Cáncer de mama ectópica axilar: caso clínico / Ectopic axillary breast cancer: case report

Resumen Introducción El tejido mamario ectópico es consecuencia de la involución incompleta de la cresta mamaria. Su localización más frecuente es axilar siendo más común en el sexo femenino. Nuestro objetivo fue presentar el caso de una patología infrecuente en su localización. Materiales y Método Se presenta el caso de una paciente de 39 años, con diagnóstico de cáncer de mama ectópica en la región axilar izquierda. Resultados Presentamos el estudio y la resolución quirúrgica de una paciente con cáncer de mama ectópica. Discusión La presencia de tejido mamario ectópico ocurre en el 2%-6% de la población general. Este tejido sufre cambios fisiopatológicos similares a los de la mama normal, entre los cuales se encuentra la malignización. El carcinoma primario de este tejido es infrecuente y su manifestación más común es el tumor palpable. Conclusiones La incidencia de carcinoma en tejido ectópico es de 0,3% de todos los cánceres de mama. El tratamiento debe seguir las mismas recomendaciones que el cáncer de mama normotópico, con igual estadio TNM.

Introduction Ectopic mammary tissue is consecuence of the incomplete involution of the mammary crest. The most frequent location is the axillary region and more common in women. Our gol was present the case of an infrequent pathology in its location. Materials and Method A case of a 39-year-old patient with a diagnosis of ectopic breast cancer in the left axillary region. Results We present the study and surgical resolution of a patient with ectopic breast cancer. Discussion Ectopic breast tissue occurs in 2-6% of the general population. This tissue undergoes pathophysiological changes similar to those of the normal breast, among which malignancy is found. The primary carcinoma of this tissue is infrequent and its most common manifestation is the palpable tumor. Conclussion The incidence of carcinoma in ectopic tissue is approximately 0.3% of all breast cancers. Treatment should follow the same recommendations as those for breast tumors with the same TNM stage.

Influência do posicionamento do retalho linfonodal vascularizado na resposta ao tratamento cirúrgico do linfedema secundário ao câncer de mama / Influence of vascularized lymph node transfer (VLNT) flap positioning on the response to breast cancer-related lymphedema treatment

RESUMO Objetivo: analisar a experiência terapêutica inicial do transplante de linfonodos vascularizados em pacientes portadoras de linfedema de membros superiores secundário ao tratamento do câncer de mama e verificar se o posicionamento do transplante influencia o resultado cirúrgico. Métodos: ensaio prospectivo, comparativo, de duas modalidades terapêuticas em 24 pacientes portadoras de linfedema de membro superior após tratamento de câncer mamário, classificados como graus 2 e 3, segundo a Sociedade Internacional de Linfedema. Os dois tipos de procedimentos realizados foram: 1) reconstrução total da mama com retalho de perfurante da artéria epigástrica inferior (DIEP- deep inferior epigastric perforator flap) associado ao retalho linfonodal, em pacientes sem reconstrução mamária prévia ou com histórico de perda da reconstrução (posicionamento axilar); 2) retalho linfonodal inguinal isolado foi realizado em pacientes com reconstrução mamária finalizada ou sem o desejo de realizar a reconstrução da mama (posicionamento no punho). Resultados: a porcentagem de redução do volume do membro afetado foi de 20,1% (p=0,0370). O número de episódios infecciosos (celulites) também sofreu redução significativa, de 41% no período pré-operatório para 12,5% no pós-operatório (p=0,004). Não foram observadas diferenças entre os grupos proximal e distal. Conclusão: o transplante de linfonodos afetou positivamente a evolução pós-operatória de pacientes portadoras de linfedema secundário ao câncer de mama. Não foram observadas diferenças em relação ao posicionamento do retalho.

ABSTRACT Objective: to evaluate the initial therapeutic experience of transplantation of vascularized lymph nodes in patients with lymphedema of the upper limbs secondary to the treatment of breast cancer, and to verify if the positioning of the transplant influences the surgical result. Methods: we conducted a prospective, comparative test of two therapeutic modalities, with 24 patients with lymphedema of the upper limb after breast cancer treatment, classified as grades 2 and 3, according to the International Lymphedema Society. The two types of procedures performed were: 1) total breast reconstruction with - deep inferior epigastric perforator (DIEP) flap associated with lymph node flap, in patients with no previous breast reconstruction or loss of previous reconstruction (axillary positioning); 2) isolated inguinal lymph node flap performed in patients with completed breast reconstruction or without the desire to perform the breast reconstruction (wrist positioning). Results: the reduction percentage of the affected limb volume was 20.1% (p=0.0370). The number of infectious episodes (cellulites) also decreased significantly, from 41% in the preoperative period to 12.5% in the postoperative one (p=0.004). There were no differences between the proximal and distal groups. Conclusion: the transplantation of lymph nodes positively affected the postoperative evolution of patients with lymphedema secondary to breast cancer. We observed no differences in relation to flap positioning.

Evaluación Y Manejo De La Enfermedad Temprana Y Localmente Avanzada: 1er Consenso Nacional Del Cáncer De Mama de la Sociedad Panameña de Oncología (SPO) / Evaluation and Management of Early and Loc ally Adv anced Disease: 1st National Con­ sens us of Breas t Canc er of the Panamanian Soc iety of Oncology (SPO

El manejo de los pacientes con cáncer de mama temprano o localmente avanzado requiere de la evaluación inicial de un grupo de médicos familiarizados con el diagnóstico, estadificación y trata­mientos de estas enfermedades, de tal manera que se pueda optimizar los resultados no solamen­te oncológicos (Curación), sino también cosméticos. La decisión sobre el tratamiento local (cirugía y Radioterapia) y sistémico (Quimioterapia y Hormonoterapia) está basada en las características clí­nicas y moleculares de tumor, así como por las preferencias del paciente

The management of patients with earlyor locally advanced breast cancer requires the initial evalua­tion of a group of physicians familiar with the diagnosis, staging and treatment of these diseases, in order to optimize the results not only oncological (Healing), but also cosmetics. The decision on local treatment (surgery and Radiotherapy) and systemic treatment (Chemotherapy and Hormonot­herapy) is based on the clinical and molecular characteristics of the tumor, aswell as on the pa­tient's preferences

Radical resection and local coverage of hidradenitis suppurativa - acne inversa: analysis of results / Tratamento cirúrgico de hidradenite supurativa - acne inversa: ressecção radical e cobertura local - análise de resultados

ABSTRACT Objective: to evaluate the primary outcome of local complications and late recurrence in patients with hidradenitis suppurativa undergoing radical resection and specific reconstruction. Methods: we conducted a retrospective analysis of the medical records of patients attended by the Plastic Surgery Service of the Clinics Hospital, Medical School, USP, between 2010 and 2016. We included patients who underwent radical resection of hidradenitis suppurativa in advanced stage and reconstruction through primary closure, grafts or flaps. Results: we analyzed 34 lesions in 19 patients, of which 64.5% had local complications, though with 73.5% efficient healing after 12 weeks postoperatively. We observed late recurrence in 47%, but in isolation, 22.2% of the reconstructions with locoregional flaps had recurrence after one year. Conclusion: extensive and radical resection of the disease associated with locoregional flap coverage (pedicled or perforating) has been shown to be the best management in terms of late results.

RESUMO Objetivo: avaliar o desfecho primário de complicações locais e de recidiva tardia em pacientes com diagnóstico de hidradenite supurativa submetidos à ressecção radical e reconstrução específica. Métodos: análise retrospectiva baseada nos prontuários dos pacientes atendidos pelo serviço universitário de Cirurgia Plástica do Hospital das Clínicas da Faculdade de Medicina da USP, entre 2010 a 2016. Foram incluídos apenas pacientes submetidos à ressecções radicais de hidradenite supurativa em grau avançado, submetidos à reconstrução através de fechamento primário, enxertos ou retalhos. Resultados: foram analisadas 34 lesões, das quais 64,5% apresentaram complicações locais, porém com 73,5% de cicatrização eficiente após 12 semanas de pós-operatório. Recidiva tardia foi observada em 47%, porém, isoladamente, 22,2% das lesões reconstruídas com retalhos locorregionais apresentaram recidiva tardia após um ano. Conclusão: a estratégia de ressecção ampla e radical da doença associada à cobertura da ferida com retalho locorregional (pediculado ou perfurante) demonstrou ser o melhor manejo em termos de resultados tardios.

Uso de colgajos perforantes para el tratamiento de hidradenitis supurativa axilar y esternal graves / Use of perforator flaps for treatment of severe axillary and sternal hidradenitis suppurativa

Resumen Objetivo: Presentar una serie de reconstrucciones con colgajos perforantes en pacientes con casos severos de hidradenitis supurativa y sus resultados. Pacientes y métodos: Se realizaron 7 reconstrucciones axilares y un caso de reconstrucción esternal en 5 pacientes. Todos los pacientes correspondieron a la clasificación II o III de Hurley, y fueron derivados a nuestro servicio después de por lo menos un año de tratamiento médico sin obtener resultados. El equipo de cirugía plástica realizó tanto la resección como la reconstrucción en todos los casos. Los vasos perforantes fueron marcados con un dispositivo Doppler sonido. Resultados: Se obtuvo cobertura en todos los casos, con solo una pérdida parcial de colgajo que fue resuelta con curaciones. Tras un seguimiento de 26 meses, no hubo recidiva de hidradenitis supurativa. Todas las reconstrucciones evolucionaron con resultados funcionales óptimos. Conclusión: Los colgajos perforantes son una buena alternativa para el tratamiento de casos severos de hidradenitis supurativa, tanto esternal como axilar. Por esta razón, debe ser considerado en el armamento de cirujanos plásticos que traten esta enfermedad, una vez que el tratamiento médico haya fallado.

Abstract Aim: To present a brief series of reconstructions with perforator flaps in severe cases of hidradenitis suppurativa patients and results. Patients and methods: Seven axillary and one sternal case in five patients were operated on. All patients were in stage II or III according to Hurley classification, and were referred after at least one year of medical treatment with no satisfactory result. The plastic surgery team performed both, resection and reconstruction in all cases. Perforator vessels were marked using a handheld Doppler device. Results: One partial flap failure occurred, which healed with standard wound care. After a median follow up of 26 months, no relapse of hidradenitis suppurativa occurred. All reconstructions evolved with full functional results. Conclusion: Perforator flaps are a good choice in the treatment of severe cases of hidradenitis suppurativa, both sternal and axillary. It should be considered in the armamentarium of any plastic surgeon treating patients with this condition, once the medical treatment has failed.

Complete axillary dissection without drainage for the surgical treatment of breast cancer: a randomized clinical trial

OBJECTIVE: This randomized clinical trial evaluated the possibility of not draining the axilla following axillary dissection. METHODS: The study included 240 breast cancer patients who underwent axillary dissection as part of conservative treatment. The patients were divided into two groups depending on whether or not they were subjected to axillary drainage. ClinicalTrials.gov: NCT01267552. RESULTS: The median volume of fluid aspirated was significantly lower in the axillary drainage group (0.00 ml; 0.00 - 270.00) compared to the no drain group (522.50 ml; 130.00 - 1148.75). The median number of aspirations performed during conservative breast cancer treatment was significantly lower in the drainage group (0.5; 0.0 - 4.0) compared to the no drain group (5.0; 3.0 - 7.0). The total volume of serous fluid produced (the volume of fluid obtained from drainage added to the volume of aspirated fluid) was similar in the two groups. Regarding complications, two cases (2.4%) of wound dehiscence occurred in the drainage group compared to 13 cases (13.5%) in the group in which drainage was not performed, with this difference being statistically significant. Rates of infection, necrosis and hematoma were similar in both groups. CONCLUSION: Safety rates were similar in both study groups; hence, axillary dissection can feasibly be performed without drainage. However, more needle aspirations could be required, and there could be more cases of wound dehiscence in patients who do not undergo auxiliary drainage.

Zetaplastia na retração axilar: técnica e tática para facilitar o aprendizado dos residentes / Z-plasty in axillary retraction: techniques and strategies to facilitate learning by medical residents

Introdução: São apresentados dois casos de retração em região axilar após queimadura em que a correção cirúrgica foi realizada empregando-se zetaplastias múltiplas. Apresentamos uma tática de marcação que visa facilitar o aprendizado desse procedimento pelos residentes de Cirurgia Plástica. Métodos: Dois pacientes com retrações axilares e de membros superiores após queimadura com líquido aquecido foram submetidos à correção cirúrgica empregando-se a zetaplastia múltipla. A tática de planejamento proposta nesse estudo preconiza primeiro a marcação do retalho triangular localizado no ponto médio da retração axilar, o qual irá avançar e cruzar o eixo da cicatriz, e a partir daí o desenho dos retalhos subsequentes com ângulo de 60° entre si. Acreditamos que essa sistematização da marcação facilita o planejamento e aprendizado da plástica em Z. Resultados: Os pacientes apresentaram adequadas amplitude de movimento e recuperação funcional do membro acometido no pós-operatório. Não houve necrose das extremidades dos retalhos, que preconizamos serem cuidadosamente trabalhadas e um pouco arredondadas; e a execução do procedimento foi simples devido à tática de marcação que aplicamos. Conclusão: A tática de marcação que apresentamos é reprodutível e de fácil aprendizado. A zetaplastia múltipla foi eficaz em restabelecer a amplitude de movimento das áreas com sequela de queimadura tratadas com esse método.

Introduction: Herein, we present two cases of post-burn retraction of the axillary region, which were subsequently surgically corrected using multiple Z-plasties. We present a marking strategy to facilitate the learning of this procedure by plastic surgery residents. Methods: Two patients with axillary and upper limb retractions due to burns with hot liquids were surgically treated using multiple Z-plasties. The strategy proposed in this study recommends the marking of the triangular flap located at the midpoint of the axillary retraction, which then advances and crosses the axis of the scar. Then, subsequent flaps are made at an angle of 60° to each other. We believe that this systematization of marking facilitates the planning and learning of Z-plasty. Results: The study patients achieved an adequate range of motion and functional recovery of the affected limb postoperatively. We observed no cases of necrosis of the flap ends, which should be carefully worked and slightly rounded. The execution of the procedure was simple using the suggested marking strategy. Conclusion: The presented marking strategy was reproducible and easy to learn. Multiple Z-plasties were effective in restoring the range of motion of the areas affected by burns that were treated using this method.

Retalho fasciocutâneo torácico lateral para reconstrução de defeitos axilares após ressecção de hidradenite supurativa: série de 10 casos / Lateral thoracic fasciocutaneous flap for reconstruction of axillary defects after resection of hidradenitis suppurativa: a series of 10 cases

INTRODUÇÃO: A hidradenite supurativa (HS) é uma inflamação folicular crônica que apresenta quadro clínico variado, desde pequenos nódulos isolados até diversas lesões abscedadas, com formação de fístulas e cicatrizes. A região axilar é uma das áreas mais frequentemente acometidas. O objetivo é analisar uma série de casos acometidos por HS na região axilar, submetidos à exérese cirúrgica ampliada e reconstrução com retalho fasciocutâneo torácico lateral. MÉTODOS: Análise retrospectiva dos prontuários dos pacientes submetidos a tratamento no período entre 2010 e 2012. RESULTADOS: Dez pacientes foram operados, sendo que em dois havia acometimento bilateral, totalizando 12 procedimentos. Foi observado um tempo médio de evolução antes da indicação cirúrgica de 38 meses. O defeito médio observado após a ressecção foi de 10 x 9 cm. O tamanho médio dos retalhos foi de 15 x 10 cm. Em relação às complicações precoces, foram observados dois casos de deiscência (região axilar) e um caso de epiteliólise parcial (segmento distal do retalho). CONCLUSÃO: Observamos que a dissecção deste retalho não é tecnicamente difícil e que não apresenta sequelas funcionais ou estéticas significativas na área doadora, sendo uma opção confiável e versátil para reconstrução de defeitos axilares de maior porte.

INTRODUCTION: Hidradenitis suppurativa (HS) is a chronic follicular inflammation that presents varied clinical features, from isolated small nodules to several abscessed lesions, with formation of fistulas and scars. The axillary region is one of the most frequently affected areas. The objective is to evaluate a series of patients with HS in the axillary region who underwent extensive surgical excision and reconstruction with a lateral thoracic fasciocutaneous flap. METHODS: A retrospective analysis of the medical records of patients who underwent treatment between 2010 and 2012 was conducted. RESULTS: Ten patients were operated, of whom two had bilateral involvement, totaling 12 procedures. The mean progression time before the surgical indication was 38 months. The mean defect size after the resection was 10 x 9 cm. The mean size of the flaps was 15 x 10 cm. With regard to early complications, two cases of dehiscence (axillary region) and one case of partial epitheliolysis (distal segment of the flap) were observed. CONCLUSION: We observed that dissection of lateral thoracic fasciocutaneous flaps is not technically difficult and does not present significant functional or aesthetic sequelae in the donor area, making it a reliable and versatile option for reconstruction of larger axillary defects.

Tiroidectomía endoscópica por vía transaxilar (para un tumor benigno de la tiroides) / Endoscopic thyroidectomy via transaxillary (for a benign tumor of the thyroid)

Se presenta el primer caso de tiroidectomía endoscópica por via transaxilar sin insuflación de gas realizada en Perú en una paciente con un nódulo benigno localizado en el lóbulo izquierdo de la glándula tiroides. La operación fue realizada con instrumentos de endocirugía, una endocámara y equipo sellador de vasos a través de una incisión axilar izquierda. esta técnica permite realizar una desección segura con visión magnificada de la glándula tiroides disminuyendo la posibilidad de complicaciones y eliminando la cicatriz en la región cervical anterior.

This paper presents the first report of an endoscopic gasless transaxillary thyroidectomy in Peru of a female patient with a benign left thyroid nodule. The operation was perdormed with endoscopic instruments, an endocamera, and a vessel sealing instrument through a left axillary incision. This technique permits a safe thyroid dissection with magnified vision, which lowers the possibility of complications and eliminates the anterior neck scar.

Reconstrucción axilar mediante colgajos en secuelas de quemadura / Axillary reconstruction through flaps in sequels burn

Las secuelas de quemadura en la región axilar son complejas y tienen relación directa con su anatomía. La reparación va a depender del defecto, desde contracturas leves que comprometan uno de los pilares a contracturas complejas donde la articulación está comprometida en bloque con la pared torácica. En este trabajo presentamos nuestra experiencia mediante la utilización de colgajos en todos los casos, presentando una diversidad de técnicas, desde zetaplastias, colgajos cutáneos, fasciocutáneos y musculocutáneos, tanto en secuelas axilares agudas como crónicas, con excelentes resultados estéticos y funcionales

The sequelae of burn in the axillary region are complex and are directly related to their anatomy. The repair will depend on the defect, from mild contractions that commit one of the pillars to complex joint contractures which is committed to block the chest wall. We present our experience using fl aps in all cases, presenting a variety of techniques, from Z-plasties, skin fl aps, musculocutaneous and fasciocutaneous both acute and chronic sequelae axillary, with excellent aesthetic and functional results

Abordagem cirúrgica axilar no câncer de mama estadiamento clínico T1-T2N0M0: complicações pós-operatórias e sobrevida em uma coorte hospitalar de mulheres do Rio de Janeiro / Auxillary surgical approach in breast cancer clinical stage T1-T2N0M0: postoperative complications and survival in a hospital cohort of women of Rio de Janeiro

As preocupações relacionadas ao prognóstico e qualidade de vida das pacientes com estadiamento precoce sem comprometimento linfonodal têm aumentado, especialmente no que se refere à abordagem cirúrgica axilar, devido ao aumento do diagnóstico precoce e avanços no tratamento do câncer de mama. Enquanto a biópsia do linfonodo sentinela (BLS) tem se mostrado eficiente e mais protetora do que a linfadenectomia axilar (LA) na incidência de complicações, ainda existem preocupações relacionadas a sobrevida das pacientes, principalmente na presença das micrometástases linfonodais. Objetivo: Caracterizar a incidência de complicações pós-operatórias em mulheres com câncer de mama classificação T1-T2N0M0, e determinar a sobrevida global (SG) e livre de doença (SLD) de mulheres diagnosticadas e tratadas no Instituto Nacional de Câncer (INCA) entre 2007 a 2009 segundo a abordagem cirúrgica axilar (BLS e LA). Métodos: Trata-se de um estudo observacional de uma coorte de 933 mulheres com diagnóstico clínico T1-2N0M0 atendidas no Hospital de Câncer III do Instituto Nacional de Câncer, no período de Janeiro de 2007 a Dezembro de 2009, e seguidas por um período de 60 meses. A coleta de dados foi realizada com base na análise do Registro Hospitalar de Câncer, dos prontuários físicos e/ou eletrônicos das pacientes e da ficha de avaliação do Serviço de Fisioterapia do HC-III/INCA. Dentre as informações avaliadas, constaram as características sociodemográficas, clínicas, de hábitos de vida, tratamentos empregados e variáveis de desfecho. As variáveis de desfecho serão àquelas referentes às complicações pós-cirúrgicas no membro superior afetado, status da doença (resposta ao tratamento e recidiva) e de status vital...

With increased early detection and advances in treatment of breast cancer, concerns related to the prognosis and quality of life of patients with early stage have increased without lymph node involvement, especially with respect to the axillary approach. However, while the sentinel lymph node biopsy (BLS) it has proved so efficient and more protective than the axillary lymphadenectomy (LA) in the incidence of complications, there are still concerns about the survival of patients, especially in the presence of lymph node micrometastase. Objective: To characterize the incidence of postoperative complications in women with breast cancer classification T1 and T2N0M0, according to axillary surgical approach, and determine overall survival and disease-free survival of women diagnosed and treated at the National Cancer Institute (INCA) between 2007 2009. Methods: Observational study of a cohort of 933 women with clinical diagnosis T1-2N0M0 treated at Hospital Cancer-III of the National Cancer Institute (HC-III / INCA) in 2007-2009, and followed by a period of 60 months. Data collection was based on analysis of the Hospital Registry Cancer, the physical and/or electronic records of patients - HCIII/INCA and clinical evaluation form the Physical Therapy Service of the HC-III/INCA. Among the evaluated information included sociodemographic, clinical, lifestyle habits, implemented treatments and outcome variables. The outcome variables will be those related to post-surgical complications in the affected upper limb, disease status (response to treatment and relapse) and vital status...

Horizontal right axillary minithoracotomy: aesthetic and effective option for atrial and ventricular septal defect repair in infants and toddlers / Minitoracotomia axilar direita horizontal: opção estética e eficaz para correção de comunicação interventricular e interatrial em lactentes e crianças

Introduction: Congenital heart defects treatment shows progressive reduction in morbidity and mortality, however, the scar, resulting from ventricular (VSD) and atrial septal defect (ASD) repair, may cause discomfort. Right axillary minithoracotomy approach, by avoiding the breast growth region, is an option for correction of these defects that may provide better aesthetic results at low cost. Since October 2011, we have been using this technique for repairing VSD and ASD defects as well as associated defects. Objectives: To evaluate the efficacy of this method in children undergoing correction of VSD and ASD, to compare perioperative clinical outcomes with those repaired by median sternotomy, and to evaluate the aesthetic result. Methods: Perioperative clinical data of 25 patients submitted to axillary thoracotomy were compared with data from a paired group of 25 patients with similar heart defects repaired by median sternotomy, from October 2011 to August 2012. Results: Axillary approach was possible even in infants. There was no mortality and the main perioperative variables were similar in both groups, except for lower use of blood products in the axillary group (6/25) vs. control (13/25), with statistical difference (P =0.04). The VSD size varied from 7 to 15 mm in axillary group. Cannulation of the aorta and vena cavae was performed through the main incision, whose size ranged from 3 to 5 cm in the axillary group, with excellent aesthetic results. Conclusion: The axillary thoracotomy was effective, allowing for a heart defect repair similar to the median sternotomy, with more satisfactory aesthetic results and reduced blood transfusion, and it can be safely used in infants. .

Introdução: O tratamento dos defeitos cardíacos apresenta progressiva redução da morbimortalidade, porém, a cicatriz, sequela aparente do tratamento da comunicação interatrial (CIA) e interventricular (CIV), pode causar incômodo. A abordagem por minitoracotomia axilar é opção para correção destes defeitos, com possível melhor estética e baixo custo, além de evitar a região de crescimento da mama. Desde outubro de 2011, empregamos esta técnica para correção de CIA, CIV e defeitos associados. Objetivo: Avaliar a eficácia do método em crianças submetidas à correção de CIV e CIA, avaliar a evolução clínica perioperatória em comparação à esternotomia mediana e avaliar o resultado estético. Métodos: Dados clínicos perioperatórios de 25 pacientes submetidos à minitoracotomia axilar foram comparados com dados de grupo de 25 pacientes submetidos à correção de defeitos cardíacos semelhantes por esternotomia mediana, de outubro de 2011 a agosto de 2012. Resultados: A correção dos defeitos via axilar foi factível inclusive em lactentes. Não houve mortalidade e as principais variáveis perioperatórias foram similares em ambos os grupos, exceto pelo menor uso de hemoderivados no grupo axilar (6/25) x controle (13/25), com diferença estatística (P=0,04). A sequela ventricular nos pacientes do grupo axilar variou de 7 a 15 mm. A canulação da aorta e veias cavas foi realizada através da incisão principal, cujo tamanho variou de 3 a 5 cm no grupo axilar, com resultado estético excelente. Conclusão: A minitoracotomia axilar foi eficaz, permitiu correção do defeito cardíaco semelhante à esternotomia mediana, com resultado estético mais ...

Retalho fasciocutâneo toracodorsal no tratamento cirúrgico da hidradenite supurativa: relato de caso e revisão de literatura / Thoracodorsal fasciocutaneous flap in the treatment of hidradenitis suppurativa: a case report and literature review

A hidradenite supurativa, também conhecida como doença de Verneuil, é uma inflamação crônica e recorrente das glândulas apócrinas, sem etiologia conhecida, que evolui frequentemente com saída de secreção purulenta, formação de fístulas, cicatrizes inestéticas e retráteis, podendo acometer região inguinal, axilar, aréolas mamárias e umbigo. Neste trabalho, é apresentado um caso grave de doença de Verneuil em região axilar, em que foi realizada exérese da lesão e reconstrução com retalho fasciocutâneo toracodorsal bilateral como uma opção de reconstrução da região axilar, com boa resolubilidade e resultado estético.

Hidradenitis suppurativa also known as Verneuil's disease is a chronic inflammatory and recurrent disease that occurs in the apocrine glands. It results in recurrent abscesses with purulent secretion, fistulae formation, unaesthetic and retractable scars. The most common sites involved include the axilla, inguinoperineal regions, nipple-areolar complex, and umbilicus. Here, we report a case of severe Verneuil's disease of the axillary region managed with wide excision surgery, and thoracodorsal fasciocutaneous flap and bilateral coverage. This method provides good results for reconstruction of the axillary region.

Contractura axilar por quemadura tratada con Integra® / Axillary burn contracture treated with Integra®

Introduction: Severe axillary burn is an unusual accident that frequently evolves to contracture generating important cosmetic and functional deficiencies. Contracture scars in this region are difficult to treat because of the anatomic characteristics of the area that has multiple power vectors. Functional restoration has to be one of the main goals in the management of burns in the axilla and flaps have shown high rate of morbidity. Integra® provides satisfactory elasticity and dermal resistance which results in positive functional results. Objective: Analyze the results of the use of Integra® in axillary burn contracture scars at a specialized Burns Center. Materials and Methods: There were 4 patients who underwent reconstructive surgery using Integra® for axillary burn contractures between January 2002 and March 2006. Follow-up was divided into perioperative and late. Early follow-up checked general post-operative evolution and late follow-up was focused on functionality and patient independence evaluated using Barthel's index of daily living activities. Results: There were 3 males and 1 female, average age 27 (18-41) with a minimum follow up of 9 months. There were no perioperative complications and good or very good range of motion results. Conclusions: Our results are similar to artificial skin substitutes used in other anatomical regions.

Las quemaduras axilares severas son un accidente infrecuente que evolucionan a la retracción generando deficiencias cosméticas y funcionales. Estas cicatrices son difíciles de tratar por las características anatómicas del área, donde la corrección de un vector de movimiento puede alterar otro. Objetivo: Mostrar nuestros resultados utilizando el sustituto cutáneo Integra® en el tratamiento de cicatrices retráctiles axilares por quemadura. Pacientes y Métodos: Se recolectaron antecedentes médicos y fotográficos de pacientes portadores de cicatrices retráctiles axilares por quemadura entre enero de 2002 y marzo de 2006 en el Hospital del Trabajador de Santiago. Se evaluó pre y postoperatoriamente a los pacientes en forma subjetiva por fisiatra y con el Test de Barthel. Resultados: Se incluyeron 4 pacientes en el estudio (3 mujeres y 1 hombre), edad media 27 años (18-41). Todas las quemaduras fueron producidas por fuego. Índice de Barthel preoperatorio fue de 87,5 (levemente dependiente para las actividades de la vida diaria) y rango de movimiento moderadamente afectado. En el postoperatorio los pacientes fueron catalogados como independientes según el Test de Barthel y el rango de movimiento fue descrito como bueno o muy bueno por el fisiatra. No hubo complicaciones peri operatorias, Integra® prendió adecuadamente en todos los casos. Los pacientes fueron seguidos en promedio 16 meses (9-22). Conclusiones: Los sustitutos dérmicos han sido usados para la corrección de cicatrices de quemaduras con buenos resultados, pero no hay reportes en la axila. El pequeño número de pacientes que presentamos tienen un excelente resultado funcional, lo que nos estimula a seguir trabajando en este rumbo.

"V"-technique as a method of breast conserving surgery in multifocal and T2 invasive breast cancers situated in the upper outer quadrant / La técnica "V" como método quirúrgico para conservar las mamas en cánceres de mama invasivos T2 y multifocales situados en el cuadrante superior externo

OBJECTIVE: To assess the oncologic and cosmetic outcomes in women with multifocal breast cancers or T2 tumours with diameters larger than 3 cm situated in the upper outer quadrant who were treated with "V"-technique. METHODS: From July 1999 till June 2003, 44 conserving surgeries with "V"-technique using a local rotational flap were performed. Localization of tumours was in the upper outer quadrant. All solid tumours were larger than 3 cm in diameter. In all patients, axillary lymph node dissection was performed. All the patients received postoperative radiotherapy. Mean follow-up was 58 months. RESULTS: Out of 44 conserving surgeries with "V"-technique, an adequate distance of tumour from the margins was obtained in 84.1% (37/44). Out of 37patients who underwent conserving surgery with this technique, the cosmetic result was favourable in 83.78% (31/37). None of these patients had a corrective surgery such as reduction mammaplasty or mastopexy. Mean weight of excised tissue was 215 g. The 5-year local recurrence rate was 10.8%. The 5-year metastasis-free survival rate was 81,1%. The 5-year overall survival rate was 86.5 %. CONCLUSIONS: Surgical treatment of multifocal and T2 breast cancers larger than 3 cm in diameter situated in the upper outer quadrant and performed with "V"-technique gives a good aesthetic result and enables a wide resection of breast tissue around the tumour.

OBJETIVO: Evaluar los resultados oncológicos y cosméticos en las mujeres con cánceres multifocales de mama o tumores T2 de diámetro mayor de 3 cm, situados en el cuadrante superior externo, en pacientes tratadas con la técnica "V". MÉTODOS: De julio 1999 hasta junio de 2003, se realizaron 44 cirugías conservadoras usando la técnica "V" con colgajo local de rotación. Los tumores se hallaban localizados en el cuadrante superior. Todos los tumores sólidos tenían más de 3 centímetros de diámetro. A todas las pacientes se les practicó la disección del ganglio linfático axilar. Todas las pacientes recibieron radioterapia postoperatoria. El seguimiento promedio fue de 58 meses. RESULTADOS: De las 44 cirugías conservadoras con la técnica "V", se obtuvo una distancia adecuada del tumor en 84.1% (37/44) desde los márgenes. De 37 pacientes que tuvieron cirugía conservadora con esta técnica, el resultado cosmético fue favorable en 83.78% (31/37). A ninguna de estas pacientes se les realizó cirugías correctivas tales como mamoplastia de reducción, o mastopexia. El peso promedio del tejido extirpado fue 215 g. La tasa de recurrencia local quinquenal fue de 10.8%. La tasa de supervivencia quinquenal libre de metástasis fue 81, 1%. La tasa general de supervivencia fue de 86.5%. CONCLUSIONES: El tratamiento quirúrgico de los cánceres de mama T2 y multifocales mayores de 3 cm. de diámetro situados en el cuadrante superior externo y realizado con la técnica "V" produce un buen resultado estético y permite una resección amplia del tejido mamario alrededor del tumor.

Tratamiento conservador de la glándula mamaria: experiencia Unidad de Mastología Clínica Leopoldo Aguerrevere / Preservative breats cancer treatment: experience in Mastology Unit of Leopoldo Aguerrevere Clinic

El tratamiento conservador de la glándula mamaria ha permitido mantener el éxito oncológico en el tratamiento de cáncer invasor, sin sacrificar estética y funcionalidad. Desde marzo de 1980 en la Unidad de Mastología del Centro Clínico de Maternidad Leopoldo Aguerrevere se siguieron pacientes con cáncer de mama T1 y T2, no mayor de 3 cm, 543 pacientes se dividieron en: primer grupo 295 pacientes desde mayo 1980 al 1998, a los cuales se les realizó mastectomía parcial oncológica con disección axilar de los niveles I y II y un segundo grupo desde mayo 1998-diciembre 2004, a los cuales además de la mastectomía se les realizó identificación del ganglio centinela por técnica combinada de tecnecio 99 y azul patente, y disección axilar cuando este último fue positivo. El promedio de edad fue de 53,13 años, estadio clínico más frecuente fue I, el tamaño tumoral similar en ambos grupos de estudio. Sobrevida global para el grupo total fue 85,5% a los 5 años y 68,5% a los 10. La libre de enfermedad de 83,6% a los 5 años y 63,2% a los 10 años.

The conservative treatment of the mammary gland has allowed support the success in the treatment of invasive cancer, without sacrificing the esthetic and functionality of the organ. Since March 1980 at the mastology unit “Clinica Leopoldo Aguerrevere” we followed patients with breast cancer T1 and T2, no bigger than 3 cm. 543 patients were divide in a first group of 295 patients from May, 1980 to December 1998, to which a partial oncological mastectomy was made by axillaries dissection of the levels I and II, and a second group from May, 1998 to December 2004 with partial mastectomy and identification of the sentinel lymph node biopsy using a combined technique of tecnetium 99 and clear blue, and axillaries dissection when the sentinel node was positive. The average of age was 53.13 years and the most frequent clinical stage was I, being the tumor similar size in the both groups of study. The global survival of the total group was 85.5% at 5 years and 68.5% at 10 years. Free survival disease was 83.6% at the 5 years and 63.2% at 10 years.

Fibroadenoma en mama axilar supernumeraria: reporte de un caso / Fibroadenoma in supernumerary axilar breast: one case report

Se presenta el caso de una paciente de 41 años portadora de mamas axilares bilaterales que consulta por dolor más masa palpable en una de ellas. La paciente es sometida a resección quirúrgica que mostró que el tumor era un fibroadenoma.

This is a case report, of a 41 years old patient, with bilateral axillar fibroadenoma. The aim of the query was pain and a tangibly mass in one of it. A surgical resection was made, and it showed a fibroadenoma neoplasm.

Morbidade entre a pós-biópsia de linfonodo sentinela e a dissecção axilar no câncer de mama / Morbidity after sentinel node biopsy and axillary dissection in breast cancer

OBJETIVO: O objetivo deste estudo foi avaliar a morbidade cirúrgica pós-biópsia de linfonodo sentinela (BLS) ou dissecção axilar com (DA-NP) e sem preservação do nervo intercostobraquial (DA-NS). MÉTODOS: Fez-se estudo coorte prospectivo com 108 pacientes divididas em três grupos: BLS (n=35), DA-NP (n=36) e DA-NS (n=37). Foram avaliadas ocorrência de déficit sensorial, dor, linfedema, seroma e infecção no membro superior homolateral à cirurgia. Monofilamentos de Semmes-Weinstein foram usados para avaliar o déficit sensorial, perimetria braquial foi feita para avaliação da presença de linfedema e aplicado questionário de dor. Para análise estatística foram utilizados os testes ANOVA e Kruskal-Wallis. Foi feita análise bivariada e multivariada. RESULTADOS: Pelo menos uma complicação pós-cirúrgica, imediata ou tardia, ocorreu em 45/108 (41,7 por cento) pacientes avaliadas. A complicação mais comum foi dor. Houve diferença estatisticamente significante entre os três grupos somente quanto ao déficit sensorial (p=0,04). Dor, linfedema e déficit sensorial ocorreram com maior freqüência no grupo DA-NS. As pacientes dos grupos BLS e DA-NP não apresentaram diferenças estatisticamente significantes para nenhuma das variáveis analisadas. A pesquisa com os monofilamentos mostrou sensibilidade cutânea preservada em 28/35 pacientes do grupo BLS, em 25/36 pacientes do grupo DA-NP e em 10/37 pacientes do grupo DA-NS (p<0,001). CONCLUSÃO: A secção do nervo está relacionada a maior déficit sensorial havendo diferença estatisticamente significante entre os três grupos, o que não demonstrou ser significante com os demais critérios avaliados dentre os grupos analisados.

BACKGROUND: The aim of this study was to evaluate the morbidity after sentinel node biopsy (SNB) and axillary dissection with (AD-NS) or without sparing the intercostobrachial nerve (AD-NOS). Methods: A prospective cohort study was performed on 108 patients divided into three groups: SNB (n=35), AD-NS (n=36) and AD-NOS (n=37). We evaluated the incidence of sensory loss, pain, lymphedema, seroma formation and infection in the arm homolateral to the breast surgery. Semmes-Weinstein monofilaments were used to assess the sensory loss; brachial perimetry was used to evaluate presence of lymphedema and a pain questionnaire was administered. ANOVA and Kruskal-Wallis statistical tests were used. Bivariate and Multivariate analyses were performed. RESULTS: After surgery at least one complication was reported by 45/108 (41.7 percent) patients. Pain was the outcome more often reported by patients. In the three groups a significant difference was observed only regarding sensory loss (p=0.04). Pain, lymphedema, and sensory loss were more frequently found in the AD-NOS group. No significant difference was observed between SNB and AD-NS groups. Semmes-Weinstein monofilaments showed preservation of cutaneous sensitivity in 28/35 patients from the SNB group, in 25/36 patients from AD-NS group but in only 10/37 patients from AD-NOS group (p<0.001). CONCLUSION: The ICB section is associated with higher sensory loss, with statistically significant difference between the groups that were not shown to be significant with the others complications.

Tratamento da hiperidrose axilar com lipoaspiração / Liposuction for treatment of axillary hyperhidrosis

Introdução: A hiperidrose axilar primária e a bromohidrose são problemas comuns que levam vários pacientes a procurar atendimento médico. A remoção das glândulas sudoríparas écrinas e apócrinas da região axilar por meio de lipoaspiração superficial sob anestesia intumescente é um procedimento de pequeno porte, simples e com poucas complicações, oque pode ser observado em nosso estudo. O objetivo deste trabalho é a difusão desta técnica. Método: Vinte e cinco pacientes foram submetidos a lipoaspiração superficial da axila sobanestesia local e sedação. Resultados: Após um ano de acompanhamento pós-operatório, três pacientes apresentaram respostas regulares e dois apresentaram resultados insatisfatórios. Dentre os pacientes analisados, quatorze apresentavam bromohidrose associada e obtiveram respostas satisfatórias com redução significativa ou até mesmo desaparecimento do odor característico. Conclusão: Concluímos que o procedimento é eficaz e seguro para o tratamento de hiperidrose axilar primária e bromohidrose.

Introduction: Axillary hyperhidrosis and bromohidrosis are common problems for which many patients seek medical treatment. The removal of axillary sweat glands using liposuctionwith tumescent anesthesia in an out patient setting is a relatively short and simple procedure with few complications, as seen in this case series. The purpose of is study is to contribute for the spread of this technique. Methods: Twenty five patients were treated with axillaryliposuction under tumescent anesthesia. Results: One year after the procedure, three patients had regular results and two required additional liposuction to the same area. Those who had bromohidrosis associated presented good results with significant reduction of the odor. Conclusion: This procedure is efficient and safe when used to treat primary axillary hiperhidrosis and bromohidrosis.

need for skin pen marking for sentinel lymph node biopsy: a comparative study

There is a consensus in the literature that sentinel lymph node biopsy is the standard procedure for axillary staging in early stage [I and II] breast cancer patients. Usually during lymphoscintigraphy, the location of the sentinel lymph node is marked on the skin by an indelible ink. In this study we evaluated this issue in our patients. 40 patients with the clinical diagnosis of early stage breast cancer [stage I or II] were included into the study. All patients received periareolar intradermal injections of 18.5 MBq Tc-99m antimony sulfide colloid 2-4 hours before the surgery and 2 ml patent blue V dye in a subdermal and periareolar fashion during surgery. The patients were divided randomly into two groups [20 patients in each group]. In group I, the anterior and lateral locations of the sentinel lymph node were marked on the skin with an indelible ink. In group II, no skin marking was used. A sentinel node was defined as any blue node or any node with an ex vivo radioisotope count of twofold or greater than the axillary background. All patients underwent standard axillary lymph node dissection after sentinel node biopsy. Mean age and tumor size were not significantly different between groups. SLN detection rate and number of detected SLNs were not significantly different either [P > 0.05]. Number of detected lymph nodes was 1.24 +/- 0.43 and 1.28 +/- 0.61 in group I and II of the patients, respectively. False negative rate [negative SLN and positive axillary nodes] for both groups were 0%. Although marking the location of the sentinel lymph node on the skin with an indelible ink can guide the surgeon during surgery, it can not increase the sentinel lymph node detection rate or improve the results of sentinel lymph node biopsy