Cobertura de exposição de tela de marlex® pós reconstrução de parede abdominal: relato de três casos e revisão de literatura / Coverage of marlex® mesh extrusion after post-abdominal wall reconstruction: 03 case reports and review of the literatura

O uso de telas de material aloplástico na cirurgia de reconstrução da parede abdominal é freqüente em casos de trauma, infecção, ressecção de tumores ou até mesmo em necroses por radioterapia2,3,4,5,10,11. Apesar dessa técnica de cobertura ser de uso comum e rotineiro, em alguns casos, uma complicação é a sua exposição 2,5,6,7,8. Os retalhos são utilizados para proporcionar uma cobertura estável da tela exposta 2,3,5,8,9,11,14. Objetivos: esse trabalho descreve 03 casos de cobertura com retalho a ascio cutâneo de exposição de tela de polipropileno(Marlex ®), utilizada em situação da reconstrução de parede abdominal. Métodos: três pacientes foram submetidos à cirurgia parare construção da parede abdominal, em 20006, utilizando-se tela de polipropileno (Marlex ®). Todos evoluíram com exposição da tela. Dois eram do sexo masculino e um, do sexo feminino. No grupo masculino, um dos pacientes havia sido submetido à apendicectomia e evoluiu com fasceíte necrotizante. O outro paciente masculino teve reconstrução de parede abdominal decorrente de complicação de cirurgia para resolução de quadro de oclusão intestinal. A paciente do sexo feminino foi submetida à reconstrução da parede abdominal após peritoneostomia secundária à perfuração iatrogênica de intestino, decorrente de cirurgia ginecológica. Resultados: Os dois pacientes masculinos foram submetidos à cobertura da tela de Marlex® exposta, utilizando-seretalho inguinal, sendo que, em um dos casos, houve realização de retalho em um único tempo cirúrgico. No outro, houve reconstrução cirúrgica em dois tempos. A paciente feminina foi submetida à cirurgia com realização de retalho fasciocutâneo tipo abdominoplastia, em tempo cirúrgico único. Todos os três casos evoluíram bem, sem complicações pós-operatórias, tais como infecção ou necrose.

Background: posthetic mesh are used in abdominal wall reconstruction1,11 due to trauma, infection, tumor resection or even radiation necrosis2,3,4,5,10,11. Although this kind of coverage is widely used, exposure of the material used is a complication that is unlikely to happen2,5,6,7,8. Fasciouscutaneous flaps are used to provide a stable coverage of the exposed mesh2,3,5,8,9,11,14. Objective: thisworkdescribestree 3 casesofmes hexposure after abdominal wall reconstruction treated coverage using fasciouscutaneous flap and reviews the literature. Methods: Three patients undergone abdominal wall reconstruction in 2006 using polypropylene mesh (Marlex ®).All of them developed mesh exposure. Two were men and one was a woman. One of the men was submitted to appendicectomy and evoluated with necrotizing fasciitis; the second male patient suffered from bowel occlusion and the female pacient, was submitted to reconstruction after peritoneostomy due to iatrogenic bowel perforation duing a gynecologic procedure. Results: the two male patientsweresubmittedtomeshexposurecoverageusing inguinal flap. One of them was submitted to a one-step surgical act. The second male patient needed a two-step surgical act. The female patient was submitted to reconstruction using a one-step abdominoplasty flap. All of them evoluated well, with no post-surgical complications as infection or flap necrosis. Conclusions: although there are no statistical significancies in the three cases, we can say that fasciocutaneous flaps2,12,14 are a securemethodforcoverageofmeshexposureinprevious abdominal wall reconstruction.

Luteal phase of the menstrual cycle increases sweating rate during exercise

The present study evaluated whether the luteal phase elevation of body temperature would be offset during exercise by increased sweating, when women are normally hydrated. Eleven women performed 60 min of cycling exercise at 60 percent of their maximal work load at 32°C and 80 percent relative air humidity. Each subject participated in two identical experimental sessions: one during the follicular phase (between days 5 and 8) and the other during the luteal phase (between days 22 and 25). Women with serum progesterone >3 ng/mL, in the luteal phase were classified as group 1 (N = 4), whereas the others were classified as group 2 (N = 7). Post-exercise urine volume (213 ± 80 vs 309 ± 113 mL) and specific urine gravity (1.008 ± 0.003 vs 1.006 ± 0.002) changed (P < 0.05) during the luteal phase compared to the follicular phase in group 1. No menstrual cycle dependence was observed for these parameters in group 2. Sweat rate was higher (P < 0.05) in the luteal (3.10 ± 0.81 g m-2 min-1) than in the follicular phase (2.80 ± 0.64 g m-2 min-1) only in group 1. During exercise, no differences related to menstrual cycle phases were seen in rectal temperature, heart rate, rate of perceived exertion, mean skin temperature, and pre- and post-exercise body weight. Women exercising in a warm and humid environment with water intake seem to be able to adapt to the luteal phase increase of basal body temperature through reduced urinary volume and increased sweating rate.