Effect study of Sonic hedgehog overexpressed hair follicle stem cells in hair follicle regeneration / 中国修复重建外科杂志

OBJECTIVE@#To determine the expression level of Sonic hedgehog (Shh) in the passage of hair follicle stem cells (HFSCs), analyze the effect of Shh overexpression on the proliferation activity of HFSCs, and explore the survival of HFSCs after Shh overexpression and its effect on hair follicle regeneration.@*METHODS@#Hair follicles from the normal area (H1 group) and alopecia area (H2 group) of the scalp donated by 20 female alopecia patients aged 40-50 years old were taken, and the middle part of the hair follicle was cut under the microscope to culture, and the primary HFSCs were obtained and passaged; the positive markers (CD29, CD71) and negative marker (CD34) on the surface of the fourth generation HFSCs were identified by flow cytometry. The two groups of HFSCs were transfected with Shh-overexpressed lentivirus. Flow cytometry and cell counting kit 8 assay were used to detect the cell cycle changes and cell proliferation of HFSCs before and after transfection, respectively. Then the HFSCs transfected with Shh lentivirus were transplanted subcutaneously into the back of nude mice as the experimental group, and the same amount of saline was injected as the control group. At 5 weeks after cell transplantation, the expression of Shh protein in the back skin tissue of nude mice was detected by Western blot. HE staining and immunofluorescence staining were used to compare the number of hair follicles and the survival of HFSCs between groups.@*RESULTS@#The isolated and cultured cells were fusiform and firmly attached to the wall; flow cytometry showed that CD29 and CD71 were highly expressed on the surface of the cells, while CD34 was lowly expressed, suggesting that the cultured cells were HFSCs. The results of real-time fluorescence quantitative PCR and Western blot showed that the expression levels of Shh protein and gene in the 4th, 7th, and 10th passages of cells in H1 and H2 groups decreased gradually with the prolongation of culture time in vitro. After overexpression of Shh, the proliferation activity of HFSCs in the two groups was significantly higher than that in the blank group (not transfected with lentivirus) and the negative control group (transfected with negative control lentivirus), and the proliferation activity of HFSCs in H1 group was significantly higher than that in H2 group before and after transfection, showing significant differences ( P<0.05). At 5 weeks after cell transplantation, Shh protein was stably expressed in the dorsal skin of each experimental group; the number of hair follicles and the expression levels of HFSCs markers (CD71, cytokeratin 15) in each experimental group were significantly higher than those in the control group, and the number of hair follicles and the expression levels of HFSCs markers in H1 group were significantly higher than those in H2 group, and the differences were significant ( P<0.05).@*CONCLUSION@#Lentivirus-mediated Shh can be successfully transfected into HFSCs, the proliferation activity of HFSCs significantly increase after overexpression of Shh, which can secrete and express Shh continuously and stably, and promote hair follicle regeneration by combining the advantages of stem cells and Shh.

Clinical effects of autologous follicular unit extraction transplantation in the treatment of small area secondary cicatricial alopecia after burns / 中华烧伤杂志

Objective: To explore the clinical effects of autologous follicular unit extraction (FUE) transplantation in the treatment of small area secondary cicatricial alopecia (hereinafter referred to as cicatricial alopecia) after burns. Methods: A retrospective observational study was carried out. According to the adopted treatment methods, 18 patients (12 males and 6 females, aged (29±6) years) who received autologous FUE transplantation for small area cicatricial alopecia after burns from March 2017 to November 2019 in the First Affiliated Hospital of Air Force Medical University were included in FUE transplantation group, and 18 patients (13 males and 5 females, aged (33±5) years) who were treated with expanded flap transplantation for small area cicatricial alopecia after burns by the same surgery team during the same period in the same hospital were included in expanded flap transplantation group. All the patients were followed up for more than 1 year. At the last follow-up, the follicular unit density in the transplanted area was measured by Folliscope hair detection system and the hair survival rate was calculated; the visual analogue scale (VAS) method was adopted to evaluate the treatment effect; patients were asked their satisfaction with the treatment effect and the occurrence of complications during follow-up; the hair growth and the scalp thickness, pain, pruritus, pigmentation, and surface roughness of the transplanted area were recorded. Data were statistically analyzed with Fisher's exact probability test and independent sample t test. Results: At the last follow-up, the follicular unit density in the transplanted area of patients in FUE transplantation group was (46.8±2.0)/cm2, which was significantly higher than (42.5±4.3)/cm2 in expanded flap transplantation group (t=3.84, P<0.01); the hair survival rates of patients were similar between the two groups (P>0.05). At the last follow-up, VAS scores evaluating the treatment effect of patients were similar between the two groups (P>0.05); the satisfaction score of patients toward the treatment effect in FUE transplantation group was 8.6±1.1, which was significantly higher than 7.6±0.8 in expanded flap transplantation group (t=2.89, P<0.01). During the follow-up, no inflammation or infection occurred in patients of the two groups, but only 2 patients in expanded flap transplantation group had postoperative pain. At the last follow-up, the transplanted area of patients in the two groups was covered with new hair, and the hair growth direction was basically consistent with the surrounding normal hair; scalp thickness, pain, pruritus, pigmentation, and surface roughness of the transplanted area of patients were similar between the two groups (P>0.05). Conclusions: Autologous FUE transplantation has better long-term follicular unit density and patients' satisfaction than expanded flap transplantation in the treatment of small area cicatricial alopecia after burns, showing better postoperative effect and a good prospect of clinical application.

Comparison of postoperative mid-term and long-term quality of life between Billroth-I gastroduodenostomy and Billroth-II gastrojejunostomy after radical distal gastrectomy in patients with gastric cancer: a cohort study based on a case registry database / 中华胃肠外科杂志

Objective: The pattern of digestive tract reconstruction in radical gastrectomy for gastric cancer is still inconclusive. This study aims to compare mid-term and long-term quality of life after radical gastrectomy for distal gastric cancer between Billroth-I (B-I) and Billroth-II (B-II) reconstruction. Methods: A retrospective cohort study was conducted.Clinicopathological and follow-up data of 859 gastric cancer patients were colected cellected from the surgical case registry database of Gastrointestinal Surgery Center of Sichuan University West China Hospital, who underwent radical distal gastric cancer resection between January 2016 and December 2020. Inclusion criteria: (1) gastric cancer confirmed by preoperative gastroscopy and biopsy; (2) elective radical distal major gastrectomy performed according to the Japanese Society for Gastric Cancer treatment guidelines for gastric cancer; (3) TNM staging referenced to the American Cancer Society 8th edition criteria and exclusion of patients with stage IV by postoperative pathology; (4) combined organ resection only involving the gallbladder or appendix; (5) gastrointestinal tract reconstruction modality of B-I or B-II; (6) complete clinicopathological data; (7) survivor during the last follow-up period from December 15, 2021 to January 15, 2022. Exclusion criteria: (1) poor compliance to follow-up; (2) incomplete information on questionnaire evaluation; (3) survivors with tumors; (4) concurrent malignancies in other systems; (5) concurrent psychiatric and neurological disorders that seriously affected the objectivity of the questionnaire or interfered with patient's cognition. Telephone follow-up was conducted by a single investigator from December 2021 to January 2022, and the standardized questionnaire EORTC QLQ-C30 scale (symptom domains, functional domains and general health status) and EORTC QLQ-STO22 scale (5 symptoms of dysphagia, pain, reflux, restricted eating, anxiety; 4 single items of dry mouth, taste, body image, hair loss) were applied to evaluate postoperative quality of life. In 859 patients, 271 were females and 588 were males; the median age was 57.0 (49.5, 66.0) years. The included cases were divided into the postoperative follow-up first year group (202 cases), the second year group (236 cases), the third year group (148 cases), the fourth year group (129 cases) and the fifth year group (144 cases) according to the number of years of postoperative follow-up. Each group was then divided into B-I reconstruction group and B-II reconstruction group according to procedure of digestive tract reconstruction. Except for T-stage in the fourth year group, and age, tumor T-stage and tumor TNM-stage in the fifth year group, whose differences were statistically significant between the B-I and B-II reconstruction groups (all P<0.05), the differences between the B-I and B-II reconstruction groups in terms of demographics, body mass index (BMI), tumor TNM-stage and tumor pathological grading in postoperative follow-up each year group were not statistically significant (all P>0.05), suggesting that the baseline information between B-I reconstruction group and the B-II reconstruction group in postoperative each year group was comparable. Evaluation indicators of quality of life (EORTC QLQ-C30 and EORTC QLQ-STO22 scales) and nutrition-related laboratory tests (serum hemoglobin, albumin, total protein, triglycerides) between the B-I reconstruction group and B-II reconstruction group in each year group were compared. Non-normally distributed continuous variables were presented as median (Q(1),Q(3)), and compared by using the Wilcoxon rank sum test (paired=False). The χ(2) test or Fisher's exact test was used for comparison of categorical variables between groups. Results: There were no statistically significant differences in all indexes EORTC QLQ-30 scale between the B-I reconstruction group and the B-II reconstruction group among all postoperative follow-up year groups (all P>0.05). The EORTC QLQ-STO22 scale showed that significant differences in pain and eating scores between the B-I reconstruction group and the B-II reconstruction group were found in the second year group, and significant differences in eating, body and hair loss scores between the B-I reconstruction group and the B-II reconstruction group were found in the third year group (all P<0.05), while no significant differences of other item scores between the B-I reconstruction group and the B-II reconstruction group were found in postoperative follow-up of all year groups (P>0.05). Triglyceride level was higher in the B-II reconstruction group than that in the B-I reconstruction group (W=2 060.5, P=0.038), and the proportion of patients with hyperlipidemia (triglycerides >1.85 mmol/L) was also higher in the B-II reconstruction group (19/168, 11.3%) than that in the B-I reconstruction group (0/34) (χ(2)=0.047, P=0.030) in the first year group with significant difference. Albumin level was lower in the B-II reconstruction group than that in the B-I reconstruction group (W=482.5, P=0.036), and the proportion of patients with hypoproteinemia (albumin <40 g/L) was also higher in the B-II reconstruction group (19/125, 15.2%) than that in the B-I reconstruction group (0/19) in the fifth year group, but the difference was not statistically significant (χ(2)=0.341, P=0.164). Other nutrition-related clinical laboratory tests were not statistically different between the B-I reconstruction and the B-II reconstruction in each year group (all P>0.05). Conclusions: The effects of both B-I and B-II reconstruction methods on postoperative mid-term and long-term quality of life are comparable. The choice of reconstruction method after radical resection of distal gastric cancer can be based on a combination of patients' condition, sugenos' eoperience and operational convenience.

Hair Wash: otimizando o transplante capilar / Hair Wash: improving hair transplantation

O uso eficiente do tempo cirúrgico é uma preocupação que envolve não apenas o transplante capilar, mas cirurgias como um todo. Preconiza-se que a cirurgia da calvície, principalmente no tocante às grandes sessões de transplante de cabelos, não devam ultrapassar 6 horas por sessão, sob o risco de prejudicar os fios transplantados. A montagem do dispositivo se procede utilizando-se material estéril, com exceção do fluxômetro de ar comprimido, suporte de soro e a saída de ar comprimido que ficam fora do campo cirúrgico. O método "em Hair Wash em" possibilitou uma diminuição no tempo cirúrgico e otimização da cirurgia. O "em Hair Wash em" é um dispositivo viável, de fácil replicabilidade e que otimiza a cirurgia de restauração capilar.

An efficient use of operative time is a concern regarding not only hair transplantation but all surgical procedures. In case of large areas to be transplanted, no more than 6 hours per session is recommended, to avoid damaging transplanted hairs. We developed a device using sterilized materials, with the exception of a compressed air flowmeter, support serum, and compressed air, which remain outside the surgical field. The "Hair Wash" device shortened the operative time and improved the surgery. The "Hair Wash" device is feasible and easily replicable, and improves the hair transplant procedure.

Transplante capilar de unidades foliculares: experiência de 15 casos / Hair transplant of follicular units: a 15-case experience

Introdução: O transplante capilar de unidades foliculares (UFs) é a técnica que permite a obtenção dos resultados mais naturais. A implantação de 20 a 25 UF/cm2 possui baixo risco de dano aos folículos e tem resultado satisfatório com duas sessões. Densidade superior a 30-35 UF/cm2 permite resultado com uma única sessão, mas aumenta os riscos de dano ao folículo e perda de crescimento dos fios. O objetivo do estudo foi relatar a experiência de 15 casos de transplante capilar com implantação de 30 ou mais UF/cm2, com incisões previamente realizadas e utilizando um instrumento cirúrgico modificado para facilitar a implantação. Método: Foi realizado estudo retrospectivo de 15 pacientes submetidos em sequência a um total de 17 cirurgias, no período de julho de 2008 a junho de 2012, com tempo de seguimento de 1 ano. Resultados: Foi implantada uma quantidade média de 1433,3 UF e 3019,8 fios por cirurgia. O tempo médio de duração das cirurgias foi de 10 horas e 23 minutos. Ocorreu crescimento satisfatório dos fios com resultado visível a partir de 6 meses, com poucas complicações. Dos 15 pacientes, dois necessitaram de uma segunda sessão. Conclusões: A técnica empregada possibilitou manipulação delicada das UFs e permitiu implantação com alta densidade, obtendo bom resultado com uma sessão, mas requer tempo de execução acima da média, devendo ter uso restrito a áreas pequenas com necessidade de maior densidade.

Introduction: The transplant of follicular units (FUs) for hair restoration yields the most natural results. The implantation of 20-25 FU/cm2 has a low risk of follicular damage and yields satisfactory results within two sessions. A density greater than 30-35 FU/cm2 yields the same results within a single session but increases the risk of follicular damage and hair growth loss. We report our experience with 15 cases of hair transplantation, with an implantation density of ≥ 30 FU/cm2 and with incisions made previously using a surgical instrument modified to facilitate implantation. Method: A retrospective study of 15 patients who consecutively underwent 17 surgeries between July 2008 and June 2012 and were followed up for 1 year. Results: A mean of 1433.3 FUs and 3019.8 hairs were implanted per surgery. The mean surgical duration was 10 hours and 23 minutes. Satisfactory hair growth occurred, and results were visible at 6 months onward with few complications. Of the 15 patients, two required a second session. Conclusions: The technique used here enabled delicate manipulation of the FUs and high-density implantation that achieved good results within one session but required an above-average execution time and should be restricted to small areas requiring greater density.

Marcação de incisões receptoras em cirurgia da restauração capilar - nova metodologia para simetria de densidade / Marking the recipient sites in hair restoration surgery - new methodology to attain symmetric density

Introdução: Em cirurgias de restauração capilar, as incisões receptoras para a inserção das unidades foliculares são realizadas com micro lâminas ou agulhas, procurando conseguir a maior proximidade possível, mas visando a segurança da nutrição sanguínea dos enxertos. O objetivo deste trabalho é relatar uma metodologia de marcação prévia de traços ou pontos na pele calva da região frontal, usando carimbos criados pelo autor, objetivando fazer incisões nessas marcas, a fim de se obter simetria de densidade. Métodos: Alguns tipos de carimbos são descritos, e também suas opções de utilização na região frontal, juntamente com três tipos de tinta, uma em cada indivíduo de quatro grupos de pacientes, visando a escolha da tinta que apresentasse maior tempo de permanência na pele. Nos grupos A e B, foram testados, respectivamente, o uso das concentrações usuais das tintas de uso médico e o de uma tinta permanente. Nos grupos C e D, foi testada uma solução alcoólica de 3% de violeta de genciana, sem e com uma película de barreira em spray. Resultados: Os carimbos descritos, umedecidos com o corante testado no grupo D, deixaram traços e pontos sobre o couro cabeludo que, cobertos com a película de barreira, foram resistentes a sangue e lavagens freqüentes. Conclusões: O uso de carimbos para marcar a pele calva, usando o método descrito, facilita a simetria das incisões e a identificação das fendas para a inserção das unidades foliculares, resultando em densidade simétrica na região frontal.

Introduction: In hair restoration surgery, recipient sites for insertion of follicular units are made with microblades or needles, with the goals of achieving the closest proximity possible and to maintain vascular nutritional support for the grafts. This study describes the methodology for preparatory marking of the frontal scalp with dots or lines. Stamps developed by the author are used to make incisions at these sites in order to attain symmetric density. Methods: Several types of stamps are described. Individualized options for use in the frontal region were defined in four groups of patients; three types of inks were used in order to choose the ink with greater permanence in the skin. Groups A and B were respectively tested with common concentrations of inks for medical use and with a permanent ink. Groups C and D were tested with an alcoholic solution of 3% gentian violet, with and without the application of a barrier film spray. Results: Stamps moistened with the ink tested in group D marked lines and dots on the scalp which were resistant to blood and frequent washing, when covered with a barrier film. Conclusions: The use of stamps to mark bald skin with the methodology described improves incision symmetry and slot identification for the insertion of follicular units, in turn resulting in symmetric density in the frontal region.

Extração de unidades foliculares: transplante capilar sem cicatriz linear / Follicular unit extraction: hair transplant without linear scar

Introdução: A técnica de extração de unidades foliculares (FUE, do inglês follicular unit extraction), de um a três folículos capilares, dispensa a necessidade de ressecção da área doadora na região occipitotemporal e de outros envolvimentos táticos e técnicos para transformar o material adquirido nessas unidades. Estas são obtidas diretamente, sendo extraídas por meio de pequenos cilindros ocos (punches), com diâmetro variando de 0,8 mm a 1mm, mediante incisão circular ao redor de cada unidade folicular no couro cabeludo e, subsequente, extração. Método: Foram avaliados e acompanhados, durante 24 meses, 77 pacientes submetidos a transplante de unidades foliculares, aplicado na correção de áreas de alopecia dos mais diversos tipos (androgênica, em cicatrizes de áreas pilosas, transplantes em supercílios, em pequenas áreas de calvície). Destes, 12 eram do sexo feminino e 65 do masculino, com idades que variavam de 19 a 65 anos; sete pacientes foram operados para correção de cicatrizes inestéticas e alargadas, decorrentes de transplantes capilares anteriores, realizados por técnicas convencionais. Os cuidados transoperatórios na manipulação das unidades foliculares são mais acurados, dada a sutileza de suas estruturas. Resultados: Apesar do tempo cirúrgico aumentado, não existe cicatriz linear e as áreas doadoras são menos visíveis e totalmente camufláveis pelos cabelos adjacentes no período de 3 a 5 dias de pós-operatório, mesmo com os cabelos raspados. Conclusão: O método exige maiores cuidados quanto aos procedimentos táticos e técnicos de manipulação e à obtenção das unidades foliculares.

Introduction: Follicular unit extraction (FUE), which involves harvesting a follicular unit containing between one and three hair follicles, prevents the need for donor area resection in the occipitotemporal region for hair transplantation. This method also avoids the need to dissect the material acquired into follicular units. In this method, the follicular units are directly obtained and extracted using small hollow cylinders (punches) with a diameter of 0.8­1 mm through a circular incision around each follicular unit on the scalp. Method: Over 24 months, we evaluated 77 patients with various forms of alopecia (including androgenic and scarring hair loss, eyebrow loss, and small bald areas) who underwent follicular unit transplant. Twelve patients were women and 65 men, with ages ranging from 19 to 65 years. Seven patients underwent the procedure to correct unsightly and extended scars caused by previous hair transplants performed by conventional techniques. This method requires greater intraoperative care in handling the follicular units to avoid damaging them. Results: Although the surgical time was increased, no linear scarring was observed, and the donor areas were less visible due to being masked by adjacent hairs from 3 to 5 days after surgery. This was the case even with shaved hair. Conclusion: Although this procedure requires greater care in handling and obtaining follicular units, FUE enables hair transplants without a linear scar. As such, this method has many clinical indications.

Megassessões de unidades foliculares e fatores de crescimento plaquetário / Follicular unit megasessions and platelet growth factors

Queda de cabelo, seja parcial ou completa, é causa de preocupação significativa para homens e mulheres, que a veem como um sinal inestético e visível de envelhecimento. Avanços e refinamentos das técnicas culminaram na introdução de megassessões de microenxertos e minienxertos. Essa técnica se tornou amplamente aceita como um procedimento simples e seguro, que recria as linhas randômicas naturais do cabelo. Os folículos pilosos foram retirados da área cervical posterior, onde 500 a 1.500 unidades foliculares podem ser obtidas. A área calva foi implantada através de incisões de lâmina nº 11. Após o procedimento, gaze umedecida em solução salina foi aplicada sobre a área implantada por 24 horas. Os pontos foram removidos no 7º dia de pós-operatório. O resultado final foi obtido 8 meses a 12 meses após o procedimento, em homens, e 12 meses a 14 meses, em mulheres. Nos pacientes em que um segundo procedimento foi necessário, este foi realizado 1 ano após o transplante inicial. A qualidade e a força do cabelo transplantado permanecem em alguns pacientes por tempo indeterminado, em decorrência de características particulares, como alta qualidade histológica da área doadora, hereditariedade, hormônios e envelhecimento. A cirurgia de transplante capilar demonstra que o uso de fatores de crescimento plaquetário autólogo pode melhorar a densidade capilar. Esse processo oferece uma nova perspectiva ao transplante capilar, representando uma contribuição importante para a cirurgia de implante com megassessões de unidades foliculares.

Hair loss, whether partial or complete, is a cause of significant concern to both men and women, and is viewed as unaesthetic and a visible sign of aging. Advances and refinements in hair restoration techniques have culminated in the introduction of micrograft and minigraft megasessions. This technique has become widely accepted as a simple and safe procedure that recreates natural random-pattern hairlines. The hair follicles are harvested from the posterior cervical area, where 500 to 1500 follicular units can be obtained. Implantation in the bald area is performed via punctiform incisions using the No. 11 blade. After the procedure, gauze moistened in saline solution is applied over the implanted area for 24 hours. The stitches are removed on the 7th postoperative day. The final result is visible after 8 to 12 months in men and after 12 to 14 months in women. If an additional procedure is necessary, this can be performed 1 year after the initial transplantation. The quality and strength of the implanted hair persists for an indefinite period in some patients because of 1 the following particular characteristics: high histological quality of the donor area, heredity, hormones, or aging. This article also addresses the role of platelet-rich plasma growth factors in surgical treatment of male and female pattern baldness. The results of hair transplant surgery suggest that the use of autologous platelet growth factors improves capillary density. This offers a new perspective on hair transplantation and is an important contribution to implantation surgery with follicular unit megasessions.

Métodos de reconstrução do couro cabeludo / Scalp reconstruction procedures

A avulsão de couro cabeludo apresenta-se como lesão devastadora aos pacientes acometidos, nas esferas tanto estética e funcional como psicológica. O advento da microcirurgia e a realização do primeiro reimplante por Miller, em 1976, revolucionaram o manejo da avulsão de couro cabeludo, tornando o reimplante o tratamento de escolha sempre que possível. Com as técnicas atuais e a estrutura disponível nos centros especializados, faz-se possível o adequado manejo das avulsões de couro cabeludo por meio do reimplante microcirúrgico, obtendo-se resultados adequados e superiores às opções oferecidas previamente. Os autores abordam a reconstrução do couro cabeludo após avulsão de aproximadamente dois terços de sua extensão, causado por mordedura de cão em uma criança de 4 anos de idade, enfocando a cobertura da calota craniana com retalho microcirúrgico dos músculos grande dorsal e serrátil e as sucessivas cirurgias até a cobertura total da área de alopecia.

Scalp avulsion is a devastating injury that affects the patient esthetically, functionally, and psychologically. The advent of microsurgery and the first reimplant performed by Miller in 1976 improved the treatment of scalp avulsion, making reimplant the first choice whenever possible. With modern techniques and the equipment available in specialized centers, scalp avulsion can be adequately treated using microsurgical reimplantation. This method achieves better results as compared to previously employed procedures. We report the reconstruction of the scalp of a 4-year-old boy after the avulsion of approximately two-thirds of the scalp area due to a dog bite. We focused on covering the skull with microsurgical latissimus dorsi and serratus muscles, and performing subsequent surgeries to completely cover the alopecic areas.

Tissue expansion at Hospital de Clinicas-UFPR: our experience / Expansão tecidual no Hospital de Clínicas-UFPR: nossa experiência

BACKGROUND: The shortage of tissue for large defect reconstruction is a challenge for the plastic surgeon. Tissue expansion emerged in this context, and in the last 30 years has become one of the most widely used modalities in reconstructive surgery. Tissue expansion is a very versatile technique that can be performed in patients of all ages for the correction of different pathologies. The most common indications are burn sequelae and giant congenital nevus. The present study describes the indications and use of tissue expanders at the Hospital de Clínicas of Universidade Federal do Paraná. METHODS: Patients who underwent tissue expansion for reconstructive surgery between January 2005 and December 2009 were retrospectively reviewed. RESULTS: A total of 24 patients (70.8 percent female and 29.2 percent male) were analyzed. Ages ranged from 3 to 46 years old (average, 17.1 years). The most common indication for tissue expansion was the treatment of burn sequelae (62.5 percent), mainly in the head and neck. Alopecia was the second most prevalent indication (29.2 percent), followed by scar retraction in the neck (20.8 percent). Other indications were giant congenital melanocytic nevus (16.7 percent), Poland's syndrome (8.3 percent), abdominal scar (8.3 percent), and amastia (4.2 percent). Complications developed in 11 patients, and the highest incidence of complications, reported in 8 (72.7 percent) patients, was among those with burn sequelae as the primary pathology. The complications were infection, rupture, extrusion, wound dehiscence, and displacement of the expander. CONCLUSIONS: Tissue expansion is indicated for the treatment of several diseases among which burn sequelae is one of the most common indications.

INTRODUÇÃO: A escassez de tecidos para reconstrução de grandes defeitos é um desafio ao cirurgião plástico. Nesse contexto, surgiu a expansão tecidual, que, nos últimos 30 anos, se tornou uma das modalidades mais utilizadas na cirurgia reparadora. A expansão é uma técnica muito versátil, que pode ser realizada em todas as idades e para correção de diferentes afecções. As principais indicações são sequelas de queimadura e nevo congênito gigante. Este estudo teve como objetivo demonstrar as indicações na utilização dos expansores tissulares e sua evolução em pacientes do Hospital de Clínicas da Universidade Federal do Paraná. MÉTODO: Estudo retrospectivo, incluindo pacientes submetidos a expansão tecidual para cirurgia reconstrutora, no período de janeiro 2005 a dezembro 2009. RESULTADOS: Foram analisados 24 pacientes, sendo 70,8 por cento do sexo feminino e 29,2 por cento do sexo masculino. A idade variou entre 3 anos e 46 anos (média de 17,1 anos). A principal indicação de expansão tecidual foi o tratamento de sequelas de queimaduras (62,5 por cento), principalmente na região da cabeça e do pescoço. Alopecia foi a indicação mais prevalente (29,2 por cento), seguida por retração cicatricial em região cervical (20,8 por cento). Outras indicações foram nevo melanocítico congênito gigante (16,7 por cento), síndrome de Poland (8,3 por cento), cicatriz abdominal (8,3 por cento) e amastia (4,2 por cento). Entre os pacientes avaliados, 11 evoluíram com alguma complicação, 8 (72,7 por cento) dos quais tinham como doença primária sequela de queimaduras, demonstrando maior incidência de complicações em relação às outras indicações. As complicações encontradas foram: infecção, ruptura, extrusão, deiscência de sutura e deslocamento do expansor. CONCLUSÕES: A expansão tissular é indicada no tratamento de múltiplas doenças e uma das principais indicações continua sendo o tratamento de sequelas de queimaduras.

Perda pilosa por líquen plano pilar após transplante capilar: relato de dois casos e revisão da literatura / Hair loss due to lichen planopilaris after hair transplantation: a report of two cases and a literature review

Alopecia androgenética é tratada com frequência por meio de microtransplante capilar, téc nica em que os fios transplantados geralmente não caem, pois mantêm características da área doadora, mais resistente. O líquen plano pilar é uma alopecia cicatricial com permanente destruição pilosa. Este artigo relata dois casos de lesões compatíveis com líquen plano pilar em áreas receptora e doadora póstransplante. A dominância da área doadora foi aparentemente sobrepujada pelo líquen plano pilar, que deve ter gerado a queda dos fios. Relatos semelhantes são raros. À suspeita de líquen plano pilar, devese biopsiar o couro cabeludo e evitar o transplante durante a atividade da doença.

Androgenetic alopecia is often treated by follicular unit transplantation, a technique that involves minimal risk of hair loss because of the more resistant nature of the donor area. Lichen planopilaris is a cicatricial alopecia that causes permanent destruction of hair follicles. We report two cases of post-transplantation lesions compatible with lichen planopilaris in both recipient and donor areas. The quality of the hair follicles in the donor area was apparently compromised by lichen planopilaris, the probable cause of hair loss. Similar reports are rare. When lichen planopilaris is suspected, a biopsy of the scalp must be performed to avoid transplantation during disease activity.

Algoritmo para as alopécias cicatriciais e suas opções de tratamento / Algorithm for approaching scar alopecia and treatment options

A cirurgia plástica dispõe de um variado arsenal de técnicas para o tratamento das alopéciascicatriciais. A correção cirúrgica dos defeitos do couro cabeludo deve começar por uma sistematizaçãoda classificação das lesões. A proposta de um algoritmo tem por objetivo organizarde maneira racional as opções para cada caso, sem, no entanto, substituir o julgamento e acriatividade do cirurgião. Este trabalho apresenta um raciocínio clínico que poderá facilitara escolha da melhor opção cirúrgica para corrigir cicatrizes do couro cabeludo.

Plastic surgery has a varied arsenal of techniques for the treatment of scar alopecia. Thesurgical correction of scalp defects should begin with a systematic classification of thetype of injury. An algorithm has been developed that rationalizes and organizes the surgicaloptions in each case, without attempting to replace the surgeon’s judgment and creativity.This paper presents a clinical analysis that could assist the selection of the best surgicalalternative for different cases of scar alopecia.

Conduta pessoal em cirurgia da calvície / Personal procedures for baldness surgery

O autor apresenta um modelo pessoal de sistematização emcirurgia do transplante capilar para tratamento da calvícieandrogenética, avaliando os resultados conseguidos com novastécnicas, táticas, materiais cirúrgicos, videomicroscopia emedidas pós-operatórias que visam a maximizar os resultadosobtidos com tecnologia de ponta. São discutidos aspectosrelacionados às unidades foliculares, linha anterior, técnicaapurada e uma nova abordagem à área doadora, tanto nadissecção e retirada da faixa quanto na sutura tricofíticautilizada para repará-la.

A personal approach to the treatment of baldness is performedthrough a simple and efficient technique set on new principlessuch as the dissection of the follicular units, just single-hair-graftsfor the front hair lines, precise technique and a non traumaticapproach to the donator site where a new kind of dissection andsuture is introduced.

Functional outcomes of single follicular hair graft technique

To assess the percentage survival of follicular hair graft technique and the factors influencing it. A non-interventional descriptive study. Plastic Surgery Unit, Hayatabad Medical Complex from November 2003 to April 2004. A total of 30 patients were included in the study with pattern of baldness ranging from type II to type VII. Age ranged from 24 years to 50. Hair bearing skin strips were harvested from occipital area and sliced under magnification into grafts of various sizes. Either punch or slit knife was used for making holes in recipient area and grafting follicles. Patients were followed at 2 weeks, 3 months and 6 months. Graft survival was measured at 6 months postoperative interval. In 7 patients graft survival was above 90%; in 12 patients above 80% but less than 90%; in 7 patients between 70 and 80%; in 2 patients above 60% but less than 70%; in 2 patients less than 20% which was considered as failure. Survival was greater with punch method than use of slit knife. Chances of failure increased with the large size session, larger grafts and unknown factors that need further investigations

Implante pilosebáceo. Sistematización y conducta / Hair implant (Graft). sistematization and Technique

Se consideran algunos puntos anatomohistoquímicos como esenciales para obtener éxito en el transplante de la unidad pilosebásea para el tratamiento quirúrgico de la calvicie. Se efectúa un estudio en humanos sobre la presencia y ubicación de los receptores hormonales

Transplante capilar pelo método de micro e mini enxertos / Hair trasnplant through micro and mini method

Estudo de casos operados na Clínica de Cirurgia Plástica Curitiba, PR-Centerplast. Foram realizados 191 transplantes de cabelo pelo método de micro e mini enxertos, como tratamento de calvíce androgenética. Os resultados foram considerados satisfatórios tanto do ponto de vista médico (pela baixa incidência de complicaçöes pós-operatórias) quanto do ponto de vista estético (indetectabilidade do procedimento cirúrgico). Concluiu-se, também, que para otimizar o aspecto estético, através do aumento da densidade capilar, é necessário efetuar mais de um procedimento em cada paciente

The use of tissue expanders in extensive alopecias

The authors discuss the surgical approach in the treatment of alopecias using tissue expanders. Nine cases with extensive alopecias of varied etiologies are reported. Seven cases with good results using this technique are presented and complications observed in two cases are discussed, with the conclusion that this technique has a good indication in cases of extensive alopecia

Cirurgia de calvície: transplante de cabelo: consideraçöes técnicas / Surgery of alopecia: hair transplantation: technical considerations

O tratamento da calvície pela técnica de microenxertia autógena de couro cabeludo é enfocado sob a óptica de táticas pessoais