AIM:To report the clinical outcomes of utilizing a three-layer flap and graft in reconstruction of the lower lid in one session.METHODS:Seventeen patients with total or near total lower eyelid defect were included.The...AIM:To report the clinical outcomes of utilizing a three-layer flap and graft in reconstruction of the lower lid in one session.METHODS:Seventeen patients with total or near total lower eyelid defect were included.The defects were reconstructed in three layers.Posterior lamella was reconstructed by using tarsoconjunctival free graft from the ipsilateral upper lid and periosteal flap from lateral orbital rim.Mobilization of residual orbicularis muscle provided a rich blood supply;and the anterior lamella was reconstructed by skin flap prepared from upper lid blepharoplasty as a one-pedicular or bipedicular bucket handle flap.RESULTS:The cause of lower eyelid defect was basal cell carcinoma in 15 patients and trauma in two of them.No intraoperative and postoperative complication occurred.Patients were followed from 10 to 15mo postoperatively.Cosmetic results were favorable in all patients and we had acceptable functional results.Thickness of the reconstructed tissue was a concern in early postoperative period.CONCLUSION:Three-layer lower lid reconstruction in one session is an effective technique for total lower lid reconstruction with minimal complications and acceptable functional and aesthetic outcomes and can be considered as a safe alternative for the preexisting techniques.展开更多
Background: Traditional models for teaching surgical principles focus primarily on the apprenticeship theory;however there has been a trend in surgical education to certifying competency in a simulation environment pr...Background: Traditional models for teaching surgical principles focus primarily on the apprenticeship theory;however there has been a trend in surgical education to certifying competency in a simulation environment prior to working with patients. Many surgical models emphasize learning the technical and manual dexterity skills necessary to be a surgeon, yet few focus on obtaining the theoretical and abstract skills needed for planning complex cutaneous surgical repairs with flaps and grafts. We developed and evaluated a novel surgical flaps and grafts workshop for residents through the Department of Dermatology. Methods: Participants received a 60 minute PowerPoint lecture focusing on the basic principles of cutaneous repair with flaps and grafts, with examples and explanation of each of the four main types of flaps and grafts. The participants then received nine photocopies of Mohs micrographic surgery defects with instructions to design three repairs, focusing on functional and aesthetic outcome. Hypothetical and actual repair designs were then discussed in an open forum format. Anonymous surveys administered to 11 dermatology residents assessed their knowledge level, confidence level, and likelihood of using flaps and grafts pre- and post-workshop using Likert scales. Overall experience was also assessed. A paired sample Wilcoxon Signed Rank Test was used for analysis, since the data was non-parametrically distributed. Results: There was a statistically significant increase in confidence performing flaps post workshop (p = 0.0469). There was also an increase in knowledge of flaps and grafts, confidence in planning flaps and grafts, and confidence in performing grafts post workshop, but these findings did not reach statistical significance. The workshop had no effect on expected future use of flaps and grafts. Conclusions: The surgical workshop is a novel simulation teaching tool for learning basic principles and design of flaps and grafts in cutaneous surgery.展开更多
Background: Endarterectomy has long been the standard for common femoral artery (CFA) occlusive disease. Hybrid procedures utilizing endovascular and open techniques have recently been used for revascularization. The ...Background: Endarterectomy has long been the standard for common femoral artery (CFA) occlusive disease. Hybrid procedures utilizing endovascular and open techniques have recently been used for revascularization. The purpose of this study was to evaluate the effectiveness of the use of a stent graft to stabilize the distal flap and prevent further dissection after extensive endarterectomy. Methods: All patients from Monmouth Medical Center in Long Branch, NJ from September 2008 to March 2013 who underwent an extensive common and superficial femoral (SFA) endarterectomy combined with the use of a Viabahn (Gore Medical) stent graft to stabilize the distal flap were included in the study. These stents were deployed in the proximal SFA after extensive endarterectomy, under direct visualization, without the aid of fluoroscopy. Due to the location in the SFA, these flaps were not amenable to suture tacking. Results: Fifteen patients met these criteria and were included in our study. Twelve patients underwent femoral endarterectomy for severe claudication and three patients for limb salvage. Technical success was achieved in all 15 patients. Five patients also had stents placed proximally to increase inflow and one patient had an additional stent placed distally to improve outflow. There were no intraoperative or postoperative complications. Conclusion: Stent graft placement allows a more extensive endarterectomy to be performed by stabilizing the distal flap allowing a safe transition into the true lumen that is not possible with suture tacking.展开更多
目的:观察比较腋窝皱襞切口薄皮瓣法及小切口全厚皮片法用于腋臭治疗的疗效。方法:选取2016年11月-2021年11月笔者医院行腋臭手术治疗的78例患者,依据手术方式不同分为观察组和对照组,每组39例。观察组行腋窝皱襞切口薄皮瓣法,对照组行...目的:观察比较腋窝皱襞切口薄皮瓣法及小切口全厚皮片法用于腋臭治疗的疗效。方法:选取2016年11月-2021年11月笔者医院行腋臭手术治疗的78例患者,依据手术方式不同分为观察组和对照组,每组39例。观察组行腋窝皱襞切口薄皮瓣法,对照组行小切口全厚皮片法。比较两组患者临床疗效、围术期各项指标、温哥华瘢痕量表(Vancouver scar scale,VSS)评分、患者与观察者瘢痕评估量表(Scar assessment scale for patients and observers,POSAS)评分及并发症发生情况。结果:观察组总有效率高于对照组,复发率低于对照组,手术时间、拆线时间、愈合时间均短于对照组,出血量少于对照组,瘢痕长度短于对照组,并发症总发生率低于对照组,差异均有统计学意义(P<0.05);术后6个月,观察组VSS、PSAS、OSAS评分均低于对照组(P<0.05)。结论:腋窝皱襞切口薄皮瓣法治疗腋臭疗效优于小切口全厚皮片法,该法复发率低,瘢痕轻,并发症少,是治疗腋臭较为理想的一种术式。展开更多
Vascularization is an important factor in nerve graft survival and function. The specific molecular regulations and patterns of angiogenesis following peripheral nerve injury are in a broad complex of pathways. This r...Vascularization is an important factor in nerve graft survival and function. The specific molecular regulations and patterns of angiogenesis following peripheral nerve injury are in a broad complex of pathways. This review aims to summarize current knowledge on the role of vascularization in nerve regeneration, including the key regulation molecules, and mechanisms and patterns of revascularization after nerve injury. Angiogenesis, the maturation of pre-existing vessels into new areas, is stimulated through angiogenic factors such as vascular endothelial growth factor and precedes the repair of damaged nerves. Vascular endothelial growth factor administration to nerves has demonstrated to increase revascularization after injury in basic science research. In the clinical setting, vascularized nerve grafts could be used in the reconstruction of large segmental peripheral nerve injuries. Vascularized nerve grafts are postulated to accelerate revascularization and enhance nerve regeneration by providing an optimal nutritional environment, especially in scarred beds, and decrease fibroblast infiltration. This could improve functional recovery after nerve grafting, however, conclusive evidence of the superiority of vascularized nerve grafts is lacking in human studies. A well-designed randomized controlled trial comparing vascularized nerve grafts to non-vascularized nerve grafts involving patients with similar injuries, nerve graft repair and follow-up times is necessary to demonstrate the efficacy of vascularized nerve grafts. Due to technical challenges, composite transfer of a nerve graft along with its adipose tissue has been proposed to provide a healthy tissue bed. Basic science research has shown that a vascularized fascial flap containing adipose tissue and a vascular bundle improves revascularization through excreted angiogenic factors, provided by the stem cells in the adipose tissue as well as by the blood supply and environmental support. While it was previously believed that revascularization occurred from both nerve ends, recent studies propose that revascularization occurs primarily from the proximal nerve coaptation. Fascial flaps or vascularized nerve grafts have limited applicability and future directions could lead towards off-the-shelf alternatives to autografting, such as biodegradable nerve scaffolds which include capillary-like networks to enable vascularization and avoid graft necrosis and ischemia.展开更多
文摘AIM:To report the clinical outcomes of utilizing a three-layer flap and graft in reconstruction of the lower lid in one session.METHODS:Seventeen patients with total or near total lower eyelid defect were included.The defects were reconstructed in three layers.Posterior lamella was reconstructed by using tarsoconjunctival free graft from the ipsilateral upper lid and periosteal flap from lateral orbital rim.Mobilization of residual orbicularis muscle provided a rich blood supply;and the anterior lamella was reconstructed by skin flap prepared from upper lid blepharoplasty as a one-pedicular or bipedicular bucket handle flap.RESULTS:The cause of lower eyelid defect was basal cell carcinoma in 15 patients and trauma in two of them.No intraoperative and postoperative complication occurred.Patients were followed from 10 to 15mo postoperatively.Cosmetic results were favorable in all patients and we had acceptable functional results.Thickness of the reconstructed tissue was a concern in early postoperative period.CONCLUSION:Three-layer lower lid reconstruction in one session is an effective technique for total lower lid reconstruction with minimal complications and acceptable functional and aesthetic outcomes and can be considered as a safe alternative for the preexisting techniques.
文摘Background: Traditional models for teaching surgical principles focus primarily on the apprenticeship theory;however there has been a trend in surgical education to certifying competency in a simulation environment prior to working with patients. Many surgical models emphasize learning the technical and manual dexterity skills necessary to be a surgeon, yet few focus on obtaining the theoretical and abstract skills needed for planning complex cutaneous surgical repairs with flaps and grafts. We developed and evaluated a novel surgical flaps and grafts workshop for residents through the Department of Dermatology. Methods: Participants received a 60 minute PowerPoint lecture focusing on the basic principles of cutaneous repair with flaps and grafts, with examples and explanation of each of the four main types of flaps and grafts. The participants then received nine photocopies of Mohs micrographic surgery defects with instructions to design three repairs, focusing on functional and aesthetic outcome. Hypothetical and actual repair designs were then discussed in an open forum format. Anonymous surveys administered to 11 dermatology residents assessed their knowledge level, confidence level, and likelihood of using flaps and grafts pre- and post-workshop using Likert scales. Overall experience was also assessed. A paired sample Wilcoxon Signed Rank Test was used for analysis, since the data was non-parametrically distributed. Results: There was a statistically significant increase in confidence performing flaps post workshop (p = 0.0469). There was also an increase in knowledge of flaps and grafts, confidence in planning flaps and grafts, and confidence in performing grafts post workshop, but these findings did not reach statistical significance. The workshop had no effect on expected future use of flaps and grafts. Conclusions: The surgical workshop is a novel simulation teaching tool for learning basic principles and design of flaps and grafts in cutaneous surgery.
文摘Background: Endarterectomy has long been the standard for common femoral artery (CFA) occlusive disease. Hybrid procedures utilizing endovascular and open techniques have recently been used for revascularization. The purpose of this study was to evaluate the effectiveness of the use of a stent graft to stabilize the distal flap and prevent further dissection after extensive endarterectomy. Methods: All patients from Monmouth Medical Center in Long Branch, NJ from September 2008 to March 2013 who underwent an extensive common and superficial femoral (SFA) endarterectomy combined with the use of a Viabahn (Gore Medical) stent graft to stabilize the distal flap were included in the study. These stents were deployed in the proximal SFA after extensive endarterectomy, under direct visualization, without the aid of fluoroscopy. Due to the location in the SFA, these flaps were not amenable to suture tacking. Results: Fifteen patients met these criteria and were included in our study. Twelve patients underwent femoral endarterectomy for severe claudication and three patients for limb salvage. Technical success was achieved in all 15 patients. Five patients also had stents placed proximally to increase inflow and one patient had an additional stent placed distally to improve outflow. There were no intraoperative or postoperative complications. Conclusion: Stent graft placement allows a more extensive endarterectomy to be performed by stabilizing the distal flap allowing a safe transition into the true lumen that is not possible with suture tacking.
文摘目的:观察比较腋窝皱襞切口薄皮瓣法及小切口全厚皮片法用于腋臭治疗的疗效。方法:选取2016年11月-2021年11月笔者医院行腋臭手术治疗的78例患者,依据手术方式不同分为观察组和对照组,每组39例。观察组行腋窝皱襞切口薄皮瓣法,对照组行小切口全厚皮片法。比较两组患者临床疗效、围术期各项指标、温哥华瘢痕量表(Vancouver scar scale,VSS)评分、患者与观察者瘢痕评估量表(Scar assessment scale for patients and observers,POSAS)评分及并发症发生情况。结果:观察组总有效率高于对照组,复发率低于对照组,手术时间、拆线时间、愈合时间均短于对照组,出血量少于对照组,瘢痕长度短于对照组,并发症总发生率低于对照组,差异均有统计学意义(P<0.05);术后6个月,观察组VSS、PSAS、OSAS评分均低于对照组(P<0.05)。结论:腋窝皱襞切口薄皮瓣法治疗腋臭疗效优于小切口全厚皮片法,该法复发率低,瘢痕轻,并发症少,是治疗腋臭较为理想的一种术式。
基金supported by the National Institute of Neurological Disorders and Stroke of the National Institutes of Health under Award Number RO1 NS102360(to AYS)
文摘Vascularization is an important factor in nerve graft survival and function. The specific molecular regulations and patterns of angiogenesis following peripheral nerve injury are in a broad complex of pathways. This review aims to summarize current knowledge on the role of vascularization in nerve regeneration, including the key regulation molecules, and mechanisms and patterns of revascularization after nerve injury. Angiogenesis, the maturation of pre-existing vessels into new areas, is stimulated through angiogenic factors such as vascular endothelial growth factor and precedes the repair of damaged nerves. Vascular endothelial growth factor administration to nerves has demonstrated to increase revascularization after injury in basic science research. In the clinical setting, vascularized nerve grafts could be used in the reconstruction of large segmental peripheral nerve injuries. Vascularized nerve grafts are postulated to accelerate revascularization and enhance nerve regeneration by providing an optimal nutritional environment, especially in scarred beds, and decrease fibroblast infiltration. This could improve functional recovery after nerve grafting, however, conclusive evidence of the superiority of vascularized nerve grafts is lacking in human studies. A well-designed randomized controlled trial comparing vascularized nerve grafts to non-vascularized nerve grafts involving patients with similar injuries, nerve graft repair and follow-up times is necessary to demonstrate the efficacy of vascularized nerve grafts. Due to technical challenges, composite transfer of a nerve graft along with its adipose tissue has been proposed to provide a healthy tissue bed. Basic science research has shown that a vascularized fascial flap containing adipose tissue and a vascular bundle improves revascularization through excreted angiogenic factors, provided by the stem cells in the adipose tissue as well as by the blood supply and environmental support. While it was previously believed that revascularization occurred from both nerve ends, recent studies propose that revascularization occurs primarily from the proximal nerve coaptation. Fascial flaps or vascularized nerve grafts have limited applicability and future directions could lead towards off-the-shelf alternatives to autografting, such as biodegradable nerve scaffolds which include capillary-like networks to enable vascularization and avoid graft necrosis and ischemia.
