RESUMO
A 50-year-old man had a maxillectomy and post-operative radiotherapy for squamous carcinoma of the maxilla. The acute skin reaction merged at 2 months into a chronic comedo-type acneiform skin reaction in the irradiated area. Previous literature on this reaction to radiation is reviewed. The reaction is rare and occurs mostly in the head and neck area, more commonly in patients who have received acneigenic drugs, and with a latent period of between 2 weeks and 6 months from completion of radiotherapy. The pathogenesis of acne is discussed and a mechanism of post-irradiation acne is suggested.
Assuntos
Acne Vulgar/etiologia , Carcinoma de Células Escamosas/radioterapia , Neoplasias Maxilares/radioterapia , Lesões por Radiação/etiologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Radioterapia Adjuvante/efeitos adversosRESUMO
The submental island flap is a reliable source of skin of excellent colour, contour and texture match for facial resurfacing and leaves a well hidden donor site. The flap is safe, rapid and simple to raise. We report on its use in 12 cases of facial or intraoral reconstruction. Complications were few. However, there was one case of complete flap loss following its use in a reverse flow manner, due to the presence of an unreported, but constant, valve in the venous system of the face. We believe this flap to be a worthwhile addition to the existing surgical armamentarium.
Assuntos
Carcinoma de Células Escamosas/cirurgia , Neoplasias Faciais/cirurgia , Neoplasias Bucais/cirurgia , Transplante de Pele/métodos , Retalhos Cirúrgicos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Queixo/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Pele/irrigação sanguíneaRESUMO
The data from the first 50 patients undergoing free TRAM flap breast reconstruction in two units were examined. Average patient age was 42 years, and average weight was 62 kg. Forty percent of patients were chronic smokers, and 26 percent had low abdominal scars. Twelve percent exercised their abdominal muscles regularly. Eighteen percent had undergone radical mastectomy, whereas 76 percent had undergone modified radical mastectomy and 6 percent had undergone subcutaneous mastectomy. Postoperative radiotherapy had been given in 16 percent of patients, and 54 percent had received postoperative chemotherapy. The average time from mastectomy was 32 months, whereas six breasts were reconstructed immediately. Average operating time was 5.6 hours, and average blood loss was 2.4 units. Average hospital stay was 11.2 days. Complications included three total flap losses (6 percent) and two partial flap losses (4 percent). Abdominal hernia occurred in two patients (4 percent).
Assuntos
Mama/cirurgia , Mastectomia/reabilitação , Retalhos Cirúrgicos/métodos , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Fatores de Risco , FumarRESUMO
The radial forearm flap, although widely used, has been criticized for the poor quality of its donor site. To investigate the causes of morbidity, 100 radial artery free-flap donor sites have been reviewed. Sixty-seven patients required skin grafting (group 1), and the remaining 33 patients were closed directly (group 2). Seventeen patients in the series had compound osteocutaneous flaps (group 3). Wound healing proved to be a significant problem in groups 1 and 3, and fracture of the radius occurred in 4 of the 17 patients in group 3 and was the most significant cause of morbidity. The radial artery was reconstructed in 12 patients, but only 6 of the arteries (50 percent) were patent at the time of review. Subjective assessment on a scale of 0 to 10 demonstrated a relatively pain-free donor site with low pain scores (2.5 of 10). The cosmetic result was acceptable in men (1.5 of 10) but was less so in women (4 of 10). Angulated fracture of the radius produced an unacceptable cosmetic result (7 of 10). In light of this experience, we no longer reconstruct the radial artery as a matter of routine. The donor defect is closed directly wherever possible using an ulnar artery-based transposition flap when required. A "boat shaped" osteotomy is used in preference to right-angled bone cuts when harvesting a segment of radius to avoid the complications and sequelae of fracture. These changes in surgical technique have improved the acceptability and minimized the problems associated with this donor site.
Assuntos
Antebraço/cirurgia , Retalhos Cirúrgicos/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Artérias/cirurgia , Carcinoma de Células Escamosas/cirurgia , Estética , Feminino , Antebraço/irrigação sanguínea , Antebraço/fisiologia , Mãos/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/cirurgia , Dor/etiologia , Fraturas do Rádio/etiologia , Sensação , Retalhos Cirúrgicos/efeitos adversos , CicatrizaçãoRESUMO
A method of direct closure of the donor defect of the radial forearm flap is described. This avoids the complication of delayed wound healing which remains a problem after split skin graft reconstruction.
Assuntos
Antebraço/cirurgia , Retalhos Cirúrgicos , Humanos , MétodosRESUMO
The free transfer of two transverse scapular flaps in continuity is described. This provides a donor site capable of yielding a skin flap 50 x 10 cm. Some observations on the vascularity of adjacent axial territories are made.
Assuntos
Retalhos Cirúrgicos , Adulto , Humanos , Perna (Membro)/cirurgia , Masculino , EscápulaRESUMO
The temporo-parietal flap is used for primary reconstruction of a severed ear fragment, salvaging the cartilage framework of the amputated part.
Assuntos
Orelha Externa/cirurgia , Retalhos Cirúrgicos , Amputação Traumática/cirurgia , Pré-Escolar , Orelha Externa/lesões , Humanos , Masculino , MétodosRESUMO
Forty-one human bites of the face are presented with a comparative review of earlier published series. Their primary treatment is outlined. The majority of bites presented few initial complications due to the excellent blood supply of the face and the use of prophylactic antibiotics. Secondary reconstruction, however, usually entailed multiple staged operations.
Assuntos
Mordeduras e Picadas/cirurgia , Mordeduras Humanas/cirurgia , Cirurgia Plástica , Adolescente , Adulto , Fatores Etários , Mordeduras Humanas/microbiologia , Mordeduras Humanas/patologia , Orelha Externa/lesões , Orelha Externa/cirurgia , Feminino , Humanos , Lábio/lesões , Lábio/cirurgia , Masculino , Pessoa de Meia-Idade , Nariz/lesões , Nariz/cirurgiaRESUMO
In a retrospective review of 50 patients with wounds of the ear, simple closure was found preferable to flap repair as a method of primary treatment. Replantation of the partially or totally amputated ear as a composite graft was singularly unsuccessful in this series.