1,721,231 research outputs found
Use of cell fat mixed with platelet gel in progressive hemifacial atrophy
No full textProgressive hemifacial atrophy, also known as Parry-Romberg syndrome, is an uncommon degenerative and poorly understood condition. It is characterized by a slow and progressive atrophy affecting one side of the face. The incidence and cause of this alteration are unknown, and the pathogenesis of the syndrome is not clear. Some authors attribute the atrophy of the subcutaneous system to an alteration of the sympathetic system. Others attribute it to an alteration of the nervous system at the encephalic level or to an interstitial neuritis of the trigeminal nerve. The most common complications that appear in association with this disorder are trigeminal neuritis, facial disorders, and epilepsy. The latter is the most frequent complication of the central nervous system. Characteristically, the atrophy progresses slowly for several years and soon becomes stable. After stabilization of the disease, plastic surgery of autogenous fat grafts can be performed. This study aimed through the presentation of clinical cases to suggest a therapeutic plan comprised of two sequential treatments: aquisition of platelet gel from a small volume of blood (9 ml) followed by the Coleman technique for reconstructing the three-dimensional projection of the face contour, restoring the superficial density of the facial tissues. The results obtained prove the efficacy of these two treatments combined, and the satisfaction of the patient confirms the quality of the results
Adipose-derived stromal vascular fraction cells and platelet-rich plasma: Basic and clinical implications for tissue engineering therapies in regenerative surgery
No full textCell-based therapy and regenerative medicine offer a paradigm shift in regard to various diseases causing loss of substance or volume and tissue or organ damage. Recently, many authors have focused their attention on mesenchymal stem cells for their capacity to differentiate into many cell lineages. The most widely studied types are bone marrow mesenchymal stem cells and adipose derived stem cells (ADSCs), which display similar results. Based on the literature, we believe that the ADSCs offer advantages because of lower morbidity during the harvesting procedure. Additionally, platelet-rich plasma can be used in this field for its ability to stimulate tissue regeneration. The aim of this chapter is to describe ADSC preparation and isolation procedures, preparation of platelet-rich plasma, and the application of ADSCs in regenerative plastic surgery. We also discuss the mechanisms and future role of ADSCs in cell-based therapy and tissue engineering
A reason to research and to hope:Bloodless Surgery.Our experience
No full textABSTRACT
INTRODUZIONE
La Chirurgia senza sangue (blood less surgery ), nasce negli Ospedali Americani , per la necessita’ di minimizzare l’uso trasfusionale di sangue omologo e per la ricerca di una sapiente alternativa che riduca o elimini tutti i rischi infettivi e non ,legati alle emotrasfusioni.Inoltre , la bloodless surgery, oltre che a far fronte alle difficolta’ di reperimento e all’alto costo di sangue omologo,riesce a rispondere pienamente alle esigenze di carattere etico e alle convinzioni religiose,spesso inascoltate, di una certa parte della popolazione
MATERIALI E METODI
Il nostro Studio, dopo aver informato i candidati,contrari in vario modo all’esecuzione dell’emotrasfusione, sia dei rischi inerenti le emotrasfusioni sia di quelli derivanti dall’astensione di utilizzo dell’ emotrasfusione o di emoderivati in condizioni di necessita’, si basa sull’esecuzione, in elezione, della “Chirurgia senza Sangue”, nel rispetto rigoroso di alcuni protocolli stabiliti da linee guida internazionali e sottoposti all’approvazione dei pazienti scelti per tale studio.Il protocollo proposto e’ stato studiato ed applicato in pieno accordo dal team chirurgico- anestesiologico.Tutti i pazienti, hanno valutato e sottoscritto un consenso informato accuratamente dettagliato. Il campione esaminato reclutava 31 pazienti nel periodo Aprile/2008-Dicembre/2010,di cui n.5 testimoni di Jeova.Tutti sono stati accuratamente studiati valutati anestesiologicamente ed inseriti nei vari gruppi di studio previsti dal protocollo, distribuiti per sesso, patologie, convinzioni etiche o religiose.Tali pazienti presentavano un’ eta’variabile (28-75 a.-range 51.2 a.) e risultavano affetti da patologie neoplastiche variamente rappresentate. I pazienti selezionati e orientati,sono stati quindi preparati all’intervento chirurgico con schemi terapeutici personalizzati atti a sostenere o espandere i parametri ematici, “conditio sine qua non” per eseguire in serenita’ l’intervento chirurgico dell’ asportazione neoplastica. In particolare : 5 pazienti (1 k.colon + 1 poliposi familiare +3 k.utero) (Hb>12.5 g/dl) sono stati preparati e sottoposti pre-operatoriamente ad un prelievo di n. 2 U.I di sangue omologo costituente un “ pre-deposito ematico”.
16 pazienti sono stati orientati verso 2 diversi protocolli ben codificati da linee guida EBM: 1)gruppo di 13 pazienti (3 k.mammella, 7 k.colon, 1 k.gastrico + 2 Testimoni Jeova affetti da 1 k.pancreas, 1 fibroma utero) sono stati preparati pre-operatoriamente x 4 settimane con la somministrazione di estratti cortico-surrenalici associati a Terapia marziale (ferrogluconato di Na. 62.5 mg/x 3/os die) e folati (cps 5 mg/os die) insieme alla Vit.B.12 1 mg/im a giorni alterni x 2 settimane precedenti
2 )gruppo di 3 pazienti (2 k.gastrico ,1 k.colon),sono stati preparati con EPO (10000 UI s.c x 2 / a settimana) somministrata pre-operatoriamente per 4 settimane associata a terapia marziale (ferrogluconato di Na. 62.5 mg/x 3/os die) , folati (cps 5 mg/os die) e Vit.B.12 1 mg/ somministrata per via im a giorni alterni x 2 settimane precedenti l’intervento.
I restanti 10 pazienti (7 k.colon + 3 Testimoni Jeova affetti da 1 k.gastrico ,1 da k.colon,1 k.pancreas)(Hb>12.5 g/dl) volutamente non sono stati preparati pre-operatoriamente ma ,sulla base di una discreta perdita ematica intraoperatoria con riduzione dei parametri ematici monitorati, sono stati proprio quelli che hanno successivamente necessitato e si sono avvantaggiati di una “emodiluizione intra-operatoria” (2-4 litri) con infusione di Soluzione di Ringer/S.F in un rapporto di 3/1.
A tutti i pazienti e’ stata consigliata una dieta iperproteica pre-operatoria.Tutti i pazienti sono stati sottoposti all’ intervento chirurgico programmato previa esecuzione di anestesia generale ed e’ stato loro posizionato un saturimetro digitale mantenuto intraoperatoriamente e per le 48 h.successive.
Sono stati seguiti pedissequamente i cardini fondamentali della esecuzione della bloodless surgery ,posizionati drenaggi (spia) in tutti e monitorati i parametri ematici ed emogasanalitici sia intraoperatoriamente sia a controlli prefissati nel post.
15 pazienti hanno subito un importante o discreto sanguinamento intraoperatorio e sono stati sottoposti o a infusione del pre-deposito di sangue omologo(auto-trasfusione) (5 paz.) o a emo-diluizione intraoperatoria (10 paz.non preparati pre-operatoriamente) integrata da infusione di plasma (non nei Testimoni di Jeova).Tutti questi sono stati pero’ sottoposti a Ossigenoterapia a piu’ alti volumi di erogazione (3,5-4 l/min) x 72 ore e posti in osservazione clinica (range:6-8 h.) cautelare in T.I .
RISULTATI : Non abbiamo registrato alcuna complicanza intra - perioperatoria.
Non e’ stato necessario ricorrere ad alcuna emotrasfusione aggiuntiva o infusione di emoderivati eccedente il protocollo.I pazienti sottoposti a OssigenoTerapia a piu’ alti volumi hanno presentato un recupero clinico piu’ precoce confermando che e’ possibile sopportare anche bassi livelli di Hb (<8 g/dl) senza necessitare di emotrasfusione, perche’ la morbilita’ e la sopravvivenza dipendono non tanto dai livelli pre-operatori di Hb quanto dalla perdita ematica intraoperatoria e specificatamente dalla concentrazione dell’Ossigeno legato-libero disponibile.
CONCLUSIONI : Considerando tutti i rischi infettivi e non, correlati alle emotrasfusioni e alle infusioni di emoderivati , le difficolta’ nel loro reperimento ,gli alti costi nonche’ le convinzioni etiche e/o religiose di una parte della popolazione, esistono valide ragioni per investire culturalmente e tecnicamente in procedure e/o protocolli che puntino sia ad una maggiore sensibilizzazione degli operatori per un uso piu’ oculato e selezionato del sangue (buon uso) sia all’ impiego di efficaci strategie personalizzate , alternative alle emotrasfusioni e alle infusioni di emoderivati. Sarebbe altresi’ auspicabile la identificazione e la creazione di Centri a vari gradi di Competenze Specialistiche e di Eccellenza organizzati gerarchicamente , ove poter eseguire la “Chirurgia senza sangue”, validare nuove ricerche o protocolli e svolgere finalita’ formative altamente specialistiche.
Key words : blood, surgery, infectious, immuno modulation, cancer ,alternatives
strategies, Jehowash’s Witness
Ringraziamenti: Gli autori ringraziano sentitamente il prof. Pace Alessio per la preziosa collaborazione chirurgica fornita
Nanocrystalline silver: A systematic review of randomized trials conducted on burned patients and an evidence-based assessment of potential advantages over older silver formulations
No full textThe aim of this meta-analysis was to collect data from randomized trials in burn patients and to analyze them with a meta-analytic approach to give a clear message of potential advantages of nanocrystalline silver (NC) versus older silver formulations (SS).A review of all-English prospective randomized trials that compared NC versus silver sulfadiazine or silver nitrate was conducted. Primary outcome was the evaluation of differences in the infection rate of burns. Secondary outcomes were the eventual differences in the pain experienced during medications, the length of hospitalization (LOS) and costs.Five articles that met the inclusion criteria were selected (n = 285 patients). The NC group had a significant lower incidence of infections compared with the SS group (9.5% vs. 27.8%, odds ratio: 0.14 [95% CI: 0.06-0.35]; χ test, P < 0.001), with a 2.9-fold decrease of the risk. Not all studies investigated the pain during change of dressings, LOS and costs. However, when data were available, these showed lower costs (US 946 per patient for the NC group) and decreased pain values in the NC group (Hedges' G: -1.44 [95% CI: -1.86/-1.01]; P < 0.0001), while contrasting results were obtained for LOS.Nanocrystalline silver is a relatively new product with a significant stronger antimicrobial activity compared with older formulations. Its long lasting properties reduce dressing change frequency and are probably responsible for the decreased pain and the minor costs experienced. © 2009 Lippincott Williams & Wilkins, Inc
Fibroadenoma in the bilateral accessory axillary breast
No full textThe authors treated a case of bilateral accessory axillary breast tissue. Excision with histologic examination confirmed the diagnosis of fibroadenoma. Treatment left the woman with incision scars (3.5 cm) in the axillary pyramid, a location often not seen during a patient's normal movements. Thus, despite a minor aesthetic incision, gives the advantage of complete histologic analysis was gained. Liposuction treatment was used in this case. The scar results were good
Arm contouring after massive weight loss: Liposuction-assisted brachioplasty versus standard technique
Full text linkMassive weight loss (MWL) brachioplasty is frequently requested for the improvement of the appearance and function of arms. Despite its diffusion, this procedure can be associated with significant complications. Liposuction-assisted brachioplasty (LAB) preserves the vascular, nervous, and lymphatic network and reduces the incidence of postoperative complications. This retrospective cohort study is aimed at analyzing two different modalities of arm contouring after MWL by evaluating the outcomes and complications. Of 31 patients (all females, average age 43.5 years), 20 were managed with standard brachioplasty represented by a swallowtail scar and monobloc resection and 11 with brachioplasty combined with aggressive liposuction. Evaluated parameters included age, body mass index, method of weight loss, and complications rate. No statistical analysis was used. Major postoperative complications (reoperation, bleeding, or thromboembolism) were not reported in both groups. The incidence of minor complications (wound separation, wound infection, and seroma) was globally 42%; the incidence of complications was significantly lower in the LAB group (9% vs. 60%). The incidence of hypertrophic scarring or keloid was higher in the control group (55% vs. 18%). Most patients were satisfied after surgery: in the LAB group, 81.8% of the patients expressed a high degree of satisfaction and 18.2% a good degree of satisfaction after 4 months of follow-up. In our experience, the LAB should be preferred in MWL patients because it has a lower rate of complications and a faster recovery than the standard technique. Proper execution requires considerable technical skill and experience
Infections after plastic procedures: incidences, etiologies, risk factors, and antibiotic prophylaxis.
No full textBackground: Through a review of the English literature, this study aimed to assess the incidence, etiology, risk factors, and preventive measures for postoperative infections occurring after plastic surgery operations. Methods: All studies describing the occurrence of infections after plastic surgery procedures including case reports, prospective trials, and retrospective series were selected. Results: The 85 articles analyzed showed that incidences differ greatly among procedures and seem to be influenced by different and specific risk factors for each operation. Etiologic agents are primarily bacteria, although mycobacteria, virus, and fungi also have been described. No agreement exists on the use of antibiotic prophylaxis, except for abdominoplasties, because few specific prospective trials are present in the literature. Conclusions: Infections remain an important problem in plastic surgery with different points that still need to be clarified. Hopefully, in the future prospective randomized trials will definitively address this issue in order to provide plastic surgeons with clear and unbiased guidelines on its prevention and management. © 2007 Springer Science+Business Media, LLC
Hump-like giant desmoid tumor of the chest: a postresectional reconstruction challenge.
Full text linkDesmoid tumors (DT) are rare neoplasms with unknown etiology arising from musculoaponeurotic structures. Chest wall localization is uncommon and has been associated with high recurrence rate unless radical resection with negative margins is carried out. Postresectional reconstruction can be challenging in presence of giant lesions and might require adoption of complex reconstruction methods including use of well vascularized muscle flaps. We present a case of giant hump-like recurrent chest wall DT, which was radically resected following placement of multiple subcutaneous silicon tissue expanders, to gain redundant skin, which eventually allowed in conjunction with two transposition, cutaneous-adipose flaps, harvested from the upper gluteal region, an optimal reconstruction of the large postresectional defect
- …
