Effect of hyperbaric oxygen on the regeneration of experimental crush injuries of nerves.

Hyperbaric oxygen has been successfully used on treatment of acute ischemic injuries involving soft tissues and chronic injuries. In nerve crush injuries, the mechanisms involved are very similar to those found in ischemic injuries. Consequently, it is logical to hypothesize that hyperbaric oxygen should improve nerve repair, which is a critical step on functional recovery. In the present study, we created standard nerve crush injuries on sciatic nerves of rats, which underwent treatment with hyperbaric oxygen. Results were assessed by functional evaluation using walking-track analysis. The functional recovery indexes observed did not differ from control group. We concluded that hyperbaric oxygen therapy, in the schedule used, had no influence on functional recovery after nerve crush injuries.

[Electrical burns of the upper limbs]. / Queimaduras elétricas dos membros superiores.

During a period of 27 months, between 1991 and 1993, 15 patients with upper limb lesions caused by electrical hazards were admitted in the Burn Emergency Service of the Hospital das Clinicas-FMUSP. This lesion is usually a dramatic condition and requires a sound physiopathologic knowledge by the surgeon. These accidents may have permanent incapacitating sequelae, and due to long periods of treatment (2 months), social-economic costs are very high. Based on our experience, we suggest a less aggressive approach (no amputation at emergency), and a close continuous surveillance.

[Microsurgical reimplantation of scalp: case report]. / Reimplante microcirúrgico de couro cabeludo: relato de caso.

With the introduction of modern techniques in plastic surgery, severe injuries concerning the extremities and scalp are now amenable to surgical treatment. Successful reimplantation of the scalp either total or partial have been rarely reported in the literature. We treated a patient with avulsion affecting 2/3 of the scalp, the right ear and a cutaneous flap on right side of the face. We report here the initial care and operative procedure. The avulsed scalp was revascularized through microanastomoses of the temporal artery and vein. The reimplantation was well succeed and cosmetic results were satisfactory.

[Reduction mammoplasty with shortened scars: surgical technique]. / Mastoplastia redutora com cicatrizes reduzidas: técnica cirúrgica.

Reduction mammaplasty is nowadays one of the most frequently performed plastic surgeries. The main purpose is the reduction of the volume of breasts, but the resulting scars can jeopardize the result of the operation. The Division of Plastic Surgery follows the modern tendency of reducing the length of the incisions and thus the resulting scars. A technique that incorporates this principle was developed with good results. The technique is simple enough to be used in a training program.

[Surgical anatomy of the sural nerve]. / Anatomia cirúrgica do nervo sural.

The sural nerve is generally used as a graft in nervous reconstructions due to its easy access and minimal sequelae after its withdrawal. Although this nerve presents a constancy in its topographical localization, anatomical variations are frequent. Thus, trying to determine the formation pattern of the sural nerve complex, 38 legs from 19 cadaveres were dissected. The data obtained differ from those of the literature as to the frequency of the occurrence of the two classically known patter (pattern I and II). Besides, it was possible to identify two other paterns (pattern III and IV) of the sural nerve formation not yet described The cutaneous nerve and the comunicating peroneal nerve were found in 21% of the cases. In the literature, the frequency is of 65.8% to 80%. Pattern II, where the sural nerve is originated from the medial sural cutaneous nerve, was identified in 52.6% of cases, while in the literature its frequency is of 20 to 34.2%. Pattern III, not yet described in the literature, had the sural nerve coming from the junction between the medial sural cutaneous nerve and the lateral sural cutaneous one, with a frequency of 21% of the cases. Pattern IV, also not yet described in the literature, had the sural nerve originated from the common fibular nerve in 5.2% of patients. It was also possible to identify in the sample the presence of the lateral sural cutaneous nerve (branch of the common fibular nerve) and of the peroneal communicating nerve (branch of the lateral sural cutaneous nerve) with anatomical characteristics indicating them as an alternative source of nerve grafts.

[Preoperative psychological evaluation of patients undergoing rhytidoplasty]. / Avaliação psicológica pré-operatória de pacientes sumetidas a ritidoplastia.

In order to evaluate the dynamics of personality in a group of women submitted to surgical treatment of the aging face. The purpose of the study was to find out the motivation and expectations regarding the surgery. Twenty-eight women, with the overage age of 49 years, were studied. The method used included questionnaire, the tests Drawings of Figure Human and Crown-Crisp Experiential Index. Twenty-two of the patients answered that the personal satisfaction the mais purpose the operation. They also believed that the plastic surgery would lead to a better professional and social activity. The patients wanted to have a good feminime and youthful appearance. The results of the Crown-Crisp were significant for obsessionality, somatic anxiety and hysteria and non significant for free-floting anxiety, phobic anxiety and depression.

[Skin aging and collagen]. / Envelhecimento da pele e colágeno.

The Aging process is a dynamic and unchangeable phenomenon which affects all systems in the body. In the skin, the old appearance is represented by wrinkles and sagging and results from structural alterations on the molecular level. Modifications in collagen, the most important protein of the connective tissue, era responsible for these anatomic changes. The investigation of the qualitative and quantitative distribution of the collagen fibrils has been very useful for understanding the structural and functional alterations that occur during the aging process. The modulation of this phenomenon will only be possible if we understand its physiopathology.

Results of reconstruction of the facial nerve.

The results of surgical treatment for facial paralysis are still difficult to compare as there is no universal scoring method. The purpose of this communication is to review the results of reconstruction of the extratemporal facial nerve with nerve grafts using our own evaluation system. Fifty-nine patients were operated on during the period 1981-1991. They had lacerations or other trauma to the face which resulted in loss of continuity of the facial nerve or branches. Three groups were considered: (a) 12 patients had injuries involving the trunk and extending up to the main branches of the facial nerve; (b) 32 patients had parotid laceration or contusion on the parotid area with resulting nerve defects extending from a main branch up to distal branches; and (c) 15 patients had injuries on the distal branches: frontal, zygomatic, or mandibular. The sural nerve was used as the graft in all instances. The grafting procedure was performed from three weeks to six months after the trauma. The method of evaluation compares the normal with the paralyzed side. A score is given of 0 (no motion), 1 (weak motion), or 2 (strong motion), for each of six voluntary contractions: forehead, closure of eyelids and lips, traction, elevation, and depression of the lips. The assessment of involuntary mimic actions was done while observing blinking, speaking, smiling, and laughing. Mass movements were scored negatively. The numbers were recorded and the ratio between the paralyzed and normal side gave an estimate of the lack of symmetry.(ABSTRACT TRUNCATED AT 250 WORDS)

[The treatment of residual exophthalmos by resection of the orbital fat]. / Tratamento do exoftalmo residual pela ressecção de gordura orbitária.

The possibility of treatment of endocrine exophthalmos by resection of orbital fat has been discussed by Olivari. The orbital fat is located in two spaces: the outer space which surrounds the extraocular muscles the anterior extensions of which form the palpebral bags, and the inner space which surrounds the optic nerve, being crossed by the oculomotor, abducens and trochlear nerves. The surgical anatomy of orbital fat is discussed and the preliminary results of the resection of orbital fat for treatment of the residual exophthalmos are presented.

[The correction of cryptotia with tissue expanders]. / Correção de criptotia com expansores de tecidos.

Cryptotia is a congenital abnormality represented by the absence of the retroauricular sulcus in its superior portion. As the physiopathology of the problem involves the lack of skin tissue in the superior part of the ear sulcus, Mulliken suggested for the first time in 1988, the use of skin expanders as a method to obtain the extra skin necessary to correct this deformity. We bring forward our experience in the use of skin expanders in the treatment of three patients with cryptotia, bilateral in one of them. The technical aspects of the operations as well as the types of expanders used are described in detail. In all cases the correction of the cartilagenous deformities, freeing of the superior pole of the ear and redefinition of the retroauricular sulcus were performed. There were no significant complications. There was no change of the initial good results after a two years follow-up.

[The personality and motivational aspects of patients for mastoplasty]. / Aspectos de personalidade e motivações de pacientes para mastoplastia.

Among the conscious or unconscious reasons that lead a woman to ask for an esthetic procedure are the need to improve his self-appreciation and the desire to receive more love and approval from other people. We have found no article in the Brazilian literature regarding the psychological aspects of patients submitted to mastoplasty. Fifty-three patients awaiting mastoplasty were studied in the period between September 1990 and january 1992 as for their motivation, as well as for characteristics of their personality. The method used included an interview and tests of "Human being figure drawn" and "Crown-Crisp Experimental Index (CCEI)". The results of the interview and the "Human being Figure Drawn" showed that the majority of the patients was young, without children or with only one child. They were determined, self-centered, with some difficulties, related to their sexuality and sociality.

[The early correction of the hand deformities in Apert's syndrome. A preliminary report]. / Correção precoce das deformidades das mãos na sindrome de Apert. Communicação preliminar.

The correction of cranial and limb malformations of the Apert's syndrome requires efforts of a multidisciplinary team. The esthetic and functional repercussions that this syndrome brings to their carriers are severe and so the treatment should aim tom improve the function of the hands in order to integrate these patients in a more normal social live. In our Service, in the period from 1989 to 1992 five patients carrying this syndrome had their hand correction completed before the age of three years. It was observed that surgery was possible in this early stage with no additional complication rate. Quadrangular flaps for the neocomissure and for the coverage of the fingers were successfully used even with skeletal deviations. There was improvement of the esthetics of the hands, but their function could not be evaluated properly. Anyway, because of complex abnormalities the results will never be perfect. The early treatment of these alterations allows the gain of a better hand function and moreover accelerates the physical and intellectual development of the children.

Uso de expansores de tecido no couro cabeludo / Use of tissue expanders on the scalp

Com o advento dos expansores de tecidos surgiu uma nova opçao no tratamento da alopecia pela expansao do couro cabeludo adjacente ao defeito, evitando-se desvantagens das tecnicas anteriormente utilizadas, tais como, sequelas nas areas doadoras e deficiencia na densidade de foliculos pilosos na area reparada. Apresentamos a experiencia do grupo no tratamento de 32 pacientes portadores de alopecia com a utilizacao de expansores de tecido. As areas de alopecia variaram entre 30 e 150 cm quadrados. As patologias consistiram de 12 sequelas de queimadura, dez sequelas de trauma, dez sequelas de resseccao tumoral, quatro nevus pilosos gigantes e dois casos de calvice (padrao masculino). Em todos os casos foi possivel a remocao da area da alopecia e substituicao por couro cabeludo com pilificacao normal, sem sequelas nas areas doadoras. Como desvantagem citamos a necessidade de dois procedimentos cirurgicos e o periodo de dois a quatro meses de expansoes semanais, durante o qual ocorre deformidade evidente do segmento cefalico.

Retalhos livres para grandes reconstrucoes pos-resseccoes tumorais em cabeca e pescoco / Free flaps for great reconstructions post tumoral resections in the head and neck

Os resultados de 21 pacientes submetidos a 22 reconstrucoes na cabeca e pescoco com retalhos microcirurgicos foram analisados. Todas as cirurgias foram motivadas por resseccoes de tumores com invasao da dura-mater. Em cinco pacientes foi usado o musculo grande dorsal, em 14, o musculo reto abdominal, em dois, o grande omento e em um, o retalho para-escapular. Houve 83 por cento de sucesso na transferencia microcirurgica. Tres retalhos foram perdidos devido a trombose arterial, sendo que dois ocorreram no mesmo paciente. Em um caso houve infeccao e deiscencia da area receptora.

Tratamento de perdas de substancia ossea da regiao frontal com enxerto autogeno de tabua externa / Treatment of losses of bone substance of the frontal region with autogenic graft of outer table

Foram operados dez pacientes com perda de substancia na regiao frontal utilizando-se enxerto de tabua externa da regiao parietal, obtidos sem craniotomia. Em todos os casos foi restaurado o contorno da regiao frontal, sem sequela na area doadora. Os resultados avaliados clinica e radiologicamente mantiveram-se no acompanhamento de um ano. A utilizacao do enxerto de tabua externa da regiao parietal permite correcao dos defeitos da regiao frontal, com bons resultados esteticos. A morbidade na area e menor que na regiao da crista iliaca e ha menor reabsorcao ossea do enxerto.

Associacao de labio duplo congenito superior e inferior / Association of upper and lower congenital double lip

O labio duplo congenito e deformidade pouco relatada na literatura, nao ha registro da associacao de labio duplo congenito bilabial. Consiste de prega mucosa localizada na borda livre do labio que e salientada a abertura da boca e ao sorriso. Histologicamente apresenta glandulas salivares mucosas de aspecto hipertrofico ou normal, com pouco tecido conjuntivo, recoberto por epitelio cornificado. Nao ha musculo. Apresentamos o relato de dois casos de associacao de labio duplo congenito bilabial tratados cirurgicamente pela resseccao em elipse das pregas mucosas com resultado estetico e funcional satisfatorio.

Indicacoes inadequadas para o uso de proteses mamarias: tratamento das complicacoes / Inadequate indications for the use of mammary prosthesis: treatment of complications

O aumento do volume mamario para tratamento das hipomastias, assimetrias mamarias ou para repor volume de tecidos retirados cirurgicamente, e um problema que frequentemente traz dificuldades ao cirurgiao plastico. Nestes 28 anos de utilizacao das proteses de Cronin, surgiram algumas questoes sobre as indicacoes das proteses mamarias. Apresenta-se uma serie de dez doentes insatisfeitos com o resultado estetico obtido pela inclusao de proteses mamarias, devido a ptose, retracao capsular, assimetria e mastodinia. O tratamento constitui na retirada da protese e reconstrucao com retalhos dermo-gorduroso-glandulares locais. Em dois casos foi associada a reducao do volume mamario. Em todos os casos obtiveram-se bons resultados esteticos e remissao dos sintomas dolorosos.

Emprego do retalho da arteria interossea posterior na reparacao do antebraco e mao / Use of posterior interosseus artery flap in the forearm and hand

A arteria interossea posterior irriga a pele da face dorsal do antebraco atraves de arterias septo-cutaneas. O retalho fascio-cutaneo com pediculo distal pode ser usado para reparacoes do antebraco e mao, pois promove cobertura cutanea de boa qualidade e baixa morbidade da area doadora. O emprego da expansao previa do retalho permitiu a ampliacao de suas indicacoes e o fechamento borda a borda da area doadora sem uso de enxerto de pele.

Tratamento cirurgico da hidradenite supurativa / Surgical treatment of hidradenitis suppurativa

A hidradenite supurativa e uma doenca cutanea de evolucao cronica e localizacao peculiar, intimamente relacionada a presenca de glandulas sudoriparas do tipo apocrino. Resulta de obstrucao dos foliculos glandulares com subsequente rotura e infeccao local. Apresenta progressiva evolucao se nao tratada adequadamente, incorrendo em acentuada morbidade. Devido a escassez de relatos semelhantes, o tratamento da hidradenite permanece assunto controverso, nao havendo ate o momento, normatizacao das condutas a serem empregadas em tais casos. O presente estudo visou a analise da eficacia das medidas terapeuticas empregadas em 32 casos de pacientes que necessitaram de internacao no HCFMUSP, no periodo de 1985 a 1990. Com relacao a localizacao, 75 por cento dos pacientes possuiam lesoes perianais, seguida por incidencia similar de lesoes axilares e inguinoperineais em cerca de 40 por cento dos casos. Utilizando-se os indices de recidiva e evolucao morbida da doenca, pode-se verificar a eficiencia dos metodos terapeuticos. Tendo em vista a necessidade de intervencao com resultados mais imediatos e eficazes, o tratamento cirurgico constitui-se na melhor opcao.

[Free flaps for large reconstructions following tumoral resections in the head and neck]. / Retalhos livres para grandes reconstruções pós-ressecções tumorais em cabeça e pescoço.

The treatment of 21 patients who had cranio-facial reconstructions for extensive malignancies is reviewed. Microsurgical flaps obtained from latissimus dorsi, rectus abdominis, greater omentum and para-scapular regions were used. Good results were obtained in 86% of cases. Three flaps were lost in this series due to thrombosis of the microvascular anastomoses. Donor site morbidity occurred in only one case in which a dehiscence required a re-suture.