RESUMEN
Seizure following cerebrospinal fluid (CSF) rhinorrhoea surgery or surgery of the skull base almost always implies postoperative meningoencephalitis, unless proven otherwise. Here, we present the case of a middle-aged female in her 40's who underwent surgical CSF fistula closure and developed seizure on the eighth postoperative day. She was diagnosed to have posterior reversible encephalopathy syndrome (PRES). Early diagnosis and prompt initiation of treatment ensured that she had a complete recovery. Although not reported in the literature, PRES should always be a differential diagnosis in such situations, as delay in diagnosis may result in significant morbidity and rarely mortality.
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Rinorrea de Líquido Cefalorraquídeo , Complicaciones Posoperatorias , Convulsiones , Humanos , Femenino , Rinorrea de Líquido Cefalorraquídeo/cirugía , Rinorrea de Líquido Cefalorraquídeo/etiología , Rinorrea de Líquido Cefalorraquídeo/diagnóstico , Convulsiones/etiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Adulto , Síndrome de Leucoencefalopatía Posterior/diagnóstico , Síndrome de Leucoencefalopatía Posterior/etiología , Diagnóstico Diferencial , Imagen por Resonancia MagnéticaRESUMEN
The problem of treating purulent scleral infections, rare but extremely severe complication of ophthalmic surgeries, remains unresolved. This article presents a case of successful surgical treatment of purulent scleritis - interlamellar scleral abscess - that developed in a patient after repeat penetrating keratoplasty performed due to infectious lysis of the transplant. Although the first keratoplasty was performed for acanthamoeba keratitis, there were no signs of acanthamoeba invasion in the transplant at the time of the second surgery. Scleritis manifested as an infiltrate with pus penetrating the anterior chamber and development of keratoiridocyclitis. During surgery, the abscess cavity was opened, irrigated with an antiseptic solution, and drained into the subconjunctival space; the anterior chamber was irrigated with balanced salt solution through a separate paracentesis. No infection recurrences were noted in the postoperative period and the corneal transplant remained clear.
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Queratitis por Acanthamoeba , Queratoplastia Penetrante , Escleritis , Humanos , Queratoplastia Penetrante/métodos , Queratoplastia Penetrante/efectos adversos , Queratitis por Acanthamoeba/etiología , Queratitis por Acanthamoeba/diagnóstico , Queratitis por Acanthamoeba/cirugía , Escleritis/etiología , Escleritis/diagnóstico , Escleritis/cirugía , Resultado del Tratamiento , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Masculino , Reoperación/métodos , Esclerótica/cirugía , Adulto , FemeninoRESUMEN
PURPOSE: Parastomal hernia (PH) is a frequent complication following radical cystectomy and ileal conduit. The purpose of this study was to summarize the clinical experience and technical characteristics of laparoscopic Sugarbaker repair of PH following radical cystectomy and ileal conduit. METHODS: We retrospectively evaluated all patients who underwent laparoscopic treatment of PH following radical cystectomy and ileal conduit at Huashan Hospital, Fudan University from May 2013 to December 2022. RESULTS: Thirty-five patients were included in the study. Median follow up was 32months (IQR, 25-38 months). Three patients presented with a recurrence (8.6%), with a median time to recurrence of 14 months. Out of the 35 patients, Thirty-two underwent totally laparoscopic repair using the Sugarbaker technique, Three patients required open surgery to repair the intestinal injury after laparoscopic exploration. One patient died 9 months post-surgery due to COVID-19. During the follow-up period, two patients developed a peristomal abscess, and one patient experienced partial intestinal obstruction 10 days after surgery. CONCLUSION: Surgical management of PH following radical cystectomy and ileal conduit is challenging. The laparoscopic Sugarbaker technique for repairing PH following radical cystectomy and ileal conduit has low complication and recurrence rate.
Asunto(s)
Cistectomía , Herniorrafia , Laparoscopía , Derivación Urinaria , Humanos , Cistectomía/métodos , Cistectomía/efectos adversos , Masculino , Laparoscopía/métodos , Laparoscopía/efectos adversos , Estudios Retrospectivos , Derivación Urinaria/efectos adversos , Derivación Urinaria/métodos , Femenino , Anciano , Persona de Mediana Edad , Herniorrafia/métodos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Hernia Incisional/etiología , Hernia Incisional/cirugía , Neoplasias de la Vejiga Urinaria/cirugíaRESUMEN
Rectal prolapse is a common disease in childhood and observed mainly at the age of 1-4 years old (95% of cases). If conservative treatment is ineffective, surgical correction of rectal prolapse in children without previous anorectal surgery is performed at the age of over a year. There is a single report on examination of patients aged 4-16 years after surgical correction of anorectal malformations with postoperative rectal prolapse. We present diagnosis and successful surgical treatment of rectal prolapse in an infant who underwent previous perineal proctoplasty for fistulous form of anorectal malformation.
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Prolapso Rectal , Recto , Humanos , Prolapso Rectal/cirugía , Prolapso Rectal/etiología , Prolapso Rectal/diagnóstico , Recto/cirugía , Recto/anomalías , Resultado del Tratamiento , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/diagnóstico , Masculino , Malformaciones Anorrectales/cirugía , Malformaciones Anorrectales/diagnóstico , Femenino , Preescolar , Reoperación/métodosRESUMEN
BACKGROUND: Benign uretero-ileal anastomotic stricture (UIAS) is a potentially serious complication that can arise after radical cystectomy (RC) and subsequent urinary diversion. To preserve residual renal function and improve prognosis, it is crucial to derive insights from experience and tailor individualized treatment strategies for different patients. PATIENTS AND METHODS: From October 2014 to June 2021, a total of 47 patients with benign UIAS underwent endoscopic management (n = 19) or reimplantation surgery (n = 28). The basic data, perioperative conditions, and postoperative outcomes of the two groups were compared and analyzed to evaluate efficacy. RESULTS: Comparing preoperative and postoperative clinical efficacy within the same group, the endoscopic group showed no significant differences in creatinine and blood urea nitrogen (BUN) levels before surgery or after extubation (p > 0.05). However, significant differences were observed in glomerular filtration rate (GFR) levels on the affected side before surgery and after extubation (p < 0.05). In contrast, the laparoscopic reimplantation group did not exhibit significant differences in creatinine, BUN, or GFR levels of affected side before surgery and after extubation (p > 0.05). Postoperative clinical efficacy showed no significant difference in creatinine and BUN levels between the two groups (p > 0.05). However, GFR values of affected side in the endoscopic treatment group decreased more than those in the laparoscopic reimplantation group (p < 0.05). Additionally, the laparoscopic reimplantation group was able to remove the single-J tube earlier than the endoscopic treatment group (p < 0.05), had a lower recurrence rate of hydronephrosis after extubation (p < 0.05), and experienced a later onset of hydronephrosis compared to the endoscopic treatment group (p < 0.05). CONCLUSIONS: Based on our experience in treating UIAS following RC combined with urinary diversion, laparoscopic reimplantation effectively addresses the issue of UIAS, allowing for the removal of the ureteral stent relatively soon after surgery. This approach maintains long-term ureteral patency, preserves residual renal function, reduces the risk of ureteral restenosis and hydronephrosis, and has demonstrated superior therapeutic outcomes in this study.
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Anastomosis Quirúrgica , Cistectomía , Complicaciones Posoperatorias , Uréter , Derivación Urinaria , Humanos , Derivación Urinaria/efectos adversos , Derivación Urinaria/métodos , Cistectomía/efectos adversos , Masculino , Femenino , Anciano , Persona de Mediana Edad , Constricción Patológica/etiología , Constricción Patológica/cirugía , Anastomosis Quirúrgica/efectos adversos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Uréter/cirugía , Tasa de Filtración Glomerular , Íleon/cirugía , Estudios Retrospectivos , Neoplasias de la Vejiga Urinaria/cirugía , Resultado del Tratamiento , Creatinina/sangre , Laparoscopía/efectos adversos , Obstrucción Ureteral/cirugía , Obstrucción Ureteral/etiologíaRESUMEN
Intrathoracic herniation of the gastric tube pulled up through the retrosternal route after oesophagectomy is relatively rare and usually can be managed by conservative treatment.We present two patients who needed reoperation for intrathoracic herniation of gastric tube after minimally invasive oesophagectomy for thoracic oesophageal cancer. Postoperatively, both patients showed herniation and acute twist of the gastric tube. Due to the twist of the gastric tube, one patient had ischaemic change of the proximal tip of the gastric tube, and the other patient showed delayed gastric emptying, both of which led to surgical repairs. In this case report, we discuss why the herniation of gastric tube from the retrosternal route occurs, how to decide to do reoperation and how to prevent this complication.
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Neoplasias Esofágicas , Esofagectomía , Complicaciones Posoperatorias , Reoperación , Humanos , Esofagectomía/efectos adversos , Reoperación/métodos , Masculino , Neoplasias Esofágicas/cirugía , Complicaciones Posoperatorias/cirugía , Persona de Mediana Edad , Anciano , Hernia/etiología , Estómago/cirugía , FemeninoRESUMEN
Bariatric surgery is a safe and effective treatment option for patients with obesity and obesity-related comorbidities, with Roux-en-Y gastric bypass and sleeve gastrectomy being the two most common procedures. Despite the success of these interventions, adverse events are not uncommon. Endoscopic management has become first-line therapy when complications occur, and the armamentarium of devices and techniques continues to grow. This article focuses on the management of fistulas, leaks, and ulcers and also focuses on the etiology and endoscopic management strategy of each complication.
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Fuga Anastomótica , Cirugía Bariátrica , Complicaciones Posoperatorias , Humanos , Cirugía Bariátrica/efectos adversos , Cirugía Bariátrica/métodos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Fuga Anastomótica/cirugía , Fuga Anastomótica/etiología , Endoscopía Gastrointestinal/métodos , Obesidad Mórbida/cirugía , Obesidad Mórbida/complicaciones , Fístula Gástrica/etiología , Fístula Gástrica/cirugía , Úlcera/etiología , Úlcera/cirugía , Derivación Gástrica/efectos adversos , Derivación Gástrica/métodosRESUMEN
Weight regain, also known as recurrent weight gain, is common following bariatric surgeries. While anti-obesity medications and surgical revisions offer effective treatment options, they are not without their challenges and limitations. Over the last few decades, there have been significant advancements in endoscopic interventions to address weight regain following bariatric surgery. These procedures have demonstrated feasibility, safety, efficacy, and durability, offering minimally invasive treatment options for this patient population.
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Cirugía Bariátrica , Aumento de Peso , Humanos , Cirugía Bariátrica/métodos , Cirugía Bariátrica/efectos adversos , Endoscopía Gastrointestinal/métodos , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Recurrencia , Obesidad/cirugíaRESUMEN
BACKGROUND: Coronary artery bypass grafting (CABG) surgery is a common procedure for managing multi-vessel coronary artery disease to revascularize the myocardium. Among the various conduits used, the left internal mammary artery (LIMA) is preferred due to its better long-term patency rate. However, CABG procedures involving LIMA may result in rare but serious complications, such as avulsion of the LIMA post-CABG, which leads to disruption of blood flow to the myocardium and the development of fatal cardiac tamponade. CASE PRESENTATION: We hereby present a unique case of spontaneous avulsion of a LIMA graft to the left anterior descending artery (LAD) away from the site of anastomosis, twenty-four hours following CABG surgery in a 67-year-old male patient. Emergency re-exploration and repair of the LIMA with interposition vein graft were performed and resulted in successful stabilization of the patient's critical condition. However, this was followed by a complicated recovery period involving atrial fibrillation, acute kidney injury, and wound infection. CONCLUSION: Avulsion of LIMA graft following CABG is rare, yet a fatal complication that requires high clinical suspicion and prompt management. Avulsion has been reported a few times in literature following both minimal invasive and conventional CABG. Understanding the etiology, clinical presentation, and management of this complication is crucial to avoid catastrophic outcomes.
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Puente de Arteria Coronaria , Arterias Mamarias , Humanos , Masculino , Anciano , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/métodos , Arterias Mamarias/trasplante , Arterias Mamarias/lesiones , Arterias Mamarias/cirugía , Complicaciones Posoperatorias/cirugía , Enfermedad de la Arteria Coronaria/cirugía , Anastomosis Interna Mamario-Coronaria/efectos adversosRESUMEN
Ganglion cysts (GC) are an uncommon complication following arthroscopic knee surgery. Due to high rates of recurrence following GC resection, many symptomatic patients can experience pain and discomfort for years. The presence of a GC at the site of an arthroscopic knee portal has only been reported once before in the literature. This case report details the history, physical and treatment of an active-duty soldier who had undergone various aspirations and surgical resections with limited improvement until the most recent operative intervention. At 18 months postoperatively, the patient had not experienced recurrence and had returned to all activities. We believe this surgical technique yielded resolution of the GC because following resection, the joint was checked to exclude areas of fluid extravasation, the capsule closure was performed with non-absorbable barbed suture and the operative extremity was immobilised in extension for 2 weeks to promote soft tissue rest and healing.
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Artroscopía , Ganglión , Articulación de la Rodilla , Recurrencia , Humanos , Artroscopía/efectos adversos , Artroscopía/métodos , Ganglión/cirugía , Masculino , Articulación de la Rodilla/cirugía , Adulto , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugíaRESUMEN
Percutaneous treatment of para-prosthetic valve leaks (PVL) is an alternative to redo surgery. Based on the clinical case of an unusual aortic para-prosthetic leak closure (PVLc), are presented successively the diagnostic difficulties of PVL, the modalities of therapeutic choice, the main technical steps of PVLc followed by a review of results and complications.
Asunto(s)
Prótesis Valvulares Cardíacas , Falla de Prótesis , Humanos , Prótesis Valvulares Cardíacas/efectos adversos , Reoperación , Implantación de Prótesis de Válvulas Cardíacas , Masculino , Válvula Aórtica/cirugía , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/etiología , Femenino , AncianoRESUMEN
CASE: A 51-year-old woman, who had previously undergone C5-C7 anterior cervical discectomy and fusion, presented with symptomatic hardware failure and subsequently underwent instrumentation removal. Her postoperative course was complicated by an esophageal perforation. Despite initial repair using a rotational flap, the leak persisted, prompting esophageal reconstruction with a radial forearm free flap (RFFF). CONCLUSION: Persistent esophageal perforation is exceedingly rare and difficult to treat. This report discusses the surgical technique for RFFF, an excellent option for revising failed sternocleidomastoid rotational flaps. The decision between rotational repair and free flap reconstruction depends on factors such as defect size, vascularization, wound condition, and donor site morbidity.
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Vértebras Cervicales , Perforación del Esófago , Fusión Vertebral , Humanos , Femenino , Persona de Mediana Edad , Perforación del Esófago/cirugía , Perforación del Esófago/etiología , Vértebras Cervicales/cirugía , Fusión Vertebral/efectos adversos , Fusión Vertebral/instrumentación , Remoción de Dispositivos , Antebrazo/cirugía , Colgajos Tisulares Libres/efectos adversos , Discectomía/efectos adversos , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/etiologíaRESUMEN
BACKGROUND: Pulmonary resection is an important part of comprehensive treatment of lung cancer. Despite the progress in recent thoracic surgery, reoperation is occasionally inevitable for managing severe perioperative complications. This study aimed to investigate the incidence and causes of perioperative reoperation in lung cancer patients. METHODS: We retrospectively collected patients who underwent reoperation following pulmonary resection from January 2010 to February 2021 in China-Japan Friendship Hospital. RESULTS: Among the 5032 lung cancer patients who received primary pulmonary resection in our institute, 37 patients underwent perioperative reoperation with the rate being 0.74%. Lobectomy was the most frequently executed procedure (56.8%). The mean duration of the primary surgery was 143.6 ± 65.1 min. About half of the cases received secondary surgery within 24 h of the primary surgery, whereas only one case underwent secondary surgery 30 days after the primary surgery (due to chylous leakage). The major causes of the reoperation were bleeding (73.0%), chylous leakage (13.5%), lobar torsion (5.4%), air leakage (2.7%), atelectasis (2.9%), and cardiac herniation (2.7%). CONCLUSION: The most prevalent reasons for unplanned reoperation following pulmonary resection in lung cancer patients include bleeding, chylous leakage, and lobar torsion. The strict control of the surgical indications and standardization of surgical procedures are fundamental to reduce unplanned secondary operations after pulmonary resections. Timely identification of the need to secondary surgery is also important to ensure patients' safety.
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Neoplasias Pulmonares , Neumonectomía , Complicaciones Posoperatorias , Reoperación , Humanos , Neoplasias Pulmonares/cirugía , Reoperación/estadística & datos numéricos , Masculino , Femenino , Estudios Retrospectivos , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/etiología , Anciano , Neumonectomía/efectos adversos , Neumonectomía/métodos , China/epidemiología , Incidencia , Japón/epidemiologíaAsunto(s)
Síndrome del Asa Aferente , Anastomosis Quirúrgica , Drenaje , Pancreaticoduodenectomía , Humanos , Pancreaticoduodenectomía/efectos adversos , Pancreaticoduodenectomía/métodos , Drenaje/métodos , Constricción Patológica/etiología , Constricción Patológica/cirugía , Anastomosis Quirúrgica/efectos adversos , Síndrome del Asa Aferente/etiología , Síndrome del Asa Aferente/cirugía , Masculino , Anciano , Persona de Mediana Edad , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/etiologíaRESUMEN
PURPOSE: This study highlights the pattern of presentation, treatment, early functional outcome, and complications observed in the management of chronic patellar tendon ruptures using our preferred technique of autogenous semitendinosus graft reconstruction. METHODS: This was a retrospective case series involving consecutive patients who underwent patellar tendon reconstruction and met the inclusion criteria. The outcome measures were determined by the post-operative knee range of motion (R.O.M), the post-operative International Knee Documentation Committee (IKDC) score, and pattern of post-operative complications. RESULTS: Nine patients were included in this case series. The mean age of the patients was 35.4 ± 6.8 years (range 27-44 years). Trauma to the knee accounted for majority of the cases (62.5%). Six (66.7%) of the nine patients suffered a patellar tendon rupture from contact injury during sporting activities. The mean length of time from injury to presentation was 20.5 ± 11.2 weeks (range 6-69.5 weeks). Normal knee function in a case (11.1%), nearly normal knee function in 7 cases (77.8%), and abnormal knee function in a case (11.1%) were recorded as a measure of outcome of surgery. The mean post-operative IKDC score was 70.0 ± 6.1 (range 55-77), which was higher than the mean pre-operative score of 26.4 ± 5.1 (range 18-32). The post-operative knee R.O.M averaged 97.2 ± 16.2° (range 70-120°) with a single case with a 10° extension lag noted. CONCLUSION: Normal to near-normal knee function was obtained with the treatment of chronic patellar tendon rupture in the majority of cases using autogenous semitendinosus graft for patellar tendon reconstruction in our series.
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Tendones Isquiotibiales , Ligamento Rotuliano , Rango del Movimiento Articular , Traumatismos de los Tendones , Humanos , Adulto , Estudios Retrospectivos , Ligamento Rotuliano/cirugía , Ligamento Rotuliano/lesiones , Masculino , Rotura/cirugía , Femenino , Resultado del Tratamiento , Traumatismos de los Tendones/cirugía , Tendones Isquiotibiales/trasplante , Enfermedad Crónica , Procedimientos de Cirugía Plástica/métodos , Traumatismos de la Rodilla/cirugía , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Trasplante Autólogo/métodos , AutoinjertosRESUMEN
PURPOSE: This study aimed to compare reoperation rate and clinical outcomes between revision open reduction and internal fixation and hip arthroplasty following failed subtrochanteric fracture fixation. METHODS: A retrospective review was conducted of patients > 50 years old treated for failed fixation of subtrochanteric fractures with revision ORIF or hip arthroplasty from 2003 to 2023. Primary outcomes included rate of fracture union and reoperations after initial salvage therapy. Secondary outcomes included complications (infection, dislocation, bursitis, implant prominence, implant failure, nonunion), pain, and gait-aid requirements by final follow-up. RESULTS: Forty-four patients were identified: 34 treated with revision ORIF and 10 with hip arthroplasty. The arthroplasty cohort was older (75.4 vs. 66.0 years, p = 0.016) but did not differ from the ORIF cohort in sex, type of initial fixation, or reason for fixation failure. Patients treated with revision ORIF and patients treated with arthroplasty had similar rates of fracture union (85.3% vs. 80.0%, p = 0.772) and reoperation (35.3% vs. 30.0%, p = 0.710). There was no significant difference in rate of additional complications not requiring reoperation (0.0% vs. 40.0%, p = 0.071). The arthroplasty cohort achieved full weightbearing in significantly shorter time than the revision ORIF cohort (3.8 vs. 6.8 weeks, p = 0.005). CONCLUSION: Both revision ORIF and hip arthroplasty are acceptable options for salvage of failed subtrochanteric fracture fixation in patients greater than 50 years old, but patients should be counseled that although the rate of fracture union is high whether revision ORIF or hip arthroplasty is selected, the rate of reoperation can exceed 1-in-4 patients. LEVEL OF EVIDENCE: : Level III, Retrospective Comparative Study.
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Artroplastia de Reemplazo de Cadera , Fijación Interna de Fracturas , Fracturas de Cadera , Reoperación , Terapia Recuperativa , Humanos , Reoperación/estadística & datos numéricos , Fracturas de Cadera/cirugía , Masculino , Femenino , Anciano , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Cadera/métodos , Estudios Retrospectivos , Fijación Interna de Fracturas/métodos , Fijación Interna de Fracturas/efectos adversos , Terapia Recuperativa/métodos , Persona de Mediana Edad , Insuficiencia del Tratamiento , Anciano de 80 o más Años , Reducción Abierta/métodos , Reducción Abierta/efectos adversos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Curación de FracturaRESUMEN
Extensor mechanism (EM) disruption after total knee arthroplasty (TKA) is devastating, especially in cases of re-rupture. A 67-year-old man with diabetes had patellar tendon rupture after revision TKA and then had migration of the bone block after Achilles tendon allograft with bone block (ATBB) augmentation with cerclage. A third reconstruction was performed with open reduction and internal fixation and high-strength braided suture augmentation. Five months postoperatively, the patient had regained full range of motion with intact EM and hardware. The risk of re-rupture is high in ATBB, and the primary issues in this case were nonunion and tendinous compromise. A construct that encompasses compression and buttressing of the bone block with tendon augmentation potentially addresses the risks of recurrent EM rupture in more complex cases. [Orthopedics. 2024;47(5):e273-e276.].
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Artroplastia de Reemplazo de Rodilla , Reoperación , Humanos , Masculino , Anciano , Artroplastia de Reemplazo de Rodilla/efectos adversos , Traumatismos de los Tendones/cirugía , Ligamento Rotuliano/cirugía , Ligamento Rotuliano/lesiones , Tendón Calcáneo/cirugía , Tendón Calcáneo/lesiones , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/etiologíaRESUMEN
INTRODUCTION: Comparative data on free flap outcomes for elbow defect reconstruction are still lacking. This study aimed to compare complication rates of free muscle flaps (MFs) versus cutaneous flaps (CFs) for posterior elbow reconstruction. METHODS: In a single-center retrospective analysis, patients who underwent posterior elbow reconstruction with free MFs and CFs from 2000 to 2021 were analyzed. Retrospective chart review included patient demographics, operative details, and post-operative complications. Outcomes of interest that were compared included microvascular complications, partial or total flap necroses, wound dehiscence, hematoma or flap infection, and donor-site complications. RESULTS: Sixty-six free flaps (CFs: n = 42; MFs: n = 24) were included, with a trend over time toward using CFs (64%). MFs were used for larger defects (CF: 175 ± 82 vs. MF: 212 ± 146 cm2; p = 0.13). Outcome analysis revealed an equal distribution of microvascular complications (10% vs. 13%; p = 0.7), partial flap necrosis (7% vs. 8%; p > 0.9), wound dehiscence (7% vs. 4%; p > 0.9), evacuation of hematoma (10% vs. 4%; p = 0.7), and infection (0% vs. 4%; p = 0.4). Total flap necrosis requiring additional flap surgery was necessary in one CF (2%) and in no MF (0%) (p > 0.9). CONCLUSION: Surgical outcomes, flap necrosis rates, and microsurgical complications did not differ between CFs and MFs. Both flap types are safe and effective options. The free anterolateral thigh and latissimus dorsi flaps represent indispensable workhorses for the reconstruction of extensive elbow defects.
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Colgajos Tisulares Libres , Procedimientos de Cirugía Plástica , Complicaciones Posoperatorias , Humanos , Masculino , Estudios Retrospectivos , Femenino , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/efectos adversos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/cirugía , Adulto , Lesiones de Codo , Anciano , Codo/cirugíaRESUMEN
OBJECTIVE: Compare full-thickness skin grafts versus split-thickness skin grafts in scalp reconstruction. STUDY DESIGN: Retrospective chart review of patients who underwent scalp reconstruction with skin grafts performed at a single institution from 2011 to 2016. METHODS: χ2 or Fisher exact tests were used to compare graft integration and complication rates. The effects of graft type, defect type, graft size, and patient comorbidities on the likelihood of graft success and complications were analyzed using multivariate logistic regression. RESULTS: A hundred and twenty-five full-thickness and 93 split-thickness grafts were performed in 200 patients, including 68 defects (31.2%) with exposed calvarium. Full-thickness grafts required fewer average reconstructions (P = 0.002). A 92.8% of full-thickness grafts had complete graft integration compared with 78.5% of split-thickness grafts (P = 0.002). This difference was more evident in defects with exposed calvarium (87.2% vs. 47.6%, P ≤ 0.001). Despite higher rates of minor debridement, full-thickness grafts had less postoperative bone exposure and wound breakdown than split-thickness grafts on intact pericranium and exposed calvarium defects. Preoperative radiation, immunosuppression, and increased graft sizes were significant predictors of graft outcomes. CONCLUSIONS: Skin grafts, especially full-thickness, provide a versatile, reliable, and simple approach for reconstructing medium to large scalp defects in the appropriate patient. Even on defects with bare calvarium, full-thickness grafts can succeed when a vascularized recipient bed is prepared. Defects with exposed bone, larger graft sizes, preoperative radiation, and immunosuppression may result in decreased graft take and increased complications. LEVEL OF EVIDENCE: 3b.