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1.
Medicine (Baltimore) ; 100(27): e26575, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34232203

RESUMO

ABSTRACT: The anterolateral thigh free flap is one of the most preferred options for reconstructing soft tissues of the extremities and vascular anastomosis is one of the most important factors for flaps survival. T-anastomosis and double venous anastomosis have been widely used for increasing flap survival. This report shows both application of T-shape pedicle and multiple venous anastomosis to each 43 cases for extremity reconstruction that have not been described so far in the literature and it showed the necessity of multiple anastomosis. The locations of the lesions were 8 upper extremities (4 hands, 3 forearms, and 1 upper arm) and 35 lower extremities (5 forefeet, 6 dorsal feet, 4 plantar feet, 11 ankles, and 9 lower legs). We applied T-shaped arterial pedicle to limited anatomical area that had 2 or more major arterial communication sites to overcome the obstruction by reverse flow from communication vessels when 1 of the 2 anastomosis was obstructed. We classified multiple venous anastomosis according to flow direction and the vascular connections between the superficial and deep veins. In result, 37 cases survived completely but 2 flaps developed severe necrosis (>50%) because of infection and hematoma and 4 flaps developed partial necrosis due to wound infection. In conclusion, T-shaped pedicle and multiple venous anastomosis is a method to improve free flap survival and useful in cases where sacrificing a dominant vessel is inevitable or those in which only 1 vessel remains.


Assuntos
Retalhos de Tecido Biológico/irrigação sanguínea , Extremidade Inferior/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Lesões dos Tecidos Moles/cirurgia , Extremidade Superior/cirurgia , Veias/cirurgia , Adolescente , Adulto , Idoso , Anastomose Cirúrgica/métodos , Feminino , Humanos , Extremidade Inferior/irrigação sanguínea , Masculino , Pessoa de Meia-Idade , Extremidade Superior/irrigação sanguínea , Adulto Jovem
2.
J Cardiothorac Surg ; 16(1): 196, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34243804

RESUMO

INTRODUCTION: Regardless of its rarity, and indolent clinical course, chest wall tumor places high morbidity and burden on patients especially when invasion to a neighboring structure is found. Once detected, surgery is the cornerstone for treatment of such etiology combined with chemo-radiotherapy. In order to maintain intact respiratory function, chest wall reconstruction must be performed whenever resection is done. Herein, we present a case of chest wall tumor that necessitated three ribs and part of hemidiaphragm resection and reconstruction with optimal post-operative results. CASE PRESENTATION: A 27-year-old male patient who had chest wall and diaphragm reconstruction for a chest wall Ewing sarcoma, using a single patch of expanded polytetrafluoroethylene (ePTFE) mesh with diaphragm implanted into the middle of the mesh. There were no immediate nor post-operative complications. The patient received post-operative radiotherapy with good functional and cosmetic results. CONCLUSION: We present a novel and safe technique for combined chest wall and diaphragmatic resection following excision of an invading tumor while ensuring cosmesis and functionality of the ribcage as well as the diaphragm.


Assuntos
Diafragma/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Sarcoma de Ewing/cirurgia , Neoplasias Torácicas/cirurgia , Parede Torácica/cirurgia , Adulto , Humanos , Masculino , Politetrafluoretileno , Radioterapia Adjuvante , Costelas/cirurgia , Sarcoma de Ewing/radioterapia , Telas Cirúrgicas , Neoplasias Torácicas/radioterapia
3.
Clin Ter ; 172(4): 273-277, 2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34247210

RESUMO

Abstract: Giant omphalocele and large gastroschisis remain challenging issues faced by pediatric surgeons and neonatal intensivists. In this report, we presented 3 neonatal cases with complex congenital abdo-minal wall defects that were successfully treated with vacuum-assisted closure (VAC). Case 1 had a ruptured giant omphalocele and was treated with VAC for 24 days. She was successfully discharged at 78 days old. Case 2 had large gastroschisis that was unretractable using silo reduction. She was treated with VAC for 19 days and was succes-sfully discharged at 69 days old. Case 3 had large gastroschisis, and his defect had been closed using Gore-tex after silo reduction. VAC was applied for 14 days, and the baby was discharged at 67 days old. The VAC system can be effectively used to assist with visceral reduction, promote granulation tissue development, and skin epithelialization. This method represents a life-saving treatment for neonates with giant omphalocele and large gastroschisis.


Assuntos
Parede Abdominal/cirurgia , Anormalidades Congênitas/cirurgia , Gastrosquise/cirurgia , Hérnia Umbilical/cirurgia , Tratamento de Ferimentos com Pressão Negativa/métodos , Politetrafluoretileno , Procedimentos Cirúrgicos Reconstrutivos/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Resultado do Tratamento
4.
Medicine (Baltimore) ; 100(26): e26517, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190184

RESUMO

ABSTRACT: The purpose of this study was to examine the differences between the use of a posterior interosseous artery (PIA) flap and an anterolateral thigh (ALT) flap for post-traumatic, medium-sized soft tissue reconstruction of the hand based on flap characteristics, postoperative complications, and aesthetic outcomes.From October, 2010 to March, 2016, 62 patients undergoing soft tissue reconstruction of the hand with 30 PIA flaps and 32 ALT flaps were included in this study. The 62 patients were divided into the PIA flap group and the ALT flap group. The differences between the 2 groups were analyzed.The 62 patients included 52 males and 10 females, and the mean age at the time of surgery was 41 years. The flap failure rate was 13.3% (4/30) in the PIA flap group and 9.4% (3/32) in the ALT flap group. No significant differences in flap failure rate, recipient site complication rate, or donor site complication rate were observed between the 2 groups. However, the operative time (136 min vs 229 min) and aesthetic outcomes (flap bulk swelling, 0 cases vs 31 cases) were statistically significantly different.Both the pedicled PIA flap and the free ALT flap were comparable for the reconstruction of post-traumatic, medium-sized soft tissue defects of the hand according to the evaluated outcomes of postoperative complications. Based on the surgical characteristics of the flap and the evaluation of aesthetic outcomes, the pedicled PIA flap was significantly superior to the free ALT flap.


Assuntos
Retalhos de Tecido Biológico , Traumatismos da Mão/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Transplante de Pele , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Adulto , Estética , Feminino , Retalhos de Tecido Biológico/efeitos adversos , Retalhos de Tecido Biológico/irrigação sanguínea , Retalhos de Tecido Biológico/cirurgia , Humanos , Masculino , Duração da Cirurgia , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/efeitos adversos , Transplante de Pele/métodos , Retalhos Cirúrgicos/efeitos adversos , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos/cirurgia , Coxa da Perna
5.
Medicine (Baltimore) ; 100(22): e26235, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087908

RESUMO

RATIONALE: Degloving foot injuries are challenging to treat and associated with life-long sequelae for patients. An appropriate debridement of ischemic soft tissues with maximal preservation of glabrous skin is key during the reconstruction of these injuries. Indocyanine green (ICG) fluorescence angiography is an established technique for the intraoperative evaluation of tissue perfusion. PATIENT CONCERNS: Two patients sustained complex foot injuries in traffic accidents, including multiple fracture dislocations and extensive degloving of the plantar skin. DIAGNOSIS: Clinical inspection revealed significant degloving of the glabrous skin in both patients. INTERVENTIONS: After fracture fixation, ICG fluorescence angiography-assisted debridement with immediate latissimus dorsi free flap reconstruction was performed. OUTCOMES: In both cases, this technique allowed a precise debridement with maximal preservation of the glabrous skin. The healing of the remaining glabrous skin was uneventful and the 6-month follow-up was characterized by stable soft tissues and satisfying ambulation. LESSONS: ICG fluorescence angiography is a safe, user-friendly, and quick procedure with minimal risks, expanding the armamentarium of the reconstructive surgeon. It is highly useful for the debridement of extensive plantar degloving injuries and may also help to minimize the number of procedures and the risk of infection.


Assuntos
Desbridamento/métodos , Angiofluoresceinografia/métodos , Traumatismos do Pé/cirurgia , Pé/diagnóstico por imagem , Adulto , Assistência ao Convalescente , Criança , Desenluvamentos Cutâneos/cirurgia , Feminino , Pé/irrigação sanguínea , Pé/patologia , Traumatismos do Pé/complicações , Fraturas Múltiplas/cirurgia , Humanos , Verde de Indocianina/administração & dosagem , Masculino , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos/cirurgia , Resultado do Tratamento
6.
Biomed Res Int ; 2021: 5554500, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34124245

RESUMO

Objective: We aimed to evaluate the advantages of preoperative digital design of skin flaps to repair fingertip defects during the COVID-19 pandemic. We combined digital design with a 3D-printed model of the affected finger for preoperative communication with fingertip defect patients under observation in a buffer ward. Methods: From December 2019 to January 2021, we obtained data from 25 cases of 30 fingertip defects in 15 males and 10 females, aged 20-65 years old (mean 35 ± 5 years). All cases were treated by digitally designing preoperative fingertip defect flaps combined with a 3D-printed model. Preoperative 3D Systems Sense scanning was routinely performed, 3-matic 12.0 was used to measure the fingertip defect area ranging from 1.5 cm × 3.5 cm to 2.0 cm × 5.0 cm, and the skin flap was designed. The flap area was 1.6 cm × 3.6 cm to 2.1 cm × 5.1 cm. CURA 15.02.1 was used to set parameters, and the 3D model of the affected finger was printed prior to the operation. Full-thickness skin grafts were taken from donor areas for repair. Results: No vascular crises occurred in any of the 25 cases, and all flaps survived. The postoperative follow-up occurred over 3-12 months. All patients were evaluated 3 months after operation according to the trial standard of hand function evaluation of the Chinese Hand Surgery Society. The results showed that 20 cases had excellent outcomes (80%), four cases had good outcomes (16%), and one case had a fair outcome (4%). The excellent and good rate was 96%. Conclusions: During the COVID-19 epidemic, fingertip defects were treated with preoperative digital design of fingertip defect flaps combined with 3D printing. Precision design saves surgery time and improves the success rate of surgery and the survival rates of skin flaps. In addition, 3D model simulations improve preoperative communication efficiency, and the personalized design improves patient satisfaction.


Assuntos
COVID-19/epidemiologia , Traumatismos dos Dedos/cirurgia , Dedos/cirurgia , Pandemias , Cuidados Pré-Operatórios/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Adulto , Idoso , COVID-19/psicologia , China/epidemiologia , Feminino , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Impressão Tridimensional/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/psicologia , SARS-CoV-2/patogenicidade , Transplante de Pele/psicologia , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos/inervação , Resultado do Tratamento , Cicatrização/fisiologia
7.
Biomed Res Int ; 2021: 5554500, 2021.
Artigo em Inglês | MEDLINE | ID: covidwho-1263956

RESUMO

Objective: We aimed to evaluate the advantages of preoperative digital design of skin flaps to repair fingertip defects during the COVID-19 pandemic. We combined digital design with a 3D-printed model of the affected finger for preoperative communication with fingertip defect patients under observation in a buffer ward. Methods: From December 2019 to January 2021, we obtained data from 25 cases of 30 fingertip defects in 15 males and 10 females, aged 20-65 years old (mean 35 ± 5 years). All cases were treated by digitally designing preoperative fingertip defect flaps combined with a 3D-printed model. Preoperative 3D Systems Sense scanning was routinely performed, 3-matic 12.0 was used to measure the fingertip defect area ranging from 1.5 cm × 3.5 cm to 2.0 cm × 5.0 cm, and the skin flap was designed. The flap area was 1.6 cm × 3.6 cm to 2.1 cm × 5.1 cm. CURA 15.02.1 was used to set parameters, and the 3D model of the affected finger was printed prior to the operation. Full-thickness skin grafts were taken from donor areas for repair. Results: No vascular crises occurred in any of the 25 cases, and all flaps survived. The postoperative follow-up occurred over 3-12 months. All patients were evaluated 3 months after operation according to the trial standard of hand function evaluation of the Chinese Hand Surgery Society. The results showed that 20 cases had excellent outcomes (80%), four cases had good outcomes (16%), and one case had a fair outcome (4%). The excellent and good rate was 96%. Conclusions: During the COVID-19 epidemic, fingertip defects were treated with preoperative digital design of fingertip defect flaps combined with 3D printing. Precision design saves surgery time and improves the success rate of surgery and the survival rates of skin flaps. In addition, 3D model simulations improve preoperative communication efficiency, and the personalized design improves patient satisfaction.


Assuntos
COVID-19/epidemiologia , Traumatismos dos Dedos/cirurgia , Dedos/cirurgia , Pandemias , Cuidados Pré-Operatórios/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Adulto , Idoso , COVID-19/psicologia , China/epidemiologia , Feminino , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Anatômicos , Impressão Tridimensional/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/psicologia , SARS-CoV-2/patogenicidade , Transplante de Pele/psicologia , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos/inervação , Resultado do Tratamento , Cicatrização/fisiologia
8.
Nat Commun ; 12(1): 3961, 2021 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-34172721

RESUMO

Current materials used in biomedical devices do not match tissue's mechanical properties and leach various chemicals into the body. These deficiencies pose significant health risks that are further exacerbated by invasive implantation procedures. Herein, we leverage the brush-like polymer architecture to design and administer minimally invasive injectable elastomers that cure in vivo into leachable-free implants with mechanical properties matching the surrounding tissue. This strategy allows tuning curing time from minutes to hours, which empowers a broad range of biomedical applications from rapid wound sealing to time-intensive reconstructive surgery. These injectable elastomers support in vitro cell proliferation, while also demonstrating in vivo implant integrity with a mild inflammatory response and minimal fibrotic encapsulation.


Assuntos
Materiais Biomiméticos/administração & dosagem , Elastômeros/administração & dosagem , Procedimentos Cirúrgicos Reconstrutivos/métodos , Animais , Materiais Biocompatíveis/administração & dosagem , Materiais Biocompatíveis/química , Materiais Biocompatíveis/farmacologia , Materiais Biomiméticos/química , Materiais Biomiméticos/farmacologia , Proliferação de Células/efeitos dos fármacos , Elastômeros/química , Elastômeros/farmacologia , Géis , Injeções , Camundongos , Polímeros/administração & dosagem , Polímeros/química , Polímeros/farmacologia , Ratos , Fatores de Tempo
9.
Orthopedics ; 44(3): e446-e453, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34039212

RESUMO

Treatment of isolated complete tear of the scapholunate ligament is challenging. The purpose of this study was to determine (1) whether delayed repair of only scapholunate ligament is an option without other reconstruction procedures and (2) whether functional outcomes are possible despite radiographic presence of arthritis. This study included patients who had complete ligament tear at exploration and underwent only scapholunate ligament repair without capsulodesis or tenodesis. Fifteen patients returned for clinical and radiographic examinations. Preoperatively, mean scapholunate gap was 2.9 mm and 4.58 mm on posteroanterior and tangential posteroanterior views, respectively. Postoperatively, the final mean gap was 2.5 mm and 3.9 mm on the posteroanterior and tangential posteroanterior views, respectively. The mean preoperative and final scapholunate angles were 74° and 72.6°, respectively. Seven patients had radiographic arthritis at final follow-up. Delayed scapholunate repair is possible after complete ligament tear. At long-term follow-up, clinical functional outcomes may not correlate with radiographic presence of degenerative arthritis. [Orthopedics. 2021;44(3):e446-e453.].


Assuntos
Ligamentos Articulares/lesões , Ligamentos Articulares/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Ruptura/cirurgia , Adulto , Humanos , Osso Semilunar/cirurgia , Masculino , Pessoa de Meia-Idade , Osso Escafoide/cirurgia , Fatores de Tempo , Resultado do Tratamento
10.
Turk Neurosurg ; 31(3): 472-478, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33978202

RESUMO

Craniosynostosis surgery may result in temporal hollowing occasionally. Overexpansion of the normal side and undergrowth of the affected side exacerbate the problem in unilateral cases (like unicoronal synostosis). Temporalis muscle lies in the temporal fossa, and it is usually severed or detached from its origin in order to reach the lateral aspect of the fronto-orbital bar. Reattachment of the temporalis muscle is challenging especially when the orbital bar is moved forward. In this technical note, exposure of the lateral cranial vault with zigzag incision of the temporalis muscle in 35 nonsyndromic anterior plagiocephaly patients has been described in detail, and the ease of reattachment is demonstrated afterward.


Assuntos
Craniossinostoses/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Crânio/cirurgia , Músculo Temporal/cirurgia , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Órbita/cirurgia , Resultado do Tratamento
11.
Pediatr Surg Int ; 37(8): 1135-1139, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33942133

RESUMO

AIM: Laparoscopic pyeloplasty (LP) is less popular and considered less successful in infants compared to older children. There are few reports analyzing the functional results of LP in relation to age of surgery. The aim of this paper is to compare the functional results of LP in infants (group 1) with children over 1 year of age (group 2). MATERIAL AND METHODS: The data of all children undergoing LP between August 2016 and July 2019 were retrospectively analyzed for patient details and follow-up. Only children (n = 135) with at least 1-year follow-up and completed post-operative ultrasound and diuretic renogram were included. All children underwent pre-operative and post-operative ultrasound and diuretic renogram; pre-operative, operative and post-operative parameters were compared between both groups. Statistical analysis was done using software; Mann-Whitney U test, Student t test, and Fisher's exact test were applied. RESULTS: There were 71 infants (group 1) and 64 children > 1 year (group 2). Pre-operatively, all kidneys had SFU grade 3 or 4 HDN and 131/135 kidneys had a renal pelvic APD > 20 mm; all kidneys had unequivocal obstruction on DR. At surgery, the preferred drainage method was intra-operative antegrade placement of a JJ stent in 68 (96%) group 1 and 63 (98%) group 2 children. The remaining 4 cases (3 group 1, 1 group 2) had a nephrostomy with trans-anastomotic external stent placement, because the JJ stent could not be negotiated into the bladder. The demographic data and comparison of pre- and post-operative parameters between both groups are summarized in Tables 1 and 2, respectively. Group 1 had significantly more children with antenatal diagnosis of HDN (87% vs 56%, p = 0.0005). The 36 children with antenatal diagnosis in group 2 were initially followed expectantly; the indication for pyeloplasty was deterioration of SRF on serial DR, urinary infection, and pain, in 13, 14, and 9 children, respectively. The operating time was significantly longer in group 2 (p = 0.0001). There was no difference in the success of LP or complication rate in both groups. Group 2 had significantly more children with extrinsic obstruction (1.4% vs 17%, p = 0.001). All children underwent post-operative US and DR; a significant reduction in hydronephrosis (APD) on follow-up was noted in both groups (p = 0.0001). The mean pre-operative SRF in both groups was comparable (p = 0.088). The mean SRF in both groups improved significantly after LP; however, the mean post-operative SRF was significantly higher in group 1 when compared to group 2 (p = 0.0001). Furthermore, group 1 had significantly more kidneys demonstrating > 10% increase in SRF after LP (53% vs 26%, p = 0.0003). CONCLUSIONS: The safety profile and success of LP in infants was comparable to older children. Infant LP took shorter time to perform, while older children had increased incidence of extrinsic obstruction. Infant kidneys demonstrated better functional improvement than older children after LP. These findings should encourage more surgeons to utilize LP for pyeloplasty even in infants.


Assuntos
Rim/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/reabilitação , Ureter/cirurgia , Procedimentos Cirúrgicos Urológicos/reabilitação , Criança , Feminino , Humanos , Lactente , Laparoscopia/métodos , Laparoscopia/reabilitação , Masculino , Período Pós-Operatório , Gravidez , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Procedimentos Cirúrgicos Urológicos/métodos
12.
Orthopedics ; 44(3): e359-e366, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34039198

RESUMO

The goal of this study was to determine the threshold for achieving maximal outcome improvement (MOI) on the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and Constant-Murley (CM) questionnaires that predict satisfaction after isolated biceps tenodesis without concomitant rotator cuff repair. A retrospective analysis of prospectively collected data was performed for patients undergoing isolated biceps tenodesis from 2014 to 2017 at a single institution with minimum 6-month follow-up. Receiver operating characteristic curve analysis was used to determine thresholds for MOI for the ASES, SANE, and CM questionnaires. Stepwise multivariate logistical regression analysis was performed to identify predictors for achieving the threshold for MOI. A total of 123 patients were included in the final analysis. Receiver operating characteristic analysis determined that achieving 43.1%, 62.1%, and 61.4% MOI was the threshold for satisfaction for the ASES, SANE, and CM questionnaires, respectively. Regression analysis showed that concomitant superior labrum anterior-posterior (SLAP) repair was predictive of achieving MOI on the ASES and SANE questionnaires, whereas partial rotator cuff tear was predictive of achieving MOI on the CM questionnaire (P<.05 for both). Further, workers' compensation status, diabetes, history of ipsilateral shoulder surgery, and hypertension were negative predictors of achieving MOI on the SANE and CM questionnaires (P<.05 for all). Achieving MOI of 43.1%, 62.1%, and 61.4% is the threshold for satisfaction after biceps tenodesis for the ASES, SANE, and CM questionnaires, respectively. Concomitant SLAP repair was positively predictive of achieving MOI, whereas workers' compensation status, diabetes, history of ipsilateral shoulder surgery, and hypertension were negative predictors. [Orthopedics. 2021;44(3):e359-e366.].


Assuntos
Braço/cirurgia , Músculo Esquelético/cirurgia , Satisfação do Paciente , Tendões/cirurgia , Tenodese/métodos , Adulto , Artroscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Indenização aos Trabalhadores
13.
Pan Afr Med J ; 38: 214, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34046120

RESUMO

Introduction: anorectal malformation is a multi-systemic birth defect of the distal gastrointestinal tract, the management of which is challenging to the surgeons, the patients and the parents. The presence of associated congenital malformations may worsen the outcome with consequent psychosocial effects on the patients and the parents. The characteristics of anorectal malformations with the challenges associated with their management and the outcomes are therefore presented here. Methods: all patients managed for anorectal malformations from January 2003 to December 2017 were studied. Patients´ demography, clinical presentations, types of malformations, associated anomalies, procedures performed, post-operative complications and management outcome were obtained and analysed. Results: eighty-eight children with anorectal malformations comprising 61 (69.3%) boys and 27 (30.7%) girls were studied with 76 (86.3%) patients presenting within the first year of life. Low anorectal malformation was observed in 14 (15.9%) patients, 71 (80.7%) patients had intermediate or high malformations and cloacal malformation was present in 3 (3.4%) patients. Associated congenital malformations were observed in 18 (20.5%) patients with 10 (55.6%) patients associated with intermediate or high malformations and urogenital system was the most common system whose anomalies were associated with anorectal malformations in 12 (13.6%) patients. Anoplasty was performed on 14 (15.9%) patients, posterior sagittal anorectoplasty was performed on 67 (76.1%) patients, abdominosacroperineal pull through on 4 (4.6%) patients and posterior sagittal anorectovaginourethroplasty on 3 (3.4%) patients. Six (6.8%) neonates died. Conclusion: immediate post-operative outcome was good; however, good functional outcome can only be assessed in an atmosphere of good follow-up which is still a problem in our environment.


Assuntos
Malformações Anorretais/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Malformações Anorretais/fisiopatologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Nigéria , Complicações Pós-Operatórias/epidemiologia , Resultado do Tratamento
14.
Int J Mol Sci ; 22(8)2021 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-33920046

RESUMO

SmartBone® (SB) is a biohybrid bone substitute advantageously proposed as a class III medical device for bone regeneration in reconstructive surgeries (oral, maxillofacial, orthopedic, and oncology). In the present study, a new strategy to improve SB osteoinductivity was developed. SB scaffolds were loaded with lyosecretome, a freeze-dried formulation of mesenchymal stem cell (MSC)-secretome, containing proteins and extracellular vesicles (EVs). Lyosecretome-loaded SB scaffolds (SBlyo) were prepared using an absorption method. A burst release of proteins and EVs (38% and 50% after 30 min, respectively) was observed, and then proteins were released more slowly with respect to EVs, most likely because they more strongly adsorbed onto the SB surface. In vitro tests were conducted using adipose tissue-derived stromal vascular fraction (SVF) plated on SB or SBlyo. After 14 days, significant cell proliferation improvement was observed on SBlyo with respect to SB, where cells filled the cavities between the native trabeculae. On SB, on the other hand, the process was still present, but tissue formation was less organized at 60 days. On both scaffolds, cells differentiated into osteoblasts and were able to mineralize after 60 days. Nonetheless, SBlyo showed a higher expression of osteoblast markers and a higher quantity of newly formed trabeculae than SB alone. The quantification analysis of the newly formed mineralized tissue and the immunohistochemical studies demonstrated that SBlyo induces bone formation more effectively. This osteoinductive effect is likely due to the osteogenic factors present in the lyosecretome, such as fibronectin, alpha-2-macroglobulin, apolipoprotein A, and TGF-ß.


Assuntos
Matriz Óssea/química , Regeneração Óssea/efeitos dos fármacos , Substitutos Ósseos/farmacologia , Transplante de Células-Tronco Mesenquimais , Animais , Substitutos Ósseos/química , Bovinos , Diferenciação Celular/efeitos dos fármacos , Preparações de Ação Retardada/química , Preparações de Ação Retardada/farmacologia , Vesículas Extracelulares/química , Vesículas Extracelulares/genética , Humanos , Células-Tronco Mesenquimais/química , Células-Tronco Mesenquimais/efeitos dos fármacos , Osteoblastos/efeitos dos fármacos , Osteogênese/efeitos dos fármacos , Procedimentos Cirúrgicos Reconstrutivos/métodos
15.
Artigo em Inglês | MEDLINE | ID: mdl-33901347

RESUMO

The thoracotomy incision is essential for many thoracic surgery procedures. A number of different variations exist, and different techniques can be used, depending both on the patient and on the technical factors. The muscle-sparing technique was first described by Noirclerc et al. in 1973. [1] Initially, it was thought that preservation of the muscular structures compared with the results of a traditional posterolateral thoracotomy, in which the latissimus dorsi and sometimes the serratus anterior are often divided, would benefit long-term outcomes.  However, subsequent study results  have not demonstrated any difference in postoperative outcomes. The unequivocal benefit of a muscle-sparing approach is to preserve the latissimus dorsi for any future intervention, such as a procedure involving the chest wall and the intrathoracic flaps. In this video tutorial, we describe our approach to this commonly used incision, including the anatomy and the technical aspects used to provide optimal operative exposure and minimal postoperative complications while preserving the underlying musculature.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Músculos Superficiais do Dorso/cirurgia , Retalhos Cirúrgicos , Parede Torácica/cirurgia , Toracotomia/métodos , Feminino , Humanos , Músculos Intercostais/cirurgia , Pessoa de Meia-Idade , Músculos Superficiais do Dorso/anatomia & histologia , Parede Torácica/anatomia & histologia
16.
Int J Comput Assist Radiol Surg ; 16(6): 1059-1068, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33905085

RESUMO

PURPOSE: The management of complex mandible fractures, i.e. severely comminuted or fractures of edentulous/atrophic mandibles, can be challenging. This is due to the three-dimensional loss of bone, which limits the possibility for accurate anatomic reduction. Virtual surgery planning (VSP) can provide improved accuracy and shorter operating times, but is often not employed for trauma cases because of time constraints and complex user interfaces limited to two-dimensional interaction with three-dimensional data. METHODS: In this study, we evaluate the accuracy, precision, and time efficiency of the haptic assisted surgery planning system (HASP), an in-house VSP system that supports stereo graphics, six degrees-of-freedom input, and haptics to improve the surgical planning. Three operators performed planning in HASP on computed tomography (CT) and cone beam computed tomography (CBCT) images of a plastic skull model and on twelve retrospective cases with complex mandible fractures. RESULTS: The results show an accuracy and reproducibility of less than 2 mm when using HASP for virtual fracture reduction, with an average planning time of 15 min including time for segmentation in the software BoneSplit. CONCLUSION: This study presents an in-house haptic assisted planning tool for cranio-maxillofacial surgery with high usability that can be used for preoperative planning and evaluation of complex mandible fractures.


Assuntos
Tomografia Computadorizada de Feixe Cônico/métodos , Fixação de Fratura/métodos , Imageamento Tridimensional/métodos , Mandíbula/cirurgia , Fraturas Mandibulares/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Cirurgia Assistida por Computador/métodos , Humanos , Mandíbula/diagnóstico por imagem , Fraturas Mandibulares/diagnóstico , Reprodutibilidade dos Testes , Estudos Retrospectivos
17.
Pediatr Surg Int ; 37(8): 999-1005, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33903971

RESUMO

PURPOSE: Laparoscopic-assisted anorectoplasty (LAARP) is becoming a more popular procedure for anorectal malformation (ARM) repair. However, the conventional technique for creating pull-through tunnel between the perineal skin and the pelvic floor has been criticized as being semi-blind. This study aims to present a refined version of our previously reported clamp introduction technique for visualized tunnel formation in the center of the sphincter muscle complex (SMC) for rectal pull- through for ARMs. METHODS: A retrospective review was performed for ARM patients who underwent LAARP from Jan 2019 to Jun 2020. Longitudinal muscle tube (LMT) tunnel was created using the clamp-dilator introduction technique: a laparoscopic dilator was used to create a pelvic tunnel within LMT in high ARM, and the clamp introduction under the direct vision technique was performed for creating the perineal tunnel of LMT for both high and intermediate ARMs. RESULTS: Seventy patients (1-198 days) with high-type (27cases) and intermediate-type (43 cases) ARM underwent LAARP using clamp-dilation introduction technique. No patients suffered from urinary tract injury, recurrent rectourethral fistula, urethral diverticulum and urinary incontinence. One patient suffered from wound infection and rectal retraction which required a redo pull-through on postoperative day 7. Rectal prolapse requiring surgical intervention developed in one patient. Postoperative MRI examination confirmed central placement of the rectum within the LMT in all cases. CONCLUSION: Our experience demonstrates that a visualized tunnel formation in the LMT center can be achieved by the clamp-dilator introduction technique in LAARP for both high and intermediate ARMs.


Assuntos
Malformações Anorretais/cirurgia , Laparoscopia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Períneo/cirurgia , Período Pós-Operatório , Estudos Retrospectivos
18.
J Pediatr Adolesc Gynecol ; 34(4): 566-568, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33864958

RESUMO

BACKGROUND: Creating a functional neovagina is a practical therapeutic intervention for women with congenital vaginal agenesis and sexual needs. Although the incidence of neovaginal prolapse (NP) is low, it is inconvenient for patients and is a challenging problem for gynecologists. CASE: A 32-year-old woman who had undergone transabdominal sigmoid vaginoplasty 10 years previously at another hospital visited our clinic for evaluation and treatment of NP. Gynecological examination showed exstrophy of the vaginal apex, 4 cm beyond the hymen. Laparoscopic sacrocolpopexy was performed using a mesh. The mesh was sutured at the anterior wall and apex of the neovagina and suspended in the anterior sacral region without blood vessels. SUMMARY AND CONCLUSION: Laparoscopic sacrocolpopexy might be an effective and safe treatment for NP.


Assuntos
Anormalidades Congênitas/cirurgia , Prolapso de Órgão Pélvico/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Vagina/anormalidades , Adulto , Feminino , Humanos , Laparoscopia , Próteses e Implantes , Telas Cirúrgicas , Resultado do Tratamento , Vagina/cirurgia
19.
Medicine (Baltimore) ; 100(17): e25703, 2021 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-33907152

RESUMO

RATIONALE: Three-dimensional (3D) printing has attracted wide attention for its potential and abilities in the assistance of surgical planning and the development of personalized prostheses. We herewith report a unique case of chronic clavicle osteomyelitis treated with a two-stage subtotal clavicle reconstruction using a 3D printed polyether-ether-ketone (PEEK) prosthesis. PATIENT CONCERNS: A 23-year-old Chinese female presented to our clinic complaining about a progressive pain of her right clavicle for about 1 year. DIAGNOSES: Chronic clavicle osteomyelitis confirmed by percutaneous biopsy and lesion biopsy. INTERVENTIONS: This patient accepted a long-term conservative treatment, which did not gain satisfactory outcomes. Thus, a subtotal removal and two-stage reconstruction of the right clavicle with a 3D-printed polyether-ether-ketone prosthesis stabilized by screw fixation system was performed. OUTCOMES: At 2-year follow-up, complete pain relief and satisfactory functional recovery of her right shoulder were observed. LESSONS: Personalized 3D printed prosthesis is an effective and feasible method for reconstruction of complex bone defects.


Assuntos
Clavícula , Osteomielite , Cuidados Pré-Operatórios/métodos , Impressão Tridimensional , Implantação de Prótese , Dispositivos de Fixação Cirúrgica , Tomografia Computadorizada por Raios X/métodos , Materiais Biocompatíveis/uso terapêutico , Biópsia/métodos , Doença Crônica , Clavícula/diagnóstico por imagem , Clavícula/patologia , Clavícula/cirurgia , Feminino , Humanos , Cetonas/uso terapêutico , Osteomielite/diagnóstico , Osteomielite/fisiopatologia , Osteomielite/cirurgia , Polietilenoglicóis/uso terapêutico , Desenho de Prótese , Implantação de Prótese/instrumentação , Implantação de Prótese/métodos , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Resultado do Tratamento , Adulto Jovem
20.
Wounds ; 33(4): 99-105, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33872203

RESUMO

INTRODUCTION: The COVID-19 virus is caused by the new coronavirus, SARS-CoV-2. COVID-19 has drastically changed the medical landscape. Although predominantly impacting the respiratory system, COVID-19 has several non-respiratory symptoms associated with its presentation and course. Among these are gastrointestinal symptoms and thromboembolic events with stroke. Increasingly recognized, but often overlooked, are the coagulopathy phenomena occurring with COVID-19. The severe respiratory symptoms are the primary focus of clinical management. However, close inspection of patients demonstrates that patients often exhibit both thromboembolic and bleeding events, ranging from simple skin lesions to overt emergencies. CASE REPORT: The author presents a case of COVID-19-associated coagulopathy resulting in compartment syndrome of the arm with volar forearm necrosis, requiring flap reconstruction and tendon transfer to salvage the upper extremity. CONCLUSIONS: Massive rhabdomyolysis resulted in acute tubular necrosis with renal failure requiring hemodialysis. The timing of reconstruction of the sequelae of compartment syndrome in an acutely ill patient is challenging, but optimal timing can result in a successful outcome.


Assuntos
COVID-19/complicações , Síndromes Compartimentais/cirurgia , Pandemias , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , COVID-19/epidemiologia , Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/etiologia , Antebraço , Humanos , Masculino , Necrose/diagnóstico , Necrose/etiologia , Necrose/cirurgia , SARS-CoV-2
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