Mechanical evaluation of tibial fixation of the hamstring tendon in anterior cruciate ligament double-bundle reconstruction with and without interference screws

OBJECTIVE: The objective of this study was to compare two postero-lateral bundle (PLB) tibial fixation techniques for the reconstruction of the anterior cruciate ligament with double bundle: a technique without the use of an interference screw, preserving the native tibial insertion of the tendons of the gracilis and semitendineous muscles, and a technique with the use of an interference screw and without preserving the insertion of the tendons. METHODS: A comparative study was conducted in cadavers with a universal mechanical test machine. In total, 23 cadaver knees were randomized for tibial fixation of the PLB using the two techniques: Maintaining the tibial insertion of the tendons during reconstruction, without the use of an interference screw (group A, 11 cases); and fixating the graft with an interference screw, without maintaining the insertion of the tendons (group B, 12 cases). A continuous traction was performed (20 mm/min) in the same direction as the produced tunnel, and force (N), elongation (mm), rigidity (N/mm), and tension (N/mm2) were objectively determined in each group. RESULTS: Group A exhibited a maximum force (MF) of 315.4±124.7 N; maximum tension of 13.57±3.65 N/mm2; maximum elongation of 19.73±4.76 mm; force at the limit of proportionality (FLP) of 240.6±144.0 N; and an elongation at the limit of proportionality of 14.37±6.58 mm. Group B exhibited a MF of 195.7±71.8 N; maximum tension of 8.8±3.81 N/mm2; maximum elongation of 15.3±10.73 mm; FLP of 150.1±68.7 N; and an elongation at the limit of proportionality of 6.86±2.42 mm. When comparing the two groups, significant differences were observed in the variables of maximum force (p=0.016), maximum tension (p=0.019), maximum elongation (p=0.007), and elongation at the limit of proportionality (p=0.003). CONCLUSION: The use of the native insertion of the semitendineous and gracilis tendons, without an additional fixation device, presented mechanical superiority over their fixation with interference screws.

Reconstrucción mínimamente invasiva del ligamento anterolateral / Minimally invasive anterolateral ligament reconstruction following anterior cruciate ligament revision surgery: technical note

INTRODUCCIÓN: La inestabilidad anteroposterior y la laxitud rotatoria demostrada mediante test de pivot-shift severo podría estar causada por la combinación de lesión de ligamento cruzado anterior (LCA) y de estructuras laterales de la rodilla, particularmente del ligamento anterolateral (LAL). Este último actúa como estabilizador secundario, restringiendo la rotación interna y complementando el rol primario de estabilización del LCA. MATERIAL Y MÉTODOS: Describir la técnica de reconstrucción mínimamente invasiva del LAL tras realizar una cirugía de revisión del LCA. Además, se ofrece una breve descripción de las indicaciones quirúrgicas, resultados y complicaciones. DISCUSIÓN: La inestabilidad rotatoria persistente tras la reconstrucción de LCA indica que la reconstrucción intraarticular podría no ser suficiente para restaurar la estabilidad rotacional en un subgrupo específico de pacientes. Se han descrito numerosas técnicas de reconstrucción extraarticulares (mencionadas previamente), algunas de ellas con incisiones de gran tamaño, con los consiguientes problemas estéticos. Esta nota describe una técnica simple y mínimamente invasiva de reconstrucción de LAL, realizada tras una revisión del LCA con técnica anatómica, todo en el mismo procedimiento quirúrgico. Esta técnica está indicada en roturas agudas o exploraciones/revisiones del LCA que presenten pivot-shift severo, así como también en pacientes con roturas crónicas del LCA o en pacientes que sean hiperlaxos. A pesar de que esta técnica no ha demostrado ser superior a otras reconstrucciones extraarticulares del LAL, se presenta como una cirugía simple, confiable y rápida, con buenos resultados estéticos.

INTRODUCTION: Anteroposterior instability and rotatory laxity demonstrated by severe pivot-shift test may be caused by combined lesions of the anterior cruciate ligament (ACL) and lateral structures of the knee, particularly the anterolateral ligament (ALL). This ligament acts as a secondary stabiliser that restrains internal rotation and supplements the primary stabilising role of the ACL. MATERIAL AND METHODS: To describe a minimally invasive ALL reconstruction technique following anterior cruciate ligament revision surgery. Brief description of surgical indications, outcomes, and complications. DISCUSSION: Persistent rotatory instability after ACL reconstruction suggests that intra-articular reconstruction may not be sufficient to restore rotational stability in a subgroup of patients. Numerous extra-articular reconstruction techniques have been described with long incisions and cosmetic issues. A description is presented of a simple, minimally invasive ALL reconstruction technique performed after anatomical ACL revision in a single procedure. This technique is indicated in patients with acute ACL injuries and revision ACL associated with a severe pivot-shift, chronic ACL injuries, and joint hyper-laxity. Although this technique has not proven to be superior to any other extra-articular anterolateral ligament reconstructions, it uses simple, reliable and cosmetic surgery, with good early results in a small series of patients.

Flow-through anastomosis using a T-shaped vascular pedicle for gracilis functioning free muscle transplantation in brachial plexus injury

OBJECTIVE: In gracilis functioning free muscle transplantation, the limited caliber of the dominant vascular pedicle increases the complexity of the anastomosis and the risk of vascular compromise. The purpose of this study was to characterize the results of using a T-shaped vascular pedicle for flow-through anastomosis in gracilis functioning free muscle transplantation for brachial plexus injury. METHODS: The outcomes of patients with brachial plexus injury who received gracilis functioning free muscle transplantation with either conventional end-to-end anastomosis or flow-through anastomosis from 2005 to 2013 were retrospectively compared. In the flow-through group, the pedicle comprised a segment of the profunda femoris and the nutrient artery of the gracilis. The recipient artery was interposed by the T-shaped pedicle. RESULTS: A total of 46 patients received flow-through anastomosis, and 25 patients received conventional end-to-end anastomosis. The surgical time was similar between the groups. The diameter of the arterial anastomosis in the flow-through group was significantly larger than that in the end-to-end group (3.87 mm vs. 2.06 mm, respectively, p<0.001), and there were significantly fewer cases of vascular compromise in the flow-through group (2 [4.35%] vs. 6 [24%], respectively, p=0.019). All flaps in the flow-through group survived, whereas 2 in the end-to-end group failed. Minimal donor-site morbidity was noted in both groups. CONCLUSIONS: Flow-through anastomosis in gracilis functioning free muscle transplantation for brachial plexus injury can decrease the complexity of anastomosis, reduce the risk of flap loss, and allow for more variation in muscle placement. .

Use of local muscle flaps to cover leg bone exposures / Uso de retalhos musculares locais para cobertura de exposições ósseas na perna

Objective: To evaluate the use of the medial gastrocnemius muscle and/or soleus muscle flaps as surgical treatment of the leg bone exposure. Methods: We retrospectively analyzed the medical records of patients undergoing transposition of the medial gastrocnemius and / or soleus for treating exposed bone in the leg, from January 1976 to July 2009, gathering information on epidemiological data, the etiology the lesion, the time between the initial injury and muscle transposition, the muscle used to cover the lesion, the healing evolution of the skin coverage and the function of the gastrocnemius-soleus unit. Results: 53 patients were operated, the ages varying between nine and 84 years (mean age 41); 42 were male and 11 female. The main initial injury was trauma (84.8%), consisting of tibia and / or fibula fracture. The most frequently used muscle was the soleus, in 40 cases (75.5%). The rank of 49 patients (92.5%) was excellent or good outcome, of three (5.6%) as regular and of one (1.9%) as unsatisfactory. Conclusion: the treatment of bone exposure with local muscle flaps (gastrocnemius and/or soleus) enables obtaining satisfactory results in covering of exposed structures, favoring local vascularization and improving the initial injury. It offers the advantage of providing a treatment in only one surgical procedure, an earlier recovery and reduced hospital stay. .

Objetivo: avaliar o uso de retalhos de porção medial do músculo gastrocnêmio e/ou de músculo sóleo como tratamento cirúrgico de exposição óssea da perna. Métodos: foram analisados, retrospectivamente, os prontuários de pacientes submetidos à transposição dos músculos gastrocnêmio medial e/ou sóleo para tratar exposição óssea na perna, no período de janeiro de 1976 a julho de 2009. Foram avaliados, além dos dados epidemiológicos, a etiologia da lesão, o intervalo de tempo decorrido entre a lesão inicial e a transposição muscular, o músculo utilizado para cobrir a lesão, a evolução da cicatrização da cobertura cutânea e a função da unidade gastrocnêmio-sóleo. Resultados: foram operados 53 pacientes, variando a faixa etária entre 09 e 84 anos (média de idade de 41 anos), sendo 42 do sexo masculino e 11 do sexo feminino. A lesão inicial principal foi de origem traumática (84,8%), consistindo de fratura de tíbia e/ou fíbula. O músculo utilizado com maior frequência foi o sóleo em 40 casos (75,5%). Classificou-se 49 pacientes (92,5%) como resultado excelente ou bom, 03 (5,6%) como regular e 01 (1,9%) como insatisfatório. Conclusão: o tratamento da exposição óssea com retalhos musculares locais (gastrocnêmio e ou sóleo) possibilita a obtenção de resultados satisfatórios na cobertura das estruturas expostas, favorecendo a vascularização local e melhora da lesão inicial. Apresenta como vantagens a realização do tratamento em um só tempo cirúrgico, uma recuperação mais precoce e diminuição do tempo de internação. .

A gastrocnemius heterotopical transplant model with end-to-side neurorraphy

PURPOSE: To present an animal model to assess the effects of end-to-side innervation in the heterotopically transplanted model with reduced chances of neural contamination. METHODS: The medial portion of the gastrocnemius muscle in wistar male rats was isolated and its pedicle dissected and performed a flap in the abdominal portion. To prevent neural contamination in the abdominal region, the muscle was wrapped with a Goretex(r) sheet. The specimens were divided into 2 groups (G). In G1 was performed an end-to-end suture between tibial nerve of the gastrocnemius and femoral motor nerve and between the saphenous sensory nerve and the motor nerve. In G2 was performed a end-to-side suture between the tibial nerve and the motor femoral and between the tibial nerve and saphenous motor nerve. The specimens were evaluated 60 days later to check the structure of the neurorraphy. Sections were obtained proximal and distal to the coaptation site. RESULTS: The medial gastrocnemius muscle had the advantage of maintaining visible mass after 60 days. No disruption of the coaptation site was found. No major injury to the donor nerve was seen in group 2. CONCLUSION: The proposed model is simple, reproduciple and prevent the neural contamination in the flap in end-to-side suture. .

Reabilitação na paralisia parcial do plexo braquial / Rehabilitation after partial brachial plexus palsy

Muitas transferências musculares têm sido defendidas para restaurar os movimentos do membro superior após paralisia grave do plexo braquial. A paralisia dos músculos deltoide e supraespinal pode ser tratada por meio de transferência do músculo trapézio. A paralisia dos músculos extensores de punho, mão e dedos, quando o nervo mediano está preservado, pode ser corrigida com emprego dos músculos pronador redondo, flexor ulnar do carpo e palmar longo. Os autores descrevem um caso de reabilitação de paciente portador de lesão parcial antiga do plexo braquial à direita, de predomínio em tronco superior, principalmente da raiz de C6 e de fascículo posterior. Foi evidenciada fraqueza dos músculos deltoide e extensores do punho e dos dedos, sem antecedentes de reparo microcirúrgico do plexo braquial. Foi realizada, inicialmente, cirurgia de transferência tendínea para ganho de extensão de punho, mão e dedos e, após um ano, transferência do músculo trapézio, para estabilização do ombro. O sucesso na transferência para tratamento de paralisia do plexo braquial requereu especialização do cirurgião, motivação do paciente e programa de reabilitação.

A variety of muscle transfer techniques have been proposed to restore motion of the upper extremities following severe brachial plexus palsy. Paralysis of the deltoid and supraspinatus muscles can be treated with transfer of the trapezius muscle. Paralysis of the wrist, hand, and digital extensor muscles can be corrected using the pronator teres, flexor carpi ulnaris, and palmaris longus muscles if the median nerve is preserved. Here we describe the rehabilitation of a patient with an old partial injury to the right brachial plexus that primarily involved the upper trunk from the C6 root to the posterior cord. Weakness of the deltoid muscle, wrist, and digital extensor muscles was observed. Microsurgical repair of the brachial plexus had not been performed. Tendon transfer surgery was performed to improve wrist, hand, and digital extension. One year later, transfer of the trapezius muscle was performed to stabilize the shoulder. The success of muscle transfer in the treatment of the brachial plexus palsy required the surgeon's specialization, the patient's motivation, and a rehabilitation program.

Muscle reinnervation in one or two stages?: experimental study in rats with end-to-side nerve graft / Reinervação muscular em um ou dois estágios?: estudo experimental em ratos com enxerto de nervo término-lateral

PURPOSE: To compare muscle reinnervation in one and two surgical stages using end-to-side neurorrhaphy (ESN) without donor nerve injury. METHODS: The experiment was performed on four groups of 20 rats. Group 1 (G1), one stage, received the graft which was sutured to the tibial nerve, with ESN, and its free stump was sutured end-to-end to the distal stump of the sectioned peroneal nerve (PN), all in the same operation. In Group 2 (G2), two stages, the nerve graft was sutured to the tibial nerve, with ESN. Two months later the PN was sectioned and its distal stump connected to the distal stump of the graft as in G1. Normal control group (Gn) received the graft only sutured to the tibial nerve, with ESN. Denervated control group (Gd), as well received the graft and had the PN sectioned and its two stumps buried in adjacent musculature, with the aim of denervating the cranial tibial muscle (CTM), the target of this study. The parameters used to evaluate CTM reinnervation were muscle mass, muscle fiber's minimum diameter and area. RESULTS: The mean CTM mass, the average of the muscular fibers areas and the average of the muscular fiber minimum diameters was higher (all p<0.0001) in G2 than in G1. Comparing the four groups, these parameters had their maximum expression in Gn and the minimum in Gd, as expected. CONCLUSION: The two stages showed better muscle reinnervation than one stage.

OBJETIVO: Comparar a reinervação muscular com enxerto de nervo em um e dois tempos operatórios, utilizando a neurorrafia término-lateral (NTL) sem lesão do nervo doador. MÉTODOS: Vinte ratos foram distribuídos em quatro grupos. O grupo 1 (G1), um estágio, recebeu o enxerto que foi suturado ao nervo tibial (NT), por meio de NTL, e seu coto livre foi suturado por NTL ao coto distal do nervo peroneal (NP), seccionado a um centímetro do NT, na mesma cirurgia. O grupo 2 (G2), dois estágios, recebeu o enxerto de nervo na primeira cirurgia, como já descrito. Dois meses depois, na segunda cirurgia, o NP foi seccionado e seu coto distal ligado ao coto distal do enxerto como em G1. O grupo controle de normalidade (Gn) recebeu o enxerto da mesma forma, apenas. E o grupo controle de denervação (Gd), além de receber o enxerto, teve o NP seccionado e seus cotos sepultados na musculatura adjacente, com a finalidade de denervar o músculo tibial cranial (MTC), alvo deste estudo. Os parâmetros utilizados para avaliar a reinervação do MTC foram massa muscular, diâmetro mínimo da fibra muscular e área. RESULTADOS: O grupo G2 apresentou superioridade (p<0,0001) em relação ao G1 na massa do MTC, no diâmetro mínimo e na área das fibras musculares. Na comparação entre os quatro grupos, estes mesmos parâmetros tiveram sua expressão máxima em Gn e mínima em Gd, como era esperado. CONCLUSÃO: A reinervação muscular em dois estágios apresenta melhor resultado quando comparada à técnica em um tempo.

Anterolateral thigh free flap for the reconstruction of through and through defect of cheek following cancer ablation.

The anterolateral thigh flap is a highly versatile and reliable flap for use in the reconstruction of various soft-tissue defects of the head and neck. This flap has gained great popularity due to its versatility, ability for a two-team approach, and minimal donor site morbidity. However, it has not met the same enthusiasm in the armamentarium of Maxillofacial Surgeons due to its relative difficulty in perforator dissection, reported variations of the vascular anatomy, and the presumed increased thickness of the anterolateral thigh tissue. These obstacles may be overcome by increased surgical experience and by the ability to create a thinner suprafacial flap or thinning the flap after it has been obtained. We have described the versatility of this flap for the reconstruction of the through and through defect of cheek following cancer ablation along with difficulties in raising flap.

Biceps femoris muscle transposition for treatment of cranial cruciate ligament rupture in small breed dogs

The purpose of this study was to evaluate a new extracapsular surgical technique for the treatment of cranial cruciate ligament rupture in small breed dogs. Nine small breed dogs (seven females and two males) weighing < or = 15 kg were treated with biceps femoris muscle transposition (BFT). The duration of the BFT procedure was 20 min. Each patient underwent a standard clinical protocol and a questionnaire for the owners. Follow-up (at 1, 3, and 12 months postoperative) confirmed significant improvement in all patients, especially at 1 month postoperatively (p < 0.01) and again after complete stifle joint assessment at 3 months postoperatively. After 12 months, only two patients showed a slight increase in osteoarthritis. According to our results, BFT is a simple extracapsular surgical technique that can be used for the treatment of cranial cruciate ligament rupture in small breed dogs.

Colgajo fasciomuscular del gastrocnemio medial: presentación de un caso / Fasciomuscular flap of the medial gastrocnemius: a case presentation

Los colgajos musculares regionales constituyen actualmente una herramienta básica en la reconstrucción de los defectos fasciomiocutaneos y óseos, por su fácil disección, preservación de pedículos vasculares y aumento del aporte sanguíneo de la zona dañada. Caso clínico: paciente masculino, de piel blanca de 38 años de edad, con antecedentes de haber sufrido una fractura abierta del tercio superior de la tibia tipo II de Gustilo-Anderson; por accidente automovilístico, de urgencia se le colocó un fijador externo modelo RALCA, y posteriormente se le realizó osteosíntesis con el sistema AO (láminas y tornillos). Se usó el colgajo fasciomuscular del gastrocnemio medial para cubrir el defecto óseo en el tercio superior de la tibia derecha provocado por una osteomielitis crónica de dos años de evolución. Conclusiones: se demostró su eficacia, al ser utilizado como resolución definitiva de los defectos de larga y tórpida evolución para, de esta forma, generalizar su uso; por considerarse en la actualidad como una técnica de primera elección en la cirugía reconstructiva de la extremidad inferior.

Regional myocutaneus flaps, are currently considered a basic tool in the reconstruction of fasciomyocutaneous and bone defects because of their easy dissection, vascular pedicle preservation, and increase blood supply to the damaged area. Clinical case: a 38-year-old, white and male patient was presented with a history of having suffered an open fracture of the upper third of tibia type II of Gustilo-Anderson; by a car accident. A RALCA model, external fixator was placed and subsequently was made the osteosynthesis with the AO system (plates and screws). Myofascicular flap of the gastrocnemius muscle was used to cover bone defects of the upper third of the right tibia caused by chronic osteomyelitis, of two years of evolution. Conclusions: the effectiveness of this method of treatment is demonstrated as a definite solution for bone defects with a long and torpid evolution. Its generalized use should be considered as a primary election technique in reconstructive surgery of the lower extremity.

Uso de colgajos musculares en las perforaciones traumáticas del esófago / Use of muscular flaps to repair traumatic esophageal perforations: report of two cases

The management of esophageal perforations is variable, ranging from conservative management to esophageal excision. Muscular flaps are used specially when there are associated lesions in trachea or aorta. We report two patients managed using this last technique. A 31 years old woman that received a gun shot in the neck that was operated, repairing two tracheal and two esophageal perforations. The patient had to be reoperated 28 days later, due to a dehiscence of the esophageal suture. A muscular flap was used to repair the lesion with a good postoperative evolution. A 17 years old male that received a gunshot in the left supraclavicular region. Eight days later, he was operated, draining a right empyema and repairing an esophageal perforation using a muscular flap. The patient had a good postoperative evolution.

Las perforaciones del esófago, especialmente las de manejo tardío, representan un dilema y un reto para el cirujano. El manejo de las perforaciones tardías ha sido controversial y las opciones terapéuticas incluyen desde manejo conservador y simple drenaje hasta la resección del esófago. Se presentan 2 casos de perforaciones esofágicas producidas por proyectil de arma de fuego referidos a los 28 y 8 días respectivamente. En ambos se realizó reparación primaria reforzada con colgajo muscular.

Colgajo miocutáneo de gastrocnemius medial con isla triangular de piel y cierre en V-Y / Gastrocnemius muscle myocutaneous flap with a triangular skin isle and V-Y closure: report of five patients

A gastrocnemius muscle myocutaneous flap with a triangular skin isle and V-Y closure can be used to correct cutaneous defects with exposure of the proximal part of the tibia. The advantages of this technique are an excellent irrigation and the cutaneous closure using a flap in a zone that is exposed to multiple trauma. The presence of a arteriovenous perforating vessel previously located with color Doppler, ensures the vitality of the flap. We report five males patients aged 20 to 70 years, in whom this technique as used to correct traumatic defects of a mean diameter of 11 cm. All flaps remained viable.

Para corregir defectos cutáneos con exposición de fractura de tibia a nivel del tercio proximal, una buena alternativa es el colgajo miocutáneo de gastrocnemius medial con isla triangular de piel con cierre en V-Y. Las ventajas estriban en la excelente irrigación del colgajo, y en proporcionar un cierre cutáneo con colgajo, en una zona expuesta a múltiples traumatismos. El hecho de tener una perforante arterio venosa previamente ubicada con doppler color, asegura la vitalidad del colgajo. Se presenta la experiencia del Servicio de Cirugía Plástica del Hospital del Trabajador de Santiago consistente en 5 pacientes masculinos en los que se realiza un colgajo de perforante de gastrocnemius medial, con edad entre 20 y 70 años. La etiología del defecto fue traumática. El defecto a corregir fue en promedio de 11 cms de diámetro. Todos los colgajos fueron viables. Se destaca que este es un colgajo inédito, descrito por primera vez por el autor principal en el año 2006.

Muscle graft as a substitute for peripheral nerve graft in rats / Enxerto de músculo como substituto de nervo periférico em ratos

PURPOSE: To evaluate the applicability of the use of autogenous muscle treated in various ways, as a substitute of the nerve grafts. METHODS: Rats were divided into seven groups that received, as a treatment for a standard nerve injury, the following types of grafts: fresh muscle, muscle fixed with 10 percent formaldehyde, muscle frozen in a freezer, muscle frozen in refrigerator, nerveless muscle, peripheral nerve and a group was without any treatment. It assessed the histological appearance of the nerve fibers in the segment repaired. RESULTS: The evaluation of the segment nervous repaired showed nerve fibers through the graft in almost all groups, but the methodology employed has not adequately characterized the differences between the groups. CONCLUSION: This study showed the migration of nerves fibers through all grafts used.

OBJETIVO: Avaliar a aplicabilidade do uso de músculo autógeno, tratado de diversas maneiras, em substituição aos enxertos de nervo. MÉTODOS: Os ratos foram separados em sete grupos que receberam, como tratamento a uma lesão nervosa padronizada, os seguintes tipos de enxertos: músculo fresco, músculo fixado com formol 10 por cento, músculo congelado em freezer, músculo congelado em refrigerador, músculo denervado, nervo periférico e um grupo ficou sem qualquer tratamento. Foi avaliado o aspecto histológico das fibras nervosas no segmento reparado. RESULTADOS: A avaliação do segmento nervoso reparado mostrou que existiam axônios em quase todos os grupos, mas a metodologia empregada não possibilitou caracterizar adequadamente as diferenças entre os grupos. CONCLUSÃO: Este estudo mostrou a migração de axônios por meio de todos os enxertos utilizados.

Aspectos da distribuição de tecidos músculo-esqueléticos de um banco de tecidos / Aspects of the distribution of musculoskeletal tissues by a tissue bank

OBJETIVO: Avaliar as características da distribuição desses por um Banco de Tecidos no Brasil. MÉTODOS: Base de dados do Banco de Tecidos entre setembro de 2006 e junho de 2008. Características dos receptores foram tabuladas. Os tipos de tecidos processados foram: cabeças femorais, osso metafisio-epifisário, osso cortical, ossos curtos ou chatos e tendões. O destino dos enxertos foi analisado. Frequências das distribuições foram obtidas e analisadas. RESULTADOS: Foram distribuídas 734 unidades tecidos fresco-congelados, transplantadas em 683 receptores. Doadores de múltiplos órgãos originaram 97,9 por cento dos tecidos e doadores vivos os demais. Foram transplantados 489 unidades de osso córtico-esponjoso, 137 de osso metafisio-epifisário, 44 de osso chato ou curto, 3 de tendão, 29 de osso particulado e 32 de cabeças femorais. A média de idade dos receptores foi 50,3 anos, sendo 59,5 por cento do sexo feminino e 40,5 por cento do masculino. Os tecidos foram destinados para uso ortopédico em 21,1 por cento dos casos e buco-maxilo-facial, em 78,9 por cento. CONCLUSÃO: O Banco de Tecidos aumentou o número de distribuições em resposta à demanda crescente de tecidos, principalmente para uso em cirurgia buco-maxilo-facial.

OBJECTIVE: Is to evaluate the characteristics of the distribution of these grafts by a Tissue Bank in Brazil. METHODS: Tissue Bank database from September 2006 to June 2008. The characteristics of the recipients were drawn up in the table form. The types of tissue processed were: femoral heads, metaphyseal-epiphyseal bone, cortical bone, flat or short bones and tendons. The intended purpose of the grafts was analyzed, and distribution frequencies were also obtained and analyzed. RESULTS: Altogether, 734 units of fresh-frozen tissue were distributed and transplanted into 683 recipients. In terms of origin of the tissues, 97.9 percent came from multiple organ donors, and the remainder from living donors. A total of 489 units of cortical bone were transplanted, 137 of metaphyseal-epiphyseal bone, 44 of short or flat bones, 3 of tendon, 29 of particulate bone and 32 femoral heads. The mean age of the recipients was 50.3 years; 59.5 percent were women and 40.5 percent men. The tissues were used in orthopedic surgeries in 21.1 percent of the cases, and in oral and maxillofacial procedures in 78.9 percent. CONCLUSION: The Tissue Bank has increased the number of distributions in response to the growing demand for tissues, particularly for use in oral and maxillofacial procedures.

Head and neck reconstruction using infrahyoid myocutaneous flaps

CONTEXT AND OBJECTIVE: The use of pedicled myocutaneous flaps in head and neck reconstruction is widely accepted. Here we describe our experience with infrahyoid flaps (IHFs) employed to cover surgical defects in the oral cavity and oropharynx in patients with benign and malignant tumors. The aim was to evaluate the success rate for infrahyoid myocutaneous flap procedures performed at a single institution. DESIGN AND SETTING: Retrospective study, at the Head and Neck Surgery Service, Unicamp. METHODS: Fourteen IHFs were used to reconstruct surgical defects in eleven men (78.5 percent) and three women (21.5 percent) with a mean age of 66.4 years. The anterior floor of the mouth was reconstructed in nine patients (64.2 percent), the base of tongue in three (21.4 percent), the lateral floor in one (7.1 percent), and the retromolar area (7.1 percent) in one. Thirteen patients (92.8 percent) had squamous cell carcinoma (SCC) and one (7.2 percent) ameloblastoma. The disease stage was T3 in eight (61.5 percent) of the SCC cases and T4 in five (38.5 percent). RESULTS: No patient presented total flap loss or fistula. The most common complication was epidermolysis, which delayed the beginning of oral ingestion. The patients with SCC received postoperative radiotherapy without major consequences to the flap. CONCLUSION: IHF is a safe and reliable procedure for reconstructing head and neck surgical defects. Due to its thinness and malleability, its use for oral cavity and oropharynx defects provides favorable cosmetic and functional outcomes. Complications, when present, are easy to manage.

CONTEXTO E OBJETIVO: O uso de retalhos miocutâneos pediculados para reconstrução cirúrgica na região de cabeça e pescoço (RCP) é consagrado. Apresentaremos a experiência com o uso do retalho infrahiódeo (RIH) em reconstrução de defeitos cirúrgicos na cavidade oral e orofaringe em portadores de tumores benignos e malignos. O objetivo foi avaliar o índice de sucesso do RIH em defeitos da cavidade oral em uma única instituição. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo, no Serviço de Cirurgia de Cabeça e Pescoço, Universidade Estadual de Campinas (Unicamp). MÉTODOS: Foram utilizados 14 RIH para reconstrução em RCP em 11 homens (78,5 por cento) e 3 mulheres (21,5 por cento). Em nove (64,2 por cento) pacientes, a reconstrução foi de assoalho oral anterior, três (21,4 por cento) de base de língua, um (7,1 por cento) de assoalho lateral e um de trígono retromolar (7,1 por cento). O carcinoma espinocelular (CEC) foi neoplasia presente em 13 deles (92,8 por cento) e um (7,2 por cento) ameloblastoma de mandíbula. O estádio era T3 em oito (61,5 por cento) e T4 em cinco (38,5 por cento) dos casos de CEC. RESULTADOS: Não houve caso de perda total do retalho ou fístula. A complicação mais comum foi epidermólise, retardando o início da ingestão oral. Pacientes com CEC receberam radioterapia pós-operatória sem conseqüências para o retalho. CONCLUSÃO: O RIH é um retalho seguro e confiável para o cirurgião de cabeça e pescoço na reconstrução na RCP. Devido à espessura e maleabilidade, sua utilização para reconstrução de defeitos da cavidade oral e orofaringe proporciona bom aspecto cosmético e funcional. Complicações são de fácil manuseio.

Enxerto autólogo de peritônio-fáscia-músculo, no canal inguinal de ratos / Peritoneal-fascia-muscle autologous graft in the inguinal canal of rats

OBJETIVO: Estudar um fragmento de tecido autólogo, constituído por peritônio-fáscia-músculo, implantado no nível da parede do canal inguinal e no funículo espermático de ratos a fim de verificar o comportamento histológico da pega e da integração tecidual. MÉTODOS: Trinta e seis ratos foram distribuídos em quatro grupos. Os ratos do grupo A, B, C e D foram submetidos a laparotomia mediana para obtenção dos espécimes a serem implantados. No grupo A, foi implantado tecido composto por peritônio e fáscia transversal na parede do canal inguinal. No B, o tecido implantado era acrescido de parte do músculo reto do abdome e implantado na parede do canal inguinal. No C, o tecido enxertado era semelhante ao do grupo A, agora enxertado no funículo espermático. No D, o tecido enxertado era semelhante ao grupo B, agora enxertado no funículo espermático. RESULTADOS: Após 21 dias de implante estes tecidos apresentavam histologicamente as seguintes alterações: os grupos A e C, tecido fibroadiposo com vasos dilatados, focos de fibrose e infiltrado linfoplasmocitário e os grupos B e D, tecido fibroadiposo com vasos dilatados, musculatura esquelética e focos de fibrose. A fibrose mostrou-se mais intensa nos grupos B e D. No grupo B, sempre encontramos o músculo esquelético, enquanto no grupo D este tecido estava presente em seis animais, quase que totalmente substituído por tecido fibroso em dois e ausente em um. CONCLUSAO: Todos os tecidos implantados sobreviveram e incorporaram-se no local, podendo ser útil na correção de defeitos do canal inguinal, nas situações em que o tecido autólogo estiver indicado.

Empleo del colgajo muscular sóleo, como cobertura de los defectos cutáneos / Use of soleus muscle flap as cover of skin defects

Se presentó un paciente de 38 años de dad que hace 5 años sufrió una fractura abierta de tibia derecha. Se trató quirúrgicamente con fijadores externos y evolucionó a una osteomielitis crónica. Se realizó necrectomía y secuestrectomía en varias ocasiones que resolvieron la lesión ósea, quedó como secuelas un defecto cutáneo en la cara anterointerna del tercio medio de la pierna con exposición de tejido óseo. En esta ocasión se utilizó como cobertura un colgajo con vascularización proximal del músculo sóleo, se complementó con injerto parcial de piel y evolucionó satisfactoriamente

Medical head of the gastrocnemius muscle with adipofascial extension flap for tibial bone coverage

The gastrocnemius muscle remains the workhorse for providing soft tissue over the knee and upper tibia. Other local flaps were described to be used as an alternative to the gastrocnemius muscle as for example the posterior fasciocutaneous flap and saphenous flap. In this study, ten cases of defects located along the upper two thirds of the tibia which were covered using the medial head of gastrocnemius muscle with adipofascial extension flap were described. Nine flaps survived completely and one flap had marginal loss of 1cm. it was noticed that an adipofascial extension up to 12 x 6 cm can be elevated simply, survives in most of the cases and enable the surgeon to cover the whole length of the upper two thirds of the tibia. Also, it can be used in cases of scarred leg skin, it preserves normal leg skin, it is easy to perform subsequent orthopaedic work underneath and effective in the treatment of osteomyelitis