RESUMO
La endodoncia es preventiva cuando sacrifica la totalidad o parte del tejido pulpar vital para evitar una posible invasión microbiana a los tejidos de so- porte del diente. Esta endodoncia pasa a ser curativa cuando se instala en ellos la noxa bacteriana, donde la farmacoterapéutica local alcanza una relevancia significativa. Cuando se realiza la obturación del conducto radicu- lar con un biomaterial no reabsorbible y se invade el periodonto, la posterior reparación posendodóntica solo se realiza a expensas del hueso medular y se impide el cierre de la trayectoria final del conducto radicular con tejido mineralizado de origen perio- dontal (cemento secundario). Aplicando una técnica intralesional, ya sea transfo- ramen apical o utilizando como vector un trayecto fistuloso, se viabiliza una terapia intralesional con biomateriales biodegradables y bioactivos. Se obtiene así, mayor calidad y rapidez en la regeneración ad integrum de los tejidos lesionados, por medio de la activación de la fase defensiva-constructiva y el cierre del foramen apical con tejido mineralizado. Los tejidos afectados curan con una cinética significativamente más rápida, sin recurrir a la cirugía complementaria de la endodoncia, procedimiento invasivo asociado con ciertos efectos adversos (AU)
Endodontics is preventive when it sacrifices all or part of the vital pulp tissue to avoid possible microbial invasion of the supporting tissues of the tooth. This endodontics becomes curative when bacterial noxa settles in them, where local pharmacotherapeutics reaches significant relevance. When root canal obturation is performed with a non-resorbable biomaterial and the periodontium is invaded, the subsequent postendodontic repair is only performed at the expense of the medullary bone and the closure of the final trajectory of the root canal with mineralized tissue of periodontal origin is prevented. (Secondary cement). Applying an intralesional technique, be it apical transformation or using a fistulous tract as a vector, intralesional therapy with biodegradable and bioactive biomaterials becomes viable. In this way, greater quality and speed is obtained in the ad integrum regeneration of injured tissues, through the activation of the defensive-constructive phase and the closure of the apical foramen with mineralized tissue. Affected tissues heal with significantly faster kinetics, without resorting to complementary endodontic surgery, an invasive procedure associated with certain adverse effects (AU)
Assuntos
Humanos , Feminino , Adulto , Doenças Periapicais/terapia , Aloenxertos Compostos , Cicatrização/fisiologia , Medronato de Tecnécio Tc 99mRESUMO
Background. Cranioplasty is a procedure that provides coverage for cranial defects after bone resection because of different etiologies such as intracranial hemorrhage, trauma, tumor or infection. One of the most important postoperative complications is the exposure of the plate, that may happen after a skin wound dehiscence. These are challenging situations for the plastic surgeon. Free tissue transfer provides a solution for these patients. The forearm radial flap provides all the conditions to solve these problem Methods. A retrospective study was performed with fourteen patients at the Santojanni Hospital between January 2018 and March 2020. All of them presented exposure of the cranioplasty plate. The defect area was analyzed. The average area to be covered was 5.07 cm2 (1.5 cm2-12.8 cm2). A radial forearm free flap was performed for all patients. Homolateral facial vessels (57%) were used as the first choice; the contralateral facial vessels were used in case of previous radiation therapy (29%) and in these cases a bypass was used in one case with venous interposition in three cases and arterial in the rest; superficial temporal vessels (14%). Results. Flap vitality was 100%. Average follow-up of 12 months (23 m-4 m). One patient presented seroma in the donor area. No new exposures or dehiscences were presented. Conclusions. Free tissue transfer provides an effective coverage to exposed material. The forearm flap provides reliable, thin, well-vascularized soft tissue that can be used to seal the dura, remove dead space, cover the exposed defect, not only but also it provides a long pedicle that allows distant anastomosis in cases of radiation therapy.
Introducción. La craneoplastia es un procedimiento necesario para cubrir defectos craneales luego de resección ósea por distintas etiologías, tales como hemorragia intracraneal, traumatismos craneoencefálicos, tumores o infecciones. Una de las complicaciones frecuentes es la exposición de placas de craneoplastia por dehiscencia de herida cutánea. Estas son complicaciones frecuentes y frustrantes para el paciente y el cirujano plástico. La transferencia de tejidos a distancia brinda una solución para estos pacientes. El colgajo radial antebraquial reúne las condiciones necesarias para la cobertura. Material y métodos. Se realiza un estudio retrospectivo con un total de 14 pacientes en el Hospital Santojanni en el período comprendido entre enero de 2018 y marzo de 2020. Todos presentaron exposición de la placa de craneoplastia. Se analizó el área de defecto, siendo el área promedio a cubrir de 5,07 cm2 (1,5-12,8 cm2). Se realiza cobertura con colgajo radial antebraquial. Se utilizan vasos faciales homolaterales (57%) como primera elección; vasos faciales contralaterales, por radioterapia (29%) y en ellos se utilizó bypass en un tiempo con interposición venosa en tres casos y arterial en el restante; vasos temporales superficiales (14%). Resultados. Se logró cobertura completa en todos los pacientes. La vitalidad de los colgajos fue del 100%. Seguimiento promedio de 12 meses (4-23 meses). Un paciente presentó seroma en la zona dadora. No se presentaron nuevas exposiciones ni dehiscencias. Conclusiones. La transferencia con tejido a distancia permite una eficaz cobertura de material expuesto. El colgajo antebraquial proporciona tejido blando confiable, delgado y bien vascularizado, que se puede utilizar para sellar la duramadre, eliminar el espacio muerto, cubrir el defecto expuesto y también posee un pedículo largo que permite anastomosis a distancia en casos de defectos tratados con radioterapia. Palabras claves: complicaciones de craneoplastias, reconstruccion de cuero cabelludo,
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Próteses e Implantes , Reologia , Crânio , Cirurgia Plástica , Retalhos de Tecido Biológico , Aloenxertos CompostosRESUMO
Early results of hand and face transplants and other grafts such as those of uterus, penis, trachea, larynx, or abdominal wall have confirmed the potential for vascularized composite allotransplantation (VCA) to restore appearance, anatomy, function, independence, and social integration in patients suffering from devastating tissue deficits untreatable by conventional treatment options. Despite such promise, these novel and complex procedures face challenges and controversies that remain open to discussion and debate. Indeed, many barriers to clinical advancement and negative stakeholder perceptions still exist. The bioethical challenges surrounding VCA include but are not limited to justice and vulnerability of subjects, and their experiences with risks, benefits and outcomes, provider economy of fame, public awareness and attitudes toward transplantation, and policy and regulatory issues shaping progress of the field. The First International Workshop on Bioethical Challenges in Reconstructive Transplantation was organized by the Brocher Foundation in Hermance, Switzerland. VCA professionals representing teams from across the world examined bioethical issues in VCA related to standards for safety, efficacy, feasibility, privacy, confidentiality, and equitability. Key discussion topics from the workshop were included in a survey questionnaire implemented across VCA professionals attending the 13th Congress of International Society of VCA held in Salzburg, Austria. The insights from the Brocher workshop and International Society of VCA survey as presented here could help inform the future development of clinical practice and policy strategies in VCA to ensure value, accessibility, and acceptance of these procedures by potential donors, potential or actual recipients and their families, and providers and payers.
Assuntos
Tomada de Decisão Clínica/ética , Aloenxertos Compostos , Confidencialidade/ética , Consentimento Livre e Esclarecido/ética , Segurança do Paciente , Obtenção de Tecidos e Órgãos/ética , Alotransplante de Tecidos Compostos Vascularizados/ética , Sobrevivência de Enxerto , Humanos , Complicações Pós-Operatórias/etiologia , Medição de Risco , Fatores de Risco , Resultado do Tratamento , Alotransplante de Tecidos Compostos Vascularizados/efeitos adversosRESUMO
Introdução: Estudos recentes apontam a utilização do curativo biológico com base em animais aquáticos como biomaterial na medicina regenerativa, apresentando boa aderência ao leito das feridas. O objetivo foi avaliar a eficácia da utilização da pele da Tilápia-do-Nilo (Oreochromis niloticus) como curativo biológico oclusivo, no manejo/tratamento de queimaduras de 2º grau em adultos. Métodos: Estudo clínico com 30 pacientes aleatoriamente tratados com pele da Tilápia-do-Nilo (n = 15) e hidrofibra com prata Aquacel Ag® (n =1 5). Resultados: Em relação à duração, o tratamento com a pele da Tilápiado-Nilo obteve uma média de dias de tratamento (9,6 ± 2,4) similar ao material comparativo (10,7 ± 4,5). Quanto ao relato de dor durante a troca de curativos, não houve diferença estatisticamente significante (p > 0,68) entre os grupos. Após a troca do curativo, não houve inferioridade no registro do valor na escala analógica de dor, em que 66,7% dos tratados com pele da Tilápia-do-Nilo relataram diminuição dos eventos álgicos. Constatou-se ainda que 60% dos pacientes tratados com a pele da Tilápia-do-Nilo não tiveram seus curativos substituídos em qualquer momento do tratamento. Para o curativo Aquacel AG®, 53,3% dos pacientes tiveram mais de uma substituição de curativos. Conclusões: Com base na pesquisa, pode-se concluir que a pele da Tilápia-do-Nilo é eficaz como curativo biológico oclusivo. Houve similaridade entre os grupos para a média de dias de tratamento (completa cicatrização da ferida) e para o relato de dor durante a realização do curativo. Também, a não inferioridade relacionada a dor após os curativos e suas trocas (quando existentes) e na quantidade de substituições destes.
Introduction: Recent studies have suggested the use of biological dressings made of aquatic animals as biomaterials in regenerative medicine since they demonstrate good adherence to the wound bed. The objective of this study was to evaluate the efficacy of Nile tilapia skin (Oreochromis niloticus) as an occlusive biological dressing in the management and treatment of second-degree burns in adults. Methods: This clinical study included 30 patients randomly treated with Nile tilapia skin (n = 15) or Aquacel Ag® silver-based hydrofiber dressing (n = 15). Results: The Nile tilapia skin yielded a similar mean treatment time (9.6 ± 2.4 days) to that of the comparative material (10.7 ± 4.5 days). There was no statistically significant intergroup difference (p > 0.68) in pain during dressing changes. No disadvantage in pain was noted, as 66.7% of patients treated with Nile Tilapia skin reported a decrease in pain events. Moreover, 60% of the patients treated with the Nile Tilapia skin did not require dressing replacement at any time during treatment. For the Aquacel AG® dressing, 53.3% of the patients required more than one dressing replacement. Conclusions: Our findings suggest that the Nile tilapia skin is as effective as an occlusive biological dressing. The average treatment time (complete wound healing) and pain reports during dressing changes were similar between groups. Furthermore, pain after and number of dressing exchanges (when performed) were not worse.
Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Cicatrização , Curativos Biológicos/efeitos adversos , Curativos Biológicos/normas , Queimaduras/complicações , Queimaduras/diagnóstico , Carboximetilcelulose Sódica/análise , Carboximetilcelulose Sódica/efeitos adversos , Carboximetilcelulose Sódica/uso terapêutico , Transplante de Pele/efeitos adversos , Transplante de Pele/métodos , Ciclídeos/lesões , Aloenxertos Compostos/fisiopatologia , Aloenxertos Compostos/lesões , Curativos Oclusivos/efeitos adversos , Curativos Oclusivos/normasRESUMO
BACKGROUND: Vascularized composite allografts (VCA) are novel, life-enhancing forms of transplantation (Tx). However, host immune responses to the various VCA components, especially those involving skin, are complex and make selection of appropriate therapy challenging. Although the interplay between Foxp3+ T regulatory (Treg) cells and CD4 and CD8 effector T cells is of central importance in determining the acceptance or rejection of solid organ allografts, there is little information available concerning the contribution of Treg cells to VCA survival. In addition, the effects of therapeutic expansion in vivo of host Treg cell populations on VCA survival are unknown. METHODS: We established a fully major histocompatibility complex-disparate (BALB/c- > C57BL/6) murine orthotopic forelimb Tx model to explore the benefits of pre- and post-Tx IL-2/anti-IL-2 monoclonal antibody complex (IL-2C) administration to expand the host Treg cell population and thereby attempt to promote Treg cell-dependent VCA survival. RESULTS: Both strategies expanded the Treg cell population in vivo and prolonged VCA survival (P < 0.001), but IL-2C administration pre-Tx led to significantly longer survival compared with IL-2C administration post-Tx (P < 0.01). In addition, compared with post-Tx therapy, pre-Tx therapy resulted in an increased ratio of Treg cells to CD8+ T cells (P < 0.001), reduced proliferation of CD4 and CD8 effector T cells, and reduced production of IFN-γ. Optimal effects were seen when combined with rapamycin therapy, whereas the combination of IL-2C therapy plus calcineurin inhibitor was counterproductive. CONCLUSIONS: Our studies involving different IL-2C-mediated Treg cell expansion strategies demonstrate that pre-Tx IL-2C therapy may be a useful component for developing strategies to promote VCA survival.
Assuntos
Aloenxertos Compostos , Membro Anterior/transplante , Sobrevivência de Enxerto/efeitos dos fármacos , Interleucina-2/farmacologia , Animais , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BL , Linfócitos T Reguladores/imunologiaRESUMO
PURPOSE OF REVIEW: One of the most important challenges in the intestinal (ITx) and multivisceral transplant (MVTx) is to achieve a successful abdominal wall closure. RECENT FINDINGS: A tension-free primary closure should be our aim. In most of the cases, we need to perform a component separation technique, alone or combined, to the use of a synthetic mesh. If those options are not feasible, the abdominal wall composite vascularized allograft transplant (AW-CVA) utilizing direct orthotopic vascularization can be considered. The nonvascularized abdominal rectus fascia has also become an alternative method used worldwide, proving to be simple and well tolerated procedure. Furthermore, the use of the AW has been recently proposed as a new tool for a sentinel monitoring of the intestinal or pancreas allograft. SUMMARY: There are different validated options for abdominal wall closure following intestinal transplantation. The long-term benefits of transplanting the abdominal wall, full or partial thickness and vascularized or nonvascularised, were shown. New developments might help to expand their applications in different areas such as reconstructive surgery and immunology.
Assuntos
Parede Abdominal/cirurgia , Aloenxertos Compostos/transplante , Intestinos/transplante , Procedimentos de Cirurgia Plástica/métodos , HumanosRESUMO
BACKGROUND: Cellular therapies for immunomodulation in vascularized composite allotransplantation (VCA) have gained importance due to their potential for minimization of immunosuppression. Adipose-derived (AD) mesenchymal stem cells (MSCs) especially have shown encouraging potential. We investigated the influence of timing and frequency of AD-MSC treatment on immunologic and graft survival as well as graft vasculopathy outcomes after VCA. METHODS: Lewis rats received full-mismatched Brown Norway rat hindlimb transplants. Recipient animals were assigned to groups receiving donor-derived AD-MSCs (10 cells/animal) either on postoperative day (POD) 1, POD 4, or repeatedly on POD 4, 8, and 15, and compared to untreated controls. RESULTS: Although AD-MSC administration on POD 1 or POD 4, 8, and 15 resulted in 50% long-term graft acceptance, recipients treated on POD 4, and controls rejected before POD 50. All treated animals revealed peripheral blood chimerism (4 weeks), most pronounced after repetitive cell administration (12.92% vs 5.03% [POD 1] vs 6.31% [POD 4]; P < 0.05; all P < 0.01 vs control 1.45%). Chimerism was associated with the generation of regulatory T cells (CD4CD25FoxP3). In vitro mixed lymphocyte reactions revealed modulation of the recipient immune response after AD-MSC treatment. Graft arteries at end point revealed significant differences of arterial intimal thickness between rejecting and AD-MSC-treated animals (P < 0.01). CONCLUSIONS: Taken together, our results point to the potential for repetitive AD-MSC administration in improving outcomes after VCA. Future studies are warranted into optimization of the dosing and frequency of AD-MSC therapy, either alone or used in, combination with other cell therapies (such as hematopoietic stem cells or bone marrow-derived MSC or dendritic cells) for optimization of appropriate conditioning or maintenance regimens.
Assuntos
Tecido Adiposo/citologia , Aloenxertos Compostos/irrigação sanguínea , Aloenxertos Compostos/transplante , Sobrevivência de Enxerto , Membro Posterior/irrigação sanguínea , Membro Posterior/transplante , Imunoterapia/métodos , Transplante de Células-Tronco Mesenquimais/métodos , Células-Tronco Mesenquimais/imunologia , Alotransplante de Tecidos Compostos Vascularizados/métodos , Animais , Proliferação de Células , Células Cultivadas , Aloenxertos Compostos/imunologia , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Membro Posterior/imunologia , Imunoterapia/efeitos adversos , Ativação Linfocitária , Masculino , Transplante de Células-Tronco Mesenquimais/efeitos adversos , Modelos Animais , Ratos Endogâmicos BN , Ratos Endogâmicos Lew , Linfócitos T Reguladores/imunologia , Fatores de Tempo , Quimeras de Transplante , Tolerância ao Transplante , Doenças Vasculares/imunologia , Doenças Vasculares/prevenção & controle , Alotransplante de Tecidos Compostos Vascularizados/efeitos adversosRESUMO
BACKGROUND: The development of safe and reliable protocols for the transplantation of the face and hands may be accomplished with animal modeling of transplantation of vascularized composite allografts (VCA). Previously, we demonstrated that tolerance to a VCA could be achieved after canine recipients were simultaneously given marrow from a dog leukocyte antigen-identical donor. In the present study, we extend those findings across a dog leukocyte antigen mismatched barrier. METHODS: Eight recipient dogs received total body irradiation (4.5 cGy), hematopoietic cell transplantation (HCT), either marrow (n = 4) or granulocyte-colony stimulating factor mobilized peripheral blood stem cells (n = 4), and a VCA transplant from the HCT donor. Post grafting immunosuppression consisted of mycophenolate mofetil (28 days) and cyclosporine (35 days). RESULTS: In 4 dogs receiving bone marrow, 1 accepted both its marrow transplant and demonstrated long-term tolerance to the donor VCA (>52 weeks). Three dogs rejected both their marrow transplants and VCA at 5 to 7 weeks posttransplant. Dogs receiving mobilized stem cells all accepted their stem cell transplant and became tolerant to the VCA. However, 3 dogs developed graft-versus-host disease, whereas 1 dog rejected its stem cell graft by week 15 but exhibited long-term tolerance toward its VCA (>90 weeks). CONCLUSIONS: The data suggest that simultaneous transplantation of mobilized stem cells and a VCA is feasible and leads to tolerance toward the VCA in a haploidentical setting. However, there is a higher rate of donor stem cell engraftment compared with marrow HCT and an increase in the incidence of graft-versus-host disease.
Assuntos
Células da Medula Óssea/metabolismo , Aloenxertos Compostos/imunologia , Sobrevivência de Enxerto , Mobilização de Células-Tronco Hematopoéticas/métodos , Transplante de Células-Tronco Hematopoéticas , Animais , Antígenos/química , Ciclosporina/farmacologia , Cães , Rejeição de Enxerto/imunologia , Doença Enxerto-Hospedeiro , Fator Estimulador de Colônias de Granulócitos/farmacologia , Terapia de Imunossupressão , Leucócitos/imunologia , Ácido Micofenólico/farmacologia , Reprodutibilidade dos Testes , Transplante de Pele , Condicionamento Pré-Transplante , Tolerância ao Transplante , Transplante HomólogoRESUMO
There are 40 vascularized composite allotransplant programs across 5 continents served by 31 organ procurement organizations (or equivalent). The organizations' websites inform about organ and tissue donation. This research explored worldwide educational efforts on vascularized composite allograft (VCAG) donation via their corporate websites as well as options within donor registries and donor card systems to indicate a VCAG donation preference. Of these, 13 (41.9%) of 31 had VCAG content and 7 (22.6%) of 31 offered a mechanism for individuals to voice a preference about VCAG donation through an opt in donor registry or card or an opt out registry. In North America, the only donor registration/card system that facilitated VCAG donation is in Mexico. The resistance to consent for VACG donation is likely due to poor public education and the personal nature of face, hand, uterus, and penile allografts. Efforts to reduce this resistance can begin with the assistance of website content, registries, and donor cards.
Assuntos
Aloenxertos Compostos , Sistema de Registros , Obtenção de Tecidos e Órgãos , Feminino , Humanos , Masculino , México , Doadores de TecidosRESUMO
BACKGROUND: Strategies aiming at minimization or elimination of systemic immunosuppression are key immediate goals for clinical expansion of vascularized composite allotransplantation (VCA). We compared the in vitro and in vivo immunomodulatory efficacy of adipose-derived mesenchymal stem cells (AD-MSCs) and bone marrow (BM)-derived MSCs in a rat VCA model. METHODS: Both cell types were tested in vitro for suppressor function using mixed lymphocyte reactivity assays. AD-MSCs or BM-MSCs were administered intravenously (1 × 10 or 5 × 10 cells/animal) to Lewis rat recipients of mismatched Brown Norway hindlimb transplants. Short course tacrolimus (FK-506) monotherapy was withdrawn at postoperative day 21. In vivo regulatory T-cell induction, peripheral blood chimerism, and microchimerism in lymphatic organs were analyzed. RESULTS: AD-MSCs and BM-MSCs exhibited strong dose-dependent suppressor function in vitro, which was significantly more pronounced for AD cells. In vivo, all animals revealed peripheral multi-lineage chimerism at four weeks (P < 0.01) independent of cell type and dosage. Regulatory T-cell levels were increased with both cell types, the most in AD-MSC groups. These immunomodulatory effects were only transient. MSC treatment resulted in long-term (>120 day) allograft survival in 47% of the animals, which correlated with durable microchimerism in BM and spleen. CONCLUSIONS: AD-MSCs and BM-MSCs exert immunomodulatory effects that prolong survival of immunogenic skin-bearing VCA grafts with short course (21 day) tacrolimus induction therapy. The in vivo findings in terms of allograft survival did not reflect superior immunomodulatory characteristics of AD-MSCs found in vitro.
Assuntos
Tecido Adiposo/citologia , Transplante de Medula Óssea , Aloenxertos Compostos/irrigação sanguínea , Aloenxertos Compostos/transplante , Sobrevivência de Enxerto , Membro Posterior/irrigação sanguínea , Membro Posterior/transplante , Terapia de Imunossupressão/métodos , Transplante de Células-Tronco Mesenquimais , Transplante de Pele , Alotransplante de Tecidos Compostos Vascularizados , Animais , Células Cultivadas , Aloenxertos Compostos/efeitos dos fármacos , Esquema de Medicação , Sobrevivência de Enxerto/efeitos dos fármacos , Membro Posterior/efeitos dos fármacos , Imunossupressores/administração & dosagem , Masculino , Ratos Endogâmicos BN , Ratos Endogâmicos Lew , Linfócitos T Reguladores/imunologia , Tacrolimo/administração & dosagem , Fatores de Tempo , Quimeras de Transplante , Tolerância ao TransplanteRESUMO
BACKGROUND: Hand/upper extremity transplantation is the most common form of vascularized composite allotransplantation performed to date. An Update of worldwide outcomes is reported. METHODS: The authors summarize the international experience with 107 known transplanted hand/upper extremities in 72 patients. Data from published medical literature, national and international meetings, lay press reports, and personal communications were utilized to provide the most up-to-date summary. RESULTS: Although 24 losses (including four mortalities) are known, three of the four reported mortalities and eight of 24 limb losses were caused by multiple type vascularized composite allotransplantations (combined upper and lower limb or upper limb and face). Seven more losses were attributable to 15 patients in the early experience in China. In the United States and Western Europe, only three other non-acute graft losses have been reported, resulting in a patient survival rate for unilateral or bilateral hand transplantation in isolation of 98.5 percent and an overall graft survival rate of 83.1 percent. CONCLUSIONS: Published functional outcomes continue to demonstrate improvement in function and quality of life. The international experience supports the idea that, for properly selected individuals, hand and upper extremity transplantation should be considered an important treatment option.
Assuntos
Braço/transplante , Transplante de Mão/estatística & dados numéricos , Alotransplante de Tecidos Compostos Vascularizados/estatística & dados numéricos , Austrália , China , Aloenxertos Compostos/estatística & dados numéricos , Europa (Continente) , Facilitação Imunológica de Enxerto , Sobrevivência de Enxerto , Humanos , México , Seleção de Pacientes , Recuperação de Função Fisiológica , Sistema de Registros , Resultado do Tratamento , Estados UnidosRESUMO
Nas amputações mais distais da ponta dos dedos, o reimplante microcirúrgico pode não ser praticável. Nestes casos, o enxerto composto oferece os melhores resultados funcionais e estéticos, sendo, porém, incerta a sua reintegração. Várias técnicas foram aventadas para melhorar a sobrevida do enxerto volumoso, basicamente diminuindo o seu volume, associando ou não um retalho cutâneo. Outras técnicas criam uma superfície adicional de contato para difusão plasmática, o "bolso subcutâneo", sem diminuir o volume do enxerto composto, com altas taxas de sucesso. O presente artigo apresenta um caso de amputação da ponta distal do dedo mínimo (zona I de Ishikawa) numa criança de 2 anos de idade. Impossível de reimplante microcirúrgico, a reintegração foi feita com enxerto composto do coto amputado, sem desbridamento, e com a criação de uma nova superfície de contato para difusão plasmática, na extremidade distal do coto enxertado, no plano dérmico da região hipotênar, aumentando assim a área de contato e diminuindo a distância radial da difusão plasmática no enxerto composto. Doze dias após, esse contato adicional foi separado e ambas as superfícies apresentaram sangramento. A reintegração foi total, com mínimas cicatrizes no dedo e na região hipotênar. Uma breve revisão bibliográfica foi feita e discutidos os conceitos cirúrgicos, assim como os fatores que influenciam na sobrevida do enxerto composto. Na área receptora, o plano anatômico mais adequado e melhor vascularizado, para o contato adicional com o enxerto, necessita ser determinado.
In more-distal amputations of the fingertips, microsurgical replantation is not feasible. For these cases, composite graft provides the best functional and aesthetic results. However, its reintegration is uncertain. Several techniques have been proposed to improve bulky graft survival by basically reducing its volume, regardless of whether a skin flap is connected. Other techniques create an additional contact surface for plasmatic diffusion, the so-called subcutaneous pocket, without reducing the composite graft volume and yielding high success rates. This article presents a case of amputation of the distal tip of the fifth digit (Ishikawa zone I) of a 2-year-old child. Because of the impossibility of microsurgical replantation, a composite graft was used to reintegrate the amputated stump, without debridement, by creating a new contact surface for plasmatic diffusion at the distal end of the grafted stump, on the dermal plane in the hypothenar region, thereby increasing the contact area and decreasing the radial distance for the plasmatic diffusion of the composite graft. Twelve days later, the additional contact was separated and both surfaces presented bleeding. Full reintegration occurred with minimal scarring of the finger and hypothenar region. A brief literature review was conducted, discussing surgical concepts and factors that influence composite graft survival. The most appropriate and best vascularized anatomic plane for additional contact with the graft in the recipient area needs to be determined.
Assuntos
Humanos , Masculino , Pré-Escolar , História do Século XXI , Reimplante , Criança , Procedimentos de Cirurgia Plástica , Falanges dos Dedos da Mão , Aloenxertos Compostos , Traumatismos dos Dedos , Amputação Cirúrgica , Cotos de Amputação , Reimplante/métodos , Procedimentos de Cirurgia Plástica/métodos , Falanges dos Dedos da Mão/cirurgia , Aloenxertos Compostos/cirurgia , Traumatismos dos Dedos/cirurgia , Dedos , Dedos/cirurgia , Amputação Cirúrgica/métodos , Cotos de Amputação/cirurgiaRESUMO
Vascularized bone marrow transplantation (VBMT) appears to promote tolerance for vascularized composite allotransplantation (VCA). However, it is unclear whether VBMT is critical for tolerance induction and, if so, whether there is a finite amount of VCA that VBMT can support. We investigated this with a novel VCA combined flap model incorporating full-thickness hemiabdominal wall and hindlimb osteomyocutaneous (HAW/HLOMC) flaps. Effects of allograft mass (AM) and VBMT on VCA outcome were studied by comparing HAW/HLOMC VCAs with fully MHC-mismatched BN donors and Lewis recipients. Control groups did not receive treatments following transplantation. Treatment groups received a short course of cyclosporine A (CsA), antilymphocyte serum, and three doses of adipocyte-derived stem cells (POD 1, 8, and 15). The results showed that all flaps in control allogeneic groups rejected soon after VCAs. Treatment significantly prolonged allograft survival. Three of eight recipients in HLOMC treatment group had allografts survive long-term and developed donor-specific tolerance. Significantly higher peripheral chimerism was observed in HLOMC than other groups. It is concluded that the relative amount of AM to VBMT is a critical factor influencing long-term allograft survival. Accordingly, VBMT content compared with VCA mass may be an important consideration for VCA in humans.
Assuntos
Parede Abdominal/cirurgia , Transplante de Medula Óssea/métodos , Aloenxertos Compostos , Membro Posterior/cirurgia , Retalhos Cirúrgicos , Alotransplante de Tecidos Compostos Vascularizados/métodos , Animais , Medula Óssea/irrigação sanguínea , Medula Óssea/imunologia , Estudos de Viabilidade , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto , Tolerância Imunológica , Imunossupressores/uso terapêutico , Teste de Cultura Mista de Linfócitos , Subpopulações de Linfócitos/imunologia , Masculino , Tamanho do Órgão , Ratos , Ratos Endogâmicos BN , Ratos Endogâmicos Lew , Transplante de Pele , Cauda , Quimeras de TransplanteRESUMO
En la búsqueda de dar solución a defectos del tercio inferior de la oreja se han utilizado diversas técnicas reconstructivas que abarcan desde la colocación de injertos compuestos contralaterales hasta el tallado de colgajos, que dependen de la cesión de tejidos vecinos. Aquí exponemos una opción válida: el colgajo de Antia-Buch aplicado al tercio inferior, con un resultado aceptable, sin agregar más zonas de comorbilidad a la existente
In the search of solution forthe lower third defects of the ear there have been used diverse reconstructions technics, from harvested of composite grafts till local fl aps, that depends from a near donor zone. Here we show a valid option: the AntiaBuch fl ap in application for the lower third of the ear, with an acceptable result, without adding extra morbidity to the zone
Assuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Operatórios/métodos , Retalhos Cirúrgicos/cirurgia , Pavilhão Auricular/anormalidades , Aloenxertos Compostos/cirurgiaRESUMO
La reconstrucción secundaria determinada por traumatismos severos de alta energía y procedimientos oncológicos con grandes pérdidas de cobertura cutánea requiere la transferencia con microcirugía para aportar un tejido sano vascularizado al sector comprometido. Sin embargo, debido a procesos cicatriciales y traumáticos, no siempre es posible hallar los vasos receptores para la transferencia. Una solución a dicha dificultad es la utilización de injertos venosos y arteriales o la confección de una fístula arteriovenosa cercana a la pérdida de sustancia. Se crea una fístula arteriovenosa temporalmente y luego se dividirá aportando los vasos necesarios para el colgajo libre. Desde agosto 2007 a agosto 2011 se realizaron 28 fístulas arteriovenosas en 27 pacientes que han sido utilizadas para transferencia de 22 colgajos libres. Las edades de los pacientes van desde los 12 a los 65 años de edad, con una media de 40,44 años. el tiempo de seguimiento de estos pacientes va desde los 2 hasta los 48 meses. De las 28 fístulas realizadas, 22 han podido ser utilizadas para transferir colgajos libres en forma exitosa. Las otras 6 fallaron. Las fístulas arteriovenosas determinaron cambios fisiológicos y en las características de flujo que permitió mayor seguridad en el momento de la transferencia de los colgajos. La utilización de fístulas arteriovenosas permite no sólo tener vasos receptores de buena calidad próximos a la lesión, sino también conseguir con ellas, un mayor flujo sanguíneo arterial y disminución de las resistencias periféricas gracias a cambios fisiológicos e histológicos que se producen a nivel del puente arteriovenoso.