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1.
Facial Plast Surg Clin North Am ; 30(2): 271-276, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35501064

RESUMO

This study investigated eye movement patterns using eye tracking technology when looking at preoperative and postoperative images of patients that underwent bilateral periorbital cosmetic surgery. The sequence of facial recognition before surgery was periorbital-nose-perioral, whereas following surgery it was nose-periorbital-perioral. This study revealed that the sequence of facial feature recognition is influenced by the aesthetic liking of the observer and that alteration to facial features influences the sequence of facial feature recognition. The eye movement pattern, however, seems to follow the internal representation of beauty where aesthetically pleasing facial features are observed later during first image exposure and are viewed shorter.


Assuntos
Blefaroplastia , Reconhecimento Facial , Blefaroplastia/efeitos adversos , Blefaroplastia/métodos , Tecnologia de Rastreamento Ocular , Pálpebras , Humanos , Transplante de Pele
2.
Eur Rev Med Pharmacol Sci ; 26(8): 2918-2925, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35503636

RESUMO

OBJECTIVE: Despite advances in plastic and reconstructive surgery, repairing soft tissue defects of the foot remains a complex surgical challenge when conventional methods cannot cover defects. We presented a case in which a free flap was used for reconstruction and reviewed the literature. PATIENTS AND METHODS: A 75-year-old woman with an acral melanoma history had a large exophytic mass on her right foot. Using PubMed, we found that reconstructive options in the literature include local flaps, fascial flaps, muscle flaps, and free flaps. RESULTS: Melanoma recurred four times at the same site after complete excision of the compound nevi in the present case. Melan A, Vimentin (+), S-100 (+), and HMB-45 positivity were found in immunohistochemical staining and increased Ki-67 proliferation. The defects in soft tissue are repaired using a free anterolateral thigh perforator flap. No complications were raised in the patient. CONCLUSIONS: Foot melanoma is difficult to be resected because it necessitates a wide excision, which can result in large defects. The free flap, in our experience, can easily be performed while preserving function and improving cosmesis. This flap is an appealing option for concealing defects in the distal extremities.


Assuntos
Melanoma , Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Idoso , Doença Crônica , Feminino , Humanos , Melanoma/cirurgia , Retalho Perfurante/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recidiva , Neoplasias Cutâneas , Transplante de Pele/métodos , Lesões dos Tecidos Moles/cirurgia , Coxa da Perna/cirurgia , Resultado do Tratamento
4.
Artigo em Chinês | MEDLINE | ID: mdl-35511627

RESUMO

A case of large ulcerative basal cell carcinoma was reported here. The patient had a history of skin ulceration on the right face 20 years ago, which has not been paid attention to. Recently the area of ulcer gradually increasing, and consciously affects the function, so the patient came to our hospital for the sake of treatment. The diagnosis of right facial basal cell carcinoma (T4NXMX) was made by MRI, CT and histopathological examination. After improving the preoperative examination, surgical treatment was performed on May 10, 2020, the postoperative flap survived, the face recovered well, there was no recurrence after 6 months follow-up, the result was satisfied, and it is still in the follow-up.


Assuntos
Carcinoma Basocelular , Procedimentos Cirúrgicos Reconstrutivos , Neoplasias Cutâneas , Carcinoma Basocelular/cirurgia , Face/cirurgia , Humanos , Neoplasias Cutâneas/cirurgia , Transplante de Pele , Retalhos Cirúrgicos , Resultado do Tratamento
5.
Zhonghua Shao Shang Za Zhi ; 38(5): 454-461, 2022 May 20.
Artigo em Chinês | MEDLINE | ID: mdl-35599421

RESUMO

Objective: To explore the effects of expanded frontal-parietal pedicled flap in reconstructing cervical scar contracture deformity in children after burns. Methods: A retrospective observational study was conducted. From January 2015 to December 2020, 18 male children with cervical scar contracture deformity after burns who met the inclusion criteria were admitted to Zhengzhou First People's Hospital, aged 4 to 12 years, including 10 cases with degree Ⅱ cervical scar contracture deformity and 8 cases with degree Ⅲ scar contracture deformity, and were all reconstructed with expanded frontal-parietal pedicled flap. The surgery was performed in 3 stages. In the first stage, a cylindrical skin and soft tissue expander (hereinafter referred to as expander) with rated capacity of 300 to 500 mL was placed in the frontal-parietal region. The expansion time was 4 to 6 months with the total normal saline injection volume being 2.1 to 3.0 times of the rated capacity of expander. In the second stage, expander removal, scar excision, contracture release, and flap transfer were performed, with the flap areas of 18 cm×9 cm to 23 cm×13 cm and the secondary wound areas of 16 cm×8 cm to 21 cm×11 cm after scar excision and contracture release. After 3 to 4 weeks, in the third stage, the flap pedicle was cut off and restored. The rated volume of placed expander, total normal saline injection volume, type of vascular pedicle of flap, survival of flap and reconstruction of scar after the second stage surgery were recorded. The neck range of motion and cervico-mental angle were measured before surgery and one-year after surgery. The appearance of neck, occurrence of common complications in the donor and recipient sites of children, and satisfaction of children's families for treatment effects were followed up. Data were statistically analyzed with paired sample t test. Results: All the patients successfully completed the three stages of operation. The rated volume of implanted expander was 300 mL in 6 children, 400 mL in 9 children, and 500 mL in 3 children, with the volume of normal saline injection being 630 to 1 500 mL. The type of vascular pedicle of flap was double pedicle in 13 cases and was single pedicle in 5 cases. All the flaps in 17 children survived well, and the secondary wounds after neck scar excision and contracture release were all reconstructed in one procedure. In one case, the distal blood supply of the single pedicled flap was poor after the second stage surgery, with necrosis of about 2.5 cm in length. The distal necrotic tissue was removed on 10 days after the operation, and the wound was completely closed after the flap was repositioned. In the follow-up of 6 months to 3 years post operation, the cervical scar contracture deformity in 18 children was corrected without recurrence. The flap was not bloated, the texture was soft, and the appearances of chin and neck were good. The range of motion of cervical pre-buckling, extension, left flexion, and right flexion, and cervico-mental angle in one year after operation were improved compared with those before operation (with t values of 43.10, 22.64, 27.96, 20.59, and 88.42, respectively, P<0.01). The incision in the frontal donor site was located in the hairline, the scar was slight and concealed. No complication such as cranial depression was observed in expander placement site, and the children's families were satisfied with the result of reconstruction. Conclusions: Application of expanded frontal-parietal pedicled flap in reconstructing the cervical scar contracture deformity in children after burns can obviously improve the appearance and function of neck, with unlikely recurrence of postoperative scar contractures, thus it is an ideal method of reconstruction.


Assuntos
Queimaduras , Contratura , Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Queimaduras/complicações , Queimaduras/cirurgia , Criança , Cicatriz/complicações , Cicatriz/cirurgia , Contratura/etiologia , Contratura/cirurgia , Humanos , Masculino , Procedimentos Cirúrgicos Reconstrutivos/métodos , Solução Salina , Transplante de Pele , Resultado do Tratamento
6.
Ann Plast Surg ; 88(5): 500-506, 2022 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-35443267

RESUMO

BACKGROUND: The reconstruction of a fingertip degloving injury presents a functional and aesthetic challenge. We used a dorsal digital perforator flap combined with a cross-finger flap to reconstruct this type of injury. The purposes of this retrospective study were to evaluate the efficacy of the combined flaps and to present our clinical experience. METHODS: From November 2016 to October 2019, 16 patients (13 men and 3 women) with fingertip degloving injuries were treated with a dorsal digital perforator flap combined with a cross-finger flap for innervated reconstruction. We used an innervated dorsal digital perforator flap for the reconstruction of the dorsal defect of the degloved fingertip and an innervated cross-finger flap for the volar defect. The average size of the defect was 4.2 × 1.9 cm. The average sizes of the flaps were 2.3 × 2.1 cm (the dorsal digital perforator flap) and 2.5 × 2.1 cm (the cross-finger flap). RESULTS: All flaps and skin grafts survived completely without ischemia or venous congestion. All wounds and their donor sites healed primarily without exudation and infection. Patients were followed up for a mean time of 11.3 ± 1.9 months (range, 9-15 months). At the final follow-up, no significant difference was seen in the averaged total active motion between the injured fingers and the contralateral fingers. No significant difference was found in the averaged total active motion between the donor fingers and the contralateral fingers. All flaps obtained excellent or good sensory performance. All flaps had mild cold intolerance. Thirteen patients had no pain, 2 reported mild pain, and 1 experienced moderate pain. Ten patients were very satisfied with the appearance of the reconstructed finger. CONCLUSIONS: The dorsal digital perforator flap combined with a cross-finger flap is an effective and reliable method for the reconstruction of fingertip degloving injuries.


Assuntos
Desenluvamentos Cutâneos , Traumatismos dos Dedos , Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Desenluvamentos Cutâneos/cirurgia , Feminino , Traumatismos dos Dedos/cirurgia , Dedos/inervação , Dedos/cirurgia , Humanos , Masculino , Dor , Retalho Perfurante/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Transplante de Pele/métodos , Lesões dos Tecidos Moles/cirurgia , Resultado do Tratamento
7.
Ann Plast Surg ; 88(5): 507-512, 2022 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-35443268

RESUMO

BACKGROUND: Dorsal digital soft tissue defects are considered among the most challenging to reconstruct. Numerous treatment options are proposed, including advancement flaps, antegrade, retrograde flow flaps, adipofascial flaps, and digital artery perforator flaps. However, the optimal treatment remains controversial. The concept of the "bridge principle," consisting of the indirect transfer of the flap to the defect area through a muscular bridge, has recently introduced by authors for medial canthal reconstruction. The aim of the study was to examine the feasibility of its application in digital reconstruction for dorsal defects and the development of a new flap. The utilization of the dorsal subcutaneous adipofascial digital or toe tissue as a "bridge" led to description and development of bridged digital artery perforator flaps as an alternative treatment of such defects. METHODS: From November 2017 to September 2019, a series of 14 patients (mean age of 57.1 years) suffered from dorsal digital or toe soft tissue defects of different dimensions and sustained reconstruction with this new technique. RESULTS: Twelve digits and 2 toes have been concerned. The mean size of the defects was 1.3 × 1.1 cm. All flaps survived without a sign of venous congestion. No functional digital or toe problems were observed during the follow-up period (mean of 11.6 months). Minor wound dehiscence presented in 2 cases (2 of 14 [14.3%]) and a transient skin swelling around the flap in 1. CONCLUSIONS: A new concept was introduced to resolve a challenging problem. Initial outcomes are very encouraging. These flaps could be a valuable and reliable reconstructive option.


Assuntos
Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Humanos , Extremidade Inferior/cirurgia , Pessoa de Meia-Idade , Retalho Perfurante/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Lesões dos Tecidos Moles/cirurgia , Dedos do Pé/cirurgia , Resultado do Tratamento , Artéria Ulnar
8.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 36(4): 446-450, 2022 Apr 15.
Artigo em Chinês | MEDLINE | ID: mdl-35426284

RESUMO

Objective: To explore the feasibility of peroneal perforating chimeric tissue flap in repairing the composite defects of calf and heel based on lower limb angiography, and the clinical effect. Methods: The digital subtraction angiography images of lower limbs of 50 patients met the selection criteria between May 2011 and October 2014 were used as the research object to observe the course of peroneal artery and its perforating vessels. Based on the observation results, between April 2015 and October 2020, the peroneal perforating chimeric tissue flap was designed to repair 7 cases of composite defects of the calf and heel. There were 5 males and 2 females with an average age of 38 years (range, 25-55 years). The causes of injury included traffic accident in 4 cases, falling from height in 2 cases, and machine strangulation in 1 case. There were 5 cases of calf skin defect and tibial defect. The size of skin defect ranged from 5 cm×3 cm to 11 cm×7 cm, and the length of bone defect was 5-8 cm. There were 2 cases of heel skin defect and calcaneal defect. The sizes of skin defects were 5.0 cm×4.0 cm and 7.5 cm×6.5 cm, and the bone defects were 3.0 cm×2.6 cm and 4.0 cm× 3.0 cm. For the calf defect, the size of skin flap ranged from 6 cm×4 cm to 12 cm×8 cm, and the length of the fibula was the same as that of the tibial defect. For the heel defect, the sizes of the skin flaps were 8.5 cm×5.5 cm and 13.0 cm×5.0 cm, and the lengths of the fibulae were 10 cm and 12 cm. Free transplantation was performed in 5 cases and pedicle transplantation in 2 cases. The wound at donor site was repaired with skin grafting or sutured directly. Results: The peroneal artery ran close to the fibula 7.25-8.40 cm below the fibula head and send out 5-7 perforating vessels, with an average of 6.5 vessels. Perforating vessels mainly appeared in four places, which were (9.75±0.91), (13.21±0.74), (18.15±1.22), and (21.40±0.75) cm below the fibular head, with the occurrence rates of 94%, 90%, 96%, and 88%, respectively. Clinical application of 7 cases of peroneal perforating chimeric tissue flap all survived, all wounds healed by first intention. The skin graft at donor site survived and the incision healed by first intention. All patients were followed up 6-36 months, with an average of 12 months. Peroneal perforator chimeric tissue flap had good shape and soft texture. X-ray films showed that the bone graft healed well, and the healing time was 6-11 months (mean, 7 months). No obvious bone resorption was observed during follow-up. Five patients had no pain when walking, and 1 had mild pain with claudication. Postoperative heel ulcers formed in 1 case and healed after wearing custom plantar pressure dispersing shoes. At 6 months after operation, 2 patients were rated as grade Ⅳ and 5 patients as grade Ⅴ according to Holden walking function score. Conclusion: The peroneal perforating vessel distribution is constant and the peroneal perforating chimeric tissue flap is safe and reliable for repairing the composite defects of calf and heel.


Assuntos
Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Adulto , Feminino , Humanos , Masculino , Retalho Perfurante/irrigação sanguínea , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele , Lesões dos Tecidos Moles/diagnóstico por imagem , Lesões dos Tecidos Moles/cirurgia , Artérias da Tíbia/diagnóstico por imagem , Artérias da Tíbia/cirurgia , Resultado do Tratamento
9.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 36(4): 451-455, 2022 Apr 15.
Artigo em Chinês | MEDLINE | ID: mdl-35426285

RESUMO

Objective: To explore the feasibility and effectiveness of perforator propeller flap sequential transfer technique in repair of soft tissue defect of distal lower extremity. Methods: Between July 2015 and July 2021, 10 patients with soft tissue defect of distal lower extremity were treated with perforator propeller flap sequential transfer technique. There were 8 males and 2 females, with a median age of 47 years (range, 6-71 years). The etiologies included malignant tumor in 5 cases, trauma in 3 cases, postburn scar contracture in 1 case, and diabetic foot ulcer in 1 case. The defects were located at the pretibial area in 1 case, the distal lower extremity and Achilles tendon in 3 cases, the dorsum of foot and lateral malleolar area in 4 cases, the heel in 1 case, and the plantar foot in 1 case. The size of the defect ranged from 5 cm×3 cm to 8 cm×8 cm. Peroneal artery perforator propellor flaps (the 1st flap) in size of 14 cm×4 cm to 29 cm×8 cm were used to repair the defects of distal lower extremity. The donor site defects were repaired with the other perforator propeller flaps (the 2nd flap) in size of 7 cm×3 cm to 19 cm×7 cm. The donor site of the 2nd flap was directly closed. Results: All the operations were successfully completed and all of the 2nd flaps were elevated within 1 hour. Eight the 1st flaps survived completely; 2 had venous congestion. Among the 2 patients with venous congestion, 1 had necrosis of the distal end of the flap, and the secondary wound was repaired by skin grafting; 1 recovered spontaneously after 7 days. The 2nd flaps totally survived. No complication such as hematoma or infection occurred. Primary closure was achieved in all the recipient and donor sites. All patients were followed up 2-39 months,with a median of 15.5 months. The color, texture, and thickness of the flaps matched well with those of recipient sites. The normal contour of the leg was preserved. During follow-up, no recurrence of malignance or ulcer was observed. The scar contracture was completely released. All patients were satisfied with the reconstructive outcomes. Conclusion: The application of the perforator propeller flap sequential transfer technique can improve the repair ability of the lower extremity perforator propeller flap while ensuring the first-stage closure of the donor site, thereby improving the effectiveness.


Assuntos
Contratura , Hiperemia , Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Adolescente , Adulto , Idoso , Criança , Cicatriz/cirurgia , Contratura/cirurgia , Feminino , Humanos , Hiperemia/cirurgia , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Retalho Perfurante/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele , Lesões dos Tecidos Moles/cirurgia , Resultado do Tratamento , Adulto Jovem
10.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 36(4): 456-460, 2022 Apr 15.
Artigo em Chinês | MEDLINE | ID: mdl-35426286

RESUMO

Objective: To investigate the effectiveness of the wrap-around great toe flap combined with medial plantar artery perforator flap (MPAP) for repairing the completely degloved fingers. Methods: Between February 2018 and December 2019, 12 patients with the completely degloved fingers caused by machine strangulation were admitted. There were 9 males and 3 females with a median age of 32 years (range, 18-42 years). The injured finger was index finger in 7 cases, middle finger in 3 cases, and ring finger in 2 cases. The skin was avulsed from the metacarpophalangeal joint level, with the intact tendon and joint. The interval between injury and admission was 1-8 hours (mean, 5 hours). All fingers were taken debridement during the emergency operation. The size of the skin defect ranged from 8.0 cm×5.0 cm to 12.0 cm×7.5 cm. After flap thinning, the wrap-around great toe flap (8.0 m×2.0 cm-12.0 cm×3.5 cm) and MPAP (8.0 cm×4.0 cm-12.0 cm×5.5 cm) were used to repair the degloved finger. The donor sites were repaired with the full-thickness skin graft or the flap. Results: All flaps and skin grafts survived completely without significant complications and the wounds at recipient and donor sites healed by first intention. All patients were followed up 12-16 months (mean, 14 months). The texture, appearance, and color of the affected fingers were close to those of normal fingers, and the nails grew normally. At last follow-up, the mean two-point discrimination of the flap was 9 mm (range, 8-10 mm), and the sensation of the injured finger recovered to S3-S4. And 10 cases were rated as excellent and 2 cases as good according to the Michigan Hand Outcomes Questionnaire (MHQ). There was no complication such as pain from walking or skin ulceration at the donor site. The American Orthopaedic Foot and Ankle Society (AOFAS) score was excellent in 9 cases and good in 3 cases. Conclusion: Treating for the completely degloved fingers, the wrap-around great toe flap combined with MPAP can obtain good effectiveness in the respect of the sensation, function, and appearance.


Assuntos
Traumatismos dos Dedos , Hallux , Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Adolescente , Adulto , Feminino , Traumatismos dos Dedos/cirurgia , Dedos/cirurgia , Hallux/cirurgia , Humanos , Masculino , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Lesões dos Tecidos Moles/cirurgia , Artérias da Tíbia/cirurgia , Resultado do Tratamento , Adulto Jovem
11.
Sci Rep ; 12(1): 6168, 2022 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-35418596

RESUMO

Hydrogen is effective against ischemia-reperfusion (I/R) injury in skin flaps. However, the difficulty of continuously administering a sufficient amount of hydrogen using conventional methods has been an issue in the clinical application of hydrogen-based therapy. An Si-based agent administered orally was previously shown to continuously generate a large amount of hydrogen in the intestinal environment. In this study, we assessed the effect of the Si-based agent on the inhibition of I/R injury in skin flaps using a rat model. In the I/R groups, the vascular pedicle of the abdominal skin flap was occluded for three hours followed by reperfusion. In the I/R + Si group, the Si-based agent was administered perioperatively. After reperfusion, flap survival rate, blood flow, oxidative stress markers, inflammatory markers/findings, and degree of apoptosis were evaluated. Flap survival rate was significantly higher, and histological inflammation, apoptotic cells, oxidative stress markers, and levels of inflammatory cytokine mRNA and protein expression were significantly lower, in the I/R + Si group compared to the I/R group. The Si-based agent suppressed oxidative stress, apoptosis, and inflammatory reactions resulting from I/R injury, thereby contributing to improvements in skin flap survival.


Assuntos
Hidrogênio , Traumatismo por Reperfusão , Animais , Modelos Animais de Doenças , Hidrogênio/metabolismo , Hidrogênio/farmacologia , Hidrogênio/uso terapêutico , Inflamação/patologia , Ratos , Ratos Sprague-Dawley , Traumatismo por Reperfusão/tratamento farmacológico , Traumatismo por Reperfusão/metabolismo , Traumatismo por Reperfusão/prevenção & controle , Pele/metabolismo , Transplante de Pele
12.
Ulus Travma Acil Cerrahi Derg ; 28(3): 262-267, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-35485568

RESUMO

BACKGROUND: There are various surgical and invasive treatment systems such as conservative skin grafts and autologous epider-mal grafting (AEG) for diabetic foot ulcers. This study aims to evaluate the feasibility of using a novel epidermal graft harvesting system in diabetic foot ulcer emergencies. METHODS: A retrospective clinical study was conducted with 15 diabetic foot ulcer patients, and after written and signed consent forms were taken, AEG system was applied to all patients. All of the clinical data of the patients such as their American Society of Anesthesiologists (ASA) Physical Status Classification System scores, size of pre-application wound area (cm2), time to complete re-epithelization of the wound, pain scores using the visual analog scale (VAS) for both donor and recipient sites, changes in size of wound, complete dermal response time, and patients' demographics, comorbidities were recorded. The age, gender, pre-post appli-cation wound area (cm2), time of healing, ASA, and VAS variables were compared each other and analyzed statistically. P<0.05 was considered as statistically significant. RESULTS: The mean of time for complete wound healing was 5.9 (range 4-8) weeks. There was no statistically difference between recipient wound size and patient's age; size of both types of wounds (cm2) and time (weeks) for complete reduction for both types of wounds; and time to complete both types of wound healing and gender (p=0.509, 0.788, and 0.233, respectively). ASA scores did not impact the time required for complete healing of the wound (p=0.749). CONCLUSION: The current study has tried to evaluate the efficacy of the AEG system in a homogenous population with diabetic foot ulcers. An epidermal harvesting system may be used effectively and safely in patients with diabetic foot ulcer emergencies.


Assuntos
Diabetes Mellitus , Pé Diabético , Diabetes Mellitus/cirurgia , Pé Diabético/cirurgia , Emergências , Humanos , Recém-Nascido , Estudos Retrospectivos , Transplante de Pele , Cicatrização/fisiologia
13.
Orv Hetil ; 163(14): 564-568, 2022 Apr 03.
Artigo em Inglês | MEDLINE | ID: mdl-35377856

RESUMO

Összefoglaló. Elektromos áram okozta égési sérülések gyermekkorban ritkán fordulnak elo, az összes égés mindössze 2-10%-át teszik ki. Nehézséget okozhat a sérülés valódi súlyosságának meghatározása a kicsiny ki- és bemeneti sebek miatt. Áramégések során a legtöbb esetben mély necrosis alakul ki. Ilyen sérülések esetén a bor, a lágy részek, a csontok, illetve fiatal életkorban a növekedési zóna sérülésével is számolni kell, ami növekedési zavart és ezáltal másodlagos deformitásokat okozhat. Jelen esettanulmányunk célja az áramégés során létrejött gyermekkori kézujjsérülések ellátásának és késoi szövodményeinek bemutatása. Egy 15 éves fiúgyermek izzócsere közben ráfogott egy vezetékre, ami a jobb mutatóujján égési sérülést okozott. Distalis interphalangealis ízülete felett volarisan 25 × 14 milliméter nagyságú bemeneti, dorsalisan a körömágy lateralis szélén 8 × 7 milliméteres kimeneti áramjegy volt látható fehér, necroticus sebalappal, mely III . fokú égési sérülésnek bizonyult. A mély égési sérülés miatt necrectomia, keresztlebeny-plasztika és az adóterület teljes vastagságú borrel végzett transzplantálása történt. A primer rekonstrukciót követoen három héttel a lebeny leválasztására került sor. A nyomon követés során a mutatóujj körömperc-deviációja volt észlelheto. A röntgenvizsgálat a körömpercbázis ízfelszínét is érinto csonthiányt igazolt. Egy 2 éves leánygyermek szöggel nyúlt a konnektorba, emiatt hüvelykujján és tenyerén keletkezett égési sérülés. Interphalangealis ízülete felett dorsalisan és volarisan, valamint a hypothenar területén III. fokú égési sérülés volt látható. Necrectomiát követoen a hüvelykujj ventralis bordefektusának zárása elforgatott lebennyel, a donorterület és a dorsalis bordefektus fedése teljes vastagságú borrel történt. A gyermek nyomon követése jelenleg is zajlik, rövid távon a csontérintettség okozta végperc-deviáció látható. A gyermekek hosszú távú nyomon követése szükséges a késoi szövodmények felismerése és kezelése céljából. Orv Hetil. 2022; 163(14): 564-568. Summary. Pediatric electrical injuries are rare; they only constitute 2-10% of all burn causes. Determination of their actual severity may be challenging due to their small entry and exit wounds. Deep necrosis develops during electrical burns in most cases. These injuries can damage the skin, soft and bone tissues, and in children, the growth plate, which may cause secondary deformities. The objective of these case reports was the presentation of paediatric electrical finger injuries' management and late-onset complications. A 15-year-old boy touched an electric wire while changing a lightbulb, which caused a burn injury on his right index finger. During the physical examination, a 25 × 14 mm, third-degree burn was identified volarly, above the distal interphalangeal joint as an entry wound, and an 8 × 7 mm exit site occurred dorsally at the nailbed's lateral edge. Necrectomy and cross finger flap surgery were performed. The cross flap was separated three weeks after the primary reconstruction. Throughout the follow-up examinations, the ulnar deviation of the distal digit was observed. X-ray confirmed the bone atrophy of the distal phalanx base. A 2-year-old girl inserted a nail into the power outlet, causing third-degree burns on her thumb around the interphalangeal joint and hypothenar region. After necrectomy, the thumb's skin defect was reconstructed with a rotated flap, while the donor site received full-thickness skin graft transplantation. The follow-up of the child is still ongoing. Long term follow-up of these patients is necessary to identify and treat late-onset complications. Orv Hetil. 2022; 163(14): 564-568.


Assuntos
Traumatismos dos Dedos , Procedimentos Cirúrgicos Reconstrutivos , Adolescente , Criança , Pré-Escolar , Feminino , Traumatismos dos Dedos/cirurgia , Mãos/cirurgia , Humanos , Masculino , Transplante de Pele , Retalhos Cirúrgicos/cirurgia
14.
J Wound Care ; 31(4): 282-292, 2022 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-35404698

RESUMO

OBJECTIVE: In the microenvironment of wound sites, naturally occurring growth factors are crucial for cell migration, opsonisation, chemotaxis, differentiation and angiogenesis. Exogenous growth factors, such as platelet-rich plasma (PRP) and adipose tissue, also improve healing. METHOD: In the present within-subject study, we described the effects of PRP and adipose tissue extract (ATE) on skin graft donor site wound healing in patients requiring split-thickness skin grafts. Each patient, having at least two donor sites, received both control (no growth factor) and experimental (PRP or ATE) treatments. Wounds were evaluated on days 5, 7, 10, 15, 30 and 60. Digital photography and spectral images were used to analyse haemoglobin and melanin content, and re-epithelialisation area. Pain was assessed by visual analogue scale. Scar characteristics were scored on days 30 and 60. Biomaterial samples were analysed for growth factor and protein content. RESULTS: The study included 24 patients (18 male and six female; mean age: 59.1 years). PRP was topically applied to wounds in 11 patients (13 donor sites) and ATE in 13 patients (15 sites). ATE-treated donor sites exhibited significantly accelerated wound re-epithelialisation on days 5 and 7 compared with control sites (p=0.003 and 0.04, respectively). PRP accelerated healing on day 7 compared with control sites (p=0.001). Additionally, the application of ATE improved scar quality on days 30 and 60 (p=0.0005 and 0.02, respectively). Pain scores did not differ significantly between treatments. CONCLUSION: In this study, both growth factor sources stimulated wound healing. ATE is an alternative source of growth factors that promote early wound healing and improve scar quality.


Assuntos
Plasma Rico em Plaquetas , Transplante de Pele , Tecido Adiposo , Cicatriz , Feminino , Humanos , Peptídeos e Proteínas de Sinalização Intercelular/uso terapêutico , Masculino , Pessoa de Meia-Idade , Dor , Pele , Transplante de Pele/métodos , Cicatrização
15.
J Wound Care ; 31(4): 356-359, 2022 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-35404703

RESUMO

OBJECTIVE: Martorell hypertensive ischaemic ulcers are often misdiagnosed and can be a clinical and therapeutic challenge. Controversy exists regarding both their underlying triggers and the type of treatment that should be carried out. This study was designed to compare the effectiveness of punch grafting and conventional therapy in pain reduction. METHOD: A single-centre retrospective study was performed, including 40 patients with a clinical diagnosis of a Martorell ulcer or post-traumatic ulcer secondary to arteriolopathy in the elderly, who were treated with punch grafting (n= 24) or conventional medical treatment (n=16). RESULTS: There was a statistically and clinically significant reduction in pain after punch grafting. The minimal overall reduction was of three points in visual analogue pain scores. Of the patients who received punch grafting, 80% reported a VAS pain score of 0 at the third follow-up, in contrast with the 44% (n=4) patients who were treated without punch grafting. The mean time to epithelialisation was 82.1 days in patients who received conventional treatment and 43.5 days in those who received punch grafts. CONCLUSION: Punch grafting is a simple, validated and cost-effective technique that can be performed on an outpatient basis, promotes wound healing and reduces pain. It may control pain and stimulate epithelialisation even if the wound does not present with optimum wound bed characteristics for graft taking. Pain reduction and faster epithelialisation are associated with improvements in patients' quality of life.


Assuntos
Arteriolosclerose , Úlcera da Perna , Úlcera Cutânea , Idoso , Humanos , Úlcera da Perna/cirurgia , Dor , Qualidade de Vida , Estudos Retrospectivos , Transplante de Pele/métodos , Úlcera Cutânea/cirurgia , Úlcera
16.
J Wound Care ; 31(Sup4): S16-S23, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35404711

RESUMO

OBJECTIVE: Artificial dermal templates (ADTs), were designed initially to provide extracellular matrix and skin substitute for extensive burn injuries. Use of ADTs in a variety of other indications, has also been described in the literature. In this study, we describe our experience of using ADTs for different indications in burn contractures and wound coverage. METHOD: In this retrospective study, patients requiring burn scar contracture release, permanent wound coverage for acute traumatic wounds and temporary wound coverage to prepare for complex reconstructions, and where the ADT Pelnac (Gunze Ltd., Japan) was applied, were evaluated. Data regarding patient sex, age, type and location of injury, comorbidities, operations and complications were recorded. RESULTS: A total of 24 patients were included in the study, of whom 12 patients were operated on for burn contractures. ADTs were used with split-thickness skin grafts (STSGs) or Z-plasties in a single-stage procedure. In six patients, ADT and STSGs were used to cover defects with exposed bone or tendon. Of the patients, six had their wounds covered temporarily while they were stabilised for complex reconstructions or were awaiting definitive histopathological results. Revisional surgeries due to graft failures or insufficient contracture releases were required by 12 patients. All temporary wound coverage patients had successful flap reconstructions after stabilisation of their general status, had tumour-free margins in the histopathological examination, and no necrosis or infection was seen on follow-up. CONCLUSION: In this study, ADTs had positive effects on selected patients, but comprehensive and comparative clinical studies are needed for different indications to choose between these templates.


Assuntos
Queimaduras , Contratura , Pele Artificial , Queimaduras/patologia , Queimaduras/cirurgia , Contratura/cirurgia , Humanos , Estudos Retrospectivos , Transplante de Pele/métodos , Cicatrização
17.
J Wound Care ; 31(Sup4): S24-S30, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35404716

RESUMO

OBJECTIVE: Conventional skin graft fixation uses a tie-over bolus dressing with splint fixation. However, splints are highly uncomfortable and contribute considerably to medical waste. Previous study has shown positive results using hydrofiber for skin graft fixation. The aim of this study was to assess the effectiveness of using adhesive hydrofiber foam for skin graft fixation. METHOD: In this retrospective study, patients reconstructed with split-thickness skin graft that was fixated only with adhesive hydrofiber foam from April 2017 until April 2019 were included. RESULTS: A total of 44 patients took part, of whom 32 were male and 12 female, with a mean age of 56±19 years. The mean operative time was 77.5±91 minutes. The average defect size was 42±37cm2. The mean skin graft take was 97±5%. The mean length of hospital admission after skin grafting until discharge was 8.5±9.2 days. Excluding those patients undergoing other procedures at the same time as the skin graft gave a total of 34 patients. Their mean operative time was 32±20 minutes, and mean length of hospital stay after skin grafting was 4.0±4.7 days. CONCLUSION: Adhesive hydrofiber foam for skin graft fixation was technically very easy to apply, resulting in a waterproof, non-bulky, secure dressing. Splints were not required. Patients were allowed to mobilise. This method resulted in increased patient comfort and decreased medical waste. From these findings, we believe that this is an extremely simple and effective method of skin graft fixation.


Assuntos
Resíduos de Serviços de Saúde , Transplante de Pele , Adesivos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplante de Pele/métodos , Cicatrização
18.
J Orthop Surg (Hong Kong) ; 30(1): 10225536221094258, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35404723

RESUMO

PURPOSE: To evaluate the clinical efficacy of using free tissue flap combined with contralateral instep thick plantar skin in reconstructing complex plantar forefoot defects. METHODS: During the past 8 years, 15 patients, aged 25-60 years, with defects in the soft-tissue and composite bone of the forefoot were treated. Their defects were caused by trauma. These defects were all located on the plantar forefoot. The free tissue flaps transposed to reconstruct defects were anterolateral thigh flaps, groin flaps, and latissimus dorsi flaps. Flap size varied in width 4-cm and length (6-16 cm). The mean size of flaps was 80.3 cm2. The follow-up period ranged from 12 to 90 months (mean, 25.5 months). RESULTS: Partial flap loss was observed in one anterolateral thigh flap and one latissimus dorsi flap. One patient showed skin graft loss at the defect site, and the wound was re-epithelialized by changing dressings. Hyperkeratosis was not observed in any of the cases. All patients were able to walk near-normally within 2.5 months after surgery, and there was no recurrence of ulceration. CONCLUSION: We advocate using a free tissue flap combined with contralateral instep thick plantar skin for reconstruction of moderate or large complex plantar forefoot defects.


Assuntos
Traumatismos do Pé , Retalhos de Tecido Biológico , Procedimentos Cirúrgicos Reconstrutivos , , Traumatismos do Pé/cirurgia , Retalhos de Tecido Biológico/transplante , Humanos , Transplante de Pele , Resultado do Tratamento
19.
Artigo em Inglês | MEDLINE | ID: mdl-35457678

RESUMO

Vitiligo is described as a dermatological condition characterized by pigmentation disorders in both the skin and mucous membranes. Clinically, this disease is characterized by the presence of well-defined white areas of various shapes and sizes, which are a manifestation of a reduced number of melanocytes. Due to the fact that vitiligo can be a significant cosmetic problem for patients, a number of methods are currently available to help fight for a better skin appearance. If all the available non-invasive procedures turn out to be ineffective, surgery can help, which is a very good alternative in the case of difficult-to-treat but stable changes. Both the development of new techniques and modifications to the already available treatment of cell and tissue transplantation give hope to numerous patients around the world. The effectiveness of a particular method is determined by its appropriate selection depending on the lesions undergoing therapy. Each form of surgical intervention has its advantages and disadvantages, which, along with the location or size of the treated hypopigmentation area, should be analyzed by a doctor and discussed with their patient. This article is an overview of the currently available methods of surgical treatment of vitiligo and a comparison of their pros and cons.


Assuntos
Vitiligo , Humanos , Melanócitos , Pele , Transplante de Pele/métodos , Resultado do Tratamento , Vitiligo/cirurgia
20.
Zhonghua Shao Shang Za Zhi ; 38(4): 301-305, 2022 Apr 20.
Artigo em Chinês | MEDLINE | ID: mdl-35462506

RESUMO

Skin and soft tissue expansion can provide skin tissue similar to the recipient area in color and texture, which is one of the ideal methods in the repair of superficial defects. However, due to the long treatment cycle and relatively high complications rate in pediatric patients, expansion still faces many challenges. Based on the clinical practice and the current progress in skin and soft tissue expansion, this paper briefly discusses the change of skin after expansion, and the application, prevention and treatment of complications in the application of expansion in pediatric patients, aiming to provide reference for expansion in pediatric patients.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Lesões dos Tecidos Moles , Criança , Humanos , Transplante de Pele , Lesões dos Tecidos Moles/cirurgia , Expansão de Tecido , Resultado do Tratamento
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