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Free fibular flap with periosteal excess for mandibular reconstruction.
No full textBackground In microvascular transfer of fibular osteocutaneous flap for mandible reconstruction after cancer ablation, good bone union is necessary to allow timely radiation therapy after surgery. As the area of bone contact between fibula and the original mandible at the edge of the mandibular defect is small, a periosteal excess at both ends of the fibula covering the bone junction can be used to increase the chance of bone union. The purpose of this study is to investigate whether a periosteal excess surrounding both ends of the fibula flap can provide better blood supply and, therefore, ensure bone union and wound healing at 6 weeks after surgery and before radiation therapy initiation. Patients and methods The transfer of fibular osteocutaneous flap with periosteal excess was only applied to reconstruct segmental mandibular defects. As a consequence, only cases in which osteotomy of fibula was not performed were included in this study. A total of 34 fibular flaps without osteotomies were performed between 2000 and 2008; 17 with and 17 without the periosteal excess. The bone union was evaluated in terms of osseous callus formation using X-rays and CT three-dimensional images at 6 weeks after surgery, and results were assessed by three independent radiologists. Results There was a significant difference between reconstructions with and without the periosteal excess in terms of bone union (P = 0.022). With reference to postoperative complications, the group reconstructed without periosteal excess presented a higher number of complications, mainly consisting of partial and total flap necrosis, respectively six (35.29%) and two (11.76%) cases. In the group reconstructed with periosteal excess, no loss of the skin island has occurred. A significant difference was observed in terms of partial flap necrosis (P = 0.024), while the other complications did not reveal a statistically significant difference (P > 0.05). Conclusions The use of a periosteal excess at both ends of the fibula flap provides better blood supply and is, therefore, able to ensure good bone healing and skin paddle survival regardless of the radiotherapy
The double opposing "Y" technique for umbilical reconstruction after omphalectomy.
No full textBACKGROUND: Abdominal surgical procedures, such as ventral hernia repair, may require the removal of the umbilicus, which gives an unnatural appearance to the abdomen. This situation can be corrected by umbilical reconstruction during the same operative time or at a later stage. In previous studies, we reported a versatile technique for umbilicoplasty based on a double opposing "Y" incision on the abdominal flap to create a new umbilicus. We now report the use of this technique for umbilical reconstruction in patients who underwent previous or concurrent omphalectomy.
METHODS: A prospective open-label study was performed on 10 patients undergoing the double opposed "Y" umbilicoplasty after omphalectomy. Postoperative patients' satisfaction and results were evaluated during the follow-up of minimum I year. A modified 5 ml syringe was used to assess depth and volume of umbilical stalk. Depth value variations from one month to one year after surgery were statistically compared using the Wilcoxon test.
RESULTS: Complete healing of the new umbilicus was achieved in 14-21 days in nine cases. In one case, partial dehiscence of the wound occurred and complete healing was achieved in 4 weeks. Follow-up time ranged from 1 to 4 years. In all patients, a three-dimensional umbilicus with satisfactory depression was created. During follow-up, no significant changes in shape, dimension and appearance were observed. All patients were pleased with the results. No cicatricial umbilical stenosis occurred.
CONCLUSIONS: The double opposing "Y" technique creates a new natural umbilical scar; this technique can be easily performed for umbilical reconstruction after omphalectomy
Periorbital area rejuvenation using carbon dioxide therapy
No full textBackground: Different conservative and surgical approaches are used for periorbital region rejuvenation, but none of them is effective in the treatment of the medial third of the lower eyelid. Objective: The present study is designed to assess the effectiveness of carboxytherapy in the treatment of wrinkles on the median and medial region of the lower eyelid and dark circles around the eyes. Methods and Materials: From January 2008 to December 2010, 90 patients with moderate to severe periorbital wrinkles and/or dark circles underwent subcutaneous injections of CO2 once a week for 7 weeks. Patients were assessed before and 2 months after the treatment through photographic documentation and the compilation of visual analog scales. Results: At the end of the study period, patients reported a reduction of facial fine lines and wrinkles as well as a decrease in periorbital hyperpigmentation. A few side effects were observed but they were all transient and did not require discontinuation of treatment. Conclusion: Carbon dioxide therapy results as an effective noninvasive modality for the rejuvenation of the periorbital area. © 2012 Wiley Periodicals, Inc
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Transverse upper gracilis flap with implant in postmastectomy breast reconstruction: a case report.
No full textAutologous flaps can be used in combination with prosthesis in postmastectomy breast reconstruction. The deep inferior epigastric perforator
(DIEP) flap is considered the preferred choice among autologous tissue transfer techniques. However, in patients with a peculiar figure
(moderately large breasts and large thighs with flat stomach), who cannot use their abdominal tissue, the transverse upper gracilis
(TUG) flap with implant is investigated as a further option for breast reconstruction. This report presents a patient who underwent the
TUG flap plus implant reconstruction. A bilateral skin-sparing mastectomy was performed removing 340 g for each breast. The volume of
the TUG flaps was 225 g (left) and 250 g (right). Preoperative volumes were restored by placing under the TUG muscle a round textured
implant. No complications occurred during the postoperative period both in the recipient and donor site and the outcomes of the procedure
were good. In cases where the use of the DIEP flap is not possible because of past laparotomies or inadequate abdominal volume,
the TUG flap plus implant may be considered as a valid alternative
Coverage of exposed hardware after lower leg fractures with free flaps or pedicled flaps
Full text linkAbstract. – OBJECTIVE: The placement of osteosynthetic materials in the leg may be complicated by hardware exposure. Successful soft tissue reconstruction often provides a critical means for limb salvage in patients with hardware exposure in the leg. Free flaps are currently considered the standard surgical procedure for soft tissue coverage of the wounds with internal hardware exposure. However, to date, no conclusive literature shows the superiority of a specific type of flap. MATERIALS AND METHODS: The current review compares data from the literature concerning outcomes and complications of free and pedicled flaps for exposed osteosynthetic material preservation in the leg. RESULTS: A total of 81 cases from twelve different articles presenting internal hardware exposure of the leg were analyzed in our study. Thirty-two patients underwent immediate reconstructive surgery with pedicled flaps, while forty-nine patients underwent free flap reconstruction. The overall survival rate for pedicled flaps was 96.77%, while for free flaps it was 97.77%. The overall implant preservation rate was 78.12% for pedicled flaps and 53.33% for free flaps. With reference to postoperative complications, the overall complication rate was 46.87% for pedicled flaps and 10.20% for free flaps. CONCLUSIONS: No significant difference was found in terms of overall flap survival. However, a significant difference was found regarding successful implant preservation (78.12% in the pedicled flap group vs. 53.33% in the free flap group). In particular, the first observation appears to be in contrast with the current trend of considering the free flaps the first choice procedure for soft tissue coverage of the wounds with internal hardware exposure. Nevertheless, a higher occurrence of postoperative complications was observed in the pedicled flap group (46.87% vs. 10.20%). The choice of the most appropriate reconstructive procedure should take into account several issues including the size of the wounds with internal hardware exposure, the possibility of soft tissue coverage with pedicled flaps, the availability of recipient vessels, general conditions of the patients (such as age, diabetes, smoking history), patients’ preference and presence of a microsurgical team. However, according to the results of this review, we believe that pedicled flap reconstruction should be reconsidered as a valid alternative procedure for skin tissue loss with hardware exposure whenever it is possible
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
First report of digital skin ulcer with Stenotrophomonas maltophilia infection in an immunocompetent patient.
No full textAbstract. Stenotrophomonas maltophilia is an aerobic
Gram-negative bacillus that usually causes infection in
immunocompromised patients. We present the case of an
immunocompetent patient with a distal necrosis of the
second and third fingers of the right hand caused by S.
maltophilia infection. The patient underwent antibiotic
therapy with trimethoprim/sulphamethoxazole on the basis
of the susceptibility tests and he underwent surgical
debridement of the necrotic tissues, including of the distal
phalanx bone, and reconstruction with Atasoy flap.
Stenotrophomonas maltophilia is emerging as an important
cause of skin infection in immunoresponsive patients. Several
community-acquired infections have been reported, however,
as far as we are aware, our case represents the first report of
a digital wound of intact skin caused by community-acquired
S. maltophilia infection in an immunocompetent patient
Evidence-Based Evaluation Technique to Assess Augmentation Mammaplasty Results: A Simple Method to Objectively Analyze Mammary Symmetry and Position
No full textBACKGROUND:
Despite the great variety of mammaplasty techniques, outcome assessment remains a challenging issue.
OBJECTIVES:
The authors devised an objective method to evaluate mammary symmetry based on statistical analysis of objective manual breast measurements and validated the method by applying it to results of a randomized controlled trial on the correction of breast asymmetry.
METHODS:
Sixty consecutive patients with hypoplastic breasts and small-volume asymmetry were enrolled in the study and randomly assigned to 1 of 2 groups. One group received a fixed-volume implant in 1 breast and an adjustable-volume implant in the other. The other group received 2 fixed-volume implants of different sizes. The differences in specific breast and chest measurements, obtained before surgery and during follow-up, were analyzed statistically with the Wilcoxon signed rank test.
RESULTS:
Correction of the asymmetry resulted in the reduction of the differences between left and right values for each specific breast measurement. Placement of an adjustable implant on 1 side yielded better symmetry than placement of 2 fixed-volume prostheses of different sizes. Patient and physician satisfaction was high for both groups.
CONCLUSIONS:
This objective analysis of clinical parameters enables comparing results for different patients in large clinical trials and for the same patient at different follow-up periods
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