Photobiomodulation with laser and led on mesenchymal stem cells viability and wound closure in vitro.

Mesenchymal stem cells can differentiate into specific cell lineages in the tissue repair process. Photobiomodulation with laser and LED is used to treat several comorbidities, can interfere in cell proliferation and viability, in addition to promoting responses related to the physical parameters adopted. Evaluate and compare the effects of laser and LED on mesenchymal cells, with different energy doses and different wavelengths, in addition to viability and wound closure. Mesenchymal stem cells derived from human adipocytes were irradiated with laser (energy of 0.5 J, 2 J and 4 J, wavelength of 660 nm and 830 nm), and LED (energy of 0.5 J, 2 J and 4 J, where lengths are 630 nm and 850 nm). The wound closure process was evaluated through monitoring the reduction of the lesion area in vitro. Viability was determined by analysis with Hoechst and Propidium Iodide markers, and quantification of viable and non-viable cells respectively Data distributions were analyzed using the Shapiro-Wilk test. Homogeneity was analyzed using Levene's test. The comparison between the parameters used was analyzed using the Two-way ANOVA test. The T test was applied to data relating to viability and lesion area. For LED photobiomodulation, only the 630 nm wavelength obtained a significant result in 24, 48 and 72 h (p = 0,027; p = 0,024; p = 0,009). The results related to the in vitro wound closure test indicate that both photobiomodulation with laser and LED demonstrated significant results considering the time it takes to approach the edges (p < 0.05). Considering the in vitro experimental conditions of the study, it is possible to conclude that the physical parameters of photobiomodulation, such as energy and wavelength, with laser or LED in mesenchymal stem cells, can play a potential role in cell viability and wound closure.

Effects of therapeutic ultrasound and paraffin with or without vacuum massage on biomechanical properties of grafted skin after burn: a randomized controlled trial.

OBJECTIVE: This study aimed to compare the effects of therapeutic ultrasound and paraffin with or without vacuum massage on the biomechanical properties of grafted skin after a burn. METHODS: A total of 44 patients with deep second- and third-degree burns, with a mean age of 35.89 (±11.53) years, who visited the Hospital Burn Unity, were included in the study. The therapeutic interventions were randomly defined by drawing lots, with a crossover design (crossover), and a minimum interval of 7 days (washout) between interventions. Skin biomechanical parameters such as distensibility (R0) and viscoelasticity (R6) were noninvasively evaluated by Cutometer before and after 0, 10, 20, and 30 min of intervention with therapeutic ultrasound and paraffin alone, as well as associated with negative pressure therapy of the skin (vacuum therapy). In this study, all groups showed increased distensibility (R0) in the period immediately after the application of the resources and a progressive reduction in the effects in the consecutive tests. Participants with skin grafts showed a decrease in viscoelasticity (R6) in all groups, except therapeutic paraffin and therapeutic ultrasound and vacuum massage. CONCLUSION: The biomechanical properties of grafted skin after a burn are altered after therapeutic intervention with ultrasound alone or associated with vacuum massage, such as intervention with paraffin associated with vacuum massage, for both parameters evaluated, skin distensibility (R0) and skin viscoelasticity (R6). However, the same did not occur for the intervention with isolated paraffin. There was no significant difference between the interventions therapeutic ultrasound and therapeutic paraffin.

Intra- and inter-examiner reliability of digital images of skin donor areas in burns.

OBJECTIVE: The main objective of this study was to evaluate intra- and inter-rater reliability in the analysis of digital images of donor areas for skin in burn patients using the CaPAS plugin in the ImageJ®. METHODS: Donor sites were reviewed by two independent reviewers in duplicate. The capture of images was standardized on the same device and distance (with a millimeter ruler), without a flash. The evaluators were trained to capture the images and use the plugin. RESULTS: We selected 70 images from donor areas, from men and women between 18 and 60 years old. In the analysis of intra-examiner reliability, eight of the nine variables exhibited excellent reliability (0.985-0.998) and one (entropy) exhibited good reliability (0.525). The same was true for the inter-examiner analysis: excellent reliability for eight variables (0.824-0.993) and good reliability for entropy (0.501). CONCLUSIONS: The CaPAS plugin has proven to be a reliable tool for use in research in skin donor areas in burns, as demonstrated by its excellent intra- and inter-examiner reliability values. This is a pioneering study in the quantitative assessment of skin donor areas in burn patients using the CaPAS plugin.

Intra- and inter-examiner reliability of digital images of skin donor areas in burns

SUMMARY OBJECTIVE: The main objective of this study was to evaluate intra- and inter-rater reliability in the analysis of digital images of donor areas for skin in burn patients using the CaPAS plugin in the ImageJ®. METHODS: Donor sites were reviewed by two independent reviewers in duplicate. The capture of images was standardized on the same device and distance (with a millimeter ruler), without a flash. The evaluators were trained to capture the images and use the plugin. RESULTS: We selected 70 images from donor areas, from men and women between 18 and 60 years old. In the analysis of intra-examiner reliability, eight of the nine variables exhibited excellent reliability (0.985-0.998) and one (entropy) exhibited good reliability (0.525). The same was true for the inter-examiner analysis: excellent reliability for eight variables (0.824-0.993) and good reliability for entropy (0.501). CONCLUSIONS: The CaPAS plugin has proven to be a reliable tool for use in research in skin donor areas in burns, as demonstrated by its excellent intra- and inter-examiner reliability values. This is a pioneering study in the quantitative assessment of skin donor areas in burn patients using the CaPAS plugin.

Escalas de avaliação de cicatrizes em pacientes vítimas de queimaduras: Revisão de literatura / Burns scars scale evaluation in patients victims of burns injury: Literature review

OBJETIVO: Analisar as evidências disponíveis na literatura sobre escalas subjetivas de avaliação de cicatrizes em indivíduos vítimas de queimaduras. MÉTODO: Foi realizada uma revisão integrativa da literatura no período de 2016 a 2020, nas bases de dados da PubMed, LILACS, PEDro e SCIELO, utilizando os descritores em inglês: "burn injury", "scar" e "assessment"; e em português: queimaduras, cicatriz, escalas e avaliação, combinando-os como estratégia de busca. RESULTADOS: Foram encontrados 382 artigos, sendo selecionados dez, destacando-se que as principais escalas utilizadas foram a Escala de Avaliação Cicatricial Paciente/Observador (POSAS) e a Escala de Cicatrização de Vancouver (VSS). Estas escalas apresentaram boa confiabilidade na sua aplicação, tendo a POSAS confiabilidade maior que a VSS, havendo correlação positiva entre os itens elasticidade, espessura, vascularização e cor, das escalas subjetivas com instrumentos objetivos de avaliação de cicatrizes. CONCLUSÕES: Neste trabalho de revisão integrativa as escalas mais utilizadas para avaliação de cicatrizes após queimadura foram POSAS e VSS. A escala POSAS foi a mais citada nos estudos analisados, destacando-se pelo maior número de itens avaliados na cicatriz, tanto pelo observador como na avaliação do paciente; valorizando sintomas como dor e coceira. Quando comparadas com avaliações realizadas com instrumentos objetivos de análise das características cicatriciais, foi encontrada uma correlação positiva, viabilizando uma utilização confiável, apesar da necessidade de escalas mais completas serem desenvolvidas. Sendo assim, de acordo com os dados coletados, estas escalas podem ser consideradas bons instrumentos para avaliação de cicatrizes causadas por queimaduras.

OBJECTIVE: To analyze the evidence available in the literature on subjective scar assessment scales in burn victims. METHODS: A literature review was carried out from 2016 to 2020, in the PubMed, LILACS, PEDro and SCIELO databases, using the English keywords: "burn injury", "scar" and "assessment"; and in Portuguese: burns, scar, scales and assessment, combining them as a search strategy. RESULTS: A total of 382 articles were found, ten being selected, highlighting that the main scales used were the Patient/Observer Scar Assessment Scale (POSAS) and the Vancouver Scar Scale (VSS). These scales showed good reliability in their application, with POSAS being more reliable than VSS, with a positive correlation between the items elasticity, thickness, vascularization and color of the subjective scales with objective instruments for scar assessment. CONCLUSIONS: In this integrative review, the most used scales to assess scars after burns were POSAS and VSS. The POSAS scale was the most cited by the largest number of studies, if highlighted by the observer, as a patient assessment; symptoms such as pain and recovery. When the measures, with estimates, were found with the objective of analyzing the characteristics, a positive certainty, enabling a reliable use, despite the need for more complete scales to be found. Therefore, according to the functioning data, they can be improved with the functioning evaluation instruments, according to the evaluation instruments.

Effects of therapeutic ultrasound and paraffin with or without vacuum massage on biomechanical properties of grafted skin after burn: a randomized controlled trial

SUMMARY OBJECTIVE: This study aimed to compare the effects of therapeutic ultrasound and paraffin with or without vacuum massage on the biomechanical properties of grafted skin after a burn. METHODS: A total of 44 patients with deep second- and third-degree burns, with a mean age of 35.89 (±11.53) years, who visited the Hospital Burn Unity, were included in the study. The therapeutic interventions were randomly defined by drawing lots, with a crossover design (crossover), and a minimum interval of 7 days (washout) between interventions. Skin biomechanical parameters such as distensibility (R0) and viscoelasticity (R6) were noninvasively evaluated by Cutometer before and after 0, 10, 20, and 30 min of intervention with therapeutic ultrasound and paraffin alone, as well as associated with negative pressure therapy of the skin (vacuum therapy). In this study, all groups showed increased distensibility (R0) in the period immediately after the application of the resources and a progressive reduction in the effects in the consecutive tests. Participants with skin grafts showed a decrease in viscoelasticity (R6) in all groups, except therapeutic paraffin and therapeutic ultrasound and vacuum massage. CONCLUSION: The biomechanical properties of grafted skin after a burn are altered after therapeutic intervention with ultrasound alone or associated with vacuum massage, such as intervention with paraffin associated with vacuum massage, for both parameters evaluated, skin distensibility (R0) and skin viscoelasticity (R6). However, the same did not occur for the intervention with isolated paraffin. There was no significant difference between the interventions therapeutic ultrasound and therapeutic paraffin.

Comparison Between Two Strategies of Topical Treatment in Tar Burn: A Case Report.

The management of tar burns presents a wide range of possible approaches, and several strategies can be used to reduce the damage regarding the removal of tar adhered to the patient's skin. Tar residues should preferably be emulsified with solvent solutions. Due to the low incidence of tar burns, it has not yet been possible to select the appropriate agent for the removal of the adhered tar. In this article, we reported a case of a 47-year-old man with a tar burn in his forehead region and his both upper limbs treated with two different approaches and the outcomes. In the right upper limb, the removal of tar with oil-based on essential fatty acids was attempted at the time of hospital admission, whereas in the left upper limb, he was treated with 1% silver sulfadiazine cream, sterile gauze, and bandage. On the right upper limb, the treatment was eventually performed with debridement and split-thickness skin grafting. On the left upper limb, there was complete re-epithelialization of the burns. The more conservative approach of keeping a dressing with 1% silver sulfadiazine on the tar itself, followed by removing the material in the dressing changes was considered better than the immediate removal of tar with an oily solution, especially about pain. Our impression was that the application of 1% silver sulfadiazine cream at the time of the admission, as well as in the following days, may be beneficial for the removal of the tar in close contact with the skin. Possibly, this approach leads to less trauma to the skin and, eventually, simplifies the treatment of burns by hot tar.

Covid-19 e cirurgia plástica: relato de caso de tratamento de ferida complexa / Covid-19 and Plastic Surgery: a case report of complex wound treatment

Introdução: A pandemia decorrente da Covid-19 modificou de forma significativa a rotina e o trabalho das especialidades médicas. Relatamos o caso de um paciente tratado pela cirurgia plástica que contraiu o vírus Sars- CoV-2. Relato de caso: Homem de 66 anos, com ferida complexa em tornozelo, foi tratado com desbridamento cirúrgico e terapia por pressão negativa, sendo posteriormente submetido à cobertura cutânea da ferida com enxerto de pele parcial. No pós-operatório imediato, iniciou quadro de tosse seca, sendo que nesse mesmo dia havia sido confirmado um exame positivo do novo coronavírus em outro paciente que estava no mesmo quarto. Diante disso, solicitamos testagem com PCR que também resultou positiva para presença de Sars-CoV-2. O paciente evoluiu bem, com alta hospitalar no 5º dia de pós-operatório, após a retirada do curativo de Brown, e com retorno após o período de isolamento preconizado (14 dias). Discussão: O manejo de pacientes que necessitam de procedimentos cirúrgicos em meio a uma pandemia viral deve considerar a adoção de medidas preventivas que reduzam a possibilidade de transmissão do vírus. Como exemplo, citamos a redução do tempo de internação hospitalar, o uso de terapias que aceleram o processo terapêutico, o isolamento do paciente em casos confirmados e o uso de equipamentos de proteção individual. Conclusão: Apesar da infecção deste paciente pelo Sars-CoV-2, enfatizamos que a equipe de cirurgia plástica deve atuar de maneira precoce durante o processo de tratamento. Tais ações reduzem a possibilidade de disseminação do novo coronavírus para outros pacientes e para equipe de saúde.

Introduction: A pandemic from Covid-19 has significantly changed the routine and work of medical specialties. We report the case of a patient treated by plastic surgery who was infected by the Sars-CoV-2 virus. Case report: A 66-year-old man, with a complex wound on his ankle, was treated with surgical debridement and negative pressure wound therapy, and subsequently underwent cutaneous coverage of the wound with split thickness skin graft. In the immediate postoperative period, dry cough started, and that same day a positive examination of the new coronavirus was confirmed in another patient who was in the same infirmary. Therefore, we requested a PCR test that was also positive for the presence of Sars- CoV-2. The patient evolved well, being discharged on the 5th postoperative day, after the removal of Browns dressing, and returning after the recommended isolation period (14 days). Discussion: The management of patients with surgical procedures in the midst of a viral pandemic should consider the adoption of preventive measures that reduce the possibility of virus transmission. As an example, we mention the reduction in hospital stay, the use of therapies that speed up the therapeutic process, the isolation of the patient in confirmed cases and the use of personal protective equipment. Conclusion: Despite the infection of this patient by Sars-CoV-2, we emphasize that the plastic surgery team must act early during the treatment process. These actions include the possibility of spreading a new coronavirus to other patients and the healthcare team.

Cirurgia reparadora no contexto da Covid-19: complicações evolutivas no tratamento de ferida complexa inguinal / Reconstructive surgery in the context of Covid-19: complications in the treatment of an inguinal complex wound

Introdução: No final de 2019, o mundo viu surgir uma nova síndrome respiratória denominada Covid-19, causada por um novo tipo de coronavírus, o Sars-CoV-2. Classificada como uma pandemia, ela tem causado impactos de magnitude ainda imensuráveis. Relato de caso: Homem de 57 anos desenvolveu ferida inguinal direita, após exploração cirúrgica por infecção de prótese usada em bypass femoro-poplíteo. A equipe de cirurgia plástica optou pelo tratamento com desbridamento cirúrgico, associado com terapia por pressão negativa para preparo do leito da ferida. No pós-operatório, apresentou síndrome respiratória aguda grave e suspeita de Covid-19, com necessidade de intubação e de cuidados intensivos. Foi colhido amostra para RT-PCR do Sars-CoV-2 e associado ao tratamento as medicações cloroquina e azitromicina. Apesar do tratamento intensivo, o paciente foi a óbito. O resultado do exame RT-PCR para o novo coronavírus foi positivo, sendo liberado dois dias após a morte. Discussão: A análise deste relato permite supor que o paciente provavelmente contraiu o novo coronavírus dentro do próprio hospital, pois o mesmo encontrava-se internado pelo período dos 35 dias anteriores à evolução para insuficiência respiratória. Esse fato, juntamente com sua evolução desfavorável, corrobora a orientação de minimizar ao máximo as internações e os procedimentos cirúrgicos a fim de promover maior segurança ao paciente e à equipe de saúde. Conclusão: Pacientes internados estão susceptíveis à infecção pelo novo coronavírus e podem configurar grupo de maior de risco, uma vez que muitos deles já se encontram debilitados.

Introduction: At the end of 2019, the world saw the emergence of a new respiratory syndrome called Covid-19, caused by a new type of coronavirus, Sars-CoV-2. Classified as a pandemic, it has caused impacts of considerable magnitude. Case Report: A 57-year-old man developed a right inguinal wound after surgical exploration for infection of a prosthesis used in a femur-popliteal bypass. The Plastic Surgery team opted for treatment with surgical debridement associated with negative pressure therapy to prepare the wound bed. In the postoperative period, he had severe acute respiratory syndrome and suspected Covid-19, requiring intubation and intensive care. A sample for RT-PCR of Sars-CoV-2 was collected, and the medications chloroquine and azithromycin were associated with the treatment. Despite intensive treatment, the patient died. The result of the RT-PCR test for the new coronavirus was positive, being released two days after death. Discussion: The analysis of this report allows us to suppose that the patient probably contracted the new coronavirus at the hospital, as he was hospitalized for 35 days before the evolution of respiratory failure. This fact, together with its unfavorable evolution, corroborates the orientation of minimizing hospitalizations and surgical procedures as much as possible to promote more safety for the patient and the health team. Conclusion: Inpatients are susceptible to infection with the new coronavirus and can set up a group at higher risk since many of them are already weakened.

Application of unilateral pectoralis major muscle flap in the treatment of sternal wound dehiscence

Abstract Objective: This study aims to report the use of the unilateral pectoralis major muscle flap for the treatment of the sternal wound dehiscence. Methods: A retrospective study including patients who underwent unilateral pectoralis major muscle flap was performed for the treatment of sternotomy dehiscence due to coronary artery bypass, valve replacement, congenital heart disease correction and mediastinitis, between 1997 and 2016. Data from the epidemiological profile of patients, length of hospital stay, postoperative complications and mortality rate were obtained. Results: During this period, 11 patients had their dehiscence of sternotomy treated by unilateral pectoralis major muscle flap. The patients had a mean age of 54.7 years, the mean hospital stay after flap reconstruction was 17.9 days (from 7 to 52 days). In two patients, it was necessary to harvest a flap from the rectus abdominis fascia, in association with the pectoralis major muscle flap, to facilitate the closure of the distal wound. In the postoperative period, seroma discharge from the surgical wound was observed in six patients, five reported intense pain (temporary), three had partial cutaneous dehiscence, and two presented granuloma of the incision. Conclusion: The complex wound from sternotomy dehiscences presents itself as a challenge to surgical teams. Treatment should include debridement of necrotic tissue and preferably coverage with well-vascularized tissue. We propose that the unilateral pectoralis major muscle flap is an interesting and low morbidity option for the reconstruction of sternal wound dehiscences, with proper sternum stability and satisfactory functional and aesthetic outcomes.

Curativos de prata iônica como substitutos da sulfadiazina para feridas de queimaduras profundas: relato de caso / Ionic silver dressings as substitute for sulfadiazine for deep burn wounds: case report / Apósitos de plata iónica como sustitutos de sulfadiazina en las heridas por quemaduras profundas: reporte de caso

OBJETIVO: Este artigo tem por objetivo relatar as possíveis vantagens de curativos na forma de lâminas impregnadas com prata iônica (Atrauman®, Mepilex border Ag®, Mepilex-Ag® e Silvercel não aderente®) como agentes tópicos substitutos do creme de sulfadiazina de prata 1% nas queimaduras profundas. RELATO DOS CASOS: Foram tratados 31 pacientes. O Atrauman-Ag® foi empregado em 15 pacientes, o Mepilex border Ag® em três, Mepilex-Ag® em quatro e o Silvercel não aderente® em nove pacientes. Do total, relatamos a utilização destes novos curativos em dois pacientes do estudo com diagnóstico inicial de queimadura profunda. Em nenhum caso foram observados sinais de infecção nas feridas, apesar das trocas de curativos terem sido realizadas entre 4 a 7 dias, mesmo nas queimaduras de espessura total. O conforto propiciado por estes curativos foi evidente, minimizando o estresse e dor e as feridas de espessura parcial se apresentaram com sinais evidentes de rápida epitelização. CONCLUSÃO: Neste estudo preliminar, notamos que todos pacientes se beneficiaram de modo significativo do uso de curativos modernos com lâminas impregnadas por prata iônica quando comparados ao curativo convencional de sulfadiazina. Além da proteção contra infecção, mesmo nas queimaduras de espessura total, eles oferecem a enorme vantagem de as trocas serem espaçadas entre 4 a 7 dias, quando comparados à sulfadiazina, que exige a troca diária dos curativos, minimizando dor e desconforto aos pacientes e também o estresse da equipe de saúde envolvida nos Centros de Tratamento de Queimados.(AU)

OBJECTIVES: This article aims to evaluate the efficacy, and possible advantages of dressings in the form of ionic silver impregnated sheets (Atrauman Ag®, Mepilex Border Ag®, Mepilex - Ag® and Silvercel non - adherent®) as a local substitute agents for the cream of silver sulfadiazine-1% on deep burns. CASE REPORTS: 31 patients were treated. Atrauman-Ag® was used in 15 patients, Mepilex Border Ag® in three, Mepilex-Ag® in four and Silvercel non-adherent® in nine patients. Of the total, we report the use of these new dressings in two patients. In no case were signs of wound infection, even though dressing changes were performed between 4 and 7 days, also in total thickness burns. The comfort provided by these dressings was evident, minimizing stress and pain and partial thickness wounds presented with clear signs of rapid epithelization. CONCLUSION: In this preliminary study, we noticed that all patients benefited significantly from the use of new dressings with ionic silver impregnated sheets when compared to the conventional dressing of sulfadiazine cream. In addition to protection against infection, even in full-thickness burns, they offer the significant advantage that the changes of dressings are spaced between 4 and 7 days. Compared to sulfadiazine, which requires the daily exchange of dressings, they minimize pain and discomfort to patients, and also the stress to the health team involved in the treatment of the Burn Treatment Centers.(AU)

Objetivos: Este artículo tiene como objetivo evaluar la eficacia preliminar y los beneficios potenciales de la curación en forma de láminas impregnadas con plata iónica (Atrauman®, Mepilex Border Ag®, Mepilex-Ag® y Silvercel no aderente®) como sustitutos de crema de sulfadiazina de plata al 1% en quemaduras profundas. Casos Clínicos: Se han tratado 31 pacientes. El Atrauman-Ag® se utilizó en 15 pacientes, Mepilex Border Ag® en tres, Mepilex Ag® en cuatro y Silvercel no adherente® en nueve pacientes. Del total, se presenta la utilización de estos nuevos apósitos en dos pacientes. En ningún caso se observaron signos de infección en las heridas, a pesar de los cambios de apósito se llevaron a cabo entre los 4 y 7 días, incluso en quemaduras de espesor total. La comodidad ofrecida por éstos curación era evidente, lo que minimiza el estrés y el dolor y las heridas de espesor parcial se presentan con signos claros de una rápida epitelización. Conclusión: En este estudio preliminar, se observó que todos los pacientes se beneficiaron significativamente del uso de apósitos impregnados con plata iónica en comparación con sulfadiazina. Además de la protección contra la infección, incluso en quemaduras de espesor total, ofrecen la gran ventaja de las cambios están separadas de 4 a 7 días en comparación con sulfadiazina, que requiere el cambio diario de vendajes, minimizando dolor y malestar a los pacientes, e también el estrés del personal de salud de los centros de tratamiento de Queimados.(AU)

Gluteal Augmentation with Silicone Implants: A New Proposal for Intramuscular Dissection.

BACKGROUND: Gluteoplasty has gained notoriety over the last decades, which has motivated the development of various surgical techniques. Nevertheless, the fear of dissection of the intramuscular plane without direct visualization may inhibit learning and development of gluteal augmentation with implants. Moreover, literature detailing the technical steps of intramuscular dissection for the construction of the implant pocket is scarce. This study presents a new approach to intramuscular dissection for gluteal augmentation with silicone implants, a variation of the conventional surgical technique. METHODS: We performed a retrospective analysis of a series of 12 female patients submitted to a variation of the intramuscular dissection technique for gluteal augmentation with silicone implants. Data from patients, implants, follow-up time, postoperative complications, and the degree of patient satisfaction were obtained. This technique follows the principle of alternating spatulas to perform the blunt dissection of the implant pocket. RESULTS: In this series, the proposed technique is controlled and safe for intramuscular dissection, which can be used for both experienced and training surgeons. This technique is based on well-known anatomical points and references. We observed that the implant was well positioned and covered, the patients were satisfied with the result, and the number of complications was low. CONCLUSIONS: This variation of the intramuscular dissection technique for gluteal augmentation with silicone implants provides an easily reproducible and safe procedure that involves well-controlled technical steps, especially during dissection of the intramuscular pocket. In this series of patients, training surgeons learned faster, results were satisfactory, and the number of complications was low. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Single Stage Augmentation Mastopexy with L-shaped Inferior Pedicle Combined with Dual Plane Implant Placement.

Supplemental Digital Content is available in the text.

Negative pressure therapy for the treatment of complex wounds / Terapia por pressão negativa no tratamento de feridas complexas

ABSTRACT The objective of this study is to evaluate the effectiveness of negative pressure therapy (NPT) in the treatment of complex wounds, with emphasis on its mechanisms of action and main therapeutic indications. We searched the Pubmed / Medline database for articles published from 1997 to 2016, and selected the most relevant ones. The mechanisms of action of NPT involveboth physical effects, such as increased perfusion, control of edema and exudate, reduction of wound dimensions and bacterial clearance, and biological ones, such as the stimulation of granulation tissue formation, microdeformations and reduction of Inflammatory response. The main indications of NPT are complex wounds, such as pressure ulcers, traumatic wounds, operative wound dehiscences, burns, necrotizing wounds, venous ulcers, diabetic wounds, skin grafts, open abdomen, prevention of complications in closed incisions and in the association with instillation of solutions in infected wounds.

RESUMO O objetivo desse estudo é avaliar a eficácia da terapia por pressão negativa (TPN) no tratamento de feridas complexas, com ênfase em seus mecanismos de ação e principais indicações terapêuticas. Foi realizada revisão na base de dados Pubmed / Medline, em artigos publicados de 1997 a 2016, e selecionados os mais relevantes. O mecanismo de ação da TPN envolve efeitos físicos, como o aumento da perfusão, controle do edema e do exsudato, redução das dimensões da ferida e depuração bacteriana, e biológicos, como o estímulo à formação de tecido de granulação, microdeformações e redução da resposta inflamatória local. As principais indicações da TPN são as feridas complexas como úlceras por pressão, feridas traumáticas, deiscências de ferida operatória, queimaduras, feridas necrotizantes, úlceras venosas, feridas diabéticas, os enxertos de pele, o abdome aberto, na prevenção de complicações em incisões fechadas e na associação com instilação de soluções em feridas infectadas.

Evidences of autologous fat grafting for the treatment of keloids and hypertrophic scars / Evidências da lipoenxertia autóloga para o tratamento de queloides e cicatrizes hipertróficas

SUMMARY Introduction Since the 1980s, the use of autologous fat grafting has been growing in plastic surgery. Recently, this procedure has come to be used as a treatment for keloids and hypertrophic scars mainly due to the lack of satisfactory results with other techniques. So far, however, it lacks more consistent scientific evidence to recommend its use. The aim of this study was to review the current state of autologous fat grafting for the treatment of keloids and hypertrophic scars, their benefits and scientific evidences in the literature. Method A review in the Pubmed database was performed using the keywords “fat grafting and scar”, “fat grafting and keloid scar” and “fat grafting and hypertrophic scar.” Inclusion criteria were articles written in English and published in the last 10 years, resulting in 15 studies. Results These articles indicate that autologous fat grafting carried out at sites with pathological scars leads to a reduction of the fibrosis and pain, an increased range of movement in areas of scar contraction, an increase in their flexibility, resulting in a better quality of scars. Conclusion So far, evidences suggest that autologous fat grafting for the treatment of keloids and hypertrophic scars is associated with a better quality of scars, leading to esthetic and functional benefits. However, this review has limitations and these findings should be treated with reservations, since they mostly came from studies with low levels of evidence.

RESUMO Introdução a partir da década de 1980, o uso da lipoenxertia autóloga tem crescido na cirurgia plástica. Recentemente, esse procedimento passou a ser utilizado como tratamento de queloides e cicatrizes hipertróficas, principalmente em decorrência da falta de resultados satisfatórios com outras técnicas. No entanto, até o momento, faltam evidências científicas mais consistentes que recomendem seu uso. O objetivo deste estudo foi realizar uma revisão do estado atual da lipoenxertia autóloga no tratamento de queloides e cicatrizes hipertróficas, os benefícios e as evidências científicas presentes na literatura. Método foi realizada uma revisão na base de dados Pubmed com os descritores “fat grafting and scar”, “fat grafting and keloid scar” e “fat grafting and hypertrofic scar”. Os critérios de inclusão foram artigos escritos em inglês e publicados nos últimos 10 anos, resultando em 15 estudos. Resultados os artigos indicam que a lipoenxertia autóloga realizada em locais com cicatrizes patológicas leva a uma diminuição da fibrose e da dor, à maior amplitude de movimentos em áreas de retração cicatricial, ao aumento de sua maleabilidade, resultando na melhor qualidade das cicatrizes. Conclusão até o momento, as evidências sugerem que a lipoenxertia autóloga para o tratamento das queloides e cicatrizes hipertróficas está associada à uma melhor qualidade das cicatrizes, levando a benefícios estéticos e funcionais. Contudo, esta revisão possui limitações e os acha dos devem ser analisados com ressalvas, já que a maioria provem de estudos com baixos níveis de evidência.