RESUMEN
Since its inception, microvascular free tissue transfer has broadened possibilities for oncologic ablation and restoration of form and function. Developments throughout recent decades have resulted in increasing flap success rates and complexity. Advances in technology and knowledge gained from past experiences will continue to improve surgical efficiency, flap success rates, and ultimately, patient outcomes.
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Neoplasias de Cabeza y Cuello , Procedimientos de Cirugía Plástica , Humanos , Neoplasias de Cabeza y Cuello/cirugía , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/tendencias , Microcirugia/métodos , Microcirugia/tendencias , Colgajos Tisulares Libres/irrigación sanguínea , Colgajos Quirúrgicos/irrigación sanguíneaRESUMEN
Breast cancer is rising among women in India. Most of the cases are presented at the locally advanced stage where axillary dissection is needed. In this article, we have described our approach of axillary dissection in the technically challenging high nodal burden axillas.
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Axila , Neoplasias de la Mama , Escisión del Ganglio Linfático , Músculos Superficiales de la Espalda , Humanos , Escisión del Ganglio Linfático/métodos , Femenino , Neoplasias de la Mama/cirugía , Resultado del Tratamiento , India , Colgajos QuirúrgicosRESUMEN
Robotic surgery has been widely used in surgical gastric cancer treatments, including proximal gastrectomy. Single-port robotic system is gaining more popularity in robotic surgery, but there has been no report on its application in robotic proximal gastrectomy with right-sided overlap and single-flap valvuloplasty (RPG-ROSF). Here, we report an RPG-ROSF using a novel single-port robotic system in a 51-year-old male patient with an early-stage gastroesophageal cancer detected by gastroscopy. It took 90 min for robotic setup, 143 min for dissection, and 161 min for digestive tract reconstruction. There was no complication during and after the surgery. The patient was discharged in 8 days postsurgery. The pathological staging of the adenocarcinoma was pT1aN0M0. This preliminary study demonstrated the feasibility and safety of a novel single-port robot in RPG-ROSF.
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Adenocarcinoma , Gastrectomía , Procedimientos Quirúrgicos Robotizados , Neoplasias Gástricas , Humanos , Masculino , Gastrectomía/métodos , Neoplasias Gástricas/cirugía , Neoplasias Gástricas/patología , Persona de Mediana Edad , Adenocarcinoma/cirugía , Adenocarcinoma/patología , Neoplasias Esofágicas/cirugía , Neoplasias Esofágicas/patología , Colgajos QuirúrgicosRESUMEN
PURPOSE: This study aims to investigate whether contrast-enhanced ultrasound (CEUS) could be used to reveal the status of blood supply of the superficial flap of rat model in the early postoperative stage. METHODS: One viable and one ischemic random-pattern flap were prepared on the left and right back of the same rat respectively with a number of 40. CEUS examinations were applied within 12 h and 7 days postoperatively, and the quantitative measurements of microvascular blood volume (BV) of the base and the end of both flaps were expressed using acoustic intensity as a ratio to that of the healthy skin. RESULTS: Within 12 h post operation, there was a smaller BV value of the ischemic ends than that of both the ischemic bases and viable ends (p < 0.001), while no difference was indicated between ischemic bases and viable bases or between viable bases and viable ends. The same result was provided 7 days post operation. CONCLUSION: Microcirculation of superficial tissues such as random-pattern flaps in this rat model can be assessed quantitatively by CEUS. It could sensitively and accurately reveal the objective status of tissue perfusion in the early postoperative stage.
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Medios de Contraste , Microcirculación , Colgajos Quirúrgicos , Ultrasonografía , Animales , Colgajos Quirúrgicos/irrigación sanguínea , Microcirculación/fisiología , Masculino , Ratas Sprague-Dawley , Ratas , Isquemia/diagnóstico por imagen , Periodo Posoperatorio , Volumen SanguíneoRESUMEN
BACKGROUND: Catastrophic loss of the penis following post-circumcision necrosis is a rare and devastating complication. Treatment options are limited, and the process is highly challenging. This study aims to report the successful application of our combined treatment approach for a 6-year-old patient who experienced total penile loss due to progressive necrosis 1 year after circumcision. METHODS & RESULTS: Following penile degloving, proximal penile mobilisation and separation and reshaping of the corpora were performed. The penile shaft was covered with a tunnelled composite anterior-lateral inguinal skin flap. Glanuloplasty was performed using a left buccal mucosal graft, followed by 10 sessions of hyperbaric oxygen therapy. At 1.5 months postoperatively, urethral dilation was performed once because of minor voiding difficulties. At 10 months postoperatively, the patient had excellent voiding function and no additional complaints. The patient expressed high satisfaction with the outcome and is still under close follow up. CONCLUSIONS: A standard treatment for serious complications such as necrosis and total penile loss has not been established yet. Although scrotal skin flap is a straightforward technique, it was not preferred in our case because of fibrosis following scrotal necrosis and potential risk of hair growth. The developed approach could be an effective alternative to other techniques.
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Circuncisión Masculina , Oxigenoterapia Hiperbárica , Mucosa Bucal , Pene , Colgajos Quirúrgicos , Humanos , Masculino , Pene/cirugía , Mucosa Bucal/trasplante , Niño , Circuncisión Masculina/efectos adversos , Complicaciones Posoperatorias/terapia , Complicaciones Posoperatorias/etiología , Necrosis/etiología , Terapia CombinadaRESUMEN
Pure vascularized periosteal transplants have been shown to be extremely effective at achieving rapid bone healing in children with biologically complex non-union. Free tibial and fibular periosteal transplants are generally indicated when large periosteal flaps are necessary. We report using a vascularized femoral myo-periosteal graft (VFMPG) to treat distal tibial osteotomy non-union in a six-year-old boy with congenital pseudarthrosis of the tibia. The graft consisted of a 9 cm myo-periosteal flap (after 50% of elastic retraction) that incorporated the vastus intermedius muscle and diaphyseal femoral periosteum nourished by the descending branch of the lateral circumflex femoral vessels. Plantaris medialis was used as a recipient vessel. Healing occurred 10 weeks after surgery. The patient resumed gait and sports activity without orthosis. No donor or recipient site complications occurred 17 months after surgery. Employing a VFMPG might be an alternative to other free or large vascularized periosteal flaps currently in use for complex pediatric non-unions.
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Fémur , Periostio , Seudoartrosis , Colgajos Quirúrgicos , Humanos , Masculino , Seudoartrosis/cirugía , Seudoartrosis/congénito , Periostio/trasplante , Niño , Fémur/trasplante , Fémur/irrigación sanguínea , Fémur/cirugía , Colgajos Quirúrgicos/irrigación sanguínea , Osteotomía/métodos , Tibia/cirugía , Tibia/trasplante , Fracturas de la Tibia/cirugíaRESUMEN
BACKGROUND: Elevated body mass index (BMI) is a known perioperative risk factor for complications such as delayed wound healing and infection. However, there is a gap in understanding how elevated BMI impacts outcomes after posttraumatic lower extremity (LE) microvascular reconstruction. METHODS: A retrospective review was performed at a level 1 trauma center between 2007 and 2022 of patients who underwent posttraumatic microvascular LE reconstruction. Demographics, flap/wound details, complications, and outcomes were recorded. Patients were stratified into BMI Center for Disease Control categories. RESULTS: A total of 398 patients were included with an average BMI of 28.2 ± 5.8. Nearly half (45%) of LE defects were located in the distal third of the leg, 27.5% in the middle third, and 34.4% in the proximal third. Most reconstructions utilized muscle-containing flaps (74.4%) compared with fasciocutaneous flaps (16.8%). Surgical approaches included free flaps (47.6%) and local flaps (52.5%). Class III obese patients were significantly more likely to be nonambulatory than nonobese patients (OR: 4.10, 95% CI 1.10-15.2, p = 0.035). At final follow-up, 30.1% of patients with Class III obesity were ambulatory, requiring either wheelchairs (42.3%) or assistance devices (26.9%). There were no significant differences in complication rates based on obesity status (0.704). The average follow-up time for the entire cohort was 5.8 years. CONCLUSIONS: BMI is critical for patient care and surgical decision-making in LE reconstruction. Further research is warranted to optimize outcomes for higher BMI patients, thereby potentially reducing the burden of postoperative complications and enhancing overall patient recovery.
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Índice de Masa Corporal , Traumatismos de la Pierna , Microcirugia , Procedimientos de Cirugía Plástica , Complicaciones Posoperatorias , Humanos , Masculino , Estudios Retrospectivos , Femenino , Adulto , Microcirugia/métodos , Microcirugia/efectos adversos , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/efectos adversos , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Traumatismos de la Pierna/cirugía , Resultado del Tratamiento , Obesidad/complicaciones , Extremidad Inferior/cirugía , Factores de Riesgo , Colgajos Tisulares Libres/trasplante , Colgajos Tisulares Libres/irrigación sanguínea , Colgajos Tisulares Libres/efectos adversos , Colgajos Quirúrgicos/irrigación sanguínea , Colgajos Quirúrgicos/trasplante , Colgajos Quirúrgicos/efectos adversosRESUMEN
BACKGROUND: Despite advancements in reconstructive procedures, ischemia-reperfusion (I/R) injury remains a significant challenge in reconstructive surgery, with mitochondrial dysfunction playing a pivotal role. Mitochondrial transplantation has emerged as a promising therapeutic strategy to address this issue. This study aims to evaluate the impact of umbilical cord mesenchymal stem cell-derived mitochondrial transplantation on skin flap I/R models in rats. MATERIAL AND METHODS: Twenty male rats underwent I/R injury on skin flaps, with or without mitochondrial transplantation administered via intravenous or subcutaneous routes. Analysis encompassed histopathology, inflammatory, apoptotic, oxidative stress, and hypoxia markers. RESULTS: Results revealed a reduction in inflammation, apoptosis, oxidative stress, and hypoxia in the transplantation group compared to controls. CONCLUSION: The findings suggest that umbilical cord mesenchymal stem cell-derived mitochondrial transplantation shows promise in enhancing flap viability and attenuating I/R injury, offering valuable insights for improved outcomes in reconstructive surgery. However, further exploration in larger animal models and refinement of delivery methods and dosage are warranted to fully elucidate its clinical translatability.
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Modelos Animales de Enfermedad , Trasplante de Células Madre Mesenquimatosas , Mitocondrias , Daño por Reperfusión , Cordón Umbilical , Animales , Masculino , Ratas , Trasplante de Células Madre Mesenquimatosas/métodos , Cordón Umbilical/citología , Mitocondrias/trasplante , Mitocondrias/metabolismo , Ratas Sprague-Dawley , Células Madre Mesenquimatosas , Colgajos Quirúrgicos/patología , Estrés Oxidativo , ApoptosisRESUMEN
BACKGROUND: Ischemia-reperfusion injury (IRI) is a phenomenon that affects transplant survival. The aim of our study was to examine the effects of IRI in isogenic and allogeneic muscle and skin transplantation models exposed to prolonged warm ischemia. METHODS: Forty-eight Lewis rats and 16 Brown-Norway rats were used to create four groups: Isogenic Inguinal Flap Transplantation (IST), Isogenic Gastrocnemius Muscle Flap Transplantation (IMT), Allogeneic Inguinal Flap Transplantation (AST), and Allogeneic Gastrocnemius Muscle Flap Transplantation (AMT). Malonyldialdehyde (MDA) and superoxide dismutase (SOD) levels were measured on postoperative days 1, 7, 21, 35, 63, 100, and 120 in all groups. Donor-specific chimerism (DSC) in peripheral blood was evaluated in the allogeneic groups on postoperative days 7, 21, 35, 63, 100, and 120. The microRNA-21 and microRNA-205 levels were evaluated on postoperative days 1, 7, and 120 in all groups. At the end of the study, a histopathological examination was performed. RESULTS: A statistically significant difference was found between the groups in terms of MDA and SOD levels. DSC was detected in the AMT group. A significant increase in microRNA-205 was observed, especially in the AMT group. There was no significant difference in the number of functional muscle units between the muscle transplantation groups. CONCLUSION: The presence of DSC in the AMT group and the lack of a significant difference in the number of functional muscle units in the IMT and AMT groups are noteworthy findings.
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Ratas Endogámicas Lew , Daño por Reperfusión , Trasplante de Piel , Animales , Daño por Reperfusión/patología , Ratas , Masculino , Músculo Esquelético/irrigación sanguínea , Colgajos Quirúrgicos/irrigación sanguínea , Modelos Animales de Enfermedad , Trasplante Homólogo , Ratas Endogámicas BNRESUMEN
BACKGROUND: Hypospadias is one of the common congenital anomalies of male genitalia. Although over 300 different operative techniques have been described, post-operative complications are still common, of which glans dehiscence (GD) is the most severe complication requiring redo urethroplasty. Some surgeons use the vascular flap to cover the glanular part of the neourethra to prevent GD, but there are controversies regarding its usefulness. There is a paucity in the literature, about articles evaluating the risk of GD associated with vascular flap coverage of the glanular neourethra during primary urethroplasty. MATERIALS AND METHODS: We planned a single-blinded, parallel-design, randomised controlled trial involving 56 cases of hypospadias treated with single-stage urethroplasty amongst the admitted cases of hypospadias for primary urethroplasty in the Department of Paediatric Surgery, AIIMS, Bhubaneswar, from November 2017 to December 2019 as an M.Ch. thesis project. This was approved by the Institutional Ethics Committee and enrolled in the national registry of clinical trial. 28 patients were randomised into Group A (without flap coverage of the glanular part of the neourethra) and 28 patients were randomised into Group B (with flap coverage of the glanular neourethra). RESULTS: Only 2 (7.1%) cases amongst the Group A patients developed GD, while 9 (32.1%) cases of Group B had GD (P = 0.013). CONCLUSIONS: Extending the vascular flap coverage up to the glanular part of the neourethra till the neo-meatus during primary urethroplasty is significantly associated with GD.
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Hipospadias , Colgajos Quirúrgicos , Dehiscencia de la Herida Operatoria , Uretra , Procedimientos Quirúrgicos Urológicos Masculinos , Humanos , Masculino , Hipospadias/cirugía , Uretra/cirugía , Procedimientos Quirúrgicos Urológicos Masculinos/métodos , Método Simple Ciego , Lactante , Preescolar , Complicaciones Posoperatorias/epidemiología , Procedimientos de Cirugía Plástica/métodos , NiñoRESUMEN
BACKGROUND: Wound dehiscence is one of the main complications in complete primary repair of exstrophy (CPRE). In our pediatric urology unit, we have switched to the use of inferior epigastric artery based rectus abdominis flap cover for abdominal wall closure in addition to measures like osteotomy and postoperative hip spica. AIM: to assess the efficacy of Recus abdominis flap in prevenion of wound dehisence. METHODS: This study was conducted from June 2014 to June 2021 comparing two groups of the patients; group I consisted of thirty patients of CPRE with rectus flap repair of abdominal wall (CPRE-RF) and group II consisted of thirty patients with CPRE without rectus flap. Clinical and surgical details, including the outcome with regards to wound dehiscence and continence, were recorded. RESULTS: The mean age of the patients in CPRE-RF was 5 months and that with only CPRE was 4.6 months. Mean pubic diastasis in Group l was 4.8± 1.07 cm and that of Group II was 4.6±1.3 cm. None of the patients in CPRE-RF had wound dehiscence or bladder prolapse while as 6 patients in CPRE alone had wound dehiscence and 1 had bladder prolapse. This difference was statistically significant. Primary bladder continence was achieved in 4 patients in CPRE-RF and 3 patients in CPRE group. Hypospadias had almost similar occurrence in the two groups. One patient in each group had bladder neck fistula. CONCLUSION: Use of rectus muscle flap in complete Primary Repair ofExtrophy bladder helps in prevention of wound dehiscence and contributes in achievement of final goal of continence in wide gap pubic diatasis.
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Extrofia de la Vejiga , Recto del Abdomen , Colgajos Quirúrgicos , Dehiscencia de la Herida Operatoria , Humanos , Extrofia de la Vejiga/cirugía , Masculino , Femenino , Recto del Abdomen/trasplante , Lactante , Dehiscencia de la Herida Operatoria/prevención & control , Dehiscencia de la Herida Operatoria/cirugía , Procedimientos de Cirugía Plástica/métodos , Estudios Retrospectivos , Resultado del Tratamiento , Procedimientos Quirúrgicos Urológicos/métodosRESUMEN
OBJECTIVE: To evaluate the early detection of vascular obstruction in microvascular flaps using a thermographic camera. STUDY DESIGN: A cross-sectional study. Place and Duration of the Study: Department of Plastic Surgery, Jinnah Burn and Reconstructive Surgery Centre, Lahore, Pakistan, from July to December 2023. METHODOLOGY: Microvascular flaps with cutaneous islands were monitored postoperatively with a thermographic camera in addition to conventional clinical methods. The decision to re-explore was based on conventional methods, and confirmation was achieved through intraoperative findings of vascular obstruction during re-exploration. RESULTS: Thirty-one patients who underwent microvascular surgery were monitored postoperatively with a thermographic camera. There were 20 (64.5%) anterolateral thigh flaps, 4 (12.9%) radial forearm flaps, 3 (9.7%) scapular-parascapular flaps, 1 (3.2%) medial plantar flap, 1 (3.2%) myocutaneous gracilis flap, 1 (3.2%) latissimus dorsi (LD) flap, and 1 (3.2%) chimeric adductor longus and gracilis flap. Three (9.7%) flaps developed postoperative vascular obstruction. The thermographic camera detected complications two to four hours earlier than conventional methods, with a statistically significant difference (p >0.109). CONCLUSION: A thermographic camera is a valuable, non-invasive, and simple tool for monitoring microvascular flaps. It can detect complications several hours earlier and has the potential to be a practice-changing modality. KEY WORDS: Microvascular flaps, Thermographic camera, Vascular obstruction.
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Colgajos Quirúrgicos , Termografía , Humanos , Masculino , Termografía/métodos , Femenino , Estudios Transversales , Colgajos Quirúrgicos/irrigación sanguínea , Persona de Mediana Edad , Adulto , Procedimientos de Cirugía Plástica/métodos , Complicaciones Posoperatorias/diagnóstico , Diagnóstico Precoz , Adulto Joven , Anciano , Pakistán , AdolescenteRESUMEN
BACKGROUND: Random-pattern skin flaps are commonly used to repair skin tissue defects in surgical tissue reconstruction. However, flap necrosis in the distal area due to ischemia injury is still challenging for its applications in plastic surgery. The complications of diabetes will further increase the risk of infection and necrosis. METHODS: This study induced type 2 diabetes mellitus (T2DM) rats with a high-fat diet and STZ. The survival rate of the skin flap was observed by adding inorganic sodium nitrate to drinking water. Histology and immunohistochemistry were used to detect the damage to the skin flap. The nitrate content was measured by total nitric oxide and nitrate/nitrite parameter assay. Dihydroethidium and malondialdehyde (MDA) assays were used to value oxidative stress. Rat colon feces were collected for 16s rRNA gene sequence. RESULTS: Our studies showed that nitrate administration leads to anti-obesity and anti-diabetic effects. Nitrate directly increased the survival area of skin flaps in diabetic rats and mean blood vessel density by enhancing angiogenesis, inhibiting apoptosis, and reducing oxidative stress. The 16s rRNA sequence revealed that nitrate may regulate the homeostasis of the gut microbiota and re-store energy metabolism. CONCLUSION: Dietary nitrate has been shown to maintain the homeostasis of oxidative stress and gut microbiota to promote flap survival in rats with T2DM.
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Diabetes Mellitus Experimental , Diabetes Mellitus Tipo 2 , Microbioma Gastrointestinal , Homeostasis , Nitratos , Estrés Oxidativo , Colgajos Quirúrgicos , Animales , Estrés Oxidativo/efectos de los fármacos , Ratas , Nitratos/metabolismo , Diabetes Mellitus Tipo 2/metabolismo , Diabetes Mellitus Tipo 2/patología , Microbioma Gastrointestinal/efectos de los fármacos , Diabetes Mellitus Experimental/metabolismo , Masculino , Ratas Sprague-Dawley , Supervivencia de Injerto/efectos de los fármacos , Dieta Alta en Grasa/efectos adversosRESUMEN
PURPOSE: To evaluate exogenous hyaluronic acid (HA) derived from bacterial fermentation through enteral and parenteral routes in ischemic skin flaps induced in rats, using clinical and histological exams; and interleukins (IL) as tissue inflammatory biomarkers. METHODS: Sixty-four male adults Wistar rats with ischemic skin flaps on the dorsum were randomized into four groups, based on the treatment protocol: subcutaneous administration of saline solution (0.9%) (GI); oral administration of distilled water (GII); subcutaneous administration of HA (0.3%) (GIII); and oral administration of HA (1%) (GIV). Flaps of all groups were comparable regarding clinical and macroscopic evaluation, histological examination, pro-inflammatory cytokines (IL-1ß, IL-6, and tumor necrosis factor-α) and anti-inflammatory cytokine IL-10. RESULTS: A lower percentage of necrosis was identified in flaps treated with subcutaneous administration of HA (0.3%). The pro- and anti-inflammatory cytokines, epidermis thickness, blood vessels, and inflammatory cells showed statistically significant inter-group and intra-group differences (p < 0.05). CONCLUSIONS: High molecular HA (1,400 ~ 2,000 kDa) administrated by subcutaneous or oral route exhibited beneficial effects in ischemic skin flaps of rats. However, subcutaneous administration of HA (0.3%) showed better results in terms of the percentage of necrosis and epithelialization.
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Ácido Hialurónico , Isquemia , Distribución Aleatoria , Ratas Wistar , Colgajos Quirúrgicos , Animales , Masculino , Ácido Hialurónico/administración & dosificación , Colgajos Quirúrgicos/irrigación sanguínea , Colgajos Quirúrgicos/patología , Piel/efectos de los fármacos , Piel/patología , Método Doble Ciego , Citocinas/análisis , Citocinas/metabolismo , Necrosis , Ratas , Administración Oral , Modelos Animales de Enfermedad , Reproducibilidad de los ResultadosRESUMEN
BACKGROUND: In this report, we describe an uncommon instance of fungating synovial sarcoma affecting the posterior aspect of the neck. Although the existing literature has documented a limited number of cases, this particular case contributes to the knowledge about it, which is scarce. CASE PRESENTATION: A total of 5 months before the examination, a Pakistani-Asian male, age 20 years, complained of a malodorous fungating swelling on the posterior aspect of his neck. An examination revealed a foul-smelling, 10 × 13 cm fungating enlargement surrounded by maggots and hemorrhaging at the site of the incision. A hemoglobin level of 6 and a total leukocyte count (TLC) of 23,000 indicated the patient's disoriented and pallid appearance. He was expeditiously admitted, and preoperatively, the general well-being of the patient was optimized. After a comprehensive discussion with the medical team, a strategy for marginal excision and coverage with a latissimus dorsi (LD) flap and grafting was devised. The tumor was successfully excised, and an LD flap with graft was conducted on the patient during surgery; however, the infection caused the failure of half of the graft. Following that, the lesion was debrided, and re-grafting was performed. The patient was subsequently administered 5 cycles of chemotherapy and 32 cycles of radiotherapy. He was diagnosed with pulmonary metastasis 2 years later. Sadly, the patient died during a follow-up visit 3.5 years later. CONCLUSIONS: The patient's unfavorable prognosis after surgical intervention, radiotherapy, and chemotherapy, despite undergoing all-encompassing treatments, underscores the importance of early detection and intervention in fungating tumor cases.
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Neoplasias de Cabeza y Cuello , Sarcoma Sinovial , Humanos , Masculino , Sarcoma Sinovial/terapia , Sarcoma Sinovial/cirugía , Sarcoma Sinovial/patología , Adulto Joven , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/terapia , Neoplasias de Cabeza y Cuello/cirugía , Colgajos QuirúrgicosRESUMEN
BACKGROUND: Alveolar Bone loss occurs frequently during the first six months after tooth extraction. Various studies have proposed different methods to reduce as much as possible the atrophy of the alveolar ridge after tooth extraction. Filling the socket with biomaterials after extraction can reduce the resorption of the alveolar ridge. We compared the height of the alveolar process at the mesial and distal aspects of the extraction site and the resorption rate was calculated after the application of HA/ß-TCP or synthetic co-polymer polyglycolic - polylactic acid PLGA mixed with blood to prevent socket resorption immediately and after tooth extraction. METHODS: The study was conducted on 24 extraction sockets of impacted mandibular third molars bilaterally, vertically, and completely covered, with a thin bony layer. HA/ß-TCP was inserted into 12 of the dental sockets immediately after extraction, and the synthetic polymer PLGA was inserted into 12 of the dental sockets. All sockets were covered completely with a full-thickness envelope flap. Follow-up was performed for one year after extraction, using radiographs and stents for the vertical alveolar ridge measurements. RESULTS: The mean resorption rate in the HA/ß-TCP and PLGA groups was ± 1.23 mm and ± 0.1 mm, respectively. A minimal alveolar bone height reduction of HA/ß-TCP was observed after 9 months, the reduction showed a slight decrease to 0.93 mm, while this rate was 0.04 mm after 9 months in the PLGA group. Moreover, the bone height was maintained after three months, indicating a good HA/ß-TCP graft performance in preserving alveolar bone (1.04 mm) while this rate was (0.04 mm) for PLGA. CONCLUSION: The PLGA graft demonstrated adequate safety and efficacy in dental socket preservation following tooth extraction. However, HA/ß-TCP causes greater resorption at augmented sites than PLGA, which clinicians should consider during treatment planning.
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Pérdida de Hueso Alveolar , Sustitutos de Huesos , Ácido Láctico , Copolímero de Ácido Poliláctico-Ácido Poliglicólico , Extracción Dental , Alveolo Dental , Humanos , Alveolo Dental/cirugía , Pérdida de Hueso Alveolar/prevención & control , Sustitutos de Huesos/uso terapéutico , Copolímero de Ácido Poliláctico-Ácido Poliglicólico/uso terapéutico , Masculino , Femenino , Ácido Láctico/uso terapéutico , Adulto , Ácido Poliglicólico/uso terapéutico , Proceso Alveolar/patología , Tercer Molar/cirugía , Diente Impactado/cirugía , Estudios de Seguimiento , Adulto Joven , Colgajos Quirúrgicos , Materiales Biocompatibles/uso terapéutico , Aumento de la Cresta Alveolar/métodos , Hidroxiapatitas/uso terapéutico , Mandíbula/cirugía , Fosfatos de Calcio/uso terapéutico , Resultado del TratamientoRESUMEN
BACKGROUND: The efficacy of injections of mesenchymal stem cells (MSC) for anal fistula treatment may be impaired by the persistence of stools passing into the fistula, causing bacterial contamination and a local inflammatory reaction. We aimed to compare remission rates between patients treated by MSC injection with simple sutures and those treated with a rectal advancement flap. METHODS: This single-center prospective study compared the first patients who underwent internal opening closure with sutures with the subsequent patients treated with a flap. Complete clinical remission was defined as complete closure of the external opening(s) without pain or discharge, and complete radiological remission was defined as a Magnifi-CD score of 0. RESULTS: We compared the first 42 patients who had sutures with the 20 subsequent patients who had an advancement flap. The median follow-up was 15.5 [8.8-24.9] months. The cumulative incidence of complete clinical response at M12 was 53.8% [38.1-69.6%] in the suture group versus 93.3% [77.4-100.0] in the flap group (p < 0.001). The Magnifi-CD score was 0 for 41.7% [25.5-59.2%]) of patients treated with sutures versus 72.7% [39.0-63.9%]) of patients treated with a flap (p = 0.093). Anal incontinence score did not differ between the two groups. Practicing an advancement flap was the only significant factor associated with complete clinical remission over time (adjusted HR [95% CI] of 2.6 [1.4-4.9], p = 0.003). CONCLUSIONS: Complete clinical remission rates following MSC injection are significantly higher after closure of the internal opening with a rectal flap than after closure with sutures, without consequences on anal continence.
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Enfermedad de Crohn , Trasplante de Células Madre Mesenquimatosas , Fístula Rectal , Colgajos Quirúrgicos , Humanos , Enfermedad de Crohn/complicaciones , Fístula Rectal/etiología , Fístula Rectal/terapia , Fístula Rectal/cirugía , Masculino , Femenino , Estudios Prospectivos , Adulto , Trasplante de Células Madre Mesenquimatosas/métodos , Resultado del Tratamiento , Persona de Mediana Edad , Técnicas de Sutura , Recto/cirugía , Inducción de Remisión , Estudios de SeguimientoAsunto(s)
Epiplón , Colgajos Quirúrgicos , Infección de la Herida Quirúrgica , Humanos , Epiplón/trasplante , Epiplón/cirugía , Masculino , Mediastino/cirugía , Enfermedades del Colon/cirugía , Enfermedades del Colon/etiología , Colon Transverso/cirugía , Esternón/cirugía , Anciano , Hernia/etiologíaRESUMEN
INTRODUCTION: Smoking poses a risk to flap viability, with nicotine being a major contributor to the formation of free radicals. Allopurinol, known for its antioxidant properties, has been shown to enhance tissue survival in ischemic conditions by reducing the production of reactive oxygen species (ROS). This study aims to assess the impact of allopurinol on the viability and success of skin flaps in Wistar rats exposed to nicotine. METHODS: This study examined skin flap survival in nicotine-exposed rats treated with allopurinol. Twenty-eight rats were separated into two groups. During 1 month of nicotine exposure, the treatment group received systemic allopurinol 7 days before and 2 days after the flap procedure, while the control group received no allopurinol. Pro-angiogenic factors, proinflammatory factors, anti-inflammatory factors, and oxidative markers were assessed on the 7th day after the flap procedure using enzyme-linked immunosorbent assay method. Macroscopic flap viability was evaluated on the 7th day using Image J photos. RESULTS: As an oxidative marker, malondialdehyde levels were significantly lower in rats given allopurinol than in controls (P < 0.001). The levels of interleukin 6 and tumor necrosis factor α, as markers of inflammatory factors, were significantly lower in the group of rats given allopurinol compared to controls (P < 0.001). The level of angiogenesis in rats given allopurinol, measured by vascular endothelial growth factor levels, was also higher in the treatment group compared to controls (P < 0.001). Macroscopically, the percentage of distal flap necrosis in Wistar rats given allopurinol was lower and statistically significant compared to controls (P < 0.001). CONCLUSIONS: Xanthine oxidoreductase is part of a group of enzymes involved in reactions that produce ROS. Allopurinol, as an effective inhibitor of the xanthine oxidase enzyme, can reduce oxidative stress by decreasing the formation of ROS. This reduction in oxidative stress mitigates the risk of ischemic-reperfusion injury effects and significantly increases the viability of Wistar rat flaps exposed to nicotine.