RESUMO
BACKGROUND: Hypospadias is the most common congenital malformation of the male urinary tract, wherein the urethral opening is located proximal to the normal site. Tubularized incised-plate urethroplasty reconstruction, and its efficacy, remains controversial due to the high recurrence rate. This study aimed to evaluate the results of dartos fascia-reinforced flap surgery in hypospadias patients with previous operative complications. METHODS: Nine patients (mean age, 12 years) who had previous one- or two-stage repair with TIP urethroplasty and suffered from urethrocutaneous fistulas or fissures as complications, underwent dartos fascia-reinforced flap surgery in our clinic between January 2010 and December 2012. The mean postoperative follow-up period was 6 months. RESULTS: Among the 9 patients, 7 had complete correction. In all the patients, the maximum uroflow angle was >45degrees. No patient complained of an unnatural urinating position. The patients and parents gave very high satisfaction scores (4.7 points) with regard to the appearance of the outer genitalia. CONCLUSION: The dartos fascia-reinforced flap could be a useful and reliable option for complications of hypospadias repair or fissure with the prepuce preserved, given that histological aspects vary and that the possibility of recurrence in the glanular region is high.
Assuntos
Feminino , Humanos , Masculino , Fístula , Seguimentos , Cirurgia Geral , Hipospadia , Pais , Recidiva , Retalhos Cirúrgicos , Uretra , Sistema UrinárioRESUMO
BACKGROUND: Breast-conserving surgery is widely accepted as an appropriate method in breast cancer, and the lateral thoracodorsal flap provides a simple, reliable technique, especially when a mass is located in the lateral breast. This study describes the usefulness of a lateral thoracodorsal flap after breast conserving surgery in laterally located breast cancer. METHODS: From September 2008 to February 2013, a lateral thoracodorsal flap was used in 20 patients with laterally located breast cancer treated at our institution. The technique involves a local medially based, wedge shaped, fasciocutaneous transposition flap from the lateral region of the thoracic area. Overall satisfaction and aesthetic satisfaction surveys were conducted with the patients during a 6-month postoperative follow-up period. Aesthetic results in terms of breast shape and symmetry were evaluated by plastic surgeons. RESULTS: The average specimen weight was 76.8 g. The locations of the masses were the upper lateral quadrant (n=15), the lower lateral quadrant (n=2), and the central lateral area (n=3). Complications developed in four of the cases, partial flap necrosis in one, wound dehiscence in one, and fat necrosis in two. The majority of the patients were satisfied with their cosmetic outcomes. CONCLUSIONS: Partial breast reconstruction using a lateral thoracodorsal flap is well matched with breast color and texture, and the surgery is less aggressive than other techniques with few complications. Therefore, the lateral thoracodorsal flap can be a useful, reliable technique in correcting breast deformity after breast conserving surgery, especially in laterally located breast cancer.
Assuntos
Feminino , Humanos , Mama , Neoplasias da Mama , Anormalidades Congênitas , Cosméticos , Necrose Gordurosa , Seguimentos , Mamoplastia , Mastectomia , Mastectomia Segmentar , Necrose , Retalhos CirúrgicosRESUMO
BACKGROUND: Amniotic-fluid-derived stem cells and amniocytes have recently been determined to have wound healing effects, but their mechanism is not yet clearly understood. In this study, the effects of amniotic fluid stem cells and amniocytes on wound healing were investigated through animal experiments. METHODS: On the back of Sprague-Dawley rats, four circular full-thickness skin wounds 2 cm in diameter were created. The wounds were classified into the following four types: a control group using Tegaderm disc wound dressings and experimental groups using collagen discs, amniotic fluid stem cell discs, and amniocyte discs. The wounds were assessed through macroscopic histological examination and immunohistochemistry over a period of time. RESULTS: The amniotic fluid stem cell and amniocyte groups showed higher wound healing rates compared with the control group; histologically, the inflammatory cell invasion disappeared more quickly in these groups, and there was more significant angiogenesis. In particular, these groups had significant promotion of epithelial cell reproduction, collagen fiber formation, and angiogenesis during the initial 10 days of the wound healing process. The potency of transforming growth factor-beta and fibronectin in the experimental group was much greater than that in the control group in the early stage of the wound healing process. In later stages, however, no significant difference was observed. CONCLUSIONS: The amniotic fluid stem cells and amniocytes were confirmed to have accelerated the inflammatory stage to contribute to an enhanced cure rate and shortened wound healing period. Therefore, they hold promise as wound treatment agents.
Assuntos
Animais , Feminino , Humanos , Ratos , Líquido Amniótico , Bandagens , Colágeno , Células Epiteliais , Fibronectinas , Imuno-Histoquímica , Ratos Sprague-Dawley , Reprodução , Pele , Células-Tronco , CicatrizaçãoRESUMO
In combined techniques of a buried suture and an incision method, the eyes are opened easily with minimal effort, because the strength of the levator palpebrae muscle in the early stage of the eye opening process is firstly transmitted to the tarsal plate. The power of eye opening is efficiently transmitted without diminishing its strength. In addition, postoperative swelling on the lower flap is minimal, without loss of the power of eye opening, which allows for effective correction of ptosis in case of weak levator function. The elevation force of the upper eyelid is mainly initiated from the contraction of the levator palpebrae superioris and transmitted to the levator aponeurosis which is inserted into the anterior surface of the tarsal plate. The classical surgical procedure for bleoharoptosis is accomplished by strengthening the weak levator aponeurosis by means of levator plication, shortening, or Muller tucking procedure. The levator sheath thickens to form the superior transverse ligament of Whitnall and runs continuously inferiorly anterior to the levator aponeurosis and forms the deep layer of the orbital septum. The author has used the levator sheath to reinforce the weak levator aponeurosis effectively in cases of all ptotic eyelids. The elevation effect of the levator sheath plication is more than 1mm of the eyelid level in average and it is same effect to more than 3-4mm plication of the levator aponeurosis.
Assuntos
Blefaroplastia , Blefaroptose , Contratos , Olho , Pálpebras , Ligamentos , Músculos , Órbita , SuturasRESUMO
In prominent ears, major common deformities are a poorly developed antihelical fold and the formation of excessive conchal cartilage, in particular the posterior conchal wall. Goal of the surgical correction of prominent ears is narrowing of the conchoscaphal angle by folding of the antihelix and reduction of the concha. In this study, cartilage sparing otoplasty is refined by the addition of minimal dissection of the medial and lateral margin of the medial and lateral cut cartilage through the posterior approach and horizontal mattress sutures between two margins. A total of 9 patients were operated between 1999 and 2001. Among them, 4 patients were bilateral and 5 patients were unilateral. There were no hematomas. There was mild recurrence of the upper antihelical fold in one patient who requested further surgery. Two patients developed suture extrusion. This technique is a simple and safe procedure with reliable results and does not cause anterior scarring or skin necrosis.
Assuntos
Humanos , Cartilagem , Cicatriz , Anormalidades Congênitas , Orelha , Hematoma , Necrose , Recidiva , Pele , SuturasRESUMO
An arterialized venous flap has the advantages of being thin and pliable, utilizing a large-caliber vein with a pedicle of almost any length, as well as obviating the need to sacrifice a donor artery. However, the main disadvantage of this flap is the partial necrosis of the large flap. The aim of this study was to investigate the efficacy of a surgical delay procedure and a combined surgical and chemical delay procedure on the survival of arterialized venous flaps. Ninety New Zealand white rabbits were divided into three groups: control group, a surgical delay group and a combined surgical and chemical delay group. These groups were further divided into subgroups depending on the delay period and the chemical agents. One arterialized venous flap was made from only one ear of each rabbit due to operative mortality, and 10 rabbits were distributed to each subgroup. The arterialized venous flap had an arterial inflow by anastomosis of the central auricular artery to the anterior branch of the central auricular vein and a venous outflow through the anterior marginal vein. The results were as follows ; 1. Control group : The arterialized venous flaps without any delay procedure showed complete necrosis of all flaps. 2. Surgical delay group : The mean percentages of survival areas of arterialized venous flaps were 36.6% in the 4-day delay group, 59.7% in the 7-day delay group. 3. Combined surgical and chemical delay group: a. A 3-day chemical delay in a continuation of a 4-day simultaneous surgical and chemical delay group: The mean percentages of survival areas of the arterialized venous flaps were 81.1% in the doxazosin mesylate group, 72.8% in the nitroglycerine patch group and 92.9% in a combination group of doxazosin mesylate and nitroglycerine patch. b. A 3-day chemical delay in a continuation of a 7-day simultaneous surgical and chemical delay group : The mean percentages of survival areas of the arterialized venous flaps were 94% in the doxazosin mesylate group, 90.2% in the nitroglycerine patch group and 99% in a combination group of doxazosin mesylate and nitroglycerine patch. In conclusion, the surgical delay procedure increases the percentage of survival areas of the arterialized venous flap in proportion to the delay period. The combination group of surgical and chemical delay procedure had a significant increase of the percentage of survival areas than that of the surgical delay group(p < 0.001). The best survival of the flap was obtained from the subgroup which had a 3-day chemical delay in a continuation of a 7-day simultaneous surgical and chemical delay with combined chemical agents.
Assuntos
Humanos , Coelhos , Artérias , Doxazossina , Orelha , Mortalidade , Necrose , Nitroglicerina , Doadores de Tecidos , VeiasRESUMO
An arterialized venous flap has the advantages of being thin and pliable, utilizing a large-caliber vein with a pedicle of almost any length, as well as obviating the need to sacrifice a donor artery. However, the main disadvantage of this flap is the partial necrosis of the large flap. The aim of this study was to investigate the efficacy of a surgical delay procedure and a combined surgical and chemical delay procedure on the survival of arterialized venous flaps. Ninety New Zealand white rabbits were divided into three groups: control group, a surgical delay group and a combined surgical and chemical delay group. These groups were further divided into subgroups depending on the delay period and the chemical agents. One arterialized venous flap was made from only one ear of each rabbit due to operative mortality, and 10 rabbits were distributed to each subgroup. The arterialized venous flap had an arterial inflow by anastomosis of the central auricular artery to the anterior branch of the central auricular vein and a venous outflow through the anterior marginal vein. The results were as follows ; 1. Control group : The arterialized venous flaps without any delay procedure showed complete necrosis of all flaps. 2. Surgical delay group : The mean percentages of survival areas of arterialized venous flaps were 36.6% in the 4-day delay group, 59.7% in the 7-day delay group. 3. Combined surgical and chemical delay group: a. A 3-day chemical delay in a continuation of a 4-day simultaneous surgical and chemical delay group: The mean percentages of survival areas of the arterialized venous flaps were 81.1% in the doxazosin mesylate group, 72.8% in the nitroglycerine patch group and 92.9% in a combination group of doxazosin mesylate and nitroglycerine patch. b. A 3-day chemical delay in a continuation of a 7-day simultaneous surgical and chemical delay group : The mean percentages of survival areas of the arterialized venous flaps were 94% in the doxazosin mesylate group, 90.2% in the nitroglycerine patch group and 99% in a combination group of doxazosin mesylate and nitroglycerine patch. In conclusion, the surgical delay procedure increases the percentage of survival areas of the arterialized venous flap in proportion to the delay period. The combination group of surgical and chemical delay procedure had a significant increase of the percentage of survival areas than that of the surgical delay group(p < 0.001). The best survival of the flap was obtained from the subgroup which had a 3-day chemical delay in a continuation of a 7-day simultaneous surgical and chemical delay with combined chemical agents.
Assuntos
Humanos , Coelhos , Artérias , Doxazossina , Orelha , Mortalidade , Necrose , Nitroglicerina , Doadores de Tecidos , VeiasRESUMO
No abstract available.
Assuntos
Retalhos de Tecido Biológico , Neoplasias de Cabeça e Pescoço , CabeçaRESUMO
No abstract available.
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No abstract available.