Redefining the Reconstructive Ladder in Vulvoperineal Reconstruction: The Role of Pedicled Perforator Flaps

2021 ◽  
Author(s):  
Jhonatan Elia ◽  
Nicholas T. K. Do ◽  
Tommy N.-J. Chang ◽  
Chyong-Huey Lai ◽  
Hung-Hsueh Chou ◽  
...  
Keyword(s):  
Disease Recurrence ◽  
Senior Author ◽  
Previous Surgery ◽  
Perforator Flaps ◽  
Pedicle Flap ◽  
Reconstructive Ladder ◽  
Flap Design ◽  
Average Defect

Abstract Background Gynecological reconstruction is difficult, particularly in cases with recurrence and received previous surgeries and/or radiotherapy and necessitate secondary reconstruction. Perforator flaps can preserve other donor sites for potential later reconstruction, and they also can be better tailored to the defect. We hypothesized that the use of perforator-based flaps can better restore the defect with less complications. Methods A retrospective review was conducted of all patients who underwent vulvar–perineum reconstruction between 2011 and 2018 by the senior author, and oncologic and reconstructive outcomes and complications were analyzed. Results Thirty-three patients underwent 55 soft tissue reconstructions for vulvar–perineum defects during the study period. The mean follow-up time was 27.6 ± 28.9 months. Squamous cell carcinoma was the most common cancer (45.5%). For 11 patients (33.3%), the procedures were performed for the treatment of recurrent cancer. The average defect size was 39.8 ± 34.3 cm2. The overall survival rate was 90.3%. Profunda artery perforator flaps were the most commonly applied flap for reconstruction in both the primary and recurrent groups. Poor wound healing was the most common complication which occurred in 10 of the 55 flaps (18.2%). Perforator flaps presented fewer complications than myocutaneous flaps or traditional random flaps. Similarly, Island pedicle flap design also presented fewer complications than traditional rotation flaps. With proper reconstruction, previous surgery or radiotherapy did not contribute to an increase in complications. Conclusion In our experience, perforator flaps can provide satisfactory reconstruction for perineum reconstruction with low postoperative complications while preserving other donor sites in the event of disease recurrence for repeat resection and reconstruction. Previous surgery or radiotherapy did not increase the complications or preclude its usage. A redefined reconstructive ladder was created to help selecting the best state-of-the-art technique for reconstruction to achieve better results.

Extramedullary Nasal Plasmacytoma — An Unusual Clinical Entity

1996 ◽  
Vol 75 (3) ◽  
pp. 171-173 ◽  
Author(s):  
Gordon Soo ◽  
Anthony Chan ◽  
Dennis Lam ◽  
Victor Abdullah ◽  
C. Andrew van Hasselt
Keyword(s):  
World Literature ◽  
Residual Disease ◽  
Disease Recurrence ◽  
Extramedullary Plasmacytoma ◽  
Intracranial Extension ◽  
Long Term Follow Up ◽  
Unusual Appearance

A case of extramedullary plasmacytoma with its unusual appearance is reported. This is the second reported case in world literature affecting the paranasal sinuses with intracranial extension. The role of surgery is to obtain tissue for diagnosis and to excise residual disease. Radiotherapy is the treatment of choice and long-term follow-up is necessary for monitoring disease recurrence. The overall 10-year survival is about 50%. The case is discussed with a general review of the management of this pathology.

scholarly journals The role of intermittent negative pressure wound therapy combined with a mesh incision in the salvage of perforator flap with venous congestion, a case report

2020 ◽  
Author(s):  
Zhaoyue Li ◽  
Kun Xie ◽  
Rui He ◽  
Qiang Li ◽  
Changqing Zhou ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Perforator Flap ◽  
Venous Congestion ◽  
Continuous Mode ◽  
Perforator Flaps ◽  
Wound Therapy ◽  
Improve Wound Healing

Abstract Background: The application of perforator flap is becoming wide. The most common postoperative complication is venous congestion but traditional treatments’ effect is limited. A new method called negative pressure wound therapy(NPWT) was introduced to improve wound healing. Many scholars have tried this method with continuous mode and achieved good outcomes. In this paper, we tried a different mode(intermittent) of negative pressure wound therapy on congested perforator flaps after a mesh incision, and we expected this paper could provide information for follow-up clinical research.Case presentation: A retrospective research of 6 patients (6 perforator flaps) who had been suffered from venous congestion from June, 2016 to June, 2019 was performed. All flaps were treated by intermittent negative pressure wound therapy after a mesh incision. Among 6 flaps, 4 of them were totally survived while the other 2 of them were mostly survived.Conclusions: Intermittent negative pressure wound therapy combined with a mesh incision can be a safe option to rescue perforator flaps with venous congestion. This technique has a certain success rate and clinical application value.

Stenting as Monotherapy for Uncoilable Intracranial Aneurysms

2012 ◽  
Vol 73 (suppl_1) ◽  
pp. ons80-ons85 ◽  
Author(s):  
Ketan R. Bulsara ◽  
Gregory A. Kuzmik ◽  
Ryan Hebert ◽  
Vincent Cheung ◽  
Charles C. Matouk ◽  
...  
Keyword(s):  
Clinical Condition ◽  
Intracranial Aneurysms ◽  
Senior Author ◽  
Radiographic Outcomes ◽  
Effective Option ◽  
Good Clinical Condition ◽  
Aneurysm Occlusion ◽  
Flow Diverters

Abstract BACKGROUND: Small, blister-like aneurysms (BLAs), by virtue of their unique morphology, are difficult to treat with conventional modalities. The use of oversized self-expanding stents as monotherapy for BLAs is a relatively new and promising concept that warrants further investigation. OBJECTIVE: To clarify the role of oversized self-expanding stents as monotherapy for BLAs. METHODS: Five consecutive patients were treated for BLAs with oversized self-expanding stents alone by the senior author (K.R.B.). We report on their clinical and radiographic outcomes. RESULTS: All 5 patients in our series were discharged in good clinical condition. Complete aneurysm occlusion was observed in all patients at the time of most recent radiographic follow-up. Mean follow-up time was 13.6 months (range, 1 month to 4.5 years). CONCLUSION: The use of oversized self-expanding stents to redirect flow away from aneurysms is an effective option for patients with BLAs. This approach represents an alternative to the use of flow diverters.

Role of Dermatologists in Treating Melanoma

2006 ◽  
Vol 4 (7) ◽  
pp. 695-702 ◽  
Author(s):  
Allan C. Halpern ◽  
Sanjay K. Mandal
Keyword(s):  
Primary Melanoma ◽  
Disease Recurrence ◽  
Lymph Node Biopsy ◽  
Warning Signs ◽  
Melanoma Detection ◽  
Early Warning Signs ◽  
Excision Margins

Melanoma is a major focus of dermatology training and practice, with dermatologists playing a central role in managing melanoma through primary prevention, secondary prevention, diagnosis, and treatment of thinner tumors. Dermatologists have led public health efforts to raise melanoma awareness, promulgate the early warning signs of melanoma, and promote melanoma prevention through sun protection. Dermatologists have unique expertise in melanoma risk assessment and the clinical diagnosis of melanoma through visual inspection and the use of diagnostic aids, including dermoscopy and photographically assisted follow-up. Increasing incidence of melanoma, earlier melanoma detection, narrower excision margins, and improved surgical training in dermatology have recently combined to enhance the role of dermatologists in melanoma care. For patients with thin primary melanomas, dermatologists are increasingly assuming complete care, including wide local excision and long-term surveillance for both disease recurrence and detection of new primary melanoma. Conversely, the advent of sentinel lymph node biopsy and adjuvant therapy has made melanoma management more complex and has intensified the need for a multidisciplinary approach to the disease. In this context, dermatologists contribute significantly to the formation, administration, and implementation of multidisciplinary melanoma programs.

Radical excision of craniopharyngioma

1985 ◽  
Vol 62 (2) ◽  
pp. 174-181 ◽  
Author(s):  
Lindsay Symon ◽  
William Sprich
Keyword(s):  
Operative Mortality ◽  
Tumor Resection ◽  
Senior Author ◽  
Morbidity Rate ◽  
Radical Excision ◽  
Major Morbidity ◽  
Content Type ◽  
Surgical Extirpation

✓ A series is presented of 20 craniopharyngioma patients who were treated between 1977 and 1981. All 20 cases underwent radical tumor resection via a frontotemporal craniotomy, with a concomitant temporal tip resection. All operations were performed by the senior author. The operative mortality rate was 5%, and the major morbidity rate 22.2%. The average follow-up period was 3.1 years. The role of radical surgical extirpation in adults is emphasized: the results compare favorably with the current radiotherapeutic and more conservative surgical statistics.

Psychological Resilience Provides No Independent Protection From Suicidal Risk

Crisis ◽  
2016 ◽  
Vol 37 (2) ◽  
pp. 130-139 ◽  
Author(s):  
Danica W. Y. Liu ◽  
A. Kate Fairweather-Schmidt ◽  
Richard Burns ◽  
Rachel M. Roberts ◽  
Kaarin J. Anstey
Keyword(s):  
Risk Factors ◽  
Well Being ◽  
Current Status ◽  
Psychological Resilience ◽  
Cross Sectional ◽  
Life Project ◽  
Resilience Factors ◽  
First Time

Abstract. Background: Little is known about the role of resilience in the likelihood of suicidal ideation (SI) over time. Aims: We examined the association between resilience and SI in a young-adult cohort over 4 years. Our objectives were to determine whether resilience was associated with SI at follow-up or, conversely, whether SI was associated with lowered resilience at follow-up. Method: Participants were selected from the Personality and Total Health (PATH) Through Life Project from Canberra and Queanbeyan, Australia, aged 28–32 years at the first time point and 32–36 at the second. Multinomial, linear, and binary regression analyses explored the association between resilience and SI over two time points. Models were adjusted for suicidality risk factors. Results: While unadjusted analyses identified associations between resilience and SI, these effects were fully explained by the inclusion of other suicidality risk factors. Conclusion: Despite strong cross-sectional associations, resilience and SI appear to be unrelated in a longitudinal context, once risk/resilience factors are controlled for. As independent indicators of psychological well-being, suicidality and resilience are essential if current status is to be captured. However, the addition of other factors (e.g., support, mastery) makes this association tenuous. Consequently, resilience per se may not be protective of SI.

Abusive head trauma (AHT) outcome at long-term follow-up and the role of elective neurosurgical approach: A report of 22 cases

2013 ◽  
Author(s):  
Francesca Menegazzo ◽  
Melissa Rosa Rizzotto ◽  
Martina Bua ◽  
Luisa Pinello ◽  
Elisabetta Tono ◽  
...  
Keyword(s):  
Head Trauma ◽  
Abusive Head Trauma ◽  
Long Term Follow Up

The role of ultrasound examination in early detection and follow-up of arterio-portal shunts

2008 ◽  
Vol 29 (S 1) ◽  
Author(s):  
S Ioanitescu ◽  
L Micu ◽  
A Rampoldi ◽  
N Masala ◽  
V Marcu ◽  
...  
Keyword(s):  
Early Detection ◽  
Ultrasound Examination

Tax evasion in the medical profession An Empirical Study in the General Tax Authority in Iraq

2019 ◽  
Vol 118 (11) ◽  
pp. 80-88
Author(s):  
Ramyar Rzgar Ahmed ◽  
Hawkar Qasim Birdawod ◽  
S. Rabiyathul Basariya
Keyword(s):  
Tax Evasion ◽  
Income Tax ◽  
Medical Profession ◽  
Great Influence ◽  
Tax Law ◽  
Degree Of Confidence ◽  
Medical Professions ◽  
Shed Light

The study dealt with tax evasion in the medical profession, where the problem was the existence of many cases of tax evasion, especially tax evasion in the income tax of medical professions. The aim of the study is to try to shed light on the phenomenon of tax evasion and the role of the tax authority in the development of controls and means that reduce the phenomenon of tax evasion. The most important results of the low level of tax awareness and lack of knowledge of the tax law and the unwillingness to read it and the sense of taxpayers unfairness of the tax all lead to an increase in cases of tax evasion and in suggested tightening control and follow-up on the offices of auditors, through the investigation and auditing The reports of certified accountants and the use of computers for this purpose in order to raise the degree of confidence in these reports and bring them closer to the required truth and coordination and cooperation with the Union of Accountants and Auditors and inform them about each case of violations of the auditors and accountants N because of its great influence in the rejection of the organization of the accounts and not to ratify fake accounts lead to show taxpayers accounts on a non-truth in order to tax evasion.

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