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1.
Kyobu Geka ; 73(10): 887-891, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-33130785

RESUMO

Esophageal reconstruction using intestine is often performed for esophageal cancer patients in cases where the stomach cannot be used. We have previously performed reconstruction using ileocolon with supercharge and drainage as our 1st choice in those cases. However, a less invasive, simpler, and safer reconstructive technique using pedicled jejunal flap has recently become popular at our facility. When making the pedicled jejunal flap, the 1st jejunal vascular arcade was preserved, which in many cases allowed it to be pulled up to the cervical region by processing and transection up to the 2nd jejunal vascular branch. But supercharge and superdrainage may be required for pedicled jejunal flap reconstruction when blood flow of jejunal flap is not good condition. And free jejunal reconstruction is performed to reconstruction after cervical esophagectomy. Vascular anastomosis is essential for free jejunal reconstruction. This article describes the surgical technique and perioperative management of esophageal reconstruction with vascular anastomosis.


Assuntos
Neoplasias Esofágicas , Procedimentos Cirúrgicos Reconstrutivos , Anastomose Cirúrgica , Neoplasias Esofágicas/cirurgia , Esofagectomia , Humanos , Jejuno/cirurgia , Retalhos Cirúrgicos
2.
Vestn Otorinolaringol ; 85(5): 74-77, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33140939

RESUMO

The object of the clinical research was 367 patients after rhinoplasty. All patients before the operation fill in a special questionnaire, allowing to evaluate quantify the signs of dysmorphophobia. Patients with low index of dysmorphophobia (within 5-6 points) adequately estimated the result of the operation because their opinion coincided with the opinion of the doctor and in some cases they didn't notice even insignificant defects the doctor saw. The total number of these results satisfying the patient and the doctor composed 93% (341 patients). The patients who attaches great importance to insignificant defect of their appearance the index of desmorphophobia was high (16 patients - the average index of dysmorphophobia - 15). Questionnaires containing questions that allows to expose the signs of dysmorphophobia may be useful in the time of selection of patients for plastic surgery, in particular rhinoplasty. According to the questionnaire worked out by us, the index of dysmorphophobia of 5 points and below allows to count up on an adequate evaluation. The importance of index from 6 to 10 points may require psychological support of the patient who will much evaluate the result.


Assuntos
Médicos , Procedimentos Cirúrgicos Reconstrutivos , Rinoplastia , Cirurgia Plástica , Humanos , Satisfação do Paciente , Inquéritos e Questionários
3.
Artigo em Russo | MEDLINE | ID: mdl-33161681

RESUMO

Nikolai Olegovich Milanov, the academician of the Russian Academy of Medical Sciences, leading Russian surgeon, Merited Scientist of the Russian Federation, is one of the pioneers of development of reconstructive microsurgery in our country. He made immense contribution to development of modern plastic and reconstructive microsurgery. He is the author of unique developments that inputted significantly into successive achievements in treatment of traumatic and iatrogenic tissue defects and congenital pathology. The priority areas of his research were replantation of fingers, hands and larger segments of limbs in adults and lower extremities in children, abjuncted because of wheeled traumas, auto-transplantation of revasculized tissue complexes in post-traumatic, congenital and acquired pathologies in adults and children, in oncologic diseases, in extensive tracheal defects, reconstructive microsurgery of blood and lymph vessels and peripheral nerves, reconstructive microsurgery in male and female infertility. He introduced to clinical practice great number of new surgical interventions based on micro-surgical auto-transplantation of various tissue complexes. He achieved brilliant successes in scientific and practical activities during 39 years of work. He was the first in the world who underwent a successful re-implantation of lower limb, amputated at the level of upper third of leg by train wheel in 2.5-year-old child. He also was the first surgeon who performed unique operation of simultaneous replantation of two limbs, amputated at the level of middle third of leg in 7-year-old child. N. O. Milanov used the micro-surgical technique of applying direct lymphatic venous anastomoses in lymphatic edema. He developed innovative methods of multiple transplantation of toes to hand and transplantation of omentum, for example, to close defects of the scalp in basal cell carcinoma. This brilliant surgeon can be called the founder of clinical auto-transplantology. He actively participated in resolving problem of "prefabrication" of various tissue complexes with desired properties for their subsequent auto-transplantation. Under the direction of N. O. Milanov, the new scientific school was formed that included such well-known surgeons as R. T. Adamyan, A. I. Nerobeev, I. V. Reshetov and many others.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Cirurgia Plástica , Aniversários e Eventos Especiais , Masculino , Microcirurgia , Federação Russa
4.
Bone Joint J ; 102-B(11): 1567-1573, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33135449

RESUMO

AIMS: The aim of this study was to report the results of three forms of reconstruction for patients with a ditsl tibial bone tumour: an intercalary resection and reconstruction, an osteoarticular reconstruction, and arthrodesis of the ankle. METHODS: A total of 73 patients with a median age of 19 years (interquartile range (IQR) 14 to 36) were included in this retrospective, multicentre study. RESULTS: Reconstructions included intercalary resection in 17 patients, osteoarticular reconstruction in 11, and ankle arthrodesis in 45. The median follow-up was 77 months (IQR 35 to 130). Local recurrence occurred in eight patients after a median of 14 months (IQR 9 to 36), without a correlation with adequacy of margins or reconstructive technique. Major complications included fracture of the graft in ten patients, nonunion of the proximal osteotomy in seven, and infection in five. In the osteoarticular group, three of 11 patients developed radiological evidence of severe osteoarthritis, but only one was symptomatic and required conversion to ankle arthrodesis. Functional evaluation showed higher values of the Musculoskeletal Tumour Society (MSTS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores in the intercalary group compared with the others. CONCLUSION: Preservation of the epiphysis in patients with a distal tibial bone tumour is a safe and effective form of limb-sparing treatment. It requires rigorous preoperative planning after accurate analysis of the imaging. When joint-sparing resection is not indicated, ankle arthrodesis, either isolated tibiotalar or combined tibiotalar and subtalar arthrodesis, should be preferred over osteoarticular reconstruction. Cite this article: Bone Joint J 2020;102-B(11):1567-1573.


Assuntos
Articulação do Tornozelo/cirurgia , Neoplasias Ósseas/cirurgia , Procedimentos Ortopédicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Tíbia/cirurgia , Adolescente , Adulto , Artrodese , Neoplasias Ósseas/terapia , Criança , Feminino , Humanos , Salvamento de Membro , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
5.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(11): 1410-1416, 2020 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-33191699

RESUMO

Objective: To investigate the influence of the design and application of novel surgical template on the accuracy of reconstructed mandibula and implant position in occlusion-guided functional mandibular reconstruction, so as to provide guidance for clinical treatment. Methods: Between January 2017 and May 2019, 11 patients with segmental mandible defects were treated, including 8 males and 3 females with an average age of 31.8 years (range, 19-45 years). There were 6 cases of ameloblastoma, 3 cases of keratocystic tumor, and 2 cases of ossifying fibroma. According to Urken classification of mandible defects, there were 1 case of CRB, 4 cases of RB, 2 cases of RBS, and 4 cases of SB. According to the occlusion relationship, a novel surgical template with the reconstruction titanium plate screws and implants drill-guided information was designed and manufactured. With the help of the novel surgical template, the "one and a half" fibula reconstruction mode was used for jaw functional reconstruction, and the implant supported denture was finally completed. The postoperative CT at 1 week were collected to analyze the morphology of the preoperative virtual design jaw and postoperative jaw. The coincidence of fibular reconstructed mandible (fibular upper barrel, fibular reconstructed ramus and condyle, and whole mandible) and implant in mandible were calculated. When the coincidence was less than 80%, it was considered that the deviation was obvious. Oral panoramic X-ray film and cone beam CT were examined at 6 months after operation to evaluate the osseointegration before implant repair. Results: None of the 11 flaps had postoperative vascular crisis. One flap occurred necrosis at 1 month after reconstruction combined with 3 implants failed, and had been removed at 6 months after reconstructed surgery; the others had no flap necrosis. One week postoperatively, the coincidence of the fibular upper barrel was 87.55%±3.08%, the whole mandible was 82.68%±5.94%, and the implant in mandible was 88.00%, with significant differences ( t=8.131, P=0.000; t=2.118, P=0.046; Z=4.070, P=0.000) when compared to 80%, respectively. The fibular reconstructed ramus and condyle was 77.82%±3.54%, with no significant difference ( t=-2.042, P=0.068) when compared to 80%. Six months postoperatively, oral panoramic X-ray film and cone beam CT showed that all 22 implants achieved osseointegration and the palatal mucosa transplantation was performed, then finally completed the denture rehabilitation at 6-9 months after operation. All patients were satisfied with their postoperative appearance. Conclusion: The novel surgical template can guarantee the accuracy of functional mandible reconstruction guided by occlusal guidance, and ultimately achieve the beautiful contour of jaw and occlusal function reconstruction, and improve the patient's life quality.


Assuntos
Ameloblastoma , Retalhos de Tecido Biológico , Neoplasias Mandibulares , Reconstrução Mandibular , Procedimentos Cirúrgicos Reconstrutivos , Adulto , Ameloblastoma/cirurgia , Transplante Ósseo , Feminino , Fíbula/cirurgia , Humanos , Masculino , Mandíbula/cirurgia , Neoplasias Mandibulares/cirurgia , Pessoa de Meia-Idade , Retalhos Cirúrgicos , Adulto Jovem
6.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(11): 1417-1422, 2020 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-33191700

RESUMO

Objective: To investigate the application value of contrast-enhanced ultrasound (CEUS) technique to assist the repair of oral and maxillofacial defects by superficial inferior epigastric artery perforator flap. Methods: Sixteen oral cancer patients, 10 males and 6 females, who were to undergo superficial inferior epigastric artery perforator flap repair between June 2018 and February 2020, were selected, with an average age of 55.8 years (range, 24-77 years). There were 13 cases of squamous cell carcinoma, 2 cases of adenoid cystic carcinoma, and 1 case of mucinous epidermis-like carcinoma. The color Doppler ultrasound (CDUS) and CEUS were used to screen the superficial inferior epigastric artery, assisted in the design of the flap, and compared it with the actual intraoperative exploration. The sensitivity, specificity, positive predictive value, and negative predictive value of CEUS and CDUS examinations were analyzed. Fourteen of 16 patients were repaired with superficial inferior epigastric artery perforator flap, and 2 patients were repaired with superficial iliac artery flap because the source artery was not found. After surgery, regular follow-up was performed to check for disease recurrence and metastasis and to evaluate the appearance of the patien's donor area, the recovery of transoral feeding function, and the presence of complications. Results: Comparison of preoperative CDUS and CEUS findings and intraoperative exploration showed that CEUS had 100% sensitivity, specificity, positive predictive value, and negative predictive value for vascular exploration of the superficial inferior epigastric artery perforator flap, compared with 57%, 100%, 100%, and 25% for CDUS. The preoperative CDUS identified 25 penetrating vessels in 14 cases repaired with superficial inferior epigastric artery flaps. All vessel signals were enhanced by CEUS enhancement, and an additional 11 penetrating vessels were identified confirmed intraoperatively. The preoperative CEUS measurements of the initial diameter of superficial arteries in the abdominal wall were significantly higher than both CDUS and intraoperative measurements ( P<0.05); the difference in peak systolic velocity between CEUS and CDUS measurements was significant ( t=3.708, P=0.003). One case of superficial epigastric artery perforator flap developed venous embolism crisis at 48 hours after operation, the wound healing delayed. The other incisions in donor sites healed by first intention. All the patients were followed up 3-12 months, with an average of 8 months. No recurrence or metastasis appeared during the follow-up. There was no serious complications such as abdominal wall hernia, the location of abdominal scarring was hidden, and transoral feeding was resumed. Conclusion: The superficial inferior epigastric artery perforator flap with small injury in supply area and hidden scar location is a better choice for repairing oral and maxillofacial defects. The use of CEUS technique to assist the preoperative design of the superficial inferior epigastric artery perforator flap has good feasibility and high accuracy.


Assuntos
Parede Abdominal , Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Adulto , Idoso , Artérias Epigástricas/diagnóstico por imagem , Artérias Epigástricas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Adulto Jovem
7.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(11): 1423-1428, 2020 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-33191701

RESUMO

Objective: To evaluate the effectiveness of pedicled skin flap of foreskin for phalloplasty and Sugita surgical method in the treatment of complete concealed penis. Methods: The clinical data of 46 children with complete concealed penis between January 2016 and January 2018 were analyzed retrospectively. Among which, 25 cases were treated with pedicled skin flap of foreskin for phalloplasty (group A) and 21 cases were treated with Sugita surgical method (group B) with an average age of 4.7 years (range, 2 years and 8 months to 11 years). At 3 months after operation, the concealed penis recovery was scored from three aspects of postoperative penis length (the difference of the penis length between at 3 months after operation and before operation), penis appearance, and skin appearance (the total score was 10). And the parents evaluation of satisfaction degree of penis exposure, penis appearance, and foreskin appearance after surgical correction was collected. Results: Eighteen cases (72.0%) in group A and 15 cases (71.4%) in group B were followed up with an average of 13 months (range, 3-36 months). The incisions healed well in both groups, and there was no flap dehiscence, infection, necrosis, and penile erectile dysfunction. The penile length of the two groups increased significantly at 3 months after operation ( P<0.05); there was no significant difference between the two groups in terms of penis length and increased length at 3 months after operation and score of increase penis length after operation ( P>0.05). No penile retraction occurred in the two groups. And there was no significant difference between the two groups in penis appearance score, but the penis appearance score, skin appearance score, and total score of group A were significantly better than those of group B ( P<0.05). At 3 months after operation, the satisfaction rate of penis exposure in group A and group B was 88.9% and 80.0%, respectively, with no significant difference ( χ 2=0.50, P=0.48); the satisfaction rate of penis appearance was 72.2% and 53.3%, and the satisfaction rate of foreskin appearance was 94.4% and 53.3%, respectively, and the differences were significant ( χ 2=5.13, P=0.03; χ 2=7.53, P=0.01). Conclusion: Both surgical methods are suitable for correction of complete concealed penis, and the penile length gets a satisfactory recovery. However, the lymphedema of the prepuce after Sugita surgical method is serious, which can easily lead to poor appearance of the penis after operation. In general, the effectiveness of pedicled skin flap of foreskin for phalloplasty is better than that of the Sugita surgical method.


Assuntos
Prepúcio do Pênis , Procedimentos Cirúrgicos Reconstrutivos , Criança , Prepúcio do Pênis/cirurgia , Humanos , Lactente , Masculino , Pênis/cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Urológicos Masculinos
8.
Urologiia ; (5): 73-77, 2020 Nov.
Artigo em Russo | MEDLINE | ID: mdl-33185351

RESUMO

AIM: Urethral stenosis is one of the serious complications after proximal hypospadias repair. A variety of techniques has been suggested for its correction, such as urethral dilation using bougies, endoscopic incisions and one- or two-staged urethroplasty with buccal mucosa. The aim of our study was to improve results of urethral stenosis correction in children after multiple proximal hypospadias repairs. MATERIALS AND METHODS: A total of 24 patients with urethral stenosis after proximal hypospadias repairs underwent treatment in the Department of Uroandrology of the Russian Childrens Clinical Hospital from 2015 to 2019. The age of the patients was from 3-17 years (average - 4.2) with penoscrotal form of hypospadias in 12, scrotal in 8, and perineal in 4 patients. All children previously underwent 2-8 hypospadias repairs. Patients were divided into 2 groups. In group I, 16 patients had urethral stenosis from the glans of the penis to the penoscrotal area, urethral diameter of 3-4 Ch and ventral penile curvature of 45-60o. These patients were treated with a two-staged urethroplasty, similar to Brackas technique. In group II, 8 patients with urethral stenosis in the penile shaft area, urethral diameter of 6 Ch, without penile curvature were included. They underwent to a one-stage urethroplasty with buccal mucosa graft, which was sutured on the dorsolateral aspect of the urethra, with a formation of the age-appropriate urethra (Dorsolateral Inlay). RESULTS: All patients in both groups had successful results with flow rate of 8-12 ml/sec. CONCLUSIONS: The correction of urethral stenosis in children after proximal hypospadias repairs can be performed using buccal mucosa. In cases of long urethral stenosis, urethral diameter of 3-4 Ch, penile curvature, and scarring of the penile skin, a two-staged urethroplasty is recommended. In patients with stenosis of the penile shaft, urethral diameter of 6 Ch and lack of penile curvature, a one-stage urethroplasty with buccal mucosa fixation on the dorsolateral aspect of the urethra (Dorsolateral Inlay) allows to achieve successful results.


Assuntos
Hipospadia , Procedimentos Cirúrgicos Reconstrutivos , Estreitamento Uretral , Criança , Humanos , Hipospadia/cirurgia , Lactente , Masculino , Pênis/cirurgia , Federação Russa , Resultado do Tratamento , Uretra/cirurgia , Estreitamento Uretral/etiologia , Estreitamento Uretral/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
9.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(10): 1288-1293, 2020 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-33063495

RESUMO

Objective: To explore the suitable division of male genitalia subunits and the effectiveness of large-area perineum defect repair under its guidance. Methods: According to the anatomical and functional characteristics of male genitalia, the subunit division scheme was proposed: area Ⅰ, glans penis; area Ⅱ, body of penis; area Ⅲ, scrotum; area Ⅳ, scrotum. Between April 2017 and July 2019, 12 patients with large genitalia defects were treated, with an average age of 60.9 years (range, 57-66 years) and an average disease duration of 2.7 years (range, 2-5 years). The defect area involved area Ⅰ in 1 case, area Ⅱ in 7 cases, area Ⅲ in 5 cases, and area Ⅳ in 8 cases; the size of area ranged from 6 cm×4 cm to 23 cm×16 cm. The causes of defect included 3 cases of trauma, 6 cases of Paget disease, 2 cases of squamous cell carcinoma, 1 case of spindle cell tumor. According to the design of the corresponding repair scheme, the main repair methods were to rotate and advance the skin flap and pedicled skin flap in the same area. When the defect was large, the free skin flap transplantation, free skin grafting, and free mucosa transplantation were used to repair the defect. Results: All the patients were followed up 6-13 months with an average of 8.6 months. Skin flap, skin graft, and mucosa survived in one stage in 10 patients; infection occurred in 1 case after the scrotal flap of area Ⅲ was transferred to repair the defect in area Ⅱ, 1 case had distal venous crisis at 2 days after repair area Ⅲ defect used free anterolateral thigh flap, and after active treatment, the condition improved. The appearance of the receiving area and the supplying area was good, and the local feeling was recovered satisfactorily. The range of motion of hip joint was good in 10 cases, and 2 cases were slightly stretched but did not affect normal life. All patients had normal urination and defecation function, and were satisfied with the treatment effectiveness. Conclusion: The subunits of male genitalia can be used to guide the repair of the defect, which can better restore the physiological appearance and function, and has positive clinical significance.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Períneo/cirurgia , Transplante de Pele , Lesões dos Tecidos Moles/cirurgia , Coxa da Perna
10.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3823-3826, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018834

RESUMO

the purpose of targeted muscle reinnervation (TMR) surgery is to provide more electromyography information for prosthetic control by reconstructing the deconstructed structure between the distal nerve and the stump muscle. Functional electrical stimulation (FES) of denervated muscles or proximal nerve stump after peripheral nerve surgery can effectively promote nerve regeneration and muscle function recovery. This pilot divided SD adult male rats into normal control group, denervation group, TMR group, and FES group according to whether they received TMR surgery and whether they received FES after surgery. The results showed that low-frequency electrical stimulation treatment could effectively promote transplanted nerve regeneration and significantly enhances motor function of target muscles.Clinical Relevance-This experiment successfully established TMR rat models, and explored the recovery of injured neuromuscular function by using electrodes implanted intramuscularly and analyzing myoelectric signals, and the use of low-frequency electrical stimulation treatment had a positive effect on the regeneration of the transplanted nerve.


Assuntos
Fenômenos Fisiológicos Musculoesqueléticos , Procedimentos Cirúrgicos Reconstrutivos , Animais , Estimulação Elétrica , Masculino , Regeneração Nervosa , Procedimentos Neurocirúrgicos , Ratos
11.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4200-4203, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018923

RESUMO

This paper presents a novel lead body design for active implantable medical devices (AIMD) to reduce Radio-frequency (RF) induced heating during magnetic resonance imaging (MRI) scanning. By introducing a counterpoise electrode to the original lead construct, part of the RF-induced energy can be decoyed into the surrounding tissues while the therapy signal is intact. The numerical simulation studies of three leads with different configurations are presented to demonstrate the effectiveness of this technique. From simulation results at 1.5 T, the peak 1g average SAR value can be reduced by a factor of 3 when the length of the counterpoise electrode is properly designed.


Assuntos
Calefação , Procedimentos Cirúrgicos Reconstrutivos , Imagem por Ressonância Magnética , Próteses e Implantes , Ondas de Rádio/efeitos adversos
12.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 898-901, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018129

RESUMO

This paper introduces a lossless approach for data reduction in multi-channel neural recording microsystems. The proposed approach benefits from eliminating the redundancy that exists in the signals recorded from the same space in the brain, e.g., local field potentials in intra-cortical recording from neighboring recording sites. In this approach, a single baseline component is extracted from the original neural signals, which is treated as the component all the channels share in common. What remains is a set of channel-specific difference components, which are much smaller in word length compared to the sample size of the original neural signals. To make the proposed approach more efficient in data reduction, length of the difference component words is adaptively determined according to their instantaneous amplitudes. This approach is low in both computational and hardware complexity, which introduces it as an attractive suggestion for high-density neural recording brain implants. Applied on multi-channel neural signals intra-cortically recorded using 16 multi-electrode array, the data is reduced by around 48%. Designed in TSMC 130-nm standard CMOS technology, hardware implementation of this technique for 16 parallel channels occupies a silicon area of 0.06 mm2, and dissipates 6.4 µW of power per channel when operates at VDD=1.2V and 400 kHz.Clinical Relevance- This paper presents a lossless data reduction technique, dedicated to brain-implantable neural recording devices. Such devices are developed for clinical applications such as the treatment of epilepsy, neuro-prostheses, and brain-machine interfacing for therapeutic purposes.


Assuntos
Interfaces Cérebro-Computador , Procedimentos Cirúrgicos Reconstrutivos , Encéfalo , Próteses e Implantes , Registros
13.
Medicine (Baltimore) ; 99(40): e22506, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019450

RESUMO

RATIONALE: Primary repair of acute ligament injury is possible due to the proximity of the ends. In the case of chronic injury, however, primary repair is difficult because the ends of ruptured ligament will have receded, and tendon graft, transfer, or reconstruction is needed. Satisfactory clinical results have been reported after reconstruction with newly formed interposed scar tissue between the ends of the ruptured tendon in chronic Achilles tendon injury and chronic extensor halluces longus (EHL) tendon injury. Here, we report a patient treated with reconstructive surgery using well-formed scar tissue between the ends in a case of chronic EDL tendon rupture. PATIENT CONCERNS: A 34-year-old woman visited the clinic with pain in the dorsum aspect of the right foot associated with weakness and loss of extension of the second toe. She had sustained an injury to the dorsal aspect of her foot by falling on broken glass 3 months before coming to our clinic. The patient reported pain and limitation of the extension of the second toe for 2 months. Her pain continued to worsen, and 1 month later she was transferred to our hospital because a different local clinician suspected she had ruptured her second EDL tendon. DIAGNOSIS: Magnetic resonance imaging (MRI) revealed complete rupture of the second EDL tendon at the metatarsal neck junction, with displacement of the distal end to the proximal phalanx shaft area and of the proximal end to the metatarsal shaft area. INTERVENTIONS: Chronic rupture of the EDL tendon was treated with direct reconstruction using interposed scar tissue. OUTCOMES: At the 3-month follow-up, the patient was almost asymptomatic and had nearly full range of motion in dorsiflexion of the second toe. She has no discomfort in her daily life and has returned to almost her preoperative level of functional activities. LESSONS: Here, we presented an extremely rare case of reconstruction using interposed scar tissue in a patient with neglected EDL tendon rupture. Direct reconstruction using interposed scar tissues located between the ends of the ruptured tendon is considered a reliable method with satisfactory clinical results in carefully selected patients.


Assuntos
Cicatriz/cirurgia , Pé/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Traumatismos dos Tendões/cirurgia , Adulto , Doença Crônica , Feminino , Humanos
14.
Stomatologiia (Mosk) ; 99(5): 87-91, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33034183

RESUMO

The paper presents a clinical case demonstrating the necessity for scarce dental implants surgery in tissues affected by multiply surgical and radiological procedures. The patient underwent 13 interventions, 4 reconstructive procedures and 3 courses of radiotherapy resulting in extensive facial defect. An orthopedic construction was fixed in a defect on mechanically stable single-stage implants with screw-retained orthopedic platform and trans-zygomatic implants on the contralateral side. The method is based on virtual diagnostics and choice of materials for 3D-prototyping of a framework to fill the defect and serve as supportive element for fixation and stabilization of obturator and facial mask.


Assuntos
Implantes Dentários , Procedimentos Cirúrgicos Reconstrutivos , Prótese Dentária Fixada por Implante , Humanos
15.
Khirurgiia (Mosk) ; (9): 69-74, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33030004

RESUMO

Critical limb ischemia, especially in the absence of autologous vein, prosthetic and native vascular infections are isolated diseases for which there currently doesn't have best surgical treatment. Vascular allografts may be the treatment of choice for these patients. In this analysis, we tried to reflect the directions of development of vascular allotransplantation, global trends related to indications for their use, methods of conservation, degradation and endothelial dysfunction. At the present time there doesn't have meta-analyzes on the efficiency of using arterial allografts or other options for implantation (synthetic graft, xenografts) for critical limb ischemia and graft and native infections. Now it is wrong to recommend using them always. Further studies of their performance are necessary. In addition, development of graft control techniques is also needed when rejection develops. Currently, there are no special diagnostic markers, the assessment of which could save patients with immune-mediated dilatation and dysfunction of allografts.


Assuntos
Artérias , Procedimentos Cirúrgicos Reconstrutivos , Aloenxertos , Humanos , Extremidade Inferior , Transplante Homólogo
16.
Arthroscopy ; 36(10): 2642-2644, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33039039

RESUMO

Despite acromioclavicular (AC) joint injuries being common, there are still controversies about the treatment; nonoperative versus surgical, who to operate, when to operate, which technique to use, and which rehabilitation protocol to use. Orthopaedic surgeons are often faced with these patients fearing not regaining normal function and to some degree acceptable cosmetic outcomes. Despite increasing interest in surgical management of type 3 AC joint injuries, surgical management has not been demonstrated to yield superior functional outcomes compared with nonoperative treatment. Interestingly, studies have demonstrated that good outcomes are achieved with most surgical techniques even though they are all associated with loss of initial reduction. This brings into question whether surgery is necessary in the early phase and how we can mitigate the effects of gravity to maintain reduction. Studies that can aid surgeons in patient selection for treatment protocols (nonoperative versus surgical) and timing of surgery are needed. We recommend early surgery, and restricted rehabilitation, for high-grade acromioclavicular joint dislocation.


Assuntos
Articulação Acromioclavicular , Luxações Articulares , Procedimentos Cirúrgicos Reconstrutivos , Luxação do Ombro , Articulação Acromioclavicular/cirurgia , Humanos , Luxações Articulares/cirurgia , Postura , Luxação do Ombro/cirurgia
17.
Anticancer Res ; 40(11): 6539-6543, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33109595

RESUMO

BACKGROUND: Omentoplasty is sometimes used to prevent perineal wound complications after abdominoperineal resection (APR) following neoadjuvant chemoradiotherapy (NACRT). However, recent studies have raised some controversy about its clinical benefit. PATIENTS AND METHODS: Outcomes for rectal cancer patients who received APR after NACRT were retrospectively compared between the groups with omentoplasty (n=28) and without omentoplasty (n=14). RESULTS: The operative time was significantly longer in the omentoplasty group (575 vs. 404 min, p<0.001). Laparoscopic surgery was performed more frequently in the omentoplasty group. Perineal wound problems including dehiscence and infection were significantly reduced in the omentoplasty group (46.4% vs. 78.6%, p<0.001). Univariate and multivariate analyses revealed that omentoplasty was the most important factor in reducing perineal wound complications (odds ratio=0.020, 95% confidence intervaI=0.001-0.393; p=0.001). CONCLUSION: Omentoplasty was useful in reducing perineal wound complications after APR following NACRT.


Assuntos
Complicações Pós-Operatórias/cirurgia , Protectomia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias Retais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimiorradioterapia , Feminino , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Omento/fisiopatologia , Omento/cirurgia , Duração da Cirurgia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/prevenção & controle , Protectomia/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/patologia , Neoplasias Retais/radioterapia , Cicatrização
18.
Medicine (Baltimore) ; 99(44): e23022, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126386

RESUMO

With aging, pressure ulcers become a common health problem causing significant morbidity and mortality for physically limited or bedridden elderly persons. Here, we present our strategy for such patients. Between August 2010 and March 2019, 117 patients were enrolled. Patient age, etiology, defect size and location, flap reconstruction, outcome, and follow-up period were reviewed. Of these patients, 64 were female and 53 were male, with an age range of 21 to 96 years (mean 75.6). The mean area of defect was 61.5 cm. The most common etiology was dementia (33.3%), and ulcers were most frequently caused by sacral pressure (70.3%). The commonest surgical treatment was a V-Y advancement flap (50%). The complication rate was 27.5%, including dehiscence and late recurrence. Negative pressure wound therapy could be used if the initial defect was large. V-Y advancement flap is the most frequent surgical treatment for sacral pressure ulcers because it is simple and available for most types of defect. Primary closure may be considered as the simplest method if the defective area is <16 cm. Intraoperative indocyanine green angiography can help avoid secondary flap revisions. Our protocol ensures a short surgery time, little bleeding, and a low complication rate.


Assuntos
Lesão por Pressão/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Lesão por Pressão/patologia , Procedimentos Cirúrgicos Reconstrutivos , Sacro , Retalhos Cirúrgicos , Resultado do Tratamento , Adulto Jovem
19.
Unfallchirurg ; 123(11): 879-889, 2020 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-33048209

RESUMO

Injuries of the sternoclavicular joint (SCJ) are rare accounting for 3% of all injuries to the shoulder girdle and are often overlooked. The SCJ is surrounded by tight ligamentous structures, thus substantial energy with corresponding force vectors is needed to cause dislocation. Causative are mostly high-energy traumas. Anterior dislocation is most common but in rare cases potentially life-threatening posterior dislocation occurs, which requires immediate reduction. The established gold standard is 3D reconstruction in contrast-enhanced computed tomography (CT) for depiction of neurovascular structures. Low-grade instability can initially be treated conservatively. For unsuccessful attempts at reduction, high-grade instability and chronic instability various surgical techniques are established. Next to retentive augmentation with suture materials, in acute cases with chronic instability biological tendon augmentation is preferred. In cases of posttraumatic instability arthritis SCJ resection with or without additive biological augmentation can be carried out. Various study groups have shown good to very good midterm outcome.


Assuntos
Luxações Articulares , Procedimentos Cirúrgicos Reconstrutivos , Articulação Esternoclavicular , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Articulação Esternoclavicular/diagnóstico por imagem , Articulação Esternoclavicular/lesões , Articulação Esternoclavicular/cirurgia , Suturas , Tendões
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