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1.
J Craniofac Surg ; 33(3): e320-e322, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-35727660

RESUMO

ABSTRACT: Composite full-thickness nasal defects that include adjacent facial units still remain a challenge for reconstructive surgeons. The commonly used auricular free flap (AFF) might not be sufficient for full coverage of a defect, and radial forearm free flap (RFFF) lacks the rigid component for nasal framework. Therefore, the authors present a chimeric flap combined of both AFF and RFFF for the reconstruction of extended nasal defects. Auricular free flap enables the restoration of the exact contour of nose, and it preserves similar texture and color of the skin. Moreover, its harvesting results in minimal deformity of donor site. Radial forearm free flap gives the possibility of covering extensive defects of the facial units thanks to its elasticity and long vascular pedicle. The combination of both flaps seems to be an optimal solution for the reconstruction of extended nasal defects, giving satisfactory aesthetic results. Also, it might not require any further corrections, remaining a one-stage procedure.


Assuntos
Antebraço/cirurgia , Retalhos de Tecido Biológico , Nariz/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Rinoplastia/métodos , Humanos , Nariz/irrigação sanguínea , Procedimentos de Cirurgia Plástica/normas
2.
J Craniofac Surg ; 33(6): 1655-1658, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34907952

RESUMO

ABSTRACT: The restoration of large full-thickness lip defects still remains a formidable challenge for the reconstructive surgeons. Traumatic injuries, infections and tumors (primarily squamous cell carcinoma) are the most common source of the lip defects. Lower lips are more important in providing oral competence, unfortunately throughout the life-time they are significantly more exposed to ultraviolet radiation and thus are the most common site for the lip cancers (89%). This type of defect requires a complex reconstruction of an adequate sphincter function, defined vermilion, proper oral lining and sufficient mouth opening. To maintain the oral competence, it is of paramount importance to restore the function of orbicularis oris, which principally composes the body of the lip. Currently, the dynamic reconstructions are gaining considerable interest. They enables not only improvement of appearance but also a restoration of function and preservation of health-related quality of life. The use of the free gracilis muscle transfer to reconstruct the lower lip and its dynamic character in contrast to other, static reconstructions can provide the sufficient movement of the lower lip, which does not depend on function of other mimic muscles as it becomes an independent motor unit with its own neurotization. In our opinion the free functioning gracilis muscle flap, due to its anatomic and functional features as well as low-rate donor-site morbidity is the worth considering option for a lower lip reconstruction.


Assuntos
Músculo Grácil , Neoplasias Labiais , Procedimentos de Cirurgia Plástica , Músculo Grácil/cirurgia , Humanos , Lábio/cirurgia , Neoplasias Labiais/cirurgia , Qualidade de Vida , Raios Ultravioleta
3.
J Craniofac Surg ; 33(7): 1962-1970, 2022 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-35175985

RESUMO

ABSTRACT: Ameloblastoma (AM) is the most common, locally aggressive odontogenic tumor. It comprises about 1% of all head and neck neoplasms. It occurs mainly in young adults in their 3rd and 4th decade of life. It localizes in the mandible in about 80% of the cases. According to the 2017 WHO classification, 4 types of ameloblastoma can be distinguished: ameloblastoma (previously referred to as solid/multicystic-SMA; the "conventional type" AM), unicystic (AM-UA), extraosseous/peripheral (AM-PA), and malignant/metastatic (AM-MA). Solid, multicystic is the most common type. It is characteristic for its aggressiveness and high risk of recurrence. Radical resection with consecutive reconstruction is the treatment of choice of mandibular ameloblastomas.In this study, the authors present their experience in the surgical treatment of mandibular ameloblastomas with vascularized free flap reconstructions. They discuss new technological possibilities that could improve the precision of the reconstructive procedure and therefore result in the better aesthetic outcome.The retrospective study of a group of 21 patients suffering from mandibular ameloblastoma who underwent segmental man-dibulectomy with simultaneous microvascular free flap reconstruction was conducted. A thorough clinical analysis with various aspects was performed. Tumors resected before 2017 were double checked patomorphologically and assigned to the corrected subtype group.Seven patients were admitted to the department due to recurrent ameloblastoma. The most common localization of the tumor was the mandibular body ( n = 6) andbodywith ramus of the mandible ( n = 6). A total amount of 10 iliac crest free flaps and 12 fibular free flaps were performed. Complications were reported in 4 patients. A purulent oro-cutaneus fistula occurred in 3 patients. There was a flap failure in each reconstructive group. The virtual surgical planning with intraoperative cone-beam computed tomography was used in 3 patients. Dentition implantation was conducted in 4 patients (3 simultaneously, 1 postponed). The mean follow-up was 5 years and 8 months.Radical resection that covers radical segmental mandibulect-omy with immediate microvascular free flap reconstruction is a first-line and only effective treatment of mandibular ameloblas-tomas, that eliminates the risk of recurrence. The extent of surgical margins seems not to influence the recurrence rate, yet further investigation with statistical analysis should be performed. The choice of the adequate free flap must be adapted to dimensions and localization of the tumor and to each patient individually.New technologies such as virtual surgical planning with 3D models and intraoperative cone-beam computed tomography can make the reconstruction more accurate, improving patient's quality of life.


Assuntos
Ameloblastoma , Retalhos de Tecido Biológico , Neoplasias Mandibulares , Reconstrução Mandibular , Procedimentos de Cirurgia Plástica , Ameloblastoma/diagnóstico por imagem , Ameloblastoma/patologia , Ameloblastoma/cirurgia , Transplante Ósseo/métodos , Estética Dentária , Fíbula/cirurgia , Retalhos de Tecido Biológico/cirurgia , Humanos , Masculino , Mandíbula/cirurgia , Neoplasias Mandibulares/patologia , Neoplasias Mandibulares/cirurgia , Reconstrução Mandibular/métodos , Qualidade de Vida , Procedimentos de Cirurgia Plástica/métodos , Estudos Retrospectivos , Adulto Jovem
4.
J Craniofac Surg ; 32(5): e517-e519, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33770027

RESUMO

ABSTRACT: The main scope of the kiss flap technique is to harvest double-skin paddle flaps, narrower than those harvested in a standard manner and rearrange them side-by-side ("kissing") in order to match the exact size and contour of the defect. Apart from the possibility of custom-designing the desired shape of soft tissue coverage, the kiss technique enables tension-free direct closure of the donor site, reducing its morbidity and improving aesthetic appearance. In this paper, two patients with severe scalp defects after cancer resections are presented. Due to poor elasticity of surrounding tissues, complexity of composite defect together with extensive range of resection: the kiss technique was applied to the anterolateral thigh flap in both cases. Possibility of implementing the described method in almost all perforator-based flaps is encouraging. Although, prolonged operating time, the necessity of meticulous preoperative perforator mapping as well as extended surgical dissection should be taken into consideration when planning kiss flaps.


Assuntos
Retalho Perfurante , Procedimentos de Cirurgia Plástica , Lesões dos Tecidos Moles , Humanos , Couro Cabeludo/cirurgia , Lesões dos Tecidos Moles/cirurgia , Coxa da Perna/cirurgia , Resultado do Tratamento
5.
Ann Surg ; 266(2): e19-e24, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28463895

RESUMO

OBJECTIVE: Evaluate the possibility of performing a complex vascular allotransplant of all neck organs including skin. SUMMARY BACKGROUND DATA: There are 2 previous attempts described in the literature, none of them being that complex. The first one is nonfunctional due to chronic rejection, the second one is viable yet considerably limited in complexity (no parathyroids, no skin). METHODS: The allotransplantation was performed simultaneously on 2 adjacent operating rooms, using microsurgical techniques. RESULTS: The patient's voice, breathing through mouth, swallowing, and endocrinal functions have been fully restored. CONCLUSIONS: Achieved results show clearly that such operations performed in selected patients can nearly fully restore functional and aesthetic effects in 1 single procedure.


Assuntos
Laringe/transplante , Glândulas Paratireoides/transplante , Faringe/cirurgia , Glândula Tireoide/transplante , Traqueia/transplante , Adulto , Carcinoma de Células Escamosas/cirurgia , Estética , Humanos , Neoplasias Laríngeas/cirurgia , Laringectomia/efeitos adversos , Masculino , Complicações Pós-Operatórias , Recuperação de Função Fisiológica , Transplante Homólogo
6.
Biochem Genet ; 55(4): 322-334, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28421310

RESUMO

Oral cavity cancer belongs to head-and-neck squamous cell carcinoma group. The purpose of the study was to assess the levels of certain proteins in a tumour and surgical margin in a group of patients with oral cavity cancer. The levels of DAPK1, MGMT, CDH1, SFRP1, SFRP2, RORA, TIMP3, p16, APC and RASSF1 proteins were measured by ELISA in tissue homogenates. The protein levels of DAPK1, MGMT, CDH1, SFRP2 and RASSF1 were significantly higher in tumour tissue than in the margin, contrary to TIMP3 which was lower in the tumour itself. DAPK1 level in the tumour was significantly higher in females than in males, the MGMT and p16 levels were lower in the tumours with lymph node metastasis (N1 + N2) than in N0 samples. The CDH1 expression was higher in a group with smoking habits, whereas TIMP3 was lower in this group. Changes in the levels of proteins in tumour and surgical margin may be either reflective of tumour occurrence and development, or they might be also responsible for the progress and reoccurrence of the disease. Levels of the studied proteins might be good prognostic factors; however, further studies are required.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Metilação de DNA/genética , Neoplasias Bucais/cirurgia , Proteínas de Neoplasias/genética , Adulto , Idoso , Antígenos CD , Caderinas/biossíntese , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/patologia , Proteínas Quinases Associadas com Morte Celular/biossíntese , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Boca/patologia , Boca/cirurgia , Neoplasias Bucais/genética , Neoplasias Bucais/patologia , Regiões Promotoras Genéticas , Inibidor Tecidual de Metaloproteinase-3/biossíntese
7.
Z Gastroenterol ; 55(10): 1004-1008, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29020699

RESUMO

Introduction Colonoscopy trainers have gained recognition for improving endoscopy skills and preparing for real procedures on humans. Unfortunately, due to their high price, commercial simulators are hard to obtain, especially for small medical centers. However, a solution might be to construct a device for themselves. Aim Our goal was to build a relatively cheap and easy-to-construct simulator for residents who want to start learning colonoscopy. Materials and methods The box model colonoscopy trainer was designed and constructed. The artificial colon was made from 2 layers of fabric and rubber rings between them. Velcro attached to the artificial colon and to the box, and the tarp straps that simulate peritoneal adhesions allow the bowel to be arranged in many different configurations. Moreover, some aspects of polypectomy training have been incorporated in the colonoscopy simulator. Results The self-constructed simulator was found to be an effective training device, with the total cost of parts not exceeding $30. Conclusions In this paper, we present the first homemade simulator for colonoscopy training. It offers the opportunity for skills acquisition in a preclinical setting.


Assuntos
Colonoscopia , Treinamento por Simulação , Competência Clínica , Colonoscopia/educação , Educação de Pós-Graduação em Medicina , Humanos , Treinamento por Simulação/métodos
9.
Children (Basel) ; 11(6)2024 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-38929270

RESUMO

BACKGROUND: Pressure ulcers pose significant challenges in terms of treatment, often exhibiting a low success rate and a propensity for recurrence. Children with neurological impairments such as myelomeningocele and those with spinal injuries are particularly vulnerable to developing pressure ulcers. Despite advancements, achieving successful reconstruction remains a formidable task. Common sites prone to pressure ulcer formation include the sacral and ischial regions, as well as areas over bony prominences. Additionally, pressure ulcers attributable to medical devices facilitating ambulation are observed. While many pressure sores resolve spontaneously, conservative management may prove ineffective for some, especially in cases of stage 3 and 4 ulcers, necessitating surgical intervention. Various surgical techniques are employed for the treatment of decubitus ulcers, yet there exists no universally accepted gold standard for their management. This paper presents our institutional experience in this domain, highlighting differences in surgical approaches, treatment outcomes, complication rates, and long-term follow-up. METHODS: This study involved a retrospective analysis of medical records from 11 children, ranging in age from 10 to 17 years, who presented with extensive pressure ulcers that were unresponsive to conservative treatment measures. Data collection spanned from February 2017 to June 2022. The pressure ulcers affected various anatomical regions, including the ischial area (5/11 patients), sacral region (3/11 patients), lower limb (1/11 patients), elbow (1/11 patients), and perineal area (1/11 patients). Surgical intervention was the chosen approach for all cases, employing techniques such as reconstructive surgery utilizing perforator, pediculated flaps, and locoregional flaps. RESULTS: Eleven patients with sore ulcers (stage 3 and 4) were treated surgically. We present our experience of using surgical methods, including pedicled anterolateral flaps, pedicled gracilis musculocutaneous flaps, propeller flaps and locoregional flaps. In some cases, surgery was performed after 60 days of hospitalization or ten years after ulcer occurrence. We reviewed the length of hospital stay, surgical management and patient satisfaction. Patients were followed up to 5 years post-surgery. All flaps survived except for one flap where partial necrosis was observed. The recurrence rate was 9.01% (1/11). One patient underwent another surgery. The general outcome was satisfactory. CONCLUSIONS: Conclusions: Our findings underscore the efficacy of flap reconstruction surgical techniques in the management of pressure ulcers among pediatric patients. Based on our experience and the outcomes observed, we advocate for considering reconstructive surgery as a viable therapeutic option early in the treatment course, particularly for stage 3 and 4 ulcers. This approach not only addresses the immediate needs of patients but also holds promise for long-term wound healing and prevention of recurrence.

10.
J Clin Med ; 13(14)2024 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-39064257

RESUMO

Background: Primary malignant bone tumors are most commonly associated with mutilating surgical procedures that can significantly disturb the motor development of a young patient and are frequently affiliated with major postoperative complications. Unfortunately, despite available autologous tissue donor sites, artificial materials are still most commonly used for the reconstruction of post-resection defects. Reconstructive microsurgery is increasingly recognized as an effective method of functional reconstruction, creating the possibility of performing limb-sparing surgery (LSS) with significant limitation of major postoperative complications at the same time. Methods: The study group consisted of 9 pediatric patients diagnosed with primary malignant bone tumor in the limb location. In order to perform microvascular reconstruction, 9 free fibula flaps were used in combination with a bone allograft (Capanna method). The functional outcome of the reconstruction was assessed on the basis of the MSTS (Musculoskeletal Tumor Society Scoring System) scale. Results: The presented analysis proves the effectiveness of this reconstructive procedure and the possibility of performing LSS with reasonable functional outcomes after appropriate patient qualification. In this study, all limbs included were spared. In all cases, the R0 surgical margins were achieved and no reports of local recurrences were reported during the follow-up. The average score on the MSTS scale was 27/30 points. Conclusions: Microvascular reconstructive surgery is an individually personalized and highly effective method of treating patients with primary bone tumors in the limb location and provides satisfactory functional outcomes.

11.
J Clin Med ; 13(7)2024 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-38610780

RESUMO

Background: Maxillofacial microvascular free-flap reconstructions are significant interventions in the management of congenital defects, traumatic injuries, malignancies, and iatrogenic complications in pediatric and young adult patients. Craniofacial disorders within this demographic can result in profound functional, cosmetic, and psychosocial impairments, highlighting the critical need for thorough investigation into factors that may influence procedural success and postoperative quality of life. This retrospective chart review aims to examine the outcomes and potential influencing factors, aiming to offer valuable insights into optimizing the effectiveness of these reconstructions and improving patient outcomes. Methods: A single head and neck surgical team performed all the included 136 procedures. Demographic and surgical patient data were recorded. Type of transfer performed in each recipient site and major complications were analyzed. Relevant influencing factors, such as age, gender, and etiology of defect were determined using the ANOVA test and χ2 test of independence. Results: The results indicate a 90% success rate. No significant relationship was found between the incidence of total flap loss and patient age, etiology, or graft source. The maxillary reconstructions showed a higher incidence of total flap loss compared to mandibular reconstructions (11 vs. 3 cases). Conclusions: Despite the high success rate, the findings underline the necessity for further research to validate these observations and enhance surgical methods for pediatric and young adult patients.

12.
Stem Cell Res Ther ; 15(1): 27, 2024 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-38303049

RESUMO

BACKGROUND: Adipose-derived stromal cells (ADSCs) demonstrate ability to promote tissue healing and down-regulate excessive inflammation. ADSCs have been used to treat critical limb ischemia in preclinical and clinical trials, but still, there is little known about their optimal delivery strategy. To date, no direct analysis of different methods of ADSCs delivery has been performed in the hindlimb ischemia model. Therefore, in this study we focused on the therapeutic efficacy of different ADSCs delivery methods in a murine model of hindlimb ischemia. METHODS: For the hADSCs isolation, we used the subcutaneous adipose tissue collected during the surgery. The murine hindlimb ischemia was used as a model. The unilateral femoral artery ligation was performed on 10-12-week-old male C57BL/6. ADSCs were delivered directly into ischemic muscle, into the contralateral muscle or intravenously. 7 and 14 days after the surgery, the gastrocnemius and quadriceps muscles were collected for the immunohistochemical analysis. The results were analyzed with relevant tests using the Statistica software. RESULTS: Our research revealed that muscle regeneration, angiogenesis, arteriogenesis and macrophage infiltration in murine model of hindlimb ischemia differ depending on ADSCs delivery method. We have demonstrated that intramuscular method (directly into ischemic limb) of ADSCs delivery is more efficient in functional recovery after critical limb ischemia than intravenous or contralateral route. CONCLUSIONS: We have noticed that injection of ADSCs directly into ischemic limb is the optimal delivery strategy because it increases: (1) muscle fiber regeneration, (2) the number of capillaries and (3) the influx of macrophages F4/80+/CD206+.


Assuntos
Tecido Adiposo , Isquemia Crônica Crítica de Membro , Camundongos , Masculino , Humanos , Animais , Modelos Animais de Doenças , Neovascularização Fisiológica , Membro Posterior/irrigação sanguínea , Músculo Esquelético , Isquemia/terapia , Células Estromais
13.
Med Sci Monit ; 19: 690-5, 2013 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-23963109

RESUMO

BACKGROUND: 8-hydroxy-2'-deoxyguanosine (8-OHdG) is one of the most abundant oxidatively modified lesions in DNA and is a marker of the oxidative stress. 8-OHdG is a mutagenic lesion and it can mispair with adenine, causing G:C→T: A transversion. Our task was to determine the 8-OHdG level in patients with colorectal adenocarcinoma directly in tumor tissues and corresponding normal mucosa. MATERIAL/METHODS: Samples of tumor tissues and corresponding normal mucosa of 47 patients undergoing surgery for colorectal cancer were analyzed. DNA was isolated from both tumor and normal tissues. Then, DNA was hydrolyzed to nucleotides using nuclease P1 and alkaline phosphatase. The 8-OHdG and 2'-dG (2'-deoxyguanosine) were determined in hydrolysates by high-performance liquid chromatography (HPLC) with electrochemical (EC) and UV detector. RESULTS: The levels of 8-OHdG in colorectal adenocarcinoma tissues were higher than in corresponding normal mucosa. No significant differences were shown in 8-OHdG levels in the cancerous and cancer-free tissues between age and sex and stages A/B and C/D of Duke's classification. CONCLUSIONS: 8-OHdG reflects the local oxidative stress in colon adenocarcinoma tissue together with ageing processes, but not the intensity of tumorigenesis itself. Because of many factors that could influence the oxidative modification of DNA bases, its role as a diagnostic and/or prognostic factor in colon adenocarcinoma seems to be limited.


Assuntos
Adenocarcinoma/metabolismo , Neoplasias Colorretais/metabolismo , DNA/análise , Desoxiguanosina/análogos & derivados , Estresse Oxidativo/fisiologia , 8-Hidroxi-2'-Desoxiguanosina , Adulto , Cromatografia Líquida de Alta Pressão , Desoxiguanosina/análise , Feminino , Humanos , Masculino , Polônia , Estatísticas não Paramétricas
14.
J Clin Med ; 12(3)2023 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-36769772

RESUMO

This is a retrospective study describing a multi-stage protocol for the management of severe mandibular hypoplasia in craniofacial microsomia (CFM) with accompanying obstructive sleep apnea (OSA). Patients with severe mandibular hypoplasia require reconstruction functionality and esthetical features. In the cohort, reconstructions based on free fibular flaps (FFF) may be the most effective way. Patients aged 4-17 years with severe mandibular hypoplasia were treated with FFF, which initially improved the respiratory function assessed on polysomnography (AHI). In the next stages of treatment of cases with respiratory deterioration, it was indicated to perform distraction osteogenesis (DO) of the mandible and the structures reconstructed with FFF. All surgeries were planned in accordance with virtual surgery planning VSP. The aim of the study was to prospectively assess the effectiveness of multi-stage mandibular reconstruction in craniofacial microsomia with the use of a free fibula flap in terms of improving respiratory failure due to obstructive sleep apnea (OSA). The FFF reconstruction method, performed with virtual surgical planning (VSP), is proving to be an effective alternative to traditional methods of mandibular reconstruction in patients with severe CFM with OSA.

15.
Otolaryngol Pol ; 77(2): 1-5, 2023 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-36806468

RESUMO

The authors would like to present the possibilities of reconstructive surgery using free microvascular flaps with bone elements in the treatment of cavities in the head and neck area. The cavities in the presented article resulted both from resection of tumors in the head and neck area as well as congenital defects and radiation damage. The authors would like to discuss the difficulties that may arise during the postoperative period, including the maintenance of the graft's viability, the healing of the donor site and systemic problems. The article presents 33 reconstruction surgeries performed on 31 patients using different flaps, briefly describing their advantages and technical difficulties that may arise during the microvascular anastomoses. The authors emphasise the importance of a well-conducted qualification for the surgery as well as the need to discuss the course of the surgery and recovery and other possible treatment options with patients and their families. The complications that happened in the presented group and how they were treated are described. The authors discuss in details the 3 cases with different types of reconstructive procedures and draw attention to the importance of postoperative care consisting of the constant monitoring of the viability of the graft carried out by qualified personnel of the Otolaryngology Department and appropriately conducted anticoagulant therapy.


Assuntos
Retalhos de Tecido Biológico , Otolaringologia , Humanos , Pescoço , Período Pós-Operatório
16.
Eur J Med Res ; 28(1): 386, 2023 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-37770987

RESUMO

BACKGROUND: Mandible tumors are very rare. One of the main methods of the treatments is resection of the tumor and then reconstruction of the mandible. The donor site is often distant tissue-fibula or ilium. Following this, it is necessary to improve the patient in two ways, on one hand restoring the function of the mandible, and on the other hand, improving the donor site area. For that reason, physiotherapy after tumor resection and reconstruction of the mandible is very complicated. The aim of this bibliographic review was to find the methods of the reconstruction of the mandible in the context of patients' functional assessment after surgeries to create effective physiotherapeutic procedures in the feature. METHODS: PEDro, Medline (PubMed), Cochrane Clinical Trials were searched. RESULTS: 767 articles were found. 40 articles were included to this literature review. CONCLUSIONS: Authors showed different kinds of surgeries strategy for patients with tumors of the mandible. They also showed manners of patients' functional assessment in the localization of transplantation and donor site. It could be useful for physiotherapists during planning of comprehensive physiotherapy.


Assuntos
Neoplasias Mandibulares , Procedimentos de Cirurgia Plástica , Humanos , Transplante Ósseo/métodos , Mandíbula/cirurgia , Neoplasias Mandibulares/cirurgia , Fíbula/cirurgia
17.
Med Sci Monit ; 18(4): CS31-6, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22460099

RESUMO

BACKGROUND: Reconstruction of the pharynx and cervical esophagus has significantly progressed in the last 2 decades. A revolution in microvascular surgery has provided numerous choices for primary restoration, or in secondary reconstructions necessary for recurrences or complications of primary surgery. The goals of reconstruction after laryngopharyngoesophagectomy are to provide continuity of the alimentary tract, to protect major blood vessels, to heal the primary wound, and to restore the swallowing and breathing functions with minimal donor site and neck morbidity and deformation. CASE REPORT: We present 3 cases with complex defects of the laryngopharynx, cervical esophagus and trachea and anterior neck skin following central neck exenteration safely reconstructed with a single anterolateral thigh flap. No postoperative complications occurred in any of the 3 cases of reconstructions, each using a single anterolateral thigh flap. CONCLUSIONS: This approach significantly simplified the reconstruction, with quick recovery, short hospital stay and excellent functional and aesthetic results.


Assuntos
Retalhos de Tecido Biológico , Laringectomia/métodos , Laringe/cirurgia , Terapia de Salvação , Idoso , Humanos , Laringe/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia , Recidiva
18.
Contemp Oncol (Pozn) ; 16(6): 546-50, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23788942

RESUMO

AIM OF THE STUDY: The aim of the study was to develop standards for the prefabrication of free microvascular flaps in an animal model, followed by their application in clinical practice, and quantitative/qualitative microscopic assessment of the extent of development of a new microvascular network. MATERIAL AND METHODS: The study was carried out in 10 experimental pigs. As the first stage, a total of 20 prefabricated flaps were created using polytetrafluoroethylene (PTFE) as a support material, placed horizontally over an isolated and distally closed vascular pedicle based on superficial abdominal vessels. After completing the animal model study, one patient was selected for the grafting of the prefabricated free flap. RESULTS: All 20 free flaps prefabricated in the animal model were analyzed microscopically, exhibiting connective tissue rich in fibroblasts and small blood vessels in the porous areas across the entire thickness of the PTFE element. CONCLUSIONS: Flap prefabrication is a new and fast developing reconstruction technique. The usefulness of prefabrication techniques and their status in reconstructive surgery still needs to be investigated experimentally and clinically. The method based on prefabricated free flaps is the first step towards anatomical bioengineering that will make it possible to replace missing organs with their anatomically perfect equivalents.

19.
Oral Oncol ; 127: 105800, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35255279

RESUMO

INTRODUCTION: Post- resection defects in the area of the head and neck frequently result in functional impairment of the masticatory system and unaesthetic outcome in the facial appearance. In pediatric population they exert a devastating effect on speech development, breathing and facial growth leading to secondary deformations which are extremely challenging in reconstruction by means of conventional surgery protocols. MATERIAL AND METHODS: 21 patients (14 males/ 7 females) aged 4-17 years old, treated between 2015 and 2019 due to malignant/benign tumors or congenital deformities requiring mandible resection were enrolled in the study. All patients underwent Virtual Surgical Planning (VSP), mandible tumor resection with use surgery guides and defect reconstruction with microvascular bone graft supported with custom implants. Postoperatively, 3D models used for the planning and postoperative 3D model of the reconstructed mandible were compared using authors method based on easily measurable morphometric measurements (3 angles, 3 linear dimensions), allowing a three-dimensional quantitative assessment of postoperative outcomes of the surgery. Linear regression analysis and one-way analysis of variance were used to evaluate the clinical material. The difference was considered significant if p < 0.05. RESULTS: Free fibula flap (FFF) was most commonly used type of the reconstruction of the pediatric mandible. The average maximum deviation for the analyzed cases was 7.7 mm, and the average minimum deviation was -6.09 mm, however without significant differences and the postoperative position of the mandible condyle was comparable to the position designed in the 3DVSP preoperatively. Position of the whole reconstructed mandible by means of individually planned grafts and plates provided comparable position of the ramus and mandible body and no chin deviation as the differences between the pre-operative axial and sagittal angles and their post-operative equivalents were insignificant (p > 0,05). CONCLUSIONS: This study confirms applicability of the 3DVSP in pediatric craniomaxillofacial surgery. Preoperative planning of the osteotomies, grafting technique and production of the individualized guides and implants provides precise tumor resection and immediate reconstruction adjusted to the specific anatomy of the pediatric patients.


Assuntos
Retalhos de Tecido Biológico , Neoplasias Mandibulares , Reconstrução Mandibular , Adolescente , Criança , Pré-Escolar , Feminino , Fíbula/cirurgia , Retalhos de Tecido Biológico/cirurgia , Humanos , Masculino , Mandíbula/cirurgia , Neoplasias Mandibulares/cirurgia , Reconstrução Mandibular/métodos
20.
Genes (Basel) ; 13(11)2022 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-36360322

RESUMO

Oral squamous cell carcinoma (OSCC) is one of the most prevalent types of cancers worldwide. LTF arrests the G1 to S phase transition of the cell cycle. This study is the first that has aimed to determine the possible association between the LTF polymorphisms (rs2073495, rs1126478, rs34827868, rs1042073, rs4637321, rs2239692 and rs10865941), the mRNA LTF expression, the risk of OSCC and the influence on the TNM staging and histological grading. This study was composed of 176 Polish patients, including 88 subjects diagnosed with OSCC and 88 healthy individuals. QuantStudio Design and Analysis Software v1.5.1 was used for the single nucleotide polymorphism (SNP) analysis and mRNA LTF expression. The G/G genotype of rs2073495 and the G/G genotype of rs4637321 were linked, with an increased risk of OSCC. There were no significant influences between the TNM staging and the histological grading and the LTF genotype. We found no statistically significant dissimilarities in the expression level of LTF genes in the tumour and margin specimens. No association was found between the gene expression levels, the other parameters or LTF polymorphisms in the tumour and margin samples. In conclusion, rs2073495 and rs4637321 polymorphisms may affect the risk of OSCC. These results should be validated on larger and different cohorts to better comprehend the role of the LTF gene in OSCC.


Assuntos
Carcinoma de Células Escamosas , Neoplasias de Cabeça e Pescoço , Neoplasias Bucais , Humanos , Neoplasias Bucais/genética , Neoplasias Bucais/patologia , Polimorfismo de Nucleotídeo Único , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço , Predisposição Genética para Doença , RNA Mensageiro/genética , Lactoferrina/genética
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