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A neurofibromatose tipo 1 (NF1) é um distúrbio neurocutâneo hereditário no qual se formam tumores no sistema nervoso (neurofibromas). Os neurofibromas são os tumores benignos mais comuns na NF1. O tipo, o tamanho, o número e a localização dos neurofibromas devem ser considerados para a escolha do tratamento. Apresentamos um caso de NF1, no qual foi realizada uma ampla ressecção do couro cabeludo devido à presença de múltiplos neurofibromas. Associado a isso, a reconstrução foi realizada com retalhos de avanço mais autoenxerto de pele parcial, com resultados favoráveis e boa cobertura das áreas onde os tumores foram removidos.
Neurofibromatosis type 1 (NF1) is an inherited neurocutaneous disorder in which tumors form in the nervous system (neurofibromas). Neurofibromas are the most common benign tumors in NF1. The type, size, number, and location of the neurofibromas should be considered for the choice of treatment. We present a case of NF1, in which a wide scalp resection was performed due to the presence of multiple neurofibromas. Associated with this, reconstruction was performed with advancement flaps plus partial skin autograft with favorable results and good coverage of the areas where the tumors were removed.
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Objective:To evaluate the outcomes of reconstruction with half of peroneous longus tendon autograft for the treatment of chronic Achilles tendon rupture combined with tendon defects.Methods:A retrospective case series study was conducted on the clinical data of 14 patients with chronic tendon rupture combined with defects admitted to Orthopedic Sports Medicine Center, West China Hospital, Sichuan University from November 2017 to August 2020, including 11 males and 3 females, aged 26-62 years [(42.8±10.7)years]. All the patients underwent Achilles tendon reconstruction with half of peroneus longus tendon autograft. American Orthopedic Foot and Ankle Society (AOFAS) score, Achilles tendon total rupture score (ATRS) and Visual Analogue Scale (VAS) were compared before surgery, at 12 months after surgery and at the last follow-up. At the last follow-up, MRI of the injured ankle was prescribed to evaluate tendon healing; Thomspon test was performed and the patients were asked to do single-leg heel raise; the patients were asked about their conditions in returning to daily life activities and sports. Postoperative complications were observed.Results:All the patients were followed up for 24-47 months [(35±9)months]. AOFAS score, ATRS and VAS at 12 months after surgery were (87.9±6.6)points, (80.9±2.4)points and (2.0±0.3)points respectively, superior to those before surgery [(52.7±16.9)points, (42.0±4.4)points and (4.1±0.4)points respectively] ( P<0.05). The afore-mentioned results at the last follow-up were (95.2±7.2)points, (85.9±2.5)points and (0.8±0.3)points respectively, superior to those at 12 months after surgery ( P<0.05). MRI images of the affected ankle joints showed satisfactory healing of the reconstructed Achilles tendon at the last follow-up. All the patients, being negative in Thompson test at the last follow-up, were able to complete the heel lift on the affected side. All the patients resumed activities of daily living at the last follow-up, among whom 5 resumed to moderate- to high-intensity sports activities, such as basketball sport, and moderate-to high-intensity physical training, 5 resumed light-intensity sports activities such as jogging and swimming, and the other 4 did not resume sports due to fear of re-injury or aging. One patient had delayed wound healing, which was considered gout-related. One patient complained about mild pain at the Achilles tendon in cold weather or after long walks. No re-rupture of the Achilles tendon occurred. No patient complained about discomfort at the graft harvest site, calcaneal valgus or restricted ankle plantar flexion. Conclusions:For patients with chronic Achilles tendon rupture combined with tendon defects, reconstruction with half of peroneous longus tendon autograft facilitates postoperative spinal function recovery and pain alleviation, achieves satisfaction with the returning to daily activity and sports, and has few complications.
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Objective:To compare the clinical efficacy and safety of water jet-assisted dermabrasion versus electric dermabrasion in combination with suction blister epidermal grafting in the treatment of vitiligo.Methods:A total of 60 vitiligo patients were enrolled from the Department of Dermatology, Xijing Hospital from March 2020 to March 2022. Thirty patients firstly received water jet-assisted dermabrasion, 30 firstly received electric dermabrasion, and then all were treated with suction blister epidermal grafting. Follow-up visits were conducted once a month, and the repigmentation of skin lesions and efficacy were evaluated and compared between the two groups 6 months after surgery.Results:There were 30 patients with 312 skin lesions in the water jet-assisted dermabrasion group, including 13 males and 17 females, with the ages and disease duration being 24.41 ± 3.12 years and 5.13 ± 2.34 years respectively; there were 30 patients with 301 skin lesions in the electric dermabrasion group, including 11 males and 19 females, with the ages and disease duration being 22.73 ± 5.11 years and 4.88 ± 2.21 years respectively. No significant differences were observed in the age, gender, disease duration, and dermabrasion sites between the two groups (all P > 0.05). Six months after the operation, 187 (59.94%) skin lesions were healed, 103 (33.01%) were markedly improved, and 22 (7.05%) were improved in the water jet-assisted dermabrasion group; in the electric dermabrasion group, 166 (55.15%) lesions were healed, 108 (35.88%) were markedly improved, and 27 (8.97%) were improved; there was no significant difference in the total response rate between the water jet-assisted dermabrasion group (92.95%) and the electric dermabrasion group (91.03%; χ2 = 0.27, P = 0.602). The water jet-assisted dermabrasion group showed significantly higher degree of repigmentation (90.47% ± 2.53%), matching degree of skin color (3.53 ± 0.21 points), and patient satisfaction scores (3.32 ± 0.27 points) compared with the electric dermabrasion group (82.40% ± 5.33%, 2.71 ± 0.32 points, 2.68 ± 0.41 points, t = 5.30, 8.28, 5.09, respectively, all P < 0.05). No adverse reactions/events were seen in either group. Conclusions:The water jet-assisted dermabrasion combined with suction blister epidermal grafting and electric dermabrasion combined with suction blister epidermal grafting showed similar efficacy in the treatment of vitiligo, with good safety profiles. However, the degree of repigmentation, matching degree of skin color, and patient satisfaction rates were all higher in the patients receiving water jet-assisted dermabrasion than those receiving electric dermabrasion.
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Objetivo: apresentar o relato de duas pacientes com agenesias dentárias em que cinco dentes autotransplantados foram utilizados como modalidade de tratamento. Além disso, objetiva-se mostrar questões sobre a técnica cirúrgica, suas indicações e previsibilidade. Relato de caso: Neste estudo, foram relatados 5 casos de autotransplante dentário em duas pacientes jovens, em que a equipe realizou os procedimentos e o acompanhamento clínico e radiográfico por 5 e 7 anos. Devido à alta sensibilidade da técnica, foram seguidos princípios previamente estabelecidos na literatura envolvendo o autotransplante dentário. Durante o período de acompanhamento, os dentes se mantiveram em posição e em função e as pacientes não apresentavam queixas associadas. Considerações finais: a técnica do autotransplante dentário, quando bem indicada e executada, é capaz de promover resultados bastante satisfatórios, sendo uma ótima alternativa reabilitadora, com taxas de sucesso elevadas e custos reduzidos. No entanto, critérios em relação aos sítios doadores e receptores e a habilidade do cirurgião devem ser levados em conta para o sucesso do técnica.
Objective: presenting the report of two patients with tooth agenesis in which five autotransplanted teeth were used as a treatment modality. Furthermore, the aim is to show questions about the surgical technique and its indications and predictability. Case report: In this study, 5 cases of dental autotransplantation were reported in two young patients, in which the team performed procedures and had clinical and radiographic follow-up for 5 and 7 years. Due to the high sensitivity of the technique, principles previously established in the literature involving dental autotransplantation were followed. During the follow-up period, the teeth remained in position and function and the patients had no associated complaints. Final considerations: the dental autotransplantation technique, when well indicated and executed, is capable of achieving very satisfactory results, being a great rehabilitative alternative, with high success rates and reduced costs. However, criteria regarding donor and receptor sites and the surgeon's skill must be taken into account for the success of the technique.
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Humanos , Femenino , Adolescente , Adulto , Diente/trasplante , Reimplante Dental/métodos , Anodoncia/cirugía , Trasplante Autólogo/métodos , Estudios de Seguimiento , Resultado del TratamientoRESUMEN
Objective:To investigate the efficacy of autologous fat grafting in the treatment of stable linear scleroderma.Methods:A retrospective analysis was performed on 40 patients with stable linear scleroderma who received autologous fat grafting from October 2017 to November 2020 in the Department of Dermatology, Xijing Hospital, Air Force Medical University. There were 22 males and 18 females, aged 12 - 36 (18.2 ± 4.82) years. Skin lesions involved the forehead in 16 cases, the perioral area in 4, the lower jaw in 2, the cheek in 9, the trunk in 5, and the lower limb in 4, and the size of depressed skin defects was 3 - 24 cm 3. The patients′ subjective satisfaction rate, the decrease in the size of depressed skin defects, and the incidence of adverse reactions after autologous fat grafting were analyzed during the follow-up. Results:Six months after the grafting, 40 patients were followed up and evaluated, and the size of depressed skin defects markedly decreased. The satisfaction rate for appearance improvement after the first grafting was 60% (24/40) ; 35 patients received the second grafting, with a satisfaction rate of 88.6% (31/35) ; 17 received the third grafting, with a satisfaction rate of 94.1% (16/17) ; the total satisfaction rate was 87.5% (35/40). After the grafting, local skin unevenness was observed in the grafting area in 3 patients, and in the liposuction area in 2. The incidence rate of postoperative adverse reactions was 12.5% (5/40) .Conclusion:Autologous fat grafting was markedly effective in the treatment of stable linear scleroderma.
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Objective:To investigate the clinical effects of antibiotic-loaded calcium sulfate-autologous iliac bone combined with sural neurocutaneous flap in the one-stage treatment of chronic calcaneus osteomyelitis plus skin and soft tissue defects.Methods:From January 2013 to September 2019, 48 patients were admitted to Department of Orthopedic Trauma, Xi'an Honghui Hospital Affiliated to Xi'an Jiaotong University for chronic calcaneal osteomyelitis complicated with skin and soft tissue defects. They were divided into 2 groups according to different bone grafts. In group A of 26 patients treated at one stage by antibiotic-loaded calcium sulfate-autologous iliac bone combined with sural neurocutaneous flap, there were 16 males and 10 females with an age of (45.0±11.7) years and an area of skin defect of (56.0±16.7) cm 2. In group B of 22 patients treated at one stage by simple autologous iliac bone combined with sural neurocutaneous flap, there were 13 males and 9 females with an age of (43.6±9.6) years and an area of skin defect of (53.8±16.2) cm 2. The volume of the ilium harvested, fracture healing time, infection control, donor site complications, pain score of visual analogue scale (VAS) and function recovery of the ankle were compared between the 2 groups. Results:There was no significant difference in the preoperative general data between the 2 groups, showing comparability ( P>0.05). The 48 patients were followed up for (15.3±6.0) months. Group A had a significantly smaller volume of the ilium harvested [(67.3±14.1) cm 3] than group B [(90.7±23.5) cm 3], a significantly lower rate of donor site complications [3.8% (1/26)] than group B [31.8% (7/22)], significantly lower VAS pain scores at 6, 12, 24, 48 and 72 hours than group B, and significantly lower WBC count, erythrocyte sedimentation rate and C-reactive protein at 2, 4, 8 weeks after operation than group B (all P<0.05). There was no statistically significant difference between the 2 groups in the infection control rate [96.2% (25/26) versus 77.3% (17/22)], the fracture healing time [(6.2±1.9) months versus (6.4±2.1) months], or the ankle-hindfoot score of AOFAS (The American Orthopaedic Foot and Ankle Society) (83.9±7.2 versus 82.5±8.7) at 6 months after operation (all P>0.05). Conclusion:In one-stage treatment of chronic calcaneal osteomyelitis complicated with skin and soft tissue defects, compared with simple autologous iliac bone combined with sural neurocutaneous flap, antibiotic-loaded calcium sulfate-autologous iliac bone combined with sural neurocutaneous flap can reduce the volume of the ilium harvested, pain score of VAS, and incidence of donor site complications, and improve the recovery of inflammatory indicators, leading to fine clinical effects.
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Femoral head fracture is commonly seen in high-energy injury. However, compression fracture of femoral head is more rare. In most classifications of femoral head fracture, the compression is unusually involved. A case about acute traumatic dislocation of hip joint with compression fracture of femoral head is reported, involving a patient who hurt himself by riding electric bike and hitting the flower bed. He came to our hospital complaining of pain and limited motion of his right leg. The diagnosis of right hip anterior dislocation with the compression fracture of femoral head was confirmed by medical history, physical examination and imaging. Closed reduction of hip dislocation was performed in an emergency. Then we transplanted the bone cartilage from the non-weight-bearing area under the femoral head to the collapsed weight-bearing area, fixing it with countersunk hollow screws, and then the non-weight-bearing donor area was reconstructed with autogenous iliac bone, using surgical hip dislocation. The anatomical structure of the femoral head was therefore restored successfully during the operation. Three months after surgery, the X-ray showed that the femoral head was smooth and the cartilage graft was well fixed. Eight months after surgery, the patient gradually increased the bearing weight from partial to full according to his own condition, and there was no obvious pain in hip. After 24-month follow-up, we found the X-rays showed good reduction and fixation of the femoral head fracture. The CT scan showed no necrosis or cystic degeneration. He got well-active and passive movement in hip joint, and got no pain when walking with burden. For the patient with hip dislocation and compression fracture of femoral head, early joint reduction and non-weight-bearing osteocartilage transplantation can restore the anatomical structure of the weight-bearing area of the femoral head, to avoid traumatic osteoarthritis, and to improve the long-term quality of life of patients.
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Objective:To explore the mid-term efficacy of liquid nitrogen-inactivated autologous tumor segment bone replantation for repairing bone defects after resection of malignant tumors in the long bone shaft.Methods:A retrospective analysis was performed on the clinical data of 16 patients treated with liquid nitrogen-inactivated autologous bone graft at Beijing Jishuitan Hospital from July 2015 to June 2017 to repair defects caused by malignant tumour resection of the diaphysis. There were 10 males and 6 females with a mean age of 23.4±11.6 years (range, 8-44 years), including 8 classic osteosarcoma, 2 high-grade surface osteosarcoma, 4 Ewing's sarcoma, 1 periosteal osteosarcoma, and 1 undifferentiated pleomorphic sarcoma. Tumors were located in the humerus in 2 cases, in the femur in 8 cases and in the tibia in 6 cases. The mean length of tumor was 12.4±4.8 cm (range, 5.5-26 cm). Postoperative imaging examination was performed every 6 months, and the healing status of the transplanted bone-host bone was evaluated based on the imaging assessment method of the International Society of Limb Salvage (ISOLS) imaging assessment after allogeneic bone transplantation, and the complications were assessed using the Henderson classification. The five-year survival rate for patients and grafted bone was calculated using the Kaplan-Meier survival curve.Results:The median follow-up was 64 (60.3, 69.8) months. At the end of follow-up, 13 patients were tumour free and 3 patients died of multiple metastases at 19, 20 and 33 months after surgery. There were 32 osteotomy ends in 16 patients, of which 30 healed, including 11 metaphyseal osteotomy ends, and the healing time was 9 (6, 12) months after replantation of the tumour segment with liquid nitrogen-inactivated autologous bone; 19 osteotomy ends in the diaphysis took 13 (9, 21) months to heal, with a statistically significant difference in healing time between different sites ( Z=-2.25, P=0.025). Sixteen patients had six complications, including two cases of non-union at the diaphyseal site, one case of failure of internal fixation due to non-union, three cases of recurrence, and no soft tissue complications or infections. One patient with failed internal fixation was treated with a vascularized tip iliac bone graft that healed 6 months after surgery. Another patient died of multiple metastases with 1 unhealed diaphysis left. Three cases of recurrence were all located in the extracranial soft tissue of the autologous tumor segment inactivated by liquid nitrogen. Among them, one case underwent reoperation and local radiotherapy, and there was still no tumor survival after 65 months of surgery, and two cases died due to multiple metastases. The five-year survival rate of patients was 81% as calculated using the Kaplan-Meier survival curve, and the graft survival rate was 100%. There was no amputation and the limb salvage rate was 100%. Conclusion:The use of liquid nitrogen-inactivated autologous tumor segment bone replantation for reconstruction of bone defects after resection of malignant tumors in the shaft has advantages of higher healing rate, shorter healing time at the metaphyseal end compared to the osteotomy end, fewer complications, and higher survival rate of the replanted bone.
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Objective:To explore the clinical effect of dermal and subcutaneous injection of autologous peripheral blood nucleated cells in improving periocular wrinkles.Methods:Eighteen cases of beauty seekers who planned to improve periocular wrinkles were selected as the research objects of this study. Autologous nucleated cells and blood active components were isolated and purified by negative collection mixed method and evenly injected into the periocular skin of patients. VISIA image analysis system, and satisfactory score were used to detect and evaluate the related characteristics of periocular skin at different stages before and after treatment. The scores were compared and analyzed, and the complications after treatment were recorded.Results:The 18 patients were followed up. The score of VISIA periorbital static wrinkles decreased from (22.09±8.21) before treatment to (18.31±7.84) one month after treatment, and the difference was statistically significant ( t=-7.495, P<0.05). 17 patients were satisfied; After 3 months of follow-up, 15 cases were satisfied. The texture, consistency and pore state of periorbital skin were improved in some patients (10 cases). Conclusions:Autologous peripheral blood nucleated cell therapy can improve periorbital wrinkles, especially skin fine lines, and geta high satisfactory rate. There are almost no adverse reactions after the treatment, which is worthy of clinical application.
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Objective:To explore the application experience of autologous fat transplantation in improving the facial contour of young cosmetic patients.Methods:From October 2017 to October 2020, the plastic surgery department of Beijing Tsinghua Changgung Hospital admitted 10 young cosmetic patients with poor facial contours, including 1 male and 9 females, aged 18-35 years, with an average of 28 years. Autologous subcutaneous fat was harvested by liposuction and static purification and then injected into the areas with poor facial contour with an amount of 10%-30% over.Results:The facial contour of 10 young cosmetic patients was well improved, and there were no postoperative complications such as facial asymmetry, local uneven skin, skin infection and necrosis or fat embolism. 8 cases were filled once and 2 cases were filled twice. The patients were followed up for 6-24 months and the postoperative effect was good. The excellent and good rate evaluated by patients, plastic surgeon and the third party doctor was more than 80%.Conclusions:The use of autologous fat to improve the facial contour of young cosmetic patients is easy to operate with less trauma and good effect, which is worthy of promotion.
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RESUMEN Fundamento En la rinoplastia moderna existen nuevos conceptos orientados al logro del modelo ideal de una nariz. Muchas técnicas han envejecido, pero han surgido otras nuevas, menos invasivas. Objetivo describir los resultados de la rinoplastia mediante la técnica de reubicación de autoinjertos en pacientes con deformidades nasales. Métodos estudio descriptivo, de serie de casos, realizado en el Hospital General Universitario Dr. Gustavo Aldereguía Lima, de Cienfuegos. Se incluyeron 25 pacientes que acudieron a la consulta de Cirugía Maxilofacial por deformidades nasales, entre 2009 y 2019, a los cuales se aplicó la técnica quirúrgica de rinoplastia (la técnica de Joseph modificada). Se analizó edad, sexo, color de la piel, tipo de injerto, técnica empleada (endonasal, abierta) y tipo de anestesia. Resultados predominó el sexo femenino y el color blanco de la piel. La técnica quirúrgica más utilizada fue la endonasal (20 pacientes). Todos fueron operados con anestesia local. El grupo de edad más numeroso fue el de 15-30 años. La giba osteocartilaginosa fue el injerto empleado en el 72 % de los casos. Conclusión con la técnica de reubicación de autoinjertos se obtuvieron resultados favorables en la serie de casos descrita. Esta resulta de las más avanzadas en el contexto de la cirugía estética nasal.
ABSTRACT Background In modern rhinoplasty there are new concepts aimed at achieving the ideal model of a nose. Many techniques have become old, but new, less invasive ones have emerged. Objective to describe the results of rhinoplasty using the autograft relocation technique in patients with nasal deformities. Methods a descriptive case series study conducted at the Dr. Gustavo Aldereguía Lima General University Hospital, in Cienfuegos. 25 patients were included in the research, who attended the Maxillofacial Surgery consultation due to nasal deformities, between 2009 and 2019, to whom the rhinoplasty surgical technique (the modified Joseph technique) was applied. Age, sex, skin color, type of graft, technique used (endonasal, open) and type of anesthesia were analyzed. Results female sex and white skin color predominated. The most used surgical technique was endonasal (20 patients). All were operated under local anesthesia. The largest age group was 15-30 years old. The osteocartilaginous hump was the graft used in 72% of the cases. Conclusion with the autograft relocation technique, favorable results were obtained in the case series described. This is one of the most advanced in the context of nasal cosmetic surgery.
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Objective:To evaluate the efficacy of embedding suture in pterygium excision combined with autologous conjunctival transplantation, and to compare the differences between embedding suture, continuous suture and intermittent suture.Methods:A randomized controlled study was conducted.One hundred and twenty patients (120 eyes) with primary pterygium, who underwent pterygium excision combined with autologous conjunctival transplantation in Shanghai Aier Eye Hospital from May to July 2020, were enrolled.The patients were randomly divided into the embedding suture group, continuous suture group and interrupted suture group, with 40 eyes in each group.The operation duration was recorded and the patients received follow-up visit at 0.5, 1, 3, 7, 10, 14 days and 1, 3 and 6 months after the operation.The five-point method was used to record the postoperative pain score.The corneal epithelial healing was evaluated by sodium fluorescein staining.The complications such as graft detachment, graft displacement or pterygium recurrence were observed with a slit lamp microscope.This study adhered to the Declaration of Helsinki.The study protocol was approved by an Ethics Committee of Shanghai Aier Eye Hospital (No.SHAIER2020RB03). Written informed consent was obtained from each subject before any medical examination.Results:The operation time of continuous suture, interrupted suture and embedding suture was (14.45±2.78), (16.28±2.24) and (16.58±2.22) minutes, respectively, and the overall difference was statistically significant ( F=8.98, P<0.05). The operation time of continuous suture was significantly shorter than that of interrupted suture and embedding suture (both at P<0.017), and there was no significant difference between embedding suture and interrupted suture ( P>0.017). There was a statistically significant overall difference in pain scores among the three groups at various time points after the operation ( P<0.05). At 0.5, 1, 3, 7 and 10 days after the operation, the pain scores of embedding suture were lower than those of continuous suture and interrupted suture (all at P<0.05). On the 7th day after the operation, there was no significant difference in the unhealed rate of corneal epithelium among the three groups ( P=1.000). On the 10th day after the operation, the corneal epithelia of the three groups were all healed.During the six months after the operation, no complications such as displacement, detachment, necrosis, infection of graft and eye movement disorder occurred in the three groups.There was no significant difference in the recurrence rate of pterygium ( P=1.000). Conclusions:Embedding suture method can effectively reduce the irritation symptoms after pterygium conjunctival transplantation, and has stable fixation of implants.Compared with the traditional interrupted suture, it does not increase the recurrence rate, incidence of adverse reactions, operation time and economic burden of patients.
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In the process of radical resection of abdominal malignant tumors, large blood vessels are often invaded, which not only increases the difficulty of operation, but also directly affects the curative effect and prognosis. As the concept of expanded radical surgery combined with vascular resection and reconstruction and related techniques have been gradually recognized, surgeons have begun to use autologous, allogeneic or artificial vessels to repair the defective blood vessels during surgery, so as to achieve the effect of radical surgery. However, due to the short comings of these materials, scholars have been looking for better alternatives. In view of the fact that the mesothelial cells of the peritoneum and the endothelial cells of the blood vessels have many similarities in embryology, histology and physiology, and peritoneum is also easier to obtain than autologous, allogeneic or artificial vessels. To make the autologous peritoneum into a patch for repairing the defective blood vessels is feasible in theoretical and technical. In this paper, we review the current research progress of autologous peritoneal patch to repair blood vessels of defect.
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Objective:To compare the efficacy of arthroscopic anterior cruciate ligament reconstruction using tendon autograft with figure-of-four position and traditional knee hyperflexed position for femoral tunnel creation.Methods:A retrospective case series study was conducted to analyze the clinical data of 46 patients with ACL injury admitted to Second Affiliated Hospital of Harbin Medical University from August 2019 to October 2019, including 26 males and 20 females; aged 24-40 years [(31.1±7.5)years]. All patients underwent arthroscopic ACL reconstruction using tendon autograft. The femoral tunnel was created with figure-of-four position in 21 patients (figure-of-four position group) and with traditional knee hyperflexed position in 25 patients (knee hyperflexed position group). The operation time was compared between the two groups. The center position, length and angle of femoral tunnel were evaluated and measured by three dimensional CT reconstruction and Bernard quadrant method at 8 weeks postoperatively. The knee function was assessed by knee Lysholm score preoperatively, at 8 weeks and at 1 year postoperatively. Complications were observed as well.Results:All patients were followed up for 2-20 months [(15.3±2.1)months]. The operation time was (28.5±2.6)minutes in figure-of-four position group, significantly less than (39.5±2.4)minutes in knee hyperflexed position group ( P<0.05). The tunnel center position was located at (27.1±1.4)% and (25.1±2.6)% within the Bernard quadrant in figure-of-four position group, similar with (28.1±2.8)% and (26.1±3.1)% in knee hyperflexed position group (all P>0.05). Total tunnel length and thick tunnel length were (42.1±2.4)mm and (34.1±2.4)mm in figure-of-four position group, significantly longer than (38.2±2.5)mm and (31.1±2.7)mm in knee hyperflexed position group (all P<0.05). The coronal plane angle of the tunnel was (41.1±2.4)° in figure-of-four position group, significantly smaller than (47.5±2.6)° in knee hyperflexed position group ( P<0.05). The sagittal plane angle of the tunnel was (42.1±1.4)° in figure-of-four position group, significantly greater than (37.1±1.8)° in knee hyperflexed position group ( P<0.05). Figure-of-four position group showed the knee Lysholm score of (53.4±5.2)points preoperatively, (97.1±1.4)points at 8 weeks postoperatively and (98.3±2.3)points at 1 year postoperatively. Knee hyperflexed position group showed the knee Lysholm score of (54.3±7.4)points preoperatively, (97.1±1.6)points at 8 weeks postoperatively and (98.1±1.3)points at 1 year postoperatively. The knee Lysholm score did not differ significantly between the two groups (all P>0.05), but the knee function was significantly improved in both groups when compared with that before the operation (all P<0.05). There were 1 patient with femoral tunnel fracture, one with injury to the medial condylar cartilage and one with injury to the posterior root of lateral meniscus in knee hyperflexed position group, while no above-mentioned complications occurred in figure-of-four position group ( P<0.05). Conclusion:Arthroscopic ACL reconstruction using tendon autograft with femoral tunnel creation through figure-of-four position and traditional knee hyperflexed position can both contribute knee functional recovery, but the figure-of-four position has the advantages of short operation time, accurate tunnel positioning, favorable length and angle of the tunnel and less complications.
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Objective:To investigate the application and curative effect of fat grafting in supraorbital area in double blepharoplasty in patients with negative vector of the eyelid- globe.Methods:From January 2019 to January 2020, 78 patients who came to Fuzhou Meilai Huamei Beauty Hospital for double blepharoplasty were collected as patients with negative eyelid- globe vector. The patients were randomly divided into 2 groups, with 42 cases in the combined group and 36 cases in the simple group. The combined group underwent double blepharoplasty combined with fat grafting in the supraorbital area, and the simple group only underwent double blepharoplasty.Results:The postoperative follow-up was 3-12 months, with an average follow-up of 6 months. The efficacy of the combined group and the simple group was compared. There was no surgical complications in both groups. In improving the eyelid-globe vector, the combined group was higher than that of the simple group. The overall satisfaction of the combined group was higher than that of the simple group. Among them, the satisfaction of eye appearance, self-confidence, mental health, surgical results, decision-making and facial rejuvenation were all higher than those of the simple group, and there was no difference in the impact on early life between the two groups.Conclusions:Double blepharoplasty undergoing fat grafting in the supraorbital area at the same time are safe and conforms to the aesthetic standard. The patients are satisfied with the postoperative effects.
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Objective:To investigate the effect of expanded polytetrafluoroethylene (E-PTFE) combined with autologous costal cartilage in rhinoplasty.Methods:Forty-two patients who underwent rhinoplasty in the form of E-PTFE combined with autologous costal cartilage in the Department of Plastic Surgery, Jiangsu Province Hospital of Chinese Medicine from January 2017 to December 2018 were selected as the research object. The polytetrafluoroethylene combined with autologous costal cartilage was used for rhinoplasty. The dorsal nasal skin was dissected through an inverted " V" type combined with subalar cartilage incision, and then the costal cartilage was cut into appropriate cartilage slices to build the nasal tip stent. According to the degree of elevation of the nasal dorsum, the sculpted E-PTFE was placed under the nasal dorsal fascia. The rectus abdominis fascia covered the apex of the nose, and the incision was closed by suture.Results:The nasal appearance of the forty-two patients was significantly improved, with good nasal shape and no serious complications. After 6-12 months of follow-up, 40 cases were satisfacted with the effect of the rhinoplasty, accounting for 95.2%.Conclusions:The use of polytetrafluoroethylene combined with autologous costal cartilage can effectively raise the dorsum of the nose, extend the length of the nose, project the nasal tip in the rhinoplasty. This procedure is accurate and safe, reach a favorable long-term shape and own high satisfaction, and it thus is worthy of popularization in clinic.
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Objective:To investigate the causes of buccal masses after temporal autologous fat grafting, and to summarize the therapeutic methods to avoid medical disputes.Methods:Ten female patients (25-40 years; mean age, 33.1±7.5 years) with buccal mass complication after temporal autologous fat grafting were retrospectively analyzed, and statistics was done on their fat injection history, postoperative buccal mass symptom onset time, intraoperative mass conditions, postoperative pathological and fluid bacterial culture results, and postoperative recovery.Results:The unilateral temporal fat injection volume was 15-30 ml, and the buccal masses occurred 1-6 months after temporal autologous fat grafting. Lipoid masses were found in the buccal space during the operation, and some of them contained liquid. The postoperative pathological results indicated local necrosis in fibrotic adipose tissues. All the fluid bacteria cultures were negative, only one showed positive culture of acid-fast bacilli. 6-12 months postoperative follow-up visit was performed, and 9 patients recovered and 1 patient recovered after re-operation.Conclusions:The overfilled fat and liquefied necrotic fat after temporal fat grafting may move down to buccal space to form buccal masses, which should be treated by operation early to achieve a good prognosis.
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OBJECTIVE@#To investigate the early efficacy of arthroscopic autologous osteochondral grafting in the treatment of recurrent anterior shoulder dislocation.@*METHODS@#From January 2019 to January 2021, 17 patients with recurrent anterior dislocation of shoulder who underwent arthroscopic autologous osteochondral grafting were selected, including 12 males and 5 females, ranging in age from 17 to 55 years old, with a mean of (32.88±12.33) years old. Rowes rating system for Bankart repair(Rowe), Oxford Shoulder Instability Score (OSIS) and Simple Shoulder Test (SST) were compared before operation, 6 months after operation and at the latest follow-up. OSIS and SST used to evaluate shoulder function were recorded before surgery and at the latest follow-up. The shoulder mobility and intraoperative and postoperative complications were also recorded.@*RESULTS@#All 17 patients were followed up, and the duration ranged from 7 to 25 months, with a mean of (18.4±5.4) months. During the follow-up period, there was no re-dislocation, no vascular or nerve injury. Rowe score increased from 26.2±6.0 before operation to 74.4±4.0 and 82.4±3.1 after 6 months and the latest follow-up. There was significant difference in Rowe score between different time points after operation and before operation (P<0.05). The OSIS increased from 37.0±3.6 before operation to 47.4±2.6 and 52.7±2.6 after 6 months and the latest follow-up. There was significant difference in OSIS between different time points after operation and before operation (P<0.05). The SST score increased from 6.8±0.7 before operation to 9.8±0.8, 11.6±2.6 after 6 months and the latest follow-up. There was significant difference in SST score between different time points after operation and before operation (P<0.05). At the latest follow-up, the lateral external rotation and abduction external rotation activities of the patient were significantly improved compared with those before operation.@*CONCLUSION@#This study provides preliminary evidence that arthroscopic autologous osteochondral grafting can achieve satisfactory early clinical outcomes and stability in patients with recurrent anterior shoulder dislocation with glenoid fracture and defect less than <20%, which is a reliable and effective procedure.
Asunto(s)
Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Artroscopía/métodos , Inestabilidad de la Articulación/cirugía , Rango del Movimiento Articular , Luxación del Hombro/cirugía , Articulación del Hombro/cirugíaRESUMEN
Objective:To investigate the effect of inferior epigastric artery perforator flap transplantation in repairing traumatic soft tissue defects of lower limbs.Methods:A retrospective case series study was conducted to analyze the clinical data of 34 patients with traumatic soft tissue defects of lower limbs admitted to Chongqing Great Wall Hospital from January 2019 to May 2021, including 31 males and 3 females; aged 12-65 years [(38.5±5.6)years]. There were 8 patients with defects on the calf and 26 on the ankle. All wounds were found with exposed tendons, muscles and/or bones. The area of soft tissue defects ranged from 10 cm×6 cm to 40 cm×11 cm. All patients were repaired with inferior epigastric artery perforator flap. The wound healing, flap survival and recovery were observed. The visual analogue scale (VAS) and American Orthopedic Foot and ankle Society (AOFAS) ankle-hindfoot score were used to evaluate pain and ankle function before operation and at 3 days, 7 days, 14 days, 1 month, 3 months, 6 months and 12 months after operation. The complications were observed.Results:All patients were followed up for 12-36 months [(19.5±5.3)months]. All wounds were healed by stage I, showing the healing time of 14-24 days [(17.6±2.8)days]. All flaps survived with good color, soft texture and satisfactory appearance, with no obvious swelling. All flaps produced protective sensation. The VAS was (4.3±0.8)points, (3.3±0.7)points, (1.4±0.5)points, (1.2±0.3)points, (0.8±0.2)points and (0.4±0.1)points at 7 days, 14 days, 1 month, 3 months, 6 months and 12 months after operation, decreased gradually from preoperative (7.4±1.3)points (all P<0.05). The AOFAS ankle-hindfoot score was (35.6±3.1)points, (42.6±3.6)points, (50.3±4.3)points, (56.2±5.6)points, (60.3±6.8)points and (65.3±9.0)points at 7 days, 14 days, 1 month, 3 months, 6 months and 12 months after operation, increased from preoperative (22.4±2.5)points (all P<0.05). The ankle function was excellent in 25 patients, good in 5 and fair in 4 at 12 months after operation, with an excellent and good rate of 88.2%. Venous crisis occurred in 3 patients after operation, and the flaps survived completely after venous reanastomosis or venous bridging. Conclusion:For traumatic soft tissue defects of lower limbs, inferior epigastric artery perforator flap transplantation has advantages of enhanced survival of flaps, satisfactory appearance, attenuated pain, good functional recovery and few complications.
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Introdução: O tratamento de câncer de mama através de mastectomia causa grande impacto na qualidade de vida dos pacientes, ocasionando um número crescente de buscas por procedimentos reconstrutivos. O enxerto de gordura, também conhecido como lipoenxertia, foi descrito pela primeira vez em 1893, por Neuber, tendo aumentado o seu uso e aceitação no decorrer dos anos. De acordo com a Sociedade Brasileira de Cirurgia Plástica, as cirurgias reparadoras correspondem a 39,7% dos procedimentos plásticos realizados no Brasil, com as reconstruções mamárias sendo 6,1% desse número, configurando parte do tratamento do câncer de mama. O presente estudo objetivou revisar o uso de lipoenxertia na reconstrução mamária após tratamento do câncer de mama. Métodos: Foi realizada uma revisão da literatura utilizando os bancos de da-dos PubMed, MEDLINE, LILACS e SciELO, através dos descritores: "breast reconstruction"; "fat grafting"; and "breast cancer". Resultados: No total, foram encontrados 838 artigos nas bases de dados pesquisadas, dos quais 20 foram selecionados para a extração dos dados após a aplicação dos critérios de inclusão e exclusão. Conclusão: Constatou-se que a gordura autóloga é um procedimento bem estabelecido para reconstrução mamária, apesar de apresentar algumas possíveis complicações. Ademais, mais estudos a longo prazo devem ser realizados visando conso-lidar o entendimento e segurança do procedimento.
Introduction: The treatment of breast cancer through mastectomy greatly impacts patients' quality of life, causing an increasing number of searches for reconstructive procedures. The fat graft, also known as lipografting, was described by Neuber in 1893, and has increased its use and acceptance over the years. According to the Sociedade Brasileira de Cirurgia Plástica (Brazilian Society of Plastic Surgery), reconstructive surgeries correspond to 39.7% of plastic procedures performed in Brazil, with breast reconstructions being 6.1% of this number, constituting part of breast cancer treatment. The present study aimed to review the use of lipografting in breast reconstruction after breast cancer treatment. Methods: A review of the literature was carried out using the databases of PubMed, MEDLINE, LILACS and SciELO, using the descriptors: "breast reconstruction"; "fat grafting"; and "breast cancer". Results: In total, 838 articles were found in the databases searched, of which 20 were selected for data extraction after applying the inclusion and exclusion criteria. Conclusion: It was found that autologous fat is a well-established procedure for mammary reconstruction, despite presenting some possible complications. Furthermore, more long-term studies should be conducted to address the understanding and safety of the procedure.