Nevo azul no aparato ungueal: relato de um caso / Blue nevus of the nail apparatus: a case report

A discromia azul das unhas possui vários diagnósticos diferenciais. Crescimento da lesão, distrofia ungueal associada e extensão periungueal requerem avaliação para excisão cirúrgica. Mulher, 27 anos, apresentava mancha azulada, semicircular, ocupando cerca de 50% da lúnula, sem alteração da lâmina suprajacente, com pequena alteração da porção distal da unha, com camadas do tipo "onicosquizia localizada", sem história prévia de trauma ou sangramento. Realizada avulsão parcial da placa e biópsia excisional por saucerização da lesão fortemente pigmentada. O exame histopatológico foi compatível com nevo azul. Sugere-se que, neste caso, o nevo se situasse em posição submatricial, não interferindo, portanto, na coloração da lâmina ungueal

Blue nail dyschromia has several differential diagnoses. Lesion growth, associated nail dystrophy, and nail extension require evaluation for surgical excision. We report the case of a 27-year-old woman presenting a bluish, semicircular stain, occupying about 50% of the lunula. The patient presented no changes in the overlying lamina, small alteration of the distal nail portion, localized onychoschizia-type layers, and no previous trauma or bleeding history. We performed partial avulsion of the plaque and shave biopsy, evidencing an intensely pigmented lesion. Histopathological examination was compatible with blue nevus. In this case, the nevus should be located in the sub-matricial position, thus not interfering with the nail plate color

Dermatofibrossarcoma protuberans de apresentação clínica atípica: relato de um caso / Atypical presentation of dermatofibrosarcoma protuberans: Case report

Introdução: O dermatofibrossarcoma protuberans (DFSP) é um sarcoma localmente agressivo que apresenta recidiva local em até 60% dos casos e raras metástases pulmonares. Métodos: Paciente masculino, de 41 anos, apresenta tumoração amolecida à palpação, localizada no hálux direito há dois anos. Histopatologia com células fusiformes em arranjo estoriforme. A imuno-histoquímica foi focalmente positiva para o CD34. Discussão: Algumas variantes clínicas são descritas. As principais são: lesões nodulares confluentes formando uma placa, muitas vezes com aspecto clínico semelhante ao de queloide; lesão tumoral; placa atrófica. Conclusão: Casos de DFSP simulando cisto subcutâneo foram encontrados na literatura, porém trata-se de uma apresentação clínica inusitada de DFSP.

Introduction: Dermatofibrosarcoma protuberans (DFSP) is a local aggressive sarcoma that presents 60% of recurrences. Rarely it presents lung metastasis too. Methods: 41 years old man presented a soft tumor in his right hallux for two years. Histopathology has shown spindle-shaped cells arranged in a storiform manner, and immunohistochemistry was CD34 positive. Discussion: The literature describes some clinical types of DFSP. The most common are: confluent nodules forming a plaque, sometimes similar to keloids, tumoral lesions, and atrophic plaques. Conclusion: DFSP cases simulating a subcutaneous cyst have been described in the literature; nevertheless, it is an unusual presentation of this tumor.

Tunnel fistulectomy with multiseton drainage in treatment of complicated anal fistula / 中华全科医师杂志

Seventy seven patients with complicated anal fistula were randomly assigned to receive tunnel fistulectomy with multiseton drainage (group A, n=38) or traditional fistulectomy (group B, n=39) for treatment.The clinical data and the treatment outcomes of two groups were compared.There was no significant difference in operation time between two groups (P>0.05). However, group A was significantly superior to group B in postoperative pain Numerical Pain Rating Scak (NPRS) score [(2.2±0.84) vs. (4.2±1.3), P<0.05)], wound surface area [(3.7±0.84) cm2 vs. (7.28±1.83) cm2, P<0.05], wound healing time [(23.4±2.41) d vs. (38.8±3.49) d, P<0.05 ], cure rate(97.4% vs. 79.5%, P<0.05) and recurrent rate 1 year after surgery(5.3% vs. 25.6%, P<0.05). The postoperative anorectal dynamic parameters of group A were also better than those of group B (P<0.05). Compared to traditional fistulectomy, the tunnel fistulectomy with multiseton drainage has advantages of less pain, faster recovery, less disturbance in anal function and better long-term clinical effect in treatment of complicated anal fistula.

Optimizing suction blister epidermal graft technique in the surgical treatment of vitiligo

Abstract: Surgical management of vitiligo is considered an excellent terapeutic option for recalcitrant cases, provided the disease is stable and there is absence of Koebner phenomenom. Among surgical modalities, Suction Blister Epidermal Graft is a low cost and effective option (65 to 100% repigmentation can be achieved in up to 80% of patients). We describe how it can be optimized by using an alternative suction equipment, by customization of graft format and by application of an anesthetic technique that substantially reduces procedure time.

Performance of drainage through micropores in the treatment of axillary osmidrosis with subcutaneous trimming / 中华皮肤科杂志

Objective To evaluate the performance of drainage through micropores in the treatment of axillary osmidrosis with subcutaneous trimming.Methods Forty-eight patients with axillary osmidrosis were enrolled in this study,and treated by subcutaneous trimming.After removal of apocrine sweat glands and hair follicles,a scalpel was used to cut several micropores (measuring 3 mm in length) along dermal ridges in skin flaps.Then,drainage was carried out through the micropores.Subsequently,the incisions were sewed up with 3-0 sutures followed by compression bandaging with elastic bandages.Dressings were changed and incisions were examined at 24 hours after operation,and bandages were taken off and skin flap viability was evaluated at 10 days.All the patients were followed for 3 months.Results After treatment,sweating was decreased and axillary odor disappeared in all the patients with a return to normal social activities.No obvious scar formed.Conclusion Drainage through micropores performs well in the treatment of axillary osmidrosis with subcutaneous trimming.

Onicocriptosis unilateral asociada a granuloma piógeno. Presentación de un caso / Unilateral Onychocryptosis Associated with Pyogenic Granuloma. A Case Report

No todas las formaciones que se encuentran asociadas a la onicocriptosis y localizadas en el labio ungueal son granulomas piogénicos, ya que en la mayoría de las ocasiones se trata de una proliferación fibrosa fruto del afán reparativo del organismo. Por tales razones se decidió la presentación del caso de una paciente con onicocriptosis asociada a granuloma piógeno, diagnosticada con anterioridad en el Servicio de Ortopedia del Hospital General Universitario Dr. Gustavo Aldereguía Lima de Cienfuegos. Esta paciente acudió a la consulta de Podología de la Filial de Ciencias Médicas, por presentar recidiva. Se determinó aplicar la técnica de cirugía menor fenol/alcohol, con resultados positivos.

Not all growths associated with onychocryptosis and located on the ungueal labia are pyogenic granulomas, since in most cases they are fibrous proliferations caused by the reparative response of the body. Hence, we decided to present the case of a patient with onychocryptosis associated with pyogenic granuloma diagnosed earlier in the Orthopedics Department of the Dr. Gustavo Aldereguía Lima University General Hospital of Cienfuegos. This patient attended the Podiatry consultation of the Medical Sciences Subsidiary Faculty due to recurrence. Phenol and alcohol procedure was performed with positive results.

Epidermal curettage technique (ECT) for tissue harvest from the donor area for melanocyte autologous grafting in cases of vitiligo

Vitiligo is a dermatosis requiring complex treatment. In clinically stable cases, melanocyte autologous grafting has shown good results, using different methodologies for obtaining the donor area: dermatomes, punches, blisters. However, these techniques are complex and require specific instruments. This study presents a simple technique for melanocyte harvest that has been performed in our service for more than ten years and includes epidermal curettage of the donor area, grafting of the obtained material, which was homogenized with saline or hyaluronic acid, on the achromic area, and the application of a semipermeable dressing that is removed 1 week later.

Using 80% trichloroacetic acid in the treatment of ingrown toenails / Acido Tricloroacetico a 80% no tratamento da onicocriptose

BACKGROUND: Ingrown nails are a very common problem. There are different stages of disease and diverse therapeutic options. Phenol and sodium hydroxide are commonly used agents for chemical matricectomy but both frequently entail excessive healing times. OBJECTIVE: This prospective study aimed mainly to evaluate the efficacy of partial nail avulsion and selective chemical cauterization of the matrix using 80% TCA in the treatment of the ingrowing nail. METHODS: One-hundred-and-thirty-three patients with 197 ingrown toenails were included in this study. Preoperatively, we tried to find predisposing factors to the disease. In the postoperative period, patients were evaluated for potential complications at days 3, 30, 180, 270 and 360. Pain was measured before surgery, as well as 24 hours and 72 hours after surgery. RESULTS: There were only 3 cases (out of 197) of ingrown nail recurrence. Preoperatively, we found the presence of drainage in 82% of patients, which, following the first visit after surgery, was reduced to 19%. Persistent granulation tissue was found in 3% of the patients (versus 75% prior to surgery). The most frequent predisposing factors for the ingrown nail were excessive trimming of the lateral nail plate (63%), plantar hyperhidrosis (58%) and heavy nail folds (39%). Pain was substantially reduced after surgery. CONCLUSION: It is assumed that chemical procedures for the ingrown toenail are associated with delayed healing times but our results demonstrated quick recovery. Using 80% TCA for selective matricectomy in the ingrown toenail is an effective, quick and easy method. .

FUNDAMENTO: A unha encravada é uma patologia muito frequente. A doença engloba diferentes estadios existindo diferentes soluções terapêuticas. O fenol e o hidróxido de sódio são largamente utilizados na matricetomia química porém ambos cursam com longos tempos de cura. OBJETIVO: O principal objectivo deste estudo prospectivo foi avaliar a eficácia da mactricectomia com ácido tricloroacético a 80% no tratamento da unha encravada. MÉTODOS: Foram incluídos no estudo 133 doentes com 197 unhas encravadas. Factores predisponentes foram avaliados pré-operatoriamente. No período pós-operatório os doentes foram avaliados para potenciais complicações ao dia 3, 30, 180, 270 e 360. A dor foi avaliada antes da cirurgia, 24 horas e 72 horas depois da cirurgia. RESULTADOS: Ocorreram apenas 3 (em 197) casos de recorrência da unha encravada. Antes da cirurgia registou-se exsudação em 82% dos doentes sendo que na primeira visita após a cirurgia este número foi reduzido para 19%. Observou-se ainda tecido de granulação persistente em 3% dos doentes (versus 75% antes da cirurgia). Os factores predisponentes mais frequentemente encontrados para unha encravada foram o corte excessivo da porção lateral da placa ungueal (63%), hiperhidrose plantar (58%) e pregas ungueais espessadas (39%). A dor teve uma redução dramática após a cirurgia. CONCLUSÃO: É assumido que os procedimentos químicos para a unha encravada estão associados com longos tempos de cura mas os nossos resultados mostraram uma rápida recuperação. No tratamento da unha encravada a matricectomia parcial com ácido tricloroacético a 80% é um método rápido, eficaz e de fácil execução. .

Analysis of the effect of the two kinds of operation mode the treatment of high anal fistula / 中国基层医药

Objective To investigate the treatment of moed high anal fistula operation.Methods 110 cases of high anal fistula patients were randomly divided into the incision line selective suture group(treatment group 55 cases) and incision group(55 cases in the control group),on two groups of treatment time,the cure rate,the anal function were analyzed.Results The cure rate of the treatment group and control group were 98 ％,86％,respectively,the cure rates of two groups have no significant difference (x2 =1.557,P ＞ 0.05),the healing time and postoperative anal function evaluation in treatment group was superior than those in control group (t =3.440,4.671,all P ＜ 0.01).Conclusion Incisionunder selective suture in the treatment of high anal fistula operation is a better way.

Utilidade da técnica de fechamento cirúrgico "ponto em alfa" na onicocriptose / Benefits of the alpha stitch technique in surgical closure in onychocryptosis

Introdução: Aspecto pouco avaliado da onicocriptose ­ principal causa de cirurgia do aparelho ungueal ­ é como deve ser realizado o fechamento cirúrgico. Descreve-se nova técnica denominada "ponto alfa" que permite a retificação da dobra ungueal por posicioná-la no nível da placa ou abaixo dela. Objetivo: Demonstrar a utilidade da técnica de fechamento cirúrgico "ponto alfa" na matricectomia cirúrgica da onicocriptose. Métodos: Selecionados 20 pacientes com onicocriptose graus II e III, submetidos à matricectomia cirúrgica com acompanhamento durante seis meses. O fechamento cirúrgico foi realizado com a técnica "ponto alfa". Resultados: No total, 27 dobras ungueais laterais foram operadas, 81,8% delas com resultado esperado, e 18,1% com resultado duvidoso. Conclusões: O "ponto alfa" permite correta cicatrização da dobra ungueal retificada, posicionada no nível da placa ungueal ou abaixo dela, com bons resultados estéticos, rápida recuperação, mínima morbidade e baixo número de recidivas. Poderá ser usado em procedimentos cirúrgicos de outras afecções ungueais.

Introduction: A poorly described aspect of onychocryptosis ­ the main cause for nail unit surgeries ­ is how to perform its surgical closure. The present article describes a new technique denominated alpha stitch that allows the straightening out of the nail fold by positioning it at or below the nail plate's level.Objective: To demonstrate the benefits of the alpha stitch surgical closure technique in the surgical matricectomy for onychocryptosis.Methods: Twenty patients with onychocryptosis grades II and III underwent surgicalmatricectomy and were followed up for six months. The surgical closure was performed using the alpha stitch technique.Results: A total of 27 lateral nail folds were operated, with 81.8% yielding the expected result, and 18.1% presenting uncertain outcomes.Conclusions: The alpha stitch allows the proper healing of the straightened out nail fold, which is positioned at or below the nails plate's level, with good results, fast recovery, minimal morbidity and a small number of recurrences. The technique can also be used in surgical procedures involving other nail disorders.

Synchronous subungual glomus tumors in the same finger / Tumores glômicos subungueais sincrônicos no mesmo dedo

The glomus tumor is an uncommon benign neoplasm of glomus cells. In the majority of the cases it is presented as a solitary painful papule in the subungual region. We report a rare case of a patient with two individual synchronous glomus tumors under the nail bed of the same finger.

O tumor glômico é uma neoplasia benigna de células glômicas. Na maioria dos casos se apresenta como uma pápula solitária dolorosa na região subungueal. Relatamos o caso raro de um paciente com dois tumores glômicos sincrônicos sob o leito ungueal do mesmo dedo.

Avaliação histológica comparativa da eficácia de ácido tricloroacético e subcisão, isolados e combinados, no tratamento de estrias abdominais / Comparative histological evaluation of the effectiveness of trichloroacetic acid and subcision (isolated or combined) in the treatment of abdominal striae

Introdução: estrias são consideradas cicatrizes, não sendo conhecidos tratamentos resolutivos para essa condição. Objetivo: comparar a resposta de três modalidades terapêuticas: subcisão , subcisão + ATA 20% e ATA 20% no tratamento de estrias. Métodos: 11 pacientes portadoras de estrias em abdômen inferior, dividido em quadrantes: uma estria de cada quadrante foi submetida a: subcisão, subcisão + ATA 20% e ATA 20%, respectivamente. O quarto quadrante foi utilizado como controle. Cada estria selecionada foi biopsiada antes e após 12 semanas. Para avaliar a eficácia, utilizou-se o teste de Wilcoxon. Para ava-liar comparativamente as diferenças entre os tratamentos foi aplicado o teste de Kruskal-Wallis. Resultados: Em todos os tratamentos realizados houve redução da média pré e pós-tratamento; no entanto, o tratamento com ATA 20% mostrou-se estatisticamente significativo no parâmetro epidérmico e na coloração de fibras colágenas. A subcisão associada ao ATA 20% teve resultado estatisticamente significativo no parâmetro derme superficial enquanto a subcisão isolada mostrou-se significativa apenas na derme superficial. Realizou-se uma sessão de tratamento, sendo necessários estudos subsequentes para avaliação clinico-histológica após número maior de sessões. Conclusões: Os tratamentos propostos são seguros e de baixo custo operacional, sendo ótima opção para estrias abdominais.

Introduction: Abdominal striae(i.e. stretch marks) are considered scars, for which there are no known treatments. Objective: To compare the effectiveness of three treatments: subcision, 20% trichloroacetic acid, and subcision + 20% trichloroacetic acid in the treatment of stretch marks. Methods: The lower abdomens of 11 patients with stretch marks were divided into four quadrants. Each patient had one stria selected for a single treatment session; the three treatments (subcision, 20% trichloroacetic acid, and subcision + 20% trichloroacetic acid) were administered in 3 quadrants, and the 4th quadrant served as a control. Each selected stria was biopsied before and after 12 weeks. The Wilcoxon test was used to evaluate the efficacy of the treatment. The Kruskal-Wallis test was used to evaluate the differences between the treatments. Results: In all treatments there was a reduction in the mean value after treatment, however the 20% trichloroacetic acid treatment was statistically significant for the epidermalparameter and the collagen fiber staining. The subcision associated with 20% trichloroacetic acid presented a statistically significant result in the superficial dermis parameter, while the isolated subcision was significant in the superficial dermis parameter only. Conclusions: These treatments are safe and present low operating costs, which make them a great alternative for treating abdominal striae. Future studies should conduct a clinical-histological evaluation after a greater number of sessions.

Correção de defeitos cirúrgicos grandes: técnica da dupla cerclagem / Correction of large surgical defects: double cerclage technique

Feridas cirúrgicas de grandes dimensões requerem fechamento através de retalhos ou enxertos, muitas vezes de difícil execução. A técnica da dupla cerclagem constitui alternativa eficaz para o fechamento direto, mesmo que parcial, desse tipo de defeito. Demonstraremos caso ilustrativo da técnica.

Large surgical wounds can be closed using flaps or grafts, which are often difficult to carry out. The double cerclage technique is an effective option for direct ? though partial ? closure of this type of incision. The technique will be demonstrated using an illustrative case.

M-plastia pós-ajustada / Post-adjusted M-plasty

M-plastia pós-ajustada pode ser usada em qualquer defeito cirúrgico passível de fechamento por aproximação direta das bordas, evitando formação de protrusões apicais. É realizada sem planejamento prévio, sendo retirado tecido somente quando houver protrusão percebida pelo cirurgião no ato cirúrgico. Possui as vantagens de poupar tecido sadio, adaptar as incisões às linhas de força, rugas e unidades de junção cosmética de cada paciente, além da possível utilização do pedículo do M como pequeno retalho de avanço. Neste trabalho, é relatado o passo a passo desse procedimento cirúrgico, evidenciando suas diferenças e vantagens quando comparado à M-plastia tradicional.

Post-adjusted M-plasty can be used in any surgical defect that can be closed by direct approximation of the borders to avoid the formation of apical protrusions. It is performedwithout prior planning; the tissue is removed only if the surgeon detects a protrusion during surgery. This method offers the advantage of sparing healthy tissue by adjusting the incisions to each patient?s skin?s tension lines, wrinkles and junctions of cosmetic units, in addition to the possible use of the ?M?s pedicle as a small advancement flap. This study describes the procedure step by step, highlighting the differences and advantages compared to traditional M-plasty.