RESUMEN
BACKGROUND: Poland syndrome is a sporadic, congenital unilateral absence of the sternocostal head of the pectoralis major muscle that can occur with other ipsilateral chest wall and limb derangements. The chest wall deficiency is primarily cosmetic, its incidence is unknown, male patients may be affected more than female patients, the right side is affected more than the left, and associated comorbidities may exist. Chest wall repair depends on anatomical type and gender. METHODS: Sixty-three patients with Poland syndrome were divided into two treatment groups by chest wall anatomy and gender. Surgical repair was based on this division. Seventy-six operations were performed by the senior author (A.E.S.) during a 30-year period, and long-term outcomes are presented. Corrective methods included use of custom-made chest wall prostheses, mammary prostheses, latissimus dorsi muscle transfers, transverse rectus abdominis musculocutaneous flaps, sternal/rib reconstruction, or a combination of methods. Follow-up ranged from 1 to 21 years. RESULTS: Two anatomical forms of the disorder are described, each with unique surgical requirements. The simple deformity was effectively repaired with a latissimus dorsi muscle transfer plus, in female patients, a sublatissimus mammary prosthesis. Repair of the complex deformity, in addition to the latissimus transfer, selectively included musculoskeletal chest wall realignment. Custom-made chest wall prostheses carried a higher risk of complications. CONCLUSIONS: Poland syndrome of the chest wall exists in two forms: the more common simple variety and a complex form (as originally described by Poland). Repair of the chest wall can be effectively tailored to these anatomical types, gender, and patient preference.
Asunto(s)
Síndrome de Poland/diagnóstico , Síndrome de Poland/cirugía , Pared Torácica/anomalías , Pared Torácica/cirugía , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Adulto JovenRESUMEN
UNLABELLED: Background. Therapeutic use of supplemental arginine has been proposed as an efficacious method to produce nitric oxide (NO) from nitric oxide synthase (NOS) and proline and polyamines from arginase to improve wound healing. This study was designed to examine the effects of arginine on wound angiogenesis and granulation tissue formation. METHODS: A ventral hernia, surgically created in the abdominal wall of 12 swine, was repaired with silicone sheeting and skin closure. An osmotic infusion pump, inserted in a remote subcutaneous pocket, continuously delivered saline solution (n = 6) or L-arginine (n = 6) into the wound environment. Granulation tissue thickness was determined by ultrasonography. Fluid was aspirated serially from the developing wound compartment for measurement of nitrite/nitrate (NOx) and amino acid concentrations. On day 14, the animals were sacrificed, and the abdominal wall was harvested for histologic analysis. RESULTS: In animals that received saline, a 4-fold increase in granulation tissue thickness was measured during the 14-day interval. In contrast, in L-arginine treated animals, the day 14 granulation tissue thickness was unchanged from day 4 values of saline treated animals (10.1 mm ± 1.1 mm versus 20.2 mm ± 1.7 mm at day 14; P < 0.05). Wound vessel count and vascular surface area estimates derived from image analysis of histologic sections were 2- to 3-fold lower in L-arginine animals compared to controls (P < 0.05). Progressive and sustained increases in wound fluid NOx and homocysteine levels were noted in L-arginine treated animals compared to controls (230 µm/L versus 75 µm/L at day 14 [P < 0.05]; peak 25.2 µm/L versus 17.3 µm/L at day 7 [P <0.05], respectively). CONCLUSION: Supplemental arginine induces sustained NO production and creates a methylation demand, resulting in elevated homocysteine concentrations with consequent reductions in wound angiogenesis and granulation tissue formation. .