RESUMEN
The choice between skin graft and local flap reconstruction depends upon the surgeon's experience and the facilities available. For skin cancers, our main objective is clear, oncologic clearance with preservation of function. For some patients, aesthetic outcome is often equally important. In our experience, majority of our trainees will often choose skin graft reconstruction as their primary choice of reconstruction due to the fact that there is a perceived idea that this is easier to perform than a local flap. However, for lower limb or head and neck reconstructions, skin graft may result in a significant contour defect which can potentially be avoided. We present a series of cases of an alternative flap, the trapezoid advancement, a very simple design that can be utilised in several areas of the body and technically very easily replicated. This technique allows for the advancement of tissue with a minimal tension closure as compared to other local flaps. Our results showed no flap loss and excellent cosmetic outcome.
RESUMEN
BACKGROUND: Craniofacial anomalies, although uncommon, can have considerable effects on the individual, their family and society.(1-4) They carry with them a large morbidity and require a highly specialized, multidisciplinary approach to treatment.(5) Facing the World (FTW), was founded in 2002, to offer facial reconstructive surgery to children with complex, craniofacial anomalies with no prospect of local treatment, from developing countries anywhere in the world. METHODS: We present an 8-year audit of the cases treated by FTW, where children are brought from their own countries to the UK for treatment. Patient selection takes place prior to their arrival in the UK by a multidisciplinary team. Specifically the condition has to be correctable to a degree that justifies the risks involved with the surgery, and the disruption to the child and their family. RESULTS: Since inception, FTW has evaluated more than 300 cases and provided treatment in the UK for over 24 cases from 18 different countries. We present our range of cases and complications. We discuss our complication rate of 28% and mortality rate of 4% (1 case). CONCLUSIONS: Key to the sustainability of FTW is the development of local healthcare infrastructure within the developing countries to facilitate eventual local management of the more straightforward cases and follow up of these patients by well-trained medical staff. By establishing these programs, FTW aims to not only change these children's lives but to raise awareness, and help to expand the global craniofacial network whereby in the future, satellite partners will be present to help manage these conditions locally. LEVEL OF EVIDENCE: III.
Asunto(s)
Anomalías Craneofaciales/diagnóstico , Anomalías Craneofaciales/cirugía , Países en Desarrollo , Obtención de Fondos/organización & administración , Misiones Médicas/organización & administración , Procedimientos de Cirugía Plástica/estadística & datos numéricos , Adolescente , Niño , Preescolar , Anomalías Congénitas/diagnóstico , Anomalías Congénitas/cirugía , Femenino , Salud Global , Humanos , Lactante , Masculino , Auditoría Médica , Área sin Atención Médica , Reino Unido , Adulto JovenRESUMEN
Bis-phenol, a phenolic antioxidant, is an inhibitor of sarcoplasmic reticulum (SR), endoplasmic reticulum (ER) and plasma membrane Ca2+ ATPases. The concentration of bis-phenol giving half-maximal inhibition of the SR Ca(2+)-ATPase is 2 microM. On binding to the SR Ca(2+)-ATPase it shifts the E2 to E1 transition towards the E2 state and slows the transition between E2 to E1. Bis-phenol completely inhibits Ca(2+)-dependent ATP hydrolysis and Ca2+ uptake by rat cerebellar microsomes at a concentration of 30 microM. The plasma membrane Ca(2+)-ATPase is also completely inhibited at similar concentrations, however, the Na+/K(+)-ATPase is only marginally affected. Other inhibitors of the ER Ca(2+)-ATPases, thapsigargin and 2,5-di-(tert-butyl)-1,4-benzohydroquinone (BHQ), inhibit Ca2+ uptake by approximately 75%. Bis-phenol therefore inhibits all types of ER Ca(2+)-ATPases present in cerebellum. This inhibitor is also able to mobilize Ca2+ from intracellular Ca2+ stores, including those sensitive to InsP3, in intact HL-60 cells.