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J Farhadi

Publications and source records attributed to J Farhadi.

8 recordsLinked to original sources
PubMed2006

[The infragluteal perforator flap].

PURPOSE: Pressure sores of the ischial tuberosities are mostly covered with fascio- or myocutaneous flaps of the posterior thigh. In doing so, vascular territories of adjacent flaps are violated, which are not available any more in case of ulcer recurrences. In consideration of the high recurrence rates of pressure sores in paraplegics, we developed an infragluteal perforator flap that spares adjacent vascular territories. PATIENTS/MATERIAL AND METHOD: Infragluteal perforator flaps were dissected in five fresh human cadavers to investigate the anatomic relations of the cutaneous branches of the inferior gluteal artery and the inferior clunial nerves and to define the anatomic landmarks for clinical application of an innervated flap. In six paraplegic patients with primary (5/6) and secondary (1/6) pressure sores of the ischial tuberosity, infragluteal perforator flaps were used for wound coverage. The donor defect was closed primarily and postoperative care and patient mobilisation followed a standardised protocol. RESULTS: In eleven infragluteal perforator flaps that were dissected in cadavers and patients, we found one or two cutaneous branches of the descending branch of the inferior gluteal artery at the lower border of the gluteus maximus muscle that supplied the infragluteal skin. Infragluteal perforator flaps could be harvested on these perforator vessels and transferred to the ischial defects without tension due to the excellent mobility of the skin island. The descending branch of the inferior gluteal artery could be spared in all cases for future flaps. In one patient with multiple recurrences of an ischial pressure sore flap necrosis occurred due to venous congestion. The other five infragluteal perforator flaps healed without complications. CONCLUSION: The infragluteal perforator flap is suitable for the closure of pressure sores of the ischial tuberosities and can be used as a sensitised flap by inclusion of the inferior clunial nerves. Compared to traditional pedicled flaps of the posterior thigh, the infragluteal perforator flap reduces donor site morbidity and spares the vascular territories of adjacent flaps for future recurrent ulcers.

Adult↗
PubMed1999

Clinical experience of feeding through a needle catheter jejunostomy after major abdominal operations.

OBJECTIVE: To report our incidence of local and systemic complications after needle-catheter jejunostomy. DESIGN: Retrospective analysis. SETTING: University hospital, Switzerland. RESULTS: 100 patients (70 men and 30 women; mean age 65 years, range 42-90) had needle-catheter jejunostomy for postoperative enteral feeding. 26 developed catheter-related and 18 nutrition-related complications. Most of the complications were minor (lumenal obstruction of the catheter or local cellulitis) and only 3 patients needed reoperation, 2 because the catheter broke with extravasation of the nutrition formula into the subcutaneous tissue, and the other because of a small bowel obstruction. There was no small bowel necrosis and no patient died as a direct result of the jejunostomy. Overall, 92 patients were fed enterally according to the protocol, and 8 required removal of the catheter. CONCLUSION: Needle-catheter jejunostomy gives a safe and effective access for postoperative enteral feeding. Minor technical complications are common and can be reduced by a meticulous insertion technique and careful postoperative management. Regular clinical surveillance may reduce the incidence of nutrition-related complications.

Adult↗
PubMed1998

Laparoscopic treatment of large paraesophageal hernia with totally intrathoracic stomach.

BACKGROUND: Once paraesophageal hernia has been diagnosed, it should be repaired immediately because of life-threatening complications such as bleeding, ischemia, and perforation when intrathoracic strangulation or volvulus occurs. We describe our surgical strategy for treating this rare type of hiatal hernia with regard to early and late postoperative complications. STUDY DESIGN: This was a retrospective case series from a university hospital. Twelve patients (seven women and five men) with a mean age of 64 years (range, 50-76 years) and a completely intrathoracic stomach underwent laparoscopic paraesophageal hernia repair. Seven patients had a type 2 hernia, and five patients had a type 3 hernia. Additional organoaxial volvulus was present in three patients. All patients underwent reduction of the stomach and the greater omentum, excision of the hernia sac, closure of the hiatal defect, and a floppy Nissen fundoplication. RESULTS: Because of severe adhesions, one patient needed an open stomach reduction (conversion rate, 8%). The mean operating time was 161 minutes (range, 110-200 minutes), blood loss was minimal, and the mean postoperative hospital stay was 6 days (range, 4-7 days). There were no intraoperative complications, but early postoperative complications occurred in three patients (25%; one with dysphagia, 1 reoperation due to organoaxial gastric rotation with gastroduodenal obstruction, and one with deep venous thrombosis). No deaths occurred. Followup in all patients is complete, with a mean followup time of 21 months (range, 3-40 months). The complication rate after long-term followup was 8%, and reflux esophagitis symptoms in one patient were completely relieved by medical therapy. CONCLUSIONS: Laparoscopic paraesophageal hernia repair was feasible and safe with low morbidity and mortality rates in this elderly patient group. To achieve good long-term results, standard surgical treatment should include reduction of the stomach, complete excision of the hernia sac, closure of the hiatal defect, floppy Nissen fundoplication, and anterior gastropexy.

Aged↗
PubMed1998

[Cholelithiasis--laparoscopy or laparotomy?].

Between 10% and 15% of the adult population have gallstones and therefore symptomatic cholelithiasis is the second most common indication for surgery in general practice. It's diagnosis depends on the patients history, clinical findings, laboratory tests and ultrasound. In case of symptomatic gallstones surgery offers the only permanent cure and specific complications due to gallstones such as ileus or fistula are becoming rare. With the introduction of minimal invasive surgery at the end of this century laparoscopic cholecystectomy is now considered to be the standard treatment for symptomatic gallstones. This approach can be offered to > 90% of patients in elective cases and in between 60%-80% of patients having acute cholecystitis with a low morbidity and mortality rate. The main advantages of the laparoscopic approach are the overall increased patients comfort with less postoperative pain, shorter hospital stay, recovery and off work time. Although the rate of common bile duct injury appears to be increased using this minimal invasive approach, this rate is still sufficiently small to justify the use of laparoscopic cholecystectomy for symptomatic disease. Open cholecystecomy remains the treatment of choice for complicated gallstone disease (i.e. cancer, Mirizzi syndrome, severe inflammation) and high risk patients. In case of acute cholecystitis the laparoscopic treatment with all it's advantages may also be offered to many patients. However, in those cases the conversion rate to the open approach may be markedly increased which has not to be considered as a complication of the laparoscopic approach but as a maximization of safety and effectiveness of the treatment.

Adult↗
PubMedDate not supplied

Bi-zonal cartilaginous tissues engineered in a rotary cell culture system.

In this study, we aimed at validating a rotary cell culture system (RCCS) bioreactor with medium recirculation and external oxygenation, for cartilage tissue engineering. Primary bovine and human culture-expanded chondrocytes were seeded into non-woven meshes of esterified hyaluronan (HYAFF-11), and the resulting constructs were cultured statically or in the RCCS, in the presence of insulin and TGFbeta3, for up to 4 weeks. Culture in the RCCS did not induce significant differences in the contents of glycosaminoglycans (GAG) and collagen deposited, but markedly affected their distribution. In contrast to statically grown tissues, engineered cartilage cultured in the RCCS had a bi-zonal structure, consisting of an outgrowing fibrous capsule deficient in GAG and rich in collagen, and an inner region more positively stained for GAG. Structurally, trends were similar using primary bovine or expanded human chondrocytes, although the human cells deposited inferior amounts of matrix. The use of the presented RCCS, in conjunction with the described medium composition, has the potential to generate bi-zonal tissues with features qualitatively resembling the native meniscus.

Adult↗