Alterações nervosas na ritidoplastia: uma revisão sistemática / Nerve alterations in rhytidoplasty: a systematic literature review

INTRODUÇÃO: A ritidoplastia se tornou uma das cirurgias estéticas mais realizadas por cirurgiões plásticos ao redor do mundo. Junto com o aumento do número de cirurgias, a quantidade de complicações associadas ao procedimento também aumentou, sendo que as alterações nervosas são uma das que despertam maiores preocupações. O presente estudo visa a identificar, por meio de uma revisão sistemática, as principais estruturas nervosas lesadas durante uma ritidoplastia, tanto por técnicas convencionais como endoscópicas. MÉTODOS: Uma revisão sistemática da literatura foi realizada nas principais bases de dados utilizadas atualmente. Artigos que preencheram os critérios de inclusão foram analisados na íntegra e suas referências, verificadas. Ao final, 20 estudos foram incluídos. RESULTADOS: Nestes 20 artigos, no total, foram avaliados 3.347 pacientes, sendo encontradas 142 lesões nervosas: 79 do nervo facial; 55 do nervo trigêmeo, e oito do nervo auricular magno. Destas, apenas duas foram definitivas. As lesões, proporcionalmente, foram mais comuns nas técnicas videoassistidas (81%), quando comparadas com as convencionais (19%). CONCLUSÃO: Encontramos que as lesões dos ramos temporal e bucal são mais frequentes no facelift e as do nervo auricular magno, na ritidoplastia cervical. Apesar de as lesões nervosas serem pouco frequentes na literatura, faltam estudos bem desenhados que busquem conhecer melhor estas complicações.

INTRODUCTION: Rhytidoplasty has become one of the most common aesthetic surgeries performed by plastic surgeons worldwide. Along with the increase in the number of surgeries performed, the number of procedure-related complications has also increased. In particular, nerve injuries are the major concern. By conducting a systematic review, the present study aimed to identify the main nerve structures injured during rhytidoplasty, by either the conventional or endoscopic technique. METHODS: A systematic literature review was performed in the main databases currently used. Articles that met the inclusion criteria were analyzed in their entirety, and their references were checked. Finally, 20 studies were included. RESULTS: In these 20 articles, 3,347 patients were evaluated and 142 nerve injuries found, of which 79 were of the facial nerve, 55 were of the trigeminal nerve, and eight were of the great auricular nerve. Of these, only two were definitive. The lesions were more prevalent (81%) with the video-assisted techniques than with the conventional techniques (19%). CONCLUSION: We found that the injuries of the temporal and buccal branches were more frequent during facelifts; and those of the great auricular nerve, during cervical rhytidoplasty. Although nerve injuries are infrequent in the literature, well-designed studies that aim to better understand these complications are lacking.

Thoraco-omphalopagus asymmetric conjoined twins: report of a case and complete review of the literature.

Thoraco-omphalopagus asymmetric conjoined twinning is a rare condition in which a grossly defective foetus (the parasite) is attached to the thorax and upper abdomen of the main foetus (the autosite). We describe a case of thoraco-omphalopagus asymmetric conjoined twins in which the autosite had an associated large-diameter omphalocoele that was successfully separated at our institution. Reconstruction of the resulting abdominal-wall defect was performed using a flap from the gluteal region and the proximal portion of the inferior limb of the parasite, which is demonstrated. In addition, a review of all previously published cases is presented, showing that overall positive results can be obtained in treating this condition and that the presence and degree of cardiac involvement have a major influence on the prognosis.

Lesão de couro cabeludo de espessura total de origem infecciosa / Total-chickness lesion of the scalp of infectious origin

A reconstrução do couro cabeludo, além do propósito de manutenção da forma, é de fundamental importância para a integridade do arcabouço ósseo, com o objetivo de proteção do sistema nervoso central. No presente trabalho, é descrito o caso de uma criança de 1 ano e 5 meses de idade, com lesão de espessura total do couro cabeludo, presença de áreas de isquemia na região da calota craniana após infecção e ausência de periósteo. Foram realizados, em regime de urgência, desbridamento da lesão, lavagem com soro fisiológico a 9% e curativo com pomada de sulfadiazina de prata, durante dois dias. Posteriormente, o paciente foi levado ao centro cirúrgico para realização de múltiplas microperfurações da tábua externa do crânio. Foi realizado curativo com gaze raiom embebida em emulsão de petrolatum, que foi retirada no sétimo dia de pós-operatório, acompanhado de cobertura antibiótica. Finalmente, no décimo dia de pós-operatório, foi realizado enxerto de pele parcial, com obtenção de resultado estético satisfatório.

Scalp reconstruction aims to achieve an appropriate appearance and is fundamentally important to the integrity of the skeletal structure to protect the central nervous system. The present work describes the case of a child aged 1 year and 5 months with a total-thickness lesion of the scalp presenting with ischemic areas in the cranial calotte and absence of periosteum after infection. The lesion was urgently debrided, washed with 9% normal saline, and dressed with silver sulfadiazine ointment for 2 days. The patient was subsequently transferred to the surgical center, and multiple perforations were made in the outer table of the skull. A dressing was made with rayon gauze soaked with petrolatum emulsion and removed 7 days after the surgery accompanied by antibiotic administration. Finally, 10 days after surgery, split-thickness skin grafting was performed, and satisfactory aesthetic results were obtained.

Seven-year institutional experience in the surgical treatment of orbito-zygomatic fractures.

INTRODUCTION: Facial trauma is a common injury in the urban setting. Many studies have been published on the epidemiology of facial fractures, but few of them conducted in Brazil. The purpose of this study was to analyze the epidemiological characteristics of patients treated for orbito-zygomatic fractures at our institution. METHODS: Retrospective analysis of 141 patients with orbito-zygomatic complex fractures who underwent surgical treatment between May 2001 and May 2008. RESULTS: The population studied consisted mostly of males (86.5% of patients), with a male:female ratio of 6.4:1. A marked predominance of patients aged 21-30 years was observed (34.3%). Traffic-related causes were the most common, with motorcycle accidents as the most frequent aetiology (24.8% of patients), followed by car accidents (19.2%) and interpersonal violence (15.2%). Associated injuries accounted for 88 lesions in 65 patients, and their occurrence was statistically associated with traffic-related causes. All patients enrolled in the study were managed with operative treatment. The most utilized method for treatment was internal fixation with miniplates and screws (83.7% of the cases). The complication rate was 24.8%. CONCLUSION: Orbito-zygomatic fractures can cause significant morbidity and impairment in patients' quality of life. Despite recent improvements in legislation and educational campaigns, traffic remains the main cause of these injuries. More intensive efforts should be made in order to reduce its impact in the aetiology of facial trauma.

Malformações capilares: resultados preliminares do tratamento associando laser ND:Yag 1064 nm e luz intensa pulsada / Capillary malformations: preliminary results of treatment associating ND:Yag 1064 nm laser and intense pulsed light

Introdução: As malformações vasculares congênitas do tipo capilar têm seus melhores resultados até o momento com o laser de corante. Nós associamos, em um único equipamento, o laser ND:Yag 1064 nm de pulso longo e a luz intensa pulsada, para o tratamento de lesões superficiais e profundas. Método: Dezessete pacientes foram tratados com a associação descrita em regime ambulatorial, com anestesia tópica, apenas em intervalos mensais, pelo mesmo cirurgião. O equipamento utilizado foi a plataforma Synchro (DEKA), com a ponteira de 4 mm de diâmetro e fluência de 110 J/cm2 para o laser ND:Yag 1064nm. Para a luz intensa pulsada foi utilizado um filtro de corte de 550 nm, a ponteira de 46 x 10 mm e 21 J/cm2 de fluência, divididos em dois disparos. Os resultados foram avaliados clinicamente e por meio de fotografias, em conjunto com os pacientes. Resultados: Dentre os dezessete pacientes tratados, quatro resultados foram considerados excelentes, nove, bons, quatro, regulares e nenhum insuficiente. Conclusão: O tratamento pode ser realizado adequadamente com anestesia tópica em regime ambulatorial. A associação das duas tecnologias possibilitou a obtenção de resultados satisfatórios e, provavelmente, é mais uma técnica no tratamento destas lesões.

Introduction: Congenital vascular malformations up to know, have their best results with dye laser. We associate, in single equipment, long pulse Nd:Yag 1064 nm laser and intense pulsed light, for simultaneous treatment of the superficial and deep lesions. Methods: Seventeen patients were treated with the association described in an office basis with topical anesthesia only at monthly intervals by the same surgeon. The equipment utilized was the Synchro Platform (DEKA) with a 4 mm diameter spot size and fluency of 110 J/cm2 for the ND:Yag 1064 nm laser. For the intense pulsed light was utilized a 550 nm cutoff filter with a 46 x 10 mm spot size and 21 J/cm2 as fluency, divided in two shots. Results were evaluated through clinical and photographical analysis together with the patient. Results: Among the seventeen patients treated, four results were considered excellent, nine, good,four, regular and none insufficient. Conclusion: The treatment can adequately be done in an office basis with topical anesthesia. Association of the two different technologies got a satisfactory result and it is probably one more technique for treating such lesions.

Umbilical grafting in treatment of recurrent stomal stenosis.

OBJECTIVES: The continent catheterizable conduit was first described by Mitrofanoff and is a good option for treating patients with urinary incontinence of different etiologies and those unable to perform transurethral self-catheterization. Stomal stenosis is the most common minor complication involved in this procedure and often is not an easily dealt with problem. Stenosis has a tendency to recur, and the surgical approach becomes progressively more difficult because of local fibrosis and retraction. We present our initial experience with a new surgical technique involving umbilical grafting for the treatment of stomal and urethral meatal stenosis. METHODS: Four female patients who presented with either recurrent stomal or urethral meatal stenosis underwent a new surgical approach with umbilical grafting for treatment. We present the results of this new technique. RESULTS: The initial clinical results of this innovative technique, at a median of 4 months of follow-up, showed that all 4 patients remained continent and mostly satisfied with their voiding pattern. CONCLUSIONS: The results of our study have shown that umbilical grafting is a viable option for the treatment of recurrent stomal and urethral stenosis.

Otoplastia com anestesia tópica: estudo de dez casos / Otoplasty with topical anaesthesia: study of ten cases

Foram estudados 10 casos consecutivos (6 do sexo masculino e 4 do sexo feminino) de pacientes portadores de orelha de abano, que foram submetidos a otoplastia pela técnica da Mustardé modificada utilizando-se a anestesia tópica com lidocaína associada à prilocaína em mistura eutética. A faixa etária dos pacientes variou de 6 a 26 (X = 16,5 anos). A duraçäo média do procedimento cirúrgico for de 70 minutos (40 a 100 minutos). O tempo de espera entre aplicaçäo do anestésico e o início variou de 90 a 120 minutos. Näo foram obaservadas reaçöes diversas que contraindicassem a realizaçäo do procedimento. A istura mostrou-se eficaz na produçäo de analgesia durante o procedimento