Alternativas de retalhos cutâneos para lesões dermatológicas na perna / Skin flap alternatives for dermatological lesions on the leg

A utilização de retalhos de pele para a cobertura de lesões é melhor opção do que o enxerto de pele, considerando-se a heterogeneidade do leito receptor após a ressecção do tumor e a maior segurança oferecida. Para melhor resultado devem ser levados em consideração também o local e a extensão da lesão, além da segurança da vascularização. Foram realizadas três ressecções com diferentes técnicas de cobertura. Os pacientes apresentaram excelente evolução, sem necroses ou deiscências.

The use of skin flaps for covering lesions is a better option than skin grafts, due to the diversity of the receptor area after the tumor's resection and the greater degree of safety. For better results, the lesion's location and extent, as well as the safety of the vascularization, should also be taken into account. Three resections were performed, with different coverage techniques. The patients had excellent development, without necrosis or dehiscence.

Hipoplasia do músculo grande dorsal: relato de caso / Latissimus dorsi muscle hypoplasy: case report

Introdução: O músculo grande dorsal é largo, um retalho muscular muito versátil e bem vascularizado. Devido a sua confiabilidade, é frequentemente usado para reconstrução de mama após mastectomia. Ele pode também ser usado na reconstrução de cabeça, pescoço e tórax, pediculado ou como retalho livre. Relato do caso: Os autores relatam o caso de uma paciente no pós-operatório de 8 anos de uma mastectomia esquerda e reconstrução imediata com implante mamário de silicone, que após radioterapia evoluiu com radio dermite e extrusão do implante. Foi programada, então, reconstrução com o músculo grande dorsal e, durante a cirurgia, foi identificado um músculo hipoplásico, que inviabilizou a sua utilização para o procedimento proposto.

Introduction: The latissimus dorsi muscle is a wide and well vascularized flap with great versatility. Its reliance brings a very good option of reconstruction following mastectomy. It also can be used for head, neck and chest reconstruction both a pedicled or as a free flap. Case report: The authors present a case of a patient who was submitted to a left mastectomy 8 years ago and had immediate reconstruction with silicone implant that extruded due to radiotherapy. The initial surgery proposal was to perform a regular latissimus dorsi flap to rebuild the breast but during the procedure it was found a hypoplasic muscle that resulted in an impracticable proper reconstruction.

Lymphoscintigraphic appraisal of the lower limbs after liposuction.

BACKGROUND: The trauma resulting from liposuction damages the subcutaneous cellular tissue and subsequently the lymphatic structures. In turn, this damage can reduce lymphatic drainage, which may or may not appear clinically as some degree of edema. OBJECTIVE: It is possible to evaluate the function of the lymphatic system using lymphoscintigraphy. We conducted a study to evaluate the lymphatic system using this technique both before and after liposuction of the lower limbs. METHODS: The study included seven women ranging from 18 to 42 years of age, all of whom were diagnosed with lipodystrophy solely in the lateral and medial regions of the upper third of the thighs. This study was conducted in three stages: preoperative lymphoscintigraphy, liposuction, and postoperative lymphoscintigraphy three months postoperatively. The Wilcoxon signed-rank test was used for the statistical analysis of the results. RESULTS: A comparison of values for the average time of the radiopharmaceutical acquisition curve and clearance in the areas of lymphoscintigraphic interest both before and three months after liposuction did not reveal significant results. CONCLUSIONS: A comparison of preoperative and postoperative lymphoscintigraphic findings showed no significant damage to the lymphatic system associated with liposuction of the lower limbs.

Surgical treatment of the acute columellar-labial angle.

BACKGROUND: The acute columellar-labial angle is associated with a long upper lip and can promote disharmony in the adult face. The different alloplastic or biologic materials used to correct this defect all have some disadvantages. OBJECTIVE: The authors propose the concomitant treatment of the acute columellar-labial angle, associated or not with the retracted columella and/or shortening of the lower lip, by rotating cutaneous flaps of the upper lip into a columellar pocket. METHODS: The superior border of an upper lip flap was defined by a line drawn from the columellar-labial fold and extending laterally, contouring the nostrils. The inferior border was defined by a second line parallel to the first but in a lower position, meeting the upper border at the lateral margins. The flap was deepithelialized and elevated from the lateral margins to the central area (pedicle). After the flap edges were sutured together, it was rotated into a columellar pocket. The donor site was sutured. RESULTS: Twelve patients underwent treatment as a single procedure, while 13 received surgery for the columellar-labial angle in association with a face lift. In all patients, the acute columellar-labial angle increased, and the retracted columella associated with shortening of the upper lip was filled in. CONCLUSIONS: Rotation of the upper lip flap into the columellar pocket results in a significant enlargement of the columellar-labial angle and shortening of the upper lip.

Comparison between textured silicone implants and those bonded with expanded polytetrafluoroethylene in rats.

PURPOSE: Comparison of the inflammatory reaction promoted by textured silicone implants and that caused by the implant bonded with e-ptfe. METHODS: One-hundred and fifty rats were divided into three equal groups (control, silicone, and bonded e-ptfe). These groups were subdivided into five groups, according to the second operation, i.e., 7,30,60,90 and 180 days. Histology of the peri-implant tissue was analyzed by morphometry with blood count (neutrophils, lymphocytes, macrophages, fibroblasts and capillaries). RESULTS: Comparison of subgroups 7,30,60,90, 180 days: - neutrophils: silicone: > in subgroup 7 days; bonded e-ptfe: > in subgroups 7 and 30 days; - lymphocytes: silicone: > in subgroup 7 and 180 days; bonded e-ptfe: > in subgroup 180 days; - macrophages: silicone: > in subgroup 7 and 60 days; bonded e-ptfe: > in subgroup 7,30 and 60 days; - fibroblasts: silicone: > in subgroup 30 and 60 days;- vascular volume: silicone: in subgroup 7, 60 and 90 days; bonded e-ptfe: > in subgroup 7 days. Comparison of groups: neutrophils : 7 days: > in silicone and bonded e-ptfe; 30 days: > in bonded e-ptfe; - lymphocytes: - 7,30,90 and 180 days: in the control; macrophages: - 7,30 and 60 days: > in silicone & bonded e-ptfe; 180 days > in silicone; fibroblasts: - 7,30 and 90 days: > in silicone and bonded e-ptfe; 180 days: > in bonded e-ptfe; vascular volume 7,60,90 and 180 days: > in silicone and bonded e-ptfe; 30 days: > in bonded e-ptfe. CONCLUSIONS: The acute stage of the inflammatory response was more severe and irregular in the silicone implant; both the silicone implant and the silicone bonded with e-ptfe promoted chronic inflammatory reaction and weak foreign body inflammatory response. These reactions were greater in the silicone implant group.

Comparison between textured silicone implants and those bonded with expanded polytetrafluoroethylene in rats

PURPOSE: Comparison of the inflammatory reaction promoted by textured silicone implants and that caused by the implant bonded with e-ptfe. METHODS: One-hundred and fifty rats were divided into three equal groups (control, silicone, and bonded e-ptfe). These groups were subdivided into five groups, according to the second operation, i.e., 7,30,60,90 and 180 days. Histology of the peri-implant tissue was analyzed by morphometry with blood count (neutrophilos, lymphocytes, macrophages, fibroblasts and capillaries). RESULTS: Comparison of subgroups 7,30,60,90, 180 days: - neutrophils: silicone: > in subgroup 7 days; bonded e-ptfe: > in subgroups 7 and 30 days; - lymphocytes: silicone: > in subgroup 7 and 180 days; bonded e-ptfe: > in subgroup 180 days; - macrophages: silicone: > in subgroup 7 and 60 days; bonded e-ptfe: > in subgroup 7,30 and 60 days; - fibroblasts: silicone: > in subgroup 30 and 60 days;- vascular volume: silicone: in subgroup 7, 60 and 90 days; bonded e-ptfe: > in subgroup 7 days. Comparison of groups: neutrophils : 7 days: > in silicone and bonded e-ptfe; 30 days: > in bonded e-ptfe; - lymphocytes: - 7,30,90 and 180 days: in the control; macrophages: - 7,30 and 60 days: > in silicone & bonded e-ptfe; 180 days > in silicone; fibroblasts: - 7,30 and 90 days: > in silicone and bonded e-ptfe; 180 days: > in bonded e-ptfe; vascular volume 7,60,90 and 180 days: > in silicone and bonded e-ptfe; 30 days: > in bonded e-ptfe. CONCLUSIONS: The acute stage of the inflammatory response was more severe and irregular in the silicone implant; both the silicone implant and the silicone bonded with e-ptfe promoted chronic inflammatory reaction and weak foreign body inflammatory response. These reactions were greater in the silicone implant group.

OBJETIVO: Comparar a reação inflamatória provocada pelo implante de silicone texturizado, com aquela causada por este recoberto com PTFE-E. MÉTODOS: Foram utilizadas 150 ratas, divididos em três grupos igruais (controle, silicone e recoberto PTFE-E). Os grupos foram subdivididos em cinco subgrupos, ou seja, 7, 30, 60, 90 e 180 dias, de acordo com a data do segundo ato operatório. O tecido perimplante foi analisado histologicamente, por meio de técnica morfométrica, com contagem de neutrófilos, linfócitos, macrófagos, fibroblastos e capilares. RESULTADOS: Comparação dos subgrupos 7, 30, 60, 90 180 dias: - neutrófilos - silicone: > no subgrupo 7 dias; rec-ptfe: > nos subgrupos 7 e 30 dias; - linfócitos: silicone: > no subgrupo 7 e 180 dias; rec-ptfe: > no subgrupo 180 dias; - macrófagos: silicone: > no subgrupo 7 e 60 dias; rec-ptfe: > no subgrupo 7, 30 e 60 dias; - fibroblastos: silicone: > no subgrupo 30 e 60 dias; - volume vascular: silicone: > no subrupo 7, 60 e 90 dias; rec-ptfe: > no subgrupo 7 dias . Comparação dos gurpos: - neutrófilos - 7 dias: > no silicone e rec-ptfe; 30 dias: > no rec-ptfe; - linfócitos - 7, 30, 90 e 180 dias: > no controle; - macrófagos - 7, 30 e 60 dias: > no silcone e rec-ptfe; 180 dias: > no silicone; - fibroblastos - 7, 30 e 90 dias: > no silicone e rec-ptfe; 180 dias: > no rec-ptfe; - volume vascular - 7, 60, 90 e 180 dias: > no silicone e rec-ptfe; 30 dias: > no rec-ptfe. CONCLUSÕES: A fase aguda da reação inflamatória foi mais intensa e irregular no implante de silicone; tanto o implante de silicone como o de silicone recoberto por ptfe-e induziram a reação inflamatória crônica e a fraca reação inflamatória tipo corpo estranho. Estas forram maiores no implante de silicone.

Treatment of severe gynecomastia (Grade III) by resection of periareolar skin.

BACKGROUND: The difficulty of treating severe gynecomastia lies in the resection of excess skin. This resection can result in extensive scars located in conspicuous sites. Several procedures have been proposed in an attempt to solve this problem. OBJECTIVE: The authors propose a new technique for treating severe gynecomastia using a periareolar approach, starting from the principle of vascularization of the nipple-areola complex (NAC) by way of the subdermal plexus. METHOD: The patient was marked preoperatively. Under general anesthesia, lipoplasty of the periglandular area was performed, followed by deepithelialization of excess skin. The glandular tissue was resected through a transdermal incision in the lower portion of the deepithelialized area. RESULTS: Twelve patients with severe gynecomastia underwent surgery over a 5-year period. No cases of partial or total necrosis of the NAC were observed. Complications included 1 case of unilateral hematoma, 1 case of bilateral seroma and 2 cases of decreased sensibility of the NAC. CONCLUSIONS: A new periareolar approach to correction of gynecomastia permits broad resection of excess skin and submammary tissue, while avoiding unattractive scars on the patient's chest.

Estudo comparativo das reações teciduais ao implante de pericárdio bovino e a inclusão de politetrafluoroetileno expandido em ratos / A comparison of tissue reactions to bovine pericardial implants and expanded polytetrafluoroethylene inclusions in a rat model

OBJETIVO: Comparar a reação tecidual à inclusão de politetrafluoroetileno-expandido com a reação tecidual ao implante de pericárdio bovino. MÉTODOS: Vinte ratos foram divididos em dois grupos iguais: 7 e 30 dias. Um disco de cada material foi introduzido no dorso de cada animal. As peças e o tecido reacional foram retirados 7 e 30 dias após a introdução, para a realização do estudo morfométrico. Para análise estatística foram aplicados os testes de Mann-Whitney e Wilcoxon. RESULTADOS: No PTFE-E, no grupo 30 dias, houve um aumento significante no número de fibroblastos e uma diminuição significante no número de neutrófilos, linfócitos e apilares. Em relação ao pericárdio bovino, ocorreu uma diminuição significante no número de fibroblastos. Quando os mesmos períodos foram comparados, o número de fibroblastos foi significativamente maior no PTFE-E, aos 30 dias, assim como o número de plasmócitos e linfócitos no grupo 30 dias , no pericárdio bovino. CONCLUSÕES: A reposta inflamatória foi menor e menos durável no PTFE-E; a reparação foi menor no PTFE-E e não houve reação de corpo estranho para ambos os materiais.

Estudo comparativo das reaçöes teciduais a implantaçäo de silicone e politetrafluoroetileno no dorso de ratos / Comparative study of the tecidual reactions of silicone and expanded polietrafluoroetilene implanted at back of the rats

A importância das biopóteses na medicina abrange diversas áreas cirúrgicas. Com o objetivo de comparar a reaçäo tecidual do implante de silicone, um dos mais utilizados, com o implante de politetrafluoroetileno expandido (PTFE-E), de uso mais recente, nos propusemos a realizar este estudo. Foram utilizados trinta ratos (Rattus norvegicus albinus) machos, distribuidos em três grupos iguais, com implantes de fragmento discóides dos materiais citados, no dorso de cada rato. Os grupos diferiram entre si quanto ao período de eutanásia: três, sete e trinta dias. Com base no modelo experimental e utilizando metodologia morfométrica, do ponto de vista histológico näo houve reaçäo inflamatória aguda importante que se pudesse correlacionar aos meteriais de implantes. A proliferaçäo vascular e a presença de fibrose foram prolongadas em relaçäo à cicatrizaçäo normal. A irregularidade do PTFE-E, provavelmente relaciona-se à maior quantidade de vasos e de fibrose tardia constatada neste material, quando comparado ao implante de silicone