Bupivacaine Injection in the Extra Ocular Muscle of Rabbits: Analysis of Global and Orbital Layers.

PURPOSE: To verify the cross sectional area (CSA) of fibers positive for myosin type 1 in the global and orbital layers after bupivacaine (BUP) injection in the superior rectus of the right eye of rabbits. MATERIALS AND METHODS: A total of 40 rabbits were studied; 32 specimens received a 0.3 mL injection of BUP at 1.5% in the superior rectus of the right eye and were euthanised after 7, 28, 60 and 92 days. Another eight rabbits were used as the control group. Immunohistochemical analysis was performed using anti-slow myosin (type 1) antibodies. The ImageJ software was used to measure the CSA of the fibers. Six slides were excluded from the analysis. Finally, 7,204 fibers were counted and statistically analysed. RESULTS: The mean CSA was 0.040 µm2 for all the studied fibers. For the orbital layer, mean CSA was 0.038 µm2, whereas the global area measured 0.042 µm2. No statistically significant differences were observed when comparing the orbital layer groups. However, when comparing the mean CSA in the global layer of the control group with the 60-day group an increase was found (0.0339 ± 0.0062 versus 0.0503 ± 0.0114; p = .009). CONCLUSION: This study revealed that 60 days after BUP injection, the extra ocular muscle of rabbits presented an increase in the CSA of myosin 1 type fibers in the global layer.

IS OBESITY A RISK FACTOR FOR FREE VASCULARIZED FIBULAR FLAP COMPLICATIONS?

OBJECTIVE: Although our knowledge of bone reconstruction through microsurgery has increased, the vascularized fibula flap remains one of the most difficult free flap reconstructions to perform, and complications remain a challenge. The incidence of obesity is increasing and is associated with higher rates of free flap complications, which can lead to disastrous results. Since there is no consensus in literature regarding the influence of obesity on free flap outcomes in orthopedic surgeries that require segmental bone reconstruction, the objective of this study was to determine whether obesity increases the risk of post-operative complications (Clavien-Dindo grade III) after free vascularized fibular flap surgery. METHODS: A cohort study was conducted in all patients undergoing free flap limb reconstructions between July 2014 and July 2018. Patients were separated in two groups based on their body mass index (BMI): non-obese and obese (BMI≥30 kg/m2). RESULTS: Twenty-three free vascularized fibular flaps were studied. The indications included trauma in 13, tumors in 7, and congenital pseudarthrosis of the tibia in 3. Obese patients were associated with an increase in surgical complications (p=0.038). During the final follow-up, consolidation was obtained in 17 patients (74%). CONCLUSION: Obesity is a risk factor for complications in free vascularized fibular flap surgery. Level of evidence IV, original article.

OBJETIVO: Apesar do crescente conhecimento em reconstrução óssea por meio de microcirurgia, o retalho livre de fíbula vascularizada ainda permanece como uma das reconstruções mais difíceis de ser executada, e suas complicações ainda são um desafio. A incidência da obesidade tem aumentado e está associada a taxas mais altas de complicações de retalhos livres, o que pode levar a resultados desastrosos. Uma vez que não há consenso na literatura a respeito da influência da obesidade nos desfechos dos retalhos livre em cirurgias ortopédicas que requeiram reconstrução de segmento ósseo, o objetivo deste estudo foi avaliar se a obesidade aumenta o risco de complicações pós-operatórias (Clavien-Dindo grau III) após a cirurgia de retalho livre de fíbula vascularizada. MÉTODOS: Foi realizado um estudo de coorte transversal, com a inclusão de todos os pacientes submetidos à reconstrução de membros com retalho livre de fíbula vascularizada, entre julho de 2014 e julho de 2018. Os pacientes foram separados em dois grupos, com base no índice de massa corporal: não obesos e obesos (no índice de massa corporal ≥ 30 kg/m2). RESULTADOS: Foram analisados 23 retalhos livres de fíbula vascularizada. As indicações foram trauma em 13 casos, tumor em sete e pseudoartrose congênita da tíbia em três. Pacientes obesos foram associados a aumento nas complicações cirúrgicas (p = 0,038). No final do acompanhamento, a consolidação óssea foi obtida em 17 pacientes (74%). CONCLUSÃO: A obesidade é um fator de risco para complicações no retalho livre de fíbula vascularizada. Nível de evidência IV, artigo original.