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Makihara S, Otani Y, Uraguchi K, Shimizu A, Murai A, Higaki T, Akisada N, Fujimoto S, Makino T, Ishida J, Fujii K, Yasuhara T, Ota T, Matsumoto H, Ando M. Combined simultaneous endoscopic endonasal and transcranial surgery using high-definition three-dimensional exoscope for malignant tumors of the anterior skull base. Head Neck 2024; 46:1074-1082. [PMID: 38450867 DOI: 10.1002/hed.27724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 02/05/2024] [Accepted: 02/26/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Advanced surgical interventions are required to treat malignancies in the anterior skull base (ASB). This study investigates the utility of endoscopic endonasal and transcranial surgery (EETS) using a high-definition three-dimensional exoscope as an alternative to traditional microscopy. METHODS Six patients with carcinomas of varying histopathologies underwent surgery employing the EETS maneuver, which synchronized three distinct surgical modalities: harvesting of the anterolateral thigh flap, initiation of the transnasal technique, and initiation of the transcranial procedure. RESULTS The innovative strategy enabled successful tumor resection and skull base reconstruction without postoperative local neoplastic recurrence, cerebrospinal fluid leakage, or neurological deficits. CONCLUSION The integration of the exoscope and EETS is a novel therapeutic approach for ASB malignancies. This strategy demonstrates the potential of the exoscope in augmenting surgical visualization, enhancing ergonomics, and achieving seamless alignment of multiple surgical interventions. This technique represents a progressive shift in the management of these complex oncological challenges.
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Affiliation(s)
- Seiichiro Makihara
- Department of Otolaryngology - Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshihiro Otani
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kensuke Uraguchi
- Department of Otolaryngology - Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Aiko Shimizu
- Department of Otolaryngology - Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Aya Murai
- Department of Otolaryngology - Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takaya Higaki
- Department of Otolaryngology - Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Naoki Akisada
- Department of Otolaryngology - Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shohei Fujimoto
- Department of Otolaryngology - Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takuma Makino
- Department of Otolaryngology - Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Joji Ishida
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kentaro Fujii
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Takao Yasuhara
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Tomoyuki Ota
- Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Hiroshi Matsumoto
- Department of Plastic and Reconstructive Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Mizuo Ando
- Department of Otolaryngology - Head & Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Vinciguerra A, Atallah S, Boaria F, Molher J, Verillaud B, Chatelet F, Herman P. Septal Nasopharyngeal "Kite Flap" for Long-Term Patency of Petrous Apex Cholesterol Granuloma. Laryngoscope 2024; 134:2111-2114. [PMID: 37767864 DOI: 10.1002/lary.31062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/20/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
Medial petrous apex cholesterol granuloma is a benign lesion which treatment is generally based on a trans-nasal marsupialization. When the artificial ostium is created, it is usually kept open with local flaps, like the septal nasopharyngeal "kite flap", a reliable local vascularized flap. Laryngoscope, 134:2111-2114, 2024.
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Affiliation(s)
| | - Sarah Atallah
- Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France
| | - Francesco Boaria
- Section of Otorhinolaryngology-Head and Neck Surgery, Department of Neurosciences, University of Padua, Padua, Italy
| | - Joffrey Molher
- Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France
| | - Benjamin Verillaud
- Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France
- Université Paris Cité, Paris, France
- Inserm U1141, Paris, France
| | - Florian Chatelet
- Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France
| | - Philippe Herman
- Otorhinolaryngology and Skull Base Center, AP-HP, Hospital Lariboisière, Paris, France
- Université Paris Cité, Paris, France
- Inserm U1141, Paris, France
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Li L, Fan L, Jiang Z, Yang X, Wang D, Chen F, Gu D, Liu J. Pedicled flaps reconstruction of hypopharynx and laryngeal defects: Successful preservation of laryngeal function in patients with advanced hypopharyngeal cancer. Head Neck 2024; 46:E49-E56. [PMID: 38275118 DOI: 10.1002/hed.27650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/14/2023] [Accepted: 01/14/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Preserving laryngeal function and reconstructing the hypopharynx in advanced hypopharyngeal cancer pose significant challenges for head and neck surgeons. METHODS A 48-year-old male patient was diagnosed with advanced hypopharyngeal cancer originating from the left pyriform sinus. The tumor extended into the hypopharynx, left vocal cord, ventricular fold, partial aryepiglottic fold, and a segment of the cervical esophagus. A curative tumor resection was performed, and a well-thought-out strategy was employed for hypopharyngeal repair and laryngeal reconstruction. RESULTS Following the surgery, the patient demonstrated exceptional flap survival, and the tracheostomy tube was removed at the 6-month mark. No surgery-related complications were observed, and both swallowing and vocal functions exhibited a robust recovery. CONCLUSION Our reconstruction strategy proves effective in preserving laryngeal function among patients with advanced hypopharyngeal cancer.
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Affiliation(s)
- Leyu Li
- Department of Otolaryngology - Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
- Head and Neck Surgical Center, West China Hospital, Chengdu, China
| | - Lixiao Fan
- Department of Otolaryngology - Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
- Head and Neck Surgical Center, West China Hospital, Chengdu, China
| | - Zheng Jiang
- Department of Otolaryngology - Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
- Head and Neck Surgical Center, West China Hospital, Chengdu, China
| | - Xin Yang
- Department of Otolaryngology - Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
- Head and Neck Surgical Center, West China Hospital, Chengdu, China
| | - Dejuan Wang
- Department of Otolaryngology - Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
- Head and Neck Surgical Center, West China Hospital, Chengdu, China
| | - Fei Chen
- Department of Otolaryngology - Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
- Head and Neck Surgical Center, West China Hospital, Chengdu, China
| | - Deying Gu
- Department of Otolaryngology - Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jun Liu
- Department of Otolaryngology - Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
- Head and Neck Surgical Center, West China Hospital, Chengdu, China
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Mallappa J, Patil L, Mani AD, Gowda TM. Novel biomaterial advanced platelet-rich fibrin plus block for multiple gingival recession. Clin Adv Periodontics 2024; 14:63-69. [PMID: 37417683 DOI: 10.1002/cap.10257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/15/2023] [Accepted: 07/04/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND The study was aimed to assess and compare hard and soft tissue augmentation clinicoradiographically with and without advanced platelet-rich fibrin + (A-PRF+) block for the treatment of multiple gingival recession using vestibular incision subperiosteal tunnel access (VISTA). METHODS A total of 24 patients, exhibiting multiple Miller's Class I or II recessions in the maxillary esthetic zone were included. Participants were divided into two groups, Group 1 was treated with VISTA & A-PRF+ block whereas Group 2 was with VISTA technique alone. Clinical parameters probing depth, width of keratinized gingiva, gingival biotype, recession depth, and clinical attachment level were recorded at baseline and the end of 6 months. The radiographic cone beam computed tomography measurements of labial plate thickness were taken at baseline and 6 months postoperatively. RESULTS From baseline to 6 months both the groups showed a clinical and statistical improvement in the parameters. However, a statistically significant difference between the treatment modalities was not observed. In the inter-group comparison radiographically, labial plate thickness was statistically significant at the end of 6 months when compared to the baseline. CONCLUSION A-PRF+ block along with the VISTA technique can be an alternative effective root coverage procedure for the management of multiple gingival recessions in the maxillary esthetic zone. KEY POINTS Why is this study new information? To the best of our knowledge, this is the first study using advanced platelet-rich fibrin plus block for the treatment of multiple gingival recession with a thin labial plate. What are the keys to the successful management of these types of cases? Minimally invasive vestibular incision subperiosteal tunnel access technique, and avoidance of second surgical site morbidity are important factors for treatment and for patient compliance. What are the primary limitations of this study? Short study duration, small sample size, and no histological correlation can be considered as limitations of the study.
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Affiliation(s)
- Jayasheela Mallappa
- Department Of Periodontics, Bapuji Dental College And Hospital, Davangere, India
| | - Leena Patil
- Department Of Periodontics, Bapuji Dental College And Hospital, Davangere, India
| | - Adi Deepika Mani
- Department Of Periodontics, Bapuji Dental College And Hospital, Davangere, India
| | - Triveni M Gowda
- Department Of Periodontics, Bapuji Dental College And Hospital, Davangere, India
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Gutkind NE, Pirakitikulr N, Alabiad C, Tse DT, Rong A. Difficulties of nasocutaneous fistula repair, following lacrimal outflow system malignancy resection. Orbit 2024; 43:90-94. [PMID: 37199572 PMCID: PMC10656355 DOI: 10.1080/01676830.2023.2211682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/03/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE To evaluate the incidence of nasocutaneous fistula (NCF) development, following en bloc resection of lacrimal outflow system malignancies (LOSM), and describe the methods of surgical repair. METHODS Retrospective review of all patients who underwent resection of LOSM with reconstruction and post-treatment protocol at the University of Miami between 1997 and 2021. RESULTS Of the 23 included patients, 10 (43%) developed postoperative NCF. All NCFs developed within one year of surgical resection or completion of radiation therapy. NCF was seen more frequently in patients who underwent adjuvant radiation therapy and those who had reconstruction of the orbital wall with titanium implants. All patients underwent at least one revisional surgery to close the NCF, including local flap transposition (9/10), paramedian forehead flap (5/10), pericranial flap (1/10), nasoseptal flap (2/10), and microvascular free flap (1/10). Local tissue transfer, pericranial, paramedian, and nasoseptal forehead flaps failed in most cases. Two patients had long-term closure; one patient who underwent a paramedian flap and a second who underwent a radial forearm free flap, suggesting that well-vascularized flaps may be the most viable option for repair. CONCLUSIONS NCF is a known complication, following en bloc resection of lacrimal outflow system malignancies. Risk factors for formation may include adjuvant radiation therapy and use of titanium implants for reconstruction. Surgeons should consider utilizing robust vascular-pedicled flaps or microvascular free flaps for repair of NCF in this clinical scenario.
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Affiliation(s)
- Naomi E. Gutkind
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL. USA
| | - Nathan Pirakitikulr
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL. USA
- Jules Stein Eye Institute, University of California Los Angeles, Los Angeles, CA. USA
| | - Chris Alabiad
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL. USA
| | - David T. Tse
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL. USA
| | - Andrew Rong
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL. USA
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Evans J, Chang C, Jones C, Anderson I, Berner JE, Crowley TP, Ragbir M. Clinical characteristics and treatment outcomes of angiosarcoma of the head and neck: A 17-year single-centre experience. J Plast Reconstr Aesthet Surg 2024; 88:452-456. [PMID: 38091688 DOI: 10.1016/j.bjps.2023.11.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 11/05/2023] [Accepted: 11/26/2023] [Indexed: 01/02/2024]
Abstract
INTRODUCTION Angiosarcomas in the head and neck region are aggressive tumours associated with high local recurrence and metastatic rates. We present our 17-year experience at the North of England Bone and Soft Tissue Tumour Service. METHODS A retrospective review of our prospectively maintained database was undertaken, looking for patients diagnosed with angiosarcomas affecting the head and neck. Data were gathered using a pre-defined proforma to include demographics, histological characteristics, treatment modalities, adjuvant therapies, local recurrence, distant spread, and disease-specific survival. RESULTS A total of 23 patients (17 males, 6 females) were identified, with a mean age of 76 years at presentation. Fourteen presented with scalp lesions, whereas the remainder arose on the face. Eighteen patients underwent resection with curative intent, whereas three received palliative radiotherapy and two received comfort-based care only. Of the patients undergoing surgery, 12 had local flap reconstruction and 6 underwent free tissue transfer. Clear resection margins were obtained in nine cases (50%). Fourteen patients (78%) presented with local recurrence after surgery, and 11 (61%) developed distant metastases. The median disease-specific survival time for patients treated with curative intent was 38 months. Eight patients had mapping biopsies ahead of their resection; however, complete resection was achieved in only two cases. DISCUSSION Angiosarcomas of the head and neck are associated with a poor prognosis, with most patients rapidly developing local recurrence, resulting in adverse clinical outcomes. Mapping biopsies do not demonstrate a clear advantage for achieving complete surgical resection. A radical surgical approach is warranted, given the aggressiveness of the pathology. However, there remains no consensus on optimal surgical management; we recommend further synthesising studies to determine the most appropriate treatment pathway.
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Affiliation(s)
- Jonathan Evans
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom.
| | - Chad Chang
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom; Division of Plastic and Reconstructive Surgery, Department of Surgery, China Medical University Hospital, Taichung, Taiwan
| | - Christopher Jones
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Iain Anderson
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Juan Enrique Berner
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Timothy P Crowley
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Maniram Ragbir
- The North of England Bone and Soft Tissue Tumour Service, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
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冉 小, 刘 元, 朱 珊, 李 杉, 陈 子, 韩 婷, 晋 圣, 周 梦, 臧 梦. [Principle and clinical application of keloid core excision technique]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2023; 37:1569-1577. [PMID: 38130203 PMCID: PMC10739659 DOI: 10.7507/1002-1892.202308033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 11/07/2023] [Indexed: 12/23/2023]
Abstract
Objective To review the research progress of the principle and clinical application of keloid core excision technique. Methods The literature on keloid core excision technique at home and abroad in recent years was extensively reviewed, and the principle, development history, indications, advantages and disadvantages of this technique were summarized, and the existing controversies were analyzed. Results Keloid core excision is a technique to remove the inner fibrous core from the keloid and cover the defect with the keloidal flap. It reduces the wound tension, yields good aesthetic results in the treatment of ear keloids, and reduces the recurrence rate of keloids combining with adjuvant therapies. Conclusion The keloid core excision technique has specific advantages, yet its overall efficacy remains controversial. Further studies are imperative to explore the mechanisms regarding keloid recurrence and the vascular supply principles of the keloidal flap. It is also necessary to define appropriate surgical indications and safety protocols of this technique.
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Affiliation(s)
- 小叶 冉
- 中国医学科学院 北京协和医学院整形外科医院瘢痕与创面治疗中心(北京 100144)Scar & Wound Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P. R. China
| | - 元波 刘
- 中国医学科学院 北京协和医学院整形外科医院瘢痕与创面治疗中心(北京 100144)Scar & Wound Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P. R. China
| | - 珊 朱
- 中国医学科学院 北京协和医学院整形外科医院瘢痕与创面治疗中心(北京 100144)Scar & Wound Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P. R. China
| | - 杉珊 李
- 中国医学科学院 北京协和医学院整形外科医院瘢痕与创面治疗中心(北京 100144)Scar & Wound Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P. R. China
| | - 子翔 陈
- 中国医学科学院 北京协和医学院整形外科医院瘢痕与创面治疗中心(北京 100144)Scar & Wound Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P. R. China
| | - 婷璐 韩
- 中国医学科学院 北京协和医学院整形外科医院瘢痕与创面治疗中心(北京 100144)Scar & Wound Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P. R. China
| | - 圣阳 晋
- 中国医学科学院 北京协和医学院整形外科医院瘢痕与创面治疗中心(北京 100144)Scar & Wound Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P. R. China
| | - 梦琪 周
- 中国医学科学院 北京协和医学院整形外科医院瘢痕与创面治疗中心(北京 100144)Scar & Wound Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P. R. China
| | - 梦青 臧
- 中国医学科学院 北京协和医学院整形外科医院瘢痕与创面治疗中心(北京 100144)Scar & Wound Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P. R. China
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Okui T, Morioka R, Sonoyama R, Ishizuka S, Okuma S, Tatsumi H, Okui T, Suda S, Hayashida K, Kanno T. [A Case of Recurrent Tongue Cancer in a Patient of AYA Generation Who Underwent Salvage Surgery and Oral-Maxillofacial Reconstruction after Super-Selective Intra-Arterial Chemoradiotherapy]. Gan To Kagaku Ryoho 2023; 50:1595-1599. [PMID: 38303353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Radical tumor resection for oral cancer can cause morphological and esthetic disorders and oral and maxillofacial dysfunction and maintaining a social life could become challenging, especially in the adolescents and young adults(AYA)generation. Conversely, chemoradiotherapy for young patients may cause adverse reactions such as impaired fertility and late side effects of radiation. Therefore, treatment should be performed cautiously. We report a case of AYA generation patient who underwent salvage surgery and maxillofacial reconstruction for recurrent tongue cancer after super-selective intra-arterial chemoradiotherapy. The patient was a 30-year-old woman who was 20 weeks pregnant. She was diagnosed with Stage Ⅲ squamous cell carcinoma of the right tongue, cT3N0M0. After abortion, the patient underwent super-selective intra-arterial chemoradiotherapy and achieved a complete response. However, 13 years later, a recurrence of Stage ⅣA tongue cancer, r- cT4aN2bM0, was reported. Additionally, the patient had osteoradionecrosis. We performed radical tumor resection(bilateral neck dissection plus subtotal glossectomy plus segmental mandibulectomy)and maxillofacial reconstruction with a fibula flap. Subsequently, we performed occlusal reconstruction treatment using dental implants. Three years postoperatively, no tumor recurrence was observed, and the patient was satisfied with the restored morpho-aesthetic and maxillo-oral functions.
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Affiliation(s)
- Taro Okui
- Dept. of Oral and Maxillofacial Surgery, Shimane University Faculty of Medicine
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Akyuz M, Ozsoy E, Tokuc E, Artuk I, Kayar R, Bastug Y, Öztürk Mİ. Management and outcomes of urethral stricture: single centre experience over 13 years. Aktuelle Urol 2023; 54:482-486. [PMID: 36002031 DOI: 10.1055/a-1904-6943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
AIM To present a comprehensive summary of the diagnosis, treatment and follow-up process of patients who underwent open urethroplasty in our tertiary referral center for the treatment of urethral stricture in the last 13 years. MATERIALS AND METHODS Two hundred and forty-five (245) patients who underwent open urethroplasty between January 2008 and June 2021 were retrospectively analysed. Detailed history, physical examination, uroflowmetry, retrograde urethrography and/or voiding cystourethrography and/or urethroscopy were used throughout the preoperative diagnosis process. While evaluating the postoperative patency rates, the absence of preoperative voiding symptoms after the operation and Qmax 15 ml/sec and above were taken into account. RESULTS Mean stricture length was 3.8 +/- 1.4 cm. Transurethral endoscopic interventions in 79 patients (32.2%), catheterisation in 55 patients (22.4%), trauma in 54 patients (22%), infection in 15 patients (6.2%), and idiopathology in 42 patients (17.2%) were the causes for the stricture. Buccal mucosal graft was used in 125 patients (51%), penile skin flap in 32 patients (13%), end-to-end anastomosis in 83 patients (33.8%) and Heineke-Mikulicz technique in 5 patients (2%). Mean follow-up period was 67.1 +/- 28.9 months. Success rates of patients were 84% (105) in buccal mucosal graft, 78.1% (25) in penile skin flap, 86.7% (72) with end-to-end anastomosis and 80% (4) with Heineke-Mikulicz technique. CONCLUSION Among treatment options for urethral stricture, urethroplasty techniques is the most successful treatment. Consideration of the factors leading to the formation of the stricture, with the intraoperative findings and surgical experience will maximize the benefit the patient receives.
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Affiliation(s)
- Mehmet Akyuz
- Urology, Istsanbul Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Emrah Ozsoy
- Urology, Ünye Çakırtepe Hospital, Ordu, Turkey
| | - Emre Tokuc
- Urology, Istsanbul Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ilker Artuk
- Urology, Istsanbul Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ridvan Kayar
- Urology, Istsanbul Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Yavuz Bastug
- Urology, Istsanbul Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Metin İshak Öztürk
- Urology, Istsanbul Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
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Tatara N, Yoshitomi S, Morikawa N, Hara K, Tsuji H. [A Case of Giant Phyllodes Tumor Treated with Breast Reconstruction]. Gan To Kagaku Ryoho 2023; 50:1733-1735. [PMID: 38303189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
A 62-year-old woman was diagnosed with right breast tumor 2 years ago, which she refused to undergo surgery. The patient experienced a rapid enlargement of the mass over the past 1 month, and visited hospital. The patient was diagnosed with a borderline phyllodes tumor by needle biopsy. Her right breast was occupied by an 18 cm mass. We conducted tumor resection and immediate reconstruction with DIEAP flap. The pathological diagnosis was a malignant phyllodes tumor, and the postoperative radiation to the chest wall was performed. During a year and a half follow up, she has no recurrence and highly satisfied with the reconstructed breast. Phyllodes tumors may recur locally regardless of whether they are benign or malignant, and we need strict follow-up.
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Affiliation(s)
- Nozomi Tatara
- Dept. of Breast and Endocrine Surgery, Japanese Red Cross Okayama Hospital
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Terakawa H, Kawata C, Kurokawa Y, Ooe Y, Mohri R, Hirata M, Moriyama H, Kinoshita J, Kawashima H, Inaki N. [A Case of Resection of Right Axillary Accessory Breast Cancer with Skin Invasion]. Gan To Kagaku Ryoho 2023; 50:1417-1419. [PMID: 38303293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
A 56-year-old female was referred to our hospital for further examination and treatment because of her increasing right axillary mass for 1 year. Based on histological examination diagnosing the right axillary mass as carcinoma and radiological examination showing no evidence of distal metastasis, we decided to perform a radical resection. The patient underwent right axillary mass resection, axillary lymph node dissection, and latissimus dorsi musculocutaneous flap reconstruction. Right-sided breast cancer was diagnosed based on histopathological examination. The diagnosis was similar to that of breast cancer. The patient underwent adjunctive chemotherapy and is currently undergoing endocrine therapy. The incidence of accessory breast cancer is 0.2-0.6% among all breast cancers and is relatively rare. Postoperative adjuvant pharmacotherapy has no consensus. However, endocrine therapy, chemotherapy, and molecular target therapy are performed in cases of conventional breast cancer. Herein, we describe a case of right axillary accessory breast cancer with skin invasion successfully treated with radical resection.
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Affiliation(s)
- Hirofumi Terakawa
- Dept. of Gastrointestinal Surgery, Breast Oncology, Kanazawa University Hospital
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12
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Ha JH, Lee SY, Choi TH, Park SO. Surgical delay increases the survival of expanded random-pattern flap in pediatric patients. Sci Rep 2023; 13:19204. [PMID: 37932369 PMCID: PMC10628270 DOI: 10.1038/s41598-023-45852-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/24/2023] [Indexed: 11/08/2023] Open
Abstract
Despite the aid of tissue expansion, the ideal design of random pattern flap is not always available in patients with extensive skin lesions. We investigated the effectiveness of surgical delay on expanded flaps in pediatric patients. Retrospective cohort study was performed on patients who underwent tissue expansion surgery for extensive skin lesions at Seoul National University Children's Hospital. The surgical delay technique was employed for patients with unfavorable flap conditions related to location or transposition angles. The dimensions of skin lesions and flaps were measured based on medical photographs. Fifty patients underwent a total of 66 tissue expansion procedures (49 conventional procedures among 41 patients, 17 surgical delay procedures among 15 patients) from January 2016 to September 2019. Although flaps in the surgical delay group were more narrow-based (p < 0.001), the partial flap loss rate and excised area-to-inflation amount ratio was comparable between the two groups (p = 0.093 and p = 0.194, respectively). Viable flaps, excluding postoperative necrosis, in the surgical delay group were significantly more narrow-based in terms of the length-to-base width ratio and the area-to-base width ratio compared to conventional group (p < 0.01, p < 0.01). Surgical delay can result in outcomes comparable to well-designed random flaps, even in disadvantageous conditions. Patients with large skin lesions but limited areas for expansion may benefit from surgical delay.
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Affiliation(s)
- Jeong Hyun Ha
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
- Interdisciplinary Program of Medical Informatics, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Se Yeon Lee
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tae Hyun Choi
- The Nevus Plastic Surgery Clinic, Seoul, Republic of Korea
| | - Seong Oh Park
- Department of Plastic and Reconstructive Surgery, Hanyang University College of Medicine, Seoul, Republic of Korea.
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13
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Shaari D, Dowling E, Urken ML. How I Do It: Sternocleidomastoid Flap Augmentation of Tracheal Repair After Resection for Invasive Thyroid Cancer. Laryngoscope 2023; 133:3228-3231. [PMID: 37067021 DOI: 10.1002/lary.30700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/24/2023] [Indexed: 04/18/2023]
Abstract
Surgical treatment for thyroid carcinoma invading the trachea often involves circumferential tracheal resection and primary tracheal repair. This procedure involves a significant risk of anastomotic breakdown. We present a novel approach to cricotracheal repair using an SCM flap bolster designed to reduce the risk of anastomotic complications. Laryngoscope, 133:3228-3231, 2023.
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Affiliation(s)
- Diana Shaari
- Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, New York, U.S.A
| | - Eric Dowling
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Mark L Urken
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
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14
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Nawojowska Á, Mendes S, Cabral D, Antunes M, Félix F. Innovative 3d-Printed Prosthesis In A Rare Case Of A Huge Mass Of Anterior Thoracic Wall - Low Grade Fibromyxoid Sarcoma (Lgfms). Port J Card Thorac Vasc Surg 2023; 30:81-84. [PMID: 38499031 DOI: 10.48729/pjctvs.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/11/2023] [Indexed: 03/20/2024]
Abstract
The need for complete resection of chest wall tumors creates a huge challenge in terms of reconstructing the complex dynamics of the thorax. We are reporting a case of a low-grade fibromyxoid sarcoma (LGFMS) diagnosed in a young male, where the complete resection of the mass, sternum and parcially the pericardium was performed. Subsequently, a composite porous high-density polyethylene StarPore® prosthesis of the sternum and costal arches was used and the latissimus dorsi muscle free flap with skin graft was implanted over the sternum.
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Affiliation(s)
- Ágata Nawojowska
- Serviço de Cirurgia Torácica, Hospital Pulido Valente, CHULN. Portugal
| | - Samuel Mendes
- Serviço de Cirurgia Torácica, Hospital Pulido Valente, CHULN. Portugal
| | - Daniel Cabral
- Serviço de Cirurgia Torácica, Hospital Pulido Valente, CHULN. Portugal
| | - Mariana Antunes
- Serviço de Cirurgia Torácica, Hospital Pulido Valente, CHULN. Portugal
| | - Francisco Félix
- Serviço de Cirurgia Torácica, Hospital Pulido Valente, CHULN. Portugal
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15
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Ouhaddi Y, Dalisson B, Rastinfard A, Gilardino M, Watters K, Job D, Azizi-Mehr P, Merle G, Lasagabaster AV, Barralet J. Necrosis reduction efficacy of subdermal biomaterial mediated oxygen delivery in ischemic skin flaps. Biomater Adv 2023; 153:213519. [PMID: 37392519 DOI: 10.1016/j.bioadv.2023.213519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/24/2023] [Accepted: 06/10/2023] [Indexed: 07/03/2023]
Abstract
Inadequate tissue blood supply as may be found in a wound or a poorly vascularised graft, can result in tissue ischemia and necrosis. As revascularization is a slow process relative to the proliferation of bacteria and the onset of tissue necrosis, extensive tissue damage and loss can occur before healing is underway. Necrosis can develop rapidly, and treatment options are limited such that loss of tissue following necrosis onset is considered unavoidable and irreversible. Oxygen delivery from biomaterials exploiting aqueous decomposition of peroxy-compounds has shown some potential in overcoming the supply limitations by creating oxygen concentration gradients higher than can be attained physiologically or by air saturated solutions. We sought to test whether subdermal oxygen delivery from a material composite that was buffered and contained a catalyst, to reduce hydrogen peroxide release, could ameliorate necrosis in a 9 × 2 cm flap in a rat model that reliably underwent 40 % necrosis if untreated. Blood flow in this flap reduced from near normal to essentially zero, along its 9 cm length and subdermal perforator vessel anastomosis was physically prevented by placement of a polymer sheet. In the middle, low blood flow region of the flap, treatment significantly reduced necrosis based on measurements from photographs and histological micrographs. No change was observed in blood vessel density but significant differences in HIF1-α, inducible nitric oxide synthase and liver arginase were observed with oxygen delivery.
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Affiliation(s)
- Yassine Ouhaddi
- Division of Orthopaedics, Department of Surgery, Faculty of Medicine and Health Sciences, Montreal General Hospital, Montreal, QC H3G 1A4, Canada
| | - Benjamin Dalisson
- Faculty of Dentistry, McGill University, 2001 McGill College Avenue, Montreal, QC, H3A 1G1, Canada
| | - Arghavan Rastinfard
- Division of Orthopaedics, Department of Surgery, Faculty of Medicine and Health Sciences, Montreal General Hospital, Montreal, QC H3G 1A4, Canada
| | - Mirko Gilardino
- Division of Pastic and Reconstructive Surgery, Department of Surgery, Montreal General Hospital, Montreal, QC H3G 1A4, Canada
| | - Kevin Watters
- Department of Pathology, Glen Site, McGill University Health Centre, Montreal, Quebec H4A 3J1, Canada
| | - Dario Job
- Division of Orthopaedics, Department of Surgery, Faculty of Medicine and Health Sciences, Montreal General Hospital, Montreal, QC H3G 1A4, Canada
| | - Parsa Azizi-Mehr
- Division of Orthopaedics, Department of Surgery, Faculty of Medicine and Health Sciences, Montreal General Hospital, Montreal, QC H3G 1A4, Canada
| | - Geraldine Merle
- Division of Orthopaedics, Department of Surgery, Faculty of Medicine and Health Sciences, Montreal General Hospital, Montreal, QC H3G 1A4, Canada
| | - Arturo Vela Lasagabaster
- Division of Pastic and Reconstructive Surgery, Department of Surgery, Montreal General Hospital, Montreal, QC H3G 1A4, Canada
| | - Jake Barralet
- Division of Orthopaedics, Department of Surgery, Faculty of Medicine and Health Sciences, Montreal General Hospital, Montreal, QC H3G 1A4, Canada; Faculty of Dentistry, McGill University, 2001 McGill College Avenue, Montreal, QC, H3A 1G1, Canada.
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16
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Gabusi A, Stefanini M, Gissi DB, Rossi R, Sangiorgi M, Loi C, Filippi F, Montebugnoli L, Zucchelli G, Bardazzi F. Surgical management of gingival recessions in patients with refractory gingival pemphigus vulgaris: A multidisciplinary challenge. Clin Adv Periodontics 2023; 13:168-173. [PMID: 36733218 DOI: 10.1002/cap.10238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/29/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Mucogingival surgery for root coverage of gingival recessions (GRs) is usually performed in patients with unremarkable periodontal and systemic health. However, the predictable results of surgical procedures and increasingly high aesthetic expectations of patients necessitate optimal management of GR also in patients with systemic conditions that affect the oral cavity. In patients with pemphigus vulgaris (PV), mucosal fragility and complicated surgical management of inflamed soft tissues are major challenges. METHODS AND RESULTS A 36-year-old female patient with PV and deep GR on the mandibular incisors is presented. After initial unresponsiveness to steroids and immunosuppressants, complete clinical remission was achieved through repeated rituximab infusions and topical platelet-rich plasma. After > 1 year of stable clinical remission off therapy the patient successfully underwent surgical procedures for vertically coronally advanced flap with connective tissue graft. CONCLUSIONS To the best of our knowledge, no studies have described the surgical management of GR in PV patients. Although controlled studies are required to confirm present results, complete and stable clinical remission is necessary to avoid complications. Collaboration among dermatologists, oral medicine specialists, and periodontologists is essential to determine whether mucogingival surgery for root surface exposure is indicated for PV patients. KEY POINTS Why are these cases new information? This is the first report of root coverage in a patient with oral PV What are the keys to the successful management of these cases? The achievement of complete and stable clinical remission from oral PV Multidisciplinary collaboration among dermatologists, oral medicine specialists, and periodontologists What are the primary limitations to success in these cases? The refractoriness of gingival lesions induced by PV Poor mucogingival conditions of inflamed gingival tissues exacerbated by PV.
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Affiliation(s)
- Andrea Gabusi
- Section of Oral Sciences, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Martina Stefanini
- Section of Oral Sciences, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Davide Bartolomeo Gissi
- Section of Oral Sciences, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Roberto Rossi
- Section of Oral Sciences, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Matteo Sangiorgi
- Section of Oral Sciences, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Camilla Loi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
- Division of Dermatology, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Federica Filippi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
- Division of Dermatology, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lucio Montebugnoli
- Section of Oral Sciences, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giovanni Zucchelli
- Section of Oral Sciences, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Federico Bardazzi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
- Division of Dermatology, IRCCS (Istituto di Ricovero e Cura a Carattere Scientifico) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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17
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Tai JHC, Lai KKH, Kuk AKT, Chan E, Ko CKL. Modified vertical lid split orbitotomy: a case series and literature review. Orbit 2023; 42:181-184. [PMID: 35657059 DOI: 10.1080/01676830.2022.2083185] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To describe the modified vertical lid split (VLS) technique for anterior orbitotomy and report surgical outcomes in patients with intraconal lesion removal using this surgical technique. METHOD Retrospective review of medical records and orbital images. RESULTS A total of four (female = 3) patients with intraconal orbital lesions underwent modified VLS orbitotomy from January 1, 2019 to June 30, 2021 in Hong Kong East Cluster. The average age was 49.3 years old (range: 35-65). Complete excision of intraconal orbital lesion was performed in all four cases. All cases were cavernous haemangioma histologically. All patients were satisfied with their cosmesis postoperatively and most had satisfactory postoperative extraocular movement. CONCLUSION Modified VLS approach is simple and provides good intraoperative surgical exposure for intraconal lesions, giving the additional advantage of better scar camouflage.
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Affiliation(s)
- Jacqueline H C Tai
- Department of Ophthalmology, Tung Wah Eastern Hospital, Causeway Bay, Hong Kong
| | - Kenneth K H Lai
- Department of Ophthalmology, Tung Wah Eastern Hospital, Causeway Bay, Hong Kong
| | - Andrew K T Kuk
- Department of Ophthalmology, Tung Wah Eastern Hospital, Causeway Bay, Hong Kong
| | - Edwin Chan
- Department of Ophthalmology, Tung Wah Eastern Hospital, Causeway Bay, Hong Kong
| | - Callie K L Ko
- Department of Ophthalmology, Tung Wah Eastern Hospital, Causeway Bay, Hong Kong
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18
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Lattimore CM, Meneveau MO, Marsh KM, Shada AL, Slingluff CL, Dengel LT. A Novel Fascial Flap Technique After Inguinal Complete Lymph Node Dissection for Melanoma. J Surg Res 2022; 278:356-363. [PMID: 35671681 DOI: 10.1016/j.jss.2022.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/07/2022] [Accepted: 04/13/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Inguinal complete lymph node dissection (CLND) for metastatic melanoma exposes the femoral vein and artery. To protect femoral vessels while preserving the sartorius muscle, we developed a novel sartorius and adductor fascial flap (SAFF) technique for coverage. METHODS The SAFF technique includes dissection of fascia off sartorius and/or adductor muscles, rotation over femoral vasculature, and suturing into place. Patients who underwent inguinal CLND with SAFF for melanoma at our institution were identified retrospectively from a prospectively-collected database. Patient characteristics and post-operative outcomes were obtained. Multivariate logistic regression assessed associations of palpable and non-palpable disease with wound complications. RESULTS From 2008 to 2019, 51 patients underwent CLND with SAFF. Median age was 62 years, and 59% were female. Thirty-one (61%) patients were presented with palpable disease and 20 (39%) had non-palpable disease. Fifty-five percent (95% confidence interval CI: 40%-69%) experienced at least one wound complication: wound infection was most common (45%; 95% CI: 31%-60%), while bleeding was the least (2%; 95% CI: 0.05%-11%). Complications were similar, with and without palpable disease. CONCLUSIONS The SAFF procedure covers femoral vessels, minimizes bleeding, preserves the sartorius muscle, and uses standard surgical techniques easily adoptable by surgeons who perform inguinal CLND.
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Affiliation(s)
- Courtney M Lattimore
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Max O Meneveau
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Katherine M Marsh
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Amber L Shada
- Department of Surgery, University of Wisconsin, Madison, Wisconsin
| | - Craig L Slingluff
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia
| | - Lynn T Dengel
- Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.
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Coseriu A, Prodan L, Fetti A, Filip C. Surgical management of massive penoscrotal lymphedema. Case report and literature review. Ann Ital Chir 2022; 11:S2239253X22035927. [PMID: 36200282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Giant lymphedema of the penis and scrotum is a rare and peculiar condition that carries many challanges for both the patient and the physician. The etiology of the disease is often difficult to trace, especially in geographical areas where filariasis is not endemic. CASE PRESENTATION We reported an advanced case of massive penoscrotal lymphedema presented to our plastic surgery department. Extensive physical examination and imaging investigations allowed for a wide surgical excision of the tumor with the preservation of the penile body and testicles. The reconstruction was performed with adjacent healthy skin flaps and a split-thickness skin graft for the penis. The outcome was a success and the follow-up revealed no recurrences. DISCUSSION Although the onset of the disease was poorly established, we regarded it as a secondary lymhpedema resulting from chronic local infection. The particularity of this case was the exclusive involvement of the superficial structures, as seen in similar cases from the literature. The clinical presentation explained by the distinctive lymphatic drainage offered a guided and rather secure surgical approach. The reconstruction techniques are varied and should not pose recurrence risks as long as functional tissue is used. CONCLUSION Massive penoscrotal lymphedema cases display unique evolution and features leading to great impairment. In most instances, surgery is the treatment of choice as the pathological changes are irreversible. Our technique was innovative and comprised similarities and differences compared to other research, nevertheless, the results were a success. KEY WORDS Penoscrotal Lymphedema, Surgical Excision, Reconstruction Techniques.
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20
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Abouzid A, Shetiwy M, Hossam A, Abd Elghaffar M. Abdominal wall reconstruction using Omental Flap with Mesh repair following resection of Aggressive Abdominal Wall Neoplasms. Oncol Res Treat 2022; 45:415-422. [PMID: 35537417 DOI: 10.1159/000524871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/24/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Resection of large anterior abdominal wall tumors causes a large full-thickness abdominal wall defects, and the repair of these defects remains a challenging point. METHODS Between July 2016 and February 2021, we retrospectively reviewed the internal database registry of the Oncology Center, Mansoura University (OCMU) Egypt, for patients with large abdominal wall defects after abdominal wall tumors resection and repair with omental flaps and synthetic Polypropylene (PP) mesh. Thirty-two patients met the inclusion criteria. They were analyzed for demographics, operative data including defect size, mesh size, intrabdominal tumor extension and postoperative outcomes and complications. RESULTS Thirty-Two patients with abdominal wall neoplasm underwent local resection in our center and the defect was closed with omental flap and PP mesh. The mean operative time was 143.75 ± 30.77 mins. The mean size of the abdominal wall defect was 50.78 cm2 (range: 25 - 90 cm2). The meshes used in reconstruction had a mean size of 89.53 cm2 (range: 55 - 130 cm2). The median follow-up period of the patients was 13.5 months (range: 5-54 months). Post-operative complications included infection (n = 4 cases), seroma (n = 2 cases), hematoma (n =1 case) and abnormal sensation (n = 5 cases). Tumor recurrence was reported in two cases and no cases developed incisional hernia during the follow up period. CONCLUSION Immediate use of omental flap with synthetic (PP) mesh for reconstruction of abdominal wall defects is a feasible technique and has avoided the complications associated with the use of synthetic mesh alone.
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Affiliation(s)
- Amr Abouzid
- Department of Surgical Oncology, Oncology Center, Mansoura University (OCMU), Mansoura, Egypt
| | - Mosab Shetiwy
- Department of Surgical Oncology, Oncology Center, Mansoura University (OCMU), Mansoura, Egypt
| | - Amr Hossam
- Department of Surgical Oncology, Oncology Center, Mansoura University (OCMU), Mansoura, Egypt
| | - Mohamed Abd Elghaffar
- Department of Surgical Oncology, Oncology Center, Mansoura University (OCMU), Mansoura, Egypt
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21
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Fan W, Liu Z, Chen J, Liu S, Chen T, Li Z, Lin D. Effect of memantine on the survival of an ischemic random skin flap and the underlying mechanism. Biomed Pharmacother 2021; 143:112163. [PMID: 34517281 DOI: 10.1016/j.biopha.2021.112163] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Skin flap transplantation is a common wound repair method in orthopedic surgery, but skin flap necrosis remains problematic. Memantine, an excitatory amino acid receptor antagonist, is currently used in the treatment of moderate to severe Alzheimer's disease, due to its ability to promote angiogenesis and reduce oxidative stress. This study investigated the effect of memantine on the survival of random skin flaps in Sprague-Dawley (SD) rats. MATERIALS AND METHODS Thirty six male SD rats were divided into control, high-dose (20 mg/kg per day), and low-dose (10 mg/kg per day) groups and underwent a McFarland flap procedure. Seven days later, the survival of the flap was evaluated, The microvascular density and neutrophil density were measured by hematoxylin and eosin staining. Lead angiography was used to detect angiogenesis, and laser Doppler was used to detect blood perfusion. Expression levels of vascular endothelial growth factor (VEGF), interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF)-α, Toll-like receptor (TLR) 4, nuclear factor kappa B(NF-κB) and Mitogen-activated protein kinase(MAPK)were detected by immunohistochemistry. Oxidative stress was evaluated by measuring the levels of malondialdehyde (MDA) and superoxide dismutase (SOD). RESULTS Compared with the control group, the flap survival area of memantine group, especially the high-dose group, was larger, VEGF expression, microvascular density, angiogenesis, blood perfusion, and superoxide dismutase in the flap were higher in the Memantine-H group than in the Memantine-L and control groups (P < 0.01). In addition, levels of neutrophil density, IL-1β, IL-6, TNF-α, TLR4, NF-κB, MAPK and malondialdehyde decreased significantly in the Memantine-H group (P < 0.01). CONCLUSIONS Memantine can promote the survival of skin flap in rats by improving the blood supply, promoting angiogenesis, inhibiting the inflammatory response, and reducing ischemia-reperfusion injury.
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Affiliation(s)
- Weijian Fan
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhenhua Liu
- Department of Orthopaedics, The First People's Hospital of Jiande, Jiande, Zhejiang, China
| | - Jianpeng Chen
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shaodong Liu
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Tingxiang Chen
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zhijie Li
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
| | - Dingsheng Lin
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
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22
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Nedomansky J, Haslik W, Pluschnig U, Kornauth C, Deutschmann C, Hacker S, Steger GG, Bartsch R, Mader RM. Tissue distribution of epirubicin after severe extravasation in humans. Cancer Chemother Pharmacol 2021; 88:203-209. [PMID: 33907881 PMCID: PMC8236455 DOI: 10.1007/s00280-021-04280-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/14/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE As critical parameter after extravasation of cytotoxic vesicants, anthracyclines were determined in removed tissue from patients requiring surgical intervention due to tissue necrosis. We monitored their distribution within the affected lesion to establish a possible dose-toxicity relation. METHODS From six patients scheduled for surgery, removed tissue flaps were systematically analysed by HPLC (epirubicin: 5 subjects; doxorubicin: 1 subject). RESULTS After extravasation, tissue concentrations were highly variable with an individual anthracycline distribution pattern ranging from a few nanograms up to 17 µg per 100 mg tissue, which indicated a substantial difference in tissue sensitivity among patients. The resection borders coincided with the extension of the erythema and guided the surgical intervention after demarcation of the lesion, which occurred usually 2 or 3 weeks after extravasation. At that time, drug was hardly detected at the resection borders. Wound drains were negative for the extravasated drugs while showing a time profile of vascular growth factors and inflammatory cytokines, which was highly similar to routine surgery. In all six patients, surgical debridement with immediate wound closure led to healing within approximately 2 weeks, when therapy was resumed in all patients with reasonable time delay. CONCLUSION Surgical intervention after demarcation of the extravasation lesion allows for almost uninterrupted continuation of treatment independent of the amount of extravasated anthracycline. As even minor amounts of the vesicants may trigger tissue necrosis, preventive measures merit the highest priority.
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Affiliation(s)
- Jakob Nedomansky
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Werner Haslik
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Ursula Pluschnig
- Department of Medicine I, Clinical Division of Oncology, Comprehensive Cancer Center of the Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christoph Kornauth
- Department of Pathology, Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Christine Deutschmann
- Department of Obstetrics and Gynecology, Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Stefan Hacker
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Comprehensive Cancer Center of the Medical University of Vienna, Vienna, Austria
| | - Günther G Steger
- Department of Medicine I, Clinical Division of Oncology, Comprehensive Cancer Center of the Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Rupert Bartsch
- Department of Medicine I, Clinical Division of Oncology, Comprehensive Cancer Center of the Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Robert M Mader
- Department of Medicine I, Clinical Division of Oncology, Comprehensive Cancer Center of the Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Arkoumanis PT, Theodosopoulos T, Gkiokas G, Vezakis A, Dellis A, Konstantopoulos P, Yue D, Zargaran D, Ioannidi L, Spyropoulos V. Single Dose of Sildenafil and Atorvastatin Increase Skin Survivability, but only Atorvastatin Increase Nitric Oxide in Rat Ischeamia Reperfusion Model. Chirurgia (Bucur) 2021; 115:783-791. [PMID: 33378637 DOI: 10.21614/chirurgia.115.6.783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 11/23/2022]
Abstract
Background: Ischeamia reperfusion injury is a frequent challenge during tissue reconstruction. Atorvastatin and Sildenafil, have been studied for their protective and/or therapeutic effects on various organ systems subjected to IRI. The aim of the present study was to compare a single dose of Atorvastatin and Sildenafil pretreatment on acute oxidative/nitrosative stress and the subsequent dermal flap necrosis. Materials and Methods: Forty-five Sprague-Dawley rats, were randomly allocated into three equal groups(n=15): Group A: Control rats treated with intraperitoneal saline, Group B: Sildenafil group, and Group C: atorvastatin group. All rats underwent flap elevation and inferior epigastric artery occlusion thirty minutes after drug administration. Myeloperoxidase activity, malondialdehyde levels and inducible nitric oxide synthase activity were evaluated 12 hours after reperfusion. Flap survivability was analysed 7 days after the procedure. Results: Statistically significant reduction was detected in sildenafil and atorvastation. Measurements of myelopyroxidase followed a similar pattern, interestingly malonadehyde levels measured to be significantly lower in the sildenafil group. Contrary, iNOS activity atorvastatin was significantly elevated in atorvastatin group. Conclusion: The single dose of atorvastatin or sildenafil increase flap survivability almost equally, however only atorvastatin enhances significantly iNOS expression.
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He JB, Ma XY, Li WJ, Liu YY, Lin DS. Exenatide inhibits necrosis by enhancing angiogenesis and ameliorating ischemia/reperfusion injury in a random skin flap rat model. Int Immunopharmacol 2021; 90:107192. [PMID: 33214096 DOI: 10.1016/j.intimp.2020.107192] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/06/2020] [Accepted: 11/06/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Random skin flaps are often used for plastic repair because they are convenient and flexible. However, necrosis of flaps is a common complication that may lead to disastrous consequences. Exenatide, a glucagon-like peptide 1 receptor agonist, can enhance angiogenesis and ameliorate ischemia/reperfusion injury. Our experiments explored random skin flap outcomes after its use. METHODS We established modified dorsal McFarlane flaps on 54 Sprague-Dawley rats and divided the rats into three groups (control, Exe-I, and Exe-II). We intraperitoneally injected either 4 or 8 μg/kg/day exenatide into the rats of the Exe-I and Exe-II groups, respectively. On the seventh day after the operation, we measured the levels of superoxide dismutase (SOD) and malondialdehyde (MDA). Tissue sections were obtained for histopathological and immunohistochemical analyses, and we evaluated the expression of vascular endothelial growth factor (VEGF), interleukin (IL) 6, IL-1β, nuclear factor kappa beta (NF-κB), Toll-like receptor 4 (TLR4), and tumor necrosis factor α (TNF-α). We measured blood flow reconstruction and angiogenesis using laser Doppler blood flowmetry and lead oxide/gelatin angiography, respectively. RESULTS Exenatide increased the average survival area of the flap and improved microvascular density and blood flow intensity in a dose-dependent manner. Meanwhile, the SOD level was up-regulated and the MDA level down-regulated. Exenatide also enhanced the expression of VEGF and reduced the expression of inflammatory cytokines (IL-6, IL-1β, NF-κB, TLR4, and TNF-α), thereby promoting angiogenesis and inhibiting inflammation. CONCLUSIONS Exenatide potentially inhibits necrosis in our rat random skin flap model.
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Affiliation(s)
- Ji-Bing He
- Department of Hand Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Xin-Yi Ma
- Department of Hand Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Wen-Jie Li
- Department of Hand Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Ying-Ying Liu
- Department of Hand Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Ding-Sheng Lin
- Department of Hand Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China.
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Wu D, Liu C, Li B, Wang D, Fang X. Influence of Cap Thickness on Corneal Curvature and Corneal Biomechanics After SMILE: A Prospective, Contralateral Eye Study. J Refract Surg 2020; 36:82-88. [PMID: 32032428 DOI: 10.3928/1081597x-20191216-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 12/16/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the impact of cap thickness for small incision lenticule extraction (SMILE) on changes in corneal curvature and biomechanics. METHODS One hundred eyes (50 patients) were enrolled in this prospective contralateral eye study. The difference in manifest refraction spherical equivalent (MRSE) in the same patient was less than 0.50 diopters. SMILE was performed with a randomized cap thickness of 110 µm in one eye and 140 µm in the other eye. MRSE, uncorrected distance visual acuity (UDVA), and corneal curvature and biomechanics were evaluated. The anterior and posterior surfaces of the corneal curvature (mean keratometry [Km] values 2, 4, and 6 mm from the pupil center) were measured by Pentacam HR (Oculus Optikgeräte, Wetzlar, Germany) and changes in corneal biomechanics at 6 months postoperatively by Scheimpflug technology. RESULTS There was no significant between-group difference in UDVA or MRSE postoperatively. Postoperative changes in Km at the anterior surface (ΔKm-ant) in the 4-mm zone were significantly higher in the 110-µm group than in the 140-µm group at 1 day and 1, 3, and 6 months postoperatively (P = .043, .045, .003, and .049, respectively); at 3 months, the ΔKm-ant in the 6-mm zone was higher in the 110-µm group (P = .035). The changes in second appla-nation time, deformation amplitude, and integrated radius were significantly less in the 110-µm group (P = .031, .049, and < .001, respectively). CONCLUSIONS A thicker corneal cap caused less change in anterior surface curvature after SMILE for moderate or low myopia, with no significant difference in UDVA and MRSE. [J Refract Surg. 2020;36(2):82-88.].
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Avila A, Bartholomew AJ, Sosin M, Deldar R, Griffith KF, Willey SC, Song DH, Fan KL, Tousimis EA. Acute Postoperative Complications in Prepectoral versus Subpectoral Reconstruction following Nipple-Sparing Mastectomy. Plast Reconstr Surg 2020; 146:715e-720e. [PMID: 33234947 DOI: 10.1097/prs.0000000000007326] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nipple-sparing mastectomy is associated with improved aesthetics and oncologic safety. Recently, there has been a resurgence in prepectoral reconstruction. Because of limited data comparing complication rates on patients undergoing prepectoral breast reconstruction, this study compared 30-day postoperative complications by plane of prosthetic placement. METHODS A retrospective review was conducted on all consecutive patients undergoing nipple-sparing mastectomy with implant-based reconstruction with either prepectoral or subpectoral placement from 2014 to 2018. The primary outcome was a composite, acute 30-day postoperative complication, including nipple-areola complex necrosis, mastectomy flap necrosis, wound dehiscence, infection, hematoma, and seroma. Secondary outcomes included nipple loss and rates of unintended reoperations. Univariate and mixed effects multivariate logistic regression were used to compare outcomes. RESULTS A total of 228 patients and 405 breasts were included in the final cohort, with 202 in the subpectoral cohort and 203 in the prepectoral cohort. The overall complication rate was 7.65 percent, with no significant difference between subpectoral and prepectoral cohorts (9.41 percent versus 5.91 percent, respectively; p = 0.148). Prepectoral reconstruction was associated with significantly reduced ischemic complications, including nipple loss because of necrosis (2.97 percent versus 0.49 percent, respectively; p = 0.015) and mastectomy flap necrosis (5.45 percent versus 0 percent; p = 0.003). There were no significant differences in rates of infection, hematoma, seroma, or implant loss/exchange. CONCLUSIONS Prepectoral reconstruction is associated with similar overall 30-day postoperative complications and reoperations compared to traditional subpectoral implants. However, prepectoral reconstruction was associated with significantly decreased ischemic complications, including mastectomy flap necrosis and nipple-areola complex loss because of necrosis. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Azalia Avila
- From the Department of Surgery, Division of Breast Surgery, and the Department of Plastic Surgery, MedStar Georgetown University Hospital; and the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Alex J Bartholomew
- From the Department of Surgery, Division of Breast Surgery, and the Department of Plastic Surgery, MedStar Georgetown University Hospital; and the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Michael Sosin
- From the Department of Surgery, Division of Breast Surgery, and the Department of Plastic Surgery, MedStar Georgetown University Hospital; and the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Romina Deldar
- From the Department of Surgery, Division of Breast Surgery, and the Department of Plastic Surgery, MedStar Georgetown University Hospital; and the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Kayla F Griffith
- From the Department of Surgery, Division of Breast Surgery, and the Department of Plastic Surgery, MedStar Georgetown University Hospital; and the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Shawna C Willey
- From the Department of Surgery, Division of Breast Surgery, and the Department of Plastic Surgery, MedStar Georgetown University Hospital; and the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - David H Song
- From the Department of Surgery, Division of Breast Surgery, and the Department of Plastic Surgery, MedStar Georgetown University Hospital; and the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Kenneth L Fan
- From the Department of Surgery, Division of Breast Surgery, and the Department of Plastic Surgery, MedStar Georgetown University Hospital; and the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
| | - Eleni A Tousimis
- From the Department of Surgery, Division of Breast Surgery, and the Department of Plastic Surgery, MedStar Georgetown University Hospital; and the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health
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Pruimboom T, Schols RM, Van Kuijk SMJ, Van der Hulst RRWJ, Qiu SS. Indocyanine green angiography for preventing postoperative mastectomy skin flap necrosis in immediate breast reconstruction. Cochrane Database Syst Rev 2020; 4:CD013280. [PMID: 32320056 PMCID: PMC7175780 DOI: 10.1002/14651858.cd013280.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Breast cancer will affect one in eight women during their lifetime. The opportunity to restore the removed tissue and cosmetic appearance is provided by reconstructive breast surgery following skin-sparing mastectomy (SSM). Mastectomy skin flap necrosis (MSFN) is a common complication following SSM breast reconstruction. This postoperative complication can be prevented by intraoperative assessment of mastectomy skin flap viability and intervention when tissue perfusion is compromised. Indocyanine green fluorescence angiography is presumed to be a better predictor of MSFN compared to clinical evaluation alone. OBJECTIVES To assess the effects of indocyanine green fluorescence angiography (ICGA) for preventing mastectomy skin flap necrosis in women undergoing immediate breast reconstruction following skin-sparing mastectomy. To summarise the different ICGA protocols available for assessment of mastectomy skin flap perfusion in women undergoing immediate breast reconstructions following skin-sparing mastectomy. SEARCH METHODS We searched the Cochrane Breast Cancer Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL; Issue 3, 2019), MEDLINE, Embase, the World Health Organization's International Clinical Trials Registry Platform (ICTRP) and Clinicaltrials.gov in April 2019. In addition, we searched reference lists of published studies. SELECTION CRITERIA We included studies that compared the use of ICGA to clinical evaluation to assess mastectomy skin vascularisation and recruited women undergoing immediate autologous or prosthetic reconstructive surgery following SSM for confirmed breast malignancy or high risk of developing breast cancer. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the risk of bias of the included nonrandomised studies and extracted data on postoperative outcomes, including postoperative MSFN, reoperation, autologous flap necrosis, dehiscence, infection, haematoma and seroma, and patient-related outcomes. The quality of the evidence was assessed using the GRADE approach and we constructed two 'Summary of finding's tables: one for the comparison of ICGA to clinical evaluation on a per patient basis and one on a per breast basis. MAIN RESULTS Nine nonrandomised cohort studies met the inclusion criteria and involved a total of 1589 women with 2199 breast reconstructions. We included seven retrospective and two prospective cohort studies. Six studies reported the number of MSFN on a per breast basis for a total of 1435 breasts and three studies reported the number of MSFN on a per patient basis for a total of 573 women. Five studies reported the number of other complications on a per breast basis for a total of 1370 breasts and four studies reported the number on a per patient basis for a total of 613 patients. Therefore, we decided to pool data separately. Risk of bias for each included nonrandomised study was assessed using the Newcastle-Ottawa Scale for cohort studies. There was serious concern with risk of bias due to the nonrandomised study design of all included studies and the low comparability of cohorts in most studies. The quality of the evidence was found to be very low, after downgrading the quality of evidence twice for imprecision based on the small sample sizes and low number of events in the included studies. Postoperative complications on a per patient basis We are uncertain about the effect of ICGA on MSFN (RR 0.79, 95% CI 0.40 to 1.56; three studies, 573 participants: very low quality of evidence), infection rates (RR 0.91, 95% CI 0.60 to 1.40; four studies, 613 participants: very low quality of evidence), haematoma rates (RR 0.87, 95% CI 0.30 to 2.53; two studies, 459 participants: very low quality of evidence) and seroma rates (RR 1.68, 95% CI 0.41 to 6.80; two studies, 408 participants: very low quality of evidence) compared to the clinical group. We found evidence that ICGA may reduce reoperation rates (RR 0.50, 95% CI 0.35 to 0.72; four studies, 613 participants: very low quality of evidence). One study considered dehiscence as an outcome. In this single study, dehiscence was observed in 2.2% of participants (4/184) in the ICGA group compared to 0.5% of participants (1/184) in the clinical group (P = 0.372). The RR was 4.00 (95% CI 0.45 to 35.45; one study; 368 participants; very low quality of evidence). Postoperative complications on a per breast basis We found evidence that ICGA may reduce MSFN (RR 0.62, 95% CI 0.48 to 0.82; six studies, 1435 breasts: very low quality of evidence), may reduce reoperation rates (RR 0.65, 95% CI 0.47 to 0.92; five studies, 1370 breasts: very low quality of evidence) and may reduce infection rates (RR 0.65, 95% CI 0.44 to 0.97; five studies, 1370 breasts: very low quality of evidence) compared to the clinical group. We are uncertain about the effect of ICGA on haematoma rates (RR 1.53, CI 95% 0.47 to 4.95; four studies, 1042 breasts: very low quality of evidence) and seroma rates (RR 0.71, 95% CI 0.37 to 1.35; two studies, 528 breasts: very low quality of evidence). None of the studies reported patient-related outcomes. ICGA protocols: eight studies used the SPY System and one study used the Photodynamic Eye imaging system (PDE) to assess MSFN. ICGA protocols in the included studies were not extensively described in most studies. AUTHORS' CONCLUSIONS Although mastectomy skin flap perfusion is performed more frequently using ICGA as a helpful tool, there is a lack of high-quality evidence in the context of randomised controlled trials. The quality of evidence in this review is very low, since only nonrandomised cohort studies have been included. With the results from this review, no conclusions can be drawn about what method of assessment is best to use during breast reconstructive surgery. High-quality randomised controlled studies that compare the use of ICGA to assess MSFN compared to clinical evaluation are needed.
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Affiliation(s)
- Tim Pruimboom
- Maastricht University Medical CenterDepartment of Plastic, Reconstructive and Hand SurgeryP. Debyelaan 25MaastrichtLimburgNetherlands6229 HX
| | - Rutger M Schols
- Maastricht University Medical CenterDepartment of Plastic, Reconstructive and Hand SurgeryP. Debyelaan 25MaastrichtLimburgNetherlands6229 HX
| | - Sander MJ Van Kuijk
- Maastricht University Medical CenterDepartment of Clinical Epidemiology and Medical Technology AssessmentMaastrichtNetherlands
| | - René RWJ Van der Hulst
- Maastricht University Medical CenterDepartment of Plastic, Reconstructive and Hand SurgeryP. Debyelaan 25MaastrichtLimburgNetherlands6229 HX
| | - Shan S Qiu
- Maastricht University Medical CenterDepartment of Plastic, Reconstructive and Hand SurgeryP. Debyelaan 25MaastrichtLimburgNetherlands6229 HX
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Lim DH, Hyun J, Shin E, Ko BW, Chung ES, Chung TY. Incidence and Risk Factors of Opaque Bubble Layer Formation According to Flap Thickness During 500-kHz FS-LASIK. J Refract Surg 2020; 35:583-589. [PMID: 31498416 DOI: 10.3928/1081597x-20190814-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/14/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To present the incidence, risk factors, and effect of opaque bubble layer (OBL) formation during flap creation in laser-assisted in situ keratomileusis (LASIK) with a 500-kHz femtosecond laser on visual performance. METHODS In this retrospective study, preoperative characteristics (age, sex, keratometric value, spherical equivalent, and central corneal thickness) and intraoperative surgical factors (used energy, docking type, and flap thickness) were compared between eyes with and without OBL formation during flap creation. Possible risk factors for specific types of OBLs were analyzed. RESULTS One hundred thirty-five eyes of 71 patients underwent LASIK, and OBL developed in 98 eyes (72.59%). In the univariate analysis, the greater than 80-µm flap group was associated with a lower OBL occurrence than the 80-µm flap group (P = .0424, odds ratio [OR] = 0.481) and hard docking was associated with increased OBL formation (P = .0001, OR = 6.859). In the multivariate analysis, hard docking was a risk factor for OBL development (P = .0003, OR = 6.329). In the subgroup analysis, hard docking had a marginal effect on OBL occurrence in the 80-µm flap group (P = .086, OR = 3.564), but it had a strong effect in the greater than 80-µm flap group (P = .0018, OR = 10.210). CONCLUSIONS Hard docking is a risk factor for OBL development. However, hard docking had a small effect on OBL occurrence in the 80-µm flap group during LASIK. OBL formation did not affect visual performance. [J Refract Surg. 2019;35(9):583-589.].
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Vania R, Pranata R, Irwansyah D. Topical nitroglycerin is associated with a reduced mastectomy skin flap necrosis-systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2020; 73:1050-1059. [PMID: 32146114 DOI: 10.1016/j.bjps.2020.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 12/19/2019] [Accepted: 01/05/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The flap necrosis rate remains high despite the advancement of technology in daily practices. Several randomized trials of topical Nitroglycerin (NTG) have shown promise in reducing flap necrosis. We aim to evaluate the efficacy and safety of topical NTG in preventing flap failure based on existing databases. METHOD We searched through PubMed, EuropePMC, EBSCOhost, Cochrane CENTRAL database, Clinicaltrials.gov, and hand sampling for "flap survival", "topical nitroglycerin", and "flap perfusion". RESULTS With a total of 6947 patients from 3 RCT and 2 retrospective cohorts, NTG was shown to prevent flap failure in mastectomy flaps by NTG with an OR 0.23 [0.10, 0.53]; p < 0.001), I2 73%. Upon sensitivity analysis to reduce heterogeneity, the OR was 0.17 [0.07, 0.40]; p < 0.001, I2 52%. Upon subgroup analysis of RCT, the OR was 0.17 [0.10, 0.30]; p < 0.001, I2 50%. Newer studies subgroup had OR 0.48 [0.33, 0.70]; p<0.001; I2 46. Upon subgroup analysis of single application only, the OR for flap necrosis was 0.36 [0.18, 0.73]; p = 0.005, I2 67% and subgroup analysis repeated application had an OR of 0.05 [0.01, 0.21]; p < 0.001, I2 14%. CONCLUSION Nitroglycerin seemed to be an ideal agent to increase the chance of flap survival in mastectomy flaps. It has an excellent safety profile, hence, is suitable for empiric use. More randomized controlled trials comparing different regiments and other preparations are needed to conclude whether repeated application at a low dose is most effective, and whether the success is reproducible on other types of flaps.
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Affiliation(s)
- Rachel Vania
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia; Department of Plastic Surgery, Gatot Subroto Army Central Hospital, Jakarta, Indonesia.
| | - Raymond Pranata
- Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.
| | - Denny Irwansyah
- Department of Plastic Surgery, Gatot Subroto Army Central Hospital, Jakarta, Indonesia; Faculty of Medicine, Syiah Kuala University, Banda Aceh, Indonesia.
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Martignago CCS, Tim CR, Assis L, Andrade ALM, Brassolati P, Bossini PS, Leiebano RE, Parizotto NA. Preemptive treatment with photobiomodulation therapy in skin flap viability. J Photochem Photobiol B 2019; 201:111634. [PMID: 31715551 DOI: 10.1016/j.jphotobiol.2019.111634] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 08/06/2019] [Accepted: 09/17/2019] [Indexed: 02/06/2023]
Abstract
Skin Flap is used in reconstructive plastic surgery. However, complications such as ischemia followed by local necrosis may occur, requiring a new surgical procedure. It is well known that photobiomodulation therapy (PBMT) is an effective technique for improving microcirculation and neoangiogenesis, which contributes positively to the blood supply in the pre and post surgical period. Thus, the objective of the present study was to investigate the effects of preemptive treatment with laser PBMT with different energies on the viability in skin flaps in rats. Sixty-three Wistar rats, male, were randomized into five groups: Control Group (CG) (n = 15): PBMT simulation; Preemptive group 1.1 J laser (GP1) (n = 15): preemptive laser PBMT with 1.1 J of energy per point; Preemptive group 4 J laser (GP4) (n = 15): preemptive PBMT with 4 J of energy per point; Laser group 11 J (G1) (n = 9): PBMT immediately after surgery with 1.1 J of energy per point; Laser group 4 J (G4) (n = 9): TFMB immediately after surgery with 4 J of energy per point. The CG, GP1 and GP4 groups started treatment 72 h prior to surgery and were subdivided into two experimental periods, one of them on the day of the flap and the other along with the other groups on the seventh postoperative day. Three days after the randomization, the animals underwent random skin flap surgery. PBMT was performed with a 660 nm laser at three points. In the first experimental period, a greater number of vessels were found, as well as mast cells in GP1 compared to the CG and greater expression of fibroblast growth factor and vascular endothelial growth factor in the GP1 and GP4 groups compared to the CG. In the second experimental period, GP1 presented a lower percentage of necrotic tissue, a higher number of vessels and a percentage of cells labeled with both VEGF and hypoxia indicible factor alpha (HIF-1α) compared to the CG, FGF in GP1, GP4 and G4 when compared to the CG. Thus, it was concluded that preemptive treatment with PBMT with the application of 1.1 J of energy per point is effective in improving the viability of the skin flap.
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Affiliation(s)
- C C S Martignago
- Federal University of São Carlos, São Carlos, São Paulo, Brazil.
| | - C R Tim
- Brasil University - São Paulo, São Paulo, Brazil
| | - L Assis
- Brasil University - São Paulo, São Paulo, Brazil; Federal University of São Paulo, Santos, São Paulo, Brazil
| | - A L M Andrade
- Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - P Brassolati
- Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - P S Bossini
- Researcher of the Nucleus of Research and Teaching of Phototherapy in Health Sciences, São Carlos, São Paulo, Brazil
| | - R E Leiebano
- Federal University of São Carlos, São Carlos, São Paulo, Brazil
| | - N A Parizotto
- Federal University of São Carlos, São Carlos, São Paulo, Brazil; Brasil University - São Paulo, São Paulo, Brazil; University of Araraquara, Araraquara, São Paulo, Brazil
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Rajpal N, Walters ET, Elmarsafi T, Pittman TA, Johnson-Arbor KK. Use of hyperbaric oxygen therapy for tissue ischemia after breast reconstruction. Undersea Hyperb Med 2019; 46:461-465. [PMID: 31509902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Mastectomy skin flap necrosis represents a significant complication of breast reconstructive procedures and is reported to occur in 30%-52% of patients undergoing breast reconstruction. Early identification of ischemia and early initiation of hyperbaric oxygen (HBO2) therapy can mitigate the effects of ischemia and rescue otherwise non-viable breast flap tissue. METHODS We retrospectively examined the outcomes of HBO2 therapy in eight breasts with compromised mastectomy skin flaps between September 2015 and January 2017. Indocyanine green angiography (ICGA) was used to assess perfusion intraoperatively and post-HBO2 administration. RESULTS Seven patients were referred for HBO2 within 24 hours of mastectomy. One patient failed to improve despite starting hyperbaric treatment within 24 hours. All other patients manifested successful healing of their mastectomy skin flaps with acceptable cosmesis after 10 HBO2 treatments. The mean relative perfusion of the at-risk area was 13.8% (±3.7%) pre-HBO2 and 101.6% (±37.3%) post-HBO2. The average area at-risk pre-HBO2 was 17.1 cm2 and reduced to zero post-HBO2. Relative perfusion values after HBO2 were found to be 6.8 (±3.4) times greater than those measured prior to HBO2. CONCLUSIONS A short course of HBO2 may be sufficient to successfully rescue at risk post-mastectomy breast flaps. ICGA is a useful adjunct for evaluating post-mastectomy breast flap perfusion before and after HBO2 therapy.
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Affiliation(s)
- Neha Rajpal
- Georgetown University School of Medicine, Washington DC, U.S
| | - Elliot T Walters
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington DC, U.S
| | - Tammer Elmarsafi
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington DC, U.S
| | | | - Kelly K Johnson-Arbor
- Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington DC, U.S
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Ferhatoglu MF, Kartal A, Ekici U, Kebudi A. Effects of Bathing Habits on Postoperative Wound Complications Following Sacrococcygeal Pilonidal Sinus Surgery: A Retrospective Analysis of 67 Adolescent Patients. Wounds 2019; 31:292-296. [PMID: 31747369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Sacrococcygeal pilonidal sinus disease generally affects young people and impacts their quality of life. Few published studies assessing the characteristics of the disease in the adolescent population exist. OBJECTIVE In this paper, the authors aim to evaluate the effects of bathing habits on wound complications in adolescent patients following Karydakis flap surgery for sacrococcygeal pilonidal sinus. MATERIALS AND METHODS The medical records of 79 adolescent patients who underwent sacrococcygeal pilonidal sinus surgery between January 2014 and December 2017 at the Surgery Clinic of Malatya State Hospital (Malatya, Turkey) were evaluated retrospectively. Following exclusion, 67 patients were evaluated for demographics, body mass index (BMI), previous abscess formation, bathing frequency, number of sinus pits, and postoperative wound infection and dehiscence. The total follow-up time for the 67 patients was 90 days. RESULTS The BMIs of patients with previous abscess formation were significantly higher (P = .029). In the cases with abscess, the number of pilonidal sinus pits was significantly higher (P = .039) There was a statistically significant difference between postoperative complication rates according to the number of baths per week. Wound infection rates were found to be higher in patients who bathed more than twice weekly during the 28 days after surgery (P = .005). No statistical significance was observed in complication rates from days 28 to 90 after the surgery between those who bathed twice weekly and more than twice weekly (P > .05). CONCLUSIONS Postoperative wound complications in adolescent patients treated with Karydakis flap surgery for sacrococcygeal pilonidal sinus are more frequent in those who bathe more than twice weekly during the first 28 days postoperatively.
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Affiliation(s)
| | - Abdulcabbar Kartal
- Okan University, Faculty of Medicine, Department of General Surgery, Istanbul, Turkey
| | | | - Abut Kebudi
- Okan University, Faculty of Medicine, Department of General Surgery, Istanbul, Turkey
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Ito H, Ueno T, Suga H, Shiraishi T, Isaka H, Imi K, Miyamoto K, Tada M, Ishizaka Y, Imoto S. Risk Factors for Skin Flap Necrosis in Breast Cancer Patients Treated with Mastectomy Followed by Immediate Breast Reconstruction. World J Surg 2019; 43:846-852. [PMID: 30426185 DOI: 10.1007/s00268-018-4852-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Skin-sparing mastectomy (SSM) and nipple-sparing mastectomy (NSM) are the standard techniques for achieving a cosmetic outcome, but necrosis of a cutaneous flap including the nipple-areolar complex (NAC) is a serious complication. To analyze the risk factors for skin flap necrosis, we retrospectively evaluated a clinical database of breast cancer patients treated with mastectomy followed by immediate breast reconstruction. METHODS Four hundred and twelve cases were consecutively recorded between 2006 and 2016. Body weight (BW), body mass index (BMI), distance from NAC to referent tumor, distance from overlying skin to the tumor and weight of breast resection (WBR) as measured in the operating theater were included in the statistical analysis. RESULTS NSM, SSM and total mastectomy were performed in 123 (30%), 96 (23%) and 193 cases (47%), respectively. A tissue expander was used in 379 cases (92%), a silicone implant in 8 (2%) and autologous breast reconstruction in 25 (6%). Skin flap necrosis was found in 7% of all cases and NAC necrosis in 13% of NSM cases. In a univariate analysis, BW, NSM and WBR were risk factors for skin flap necrosis, and BW, BMI and WBR were risk factors for NAC necrosis. In a multivariate analysis, NSM and WBR remained significant risk factors for skin flap necrosis, and WBR was a significant risk factor for NAC necrosis. CONCLUSIONS WBR is an important risk factor for skin flap necrosis. Especially, NAC necrosis should be considered for patients with large-volume breasts who undergo NSM and immediate breast reconstruction.
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Affiliation(s)
- Hiroki Ito
- Department of Breast Surgery, Kaneko Clinic, Kagoshima, Kagoshima, Japan
- Department of Breast Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Takayuki Ueno
- Breast Surgical Oncology, Breast Oncology Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Minatoku, Tokyo, Japan
- Department of Breast Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Hirotaka Suga
- Department of Plastic Surgery, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Tomohiro Shiraishi
- Department of Plastic Surgery, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Hirotsugu Isaka
- Department of Breast Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Kentaro Imi
- Department of Breast Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Kaisuke Miyamoto
- Department of Breast Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Manami Tada
- Department of Breast Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Yoshiharu Ishizaka
- Department of Breast Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Shigeru Imoto
- Department of Breast Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
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Benderli Cihan Y. Which type of flap is more resistant to radiotherapy in breast cancer ? J BUON 2019; 24:1309-1310. [PMID: 31424696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Yasemin Benderli Cihan
- Department of Radiation Oncology, Kayseri Education and Research Hospital, Kayseri, Turkey
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Mifflin MD, Mortensen XM. Intraoperative optical pachymetry in photorefractive keratectomy. J Cataract Refract Surg 2019; 45:495-500. [PMID: 30819562 DOI: 10.1016/j.jcrs.2018.11.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 11/24/2018] [Accepted: 11/28/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To study the effect of variables on the accuracy and reliability of the optical pachymeter built into the WaveLight EX500 excimer laser during photorefractive keratectomy (PRK). SETTING John A. Moran Eye Center, University of Utah, Salt Lake City, USA. DESIGN Retrospective case series. METHODS A chart review of 352 eyes (181 patients) that had excimer laser PRK was performed. Programmed excimer laser residual stromal bed (RSB) measurements, optical pachymeter measurements after ablation, and Scheimpflug pachymetry measurements (Pentacam) at the 1-year follow-up were compared. Variables included ablation time, preoperative spherical equivalent (SE), 1-year SE, mitomycin-C use, operating room temperature and humidity, and programmed monovision. RESULTS The mean programmed RSB was 27 μm greater than the optical pachymetry post-ablation measurement (P < .001). Of patients with a 1-year follow-up, the 1-year Scheimpflug pachymetry RSB was 24 μm greater than the optical pachymetry post-ablation RSB (P < .001). Comparison of the programmed RSB with the optical pachymetry post-ablation RSB showed that the preoperative SE and ablation time had a Pearson correlation coefficient of -0.36 and 0.30, respectively (P < .001). There was no correlation between operating room temperature, humidity, or programmed monovision with these differences. CONCLUSIONS The RSB post-ablation values measured by optical pachymetry during PRK were significantly lower than the programmed excimer laser RSB value and 1-year Scheimpflug pachymetry RSB value. Intraoperative pachymetry during PRK underpredicted the actual long-term RSB thickness. The greater temporary drying effect associated with increased ablation time in higher myopic corrections might have caused this error.
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Affiliation(s)
- Mark D Mifflin
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, USA.
| | - Xavier M Mortensen
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, USA
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Farrokhi M, Gashti MZ, Hoormand M, Bakhtiarian A, Habibi R. Combination therapy profoundly improved skin flap survival by modulating KATP channels and nitric oxide. Adv Med Sci 2019; 64:117-123. [PMID: 30640077 DOI: 10.1016/j.advms.2018.08.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 07/20/2018] [Accepted: 08/31/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE A potential therapeutic approach on skin flap necrosis is to target parallel pathways involved in necrosis. Azelaic Acid, Minoxidil and Caffeine combination was tried on skin flap survival by their possible interaction with ATP sensitive potassium (KATP) channels and nitric oxide pathway. MATERIAL AND METHODS Sprauge-Dawley rats were divided into 8 groups for skin flap surgery. Azelaic acid, minoxidil, caffeine, or their combination were applied topically in different groups. Two additional groups were treated with L-NAME or glibenclamide in addition to the combination therapy. Percentage of flap necrosis was calculated and flap samples were removed to measure tissue malondialdehyde (MDA) and nitric oxide (NO) and expression of inducible nitric oxide synthase (iNOS), Bcl-2 and Bax proteins. RESULTS Combination therapy profoundly decreased skin flap necrosis, tissue MDA contents, and expression of the pro-apoptotic protein Bax (p < 0.05 vs. single treatments). These effects were reversed by L-NAME and glibenclamide pre-treatments. Further evaluations showed combination therapy increases flap tissue NO content and iNOS expression (p < 0.05 vs. single treatments). CONCLUSION Beneficial effect of the combination therapy with azelaic acid, minoxidil and caffeine therapy on rescuing the flap from necrosis by targeting parallel signaling pathways suggested potential applications in clinical practice.
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Affiliation(s)
- Mahtab Farrokhi
- Department of Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mahmood Hoormand
- Department of Pharmacology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Azam Bakhtiarian
- Department of Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Rohalah Habibi
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran.
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Korhonen TK, Salokorpi N, Ohtonen P, Lehenkari P, Serlo W, Niinimäki J, Tetri S. Classification of bone flap resorption after cranioplasty: a proposal for a computed tomography-based scoring system. Acta Neurochir (Wien) 2019; 161:473-481. [PMID: 30644012 PMCID: PMC6407745 DOI: 10.1007/s00701-018-03791-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 12/24/2018] [Indexed: 11/25/2022]
Abstract
Background Bone flap resorption (BFR) is the most prevalent complication resulting in autologous cranioplasty failure, but no consensus on the definition of BFR or between the radiological signs and relevance of BFR has been established. We set out to develop an easy-to-use scoring system intended to standardize the interpretation of radiological BFR findings. Methods All 45 autologous cranioplasty patients operated on at Oulu University Hospital from 2004 to 2014 were identified, and the bone flap status of all the available patients was evaluated using the new scoring system. Derived from previous literature, a three-variable score for the detection of BFR changes is proposed. The variables “Extent” (estimated remaining bone volume), “Severity” (possible perforations and their measured diameter), and “Focus” (the number of BFR foci within the flap) are scored from 0 to 3 individually. Using the sum of these scores, a score of 0–9 is assigned to describe the degree of BFR. Additionally, independent neurosurgeons assessed the presence and relevance of BFR from the same data set. These assessments were compared to the BFR scores in order to find a score limit for relevant BFR. Results BFR was considered relevant by the neurosurgeons in 11 (26.8%) cases. The agreement on the relevance of BFR demonstrated substantial strength (κ 0.64, 95%CI 0.36 to 0.91). The minimum resorption score in cases of relevant BFR was 5. Thus, BFR with a resorption score ≥ 5 was defined relevant (grades II and III). With this definition, grade II or III BFR was found in 15 (36.6%) of our patients. No risk factors were found to predict relevant BFR. Conclusions The score was proven to be easy to use and we recommend that only cases with grades II and III BFR undergo neurosurgical consultation. However, general applicability can only be claimed after validation in independent cohorts.
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Affiliation(s)
- Tommi K Korhonen
- Department of Neurosurgery, Oulu University Hospital, Kajaanintie 52, 90029, Oulu, Finland.
- Research Unit of Clinical Neuroscience, Neurosurgery, University of Oulu, Oulu, Finland.
| | - Niina Salokorpi
- Department of Neurosurgery, Oulu University Hospital, Kajaanintie 52, 90029, Oulu, Finland
- Research Unit of Clinical Neuroscience, Neurosurgery, University of Oulu, Oulu, Finland
| | - Pasi Ohtonen
- Division of Operative Care, Oulu University Hospital, Oulu, Finland
| | - Petri Lehenkari
- Department of Anatomy and Cell Biology and Department of Surgery, MRC Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Willy Serlo
- PEDEGO Research Unit, MRC Oulu, University of Oulu, and Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Jaakko Niinimäki
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Sami Tetri
- Department of Neurosurgery, Oulu University Hospital, Kajaanintie 52, 90029, Oulu, Finland
- Research Unit of Clinical Neuroscience, Neurosurgery, University of Oulu, Oulu, Finland
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Barzaghi LR, Parisi V, Gigliotti CR, Giudice L, Snider S, Dell'Acqua A, Del Vecchio A, Mortini P. Bone resorption in autologous cryopreserved cranioplasty: quantitative evaluation, semiquantitative score and clinical significance. Acta Neurochir (Wien) 2019; 161:483-491. [PMID: 30617716 DOI: 10.1007/s00701-018-03789-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/24/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Changes after reimplantation of the autologous bone have been largely described. However, the rate and the extent of resorption in cranial grafts have not been clearly defined. Aim of our study is to evaluate the bone flap resorption (BFR) after cryopreservation. METHODS We retrospectively reviewed 27 patients, aged 18 years or older, subjected to cranioplasty (CP) adopting autologous cryopreserved flap. The BFR was derived from the percentage of decrease in flap volume (BFR%), comparing the first post-operative computed tomography (CT) and the last one available (performed at least 1 year after surgery). We also proposed a semiquantitative scoring system, based on CT, to define a clinically workable BFR classification. RESULTS After a mean ± SE follow-up of 32.5 ± 2.4 months, the bone flap volume decreased significantly (p < 0.0001). The mean BFR% was 31.7 ± 3.8% and correlated with CT-score (p < 0.001). Three BFR classes were described: mild (14.8% of cases) consisting in minimal bone remodelling, CT-score ≤ 6, mean BFR% = 3.5 ± 0.7%; moderate (51.9% of cases) corresponding to satisfactory cerebral protection, CT-score < 13, mean BFR% = 25.6 ± 2.2%; severe (33.3% of cases) consisting in loss of cerebral protection, CT-score ≥ 13, mean BFR% = 54.2 ± 3.9%. Females had higher BFR% than males (p = 0.022). BFR classes and new reconstructive surgery were not related (p = 0.58). CONCLUSIONS BFR was moderate or severe in 85.2% of re-implanted cryopreserved flaps. The proposed CT-score is an easy and reproducible tool to define resorption extent.
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Affiliation(s)
- Lina Raffaella Barzaghi
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy.
| | - Veronica Parisi
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Carmen Rosaria Gigliotti
- Department of Medical Physics, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Lodoviga Giudice
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Silvia Snider
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
| | - Antonio Dell'Acqua
- Department of Neurocritical Care, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Antonella Del Vecchio
- Department of Medical Physics, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Pietro Mortini
- Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy
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Marinescu SA, Bejinariu CG, Şapte E, Marinaş MC, Giuglea C. Complications related to breast reconstruction after mastectomy using multiple surgical techniques - a national and international comparative analysis. Rom J Morphol Embryol 2019; 60:87-93. [PMID: 31263831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The present paper describes and analyzes complications related to alloplastic breast reconstruction, as well as those associated with surgical techniques involving myocutaneous flaps. The article also contains a comparative analysis of the results obtained with the data in the international specialized literature. The statistical analysis is primary based on data obtained from patients included in the National Breast Reconstruction Program developed within the "Bagdasar-Arseni" Emergency Clinical Hospital, Bucharest, Romania, between 2015 and 2019. In order to highlight and present a thorough comparison between the possible long-term complications associated with multiple reconstructive techniques, the paper also includes data related to patients who have undergone such surgical interventions in the aforementioned Health Unit, but which were not included in the national program, resulting a total of 73 reconstructive surgical interventions. The research results show that the overall rate of complications was 43.83%, skin necrosis, superficial infection and seroma being in this order the main complications that were identified. In the authors' opinion, risks of complications are moderated in relation with breast reconstruction surgery. However, the complication rate significantly varies depending on the chosen technique. The lowest risk levels registered in this study were associated with the breast reconstruction using the two-stage expander-implant technique. The analysis compares the achieved results with data provided by international studies, the main differences being caused by the status of the medical infrastructure, as well as the moment of hospital admission that is primarily determined by the level of medical education.
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Affiliation(s)
- Silviu Adrian Marinescu
- Department of Plastic and Reconstructive Surgery, "Carol Davila" University of Medicine and Pharmacy, "Bagdasar-Arseni" Emergency Clinical Hospital, Bucharest, Romania;
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Kim JH, Hwang SY, Kwon TH, Chong K, Yoon WK, Kim JH. Defining "early" cranioplasty to achieve lower complication rates of bone flap failure: resorption and infection. Acta Neurochir (Wien) 2019; 161:25-31. [PMID: 30511143 DOI: 10.1007/s00701-018-3749-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/26/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although cranioplasty (CP) is a frequently performed and simple procedure, complications are common, particularly bone flap resorption and infection. The timing of surgery is as an important contributory factor, but the optimal timing has not been clearly determined. OBJECTIVE We retrospectively investigated bone flap resorption and surgical site infection after CP to determine the optimal timing of surgery for reduction of complications. METHODS The study enrolled 126 patients who underwent decompressive craniectomy (DC) and subsequent CP. Patients with bone flap resorption or surgical site infection were analyzed as the "complication" group. Receiver operating characteristic curve analysis was performed and the Youden index was used to dichotomize "early CP" and "late CP" groups. Univariate and multivariate survival analyses were performed. RESULTS The complication group included 42 patients. The Youden index was used to identify a cutoff value for the DC-CP interval of > 44 days, and this was used to define early (< 45 days) and late (≥ 45 days) CP. Late CP was a significant risk factor in univariate and multivariate Cox regression analyses. CONCLUSION This study showed that early CP before 45 days after DC is associated with a lower rate of bone flap resorption and surgical site infection than late CP.
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Affiliation(s)
- Jang Hun Kim
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
- Focused Training Center for Trauma, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Soon-Young Hwang
- Biostatistical consulting lab, Medical Science Research Center, Korea University College of Medicine, Seoul, Republic of Korea
| | - Taek-Hyun Kwon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyuha Chong
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Won-Ki Yoon
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jong Hyun Kim
- Department of Neurosurgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
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Taneri S, Kiessler S, Rost A, Schultz T, Dick HB. Flap Melting Over Corneal Inlay for Hyperopic Correction. J Refract Surg 2018; 34:775-778. [PMID: 30428098 DOI: 10.3928/1081597x-20180823-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 08/22/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To report two cases of flap melting over corneal inlays for hyperopic correction several years after implantation. METHODS The corneal inlay (+6.00 diopters [D]; PermaVision intracorneal lens; Anamed Inc., Lake Forest, CA) was implanted underneath a LASIK flap in two patients. RESULTS Visual acuity and slit-lamp findings of both patients were stable for several years. At 9 years postoperatively, the first patient presented with a sudden loss of corrected distance visual acuity (CDVA) due to partial flap melting over the inlay while the surrounding anterior cornea showed opacification. The inlay was explanted immediately. Three years after explantation, CDVA returned to 1.0. Similarly, the second patient presented 11 years postoperatively with loss of vision, opacification, and partial flap melting. The inlay was explanted. Two years later, CDVA recovered. CONCLUSIONS Potentially severe biocompatibility issues of corneal inlays may occur even after several uneventful years. [J Refract Surg. 2018;34(11):775-778.].
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Chen T, Tu Q, Cheng L, Li Z, Lin D. Effects of curculigoside A on random skin flap survival in rats. Eur J Pharmacol 2018; 834:281-287. [PMID: 30030989 DOI: 10.1016/j.ejphar.2018.07.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/13/2018] [Accepted: 07/18/2018] [Indexed: 12/17/2022]
Abstract
Necrosis in distal areas of random skin flaps remains a challenging issue. Curculigoside A (CA), one of the main bioactive phenolic compounds, has been reported to induce angiogenesis in vitro by increasing proliferation, tube formation, and migration. In addition, CA was shown to increase vascular endothelial growth factor (VEGF) expression. In this study, we investigated the potential use of CA as a novel candidate to enhance the viability of the ischemic skin flap. A modified McFarlane flap was used as a surgical model in Sprague-Dawley rats. Three groups of rats were treated as follows: the control group received 0.9% saline orally, while rats in the two treatment groups were administered 10 mg/kg or 20 mg/kg CA orally for 7 days, respectively. On day7, the mice were killed, and tissue samples were collected for hematoxylin and eosin staining and immunohistochemical examination, while laser Doppler imaging and oxide-gelatin angiography were performed to assess angiogenesis. Kits for the analysis of superoxide dismutase (SOD) and malondialdehyde (MDA) were used to verify the oxidative stress level. Treating animals with CA significantly increased the surviving portion of the flaps. VEGF and SOD expression and microvessel development were markedly increased, and the MDA level was reduced, in the CA treatment groups. Histological studies demonstrated that CA promoted angiogenesis and attenuated inflammatory cell numbers. These findings indicated that CA increases random skin flap survival.
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Affiliation(s)
- Tingxiang Chen
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xue yuan Xi Road, Wenzhou, Zhejiang, China
| | - Qiming Tu
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xue yuan Xi Road, Wenzhou, Zhejiang, China
| | - Liang Cheng
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xue yuan Xi Road, Wenzhou, Zhejiang, China
| | - Zhijie Li
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xue yuan Xi Road, Wenzhou, Zhejiang, China.
| | - Dingsheng Lin
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, 109 Xue yuan Xi Road, Wenzhou, Zhejiang, China.
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Tenenhaus M, Gaid NA, Hayes S, Foubert P, Grover I. Injection of SVF combined with HBO2 improves viability of unfavorably designed flaps. Undersea Hyperb Med 2018; 45:381-388. [PMID: 30241116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE Soft-tissue reconstruction is complicated by ischemia and reperfusion injury. Animal trials have documented the independent healing benefits of hyperbaric oxygen preconditioning (HBOP) and stem cell delivery in cutaneous flaps. We explored the role of HBOP and stem cell delivery in flap preconditioning and survival. METHODS We designed a randomized controlled trial to assess the effects of hyperbaric oxygen preconditioning and stromal vascular fraction (SVF) delivery on flap survival. Of the first 24 guinea pigs, six received neither HBOP nor injections, and six underwent HBOP without injections. Of the remaining 12 animals, six received SVF or saline injections in the absence of HBOP. The final six animals received autologous SVF injections or saline injections followed by four HBOP treatments. To enhance clinical relevance, a group of 6 animals underwent HBOP prior to SVF or saline injections. Thereafter, an unfavorably designed cutaneous flap was elevated and assessed via study-blinded observer, as well as by quantification of TUNEL-positive cells. RESULTS Distal necrosis of the tissue flap was more extensive in the no-intervention group (45% of flap). Flaps treated with HBOP only and those treated with SVF injections demonstrated only 38.2% and 27.1% distal necrosis. The most significant difference occurred in the combination HBOP and SVF group, where distal necrosis was only 21.1% of the flap (p ≤ 0.05). SVF delivery immediately prior to flap elevation further minimized distal necrosis of the flap to 15.6%. These findings were mirrored by the TUNEL assay. CONCLUSIONS Combining HBOP and SVF improves flap viability.
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Affiliation(s)
- Mayer Tenenhaus
- University of California San Diego, UCSD Medical Center Hillcrest
| | - Nicole Ann Gaid
- University of California San Diego, UCSD Medical Center Hillcrest
| | - Sandra Hayes
- University of California San Diego, UCSD Medical Center Hillcrest
| | - Philippe Foubert
- University of California San Diego, UCSD Medical Center Hillcrest
| | - Ian Grover
- University of California San Diego, UCSD Medical Center Hillcrest
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Lai HW, Chen ST, Lin SL, Lin YL, Wu HK, Pai SH, Chen DR, Kuo SJ. Technique for single axillary incision robotic assisted quadrantectomy and immediate partial breast reconstruction with robotic latissimus dorsi flap harvest for breast cancer: A case report. Medicine (Baltimore) 2018; 97:e11373. [PMID: 29979425 PMCID: PMC6076135 DOI: 10.1097/md.0000000000011373] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/05/2018] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The clinical application of robotic surgery in breast conserving surgery or volume replacement with robotic latissimus dorsi flap harvest (RLDFH) has been rarely reported. In this study, we report the preliminary experience and clinical outcome of robotic assisted quadrantectomy (RAQ) and immediate partial breast reconstruction (IPBR) with RLDFH. PATIENT CONCERN Decreasing and avoid back scar length after latissimus dorsi flap harvest. DIAGNOSES One 28 years old female with left breast cancer underwent RAQ and IPBR with RLDFH. Initially, she was diagnosed with left breast infiltrating carcinoma that was clinical stage T3N1M0 and triple negative. INTERVENTIONS Neoadjuvant chemotherapy consisting of 4 cycles of epirubicin and cyclophosphamide followed by 4 cycles of docetaxel was performed. Breast magnetic resonance imaging showed residual breast cancer about 4.5 cm over the left upper outer quadrant of the breast. Sentinel lymph node biopsy showed no lymph node metastasis. RAQ, which took 82 minutes, was performed first, and the resected breast specimen's weight was 203 gm. She received IPBR with RLDFH, which took 97 minutes. OUTCOMES The overall blood loss was 40 mL. The final pathology result was ypT2 (4.2 cm)N0 (sn0/3)M0 and stage IIA. The resection margin was free of tumors. The post-operative recovery was smooth except for seroma formation over the back, which was relieved after repeated aspiration at an outpatient clinic. The patient was satisfied with the post-operative scar and aesthetic outcome. No local recurrence, distant metastasis or case mortality was found during 5 months of follow-up. LESSONS RAQ and IPBR with RLDFH is a safe alternative for small-to-medium-breast-size women with breast cancer who desire breast conservation and are indicated for volume replacement with autologous latissimus dorsi flap.
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Affiliation(s)
- Hung-Wen Lai
- Endoscopic and Oncoplastic Breast Surgery Center
- Division of General Surgery
- Comprehensive Breast Cancer Center
- School of Medicine, National Yang Ming University, Taipei
- Division of Breast Surgery, Yuanlin Christian Hospital, Yuanlin
- Minimal Invasive Surgery Research Center
- Kaohsiung Medical University, Kaohsiung
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Shou-Tung Chen
- Endoscopic and Oncoplastic Breast Surgery Center
- Division of General Surgery
- Comprehensive Breast Cancer Center
| | - Shih-Lung Lin
- Division of Plastic and Reconstructive Surgery, Department of Surgery
| | - Ya-Ling Lin
- Endoscopic and Oncoplastic Breast Surgery Center
- Minimal Invasive Surgery Research Center
| | - Hwa-Koon Wu
- Department of Radiology, Changhua Christian Hospital, Changhua
| | - Shu-Hsin Pai
- Endoscopic and Oncoplastic Breast Surgery Center
- Minimal Invasive Surgery Research Center
| | - Dar-Ren Chen
- Endoscopic and Oncoplastic Breast Surgery Center
- Division of General Surgery
- Comprehensive Breast Cancer Center
| | - Shou-Jen Kuo
- Division of General Surgery
- Comprehensive Breast Cancer Center
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Li Y, Cui C, Zhang R, Zhang Q, Xu Z, Xu F, Li D. Anatomical and Histological Evaluation of the Retroauricular Fascia Flap for Staged Auricular Reconstruction. Aesthetic Plast Surg 2018; 42:625-632. [PMID: 29470606 DOI: 10.1007/s00266-018-1098-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 01/28/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The retroauricular fascia flap (RFF) is one of the most commonly used vascularized linings for auriculocephalic sulcus reconstruction in staged total auricular reconstruction. This study aims to investigate the histomorphometric features regarding the retroauricular fascia. METHODS Histological evaluation included qualitative observation and quantitative analysis of sections of RFF stained with hematoxylin and eosin, Masson's trichrome, Elastica van Gieson, CD31, and Lyve-1. Ultrasonographic evaluation included measurement of the thickness of the superficial layer of the retroauricular fascia (RFF origin) at three different positions in microtia patients. P < 0.05 was considered statistically significant. RESULTS RFF was a thin, highly organized layer with mainly collagen fibers. From its superior to inferior portions, the percentage of collagen fibers differed significantly (superior 87.57 ± 10.85%, middle 68.29 ± 29.02%, inferior 53.31 ± 33.33%, p < 0.05). The percentages of elastic fibers in the superior (4.86 ± 5.17%) and middle (5.05 ± 5.37%) areas were higher than that in the inferior (2.14 ± 2.42%, p < 0.05). RFF blood vessel density (20× magnification) decreased significantly from the superior to inferior portions (superior 6.39 ± 1.18, middle 5.17 ± 1.15, inferior 2.67 ± 0.78, p < 0.05). Lymphatic vessel density (20× magnification) also decreased significantly from the superior to inferior regions (superior 6.80 ± 0.62, middle 5.26 ± 1.17, inferior 2.11 ± 0.46, p < 0.05). Thickness of the superficial layer of retroauricular fascia increased significantly from the superior to inferior regions (superior 0.29 ± 0.06 mm, middle 0.36 ± 0.09 mm, inferior 0.53 ± 0.14 mm, p < 0.001). CONCLUSIONS From cranial to caudal, the RFF became thicker, less elastic, and less vascularized, and contained fewer lymphatic vessels. Therefore, when the retroauricular fascia is large enough, the superior portion would be preferred for RFF in auriculocephalic sulcus reconstruction. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Yiyuan Li
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639, Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Chunxiao Cui
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639, Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Ruhong Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639, Zhi Zao Ju Rd., Shanghai, 200011, China.
| | - Qun Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639, Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Zhicheng Xu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639, Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Feng Xu
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639, Zhi Zao Ju Rd., Shanghai, 200011, China
| | - Datao Li
- Department of Plastic and Reconstructive Surgery, Shanghai 9th People's Hospital, Shanghai JiaoTong University School of Medicine, No. 639, Zhi Zao Ju Rd., Shanghai, 200011, China
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Myung Y, Son Y, Nam TH, Kang E, Kim EK, Kim IA, Eom KY, Heo CY, Jeong JH. Objective assessment of flap volume changes and aesthetic results after adjuvant radiation therapy in patients undergoing immediate autologous breast reconstruction. PLoS One 2018; 13:e0197615. [PMID: 29782518 PMCID: PMC5962051 DOI: 10.1371/journal.pone.0197615] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 05/05/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The use of immediate breast reconstruction and adjuvant radiation therapy is increasing in breast cancer patients. This study aimed to analyze the aesthetic outcome and changes in flap volume in patients with breast cancer undergoing radiation therapy of the surgical site after immediate autologous tissue reconstruction. METHODS Immediate abdominal free flap breast reconstruction following unilateral mastectomy was performed in 42 patients; 21 patients received adjuvant radiation (study group) and 21 patients did not (control group). To compare flap volume, three-dimensional computed tomography (CT) was performed before and after radiation. Also, aesthetic analysis was performed in both groups to evaluate shape changes. RESULTS There was a 12.3% flap volume reduction after the completion of radiation in the experimental group that was significantly greater than the 2.6% volume reduction observed in the non-radiation group (P<0.01). There was no significant difference in the short- and long-term aesthetic results between the groups. CONCLUSIONS When performing immediate autologous breast reconstruction, 14% volume overcorrection is recommended for patients in whom adjuvant radiation therapy is anticipated to improve aesthetic outcomes.
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Affiliation(s)
- Yujin Myung
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yousung Son
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Tae-hyun Nam
- Department of Diagnostic Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eunyoung Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Eun-Kyu Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - In Ah Kim
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Keun-Yong Eom
- Department of Radiation Oncology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Chan Yeong Heo
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae Hoon Jeong
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
- * E-mail:
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Froum SJ, Khouly I. Survival Rates and Bone and Soft Tissue Level Changes Around One-Piece Dental Implants Placed with a Flapless or Flap Protocol: 8.5-Year Results. INT J PERIODONT REST 2018; 37:327-337. [PMID: 28402342 DOI: 10.11607/prd.3073] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The purpose of the current study was to determine the survival rates and to measure marginal bone changes and peri-implant conditions 8.5 years after placement of one-piece implants with an anodically oxidized surface (AOS). A total of 52 subjects who received a one-piece implant with an AOS using a flapless or flap protocol and completed a previous randomized clinical trial were contacted for a recall visit 8.5 years after implant placement (T8.5). Implant success and survival rates, probing pocket depth (PPD), presence of bleeding on probing (BoP), papilla level, and incidence of complications and peri-implant disease were assessed by a single, blinded examiner. A second blinded examiner evaluated marginal bone level changes. Results for 8.5 years were compared to those at the time of implant placement, implant loading (0.5 year), and 1 and 1.5 years follow-up. The results based on 28 patients who attended the follow-up visit (half had flapless and half a flap protocol) showed a 100% implant survival rate and a 96.4% implant success rate 8.5 years after implant placement using one-piece implants, with no difference in survival and success rates between the flapless and the flap protocol. During the same follow-up period, a significant increase in crestal bone height from 1.5 to 8.5 years was observed. Analysis suggested decreasing mean levels of bone loss with time (P < .001). Moreover, there was 0.8 to 1.0 mm of bone loss through year 1.5, which decreased to 0.3 mm at 8.5 years (P < .05). There was no statistically significant difference in PPD or BoP over time. Similar mean levels of PPD were found in flap and flapless groups (mean [SD] = 2.4 [0.3] and 2.2 [0.4] mm, respectively [P = .18]), as well as similar rates of BoP (22.8% vs 17.9%, respectively). Papilla levels increased during the first year after implant loading. However, there was little additional change between 1.5 and 8.5 years. A total of eight fractured porcelain crowns and three crown loosenings were reported. One-piece implants with an AOS showed high survival rates and stable marginal bone and periimplant soft tissue levels regardless of whether a flapless or flap protocol was used.
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Zhao J, Zhao F, Huang J, Xu H, Chen Y, Zhou X. Two-Year Outcome of a Patient Treated With Phototherapeutic Keratectomy and Autologous SMILE Lenticule Transplantation for Flap-Related Complications Following LASIK. J Refract Surg 2018; 34:281-285. [PMID: 29634844 DOI: 10.3928/1081597x-20180130-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 12/28/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe a patient with flap complications after LASIK who was subsequently treated using phototherapeutic keratectomy (PTK) and an autologous lenticule transplant obtained via small incision lenticule extraction (SMILE). METHODS A 23-year-old man experienced free flap and partial flap loss in the left eye following LASIK, resulting in corneal stroma opacity 1 month later. The manifest refraction was -3.25 diopters sphere (DS)/-0.50 diopters cylinder (DC) × 100° in the right eye and +2.50 DS/-1.25 DC × 155° in the left eye. His left eye was treated with PTK and transplantation of an autologous lenticule obtained from his right eye using the SMILE procedure. RESULTS At the 2-year follow-up visit, the uncorrected distance visual acuity of the left eye had improved from 20/100 to 20/22 and the corrected distance visual acuity had improved from 20/25 to 20/18. Central corneal thickness had increased from 464 to 499 µm. The mean keratometry value had decreased from 45.00 diopters (D) at the 1-month follow-up visit to 39.40 D at the 2-year follow-up visit. Optical coherence tomography examination revealed that the lenticule remained transparent and exhibited a visible demarcation line. CONCLUSIONS The transplantation of an autologous lenticule obtained via SMILE combined with PTK improved uncorrected and corrected acuity in this patient with flap loss after LASIK. [J Refract Surg. 2018;34(4):281-285.].
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Weber R, Silver A, Williams SJ, Stephenson L, Usera PC, Zhang F, Tian H, Yang W, Wang WZ, Fang XH, Zamboni WA, Baynosa R. Random flap survival with hyperbaric oxygen: daily versus twice-daily treatments. Undersea Hyperb Med 2018; 45:157-164. [PMID: 29734567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE Hyperbaric oxygen (HBO₂) therapy is used to improve the survival of compromised flaps. Compromised flaps are complications encountered postsurgically, or in traumatic degloving or avulsion injuries. Failed flaps lead to persistence of the defect, requirement of another donor site, and psychosocial sequelae. Although evidence of the benefit of HBO₂ therapy is significant, there is no consensus on the optimal treatment regimen. The purpose of this study is to examine whether twice-daily treatments (BID HBO₂) provide additional benefit compared to daily treatments (QD HBO₂) in a rat compromised random flap model. METHODS A rat random flap model was used with subjects divided into three groups: 1) control group; 2) QD HBO₂; and 3) BID HBO₂, where HBO₂ was performed with 100% oxygen at 2.5 atmospheres absolute/ATA (253 kPa) for 90 minutes. After 10 days, areas of flap necrosis were measured and biopsies were taken for histologic analysis. Statistical analysis was performed using ANOVA and paired t-tests. A P-value ⟨0.05 was considered significant. RESULT Both treatment groups had significantly increased mean flap survival compared to controls (P⟨0.05). There was no significant difference in flap survival between the QD and BID groups. Capillary proliferation in the QD group was increased compared with controls. CONCLUSION Both QD and BID HBO₂ protocols can significantly decrease random flap necrosis. However, the results of this study suggest there is no additional benefit gained with BID treatments. Clinical studies are warranted to confirm these findings and assist in formalization of protocols for the use of HBO₂in treating compromised random flaps.
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Affiliation(s)
- Rachel Weber
- UNLV School of Medicine, Division of Plastic Surgery, Las Vegas, Nevada, U.S
| | - Andrew Silver
- UNLV School of Medicine, Division of Plastic Surgery, Las Vegas, Nevada, U.S
| | - Shelley J Williams
- UNLV School of Medicine, Division of Plastic Surgery, Las Vegas, Nevada, U.S
| | - Linda Stephenson
- UNLV School of Medicine, Division of Plastic Surgery, Las Vegas, Nevada, U.S
| | - Phillip C Usera
- UNLV School of Medicine, Division of Plastic Surgery, Las Vegas, Nevada, U.S
| | - Fan Zhang
- UNLV School of Medicine, Division of Plastic Surgery, Las Vegas, Nevada, U.S
| | - Honglin Tian
- UNLV School of Medicine, Division of Plastic Surgery, Las Vegas, Nevada, U.S
| | - Wei Yang
- UNLV School of Medicine, Division of Plastic Surgery, Las Vegas, Nevada, U.S
| | - Wei Z Wang
- UNLV School of Medicine, Division of Plastic Surgery, Las Vegas, Nevada, U.S
| | - Xin Hua Fang
- UNLV School of Medicine, Division of Plastic Surgery, Las Vegas, Nevada, U.S
| | - William A Zamboni
- UNLV School of Medicine, Division of Plastic Surgery, Las Vegas, Nevada, U.S
| | - Richard Baynosa
- UNLV School of Medicine, Division of Plastic Surgery, Las Vegas, Nevada, U.S
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