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1.
Medicine (Baltimore) ; 100(4): e24092, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530203

RESUMO

INTRODUCTION: Dissecting cellulitis of the scalp, or Hoffman disease, is described as an extremely rare condition. Clinically, it is represented by recurrent painful nodules, purulent drainage, interconnected sinus tracts and keloid formation, leading to scaring and cicatricial alopecia. Without a precise diagnosis and an adequate treatment, the repercussions consist of severe infectious complications along with psychological negative effects and serious aesthetic alterations. There is no standard treatment. In refractory cases, surgical management is reported. PATIENT CONCERNS: We report a case of a 65-year-old Caucasian male patient, with a 5-year history of Hoffman disease, who presented with multiple abscesses and sinus tracts of the scalp and patches of alopecia. The lesions were non-responsive to medical treatment. DIAGNOSIS: The diagnosis of DCS has been established on the basis of the clinical appearance and has been confirmed histopathologically. INTERVENTIONS: The patient underwent wide excision of the scalp, followed by reconstruction using free latissimus dorsi flap and covered by meshed split-thickness skin graft. OUTCOMES: Eighteen-month follow-up revealed complete remission of symptoms and lesions along with satisfactory cosmetic result. CONCLUSION: The scope of this case report is to raise awareness of the following aspects: Hoffman disease has an extremely low occurrence rate, a difficult differential diagnosis and no standard therapeutical strategy. It also highlights the effectiveness of scalpectomy and free latissimus dorsi flap covered by meshed split-thickness skin graft in treating a very advanced stage of the disease together with providing a natural contouring of the scalp. Ultimately, it discusses the other treatment alternatives.


Assuntos
Celulite (Flegmão)/cirurgia , Retalhos de Tecido Biológico , Dermatoses do Couro Cabeludo/cirurgia , Transplante de Pele/métodos , Idoso , Humanos , Masculino
2.
BMC Surg ; 21(1): 41, 2021 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-33461533

RESUMO

BACKGROUND: Scalp reconstruction is a common challenge for surgeons, and there are many different treatment choices. The "crane principle" is a technique that temporarily transfers a scalp flap to the defect to deposit subcutaneous tissue. The flap is then returned to its original location, leaving behind a layer of soft tissue that is used to nourish a skin graft. Decades ago, it was commonly used for forehead scalp defects, but this useful technique has been seldom reported on in recent years due to the improvement of microsurgical techniques. Previous reports mainly used the crane principle for the primary defects, and here we present a case with its coincidental application to deal with a complication of a secondary defect. CASE REPORT: We present a case of a 75-year-old female patient with a temporoparietal scalp squamous cell carcinoma (SCC). After tumor excision, the primary defect was reconstructed using a transposition flap and the donor site was covered by a split-thickness skin graft (STSG). Postoperatively, the occipital skin graft was partially lost resulting in skull bone exposure. For this secondary defect, we applied the crane principle to the previously rotated flap as a salvage procedure and skin grafting to the original tumor location covered by a viable galea fascia in 1.5 months. Both the flap and skin graft healed uneventfully. CONCLUSIONS: Currently, the crane principle is a little-used technique because of the familiarity of microsurgery. Nevertheless, the concept is still useful in selected cases, especially for the management of previous flap complications.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Couro Cabeludo/cirurgia , Neoplasias Cutâneas/cirurgia , Transplante de Pele/métodos , Retalhos Cirúrgicos , Idoso , Feminino , Humanos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Couro Cabeludo/anormalidades , Neoplasias Cutâneas/patologia , Crânio , Resultado do Tratamento
3.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431443

RESUMO

Pubic osteomyelitis is a rare and often late-onset complication of radiation therapy and surgery for vulvar and vaginal carcinoma. It typically presents with vulvar pain, fever, vaginal discharge and/or gait disorders. Pubic osteomyelitis is often accompanied by fistulas or wound dehiscence in the pelvic area. Its accurate diagnosis and treatment are challenging and require a multidisciplinary team effort. In our patients, multiple combined surgical procedures, long-term antibiotic treatment and days to weeks of hospital admission were necessary to treat pubic osteomyelitis. We emphasise the importance of timely and adequate diagnosis and multidisciplinary approach resulting in a course of treatment that is as effective as possible, limiting the impact on quality of life, which is generally high in this group of patients.


Assuntos
Carcinoma/terapia , Quimiorradioterapia Adjuvante/efeitos adversos , Osteomielite/terapia , Lesões por Radiação/terapia , Ferida Cirúrgica/terapia , Neoplasias Vulvares/terapia , Adulto , Antibacterianos/uso terapêutico , Artrodese , Transplante Ósseo , Carcinoma/patologia , Feminino , Humanos , Aplicação de Sanguessugas , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Osteomielite/diagnóstico , Osteomielite/etiologia , Equipe de Assistência ao Paciente , Osso Púbico/diagnóstico por imagem , Osso Púbico/efeitos da radiação , Osso Púbico/cirurgia , Lesões por Radiação/diagnóstico , Lesões por Radiação/etiologia , Articulação Sacroilíaca/diagnóstico por imagem , Articulação Sacroilíaca/efeitos da radiação , Articulação Sacroilíaca/cirurgia , Transplante de Pele , Ferida Cirúrgica/complicações , Resultado do Tratamento , Vulva/patologia , Vulva/cirurgia , Neoplasias Vulvares/patologia
4.
BMJ Case Rep ; 14(1)2021 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-33500305

RESUMO

Nasal reconstruction following a total or subtotal resection presents a challenging clinical scenario. Ample external skin coverage is readily available using the paramedian forehead flap (PMFF), but restoring adequate internal lining of sufficient size and pliability is a major limitation. Intranasal mucosal flaps or free tissue transfer is often employed for this purpose, each with their own sets of limitations. Prelamination of the PMFF with a skin graft prior to transfer is a method to create a composite flap with both internal and external lining. Another challenge in subtotal nasal reconstruction centres around restoring adequate dimensions to the nose without an existing template to work from. Three-dimensional (3D) printing has become an increasingly popular tool in reconstructive surgery as it captures precise patient-specific dimensions to guide reconstruction. Herein, we describe a case of subtotal nasal reconstruction using a prelaminated PMFF using a patient-specific 3D printed model as a template for reconstruction.


Assuntos
Procedimentos Cirúrgicos Nasais/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Retalhos Cirúrgicos/transplante , Idoso , Carcinoma Basocelular/cirurgia , Testa , Humanos , Masculino , Neoplasias Nasais/cirurgia , Impressão Tridimensional , Neoplasias Cutâneas/cirurgia
5.
BMJ Case Rep ; 14(1)2021 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-33414112

RESUMO

Influenza A and B commonly cause benign respiratory disease in humans, but can cause more severe illness in high-risk populations. We report an unusual case of a previously healthy adult patient who presented with myositis and severe rhabdomyolysis secondary to influenza A infection that resulted in atraumatic compartment syndrome of all four extremities, each requiring emergent fasciotomy. The patient was subsequently managed with delayed primary closure and skin grafting in the operating room. Prompt recognition of this rare complication by the team resulted in no limb amputations. On his first follow-up appointment, 1 month after discharge, he had regained full functionality in both his hands and his feet were both close to 50% of baseline and improving with physical therapy.


Assuntos
Extremidades/patologia , Influenza Humana/complicações , Miosite/complicações , Rabdomiólise/complicações , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/cirurgia , Extremidades/cirurgia , Humanos , Vírus da Influenza A , Masculino , Pessoa de Meia-Idade , Miosite/virologia , Rabdomiólise/virologia , Transplante de Pele
6.
Zhonghua Shao Shang Za Zhi ; 37(1): 64-69, 2021 Jan 20.
Artigo em Chinês | MEDLINE | ID: mdl-33499571

RESUMO

Objective: To investigate the effects of the dorsal branch of digital artery pedicled flap combined with V-Y advancement flap for repair of degloving injury of fingertip and reverse dorsal metacarpal recurrent artery pedicled island flap for relaying repair of the soft tissue defects in the donor sites of the proximal dorsum. Methods: A total of 21 patients with degloving injuries of fingertips at the 2nd to 5th fingers were hospitalized in the Department of Hand Surgery of the Second Hospital of Tangshan from June 2016 to January 2019, including 14 males and 7 females aged 24-60 years. The retrospective clinical follow-up study was conducted. The areas of wounds after debridement ranged from 2.0 cm×1.5 cm to 3.5 cm×2.2 cm. The dorsal branch of digital artery pedicled flaps with dorsal branch of the proper digital nerve and dorsal digital nerve were designed in the proximal dorsum of the affected fingers to repair dorsal wounds in the distal dorsum of the affected fingers, and the sizes of the flaps ranged from 1.6 cm×1.5 cm to 2.6 cm×2.4 cm. The V-Y advancement flaps in the palmar side of the affected fingers were designed to repair palmar wounds in the distal segment of the affected fingers, and the sizes of the flaps ranged from 0.8 cm×0.6 cm to 2.0 cm×1.5 cm. The reverse dorsal metacarpal recurrent artery pedicled island flaps were used to repair the soft tissue defects in the donor sites of proximal dorsum, the sizes of the flaps ranged from 1.8 cm×1.7 cm to 2.8 cm×2.6 cm, and the donor sites of the flaps in back of hand were sutured directly. The survivals after the operation and the blood supply and appearance during follow-up of the three flaps were observed. At the final follow-up, the static two-point discrimination distance of the three flaps was measured, the satisfaction degree of patients for the appearance of hand was evaluated based on Michigan Hand Function Questionnaire, and the total active range of motion of the injured finger joints was assessed by the trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association. Results: All the flaps survived after operation. Tension blisters appeared on the surface of one dorsal branch of digital artery pedicled flap, and the wound healed after removing the stitch at the pedicle and changing dressings. During follow-up of 6-20 months, with an average of 12 months, the three kinds of flaps had good appearance, soft texture, and similar color with surrounding tissue, and with only linear scars in donor sites of the dorsal hand. At the final follow-up, the static two-point discrimination distances of V-Y advancement flaps, dorsal branch of digital artery pedicled flaps, and reverse dorsal metacarpal recurrent artery pedicled island flaps were 4-7 mm, 5-10 mm, and 8-15 mm, respectively. Sixteen patients were strongly satisfied with the appearance of hand, and the remaining five patients were satisfied with the appearance of hand. The total active range of motion of the injured finger joints was evaluated as excellent in 17 cases, good in 4 cases. Conclusions: The operation is simple and reliable for dorsal branch of digital artery pedicled flap combined with V-Y advancement flap to repair the degloving injury of fingertip, and reverse dorsal metacarpal recurrent artery pedicled island flaps to repair the soft tissue defects in the donor sites of the proximal dorsum, and the appearance and function of the affected fingers recover well, with minimal injury.


Assuntos
Desenluvamentos Cutâneos , Traumatismos dos Dedos , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Adulto , Feminino , Traumatismos dos Dedos/cirurgia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplante de Pele , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Resultado do Tratamento , Adulto Jovem
7.
Zhonghua Shao Shang Za Zhi ; 37(1): 93-96, 2021 Jan 20.
Artigo em Chinês | MEDLINE | ID: mdl-33499577

RESUMO

For the wounds caused by burns and other various reasons, the key of therapy is to close the open wounds in time by surgical operation. One of the most important methods is autologous skin grafting. However, for large area and long-term chronic trauma, the lack of autologous skin makes the treatment a huge challenge. For this reason, clinical medical workers have gradually developed miniature free skin grafting through continuous research. This paper reviews the relevant skin grafting techniques, including pinch free skin grafting, stamp free skin grafting, meek grafting, microne free skin grafting, etc.


Assuntos
Queimaduras , Transplante de Pele , Queimaduras/cirurgia , Humanos , Pele , Cicatrização
8.
Zhonghua Shao Shang Za Zhi ; 36(12): 1199-1203, 2020 Dec 20.
Artigo em Chinês | MEDLINE | ID: mdl-33379857

RESUMO

Objective: To explore the methods of repairing large soft tissue defect with latissimus dorsi myocutaneous flap and the management of secondary wound in donor site. Methods: From June 2015 to June 2019, 30 patients with soft tissue defect caused by various reasons or hyperplastic scar were hospitalized in the First Medical Center of Chinese PLA General Hospital, including 10 males and 20 females, aged 25-64 years, with 18 cases of head soft tissue defects caused by the growth and rupture of tumor, 7 cases of hypertrophic scar in trunk and limbs, and 5 cases of facial and neck soft tissue defects caused by trauma. The area of primary wound after debridement or enlarged lesion resection was 14 cm×10 cm-18 cm×16 cm. Preoperative evaluation of 20 patients showed that the wound was relatively large, and the donor site could not be directly closed by suturing after resection of conventional single-lobe latissimus dorsi myocutaneous flap, so the bilobed latissimus dorsi myocutaneous flap with area of 14 cm×5 cm-18 cm×8 cm was cut to repair the wound, and the donor site was directly closed by suturing. Preoperative evaluation of 10 patients showed that the donor site could be directly closed by suturing after resection of conventional single-lobe latissimus dorsi myocutaneous flap, so that conventional single-lobe latissimus dorsi myocutaneous flap with area of 11 cm×9 cm-13 cm×10 cm was resected to repair the primary wound, resulting in big tension in donor site and secondary wound with area of 6 cm×4 cm-8 cm×6 cm that couldn't be directly sutured, which was repaired with donor site local flap with area of 7 cm×4 cm-9 cm×6 cm, and the second donor site was directly closed by suturing. Intraoperative end-to-end anastomosis was performed between the thoracodorsal arteries and veins of the latissimus dorsi myocutaneous flap and the arteries and veins of the primary recipient wound. The survival of latissimus dorsi myocutaneous flaps and local flaps were observed after surgery, and the appearance and function of the donor and recipient areas were observed during follow-up. Results: All the latissimus dorsi myocutaneous flaps and local flaps survived in the patients after surgery. Follow-up of 6-12 months showed that the latissimus dorsi myocutaneous flap was similar in color to the surrounding normal skin, with soft texture and good elasticity. The donor site of 20 patients repaired with bilobed latissimus dorsi myocutaneous flaps were only left with linear scars, among which 2 patients had hypertrophic scars and none had functional impairment. The donor site of 10 patients repaired with single-lobe latissimus dorsi myocutaneous flaps and donor site local flaps had good appearance, left with linear scar, irregular shape, but no local traction or dysfunction. Conclusions: When repairing a large soft tissue defect, the bilobed latissimus dorsi myocutaneous flap or the single-lobe latissimus dorsi myocutaneous flap combined with the local flap transfer in the donor site can be used after preoperative evaluation so that the donor site wound can be closed at one time while repairing the primary wound. The donor site has less scar, and both the recipient and donor sites have good appearance and function after surgery.


Assuntos
Retalho Miocutâneo , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Músculos Superficiais do Dorso , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transplante de Pele , Lesões dos Tecidos Moles/cirurgia , Resultado do Tratamento
9.
Zhonghua Shao Shang Za Zhi ; 36(12): 1204-1207, 2020 Dec 20.
Artigo em Chinês | MEDLINE | ID: mdl-33379858

RESUMO

Objective: To explore the application effect of sustainable skin-stretching device in scalp and soft tissue defect. Methods: From June 2017 to January 2020, 5 patients (3 males and 2 females, aged 31-57 (38.0±2.1) years) with large area of scalp and soft tissue defect and skull exposure were admitted to Department of Reparative and Reconstructive Surgery of the Second Hospital of Dalian Medical University. The wound area ranged from 16.0 cm×8.0 cm to 18.0 cm×12.0 cm. The sustainable skin-stretching device was installed after debridement operation for scalp wound. The wound was stretched from the 3rd day after installation of the device, at a basic speed of 1 mm/d and finished for 3 times on average. During stretching, close attention was paid to the changes in blood flow of the wound margin and the subjective feeling of the patients. When the result was negative in the squeezing and pinching test for wound margin after stretching, the further stretching was stopped, the final stretching state was maintained for 3 days, and the wounds were sutured directly. The wound healing during stretching of sustainable skin-stretching device and the occurrence of complications were observed. The rest wound areas after stretching for 5, 10, 15, and 20 days were measured. The wound healing and hair growth were observed during follow-up. Results: All the wounds of 5 patients was sutured directly after stretching for 19-23 d. There was no tension blister on the margin of wounds during stretching, and the margin of wounds healed well after being sutured without skin necrosis. After stretching treatment for 5-20 d, the wound areas were gradually decreased. During follow-up of 2-11 (4.5±1.5) months, the elasticity, color, feeling, and regenerated hair growth of the stretched scalp tissue were close to those of the surrounding normal skin tissue. The linear scar formed on the margin of wounds, but no scar formed on the wounds. Conclusions: The application of sustainable skin-stretching device can reduce the difficulty in repairing scalp and soft tissue defect, with the regenerated hair growing well after treatment, which is worthy of clinical promotion.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Couro Cabeludo , Pele , Transplante de Pele , Lesões dos Tecidos Moles/cirurgia , Resultado do Tratamento
10.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(12): 1585-1589, 2020 Dec 15.
Artigo em Chinês | MEDLINE | ID: mdl-33319540

RESUMO

Objective: To investigate the effectiveness of anterolateral femoral flap in combination with fascia lata grafting in repair of large Achilles tendon and skin defects. Methods: The clinical data of 18 patients with large Achilles tendon and skin defects repaired with anterolateral femoral flap in combination with fascia lata grafting between January 2018 and January 2019 were retrospectively reviewed. There were 14 males and 4 females; age ranged from 32 to 57 years (mean, 42.1 years). There were 9 cases of postoperative infection of Achilles tendon rupture, 1 case of traffic accident injury, and 8 cases of combined infection of skin and Achilles tendon defects after heel trauma. The length of Achilles tendon defect was 4-8 cm, with an average of 5.6 cm; the range of the skin defect was 14 cm×3 cm to 20 cm×5 cm. Flap survival was observed, and ankle function recovery was evaluated according to McComis functional assessment criteria, and dorsal extension and plantar flexion mobility of the affected limb were measured at last follow-up and compared with those of the healthy side. Results: Eighteen cases were followed up 8-24 months, with an average of 16.7 months. All the flaps survived after operation, the flaps were soft and elastic, and the incisions healed by first intention. At last follow-up, 15 cases were excellent, 2 cases were good, and 1 case was acceptable according to McComis functional evaluation criteria, with an excellent and good rate of 94.4%. The two-point discrimination of the heel posterior region of the affected foot was 4-7 mm, with an average of 5.32 mm. The heel-raise test was negative. The dorsiflexion range of the affected side was (21.55±1.26)°, which was significantly different from that of the healthy side (25.23±1.45)° ( t=8.128, P=0.000); the plantar flexion of the affected side was (44.17±1.52)°, which was not significantly different from that of the healthy side (46.13±1.31)° ( t=0.444, P=0.660). Conclusion: The application of anterolateral femoral flap in combination with fascia lata grafting for the repair of large Achilles tendon and skin defects can achieve good effectiveness.


Assuntos
Tendão do Calcâneo , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Tendão do Calcâneo/lesões , Adulto , Fascia Lata , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplante de Pele , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Resultado do Tratamento
11.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(12): 1590-1593, 2020 Dec 15.
Artigo em Chinês | MEDLINE | ID: mdl-33319541

RESUMO

Objective: To explore the application of the dorsal foot hexagonal flap for reconstruction of the web space in the fourth and fifth toe syndactyly combined with polydactyly. Methods: Between May 2016 and October 2019, 27 patients (34 feet) with the fourth and fifth toe syndactyly combined with polydactyly were treated, including 12 males and 15 females with an average age of 22.8 months (range, 10 months to 8 years). There were 7 bilateral feet and 20 unilateral foot. Twenty-four of which were incomplete and 10 were complete syndactyly of the fourth and fifth toes, and the fifth toes showed various degrees of fibular deflection. All the 34 feet were treated with one-stage reconstruction of the toe web with the dorsal foot hexagonal flap, and the correction of the fibular deviation of the fifth toe was made by removing the tibial polydactyly and using the articular surface dressing or wedge osteotomy. Results: All wounds healed by first intention without skin-frafting. All patients were followed up 6-36 months (mean, 18 months). There was no flexion contracture and obvious scar hyperplasia in all the patients, and the width and slope of the toe webs were normal. Three of the 34 webs developed web creep, and the rest of the toe webs were normal in depth. All 34 feet were corrected with peroneal fibular deviation, and the function of toe flexion was good. All parents of the children were satisfied with the outcome. Conclusion: The reconstruction of toe webs with dorsal foot hexagonal flaps for the treatment of the fourth and fifth toes syndactyly combined with polydactyly requires no skin graft. The operation is simple with high survival rate of the flap, the appearance and function of the toes are good, and the effectiveness is satisfactory.


Assuntos
Polidactilia , Procedimentos Cirúrgicos Reconstrutivos , Sindactilia , Criança , Feminino , Humanos , Lactente , Masculino , Polidactilia/cirurgia , Transplante de Pele , Retalhos Cirúrgicos , Sindactilia/cirurgia , Dedos do Pé/cirurgia , Resultado do Tratamento
12.
BMJ Case Rep ; 13(12)2020 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-33370943

RESUMO

A previously independent 56-year-old immunocompetent woman presented with septic shock in the setting of periorbital swelling and diffuse infiltrates on chest imaging. Blood cultures were positive for growth of group A Streptococcus (GAS). Broad spectrum antimicrobials were initiated with the inclusion of the antitoxin agent clindamycin. Necrosis of periorbital tissue was noted and surgical consultation was obtained. Débridement of both eyelids with skin grafting was performed. GAS was isolated from wound cultures and also observed on periorbital tissue microscopy. The final diagnosis was bilateral periorbital necrotising fasciitis (PONF) associated with invasive GAS infection. The patient had a prolonged intensive care unit course with input from multiple specialist teams. This case demonstrates the importance of early recognition and treatment of PONF, the profound systemic morbidity caused by these infections, and illustrates successful multidisciplinary teamwork.


Assuntos
Fasciite Necrosante/complicações , Choque Séptico/microbiologia , Infecções Estreptocócicas/complicações , Streptococcus pyogenes/isolamento & purificação , Antibacterianos/uso terapêutico , Desbridamento , Quimioterapia Combinada , Pálpebras/microbiologia , Pálpebras/cirurgia , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/microbiologia , Fasciite Necrosante/terapia , Feminino , Humanos , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Choque Séptico/diagnóstico , Choque Séptico/terapia , Transplante de Pele , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/terapia , Resultado do Tratamento
13.
Acta Cir Bras ; 35(11): e301105, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33331455

RESUMO

PURPOSE: To assess the action of pentoxifylline, administered by subcutaneous route, on skin flap tissue repair in rats, and to verify the histological aspects and biomarkers. METHODS: Thirty-two male Wistar rats were divided into four groups: control (CT) and treated with pentoxifylline (P1, P3 and P5). Modified McFarlane technique flap was used. Ten days later, the animals were euthanized and the areas of viable and necrotic tissue were evaluated. Hematoxylin/eosin staining was used to assess the morphometric characteristics of the number of vessels and epithelial thickness. Picrosirius red was used to assess collagen density. VEGF and TGF-?1 levels on the skin flap and serum of the animals were measured by the ELISA method. RESULTS: The macroscopic evaluation of the skin flap dimensions showed reduced necrotic tissue in the pentoxifylline (p < 0.05) treated groups. There was an increase in angiogenesis and reepithelization, demonstrated by analyses with an increased number of vessels (p < 0.05), VEGF and epithelial thickness. Fibrogenic effect showed decreased collagen density and TGF-ß1 in the skin flap and serum. CONCLUSION: The benefits of pentoxifylline administered by subcutaneous route, at dose 100 mg/kg, which was effective to improve the survival of skin flap by acting on tissue repair components, stimulating angiogenesis and reepithelization, in addition to reducing fibrogenesis.


Assuntos
Pentoxifilina , Animais , Sobrevivência de Enxerto , Masculino , Necrose , Pentoxifilina/farmacologia , Ratos , Ratos Wistar , Transplante de Pele , Retalhos Cirúrgicos
14.
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
15.
Rozhl Chir ; 99(9): 408-412, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33242970

RESUMO

INTRODUCTION: Perianal hidradenitis suppurativa is a chronic recurrent inflammatory, suppurative, and fistulising disease of apocrine glands, adjacent anal canal and soft tissues. Perianal area is the second most common affected area after axilla. There are three grades of the disease. Hidradenitis suppurativa represents a chronic, recurrent, deep-seated folliculitis resulting in abscesses, followed by the formation of sinus tracts and subsequent scarring. Perianal hidradenitis suppurativa is the last and the most serious grade of the disease and a specific access is needed for patient preparation and surgical treatment alone. The currently preferred method of treatment for patients with extensive perianal hidradentitis is excision and closure with combination of skin flaps, primary suture and skin graft in one or two stages. CASE REPORTS: There are three case reports of perianal hidradenitis suppurativa in this article. The local and overall initial treatment of patients followed by a radical excision and closure with a rotation skin flaps and skin grafts is described. The final results were satisfactory, with no recurrence or serious complication.


Assuntos
Hidradenite Supurativa , Períneo , Axila , Hidradenite Supurativa/cirurgia , Humanos , Transplante de Pele , Retalhos Cirúrgicos
18.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(10): 1288-1293, 2020 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-33063495

RESUMO

Objective: To explore the suitable division of male genitalia subunits and the effectiveness of large-area perineum defect repair under its guidance. Methods: According to the anatomical and functional characteristics of male genitalia, the subunit division scheme was proposed: area Ⅰ, glans penis; area Ⅱ, body of penis; area Ⅲ, scrotum; area Ⅳ, scrotum. Between April 2017 and July 2019, 12 patients with large genitalia defects were treated, with an average age of 60.9 years (range, 57-66 years) and an average disease duration of 2.7 years (range, 2-5 years). The defect area involved area Ⅰ in 1 case, area Ⅱ in 7 cases, area Ⅲ in 5 cases, and area Ⅳ in 8 cases; the size of area ranged from 6 cm×4 cm to 23 cm×16 cm. The causes of defect included 3 cases of trauma, 6 cases of Paget disease, 2 cases of squamous cell carcinoma, 1 case of spindle cell tumor. According to the design of the corresponding repair scheme, the main repair methods were to rotate and advance the skin flap and pedicled skin flap in the same area. When the defect was large, the free skin flap transplantation, free skin grafting, and free mucosa transplantation were used to repair the defect. Results: All the patients were followed up 6-13 months with an average of 8.6 months. Skin flap, skin graft, and mucosa survived in one stage in 10 patients; infection occurred in 1 case after the scrotal flap of area Ⅲ was transferred to repair the defect in area Ⅱ, 1 case had distal venous crisis at 2 days after repair area Ⅲ defect used free anterolateral thigh flap, and after active treatment, the condition improved. The appearance of the receiving area and the supplying area was good, and the local feeling was recovered satisfactorily. The range of motion of hip joint was good in 10 cases, and 2 cases were slightly stretched but did not affect normal life. All patients had normal urination and defecation function, and were satisfied with the treatment effectiveness. Conclusion: The subunits of male genitalia can be used to guide the repair of the defect, which can better restore the physiological appearance and function, and has positive clinical significance.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Períneo/cirurgia , Transplante de Pele , Lesões dos Tecidos Moles/cirurgia , Coxa da Perna
19.
Zhongguo Gu Shang ; 33(8): 757-60, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32875768

RESUMO

OBJECTIVE: To analyze the clinical application value of adjustable skin retractor in large area of limb wound defect in children. METHODS: From January 2017 to January 2019, 11 children including 9 males and 2 females, aged 4 to 12 (8.3±2.7) years old with severe lower extremity wound defects were treated with adjustable skin stretch and closure device, all of them were unilateral lower extremity large area wound defects, including 4 cases of limb skin defect caused by traffic accident, 3 cases of failure to close after osteofasciotomy and decompression, 3 cases of plate exposure after internal fixation of lower extremity fracture and 1 case of ischemic necrosis after debridement and suturing of skin avulsion. The width of the wound was (5.6±1.2) cm and the length was (7.0±1.6) cm. VSD negative pressure drainage and expanded suture were used in all the patients. Four of them had been treated with free skin graft and two had been treated with local flap transfer. The graft or flap operation failed, and the effect of the early treatment was not good. RESULTS: After 5 to 14 (10.5±2.6) days of continuous traction, the wound was closed and no skin grafting or flap repair was performed. No complications such as poor blood supply, skin infection and necrosis, peripheral sensory disturbance occurred. All 11 patients were followed up for 3 to 18 (8.9±3.8) months. The wound edge skin was linear healing with slight scar. CONCLUSION: It is in accordance with Wolff's law and the concept of natural tissue reconstruction to treat large-scale limb wound defects in children with adjustable skin stretch and closure device, which provides an effective method for the treatment of limb skin and soft tissue defects in children.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Transplante de Pele , Resultado do Tratamento , Cicatrização
20.
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
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