Defect coverage Dotaz Zobrazit nápovědu
We report a case of a 17-year-old patient who sustained multiple finger contusions on the left hand. After thorough debridement, the volar and dorsal defects of the middle finger were covered simultaneously with bilobed arterialized venous free flap from the left forearm. The flap was composed of 2 paddles, which were connected by a subcutaneous bridge containing a subcutaneous venous network. The subdermal plexus in the bridge was interrupted with no impairment of blood supply to the second cutaneous paddle. The flap survived completely with only temporary mild venous congestion. Excellent functional and cosmetic result was reached. We consider bilobed arterialized venous free flap as a useful option for coverage of concomitant volar and dorsal digital defects.
The gold standard for the treatment of periocular basal cell carcinoma is surgical resection followed by ophthalmoplastic reconstruction. The highest priority in most cases is the complete histopathologically controlled tumor excision. The histopathological preparation can be carried out in two stages by rapid overnight embedding or intraoperatively by a rapid frozen section procedure. A variety of reconstruction methods enable a customized and in most cases also a cosmetically and functionally attractive defect coverage. Postoperatively, a regularly performed tumor aftercare is essential.
- Klíčová slova
- Defect coverage, Frozen sections, Histopathology, Reconstruction methods, Tumor excision,
- MeSH
- bazocelulární karcinom * MeSH
- lidé MeSH
- nádory kůže * MeSH
- nádory očního víčka MeSH
- retrospektivní studie MeSH
- zmrazené řezy MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
Upper abdominal wall defects secondary to trauma are not amenable to immediate closure in most cases. After a primary coverage, the definitive reconstruction can be done at a later date, using prosthetic mesh or flap. The majority of these complex procedures is, however, not available in the austere environment. The authors report a clinical case of upper full-thickness defects of the abdominal wall secondary to an explosion in Afghanistan. The patient was managed by a French Forward Surgical Team. The defect was immediately reconstructed in a one-stage surgery using a pedicled myofascial latissimus dorsi flap with good functional results. The pedicled latissimus dorsi flap is commonly used for coverage of both extrathoracic and intrathoracic defects. It is, therefore, possible to extend the harvesting of the muscle to the thoracolumbar fascia and the posterior third of the iliac crest. It provides a very large flap to cover an upper full-thickness abdomen wall defect. The harvest technique is simple, short, and largely accessible to a general surgeon. It provides immediate and definitive closure with a short hospital stay, what is clearly adapted in austere environment.
- MeSH
- bomby * MeSH
- chirurgické laloky transplantace MeSH
- debridement metody MeSH
- dítě MeSH
- fascie transplantace MeSH
- lidé MeSH
- penetrující rány chirurgie MeSH
- polytrauma chirurgie MeSH
- poranění břicha chirurgie MeSH
- povrchové zádové svaly transplantace MeSH
- techniky uzavření břišních poranění MeSH
- terapie ran pomocí řízeného podtlaku metody MeSH
- transplantace kůže metody MeSH
- válka v Afghánistánu 2001- MeSH
- zákroky plastické chirurgie metody MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
In recent years new modern therapeutic concepts have been developed in the treatment of malignant eyelid tumors; however, surgical restoration remains an important component of the therapeutic options addressed, which include microsurgical tumor excision into healthy tissue and subsequent coverage of the defects. An ophthalmic surgeon experienced in oculoplastic surgery is responsible for the recognition and evaluation of the existing alterations and planning a procedure together with the patient that meets the patient's expectations. The planning of surgery must always be individualized and fit the initial findings. Depending on the defect size and localization, different coverage strategies are available to the surgeon. To ensure successful reconstruction, every surgeon should master a wide range of reconstructive techniques.
In den letzten Jahren haben sich neue, moderne Therapiekonzepte in der Behandlung von malignen Lidtumoren entwickelt. Die chirurgische Sanierung bleibt jedoch weiterhin ein wichtiger Bestandteil der Therapiemöglichkeiten, welche die mikrochirurgische Tumorexzision im gesunden Gewebe sowie die anschließende Deckung der Defekte umfassen. Ein okuloplastisch erfahrener Ophthalmochirurg ist für die Erkennung und Bewertung der vorhandenen Veränderung zuständig und sollte zusammen mit dem Patienten ein dessen Vorstellungen entsprechendes Vorgehen planen. Die Operationsplanung muss stets individuell erfolgen und passend zum Ausgangsbefund durchgeführt werden. Abhängig von der Defektgröße und Lokalisation stehen dem Operateur unterschiedliche Deckungsstrategien zur Verfügung. Um eine erfolgreiche Rekonstruktion zu gewährleisten, sollte jeder Operateur eine breite Palette rekonstruktiver Techniken beherrschen.
- Klíčová slova
- Defect coverage, Microsurgical tumor excision, Oculoplasty, Ophthalmic surgeon, Reconstructive techniques,
- MeSH
- chirurgové * MeSH
- lidé MeSH
- nádory kůže * chirurgie MeSH
- nádory očního víčka * patologie MeSH
- oftalmologie * MeSH
- zákroky plastické chirurgie * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- přehledy MeSH
In recent years new modern therapeutic concepts have been developed in the treatment of malignant eyelid tumors; however, surgical restoration remains an important component of the therapeutic options addressed, which include microsurgical tumor excision into healthy tissue and subsequent coverage of the defects. An ophthalmic surgeon experienced in oculoplastic surgery is responsible for the recognition and evaluation of the existing alterations and planning a procedure together with the patient that meets the patient's expectations. The planning of surgery must always be individualized and fit the initial findings. Depending on the defect size and localization, different coverage strategies are available to the surgeon. To ensure successful reconstruction, every surgeon should master a wide range of reconstructive techniques.
In den letzten Jahren haben sich neue, moderne Therapiekonzepte in der Behandlung von malignen Lidtumoren entwickelt. Die chirurgische Sanierung bleibt jedoch weiterhin ein wichtiger Bestandteil der Therapiemöglichkeiten, welche die mikrochirurgische Tumorexzision im gesunden Gewebe sowie die anschließende Deckung der Defekte umfassen. Ein okuloplastisch erfahrener Ophthalmochirurg ist für die Erkennung und Bewertung der vorhandenen Veränderung zuständig und sollte zusammen mit dem Patienten ein dessen Vorstellungen entsprechendes Vorgehen planen. Die Operationsplanung muss stets individuell erfolgen und passend zum Ausgangsbefund durchgeführt werden. Abhängig von der Defektgröße und Lokalisation stehen dem Operateur unterschiedliche Deckungsstrategien zur Verfügung. Um eine erfolgreiche Rekonstruktion zu gewährleisten, sollte jeder Operateur eine breite Palette rekonstruktiver Techniken beherrschen.
- Klíčová slova
- Defect coverage, Microsurgical tumor excision, Oculoplasty, Ophthalmic surgeon, Reconstructive techniques,
- MeSH
- chirurgové * MeSH
- lidé MeSH
- nádory kůže * chirurgie MeSH
- nádory očního víčka * chirurgie MeSH
- oftalmologie * MeSH
- zákroky plastické chirurgie * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
The boy:girl ratio was calculated for all live births with cardiac malformation in Bohemia (population 6.3 million) from 1977-1984. Complete coverage of all deceased children in Bohemia by necropsy and of all patients with heart disease by our center enabled us to collect reliable data. Of 4409 children born with a heart defect, there were 2296 boys and 2113 girls, a ratio of 1.09:1. In the total population of 664,218 children born during the same period of time, the ratio was 1.06:1. A higher proportion of boys was found with double outlet right ventricle (2.68:1), hypoplastic left heart (2.25:1), transposition of the great arteries (2.11:1), aortic stenosis (1.95:1), pulmonary atresia (1.55:1), tricuspid atresia (1.45:1), coarctation of the aorta (1.30:1), and corrected transposition of the great arteries (1.25:1). There were significantly more girls than boys with persistent ductus arteriosus (1:1.66), Ebstein's anomaly of the tricuspid valve (1:1.57), truncus arteriosus (1:1.22), atrioventricular septal defect (1:1.17), and tetralogy of Fallot (1:1.12). The difference in sex prevalence in the remaining heart defects was less than 10%.
- MeSH
- kohortové studie MeSH
- kojenec MeSH
- lidé MeSH
- novorozenec MeSH
- poměr pohlaví MeSH
- předškolní dítě MeSH
- prevalence MeSH
- rozložení podle pohlaví MeSH
- vrozené srdeční vady klasifikace epidemiologie MeSH
- Check Tag
- kojenec MeSH
- lidé MeSH
- mužské pohlaví MeSH
- novorozenec MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Československo epidemiologie MeSH
The authors present an account on a patient with extensive damage of the tissue in the area of the right groin with complete severing of the artery and vein. After control of the infections they reconstructed the arterial supply and skin cover in one stage. They used a PTFE prosthesis with an extraanatomical localization and a muculocutaneous flap formed from the musculus rectus abdominis on a caudal stalk.
- MeSH
- arteria femoralis chirurgie MeSH
- cévy - implantace protéz * MeSH
- chirurgické laloky * MeSH
- dospělí MeSH
- infekce měkkých tkání chirurgie MeSH
- intravenózní abúzus drog komplikace MeSH
- lidé MeSH
- nemoci cév etiologie chirurgie MeSH
- třísla chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- kazuistiky MeSH
BACKGROUND: Reconstruction of upper and lower extremity defects can be challenging. Especially in distal parts, relatively thin flaps are needed not to interfere with the function or aesthetic appearance of the extremity. The superficial circumflex iliac artery perforator (SCIP) flap represents a powerful but still not so commonly used tool for this kind of reconstruction. In this article, we present several cases of the use of the SCIP flap for extremity defect coverage. CASE SERIES: We present five cases (three men and two women) of upper or lower extremities defect coverage with a SCIP flap performed between January and June 2021 at our department. The mean age of the patients was 43 years (28-67 years). The body mass index was 28.6 on average. Two defects were located on hands and three defects on lower extremities. In three cases, the cause of the defect was trauma, and in the remaining two, it was a tumor resection. The mean thickness of the flap was 9.4 mm. We experienced no total flap loss and no revision surgery for ischemia or congestion was needed. One of the patients developed marginal flap necrosis, which was corrected by necrectomy and direct skin closure. CONCLUSION: Our case series demonstrates the possible use of the SCIP flap in the reconstruction of upper and lower extremities. With its thinness, low donor-site morbidity, and ease of harvest, we recommend the SCIP flap to be considered as one of the primary reconstructive options for various extremities defects.
- Klíčová slova
- SCIP, extremities defects, free flap reconstruction, hand, lower extremity, superficial circumflex iliac artery perforator,
- MeSH
- arteria iliaca chirurgie MeSH
- dolní končetina chirurgie MeSH
- dospělí MeSH
- horní končetina chirurgie MeSH
- lidé MeSH
- perforátorový lalok * krevní zásobení MeSH
- zákroky plastické chirurgie * MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: The anterolateral thigh (ALT) flap was described as the fasciocutaneous flap. It can be harvested as a pedicled and/or free flap. Majority of the free flaps are harvested as a fasciocutaneous flap. Their use in head and neck reconstruction and limb trauma is well established. Apart from these advantages, this flap has various applications which are less utilized. ALT flap can be used as a myocutaneous flap along with vastus lateralis muscle. When muscle and fasciocutaneous flaps are required, both can be harvested as a chimeric flap which can cover two different regions of the wound. Moreover, harvest of the pedicled flap procedure is less time-consuming than that of a free flap. Since it has a long vascular pedicle, when used as pedicled flap, it can reach up to the gluteal region. To evaluate these less applied advantages of pedicled ALT flap, our study was undertaken. This study aimed to evaluate the efficiency of ALT flap in terms of the surface area of coverage, arc of rotation and the advantages of including vastus lateralis muscle as part of the flap. METHODS: A retrospective record analysis of all pedicled ALT flap reconstruction of trochanteric, upper thigh, gluteal and flank regions from 2016 to 2018 was undertaken; 7 patients with 8 defects were included. RESULTS: All the flaps healed successfully. There was no major necrosis of the flap and minor complications like wound gapping were found in three patients. CONCLUSION: The ALT-vastus lateralis flap dimensions can be very large and can be easily harvested in a very short time. Vastus lateralis muscle harvested can be used to fill the defect or can be used as chimera to cover the defect. The use of muscle over long standing infective pressure sores can sterilize the wound bed and help in preventing recurrence. The vascularity of this flap is robust and highly reliable. Even after a maximum arc of rotation (up to 170°) all the flaps survived without any major complications.
- Klíčová slova
- pedicled ALT flap – reconstructive surgery – pressure sore – anterolateral thigh flap,
- MeSH
- lidé MeSH
- myokutánní lalok * chirurgie MeSH
- retrospektivní studie MeSH
- stehno chirurgie MeSH
- volné tkáňové laloky * chirurgie MeSH
- zákroky plastické chirurgie * metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: The temporoparietal fascia flaps (TPFF) have been widely used to cover the framework in auricular reconstructions. However, flap harvesting is mostly done by open surgery which may be easier but often results in bad scarring and hair loss. We would like to present a series of cases using endoscopic-assisted flap harvesting techniques with only one single cosmetic auricular incision. PATIENTS AND METHODS: Prospective studies from June 2018 to September 2021 on patients who underwent single-stage total auricular reconstruction using autologous costal cartilage and porous polyethylene (PPE) framework. Variables include age, gender, flap survivability as well as visual results and complications. RESULTS: A total of 61 TPFFs were harvested to cover 15 autologous costal cartilages and 46 PPE frameworks in 60 patients (one patient had operation on both sides). TPFF harvests are performed by endoscopic techniques with one single auricular incision. There was no flap necrosis, no bleeding and no cases required framework removal. Only 7/61 (11.5%) ears had small framework exposure which resolved on their own or only required local skin flap coverage and 1 ear had frontal nerve injury. CONCLUSION: Single-stage auricular reconstruction is a difficult surgery, yet greatly beneficial to young children. Through a single-incision endoscopic technique, we can obtain sufficiently large high-survivability TPFFs ensuring full coverage of the autologous costal cartilage or PPE framework. This method is reliable, and reproducible with advanced training. After reviewing the literature, we can state that our report probably includes the largest endoscopic-assisted TPFF harvesting series and the first to implement single-incision endoscopic technique in auricular reconstructions.
- Klíčová slova
- auricular defect, auricular reconstruction, microtia, porous polyethylene framework, single incision endoscopy, temporoparietal fascia flap,
- MeSH
- chirurgická rána * MeSH
- chirurgické laloky MeSH
- dítě MeSH
- fascie MeSH
- lidé MeSH
- polyethylen MeSH
- předškolní dítě MeSH
- prospektivní studie MeSH
- zákroky plastické chirurgie * metody MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- předškolní dítě MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- polyethylen MeSH
