Effects of Combined Intralesional 5-Fluorouracil and Topical Silicone in Prevention of Keloids: A Double Blind Randomized Clinical Trial Study

Keloids are aesthetically disfiguring and severely disabling. The optimal treatment remains undefined. This clinical study, evaluate the efficacy and side effects of combined topical silicone and 5-Fluorouracil on the prevention of keloids. In this double blind randomized clinical trial, fifty patients with keloids were randomly allocated in two groups. The control group were treated by perilesional surgical excision of keloids combined with topical silicone and the trial group were treated with adjuvant treatment of intralesional 5-Fluorouracil. All patients were examined and assessment was done by an independent observer. the data collected were analyzed by SPSS statistical software with using tables and χ square tests. 75% of the cases in the trial group were keloid free 21% have keloid partially improvement and 4% have keloid recurrence, compared to patients in the control group respectively: 43%, 35% and 22%, findings suggest that efficacy of 5-Fluorouracil combined with topical silicone used for the prevention of keloid is comparable to other modality. The lack of any serious side effects and the evidence of recurrence at one year of follow-up make this an effective tool for the prevention of keloids

The anatomy of superficial inferior epigastric artery flap Anatomia do retalho com a artéria epigástrica superficial

PURPOSE: To describe the anatomical variations of superficial inferior epigastric artery (SIEA) flap as a muscle-sparing flap. METHODS: A series of 40 dissections were performed on 20 preserved or fresh male cadavers. The site origin and drainage of vessels, caliber, length, and correlation between diameter and length of pedicle were identified. RESULTS: The SIEA and SIEV were identified at inguinal ligament level in 38 (95%) and 40 (100%) dissections, respectively. The SIEA originated directly from a common femoral artery 22 (57.9%) or a common trunk with other arteries. The SIEA was found within 1 cm of the midpoint of the inguinal ligament in 33 of 38 cases. The meanSD length of SIEA was 3.041.73 (0.5-7) cm. The meanSD caliber of SIEA was 1.450.35 (0.7-2.1) mm. The length of SIEV ranged from 2.2 to 12 cm with a meanSD of 5.452.08 cm. The caliber of SIEV ranged from 1.6 to 4 mm with a meanSD of 2.140.45 mm. The length of SIEA correlated with caliber of arterial pedicle (p<0.001 and correlation coefficient = 0.517). CONCLUSION: The inferior epigastric artery flap can be applied to microsurgical flap transfer, potentially in breast reconstruction, hemifacial atrophy, phalloplasty, or when extremely large amounts of skin coverage are required.<br>OBJETIVO: Descrever as variações anatômicas do retalho muscular com artéria epigástrica superficial. MÉTODOS: Foram realizadas uma série de 40 dissecções em cadáveres do gênero masculino, preservados ou recentes, Foram identificados o local de origem e drenagem dos vasos: calibre, comprimento e correlação entre diâmetro e comprimento do pedículo. RESULTADOS: As artérias e veias epigástricas superficiais foram identificadas no nível do ligamento inguinal respectivamente em 38 (95%) e 40 (100%) das dissecções. A artéria epigástrica superficial originava diretamente da artéria femoral em 22 (57,9%) ou de um tronco comum com outras artérias. A artéria foi encontrada em um cm do ponto médio do ligamento inguinal em 33 de 38 casos. A média do comprimento da artéria epigástrica superficial foi de 3.04 1.73 (0,5-7) cm. A média do calibre da artéria foi 1.45 0.35 (0.7-2.1). O comprimento da veia epigástrica superficial foi de 2.2 a 12 cm com média de 5.452.08 cm. O calibre da veia era de 1.6 a 4 mm com média de 2.140.45 mm. O comprimento da artéria epigástrica superficial foi correlacionado com o calibre do pedículo arterial. CONCLUSÃO: O retalho com a artéria epigástrica superficial pode ser aplicado em microcirurgia de retalhos, potencialmente em reconstrução mamária, atrofia hemifacial, faloplastia ou quando se faz necessário aplicar em perdas acentuadas de pele

Breast Reconstruction Using Tram Flap: Prospective Outcome And Complications

Background: The transverse rectus abdominis musculocutaneous (TRAM) flap remains the gold standard for postmastectomy reconstruction either immediate or delayed. However, transfer of TRAM flap can be associated with donor site morbidities and complications in flap. A successful reconstruction consists of careful patient selection, surgical technique and meticulous preoperative planning. This study was designed to evaluate outcome and complications of breast reconstruction with TRAM flap in association with patient conditions and risk factors, prospectively. Methods: Breast reconstruction was performed in 44 women consecutively, using the TRAM flap during a 3-year period, 1999 2002. Modified radical mastectomy accompanying immediate reconstructions with TRAM flap was performed for 12 patients and delayed reconstruction was used for other patients with previous mastectomy. Results: The mean age of the patients was 40.41±4.43 years. Thirty (68.18%) patients had comorbidities, consisting of radiation therapy, obesity, hypertension, diabetes mellitus, smoking and abdominal scar. Contralateral and ipsilateral TRAM flaps were used in 26(59.09%) and 14(31.81%) reconstructions, respectively. The abdominal defect was repaired in layers with the use of synthetic mesh in 30(68.18%) patients. The overall complication rate was 31.82%, such as fat necrosis (15.91%), partial flap loss (13.64%), etc. Satisfaction rates were excellent in 10 (22.72%), good in 25 (56.82%), moderate in five (11.36%), and poor in four (9.09%) patients. The mean of postoperative inpatient hospital days were 15.18±4.89 and 14.28±6.52 in patients with contralateral and ipsilateral flaps, respectively (p>0.05). A significant association was observed between overall complications and comorbidities. Partial flap loss and fat necrosis was associated with smoking, and abdominal hernia was associated with obesity marginally. Conclusions: The outcome of breast reconstruction using TRAM flap is similar by surgical technique and time of reconstruction. The most common flap complications were fat necrosis and partial flap loss that was associated with smoking. Acceptable satisfaction is obtained by TRAM flap

Anatomy Of The Superficial Inferior Epigastric Artery Flap

Background: Several case studies have described the use of the superficial inferior epigastric artery (SIEA) flap as a pedicled flap for reconstruction of upper and lower ex tremities, or a free fasciocutaneous flap when a large amount of skin coverage is required for hemifacial atrophy, breast or head and neck reconstruction. Apparently, the anatomical findings of previous studies are relatively discrepant. This study was designed to describe the anatomical variations of SIEA and superficial inferior epigastric vein (SIEV). Methods: A series of 40 dissections were performed on 20 preserved or fresh male cadavers. The site of origin and drainage of vessels, caliber, length, and correlation between diameter and length of pedicle were identified. Results: The SIEA and SIEV were identified at the inguinal ligament level in 38 (95%) and 40 (100%) dissections, respectively. The SIEA originated directly from the common femoral artery in 22 (57.9%) or as a common trunk with other arteries. The SIEA was found within 1 cm of the midpoint of the inguinal ligament in 33 of 38 cases. The mean±SD length of SIEA was 3.04±1.73 (0.5- 7) cm. The mean±SD caliber of SIEA was 1.45±0.35 (0.7- 2.1) mm. The length of SIEV ranged from 2.2 to 12 cm with a mean±SD of 5.45±2.08 cm. The caliber of SIEV ranged from 1.6 to 4 mm with a mean±SD of 2.14±.45 mm. The length of SIEA correlated with caliber of the arterial pedicle (p<0.001 and correlation coefficient = 0.517). Conclusion: This study suggests that the SIEA flap can be applied for micro surgical flap transfer, potentially in breast reconstruction, hemifacial atrophy, phalloplasty, or when extremely large amounts of skin coverage are required