Developing a Biodegradable Film for Packaging with Lignocellulosic Materials from the Amazonian Biodiversity.

The development of packaging films made from renewable raw materials, which cause low environmental impact, has gained attention due to their attractive properties, which have become an exciting option for synthetic films. In this study, cellulose micro/nanofibrils (MFC/NFC) films were produced with forest residues from the Amazon region and evaluated for their potential to generate alternative packaging to traditional plastic packaging. The MFC/NFC were obtained by mechanical fibrillation from fibers of açaí seeds (Euterpe oleracea), titica vine (Heteropsis flexuosa), and commercial pulps of Eucalyptus sp. for comparison. The fibrillation of the titica vine culminated in higher energy expenditure on raw materials. The açaí films showed a higher tensile strength (97.2 MPa) compared to the titica films (46.2 MPa), which also showed a higher permeability rate (637.3 g day-1 m-2). Films of all raw materials scored the highest in the grease resistance test (n° 12). The films produced in the study showed potential for use in packaging for light and low moisture products due to their adequate physical, mechanical, and barrier characteristics. New types of pre-treatments or fibrillation methods ecologically correct and viable for reducing energy consumption must be developed, mainly for a greater success of titica vine fibrillation at the nanoscale.

Extracorporeal Pedicles for Free Flap Reconstruction in Diabetic Lower Extremity Wounds.

Diabetic foot ulcers are a severe complication of diabetes, and their management requires a multidisciplinary approach for optimal management. When treating these ulcers, limb salvage remains the ultimate goal. In this article, we present the "hanging" free flap for the reconstruction of chronic lower extremity diabetic ulcers. This two-staged approach involves standard free flap harvest and inset; however, following inset the "hanging" pedicle is covered within a skin graft instead of making extraneous incisions within the undisturbed soft tissues or tunnels that can compress the vessels. After incorporation, a second-stage surgery is performed in 4 to 6 weeks which entails pedicle division, flap inset revision, and end-to-end reconstruction of the recipient vessel. Besides decreasing the number of incisions on diabetic patients, our novel technique utilizing the "hanging" pedicle simplifies flap monitoring and inset and allows reconstruction of recipient vessels to reestablish distal blood flow.

The First Dorsal Metacarpal Artery Perforator Free Flap: The Comet Flap.

BACKGROUND: Distal extremity defects pose a particular challenge to the reconstructive surgeon; however, advances in perforator flaps have expanded the potential reconstructive options. In this article, the authors present their experience in reconstructing distal extremity defects using a thin, cutaneous free flap based on the perforator of the first dorsal metacarpal artery: the comet flap. METHODS: A retrospective review was performed on all patients who presented with a distal extremity defect and underwent reconstruction using a comet flap between 2015 and 2019. Patient demographics, flap anatomy and harvest, and postoperative course were reviewed and analyzed. RESULTS: A total of 16 patients were included. The mean patient age was 36.5 years. Trauma was the most common cause. The average defect size was 5.4 × 3.2 cm. The average pedicle length of the comet flap ranged from 3.5 to 30 cm, depending on involvement of the radial vessels. All donor sites underwent uncomplicated closure with local rhomboid flaps. One flap was complicated by an acute venous thrombosis that was successfully treated operatively. The flap survival rate was 95 percent. All patients were able to maintain their preoperative range of motion and were satisfied with their final outcome. Follow-up time ranged from 6 to 50 months. CONCLUSIONS: Local flaps remain an important reconstructive approach for distal extremity defects; however, in complex soft-tissue injuries, free tissue transfers become necessary. The comet flap is a safe, versatile, and reliable flap for reconstructing upper and lower extremity defects that can be performed in a single procedure under regional anesthesia. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

O emprego dos retalhos livres em pacientes queimados: experiência de 58 retalhos em 46 pacientes / Free tissue transfers in the management of burns: experience with 58 flaps in 46 patients

A grande maioria das queimaduras de terceiro grau é tratada com a excisão tangencial,seguida da enxertia de pele. No entanto, as deformidades secundárias são frequentes, principalmentenos membros superiores e na cabeça e pescoço. As contraturas causadas pelasqueimaduras graves podem ser tratadas das formas mais diversas. Aquelas limitadas às pequenasáreas podem ser tratadas com zetaplastias, enxertos ou retalhos locais; mas quandoa contratura é extensa é difícil atingir bons resultados com os métodos convencionais. Osautores descrevem a sistematização e a estratégia na reconstrução primária ou secundáriaem pacientes queimados com o emprego de 58 retalhos livres, em 44 pacientes.

Tangential excision is the debridement of necrotic tissue until viable tissue is reached. Thesecond phase of surgical treatment is wound closure. The gold standard of wound coverageis autologus skin grafting. However, results can be disappointing in severe burns that involvethe upper extremity and the neck. Fifty-eight free flaps for 46 patients with deep burns werereviewed retrospectively to determine indication, methods and outcomes.

Reconstrução dos membros com retalhos microcirúrgicos na urgência: experiência de 10 anos com 154 casos consecutivos / Reconstruction of the limbs with microvasculor free fIops in emergency: a 10 years experience with 154 consecutive cases

Os autores analisam a casuística de 154 pacientes portadores de traumatismos complexos dos membros. A idade dos pacientes variou de 3 a 72 anos, com média de 28 anos e 4 meses. O tamanho da perda cutânea variou de 12 a 840 cm2, com média de 170 cm2. O tratamento das lesões complexas dos membros iniciou-se pelo desbridamento radical, seguido pela irrigação abundante. A seguir, a estabilização esquelética foi realizada, quando necessária. Após 48 horas, foi realizado novo desbridamento e programada a cobertura precoce e definitiva do trauma (até a primeira semana) com retalhos livres. Os retalhos empregados foram: plantar (2), grácil (8), fáscia temporal (9), latíssimo do dorso (15), lateral do braço (16), reto do abdome (24), radial antebraquial (32) e retalhos perfurantes (48). Os autores discutem as indicações dos retalhos livres na urgência, os fatores que influenciaram o índice do sucesso, assim como o planejamento de cada retalho. Fez parte deste estudo a análise dos fatores que poderiam influenciar os resultados. Dentre eles, foram considerados a perda (criada pelo trauma de alta energia entre um objeto e o membro), a idade, o sexo e o número de anastomoses venosas realizadas para cada retalho. A análise estatística pelo teste não paramétrico de Mann-Whitney demonstrou que as grandes perdas cutâneas interferiram no índice de sucesso dos retalhos. O índice das complicações foi baixo, os resultados definitivos foram bons em 93 per cent dos pacientes operados. Baseados, nestes resultados, os autores concluem que o tamanho da perda cutânea tem influência no índice de sucesso dos retalhos e que o emprego dos retalhos livres na urgência é um método eficiente e seguro no tratamento das lesões complexas dos membros.