The Experts below are selected from a list of 201 Experts worldwide ranked by ideXlab platform
Karol Naranjo - One of the best experts on this subject based on the ideXlab platform.
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treatment of hidradenitis suppurativa with extensive resection of the lesion and coverage with perforator flaps of the Lateral Thoracic wall Lateral Thoracic Artery thoracodorsal Artery perforators
Plastic and reconstructive surgery. Global open, 2019Co-Authors: Jorge M. Rodriguez, Felipe Rodriguez, Daniel Rivera, Karol NaranjoAbstract:HS refers to the acute or chronic inflammation of the sweat glands by occlusion, the typical place of appearance is the groin and the axila, with an incidence of 1% reaching up to 4.1% according to some authors.1–6 Other commonly affected areas are the perianal and perineal region.7 Most patients (64.7%) state that the improvement in their quality of life, as measured by the Dermatological Life Quality Index (DLQI), improved significantly when they underwent invasive procedures rather than taking antibiotics, regardless of the location and extent of resection.7 Even though the gold standard for managing advanced stages of the disease is resection of the affected skin, there is debate about which is the proper technique for coverage. Recent studies have compared the use of the thoracodorsal Artery perforator flap (TDAP) versus skin grafts for the reconstruction of axillary defects after resection, finding a better postoperative response (shorter recovery time, fewer complications, shorter follow-up, and a better life quality) in those treated with the TDAP flap rather to those treated with skin grafts only.10 The use of a Lateral Thoracic Artery perforator flap has also been described, demonstrating a rapid recovery without the need to immobilize the arm, with a scar that easily hides behind the arm in a neutral position11,12 or, as in one of our cases, the possibility to hide within the brassiere line.
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Treatment of Hidradenitis Suppurativa with Extensive Resection of the Lesion and Coverage with Perforator Flaps of the Lateral Thoracic Wall (Lateral Thoracic Artery, Thoracodorsal Artery Perforators)
Wolters Kluwer, 2019Co-Authors: Jorge M. Rodriguez, Felipe Rodriguez, Daniel Rivera, Karol NaranjoAbstract:Summary:. Stage IV hidradenitis suppurativa in the axilla is a chronic disease in which the removal of the affected area and a reconstruction with disease free skin is the definitive treatment; however there is some controversy about the technique to be used in this reconstruction. Studies show superiority in wide resections, and coverage with flaps rather than grafts. The use of pedicle flaps of Lateral Thoracic Artery perforators and thoracodorsal Artery perforators has demonstrated superior performance to other techniques in postsurgical follow-up. This article describes the cases of 2 patients with chronic HS in which lesions were resected with disease-free margins and the reconstruction of the defect is carried out with Lateral Thoracic wall perforator flaps and the subsequent improvement in their life quality after surgery
Jorge M. Rodriguez - One of the best experts on this subject based on the ideXlab platform.
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treatment of hidradenitis suppurativa with extensive resection of the lesion and coverage with perforator flaps of the Lateral Thoracic wall Lateral Thoracic Artery thoracodorsal Artery perforators
Plastic and reconstructive surgery. Global open, 2019Co-Authors: Jorge M. Rodriguez, Felipe Rodriguez, Daniel Rivera, Karol NaranjoAbstract:HS refers to the acute or chronic inflammation of the sweat glands by occlusion, the typical place of appearance is the groin and the axila, with an incidence of 1% reaching up to 4.1% according to some authors.1–6 Other commonly affected areas are the perianal and perineal region.7 Most patients (64.7%) state that the improvement in their quality of life, as measured by the Dermatological Life Quality Index (DLQI), improved significantly when they underwent invasive procedures rather than taking antibiotics, regardless of the location and extent of resection.7 Even though the gold standard for managing advanced stages of the disease is resection of the affected skin, there is debate about which is the proper technique for coverage. Recent studies have compared the use of the thoracodorsal Artery perforator flap (TDAP) versus skin grafts for the reconstruction of axillary defects after resection, finding a better postoperative response (shorter recovery time, fewer complications, shorter follow-up, and a better life quality) in those treated with the TDAP flap rather to those treated with skin grafts only.10 The use of a Lateral Thoracic Artery perforator flap has also been described, demonstrating a rapid recovery without the need to immobilize the arm, with a scar that easily hides behind the arm in a neutral position11,12 or, as in one of our cases, the possibility to hide within the brassiere line.
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Treatment of Hidradenitis Suppurativa with Extensive Resection of the Lesion and Coverage with Perforator Flaps of the Lateral Thoracic Wall (Lateral Thoracic Artery, Thoracodorsal Artery Perforators)
Wolters Kluwer, 2019Co-Authors: Jorge M. Rodriguez, Felipe Rodriguez, Daniel Rivera, Karol NaranjoAbstract:Summary:. Stage IV hidradenitis suppurativa in the axilla is a chronic disease in which the removal of the affected area and a reconstruction with disease free skin is the definitive treatment; however there is some controversy about the technique to be used in this reconstruction. Studies show superiority in wide resections, and coverage with flaps rather than grafts. The use of pedicle flaps of Lateral Thoracic Artery perforators and thoracodorsal Artery perforators has demonstrated superior performance to other techniques in postsurgical follow-up. This article describes the cases of 2 patients with chronic HS in which lesions were resected with disease-free margins and the reconstruction of the defect is carried out with Lateral Thoracic wall perforator flaps and the subsequent improvement in their life quality after surgery
Geeta Shetty - One of the best experts on this subject based on the ideXlab platform.
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chest wall perforator flaps for partial breast reconstruction surgical outcomes from a multicenter study
Archives of Plastic Surgery, 2020Co-Authors: Soni Soumian, Rishikesh Parmeshwar, Mihir Chandarana, Sekhar Marla, Sankaran Narayanan, Geeta ShettyAbstract:BACKGROUND Perforator Artery flaps based on the branches of intercostal arteries and Lateral Thoracic Artery can be used for reconstruction after breast-conserving surgery (BCS). Although described more than a decade ago, these have not been adopted widely in clinical practice. We report on short-term and long-term surgical outcomes of partial breast reconstruction using chest wall perforator flaps from a prospective multicenter audit. METHODS All patients operated for BCS and partial breast reconstruction using intercostal Artery perforator or Lateral Thoracic Artery perforator flaps from January 2015 to October 2018 were included in the analysis. Oncoplastic breast surgeons with appropriate level of training performed all tumor excisions and reconstructions as a single-stage procedure. Patient characteristics, treatment details and surgical outcomes were noted. Specific outcomes recorded were margin re-excision and complication rates. RESULTS One hundred and twelve patients underwent the procedure in the given study period. The median age was 54 years. Median specimen weight was 62.5 g and median volume of excision was 121.4 mL. Fifteen patients (13.39%) underwent a margin re-excision for close or positive margins without additional morbidity. One patient required a completion mastectomy. Eight patients (7.14%) had an early complication. None of the patients required a contraLateral symmetrization procedure. The results were comparable across the participating centers. CONCLUSIONS Chest wall Artery perforator-based flaps are an excellent option for Lateral and inferior quadrant partial breast reconstructions. The short and long-term surgical outcomes are comparable across sites and can be performed with minimal morbidity. Patient-reported outcome measures need to be studied.
Den Hondt Margot - One of the best experts on this subject based on the ideXlab platform.
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From bed to bench: towards the creation of a tissue-engineered trachea
2018Co-Authors: Den Hondt MargotAbstract:Reconstruction of defects involving more than half of the length of the trachea is challenging. Techniques to close these lesions include the use of autologous, allogenic and synthetic tissues. The key aspects of treating long-segment tracheal lesions are not yet fully elucidated. Tissue engineering emerged as a promising field of research to create non-immunogenic scaffolds and aims to construct a functional substitutes for damaged tissues by combining the principles of biology and engineering. However, the initial enthusiasm regarding the large-scale production of individualized, off-the-shelf scaffolds in the near future has merged with the current clinical pragmatism. We began this thesis with a work-up of the methodological aspects, i.e., our rabbit model. This model was introduced by Professor Delaere in the nineties as the gold standard for research concerning trachea transplantation. This groundbreaking research anticipated the first human tracheal allotransplantation with cessation of immunosuppression by a multidisciplinary team in our center in 2007. With the preclinical experimental work in this thesis, we would like to advance these insights towards the creation of a decellularized tracheal tube lined with autologous epithelium. Current procedures all use a specific technique to revascularize and reepithelialize the trachea. These different perspectives regarding the need to create full submucosal vasculature and a confluent mucosal covering resulted in heterogenous outcomes. As a guideline for future research, we attempted to define valid criteria for successful trachea transplantation. These minimum requirements constitute the basis of upcoming experiments. In a second animal study, we speculated whether allogenic cartilage could be transplanted without immunosuppression since the first clinical transplantations performed by our group showed that immunosuppressive medication could be ceased after implantation even though the transplanted cartilage was allogenic. We found that rabbit tracheae stripped of their highly immunogenic mucosa and submucosa show good biocompatibility for up to two months after implantation. By using an acellular dermal matrix as a neo-submucosa, stenosis could also be prevented. Moreover, subsequent grafting of the implanted trachea with buccal mucosa was successful. Therefore, we could create a composite construct that did not elicit an immune response. However, submucosal revascularization was only reliable upon opening of the transplant longitudinally. Current human tissue engineering techniques focus on the aggressive detergent-enzymatic decellularization of tracheae to obtain a fully acellular construct. However, this may impact the mechanical integrity of the windpipe. In our third preclinical study, we showed that less aggressive decellularization not only leads to the preservation of chondrocytes and the ECM but also to the preservation of tracheal mechanical properties. In contrast to transplants that were decellularized more aggressively, tube collapse could be avoided during inspiration. Subsequently, we investigated whether implantation of these gently decellularized tracheae was feasible. As we already established, preservation of chondrocytes was not disadvantageous for tracheal biocompatibility. Again, full submucosal revascularization of the tube wrapped in the Lateral Thoracic Artery flap appeared to be a limiting factor for successful transplantation. By opening the tracheae longitudinally, a barrier to the ingrowth of submucosal capillaries was removed. Integra(TM) prevented stenosis during revascularization. Buccal grafts were subsequently found to serve as a suitable autologous mucosal covering. The tracheae were implanted in the heterotopic position since orthotopic transfer of these constructs was practically unfeasible due to the inherent thickness of a transplant covered with a multilayered epithelium. To obtain optimal results, the transplant must be covered with a functional, single-layered epithelium. As we also observed, these cells are best applied as a confluent layer to prevent stenosis. Therefore, our following study focused on cultivating an epithelial cell sheet. The challenge was the transfer of a single-layered cell sheet as an intact structure onto the internal surface of an implanted trachea. For this purpose, we used temperature-responsive culture ware. Once the cells were successfully transferred, we were able to stain a single-layered epithelium covering a heterotopically implanted trachea up to three days later. However, the transfer itself was sensitive to minor temperature fluctuations. As in the clinical setting, restoration of the submucosal vasculature was an important obstacle in our experimental setting. Previous research in our group showed that vascularization of full-thickness wounds can be enhanced with endothelial progenitor cells. In our last rabbit study, we investigated whether additional seeding of tracheae with endothelial progenitor cells could accelerate and/or improve this process. We seeded an acellular dermal matrix with autologous blood outgrowth endothelial cells (BOECs), which was then transferred to the internal tracheal surface. This construct was wrapped in the Lateral-Thoracic Artery flap. Rabbit BOECs were successfully isolated from the mononuclear fraction of peripheral venous blood samples. The combined results of qRT-PCR and CD31 immunohistochemistry allowed reliable characterization of rabbit BOECs. Furthermore, we could demonstrate that seeded tracheae exhibited better central submucosal vasculature. In conclusion, we were able to create a non-immunogenic tracheal scaffold covered with an autologous epithelium, with preserved mechanical properties, and with improved central submucosal vascularization. These translational data guide us towards the development of a clinical, custom-made tissue-engineered trachea.status: publishe
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Van de kliniek terug naar het labo: naar de ontwikkeling van een tissue-engineered trachea
2018Co-Authors: Den Hondt MargotAbstract:Reconstruction of defects involving more than half of the length of the trachea is challenging. Techniques to close these lesions include the use of autologous, allogenic and synthetic tissues. The key aspects of treating long-segment tracheal lesions are not yet fully elucidated. Tissue engineering emerged as a promising field of research to create non-immunogenic scaffolds and aims to construct a functional substitutes for damaged tissues by combining the principles of biology and engineering. However, the initial enthusiasm regarding the large-scale production of individualized, off-the-shelf scaffolds in the near future has merged with the current clinical pragmatism. We began this thesis with a work-up of the methodological aspects, i.e., our rabbit model. This model was introduced by Professor Delaere in the nineties as the gold standard for research concerning trachea transplantation. This groundbreaking research anticipated the first human tracheal allotransplantation with cessation of immunosuppression by a multidisciplinary team in our center in 2007. With the preclinical experimental work in this thesis, we would like to advance these insights towards the creation of a decellularized tracheal tube lined with autologous epithelium. Current procedures all use a specific technique to revascularize and reepithelialize the trachea. These different perspectives regarding the need to create full submucosal vasculature and a confluent mucosal covering resulted in heterogenous outcomes. As a guideline for future research, we attempted to define valid criteria for successful trachea transplantation. These minimum requirements constitute the basis of upcoming experiments. In a second animal study, we speculated whether allogenic cartilage could be transplanted without immunosuppression since the first clinical transplantations performed by our group showed that immunosuppressive medication could be ceased after implantation even though the transplanted cartilage was allogenic. We found that rabbit tracheae stripped of their highly immunogenic mucosa and submucosa show good biocompatibility for up to two months after implantation. By using an acellular dermal matrix as a neo-submucosa, stenosis could also be prevented. Moreover, subsequent grafting of the implanted trachea with buccal mucosa was successful. Therefore, we could create a composite construct that did not elicit an immune response. However, submucosal revascularization was only reliable upon opening of the transplant longitudinally. Current human tissue engineering techniques focus on the aggressive detergent-enzymatic decellularization of tracheae to obtain a fully acellular construct. However, this may impact the mechanical integrity of the windpipe. In our third preclinical study, we showed that less aggressive decellularization not only leads to the preservation of chondrocytes and the ECM but also to the preservation of tracheal mechanical properties. In contrast to transplants that were decellularized more aggressively, tube collapse could be avoided during inspiration. Subsequently, we investigated whether implantation of these gently decellularized tracheae was feasible. As we already established, preservation of chondrocytes was not disadvantageous for tracheal biocompatibility. Again, full submucosal revascularization of the tube wrapped in the Lateral Thoracic Artery flap appeared to be a limiting factor for successful transplantation. By opening the tracheae longitudinally, a barrier to the ingrowth of submucosal capillaries was removed. Integra(TM) prevented stenosis during revascularization. Buccal grafts were subsequently found to serve as a suitable autologous mucosal covering. The tracheae were implanted in the heterotopic position since orthotopic transfer of these constructs was practically unfeasible due to the inherent thickness of a transplant covered with a multilayered epithelium. To obtain optimal results, the transplant must be covered with a functional, single-layered epithelium. As we also observed, these cells are best applied as a confluent layer to prevent stenosis. Therefore, our following study focused on cultivating an epithelial cell sheet. The challenge was the transfer of a single-layered cell sheet as an intact structure onto the internal surface of an implanted trachea. For this purpose, we used temperature-responsive culture ware. Once the cells were successfully transferred, we were able to stain a single-layered epithelium covering a heterotopically implanted trachea up to three days later. However, the transfer itself was sensitive to minor temperature fluctuations. As in the clinical setting, restoration of the submucosal vasculature was an important obstacle in our experimental setting. Previous research in our group showed that vascularization of full-thickness wounds can be enhanced with endothelial progenitor cells. In our last rabbit study, we investigated whether additional seeding of tracheae with endothelial progenitor cells could accelerate and/or improve this process. We seeded an acellular dermal matrix with autologous blood outgrowth endothelial cells (BOECs), which was then transferred to the internal tracheal surface. This construct was wrapped in the Lateral-Thoracic Artery flap. Rabbit BOECs were successfully isolated from the mononuclear fraction of peripheral venous blood samples. The combined results of qRT-PCR and CD31 immunohistochemistry allowed reliable characterization of rabbit BOECs. Furthermore, we could demonstrate that seeded tracheae exhibited better central submucosal vasculature. In conclusion, we were able to create a non-immunogenic tracheal scaffold covered with an autologous epithelium, with preserved mechanical properties, and with improved central submucosal vascularization. These translational data guide us towards the development of a clinical, custom-made tissue-engineered trachea.status: publishe
Daniel Rivera - One of the best experts on this subject based on the ideXlab platform.
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treatment of hidradenitis suppurativa with extensive resection of the lesion and coverage with perforator flaps of the Lateral Thoracic wall Lateral Thoracic Artery thoracodorsal Artery perforators
Plastic and reconstructive surgery. Global open, 2019Co-Authors: Jorge M. Rodriguez, Felipe Rodriguez, Daniel Rivera, Karol NaranjoAbstract:HS refers to the acute or chronic inflammation of the sweat glands by occlusion, the typical place of appearance is the groin and the axila, with an incidence of 1% reaching up to 4.1% according to some authors.1–6 Other commonly affected areas are the perianal and perineal region.7 Most patients (64.7%) state that the improvement in their quality of life, as measured by the Dermatological Life Quality Index (DLQI), improved significantly when they underwent invasive procedures rather than taking antibiotics, regardless of the location and extent of resection.7 Even though the gold standard for managing advanced stages of the disease is resection of the affected skin, there is debate about which is the proper technique for coverage. Recent studies have compared the use of the thoracodorsal Artery perforator flap (TDAP) versus skin grafts for the reconstruction of axillary defects after resection, finding a better postoperative response (shorter recovery time, fewer complications, shorter follow-up, and a better life quality) in those treated with the TDAP flap rather to those treated with skin grafts only.10 The use of a Lateral Thoracic Artery perforator flap has also been described, demonstrating a rapid recovery without the need to immobilize the arm, with a scar that easily hides behind the arm in a neutral position11,12 or, as in one of our cases, the possibility to hide within the brassiere line.
-
Treatment of Hidradenitis Suppurativa with Extensive Resection of the Lesion and Coverage with Perforator Flaps of the Lateral Thoracic Wall (Lateral Thoracic Artery, Thoracodorsal Artery Perforators)
Wolters Kluwer, 2019Co-Authors: Jorge M. Rodriguez, Felipe Rodriguez, Daniel Rivera, Karol NaranjoAbstract:Summary:. Stage IV hidradenitis suppurativa in the axilla is a chronic disease in which the removal of the affected area and a reconstruction with disease free skin is the definitive treatment; however there is some controversy about the technique to be used in this reconstruction. Studies show superiority in wide resections, and coverage with flaps rather than grafts. The use of pedicle flaps of Lateral Thoracic Artery perforators and thoracodorsal Artery perforators has demonstrated superior performance to other techniques in postsurgical follow-up. This article describes the cases of 2 patients with chronic HS in which lesions were resected with disease-free margins and the reconstruction of the defect is carried out with Lateral Thoracic wall perforator flaps and the subsequent improvement in their life quality after surgery
