1,720,995 research outputs found
Tracheal reconstruction: mini-review and anatomical study on the use of antero lateral thigh fascial flap for heterotopical transplantation
No full textBACKGROUND: The reconstructive tracheal options for extensive lesions still remain limited and although a valid substitute is required unfortunately, the biomechanical tracheal characteristics do not allow an easy replacement. In this study we reviewed the described options and investigated, in human cadaver model, whether thigh fascia can be used, as an alternative to forearm fascia, as recipient site for trachea graft heterotopical allotransplantation. ANATOMICAL STUDY: In three fresh cadavers, 3 tracheal graft, 6 radial forearm (RF) fascial flaps and 6 antero-lateral thigh (ALT) fascial flaps were harvested. For each flap we simulated the heteretopical transplantation of the trachea in each fascial flap, and the harvesting of the composite graft as a free flap. The composite graft was finally decomposed at bench and the pedicle was injected to confirm fascial vascularization. The main measured outcomes were: flap fascia vascularization after pedicle injection, average time of flap harvesting, number of perforators included in ALT fascial flap and diameter of the vessels for anastomosis. Difficulties were noted, in order to compare RF flap and ALT flap. RESULTS: Fascia vascularization was confirmed in all cases by pedicle injection. The main difficulty with radial flap was to harvest the fascial layer due to its thinness and its strong adherence to palmaris longus tendon, while the main difficulty with ALT flap was to prevent any traction on the perforators. The average time of flap harvesting and graft inset (by a junior plastic surgeon) was 1 h and 30 min for radial forearm flap and 2 h and 10 min for ALT flap. CONCLUSION: Despite many different techniques proposed in the literature, tracheal heterotopical allotransplantation still seemed the most promising, and ALT flap promised be a feasible alternative for heterotopical transplantation of trachea
Association of Surgery and Pulsed Dye Laser for the Treatment of an Ear Keloid: A Case Report
No full textBackground and Objective: A keloidal scar is a benign hyperproliferation of dermal collagen resulting from abnormal healing. The ear is probably the most frequent interested area and these kind of keloids are responsible for cosmetic disfigurement. Numerous treatments have been applied for keloids. Surgery is generally not indicated because of the high risk of recurrence while laser technologies have been tested to prevent and treat hypertrophic scars. The association between laser and surgery was poorly reported in literature. We decided to associate surgery and pulsed Dye laser in just one case of ear keloid.
Materials and Methods: We treated a female patient affected by an earlobe keloid with a surgical excision and subsequent pulsed Dye laser treatment.
Results: The aesthetic result was good and no signs of recurrence was observed.
Conclusion: We believe that the association between surgery and Pulsed-Dye laser can be useful to treat keloids reducing the risk of recurrence
Aesthetical outcome after breast reconstruction using deep inferior epigastric perforator flap: Personal techniques
No full textBackground: Now-a-days, deep inferior epigastric perforator (DIEP) flap breast reconstruction is widespread throughout the world. The aesthetical result is very important in breast reconstruction and its improvement is mandatory for plastic surgeons. Materials and Methods: The most frequent problems, we have observed in breast reconstruction with DIEP flap are breast asymmetry in terms of volume and shape, the bulkiness of the inferior lateral quadrant of the new breast, the loss of volume of the upper pole and the lack of projection of the inferior pole. We proposed our personal techniques to improve the aesthetical result in DIEP flap breast reconstruction. Our experience consists of more than 220 DIEP flap breast reconstructions. Results: The methods mentioned for improving the aesthetics of the reconstructed breast reported good results in all cases. Conclusion: The aim of our work is to describe our personal techniques in order to correct the mentioned problems and improve the final aesthetical outcome in DIEP flap breast reconstruction
Early Correction of Septum JJ Deformity in Unilateral Cleft Lip–Cleft Palate
No full textBackground: The treatment of patients affected by unilateral cleft lip–cleft palate is based on a multistage procedure of surgical and nonsurgical treatments in accordance with the different types of deformity. Over time, the surgical approach for the correction of a nasal deformity in a cleft lip–cleft palate has changed notably and the protocol of treatment has evolved continuously. Not touching the cleft lip nose in the primary repair was dogmatic in the past, even though this meant severe functional, aesthetic, and psychological problems for the child. McComb reported a new technique for placement of the alar cartilage during lip repair. The positive results of this new approach proved that the early correction of the alar cartilage anomaly is essential for harmonious facial growth with stable results and without discomfort for the child.
Methods: The authors applied the same principles used for the treatment of the alar cartilage for correction of the septum deformity, introducing a primary rhinoseptoplasty during the cheiloplasty. The authors compared two groups: group A, which underwent septoplasty during cleft lip repair; and group B, which did not.
Results: After the anthropometric evaluation of the two groups, the authors observed better symmetry regarding nasal shape, correct growth of the nose, and a strong reduction of the nasal deformity in the patients who underwent primary JJ septum deformity correction.
Conclusion: The authors can assume that, similar to the alar cartilage, the septum can be repositioned during the primary surgery, without causing growth anomaly, improving the morphologic/functional results
Clinical evidences, personal experiences, recent applications
Full text linkManagement of difficult wounds can be a complex, challenging
and expensive task, especially for wounds showing
a slow healing process. Topical negative pressure
(TNP) therapy has greatly improved difficult wounds
treatment. It allows to treat patient on an outpatient
management, to reduce the complication rate with
shorter hospital stay, to avoid frequent dressings with
expensive advanced materials and allow a lower commitment
of health professionals. Vacuum Assisted Closure®
(VAC®) system is a therapeutic device based on the administration
of a controlled TNP introduced by Morykwas
and Argenta in 1997. It is indicated in different kinds of
wound, but clinical evidences are present only for few of
them. In this work we summarize indications and recommendations
for VAC® therapy and we analyze the actual
better choice of treatment based on evidences and personal
experience in order to stimulate further studies.
Finally we introduce recent applications of VAC® system
such as Prevena®, VAC Instill® and VAC Via®. Prevena® is
a system based on TNP indicated in the management of
closed wounds that present risk factors for dehiscence.
VAC Instill® is a system that allows to associate TNP and
topical administration of solutions, such as antibiotics or
disinfectants, to treat specific type of wounds. VAC Via®
is a device based on TNP, characterized by little dimension
and a preset system that allow the treatment of
little wounds for 7 d, with no impairment for the patient.
The aim of our paper is to describe a report of VAC®
therapy use in order to stimulate further studies and to
define the level of evidence of VAC® therapy
Patient Satisfaction and Quality of Life in DIEAP Flap versus Implant Breast Reconstruction
Full text linkThe psychological impact of breast reconstruction has widely been described, and multiple studies show that reconstruction improves the well-being and quality of life of patients. In breast reconstruction, the goal is not only the morphological result, but mainly the patient's perception of it. The objective of our study is to compare the physical and psychosocial well-being and satisfaction concerning the body image of patients who had reconstruction with breast implants to those of patients who had reconstruction with deep inferior epigastric artery perforator flaps. Our results demonstrated a similar quality of life between the two groups, but the satisfaction level was significantly higher in patients who had reconstruction with autologous tissue. Feedback from patients who have already received breast reconstruction may be useful in the decision-making process for future patients and plastic surgeons, enabling both to choose the reconstructive technique with the best long-term satisfaction
Severe local skin reaction after the application of ingenol mebutate gel treated by photodynamic therapy: A case report
Full text linkIngenol mebutate (IM) was recently introduced for the treatment of actinic keratosis (AK). It is considered a
safe and effective treatment in spite of local reactions frequently reported. These reactions may consist of erythema,
flaking, crusting, swelling, vesicles and erosions, and would usually spontaneously recede within 20–30 days. We
reported a case of a patient affected by multiple actinic keratosis of the scalp treated with IM. The patient reported a
severe reaction that was not solved in two months. We decided to treat the reaction with photodynamic therapy and
aminolevulinic acid. This treatment was demonstrated to be effective in solving this severe side effec
Vulvar reconstruction by perforator flaps: Algorithm for Flap Choice Based on the Topography of the Defect.
No full textOBJECTIVE
Many techniques have been proposed to reconstruct acquired vulvar defects. In our experience every type of vulvar defect can be repaired with two pedicled flaps: the pedicle Deep Inferior Epigastric Perforator flap and the Lotus Petal Flap.
MATERIALS AND METHODS
We report our reconstructive algorithm for vulvar reconstruction, based on the topography of the defect, applied in 22 consecutive patients from 2000 to 2012. According to the proposed algorithm, Deep Inferior Epigastric Perforator flap and Lotus Petal Flap (mono or bilateral type) can repair all kinds of wide vulvar defects. Surgical defects were classified in type I (IA and IB) and type II in relation to the anatomy of the defect.
RESULTS
No major complications were reported in our series. All patients reported satisfactory results, both functionally and aesthetically.
CONCLUSION
We propose an easy classification of acquired vulvar defects separating the ones consequent only to the vulvar resection, with preservation of vagina (type I), by the wider defects following vaginal and vulvar resection (type II); type I can be subclassified into defects consequent to half-vulvar resection (type IA) or to total vulvar resection (type IB). Type I defects (IA and IB) can be reconstructed with mono or bilateral Lotus Petal Flap; in type II resections we have a great wound that required more tissue to fulfill the pelvic dead space, so we prefer pedicle Deep Inferior Epigastric Perforator flap
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
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