Versatilidad del colgajo VRAM / Versatility of the VRAM flap

Los defectos extensos de la pared abdominal y de la zona perineal derivados de las resecciones tumorales o posteriores a procesos infecciosos pueden ser resueltos de una manera rápida y sin la ayuda de técnicas microquirúrgicas mediante el colgajo VRAM, una herramienta reconstructiva importante que ha entrado en desuso, pero que sin lugar a dudas es una estrategia que proporciona seguridad para el cirujano plástico en los casos indicados. En nuestro trabajo se describe una serie de casos en los que se utilizó al colgajo VRAM para la reconstrucción de defectos en pared abdominal y la zona perineal; defectos amplios que fueron satisfactoriamente resueltos, en donde se denotan las ventajas que ofrece este colgajo para la resolución de problemas reconstructivos de las áreas anatómicas en cuestión.

Extensive defects of the abdominal wall and perineal area derived from tumor resections or after infectious processes can be resolved quickly and without the help of microsurgical techniques using the VRAM flap, an important reconstructive tool that an important reconstructive tool that that has gone into disuse, but without a doubt it is a strategy that provides security for the plastic surgeon in the indicated cases. In our work, a series of cases are described in which the VRAM flap was used for the reconstruction of defects in the abdominal wall and the perineal area; large defects that were satisfactorily resolved, where the advantages offered by this flap for the resolution of reconstructive problems of the anatomical areas in question are denoted.

Relação entre a diástase do músculo reto abdominal supraumbilical e infraumbilical e a contração dos músculos do assoalho pélvico de puérperas / Relationship between supra- and infraumbilical diastasis recti abdominis and pelvic floor muscles contraction of puerperal women

Objetivo: Avaliar a relação entre diástase músculo reto abdominal (DMRA) supra- e infraumbilical com a contração da musculatura do assoalho pélvico (MAP) de mulheres no pós-parto imediato, internadas em uma maternidade pública. Metodologia: Estudo transversal aprovado pelo Comitê de Ética em Seres Humanos (nº 1.674.698; CAA 6163616.8.0000.0096). Participaram 60 puérperas de baixo risco, assistidas nas enfermarias de uma maternidade. A DMRA foi avaliada pela palpação abdominal e graduada conforme a quantidade de polpas digitais. A contração da MAP foi avaliada por meio da inspeção visual. A correlação das variáveis foi realizada pelo teste de Spearman, com nível de significância em p<0,05. Resultados: 40 puérperas (66,7%) apresentaram DMRA supraumbilical e 23 participantes (38,4%) mantinham DMRA infraumbilical maior do que 2 polpas digitais. Cerca de 71,4% das puérperas contraíram MAP isoladamente e 12,7% contraíram MAP utilizando mecanismos compensatórios; 14,3% das puérperas não conseguiram realizar a contração. A DMRA supraumbilical está correlacionada com a contração da MAP com músculos acessórios de primíparas (p=0,03; r=-0,46); a sustentação da contração da MAP em multíparas (p=0,03; r=-0,43); e a ausência da contração da MAP (=0,03; r=0,35) e ao tempo de sustentação da contração (p=0,02; r=-0,40) em puérperas que realizaram parto vaginal. Conclusão: A presença da DMRA supraumbilical apresenta correlação com a função da MAP de puérperas de acordo com a paridade e a via de parto do último parto. (AU)

Aim: to analyze the relationship between supra- and infraumbilical diastasis recti abdominis (DRA) and pelvic floor musculature (PFM) contraction of women at immediate postpartum, admitted in a public maternity hospital. Methodology: Cross-sectional study approved by the Human Ethics Committee (nº 1.674.698; CAA 56163616.8.0000.0096). Sixty low-risk puerperal women attended at the maternity participated were included. DRA was assessed by abdominal palpation and graded according to number of digital pulps. PFM contraction was assessed by visual inspection. The correlation of variables was performed using the Spearman test, with a significance level of p <0.05. Results: 40 participants (66.7%) had supraumbilical DRA and 23 participants (38.4%) had infraumbilical DRA greater than 2 digital pulps. About 71.4% of women contract only PFM and 12.7% contract PFM using compensatory mechanisms; 14.3% of puerperal women were unable to perform a contraction. Supraumbilical DRA is correlated with PFM contraction and accessory muscles (p = 0.03; r = -0.46); to time of sustained PFM contraction in multiparous women (p = 0.03; r = -0.43); and absence of PFM contraction (= 0.03; r = 0.35) and the time of sustained PFM contraction (p = 0.02; r = -0.40) in puerperal women who underwent vaginal delivery. Conclusion: The presence of supraumbilical DRA correlates with PFM function according to the parity and the type of delivery. (AU)

Anatomical study and clinical importance of the inferior epigastric artery / Estudio anatómico e importancia clínica de la arteria epigástrica inferior

SUMMARY: The inferior epigastric artery (IEA) is a major blood vessel that supplies the anterior abdominal wall. The aim of the current study was to provide clinicians, surgeons, and obstetricians with sufficient anatomical data on the inferior epigastric artery, such as its origin and branching pattern. The study included 20 embalmed cadavers, these cadavers were dissected, and the inferior epigastric artery and vena comitans/venae comitantes were identified and traced downwards to the external iliac vessels. The origins, caliber, course and pedicle length of both the artery and the vein(s) were studied. The inferior epigastric artery arose independently from the distal external iliac artery deep to the inguinal ligament in 19 (95 %) cadavers. The artery entered the rectus abdominis muscle at its middle third in 13 (65 %) cases and at its lower third in the remaining specimens. In this study, we found that the artery divided into two branches in 18 (90 %) of the cases; in the remaining two cases, it continued as one trunk. The average pedicle length was 7.2 cm. The mean caliber of the IEA was 3.7 mm. In 18 (90 %) dissections, the venous drainage consisted of a pair of venae comitantes that united to form a common vessel at their draining point on the external iliac vein. The average diameter was 3.9 mm. The current study focuses on the anatomical features of the inferior epigastric artery to increase the success rate of abdominal and pelvic operations in clinical practice.

RESUMEN: La arteria epigástrica inferior (AEI) es un vaso sanguíneo principal que irriga la pared abdominal anterior. El objetivo del presente estudio fue proporcionar a los médicos, cirujanos y obstetras suficientes datos anatómicos sobre la arteria epigástrica inferior, como su origen y patrón de ramificación. El estudio incluyó 20 cadáveres embalsamados, los que se disecaron y se identificó la arteria epigástrica inferior y la vena concomitante y se siguieron hasta los vasos ilíacos externos. Se estudiaron los orígenes, calibre, trayecto y longitud del pedículo tanto de la arteria como de la (s) vena (s). La arteria epigástrica inferior surgió independientemente de la arteria ilíaca externa profunda al ligamento inguinal en 19 (95 %) cadáveres. La arteria ingresó al músculo recto del abdomen en su tercio medio en 13 (65 %) casos y en su tercio inferior en las muestras restantes. En este estudio, encontramos que la arteria se dividió en dos ramas en 18 (90 %) de los casos; en los dos casos restantes, continuó como un tronco. La longitud media del pedículo fue de 7,2 cm. El calibre medio del AEI fue de 3,7 mm. En 18 (90 %) disecciones, el drenaje venoso consistió en un par de venas concomitantes las que formaron un vaso común en su punto de drenaje en la vena ilíaca externa. El diámetro medio fue de 3,9 mm. El estudio actual se centra en las características anatómicas de la arteria epigástrica inferior con el propósito de mejorar la tasa de éxito de las cirugías abdominales y pélvicas en la práctica clínica.

Atuação fisioterapêutica na redução da diástase abdominal no puerpério imediato / Physiotherapy in the reduction of diastasis of the recti abdominis in inmediate pospartum / Fisioterapia para reducir la diástasis abdominal en el posparto inmediato

Objetivo: verificar se a intervenção fisioterapêutica no puerpério imediato contribui para a redução da diástase. Métodos: estudo de intervenção com randomização de dois grupos de 25 puérperas recrutadas em uma maternidade de Vitória-ES. Ambos foram submetidos à avaliação e mensuração da diástase através de um paquímetro, e no grupo de tratamento além da avaliação foi aplicado um protocolo de tratamento fisioterápico às 06 e 18 horas após o parto. Os dados foram analisados através dos testes de Wilcoxon, Mann-Whitney e teste t pareado. Resultados: houve diminuição da diástase abdominal entre a primeira e a última avaliação em ambos os grupos, no entanto, a análise entre grupos identificou uma redução mais acentuada no grupo de tratamento (p<0,001). Conclusão: os achados deste estudo mostram que o atendimento fisioterápico no puerpério imediato é capaz de influenciar positivamente na redução da diástase abdominal, proporcionando às puérperas uma recuperação mais rápida

Objective: to verify if the physiotherapeutic intervention in the immediate puerperium contributes to the reduction of the diastasis. Methods: randomized intervention study of two groups of 25 mothers recruited at a maternity hospital in Vitória-ES. Both were submitted to diastasis evaluation and measurement using a caliper, and in the treatment group, in addition to the evaluation, a physical therapy protocol was applied at 06 and 18 hours after delivery. Data were analyzed by Wilcoxon, Mann-Whitney and paired t-tests. Results: there was a decrease in the abdominal diastasis between the first and last evaluation in both groups and the variables studied, however, the analysis between groups identified a sharper decline in the treatment group (p <0.001). Conclusion: the findings of this study show that the physiotherapeutic care in the immediate puerperium is able to positively influence the reduction of the abdominal diastasis, providing a faster recovery to the puerperal women

Objetivo: verificar si la intervención de fisioterapia en el período posparto inmediato contribuye a la reducción de la diástasis. Métodos: estudio de intervención aleatorizado de dos grupos de 25 madres reclutadas en un hospital de maternidad en Vitória-ES. Ambos fueron sometidos a evaluación y medición de la diástasis utilizando un calibrador, y en el grupo de tratamiento, además de la evaluación, se aplicó un protocolo de fisioterapia a las 06 y 18 horas después del parto. Los datos fueron analizados por Wilcoxon, Mann-Whitney y pruebas t pareadas. Resultados: hubo una disminución en la diástasis abdominal entre la primera y la última evaluación en ambos grupos y las variables estudiadas, sin embargo, el análisis entre los grupos identificó una reducción más marcada en el grupo de tratamiento (p <0.001). Conclusión: los resultados de este estudio muestran que la atención de fisioterapia en el período posparto inmediato puede influir positivamente en la reducción de la diástasis abdominal, proporcionando a las mujeres puerperales una recuperación más rápida

Estado del arte de la plicatura de rectos / State-of-art of rectus shealth plication

Introducción. La abdominoplastia es un procedimiento que se utiliza para definir el contorno corporal actuando sobre todas las capas de la pared mediante la resección del exceso de piel y grasa subcutánea y la reparación del sistema músculo-aponeurótico. Uno de los componentes a tratar en toda abdominoplastia es la diastasis abdominal, que se logra a través de la plicatura de rectos. Muchas controversias han surgido acerca de la efectividad y duración de la corrección, del mejor tipo de sutura y las consecuencias sobre la presión intraabdominal y el embarazo. Materiales y metodos. Se llevó a cabo una revisión sistemática de la literatura utilizando las bases de datos MEDLINE, LILACS, MEDES y SciELO. Tanto artículos de habla inglesa como hispana fueron tenidos en cuenta. Las palabras clave utilizadas para la búsqueda inicial fueron rectus plication, rectus shealth plication, diastasis, abdominal closure, plicatura abdominal. Resultados. Luego de la búsqueda, 58 artículos fueron seleccionados y revisados. En base a la información obtenida, se dividió la información y se desarrollaron de manera objetiva en puntos separados. Conclusiones. A pesar de que la bibliografía muestra conclusiones disímiles y variables, la plicatura es un procedimiento seguro y potencialmente benefi cioso para la salud tanto en dolores lumbares como incontinencia urinaria, y puede usarse en aquellos casos intratables. Tanto suturas de reabsorción lenta como el PDS y las suturas no absorbibles pueden ser utilizadas para el cierre de la diastasis abdominal con excelentes resultados a largo plazo y sin riesgo de recurrencia

Introduction. Abdominoplasty is a body-contouring procedure for functional and aesthetic improvement that addresses deformity from excess skin and fat and musculofascial laxity. Diastasis repair by plication of the rectus sheath is an integral part of most abdominoplasty procedures. There is no consensus regarding what suture material is best and contradictory information about long term durability, changes in the intraabdominal pressure and pregnancy is seen in the literature. Material and methods. A systematic review of current available literature was performed using the MEDLINE, LILACS, MEDES and SciELO databases. Key words used for initial data bank searches included "rectus plication", "rectus shealth plication" "diastasis" "abdominal closure", "plicatura abdominal". Furthermore, bibliographies and individual plastic surgery journals were searched for additional reference information. Results. Fifty-eight articles met the criteria and were analyzed critically for inclusion. From this information, a narrative synthesis of data was undertaken. Conclusions. Although current literature shows diff erent conclusions, rectus shelth plication can be consider a safe and pottencially benefi tial procedure with signifi cant improvements in posture and quality of life. Absorbable and non absorbable sutures seems to be reliable sutures for the correction of rectus diastasis.

Perineal repair after abdominoperineal excision with rectus abdominis myocutaneous flap / Reconstrução do períneo após amputação abdominoperineal com retalho pediculado do músculo reto abdominal

ABSTRACT Background: Abdominoperineal excision of the rectum (APR) remains the only potential curative treatment for very low rectal adenocarcinoma and squamous cell carcinoma of the anus. Yet, it implies a significant perineal exenteration and has set the attention on the perineal reconstruction. Aim: To present technique used in one case of APR for anal cancer, with resection of the vaginal posterior wall with large perineal defect which has called for the necessity of a flap for reconstruction Method: To cover the large perineal defect and reconstruct the posterior vaginal wall was perform a standardized and reproducible surgical technique using oblique rectus abdominis myocutaneous (ORAM) flap. The overlying skin of this flap is thick and well vascularized by both superficial branches and perforators of the superior epigastric artery and the deep inferior epigastric artery which serves as the vascular pedicle for the ORAM flap. Results: This procedure was applied in a 65-year-old woman with recurrent squamous cell carcinoma of the anus infiltrating the posterior wall of the vagina. Was performed an APR with en-bloc resection of the vaginal posterior wall in order to achieve tumor-free margins. Postoperative course was uneventful and she was discharged home at postoperative day 9. Final pathological report confirmed the oncological adequacy of the procedure (R0) and showed a rypT4N0 lesion. Conclusion: Flap reconstruction is an effective way to cover the perineal wound reducing both perineal complication rate and wound healing delay. The ORAM is particularly interesting for female whose tumors require resection and subsequent reconstruction of the posterior wall of the vagina.

RESUMO Racional: A amputação abdominoperineal do reto (APR) continua sendo o único tratamento curativo nos casos de adenocarcinoma retal muito baixo e carcinoma espinocelular do ânus. No entanto, implica em exenteração perineal significativa e exige atenção na reconstrução perineal. Objetivo: Propor, ilustrando com um caso clinico, proposta de APR para câncer anal com ressecção da parede posterior da vagina com cobertura do grande defeito perineal através de reconstrução com retalho miocutâneo oblíquo do reto abdominal (ORAM). Método: Para cobrir o defeito e reconstruir a parede vaginal posterior, realizou-se técnica de retalho miocutâneo oblíquo do reto abdominal (ORAM). A pele subjacente desse retalho por ser espessa e bem vascularizada por ramos perforantes superficiais da artéria epigástrica superior e pela artéria epigástrica inferior profunda serviu como pedículo vascular. Resultado: Este procedimento foi aplicado em uma mulher de 65 anos com recidiva de carcinoma espinocelular do ânus infiltrado na parede posterior da vagina. Foi realizada APR com ressecção em bloco da parede posterior vaginal com o objetivo de obter margens livres de tumor. O pós-operatório transcorreu sem intercorrências e a paciente recebeu alta hospitalar no 9° dia pós-operatório. O relatório patológico final confirmou a adequação oncológica do procedimento (R0) e mostrou uma lesão rypT4N0 de 6,5 cm. Conclusão: A reconstrução perineal com utilização de retalho é maneira eficaz de fechar a ferida operatória, reduzindo a taxa de complicações perineais e o atraso na cicatrização. O retalho de tipo ORAM é particularmente interessante para mulheres cujos tumores requerem ressecção e subsequente reconstrução da parede posterior da vagina.

Is rectus abdominis thickness associated with survival among patients with liver cirrhosis? A prospective cohort study

ABSTRACT BACKGROUND: Sarcopenia may affect patients with liver cirrhosis and worsen disease outcomes. OBJECTIVES: To evaluate ultrasound-measured psoas major (PM) and rectus abdominis (RA) thickness for predicting survival among patients with liver cirrhosis. DESIGN AND SETTING: Prospective cohort study in a tertiary-level hospital. METHODS: 61 patients with liver cirrhosis were prospectively included during a 15-month period and followed up for at least six months. Cirrhosis was classified using the Child-Pugh score. Sarcopenia was assessed using surrogate parameters: handgrip strength (HGS), mid-arm muscle circumference (MAMC) and SGA (subjective global assessment). We used ultrasound to measure RA and PM thickness at admission. RESULTS: There were 41 men. The patients' mean age was 58.03 ± 10.8 years. 26.22% of them were Child-Pugh A, 45.9% B and 27.86% C. The patients were followed up for 11.9 ± 5.63 months. RA thickness correlated moderately with MAMC (r = 0. 596; P < 0.0001) and HGS (r = 0.515; P < 0.0001) and decreased with increasing SGA class (A, 10.6 ± 2.8 mm; B, 8.3 ± 1.9 mm; C, 6.5 ± 1.9 mm; P < 0.0001). Survival at six months was independently predicted by using the model for end-stage liver disease-serum sodium score (odds ratio, OR 1.305; 95% OR confidence interval 1.083-1.572; P = 0.005). Survival during follow-up was independently predicted by RA thickness (hazard ratio, HR 0.701; 95% HR confidence interval 0.533-0.922; P = 0.011) and ascites (HR 1.876; 95% HR confidence interval 1.078-3.267; P = 0.026). PM thickness did not have any predictive value. CONCLUSIONS: As a surrogate marker of sarcopenia, RA thickness may predict survival among patients with liver cirrhosis.

Redefinição natural do abdome em abdominoplastia com uso de lipoaspiração convencional: estudo prospectivo / Redefining natural abdominal anatomy in abdominoplasty using conventional liposuction: a prospective study

Introdução: A evolução da abdominoplastia se mantém constante desde 1899. Atualmente, com o avanço das técnicas de lipoaspiração, o conceito de lipoaspiração de alta definição tem como objetivo de corrigir estigmas causados pelo procedimento, como o aspecto "tenso" e a falta de convexidades e concavidades naturais abdominais. Métodos: Apresentamos uma proposta de busca da redefinição natural do abdome, através da lipoabdominoplastia tradicional com lipoaspiração seletiva, procurando obter resultados cirúrgicos com padrão natural, reproduzível para a maioria dos pacientes. Foram realizadas 21 abdominoplastias, entre novembro de 2018 e maio de 2019, utilizando a técnica descrita. Resultados: A técnica demonstrada apresentou resultados estéticos satisfatórios em obter a aparência abdominal natural através da lipoaspiração profunda e superficial, em áreas de sombras abdominais. Conclusão: O trabalho demonstrou-se seguro sob o ponto de vista vascular, além de ser reprodutível ao passo que utiliza lipoaspiração convencional, utilizada pela ampla maioria dos cirurgiões plásticos.

Introduction: Abdominoplasty techniques have constantly evolved since 1899. With modern liposuction techniques, the concept of high-definition liposuction aims to correct stigmas secondary to the procedure, such as a "tense" appearance and lack of natural abdominal convexity and concavity. Methods: Here we propose a technique to redefine the natural abdominal anatomy using traditional lipoabdominoplasty with selective liposuction to achieve more natural-looking surgical results that are reproducible for most patients. This study included 21 abdominoplasty procedures using the described technique performed between November 2018 and May 2019. The technique showed satisfactory ability to achieve a natural abdominal appearance using deep and superficial liposuction in abdominal shadow areas. Conclusion: The study showed that the technique is safe from a vascular point of view and reproducible due to the use of conventional liposuction, which is available to the vast majority of plastic surgeons.

Avaliação eletromiográfica do exercício swan na Wunda Chair: Co-ativação dos músculos do core / Electromyographic evaluation of the swan exercise in the Wunda Chair: Co-activation of the core muscles

A principal finalidade do método Pilates é desenvolver uma automação dos músculos do core. Sendo assim, o objetivo deste estudo foi analisar a razão eletromiográfica dos músculos Oblíquo Interno (OI) e Reto do Abdômen (RA) localizados na parte anterior do tronco, a razão eletromiográfica dos músculos Multífido (MU) e Longuíssimo do Tórax (LO) localizados na parte posterior do tronco, e também a razão ântero-posterior (A/P=RA+IO/LO+MU) desses músculos durante o exercício swan do método Pilates, realizado sobre a Wunda Chair. Na comparação entre as três razões, foram encontradas diferenças estatísticas (p = 0,0103), apenas entre as razões ântero-posterior (A/P), e entre a razão dos músculos localizados na parte posterior do tronco (MU/LO). Os resultados demonstraram que houve um predomínio na atividade eletromiográfica dos músculos da região posterior em relação aos músculos da região anterior do tronco e que os músculos estabilizadores apresentaram maior atividade eletromiográfica em comparação com os músculos globais ou mobilizadores. O exercício swan pode ser utilizado como forma de treinamento para a musculatura do tronco, e como consequência gerar maior estabilidade a coluna vertebral, pois o exercício prioriza a diminuição da carga sobre a coluna vertebral. (AU)

The main purpose of the Pilates method is to develop an automation of core muscles. Thus, the aim of this study was to analyze the electromyographic ratio of the Internal Oblique (IO) and Rectus Abdominis (RA) muscles located in the anterior part of the trunk, the electromyographic ratio of the Multifidus (MU) and Longissimus Thoracis (LO) muscles, located in the posterior part of the trunk, and also the ratio antero- posterior (A/P=RA+IO/LO+MU) of these muscles during the swan exercise of the Pilates, performed on the Wunda Chair. In the comparison between the three ratios, statistical differences (p = 0.0013) were found only between the antero-posterior (A/P) ratios and the ratio of the muscles located in the posterior part of the trunk (MU/LO). The results showed a predominance of the electromyographic activity in the muscles of the posterior region in relation to the muscles of the anterior region of the trunk. The stabilizing muscles presented greater electromyographic activity in comparison to the global or mobilizing muscles. The swan can be used as training for the trunk muscles, and therefore generates greater stability of the spine, since exercise prioritizes the decrease of the load on the spine. (AU)

Rectus abdominis muscle flap for repair of the gastrojejunal leakage after distal gastrectomy with Billroth II anastomosis for gastric cancer / Colgajo del músculo recto abdominal para reparación de la dehiscencia gastroyeyunal luego de gastrectomía distal con anastomosis Billroth II por cáncer gástrico

Anastomotic leakages at the gastrojejunostomy site are difficult to repair, due to complex gastrointestinal anatomy. This is the first study reporting clinical use of rectus abdominis muscle (RAM) flap for repair of gastrojejunostomy leakage. A patient with leakage of gastrojejunostomy after distal gastrectomy with Billrroth II anastomosis for gastric cancer underwent repair using left RAM flap, based on superior epigastric artery. Rectus abdominis muscle flap, after being harvested was then anchored to the edges of the leak of gastrojejunostomy with few interrupted 2-0 vicryl sutures. Gastrojejunostomy leak sealed in the two cases. Rectus abdominis muscle flap for closure of gastrointestinal defect is a simple, technically easy and dependable procedure, which can be performed, quickly in critically ill patients. It can be used for repair of a large gastrointestinal defect with friable edges when omentum is not available or when other conventional methods are impractical.

Las dehiscencias anastomóticas en el sitio de gastroyeyunostomía son difíciles de reparar, debido a la compleja anatomía gastrointestinal. Este es el primer estudio que comunica el uso clínico del colgajo del músculo recto abdominal (MRA) para la reparación de la dehiscencia de gastroyeyunostomía. A un paciente con dehiscencia de gastroyeyunostomía, luego de una gastrectomía distal con anastomosis Billrroth II para cáncer gástrico, se le realizó una reparación utilizando colgajo izquierdo del MRA, basado en la arteria epigástrica superior. El colgajo del músculo recto abdominal, después de ser extraído, se fijó a los bordes de la dehiscencia de la gastroyeyunostomía con pocas suturas de vicryl 2-0 interrumpidas. La dehiscencia de la gastroyeyunostomía fue sellada. El colgajo del músculo reto abdominal para el cierre del defecto gastrointestinal es un procedimiento simple, técnicamente fácil y confiable, que puede realizarse rápidamente en pacientes críticamente enfermos. Se puede utilizar para la reparación de un gran defecto gastrointestinal con bordes friables cuando el omento no está disponible o cuando otros métodos convencionales no son prácticos.

Desempenho muscular respiratório após 12 sessões de treinamento utilizando o aparelho Reformer do método Pilates / Rendimiento muscular respiratorio después de 12 sesiones de entrenamiento utilizando el aparato Reformer del método Pilates / Respiratory muscle performance after 12 sessions of training using the apparatus Reformer of Pilates method

RESUMO Analisar o desempenho muscular respiratório em praticantes de exercícios utilizando o aparelho Reformer do Método Pilates após um treinamento de 12 sessões. O estudo foi realizado com 24 voluntárias, adultas jovens, saudáveis, não tabagistas e não praticantes de exercício físico regular, divididas em Grupo Controle (GC) e Grupo Treinado (GT). Os dois grupos foram submetidos às avaliações inicial e final para análise do desempenho dos músculos respiratórios por meio da manovacuometria e da eletromiografia do músculo reto abdominal. Utilizou-se o teste de Shapiro-Wilk para verificar a normalidade dos dados. A análise de variância two-way foi empregada para as comparações entre os grupos (GT e GC) e os momentos (inicial e final). Para comparações múltiplas, utilizou-se o teste post-hoc de Scheffé. Os GC e GT foram pareados para idade e IMC e, para verificação de diferenças entre os grupos, utilizou-se o teste t pareado. Considerou-se p<0,05 para significância. Houve diferença significante (p=0,039) entre os valores iniciais (116,6 ± 12,8) e finais (120 ± 12,8) de PImáx no GT, assim como entre os valores iniciais (75,3 ± 12,4) e finais (89,3 ± 13,7) de PEmáx nesse mesmo grupo (p=0,0005). Para a eletromiografia houve diferença significante (p=0,03) entre o momento inicial (42,1 ± 15,8) e final (76,7 ± 37,1) do GT para o músculo reto abdominal esquerdo. Conclui-se que as doze sessões de Pilates utilizando o aparelho Reformer melhoraram o desempenho muscular respiratório, aumentando a força da musculatura inspiratória e expiratória.

RESUMEN Evaluar el rendimiento de los músculos respiratorios en practicantes de ejercicios utilizando el método Reformer de Pilates después de un entrenamiento de 12 sesiones. Este estudio se realizó con 24 voluntarios, adultos jóvenes, sanos, no fumadores y no deportistas regulares, siendo divididos en grupo control (GC) y grupo entrenado (GE). El GE participó en un programa de entrenamiento ejecutando 6 ejercicios en el aparato Reformer. Ambos grupos se sometieron a evaluaciones iniciales y finales para analizar el rendimiento de los músculos respiratorios mediante la manovacuometría y la electromiografía del músculo recto abdominal. La prueba de Shapiro-Wilk se utilizó para verificar la normalidad de los datos. Se utilizó el análisis de varianza two-way para las comparaciones entre los grupos (GE y GC) y los momentos (inicial y final). Para comparaciones múltiples, se utilizó la prueba post-hoc de Scheffé. El GC y el GE se emparejaron por edad e IMC mediante la prueba t pareada. Se consideró el valor de significación p<0,05. Se observó una diferencia significativa (p=0,039) entre los valores iniciales (116,6 ± 12,8) y finales (120 ± 12,8) de PImax en el grupo entrenado, así como entre los valores de iniciales (75,3 ± 12,4) y finales (89,3 ± 13,7) de PEmax en el mismo grupo (p=0,0005). En la electromiografía, se observó una diferencia significativa (p=0,03) entre los momentos inicial (42,1 ± 15,8) y final (76,7 ± 37,1) del GE para el músculo recto abdominal izquierdo. Se concluye que las 12 sesiones de Pilates utilizando el aparato Reformer mejoran el rendimiento de los músculos respiratorios, aumentando la fuerza muscular inspiratoria y espiratoria.

ABSTRACT To analyze respiratory muscle performance in exercise practitioners using the Reformer of Pilates method after a 12-session training. This study was carried out with 24 volunteers, healthy young adults, non-smokers and non-regular exercisers, divided into control group (CG) and trained group (TG). The TG participated in a training program executing 6 exercises in the Reformer apparatus. Both groups were submitted to the initial and final evaluations to analyze the performance of the respiratory muscles through the manovacuometry and electromyography of the rectus abdominis muscle. The Shapiro-Wilk test was used to verify the data normality. Two-way analysis of variance was used for the comparisons between the groups (TG and CG) and moments (Initial and Final). For multiple comparisons, the Scheffé post hoc test was used. The groups Control and Trained were paired by age and BMI by paired t test. P <0.05 was considered for significance. A significant difference (p=0039) was observed between the initial (116.6 ± 12.8) and final (120 ± 12.8) values of MIP in the trained group, as well as between baseline values (75.3 ± 12.4) and final (89.3 ± 13.7) of MEP in the same group (p=0.0005). For electromyography, a significant difference (p=0.03) was observed between the initial (42.1 ± 15.8) and final (76.7 ± 37.1) moments of the TG for the left rectus abdominis muscle. The conclusion is that the 12 Pilates sessions using the Reformer apparatus improve respiratory muscle performance, increasing the inspiratory and expiratory muscle strength.

Tratamiento endoscópico subcutáneo de la diastasis de músculos rectos y de otros defectos de línea media / Subcutaneous endoscopic repair of diastasis recti and other midline defects

Antecedentes: la diastasis de rectos constituye la separación de la línea media o línea alba, originada en una laxitud de las fibras entrecruzadas de la aponeurosis de ambos músculos rectos. En la actualidad se discute su corrección quirúrgica, existiendo una multiplicidad de factores que lo justifican. Objetivo: analizar la factibilidad y la seguridad del abordaje endoscópico subcutáneo para efectuar la plicatura de músculos rectos, y la corrección de otros defectos de la línea media, en pacientes sin lipodistrofia abdominal. Material y métodos: entre marzo de 2014 y febrero de 2017 fueron abordados por esta vía 42 pacientes con diastasis asociada a otros defectos de línea media. Se analizaron datos demográficos, características de la diastasis, tamaño de los defectos, tiempo operatorio, estadía hospitalaria y complicaciones. El dolor posoperatorio se midió mediante una escala visual análoga, y se valoró la morbilidad y recurrencia mediante ultrasonografía. Resultados: 42 pacientes fueron intervenidos por vía endoscópica. Un 76% fueron de sexo femenino, con una edad promedio de 39 años. En el 93% de los casos, la diastasis fue supraumbilical e infraumbilical, y su tamaño promedio fue de 5,5 cm. Los defectos asociados en su mayoría fueron hernia umbilicales. No se registraron complicaciones intraoperatorias, con un tiempo quirúrgico promedio de 80 minutos. La intensidad de dolor posoperatorio fue de 4,1 puntos. La morbilidad más asociada fue el seroma. Conclusiones: la reparación endoscópica subcutánea de la diastasis de rectos, asociada a otros defectos de la línea media, es factible y segura de realizar. Aporta ventajas estéticas considerables, permitiendo su corrección con complicaciones mínimas.

Background: Diastasis recti is the separation of the midline or linea alba due to laxity of the intercrossed fibers of both aponeurosis of the rectus abdominis muscles. Although the surgical correction of this condition is still under debate, many factors justify it. Objective: The aim of this study was to analyze the feasibility and safety of the endoscopic subcutaneous approach for plication of the rectus muscles associated with other midline defects repair in patients without abdominal lipodystrophy. Material and methods: Between March 2014 and February 2017, 42 patients underwent subcutaneous endoscopic repair of diastasis recti and other midline defects. The demographic data, the characteristics and size of the defects, the surgical time, hospital stay and complications were analyzed. Postoperative pain was measured using a visual analogue scale. Ultrasound was used to evaluate morbidity and recurrence. Results: A total of 42 patients underwent the endoscopic approach; 76% were women and mean age was 39 years. In 93% of the cases, diastasis was supraumbilical and infraumbilical, with a mean size of 5.5 cm. Umbilical hernias were the most common associated defects. No intraoperative complications were reported. Mean surgical time was 80 minutes; the intensity of posoperative pain was 4.1 points and seroma was the most common complications. Conclusions: Subcutaneous endoscopic repair of diastasis recti and other midline defects is a feasible and safe procedure that allows the simultaneous correction of both conditions with minimal complications and esthetic benefits.

Fibrohistiocitoma maligno gigante de face: tratamento reparador microcirúrgico utilizando retalho miocutâneo transverso do reto do abdome - Relato de caso / Giant malignant fibrous histiocytoma of the face: case report of microsurgical repair using a transverse rectus abdominis myocutaneous flap

Introdução: A ressecção de tumores invasivos de cabeça e pescoço pode resultar em defeitos extensos e complexos exigindo reparação imediata. Uma das opções de reparação é a transferência, utilizando técnica de microcirurgia vascular, do retalho musculocutâneo do reto abdominal pediculado nos vasos epigástricos inferiores profundos (TRAM). O presente estudo tem como objetivo registrar um procedimento utilizado no tratamento reparador microcirúrgico de fibrohistiocitoma maligno gigante de face com retalho TRAM. Relato de Caso: Paciente procurou atendimento médico devido a lesão tumoral gigante em hemiface direita. Foi realizada a tomografia computadorizada do crânio revelando volumoso processo expansivo de aspecto vegetante com limites mal definidos. Após os procedimentos básicos no pré-operatório, realizou-se a exérese do tumor que acometia músculos masseter e temporal direito, glândula parótida, assoalho orbitário à direita e osso malar. Posteriormente, retirou-se o retalho microcirúrgico do músculo reto do abdome em conjunto com a artéria epigástrica inferior profunda através de incisão cirúrgica da área hipogástrica. Em seguida, dissecção da artéria e veia facial utilizando microscópio e anastomoses venosa e arterial. Quanto à evolução retalho apresentou-se íntegro, com boa perfusão, sem sinais de infecção. Conclusões: A reconstrução facial microcirúrgica oferece liberdade ao cirurgião de cabeça e pescoço para realizar grandes ressecções tumorais.

Introduction: The resection of invasive tumors of the head and neck can result in extensive and complex defects requiring immediate repair. One repair option is the transfer of a transverse rectus abdominis myocutaneous (TRAM) flap pedicled on deep inferior epigastric vessels using vascular microsurgery. This study aimed to register a procedure used in the microsurgical treatment of giant malignant fibrous histiocytoma of the face using a TRAM flap. Case Report: A male patient sought medical care for a giant tumoral lesion in the right hemiface. Computed tomography of the skull revealed a voluminous expansive process of vegetating aspect with poorly defined borders. The excision of the tumor affected the right masseter and temporalis muscles, parotid gland, and right orbital and malar bones. Subsequently, microsurgical withdrawal of the TRAM flap was performed with the deep inferior epigastric artery through a surgical incision in the hypogastric area. Dissection of the facial artery and vein under microscopy and venous and arterial anastomoses followed. The flap was intact with good perfusion and no signs of infection. Conclusions: Microsurgical facial reconstruction allows head and neck surgeons to resect large tumors.

Reconstrucción mamaria con colgajo musculocutáneo de recto abdominal con isla transversa de piel (TRAM): experiencia de 12 años en Hospital El Pino / Breast reconstruction with musculocutaneous flap of abdominal rectus with transverse skin island (TRAM): 12 years of experience at Hospital El Pino

Objetivos: Analizar los resultados de reconstrucción mamaria con colgajo musculocutáneo de recto abdominal con isla transversa de piel (TRAM) en el Servicio de Cirugía del Hospital El Pino. Materiales y Métodos: Estudio retrospectivo de pacientes sometidas a mastectomía por cáncer de mama y posterior reconstrucción con colgajo TRAM pediculado en los últimos 12 años (2005-2017). Resultados: Se realizaron 12 reconstrucciones mamarias, 6 fueron con colgajo TRAM pediculado. La mayoría de las pacientes recibieron tratamiento adyuvante con radioterapia (1 caso), quimioterapia (1 caso), quimioterapia + radioterapia (2 casos). El tiempo transcurrido entre la mastectomía y reconstrucción mamaria fue en promedio de 2,5 años. Se produjeron 4 complicaciones (66,7%) que necesitaron reintervención: hematoma posoperatorio precoz, infección y necrosis grasas de colgajo, dehiscencia de sutura abdominal, necrosis grasa + fibrosis de colgajo TRAM. La evaluación de los resultados fue subjetiva obteniéndose muy buenos resultados en el 66,7% de los casos. No hubo complicaciones en sitio donante. Discusión: El colgajo TRAM pediculado es el tejido autólogo más utilizado en reconstrucción mamaria. Su tasa de complicación es de 26% muy por debajo a lo obtenido en nuestra experiencia. Las principales complicaciones son fibrosis y necrosis grasa de colgajo, pérdida de colgajo, seroma e infección siendo la necrosis grasa la más frecuente en nuestra serie. El uso de colgajo TRAM otorga mayor satisfacción con apariencia, tamaño y sensación del seno. Debido a los resultados obtenidos creemos que el colgajo TRAM pediculado es una excelente alternativa de reconstrucción mamaria en nuestro hospital.

Objectives: To analyze the results of breast reconstruction with musculocutaneous flap of the rectus abdominis with transverse skin island (TRAM) in the Service of Surgery of El Pino Hospital. Materials and Methods: Retrospective study of patients undergoing mastectomy for breast cancer and subsequent reconstruction with pedicled TRAM flap in the last 12 years (2005-2017). Results: 12 mammary reconstructions were performed, 6 were with pedicled TRAM flap. The majority of patients received adjuvant treatment with radiotherapy (1 case), chemotherapy (1 case), chemotherapy + radiotherapy (2 cases). The time elapsed between the mastectomy and breast reconstruction was on average 2.5 years. There were 4 complications (66.7%) that required reintervention: early postoperative hematoma, infection and flap fat necrosis, abdominal suture dehiscence, fat necrosis + TRAM flap fibrosis. The evaluation of the results was subjective, obtaining very good results in 66.7% of the cases. There were no complications in the donor site. Discussion: The pedicled TRAM flap is the most used autologous tissue in breast reconstruction. Its complication rate is 26%, much lower than that obtained in our experience. The main complications are fibrosis and flap fat necrosis, flap loss, seroma and infection, with fat necrosis being the most frequent in our series. The use of TRAM flap gives greater satisfaction with appearance, size and sensation of the breast. Due to the results obtained, we believe that the pedicled TRAM flap is an excellent alternative for breast reconstruction in our hospital.

Patient satisfaction with breast reconstructionusing musculocutaneous flap from latissimus dorsiversus from rectus abdominis: a cross-sectional study

ABSTRACT BACKGROUND: Breast cancer is the second most frequent type of cancer worldwide and the most common type among women. The treatment for this condition has evolved over recent decades with therapeutic and technological advances. Breast reconstruction techniques using musculocutaneous flaps from the latissimus dorsi and rectus abdominis have aroused interest regarding patients' quality of life. Our goal here was to compare patients' satisfaction scores after they underwent breast reconstruction using musculocutaneous flaps from either the latissimus dorsi or the rectus abdominis. DESIGN AND SETTING: Primary, clinical, analytical, observational and cross-sectional study conducted in a federal university and a public hospital. METHODS: Demographic and clinical data were collected. The Mini-Mental State Examination was then applied, with testing for specificity and sensitivity. Lastly, a breast evaluation questionnaire was applied to evaluate breast satisfaction among 90 women, who were divided into three groups: mastectomy (control; n = 30); breast reconstruction using flap from the latissimus dorsi (n = 30); and reconstruction using flap from the rectus abdominis (n = 30). RESULTS: The groups were homogeneous regarding the main demographic data and the questionnaire responses (P < 0.05). Compared with the control group, the reconstruction groups showed significant improvement in satisfaction (P < 0.0002) after one year. CONCLUSION: Within our sample, women who underwent breast reconstruction with flaps from either the latissimus dorsi or the rectus abdominis had similar satisfaction scores.

Reconstrucción perineal con colgajo miocutáneo vertical de recto anterior del abdomen luego de amputación abdomino perineal extraelevador. Una alternativa factible para el cirujano colorrectal / Perineal reconstruction with vertical myocutaneous flap of the anterior rectus abdominis after extra-elevating perineal abdominal amputation. A feasible alternative for the colorectal surgeon

Las complicaciones perienales luego de la amputación abdominoperineal son frecuentes y clínicamente relevantes en términos de estadía hospitalaria, costos, calidad de vida y los resultados oncológicos. La utilización creciente de radioterapia pre operatoria y la incorporación gradual a la técnica extra-elevador, ha llevado a un aumento en la morbilidad perineal. Es por elloque la búsqueda de una técnica confiable y con buenos resultados para el cierre perineal se hace necesaria. Se han publicado muchas series que describen diferentes técnicas de cierre del defecto perineal, pero faltan estudios clínicos de alta calidad que indiquen cuál es la mejor opción. Cuando la proctectomía resulta en un amplio defecto perineal, el colgajo vertical del recto del abdomen parece ser la mejor opción. Presentamos dos casos de tumores anorectales localmente avanzados en los que se realizó una amputación abdominoperineal extraelevador con posterior reconstrucción perineal con colgajo de recto anterior y, a su vez, describimos la técnica quirúrgica. (AU)

Perineal complications after abdominoperineal amputation are frequent and clinically relevant in terms of hospital stay, costs, quality of life and oncological results. The growing utilization of pre-operative radiotherapy and the gradual incorporation to the extra-elevator technique, has leaded to an increase in perineal morbidity. That is why the search for a reliable technique with good postoerative outcomes for the perineal closure is necessary. Many series describing different closure techniques of the perineal defect have been published, but high quality clinical studies have to indicate which the best option is. When the proctectomy results in a wide perineal defect, the vertical rectus abdominis flap seems to be the best option. We presented two cases of locally advanced anorectal tumors in which an extraelevatory abdominoperineal amputation was carried out with posterior perineal reconstruction with vertical rectus abdomins flap and we described the surgical technique. (AU)

Colgajo de recto anterior del abdomen para el tratamiento de los defectos de cobertura lumbosacros / Rectus abdominis flap for the treatment of lumbosacral coverage defects

Introducción: El principio de tratamiento de los defectos de cobertura lumbosacros se basa en el manejo del espacio muerto y la cobertura del defecto. El objetivo de este estudio es presentar la técnica quirúrgica, los resultados y las complicaciones de una serie de pacientes tratados con colgajo de recto anterior para defecto lumbosacro. Materiales y Métodos: Se efectuó una revisión retrospectiva durante un período de seis años. Se analizaron variables demográficas preoperatorias. Se describen la técnica quirúrgica y las complicaciones intraoperatorias. Se analizaron las variables posoperatorias, como complicaciones del sitio donante, complicaciones del sitio receptor y duración del colgajo. Resultados: Cinco pacientes cumplieron con los criterios de inclusión (edad promedio 50 años): cuatro con tumor sacro y una paciente con osteomielitis lumbosacra. El seguimiento promedio fue de 20 meses. El tamaño promedio de la pastilla cutánea fue de 8 x 13 cm. Entre las complicaciones, se registró una lesión del pedículo intraoperatoria (reparación microquirúrgica) y el óbito de un paciente. Se evidenció una infección con dehiscencia de la herida como complicación posoperatoria. No hubo complicaciones vasculares posoperatorias en los colgajos y todos permanecieron vitales durante el seguimiento. Conclusión: El colgajo de recto anterior ha de ser considerado una opción válida en el tratamiento de heridas con grandes defectos de partes blandas a nivel lumbosacro. Provee de suficiente volumen de piel y tejido muscular para la cobertura de dichos defectos. La técnica es relativamente sencilla sin necesidad de procedimiento microquirúrgico. Nivel de Evidencia: IV

Introduction: Treatment of soft tissue lumbosacral defects is based on dead space management and defect coverage. The aim of this study is to describe the surgical technique, results and complications of patients who underwent rectus abdominis flap for lumbosacral defects coverage. Methods: A six-year retrospective review was performed. Demographic characteristics are analyzed. Surgical technique and intra-operative complications are described. Postoperative variables, such as donor site complications, recipient site complications, and flap survival were also reported. Results: Five patients met the inclusion criteria (average age, 50 years). Four patients presented sacral tumor diagnosis and one patient had lumbosacral osteomyelitis. Mean follow-up was 20 months. Flap average size was 8 x 13 cm. Intraoperative complications were one pedicle injury (microsurgical repair) and the death of a patient. Regarding postoperative complications, one wound dehiscence was reported. None of the flaps suffered vascular complications and all remained vital throughout follow-up. Conclusion: Rectus abdominis flap should be considered a valid option in the management of large soft tissue lumbosacral defects. This flap provides sufficient skin volume and muscular tissue. Surgical technique is relatively simple with no need for microsurgical procedure. Level of Evidence: IV

Hematoma de la vaina de los rectos en un recién nacido macrosómico después de un parto distócico: A propósito de un caso / Rectus sheath hematoma in a macrosomie neonate following difficult delivery: Case report

La macrosomía es un factor de riesgo de traumatismos obstétricos y se asocia con morbimortalidad neonatal. El cefalohematoma y la fractura clavicular son los más frecuentes. Los traumatismos intrabdominales son poco frecuentes. El hematoma de la vaina de los rectos es una acumulación de sangre en la vaina del músculo recto mayor del abdomen. Se asocia con traumatismos, cirugías y tratamiento anticoagulante, en especial en los adultos y las personas de edad avanzada. En este artículo presentamos el caso de un recién nacido de sexo masculino con parto vaginal distócico. Durante el examen físico se observó un hematoma periumbilical de 1 x 1 cm y un cefalohematoma parietal de 1 x 1 cm. En la ecografía abdominal y la tomografía computada del abdomen se observó un hematoma de la vaina del recto derecho de 7 x 4 x 2 cm.

Macrosomia is a risk factor for birth injuries and is associated with neonatal morbidity and mortality. Cephalohematoma and clavicular fracture are the most frequent birth injuries. Intraabdominal injuries are uncommon birth injuries. Rectus sheath hematoma (RSH) is an accumulation of blood in the sheath of rectus abdominis muscle. It is associated with trauma, operations and anticoagulant therapy, especially in adults and elders. We present a macrosomic male neonate with difficult vaginal delivery, who had in the physical examination periumblical ecchymose of 1x1 cm and a parietal cephalohametoma of 1x1 cm. The abdominal ultrasonogram and the computed tomography scan of the abdomen showed a 7x4x2 cm right rectus sheath hematoma.

Glucose level evaluation in monopedicled rectus abdominis myocutaneous flap after venous occlusion: experimental study in rats / Avaliação do nível glicêmico em retalho miocutâneo do reto abdominal monopediculado após oclusão venosa: estudo experimental em ratos

ABSTRACT Objective: to validate an experimental model for the measurement of glycemic levels in surgical flaps with the use of common glucometers, and to analyze the diagnostic criteria for hypoperfusion of such flaps. Methods: we performed vertical myocutaneous rectus abdominis flaps with upper pedicles bilaterally in 20 male Wistar rats, divided into two groups: with and without venous occlusion of the pedicle. We measured glucose levels in the flaps and in the systemic circulation with standard glucometers. We tested the accuracy of alternative diagnostic criteria for the detection of hypoperfusion. Results: from 15 minutes of venous occlusion on, there was a significant reduction in glucose levels measured in the congested flap (p<0.001). Using a minimum difference of 20mg/dl in the glycemic levels between the flap and systemic blood, 30 minutes after occlusion, as a diagnostic criterion, the sensitivity was 100% (95% CI 83.99-100%) and specificity of 90% (95% CI 69.90-97.21%) for the diagnosis of flap congestion. Conclusion: It is possible to measure glucose levels in vertical myocutaneous rectus abdominis flaps of Wistar rats, perfused or congested, using a common glucometer. The diagnostic criteria that compare the glucose levels in the flaps with the systemic ones were more accurate in the evaluation of tissue perfusion.

RESUMO Objetivo: validar um modelo experimental para mensuração de níveis glicêmicos em retalhos cirúrgicos com a utilização de glicosímetros comuns, e analisar os critérios diagnósticos para hipoperfusão destes retalhos. Métodos: foram realizados retalhos miocutâneos verticais de reto abdominal com pedículos superiores, bilateralmente, em 20 ratos Wistar machos, divididos em dois grupos: com e sem oclusão venosa do pedículo. Os níveis de glicose foram mensurados nos retalhos e na circulação sistêmica com glicosímetros comuns. A acurácia de critérios diagnósticos alternativos foi testada para a detecção de hipoperfusão. Resultados: a partir de 15 minutos de oclusão venosa, houve uma redução significativa dos níveis de glicose medidos no retalho congesto (p<0,001). Utilizando como critério diagnóstico uma diferença mínima de 20mg/dl nos níveis glicêmicos do retalho e do sangue sistêmico, 30 minutos após a oclusão, a sensibilidade foi de 100% (intervalo de confiança de 95% - 83,99 a 100%) e especificidade de 90% (intervalo de confiança de 95% - 69,90 a 97,21%) para o diagnóstico de congestão do retalho. Conclusão: os resultados demonstraram que é possível medir níveis de glicose em retalhos miocutâneos verticais de reto abdominal de ratos Wistar, perfundidos ou congestos, utilizando um glicosímetro comum. Os critérios diagnósticos que comparam os níveis de glicose nos retalhos com os níveis sistêmicos foram mais precisos na avaliação da perfusão tecidual.