ABSTRACT
La reconstrucción de la pared torácica exige un amplio conocimiento de las técnicas reconstructivas y un buen plan operatorio. Por una parte es necesario mantener la estabilidad de la caja torácica y por otro proporcionar una buena base para la cobertura dérmica omusculocutánea que confiera buenos resultados funcionales y plásticos. En este trabajo describimos 2 casos clínicos en los que la reconstrucción de la pared torácica anterior se realizó con placas de ácido poli-L-láctico sobre las que se colocaron sendos colgajos musculocutáneos (AU)
Chest wall reconstruction requires an extensive knowledge of reconstructive techniques and a good surgical plan. On one hand, it is necessary to maintain stability of the rib cage and, on the other, provide a good foundation for dermal coverage or musculocutaneous flaps which confers good functional and plastic results. In this article we describe 2 cases in which anterior chest wall reconstruction was performed with plates of poly-L-lactic acid, on which were placed the musculocutaneous flaps (AU)
Subject(s)
Humans , Female , Aged , Thoracic Injuries/complications , Thoracoplasty/methods , Thoracic Wall/surgery , Surgical Mesh , Polyglactin 910/therapeutic use , Plastic Surgery Procedures/methodsABSTRACT
Analizamos la evolución en el diseño, la tasa de complicaciones y el grado de satisfacción tras la realización de 222 colgajos toracoepigástricos en 215pacientes para reconstrucción mamaria diferida e inmediata. El seguimiento medio fue de 112 meses. El 45% de las reconstrucciones mamarias de nuestra Unidad se han realizado con este tipo de colgajo. Del diseño original se ha ido evolucionando al propuesto por Holmström con algunas modificaciones. En 166casos se asociaron en el mismo acto quirúrgico diferentes procedimientos encaminados a obtener la simetría mamaria. No hubo mortalidad operatoria y aunque la tasa de morbilidad fue del 66/222 (30%) la mayoría de las complicaciones no precisaron tratamiento específico. El grado de satisfacción de las pacientes con el procedimiento fue muy alto. Concluimos que el colgajo toracoepigástrico es una técnica simple, que cumple todos los objetivos de una reconstrucción mamaria y puede ser utilizado en un número sustancial de casos, con una morbilidad aceptable y resultados muy bien valorados por las pacientes (AU)
We analyse the evolution in the design, the rate of complications and the degree of satisfaction after the accomplishment of 222 lateral thoracodorsal flaps in215 patients for delayed and immediate mammary reconstruction. The average follow-up was of 112months. Forty-five percent of the mammary reconstruction scarried out in our Unit have been made with this type of flap. The original design has been evolved to the proposed one by Holmström with some modifications. In 166 cases it was associated with other procedures to obtain mammary symmetry. There was no operative mortality and although the rate of morbidity was of 66/222 (30%), most of complications did not need specific treatment. Patients satisfaction with the procedure was very high. We conclude that lateral thoracodorsal flap is a simple technique that fulfills all the objectives for mammary reconstruction, it can be used in a substantial number of cases, with an acceptable morbidity and high patients´ satisfaction (AU)
Subject(s)
Humans , Female , Adult , Middle Aged , Surgical Flaps , Mammaplasty/methods , Mammaplasty/trends , Breast/pathology , Breast/surgery , Breast Neoplasms/epidemiology , Breast Neoplasms/surgery , Surgical Flaps/pathology , Surgical Flaps/trends , Mammaplasty/instrumentation , Mammaplasty , Mammary Arteries/surgerySubject(s)
Congenital Abnormalities/genetics , Scalp/abnormalities , Adult , Alopecia/pathology , Congenital Abnormalities/pathology , Family , Female , HumansABSTRACT
The relationship between wound healing and skin prolylhydroxylase activity was examined in 212 patients undergoing reconstructive procedures and 109 controls using skin prolylhydroxylase activity as an index of collagen synthesis. In the control group, the median value of skin prolylhydroxylase activity was 360 cpm/mg protein. There was a higher skin prolylhydroxylase activity in 274 patients with successful healing (368 cpm/mg protein) than there was in 33 patients who required local wound care (202 cpm/mg protein) and 14 patients with severe local complications (71 cpm/mg protein, p = 0.02). Skin prolylhydroxylase activity was also significantly lower (p = 0.002) in patients with laboratory criteria for malnutrition (albumin < 3.5 g/dl, 108 cpm/mg protein; total lymphocyte count < 1,500 mm3, 211 cpm/mg protein, and albumin < 3.5 g/dl + lymphocyte count < 1,500 mm3, 52 cpm/mg protein), but age, diabetes mellitus, malignancy and wound infection did not affect skin prolylhydroxylase activity. These results suggest that skin prolylhydroxylase activity is reduced in patients with malnutrition and delayed wound healing.
