RESUMO
Lymphedema refers to the accumulation of protein-rich fluid in the interstitial spaces. This can occur secondary to congenital malformation of the lymphatic channels or nodes or as a result of an insult that damages appropriately formed channels and nodes. Stagnant, protein-rich lymph initiates an inflammatory response that leads to adipocyte proliferation, fibrous tissue deposition, and increased susceptibility to infections. The end result is permanent disfigurement and dermal changes. Early and accurate diagnosis is essential, since lymphedema is a chronic and progressive problem. When lymphedema affects the lower extremity, it is important to manage it in a way that preserves function and mobility. Early diagnosis also allows for a proactive rather than reactive approach to treatment and utilization of novel physiologic procedures, such as lymphovenous anastomosis and vascularized lymph node transfer. Such interventions slow down disease progression and reduce morbidity by allowing the surgeon to salvage the remaining functional lymphatic channels. When physiologic procedures fail or when faced with a delayed presentation, the addition of excisional procedures can provide a more comprehensive treatment of this debilitating disease. The aim of this article is to review the most current concepts in the surgical management of lower extremity lymphedema.
RESUMO
BACKGROUND: The medial thigh is a well-hidden area. The two most common flaps from this area are the transverse upper gracilis (TUG) and profunda artery perforator (PAP) flaps. Herein, we explored the applications of combined TUGPAP flap to reconstruct large and complex defects in different regions. METHODS: Between November 2015 and May 2017, 28 patients who underwent reconstruction and extensive soft tissue coverage with the TUGPAP flap for the breasts, head and neck, and pelvi-perineal regions were included. The defects size ranged from 22 to 29 × 6-8 cm. All flaps were based on the two pedicles: the medial circumflex femoral artery for TUG flap and the profunda artery perforator for PAP flap. They were each anastomosed to a set of recipient vessels. A "Y"-shaped interposition vein graft (YVG) was used if only one recipient artery was available. RESULTS: The harvested skin paddle had dimensions ranged from 20 to 30 × 6-9 cm and all flaps survived completely. Postoperative complications included one case each of donor and recipient site seroma, and one case of wound dehiscence. They were all successfully managed conservatively. During an average follow-up period of 12.7 months, one patient reported permanent paresthesia in the donor site and another developed hypertrophic scar. All patients were able to resume daily activity without major concerns. CONCLUSION: The combined TUGPAP flap is a safe, effective, and a good alternative to the common workhorse flaps as it offers the potential for a large skin paddle and decent soft tissue volume with low donor site morbidity in a well-concealed area.
Assuntos
Neoplasias Hipofaríngeas/cirurgia , Mamoplastia/métodos , Microcirurgia/métodos , Recidiva Local de Neoplasia/cirurgia , Retalho Perfurante/cirurgia , Artérias/cirurgia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Retalho Perfurante/irrigação sanguínea , Reoperação , Estudos Retrospectivos , Coleta de Tecidos e Órgãos/métodos , Veias/transplanteRESUMO
The evaluation of the performance of an experimental apparatus for the determination of flour sorption isotherms was carried out. To adjust the water activity - Aa - values (0.51; 0.57; 0.67; 0.75; 0.79 and 0.81) of the air stream, saturated salt solutions were used. The comparison of the apparatus with and without air recycling, was done by determining the sorption isotherm of soybean flour at 35°C. The air recycling model enables to obtain reliable data in a high Aa range, where samples are usually impaired by microbial growth when the other model is used. Time to obtain equilibrium for soybean flour with the air recycling model was about 50% less than for the model without air recycling.
Foi realizada a avaliação do desempenho de equipamento experimental para a determinação de curvas de umidade de equilíbrio - isoterma de adsorção - de farinhas pelo método dinâmico. Para o ajuste dos valores definidos (0,51; 0,57; 0,67; 0,75; 0,79 e 0,81) de atividade de água - Aa - na corrente de ar, foram usadas soluções saturadas de sais. A comparação da eficiência do equipamento, com e sem recirculação de ar, foi feita determinando-se a isoterma de adsorção de farinha de soja a 35°C. A versão com recirculação de ar permite a obtenção de dados de equilíbrio em elevados níveis de Aa, nos quais há perda das amostras por crescimento microbiano quando se emprega a versão sem recirculação. Os tempos necessários para a obtenção do equilíbrio da farinha com as umidades relativas das correntes de ar são cerca de 50% menores na versão com recirculação de ar.
RESUMO
The evaluation of the performance of an experimental apparatus for the determination of flour sorption isotherms was carried out. To adjust the water activity - Aa - values (0.51; 0.57; 0.67; 0.75; 0.79 and 0.81) of the air stream, saturated salt solutions were used. The comparison of the apparatus with and without air recycling, was done by determining the sorption isotherm of soybean flour at 35°C. The air recycling model enables to obtain reliable data in a high Aa range, where samples are usually impaired by microbial growth when the other model is used. Time to obtain equilibrium for soybean flour with the air recycling model was about 50% less than for the model without air recycling.
Foi realizada a avaliação do desempenho de equipamento experimental para a determinação de curvas de umidade de equilíbrio - isoterma de adsorção - de farinhas pelo método dinâmico. Para o ajuste dos valores definidos (0,51; 0,57; 0,67; 0,75; 0,79 e 0,81) de atividade de água - Aa - na corrente de ar, foram usadas soluções saturadas de sais. A comparação da eficiência do equipamento, com e sem recirculação de ar, foi feita determinando-se a isoterma de adsorção de farinha de soja a 35°C. A versão com recirculação de ar permite a obtenção de dados de equilíbrio em elevados níveis de Aa, nos quais há perda das amostras por crescimento microbiano quando se emprega a versão sem recirculação. Os tempos necessários para a obtenção do equilíbrio da farinha com as umidades relativas das correntes de ar são cerca de 50% menores na versão com recirculação de ar.