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Reconstruction of extremity long bone defects with vascularized fibula bone grafts

Plastic and Aesthetic Research 2019年第6期6卷 1-12页

作者： Corinne Wee DanieI Ruter Steven SchuIz Geoffroy Sisk JuIie West Scott TintIe Ian VaIerio Division of Plastic and reconstructive surgery in the department of surgery Case Western Reserve UniversityClevelandOH 44106USA Division of Plastic and reconstructive surgery in the department of surgery Albany Medical CollegeAlbanyNY 12208USA department of Plastic and reconstructive surgery The Ohio State UniversityColumbusOH 43212USA department of Orthopaedic surgery Walter Reed National Military Medical CenterBethesdaMD 20889USA

Aim: Composite tissue defects encompassing bone and/or isolated bony defects can pose a surgical challenge;however, their reconstruction is critical for successful functional limb salvage. These cases become increasingly problematic as secondary defects, following multiple nonvascularized grafting attempts resulting in complex bony nonunion. Herein, our experience utilizing fibula vascularized bone grafts (VBGs) for bone restoration will be presented to demonstrate their utility in a variety of reconstructions for limb salvage. Methods: This is a case series describing a series of vascularized fibula grafts for extremity reconstruction performed by a single academic surgeon over multiple institutions in seven years. Results: Twenty-seven (27) total VBGs met inclusion criteria and underwent reconstruction for traumatic (16), oncologic (6) and chronic degenerative (5) etiologies. Bony union was achieved in 26 of 27 cases. Conclusion: The decision-making process for bony reconstruction in these scenarios is difficult and multivariable. Fibula VBGs can provide a single-stage solution for autologous bony and soft tissue replacement of large or complex bone defects and can often be superior options compared with non-vascularized bone grafts or non-bone internal fixation techniques. Their osteogenic potential is unmatched by allogenic or synthetic substitutions. These benefits are evident in a variety of clinical settings such as pediatrics, oncology and trauma.

关键词： Vascularized bone vascularized bone grafts composite extremity defect restoration bone reconstruction free tissue transfer microsurgery

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Malignant triton tumor in the abdominal wall:A case report

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World Journal of Clinical Cases 2024年第8期12卷 1467-1473页

作者： Ho Jik Yang Donghyun Kim Won Suk Lee Sang-Ha Oh department of Plastic and reconstructive surgery Chungnam National University Sejong HospitalSejong 30099South Korea department of Plastic and reconstructive surgery Chungnam National University HospitalDaejeon 35015South Korea department of Emergency Eulji University HospitalDaejeon 35233South Korea department of Plastic and reconstructive surgery Chungnam National University College of MedicineDaejeon 35015South Korea

BACKGROUND Malignant triton tumors(MTTs)comprise a subgroup of malignant peripheral nerve sheath tumors(MPNSTs)that exhibits rhabdomyosarcomatous differen-tiation and follow an aggressive *** are primarily located along peripheral *** of MTTs in the abdominal wall have not been *** has a poorer prognosis than classic MPNSTs,and accurate diagnosis necessitates a keen understanding of the clinical history and knowledge of its differential diagnosis *** for MTTs mirrors that for MPNSTs and is predominantly *** SUMMARY A 49-year-old woman presented with a subcutaneous mass in her lower abdo-minal wall and a pre-existing surgical scar that had grown slowly over 3-4 months before the *** had previously undergone radical hysterectomy and concurrent chemo-radiotherapy for cervical cancer approximately 5 years prior to the *** computed tomography(CT)showed a 1.3 cm midline mass in the lower abdomen with infiltration into the rectus abdominis *** was no sign of metastasis(T1N0M0).An incisional biopsy identified sporadic MTT of the lower abdomen.A comprehensive surgical excision with a 3 cm margin inclusive of the peritoneum was ***-quently,the general surgeon utilized an approach akin to the open peritoneal onlay mesh *** patient underwent additional treatment with an excision shaped as a mini-abdominoplasty for the skin *** complications arose,and annual follow-up CTs did not show signs of recurrence or *** An abdominal MTT was efficaciously treated with extensive excision and abdominal wall reconstruction,eliminating the need for postoperative radiotherapy.

关键词： Malignant triton tumor Abdominal wall Surgical excision Reconstruction Case report

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Two Modified Surgical Procedures for Treating Early Stage Breast Cancer in China

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2014年第6期34卷 917-920页

作者：邓裴吴乐昊任玉萍吴毅平 department of Plastic and reconstructive surgery Tongji Hospital Tongji Medical College Huazhong University of Science and Technology

Conventional pedicled-flap based surgeries in treating breast cancer have their limitations. New surgical regimens are yet to be explored, which will follow the oncological principle of being “to- tal tumor free”, whilst fit into the unique characteristics of China＇s own medical system as well as pa- tients＇ demand. From 2007 to 2013, 143 patients with early stage breast cancer were included in the study, with the average age of 46.1 years. Fifty-three patients were subjected to modified breast con- serving surgery （MBCS）＋latissimus dorsi （LD） flap reconstruction, 41 to skin sparing mastectomy （SSM）＋implant＋LD flap reconstruction, 29 to MBCS＋distal transverse rectus abdominis myocutaneous （DTRAM） flap reconstruction, and 20 to SSM＋DTRAM flap reconstruction. The results showed that out of the 143 patients, there was no graft loss. Minor complications included 4 cases of fat liquefaction, and 6 cases of seratoma, which all resolved after conservative treatment. Five patients had visible protu- berance in the abdomen, but not leading to any gastrointestinal symptoms. The reconstructed breasts all presented good shape. 96.7% of the patients were satisfied with the outcome. The follow-up period var- ied from 6 months to 60 months, and only one patient died from tumor metastasis in the brain. No local recurrence occurred. It was concluded that these two modified pedicled-flap surgeries are readily practi- cal, and aesthetically satisfactory, with high applicability in China. They do not compromise the on- cological outcomes, but also are well-accepted by Chinese patients.

关键词： early breast cancer breast conserving surgery modified transverse rectus abdominismyocutaneous flap reconstruction

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Effect of recombinant human bone morphogenetic protein 2/polylactide-co-glycolic acid (rhBMP-2/PLGA) with core decompression on repair of rabbit femoral head necrosis

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Asian Pacific Journal of Tropical Medicine 2014年第11期7卷 895-899页

作者： Zhao-Xun Pan Hong-Xin Zhang Ye-Xin Wang Long-Di Zhai Wei Du department of joint surgery No 89 Hospital of People's Liberation Army

Objective:To observe the effect of recombinant human bone morphogenetic protein 2/polylactide-co-glycolic acid(rhBMP-2/PLGA) with core decompression on repair of rabbit femoral head ***:Bilateral femoral head necrosis models of rabbit were established by steroid injection.A total of 48 rabbits(96 femoral head necrosis) were randomly divided into 4groups:Group A,control group with12 rabbits,24 femoral head necrosis;Group B,treated with rhBMP-2/PLCA implantation after core depression,with 12 rabbits,24 femoral head necrosis;Group C,treated with rhBMP-2 implantation after core depression,with 12 rabbits,24 femoral head necrosis;Croup D treated with core depression group without implantation,with 12 rabbits,24 femoral head *** animals were sacrificed after 12 *** ability of repairing bone defect was evaluated by X-ray *** mineral density analysis of the defect regions were used to evaluate the level of *** morphologic change and bone formation was assessed by HE *** angiogenesis was evaluated by VEGF ***:The osteogenetic ability and quality of femoral head necrosis in group B were better than those of other groups after 12 weeks by X-ray radiograph and morphologic *** the angiogenesis in group B was better than other *** C had similar osteogenetic quality of femoral head necrosis and angiogenesis with group ***:The treatment of rhBMP-2/PLCA implantation after core depression can promote the repair of rabbit femoral head *** is a promising and efficient synthetic bone material to treat the femoral head necrosis.

关键词： rhBMP-2 Microsphere Core decompression Femoral head necrosis

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Free tissue transfer for lower extremity trauma in the pediatric patient

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Plastic and Aesthetic Research 2022年第1期9卷 529-538页

作者： Sammy Othman Denis Knobel Division of Plastic and reconstructive surgery Department of SurgeryNorthwell HealthNew YorkNY 11021USA

Aim:The utilization of free-tissue transfer secondary to traumatic lower extremity defects in the pediatric population is scarcely *** include microsurgeon inexperience,inadequate center resources,and fear of historically described poor surgical *** aim of this study is to investigate more recent articles describing free-flap microsurgical reconstruction for these ***:A systematic review of the literature was conducted through the online databases PubMed,Embase,and Web of Science,examining for articles with at least 20 subjects utilizing free-tissue transfer for soft-tissue defects of the pediatric(aged 18 and younger)lower extremity following traumatic etiology since *** included flap failure,return to the operating room,and functional status,where ***:Seven studies were deemed appropriate for inclusion,with a total of 243 flaps *** vehicle and motorcycle accidents were greater than 75%of total *** defects involved the foot or ankle(65.1%).In total,perforator flaps compromised the majority of flaps(54%),with the most common being the anterolateral thigh,the scapular/parascapular,and deep inferior epigastric *** common perforators included the groin flap,tensor fascia lata,radial forearm,lateral arm,and thoracodorsal perforator ***-based flaps were less common(46%),with the latissimus dorsi and rectus muscle flaps composing the *** most commonly used recipient vessel was the anterior tibialis(49.5%)and posterior tibialis vessels(45.3%).Most studies performed reconstruction within 7-10 days of *** was a cumulative 6.5%flap failure ***:Free tissue transfer for pediatric lower extremity trauma is an important tool that likely leads to powerful *** trends indicate increasing usage of perforator *** study shows that based on existing data,free flap utilization for pediatric patients is an adequate modality for repair,and ma

关键词： reconstructive surgery pediatric trauma pediatric lower extremity microsurgery soft-tissue freetissue transfer

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Supraclavicular lymph node transplant:a focus on technique

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Plastic and Aesthetic Research 2022年第1期9卷 77-83页

作者： Maureen Beederman David W.Chang Section of Plastic and reconstructive surgery Department of SurgeryThe University of Chicago MedicineChicagoIL 60637USA

Physiologic surgical options,including vascularized lymph node transplant and lymphovenous bypass are becoming increasingly popular interventions for the treatment of lymphedema of both the upper and lower *** different lymph node donor sites have been described,including submental,lateral thoracic,superficial groin,supraclavicular,and various intraabdominal *** paper describes a step-by-step approach to the harvest of vascularized lymph nodes from the supraclavicular area,which is the preferred donor site for most patients with both upper and lower extremity lymphedema.

关键词： Lymphedema surgery lymph node transplant microsurgery

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Diagnostic workup of lymphedema

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Plastic and Aesthetic Research 2019年第10期6卷 15-23页

作者： Zheng-Yun Liang Xiao Long Nan-Ze Yu Jiu-Zuo Huang department of Plastic surgery and reconstructive surgery Peking Union Medical College HospitalBeijing 100005China

Lymphedema is a chronic and progressive pathological state of tissue swelling caused by congenital or acquired lymphatic ***,physical and laboratory examinations could help to diagnosis>90%lymphedema *** stage lymphedema could be challenging to *** aim of this review is to provide an objective appraisal of current diagnostic methods,such as lymphoscintigraphy,lympho-fluoroscopies,lymphangiography and *** on their respective advantages and weaknesses,and hopefully shed some lights on developing a practical diagnosis modality beneficial to early detection and clinical decision making of lymphedema.

关键词： Lymphedema diagnosis lymphoscintigraphy magnetic resonance lymphangiography indocyanine green tissue dielectric constant bioelectrical impedance spectroscopy

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Continuous wound infusion of local anaesthetic agents following colorectal surgery:Systematic review and meta-analysis

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World Journal of Gastroenterology 2008年第34期14卷 5301-5305页

作者： Alan Karthikesalingam Stewart R Walsh Sheraz R Markar Umar Sadat Tjun Y Tang Charles M Malata department of General surgery Addenbrooke’s HospitalCambridge University Hospitals NHS Foundation Trust department of Plastic and reconstructive surgery Addenbrooke’s HospitalCambridge University Hospitals Foundation Trust

AIM:To provide a specifi c review and meta-analysis of the available evidence for continuous wound infusion of local anaesthetic agents following midline laparoto-my for major colorectal surgery. METHODS: Medline, Embase, trial registries, conference proceedings and article reference lists were searched to identify randomised, controlled trials of continuous wound infusion of local anaesthetic agents following colorectal surgery. The primary outcomes were opioid consumption, pain visual analogue scores (VASs), return to bowel function and length of hospital stay. Weighted mean difference were calculated for continuous outcomes. RESULTS: Five trials containing 542 laparotomy wounds were eligible for inclusion. There was a sig- nificant decrease in post-operative pain VAS at rest on day 3 (weighted mean difference: -0.43; 95% CI: -0.81 to -0.04; P = 0.03) but not on post-operative day 1 and 2. Local anaesthetic infusion was associated with a signifi cant reduction in pain VAS on movement on all three post-operative days (day 1 weighted mean difference: -1.14; 95% CI: -2.24 to -0.041; P = 0.04, day 2 weighted mean difference: -0.97, 95% CI: -1.91to -0.029; P = 0.04, day 3 weighted mean difference: -0.61; 95% CI: 1.01 to -0.20; P = 0.0038). Local an- aesthetic wound infusion was associated with a signifi - cant decrease in total opioid consumption (weighted mean difference: -40.13; 95% CI: -76.74 to -3.53; P = 0.03). There was no signifi cant decrease in length of stay (weighted mean difference: -20.87; 95% CI: -46.96 to 5.21; P = 0.12) or return of bowel function (weighted mean difference: -9.40; 95% CI: -33.98 to 15.17; P = 0.45). CONCLUSION: The results of this systematic re- view and meta-analysis suggest that local anaesthetic wound infusion following laparotomy for major color- ectal surgery is a promising technique but do not pro- vide conclusive evidence of benefi t. Further research is required including cost-effectiveness analysis.

关键词： Colorectal surgery Laparotomy Local anaesthesia Infusion Wound healing

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Reconstruction of the lower back wound with delayed infection after spinal surgery:A case report

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World Journal of Clinical Cases 2023年第27期11卷 6646-6652页

作者： DoWon Kim SooA Lim SuRak Eo Jung Soo Yoon department of Plastic and reconstructive surgery DongGuk University Ilsan HospitalGoyang 10326South Korea

BACKGROUND Orthopedic surgeries after device implantation are susceptible to infections and may require device removal in the worst *** this reason,many efforts are being made to control infections after spinal surgery;however,the number of infec-tion cases is increasing owing to the increasing number of elderly *** SUMMARY A 75-year-old male with a chronic spinal defect due to previous spine surgery underwent reconstruction using a perforator-based island *** bursectomy and confirmation that there was no connection with the deep tissue,reconstruction was ***,wound disruption occurred with abscess formation on postoperative day 29,which led to an imaging workup revealing delayed deep tissue *** Infection is one of the most common causes of surgical wound dehiscence and is associated with devastating results if not controlled promptly and *** should always suspect delayed infections when reconstructing chronic soft tissue defects.

关键词： Surgical wound dehiscence Surgical wound infection Lumbar spine Complications Abscess Case report

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Early burn wound excision in mass casualty events

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Military Medical Research 2023年第2期10卷 279-280页

作者： Agnieszka Surowiecka Tomasz Korzeniowski Jerzy Struzyna East Center of Burns Treatment and reconstructive surgery 21-010 tecznaPoland Chair and department of Didactics and Medical Simulation Medical University of Lublin20-093 LublinPoland department of Plastic surgery Reconstructive Surgery and Burn TreatmentMedical University of Lublin20-093 LublinPoland

Dear Editor,The aim of the letter is to stress the need of creating unified recommendations concerning early burn wound excision in cases of mass casualty burns *** are several triage methods,both for civilian and military circumstances,that govern burn casualty triage and evacuation from the incident site,as well as hospital referral up to 120 h from the disaster.

关键词： Burn wound Early excision Enzymatic debridement

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