Heutzutage stellt die freie mikrovaskulär anastomosierte Lappenplastik den Goldstandard in der plastisch rekonstruktiven Wiederherstellungschirurgie dar. Dieses Verfahren findet mit zunehmender Häufigkeit Einsatz, um komplexe Gewebedefekte zu decken, eine drohende Endgliedamputation zu vermeiden, oder um nach onkologisch bedingten Tumorresektionen die Funktionsfähigkeit des Gewebeabschnittes zu rekonstruieren und ästhetisch zu formen. Obwohl die Erfolgsquote nach einem freien Gewebetransfer hoch ist, zeigt sich auch regelmäßig die Indikation zu Revisionseingriffen. Hauptverantwortlich hierfür sind meist Wundheilungsstörungen oder Insuffizienzen der mikrovaskulär geschlossenen Gefäßanastomosen. Meine Arbeit zielte auf die retrospektive Auswertung von freien Lappenplastiken im Zeitraum von Mai 2012 bis Oktober 2017 am Universitätsklinikum Leipzig. Hauptaufgabe war es, mögliche Risikofaktoren auf statistische Signifikanz zu überprüfen, um so mögliche Ausschlusskriterien zu finden, unter denen eine freie Lappenplastik mit einer erhöhten postoperativen Komplikationsrate einhergeht. Hierzu wurden 193 freie Gewebetransfers bei 177 Patienten aus der Abteilung für Plastische, Ästhetische und spezielle Handchirurgie näher betrachtet. 14 der 177 Patienten haben zwei, und ein Patient drei freie Hautlappentransplantationen erhalten, da bei diesen Patienten postoperativ Lappenkomplikationen aufgetreten sind. Bei 32 von 193 freien Gewebetransfers folgte eine komplette Lappennekrose auf die freie Lappenplastik. Daher ist es besonders wichtig, bereits präoperativ die potentielle Patientengruppe ausfindig zu machen, bei der postoperativ eine erneute Revisionsoperation indiziert sein könnte. Hierbei ist die Kenntnis über alle vorhandenen Risikofaktoren des jeweiligen Patienten der entscheidende Faktor. In dieser Arbeit wurden patientenbezogene Risikofaktoren wie ein erhöhtes Lebensalter, arterielle Hypertonie, Diabetes Mellitus, Nikotinabusus und ein erhöhter Body-Mass-Index untersucht und die Ergebnisse anschließend mit dem aktuellen Literaturstand verglichen. Es wurde der Frage nachgegangen, ob diese Risikofaktoren eine signifikante Verschlechterung des Lappenüberlebens nach sich ziehen und sich somit die Lappenkomplikationsrate erhöht. Ebenso wurden patientenunspezifische Einflussgrößen wie die Schnitt-Naht-Zeit der Operation, die Größe der operierten Lappenplastik, oder die Art und Weise der mikrovaskulären Anastomose statistisch analysiert. Besonders wichtig erscheint ebenfalls die postoperative Überwachung des frei transplantierten Lappens. So müssen Störungen der Mikrozirkulation schnellstmöglich detektier- und behebbar sein. Die Auswertung dieser Arbeit zeigt, dass im präoperativen Setting nahezu keine signifikanten Risikofaktoren relevant sind, die die Indikationstellung zu einer freien Lappenplastik verhindern. Auch verschiedene Anastomosetechniken mit einer oder zwei Venen oder Arterien und einer jeweiligen End-zu-End und End-zu-Seit Anastomose waren statistisch nicht signifikant. Allein die Zeit zwischen einem Unfallereignis oder dem letzten Débridement und der Deckung des entstandenen Gewebedefekts mit Hilfe einer freien Lappenplastik zeigte sich als signifikanter Faktor. Patienten die innerhalb der ersten 72 Stunden nach einem Unfall eine freie Lappenplastik erhalten haben, zeigten postoperativ eine höhere Lappennekroserate. Letztendlich zeigt diese Dissertation, dass es prä- peri- und postoperativ einer interdisziplinär engen Interaktion zwischen den einzelnen Fachbereichen der Inneren Medizin, Anästhesie, Unfall- und plastischer Chirurgie bedarf, um konstant ein möglichst positives Outcome für jeden Patienten nach freier Lappenplastik zu ermöglichen. Es existieren nach Auswertung aller Datensätze und unter Berücksichtigung aller vorhandenen Komorbiditäten der jeweiligen Patienten nahezu keine signifikanten patientenspezifischen Risikofaktoren. Die Indikation zur freien Lappenplastik kann somit bei größeren Gewebedefekten großzügig gestellt werden. In Anbetracht der Vielzahl vorhandener Möglichkeiten zur postoperativen Überwachung wäre auch am Universitätsklinikum Leipzig die Möglichkeit gegeben, eines dieser Verfahren zu standardisieren, um die totale Lappennekroserate von 16% langfristig zu minimieren. Diese Arbeit hat mit statistischer Signifikanz gezeigt, dass eine spätere plastische Deckung weniger Komplikationen, und vor allem weniger Lappenverluste im Vergleich zu einer frühzeitigen Rekonstruktion mit sich bringt. Zukünftig sollte die Stabilisierung des Patienten, das sequentielle Débridement und die knöcherne Rekonstruktion im Vordergrund durchgeführt werden. Im Zeitalter der Vakummversiegelung hat sich die Zeitspanne bis zur plastischen Deckung verlängert und die zusätzlichen Behandlungskosten könnten durch die besseren Ergebnisse begründet werden.:Inhaltsverzeichnis Abkürzungsverzeichnis i Abbildungsverzeichnis ii Tabellenverzeichnis v 1 Einleitung 1 1.1 Historische Entwicklung der Mikrochirurgie 1 1.2 Geschichte der freien Lappenplastiken 1 1.3 Konzepte der Gewebedeckung im zeitlichen Wandel 3 1.3.1 Rekonstruktive Leiter 3 1.3.2 Rekonstruktiver Fahrstuhl 4 1.3.3 Rekonstruktives Uhrwerk 5 1.4 Lappenarten 6 1.4.1 Verschiedene Formen freier Lappenplastiken 6 1.5 Mikrochirurgische Anastomosen 8 1.6 Supermikrochirurgie 9 1.7 Anatomie und Operationstechnik des ALT-Lappens 9 1.8 Anatomie und OP-Technik des M. latissimus dorsi Lappens 13 1.9 Operationsindikationen 15 2 Zielsetzung der Dissertation 15 3 Material und Methoden 16 3.1 Art der klinischen Studie 16 3.2 Patientenkollektiv 16 3.3 Untersuchungsmethoden 16 3.4 Untersuchungsparameter 17 3.4.1 Demographische Daten 17 3.4.2 Klinische Größen 17 3.4.3 Risikofaktoren 17 3.4.4 Prä-, peri- und postoperative Daten 18 3.4.5 Patientenspezifische Risikofaktoren 21 3.4.6 Zeitspanne von Ursache bis Therapie mit freier Lappenplastik 21 3.4.7 Komplikationen 22 3.5 Statistische Auswertung 22 4 Ergebnisse 24 4.1 Patienten 24 4.1.1 Patientenkollektiv 24 4.1.2 Patientenalter und Geschlechtsverteilung 25 4.1.3 Lappenentnahmeregion 25 4.2 Operationsparameter 27 4.2.1 Operationsdauer 27 4.2.2 Anzahl der mikrovaskulär anastomosierten Blutgefäße 28 4.2.3 Verschiedene Varianten der mikrovaskulären Anastomosierung 33 4.2.4 Zeitspanne von Ursache bis Therapie mit freier Lappenplastik 38 4.2.5 Größe der freien Lappenplastik 41 4.2.6 Hebestellenmorbidität 43 4.2.7 Empfangsstelle der freien Lappenplastik 44 4.2.8 Stationäre Verweildauer 46 4.2.9 Gleichzeitige unfallchirurgische Versorgung 47 4.2.10 Kostenträger 49 4.2.11 Lernkurve 49 4.3 Patientenspezifische Risikofaktoren 51 4.3.1 Geschlecht 51 4.3.2 Erhöhtes Patientenalter 53 4.3.3 Body-Mass-Index 55 4.3.4 Arterielle Hypertonie 60 4.3.5 Nikotinabusus 62 4.3.6 Diabetes Mellitus 64 4.3.7 Kombination von Risikofaktoren 66 5 Diskussion 68 5.1 Methodik 68 5.2 Patientenkollektiv 69 5.3 Lappenarten 70 5.4 Patientenalter 71 5.5 Patientengeschlecht 72 5.6 Body-Mass-Index 73 5.7 Arterielle Hypertonie 75 5.8 Nikotinabusus 76 5.9 Diabetes Mellitus 77 5.10 Mikrovaskuläre Anastomose 78 5.11 Coupler Systeme 80 5.12 Schnitt-Naht-Zeit 81 5.13 Zeitspanne von Verletzung bis OP der freien Lappenplastik 82 5.14 Gleichzeitige unfallchirurgische Versorgung 83 5.15 Kostenträger 84 5.16 Lernkurve 85 5.17 Lappenmonitoring 85 6 Zusammenfassung 91 7 Literatur 94 8 Erklärung zur eigenständigen Abfassung der Arbeit 108 9 Danksagung 109 10 Lebenslauf 110

Species interact and exploit one another for a number of reasons, including transportation, shelter or nutrition such as in parasitic relationships. Parasitism is an important aspect in life and is common in all taxonomic groups. Parasites are often host-specific and can be endoparasites or ectoparasites. The phylum Platyhelminthes includes the class Monogenea or monogenetic parasitic flukes. Monogeneans are mainly parasitic in fish but the family Polystomatidae, also commonly referred to as polystomes, are found on the skin and gills of the Australian lungfish, tadpole gills, kidneys and urinary bladders of frogs, gills and skin of salamanders, cloaca and phalodeum of caecileans, on the eye, in the nose, mouth or urinary bladder of freshwater turtles and on the eye of the hippopotamus. Polystomes have a cosmopolitan distribution, and are found on all hospitable continents. Polystome species were first discovered in the 1758. Between 1961 and 1980 French researchers focussed on Central and West Africa and described a large number of parasites. Polystome discovery has steadily decreased in the last 30 years, however despite this, new species are still being discovered annually. The list of currently known polystomes is most likely only a small portion of the species that exists. Wherever scientists searched for polystomes, new species were discovered. The current distribution of polystomes is not at all a true reflection of their global distribution but merely an indication of research effort. Monogenean flatworms exhibit many variations in the morphology of the intestinal tract. These parasites display two distinct diets, where one group mainly feeds on blood while the other mainly feeds on mucus and epithelial tissues. Thus the feeding habits and other factors such as the shape of the caeca, the presence/absence and number of medial and lateral diverticula as well as anastomosis may play a role in the morphology of the intestinal tract, which can be used as a classification tool to classify polystome species into specific genera. The three aims of the study were to:  Conduct a literature study to compile a species list and source of information on all valid polystome taxa.  Review the intestine shape of all polystomes and evaluate it as a taxonomic characteristic.  Conduct a species description of a new North American chelonian polystome belonging to the genus Polystomoides. / MSc (Environmental Sciences), North-West University, Potchefstroom Campus, 2015

Species interact and exploit one another for a number of reasons, including transportation, shelter or nutrition such as in parasitic relationships. Parasitism is an important aspect in life and is common in all taxonomic groups. Parasites are often host-specific and can be endoparasites or ectoparasites. The phylum Platyhelminthes includes the class Monogenea or monogenetic parasitic flukes. Monogeneans are mainly parasitic in fish but the family Polystomatidae, also commonly referred to as polystomes, are found on the skin and gills of the Australian lungfish, tadpole gills, kidneys and urinary bladders of frogs, gills and skin of salamanders, cloaca and phalodeum of caecileans, on the eye, in the nose, mouth or urinary bladder of freshwater turtles and on the eye of the hippopotamus. Polystomes have a cosmopolitan distribution, and are found on all hospitable continents. Polystome species were first discovered in the 1758. Between 1961 and 1980 French researchers focussed on Central and West Africa and described a large number of parasites. Polystome discovery has steadily decreased in the last 30 years, however despite this, new species are still being discovered annually. The list of currently known polystomes is most likely only a small portion of the species that exists. Wherever scientists searched for polystomes, new species were discovered. The current distribution of polystomes is not at all a true reflection of their global distribution but merely an indication of research effort. Monogenean flatworms exhibit many variations in the morphology of the intestinal tract. These parasites display two distinct diets, where one group mainly feeds on blood while the other mainly feeds on mucus and epithelial tissues. Thus the feeding habits and other factors such as the shape of the caeca, the presence/absence and number of medial and lateral diverticula as well as anastomosis may play a role in the morphology of the intestinal tract, which can be used as a classification tool to classify polystome species into specific genera. The three aims of the study were to:  Conduct a literature study to compile a species list and source of information on all valid polystome taxa.  Review the intestine shape of all polystomes and evaluate it as a taxonomic characteristic.  Conduct a species description of a new North American chelonian polystome belonging to the genus Polystomoides. / MSc (Environmental Sciences), North-West University, Potchefstroom Campus, 2015

Os objetivos deste trabalho foram, em indivíduos com câncer de coto gástrico: identificar o padrão de disseminação de linfonodos acometidos, quantificar a invasão tumoral da linha de anastomose, correlacionar a invasão da linha de anastomose com o comprometimento linfonodal e mesenterial, correlacionar o acometimento linfonodal com sobrevivência e correlacionar o acometimento da linha de anastomose com sobrevivência. Foi realizado estudo retrospectivo com revisão de prontuários, peças cirúrgicas e exames anátomo-patológicos de 113 pacientes. O câncer de coto gástrico não tem um padrão de disseminação linfonodal específico; 75% dos pacientes apresentaram invasão tumoral da linha de anastomose; em 66,7% dos casos ocorreu invasão da linha anastomótica e linfonodal concomitantes; menos de 10% dos casos exibiam invasão mesenterial; houve óbito em 86,5% dos casos com invasão linfonodal e 64,7% com invasão da linha de anastomose e em 100% com invasão mesenterial. / The objectives of this study are to identify the metastatic pattern of lymph node for gastric stump cancer; to quantify the invasion of anastomotic site by tumor; to relate the invasion of anastomotic site with metastasis lymph node or mesenterial lymph node and these parameters with the survival of patients with gastric stump cancer. One hundred and thirteen patients with gastric stump cancer were retrospectively analyzed along with their medical records, surgical pieces and histopathologic exam. The metastatic pattern of lymph node isnt specific to gastric stump cancer. 75% of patients had tumoral invasion in the anastomotic site. In 66.7% of the cases there was an invasion of the anastomotic site with metastatic lymph nodes. 9% of patients had mesenterial lymph node invasion by tumor. Fatal cases occurred in 86,5% of the patients with metastatic lymph node, 64,7% with invasion of the anastomotic site and 100% with mesenterial lymph node invasion.

Os autores apresentam os resultados obtidos no desenvolvimento de um modelo experimental de fístula brônquica e na comparação de diferentes formas de proteção no modelo de fístula brônquica desenvolvido. Para isso, foram utilizados ratos submetidos a pneumonectomia esquerda e o coto brônquico protegido com músculo intercostal ou gordura pericárdica pediculados. Os resultados demonstraram ser possível o desenvolvimento de um modelo de fístula brônquica em ratos com 65% de confiança e que não há diferença estatística (p>0,05) entre tecidos utilizados na proteção brônquica, desde que sejam pediculados. / The authors present the resulte obtained after the development of an experimental model of bronchíal fistula and the comparison among different forms of post-pneumonectomy bronchial fistula protection. In order to achieve 'ha',were used rats that undergone left pneumonectomy whose bronchial stump was protected with either pedided muscle or pedicled fat. The results showed that it was possible to develop a bronchial fistula model with 65% of certainty and there was no slatistical difference (p>0,05) among the tissues used for bronchial protection, once they were pedicled.

Objetivo: Avaliar o efeito da oxigenoterapia hiperbárica na cicatrização da anastomose esôfagojejunal em ratos gastrectomizados. Material e Métodos: Foram operados 40 ratos Wistar, adultos machos, com peso entre 322g e 506g. Os animais foram divididos aleatoriamente em dois grupos. No grupo A (controle), 20 ratos foram submetidos à gastrectomia total. No grupo B, 20 ratos foram igualmente gastrectomizados e receberam tratamento pósoperatório com oxigenoterapia hiperbárica por 90 minutos/dia durante sete dias. Todos os ratos foram sacrificados no oitavo dia de pós-operatório e avaliados de acordo com as seguintes variáveis em estudo:a) presença ou não de fístula anastomótica; b) avaliação da cicatrização da anastomose esôfagojejunal através da medida da força de ruptura à tração na linha da sutura segundo Hendriks & Mastboom; c) determinação da concentração de colágeno na anastomose, pelos critérios de Kovács. Para análise estatística comparativa entre os grupos foi utilizado o teste t de Student, considerando-se como significativo p <0,05. Resultados: Houve 20% de óbitos na amostra, sendo cerca de 60% no grupo A e os 40% restantes no grupo B (p=N.S.) . Ocorreu apenas uma fístula anastomótica em cada grupo, sendo que em ambos não houve morbidade relacionada ou óbito. As medidas de força de ruptura à tração na linha da sutura entre os grupos (p=0,528) e a determinação da concentração de colágeno na anastomose esôfagojejunal (p=0,89) não mostraram diferença estatisticamente significativa nos dois grupos. Conclusões: Utilizando parâmetros clínicos, mecânicos e bioquímicos para avaliar a anastomose esôfagojejunal, concluímos que no presente estudo a oxigenoterapia hiperbárica não interferiu no processo de cicatrização desta anastomose. / Purpose: To evaluate the effect of the hyperbaric oxygen therapy on the healing of the esophagojejunal anastomosis in gastrectomized rats. Material and Methods: 40 Wistar rats male adults with weighing between 322g to 506g were operated. The animals were divided in two ramdom groups.20 rats from group A (control group), were submitted to total gastrectomy. In group B, 20 rats were equally gastrectomized and received postoperative treatment with hyperbaric oxygen for 90 minutes/day during seven days. All rats were sacrificed on the eighth postoperative day and evaluated according to the following study variables :a) whether there were any anastomotic fistula or not; b) evaluating esophagojejunal anastomosis healing by measuring breaking strength at the suture line as per Hendriks & Mastboom; c) determining of the collagen concentration on the anastomosis, as per Kovács criteria. For the comparative statistical analyses between the groups, Student’s “t” test was used, whereas p<0,05 was significant. Results: There was a 20% rate of deceasing in the sample, whereas 60% occurred in group A and 40% in group B (p=N.S.). There was only one anastomotic fistula in each group, and in neither one occurred any morbidity or deaths related. Breaking strength measured at the suture line (p=0,528) and collagen concentration determined at the esophagojejunal anastomosis (p=0,89) did not present any significant statistical difference in either group. Conclusions: By using clinical, mechanical and biochemical parameters to evaluate the esophagojejunal anastomosis, it was possible to conclude that, in this study, hyperbaric oxygen therapy did not interfere with the healing process of the anastomosis.

Objetivo: Avaliar o efeito da oxigenoterapia hiperbárica na cicatrização da anastomose esôfagojejunal em ratos gastrectomizados. Material e Métodos: Foram operados 40 ratos Wistar, adultos machos, com peso entre 322g e 506g. Os animais foram divididos aleatoriamente em dois grupos. No grupo A (controle), 20 ratos foram submetidos à gastrectomia total. No grupo B, 20 ratos foram igualmente gastrectomizados e receberam tratamento pósoperatório com oxigenoterapia hiperbárica por 90 minutos/dia durante sete dias. Todos os ratos foram sacrificados no oitavo dia de pós-operatório e avaliados de acordo com as seguintes variáveis em estudo:a) presença ou não de fístula anastomótica; b) avaliação da cicatrização da anastomose esôfagojejunal através da medida da força de ruptura à tração na linha da sutura segundo Hendriks & Mastboom; c) determinação da concentração de colágeno na anastomose, pelos critérios de Kovács. Para análise estatística comparativa entre os grupos foi utilizado o teste t de Student, considerando-se como significativo p <0,05. Resultados: Houve 20% de óbitos na amostra, sendo cerca de 60% no grupo A e os 40% restantes no grupo B (p=N.S.) . Ocorreu apenas uma fístula anastomótica em cada grupo, sendo que em ambos não houve morbidade relacionada ou óbito. As medidas de força de ruptura à tração na linha da sutura entre os grupos (p=0,528) e a determinação da concentração de colágeno na anastomose esôfagojejunal (p=0,89) não mostraram diferença estatisticamente significativa nos dois grupos. Conclusões: Utilizando parâmetros clínicos, mecânicos e bioquímicos para avaliar a anastomose esôfagojejunal, concluímos que no presente estudo a oxigenoterapia hiperbárica não interferiu no processo de cicatrização desta anastomose. / Purpose: To evaluate the effect of the hyperbaric oxygen therapy on the healing of the esophagojejunal anastomosis in gastrectomized rats. Material and Methods: 40 Wistar rats male adults with weighing between 322g to 506g were operated. The animals were divided in two ramdom groups.20 rats from group A (control group), were submitted to total gastrectomy. In group B, 20 rats were equally gastrectomized and received postoperative treatment with hyperbaric oxygen for 90 minutes/day during seven days. All rats were sacrificed on the eighth postoperative day and evaluated according to the following study variables :a) whether there were any anastomotic fistula or not; b) evaluating esophagojejunal anastomosis healing by measuring breaking strength at the suture line as per Hendriks & Mastboom; c) determining of the collagen concentration on the anastomosis, as per Kovács criteria. For the comparative statistical analyses between the groups, Student’s “t” test was used, whereas p<0,05 was significant. Results: There was a 20% rate of deceasing in the sample, whereas 60% occurred in group A and 40% in group B (p=N.S.). There was only one anastomotic fistula in each group, and in neither one occurred any morbidity or deaths related. Breaking strength measured at the suture line (p=0,528) and collagen concentration determined at the esophagojejunal anastomosis (p=0,89) did not present any significant statistical difference in either group. Conclusions: By using clinical, mechanical and biochemical parameters to evaluate the esophagojejunal anastomosis, it was possible to conclude that, in this study, hyperbaric oxygen therapy did not interfere with the healing process of the anastomosis.

Objetivo: Avaliar o efeito da oxigenoterapia hiperbárica na cicatrização da anastomose esôfagojejunal em ratos gastrectomizados. Material e Métodos: Foram operados 40 ratos Wistar, adultos machos, com peso entre 322g e 506g. Os animais foram divididos aleatoriamente em dois grupos. No grupo A (controle), 20 ratos foram submetidos à gastrectomia total. No grupo B, 20 ratos foram igualmente gastrectomizados e receberam tratamento pósoperatório com oxigenoterapia hiperbárica por 90 minutos/dia durante sete dias. Todos os ratos foram sacrificados no oitavo dia de pós-operatório e avaliados de acordo com as seguintes variáveis em estudo:a) presença ou não de fístula anastomótica; b) avaliação da cicatrização da anastomose esôfagojejunal através da medida da força de ruptura à tração na linha da sutura segundo Hendriks & Mastboom; c) determinação da concentração de colágeno na anastomose, pelos critérios de Kovács. Para análise estatística comparativa entre os grupos foi utilizado o teste t de Student, considerando-se como significativo p <0,05. Resultados: Houve 20% de óbitos na amostra, sendo cerca de 60% no grupo A e os 40% restantes no grupo B (p=N.S.) . Ocorreu apenas uma fístula anastomótica em cada grupo, sendo que em ambos não houve morbidade relacionada ou óbito. As medidas de força de ruptura à tração na linha da sutura entre os grupos (p=0,528) e a determinação da concentração de colágeno na anastomose esôfagojejunal (p=0,89) não mostraram diferença estatisticamente significativa nos dois grupos. Conclusões: Utilizando parâmetros clínicos, mecânicos e bioquímicos para avaliar a anastomose esôfagojejunal, concluímos que no presente estudo a oxigenoterapia hiperbárica não interferiu no processo de cicatrização desta anastomose. / Purpose: To evaluate the effect of the hyperbaric oxygen therapy on the healing of the esophagojejunal anastomosis in gastrectomized rats. Material and Methods: 40 Wistar rats male adults with weighing between 322g to 506g were operated. The animals were divided in two ramdom groups.20 rats from group A (control group), were submitted to total gastrectomy. In group B, 20 rats were equally gastrectomized and received postoperative treatment with hyperbaric oxygen for 90 minutes/day during seven days. All rats were sacrificed on the eighth postoperative day and evaluated according to the following study variables :a) whether there were any anastomotic fistula or not; b) evaluating esophagojejunal anastomosis healing by measuring breaking strength at the suture line as per Hendriks & Mastboom; c) determining of the collagen concentration on the anastomosis, as per Kovács criteria. For the comparative statistical analyses between the groups, Student’s “t” test was used, whereas p<0,05 was significant. Results: There was a 20% rate of deceasing in the sample, whereas 60% occurred in group A and 40% in group B (p=N.S.). There was only one anastomotic fistula in each group, and in neither one occurred any morbidity or deaths related. Breaking strength measured at the suture line (p=0,528) and collagen concentration determined at the esophagojejunal anastomosis (p=0,89) did not present any significant statistical difference in either group. Conclusions: By using clinical, mechanical and biochemical parameters to evaluate the esophagojejunal anastomosis, it was possible to conclude that, in this study, hyperbaric oxygen therapy did not interfere with the healing process of the anastomosis.

Os objetivos deste trabalho foram, em indivíduos com câncer de coto gástrico: identificar o padrão de disseminação de linfonodos acometidos, quantificar a invasão tumoral da linha de anastomose, correlacionar a invasão da linha de anastomose com o comprometimento linfonodal e mesenterial, correlacionar o acometimento linfonodal com sobrevivência e correlacionar o acometimento da linha de anastomose com sobrevivência. Foi realizado estudo retrospectivo com revisão de prontuários, peças cirúrgicas e exames anátomo-patológicos de 113 pacientes. O câncer de coto gástrico não tem um padrão de disseminação linfonodal específico; 75% dos pacientes apresentaram invasão tumoral da linha de anastomose; em 66,7% dos casos ocorreu invasão da linha anastomótica e linfonodal concomitantes; menos de 10% dos casos exibiam invasão mesenterial; houve óbito em 86,5% dos casos com invasão linfonodal e 64,7% com invasão da linha de anastomose e em 100% com invasão mesenterial. / The objectives of this study are to identify the metastatic pattern of lymph node for gastric stump cancer; to quantify the invasion of anastomotic site by tumor; to relate the invasion of anastomotic site with metastasis lymph node or mesenterial lymph node and these parameters with the survival of patients with gastric stump cancer. One hundred and thirteen patients with gastric stump cancer were retrospectively analyzed along with their medical records, surgical pieces and histopathologic exam. The metastatic pattern of lymph node isnt specific to gastric stump cancer. 75% of patients had tumoral invasion in the anastomotic site. In 66.7% of the cases there was an invasion of the anastomotic site with metastatic lymph nodes. 9% of patients had mesenterial lymph node invasion by tumor. Fatal cases occurred in 86,5% of the patients with metastatic lymph node, 64,7% with invasion of the anastomotic site and 100% with mesenterial lymph node invasion.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Urethral stenosis is still a challenge for urological surgeons even though there are several corrective techniques in humans. In veterinary medicine there are few alternatives, especially in dogs affected by extensive intra-pelvic lesions and the usual treatment in the clinical routine is prepubic urethrostomy, a procedure related to several complications. Before research aimed at describe an innovative surgical technique of prepubic urethral transposition to restore urinary flow interrupted by stenosis of extensive segments of the membranous urethra in adult male dogs. This study was developed in two stages that occurred concomitantly. In one of the stages, 18 adult male dogs from Hospital de Clínicas Veterinaria of the Universidade Federal de Pelotas (HCV/UFPel) were used. The surgical technique consisted initially of orchiectomy, followed by celiotomy, transverse section of the penis in the pre-scrotal region and transposition into the abdominal cavity making anastomosis to the prostatic urethra. In this stage, the feasibility of the technique, surgical time, description of the anatomical planes discussed, pre and postoperative length of the urethra were evaluated, and then submitted to retrograde contrast-enhanced urethrocystography for evaluation of anastomosis effusion, urethral diameter and constriction in the anastomosis. In the other stage, the same surgical technique was applied to six male dogs treated at the HCV/UFPel, which were affected by extensive stenosis of the intra-pelvic urethra, with prepubic urethral transposition as an alternative to prepubic urethrostomy and genitalia ablation external. These six dogs were evaluated clinically and by urethrocystographies with intervals between seven and 48 XX months post-procedure, none of which presented voiding or stenosis images. It is concluded that the prepubic urethral transposition is a feasible technique in dogs, effective in maintaining the diameter and sealing of the anastomosis, giving a new urethral pathway to restore the urinary flow. / A estenose uretral ainda é um desafio para os cirurgiões urológicos ainda que existam diversas técnicas corretivas em humanos. Na medicina veterinária há poucas alternativas, principalmente em cães acometidos por lesões intrapélvicas extensas e o tratamento usual na rotina clínica é a uretrostomia pré-púbica, procedimento relacionado a diversas complicações. Diante disso, o objetivo deste trabalho é propor e descrever uma técnica cirúrgica inovadora de transposição uretral pré-púbica para restituir o fluxo urinário interrompido por estenose de segmentos extensos da uretra membranosa em cães machos adultos. Este estudo foi desenvolvido em duas etapas que ocorreram de forma concomitante. Em uma das etapas, utilizou-se 18 cadáveres de cães machos adultos oriundos do Hospital de Clínicas Veterinária da Universidade Federal de Pelotas (HCV/UFPel), cuja técnica cirúrgica consistiu inicialmente pela orquiectomia, seguida de celiotomia retroumbilical, secção transversa do pênis na região pré-escrotal e transposição deste em direção à cavidade abdominal fazendo-se anastomose à uretra prostática. Nesta etapa avaliou-se a exequibilidade da técnica, tempo cirúrgico, descrição das estruturas anatômicas abordadas, comprimento pré e pós-operatório da uretra, a seguir, foram submetidos a uretrocistografia retrógrada com contraste positivo para avaliação de derrame na anastomose, diâmetro uretral e constrição na anastomose. Na outra etapa, a mesma técnica cirúrgica foi aplicada em seis cães machos atendidos no HCV/UFPel acometidos por estenose extensa da uretra intrapélvica, fazendo-se a transposição uretral pré-púbica como alternativa à uretrostomia pré-púbica e ablação da genitália externa. Os cães foram avaliados clinicamente e por uretrocistografias com intervalos entre sete e 48 meses após o procedimento, sendo que nenhum apresentou alteração do jato miccional ou imagens de estenose. Conclui-se que a transposição uretral pré-púbica é uma técnica exequível em cães, eficaz na manutenção diâmetro e no selamento da anastomose, conferindo um novo trajeto uretral para restituir o fluxo urinário.