- MeSH
- diferenciální diagnóza MeSH
- lidé MeSH
- novorozenec MeSH
- syndrom amniálních pruhů * chirurgie diagnóza klasifikace MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- dítě MeSH
- hojení ran * MeSH
- jizva hypertrofická patofyziologie terapie MeSH
- jizva * klasifikace terapie MeSH
- lidé MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
In patients with large breasts undergoing a subcutaneous mastectomy with immediate implant-based reconstruction, is necessary to perform a mastopexy. The combination of these procedures increases the complication rate. To reduce it, it is necessary to cover the lower pole of the implant. Our study aimed to compare the use of an autologous dermal flap and an absorbable breast mesh. A total of 64 patients without previous breast surgery were divided into 2 groups, each with 32 patients. In the 1st group, the implant was covered with an autologous caudally based dermal flap, sutured to the great pectoral muscle. In the 2nd group, the implant was covered with a fully absorbable breast mesh, fixed caudally in the inframammary fold and cranially to the great pectoral muscle. The incidence of complications, the aesthetic effect, and patient satisfaction were evaluated in a one-year follow-up. In the 1st group, there were 2 cases of seroma, 2 partial nipple-areola complex necrosis, 4 cases of dehiscence in the T-suture, and the malposition of the implant in 2 patients. In the 2nd group, there were 2 cases of seroma, 2 cases of T-junction dehiscence, and 1 case of full nipple-areola complex necrosis, which resulted in implant loss. There was no significant difference in patient satisfaction between the study groups. The dermal flap is more suitable for breasts with pronounced ptosis. The use of the synthetic mesh is suitable for smaller breasts, where the possible dermal flap would be too small to cover the implant. LEVEL OF EVIDENCE IV: 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 .
- MeSH
- chirurgické síťky MeSH
- lidé MeSH
- mamoplastika * škodlivé účinky metody MeSH
- mastektomie metody MeSH
- nádory prsu * chirurgie MeSH
- nekróza chirurgie MeSH
- prsní bradavky chirurgie MeSH
- retrospektivní studie MeSH
- serom chirurgie MeSH
- subkutánní mastektomie * metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Klíčová slova
- EQUITAMP,
- MeSH
- duktální karcinom prsu ošetřování MeSH
- hemostatické techniky MeSH
- hojení ran MeSH
- kombinace amoxicilinu a kyseliny klavulanové aplikace a dávkování MeSH
- kožní vředy etiologie farmakoterapie ošetřování MeSH
- krvácení terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- metastázy nádorů diagnostické zobrazování MeSH
- nádory prsu * ošetřování patologie MeSH
- tampony chirurgické MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
PURPOSE OF THE STUDY Cranioplasty is currently the most common neurosurgical procedure. The purpose of this study is to describe the first experience with successful use of the Cranio-Oss (PEEK) custom implant for cranioplasty. MATERIAL AND METHODS In the period 2012 to 2013, a total of 26 cranioplasties were performed. In fourteen patients, their own bone flap was used for reconstruction. In four cases, a synthetic Cranio-Oss bone implant made of PEEK was used. In six patients, the defect was covered by an intraoperatively-made Palacos implant and in two cases, minor defects were covered with a titanium mesh. The patients were followed up for at least five years. Cranio-Oss is a cranial implant made from polyetheretherketone (PEEK), a synthetic biocompatible material. The implant is created using the CAD/CAM method in the shape of the bone defect based on the CT scan. Creating optimal roughness of the implant surface and of the surface of the contact area attached to the bone bed is controlled and included already in the strategy for machining individual areas of the implant during its manufacturing at a 5-axis machining centre. RESULTS The Cranio-Oss implant was used in four younger patients to cover larger and complex-shaped defects. The mean age of patients in this group was 47 years. The implant was fixed to the skull by micro-plates. In all the cases the wound healed well with good cosmetic results without the necessity of revision with respect to the used implant. The follow-up CT scans always showed the implant in situ with no signs of malposition. DISCUSSION Autologous bone flap is the most suitable material for defect reconstruction after craniectomy. This option is affordable and represents one of the best methods of reconstruction of defects after craniectomy in terms of cosmetic results. In some cases, the original skull cannot be used for cranioplasty (e.g. if destructed by tumourous process, infected or in comminuted fractures). In such cases, the defect needs to be managed using a synthetic implant. In case of extensive defects, the most suitable option is a custom made implant from advanced biomaterials. CONCLUSIONS Authors prefer using autologous bone flaps during cranioplasty. In cases where this method is unavailable, a synthetic bone substitute has to be used. The first medium-term experience with the use of a Cranio-Oss implant made of PEEK showed that it is a suitable alternative to the patient's own bone. No complications associated with this synthetic implant were reported and its use to manage skull defects can be strongly recommended. With respect to legal and accreditationrelated difficulties connected with bone fragments storage and thanks to the continuous cost reduction of synthetic implants will their importance grow in the future. Key words: decompressive craniectomy, bone substitute, craniotrauma.
- MeSH
- biokompatibilní materiály aplikace a dávkování MeSH
- ketony aplikace a dávkování MeSH
- lebka chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- polyethylenglykoly aplikace a dávkování MeSH
- protézy a implantáty MeSH
- retrospektivní studie MeSH
- zákroky plastické chirurgie přístrojové vybavení metody MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Míšní léze představuje komplikovaný stav spojený se závažnými následky jak pro pacienta, tak pro společnost. Regenerační schopnosti míchy jsou značně omezené. Z tohoto pohledu je důležitá rychlá diagnostika následovaná odpovídající léčbou v závislosti na příčině léze. Etiologii míšní léze lze v zásadě rozdělit na traumatickou a netraumatickou. Traumatické míšní léze jsou nejčastěji spojené s poraněním páteře. Nádory, degenerativní změny a různé typy krvácení jsou nejčastější příčinou netraumatických míšních lézí. Včasná dekomprese představuje spolu s odpovídající konzervativní léčbou v současné době jedinou šanci na možné zlepšení klinického stavu. U déletrvající kompletní míšní léze je i přes značné úsilí na experimentální úrovni prognóza pacientů nepříznivá a zlepšení těžkého neurologického deficitu je spíše výjimečné.
Spinal cord lesions represent a complicated clinical problem connected with serious consequences both for the patient andthe society. Regenerative potential of spinal cord is extremely limited. From this point of view, fast diagnostics followed by anappropriate treatment based on the etiology of the lesion is fundamental. Etiology of spinal cord lesions can be traumatic andnon-traumatic. Traumatic spinal cord lesions are most often connected with spine injuries. Tumors, degenerative diseases andvarious hemorrhages are the most common cause of non-traumatic spinal cord lesions. Early decompression along with anadequate conservative treatment currently represents the only therapy with prospect of clinical improvement. In prolongedcomplete spinal cord lesions, the patient prognosis is, in spite of significant efforts in experimental research, still unfavourableand the improvement of a serious neurological deficit is rather exceptional.
- Klíčová slova
- míšní léze,
- MeSH
- akutní nemoc MeSH
- časové faktory MeSH
- chirurgická dekomprese MeSH
- fraktury páteře chirurgie komplikace MeSH
- lidé MeSH
- nádory míchy * chirurgie MeSH
- poranění míchy * etiologie chirurgie MeSH
- poranění páteře komplikace MeSH
- prognóza MeSH
- spinální epidurální hematom * diagnóza etiologie terapie MeSH
- Check Tag
- lidé MeSH
