RESUMEN
Thoracoabdominal (TA) flaps are a good option for primary closure of small and medium defects after mastectomy for locally advanced breast tumours. Although they have a higher rate of necrosis than myocutaneous flaps, they can be easily performed by breast surgeons. Few studies on this procedure have been reported, and we have been unable to identify any prior publications reporting breast reconstruction with TA flaps.
Asunto(s)
Neoplasias de la Mama , Mamoplastia , Colgajo Miocutáneo , Humanos , Femenino , Mastectomía , Neoplasias de la Mama/cirugía , Neoplasias de la Mama/patología , Mamoplastia/métodos , Colgajo Miocutáneo/patología , Colgajo Miocutáneo/cirugía , Necrosis/cirugíaRESUMEN
BACKGROUND: Numerous authors have reported their outcomes after using Furlow's palatoplasty for cleft palate repair. However, little attention has been given to the operative complications associated with this technique. The present study was carried out to present cases and analyze the various factors influencing the development of this complication accompanying Furlow's palatoplasty. MATERIALS AND METHODS: This is a case report study of patients with cleft palate admitted to our center due to sequelae after primary cleft palate repair using Furlow palatoplasty between 2003 and 2021. Patient information was identified from the Smile Train cleft charity organization, parents' reports, and hospital records (intake forms and operating room registries). RESULTS: Five patients were identified as having secondary cleft palate with palatal flap necrosis and associated with Furlow palatoplasty during patient evaluation at our center between 2003 and 2021. The observed prevalence was 1.54%. CONCLUSIONS: Palatal flap necrosis is a rare but serious complication after primary Furlow's palatoplasty. The occurrence of this complication can be reduced by careful preoperative planning, and prevention is possible.
Asunto(s)
Fisura del Paladar , Procedimientos de Cirugía Plástica , Enfermedades Vasculares , Insuficiencia Velofaríngea , Humanos , Lactante , Fisura del Paladar/cirugía , Estudios Retrospectivos , Procedimientos de Cirugía Plástica/efectos adversos , Complicaciones Posoperatorias/cirugía , Necrosis/etiología , Necrosis/cirugía , Resultado del Tratamiento , Paladar Blando/cirugía , Insuficiencia Velofaríngea/cirugíaAsunto(s)
COVID-19 , Colgajos Tisulares Libres , Procedimientos de Cirugía Plástica , Traumatismos de los Tejidos Blandos , COVID-19/complicaciones , Niño , Extremidades/cirugía , Colgajos Tisulares Libres/cirugía , Humanos , Extremidad Inferior/cirugía , Necrosis/etiología , Necrosis/cirugía , Traumatismos de los Tejidos Blandos/cirugía , Síndrome de Respuesta Inflamatoria SistémicaRESUMEN
Wound infection is frequently reported following snakebite (SB). This study is retrospective. It was conducted in the emergency department and the Intensive Care Unit (ICU) of Cayenne General Hospital between 1 January 2016 and 31 July 2021. We included 172 consecutive patients hospitalized for SB envenoming. All patients were monitored for wound infection. Sixty-three patients received antibiotics at admission (36.6%). The main antibiotic used was amoxicillin-clavulanate (92.1%). Wound infection was recorded in 55 cases (32%). It was 19% in grade 1, 35% in grade 2, and 53% in grade 3. It included abscess (69.1%), necrotizing fasciitis (16.4%), and cellulitis (21.8%). The time from SB to wound infection was 6 days (IQR: 3-8). The main isolated microorganisms were A. hydrophila and M. morganii (37.5% and 18.8% of isolated organisms). Surgery was required in 48 patients (28.1%), and a necrosectomy was performed on 16 of them (33.3%). The independent factors associated with snakebite-associated infection were necrosis (p < 0.001, OR 13.15, 95% CI: 4.04-42.84), thrombocytopenia (p = 0.002, OR: 3.37, 95% CI: 1.59-7.16), and rhabdomyolysis (p = 0.046, OR: 2.29, 95% CI: 1.02-5.19). In conclusion, wound infection following SB is frequent, mainly in grade 2 and 3 envenomed patients, especially those with necrosis, thrombocytopenia, and rhabdomyolysis. The main involved bacteria are A. hydrophila and M. morganii.
Asunto(s)
Infecciones Bacterianas/etiología , Mordeduras de Serpientes/complicaciones , Infección de Heridas/etiología , Adulto , Antibacterianos/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/cirugía , Vesícula/complicaciones , Vesícula/tratamiento farmacológico , Vesícula/cirugía , Femenino , Guyana Francesa , Humanos , Masculino , Persona de Mediana Edad , Necrosis/complicaciones , Necrosis/tratamiento farmacológico , Necrosis/cirugía , Estudios Retrospectivos , Rabdomiólisis/complicaciones , Rabdomiólisis/tratamiento farmacológico , Rabdomiólisis/cirugía , Mordeduras de Serpientes/tratamiento farmacológico , Mordeduras de Serpientes/cirugía , Trombocitopenia/complicaciones , Trombocitopenia/tratamiento farmacológico , Trombocitopenia/cirugía , Infección de Heridas/tratamiento farmacológico , Infección de Heridas/cirugíaAsunto(s)
Páncreas , Pancreatitis Aguda Necrotizante , Colecistectomía , Drenaje , Endoscopía , Humanos , Necrosis/etiología , Necrosis/cirugía , Páncreas/diagnóstico por imagen , Páncreas/cirugía , Pancreatitis Aguda Necrotizante/diagnóstico por imagen , Pancreatitis Aguda Necrotizante/cirugía , Resultado del TratamientoRESUMEN
INTRODUCTION: Myelomeningocele (MMC) is a complex congenital defect resulting from incomplete closure of the neural tube. The aim of this study is to present an unusual technique for the closure of a large defect. CASE REPORT: Here we report a patient that was prenatally diagnosed with MMC. At birth, a skin defect of approximately 5 x 7 cm was observed. To repair the defect, a Z-plasty was performed; however, necrosis of the flap developed 3 days after the surgery. The devitalized tissue was removed, and a human pericardial graft was used to cover the defect. DISCUSSION: Different techniques have been described for the repair of MMC with a large skin defect, such as rotation skin flaps as well as synthetic and biological grafts. In our patient, a new technique without prior experience consisting of the application of human cadaveric pericardial graft was used with good results and no complications. CONCLUSION: Closure of MMC is often a surgical challenge. Here we describe a surgical technique for the closure of large skin defects.
Asunto(s)
Meningomielocele , Procedimientos de Cirugía Plástica , Humanos , Recién Nacido , Meningomielocele/complicaciones , Meningomielocele/diagnóstico por imagen , Meningomielocele/cirugía , Necrosis/cirugía , Procedimientos de Cirugía Plástica/métodos , Piel , Colgajos QuirúrgicosAsunto(s)
Presión de las Vías Aéreas Positiva Contínua/efectos adversos , Deformidades Adquiridas Nasales/cirugía , Nariz/patología , Colgajos Quirúrgicos/trasplante , Humanos , Lactante , Recién Nacido , Necrosis/etiología , Necrosis/patología , Necrosis/cirugía , Nariz/cirugía , Deformidades Adquiridas Nasales/etiología , Deformidades Adquiridas Nasales/patología , Resultado del TratamientoRESUMEN
Snakebites are a neglected and underestimated global health hazard. In the Brazilian Amazon, Bothrops snakebites are the most prevalent and may lead to severe complications. Here we describe a severe case of Bothrops atrox snakebite that, owing to delayed medical assistance, presented with renal and respiratory failure, compartment syndrome, and tissue necrosis. After several fasciotomy surgeries, the patient survived; however, he showed significant functional disability. Prompt management of snake envenomation would aid in the early diagnosis of local and systemic complications and, consequently, would result in a better functional outcome with improved quality of life.
Asunto(s)
Bothrops , Síndromes Compartimentales/fisiopatología , Necrosis/patología , Calidad de Vida , Mordeduras de Serpientes/complicaciones , Adulto , Animales , Brasil , Síndromes Compartimentales/etiología , Cuidados Críticos , Fasciotomía , Humanos , Masculino , Necrosis/etiología , Necrosis/cirugía , Trasplante de TejidosRESUMEN
BACKGROUND: The palatal fistula is an important surgical challenge within the longitudinal follow-up of patients with repaired cleft palate as the success rate of palatal fistula reconstruction by adopting several surgical techniques is variable and often unsatisfactory. The purpose of this retrospective study was to report the clinical outcomes of an algorithm for the surgical management of palatal fistulae in patients with repaired cleft palate. METHODS: Consecutive patients (nâ=â101) with repaired cleft palate and palatal fistula-related symptoms who were treated according to a specific algorithm between 2009 and 2017 were included. Based on the anatomical location (Pittsburgh fistula types II-V), amount of scarring (minimal or severe scarred palate), and diameter of the fistula (≤5âmm or >5âmm), 1 of 3 approaches (local flaps [62.4%], buccinator myomucosal flaps [20.8%], or tongue flaps [16.8%]) was performed. For clinical outcome assessment, symptomatic and anatomical parameters (fistula-reported symptoms and residual fistula, respectively) were combined as follows: complete fistula closure with no symptoms; asymptomatic narrow fistula remained; or failure to repair the fistula ("good," "fair," or "poor" outcomes, respectively). Surgical-related complication data were also collected. RESULTS: Most patients (91.1%) presented "good" clinical outcomes, ranging from 86.2% to 100% (86.2%, 100%, and 100% for local flaps, buccinator flaps, and tongue flaps, respectively). All (8.9%) "fair" and "poor" outcomes were observed in fistulae reconstructed by local flaps. All "poor" (5%) outcomes were observed in borderline fistulae (4-5âmm). No surgical-related complications (dehiscence, infections, or necrosis) were observed, except for an episode of bleeding after the 1st stage of tongue flap-based reconstruction (1.0%). CONCLUSION: A high rate of fistula resolution was achieved using this algorithm for surgical management of palatal fistulae in patients with repaired cleft palate.
Asunto(s)
Fisura del Paladar/cirugía , Fístula Oral/cirugía , Preescolar , Cicatriz/cirugía , Humanos , Necrosis/cirugía , Complicaciones Posoperatorias , Procedimientos de Cirugía Plástica/métodos , Estudios Retrospectivos , Colgajos Quirúrgicos/cirugía , Lengua/cirugíaRESUMEN
Purpose: To evaluate the use of adipose-derived stem cells (ADSC) in reducing the necrosis area in an experimental model of cutaneous ischemic flap in rats submitted to subcutaneous nicotine injection to simulate a smoker patient. Methods: In an experimental study, 30 rats were enrolled and divided into two experimental groups of 15 animals all submitted to a subcutaneous nicotine injection to create ischemic cutaneous flaps on their backs. Other 10 animals were used only to obtain adipose tissue derived stem cells (ADSC). The first group (n=15) received ADSC treatment at the end of surgery while the other group, the control (n=15), received no other interventions. After euthanasia, a decal was performed on the whole area of the flap, accurately defining the transition from necrosis to healthy region. Photos of all animals were collected and evaluated by scales standardized by Paint-Autocad- 2015 software to define the area of flap necrosis in each rat. Student T test was performed to compare the groups, considering a p< 0.05 significant. Data were analyzed using SPSS IBM® 18 version. Results: Through the analysis of the images by the program Paint-Autocad-2015 and the area of decal obtained by the transparent sheet, we obtained a mean of 46% necrosis of the total area of the flap in the treatment group and 69.4% in the control group. In the descriptive analysis, a mean of 3.7 cm of necrosis CI 95% (3.2 - 4.2) was evident in the treatment group whereas a mean value of 5.56 CI 95% (5.2 - 5.9) was found in control group, with p value <0.001 for this comparison. Conclusion: The application of adipose-derived stem cells reduces the percentage of necrosis in an experimental model of randomized cutaneous flap in rats submitted to subcutaneous nicotine injection.(AU)
Asunto(s)
Animales , Ratas , Cicatrización de Heridas/genética , Células Madre , Nicotina/efectos adversos , Nicotina/genética , Necrosis/genética , Necrosis/prevención & control , Necrosis/cirugía , Colgajos Quirúrgicos/cirugía , Fumadores , Ratas Wistar/cirugía , Modelos AnimalesRESUMEN
Uterine torsion is an uncommon entity that is defined as a rotation of greater than 45° around the longitudinal axis of the uterus. Although cases of uterine torsion among pregnant patients have been mentioned in the literature, torsion of a non-gravid uterus is a rare occurrence. A 73-year-old nulliparous woman with a known fibroid uterus underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy with frozen section of a 17-18 cm pelvic mass seen on CT imaging. The source of the pelvic mass was unclear on imaging, and benign and malignant possibilities were discussed. During the procedure, necrosis of the uterine fundus and bilateral adnexa were seen due to the fundus being torsed with the uterine fibroid being the pivot point. Uterine torsion, though rare, can be the cause of acute pelvic pain in a postmenopausal woman.
Asunto(s)
Dolor Abdominal/diagnóstico por imagen , Enfermedades de los Anexos/diagnóstico por imagen , Leiomioma/patología , Necrosis/diagnóstico por imagen , Anomalía Torsional/diagnóstico por imagen , Ultrasonografía , Enfermedades Uterinas/diagnóstico por imagen , Dolor Abdominal/cirugía , Enfermedades de los Anexos/patología , Enfermedades de los Anexos/cirugía , Anciano , Femenino , Secciones por Congelación , Humanos , Histerectomía , Necrosis/patología , Necrosis/cirugía , Posmenopausia , Salpingooforectomía , Anomalía Torsional/patología , Anomalía Torsional/cirugía , Resultado del Tratamiento , Enfermedades Uterinas/patología , Enfermedades Uterinas/cirugíaRESUMEN
INTRODUCTION: The purpose of this prospective cohort study was to evaluate whether serum procalcitonin (PCT) levels predict the need for surgery and the presence of ischemia and/or necrosis (I/N) in small bowel obstruction. METHOD: Of 54 patients included, conservative management was performed in 31 (non-surgical group) and an exploratory laparotomy in 23 (surgical group). The reference value of the PCT was between 0.10 and 0.50 ng/mL. RESULTS: PCT levels were higher in the surgical group (7.05 ± 7.03 ng/mL) than in the non-surgical (0.37 ± 0.63 ng/mL), and in patients with I/N (10.06 ± 7.07 ng/mL) than without I/N (1.52 ± 1.45 ng/mL). In the ROC curve, the area under the curve was 0.91 for the need for surgery and 0.93 for I/N. PCT ≥ 0.80 ng/mL had the best sensitivity and specificity for surgery and ≥ 1.95 ng/mL for I/N. PCT was also an independent predictor for these events. CONCLUSIONS: The levels of PCT can recognize the need for surgery and the presence of I/N in small bowel obstruction. Additional studies are needed to affirm or invalidate our findings.
OBJETIVO: El propósito de este estudio de cohorte prospectivo fue evaluar si las concentraciones séricas de procalcitonina (PCT) predicen la necesidad de cirugía y la presencia de isquemia o necrosis (I/N) en la obstrucción del intestino delgado. MÉTODO: De 54 pacientes incluidos, se realizó manejo conservador en 31 (grupo no quirúrgico) y laparotomía exploradora en 23 (grupo quirúrgico). El valor de referencia de la PCT fue entre 0.10 y 0.50 ng/ml. RESULTADOS: Los valores de PCT fueron mayores en el grupo quirúrgico (7.05 ± 7.03 ng/ml) que en el no quirúrgico (0.37 ± 0.63 ng/ml), y en los pacientes con I/N (10.06 ± 7.07 ng/ml) que en aquellos sin I/N (1.52 ± 1.45 ng/ml). En la curva COR (Característica Operativa del Receptor), el área bajo la curva fue 0.91 para la necesidad de cirugía y 0.93 para la I/N. La PCT ≥ 0.80 ng/ml obtuvo las mejores sensibilidad y especificidad para una cirugía, y ≥ 1.95 ng/ml para I/N. La PCT también fue un predictor independiente para estos eventos. CONCLUSIONES: Los valores de PCT permiten reconocer la necesidad de cirugía y la presencia de I/N en la obstrucción del intestino delgado. Son necesarios estudios adicionales para reafirmar o invalidar nuestros hallazgos.
Asunto(s)
Obstrucción Intestinal/sangre , Intestino Delgado/irrigación sanguínea , Intestino Delgado/patología , Isquemia/sangre , Polipéptido alfa Relacionado con Calcitonina/sangre , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Obstrucción Intestinal/complicaciones , Obstrucción Intestinal/cirugía , Intestino Delgado/cirugía , Isquemia/cirugía , Masculino , Persona de Mediana Edad , Necrosis/sangre , Necrosis/cirugía , Valor Predictivo de las PruebasRESUMEN
Úlceras de pressão são alterações da integridade da pele e tecidos subjacentes, causadas por pressão, mais usualmente sobre proeminências ósseas, especialmente em áreas desprovidas de sensibilidade, levando à necrose e ulceração. Dados da literatura internacional estimam que 3 a 14% dos pacientes hospitalizados desenvolvem úlceras de pressão. Descrevemos a correção simultânea de úlceras sacral e isquiática extensas em paciente paraplégico jovem utilizando retalho fasciomiocutâneo de glúteo máximo e de face posterior da coxa.
Pressure ulcers are alterations of the integrity of the skin and underlying tissues, caused by pressure, more commonly on bony prominences, especially in areas devoid of sensitivity, which lead to necrosis and ulceration. Data from the international literature estimate that 314% of hospitalized patients develop pressure ulcers. We herein describe the simultaneous correction of extensive sacral and ischial ulcers in a young paraplegic patient, using a gluteus maximus fasciomyocutaneous flap from the posterior aspect of the thigh.
Asunto(s)
Humanos , Masculino , Adulto , Paraplejía/cirugía , Paraplejía/complicaciones , Úlcera por Presión/cirugía , Úlcera por Presión/complicaciones , Colgajo Miocutáneo/cirugía , Colgajo Miocutáneo/efectos adversos , Necrosis/cirugía , Factores de Riesgo , Espasticidad MuscularRESUMEN
OBJECTIVE: to report the experience of the Division of Plastic Surgery of the Hospital das Clínicas of the Medical School of the University of São Paulo in the treatment of cutaneous lesions due to accidental extravasation of drugs. METHODS: we included patients with lesions due to extravasation of drugs over a period of 18 months. We retrospectively evaluated the following parameters: age, diagnoses during hospitalization and comorbidities, serum levels of albumin and hemoglobin, place of hospitalization, drug involved, anatomic segment affected, therapeutic management and death during hospitalization. RESULTS: we followed-up 14 patients. The main drug involved was noradrenaline (21%). All patients underwent debridement of tissue necrosis. Three patients were submitted to flaps after preparation of the wound bed with negative pressure therapy, with good results. Seven patients had no definitive treatment of their lesions due to lack of clinical conditions. CONCLUSION: in patients with favorable clinical conditions, the definitive treatment with flaps was adequate for cases of wounds due to extravasation of drugs in the subcutaneous tissue when there was exposure of noble structures.
OBJETIVO: relatar a experiência da Divisão de Cirurgia Plástica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo no tratamento de lesões cutâneas por extravasamento acidental de drogas. MÉTODOS: foram incluídos os pacientes com lesões por extravasamento de drogas num período de 18 meses. Os seguintes parâmetros foram avaliados retrospectivamente: idade, diagnósticos durante internação e comorbidades, níveis séricos de albumina e hemoglobina, local de internação, droga envolvida, segmento anatômico acometido, conduta terapêutica e óbito durante internação. RESULTADOS: foram acompanhados 14 pacientes. A principal droga envolvida foi a noradrenalina (21%). Todos os pacientes foram submetidos a desbridamento da necrose tecidual. Três pacientes foram submetidos a retalhos após preparo do leito com terapia por pressão negativa, com bons resultados. Sete pacientes não tiveram tratamento definitivo de suas lesões por falta de condições clínicas. CONCLUSÃO: o tratamento definitivo por meio de retalhos se mostrou adequado para os casos de feridas por extravasamento de drogas em tecido subcutâneo, quando há exposição de estruturas nobres, em pacientes com condições clínicas favoráveis.
Asunto(s)
Extravasación de Materiales Terapéuticos y Diagnósticos/cirugía , Traumatismos de la Mano/inducido químicamente , Norepinefrina/efectos adversos , Tejido Subcutáneo/patología , Anciano , Anciano de 80 o más Años , Humanos , Lactante , Persona de Mediana Edad , Necrosis/cirugía , Estudios Retrospectivos , Colgajos QuirúrgicosRESUMEN
Introdução: Segundo dados do Instituto Nacional de Câncer (INCA) de 2016, estima-se em 57.960 novos casos de câncer de mama no Brasil, o que corresponde a 25% dentre todos os tipos de cânceres no país (excluindo-se os tumores de pele não melanoma). O presente artigo visa apresentar uma forma de abordagem para as reconstruções mamárias imediatas com loja retropeitoral superior e subcutânea mista inferior. Métodos: Os autores descrevem da técnica de reconstrução mamária com retalho do músculo peitoral e pedículo cutâneo inferior, associado à inclusão de implante mamário de silicone. Foi realizada análise retrospectiva de prontuários das pacientes operadas entre os anos 2012 e 2016 no Serviço de Cirurgia Plástica da clínica privada do autor sênior, no Hospital Daher e no Hospital das Forças Armadas. Resultados: Os resultados são satisfatórios, com baixos índices de complicações e com satisfação elevada para os pacientes e os autores. Trinta e seis pacientes foram submetidas à reconstrução mamária com a técnica descrita, com média de idade de 59 anos. As complicações apresentadas foram necrose de complexo areolopapilar, deiscência, seroma, hematoma, liponecrose, deslocamento do implante e trombose venosa profunda. Nenhuma paciente teve necessidade de resgate da reconstrução ou apresentou recidiva da neoplasia mamária durante o período do estudo. Conclusão: Trata-se de técnica que preserva a pele da mama em sua parte inferior, com baixa possibilidade de deiscência ou extrusão do implante nesta região, proporcionando uma dupla proteção deste implante com o músculo peitoral maior nos dois terços superiores e o retalho cutâneo-dermogorduroso no terço inferior, caracterizando um "dual-plane".
Introduction: A total of 57,960 new cases of breast cancer were expected in Brazil in 2016 according to data from the National Cancer Institute, corresponding to 25% of cancers in the country (excluding non-melanoma skin tumors). This study aims at presenting a surgical approach for immediate breast reconstructions with upper retropectoral and lower mixed subcutaneous cavities. Methods: The authors performed breast reconstruction using flaps of the pectoral muscle and inferior cutaneous pedicle associated with insertion of silicone breast implants. The medical records of patients operated between 2012 and 2016 at the Plastic Surgery Service of the senior author's private clinic at Daher Hospital and Armed Forces Hospital were retrospectively analyzed. Results: The results were satisfactory, with low complication rates and high patient and author satisfaction. Thirty-six patients, with a mean age of 59 years, underwent breast reconstruction using the described technique. The complications were nipple-areola complex necrosis, dehiscence, seroma, hematoma, liponecrosis, implant displacement, and deep venous thrombosis. No patient needed salvage surgery or had recurrence of mammary neoplasia during the study period. Conclusion: The present technique preserves the skin located at the lower portion of the breast, with a low risk of dehiscence or extrusion of the implant in this region, providing a double protection of the implant, with the pectoralis major muscle in the upper two thirds and the cutaneous-dermis-fat flap in the lower third, characterizing a "dual-plane" positioning.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Historia del Siglo XXI , Complicaciones Posoperatorias , Neoplasias de la Mama , Estudios Retrospectivos , Mamoplastia , Procedimientos de Cirugía Plástica , Técnicas de Diagnóstico Quirúrgico , Necrosis , Complicaciones Posoperatorias/diagnóstico , Neoplasias de la Mama/cirugía , Neoplasias de la Mama/complicaciones , Mamoplastia/métodos , Mamoplastia/estadística & datos numéricos , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/estadística & datos numéricos , Técnicas de Diagnóstico Quirúrgico/normas , Técnicas de Diagnóstico Quirúrgico/estadística & datos numéricos , Necrosis/cirugía , Necrosis/complicaciones , Necrosis/diagnósticoRESUMEN
RESUMO Objetivo: relatar a experiência da Divisão de Cirurgia Plástica do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo no tratamento de lesões cutâneas por extravasamento acidental de drogas. Métodos: foram incluídos os pacientes com lesões por extravasamento de drogas num período de 18 meses. Os seguintes parâmetros foram avaliados retrospectivamente: idade, diagnósticos durante internação e comorbidades, níveis séricos de albumina e hemoglobina, local de internação, droga envolvida, segmento anatômico acometido, conduta terapêutica e óbito durante internação. Resultados: foram acompanhados 14 pacientes. A principal droga envolvida foi a noradrenalina (21%). Todos os pacientes foram submetidos a desbridamento da necrose tecidual. Três pacientes foram submetidos a retalhos após preparo do leito com terapia por pressão negativa, com bons resultados. Sete pacientes não tiveram tratamento definitivo de suas lesões por falta de condições clínicas. Conclusão: o tratamento definitivo por meio de retalhos se mostrou adequado para os casos de feridas por extravasamento de drogas em tecido subcutâneo, quando há exposição de estruturas nobres, em pacientes com condições clínicas favoráveis.
ABSTRACT Objective: to report the experience of the Division of Plastic Surgery of the Hospital das Clínicas of the Medical School of the University of São Paulo in the treatment of cutaneous lesions due to accidental extravasation of drugs. Methods: we included patients with lesions due to extravasation of drugs over a period of 18 months. We retrospectively evaluated the following parameters: age, diagnoses during hospitalization and comorbidities, serum levels of albumin and hemoglobin, place of hospitalization, drug involved, anatomic segment affected, therapeutic management and death during hospitalization. Results: we followed-up 14 patients. The main drug involved was noradrenaline (21%). All patients underwent debridement of tissue necrosis. Three patients were submitted to flaps after preparation of the wound bed with negative pressure therapy, with good results. Seven patients had no definitive treatment of their lesions due to lack of clinical conditions. Conclusion: in patients with favorable clinical conditions, the definitive treatment with flaps was adequate for cases of wounds due to extravasation of drugs in the subcutaneous tissue when there was exposure of noble structures.
Asunto(s)
Humanos , Lactante , Anciano , Anciano de 80 o más Años , Norepinefrina/efectos adversos , Tejido Subcutáneo/patología , Extravasación de Materiales Terapéuticos y Diagnósticos/cirugía , Traumatismos de la Mano/inducido químicamente , Colgajos Quirúrgicos , Estudios Retrospectivos , Persona de Mediana Edad , Necrosis/cirugíaRESUMEN
Introdução: Nas abdominoplastias clássicas, um resultado indesejado após o tracionamento do retalho abdominal é a ocorrência de uma retração suprapúbica, no meio da cicatriz horizontal quando esta coincide com o ponto superior da antiga cicatriz umbilical. Métodos: Foram avaliadas 45 pacientes submetidas à dermolipectomia abdominal associada à lipoaspiração de todo o abdome e flancos, com decorticação de uma área suprapúbica cerca de 5 cm acima da marcação inicial da linha de incisão, com posterior fixação na borda inferior do retalho abdominal. Resultados: Não foram observadas depressões ou necroses na região suprapúbica. Conclusão: Observamos, nos casos operados, que a presença de um coxim dermogorduroso na porção central da linha de sutura nas abdominoplastias clássicas, associada à reconstituição completa dos planos cirúrgicos e fixação deste coxim no retalho abdominal superior, evita a ocorrência de depressões nesta região, evita ocorrência de necroses e melhora a qualidade da cicatriz por redução da tensão de tração sobre os tecidos.
Introduction: In classic abdominoplasty, an undesirable result after abdominal flap traction is the occurrence of a suprapubic retraction in the middle of the horizontal scar when it coincides with the superior point of the old umbilical scar. Methods: Forty-five patients underwent abdominal dermolipectomy associated with liposuction of the entire abdomen and flanks, with decortication of the suprapubic area approximately 5 cm above the initial marking of the incision line, with posterior fixation at the lower border of the abdominal flap. Results: No depressions or necroses were observed in the suprapubic region. Conclusion: We observed that the presence of a dermofat flap in the central portion of the suture line in the classic abdominoplasties associated with the complete reconstruction of the surgical planes and the fixation of this flap in the upper abdominal flap avoids the occurrence of depressions in this region, prevents occurrence of necrosis, and improves the quality of the scar by reducing the tensile stress on the tissues.
Asunto(s)
Humanos , Femenino , Historia del Siglo XXI , Lipectomía , Adherencias Tisulares , Estudios Prospectivos , Cicatriz , Abdomen , Abdominoplastia , Necrosis , Lipectomía/efectos adversos , Lipectomía/métodos , Adherencias Tisulares/complicaciones , Adherencias Tisulares/terapia , Cicatriz/cirugía , Cicatriz/complicaciones , Abdominoplastia/métodos , Abdominoplastia/rehabilitación , Abdomen/cirugía , Necrosis/cirugía , Necrosis/complicaciones , Necrosis/terapiaRESUMEN
Introdução: A mastectomia é muito traumática para a mulher, sendo a reconstrução mamária um procedimento essencial para melhorar o bem-estar psicossocial e a qualidade de vida destas pacientes. A maioria dos cirurgiões plásticos não realiza reconstrução mamária. Sua prática requer um treinamento avançado com longa curva de aprendizado. A reconstrução mamária, utilizando o retalho excedente da abdominoplastia reversa, pode ser uma opção prática e de muita aplicabilidade em pacientes cuidadosamente selecionadas. Métodos: No período de agosto de 2014 a junho de 2016, doze pacientes foram submetidas à reconstrução mamária, com a técnica de miniabdominoplastia reversa. A simetrização foi realizada em seis pacientes que fizeram reconstrução unilateral, sendo um caso reconstruído bilateralmente. Em sete pacientes, os implantes foram colocados em plano supra muscular, e em cinco, em posição sub submuscular. Resultados: Uma paciente apresentou seroma, uma outra teve epiteliólise, um caso de necrose parcial da pele do retalho superficial, todos com evolução favorável. Somente uma paciente teve extrusão do implante. Conclusão: A reconstrução mamária com retalho excedente de miniabdominoplastia reversa associada à colocação de implante demonstrou ser uma boa opção de reconstrução mamária para casos selecionados, com baixa taxa de complicações. Pacientes com flacidez e lipodistrofia no abdome superior são as candidatas ideais para utilização da técnica.
Introduction: Mastectomy is very traumatic for women, and breast reconstruction is an essential procedure to improve their psychosocial well-being and quality of life. Most plastic surgeons do not perform breast reconstruction. This practice requires advanced training with a long learning curve. Breast reconstruction using excess flaps in reverse abdominoplasty can be a practical option and of great applicability in carefully selected patients. Methods: From August 2014 to June 2016, 12 patients underwent breast reconstruction using the reverse mini abdominoplasty technique. Symmetrization was performed in six patients who underwent unilateral reconstruction, with one case reconstructed bilaterally. The implants were placed in the supra-muscular plane and in a submuscular position in seven and five patients, respectively. Results: There was one case each of seroma, epitheliolysis, and partial superficial necrosis of the superficial flap, all with favorable evolution. Only one patient underwent implant extrusion. Conclusion: Breast reconstruction using excess flaps in reverse mini abdominoplasty associated with implant placement is a good option for breast reconstruction in selected patients with a low complication rate. Patients with flaccidity and lipodystrophy in the upper abdomen are the ideal candidates for the use of this technique.
Asunto(s)
Humanos , Femenino , Adulto , Persona de Mediana Edad , Historia del Siglo XXI , Complicaciones Posoperatorias , Mama , Mamoplastia , Implantación de Mama , Procedimientos de Cirugía Plástica , Seroma , Abdomen , Abdominoplastia , Necrosis , Complicaciones Posoperatorias/cirugía , Mama/cirugía , Mamoplastia/métodos , Implantación de Mama/métodos , Procedimientos de Cirugía Plástica/métodos , Seroma/complicaciones , Abdominoplastia/métodos , Abdomen/cirugía , Necrosis/cirugíaAsunto(s)
Rechazo de Injerto/cirugía , Cálices Renales/cirugía , Trasplante de Riñón/efectos adversos , Enfermedades Ureterales/cirugía , Ureterostomía/métodos , Adulto , Femenino , Humanos , Necrosis/cirugía , Radiografía Intervencional/métodos , Terapia Recuperativa/métodos , Stents , Resultado del Tratamiento , Enfermedades Ureterales/etiología , Enfermedades Ureterales/patologíaRESUMEN
Se presenta un paciente masculino de 29 años, mestizo, recluso, quien 7 días antes de haber sido remitido al servicio de urgencias del Hospital Universitario Amalia Simoni se había inoculado, en autoagresión, heces fecales en la pierna y el muslo derechos. Refirió dolor y presentaba gran toma del estado general. A la exploración física se constató aumento de volumen generalizado del miembro inferior derecho, con zonas de eritema marcado que alternaban con áreas de necrosis que incluso afectaban el abdomen bajo, aumento de la temperatura local; a la palpación, dolor intenso con amplia zona de crepitación subcutánea, además de bulas de contenido serohemático, pútrido, de olor fétido. La radiografía reveló aumento marcado de la opacidad de las partes blandas, bandas de gas a nivel del tejido celular subcutáneo y presencia de numerosas bulas sin toma ósea. Se decidió tratamiento quirúrgico multidisciplinario que incluyó la desarticulación en guillotina del miembro inferior derecho a nivel de la cadera y toilette amplia, medidas de soporte vital, y la combinación de clindamicina, vancomicina y meronem. La gangrena gaseosa es una infección fulminante de los tejidos blandos con una mortalidad elevada; la sospecha diagnóstica y el entendimiento de la fisiopatología mejoran el pronóstico. El soporte vital, el equilibrio del medio interno, el uso de antimicrobianos de amplio espectro y un tratamiento quirúrgico agresivo, disminuyen la mortalidad(AU)
A case of a 29-year convict mestizo male patient is presented here. This patient is referred to the emergency department of Traumatology at Amalia Simoni University Hospital, seven days after having self-inoculated with stool in his right leg and thigh as self-harm. The patient complained of pain and his general was very poor. Physical examination revealed generalized increase in volume of the right lower limb, with marked erythema areas alternating with areas of necrosis that were even affecting the lower abdomen; increased local temperature, tenderness, pain with subcutaneous crepitus in wide area were found, as well as bulls serohematic bulls, putrid, foul-smelling. Radiography reveals marked increase in opacity of the soft tissues, bands of gas at the level of subcutaneous tissue and the presence of numerous bulls without bone involvement. Multidisciplinary surgical treatment was decided including the guillotine disarticulation of the right leg to hip level and wide toilette, life support, and the combination of clindamycin, vancomycin, and meronem. Gas gangrene is a fulminant soft tissue infection with high mortality; the suspected diagnosis and understanding of the pathophysiology improve prognosis. Life support, balance the internal environment, the use of broad-spectrum antimicrobials and aggressive surgical treatment, reduce mortality(AU)