Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 822
Filter
1.
An. Fac. Cienc. Méd. (Asunción) ; 54(3): 173-178, Dec. 2021.
Article in Spanish | LILACS | ID: biblio-1352991

ABSTRACT

El colgajo de fascia temporal superficial es muy versátil para la reconstrucción de defectos tisulares localizados en los tercios superior y medio de la cara, en la región orbito-palpebral, en la cavidad oral, en la base del cráneo y a nivel mandibular. En nuestra experiencia, constituye una opción segura para reconstrucciones complejas de cavidades. En el presente artículo los autores exponen el caso de una paciente en quien se reconstruyó un defecto de órbita con un colgajo de fascia temporal superficial prelaminado


The superficial temporal fascia flap is versatile for the reconstruction of tissue defects located in the upper and middle thirds of the face, in the orbital-palpebral region, in the oral cavity, at the base of the skull and at the mandibular level. In our experience, it is a safe option for complex cavity reconstructions. In this article the authors present the case of a patient in whom an orbit defect was reconstructed with a pre-laminated superficial temporal fascia flap


Subject(s)
Transplants , Orbit , Fascia
2.
Revista Brasileira de Ciência e Movimento ; 28(4): 180-193, ago. 2021. tab
Article in Portuguese | LILACS | ID: biblio-1342865

ABSTRACT

Este estudo investiga o efeito da autoliberação miofascial sobre o desempenho de potência muscular no salto vertical, salto horizontal e agilidade uniplanar em atletas de futebol sub-13, cuja amostra foi composta por 22 adolescentes do sexo masculino, praticantes de uma escolinha de futebol da cidade de Juiz de Fora, MG. Ao todo, realizaram-se três dias de testes de cada variável, assim como o protocolo de autoliberação, com intervalo de 48 horas entre as sessões. Para o protocolo controle, os participantes foram orientados a realizar três tentativas de salto horizontal, vertical e agilidade uniplanar, com intervalo de dois minutos para cada tentativa e uma pausa de cinco minutos entre os testes. Os mesmos procedimentos foram repetidos para a realização do protocolo experimental de autoliberação, porém executou-se, nos pré-testes de membros inferiores, um minuto de autoliberação miofascial, com ordem aleatória dos grupos musculares (quadríceps, isquiostibiais e gastrocnêmio), com o total de seis minutos de autoliberação, validando-se os melhores resultados de cada teste dos protocolos controle e experimental, em que utilizou-se o Foam Rolling. Observou-se uma média de 2,8 (±0,8) para os estágios de desenvolvimento dos participantes, considerando a Escala de Tanner. Quanto ao protocolo de autoliberação, o desempenho no salto vertical foi significativamente superior após a utilização do Foam Rolling, comparado ao controle. Não houve diferença significativa no desempenho de salto horizontal e agilidade uniplanar ao comparar o protocolo controle com o experimental, todavia, efeitos adversos não foram observados na utilização deste método.(AU)


This study investigates the effect of myofascial self-liberation on the performance of muscle power in the variables of vertical jump, horizontal jump and uniplanar agility in under-13 soccer athletes, whose sample was composed of 22 male adolescents, practitioners of a soccer school from the city of Juiz de Fora, MG. In all, three days of tests were performed for each variable, as well as the self-release protocol, with an interval of 48 hours between sessions. For the control protocol, participants were instructed to make three attempts to jump horizontally, vertically and uniplanar agility, with an interval of two minutes for each attempt and a five-minute pause between tests. The same procedures were repeated for the experimental self-liberation protocol, however, in the lower limb pre-tests, a minute of myofascial self-liberation was performed, with a random order of the muscle groups (quadriceps, hamstrings and gastrocnemius), with the total of six minutes of self-liberation, validating the best results of each test of the control and experimental protocols, in which Foam Rolling was used. An average of 2.8 (± 0.8) was observed for the participants' developmental stages, considering the Tanner Scale. As for the selfliberation protocol, the performance in the vertical jump was significantly higher after using Foam Rolling, compared to the control. There was no significant difference in the performance of horizontal jump and uniplanar agility when comparing the control protocol with the experimental one, however, adverse effects were not observed in the use of this method.(AU)


Subject(s)
Humans , Male , Adolescent , Soccer , Sports , Exercise , Adolescent , Musculoskeletal Manipulations , Fascia , Potency , Lower Extremity , Efficiency , Athletes , Muscles
3.
J. coloproctol. (Rio J., Impr.) ; 41(2): 193-197, June 2021. ilus
Article in English | LILACS | ID: biblio-1286994

ABSTRACT

Abstract The postoperative outcome of rectal cancer has been improved after the introduction of the principles of total mesorectal excision (TME). Total mesorectal excision includes resection of the diseased rectum and mesorectum with non-violated mesorectal fascia (en bloc resection). Dissection along themesorectal fascia through the principle of the "holy plane" minimizes injury of the autonomic nerves and increases the chance of preserving them. It is important to stick to the TME principle to avoid perforating the tumor; violating the mesorectal fascia, thus resulting in positive circumferential resection margin (CRM); or causing injury to the autonomic nerves, especially if the tumor is located anteriorly. Therefore, identifying the anterior plane of dissection during TME is important because it is related with the autonomic nerves (Denonvilliers fascia). Although there are many articles about the Denonvilliers fascia (DVF) or the anterior dissection plane, unfortunately, there is no consensus on its embryological origin, histology, and gross anatomy. In the present review article, I aim to delineate and describe the anatomy of the DVF inmore details based on a review of the literature, in order to provide insight for colorectal surgeons to better understand this anatomical feature and to provide the best care to their patients.


Resumo O resultado pós-operatório do câncer retal foi melhorado após a introdução dos princípios da excisão total do mesorreto (TME, na sigla em inglês). A excisão total do mesorreto inclui a ressecção do reto e do mesorreto afetados com fáscia mesorretal não violada (ressecção em bloco). A dissecção ao longo da fáscia mesorretal pelo princípio do "plano sagrado" minimiza a lesão dos nervos autônomos e aumenta a chance de preservá-los. É importante seguir o princípio da TME para evitar: a perfuração do tumor; a violação da fáscia mesorretal, resultando em margem de ressecção circunferencial (CRM) positiva; ou a lesão aos nervos autônomos, especialmente se o tumor estiver localizado anteriormente. Portanto, a identificação do plano anterior de dissecção durante a TME é importante, pois está relacionada comos nervos autonômicos (fáscia de Denonvilliers). Embora existammuitos artigos sobre a fáscia de Denonvilliers (DVF, na sigla em inglês) ou o plano de dissecção anterior, infelizmente não há consenso sobre sua origem embriológica, histologia e anatomia macroscópica. No presente artigo de revisão, retendo delinear e descrever a anatomia da DVF em mais detalhes com base em uma revisão da literatura, a fim de fornecer subsídios para os cirurgiões colorretais entenderemmelhor esta característica anatômica e fornecer o melhor cuidado para seus pacientes.


Subject(s)
Rectal Neoplasms , Fascia/anatomy & histology , Rectum/anatomy & histology , Rectum/surgery , Rectum/pathology
4.
Article in Chinese | WPRIM | ID: wpr-888619

ABSTRACT

In 1982, total mesorectal excision(TME) was proposed by Professor R. J. Heald, which was a milestone-style for rectal cancer surgery. The concept of TME has reduced the local recurrence rate of mid-low rectal cancer (MLRC) significantly, thus becomes the gold standard for MLRC surgery. However, the incidence of urogenital dysfunction after TME remains high, among which urinary dysfunction reaches 30%-60%, and sexual dysfunction reaches 50%-70%. In recent years, studies have shown that the removal of Denonvilliers' fascia (DVF) during TME is an important cause of postoperative urination and sexual dysfunction. Therefore, DVF preserving total mesorectal excision (iTME) has been recognized by more and more surgical experts. On the basis of existing literature and clinical practice, we organize experts to discuss and vote, put forward recommendations for several issues of iTME, and finally formulate this expert consensus. The formulation of this consensus aims to increase surgeons' awareness of the value and functional protection of DVF during TME surgery, clarify the indications and contraindications of iTME, and standardize the procedure of iTME, so as to reduce postoperative urination and sexual dysfunction and improve the quality of life of patients with MLRC. The level of evidence and recommendation of this consensus is determined by Grading Recommendations, Assessment, Development and Evaluation (GRADE), and the consensus content is determined through expert voting and Delphi method.


Subject(s)
China , Consensus , Fascia , Humans , Neoplasm Recurrence, Local , Quality of Life , Rectal Neoplasms/surgery , Rectum/surgery
5.
Rev. bras. ortop ; 55(6): 736-741, Nov.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1156197

ABSTRACT

Abstract Objective To describe and demonstrate the outcomes of the modified Monteiro (1991) technique for lower limb reconstruction with a fasciocutaneous flap of the distal pedicle in a series of 15 cases. Method We present the technique and outcomes from a series of 15 cases of the modified technique using a fasciocutaneous flap of the distal pedicle to repair the lower third of the leg and the foot. Results Outcomes were satisfactory since these flaps provided good cutaneous and subcutaneous tissue coverage in cases with bone exposure and skin loss. The donor area was closed 3 days after surgery with a partial skin graft to provide better graft viability. Conclusion The fasciocutaneous flap of the distal pedicle proved to be a good option for reconstruction of the middle and lower thirds of the leg, offering good bone coverage.


Resumo Objetivo Descrever e demonstrar o desfecho da técnica modificada de Monteiro (1991) para a reconstrução do membro inferior com retalho fasciocutâneo de pedículo distal numa série de 15 casos. Método Com uma série de 15 casos, apresentamos a técnica e o desfecho da técnica modificada do retalho fasciocutâneo de pedículo distal com para a reparação do terço inferior da perna e do pé. Resultados Os resultados foram satisfatórios porque os retalhos proporcionaram boa cobertura de pele e tecido celular subcutâneo nos casos de exposição óssea e perda cutânea. A área doadora foi fechada 3 dias após a cirurgia, com enxerto de pele de espessura parcial, proporcionando uma melhor viabilidade do enxerto. Conclusão O retalho fasciocutâneo de pedículo distal mostrou-se como uma boa opção para a reconstrução do terço médio e inferior da perna, oferecendo boa cobertura óssea.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Surgical Flaps , Tissue Donors , Bereavement , Skin Transplantation , Lower Extremity , Fascia , Foot , Leg
6.
Rev. Pesqui. Fisioter ; 10(3): 410-416, ago.2020. tab, ilus
Article in English, Portuguese | LILACS | ID: biblio-1223876

ABSTRACT

O Functional Fascial Taping (FFT) é uma técnica de aplicação de bandagem rígida objetivando estimular o alinhamento estrutural das fibras de colágeno da fáscia muscular, desobstruindo a passagem dos fluidos assegurando assim sua função. OBJETIVO: Avaliar os efeitos do FFT associado a Fisioterapia convencional nas disfunções crônicas no joelho baseado nas variáveis intensidade da dor, amplitude de movimento, força e flexibilidade muscular. METODOLOGIA: Tratou-se de um estudo quase-experimental realizado com 10 pacientes de ambos os gêneros e sintomatologia de dor e limitação funcional, estando em tratamento fisioterapêutico. Todos os pacientes foram submetidos a avaliação cinético-funcional, incluindo dados de dor, amplitude de movimento, força e flexibilidade muscular. A aplicação do FFT foi padronizada, onde primeiro identificou-se os vetores, seguido da aplicação do tape hipoalergênico. Depois aplicou-se três tiras de bandagem rígida, então, recobriu-se com o tape hipoalergênico novamente. A aplicação da bandagem ocorreu três vezes por semana, totalizando 10 sessões. RESULTADOS: Houve redução nos níveis de dor de mediana 10,0 cm para 2,0 cm ao final das 10 sessões (Z=2,6; p=0,007). Aumentou a força muscular para extensão do joelho com mediana inicial de 4,0 para final de 4,0 (Z=2,0; p=0,04). A amplitude de movimento para flexão (Mediana: de 102,5° para 110,0°, Z=2,3, p=0,01) e flexibilidade muscular (Mediana: de 5,0 cm para 0,0 cm, Z=2,0, p=0,04) também melhorou significavamente. CONCLUSÃO: O FFT pode ser utilizado como coadjuvante no tratamento de desordens no joelho, tanto ortopédicas quanto reumáticas, auxiliando a manutenção de uma mecânica funcional equilibrada, o que favorece a redução no quadro álgico, aumento no arco de movimento e melhora na força e flexibilidade muscular.


Functional Fascial Taping (FFT) is a rigid bandage technique aimed at stimulating the structural alignment of the collagen fibers of the muscular fascia, unblocking the passage of fluids thus ensuring its function. OBJECTIVE: To evaluate the effects of FFT associated with conventional physiotherapy on chronic knee dysfunctions based on the variables pain intensity, range of motion, muscle strength and flexibility. METHODOLOGY: This is a quasiexperimental study performed with 10 patients of both genders and symptomatology of pain and functional limitation, being in physiotherapeutic treatment. All of them underwent kinetic-functional evaluation, including data on pain, range of motion, muscle strength and flexibility. The application was standardized: first we identified the vectors, followed by the application of hypoallergenic tape. Then applied three strips of rigid bandage, then covered or hypoallergenic tape again. One application three times a week, totaling 10 sessions. RESULTS: There was a reduction in pain levels from a median 10.0 cm to 2.0 cm at the end of the 10 sessions (Z = 2.6; p = 0.007). Increased muscle strength for knee extension with initial median of 4.0 to final of 4.0 (Z = 2.0; p = 0.04). Range of motion also improved significantly for knee flexion (Median: from 102.5 ° to 110.0 °, Z = 2.3, p = 0.01) and increased flexibility (Median: from 5.0 cm to 0.0, Z = 2.0 cm, p = 0.04). CONCLUSION: FFT can be used as a coadjuvant in the treatment of knee disorders, both orthopedic and rheumatic, allowing stimuli to maintain a more balanced functional mechanics, which favors the reduction in pain, an increase in the range of motion and improvement in strength and muscle flexibility.


Subject(s)
Fascia , Range of Motion, Articular , Physical Therapy Specialty
7.
Braz. j. otorhinolaryngol. (Impr.) ; 86(4): 483-489, July-Aug. 2020. tab, graf
Article in English | LILACS | ID: biblio-1132618

ABSTRACT

Abstract Introduction Elevation of tympanomeatal flap is one of the basic steps of tympanoplasty. A satisfactory level of anatomic and functional success can be achieved by using different grafts with limited tympanomeatal flap elevation. Objectives We aimed to compare the anatomic and functional success of tragal cartilage perichondrium and temporal muscle fascia in cases of endoscopic type 1 tympanoplasty performed with limited tympanomeatal flap elevation. Methods In total, 81 cases (33 females, 48 males, mean age 22.1<±<10.1 years, interval 18-49 years) which underwent transcanal endoscopic type 1 tympanoplasty with limited elevation of tympanomeatal flap were included the present study. All cases were divided into two groups as tragal cartilage perichondrium (group A) and temporal muscle fascia (group B). The comparison of the groups were made considering the pre- and postoperative air-bone gap and the tympanic membrane status. Results There was no statistically significant difference between Group A and Group B in preoperative and in postoperative air-bone gap values (p<=<0.608 and 0.529, respectively). In Group A and B, postoperative air-bone gap values demonstrated significant decrease compared to the preoperative values (p<=<0.0001). Group A and group B did not demonstrate significant differences between postoperative improvements of air-bone gap values (p<=<0.687). Graft retention success was 92.6% in group A while it was 90.0% in group B. There was no statistically significant difference between the groups in terms of graft retention success (p<=<0.166). Conclusion In accordance with the results of this study, we believe that both tragal cartilage perichondrium and temporal muscle fascia, and also in limited tympanomeatal flap elevation in endoscopic tympanoplasty are all eligible for result in safe and successful surgery.


Resumo Introdução O descolamento do retalho timpanomeatal é uma das etapas básicas da timpanoplastia. Um nível satisfatório de sucesso na restauração anatômica e funcional pode ser alcançado com o uso de diferentes enxertos e descolamento limitado do retalho timpanomeatal. Objetivos Comparar os resultados anatômicos e funcionais entre o uso de pericôndrio de cartilagem tragal e de fáscia do músculo temporal em timpanoplastias endoscópicas tipo 1 feitas com descolamento limitado do retalho timpanomeatal. Método Foram incluídos no estudo 81 pacientes (33 mulheres, 48 homens, média de 22,1 ± 10,1 anos, variação de 18-49 anos), submetidos a timpanoplastia endoscópica transcanal tipo 1 com descolamento limitado do retalho timpanomeatal. Todos os casos foram divididos em dois grupos: pericôndrio da cartilagem tragal (grupo A) e fáscia do músculo temporal (grupo B). Na comparação dos grupos consideraram-se o gap aéreo-ósseo, pré e pós-operatório, e a condição da membrana timpânica. Resultados Não houve diferença estatisticamente significante entre os grupos A e B no pré e pós-operatório (p = 0,608 e 0,529, respectivamente). Nos grupos A e B, os valores do gap aéreo-ósseo no pós-operatório demonstraram redução significante em relação aos valores pré-operatórios (p = 0,0001). Os grupos A e B não demonstraram diferenças significantes entre as medidas pré e pós-operatórias dos valores dos gaps (p = 0,687). O sucesso da retenção do enxerto foi de 92,6% no grupo A, enquanto no grupo B foi de 90,0%, não ocorreu diferença estatisticamente significante entre os grupos (p = 0,166). Conclusão De acordo com os resultados deste estudo, acreditamos que tanto o pericôndrio da cartilagem tragal como a fáscia do músculo temporal, usados com descolamento limitado do retalho timpanomeatal na timpanoplastia endoscópica, são elegíveis para uma cirurgia segura e bem-sucedida.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Tympanoplasty , Temporal Muscle , Cartilage , Retrospective Studies , Treatment Outcome , Tympanic Membrane Perforation , Fascia
8.
Int. j. med. surg. sci. (Print) ; 7(2): 1-14, jun. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1179229

ABSTRACT

El Plexo Hipogástrico Inferior (PHI) es un plexo difícil de definir y disecar, de allí la facilidad con que puede lesionarse tanto en la investigación anatómica como quirúrgica. Definir sus relaciones, con respecto a las fascias endopelvianas (FEP), incluyendo su formación y sus ramos, (Baader et al., 2003, p. 129)facilitaría su disección. Esta investigación anatómica pretende estandarizar Se utilizó material cadavérico perteneciente a la Tercera Cátedra de Anatomía de la Facultad de Medicina de la Universidad de Buenos Aires. Se disecaron un bloque de órganos de cadáver adulto formolizado (n=1) y diecisiete (n = 17) hemipelvis: cinco (n = 5) hemipelvis masculinas adultas formolizadas, nueve (n = 9) hemipelvis fetales formalizadas (7 masculinos y 2 femeninas), entre 18 y 36 semanas de edad gestacional calculada por la longitud femoral y tres (n = 3) hemipelvis adultas de cadáveres frescos, dos (n = 2) femeninas y un (n = 1) masculino. Se utilizaron elementos de microdisección y lupas.Pudimos distinguir tres sectores diferentes: el primero, preplexual, ubicado posterior y lateralmente a la FEP, donde los componentes simpáticos (nervios hipogástricos) y los parasimpáticos (nervios esplácnicos pélvicos) aún no han confluido para su formación. Un segundo sector, plexual, con el plexo ya completamente formado, ubicado en el espesor de la FEP. Por último, su porción terminal, ya desprovisto de la FEP, formado por nervios que se dirigen a la membrana perineal acompañados por vasos arteriales y venosos. Cada uno de estos sectores requiere distinto abordaje tanto en la disección anatómica como quirúrgica.


The Inferior Hypogastric Plexus (PHI) is a difficult plexus to define and dissect, hence the ease with which it can be injured both in anatomical and surgical research. Defining its relationships, with respect to the endopelvic fascia (FEP), including its formation and branches, (Baader et al., 2003, p. 129) would facilitate their dissection. This anatomical investigation aims to standardize different portions that require a different approach to preserve their integrity.Cadaveric material belonging to the Third Chair of Anatomy of the School of Medicine, Buenos Aires University was used. One (n=1) formolized male adult organ block and seventeen (n=17) hemipelvis were dissected: five (n=5) adult male hemipelvis formolized, nine (n=9) fetal hemipelvis formolized (7 male and 2 female), between 18 and 36 weeks of gestational age calculated by femoral length, and three (n=3) adult hemipelvis from fresh cadavers, two (n=2) female and one (n=1) male. Microdissection elements and magnifying glasses were used. We were able to distinguish three different sectors: the first, preplexual, located posterior and lateral to the FEP, where the sympathetic components (hypogastric nerves) and the parasympathetic (pelvic splanchnic nerves) have not yet converged to form the plexus. A second sector, plexual, with the plexus already fully formed, located in the thickness of the FEP. Finally, its terminal portion, already devoid of the FEP, formed by nerves that go to the perineal membrane accompanied by arterial and venous vessels. Each of these sectors requires a different approach in both anatomical and surgical dissection.


Subject(s)
Humans , Pelvis/anatomy & histology , Fascia/anatomy & histology , Hypogastric Plexus
9.
Rev. Pesqui. Fisioter ; 10(2): 188-194, Maio 2020. tab, ilus
Article in English, Portuguese | LILACS | ID: biblio-1223562

ABSTRACT

A variável força muscular (FM) na prática esportiva, sobretudo no futebol, é de extrema importância em atividades como chutes, disputas de bola, arrancadas e saltos. Além disso, permite identificar indivíduos que estão em grupos de risco para lesões. Assim, técnicas, como a auto liberação miofascial (ALM), vêm sendo utilizadas para o aprimoramento do desempenho esportivo e para prevenir lesões. OBJETIVO: Verificar o efeito crônico da ALM na FM em atletas de futebol feminino. METODOLOGIA: Este estudo trata-se de um ensaio clínico randomizado. Participaram do estudo 14 atletas de futebol feminino. Inicialmente foram realizadas avaliações no aparelho dinamômetro isocinético dos extensores e flexores de joelho. As participantes foram divididas em dois grupos, um grupo intervenção (GI) e um grupo controle (GC). As participantes do GI realizaram um aquecimento associado à ALM com um foam roller. Já as participantes do GC, realizaram o mesmo aquecimento, porém sem a associação da ALM. Após 48 horas da última intervenção, foi realizada uma reavaliação no aparelho dinamômetro isocinético. RESULTADOS: Não foram verificados efeitos significativos entre os grupos no pós-teste. Na comparação pré e pós-teste entre os grupos, houve uma piora significativa na variável pico de torque de extensão do membro inferior dominante no grupo que não fez a ALM (p = 0,013). CONCLUSÃO: Conclui-se que uma abordagem crônica de ALM não foi capaz de gerar mudanças significativas na FM dos extensores e flexores de joelho. Mais estudos são necessários para apoiar esses achados. Registro ReBEC: RBR-7qnxty.


The variable muscle strength (MS) in sports practice, especially in football, is extremely important in activities such as kicks, ball disputes, sprints and jumps. In addition, it allows identifying individuals who are at risk groups for injuries. Thus, techniques, such as selfmyofascial release (SMF), have been used to improve sports performance and to prevent injuries. OBJECTIVE: To verify the chronic effect of SMF on MS in female soccer athletes. METHODOLOGY: This study is a randomized clinical trial. 14 female soccer athletes participated in the study. Initially, evaluations were performed on the isokinetic dynamometer device of knee extensors and flexors. The participants were divided into two groups, an intervention group (IG) and a control group (CG). IG participants performed a warm-up associated with SMF with a foam roller. CG participants, on the other hand, performed the same warm-up, but without the association of SMF. 48 hours after the last intervention, a reassessment was performed on the isokinetic dynamometer device. RESULTS: There were no significant effects between groups in the post-test. In the pre- and post-test comparison between the groups, there was a significant worsening in the peak torque variable of the dominant lower limb extension in the group that did not perform SMF (p = 0.013). CONCLUSION: It is concluded that a chronic SMF approach was not able to generate significant changes in the MS of knee extensors and flexors. Further studies are needed to support these findings. ReBEC Registration: RBR-7qnxty.


Subject(s)
Muscle Strength , Soccer , Fascia
10.
Int. j. morphol ; 38(2): 363-366, abr. 2020. tab
Article in English | LILACS | ID: biblio-1056448

ABSTRACT

Manual tests in clinical investigation must be supported by anatomical and physiological findings in order to obtain an objective information. The application of different mandibular positions in children obtains a variation in the 'hip rotators test' (p < 0.001). The possible relationships behind the muscle tone of the external rotators of the hips and the stomatognathic system are exposed, with special attention on the fascial tissue and its morphological characteristics. Despite these anatomical and physiological connections, there is no further evidence of a strong cause-effect relationship in this test.


Las pruebas manuales en la investigación clínica deben estar respaldadas por hallazgos anatómicos y fisiológicos para obtener una información objetiva. La aplicación de diferentes posiciones mandibulares en niños muestra una variación en la "prueba de rotadores de cadera" (p <0,001). Se exponen las posibles relaciones del tono muscular de los rotadores externos de las caderas y el sistema estomatognático, con especial atención en el tejido fascial y sus características morfológicas. A pesar de estas conexiones anatomofisiológicas, no existe una evidencia mayor de una relación importante causa-efecto en esta prueba.


Subject(s)
Humans , Male , Female , Child , Adolescent , Stomatognathic System/anatomy & histology , Fascia/anatomy & histology , Hip/physiology , Muscle Tonus , Posture
11.
Rev. Col. Bras. Cir ; 47: e20202524, 2020. tab, graf
Article in English | LILACS | ID: biblio-1136565

ABSTRACT

ABSTRACT Objective: to identify predictive factors for lethality and complications of deep fascial space infections of the neck (DFSIN), establishing an early and aggressive treatment in the neck before the progression to descending mediastinitis. Methods: we retrospectively analyzed 133 cases of DFSIN treated at Discipline of Head and Neck Surgery of the Medicine School of Santa Casa de Misericórdia de São Paulo. We accessed demographic characteristics, associated diseases, clinical presentation, laboratorial tests, length of hospital stay, number of involved anatomic neck spaces, intra-operative and microbiology findings. We analyzed these data using logistic regression to predict DFSIN lethality and life threatening complications (mediastinitis, septic shock, pneumonia, pleural empyema, skin necrosis). Results: lethality and complication ratios were 9% and 50.3%, respectively. The logistic regression model showed that patients with septic shock were more likely to have progression to death (p < 0.001) and, the presence of more than two involved neck spaces (p < 0.001) and older individuals (p = 0.017) were more likely to have complicated deep neck infections. Descending necrotizing mediatinitis increased the lethality ratio by 50%, and was associated to necrotizing fasciitis (p=0.012) and pleural empyema (p<0.001). Conclusion: septic shock is a lethal predictive factor and age as well as more than two involved neck spaces are the predictive factors for complications. Necrotizing fasciitis is an important factor for complications and death. Therefore, its surgical treatment must be more aggressive. Descending mediastinitis has a high lethal rate and the successful treatment is based on early diagnosis and aggressive surgical approach.


RESUMO Objetivo: identificar os fatores preditivos de letalidade e complicações associados às infecções dos espaços fasciais profundos do pescoço, com intuito de estabelecer tratamento mais precoce antes de evolução para a mediastinite. Métodos: estudo retrospectivo de 133 casos, tratados na Disciplina de Cirurgia de Cabeça e Pescoço da Faculdade de Ciências Médicas da Santa Casa de São Paulo. Por meio da análise de regressão logística, estes dados foram estudados para a predição de letalidade e complicações graves (mediastinite, choque séptico, empiema pleural, pneumonia e necrose de pele). Resultados: a taxa de letalidade identificada foi de 9% e, de complicações de 50,3%. Identificou-se como fator preditivo de letalidade, a presença de choque séptico (p<0,001) e, para o ocorrência de complicações, a idade (p=0,017) e o acometimento de mais de dois espaços anatômicos (p<0,001). A ocorrência de mediastinite descendente necrosante esteve associada à presença de fasciíte necrosante (p=0,012) e empiema pleural (p<0,001). Conclusão: o fator preditivo de letalidade foi a presença de choque séptico e, para ocorrência de complicações graves, a idade e/ou a presença de mais de dois espaços anatômicos acometidos pela infecção. A fasciíte necrosante é fator importante para ocorrência de complicações e morte. Nestes casos, a conduta cirúrgica deve ser mais agressiva. A mediastinite descendente apresenta taxa de letalidade alta e o sucesso no tratamento está no diagnóstico precoce e na intervenção cirúrgica agressiva.


Subject(s)
Humans , Adult , Fasciitis, Necrotizing/mortality , Infections/complications , Infections/etiology , Neck , Retrospective Studies , Empyema, Pleural , Fascia , Middle Aged
13.
Article in English | WPRIM | ID: wpr-785431

ABSTRACT

PURPOSE: Local anesthetics can decrease postoperative pain after appendectomy. This study sought to verify the efficacy of bupivacaine on postoperative pain and analgesics use after single-incision laparoscopic appendectomy (SILA).METHODS: Between March 2014 and October 2015, 68 patients with appendicitis agreed to participate in this study. After general anesthesia, patients were randomized to bupivacaine or control (normal saline) groups. The assigned drugs were infiltrated into subcutaneous tissue and deep into anterior rectus fascia. Postoperative analgesics use and pain scores were recorded using visual analogue scale (VAS) by investigators at 1, 8, and 24 hours and on day 7. All surgeons, investigators and patients were blinded to group allocation.RESULTS: Thirty patients were allocated into the control group and 37 patients into bupivacaine group (one patient withdrew consent before starting anesthesia). Seven from the control group and 4 from the bupivacaine group were excluded. Thus, 23 patients in the control group and 33 in the bupivacaine group completed the study. Preoperative demographics and operative findings were similar. Postoperative pain and analgesics use were not different between the 2 groups. Subgroup analysis determined that VAS pain score at 24 hours was significantly lower in the bupivacaine group (2.1) than in the control group (3.8, P = 0.007) when surgery exceeded 40 minutes. During immediate postoperative period, bupivacaine group needed less opioids (9.1 mg) than control (10.4 mg).CONCLUSION: Bupivacaine did not decrease pain and analgesics use. When surgery exceeded 40 minutes, bupivacaine use might be associated with less pain and less analgesics use.


Subject(s)
Analgesics , Analgesics, Opioid , Anesthesia, General , Anesthesia, Local , Anesthetics, Local , Appendectomy , Appendicitis , Bupivacaine , Demography , Fascia , Humans , Laparoscopy , Pain, Postoperative , Postoperative Period , Research Personnel , Subcutaneous Tissue , Surgeons
14.
Rev. bras. cir. plást ; 34(3): 414-418, jul.-sep. 2019. ilus
Article in English, Portuguese | LILACS | ID: biblio-1047171

ABSTRACT

O aumento do dorso nasal nas rinoplastias é foco de estudo de diversos trabalhos que buscam as melhores fontes de enxerto e técnicas cirúrgicas. A utilização de cartilagem já é consagrada para este fim, a partir do septo nasal, da concha auricular ou dos arcos costais. Nos últimos anos, têm-se buscado meios para reduzir a palpabilidade e dispersibilidade dos enxertos cartilaginosos. Assim, são descritos materiais sintéticos, como o SURGICEL®; e, autólogos, representados pelas fáscias. A fáscia temporal é mais amplamente utilizada, porém requer uma nova incisão cirúrgica, aumentando o tempo e a morbidade da cirurgia. É também descrito o uso de fáscia lata e fáscia reto abdominal, comparativamente mais espessas e menos flexíveis. Em muitos casos de rinoplastia fazse necessária a retirada da cartilagem costal, o que permite a coleta de fáscia do músculo peitoral maior pela mesma incisão cirúrgica. Dessa forma, descrevemos a utilização da fáscia do músculo peitoral maior envolvendo cartilagem costal picada, em uma rinoplastia estruturada com aumento do dorso.


Increasing the nasal dorsum in rhinoplasty is the focus of several studies that seek the best graft sources and surgical techniques. The use of cartilage from the nasal septum, ear shell, or costal arches is already established for this purpose. In recent years, methods have been sought to reduce the palpability and dispersibility of cartilaginous grafts. Thus, synthetic materials such as SURGICEL® and autologous materials such as fascia have been explored. Temporal fascia are more widely used but require a new surgical incision, increasing surgical time and morbidity. Also described is the use of fascia lata and rectus abdominis fascia, which are comparatively thicker and less flexible. In many rhinoplasty procedures, it is necessary to remove the costal cartilage, which allows the collection of fascia from the major chest muscles through the same surgical incision. Thus, we describe the use of major chest muscle fascia and chopped costal cartilage in structured rhinoplasty to increase the dorsum.


Subject(s)
Humans , Female , Adult , History, 21st Century , Prostheses and Implants , Rhinoplasty , Transplantation, Autologous , Fascia , Costal Cartilage , Graft Survival , Prostheses and Implants/adverse effects , Rhinoplasty/adverse effects , Rhinoplasty/methods , Transplantation, Autologous/adverse effects , Transplantation, Autologous/methods , Transplants/surgery , Fascia/anatomy & histology , Fascia/transplantation , Costal Cartilage/surgery , Costal Cartilage/cytology
15.
Fisioter. Bras ; 20(2): 272-277, Maio 1, 2019.
Article in Portuguese | LILACS | ID: biblio-1281189

ABSTRACT

O Brasil apresenta altas taxas de cesariana, uma das maiores do mundo. Com essa predominância, ocorre consequentemente o aumento das cicatrizes. A técnica de crochetagem tem como objetivo tratar tensões musculares e fasciais, liberando aderências encontradas em patologias ortopédicas. O objetivo deste trabalho foi avaliar o efeito da crochetagem miofascial sobre a intensidade de dor, sensibilidade, amplitude de movimento e temperatura de superfície, quando aplicada sobre cicatriz de cesariana. Para o estudo foram selecionadas 26 mulheres, matriculadas em cursos da área da saúde da universidade, com idade ≥ 18 anos, que realizaram tal cirurgia. As mesmas foram avaliadas e receberam aplicação da técnica, retornando no dia subsecutivo para a reavaliação. A flexibilidade foi avaliada pelo teste de "Teste do Sentar e Alcançar", avaliação da dor do local através da algometria e para análise térmica foi utilizado um sistema imageador. Os resultados demonstraram uma diminuição da intensidade de dor (p = 0,0001), dor ao movimento (p = 0,0001), flexibilidade (p = 0,01) e a avaliação da temperatura no local dos sintomas não teve alterações (p = 0,70). A crochetagem miofascial contribuiu para a diminuição da sensação de dor, assim como a sensibilidade vertebral correspondente ao dermátomo, e foi observado um ganho considerável na flexibilidade da amostra estudada. (AU)


Brazil has high cesarean rates, one of the largest in the world. With this predominance, consequently, the scars increase. The technique of crocheting aims to treat muscular and fascial tensions, releasing adhesions found in orthopedic pathologies. The objective of this study was to evaluate the effect of myofascial crocheting on pain intensity, sensitivity, range of motion and surface temperature when applied on cesarean section. For the study, 26 women, students in health care courses, aged ≥ 18 years, who underwent cesarean surgery were evaluated, before and after 24 hours of the application of the technique. We assessed pain, with algometry and numerical scale, flexibility, with tape measure by the test of sit reaching and vascular changes and by thermography. For statistical analysis, the T-Student and Wilcoxon tests were used for parametric and non-parametric variables. The level of significance was 5%. The results showed a decrease in pain complaints in general (p = 0.0001), pain on movement (p = 0.0001), pain sensitivity (p = 0.005), flexibility (p = 0.01) did not change (p = 0.70). Myofascial sizing contributed to the reduction of reported pain sensation and movement, improved spinal pain sensitivity in the corresponding dermatome and increased overall flexibility in the studied sample.(AU)


Subject(s)
Humans , Female , Cicatrix , Musculoskeletal Manipulations , Pain , Cesarean Section , Musculoskeletal Diseases , Fascia
16.
Rev. bras. ortop ; 54(2): 128-133, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-1013701

ABSTRACT

Abstract Objective The present study aims to evaluate the use of the reverse-flow sural fasciocutaneous flap to cover lesions in the distal third of the lower limb. Methods A total of 24 cases were analyzed, including 20 traumatic injuries, 3 sports injuries, and 1 case of tumor resection. Results Among the 24 evaluated medical records, 16 patients were male, and 8 were female. Their age ranged from6 to 75 years old. Most of the patients evolved with total healing of the flap (n= 21). There was only one case of total necrosis of the flap in an insulin-dependent diabetic, high blood pressure patient, evolving to subsequent limb amputation. In two cases, there was partial necrosis and subsequent healing by secondary intention; one of these patients was a heavy smoker. Complications were associated with comorbidities and, unlike other studies, no correlation was observed with the learning curve. There was also no correlation with the site or size of the lesion to be covered. Conclusion It is clinically relevant that the success rate of the reverse-flow sural fasciocutaneous flap technique was of 87.5%. This is a viable and effective alternative in the therapeutic arsenal for complex lower limb lesions.


Resumo Objetivo Avaliar o uso do retalho fasciocutâneo sural de fluxo reverso na cobertura de lesões no terço distal dos membros inferiores. Métodos Foram analisados 24 casos, 20 de origem traumática, três por lesões esportivas e um por ressecção de lesão tumoral. Resultados Dos 24 prontuários avaliados, 16 eram homens e oito mulheres. A idade variou de seis a 75 anos. A maioria dos pacientes evoluiu com cicatrização total do retalho (21). Houve apenas um caso de necrose total do retalho em paciente diabético insulinodependente e hipertenso, evoluiu para posterior amputação do membro. Em dois casos, houve necrose parcial composterior cicatrização por segunda intenção, um desses pacientes era tabagista pesado. As complicações foram associadas às comorbidades e, ao contrário do evidenciado por outros estudos, não houve correlação com a curva de aprendizado. Também não houve correlação com o local ou o tamanho da lesão a ser coberta. Conclusão Tem-se como relevância clinica que a técnica de retalho fasciocutâneo sural de fluxo reverso usada obteve 87,5% de sucesso, é uma opção viável e eficaz no arsenal terapêutico das lesões complexas dos membros inferiores.


Subject(s)
Humans , Male , Female , Sural Nerve/transplantation , Surgical Flaps , Fascia/transplantation , Leg Injuries
17.
In. Castillo Pino, Edgardo A. Tratado de perineología: disfunciones del piso pélvico. Montevideo, Academia Nacional de Medicina, 2019. p.327-332.
Monography in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1348383
18.
J. vasc. bras ; 18: e20180117, 2019. ilus
Article in English | LILACS | ID: biblio-1002492

ABSTRACT

Acute compartment syndrome of the lower extremities after urological surgery in the lithotomy position is a rare but potentially devastating clinical and medicolegal problem. We report the case of a 67-year-old male who underwent laparoscopic prostatectomy surgery to treat cancer, spending 180 minutes in surgery. Postoperatively, the patient developed acute compartment syndrome of both legs, needing emergency bilateral four-compartment fasciotomies, with repeated returns to the operating room for second-look procedures. The patient also exhibited delayed wound closure. He regained full function within 6 months, returning to unimpaired baseline activity levels. This report aims to highlight the importance of preoperative awareness of this severe complication which, in conjunction with early recognition and immediate surgical management, may mitigate long-term adverse sequelae and improve postoperative outcomes


A síndrome compartimental aguda dos membros inferiores após cirurgia urológica na posição de litotomia é um problema clínico e médico-legal raro, mas potencialmente devastador. Reportamos o caso de um homem de 67 anos submetido a uma prostatectomia laparoscópica por câncer. A cirurgia durou 180 min. No pós-operatório, o paciente desenvolveu síndrome compartimental aguda de ambos os membros inferiores, necessitando de fasciotomias de urgência, com retornos repetidos à sala de cirurgia para procedimentos adicionais. O paciente também apresentou fechamento tardio da ferida. Ele recuperou a função completa dentro de 6 meses e retornou a um nível de atividade basal irrestrito. Este artigo tem a importância de ressaltar a consciência pré-operatória desta grave complicação que, em conjunto com o reconhecimento precoce e o tratamento cirúrgico imediato, pode mitigar sequelas adversas em longo prazo e melhorar os resultados pós-operatórios


Subject(s)
Humans , Male , Aged , Postoperative Complications/diagnosis , Urologic Surgical Procedures/adverse effects , Urologic Surgical Procedures/methods , Compartment Syndromes , Lower Extremity , Prostatectomy/methods , Prostatic Neoplasms , Blood Pressure , Risk Factors , Laparoscopy/methods , Fascia , Patient Positioning/methods , Fasciotomy/methods
19.
Clinics ; 74: e727, 2019. tab, graf
Article in English | LILACS | ID: biblio-1001835

ABSTRACT

OBJECTIVES: To compare the ultrasonographic findings of entheses in ankylosing spondylitis (AS) patients with those of healthy control individuals and to assess the ability of ultrasound (US) to identify aspects related to the disease. METHODS: A cross-sectional study involving 50 patients with AS and 30 healthy controls was performed. Clinical assessment included the use of a visual analog scale for pain, assessment of swelling of the enthesis, global assessments for patients and physician, use of a disease activity index, mobility and dysfunctional indices, erythrocyte sedimentation rate and clinical enthesitis index. US was performed for the following entheses by two experienced musculoskeletal radiologists: brachial triceps, distal quadriceps, proximal and distal patellar tendons, calcaneal tendon, and plantar fascia; the total and subitems of the Madrid Sonographic Enthesitis Index were used for evaluations. RESULTS: Comparison between groups showed a statistically significant difference with worse scores in AS patients, with bone erosion of the calcaneal enthesis and bone erosion and thickening of the plantar fascia. The odds ratio for thickening of the plantar fascia in the AS group was 3.47, according to logistic regression analysis. The AS group also had worse scores regarding the presence of calcification in the quadriceps enthesis, with a fivefold increased risk. CONCLUSION: US analysis showed that only entheses of the foot and quadriceps were able to differentiate AS patients from healthy individuals.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Spondylitis, Ankylosing/diagnostic imaging , Calcaneus/diagnostic imaging , Quadriceps Muscle/diagnostic imaging , Achilles Tendon/diagnostic imaging , Severity of Illness Index , Observer Variation , Cross-Sectional Studies , Ultrasonography/methods , Patellar Ligament/diagnostic imaging , Diagnosis, Differential , Fascia/diagnostic imaging
20.
Article in English | WPRIM | ID: wpr-759983

ABSTRACT

A Morel-Lavallée lesion is a posttraumatic, closed internal degloving injury caused by shearing force abruptly separating the skin and superficial fascia from the deep fascia and creating a potential space. Blood, lymphatic fluid, and debris collect and fill the space. The most commonly affected sites are the thigh, knee, hip, and pelvic area, but the lesion can occur anywhere in the body. Among various treatments, surgical procedure is a good option if the lesion is chronic and a thick peripheral capsule has developed. We report an uncommon case of a chronic Morel-Lavallée lesion in the sacrococcygeal area, a rarely reported location, with an associated coccygeal fracture and dislocation.


Subject(s)
Coccyx , Joint Dislocations , Fascia , Hip , Knee , Skin , Subcutaneous Tissue , Thigh
SELECTION OF CITATIONS
SEARCH DETAIL