RESUMEN
BACKGROUND: The aim of this study was to investigate the effect of subcutaneously applied thrombolytic, anticoagulant, and vasodilator agents on the survival of random-pattern skin flap. METHODS: A caudally based dorsal flap model was used in 24 rats in four groups. In group 1 (n = 6), flap was elevated and sutured. In group 2 (n = 6), enoxaparin sodium was injected subcutaneously immediately after surgery, on days 1 and 2. In group 3 (n = 6), a transdermal nitroglycerin was applied directly following surgery, on days 1 and 2. In group 4 (n = 6), alteplase was injected subcutaneously immediately after surgery, on days 1 and 2. Blood flow was measured with laser Doppler flowmetry at the proximal and distal halves of flap before, immediately after surgery, and on days 3 and 7. Histologic samples were taken from the same locations on day 3 and day 7 postoperatively. Vessel and lymphocyte count was obtained. Photographs were taken to determine flap necrosis areas at day 7 postoperatively. RESULTS: Area of skin necrosis was found to be less in all medication groups. But only enoxaparin sodium group showed significant decrease in skin necrosis (p < 0.05). Laser Doppler flowmetry showed a gradual decrease in all groups over time, with no statistically significant result. The histologic findings revealed the induction of angiogenesis in all experimental groups. CONCLUSION: Subcutaneously applied thrombolytic, anticoagulant, and vasodilator agents increase random-pattern skin flap survival with only enoxaparin sodium showing significant decrease in flap necrosis.
Asunto(s)
Anticoagulantes/farmacología , Fibrinolíticos/farmacología , Supervivencia de Injerto/efectos de los fármacos , Colgajos Quirúrgicos/irrigación sanguínea , Vasodilatadores/farmacología , Animales , Masculino , Modelos Animales , Necrosis , Ratas , Ratas Wistar , Piel/irrigación sanguínea , Piel/efectos de los fármacosRESUMEN
Despite appropriate surgical technique and follow-up, flap failures can be encountered for which no valid reason is evident. Current literature states that these unpredictable flap failures can be caused by unknown patient factors, such as undiagnosed hypercoagulability. Our approach and experience utilizing an algorithm to minimize unpredictable failures in microvascular breast reconstruction by predetermining hypercoagulation risk factors in preoperative patients is presented. A prospective assessment of microsurgical breast reconstruction candidates between October 2007 and December 2010 was conducted. Patients were questioned about their tendency toward hypercoagulation. A thrombophilia panel was requested for patients confirming any risk factors. Appropriate surgical planning was conducted according to results of the panel. Of the 60 patients thoroughly questioned about hypercoagulation tendency, 21 (35%) confirmed having prothrombotic tendency and were referred to the thrombophilia testing. The results indicated hypercoagulation in 9 (15%) patients. The primary reconstruction plan of utilizing free flaps was abandoned for these patients and pedicled flaps or implants were preferred for reconstruction. These percentages emphasize the value of questioning risk factors and testing for hypercoagulation in patients seeking microsurgical breast reconstruction. We believe that detailed preoperative questioning of risk factors and appropriate testing according to prothrombotic tendency is beneficial in minimizing unpredictable flap failures and increasing rates of success.
Asunto(s)
Algoritmos , Colgajos Tisulares Libres , Mamoplastia/métodos , Trombofilia/complicaciones , Trombofilia/diagnóstico , Adulto , Femenino , Humanos , Microcirugia/métodos , Estudios Prospectivos , Factores de Riesgo , Encuestas y Cuestionarios , Insuficiencia del TratamientoAsunto(s)
Disartria/inducido químicamente , Fibrinolíticos/efectos adversos , Traumatismos de los Dedos/cirugía , Piracetam/efectos adversos , Colgajos Quirúrgicos/irrigación sanguínea , Adulto , Quimioprevención/efectos adversos , Humanos , Masculino , Procedimientos de Cirugía Plástica , Dedos del Pie/trasplanteRESUMEN
Temporalis muscle metastasis of a tumor is a rare condition. Basaloid squamous cell carcinoma is an uncommon variant of squamous cell carcinoma, which often occurs in the aerodigestive tract. To the best of our knowledge, there have been no previous reports dealing with temporalis muscle metastasis from esophageal carcinoma in the literature.
Asunto(s)
Carcinoma Basoescamoso/secundario , Neoplasias Esofágicas/patología , Neoplasias de los Músculos/secundario , Músculo Temporal , Biopsia , Carcinoma Basoescamoso/cirugía , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Neoplasias de los Músculos/cirugíaRESUMEN
Odontogenic keratocyst is an epithelial developmental odontogenic cyst most commonly occurring in the jaws. It comprises approximately 11% of all cysts of the jaws. It has an aggressive behavior including high rates of recurrence, rapid growth, and extension into adjacent tissues. Odontogenic keratocyst is commonly found in the mandible with a predilection for angle and ascending ramus of the mandible. We document a case of odontogenic keratocyst that is unusually originated from the temporomandibular joint and we review the existing literature concerning odontogenic keratocyst. As far we know this is the first case of the odontogenic keratocyst originating from the temporomandibular joint.