ABSTRACT
OBJECTIVE: To describe vulvoperineal reconstruction with a flap of the sulcus gluteus. STUDY DESIGN: Nonrandomized, prospective study in patients with vulvar cancer and vulvar intraepithelial neoplasia. After oncologic surgery, reconstruction with a sulcus gluteus flap was performed. The flap is supplied by the internal pudendal artery, and innervation is provided by the pudendal nerve. The tuber ischiale is the anatomic landmark for locating the pedicle. Follow-up was from 2 months to 2 years. Immediate and long-term complications were assessed. Aesthetic and functional results were analyzed and related to the quality of life and length of hospitalization. RESULTS: Vulvoperineal reconstruction was carried out in 6 patients who had undergone radical surgery. For reconstruction we used the sulcus gluteus flap in 4 unilateral cases and in 2 bilateral cases, for a total of 8 flaps. Cutaneous flaps of the sulcus gluteus provided good functional and aesthetic results. All flaps survived. There was no flap necrosis. The average length of hospitalization was 4 days. Complications were 2 breakdowns of the wound and 1 lymphocele. Postoperative discomfort was minimum. Patients were allowed to walk on day 6 and to sit on day 15. CONCLUSION: The advantages of this reconstruction are that it: is useful in cases of lymphadenectomy, is sensitive and maintains innervation, is distant enough from the receptor area to be used for large vulvar lesions, is able to hide the scar from the donor area in the sulcus gluteus, has a low complication rate, has a short hospitalization time and provides very good compliance with follow-up.
Subject(s)
Carcinoma/surgery , Plastic Surgery Procedures/methods , Surgical Flaps , Vulvar Neoplasms/surgery , Adult , Aged , Buttocks , Carcinoma/pathology , Female , Follow-Up Studies , Graft Rejection , Graft Survival , Gynecologic Surgical Procedures/methods , Humans , Middle Aged , Perineum/surgery , Prospective Studies , Risk Assessment , Sampling Studies , Treatment Outcome , Vulvar Neoplasms/pathologyABSTRACT
El manejo del cáncer ginecológico y en particular el de vulva, se ve caracterizado en los últimos años por un diagnóstico más precoz y en una población más joven. A su vez, el trtamiento quirúrgico ha tendido hacia procedimientos ablativos más seguros y menos radicales, que preservan la función sin sacrificar la curabilidad. Por lo tanto el objetivo del cirujano plástico en la reconstrucción debe ser: 1) Minimizar la deformidad 2) Disminuir las consecuencias psicosexuales del tratamiento 3) Mantener la función sexual 4) Mantener la integridad intestinal y urinaria. Por lo tanto se debe planificar cuidadosamente la reconstrucción(AU)
Subject(s)
Female , Adult , Humans , Carcinoma, Squamous Cell/diagnosis , Carcinoma, Squamous Cell/surgery , Vulvar Neoplasms/diagnosis , Vulvar Neoplasms/surgery , Surgical Flaps , Postoperative CareABSTRACT
El manejo del cáncer ginecológico y en particular el de vulva, se ve caracterizado en los últimos años por un diagnóstico más precoz y en una población más joven. A su vez, el trtamiento quirúrgico ha tendido hacia procedimientos ablativos más seguros y menos radicales, que preservan la función sin sacrificar la curabilidad. Por lo tanto el objetivo del cirujano plástico en la reconstrucción debe ser: 1) Minimizar la deformidad 2) Disminuir las consecuencias psicosexuales del tratamiento 3) Mantener la función sexual 4) Mantener la integridad intestinal y urinaria. Por lo tanto se debe planificar cuidadosamente la reconstrucción
Subject(s)
Female , Adult , Humans , Carcinoma, Squamous Cell/surgery , Carcinoma, Squamous Cell/diagnosis , Vulvar Neoplasms/surgery , Vulvar Neoplasms/diagnosis , Postoperative Care , Surgical FlapsABSTRACT
INTRODUCTION: The process of pancreatic regeneration, well known and accepted, is less known than the hepatic and includes different mechanisms and factors. Pancreatic regeneration is better known in acute pancreatitis. After an extensive pancreatic necrosis, the morphological and functional regeneration is assessed by dynamic computed tomography associated with normalization of glycemia and the exocrine function. Different groups identified and evaluated experimentally and clinically the actions of multiple factors involved in the process of pancreatic regeneration. Even difficult to assess, pancreatic regeneration after partial pancreatectomy is well documented and of capital importance. CASE REPORT: A 57-year-old woman with discomfort in the upper-left abdominal quadrant. CT scans showed a tumor in the body and tail of the pancreas adherent to the spleen. Preoperative CA 19-9 was normal. She was operated on and the tumor resected en bloc with the spleen. Only the head of the pancreas was preserved. Intraoperative pathological examination of the specimen showed a mucinous cistoadenoma with no malignant degeneration. Postoperative course was uneventful and discharged at p.o. day 10, with ongoing diabetes. Four month later she presented pain in the upper-left quadrant with hyperamylasemia. CT scans showed a normal body and tail with an image of pseudocyst at the top of the pancreatic tail. One year after the initial surgery she remained asymptomatic, without diabetes and with no dietary restrictions. Further CT controls showed images of the entire regeneration of the body and tail of the pancreas...(AU)
Subject(s)
Humans , Female , Middle Aged , Regeneration , Pancreas/physiology , Spleen/surgery , Pancreatectomy/methods , Pancreas/surgery , Pancreas/diagnostic imaging , Pancreatic Neoplasms/surgery , Pancreatic Neoplasms/diagnostic imaging , Cystadenocarcinoma, Mucinous/surgery , Cystadenocarcinoma, Mucinous/diagnostic imaging , Tomography, X-Ray Computed/methods , Postoperative PeriodABSTRACT
INTRODUCTION: The process of pancreatic regeneration, well known and accepted, is less known than the hepatic and includes different mechanisms and factors. Pancreatic regeneration is better known in acute pancreatitis. After an extensive pancreatic necrosis, the morphological and functional regeneration is assessed by dynamic computed tomography associated with normalization of glycemia and the exocrine function. Different groups identified and evaluated experimentally and clinically the actions of multiple factors involved in the process of pancreatic regeneration. Even difficult to assess, pancreatic regeneration after partial pancreatectomy is well documented and of capital importance. CASE REPORT: A 57-year-old woman with discomfort in the upper-left abdominal quadrant. CT scans showed a tumor in the body and tail of the pancreas adherent to the spleen. Preoperative CA 19-9 was normal. She was operated on and the tumor resected en bloc with the spleen. Only the head of the pancreas was preserved. Intraoperative pathological examination of the specimen showed a mucinous cistoadenoma with no malignant degeneration. Postoperative course was uneventful and discharged at p.o. day 10, with ongoing diabetes. Four month later she presented pain in the upper-left quadrant with hyperamylasemia. CT scans showed a normal body and tail with an image of pseudocyst at the top of the pancreatic tail. One year after the initial surgery she remained asymptomatic, without diabetes and with no dietary restrictions. Further CT controls showed images of the entire regeneration of the body and tail of the pancreas...
Subject(s)
Humans , Female , Middle Aged , Pancreas/physiology , Pancreatectomy/methods , Regeneration , Spleen/surgery , Cystadenocarcinoma, Mucinous , Cystadenocarcinoma, Mucinous/surgery , Pancreas , Pancreas/surgery , Pancreatic Neoplasms , Pancreatic Neoplasms/surgery , Postoperative Period , Tomography, X-Ray Computed/methodsABSTRACT
Se estudiaron 69 pacientes portadores de litiasis vesicular sintomática a los que se les efectuó una colecistectomía laparoscópica.El estudio prospectivo incluyó un protocolo en donde a los que se sospechó la presencia de litiasis coledociana se les efectuó una colangiografía retrógrada endoscópica.De los 6 enfermos sometidos a la misma tres tenían cálculos en colédoco,habiendo sido tratados por una papilotomía endoscópica y en las 48 hs. siguientes se les realizó colecistectomía laparoscópica.El procedimiento laparoscópico resultó exitoso en todos los pacientes tratados con un 2,8 por ciento de morbilidad y sin mortalidad.Un estudio gasométrico realizado en el intra y postoperatorio inmediato demostró la seguridad del método con respecto a las posibles modificaciones metabólicas o hemodinámicas que pueden derivar de la absorción de CO2 introducido parala producción del neumoperitoneo.De la misma forma estudios funcionales respiratorios demostraron una menor incidencia de alteraciones comparadas con una serie histórica de colecistectomías convencionales.Las ventajas más notables de este procedimiento fueron rehabilitación más rápida, menos dolor en el postoperatorio y,desde el punto de vista costo/beneficio, un ahorro en los días/camas con un promedio de internación cercano a las 24 hs.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Blood Gas Analysis , Gallstones/surgery , Cholecystectomy , Laparoscopy , Cholecystitis/surgery , Intraoperative Complications , General Surgery/education , Cost-Benefit Analysis , Pain, Postoperative , Hospitals, University/standardsABSTRACT
Se estudiaron 69 pacientes portadores de litiasis vesicular sintomática a los que se les efectuó una colecistectomía laparoscópica.El estudio prospectivo incluyó un protocolo en donde a los que se sospechó la presencia de litiasis coledociana se les efectuó una colangiografía retrógrada endoscópica.De los 6 enfermos sometidos a la misma tres tenían cálculos en colédoco,habiendo sido tratados por una papilotomía endoscópica y en las 48 hs. siguientes se les realizó colecistectomía laparoscópica.El procedimiento laparoscópico resultó exitoso en todos los pacientes tratados con un 2,8 por ciento de morbilidad y sin mortalidad.Un estudio gasométrico realizado en el intra y postoperatorio inmediato demostró la seguridad del método con respecto a las posibles modificaciones metabólicas o hemodinámicas que pueden derivar de la absorción de CO2 introducido parala producción del neumoperitoneo.De la misma forma estudios funcionales respiratorios demostraron una menor incidencia de alteraciones comparadas con una serie histórica de colecistectomías convencionales.Las ventajas más notables de este procedimiento fueron rehabilitación más rápida, menos dolor en el postoperatorio y,desde el punto de vista costo/beneficio, un ahorro en los días/camas con un promedio de internación cercano a las 24 hs.
