Propeller Flap: Surgical Option after Resection of Lower Limb Melanoma

Objective: To describe a series of cases of lower limb reconstruction using an axial reverse flow flap (propeller flap) after melanoma excision. Patients and methods: From August 2014 to December 2016, at the Plastic Surgery Service at UNIFESP, five patients with defects in the lower limbs after melanoma resection were reconstructed using propeller flap. In all cases, the perforating vessels were previously mapped using Doppler ultrasound. Results: The size of the defect ranged from 4 cm × 3 cm to 8 cm × 4.5 cm. One case had a 180º rotation. In all the others, a 90° rotation was sufficient. All patients had good aesthetic results. Conclusion: The propeller flap is a simple and low cost technique. It is indicated for reconstruction of the distal third of small and/or medium-sized lower limb. The aesthetic result is satisfactory with the thickness and color of the flap very similar to the excised area.

Short-Term Outcomes of Laparoscopic/Robotic Gastrectomy Compared with Open Gastrectomy for Advanced Gastric Cancer Following Chemotherapy

Purpose This study aimed to investigate the short-term outcomes of laparoscopic gastrectomy/robotic gastrectomy after chemotherapy in patients with advanced gastric cancer and compare these outcomes with those of open gastrectomy. Methods Fifty patients who underwent radical gastrectomy for advanced gastric cancer after chemotherapy between 2007 and 2021 were retrospectively analyzed. The patients were divided into two groups: the laparoscopic gastrectomy/robotic gastrectomy (n = 11) and open gastrectomy (n = 39) groups. The short-term outcomes of these procedures were subsequently examined. Results The laparoscopic gastrectomy/robotic gastrectomy group had significantly shorter hospital stays and lower intraoperative blood loss than the open gastrectomy group. The overall complication rates were 12.8% (5 of 39 patients) and 0% (0 of 11 patients) in the open gastrectomy and laparoscopic gastrectomy/robotic gastrectomy groups, respectively (P = 0.1). Conclusions Laparoscopic gastrectomy/robotic gastrectomy may be a surgical option after chemotherapy for patients with advanced gastric cancer.

The modified transmanubrial approach in thyroid malignant tumors: an optimal and less invasive surgical option.

- We retrospectively evaluated a large series of patients (n: 15) underwent a modified transmanubrial approach for wide mediastinal resection in case of malignance thyroid mass - In fourteen cases, also with thyroid tumor involving the middle line. A bilateral mTMA was necessary to perform a cava vein resection. - No major postoperative and cutaneous/sternum complications were detected. - mTMA allows an optimal exposure of the upper thoracic inlet achieving a complete radical oncological resection of the tumor/lymph-node and a safety vascular/tracheal control. - As a limitation, the modified mTMA is anatomically more demanding and not familiar for most surgeons in comparison to sternotomy

Surgical correction of posttraumatic nasal deformities in adolescent athletes

Nasal breathing is of great importance for professional athletes because of the peculiarities of carbon dioxide metabolism in the body. Problems with nasal breathing caused by post-traumatic deformities of the nose can be successfully corrected with the help of rhinoseptoplasty, but the possibility of performing this surgery on patients under 18 years of age is a discussed matter. This study aimed to analyze the results of the effect functional rhinoseptoplasty has on nasal breathing, consider rhinoseptoplasty as the preferred method of treatment for adolescents with post-traumatic deformities of the structures of the nose. The study involved 15 professional athletes aged 15–18 years with post-traumatic deformities of the external nose and troubled nasal breathing. Five of them (33.3%) were female, 10 (66.7%) were male; all underwent open rhinoseptoplasty. The NOSE and SCHNOS questionnaires were used to assess the symptoms of nasal obstruction before and after surgery. Post-surgery, all patients subjectively noted that their nasal breathing improved, which was confirmed by the filled questionnaires. There were no significant complications registered during the follow-up period. Functional rhinoseptoplasty is a viable surgical option for adolescents under 18 years of age.

A Unique and Rare Presentation of Obstructed Choledochal Cyst in an Adult: A Case Report

Choledochal cysts in adults are rare congenital abnormalities. Approximately 80% are found in childhood. Thus, their presentation in adults is always associated with complications, such as stone formation, inflammation and malignancies. The pathophysiology of this disease is yet uncertain. There are different types of choledochal cysts. Diagnosis can be challenging clinically; however, imaging techniques, such as ultrasound, magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT), can be helpful. We found several procedures performed in the extant literature, such as choledochoduodenostomy and choledochojejunostomy submucosal excision of the cyst; however, the best surgical option is excision with hepaticojejunostomy. We discuss the unusual presentation of a 33-year-old female patient with an obstructed choledochal cyst, despite having undergone a drainage procedure in childhood.

Septodermoplasty: Make It Easier

Septodermoplasty (SDP) is a technique that presents a surgical option for the treatment of recalcitrant epistaxis from hereditary hemorrhagic telangiectasia. It involves the removal of affected nasal epithelium, replacing it with a split thickness skin graft (STSG). However, the inherent challenges with SDP are that owing to the floppy and unstable nature of the STSG, especially if simultaneously grafting the lateral nasal wall in addition to the septum and nasal floor, there is a risk of inadvertently stripping and displacing the STSG from its intended position. In this article we offer some techniques that utilize microdebrider for addressing mucosal lesions and fixate silastic sheet on floppy STSG as a scaffold to make it firm and easy to handle in order to hold the graft right in place.

Window denture: An unconventional approach for the bulky edentulous ridges

Prosthetic rehabilitation in patients having prominent labial ridge with conventional complete denture is an uphill task. Severe labial ridge undercuts are commonly seen incompletely edentulous maxilla than in mandible. This may be attributed to the fact related to the proclined maxillary anteriors, indicated for extraction. Treatment approaches generally involve either a surgical or a non-surgical option. The non-surgical or the prosthetic option generally involves the fabrication of conventional complete denture, which may further compromise the esthetics due to excessive thickness of the labial flange. To challenge such situations, an unconventional approach is needed for fabricating a complete denture. This case report delineates a simple, economical, conservative and non-surgical treatment approach for fabrication of denture in a patient with excessive bulky maxillary ridge, to pronounce the final facial aesthetics of the patient.

Selective Hemorrhoidal Dearterialization with High Mucopexy in the Surgical Treatment of Hemorrhoidal Disease

The doppler-guided transanal hemorrhoidal dearterialization technique associated with mucopexy is a noninvasive surgical option used to treat hemorrhoidal disease (HD). Objective To compare and analyze the results using a variation of the doppler-guided transanal hemorrhoidal dearterialization technique with the technique of selective hemorrhoidal dearterialization with high mucopexy in the treatment of HD. Method A total of 292 patients who underwent surgical treatment for grade II, III and IV HD from March 2012 to December 2017 were studied. From this total, 110 (37.6%) patients underwent a conventional doppler-guided transanal hemorrhoidal dearterialization with mucopexy (CD), and 182 (62.3%) underwent selective hemorrhoidal dearterialization with high mucopexy (SHeLF). In the group of patients undergoing CD, 4 patients (3.64%) had grade II HD, 82 (74.55%) grade III, and 24 (21.82%) grade IV. In the group submitted to SHeLF, 18 (9.89%) patients had grade II HD, 86 (47.25%) had grade III, and 65 (35.71%) had grade IV. The same surgeon operated all patients under spinal anesthesia. In patients undergoing CD, six arterial branches have been dearterialized, while in patients undergoing SHeLF, the hemorrhoidary nipples submitted to a dearterialization were selected (from 1 to 5) by intraoperative evaluation followed by high rectal mucopexy. In the postoperative period, the following parameters were evaluated: pain, tenesmus, bleeding, and recurrence.Moderate results to severe pain was a postoperative complaint reported by 13 (11.82%) patients undergoing CD, and by 19 (10.44%) undergoing SHeLF. Intense tenesmus was reported by 26 (23.64%) patients undergoing CD and by 7 (3.85%) undergoing SHeLF. Three patients (2.73%) undergoing CD and 1 (0.55%) undergoing SHeLF evolved with postoperative bleeding. One patient (0.55%) in the group undergoing CD required surgical review of hemostasis. Six patients (5.45%) who underwent CD and 8 (4.39%) who underwent SHeLF were reoperated due to disease recurrence. Conclusion Comparing statistics, patients undergoing the SHeLF technique have less postoperative pain, tenesmus and postoperative bleeding when compared with CD.