Radiofrequency versus scalpel incision for upper blepharoplasty: a clinicopathologic and photo documentation comparison / Radiofrequencia versus lâmina fria em blefaroplastia superior: comparação clinicopatológica e foto documentação

Abstract Objective: The aim of this study is to compare scar appearance and the histopathological aspects of inflammatory response induced by the use of radiofrequency [RF] incision and a cold-blade scalpel incision in upper blepharoplasty surgery. Methods: This is a comparative, prospective, double-blind study that recruited 10 Caucasian patients from Oculoplastic Sector of Ophthalmological Center of Minas Gerais (Belo Horizonte, MG, Brazil) aged 60-70 years, Fitzpatrick skin types 3 and 4, with upper eyelid dermatochalasis and indication for upper blepharoplasty. These patients underwent upper blepharoplasty using RF incision in one eyelid (10 eyelids in total) and cold-blade incision in the contralateral eyelid (10 eyelids in total). The two techniques were compared for clinical scar appearance and histopathology of the excised tissue materials (i.e., upper eyelid skin). To evaluate clinical scar appearance, we employed two distinct methods: photo-documentation and statistical analysis of the assessment performed by two masked observers (oculoplastic specialists) that examined all patients during all the follow-up based on Vancouver scar scale criteria, which includes attributes related to scar's vascularization, thickness, pigmentation, and elasticity. Follow-up was performed on days 30, 60, and 180 after surgery. After the follow-up period, the collected data were statistically analyzed by using the Wilcoxon signed-rank test. Results: The eyelids incised with a scalpel displayed thicker scars (hypertrophic scars), which differed significantly only in the first month after surgery (p = 0.022). The two surgical techniques did not show statistically significant difference in vascularity, elasticity, or pigmentation of the scar during the follow up period (sixth postoperative month). Regarding the histopathological evaluation, the excised skin fragments exhibited the same patterns, except the cautery effect that was observed at the edges of the skin excised with RF, which showed 0.20-0.30-mm thick thermal damage. Conclusion: The two techniques did not show statistically significant difference in terms of scar appearance after the sixth postoperative month.

Resumo Objetivo: Este estudo comparou o aspecto da cicatriz e histopatologia da resposta inflamatória induzidas pelo uso de radiofrequência [RF] e incisão fria em blefaroplastia superior. Métodos: Trata-se de um estudo comparativo, prospectivo, duplo-cego, no qual foram selecionados dez pacientes da raça branca do Departamento de Plástica Ocular do Centro Oftalmológico de Minas Gerais, na faixa etária entre 60-70 anos, fototipos 3 e 4 pela classificação Fitzpatrick, que apresentavam dermatocalase com indicação de blefaroplastia superior. Estes pacientes foram submetidos à blefaroplastia superior com a utilização da RF em uma pálpebra (total de 10 pálpebras) e de incisão fria na pálpebra contralateral (total de 10 pálpebras). As duas técnicas foram comparadas quanto ao aspecto clínico da cicatriz e avaliação histopatológica do material excisado (pele de pálpebra superior). Para avaliação do aspecto clínico da cicatriz optamos por dois métodos: a fotodocumentação e análise estatística da avaliação de dois observadores oculoplásticos mascarados que examinaram os pacientes durante todo o período de follow-up baseado na escala de cicatrização de Vancouver que inclui atributos relacionados à vascularização, espessura, pigmentação e elasticidade. O seguimento foi feito com 30, 60 e 180 dias de pós operatório. Após o follow-up, foi realizada análise estatística dos dados através do Teste de Pontos com Sinais de Wilcoxon. Resultados: As pálpebras operadas com bisturi apresentaram tendência a cicatrizes mais grossas (hipertróficas) com diferença estatisticamente significativa apenas para o primeiro mês de cirurgia (p=0.022). Não houve diferença estatisticamente significativa entre vascularização, elasticidade e pigmentação entre as duas técnicas de cirurgia avaliadas. Em relação à avaliação histopatológica, os fragmentos de pele excisados apresentaram o mesmo padrão inflamatório com a exceção do efeito de cautério nas bordas das peles excisadas com RF, que variaram de 0,20-0,30mm de espessura de dano térmico. Conclusão: As duas técnicas não mostraram diferença estatisticamente significativa no aspecto clínico da cicatriz após o sexto mês pós-operatório.

Secondary healing strategy for difficult wound closure in invasive vulvar cancer: a pilot case-control study

OBJECTIVES: Despite the number of surgical advances and innovations in techniques over time, radical vulvectomy frequently results in substantial loss of tissue that cannot be primarily closed without tension, the mobilization of surrounding tissues or even the rotation of myocutaneous flaps. The aim of this study was to evaluate the feasibility of leaving the surgical vulvar open wound for secondary healing in situations where primary closure of the vulvar wound is not possible. METHODS: This case-control pilot study analyzed 16 women with a diagnosis of squamous cell carcinoma of the vulva who first underwent inguinofemoral lymphadenectomy, 6-week sessions of chemotherapy and 25 daily sessions of radiotherapy. Afterward, excision of the vulvar lesion with free margins was performed between January 2011 and July 2017. Twelve patients underwent primary closure of the wound (control), and in 4 patients, the surgical wound was left open for secondary healing by means of a hydrofiber (case). The inclusion criteria were a) FIGO-2009 stage II up to IIIC; b) squamous cell carcinoma; and c) no evidence of pelvic or extrapelvic disease or pelvic nodal involvement. The exclusion criteria were extrapelvic disease or pelvic nodal involvement, another primary cancer, or a poor clinical condition. ClinicalTrials.gov: NCT02067052. RESULTS: The mean age of the patients at the time of the intervention was 62.1. The distribution of the stages was as follows: II, n=6 (37 %); IIIA, n=1 (6%), IIIB, n=1 (6%) and IIIC, n=8 (51%). The mean operative time was 45 minutes. The hospital stay duration was 2 days. Full vulvar healing occurred after an average of 30 days in the control group and after an average of 50 days in the case group. CONCLUSION: A secondary healing strategy may be an option for the treatment of vulvar cancer in situations of non-extensive surgical wounds when primary closure of the wound is not possible.

Tissue microarray technology and collagen evaluation to analyze surgical trauma performed with usual blade or ultrasonic harmonic scalpels in rats

Abstract Purpose: To compare wound healing performed with cold blade (CSB) and ultrasonic harmonic scalpel (UHS) in the abdominal aponeurosis of rats. Methods: Eighty Wistar rats divided into two groups and underwent midline incision in the linea alba with cold blade and harmonic ultrasonic scalpel. Analysis were performed in subgroups of 10 animals after 3, 7, 14 and 21 days. Macroscopically was observed the presence of hematoma, infection, wound dehiscence, fistula and adherences. Microscopically were used collagen and immunohistochemical staining methods. Results: Macroscopic, complications showed no statistical difference. Immunohistochemical analysis for MMP-9 was more intense in UHS group (p<0.05). TGF β presented its lower expression in UHS group at 14 and 21 days, with no statistical difference at 3 and 7 days (p<0.05). α-AML expression appeared higher in UHS group after 14 days and remained similar in others (p<0.05). Collagen deposition had no change in type I, and increased in type III in UHS; at 7th day the deposition was higher in CSB group; at 14th was similar in both groups (p<0.001). Conclusion: UHS compared to the CSB has higher lesion area at the time of the incision; as well as it led to the delay of regeneration and scar maturation process.

Rectal application of argan oil improves healing of colorectal anastomosis in rats

Abstract Purpose: To investigate the possible effects of argan oil on the healing of colorectal anastomoses. Methods: I n Group 1 (sham), laparotomy was performed and the colon was mobilized. In the control (Group 2) and argan oil (Group 3) groups, colonic resection and anastomosis were applied. To the control and sham groups, 2 mL of 0.9% NaCl was administred rectally, and in the argan oil group, 2 mL/day argan oil was applied rectally for 7 days. Results: The mean bursting pressures of the argan oil and sham groups were significantly higher than the values in the control group. A significant difference was determined between the tissue hydroxyproline and prolidase levels of control group and other groups. Histopathologically, argan oil showed significant beneficial effects on colonic wound healing. In the argan oil and sham groups, the tissue malondialdehyde and fluorescent oxidation product levels were found to be lower and total sulfhydryl levels were higher than the control group. Conclusions: The rectally administered argan oil was observed to have significantly ameliorated wound healing parameters and exerted a significant antioxidant effect. This is the first study in the literature about the beneficial effects of argan oil on colorectal anastomoses.

Avaliação da eficácia de três marcadores imunoistoquímicos envolvidos nos diferentes tempos da cicatrização da ferida cirúrgica / Comparative efficacy of immunohistochemical markers in surgical healing

RESUMO Objetivo: avaliar a eficácia de três marcadores imunoistoquímicos envolvidos no processo de cicatrização de ferida cirúrgica. Métodos: estudo experimental em 40 ratos da raça Wistar, dos marcadores metaloproteinases e metaloproteinase da matriz 9 (MMP-9), fator de transformação do crescimento beta (TGF-β) e miofibroblasto e alfa actina de músculo liso (α-AML), estudados a partir de fragmentos de cicatriz cirúrgica de incisão abdominal envolvendo pele, aponeurose e peritônio. Os animais foram distribuídos em quatro subgrupos de dez de acordo com o dia da morte, programada em três, sete, 14 e 21 dias. Resultados: na expressão da MMP-9 ocorreu aumento progressivo de sua concentração, mais evidente do 7º ao 14º dias variando a imuno-expressão tecidual entre 2,65% e 11,50%.TGF- β mostrou expressão em nível alto no 3º dia, caiu no 7º, voltando a subir no 14º, com pequena queda no 21º dia variando a imuno-expressão tecidual entre 0,03% e 2,92%. A α-AML apresentou níveis com pouca variação e discreto aumento variando a imuno-expressão tecidual entre 0,88% e 3,23%. Conclusão: a MMP-9 se apresentou como melhor marcador, seguido pela TGF-β. Já o α-AML não se mostrou um bom sinalizador da evolução da reparação tissular.

ABSTRACT Objective: to evaluate the efficacy of three immunohistochemical markers involved in the wound healing process. Methods: experimental study of 40 Wistar rats of the markers metalloproteinases and matrix metalloproteinase 9 (MMP-9), beta transforming growth factor (TGF-β) and myofibroblasts and smooth muscle actin alpha (α-MLA) markers, studied from fragments of surgical scar of abdominal incision involving skin, aponeurosis and peritoneum. The animals were divided into four subgroups of ten according to the day of death, scheduled in three, seven, 14 and 21 days. Results: MMP-9 expression showed a progressive increase of its concentration, more evident from 7th to 14th days, varying the tissue immunoexpression between 2.65% and 11.50% . TGF- β showed expression at high level on the 3rd day, fell in the 7th, rising again in the 14th, with a small decrease in the 21st day, varying the tissue immunoexpression between 0.03% and 2.92%. The α-AML presented levels with little variation and a slight increase, varying the tissue immunoexpression between 0.88% and 3.23%. Conclusion: MMP-9 presented as the best marker, followed by TGF-β. However, α-AML was not a good indicator of the evolution of tissue repair.

The acute effects of preoperative ozone theraphy on surgical wound healing

ABSTRACT PURPOSE: To investigate the effects of preoperative rectal ozone insufflation on surgical wound healing over the proinflammatory cytokines and histopathological changes. METHODS: Twenty one rabbits were divided into 3 groups. Sham, surgical wound, and ozone applied (6 sessions, every other day 70 µg/mL in 12 mL O2-O3 mixture rectally) surgical wound groups were created. TNF-alpha and IL-6 levels from all rabbits were studied at the basal, 24th hour, and 72nd hour. The histopathological examination was done by removing the surgical scar tissue at the end of 72nd hour. RESULTS: TNF-alfa and IL-6 levels were significantly lower compared to the control group, in the rabbits treated with ozone. The increase in angiogenesis, the decrease in the number of inflammatory cells, epidermal and dermal regeneration, better collagen deposition, and increased keratinisation in stratum corneum were observed in the histopathological examination. It was determined that the wound healing noticeably accelerated in the ozone group. CONCLUSION: Preoperative rectal ozone insufflation had a positive effect on surgical wound healing in acute period.

Ninfoplastia em estrela: técnica para redução dos pequenos lábios vulvares / Star nymphoplasty: a surgical technique for labia minora hypertrophy

Introdução: O cirurgião plástico tem sido consultado com frequência, nos últimos anos, sobre a forma e as dimensões dos pequenos lábios vulvares e outras estruturas circunvizinhas, não só pela questão estética, mas também pela funcional, da dispareunia. Os autores apresentam uma técnica de tratamento estético e funcional da genitália externa feminina, a vulva, com o intuito de corrigir a hipertrofia dos pequenos lábios (ninfas), sem alterar­lhes a forma. Método: A técnica consiste na abordagem do pequeno lábio vulvar, com uma incisão em forma de estrela, produzindo um encurtamento das ninfas tanto ântero-posteriormente como crânio-caudalmente. O estudo é de tipo retrospectivo de um período de 15 anos, com seguimento clínico e cirúrgico de 64 pacientes de sexo feminino, com uma faixa etária entre 14 e 58 anos, todas submetidas à ninfoplastia em estrela, técnica proposta neste estudo. Resultados: Os resultados foram obtidos da ficha dos pacientes operados no período compreendido entre janeiro de 1996 e dezembro de 2011, no Hospital da Lagoa e na Interclínica-Centroplástica, Jardim Botânico, Rio de Janeiro-RJ. Alto índice de satisfação das pacientes com o tamanho e o formato estético da genitália. Houve uma baixa taxa de complicações e queixas residuais. Conclusão: Este ato cirúrgico é feito com o objetivo de remanejar a estrutura tecidual hipertrófica dos pequenos lábios vulvares. De um ponto de vista técnico, pode-se considerar como um procedimento simples e eficaz no tratamento tanto funcional como estético da genitália feminina.

Introduction: In recent years, women have been frequently consulting the plastic surgeon concerning the shape and dimensions of the labia minora and other surrounding structures, not only for aesthetic but also functional reasons, e.g., dyspareunia. The authors present a technique for the aesthetic and functional treatment of the external female genitalia, the vulva, with the purpose of correcting hypertrophy of the labia minora (nymphs), without changing their form. Method: This technique consists in the incision in the shape of a star leading to a shortening of nymphs both anteroposteriorly and craniocaudally. This is a 15-year retrospective study, with clinical and surgical follow-up of 64 female patients with an age range between 14 and 58 years, all submitted to star nymphoplasty, the technique proposed in this study. Results: The results were obtained from the patients operated from January 1996 to December 2011, at the Hospital da Lagoa and at Interclínica-Centroplástica, Jardim Botânico, Rio de Janeiro, RJ. A high rate of patient satisfaction with the size and aesthetic shape of the genitalia was achieved. There was a low rate of complications and remaining complaints. Conclusion: This surgical procedure is done with the objective of reshaping the tissue structure of the hypertrophic labia minora. From a technical point of view, it can be considered as a simple and effective functional and aesthetic treatment of the female genitalia.