Uso de matriz dérmica acelular heteróloga em cirurgia plástica reparadora / Use of acellular dermal matrix xenograft in reconstructive plastic surgery

INTRODUÇÃO: Feridas complexas são um desafio para o cirurgião plástico. Nestes casos, a solução mais comum é a indicação de enxertia de pele ou de retalhos, no entanto, dependendo das estruturas afetadas, os resultados podem não ser satisfatórios. As matrizes foram inicialmente desenvolvidas para o tratamento de sequelas de queimaduras. Desde então, desenvolveram-se diferentes variedades, as quais são aplicadas no tratamento de diversas patologias, inclusive feridas complexas. Apenas algumas matrizes dérmicas acelulares heterólogas (MDAH) estão disponíveis no Brasil e a um custo ainda muito elevado. O objetivo desse estudo é relatar a experiência adquirida com a utilização de MDAHs para o tratamento de pacientes com necessidade de cirurgia plástica reparadora. MÉTODO: No período de fevereiro de 2011 a julho de 2014 foram utilizadas 5 diferentes MDAHs no tratamento de 24 lesões de diferentes etiologias, inclusive para 3 etiologias não descritas na literatura: rinofima, hidrosadenite supurativa e síndrome de Lyell (necrólise epidérmica tóxica-NET). RESULTADOS: Os 20 pacientes de diferentes etiologias e que receberam o tratamento com enxerto de MDAH em diferentes regiões anatômicas, associados ou não à enxertia de pele autóloga, alcançaram a solução de suas patologias com adequados padrões funcionais e estéticos. CONCLUSÃO: O emprego de MDAH pode ser considerado como alternativa no tratamento de diversos casos de difícil resolução e tem seu lugar na Cirurgia Plástica moderna, porém sua indicação deve ser bem avaliada devido ao alto custo do material.

INTRODUCTION: Complex wounds pose a challenge to the plastic surgeon. In these cases, the most common solution is skin grafting or the use of flaps; however, depending on the affected structure, the results may not be satisfactory. Matrices were initially developed for the treatment of burn sequelae. Since then, different varieties of matrices have been developed for application in the treatment of several diseases, including complex wounds. Only a few heterologous acellular dermal matrices (HADMs) are available in Brazil, and they are still very expensive. The objective of this study was to report the experience with the use of HADMs for the treatment of patients with a need for reconstructive plastic surgery. METHOD: From February 2011 to July 2014, five different HADMs were used in the treatment of 24 lesions of different etiologies, including three etiologies not previously described in the literature: rhinophyma, hidradenitis suppurativa, and Lyell's syndrome (toxic epidermal necrolysis). RESULTS: Twenty patients with lesions of different etiologies and who received treatment with HADM grafts in different anatomical regions, associated or not with autologous skin grafting, attained adequate aesthetic and functional results. CONCLUSION: The use of HADMs can be considered an alternative in the treatment of several difficult-to-treat cases, and has its place in modern plastic surgery; however, its indication should be carefully evaluated owing to the high cost of the materials.

Histological comparison of the alar nasal cartilages in unilateral cleft lip

Patients with unilateral cleft lip display characteristic nasal changes that are independent of the degree of deformity. Defenders of the intrinsic theory consider these deformities to be due to embryogenic alterations of the alar nasal cartilages. Those that propose the extrinsic theory defend the thesis that the deformity is due to disorganization of the perioral muscles deformed by the cleft. The purpose of this study is to contribute histological evidence to help clarify the issue. PATIENTS AND METHODS: Specimens of the lateral portion of both the healthy and the cleft side of the alar cartilages were obtained from 18 patients. These uniformly cut specimens were stained by hematoxylin and eosin. Samples from 2 patients were excluded due to imperfections. The same pathologist examined all the slides. He was unaware of the origins of the specimens; he counted the number of chondrocytes and quantified the cartilage matrixes. RESULTS: All data was analyzed statistically, and no significant statistical differences were apparent, either in the number of chondrocytes or the cartilage matrix between the healthy side and the cleft side. DISCUSSION: These results apparently support the group that defend the extrinsic theory; nevertheless, the doubt about the composition of the cartilage matrix remains, not only concerning the glycosaminoglycans that compose them, but also regarding elastin and collagen and its linkages that can cause different degrees of collagen consistency