Uso do curativo hemostático de gelatina absorvível no cuidado pós-operatório do pedículo vascular dos retalhos interpolados / Use of absorbable hemostatic gelatin sponge in postoperative care of the vascular pedicle of interpolated flaps

Os retalhos interpolados têm sido um dos mais importantes e funcionais retalhos no arsenal da cirurgia plástica reconstrutiva, tornando-se uma opção segura mesmo nos casos mais difíceis. O pedículo do retalho interpolado necessita de curativo para evitar sangramento e a contaminação local. Este curativo frequentemente falha na prevenção de pequenos sangramentos que ocorrem durante as primeiras 24-48 horas, forçando a troca recorrente do mesmo, em média de três a cinco trocas. A técnica proposta neste trabalho consiste na aplicação direta de uma camada de GELFOAM®, envolto por gaze petrolizada, para prevenção do sangramento da área cruenta do pedículo do retalho, acarretando melhor hemostasia e menos manipulação do pedículo vascular.

Interpolated flaps are among the most important and functional flaps in reconstructive plastic surgery, representing a safe option even in the most difficult cases. The pedicle of the interpolated flap requires a dressing to avoid bleeding and local contamination. This dressing often fails to prevent minor bleedings, which occurs within the first 24-48 hours. As a result, it needs to be continuously changed, from three to five times on average. The technique proposed in this study consists in a direct application of a GELFOAM® layer. This is subsequently wrapped with petroleum gauze to prevent bleeding of the open area in the pedicle flap, improving hemostasis and reducing the manipulation of the vascular pedicle.

Dacron graft intussusception technique for treatment of type a aortic dissections: technical notes and preliminary results

Abstract Introduction: Optimal surgical management for acute type A aortic dissection (AAAD) remains unclear. The in-hospital mortality rate is still high (15%), and the intraoperative bleeding is an independent risk factor for hospital mortality. Objective: The aim of our study was describe a new method for aortic anastomosis in the repair of AAAD and report the hospital mortality and bleeding complications. Methods: Between January 2008 and November 2014, 24 patients, 16 male, median age 62 years, underwent surgical treatment of AAAD. The surgical technique consisted of intussusception of a Dacron tube in the dissected aorta, which is anastomosed with a first line of 2-0 polyester everting mattress suture and a second line of 3-0 polypropylene running suture placed at the outermost side. Open distal anastomosis was performed with bilateral selective antegrade cerebral perfusion in 13 (54.1%) patients. Results: Cardiopulmonary bypass and aortic clamping time ranged from 75 to 135 min (mean=85 min) and 60 to 100 min (mean=67 min), respectively. The systemic circulatory arrest ranged from 29 to 60 min (mean=44.5 min). One (4.1%) patient required reoperation for bleeding, due to the use of preoperative clopidogrel. The postoperative bleeding was 382-1270 ml (mean=654 ml). We used an average of 4.2 units of red blood cells/patient. There were two (8.3%) hospital deaths, one due to intraoperative bleeding and another due to mesenteric ischemia. The average length of stay in the intensive care unit and hospital was 44 hours and 6.7 days, respectively. Conclusion: This new method for surgical correction of AAAD was reproducible and resulted in satisfactory clinical outcomes.

The surgical management of massive intraoperative and postoperative suprachoroidal hemorrhage: anatomic and functional outcomes / O tratamento cirúrgico da hemorragia supracoroidea massiva intraoperatória e pós-operatória: resultados anatômicos e funcionais

PURPOSE: To describe the clinical characteristics, management and treatment outcomes of patients with post-surgical suprachoroidal hemorrhage (SCH). METHODS: A retrospective cross-sectional study was conducted, in which the medical records of 9 consecutive patients with SCH admitted to the Goldschleger Eye Institute were reviewed. RESULTS: The mean age was 74 years (range 61-84) and the mean follow-up time was 38.3 ± 0.1 months (range 4-87 months). Four cases were associated with glaucoma surgeries (2 trabeculectomies and 2 Ahmed valve implantations), 3 cases with cataract surgery and 2 cases with pars plana vitrectomy. The diagnosis of SCH was ranging from intra-operative to 8 days following the primary procedure. Most patients underwent posterior sclerotomies and drainage alone or combined with pars plana vitrectomy in a mean timing of intervention of 11 ± 4 days. At one month of follow-up the visual acuity improved in 7 eyes and remained stable in 2, compared to the VA prior to the drainage operation. The mean VA improved from 2.03 to 1.285 logMAR units at 1 month following the drainage procedure (p=0.003). CONCLUSIONS: SCH still remains a challenging complication of many ophthalmological procedures. The current surgical management may improve visual acuity though the general prognosis is still poor.

OBJETIVOS: Descrever as características clínicas, manejo e desfechos do tratamento de pacientes com hemorragia supracoroidea pós-operatória. MÉTODOS: Um estudo transversal foi realizado. Neste foram revisados os prontuários médicos de nove pacientes consecutivos com hemorragia supracoroidea que foram admitidos para internação no Serviço de Oftalmologia do Goldschleger Eye Institute. RESULTADOS: A média de idade foi 74 anos (61-84) e o tempo médio de seguimento foi 38,3 ± 0,1 meses (4-87 meses). Quatro casos foram associados com cirurgias de glaucoma (2 trabeculectomias e 2 implantes de válvula de Ahmed), 3 casos com cirurgia de catarata e 2 casos com vitrectomia. O diagnóstico de hemorragia supracoroidea foi de intraoperatório até 8 dias após o procedimento primário. A maioria dos pacientes se submeteu a esclerectomia posterior e drenagem com ou sem vitrectomia via pars plana combinada. A média do tempo de intervenção foi 11 ± 4 dias. Após um mês de seguimento a acuidade visual melhorou em 7 olhos e se manteve estável em 2, comparando com a acuidade visual prévia a cirurgia de drenagem. A acuidade visual media melhorou de 2,03 para 1,285 logMAR após 1 mês de seguimento depois da drenagem por esclerectomia posterior (p=0,003). CONCLUSÕES: Hemorragia supracoroidea ainda é uma complicação desafiadora de muitos procedimentos oftalmológicos. O manejo cirúrgico atual pode melhorar a acuidade visual apesar de o prognostico desta afecção ser ainda reservado.

"Liver clot"-A rare periodontal postsurgical complication.

Bleeding is a common sequela of oral and periodontal surgery. Generally, bleeding is self-limiting. Following traumatic injury or surgical procedures, hemorrhage can range from a minor leakage or oozing at the site, to extensive bleeding leading to complete exsanguinations. Significant postsurgical hemorrhage following periodontal surgery is uncommon due to the primary closure of the soft tissues. This case report describes the unique formation of a "liver clot" or "currant jelly clot" following periodontal flap surgery. The likelihood of this may be attributed to many factors, like infection, intrinsic trauma, presence of foreign bodies like splinter of bone, a fleck of enamel, or a piece of dental restorative dressing material that may cause repeated, delayed organization of blood coagulum.

Iatrogenic hemorrhage from left umbilical vein after cardiac surgery: An unusual complication.

Postoperative bleeding is a concern for all patients undergoing heart surgery, which could be due to surgical causes or coagulation disorder. The patients at risk for coagulopathy include those patients with complex or prolonged procedures, those exposed to preoperative anticoagulants and, to a lesser extent, patients with a preoperatively elevated prothrombin time and activated clotting time. However, intraabdominal bleeding after cardiac surgery is rare (0.3-2%). As the mortality rate of patients exposed to these complications is high (11-59%), timely recognition and prompt management is vital for patient's safety and for avoidance of postoperative complications. Here, we present a case of free intraabdominal hemorrhage as sequelae of pacing wire insertion in open heart surgery and its successful management.

Algunos aspectos del manejo perioperatorio de recién nacidos o lactantes sometidos a cirugía cardíaca / Some aspects about perioperatory management of newborns or infants submitted to cardiac surgery

El principal objetivo en el cuidado del paciente cardioquirúrgico debe ser la protección de las funciones cardíacas y pulmonares y la mantención de la homeostrasis