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1.
Bone Joint J ; 101-B(9): 1144-1150, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474137

RESUMO

AIMS: The aim of this study was to report the results of custom-made endoprostheses with extracortical plates plus or minus a short, intramedullary stem aimed at preserving the physis after resection of bone sarcomas in children. PATIENTS AND METHODS: Between 2007 and 2017, 18 children aged less than 16 years old who underwent resection of bone sarcomas, leaving ≤ 5 cm of bone from the physis, and reconstruction with a custom-made endoprosthesis were reviewed. Median follow-up was 67 months (interquartile range 45 to 91). The tumours were located in the femur in 11 patients, proximal humerus in six, and proximal tibia in one. RESULTS: The five-year overall survival rate was 78%. No patient developed local recurrence. The five-year implant survival rate was 79%. In all, 11 patients (61%) developed a complication. Seven patients (39%) required further surgery to treat the complications. Implant failures occurred in three patients (17%) including one patient with aseptic loosening and two patients with implant or periprosthetic fracture. The preserved physis continued to grow at mean 3.3 cm (0 to 14). The mean Musculoskeletal Society score was 88% (67% to 97%). CONCLUSION: Custom-made endoprostheses that aim to preserve the physis are a safe and effective option for preserving physeal growth, limb length, and joint function with an acceptable rate of complications. Cite this article: Bone Joint J 2019;101-B:1144-1150.


Assuntos
Neoplasias Ósseas/cirurgia , Lâmina de Crescimento/cirurgia , Osteossarcoma/cirurgia , Próteses e Implantes , Adolescente , Criança , Feminino , Fêmur/cirurgia , Fixação Intramedular de Fraturas , Humanos , Úmero/cirurgia , Salvamento de Membro/métodos , Masculino , Desenho de Prótese , Falha de Prótese , Implantação de Prótese/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Recuperação de Função Fisiológica , Reoperação , Tíbia/cirurgia
2.
J Laryngol Otol ; 133(8): 658-661, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31270001

RESUMO

OBJECTIVE: This study aimed to evaluate the long-term results of ossiculoplasty using bone cement. METHOD: Forty patients (24 females and 16 males; mean age: 34.1 ± 11.8 years; range, 9-54 years) with chronic otitis media with perforation but without cholesteatoma who had undergone incudostapedial rebridging ossiculoplasty using bone cement were evaluated retrospectively. Pre-operative and post-operative audiograms were evaluated. Bone conduction, air conduction and air-bone gaps were calculated according to international guidelines. RESULTS: There was a mean reduction in pre-operative and post-operative air conduction (12.30 ± 11.98 dB), and this result was significant (p = 0.0001). There was a mean reduction in pre-operative and post-operative bone conduction (4.30 ± 6.69 dB), and this result was significant (p < 0.0001). The pre-operative air-bone gap was 27.65 dB and decreased to 19.65 dB during follow-up (p = 0.0001). No adverse reactions or complications were observed. CONCLUSION: Bone cement is reliable for the repair of incudostapedial-joint defects.


Assuntos
Perda Auditiva Condutiva/cirurgia , Substituição Ossicular/instrumentação , Otite Média/cirurgia , Cirurgia do Estribo/instrumentação , Adolescente , Adulto , Audiometria , Cimentos para Ossos , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Otite Média/complicações , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
3.
Bone Joint J ; 101-B(7): 880-888, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31256665

RESUMO

AIMS: The aim of this study was to describe the use of 3D-printed sacral endoprostheses to reconstruct the pelvic ring and re-establish spinopelvic stability after total en bloc sacrectomy (TES) and to review its outcome. PATIENTS AND METHODS: We retrospectively reviewed 32 patients who underwent TES in our hospital between January 2015 and December 2017. We divided the patients into three groups on the basis of the method of reconstruction: an endoprosthesis group (n = 10); a combined reconstruction group (n = 14), who underwent non-endoprosthetic combined reconstruction, including anterior spinal column fixation; and a spinopelvic fixation (SPF) group (n = 8), who underwent only SPF. Spinopelvic stability, implant survival (IS), intraoperative haemorrhage rate, and perioperative complication rate in the endoprosthesis group were documented and compared with those of other two groups. RESULTS: The mean overall follow-up was 22.1 months (9 to 44). In the endoprosthesis group, the mean intraoperative hemorrhage was 3530 ml (1600 to 8100). Perioperative complications occurred in two patients; both had problems with wound healing. After a mean follow-up of 17.7 months (12 to 38), 9/10 patients could walk without aids and 8/10 patients were not using analgesics. Imaging evidence of implant failure was found in three patients, all of whom had breakage of screws and/or rods. Only one of these, who had a local recurrence, underwent re-operation, at which solid bone-endoprosthetic osseointegration was found. The mean IS using re-operation as the endpoint was 32.5 months (95% confidence interval 23.2 to 41.8). Compared with the other two groups, the endoprosthesis group had significantly better spinopelvic stability and IS with no greater intraoperative haemorrhage or perioperative complications. CONCLUSION: The use of 3D-printed endoprostheses for reconstruction after TES provides reliable spinopelvic stability and IS by facilitating osseointegration at the bone-implant interfaces, with acceptable levels of haemorrhage and complications. Cite this article: Bone Joint J 2019;101-B:880-888.


Assuntos
Procedimentos Ortopédicos/métodos , Ossos Pélvicos/fisiologia , Impressão Tridimensional , Próteses e Implantes , Procedimentos Cirúrgicos Reconstrutivos/métodos , Sacro/cirurgia , Coluna Vertebral/fisiologia , Adolescente , Adulto , Idoso , Criança , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osseointegração , Avaliação de Resultados (Cuidados de Saúde) , Complicações Pós-Operatórias/prevenção & controle , Período Pós-Operatório , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Recuperação de Função Fisiológica , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Adulto Jovem
5.
Orthopade ; 48(7): 572-581, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-31069450

RESUMO

BACKGROUND: Endoprosthetic replacement is a valuable treatment option following intercalary resection of bone tumours in the diaphysis. OBJECTIVES: To identify indication, operative technique, implants currently available, literature results and alternative procedures for the alloplastic reconstruction of segmental bone defects. MATERIALS AND METHODS: This review article summarizes the authors' own experiences and relevant clinical studies focussing on this topic. RESULTS: According to the literature, 10-year-survival rates of intercalary endoprostheses range between 64 and 80%. Yet, comparisons between different publications are difficult due to the limited number of cases, different implants, follow-up periods and the heterogeneous patient populations. Biological alternatives for reconstruction are autologous bone transplantation, distraction osteogenesis and bone transport, allogenic bone transplantation, and the induced membrane technique. Innovative tissue engineering approaches are still limited to preclinical testing. CONCLUSIONS: Short- to mid-term results for segmental endoprostheses following intercalary resections are satisfactory and may be regarded as superior to those of biological reconstructions due to the immediate full weight-bearing capability. However, they are mainly applied for elderly patients and in palliative situations because of potential long-term complications.


Assuntos
Neoplasias Ósseas , Procedimentos Cirúrgicos Reconstrutivos , Idoso , Neoplasias Ósseas/cirurgia , Transplante Ósseo , Humanos , Salvamento de Membro , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Reimplante , Estudos Retrospectivos , Resultado do Tratamento
6.
J Craniofac Surg ; 30(3): 736-738, 2019 May/Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31048609

RESUMO

Correction of microstomia is challenging with a high rate of recurrence. We report the successful treatment of microstomia using acellular dermal matrix (ADM) as an adjunct for intraoral lining with >1 year of follow-up.A 9-year-old international patient with severe immunodeficiency presented with severe microstomia because of recurrent oral infections. She had undergone 3 previous failed attempts to re-establish an adequate oral opening and was dependent on enteral nutrition via gastrostomy tube. She underwent release of the oral commissure scar contracture and orbicularis oris and the resultant mucosal defect was lined with ADM. A postoperative splint was used for 8 weeks. One-year follow-up demonstrated maintenance of the oral aperture with complete mucosalization of the ADM; the patient was able to resume oral diet and regular dental hygiene.Mucosal reconstruction with ADM is a viable alternative to local flaps and in this case exhibited minimal soft tissue contraction.


Assuntos
Bochecha/cirurgia , Microstomia/cirurgia , Mucosa Bucal/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Derme Acelular , Criança , Cicatriz/cirurgia , Feminino , Humanos , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/métodos
7.
J Craniofac Surg ; 30(3): 860-862, 2019 May/Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31048614

RESUMO

Various surgical techniques and approaches for addressing nasal valve collapse have been described in the literature. Still, new techniques continue to be developed and old techniques continue to be improved upon. The aim of the present study was to validate the use of the internal nasal valve expanding graft for middle vault reconstruction and to review the authors' experience using this technique. A total of 32 patients who underwent middle vault reconstruction were retrospective reviewed. Analysis using Visual Analogue Scale (VAS) and Nasal Obstruction Symptom Evaluation (NOSE)-scale was performed pre- and postoperatively. Visual Analogue Scale scores for nasal airflow per side were collected on a 10-point scale, with 1 indicating total obstruction and 10 indicating a perfect nasal airway. Nasal Obstruction Symptom Evaluation scale was used to assess nasal obstruction. Minimum follow-up period was 6 months after the operation. Pre- and postoperative VAS scores were used to assess degree of nasal valve collapse according to examination findings. It was significant that there was improvement in nasal valve collapse after surgery (P < 0.05). Based upon pre- and postoperative calculations made using NOSE scores, there was significant improvement regarding nasal blockage or congestion, troubled breathing and sleeping, and air through nose during exercise, respectively (P < 0.05). No complications in terms of septal perforation, hematoma, synechiae, or infection that required further intervention were noted at postoperative follow-ups. In conclusion, internal nasal valve expanding graft has now been shown to be successful for middle vault reconstruction in a group of appropriately selected patient.


Assuntos
Obstrução Nasal/cirurgia , Nariz/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Humanos , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Transplantes , Resultado do Tratamento
8.
J Craniofac Surg ; 30(3): 888-890, 2019 May/Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31048615

RESUMO

Extensive full-thickness burn injury of the scalp involving the skull is a challenge to reconstruct. Here, the authors report a case of a 6-year old girl who suffered extensive flame burn injury involving a scalp defect of 1,5% total body surface area. After necrosectomy, full table damage of the skull was observed with a partially exposed dura mater. Neurosurgical consultation was necessary to accomplish a vital wound bed. Subsequently, in the absence of enough adequate tissue available for flap surgery reconstruction, reconstruction was performed by using a bilayer Integra Dermal Regeneration Template (IDRT) resulting in a lasting and stable coverage of the defect. This is the first case-report describing application of IDRT on a full-thickness scalp and skull defect with exposed dura mater in a child. Our results are encouraging and demonstrate that Integra can be used in a child to successfully cover exposed dura when no viable skull remains.


Assuntos
Queimaduras/cirurgia , Sulfatos de Condroitina/uso terapêutico , Colágeno/uso terapêutico , Procedimentos Cirúrgicos Reconstrutivos , Couro Cabeludo , Crânio , Criança , Feminino , Humanos , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Couro Cabeludo/lesões , Couro Cabeludo/cirurgia , Crânio/lesões , Crânio/cirurgia
9.
J Biol Regul Homeost Agents ; 33(3): 1011-1013, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31056888

RESUMO

Skin cancer basal cell carcinoma (BCC) is a quite common lesion with a worldwide annual incidence between 3% and 8%. Tissue reconstruction should be biologically driven: nowadays, the naso-genial flap is one of the safest and usable flaps for the reconstruction of the labial and nasal region after invasive surgery aimed at a full BCC excision. In fact, the proximity of this flap to the area to be treated, the similar colour of the skin and the technical possibility to perform a single surgery to both harvest the flap and remove the lesion in the area to be then reconstructed, make it highly preferred by surgeons. In order to prevent the most severe swelling, the Authors started to use a novel method consisting in the use of the small-diameter cannula for lipoaspiration technique (SDCL). The correct use of SDCL allows to aspirate the adipose tissue, thus obtaining an available adipose-based scaffold, highly compatible with the area in which the flap is to be placed.


Assuntos
Cânula , Carcinoma Basocelular/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias Cutâneas/cirurgia , Estética , Humanos , Retalhos Cirúrgicos
10.
Rev Assoc Med Bras (1992) ; 65(3): 410-418, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30994841

RESUMO

INTRODUCTION: There is a worldwide increase in the number of invasive aesthetic procedures, and there is a general apprehension in medical societies towards the assurance of patient safety, that is dependent on the quality and certification of providers, of the materials and substances used, and where they take place.It is the main objective of this study to determine the perception of the gravity of non-authorized substances for clinical use in invasive aesthetic procedures among Portuguese plastic surgeons and its variation by the clinical sector of practice. METHODS: We proceeded to an inquiry by using a questionnaire, measured in a Linkert scale, and the collected data were statistically treated with a non-parametric Kruskal-Wallis test. RESULTS: We obtained a 41,4% answer rate and a global perception that this is a serious problem - a median of 8,00 and mean of 7,45 points on a 1 to 10 scale. 70% of the plastic surgeons that answered the questionnaire work both in the private and public sector, 19% exclusively in the public sector and 11% only in private practice. The perception of the problem was most serious among those that work exclusively in the private sector (statistically significant difference). CONCLUSION: The causes of the observed difference may reside in various reasons: the higher number of patients submitted to invasive aesthetic procedures exclusively in private practice; the higher perception of regulatory deficits in the private sector; scarce specific health politics for procedures outside the traditional boundaries of medicine; the difficulty for independent regulatory agencies to adopt effective measures.


Assuntos
Padrões de Prática Médica/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Medicamentos Fora do Padrão/efeitos adversos , Cirurgiões/estatística & dados numéricos , Regulamentação Governamental , Humanos , Legislação de Dispositivos Médicos , Portugal , Padrões de Prática Médica/legislação & jurisprudência , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Estatísticas não Paramétricas , Cirurgia Plástica/efeitos adversos , Cirurgia Plástica/estatística & dados numéricos , Inquéritos e Questionários
11.
Ann Vasc Surg ; 59: 314.e1-314.e4, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31009726

RESUMO

Secondary stent graft infection is a life-threatening complication after thoracic endovascular aortic repair (TEVAR). There is no consensus on optimal treatment strategy, but combined antibiotic and surgical treatment is advocated. Two years after his TEVAR procedure, a 70-year-old patient was admitted to the hospital with a secondary periaortic abscess. At first, the abscess was managed with clindamycin and transesophageal drainage. The abscess would not dissipate, and an infected iatrogenic aortoesophageal fistula was formed, which was surgically treated with esophageal resection, gastric tube reconstruction, and omental flap coverage.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Fístula Esofágica/cirurgia , Esofagectomia , Omento/cirurgia , Infecções Relacionadas à Prótese/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Stents/efeitos adversos , Retalhos Cirúrgicos , Fístula Vascular/cirurgia , Idoso , Antibacterianos/uso terapêutico , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aortografia/métodos , Implante de Prótese Vascular/instrumentação , Angiografia por Tomografia Computadorizada , Drenagem/instrumentação , Procedimentos Endovasculares/instrumentação , Fístula Esofágica/diagnóstico por imagem , Fístula Esofágica/microbiologia , Humanos , Doença Iatrogênica , Masculino , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Resultado do Tratamento , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/microbiologia
12.
Transplant Proc ; 51(5): 1506-1510, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31010699

RESUMO

BACKGROUND: Congestion of the anterior section of the grafted liver might be a problem when performing living donor liver transplant using a right lobe graft without middle hepatic vein (MHV). This can be prevented by MHV tributary reconstruction. We report our procedure and results of reconstructing MHV tributaries using artificial vascular grafts (AVGs). METHODS: We consider venous reconstruction when the estimated territory of each MHV tributary of the transplanted liver is more than 100 mL. For tributaries distant from the stump of the right hepatic vein of the graft, we use heparin-bonded AVGs made of expanded polytetrafluoroethylene with circular rings as the interposition graft between the MHV tributary and the inferior vena cava. During donor surgery, the suturing margin of the MHV tributary is secured before cutting, and it is anastomosed to the AVG during back-bench surgery. After restoration of portal flow in the recipient, we anastomose the AVG at a new position on the inferior vena cava. RESULTS: The above procedure was performed for 4 cases. The estimated drainage territory of the vein that was reconstructed using the AVG ranged from 104 to 180 mL. The AVG patency was achieved for about 2 months in all cases. In terms of morbidity, biloma and pancreatic fistula were observed in 2 cases, although removal of the AVG was not required postoperatively in any of the cases. CONCLUSION: The heparin-bonded expanded polytetrafluoroethylene AVG with circular rings is a feasible option for MHV tributary reconstruction in living donor liver transplant using right liver lobe grafts without MHVs.


Assuntos
Prótese Vascular , Veias Hepáticas/cirurgia , Transplante de Fígado/métodos , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Vasculares/instrumentação , Adulto , Feminino , Humanos , Fígado/irrigação sanguínea , Doadores Vivos , Masculino , Pessoa de Meia-Idade , Politetrafluoretileno , Período Pós-Operatório , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Vasculares/métodos
13.
Plast Reconstr Surg ; 143(5): 993e-1002e, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31033820

RESUMO

BACKGROUND: Cell-seeded biomaterial scaffolds have been proposed as a future option for reconstruction of bone tissue. The ability to generate larger, functional volumes of bone has been a challenge that may be addressed through the use of perfusion bioreactors. In this study, the authors investigated use of a tubular perfusion bioreactor system for the growth and differentiation of bone marrow stromal (mesenchymal stem) cells seeded onto fibrin, a highly angiogenic biomaterial. METHODS: Cells were encapsulated within fibrin beads and cultured either within a tubular perfusion bioreactor system or statically for up to 14 days. Scaffolds were analyzed for osteogenic differentiation. A rodent cranial defect model (8-mm diameter) was used to assess the bone regeneration of scaffolds cultured in the bioreactor, statically, or used immediately after formation. Immunohistochemistry was used to visualize CD31 vessel density. Micro-computed tomographic imaging was used to visualize mineral formation within the defect volume. RESULTS: Tubular perfusion bioreactor system-cultured samples showed significantly greater osteodifferentiation, indicated by an increase in VEGF expression and mineral deposition, compared with statically cultured samples. Increased expression of OPN, RUNX2, VEGF, and CD90 was seen over time in both culture methods. After implantation, bioreactor samples exhibited greater bone formation and vessel density compared with all other groups. Analysis of micro-computed tomographic images showed full union formation through the greatest diameter of the defect in all bioreactor samples and the highest levels of mineralized volume after 8 weeks. CONCLUSION: Mesenchymal stem cells encapsulated in fibrin beads and cultured in the tubular perfusion bioreactor system resulted in increased vascularization and mineralized tissue formation in vivo relative to static culture.


Assuntos
Regeneração Óssea , Técnicas de Cultura de Células/métodos , Osteogênese/fisiologia , Crânio/lesões , Tecidos Suporte , Animais , Reatores Biológicos , Células da Medula Óssea/fisiologia , Técnicas de Cultura de Células/instrumentação , Diferenciação Celular/fisiologia , Células Cultivadas , Traumatismos Craniocerebrais/cirurgia , Modelos Animais de Doenças , Humanos , Masculino , Células-Tronco Mesenquimais/fisiologia , Procedimentos Ortopédicos/instrumentação , Procedimentos Ortopédicos/métodos , Perfusão/métodos , Ratos , Ratos Sprague-Dawley , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Crânio/cirurgia , Resultado do Tratamento
14.
Plast Reconstr Surg ; 143(5): 1421-1428, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31033824

RESUMO

BACKGROUND: Collateral ligament injury of the metacarpophalangeal joint of the fingers is underreported in the literature and widely underestimated by the medical community. Here, the authors present results from a large series of patients and review factors influencing success of surgery. METHODS: The authors performed a retrospective study of 46 patients who underwent surgical fixation of the metacarpophalangeal collateral ligament using bone anchor in an acute or chronic setting. The diagnosis was predominantly clinical, based on laxity testing of the joint. The authors collected demographic data and intraoperative findings and postoperative results. RESULTS: Following surgery, with a median follow-up of 17 months, all patients presented with a stable joint and complete resolution of pain. The mean flexion of the metacarpophalangeal joint was 77.11 degrees, and mean extension was 0.84 degrees. The authors measured the injured grip strength at a mean of 88.52 percent of the opposite hand, and the mean Quick Disabilities of the Arm, Shoulder and Hand questionnaire score used to evaluate disability was 9.56 on a scale of 100 (with 100 being complete disability). CONCLUSIONS: Surgical treatment of metacarpophalangeal collateral ligament rupture of the fingers is a safe technique that gives reproducible positive results in terms of mobility, strength, and disability scale score. The authors' results show that anchoring of the ligament should be performed even with prolonged time from injury to surgery.


Assuntos
Ligamentos Colaterais/cirurgia , Traumatismos dos Dedos/cirurgia , Articulação Metacarpofalângica/lesões , Procedimentos Ortopédicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Ligamentos Colaterais/lesões , Avaliação da Deficiência , Estudos de Viabilidade , Feminino , Traumatismos dos Dedos/complicações , Seguimentos , Humanos , Masculino , Articulação Metacarpofalângica/fisiologia , Articulação Metacarpofalângica/cirurgia , Pessoa de Meia-Idade , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/instrumentação , Amplitude de Movimento Articular , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Reprodutibilidade dos Testes , Estudos Retrospectivos , Ruptura/cirurgia , Âncoras de Sutura , Resultado do Tratamento
15.
Arch Orthop Trauma Surg ; 139(6): 843-849, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30887123

RESUMO

INTRODUCTION: High loosening rates after distal femoral replacement may be due to implant design not adapted to specific anatomic and biomechanical conditions. MATERIALS AND METHODS: A modular tumor system (MUTARS®, Implantcast GmbH) was implanted with either a curved hexagonal or a straight tapered stems in eight Sawbones® in two consecutively generated bone defect (10 cm and 20 cm proximal to knee joint level). Implant-bone-interface micromotions were measured to analyze main fixation areas and to characterize the fixation pattern. RESULTS: Although areas of highest relative micromotions were measured distally in all groups, areas and lengths of main fixation differed with respect to stem design and bone defect size. Regardless of these changes, overall micromotions could only be reduced with extending bone defects in case of tapered stems. CONCLUSIONS: The tapered design may be favorable in larger defects whereas the hexagonal may be advantageous in defects located more distally.


Assuntos
Interface Osso-Implante/fisiologia , Fêmur , Procedimentos Ortopédicos/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Fêmur/fisiologia , Fêmur/cirurgia , Humanos , Desenho de Prótese
16.
Ann Vasc Surg ; 58: 289-294, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30769055

RESUMO

BACKGROUND: Primary leiomyosarcoma of the inferior vena cava (IVC) is a rare soft tissue sarcoma. Techniques for caval reconstruction after tumor resection vary widely. Our single-center experience serves as one of the largest reviews of caval reconstruction using polytetrafluoroethylene (PTFE) interposition grafts published in the past 10 years. METHODS: We conducted a single-center retrospective review of all patients who had undergone surgical resection of IVC leiomyosarcomas since January 1, 2007. Information regarding the procedure and patient-specific data was obtained from the institution's electronic medical record. RESULTS: We identified 4 patients (3 women and 1 man) who had undergone surgical resection for IVC leiomyosarcoma with PTFE graft reconstruction. Adjunct procedures (i.e., arteriovenous fistulas) were not used to maintain graft patency. There was no perioperative mortality within our patient population. One patient returned within 30 days with an acute kidney injury associated with a partially occlusive thrombus in the proximal part of the PTFE conduit. Another patient was found to have infolding of the PTFE graft due to inappropriate graft oversizing at the time of the index operation. Two patients developed distant metastases within a year of surgery, despite having tumor-free margins at the time of the initial operation. All the PTFE interposition grafts remained patent throughout the follow-up without the need for an additional intervention. CONCLUSIONS: PTFE interposition graft may be a safe and effective conduit for caval reconstruction after resection of a primary leiomyosarcoma of the IVC, but further research is necessary to establish appropriate management guidelines.


Assuntos
Implante de Prótese Vascular/instrumentação , Prótese Vascular , Leiomiossarcoma/cirurgia , Politetrafluoretileno , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Neoplasias Vasculares/cirurgia , Veia Cava Inferior/cirurgia , Implante de Prótese Vascular/efeitos adversos , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Leiomiossarcoma/diagnóstico por imagem , Leiomiossarcoma/patologia , Masculino , Pessoa de Meia-Idade , Flebografia/métodos , Complicações Pós-Operatórias/etiologia , Desenho de Prótese , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Neoplasias Vasculares/diagnóstico por imagem , Neoplasias Vasculares/patologia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologia
17.
Neurol Med Chir (Tokyo) ; 59(3): 79-88, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30787233

RESUMO

Endoscopic skull base reconstruction (ESBR) following expanded-endoscopic endonasal approaches (EEA) in high-risk non-ideal endoscopic reconstructive candidates remains extremely challenging, and further innovations are still necessary. Here, the aim is to study the reconstructive knowledge gap following expanded-EEA and to introduce the watertight robust osteoconductive (WRO)-barrier as an alternative durable option. Distinctively, we focused on 10 clinical circumstances. A 3D-skull base-water system model was innovated to investigate the ESBR under realistic conditions. A large-irregular defect (31 × 89 mm) extending from the crista galli to the mid-clivus was achieved. Then, WRO-barrier was fashioned and its tolerance was evaluated under stressful settings, including an exceedingly high (55 cmH2O) pressure, with radiological assessment. Next, the whole WRO-barrier was drilled to examine its practical-safe removal (simulating redo-EEA) and the whole experiment was repeated. Finally, WRO-barrier was kept into place to value its 18-month long-term high-tolerance. Results in all experiments of WRO-barriers were satisfactorily fashioned to conform the geometry of the created defect under realistic circumstances via EEA, tolerated an exceedingly high pressure without evidence of leak even under stressful settings, resisted sudden-elevated pressure, and remained in its position to maintain long-term watertight seal (18 months), efficiently evaluated with neuroimaging and simply removed-and-reconstructed when redo-EEA is needed. In conclusion, WRO-barrier as an osteoconductive watertight robust design for cranial base reconstruction possesses several distinct qualities that might be beneficial for patients with complex skull base tumours.


Assuntos
Cirurgia Endoscópica por Orifício Natural/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Base do Crânio/cirurgia , Cadáver , Humanos , Modelos Anatômicos , Retalhos Cirúrgicos
18.
Ann Vasc Surg ; 57: 275.e5-275.e8, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30711500

RESUMO

A 21-year-old man was referred to our department for treatment of multiple aneurysms, including bilateral renal artery aneurysms. He was clinically diagnosed with Loeys-Dietz syndrome. So, we developed a 2-stage surgical strategy. The first surgery involved reconstructing the right renal artery and replacing part of the abdominal aorta, bilateral common iliac artery, and bilateral internal and external iliac arteries with a synthetic graft. Although stent grafting of the left renal artery aneurysm had been scheduled for the second surgery, sudden rupture of the left renal artery aneurysm forced us to perform emergency renal artery reconstruction.


Assuntos
Aneurisma Roto/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Aneurisma Ilíaco/cirurgia , Síndrome de Loeys-Dietz/complicações , Procedimentos Cirúrgicos Reconstrutivos , Artéria Renal/cirurgia , Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/etiologia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/etiologia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Emergências , Humanos , Aneurisma Ilíaco/diagnóstico por imagem , Aneurisma Ilíaco/etiologia , Síndrome de Loeys-Dietz/diagnóstico , Síndrome de Loeys-Dietz/genética , Masculino , Desenho de Prótese , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Artéria Renal/diagnóstico por imagem , Resultado do Tratamento , Adulto Jovem
19.
Female Pelvic Med Reconstr Surg ; 25(2): 83-87, 2019 Mar/Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30807405

RESUMO

OBJECTIVE: The primary objective of this study was to compare case and mesh placement times between Restorelle Y mesh and flat mesh. The secondary objective was to compare subjective and objective outcomes between the 2 mesh configurations. METHODS: This is a randomized trial of women undergoing laparoscopic (LSC) or robotic (RSC) sacrocolpopexy for posthysterectomy vaginal prolapse. Subjects were predetermined to undergo either an LSC or RSC and randomized to Y mesh or flat mesh. Case and mesh placement times were defined as incision time to time of closure and time from mesh introduced into the abdomen to placement of the last sacral stitch, respectively. All subjects underwent Pelvic Organ Prolapse Quantification System examination and completed the 20-item Pelvic Floor Disability Index preoperatively, at 6, 12, and 24 months. RESULTS: Sixty-two patients were enrolled, and 59 patients were implanted with mesh: 30 with Y mesh (17 LSC, 13 RSC) and 29 with flat mesh (18 LSC, 11 RSC). There were no differences in patient characteristics between mesh groups. Mean case and mesh placement times for all subjects were 204.4 ± 48 and 46.1 ± 13.5 minutes, respectively, with no differences between the groups. At 6 months, 20-item Pelvic Floor Disability Index scores improved significantly for all subjects with no differences by mesh type. Three subjects (5.5%) reported vaginal bulge symptoms, and no subjects were retreated for prolapse or were found to have recurrent prolapse on examination. There were also no mesh erosions. CONCLUSIONS: Case and mesh placement times do not differ in patients undergoing LSC or RSC with either Restorelle Y mesh or flat mesh. At 6 months, subjective and objective successes were 94% and 100%, respectively.


Assuntos
Laparoscopia/instrumentação , Duração da Cirurgia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Robóticos/instrumentação , Telas Cirúrgicas , Prolapso Uterino/cirurgia , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Sacro/cirurgia , Índice de Gravidade de Doença , Resultado do Tratamento , Vagina/cirurgia
20.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 33(2): 190-194, 2019 02 15.
Artigo em Chinês | MEDLINE | ID: mdl-30739413

RESUMO

Objective: To investigate the application of high frequency color Doppler ultrasound (HFCDU) combined with wide-field imaging in the preoperative navigation of anterolateral thigh perforator flap graft. Methods: Between January 2017 and March 2018, 28 patients with skin and soft tissue defects were treated, including 22 males and 6 females, with an average age of 33.5 years (range, 17-66 years). The causes of injury included 2 cases of scald scar, 7 cases of heavy object crushing injury, 12 cases of traffic accident injury, 4 cases of fall injury, 2 cases of machine injury, and 1 case of infection ulcer. Injury sites included 6 cases of hand and wrist, 12 cases of lower leg, 10 cases of foot. After debridement, the wound area ranged from 6.0 cm×3.5 cm to 24.0 cm×9.0 cm, and all patients were treated with free circumflex femoral artery perforator flap graft. Combo of HFCDU and wide-field imaging navigation were done preoperatively to detect the origin, quantity, course, surface location, hemodynamic characteristics, and the relationship with body area of perforator branch of lateral circumflex femoral artery. According to the perforator information displayed by wide-field imaging of source artery, the dominant perforator was determined to be a pedicle for designed flap. The flap size ranged from 7.0 cm×4.5 cm to 26.0 cm×7.0 cm. The flap donor area was sutured directly. Results: The dominant perforator was successfully detected by HFCDU combined with wide-field imaging in 28 patients before operation. The existence of the perforator was confirmed during operation, and the location was accurate. The course characteristics of the perforate were consistent with the results of wide-field imaging. The grafted flaps survived completely among 27 patients after operation. Necrosis at the edge of the flap was observed in 1 patient, which healed after dressing change. All patients were followed up 3-12 months, with an average of 9 months. All the flaps have good blood supply, good elasticity and shape. The donor areas healed perfectly. Conclusion: Using HFCDU and wide-field imaging navigation for designing of anterolateral thigh perforator flaps can clearly show the characteristics of perforators, hemodynamic information, and the relationship with body area, so that the surgeons can understand the perforators more accurately and intuitively, and improve the success and efficiency of flap graft surgery.


Assuntos
Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Transplante de Pele , Lesões dos Tecidos Moles/cirurgia , Coxa da Perna , Ultrassonografia Doppler em Cores , Adulto Jovem
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