Importance of lateral row perforator vessels in deep inferior epigastric perforator flap harvesting.

Free flaps based on perforator vessels, and in particular the deep inferior epigastric perforator (DIEP) flap, are currently being applied in abdominal reconstruction. However, one of the main disadvantages is the operative complexity. Through anatomical study and clinical experience with the DIEP flap in breast reconstruction, the intramuscular path of the perforator vessels was comparatively studied, to establish the main anatomical parameters that favor procedure planning. Thirty DIEP flaps from 15 fresh cadavers were used. The number, location, and intramuscular course of the perforator vessels were determined. In addition, an initial clinical study was performed in 31 patients using 35 DIEP flaps in breast reconstruction. The number, location, and the intramuscular course of the perforators were assessed. In the cadaver study, 191 perforator vessels were detected (6.4 vessels per flap). Thirty-four percent were located in the lateral row, and the rectilinear course was observed in 79.2 percent of these vessels. In the medial row, only 18.2 percent of the perforator vessels presented this configuration (p = 0.001). Thirty-one patients underwent DIEP flap breast reconstruction, with 26 immediate and four bilateral reconstructions. In 22 of 35 flaps (62.9 percent), two perforators were used. In 25 flaps (71.4 percent), the lateral row perforators with a rectilinear course were observed. Mean operative time was 7 hours and 37 minutes. Two total flap losses and two partial necroses were observed. The majority of the lateral row perforators presented a rectilinear intramuscular course, which was shorter than that of the medial row perforators. This anatomical characteristic favors dissection with reduced operative time and vascular lesion morbidity, resulting in an important anatomical parameter for DIEP flap harvesting.

Consideraçöes no tratamento do traumatismo da ponta digital / Considerations of finger injuries treatments

Os autores fazem uma revisao bibliográfica no que se refere a lesoes traumáticas de ponta de dedo e do leito ungueal, a fim de oferecer uma orientaçao mais eficaz sobre procedimentos a serem observados para estes casos nos serviços de urgência. Os autores reportam um levantamento das práticas adotadas nos últimos dez anos, o que possibilita uma atualizaçao dos métodos e técnicas para o tratamento deste tipo de patologia.

Extrofia vesical em adulto / Extrophy complex and erectile dysfunction in an adult male

Os autores relatam caso de um paciente do sexo masculino, 31 anos, com quadro de extrofia vesical-epispadica e disfunçäo erétil tratado cirurgicamente com a confecçäo de reservatório, implante de prótese peniana e correçäo da fragilidade da parede músculo-aponeurótica da parede abdominal com uso de tela de polipropileno. Foi realizada revisäo da literatura, abordando aspectos relevantes desta complexa entidade