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1.
Internist (Berl) ; 60(10): 1102-1105, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31451847

RESUMO

A 46-year-old immunosuppressed patient presented with a breast implant-associated infection 10 years after breast augmentation in Southeast Asia. No pathogen was identified in the initial conventional microbiological workup. Subsequently, infection with Mycobacterium abscessus-a nontuberculous mycobacteria-was diagnosed using a special culture technique. Increased rates of such infections are reported after cosmetic surgery in foreign countries, presumably due to inoculation with these ubiquitous pathogens. This case highlights the fact that the differential diagnosis and thus the microbiological workup should be extended in cases without initial pathogen detection.


Assuntos
Implantes de Mama/efeitos adversos , Corpos Estranhos/microbiologia , Mastodinia/etiologia , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Micobactérias não Tuberculosas/isolamento & purificação , Infecções Relacionadas à Prótese/microbiologia , Infecção da Ferida Cirúrgica/microbiologia , Implantes de Mama/microbiologia , Febre/etiologia , Humanos , Hospedeiro Imunocomprometido , Pessoa de Meia-Idade , Infecções por Mycobacterium não Tuberculosas/microbiologia
2.
J Plast Reconstr Aesthet Surg ; 72(10): 1632-1639, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31375431

RESUMO

INTRODUCTION: Preoperative imaging by Computed Tomographic Angiography (CTA) has been promoted a gold standard tool for perforator mapping in abdominally based microsurgical breast reconstruction, while Color Doppler Ultrasound (CDU) has lost its popularity. As the CTA X-ray exposure might have long-term consequences for patients, CDU has regained importance for preoperative workup in our center. Our aim was to revisit the role of CDU by comparing the reliability of CDU and CTA in predicting intraoperative perforator selection. MATERIALS AND METHODS: We performed a retrospective chart review study of patients who underwent microsurgical breast reconstructions with DIEP flaps at our institution. Both CTA and CDU were performed prior to the surgery, and both imaging entities were thoroughly examined by the surgical team. Perforator identification, number, size, and location were assessed and correlated with CTA and CDU data and with intraoperative findings. RESULTS: We identified 98 patients who received 125 DIEP flap surgeries. A significantly stronger correlation was found between CDU and intraoperative findings of perforator detection and size (p<0.0001) and selection (r = 0.9987, CI 0.9981-0.9991, p < 0.0001 and r = 0.01, CI -0.18-0.2, p = 0.91, respectively), when compared with CTA data. If none of the preoperative imaging studies matched intraoperative perforator selection, an association with a higher incidence of flap loss (Odds ratio 4.483, CI 0.5068-39.65, p = 0.2171) was found. CONCLUSIONS: Our data suggests that CDU might regain relevance as a safe and reliable preoperative imaging study, without the risk and potential consequences of X-ray exposure. Preoperative imaging tools like CDU and CTA should be considered part of the gold standard in abdominally based free flap breast reconstruction.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Artérias Epigástricas/diagnóstico por imagem , Mamoplastia/métodos , Retalho Perfurante/transplante , Ultrassonografia de Intervenção/métodos , Músculos Abdominais/irrigação sanguínea , Músculos Abdominais/cirurgia , Adulto , Autoenxertos , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Estudos de Coortes , Artérias Epigástricas/transplante , Feminino , Sobrevivência de Enxerto , Humanos , Cuidados Intraoperatórios/métodos , Mastectomia/métodos , Microcirurgia/métodos , Pessoa de Meia-Idade , Retalho Perfurante/irrigação sanguínea , Prognóstico , Estudos Retrospectivos , Medição de Risco , Suíça , Resultado do Tratamento , Ultrassonografia Doppler em Cores/métodos
3.
J Plast Reconstr Aesthet Surg ; 70(9): 1261-1266, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28716695

RESUMO

BACKGROUND: Little attention has been given to the segmental free gracilis muscle flap supplied by secondary proximal pedicles. We introduce a technical refinement for small-sized three-dimensional defect reconstruction on the foot. METHODS: Between November 2013 and August 2016, three patients with a mean age of 66 years (range 47-70 years) were included. A segmental gracilis free flap supplied by the most proximal secondary pedicle was harvested according to a modified "nugget design" to treat small-sized defects on the lower extremity requiring dead space reconstruction. Minor and major complications, sensitivity with Semmes-Weinstein monofilament test, soft tissue stability and patient satisfaction at final follow-up were recorded. RESULTS: In one case, a segmental gracilis muscle was used for dorsal foot reconstruction after debridement of metatarsal phalanx I with osteomyelitis. In two cases, the segmental gracilis free muscle was harvested for defect reconstruction on the right plantar foot after excision of a melanoma. The first patient required revision after partial failure of the initial segmental gracilis free muscle flap. Overall, good results in foot function and a high degree of patient satisfaction was achieved (Likert scale 9.7, range 9-10) after a mean follow-up of 13 months (range 3-24 months). CONCLUSIONS: Taken from the very proximal dorsal part of the gracilis muscle supplied by the most proximal secondary pedicle and leaving the vast majority of the muscle intact preserves the option to harvest a normal gracilis flap. This technique is especially suitable for small, three-dimensional defects on the lower extremity.


Assuntos
Pé/cirurgia , Retalhos de Tecido Biológico , Procedimentos de Cirurgia Plástica/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Músculo Grácil/transplante , Humanos , Pessoa de Meia-Idade
4.
Microsurgery ; 37(5): 431-435, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27571547

RESUMO

In this report, we present two cases of the bony reconstruction with the medial trochlea (MFT) flap including a skin island that was used to monitor the perfusion of flap in the postoperative period. Between March 2013 and April 2015, we performed surgery on two patients who suffered from scaphoid and talus non-union after trauma and initial treatment by osteosynthesis. A skin island (1 cm × 1 cm and 3 cm × 1 cm, respectively) was included with the osseous flap (1.6 cm × 1 cm × 1 cm and 2 cm × 3 cm × 2 cm, respectively) to assess the perfusion of the flap. The design of the skin island was based on either the saphenous artery perforator or a cutaneous perforator of the descending genicular artery. Both flaps remained viable throughout the postoperative period, and there were no donor site complications. After a follow-up of 36 and 11 months, bony union was observed in both patients with a high degree of satisfaction. Thus, a MFT flap with a skin island could be a tool to assess the perfusion of the flap in the early postoperative period. © 2016 Wiley Periodicals, Inc. Microsurgery 37:431-435, 2017.


Assuntos
Fraturas não Consolidadas/cirurgia , Retalhos de Tecido Biológico/transplante , Procedimentos de Cirurgia Plástica/métodos , Osso Escafoide/lesões , Tálus/lesões , Feminino , Retalhos de Tecido Biológico/irrigação sanguínea , Humanos , Joelho , Masculino , Pessoa de Meia-Idade , Osso Escafoide/cirurgia , Tálus/cirurgia , Adulto Jovem
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