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1.
Plast Surg Nurs ; 41(1): 36-39, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33626561

RESUMO

On March 11, 2020, the World Health Organization declared COVID-19 to be a pandemic, challenging health care systems all over the world. National health care systems have reorganized to cope with the disease. Surgical services departments around the world have been affected and elective surgical procedures have been postponed to conserve medical resources. When a patient with COVID-19 requires an urgent microsurgical free flap due to trauma or a tumor, personnel from the health care facility must have a protocol in place to follow for the patient's care and follow-up. In this article, we present our protocol for patients with COVID-19 requiring reconstructive microsurgery.


Assuntos
COVID-19/prevenção & controle , Retalhos de Tecido Biológico/transplante , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Microcirurgia/métodos , Assistência Perioperatória/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Assistência ao Convalescente/métodos , Assistência ao Convalescente/normas , COVID-19/complicações , COVID-19/transmissão , Protocolos Clínicos , Hospitais Universitários , Humanos , Controle de Infecções/normas , Microcirurgia/normas , Assistência Perioperatória/normas , Procedimentos Cirúrgicos Reconstrutivos/normas , Espanha
2.
J Plast Reconstr Aesthet Surg ; 74(5): 987-994, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33431341

RESUMO

BACKGROUND: The majority of hindquarter amputation defects can be reconstructed with local anterior or posterior thigh flaps. Less than 5% of soft tissue defects require free flap reconstruction after tumour resection. Lower extremity fillet flap is described for reconstructing such defects, but the majority of publications are case reports or short single institutional series. There is a lack of data regarding the oncological outcomes of this highly selected patient group. METHODS: Three tertiary sarcoma units treated twelve patients with hindquarter amputation or hip disarticulation for oncological indications with a free flap reconstruction of the soft tissue defect. RESULTS: The median age of patients was 60 (range 12-76) years. Bone resection was carried out through the SI-joint in six patients and through the sacrum in five patients, with one patient undergoing hip disarticulation. Nine patients had R0 resection margin and three had R1 resection. The median surgical time and flap ischaemia time was 420 (249-650) and 89 (64-210) min, respectively. Median hospital and ICU stay was 18 (10-42) and 3 (1-8) days, respectively. Median blood loss was 2400 (950-10000) ml. There were three returns to theatre due to vascular compromise, with one total flap loss due to arterial thrombosis. Overall survival was 58% (95%CI 28-91%) both at 1-year and at 3-years. DISCUSSION: Carefully selected patients requiring hindquarter amputation with extensive soft tissue defect necessitating free flap reconstruction can be reconstructed with a lower extremity free fillet flap with low rate of local wound complications. Survival of these patients is similar to that in patients requiring less extensive resection.


Assuntos
Retalhos de Tecido Biológico/transplante , Hemipelvectomia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Sarcoma/cirurgia , Adolescente , Adulto , Idoso , Perda Sanguínea Cirúrgica , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Sarcoma/diagnóstico por imagem , Sarcoma/mortalidade , Taxa de Sobrevida
3.
J Plast Reconstr Aesthet Surg ; 74(5): 1013-1021, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33446463

RESUMO

BACKGROUND: Chimeric anterolateral thigh free flaps (ALT) have been commonly used for head and neck defects, which require two epithelial lined surfaces. However, because of unpredictable vascular anatomy, it is a challenge to consistently elevate large chimeric flaps with multiple perforators based on the Lateral Circumflex Femoral Artery (LCFA). Here, we present our method to reliably harvest a chimeric flap from the ALT territory and investigate its long-term outcomes when used in the reconstruction of extensive head and neck defects. METHODS: A prospective review of practice consisting of 27 patients, between January 2011 and April 2019, with extensive through-and-through head and neck defects, which require dual paddle flaps underwent reconstruction with chimeric ALT harvested with a portion of distal vastus lateralis. The age of the patients ranged from 32 to 68 years (mean 53.2 years). RESULTS: Flap length ranged from 17 to 30 cm (mean, 25.6 cm). The mean flap area was 261.6 cm2 (range, from 225 to 340 cm2). The mean ischemia time was 162.9 min (range, from 59 to 269 min). At a mean follow-up time of 33.4 months (range, from 4 to 91 months), four patients died of cancer recurrence. For the other 23 patients, 4 required revision to achieve better cosmetic lip competence. All flaps survived with two recorded returns to theater for pedicle exploration associated with partial flap loss only. CONCLUSION: Harvesting the chimeric ALT with a portion of vastus lateralis distally negates the need for tenuous intramuscular perforator dissection. It is a reliable option for head and neck surgery, which require composite reconstruction. Using this technique produces a good functional cosmetic outcome. It also allows large defects to be reconstructed in a single sitting with free tissue transfer.


Assuntos
Retalhos de Tecido Biológico/transplante , Neoplasias de Cabeça e Pescoço/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Coxa da Perna/cirurgia , Adulto , Idoso , Estética , Retalhos de Tecido Biológico/irrigação sanguínea , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Coxa da Perna/irrigação sanguínea
4.
Laryngoscope ; 131(6): E1818-E1820, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33399217

RESUMO

Keloids present a challenging clinical problem due to their propensity for recurrence and need for adjuvant therapy. We present a case where a large keloid resection required free tissue transfer and immediate radiation therapy was employed 24 hours postoperatively. There were no significant issues with flap survival, wound healing, or recurrence 2 years postoperatively. This is the first case report of successful radiation treatment 1 day after reconstruction of the head and neck with a free flap. Laryngoscope, 131:E1818-E1820, 2021.


Assuntos
Retalhos de Tecido Biológico/transplante , Queloide/radioterapia , Queloide/cirurgia , Pescoço , Terapia Combinada , Humanos , Queloide/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Cicatrização
6.
Plast Reconstr Surg ; 147(1S-1): 9S-15S, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33347058

RESUMO

SUMMARY: Wounds have been one of the most prominent pathologies since the beginning of humanity. For the last 5 decades, a drastic improvement of healing has been observed, thanks to new medical devices based on fluid aspiration capacities and the development of negative pressure wound therapy. Negative-pressure wound therapy was initially designed for a double action, fluid aspiration and mechanical stimulation of wound edges by a foam. Successive technical evolutions of negative pressure wound therapy were declined since 1997 when Argenta and Morykwas first presented their solution. The adjunct of instillation in 2009 was considered as the first interactive dressing, allowing topical wound solutions to sequentially reach the wound, in alternance with negative pressure. Other devices based on the same principle were designed to prevent postoperative infections when placed over a suture after surgery. This long evolution could enhance the armamentarium of possible solutions, considerably reducing the wound healing time.


Assuntos
Desbridamento/métodos , Tratamento de Ferimentos com Pressão Negativa/métodos , Infecção da Ferida Cirúrgica/prevenção & controle , Irrigação Terapêutica/métodos , Ferimentos e Lesões/terapia , Anti-Infecciosos Locais/administração & dosagem , Bandagens , Doença Crônica/terapia , Soluções Cristaloides/administração & dosagem , Desbridamento/história , Desbridamento/instrumentação , Retalhos de Tecido Biológico/transplante , História do Século XX , História do Século XXI , Humanos , Instilação de Medicamentos , Salvamento de Membro/métodos , Tratamento de Ferimentos com Pressão Negativa/história , Tratamento de Ferimentos com Pressão Negativa/instrumentação , Doença Arterial Periférica/terapia , Transplante de Pele/métodos , Irrigação Terapêutica/história , Irrigação Terapêutica/instrumentação , Resultado do Tratamento , Cicatrização , Ferimentos e Lesões/complicações
7.
Oral Oncol ; 115: 105114, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33334689

RESUMO

In COVID-19 pandemic era, one major concern is related to ensure optimal management to oncologic patients, even though a context of radical uncertainty. The aim of our effort is to guarantee high-quality and timely care, minimizing COVID-19 infection risk, according to our head and neck (HN) reconstructive mission, still more challenging because of the criticality of the period. Thus, our reconstructive decision algorithm is changed. Microvascular free flaps, reported to be the gold standard for surgical reconstruction, represent extremely specialized procedures necessitating an extended resource allocation not affordable in the adversities of the period. Therefore, we are obliged to define a paradigm shift in our approach, based on free-style reconstructive surgery principles of propeller flap concept. According to our experience, we believe that this viable and feasible surgical technique could represent a reconstructive landmark in this pandemic era, since any guideline is missing, besides HN reconstructive surgery is most likely heading towards a new reconstructive approach.


Assuntos
COVID-19/complicações , Neoplasias de Cabeça e Pescoço/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Tomada de Decisão Clínica , Feminino , Retalhos de Tecido Biológico/transplante , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento
8.
Medicine (Baltimore) ; 99(50): e20819, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327220

RESUMO

PURPOSE: The aim of the soft tissue reconstruction of plantar forefoot should yield weight-bearing function and aesthetic contour, which poses a significant challenge for reconstructive surgeons to provide an appropriate flap according to the "like for like" reconstructive principle. Local flaps and pedicled flaps have been described for the reconstruction of small- to medium-sized defects of plantar forefoot and achieved optimal results. However, reconstruction of extensive defects of plantar forefoot is rarely investigated. In this study, we present our experience using the free anterolateral thigh (ALT) flap in the reconstruction of extensive defects of plantar forefoot. METHODS: Between November 2011 and April 2017, 9 patients were treated for extensive soft tissue defects in the plantar forefoot areas with ALT flaps. The mean age at the time of surgery was 39.3 years (range, 25-64 years). RESULTS: The follow-up period ranged from 12 to 77 months, with a mean of 31 months. All flaps survived well, and the patients were satisfied with the aesthetic and functional results. The size of the flaps ranged from 63 to 455 cm, with a mean of 197.7 cm. Seven patients with no bony involvement began to gradually weight-bear at 3 weeks postoperatively. During the follow-up time, postoperative ulceration at the reconstructed weight-bearing areas was not encountered. CONCLUSION: The ALT flap is a reliable option for treatment of extensive defects of plantar forefoot, resulting in an optimal functional and aesthetic outcome. Even when a total plantar loss exits, excellent results can be achieved.


Assuntos
Antepé Humano/cirurgia , Retalhos de Tecido Biológico/transplante , Coxa da Perna/cirurgia , Adulto , Estética , Feminino , Seguimentos , Traumatismos do Pé/complicações , Traumatismos do Pé/cirurgia , Antepé Humano/anormalidades , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/métodos , Resultado do Tratamento , Suporte de Carga/fisiologia
9.
Medicine (Baltimore) ; 99(46): e23147, 2020 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-33181685

RESUMO

Whether a strategy of postoperative non-sedation produces better outcomes compared with sedation in patients after head and neck reconstruction remains controversial. Therefore, we retrospectively investigated outcomes in 150 of these patients in our institution.Patients with head and neck cancer that received free anterolateral thigh flap were studied retrospectively, and were categorized in terms of their postoperative care into "sedation" and "non-sedation" groups. The related parameters of each patient were collected for analysis.Overall, 150 patients were included (sedation protocol (N = 56) and non-sedation strategy (N = 94)). No significant differences were observed between groups in patient demographics or postoperative outcomes. Significantly shorter durations of mean and median intensive care unit (ICU) length of stay, mechanical ventilation, hospitalization, and operative time were observed in the non-sedation group than in the sedation group. Among all patients, the sedation and flap reopen were the common variables related to prolonged ICU stay, mechanical ventilator duration, and hospitalization.The current study suggested the strategy of postoperative non-sedation is associated with a significant decrease in the duration of mechanical ventilation, ICU length of stay, hospitalization. Regardless of hospital stay, there were no differences in postoperative outcome between 2 groups.


Assuntos
Sedação Consciente , Duração da Terapia , Retalhos de Tecido Biológico , Neoplasias de Cabeça e Pescoço/cirurgia , Cuidados Pós-Operatórios , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Reconstrutivos , China/epidemiologia , Sedação Consciente/efeitos adversos , Sedação Consciente/métodos , Sedação Consciente/estatística & dados numéricos , Feminino , Retalhos de Tecido Biológico/efeitos adversos , Retalhos de Tecido Biológico/irrigação sanguínea , Retalhos de Tecido Biológico/transplante , Neoplasias de Cabeça e Pescoço/epidemiologia , Humanos , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos
10.
Rev. argent. cir. plást ; 26(3): 121-126, 20200900. fig, ilus
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1148265

RESUMO

El colgajo peroneo posterior es un colgajo fasciocutáneo, que está basado en 4 posibles fuentes como son perforantes fasciocutáneas de la arteria peronea, perforantes fasciocutáneas de la arteria tibial posterior, perforantes venocutáneas de la vena safena menor y perforantes neurocutáneas del nervio sural. El objetivo de este trabajo es describir la técnica quirúrgica y demostrar la versatilidad que tiene el colgajo peroneo posterior para la reconstrucción y cobertura de defectos del tercio distal de la pierna y el tercio proximal del pie, proporcionando el potencial para el cierre simple y eficiente de dichos defectos. Este colgajo proporciona grandes ventajas debido a que es reproducible en cualquier centro quirúrgico y no requiere un entrenamiento específico en microcirugía del cirujano y del resto del equipo quirúrgico. Si bien las complicaciones existen, la mayoría no son graves y en general son de resolución simple. En los últimos años, se ha incrementado el empleo del colgajo fasciocutáneo peroneo posterior para lograr la cobertura de los defectos de partes blandas del tercio distal de la pierna y pie. El éxito de estos colgajos está relacionado con el tipo de paciente y de su lesión: el porcentaje es alto en pacientes jóvenes y sanos en quienes el origen del defecto es traumático.


The posterior peroneal flap is a fasciocutaneous flap, which is based on 4 possible sources such as fasciocutaneous perforations of the peroneal artery, fasciocutaneous perforations of the posterior tibial artery, venocutaneous perforations of the saphenous vein, and neurocutaneous perforators of the sural nerve. The objective of this work is to describe the surgical technique and demonstrate the versatility of the posterior peroneal flap for the reconstruction and coverage of defects in the distal third of the leg and the proximal third of the foot, providing the potential for simple and efficient closure of said defects. It provides great advantages because it is reproducible in any surgical center and does not require specific training in microsurgery of the surgeon and the rest of the surgical team. Although complications do exist, most are not serious and are generally of simple resolution. In recent years, the use of the posterior peroneal flap has been increased to achieve coverage of soft tissue defects of the distal third of the leg and foot. The success of these flaps is related to the type of patient and his injury, the success rate is high in young and healthy patients in whom the origin of the defect is traumatic.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Procedimentos Cirúrgicos Operatórios/métodos , Deformidades do Pé , Retalhos de Tecido Biológico/transplante , Liberação de Cirurgia , Traumatismos da Perna
12.
Am J Otolaryngol ; 41(4): 102536, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32487337

RESUMO

LEARNING OBJECTIVES: Identify factors associated with skin graft take in fibula free flaps (FFF) and radial forearm free flaps (RFFF) donor sites. STUDY OBJECTIVES: To determine which factors are associated with decreased skin graft take at the donor site in FFF and RFFF in head and neck patients. DESIGN: Retrospective Chart Review Case Series. SETTING: Multicenter Tertiary Care. METHODS: A multicenter retrospective review was performed at three institutions identifying patients who underwent free tissue transfer, specifically either FFF or RFFF, between 2007 and 2017. Patient demographics, medical history, and social history were examined including age, gender, BMI, smoking status, diabetes and preoperative anticoagulation use. Preoperative, intraoperative data, and postoperative data were also examined including tourniquet use, type of flap, area of skin graft, if the skin graft had a donor site or if it was taken from the flap, wound NPWT use, cast use, use of physical therapy, DVT prophylaxis, limb ischemia, heparin drip, and postoperative aspirin use. Statistical analysis was used to determine which factors were significantly associated with skin graft take. RESULTS: 1415 patients underwent a forearm or fibula flap and 938 patients underwent split-thickness skin graft. Of these, 592 patients had sufficient information and were included in the final analysis. There were 371 males and 220 females. The average age was 55.7. Complete skin graft take was seen in 480 patients (81.1%). On univariate analysis, patients with diabetes (p = .003), type of flap (fibula p < .001), skin graft area (p = .006), tourniquet use (p = .003), DVT prophylaxis (p = .008) and casting (p = .003) were significantly associated with decreased skin graft take rate. In a multivariate analysis, diabetes (OR 2.17 (95%CI 1.16-3.98)), fibula flaps (OR 2.86 (95%CI 1.79-4.76)), an increase in skin graft area (OR 1.01 (95%CI 1.01-1.01)), post-operative aspirin (OR 2.63 (95%CI 1.15-5.88), and casting (OR 2.94 (95%CI 1.22-7.14)) were associated with poor rates of skin graft take. CONCLUSION: Several factors affect skin graft take rate and should be considered when performing a skin graft for a donor site defect.


Assuntos
Fíbula/cirurgia , Antebraço/cirurgia , Retalhos de Tecido Biológico/transplante , Transplante de Pele/métodos , Coleta de Tecidos e Órgãos/métodos , Transplantes , Adulto , Idoso , Aspirina/administração & dosagem , Surdez , Diabetes Mellitus Tipo 2 , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Mitocondriais , Estudos Retrospectivos , Torniquetes , Trombose Venosa/prevenção & controle
13.
Plast Reconstr Surg ; 145(5): 1267-1274, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332551

RESUMO

BACKGROUND: The forearm is a common donor site, providing thin, pliable workhorse flaps for head and neck reconstruction. There are no prospective studies comparing the donor-site morbidity of the radial forearm flap to the ulnar artery perforator flap. METHODS: All patients undergoing forearm free flaps were included for analysis and followed for a minimum of 1 year. Grip strength, sensation to light touch, temperature sensation, and wound healing were assessed. RESULTS: A total of 98 patients were enrolled (radial forearm flap, n = 50; ulnar artery perforator flap, n = 48). There were three osteocutaneous radial forearm flaps performed. The donor site was closed primarily in one radial forearm flap patient and four ulnar artery perforator flap patients. The majority of donor sites were resurfaced with full-thickness skin grafts (radial forearm flap, n = 40; ulnar artery perforator flap, n = 44), and the remaining were closed with split-thickness skin grafts. Average grip strength compared to baseline measured at 1, 3, 6, and 12 months after surgery demonstrated no significant differences. All patients returned to baseline sensation to light touch with no long-term sensory deficits at 1 year. No patients suffered significant changes in temperature sensation or cold intolerance. Seven patients suffered partial skin graft loss (radial forearm flap, n = 5; ulnar artery perforator flap, n = 2); all of them healed secondarily with local wound care. There were no flap losses in the study. CONCLUSIONS: The radial forearm and ulnar artery perforator flaps are equivalent in terms of success and donor-site morbidity. Selection of flap should be based on need for pedicle length, flap bulk, concerns with radial or ulnar dominance, and surgeon comfort. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.


Assuntos
Retalhos de Tecido Biológico/transplante , Retalho Perfurante/transplante , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Coleta de Tecidos e Órgãos/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Antebraço/irrigação sanguínea , Antebraço/fisiopatologia , Antebraço/cirurgia , Retalhos de Tecido Biológico/efeitos adversos , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Retalho Perfurante/efeitos adversos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Prospectivos , Artéria Radial/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Coleta de Tecidos e Órgãos/métodos , Sítio Doador de Transplante/fisiopatologia , Sítio Doador de Transplante/cirurgia , Artéria Ulnar/cirurgia
14.
Plast Reconstr Surg ; 145(5): 1302-1312, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32332556

RESUMO

BACKGROUND: Limb salvage techniques using free tissue transfer in patients with chronic wounds caused by longstanding osteomyelitis, diabetes, and peripheral vascular disease are technically challenging. The longitudinal slit arteriotomy end-to-side anastomosis is the authors' preferred technique because it is the least invasive arteriotomy and is especially important for diseased recipient arteries. The authors reviewed highly comorbid patients who underwent free tissue transfer with this technique to understand the success rates, overall outcomes, and long-term limb salvage rates. METHODS: A retrospective review was performed to analyze outcomes of free tissue transfer using longitudinal slit arteriotomy end-to-side anastomosis between 2012 and 2018 performed by the senior surgeon (K.K.E.). RESULTS: One hundred fifteen free flaps were identified. Patients were, on average, 55.9 years old, with a body mass index of 29.2 kg/m. Comorbidities included osteomyelitis (83.5 percent), hypertension (60.9 percent), tobacco use (46.1 percent), diabetes (44.3 percent), peripheral vascular disease (44.3 percent), hypercoagulability (35.7 percent), and arterial calcifications (17.4 percent). Overall flap success was 93.0 percent; 27.8 percent required reoperation perioperatively because of complications. On univariate analysis, diabetes mellitus, hypertension, and hypercoagulability were significantly associated with eventual amputation (p < 0.05). Multivariate analysis showed that intraoperative thrombosis and take back was independently associated with flap failure. There was an overall limb salvage rate of 83.5 percent, and of those salvaged, 92.7 percent were ambulating without a prosthesis at a mean follow-up of 1.53 years. CONCLUSIONS: This is the largest series of longitudinal slit arteriotomy end-to-side anastomosis for patients undergoing free tissue transfer for limb-threatening defects in the compromised host. Overall flap success, limb salvage rates, and functional outcomes are high using this technique. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Artérias/cirurgia , Retalhos de Tecido Biológico/transplante , Isquemia/cirurgia , Perna (Membro)/irrigação sanguínea , Salvamento de Membro/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Anastomose Cirúrgica/estatística & dados numéricos , Doença Crônica/terapia , Estado Terminal/terapia , Pé Diabético/complicações , Pé Diabético/epidemiologia , Feminino , Retalhos de Tecido Biológico/efeitos adversos , Humanos , Isquemia/diagnóstico , Isquemia/etiologia , Perna (Membro)/cirurgia , Salvamento de Membro/efeitos adversos , Salvamento de Membro/métodos , Masculino , Pessoa de Meia-Idade , Osteomielite/complicações , Osteomielite/epidemiologia , Doenças Vasculares Periféricas/complicações , Doenças Vasculares Periféricas/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fumar/efeitos adversos , Fumar/epidemiologia , Resultado do Tratamento , Adulto Jovem
15.
Am J Otolaryngol ; 41(4): 102475, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32291182

RESUMO

PURPOSE: Pectoralis major muscle flaps (PMMF) are a commonly used reconstructive modality to repair head and neck defects. As the use of free flap reconstruction is increasingly practiced in the head and neck, the role of the PMMF may be changing as well. This study sought to analyze indications and outcomes for PMMF following head and neck resections from one surgeon's experience. MATERIALS AND METHODS: Retrospective review from December 1, 2013 through September 30, 2017 at a tertiary care academic medical center. Indications for the PMMF were examined as well as surgical outcomes. Basic demographic data, patient head and neck cancer history, history of radiation and/or chemotherapy, and history of previous reconstructive procedures were obtained and compared across all subjects. RESULTS: Forty patients underwent a PMMF within the designated time frame. The majority of patients were male (83%) and the average age was 65 years (range 55.4-74.6 years). Of the 40 cases, 9 of the PMMFs were performed as primary reconstruction of the defect. In the remaining 31 cases, these flaps were utilized as a secondary reconstructive option following fistula formation (13), dehiscence (6), need for an additional flap for recurrent disease (6) infection (4), or major bleeding (2). In every case that it was utilized, the PMMF was the definitive reconstruction. Within the same time frame, 429 free flaps were performed by the same surgeon, with an average of 125 free flaps performed yearly. The rate of total flap failure overall was 3.9%. The other failed free flap reconstructive options used besides a PMMF were secondary free flaps (11), local wound care (4), or obturator placement (2). The secondary pectoralis flaps occurred following 7.2% of free flaps with total or partial failure that were performed within the same time range. The indications for the PMMF did not change or evolve during the time frame of the study. CONCLUSIONS: Although free flaps were performed with far greater frequency than PMMFs at our institution, the PMMF demonstrated continued utility as a secondary reconstructive option. For a surgeon who performs a high volume of free flaps, preservation of the pectoralis muscle and associated vasculature for possible later secondary reconstruction should be considered due to its strong efficacy.


Assuntos
Retalhos de Tecido Biológico/transplante , Neoplasias de Cabeça e Pescoço/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Músculos Peitorais/cirurgia , Músculos Peitorais/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Idoso , Feminino , Retalhos de Tecido Biológico/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Coleta de Tecidos e Órgãos , Resultado do Tratamento
16.
Facial Plast Surg Aesthet Med ; 22(4): 262-267, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32250652

RESUMO

Objectives: To determine the quantitative volume change over time of vascularized adipofascial anterolateral thigh (AFALT) free flaps in facial reconstruction, and to evaluate patient factors that are associated with changes in volume. Methods: A retrospective review was performed on patients who underwent AFALT reconstruction for large volume parotid and midface defects after head and neck cancer surgery at a single tertiary care hospital from 2011 to 2018. Flap volume was measured at different time points using 3D Slicer, a free open source software for medical image computing. Trends in volume change over time were evaluated. A multiple linear regression model was used to analyze patient factors associated with mean final volume change. Results: Twenty-one patients were included. The median follow-up period from surgery was 17 months (interquartile range [IQR] = 9-25 months). The first imaging study was obtained a median of 3 months after surgery (IQR = 1-4 months). The majority of patients underwent postoperative radiation (20/21, 95%). Mean final total volume percentage change over time was 96.6% (standard deviation = 21.7%). After controlling for age, smoking history, recurrence, and length of follow-up, a reduction in body mass index (BMI) ≥1.5 U from baseline had the greatest association with mean final volume percentage change (ß -31, 95% confidence interval: -52 to -11, p = 0.005). Conclusions: Free tissue transfer using AFALT flaps in the head and neck provided relatively stable volume maintenance over time, even after postoperative radiation. The volume of transplanted fat can change depending on patient factors, such as BMI.


Assuntos
Face/cirurgia , Fáscia/transplante , Retalhos de Tecido Biológico/transplante , Neoplasias de Cabeça e Pescoço/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Gordura Subcutânea/transplante , Adulto , Idoso , Idoso de 80 Anos ou mais , Face/patologia , Fáscia/patologia , Feminino , Seguimentos , Retalhos de Tecido Biológico/patologia , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Gordura Subcutânea/patologia , Coxa da Perna/cirurgia , Resultado do Tratamento
17.
Sci Rep ; 10(1): 4300, 2020 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-32152445

RESUMO

Reconstruction of composite oral and maxillofacial defects using free flaps is challenging. The key to such delicate reconstruction lies in the evaluation of the defect. However, few reports have described the clinical classification of these difficult defects. In this study, we proposed a classification method and developed different reconstructive solutions using free flap techniques according to this classification. This classification method was established based on two parameters (the elements and distribution of the missing tissues). Among the 17 patients with composite oral and maxillofacial defects included in this study, 8 patients presented with type A defects, one patient presented with a type B defect, and the other 8 patients presented with type C defects. No type D defects were observed in this study. Three types of free flaps were used to reconstruct the respective types of composite defects. Perforator-based ALT flaps were used to reconstruct Type A defects. Branch-based ALT flaps were used to reconstruct Type B defects. For Type C defects, two reconstructive solutions were used, including a well-designed fibular flap and a perforator-based ALT flap with or without a metal plate for bony reconstruction. All flaps survived after surgery. This classification system may help select and design specific free flaps for reconstructing composite oral and maxillofacial defects.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Faciais/cirurgia , Retalhos de Tecido Biológico/transplante , Neoplasias Maxilares/cirurgia , Neoplasias Bucais/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/classificação , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adolescente , Adulto , Idoso , Carcinoma de Células Escamosas/patologia , Neoplasias Faciais/patologia , Feminino , Humanos , Masculino , Neoplasias Maxilares/patologia , Pessoa de Meia-Idade , Neoplasias Bucais/patologia , Adulto Jovem
18.
Plast Reconstr Surg ; 145(4): 686e-696e, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32221195

RESUMO

BACKGROUND: The resurgence of prepectoral breast reconstruction has brought strict patient inclusion and exclusion criteria by numerous authors. This article provides an overview of a single surgeon's experience with 201 patients, 313 breasts using immediate, direct-to-implant prepectoral breast reconstruction. The article compares surgical outcomes of different patient cohorts to elucidate risk factors that may predispose patients toward developing complications. METHODS: A retrospective chart review was performed, identifying all patients who underwent prepectoral, direct-to-implant breast reconstruction from June of 2016 to June of 2018. RESULTS: A total of 201 patients representing 313 breasts were included. A midlateral incision was used in 157 breasts (50.2 percent), followed by a skin-reducing, Wise-pattern in 90 breasts (28.8 percent). Acellular dermal matrix was used in 243 breasts (77.6 percent), free nipple grafts were used in 39 breasts (12.5 percent), and postmastectomy radiation therapy was used in 58 breasts (18.5 percent). Complications requiring operative intervention occurred in 24 breasts (7.7 percent), and minor complications occurred in 23 breasts (7.3 percent). There were no significant differences in complication rates for (1) acellular dermal matrix use versus non-acellular dermal matrix use, (2) Wise-pattern versus other incision, or (3) postmastectomy radiotherapy (p > 0.05). CONCLUSIONS: This represents the largest single-surgeon, direct-to-implant prepectoral cohort in the literature. Surgical complications did not differ with acellular dermal matrix use, incision selection, and the use of postmastectomy radiation therapy. There may be an association between acellular dermal matrix use and major complications and radiotherapy with minor complications. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Implante Mamário/efeitos adversos , Implantes de Mama/efeitos adversos , Neoplasias da Mama/terapia , Retalhos de Tecido Biológico/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Derme Acelular/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Mama/patologia , Mama/efeitos da radiação , Mama/cirurgia , Implante Mamário/instrumentação , Implante Mamário/métodos , Neoplasias da Mama/patologia , Feminino , Retalhos de Tecido Biológico/transplante , Humanos , Mastectomia/efeitos adversos , Pessoa de Meia-Idade , Mamilos/transplante , Complicações Pós-Operatórias/etiologia , Radioterapia Adjuvante/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
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