Tunneled island flaps in facial defects reconstruction.

The reconstruction of facial surgical defects is usually challenging for the dermatologic surgeon. Three different cases of facial defects in which tunneled island flaps were used are reported. In 2 cases, wide defects involving the nasal dorsum and ala were repaired using a nasolabial island flap tunneled through the lateral side of the nose. A tunneled island glabellar flap was used for medial canthus reconstruction in the third case. Despite complex pedicle dissection and frequent trapdoor deformation, tunneled island flaps allow reconstruction of wide defects in a single-staged procedure, camouflaging the scar of the donor area in boundaries of cosmetic units and preserving the facial central symmetry.

Colgajo fasciocutáneo por pérdida del pulpejo. Presentación de un caso / Fasciocutaneous flap by soft flesh losses. Case Presentation

Introducción: Las pérdidas de sustancia de los pulpejos constituyen uno de los motivos de consulta más frecuentes en las salas de urgencias de traumatología. El pulpejo es el área del dedo con mayor densidad de terminaciones sensoriales, que constituyen el primer eslabón de conexión entre nuestro sistema nervioso central y el medio externo en cuanto a la sensación táctil se refiere. Objetivo: Evidenciar las ventajas del uso del colgajo fasciocutáneo pectoral presentando un caso con lesión del pulpejo del pulgar. Presentación del caso: Un paciente con pérdida traumática del pulpejo del pulgar, a quien se le realiza un colgajo fasciocutáneo pectoral, revisando las particularidades morfofisiológicas del sitio operatorio y el proceder. Conclusiones: Los conocimientos de Morfofisiología Humana tienen importancia y aplicación en diferentes procederes médico-quirúrgicos(AU)

Introduction: Soft flesh losses is one of the most frequent consult's reasons in traumatology's emergency wards. Soft flesh is the at;the finger with higher density of sensorial endings, which constitute the first link between our central nervous system and the external environment in terms of tactile sensation. Objective: to remark the advantage of the use of Pectoral fasciocutaneous flap through a Case Presentation. Case presentation: patient suffering a soft flesh traumatic loss of the tactile pad of the thumb, reviewing the morphophysiological specificities of surgery area and procedure. Conclusions: it is concluded that Human Morphophysiological knowledge are important in several medical-surgical procedures(AU)

Tunneled island flaps in facial defects reconstruction

Abstract The reconstruction of facial surgical defects is usually challenging for the dermatologic surgeon. Three different cases of facial defects in which tunneled island flaps were used are reported. In 2 cases, wide defects involving the nasal dorsum and ala were repaired using a nasolabial island flap tunneled through the lateral side of the nose. A tunneled island glabellar flap was used for medial canthus reconstruction in the third case. Despite complex pedicle dissection and frequent trapdoor deformation, tunneled island flaps allow reconstruction of wide defects in a single-staged procedure, camouflaging the scar of the donor area in boundaries of cosmetic units and preserving the facial central symmetry.

Effect of different receptor sites on the development after ovarian autograft balb/c female mice / Efeito de diferentes sítios receptores no desenvolvimento do autotransplante ovariano em camundongas balb/c

The aim of this study was to compare two receptor sites in ovarian autologous transplantation in mice. Twelve Balb-c mice were randomly divided into three groups of four animals each: G1 - non-transplanted animals, G2 - animals which received the ovarian fragment in the perimetrium, G3 - animals which had the abdominal subcutaneous tissue as a receptor site. For transplantation, mice were subjected to bilateral salpingectomia. The left ovary was submitted for histological processing. The right ovarian cortex was fragmented and reimplanted in the specified places according to the groups. Transplants were recovered in 3/4 of the mice in each treatment group. In vaginal washes, the return of the ovarian activity in half of the females of G3 and 3/4 females of G2 was observed. It was detected the presence of corpora lutea in 1/4 of G3 transplants and half in G2. In follicular population all stages of development were observed. Comparing the receptor sites, it was observed a higher percentage of return to cyclicity, as well as of follicles, in animals which had the perimetrium as the site of transplantation. In the subcutaneous, there was a lower follicular growth and lower quantity of corpus luteum. Thus, ovarian autologous transplantation allocated in the subcutaneous tissue and perimetrium allowed both tissue maintenance and follicular development; however, the site of choice will depend on the final goal one aims with the technique

Objetivou-se comparar dois sítios receptores no transplante autólogo ovariano em camundongas. Doze camundongas BALB/c foram divididas aleatoriamente em três grupos experimentais com quatro animais em cada. O G1 - animais não submetidos ao transplante, G2 - animais que receberam o fragmento ovariano no perimétrio, G3 - animais que tiveram o tecido subcutâneo abdominal como sítio receptor. Para o transplante, as fêmeas foram submetidas à ovariossalpingectomia bilateral. O ovário esquerdo foi encaminhado para processamento histológico. O córtex do ovário direito foi fragmentado e reimplantado nos locais especificados de acordo com os grupos. Os transplantes foram recuperados em 3/4 das camundongas em cada grupo tratado. No lavado vaginal, observou-se em metade das fêmeas do G3 e em 3/4 das fêmeas do G2 retorno da ciclicidade. Observou-se presença de corpos lúteos em 1/4 dos transplantes do G3 e metade nos do G2. Na população folicular, foram observados todos os estádios de desenvolvimento. Comparando os sítios receptores observou-se maior porcentagem de retorno à ciclicidade, bem como de folículos, nos animais que tiveram o perimétrio como local do transplante. Já no subcutâneo houve menor crescimento folicular e menor quantidade de corpos lúteos. Dessa forma, conclui-se que o transplante autólogo ovariano alocado no tecido subcutâneo e no perimétrio permitiu tanto a manutenção tecidual quanto o desenvolvimento folicular, porém, o sítio de escolha vai depender do objetivo final que se almeja com a técnica

Effect of different receptor sites on the development after ovarian autograft balb/c female mice / Efeito de diferentes sítios receptores no desenvolvimento do autotransplante ovariano em camundongas balb/c

The aim of this study was to compare two receptor sites in ovarian autologous transplantation in mice. Twelve Balb-c mice were randomly divided into three groups of four animals each: G1 - non-transplanted animals, G2 - animals which received the ovarian fragment in the perimetrium, G3 - animals which had the abdominal subcutaneous tissue as a receptor site. For transplantation, mice were subjected to bilateral salpingectomia. The left ovary was submitted for histological processing. The right ovarian cortex was fragmented and reimplanted in the specified places according to the groups. Transplants were recovered in 3/4 of the mice in each treatment group. In vaginal washes, the return of the ovarian activity in half of the females of G3 and 3/4 females of G2 was observed. It was detected the presence of corpora lutea in 1/4 of G3 transplants and half in G2. In follicular population all stages of development were observed. Comparing the receptor sites, it was observed a higher percentage of return to cyclicity, as well as of follicles, in animals which had the perimetrium as the site of transplantation. In the subcutaneous, there was a lower follicular growth and lower quantity of corpus luteum. Thus, ovarian autologous transplantation allocated in the subcutaneous tissue and perimetrium allowed both tissue maintenance and follicular development; however, the site of choice will depend on the final goal one aims with the technique(AU)

Objetivou-se comparar dois sítios receptores no transplante autólogo ovariano em camundongas. Doze camundongas BALB/c foram divididas aleatoriamente em três grupos experimentais com quatro animais em cada. O G1 - animais não submetidos ao transplante, G2 - animais que receberam o fragmento ovariano no perimétrio, G3 - animais que tiveram o tecido subcutâneo abdominal como sítio receptor. Para o transplante, as fêmeas foram submetidas à ovariossalpingectomia bilateral. O ovário esquerdo foi encaminhado para processamento histológico. O córtex do ovário direito foi fragmentado e reimplantado nos locais especificados de acordo com os grupos. Os transplantes foram recuperados em 3/4 das camundongas em cada grupo tratado. No lavado vaginal, observou-se em metade das fêmeas do G3 e em 3/4 das fêmeas do G2 retorno da ciclicidade. Observou-se presença de corpos lúteos em 1/4 dos transplantes do G3 e metade nos do G2. Na população folicular, foram observados todos os estádios de desenvolvimento. Comparando os sítios receptores observou-se maior porcentagem de retorno à ciclicidade, bem como de folículos, nos animais que tiveram o perimétrio como local do transplante. Já no subcutâneo houve menor crescimento folicular e menor quantidade de corpos lúteos. Dessa forma, conclui-se que o transplante autólogo ovariano alocado no tecido subcutâneo e no perimétrio permitiu tanto a manutenção tecidual quanto o desenvolvimento folicular, porém, o sítio de escolha vai depender do objetivo final que se almeja com a técnica(AU)

Comparing rates of distal edge necrosis in deep-plane vs subcutaneous cervicofacial rotation-advancement flaps for facial cutaneous Mohs defects.

IMPORTANCE: The cervicofacial rotation-advancement flap is commonly used for facial defects. Decreasing the rate of distal edge necrosis (DEN) encountered with this flap would help prevent complications in sensitive areas such as the eyelid, lip, and nose. OBJECTIVE: To compare the untoward occurrence of DEN between 2 surgical dissection methods for reconstructive cervicofacial rotation-advancement flaps. DESIGN, SETTING, PARTICIPANTS, AND EXPOSURE: A review was conducted of 88 patients who underwent cervicofacial flap reconstruction for Mohs ablative surgery between January 1, 2003, and June 30, 2012, by the senior author (A.A.J.). All patients had periorbital, midfacial, cervical, and/or lateral temporal/forehead defects following Mohs surgical ablation. Patients were categorized into 1 of 2 groups on the basis of the surgical technique used: subcutaneous (SC) cervicofacial elevation or deep-plane (DP) cervicofacial elevation. Subcategories of smokers and nonsmokers within each group were further reviewed. Statistical analysis of DEN between categories and subcategories was performed. RESULTS: Sixty-nine patients were in the SC group and 19 were in the DP group. The mean defect size among both groups was 14.3 cm(2). The rate of active or recent smokers was 23% in the SC group and 11% in the DP group. The rate of DEN among nonsmokers in the SC group was 23% (n = 53) compared with 0% in the 17 DP nonsmokers (P = .03). The rate of smokers with DEN in the SC group was 75% and 0% in the DP group (P = .09). The mean area of DEN in the SC group was 0.8 cm(2). CONCLUSIONS AND RELEVANCE: Our statistically significant data indicate that DP dissection is a superior technique for avoiding DEN in nonsmokers. We found better outcomes in smokers as well. Thus, we strongly advocate the use of the DP approach as the criterion standard in cervicofacial flap elevation. LEVEL OF EVIDENCE: 3.

Mecanismos envolvidos na resposta imune e inflamatória frente à implantação de membrana de cortical óssea bovina no tecido subcutâneo de camundongos: caracterização histomorfométrica, imunoenzimática e molecular / Mechanisms involved in immune and inflammatory response to implantation of bovine bone cortical membrane in subcutaneous tissue of mice: characterization histomorphometric, imunoenzimatic and molecular

Os avanços relacionados à ciência dos biomateriais e engenharia tecidual buscam esclarecer os mecanismos envolvidos na resposta biológica associada ao uso desses dispositivos e sua interação com o sistema imune. Neste estudo, avaliou-se a resposta imune e inflamatória desenvolvida em camundongos frente à implantação de membrana de cortical óssea bovina no tecido subcutâneo, em implantação única e sequencial de duas membranas, assim como os possíveis mecanismos envolvidos no processo de reconhecimento e reabsorção desse biomaterial, de acordo com análise histomorfométrica, enzimática e molecular. Após a implantação da membrana, sinais de reabsorção que antes eram notados em pontos isolados, aos poucos se unem até sua completa degradação, observada somente após 15 dias. Todo o processo de reabsorção da membrana é acompanhado por uma reação inflamatória de magnitude moderada, seguida pelo declínio do número de leucócitos, surgimento de células gigantes multinucleadas e formação de uma cápsula de tecido conjuntivo fibroso. A cinética de TNF-α e MMP-2, MMP-8, MMP-9 e MMP-13 apresentou um padrão de produção decrescente, entretanto os níveis dos inibidores de metaloproteinases (TIMPs) e TGF-β parecem atuar de forma inversa. A velocidade de reabsorção após duas implantações consecutivas da membrana foi maior quando comparada ao grupo de animais que sofreu apenas uma implantação, porém os resultados do teste de hipersensibilidade do tipo tardia (DTH) demonstraram que a membrana é biocompatível, pois não elicitou resposta imunológica exacerbada após uma segunda implantação, confirmando então a natureza não imunogênica desse biomaterial. Finalmente, os animais CD14KO e MyD88KO apresentaram uma reabsorção mais lenta da membrana implantada, quando comparados aos animais C57Bl/6 (WT)...

Advances related to the biomaterials science and tissue engineering seek to clarify the mechanisms involved in the biological response associated with the use of those devices and their interaction with the immune system. This study evaluated the inflammatory and immune response developed in mice after implantation bovine bone cortical membrane in subcutaneous tissue, in both, unique and sequential implantation of 2 membranes, as the mechanisms involved in this biomaterial recognition and resorption process, on regards to histomorphometric, enzymatic and molecular analysis. After membrane implantation, previously observed signs of resorption in isolated spots, gradually unite until their complete degradation after 15 days. The whole membrane resorption process is accompanied by a moderate inflammatory reaction, followed by a decline in the leukocytes number, appearance of multinucleated giant cells and formation of a capsule of fibrous connective tissue. The kinetics of TNF-α, MMP-2, MMP-8, MMP-9 e MMP-13 showed a pattern of decreasing production, however, levels of metalloproteinases inhibitors (TIMPs) and TGF-β seem to act in reverse way. The resorption rate after two successive membrane implantations was higher when compared to the group which suffered only one implantation, however, the results of delayed test hypersensity (DTH) demonstrated that the membrane is biocompatible, that is, it does not elicited too high immune response after a second position, confirming the non immunogenic nature of this biomaterial. Eventually, CD14KO and MyD88KO strains showed a slower membrane resorption when compared to animals C57Bl/6, demonstrating that the CD14 and MyD88 molecules are involved in biomaterial recognition and play an important role in bovine cortical bone membrane resorption process, indicating that PAMPs and/or DAMPs are involved in biological response generated by this biomaterial.

Reconstruction after extended orbital exenteration using a fronto-lateral flap.

Orbital exanteration is usually performed for advanced neoplasms of the eyelids and is associated with significant distress for patients. Its reconstruction should aim for functional and aesthetic results and safety for further oncological treatment. The ideal reconstruction should provide adequate cutaneous covering, short healing time, obliteration and closure of communication with facial sinuses and nasal cavity, resistance to radiotherapy, low morbidity and favorable rehabilitation. In 10 patients, a flap based on the frontal branch of the temporal artery was used for immediate reconstruction after orbital exenteration. Flap demarcation began through the frontal midline from the glabella to 0.5 cm above the hairline. Its elevation was performed in a plane above the periosteum and galea, including skin, subcutaneous tissue and frontal muscle. It was rotated tension-free over the defect. In all patients, adequate closure of the defect and obliteration of the orbital cavity was achieved. There was no flap loss or major complications. The lateral frontal flap is easy and fast to execute, with a reliable blood supply and reproducible technique. Its main applicability is for patients with orbital defects and high surgical risks with contraindications for microsurgical reconstruction.

Implantação de osso bovino desproteinizado, hidroxiapatita-Beta TCP e calcário dolomítico em tecido subcutâneo de ratos: análise microscópica descritiva, quantitativa das eações teciduais / Placement of deproteinized bovine bone, beta-hydroxyapatite TCP and calcareous dolomite in subcutaneous tissue of rats: descriptive, quantitative and comparative analysis of tissue reactions

A reação do tecido subcutâneo de rato foi avaliada frente à implantação de microgrânulos de osso bovino desproteinizado, de cerâmica de HA-I3TCP densa e de dolomita em pó. Foram utilizados 54 ratos, divididos em 03 grupos, os quais receberam os implantes acondicionados em cápsulas de colágeno pelos períodos de 30, 60 e 90 dias. Os espécimes foram analisados pela microscopia óptica de modo descritivo e quantitativo, o qual teve como padrão 04 critérios: infiltrado inflamatório, tecido fibrocelular, reabsorção do material implantado e necrose, cujos valores foram submetidos aos testes de Kruskal-Wallis e de Dun. Os resultados obtidos revelaram que a cerâmica bifásica (HA-I3TCP) provocou reações teciduais definidas como biocompatíveis, semelhantes àquelas oriundas do osso bovino desproteinizado, enquanto que a dolomita induziu à necrose, caracterizando uma agressão tóxica.

The reaction of the subcutaneous tissue of rats was evaluated after placement of microgranules of deproteinized bovine bone, dense HA-J3TCP ceramic and dolomite powder. The study was conducted on 54 rats divided in 3 groups, which received the implants stored in collagen capsules for periods of 30, 60 and 90 days. The specimens were submitted to descriptive and quantitative analysis by light microscopy, based on four criteria: inflammatory infiltrate, fibrocellular tissue, resorption of implanted material and necrosis. The results were analyzed by the Kruskal-Wallis and Dunn's tests. The results revealed that the biphasic ceramic (HAJ3TCP) promoted tissue reactions considered as biocompatible, similar to those promoted by the deproteinized bovine bone. Conversely, the dolomite caused necrosis, characterizing a toxic aggression.

L-glutamic acid in the prevention of the calcification of bovine pericardial fixed in glutaraldehyde: study in rats.

OBJECTIVE: To evaluate the efficiency of L-glutamic acid to prevent calcification of glutaraldehyde bovine pericardium implanted in rats' subcutaneous tissues. METHODS: Fifty four Wistar rats were divided in six groups according to the type of the bovine pericardium implanted. At first, all pericardia were initially cross-linked with 0.5% glutaraldehyd (GDA) fixative for 72 h. In Group I, after the initial fixation, the pericardia were preserved in 0.2% GDA fixative until the implantation, whereas in Group II they were stocked in Paraben solution. In Groups III and IV, after the initial fixation in 0.5% GDA fixative, the pericardia were treated with 8% L-glutamic acid at pH 7.4 and 3.5, respectively, being subsequently stocked in Paraben solution. Groups V and VI were similar to III and IV, except for the concentration of L-Glutamic acid which was 0.8%. Explantation was done at 15, 30, and 60 days, and the specimens submitted to histological analysis with Hematoxylin and eosin (HE) and Von Kossa stains, besides calcium quantification with atomic spectrofotometry. RESULTS: Microscopic analysis demonstrated severe and progressive calcification in groups I, II, and III, whereas in groups IV, V, and VI calcification, when present, was mild and focal. Spectrofotomety confirmed these findings, revealing calcium contents of 1.93 microg/mg of tissue at 60 days in the control group. Groups IV and VI showed the least calcium contents (0.063 e 0.066, respectively). CONCLUSIONS: The use of L-glutamic acid in segments of bovine pericardium with glutaraldehyde fixative was effective in preventing the calcification when implanted in rats' subcutaneous up to 60 days.