Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.899
Filtrar
1.
BMC Surg ; 21(1): 147, 2021 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-33743633

RESUMO

BACKGROUND: Chest keloids often converged into a large lesion on the chest in some patients. Such keloids often lead to obstacle to excision and reconstruction. We describe a surgical method for large chest keloids with expanded parasternal intercostal perforator flap (EPIPF). METHODS: Fifteen patients with chest keloid were treated with EPIPF in our department between August 2017 and Dec 2019. The surgical treatment was divided into two different phases. In the first phase, we implanted skin expanders into the layer under the deep fascia beside the keloids. The expander was expanded every week for about 3-4 months. In the second phase, the expander was removed, the keloid tissue was removed and an expanded perforator flap was then designed to cover the wound. Patients were followed-up after surgery. Complications after surgery were analyzed. Recurrence and the patients, satisfactory rate was recorded. RESULTS: Of the 15 patients, one patient complicated with undesirable small area wound healing. 11 were cured without scar hypertrophy or recurrence and four were partially cured with a small portion of scar hypertrophy. Eleven patients thought that the esthetic result was good (73.7%), and 4 patients thought the result was acceptable (26.7%). None patient was dissatisfied. CONCLUSION: EPIPF are effective surgical method for managing large chest keloids. It can offer enough skin flap coverage for keloid wound resurfacing with stable blood supply to assure satisfactory results. LEVEL OF EVIDENCE: Level IV, case series.


Assuntos
Queloide , Retalho Perfurante , Procedimentos Cirúrgicos Torácicos , Adulto , Humanos , Queloide/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Procedimentos Cirúrgicos Torácicos/métodos , Resultado do Tratamento , Adulto Jovem
2.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(3): 349-355, 2021 Mar 15.
Artigo em Chinês | MEDLINE | ID: mdl-33719245

RESUMO

Objective: To explore the reliability and effectiveness of soft tissue defect reconstruction using the lower trapezius musculocutaneous flap carrying a portion of the latissimus dorsi muscle. Methods: Between December 2014 and December 2019, 13 patients underwent the reconstruction of soft tissue defects in various sites using the lower trapezius musculocutaneous flap carrying a portion of the latissimus dorsi muscle. There were 10 males and 3 females, with an average age of 52.1 years (range, 29-83 years). Twelve wounds were resulted from resection of various malignant tumor, including 6 cases of head and neck tumors, 5 cases of shoulder and back tumors, 1 case of chest and back tumors. Among the 12 cases, 4 cases were complicated with wound infection and bone exposure, 1 case with skull defect and cerebral dura exposure, and 1 case with wound infection, skull necrosis, and cerebrospinal fluid leakage. One case was injured in a traffic accident, which resulted in infection wound in the back and shoulder and bone exposure. The sizes of the defect and musculocutaneous flap ranged from 11 cm×7 cm to 23 cm×15 cm and 25 cm×8 cm to 40 cm×14 cm, respectively. According to the spatial relationship between the donor and recipient sites, propeller flaps (8 cases) or percutaneous tunnel island flaps (5 cases) were used to transfer the myocutaneous flap to the recipient area to repair the wound. The donor site was directly closed and sutured in 9 cases, and those with excessive tension were repaired with free skin grafts in 2 cases or transferred flaps in 2 cases. Results: After the operation, necrosis of the distal 4-cm of the musculocutaneous flap occurred in 2 cases. After debridement, the resultant wounds were reconstructed using a local flap and a posterior intercostal artery perforator flap, respectively. The remaining 11 myocutaneous flaps survived completely without arteries and veins crisis. The wounds in the donor and recipient areas healed by first intention. All the patients were followed up 1 to 48 months (mean, 7.4 months). The color and texture of the flap were good. During the follow-up, 1 patient underwent tumor resection again due to tumor recurrence, and 1 patient with a scalp hemangiosarcoma died due to unexplained thoracic hemorrhage. Tumor recurrence was not found in the remaining patients. The musculocutaneous flap coverage was stable and the infection was controlled. Conclusion: The lower trapezius musculocutaneous flap carrying a portion of the latissimus dorsi muscle can be an alternation option to reconstruct refractory wounds with exposure of vital structures and organs and infection.


Assuntos
Retalho Miocutâneo , Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Músculos Superficiais do Dorso , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Transplante de Pele , Lesões dos Tecidos Moles/cirurgia , Resultado do Tratamento
3.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 56(3): 276-278, 2021 Mar 09.
Artigo em Chinês | MEDLINE | ID: mdl-33663158

RESUMO

To explore the feasibility of using the posteromedial thigh flap as an alternative source for oral and maxillofacial reconstruction. During January 2019 to January 2020, twenty-three patients underwent oral and maxillofacial tumor ablation and defect reconstruction with 23 posteromedial thigh flaps were enrolled in the Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhengzhou University. Thirteen of the patients were male and ten were female, with age of (54.5±9.7) years (33-72 years). The numbers and types of perforators, the dimension of flap and the vascular pedicle length were measured. The outcomes of flaps and donor-site complication were recorded. The patients' satisfaction with donor-site cosmesis were evaluated by the visual analogue scale (VAS). More than one sizable perforators was found in each case and the median number of perforators was 2 (range, 1 to 4), and all of the perforators were musculocutaneous. The pedicle length was (9.8±1.5) cm (range, 7.3 to 13.4 cm). The diameters of artery and the larger vein were 2.0 mm (range, 1.5 to 2.5 mm) and 2.0 mm (range, 1.5 to 3.0 mm), respectively. The dimension of the flaps ranged from 8 cm×6 cm to 12 cm×8 cm, and the donor sites were all closed primarily. All of the flaps were clinically survived, only one patient experienced partial wound dehiscence of donor site 14 days postoperatively and no donor site infection or permanent muscular weakness was reported. The VAS scores of the patients' satisfaction with donor-site cosmesis were all more than 8. The perforators of the posteromedial thigh flap is consistent and the donor-site scar is well concealed, which make the posteromedial thigh flap an excellent option for oral and maxillofacial reconstruction.


Assuntos
Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Adulto , Artérias , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transplante de Pele , Retalhos Cirúrgicos , Coxa da Perna/cirurgia
4.
Zhonghua Shao Shang Za Zhi ; 37(2): 187-190, 2021 Feb 20.
Artigo em Chinês | MEDLINE | ID: mdl-33648330

RESUMO

Objective: To explore the clinical effects of anterograde sural neurovascular flap in repairing skin and soft tissue defect around the knee. Methods: Nine patients with skin and soft tissue defect around the knee admitted to Beijing Fengtai YouAnMen Hospital from May 2011 to December 2018, were included in this retrospective descriptive study, including 8 males and 1 female, aged 16 to 65 years. The wound area after debridement ranged from 8 cm×5 cm to 18 cm×10 cm. Anterograde sural neurovascular flap was used to repair the wounds in 9 patients, with the area ranging from 9 cm×6 cm to 20 cm×12 cm. The donor sits of flaps in 2 patients were closed and sutured directly, and the donor sits of flaps in 7 patients were repaired with medial split-thickness skin graft of the ipsilateral thigh. The flap survival, complications, and follow-up after operation were recorded. Results: The flaps survived and the blood supply was good in 8 patients and the wounds were closed. One patient developed skin ischemic necrosis which was cured after three weeks of dressing change. All the skin grafts in the donor site of flap in 7 patients survived. In 6 months to 5 years of follow-up after surgery, the skin flap had good texture, color, and shape, and normal sensation. Except for one patient whose knee had poor recovery of function, the knee joint function of the other patients recovered well. Conclusions: The anterograde sural neurovascular flap has the advantages of high survival rate, satisfactory appearance and functional recovery post surgery, and is an ideal flap for repairing the skin and soft tissue defect around the knee.


Assuntos
Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Adolescente , Adulto , Idoso , Feminino , Humanos , Articulação do Joelho , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplante de Pele , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Resultado do Tratamento , Adulto Jovem
5.
J Surg Oncol ; 123(5): 1232-1237, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33567142

RESUMO

BACKGROUND: The internal mammary artery/vein (IMA/V) are commonly used recipients for free flap breast reconstruction, but requires costal cartilage resection and limits future use of the IMA. This study aimed to evaluate the feasibility of the thoracoacromial artery/vein (TAA/V) as recipients for deep inferior epigastric artery perforator (DIEP) flap breast reconstruction compared with using the IMA/V. METHODS: Medical charts of patients who underwent free DIEP flap breast reconstruction using the TAA/V or the IMA/V as recipient vessels were reviewed. Patient and vessel characteristics, time for vessel preparation and anastomosis, and postoperative pain were compared between TAA/V and IMA/V groups. RESULTS: Thirty-four patients were included; 12 in TAA/V group, and 22 in IMA/V group. There was no flap failure in both groups. There were statistically significant differences between TAA/V and IMA/V groups in vessel preparation time (10.9 ± 3.7 min vs. 24.1 ± 6.0 min, p < .001), anastomosis time (31.2 ± 12.1 min vs. 42.1 ± 11.2 min, p = .017), and total dose of acetaminophen (4566.7 ± 1015.6 mg vs. 5436.4 ± 1323.3 mg, p = .041). CONCLUSIONS: The TAA/V could be safely used as recipient vessels for DIEP flap breast reconstruction with shorter time and less postoperative pain.


Assuntos
Neoplasias da Mama/cirurgia , Artérias Epigástricas/cirurgia , Mamoplastia/métodos , Artéria Torácica Interna/cirurgia , Retalho Perfurante/irrigação sanguínea , Artérias Torácicas/cirurgia , Veias/cirurgia , Adulto , Idoso , Neoplasias da Mama/patologia , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Retalho Perfurante/transplante , Prognóstico , Estudos Retrospectivos
6.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33542012

RESUMO

A 40-year-old woman was referred to infectious disease specialists for a Mycobacterium mageritense skin infection following mastectomy and bilateral reconstruction with deep inferior epigastric perforator flap. Her case demonstrates the difficulty in treating non-tuberculosis mycobacterial infections, especially the rarely seen species. She failed to respond to dual antibiotic therapy containing imipenem-cilastin despite reported sensitivity. Additionally, her course was complicated by intolerance to various regimens, including gastrointestinal distress, a drug rash with eosinophilia and systemic symptoms, and tendinopathy. With few published data, no treatment guidelines, and limited medications from which to choose for M. mageritense, her treatment posed a challenge. She ultimately required aggressive surgical intervention and a triple therapy antibiotic regimen. The duration of our patient's treatment and the extent of her complications suggest a potential need for early surgical intervention in postsurgical wounds infected with M. mageritense that do not respond to conventional treatment.


Assuntos
Antibacterianos/uso terapêutico , Ciprofloxacino/uso terapêutico , Desbridamento/efeitos adversos , Doxiciclina/uso terapêutico , Mamoplastia , Mastectomia , Mycobacteriaceae/isolamento & purificação , Complicações Pós-Operatórias/tratamento farmacológico , Adulto , Neoplasias da Mama/cirurgia , Feminino , Humanos , Retalho Perfurante
7.
J Surg Oncol ; 123(4): 1067-1080, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33428783

RESUMO

BACKGROUND: Postoperative complications after flap-coverage in sarcoma treatment can postpone postoperative adjunct treatments. Here, we present our experience with the use of the superficial circumflex iliac artery perforator (SCIP) flap after sarcoma resection. PATIENTS AND METHODS: Patients undergoing immediate reconstruction surgery with a flap after sarcoma resection at a single institution from February 2017 to April 2020 were identified. Patient demographics, tumor characteristics, surgical characteristics, and complications were examined. RESULTS: Thirty-five consecutive patients underwent reconstructions using a SCIP flap (34 free and one pedicled SCIP flaps). We also identified 47 consecutive patients who underwent reconstruction with other pedicled or free flaps over the same time period. No significant differences were found in patient age, gender, defect size, or operative time between these two groups. The incidences of overall complications (20/47 [42.6%] vs. 3/35 [8.5%], p < .001), flap dehiscence (7/47 [14.8%] vs. 0/35 [0%], p = .018), and total flap complications (15/47 [31.9%] vs. 2/35 [5.7%], p = .005) were statistically greater in the control group than in the SCIP group. CONCLUSION: With its minimal postoperative complication rate both in the reconstruction site and the donor site, the SCIP flap can be considered an optimal reconstruction option after sarcoma resection.


Assuntos
Retalhos de Tecido Biológico/irrigação sanguínea , Artéria Ilíaca/transplante , Retalho Perfurante/irrigação sanguínea , Retalho Perfurante/inervação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Sarcoma/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Criança , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Adulto Jovem
8.
Injury ; 52(3): 402-406, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33341244

RESUMO

BACKGROUND: COVID-19 has created huge pressures on healthcare systems. The ongoing provision of major trauma services during this time has proved challenging. We report our experience of managing open lower limb fractures (oLLFs) during the pandemic in a London major trauma centre (MTC). METHODS: This was a prospective study of all open lower limb fractures presenting to our unit over the initial 48 days of UK government lockdown - 24th March till 10th May 2020. Results were compared to the same time period in 2019 retrospectively. Epidemiological data, mechanism, Gustilo-Anderson (G-A) severity grading, time to initial debridement and definitive coverage were analysed. RESULTS: There was a 64% reduction in emergency department (ED) attendances (25,264 vs 9042). There was an 18% reduction in oLLFs (22 vs 18). Approximately three-quarters of injuries were in males across both cohorts (77% vs 78%) and tended to occur in younger patients (median age, 37 vs 35). Road-traffic-accidents (RTAs) were the most common injury mechanism in both 2019 and lockdown, but a rise in jumpers from height was seen in the latter. A similar pattern of G-A severities were seen, however only 3 injuries during lockdown required major soft tissue reconstruction. There was no significant difference in times taken for initial debridement (p = 0.72786) or definitive wound coverage (p = 0.16152). A greater proportion of independent operating was seen during lockdown between orthopaedics and plastic surgery. CONCLUSIONS: Despite government lockdown measures, oLLFs still placed significant burden on our MTC. Notwithstanding significant staffing alterations and theatre pressures, we have been able to ensure these lower limb emergencies remain a surgical priority and have managed to utilise resources appropriately.


Assuntos
Fraturas do Fêmur/cirurgia , Traumatismos do Pé/cirurgia , Fraturas Expostas/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Desbridamento/métodos , Feminino , Fraturas do Fêmur/epidemiologia , Traumatismos do Pé/epidemiologia , Fraturas Expostas/epidemiologia , Retalhos de Tecido Biológico , Humanos , Tempo de Internação , Londres , Masculino , Pessoa de Meia-Idade , Retalho Perfurante , Cirurgia Plástica , Retalhos Cirúrgicos , Fraturas da Tíbia/epidemiologia , Fatores de Tempo , Centros de Traumatologia , Técnicas de Fechamento de Ferimentos , Adulto Jovem
9.
J Plast Reconstr Aesthet Surg ; 74(4): 718-729, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33334702

RESUMO

BACKGROUND: Perforator flaps yield the best results for the patient with the least morbidity, and they should be considered the gold standard in head and neck reconstruction. Although deep inferior epigastric perforator (DIEP) flap is considered as the gold standard in breast reconstruction, its use in head and neck reconstructive surgery does not seem so widespread. The objective of this study is to conduct a systematic review of the use, applications and results of the DIEP flap in the head and neck area. METHODS: Search was conducted in different indexed databases (PubMed/MEDLINE, the Cochrane Library, Scielo and Web of Science) and through meta-searcher Trip Database with deep inferior epigastric perforator flap AND head neck keywords. Studies on animal and human experiments published in peer-reviewed journals, where investigators assessed the use of DIEP flap, according to the Koshima criteria, in the head and neck area were considered. RESULTS: A total of 31 articles and 185 flaps with 95% of survival were found. Thrombosis or venous stasis is the most frequent cause of flap loss and 16.1% presented some type of complication, the most frequent being the dehiscence. The most use was in the reconstruction of glossectomy defect secondary to squamous cell carcinoma (30.51%), being able potentially to re-establish sensory innervation in oral cavity. The assessment of risk bias (National Institutes of Health) highlights the lack of uniformity, with no standardisation of the outcome variable collection and monitoring. DISCUSSION: By virtue of its versatility, reliable vascular supply and high flap survival rate, the DIEP flap reconstruction could be an option in complicated 3-dimensional head and neck defects while maintaining the standard of low donor site morbidity.


Assuntos
Artérias Epigástricas/transplante , Neoplasias de Cabeça e Pescoço/cirurgia , Retalho Perfurante/irrigação sanguínea , Procedimentos Cirúrgicos Reconstrutivos/métodos , Animais , Rejeição de Enxerto , Sobrevivência de Enxerto , Humanos
10.
Medicine (Baltimore) ; 99(50): e23080, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327231

RESUMO

BACKGROUND: Head and neck tissue defects cause great physical and psychological damage to patients. Therefore, accurate positioning of perforating vessels before operation is of great significance for improving the success rate of flap preparation and avoiding unnecessary incision injury. METHODS/DESIGN: A total of 60 patients with laryngeal cancer in otolaryngology, Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Southwest Medical University and the Third People's Hospital of Mianyang city from October 2020 to October 2021 will be selected and randomly divided into CT angiogram (CTA) group (n=20), mimics group (n = 20) and CTA + mimics group (n = 20) according to the numerical table. Patients in the CTA group will receive CTA examination of lower extremities. Patients in mimics group will receive digital technology in the positioning of perforator. Patients in CTA + mimics group will receive CTA + digital technology. All the patients will receive the flap cutting and the flap making; the doctor will determine the perforation branch of the flap with 3-D visual positioning, measure the preoperative indicators intraoperatively and complete the wound repair. Finally, the survival rate, sensitivity, specificity and accuracy of the flap will be measured. DISCUSSION: The anterolateral thigh flap has been widely used to repair various tissue defects and has obtained good clinical results. The extensive clinical application mainly focuses on 2 aspects, namely the study of vascular anatomy of lateral flap and the exploration of preoperative flap design technology. Perforator is the direct blood supply source of anterolateral thigh flap, so it is particularly important to study the anatomy of perforator. Therefore, this study will reveal CTA combined with digital technology in the vascular anatomy of the anterior external femoral flap and the design of the flap before and during surgery, so as to provide help for the repair of tissue defects. TRIAL REGISTRATION: It has been registered at http://www.chictr.org.cn/listbycreater.aspx (Identifier: ChiCTR2000038951), Registered on October 10th, 2020.


Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Neoplasias Laríngeas/complicações , Lesões dos Tecidos Moles/cirurgia , Coxa da Perna/cirurgia , Adulto , Idoso , China/epidemiologia , Angiografia por Tomografia Computadorizada/métodos , Feminino , Neoplasias de Cabeça e Pescoço/patologia , Humanos , Imageamento Tridimensional/métodos , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/cirurgia , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Retalhos Cirúrgicos/transplante , Taxa de Sobrevida , Coxa da Perna/irrigação sanguínea , Resultado do Tratamento
11.
Medicine (Baltimore) ; 99(50): e23590, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327322

RESUMO

RATIONALE: Cutaneous perforators of peroneal vessels are divided into proximal and distal perforators on the basis of perforator distributions and musculocutaneous or septocutaneous properties. The traditional fibular osteocutaneous free flap is raised over the distal two-thirds of the fibula with a skin paddle based on distal perforators, which is affixed to the posterior crural septum. However, the skin pedicle may not be available due to anatomic variations or intraoperative injuries. Herein, because of the absence of distal perforators, we reserved and expropriated proximal perforators originating from the musculocutaneous branch of the superior part of the peroneal artery before it divided into nutrient and arcuate arteries and successfully harvested a separate osteal fibula and proximal perforator skin paddle with a single vascular pedicle-peroneal vessel. PATIENT CONCERNS: A 62-year-old man with a 6-month history of mandibular swelling and soft tissue invasion was referred to us. DIAGNOSIS: Panoramic radiography and computed tomography showed an irregular radiolucent lesion of the mandibular body, and histopathological analysis confirmed a follicular-pattern ameloblastoma. INTERVENTIONS: The diseased mandible and soft tissue were resected and reconstructed with a vascularized fibular osteal flap with the proximal perforator skin paddle. OUTCOMES: The mandibular contour was successfully restored; the skin paddle in the mouth was in good condition after 8 months of follow-up. LESSONS: The proximal perforator is reliable and practical for supplying a skin paddle and has significant potential for future applications. We recommend reserving the proximal perforator skin paddle as a backup flap when planning to raise a fibula flap, since unavailability or injury of the traditional fibular skin island based on distal perforators occurs frequently. This approach can avoid the exploration for a second donor site, save surgical time, and reduce surgical complexity. Moreover, we anticipate more frequent use of the proximal perforator flap in the future because of its flexibility and large volume, and since it can be combined with the osteal fibula or fibular osteocutaneous flap. However, an understanding of the traits of the proximal perforator and determination of its peroneal origin by computed tomography angiography is crucial for predesigning fibular osteal flaps with a proximal perforator skin paddle.


Assuntos
Ameloblastoma/diagnóstico , Neoplasias Maxilomandibulares/diagnóstico , Mandíbula , Ameloblastoma/complicações , Ameloblastoma/diagnóstico por imagem , Ameloblastoma/cirurgia , Diagnóstico Diferencial , Edema/etiologia , Fíbula , Retalhos de Tecido Biológico , Humanos , Neoplasias Maxilomandibulares/complicações , Neoplasias Maxilomandibulares/diagnóstico por imagem , Neoplasias Maxilomandibulares/cirurgia , Masculino , Pessoa de Meia-Idade , Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos
12.
Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 55(12): 1126-1130, 2020 Dec 07.
Artigo em Chinês | MEDLINE | ID: mdl-33342127

RESUMO

Objective: To evaluate clinical applications and efficacy of submental artery perforator flap in reconstruction surgery after removal of pharyngeal carcinoma. Methods: A total of 27 patients in the Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University were included, 23 males and 4 females with age from 40 to 70 years old, and 17 patients were hypopharyngeal carcinoma (HPC) and 10 patients were oropharyngeal carcinoma (OPC). All patients underwent tumor resection followed by simultaneously reconstruction surgery using submental artery perforator flap between January 2015 and December 2019. Of 5 patients with palatine tonsil cancer, 4 underwent the combined approach of neck and oral resection and 1 with madibulotomy. All 5 patients with tongue base cancer received transhyoid partial glossotomy with or without partial laryngectomy. Sixteen patients with pyriform sinus carcinoma received partial laryngo-pharyngectomy with preservation of laryngeal functions. One patient with posterior hypopharyngeal wall carcinoma had partial pharyngectomy. Prognosis and laryngeal functions were analyzed after reconstruction surgery with submental artery perforator flap in patients with pharyngeal carcinoma. Results: The 27 patients were followed up for 6-66 months, with a median of 13 months, of them 24 patients were alive without recurrence or metastasis, 1 patient died of recurrence, 1 patient died of esophageal carcinoma and 1 patient was alive with the recurrence of tongue base carcinoma. Postoperative complications included flap failure for 1 case, pharyngeal fistula for 1 case, subcutaneous hydrops for 2 cases and lymphatic fistula for 1 case. Total 2 and 3 year survival rates were 92.9% and 88.9%, respectively. Total decanulation rate was 92.6%; decanulation rate and intubation time were 16/17 and 3.5 months in HPC patients; and decanulation rate and intubation time were 9/10 and 2 months in OPC patients. Total oral feeding rate was 92.6% and nasogastric feeding time was 3.5 weeks in HPC patients and 3 weeks in OPC patients. Conclusion: The submental artery perforator flap is an excellent choice for reconstruction surgery after removal of oropharyngeal and hypopharyngeal carcinoma, with good outcomes of laryngeal functions.


Assuntos
Carcinoma , Neoplasias Hipofaríngeas , Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Adulto , Idoso , Artérias , Carcinoma/cirurgia , Feminino , Humanos , Neoplasias Hipofaríngeas/cirurgia , Masculino , Pessoa de Meia-Idade
13.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(11): 1417-1422, 2020 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-33191700

RESUMO

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


Assuntos
Parede Abdominal , Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Adulto , Idoso , Artérias Epigástricas/diagnóstico por imagem , Artérias Epigástricas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Adulto Jovem
14.
J Craniomaxillofac Surg ; 48(11): 1066-1073, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32994154

RESUMO

Aim of the study was to compare perforator vessel location using color-coded Doppler ultrasound and hyperspectral imaging in the area of the antero-lateral thigh. In a cross-sectional case-control study, the bilateral antero-lateral thigh region was examined for perforator vessel location via color-coded Doppler ultrasound (control) and hyperspectral imaging (test). For hyperspectral imaging, all measurements were conducted without cooling (T0) and after 1 (T1), 2 (T2) and 3 min (T3) of cooling. Additionally, in the reperfusion period after cooling, hyperspectral imaging was conducted at 1, 2 and 3 min (T4/T5/T6). Results from color-coded Doppler ultrasound and hyperspectral imaging were matched at all time points (T0-T6). In total, 71/73 perforator vessel locations could be matched (sensitivity: 97%). Matching of color-coded Doppler ultrasound and hyperspectral imaging was significantly influenced by the cooling protocol and the highest matching values were seen at T3 (3 min cooling; 60 perforator vessels) and T4 (3 min cooling & 1 min reperfusion; 62 perforator vessels) without significant differences (sensitivity 98%; p = 0.9). There were significant differences between T4 and T0, T1 (both p < 0.001), T5 (p = 0.045) and T6 (p = 0.012). For clinical proof of concept, a patient case using a free antero-lateral thigh flap for reconstruction of a facial defect after perforator vessel identification via color-coded Doppler ultrasound and hyperspectral imaging (3 min cooling & 1 min reperfusion) was carried out successfully. In conclusion, hyperspectral imaging potentially offers an additional opportunity for non-invasive, user-independent perforator-site assessment if prior cooling of the site is conducted.


Assuntos
Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Estudos de Casos e Controles , Estudos Transversais , Estudos de Viabilidade , Humanos , Coxa da Perna/diagnóstico por imagem , Coxa da Perna/cirurgia
15.
Zhonghua Shao Shang Za Zhi ; 36(9): 870-872, 2020 Sep 20.
Artigo em Chinês | MEDLINE | ID: mdl-32972074

RESUMO

From September 2013 to October 2018, 39 patients (28 males and 11 females, aged 21 to 76 years) with stage 4 pressure ulcers were admitted to the General Hospital of Xinjiang Military Command. The area of pressure ulcers ranged from 2 cm×2 cm to 20 cm×12 cm on admission. The two-stage method of debridement and skin flap transfer was exploited to repair the wounds. In the first stage, a thorough debridement was performed (26 cases underwent debridement once, 10 cases twice, and 3 cases for three times). The skin flap transfer surgery was conducted in the second stage after 6 to 12 days (local skin flap for 16 cases, vascularized island flap for 8 cases, fascial flap for 5 cases, gluteus maximus flap for 5 cases, and biceps femoris flap for 5 cases), with flap area of 4 cm×2 cm to 16 cm×10 cm. Some donor sites were closed by direct suture and the other donor sites which can not be sutured were covered by medium-thickness skin graft from the lateral thigh. All the pressure ulcers of 39 cases were healed with no sinus. During follow-up of 6 months to 5 years, no recurrence of pressure ulcer at the surgical site was observed; the flaps achieved soft texture and good appearance. Thus, the two-stage method of debridement and skin flap transfer achieved good long-term curative effect and could be a preferable option for treating stage 4 pressure ulcers.


Assuntos
Retalho Perfurante , Lesão por Pressão , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Adulto , Idoso , Desbridamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Lesão por Pressão/cirurgia , Transplante de Pele , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Resultado do Tratamento , Adulto Jovem
16.
Zhonghua Shao Shang Za Zhi ; 36(9): 876-879, 2020 Sep 20.
Artigo em Chinês | MEDLINE | ID: mdl-32972076

RESUMO

On April 11, 2019, a 36-year-old female patient was admitted to Hunan Cancer Hospital. Five years after the modified radical mastectomy for right breast cancer, she planned to undergo scar releasing and reconstruction of right chest wall and free deep inferior epigastric artery perforator (DIEP) flap transfer, right breast reconstruction, and left breast mastopexy. The defect of right chest wall after scar resection was 18 cm×10 cm. During the operation, the vascular pedicle of DIEP flap was accidentally injured, then the profunda artery perforator flap in left inner thigh was designed for salvage. The size of the flap was 20 cm×11 cm, the thickness was 4.5 cm, the length of perforator vessel pedicle was 7.6 cm, and the weight of the flap was 360 g. The right breast defect was repaired with the transferred flap and the deep cavity was filled. The vascular pedicle of profunda artery was anastomosed with the proximal end of the right internal mammary artery. The blood supply of the flap was good during surgery. The left breast mastopexy was completed at the same time, and the donor site of thigh and abdomen was closed directly. The flap survived well and the donor site healed well after surgery. During the follow-up of 7 months post surgery, the appearance and function of thigh donor site were good, no obvious complications were found, and the reconstructed breast was smaller than the contralateral side. This case suggests that the profunda artery perforator flap could be a valuable option as an alternative for DIEP harvesting failure for autologous breast reconstruction.


Assuntos
Neoplasias da Mama , Mamoplastia , Retalho Perfurante , Adulto , Neoplasias da Mama/cirurgia , Artérias Epigástricas/cirurgia , Feminino , Humanos , Mastectomia
17.
Nan Fang Yi Ke Da Xue Xue Bao ; 40(6): 814-821, 2020 Jun 30.
Artigo em Chinês | MEDLINE | ID: mdl-32895207

RESUMO

OBJECTIVE: To evaluate the effect of using free double- leaf perforator flap posterolateral calf peroneal artery in anatomical reconstruction of the oropharyngeal structure after ablation of advanced oropharyngeal carcinoma. METHODS: Twenty-six patients with oropharyngeal defects after ablation of oropharyngeal malignancies were recruited, including 12 with carcinoma in the tongue base, 5 in the latenral pharyngeal wall and 9 in the soft palate. Between July, 2016 and July, 2018, the patients underwent surgeries for reconstruction of the oropharyngeal defects using flaps. The areas of tissue defects repaired by double-leaf perforator flaps ranged from 40.5 to 72.5 cm2. Reconstruction was performed for oropharyngeal defects in the soft palate, pterygopalate, parapharyngeal, pterygo- mandibular, and tongue base tissues. The patients' outcomes including mouth opening, functions of deglutition, linguistic function, restoration of palatopharyngeal anatomical structure and postoperative survival were evaluated, and their quality of life was assessed using FACT-H&N scale (Chinese Edition). RESULTS: All the 26 patients with transplantation of the free flaps survived. Six months after the operation, the oropharyngeal function and anatomical structure of the patients were basically restored. The questionnaire survey showed that the patients' physical, social/family, emotional and functional conditions, the total score of the core scale, items scores for the head and neck, and the total score of the scale all improved significantly after the operation compared with those before the operation (P < 0.05). CONCLUSIONS: The free peroneal artery bilobate perforator flap in the posterolateral crus, which seldom has anatomical variations of the blood vessels, allows flexible design and contains rich tissue volume to facilitate defect repair with different approaches and ranges. The application of this flap, which is an ideal perforator flap for reconstruction of the oropharyngeal structure and function, can improve the quality of life of patients following operations for advanced oropharyngeal cancer.


Assuntos
Retalhos de Tecido Biológico , Neoplasias Orofaríngeas , Retalho Perfurante , Artérias , Humanos , Qualidade de Vida , Procedimentos Cirúrgicos Reconstrutivos , Transplante de Pele , Lesões dos Tecidos Moles
18.
Artigo em Chinês | MEDLINE | ID: mdl-32791594

RESUMO

Objective:To explore the application value of anteromedial thigh flap(AMT) as alternative flap in repairing maxillofacial soft tissue defects. Method:Sixty patients were scheduled to underwent anterolateral thigh flap(ALT) reconstruction. Preoperative CT angiography were conducted. Imaging workstations were used to locate perforator vessels in the anterolateral and anteromedial areas respectively. Four patients had no suitable perforator during the preparation of AMT flaps. In the same operation area, ALT flaps were prepared to reconstruct the defect according to the location of the perforator vessels in the anteromedial areas. Result:All four AMT flaps survived uneventfully. Flap sizes ranged from 9 cm×6 cm to 7 cm×4 cm. The follow-up period ranged from 6 to 12 months, the functions of recipient and donor sites recovered well. Conclusion:Preoperative CT angiography can improve the accuracy of the preparation of skin flap effectively. When no sizable perforator is available during harvest of the ALT flap, successful reconstruction can be achieved using the ipsilateral AMT flap.


Assuntos
Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles/cirurgia , Humanos , Transplante de Pele , Coxa da Perna/cirurgia
19.
Plast Reconstr Surg ; 146(2): 227-237, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740566

RESUMO

BACKGROUND: Preoperative planning of microsurgical perforator free flaps continues to be a discussion topic among microsurgeons. The purpose of this study was to compare the ability of three methods of preoperative vascular mapping-hand-held Doppler imaging, color Doppler ultrasonography, and computed tomographic angiography-to detect perforators and their concordance with surgical findings. METHODS: A prospective study was performed to evaluate the sensitivity, specificity, and accuracy of hand-held Doppler imaging, color Doppler ultrasonography, and computed tomographic angiography to detect free flap perforators. Each patient undergoing a free flap reconstruction was studied preoperatively with the three methods, and the results were compared to the intraoperative findings. RESULTS: Fifty-three patients undergoing autologous tissue reconstruction were included. Most reconstructions (71.7 percent) were performed with anterolateral thigh flaps. The positive predictive value (color Doppler ultrasonography, 100 percent; computed tomographic angiography, 100 percent; hand-held Doppler imaging, 88.6 percent) and negative predictive value (color Doppler ultrasonography, 100 percent; computed tomographic angiography, 94.3 percent; hand-held Doppler imaging, 90.5 percent) rates were significantly different between methods. The high resolution of the color Doppler ultrasonography probe provided a direct vision of the vasculature arborization and efficiently detected vessels with diameters of less than 0.5 mm. The sensitivity, specificity, and accuracy of color Doppler ultrasonography were greater than those of both computed tomographic angiography and hand-held Doppler imaging. There was 100 percent concordance between color Doppler ultrasonography perforators and the surgical findings. CONCLUSIONS: Color Doppler ultrasonography provides a reproducible, harmless, and accurate way to visualize vascular anatomy. It has a high correlation with the surgical findings, signifying advantages over hand-held Doppler and computed tomographic angiography in sensitivity, specificity, and accuracy. CLINICAL QUESTION/LEVEL OF EVIDENCE: Diagnostic, II.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Computadores de Mão , Retalho Perfurante/irrigação sanguínea , Procedimentos Cirúrgicos Reconstrutivos/métodos , Ultrassonografia Doppler em Cores/métodos , Doenças Vasculares/cirurgia , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes , Resultado do Tratamento , Doenças Vasculares/diagnóstico
20.
Plast Reconstr Surg ; 146(2): 196e-204e, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740595

RESUMO

BACKGROUND: Phalloplasty often requires free tissue transfer. There is ample literature describing flap-related outcomes, but the microsurgical technique used, including choice of recipient vessels, has been an overlooked yet important topic. In this study, the authors review the outcomes of their experience with the deep inferior epigastric artery and locoregional veins and outline technical modifications that occurred during the study period. METHODS: A retrospective chart analysis of patients who underwent microsurgical phalloplasty between September of 2016 and July of 2019 was performed. Variables included flap design, donor site, and recipient vessels. The outcome measures were return to the operating room for flap compromise and partial or complete flap loss. RESULTS: Forty-two phalloplasties using the deep inferior epigastric artery were identified. There were six take-backs for flap compromise, and four patients required venous revision, one of whom lost his urethral flap on postoperative day 9. There was a decrease in take-back rate from 30 percent in the first 20 patients to 0 percent in the second 22 patients in the study period. A total of 11.9 percent of patients had partial flap loss. This decreased from 15 percent to 9 percent in the two groups. CONCLUSION: After an initial learning curve, the combination of deep inferior epigastric artery, deep inferior epigastric vein, and great saphenous vein combined with specific technical modifications such as targeted coagulation of the vasa nervorum of the clitoral nerve has proven to be a reliable technique. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Microcirurgia/métodos , Pênis/cirurgia , Retalho Perfurante/transplante , Complicações Pós-Operatórias/prevenção & controle , Cirurgia de Readequação Sexual/métodos , Adulto , Artérias Epigástricas/transplante , Feminino , Disforia de Gênero/cirurgia , Humanos , Masculino , Pênis/irrigação sanguínea , Retalho Perfurante/irrigação sanguínea , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Pessoas Transgênero , Veias/transplante
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...