Prelaminated Supraclavicular Island Flap for Total Ear Reconstruction: A New Technique.

Major ear reconstruction has progressed over the past years with the emergence of new techniques directed mainly to patients without available or usable local skin. However, microsurgical transfer requires specific training and eligible patients. The authors report a successful ear reconstruction with a prelaminated supraclavicular island flap in 3 stages, which may be a valuable resource for selected patients or when microsurgery is not available. Advantages and disadvantages of this new technique are discussed, and a possible solution to achieve a more satisfactory result is suggested.

Supraclavicular flap as a salvage procedure in reconstruction of head and neck complex defects.

The supraclavicular island flap (SCIF) is an interesting therapeutic option in head and neck reconstruction. Since popularized by Pallua in the late 90s, several clinical series have been published showing its versatility and usefulness. However, only a few studies have focused on factors associated with complications from SCIF use. In this study, we analyzed the factors contributing to SCIF unreliability. We performed a retrospective review of the data of 87 patients undergoing SCIF reconstruction between 2008 and 2015. No significant differences in mean complication rates were observed when the SCIF was used for primary or salvage reconstruction (28% versus 25%, respectively, p = 0.816) or for cutaneous or intraoral reconstruction (27% versus 28%, respectively, p = 0.932). Flap folding, preoperative radiotherapy, and microsurgery were associated with significantly increased complication rates (p = 0.002, p = 0.043, and p = 0.001, respectively), whereas smoking (p = 0.431) had no impact with regard to this. In conclusion, the SCIF is a versatile flap and an important therapeutic tool for use in salvage surgeries, particularly in those performed in patients with poor clinical conditions and limited flap options.

A clinical experience of the supraclavicular flap used to reconstruct head and neck defects in late-stage cancer patients.

The supraclavicular island flap has been widely used in head and neck reconstruction, providing an alternative to the traditional techniques like regional or free flaps, mainly because of its thin skin island tissue and reliable vascularity. Head and neck patients who require large reconstructions usually present poor clinical and healing conditions. An early experience using this flap for late-stage head and neck tumour treatment is reported. Forty-seven supraclavicular artery flaps were used to treat head and neck oncologic defects after cutaneous, intraoral and pharyngeal tumour resections. Dissection time, complications, donor and reconstructed area outcomes were assessed. The mean time for harvesting the flaps was 50 min by the senior author. All donor sites were closed primarily. Three cases of laryngopharyngectomy reconstruction developed a small controlled (salivary) leak that was resolved with conservative measures. Small or no strictures were detected on radiologic swallowing examinations and all patients regained normal swallowing function. Five patients developed donor site dehiscence. These wounds were treated with regular dressing until healing was complete. There were four distal flap necroses in this series. These necroses were debrided and closed primarily. The supraclavicular flap is pliable for head and neck oncologic reconstruction in late-stage patients. High-risk patients and modified radical neck dissection are not contraindications for its use. The absence of the need to isolate the pedicle offers quick and reliable harvesting. The arc of rotation on the base of the neck provides adequate length for pharyngeal, oral lining and to reconstruct the middle and superior third of the face.

Sensibility of the ear after otoplasty.

Changes in skin sensibility occur in various postoperative plastic surgeries, especially when they involve major skin and subcutaneous dissection. There were no studies so far that objectively compared changes of ear sensibility. This prospective study was conducted to compare ear sensibility before and after otoplasty. Patients with prominent ears (n = 15) underwent bilateral otoplasty. Ear tactile sensibility was tested preoperatively and 6 and 12 months after surgery by Pressure Specified Sensory Device, an apparatus that quantifies cutaneous pressure sensation (g/mm(2)). Comparison between preoperative and 6-months postoperative results indicated an increment on mean skin pressure thresholds; however, mean thresholds between pre- and 12 months postoperative period were similar. Vibratory and hot/cold sensibility did not present any difference during this period. This is the first comparative assessment of ear tactile sensibility using quantitative methods. After otoplasty, initially there was reduction in an ear tactile sensibility, followed by a return to levels similar to preoperative sensibility.

Biomechanical analysis of sutures used for mesh fixation in the donor area after removal of the rectus abdominis muscle.

BACKGROUND: The use of synthetic mesh for abdominal wall closure after removal of the rectus abdominis is established but not standardised. This study compares two forms of mesh fixation: a simple suture, which fixes the mesh to the edges of the defect on the anterior rectus abdominis fascia; and total fixation, which incorporates the fasciae of the internal oblique, external oblique and transverse muscles in the suture, anchoring the mesh in the position of the removed muscle. METHOD: A total of 16 fresh cadavers were dissected. Two sutures were compared: simple and total. Three different sites were analysed: 5 cm above, 5 cm below and at the level of the umbilicus. The two sutures compared were tested in each region using a standardised technique. All sutures were performed with nylon 0, perpendicular to the linea alba. Each suture was secured to a dynamometer, which was pulled perpendicularly towards the midline until the rupture of the aponeurosis. 'Rupture resistance' was measured in kilogram force. The mean among the groups was compared using the paired Student's t-test to a significance level of 1% (p<0.01). RESULTS: The mean rupture resistance of the total suture was 160% higher than that of the simple suture. CONCLUSION: The total suture includes the external oblique, internal oblique and transverse fasciae, which are multi-directional, and creates a much higher resistance when compared with the simple suture. Total suture may reduce the incidence of bulging and hernias of the abdominal wall after harvesting the rectus abdominis muscle, but comparative clinical studies are necessary.

Hematoma intraneural experimental em ratos: avaliação da recuperação funcional e histomorfometria neural / Experimental intraneural hematoma model in rats: evaluation of functional recovery and neural histomorphometry

A formação do hematoma intraneural com comprometimento de nervos periféricos pode ocorrer após trauma ou coagulopatias. O tratamento expectante ou abordagem cirúrgica descompressiva ainda não estão definidos. Foram estudados 40 ratos da raça Wistar divididos em 4 grupos. No grupo A realizou-se injeção intraneural de 0,2 ml de sangue autógeno no nervo ciático direito. No grupo B, após produção do hematoma, fez-se descompressão imediata com epineurotomia longitudinal. No grupo D realizamos liberação imediata do hematoma com neurólise interfascicular. No grupo C (CONTROLE) apenas realizou-se a exposição do nervo ciático sem formação de hematoma. A avaliação da função nervosa foi feita com o índice de Função Ciática de Bain-Mackinnon-Hunter (IFC). O grupo A apresentou IFC inicial de -28,43, com recuperação funcional no 5° dia. A drenagem imediata desse hematoma através de uma epineurotomia longitudinal (B) determinou retorno da função ciática normal desde o 1° dia (IFC= -14,42). Tratando o hematoma através da neurólise interfascicular observamos um IFC inicial de -23,69 e retorno da função ciática normal no 3° dia. Os parâmetros histomorfométricos apontaram melhora dos parâmetros de isquemia após os 2 tipos de intervenção cirúrgica aplicadas neste estudo. Não houve diferença entre os tipos de intervenções aplicadas.

Emergence of intraneural hematoma with involvement of peripheral nerves can occur after trauma or coagulation disorders. The decision for expectant management or decompressive surgical techniques is still controversial. Forty male Wistar rats were divided into 4 groups. In group A, an intraneural injection of autologous blood was provided at the right sciatic nerve. In group B, after the hematoma creation, a longitudinal epineurotomy was performed. In the group C (sham-operated), the sciatic nerve was exposed without hematoma. In group D. immediately after the hematoma creation, an interfascicular neurolysis was performed. Nerve function recovery was assessed using the Bain-Mackinnon-Hunter Sciatic Function Index (SFI). At the end of the study, the animals were sacrificed and a specimen of the sciatic nerve at compression midpoint was removed for morphometric analysis. Group A displayed an initial SFI of -28.43, with full functional recovery on the fifth day. Immediate drainage of the hematoma by longitudinal epineurotomy (group B) promoted recovery of normal sciatic function on the first day (SFI -14.42). Addressing the hematoma via interfascicular neurolysis resulted in an initial SFI of -23.69 and recovery of normal sciatic function on the third day. The morphometric variables indicated an improvement of ischemic parameters following both types of surgical intervention.

Tensor fasciae latae perforator flap: minimizing donor-site morbidity in the treatment of trochanteric pressure sores.

BACKGROUND: To report a new technique with less morbidity for coverage of trochanteric defects, an anatomical and clinical study was performed. METHODS: Twenty-four fresh cadavers were dissected. The following parameters were measured: origin, location, number, and length of the perforating vessels. In addition, a clinical study was performed on 21 patients with trochanteric pressure sores. RESULTS: The anatomical study of 24 fresh cadavers revealed the constant presence of perforator pedicles anterior to the greater trochanter, which provides an adequate arc of rotation arc for flap harvest without sacrificing the underlying muscles. The mean length of the pedicles was 9.59 +/- 2.16 cm. This flap is nourished by perforator vessels arising from the ascending branch of the lateral circumflex femoral artery, which arises from the deep femoral artery and runs through the intermuscular septum, tensor fasciae latae, and rectus femoralis muscles. In this study, flaps were raised based on perforators located preoperatively using a unidirectional Doppler probe. Good results were obtained with primary closure of the donor site, with only two donor-site dehiscences. CONCLUSIONS: This flap is an alternative to myocutaneous flaps, as it preserves local musculature without functional sequelae in patients who walk. It also preserves the local musculature in the event of recurrence, as is usually seen in paralytic patients with pressure sores.

Prevalencia de toxoplasmose, leishmaniose, doenca de Chagas e enteroparasitoses em voluntarios da populacao de Cajati, estado de Sao Paulo, 1998 / Prevalence of toxoplasmosis, leishmaniosis, Chagas disease and intestinal parasitosis in volunteers from Cajati's population, state of Sao Paulo, 1998

Avaliamos a prevalencia de algumas doencas parasitarias no municipio de Cajati-SP (Vale do Ribeira), atraves da Bandeira Cientifica-1998, do Departamento Cientifico do Centro Academico Oswaldo Cruz, da Faculdade de Medicina da Universidade de Sao Paulo. Durante uma semana de intervencao, foram colhidas amostras em pacientes que buscaram ativamente um dos 3 postos de saude locais, englobando...