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En las consultas de cirugía general se reciben, con frecuencia, pacientes portadores de hernias de la pared abdominal y, dentro de ellas, las hernias de la región inguinal. La hernia, como entidad, se menciona desde el año 1500 a. C. en el papiro Ebers. Su incidencia es alta, con una anatomía compleja, y en ocasiones se plantean porcentajes de recidivas frecuentes, por lo que hace de esta entidad un interesante tema con gran valor para los cirujanos en general. El objetivo de este trabajo es considerar que la técnica de reparación herniaria de Mohan Desarda cumple con los principios fundamentales de reparación de la hernia. En ella las complicaciones son mínimas debido a la utilización de una franja de tejido autólogo como refuerzo para el cierre del defecto, y el índice de recidiva es menor en comparación con el demostrado por otras.
In general surgery consultations, patients carrying hernias of the abdominal walls, and within them, hernias of the abdominal wall, are frequently received. The hernia, as an entity, has been mentioned since the year 1500 BC C. on the Ebers papyrus. Its incidence is high, with a complex anatomy, and sometimes percentages of frequent recurrency are stated, which makes this entity an interesting topic of great value for surgeons in general. The main objective of this work is to consider that Mohan Desarda's hernia repair technique complies with the main principles of hernia repair. In it, complications are minimal due to the use of a strip of autologous tissue as reinforcement for closing the defect, and the recurrence index is lower compared to that demonstrated by others.
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Objective: To generalize the application and prospect of computed tomographic angiography (CTA) in deep inferior epigastric artery perforator (DIEP) flap transfer for breast reconstruction. Methods: The related literature using CTA for DIEP flap reconstruction of breast in recent years was reviewed and analyzed. Results: Preoperative CTA can accurately assess the vascular anatomy of the chest and abdomen wall, precisely locating the perforator in the abdominal donor site, and identifying the dominant perforator; guide the selection of intercostal space to explore internal mammary artery and internal mammary artery perforator in the chest recipient vessels. It can also reconstruct the volume of the abdominal flap with reference to the size of the contralateral breast and pre-shape the abdominal flap, which are crucial to formulate the surgical plan and improve the reliability of flap. Conclusion: Preoperative CTA has enormous application potential and prospects in locating donor area perforator, in selecting recipient vessels, and in evaluating breast volume for autologous breast reconstruction with DIEP flap.
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BACKGROUND: It is very difficult for urologists to choose what kind of substitute and how to reconstruct the long ureteral injuries to restore the integrity and function of the ureter. OBJECTIVE: To review recent progress and the evolution trends in the reconstruction methods of long ureteral injuries. METHODS: Relevant articles published from 1950 to 2019 were searched in PubMed, Web of Science, MEDLINE, and WanFang databases. The keywords were “ureteral injuries, ureteral replacement, biomaterial, tissue engineering, 3D bioprinting” in English and Chinese, respectively. The articles addressing ureteral replacement materials and reconstruction of ureteral injuries were selected. RESULTS AND CONCLUSION: In the reconstruction of long ureteral injury, the earliest repair method is to use autologous tissues, such as ileal, bladder muscle flap (Boari flap), and buccal mucosa graft. But such operations are difficult to avoid the damage to the surrounding tissues and organs. After that, various non-biomaterials were produced for ureteral replacement, but failed due to immune rejection and lack of peristalsis. With the development of cytology, biology and materials, the damaged tissues and organs have been regenerated by using autologous cells. Due to the development of regenerative medicine and three-dimensional printing technology, complex multi-component and multi-layered hollow tube structures that similar to their internal counterparts can be generated with three-dimensional bioprinting. But three-dimensional bioprinting cannot reconstruct the ureter and bladder with normal peristalsis and contraction function.
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BACKGROUND: Rotator cuff injury is the main cause of shoulder dysfunction in adults. The rate of retear is very high in patients with rotator cuff tear treated with simple surgical suture. Biological materials can optimize the biomechanical property after rotator cuff injury. OBJECTIVE: To review the latest research and clinical application of biomaterials in the repair of rotator cuff injury. METHODS: PubMed and Web of science databases were retrieved for the latest researches on the biomaterials for repair of rotator cuff. The search terms were “rotator cuff injuries; biological materials; autograft; extracellular matrix materials; synthetic materials; biological scaffold; biological patch; augmentation”. Fifty-seven articles were classified and compared to discuss the advantages and disadvantages of various repair biomaterials. RESULTS AND CONCLUSION: Currently, the biomaterials for repair of rotator cuff injury can be divided into three categories: untreated human tissue transplantation materials, extracellular matrix materials and synthetic materials. The latest clinical reports show that untreated human tissue transplantation materials often have different clinical effects. The results of extracellular matrix materials derived from human allogenic dermal materials are still acceptable. Most scholars do not recommend the use of small intestinal submucosal grafts from pigs. The latest three-dimensional collagen scaffolds and synthetic absorbable materials have good application prospects due to their good porosity and the ability to induce the healing of tendon and bone tissues. However, most of them are still in the stage of animal experiments, and more clinical trials are needed to confirm their safety and effectiveness. There is no safe and effective biomaterial to treat rotator cuff tear. With the development of tissue engineering technology and materials science, it is expected to find a satisfactory material in the future by combining the macroscopic properties of biological scaffolds or synthetic materials with the microscopic properties of stem cells or cytokines.
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One hundred and twenty nine patients with pelvic organ prolapse (stage Ⅲ to Ⅳ according to POP-Q staging) diagnosed in our hospital from January 2010 to December 2016 were enrolled,among whom 66 cases underwent vaginal hysterectomy plus vaginal anterior and posterior wall repair (TO group),63 cases underwent vaginal hysterectomy plus pelvic floor reconstruction with autologous tissue (AT group).Clinical parameters,perioperative and postoperative complications were analyzed.There was no statistically significant difference in intraoperative blood loss,indwelling urethral catheter time,length of hospital stay,and anal exhaust time between group AT and group TO (P＞O.05).The average operation time of group AT was significantly longer than that of group TO (P＜0.05).The postoperative rotation angle of urethra (UR),posterior vesicourethral angle (RVA),and bladder neck descent (BND) of group AT were significantly reduced (P＜0.05).The BND of group AT was significantly smaller than that of group TO 3 months and 12 months after the surgery (P＜0.05).There was no statistically significant difference in UR before and 12 months after surgery in group TO (P＞0.05),while the BND at 12 months after operation in group TO was increased compared to 3 months after operation (P＜0.05).There were significant differences in scores of PFIQ-7 and PISQ-12 before surgery and 12 month after surgery in both groups (P＜0.05).There was no statistically significant difference between the two groups in the incidence of postoperative recurrence and pressure incontinence (P＜0.05).It is suggested that the stability of pelvic floor anatomical structure after pelvic floor reconstruction with autologous tissue is better than that of the traditional surgery,especially for patients with severe pelvic organ prolapse.
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Objective Study the clinical value of using laparoscopic treatment in the autologous tissue repair for curing children's indirect inguinal hernia. Method Review and analyze 190 children's indirect inguinal hernia cases cured by using laparoscopic high ligation of hernia sac and autologous tissue repair in the past 5 years. Out of them, 153 cases are unilateral indirect hernia and 37 cases bilateral indirect hernia.183 cases (including 11 recurrent hernia cases) are normal cases of oblique hernia and 7 are urgency cases of incarcerated oblique hernia. Results All 190 cases have successful operations. The average operation time for unilateral indirect hernia is 10 minutes.Forbilateralindirect hernia,it is 18 minutes.The average time of stay in hospital is 1 day and there is no complication occurred after operation. Follow-up visits have been carried out for all cases. The duration ranges from 6 months to 5 years and there are five recurrent cases.Conclusion It is effective to use laparoscopic treatment in the autologous tissue repair for curing children's indirect inguinal hernia. It has many advantages, such as short operation time, few operative damages and complications, low recurrence rate and quick recovery. The treatment can be applied to contra-lateral oblique inguinal hernia or bilateral inguinal hernia repairs.
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Breast is one of the most important organ which characterize the femininity and the maternity. As growing not only in numbers of breast cancer patients but also concerns about the quality of life, breast reconstruction after mastectomy turns into hot topics in the area of plastic surgery. Historically, numerous operation techniques have been introduced for breast reconstruction using prosthesis (tissue expander and breast implant) and autologous tissues (various pedicled flaps and free flaps). The most ideal method for breast reconstruction is to make a natural soft breast with less complications and morbidities, and no single technique can be universally accepted in every cases. However, in terms of making a natural, good-looking breast autologous tissue is more superior to tissue expander and breast implant in breast reconstruction. Usually a breast reconstruction is performed in 3 stages; 1st stage is breast mound reconstruction using autologous tissue or tissue expander and implant. 2nd stage is revision of the reconstructed breast and donor site such as abdomen (scar revision, volume adjustment using suction-assisted lipectomy and excision), nipple reconstruction, and surgery of the opposite normal breast (augmentation, mastopexy, or reduction) for maximizing cosmetic results. 3rd stage is a intradermal tattooing for nipple-areolar complex. In this article, various techniques are presented with their indications, methods, advantages and disadvantages. For the choice of best modality, many factors should be considered including an extent of mastectomy, the size and shape of opposite breast, the condition of possible donor sites, postoperative adjuvant therapy (radiation, chemotherapy), patient's age, and patient's preferance.
Subject(s)
Female , Humans , Abdomen , Breast Implants , Breast Neoplasms , Breast , Femininity , Lipectomy , Mammaplasty , Mastectomy , Nipples , Prostheses and Implants , Quality of Life , Surgery, Plastic , Surgical Flaps , Tattooing , Tissue Donors , Tissue Expansion DevicesABSTRACT
Objective To explore the feasibility of repairing and strengthening the posterior wall of the inguinal canal with laparoscopic hernioplasty using autologous anterior abdominal wall tissues.Methods From January 2001 to September 2007,173 adult patients with inguinal hernia(141 cases of indirect hernia,28 cases of direct hernia,3 cases of femoral hernia,and 1 case of obturator hernia)were treated by laparoscopic hernioplasty with autologous tissues obtained from the median,internal,and lateral umbilical folds,and the U-shape fold.Three trocars were used to perform the laparoscopy by one surgeon,who completed the intracavity suturing using two hands.Results All the 173 operations were completed without converting to open surgery.Among the 152 cases of unilateral hernia,the mean operation time was 25 min(10-40 min),while in the 21 cases of bilateral hernia,the mean operation time was 40 min(20-60 min).Postoperative complications included retroperitoneal hematoma(1 case),scrotal swelling(3),testicular hydrocele(1),subcutaneous hemorrhage at the inguinal area(2),and scrotitis(1).The patients were followed up for 1-84 months(mean 35 months),during which 3 patients had recurrence.Conclusions Laparoscopic hernioplasty with autologous tissues is feasible and safe for adult patients with inquinal hernia with advantages of short hospitalization,minimal surgical trauma,quick recovery,and low rate of recurrence.
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Objective To evaluate the results of lung volume reduction surgery (LVRS) using domestic staplers and autologous tissue. Methods Thirteen male patients received LVRS from June 2000 to March 2006 in this hospital. The age range was 56~68 years (mean, 60.5 years). The patients had a history of chronic obstructive pulmonary disease (COPD) for 2~16 years (mean, 11 years). The operation was performed under general anesthesia, with single lung ventilation. A muscle sparing thoracotomy in the 5th intercostal space was conducted. The “target area” was identified by combination of observation and palpation during operation and preoperative CT scans. The cutting edge was stapled with domestic staplers buttressed with autologous tissue. Results All the procedures were successfully accomplished. Follow-up observations for 8 months ~ 5 years showed no dyspnea and improved activities. At 6 months after operation, the FEV_1 and the PaO_2 were increased by 94.4%?21.2% and 12.5%?3.1%, while the RV and TLC were decreased by 24.1%?7.8% and 20.8%?5.1%, respectively. All the abovementioned parameters were significantly changed before and after operation (P