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1.
Ann Oncol ; 35(2): 221-228, 2024 Feb.
Article in English | MEDLINE | ID: mdl-38072158

ABSTRACT

BACKGROUND: Metastatic basal cell carcinoma (mBCC) is a rare condition with no effective second-line treatment options. Cemiplimab is an immune checkpoint inhibitor that blocks the binding of programmed cell death-1 (PD-1) to its ligands, programmed death-ligand 1 (PD-L1) and programmed death-ligand 2 (PD-L2). Here, we present the final analysis of cemiplimab in patients with mBCC after first-line hedgehog pathway inhibitor (HHI) treatment (NCT03132636). PATIENTS AND METHODS: In this open-label, single-arm, phase II study, adults with mBCC and Eastern Cooperative Oncology Group performance status ≤1, post-HHI treatment, received cemiplimab 350 mg intravenously every 3 weeks for ≤93 weeks or until disease progression or unacceptable toxicity. The primary endpoint was objective response rate (ORR) by independent central review (ICR). Duration of response (DOR) was a key secondary endpoint. Other secondary endpoints were ORR per investigator assessment, progression-free survival (PFS), overall survival (OS), complete response rate, safety, and tolerability. RESULTS: Fifty-four patients were enrolled: 70% were male and the median age of patients was 64 [interquartile range (IQR) 57.0-73.0] years. The median duration of follow-up was 8 months (IQR 4-21 months). The ORR per ICR was 22% [95% confidence interval (CI) 12% to 36%], with 2 complete responses and 10 partial responses. Among responders, the median time to response per ICR was 3 months (IQR 2-7 months). The estimated median DOR per ICR was not reached [95% CI 10 months-not evaluable (NE)]. The disease control rate was 63% (95% CI 49% to 76%) per ICR and 70% (95% CI 56% to 82%) per investigator assessment. The median PFS per ICR was 10 months (95% CI 4-16 months); the median OS was 50 months (95% CI 28 months-NE). The most common treatment-emergent adverse events were fatigue [23 (43%)] and diarrhoea [20 (37%)]. There were no treatment-related deaths. CONCLUSIONS: Cemiplimab demonstrated clinically meaningful antitumour activity, including durable responses, and an acceptable safety profile in patients with mBCC who had disease progression on or intolerance to HHI therapy.


Subject(s)
Antibodies, Monoclonal, Humanized , Antineoplastic Agents , Carcinoma, Basal Cell , Skin Neoplasms , Adult , Humans , Male , Middle Aged , Aged , Female , Hedgehog Proteins , Ligands , Antineoplastic Agents/therapeutic use , Carcinoma, Basal Cell/drug therapy , Carcinoma, Basal Cell/chemically induced , Disease Progression , Amides/therapeutic use , Skin Neoplasms/drug therapy , Skin Neoplasms/pathology
2.
Oncogene ; 33(22): 2898-908, 2014 May 29.
Article in English | MEDLINE | ID: mdl-23873025

ABSTRACT

Melanoma cells facilitate endothelial gap formation, the first step during tumor transendothelial migration, which is mediated by both adhesion and endogenously produced chemokines (in particular, interleukin-8 (IL-8)). Tetraspanins are localized to the cell surface in cancer and participate in various functions including invasion of tissues mediated by secretion of cytokines and matrix metalloproteinases. However, little is known about the role of CD82 tetraspanins in malignant melanomas during cancer cell invasion. In this study, we investigated the functional importance of CD82 expression in melanoma-mediated gap formation by using cDNAs to induce CD82 expression in highly invasive melanoma cell lines. Results showed that CD82 expression inhibited melanoma cell-induced gap formation, melanoma cell extravasation in vitro and subsequent lung metastasis development in vivo. Mechanistic studies showed that inducible expression of CD82 in highly metastatic melanoma cells significantly increased p21 expression upon binding of Duffy antigen receptor group (DARC), inducing tumor cell senescence and interrupting IL-8-mediated vascular endothelial (VE)-cadherin disassembly. Taken together, these studies provide a rationale for using drug therapies that restore CD82 expression and inhibit IL-8 production to inhibit late-stage melanoma cell extravasation and subsequent metastasis development.


Subject(s)
Endothelial Cells/metabolism , Interleukin-8/metabolism , Kangai-1 Protein/genetics , Melanoma/genetics , Melanoma/metabolism , Adult , Aged , Animals , Duffy Blood-Group System/metabolism , Female , Gene Expression , Human Umbilical Vein Endothelial Cells/metabolism , Humans , Lung Neoplasms/genetics , Lung Neoplasms/secondary , Male , Melanoma/pathology , Mice , Middle Aged , Neoplasm Invasiveness , Neoplasm Metastasis , Neoplasm Staging , Protein Binding , Receptors, Cell Surface/metabolism
3.
Drug Res (Stuttg) ; 63(9): 477-83, 2013 Sep.
Article in English | MEDLINE | ID: mdl-23780502

ABSTRACT

In order to assess the bioequivalence of 2 different formulations of montelukast, a pivotal trial for the montelukast 10 mg film-coated tablets formulation and a pivotal trial for the montelukast 5 mg chewable tablets formulation were conducted.For the 10 mg study, 34 healthy subjects were enrolled in a single centre, randomised, single-dose, open-label, 2-way crossover study, with a minimum washout period of 7 days, while for the 5 mg study, 42 healthy subjects were included in another study with a similar design. For both studies, plasma samples were collected up to 24 h post-dosing and drug levels were determined by reverse liquid chromatography and detected by tandem mass spectrometry detection.Pharmacokinetic parameters used for bioequivalence assessment, area under the concentration-time curve from time zero to time of last non-zero concentration (AUC0-t) and from time zero to infinity (AUC0-inf) and maximum observed concentration (Cmax), were determined from the drug concentration data using non-compartmental analysis.In the 10 mg study, the 90% confidence intervals obtained by analysis of variance were 99.62-120.51% for Cmax, 102.25-117.37% for AUC0-t and 101.96-116.67% for AUC0-inf, which were within the predefined acceptable range of 80.00-125.00%.In the 5 mg study, the 90% confidence intervals were 91.14-98.46% for Cmax, 93.02-98.42% for AUC0-t and 93.09-98.63% for AUC0-inf, which were within the predefined acceptable range of 80.00-125.00%.Bioequivalence between formulations was concluded both in terms of rate and extent of absorption for both strengths.


Subject(s)
Acetates/pharmacokinetics , Leukotriene Antagonists/pharmacokinetics , Quinolines/pharmacokinetics , Acetates/administration & dosage , Acetates/adverse effects , Adult , Cross-Over Studies , Cyclopropanes , Female , Humans , Male , Middle Aged , Quinolines/administration & dosage , Quinolines/adverse effects , Sulfides , Tablets , Therapeutic Equivalency
4.
Arzneimittelforschung ; 62(7): 307-12, 2012 Jul.
Article in English | MEDLINE | ID: mdl-22628062

ABSTRACT

Escitalopram, CAS registry number 128196-01-0 is an orally administrated selective serotonin reuptake inhibitor (SSRI).The objective of this trial was to assess bioequivalence between an escitalopram formulation manufactured by Grupo Tecnimede and that of a European reference formulation, while evaluating both formulations' tolerability as a secondary objective.24 healthy subjects were enrolled in a single centre, randomised, single-dose, open-label, 2-way crossover study. Drug levels were determined by reverse liquid chromatography and detected by tandem mass spectrometry detection, LC-MS/MS method. Pharmacokinetic parameters used for bioequivalence assessment were determined from the drug concentration data using non-compartmental analysis.Mean±Standard deviation (SD) Cmax values were 18.89±5.06 ng/mL and 18.45±5.05 ng/mL for reference and test, respectively. AUClast was 577.16±196.20 ng · h/mL after the administration of the reference and 577.69±220.88 ng · h/mL for the test. AUCinf was 595.66±203.80 ng · h/mL after the administration of the reference 596.19±235.47 ng · h/mL for the test.The 90% confidence intervals obtained by analysis of variance were 92.38-103.38% for Cmax, 94.10-104.37% for AUClast and 93.80-104.09% for AUCinf, which were within the predefined acceptable range of 80.00-125.00%. Both formulations were well tolerated, with no major side effects and no relevant differences in safety profiles observed between the preparations.The design of the study was adequate to determine the pharmacokinetic parameters of the test and the reference formulations. Bioequivalence between formulations was concluded both in terms of rate and extent of absorption.


Subject(s)
Citalopram/pharmacokinetics , Selective Serotonin Reuptake Inhibitors/pharmacokinetics , Administration, Oral , Adult , Area Under Curve , Chemistry, Pharmaceutical , Citalopram/administration & dosage , Cross-Over Studies , Female , Humans , Male , Middle Aged , Selective Serotonin Reuptake Inhibitors/administration & dosage , Therapeutic Equivalency , Young Adult
5.
Eur J Surg Oncol ; 35(6): 568-72, 2009 Jun.
Article in English | MEDLINE | ID: mdl-19013049

ABSTRACT

INTRODUCTION: Merkel cell carcinoma (MCC) is a very rare and aggressive neoplasm. Due to its rarity, therapeutic guidelines are not well established, especially for regionally advanced disease. Hyperthermic isolated limb perfusion (HILP) with Melphalan and either with or without tumor necrosis factor-alpha (TNF-alpha) is becoming more common in clinical practice, yet the long-term response is not clear. Previous reports have established indications for treatment of unresectable MCC as well as the outcome of MCC patients receiving perfusion treatment in combination with other therapies (e.g., radiation). METHOD: A review was performed of the most important articles in MEDLINE from the last 20 years related to HILP and MCC. It was possible to collect all cases of HILP from the literature. Details of one case of MCC where HILP was administered was included in the literature review. RESULTS: A total of nine cases of MCC receiving ILP were identified in the literature; of these, seven achieved a complete response, one a partial response and one no response. All five patients treated without TNF-alpha had a complete response. Of the four patients treated with TNF-alpha, two had complete, one partial and one no response. CONCLUSION: Based on the cases described, isolated limb perfusion is an acceptable option to treat regional advanced cases of MCC, and the use of TNF-alpha does not impact the overall response.


Subject(s)
Antineoplastic Agents/administration & dosage , Carcinoma, Merkel Cell/drug therapy , Melphalan/administration & dosage , Skin Neoplasms/drug therapy , Aged, 80 and over , Chemotherapy, Cancer, Regional Perfusion , Extremities , Fatal Outcome , Female , Groin , Humans , Hyperthermia, Induced , Lymph Node Excision , Lymphatic Metastasis , Tumor Necrosis Factor-alpha/administration & dosage
6.
Int J Clin Pharmacol Ther ; 46(11): 591-6, 2008 Nov.
Article in English | MEDLINE | ID: mdl-19000558

ABSTRACT

This study was conducted in order to compare the bioavailability of two tablet formulations containing 1,000 mg levetiracetam, (S)-a-ethyl-2-oxo-1-pyrrolidine acetamide, 102767-28-2 CAS registry number. 18 healthy subjects were enrolled in a single-center, randomized, single-dose, open-label, 2-way crossover study, with a minimum washout period of 7 days. Plasma samples were collected up to 36.0 hours post-dosing. Levetiracetam levels were determined by reverse liquid chromatography and detected by tandem mass spectrometry detection, LC-MS/MS method. Pharmacokinetic parameters used for bioequivalence assessment, area under the concentration-time curve from time 0 to time of last non-zero concentration (AUClast) and from time zero to infinitive (AUCinf) and maximum observed concentration (Cmax), were determined from the levetiracetam concentration data using non-compartmental analysis. The 90% confidence intervals obtained by analysis of variance were 88.98 - 108.75% for Cmax, 99.90 - 104.81% for AUClast and 100.11 - 105.23 %for AUCinf this is, within the predefined ranges. Bioequivalence between formulations was concluded both in terms of rate and extent of absorption.


Subject(s)
Anticonvulsants/pharmacokinetics , Piracetam/analogs & derivatives , Administration, Oral , Adult , Analysis of Variance , Anticonvulsants/blood , Area Under Curve , Chemistry, Pharmaceutical , Cross-Over Studies , Fasting , Female , Half-Life , Humans , Levetiracetam , Male , Middle Aged , Piracetam/blood , Piracetam/pharmacokinetics , Therapeutic Equivalency
7.
Aesthetic Plast Surg ; 25(2): 134-9, 2001.
Article in English | MEDLINE | ID: mdl-11349304

ABSTRACT

Retinoic acid (RA) and glycolic acid (GA) are frequently used in the treatment of acne and skin aging, as well as improving skin healing after dermabrasion and in photoaged skin. Examples of histologic alterations caused by these substances are vascularization increase and interference with inflammatory as well as regenerative skin processes. The objective of this study was to evaluate the possible decrease of skin flap necrosis areas in rats, by applying both substances to the skin 14 and 30 days before surgery, and analyzing histopathologic skin alterations after treatment. Fifty Wistar rats were divided into five groups of 10 animals each. They received daily retinoic acid application for 14 and 30 days, daily glycolic acid application for 14 and 30 days, and vehicle application (control group) for 14 days. After treatment, each rat was submitted to random dorsal skin flap (10 x 3 cm) elevation; flaps were sutured back in place over isolating plastic strips. The rats were sacrificed after 7 days and flap necrosis areas were measured through transparency and then analyzed using computer scanning. Statistical analysis was carried out using monocaudal nonpaired t tests and histopathologic examination was performed in all cases. Compared with the control group, treatment with both acids did not decrease average flap necrosis areas. Though groups RA 30 days and GA 14 days presented larger necrosis area averages (p < 0.05), groups RA 14 days and GA 30 days showed no statistically significant difference (p > 0.05) when compared to the control group. Both substances caused spongiosis, stratum corneum thickening, and vascularization increase, with GA inducing greater granulomatous reaction and RA more spongiosis and queratinization. Group RA 30 days showed the most significant dermo-epithelial (including vascular) regenerative and proliferative effects. Retinoic and glycolic acid treatment led to significant and well-known skin alterations, with group RA 30 days showing most notable dermo-epithelial proliferative effects. In our experimental model, preoperatory RA and GA application did not decrease rat dorsal skin flap necrosis area when compared to the control group.


Subject(s)
Glycolates/pharmacology , Glycolates/therapeutic use , Keratolytic Agents/pharmacology , Keratolytic Agents/therapeutic use , Skin/drug effects , Skin/pathology , Tretinoin/pharmacology , Tretinoin/therapeutic use , Animals , Glycolates/administration & dosage , Keratolytic Agents/administration & dosage , Male , Necrosis , Rats , Rats, Wistar , Surgical Flaps , Tretinoin/administration & dosage
8.
Plast Reconstr Surg ; 105(7): 2452-4, 2000 Jun.
Article in English | MEDLINE | ID: mdl-10845301

ABSTRACT

We report the case of a 47-year-old woman with a large keloid scar on the sternum who was submitted to a simultaneous scar removal with bilateral breast-reduction mammaplasty. Breast reduction was performed to reduce local skin tension and to provide a skin flap for the full reconstruction of the scar-removal site. The association of these surgical procedures stands as a viable alternative for the reconstruction of the sternum region, producing less keloid scarring.


Subject(s)
Breast/pathology , Keloid/surgery , Mammaplasty/methods , Sternum , Surgical Flaps , Breast/surgery , Female , Humans , Keloid/etiology , Middle Aged
9.
Ann Plast Surg ; 44(4): 367-73; discussion 373-4, 2000 Apr.
Article in English | MEDLINE | ID: mdl-10783091

ABSTRACT

Cutaneous injuries of the inferior third of the leg and dorsum of the foot represent a great challenge for plastic surgeons. The poor vascularization and subsequent poor healing encountered in these regions demand detailed knowledge of the local anatomy to select the best surgical alternative for each patient. In patients in whom local or free muscular flaps are not suitable, the fasciocutaneous flaps seem to be a good alternative. The distal pedicled fasciocutaneous flap of the calf was used to cover skin defects of the leg and foot in 22 patients. In 4 patients the authors designed an island flap to prevent a large defect in the donor area and to decrease the time of hospitalization and recovery of the patient. In a severe defect, the flap was used as a cross-leg flap. The results were satisfactory because the flap provided stable coverage for different defects with few complications. The island flap is a good option for achieving a better aesthetic result and can be used in select patients.


Subject(s)
Foot Injuries/surgery , Leg Injuries/surgery , Surgical Flaps , Humans , Surgical Flaps/blood supply
10.
Ann Plast Surg ; 39(5): 461-8, 1997 Nov.
Article in English | MEDLINE | ID: mdl-9374141

ABSTRACT

In patients who undergo oral cavity reconstruction, loss of sensation plays a vital role in producing disturbances in postoperative oral function. Microsurgical techniques have provided a method of addressing this deficit through the use of sensate cutaneous free flaps in which microneural anastomoses are performed between a sensory nerve supplying the flap, and a recipient nerve in the head and neck. The purpose of this study was to compare the cutaneous sensation of the radial forearm flap and lateral arm flap donor sites, the two most commonly used intraoral sensate flaps. For comparison, sensation was also determined in five intraoral sites: the tip of tongue, lateral tongue, cheek, gingiva, and hard palate. Sensation was evaluated at the two potential donor sites in 66 random subjects using static and moving two-point discrimination, thermal sensation differences, and Semmes-Weinstein monofilament pressures. In the same subjects Semmes-Weinstein monofilament pressures were used to evaluate intraoral sensation. Information was recorded on age, sex, smoking and denture status. All four sensory evaluations demonstrated that the lateral arm flap donor site was more sensitive than the radial forearm donor site. Thermal sensitivity differentials (0.52 vs. 0.40 degrees C, p < 0.001), static two-point discrimination (15.4 vs. 15.0 mm, p < 0.2), moving two-point discrimination (5.8 vs. 4.8 mm, p < 0.03), and Semmes-Weinstein monofilament pressures (5.10 vs. 4.08 g per square millimeter, p < 0.001) all indicated a more sensitive lateral arm flap donor site. Older subjects had significantly decreased sensation at both donor sites based on static two-point discrimination and Semmes-Weinstein monofilament testing. No sex differences were noted. Based on Semmes-Weinstein monofilament testing in the mouth, the tip of the tongue is the most sensitive area (2.26 g per square millimeter), followed by the hard palate (3.60 g per square millimeter), the lateral tongue (4.08 g per square millimeter), the cheek (4.77 g per square millimeter), and the gingiva (8.06 g per square millimeter). Smokers had significantly decreased sensation at the tip of tongue and hard palate. Denture wearers had significantly diminished sensation in all intraoral locations except the lateral tongue. Older patients had significantly diminished sensation at all intraoral sites. No sex differences were noted. The lateral arm flap donor site is a more sensitive region than the radial forearm flap donor site. However, the lateral arm flap donor site is less sensitive than the tip of tongue and hard palate, while the radial forearm flap donor site is less sensitive than the tip of tongue, hard palate, lateral tongue, and cheek. This suggests that for certain locations, intraoral sensate flaps may require measures such as sensory reeducation protocols to approach normal recipient site sensation.


Subject(s)
Mouth/surgery , Sensation , Surgical Flaps , Adult , Aged , Aged, 80 and over , Arm , Female , Humans , Male , Middle Aged , Mouth/innervation , Smoking
11.
Plast Reconstr Surg ; 97(4): 807-11; discussion 812-4, 1996 Apr.
Article in English | MEDLINE | ID: mdl-8628776

ABSTRACT

The efficacy of presuturing was tested by quantitating the tissue gains for standardized wounds in a white swine piglet (9 to 11-kg) model. Also measured were the changes in wound closure tension for the wounds. Measurements were carried out at 1, 4, 17, 24, 48, and 72 hours in a total of 20 piglets. Presuturing was carried out on one of the flanks and the opposite flank served as the control. Presuturing achieved a modest tissue gain, amounting to 67 mm at 4 hours and a maximum of 1.4 cm at 48 and 72 hours, for a 4-cm defect. The encouraging tissue gain was unfortunately not paralleled by a decrease in the tension required to approximate the wound edges. At 4 hours, the tension to close the wound was 1.2 N (only 120 g) less than the control wound. This initial small reduction in wound-closing tension was diminished thereafter, and at 72 hours the wounds were stiffer and harder to close than the control. This appeared to be due to tissue edema and was confirmed by an increase in measurable tissue water with increasing time. In this model, presuturing produces a minimal tissue advancement and even less reduction in wound-closing tension. It is concluded, from this work and from previously published work, that undermining will prove generally to be a more useful technique in closing broad defects.


Subject(s)
Suture Techniques , Tissue Expansion/methods , Wounds and Injuries/surgery , Animals , Evaluation Studies as Topic , Skin Physiological Phenomena , Stress, Mechanical , Swine
13.
Ann Plast Surg ; 33(1): 9-16, 1994 Jul.
Article in English | MEDLINE | ID: mdl-7944207

ABSTRACT

The current treatment of extremity sarcomas is multimodal, consisting of limb-sparing surgery, adjuvant radiotherapy, and/or chemotherapy. This approach has decreased the need for amputations and increased the demand for coverage of large composite defects. To date, the role of microsurgery in lower extremity reconstruction after oncologic resection has not been well defined. This study reviews a single center's experience with free tissue transfer for reconstruction of the lower extremity after oncologic resection. Fifty-nine free flaps were performed in 57 patients over a 5-year period. Forty-six patients (78%) underwent primary reconstruction and 35 patients (61%) received adjuvant therapy. Overall flap success rate was 96.6%. Most flaps were soft-tissue types including musculocutaneous (78%), skin only (11%), and muscle plus skin graft (4%). Osteocutaneous flaps were uncommon. There were major complications in 12% and minor complications in 7%. This study demonstrates that free tissue transfer for lower extremity reconstruction following oncologic resection has a high success rate that is similar to other free flap applications. It has become an integral part of lower extremity sarcoma management. Free flaps permit uninterrupted adjuvant therapy and enhance the efficacy of limb salvage surgery.


Subject(s)
Bone Neoplasms/surgery , Leg/surgery , Osteosarcoma/surgery , Sarcoma/surgery , Surgical Flaps , Adult , Bone Neoplasms/epidemiology , Bone Neoplasms/therapy , Combined Modality Therapy , Female , Humans , Male , Osteosarcoma/epidemiology , Osteosarcoma/therapy , Postoperative Complications/epidemiology , Sarcoma/epidemiology , Sarcoma/therapy
15.
Rev Hosp Clin Fac Med Sao Paulo ; 47(6): 285-9, 1992.
Article in Portuguese | MEDLINE | ID: mdl-1340621

ABSTRACT

The clinical features of the toxic shock syndrome are well established. It is rapidly developing disease and may be lethal if not recognized and treated in time. Once the syndrome was associated with the use of tampon by menstruating women. Recently this syndrome has been reported as due to Staphylococcus aureus infection. A severe case of toxic shock syndrome in a 18-years-old patient after reduction mammoplasty is reported, and the importance of an early diagnosis is emphasized.


Subject(s)
Mammaplasty , Postoperative Complications/etiology , Shock, Septic/etiology , Staphylococcal Infections/etiology , Acute Disease , Adolescent , Combined Modality Therapy , Female , Humans , Mastectomy, Radical , Postoperative Complications/diagnosis , Postoperative Complications/therapy , Reoperation , Shock, Septic/diagnosis , Shock, Septic/therapy , Staphylococcal Infections/diagnosis , Staphylococcal Infections/therapy , Time Factors
16.
Ann Plast Surg ; 29(5): 433-7, 1992 Nov.
Article in English | MEDLINE | ID: mdl-1444132

ABSTRACT

The surgical treatment of pressure sores has improved with the development of many techniques to provide coverage of these defects. Few deliver sensate coverage. This report describes tissue expansion of back skin to provide definitive sensate coverage of a pressure sore, thereby preventing its recurrence. Follow-up of 5.5 years is presented with a review of the literature.


Subject(s)
Dermatologic Surgical Procedures , Pressure Ulcer/surgery , Sensation , Tissue Expansion , Adult , Diabetes Complications , Female , Follow-Up Studies , Humans , Pressure Ulcer/etiology , Sacrum , Spinal Cord Diseases/complications , Surgical Flaps , Time Factors , Tissue Expansion Devices
17.
Ann Plast Surg ; 29(4): 367-70, 1992 Oct.
Article in English | MEDLINE | ID: mdl-1466536

ABSTRACT

A 42-year-old woman with pronounced skin laxity of her neck underwent a rhytidectomy and was found to have pseudoxanthoma elasticum-like changes of her skin. Her medical history was significant for Wilson's disease, requiring that she take penicillamine for 26 years. In patients on long-term penicillamine therapy, 20% to 33% will develop a dermatopathy. The drug has been used to alter scar formation in various surgical conditions. Penicillamine is known to alter cross-linking of elastin and collagen fibers. A review of the literature reveals other penicillamine-related dermatopathies that may present to the surgeon.


Subject(s)
Facial Dermatoses/chemically induced , Facial Dermatoses/surgery , Penicillamine/adverse effects , Pseudoxanthoma Elasticum/chemically induced , Pseudoxanthoma Elasticum/surgery , Rhytidoplasty , Adult , Facial Dermatoses/pathology , Female , Humans , Neck/pathology , Pseudoxanthoma Elasticum/pathology , Skin Aging/drug effects
18.
Ann Plast Surg ; 29(1): 18-22, 1992 Jul.
Article in English | MEDLINE | ID: mdl-1386719

ABSTRACT

One hundred three patients underwent abdominoplasty combined with other intraabdominal procedures including 67 tubal ligations, 34 total abdominal hysterectomies and 2 cholecystectomies, from January 1983 to July 1991. The patients were divided into two groups, those undergoing the standard or total abdominoplasty and those undergoing limited abdominoplasty with or without liposuction in delimited areas. In this series of 103 patients, we found only two minor complications and only three patients were transfused with autologous units of blood. When performed by well-schooled surgical teams, abdominoplasty may be combined with intraabdominal procedures with gratifying results.


PIP: Between January 1983 and July 1991, well trained surgical teams performed either standard abdominoplasty or miniabdominoplasty on 103 patients who also underwent tubal ligation, total abdominal hysterectomy, or cholecystectomy to determine whether surgeons can effectively combine abdominoplasty with other intraabdominal procedures. Prescribed preoperative procedures included respiratory exercises. Physicians advised patients to stop smoking 2 weeks before surgery. Physicians also instructed them not to take any aspirin or other drugs with anticoagulant effects 2 weeks before surgery. Tubal ligation patients who also underwent standard abdominoplasty were in the operating room for 3 hours and for 2 hours if they underwent miniabdominoplasty. Total abdominal hysterectomy patients were in the operating room for either 3-4 hours (standard abdominoplasty) or 2.5-3 hours (miniabdominoplasty). Surgeons performed cholecystectomy in those patients who only underwent standard abdominoplasty. They were in the operating room for 4-5 hours. The combination of intraabdominal procedure and standard abdominoplasty increased the time in the operating room by 40-90 minutes. Number of days in the hospital for standard abdominoplasty patients included 2-3 for tubal ligation, 5 for total abdominal hysterectomy, an 5-7 for cholecystectomy. Miniabdominoplasty patients were in the hospital 1-2 days for tubal ligation and 5 days for total abdominal hysterectomy. Only 2 minor complications occurred: a seroma and a minor skin slough. 3 patients required transfusion of autologous units of blood and non of them lost more than 500 ml of blood. The physicians encouraged all patients to become ambulatory soon after the operation and to wear elastic stockings to prevent thromboembolic events. As a result, none of the patients suffered a pulmonary embolism. In conclusion, good surgical teams can safely and effectively combine abdominoplasty with intraabdominal procedures.


Subject(s)
Abdominal Muscles/surgery , Cholecystectomy , Hysterectomy , Lipectomy/methods , Sterilization, Tubal , Blood Loss, Surgical , Female , Follow-Up Studies , Humans , Length of Stay , Postoperative Complications/etiology , Suture Techniques
20.
Clin Plast Surg ; 18(3): 593-9, 1991 Jul.
Article in English | MEDLINE | ID: mdl-1889169

ABSTRACT

Soft-tissue expansion in the lower extremities is typically well tolerated. The more proximal one is--that is, the closer to the thigh and buttocks--the easier and less complication prone the expansion will be. It is another valuable technique for resurfacing the lower extremity and for reconstructing defects in contour and in skin character. There are limitations to this technique, which generally is most useful in late reconstructions. Intraoperative expansion has no place in lower extremity reconstruction. Soft-tissue expansion may be limited by an unsuitable geometry or the sheer size of defects. It should not be used next to open wounds. Soft-tissue expansion offers significant advantage in that the coverage of a defect will be replaced with tissue like that lost. Seldom does one see necrosis of advanced flaps, so that there is little risk of tissue loss in using this modality. There is an excellent vascularity to the flaps and an excellent character to the skin. In addition, in this cost-conscious era, soft-tissue expansion is quite cost effective, and in many cases the procedures can be conducted on an outpatient basis with a minimum of hospitalization, if any. With care to select patients properly, design carefully, and conduct expansion in a leisurely fashion, soft-tissue expansion offers a valuable means of reconstructing both large and small lower extremity defects.


Subject(s)
Leg/surgery , Tissue Expansion/methods , Adult , Carbuncle/surgery , Female , Humans , Leg Injuries/surgery , Osteitis/surgery , Tibia , Tissue Expansion/adverse effects
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