ABSTRACT
BACKGROUND: During the past 15 years, polymethylmethacrylate has been used as a synthetic permanent filler for soft-tissue augmentation. METHODS: This article reports 32 cases of complications seen at Hospital das Clínicas, Faculty of Medicine, University of São Paulo, for procedures performed elsewhere. RESULTS: The average age of the patients was 43.6 years (range, 22 to 70 years). Twenty-five patients were women. Sixteen injection procedures were performed by certified plastic surgeons, nine by dermatologists, two by urologists, and one by a nonphysician. Complications were classified into five groups according to main presentation as follows: tissue necrosis (five cases), an acute complication that can be related to technical mistakes but that can also be dependent on patient factors or caused by local infection; granuloma (10 cases), which usually presents as a subacute complication 6 to 12 months after the procedure; chronic inflammatory reactions (10 cases), which usually occur years later and can be related to a triggering event, such as another operation or infection in the area that was injected (these reactions are immunogenic in origin and may have cyclic periods of activation and remission); chronic inflammatory reaction in the lips (six cases), which may be present with severe symptoms, especially with lymphedema, because of mobility of the lip; and infections (one case), which are rare but possible complications after filling procedures. CONCLUSIONS: Polymethylmethacrylate filler complications, despite being rare, are often permanent and difficult or even impossible to treat. Safety guidelines should be observed when considering use of polymethylmethacrylate for augmentation.
Subject(s)
Biocompatible Materials/adverse effects , Foreign-Body Reaction/etiology , Granuloma, Foreign-Body/etiology , Polymethyl Methacrylate/adverse effects , Postoperative Complications/etiology , Prostheses and Implants/adverse effects , Rhytidoplasty , Surgical Wound Infection/etiology , Adult , Aged , Biocompatible Materials/administration & dosage , Brazil , Cheilitis/epidemiology , Cheilitis/etiology , Cheilitis/surgery , Chronic Disease , Cross-Sectional Studies , Female , Foreign-Body Reaction/epidemiology , Foreign-Body Reaction/surgery , Granuloma, Foreign-Body/epidemiology , Granuloma, Foreign-Body/surgery , Humans , Injections, Intradermal , Male , Middle Aged , Polymethyl Methacrylate/administration & dosage , Postoperative Complications/epidemiology , Postoperative Complications/surgery , Reoperation , Surgical Wound Infection/epidemiology , Surgical Wound Infection/surgeryABSTRACT
O retalho cutâneo lateral da coxa baseado no pedículo da artéria genicular lateral superior(AGLS) localiza-se na face lateral e distal da coxa e pode ser utilizado para reparação do revestimento cutâneo do joelho e da região proximal da perna. Nesse trabalho foi realizado estudo anatômico e histomorfométrico em 18 cadáveres, totalizando 36 peças anatômicas. O objetivo foi determinar os parâmetros de dissecção do retalho e suas características anatômicas. A sua aplicação clínica foi demonstrada em quatro pacientes. O pedículo vascular representado pela artéria genicular lateral e duas veias comitantes esteve presente em 100 por cento dos casos, com trajeto intramuscular em 40 por cento das vezes. Em relação ao côndilo lateral do femur está a uma distância média de 7,40 ± 2,77 cm tendo um trajeto no trígono delimitado anteriormente pelo músculo vasto lateral, posteriormente, pelo músculo bíceps femoral e distalmente, pelo próprio côndilo lateral do fêmur. O comprimento médio do pedículo foi de 6,09 ± 1,91 cm . O estudo demonstrou que o retalho apresenta anatomia constante e tem arco de rotação suficiente para as reconstruções do joelho e da região proximal e lateral da perna, conferindo revestimento cutâneo delgado com qualidade de pele semelhante à região adjacente.
