Successful engraftment of skin grafts highly depends on the quality of the wound bed. Good quality of blood vessels near the surface is critical to support the viability of the graft. Ischemic, irradiated scar tissue, bone and tendons will not have the sufficient blood supply. In such situations flaps are to be resorted. However, the flaps also need to have good vascularity over the limbs. The introduction of dermal substitutes has provided a novel method for repairing various severe skin defects. These substitutes act as dermal regenerative templates, which facilitate dermal reconstruction and regeneration. This study was done to ascertain the effectiveness of these substitutes in the treatment of complex wounds. Between January 2022 and June 2023, 20 patients who had complex wounds, which could not be treated with simple skin grafting and who were treated with collagen and elastin matrix and split skin grafting (SSG) were retrospectively studied. The percentage of SSG take as per the records was noted at a 10-day post-operative period. Patient characteristics, comorbidities, duration and outcomes of the treatment were noted. Twenty patients were included in the study. The minimum size of the ulcer was 5 × 4 cm (area of 20 cm2) and the maximum size of the ulcer was 15 × 15 cm (225 cm2). Average take of skin graft was 93.7% at 10th post-operative day. Recurrence at 6 months was nil. The scar quality was assessed by patient and observer at 3 months and 6 months post-operatively. The lower-limb ulcers with compromised surrounding tissue are complex. The major goal in these cases is to do simple surgery and prevent recurrence. The collagen and elastin matrices provide structural support for cellular infiltration, which helps maximize a SSG take and a stable long-term scar.
- MeSH
- Varicose Ulcer pathology therapy MeSH
- Elastin therapeutic use MeSH
- Collagen therapeutic use MeSH
- Middle Aged MeSH
- Humans MeSH
- Leg Injuries * pathology therapy MeSH
- Health Care Surveys methods statistics & numerical data MeSH
- Skin Transplantation * methods MeSH
- Leg Ulcer pathology therapy MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Clinical Study MeSH
Complex injuries to the posterior trunk can still pose a significant challenge to the reconstructive surgeon. Due to the lack of skin laxity, dependent anatomical location and the importance of the deeper structures, a systematic approach tailored to the individual defect should be considered for these types of reconstructions. In our case report, we present a reconstructive solution of a chronic defect of the back caused by resection of an ulceration. What was previously considered to be a relapse of a malignant melanoma turned out to be a chronic osteomyelitis of the spinous processes of the thoracic vertebrae. The defect after the resection of the ulceration and infected spinous processes of the thoracic vertebrae with exposed dorsal lamina was covered with pedicled myocutaneous flap. Reconstruction yielded well-vascularized tissue that provided sufficient volume and tissue quality. Even in the light of modern perforator flaps, local or locoregional muscle and myocutaneous flaps remain the first choice for the treatment of deep back defects. Considering all the factors in the given case, plastic surgeons are able to tailor the reconstructive technique to every individual case to match the desired reconstruction goal.
- MeSH
- Surgical Flaps * surgery MeSH
- Dermatologic Surgical Procedures methods MeSH
- Thoracic Vertebrae surgery pathology MeSH
- Humans MeSH
- Melanoma, Cutaneous Malignant complications MeSH
- Osteomyelitis * surgery MeSH
- Postoperative Care methods MeSH
- Aged MeSH
- Staphylococcal Infections complications MeSH
- Ulcer surgery complications pathology MeSH
- Back surgery pathology MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Publication type
- Case Reports MeSH
Replication forks stalled at co-transcriptional R-loops can be restarted by a mechanism involving fork cleavage-religation cycles mediated by MUS81 endonuclease and DNA ligase IV (LIG4), which presumably relieve the topological barrier generated by the transcription-replication conflict (TRC) and facilitate ELL-dependent reactivation of transcription. Here, we report that the restart of R-loop-stalled replication forks via the MUS81-LIG4-ELL pathway requires senataxin (SETX), a helicase that can unwind RNA:DNA hybrids. We found that SETX promotes replication fork progression by preventing R-loop accumulation during S-phase. Interestingly, loss of SETX helicase activity leads to nascent DNA degradation upon induction of R-loop-mediated fork stalling by hydroxyurea. This fork degradation phenotype is independent of replication fork reversal and results from DNA2-mediated resection of MUS81-cleaved replication forks that accumulate due to defective replication restart. Finally, we demonstrate that SETX acts in a common pathway with the DEAD-box helicase DDX17 to suppress R-loop-mediated replication stress in human cells. A possible cooperation between these RNA/DNA helicases in R-loop unwinding at TRC sites is discussed.
- MeSH
- Flap Endonucleases metabolism genetics MeSH
- DEAD-box RNA Helicases * metabolism genetics MeSH
- DNA-Binding Proteins * metabolism genetics MeSH
- DNA Helicases * metabolism genetics MeSH
- DNA Ligase ATP metabolism genetics MeSH
- DNA metabolism genetics MeSH
- Endonucleases * metabolism genetics MeSH
- Transcription, Genetic MeSH
- Humans MeSH
- Multifunctional Enzymes * metabolism genetics MeSH
- R-Loop Structures * MeSH
- DNA Replication * MeSH
- RNA Helicases * metabolism genetics MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
Autoři prezentují novou modifikaci rekonstrukce očnice založené na volném laloku musculus vastus lateralis u 41letého pacienta se sekundárním defektem po poranění technickým olejem pod vysokým tlakem. Pacient podstoupil více rekonstrukčních zákroků v různých zdravotnických centrech se špatnými funkčními a estetickými výsledky vč. jednoduchých místních plastik. Pacient podstoupil současnou rekonstrukci měkkých tkání očnice a spojivkového vaku na základě prelaminovaného volného laloku vastus lateralis. Dvoufázová rekonstrukce těchto struktur je výhodná jak pro psychický a mentální stav pacienta, tak pro ekonomiku zdravotního systému. Proto kdykoli je to možné, měli bychom se snažit snížit počet nutných zákroků. Autoři jsou přesvědčeni, že jejich technika může významně zlepšit kvalitu života pacientů po exenteraci, ale současně zdůrazňují, že je třeba provést více zákroků za účelem jejího zdokonalení.
The authors present a novel modification of vastus lateralis muscle free flap based orbital reconstruction in a 41-year-old patient, with a secondary defect to an injury with technical oil under high pressure. The patient underwent multiple reconstructive procedures in different medical centers with poor functional and esthetic results including simple local plasty techniques. The patient underwent simultaneous reconstruction of the soft tissues of the orbit, and conjunctival sac based on a prelaminated vastus lateralis free flap. The two-stage reconstruction of these structures is beneficial both for the patient's psychical and mental condition and for health system finances. Therefore, whenever it's possible, we should try to decrease the number of required procedures. The authors believe that their technique can significantly improve the quality of life of patients after exenteration but simultaneously they emphasize the need to carry out more procedures in order to refine it.
- Keywords
- Key words orbital reconstruction – vastus lateralis muscle free flap – exenteration – case report – microsurgery,
- MeSH
- Surgical Flaps MeSH
- Adult MeSH
- Quality of Life MeSH
- Humans MeSH
- Orbit * surgery MeSH
- Lacrimal Apparatus surgery MeSH
- Treatment Outcome MeSH
- Plastic Surgery Procedures * MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
... Li -- PART IV Eye Banking -- 24 Eye Banking: Structure and Function, 246 -- Donna C. ... ... Ip -- 146 Conjunctival Flaps, 1489 -- Ana Carolina Vieira, Mark J. ...
Fifth edition 2 svazky : ilustrace ; 28 cm
- Conspectus
- Ortopedie. Chirurgie. Oftalmologie
- NML Fields
- oftalmologie
- NML Publication type
- kolektivní monografie
Low solubility of reactants or products in aqueous solutions can result in the enzymatic catalytic reactions that can occur in non-aqueous solutions. In current study we investigated aqueous solutions containing different organic solvents / deep eutectic solvents (DESs) that can influence the protease enzyme's activity, structural, and thermal stabilities. Retroviral aspartic protease enzyme is responsible for the cleavage of the polypeptide precursors into mature viral components, a very crucial step for virus life cycle. In molecular dynamic simulations (MDS), the complex of the protease enzyme with Darunavirwas found highly stable in urea aqueous solution compared to when with the ethylene glycol (EG) or glycerol solvents. Particularly, in different organic solvents the presence of Darunavir induced protein-protein interactions within the protease homodimer. For the systems with EG or glycerol solvents, the flap domains of the enzyme formed an "open" conformation which lead to a weak binding affinity with the drug. Conserved D25 and G27 residues among this family of the aspartic protease enzymes made a stable binding with Darunavir in the urea systems. Unfolding of the protease dimer was initiated due to self-aggregation for the EG or glycerol organic solvents, which formed an "open" conformation for the flap domains. On the contrary lack of such clustering in urea solvent, the protease showed conventional structural folding in the presence or absence of the drug molecule. These novel findings may help to better understand the protease enzymes, which could be controlled by deep eutectic solvents.
In an effort to expand knowledge of Clade 3-one of the ten clades that compose the non-monophyletic order 'Tetraphyllidea' all current members of which parasitise orectolobiform sharks-we targeted species of orectolobiform sharks that had not previously been examined for 'tetraphyllidean' cestodes. That work led to the discovery of three new species off Australia and Taiwan. Ambitalveolus gen. n. was erected to accommodate these species. Ambitalveolus costelloae gen. n. et sp. n., Ambitalveolus kempi sp. n., and Ambitalveolus penghuensis sp. n. differ from one another in scolex size, genital pore position, and number of marginal loculi, proglottids, and testes. Among 'tetraphyllideans', the new genus most closely resembles the two other genera in Clade 3. It differs from Carpobothrium Shipley et Hornell, 1906 in lacking anterior and posterior flap-like extensions of its bothridia; instead, its bothridia are essentially circular. It differs from Caulopatera Cutmore, Bennett et Cribb, 2010 in that its vitelline follicles are in two lateral bands, rather than circum-medullary, and in that its bothridia bear, rather than lack, conspicuous marginal loculi. A key to the three genera in Clade 3 is provided. A phylogenetic analysis including new sequence data for one of the three new species of Ambitalveolus gen. n., the only species of Caulopatera, and all four described species and one undescribed species of Carpobothrium supports previously hypothesised close affinities between Caulopatera and Carpobothrium, with the new genus as their sister group. This is the first report of 'tetraphyllidean' cestodes from the orectolobiform shark family Brachaeluridae Applegate. The association of the new species with orectolobiform sharks is consistent with those of the other members of Clade 3. However, whereas species of Carpobothrium and Caulopatera parasitise members of the hemiscylliid genus Chiloscyllium Müller et Henle, species of Amitalveolus gen. n. parasitise members of the Brachaeluridae and Orectolobidae Gill.
- MeSH
- Cestoda * genetics MeSH
- Cestode Infections * epidemiology veterinary MeSH
- Phylogeny MeSH
- Microscopy, Electron, Scanning MeSH
- Fish Diseases * epidemiology MeSH
- Sharks * MeSH
- Animals MeSH
- Check Tag
- Animals MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Australia MeSH
- Taiwan MeSH
Úvod: Chirurgická navigace s technikami trojrozměrného (3D) tisku představuje dvě hlavní výhody: za prvé, z technického hlediska usnadňuje orientaci v cílových anatomických strukturách, což vede ke zlepšení přesnosti chirurgického zákroku. Navíc zkracuje dobu složitých chirurgických zákroků tím, že připravuje přesnou polohu přizpůsobených autologních štěpů pomocí fixačních zařízení. Za druhé, z klinického hlediska zkracuje dobu operace a také zmenšuje dopad chirurgického stresu na sousední tkáně. Materiál a metody: V této studii byly pomocí 3D navigace a plánování hodnoceny dva maxilofaciální postupy – resekce styloidního procesu v důsledku Eaglova syndromu a mikrovaskulární rekonstrukce mandibuly volným lalokem z fibuly. Všichni pacienti, kteří podstoupili tyto postupy, byli rozděleni do dvou skupin (s 3D navigací nebo bez ní). Výsledky: Ve skupině Eaglova syndromu nezávislý t-test ukázal významný rozdíl v operační době mezi skupinou 1 (M = 148; SD = 0) a skupinou 2 (M = 78; SD = 4,24; t (1) = 13,472; p = 0,047. Nebyl žádný významný rozdíl v délce pooperační hospitalizace (2 dny), který byl stejný ve všech skupinách pacientů. Ohledně rekonstrukce čelisti volným lalokem z fibuly, nezávislý t-test odhalil významný rozdíl v operačním čase s 3D tiskovými šablonami (M = 8:40:25; SD = 0:58:07) a bez nich (M = 10:43:15; SD = 3 :04:32); t (14) = 2,133; p = 0,051. Podobně nebyl žádný významný rozdíl mezi skupinami (skupina 1 M = 15,5; SD = 0,71; skupina 2 M = 13; SD = 1,63) v délce trvání pooperační hospitalizace; t (4) = 1,98; p = 0,119. Závěr: Stručně řečeno, zkrácení doby operace při Eaglově syndromu a při mikrovaskulární rekonstrukci dolní čelisti pomocí volného laloku z fibuly zmírňuje chirurgický stres na cílové tkáně, což umožňuje rychlejší hojení tkání a rychlejší zotavení.
Background: Surgical navigation with three-dimensional (3D) printing techniques presents two major advantages: First, from a technical aspect, it facilitates orientation in target anatomical structures resulting in improvement of the accuracy of surgery. Moreover, it shortens the time of complex surgical interventions by preparing the exact position of customized autologous grafts with fixation devices. Second, from a clinical point of view, it also lessens the impact of surgical stress to adjacent tissues by decreasing the duration of surgery. Material and methods: Two maxillofacial procedures were evaluated in this study using 3D navigation and planning approach – resection of the styloid process due to Eagle’s syndrome and microvascular mandibular reconstruction with the fibula free flap. All patients who underwent these procedures were divided into two groups (with or without 3D navigation). Results: In the Eagle’s syndrome group procedure independent t-test showed significant difference in the operating time between group 1 (M = 148; SD = 0) and group 2 (M = 78; SD = 4.24) t (1) = 13.472; P = 0.047. There was no significant difference in the duration of postoperative hospitalization (2 days), which was equal in all patient groups. Regarding the fibula free flap procedure, the independent t-test revealed significant difference in operating time with (M = 8: 40 : 25; SD = 0 : 58 : 07) and without 3D printing guides (M = 10 : 43 : 15; SD = 3 : 04 : 32) t (14)=2.133, P = 0.051. Similarly, there was no significant difference between groups (group 1 M = 15.5; SD = 0,71; group 2 M = 13; SD = 1,63) in the duration of postoperative hospitalization time t (4) =1,98; P = 0.119. Conclusion: In summary, reduction in operation time in Eagle’s syndrome and in microvascular mandibular reconstruction with the fibula free flap group mitigates the surgical stress on target tissues enabling faster tissue healing and quicker recovery.
OBJECTIVE: The light emitted from the endoscope during transcanal endoscopic ear surgery (TEES) heats the intratympanic space. This heat may potentially be dangerous to nearby important structures, as documented by in vitro and by animal and cadaveric studies. The aim of our work was to monitor middle ear temperatures during TEES in vivo. STUDY DESIGN: Cohort study. SETTING: Tertiary referral hospital. PATIENTS: Four patients (15-69 yrs old) underwent transcanal endoscopic tympanoplasties for chronic perforation or retraction. INTERVENTION: After elevating the tympanomeatal flap, a thermocouple was placed in the middle ear to measure the heat generated by a 30° Hopkins rod telescope (11 cm long, 2.7 mm wide) and fiberoptic light emitting diode light source. MAIN OUTCOME MEASURES: Middle ear temperature in the retrotympanum was monitored under these conditions: at 50 and 100% light intensity, after removing and wiping the endoscope tip, during suctioning and following middle ear irrigation. RESULTS: Maximum middle ear temperature ranged from 36.26-37.30°C. Pulling out and wiping the endoscope caused no change or minimal decrease of 0.16°C. Middle ear irrigation caused a temperature drop of 2.05°C to 5.11°C. Suctioning was associated with a drop from 0.24°C to 3.91°C that was dependent on the depth of the endoscopic tip. CONCLUSION: Middle ear temperatures during TEES using a Hopkins rod telescope and light-emitting diode light source reach values corresponding to physiological body temperature, and do not reach dangerous levels.
- MeSH
- Endoscopy MeSH
- Cohort Studies MeSH
- Humans MeSH
- Otologic Surgical Procedures * MeSH
- Ear, Middle surgery MeSH
- Body Temperature * MeSH
- Temperature MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
Úvod: Ablativní chirurgická resekce má zásadní význam pro dosažení lepších onkologických výsledků u pacientů s karcinomem hlavy a krku. Radikální chirurgická resekce však vytváří požadavek na komplexní rekonstrukci jednotlivých anatomických struktur. Mikrovaskulární volné laloky byly doporučeny jako zlatý léčebný standard pro rekonstrukci hlavy a krku po definitivní onkologické operaci. Supraklavikulární ostrůvkový lalok (SCAIF) je tenký a spolehlivý fasciokutánní stopkovaný lalok, která se snadno a rychle preparuje. Materiál a metody: Do této studie bylo zahrnuto celkem 19 pacientů, kteří podstoupili rekonstrukci hlavy a krku pomocí SCAIF. SCAIF byl použit k rekonstrukci onkologického defektu u 17 pacientů, u 1 pacienta k rekonstrukci kožního defektu dolní poloviny obličeje po radioterapii a u 1 pacienta k uzávěru otevřené rány (poranění výbuchem). Výsledky: U žádného pacienta nedošlo k závažné komplikaci při ani po operaci. SCAIF byl úspěšně použit u 18 z 19 pacientů pro rekonstrukční chirurgii hlavy a krku. Častečná nekróza kůže byla pozorována v rozsahu 1,5 cm od distálního okraje laloku a byla ošetřena konzervativně lokální péčí o ránu. Dehiscence rány v donorské oblasti laloku se neobjevila u žádného pacienta. Závěr: SCAIF představuje dobrou alternativu k volným lalokům, přičemž poskytuje téměř ekvivalentní funkční výsledky a vyžaduje méně operačního času a chirurgického úsilí.
Background: The ablative surgical resection has a critical importance for achieving better oncological outcomes for patients with head and neck cancer. However, radical surgical resections reveal the reconstruction requirement of complex anatomical structures. Microvascular free flaps have been recommended as a gold standard treatment choice for head and neck reconstruction following definitive oncological surgery. The supraclavicular artery island flap (SCAIF) is a thin and reliable fasciocutaneous pedicled flap that is simple and quick to harvest. Material and methods: A total of 19 patients who underwent head and neck reconstruction with SCAIF were included in this study. The SCAIF was used for the reconstruction of oncological defects in 17 patients while it was used for the reconstruction of a skin defect on the lower face following radiotherapy in 1 patient and for cervical open wound (blast injury) closure in 1 patient. Results: There were neither intraoperative nor postoperative major complications in any patient. The SCAIF has been used successfully in 18 of 19 patients for head and neck reconstructive surgery. Partial necrosis of the skin was detected in 1 patient (5.3%) only, while a total flap failure has not occurred in any patient. The partial skin necrosis was seen in an area of 1.5 cm of the distal end of the flap and was managed conservatively with local wound care. Wound dehiscence has not appeared in the flap donor area in any patient. Conclusion: The SCAIF constitutes a good alternative to free flaps, providing almost equivalent functional results and requiring less operative time and surgical effort.
