RESUMO
Cleft sternum is a rare congenital chest deformity that develops during the first trimester. Failure of the process of midline mesenchymal strip fusion leads to absence of the sternum, resulting in cleft formation. Multiple surgical approaches have been described in the closure of sternal clefts. An optimal surgical approach is still debatable. We describe 2 cases of complete sternal clefting treated with staging of the repair. Dermal allograft and synthetic mesh along with myofasciocutaneous flaps are used a bridging method to future definitive treatment. Most patients will require secondary cardiothoracic procedures for underlying cardiac conditions, and disruption of any primary repair is compromised on reentry into the chest. Staging this procedure avoids this potential problem. Also, concerns regarding chest wall constriction and cardiopulmonary compromise are minimized. Once the child has matured, definitive treatment can be pursued with more abundant autologous donor tissue. Our approach is safe with minimal complications and is well tolerated by the patients.
Assuntos
Procedimentos de Cirurgia Plástica/métodos , Transplante de Pele/métodos , Esterno/anormalidades , Telas Cirúrgicas , Pré-Escolar , Feminino , Humanos , Lactente , Anormalidades Musculoesqueléticas/diagnóstico , Anormalidades Musculoesqueléticas/cirurgia , Procedimentos de Cirurgia Plástica/instrumentação , Transplante de Pele/instrumentação , Esterno/cirurgia , Parede Torácica/cirurgia , Transplante HomólogoRESUMO
Superficial inferior epigastric artery (SIEA) flaps are ideal for breast reconstruction when the anatomy permits it. Due to the peripheral and superficial location of the pedicle, these flaps can be complicated by vessel kinking against the remaining ribs after insetting. Here, we describe a novel method for SIEA flap salvage after kinking or avulsion of the traditional anastomosis to the internal mammary vessels.
Assuntos
Mamoplastia/métodos , Retalhos Cirúrgicos/irrigação sanguínea , Anastomose Cirúrgica , Neoplasias da Mama/cirurgia , Artérias Epigástricas , Feminino , Humanos , Artéria Torácica Interna/cirurgia , Mastectomia , Microcirurgia , Pessoa de Meia-Idade , Fluxo Sanguíneo RegionalRESUMO
We report a case of an abdominal aortic aneurysm (AAA) associated with an aortocaval fistula managed with endovascular techniques. The patient had a known AAA, and on the latest computed follow-up tomographic scan, evidence of fistulization between the aorta and the vena cava was suggested, which was later corroborated by standard contrast angiography. His comorbidities precluded an open repair, and this prompted consideration for an endovascular intervention. Successful exclusion of the AAA was performed, with no evidence of endoleaks or persistence of the fistula. The endovascular approach provides an efficacious alternative to traditional methods for repair of an aortocaval fistula, which is especially important in elderly patients with several comorbidities.
