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1.
Medicine (Baltimore) ; 99(35): e21942, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871940

RESUMO

RATIONALE: Currently, digital surgical techniques have been widely used in the precise treatment of mandibular resection and reconstruction with fibula flaps. Utilizing these innovative techniques in surgical planning and hardware fabrication before surgery has shown to provide great help. However, it is difficult for even experienced surgeons to place the preformed reconstruction plate in the same position as its preoperative design, causing surgical results to differ from preoperative planning. This study aims to solve these acknowledged challenges by creating newly designed equipment. PATIENT CONCERNS: Two patients suffering from long-term expansion of the mandible were admitted to our department. Case I was a 39-year-old female patient who was concerned about the disease in the middle of the mandible, Case II was a 45-year-old female patient who was concerned about the disease at the left mandibular angle and ramus region. DIAGNOSES: Two patients were diagnosed with the mandibular ameloblastoma based on computed tomography (CT) scan and pathological results. INTERVENTIONS: Personalized 3-dimensional (3D) surgical guides were applied to 2 patients with mandibular ameloblastoma who underwent mandibular resection and reconstruction with vascularized fibula flaps using a specially optimized and designed reconstruction guide plate. OUTCOMES: We achieved precise mandibular repair with such a guide in full accordance with the preoperative plan and ensured the restoration of patient facial symmetry. LESSONS: Optimized reconstruction guide template could accurately locate the preformed reconstruction plate. This component had the ability to ensure that the location of the actual reconstruction plates were highly consistent with preoperative designed models.


Assuntos
Ameloblastoma/cirurgia , Fíbula/transplante , Mandíbula/cirurgia , Neoplasias Mandibulares/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Adulto , Ameloblastoma/diagnóstico por imagem , Feminino , Fíbula/irrigação sanguínea , Humanos , Mandíbula/diagnóstico por imagem , Neoplasias Mandibulares/diagnóstico por imagem , Pessoa de Meia-Idade , Medicina de Precisão , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos/transplante
2.
Clinics (Sao Paulo) ; 75: e1123, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32556055

RESUMO

OBJECTIVE: The objective of this study was to compare two postero-lateral bundle (PLB) tibial fixation techniques for the reconstruction of the anterior cruciate ligament with double bundle: a technique without the use of an interference screw, preserving the native tibial insertion of the tendons of the gracilis and semitendineous muscles, and a technique with the use of an interference screw and without preserving the insertion of the tendons. METHODS: A comparative study was conducted in cadavers with a universal mechanical test machine. In total, 23 cadaver knees were randomized for tibial fixation of the PLB using the two techniques: Maintaining the tibial insertion of the tendons during reconstruction, without the use of an interference screw (group A, 11 cases); and fixating the graft with an interference screw, without maintaining the insertion of the tendons (group B, 12 cases). A continuous traction was performed (20 mm/min) in the same direction as the produced tunnel, and force (N), elongation (mm), rigidity (N/mm), and tension (N/mm2) were objectively determined in each group. RESULTS: Group A exhibited a maximum force (MF) of 315.4±124.7 N; maximum tension of 13.57±3.65 N/mm2; maximum elongation of 19.73±4.76 mm; force at the limit of proportionality (FLP) of 240.6±144.0 N; and an elongation at the limit of proportionality of 14.37±6.58 mm. Group B exhibited a MF of 195.7±71.8 N; maximum tension of 8.8±3.81 N/mm2; maximum elongation of 15.3±10.73 mm; FLP of 150.1±68.7 N; and an elongation at the limit of proportionality of 6.86±2.42 mm. When comparing the two groups, significant differences were observed in the variables of maximum force (p=0.016), maximum tension (p=0.019), maximum elongation (p=0.007), and elongation at the limit of proportionality (p=0.003). CONCLUSION: The use of the native insertion of the semitendineous and gracilis tendons, without an additional fixation device, presented mechanical superiority over their fixation with interference screws.


Assuntos
Lesões do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Parafusos Ósseos , Tendões dos Músculos Isquiotibiais/cirurgia , Músculo Esquelético/transplante , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Tíbia/cirurgia , Fenômenos Biomecânicos , Humanos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estresse Mecânico
3.
Plast Reconstr Surg ; 146(4): 833-841, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32590513

RESUMO

BACKGROUND: Spring-assisted surgery is an accepted alternative to cranial vault remodeling for treatment of sagittal craniosynostosis. The long-term safety and efficacy profiles of spring-assisted surgery have not been established. METHODS: This study is a retrospective examination of all patients treated with spring-assisted surgery (n = 175) or cranial vault remodeling (n = 50) for sagittal craniosynostosis at the authors' institution from 2003 to 2017. Data collected included demographic and operative parameters, preoperative and postoperative Cephalic Indices, and complications. Whitaker grades were assigned blindly by a craniofacial surgeon not involved in patients' care. RESULTS: The mean age at surgery was significantly lower for the spring-assisted surgery group compared with the cranial vault remodeling group (4.6 months versus 22.2 months; p < 0.001). Even when combining spring placement with spring removal operations, total surgical time (71.1 minutes versus 173.5 minutes), blood loss (25.0 ml versus 111.2 ml), and hospital stays (41.5 hours versus 90.0 hours) were significantly lower for the spring-assisted surgery cohort versus the cranial vault remodeling group (p < 0.001 for all). There were no differences in infection, reoperation rate, or headaches between the groups. The percentage improvement in Cephalic Index was not significantly different at 1 (p = 0.13), 2 (p = 0.99), and 6 (p = 0.86) years postoperatively. At 12 years postoperatively, the spring-assisted surgery group had persistently improved Cephalic Index (75.7 preoperatively versus 70.7 preoperatively). Those undergoing spring-assisted surgery had significantly better Whitaker scores, indicating less need for revision surgery, compared with the cranial vault remodeling group (p = 0.006). CONCLUSION: Compared with the authors' cranial vault remodeling technique, spring-assisted surgery requires less operating room time and is associated with less blood loss, but it has equivalent long-term Cephalic Indices and subjectively better shape outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Craniossinostoses/cirurgia , Crânio/cirurgia , Humanos , Lactente , Procedimentos Ortopédicos/instrumentação , Procedimentos Ortopédicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
5.
Orthopade ; 49(5): 417-423, 2020 May.
Artigo em Alemão | MEDLINE | ID: mdl-32266432

RESUMO

BACKGROUND: Management of acetabular bone loss is a demanding problem in revision total hip arthroplasty. OBJECTIVES: The aim of this review is to introduce and discuss the results and the advantages and disadvantages of custom-made implants as a treatment option for severe acetabular bone defects. MATERIALS AND METHODS: A selective review of the existing literature of custom made acetabular implants was performed on PubMed. RESULTS: Studies showed good clinical and radiological outcomes of custom made acetabular implants and a survival rate of more than 90%. CONCLUSION: Custom-made acetabular implants are a reliable treatment option for severe acetabular defects and allow the reconstruction of the centre of rotation of the hip. The costs of these implants are high and planning is time consuming.


Assuntos
Acetábulo/cirurgia , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/métodos , Prótese de Quadril , Procedimentos Cirúrgicos Reconstrutivos/métodos , Desenho de Prótese , Falha de Prótese , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
6.
Plast Reconstr Surg ; 145(5): 1252-1261, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332549

RESUMO

BACKGROUND: Because auricular reconstruction is a complex and relatively uncommon procedure, there are many patients that have had disappointing reconstructions. This study describes the authors' large experience with secondary procedures in patients with unsatisfactory or failed initial ear reconstruction. METHODS: A prospectively maintained database of all consecutive patients who underwent secondary total ear reconstruction from March of 1991 to December of 2017 was reviewed. Demographic data and outcomes were assessed. Patients with acquired absence of the ear were not included. RESULTS: There were 144 microtia patients that met the inclusion criteria. Patient age at the time of the secondary reconstruction ranged from 3 to 59 years. Follow-up duration ranged from 1 to 21 years. Primary reconstruction was performed with rib cartilage in 91 patients, porous polyethylene implant in 47 patients, prosthesis in four patients, and irradiated cadaver rib cartilage in two patients. All secondary reconstructions were performed with porous polyethylene implants. The alloplastic framework was covered with a temporoparietal fascia flap in 76 patients, an occipital fascia flap in 64 patients, and a free fascia flap in four patients (two radial forearm flaps in the same patient, one contralateral temporoparietal fascia flap, and one lateral arm flap). Fourteen patients (10 percent) had complications requiring revision surgery. Secondary surgery was successful in all but one patient. CONCLUSIONS: These data represent the largest series of secondary total ear reconstructions. The use of a porous polyethylene implant is an ideal method for these patients because of its minimal morbidity and relatively low complication rate. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Microtia Congênita/cirurgia , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reoperação/métodos , Terapia de Salvação/métodos , Adolescente , Adulto , Cartilagem/transplante , Criança , Pré-Escolar , Pavilhão Auricular/anormalidades , Pavilhão Auricular/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Polietileno , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Próteses e Implantes , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Reoperação/efeitos adversos , Reoperação/instrumentação , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Terapia de Salvação/efeitos adversos , Terapia de Salvação/instrumentação , Terapia de Salvação/estatística & dados numéricos , Retalhos Cirúrgicos/efeitos adversos , Retalhos Cirúrgicos/transplante , Transplante Autólogo/efeitos adversos , Transplante Autólogo/métodos , Transplante Autólogo/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
7.
World Neurosurg ; 138: e922-e929, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32272268

RESUMO

BACKGROUND: Cranioplasty is a common neurosurgical procedure with the goal of restoring skull integrity. Custom-made porous hydroxyapatite prostheses have long been used for cranial reconstruction in patients with traumatic brain injury. We present a large consecutive series of 2 groups of patients undergoing cranioplasty with hydroxyapatite custom bone and compare the adverse events (AEs) between the 2 groups. METHODS: We examined a series of consecutive patients who underwent cranioplasty using custom-made porous hydroxyapatite implants following tumor resection and traumatic brain injury at a single center between March 2003 and May 2018. The implants were designed and produced according to the surgeon's specifications and based on the patient's computed tomography scan data obtained through a standardized protocol. AEs were recorded. RESULTS: Information on 38 patients with tumor and 39 patients with traumatic brain injury was collected and analyzed. A significant difference in the timing of surgery was found between the 2 groups; single-stage surgery was performed in 84% of patients in the tumor versus 8% of those in the traumatic brain injury group (P < 0.0001). The rate of AEs was not significantly different between the 2 groups (P = 0.4309) and was not related to the timing of surgery. CONCLUSIONS: Custom-made hydroxyapatite cranioplasty is a solution for cranial reconstruction in patients with cranial tumors. The low incidence of AEs in a consecutive series of patients with either trauma or tumors demonstrates that these prostheses represent a safe solution independent of the characteristics of cases.


Assuntos
Lesões Encefálicas Traumáticas/cirurgia , Neoplasias Encefálicas/cirurgia , Procedimentos Neurocirúrgicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Durapatita , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Porosidade , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Resultado do Tratamento
8.
Ann R Coll Surg Engl ; 102(6): e136-e140, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32326733

RESUMO

Acromioclavicular joint injuries are common and account for up to 12% of all shoulder girdle injuries and have been reported as being as high as 50% in sports-related shoulder injuries. While the majority of acromioclavicular joint dislocations can be treated non-operatively, there are certain injury configurations, which can include high-grade dislocations in overhead athletes, where surgery may be indicated. The surgical management of acromioclavicular joint instability has moved towards recreating the action of the coracoclavicular ligaments by resuspending the clavicle on to the coracoid. Multiple techniques using high-strength sutures, synthetic ligaments, tendon allografts or autografts passed either around or through the coracoid process have been described. However, an unusual, but significant, complication associated with these techniques is an iatrogenic fracture of the coracoid process. We report the case of a patient with an iatrogenic coracoid fracture following two failed acromioclavicular joint resuspensory reconstructions using a synthetic ligament. This injury was successfully treated with an autologous hamstring graft reconstruction, initially protected with a hook plate.


Assuntos
Articulação Acromioclavicular/cirurgia , Fraturas Ósseas/cirurgia , Luxações Articulares/cirurgia , Complicações Pós-Operatórias/cirurgia , Reoperação/métodos , Adulto , Artroscopia/efeitos adversos , Artroscopia/instrumentação , Artroscopia/métodos , Placas Ósseas , Processo Coracoide/lesões , Processo Coracoide/cirurgia , Tendões dos Músculos Isquiotibiais/transplante , Humanos , Masculino , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recidiva , Reoperação/instrumentação , Transplante Autólogo/métodos , Resultado do Tratamento
9.
J Surg Oncol ; 121(7): 1104-1114, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32153042

RESUMO

BACKGROUND AND OBJECTIVES: Acetabular reconstruction with a coned-stem prosthesis has been one of the reliable procedures following pelvic tumor resections but is associated with a risk of complications and postoperative morbidity. We investigated whether navigated reconstruction could decrease the complication rate and optimize outcomes. METHODS: A retrospective study was conducted on 33 patients who underwent acetabular resection and reconstruction with ice-cream cone prostheses; outcomes were compared between the navigated and nonnavigated groups. RESULTS: A clear margin was obtained in 91% and 82% of the navigated and nonnavigated groups, respectively. The local recurrence (LR) rate was 12%, and all LRs occurred in the nonnavigated group. The rate of major complications requiring surgical intervention was significantly lower in the navigated group (9%) than in the nonnavigated group (50%; P = .024). Two implant failures occurred in the nonnavigated group. Functional outcomes were significantly correlated with the occurrence of major complications (P = .010) and the use of navigation (P = .043); superior functional scores were observed in the navigated group (Musculoskeletal Tumor Society, 73% vs 55%; Toronto Extremity Salvage Score, 73% vs 56%). CONCLUSION: Ice-cream cone prosthesis is an acceptable reconstruction modality following periacetabular tumor resections, and computer navigation are useful to facilitate proper resection margins and implant position.


Assuntos
Acetábulo/cirurgia , Neoplasias Ósseas/cirurgia , Prótese de Quadril , Neoplasias Pélvicas/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Pélvicas/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Implantação de Prótese/efeitos adversos , Implantação de Prótese/instrumentação , Implantação de Prótese/métodos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Estudos Retrospectivos , Cirurgia Assistida por Computador/efeitos adversos , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X , Adulto Jovem
10.
Ann R Coll Surg Engl ; 102(5): 335-339, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32159373

RESUMO

INTRODUCTION: Limited literature exists on oncological chest wall reconstruction in the paediatric population, with the field still largely undecided on the best surgical reconstructive techniques to employ. The use of biological grafts/meshes is gaining popularity in certain adult surgical procedures but their use in paediatric procedures is rarely reported in the literature. We present the outcomes of our institution's multidisciplinary approach to managing paediatric chest wall tumours as well as our experience with the use of biological grafts for chest wall reconstruction following oncological resections. METHODS: Data were analysed retrospectively from eight paediatric patients who were treated for primary chest wall tumours between 2010 and 2018. RESULTS: The tumours comprised two lipoblastomas, three Ewing's sarcomas, an undifferentiated sarcoma with osteosarcomatous differentiation, a high grade undifferentiated sarcoma and a myofibroma. Seven of the eight patients underwent chest wall reconstruction with a biological graft. There were no postoperative mortalities and no evidence of recurrence in any of the patients in the series. No further chest wall operations were required and there were no postoperative infection related complications. CONCLUSIONS: We support the use of biological grafts for chest wall reconstruction after oncological resections and maintain that a multidisciplinary approach is essential for the management of paediatric chest wall tumours.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias Torácicas/cirurgia , Parede Torácica/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/prevenção & controle , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Estudos Retrospectivos , Telas Cirúrgicas , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Resultado do Tratamento
11.
Plast Reconstr Surg ; 145(6): 1486-1494, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32195855

RESUMO

BACKGROUND: Large decompressive craniectomies may be life-saving; however, they may also result in syndrome of the trephined. This postrecovery sequela is characterized by dizziness, fatigue, depression, weakness, speech slowing, gait disturbance, and impaired mentation. Because this entity is poorly understood, the authors attempted to quantify the functional improvement in patients with syndrome of the trephined after cranial vault reconstruction. METHODS: Patients with cranial vault defects (>50 cm) from trauma, meningioma, and hemorrhage were studied preoperatively and postoperatively (6 months) after cranial vault reconstruction using (1) the Cognistat Active Form and (2) the Functional Independence Measure instrument (n = 40). Cranial vault reconstructive techniques varied from split cranial bone to alloplastic implants (polyetheretherketone or titanium mesh). RESULTS: Of the 143 patients treated with decompressive craniectomies, 28 percent (n = 40) developed symptoms of syndrome of the trephined. A larger craniectomy defect size correlated with development of syndrome of the trephined. Time from craniectomy to presentation of symptoms was 4.5 months. Time from craniectomy to cranial vault reconstruction was 6.1 months. Time from cranial vault reconstruction to symptom improvement was 4.3 days. Complete functional recovery of syndrome of the trephined was seen in 70 percent. Type of cranial vault reconstruction included polyetheretherketone implant (57.5 percent), split calvarial graft (22.5 percent), and titanium mesh (20 percent), and was not a determinant of functional improvement. Cognistat assessment score noted improvement (from 38 to 69); likewise, the Functional Independence Measure measurement tool showed improvement (from 38 to 98). CONCLUSIONS: Syndrome of the trephined occurs more frequently than previously described in posttraumatic patients with large cranial vault defects. Cranial vault reconstruction leads to significant, quantifiable functional improvement in a large number of patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Craniectomia Descompressiva/efeitos adversos , Doenças do Sistema Nervoso/cirurgia , Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Trepanação/efeitos adversos , Adulto , Placas Ósseas , Transplante Ósseo , Feminino , Humanos , Cetonas , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/etiologia , Polietilenoglicóis , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Estudos Retrospectivos , Crânio/cirurgia , Síndrome , Titânio , Resultado do Tratamento
13.
Plast Reconstr Surg ; 145(3): 617e-628e, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32097332

RESUMO

LEARNING OBJECTIVES: After reviewing this article, the participant should be able to: Start early protected movement at 3 to 5 days after surgery with relative motion extension splinting for zone 5 extensor tendon lacerations over the hand. Allow patients to resume regular activities much sooner than the conventional 3 to 4 weeks of splinting after extensor tendon repair. Improve the rehabilitation of boutonniere deformities with relative motion splinting. SUMMARY: This article focuses on surgery and rehabilitation of extensor tendon injuries from the proximal interphalangeal joint (boutonniere) to the wrist. Relative motion flexion and extension splinting and wide awake, local anesthesia, no tourniquet surgery have revolutionized the management of these lesions, with early protected movement, sooner return to regular activities, and improved rehabilitation. This article explains and illustrates these new advances in extensor tendon management.


Assuntos
Articulações dos Dedos/cirurgia , Deformidades Adquiridas da Mão/cirurgia , Cuidados Pós-Operatórios/tendências , Procedimentos Cirúrgicos Reconstrutivos/tendências , Traumatismos dos Tendões/cirurgia , Articulações dos Dedos/fisiopatologia , Deformidades Adquiridas da Mão/etiologia , Deformidades Adquiridas da Mão/fisiopatologia , Deformidades Adquiridas da Mão/reabilitação , Humanos , Cuidados Pós-Operatórios/instrumentação , Cuidados Pós-Operatórios/métodos , Amplitude de Movimento Articular , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recuperação de Função Fisiológica , Traumatismos dos Tendões/complicações , Traumatismos dos Tendões/fisiopatologia , Traumatismos dos Tendões/reabilitação , Fatores de Tempo , Resultado do Tratamento
14.
Plast Reconstr Surg ; 145(3): 608e-616e, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32097331

RESUMO

BACKGROUND: Various surgical techniques exist for lower extremity reconstruction, but limited high-quality data exist to inform treatment strategies. Using multi-institutional data and rigorous matching, the authors evaluated the effectiveness and cost of three common surgical reconstructive modalities. METHODS: All adult subjects with lower extremity wounds who received bilayer wound matrix, local tissue rearrangement, or free flap reconstruction were retrospectively reviewed (from 2010 to 2017). Cohorts' comorbidities and wound characteristics were balanced. Graft success at 180 days was the primary outcome; readmissions, reoperations, and costs were secondary outcomes. RESULTS: Five hundred one subjects (166 matrix, 190 rearrangement, and 145 free flap patients) were evaluated. Matched subjects (n = 312; 104/group) were analyzed. Reconstruction success at 180 days for matrix, local tissue rearrangement, and free flaps was 69.2 percent, 91.3 percent, and 93.3 percent (p < 0.001), and total costs per subject were $34,877, $35,220, and $53,492 (p < 0.001), respectively. Median length of stay was at least 2 days longer for free flaps (p < 0.0001). Readmissions and reoperations were greater for free flaps. Local tissue rearrangement, if achievable, provided success at low cost. Free flaps were effective with large, traumatic wounds but at higher costs and longer length of stay. Matrices successfully treated older, obese patients without exposed bone. CONCLUSIONS: Lower extremity reconstruction can be performed effectively using multiple modalities with varying degrees of success and costs. Local tissue rearrangement and free flaps demonstrate success rates greater than 90 percent. Bilayer wound matrix-based reconstruction effectively treats a distinct patient population. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Retalhos de Tecido Biológico/transplante , Traumatismos da Perna/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Pele Artificial , Adulto , Idoso , Amputação/economia , Amputação/estatística & dados numéricos , Sulfatos de Condroitina/uso terapêutico , Colágeno/uso terapêutico , Feminino , Retalhos de Tecido Biológico/efeitos adversos , Retalhos de Tecido Biológico/economia , Sobrevivência de Enxerto , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Traumatismos da Perna/diagnóstico , Traumatismos da Perna/economia , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/economia , Readmissão do Paciente/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/economia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Reoperação/economia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Índice de Gravidade de Doença , Transplante de Pele/efeitos adversos , Transplante de Pele/economia , Transplante de Pele/instrumentação , Resultado do Tratamento
15.
Transplant Proc ; 52(2): 584-586, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32037063

RESUMO

Post-thoracotomy wound dehiscence after a lung transplant carries with it morbidity in the postoperative period. While this complication has been widely reported in the literature after a clamshell incision, the thoracotomy dehiscence's surgical solution has not received much emphasis. We present an original technical solution to deal with this complication, performed successfully in a 62-year-old woman diagnosed as having idiopathic pulmonary hemosiderosis after a single lung transplant. This surgical treatment consists of necrotic rib tissue removal, pleural effusion drainage, pulmonary adhesion removal, and chest wall defect reparation with bioabsorbable mesh. This operative technique results safe and effective for thoracotomy dehiscence reparation.


Assuntos
Transplante de Pulmão/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Deiscência da Ferida Operatória/etiologia , Deiscência da Ferida Operatória/cirurgia , Toracotomia/efeitos adversos , Feminino , Humanos , Transplante de Pulmão/métodos , Pessoa de Meia-Idade , Próteses e Implantes , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Toracotomia/métodos
16.
Acta Orthop ; 91(3): 341-346, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32106736

RESUMO

Background and purpose - The pelvis is the 3rd most common site of skeletal metastases. In some cases, periacetabular lesions require palliative surgical management. We investigated functional outcome, complications, and implant and patient survival after a modified Harrington's procedure.Patients and methods - This retrospective cohort study included 89 cases of surgically treated periacetabular metastases. All patients were treated with the modified Harrington's procedure including a restoration ring. Lesions were classified according to Harrington. Functional outcome was assessed by Harris Hip Score (HHS) and Oxford Hip Score (OHS). Postoperative complications, and implant and patient survival are reported.Results - The overall postoperative functional outcome was good to fair (OHS 37 and HHS 76). Sex, age, survival > 6 and 12 months, and diagnosis of the primary tumor affected functional outcome. Overall implant survival was 96% (95% Cl 88-100) at 1 year, 2 years, and 5 years; only 1 acetabular implant required revision. Median patient survival was 8 months (0-125). 10/89 patients had postoperative complications: 6 major complications, leading to revision surgery, and 4 minor complications.Interpretation - Our modified Harrington's procedure with a restoration ring to achieve stable fixation, constrained acetabular cup to prevent dislocation, and antegrade iliac screws to prevent cranial protrusion is a reliable reconstruction for periacetabular metastases and results in a good functional outcome in patients with prolonged survival. A standardized procedure and low complication rate encourage the use of this method for all Harrington class defects.


Assuntos
Acetábulo/cirurgia , Neoplasias Ósseas/patologia , Fixadores Internos , Neoplasias Pélvicas/cirurgia , Pelve/cirurgia , Implantação de Prótese/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Acetábulo/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Pélvicas/secundário , Falha de Prótese , Implantação de Prótese/efeitos adversos , Implantação de Prótese/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Estudos Retrospectivos , Resultado do Tratamento
18.
J Orthop Surg (Hong Kong) ; 28(1): 2309499019900472, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31994969

RESUMO

PURPOSE: For anterior spine column reconstruction after corpectomy, expandable cages offer solid anterior support and allow correction of deformity, providing excellent primary stability. To provide a larger body of clinical observations concerning the effectiveness of the approach, this retrospective study examines patients treated by corpectomy and reconstruction with an expandable cage for different pathologies. METHODS: Across 5 years, 39 patients underwent vertebral reconstruction with expandable cages after single (n = 34), double (n = 4), or triple (n = 1) corpectomy. Pathologies were tumors (n = 21), fractures, or deformities in traumatic injuries (n = 14), degenerative pathology (n = 2), and infection (n = 2). Levels were cervical (n = 10), thoracic (n = 14), and lumbar (n = 15). All patients were evaluated clinically and radiographically. RESULTS: There were no cases of neurologic deterioration. Nurick grade showed significant improvement at 3 months postoperative versus preoperative (p < 0.01). Visual analog scale significantly improved preoperatively versus 3 and 12 months postoperatively (both p = 0). Regional angulation was significantly corrected, from preoperative to 3 and 12 months postoperative, at cervical, thoracic, and lumbar levels. We achieved reconstruction of the normal local anatomy with full recovery of the height of the vertebral body. Six patients (15.4%) had complications and two (5.1%) underwent revision surgery. CONCLUSIONS: In our experience, expandable cages confer stable anterior support, providing significant improvement of the segmental kyphosis angle and restoration of the original somatic height. Our clinical results are favorable, and the low rate of complications and revision accentuates the expandable cage as a valuable tool to replace the vertebral body in diverse pathologies and different spine levels.


Assuntos
Fixadores Internos , Doenças da Coluna Vertebral/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral/instrumentação , Coluna Vertebral/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Fusão Vertebral/métodos , Resultado do Tratamento , Adulto Jovem
19.
World Neurosurg ; 133: e327-e341, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31520760

RESUMO

BACKGROUND: Medical implications of 3-dimensional (3D) printing technology have evolved and are increasingly used. Surgical spine oncology involves at times complex resection using various surgical approaches and unique spinal reconstruction. As high general complication rates, including hardware failure, are reported, careful preoperative planning and optimized fixation techniques should be performed. 3D printing technology allows the improvement of preoperative planning, practice and exploration of various surgical approaches, and designing customized surgical tools and patient specific implants. OBJECTIVE: To investigate the use of 3D printing technology in complex spine surgeries. METHODS: Between 2015 and 2018, all complex spine oncological cases were evaluated and assessed for the possible benefit of use of 3D printing technology. Following high-quality imaging, a computerized integrated 3D model was created. Based on the planned procedure considering the various surgical steps, a customized 3D model was planned and printed, and in select cases a 3D custom-made implant was designed and printed in various sizes with matching trials. RESULTS: A total of 7 cases were selected for the use of a 3D printing technology. For all, a custom-made model was created. In 3 of these cases, a customized 3D-printed implant was used. Special customized intraoperative instruments were made for 2 cases, and a simulated surgical approach was performed in 5 cases. In 2 cases, pre-bent rods were made based on the model created and were used in surgery later on. CONCLUSIONS: For complex spine oncology cases, the use of 3D printing allowed better preoperative planning, simplified the operative procedure, and enabled improved reconstruction.


Assuntos
Imagem por Ressonância Magnética , Modelos Anatômicos , Impressão Tridimensional , Próteses e Implantes , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias da Coluna Vertebral/cirurgia , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Transplante Ósseo , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Ductal de Mama/secundário , Carcinoma Ductal de Mama/cirurgia , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/secundário , Carcinoma de Células Renais/cirurgia , Condrossarcoma/diagnóstico por imagem , Condrossarcoma/patologia , Condrossarcoma/cirurgia , Desenho de Equipamento , Feminino , Tumores de Células Gigantes/diagnóstico por imagem , Tumores de Células Gigantes/patologia , Tumores de Células Gigantes/cirurgia , Hemangioma/diagnóstico por imagem , Hemangioma/patologia , Hemangioma/cirurgia , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoma Osteoide/diagnóstico por imagem , Osteoma Osteoide/patologia , Osteoma Osteoide/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Sarcoma de Ewing/diagnóstico por imagem , Sarcoma de Ewing/secundário , Sarcoma de Ewing/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/patologia , Neoplasias da Coluna Vertebral/secundário , Cirurgia Assistida por Computador/instrumentação , Instrumentos Cirúrgicos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/patologia , Vértebras Torácicas/cirurgia , Adulto Jovem
20.
Neurosurgery ; 86(1): E15-E22, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31529096

RESUMO

BACKGROUND: Autologous bone removed during craniectomy is often the material of choice in cranioplasty procedures. However, when the patient's own bone is not appropriate (infection and resorption), an alloplastic graft must be utilized. Common options include titanium mesh and polyetheretherketone (PEEK)-based custom flaps. Often, neurosurgeons must decide whether to use a titanium or custom implant, with limited direction from the literature. OBJECTIVE: To compare surgical outcomes of synthetic cranioplasties performed with titanium or vs custom implants. METHODS: Ten-year retrospective comparison of patients undergoing synthetic cranioplasty with titanium or custom implants. RESULTS: A total of 82 patients were identified for review, 61 (74.4%) receiving titanium cranioplasty and 21 (25.6%) receiving custom implants. Baseline demographics and comorbidities of the 2 groups did not differ significantly, although multiple surgical characteristics did (size of defect, indication for craniotomy) and were controlled for via a 2:1 mesh-to-custom propensity matching scheme in which 36 titanium cranioplasty patients were compared to 18 custom implant patients. The cranioplasty infection rate of the custom group (27.8%) was significantly greater (P = .005) than that of the titanium group (0.0%). None of the other differences in measured complications reached significance. Discomfort, a common cause of reoperation in the titanium group, did not result in reoperation in any of the patients receiving custom implants. CONCLUSION: Infection rates are higher among patients receiving custom implants compared to those receiving titanium meshes. The latter should be informed of potential postsurgical discomfort, which can be managed nonsurgically and is not associated with return to the operating room.


Assuntos
Craniotomia/instrumentação , Próteses e Implantes , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Telas Cirúrgicas , Infecção da Ferida Cirúrgica/epidemiologia , Adulto , Craniotomia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Próteses e Implantes/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Crânio/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Titânio
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