RESUMO
The management of wounds with tendon and/or bone exposure is challenging because of the insufficient blood supply to the wound bed. We describe our experience with 19 patients using a perifascial areolar tissue (PAT) graft with topical administration of basic fibroblast growth factor (bFGF) in the treatment of complex wounds with exposed tendons and/or bones in the extremities. Using a PAT graft is minimally invasive and technically easy, and the donor site is relatively preserved. However, PAT grafts for the treatment of a complex wound with large areas of exposed tendons and/or bones have sometimes failed to survive because of insufficient vascularization of the wound bed. Therefore, topical administration of bFGF, which promotes angiogenesis, was added to the graft. All grafts showed good graft survival and successfully covered the tendons and bones. Topical administration of bFGF accelerated vascularization in the PAT graft and facilitated wound healing by increasing the blood supply to the wound bed and achieved success with the PAT graft. In conclusion, using a PAT graft with topical administration of bFGF is a suitable option for the treatment of complex wounds with a large proportion of exposed tendons and/or bones. With minimal damage to the tissues near the wound, the PAT graft can be a useful option for limb salvage and could become a valuable tool for reconstructive surgeons.
Assuntos
Fator 2 de Crescimento de Fibroblastos/administração & dosagem , Retalhos Cirúrgicos/transplante , Cicatrização/efeitos dos fármacos , Ferimentos e Lesões/tratamento farmacológico , Ferimentos e Lesões/cirurgia , Administração Tópica , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Rejeição de Enxerto , Sobrevivência de Enxerto/efeitos dos fármacos , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Prognóstico , Procedimentos de Cirurgia Plástica/métodos , Estudos Retrospectivos , Índice de Gravidade de Doença , Transplante de Pele/métodos , Lesões dos Tecidos Moles/diagnóstico , Lesões dos Tecidos Moles/tratamento farmacológico , Lesões dos Tecidos Moles/cirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Resultado do Tratamento , Cicatrização/fisiologia , Ferimentos e Lesões/diagnóstico , Adulto JovemRESUMO
A familial amyotrophic lateral sclerosis (FALS) patient with G37R mutation of superoxide dismutase 1 (SOD1) gene revealed an early onset and relatively slow progression. Neuropathological examination of this patient showed widespread neuronal degeneration extending to overall length of the spinal cord and the brainstem with extremely rare Lewy body-like inclusions (LBI), while there were no vacuoles in neurons, a characteristic feature in transgenic mice expressing G37R SOD1 mutation.
