Submerged vascular anastomosis. A technique for vascular suturing in experimental microsurgery

ABSTRACT Purpose: To evaluate the impact of submersion of the microsurgical anastomosis suture area using saline (0.9% NaCl) in an experimental laboratory during the training of medical students and resident physicians. Methods: Wistar rats (n = 10) were selected to have the two femoral arteries sectioned and anastomosed end-to-end under optical magnification. They were randomly divided, so that on one side suturing was performed under submersion with saline, and the contralateral side was kept dry during the procedure. The surgical times, as well as the patency within 30 min and 72 h of the procedure, were evaluated. Results: Six male Wistar rats survived the surgical anesthetic procedure, with the average initial weight of 243.3 g and the average artery diameter of 0.86 mm, with average time of 15.67 min for the submerged technique and 20.50 min for the dry technique (p = 0.03). The failure rates were 17 and 50% for the submerged group and the dry one, respectively (p = 0.62). Conclusions: Submerged microvascular suture does not compromise the patency of the vessel or increase the time of anastomosis. Therefore, it is a strategy that can be applied by the surgeon according to his/her technical preferences.

Analysis of effect isoxsuprine hydrochloride and nicotine in the Transverse Rectus Abdominis Myocutaneous flap (TRAM) in rats

PURPOSE: To evaluate the effects of isoxsuprine and nicotine on TRAM. METHODS: Forty eight 48 Wistar rats distributed into four Groups (n=12). All rats received medication managed daily for 20 days: saline solution (SA), nicotine solution (NI), isoxsuprine solution (IS) and nicotine solution (NI) + isoxsuprine solution (IS). On day 21st the rats were submitted to the caudally based, right unipedicled TRAM flap and after 48 hours, made the macroscopic evaluation of the surface of the flap, photographic documentation and collection of material for histology. Data from macroscopic evaluation were analyzed by ANOVA and microscopic evaluation by Kruskal-Wallis test, with significance level of 5%. RESULTS: In the macroscopic evaluation of isoxsuprine Group retail presented absolute numbers: final area (p=0.001*) and viable area (p=0.006*) with the highest values; necrosis (p=0.001*) had the lowest value. Microscopic examination revealed no significant findings in the study of TRAM under the action of isoxsuprine and nicotine to the percentage of necrosis in the left and right cranial and caudal regions. CONCLUSIONS: There was significant improvement in viability of TRAM using the isoxsuprine solution alone. No influence using nicotine alone and in association with isoxsuprine.(AU)

Evaluation of fecal microorganisms of children with cleft palate before and after palatoplasty

This study isolated and quantified intestinal bacteria of children with cleft palate before and after palatoplasty. A prospective study was conducted from May 2007 to September 2008 on 18 children with cleft palate, aged one to four years, of both genders, attending a tertiary cleft center in Brazil for palatoplasty, to analyze the effect of surgical palate repair on the concentration of anaerobes Bacteroides sp, Bifidobacterium sp and microaerophiles Lactobacillus sp in feces of infants with cleft palate before and 24 hours after treatment with cefazolin for palatoplasty. There was significant reduction of Lactobacillus sp (p < 0.002), Bacteroides sp (p < 0.001) and Bifidobacterium sp (p = 0.021) after palatoplasty, revealing that surgery and utilization of cefazolin significantly influenced the fecal microbiota comparing collections before and after surgery. However, due to study limitations, it was not possible to conclude that other isolated factors, such as surgical stress, anesthetics and other medications used in palatoplasty might have a significant influence on the microbiota. Considering the important participation of the intestinal microbiota on both local and systemic metabolic and immunological activities of the host, professionals should be attentive to the possible influence of these changes in patients submitted to cleft repair.(AU)

Oncoplastic approach in the conservative treatment of breast cancer: analysis of costs / Abordagem oncoplástica no tratamento conservador do câncer mamário: análise de custos

PURPOSE: To analyze the direct costs of conservative surgical treatment of breast cancer, performed in a university hospital, to the Brazilian National Health Care Public System (SUS), checking the impact of the oncoplastic approach on these costs. METHODS: One hundred thirty eight breast cancer patients who had undergone conservative treatment with oncoplastic approach (n=36) or not (control group, n=102), in the period from 2005 to 2010, were enrolled. Sociodemographic and clinical data were recorded. The direct costs of the surgical procedure were obtained and analyzed. RESULTS: Groups did not differ in regard to age (p=0.963), and patients in oncoplastic group had a longer time of hospital stay (p=0.000). The median direct cost for the oncoplastic group was R$461.00 and for the control group was R$229.00 (p=0.000). CONCLUSION: The oncoplastic approach has generated higher direct costs in conservative surgical treatment of breast cancer to SUS.(AU)

OBJETIVO: Analisar os custos diretos do tratamento cirúrgico conservador do câncer mamário, realizado pelo Sistema Único de Saúde (SUS) em um hospital universitário, verificando o impacto da abordagem oncoplástica sobre estes custos. MÉTODOS: Foram incluídas 138 pacientes submetidas ao tratamento conservador do câncer mamário pelo SUS, com abordagem oncoplástica (n=36) ou não (grupo controle, n=102), no período de 2005 a 2010. Foram registrados dados sócio-demográficos e da operação. Os custos diretos do procedimento cirúrgico foram obtidos e analisados. RESULTADOS: Não houve diferença entre os grupos quanto à idade (p=0.963), e o tempo de internação hospitalar foi maior no grupo oncoplástica (p=0,000). A mediana dos custos diretos do grupo oncoplástica foi de R$461,00 e do grupo controle foi de R$229,00 (p=0,000). CONCLUSÃO: A abordagem oncoplástica gerou custos diretos maiores para o tratamento cirúrgico conservador do câncer mamário pelo SUS.(AU)

Effects of uterine cervix constriction on Wistar rats / Efeitos da constrição do cérvix uterino em ratos Wistar

PURPOSE: To verify if uterine cerclage can induce craniosynostosis or any cranial deformity in new born Wistar rats. METHODS: One pregnant female Wistar rat underwent laparotomy on day 18 of gestation and the uterus cervix was closed with a 3-0 nylon suture to avoid delivery, that occurs normally on the 21 day. The suture was released after 48 hours beyond the normal gestation period. The female rat delivered 11 pups. Six surviving rats from the delivery (group A - constrained group). Two rats were born from another mother and in the same age were used as control group (group B - 2 nonconstrained controls) were allowed to grow. They were sacrificed 1.2 years after their birth all the eight animals. Linear measurement, routine histology and computed tomography of the skull were performed at the time of their death to evaluate the cranial asymmetries by mesurements of the anatomical landmarks of the craniofacial skeleton of the rats on the two groups and compared then. RESULTS: We did not observe statistically significant differences in any of the compared measurements (p>0.05) obtained through the morphologic and radiologic methods. Histologic examinations did not reveal any sign of premature fusion or suture imbrications. Critical decrease in longitudinal body size was noticed as the limbs too in all the animals of group A. CONCLUSION: Constriction of uterine cervix leads to fetus suffering, even death for a few animals, associated to small body size, but not to craniosynostosis.(AU)

OBJETIVO: Verificar se a cerclagem intra-uterina pode induzir, ao nascimento de ratos Wistar, craniossinostose ou qualquer outra deformidade craniana. MÉTODOS: Uma rata Wistar prenhe foi submetida à laparotomia no 18º dia de gestação e o cérvix uterino foi suturado com 3-0 nylon, impedindo o parto normal que normalmente ocorre no 21º dia de gestação. A sutura foi liberada 48 horas após o período gestacional normal. A rata gestante deu à luz 11 animais. Seis ratos sobreviveram ao parto (grupo A com restrição). Dois ratos nascidos de outra mãe e com a mesma idade foram utilizados como controle (grupo B sem restrição controle) durante o seu crescimento. Os oito animais foram sacrificados após 1,2 ano. Medidas lineares, histologia e tomografia computadorizada foram utilizadas para a aferição de assimetrias cranianas através da mensuração de pontos anatômicos do esqueleto craniofacial dos ratos dos dois grupos. RESULTADOS: Não foi observada diferença estatisticamente significante entre as medidas obtidas nos ratos dos dois grupos (p>0,05) obtidas através de métodos morfológicos e radiológicos. As análises histológicas não revelaram sinais de fusão prematura da suturas do crânio. Diminuição do segmento corpóreo, bem como do tamanho dos membros foi evidenciado em todos os animais do grupo A. CONCLUSÃO: A restrição do cérvix uterino levou ao sofrimento fetal, morte de alguns animais e diminuição do tamanho do corpo de todos os animais, mas não craniossinostose.(AU)

Nicotine on rat TRAM flap / Nicotina em retalho TRAM em ratos

PURPOSE: The transverse rectus abdominis myocutaneous (TRAM) flap is one of the preferential techniques used in breast reconstruction following mastectomy. Nicotine has a detrimental effect on cutaneous flap survival; although there are no experimental studies proving this effect on musculocutaneous flaps. The aim of this study is to verify the effect of nicotine on the rat TRAM flap. METHODS: 30 Wistar EPM-1 rats were randomly distributed in two groups: control and experimental. The animals of the control group received saline solution injected subcutaneously, in a volume of 0.2 ml, twice a day, during 28 days in the preoperative period. The animals of the experimental group were treated with nicotine, injected subcutaneously, in a dose of 2 mg/kg twice a day, during 28 days in the preoperative period. All the animals were submitted to the caudally based, right unipedicled TRAM flap. 48 hours after the procedure, a study of the viable area of the flap was done through photographic documentation. Statistical analysis was performed with nonparametric Mann-Whitney's test. RESULTS: The experimental group had significantly greater area of necrosis when compared with the control group (p<0.001). CONCLUSION: Nicotine increased the area of necrosis of the TRAM flap, in rats(AU)

OBJETIVOS: O retalho musculocutâneo transverso do músculo reto do abdome (TRAM) é uma das principais opções na reconstrução do relevo mamário pós-mastectomia. A nicotina tem efeito deletério na viabilidade de retalhos cutâneos; porém, não foram encontrados trabalhos experimentais comprovando este efeito em retalhos musculocutâneos. O objetivo deste trabalho é investigar o efeito da nicotina na viabilidade do retalho TRAM, em ratos. MÉTODOS: Foram utilizados 30 ratos da linhagem Wistar EPM-1. Os animais foram distribuídos aleatoriamente em dois grupos: controle e experimento. Os animais do grupo controle foram tratados com solução salina injetada no tecido celular subcutâneo num volume de 0,2 ml, duas vezes ao dia, durante 28 dias no período pré-operatório. Os animais do grupo experimento foram tratados com nicotina injetada no tecido celular subcutâneo em uma dose de 2mg/kg/2 vezes ao dia, durante 28 dias no período pré-operatório. Todos os animais foram submetidos ao procedimento do retalho TRAM de base caudal unilateral à direita (pedículo não dominante). 48 horas depois, foi feita a avaliação da área viável de superfície do retalho, por documentação fotográfica. Para análise dos resultados foram utilizados testes não paramétricos: Mann-Whitney. RESULTADOS: O grupo experimento apresentou uma área de necrose maior, quando comparado com o grupo controle (p<0,001). CONCLUSÃO: A nicotina aumentou a área de necrose do retalho TRAM, em ratos(AU)

Ultrasonography for measuring rectus abdominis muscles diastasis / Ultra-sonografia para medir a diástase dos músculos retos do abdome

PURPOSE: Preoperative imaging evaluation may be useful for determining the position of recti abdominis muscles before their correction. The purpose of this study is to evaluate the accuracy of ultrasonography to measure the width of rectus abdominis muscle diastasis. METHODS: Rectus diastasis was measured by ultrasonography preoperatively in 20 females. Rectus diastasis was measured in seven levels along the anterior rectus sheath by ultrasound after sustained deep inspiration and after expiration. Rectus diastasis, at the same levels, was also measured after its exposition during abdominoplasty by two independent observers, using a surgical compass. These values were compared using Wilcoxon's statistical text, for non independent values. RESULTS: There was no significant difference between the values obtained by ultrasound and those measured during surgery in the supra-umbilical levels and at the level of the umbilicus. However, below the umbilicus these values differed significantly, showing smaller values in the imaging evaluation. CONCLUSION: Ultrasonography is an accurate method to measure rectus diastasis above the umbilicus and at the umbilical level.(AU)

OBJETIVO: Estudos radiológicos pré-operatórios podem ser úteis para determinar a posição dos músculos retos do abdome antes de sua correção. O objetivo deste estudo é avaliar a acurácia da ultra-sonografia para medir a largura da diástase dos músculos retos do abdome. MÉTODOS: A diástase dos músculos retos foi medida pela ultra-sonografia, no pré-operatório em 20 mulheres. A diástase dos retos foi medida em sete níveis da bainha anterior dos retos foram examinados com ultra-som após inspiração profunda sustentada e após expiração. A diástase dos retos, nos mesmos níveis, foi também medida após sua exposição durante a abdominoplastia, por dois observadores independentes, usando compasso cirúrgico. As medidas foram comparadas usando o teste estatístico de Wilcoxon para dados não independentes. RESULTADOS: Não houve diferença significante entre as medidas ultra-sonográficas e intra-operatórias nos níveis supra-umbilicais e na cicatriz umbilical. Todavia, inferiormente à cicatriz umbilical, essas medidas diferiram significantemente sendo as ultra-sonográficas menores nestes pontos. CONCLUSÃO: A ultra-sonografia é um método acurado para medir a diástase de retos na região supra- umbilical e no nível do umbigo.(AU)