Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 113
Filter
1.
Rev. argent. cir. plást ; 26(3): 134-139, 20200900. fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1151318

ABSTRACT

Introducción. Múltiples técnicas han sido descriptas para la reconstitutición de la función del pulgar quemado, aunque sin relación costo-beneficio. El colgajo en cometa, descripto por Foucher en 1979, aporta cobertura cutánea, sensibilidad y permite mejoría funcional. El objetivo de este trabajo es presentar nuestra experiencia y resultados utilizando el kite flap. Materiales y métodos. Se realiza un estudio restrospectivo, descriptivo, de 4 casos de secuelas de quemaduras en pulgar de la mano atendidas en el Servicio de Cirugía Plástica y Reparadora del Hospital de Quemados de la Ciudad de Buenos Aires en un periodo comprendido desde el año 2016 al 2019. Se realizan colgajos en cometa en isla o tunelizados y posterior rehabilitación kinésica. El seguimiento mínimo de la serie es de 3 meses y se toman registros fotográficos pre-, intra- y posoperatorios. Las variables analizadas incluyen: sufrimiento de colgajos, dehiscencia, congestión venosa, prendimiento de injertos en zona dadora, reintervenciones y mejoría en la función de abducción del pulgar y pinza de la mano. Resultados. Se realizaron 3 colgajos en cometa tunelizados y 1 en isla. La totalidad se presentaron vitales aunque con congestión venosa en las primeras 72 hs. No se registraron complicaciones y no fueron necesarias reintervenciones. La mejoría en la función de pinza y de abducción del pulgar fue objetivable mediante la observación y referida por los pacientes y/o familiares según correspondiera. Conclusiones. Creemos que el colgajo en cometa es la mejor opción de tratamiento para las secuelas de quemadura en pulgar por aportar adecuada cobertura cutánea, ser técnicamente sencillo y poder hallar el pedículo en el 100% de la población. La congestión venosa es la regla, aunque también la supervivencia, siendo la morbilidad de la zona dadora mínima y la mejoría en la función de pinza y abducción del pulgar francamente objetivable.


Introduction. Multiple techniques have been described for repair the burned thumb function, although without cost-benefit ratio. The kite flap described by Foucher in 1979, provides skin coverage, sensitivity and allows functional improvement. The goal of this study it to present our experience and results obtained using the kite flap Materials and methods. A retrospective, descriptive study of 4 cases of burned hand's thumb treated in the Plastic Surgery Unit of the Hospital de Quemados on Buenos Aires in a three year's period from 2016 to 2019. Island or tunneled's kite flaps and subsequent kinesic rehabilitation are performed. The minimum follow-up of the series is 3 months and fotographic records pre, intra and postoperative are taken. The variables analyzed include: suffering from flaps, dehiscence, venous congestion, grafting losts on the donor zone, reinterventions and improvement in the function of thumb abduction and hand clamp . Results. 3 tunelled kite flaps and 1 on island were made. All of them were vital, although with venous congestion in the first 72 hours. No complications were recorded and no reinterventions were necessary. The improvement in hand clamp function and thumb abduction was marked through observation and when it posible, referred by patients. Conclusions. We believe that kite flap is the best option of treatment for sequelae of burns affecting hand's thumb for providing adequate skin coverage, being technically simple and being able to find the pedicle at 100% of the population. Venous congestion is the rule, although survival is also. Donor zone´s morbidity is minimal and the improvement in thumb function is clear


Subject(s)
Surgical Flaps/surgery , Sutures , Thumb/injuries , Burns/therapy , Skin Transplantation/methods , Epidemiology, Descriptive , Retrospective Studies
3.
Arq. bras. oftalmol ; 83(1): 11-18, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1088949

ABSTRACT

ABSTRACT Purpose: To determine the long-term functional and cosmetic outcomes in patients who underwent modified Hughes procedure with different types of anterior lamellar reconstruction for lower eyelid defects. Methods: This study included 58 patients who had undergone a modified Hughes flap for reconstruction of lower eyelids after tumor excision within a 10-year period. Data regarding patient demographics, size of eyelid defect, tumor pathology, surgical techniques, functional and cosmetic outcomes, and complications were recorded. Postoperative complications were evaluated according to the type of anterior lamella reconstruction (i.e., advancement flap or free skin graft). Multivariate logistic regression analysis was performed to identify risk factors affecting the success of the procedure. Results: The average size of the lower eyelid defect was 22 ± 6.3 mm (range: 11-30 mm). The anterior lamella was reconstructed with advancement flaps and full-thickness skin grafts in 36 (58.6%) and 24 (41.4%) patients, respectively. Mean follow-up time was 23.6 ± 11.9 months. Postoperative complications included trichiasis (three patients; 5.2%), ectropion (two patients; 3.0%), flap necrosis (one patient; 1.7%), flap dehiscence (one patient; 1.7%), infection (one patient; 1.7%), and eyelid margin erythema (one patient; 1.7%). The rates of complication and secondary surgery were similar among the different types of anterior lamellar reconstruction (p=768 and p=0.139, respectively). Success of the modified Hughes procedure was not significantly affected by any of the identified risk factors (p>0.05). Functional and cosmetic outcomes were 96.6% and 94.8%, respectively. Conclusion: Modified Hughes procedure is a safe and effective option for the reconstruction of small and large defects of the lower eyelid, regardless of the type of anterior lamella reconstruction (i.e., advancement flap or skin graft).


RESUMO Objetivo: Determinar os resultados funcionais e cosméticos a longo prazo de pacientes submetidos ao procedimento de Hughes modificado com diferentes tipos de reconstrução lamelar anterior para defeitos palpebrais inferiores. Métodos: Este estudo incluiu 58 pacientes que foram submetidos a um retalho de Hughes modificado para reconstrução das pálpebras inferiores após excisão do tumor durante um intervalo de 10 anos. Dados referentes à demografia dos pacientes, tamanho do defeito palpebral, patologia tumoral, técnicas cirúrgicas, resultados funcionais e cosméticos e complicações foram registrados. As complicações pós-operatórias foram avaliadas de acordo com o tipo de reconstrução da lamela anterior (ou seja, retalho de avanço ou enxerto de pele livre). A análise de regressão logística multivariada foi realizada para identificar os fatores de risco que afetam o sucesso do procedimento. Resultados: O tamanho médio do defeito da pálpebra inferior foi de 22 ± 6,3 mm (11-30 mm). A lamela anterior foi reconstruída com retalhos de avanço e enxertos de pele de espessura total em 36 (58,6%) e 24 (41,4%) pacientes, respectivamente. O tempo médio de acompanhamento foi de 23,6 ± 11,9 meses. Complicações pós-operatórias incluíram triquíase (três pacientes: 5,2%), ectrópio (dois pacientes: 3%), necrose de retalho (um paciente: 1,7%), deiscência de retalho (um paciente: 1,7%), infecção (um paciente: 1,7%) e eritema na margem palpebral (um paciente: 1,7%). As taxas de complicação e de cirurgia secundária foram semelhantes entre os diferentes tipos de reconstrução lamelar anterior (p=768 e p=0,139, respetivamente). O sucesso do procedimento de Hughes modificado não foi significativamente afetado por nenhum dos fatores de risco identificados (p>0,05). Resultados funcionais e cosméticos foram de 96,6% e 94,8%, respetivamente. Conclusão: O procedimento de Hughes modificado é uma opção segura e eficaz para a reconstrução de pequenos e grandes defeitos da pálpebra inferior, independentemente do tipo de reconstrução da lamela anterior (ou seja, retalho de avanço ou enxerto de pele).


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Carcinoma, Basal Cell/surgery , Skin Transplantation/methods , Eyelid Neoplasms/surgery , Postoperative Complications , Surgical Flaps , Carcinoma, Basal Cell/complications , Retrospective Studies , Blepharoplasty/methods , Ectropion/surgery , Eyelid Neoplasms/complications , Eyelids/surgery
4.
Rev. bras. cir. plást ; 34(4): 557-560, oct.-dec. 2019. ilus
Article in English, Portuguese | LILACS | ID: biblio-1047927

ABSTRACT

O xantogranuloma juvenil (XGJ) é um tumor benigno e o mais comum do grupo das doenças histiocitárias proliferativas nãoLangerhans. Lesões; 2cm são consideradas XGJ gigantes, com relatos de lesões de até 18cm. Lesões oculopalpebrais podem necessitar de tratamento cirúrgico para controle de sintomas. Esse trabalho relata o caso de um menino de 8 anos que teve as 4 pálpebras acometidas por XGJ gigantes, além do terço médio. Ele foi submetido a 3 ressecções, sendo uma bastante profunda, necessitando enxerto de pele de espessura total diretamente sobre o músculo levantador da pálpebra superior. Posteriormente, 3 procedimentos de lipoenxertia foram realizados, atingindo resultado funcional e estético adequado, sem recorrência lesional.


Juvenile xanthogranuloma (JXG) is the most common benign tumor of the group of non-Langerhans histiocytic proliferative diseases. Lesions >2 cm are considered giant JXG, with reports of lesions of up to 18 cm. Oculopalpebral lesions may require surgical treatment to control symptoms. This study reports a case of an 8-year-old boy who had four eyelids and the middle third of the face affected by giant JXG. He underwent three resections, one of which was of great depth that required a full-thickness skin graft directly on the levator palpebrae superioris muscle. Subsequently, four fat-grafting procedures were performed and adequate functional and


Subject(s)
Humans , Male , Child , History, 21st Century , Eye Injuries , Skin Transplantation , Xanthogranuloma, Juvenile , Reconstructive Surgical Procedures , Eye , Eyelid Neoplasms , Myocutaneous Flap , Eye Injuries/surgery , Skin Transplantation/methods , Xanthogranuloma, Juvenile/surgery , Xanthogranuloma, Juvenile/therapy , Reconstructive Surgical Procedures/methods , Eye/anatomy & histology , Eyelid Neoplasms/surgery , Eyelid Neoplasms/therapy , Myocutaneous Flap/surgery , Myocutaneous Flap/transplantation
6.
Int. braz. j. urol ; 45(5): 1057-1063, Sept.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1040063

ABSTRACT

ABSTRACT Purpose Penile skin flap uretroplasty is a useful technique for a long urethral stricture due to the ample length and surgical handling characteristics. We investigated the surgical technique and initial results of uretroplasty for anterior urethral strictures using a dorsal penile skin flap. Patients and methods From January 2003 to January 2018, a total of 77 patients underwent substitution urethroplasty using dorsal penile skin flap for bulbar urethral strictures in our institution. All patients were assessed preoperatively, and followed postoperatively by physical examination, urinalysis, retrograde and voiding urethrography, uroflowmetry and post-void residual urine measurement. Success was defined as no requirement of additional urethral instrumentation. Results The mean age was 45 years (10-87). The mean stricture length was 5cm (3-10cm). The mean flap length was 6cm. Urinary fistula was the most common postoperative complication. The mean follow-up was 60 months (6-120). The overall success rate was 88%. Recurrent strictures were found in 4 patients (5%) at 1 year. At 3 year follow-up, 5 (7%) more patients had recurrences. All recurrences were managed by internal urethrotomy. Conclusions Substitution urethroplasty using penile skin flap appear to be a safe and efficient technique for the treatment of a long and complex anterior urethral stricture. It provides encouraging cosmetic and functional results.


Subject(s)
Humans , Male , Child , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Penis/surgery , Surgical Flaps/transplantation , Urethral Stricture/surgery , Skin Transplantation/methods , Postoperative Complications , Recurrence , Reproducibility of Results , Retrospective Studies , Treatment Outcome , Middle Aged
8.
Rev. cir. (Impr.) ; 71(4): 345-351, ago. 2019. tab, ilus
Article in Spanish | LILACS | ID: biblio-1058283

ABSTRACT

Resumen Objetivo: Presentar 4 casos clínicos en los cuales el uso de dermis artificial Integra® resultó ser una solución segura y confiable para defectos de cuero cabelludo. Materiales y Método: Revisión de fichas clínicas de pacientes ingresados al Departamento de Cirugía Plástica y Quemados del Hospital del Trabajador de Santiago con diagnóstico de lesión traumática extensa de cuero cabelludo entre los años 2005-2013 que se resolvieron con uso de Integra®. Resultados: 4 pacientes de sexo femenino con lesión traumática que comprometían entre 70-98% de la superficie de cuero cabelludo, tiempo promedio entre aplicación de Integra® e injerto dermoepidérmico fue 18 días con 100% de cobertura; solo hubo complicaciones menores (ulceración crónica de vertex y dolor neuropático). El tiempo promedio de alta laboral fue 368 días, usando órtesis capilar. Discusión: La cobertura inmediata del tejido es fundamental para la reconstrucción exitosa del cuero cabelludo. Aparte del tejido autólogo, la dermis artificial constituye una alternativa para la reconstrucción rápida del cuero cabelludo con excelentes resultados. Conclusiones: Integra® es una solución segura y confiable para reconstruir defectos complejos del cuero cabelludo.


Aim: To present 4 clinical cases in which the use of artificial dermis (Integra®) turned out to be a safe and reliable solution for scalp defects. Materials and Method: review of clinical records of patients admitted to the Department of Plastic Surgery and Burns of the Hospital of the Worker of Santiago with a diagnosis of extensive traumatic injury of the scalp between the years 2005-2013 that were resolved with use of Integra®. Results: 4 female patients with traumatic injury that compromised between 70-95% of the surface of scalp, average time between application of integra and dermoepidermal graft was 18 days with 100% coverage; there were only minor complications (chronic vertex ulceration and neuropathic pain). The average time of high labor was 368 days, using capillary orthosis. Discussion: The immediate coverage of the tissue is essential for the successful reconstruction of the scalp. Apart from autologous tissue, the artificial dermis is an alternative for rapid reconstruction of the scalp with excellent results. Conclusions: Integra is a safe and reliable solution to reconstruct complex defects of the scalp.


Subject(s)
Humans , Female , Adult , Middle Aged , Scalp/surgery , Scalp/injuries , Skin Transplantation/methods , Skin, Artificial , Wounds and Injuries/surgery , Retrospective Studies , Treatment Outcome , Degloving Injuries/surgery
9.
Rev. argent. cir. plást ; 25(2): 89-92, apr-jun.2019. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1177075

ABSTRACT

Describimos un enfoque simple y rápido para elevar colgajos fasciocutáneos surales y mostramos sus aplicaciones clínicas. El colgajo se elevó con fascia y manguito de tejido celular subcutáneo sobre piel. El pedículo distal se diseccionó hasta 5 cm sobre maléolo lateral, El sitio donante se injertó. Los defectos fueron resultado de lesiones por quemaduras eléctricas del tercio distal de la pierna más exposición osteotendinosa.


We describe an easy and fast process to raise sural fasciocutaneous flaps and show its applications.The flap was raised with fascia and a sleeve of subcutaneous cellular tissue. The distal pedicle was dissected up to 5 cm over the lateral malleolus. Then the donor site was grafted. The defects were results of electrical burns of the distal third of the leg plus osteotendinous exposure.


Subject(s)
Humans , Female , Adolescent , Surgical Flaps , Burns, Electric/surgery , Burns, Electric/therapy , Skin Transplantation/methods , Lower Extremity/surgery , Necrosis
10.
Rev. bras. cir. plást ; 34(1): 79-85, jan.-mar. 2019. ilus, tab
Article in English, Portuguese | LILACS | ID: biblio-994550

ABSTRACT

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.


Subject(s)
Humans , Adult , Middle Aged , Wound Healing , Biological Dressings/adverse effects , Biological Dressings/standards , Burns/complications , Burns/diagnosis , Carboxymethylcellulose Sodium/analysis , Carboxymethylcellulose Sodium/adverse effects , Carboxymethylcellulose Sodium/therapeutic use , Skin Transplantation/adverse effects , Skin Transplantation/methods , Cichlids/injuries , Composite Tissue Allografts/physiopathology , Composite Tissue Allografts/injuries , Occlusive Dressings/adverse effects , Occlusive Dressings/standards
11.
Int. j. odontostomatol. (Print) ; 12(4): 401-406, dic. 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-975764

ABSTRACT

RESUMEN: Los injertos de piel consisten en la toma de un segmento de epidermis y dermis logrando una separación completa del sitio dador y del aporte vascular, transfiriéndolos a un sitio receptor. Existen dos tipos de injertos de piel: de espesor parcial y de espesor total. En cavidad oral se utilizan en reconstrucción de lengua, piso de boca, mucosa bucal y defectos producto de maxilectomías. Se presenta el caso de un paciente sexo masculino 26 años que acudió por secuela de tejidos duros y blandos secundarios a trauma facial hace 7 años. Al examen se observó pérdida de fondo de vestíbulo en sector mandibular anteroinferior y pérdida de piezas anteroinferiores. Bajo anestesia general, se realizó vestibuloplastía más injerto de piel de espesor parcial abordando el antebrazo izquierdo de donde se tomó el injerto de piel con el dermatomo. Se llevó el injerto a boca posicionándolo con la dermis hacia la zona cruenta del sitio receptor, cubriendo la cara interna de labio denudada y fijándolo con sutura continua. Se instaló splint de acrílico en el área para mantener colgajos en posición fijándolo con 3 tornillos de 15 mm. Debemos considerar todos los requisitos funcionales de la cavidad oral al momento de planificar una reconstrucción. El injerto de piel de espesor parcial permite tener una buena resistencia, movilidad adecuada y menor contracción por cicatrización. El paciente evoluciona de manera satisfactoria con una clara mejoría en la función labial, en la morfología del vestíbulo oral y en su estética.


ABSTRACT: Skin grafts consist in taking a segment of dermis and epidermis, achieving a complete separation of the donor site and vascular supply, and transferring them to a receptor site. There are two types of skin grafts: split-thickness and full-thickness. In the oral cavity, they are used in tongue reconstruction, oral mucosa reconstruction, floor of mouth reconstruction and in defects product of maxillectomies. We present a case of a 26-year-old male patient who presented sequelae of hard and soft tissues secondary to facial trauma. Clinical examination showed a compromised vestibule and loss of anterior mandibular teeth. Under general anesthesia, soft tissue management consisting of vestibuloplasty and a split-thickness skin graft was performed. The skin graft was taken from the forearm with a dermatome. The graft was then taken to the mouth with the dermis towards the wounded area of the recipient site, covering the inner face of the denuded lip and fixing it with sutures. An acrylic splint was installed in the area to keep the flaps and skin graft in position, fixing it with three 15 mm screws. We must consider all functional requirements of the oral cavity when planning a reconstruction. The split-thickness skin graft allows for good resistance, adequate mobility and less contraction due to scars. The patient evolves with definite improvement in labial function, the morphology of the oral vestibule and in its aesthetic.


Subject(s)
Humans , Male , Adult , Wound Healing/physiology , Skin Transplantation/methods , Vestibuloplasty/methods , Reconstructive Surgical Procedures/methods
12.
Int. braz. j. urol ; 44(4): 838-839, July-Aug. 2018.
Article in English | LILACS | ID: biblio-1040041

ABSTRACT

ABSTRACT Objectives: Buccal mucosa grafts and fascio-cutaneous flaps are frequently used in long anterior urethral strictures (1). The inlay and onlay buccal mucosa grafts are easier to perform, do not need urethral mobilization and generally have good long-term results (2-4). In the present video, we present a case where we used a double buccal mucosa graft technique in a simultaneous penile and bulbar urethral stricture. Materials and Methods: A 54 year-old male patient was submitted to appendectomy where a urethral catheter was used for two days in May 2015. Three months after surgery, the patient complained of acute urinary retention and a supra-pubic tube was indicated. Urethrocystography was performed two weeks later and showed strictures in penile and bulbar urethra with 3.5 cm and 3 cm in length respectively. Urethroplasty was proposed for the surgical treatment in this case. We used a perineal approach with a ventral sagittal urethrotomy in both strictures. Penile urethra stricture measuring 3.5 cm in length was observed and a free graft from the buccal mucosa was harvested and placed into the longitudinal incision in the dorsal urethra and fixed with interrupted suture as dorsal inlay. Bulbar urethra stricture measuring 3 cm was observed and a free graft from the buccal mucosa was harvested and placed into the longitudinal incision in the ventral urethra and fixed with interrupted suture as ventral onlay. The ventral urethrotomy was closed over a 16Fr Foley catheter and the skin incision was then closed in layers. Results: No intraoperative or postoperative complications occurred. The patient could achieve satisfactory voiding and no complication was seen during the six-month follow-up. Postoperative imaging demonstrated a widely patent urethra, and the mean peak flow was 12 mL/s. Conclusion: The BMG placement can be ventral, dorsal, lateral or combined dorsal and ventral BMG in the meeting of stricture but the first two are most common (5, 6). Ventral location provides the advantages of ease of exposure and good vascular supply by avoiding circumferential rotation of the urethra (7). Early success rates of dorsal and ventral onlay with BMG were 96 and 85%, respectively. However, long-term follow-up revealed essentially no difference in success rates (8-11). Anterior urethral stricture treatments are various, and comprehensive consideration should be given in selecting individualized treatment programs, which must be combined with the patient's stricture, length, complexity, and other factors. Traditionally, anastomotic procedures with transection and urethral excision are suggested for short bulbar strictures, while longer strictures are treated by patch graft urethroplasty preferably using the buccal mucosa as gold-standard material due to its histological characteristics. The current management for complex urethral strictures commonly uses open reconstruction with buccal mucosa urethroplasty. However, there are multiple situations whereby buccal mucosa is inadequate (pan-urethral stricture or prior buccal harvest) or inappropriate for utilization (heavy tobacco use or oral radiation). Multiple options exist for use as alternatives or adjuncts to buccal mucosa in complex urethral strictures (injectable antifibrotic agents, augmentation urethroplasty with skin flaps, lingual mucosa, colonic mucosa, and new developments in tissue engineering for urethral graft material). In the present case, our patient had two strictures and we chose to correct the first stricture with a dorsal graft and the bulbar stricture with a ventral graft because of our personal expertise. We can conclude that the double buccal mucosa graft is easier to perform and can be an option to repair multiple urethral strictures.


Subject(s)
Humans , Male , Penile Diseases/surgery , Urethral Stricture/surgery , Skin Transplantation/methods , Mouth Mucosa/transplantation , Urologic Surgical Procedures, Male/methods , Surgical Flaps/transplantation , Reproducibility of Results , Treatment Outcome , Constriction, Pathologic/surgery , Middle Aged
13.
Rev. Assoc. Med. Bras. (1992) ; 64(6): 501-508, June 2018. graf
Article in English | LILACS | ID: biblio-956484

ABSTRACT

SUMMARY OBJECTIVE To report the surgical procedures and efficacy of using medial plantar venous flap for the repair of soft tissue defects of the fingers. Methods From March 2010 to April 2012, medial plantar venous flaps were harvested to repair the wounds of 31 fingers in 29 cases. Among them, there were 13 middle fingers with defects at the tips in 11 cases, 7 fingers with defects in the dorsal part in 7 cases, and 11 fingers with defects in the finger pulp in 11 cases. The size of the defects ranged from 1.2cm×1.5 cm to 2.5cm × 3.5cm. Medial plantar venous flaps of 1.5cm × 2cm - 3×4 cm were harvested. Full-thickness skin grafts were adopted for the donor areas. RESULTS All 31 flaps survived, except for 1 flap with arterial crisis and 2 cases with venous crisis. These conditions were timely corrected by secondary anastomosis of artery and vein and the flaps survived. The wounds and the donor areas achieved healing by the first intention. All grafted skins survived. Postoperative follow-up was conducted for 26 fingers in 24 cases for 4-12 months, excluding 5 cases with lost follow-up. The dorsal part of the damaged fingers had normal morphology, and the skin color and texture were similar to those of the normal skin. After the repair of defects in the fingertip and pulp, fingerprints appeared, and the protective sensation was restored. CONCLUSION The soft tissue defects of the fingers can be satisfactorily repaired with medial plantar venous flap, and little damage is caused to the donor area. This method is proven effective for the repair of soft tissue defects of the fingers.


RESUMO OBJETIVO Relatar os procedimentos cirúrgicos e a eficácia do uso de retalhos plantares mediais venosos para reparo de defeitos de tecidos moles dos dedos. METODOLOGIA De março de 2010 a abril de 2012, foram colhidos retalhos plantares mediais venosos para reparar ferimentos de 31 dedos em 29 casos. Entre eles, 13 dedos médios com defeitos nas pontas em 11 casos, 7 dedos com defeitos na parte dorsal em 7 casos e 11 dedos com defeitos na polpa digital em 11 casos. O tamanho dos defeitos variava de 1,2 cm × 1,5 cm a 2,5 cm × 3,5 cm. Foram colhidos retalhos plantares mediais venosos de 1,5 cm × 2 cm a 3 cm × 4 cm. Foram adotados enxertos de pele de espessura total na área doadora. RESULTADOS Todos os 31 retalhos sobreviveram, com exceção de 1 retalho com crise arterial e 2 casos com crise venosa. Esses problemas foram corrigidos a tempo com anastomoses secundárias das artérias e veias e os retalhos sobreviveram. Os ferimentos e áreas doadoras atingiram cicatrização por primeira intenção. Todos os enxertos de pele sobreviveram. Foi realizado acompanhamento pós-operatório em de 26 dedos em 24 casos por 4 a 12 meses, sendo que dos casos tratados 5 não tiveram acompanhamento. As partes dorsais dos dedos lesionados apresentaram morfologia normal, com cor e textura da pele muito similares a da pele normal. Após o reparo dos defeitos nas pontas e polpas digitais, impressões digitais apareceram e a sensação protetora foi restaurada. CONCLUSÃO Os defeitos de tecido mole dos dedos podem ser reparados de forma satisfatória com retalhos plantares mediais venosos, com poucos danos à área doadora. Este método mostrou se eficaz para o reparo de defeitos de tecido mole dos dedos.


Subject(s)
Humans , Male , Female , Adult , Young Adult , Surgical Flaps/surgery , Reconstructive Surgical Procedures/methods , Finger Injuries/surgery , Surgical Flaps/blood supply , Wound Healing , Skin Transplantation/methods , Soft Tissue Injuries/surgery , Reconstructive Surgical Procedures/instrumentation , Foot , Middle Aged
14.
Rev. bras. cir. plást ; 33(1): 119-129, jan.-mar. 2018. tab
Article in English, Portuguese | LILACS | ID: biblio-883648

ABSTRACT

O objetivo deste estudo foi verificar, por meio de uma revisão da literatura, a possibilidade de se estabelecer, com base em evidências científicas, o curativo tópico mais adequado para a aplicação em áreas doadoras em enxertos de pele parcial. Foram analisados os mais relevantes estudos publicados originalmente nos últimos sete anos, em qualquer idioma, porém, que estivessem indexados às bases de dados US National Library of Medicine (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). As buscas foram realizadas por meio do uso de descritores associados ao tema e de critérios de inclusão e exclusão. A amostra final deste estudo foi composta por 25 publicações, sendo uma nacional e 24 internacionais. Com base nos achados, constatou-se que há uma lacuna na literatura acerca de estudos que visam analisar os diferentes tipos de curativos usados em áreas doadoras em enxertos de pele parcial. Por meio da revisão da literatura realizada, pode-se concluir que não é possível se estabelecer o curativo mais adequado para uso em áreas doadoras de enxertos de pele parcial, devido à falta de evidências científicas que possibilitem um achado conclusivo acerca do tema.


This study aimed to assess the possibility of establishing the most suitable split-thickness skin graft donor site dressings on the basis of scientific evidence gathered through a literature review. The most relevant studies originally published in any language in the last 7 years and indexed in the US National Library of Medicine (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), and Latin American and Caribbean Literature Health Sciences (LILACS) databases were evaluated. A literature survey was performed using keywords related to the theme and inclusion and exclusion criteria. The final sample comprised 25 publications, one domestic and 24 international. The results showed a gap in the literature with respect to studies that evaluated different split-thickness skin graft donor site dressings. The literature review revealed the impossibility of establishing the most effective split-thickness skin graft donor site dressing due to the lack of scientific evidence, thus preventing the formulation of a definite conclusion on this topic.


Subject(s)
Humans , History, 21st Century , Transplantation, Autologous , Wound Healing , Wounds and Injuries , Biological Dressings , Review Literature as Topic , Skin Transplantation , Scientific Integrity Review , Reconstructive Surgical Procedures , Transplantation, Autologous/methods , Transplantation, Autologous/rehabilitation , Wound Healing/drug effects , Wounds and Injuries/surgery , Wounds and Injuries/therapy , Biological Dressings/adverse effects , Skin Transplantation/methods , Skin Transplantation/rehabilitation , Reconstructive Surgical Procedures/adverse effects , Reconstructive Surgical Procedures/methods
15.
Int. braz. j. urol ; 44(1): 163-171, Jan.-Feb. 2018. tab, graf
Article in English | LILACS | ID: biblio-892955

ABSTRACT

ABSTRACT Purpose To evaluate the surgical outcome and predictors of failure of substitution urethroplasty using either dorsal onlay buccal mucosal (BM) graft or ventral onlay penile skin flap (PS) for anterior urethral stricture ≥ 8cm. Patients and methods Between March 2010 and January 2016, 50 patients with anterior urethral stricture ≥ 8 cm were treated at our hospital. The surgical outcome and success rate were assessed. The predictors of failure were analyzed using multivariate analysis. Failure was considered when subsequent urethrotomy or urethroplasty were needed. Results Dorsal onlay BM graft was carried out in 24 patients, while PS urethroplasty in 26 patients. There was no significant difference between both groups regarding patients demographics, stricture characteristics or follow-up period. One case in the BM group was lost during follow-up. Stricture recurrence was detected in 7 (30.4%) patients out of BM group while in 6 (23.1%) patients out of PS group (p value= 0.5). No significant differences between both groups regarding overall early and late complications were observed. Occurrence of early complications and the stricture length were the only predictors of failure in univariate analysis, while in multivariate analysis the occurrence of early complications was only significant. Conclusion On short-term follow-up, both dorsal onlay BM graft and ventral onlay PS flap urethroplasty have similar success rates. However, BM graft has a potential advantage to reduce operative time and is also technically easier. The surgeon should avoid early local complications as they represent a higher risk for failure.


Subject(s)
Humans , Male , Adult , Penis , Urologic Surgical Procedures, Male , Surgical Flaps/transplantation , Urethral Stricture/surgery , Skin Transplantation/methods , Mouth Mucosa/transplantation , Urethral Stricture/pathology , Retrospective Studies , Follow-Up Studies , Treatment Outcome , Middle Aged
16.
Rev. chil. cir ; 70(1): 70-74, 2018. ilus
Article in Spanish | LILACS | ID: biblio-899659

ABSTRACT

Resumen Introducción A pesar de la evidencia sobre los malos resultados y riesgos del uso de inyecciones subcutáneas de silicona para mejorar el contorno corporal, esta técnica sigue siendo utilizada por personas no calificadas. Caso clínico Paciente de 56 años quien consultó por cuadro de celulitis en pierna izquierda. Se obtuvo el antecedente de intervención con silicona en cara, dorso de las manos, glúteos y piernas el año 2000. El cuadro progresó con múltiples abscesos en la totalidad de la pierna y sepsis. Se realizaron aseos quirúrgicos exponiendo planos fascial y muscular, se utilizó terapia local con sistemas de presión negativa y posterior injerto dermo-epidérmico (IDE). El manejo multidisciplinario se realizó en unidades críticas. Los resultados del manejo fueron satisfactorios, salvando la extremidad con cobertura total, logrando el alta luego de 4 meses. Conclusión A pesar de conocerse los peligros de la inyección de silicona, este sigue siendo un procedimiento frecuente. En nuestra paciente se manifestó como fascitis de la pierna, requiriendo tratamiento quirúrgico agresivo. Conocer esta entidad, su diagnóstico y tratamiento es fundamental para tratar pacientes con complicaciones graves.


Introduction Despite the evidence of poor performance and risks of using silicone subcutaneous injections to improve body contour, this technique is still used by untrained people, generating an iatrogenic entity with serious complications. Case report 56 year old female presented left lower extremity cellulitis. A history of previous intervention with silicone injections in face, back of hands, buttocks and legs in year 2000 was obtained. An inflammatory process progressed locally and systemically with multiple abscesses, subcutaneous thickness in the entire leg and sepsis, requiring multiple surgical procedures, reaching fascial and muscle planes exposition of the left leg. The patient underwent local therapy with negative pressure systems and subsequent dermoepidermal graft. Multidisciplinary management was performed on a critical unit. The results were satisfactory, preserving the limb with full coverage. She was discharged after four months of inpatient management. Conclusion Despite knowing the risks of silicone injection (industrial or medical) it remains a common procedure. In our patient she presented as leg fasciitis, requiring aggressive surgical treatment. Knowing this entity, its diagnosis and treatment is essential to treat patients with serious complications.


Subject(s)
Humans , Female , Middle Aged , Silicones/adverse effects , Granuloma, Foreign-Body/surgery , Granuloma, Foreign-Body/chemically induced , Skin Transplantation/methods , Silicones/administration & dosage , Ulcer/chemically induced , Cellulitis/chemically induced , Sepsis , Lower Extremity , Erythema , Fasciitis/chemically induced , Injections, Subcutaneous
17.
Rev. Col. Bras. Cir ; 44(6): 659-664, Nov.-Dec. 2017. graf
Article in English | LILACS | ID: biblio-1041124

ABSTRACT

ABSTRACT Lower limb recurrent ulcers, usually caused by prolonged decubitus, trauma, diabetes or burns, may not heal with conventional clinical or surgical treatment. Frequently, laminated skin grafts do not integrate with the recipient layer, and the only alternatives are neighbor microsurgical flaps. These have higher morbidity and create secondary defects, to be corrected with skin grafts, when fasciocutaneous or miocutaneous segments are removed for the treatment of the primary defect. We describe the non-conventional use of punch grafts in the treatment of lower limb ulcers, when conventional skin laminated graft failed, without the use of flaps. Since this is a very successful technique, its use should be considered as a valuable alternative for the treatment of recurrent lower limb ulcers. It is a simple and easy-learned technique that may be used by different surgeons, even in remote places without correct specialized hospital facilities.


RESUMO As ulcerações recidivantes de membros inferiores, decorrentes de decúbito prolongado, trauma, diabetes ou queimaduras, podem não responder adequadamente aos tratamentos convencionais, clínicos e cirúrgicos. Frequentemente, nestes casos, enxertos de pele laminada não se integram ao leito receptor, deixando o uso de retalhos de vizinhança e microcirúrgicos como únicas alternativas. Estes retalhos implicam em maior morbidade e criam defeitos secundários, a serem reparados por enxertos de pele, após fornecerem o segmento cutâneo, fasciocutâneo ou miocutâneo para o tratamento do defeito primário. Descrevemos o uso não convencional de enxertos em punch ("punch grafts") no tratamento de ulcerações de membros inferiores, em situações em que a enxertia de pele laminada convencional não teve sucesso e retalhos não foram empregados. Pelo êxito desta técnica, seu uso deve ser considerado como uma valiosa alternativa no tratamento de úlceras recidivantes de membros inferiores. Sendo uma técnica simples e de fácil aprendizado, pode ser empregada por cirurgiões de diferentes especialidades, mesmo em locais remotos, onde inexistam as facilidades de um centro médico-hospitalar especializado.


Subject(s)
Humans , Surgical Flaps , Skin Transplantation/methods , Leg Ulcer/surgery , Microsurgery
18.
Rev. chil. cir ; 69(6): 489-494, dic. 2017. ilus
Article in Spanish | LILACS | ID: biblio-899642

ABSTRACT

Resumen Introducción: Las lesiones complejas de la cara plantar del pie son de difícil manejo desde el punto de vista reconstructivo. En la literatura el tratamiento de elección es la cobertura mediante colgajos libres. Nuestro objetivo es presentar el caso de un paciente con una lesión plantar compleja, exitosamente resuelta con el uso de matriz de regeneración dérmica (Integra®) e injerto dermoepidérmico. Caso clínico: Hombre de 35 años, que sufre quemadura eléctrica de alta tensión con lesión compleja plantar bilateral. Se manejó con escarectomías sucesivas hasta delimitar el daño tisular, y posterior cobertura con Integra® e injerto con resultado estético y funcional óptimo. Discusión: Aunque los colgajos libres son la elección en el tratamiento de esta zona anatómica, infrecuentemente son la única alternativa de reconstrucción en el paciente quemado. No hay mayor evidencia en la literatura en el uso de matrices dérmicas para la cobertura de este tipo de lesiones. Conclusión: Los autores consideran que el manejo de lesiones plantares complejas mediante el uso de matrices de regeneración dérmica es una alternativa válida a considerar en situaciones en que, por diversos motivos, no se puede ofrecer un colgajo libre.


Abstract Introduction: Complex wounds of the plantar aspect of the foot are difficult to manage in the reconstructive point of view. The standard of treatment is covering the defect with free flaps. Our goal is to present the case of a patient successfully treated with the use of matrix dermal regenaration Integra® and dermoepidermal graft for a complex plantar lesion. Clinical case: Thirty-five year old man, who suffers from high voltage electrical burn with bilateral plantar complex injury. It was handled with successive escharectomies to delimit tissue damage and subsequent coverage with Integra® and grafting with optimal aesthetic and functional results. Discussion: Although free flaps are the choice in the treatment of this anatomical area, they are infrequently the only reconstructive option in burned patients. There is no greater evidence in the literature on the use of dermal matrices to cover such injuries. Conclusion: The authors believe that the management of complex footpad lesions using dermal regeneration matrices are a valid alternative to consider in situations where for various reasons, free flaps can't be offered.


Subject(s)
Humans , Male , Adult , Burns, Electric/surgery , Skin Transplantation/methods , Skin, Artificial , Foot/surgery , Regeneration
19.
Rev. bras. cir. plást ; 32(4): 562-569, out.-dez. 2017. ilus, tab
Article in English, Portuguese | LILACS | ID: biblio-878778

ABSTRACT

Introdução: Enxertos de pele autólogos são utilizados em tratamento de pacientes queimados. Esses enxertos podem ser armazenados e preservados, desde que o processo de armazenamento seja realizado com rígido controle de qualidade, para garantir a redução dos riscos de infecção. Métodos: Foi realizado um estudo de coorte retrospectivo na Unidade de Queimados do Hospital das Clínicas de São Paulo no período de fevereiro de 2015 a julho de 2016, em que foi estabelecido um protocolo para armazenamento de pele refrigerada com controle de coleta, preservação, embalagem e registro de todos os processos. Para garantia de qualidade, foram coletadas biópsias dos enxertos para microbiologia pré e pós-armazenamento e realizado um estudo transversal de prevalência de contaminação pré e pós-estocagem. Resultados: Os pontos críticos encontrados foram inadequação de embalagem, ausência de registros de processos, falta de coleta de biópsias para microbiologia e falhas no descarte. A maior parte das amostras estava contaminada tanto pré como pós-estocagem (84,2%). Apenas dois pacientes apresentaram microbiologia estéril no pré e contaminada no pós, porém foram encontrados germes da pele do tipo gram+. Conclusão: Foi estabelecido um método promissor de armazenamento de pele refrigerada que necessita alguns pequenos ajustes para adequação ao controle de qualidade.


Introduction: Autologous skin grafts are used for treatment of burn patients. These grafts can be stored and preserved, as long as the storage process is performed with strict quality control to reduce the risk of infection. Methods: A retrospective cohort study was conducted in the Burn Unit of the Hospital das Clínicas de São Paulo from February 2015 to July 2016. During this period, a protocol was established to store refrigerated skin, with control of collection, preservation, and packaging, and recording of all processes. To ensure quality, graft biopsies were collected for pre- and poststorage microbiology testing and a cross-sectional study for contamination was performed. Results: Critical deficiencies included inadequate packaging, lack of processing records, lack of biopsies for microbiology testing, and failure to discard specimens. Most of the samples were contaminated before and after storage (84.2%). Only two samples were sterile before storage but became contaminated after storage, with growth of Gram-positive skin bacteria. Conclusion: A promising method for the storage of refrigerated skin was established, but requires minor adjustments in quality control.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , History, 21st Century , Quality Control , Refrigeration , Tissue Preservation , Transplantation, Autologous , Retrospective Studies , Skin Transplantation , Refrigeration/methods , Tissue Preservation/methods , Transplantation, Autologous/legislation & jurisprudence , Transplantation, Autologous/methods , Skin Transplantation/legislation & jurisprudence , Skin Transplantation/methods
20.
An. bras. dermatol ; 92(6): 888-890, Nov.-Dec. 2017. graf
Article in English | LILACS | ID: biblio-1038260

ABSTRACT

Abstract: Surgical management of vitiligo is considered an excellent terapeutic option for recalcitrant cases, provided the disease is stable and there is absence of Koebner phenomenom. Among surgical modalities, Suction Blister Epidermal Graft is a low cost and effective option (65 to 100% repigmentation can be achieved in up to 80% of patients). We describe how it can be optimized by using an alternative suction equipment, by customization of graft format and by application of an anesthetic technique that substantially reduces procedure time.


Subject(s)
Humans , Vitiligo/surgery , Skin Transplantation/instrumentation , Skin Transplantation/methods , Epidermis/transplantation , Reproducibility of Results , Blister
SELECTION OF CITATIONS
SEARCH DETAIL