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1.
J Hand Surg Am ; 45(9): 869-875, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32888437

RESUMO

The case spectrum in hand surgery is one of extremes-purely elective day surgery cases under local anesthesia to mangling limb injuries that require immediate, and frequently, lengthy, surgery. Despite the cancellation of most elective orthopedic and plastic surgical procedures, hand surgeons around the world continue to see a steady stream of limb-threatening cases such as severe trauma and infections that require emergent surgical care. With the increase in community-spread, an increasing number of COVID-19-infected patients may be asymptomatic or have mild, nonspecific or atypical symptoms. Some of them may already have an ongoing, severe infection. The time-sensitive nature of some of these cases means that hand surgeons may need to operate urgently on patients who may be suspected of COVID-19 infections, often before confirmatory test results are available. General guidelines for perioperative care of the COVID-19-positive patient have been published. However, our practices differ from those of general orthopedic and plastic surgery, primarily because of the focus on trauma. This article discusses the perioperative and technical considerations that are essential to manage the COVID-19 patient requiring emergency care, without compromising clinical outcomes and while ensuring the safety of the attending staff.


Assuntos
Amputação Traumática/cirurgia , Betacoronavirus , Infecções por Coronavirus , Traumatismos dos Dedos/cirurgia , Microcirurgia/métodos , Pandemias , Pneumonia Viral , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Tratamento de Emergência , Humanos , Masculino
2.
Medicine (Baltimore) ; 99(36): e22029, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899058

RESUMO

This study aims to describe the role of open surgical treatment for focal brainstem gliomas (FBSGs) with the assistance of multimodal neuronavigation and intraoperative neurophysiological monitoring (IOM) in children to investigate the efficacy of microsurgical treatment in pediatric FBSGs. Also the prognostic factors related to the overall survival (OS) of FBSGs to describe the patient and tumor characteristics relevant to prognosis/outcome were focused on. Clinical data of 63 pediatric patients below 16 years of age with FBSGs admitted to the Neurosurgical Unit of Beijing Tiantan Hospital from January 2012 to December 2018 were retrospectively analyzed. All patients underwent initial surgical treatment, followed by magnetic resonance diffusion tensor imaging (DTI), neuronavigation and IOM. Gross or near total resection (GTR or NTR) was achieved in 57/63 (90.5%) cases, and subtotal resection (STR) was achieved in 6/63 (9.5%) cases. Postoperative adjuvant therapy was received by 27/63 (42.9%) cases. Postoperative pathological examination revealed that 36/63 (57.1%) cases had grade I gliomas, 22/63 (34.9%) had grade II, and 5/63 (8.0%) had grade III-IV gliomas according to the WHO classification. The mean Karnofsky score preoperatively was 60, and at the time of follow-up was 90. Consecutively, 6 cases demonstrated disease progression, and 5 of these were deceased. The OS in all patients was 81.2% at 5 years. Histological grade (P < .001) and age at diagnosis (P = .023) showed significant association with prolonged OS. Multimodal neuronavigation and IOM allow very precise intracranial surgery, contributing to a maximally safe resection that might decrease the postoperative disability and mortality rate. This study also showed that pediatric FBSGs were mostly low-grade tumors with excellent surgical outcomes. Consequently, it is suggested that microsurgery can be used to treat FBSGs in children in order to provide better prognosis and survival outcomes.


Assuntos
Neoplasias do Tronco Encefálico/patologia , Glioma/cirurgia , Monitorização Neurofisiológica Intraoperatória/métodos , Neuronavegação/métodos , Adolescente , Quimioterapia Adjuvante , Criança , Pré-Escolar , China/epidemiologia , Imagem de Tensor de Difusão/métodos , Progressão da Doença , Feminino , Glioma/diagnóstico por imagem , Humanos , Lactente , Avaliação de Estado de Karnofsky , Masculino , Microcirurgia/métodos , Gradação de Tumores , Cuidados Pós-Operatórios , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida
3.
Plast Reconstr Surg ; 146(2): 196e-204e, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740595

RESUMO

BACKGROUND: Phalloplasty often requires free tissue transfer. There is ample literature describing flap-related outcomes, but the microsurgical technique used, including choice of recipient vessels, has been an overlooked yet important topic. In this study, the authors review the outcomes of their experience with the deep inferior epigastric artery and locoregional veins and outline technical modifications that occurred during the study period. METHODS: A retrospective chart analysis of patients who underwent microsurgical phalloplasty between September of 2016 and July of 2019 was performed. Variables included flap design, donor site, and recipient vessels. The outcome measures were return to the operating room for flap compromise and partial or complete flap loss. RESULTS: Forty-two phalloplasties using the deep inferior epigastric artery were identified. There were six take-backs for flap compromise, and four patients required venous revision, one of whom lost his urethral flap on postoperative day 9. There was a decrease in take-back rate from 30 percent in the first 20 patients to 0 percent in the second 22 patients in the study period. A total of 11.9 percent of patients had partial flap loss. This decreased from 15 percent to 9 percent in the two groups. CONCLUSION: After an initial learning curve, the combination of deep inferior epigastric artery, deep inferior epigastric vein, and great saphenous vein combined with specific technical modifications such as targeted coagulation of the vasa nervorum of the clitoral nerve has proven to be a reliable technique. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Microcirurgia/métodos , Pênis/cirurgia , Retalho Perfurante/transplante , Complicações Pós-Operatórias/prevenção & controle , Cirurgia de Readequação Sexual/métodos , Adulto , Artérias Epigástricas/transplante , Feminino , Disforia de Gênero/cirurgia , Humanos , Masculino , Pênis/irrigação sanguínea , Retalho Perfurante/irrigação sanguínea , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Pessoas Transgênero , Veias/transplante
4.
Plast Reconstr Surg ; 146(2): 227-237, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740566

RESUMO

BACKGROUND: Preoperative planning of microsurgical perforator free flaps continues to be a discussion topic among microsurgeons. The purpose of this study was to compare the ability of three methods of preoperative vascular mapping-hand-held Doppler imaging, color Doppler ultrasonography, and computed tomographic angiography-to detect perforators and their concordance with surgical findings. METHODS: A prospective study was performed to evaluate the sensitivity, specificity, and accuracy of hand-held Doppler imaging, color Doppler ultrasonography, and computed tomographic angiography to detect free flap perforators. Each patient undergoing a free flap reconstruction was studied preoperatively with the three methods, and the results were compared to the intraoperative findings. RESULTS: Fifty-three patients undergoing autologous tissue reconstruction were included. Most reconstructions (71.7 percent) were performed with anterolateral thigh flaps. The positive predictive value (color Doppler ultrasonography, 100 percent; computed tomographic angiography, 100 percent; hand-held Doppler imaging, 88.6 percent) and negative predictive value (color Doppler ultrasonography, 100 percent; computed tomographic angiography, 94.3 percent; hand-held Doppler imaging, 90.5 percent) rates were significantly different between methods. The high resolution of the color Doppler ultrasonography probe provided a direct vision of the vasculature arborization and efficiently detected vessels with diameters of less than 0.5 mm. The sensitivity, specificity, and accuracy of color Doppler ultrasonography were greater than those of both computed tomographic angiography and hand-held Doppler imaging. There was 100 percent concordance between color Doppler ultrasonography perforators and the surgical findings. CONCLUSIONS: Color Doppler ultrasonography provides a reproducible, harmless, and accurate way to visualize vascular anatomy. It has a high correlation with the surgical findings, signifying advantages over hand-held Doppler and computed tomographic angiography in sensitivity, specificity, and accuracy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, II.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Computadores de Mão , Retalho Perfurante/irrigação sanguínea , Procedimentos Cirúrgicos Reconstrutivos/métodos , Ultrassonografia Doppler em Cores/métodos , Doenças Vasculares/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes , Resultado do Tratamento , Doenças Vasculares/diagnóstico
5.
Plast Reconstr Surg ; 146(2): 137e-146e, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740570

RESUMO

BACKGROUND: Abdominally based free tissue transfer (FTT) and latissimus dorsi and immediate fat transfer (LIFT) procedures are both fully autologous options for breast reconstruction. The former is specialized and requires comfort with microsurgical technique, whereas LIFT combines a common set of techniques familiar to all plastic surgeons. Comparing the two methods for clinical effectiveness and complications for equivalency in outcomes may help elucidate and enhance patient decision-making. METHODS: A retrospective review of a prospectively maintained database between March of 2017 and July of 2018 was performed to compare the LIFTs and FTTs performed by the senior surgeon. Outcomes of interest included postoperative complications, flap success, and follow-up revision and fat-grafting procedures. RESULTS: Sixty-five breasts were reconstructed by FTT; and 31 breasts were reconstructed with LIFT. Demographics were similar (p > 0.05). LIFT had a shorter length of operation time (343 ± 128 minutes versus 49 ± 137 minutes) (p < 0.0001) and a shorter length of stay (1.65 ± 0.85 days versus 3.83 ± 1.65 days) (p < 0.001). FTTs had a shorter time until drain removal (13.3 ± 4.3 days versus 24.0 ± 11.2 days) (p < 0.0001). The number of major (requiring operation) and minor complications were not statistically different (i.e., FTTs, 20.0 percent major and 27.7 percent minor; LIFT, 12.9 percent major and 19.35 percent minor) (p > 0.05). The need for revisions (FTTs, 0.80 ± 0.71; LIFT, 0.87 ± 0.71) and fat grafting (FTTs, 41.54 percent; LIFT, 58.8 percent) was not statistically different (p > 0.05). CONCLUSIONS: Both the LIFT and abdominally based FTT have similar outcomes and complication rates. However, LIFT may be preferred in patients who require shorter operation times. The LIFT may be the fully autologous breast reconstruction of choice for nonmicrosurgeons. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Gordura Abdominal/transplante , Neoplasias da Mama/cirurgia , Mama/cirurgia , Retalhos de Tecido Biológico , Mamoplastia/métodos , Microcirurgia/métodos , Músculos Superficiais do Dorso/transplante , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
6.
J Vis Exp ; (160)2020 06 26.
Artigo em Inglês | MEDLINE | ID: mdl-32658198

RESUMO

Murine cardiac transplantation has been performed for more than 40 years. With advancements in microsurgery, certain new techniques have been used to improve surgical efficiency. In our lab, we have optimized the cuff technique with two major steps. First, we used the inner tube technique to insert a temporary inner tube into the external jugular vein and carotid artery blood vessel to facilitate eversion of the vessel over the cuff. Second, we performed complete heterotopic cardiac transplantation through the collaboration of two experienced surgeons. These modifications effectively reduced the operation time to 25 minutes, with a success rate of 95%. In this report, we describe these procedures in detail and provide a supplemental video. We believe that this report on the improved cuff technique will offer practical guidance for murine heterotopic heart transplantation and will enhance the utility of this mouse model for basic research.


Assuntos
Transplante de Coração/métodos , Microcirurgia/métodos , Animais , Modelos Animais de Doenças , Camundongos
7.
Orv Hetil ; 161(30): 1260-1265, 2020 07.
Artigo em Húngaro | MEDLINE | ID: mdl-32653869

RESUMO

Surgical guides and three-dimensional (3D) planning softwares used in everyday dental implantology open new possibilities in other fields of dentistry. While using the operation microscope in endodontic microsurgery provides more precise apicectomy, there is still no consent on the exact localisation and size of the bony window to be prepared for this surgery. Our aim is to describe a new, guided endodontic microsurgery method when osteotomy and apicectomy are planned in a 3D software and performed with a trephine bur. Based on data from Cone Beam Computed Tomography, planning of the surgical guide was performed with a 3D planning software (Smart Guide, dicomLAB, Hungary) in order to define the size of the bony window, the angulation and the depth of the trephine bur during the apicectomy. After preparing a mucoperiosteal flap, with the help of the dentally supported surgical guide, the trephine bur removes the cortical bone and the apex of the root simultaniously. Following the modern microsurgical protocol, after performing the ultrasonic retrograde preparation, mineral trioxide aggregate (ProRoot MTA; Dentsply Maillefer, Ballaigues, Switzerland) is placed as a retrograde filling to close the resected area. After the uneventful healing period, a complete bony regeneration can be seen on the 1-year follow up X-ray. The patient is symptom-free. This technique is considered to be faster and more precise than the non-guided endodontic microsurgery carried out without the utilization of a trephine bur. Orv Hetil. 2020; 161(30): 1260-1265.


Assuntos
Apicectomia/métodos , Tomografia Computadorizada de Feixe Cônico/métodos , Cavidade Pulpar/cirurgia , Endodontia/métodos , Microcirurgia/métodos , Osteotomia/métodos , Impressão Tridimensional , Materiais Restauradores do Canal Radicular , Tratamento do Canal Radicular/métodos , Compostos de Alumínio , Compostos de Cálcio , Cavidade Pulpar/diagnóstico por imagem , Combinação de Medicamentos , Humanos , Hungria , Óxidos , Radiografia Dentária , Silicatos , Dente , Resultado do Tratamento , Procedimentos Cirúrgicos Ultrassônicos
9.
J Fr Ophtalmol ; 43(8): 753-760, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32620412

RESUMO

PURPOSE: The objective of this study is to evaluate the preoperative and short- and long-term postoperative results in terms of visual acuity, refractive error, and corneal wavefront aberrations in patients with myopia and myopic astigmatism undergoing small incision lenticule extraction (SMILE). METHODS: Seventy-nine eyes of 52 myopes with or without astigmatism (41 right and 38 left) were enrolled in this retrospective study. The measurements included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical equivalent (SE) and wavefront aberrations. All the measurements before and after SMILE surgery were systematically recorded. RESULTS: Mean preoperative UDVA was 1.19±0.24 logMAR and improved to 0.06±0.17 logMAR at the 3-year postoperative follow-up. At the conclusion of the 3-year follow-up, UDVA was better than or equal to 20/20 and 20/25 in 73% and 84% of eyes, respectively. At 1 month postoperatively, CDVA was 0.05±0.23 logMAR and significantly lower than the preoperative CDVA, 0.02±0.04 log MAR (P>0.05). However, at 1 year and 3 years after surgery, CDVA showed a significant increase compared to preoperative CDVA. At the conclusion of the 3-year follow-up, SE was -0.47 D, and 69.6% and 83.5% of the eyes were within±0.50 D and±1.00 D, respectively, of the intended correction. HOA's, coma, and spherical aberration increased significantly. No significant change in trefoil was detected. CONCLUSION: This study showed that SMILE produces a stable, safe outcome for surgical treatment of myopia and myopic astigmatism.


Assuntos
Astigmatismo/cirurgia , Cirurgia da Córnea a Laser/efeitos adversos , Microcirurgia/efeitos adversos , Miopia/cirurgia , Adulto , Astigmatismo/complicações , Astigmatismo/epidemiologia , Astigmatismo/patologia , Córnea/patologia , Córnea/cirurgia , Cirurgia da Córnea a Laser/métodos , Topografia da Córnea , Aberrações de Frente de Onda da Córnea/epidemiologia , Aberrações de Frente de Onda da Córnea/etiologia , Feminino , Humanos , Lasers de Excimer/efeitos adversos , Masculino , Microcirurgia/métodos , Microcirurgia/estatística & dados numéricos , Pessoa de Meia-Idade , Miopia/complicações , Miopia/epidemiologia , Miopia/patologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Refração Ocular/fisiologia , Erros de Refração/epidemiologia , Erros de Refração/etiologia , Estudos Retrospectivos , Ferida Cirúrgica/patologia , Centros de Atenção Terciária/estatística & dados numéricos , Fatores de Tempo , Resultado do Tratamento , Acuidade Visual/fisiologia , Adulto Jovem
10.
Medicine (Baltimore) ; 99(25): e20747, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569218

RESUMO

RATIONALE: Optic Schwannoma is rarely observed clinically as optic nerve had anatomically impossibility for the location of Schwannoma. However, several reports described the established cases of optic Schwannoma, of which the locations were in orbit or within optic canal. The occurrence of optic Schwannoma intracranially has been not reported. PATIENT CONCERNS: A 60-year-old female complained of visual impairment in the right eye and the frequent headache and the dizziness over 2 years with unknown reasons. The result of magnetic resonance imaging (MRI) showed a round, well-circumscribed, heterogeneously enhancing signal with cystic change displayed on the right suprasellar cistern. DIAGNOSES: Intracranial optic Schwannomas. INTERVENTIONS: The patient accepted microneurosurgery assisted by endoscopy. We observed a gray and yellow lesion located near the right anterior clinoid process with a mid-sized cyst. And there was a vague boundary between the tumor and the right optic nerve which was compressed by the tumor. Optic chiasm and left optic nerve were also compressed. Meanwhile, the tumor had also adhesion to the right anterior cerebral artery (ACA). OUTCOMES: After the tumor was totally resected, the patient had satisfactory recovery. LESSONS: We reported an intracranial optic Schwannoma removal with the lateral supraorbital keyhole approach assisted by neuroendoscopy. Intracranial optic Schwannoma was rarely seen clinically. Neuroendoscopy imaging suggested the close relationship between the tumor and ACA, supporting vasculature-origin hypothesis for the optic Schwannoma.


Assuntos
Microcirurgia/métodos , Neurilemoma/cirurgia , Neuroendoscopia/métodos , Neoplasias do Nervo Óptico/cirurgia , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neurilemoma/diagnóstico por imagem , Nervo Óptico/diagnóstico por imagem , Nervo Óptico/cirurgia , Neoplasias do Nervo Óptico/diagnóstico por imagem
11.
J Hand Surg Am ; 45(6): 536-541, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-141759

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic is rapidly evolving. Tan Tock Seng Hospital and the National Centre for Infectious Disease see the majority of confirmed and suspected cases in Singapore. This article describes the impact of COVID-19 on the practice of hand and reconstructive microsurgery (HRM) in our institution. It details our department's response as the situation escalated and the impact on the HRM elective and emergency workload, including the use of personal protective equipment on the surgical practice of HRM, as well as the effects of the condition on social and academic life.


Assuntos
Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Mãos/cirurgia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Betacoronavirus , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/prevenção & controle , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Masculino , Microcirurgia/métodos , Microcirurgia/estatística & dados numéricos , Pandemias/prevenção & controle , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Medição de Risco , Singapura , Resultado do Tratamento
13.
Nat Protoc ; 15(6): 1992-2023, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32405052

RESUMO

Cranial microsurgery is an essential procedure for accessing the brain through the skull that can be used to introduce neural probes that measure and manipulate neural activity. Neuroscientists have typically used tools such as high-speed drills adapted from dentistry to perform these procedures. As the number of technologies available for neuroscientists has increased, the corresponding cranial microsurgery procedures to deploy them have become more complex. Using a robotic tool that automatically performs these procedures could standardize cranial microsurgeries across neuroscience laboratories and democratize the more challenging procedures. We have recently engineered a robotic surgery platform that utilizes principles of computer numerical control (CNC) machining to perform a wide variety of automated cranial procedures. Here, we describe how to adapt, configure and use an inexpensive desktop CNC mill equipped with a custom-built surface profiler for performing CNC-guided microsurgery on mice. Detailed instructions are provided to utilize this 'Craniobot' for performing circular craniotomies for coverslip implantation, large craniotomies for implanting transparent polymer skulls for cortex-wide imaging access and skull thinning for intact skull imaging. The Craniobot can be set up in <2 weeks using parts that cost <$1,500, and we anticipate that the Craniobot could be easily adapted for use in other small animals.


Assuntos
Craniotomia/instrumentação , Microcirurgia/instrumentação , Procedimentos Cirúrgicos Robóticos/instrumentação , Crânio/cirurgia , Animais , Craniotomia/métodos , Desenho de Equipamento , Feminino , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Microcirurgia/métodos , Procedimentos Cirúrgicos Robóticos/métodos
14.
World Neurosurg ; 139: e585-e591, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32371074

RESUMO

BACKGROUND: Vestibular schwannoma (VS) is a benign, usually slow-growing tumor. The drawback of radical microsurgical VS resection is the increased likelihood of neurologic injury, forcing surgeons to leave a tumor remnant in some cases. We evaluated the prognostic value of magnetic resonance imaging (MRI) enhancement patterns to determine the risk of tumor regrowth. METHODS: This clinical study included 30 patients (20 women and 10 men) with VS who underwent surgery via a retrosigmoid transmeatal approach. The extent of resection was assessed by MRI 6 months after surgery. Two subtypes of intracanalicular linear enhancement were defined: linear enhancement of the walls of the internal auditory canal (IAC) or in the cerebellopontine angle (CPA) and linear enhancement covering the end of the IAC. All patients included in the study underwent follow-up MRI every year for at least 6 years. RESULTS: Intracanalicular nodular enhancement suggestive of a tumor remnant was seen in the IAC in 11 patients (36.7%). Volume of nodular enhancements was <0.5 cm3 when measurable. The enhancement remained stable throughout follow-up except in 2 cases that showed a slight decrease in size and in 1 case with an initial tumor remnant of 0.5 cm3 showing a slight increase over the years. Eighteen patients (60%) had linear enhancement in the IAC or in the CPA. No patients with linear enhancement showed nodular enhancement. CONCLUSIONS: Although specific monitoring protocols can be designed based on MRI findings 6 months after microsurgical VS resection, follow-up should be maintained indefinitely given the slight possibility of very late regrowth.


Assuntos
Imagem por Ressonância Magnética/métodos , Microcirurgia/métodos , Neuroma Acústico/diagnóstico por imagem , Neuroma Acústico/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adulto , Idoso , Meios de Contraste , Orelha Interna/cirurgia , Feminino , Gadolínio , Humanos , Aumento da Imagem , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Resultado do Tratamento , Adulto Jovem
15.
J Hand Surg Am ; 45(6): 536-541, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32387156

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic is rapidly evolving. Tan Tock Seng Hospital and the National Centre for Infectious Disease see the majority of confirmed and suspected cases in Singapore. This article describes the impact of COVID-19 on the practice of hand and reconstructive microsurgery (HRM) in our institution. It details our department's response as the situation escalated and the impact on the HRM elective and emergency workload, including the use of personal protective equipment on the surgical practice of HRM, as well as the effects of the condition on social and academic life.


Assuntos
Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Mãos/cirurgia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Betacoronavirus , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/prevenção & controle , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Masculino , Microcirurgia/métodos , Microcirurgia/estatística & dados numéricos , Pandemias/prevenção & controle , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Medição de Risco , Singapura , Resultado do Tratamento
16.
Acta Chir Plast ; 61(1-4): 16-23, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32380838

RESUMO

Microvascular free flap reconstruction is a routine option for coverage of a variety of tissue defects. Accurate monitoring in the postoperative period is a crucial part of successful flap surgery allowing early detection of vascular compromise and prompt intervention in flap salvaging. Despite that many safety procedures to assess flap viability have been developed, flap failure is consistently seen in 2-5% of free tissue transfers. In addition, great progress is being made in relation to various state-of-the-art technologies for flap monitoring. However, the gold standard still remains clinical monitoring at most institutions even though there is no standardized management protocol. The review should present a prospective optimal monitoring protocol and introduce some of the latest monitoring devices based on the recent literature and personal experience.


Assuntos
Retalhos de Tecido Biológico , Procedimentos Cirúrgicos Reconstrutivos/métodos , Protocolos Clínicos , Sobrevivência de Enxerto , Humanos , Microcirurgia/efeitos adversos , Microcirurgia/métodos , Monitorização Fisiológica , Estudos Prospectivos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos
17.
World Neurosurg ; 140: 283-287, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32454194

RESUMO

BACKGROUND: We report a technique for the sphenoid ridge keyhole approach using the Lone Star (LS) retractor system as an extracranial tissue retractor in microsurgical clipping of unruptured middle cerebral artery aneurysms. METHODS: The LS retractor system is used as the extracranial tissue retractor. A skin incision (50-60 mm) without shaving is made. The temporal fascia is cut, and skin and fascia flap are reflected anteriorly. On the temporal muscle, keyhole craniotomy is registered using the navigation system such that the lateral edge of the sphenoid ridge is the center of the craniotomy. After the temporal muscle is split in the direction of the muscle fiber, keyhole craniotomy of approximately 30 mm in diameter is created. After dural incision, the Sylvian fissure is dissected by a standard microsurgical technique using brain retractors, and the target aneurysm is clipped. RESULTS: By precise registration of the sphenoid ridge keyhole craniotomy, the Sylvian fissure emerged in the center of the keyhole. Using the LS retractor system, a flat and shallow operative field was obtained. There were no complications using this method. CONCLUSIONS: We optimized the craniotomy, manipulating the target aneurysm in the center of the keyhole. It did not interfere with conventional microsurgical techniques.


Assuntos
Craniotomia/métodos , Aneurisma Intracraniano/cirurgia , Microcirurgia/métodos , Osso Esfenoide/cirurgia , Humanos , Instrumentos Cirúrgicos
19.
Head Neck ; 42(6): 1168-1172, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-116896

RESUMO

BACKGROUND: The SARS-CoV-2 (COVID-19) pandemic has caused rapid changes in head and neck cancer (HNC) care. "Real-time" methods to monitor practice patterns can optimize provider safety and patient care. METHODS: Head and neck surgeons from 14 institutions in the United States regularly contributed their practice patterns to a shared spreadsheet. Data from 27 March 2020 to 5 April 2020 was analyzed. RESULTS: All institutions had significantly restricted HNC clinic evaluations. Two institutions stopped free-flap surgery with the remaining scheduling surgery by committee review. Factors contributing to reduced clinical volume included lack of personal protective equipment (PPE) (35%) and lack of rapid COVID-19 testing (86%). CONCLUSIONS: The COVID-19 pandemic has caused a reduction in HNC care. Rapid COVID-19 testing and correlation with infectious potential remain paramount to resuming the care of patients with head and neck cancer. Cloud-based platforms to share practice patterns will be essential as the pandemic evolves.


Assuntos
Infecções por Coronavirus/epidemiologia , Neoplasias de Cabeça e Pescoço/cirurgia , Microcirurgia/métodos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Padrões de Prática Médica/organização & administração , Oncologia Cirúrgica/organização & administração , Técnicas de Laboratório Clínico , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Bases de Dados Factuais , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Masculino , Oncologia/organização & administração , Segurança do Paciente/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Sociedades Médicas , Inquéritos e Questionários , Estados Unidos
20.
Ann R Coll Surg Engl ; 102(7): e152-e154, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32306741

RESUMO

Laryngeal haemangiomas can commonly be seen in children, and first-line treatment is usually propranolol. However, in adults, cavernous haemangioma of the vocal cord(s) is an extremely rare condition - with this being the only published adult case presenting with acute respiratory distress - the mainstay of treatment is surgical excision under microlaryngoscopy. Presentation in adults can be unpredictable, but primarily consists of hoarseness which can be associated with, dyspnoea, dysphagia, and haemoptysis - and in one documented case stenosis of the aero-digestive tract led to death. Due to these airway difficulties, surgery can often prove challenging. In this study, we explore the unusual case of a previously well 71-year-old gentleman presenting to the Emergency Department, with worsening shortness of breath as his primary complaint. Uniquely, in this case, an awake fibre-optic intubation was undertaken to manage the difficult airway and a microlaryngoscopy was performed. A 20x10x15mm lesion was excised, which had characteristics in keeping with a cavernous haemangioma on microscopic examination.


Assuntos
Hemangioma Cavernoso/complicações , Neoplasias Laríngeas/complicações , Síndrome do Desconforto Respiratório do Adulto/etiologia , Prega Vocal , Idoso , Hemangioma Cavernoso/diagnóstico , Hemangioma Cavernoso/cirurgia , Humanos , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/cirurgia , Laringectomia/métodos , Laringoscopia , Masculino , Microcirurgia/métodos , Síndrome do Desconforto Respiratório do Adulto/diagnóstico
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