RESUMEN
Objective: To investigate outcomes of laryngotracheal reconstruction (LTR)with anterior and posterior costal cartilage grafts in severe pediatric subglottic stenosis (SGS) or laryngeal web (LW). Methods: A review of patients with severe subglottic stenosis or laryngeal web between January 2020 and January 2022 was performed. Demographic features including gender, age at diagnosis, age at surgery, etiology, airway support, and other comorbidities were collected preoperatively. Patients were evaluated in surgical site, breathing, swallowing, phonation and complications postoperatively.Descriptive analysis was used in this research. Results: Eight patients were included: six with grade Ⅲ SGS following Cotton-Myer grading scale, and two with type Ⅲ LW following Cohen's classification. All patients underwent LTR with anterior and posterior costal cartilage grafts. Five patients underwent single-stage LTR (ssLTR), and three patients underwent double-stage LTR (dsLTR). Seven out of eight patients were able to successfully extubate or decannulate with normal swallowing function; four patients had mild hoarseness, and three had moderate hoarseness. One patient failed in extubation, and underwent tracheotomy. Conclusions: LTR with anterior and posterior costal cartilage grafts is an effective and safe treatment for severe SGS or LW. Careful preoperative assessment of disease severity and overall medical status will help selection between ssLTR and dsLTR, thereby maximizing patient outcomes for both modalities.
Asunto(s)
Niño , Humanos , Constricción Patológica/complicaciones , Cartílago Costal , Ronquera , Enfermedades de la Laringe/complicaciones , Laringoestenosis/etiología , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE@#To review the advances in methods for reconstructing nipple projection based on tissue graft support.@*METHODS@#The literature related to nipple projection reconstruction based on tissue graft support was reviewed and summarized in terms of the advantages and disadvantages of various tissue grafts and the improved nipple projection results.@*RESULTS@#Loss of nipple projection is a common cause of decreased patient's satisfaction. Reconstructing nipple projection based on tissue graft support is a more common clinical method and can be done with autologous and allogeneic tissues. Autologous tissue grafts include dermis, adipose tissue with dermis, adipose tissue, ear cartilage, rib cartilage, and contralateral nipple tissue. Autologous tissue grafts are easy to obtain and have no immune rejection, but may lead to donor area damage and prolong the surgical time for tissue collection. Allogeneic tissue grafts include acellular dermal matrix, lyophilized rib cartilage, and extracellular matrix collagen, and decellularized nipple tissue. Allogeneic tissue grafts do not cause additional donor area damage, are highly malleable, and can be designed to be utilized according to the recipient area, but the high cost often limits the development of this technique.@*CONCLUSION@#There is no gold standard regarding tissue graft-assisted nipple projection reconstruction techniques, and there are advantages and disadvantages to both autologous and allogeneic tissue grafts. Surgeons should choose the appropriate graft based on the actual condition of the patient.
Asunto(s)
Humanos , Tejido Adiposo , Autoinjertos , Cartílago Costal , Pezones/cirugía , TrasplantesRESUMEN
Introducción: La reconstrucción de la oreja en la actualidad es un problema difícil de solucionar. Se han propuesto varias técnicas quirúrgicas y solo las que se basan en el uso de cartílago costal autólogo son las que se aceptan a nivel mundial. Objetivo: Evaluar la efectividad de la técnica de reconstrucción del pabellón auricular descrita por Burt Brent. Métodos: Se realizó un estudio cuantitativo con diseño descriptivo de corte transversal con 41 pacientes que presentaron microtia congénita o perdida adquirida de la oreja; a quienes se les realizó reconstrucción auricular con cartílago costal autólogo tratados en el Hospital "William Soler", el Centro de Investigaciones Médico-Quirúrgica y Clínica Central "Cira García" en el Servicio de Cirugía Plástica desde 1994 hasta 2019. Se describió y se documentó la técnica empleada descrita por Burt Brent. Se utilizó una escala de 10 puntos que se basó en la anatomía auricular normal para la valoración de los resultados. Resultados: Se encontraron 32 pacientes portadores de microtia congénitas (78,04 %) y 9 pérdidas traumáticas (21,95 %), predominó el sexo femenino (56,09 %). La incidencia fue mayor en el lado derecho (68,75 %) en pacientes con microtia congénita. En el 95 % de los casos se alcanzaron resultados favorables y satisfactorios. Conclusiones: La reconstrucción del pabellón auricular requiere el empleo de un fragmento de cartílago costal de suficiente tamaño, forma y proyección. La clave consiste en esculpir un marco cartilaginoso de la oreja y mantener estos detalles a través de la piel lo más semejante a la oreja normal. Para un resultado satisfactorio se requiere una alta especialización.
Introduction: Auricle reconstruction is, nowadays, a difficult problem to solve. Several surgical techniques have been proposed and only those based on the use of autologous costal cartilage are accepted worldwide. Objective: To evaluate the effectiveness of the auricle reconstruction technique described by Burt Brent. Methods: A quantitative study with a cross-sectional descriptive design was carried out with 41 patients who presented congenital microtia or acquired loss of the ear and who were performed auricle reconstruction with autologous costal cartilage in the plastic surgery service at Hospital "William Soler", Centro de Investigaciones Médico-Quirúrgicas and Clínica Central "Cira García", from 1994 to 2019. The used technique described by Burt Brent was, in turn, described and documented. A 10-point scale based on the normal atrial anatomy was used to assess the outcomes. Results: Thirty-two patients with congenital microtia (78.04 %) and nine traumatic losses (21.95 %) were found, with a predominance of the female sex (56.09 %). The incidence was higher on the right side (68.75 %) in patients with congenital microtia. Favorable and satisfactory outcomes were achieved in 95 % of cases. Conclusions: Auricle reconstruction requires the use of a costal cartilage piece of enough size, shape and projection. The key is to sculpt a cartilaginous framework of the ear and to maintain these details through the skin as close as possible to the normal ear. A high level of specialization is required for a satisfactory outcome.
Asunto(s)
Humanos , Cartílago Costal/lesiones , Epidemiología Descriptiva , Estudios TransversalesRESUMEN
Durante los últimos años, la cirugía endoscópica transesfenoidal se ha convertido en el procedimiento quirúrgico de elección para el tratamiento de tumores hipofisarios. La técnica de abordaje actual es el resultado de una evolución histórica de vía por craneotomía a vía endonasal con ingreso a través del seno esfenoidal. Aunque la cirugía de tumores hipofisarios vía transesfenoidal endoscópica ha permitido disminuir las complicaciones graves asociadas a los abordajes externos, no estaÌ exenta de complicaciones, como la fístula de líquido cefalorraquídeo. A nivel del abordaje nasal, hay escasas descripciones de complicaciones y el compromiso del cartílago septal con deformidad en silla de montar no es una complicación documentada. Se presenta un caso de rinodeformidad en silla de montar poscirugía transesfenoidal de hipófisis en una paciente de 32 años a quien se le practicó una reconstrucción nasal con cartílago costal autólogo. En nuestra búsqueda bibliográfica es el primer caso registrado en Iberolatinoamérica
In recent years, transsphenoidal endoscopic surgery has become the surgical procedure of choice for the treatment of pituitary tumors. The current approach technique is the result of an historical evolution from craniotomy surgery to an endonasal procedure with entry through the sphenoid sinus. Although endoscopic transsphenoidal surgery has made it possible to reduce serious complications associated with external approaches, it is not without complications, such as cerebrospinal fluid fistula. At the level of the nasal approach, there are few descriptions of complications and involvement of the septal cartilage with saddle deformity is not a documented complication. We present a case of saddle rhinodeformity after transsphenoidal pituitary surgery in a 32-year-old patient who underwent nasal reconstruction with autologous costal cartilage. In our bibliographic search, it is the first case registered in IberoLatin America.
Asunto(s)
Humanos , Femenino , Adulto , Enfermedades de la Hipófisis/complicaciones , Complicaciones Posoperatorias/terapia , Trasplante Autólogo , Nariz/cirugía , Neoplasias Nasales/terapia , Cirugía Endoscópica por Orificios Naturales/métodos , Cartílago Costal/trasplanteRESUMEN
O aumento do dorso nasal nas rinoplastias é foco de estudo de diversos trabalhos que buscam as melhores fontes de enxerto e técnicas cirúrgicas. A utilização de cartilagem já é consagrada para este fim, a partir do septo nasal, da concha auricular ou dos arcos costais. Nos últimos anos, têm-se buscado meios para reduzir a palpabilidade e dispersibilidade dos enxertos cartilaginosos. Assim, são descritos materiais sintéticos, como o SURGICEL®; e, autólogos, representados pelas fáscias. A fáscia temporal é mais amplamente utilizada, porém requer uma nova incisão cirúrgica, aumentando o tempo e a morbidade da cirurgia. É também descrito o uso de fáscia lata e fáscia reto abdominal, comparativamente mais espessas e menos flexíveis. Em muitos casos de rinoplastia fazse necessária a retirada da cartilagem costal, o que permite a coleta de fáscia do músculo peitoral maior pela mesma incisão cirúrgica. Dessa forma, descrevemos a utilização da fáscia do músculo peitoral maior envolvendo cartilagem costal picada, em uma rinoplastia estruturada com aumento do dorso.
Increasing the nasal dorsum in rhinoplasty is the focus of several studies that seek the best graft sources and surgical techniques. The use of cartilage from the nasal septum, ear shell, or costal arches is already established for this purpose. In recent years, methods have been sought to reduce the palpability and dispersibility of cartilaginous grafts. Thus, synthetic materials such as SURGICEL® and autologous materials such as fascia have been explored. Temporal fascia are more widely used but require a new surgical incision, increasing surgical time and morbidity. Also described is the use of fascia lata and rectus abdominis fascia, which are comparatively thicker and less flexible. In many rhinoplasty procedures, it is necessary to remove the costal cartilage, which allows the collection of fascia from the major chest muscles through the same surgical incision. Thus, we describe the use of major chest muscle fascia and chopped costal cartilage in structured rhinoplasty to increase the dorsum.
Asunto(s)
Humanos , Femenino , Adulto , Historia del Siglo XXI , Prótesis e Implantes , Rinoplastia , Trasplante Autólogo , Fascia , Cartílago Costal , Supervivencia de Injerto , Prótesis e Implantes/efectos adversos , Rinoplastia/efectos adversos , Rinoplastia/métodos , Trasplante Autólogo/efectos adversos , Trasplante Autólogo/métodos , Trasplantes/cirugía , Fascia/anatomía & histología , Fascia/trasplante , Cartílago Costal/cirugía , Cartílago Costal/citologíaRESUMEN
Relapsing polychondritis (RP) is a rare autoimmune disorder of unknown etiology characterized by recurrent episodes of inflammation and the destruction of cartilaginous tissues, primarily involving the ear, nose, and the respiratory tract. Nasal chondritis is present in 24% of patients at the time of diagnosis and develops subsequently in 53% throughout the diseases progress. Progressive destruction of nasal cartilage leads to the characteristic flattening of the nasal bridge, resulting in the saddle nose deformity. In patients with RP, surgical management for saddle nose is carefully decided due to the disease relapsing characteristics. We present a RP patient with a saddle nose deformity who underwent reconstruction rhinoplasty with autologous costal cartilage grafting. At 6-month follow-up, the patient retained good esthetic results and showed neither complication nor relapse of RP.
Asunto(s)
Humanos , Anomalías Congénitas , Cartílago Costal , Diagnóstico , Oído , Estudios de Seguimiento , Inflamación , Cartílagos Nasales , Nariz , Policondritis Recurrente , Recurrencia , Sistema Respiratorio , Rinoplastia , TrasplantesRESUMEN
Binder syndrome, also called the congenital flat nose syndrome, is a rare congenital malformation with a flat facial profile, intermaxillary hypoplasia and malocclusion. Rhinoplasty plays an important part in the multidisciplinary surgical protocol for this syndrome, for which weak nasal framework and soft tissue underdevelopment have been considered a great challenge. We present a case of Binder syndrome of a 27-year-old male. The nose was reconstructed with a caudal septum replacement graft and bilateral extended spreader grafts using costal cartilage.
Asunto(s)
Adulto , Humanos , Masculino , Cartílago Costal , Maloclusión , Nariz , Rinoplastia , TrasplantesRESUMEN
En los procedimientos reconstructivos nasales, tres son los factores determinantes: la mucosa respiratoria, la estructura cartilaginosa u ósea y la cobertura de piel. Sin lugar a dudas, la estructura cartilaginosa u ósea es el pilar fundamental para la mantención de la estructura anatómica1. La literatura habla de varias técnicas para generar la estructura necesaria. Algunas de ellas utilizan cartílago septal, otras utilizan hueso de distintos orígenes con fi jación, otras utilizan cartílago costal. El propósito de este trabajo es confi rmar los conceptos del pilar cartilaginoso en "L" de cartílago costal, descripto por Gillies (1920), Brown y McDowell (1951) y Millard (1957), y además plantea un ajuste en el modelo, en la confección y en sus medidas (Figuras 1 a 7), a fi n de que esta estructura supere las desventajas descriptas en la literatura (no /ofrece una estabilización rígida, la cicatrización en la reconstrucción produce desviación de esta estructura). Se describe también la obtención, el modelaje y la colocación.
Asunto(s)
Humanos , Adulto , Persona de Mediana Edad , Rinoplastia/métodos , Procedimientos de Cirugía Plástica/métodos , Cartílagos Nasales/cirugía , Cartílago Costal/trasplanteRESUMEN
Introducción: El injerto de preferencia para cirugía nasal es el cartílago septal. El Injerto de cartílago costal otorga gran material para trabajo ya que posee características similares al cartílago septal. Este injerto se utiliza generalmente para cirugías de dorso nasal, nariz en silla de montar, laterorrinias, disfunciones de la válvula nasal interna y/o externa, poca proyección nasal y rinoplastías de revisión. Objetivo: Conocer las características, resultados y complicaciones de las rinoplastías con injerto de cartílago costal realizadas en el Hospital San Juan de Dios (HSJD) entre los años 2010 y 2016. Material y método: Estudio retrospectivo con revisión de fichas clínicas de pacientes sometidos a cirugías de reconstrucción nasal con injerto de cartílago costal en el HSJD entre enero 2010 y agosto 2016. Resultado: Entre los años 2010 y 2016 se realizaron 20 rinoplastías con uso de cartílago costal: 14 eran hombres (70%) y 6 eran mujeres (30%). En 14 pacientes se usó el cartílago costal en la primera cirugía. No se presentaron complicaciones a corto, mediano y largo plazo. Conclusión: El injerto de cartílago costal es una herramienta útil a la hora de enfrentarse a cirugías complicadas. La técnica quirúrgica no es dificultosa y tiene una baja tasa de complicaciones.
Introduction: The ideal graft for nasal surgery is septal cartilage. The costal cartilage has similar characferistics to the septal cartilage. This particular graft is generally used for nasal dorsum, saddle nose, nasal deviations, dysfunctions of the internal or external nasal valve, poor nasal projection and revision rhinoplasty. Aim: Determine the characteristics, outcomes and complications of rhinoplasty with costal cartilage graft made in the San Juan de Dios Hospital (HSJD) between 2010 and 2016. Material and method: Retrospective study with reviewing medical records of all patients underwent nasal surgery reconstruction with costal cartilage graft in the HSJD between January 2010 and August 2016. Results: Between 2010 and 2016 a total of 20 rhinoplasties were performed with use of costal cartilage. Of these 14 were men (70%) and 6 were women (30%). In 14 patients we used the costal cartilage in the first surgery. No complications in short, medium and long term were presented. Conclusion: The rib cartilage graft is a useful tool when dealing with complicated surgeries. The surgical technique is not difficult and has a low complication rate.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Cartílago Costal/trasplante , Nariz/cirugía , Rinoplastia/métodos , Tempo Operativo , Complicaciones Posoperatorias , Procedimientos de Cirugía Plástica/métodos , Estudios Retrospectivos , Trasplantes , Resultado del TratamientoRESUMEN
A 71-year-old man was referred for an anterior chest wall mass. Chest computed tomography (CT) and positron emission tomography-CT suggested a malignant tumor. Surgical biopsy through a vertical subxiphoid incision revealed an extra-gastrointestinal stromal tumor (EGIST). En bloc resection of the tumor, including partial resection of the sternum, costal cartilage, pericardium, diaphragm, and peritoneum, was performed. Pathologic evaluation revealed a negative resection margin and confirmed the tumor as an EGIST. On postoperative day 17, the patient was discharged without any complications. At the 2-week follow-up, the patient was doing well and was asymptomatic.
Asunto(s)
Anciano , Humanos , Biopsia , Cartílago Costal , Diafragma , Electrones , Estudios de Seguimiento , Tumores del Estroma Gastrointestinal , Pericardio , Peritoneo , Esternón , Pared Torácica , TóraxRESUMEN
Introdução: A rinoplastia, como outras subespecialidades da Cirurgia Plástica, apresentou evolução muito grande nas últimas décadas, tanto em termos de técnica operatória quanto em diagnóstico das alterações a serem tratadas. O objetivo deste trabalho é avaliar a eficácia das técnicas Estruturada e Convencional na abordagem estética e reparadora do nariz. Métodos: Foram estudados de forma retrospectiva 49 pacientes operados pelo autor do trabalho, que foram submetidos a uma das duas técnicas operatórias. A eficácia das técnicas foi avaliada a partir da crítica dos pacientes e do cirurgião com relação aos resultados e à capacidade de se chegar ao objetivo do pré-operatório. Resultados: Ambas as técnicas se mostraram eficazes para alcançar o objetivo final da cirurgia. A satisfação dos pacientes e do cirurgião foram semelhantes nos dois casos, e não houve complicações maiores em nenhum dos grupos. Conclusão: O trabalho mostrou que tanto a técnica Estruturada quanto a Convencional são eficazes para o tratamento das alterações nasais, sendo o mais importante o correto diagnóstico pré-operatório das alterações para a escolha da melhor abordagem em cada caso.
Introduction: Rhinoplasty, like other plastic surgery subspecialties, has greatly evolved in recent decades, as both a surgical technique and a diagnosis of the alterations that need to be performed. The objective of the current study was to evaluate the efficacy of the structured and conventional surgical techniques on nasal aesthetic and corrective approaches. Methods: A total of 49 patients, who underwent surgical operation by the author of this work, were retrospectively studied. The patient generally underwent one of the two surgical techniques. The efficacy of each technique was evaluated by means of the critique provided by the patients and the surgeon regarding the results, and the ability to reach the pre-operative goals. Results: Both techniques were efficient in attaining the final objective of the surgery. Patient and surgeon satisfaction were similar in both cases, and there were no major complications in any of the groups. Conclusion: The present work showed that both the structured and the conventional techniques were efficient in the treatment of nasal alterations. The most important factor for selecting the best approach in each case was the correct pre-operative diagnosis of the required alterations.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Historia del Siglo XXI , Rinoplastia , Nariz , Estudios Retrospectivos , Procedimientos de Cirugía Plástica , Evaluación de Eficacia-Efectividad de Intervenciones , Cartílagos Nasales , Cartílago Costal , Estudio Clínico , Rinoplastia/métodos , Nariz/cirugía , Procedimientos de Cirugía Plástica/métodos , Cartílagos Nasales/cirugía , Cartílagos Nasales/patología , Cartílago Costal/cirugía , Cartílago Costal/patologíaRESUMEN
Introducción: la finalidad es ponderar el conocimiento anatómico indispensable de la pared torácica para la recolección segura de cartílago costal en rinoplastia. Materiales y métodos: Se dividió en dos fases. Esta presentación corresponde a la Fase I, de tipo descriptiva observacional. La Fase II (actualmente en curso) tiene un diseño prospectivo y experimental para una futura presentación. Primera instancia: recolección de información bibliográfica, de no más de 5 años de antigüedad en bases de datos médicos y textos específicos. Segunda instancia: representación del acto quirúrgico en 3 especímenes cadavéricos humanos. En cada espécimen se realizaron 4 abordajes (2 submamarios y 2 subcostales inferiores) se hizo hincapié en la descripción de aquellas estructuras anatómicas importantes para respetar en el abordaje de la pared torácica. Resultados: Fue posible recrear las diferentes técnicas de abordaje de la pared costal. Se pudo constatar que la ubicación del paquete vasculonervioso dentro del surco costal fue constante inter especímenes e intra espécimen. La relación entre el pericondrio interno, la fascia endotorácica y la hoja parietal de la pleura resultó ser un sistema fibroadhesivo complejo y variable. Coincidimos con la bibliografía acerca de que la técnica se dificulta cuando se realiza la recolección a nivel costal más proximal. Conclusiones: Creemos que el conocimiento de la anatomía torácica es indispensable para realizar una correcta técnica de disección y posterior recolección de cartílago costal; esto disminuiría las complicaciones y la morbilidad en el sitio dador. El neumotórax y el dolor neuropático provienen del daño de estructuras anatómicas constantes.
Introduction: the purpose is to weight the anatomical knowl edge essential to the chestwall for the safe collection of costal cartilage in rhinoplasty. Materials and methods: It is divided in to two phases. This presentation corresponds to Phase I, of an observational descriptive type. Phase II (currently underway) has a prospective and experimental design for future presentation. First instance: collection of bibliographic information, not more than 5 years old in medical databases and specific texts. Second instance: representation of the surgical act in 3 human cadaveric specimens. In each specimen, 4 approaches (2 sub mamarios and 2 lower subcostals) were performed, emphasizing the description of those anatomical structures important to respect in the thoracic wall approach. Results: It was possible to recreate the different techniques of approaching the costal wall. It was observed that the location of the vasculo nervioso package with in the costal groove was constant between specimens and intra specimen. The relationship between the internal perichondrium, the endothoracic fascia and the parietal leaf of the pleura turned out to be a complex and variable fibro adhesive system. We agree with the bibliography that the technique is difficult twhen the collection is carried out at the most proximal costal level. Conclusions: We believe that knowl edge of the thoracic anatomy is essential to perform a correct technique of dissection and later collection of costal cartilage, this would reduce complications and morbidity in the donor site. Pneumothorax and neuropathic painarise from the damage of constant anatomical structures.
Introdução: o objetivo é avaliar o conhecimento anatômico essencial da parede torácica para a recolha de cartilagem costal em rinoplastia. Materiais e métodos: dividido em duas fases. Esta apresentação corresponde à Fase I, observacional descritivo. Fase II (em curso) tem um desenho prospectivo e experimental para uma apresentação futuro. Primeira instância: recolha de informação bibliográfica, não mais de 5 anos de idade em bancos de dados médicos e textos específicos. Segunda instância: a representação da cirurgia em 3 espécimes de cadá- veres humanos. Em cada espécime 4 abordagens (2 submamária e 2 inferior subcostal) enfatizou a descrição dessas estruturas anatômicas importantes a respeitar no tratamento da parede torácica foram realizadas. Resultados: Foi possível recriar as diferentes técnicas de abordagem parede torácica. Verificou-se que a localização do feixe neurovascular no sulco costal foi constante espécimes inter e intra espécime. A relação entre o pericôndrio interno, a fáscia e a folha intratorácica pleura parietal provou ser um sistema de fibro adhesive complexa e variável. Estamos de acordó com a literatura que a técnica é difícil quando a coleção é composta nível costal mais proximal. Conclusão: Acreditamos que o conhecimento da anatomia torácica é essencial para uma correta técnica de dissecção e subsequenterecolha de cartilagem costal, este iria diminuir as complicações e morbidade no sítiodoador. Pneumotórax e dorneuropática vem de danos causados por estrutura sanatômicas constantes.
Asunto(s)
Masculino , Femenino , Humanos , Cartílago Costal/anatomía & histología , Cartílago Costal/cirugía , Cartílago Costal/trasplante , Autoinjertos/fisiopatología , Nervios Intercostales/anatomía & histología , Complicaciones Posoperatorias , Neumotórax/prevención & control , Rinoplastia , Trasplante AutólogoRESUMEN
Aim: To assess the presence of donor site sequel of patients undergoing ear reconstruction with costal cartilage harvest, using supraperichondrial technique. methods: Cross-sectional study; patients under 15 years. The cartilages were harvested with perichondrium. Three observers performed donor site assessment; they were independent to this study (validated Strasser score: deformity, asymmetry, contour and scar). Children and their mothers were applied satisfaction survey. Analysis of the association between variables: nonparametric tests. Results: 19 reconstructions, 18 patients, age 8 (6-15) years, follow-up 50 (14-96) months; number of rib cartilage harvested 3 (2-4) units. Expert assessment: excellent in 2 (10.5%) cases, good in 10 (52.6%), regular in 7 (36.8%). Most mothers and patients rated the result as good. There was no significant difference in the score, with respect to the number of harvested costal cartilages. To separate them by age, poorer results were obtained at surgery before 10 years of age than in older (p < 0.03). Conclusion: Ear reconstruction and supraperichondrial technique for costal cartilage allows obtain good results in donor site. There is high satisfaction when evaluated by the patient and his mother, as well as observers. The result is not dependent on the number of harvested cartilage, but is related to age at surgery, best results were obtained in patients operated over 10 years of age.
Objetivo: Evaluar presencia de secuela en zona dadora de pacientes sometidos a reconstrucción auricular con cartílago costal con técnica suprapericóndrica. material y método: Corte transversal; pacientes menores de 15 años. Cartílagos fueron levantados con pericondrio. Evaluación de zona dadora fue realizada por tres observadores independientes (escala validada de Strasser: deformidad, asimetría, contorno y cicatriz). A niños y madres se les aplicó encuesta de satisfacción. En el análisis de la asociación entre variables se utilizan pruebas no paramétricas. Resultados: 19 reconstrucciones, 18 pacientes, mediana edad 8 (6-15) años, seguimiento 50 (14-96) meses, número de cartílagos costales obtenidos 3 (2-4) unidades. Evaluación de expertos: excelente en 2 (10,5%) casos, bueno en 10 (52,6%) y regular en 7 (36,8%). La mayoría de las madres y pacientes calificó como bueno el resultado. No hubo diferencia significativa en el puntaje con respecto al número de cartílagos costales cosechados. Al separarlos por edad se obtuvo peores resultados en los intervenidos antes de los 10 años que en mayores (p < 0,03). Conclusión: La reconstrucción auricular con cartílago costal y técnica suprapericóndrica, permite obtener buenos resultados en zona dadora. Existe alta satisfacción al ser evaluada por el paciente y su madre, así como por los observadores. El resultado no es dependiente del número de cartílagos; sí en relación a la edad de la cirugía: mejores resultados en pacientes operados sobre los 10 años de edad, lo que concuerda con otros estudios.
Asunto(s)
Humanos , Niño , Adolescente , Trasplante de Tejidos/métodos , Procedimientos de Cirugía Plástica/efectos adversos , Cartílago Costal/trasplante , Microtia Congénita/cirugía , Estudios Transversales , Encuestas y Cuestionarios , Estudios de Seguimiento , Satisfacción del Paciente , Sitio Donante de TrasplanteRESUMEN
Pectus arcuatum is a rare complex chest wall deformity. A 31-year-old female presented with a severely protruding upper sternum combined with a concave lower sternum. We planned a modified Ravitch-type operation. Through vertical mid-sternal incision, chondrectomies were performed from the second to fifth costal cartilages, saving the perichondrium. Horizontal osteotomy was performed in a wedge shape on the most protruding point, and followed by an additional partial osteotomy at the most concaved point. The harvested wedge-shape bone fragments were minced and re-implanted to the latter osteotomy site. The osteotomized sternum was fixed with multiple wirings. With chondrosternoplasty, a complex chest wall deformity can be corrected successfully.
Asunto(s)
Adulto , Femenino , Humanos , Trasplante Óseo , Anomalías Congénitas , Cartílago Costal , Tórax en Embudo , Osteotomía , Pectus Carinatum , Esternón , Pared TorácicaRESUMEN
<p><b>OBJECTIVE</b>To investigate the trans-areola approach for costicartilage harvesting in order to avoid the obvious scar resulted by traditional approach through chest incision.</p><p><b>METHODS</b>From 2013, 7 cases who underwent rhinoplasty received costicartilage harvesting through trans-areola approach. The incision was designed along the lower interior edge of right areola. Then the dissection was performed to expose the 5th costicartilage. Then a costicartilage, 2 - 5 cm in length, was harvested. The incision was closed delicately. The suture was removed 7 days after operation.</p><p><b>RESULTS</b>The patients were followed up for 3 months to 2 years without hypertrophic scar and breast deformity. The scar was located in conceal location. The satisfactory rate was higher than that in patients with chest incision.</p><p><b>CONCLUSIONS</b>The scar resulted from trans-areola approach is comparatively conceal, compared with that at chest.</p>
Asunto(s)
Femenino , Humanos , Mama , Cirugía General , Cicatriz , Patología , Cartílago Costal , Disección , Métodos , Estudios de Seguimiento , Pezones , Cirugía General , Rinoplastia , Métodos , Factores de Tiempo , Recolección de Tejidos y Órganos , Métodos , Sitio Donante de TrasplanteRESUMEN
<p><b>OBJECTIVE</b>Augmentation rhinoplasty is a commonly procedure in clinical work for a plastic surgeon. Autologous costal cartilage is widely used in aesthetic rhinoplasy because of the abundant in quality. However, the cartilage may warp, and it is not easy-handling for inexperienced plastic surgeons. We-used diced cartilage combined with thin strips as columellar struts, which can be easily shaped, and reduce the warping incidence.</p><p><b>METHODS</b>From July 2012 to March 2014, 61 patients were performed diced costal cartilage for nasal augmentation via endonasal approach. Standardized photographs are obtained before and after surgery. Postoperative outcome is graded by patient's self-evaluation of the nasal appearance with a satisfaction scale.</p><p><b>RESULTS</b>Among the 61 cases, 25 were revision cases. The follow-up time was no less than 6 months, with an average time of 10.9 months. 28 patients reported improved or better nasal appearance. One patient required revision surgery because of overcorrection. Supratip step-off was observed in one patient and corrected by external reshaping. No warping, infection, irregularity, absorption, airway obstruction, or donor-site morbidity were observed. All patients were satisfied with the final appearance.</p><p><b>CONCLUSIONS</b>Diced costal cartilage is a reliable option for nasal augmentation and revision rhinoplasty. Good outcomes can be achieved postoperatively, with aesthetically pleasing appearance and simple procedure.</p>
Asunto(s)
Humanos , Cartílago Costal , Trasplante , Estética , Tabique Nasal , Reoperación , Estudios Retrospectivos , Rinoplastia , MétodosRESUMEN
OBJECTIVE@#To analyze postmortem chemical changes in Landrace costal cartilages and ribs using attenuated total reflection-Fourier transform infrared (ATR-FTIR) spectroscopy, and to provide a novel technique for estimation of postmortem interval (PMI).@*METHODS@#The swines were sacrificed by hemorrhage and their costal cartilages and ribs were kept in 20 degrees C. The chemical analysis of the costal cartilages and ribs were performed using ATR-FTIR every 72 h. The correlation between the certain spectral parameters and PMI was also analyzed. The time-dependent changes of costal cartilages were more significant than ribs.@*RESULTS@#There were no obvious changes for the main absorbance bands position, and some absorbance band ratios showed time-dependent changes and significant correlations with the PMI.@*CONCLUSION@#ATR-FTIR has the ability to analyze postmortem chemical changes of the swine costal cartilages and ribs, and it can be a new method to estimate PMI based on spectroscopy.
Asunto(s)
Animales , Ratas , Autopsia , Cartílago Costal , Patologia Forense/métodos , Hemorragia , Modelos Animales , Cambios Post Mortem , Ratas Sprague-Dawley , Análisis de Regresión , Costillas , Espectroscopía Infrarroja por Transformada de Fourier , Porcinos , Factores de TiempoRESUMEN
The complexity of the auricle makes its reconstruction technically difficult, owing to the convexities and concavities of the underlying cartilage with its tightly adherent and thin overlying skin. This article gives an overview of the current practice in the field of auricular reconstruction. The majority of surgeons who perform auricular reconstruction continues to employ the well-established techniques developed by Brent and Nagata. Surgery takes between two and four stages, with the initial stage being construction of a framework of autogenous rib cartilage which is implanted into a subcutaneous pocket. Several modifications of these techniques have been reported. Understanding the various treatment options and having sufficient practice to increase the surgeon's skills are crucial to providing the patients with the best outcomes possible.
Asunto(s)
Humanos , Cartílago , Microtia Congénita , Cartílago Costal , Costillas , Piel , CirujanosRESUMEN
BACKGROUND: This report describes the authors’ experience of “melting” septal cartilage after placement of a septal extension graft in a nasopharyngeal cancer patient that had been previously undergone radiation therapy, and provides a review of the literature. METHODS: Electronic medical records were used to obtain details of the patient's clinical history. RESULTS: A 32-year-old woman, who had previously undergone radiotherapy for nasopharyngeal cancer, visited our department to for rhinoplasty. Rhinoplasty was performed using a septal extension graft to raise the nasal tip (first operation). Five days after surgery, it was found that the septal extension graft was melting without any signs of infection, that is, the graft had softened, lost elasticity, thinned, and partially disappeared without any sign of infection at 5 days, and thus, the nasal tip was reconstructed with conchal cartilage (second operation). Five months after surgery, it was found that almost all septal cartilage had disappeared without any sign of infection, and thus, the entire nasal septum was reconstructed using 2-mm costal cartilage and an onlay graft was used for tip augmentation (third operation). CONCLUSIONS: After cartilage has been exposed to radiotherapy, its patency should be viewed with suspicion. Further studies are needed for determine the mechanism responsible for cartilage damage after radiotherapy.