Tratamento de lesões cutâneas múltiplas na neurofibromatose tipo 1: nova técnica de excisão eletrocirúrgica / Treatment of multiple cutaneous lesions in neurofibromatosis type 1: new excision electrosurgical technique

A neurofibromatose tipo 1 (NF1) é um distúrbio autossômico dominante que apresenta lesões cutâneas múltiplas, frequentemente chegando à faixa de 500 a 1.000 lesões. Além das implicações psicológicas, as lesões apresentam um difícil dilema cirúrgico pela existência de limitadas opções. Os autores apresentam uma série de 175 pacientes com inúmeras lesões cutâneas tratadas com uma nova abordagem, utilizando a excisão por eletrocautério. A técnica resulta na remoção de grandes números de lesões com uma discreta cicatriz, um mínimo de desconforto e uma significativa satisfação do paciente.

A survey of microvascular protocols for lower extremity free tissue transfer II: postoperative care.

Due to the complex, and often tenuous nature of microsurgical tissue transfer, postoperative monitoring of free tissue flaps plays a vital role in the management of such patients. Some of the more challenging reconstructive problems occur in patients with lower extremity trauma, yet to date, no preferred protocol exists for the postoperative care of lower extremity free flaps. The present study sought to evaluate and assess current preferences in monitoring following lower extremity free tissue transfer. Members of the American Society of Plastic Surgeons (ASPS) were surveyed with regard to their choice for postoperative monitoring and return to dependent positioning ("dangling"). The results demonstrate that there is some agreement among surgeons regarding the optimal means for postoperative monitoring. Most rely on clinical observation in addition to conventional Doppler probe for an average of 4.8 days. Most surgeons follow their own flaps in addition to relying on the residents and nursing staff. The study also notes a wide variety in the times and frequencies at which dangling of the extremity was commenced. Most respondents initiate dangling within 2 weeks of surgery and begin with only 1 to 5 minutes per session.

Electrosurgical excision technique for the treatment of multiple cutaneous lesions in neurofibromatosis type I.

Neurofibromatosis I (NF1) is an autosomal dominant disease that presents with multiple cutaneous lesions often numbering into the 500-1000 range. In addition to the psychosocial implications, there are limited surgical options for this condition. A series of 97 consecutive patients with NF1 presented with numerous cutaneous lesions. Treatment involved electrocautery excision of the lesions using a handheld device in one or more stages. This technique resulted in the removal of large numbers of lesions in limited stages, with minimal scarring, minor discomfort and high patient acceptance. For patients with NF1, single or multistage excision of cutaneous lesions using electrocautery produces an acceptable aesthetic result with high patient satisfaction.

A survey of microvascular protocols for lower-extremity free tissue transfer I: perioperative anticoagulation.

Reconstruction of the lower extremity using free tissue transfer is performed throughout the country by numerous surgical teams. However, no established protocol exists for the use of anticoagulation in the perioperative period. The present study sought to analyze trends in current protocols regarding perioperative anticoagulation for lower-extremity free flap reconstruction. Members of the American Society of Plastic Surgeons were surveyed with regard to their preferences for perioperative anticoagulation in conjunction with lower-extremity free tissue transfer. The results demonstrated tremendous variability in both the agents used and therapeutic periods employed. They highlighted the absence of 1 or more common anticoagulation protocols and tried to establish common trends in the use of such agents.

Laparoscopic-assisted abdominal wall reconstruction in prune-belly syndrome.

Prune-belly syndrome (PBS) refers to a congenital absence or weakness of the musculature of the abdominal wall, in conjunction with anomalies of the gastrointestinal or genitourinary systems. As such, many patients undergo numerous intra-abdominal procedures and develop significant peritoneal adhesions, making reoperation a challenging endeavor. Numerous approaches to abdominal wall reconstruction in patients with PBS have been reported. The authors describe a novel approach that uses laparoscopic visualization of intra-abdominal contents combined with abdominal wall plication. This technique has been safely performed in 6 patients with PBS. It is believed to improve safety and allows for bilateral, vertical, 2-layer, fascial plication to strengthen the abdominal wall.

Hyoid bone fractures.

Surgeons who manage patients with craniofacial trauma should be comfortable with evaluating and treating fractures throughout the head and neck. This includes the hyoid bone, which may cause significant airway concerns if fractured. The authors report the case of a patient who sustained a fracture of the hyoid bone. The hospital records from a busy, level I trauma center were reviewed to document similar injuries over a seven-year period. To supplement the scant literature concerning hyoid fractures, a review of the anatomy, diagnosis, and management of such injuries is provided.

Quality of life and facial trauma: psychological and body image effects.

This study evaluated the social and psychologic impact of facial trauma on previously healthy individuals. Inclusion criteria for the study included 18- to 45-year-old individuals who had a facial laceration of 3 cm or greater and/or a fractured facial bone requiring operative intervention within 6 months to 2 years prior to participation in the study. Retrospective analysis of patients at Yale New Haven Hospital Emergency Department was done between May 1997 and December 1998. When compared with a control population, the study group showed a statistically significant lower satisfaction with life, more negative perception of body image, higher incidence of posttraumatic stress disorder, higher incidence of alcoholism, and an increase in depression. Also, among the study group there was a significantly higher incidence of posttrauma unemployment, marital problems, binge drinking, jail, and lower attractiveness scores. In conclusion, in this preliminary study, it appears that the result of facial scarring/trauma includes a significantly decreased satisfaction with life, an altered perception of body image, a higher incidence of posttraumatic stress disorder, a higher incidence of alcoholism, and increased posttrauma jail, unemployment, binge drinking, and marital problems. Thus, it appears that there is significant negative social and functional impact related to facial trauma and scarring.