Comparative Analysis of the Treatment of Skin Lesions of the Lower Limbs with Sural Flap versus Propeller Flap / Análise comparativa do tratamento de lesões cutâneas dos membros inferiores com retalho sural versus retalho propeller

Abstract Objective The objective of the present study was to prospectively compare the sural and propeller flaps for soft-tissues coverage of the lower extremity. The following variables were evaluated: incidence of complete or partial flap loss and donor area morbidity (primary closure versus skin graft). Methods Prospective and randomized analysis of data collected from all patients presenting with soft tissue defects of the lower third of the leg and heel treated with reverse sural or propeller flaps. Results Twenty-four patients aged between 4 and 60 years old were evaluated between 2011 and 2017. Complete coverage was obtained in 22 of the 24 patients (91.6%). Two flaps failed (8.4%). The sural flap, being the most popular option, continues to represent a safe and versatile alternative for skin defects of the lower third of the leg and heel region. Likewise, the propeller flap was a comparable option to treat these challenging defects. Conclusion Sural and propeller flaps are good options for soft tissues coverage of the lower extremity, with low complication rates (partial or total flap loss).

Resumo Objetivo O objetivo do presente estudo foi comparar prospectivamente os retalhos sural e propeller para cobertura de partes moles da extremidade inferior. Foram avaliadas as seguintes variáveis: incidência de perda total ou parcial do retalho e morbidade da área doadora (fechamento primário versus enxerto de pele). Métodos Análise prospectiva e randomizada de dados coletados de todos os pacientes apresentando defeitos em tecidos moles da extremidade distal da perna e do retropé submetidos aos retalhos em questão. Resultados Foram avaliados 24 pacientes com idades entre 4 e 60 anos, entre 2011 e 2017. Cobertura completa foi obtida em 22 dos 24 pacientes (91,6%) e observamos falha em 2 retalhos (8,4%). O retalho sural, sendo a opção mais popular, continua a representar uma alternativa segura e versátil para defeitos cutâneos do terço distal da perna e da região do calcanhar. O retalho propeller, da mesma maneira, mostrou-se uma opção comparável para o tratamento destas lesões desafiadoras. Conclusão Os retalhos sural e propeller são boas opções para a cobertura de partes moles da extremidade inferior, demostrando baixas taxas de complicações como perda parcial ou total do retalho.

Desenlaces a largo plazo en pacientes trasplantados renales con donantes de criterios expandidos: experiencia de 10 años / Long-term outcomes in kidney transplant patients with expanded criteria donors: 10-year experience

Introducción. El trasplante renal es el tratamiento de elección para la enfermedad renal crónica. Debido a la brecha con la disponibilidad de donantes, el uso de criterios expandidos es una opción que busca mejorar la tasa de donación mundial. El objetivo de este estudio fue comparar la sobrevida del injerto y del paciente trasplantado con donante de criterios expandidos versus el donante estándar. Métodos. Cohorte retrospectiva de 1002 pacientes con trasplante renal donde se determinó la sobrevida del injerto renal y del receptor a 10 años después del trasplante. La sobrevida del injerto renal y el receptor fueron estimadas por el método de Kaplan-Meier. Una regresión de Cox fue realizada ajustando el modelo multivariado.Resultados. El análisis incluyó 1002 receptores, con un 18,8 % (n=189) que correspondían al uso de donante de criterios expandidos. El grupo de trasplante renal con donante de criterios expandidos tuvo menor sobrevida del paciente (48,1 % versus 63,8 %) y del injerto (63,3 % versus 74,7 %) en comparación con el grupo de trasplante renal con donantes con criterios estándar a los 10 años después del trasplante. La asociación de trasplante renal con donante de criterios expandidos y muerte o pérdida del injerto renal no fueron significativas cuando se ajustaron las variables en el modelo multivariado. Conclusión. El trasplante renal con donante de criterios expandidos tiene menor sobrevida del receptor y del injerto frente al grupo de trasplante renal con donante estándar. No hubo diferencias estadísticamente significativas en cuanto al trasplante renal con donante de criterios expandidos frente a la pérdida del injerto renal o muerte.

Introduction. Kidney transplantation is the treatment of choice for chronic kidney disease. Due to the gap with donor availability, the use of expanded criteria is an option that seeks to improve the global donation rate. The objective of this study was to compare the survival of the graft and the transplanted patient with an expanded criteria donor versus the standard donor. Methods. Retrospective cohort of 1002 kidney transplant patients where survival of the kidney graft and the recipient was determined at 10 years after transplantation. The survival of the kidney graft and the recipient were estimated by the Kaplan-Meier method. A Cox regression was performed by fitting the multivariate model. Results. The analysis included 1002 recipients with 18.8% (n=189) corresponding to the use of an expanded criteria donor. The expanded criteria donor kidney transplant group had lower patient (48.1% versus 63.8%) and graft (63.3% versus 74.7%) survival compared to the donor kidney transplant group with standard criteria at 10 years post-transplant. The association of kidney transplantation with expanded criteria donor and death or loss of the kidney graft were not significant when the variables were adjusted in the multivariate model. Conclusion. Kidney transplantation with an expanded criteria donor has a lower recipient and graft survival compared to the standard kidney transplant group. There were no statistically significant differences in expanded criteria donor kidney transplantation versus kidney graft loss or death.

Evaluation of bone availability for grafts in different donor sites, through computed tomography

Abstract Objective To quantify the bone volume that can be safely withdrawn from 3 donor sites: (1) the mandibular symphysis, (2) the oblique mandibular line and (3) the skullcap. Methodology For the symphysis, 200 tomographic exams were evaluated by the extension of the anterior loop of mental foramen, by the nerve, by the distance of the foramens, by the distance between the vestibular cortical and the lingual plates and by the distance between the apexes, or lower anterior teeth, and the mandibular base, using the "distance" tool of the I-CAT Vision, in the panoramic and parasagittal reformations. For the oblique line, 70 TCFC exams were analyzed retrospectively in panoramic and parasagittal reformations, evaluating the thickness of the vestibular cortical and the distance between the cortical and the mandibular canal. For the cranial bone, a hexagonal donor site located in parietal area was considered. Results The average dimensions of the bone blocks that can be safely removed from the region of the mandibular symphysis are: 32.27 mm in length, 4.87 mm in height and 4 mm in thickness, providing a volume of 628.61 mm3 available for grafting. In the oblique line, the available bone volume for grafting was 859.61 mm3. In the region of the cranial vault, multiplying the average bone thickness by the area of the hexagon, an average volume of 2,499 mm3 was obtained. Conclusions Comparing the donor sites, the bone availability in the cranial vault is 3 times greater than in the mandibular posterior region, and at least 2 times greater than in the mandibular symphysis.

Feasibility of TRPM8 Agonist Agent for Management of Skin Graft Donor Site

Computed tomography-guided bone block harvesting from the mandibular ramus / Toma de bloque óseo de rama mandibular guiada por tomografía computadorizada

SUMMARY: The aim of this study was to ascertain the distance from the mandibular canal to the lateral, medial and upper zones of the mandibular ramus in order to identify safety margins that reduce the risk of nerve injuries in the process of removing a bone graft. A descriptive study was conducted, analyzing bilaterally 20 CBCT exams from different patients, taking measurements at 4 points in the central, lateral and medial areas of the corresponding mandibular ramus, which was located at a distance of 5 mm between each line, starting at the distal point of the second molar. Forty hemimandibles were included in this study, estimating a vertical distance for the 4 points of analysis, from between 16 and 17 mm, a distance laterally of 5 mm approximately and medially approximately from 3 to 3.9 mm; the lateral zone was significantly larger than the medial zone. It is estimated that the maximum achievement of a bone block from the area posterior to the second molar must be 13 mm deep and 3 mm laterally to minimize the risks of injuries to the inferior alveolar neurovascular bundle.

RESUMEN: El objetivo de esta investigación fue conocer la distancia que existe desde el canal mandibular a la zona lateral, medial y a la zona superior de la rama mandibular a fin de identificar márgenes de seguridad que minimicen el riesgo de lesiones nerviosas en el proceso de retiro de un injerto óseo. Se realizó un estudio descriptivo, analizando bilateralmente 20 exámenes CBCT de pacientes distintos, realizando mediciones en 4 puntos de la zona central, lateral y medial de la rama mandibular correspondiente, los cuales fueron ubicados con distancia de 5 mm entre cada línea, iniciando en el punto distal del segundo molar. Cuarenta hemimandíbulas fueron incluidas en esta investigación, estimando una distancia vertical, para los 4 puntos de análisis, de entre 16 y 17 mm, una distancia hacia lateral de 5 mm aproximadamente y hacia medial aproximadamente de 3 a 3,9 mm; la zona lateral fue significativamente mas grande que la zona medial. Se estima, que la obtención máxima de un bloque óseo desde la zona posterior al segundo molar debe ser con 13 mm de profundidad y 3 mm desde lateral para minimizar los riesgos de lesiones al paquete neurovascular alveolar inferior.

Hair Diameter Variation in Different Vertical Regions of the Occipital Safe Donor Area

BACKGROUND: Little is known concerning hair diameter variation within the safe donor area for hair transplantation surgery. Thicker or thinner hair may be needed, depending on the recipient area, hairline design, and the purpose of surgery. METHODS: Twenty-seven patients (7 men and 20 women; mean age, 28 years; range, 20–47 years) were included in this study. The midoccipital point was used as the reference point on the horizontal plane at the upper border of the helical rim. The target area width was 15 cm (7.5 cm to the right and left of the reference point) and the height was 8 cm (2 cm above and 6 cm below the reference point). The study area was divided horizontally into 3 5-cm sections (A, B, C) and vertically into 4 2-cm sections (1–4), creating a total of 12 zones. Ten anagen hairs were randomly obtained from each zone and their diameters were measured. RESULTS: Hair diameter in the 4 vertical sections varied significantly, gradually decreasing from sections 1 (superior) to 4 (inferior) in all 3 horizontal sections (A, B, and C). CONCLUSIONS: Our results suggest that sections 1 and 2 of the occipital safe donor area would be useful for obtaining thicker hair, such as in procedures to treat male- and female-pattern hair loss, whereas hair from zones 3 and 4 could be useful for transplantation surgery requiring thinner hair, such as eyebrows, eyelashes, and female hairline correction. Our results may be clinically valuable for planning hair transplant surgery and choosing the optimal donor region.

Evaluación de zona dadora en reconstrucción auricular de microtia con técnica suprapericóndrica en la obtención de cartílago costal / Evaluation of donor site in auricular reconstruction of microtia with supraperichondrial costal cartilage harvest technique

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.

Advanced orbicularis oculi muscle flap for eyelid defect / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the application and therapeutic effect of advanced orbicularis oculi muscle (OOM ) flap for eyelid defect.</p><p><b>METHODS</b>Uni-pedicle or bi-pedicle advanced OOM flaps were designed according to the location, depth and size of the eyelid defects. The resulted wounds in the donor sites were closed directly. The flap size ranged from 1.5 cm x 0.5 cm - 6.0 cm x 3.5 cm.</p><p><b>RESULTS</b>120 cases were treated. All the flaps survived except for 3 flaps with epidermis necrosis at the end of flaps, which healed after dressing. The patients were followed up for 3 -36 months with inconspicious scar in donor sites. The flap color, texture had a good match with surrounding skin.</p><p><b>CONCLUSIONS</b>The OOM flap is ideal for eyelid defect with reliable blood supply, satisfied color and texture. The wound at donor site can be closed directly with less morbidity.</p>

Application of trans-areola approach for costicartilage harvesting / 中华整形外科杂志

<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>

Donor-Site Morbidity after Partial Second Toe Pulp Free Flap for Fingertip Reconstruction

BACKGROUND: In this study, we characterize the morbidity at the donor-site of partial second toe pulp free flaps in terms of wound management as well as long-term outcomes. METHODS: A single-institutional retrospective review was performed for patients who had undergone partial second toe pulp free flap transfer to the fingertip. Patient charts were reviewed for infection, skin necrosis, wound dehiscence, and hematoma for the donor site. Additionally, a questionnaire survey was given to patients who had a follow-up of longer than 1 year to characterize long-term postoperative pain and appearance. RESULTS: The review identified a total of 246 cases. Early wound complications were significant for wound dehiscence (n=8) and hematoma (n=5) for a wound complication rate of 5.3%. The questionnaire was distributed to 109 patients, and 54 patients completed the survey. Out of these 54 patients, 15 patients continued to have donor-site pain (28%) at a mean follow-up period of 32.4 months. However, the pain intensity was relatively low in the range between 2 to 5, on a 0-10 scale. None of these patients felt this donor-site pain interfered significantly with daily activity, nor did any patient require pain medications of any type. Donor-site appearance was satisfactory to most patients. CONCLUSIONS: The partial second toe pulp flap was associated with low rates of wound complications and favorable long-term outcomes. Given the functional and aesthetic gain in the recipient finger, donor-site morbidities appear acceptable in this patient population. This study can be helpful in counseling patients regarding donor-site morbidity during the informed consent process.

The anatomy and clinical application of reverse saphenous nerve neurocutaneous flaps for reparing skin defects of forefoot / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the effect of reverse saphenous nerve neurocutaneous flaps for skin defects of forefoot.</p><p><b>METHODS</b>In the anatomic study, 50 cadaveric feet were injected with red latex and the anastomosis, distribution and external diameters of medialtarsal artery, medial anterior malleolus artery, medial plantar artery, the superficial branch of the medial basal hallucal artery and saphenousnerve nutritional vessels were observed. Based on anatomic research results, we designed the reverse saphenous nerve neurocutaneous flaps for repairing skin defects of forefoot.</p><p><b>RESULTS</b>The blood supply of reverse saphenous nerve neurocutaneous flaps were based on the vasoganglion, which consist of arterial arch at the superior border of abductor hallucis and arterial network on the surface of abductor hallucis around the saphenous nerve and medial pedis flap. From Oct. 2006 to Oct. 2011, the reverse saphenous nerve neurocutaneous flaps were used to repair skin defects of forefoot in 11 cases. The flap size ranged from 2.5 cm x 3.5 cm to 7.5 cm x 8.5 cm. The wounds at donor site were covered with full-thickness skin graft. All flaps survived completely with no ulcer at the donor site. 11 cases were followed up for 6 to 18 months( mean, 10 months). The skin color and texture were satisfactory. The patients could walk very well.</p><p><b>CONCLUSIONS</b>It is reliable to repair the skin defects of forefoot with reverse saphenous nerve neurocutaneous flaps. It is easily performed with less morbidity. This flap should be considered as a preferential way to reconstruct skin defects of forefoot.</p>

Reconstruction of the 1/4 defect on upper-lip vermilion with a lower-lip vermilion compound tissue flap / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the reconstruction of 1/4 defect on upper-lip vermilion with a lower-lip vermilion compound tissue flap pedicled at oral commissure.</p><p><b>METHORDS</b>At the first stage, the lower lip mucosal flap pedicled by inferior labial artery was transposed to reconstruct the defect on upper lip vermilion and tubercle. The defect at the donor site was closed directly. At the second stage, the flap pedicle was cut off and revised.</p><p><b>RESULTS</b>6 patients were treated with satisfactory aesthetic results. All the flaps survived completely. The oral commissure kept normal with no obvious scar at the donor sites.</p><p><b>CONCLUSIONS</b>The modified crosslip vermilion flap pedicled at oral commissure has the advantages of avoiding inconvenience in feeding, speaking and cleaning. The procedure is simple with available blood supply. Both aesthetic and functional results are satisfactory.</p>

Reconstruction of soft tissue defects at finger tip with relay flaps pedicled by perforator from digital artery / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the application of relay flaps pedicled by perforator from digital artery for reconstruction of soft tissue defects at finger tip.</p><p><b>METHODS</b>From Mar. 2012 to Jun. 2014, 9 cases with soft tissue defects at finger tip were reconstructed with relay flaps at one side of finger pedicled by perforator from digital artery. The flap size ranged from 1.3 cm x 1.6 cm to 1.6 cm x 2.2 cm. The defects at donor sites were covered by adjacent web perforator V-Y advanced flaps.</p><p><b>RESULTS</b>All the 18 flaps in 9 cases survived completely with primary healing both in recipient and donor sites. The patients were followed up for 5 months to 2 years ( average, 12 months) with good elasticity and cosmetic results. No pain happened in the treated finger. The 2-point discrimination distance was 7-8 mm in fingertip flaps, and 10-12 mm in web perforator flaps. Hand function was graded as excellent in 7 cases, good in 2 cases, based on ATM assessment. The affected fingers had normal temperature and cold-resistance during winter. The width and depth of web in the donor site were not affected.</p><p><b>CONCLUSIONS</b>The relay flaps pedicled by perforator from digital artery can be applied for reconstruction of soft tissue defects at finger tip. The procedure is easy with satisfactory results and reservation of main artery. No skin graft is necessary for closure of defects on donor sites.</p>

A Rabbit Model of Fat Graft Recipient Site Preconditioning Using External Negative Pressure

BACKGROUND: Fat is widely used in soft tissue augmentation. Nevertheless, it has an unpredictably high resorption rate. Clinically, external expansion with negative pressure is used to increase fat graft survival. In this study, fat graft recipient sites were preconditioned by external application of negative pressure in order to test for improvements in vascularity and fat graft survival. METHODS: Negative pressure was applied randomly to either the left or right dorsal ear of 20 New Zealand male white rabbits at a pressure of -125 mm Hg. The negative pressure was removed one week after the skin perfusion was measured. The skin flap at each ear was elevated, and 1 g of fat was grafted above the dorsal perichondrium. After one week, the fat weight, microvessel density, mature vessel density of the skin and fat, and amount of glycerol released were measured. Three months after the grafting, the same measurements were performed, with the exception of glycerol release. RESULTS: The fat survival rate of the experimental group (75.4%+/-3.9%) was higher than that of the control group (53.1%+/-4.3%) (P<0.001). Skin perfusion was higher in the experimental group. The glycerol release in the experimental group was significantly higher than in the control. The microvessel density of the skin and fat was significantly higher in the experimental group. Three months after the grafting, the skin and fat mature vessel density was significantly higher in the experimental groups. CONCLUSIONS: Negative pressure prior to fat grafting increased the vascularity of the recipient site, and, accordingly, enhanced fat graft survival.

Management of the Accidental STSG Donor Site Injury: Case Reports

When the split thickness skin graft (STSG) was harvested from the patient's posterior thigh in supine position, an accidental donor site injury could occur by postural instability with the raised leg of patient. The idea of partial return of the harvested graft to the donor site, spraying fibrin sealant and using skin fragments have been individually introduced as the management of donor site injury created during harvest of the STSG. However, in our knowledge, there has been no attempt to combine the three ideas and apply to the accidental STSG donor site injury. We present the fragments regraft technique, with deliberately leaving some of harvested skin, cutting the remnant skin into small pieces, and immediately returning the skin fragments by spraying fibrin sealant on the damaged donor site wound. This method could be considered as a treatment option to prevent delayed wound healing of STSG donor site injury, especially when elderly or debilitated patients who are suspected of a delayed wound healing and poor-quality skin.

Heterogeneous living donor hepatic fat distribution on MRI chemical shift imaging

PURPOSE: We evaluated the heterogeneity of steatosis in living donor livers to determine its regional differences. METHODS: Between June 2011 and February 2012, 81 liver donors were selected. Fat fraction was estimated using magnetic resonance triple-echo chemical shifting gradient imaging in 13 different regions: segment 1 (S1), S2, S3, and each peripheral and deep region of S4, S5, S6, S7, and S8. RESULTS: There were differences (range, 3.2%-5.3%) in fat fractions between each peripheral and deep region of S4, S6, S7, and S8 (P < 0.001, P = 0.004, P < 0.001, and P = 0.006). Fat deposit amount in S1, S2, S3 and deep regions of S4-S8 were significantly different from one another (F [4.003, 58.032] = 8.684, P < 0.001), while there were no differences among the peripheral regions of S4-S8 (F [2.9, 5.3] = 1.3, P = 0.272) by repeated measure analysis of variance method. And regional differences of the amount of fat deposit in the whole liver increased as a peripheral fat fraction of S5 increased (R2 = 0.428, P < 0.001). CONCLUSION: Multifocal fat measurements for the whole liver are needed because a small regional evaluation might not represent the remaining liver completely, especially in patients with severe hepatic steatosis.

Fournier?s gangrene - delayed pedicle flap based upon the anterior abdominal wall

Introduction Fournier’s gangrene is a poly-microbial necrotizing fasciitis that involves the perineum and/or external genitalia. Urgent surgical debridement is well recognized as essential acute treatment yet unique challenges arise for plastic surgical reconstruction to obtain a complete functional recovery. This case describes a successful delayed pedicle flap repair based upon the anterior abdominal wall. Case description A 24 year old man was admitted to ICU ten days after elective circumcision with Fournier’s gangrene. He underwent a number of surgical debridements, and was referred for plastic surgical management. He had penile reconstruction using a random pattern abdominal flap, which was performed as a three stage procedure including flap vascular delay technique. Discussion Perineal and penile skin loss can be significant and is difficult to repair. Various techniques have been used to reconstruct lost tissue: skin grafts, transposition of the testes and spermatic cords to the thigh, flaps, and other types of pediculated myocutaneous flaps. Muscle flap reconstruction provides an environment that allows for complete regeneration of the urethral epithelium but is bulky and unsightly. Skin grafts contract and may produce painful and dysfunctional reconstructions. This novel technique produces a functional, and aesthetic reconstruction. Conclusion Penile skin recovery following Fournier’s gangrene recovery is problematic. This case demonstrates the functionality of a delayed flap repair using the anterior abdominal wall. .

Surgical techniques for maxillary bone grafting - literature review / Técnicas cirúrgicas para a enxertia óssea dos maxilares - revisão da literatura

For oral rehabilitation with implant-supported prostheses, there are required procedures to create the bone volume needed for installation of the implants. Thus, bone grafts from intraoral or extraoral donor sites represent a very favorable opportunity. This study aimed to review the literature on the subject, seeking to discuss parameters for the indications, advantages and complications of techniques for autogenous bone grafts.

Para a reabilitação bucal com as próteses implantossuportadas é necessário a realização de procedimentos para criar o volume ósseo necessário para a instalação dos implantes. Com isso, os enxertos ósseos provenientes de áreas doadoras intrabucais ou extrabucais, representam uma possibilidade bastante favorável. O presente trabalho objetivou realizar uma revisão da literatura em que procurou discutir parâmetros para as indicações, as vantagens e complicações para as técnicas dos enxertos ósseos autógenos.

Existen diferencias en la sobrevida de pacientes e injertos renales con 3 años de funcionamiento, según si su proveniencia fue de donantes vivos o fallecidos / Are there differences in the survival of patients with kidney graft functioning during 3 years, as if the donor was dead or alive?

Antecedentes: El trasplante renal (TxR) es el tratamiento de elección para la mayoría de los pacientes con insuficiencia renal crónica etapa 5. Clásicamente se ha comunicado que los TxR con donante fallecido presentan una menor sobrevida que los TxR con donante vivo. Objetivos: Determinar si existen diferencias significativas en la superviviencia de pacientes e injertos en trasplantados renales que han alcanzado los 3 años con un injerto funcionante, según si el donante fue un sujeto vivo o fallecido. Conocer si las causas de pérdida del injerto y las complicaciones presentadas durante la evolución del trasplante fueron diferentes entre ellos. Sujetos y Métodos: Se incluyeron 188 pacientes trasplantados en 3 hospitales entre 1976-2001 y que tenían un injerto funcionante al tercer año de la intervención. De ellos, 96 recibieron injerto de donante vivo y 92 de uno fallecido. Resultados: La supervivencia de injertos y pacientes fue similar en ambos grupos. La frecuencia de rechazo crónico como pérdida del injerto fue mayor en sujetos con donante vivo. Los pacientes con donante cadáver se hospitalizaron más frecuentemente por infecciones durante los primeros 3 años y presentaron más frecuentemente una función renal retardada. Conclusiones: No existieron diferencias significativas en la supervivencia de los pacientes o injertos según el tipo de donante en los trasplantados que alcanzaron lo 3 años con un injerto funcionante. Las causas de pérdida de los injertos y las complicaciones durante la evolución fueron similares, con excepción de una incidencia mayor de requirimiento de diálisis post-operatoria y de hospitalizaciones por infecciones en los que recibieron un injerto de un donante fallecido.

Background: Renal transplantation is the treatment of choice for most patients with chronic kidney disease stage 5. Traditionally, it has been reported that kidney transplants in patients with a deceased donor have a lower survival than the ones with a living donor. Aim: To determine whether there are significant differences in patients and grafts survival in kidney transplant recipients who have reached 3 years with a functioning graft, depending on whether the donor was a living or deceased individual. Also, to determine if the causes of graft loss and complications presented during the follow up were different between them. Subjects and Methods: 188 patients transplanted in 3 hospitals (1976 to 2001) and who had a functioning graft in the third year of the intervention. Of these, 96 received grafts from living donors and 92 from deceased donors. Results: Graft and patient survival was similar in both groups. The frequency of graft loss due to chronic rejection was higher in patients with living donors. Patients with deceased donors were hospitalized more frequently for infections during the first three years and more frequently had delayed renal function. Conclusions: No significant differences in the survival of patients or grafts that reached 3 years functioning normally were founded instead the type of donor. The complications during the follow up were similar between both groups, except for a higher incidence of dialysis requirement in the postoperative period and hospitalizations due to infections in patients receiving grafts from deceased donors.

Application of three-diinensional CT in the treatment of oblique facial clefts with mandibular outer cortex / 中华整形外科杂志

<p><b>OBJECTIVE</b>To investigate the application of three-dimensional CT(3D-CT) in the treatment of oblique facial clefts with mandibular outer cortex, including the surgical design and results assessment.</p><p><b>METHODS</b>From Jan. 2003 to Dec. 2013, 22 cases with oblique facial cleft, who underwent mandibular outer cortex onlay bone graft were retrospectively studied. 3D images from CT data were reconstructed before operation for design. Then the mandibular outer cortex onlay bone transplant was performed to reconstruct the bone defect and cleft. 3D CT was performed 5-10 days postoperatively and 6- 12 months postoperatively to assess the facial symmetry.</p><p><b>RESULTS</b>According to the results of CT measurement, the average volume of the orbital bone defects on the affected side decreased by(64. 6 ± 14. 4)% 5 to 10 days after operation. The average volume of the maxillary and zygomatic bone defects on the affected side decreased by(71.4 ± 15.7)% after surgery. After 6 to 12 months,the average recovery of the mandibular donor site was (57. 9 ± 13. 9)% of the removed mandibular outer cortex. The average absorption of grafted bones was(24.7 ± 25.6 )%. The average height difference between the centre of pupils on both sides before surgery was(3.76 ± 1.27) mm,which decreased to( 1. 15 ± 1.00) mm 5 to 10 days after surgery(P =0. 000) , and( 1.35 ± 1. 13) mm 6 to 12 months after surgery(P = 0. 003). The relapse may be caused by the absorption of the grafted bones.</p><p><b>CONCLUSIONS</b>3D-CT can be used for preoperative design and postoperative assessment in the treatment of oblique facial cleft with mandibular outer cortex.</p>