Enhanced morbidity of pectoralis major myocutaneous flap used for salvage after previously failed oncological treatment and unsuccessful reconstructive head and neck surgery.

INTRODUCTION: The reconstruction of complex cervicofacial defects arising from surgical treatment for cancer is a real challenge for head and neck surgeons, especially in salvage reconstruction surgery and/or failed previous reconstruction. The pectoralis major myocutaneous flap (PMMF) has been widely used in these specific situations due to its reliability and low rate of failure or complications. OBJECTIVES: Identify factors that determine complications and influence the final outcome of the reconstructions with PMMF in salvage cancer surgery or in salvage reconstruction. METHODS: A cross-sectional study design was used to evaluate a sample including 17 surgical patients treated over a period of ten years that met the inclusion criteria. RESULTS: Reconstruction was successful in 13 cases (76.5%), with two cases of partial flap loss and no case of total loss. Complications occurred in 13 cases (76.5%) and were specifically related to the flap in nine instances (52.9%). An association was identified between the development of major complications and reconstruction of the hypopharynx (P = 0.013) as well as in patients submitted to surgery in association with radiation therapy as a previous cancer treatment (P = 0.002). The former condition is also associated with major reconstruction failure (P = 0.018). An even lower incidence of major complications was noted in patients under the age of 53 (P = 0.044). CONCLUSION: Older patients, with hypopharyngeal defects and submitted to previous surgery plus radiation therapy, presented a higher risk of complications and reconstruction failure with PMMF.

Linfadenopatia cervical na infância: etiologia, diagnóstico diferenciale terapêutica: [revisão] / Cervical lymphadenopathy in children: etiology, differential diagnosis and management: [review]

Linfadenopatia é o termo empregado em qualquer alteração em tamanho e consistência de linfonodos. A linfadenopatia cervical é um problema muito frequente nos pacientes da faixa etária pediátrica e, em geral, representa reação transitória a processos inflamatórios ou infecciosos locorregionais ou sistêmicos. Porém, em uma pequena parcela, há neoplasias como fator etiológico. Na grande maioria das vezes, esses pacientes são efetivamente tratados pelo pediatra, porém, quando não há resposta à terapia inicial ou quando há suspeita de malignidade, o cirurgião pediátrico ou de cabeça e pescoço deve ser consultado. Este trabalho teve por objetivo revisar a etiologia, o diagnóstico diferencial e a terapêutica da linfadenopatia cervical na infância.

Lymphadenopathy refers to any alteration in size and consistency involving lymph nodes. Cervical lymphadenopathy is a very frequent problem in the pediatric group and, in general, represents a transitory reaction to locoregional or systemic inflammatory or infectious process. However, in a few cases, there is neoplasia as etiologic factor. Although most patients are successfully treated by their pediatrician, the pediatric or head and neck surgeon should be consulted for patients who fail to respond to initial therapy or for those in whom there is a suspiciousness of malignancy. The aim of this article was to review the etiology, the differential diagnosis, and the management of cervical lymphadenopathy in children.

Acute urinary retention as a late complication of subcutaneous liquid silicone injection: a case report / Retenção urinária aguda como complicação tardia de injeção subcutânea de silicone líquido: relato de caso

Acute urinary retention is characterized by a sudden interruption of urinary output; urine is retained in the bladder due to either functional or obstructive anatomic factors, and cannot be voided. The main causes of acute urinary obstruction are benign prostatic hyperplasia, constipation, prostate adenocarcinoma, urethral stenosis, clot retention, neurological disorders, following surgery, calculi, drugs, or urinary tract infections. A transvestite patient, aged 55 years, described having had liquid silicone subcutaneously injected in various parts of the body, the last one four years ago. He complained of absent urinary output during the last 14 hours. The physical examination revealed skin deformation due to migration of implants; a hard nodule (characterized as a foreign body) was present in the preputium and a diagnosis of acute urinary retention was made; an unsuccessful attempt to exteriorize the glans for urinary catheterization, was followed by therapeutic cystostomy. Acute urinary retention has not been mentioned in the medical literature as a complication of liquid silicone subcutaneous injection.

A retenção urinária aguda é uma condição caracterizada pela interrupção abrupta de eliminação de urina, com a presença desta represada na bexiga, sem possibilidade de eliminação, seja em virtude de fatores anatômicos obstrutivos, ou por motivos funcionais. Entre suas causas mais comuns, destaca-se a hiperplasia prostática benigna, seguida de constipação, adenocarcinoma de próstata, estenose uretral, retenção de coágulos, desordens neurológicas, pós-operatórios, cálculos, drogas e infecções do trato urinário. Paciente do sexo masculino, 55 anos, travesti, com história pregressa de injeção subcutânea de silicone líquido em diversas regiões do corpo, a última há quatro anos, queixa-se de não conseguir urinar há 14 horas. Ao exame físico, apresenta extrema deformação cutânea devido à migração do implante, palpando-se nódulo endurecido em prepúcio, característico de corpo estranho. Dado o diagnóstico de retenção urinária aguda, tentou-se, sem sucesso, exteriorizar a glande e proceder à sondagem vesical de demora, sendo então realizada cistostomia terapêutica. A retenção urinária aguda não é encontrada e sequer mencionada na literatura médica mundial como complicação de injeção subcutânea de silicone líquido.