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Biomedical subjects

V Paloma

Publications and source records attributed to V Paloma.

At least 19 recordsLinked to original sources
PubMed2000

Surgical technique for reconstruction of the nasal septum: the pericranial flap.

BACKGROUND: We describe a new technique for the surgical reconstruction of large-sized anterior septal perforations based on the pericranial flap. METHODS: The technique requires a standard open rhinoplasty combined with a pericranial flap harvested after a bicoronal approach and tunnelled to the nasal cavity. We present the case of a man with complete destruction of the nasal septum as a result of chronic cocaine abuse. RESULTS: Surgery resulted in a permanent and complete closure of the perforation. CONCLUSIONS: The main advantage of this technique is the use of well-vascularized autogenous tissue and the minimal donor site morbidity. This technique provides a new method to close large nasal perforations.

Cocaine↗
PubMed2000

Primary vaginal and pelvic floor reconstruction at the time of pelvic exenteration: a study of morbidity.

PURPOSE: The purpose of this study was to analyze our experience with the influence of reconstructive techniques at the time of pelvic exenteration on morbidity. MATERIALS AND METHODS: Between June 1986 and December 1998, 60 pelvic exenterations for gynecologic malignancies were performed in our hospital. Forty-five were selected for this study because they met two criteria: they were performed by the same team (gynecologic oncologist), and they had similar primary tumors. There were 38 cervical, 2 vaginal, and 5 uterine malignancies. Sixteen patients underwent reconstructive surgery: 11 (68.8%) with placement of a myocutaneous flap with left rectus abdominis, 3 (18.8%) with gracilis muscle, and 2 (12.5%) with the Singapore fasciocutaneous flap. Twenty-nine patients had no reconstruction. Records were reviewed and statistical analysis was performed. RESULTS: Attachment of the grafts was complete in 14 of 16 (87.5%), with a partial vulvovaginal dehiscence in 2 cases. Morbidities included secondary infection in 3 (18.8%), partial necrosis in 3 (18.8%), and partial stenosis in 5 (31.6%); the last was significantly associated with a gracilis flap (P = 0.015). There were no statistical differences between neovagina and nonneovagina groups with respect to the rate of fever, small bowel fistula, bowel obstruction, wound infection or dehiscence, hernia, colorectal leak, colostomy or urostomy prolapse, deep vein thrombosis, pulmonary embolism, intraoperative blood transfusions, or hospital stay. There were no pelvic abscesses in the neovagina group compared with 27% (6/29) in the other group (P = 0.050). Surgery was significantly longer (P = 0.019) for the reconstructive surgery group, with no statistical difference between different kinds of flaps. There were no deaths in either group. CONCLUSIONS: Reconstruction of the vagina and pelvic floor at the time of pelvic exenteration can be done safely. Although this increases surgical time, morbidity is not significantly increased. The rectus abdominis flap seems to be the preferable option for primary vaginal and pelvic floor reconstruction.

Adult↗
PubMed2000

Is the reversed fourth dorsal metacarpal flap reliable?

We have carried out a study to determine if a flap based on vessels in the fourth metacarpal space could be used safely. We studied ten fresh cadaver specimens and used the flap in nine patients. In the anatomical study, we confirmed the presence of a suitable artery in nine out of the ten hands, arising from a piercing artery at the metacarpal bases, running distally under the fascia. The pivot point is located at the metacarpal heads, where the artery anastomoses to palmar branches and dorsal digital branches. In the clinical setting, the flap was reliable in eight patients. There was one case of flap necrosis. The flap seems to be reliable but several technical points are stressed to avoid complications.

Cadaver↗
PubMed1999

Relationship between flow and incidence of thrombosis in polytetrafluoroethylene vascular grafts in free microvascular flaps in lambs.

We have done an experimental study in lambs in which we investigated the influence of flow rate on free microvascular flaps using polytetrafluoroethylene (PTFE) vascular grafts. We set up five surgical groups in which blood flow was progressively increased through the PTFE vascular graft. In group I (venous autograft) we observed just one vascular thrombosis which was located at the site of the anastomosis. In group II (PTFE 3 x 10 mm) all the microvascular flaps became necrosed after the third postoperative day. In group III (PTFE 3 x 10 mm) necrosis also developed in all cases, but the anastomoses remained permeable no longer than eight days. In group IV (3 x 15 mm) the permeability in the microvascular free flaps was about 40% after 21 days, and in group V (3 x 10 mm) it reached 70%. To match graft flow rates with flap survival we did a regression analysis of flow rates for groups II, III, and V and the corresponding survival periods for the flaps. There was a clear and highly significant relationship (r = 0.717, p = 0.0001). In conclusion, it is necessary to maintain blood flow through the prosthesis at a rate higher than the thrombogenic threshold. When the flow rate in the vessels through the PTFE grafts was higher, the viability of the flaps was better. The ideal surgical technique should always be based on an arteriovenous fistula distal to the PTFE vascular graft. It is necessary to maintain blood flow through a prosthesis at a rate higher than the thrombogenic threshold.

Animals↗
PubMed1999

Primary amyloidosis presenting as extensor tenosynovitis.

Primary amyloidosis is a systemic disease. Amyloid arthropathy is an invalidating and uncommon form of presentation, but tenosynovitis is even rarer as the first sign of the disease. We report herein a case of unilateral amyloid deposit in the synovium of the extensor tendons of the hand, which was the first manifestation of a primary amyloidosis.

Aged↗
PubMed1998

Reconstruction of pharyngostomes with a modified deltopectoral flap combining endoscopy and tissue expansion.

The problem of pharyngostomic closure is difficult to solve, as evidenced by the large number of techniques described. The authors present the reconstruction of pharyngostomes by using Bakamjian's deltopectoral flap modified by the use of endoscopically introduced expanders for those patients in whom other techniques of choice (such as vascularized free flaps) have failed or are inapplicable either because of previous radiotherapy or because of local conditions. Bakamjian's deltopectoral flap, previously expanded with an expander coated with a partial-thickness skin graft and introduced endoscopically, allowed the authors to lift the flap in one operation to close the pharyngostome. This method provides the two walls of the pharynx (the skin graft as the inner aspect and the skin flap as the outer aspect), and the donor deltopectoral area is covered and epithelialized due to the skin graft. Thus by means of endoscopic expansion we use a nonaggressive technique to increase the surface area of the donor site and to increase its vascularization (delay phenomenon). Because the expander was coated with the graft, the authors were able to cover the anterior wall of the pharyngostome and the donor site in one surgical step.

Aged↗
PubMed1998

Transconjunctival herniation of orbital fat.

The authors present 3 patients with subconjunctival fat prolapse treated at their oculoplastic unit. Albeit rare, orbital fat is a well-recognized entity, and is described in the literature as being associated with trauma and surgery. The 3 patients reported herein, however, presented with no history of trauma or surgery. This condition is produced by herniation of the intraconal fat between the conjunctiva and the sclera, presumably due to dehiscence of the Tenon's capsule. Differential diagnosis should be made with lacrimal gland ptosis, lacrimal gland tumors, and lymphoid tumors.

Adipose Tissue↗
PubMed1997

Use of frozen cranial vault bone allografts in the repair of extensive cranial bone defects.

In cranioplasty complexity is proportional to the size of the detect, particularly if greater than 50 cm2. If the patient's own bone flap is not available, allogenic frozen bone graft can be used instead. Between June 1990 and June 1995 twenty cranioplasties with allogenic frozen bone grafts were performed. Age of patients ranged between 23 and 63 years (average 38.4 years). Male/female ratio was 2:1.7. Size of craniectomy ranged between 65 and 150 cm2 (average 83.3 cm2). Follow-up ranged between 10 and 58 months (average 41 months). Donors were tested to rule out transmissible diseases, infections, sepsis and/or cancer. Bone grafts were removed under aseptic conditions, microbiological cultures were taken, wrapped in a gauze soaked with Gentamicin sulphate and Bacitracin, sealed in three sterilised vinyl plastic bags, and stored in a deep freezer for a minimum of 30 days (range 36-93 days, average 67 days), at a temperature of -80 degrees C. Grafts were placed in the defect after a step was carved on its borders to facilitate the contact between host and graft. Vancomycin 1 g. IV/12 hours and Ceftriaxone 1 g. IV/12 hours were administered for five days. Grafts were covered by means of scalp flaps. Only one required a musculocutaneous free flap. None was exposed, extruded or had to be removed. Plain skull X-ray studies showed progressive remodelling of the grafts. Partial resorption was observed in two (2/20, 10%) and loss of thickness in another 3/20 (15%), but with no changes in the contour. Biopsies were taken in 3/20 (15%) cases at a second surgical procedure. Areas of osteoclastic resorptive activity mixed with others of osteoblastic bone apposition, showed replacement with new bone. We conclude that cranial vault frozen allografts are a good alternative to autologous bone when the latter is absent or not present in sufficient amount.

Adult↗
PubMed1996

The viability of cryopreserved onlay cranial bone allografts: a comparative experimental study versus fresh autografts.

It is well known that calvarial bone autografts are the bone grafts that are the least reabsorbent and have the best long-term evolution in craniofacial surgery. However, they do have certain limitations: (1) reabsorption results in repeated surgery and the need for new donor areas, (2) a limited amount of autogenous cranial bone is available (due to avoiding areas close to cranial sutures and venous sinuses, and because the temporal bone is very fragile and the cranium has not fully developed in children), and (3) graft extraction increases surgical time and morbidity. Because of this, we present an alternative to calvarial bone autografts: cryopreserved allografts. This paper is an experimental prospective study carried out on sheep with the following goals: (1) to assess the behavior of calvarial onlay bone grafts cryopreserved at -80 degrees C, using fresh autografts implanted under the same conditions as controls; (2) to compare reabsorption percentages statistically over time; and (3) to study qualitatively any histological variations. The results obtained are (1) more reabsorption of allografts when compared to autografts (at 90 days, 21.97% versus 20.21% of grafted volume), although this difference is not statistically significant; (2) a reduction in height in all onlay grafts as a consequence of the loss of the diplöe; (3) the absence of any type of inflammation caused by a reaction to cryopreserved allografts; and (4) bone substitution performed using frozen allografts is histologically similar to that using fresh autografts.

Cryopreservation↗
PubMed1995

Effect of L-ornithine 8-vasopressin on blood loss during liposuction.

In this comparative study, we carried out liposuction on 20 patients randomly divided in two groups to find an alternative medication to epinephrine that would not result in secondary effects at the cardiovascular level but would offer a similar vasoconstricting capacity. Also, a variation of the wet technique is described that decreases blood loss secondary to liposuction. The area to undergo liposuction is infiltrated with a cannula of our own design. Epinephrine is not used as a vasoconstrictor but rather L-ornithine 8-vasopressin at a concentration of 0.01 IU/ml chilled saline. With this new technique, the amount of blood removed is minimal, even in the case of extraction of large volumes of fat.

Adolescent↗