RESUMEN
OBJECTIVE: Repair of large incisional lumbar hernias or muscular bulges is a challenge to the surgeon as reflected by the high recurrence rate. We evaluated a surgical procedure using a running strip of autogenous skin graft as a retention suture. METHODS: Eight patients with large incisional lumbar hernias (> or = 20 cm, n = 6) or muscular bulges (n = 2) underwent a parietal reconstruction with this procedure. Two patients had previously been treated with synthetic meshes without success, and one had a colocutaneous fistula. RESULTS: No recurrence was observed in 6 patients (75%) with a mean follow-up of 14 months. After significant weight gain, 2 repairs failed at 6 months and 1 year (partially in 1 case). No recurrence was noted for muscular bulges. CONCLUSION: The use of a running strip of autogenous skin graft is a simple and reliable procedure for the repair of large lumbar hernias or muscular bulges for patients with stable weight conditions.
Asunto(s)
Herniorrafia , Riñón/cirugía , Complicaciones Posoperatorias , Trasplante de Piel , Hernia/etiología , Humanos , Región Lumbosacra , Músculo Esquelético/cirugía , Recurrencia , Reoperación , Mallas QuirúrgicasRESUMEN
Skin flaps are usually required to cover amputation stumps, especially below the knee. Cross-leg flaps or free flaps can be used when local tissue is insufficient, but as emphasized by Rees in 1986, tissue expansion offers another interesting possibility for local coverage. The risk of complications, especially infection, in below-knee tissue expansion is well known, requiring rigorous patient selection based on an evaluation of skin quality, vascularization, and the patient's metabolic and psychologic status. We used this method in 5 patients (3 females, 2 males; mean age 30.4 years) who had been amputated below (n = 4) and above (n = 1) the knee. In 4 cases, amputation of a healthy limb was required after trauma and in 1 case due to purpura fulminans. Seven tissue expanders were used with slow intermittent expansion applied daily. The mean expansion period was 89.4 days. Mean hospital stay for the two operations was 5.66 and 7.33 days, respectively. Assessed on the basis of subjective and objective criteria, functional outcome was excellent in 3 patients and good in one patient. Failure occurred in one case due to infection. Despite the longer treatment period, tissue expansion for skin coverage of defective amputation stumps appears to have several advantages. It is a simple, reliable and reproducible method with a minimal scar area while preserving skin sensitivity. In addition, the length of the tibial shaft can be spared and minimal modifications are needed to fit the prosthesis.
Asunto(s)
Muñones de Amputación , Traumatismos de la Pierna/cirugía , Expansión de Tejido , Adolescente , Adulto , Femenino , Humanos , Masculino , Reoperación , Muslo/cirugía , Expansión de Tejido/efectos adversos , Expansión de Tejido/métodosRESUMEN
Two cases of right ventricular free wall rupture secondary to mediastinitis after cardiac surgery are reported. This complication is unusual and characterized by the singular mechanism of rupture (traction involving right ventricular free wall and chest adhesion) which occurs during episodes of coughing. Treatment by omentoplasty en sureda favorable outcome in both cases.
Asunto(s)
Rotura Cardíaca/etiología , Mediastinitis/complicaciones , Anciano , Puente de Arteria Coronaria/efectos adversos , Ventrículos Cardíacos , Humanos , Masculino , Persona de Mediana Edad , Hemorragia Posoperatoria/etiología , Reoperación , Rotura EspontáneaRESUMEN
Mediastinitis is a rare complication but can occur after any form of cardiac surgery via midline sternotomy. Despite early diagnosis, management in intensive care and appropriate treatment, the prognosis remains severe. Progression towards a chest wall defect, exposing a sternal flap is not uncommon and requires reconstructive surgery because of the potential life-threatening risk. Among the techniques currently used, the authors emphasize the value of pectoralis major myoplasty centered on perforating vessels derived from the internal mammary artery according to the technique described by Nahai in 1982. They have performed this procedure in 7 patients with a high-risk context, always using a single muscle, and also assessed its technical simplicity, low morbidity, absence of obvious functional handicap associated with the aesthetic aspects by means of regular review with a mean follow-up of 18 months.
Asunto(s)
Mediastinitis/complicaciones , Músculos Pectorales/trasplante , Colgajos Quirúrgicos , Dehiscencia de la Herida Operatoria/cirugía , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Mediastinitis/cirugía , Persona de Mediana Edad , Cirugía TorácicaRESUMEN
The authors describe their experience of breast reconstruction in Poland's syndrome and analyse 9 cases (eight females, one male) between 1981-1991. The mean age was 25 years (17-53 years). Three women were operated by the Mouly-Dufourmentel surgical procedure: translation of the homolateral latissimus dorsi muscle flap with a mammary prosthesis. The muscle flap was used alone in the male. Mammary prostheses were performed alone in four other women. Breast asymmetry was corrected by mammaplasty alone in one woman. In three cases, in order to achieve optimal symmetry, the controlateral ptosed hypertrophic breast was corrected (two cases in the same procedure, one case later). In three cases, a nipple-areolar restoration was performed at the patient's request. These results are analysed with an average follow-up of 5.4 years (2-11 years) and are compared to the literature data.
Asunto(s)
Mamoplastia/métodos , Síndrome de Poland/cirugía , Colgajos Quirúrgicos , Adolescente , Adulto , Implantes de Mama , Femenino , Humanos , Masculino , Persona de Mediana EdadAsunto(s)
Epistaxis , Urgencias Médicas , Epistaxis/diagnóstico , Epistaxis/etiología , Epistaxis/terapia , HumanosRESUMEN
Based on our experience with von Recklinghausen's disease, we present two cases characterized by highly developed skin tumors. One of these cases is unique in the literature. After describing these two cases, we review the different sites of the disease and discuss the limitations of surgery. Particular attention is paid to surgical palliation for patients with end-stage tumors.