scholarly journals Use of skin-fascial flaps on perforating vessels in the surgical treatment of skin melanoma

2020 ◽  
Vol 1 (3) ◽  
pp. 18-26
Author(s):  
Yu. V. Przhedetskiy ◽  
V. V. Pozdnyakova ◽  
N. A. Maximova ◽  
O. V. Khokhlova ◽  
N. A. Zakharova ◽  
...  
Keyword(s):  
Blood Flow ◽  
Surgical Treatment ◽  
Postoperative Period ◽  
Skin Color ◽  
Functional Results ◽  
Skin Defect ◽  
Skin Melanoma ◽  
High Viability ◽  
Digital Pressure ◽  
Muscle Fascia

Purpose of the study. Improving the results of surgical treatment of melanoma of the skin of the extremities by using skin-fascial flaps on perforating vessels.Patients and methods. In 42 patients with limb skin melanoma T1–3N0M0, the closure of a skin defect was performed by islet flaps on perforating vessels. Perforating vessels of the donor zone were detected with an assessment of the blood supply of the flaps in the pre- and postoperative period using ultrasound and marking of perforants with adjustment of the preliminary marking of the flaps.Results. Permanent perforating vessels with a diameter of more than 1 mm were used. After excision of the tumor, on the opposite sides of the wound defect, taking into account the location of the perforating vessels, flaps were taken, with further mobilization by excision of the fiber and muscle fascia, they were separated from the underlying tissues while maintaining the integrity of the supply vessels. The circulatory state of the selected flaps was determined by skin color and capillary response to digital pressure. The flaps were displaced to the center, covered the area of the defect and sutured with single sutures, the edges of the donor wound were mobilized, sutured with single sutures until light tension appeared and sutured into the remaining wound defect. In the postoperative period, the determination of the parameters of the blood flow of perforating vessels showed the absence of hemodynamically significant violations of the blood flow during the movement of the flap. Transient ischemia of one of the oncoming flaps after surgery developed in 11.9%, marginal necrosis of the distal flap — in 7.1% of cases. A normotrophic scar was formed, with a width of not more than 0.3 cm, which aesthetically satisfied 92.8% of patients. Assessment of two-year relapse-free survival showed a complete absence of local relapses.Conclusion. The flaps vascularized by perforating vessels have high viability, are identical in color and texture to the skin of the recipient area, and the close proximity to the receiving area contributes to minimal deformation of the donor area, which increases the radicality of the operation, reduces the incidence of postoperative complications and improves аesthetic and functional results.

scholarly journals Functional results of surgical treatment of retinal detachment

2020 ◽  
Vol 24 (2) ◽  
pp. 156-162
Author(s):  
O. E. Ilyukhin ◽  
M. A. Frolov ◽  
K. V. Ignatenko
Keyword(s):  
Blood Flow ◽  
Visual Acuity ◽  
Surgical Treatment ◽  
Retinal Detachment ◽  
Photoreceptor Cells ◽  
Functional Results ◽  
Scleral Buckling ◽  
The State ◽  
Visual Functions ◽  
Outer Segments

The article analyzes the state of patients visual acuity after successful surgical treatment of retinal detachment. On the basis of gathered data, it was concluded that in case of detachment of the macula only in 50% of cases it is possible to increase visual acuity to 0.4 and higher. Restoration of visual functions continues for at least 6 months after the operation and is determined by the restoration of the structure of the outer segments of the photoreceptor cells. During this time, it is advisable to conduct drug therapy aimed at normalizing blood flow and functional activity of the retina. Visual functions recovery continues for at least 6 months after the operation and is connected with the restored structure of the outer segments of the photoreceptor cells. Important prognostic factors of central vision restoration in the postoperative period are visual acuity before surgery, duration of existence and height of macular detachment. Data on which of the methods of surgical treatment of retinal detachment allows to achieve higher visual acuity are contradictory. There is practically no data on the comparison of the effect on visual acuity of scleral buckling and vitrectomy in the long-term period, in patients with phakic eyes and with artiphakia. On visual acuity after fitting detachment of the macula may affect macular edema, epiretinal membrane formation and retinal folds, and edema of the peripapillary optic nerve head, progressive deterioration of blood flow in the basin of the central retinal artery, short posterior ciliary arteries and ophthalmic artery. It is believed that these factors are significantly more pronounced after scleral buckling than after vitrectomy. Some indicators of optical coherence tomography correlate with visual acuity after surgical treatment of retinal detachment: the state of the articulation line of the external and internal segments of the photoreceptors, as well as the state of the external limiting membrane.

scholarly journals COMPARATIVE CHARACTERISTICS OF CLASSICAL AND EVERSION ENDARTERECTOMY OF THE CAROTID ARTERIES

2017 ◽  
Vol 4 (3) ◽  
pp. 8-15
Author(s):  
I. P. Dudanov ◽  
B. C. Abuazab ◽  
V. V. Akhmetov
Keyword(s):  
Blood Flow ◽  
Surgical Treatment ◽  
Cerebral Artery ◽  
Postoperative Period ◽  
Vascular Reactivity ◽  
Carotid Artery Disease ◽  
Spectral Expansion ◽  
Early Postoperative Period ◽  
Eversion Endarterectomy ◽  
Significant Difference

Purpose. The effectiveness of classical and eversion carotid endarterectomy (CE) in patients with cerebral ischemia in atherosclerotic stenosing carotid artery disease (ICA) was compared in the article.Material and methods. The examination and analysis of data of 122 patients with more than 60% ICA stenosis was held: men — n = 92 (60.1%), women n = 61 (39.9%). The average age was 52.3 years (ranged from 34 to 74 years). All the patients were symptomatic. 92 patients underwent an eversion endarterectomy (CE), 30 patients underwent classical CE.The effectiveness of surgical treatment was assessed by the dynamics of the neurological status, the change in the parameters of duplex and transcranial studies before the operation, on day 10, at 1, 3, 6, 9 months, 1, 1.5, 2, 3 years.Results. In patients who underwent eversion CE, in the early postoperative period, a significant decrease in the asymmetry coefficient was revealed in the study of background LSC valuesdue to an increase in the blood flow velocity in the ipsilateral middle cerebral artery (MCA) and a decrease in the linear velocity of the blood flow (LVBF) in the posterior cerebral artery (PCA) on the side of the initially stenotic ICA on the background of improvement of hemodynamic conditions in all cases (p < 0.05). In patients, a significant increase in the reactivity factor for the hypercapnic load from the initial value was noted against the background of approaching the normative indices of the pulsation index. The latent period of vascular reactivity was shortened to 24.3 ± 3.7 seconds. In patients who underwent classical CEAE n = 30, in early terms of up to 1 month, a decrease in the coefficient of asymmetry of LVBF was noted due to the normalization of the velocity characteristics of cerebral blood flow in all the main cerebral vessels of the carotid and vertebrobasilar basins. Comparative analysis of the spectral expansion (SE) values obtained initially and recorded in groups with different types of surgical intervention revealed a significant difference in the resulting data (p < 0.05). Restoration of SE parameters to normative ones was registered in the group of classical CEA in 26.7% (n = 8) and 79.3% (n = 73) with an eversion EAE for 1 month. The maximum rate of positive dynamics was traced during the first month after cerebral revascularization, complete recovery was recorded at the end of the 18th month in the group of eversion CE and 24 months in the group of classical CE. There were no significant differences in the resultant indices of regression of neurological disorders in the postoperative period of an eversion EAE and classical EAE (p > 0.05).With the eversion CE, the total number of complications was n = 9 (9.8%), and 1 (1.1%) case — restenosis in the reconstruction zone. In the case of classical CE, the total number of complications was n = 10 (33.3%), of which n = 1 (3.3%) cases of hyperperfusion syndrome were observed; in n = 2 (6.6%) patients, development of a stroke, 1 (3.3%) developed myocardial infarction. Restenosis in the reconstruction zone was formed in n = 2 (6.6%) patients, peripheral nerve damage was in n = 4 (13.3%) patients.Conclusions. Classic and eversion CE are both effective. Short- and long-term clinical and hemodynamic results of surgical treatment by the method of eversion of the CE are somewhat better than the results of classical one.Classical CE is indicated in cases of extended plaque, eversion of the CE is indicated in the cases of short local plaques. 

scholarly journals Options for assessing renal function after organ-preserving operations in patients with renal cell carcinoma

2020 ◽  
Vol 13 (5) ◽  
pp. 36-40
Author(s):  
A.V. Seregin ◽  
◽  
T.R. Indarokov ◽  
N.A. Shustitsky ◽  
A.A. Seregin ◽  
...  
Keyword(s):  
Blood Flow ◽  
Renal Function ◽  
Surgical Treatment ◽  
Functional Results ◽  
Main Task ◽  
Renal Pedicle ◽  
Central Segment ◽  
Significant Impairment ◽  
Oncological Results ◽  
Group 1

Introduction. Despite the improvement of various methods of surgical and ablative methods of treating kidney cancer, the question remains about the functional state of the kidney after surgical treatment. Along with the achievement of oncological results, the preservation of renal function is the main task in the treatment of tumorous diseases of the kidneys. Aim. To evaluate the functional results of organ-preserving operations with a preventive suture with preserved blood flow, as well as in patients who underwent a resection of the kidney with compression of the renal pedicle, using nephroscintigraphy. Material and Methods. The study included 175 patients in stages pT1a-T2bN0M0, which are divided into 2 groups. Group 1 – 150 patients who underwent organ-preserving options with the use of preventive hemostatic sutures, allowing operations to be performed without clamping the kidney leg. 25 patients underwent a resection of the kidney with compression of the renal pedicle. To assess renal function, patients underwent dynamic nephroscintigraphy. In the first group, the tumor was located in the central segment in 64 patients, in the upper segment in 45 patients, in the lower segment in 41 patients. Stage T1a was established in 74 patients, stage T1b in 53 patients, stage T2a in 4 patients. In 19 patients diagnosed with cystic T1a cancers. In the second group in the central segment – in 10 patients, in the upper segment in 7 patients and in 8 patients in the lower. According to the stages, patients were divided as follows – T1a – 16, T1b – 8, T2a – 1. Results. Organ-preserving operations were performed for all patients. In the first group, in no case did the renal pedicle be pinched. The average time of thermal ischemia in the second group was 13 ± 2 min. The perfusion and renal index for the operated kidney in both groups was comparable, and amounted to 54.13 ± 2% and 53.24 ± 4%. However, after surgical treatment, the indicators were significantly different. In the first group, the perfusion index was 46.82 ± 2.39% against 35 ± 1.52% in the second, the renal index in the first group was 46.82 ± 2.39%, against 39 ± 0.88% in the second. Conclusion. Thus, even short-term thermal ischemia leads to significant impairment of renal function. Preventive suture allows you to remove a tumor from any part of the kidney, while maintaining blood flow, and allows you to protect the renal parenchyma from ischemic damage.

Clinical and functional results of surgical treatment of cataract and presbyopia by using diffraction-refraction IOL AcrySof ReSTOR

2010 ◽  
Vol 26 (4) ◽  
pp. 26-29
Author(s):  
V. Kolomiets ◽  
◽  
S. Dmitriev ◽  
T. Dushenchuk ◽  
Yu. Lazar ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Functional Results

The Effect of Caffeine on Digital Haemodynamics

1994 ◽  
Vol 19 (3) ◽  
pp. 301-302 ◽  
Author(s):  
B. BARTON ◽  
J. M. KLEINERT
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Room Temperature ◽  
Systolic Pressure ◽  
Middle Finger ◽  
Distal Phalanx ◽  
Normal Volunteers ◽  
Pulse Volume ◽  
Digital Pressure ◽  
Digital Blood Flow

Caffeine has been shown to increase mean blood pressure, but studies documenting the effect of caffeine on digits are lacking. We evaluated the effect of caffeine on digital blood pressure and pulse volume in normal volunteers. In the first part of the study, 24 subjects were given water containing either 200 mg of caffeine or placebo. Bilateral brachial and middle finger digital pressures were measured at room temperature before ingestion and at 30 and 60 minutes after ingestion. In the second part of the study, pulse volume recordings (PVRs) were obtained in 24 subjects at the level of the distal phalanx of the middle finger of one hand immediately prior to beverage ingestion and at 10 minute intervals for 90 minutes. Differences in mean digital systolic pressure, digital/brachial index, or PVR amplitude between the control and caffeine groups were not statistically significant. The administration of caffeine was found not to alter the haemodynamics of digital blood flow or digital pressure in this population.

scholarly journals Results of surgical treatment of developmental dysplasia of hip considering child’s age

2011 ◽  
Vol 139 (1-2) ◽  
pp. 58-63 ◽  
Author(s):  
Sonja Milasinovic
Keyword(s):  
Surgical Treatment ◽  
Human Life ◽  
Functional Results ◽  
Developmental Dysplasia ◽  
Preoperative Treatment ◽  
Locomotor System ◽  
Developmental Dysplasia Of Hip ◽  
Innominate Osteotomy ◽  
Medical Documents ◽  
Late Discovery

Introduction. Developmental dysplasia of the hip (DDH) represents one of common diseases of the locomotor system. Late discovery and inadequate healing of this defect leads to serious disability in the best years of human life. Objective. The aim of this study was to analyze the quality of functional and anatomic restitution of the diseased hip, depending on the age of the patient at the time of surgery. Methods. Our retrospective study was developed on 78 children surgically treated for DDH. The examiners were distributed in three groups according to age in which they had been operated. The data were produced on the basis of full-scale medical documents for each patient. Results. We analyzed and compared anatomic and functional results of surgeries treating DDH in the group of examiners. On examination, we got data that the most prevalent were distorted gait, inequality of the legs and positive Trendelendburg?s sign in the group of children who had been operated in the oldest age. The patients who were surgically treated in older age had worse postoperative results in aspect value angle of flexion and abduction in treated hip, higher frequency in manifesting pain and asymmetric gait. Better corrective results on aspect of dimension of the colodiaphyseal and Hilgenrainer?s angle will be obtained if DDH treatment is conducted in younger age of patients. In 94.95%, the patients were treated with Salter innominate osteotomy of pelvis with osteotomy of the femur involving its shortening and reverse rotation. Preoperative treatment with Pavliks harness was provided in 44.02% children, with abduction of Hilgenrainer?s apparatus in 2.6%, with abductions ?Niva? slips in 2.6% and preoperative extension in 28.2%. Conclusion. The surgical treatment of DDH in the observed patients done at the earlier age of growth resulted in the evidently better anatomical and functional results at postoperative observation.

scholarly journals Scrotal reconstruction with superomedial fasciocutaneous thigh flap

2018 ◽  
Vol 45 (1) ◽  
Author(s):  
DANIEL FRANCISCO MELLO ◽  
AMERICO HELENE JÚNIOR
Keyword(s):  
Surgical Treatment ◽  
Complication Rate ◽  
Longitudinal Direction ◽  
Functional Results ◽  
Fasciocutaneous Flap ◽  
Surgical Time ◽  
Cross Sectional ◽  
Skin Loss ◽  
Scrotal Reconstruction ◽  
The Mean

ABSTRACT Objective: to describe the use of a superomedial fasciocutaneous thigh flap for scrotal reconstruction in open areas secondary to the surgical treatment of perineal necrotizing fasciitis (Fournier’s gangrene). Methods: retrospective analysis of cases treated at the Plastic Surgery Service of Santa Casa de Misericórdia, São Paulo, from 2009 to 2015. Results: fifteen patients underwent scrotal reconstruction using the proposed flap. The mean age was 48.9 years (28 to 66). Skin loss estimates in the scrotal region ranged from 60 to 100%. Definitive reconstruction was performed on average 30.6 days (22 to 44) after the initial surgical treatment. The mean surgical time was 76 minutes (65 to 90) to obtain the flaps, bilateral in all cases. Flap size ranged from 10cm to 13cm in the longitudinal direction and 8cm to 10cm in the cross-sectional direction. The complication rate was 26.6% (four cases), related to the occurrence of segmental and partial dehiscence. Conclusion: the superomedial fasciocutaneous flap of thigh is a reliable and versatile option for the reconstruction of open areas in the scrotal region, showing adequate esthetic and functional results.

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