RESUMO
BACKGROUND: Altered amygdala activation to fear-related stimuli has been proposed to be a potential neural correlate of heightened threat sensitivity in anxiety- and stress-related disorders. However, the role of stimulus awareness and disorder specificity remains widely unclear. Here we investigated amygdala responses to conscious and unconscious fearful faces in patients suffering from panic disorder (PD), generalized anxiety disorder (GAD), or post-traumatic stress disorder (PTSD) and in a large sample of healthy controls (HC). METHODS: During event-related functional magnetic resonance imaging participants (n = 120; 20 PD, 20 GAD, 20 PTSD, 60 HC) were confronted with briefly presented fearful faces, neutral faces, and non-faces in a backward masking paradigm. The design allowed for the analysis of trial-by-trial face detection performance and amygdala responses to fearful v. neutral faces. RESULTS: All participants exhibited increased amygdala activation to fearful v. neutral faces during conscious trials. Specifically during unconscious face processing, the PTSD, compared with all other groups, showed higher right basolateral (BLA) amygdala activity to fearful v. neutral faces. CONCLUSIONS: The present study shows that BLA amygdala hyperactivity during unconscious, but not conscious, processing of fearful faces differentiates PTSD from the investigated disorders. This finding suggests an automatic and specific neural hyper-responsivity to general fear cues in PTSD and supports the idea of categorical differences between PTSD and other anxiety-related disorders.
Assuntos
Tonsila do Cerebelo/fisiopatologia , Transtornos de Ansiedade/fisiopatologia , Medo/fisiologia , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Adolescente , Adulto , Estudos de Casos e Controles , Sinais (Psicologia) , Expressão Facial , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Transtorno de Pânico/fisiopatologia , Tempo de Reação , Análise de Regressão , Adulto JovemRESUMO
BACKGROUND: There is an ongoing debate whether transdiagnostic neural mechanisms are shared by different anxiety-related disorders or whether different disorders show distinct neural correlates. To investigate this issue, studies controlling for design and stimuli across multiple anxiety-related disorders are needed. METHOD: The present functional magnetic resonance imaging study investigated neural correlates of visual disorder-related threat processing across unmedicated patients suffering from panic disorder (n = 20), social anxiety disorder (n = 20), dental phobia (n = 16) and post-traumatic stress disorder (n = 11) relative to healthy controls (HC; n = 67). Each patient group and the corresponding HC group saw a tailor-made picture set with 50 disorder-related and 50 neutral scenes. RESULTS: Across all patients, increased activation to disorder-related v. neutral scenes was found in subregions of the bilateral amygdala. In addition, activation of the lateral amygdala to disorder-related v. neutral scenes correlated positively with subjective anxiety ratings of scenes across patients. Furthermore, whole-brain analysis revealed increased responses to disorder-related threat across the four disorders in middle, medial and superior frontal regions, (para-)limbic regions, such as the insula and thalamus, as well as in the brainstem and occipital lobe. We found no disorder-specific brain responses. CONCLUSIONS: The results suggest that pathologically heightened lateral amygdala activation is linked to experienced anxiety across anxiety disorders and trauma- and stressor-related disorders. Furthermore, the transdiagnostically shared activation network points to a common neural basis of abnormal responses to disorder-related threat stimuli across the four investigated disorders.
Assuntos
Tonsila do Cerebelo/fisiopatologia , Encéfalo/fisiopatologia , Ansiedade ao Tratamento Odontológico/fisiopatologia , Medo/fisiologia , Transtorno de Pânico/fisiopatologia , Fobia Social/fisiopatologia , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Adulto , Tonsila do Cerebelo/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Ansiedade ao Tratamento Odontológico/diagnóstico por imagem , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Transtorno de Pânico/diagnóstico por imagem , Fobia Social/diagnóstico por imagem , Transtornos de Estresse Pós-Traumáticos/diagnóstico por imagem , Percepção Visual/fisiologia , Adulto JovemRESUMO
Interpersonal violence (IPV) is one of the most frequent causes for the development of posttraumatic stress disorder (PTSD) in women. One key component in PTSD is altered processing of trauma-related cues, leading to emotional symptoms. In the everyday environment, words with trauma-associated semantic content represent typical, albeit abstract, trauma-related stimuli for patients suffering from PTSD. However, the functional neuroanatomy associated with processing single trauma-related words in IPV-PTSD is not understood. The present event-related functional magnetic resonance imaging study investigated the neural basis of trauma-related word processing in women with IPV-PTSD relative to healthy controls (HC) during a non-emotional vigilance task in which the emotional content of the words was task-irrelevant. On the behavioral level, trauma-related relative to neutral word stimuli evoked more unpleasant feelings, higher arousal as well as anxiety in IPV-PTSD patients as compared to HC. Functional imaging data showed hyperactivation to trauma-related versus neutral words in the basolateral amygdala (BLA) and cortical language-processing regions (inferior frontal gyrus, posterior cingulate cortex, angular/supramarginal gyrus) in IPV-PTSD compared to HC. These results propose a role of the BLA in hypervigilant responding to verbal trauma associated cues in IPV-PTSD. Furthermore, the particular involvement of cortical language-processing regions indicates enhanced processing of trauma-related words in brain regions associated with analysis and memory of verbal material. Taken together, our findings suggest that both subcortical and cortical mechanisms contribute to automatic responsivity to verbal trauma cues in PTSD.
Assuntos
Complexo Nuclear Basolateral da Amígdala/fisiopatologia , Córtex Cerebral/fisiopatologia , Neuroimagem Funcional/métodos , Violência por Parceiro Íntimo , Idioma , Transtornos de Estresse Pós-Traumáticos/fisiopatologia , Adulto , Feminino , Humanos , Imageamento por Ressonância MagnéticaRESUMO
Until the end of the 1990's it was thought that hormone therapy has a lot of positive health effects and should be prescribed for nearly all women. Recently conducted studies have shown that menopausal hormone therapy has a higher health risk especially for breast cancer and cardiovascular disease. In this study we investigated to what extent hormone therapy changes could be identified during the past years. We therefore analysed data of a German health insurance (Gmünder ErsatzKasse=GEK) from 2001-2005. It was shown, that studies and recommendations, as well as statements of different German institutions, which were published during this period lead to an important decrease in respect of hormone therapy prevalence. It seems that the most important impact of this topic came from the results of the Women's Health Initiative study (WHI) and the followed controversial discussion in Germany. In respect of the individual five years age groups the changes were very different and for the older women especially there were no decreases detectable. It must be expected that frequently the diagnoses of Osteoporosis results in a treatment of hormone therapy over a long period and that the recommendations and statements (as mentioned above) are not implemented sufficiently. Therefore, it is necessary to conduct an evidence based hormone therapy treatment in the practitioners daily work, to keep health risks low. Furthermore, physicians should be more engaged to show their patients alternatives instead of hormone therapy. They should also advise and support their treated patients how to quit hormone therapy.
Assuntos
Prescrições de Medicamentos/estatística & dados numéricos , Revisão de Uso de Medicamentos , Terapia de Reposição de Estrogênios/estatística & dados numéricos , Programas Nacionais de Saúde/estatística & dados numéricos , Publicações Periódicas como Assunto/estatística & dados numéricos , Adulto , Idoso , Feminino , Alemanha , Humanos , Pessoa de Meia-Idade , Estatística como AssuntoRESUMO
Body contouring surgery is traditionally part of plastic surgery training. Reconstructive techniques are needed most in trauma cases, tumor reconstructions, treatment of degenerative diseases and metabolic diseases such as Madelung's deformity, body contouring after massive weight loss, and all aesthetic plastic surgery. With various surgical techniques, liposuction became an important option in the overall treatment plan. Body contouring surgery in the massive weight loss patient is a rapidly expanding field of plastic surgery. Its challenge is the management of excess skin remaining after bariatric surgery. To achieve an aesthetic body contour, patients must accept numerous long scars. They must understand that recurrent laxity and scar migration is not necessarily a failure of the operation but rather an expected outcome. Body contouring surgery is challenging, time-consuming, and not without complications. The patient population has very real aesthetic and appearance concerns that must be addressed in an effective, definite, and safe manner.
Assuntos
Cirurgia Bariátrica , Complicações Pós-Operatórias/cirurgia , Cirurgia Plástica/métodos , Redução de Peso , Parede Abdominal/cirurgia , Cútis Laxa/etiologia , Cútis Laxa/cirurgia , Humanos , Lipectomia/métodos , Complicações Pós-Operatórias/etiologia , Fatores de Risco , Transtornos Somatoformes , Resultado do TratamentoRESUMO
The demand for a younger appearance is increasing as the average age of the population increases. Extensive anatomic studies in recent years have improved for facial and breast reconstruction the understanding of anatomic structures and the basis of the aging process. Numerous new surgical techniques have resulted. This understanding of the anatomy of aging and the diversity of surgical methods have made the attainment of naturally young facial appearance more easily possible, in which repositioning of the tissue plays a more important role than lifting. In the past, plastic surgery of the eyelids aimed primarily at hiding the aging process, not at true anatomic restoration. Modern techniques in this field aim more toward redistribution of fatty tissues and the anatomic restoration of aging structures. In this way long-term results are stabilized and secondary stigmata can be avoided. New concepts have also been established in breast surgery that allow more natural results, particularly in augmentation. Although no single method may be designated as superior, there still exists an optimal technique suited to every patient's anatomy and personal wishes.
Assuntos
Blefaroplastia/métodos , Implantes de Mama , Estética , Mamoplastia/métodos , Ritidoplastia/métodos , Tecido Adiposo/transplante , Humanos , Mamilos/cirurgia , Desenho de Prótese , Envelhecimento da Pele/fisiologia , Técnicas de SuturaRESUMO
PURPOSE: Complex defects of the forearm and hand often require microvascular reconstruction with composite osteocutaneous free flaps for limb salvage. Here, a postoperative outcome analysis of 15 patients is presented, who were treated by free composite tissue transplantation between 1992 and 2004 in a single institution. PATIENTS AND METHODS: The assessment focused on the range of motion, the pain and grip strength as well as on the patient's individual physical functioning and self perception, measured with the DASH questionnaire. Additionally complications, return to work and the donor site morbidity were documented. RESULTS: Reasons for the combined defects were trauma, infections or malignant tumors. The patients' average age was 38 years. The average osseous defect was 11.7 cm (range, 6 to 21 cm), all patients suffered from additional soft tissue defects. Microvascular osteoseptocutaneous fibula transplantations (n = 8), osteocutaneous scapular or parascapular flaps (n = 6) and osteocutaneous lateral arm flaps were performed for reconstruction. The mean hospitalisation time was 39.3 days (range, 18 - 73 d). All defects could be reconstructed in a one-step reconstructive procedure after sequential debridements or after radical tumour resection. Two patients developed a pseudarthrosis, one had to undergo an ablation procedure due to persistent infection; however, the flap was well perfused. Every patient had a markedly reduced hand function compared with the unaffected extremity, however the functional results were satisfactory with a mean DASH score of 25.3 (range, 0 to 42). This reflects only a moderate disability in activities of daily living. From the patients' point of view the functional results were more than acceptable when the potential alternatives were taken into consideration. This was also reflected by a high individual satisfaction. CONCLUSION: This retrospective analysis demonstrates that limb salvage with osteocutaneous free flaps is an important tool in the armamentarium for the treatment of composite defects in the forearm and hand. Functional results are good and the patient's high individual satisfaction justifies the use of these difficult reconstructive procedures.
Assuntos
Transplante Ósseo , Antebraço/cirurgia , Mãos/cirurgia , Microcirurgia , Retalhos Cirúrgicos , Atividades Cotidianas , Adolescente , Adulto , Infecções Bacterianas/cirurgia , Neoplasias Ósseas/cirurgia , Feminino , Seguimentos , Traumatismos do Antebraço/cirurgia , Fixação Interna de Fraturas , Traumatismos da Mão/cirurgia , Força da Mão , Humanos , Salvamento de Membro , Masculino , Pessoa de Meia-Idade , Medição da Dor , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Amplitude de Movimento Articular , Neoplasias de Tecidos Moles/cirurgiaRESUMO
Distally based DMCA flaps are an established procedure for soft tissue reconstruction in the hand. Since the introduction of the DMCA flaps, several variants have been developed to match specific defect requirements. The aim of this retrospective study is to give an overview of the experience with the DMCA flaps based on a single center's experience. 41 distally based DMCA flaps have been performed from 2000 to 2004. Twenty-nine times a distally based DMCA flap has been performed, nine times the extended distally based DMCA flap and three times a distally based DMCA fascial flap. In summary, 34 flaps showed no complications, five had a partial necrosis, but were successfully treated with split-thickness skin graft, and two flaps were lost due to infections. The distally based DMCA flaps II to IV have proven to be reliable flaps, but nevertheless require sufficient surgical experience. They are suitable for any kind of defects, including burn reconstruction. Defects of the entire finger can be covered by the various variants of the DMCA flaps.
Assuntos
Queimaduras/cirurgia , Traumatismos dos Dedos/cirurgia , Traumatismos da Mão/cirurgia , Microcirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Adolescente , Adulto , Idoso , Anastomose Cirúrgica , Artérias/cirurgia , Criança , Pré-Escolar , Desbridamento , Feminino , Sobrevivência de Enxerto/fisiologia , Humanos , Masculino , Ossos Metacarpais/irrigação sanguínea , Pessoa de Meia-Idade , Necrose/cirurgia , Complicações Pós-Operatórias/cirurgia , Reoperação , Transplante de Pele , Cicatrização/fisiologiaRESUMO
PURPOSE: Coverage of exposed functional structures such as tendons, bones, vessels or nerves at the dorsal and palmar surface of the hand requires thin, supple tissue to provide adequate range of motion and a satisfying aesthetic result. Free fascial flaps are possible alternatives to cutaneous, fasciocutaneous and muscle flaps. The purpose of this retrospective study was to evaluate the functional and aesthetic results after coverage of the hand with free serratus fascial flaps in our department. METHOD AND CLINICAL MATERIAL: From 1994 to 2002, ten patients underwent free fascial flap coverage of the hand with eleven serratus fascial flaps. Six patients could be re-examined and answered a questionnaire about their satisfaction with the functional and aesthetic results. The mean follow-up was after 34 months. RESULTS: Average active range of motion of the hand, functional improvement and the aesthetic result were satisfying in all follow-up patients. No secondary debulking or other contouring procedures were required. CONCLUSION: We recommend the use of free serratus fascial flaps as a valuable alternative to fasciocutaneous or muscle flaps since the functional results are excellent; no additional procedures were necessary and the aesthetical results are appealing.
Assuntos
Queimaduras/cirurgia , Traumatismos da Mão/cirurgia , Microcirurgia/métodos , Complicações Pós-Operatórias/etiologia , Retalhos Cirúrgicos/irrigação sanguínea , Adulto , Estética , Feminino , Sobrevivência de Enxerto/fisiologia , Mãos/irrigação sanguínea , Força da Mão/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Destreza Motora/fisiologia , Terapia Ocupacional , Medição da Dor , Satisfação do Paciente , Modalidades de Fisioterapia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/reabilitação , Reoperação , Estudos RetrospectivosRESUMO
Quality of life (QoL) can be assessed in an accurate, valid and reliable way by means of standardized QoL questionnaires and is an important endpoint in clinical trials today. The aim of this study is to implement quality of life as a diagnostic tool for problem-oriented follow-up care of cancer patients. This is done in the framework of an intervention study in the area of regional health care research using qualitative analysis and the methodological concept of barrier analysis. We developed the diagnostic tool by generating individual, graphic QoL profiles based on patients' responses to the EORTC QLQ-C30 and the corresponding disease-specific modules BR23 for breast cancer and CR38 for rectal cancer. The clinical application is investigated by assessing physicians' responses. The QoL profile is judged as a useful diagnostic tool by all participating physicians. It enables physicians to assess the QoL of the patient and incorporate the knowledge they gain in their daily practice. Especially in breast cancer follow-up care QoL profiles give added value to both patients and doctors. The next implementation steps have to extend the concept of QoL to larger groups of patients and physicians by overcoming the restraining factors as identified in the barrier analysis.
RESUMO
BACKGROUND: There are limited reconstructive options for the treatment of segmental bone defects of the upper extremity that are >6 cm in length, especially those that are associated with soft-tissue defects. The purpose of the present review was to report on our experience with fifteen patients who received an osteoseptocutaneous fibular transplant for reconstruction of a humeral defect. METHODS: The study cohort included eight male patients and seven female patients with an average age of forty-one years. The indications for the procedure included segmental nonunion (nine patients), a gunshot wound (three), a defect at the site of a tumor resection (two), and failure of an allograft-prosthesis reconstruction (one). The fibular graft was fixed by means of intramedullary impaction in eleven patients, was used as an onlay graft in three, and was used as a strut between the intact diaphysis and the humeral head in one. RESULTS: The average length of the segmental humeral defect was 9.3 cm. The average length of the fibular graft was 16.1 cm, and the average length and width of the skin paddle were 8.1 and 4.5 cm. The average duration of follow-up was twenty-four months. Three patients had venous thrombosis and underwent a successful revision of the anastomosis. Four patients had early failure of graft fixation. Three patients had a fracture of the fibular graft within the first year postoperatively. All but one of these latter seven patients were successfully treated with open reduction, internal fixation, and additional bone-grafting. One patient with an infection at the site of a nonunion and signs of graft resorption required a second fibular transplant. CONCLUSIONS: The osteoseptocutaneous fibular transplant is an effective treatment for combined segmental osseous and soft-tissue defects of the arm. However, the application of this technique to the arm is more complex than application to the forearm and is associated with a higher rate of complications.
Assuntos
Fíbula/transplante , Úmero/cirurgia , Transplante de Pele , Adolescente , Adulto , Idoso , Criança , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Doxorubicin and epirubicin are strong antineoplastic agents widely used in chemotherapy. One major complication of their use is skin sloughing after subcutaneous extravasation, the degree of which is often underestimated. Both drugs have a tendency to produce liquefying necrosis in soft tissue and chronic ulcers if extravasation occurs. Three cases of extravasation, their surgical treatment and final results are presented. In cases of doxorubicin and epirubicin extravasation it is very important to perform an early extensive surgical débridement with delayed closure to avoid long hospitalization and disabling results.
Assuntos
Antibióticos Antineoplásicos/efeitos adversos , Antineoplásicos/efeitos adversos , Doxorrubicina/efeitos adversos , Epirubicina/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/complicações , Dermatopatias/cirurgia , Transplante de Pele , Idoso , Antibióticos Antineoplásicos/administração & dosagem , Antineoplásicos/administração & dosagem , Desbridamento , Procedimentos Cirúrgicos Dermatológicos , Doxorrubicina/administração & dosagem , Epirubicina/administração & dosagem , Feminino , Humanos , Injeções Intravenosas/efeitos adversos , Masculino , Pessoa de Meia-Idade , Necrose , Pele/efeitos dos fármacos , Pele/patologia , Dermatopatias/induzido quimicamente , Úlcera Cutânea/induzido quimicamente , Úlcera Cutânea/cirurgiaRESUMO
The purpose of this retrospective study was to evaluate the clinical outcome of distraction lengthening of the thumb metacarpal without bone grafting in seven patients with traumatic thumb loss. The distraction was stopped after 57 (range, 42 to 91) days, giving a median lengthening of 28 (range, 20-36)mm. It took an average of 155 (range, 118-196) days for bony consolidation to occur. The mean pinch power was 72% of that of the uninjured hand. The two-point discrimination on the pulp of the reconstructed thumb was 10 (range, 8-12)mm. There were no major complications.
Assuntos
Metacarpo/cirurgia , Osteogênese por Distração , Polegar/cirurgia , Adulto , Feminino , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
INTRODUCTION: The "Foucher" flap is a pedicled neurovascular island flap of the first dorsal metacarpal artery. METHODS: From 1992 to 2000, thirty-three neurocutaneous island flaps from the dorsal aspect of the index finger (FDMCA flap) were performed for defect coverage and reconstruction of sensibility in the thumb. RESULTS: Static 2-PD over the flap area averaged 10.8 mm (range 4-15), compared to 8.2 mm (4-15) over the dorsal aspect of the contralateral index finger. Response to the SW monofilaments showed no difference to normal skin or only diminished light touch in 76% (19/25) patients. Seventy-six percent (19/25) were able to return to their previous jobs or resume previous activities. CONCLUSION: Based on negligible donor site morbidity of the flap and the good sensate quality and aesthetic appearance, the Foucher flap has become our first choice in defect coverage and restoration of sensibility of the thumb.
Assuntos
Retalhos Cirúrgicos , Polegar/cirurgia , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Interpretação Estatística de Dados , Estética , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos de Cirurgia Plástica , Polegar/lesões , Fatores de Tempo , Resultado do TratamentoRESUMO
The gastrointestinal tuberculosis is a rare disease and it can mimic a large variety of gastrointestinal diseases. The most common site of gastrointestinal tuberculosis is the ileocoecal region followed by the ascending colon and jejunum. Complications are an absolute indication for surgical intervention. Perforation is an extremely uncommon complication of mycobacterium tuberculosis infection.
Assuntos
Doenças do Íleo/cirurgia , Perfuração Intestinal/cirurgia , Tuberculose Gastrointestinal/cirurgia , Adulto , Diagnóstico Diferencial , Humanos , Doenças do Íleo/patologia , Íleo/patologia , Íleo/cirurgia , Mucosa Intestinal/patologia , Perfuração Intestinal/patologia , Masculino , Tuberculose Gastrointestinal/patologiaRESUMO
INTRODUCTION: Necrotizing fasciitis (NF) is a rapidly progressive soft tissue infection involving primarily the superficial fascia and subcutaneous tissue. The disease is caused by Streptococcus pyogenes or synergistic infection of anaerobic and facultative anaerobic bacteria. Further characteristics are severe, intolerable pain and a mortality of 30-50%. PATIENTS AND METHODS: From January 1996 to January 2000 12 patients underwent treatment for NF. The patients' charts were investigated retrospectively. RESULTS: In 7 patients the bacterial cultures showed a mixed, polymicrobial infection and in 5 cases only Streptococcus pyogenes. The NF was localized at the upper extremity (2), abdomen (3), back (1), hip (2) and lower extremity (4). The area involved was 8 (4-11)% of the total body surface. The surgical procedures in 12 patients were debridement (60x), local transposition flap (2), free muscle flaps (3), lower leg amputation (1) and split thickness skin graft (3x). Four patients developed streptococcal toxic shock syndrome and two died. In total there were four deaths with a mortality of 33%. In the "survivor group" the time to diagnosis was 2.8 (1-7) days, the time to radical surgery 3.3 (1-9) days. In the "mortality group" it was 6.8 (3-10) days or 9.3 (6-12) days. CONCLUSION: The prognosis of NF seems to be influenced by the site of the infection, because 4 out of 6 patients with NF of the abdomen, back or hip died, but all patients with NF of the extremities survived. The age of the patient is not a key parameter, because also young and previously healthy people also die from the streptococcal toxic shock syndrome. The interval between diagnosis and radical debridement appears to be the crucial factor in terms of prognosis, since early diagnosis and prompt, radical surgery improves the survival rate.
Assuntos
Fasciite Necrosante/cirurgia , Choque Séptico/etiologia , Adulto , Idoso , Desbridamento , Diagnóstico Diferencial , Fasciite Necrosante/complicações , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/mortalidade , Feminino , Humanos , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Choque Séptico/diagnóstico , Choque Séptico/mortalidade , Transplante de Pele , Retalhos Cirúrgicos , Fatores de Tempo , Resultado do TratamentoRESUMO
Since its introduction by Taylor in 1975, microvascular free fibula transfer has become the gold standard in osseous reconstructions requiring vascularized bone transfer. Various modifications of the free fibula have been described in the literature. We reviewed a series of 76 free vascularized fibula transfers during a 7-year period. Data was retrospectively analyzed with respect to type of procedure and outcome, general surgical complications, and flap-related (specific) complications. Of all 76 free fibula flaps, 47 cases healed uneventfully (62%). Interestingly, 53% of all extremity reconstruction cases had at least one of the above complications, whereas in maxillofacial cases the complication rate was only 25%. Complete osseous consolidation at the time of evaluation was confirmed in 58 patients (76%). Complete flap failure occurred in four patients (5%). The complication rates reflect the complexity of the procedures and appear strongly related to the underlying disease and predisposing medical risk factors. Time will tell if advances, e.g., in the field of tissue engineering, will eventually replace autologous vascularized bone transfer.
Assuntos
Fíbula/transplante , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Traumatismos do Braço/cirurgia , Carcinoma de Células Escamosas/cirurgia , Feminino , Seguimentos , Tumores de Células Gigantes/cirurgia , Humanos , Traumatismos da Perna/cirurgia , Masculino , Traumatismos Mandibulares/cirurgia , Neoplasias Mandibulares/cirurgia , Pessoa de Meia-Idade , Osteíte/cirurgia , Osteossarcoma/cirurgia , Complicações Pós-Operatórias , Pseudoartrose/cirurgia , Reoperação , Estudos Retrospectivos , Fatores de Risco , Traumatismos da Coluna Vertebral/cirurgia , Retalhos Cirúrgicos , Fatores de Tempo , Resultado do Tratamento , Ferimentos por Arma de Fogo/cirurgiaRESUMO
This article reviews the recent evolution of perforator flaps. The tie between perforator flaps and skin flaps as well as perforator flaps and musculocutaneous flaps is explained. The paraumbilical perforator flap, the deep inferior epigastric artery flap (DIEP flap), the gluteal artery perforator flap (GAP flap) and various perforator flaps and perforator-based flaps are described in combination with the review of the relevant literature. As a prospect into the future, the technique of "supra-microsurgery" is presented.
Assuntos
Microcirurgia/métodos , Retalhos Cirúrgicos/irrigação sanguínea , Artérias/cirurgia , Humanos , Coleta de Tecidos e Órgãos/métodosRESUMO
PURPOSE/BACKGROUND: Distal and proximal pedicled forearm flaps that are nourished by radial perforator vessels have been described. These flaps spare the radial artery during flap harvest. The question is, whether it is possible to raise individual free fasciocutaneous radial perforator flaps. METHOD AND MATERIAL: The number, external vessel diameter, and distribution of fasciocutaneous radial perforator vessels were investigated on 20 fresh cadaver arms. All specimen were then treated with the Spalteholz technique to demonstrate the arborizing of the perforator vessels. RESULTS: There was an average of 12 (range 9 to 16) fasciocutaneous perforator vessels per radial artery. The most proximal perforator vessel had an external diameter of 0.8 (range 0.5 to 1.0) mm, the others were measured smaller then 0.5 mm. There was a rich network of anastomoses at the level of the fascia up to the level of the subdermal plexus. CONCLUSIONS: The anatomic basis of the proximally and distally based radial perforator flaps was confirmed. Free flaps based exclusively on fasciocutaneous radial perforators would require supra-microsurgical skills due to the small vessel diameter. For practical reason it seems to be advisable to include parts of the radial artery into such a flap design.
Assuntos
Artéria Radial/anatomia & histologia , Retalhos Cirúrgicos/irrigação sanguínea , Humanos , Microcirculação/anatomia & histologia , Microcirurgia/métodos , Valores de ReferênciaRESUMO
PURPOSE: Patients with persistent peroneal palsy may require treatment for gait disturbances if conservative treatment is not tolerated. Transfer of the tibialis posterior tendon can restore foot extension and improve the patients gait pattern. PATIENTS AND METHODS: Retrospective analysis (mean follow-up 40.8 months) of 13 patients. (7â, 6â; 1998-2005) after tibialis posterior tendon transfer through the interosseous membrane to the tibialis anterior and peroneus longus tendons. Evaluation focussed on hospitalisation periods, perioperative morbidity, functional outcome (range of motion, strength, pain and gait), return to work rate and self assessment with the Funktionsfragebogen Hannover (FFbH). RESULTS: 7 iatrogenic, 5 posttraumatic and 1 congenital peroneal palsy were treated. The patients presented after an average of 8.3 months (hospitalisation 11 days). Perioperative morbidity was 38.4% (15.4% reoperation rate). The mean active range of motion of the ankle was 3°/0°/56° (extension/flexion), the average strength was 3 (MRC) and pain was 4 (visual analogue scale 1-10). 12 patients were evaluated with normal or improved gait pattern without ortheses. The mean FFbH score was 70.9%. CONCLUSION: If conservative treatment for peroneal palsy fails to improve functional outcome tendon transfers such as the tibialis posterior tendon transfer are a considerable treatment option. However, significant morbidity rates have to be anticipated. Consecutive patients should be referred in good time to specialised units.