RESUMO
Los grandes defectos torácicos requieren generalmente procedimientos complejos para su reparación; en la mayoría de los casos es necesaria la combinación de tejidos autólogos y materiales protésicos, por lo que constituye un desafío para el cirujano plástico. En nuestra experiencia se presenta una herida compleja de la pared torácica secundaria a exéresis tumoral. En general se dispone de varias opciones reconstructivas para cubrir los defectos resultantes de las amplias escisiones y poder aportar colgajos vascularizados, amplios y voluminosos. A pesar de no disponer en nuestro caso con los tejidos regionales más comúnmente usados, hemos podido dar cobertura a todo el defecto y se ha garantizado una adecuada estabilidad de la pared torácica. Se tuvo como objetivo mostrar la forma en que se realizó la reconstrucción inmediata con la combinación de colgajo de rotación y material protésico. En este artículo se revisa el hemicolgajo dermograso abdominal, la técnica de elevación y sus ventajas e inconvenientes. Se trata de una técnica de gran seguridad, versátil, con pocas secuelas en la zona donante, de tiempo quirúrgico relativamente corto.
Large thoracic defects require complex procedures for repair, in most cases it requires the combination of autologous tissues and prosthetic materials. A complex wound secondary to tumor exeresis was presented in our service. Among the multiple reconstructive options, a rotation and advancement abdominal dermofat hemicolgajo was chosen. Resulting in a technique of great safety, versatile, with little sequel in the donor area, and short surgical time
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Próteses e Implantes , Neoplasias da Mama/cirurgia , Parede Torácica/cirurgia , Gordura Abdominal/transplante , Retalho Miocutâneo/transplante , Mastectomia/métodosRESUMO
OBJECTIVE AND IMPORTANCE: Vertebrobasilar aneurysms have a risk of rupture ranging from 2.5 to 50% (especially those larger than 7 mm) and a repeat bleeding rate of between 30 and 70%. For this reason, patients with aneurysms larger than 7 mm should be treated. Considering the high complexity of surgical approaches in this area, an increasing number of reported cases are being treated with endovascular therapy. The purpose of this article is to determine the effectiveness and safety of sole stenting bypass in the treatment of three consecutive patients with vertebrobasilar aneurysms. CLINICAL PRESENTATION: Three patients (one woman and two men) with vertebrobasilar junction aneurysms were included in this study. Two of the patients presented with subarachnoid hemorrhage. INTERVENTION: An endovascular procedure was performed under general (two patients) or local (one patient) anesthesia and via a right femoral approach. By use of road map guidance, sole Express (one patient) or Express 2 (two patients) coronary stents (Boston Scientific/Scimed, Maple Grove, MN) were deployed on the diseased vessel. When the stent was in place, an immediate partial thrombosis of the aneurysm was observed, related primarily to an intra-aneurysmal flow pattern modification, possibly facilitated by modification of the angle of the parent vessel. Follow-up angiograms showed complete exclusion of the aneurysms within the circulation. Only one patient presented visual deficit as a thrombotic complication, but it disappeared completely 6 months after treatment. CONCLUSION: The sole stenting bypass technique seems to be a good alternative for the treatment of complex vertebral aneurysms by inducing thrombosis of the aneurysm with preservation of the parent vessel lumen.