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Surgical management of penoscrotal lymphedema 阴囊淋巴水肿的外科治疗
Q4 Medicine Pub Date : 2023-01-01 DOI: 10.4103/tjps.tjps_23_23
BA Ramesh, RVishnu Sundar, DeyonnaDeepthi Fernandes, JSathish Kumar
INTRODUCTION Genital elephantiasis is a debilitating condition that can have profound effects on both physical and emotional well-being. This condition arises from a reduction in lymphatic flow, resulting in significant swelling of the penis and scrotum.[1] The resulting swelling can cause considerable discomfort, making it difficult to maintain local hygiene and mobility, and can progressively impact sexual and urinary function. The aim of the surgical procedure was to address the patient’s discomfort and mobility issues caused by the weight and swelling of the penis and scrotum. The patient, a 38-year-old male, had been experiencing a gradual swelling of his penis and scrotum for 4 years. Although he had been able to manage the swelling using antibiotics and anti-filarial medications, the weight of his genitals had begun to significantly restrict his mobility. He also developed recurring scrotal skin infections, causing concern for potential complications and long-term effects on his quality of life. Despite his initial apprehension, the patient opted for surgery. Examination showed enlarged, firm, and hyperpigmented skin on the penis and scrotum, with palpable but not significantly enlarged inguinal nodes [Figure 1].Figure 1: (a and b) Genital lymphedemaVarious tests, including urine, blood, and biochemical analysis, as well as magnetic resonance imaging, showed no significant abnormalities. Lymphoscintigraphy, which could have provided further insight, was not possible due to the ongoing scrotal infection. A blood test for filariasis came back negative. The surgical procedure began by attempting to catheterize the penis, but the glans penis was not visible. To locate the urethral opening, the edematous preputial skin was opened. A catheter was inserted through the opening, serving as a guide to palpate the corpus spongiosum. Incisions were made on the distal penis, extending to Buck’s fascia and the root of the penis. The edematous penile skin, weighing 500 g, was then removed circumferentially [Figure 2].Figure 2: (a) Visualization of urethral opening after making prepuce incision. (b) After removal of penial oedematous skinThe spermatic cord structures were traced from the external inguinal ring openings to the base of the scrotum. The dissection was performed above the tunica vaginalis on both testes. The right side had a hydrocele, which required eversion of the sac. The entire edematous scrotal skin was excised, preserving the unaffected lateral skin. The excised scrotal skin weighed 1500 g [Figure 3]. To prevent torsion, both testes were anchored with multiple sutures to their respective beds, and the lateral scrotal skin was used to cover them. A thick split skin graft from the thigh was used to cover the penis, followed by the application of a negative pressure dressing to the penis skin grafts. After 1 week, the negative pressure dressing was removed, and regular dressing was continued. Although there was a 2 cm gap in the junction b
生殖器象皮病是一种使人衰弱的疾病,对身体和精神健康都有深远的影响。这种情况源于淋巴流量减少,导致阴茎和阴囊明显肿胀。[1]由此产生的肿胀可引起相当大的不适,使维持局部卫生和活动困难,并可逐渐影响性功能和泌尿功能。手术的目的是为了解决由阴茎和阴囊的重量和肿胀引起的病人的不适和活动问题。患者38岁,男性,4年来阴茎和阴囊逐渐肿胀。虽然他能够通过抗生素和抗丝虫药物控制肿胀,但他生殖器的重量已经开始严重限制他的活动能力。他还出现了反复出现的阴囊皮肤感染,引起了人们对潜在并发症和对他生活质量的长期影响的担忧。尽管病人一开始很担心,但他还是选择了手术。检查显示阴茎和阴囊皮肤肿大、紧实、色素沉着,腹股沟淋巴结可触及但未明显增大[图1]。图1:(a和b)生殖器淋巴各种检查,包括尿液、血液、生化分析以及磁共振成像,均未显示明显异常。由于持续的阴囊感染,本可以提供进一步了解的淋巴显像无法实现。血检丝虫病呈阴性手术开始时,医生试图在阴茎上插入导管,但没有看到阴茎头。打开肿胀的包皮以确定尿道开口的位置。导管通过开口插入,作为触诊海绵体的向导。在阴茎远端切口,延伸至巴克筋膜和阴茎根部。然后将重500 g的阴茎浮肿皮肤按周切除[图2]。图2 (a)包皮切开后尿道开口可视化。(b)去除阴茎水肿皮肤后,精索结构从腹股沟外环开口到阴囊底部。在两睾丸的阴道膜上方进行解剖。右侧有鞘膜积液,需要外翻囊。整个水肿阴囊皮肤被切除,保留未受影响的外侧皮肤。切除的阴囊皮肤重1500g[图3]。为了防止扭转,将两个睾丸用多条缝线固定在各自的床上,并用阴囊外侧皮肤覆盖它们。从大腿上取一块厚的裂开的皮肤移植物覆盖阴茎,然后对阴茎皮肤移植物应用负压敷料。1周后取下负压敷料,继续常规敷料。阴茎皮肤移植物与缝合的阴囊皮肤连接处虽然有2cm的间隙,但在2周内通过二次意向愈合[图4]。患者随访6个月,无并发症报告。图3:(a)卵泡积液囊开口。(b)阴茎上的负压包扎图4:(a)负压去除后立即进行。(b) 6个月后巨大阴囊水肿可由丝虫病、放射、肿瘤和肉芽肿疾病引起。生殖器淋巴水肿可引起毁容、泌尿系统问题、阳痿和复发性蜂窝织炎。情绪健康也会受到影响。[2]早期诊断和干预对于控制生殖器淋巴水肿和防止不可逆转的皮肤变化至关重要。[3]最初使用保守措施,如压迫、阴囊抬高和抗生素,但随着纤维化的发生,皮肤变得粗糙和坚韧。[4]淋巴淤积导致液体积聚、胶原蛋白产生和炎症,导致水肿、纤维化和皮肤增厚。手术干预包括切除巴克筋膜上方病变的淋巴网络,包括阴茎和阴囊周围受影响的皮肤和皮下组织。重建可能涉及分裂的皮肤移植物和皮瓣,就像这个病人所做的那样。[5]本研究的局限性是随访时间短。患者同意声明作者证明他们已经获得了所有适当的患者同意表格。在表格中,患者已经同意他/她/他们的图像和其他临床信息将在杂志上报道。患者明白他们的姓名和首字母不会被公布,并将尽力隐藏他们的身份,但不能保证匿名。财政支持及赞助无。利益冲突没有利益冲突。
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引用次数: 0
Forehead reduction and hairline lowering surgery: Aesthetic implications 前额缩小和发际线降低手术:美学意义
IF 0.1 Q4 Medicine Pub Date : 2022-10-01 DOI: 10.4103/tjps.tjps_45_22
A. Oreroğlu
Background: Forehead reduction and hairline lowering is an underestimated yet important procedure in facial beautification. Proportions of the forehead to the midface and lower face can be corrected with this surgery as well as addressing changes in hairline positioning. Objectives: The aim of this paper was to describe in detail the author's approach to hairline lowering and forehead reduction procedures with emphasis on implications to increase the aesthetic outcome. Methods: The procedure was performed under general anesthesia in a single-stage approach with the following algorithm: pretrichial incision, subgaleal dissection and preparation of a parieto-occipital scalp flap, multiple horizontal galeotomies, scalp advancement and fixation, and finally forehead skin excision and closure. Results: Forehead reduction and hairline lowering surgery was performed on 17 female patients aged between 19 and 42. Forehead length reduction was measured between 1.7 and 4.2 cm. The patients were followed up for 6 months to 3 years. Conclusions: Forehead reduction hairline lowering is an underestimated yet aesthetically important procedure for correcting facial harmony, beautification, and rejuvenative purposes. Following certain planning and technical details can help the surgeon apply the procedure properly, minimizing the risks for major and minor complication and achieving aesthetically successful results.
背景:前额缩小和发际线下降是一个被低估但重要的面部美容手术。前额与中脸和下脸的比例可以通过这种手术矫正,也可以解决发际线位置的变化。目的:本文的目的是详细描述作者的方法来降低发际线和前额减少程序,重点是提高美学效果的影响。方法:手术在全身麻醉下,采用单阶段入路,手术步骤为:毛前切口、盔骨下剥离及制备顶枕头皮瓣、多处水平盔骨切开术、头皮推进及固定、最后前额皮肤切除及闭合。结果:对17例19 ~ 42岁的女性患者行前额复位降发际术。前额长度减少了1.7到4.2厘米。随访6个月至3年。结论:前额减少发际线降低是一种被低估但在美学上重要的手术,用于纠正面部和谐,美化和恢复青春的目的。遵循一定的计划和技术细节可以帮助外科医生正确地应用手术,最大限度地减少大大小小的并发症的风险,并获得美观成功的结果。
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引用次数: 0
Polymethylmethacrylate bone cement utilization for hemostasis in an intraosseous arteriovenous malformation 聚甲基丙烯酸甲酯骨水泥在骨内动静脉畸形止血中的应用
IF 0.1 Q4 Medicine Pub Date : 2022-10-01 DOI: 10.4103/tjps.tjps_19_22
M. Dadacı, M. Kendir, Zikrullah Baycar, B. Ince
A 15-year-old girl applied to the outpatient clinic with an arteriovenous malformation, measuring approximately 20 cm × 10 cm, on the anterior aspect of the right knee. She was admitted to operation because of the failure of the previous embolization attempts. Intraoperatively, there was uncontrolled bleeding from the nidus which is located at the medulla of the tibia. After the failure of initial efforts, hemostasis could be achieved using polymethylmethacrylate cement. Arteriovenous malformations (AVMs) may cause life-threatening bleeding. In uncontrolled intraosseous bleeding, bone cement could be used for hemostasis. In this study, we present an AVM case and our experience about its management.
一名15岁女孩因右膝前侧约20 cm × 10 cm动静脉畸形就诊。由于先前的栓塞尝试失败,她接受了手术。术中,有不受控制的出血从病灶位于胫骨髓质。在最初的努力失败后,可以使用聚甲基丙烯酸甲酯水泥止血。动静脉畸形(AVMs)可能导致危及生命的出血。在不受控制的骨内出血中,骨水泥可用于止血。在本研究中,我们提出一个AVM病例和我们的治疗经验。
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引用次数: 0
Is iatrogenic sciatic nerve neuropathy following thigh lift surgery uncommon and preventable? 大腿提术后医源性坐骨神经病变罕见且可预防吗?
IF 0.1 Q4 Medicine Pub Date : 2022-10-01 DOI: 10.4103/tjps.tjps_37_22
Ç. Çiçek
Obesity is a serious public health problem, and bariatric surgery that is applied for obesity-related morbidities has led to a decrease in obesity-related morbidities and can also improve the quality of life of patients. Plastic, reconstructive, and esthetic surgery plays a major role in the management of skin laxity after bariatric surgery and is therefore generally considered a necessity. However, body contouring surgery can also be associated with some devastating complications. We present a case who developed sciatic nerve neuropathy after medial thigh lift surgery. Complete functional loss of the sciatic nerve was found by clinical and electroneurographic examination on the right side, and full nerve conductance recovery was obtained after 7 months in the patient. It is important to raise awareness about the fact that this significant complication, although rare, can occur even with such a benign and easy procedure and that it is readily reversible with prompt diagnosis and early treatment.
肥胖是一个严重的公共卫生问题,减肥手术应用于肥胖相关的疾病,可以降低肥胖相关的发病率,也可以提高患者的生活质量。整形、重建和美容手术在减肥手术后皮肤松弛的处理中起着重要作用,因此通常被认为是必要的。然而,身体塑形手术也可能伴随着一些毁灭性的并发症。我们报告一例在大腿内侧提拉手术后发生坐骨神经病变的病例。临床及右侧神经电图检查发现坐骨神经功能完全丧失,7个月后神经传导完全恢复。重要的是要提高人们对以下事实的认识,即这种严重并发症虽然罕见,但即使采用这种良性和简单的手术也可能发生,并且通过及时诊断和早期治疗很容易逆转。
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引用次数: 0
Freestyle anterolateral thigh flap and perforator variations 自由式大腿前外侧皮瓣和穿支变化
IF 0.1 Q4 Medicine Pub Date : 2022-10-01 DOI: 10.4103/tjps.tjps_27_22
E. Gur
Introduction: Anterolateral thigh (ALT) flap has become an increasingly popular reconstructive option, especially for head-and-neck and extremity defects. In addition to the many advantages of the ALT flap, there are also some disadvantages such as individual variations in the number and location of cutaneous perforators. Doppler ultrasonography (USG) is one of the most frequently used methods to overcome variations in perforator anatomy. However, the Doppler device may obtain false results so some clinics use the “freestyle” harvesting technique for ALT flap. The aim of the study is to examine experience with freestyle ALT flap harvesting and to evaluate the perforator variations. Materials and Methods: Between 2018 and 2021, 59 ALT flaps were harvested by the same microsurgical team for head-and-neck reconstructions. Of 59 patients, 23 were female and 36 were male. Cases were performed without using preoperative or peroperative imaging techniques. Results: In 2 (3%) of 59 patients, different septocutaneous flap options were used because suitable perforators could not be found in both thigh regions. For 57 ALT flaps, the rate of descending branch of lateral circumflex femoral artery (LCFA) perforators was 73%, transverse/ascending branch was 17%, aberrant perforators other than classical branches of LCFA was 7%, and the perforator from medial circumflex femoral artery was 1%. Partial necrosis due to perfusion problem was experienced in one flap and total necrosis was in two flaps. Conclusion: The advantages of the freestyle technique, such as allowing the evaluation of all perforators and designing flaps according to the appropriate perforator, provide great flexibility and convenience to the surgeon. With this, surgical problems caused by inaccurate results obtained by devices such as Doppler USG are excluded.
引言:前外侧大腿(ALT)皮瓣已成为越来越流行的重建选择,特别是头颈部和四肢缺损。ALT皮瓣除了有许多优点外,也有一些缺点,如皮肤穿支的数量和位置的个体差异。多普勒超声(USG)是克服穿支解剖变化最常用的方法之一。然而,多普勒装置可能获得错误的结果,因此一些诊所使用“自由式”收获技术用于ALT皮瓣。本研究的目的是研究自由式ALT皮瓣收获的经验,并评估穿支的变化。材料和方法:在2018年至2021年期间,同一显微外科团队收获了59个ALT皮瓣用于头颈部重建。59例患者中,女性23例,男性36例。病例在术前或术中均未使用影像学技术。结果:59例患者中有2例(3%)由于无法在两个大腿区域找到合适的穿支而选择了不同的中隔皮瓣。57个ALT皮瓣,旋股外侧动脉(LCFA)降支穿支率为73%,横支/升支为17%,LCFA经典支以外的异常穿支率为7%,旋股内侧动脉穿支率为1%。1个皮瓣因血流灌注问题出现部分坏死,2个皮瓣出现完全坏死。结论:自由式技术的优点是可以对所有穿支进行评估,并根据合适的穿支设计皮瓣,为外科医生提供了很大的灵活性和方便性。因此,排除了由多普勒USG等设备获得的不准确结果引起的手术问题。
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引用次数: 0
Soft-Tissue sarcomas: Diagnosis and treatment from the plastic reconstructive surgeon perspective 软组织肉瘤:从整形外科角度的诊断与治疗
IF 0.1 Q4 Medicine Pub Date : 2022-10-01 DOI: 10.4103/tjps.tjps_22_22
Rana Kapukaya
Advances in multimodal therapy and limb-salvage surgery (LSS) have led to improvements in the quality of life of sarcoma patients. Despite all the advances, controversy continues in the diagnosis and treatment of soft-tissue sarcomas (STSs). Significant structural and functional losses occur in the extremity due to both wide resections and radiotherapy combined with surgery. This situation necessitates the restructuring of extremity functions. The opinion of plastic surgery must be obtained, when planning LSS, before excision of high-volume tumors, to decide postresectional reconstruction and to manage the postsurgical complications. The need for plastic surgery in the multidisciplinary approach to STSs is increasing. The information presented in this article has been compiled from the articles obtained by searching the titles of “soft tissue sarcomas, reconstruction, diagnosis, current treatment” in Google Scholar and PubMed databases, international books written in the field, and the experiences of the authors.
多模式治疗和肢体保留手术(LSS)的进步导致了肉瘤患者生活质量的改善。尽管取得了这些进展,但软组织肉瘤(STSs)的诊断和治疗仍存在争议。由于广泛切除和放射治疗结合手术,肢体会发生严重的结构和功能损失。这种情况要求重新调整四肢功能。在规划LSS时,在切除大体积肿瘤前,必须征求整形外科医生的意见,以决定术后重建和处理术后并发症。需要整形手术在多学科方法的性传播感染正在增加。本文提供的信息是通过在Google Scholar和PubMed数据库中检索“软组织肉瘤,重建,诊断,目前治疗”标题获得的文章,该领域的国际书籍以及作者的经验汇编而成的。
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引用次数: 0
Comorbidity analysis of turkish patients operated for dupuytren's contracture in a university hospital 土耳其大学医院十二指肠挛缩手术患者的合并症分析
IF 0.1 Q4 Medicine Pub Date : 2022-10-01 DOI: 10.4103/tjps.tjps_32_22
A. Kose, Bahadir Demirkan, A. Sevencan, Büşra Tokmak, Can Ekinci
Background: Dupuytren's contracture (DC) is characterized by progressive fibroplasia of the palmar fascia resulting in significant impairment of hand function. Genetic factors and environmental factors are suspected in the etiology. Although the disease has a benign character, its formation and course follow a tumoral pattern. Several studies show that cancer-related mortality is higher in people with DC. Besides, various risk factors such as diabetes, smoking, and heavy handwork as triggers for DC led us to analyze the epidemiologic characteristics of our patients and search for the concomitance of chronic diseases and cancer. Methods: Seventy patients were operated for DC between 2009 and 2019. Information on occupation, dominant hand, diseased hand, family history, additional comorbidities, cancer, smoking, and drinking habits was sought. Results: A significant number of the patients were manual laborers. Most of the patients were active smokers at the time of the surgery. Dominant hand was predominantly right hand and the disease was mostly observed in the right hand but it was not significant (P > 0.05). Diabetes and cardiovascular disease (CVD) were the most common accompanying diseases. After surgery for DC, seven patients were diagnosed with cancer. Conclusions: This is the first Turkish study to show the relationship between DC and several comorbidities. Male gender and medium-heavy handwork were associated with DC. Although it was not statistically significant, the dominant hand was more affected by DC. Diabetes, CVD, smoking, and alcohol were significant comorbidities in our patients. The association between DC and cancer was remarkable.
背景:Dupuytren's挛缩(DC)以掌筋膜进行性纤维增生为特征,导致手部功能严重受损。病因中怀疑遗传因素和环境因素。虽然本病呈良性,但其形成和病程却遵循肿瘤的模式。几项研究表明,患有DC的人与癌症相关的死亡率更高。此外,糖尿病、吸烟、繁重的体力劳动等多种危险因素作为DC的触发因素,使我们分析了患者的流行病学特征,并寻找慢性病与癌症的共伴性。方法:2009年至2019年,70例患者行DC手术。调查对象的职业、惯用手、患病手、家族史、其他合并症、癌症、吸烟和饮酒习惯。结果:患者以体力劳动者为主。大多数患者在手术时都是活跃的吸烟者。优势手以右手为主,发病以右手为主,但差异无统计学意义(P > 0.05)。糖尿病和心血管疾病(CVD)是最常见的伴随疾病。在DC手术后,7名患者被诊断为癌症。结论:这是土耳其第一个显示DC与几种合并症之间关系的研究。男性和中重度手工劳动与DC相关。虽然没有统计学意义,但优势手受直流电的影响更大。糖尿病、心血管疾病、吸烟和酒精是我们患者的重要合并症。DC和癌症之间的联系是显著的。
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引用次数: 0
The first dorsal metatarsal artery adipofascial perforator flap: A useful salvage method for dorsal defects of distal foot 第一跖背动脉脂肪筋膜穿支皮瓣修复远端足背缺损的有效方法
IF 0.1 Q4 Medicine Pub Date : 2022-10-01 DOI: 10.4103/tjps.tjps_33_22
O. Eker, A. Doğramaci, M. Sutcu, Z. Tosun
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引用次数: 0
High bifurcation of superficial brachial artery 臂浅动脉高分叉
IF 0.1 Q4 Medicine Pub Date : 2022-10-01 DOI: 10.4103/tjps.tjps_20_22
Sudeshna Acharya, Sourabh Shankar Chakraborty, R. Sahu, Suresh Kotu
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引用次数: 1
Tongue schwannoma, an uncommon oral cavity mass: Experience from a case 舌神经鞘瘤,一罕见的口腔肿块:1例体会
IF 0.1 Q4 Medicine Pub Date : 2022-10-01 DOI: 10.4103/tjps.tjps_35_22
Einstein Viana-Tapia, Juan Felipe Coronado, Osvaldo C Barraza-Leones
Schwannomas are benign tumors arising from the Schwann cells, located in the peripheral nerve sheath. The incidence of tumor in the oral cavity is <1%, and the tongue is the most prevalent place in that area. A 32-year-old Hispanic female was sent from the otolaryngology department with a diagnosis of an oral mucocele in the oral cavity floor, after 8 months complaining of dysphonia and dysphagia. Physical examination reveals a submucosal mass in the anterior and ventral portion of the tongue. After characterization with magnetic resonance and biopsy guided by tomography, she underwent surgical management, with no complications. Tongue schwannomas are often misdiagnosed based on their very low incidence. A proper approach including a good physical examination, imaging and histological characterization of the lesion, and proper surgical management of this entity, will lead to cure this condition, with a low relapse rate.
神经鞘瘤是一种良性肿瘤,起源于周围神经鞘中的雪旺细胞。口腔肿瘤的发生率<1%,而舌部是口腔肿瘤最常见的部位。一名32岁的西班牙裔女性从耳鼻喉科被诊断为口腔底部的口腔粘液囊肿,8个月后主诉发音困难和吞咽困难。体格检查发现舌前部和腹侧有粘膜下肿块。在磁共振和断层扫描引导下活检后,她接受了手术治疗,没有并发症。舌神经鞘瘤由于发病率极低而常被误诊。正确的方法包括良好的体格检查,病变的影像学和组织学特征,以及对该实体的适当手术治疗,将导致这种疾病的治愈,复发率低。
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引用次数: 0
期刊
Turkish Journal of Plastic Surgery
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