1,720,964 research outputs found
Rare e complesse patologie dei tessuti molli degli arti: strategie di gestione, opzioni ricostruttive innovative e soluzioni microchirurgiche
No full textLe patologie croniche progressive o gli eventi acuti di natura traumatica possono compromettere lo stato della cute e dei tessuti molli degli arti determinandone la limitazione o la perdita della funzionalità. Compito del chirurgo plastico è tentare di correggere, riparare o ricostituire i difetti morfologico-funzionali o le perdite di sostanza dell’arto affetto. La scelta della tecnica ricostruttiva più appropriata è dettata dall’età del paziente, dalla durata e dalla natura dell’affezione, dalle caratteristiche delle lesioni e dalle condizioni dei tessuti circostanti. Le opzioni chirurgiche più comunemente utilizzate includono l’utilizzo di innesti cutanei o adiposo, l’utilizzo di matrici dermiche e l’allestimento di lembi loco-regionali o liberi microchirurgici.
La risoluzione di patologie dell’arto di raro riscontro spesso rappresenta una sfida per il chirurgo plastico in quanto le diverse tecniche ricostruttive devono essere personalizzate al singolo paziente. La rarità della patologia comporta la mancanza e la frammentarietà di evidenze scientifiche che possano guidare il chirurgo nell’iter terapeutico più appropriato. È necessario possedere un’ampia conoscenza dell’armamentario delle tecniche ricostruttive descritte in letteratura al fine di poter contribuire alla sistematizzazione e all’ampliamento delle stesse.
La presente ricerca si pone l’obiettivo di analizzare le diverse tecniche descritte per rare patologie dell’arto di interesse plastico-ricostruttivo, di fornire indicazioni operative per la gestione di casi complessi e di illustrare metodi ricostruttivi alternativi attraverso l’effettuazione di studi clinici innovativi. Patologie di raro riscontro possono essere di natura infettiva, autoimmunitaria o traumatica. In particolare, si illustrano lo stato dell’arte e i metodi ricostruttivi innovativi relativi alle patologie linfedematosa, sclerodermica e traumatica. Per quanto attiene il linfedema, vengono mostrati i risultati ottenuti attraverso l’applicazione della combinazione di terapia medica e soluzioni microchirurgiche. Le ulcere digitali della sclerosi sistemica, spesso risultanti in fenomeni amputativi, possono beneficiare dell’applicazione di dispositivi tecnologici ma anche dell’utilizzo di tessuto adiposo autologo di cui vengono presentate le innovazioni tecniche. Infine casi di estesa necrosi dell’arto richiedono competenze tecniche gestionali di cui vengono illustrati casi significativi ed emblematici. I risultati della ricerca effettuata quindi ampliano le possibilità ricostruttive delle patologie rare e complesse dell’arto fornendo gli elementi necessari al corretto inquadramento diagnostico-terapeutico del paziente e presentando valide alternative alle tecniche ricostruttive descritte.Progressive chronic diseases and acute traumatic injuries can compromise cutaneous and soft tissues of the limbs leading to limitation or loss of their function. The role of the plastic surgeon is to reconstruct, repair and restore the morphologic-functional defects of the affected limb. The choice of the reconstructive technique depends on several factors such as age of the patient, duration and nature of the disease, characteristics of the wound, and conditions of the surrounding tissues. The most commonly used surgical reconstructive options include skin grafts, acellular dermal matrices, and loco-regional or free microsurgical flaps. Reconstruction of complex and rare limb diseases often represents a challenge for the plastic surgeon. Well-described reconstructive techniques must be customized for each patient. Rare diseases are uncommon and there are no guidelines to provide rules for selecting the best reconstructive option. It is mandatory to know the armamentarium of the described techniques in order to develop innovative and useful reconstructive methods.
The aim of this research is to: (i) review the described reconstructive techniques about rare limb diseases; (ii) provide a management strategy of complex patients; (iii) study and develop alternative reconstructive approaches. Rare limb disorders have infectious, autoimmune or traumatic etiology. Specifically, the-state-of-the-art and innovative reconstructive methods related to lymphedematous, sclerotic and traumatic limb pathologies are presented. For what concerns limb lymphedema, efficacy of the medical and microsurgical combination is highlighted. With regard to systemic sclerosis digital ulcers, technical innovations in the application of modern technological devices and in the use of autologous adipose are illustrated. Finally, representative cases of extensive limb necrosis are reported in order to improve care pathways. The results of this research provide effective and alternative strategies of diagnostic and therapeutic management encouraging the approach to rare and challenging limb diseases and leading to implementation of reconstructive techniques
The Challenges in restoration of extensor tendons function at the hand
No full textThe authors discuss challenges in extensor function restoration at the finger level following distal posterior interosseous or tendon complex injuries, according to the typologies of lesions or the specific patient requirements
A Simplified and Practical Surgical Treatment for Medial Ectropion: A Case Report
Full text linkWe present the case of a 81-year-old patient with right facial palsy suffering from recurrent medial ectropion with lower lateral dislocation of the lacrimal punctum causing epiphora and photophobia. The patient was first treated for ectropion with lateral tarsal strip procedure. Unfortunately, this surgical procedure did not get the expected result. This was the reason we used the Mitek anchor system to fix the lower lateral dislocation of the punctum. We had no recurrence of symptoms during a follow-up period of 18 months
Ultrasonic Cutting and Coagulating Device in Implant-based breast reconstruction
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Digital Replantations: Comparison Veins Anastomoses first versus Arteries Anastomoses first
No full textThis retrospective study analyses the effect performing veins anastomoses before arteries anastomoses in digital replantation
New management and trauma incidence in hand surgery during the phase 1 of COVID-19 pandemic in a referral hand surgery and microsurgery center into the outbreak in North Italy
No full textBACKGROUND: This is a retrospective study of the casuistry occurred at the Hand Surgery and Microsurgery HUB Center of Emilia-Romagna during the months of March and April 2020 in the peak of Phase 1 of COVID-19 pandemic in Italy, comparing the data with the same period in 2019.METHODS: A more relevant reduction of 92.3% in elective surgery and a significantly less relevant reduction of 37.2% in emergencies was recorded. Replantation did not present reduction while cutting lesions of tendons and saw injuries increased such as the injuries during domestic activities.RESULTS: The incidence of hand trauma looks not only at the traditional field of artisanal and industrial injuries, but also to the most recorded accidents in daily life activities. The data evidenced the significantly increase of the injuries occurring in the domestic environment. The 72.8% of emergencies was treated in day-service with significantly reduction in hospitalization, costs and infective risks. Telemedicine implementation has experienced to upgrade the relationship in the emergency network.CONCLUSIONS: Hand injuries remained a major issue also during the lockdown. A functional and skill emergency service and day-service during the phase 1 COVID-19 pandemic played a relevant role in efficacy and efficiency. The utility of telemedicine was greatly limited by liability and risk management issues
Piezoelectric Bone Surgery. Overview in Applications and Proof of Feasibility in Hand and Plastic Surgery
No full textPURPOSE: Piezoelectric bone surgery was already extensively used in a number of surgical procedures ranging from dental to maxillofacial surgery. The authors aimed to determine whether piezosurgery was suitable and advantageous for performing osteotomies in Hand and Plastic reconstructive surgery. METHODS: The authors overviewed a variety of applications for Piezosurgery(®) Device, from Mectron, in bone reconstructive surgery with over the last 8 years. An overall number of 156 bone cutting procedures in adults and children was described at the phalanges, metacarpal bones and distal radius level, as well as in bone graft harvesting and bone remodeling following carpal scaphoid nonunion, scapho-lunate bone-ligament-bone reconstruction and fibula free flap in maxillofacial defects. RESULTS: The consolidation rate was 87.5% in scaphoid nonunion grafting and fixation. Bone healing was achieved in all other cases. No intra-operative complications were recorded. CONCLUSION: Piezosurgery(®) allowed high precision in bone cutting as well as custom-made graft and surface roughness were obtained, while preserving nerves, vessels and tendons integrity. The instrument may be handling moved into the surgical space in absence of vibrations, with a clear view onto the bone. The mechanical and biological characteristics of the piezoelectrical effect perfected this technique as an effective and useful instrument in Hand and Plastic surgery. The selective bone cutting properties avoided injuries to the surrounding soft tissues and thermal damage of the bony cells. Best advantages were described in feasibility and flexibility for intra-articular osteotomies, custom-made grafts and reconstructive microsurgical techniques
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