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1.
Adv Skin Wound Care ; 34(9): 498-501, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34415255

RESUMO

ABSTRACT: This article describes a series of four patients for whom a Reverdin graft was performed. The Reverdin graft, also known as a pinch graft, is a method to promote epithelialization for superficial wounds. The intervention is minimally invasive with a short learning curve. The procedure and its advantages and disadvantages are discussed in this case series. This pinch graft is a widely accepted, minimally invasive intervention to accelerate the epithelialization of wounds.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Transplante de Pele/normas , Transplante de Pele/estatística & dados numéricos
3.
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
4.
Ann Anat ; 229: 151454, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31899297

RESUMO

Existing epidermal transplantation procedures applied in burn surgery or wound treatment, such as mesh grafting or the Meek method, do not lead to a restoration of all the skin layers. Dermal skin layers are indispensable in ensuring the quality and function of the transplanted skin as a frictional surface and a carrier of skin appendages such as hair, sweat glands, and sebaceous glands, as well as nerve receptors for detecting pressure, vibration, and temperature. Because of the restricted skin surface area that can be provided by the donor, full-skin transplants cannot be transplanted over a large area. Cultured skin procedures, based on skin cells cultivated in a laboratory, have not yet reached a stage of development where a complex full epidermal transplantation is possible. In particular, the introduction of skin appendages with a functional cell-to-cell communication has not been observed thus far in cultivated skin. Based on the Reverdin transplantation method, in which concave skin islands with epidermal and dermal parts are transplanted, Davis in 1910 described the transplantation of multiple 2-5 mm sized full-skin islands as a new method for the treatment of skin lesions. Further modifying this 100-year-old procedure, we developed a miniaturization and automation of the Davis transplantation method that started in 2011 and called it "SkinDot". In the following article we describe the effectiveness of the full-skin island transplant procedure in two patients. The transplantation of single 2-3 mm full-skin islands results in a full-skin equivalent without any limits on donor area and with a reduced donor morbidity.


Assuntos
Queimaduras/cirurgia , Transplante de Pele/métodos , Biópsia por Agulha/normas , Humanos , Transplante de Pele/ética , Transplante de Pele/normas , Transplante Autólogo/métodos
6.
J Tissue Viability ; 28(3): 161-166, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31128964

RESUMO

OBJECTIVE: The aim of this study was to evaluate the impact of High Voltage Pulsed Current (HVPC) on the integration of total skin grafts in rats submitted to nicotine action. MATERIALS AND METHODS: For this purpose, 60 adult Wistar rats randomly distributed in 6 groups of 10 animals were analyzed. The electrical stimulation (anodic and cathodic stimulation, motor level, 30 min at 10 Hz; minimum voltage 20 µs and 100 µs pulse interval) was applied for seven days, starting on the third day after surgery and after the dressing was removed from the graft. RESULTS: Anodic HVPC promoted greater graft integration, demonstrating a lower percentage of tissue contraction, a lower number of inflammatory infiltrates and a greater amount of vascular endothelial growth factor (VEGF), as well as a higher number of newly formed blood vessels. CONCLUSIONS: HVPC can positively influence the integration of skin grafts in nicotine-treated rats. anodic HVPC is shown to promote greater integration in relation to a lower percentage of tissue contraction, a lower number of inflammatory infiltrates and a greater amount of vascular endothelial growth factor and newformed blood vessels. Whereas, the cathodic polarity has presented smaller amount of tissue gap.


Assuntos
Terapia por Estimulação Elétrica/normas , Nicotina/efeitos adversos , Transplante de Pele/normas , Análise de Variância , Animais , Modelos Animais de Doenças , Terapia por Estimulação Elétrica/métodos , Terapia por Estimulação Elétrica/estatística & dados numéricos , Masculino , Nicotina/uso terapêutico , Ratos , Ratos Wistar/lesões , Transplante de Pele/métodos , Cicatrização/efeitos dos fármacos , Cicatrização/fisiologia
7.
Plast Surg Nurs ; 39(2): 44-47, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31136557

RESUMO

Traditional mechanical meshing methods have generally been the first-choice treatment of patients with extensive burns (>20% total body surface area). The limited availability of donor areas has sparked the development of resources such as the Meek micrografting technique. We present the case of a 43-year-old male patient with an 85% total body surface area third-degree flame burn. After the initial stabilization, there was a need for rapid and effective coverage of as much burned surface as possible. Thus, Meek micrografting was chosen. Its results in this patient are presented and discussed. The Meek technique is a useful method of skin expansion. It is indicated in patients with extensive burns, where donor areas are limited. The high rates of graft take and quality of the coverage attained make this technique appealing, albeit at a greater economic cost than with traditional mechanical meshing methods.


Assuntos
Queimaduras/cirurgia , Transplante de Pele/métodos , Adulto , Desbridamento/métodos , Humanos , Unidades de Terapia Intensiva/organização & administração , Masculino , Transplante de Pele/normas , Obtenção de Tecidos e Órgãos/métodos
8.
AORN J ; 108(3): 239-249, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30156716

RESUMO

Perioperative personnel manage autologous tissue when they care for patients undergoing procedures requiring the use of bone, soft tissue, or other autologous tissue to repair or replace defects. Use of autologous tissue can minimize the risk of rejection, disease transfer, and infection compared with the use of artificial materials. There are important steps to follow when handling autologous tissue to ensure it is safe for replantation and does not become contaminated. This Back to Basics article provides strategies for managing some types of autologous tissue, including bone flaps, parathyroid tissue, skin grafts, and veins. Tissue management strategies include creating strict documentation policies, standardizing processes and communication, and implementing routine audits to assess compliance.


Assuntos
Autoenxertos/normas , Manejo de Espécimes/normas , Coleta de Tecidos e Órgãos/normas , Transplante Autólogo/normas , Transplante Ósseo/normas , Humanos , Guias de Prática Clínica como Assunto , Transplante de Pele/normas , Retalhos Cirúrgicos/normas , Cicatrização/fisiologia
9.
Sci Rep ; 8(1): 10977, 2018 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-30030486

RESUMO

Split-thickness skin grafts (STSG) are still the gold standard for the treatment of most skin defects. Hence, there is an ongoing need to improve this procedure. For this purpose, we herein analyzed dermal matrices seeded with adipose tissue-derived microvascular fragments (ad-MVF) in a bradythrophic wound model. In additional experiments, the matrices were covered with autologous STSG 10 days after implantation. Green fluorescence protein (GFP)+ ad-MVF were isolated from C57BL/6-Tg(CAG-EGFP)1Osb/J mice and seeded onto collagen-glycosaminoglycan matrices. Non-seeded and prevascularized matrices were implanted into full-thickness skin defects on the skull of CD1 nu/nu mice for 21 days. Vascularization, lymphangiogenesis and incorporation of the matrices were analyzed using photo-acoustic imaging, trans-illumination stereomicroscopy, histology, and immunohistochemistry. The survival rate of STSG was assessed by planimetry. After 21 days, the density of microvascular and lymphatic networks was significantly higher in prevascularized matrices when compared to controls. This was associated with an improved implant integration. Moreover, prevascularization with ad-MVF allowed successful autologous skin grafting already at day 10, while coverage of non-seeded controls at day 10 resulted in STSG necrosis. In conclusion, ad-MVF represent powerful vascularization units. Seeded on dermal substitutes, they accelerate and enhance the healing of full-thickness skin defects and allow early coverage with STSG.


Assuntos
Linfangiogênese , Neovascularização Fisiológica , Técnicas Fotoacústicas/métodos , Transplante de Pele/métodos , Cicatrização , Tecido Adiposo , Animais , Camundongos , Camundongos Endogâmicos C57BL , Microvasos/transplante , Modelos Biológicos , Transplante de Pele/normas , Pele Artificial , Transplantes
10.
J Emerg Med ; 54(4): 514-515, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29306579

RESUMO

BACKGROUND: Traumatic skin tears often occur in patients with dystrophic skin. Closing them with adhesive skin closures is useful for patients with a healthy flap, but occasionally fails to cover the entire defect. We describe a simple technique to perform mini patch grafting on the remaining raw surface without damaging healthy skin. DISCUSSION: The skin flap is spread out and fixed with adhesive skin strips to minimize defects first. Small pieces of skin are obtained by trimming the edges of the skin flap with curved tip scissors. They are placed on the defect with free spaces of 3 to 5 mm between each of the grafts. Then the whole wound is covered with a dressing and gauze pads. Healing of the ulcer could be markedly promoted with little enlargement of the skin defect. CONCLUSIONS: Small pieces of skin trimmed out from the edge of skin flap can be used as a mini patch graft that remarkably enhances healing of remaining open surface.


Assuntos
Pele/lesões , Fita Cirúrgica/tendências , Cicatrização , Anestésicos Locais/uso terapêutico , Epinefrina/uso terapêutico , Primeiros Socorros/métodos , Humanos , Transplante de Pele/métodos , Transplante de Pele/normas , Lesões dos Tecidos Moles/cirurgia , Fita Cirúrgica/normas , Vasoconstritores/uso terapêutico
11.
J Wound Ostomy Continence Nurs ; 44(5): 492-494, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28777123

RESUMO

BACKGROUND: Management of a hematoma is challenging when its size is substantial. CASE: This case report describes the successful surgical treatment of a large, superficial hematoma with an improvised skin graft and negative pressure wound therapy. CONCLUSIONS: We have found that using the patient's own skin for a skin graft may provide adequate wound coverage and decrease healing time. This method also eliminates the need for creating a donor site. This same procedure can be used on smaller lacerations or skin tears. We advocate detaching the skin flap completely before reattaching in order to prevent reperfusion injury and necrosis.


Assuntos
Hematoma/cirurgia , Transplante de Pele/métodos , Cicatrização , Idoso , Anticoagulantes/efeitos adversos , Anticoagulantes/farmacologia , Feminino , Humanos , Tratamento de Ferimentos com Pressão Negativa/métodos , Fenóis/farmacologia , Fenóis/uso terapêutico , Transplante de Pele/normas , Varfarina/efeitos adversos , Varfarina/farmacologia
12.
Mil Med ; 182(S1): 383-388, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28291503

RESUMO

BACKGROUND: Improvised explosive devices and new directed energy weapons are changing warfare injuries from penetrating wounds to large surface area thermal and blast injuries. Acellular fish skin is used for tissue repair and during manufacturing subjected to gentle processing compared to biologic materials derived from mammals. This is due to the absence of viral and prion disease transmission risk, preserving natural structure and composition of the fish skin graft. OBJECTIVES: The aim of this study was to assess properties of acellular fish skin relevant for severe battlefield injuries and to compare those properties with those of dehydrated human amnion/chorion membrane. METHODS: We evaluated cell ingrowth capabilities of the biological materials with microscopy techniques. Bacterial barrier properties were tested with a 2-chamber model. RESULTS: The microstructure of the acellular fish skin is highly porous, whereas the microstructure of dehydrated human amnion/chorion membrane is mostly nonporous. The fish skin grafts show superior ability to support 3-dimensional ingrowth of cells compared to dehydrated human amnion/chorion membrane (p < 0.0001) and the fish skin is a bacterial barrier for 24 to 48 hours. CONCLUSION: The unique biomechanical properties of the acellular fish skin graft make it ideal to be used as a conformal cover for severe trauma and burn wounds in the battlefield.


Assuntos
Antibacterianos/farmacologia , Produtos Pesqueiros/microbiologia , Regeneração/efeitos dos fármacos , Transplante de Pele/métodos , Cicatrização , Âmnio/patologia , Animais , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Traumatismos por Explosões/tratamento farmacológico , Queimaduras/tratamento farmacológico , Córion/patologia , Produtos Pesqueiros/normas , Humanos , Camundongos , Medicina Militar/métodos , Células-Tronco Embrionárias Murinas , Soluções para Preservação de Órgãos/normas , Soluções para Preservação de Órgãos/uso terapêutico , Transplante de Pele/normas
13.
Hautarzt ; 68(5): 385-392, 2017 May.
Artigo em Alemão | MEDLINE | ID: mdl-28314878

RESUMO

BACKGROUND: Treatment of pediatric burn patients is very important because of the sheer frequency of burn wounds and the possible long-term ramifications. Extensive burns need special care and are treated in specialized burn centers. OBJECTIVES: The goal of this work is to present current standards in burn therapy and important innovations in the treatment of burns in children so that the common and small area burn wounds and scalds in pediatric patients in day-to-day dermatological practice can be adequately treated. MATERIALS AND METHODS: Analysis of current literature, discussion of reviews, incorporation of current guidelines. RESULTS: Burns in pediatric patients are common. Improvement of survival can be achieved by treatment in burn centers. The assessment of burn depth and area is an important factor for proper treatment. We give an overview for outpatient treatment of partial thickness burns. New methods may result in better long-term outcome. CONCLUSIONS: Adequate treatment of burn injuries considering current literature and guidelines improves patient outcome. Rational implementation of new methods is recommended.


Assuntos
Queimaduras/cirurgia , Procedimentos Cirúrgicos Dermatológicos/normas , Pediatria/normas , Guias de Prática Clínica como Assunto , Transplante de Pele/normas , Pele/lesões , Adolescente , Queimaduras/patologia , Criança , Pré-Escolar , Procedimentos Cirúrgicos Dermatológicos/métodos , Dermatologia/normas , Medicina Baseada em Evidências , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pediatria/métodos , Pele/patologia , Transplante de Pele/métodos , Resultado do Tratamento
14.
Int Wound J ; 14(2): 399-407, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27146907

RESUMO

Reconstruction is a basic task in craniofacial plastic surgery. Different methods must be used to meet the aspirations of surgeons and patients with different defects and deformities. We make a retrospective study of our experience of craniofacial reconstruction. In accordance with 10 years' clinical experience, direct suturing, skin graft transfer, nerve anastomosis, expanded pedicled or random flaps, facial local random flaps, reduction of mandibular fracture and correction of congenital craniofacial deformities were included in this case series. These types of treatment were applied to reconstruct facial defects or deformities according to different circumstances of patients. Directed by rational design and treatment, reconstructive surgery can be executed to treat different cases with different circumstances. A total of 891 different cases with different facial circumstances were treated with different methods: direct suturing (n = 93), skin graft transfer(n = 104), nerve anastomosis (n = 38), expanded pedicled or random flaps(n = 310), facial local random or pedicled flaps(n = 231), reduction of mandibular fracture(n = 112) and correction of congenital craniofacial deformities(n = 13). Reconstructive technique must be directed by reliable methods and special guidelines in Plastic Surgery. Three guidelines are summarised: reconstruction in the first stage and returning injured tissue to its origin site as far as possible for traumatic events; adjacent tissue must be prior to other distant tissue for reconstructive choice; and reconstruction at different stages after careful design.


Assuntos
Anormalidades Craniofaciais/cirurgia , Guias de Prática Clínica como Assunto , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/normas , Transplante de Pele/métodos , Transplante de Pele/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
15.
J Burn Care Res ; 38(1): e125-e132, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-27893575

RESUMO

It is unknown whether variations in burn care affect outcomes or affect the success of emerging therapeutics. The purpose of this study was to assess burn surgeons' preferences in excision and grafting to determine if surgical technique affects outcomes. A 71-item survey evaluating skin grafting techniques and preferences was emailed to members of the American Burn Association in July and August 2015. The survey was anonymous and voluntary. Relationships between variables were evaluated using Fisher's exact test. A P-value of ≤.05 was deemed statistically significant. The survey was sent to 607 burn surgeons, and the response rate was 24%. Clinical judgment is the most widely used method to determine depth of injury. Surgeons who practice in the United States and surgeons who are board certified in general surgery are more likely to determine depth of the burn based on clinical judgment alone (P < .001). Fifty-six percent of surgeons will perform excision as early as postburn day 1 and 73% will excise greater than 20% TBSA in one setting. Surgeons at centers with bed number of ≤10 (P = .024) or surgeons with board certification in plastic surgery (P = .008) are more likely to excise deep partial-thickness burns with an attempt to retain viable dermis. Geographic location, board certification, and burn unit size all contribute to variations in practice. Strong individual preferences make standardization of therapies challenging and may affect the success of new technologies. Burn surgery continues to be an art as much as a science, and accurate documentation of techniques and outcomes is essential for optimizing successes and documenting failures of new treatment methods.


Assuntos
Queimaduras/cirurgia , Competência Clínica , Transplante de Pele/normas , Cirurgia Plástica/normas , Inquéritos e Questionários , Adulto , Idoso , Atitude do Pessoal de Saúde , Queimaduras/diagnóstico , Estudos Transversais , Desbridamento/normas , Desbridamento/tendências , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/tendências , Qualidade da Assistência à Saúde , Transplante de Pele/tendências , Sociedades Médicas , Cirurgiões/normas , Cirurgiões/tendências , Cirurgia Plástica/tendências , Resultado do Tratamento , Estados Unidos
16.
Parasitol Res ; 115(1): 407-14, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26481486

RESUMO

Allograft rejection has been an obstacle for long-term survival of patients for many years. Current strategies for transplant rejection are not as optimal as we expected, especially for long-term treatments. Trichinella spiralis, a nematode parasitized in mammalian muscle and as an invader, maintains harmonious with host in the long term by evading host immune attack. To determine whether T. spiralis infection impacts on allograft rejection, we performed mice cardiac allograft transplantation model by using BALB/c (H-2(b)) mice as donors and C57BL/6 (H-2(b)) mice orally infected with 300 muscle larvae for 28 days as recipients. Graft survival was monitored by daily palpation of the abdomen; histologic change was observed by H&E stain; and CD4(+), CD8(+), CD4(+)IFN-γ(+), and CD4(+)IL-17(+) T cells and regulatory T cells were examined with the use of flow cytometry. Serum cytokine levels were measured by Luminex. Finally, we found that mean survival time of cardiac allografts in T. spiralis group was 23.40 ± 1.99 days, while the vehicle control group was 10.60 ± 0.75 days. Furthermore, we observed alleviated histological changes in the heart allograft, decreased corresponding CD8(+) T cells, suppressed Th1 and Th17 responses, and increased regulatory T cell frequency in a murine cardiac transplantation model at day 7 post-transplantation in experimental group. These data suggest that T. spiralis infection resulted in prolonged allograft survival following murine cardiac transplantation, with suppressed Th1/Th17 responses and augmented regulatory T cells.


Assuntos
Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto/fisiologia , Transplante de Coração/normas , Trichinella spiralis/fisiologia , Triquinelose/imunologia , Aloenxertos , Animais , Linfócitos T CD8-Positivos/imunologia , Citocinas/sangue , Citometria de Fluxo , Humanos , Interferon gama/imunologia , Interleucina-17/imunologia , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Transplante de Pele/normas , Linfócitos T Reguladores/imunologia , Células Th1/imunologia , Células Th17/imunologia , Fatores de Tempo , Transplante Heterotópico , Transplante Homólogo
17.
Rev. bras. cir. plást ; 29(1): 136-141, jan.-mar. 2014.
Artigo em Inglês, Português | LILACS | ID: biblio-105

RESUMO

Introdução: O sucesso de um enxerto de pele é avaliado não apenas pela integração do enxerto em si, mas também pela qualidade da recuperação da área doadora. A despeito de as áreas doadoras de enxertos representarem o melhor local para estudo de cicatrização de feridas, regimes de tratamento, de áreas doadoras, tem sido incompletamente estudados. Objetivo: Avaliação da eficácia de espumas de poliuretano como curativo de áreas doadoras de enxertos. Método: Estudo prospectivo no qual áreas doadoras de enxertos foram tratadas com espumas de poliuretano como alternativa a filmes de acetato de celulose. Resultados: Foram tratados 11 pacientes e catorze áreas doadoras de enxerto. Aderência prolongada (73%) e odor desagradável (45%) foram os problemas encontrados. Os resultados foram considerados insatisfatórios na grande maioria dos casos (73%). Conclusões: O uso de espumas de poliuretano mostrou-se ineficaz, nesse grupo de pacientes, devido à ocorrência de alto índice de complicações.


Introduction: The success of a skin graft is evaluated by not only the integration of the graft itself, but also the quality of the recovery of the donor site. Despite the fact that graft donor sites represent the best place to study wound healing, treatment regimens for donor sites have not been studied extensively. Method: To evaluate the efficiency of polyurethane foam as a dressing for graft donor sites. Methods: We conducted a prospective study in which graft donor sites were treated with polyurethane foam dressing, as an alternative to a cellulose acetate film. Results: We treated 11 patients and 14 donor graft sites. Problems associated with the use of polyurethane foam included prolonged adherence (73%) and an unpleasant odor (45%). The majority of patients reported that they found the dressing to be unsatisfactory (73%). Conclusions: The use of a polyurethane foam was shown to be ineffective as a graft donor site dressing, due to the high rate of associated complications.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , História do Século XXI , Poliuretanos , Complicações Pós-Operatórias , Pele , Bandagens , Cicatrização , Ferimentos e Lesões , Curativos Biológicos , Eficácia , Estudos Prospectivos , Transplante de Pele , Estudo de Avaliação , Procedimentos Cirúrgicos Dermatológicos , Poliuretanos/análise , Poliuretanos/uso terapêutico , Complicações Pós-Operatórias/cirurgia , Pele/anatomia & histologia , Bandagens/efeitos adversos , Bandagens/normas , Ferimentos e Lesões/cirurgia , Ferimentos e Lesões/terapia , Curativos Biológicos/efeitos adversos , Curativos Biológicos/normas , Eficácia/métodos , Transplante de Pele/efeitos adversos , Transplante de Pele/métodos , Transplante de Pele/normas , Procedimentos Cirúrgicos Dermatológicos/efeitos adversos , Procedimentos Cirúrgicos Dermatológicos/métodos
18.
Burns ; 38(6): 796-801, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22673119

RESUMO

BACKGROUND: The Patient and Observer Scar Assessment Scale (POSAS) is used to judge scars and involves patients and caregivers. Although the opinions of both are integrated, agreement between them is poorly investigated, especially in donor site scars (DSSs). Furthermore, it is unknown which POSAS-items are mostly associated with overall cosmetic satisfaction with the scar. METHODS: We included 106 DSS-patients. Twelve weeks after wound healing, patients and caregivers rated the DSS in vivo using the POSAS, comprising seven items. They were unaware of each other's judgment. Inter-observer reliability (IOR) was expressed as intra-class correlation coefficients (ICC). Items of the POSAS that best predicted patients' overall satisfaction were identified using multivariable regression analysis. RESULTS: Eleven caregivers from different medical centers judged the DSSs. IOR for the POSAS items was 'moderate' at best regarding the item 'overall opinion' (ICC 0.44; 95% confidence interval 0.27-0.58). IORs regarding other POSAS-items were 'poor'. Itching and relief best predicted patients' overall satisfaction (total variance explained, R(2)=0.174). For caregivers, pigmentation and pliability were most predictive (R(2)=0.318). CONCLUSION: Patients and caregivers appreciate different aspects of scar characteristics using the POSAS. This calls for shared decision-making, in which patient opinions are incorporated in the treatment choice.


Assuntos
Queimaduras/complicações , Cuidadores , Cicatriz/patologia , Satisfação do Paciente , Transplante de Pele/normas , Sítio Doador de Transplante/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cicatriz/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Variações Dependentes do Observador , Valor Preditivo dos Testes , Índice de Gravidade de Doença , Adulto Jovem
19.
Am Surg ; 78(2): 151-4, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22369820

RESUMO

The aesthetic goal in skin grafting is to provide a cosmetically pleasing coverage of soft tissue defects while minimizing donor site morbidity. A skin graft should blend well with the color and texture of the surrounding skin, reduce wound size, and not interfere with the function of the reconstructed part. This review examines the key components of choosing the appropriate donor skin for a variety of defects. The decision-making process is based on the anatomic location of the defect; donor site availability; and graft size, thickness, and pigmentation. The aesthetic implications of using a sheet graft versus a meshed graft versus an expanded graft are discussed. Aside from addressing the aesthetic needs of the defect, attention is paid to the functional goals of the reconstructed part and reduced donor site morbidity. Partial graft failure can have significant deleterious effects on the aesthetic outcome of skin grafts. The need for further grafting or healing by secondary intention may result in additional scarring and deformity. Recommendations for improvement in graft take and infection control are presented.


Assuntos
Cicatriz/prevenção & controle , Estética , Transplante de Pele/métodos , Retalhos Cirúrgicos/normas , Idoso , Humanos , Transplante de Pele/normas , Cicatrização
20.
World J Urol ; 30(5): 715-21, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21989815

RESUMO

OBJECTIVE: To evaluate the validity of a single-stage dorsal inlay for recurrent peno-glandular stenosis following previous endourological or open urethroplastic surgery. Urethral glanular reconstruction included a deep dorsal incision followed by complete scar excision to create a deep groove presenting well-vascularized recipient bed ensuring appropriate graft healing. MATERIALS AND METHODS: Between April 2002 and January 2008, a total of 34 patients (mean age 51.5 years, 14-85 years) were enrolled in the study. Congenital anomalies included hypospadia (n = 19, 53%) and epispadia (n = 2, 6%). Condition of strictures was either iatrogenic (n = 7), due to infection (n = 5), or traumatic (n = 1). Foreskin grafts were used in 13 cases, foreskin and buccal mucosa in one case, penile skin in 6 cases, and inguinal skin/thigh (harvested by electrodermatom) in 14 cases. The combination of meticulous scar excision with a deep incision of the glans was used to provide a well-vascularized grafting bed, thus ensuring excellent graft healing. The outcome analysis included urinary flow, urethral calibration >18 ch, voiding cystometry, and patient's satisfaction in a follow-up regime every 3 months. RESULTS: The average graft length was 4.7 cm (median 8, range 1.5-14). Mean follow-up was 70 months. In 31 patients (91%), no recurrent glanular stenosis was observed resulting in a post-operative flow of average 26.2 ml/s (11-53). Three post-operative wound infections occurred resulting in stricture recurrence, which was treated with internal urethrotomy, buccal mucosa, or penile skin inlay, respectively. Cosmetic results were satisfactory in all patients. Post-operative voiding parameters were significantly improved (P < 0.001). CONCLUSION: The single-stage dorsal inlay for reconstruction of peno-glandular stenosis represents a reliable method even if the urethral plate is severely scarred or has been excised during previous surgery. The good results imply that a well-vascularized graft and the technical approach seem to be more important than the substitute material.


Assuntos
Hipospadia/cirurgia , Doenças do Pênis/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Procedimentos Cirúrgicos Reconstrutivos/normas , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Constrição Patológica/cirurgia , Seguimentos , Humanos , Hipospadia/patologia , Masculino , Pessoa de Meia-Idade , Recidiva , Reoperação/métodos , Reoperação/normas , Transplante de Pele/métodos , Transplante de Pele/normas , Uretra/anormalidades , Adulto Jovem
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