Lymphaticovenous anastomosis (LVA) is a surgical treatment for lymphedema that requires identification and mapping of functional lymphatic channels. This technique was performed blindly for years ...because of the lack of suitable methods of study. Progress in imaging techniques and the introduction of Indocyanine green lymphography (ICG-L) represented a significant advancement in lymphedema management. Magnetic resonance lymphangiography (MRL) has also helped improve knowledge about lymphedema anatomy and pathophysiology. We now present our protocol based on both ICG-L and MRL for optimal LVA preoperative planning.
A prospective study between April 2010 and June 2015 was conducted in 82 patients (77 females, mean age 45.5 years) with stage I (9.8%), II (73.2%), and III (17.0%) lymphedema. All patients underwent lymphedema surgical treatment with LVA. Surgery was planned based on preoperative information from ICG- L and MRL.
We obtained a mean of 6.87 lymphatic locations per extremity from MRL and selected a mean of 4.04 for LVA. When MRL data coincided with ICG-L data, we found a functional lymphatic vessel in 96.9% of cases and performed LVA successfully in 91.4%.
ICG-L and MRL are noninvasive techniques that provide images of the lymphatic system with sufficient temporal and spatial resolution to depict functional lymphatic vessels. Such knowledge is essential for preoperative planning of LVA microsurgery. We present our protocol for the approach of surgical treatment of lymphedema. This protocol represents a step forward in unifying patient selection criteria and achieving safe, effective, and rational surgery.
An accurate preoperative evaluation of the vascular anatomy of the abdominal wall is extremely valuable in improving the surgical strategy in abdominal perforator flaps. The multidetector-row ...computer tomography offers thin slice coverage of extended volumes with an extremely high spatial resolution. From October 2003 to December 2004, 66 female patients had breast reconstruction surgery in our department using the deep inferior epigastric artery perforator flap. Our multidetector-row computer tomography studies were performed using a 16-detector-row computer tomography scanner. The image assessment was carried out using the following protocol: we first identified the best three perforators from each side of the abdomen. Then we conducted a three-dimensional reconstruction of the abdomen by identifying exactly where the three best perforators emerged from the rectus abdominis fascia. We then transferred the data obtained from the image to the patient using a coordinate system. In addition, we also placed the dominant perforators in the patient by using a conventional hand-held Doppler. During the operation we compared intra-operative findings, Doppler results and computer tomography outcomes. Neither false positive nor false negative results were found in the computer tomography outcome. Multidetector-row computer tomography provides us with an easy method of interpreting the virtual anatomic dissection in three dimensions. It has high sensitivity and specificity and provides a good quality evaluation of the perforator vessels. This information allows reduction of operating time and safer performance of surgery. The multidetector-row computer tomography is a highly effective tool in the preoperative study of abdominal perforator flaps.
Breast cancer (BC) is one of the most common causes of death in women up to 50 years old. For today the choice of an adequate methods of surgical intervention and the need for an adequate surgical ...adjuvant therapy, quality of life of patients after surgeryis are important. The aim of our study was to select the volume of surgery for breast cancer using the technique of intraoperative identification of the sentinel lymph node (intraoperative ICG technology) and to evaluate the results of its urgent histological examination. It was shown that the most common method of surgery in patients who underwent intraoperative ICG technology was quadrantectomy, which was performed in 27 cases (54%), rarely subcutaneous mastectomy was performed (30%) and radical mastectomy (by Madden) – 16%. In the control group, priority was given to radical removal of the breast (63.2% of cases); partial resection (by U. Veronesi) was performed in 33.3% of patients, and subcutaneous mastectomy – in 3.5%. Pathomorphological examination of the sentinel lymph node during its intraoperative imaging using ICG-technology established metastatic lesion in 10 of 50 cases (20%) in the main group. The obtained results of the assessment of the regional lymph dissection size in the main group indicate its adequate nature to ensure the radicality of surgical treatment. In our opinion, this is one of the important preliminary conclusions of this study, because to assess the clinical significance of signal lymph node (SLN) analysis as a marker of regional tumor spread, firstly it is necessary to be sured that existing surgical techniques provide radical tumor removal.
► Effectiveness of near surface mounted steel reinforcement system was investigated. ► A total of seventeen masonry wallettes, being 1.2
m×1.2
m in size, were tested in diagonal shear. ► As-built ...tested wallettes exhibited sudden post-peak strength degradation and failed along a stepped diagonal joint crack. ► Strengthened wallettes failed along distributed diagonal cracks in a more ductile fashion. ► A shear strength increment ranging from 114% to 189% was observed for strengthened wallettes.
The in-plane shear behaviour of URM wallettes strengthened using near surface mounted high strength twisted stainless steel reinforcement (TSNSM) was investigated and in particular, the effectiveness of the reinforcing schemes to restrain the diagonal cracking failure mode was studied. A total of 17 URM wallettes, each being 1.2
m
×
1.2
m in size, were structurally tested in induced diagonal compression. Of these, 3 wallettes were tested as-built and 14 wallettes were tested after being strengthened using different patterns of TSNSM bars. Several parameters pertaining to the in-plane shear behaviour of strengthened URM walls were investigated, including failure modes, shear strength, maximum drift, pseudo-ductility, and shear modulus. It was inferred from the results that as-built tested wallettes exhibited sudden post-peak strength degradation and failed along a stepped diagonal joint crack, whilst strengthened wallettes failed along distributed diagonal cracks in a more ductile fashion and exhibited a shear strength increment ranging from 114% to 189%.
Explantation of breast implants has become increasingly common. This study aimed to analyze breast auto-augmentation following implant explantation (using a laterally designed anterior intercostal ...artery perforator AICAP flap) in patients who did not need new implants and required volume preservation. Twenty-four patients (48 breasts) aged 31–67 years (mean, 52.4 years) with body mass index (BMI) between 24.43 and 29.34 (mean, 27.32) kg/m2 underwent this procedure. All patients had implant-related problems, such as recurrent capsular contracture (n=11), seroma (n=2), animation deformity (n=3), rupture-induced bleeding (n=5), and breast implant disease (n=3). Sizes of implants removed ranged from 215 to 355 ml. The mean flap size was 23.9 cm × 7.5 cm, and the average flap thickness was 2.3 cm (range, 2.0–3.2 cm). Flap survival was clinically examined postoperatively by ultrasonography. Pre- and postoperative final breast volumes were compared by direct patient observation and independent photograph observation by three plastic surgeons according to a 4-point scale (bad=1, regular=2, good=3, and excellent=4) and the brassiere size. All flaps were completely viable after harvesting. No postoperative signs of fat necrosis were observed, and independent plastic surgeon evaluation revealed good and excellent results in all cases. Patient satisfaction evaluated by BREAST-Q data was >90%. This new design, AICAP flap (with a lateral thoracic extension), can be safely used for breast volume restitution after breast implant explantation with high patient satisfaction. This flap exhibited reasonable potential of providing additional volume in patients who undergo implant explantation and require the preservation of similar volume.
The purpose of a doctorate is educating new researchers to later produce scientific articles derived from their doctoral thesis. The objective of this study is to verify if obtaining a doctorate ...degree favors scientific production. Scientific production of researchers is analyzed based on doctoral theses in sport sciences in Spain. The methodology followed used the TESEO database and Web of Science. Results showed a total of 487 theses (97.4 theses/year) and more than 1358 papers published in Web of Science. Almost half of the doctors published the results from their doctoral thesis in Web of Science journals. The production of articles derived from doctoral programs is satisfactory. However, many new doctors do not publish in Web of Science after completing their doctoral thesis. This paper represents the first mapping of scientific production of doctoral programs in Spain. More studies must be conducted in the future in order to monitor and assess them.
► Retrofitting of damaged URM shear walls with NSM CFRP strips was examined. ► Displacement capacity and energy dissipation were highly improved by retrofitting. ► Walls retrofitted with both ...horizontal and vertical strips performed best. ► Behaviour was not significantly affected by level of existing damage.
An experimental study was conducted to assess the effect on strength and ductility of retrofitting unreinforced masonry (URM) shear panels with near surface mounted (NSM) carbon fibre reinforced polymer (CFRP) strips. A total of sixteen wall panels, 1200mm×1200mm, were subjected to vertical pre-compression combined with increasing reversing cycles of in-plane lateral displacement. All wall panels were previously tested (prior to retrofitting) under compression and cyclic shear using three different pre-compression levels resulting in various levels of damage. The damaged walls were repaired, retrofitted with NSM FRP strips and retested under pre-compression stress levels of 2.8MPa, 2MPa and 1.4MPa. The retrofitted walls displayed higher displacement capacities compared with URM walls highlighting the effectiveness of retrofitting URM walls under earthquake loading. The ultimate loads were not enhanced due to retrofitting under higher pre-compression levels. However the presence of the reinforcement did restore the ultimate loads to those observed for the original undamaged URM state. This meant that overall, the reinforcement was effective in increasing the energy dissipation capacity of the walls compared to URM. The improvements in the behaviour of the URM walls due to retrofitting were generally similar, irrespective of the amount of damage the URM walls experienced prior to retrofitting. The paper discusses the effect on strength, displacement capacity, energy dissipation and ductility achieved by FRP retrofitting of the damaged (lightly and highly) URM panels compared to the undamaged URM panels under different pre-compression levels. The broader aim of the research is to identify techniques for improving the seismic performance of existing URM walls under in-plane shear loading.
► NSM CFRP-to-masonry bond test results, including cyclic loading, are presented. ► These results were incorporated into a large database of masonry pull test results. ► Fifteen existing bond ...strength models were compared for accuracy against the database. ► A more accurate bond model is derived for both NMS and EB applications.
Debonding at the FRP-to-masonry interface has been identified as the preferred failure mechanism in fibre-reinforced polymer (FRP) retrofitted masonry as it allows for some redistribution of forces. The results of 14 FRP-to-masonry bond tests are presented, where the FRP was near surface mounted (NSM) to stack-bonded clay brick masonry. These tests were conducted to investigate the effect that variables such as cyclic loading and FRP strip dimensions have on the debonding resistance of a NSM FRP-to-masonry joint. These results were then incorporated into a large database of FRP retrofitted masonry pull test results by various researchers over the past 10years. The database includes results for both externally bonded (EB) and NSM retrofitting techniques. From this database, local bond–slip parameters such as the maximum interface shear stress, τmax, and the maximum slip, δmax, were investigated to determine correlations between these values and masonry material properties. Further, 15 existing concrete and masonry bond strength (maximum load at the FRP-to-substrate interface) models in the literature were assessed for their use with masonry by comparing these models against the results in the pull test database. Based on the comparative statistics of the test-to-predicted bond strength it is concluded that a new FRP-to-masonry bond model is required which gives more accurate predictions. Results include a discussion on the global load–slip response and FRP-to-masonry interface behaviour.
Breast cancer (BC) is one of the most common causes of death in women up to 50 years old. For today the choice of an adequate methods of surgical intervention and the need for an adequate surgical ...adjuvant therapy, quality of life of patients after surgeryis are important. The aim of our study was to select the volume of surgery for breast cancer using the technique of intraoperative identification of the sentinel lymph node (intraoperative ICG technology) and to evaluate the results of its urgent histological examination. It was shown that the most common method of surgery in patients who underwent intraoperative ICG technology was quadrantectomy, which was performed in 27 cases (54%), rarely subcutaneous mastectomy was performed (30%) and radical mastectomy (by Madden) – 16%. In the control group, priority was given to radical removal of the breast (63.2% of cases); partial resection (by U. Veronesi) was performed in 33.3% of patients, and subcutaneous mastectomy – in 3.5%. Pathomorphological examination of the sentinel lymph node during its intraoperative imaging using ICG-technology established metastatic lesion in 10 of 50 cases (20%) in the main group. The obtained results of the assessment of the regional lymph dissection size in the main group indicate its adequate nature to ensure the radicality of surgical treatment. In our opinion, this is one of the important preliminary conclusions of this study, because to assess the clinical significance of signal lymph node (SLN) analysis as a marker of regional tumor spread, firstly it is necessary to be sured that existing surgical techniques provide radical tumor removal.
Barcelona consensus on supermicrosurgery Masia, J; Olivares, L; Koshima, I ...
Journal of reconstructive microsurgery,
01/2014, Letnik:
30, Številka:
1
Journal Article
Recenzirano
The popularity of supermicrosurgery has increased dramatically over the past few years, but the lack of agreement regarding the name of the technique and its applications has caused misunderstandings ...among microsurgeons when trying to communicate and compare surgical procedures. We report the consensus reached on the name used to refer to supermicrosurgery techniques following the First European Conference on Supramicrosurgery held in Barcelona (Spain) on March 4-5, 2010. Present applications, advantages, and disadvantages of supermicrosurgery are discussed. It was agreed that supermicrosurgery was the most accurate name to reflect the essence of this extremely delicate technique. According to Koshima, supermicrosurgery is a technique of microneurovascular anastomosis for vessels of 0.3 to 0.8 mm and single nerve fascicles. The range of applications for this technique has increased rapidly and now includes lymphedema treatment, nerve reconstruction, replantation and reconstruction of amputated fingertips, microsurgical flap salvage, and new possibilities for free tissue transfer. Supermicrosurgery is a remarkably useful reconstructive tool that involves a great deal of skill and has a steep learning curve for the microsurgeon to master. Although it is currently performed by only a minority of microsurgeons, we consider it will be incorporated into conventional microsurgery in the near future.
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