Breast reconstruction with pedicled TRAM flap The pedicle transverse rectus abdominus myocutaneous flap (TRAM) is widely used for breast reconstruction, however is not exempt from complications. Between 2004 and 2010 the authors performed breast reconstruction after total mastectomy in 52 patients with pedicled TRAM flaps. Purpose: To describe the demography, outcomes and complications in patients operated for breast cancer and reconstructed with TRAM flap. To assess the influence of smoking, the laterality and timing of reconstruction. Material and Method: Retrospective, observational and comparative. We reviewed the medical records of 52 patients operated by the authors between 2004 and 2010. Four cases were excluded due to incomplete data. Results: In the 48 patients studied were 50 TRAM flaps. The most frequent comorbidity was smoking (27%). Regarding the timing of reconstruction, 74% (37) was performed immediately post-mastectomy and 26% (13) was deferred. Was used by 78% (39) ipsilateral TRAM, 18% (9) contralateral and 4% (2) bilateral. Only minor complications were observed and the cosmetic result evaluated by the surgeon's satisfaction was very good or excellent in 62% (31). Smoking, timing of reconstruction and laterality did not affect in complications or cosmetic outcome (p > 0.05). Conclusions: The pedicled TRAM flap is an excellent alternative for reconstruction in breast cancer patients. It is not exempt from complications, with a tendency to get better cosmetic results in the non-smoker group.
Acute complicated diverticulitis. New trends in treatmentDiverticular disease refers to the presence of colon diverticula. Its prevalence increases with age and in a few cases present as diverticulitis. Acute complicated diverticulitis is potentially mortal, since it can perforate and require emergency surgery. the treatment of choice is the excision of the perforated segment and the creation of a proximal colostomy. there are other therapeutic alternatives such as excision with primary anastomosis and novel approaches such as laparoscopic peritoneal lavage. We herein review the new treatments of acute diverticulitis.Key words: Diverticular disease, diverticulitis, colectomy, laparoscopic lavage.
ResumenLa enfermedad diverticular se refiere a la presencia de divertículos en el colon. Su prevalencia aumenta con la edad y sólo en pocos casos se presenta como diverticulitis aguda. La diverticulitis aguda complicada es una condición potencialmente mortal, por la posibilidad de una perforación libre que requiera cirugía de urgencia. El tratamiento de elección en la mayoría de los casos es la resección del segmento colónico que incluya la perforación y la creación de una colostomía proximal. Existen otros tratamientos en el manejo quirúrgico de la diverticulitis perforada, como la resección con anastomosis primaria y nuevas aproximaciones, como el lavado peritoneal por vía laparoscópica. Se revisa y discute en este artículo la tendencia actual en el manejo de la diverticulitis aguda perforada.Palabras clave: Enfermedad diverticular, diverticulitis aguda, colectomía, lavado peritoneal laparoscópico.
Laparoscopic peritoneal lavage as treatment for acute perforated diverticulitis Introduction: Sigmoid diverticular disease is common in the occidental world and it is responsible for a great number of hospitalizations. The prevalence of diverticular disease increases with age and only in few cases it is manifest as diverticulitis. Diverticulitis produces variable clinical manifestations, ranging from simple inflammation that only requires medical management, to a life threatening condition, due to a free perforation that requires urgent surgery. Clinical case: In this article we present a clinical case of complicated diverticulitis with free perforation treated with laparoscopic peritoneal lavage.
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