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1.
J Urol ; 203(1): 200-205, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31437120

RESUMO

PURPOSE: We investigated surgical approaches to urinary incontinence and long-term continence outcomes after successful bladder reconstruction in a heterogeneous patient population with classic bladder exstrophy. We hypothesized that while most patients will achieve urinary continence after surgery, only a select group will void volitionally per urethra. MATERIALS AND METHODS: An institutional database of 1,323 patients with exstrophy-epispadias complex was reviewed for patients with classic bladder exstrophy who underwent successful bladder closure and a subsequent continence procedure between 1975 and 2017. Procedures included bladder neck reconstruction, bladder neck reconstruction with augmentation cystoplasty or continent catheterizable stoma, and bladder neck closure with continent catheterizable stoma. Cloacal exstrophy, epispadias and variant exstrophy cases were excluded from analysis. Continence at last followup was defined as a dry interval of 3 or more hours without nighttime leakage. Those patients with more than 3 months of followup were assessed. RESULTS: Overall 432 patients underwent successful bladder closure (primary 71.5%, repeat 28.5%) and a urinary continence procedure. At last followup 162 (37%) underwent bladder neck reconstruction, 76 (18%) underwent bladder neck reconstruction with augmentation cystoplasty or continent catheterizable stoma, 173 (40%) underwent bladder neck closure with continent catheterizable stoma and 18 underwent other procedures. Median followup from the first continence procedure was 7.2 years (IQR 2.3-13.7). Continence was assessed in 350 patients. After isolated bladder neck reconstruction 91 of 142 patients were continent (64%, 95% CI 56-72). After bladder neck closure with continent catheterizable stoma 124 of 133 patients evaluated were continent (93%, 95% CI 87-97). CONCLUSIONS: Most patients with classic bladder exstrophy require multiple reconstructive procedures to achieve continence. Only about 25% of patients are expected to void normally per urethra without reliance on catheterization or urinary diversion.


Assuntos
Extrofia Vesical/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Incontinência Urinária/cirurgia , Procedimentos Cirúrgicos Urológicos/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino
2.
Ann Otol Rhinol Laryngol ; 129(1): 63-69, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31502854

RESUMO

BACKGROUND: In this paper, the author describes a novel step-by-step setback procedure for correcting protruding lobules; the success of correcting protruding lobules depends on the nature and severity of the auricular lobule deformity. Although the auricular lobules occupy small areas on either side of the head, protruding or misshapen lobules exert a significant and sometimes exaggerated disfiguring influence on the otherwise aesthetically pleasing appearance of the ears. Because the lobule is a soft structure without a cartilage skeleton, the correction of a protruding ear and lobule is always a challenge. METHODS: Protruding lobule abnormalities stem from deformities of the cauda helicis (cartilaginous helical tail) of the auricular lobule, soft tissue, and/or a shortage of anterior skin; however, the abnormalities are usually a combination of all of the above. Therefore, surgical procedures should address all of the causes of lobule deformity and preserve as much tissue and blood supply as possible. Achieving a successful intervention depends on reducing the tension that affects the entire lobule. RESULTS: This is a retrospective analysis of 660 patients who had otoplasty performed by the first author between January 2010 and December 2017. Correction of the ear lobule was needed in 398 (60.3%) patients. Of these, 44.6% patients were male, 55.4% female and the average age was 9 years (range 4-18 years). In this patient cohort, 356 (89.4%) required bilateral and 42 (10.5%) unilateral ear lobule correction. Standardized pre- and postoperative images were recorded for each patient. CONCLUSION: The goal of a setback procedure is a natural and harmonious auricular lobule appearance that is achieved through simple, optimal surgery that addresses all of the features of the auricular anatomy.


Assuntos
Pavilhão Auricular/cirurgia , Procedimentos Cirúrgicos Otológicos/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Masculino , Estudos Retrospectivos
3.
Ann Otol Rhinol Laryngol ; 129(1): 78-81, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31510759

RESUMO

BACKGROUND: The ansa cervicalis is useful for cranial nerve repair, and may be harvested without apparent morbidity. Herein we report an unusual and surgically relevant anatomic variant of the ansa cervicalis. METHODS: An adult male with left parotid adenoid cystic carcinoma underwent parotidectomy with upper-division facial nerve resection and planned interposition repair using the ansa cervicalis. The ipsilateral hypoglossal nerve was identified, together with a descending branch producing strap muscle contraction when stimulated. This presumed descendens hypoglossi was unusually large in caliber; further dissection revealed continuity with the vagus nerve. RESULTS: Ansa cervicalis harvest was aborted when its separation from vagus nerve epineurium was not possible. The sural nerve was alternatively harvested. The patient awoke with left vocal fold palsy, which completely resolved within 3 months. CONCLUSION: Anatomic variants of the ansa cervicalis exist that may preclude graft harvest and place the vagus nerve at risk of inadvertent injury.


Assuntos
Variação Anatômica , Carcinoma Adenoide Cístico/cirurgia , Plexo Cervical/anormalidades , Nervo Facial/cirurgia , Neoplasias Parotídeas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Transferência de Nervo/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Nervo Sural/transplante
4.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(12): 1177-1182, 2019 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-31874535

RESUMO

Objective: To explore the long-term efficacy of laparoscopic-assisted anorectoplasty and conventional anorectoplasty in the treatment of children with high and middle anal atresia. Methods: A retrospective cohort study was used. Inclusion criteria: (1) children with high and middle anal atresia; (2) complicated with rectourethral or rectovesical fistula; (3) complete follow-up data. Exclusion criteria: (1) complicated with 21-trisomy; (2) cerebral palsy and other mentaldisabilities; (3) Currarino syndrome; (4) FG syndrome. Clinical data of 88 patients with middle and high anal atresia, who complicated with rectourethral fistula or rectovesical fistula, and underwent anoplasty at Department of Pediatric Surgery, the First Affiliated Hospital of Zhengzhou University from January 2009 to June 2014 were enrolled in the study and analyzed. There were 24 cases with middle atresia and 64 cases with high atresia. All the cases were divided into 2 groups based on the operative method: laparoscopic group (laparoscopic-assisted anorectoplasty, 49 cases), pena group (posterior sagittal anorectoplasty, 39 cases). The demographic features of two groups were comparable. There were no statistically significant differences in gender, age, body mass, classification of anomaly types and sacral ratio (all P>0.05). Student t test and Chi square tests were used to compare the surgical conditions (operative time, postoperative hospital stay and complications), anal function (Kelly score), constipation (Krickenbeck constipation score) and anorectal pressure. Results: Children of both groups all completed operation ssuccessfully. There were no statistically significant differences between laparoscopic group and pena group in the operative time [(120±31) minutes vs. (112±23) minutes, t=1.343, P=0.091] and postoperative hospital stay [(7.1±2.3) days vs. (10.7±3.3) days, t=6.021, P=1.000]. Complications were more common in the pena group [16.3% (8/49) vs. 35.9% (14/39), χ(2)=4.436, P=0.035]. The main complications in laparoscopic group were anal prolapse (8.2%, 4/49) and anal stenosis (6.2%, 3/49), while in pena group were anal stenosis (12.8%, 5/39) and perioperative perianal skin erosion (10.3%, 4/39). As for the anal function, the degree of feces, defecation control and sphincter contractility, the single scoring differences of Kelly scoring system were not statistically significant between the two groups, but the proportion of good function in the laparoscopic group was higher than that in the pena group [67.3% (8/49) vs. 38.5% (15/39), χ(2)=7.308, P=0.007]. Constipation occurred in 6 (12.2%) patients in the laparoscopic group, of whom 5 were improved by diet regulation and 1 required laxatives, while 9 (23.1%) patients developed constipation in the pena group, of whom 4 were improved by diet regulation and 5 required long-term laxatives. The difference of constipation ratio was not statistically significant (χ(2)=1.802, P=0.180). There were no cases of Krickenbeck constipation grade 3. Compared to the pena group, the laparoscopic group had higher anal resting pressure [(33.35±9.69) mmHg vs. (27.68±10.74) mmHg, t=2.599, P=0.011], higher dilating pressure [(9.00±5.61) mmHg vs.(6.51±3.24) mmHg, t=2.462, P=0.016], higher maximal squeeze pressure [(65.80±17.23) mmHg vs. (56.74±18.93) mmHg, t=2.389, P=0.019] and longer maximal contraction time [(21.16±5.02) seconds vs. (18.44±7.24) seconds, t=2.079, P=0.041]. The rectal resting pressure [(5.36±3.00) mmHg vs. (4.61±3.93) mmHg, t=1.015, P=0.312] was not statistically significantly different. Conclusions: Compared with posterior sagittal anorectoplasty, laparoscopic-assisted anorectoplasty in the treatment of high and middle anal atresia has better long-term efficacy with less perioperative complications.


Assuntos
Anus Imperfurado/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Canal Anal/cirurgia , Criança , Humanos , Laparoscopia , Masculino , Reto/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
5.
Pan Afr Med J ; 33: 243, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692679

RESUMO

Coverage of loss of skin substances on the lower third of the leg is a challenging problem. This is due to adjacent soft tissues impairment, shortage of local vascularization and bone exposure. We conducted a retrospective study of a series of 9 cases of skin coverage of the lower third of the leg treated at the University Hospital Hassan II of Fez from 2016 to 2018. This study aims to highlight the characteristic of the loss of skin substances on the lower third of the leg, while emphasizing the difficulty of management.


Assuntos
Traumatismos da Perna/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Adolescente , Adulto , Feminino , Humanos , Traumatismos da Perna/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Pele/patologia , Lesões dos Tecidos Moles/patologia , Adulto Jovem
6.
Pan Afr Med J ; 33: 235, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31692758

RESUMO

Inguinal flap is a distant axial pediculated flap. This flap is reliable in covering large losses of substance of the upper limb. Its major drawback is that it requires two-step surgery. Inguinal flap is the elective method in the arsenal of emergency left hand surgery or in common left hand surgery. This is due to its greasy thickness and its short small pedicle, with frequent anatomical variations. The purpose of this study was to show its role imbalance out its advantages and its disadvantages. We report the case of a 33-year female patient presenting with severe deformation with closure of the anterior commissure and first metacarpophalangeal joint ankylosis after complex open trauma of the hand. The patient underwent two-step surgery with opening the first commissure and trapezio-M1 arthrodesis stabilized by plug insertion followed by immediate skin coverage by McGregor's inguinal flap and after 21days by weaning and donor site suture. Anatomical and functional outcome was good. The patient was satisfied with the scar at the donor site, which could be easily covered with clothing, by the functionality and aesthetics of the hand. McGregor's flap is an attractive solution for coverage with significant advantages from a functional and aesthetic point of view. Its role should be enhanced in the therapeutic armamentarium of flaps for limb coverage.


Assuntos
Traumatismos da Mão/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos , Adulto , Cicatriz , Feminino , Humanos , Satisfação do Paciente , Sítio Doador de Transplante
8.
Handchir Mikrochir Plast Chir ; 51(6): 418-423, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31698485

RESUMO

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


Assuntos
Microcirurgia , Procedimentos Cirúrgicos Reconstrutivos , Cirurgia Plástica , Internato e Residência , Mamoplastia/economia , Microcirurgia/economia , Microcirurgia/métodos , Nervos Periféricos/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/economia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Suíça
9.
Handchir Mikrochir Plast Chir ; 51(6): 484-491, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31698490

RESUMO

BACKGROUND: "Orthoplastics" is a relatively new approach to lower limb reconstruction, where an integration of both plastic and orthopedic expertise is required, together with the availability of well-equipped facilities. Acute shortening and long-term frames for lengthening are generally considered alternatives to length preservation and soft tissue microsurgical reconstruction, but an integration of external fixation and reconstructive microsurgery is gaining an increasing role with refinements of joint approaches. MATERIAL AND METHODS: Data on sixteen patients who underwent microsurgical lower limb reconstruction and external fixation with an orthoplastic approach, following acute or chronic tibial injury, were retrospectively reviewed. All patients presented a post traumatic soft tissue defect associated with a Gustilo III tibial fracture or a tibial septic pseudarthrosis. Data on type and timing of bone and soft tissue reconstruction, outcomes, complications and need for re-operation were extrapolated and compared to an historic group of patients treated with an orthopedic-based approach. RESULTS: In the orthoplastic group, soft tissues were reconstructed with an ALT flap in most cases; a muscle-sparing VL or ALT-VL chimeric flap was necessary in cases with a very extensive defect. In the orthopedic group, soft tissues were left to heal by second intention or patients were lately referred to plastic surgeons. Statistical comparison between the two groups has showed significant differences on the following data: time for soft tissue healing, time to bone union, number of reinterventions, post-operative deep infection rate, time to return to work. CONCLUSION: The orthoplastic approach to complex leg defects yields shorter treatment time and better functional results compared to the orthopedic-based approach. External fixation and microsurgical reconstruction are not necessarily alternative procedures but can integrate in an orthoplastic path to address at best both soft tissue and bone reconstruction.


Assuntos
Fraturas Expostas , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Fraturas da Tíbia , Fixação de Fratura , Fraturas Expostas/cirurgia , Humanos , Microcirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Tíbia , Fraturas da Tíbia/cirurgia , Resultado do Tratamento
10.
Zhonghua Wai Ke Za Zhi ; 57(11): 853-859, 2019 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-31694135

RESUMO

Objective: To establish experimental porcine model of reconstruction the neobladder by ileal seromuscular with transplantation of autologous peritoneum. Methods: This was an animal experiment carried out from January to April 2018 at animal center of Guizhou Medical University. Randomly 6 experimental female porcines were chosen, and their body weight was 28 to 33 kg. By intravenous anesthesia, the transplantation of autologous peritoneum for bladder reconstruction operation was carried out by transplanting the peritoneum onto an ileum segment which mucosa and submucosa had been removed. These flaps were used to mend and reconstruct the neobladder by suturing with edge of the detective bladder. After removal of ureteral catheters and balloon catheter at day 5 and day 7 respectively, voiding behavior was monitored, and animals were euthanized at week 12 for routine pathology, immunohistochemistry, and electron microscopic examinations. Results: Six porcines underwent reconstruction, but no one lost to complications such as peritonitis, ileus and urinary fistula. Voiding behavior was normal, and urine was clear in all animals after removal of catheters. At autopsy, reconstructed bladders were healthy. Pathological examination showed the part of reconstruction had been covered by continuous urothelium while the peritoneum disappeared and showed no ileal mucosa regrowth and residual. Scanning electron microscope showed that the transitional cells of neobladder were complete and orderly, and urothelium around suture border was continuous and no malposition. Conclusion: In this experimental porcine model, reconstruction bladder by autologous peritoneum and ileal seromuscular flaps is an ideal approach.


Assuntos
Íleo/transplante , Peritônio/transplante , Neoplasias da Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Procedimentos Cirúrgicos Urológicos/métodos , Animais , Cistectomia , Feminino , Modelos Animais , Distribuição Aleatória , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos , Suínos , Transplante Autólogo
11.
Acta Chir Orthop Traumatol Cech ; 86(5): 348-352, 2019.
Artigo em Tcheco | MEDLINE | ID: mdl-31748110

RESUMO

PURPOSE OF THE STUDY The prevalence of nerve structure injuries accompanying pelvic and acetabular fractures is stated to be 5-25 %, with most frequent injuries to motor nerve structures associated with fractures of the posterior wall of the acetabulum. Prognostically worse outcomes of regeneration are documented mainly in iatrogenic, intraoperative injuries to nerve structures. This study aims to document the functional effect of muscle transfers restoring the movement of lower extremities with irreversible nerve lesion caused by the pelvic and acetabular fracture. MATERIAL AND METHODS A total of 18 patients with irreversible palsy of lower extremities in L4-S1 segments underwent a reconstruction surgery in the period 2006-2016, of whom 13 patients with the mean age of 42 (21-79) years arrived for a follow-up. The group included 10 patients with the loss of function of peroneal portion of the sciatic nerve, one patient sustained femoral nerve lesion and two patients suffered complete sciatic nerve lesion (both the peroneal and tibial portion). The patients were evaluated at the average follow-up of 77 (24-129) months after the reconstruction surgery. The average time interval from pelvic fracture to reconstruction by muscle transfer was 47 (18-151) months. Due to a wide spectrum of functional damage, the patients were evaluated in terms of the overall effect of the reconstruction surgery on the activities of daily living using the LEFS (The Lower Extremity Functional Scale). The surgical techniques used transposition of tensor fascie latae for femoral nerve lesion, transposition of tibialis posteriormuscle for palsy of the peroneal division of the sciatic nerve and tenodesis of tibialis anterior tendon and peroneus longustendon for the palsy of the peroneal and tibial portion of sciatic nerve. RESULTS The effect of movement restoration on daily living evaluated using the LEFS achieved 65 points (53-79) which is 85% of the average value of LEFS in healthy population. The transposition of active muscles tibialis posterior and tensor fasciae latae resulted in all the patients in active movement restoration. A loss of correction of foot position following the performed tenodesis of the paralysed tibialis anterior muscle was observed in one patient, with no significant impact on function. No infection complication was reported in the group. In 78% of patients the intervention was performed as day surgery. DISCUSSION There is a better prognosis for restoration in incomplete nerve lesion than in complete lesions and also in the loss of sensation than in the loss of motor function. The mini-invasive stabilisation of pelvic ring according to literature does not increase the risk of nerve lesions, while on the other hand a higher incidence of femoral nerve damage by INFIX fixator is documented. The type of muscle transfer is selected based on the availability of active muscles suitable for transposition and also with respect to functional requirements of the patient. CONCLUSIONS Irreversible palsy of lower extremity after the pelvic fracture is easily manageable as to the restoration of function. Surgical interventions using the preserved active muscles to restore the lost movement should be a component part of comprehensive surgical care for patients who sustained a pelvic fracture and should be performed centrally at a centre availing of comprehensive expertise. Key words: nerve lesion, tendon transfer, acetabulum, pelvis, fracture.


Assuntos
Fraturas Ósseas/complicações , Traumatismos da Perna/cirurgia , Paraplegia/cirurgia , Ossos Pélvicos/lesões , Traumatismos dos Nervos Periféricos/cirurgia , Transferência Tendinosa/métodos , Acetábulo/lesões , Atividades Cotidianas , Adulto , Idoso , Humanos , Plexo Lombossacral/lesões , Pessoa de Meia-Idade , Mononeuropatias/etiologia , Mononeuropatias/cirurgia , Músculo Esquelético/inervação , Músculo Esquelético/transplante , Paraplegia/etiologia , Traumatismos dos Nervos Periféricos/etiologia , Prognóstico , Procedimentos Cirúrgicos Reconstrutivos/métodos
12.
Medicine (Baltimore) ; 98(41): e17268, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593080

RESUMO

Soft-tissue defects overlying the Achilles tendon are common complications after bicycle or motorcycle spoke injuries in children and usually require surgical management by various flaps. There is no apparent consensus on the optimal choice of flaps for these injuries. We designed a novel step-advanced rectangular flap to reconstruct small to moderate soft-tissue defects around the Achilles tendon. This study was performed to review our experience and evaluate the clinical effectiveness of the step-advanced rectangular flap.From May, 2014 to September, 2016, 12 consecutive children with soft-tissue defects overlying the Achilles tendon caused by spoke injuries were treated with the step-advanced rectangular flap. The patients' general information, surgical details, and postoperative complications were recorded. The Mazur evaluation system was used to assess clinical outcomes.All patients were followed up for ≥12 months (range 12-38 months). All flaps survived completely. Superficial infection occurred in 2 patients and healed by second intention after dressing changes; the other patients' surgical wounds healed by primary intention. The scars around the flaps in 2 patients were remarkable, and all others showed good results in terms of flap color and texture. Ankle function was normal, and satisfactory results were obtained in all cases. According to the Mazur evaluation system, the results were excellent in 9 patients and good in 3, with an excellent and good rate of 100% at 12 months postoperatively.The rectangular advancement flap appears to be a simple and reliable method for small to moderate soft tissue defects overlying the Achilles tendon in children.


Assuntos
Tendão do Calcâneo/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Traumatismos dos Tendões/cirurgia , Tendão do Calcâneo/lesões , Ciclismo/lesões , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Resultado do Tratamento
13.
Handchir Mikrochir Plast Chir ; 51(5): 356-361, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31574548

RESUMO

A consistently high proportion of thermal injuries in children are to the hand, and scalds and contact burns are the main causes. While most thermal Injuries to the hand in children can be treated conservatively, deep burns can result in scary contractures and syndactylies that cause functional impairments to the hand. Therefore, thermal injuries to the hand in children should be treated in a specialised centre, thus ensuring a differentiated approach with respect to the localisation and extent of the thermal injury.Besides acute therapy, regular follow-up consultations - including splint and compression treatments -, physiotherapy, ergotherapy and, if necessary, corrective surgical measures are of immense importance. Only adherence to this treatment regime can guarantee optimal functional and aesthetic results and minimise daily restrictions for the young patients. The purpose of this article is to illustrate/outline the essential aspects of this treatment of thermal injuries to the infantile hand.


Assuntos
Queimaduras , Traumatismos da Mão , Traumatismos do Punho , Queimaduras/cirurgia , Pré-Escolar , Contratura/cirurgia , Feminino , Traumatismos da Mão/cirurgia , Humanos , Lactente , Masculino , Modalidades de Fisioterapia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Contenções , Retalhos Cirúrgicos , Cicatrização
14.
J Craniofac Surg ; 30(7): e671-e674, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31574789

RESUMO

Cerebrospinal fluid (CSF) leak is a common complication after cranial surgery. Therefore, after neurosurgical procedures it is crucial to obtain a dural repair that is complete and watertight. There are many techniques that have been described attempting to achieve this goal. However, there are complicating factors (eg, poor tissue viability, need for future radiation, comorbidities, infection, size of the dural defect, multiple operations) that may require a more comprehensive approach to achieve an optimal healing environment. The authors present a technique that uses a muscle free flap to vascularize an autologous fascia lata graft, preserving the viability of the graft and reinforcing its healing ability.The authors applied this technique to a single patient with chronic CSF leak from poor tissue healing after treatments for recurrent medulloblastoma. After harvesting a fascia lata graft with appropriate size, the graft was sutured into the dural defect in a watertight fashion. A latissimus dorsi muscle free flap was harvested and anastomosed to a saphenous vein Corlett loop/AV fistula to the facial artery. The flap was than sutured to the graft. A drain was left in place and a skin graft was applied to the muscle flap.At 8 months follow-up the patient was able to continue with her treatment and has had a stable repair without leak or breakdown. The authors present an algorithm to facilitate dural repair selection.Duraplasty using autologous fascia lata reinforced with a free muscle flap is an effective technique to control chronic CSF leaks, especially when the dura is poorly vascularized and less viable.


Assuntos
Vazamento de Líquido Cefalorraquidiano/cirurgia , Fascia Lata/cirurgia , Retalhos de Tecido Biológico , Músculos Superficiais do Dorso/cirurgia , Adulto , Neoplasias Encefálicas/cirurgia , Feminino , Humanos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele
15.
Zhonghua Shao Shang Za Zhi ; 35(10): 715-719, 2019 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-31658541

RESUMO

Objective: To explore the application effects of enhanced computed tomography (CT) and three-dimensional reconstruction technology in the reconstruction of pediatric post-burn scars with expanded flaps. Methods: From May 2016 to March 2019, 19 children with hypertrophic scars after thermal injuries were admitted to our unit, including 10 boys and 9 girls, aged from 4 years and 5 months to 15 years and 11 months. The area of scars ranged from 5 cm×4 cm to 23 cm×9 cm. One or more skin and soft tissue expanders with suitable volume and shape were implanted into the normal skin area around scar of children. Three to six months later, enhanced CT and three-dimensional reconstruction were performed before the second stage operation to obtain three-dimensional images of the vascular branches in the donor site for expanded flaps to be cut, so as to determine the course and distribution of the vascular branches and guide the design of expanded flaps. According to the design scheme, the resection of scar, removal of expanders, and excision and transfer of flaps were performed to repair the wounds after scar resection. The area of flaps ranged from 6 cm×4 cm to 25 cm×10 cm. The donor site was closed directly. The number of flaps was counted. The anatomical structure, vascular distribution, and adverse reactions during enhanced CT and three-dimensional reconstruction of site for expanded flaps to be cut, the survival of expanded flaps and the follow-up after the second-stage operation were observed. Results: A total of 48 expanded flaps were designed and excised in 19 children. The anatomical structure of the site for expanded flaps to be cut and the adjacent spatial position relationship were visually observed through the three-dimensional reconstruction after enhanced CT, and no adverse reactions were observed. Arterial branch blood supply or venous return was observed in 29 sites for expanded flaps to be cut. All the expanded flaps survived well without blood supply disorder after the second stage operation. The children were followed up for 6 months to 1 year and 6 months after the second stage operation. The appearance of the flaps was natural, and the color and thickness of the flaps were similar to those of the surrounding normal skin, except for one child with obvious linear scar. Conclusions: Enhanced CT and three-dimensional reconstruction can assist the vascular assessment of the expended flaps, which is helpful for rational design of the flap excision and transfer protocol to improve the survival rate of flaps. Thus, it has certain clinical application value in the reconstruction of post-burn scar in children with expanded flaps.


Assuntos
Imagem Tridimensional , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos , Tomografia Computadorizada por Raios X/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Transplante de Pele
16.
Zhonghua Shao Shang Za Zhi ; 35(10): 761-763, 2019 Oct 20.
Artigo em Chinês | MEDLINE | ID: mdl-31658549

RESUMO

From January 2010 to December 2017, 4 patients of thumb with necrosis caused by electric burns (all male, aged from 31 to 58 years) were admitted to our hospital, with 1 patient of second degree injury of right thumb, 2 patients of third degree injury of right thumb, and 1 patient of third degree injury of left thumb. Routine debridement under general anesthesia was performed within 7 days after injury. The compound tissue flap of contralateral second toe was transplanted to reconstruct the thumb with third degree defect, and compound tissue flap of ipsilateral distal hallex was transplanted to reconstruct the thumb with second degree defect. Dorsalis pedics artery was anastomosed with radial artery, saphenous vein or dorsalis pedics vein was anastomosed with cephalic vein. The donor site was transplanted with split-thickness skin graft from autologous thigh. All the tissue flaps and skin grafts survived in 2 weeks after surgery. Within 1 year of follow-up, the reconstructed thumbs can achieve radial abduction and palmar abduction with good function. Reconstruction of thumb with free transplantation of compound tissue flap of toe is a good method to repair thumb with necrosis caused by electric burn.


Assuntos
Queimaduras por Corrente Elétrica/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Retalhos Cirúrgicos/inervação , Polegar/cirurgia , Adulto , Queimaduras por Corrente Elétrica/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Polegar/irrigação sanguínea , Polegar/inervação , Dedos do Pé , Resultado do Tratamento , Cicatrização
17.
Cir. pediátr ; 32(4): 201-206, oct. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-184110

RESUMO

Introducción y objetivo. Los hipospadias peneanos proximales, escrotales y perineales son un reto para el cirujano. Tras toda una carrera dedicada a los hipospadias, la autora principal del trabajo resume su experiencia y demuestra que prácticamente cualquier tipo de hipospadias puede ser resuelto completamente en un único tiempo. Método. Se trata de una revisión retrospectiva y la discusión de una serie de hipospadias proximales consecutivos tratados en una única intervención por el mismo equipo quirúrgico entre 1999 y 2016. Resultados. 196 pacientes fueron intervenidos. El 68% de los casos quedaron satisfactoriamente resueltos tras la operación. Todos los hipospadias fueron reparados con una de las siguientes técnicas: onlay, colgajo prepucial tubularizado (Duckett) o injertos de mucosa. Los injertos se utilizaron solo hasta 2005; posteriormente, el refinamiento de las técnicas quirúrgicas expuestas permitió que cualquier hipospadias fuera reparado con las técnicas de onlay o Duckett. Solo un 13% de los casos necesitó algún tipo de procedimiento quirúrgico adicional, más allá del cierre de una fístula uretral puntiforme (presente en el 25% de los pacientes).Conclusión. El diseño de las incisiones cutáneas es fundamental en la reparación de los hipospadias. Cuando las incisiones siguen las líneas que de forma natural se forman en la piel del pene y escroto se obtiene como resultado un colgajo óptimo para realizar una neouretra y recubrirla con piel, evitando incluso los injertos de mucosa. Estas modificaciones permiten que cualquier tipo de hipospadias sea reparado en un único tiempo con muy buenos resultados a largo plazo


Purpose. Proximal, scrotal and perineal hypospadias challenge the surgeon. After 40 years devoted to hypospadias surgery, the senior author summarizes her experience, share her tricks and shows that almost any hypospadias can be fully repaired in one surgery. Methods. Retrospective review and discussions of a large series of consecutive proximal hypospadias treated in one surgery by the same team from 1999 to 2016. Results. 196 patients were operated. 68% of all patients were successfully repaired after the surgery. All hypospadias were treated using one of the following techniques: onlay double flap, tubularized preputial flap or mucosal grafts (only until 2005). Urethrocutaneous fistula was present in 25% of cases, but only 13% of patients needed other further surgical procedures. Conclusion. Cutaneous incisions design is fundamental in hypo-spadias repair. When the incisions follow the natural folds that appear in penile and scrotal skin, it's possible to obtain optimal flaps for both urethroplasty and skin coverage (even avoiding the need for mucosal grafts). Consequently, almost all kinds of hypospadias can be repaired in one surgery with very good long-term results


Assuntos
Humanos , Masculino , Criança , Hipospadia/cirurgia , Uretra/cirurgia , Retalhos Cirúrgicos/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Estudos Retrospectivos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Escroto/cirurgia
18.
J Urol ; 202(6): 1256-1262, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31526259

RESUMO

PURPOSE: We assessed the probability of bladder augmentation/diversion and clean intermittent catheterization in classic bladder exstrophy in a multi-institutional cohort. MATERIALS AND METHODS: We included children born from 1980 to 2016 with bladder exstrophy and treated across 5 centers (exclusion criteria less than 1 year followup after birth, isolated epispadias, bladder exstrophy variants etc). Outcomes were probability of bladder augmentation/diversion after bladder closure and proportion of patients performing clean intermittent catheterization at last followup. Survival analysis was used. RESULTS: Of 216 patients 63.4% were male (median followup 14.4 years). Overall 4 patients (1.9%) underwent primary diversion and 212 underwent primary closure (72.6% in first week of life). After primary closure 50.9% underwent augmentation, 4.7% diversion and 44.8% neither. By age 18 years 88.5% underwent a bladder neck procedure (synchronous augmentation 27.3%). On survival analysis the probability of bladder augmentation/diversion was 14.9% by age 5 years, 50.7% by 10 years and 70.1% by 18 years. Probability of bladder augmentation/diversion varied significantly between centers (p=0.01). Probability of bladder augmentation/diversion was 60.7% 10 years after bladder neck procedure. At last followup of the entire cohort 67.4% performed clean intermittent catheterization. Among 95 patients with intact native bladders 30.5% performed clean intermittent catheterization (channel 72.4%). Among 76 adults without a diversion 85.5% performed clean intermittent catheterization (augmented bladder 100.0% clean intermittent catheterization, native bladder 31.3%). Fifteen patients underwent diversion (continent 8, ureterosigmoidostomy 5, incontinent 2). CONCLUSIONS: On long-term followup probability of bladder augmentation/diversion increased with age, with 1 in 2 patients by age 10 years and the majority in adulthood. Probability of bladder augmentation/diversion differed among institutions. Almost a third of patients, including adults, with a closed native bladder performed clean intermittent catheterization. Considering all adults only 14% did not perform clean intermittent catheterization.


Assuntos
Extrofia Vesical/terapia , Cateterismo Uretral Intermitente/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Derivação Urinária/estatística & dados numéricos , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Probabilidade , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Bexiga Urinária/anormalidades , Bexiga Urinária/cirurgia , Derivação Urinária/métodos , Adulto Jovem
19.
BMC Surg ; 19(1): 136, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31519173

RESUMO

OBJECTIVES: The pectoralis major flap has been considered the workhorse flap for chest and sternoclavicular defect reconstruction. There have been many configurations of the pectoralis major flap reported in the literature for use in reconstruction sternoclavicular defects either involving bone, soft tissue elements, or both. This study reviews the different configurations of the pectoralis major flap for sternoclavicular defect reconstruction and provides the first ever classification for these techniques. We also provide an algorithm for the selection of these flap variants for sternoclavicular defect reconstruction. METHODS: EMBASE, Cochrane library, Ovid medicine and PubMed databases were searched from its inception to August of 2019. We included all studies describing surgical management of sternoclavicular defects. The studies were reviewed, and the different configurations of the pectoralis major flap used for sternoclavicular defect reconstruction were cataloged. We then proposed a new classification system for these procedures. RESULTS: The study included 6 articles published in the English language that provided a descriptive procedure for the use of pectoralis major flap in the reconstruction of sternoclavicular defects. The procedures were classified into three broad categories. In Type 1, the whole pectoris muscle is used. In Type 2, the pectoralis muscle is split and either advanced medially (type 2a) or rotated (type 2b) to fill the defect. In type 3, the clavicular portion of the pectoralis is islandized on a pedicle, either the thoracoacromial artery (type 3a) or the deltoid branch of the thoracoacromial artery (type 3b). CONCLUSION: There are multiple configurations of the pectoralis flap reported in the English language literature for the reconstruction of sternoclavicular defects. Our classification system, the Opoku Classification will help surgeons select the appropriate configuration of the pectoralis major flap for sternoclavicular joint defect reconstruction based on size of defect, the status of the vascular anatomy, and acceptability of upper extremity disability. It will also help facilitate communication when describing the different configurations of the pectoralis major flap for reconstruction of sternoclavicular joint defects.


Assuntos
Músculos Peitorais/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos/cirurgia , Ferimentos e Lesões/cirurgia , Algoritmos , Clavícula/cirurgia , Humanos , /cirurgia , Osteomielite/cirurgia , Músculos Peitorais/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/classificação , Esterno/cirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Parede Torácica/cirurgia , Ferimentos e Lesões/etiologia
20.
Niger J Clin Pract ; 22(9): 1307-1310, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31489873

RESUMO

Midfacial fracture is discontinuity of the bone affect maxilla, palate, zygomatico-maxillary complex, nasal bones, orbits, nasal-orbital-ethmoid complex, and frontal sinus. Delayed treatment can lead to malunion or nonunion bone. A 28 years old man presented with epiphora of the left eye and upgaze diplopia. There were enophthalmos, hypoglobus of the left eye, flat nasal bridge, and depressed left malar eminence. CT scan examination revealed multiple fractures of left nasal bone, left and right anterolateral wall of maxillary sinuses, left medial orbital wall and orbital floor, and left zygomatic bone. Lacrimal irrigation test showed obstruction of left nasolacrimal duct. He underwent osteotomy and fixation with plate and screw, orbital floor reconstruction with silicone block implant, external dacryocystorhinostomy with silicone tube insertion procedure. In delayed treated malunion of midfacial fracture, fixation with plate and screw after refracture using an osteotome and orbital floor reconstruction with silicone block can be a good option for restoring normal anatomy. External dacryocystorhinostomy with silicone tube insertion is an effective treatment for post traumatic nasolacrimal duct obstruction.


Assuntos
Fraturas Múltiplas/cirurgia , Obstrução dos Ductos Lacrimais/etiologia , Ducto Nasolacrimal/cirurgia , Fraturas Orbitárias/complicações , Fraturas Orbitárias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Fraturas Zigomáticas/cirurgia , Adulto , Dacriocistorinostomia , Ossos Faciais/diagnóstico por imagem , Ossos Faciais/patologia , Feminino , Fraturas Múltiplas/diagnóstico por imagem , Humanos , Obstrução dos Ductos Lacrimais/diagnóstico por imagem , Masculino , Maxila , Ducto Nasolacrimal/diagnóstico por imagem , Órbita , Fraturas Orbitárias/classificação , Fraturas Orbitárias/diagnóstico por imagem , Osteotomia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Fraturas Zigomáticas/complicações , Fraturas Zigomáticas/diagnóstico por imagem
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