Biomedical subjects
Publications and source records attributed to A Paraskevas.
Vacuum-Assisted Closure (VAC) technique has been used in the treatment of acute and chronic wounds. The authors report a case of large thoracic defect, where the VAC was used to cover an exposed Gore Tex prosthesis after the failure of a latissimus dorsi flap. The VAC managed to save the Gore Tex prosthesis before a delayed reconstruction.
The authors report the case of a complex defect of the penis in children. Vacuum-Assisted Closure therapy as been shown to be very effective in enhancing wound debridement and the rate of granulation tissue formation. Complete closure of this complex wounds was obtained with a bilateral scrotal flap.
Total lower lip reconstruction can be performed with double cross-lip flaps. This simple technique gives satisfactory results both functionally and cosmetically. One clinical case is reported and the different procedures of total lower lip reconstruction are discussed.
The deep inferior epigastric perforator flap (DIEP) is a variation of the transverse rectus abdominis myocutaneous flap (TRAM). This flap was used as a pedicled flap to reconstruct the pelvis and thigh region after resection for cancer (four cases). Various flaps have been described for covering theses tissue defects but we prefer this perforator flap for its many advantages. This flap is very reliable and generates minimal functional sequelae on donor site. This flap is useful to cover soft tissue defects after vascular and oncologic surgery, a situation that was rarely reported to our knowledge.
Composite tissue allotransplantation is an emerging practice in the field of reconstructive surgery. Although still restricted to patients with major physical defects, it could be more widely practiced in the close future. The broadening of reconstructive surgery with "tissue reconstitution" depends on the functional results from the first hand allografts and from progress in immunotherapy. The mastery of microsurgery is a fundamental prerequisite to this activity and its development. Plastic surgeons will soon have to conceive, define, and master innovative surgical procedures for tissue restoration by microsurgical allotransplantation.
The authors describe a new position of the patient that enables the surgeon to perform a bilateral and synchronous mammaplasty, without switching sides. The patient is first raised in the sitting position, then the thigh and leg holders of the operating table are spread out to a 45-60 degrees angle. The surgeon stands in between the thighs, where he faces the chest and can operate on the breasts. The entire operation is performed by the surgeon, approaching both breasts simultaneously without the need for switching positions. The direct and central access, along with the continuing visual control of the shaping, turns the operation into a simple and faster one with better control of the cosmetic result.
Agenesis or hypoplasia of the right hepatic lobe combined with a floating gallbladder is an extremely rare condition. We report a case of hypoplasia of the right hepatic lobe, discovered in a 65-year old female. This was an incidental finding at CT scan for staging of a right colonic cancer. The CT evidenced the presence of a hypoplastic right lobe, while the left lobe was diffusely enlarged. Furthermore, the gallbladder was described as floating with partially calcified walls. The diagnosis of this rare anomaly was confirmed intraoperatively. The patient underwent right hemicolectomy and cholecystectomy. Biopsies were taken from both right and left hepatic lobes, revealing the presence of normal hepatic parenchyma. Since all causes of acquired atrophy of the liver had been ruled out, we considered this case to be of congenital origin.
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This prospective study compares the outcome of 2 groups of patients with pheochromocytoma undergoing adrenalectomy via a transabdominal approach or a laparoscopie approach. Mean operating time was exactly the same in both groups (122 and 125 minutes). Postoperative stay in the intensive care unit and in hospital was significantly shorter in the laparoscopic group as previously demonstrated fo other adrenal tumors. More important, no differences in haemodynamic changes were observed during surgery. In both groups, the increase of cathecholamine levels was identical, with a peak occuring during manipulation of tumors. Pneumoperitoneum was not responsible for any cardiovascular instability. Laparosopic adrenalectomy should therefore be preferred to open procedures in pheochromocytomas unless tumors are too large or potentially malignant.