RESUMO
BACKGROUND: Penile amputation, vaginoplasty, and clitoroplasty help male-to-female transsexuals accept their bodies and increase psychosocial function. Subsequent colpectomy is unusual. CASES: We report three patients in whom complicated, long-term problems subsequent to vaginoplasty led to total colpectomy in one case of neovaginal overgrowth of condylomata acuminata, and in two cases of colitis in rectosigmoid transplants used for neovaginoplasties. CONCLUSION: Before inversion of penile skin, in cases in which the genital skin has condylomata, the risk of condylomata overgrowth might be anticipated. Rectosigmoid vaginoplasty might result in therapy-resistent colitis, which also could lead to colpectomy.
Assuntos
Condiloma Acuminado/cirurgia , Complicações Pós-Operatórias , Transplante de Pele , Vagina/cirurgia , Neoplasias Vaginais/cirurgia , Adulto , Colite/etiologia , Feminino , Humanos , Masculino , Pênis/cirurgia , Transexualidade/cirurgiaRESUMO
A patient with a severe intra-abdominal infection required a laparostomy. A Bogota bag was combined with topical negative pressure therapy, saving nursing time and enabling successful management of wound fluid.
Assuntos
Abdome/cirurgia , Bandagens , Neoplasias do Ceco/enfermagem , Neoplasias do Ceco/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/enfermagem , Estomas Cirúrgicos , Irrigação Terapêutica/instrumentação , Idoso , Líquido Ascítico/complicações , Líquido Ascítico/terapia , Neoplasias do Ceco/complicações , Colectomia/métodos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Diverticulite/complicações , Diverticulite/enfermagem , Diverticulite/cirurgia , Humanos , Doenças do Íleo/complicações , Doenças do Íleo/enfermagem , Doenças do Íleo/cirurgia , Perfuração Intestinal/complicações , Perfuração Intestinal/enfermagem , Perfuração Intestinal/cirurgia , Laparotomia/métodos , Masculino , Cuidados Pós-Operatórios/métodos , Pressão , Vácuo , CicatrizaçãoRESUMO
The use of free vascularised bone grafts (FVBGs) is an infrequently performed surgical technique for the reconstruction of spinal defects. This field of surgery brings many challenges concerning choice of FVBG, planning of the operative procedure and selection of recipient vessels. This study aims to report our experience with FVBGs, with special emphasis on the planning and surgical technique. Over a period of 10 years (1994-2004), we used FVBG for anterior spinal reconstruction in 23 patients. In 21 patients, a free vascularised fibular graft was used, and in two cases a free vascularised iliac crest graft was used. The spinal segments reconstructed involved the cervical spine (4 cases), the thoracic spine (13 cases) and the thoraco-lumbar and lumbo-sacral spine (6 cases). Re-vascularisation of the FVBG proved to be technically feasible in 22 patients, but failed in one fibular graft due to difficulties with recipient vessels in the lumbar spine. When necessary, the fibula was osteotomized and folded in a double-, triple- or quadruple-barrel construction to increase the strength of the reconstruction. Technical challenges were met with respect to the choice of the recipient vessel at various anatomical sites. The use of FVBG is a valuable technique for the reconstruction of complex spinal disorders. Successful execution requires microvascular expertise with respect to graft harvesting and appropriate choice of recipient vessels. Adequate preoperative planning in a multidisciplinary setting and adherence to the basic principles for spinal reconstruction are required.