Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.202
Filtrar
1.
Handchir Mikrochir Plast Chir ; 51(6): 418-423, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31698485

RESUMO

The profitability of medical treatment has gained increasing importance in health politics and likewise has become a considerable part of a microsurgeon's daily practice. The resulting cost pressure leads to microsurgeons having to justify their often complex and expensive treatments against hospital providers and health insurances. In this position paper of the German Speaking Group for Microsurgery of Peripheral Nerves and Vessels, we analyze the current status of profitability of microsurgical extremity and breast reconstruction, and its impact on choice of therapy and residency training. We specifically highlight the available literature, that shows often reduced long-term treatment costs after microsurgical reconstruction in comparison to cheaper initial treatments. The statements are based on a consensus workshop on the 40th meeting of the DAM in Lugano, Switzerland.


Assuntos
Microcirurgia , Procedimentos Cirúrgicos Reconstrutivos , Cirurgia Plástica , Internato e Residência , Mamoplastia/economia , Microcirurgia/economia , Microcirurgia/métodos , Nervos Periféricos/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/economia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Suíça
2.
Curr Pain Headache Rep ; 23(10): 69, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31372836

RESUMO

PURPOSE OF REVIEW: Peripheral nerve blocks are effective and safe modalities for perioperative analgesia. But it remains unclear what blocks are adequate for ambulatory surgeries, as well as the proper patient management before and after discharge. RECENT FINDINGS: Emerging nerve blocks have sparked interests due to ease to perform under ultrasound guidance and lower risks of adverse events. Some of these novel blocks are particularly suitable for ambulatory procedures, including but not limited to motor-sparing lower extremity nerve blocks and phrenic-sparing nerve blocks for shoulder surgeries. The adoption of peripheral nerve block into outpatient surgery is a multidisciplinary effort that encompasses appropriate patient choice, careful selection of nerve blocks that minimize potential adverse events after discharge, and proper patient follow-up until block effects resolve.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Anestesia por Condução , Bloqueio Nervoso , Pacientes Ambulatoriais , Nervos Periféricos/cirurgia , Anestesia por Condução/métodos , Humanos , Bloqueio Nervoso/métodos , Ultrassonografia de Intervenção/métodos
3.
Handchir Mikrochir Plast Chir ; 51(4): 295-301, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31167234

RESUMO

Plastic and reconstructive surgery is characterized by a high degree of interdisciplinarity. Although Plastic surgery offers a wide range of reliable surgical treatment options independent departments for plastic and reconstructive surgery are not present in every university clinic or leading hospital in Germany. However, the ongoing improvements especially in the field of reconstructive microsurgery enabled and enhanced the treatment of complex defects in order to restore function as well as cosmetic outcome. Knowing the fact that patients are usually referred from other medical disciplines that are familiar with the development and treatment of the primary disease, creation of an interdisciplinary reconstructive treatment plan is crucial to guarantee best patient care. Thus, one of the future major challenges in plastic surgery will be the establishment of multidisciplinary boards in order to strengthen the role of plastic surgery within the medical system with the overall aim to solve complex reconstructive cases. During the 39th annual meeting of the German Speaking Society for Microsurgery of Peripheral Nerves and Vessels a workshop titled "The interdisciplinary microsurgeon" addressed this topic. In the present article we will highlight the consented results of the workshop and provide pitfalls and pearls concerning the implementation process of different multidisciplinary boards based on representative examples.


Assuntos
Microcirurgia , Nervos Periféricos , Procedimentos Cirúrgicos Reconstrutivos , Cirurgia Plástica , Consenso , Alemanha , Humanos , Comunicação Interdisciplinar , Nervos Periféricos/cirurgia
4.
J Surg Res ; 242: 207-213, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31085369

RESUMO

BACKGROUND: Peripheral nerve assessment has traditionally been studied through histological and immunological staining techniques in a limited cross-sectional modality, making detailed analysis difficult. A new application of serial section electron microscopy is presented to overcome these limitations. METHODS: Direct nerve repairs were performed on the posterior auricular nerve of transgenic YFP-H mice. Six weeks postoperatively the nerves were imaged using confocal fluorescent microscopy then excised and embedded in resin. Resin blocks were sequentially sectioned at 100 nm, and sections were serially imaged with an electron microscope. Images were aligned and autosegmented to allow for 3D reconstruction. RESULTS: Basic morphometry and axonal counts were fully automated. Using full 3D reconstructions, the relationships between the axons, the Nodes of Ranvier, and Schwann cells could be fully appreciated. Interactions of individual axons with their surrounding environment could be visualized and explored in a virtual three-dimensional space. CONCLUSIONS: Serial section electron microscopy allows the detailed pathway of the regenerating axon to be visualized in a 3D virtual space in comparison to isolated individual traditional histological techniques. Fully automated histo-morphometry can now give accurate axonal counts, provide information regarding the quality of nerve regeneration, and reveal the cell-to-cell interaction at a super-resolution scale. It is possible to fully visualize and "fly-through" the nerve to help understand the behavior of a regenerating axon within its environment. This technique provides future opportunities to evaluate the effect different treatment modalities have on the neuroregenerative potential and help us understand the impact different surgical techniques have when treating nerve injuries.


Assuntos
Axônios/fisiologia , Imagem Tridimensional/métodos , Microscopia Intravital/métodos , Regeneração Nervosa , Nervos Periféricos/diagnóstico por imagem , Animais , Axônios/ultraestrutura , Proteínas de Bactérias/genética , Comunicação Celular/fisiologia , Modelos Animais de Doenças , Feminino , Corantes Fluorescentes , Humanos , Proteínas Luminescentes/genética , Camundongos , Camundongos Transgênicos , Microscopia Confocal , Microscopia Eletrônica , Procedimentos Neurocirúrgicos/métodos , Traumatismos dos Nervos Periféricos/diagnóstico por imagem , Traumatismos dos Nervos Periféricos/cirurgia , Nervos Periféricos/fisiologia , Nervos Periféricos/cirurgia , Nós Neurofibrosos/fisiologia , Nós Neurofibrosos/ultraestrutura
5.
BMC Musculoskelet Disord ; 20(1): 166, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975128

RESUMO

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


Assuntos
Doenças do Sistema Nervoso/diagnóstico , Neurilemoma/cirurgia , Procedimentos Neurocirúrgicos/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Extremidades/inervação , Extremidades/cirurgia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/etiologia , Neurilemoma/patologia , Nervos Periféricos/patologia , Nervos Periféricos/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Prognóstico , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
6.
Injury ; 50(4): 848-854, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30910242

RESUMO

BACKGROUND: Complex digital injuries involving soft-tissue loss and digital nerve defect continues to pose a reconstructive challenge. This study reports the repair of such neurocutaneous defect with the bipedicled nerve flap or the Littler flap and compares the results of the two techniques. METHODS: A retrospective study was conducted in 59 patients who had a neurocutaneous defect in the single digit treated with the bipedicled nerve flap or the Littler flap from Jul 2008 to May 2016. The patients were divided into two groups based on which flap was chosen. At the final follow-up, the two groups were compared for static two-point discrimination and Semmes-Weinstein monofilament scores on both flap and pulp, and pain, cold intolerance and patient satisfaction of the reconstructed digit. RESULTS: Significant differences were found in static two-point discrimination, pain, cold intolerance, and patient satisfaction (p < 0.05). In comparison with the bipedicled flap group, the Littler flap group presented better discriminatory sensation in the flap and pulp, but exhibited higher incidence of pain and cold intolerance in the reconstructed digit. In the donor digits, the bipedicled flap group achieved lower pain incidence. Finally, the bipedicled flap group attained a larger degree of satisfaction than the Littler flap group. CONCLUSIONS: When reconstructing a complex neurocutaneous defect in the digit, choosing the bipedicled nerve flap rather than the Littler flap attains lower incidence of pain and cold intolerance, and higher patient satisfaction. Our results suggest that repair of the transected digital nerves can reduce neuroma incidence.


Assuntos
Traumatismos dos Dedos/fisiopatologia , Dedos/inervação , Nervos Periféricos/cirurgia , Lesões dos Tecidos Moles/fisiopatologia , Retalhos Cirúrgicos , Adulto , Feminino , Traumatismos dos Dedos/cirurgia , Dedos/cirurgia , Seguimentos , Humanos , Masculino , Satisfação do Paciente/estatística & dados numéricos , Nervos Periféricos/fisiopatologia , Procedimentos Cirúrgicos Reconstrutivos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Resultado do Tratamento
7.
World Neurosurg ; 126: e1302-e1308, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30898754

RESUMO

BACKGROUND: Entrapment neuropathies include a wide field of locations. In most cases, the microsurgical decompression is still the therapy of choice. However, the role of venous stasis and ischemia is still discussed controversially. Here the authors evaluated the visualization of microvessels and the microperfusion at peripheral nerves with a contact endoscope during the surgical decompression for the first time. METHODS: Eight patients were subjected to endoscopic or endoscopically assisted peripheral nerve decompression. In 3 patients with nerve tumors, the tumor carrying nerve was inspected endoscopically proximal and distal to the tumor site before and after resection. Microcirculation was assessed by a contact endoscope, allowing a 150-fold magnification, at superficial areas proximal and distal to the compression site. The electronically stored records were analyzed retrospectively using image processing software. Vessel diameter, red blood cell velocity, and blood flow, before and after decompression, were extracted. RESULTS: The contact endoscope was easy to handle intraoperatively without problems. All minimally invasive procedures were performed without complications. In the offline computer-assisted analysis, single arterioles and veins were visualized showing decreased red blood cell velocity prior to decompression. After surgical treatment, a statistically significant increase of blood flow was observed. CONCLUSIONS: Basically, the application of a contact endoscope for visualization of peripheral nerves' microcirculation is feasible. The observed effect of increased blood flow after decompression should be compared with the clinical outcome in a further prospective randomized study.


Assuntos
Síndromes de Compressão Nervosa/cirurgia , Neuroendoscopia/instrumentação , Neuroendoscopia/métodos , Nervos Periféricos/irrigação sanguínea , Adulto , Idoso , Descompressão Cirúrgica/instrumentação , Descompressão Cirúrgica/métodos , Endoscópios , Feminino , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Nervos Periféricos/cirurgia
8.
Am J Surg ; 217(5): 873-877, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30878217

RESUMO

INTRODUCTION: Enlargement of the ilioinguinal nerve distal to the inguinal ring is common in primary open inguinal herniorrhaphy and is histologically consistent with compression neuropathy. However, the origin of this neuropathy has not been thoroughly studied in primary inguinal hernia. METHODS: In this prospective study, 143 primary inguinal herniorrhaphies were performed. Prior to surgery, all patients completed a preoperative pain questionnaire from the Carolina Comfort Scale and Visual Analog Scale-evaluating pain with various activities. Pain scores were statistically compared with several different anatomical surgical observations. RESULTS: When each variable is individually compared with pain scores, a significant positive correlation exists between nerve enlargement and increased pain compared to those without enlargement for preoperative "most of the time pain" (P < 0.0017). There is also a statistically significant positive correlation between nerve enlargement and external ring fibrosis (P < 0.001). 81% of patients with enlargement have histological abnormalities. CONCLUSION: Preoperative pain in primary inguinal hernia is correlated with ilioinguinal nerve enlargement, which is also correlated with fibrosis of the external oblique fascia at the external ring.


Assuntos
Hérnia Inguinal/cirurgia , Síndromes de Compressão Nervosa/etiologia , Medição da Dor , Nervos Periféricos/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Fáscia/patologia , Fibrose , Virilha/patologia , Hérnia Inguinal/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/cirurgia , Dor/etiologia , Nervos Periféricos/cirurgia , Período Pré-Operatório , Estudos Prospectivos , Adulto Jovem
9.
Plast Reconstr Surg ; 143(3): 877-885, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30817663

RESUMO

BACKGROUND: This study was designed to assess the safety and efficacy of site-specific fat injection for the treatment of refractory migraine headaches following medical or surgical treatment. METHODS: A prospective cohort study was performed on consecutive patients who had migraine headaches with persistent symptoms after surgical decompression and were given therapeutic fat injections from September of 2012 to January of 2015 with 12 months' minimum follow-up. Clinical outcomes assessment included migraine frequency, intensity, duration, migraine headache index, and complications. A 50 percent or greater decrease in frequency, intensity, or duration was considered therapeutic success, whereas 10 percent or greater increase in migraine headache index was considered worsening of symptoms. Pairwise t tests were used to assess statistical significance (p < 0.05). RESULTS: Twenty-nine patients met inclusion criteria. All were female, with a mean age of 49.0 years (range, 21.5 to 72.5 years), and mean follow-up was 29.4 months (range, 12.3 to 49.5 months). Twenty patients (69.0 percent) experienced successful improvement; 12 (41.4 percent) experienced complete resolution. Five patients (17.2 percent) experienced subtherapeutic improvement, and four (13.8 percent) experienced worsening of symptoms. Mean improvement per patient at their last follow-up was 5.1 (39.3 percent) fewer attacks per month (p = 0.035); 3.1 (42.0 percent) lower intensity on a scale of 1 to 10 (p = 0.001); 31.8 (74.4 percent) fewer hours of duration (p = 0.219); and 52.8 percent lower migraine headache index (p = 0.012). There were no complications for any patient. CONCLUSIONS: Migraine headache symptoms were successfully reduced in the majority of cases with fat injection. A comprehensive surgical treatment algorithm including this novel procedure is presented. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Gordura Abdominal/transplante , Descompressão Cirúrgica/métodos , Transtornos de Enxaqueca/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adulto , Idoso , Cânula , Feminino , Seguimentos , Humanos , Injeções Subcutâneas/instrumentação , Injeções Subcutâneas/métodos , Pessoa de Meia-Idade , Transtornos de Enxaqueca/diagnóstico , Bainha de Mielina/patologia , Medição da Dor , Nervos Periféricos/patologia , Nervos Periféricos/cirurgia , Estudos Prospectivos , Transplante Autólogo/instrumentação , Transplante Autólogo/métodos , Resultado do Tratamento , Adulto Jovem
10.
Turk Neurosurg ; 29(4): 530-237, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30829381

RESUMO

AIM: To seek the efficacy of selective spinal nerve blocks in the treatment of groin pain that are irresponsive to peripheral nerve blocks. MATERIAL AND METHODS: This retrospective study comprised 17 patients with ilioinguinal, iliohypogastric, and genitofemoral neuralgias treated between 2017 and 2018. RESULTS: All patients received diagnostic peripheral nerve blocks and/or TAP blocks with blind or ultrasound-guided techniques. Four patients had ineffectual peripheral nerve blocks, after which they underwent T12 and L1 selective spinal nerve blocks. All four patients had satisfactory results. CONCLUSION: If distal peripheral nerve blocks are ineffective, an upper level nerve lesion, a lesion in the lumbar plexus or an L1 radiculopathy should be considered in ilioinguinal, iliohypogastric, and genitofemoral neuralgias. Upper level nerve blocks should be performed before deciding on surgery.


Assuntos
Bloqueio Nervoso Autônomo/métodos , Neuropatia Femoral/diagnóstico por imagem , Neuralgia/diagnóstico por imagem , Nervos Espinhais/diagnóstico por imagem , Adulto , Raquianestesia/métodos , Feminino , Neuropatia Femoral/cirurgia , Humanos , Plexo Lombossacral/diagnóstico por imagem , Plexo Lombossacral/cirurgia , Masculino , Pessoa de Meia-Idade , Neuralgia/cirurgia , Nervos Periféricos/diagnóstico por imagem , Nervos Periféricos/cirurgia , Estudos Retrospectivos , Nervos Espinhais/cirurgia
11.
Bone Joint J ; 101-B(2): 124-131, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30700118

RESUMO

Nerve transfer has become a common and often effective reconstructive strategy for proximal and complex peripheral nerve injuries of the upper limb. This case-based discussion explores the principles and potential benefits of nerve transfer surgery and offers in-depth discussion of several established and valuable techniques including: motor transfer for elbow flexion after musculocutaneous nerve injury, deltoid reanimation for axillary nerve palsy, intrinsic re-innervation following proximal ulnar nerve repair, and critical sensory recovery despite non-reconstructable median nerve lesions.


Assuntos
Transferência de Nervo/métodos , Traumatismos dos Nervos Periféricos/cirurgia , Extremidade Superior/inervação , Adulto , Axila/inervação , Feminino , Humanos , Masculino , Nervo Mediano/lesões , Nervo Mediano/cirurgia , Pessoa de Meia-Idade , Nervo Musculocutâneo/anatomia & histologia , Nervo Musculocutâneo/lesões , Nervo Musculocutâneo/cirurgia , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/etiologia , Nervos Periféricos/anatomia & histologia , Nervos Periféricos/cirurgia , Luxação do Ombro/etiologia , Nervo Ulnar/lesões , Nervo Ulnar/transplante , Extremidade Superior/lesões , Adulto Jovem
12.
Handchir Mikrochir Plast Chir ; 51(4): 327-333, 2019 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-30703805

RESUMO

INTRODUCTION: A recent survey among plastic surgery residents and directors of microsurgical clinics demonstrates a great interest in high- quality microsurgery education. Unfortunately, due to economic pressures, limited operating resources as well as forensic considerations, it has become a challenge to provide sufficient on-the-job training, which needs to be shifted outside of the OR. To promote microsurgical teaching, the German-speaking Working Group for Microsurgery of Peripheral Nerves and Vessels (DAM) organises two-day microsurgery academies to provide interested colleagues with a broad spectrum of microsurgical procedures. In this publication, we present the workshop concept and an evaluation of the first three years. MATERIAL AND METHODS: Since 2015, a two-day workshop has been held at the BG Trauma Centre in Ludwigshafen on a yearly basis. Each day, at least three surgical procedures were performed simultaneously in the area of breast, nerve, bone/hand, extremity and lymph reconstruction, along with presentations regarding the various cases, diseases and specific operative challenges. To evaluate this course concept, we asked participants to identify their expectations and evaluate the academy and its program. RESULTS: The academy and its goals were demonstrated. In a second step, the evaluation, conducted by 79 % of participants, was presented. 67 % of participants were consultants or residents in their final year. 90 % worked at maximum care facilities or university hospitals. 57 % reported that less than 5 microsurgery cases are performed at their institution per week. All participants considered microsurgery to be part of their future work spectrum, with the greatest fields of interest being extremity reconstruction (90 %) or microsurgical reconstruction of the hand (80 %). All participants would recommend the course to their colleagues, but suggest improving the intraoperative video monitoring. DISCUSSION: This work demonstrates that hands-on academies for microsurgery are a highly relevant teaching format, which can counteract the limitations of surgical residency training. In particular, the close contact between senior and junior surgeons was considered highly relevant for building a network within German microsurgery. The overall goal of the academy is to improve teaching and increase the enthusiasm of future microsurgeons and provide a network for German microsurgeons during their training and beyond.


Assuntos
Internato e Residência , Microcirurgia , Procedimentos Cirúrgicos Reconstrutivos , Cirurgia Plástica , Nervos Periféricos/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/educação , Cirurgia Plástica/educação
13.
J Cancer Res Clin Oncol ; 145(2): 471-477, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30603899

RESUMO

PURPOSE: This study aimed to evaluate the prognostic significance of lymphovascular (LVI), perineural invasion (PNI), and tumor budding positivity in patients with colorectal cancer. METHODS: From January 2008 to December 2011, 3707 consecutive patients who underwent curative surgery for stage I-III colorectal cancer were assessed. These patients were then categorized into four groups based on LVI, PNI, and tumor budding (risk grouping): all negative (n = 1495), 1 + only (n = 1063), 2 + only (n = 861), and all positive (n = 288). RESULTS: With a median follow-up period of 52 months, the 5-year disease-free survival rates of the risk groups were significantly different in terms of cancer staging (stage I, Stage II, and Stage III: P = 0.006, P < 0.001, and P < 0.001, respectively). In the multivariate analysis, risk grouping was an independent prognostic factor of disease-free survival. Preoperative carcinoembryonic antigen level, tumor size, T category, and N category were independent predictors of LVI, PNI, and tumor budding positivity. CONCLUSION: Risk grouping based on LVI, PNI, and tumor budding positivity is a strong predictor of disease-free survival in patients with colorectal cancer.


Assuntos
Neoplasias Colorretais/patologia , Endotélio Vascular/patologia , Linfonodos/patologia , Nervos Periféricos/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/cirurgia , Endotélio Vascular/cirurgia , Feminino , Seguimentos , Humanos , Linfonodos/cirurgia , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Invasividade Neoplásica , Nervos Periféricos/cirurgia , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
15.
J Plast Reconstr Aesthet Surg ; 72(3): 447-456, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30655242

RESUMO

While systematic reviews are regarded as the strongest level of medical evidence, inconsistency in the quality and rigor of systematic reviews raises concerns about their use as a tool in guiding quality delivery in evidence-based clinical practice. The objective of this present study was to assess methodological soundness of systematic reviews with a particular focus on peripheral nerve repair and reconstruction. We performed a comprehensive search using PubMed and Scopus to identify all systematic reviews published on peripheral nerve reconstruction in 9 high-impact surgical journals. Two authors independently performed literature searches, screened abstracts, and extracted data. Discrepancies were resolved by discussion and consensus. The quality of systematic reviews was assessed using AMSTAR criteria. Initial search retrieved 184 articles. After screening duplicates, titles, abstracts, and conducting full text reviews, 26 studies met inclusion criteria. Of those, 18 (65%) were published by Plastic Surgery, 7 (27%) by Orthopedic Surgery, and 1 (4%) by Occupational Therapy. The total number of systematic reviews published on peripheral nerves each year has shown an increasing trend from 2004 through 2015. The overall median AMSTAR score was 5, reflecting a "fair" quality. There was no evidence of AMSTAR score improvement over time. Although the number of systematic reviews published on peripheral nerve repair has risen over the last decade, their quality has not exhibited the same increase. This highlights the necessity to increase familiarity with and conform to methodological quality criteria in order to improve the integrity of evidence-based medicine in peripheral nerve repair and reconstruction.


Assuntos
Traumatismos dos Nervos Periféricos/cirurgia , Nervos Periféricos/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Literatura de Revisão como Assunto , Humanos , Procedimentos Cirúrgicos Reconstrutivos/métodos
16.
Ann Anat ; 222: 139-145, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30599238

RESUMO

Severe spinal cord injuries cause permanent neurological deficits and are still considered as inaccessible to efficient therapy. Injured spinal cord axons are unable to spontaneously regenerate. Re-establishing functional activity especially in the lower limbs by reinnervation of the caudal infra-lesional territories might represent an effective therapeutic strategy. Numerous surgical neurotizations have been developed to bridge the spinal cord lesion site and connect the intact supra-lesional portions of the spinal cord to peripheral nerves (spinal nerves, intercostal nerves) and muscles. The major disadvantage of these techniques is the increased hypersensitivity, spasticity and pathologic pain in the spinal cord injured patients, which occur due to the vigorous sprouting of injured afferent sensory fibers after reconstructive surgery. Using micro-surgical instruments and an operation microscope we performed detailed anatomical preparation of the vertebral canal and its content in five human cadavers. Our observations allow us to put forward the possibility to develop a more precise surgical approach, the so called "ventral root bypass" that avoids lesion of the dorsal roots and eliminates sensitivity complications. The proposed kind of neurotization has been neither used, nor put forward. The general opinion is that radix ventralis and radix dorsalis unite to form the spinal nerve inside the dural sac. This assumption is not accurate, because both radices leave the dural sac separately. This neglected anatomical feature allows a reliable intravertebral exposure of the dura-mater ensheathed ventral roots and their damage-preventing end-to-side neurorrhaphy by interpositional nerve grafts.


Assuntos
Paralisia/cirurgia , Traumatismos da Medula Espinal/cirurgia , Raízes Nervosas Espinhais/anatomia & histologia , Raízes Nervosas Espinhais/cirurgia , Cadáver , Dura-Máter/anatomia & histologia , Humanos , Microcirurgia/instrumentação , Músculo Esquelético/anatomia & histologia , Músculo Esquelético/cirurgia , Regeneração Nervosa , Procedimentos Neurocirúrgicos , Nervos Periféricos/anatomia & histologia , Nervos Periféricos/cirurgia , Canal Vertebral/anatomia & histologia , Medula Espinal/anatomia & histologia , Medula Espinal/cirurgia , Coluna Vertebral/anatomia & histologia
17.
Acta Neurochir Suppl ; 125: 175-178, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30610320

RESUMO

BACKGROUND: The extreme lateral approach is a direct lateral approach which allows a good control of the entire length of the vertebral artery (VA), the jugular foramen, the lowest cranial nerves, and the jugular-sigmoid complex. Herein we try to exploit the variants of the approach and we identify indications, advantages, and disadvantages. METHODS: All phases of the study were conducted at the Institute of Public Health Section of Legal Medicine and Insurance of the University. We performed the extreme lateral approach in four subjects, who died between 24 and 48 h before in non-traumatic circumstances (three men and one woman). RESULTS: The great auricular nerve, the spinal accessory, the branches of the first ventral spinal nerves, the jugular vein, and the vertebral artery were identified in all the cadavers. In all cases the right VA exited from the transverse foramen of C1. The site of SCM piercing the accessory nerve was at a distance from the tip of the mastoid between 3 and 4 cm (3.3 in one case, 3.4 in 2 cases, and 3.7 in one case). No vessels and nerves have been damaged after being identified and isolated. CONCLUSIONS: Extradural lesions at the ventro-lateral aspect of the CVJ may require an extreme lateral approach, a procedure more aggressive comparing with far lateral approach, which represents a reasonable option for large anterior and anterolateral lesions when greater exposure is required.


Assuntos
Vértebras Cervicais/anatomia & histologia , Veias Jugulares/anatomia & histologia , Procedimentos Neurocirúrgicos/métodos , Nervos Periféricos/anatomia & histologia , Artéria Vertebral/anatomia & histologia , Cadáver , Vértebras Cervicais/cirurgia , Feminino , Humanos , Veias Jugulares/cirurgia , Masculino , Nervos Periféricos/cirurgia , Crânio/cirurgia , Artéria Vertebral/cirurgia
18.
Br J Neurosurg ; 33(3): 315-319, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29745256

RESUMO

Purpose: Motor nerve transfer surgery involves re-innervation of important distal muscles using either an expendable motor branch or a fascicle from an adjacent functioning nerve. This technique is established as part of the reconstructive algorithm for traumatic brachial plexus injuries. The reproducible outcomes of motor nerve transfer surgery have resulted in exploration of the application of this technique to other paralysing conditions. The objective of this study is to report feasibility and increase awareness about nerve transfer as a method of improving upper limb function in patients with cervical motor radiculopathy of different aetiology. Results: In this case series we report 3 cases with different modes of injury to the spinal nerve roots with significant and residual motor radiculopathy that have been successfully treated with nerve transfer surgery with good functional outcomes. The cases involved iatrogenic nerve root injury, tumour related root compression and degenerative root compression. Conclusion: Nerve transfer surgery may offer reliable reconstruction for paralysis when there has been no recovery following a period of conservative management. However the optimum timing of nerve transfer intervention is not yet identified for patients with motor radiculopathy.


Assuntos
Transferência de Nervo/métodos , Radiculopatia/cirurgia , Acidentes de Trânsito , Idoso , Plexo Braquial/lesões , Plexo Braquial/cirurgia , Neuropatias do Plexo Braquial/cirurgia , Estudos de Viabilidade , Humanos , Masculino , Pessoa de Meia-Idade , Nervos Periféricos/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Terapia de Salvação/métodos , Raízes Nervosas Espinhais/cirurgia
19.
Eur J Surg Oncol ; 45(4): 498-509, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30470529

RESUMO

Several patients' and pathological characteristics in rectal surgery can significantly complicate surgical loco regional tumor clearance. The main factors are obesity, short tumor distance from anal verge, bulky tumors, and narrow pelvis, which have been shown to be associated to poor surgical results in open and laparoscopic approaches. Minimally invasive surgery has the potential to reduce perioperative morbidity with equivalent short- and long-term oncological outcomes compared to conventional open approach. Achilles' heel of laparoscopic approaches is conversion to open surgery. High risk for conversion is evident for patients with bulky and low tumors as well as male gender and narrow pelvis. Hence, patient's characteristics represent challenges in rectal cancer surgery especially in minimally invasive approaches. The available surgical techniques increased remarkably with recently developed and implemented improvements of minimally invasive rectal cancer surgery. The controversial discussions about sense and purpose of these novel approaches are still ongoing in the literature. Herein, we evaluate, if latest technical advances like transanal approach or robotic assisted surgery have the potential to overcome known challenges and pitfalls in rectal cancer surgery in demanding surgical cases and highlight the role of current minimally invasive approaches in rectal cancer surgery.


Assuntos
Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Protectomia/métodos , Neoplasias Retais/cirurgia , Procedimentos Cirúrgicos Robóticos , Conversão para Cirurgia Aberta , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Recidiva Local de Neoplasia , Duração da Cirurgia , Tratamentos com Preservação do Órgão , Nervos Periféricos/cirurgia , Protectomia/efeitos adversos , Neoplasias Retais/patologia , Taxa de Sobrevida
20.
Microsurgery ; 39(4): 332-339, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30512213

RESUMO

BACKGROUND: Due to limited number of studies, we tested feasibility of autologous epineural sheath conduit (ESC) in repair of 6-cm median nerve gaps in a sheep-the large animal model. MATERIALS AND METHODS: Eight ewes, 6-8 months old, 30-35 kg, were divided into three experimental groups: group 1-no defect repair (n = 4 nerves/group), group 2-autograft controls (n = 6 nerves/group), group 3-autologous ESC filled with saline (n = 6 nerves/group). ESC was constructed from a 6-cm long segment of sheep median nerve and tested for expression of laminin B, Glial fibrillary acidic protein (GFAP), S-100 and CD31 using immunofluorescent staining. At 6 months after nerve repair, nerve conduction velocity and somatosensory evoked potentials (SSEP) assessed neurosensory recovery, while histomorphometry tested nerve regeneration. RESULTS: Ex vivo characterization of ESC, before in vivo nerve gap repair, showed high laminin B expression, which supports axonal growth. At 6 months post-repair, structural integrity of ESC was preserved. ESC was well-vascularized and tissue adhesions were comparable to autograft controls. The maximal conduction velocities (29.80 ± 5.85 ms vs. 32.28 ± 6.75 ms; p = .44), action potential amplitudes (32.68 ± 17.44 mV vs. 44.14 ± 23.10 mV; p = .38) and SSEP amplitude values (6.18 ± 5.84 mV vs. 4.68 ± 2.53 mV; p = .28) were comparable between autograft and ESC groups. Presence of regenerating axons was confirmed in the distal segment of ESC at 6 months after repair. CONCLUSION: The feasibility of ESC in restoration of 6-cm long nerve defects in a sheep median nerve model was confirmed by nerve conduction assessments and correlated with axonal regeneration tested by histomorphometry. We confirmed ESC potential in support of regeneration of long nerve defects.


Assuntos
Modelos Animais de Doenças , Nervo Mediano/cirurgia , Nervos Periféricos/cirurgia , Animais , Potenciais Somatossensoriais Evocados/fisiologia , Estudos de Viabilidade , Feminino , Imunofluorescência , Nervo Mediano/lesões , Nervo Mediano/patologia , Regeneração Nervosa/fisiologia , Proteínas do Tecido Nervoso/metabolismo , Condução Nervosa/fisiologia , Ovinos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA