RESUMO
BACKGROUND: Implant-based immediate breast reconstruction after skin-sparing mastectomy has shown a significant improvement in patients' quality of life, making the procedure steadily more popular year after year. However, this technique has a high morbidity rate, including skin necrosis and implant exposure. METHODS: A retrospective review of a prospectively held database for autologous breast reconstruction in our institution of the last 5 years found eight cases with exposed implants after nipple-sparing mastectomy and immediate reconstruction. A single-stage procedure consisting on implant removal and immediate replacement with a deepithelialized DIEP flap was performed in all cases (10 DIEP flaps). RESULTS: All flaps were successful. Patients' mean age was 45 years old. Three patients developed seroma (5, 7, and 14 days after surgery, respectively). No infections were detected in up to 24 months of follow-up. CONCLUSIONS: Nipple-sparing mastectomy with immediate implant-based reconstruction is considered oncologically safe. However, it has a high rate of complications that could require implant removal. Immediate free flap reconstruction is a feasible and safe option to replace the missing volume with low risk of complications that result in a soft and natural-shaped breast.
Assuntos
Implantes de Mama/efeitos adversos , Neoplasias da Mama/cirurgia , Mamoplastia/efeitos adversos , Mastectomia/efeitos adversos , Complicações Pós-Operatórias , Terapia de Salvação , Retalhos Cirúrgicos/estatística & dados numéricos , Adulto , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Reoperação , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Introducción: el cáncer de piel afecta con frecuencia la región facial por su alta exposición a la radiación ultravioleta. La mejilla es un sitio frecuente y como consecuencia de la exéresis, quedan amplios defectos que requieren de técnicas reconstructivas. Este estudio tuvo como objetivo evaluar la utilidad del uso de colgajos locales para la reconstrucción de mejilla en pacientes intervenidos de lesiones tumorales de piel. Métodos: se realizó un estudio prospectivo en 27 pacientes atendidas en el Instituto Nacional de Oncología y Radiobiología desde julio de 2013 hasta julio de 2015. Resultados: el grupo etario predominante estuvo integrado por mujeres entre 67-77, el tipo histológico que predominó fue el carcinoma basocelular. Predominó la mejilla izquierda. El colgajo que más se realizó fue el de rotación (Mustardé) y la complicación más frecuente fue el ectropión. Conclusiones: todos los casos fueron reconstruidos de forma inmediata, independientemente del tamaño del defecto(AU)
Introduction: Skin cancer frequently affects the facial area, due to high exposure to ultraviolet radiation. The most frequent affected area is the cheek. The wide excisions resulting from excision require reconstructive techniques to repair them. Objective: to evaluate the usefulness of local flaps for the cheek reconstruction in skin cancer lesions. Methods: A prospective study was conducted in 27 patients seen at the National Institute of Oncology and Radiobiology from July 2013 through July 2015. Results: The predominant age group comprised women aged 67-77 years, being the basal cell carcinoma the predominant one. The left cheek was the most affected. The most used flap was the rotation flap(Mustarde) and the most common complication was ectropion. Conclusions: All the cheek defects were immediately reconstructed regardless of their size(AU)
Assuntos
Humanos , Feminino , Idoso , Bochecha/lesões , Procedimentos de Cirurgia Plástica/efeitos adversos , Neoplasias Cutâneas/diagnóstico , Retalhos Cirúrgicos/efeitos adversos , Retalhos Cirúrgicos/estatística & dados numéricos , Epidemiologia Descritiva , Estudos Longitudinais , Estudos RetrospectivosRESUMO
Palatal necrosis after palatoplasty in patients with cleft palate is a rare but significant problem encountered by any cleft surgeon. Few studies have addressed this disastrous complication and the prevalence of this problem remains unknown. Failure of a palatal flap may be attributed to different factors like kinking or section of the pedicle, anatomical variations, tension, vascular thrombosis, type of cleft, used surgical technique, surgeon's experience, infection, and malnutrition. Palatal flap necrosis can be prevented through identification of the risk factors and a careful surgical planning should be done before any palatoplasty. Management of severe fistulas observed as a consequence of palatal flap necrosis is a big challenge for any cleft surgeon. Different techniques as facial artery flaps, tongue flaps, and microvascular flaps have been described with this purpose. This review article discusses the current status of this serious complication in patients with cleft palate.
Assuntos
Fenda Labial/epidemiologia , Fenda Labial/cirurgia , Fissura Palatina/epidemiologia , Fissura Palatina/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/estatística & dados numéricos , Procedimentos de Cirurgia Plástica/estatística & dados numéricos , Adolescente , Distribuição por Idade , Causalidade , Criança , Pré-Escolar , Comorbidade , Feminino , Humanos , Incidência , Masculino , Necrose/cirurgia , Fístula Bucal , Complicações Pós-Operatórias/epidemiologia , República da Coreia/epidemiologia , Fatores de Risco , Retalhos Cirúrgicos/estatística & dados numéricos , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: The blood-brain barrier (BBB) is a highly efficient system that separates the central nervous system (CNS) from general circulation and promotes selective transport of molecules that are essential for brain function. However, it also limits the distribution of systemically administered therapeutics to the brain; therefore, there is a restricted number of drugs available for the treatment of brain disorders. Several drug-targeting strategies have been developed to attempt to bypass the BBB, but none has proved sufficiently effective in reaching the brain. METHODS: The objective of this study is to generally review these strategies of drug administration to the CNS. RESULTS: Noninvasive methods of drug delivery, such as chemical and biologic transport systems, do not represent a feasible platform, whereas for most drugs, it is still not possible to achieve therapeutic levels within the brain tissue after intravenous or oral administration, and the use of higher potency or more concentrated doses may cause serious toxic side effects. Direct intrathecal drug delivery through a catheter into the CNS also presents several problems. Intranasal drug delivery is a potential alternative method due to the direct transport into the cerebrospinal fluid (CSF) compartment along the olfactory pathway, but the study's conclusions are controversial. An endoscopic intranasal surgical procedure using established skull base surgery reconstruction techniques based on the use of a nasal mucosa surgical flap as the only obstacle between the nose and the subarachnoid space has appeared as a potential solution to increase the absorption of intranasal drugs to the CNS. CONCLUSION: Despite extensive efforts to develop new techniques to cross the BBB, none has proved sufficiently effective in reaching the brain, whereas minimizing adverse effects and the endoscopic mucosal grafting technique offers new potential promise.
Assuntos
Encefalopatias/tratamento farmacológico , Sistema Nervoso Central/efeitos dos fármacos , Sistemas de Liberação de Medicamentos/métodos , Espaço Subaracnóideo/efeitos dos fármacos , Retalhos Cirúrgicos/estatística & dados numéricos , Administração Intranasal , Animais , Barreira Hematoencefálica/fisiologia , Sistema Nervoso Central/fisiologia , Endoscopia , Humanos , Mucosa Nasal/cirurgia , Condutos Olfatórios/fisiologia , Condutos Olfatórios/cirurgia , Procedimentos de Cirurgia Plástica , Base do Crânio/cirurgia , Espaço Subaracnóideo/cirurgiaRESUMO
PURPOSE: To describe the clinical characteristics, diagnosis, treatment, and visual outcome of 61 cases of Fusarium keratitis in Mexico. METHODS: Retrospective, comparative study of 61 patients with clinically and culture-confirmed Fusarium keratitis, who were attended at an eye hospital in Mexico City from 1981 to 2001. RESULTS: Fusarium solani was the main causal agent in 83.6% of cases. Trauma history was observed in 57.4% and a history of agricultural activity in 34.4%. Signs were redness (100%), epithelial defects (98.3%), superficial corneal ulcer (95.1%), anterior chamber inflammation (91.8%), and satellite infiltrates (75.4%). In 50% of cases, the treatment was topical ketoconazole 2%; in 34.2% of cases, additional topical antifungal preparations were used. A total of 77% of patients improved and 23% worsened. Conjunctival flap was indicated in 4 of 61 patients (6.5%), and 14 of 61 patients (23%) underwent penetrating keratoplasty. Two of 61 patients were treated with tectonic keratoplasty. Evisceration surgeries were practiced in 14 of 61 patients (22.9%). The final visual acuity after medical or medical/surgical therapy, was no light perception (NLP) in 19 patients (33.33%), light perception (LP) to hand movements (HM) in 18 patients (31.57%), 20/400 to 20/200 in 1 patient (1.75%), 20/150 to 20/60 in 5 patients (8.77%), and 20/40 to 20/20 in 14 patients (24.56%). Four patients were lost to follow-up. CONCLUSIONS: Fusarium is the most common cause of fungal keratitis in Mexico. Most cases (43/54, 79.6%) improved with topical antifungal therapy (either monotherapy or combined). We suggest surgical therapy with conjunctival flap or penetrating keratoplasty in advanced cases, when there has been poor response to medical therapy or a very low final visual acuity.
Assuntos
Infecções Oculares Fúngicas , Fusarium , Adolescente , Adulto , Idoso , Agricultura , Antifúngicos/uso terapêutico , Criança , Úlcera da Córnea/microbiologia , Infecções Oculares Fúngicas/complicações , Infecções Oculares Fúngicas/diagnóstico , Infecções Oculares Fúngicas/etiologia , Infecções Oculares Fúngicas/terapia , Feminino , Humanos , Ceratite/microbiologia , Ceratite/patologia , Ceratoplastia Penetrante/estatística & dados numéricos , Masculino , México , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Oftalmológicos/estatística & dados numéricos , Retalhos Cirúrgicos/estatística & dados numéricos , Resultado do Tratamento , Adulto JovemRESUMO
Los labios comprenden una estructura móvil, formada por una capa muscular cubierta externamente por piel, internamente por mucosa y entre ambas una zona de transición, el bermellón. Debido a su ubicación, el labio inferior recibe radiaciones actínicas directamente, y ésta es la causa por la cual la incidencia de tumores es mayor que en el labio superior. Los labios desempeñan importantes funciones, por lo que la reconstrucción ofrece un gran desafío al cirujano plástico, el cual debe conservar tanto la función como el aspecto estético. Se presenta paciente de sexo masculino, 62 años, que presentaba carcinoma espinocelular de labio inferior, ulcerado, fondo granulante, bordes evertidos, duropétrea, de 3 cm, que afectaba el 70 % del labio e incluía la comisura derecha, sin adenopatías palpables, de 3 años de evolución.(AU)
Lips comprise a mobile structure, composed by a muscular layer covered by skin in the outside and mucous in the inside. Between covers there is a transition zone, the vermillion. Due to its localization, the lower lips is exposed to direct sunlinght radiation, and that is the main reason why it has a higher incidence in skin malignancies than the upper lip. Lip reconstruction after excision of malignancies is a challenge for the Plastic Surgeon, mainly because of the important functions of the mouth. The goal is to remain the preservation of those functions as well as restorting the aesthetic unit aspect. A 62 years old male is presented. The patient acussed a history of the tumor, a squamus cell carcinoma of the lower lip, of 3 years. At the admission, the patient showed a 3 cm. firm tumor involving 70 % of the lower lip, including the right commissure. An ulcer with granulation tissue and raised outlining was evident. No local or regional adhenopathies were found at the moment of the admission.(AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Labiais/cirurgia , Procedimentos de Cirurgia Plástica , Retalhos Cirúrgicos/estatística & dados numéricosRESUMO
Desde Julio del año 2004 a Septiembre del año 2008, se trataron 34 pacientes que presentaban patología ano-orificial beningna, mediante la realización del colgajo anal cutáneo por deslizamiento. La edad promedio fue de 59 años y el sexo predominante el masculino. Las patologías que presentaban fueron, enfermedad hemorroidal el 64%; estenosis anal 18% y fisura anal 18% del total de enfermos operados el 22% tenían como antecedente cirugía previa y de ellos el 50% fue por hemorroidectomía. La constipación crónica se asocia en un 98% a fisura anal; 65% a enfermedad hemorroidal y un 47% a estenosis del ano. El dolor anal presente en el 100% de los enfermos con estenosis anal y en un 92% en fisura anal. La proctorragia se presentó en el 85% de los pacientes con enfermedad hemorroidal; 73% en isura anal en un 40% en la estenosis anal.(AU)
Since July 2004 until September 2008, 34 patients with benign anal pathologywere treated by means of sliding skin anal grafts. The average was 59 years old and there were mostly male.The pathology that they presented was 64% hemorrhoids, 18% anal stenosisand 18% anal fissure; 22% of the patients had a previous surgery and 50% of them have had hemorroidectomy. Chronic head colding is associated with anal fissure in 98%, hemorrhoids in 65% and anal stenosis in 47% of the patients. Anal pain was present in 100% of the patients with anal stenosis and in 92% of the patients with anal fissure. Anal bleeding had been present in 85% of patients with hemorrhoids, 73% in anal fissure and 40% in anal stenosis. Before surgery 6 patients have had different incontinence degree, 3 referred to soild their underwear, 2 of them referred gases incontinence and 1 liquid soiling. Patients under sliding skin anal grafts surgery had a significant improvement; 28 days after surgery all of them had normal continence. Before surgery 7 patients had diminution of the anal diameter verified by the interrogatory and rectal tact. After 21 days from surgery, such diameter was considered as normal. Colonical cleanness is been made with monosodic/ bisodic phosphate with excellent results in all the patients. All patients received monodosis of antibiotic prophylactic with ciprofloxacin and metronidazol. Two patients (5.88%) had infection, because of that they received 7 days of antibiotics, resolving the infection completely. In 94% of the patients the anesthesia used was riding saddle subarachnoid blockade with hyperbaric bupivacaine, in all the cases the results were excellent. After surgery, 70% of the patients referred the pain as light, 20% as moderate and less than 10% as severe. Skin graft vitality was satifactory in100% of patients, 76% very go...(AU)
Assuntos
Humanos , Fissura Anal , Retalhos Cirúrgicos , Retalhos Cirúrgicos/estatística & dados numéricos , Doenças do Ânus , Doenças do Ânus/cirurgia , Neoplasias do Ânus , Canal Anal/patologia , Canal Anal/cirurgia , Canal Anal , Estreitamento UretralRESUMO
Estudio realizado en el hospital oncológico Dr. Juan Tanca Marengo (SOLCA) en pacientes sometidas a reconstrucción mamaria inmediata (RMI). Tipo de estudio: retrospectivo, analítico, descriptivo. Objetivos: describir y analizar diferentes técnicas quirúrgicas empleadas en reconstrucción mamaria postmastectomía. Comparar distintos procedimientos de RM según el material usado en cuanto a complicaciones y resultado estético. Determinar el método reconstructivo más adecuado y aceptado por la paciente. Resultados: de 112 pacientes sometidas a RMI postmastectomía por cáncer de mama, en el hospital oncológico Dr. Juan Tanca Marengo (SOLCA) durante 1994 - 2004, 12 fueron excluídas al ser mastectomizadas por otro motivo o por falta de seguimiento postquirúrgico. Además, la práctica inmediata de reconstrucción mamaria fue la más frecuente, siendo los tejidos autólogos (TRAM), la técnica más utilizada (79.8) ya que sus complicaciones (36.5), fueron menores que con agentes heterólogos, 69 sea con implantes y/o expansores. En cuanto al resultado estético con TRAM fue evaluado como excelente por la misma paciente (56) y médico encargado (52). Conclusión: estos resultados demuestran la importancia de capacitar y entrenar a los cirujanos en RM para brindarles a las mujeres mastectomizadas una nueva opción con buenos resultados.
Study carried out in the oncologic hospital Dr. Juan Tanca Marengo (SOLCA) inpatients subjected to immediate mammary reconstruction (IMR). Study type: retrospective, analytical, descriptive. Objectives: describe and analyze different surgical techniques used in post-mastectomy. Mammary reconstruction. Compare different procedures of MR according to the material used regarding complications and esthetic result. Determine the most appropriate and accepted by the patient reconstructive method. Results: 12 patients out of 112 subjected to post-mastectomy IMR due to mammary cancer in the oncologic hospital Dr. Juan Tanca Marengo (SOLCA) from 1994 to 2004, were excluded because they had mastectomy for other reasons or lack of post-surgical follow up. Additionally, the immediate mammary reconstruction was the most frequent, and the most used technique the autologous tissues TRAM - (79.8), since its complications (36.5) were lesser than with heterologous agents (69), be it with implanting and/or expanders. Regarding the estheticresult with TRAM, it was evaluated as excellent by the patient herself (56) and doctor in charge (52). Conclusion: these results prove the importance of preparing and training RM surgeons to offer to women that had mastectomy a new option with good results.
Assuntos
Adulto , Feminino , Pessoa de Meia-Idade , Mamoplastia , Mastectomia Radical , Neoplasias da Mama/cirurgia , Bioprótese , Retalhos Cirúrgicos/estatística & dados numéricos , TransplanteRESUMO
Introdução: O desafio da reconstrução nasal complexa está na necessidade de restaurar o forro e o suporte nasal, respeitando as subunidades do nariz, para obter um resultado estético e funcional satisfatório. Enxertos de cartilagem dependem do forro nasal para a sua vascularização e o forro nasal depende da cartilagem para o seu suporte. Freqüentemente um limitado e inadequado forro determina resultado também limitado. Objetivo: Demonstrar a aplicabilidade de retalhos intra- nasais na reconstrução do forro nasal e do esqueleto de sustentação, em pacientes submetidos a reconstrução nasal. Método e resultado: 03 pacientes com ressecção de carcinoma nasal prévia foram submetidos a reconstrução. O forro nasal foi reconstruído com retalho de mucosa septal pivô. Para estrutura de sustentação utilizou-se o retalho de cartilagem septal em dobradiça - retalho de dequervain. O resultado funcional e estético foi considerado satisfatório. Discussão: Reconstrução de defeitos nasais em espessura total necessitam adequada restauração do forro nasal. Retalhos intranasais de mucosa septal são finos, vascularizados e flexíveis e dão nutrição a cartilagem restaurada. O retalho de cartilagem septal em dobradiça restaura a parede lateral e serve de suporte ao forro. Conclusão: Retalhos intranasais de mucosa e cartilagem septal aplicam-se satisfatoriamente na restauração do forro em pacientes submetidos a reconstrução nasal.
Background: The Challenge of Complex Nasal Reconstruction Is The Necessity To Restore The Lining And The Nasal Support, Respecting The Subunits Of The Nose, To GetA SatisfatoryAesthetic And Functional Result. Cartilage Grafts Depend On Lining For Vascularization, And Lining Depends On The Cartilage Grafts For Support. Frequencily, One Limited And Inadequate Lining Determines A Limited Result. Objective: to demonstrate to the applicability of intranasal flaps in the reconstruction of the nasal lining and support in patients submitted nasal reconstruction. Methods And Results: 03 patients with previous ressection of nasal carcinoma had been submitted the reconstruction. The nasal lining was reconstructed with remnant of septal mucosa. For support it wal used the remnant of septal cartilage in hinge flap - described by de Quervain. The functional and aesthetic result was considered satisfactory. Discussion: Reconstruction of nasal defects in total thickness needs one adequate restoration the nasal lining. Intranasais flaps of septal mucosa are thin, upple and well vascularizated give to nutrition the restored cartilage. The septal cartilage flap in hinge restores the sidewall and serves of support to the lining. Conclusions: Intranasal flaps of mucosa and septal cartilage satisfactorily apply in the restoration of the lining in patients submitted the nasal reconstruction.
Assuntos
Humanos , Masculino , Feminino , Nariz , Retalhos Cirúrgicos , Nariz/anatomia & histologia , Nariz/anormalidades , Nariz/cirurgia , Retalhos Cirúrgicos/estatística & dados numéricos , Retalhos Cirúrgicos/fisiologia , Retalhos Cirúrgicos/patologiaRESUMO
BACKGROUND: Although the lateral thoracodorsal fasciocutaneous flap is a well-studied procedure for late breast reconstruction following radical surgery, there are few previous reports regarding its indication, flap design, and clinical outcome following conservative breast surgery. METHODS: Thirty-four patients underwent immediate unilateral lateral thoracodorsal fasciocutaneous flap breast reconstructions. Mean time of follow-up was 23 months. The lateral thoracodorsal fasciocutaneous flap was indicated to reconstruct moderate lateral breast defects where there was not enough breast tissue to perform the reconstruction. Flap and donor-site complications were evaluated. Information on aesthetic results and patient satisfaction was collected. RESULTS: All tumors were located in lateral breast regions, and 64.7 percent measured 2 cm or less (T1). Flap complications occurred in four patients (11.8 percent), with partial flap necrosis in three (8.8 percent). Donor-site complications occurred in eight (23.5 percent), with seroma in five (14.7 percent) and wound dehiscence in three (8.8 percent). The cosmetic result was considered to be good or very good in 88.2 percent, and the majority of patients were either very satisfied or satisfied. Surgical intervention was necessary in two cases of wound dehiscence. Serial dorsal puncture in cases of seroma were performed with satisfactory results. CONCLUSIONS: The lateral thoracodorsal fasciocutaneous flap is a simple and reliable technique for conservative breast surgery reconstruction. Success depends on patient selection, coordinated planning with the oncologic surgeon, and careful intraoperative management.
Assuntos
Mamoplastia/métodos , Retalhos Cirúrgicos , Adulto , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/cirurgia , Quimioterapia Adjuvante , Cicatriz/etiologia , Terapia Combinada , Estética , Necrose Gordurosa/etiologia , Feminino , Fibrose , Humanos , Excisão de Linfonodo , Mamoplastia/efeitos adversos , Mamoplastia/estatística & dados numéricos , Mastectomia , Pessoa de Meia-Idade , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Radioterapia Adjuvante , Reoperação , Estudos Retrospectivos , Seroma/etiologia , Retalhos Cirúrgicos/efeitos adversos , Retalhos Cirúrgicos/estatística & dados numéricos , Deiscência da Ferida Operatória/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Resultado do TratamentoRESUMO
INTRODUÇÃO: O retalho ântero-lateral da coxa é baseado em vasos perfurantes do ramo descendente da artéria circunflexa lateral femoral. Este retalho tem características muito interessantes para a cirurgia reparadora, como a pequena espessura, pedículo longo e excelente área doadora. No entanto, existem muitas controvérsias na literatura quanto aos vasos perfurantes e ao trajeto do pedículo deste retalho. Neste trabalho procurou-se estabelecer alguns parâmetros anatômicos e esclarecer estas controvérsias. MÉTODO: Estudaram-se 100 coxas de 50 cadáveres quanto aos seguintes aspectos: 1- Número e localização de perfurantes encontrados, 2- Trajeto do pedículo perfurante, 3- Trajetória intramuscular, 4- Comprimento do trajeto intramuscular, 5- Comprimento total do pedículo, 6- Diâmetro dos vasos e 7- Espessura do retalho. RESULTADOS: 1- Encontraram-se de 0 a 4 perfurantes por coxa estudada, todas em um raio de até 6cm do ponto médio entre a espinha ilíaca ântero-superior e a borda lateral da patela. 2- Os vasos perfurantes tinham trajeto músculo-cutâneo em 75,76% das coxas e septo-cutâneo em 24,24%. 3- Dos pedículos perfurantes com trajeto músculo-cutâneo, 86,67% possuíam trajetória indireta contra 13,33% com trajetória direta. 4- O comprimento médio do trajeto intramuscular dos pedículos foi de 3,67 ± 2,01 cm. 5- O comprimento médio do pedículo total foi de 11,31 ± 3,12 cm. 6- O diâmetro médio da artéria na origem do ramo descendente da artéria circunflexa femoral foi de 2,21 ± 0,85 mm e para as veias no mesmo local de 2,66 ± 1,33 mm e 2,10 ± 1,11 mm. 7- A espessura da tela subcutânea foi de 8,98 ±6,23 mm e da pele de 1,60 ± 0,76 mm. CONCLUSÕES: 1- Existiu uma pequena possibilidade de não haver pedículos perfurantes. 2- Quando presentes, os pedículos perfurantes do ramo descendente da artéria circunflexa lateral femoral eram encontrados em numero de 1 a 4, sempre em um raio de 6 cm a partir do ponto médio entre a espinha ilíaca ântero-superior e a borda...
INTRODUCTION: The anterolateral thigh flap is based on the perforator vessels of the descending branch of the lateral circumflex femoral artery. This flap has very interesting characteristics for the reconstructive surgery, like the small thickness, long pedicle and excellent donor site. On the other hand, there are many controversial data on the literature about the perforator vessels and the pedicle course of this flap. The aims of this study are to establish some anatomical parameters and clear some controversies. METHOD: A hundred thighs of 50 cadavers were studied for: 1- The number and location of the perforator vessels. 2- The course of the perforator pedicles. 3- The intramuscular course. 4- The length of the intramuscular course. 5- The total length of the vascular pedicle. 6- The diameter of the vessels. and 7- The thickness of the flap. RESULTS: 1- There were found from 0 to 4 perforators per thigh, all in a 6cm radius from the mid point between the anterosuperior iliac spine and the lateral border of the patella. 2- The pedicles was musculocutaneous in 75,76% of the thighs and septocutaneous in 24,24%. 3- Among the musculocutaneous pedicles, 86,67% had a direct intramuscular course, and 13,33% had indirect course. 4- The mean length of the intramuscular course was 3,67 ± 2,01 cm. 5- The mean total pedicle length was 11,31 ± 3,12 cm. 6-The mean artery diameter on the origin of the descending branch of the lateral circumflex femoral artery was 2,21 ± 0,85 mm and the mean vein diameter on the same spot was 2,66 ±1,33 mm and 2,10 ± 1,11 mm. 7- The mean subcutaneous fat tissue thickness was 8,98 ± 6,23 mm and the mean skin thickness was e 1,60 ± 0,76 mm. CONCLUSIONS: 1- There was a possibility of finding no perforators of the descending branch of the lateral circumflex femoral artery. 2- When present, the perforators pedicles were found in numbers between 1 to 4, always in a 6cm radius from the mid point between the anterosuperior iliac spine...
Assuntos
Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Cadáver , Quadril/anatomia & histologia , Quadril/irrigação sanguínea , Microcirurgia , Retalhos Cirúrgicos/estatística & dados numéricos , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos , Cirurgia PlásticaRESUMO
Realizou-se um estudo sobre o retalho transverso lombar, descrevendo sua anatomia, técnica operatória, aplicações clínicas e complicações. Baseado em dissecções anatômicas, este retalho é descrito como sendo do tipo axial, em sua porção proximal, nutrido pelos ramos perfurantes das artérias lombares e intercostais e, em sua porção distal, como sendo do tipo randomizado, baseado nos plexos vasculares subdérmicos, que cruzam a linha média da região lombar. Por ser um retalho de fácil execução, com um ótimo aporte sanguíneo e não inviabilizar futuras cirurgias, ele é indicado como primeira opção para o tratamento das úlceras de pressão da região sacral e das lesões localizadas na linha média e adjacências do terço inferior da região lombar.
This is a study concerning transverse lumbar flap that describes its anatomy, surgical technique, clinical applications and complications. Based upon anatomical dissections, this flap is described as with an axial pattern on its proximal portion, irrigated by perfurating branches of lumbar and intercostal arteries, and on its portion as with random pattern due to an uninterrupted subdermal vascular plexus across the midline of back. Being of simple execution, with a good blood supply and not interfiring in possible future operations, it can be indicated as first option for the treatment of sacral pressures sores as well as for lesions located on midline and nearby of the lower third of lumbar area.
Assuntos
Humanos , Masculino , Feminino , Retalhos Cirúrgicos , Úlcera por Pressão , Retalhos Cirúrgicos/estatística & dados numéricos , Retalhos Cirúrgicos/fisiologia , Retalhos Cirúrgicos/patologia , Retalhos Cirúrgicos , Úlcera por Pressão/cirurgia , Úlcera por Pressão/diagnósticoRESUMO
An audit was conducted of pedicled flaps used in reconstructive surgery in Trinidad from 1983 to 2000. This consisted of 65 flaps. There were four cases of partial flap necrosis: three involving tram flaps and the other involving the metacarpal artery flap. There were no cases of total flap loss. Pedicled flap coverage provides immediate closure of potentially difficult wounds. This early cover reduces the risk of infection as a result of increasing the blood supply and providing a physical barrier. This contributes to a shorter hospital stay and earlier rehabilitation. Our present team approach with the inclusion of a reconstructive surgeon now allows for uncompromised débridement in trauma and oncological resection.
Assuntos
Procedimentos de Cirurgia Plástica/estatística & dados numéricos , Retalhos Cirúrgicos/estatística & dados numéricos , Feminino , Humanos , Complicações Pós-Operatórias , Estudos Retrospectivos , Trinidad e TobagoRESUMO
Las mutilaciones faciales debidas a tumores malignos nasales invasores de las regiones vecinas pueden ser satisfactoriamente reconstruidas empleando el clásico "scalpng flap" propuesto por converse. la operación resectiva debe ser complementada con colgajos de vecindad (mejillas, labio superior) para lograr que el defecto o rinostoma resultante sea central y simétrico.Para lograr un buen resultado estético y funcional e invariable en el tiempo, resulta fundamental reconstruir adecuadamente la cubierta cutánea, el forromucoso y el soporte esquelético...Se detalla cada etapa quirúrgica de estas reconstrucciones y se presentan casos clínicos de tumores nasales avanzados. Infortunadamente muchos de estos pacientes llegaron a un estado crítico después de haber soportado prolongados e inadecuados tratamientos a múltiples recidivas
Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Deformidades Adquiridas Nasais/cirurgia , Deformidades Adquiridas Nasais/fisiopatologia , Retalhos Cirúrgicos/estatística & dados numéricos , Nariz , Cirurgia PlásticaRESUMO
Since its introduction by Hartrampf et al, the TRAM flap has proven to be a superior method of breast reconstruction in comparison to other techniques. This versatile flap provides a large quantity of autologous tissue, a lasting realistic breast mound in terms of ptosis, texture and symmetry. A retrospective study of cases of breast reconstruction using the pedicled TRAM flap was performed to identify outcomes and to justify or abandon the use of this procedure as a consistent reconstructive modality in breast construction. We reviewed 20 consecutive cases between July 1993 and December 1997 which were performed at two New York City Teaching Hospitals by one surgeon with residents assisting. There were 18 single pedicle flaps, 3 double pedicle and one bilateral TRAM flap. Fifteen flaps were delayed reconstructions while 5 patients had immediate reconstruction. The age range was form 28 to 63 years, the average being 43.7 years. The average follow up was 24.28 months. In all patients a modified radical mastectomy was performed by an oncologic surgeon, whose primary aim was complete tumor extirpation. In 3 patients there was a need for adjuvant chemotherapy, and this was usually administered 3 weeks after the mastectomy and reconstruction. In no instance was adjuvant chemotherapy delayed because of the reconstruction procedure. The average operating time was 4.5 hours for a single-pedicle TRAM and 6 hours for a bipedicle TRAM. There were complications in eight cases: 2 seromas; 3 with partial flap loss (2 were allowed to heal by secondary intention and one will require a latissimus dorsi flap for revision); 2 hernias treated with prosthetic mesh; and one umbilical loss. There was no perioperative mortality and the average hospitalization was 5 days for a single pedicle and 6.5 for bipedicle TRAM. There have been 2 deaths subsequently: one patient with cerebral metastases, one year after the procedure, and another with complications of lung cancer 3 months after surgery and adjuvant chemotherapy. We concluded that the pedicle TRAM flap is a reliable method of breast reconstruction with a predictable and satisfactory outcome and with minor complications it strict patient selection is observed. The resultant breast mound is uniformly accepted by the reconstructive surgeon and, most importantly, the patient, who has lost a significant part to cancer.(AU)
Assuntos
Adulto , Pessoa de Meia-Idade , Idoso , Feminino , Humanos , Retalhos Cirúrgicos/estatística & dados numéricos , Mamoplastia , Mamoplastia/mortalidade , Mamoplastia/métodos , Implantes de MamaRESUMO
Se presenta el estudio realizado en 34 mujeres con mastectomía radical por cáncer de mama. A todas las pacientes se les realizó reconstrucción mamaria con la técnica de transposición del músculo latissimus dorsi(nómina anatómica) en un tiempo quirúrgico. Se describe detalladamente la técnica empleada, se enuncian las indicaciones, especialmente cuando hay falta de tejido en calidad y cantidad suficientes y se compara la intervención propuesta con otras técnicas de reconstrucción mamaria. Las ventajas de usar tejidos vecinos, ser de corta duración, no causar trastornos funcionales en el hombro, tener menor tiempo de internación postoperatoria y ser aceptada por los pacientes son comprobadas en el estudio
Assuntos
Neoplasias da Mama , Retalhos Cirúrgicos/estatística & dados numéricos , Mastectomia/reabilitação , Procedimentos Cirúrgicos Operatórios/reabilitação , Retalhos Cirúrgicos/métodos , Mastectomia/métodos , Procedimentos Cirúrgicos Operatórios/normas , Complicações Pós-Operatórias , Cirurgia Plástica/métodos , Satisfação do Paciente/estatística & dados numéricos , Tempo de Internação , Mama/cirurgiaRESUMO
Se presenta la experiencia de 10 años en la reconstrucción mamaria post-mastectomía con la técnica del colgajo mio-cutáneo del dorsal ancho, efectuada en 107 pacientes. Se señala la importancia de la reconstrucción y la preferencia de los autores por realizarla en forma inmediata a la mastectomía (66,4%). En el 60,7%de las pacientes se completó la reconstrucción con implante protésico en un segundo tiempo operatorio, y fue necesario corregir la mama contralateral en el 75%de ellas. Se mencionan las indicaciones y las complicaciones. Se consideran ideales para ser sometidas a reconstrucción las pacientes en estadios 0, I y II que requieran la mastectomía como indicación terapéutica. Se señala que el procedimiento descripto no aumenta la incidencia ni obstaculiza el diagnóstico de recidivas locales
Assuntos
Neoplasias da Mama/epidemiologia , Mastectomia/reabilitação , Retalhos Cirúrgicos/estatística & dados numéricos , Mastectomia/métodos , Retalhos Cirúrgicos/métodos , Complicações Pós-Operatórias , Recidiva Local de Neoplasia , Satisfação do Paciente , Necrose , Tabagismo , Próteses e Implantes , Estudos Retrospectivos , Cirurgia Plástica/métodosRESUMO
Se presenta el estudio realizado en 34 mujeres con mastectomía radical por cáncer de mama. A todas las pacientes se les realizó reconstrucción mamaria con la técnica de transposición del músculo latissimus dorsi(nómina anatómica) en un tiempo quirúrgico. Se describe detalladamente la técnica empleada, se enuncian las indicaciones, especialmente cuando hay falta de tejido en calidad y cantidad suficientes y se compara la intervención propuesta con otras técnicas de reconstrucción mamaria. Las ventajas de usar tejidos vecinos, ser de corta duración, no causar trastornos funcionales en el hombro, tener menor tiempo de internación postoperatoria y ser aceptada por los pacientes son comprobadas en el estudio
Assuntos
Neoplasias da Mama , Retalhos Cirúrgicos/estatística & dados numéricos , Mastectomia/reabilitação , Procedimentos Cirúrgicos Operatórios/reabilitação , Mama/cirurgia , Cirurgia Plástica/métodos , Retalhos Cirúrgicos/métodos , Tempo de Internação , Mastectomia , Complicações Pós-Operatórias , Satisfação do Paciente/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/normasRESUMO
Se presenta la experiencia de 10 años en la reconstrucción mamaria post-mastectomía con la técnica del colgajo mio-cutáneo del dorsal ancho, efectuada en 107 pacientes. Se señala la importancia de la reconstrucción y la preferencia de los autores por realizarla en forma inmediata a la mastectomía (66,4%). En el 60,7%de las pacientes se completó la reconstrucción con implante protésico en un segundo tiempo operatorio, y fue necesario corregir la mama contralateral en el 75%de ellas. Se mencionan las indicaciones y las complicaciones. Se consideran ideales para ser sometidas a reconstrucción las pacientes en estadios 0, I y II que requieran la mastectomía como indicación terapéutica. Se señala que el procedimiento descripto no aumenta la incidencia ni obstaculiza el diagnóstico de recidivas locales