Results of replantation of 33 ring avulsion amputations

Purpose: Despite microsurgical advances, it is still difficult to achieve satisfactory functional results in cases of replantations following complete ring avulsion amputations. Our aim is to report the experience we have collected since the early 1990s in the treatment of this type of injury. Methods: We replanted 33 fingers on 33 patients (age, 15-54 y) with complete ring avulsion amputation injuries. Twenty-eight amputations were distal to the insertion of the flexor digitorum superficialis, and 5 were complete degloving injuries with intact tendons. Vascular transpositions and vein grafts were used, and in all cases, only 1 of the digital nerves was repaired. Results: The 29 successful cases were tracked over an average follow-up of 89 months. The average total active motion of the reconstructed finger was 185°. Sensibility evaluated by static 2-point discrimination varied from 9 to 15 mm and by moving 2-point discrimination from 8 to 15 mm. Five patients complained of cold intolerance. Conclusions: Resection of the avulsed digital artery and vein is the most crucial part of the procedure.Vessels reconstruction can be performed using various methods, but vessel transfers from the middle finger appear to be the most reliable solution. The outcome of the cases demonstrates that replantation should be attempted. Type of study/level of evidence: Therapeutic IV. © 2013 American Society for Surgery of the Hand

Innovative, non-contact wide field imaging of corneal endothelium

International audienceIn this paper, we investigated the possibility of getting wide-field images of corneal endothelium for patients. An optical set-up coupled to a numerical reconstruction based on Structured Illumination Mircoscopy (SIM) has been developped in order to isolate the tiny volume wich contains the endothelial mono-layer found at the inner surface of the cornea. At this moment, this imaging system seems compromised for patients and futhur refinement are investigated for stored humans corneas banks

Versatility of the perforator radial artery flap in the reconstruction of the upper limbs and comparison of the outcomes with the “classic” radial flap, a retrospective study

Introduction: Radial forearm flap, first described in the early eighties in China, is a well-known and handy flap to cover soft tissue defects of the distal upper limb. It has, though, some inconveniences, such as the sacrifice of the radial artery and non-neglectable esthetic sequelae in the donor site. In the following years, a similar flap based on the perforators of the radial artery has been described as achieving similar results, allowing to spare a main vessel. The authors reviewed retrospectively the patients that underwent surgery with one of those two flaps in their center to compare outcomes. Materials and methods: Patients operated between January 2016 and January 2022 have been reviewed. Ten had a classic radial artery flap, and ten had a radial artery perforator flap. Twelve weeks after surgery, Vancouver Scar Scale was used to assess the results at the donor site and over the flap. Reintervention and failure rate within one year and patient satisfaction -using a visual analog scale ranging from 0 to ten-at 12 months were also assessed. Results: All classic radial artery flap group patients had “successful” surgery, and none needed secondary surgery. On the other side, three patients required a second surgery in the perforator flap group, and nine out of ten ended up with “successful” flaps. Mean Vancouver Scar Scale results regarding the flap are comparable, whereas those at the donor site are significantly better in the patients with the perforator flap. Patients’ satisfaction results are similar in both groups. Conclusion: The radial artery perforator flap is an important flap to be held in mind by all surgeons approaching reconstruction of the elbow, the forearm, and the hand, and should be preferred, when possible, to the classic radial forearm flap

Conception and development of an optical characterization platform for corneal grafts stored in an original bioreactor

La transparence et les propriétés optiques du greffon cornéen sont des qualités essentielles pour le résultat post opératoire après la kératoplastie perforante et la kératoplastie lamellaire antérieure qui sont les 2 greffes les plus utilisées au monde. Pourtant, la transparence est difficile à mesurer avec précision avec les techniques d’eye banking actuelles et les propriétés optiques ne le sont pas du tout car lors de la conservation cornéenne à 4°C et plus encore en organoculture, la cornée séparée du globe est moins transparente que sur le sujet vivant et comporte des plis. Nous avons développé un outil de conservation, un bioréacteur, permettant de simuler les conditions physiologiques de la cornée pendant la conservation, permettant ainsi la caractérisation optique du greffon. L’objectif de cette thèse a été la conception et la réalisation des instruments de caractérisation des propriétés optiques et tissulaires des greffons conservés en BR. Ces propriétés sont la densité cellulaire endothéliale, la transparence, la puissance, l’épaisseur et la détection d’interfaces cicatriciellesThe optical properties of a corneal graft, namely its transparency, are pivotal to the post-operative result of penetrating keratoplasty and deep anterior lamellar keratoplasty, which are today the world’s two most performed grafts. However, transparency is difficult to accurately measure with modern eye banking techniques, and other optical properties are not measurable at all, as with both hypothermic storage and organ culture the enucleated cornea is less transparent than in a living eye, and presents endothelial folds. We developed a corneal storage device, a bioreactor, to simulate the eye’s physiological conditions during storage, thus allowing the measurement of the graft’s optical properties. The goal of this thesis was to create a set of instruments to be used in eye banking for the optical characterization of corneal grafts. The parameters to be measured are endothelial cell density, transparency, dioptric power, thickness and the presence of scar tissu

A indústria de moldes portuguesa : a transformação para a indústria 4.0

Mestrado Bolonha em Gestão e Estratégia IndustrialNo atual contexto de rápida evolução tecnológica e crescente competitividade no mercado português e internacional, o conhecimento e a inovação destacam-se como elementos-chave para responder à concorrência e ao sucesso das organizações. Conhecimento e inovação são alguns dos fatores básicos para a transformação das organizações para a Indústria 4.0, que se apresenta como a forma mais recente de revolução industrial e um meio de resposta ao contexto descrito. Poucos são os relatos sobre a implementação da Indústria 4.0 na indústria portuguesa, particularmente nas empresas do cluster dos moldes. Portanto, os principais objetivos desta dissertação são responder às seguintes questões: 1.) Em que áreas se concentraram os projetos de Indústria 4.0 realizados no cluster de moldes português? 2.) Quais são os principais obstáculos e fatores facilitadores na implementação destes projetos? Para responder a estas questões, um estudo qualitativo de caracter exploratório na forma de estudo de casos foi realizado através de entrevistas semiestruturadas a CEO’s de 4 empresas portuguesas de moldes, e uma análise temática aos respetivos dados obtidos. Concluiu-se que os clientes como stakeholders, bem como as políticas e medidas governamentais em relação à Indústria 4.0 são os principais entraves. Em contraponto, as práticas de gestão, a investigação e desenvolvimento estratégico e os colaboradores das organizações são os principais facilitadores. Relativamente aos projetos realizados, estes centraram-se no mapeamento digital dos processos, estando apenas uma das empresas a atingir atualmente a fase de análise de dados. Este trabalho está dividido em cinco capítulos. Sendo o primeiro uma introdução que procura apresentar o contexto e relevância da dissertação. O segundo capítulo corresponde à parte teórica de revisão de literatura, com exposição dos conceitos e tecnologias da Indústria 4.0, assim como de obstáculos e fatores facilitadores identificados na literatura. No terceiro capítulo é realizada uma descrição da metodologia de investigação e como esta foi concretizada, sendo que os resultados correspondentes são expostos no capítulo posterior (Capítulo 4). Por fim, a discussão e conclusões, assim como as limitações da investigação e implicações práticas, são apresentadas no último capítulo (Capítulo 5).In the current context of rapid technological evolution and growing competitiveness both in the Portuguese and international markets, knowledge and innovation stand out as key elements for responding to competition and the success of organizations. Knowledge and innovation are some of the basic factors for the transformation of organizations to Industry 4.0, which presents itself as the most recent form of industrial revolution and a means of response to the described context. Few reports exist regarding the implementation of Industry 4.0 in the Portuguese industry, particularly within companies in the molds cluster. Thus, the main objectives of this dissertation are to answer the following questions: 1.) In what areas have the Industry 4.0 projects carried out by the Portuguese molds cluster focused on? 2) What are the main obstacles and enablers in the implementation of these projects? To address these questions, a qualitative study of exploratory nature in the form of case studies was executed through semi-structured interviews with CEOs from 4 Portuguese mold companies and a thematic analysis was performed of the data collected. Regarding the projects carried out, these focused on the digital mapping of the processes, with only one of the companies currently reaching a stage of data analysis. It was reached the conclusion that the clients as stakeholders as well the government’s politics and measures regarding Industry 4.0 are the main obstacles. In contrast, management practices, research and strategic development and the staff of the organizations are the main enablers. This work is divided into five chapters. The first being an introduction that seeks to present the context and importance of the present work. The second chapter corresponds to the theoretical part of literature review, with an exposition of the concepts and technologies of Industry 4.0, as well as obstacles and enablers identified. In the third chapter a description of the research methodology and how it was carried out is given, with the corresponding results to be found in the later chapter (Chapter 4). Finally, the discussion and conclusions, as well as the limitations of the investigation and practical implications, are presented in the last chapter (Chapter 5).info:eu-repo/semantics/publishedVersio

Reconstruction of the loss of substance of the dorsum of the hand: from the conventional techniques to regenerative surgery procedures

Our aim is focused on the advantages of new technologies compared with those of traditional methods in the reconstruction of the loss of substance of the dorsum of the hand. Material of study: We observed 37 patients from 2007 to 2010 with loss of substance of the dorsum of the hand, also associated with significant comorbidities. In 27 patients we chose surgical reconstruction, in 10 patients we opted for conservative reconstruction with the use of new technologies. Results: After a median follow-up from one to three years, in all cases the skin coverage was reinstated and mobility was restored, thereby adhering to the principles of both morphological and functional reconstruction. Discussion: Concerning reconstruction by means of flaps, the main principles dictate is the new coverage must appear as much as possible, similar to the original tissue. The reconstruction must be in a single surgical time. On the other hand, the advent of advanced dressings and bioengineering has optimized conservative skin repair. Conclusions: We have seen a considerable broadening of the indications for conservative reconstruction. This method is suitable for reconstruction of the dorsum of the hand with good effectiveness, it makes it possible to obtain a tissue of good quality, which is flexible and smooth on the tendons and is not excessively thick. These methods are achieved with relative ease even in patients with poor general health. Although costly, this procedure will ultimately save the patient from further surgeries and hospitalization expenses, making it advantageous when considering the benefit-cost rati

Deep burn of hand and forearm treated by abdominal wall flap. A case report

AIM: Post-traumatic hand and forearm defects always represent a challenge for reconstructive surgeons, especially when multiple structures are involved, because of a high rate of amputation.MATERIAL OF STUDY: A 21 years old woman arrived to the E.R. with a complex crush-burn trauma of the upper limb caused by an accident with an industrial ironing machine, resulting in a ulnar bone fracture, ulnar artery laceration and a wide burn of the dorsum of the right forearm.RESULT: We achieved toTAL limb salvage with coverage of the "nobles" structures of the forearm.DISCUSSION AND CONCLUSIONS: Different reconstructive methods have been used over time to treat these defects focusing the attention on both functional and cosmetic aspects. The abdominal pedicle flap was one of the achiest reconstructive methods for hand and forearm defects. In an era in which microsurgery takes the lion's share, some basic procedure may be helpful, especially in certain cases. In this study the authors reported a case of a young woman with a complex trauma of the right arm resulting from an occupational accident

"Skin reducing mastectomy" and immediate breast reconstruction with Becker 35 contour profile breast implant: our experience

Aim: We describe in this paper our experience with the technique of skin-reducing mastectomy in the treatment of breast cancer. Methods: Between October 2005 and April 2010 in our Center 33 patients underwent breast surgery utilizing the skin-reducing mastectomy technique and immediate breast reconstruction with expansor/definitive implant Becker 35 contour profile. Contralateral symmetrization was performed in the same operation. All selected patients satisfied inclusion critera either for nipple-sparing mastectomy or prophylactic mastectomy. We selected patients who had large ptosic breasts: areola-submammary fold >8 cm and jugular-nipple distance >25 cm. After histologic exam to confirm the lack of retroareolar tissue infiltration the nipple was preserved in a superior flap. Results: Twenty-four out of 33 patients (72.7%) did not suffer from complications. In 9 patients (27.3%) we observed early complications. During follow-up we observed in24 patients (72.7%) Baker I capsular contracture, in 9 patients (27.3%) Baker II capsular contracture. Esthetic results of symmetry, shape and volume were good to optimal. Patients' satisfaction was similar. During the follow up (6-33 months, average 17.7 months) no patient suffered from breast cancer recurrence. Conclusion: The "skin-reducing mastectomy" reduces mutilation and unsightly scar visibility. It gives a pleasant aesthetic outcome without hindering oncological safety