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1.
Medicine (Baltimore) ; 99(39): e22252, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991421

RESUMO

A 31-year-old male patient with psoriasis received administration of traditional Chinese medicine (TCM) during a disease course of 14 years. He showed multiple keratoma together with squamous cell carcinoma (SCC) in left lower limbs. After admission, the conditions were stable after treatment, and received surgery for treating SCC. The skin defect was treated using full-thickness skin graft. The postoperative survival of the flap was satisfactory, and the conditions of psoriasis were well controlled. In this case, we presented the feasibility of graft in the donor site from a psoriatic lesion. Besides, we analyzed the possibility of SCC and keratinizing lesions.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Cutâneas/cirurgia , Transplante de Pele/métodos , Retalhos Cirúrgicos/transplante , Adulto , Carcinoma de Células Escamosas/complicações , Carcinoma de Células Escamosas/patologia , Humanos , Masculino , Medicina Tradicional Chinesa , Psoríase/complicações , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/patologia
2.
Ann R Coll Surg Engl ; 102(8): e219-e222, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32808811

RESUMO

Rhinophyma is a skin condition that affects the nose. It is often characterised by a large, red, bulbous nose. It can have a physical, psychological and social impact on the patient. Management options include conservative medical therapy such as retinoids or surgical excision followed by reconstruction as required. The reconstruction options can range from a dermal substitute full-thickness skin graft to local flaps, depending on the wound bed. We present a severe case of rhinophyma that required a complex reconstruction with a three-stage forehead flap because of the mass effect and the wound that resulted from the surgical excision of an extremely large and troublesome rhinophyma.


Assuntos
Testa/cirurgia , Rinofima , Transplante de Pele/métodos , Retalhos Cirúrgicos/cirurgia , Idoso , Humanos , Masculino , Rinofima/patologia , Rinofima/cirurgia
3.
Zhonghua Shao Shang Za Zhi ; 36(5): 402-404, 2020 May 20.
Artigo em Chinês | MEDLINE | ID: mdl-32456379

RESUMO

On January 1st, 2019, one male patient, aged 55 years, with chronic ulcer in right lower extremity was admitted to Northern Jiangsu People's Hospital. After admission, ulcer debridement and vacuum sealing drainage (VSD) surgery was performed in lower right extremity. Two pieces of bone-like tissue was removed from the lateral space between the Achilles tendon and fibula in the right leg, which was confirmed as ossification tissue by histopathological sections after surgery. The wounds were treated with VSD technique and dressing changes. On the 49th day after surgery, split-thickness skin graft was taken from the lateral left thigh and grafted to the wound area, which was then treated with VSD. The skin graft of patient survived well. The wound healed completely and the patient was discharged from hospital on day 77 post hospitalization. This case suggests that the patients with chronic ulcer should complete all related examinations in time, and improving the blood circulation of the wound and clearing the ectopic ossification in the wound are critical for wound healing.


Assuntos
Drenagem/métodos , Tratamento de Ferimentos com Pressão Negativa/métodos , Ossificação Heterotópica , Transplante de Pele/métodos , Úlcera/complicações , Ferimentos e Lesões/cirurgia , Humanos , Extremidade Inferior , Masculino , Pessoa de Meia-Idade
4.
Otolaryngol Head Neck Surg ; 162(6): 993-995, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32393106

RESUMO

We describe the use of the medial sural artery musculocutaneous perforator (MSAP) flap at our institution. It is a relatively new flap, originally described in 2001 for lower extremity defects, that has become increasingly popular for head and neck reconstruction due to its versatility, thinness, pliability, long pedicle, and particularly favorable donor site. It has been described for reconstruction of oral defects, but there is little published on its use in pharyngeal reconstruction. We suggest that the MSAP is an ideal flap for addressing defects caused by pharyngoesophageal stenosis, pharyngeal fistulas, or laryngopharyngectomies. We review 5 cases at our institution from June 2016 to November 2017.


Assuntos
Artérias/transplante , Esôfago/cirurgia , Músculo Esquelético/transplante , Retalho Perfurante/irrigação sanguínea , Faringe/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/irrigação sanguínea , Estudos Retrospectivos
5.
Cir. plást. ibero-latinoam ; 46(supl.1): 39-46, abr. 2020. graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-193493

RESUMO

INTRODUCCIÓN Y OBJETIVO: El uso de matrices dérmicas ha repercutido muy positivamente en los aspectos funcionales y estéticos del paciente quemado, sobre todo tras la reconstrucción de áreas especiales. Presentamos la experiencia del Servicio de Cirugía Plástica y Quemados del Hospital Universitario Miguel Servet de Zaragoza, España, en el uso de matrices dérmicas tras cirugía de quemaduras agudas o de sus secuelas. MATERIAL Y MÉTODO: Estudio observacional de recopilación de 88 casos, infantiles y adultos, tratados entre septiembre de 1999 y septiembre de 2019. Las matrices utilizadas fueron Integra® bicapa y Matriderm® monocapa, únicos sustitutos dérmicos permanentes disponibles en el ámbito de nuestra sanidad pública durante los años referidos. Recopilamos datos de sexo, edad, porcentaje de superficie corporal quemada, mecanismo de la quemadura, grado de profundidad y localización del área tratada con matrices dérmicas, si es quemadura aguda o secuela, pérdidas totales y parciales, y mostramos nuestro protocolo de actuación. RESULTADOS: Por sexos encontramos 51 varones y 37 mujeres con una media de edad de 37.67 años, con el grupo más numeroso entre 31 y 50 años; 71 casos con quemaduras agudas y en 17 con secuelas. El mecanismo de quemadura más frecuente fue el térmico (81%). La loca-lización de uso más frecuente fue la extremidad superior con 61 casos. En 67 casos utilizamos Matriderm® de 1 mm, en 13 Integra® bicapa y en 8 ambas matrices en el mismo paciente. La SCQ media de los pacientes tratados por quemaduras agudas fue del 11.7%. Constatamos 4 casos de pérdida total (1 Integra® bicapa y 3 de Matriderm® monocapa) y 11 casos de pérdidas parciales. CONCLUSIONES: El uso de matrices dérmicas debe de ser cotidiano en nuestras unidades, tanto para quemaduras agudas como para secuelas, y es necesario familiarizarse con sus indicaciones, manejo y resultados para incluirlas en nuestras escalas reconstructivas


BACKGROUND AND OBJECTIVE: Appearance of dermal matrices has had a very positive impact on the functional and aesthetic aspects in burned patients, specially after reconstruction of special areas. We present our experience in the Department of Plastic and Burns Surgery of the Miguel Servet Universitary Hospital in Zaragoza, Spain, in the use of dermal matrices in surgery of acute burns or sequelae. METHODS: We conduct an observational study on 88 cases, children and adults, treated from September 1999 to September 2019. The matrices used were Integra® bilayer and Matriderm® monolayer, the only permanent dermal substitutes available in our public health system during the referred years. We collected data on sex, age, percentage of burned body surface, burn mechanism, degree of depth and location of the area treated with dermal matrices, whether it is an acute burn or a sequel, as well as total and partial losses, and finally we show our protocol of action. RESULTS: Distribution by sex was 51 men and 37 women, average age 37.67 years being the most numerous group between 31 and 50 years; 71 cases of acute burns and 17 sequels. The most frequent burn mechanism was termal (81%). The most frequent used location was the upper limb with 61 cases. We used Matriderm® 1mm in 67 cases, Integra® bilayer in 13 and in 8 cases we used both in the same patient. The average TBSA percentage of patients treated for acute burns was 11.7%. We found 4 cases of total loss (1 of Integra® bilayer and 3 of Matriderm® monolayer), and 11 partial losses. CONCLUSIONS: Use of dermal matrices must be a daily option in our units, both for acute burns and sequelae, and we all must be familiar with their indications, management and results, to take them into account within our established reconstructive scales


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Queimaduras/cirurgia , Colágeno/uso terapêutico , Elastina/uso terapêutico , Transplante de Pele/métodos , Amplitude de Movimento Articular , Retalhos Cirúrgicos , Traumatismos da Mão/cirurgia
6.
Zhonghua Shao Shang Za Zhi ; 36(3): 179-186, 2020 Mar 20.
Artigo em Chinês | MEDLINE | ID: mdl-32241043

RESUMO

Objective: To explore the clinical effect of bi-layered artificial dermis combined with autologous skin graft in the repair of wounds with exposed bone and/or tendon. Methods: The medical records of 25 patients (aged 3 to 79 years, including 21 males and 4 females) with bone and/or tendon exposed wounds caused by various reasons, admitted to Nanfang Hospital of Southern Medical University from May 2014 to December 2018 were analyzed retrospectively. Of the 25 patients, 7 patients had exposed bone only, 13 patients had exposed tendon only, and 5 patients had exposure of both bone and tendon. The total wound area was 78.0 (53.4, 103.2) cm(2). The widths of bone exposure and tendon exposure were 3.2 (3.0, 3.6) cm and 2.0 (1.7, 2.4) cm, respectively. All wounds were implanted with bi-layered artificial dermis in the first stage after thorough wound debridement. After 2 to 3 weeks of vascularization of artificial dermis, autologous thin-to-medium-thickness skins or split-thickness skins were grafted to repair the wounds in the second stage. The vascularization of artificial dermis and its time, whether or not producing hematoma, the skin graft survival rate on day 7 post autologous skin grafting, whether or not repeating skin grafting, and the time of complete wound healing were observed and recorded. The patients were further followed up and observed for 3 or more months after discharge. Results: The vascularization of artificial dermis was achieved in 24 patients after the first transplantation with vascularization time being 11-21 (16±4) days. No hematoma was observed in the transplanted artificial dermis. Failed vascularization of grafted artificial dermis was observed in one patient who was later treated with negative pressure drainage and skin grafting alone, and was discharged with wound healing. The skin graft survival rate on day 7 post autologous skin grafting was 92.2%-100.0% ( (99.3±1.3)%), with the remaining wound areas recovered later by themselves or healed by dressing changes without repeated skin grafting. The complete wound healing time was 7-19 (11.9±2.8) days after autologous skin grafting. The patients were followed up for 3 to 60 months after discharge. Except for the pigmentation in skin graft area, the skin grafts survived well, being soft in texture and with no repeated ulceration, obvious hypertrophic scar, or contracture deformity. Conclusions: Artificial dermis combined with autologous skin grafting can effectively repair wounds with bone and/or tendon exposure, providing a repair strategy for this type of wounds.


Assuntos
Queimaduras/cirurgia , Transplante de Pele/métodos , Pele Artificial , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Derme , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tendões , Cicatrização , Adulto Jovem
7.
Zhonghua Shao Shang Za Zhi ; 36(3): 171-178, 2020 Mar 20.
Artigo em Chinês | MEDLINE | ID: mdl-32241042

RESUMO

Objective: To evaluate the efficacy and safety of cell sheets containing allogeneic keratinocytes and fibroblasts in the treatment of partial-thickness burn wounds. Methods: The cell sheets containing allogeneic keratinocytes and fibroblasts were constructed using polyurethane biofilm as carrier. Then gross observation and histological observation were conducted. From April 2016 to December 2017, Changhai Hospital of Naval Medical University recruited patients with acute partial-thickness burn wounds that met the inclusion criteria for this prospective and positively self-controlled clinical trial. Recruitment of 40 acute partial-thickness burn wounds were planned with each selected single wound being not smaller than 10 cm×10 cm and not more than 5% total body surface area (TBSA). Each wound was equally divided into two areas, which were recruited into cell sheet group and conventional treatment group according to the random number table. The wounds in cell sheet group were covered by cell sheet and then sterile gauze as secondary dressings. Depending on the wound healing and exudation, the sterile gauze was replaced every 1 to 3 day (s) after the treatment was started, and the cell sheet was replaced every 7 days (namely dressing changing). The wounds in conventional treatment group were covered by sulfadiazine silver cream gauze and then dressed with sterile gauze, with the dressings changed every 2 to 3 days depending on wound exudation. On treatment day 5, 7, 10, and 14, the wound healing rates in the two groups were calculated. The complete wound healing time, the total number of dressing changes, and the status of wound infection during treatment were recorded. The Visual Analogue Scale was used to score the pain at the first dressing change. Scar formation of patients was followed up for 6 to 12 months after injury. Safety indicators including vital signs, laboratory examination indexes, and adverse reactions during treatment were observed. Data were statistically analysed with Wilcoxon rank sum test and Bonferroni correction. Results: (1) Each prepared cell sheet had a diameter of about 8 cm and was about 49 cm(2) in size, containing 2 or 3 layers of keratinocytes and fibroblasts. (2) A total of 43 patients were enrolled, of whom 3 patients dropped out of the study. Of the 40 patients who completed the treatment, there were 22 males and 18 females who were aged 1 to 57 year (s), with total burn area of 2% to 26% TBSA. (3) On treatment day 5, 7, 10, and 14, the wound healing rates in cell sheet group were significantly higher than those in conventional treatment group (Z=4.205, 4.258, 3.495, 2.521, P<0.05 or P<0.01). The complete wound healing time in cell sheet group was 7 (6, 8) days, which was significantly shorter than 11 (7, 14) days in conventional treatment group (Z=4.219, P<0.01). The total number of wound dressing changes in cell sheet group was 1 (1, 2) times, which was significantly less than 6 (4, 7) times in conventional treatment group (Z=5.464, P<0.01). (4) The wounds in cell sheet group in 31 patients healed before the first dressing change. The pain score of wounds in the first dressing change in cell sheet group of 9 patients was 1 (0, 1) point, while the pain score of wounds in the first dressing change in conventional treatment group of 40 patients was 2 (1, 3) points. There was no obvious infection in the wounds in both groups of 40 patients before the wound healing. Nine patients completed the follow-up after the trial. In 6 patients, no scar formation was observed in cell sheet group or conventional treatment group. The color of wounds in cell sheet group was consistent with normal skin, and there was only a small amount of pigment deposition in the wounds of conventional treatment group. Three patients developed pigment deposition only in the wounds of cell sheet group but obvious scars in conventional treatment group. (5) The abnormal fluctuations of vital signs including body temperature, blood pressure, heart rate, respiratory rate, and laboratory examination indexes of all patients during treatment were alleviated through the process of burn wound healing. No obvious adverse reactions or abnormalities related to the treatment were observed. Conclusions: The cell sheet containing allogeneic keratinocytes and fibroblasts can reduce the number of dressing changes, accelerate wound epithelialization, shorten wound healing time, reduce pain during dressing change in the treatment of partial-thickness burn wounds, and it may reduce scar hyperplasia after wound healing because of accelerating wound epithelization. Its clinical application is simple, safe, and effective.


Assuntos
Queimaduras/cirurgia , Fibroblastos/transplante , Transplante de Células-Tronco Hematopoéticas , Queratinócitos/transplante , Transplante de Pele/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
8.
Medicine (Baltimore) ; 99(14): e19779, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32243413

RESUMO

RATIONALE: Surgical treatment of hidradenitis suppurativa (HS) is challenging. Wide excision of affected lesions followed by skin graft or flap coverage has been recommended to achieve remission and prevent recurrence. Herein, we present our experience of bilateral inferomedial gluteal defects coverage using symmetrical keystone flaps (KFs) designed parallel to relaxed skin-tension lines (RSTLs). PATIENT CONCERNS: An 18-year-old man was admitted for chronic inflammatory lesions in both inferomedial gluteal areas. DIAGNOSES: Physical examination revealed multiple sinuses with broad surrounding scars in both inferomedial gluteal areas, which led to a diagnosis of HS. INTERVENTIONS: We performed wide excision on all affected lesions. The size of the final defects was 6 × 10 cm on the right side, and 5 × 9 cm on the left side. We covered the defects with KFs 9 × 15 cm (right) and 8 × 12 cm (left), which were based on the hotspots of the interior gluteal artery and internal pudendal artery perforators, and parallel to RSTLs. OUTCOMES: The flaps were inset without tension on each side, and the donor sites were closed primarily. All flaps fully survived and there were no postoperative complications. The patient was satisfied with the final outcome after 6 months of follow-up. LESSONS: Successful reconstruction of bilateral inferomedial gluteal defects was achieved after resection of HS using symmetrical KFs designed parallel to RSTLs. The KF technique considering RSTLs could be a good reconstructive option for gluteal HS.


Assuntos
Nádegas/cirurgia , Hidradenite Supurativa/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Adolescente , Nádegas/microbiologia , Humanos , Masculino
9.
Gerokomos (Madr., Ed. impr.) ; 31(1): 32-35, mar. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-192210

RESUMO

Paciente de 79 años, remitida a consulta de enfermería para valoración de lesión postraumática en miembro inferior derecho de una semana de evolución, tratada con vendaje elástico y heparina de bajo peso molecular. OBJETIVO: Conocer el rol de la enfermería en la prevención y tratamiento de la dermatoporosis, a propósito de un caso clínico. METODOLOGÍA: Caso clínico con planteamiento metodológico, con consentimiento informado de la paciente y fotografías del caso. RESULTADO: La cicatrización se consiguió en un periodo de 65 días, con una correcta preparación del lecho de la herida para el posterior éxito del injerto cutáneo, controlando el edema, exudado y dolor durante las curas, realizadas cada 2-3 días de acuerdo con la efectividad del tratamiento. DISCUSIÓN: La dermatoporosis exige un mayor esfuerzo en prevención primaria y secundaria desde Atención Primaria, sobre todo a partir de la detección de las manifestaciones clínicas y complicaciones iniciales derivadas de la misma


A 79-year-old patient referred to a nursing consultation to evaluate a traumatic lesion in the right lower limb for one week, treated with elastic bandage and low molecular weight heparin. OBJECTIVE: Knowing the role of nursing in the prevention and treatment of dermatoporosis, in relation to a clinical case. METHODOLOGY: Clinical case with methodological approach, with informed consent of the patient and photographs. RESULT:The healing was achieved in a period of 65 days, with a correct preparation of the wound bed for the subsequent success of the skin graft, treating the edema, exudate and pain during the cures, made every 2-3 days in accordance with the effectiveness of the treatment. DISCUSSION: Dermatoporosis requires a greater effort in primary and secondary prevention from primary care, especially from the detection of clinical manifestations and initial complications derived from it


Assuntos
Humanos , Feminino , Idoso , Envelhecimento da Pele/patologia , Diagnóstico de Enfermagem/métodos , Transplante de Pele/métodos , Desbridamento/métodos , Extremidade Inferior/patologia , Cicatrização , Transplante de Pele/enfermagem , Transplante de Pele/reabilitação
10.
Medicine (Baltimore) ; 99(9): e19361, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118779

RESUMO

Successful reconstruction after tumor resection facilitates rapid recovery and retention of good quality of life, and this is important for a successful operation. This study aimed to analyze and compare the application and efficacy of xenogeneic acellular dermal matrix (xeno-ADM) and abdominal skin graft in hypopharynx reconstruction.This is a retrospective cohort study that included 25 patients with posterior hypopharyngeal wall cancer who underwent partial hypopharyngectomy with laryngeal preservation. The patients were divided into 2 groups according to the repair materials used. Eleven patients were treated with xeno-ADM, and 14 patients with abdominal skin grafts for repairing hypopharyngeal mucosal defects. The intraoperative data, postoperative recovery time of eating function, graft contraction, infection and pharyngeal fistula rate, and 1-year survival rate of the 2 groups were analyzed and compared.Compared with skin grafts group (23.1 ±â€Š5.8 days), the recovery time of eating function in xeno-ADM group was shorter (17.3 ±â€Š6.4 days), (P = .026). Also the number of postoperative hospitalization days were less in the xeno-ADM group (18.5 ±â€Š6.7 days) than in the skin grafts group (24.1 ±â€Š5.6 days) (P = .035). Besides, no significant differences were observed in other comparisons between the 2 groups. Also no obvious rejection and severe graft contraction were observed in both the groups. All patients were successfully decannulated.Both xeno-ADM and abdominal skin grafts demonstrated good effects in the reconstruction of hypopharynx, but the recovery time of eating function in patients with xeno-ADM was faster, which may be due to rapid epithelialization. In addition, it avoids trauma of donor sites.


Assuntos
Derme Acelular/normas , Neoplasias Hipofaríngeas/cirurgia , Complicações Pós-Operatórias/etiologia , Adulto , China , Estudos de Coortes , Feminino , Humanos , Neoplasias Hipofaríngeas/epidemiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Transplante de Pele/métodos , Transplante de Pele/normas
11.
Jt Dis Relat Surg ; 31(1): 39-42, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32160492

RESUMO

OBJECTIVES: This study aims to report the outcomes of dorsal V-Y advancement flap technique used for the reconstruction of surgical defects following total matricectomy performed for the onychogryphosis of hand nails. PATIENTS AND METHODS: A total of 18 consecutive patients (10 males, 8 females; mean age 38.4 years; range, 24 to 41 years) with 20 onychogryphotic hand nails who underwent total matricectomy and dorsal V-Y advancement flap technique were analyzed retrospectively between June 2015 and March 2018. The Mann- Whitney U test was used to compare the pre- and postoperative Quick Disability of the Arm, Shoulder, and Hand (Quick DASH) questionnaire scores while postoperative satisfaction rate was also evaluated. RESULTS: The mean follow-up period of the patients was 15.3 months. The etiology was finger trauma in eight and surgical complication of recurrent paronychia drainage in four cases, while the remaining six were idiopathic. The mean time to return to work was 5.2 weeks, and the mean pre- and postoperative Quick DASH scores were 0.97 and 3.45, respectively, with a statistically significant difference. The postoperative satisfaction was rated as excellent in 16, good in one, and moderate in one case. CONCLUSION: The dorsal V-Y advancement flap technique can be performed reliably due to its good soft tissue coverage, satisfactory cosmetic and functional outcomes, and allowing a short time to return to work.


Assuntos
Complicações Pós-Operatórias/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reoperação , Transplante de Pele/métodos , Retalhos Cirúrgicos , Adulto , Feminino , Humanos , Masculino , Doenças da Unha/etiologia , Doenças da Unha/cirurgia , Unhas/cirurgia , Reoperação/efeitos adversos , Reoperação/métodos , Estudos Retrospectivos , Resultado do Tratamento
12.
Wounds ; 32(1): 30-36, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32155126

RESUMO

INTRODUCTION: Comorbidities; inadequate vascularity; exposure of bones, tendons, or other avascular structures; and loss or removal of significant tissue volume all complicate the clinical treatment of patients with large, acute wounds. A number of amniotic tissue products are currently available for wound healing and other applications; one of these is a human amniotic suspension allograft (ASA) consisting of particulated human amniotic membrane and cells from the amniotic fluid from the same human donor. OBJECTIVE: In this study, the use of ASA with a fetal-derived bovine acellular dermal matrix to promote the healing of large, acute, full-thickness wounds is evaluated. The authors herein hypothesize treatment with ASA may allow for the healing of these wounds. MATERIALS AND METHODS: This study consisted of a chart review of 33 patients, with an average age of 42.2 years, and large acute wounds that were treated with a fetal-derived bovine acellular dermal matrix adsorbed with ASA. To the best of the authors' knowledge, this is the first study to date to investigate the usefulness of ASA in wound healing for large, complex, acute wounds. RESULTS: In this study, 30 of 33 patients were confirmed as fully healed, and 3 patients were lost to follow-up. The average wound size was 537.4 cm2, and the average time to split-thickness skin grafting (STSG) was 30.5 days, with an average time of 6.8 days until at least 95% graft take was achieved. Of the patient population studied, 45.5% had 1 or more significant comorbidities, 30.3% had wounds larger than 500 cm2, and 39.4% had exposed bone or tendon. CONCLUSIONS: In a small but challenging population including a high number of patients with comorbidities and exposed bone or tendon, it was found that ASA delivery, along with a dermal matrix, was successful in treating large, complex, acute wounds.


Assuntos
Derme Acelular , Transplante de Pele/métodos , Pele/lesões , Cicatrização , Ferimentos e Lesões/cirurgia , Derme Acelular/efeitos adversos , Doença Aguda , Adulto , Aloenxertos , Líquido Amniótico , Animais , Bovinos , Feminino , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplante de Pele/efeitos adversos , Transplante Homólogo/efeitos adversos , Transplante Homólogo/métodos
14.
Plast Reconstr Surg ; 145(4): 889-897, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32221196

RESUMO

BACKGROUND: Studies have cited possible complications and increased fluid accumulation in implant-based breast reconstruction using acellular dermal matrix. The authors propose a novel approach, manually meshing acellular dermal matrix using a skin graft mesher before use in expander-based breast reconstruction. The authors investigated postoperative drain time, complication rates, pain, and length of hospital stay in meshed versus unmeshed acellular dermal matrix cohorts. METHODS: One hundred fourteen patients and 194 reconstructed breasts were included overall. Of these, 99 patients were included in the pain and postoperative length of hospital stay analysis. Independent t test and chi-square analyses were used for bivariate comparisons. Multiple linear regression analyses were used to further delineate impact of meshing acellular dermal matrix on drain time, postoperative parenteral narcotic requirements, and length of stay between the two cohorts. RESULTS: The meshed acellular dermal matrix cohort had lower overall complication rates compared with the unmeshed cohort. Multiple linear regression analyses showed meshing the acellular dermal matrix alone decreased drain time by 7.3 days, and decreased postoperative parenteral narcotic requirements by 77 percent (20 mg morphine). Furthermore, it was the only significant predictor for a decrease in length of stay. CONCLUSIONS: Meshing acellular dermal matrix significantly decreased the time needed for postoperative drains. Statistical analysis showed significantly decreased overall and minor complication rates in the meshed cohort. Meshing significantly decreased parenteral narcotic requirements and, importantly, also decreased length of stay. All of these factors have important implications regarding cost and quality of care in expander-based breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Derme Acelular , Drenagem/estatística & dados numéricos , Mamoplastia/métodos , Analgésicos Opioides/uso terapêutico , Implantes de Mama , Neoplasias da Mama/cirurgia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Morfina/uso terapêutico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Estudos Retrospectivos , Transplante de Pele/métodos , Retalhos Cirúrgicos , Telas Cirúrgicas , Expansão de Tecido/métodos
15.
J Hand Surg Asian Pac Vol ; 25(1): 20-25, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32000602

RESUMO

Background: A hypothenar perforator free flap, which is harvested from the palm, is suitable for reconstruction of a finger pulp skin defect, but this flap has rarely been reported, and most of these flaps in previous published reports were designed on the proximal zone of the hypothenar area. In the present report, hypothenar perforator free flaps on the distal zone, namely distal hypothenar perforator free flaps, including two sensate flaps, were used for four cases with pulp defects. Methods: Four distal hypothenar perforator free flaps were used for four patients with skin defects of the finger pulp, including one thumb, two index fingers, and one little finger. The average period from the injury to reconstruction was 30.3 days (range 21 to 47 days). The age of the patients ranged from 49 to 68 years, and the flap size ranged from 18 × 30 to 25 × 45 mm2. Two cutaneous branches of the ulnar palmar digital nerve of the little finger were harvested for the sensate flaps. At final follow-up, sensory restoration of the flap was measured using the Semmes-Weinstein monofilament test and the static two-point discrimination test. Results: All donor sites were closed directly, and all flaps survived totally. The average postoperative period was 12 months (range 5 to 15 months). The Semmes-Weinstein monofilament test was all blue (3.61, 3.22, 3.61) for the three flaps followed-up for more than 12 months, including two sensate flaps and one insensate flap. The surgical scars were inconspicuous, and there were no donor site complications. Conclusions: We consider that a distal hypothenar perforator free flap has a high degree of usability for a medium-sized defect such as the whole finger pulp. In the future, whether sensory nerve branches of this flap should be sutured will need to be clarified.


Assuntos
Traumatismos dos Dedos/cirurgia , Retalho Perfurante , Transplante de Pele/métodos , Idoso , Mãos/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
17.
Transplantation ; 104(7): 1385-1395, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32053573

RESUMO

BACKGROUND: Tolerance induced in stringent animal transplant models using donor-specific transfusions (DST) has previously required additional immunological manipulation. Here, we demonstrate a dominant skin-allograft tolerance model induced by a single DST across an major histocompatibility class I mismatch in an unmanipulated B6 host. METHODS: C57BL/6 (H-2) (B6) mice were injected intravenously with splenocytes from B6.C.H-2 (H-2k) (bm1) or F1 (B6 × bm1) mice before skin transplantation. Mice were transplanted 7 days postinjection with donor (bm1 or F1) and third-party B10.BR (H-2) skin grafts. RESULTS: B6 hosts acutely rejected skin grafts from B6.C.H-2 (bm1) and F1 (B6 × bm1) mice. A single transfusion of F1 splenocytes into B6 mice without any additional immune modulation led to permanent acceptance of F1 skin grafts. This graft acceptance was associated with persistence of donor cells long-term in vivo. The more rapid removal of DST bm1 cells than F1 cells was reduced by natural killer-cell depletion. Tolerant grafts survived an in vivo challenge with naive splenocytes. Both CD4CD25 and CD4CD25 T cells from F1 DST treated B6 mice suppressed alloproliferation in vitro. Tolerance was associated with expansion of peripheral Foxp3CD4CD25 regulatory T cells (Treg) and increased forkhead box P3 (Foxp3) expression in tolerant grafts. In tolerant mice, Foxp3 Treg arises from the proliferation of indirectly activated natural Foxp3 Treg (nTreg) and depletion of Foxp3 Treg abrogates skin-graft tolerance. CONCLUSIONS: This study demonstrates that the persistence of transfused semiallogeneic donor cells mismatched at major histocompatibility class I can enhance tolerance to subsequent skin allografts through indirectly expanded nTreg leading to dominant tolerance without additional immunological manipulation.


Assuntos
Transfusão de Sangue , Rejeição de Enxerto/prevenção & controle , Transplante de Pele/métodos , Linfócitos T Reguladores/imunologia , Condicionamento Pré-Transplante/métodos , Tolerância ao Transplante , Aloenxertos/imunologia , Animais , Modelos Animais de Doenças , Rejeição de Enxerto/imunologia , Sobrevivência de Enxerto/imunologia , Humanos , Isoantígenos/administração & dosagem , Ativação Linfocitária/imunologia , Camundongos , Pele/imunologia , Transplante de Pele/efeitos adversos , Transplante Homólogo/efeitos adversos , Transplante Homólogo/métodos
18.
Plast Reconstr Surg ; 145(3): 608e-616e, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32097331

RESUMO

BACKGROUND: Various surgical techniques exist for lower extremity reconstruction, but limited high-quality data exist to inform treatment strategies. Using multi-institutional data and rigorous matching, the authors evaluated the effectiveness and cost of three common surgical reconstructive modalities. METHODS: All adult subjects with lower extremity wounds who received bilayer wound matrix, local tissue rearrangement, or free flap reconstruction were retrospectively reviewed (from 2010 to 2017). Cohorts' comorbidities and wound characteristics were balanced. Graft success at 180 days was the primary outcome; readmissions, reoperations, and costs were secondary outcomes. RESULTS: Five hundred one subjects (166 matrix, 190 rearrangement, and 145 free flap patients) were evaluated. Matched subjects (n = 312; 104/group) were analyzed. Reconstruction success at 180 days for matrix, local tissue rearrangement, and free flaps was 69.2 percent, 91.3 percent, and 93.3 percent (p < 0.001), and total costs per subject were $34,877, $35,220, and $53,492 (p < 0.001), respectively. Median length of stay was at least 2 days longer for free flaps (p < 0.0001). Readmissions and reoperations were greater for free flaps. Local tissue rearrangement, if achievable, provided success at low cost. Free flaps were effective with large, traumatic wounds but at higher costs and longer length of stay. Matrices successfully treated older, obese patients without exposed bone. CONCLUSIONS: Lower extremity reconstruction can be performed effectively using multiple modalities with varying degrees of success and costs. Local tissue rearrangement and free flaps demonstrate success rates greater than 90 percent. Bilayer wound matrix-based reconstruction effectively treats a distinct patient population. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Retalhos de Tecido Biológico/transplante , Traumatismos da Perna/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Pele Artificial , Adulto , Idoso , Amputação/economia , Amputação/estatística & dados numéricos , Sulfatos de Condroitina/uso terapêutico , Colágeno/uso terapêutico , Feminino , Retalhos de Tecido Biológico/efeitos adversos , Retalhos de Tecido Biológico/economia , Sobrevivência de Enxerto , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Traumatismos da Perna/diagnóstico , Traumatismos da Perna/economia , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/economia , Readmissão do Paciente/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/economia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Reoperação/economia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Índice de Gravidade de Doença , Transplante de Pele/efeitos adversos , Transplante de Pele/economia , Transplante de Pele/instrumentação , Resultado do Tratamento
19.
Dis Colon Rectum ; 63(4): 461-468, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31977583

RESUMO

BACKGROUND: Surgery for advanced or recurrent pelvic malignancy can result in perineal defects that cannot be closed by wound edge approximation. Myocutaneous flaps can fill the defect and accelerate healing. No reconstruction has been proven to be superior to the others. OBJECTIVE: This study aimed to compare 3 flap procedures after beyond total mesorectal excision surgery. DESIGN: This is a retrospective analysis of a prospective database, according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. SETTINGS: This study was performed at a tertiary hospital. PATIENTS: Consecutive series of patients who required flap reconstruction after beyond total mesorectal excision surgery between 2007 and 2016 were included. MAIN OUTCOME MEASURES: Short-term outcomes after oblique rectus abdominis flap vs vertical rectus abdominis flap vs inferior gluteal artery perforator flap reconstruction were evaluated. RESULTS: Included are 65 (59%) oblique rectus abdominis flap, 30 (27.3%) vertical rectus abdominis flap, and 15 (13.7%) inferior gluteal artery perforator flap outcomes. Sacrectomy was performed in 12 (18.5%), 10 (33.3%), and 8 (53.3%) patients (p = 0.016). Preoperative radiotherapy was used in 60 (92.3%), 26 (86.7%), and 11 (73.3%) patients (p = 0.11). Flap infection and dehiscence occurred in 7 (10.8%), 1 (3.3%), and 4 (26.7%) patients. There was an increased risk of flap complication with inferior gluteal artery perforator flap vs vertical rectus abdominis flap (p = 0.036). Inferior gluteal artery perforator flap (OR, 6.26; p = 0.02) and obesity (OR, 4.96; p = 0.02) were associated with flap complications. Only complications of the oblique rectus abdominis flap decreased significantly over time (p = 0.03). The length of stay and complete (R0) resection rate were not different between the groups. LIMITATIONS: This study was limited because of its retrospective nature and because it was conducted at a single center. CONCLUSIONS: The techniques appear comparable. The approaches should be considered complementary, and the choice should be individualized. See Video Abstract at http://links.lww.com/DCR/B141. COMPARACIÓN DE RESULTADOS A CORTO PLAZO DE TRES TÉCNICAS DE RECONSTRUCCIÓN CON COLGAJO UTILIZADAS DESPUÉS DE LA CIRUGÍA DE ESCISIÓN MESORRECTAL TOTAL EXTENDIDA PARA EL CÁNCER ANORRECTAL: La cirugía para malignidad pélvica avanzada o recurrente puede provocar defectos perineales, que no pueden cerrarse por aproximación de los bordes de la herida. Los colgajos miocutáneos pueden llenar el defecto y acelerar la curación. Ninguna reconstrucción ha demostrado ser superior a las demás.Comparar tres procedimientos de colgajo después de una cirugía de escisión mesorrectal total extendida.Análisis retrospectivo de una base de datos prospectiva, de acuerdo con la Declaración de Fortalecimiento de los informes de estudios observacionales en epidemiología.Hospital de tercer nivel.Series consecutivas de pacientes que requirieron reconstrucción con colgajo después de una cirugía de escisión mesorrectal total extendida entre 2007 y 2016.Resultados a corto plazo después del colgajo oblicuo recto abdominal versus colgajo vertical recto abdominal versus reconstrucción del colgajo perforador de la arteria glútea inferior.Se incluyen 65 (59%) colgajo oblicuo recto abdominal oblicuo, 30 (27.3%) colgajo vertical recto abdominal y 15 (13.7%) colgajo perforador de la arteria glútea inferior. Sacrectomía se realizó en 12 (18.5%), 10 (33.3%) y 8 (53.3%) pacientes respectivamente (p = 0.016). La radioterapia preoperatoria se utilizó en 60 (92.3%), 26 (86.7%) y 11 (73.3%) (p = 0,11). La infección del colgajo y la dehiscencia ocurrieron en 7 (10.8%), 1 (3.3%) y 4 (26.7%). Hubo un mayor riesgo de complicación con el colgajo perforador de la arteria glútea inferior en comparación al colgajo vertical del recto abdominal (p = 0.036). El colgajo perforador de la arteria glútea inferior (OR 6.26, p = 0.02) y la obesidad (OR 4.96, p = 0.02) se asociaron con complicaciones del colgajo. Solo las complicaciones del colgajo oblicuo recto abdominal disminuyeron significativamente con el tiempo (p = 0.03). La duración de la estancia hospitalaria y la tasa de resección completa (R0) no fue diferente entre los grupos.Estudio retrospectivo en centro único.Las técnicas parecen comparables. Los enfoques deben considerarse complementarios y la elección individualizada. Consulte Video Resumen en http://links.lww.com/DCR/B141.


Assuntos
Músculos Abdominais/transplante , Neoplasias do Ânus/cirurgia , Carcinoma de Células Escamosas/cirurgia , Colectomia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Retalhos Cirúrgicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Ânus/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Feminino , Seguimentos , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
20.
J Craniofac Surg ; 31(2): e169-e171, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31895852

RESUMO

Skin cancer of the nose remains a common challenge for the reconstructive surgeon with full-thickness defects being particularly problematic. Reconstruction of the internal nasal lining poses the greatest difficulty with local tissue often having unsatisfactory vascularity or surface area. We describe the reconstruction of a full thickness nasal alar defect in a patient after failed full-thickness skin graft using a single stage procedure combining a bilobed flap with a turnover flap. The patient achieved excellent initial and long-term cosmesis and functionality and was very satisfied with the results. We demonstrate that selected full-thickness nasal alar defects may be reconstructed in a single procedure using a carefully placed turnover flap for the internal nasal lining and bilobed flap for outer skin cover.


Assuntos
Nariz/cirurgia , Idoso , Feminino , Humanos , Procedimentos Cirúrgicos Reconstrutivos , Rinoplastia/métodos , Transplante de Pele/métodos , Retalhos Cirúrgicos/cirurgia
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