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1.
Curr Urol Rep ; 22(8): 39, 2021 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-34105032

RESUMO

PURPOSE OF REVIEW: To provide an overview and description of the different surgical techniques for the robotic repair of ureteral strictures. RECENT FINDINGS: The robotic repair of ureteral stenosis has emerged as a useful option for treating strictures unsuitable for endoscopic resolution with good results, lower morbidity, and faster recovery than open techniques. Depending on the stricture's length and location, the reconstructive options are reimplantation, psoas hitch, Boari flap, ureteroureterostomy, appendiceal onlay flap, buccal mucosa graft (BMG) ureteroplasty, ileal replacement, or renal autotransplantation. The robotic approach offers a magnified vision and the possibility of adding near-infrared fluorescence (NIRF) imaging, indocyanine green (ICG), and FireflyTM to facilitate the technique. Multicenter studies with extended follow-up still have to confirm the good results obtained in published case series. Robotic reconstructive techniques are useful for repairing ureteral strictures, obtaining good functional results with less morbidity and faster recovery than open procedures.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Procedimentos Cirúrgicos Robóticos , Obstrução Ureteral/cirurgia , Constrição Patológica , Humanos , Reimplante , Retalhos Cirúrgicos/cirurgia
2.
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
3.
Ann R Coll Surg Engl ; 103(5): e159-e164, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33930285

RESUMO

Submental flap (SF) is a reconstructive technique that can be utilised for reconstruction of medium to large oral cavity defects, head and neck cancer, and pharyngocutaneous fistula. The submental artery island flap is pedicled on the submental artery and veins. The vascular pedicle has a length of up to 8cm. If it is further dissected to its origin from the facial artery, the pedicle can be lengthened by an additional 1-2cm to reach the lateral canthus and zygomatic arch. The use of SF for the reconstruction of head and neck defects has re-emerged over the past decade due to various reasons. We present a series of four case reports of head and neck cancers including a basal cell carcinoma, squamous cell carcinoma, and Merkel tumour, where the SF technique was used to successfully reconstruct the resultant facial defect. The advantages and disadvantages of the SF are discussed with a brief literature review.


Assuntos
Face , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos , Idoso , Idoso de 80 Anos ou mais , Face/irrigação sanguínea , Face/cirurgia , Feminino , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos/cirurgia
4.
Artigo em Inglês | MEDLINE | ID: mdl-33804881

RESUMO

Mucosal melanomas of the head and neck region are uncommon pathologies that can affect the oral cavity, and are characterized by a high rate of mortality. Considering the lack of knowledge regarding risk and prognostic factors, current best clinical practice is represented by a large surgical excision with disease-free margins, eventually associated with a reconstructive flap. Indeed, given the frequent necessity of postoperative radiotherapy and fast healing process, a reconstruction of the surgical gap is advisable. Even if several flaps have been most commonly used, the submental island flap represents a valid alternative thanks to local advantages and similar oncologic outcomes compared to free flaps.


Assuntos
Neoplasias de Cabeça e Pescoço , Melanoma , Procedimentos Cirúrgicos Reconstrutivos , Humanos , Melanoma/cirurgia , Pescoço , Palato Duro/cirurgia , Estudos Retrospectivos , Retalhos Cirúrgicos/cirurgia
7.
Ann R Coll Surg Engl ; 103(5): 374-379, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33739158

RESUMO

INTRODUCTION: Pressure sores represent a reconstructive challenge, and the high recurrence rate and need for reoperations should always be considered. Sacrifice of muscle and fascia in primary reconstruction may compromise options for future repairs. The objective of this study was to evaluate the reliability of muscle- and fascia-sparing random pattern hatchet flap reconstruction of pressure sores in different body regions. METHODS: From November 2017 to December 2019, 36 participants with grade III and IV pressure sores underwent random pattern hatchet flap reconstruction. Early postoperative complications and flap survival were evaluated in follow up for 6-12 months. RESULTS: Thirty-six participants with an age range of 15 to 67 years who presented with pressure sores (13 sacral, 12 ischial, 10 trochanteric, and 1 scapular) underwent surgery. Complete healing of sores was observed within 21 days of surgery in 32 cases and within 30 days for the remaining four cases. Postoperative complications (11.2%) were recorded in only four participants: two experienced partial wound dehiscence, one seroma developed in a trochanteric case, and there was one infection in a sacral sore. CONCLUSIONS: Random pattern hatchet flap is a reliable tool that results in minimal complications for treatment of pressure sores of limited dimensions.


Assuntos
Lesão por Pressão/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Tronco/cirurgia , Adulto Jovem
8.
Clin Oral Investig ; 25(5): 2461-2478, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33609186

RESUMO

OBJECTIVES: This study aims to compare the treatment outcomes of periodontal intrabony defects by using platelet-rich fibrin (PRF) with other commonly utilized modalities. MATERIALS AND METHODS: The eligibility criteria comprised randomized controlled trials (RCTs) comparing the clinical outcomes of PRF with that of other modalities. Studies were classified into 10 categories as follows: (1) open flap debridement (OFD) alone versus OFD/PRF; (2) OFD/bone graft (OFD/BG) versus OFD/PRF; (3) OFD/BG versus OFD/BG/PRF; (4-6) OFD/barrier membrane (BM), OFD/PRP, or OFD/enamel matrix derivative (EMD) versus OFD/PRF; (7) OFD/EMD versus OFD/EMD/PRF; (8-10) OFD/PRF versus OFD/PRF/metformin, OFD/PRF/bisphosphonates, or OFD/PRF/statins. Weighted means and forest plots were calculated for probing depth (PD), clinical attachment level (CAL), and radiographic bone fill (RBF). RESULTS: From 551 articles identified, 27 RCTs were included. The use of OFD/PRF statistically significantly reduced PD and improved CAL and RBF when compared to OFD. No clinically significant differences were reported when OFD/BG was compared to OFD/PRF. The addition of PRF to OFD/BG led to significant improvements in CAL and RBF. No differences were reported between any of the following groups (OFD/BM, OFD/PRP, and OFD/EMD) when compared to OFD/PRF. No improvements were also reported when PRF was added to OFD/EMD. The addition of all three of the following biomolecules (metformin, bisphosphonates, and statins) to OFD/PRF led to statistically significant improvements of PD, CAL, and RBF. CONCLUSIONS: The use of PRF significantly improved clinical outcomes in intrabony defects when compared to OFD alone with similar levels being observed between OFD/BG and OFD/PRF. Future research geared toward better understanding potential ways to enhance the regenerative properties of PRF with various small biomolecules may prove valuable for future clinical applications. Future research investigating PRF at histological level is also needed. CLINICAL RELEVANCE: The use of PRF in conjunction with OFD statistically significantly improved PD, CAL, and RBF values, yielding to comparable outcomes to OFD/BG. The combination of PRF with bone grafts or small biomolecules may offer certain clinical advantages, thus warranting further investigations.


Assuntos
Perda do Osso Alveolar , Fibrina Rica em Plaquetas , Perda do Osso Alveolar/diagnóstico por imagem , Perda do Osso Alveolar/tratamento farmacológico , Perda do Osso Alveolar/cirurgia , Transplante Ósseo , Regeneração Tecidual Guiada Periodontal , Humanos , Perda da Inserção Periodontal , Retalhos Cirúrgicos/cirurgia
9.
Actas dermo-sifiliogr. (Ed. impr.) ; 112(2): 171-175, feb. 2021. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-200871

RESUMO

La reconstrucción del labio superior tras la cirugía de Mohs supone, en ocasiones, un reto para el cirujano dermatológico. Presentamos una serie de 15 pacientes (7 hombres y 8 mujeres; edad media de 65,6 años) con cáncer cutáneo (10 carcinomas basocelulares, 2 melanomas y 3 carcinomas escamosos) localizados en el labio superior intervenidos mediante cirugía de Mohs con defectos resultantes de 3-7,6 cm. Para la reconstrucción se empleó un colgajo en isla del labio superior diseñado escondiendo las incisiones en el pliegue nasolabial, en la línea de unión del bermellón con la piel y en las líneas de tensión de la piel relajada. Se explican las claves del diseño y la cirugía, enfatizando en la importancia de sacrificar en ocasiones pequeñas zonas de tejido sano. Se alcanzaron resultados satisfactorios cosméticos y funcionales, sin complicaciones posquirúrgicas en todos los pacientes


Upper-lip reconstruction after Mohs micrographic surgery is challenging for dermatologic surgeons. We describe a series of 15 patients (7 men and 8 women; mean age, 65.6 years) with skin cancer on the upper lip treated with Mohs surgery: 10 were basal cell carcinomas, 2 were melanomas, and 3 were squamous cell carcinomas. The resulting defects measured between 3 and 7.6cm. We used island flaps to reconstruct the defects in all cases, hiding the incisions in the nasolabial fold, at the line where the skin meets the vermillion border of the lip, and in the relaxed skin tension lines. We explain key aspects of the surgeries and design of the reconstructions, with emphasis on the importance of occasionally sacrificing small areas of healthy skin. Cosmetic and functional outcomes were satisfactory in all patients, and there were no postsurgical complications


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Cirurgia de Mohs/métodos , Retalhos Cirúrgicos/cirurgia , Lábio/cirurgia , Neoplasias Labiais/cirurgia , Neoplasias Cutâneas/cirurgia , Melanoma/cirurgia , Carcinoma de Células Escamosas/cirurgia , Carcinoma Basocelular/cirurgia , Resultado do Tratamento , Sulco Nasogeniano/cirurgia
10.
J Craniomaxillofac Surg ; 49(3): 231-237, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33518398

RESUMO

The purpose of this work is to analyse the soundness of the Temporalis Muscle Flap as a safe and reliable flap to restore the aesthetic and functions of the facial mesostructure after its partial resection. Subjects were selected retrospectively and were invited to come to our outpatient clinic. Here, subjects completed a clinical evaluation in which the medical examiners evaluated the aesthetic outcome, the phonation, the ocular motility and the swallowing. Twenty-two subjects were enrolled in this study and completed the clinical evaluation. The mean value of the score obtained for the aesthetic outcome was 2.91 ± 0.92, slightly less than good. The VHI-30 questionnaire for voice evaluation obtained a mean score of 22.5 ± 11.5, pointing out minor voice problems. The mean value of the P-score evaluated during Fiberoptic Endoscopic Evaluation of Swallowing was 4.64 ± 0.95, highlighting the near absence of endoscopic signs of dysphagia. On the evaluation of ocular function, only one subject showed an inferior displacement of his right eyeball without vertical diplopia. The Temporalis Muscle Flap is a safe and reliable flap that can be used to reconstruct numerous surgical defects of the maxilla, giving an excellent recovery of physical aspect, phonation, and swallowing.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Estética , Humanos , Músculos , Estudos Retrospectivos , Retalhos Cirúrgicos/cirurgia
11.
J Plast Reconstr Aesthet Surg ; 74(4): 730-739, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33386263

RESUMO

PURPOSE: Cervicofacial flaps represent an excellent option for coverage of cheek defects secondary to oncologic resection, trauma or infection. However, there remains clinical equipoise regarding whether superficial plane or deep plane dissection results in the lowest rates of complications and optimal outcomes. METHODS: A systematic review and meta-analysis of proportions was conducted to assesses outcomes between cheek reconstruction superficial plane or deep plane cervicofacial flaps. Outcome measures included flap necrosis, ectropion, hematoma formation, facial nerve injury, and requirement for further operative or non-operative intervention. RESULTS: Of 881 citations identified for review, 10 met the inclusion criteria. In total, 284 patients received superficial plane flaps while 44 patients received deep plane flaps. Overall, reported rates of complications were low for cervicofacial flaps. The proportion of necrosis, ectropion, and hematoma were 3.05% (95% CI: 0.00-10.71%), 2.03% (95% CI: 0.41-4.42%), and 0.05% (95% CI: 0.00-3.29%), respectively. No cases of permanent facial nerve injury were reported. Sub-group analysis demonstrated comparable rates of complications between superficial and deep plane dissection and no difference was found between groups. Other complications were noted with low incidence. CONCLUSIONS: Currently published literature demonstrates that superficial and deep plane cervicofacial flaps exhibit similar rates of complications, although there is a low level of evidence overall. Overall, the rates of flap necrosis (3.05%), ectropion (2.03%), and hematoma (0.05%) are low. Notably, there were no reported cases of permanent facial nerve injury from either technique.


Assuntos
Bochecha/cirurgia , Neoplasias Faciais/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos/cirurgia , Bochecha/lesões , Dissecação , Humanos , Complicações Pós-Operatórias
14.
Cir. plást. ibero-latinoam ; 46(4): 401-410, oct.-dic. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-198723

RESUMO

INTRODUCCIÓN Y OBJETIVO: Los colgajos toracoabdominales permiten el cierre de defectos torácicos con una menor morbilidad y dificultad técnica respecto a los colgajos a distancia. En cirugía recontructiva oncológica mamaria se utilizaron primariamente como colgajos fasciocutáneos para pacientes con cáncer de mama localmente avanzado (T3 y T4) que requieren grandes resecciones de piel y necesitan una cubierta rápida y eficaz del defecto torácico. En los últimos años han resurgido como opción terapéutica para solucionar complicaciones postquirúrgicas por isquemia y necrosis cutánea con exposición de expansores o implantes mamarios. El aumento de la mastectomía reductora de riesgo ha llevado a zonas de necrosis cutáneas pequeñas que requieren colgajos de vecindad para solucionar la complicación. Es en esta última indicación donde estos colgajos tienen una aplicación óptima. MATERIAL Y MÉTODO: Describimos el colgajo toracoabdominal como una técnica reconstructiva de gran utilidad para cubrir defectos cutáneos en cirugía mamaria y presentamos una clasificación útil para clarificar sus indicaciones, extraída de nuestra experiencia con dichos colgajos. RESULTADOS: Elaboramos una clasificación didáctica de los colgajos toracoabdominales, presentamos un caso clínico de cada modelo de colgajo, y recopilamos nuestra casuística. CONCLUSIONES: Destacamos el uso específico en complicaciones de cirugías de reconstrucción mamaria de los colgajos toracoabdominales como alternativa que aporta tejidos de igual coloración, fácil de realizar, con cierre directo de la zona donante por lo general y con un pedículo vascular fiable. Además, aportamos una clasificación propia


BACKGROUND AND OBJECTIVE: The thoracoabdominal flap allows the closure of thoracic defects with a lower morbidity and technical difficulty compared to remote flaps. In mammary oncological reconstructive surgery, they were primarily used as fasciocutaneous flaps for patients with locally advanced breast cancer (T3 and T4) that require large skin resections and a fast and effective coverage of the thoracic defect. In recent years they have resurged as a therapeutic option to solve postoperative complications due to ischemia and skin necrosis with exposure of expanders or breast implants.The increase in the practice of risk-reducing mastectomy has led to areas of small skin necrosis that require local flaps to solve the complication. It is in this last indication where these flaps have an optimal application. METHODS: In this study, the thoracoabdominal flap is presented as a very useful reconstructive technique to cover skin defects in breast surgery. A classification is presented in order to clarify these fasciocutaneous flaps as well as our experience with theme. RESULTS: We elaborate a didactic classification of thoracoabdominal flaps, presenting a clinical case of each flap model, and compiling our casuistry. CONCLUSIONS: We highlight the specific use in complications of breast reconstruction surgeries of thoracoabdominal flaps as an alternative that provides tissues of the same color, easy to perform, with direct closure of the donor area and with a reliable vascular pedicle. In addition, we provide our own classification


Assuntos
Humanos , Feminino , Adulto , Retalhos Cirúrgicos/classificação , Retalhos Cirúrgicos/cirurgia , Neoplasias da Mama/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Mamoplastia/métodos , Mastectomia/métodos , Neoplasias da Mama/patologia , Falha de Prótese , Mastectomia/reabilitação
15.
Cir. plást. ibero-latinoam ; 46(4): 449-454, oct.-dic. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-198729

RESUMO

La utilidad del colgajo condrocutáneo del hélix para cubrir defectos menores de 2 cm es ampliamente aceptada. Con esta publicación queremos mostrar el resultado de esta técnica para el manejo de un defecto extenso que incluía el tercio medio del hélix y antihelix. Realizamos la técnica de Antia-Buch con doble colgajo condrocutáneo para reconstruir, en un solo tiempo quirúrgico, un defecto de 40 mm en el tercio medio del pabellón auricular de una paciente de avanzada edad, que había rechazado opciones reconstructivas que requirieran varios tiempos de cirugía, obteniendo un resultado funcional y cosmético adecuado


Usefulness of chondrocutaneous helix flap for defects smaller than 2 cm is widely accepted. This paper attempts to show the outcome of this technique for the management of a large helix and antihelix defect. We performed the Antia-Buch technique, with two chondrocutaneous flaps, to reconstruct in a single surgical stage a 40 mm defect in the middle third of the auricle of an elderly patient who refused more than one surgical time, achieving an appropriate functional and cosmetical outcome


Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Pavilhão Auricular/anormalidades , Pavilhão Auricular/cirurgia , Retalhos Cirúrgicos/cirurgia , Carcinoma Basocelular/diagnóstico , Carcinoma Basocelular/cirurgia , Técnicas de Sutura/métodos , Patologia/métodos , Cartilagem da Orelha/cirurgia , Cartilagem da Orelha/transplante
18.
Actas dermo-sifiliogr. (Ed. impr.) ; 111(10): 866-869, dic. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-200936

RESUMO

La reconstrucción tras la extirpación de neoplasias cutáneas localizadas en punta nasal supone un reto cosmético-quirúrgico. Proponemos el colgajo crescéntico nasoyugal, también conocido como colgajo perialar en semiluna, como recurso quirúrgico para la cobertura de estos defectos. Presentamos una serie de 13 casos de carcinomas cutáneos, en su mayoría carcinomas basocelulares, extirpados con bordes libres, localizados en región excéntrica de punta nasal en los que la reconstrucción se realizó mediante este colgajo. Los 13 pacientes presentaron buena evolución, sin presencia de complicaciones quirúrgicas reseñables junto con resultados posquirúrgicos satisfactorios. No se objetivaron alteraciones funcionales y estéticas significativas. Por consiguiente, el colgajo crescéntico nasoyugal constituye una adecuada opción reconstructiva para la cobertura de defectos de tamaño medio de punta nasal


Reconstruction of the tip of the nose following the excision of skin cancer is a cosmetic and surgical challenge. We propose using a crescentic nasojugal flap, also known as a perialar crescentic advancement flap, to repair such defects. We present a series of 13 cases in which cutaneous carcinoma (mostly basal cell carcinoma) was excised from the lateral nasal tip with clear margins and the defect repaired with a crescentic nasojugal flap. The technique was successful in all cases. None of the patients developed notable surgical complications and the postoperative outcomes were satisfactory, with no significant functional or cosmetic problems. The crescentic nasojugal flap is therefore a good option for repairing medium-sized defects on the tip of the nose


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias Nasais/cirurgia , Retalhos Cirúrgicos/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Nariz/cirurgia , Neoplasias Cutâneas/cirurgia , Carcinoma Basocelular/cirurgia , Antibioticoprofilaxia , Cefalexina/administração & dosagem
20.
Medicine (Baltimore) ; 99(46): e22617, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181646

RESUMO

INTRODUCTION: Esophageal window defect in patients with esophageal resection could be challenging to repair. In this case report, a free posterior tibial artery perforator flap (FPTAPF) was used for semi-circumference patch esophagoplasty. PATIENT CONCERNS: For this 47-year-old male patient with recurrent laryngeal nerve schwannoma invading cervical and upper thoracic esophagus, cervical and upper thoracic esophageal reconstruction following tumor resection was needed DIAGNOSIS:: Pathologic result demonstrated recurrent laryngeal nerve schwannoma. Ultrasound examination detected a tumor (7 cm × 6 cm × 3 cm) located behind the right thyroid lobe, and contrast-enhanced computed tomography scan revealed that tumor was located between the cervical esophagus and trachea, and compressed these structures. INTERVENTIONS: The tumor had a size of 7 cm × 6 cm × 3 cm, and the semi-circumference defect of the cervical and upper thoracic esophagus was about 7 cm in length after complete tumor resection. A 7 cm × 4 cm FPTAPF was designed and harvested for esophageal reconstruction. OUTCOMES: The posterior tibial flap survived well and satisfactory recovery of esophageal function was obtained with no significant complications. No local tumor relapse was indicated by computed tomography during the 2-year postoperative follow-up. CONCLUSION: This case highlights the stable performance of FPTAPF when used for the reconstruction of large esophageal window defect.


Assuntos
Esôfago/cirurgia , Neurilemoma/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos/cirurgia , Artérias da Tíbia/transplante , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/cirurgia , Esôfago/transplante , Humanos , Masculino , Pessoa de Meia-Idade , Neurilemoma/complicações , Retalhos Cirúrgicos/transplante , Artérias da Tíbia/cirurgia
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