Use of autologous fibrin glue (platelet-poor plasma) in abdominal dermolipectomies.

BACKGROUND: Autologous plasma is endowed with properties that speed up healing, hemostasis, and adhesiveness, in addition to growth factors. Through an established protocol, it was possible to isolate thrombin, as well as the platelet-rich plasma (PRP) and platelet-poor plasma (PPP) fractions. The purpose of this study was to analyze autologous use of thrombin and PPP to foster adhesion between an abdominal dermoadipose flap and the aponeurotic surface in abdominal dermolipectomies. METHODS: The data from 40 patients who underwent abdominal dermolipectomies were analyzed, with 20 patients using thrombin and autologous PPP (Plasma group) and 20 patients with no intervention (Control group). An attempt was made to assess adhesive power by quantifying the serohematic liquid volume gauged during the postoperative days (POD), and also noting the incidence of seroma. Other variables such as age and body mass index (BMI) were also analyzed. RESULTS: The reduction in the aspiration drain debit was statistically relevant only on the first POD in the Plasma group. There was no reduction in the incidence of seroma in these patients. Similarly, age and BMI did not influence these outcomes. CONCLUSION: The PPP fostered adhesion between the abdominal dermoadipose flap and the aponeurotic surface only on the first POD and had no influence whatsoever on the incidence of seroma. There are few reports on the use of PPP for plastic surgery, particularly the autologous type, opening up possibilities for further research projects to expand its use. LEVEL OF EVIDENCE III: 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.

Protocol for obtaining platelet-rich plasma (PRP), platelet-poor plasma (PPP), and thrombin for autologous use.

BACKGROUND: Plasma has been widely studied and used in many different situations to speed up healing with better tissue adherence and hemostasis. Research projects are now attempting to isolate platelet-rich plasma (PRP) and platelet-poor plasma (PPP), making better use of their properties, particularly during operations and for wounds that are slow to heal. In view of the wide diversity of industrial machines and extraction protocols, together with the variety of industrially produced biologic glues, this article suggests an option for obtaining PRP, PPP, and human thrombin for autologous use. METHODS: A way of obtaining PRP, PPP, and thrombin is reproduced through a protocol defined and established by the authors. Autologous thrombin and plasma were obtained through the collection and successive centrifugation of ten whole blood samples, until the desired hemocomponents were isolated, followed by quantitative and qualitative analyses of the elements obtained. RESULTS: The mean platelet concentration obtained was 6.03 × 10(8) platelets/ml, with a mean thrombin concentration of 33.54 nM, both values compatible with reports in the literature when different protocols are applied. CONCLUSIONS: The protocol described is a good option for the preparation and application of PRP, PPP, and autologous thrombin, particularly as they can be obtained simultaneously, eliminating the possibilities of viral contamination and allergic reactions. Moreover, the cost of this procedure is low, it is easy to perform, and replicable. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article.

Paracoccidioidomycosis: a series of 66 patients with oral lesions from an endemic area.

Paracoccidioidomycosis (PCM) is the most important systemic mycosis in Latin America. It has been regarded as a multifocal disease, with oral lesions as the prominent feature. To provide useful information concerning the diagnosis and management of the disease, this study describes demographic and clinical data from the medical records of a consecutive series of 66 Brazilian patients from an endemic area, evaluated in a referral centre for oral diagnosis. In this sample of patients, there was a predominance of middle-aged male patients, who were primarily rural workers. Chronic multifocal disease was prevalent, with lesions also detected in the lungs, lymph nodes, skin or adrenal glands. Most of the cases presented with lesions at the gingival mucosa followed by the palate and lips; these conditions occurring in the oral cavity were frequently associated with pain. Importantly, most of the patients sought professional care for oral lesions. The diagnosis was obtained through exfoliative cytology and/or biopsy of the oral lesions. Medical treatment was effective, and there were no mortalities in the sample. The present findings not only confirm the importance of oral lesions in the diagnosis and management of PCM but also illustrate that questions still remain unclear, such as the possibility of direct inoculation of the fungus onto oral tissues.

Postbariatric buttock contouring with dermolipectomy and gluteal implants.

The authors present their experience with the use of silicone implants in the buttocks after massive weight loss. The procedure is used in combination with gluteal dermolipectomy with or without dermal fat flaps. This report highlights the simplified method of identifying the gluteal muscles, recommends using the superior margin of the gluteus maximus muscle to access the space for implant placement, and prescribes placement of the implants in either the submuscular or the intramuscular space. The described procedure has been performed for two patients to date, with encouraging and long-lasting results.

Transsphenoidal meningoencephalocele associated with cleft lip and palate: challenges for diagnosis and surgical treatment.

PURPOSE: The aim of this study was to highlight the challenges for early diagnosis and the difficulties observed in surgical treatment of patients with transsphenoidal meningoencephalocele associated with cleft lip and/or palate. METHOD: We evaluated six male patients treated over the course of 4 years. Five patients presented encephalic herniation with nonfunctional brain tissue; one of these presented herniation of the pituitary gland and cerebral ventricles. RESULTS: All the patients received surgical treatment for the cleft lip and/or palate. Only one patient underwent repair of the meningoencephalocele, via nasal endoscopy. There were no postprocedural clinical or surgical complications. CONCLUSION: The tendency is to avoid neurosurgery, opting for periodic follow-up with magnetic resonance imaging. In the presence of cleft palate, palatoplasty is essential to protect the meningoencephalocele.

Chondrocutaneous marginal ear flap.

This paper discusses a technique for the treatment of helical tumors that most times occur in aging patients with precarious clinical conditions and who wish to solve the problem in a single-stage operation. For these reasons, we have used a chondrocutaneous marginal flap of up to 4.0 cm in length based on the artery of the lobe that penetrates the helix at the level of the antitragushelicin cleft. This flap is also convenient for repairing circumscribed traumatic injuries of the helical rim.

Nanocellulose obtained from residues of peach palm extraction (Bactris gasipaes).

The large amount of residues generated by the peach palm agroindustry and its cellulose content (34 g 100g-1) motivated the present investigation, where outer sheaths were used for nanocellulose production through ultrafine grinding. Protocols combining different chemical delignification with defibrillation intensity (10 and 20 cycles) were applied and their influence over some properties and characteristics of nanofibers evaluated. At all protocols applied it was possible produce cellulose at nanometric level (widths ˜100 nm), with high crystallinity index (49.8-54.5%) and great thermal stability. The delignification influenced the defibrillation, where lignin removal resulted in well dispersed bundles of fibrils with lower widths. Lower lignin contents combined with higher shear forces released more nanofibrils, with more adsorbed water with defibrillation extension. These behavior influenced the suspension stability, that was higher at larger number of cycles (20). The results evidenced that was possible produced FNC with appropriate technical characteristics from pupunha discards.

Tissue expansion in burn sequelae repair.

Burns may cause emotional, aesthetic and functional sequelae. Extended or hypertrophic scars are usually difficult to repair using local tissues, and the use of skin grafts may cause further injuries to the donor sites. The use of tissue expanders may offer a better option in the treatment of burn sequelae. This is a report on our experience using tissue expanders in 54 cases (23 patients) of burn sequelae located in different anatomical areas. Fourteen of the patients were female and nine male ranging in age between 5 and 48. The expanders were placed in the subgaleal, submuscular, subfascial or subcutaneous planes. Skin expansion was completed in 50 cases (92.5%). The injured area was removed by advancement flaps in 44 cases and by transposition flaps in 6 of them. Primary expansion was performed in 42 cases and reexpansion in 12. The rate of complications was 24.07%, of which 30.8% were considered to be absolute and 69.2% relative. Tissue expansion is an excellent option for burn sequelae treatment because it provides skin of similar local characteristics and does not damage the donor site. The procedure can be repeated in the event of major sequelae (reexpansion).

Oral peripheral nerve sheath tumors: A clinicopathological and immunohistochemical study of 32 cases in a Brazilian population.

BACKGROUND: Oral peripheral nerve sheath tumors (OPNSTs) are reactive or neoplastic diseases that develop from proliferation of the nerve itself or their limiting sheaths. Here we describe the clinicopathologic data of OPNSTs observed in a sample of the Brazilian population and evaluate the expression of molecules associated with neural biology to determine their usefulness in the diagnosis. MATERIAL AND METHODS: Descriptive study of cases diagnosed as OPNSTs, from the Pathology Laboratory at the School of Dentistry/ Federal University of Uberlandia, followed by an immunohistochemical study of S-100, CD57, neurofilament protein (NFP) and epithelial membrane antigen (EMA). RESULTS: OPNSTs comprised 0.27% of all biopsies. There were eight patients with neurofibromas, eight with traumatic neuromas, seven with schwannomas, five with granular cell tumor (GCT), and four with palisaded encapsulated neuromas (PEN). Women were more frequently affected (60.6% of the cases). Tongue and lips prevailed as the most frequent sites. S-100 was reactive in 100% of the cases. Neural fibers evidenced by CD57 reactivity of their Schwann cells were always nested in bundles within neurofibromas and GCT, absent within schwannomas and dispersed within PEN. Reactivity for NFP was limited to axons and then followed the same pattern of CD57, though much less evident. Reactivity for EMA was observed in the capsular tissues and perineurium of nerve fascicles, and absent in parenchymal cells of GCT. CONCLUSIONS: This study showed that OPNSTs are rare, widely benign and often found in tongue and lips. OPNSTs evolve from a common origin to distinct histological patterns, with eventual overlapping in their clinical and morphologic features. The arrangement of reactive residual neural fibers for CD57 can be a useful staining in the differential diagnosis of OPNSTs. Key words:Peripheral nerve sheath tumors. Oral cavity. Differential diagnosis. Immunohistochemistry. CD57 antigens.

Ajuste sacral en lifting glúteo tras grandes perdidas ponderales / Sacral contouring in gluteal lifts after massive weight loss

Introducción y objetivo: Las alteraciones en la región glútea después de una pérdida significativa de peso o una cirugía bariátrica aparecen como piel fácida, reducción de tejido adiposo y pérdida de masa muscular, provocando diversas quejas entre los pacientes. A diferencia de los autores que predefinen la cantidad de tejido a resecar en la región sacra, empleamos este refinamiento al final de la operación, permitiendo la retirada de más piel, corrigiendo asimetrías y dando forma al surco glúteo, según la anatomia de cada individuo.Material y método.Sometimos a lifting glúteo a 15 pacientes. En 12 usamos un colgajo adiposo para proyectar la mitad superior de la región glútea. En 3, además del colgajo adiposo incluimos una prótesis de silicona a través de la misma incisión.Resultados.Entre los 15 pacientes atendidos recogimos las siguientes complicaciones: 1 caso de hematoma tratado solo con aspiración mediante punción; 2 casos de seroma con drenaje espontáneo a través de la herida quirúrgica; y 2 casos de dehiscencia parcial de suturas, con revisión de la cicatriz solo en 1 de estos casos.Conclusiones.En nuestra experiência, el ajuste cutáneo de la región sacra realizado al final de un lifting de glúteos, proporciona una mejor simetría y un posicionamiento más preciso del nuevo surco glúteo. (AU)

Background and objective: Alterations in the gluteal region after significant weight loss or bariatric surgery appear as sagging skin, reduced adipose tissue and loss of muscle mass, causing a variety of complaints from patients. Unlike the authors who pre-define the amount of tissue to be resected in the sacral region, we performed this refinement at the end of the operation, allowing the removal of more skin, correcting asymmetric aspects and shaping the gluteal sulcus, depending on the individual anatomy.Methods.Fifteen patients underwent gluteal lifting. In 12 we used an adipose flap to project the upper half of the gluteal region. In 3 of them, in addition to the adipose flap, we included a silicone prosthesis through the same incision.Results.Among our 15 patients we noticed the following occurrences: 1 case of hematoma treated only with aspiration puncture; 2 cases of seroma with spontaneous drainage through the surgical wound; and 2 cases of partial dehiscence of the sutures, with scar revision required in only 1 of these cases.Conclusions.In our experience, the skin adjustment of the sacral region performed at the end of a gluteal lifting, provides better symmetry and more precise positioning of the new gluteal groove. (AU)

Plastic surgery in chest wall reconstruction: relevant aspects - case series.

OBJECTIVE: to discuss the participation of Plastic Surgery in the reconstruction of the chest wall, highlighting relevant aspects of interdisciplinaryness. METHODS: we analyzed charts from 20 patients who underwent extensive resection of the thoracic integument, between 2000 and 2014, recording the indication of resection, the extent and depth of the raw areas, types of reconstructions performed and complications. RESULTS: among the 20 patients, averaging 55 years old, five were males and 15 females. They resections were: one squamous cell carcinoma, two basal cell carcinomas, five chondrosarcomas and 12 breast tumors. The extent of the bloody areas ranged from 4x9 cm to 25x40 cm. In 12 patients the resection included the muscular plane. In the remaining eight, the tumor removal achieved a total wall thickness. For reconstruction we used: one muscular flap associated with skin grafting, nine flaps and ten regional fasciocutaneous flaps. Two patients undergoing reconstruction with fasciocutaneous flaps had partially suffering of the flap, solved with employment of a myocutaneous flap. The other patients displayed no complications with the techniques used, requiring only one surgery. CONCLUSION: the proper assessment of local tissues and flaps available for reconstruction, in addition to the successful integration of Plastic Surgery with the specialties involved in the treatment, enable extensive resections of the chest wall and reconstructions that provide patient recovery.

Management of cleft lip and palate in Brazil.

We aimed to evaluate the treatment protocols for cleft lip and palate that are used in Brazil, to compare them with the ones proposed from elsewhere, and to discuss the official data about admission for treatment of cleft lip or palate, or both, in Brazil. We also assessed the importance of integrated action of different specialities to treat this condition. A questionnaire related to attendance protocols was developed and sent out to all Brazilian Plastic Surgery Services connected to the Brazilian Society of Plastic Surgery, and to other units involved in such treatment. We also studied the data produced by the Brazilian Department of Health about the operations done during the past five years. Many protocols were identified, but despite much controversy in many areas, a consensus was reached about the surgical techniques, the age group most suitable to be operated on, and there was total agreement about the need for multidisciplinary management. According to the State Department of Health, the number of operations done in 1995 was 9696, and this had increased to 21 022 in 1999. The state of São Paulo had done 17636 (84%) of all procedures in 1999.

Profile evaluation of patients with cleft lip and palate undergoing surgery at a reference center in rio de janeiro, Brazil.

In Brazil, the classic timeline for operating on cleft lip and palate is three months old for cheiloplasty and is 12 to 18 months old for palatoplasty. As from Brazilian treatment centers are usually located in major cities, patients living in more remote areas are often unable to receive treatment at the ideal ages. Data were analyzed retrospectively on 45 patients with cleft lip and/or palate, consecutively operated at the Reference Center, Rio de Janeiro Federal University, Brazil. Particularly noteworthy among these data are gender, clinical presentation, operations performed, age of surgery, and the distance between their homes and the hospital. The average age of patients undergoing primary cheiloplasty was 9.4 months, with primary palatoplasties performed at an average age of 7.2 years. As 67% of these patients lived in other towns, they encountered difficulties in seeking and continuing specialized care. Despite attempts to decentralize cleft palate care in Brazil, suitable conditions are not yet noted for following the treatment protocols in a full and adequate manner.

Analysis of the use of fasciocutaneous flaps for immediate vulvar reconstruction.

OBJECTIVE: To analyze the use of immediate reconstruction techniques of the vulva after surgical resection, with fasciocutaneous flaps of the medial and/or posterior thigh. METHODS: We conducted a transversal, retrospective study to analyse the outcome of immediate surgical reconstruction with fasciocutaneous flaps in nine patients who underwent vulvectomy from May 2009 to August 2010. RESULTS: Mean age was 61 years (range 36-82). In 56% of cases, diagnosis was vulvar intraepithelial neoplasia (VIN), usual type. Radical vulvectomy was performed in 45% of patients, simple vulvectomy in 33% and wide resections in 22%. Eleven fasciocutaneous flaps were made, of which 36.3% were flap transpositions from the posterior thigh, 18.2% from the medial thigh, 18.2% were in advancement flaps, 18.2% simple advancement flaps and 9.1% flap rotation from the posterior thigh. There were no major losses of the flaps made. CONCLUSION: Thigh fasciocutaneous flaps are currently the best options for immediate reconstruction after resection of vulvar cancer due to the preservation of sensibility and tissue availability in the donor areas. The association of the Plastic Surgeon with the Gynecologist offers tranquility for patients and provides good postoperative results.

Use en autologous plasma in abdominoplasty: previous note.

Autologous plasma began to be studied in the 90's, mainly because its adhesive and angiogenic properties and the presence of growth factors of platelet origin. In fact, plasma can be isolated from autologous manner, from the patient's own blood and obtained in its two parts: a high concentration of platelets (platelet-rich plasma - PRP) and one with low concentration of platelets (platelet-poor plasma - PPP). The present study is in development at the Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro (UFRJ-HUCFF) and Marcilio Dias Naval Hospital (HNMD), both in Rio de Janeiro. The objective is to evaluate the properties of platelet-poor plasma, particularly its adhesive action, in patients referred for restorative abdominal dermolipectomy, to reduce postoperative collections, such as hematoma and seroma, two major complications in this type of surgery.

Uso exclusivo de fios absorvíveis em fendas labiopalatais / Exclusive use of absorbable suture threads in cleft lip and palate

INTRODUÇÃO: O tratamento de fendas labiopalatais tem etapas que podem trazer traumas psicológicos consideráveis aos pacientes e familiares. O uso de fios absorvíveis pode eliminar um destes momentos desconfortáveis. Contudo, a utilização exclusiva deste tipo de material de síntese ainda não é a preferência de todos os cirurgiões, principalmente em planos musculares. MÉTODOS: Levantados os dados dos pacientes operados no Hospital Universitário da Universidade Federal do Rio de Janeiro, submetidos à correção de fendas labiais ou palatais, nas quais foram utilizados somente fios absorvíveis (poliglecaprona 25 - Monocryl® ou poliglactina 910 - Vicryl Rapide®) em todos os panos de sutura (mucosa, músculo, pele). O período avaliado foi de 2007 a 2014. RESULTADOS: Encontramos 360 pacientes que se enquadraram no estudo. Não observamos diferenças quanto ao aspecto local das feridas durante o processo de absorção dos fios. A incidência de deiscências ou fístulas se manteve abaixo de 1% e não houve complicações relacionadas ao objetivo do estudo. As cicatrizes não se mostraram, a longo prazo, diferentes das obtidas com o uso de fios inabsorvíveis, utilizados em outros tipos de cirurgias. CONCLUSÕES: O uso exclusivo destes fios absorvíveis se mostrou uma opção eficaz e segura. Proporcionou cicatrizes de boa qualidade, força tênsil adequada (mesmo em planos musculares) e não observamos complicações relacionadas ao processo de absorção dos materiais empregados.

INTRODUCTION: The treatment of orofacial clefts comprises steps that may result in considerable psychological trauma for patients and their caregivers. The use of absorbable sutures may help to eliminate these uncomfortable situations. However, the exclusive use of this synthetic material is still not preferred by surgeons, particularly in the muscle planes. METHODS: Data from patients who underwent surgery at the University Hospital of the Federal University of Rio de Janeiro from 2007 to 2014 were used. The patients underwent correction of cleft lip or palate, using only absorbable sutures (poliglecaprone 25 - Monocryl® or polyglactin 910 - Vicryl Rapide®) in all suture planes (mucosa, muscle, skin). RESULTS: We found 360 patients who met the inclusion criteria for this study. We did not observe differences in terms of the local appearance of the wounds during the suture absorption process. The incidence of dehiscence or fistula cases was below 1%, and there were no complications regarding the objectives of the study. In the long term, the scars did not differ from those obtained with non-absorbable sutures used in other types of surgeries. CONCLUSIONS: The exclusive use of absorbable sutures was shown to be an efficient and safe option. These resulted in good quality scars and adequate tensile strength (even in muscle planes), and we did not observe complications related to the absorption process of the material used.

[Women and surgeons]. / Mulheres e cirurgiãs.

The authors present the current view of the women in Surgery since the end of the XIX century until now. They discuss the difficulties they face when they choose Surgery as a career and the progress now achieved.

Implante mamário redondo versus anatômico: algoritmo para escolha da forma adequada / Round versus anatomical breast implants: algorithm for choosing the appropriate form

INTRODUÇÃO: Vários cirurgiões têm suas próprias fórmulas ou protocolos para selecionar os volumes e formato de implantes mamários. Para determinar a escolha do formato, medimos as distâncias entre a borda superior da mama e a papila (A) e entre a papila e sulco submamário (B). Baseados nestas medidas, propomos um algoritmo para selecionar próteses redondas ou anatômicas. MÉTODOS: As avaliações pré-operatórias foram realizadas com a paciente em posição ortostática considerando-se as medidas: 1) da fúrcula esternal à papila, para avaliar a necessidade de retirada de pele supra-areolar; 2) da base da mama, para avaliar o volume do implante; 3) das distâncias A e B, para avaliar a forma do implante. Este algoritmo foi aplicado a 59 pacientes submetidas à mamoplastia de aumento. RESULTADOS: Utilizamos implantes redondos em 27 pacientes; nove tinham distância a = b, e 18 B > A. Empregamos implantes anatômicos em 32 pacientes. Os volumes dos implantes redondos variaram entre 195 cc e 425 cc, enquanto os implantes anatômicos ficaram entre 185 cc e 315 cc. Com relação às medidas pós-operatórias das pacientes que utilizaram implantes redondos, 26 (96,3%) mantiveram a proporção desejada com B > A ou A = B. Entre as pacientes com implantes anatômicos, as medidas de 25 delas (78,1%) mostraram alteração das proporções, de A > B para A = B ou B > A. CONCLUSÕES: Quando a distância A é igual ou menor que a distância B, recomendamos implantes redondos. Quando B < A, recomendamos implantes anatômicos.

INTRODUCTION: Several surgeons have their own formulas or protocols to select the volume and shape of breast implants. To determine the shape, we measured the distances between the upper edge of the breast and the papilla (A), and between the papilla and the inframammary fold (B). Based on these measurements, we propose an algorithm to select round or anatomical implants. METHODS: Preoperative assessment was performed with the patients in the orthostatic position. The following distances were considered: 1) from the sternal notch to the papilla, to assess the need for supra-areolar skin excision; 2) breast base, to assess the volume of the implant; 3) distances A and B, to evaluate the shape of the implant. This algorithm was applied to 59 patients undergoing augmentation mammoplasty. RESULTS: We used round implants in 27 patients; nine had a distance A = B, and 18 had B > A. We utilized anatomical implants in 32 patients. The volume of round implants ranged from 195 to 425 cc, whereas that of anatomical implants ranged from 185 and 315 cc. Regarding postoperative measurements of the patients who used round implants, 26 (96.3%) maintained the desired ratio with B > A or A = B. Among the patients with anatomical implants, 25 (78.1 %) showed proportional changes from A > B to A = B or B > A. CONCLUSIONS: When the distance A is equal to or smaller than the distance B, we recommend round implants. When B < A, we recommend anatomical implants.

Male-to-female transsexual surgery: experience at the UFRJ University Hospital.

OBJECTIVE: To describe the experience of male-to-female sex reassignment surgery conducted at the Transgenitalization Program of the Clementino Fraga Filho University Hospital-UFRJ. METHODS: The selection of patients for operation followed the evaluation of a multidisciplinary team, meeting the criteria after two years of follow-up: medical diagnosis of transsexualism, patient over 21 years, no physical characteristics unsuitable for change, support at least one close relative. RESULTS: From 1997 to 2004 seventeen patients were followed, fifteen of which had confirmed transsexual condition, one was dismissed for bringing false examinations. Of the total of sixteen transsexuals, six operations were performed. The operated patients were in the age range of 25 to 40 years with an average of 31. The surgical procedure was completed without any technical difficulties in all patients. One patient had stenosis of the neo meatus and in another it was necessary to shorten the urethra. CONCLUSION: The technique provides no major difficulties in implementation, but may depend on local conditions and surgeon's creativity. The greatest difficulty is to prepare these patients so that there are neither frustrations, nor too many expectations.

Utilização do retalho miocutâneo de grande dorsal, com extensão adiposa, nas reconstruções mamárias: uma opção para preenchimento do polo superior / Use of the myocutaneous latissimus dorsi flap with fat extension in breast reconstruction: an option for filling the upper pole

INTRODUÇÃO: As sequelas de mastectomia se apresentam de formas variadas exigindo, do cirurgião, experiência e criatividade para obter o melhor resultado na reconstrução de uma nova mama. Dentre as dificuldades para que este objetivo seja alcançado, está o desafio de um melhor preenchimento do polo superior da mama. O objetivo deste trabalho é apresentar uma opção terapêutica alternativa para correção do polo superior dentre as técnicas já existentes com este propósito. MÉTODO: A técnica cirúrgica utilizou o retalho de músculo grande dorsal com extensão gordurosa para preenchimento do polo superior da neomama durante sua reconstrução. A técnica descrita foi utilizada em 8 pacientes durante a reconstrução mamária tardia, com idades variando entre 39 e 70 anos. O tamanho desta extensão gordurosa variou entre 4,0 × 10,0 e 7,0 × 13,0 cm. O componente gorduroso do retalho foi avaliado após 3 meses através de ressonância magnética. RESULTADOS: Foram usados implantes mamários que variavam entre 270 e 435 ml. O acompanhamento pós operatório variou entre 3 meses a 1 ano. Ocorreram 2 casos de epidermólise (28%) na junção do retalho cutâneo com a área receptora. Não houve perda ou sofrimento do retalho. Os resultados demonstram clinicamente ou visualmente que a correção da depressão do polo superior da neomama foi alcançada adequadamente, bem como a viabilidade do retalho gorduroso, observada nos exames de imagem (ressonância magnética). CONCLUSÃO: A técnica proposta é uma alternativa adequada para o tratamento da maioria dos casos de reconstrução mamária em que se busca o preenchimento da depressão existente no polo superior da mama.

INTRODUCTION: The sequelae of mastectomy presents in numerous ways, requiring the experience and creativity of the surgeon to achieve the best result in the reconstruction of a new breast. One of the difficulties in achieving this objective is the challenge of adequately filling the upper pole of the breast. The objective of this work was to present an alternative therapeutic option for correction of the upper pole of the neobreast. METHODS: In our surgical technique, a latissimus dorsi muscle flap with fat extension is used for filling the upper pole of the neobreast during its reconstruction. The described technique was used in 8 patients during late breast reconstruction. The patients' ages ranged from 39 and 70 years. The size of the fat extension ranged from 4.0 × 10.0 cm to 7.0 × 13.0 cm. The fat component of the flap was evaluated after 3 months by using magnetic resonance imaging (MRI). RESULTS: Breast implants that varied in volume between 270 and 435 mL were used. The follow-up period after surgery ranged from 3 months to 1 year. Two patients had epidermolysis (28%) at the junction of the cutaneous flap and the receiver area. No graft loss or other complications occurred. Our results demonstrate clinically or visually that correction of the depression in the upper pole of the neobreast was satisfactorily achieved. The viability of the fat flap, as observed on MRI, was adequate. CONCLUSION: The proposed technique is a suitable alternative method for filling the depression in the upper pole of the neobreast in most cases of breast reconstruction.