RESUMO
Vein grafts are used frequently in microvascular surgery, but an adequate supply of autogenous veins is not always available. The search for an ideal substitute for autogenous vein continues. We present a case of lower extremity reconstruction made difficult by lack of suitable autogenous vein for venous outflow from a rectus abdominus free flap. A 36 cm cryopreserved allograft saphenous vein was used on an emergency basis for this problem.
Assuntos
Criopreservação , Perna (Membro)/cirurgia , Veia Safena/transplante , Retalhos Cirúrgicos/métodos , Idoso , Humanos , Masculino , Preservação de Órgãos , Cicatrização , Ferimentos por Arma de Fogo/cirurgiaAssuntos
Carcinoma/fisiopatologia , Neoplasias Mamárias Experimentais/fisiopatologia , Expansão de Tecido , Análise de Variância , Animais , Carcinoma/patologia , Modelos Animais de Doenças , Feminino , Pressão Hidrostática , Injeções Intradérmicas , Neoplasias Mamárias Experimentais/patologia , Invasividade Neoplásica , Metástase Neoplásica , Ratos , Ratos Endogâmicos F344 , Dispositivos para Expansão de Tecidos , Células Tumorais CultivadasRESUMO
Osteomyelitis of the clavicle is an uncommon disease, but it should be considered in patients who present with pain, cellulitis, or drainage in the sternoclavicular area following head and neck surgery, irradiation, subclavian vein catheterization, or immunosuppression. An idiopathic presentation is possible. In contrast to primary osteomyelitis of the clavicle, which is occasionally seen in children, secondary osteomyelitis is quite rare. It is often mistaken for a fracture or a possible neoplasm on plain x-rays. Tomograms and CT scanning are confirmatory, and in early cases, technetium-99m bone scanning can be helpful. Treatment must include early, aggressive surgical debridement of all affected tissues, followed by wound coverage with a well-vascularized flap and perioperative antibiotics.
Assuntos
Clavícula/cirurgia , Osteomielite/cirurgia , Abscesso/complicações , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/etiologia , Lesões por Radiação/cirurgia , Infecções Estafilocócicas , Retalhos CirúrgicosRESUMO
Twenty-one patients with gigantic defects of the scalp and middle third of the face and palate following excision of neglected or recurrent tumors, burns, and infections have undergone microsurgical reconstruction. Wide resection of the middle third of the face, orbit, and palate requires "complex" three-dimensional volume reconstruction, whereas extensive defects of the scalp and skull (exceeding 80 cm2) require coverage of the larger surface area soft-tissue defect and the exposed brain and dura. The latissimus dorsi free-muscle flap and split-thickness skin graft have become our methods of choice for extensive scalp and skull defects. The latissimus dorsi musculocutaneous free flap is preferable for reconstruction of complex palatal and external skin and orbital defects of the middle third of the face. Microsurgical free-tissue transfer reliably frees the oncologic surgeon from the constraints imposed by conventional reconstructive techniques and may therefore allow improved curative or at least palliative resection of these extensive tumors.
Assuntos
Carcinoma Basocelular/cirurgia , Carcinoma de Células Escamosas/cirurgia , Neoplasias Palatinas/cirurgia , Couro Cabeludo/cirurgia , Neoplasias Cutâneas/cirurgia , Neoplasias Cranianas/cirurgia , Cirurgia Plástica/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Microcirurgia/métodos , Pessoa de Meia-Idade , Retalhos CirúrgicosRESUMO
Since the recognition of the Beckwith-Wiedemann syndrome was first noted in 1963, the number of associated anomalies has vastly increased. The rate of appearance of this abnormality is 1 in 13,5000 births. This article presents a case that includes macroglossia and ankyloglossia along with a bifid uvula and a submucous cleft of the palate. A discussion of treatment follows.
Assuntos
Síndrome de Beckwith-Wiedemann/patologia , Macroglossia/patologia , Língua/anormalidades , Anquilose/patologia , Pré-Escolar , Fissura Palatina/patologia , Feminino , Humanos , Úvula/anormalidadesRESUMO
Hidradenitis suppurativa is a devastating disease of the apocrine sweat glands. The chronic form is characterized by a malodorous discharge from multiple draining sinuses embedded in dense fibrous tissue, and physical discomfort. The disease commonly affects the axillary, perineal, and perianal regions. A case of hidradenitis suppurativa of the mammary gland necessitating mastectomy is presented here to illustrate the severity of the disease at an uncommon site. As in other regions of the body, aggressive surgical intervention provides a chance for rapid recovery. The surgical treatment should be tailored to the severity of the disease.
Assuntos
Doenças das Glândulas Sudoríparas/cirurgia , Feminino , Humanos , Inflamação , Mastectomia , Mastite/cirurgia , Pessoa de Meia-Idade , SupuraçãoRESUMO
The use of bulky retractors in experimental microsurgical procedures creates interference with the limited operative field. The current article describes a small but effective retractor made from ordinary staples, which are inexpensive and easily accessible.
Assuntos
Microcirurgia/instrumentação , AnimaisRESUMO
The current study in rats concerns two aspects of the flap/bed interaction: fluorescein kinetics and histological finding. In the control group of animals in the fluorescein kinetics experiment, flaps were raised and then reattached. In one experimental group, the flaps were raised and placed on a sterile polyethylene film. In two other groups, the flaps were raised and then the pedicle was cut, either immediately or at specific intervals. At intervals up to 24 hours several animals were injected with 5% fluorescein. In the control group fluorescein penetration increased with time, while it decreased in the polyethylene-film group. There was virtually no fluorescein staining in both cut-pedicle groups. To study histological events, the animals were divided into groups with flaps and groups in which the distal end of each flap was severed to form a contiguous skin graft. Other conditions were varied. All flaps were cultured, and biopsy specimens were obtained from three areas at several time intervals. Histological sections from the distal flap were markedly different from the corresponding skin grafts. These results corroborate previously noted survival rates.
Assuntos
Sobrevivência de Enxerto/fisiologia , Retalhos Cirúrgicos/fisiologia , Animais , Fluoresceínas/farmacocinética , Masculino , Ratos , Ratos Endogâmicos , Pele/anatomia & histologia , Pele/metabolismo , Retalhos Cirúrgicos/métodos , Fatores de TempoRESUMO
A flap needs close contact with its bed for optimal flap survival. Using a rat dorsal flap model, flap/bed contact times were varied by use of a sterile polyethylene film. In addition, the flap was modified either by removing the panniculus carnosus or by converting the distal flap into a skin graft. Finally, the effect of using a dressing was assessed. Several observations were made: (1) The initial 6 to 12 hours of a flap's interaction with its bed is critical for optimal survival; (2) fluorescein accurately predicted flap survival upon polyethylene removal; (3) removing the panniculus carnosus increased flap and skin graft survival; (4) dressing allowed flaps and skin grafts to better withstand bed deprivation; and (5) distal flaps and skin grafts under various conditions responded differently to bed deprivation.
Assuntos
Sobrevivência de Enxerto/fisiologia , Retalhos Cirúrgicos/fisiologia , Animais , Masculino , Necrose/patologia , Ratos , Ratos Endogâmicos , Pele/irrigação sanguínea , Pele/patologia , Retalhos Cirúrgicos/métodos , Fatores de TempoRESUMO
We investigated the interaction between long-term dexamethasone administration and lipectomy on regional fat deposits in the rat. Seven-week-old Sprague-Dawley rats (N = 24) were divided into 3 test groups. Group 1 (control) received 0.5 ml/kg of saline intramuscularly daily; group 2, 1 microgram dexamethasone intramuscularly; group 3, 5 micrograms dexamethasone intramuscularly. At week 9 a lipectomy of 4 regional fat deposits on the right side of the animal was done: inguinal, epididymal, interscapular, and perirenal. Injections continued for an additional 27 weeks, at which time a lipectomy was done removing left-sided depots in addition to any "regrown fat" on the previously dissected right side. Several conclusions can be made. First, rats receiving 5 micrograms/kg reaccumulated more fat than the controls in the inguinal, perirenal, and interscapular depots. Second, fat cell size in this model greatly influenced the ultimate size of each depot. Third, fat depots vary in their response to steroids and lipectomy because of local and systemic factors.