Evaluation of carboxymethylcellulose, hydroxypropylmethylcellulose, and aluminum hydroxide as potential carriers for rhBMP-2.

Conventional iliac crest nonvascularized corticocancelous bone grafts and bone flaps have been used to treat bony defects. However, these treatments have some limitations, namely, the availability of donor tissue, donor site morbidity, difficulty to shape the bone flap to the defect, and complexity of the surgery. The bone morphogenetic protein (rhBMP-2) is osteoinductive. However, its implantation requires a matrix (carrier) in order to define the shape of the resulting bone and to retain the protein at the site for the time required for induction to occur. When the ideal carrier is found, an unlimited supply of material would be available for all applications where bone is needed. In this in vitro study, we evaluated the suitability of some potential carriers for rhBMP-2 by measuring the alkaline phosphatase (ALP) activity of fibroblast cultures. Either rhBMP-2 or sodium carboxymethylcellulose significantly increased the ALP activity, when used alone. When sodium carboxymethylcellulose was combined with rhBMP-2, there was an increase in the ALP activity, but lower than those obtained when the products were used alone. Hydroxypropylmethylcellulose alone did not affect ALP activity. However, the combination of rhBMP-2 with hydroxypropylmethylcellulose did not increase the ALP activity, despite the presence of rhBMP-2. Aluminium hydroxide proved to be an unsuitable rhBMP-2 adsorbent.

[Free flaps in the reconstruction of head and neck. Clinical experience]. / Retaehos livres na reconstrução da cabeça e pescoço. Experiência clínica.

The reconstruction of head and neck defects, due to trauma, tumor resection or other, begins with a careful assessment of the patient and the respective defect. Ideally, it ends with the successful reconstructive procedure that optimally restores form and function to the patient. Free flaps have often been used as a last resort reconstructive option in the head and neck because of the need for added technical skill, a longer operating time and a perception of poor reliability. This study reviews our experience with forty-eight patients submitted to microvascular reconstructive procedures. Twelve different kinds of free flaps have been involved as the preferred choice for free flap reconstruction of a specific defect of the head and neck. The latissimus dorsi flap was used for scalp and skull reconstruction, whereas the serratus anterior or rectus abdominis free flaps were used for the reconstruction of complex defects of the middle third of the face. The radial forearm flap and the free jejunal transfer have become the preferred choices for intraoral and pharyngo-esophageal reconstruction, respectively. Good results were obtained with both functional and social rehabilitation. There were three flap losses probably due to thrombosis of the microvascular anastomosis. There was no surgical mortality. The indications for each free flap are discussed.

Reverse dorsal metacarpal osteocutaneous flap.

There are a number of possibilities for local and vascularized bone transfer when a small amount of cortico-cancellous bone is required in the hand and fingers. The authors describe the dissection technique and a clinical application of a reverse dorsal metacarpal osteocutaneous flap to reconstruct the proximal phalanx of a fifth finger. They emphasise the bone vascularisation, studied 48 hours postoperatively with a bone scan and confirmed with bone healing 4 weeks later. The advantages are: it is a compound flap, easy to dissect under tourniquet in one operation, it can be done in an emergency care situation and it does not require ligation of an important vascular axis. The essential precaution is to visualise the patency of the fourth dorsal metacarpal artery before flap dissection, acknowledging that in only 63% of cases is there a vascular pattern that allows flap dissection with a long arc of rotation.

A new approach in axillary hidradenitis treatment: the scapular island flap.

The scapular island flap technique has been used in the treatment of seven cases of axillary hidradenitis suppurativa. This flap, providing a smooth skin surface with good elastic properties, easily covers the axilla and permits the cutaneous reconstruction of the involved axillary tissue excision with satisfying aesthetic, functional results and a rapid local cicatrization. The donor site was closed by primary suture.

[Utilization of forearm island flaps in reconstructive surgery of the hand. Which one is the best option?]. / A utilização de retalhos antebraquiais em ilha na cirurgia reconstrutiva da mão. Qual a melhor opção?

The authors report their clinical experience after seventy-six forearm island flaps, and analyse the different possible forearm flap options in hand reconstructions. The different flaps-based on the radial, ulnar, interosseous and septocutaneous ulnar vessels-are compared in what, concerns the importance of the sacrificed artery, adverse sequelae of the donor area and their versatility to close large skin defects as well as their capacity to reach distal areas of the hand. Their ability to provide sensate coverage and to replace bone and tendons is also compared.

Halux pulp composite graft in nipple reconstruction.

We present a nipple reconstruction method that uses a composite graft of a constant halux's prominence. This technique, which has advantages over nipple reconstruction with toe pulp free grafts, has produced good results.

[The treatment of burn patients. What are the prospects for the northern area of Portugal?]. / Tratamento de queimados. Que perspectivas para a zona norte de Portugal?

The AA studied the distribution of age, sex, aetiology, and destiny of the 173 in-patients at the S. João Hospital (Central hospital that has no Burn Unit). In what concerns age, 38.1% are children less than 10 years old; the male/female ratio was 1.7:1. The fire and scalds are the most important aetiology. These findings are similar to those found in other countries (except in the Arabian Countries). Of these 99 burn patients have been treated in S. João Hospital, 71 patients were sent to the Burn Unit of Prelada Hospital and 3 to the Burn Unit of Coimbra University Hospital. These findings were compared to a Burn Unit of a Spanish Hospital (Alicante) which has 18 beds for adults and children, normally interning 132 patients per year. As the WHO suggest one special bed per 30,000 persons, we should be expected to have at least 110 beds for burn patients (we only have 9 beds at Prelada Hospital), the AA suggest the establishment of a Burn Unit at S. João Hospital, also due to the fact that is the only hospital that has a permanent emergency care for Plastic Surgery.