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4.
Adv Exp Med Biol ; 1213: 149-163, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32030669

RESUMO

The skin is the largest organ of our body. Skin disease abnormalities which occur within the skin layers are difficult to examine visually and often require biopsies to make a confirmation on a suspected condition. Such invasive methods are not well-accepted by children and women due to the possibility of scarring. Optical coherence tomography (OCT) is a non-invasive technique enabling in vivo examination of sub-surface skin tissue without the need for excision of tissue. However, one of the challenges in OCT imaging is the interpretation and analysis of OCT images. In this review, we discuss the various methodologies in skin layer segmentation and how it could potentially improve the management of skin diseases. We also present a review of works which use advanced machine learning techniques to achieve layers segmentation and detection of skin diseases. Lastly, current challenges in analysis and applications are also discussed.


Assuntos
Processamento de Imagem Assistida por Computador , Aprendizado de Máquina , Dermatopatias/diagnóstico por imagem , Pele/diagnóstico por imagem , Tomografia de Coerência Óptica , Humanos
5.
Plast Reconstr Surg ; 145(2): 433-443, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985637

RESUMO

BACKGROUND: This study explored the effect of a single local intraosseous application of a small dose of simvastatin on the wound healing process in type 1 diabetic rats and related mechanisms. METHODS: The authors chose the streptozotocin-induced type 1 diabetic rat to establish a full-thickness dermal wound using a 12-mm-diameter sterile disposable punch. The rats (n = 32) were divided randomly into four groups: (1) normal control rats, (2) type 1 diabetic rats with intraosseous injection of hydrogel vehicle, (3) type 1 diabetic rats with intraosseous injection of simvastatin (0.5 mg), and (4) type 1 diabetic rats with intragastric administration of simvastatin (20 mg/kg per day). Wound closure was followed by digital planimetry. Mobilization of endothelial progenitor cells into the circulatory system was studied using fluorescence-activated cell sorting. Neovascularization was analyzed with immunofluorescence histochemical staining. The relative levels of adiponectin and stromal cell-derived factor 1 (SDF-1) in serum, bone, and wound tissues were examined by enzyme-linked immunosorbent assay and Western blot. RESULTS: Diabetic rats exhibited impaired wound healing. Intraosseous administration of simvastatin accelerated wound healing beginning at day 4, and angiogenesis was more obvious than in the control group. Enzyme-linked immunosorbent assay revealed that adiponectin concentrations in the diabetic rats with intraosseous injection of hydrogel vehicle plus simvastatin 0.5-mg group were significantly higher compared with the diabetic rats with intraosseous injection of hydrogel vehicle group beginning at day 4. Intraosseous administration of simvastatin decreased the expression of adiponectin and SDF-1 in bone tissue but enhanced the expression of adiponectin in wounded skin. CONCLUSIONS: A single local intraosseous application of simvastatin promotes wound healing in type 1 diabetic rat. The underlying mechanisms may be attributed to the regulation of the adiponectin/SDF-1 pathway, which plays a pivotal role in endothelial progenitor cell mobilization and angiogenesis.


Assuntos
Indutores da Angiogênese/farmacocinética , Células Progenitoras Endoteliais/efeitos dos fármacos , Sinvastatina/farmacologia , Cicatrização/efeitos dos fármacos , Adiponectina/metabolismo , Animais , Quimiocina CXCL12/metabolismo , Diabetes Mellitus Experimental/fisiopatologia , Diabetes Mellitus Tipo 1/fisiopatologia , Combinação de Medicamentos , Hidrogéis , Injeções , Masculino , Neovascularização Fisiológica/efeitos dos fármacos , Poloxâmero/administração & dosagem , Ratos Sprague-Dawley , Sinvastatina/administração & dosagem , Pele/metabolismo
6.
Harefuah ; 159(1): 25-28, 2020 Jan.
Artigo em Hebraico | MEDLINE | ID: mdl-31930803

RESUMO

INTRODUCTION: Mycosis fungoides (MF) is the most common type of primary cutaneous T cell lymphoma. Many clinicopathological variants of MF have been described in the literature, though only a few presented in a segmental pattern. There are several unique patterns of distribution of skin diseases, one of which is the Blaschko Lines. Congenital skin diseases develop in a Blaschkoid pattern due to mosaicism. In contrast, according to Happle, the development of acquired skin diseases in a similar pattern is explained by superimposed segmental manifestation - a process which involves mosaicism overlapping a preexisting congenital mutation. The theories by which previous case reports explained the segmental appearance of MF did not cover the molecular basis for their development. We report a case of a patient who presented with MF in a unique segmental distribution consistent with the Blaschko lines. The patient was found to have an acquired mosaic mutation in GNAS gene exclusively in the involved skin which represents a superimposed segmental manifestation according to Happle's theory. This case demonstrates the hidden potential of these rare cases which allows a better understanding of the pathogenesis by which acquired diseases develop. This is a basis for further research that could help identify new therapeutic targets for MF and other diseases that share its genetic etiology.


Assuntos
Micose Fungoide , Dermatopatias , Neoplasias Cutâneas , Humanos , Linfoma Cutâneo de Células T , Pele
7.
Harefuah ; 159(1): 43-48, 2020 Jan.
Artigo em Hebraico | MEDLINE | ID: mdl-31930808

RESUMO

INTRODUCTION: Atopic dermatitis (AD) is one of the most common inflammatory skin diseases in the western world. Multiple causes have been implicated in the pathogenesis of atopic dermatitis, however in the past years many studies have highlighted the pathogenic role played by abnormal skin barrier in patients with AD. Impaired skin barriers facilitate the penetration of environmental agents/allergens into the skin with resultant chronic inflammation and atopic march. Many components of the epidermal barrier are impaired in atopic dermatitis including intracellular proteins comprising the cornified cell envelope, inter-cellular lipids and their metabolism, inter-cellular junctions and desquamation process. Investigating skin barrier abnormalities and understanding the mechanisms for its maintenance, are crucial for improving the management of AD patients and preventing the development of atopic march. Here we review the latest developments in skin barrier dysfunction in AD with associated clinical implications.


Assuntos
Dermatite Atópica , Humanos , Inflamação , Pele
9.
Medicine (Baltimore) ; 99(4): e18886, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977896

RESUMO

RATIONALE: Giant keloids often have indications for surgical resection, but postoperative reconstruction of the skin and high recurrence of keloids are a challenge for clinical treatment. This article reports a rare successful treatment of a giant keloid in the anterior chest wall by multistage surgery combined with radiotherapy, which is why this case is meaningful. PATIENT CONCERNS: A 66-year-old woman presented a giant keloid with ulcerations and severe itching on the anterior chest wall. She had a history of keloid disease for more than 10 years, and had been treated by multiple operations, with no success. DIAGNOSES: The patient was diagnosed as keloid based on her history and symptoms. Histopathology findings supported our diagnosis. INTERVENTIONS: We successfully excised the keloid after 5 operations and 2 rounds of electron-beam radiotherapy, which was applied at 24 hours after the 4th and 5th operation. OUTCOMES: There was no sign of recurrence over the follow-up period of 24 months. LESSONS: The combination of multistage surgery and radiotherapy presents as a good choice for the treatment of giant keloids.


Assuntos
Procedimentos Cirúrgicos Dermatológicos/métodos , Queloide/cirurgia , Parede Torácica/cirurgia , Idoso , Feminino , Humanos , Queloide/patologia , Queloide/radioterapia , Período Pós-Operatório , Radioterapia Adjuvante , Pele/patologia , Parede Torácica/patologia
10.
Plast Reconstr Surg ; 145(2): 348e-359e, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985636

RESUMO

BACKGROUND: The authors developed a noncontact low-frequency ultrasound device that delivers high-intensity mechanical force based on phased-array technology. It may aid wound healing because it is likely to be associated with lower risks of infection and heat-induced pain compared with conventional ultrasound methods. The authors hypothesized that the microdeformation it induces accelerates wound epithelialization. Its effects on key wound-healing processes (angiogenesis, collagen accumulation, and angiogenesis-related gene transcription) were also examined. METHODS: Immediately after wounding, bilateral acute wounds in C57BL/6J mice were noncontact low-frequency ultrasound- and sham-stimulated for 1 hour/day for 3 consecutive days (10 Hz/90.6 Pa). Wound closure (epithelialization) was recorded every 2 days as the percentage change in wound area relative to baseline. Wound tissue was procured on days 2, 5, 7, and 14 (five to six per time point) and subjected to histopathology with hematoxylin and eosin and Masson trichrome staining, CD31 immunohistochemistry, and quantitative polymerase-chain reaction analysis. RESULTS: Compared to sham-treated wounds, ultrasound/phased-array-treated wounds exhibited significantly accelerated epithelialization (65 ± 27 percent versus 30 ± 33 percent closure), angiogenesis (4.6 ± 1.7 percent versus 2.2 ± 1.0 percent CD31 area), and collagen deposition (44 ± 14 percent versus 28 ± 13 percent collagen density) on days 5, 2, and 5, respectively (all p < 0.05). The expression of Notch ligand delta-like 1 protein (Dll1) and Notch1, which participate in angiogenesis, was transiently enhanced by treatment on days 2 and 5, respectively. CONCLUSIONS: The authors' noncontact low-frequency ultrasound phased-array device improved the wound-healing rate. It was associated with increased early neovascularization that was followed by high levels of collagen-matrix production and epithelialization. The device may expand the mechanotherapeutic proangiogenesis field, thereby helping stimulate a revolution in infected wound care.


Assuntos
Pele/lesões , Terapia por Ultrassom/métodos , Cicatrização/fisiologia , Ferimentos e Lesões/terapia , Animais , Colágeno/metabolismo , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Neovascularização Fisiológica/fisiologia , Pele/metabolismo , Ferimentos e Lesões/metabolismo , Ferimentos e Lesões/patologia
11.
Medicine (Baltimore) ; 99(2): e18565, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914034

RESUMO

BACKGROUND: Atopic dermatitis (AD, atopic eczema) is a pruritic, inflammatory, chronic skin disease. Since there is limitation of conventional treatment of AD, traditional herbal medicine can be an attractive therapeutic option in patients having AD for a long time. So-Cheong-Ryong-Tang (SCRT) has been found to inhibit histamine release and degranulation of mast cells, differentiation of basophils, and proliferation of eosinophils. We designed this clinical trial to evaluate the efficacy and safety of SCRT as compared to placebo in patients with AD and respiratory disorders. METHODS/DESIGN: This study is a single-center, randomized, double-blind, placebo-controlled, and investigator-initiated clinical trial. A total of 60 patients between 7 and 65 years of age with AD and respiratory disorders who received a diagnosis of AD by Hanifin and Rajka criteria who scored 15 to 50 in a scoring atopic dermatitis (SCORAD) will be enrolled. Participants will be randomly assigned to the SCRT or placebo group in a ratio of 1:1 and they will have a visit schedule comprising 4 visits including a screening visit during 8 to 10 weeks. The participants will be administered SCRT or placebo 3 times a day for 4 weeks. The primary outcome will be measured by a change of the SCORAD index. The secondary outcomes will be measured by changes in the dose and frequency of usage of the AD ointment, dermatology life quality index scores, pruritus and sleep disorder in visual analog scale, skin moisture content, skin surface temperature, Hamilton anxiety rating scale scores, depression rating scale scores, stress/autonomic nervous function test, and attention deficit hyperactivity disorder survey scores at week 4 as compared to those at the baseline. DISCUSSION: To the best of our knowledge, SCRT has rarely been reported for dermatologic diseases. This will be the first clinical trial to assess the efficacy and safety of SCRT in patients with AD and respiratory disorders. We hope that the results of this trial will provide evidence for the use of SCRT as a new treatment for AD with respiratory disorders. TRIAL REGISTRATION: Korean National Clinical Trial Registry, Clinical Research Information Service. (KCT0004148) (https://cris.nih.go.kr/cris/search/search_result_st01_en.jsp?seq=14981<ype=&rtype=).


Assuntos
Dermatite Atópica/tratamento farmacológico , Medicamentos de Ervas Chinesas/uso terapêutico , Transtornos Respiratórios/tratamento farmacológico , Transtornos Respiratórios/epidemiologia , Adolescente , Adulto , Idoso , Criança , Depressão/epidemiologia , Dermatite Atópica/epidemiologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prurido/epidemiologia , Qualidade de Vida , Pele/fisiopatologia , Transtornos do Sono-Vigília/epidemiologia , Estresse Psicológico/epidemiologia , Adulto Jovem
12.
Adv Exp Med Biol ; 1232: 69-75, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31893396

RESUMO

We investigated the relationship between cerebral oxygenation (COX) and skin blood flow (SkBF) at the left frontal lobes of 10 healthy young men during progressive hypoxia (∼ -1 h at each of 21%, 18%, 15%, and 12% of inspired oxygen [FiO2]). Acute hypotension was manipulated by a thigh-cuff-release technique, where a pressure of 220 mmHg was applied at both thigh muscles for 3 min and the cuff was immediately released to induce acute hypotension. While the resting baseline for COX before the thigh-cuff release manipulation decreased gradually with the reduction of FiO2 (P < 0.05), the resting baseline for SkBF, mean arterial blood pressure (MAP), and cutaneous vascular conductance (CVC) were unaffected by FiO2 (P > 0.05). The acute hypotension that was induced by the thigh-cuff release decreased COX, SkBF, MAP, and CVC; thereafter, these values recovered toward their baseline values. During the hypotension phase, while the time to the nadir values for COX slowed progressively with reductions in FiO2 (P < 0.05), those for SkBF, MAP, and CVC were unaffected by FiO2 (P > 0.05). These results suggest that COX may not be associated with SkBF for the protocol or with the subjects in the present study.


Assuntos
Circulação Cerebrovascular , Lobo Frontal , Hipotensão , Pele , Adulto , Velocidade do Fluxo Sanguíneo , Lobo Frontal/fisiologia , Hemodinâmica , Humanos , Hipotensão/fisiopatologia , Masculino , Pele/irrigação sanguínea , Adulto Jovem
13.
Adv Exp Med Biol ; 1232: 361-367, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31893432

RESUMO

Hyperspectral imaging is a promising clinical imaging modality with multiple applications in wound care, dermatology, and ophthalmology. However, with current technologies, hyperspectral imagers are relatively large and expensive devices, mainly affordable only by hospitals. Multispectral imaging can be a cost-effective alternative for hyperspectral imaging and is capable of bringing diagnostics to primary health care. Multispectral imaging uses known features of tissue chromophores to simplify imaging device design. However, to maintain design simple and cost-effective the number of illumination bands should be minimal. Thus, proper band selection is very important. The goal of the current study is to develop an analytical model for the optimization of band selection for multispectral and narrow-band imaging techniques (e.g., narrow-band microscopy). METHODS: The contrast ratio has been proposed for quantification of image quality of subsurface inhomogeneities in the skin. Based on the two-flux Kubelka-Munk model, we developed an analytical approach which links the contrast ratio with optical tissue parameters. RESULTS: We obtained an explicit analytical solution for the dependence of maximal contrast ratio on optical tissue parameters. Then, we linked the minimally observable contrast ratio (cmin) with the bit depth of the camera, d: cmin = 1/(2d-1). Based on this analysis we were able to derive an explicit expression, which links camera properties with the minimally detectable changes in optical tissue parameters (both scattering and absorption). CONCLUSIONS: The proposed analytical model can be used for rapid assessment and optimization of multispectral and narrow band imaging techniques and for estimation of the accuracy of imaging techniques. The developed model confirms the utility of the contrast ratio for tissue imaging.


Assuntos
Imagem de Banda Estreita , Pele , Humanos , Iluminação , Modelos Estatísticos , Imagem de Banda Estreita/métodos , Pele/diagnóstico por imagem
14.
Anticancer Res ; 40(1): 511-518, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892606

RESUMO

BACKGROUND/AIM: This review examined the implications of using sunscreen photoprotection on 25(OH)D formation and determined the best photoprotective method to reduce the risk of skin cancer caused by ultraviolet radiation (UVR). Based on previous studies on 25(OH)D formation after use of different amounts of sunscreen and different doses of UVR for approximately one week to different body areas it is possible to estimate the amount of 25(OH)D formed after a week's holiday in Southern and Northern Europe. CONCLUSION: The best method of photoprotection by sunscreen is two consecutive applications before sun exposure, ensuring the use of sufficient amounts of sunscreen and minimizing the unprotected skin areas. The double application method simultaneously ensures a high photoprotection against erythema from sun exposure. Despite the use of sunscreen, the calculated serum 25(OH)D levels clearly increase to similar levels as those measured after sun vacations.


Assuntos
Protetores Solares/farmacologia , Vitamina D/análogos & derivados , Humanos , Pele/efeitos da radiação , Banho de Sol , Raios Ultravioleta , Vitamina D/metabolismo , Organização Mundial da Saúde
15.
Anticancer Res ; 40(1): 565-572, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31892613

RESUMO

BACKGROUND/AIM: To assess the effectiveness of three UV emitting lamps on the cutaneous production of vitamin D3, a marker of DNA damage and nitric oxide production in human skin. MATERIALS AND METHODS: Human skin samples (skin types II, III and IV) obtained from surgery were exposed to three different UV emitting lamps for varying times and then extracted and chromatographed to determine the vitamin D3 content. The skin samples exposed to the 3 UV emitting lamps were also evaluated for 8-hydroxy-2'-deoxyguanosine (a marker of DNA damage) and nitric oxide production. RESULTS: It was observed that the spectral output of the 3 lamps had different effects on the cutaneous production of vitamin D3, 8-hydroxy-2'-deoxyguanosine and nitric oxide production. One lamp demonstrated optimal production of vitamin D3 with the least amount of DNA damage and intermediate production of nitric oxide suggesting that it could be developed into a device for treating vitamin D deficiency. CONCLUSION: The spectral output of the experimental UVB emitting lamps significantly influenced the cutaneous production of vitamin D3 8-hydroxy-2'-deoxyguanosine and nitric oxide.


Assuntos
/biossíntese , Colecalciferol/biossíntese , Óxido Nítrico/biossíntese , Pele/metabolismo , Pele/efeitos da radiação , Raios Ultravioleta , Relação Dose-Resposta à Radiação , Eritema/etiologia , Humanos
16.
Hautarzt ; 71(2): 91-100, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31965205

RESUMO

The skin is a complex organ that performs a number of vital functions, including forming a physical barrier that protects our body from the penetration of pathogens and irritants and from excessive transepidermal water loss. In addition to its passive properties, the skin is also actively involved in the immune process. A complex structure of different cell types and structures allows the skin to fulfil these functions. In vitro research often faces the problem that simple 2D cell cultures are not able to adequately map these functions. Here 3D skin models offer a possible solution. In recent years, there has been significant development in this field; the reproducibility of the method as well as the physiological structure and tissue architecture of the 3D skin models have been improved. Depending on the research question, protocols for 3D skin models have been published, ranging from simple multilayer epidermis models to highly complex vascularized 3D full skin models.


Assuntos
Técnicas de Cultura de Células , Dermatologia , Modelos Biológicos , Técnicas de Cultura de Células/métodos , Epiderme , Humanos , Reprodutibilidade dos Testes , Pele
17.
Hautarzt ; 71(2): 101-108, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31965207

RESUMO

BACKGROUND: Since the establishment of dermoscopy as a routine examination procedure in dermatology, the spectrum of noninvasive, optical devices has further expanded. In difficult-to-diagnose clinical cases, these systems may support dermatologists to arrive at a correct diagnosis without the need for a surgical biopsy. OBJECTIVE: To give an overview about technical background, indications and diagnostic performance regarding four new optical procedures: reflectance confocal microscopy, in vivo multiphoton tomography, dermatofluoroscopy, and systems based on image analysis by artificial intelligence (AI). MATERIALS AND METHODS: This article is based on a selective review of the literature, as well as the authors' personal experience from clinical studies relevant for market approval of the devices. RESULTS: In contrast to standard histopathological slides with vertical cross sections, reflectance confocal microscopy and in vivo multiphoton tomography allow for "optical biopsies" with horizontal cross sections. Dermatofluoroscopy and AI-based image analyzers provide a numerical score, which helps to correctly classify a skin lesion. The presented new optical procedures may be applied for the diagnosis of skin cancer as well as inflammatory skin diseases. CONCLUSION: The presented optical procedures provide valuable additional information that supports dermatologists in making the correct diagnosis. However, a surgical biopsy followed by dermatohistopathological examination remains the diagnostic gold standard in dermatology.


Assuntos
Dermatologia , Dermatopatias , Neoplasias Cutâneas , Dermoscopia , Humanos , Microscopia Confocal , Pele , Dermatopatias/diagnóstico , Neoplasias Cutâneas/diagnóstico
18.
Hautarzt ; 71(1): 63-77, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31773173

RESUMO

Malignant melanoma is an aggressive skin cancer that originates from cells of the melanocytic lineage and is associated with an invasive growth pattern and early spread. Besides endogenous risk factors such as fair skin type or genetic disposition for the formation of multiple nevi, exposure to ultraviolet light is the most important exogenous risk factor. Treatment of patients with primary tumors includes the complete excision of the primary lesion with appropriate safety margins and in patients with an increased risk of metastasis sentinel lymph node excision. Prognostically significant parameters are the Breslow invasion depth, ulceration of the primary lesion, and sentinel lymph node status. Systemic therapy plays an important role in the adjuvant setting and for inoperable tumors. Depending on the indication and the molecular profile of the tumor tissue, immune checkpoint inhibitors or targeted kinase inhibitors can be used and may result in a significant prolongation of survival times.


Assuntos
Melanoma , Neoplasias Cutâneas , Humanos , Excisão de Linfonodo , Linfonodos , Metástase Linfática , Melanoma/diagnóstico , Melanoma/terapia , Biópsia de Linfonodo Sentinela , Pele , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/terapia
19.
Forensic Sci Int ; 306: 110066, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31765884

RESUMO

In forensic evaluation of charred corpses, internal detrimental signs may result as more significant of those observed during external examination and is often arduous to state if a victim was exposed to fire before or after death. When the histological analysis of the remaining internal viscera is necessary, the massive destruction caused by the lesion, the charring and the coarctation of the samples don't allow to give further information or to determine the remaining organic components of the viscera. This limit is determined by the intrinsic characteristics of this thermal lesivity of self-maintenance even after the exitus of the subject, worsening the initial detrimental framework. The Authors, with the purpose of improving the microscopic visualization of the samples collected from cadavers with peculiar deterioration, as in case of carbonization, suggest the use of a specific technical protocol based on the use of Sandison's rehydrating solution since the samples treated with this solution showed, at microscopic examination, a substantial histological-morphological improvement.


Assuntos
Fogo , Patologia Legal/métodos , Soluções para Reidratação , Adulto , Idoso , Idoso de 80 Anos ou mais , Aorta/patologia , Encéfalo/patologia , Cadáver , Dura-Máter/patologia , Esôfago/patologia , Feminino , Humanos , Intestino Delgado/patologia , Rim/patologia , Fígado/patologia , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Miocárdio/patologia , Pele/patologia , Baço/patologia , Adulto Jovem
20.
J Surg Oncol ; 121(1): 144-152, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31638275

RESUMO

BACKGROUND AND OBJECTIVES: Development of vascularized submental lymph node (VSLN) flap has encountered dilemmas; (a) whether to include skin paddle, (b) how to reduce the harvest area while gaining most lymph nodes. To answer, these structures were studied; submental perforator, lymph nodes in neck-level I and anterior belly of digastric muscle (ABDM). METHODS: Forty VSLN flaps were harvested from 23 cadavers. The lymph nodes and arterial supply were studied macro- and microscopically. The nodes were classified by arterial supplies, location along the longitudinal axis and relationship with ABDM. RESULTS: VSLN flap had 4.4 lymph nodes by average (range 1-8) predominantly located in the posterior three-quarter of the flap. Half of the submental perforators were originated deep to ABDM. they circumvent the muscle, supplied much of the nodes in neck sublevel Ia before reaching the skin. While sublevel Ib located the most surgically accessible submental nodes. Most of their arterial supply was branched from submental perforator lateral to ABDM, not directly from the submental artery. CONCLUSION: The flap could be reduced to the posterior three-quarter of the original area. Skin paddle should be included to serve as an indirect lymph node monitor. If Ia lymph nodes are to be included, ABDM should be sacrified.


Assuntos
Linfonodos/anatomia & histologia , Linfonodos/irrigação sanguínea , Músculos do Pescoço/anatomia & histologia , Pele/irrigação sanguínea , Retalhos Cirúrgicos/irrigação sanguínea , Idoso , Artérias/anatomia & histologia , Cadáver , Dissecação , Feminino , Humanos , Linfonodos/cirurgia , Masculino , Pessoa de Meia-Idade , Músculos do Pescoço/irrigação sanguínea
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