeks. RESULTS: The mean preoperative contractures were 35.3° (0° to 90°) at the metacarpophalangeal joint (MCPJ), 32.5° (0° to 90°) at proximal interphalangeal joint (PIPJ) (a combined deformity of 67.8°). The mean correction was 33.6° (0° to 90°) for the MCPJ and 18.2° (0° to 70°) for the PIPJ leading to a combined correction of 51.8°. There was a complete deformity correction in 21 fingers (59.5%) and partial correction in 14 digits (37.8%) with no correction in one finger. The mean residual deformities for the partial/uncorrected group were MCP 4.2° (0° to 30°), and PIP 26.1° (0° to 85°). For those achieving a full correction the mean preoperative contracture was less particularly at the PIP joint (15.45° (0° to 60°) vs 55.33° (0° to 90°)). Mean preoperative URAM scores were higher in the fully corrected group (17.4 (4 to 31) vs 14.0 (0 to 28)), but lower at three months post-surgery (0.5 (0 to 3) vs 4.40 (0 to 18)), with both groups showing improvements. Infections occurred in two patients (three digits) and both were successfully treated with oral antibiotics. No other complications were noted. The estimated cost of a fasciectomy under local anaesthetic in the community was £184.82 per patient. The estimated hospital theatre costs for a fasciectomy was £1,146.62 under general anaesthetic (GA), and £1,085.30 under an axillary block. CONCLUSION: This study suggests that a fasciectomy performed under local anaesthetic with adrenaline and without an arm tourniquet and in a community setting is safe, and results in favourable outcomes regarding the degree of correction of contracture achieved, functional scores, and short-term complications. Local anaesthetic fasciectomy in a community setting achieves a saving of £961.80 for a GA and £900.48 for an axillary block per case. Cite this article: Bone Joint J 2020;102-B(10):1354-1358.


Assuntos
Anestesia Local/economia , Anestesia Local/métodos , Contratura de Dupuytren/cirurgia , Fasciotomia/economia , Fasciotomia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestésicos Locais/administração & dosagem , Custos e Análise de Custo , Epinefrina/administração & dosagem , Feminino , Humanos , Lidocaína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reino Unido
6.
Am Surg ; 86(8): 1010-1014, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32997952

RESUMO

INTRODUCTION: Failure to perform adequate fasciotomy for a presumed or diagnosed compartment syndrome after revascularization of an acutely ischemic limb is a potential cause of preventable limb loss. When required, outcomes are best when fasciotomy is conducted with the initial vascular repair. Despite over 100 years of experience with fasciotomy, the actual indications for its performance among acute care and trauma surgeons performing vascular repairs are unclear. The hypothesis of this study was that there are many principles of fasciotomy that are uniformly accepted by surgeons and that consensus guidelines could be developed. METHODS: A 20-question survey on fasciotomy practice patterns was distributed to trauma and acute care surgeons of a major surgical society which had approved distribution. RESULTS: The response to the survey was 160/1066 (15 %). 92.5% of respondents were fellowship trained in trauma and acute care surgery, and 74.9% had been in practice for fewer than 10 years. Most respondents (71.9%) stated that they would be influenced to perform a preliminary fasciotomy (fasciotomy conducted prior to planned exploration and arterial repair) based upon specific signs and symptoms consistent with compartment syndrome-including massive swelling (55.6%), elevated compartment pressures (52.5%), delay in transfer >6 hours (47.5%), or obvious distal ischemia (33.1%). 20.6% responded that they would conduct exploration and repair first, regardless of these considerations. Prophylactic fasciotomies (fasciotomy without overt signs of compartment syndrome) would be performed by respondents in the setting of the tense compartment (87.5%), ischemic time >6 hours (88.1%), measurement of elevated compartment pressures (66.9%), and in the setting of large volume resuscitation requirements (31.3%). 69.4% of respondents selectively measure compartment pressures, with nearly three-fourths utilizing a Stryker needle device (72.5%). The most common sequence of repairs following superficial femoral artery injury with a >6-hour limb ischemia was cited as the initial insertion of a shunt, followed by fasciotomy, then vein harvest, and finally interposition repair. CONCLUSIONS: While there is some general consensus on indications for fasciotomy, there is marked heterogeneity in surgeons' opinions on the precise indications in selected scenarios. This is particularly surprising in light of the long history with fasciotomy in association with major arterial repairs and strongly suggests the need for a consensus conference and/or meta-analysis to guide further care.


Assuntos
Artérias/lesões , Síndromes Compartimentais/cirurgia , Fasciotomia/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Cirurgiões/estatística & dados numéricos , Procedimentos Cirúrgicos Vasculares , Lesões do Sistema Vascular/complicações , Artérias/cirurgia , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/prevenção & controle , Fasciotomia/métodos , Humanos , Inquéritos e Questionários , Traumatologia , Estados Unidos , Lesões do Sistema Vascular/cirurgia
7.
Plast Reconstr Surg ; 146(2): 156e-164e, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740578

RESUMO

BACKGROUND: Scarpa fascia preservation during abdominoplasty has been shown to reduce complications associated with the traditional technique. As an extension of a previously published randomized controlled trial, this study aims to clarify whether preservation of Scarpa fascia during abdominoplasty has an influence on scar quality or sensibility recovery. METHODS: This was a single-center clinical trial, involving 160 patients randomly assigned to one of two surgical procedures: classic full abdominoplasty (group A) and abdominoplasty with preservation of Scarpa fascia (group B). Patients were later convoked to assess scar quality and abdominal cutaneous sensibility. Scar quality was evaluated through the Patient and Observer Scar Assessment Scale. Cutaneous sensibility was measured on the upper and lower abdomen, using light touch, Semmes-Weinstein testing (5.07/10-g monofilament), and a 25-gauge needle. RESULTS: A total of 99 patients (group A, 54 patients; group B, 45 patients) responded to contact, with a mean follow-up time of 44 months. Concerning scar quality, Patient and Observer Scar Assessment Scale scores were similar between groups. On the upper abdomen, there was a statistically significant difference between groups on cutaneous sensibility, on the examination with the Semmes-Weinstein 5.07/10-g monofilament (group A, 79.6 percent; group B, 93.3 percent; p = 0.046) and pain (group A, 90.7 percent; group B, 100 percent; p = 0.044). No statistically significant differences were found between groups on the lower abdomen. A considerable proportion of patients (two-thirds) still presented sensibility alterations in the subumbilical area 3½ years after abdominoplasty. CONCLUSION: Scarpa fascia preservation during abdominoplasty does not influence scar quality, but it improves sensibility recovery in the supraumbilical area. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Assuntos
Abdominoplastia/métodos , Cicatriz/diagnóstico , Tratamentos com Preservação do Órgão/métodos , Complicações Pós-Operatórias/diagnóstico , Tato/fisiologia , Parede Abdominal , Abdominoplastia/efeitos adversos , Adulto , Cicatriz/etiologia , Fáscia/inervação , Fasciotomia/efeitos adversos , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Índice de Gravidade de Doença , Pele/inervação , Resultado do Tratamento , Adulto Jovem
8.
Plast Reconstr Surg ; 146(3): 265e-275e, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32842099

RESUMO

BACKGROUND: Total extraperitoneal laparoscopically assisted harvest of the deep inferior epigastric vessels permits a decrease in myofascial dissection in deep inferior epigastric artery perforator flap breast reconstruction. The authors present a reliable technique that further decreases donor-site morbidity in autologous breast reconstruction. METHODS: The authors conducted a retrospective cohort study of female subjects presenting to the senior surgeon (S.K.K.) from March of 2018 to March of 2019 for autologous breast reconstruction after a newly diagnosed breast cancer. The operative technique is summarized as follows: a supraumbilical camera port is placed at the medial edge of the rectus muscle to enter the retrorectus space; the extraperitoneal plane is developed using a balloon dissector and insufflation; two ports are placed through the linea alba below the umbilicus to introduce dissection instruments; the deep inferior epigastric vessels are dissected from the underside of the rectus muscle; muscle branches and the superior epigastric are ligated using a Ligasure; and the deep inferior epigastric pedicle is ligated and the vessels are delivered through a minimal fascial incision. The flap(s) is transferred to the chest for completion of the reconstruction. RESULTS: Thirty-three subjects totaling 57 flaps were included. All flaps were single-perforator deep inferior epigastric artery perforator flaps. Mean fascial incision length was 2.0 cm. Sixty percent of subjects recovered without narcotics. Mean length of stay was 2.5 days. Flap salvage occurred in one subject after venous congestion. Two pedicle transections occurred during harvest that required perforator-to-pedicle anastomosis. CONCLUSION: Total extraperitoneal laparoscopically assisted harvest of the deep inferior epigastric pedicle is a reliable method that decreases the donor-site morbidity of autologous breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Neoplasias da Mama/cirurgia , Laparoscopia , Mamoplastia/métodos , Retalho Perfurante/irrigação sanguínea , Coleta de Tecidos e Órgãos/métodos , Adulto , Estudos de Coortes , Artérias Epigástricas , Fasciotomia , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
9.
Vasc Endovascular Surg ; 54(8): 752-755, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32783501
10.
J Am Acad Orthop Surg ; 28(21): 874-883, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-32796365

RESUMO

With an increasing number of total hip and knee arthroplasties being done at surgical centers and vascular surgeons often not immediately available in this setting, it is critical for orthopaedic surgeons to be comfortable with the acute surgical management of vascular injuries. Although they are fortunately uncommon in primary total hip and knee arthroplasties, damage to a major artery or vein can have potentially devastating consequences. Surgeons operating both in a hospital and an ambulatory surgical setting should be familiar with techniques to gain proximal control of massive bleeding because the principles can be helpful in primary and revision arthroplasties. In this study, we review the vascular anatomy around the hip and knee and the surgical management of these potentially catastrophic complications.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Complicações Intraoperatórias/etiologia , Lacerações/etiologia , Procedimentos Cirúrgicos Vasculares , Lesões do Sistema Vascular/etiologia , Amputação , Fasciotomia , Hemorragia/etiologia , Quadril/irrigação sanguínea , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/patologia , Complicações Intraoperatórias/cirurgia , Joelho/irrigação sanguínea , Lacerações/diagnóstico , Lacerações/patologia , Lacerações/cirurgia , Neuropatias Fibulares/etiologia , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/patologia , Lesões do Sistema Vascular/cirurgia
11.
Am Surg ; 86(8): 981-984, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32779473

RESUMO

INTRODUCTION: Damage control laparotomy (DCL) is a life-saving surgical technique, but the resultant open abdomen (OA) carries serious morbidity/mortality. Many methods are utilized to manage OAs, but discrepancy exists in distinguishing closure from coverage techniques. We observed a difference in our DCL patient outcomes managed with the Wittmann Patch (WP) closure device versus the more popular ABThera (AB) coverage device. We hypothesized that the WP contributed to an improved fascial closure rate of the OAs after DCL. METHODS: A retrospective review of OAs managed with the AB or WP at our Level 1 trauma center was performed using billing codes to capture DCL patients from 2011 to 2019. Patients were divided into AB alone or WP groups. Major endpoints included primary fascial closure (PFC) and delayed fascial closure (DFC, fascial closure after greater than 7 days). RESULTS: 189 patients were identified as AB and 38 as WP. Rates of death before closure, age, gender, and Injury Severity Score were similar in both groups. PFC = 81%-90% for AB versus WP, respectively. Excluding patients with preexisting hernias PFC = 87%-100% for AB versus WP (P < .05) and DFC = 44%-100% for AB versus WP (P ≤ 0.001). WP had a statistically higher rate of PFC and DFC. There was a decreased incidence of complications in the WP versus AB group. CONCLUSIONS: While not well reported in the peer-reviewed literature, the application of the WP for management of the OA is an active form of pursuing PFC when compared with the AB, a coverage device. Our interinstitutional results have demonstrated superior PFC and DFC rates and fewer complications, in patients managed with the WP compared with the AB.


Assuntos
Abdome/cirurgia , Traumatismos Abdominais/cirurgia , Técnicas de Fechamento de Ferimentos Abdominais/instrumentação , Laparotomia , Adulto , Idoso , Fasciotomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Cicatrização
12.
Rev Chilena Infectol ; 37(2): 175-178, 2020 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-32730485

RESUMO

Acute compartment syndrome (ACS) is the increase of pressure in a closed osteofascial space. This reduces capillary perfusion below the level necessary for tissue viability. Injury could be irreversible if proper treatment is not performed. Hand ACS secondary to cutaneous loxoscelism with edematous predominance is extremely infrequent. We present a clinical case of a 22-year-old patient who started a hand compartment syndrome secondary to cutaneous loxoscelism (CL), requiring emergency surgical treatment with dorsal and palmar fasciotomy.


Assuntos
Síndromes Compartimentais , Edema , Fasciotomia , Mãos , Humanos , Adulto Jovem
13.
J Urol ; 204(6): 1341-1348, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32718276

RESUMO

PURPOSE: Surgery is the first line treatment for congenital concealed penis but penile retraction is inevitable in some cases. We investigate the anatomical and histological characteristics of penile fasciae and describe a new technique for the correction of concealed penis. MATERIALS AND METHODS: The anatomical structures of penile fasciae were observed in 10 adult cadaveric penises. Penile tissue samples were stained with hematoxylin-eosin, Masson's trichrome and Weigert's resorcin-fuchsin, respectively. From January 2017 to May 2019, 78 patients with congenital concealed penis were treated with the new surgical technique. Median patient age was 14 years (range 8 to 18). RESULTS: Dartos fascia had sublayers. The superficial layer was a well vascularized tissue composed of nonpolar collagen fibers intermixed with nerves and vessels. The deep layer was composed of a transverse arrangement of collagen fibers and elastic fibers, and there were fewer venules and nerve fibers. Based on this finding we performed anatomical resection of the deep layer of dartos fascia to correct concealed penis. During the operation dartos fascia was separated into 2 layers and a complete circular resection of the deep layer was made at the base of the penis. Mean followup was 14 months. All patients and their parents were satisfied with the outcomes. None of the patients underwent postoperative penile retraction. CONCLUSIONS: The anatomical resection of the deep layer of dartos fascia for correcting concealed penis is technically easy, safe and effective. It provides a good cosmetic appearance and functional outcomes.


Assuntos
Fáscia/patologia , Fasciotomia/métodos , Doenças dos Genitais Masculinos/cirurgia , Pênis/anormalidades , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adolescente , Adulto , Cadáver , Criança , Fasciotomia/efeitos adversos , Estudos de Viabilidade , Seguimentos , Doenças dos Genitais Masculinos/congênito , Doenças dos Genitais Masculinos/patologia , Humanos , Masculino , Pênis/patologia , Pênis/cirurgia , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
14.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(7): 689-694, 2020 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-32683831

RESUMO

Objective: To observe the anatomical architecture of rectosacral fascia and discuss the best plan for accurate peri-rectal dissection in laparoscopic/robotic total mesorectal resection (TME). Methods: A descriptive cohort study was carried out. A total of 127 patients with rectal cancer who underwent TME in the Department of Colorectal Surgery at the affiliated Union hospital of Fujian Medical University were included, patients' demographics with their pathological details and operation videos were collected for analysis. Another 20 high-definition images of post-TME surgical specimens were collected from our digital database. A total of 28 cadaveric models were examined at the Laboratory of Clinical Applied Anatomy, Fujian Medical University, to observe the anatomical details of rectosacral fascia. Results: (1) Anatomical observation showed that the pre-hypogastric fascia attaches to the proper fascia of the mesorectum in a horizontal arc posteriorly, forming the rectosacral fascia. If this fusion couldn't be identified and appropriately transected during posterior space dissection, it would be easy to destroy the proper fascia and dissect through the mesorectum resulting in residual mesorectum tissue. After the fascia transaction, the proper fascia of the mesorectum is still intact distally. The upper part of rectosacral fascia bilaterally re-separated again into the proper fascia and pre-hypogastric fascia. The pre-hypogastric fascia acts as a "fascia barrier" when dissecting the lateral space constantly from posterior to anterior. The right attachment of the rectosacral fascia was gradually transected. The pelvic plexus from the right S2-S4 was covered by the pre-hypogastric fascia which is considered the outer side layer of rectosacral fascia laterally. It was observed that the fascia continued with the anterior layer of the Denonvilliers' fascia, which has been transected during anterior space dissection. The proper fascia, which is the inner side layer of rectosacral fascia laterally, was still intact. The edge of the right rectosacral fascia attachment ran obliquely from the back and upward into the front direction. The left extension was similar to the right. (2) Cadaveric specimens: at the level of the lower edge of S4 vertebral body, the pre-hypogastric fascia fused with the proper fascia to form the rectosacral fascia. The right attachment margin of the rectosacral fascia was cut off step by step. The attachment margin of the rectosacral fascia went from the back and upward to the front downward direction. The right edge of rectosacral fascia attachment continued with the anterior layer of the Denonvilliers' fascia at the pre-rectal space and attached to the pre-hypogastric fascia laterally. The pelvic plexus sends out many tiny rectal branches on the anterolateral side, which pass through the transitional area between pre-hypogastric fascia and the anterior layer of the Denonvilliers' fascia to innervate the rectum. (3) TME specimens observation: the posterior attachment of rectosacral fascia was curved around the mesorectum with bilateral oblique attachments. The mesorectum was covered by fusion fascia below the posterior and bilateral attachment margin while it was covered only by the proper fascia above it. Conclusion: according to the morphological characteristics of rectosacral fascia, the rectosacral fascia should be dissected at the level of S4 vertebral body posterior to the rectum in an arc, shape and then enter the superior-levator space. Before dissecting the bilateral spaces, the anterior space of the rectum should be dissected first. The anterior layer of the Denonvilliers' fascia should be cut off into an inverted "U" shape, and then the lateral space should be dissected from anterior to posterior. Finally, the lateral attachment of rectosacral fascia was transected to ensure the integrity of the mesorectum without damaging the pelvic plexus branches and NVB.


Assuntos
Fáscia/anatomia & histologia , Fasciotomia/métodos , Mesentério/cirurgia , Protectomia/métodos , Neoplasias Retais/cirurgia , Cadáver , Estudos de Coortes , Dissecação , Humanos , Laparoscopia , Mesentério/anatomia & histologia , Reto/anatomia & histologia , Reto/cirurgia , Procedimentos Cirúrgicos Robóticos , Sacro
15.
Medicine (Baltimore) ; 99(23): e20504, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32501996

RESUMO

RATIONALE: Acute compartment syndrome (ACS) is a feared complication following traumatic injuries. We describe the occurrence of silent ACS of the hand in a 2-year old patient with atypical symptoms. PATIENT CONCERNS: Our patient experienced massive swelling but minimal pain of the hand after a heavy bistro table with a stone tabletop had fallen on the right hand. DIAGNOSIS: After monitoring the development of ACS for 1 night, we noted increased firmness of the swelling and impaired perfusion of the skin covering the palm and dorsum of the hand. Notably, the patient held the hand in an intrinsic minus position but did not complain of pain after administration of only a single (weight-matched) dose of ibuprofen. Our suspicion of ACS was confirmed intraoperatively because of the elevated intramuscular pressure (up to 60 mm Hg) in several hand compartments. INTERVENTIONS: We performed surgical fasciotomy of all hand compartments, followed by temporary coverage of the wounds with Epigard synthetic skin substitute. The wounds were closed stepwise after 2 and 7 days, and occupational therapy was initiated after 3 weeks. OUTCOMES: At the 1-year follow-up, we noted unrestricted wrist and finger functions of the patient. The parents reported that there was no difference in the use of the 2 hands during daily activities. LESSONS: The possible development of ACS should be borne in mind even in the absence of marked pain. Although the 3 A's (i.e., anxiety, agitation, and increased analgesic requirements) in the diagnosis of ACS in children are well established, some patients may experience only minimal pain. This challenges the correct and timely diagnosis of ACS in children, particularly if they are very young.


Assuntos
Síndromes Compartimentais/etiologia , Lesões por Esmagamento/complicações , Pré-Escolar , Síndromes Compartimentais/cirurgia , Fasciotomia/métodos , Feminino , Mãos/cirurgia , Traumatismos da Mão/complicações , Traumatismos da Mão/cirurgia , Humanos , Pediatria/métodos , Suíça
16.
Orthop Clin North Am ; 51(3): 369-372, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32498955

RESUMO

Percutaneous fasciotomy is a safe, simple, and inexpensive treatment for mild to moderate Dupuytren contracture. The decrease in extension deficit in the metacarpophalangeal and proximal interphalangeal joints after release correlates with improvement in patient-reported outcomes. Complications are rare and primarily include skin tears, which occur in approximately 4% of patients. Most patients are satisfied with the outcomes of the procedure at 1 year.


Assuntos
Contratura de Dupuytren/cirurgia , Fasciotomia/métodos , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Resultado do Tratamento
17.
J Ayub Med Coll Abbottabad ; 32(2): 263-265, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584006

RESUMO

BACKGROUND: UThe aim of this study is to share our experience regarding outcome of embolectomy in the patients presenting late with acute limb ischemia. It was a cross sectional descriptive study, conducted at CMH Rawalpindi from January 2016 to December 2017. METHODS: All those patients having non-traumatic acute limb ischemia presenting between 6 to 72 hours of the onset of symptoms with viable affected limb were included. Their data was analysed for demography, involved limb, time of embolectomy, fasciotomy, re embolectomy, amputations, reperfusion injuries and death. The patients presenting later than 72 hours, irreversible Ischemia and limb ischemia secondary to trauma or graft occlusion of previous Bypass surgery were excluded from the study.. RESULTS: A total of 49 (36 males and 13 females) patients were included in the study. Thirty-three (67.3%) patients underwent embolectomy for lower while 16 (32.6%) for upper limb ischemia. Ten (20.4%) patients had fasciotomy while 7 (14.2%) patients underwent re embolectomy. In 5 (10.2%) patients vascular bypass had to be done. Seven (14.2%) patients underwent minor amputations while 5 (10.2%) had major limb amputations. Two (4%) patients died of reperfusion injury. Overall 42 (85.7%) limbs were salvaged. CONCLUSIONS: Embolectomy is effective in late presenting acute limb ischemia with viable extremity and should be offered to these patients.


Assuntos
Embolectomia , Isquemia/cirurgia , Estudos Transversais , Fasciotomia , Feminino , Humanos , Masculino , Resultado do Tratamento , Extremidade Superior/cirurgia
18.
Wilderness Environ Med ; 31(3): 317-323, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32456876

RESUMO

Snakebites are a neglected and underestimated global health hazard. In the Brazilian Amazon, Bothrops snakebites are the most prevalent and may lead to severe complications. Here we describe a severe case of Bothrops atrox snakebite that, owing to delayed medical assistance, presented with renal and respiratory failure, compartment syndrome, and tissue necrosis. After several fasciotomy surgeries, the patient survived; however, he showed significant functional disability. Prompt management of snake envenomation would aid in the early diagnosis of local and systemic complications and, consequently, would result in a better functional outcome with improved quality of life.


Assuntos
Bothrops , Síndromes Compartimentais/fisiopatologia , Necrose/patologia , Qualidade de Vida , Mordeduras de Serpentes/complicações , Adulto , Animais , Brasil , Síndromes Compartimentais/etiologia , Cuidados Críticos , Fasciotomia , Humanos , Masculino , Necrose/etiologia , Necrose/cirurgia , Transplante de Tecidos
19.
Clin Sports Med ; 39(3): 589-596, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32446577

RESUMO

When more obvious and common causes of elbow pathology are ruled out, it is important to be aware of uncommon causes of elbow pain in throwers. The Lacertus syndrome can be a debilitating problem when overlooked; however, it can be easily diagnosed with a careful history and physical examination. If the description suggests a postexertional compartment-like problem, consider having the patient throw before the examination, and the diagnosis becomes easier to either confirm or rule out. Once the diagnosis is established treatment includes rest or fasciotomy. Recovery is uncomplicated and athletes can return to throwing within a month.


Assuntos
Artralgia/etiologia , Traumatismos em Atletas/diagnóstico , Traumatismos em Atletas/terapia , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/terapia , Cotovelo/lesões , Traumatismos em Atletas/cirurgia , Síndromes Compartimentais/cirurgia , Fasciotomia , Humanos , Exame Físico , Descanso , Volta ao Esporte
20.
Plast Reconstr Surg ; 145(6): 1464-1474, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32459776

RESUMO

BACKGROUND: This study compared the effectiveness of injectable collagenase clostridium histolyticum and percutaneous needle fasciotomy in the treatment of Dupuytren's contracture. METHODS: Patients with a total passive extension deficit of 30 degrees or more in a single digital ray were enrolled and assigned randomly to receive either collagenase clostridium histolyticum injections or percutaneous needle fasciotomy. Preoperative severity of proximal interphalangeal joint contracture for Dupuytren's disease was classified according to the British Society for Surgery of the Hand as less than 30 degrees (stage I) or 30 degrees or more (stage II). RESULTS: Of the 70 patients enrolled, 36 patients with 46 joints received collagenase clostridium histolyticum injections and 34 patients with 48 joints received percutaneous needle fasciotomy. At day 30, successful corrections were obtained in only 50 percent of the injection group and 67 percent of the fasciotomy group for stage II proximal interphalangeal joints. Recurrences were frequent among patients with stage II joint contractures. The mean Quick Disabilities of the Arm, Shoulder and Hand questionnaire score at day 30 was significantly higher in the injection group compared with the fasciotomy group (7.5 versus 4.2, respectively). In the injection group, adverse events were reported for all patients. In the fasciotomy group, complications were reported for 15 percent of patients. CONCLUSIONS: The collagenase clostridium histolyticum and percutaneous needle fasciotomy groups had similar outcomes for Dupuytren's contracture with 3 years' follow-up. Recurrences were frequent among patients with stage II proximal interphalangeal joint contractures. The Unité Rhumatologique des Affections de la Main scale and Quick Disabilities of the Arm, Shoulder and Hand questionnaire score decreased significantly for both groups at final follow-up. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Assuntos
Contratura de Dupuytren/terapia , Fasciotomia/instrumentação , Colagenase Microbiana/administração & dosagem , Complicações Pós-Operatórias/epidemiologia , Idoso , Contratura de Dupuytren/fisiopatologia , Fasciotomia/efeitos adversos , Feminino , Articulações dos Dedos/fisiopatologia , Seguimentos , Mãos , Humanos , Injeções Intralesionais/efeitos adversos , Masculino , Colagenase Microbiana/efeitos adversos , Agulhas , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Amplitude de Movimento Articular , Recidiva , Resultado do Tratamento
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