Combination of surgical techniques and reconstructive devices as an alternative treatment after fibula free flap mandibular reconstruction failure: a case report

Loss of mandibular continuity and functionality in cancer patients undergoing extensive mandible resections is challenging. In these situations, the gold standard treatment is fibula free flap reconstruction. The major challenge occurs when there is a failure of the transplanted fibula. Here we report the case of a patient who underwent right hemimandibulectomy with disarticulation and immediate mandibular reconstruction with a fibula free flap. Subsequently, the flap viability was lost, and there was necrosis of the transplanted bone segment in the short-term follow-up. Considering the best form of rehabilitation for the patient, minimizing the risks of loss and optimizing the reconstructive quality, we opted to install a customized prosthesis including a condylecavity joint component associated with a new free flap and subsequent rehabilitation of the dental occlusion with an implant-supported fixed prosthesis.

Paramedian forehead flap in the treatment of nasal, non-melanoma skin cancer: a cross-sectional study.

INTRODUCTION: nose is the central point of the face and vulnerable to the occurence of non-melanoma skin cancer (NMSC), impacting on appearance. The paramedian forehead flap (PMFF) is considered the best option to treat extensive nasal defects. The objective of this study is to present the experience on PMFF for nasal reconstruction in the treatment of NMSC of a cancer referral center. METHODS: retrospective study was carried out through data from medical records of patients who underwent nasal reconstruction with PMFF due to NMSC at the Cancer Institute of the State of São Paulo (ICESP). RESULTS: 111 patients were identified, mostly ederly, with comorbidities and on initial tumors (T1 and T2). Basal cell carcinoma (BCC) was the predominant histological type. Dorsum and tip were the most affected subunitis. In addition to skin coverage, reconstruction of the lining and structural framework was also performed in half of the cases. Second intention healing was the technique of choice in closing the donor area. Pedicle division ocurred predominantly in the second operation and the median time to complete reconstruction was 6 months. There were low complication rates. CONCLUSIONS: the PMFF is safe and effective to treat nose NMSC, even in cases of high complexity. Since the treatment time can be prolonged and impact on quality of life, it is essential to emphasize and discuss this aspect with the patients before surgery.

Tradução, adaptação e validação linguística do FACE-Q Câncer de Cabeça e Pescoço para o português do Brasil / FACE-Q Head and Neck Cancer Questionnaire for Brazilian Portuguese: Translation, Cross-Cultural Adaptation, and Linguistic Validation

Introdução: As neoplasias de cabeça e pescoço costumam afetar funções fundamentais, como engolir, falar, comer e se socializar. A avaliação do seu tratamento deve, portanto, levar em consideração a opinião do médico e a perspectiva do paciente. Essa dificuldade em avaliar o sucesso do tratamento levou ao desenvolvimento do FACE-Q - Módulo de Câncer de Cabeça e Pescoço, um questionário de resultados relatados pelo paciente que mede a aparência, função facial, qualidade de vida e experiência de cuidado para neoplasias de cabeça e pescoço. O objetivo é a tradução, adaptação cultural e validação linguística do questionário FACE- Q Câncer de Cabeça e Pescoço para o português brasileiro. Métodos: A tradução, adaptação cultural e validação linguística do questionário completo ocorreram em quatro etapas, usando as diretrizes oficiais da Organização Mundial da Saúde e da Sociedade Internacional de Farmacoeconomia e Pesquisa de Resultados. Resultados: Uma versão em português brasileiro semântica, idiomática e conceitualmente equivalente foi obtida por meio de uma tradução validada linguisticamente do módulo FACE-Q Head and Neck Cancer em inglês. Conclusão: A versão em português brasileiro apresenta uma versão com equivalente ao instrumento original em inglês, que pode ser utilizada como avaliação crítica de resultados relatados pelo paciente.

Introduction: Head and neck neoplasms often affect fundamental functions, such as swallowing, speech, eating, and socializing. Evaluating their treatment should consider the physician's opinion and the patient's perspective. This difficulty in assessing the success of treatment led to the development of the FACE-Q Head and Neck Cancer Module, a questionnaire of patient-reported outcomes that measure the appearance, facial function, quality of life, and experience of care to head and neck neoplasms. The objective is to translation, cultural adaptation, and linguistic validation of the FACE-Q Head and Neck Cancer questionnaire for Brazilian Portuguese. Methods: The translation, cultural adaptation, and linguistic validation of the full questionnaire took place in four stages, using official guidelines from the World Health Organization and the International Society of Pharmacoeconomics and Outcomes Research. Results: A semantic, idiomatic, and conceptually equivalent Brazilian Portuguese version was achieved through a linguistically validated translation of the English FACE-Q Head and Neck Cancer module. Conclusion: The Brazilian Portuguese version presents a version equivalent to the original English instrument, which can be used as a critical patient-reported outcome assessment.

Paramedian forehead flap in the treatment of nasal, non-melanoma skin cancer: a cross-sectional study / Retalho frontal paramediano no tratamento do câncer de pele não-melanoma de nariz: um estudo transversal

ABSTRACT Introduction: nose is the central point of the face and vulnerable to the occurence of non-melanoma skin cancer (NMSC), impacting on appearance. The paramedian forehead flap (PMFF) is considered the best option to treat extensive nasal defects. The objective of this study is to present the experience on PMFF for nasal reconstruction in the treatment of NMSC of a cancer referral center. Methods: retrospective study was carried out through data from medical records of patients who underwent nasal reconstruction with PMFF due to NMSC at the Cancer Institute of the State of São Paulo (ICESP). Results: 111 patients were identified, mostly ederly, with comorbidities and on initial tumors (T1 and T2). Basal cell carcinoma (BCC) was the predominant histological type. Dorsum and tip were the most affected subunitis. In addition to skin coverage, reconstruction of the lining and structural framework was also performed in half of the cases. Second intention healing was the technique of choice in closing the donor area. Pedicle division ocurred predominantly in the second operation and the median time to complete reconstruction was 6 months. There were low complication rates. Conclusions: the PMFF is safe and effective to treat nose NMSC, even in cases of high complexity. Since the treatment time can be prolonged and impact on quality of life, it is essential to emphasize and discuss this aspect with the patients before surgery.

RESUMO Introdução: o nariz é o ponto central da face e vulnerável à ocorrência de câncer de pele não-melanoma (CPNM), com impacto potencial na aparência. O retalho frontal paramediano (RFPM) é considerado a melhor opção para o tratamento de defeitos extensos no nariz. O objetivo deste estudo é apresentar a experiência de um centro oncológico de referência no uso de RFPM para reconstrução nasal no tratamento do CPNM. Métodos: estudo retrospectivo foi desenvolvido através do levantamento de dados de prontuário de pacientes submetidos à reconstrução nasal com RFPM devido à CPNM no Instituto do Câncer do Estado de São Paulo (ICESP). Resultados: 111 pacientes foram identificados, a maioria idosos, com comorbidades e portadores de tumores iniciais (T1 e T2). O carcinoma basocelular (CBC) foi o tipo histológico predominante. Dorso e ponta foram as subunidades mais acometidas. Além da cobertura cutânea, em metade dos casos foi realizada também a reconstrução do forro ou arcabouço do nariz. Cicatrização por segunda intenção foi a técnica de escolha no fechamento da área doadora. A liberação do pedículo foi realizada predominantemente no segundo tempo cirúrgico e o tempo para finalização do tratamento teve mediana de 6 meses. Houve baixa taxa de complicações. Conclusões: o RFPM é seguro e eficaz no tratamento do CPNM nasal, mesmo em casos de elevada complexidade. O tempo total de tratamento pode ser prolongado e impactar na qualidade de vida, sendo fundamental enfatizar e discutir este aspecto com o paciente antes da cirurgia.

Application of FACE-Q and NOSE in Nasal Reconstruction with Paramedian Frontal Flap after Skin Cancer Resection.

INTRODUCTION: Nonmelanoma skin cancer (NMSC) is responsible for high morbidity and mortality, resulting in a high cost to the health system. The nose is the leading region affected by this type of tumor and may need reconstruction by tissue transfer. The paramedian forehead flap (PFF) is one of the main options used, and the factors that influence the result should be studied. The FACE-Q questionnaire allows the assessment of appearance, quality of life, and side effects related to the procedure, whereas the Nasal Obstruction Symptom Evaluation questionnaire enables the nose function evaluation. METHODS: This study evaluates nasal reconstruction with a PFF after resection of NMSC with the FACE-Q questionnaire and Nasal Obstruction Symptom Evaluation. Spearman Rank correlation coefficient tests between the questionnaire results and patients' characteristics were performed. RESULTS: The questionnaires were completely answered by 49 patients who underwent this reconstruction between 2011 and 2019 in a cancer center. The patients' evaluations demonstrate high satisfaction with appearance, quality of life, side effects, and function. Completing reconstruction under 6 months was associated with a higher quality of life among patients (P = 0.002). Reconstruction of lining or scaffold, moment of flap division, complications, and number of operations did not show an association. CONCLUSION: This study suggests that the PFF is a reliable option for nasal reconstruction. Identifying the total reconstruction time as an impact factor on patients' quality of life should be considered when planning treatment.

MISIAN (Minimally Invasive Surgery for Treatment of Unruptured Intracranial Aneurysms): A Prospective Randomized Single-Center Clinical Trial With Long-Term Follow-Up Comparing Different Minimally Invasive Surgery Techniques with Standard Open Surgery.

BACKGROUND: Unruptured intracranial aneurysms (UIAs) are increasingly diagnosed but treatment is still controversial. Although the descriptions and use of minimally invasive surgery (MIS) have increased, comparative studies with standard approaches are rare. OBJECTIVE: MISIAN (Minimally Invasive Surgery for Treatment of Unruptured Intracranial Aneurysms) is a prospective randomized single-center clinical trial with long-term follow-up comparing different MIS techniques with standard open surgery for treatment of UIAs. METHODS: We randomly allocated a standard pterional approach (PtA) or MIS (1:2) to 111 patients with UIAs of the anterior circulation (mean dome diameter, 6.4 mm; range, 3-20 mm). Patients selected for MIS underwent a second randomization between a transeyelid approach (TelA) or nanopterional approach (NPtA) (1:1). RESULTS: Forty-one patients were randomized to and treated with the PtA, 36 with the TelA, and 34 with the NPtA. Only patients treated with PtA had permanent facial nerve palsy (n = 4 [10%]; P = 0.032). MIS cosmetic results were considered better than those of PtA by independent observers (P < 0.001), and less temporal atrophy in the MIS group was also observed (P = 0.0034). The proportion of excellent results was higher in the TelA group than in the NPtA group (86% vs. 67.6%; P = 0.039). Patients undergoing MIS also reported consistently higher satisfaction and quality-of-life scores (P < 0.001). CONCLUSIONS: MIS is superior to standard PtA for microsurgical clipping of small UIAs of the anterior circulation in terms of cosmetic, satisfaction, and quality-of-life outcomes. The TelA or NPtA for UIAs did not show significant outcome differences at 12-18 months.

Supercharged cervical anastomosis for esophagectomy and gastric pull-up.

OBJECTIVE: Esophagectomy has high rates of morbidity and mortality. Anastomotic leakage is the most frequent complication and is likely caused by diminished anastomotic perfusion. Supercharged microvascular anastomosis has previously been performed in select patients to supplement the blood supply to the graft and anastomosis after esophagectomy. This study aimed to evaluate complications that may arise after performing the supercharged cervical anastomosis for esophagectomy procedure. METHODS: This prospective comparative study evaluated patients who underwent esophagectomy with gastric reconstruction and cervical anastomosis for locally advanced esophageal carcinoma. Patients were divided into group 1, in which conventional cervical anastomosis was performed, and group 2, in which cervical anastomosis using the supercharged cervical anastomosis for esophagectomy procedure was performed. The anastomotic perfusion areas in group 2 patients were evaluated using indocyanine and the SPY device (Novadaq Technologies, Inc, Toronto, Ontario, Canada) before and after supercharged cervical anastomosis for esophagectomy. Postesophagectomy complications were also recorded. RESULTS: The study enrolled 80 patients, which included 62 (77.5%) men, mean age 64.3 years. Groups 1 and 2 comprised 55 patients and 25 patients, respectively. Leakage occurred in 10.5% and 0% of patients in groups 1 and 2, respectively (P = .169), whereas the corresponding anastomotic stricture rates were 14.5% and 4%, respectively (P = .260). Perfusion analyses showed a 26.5% improvement in the anastomotic area after venous anastomosis and a 34.6% improvement after arterial and venous anastomosis. CONCLUSIONS: The supercharged cervical anastomosis for esophagectomy procedure may reduce the occurrence of anastomotic leakage and improve perfusion in the anastomotic area via vein and arterial microanastomoses.

Smartphone-assisted minimally invasive neurosurgery.

OBJECTIVE: Advances in video and fiber optics since the 1990s have led to the development of several commercially available high-definition neuroendoscopes. This technological improvement, however, has been surpassed by the smartphone revolution. With the increasing integration of smartphone technology into medical care, the introduction of these high-quality computerized communication devices with built-in digital cameras offers new possibilities in neuroendoscopy. The aim of this study was to investigate the usefulness of smartphone-endoscope integration in performing different types of minimally invasive neurosurgery. METHODS: The authors present a new surgical tool that integrates a smartphone with an endoscope by use of a specially designed adapter, thus eliminating the need for the video system customarily used for endoscopy. The authors used this novel combined system to perform minimally invasive surgery on patients with various neuropathological disorders, including cavernomas, cerebral aneurysms, hydrocephalus, subdural hematomas, contusional hematomas, and spontaneous intracerebral hematomas. RESULTS: The new endoscopic system featuring smartphone-endoscope integration was used by the authors in the minimally invasive surgical treatment of 42 patients. All procedures were successfully performed, and no complications related to the use of the new method were observed. The quality of the images obtained with the smartphone was high enough to provide adequate information to the neurosurgeons, as smartphone cameras can record images in high definition or 4K resolution. Moreover, because the smartphone screen moves along with the endoscope, surgical mobility was enhanced with the use of this method, facilitating more intuitive use. In fact, this increased mobility was identified as the greatest benefit of the use of the smartphone-endoscope system compared with the use of the neuroendoscope with the standard video set. CONCLUSIONS: Minimally invasive approaches are the new frontier in neurosurgery, and technological innovation and integration are crucial to ongoing progress in the application of these techniques. The use of smartphones with endoscopes is a safe and efficient new method of performing endoscope-assisted neurosurgery that may increase surgeon mobility and reduce equipment costs.

Minimally Invasive Transpalpebral Endoscopic-Assisted Amygdalohippocampectomy.

BACKGROUND: Although anterior temporal lobectomy may be a definitive surgical treatment for epileptic patients with mesial temporal sclerosis, it often results in verbal, visual, and cognitive dysfunction. Studies have consistently reported the advantages of selective procedures compared with a standard anterior temporal lobectomy, mainly in terms of neuropsychological outcomes. OBJECTIVE: To describe a new technique to perform a selective amygdalohippocampectomy (SAH) through a transpalpebral approach with endoscopic assistance. METHODS: A mini fronto-orbitozygomatic craniotomy through an eyelid incision was performed in 8 patients. Both a microscope and neuroendoscope were used in the surgeries. An anterior SAH was performed in 5 patients who had the diagnosis of temporal lobe epilepsy with mesial temporal sclerosis. One patient had a mesial temporal lesion suggesting a ganglioglioma. Two patients presented mesial temporal cavernomas with seizures originating from the temporal lobe. RESULTS: The anterior approach allowed removal of the amygdala and hippocampus. The image-guided system and postoperative evaluation confirmed that the amygdala may be accessed and completely removed through this route. The hippocampus was partially resected. All patients have discontinued medication with no more epileptic seizures. The patients with cavernomas and ganglioglioma also had their lesions completely removed. One-year follow-up has shown no visible scars. CONCLUSION: The anterior route for SAH is a rational and direct approach to the mesial temporal lobe. Anterior SAH is a safe, less invasive procedure that provides early identification of critical vascular and neural structures in the basal cisterns. The transpalpebral approach provides a satisfactory cosmetic outcome.

Minimally Invasive Transpalpebral ''Eyelid'' Approach to Unruptured Middle Cerebral Artery Aneurysms.

BACKGROUND: Although recent technological advances have led to successful endovascular treatment, middle cerebral artery (MCA) aneurysms are still prone to surgery. Because minimally invasive options are limited and possess several functional and cosmetic drawbacks, a transpalpebral approach is proposed as a new alternative. OBJECTIVES: To describe and assess surgical results of the minimally invasive transpalpebral approach in patients with MCA aneurysms. METHODS: The data of 25 patients with unruptured MCA aneurysms from 2013 to 2016 were included in a cohort prospective database. We describe modifications of the approach and technique for MCA aneurysm clipping, in a step-by-step manner. The outcome was based on complications, procedural morbidity and mortality, and clinical and angiographic outcomes. RESULTS: All procedures were successfully performed in a standardized way, and no major complications related to the new approach were observed. Twenty-two patients were discharged the day after surgery (88%). The majority of aneurysms were 5 to 6 mm in diameter (mean, 7 mm; range 4-21 mm). All patients underwent postoperative angiographic control, which showed no significant residual neck. A 3-mo follow-up was sufficient to show no visible scars with excellent cosmetic results. The mean duration of follow-up was 16 mo. CONCLUSION: The transpalpebral approach comes as a minimally invasive, safe, definitive, and cosmetically adequate solution for MCA aneurysms at the present time.

Interferência de células-tronco derivadas de tecido adiposo na atividade de produtos finais de glicação avançada em fibroblastos de pacientes diabéticos / Effect of adipose tissue derived stem cells on advanced glycation end products activity in fibroblasts from diabetic patients

Feridas nos membros inferiores são a principal causa de hospitalização e morbidade nos pacientes portadores de diabetes mellitus (DM). Atualmente, atribuem-se as complicações tardias do DM ao acúmulo de produtos finais de glicação avançada (AGE) nos diversos órgãos-alvo, incluindo a pele. Já foi demonstrado que a função deficitária dos fibroblastos de diabéticos está relacionada diretamente ao acúmulo de AGEs. Neste cenário, o uso de células-tronco mesenquimais tem ganhado destaque, tendo sido demonstrado, na literatura, que células-tronco derivadas de medula óssea (BMSC) produzem lisozima, um anti-AGE fisiológico. As células-tronco derivadas do tecido adiposo (ADSC) são de fácil captação e apresentam melhor rendimento em cultura celular quando comparadas às BMSC. Neste estudo, investigamos se as ADSC sintetizam lisozima e avaliamos se o produto das ADSC tem a capacidade de diminuir os efeitos deletérios dos AGEs nos fibroblastos. Para esse fim, foram cultivadas ADSC provenientes de lipoaspiração de pacientes hígidos, fibroblastos provenientes de feridas de pacientes diabéticos e fibroblastos provenientes de pacientes hígidos. Os fibroblastos de pacientes diabéticos ou hígidos foram submetidos a três meios de cultura diferentes: normoglicêmico (controle), contendo AGE ou contendo AGE mais o meio de cultura proveniente de ADSC (eluato) e, nesses grupos, foi feito ensaio de migração de fibroblastos. Observamos que, nos meios contendo AGE, não ocorreu migração dos fibroblastos, e na cultura contendo AGE mais eluato, os fibroblastos apresentaram migração semelhante à do grupo controle. Concluímos que as ADSC produzem lisozima e que os produtos sintetizados por essas células têm a capacidade de inibir os efeitos deletérios dos AGEs em fibroblastos in vitro.

Lower limb ulcers are one of the major causes of morbidity and hospital admission in diabetic patients. Current researches indicate that diabetes mellitus (DM) complications are related to the accumulation in target organs, including the skin of advanced glycation end products (AGEs). It has been shown that cutaneous fibroblasts dysfunction in DM patients is directly dependent on AGE accumulation. In this context, the use of mesenchymal stem cells has been proposed, since bone marrow stem cells (BMSC) produce lysozyme, a physiological anti-AGE enzyme. Adipose tissue derived stem cells (ADSC) are easier to harvest and proliferate faster in cell cultures compared to BMSC. In this study, we investigated whether ADSC are able to produce lysozyme and also the ability of those stem cells to reduce the deleterious effects of AGEs in fibroblasts. ADSC were isolated and cultured from liposuction samples from non diabetic patients; fibroblasts were also isolated and cultured from wounds of diabetic patients and from non diabetic patients' skin. Fibroblasts were maintained in three different conditions: in normoglycemic culture medium (control), a culture medium containing AGE or a culture medium previously in contact with ADSC for 24 hours (eluate) with addition of AGE. A fibroblast migration assay was performed. There was a lack of fibroblast migration in fibroblast culture with AGE-supplemented medium, whereas fibroblast culture containing ADSC's eluate and AGE showed fibroblast migration similar to the control group. Our study demonstrates that ADSC can synthesize lysozyme and we infer that the products of ADSC are able to inhibit in vitro AGE deleterious effects in fibroblas.

Cultivo de células-tronco derivadas de tecido adiposo: uma análise crítica / Culture of adipose-derived stem cells:a critical analysis

Introdução: células-tronco derivadas de tecido adiposo (ADSCs) são pluripotentes, tem coleta poucoinvasiva e apresentam alto rendimento celular em cultura, além do fato de o número de lipoaspirações, a principalfonte destas células, estar aumentando ao redor do mundo. A Cirurgia Plástica tem encontrado benefícios de seu usoem diversas áreas, o que ressalta a importância de se analisar criticamente os protocolos de cultivo atualmenteutilizados. Objetivo: descrever detalhadamente o protocolo de cultivo adotado pelo nosso laboratório para podermos realizar uma análise crítica sobre o cultivo de ADSCs. Método: excedentes de tecido adiposo foram doados ao laboratório com finalidade de pesquisa por cinco pacientes de ambos os sexos e faixa etária de 20 a 45 anos. De cada paciente, 30 mL do material gorduroso foram coletados em frasco estéril e transportados ao laboratório de cultura celular, onde foram submetidos, por 45 min, à digestão enzimática por 30 mg de colagenase tipo IA diluída em30mL de meio de Dulbecco Modificado por Eagle (DMEM) e posteriormente centrifugados para que se isolem ascélulas da matriz extracelular. A amplificação das culturas foi feita com solução de tripsina 0,05% + EDTA 0,02%. Para congelamento, utilizou-se meio de congelamento composto por 60% DMEM, 10% dimetilsulfóxido (DMSO) e 30% SBF. Resultados: o protocolo apresentado para o cultivo de ADSCs demonstrou um cultivo celularsatisfatório, completando três passagens de cultura em todas as amostras, com posterior congelamento edescongelamento. Conclusões: a literatura científica nos indica que a colagenase possibilita extração e isolamento de ADSCs, devendo-se atentar ao tipo utilizado. Quanto ao congelamento, dado a citotoxicidade do DMSO, novos protocolos com grandes amostras substituindo este crioprotetor por trealose devem ser testados, visto que este último produziu bons resultados e não apresentou efeitostóxicos nos estudos já publicados.

Introduction: adipose-derived stem cells (ADSCs) are pluripotent and present little invasive collectionand high cell yield in culture, besides the fact that the number of liposuctions, the main source of these cells, is increasing around the world. Plastic Surgery has found the benefits of the use of those cells in several areas, which increases the importance of critically analyzing the protocolscurrently used for cell cultivation. Objective: to describe in detail the cultivation protocol adopted by our laboratory in order to perform a critical analysis of the culture of ADSCs. Method: surpluses of adipose tissue were donated to the laboratory with research purposes for 5 patients of bothgenders and age between 20 and 45 years. From each patient, 30 mL of fatty material was collected in a sterile flask and transported to the laboratory for cell culture, where they were subjected during 45 min to enzymatic digestion by 30 mg of type IA collagenase diluted in 30mL of Dulbecco’s Modified Eagle Medium (DMEM) and thencentrifuged to isolate the cells from the extracellular matrix. The amplification of the cultures was made with 0.05%trypsin solution + EDTA 0.02%. For cryopreservation was used freezing media consisting of 60% DMEM, 10%dimethylsulfoxide (DMSO) and 30% FBS. Results: The above protocol for growing ADSCs obtained a satisfactorycell culture, completing three cell passages in all samples, with subsequent freezing and thawing. Conclusions: The scientific literature indicates that collagenase get the bestresults in the extraction and isolation of ADSCs, paying attention to the type used. Regarding freezing, given thecytotoxicity of DMSO, new protocols with large samples replacing this cryoprotectant by trehalose should be tested, since the latter has produced good results and showed no toxic effects in published studies.

Replacement of fetal calf serum by human serum as supplementation for human fibroblast culture / Substituição de soro bovino fetal por soro humano como suplemento para cultura de fibroblastos humanos

INTRODUCTION: Fetal calf serum (FCS) is commonly used as a supplement in the culture medium for fibroblast cells. This supplementation is far from ideal as sample quality varies from batch to batch and the composition of FCS is not completely known. In addition, FCS may be contaminated with viruses and/or prions and may also cause adverse immunologic responses in humans. Due to these facts, a worldwide effort is being made to find alternatives for xenobiotic elements in cell cultures. Human serum could be a safer alternative, especially for clinical application. METHODS: We investigated human serum as a substitute for FCS in human fibroblast culture. Fresh human serum was obtained from 10 healthy volunteers. Fibroblasts were cultivated in multiwell plates containing either Dulbecco's modified Eagle's medium (DMEM) plus 10 percent FCS (D10) or DMEM plus 10 percent human serum (D10H). Cell counts were obtained between 24 and 264 hours of cultivation; results were expressed as the mean number of cells ± standard error of the mean to create cell proliferation curves. RESULTS: There was no statistical difference in fibroblast proliferation between the two groups. Human serum supported human fibroblast growth and proliferation, suggesting that it may be a potential substitute for FCS in human cell culture. Cells cultivated with human serum presented a different morphology, appearing smaller and more rounded as compared to cells cultivated in D10. CONCLUSIONS: These results demonstrate that human serum can be substituted for FCS in human fibroblasts culture and that fibroblasts cultivated in the presence of human serum have a morphology that is similar to in vivo fibroblasts.

INTRODUÇÃO: Soro bovino fetal (SBF) é comumente usado como suplemento no meio de cultura para cultivar fibroblastos. Essa forma de suplementação, porém, não é ideal, pois a qualidade das amostras de SBF é variada e sua composição não é completamente conhecida. Além disso, o SBF pode apresentar contaminação por vírus e príons ou causar complicações imunológicas. Assim, a comunidade científica tem buscado alternativas ao uso de elementos xenobióticos em cultura celular. O soro humano pode ser uma dessas alternativas, principalmente para aplicação clínica. MÉTODO: Soro humano, obtido de sangue de 10 voluntários saudáveis submetidos a avaliação sorológica prévia, foi testado como substituto do SBF em cultura de fibroblastos humanos. As células foram cultivadas em placas multipoços, contendo Dulbecco's Modified Eagle's Medium (DMEM) mais 10 por cento de SBF (D10) ou DMEM mais 10 por cento de sroro humano (D10H). Entre 24 e 264 horas de exposição aos meios testados, as células foram contadas e os resultados foram expressos em média ± erro padrão da média, para obtenção de curvas de proliferação celular. RESULTADOS: Não houve diferença estatística entre os grupos de proliferação. Fibroblastos na presença de soro humano aparentavam ser menores e mais arredondados em comparação àqueles mantidos em D10. CONCLUSÕES: Os resultados permitem inferir que o soro humano pode substituir o SBF em cultura de fibroblastos e que fibroblastos cultivados em meio suplementado por soro humano apresentam morfologia mais semelhante àqueles in vivo.

Alterações no processo de reparo fisiológico / Changes in physiological repair process

A resposta humana à solução de continuidade da pele é o reparo da ferida, que objetiva restaurar rapidamente essa barreira. Nem sempre este processo acontece de maneira fisiológica, podendo ocorrer aumento dafibrose cicatricial, gerando problemas funcionais e estéticos para o paciente.Este é o caso das cicatrizes exuberantes: cicatrizes hipertróficas e queloides. A cicatriz hipertrófica decorre da resposta ao aumento de tensão, demora na reepitelização e/ou infecção da ferida, sendo caracterizada por limitar-se às bordas da lesão e pelo aspecto eritematoso, áspero e rígido. Trata-se basicamente de uma fase maturacional prolongada, tendendo a involuir na maioria das vezes. Queloides, por sua vez, são situações patológicas que podem surgir na ausência de estímulo danoso, sendo relacionados a áreas com maiores quantidades de glândulas sebáceas e à produção de melanina. Possuem aspecto nodular e expansão para além das bordas da lesão original, não involuindo com o tempo. Durante o reparo da feridapode também ocorrer maior degradação de colágeno que síntese, resultandona formação de ulcerações ou feridas cutâneas que, dependendo do tempo de existência, são consideradas crônicas e de difícil resolução.

Human response to the disruption of the skin continuity is the wound repair, which aims the rapid restoration of this barrier. Not always this process happens physiologically, and sometimes it can lead to an increase of the scar fibrosis, causing functional and aesthetic problems to the patient. These facts can occur in hypertrophic scars and in keloids. Hypertrophic scarring is a response to increased tension, delayedreepithelialization and/or wound infection, characterized by being confined to the edges of the lesion and the erythematous, rough and stiff appearance. It is basically a result of a prolonged maturation phase, and tends to regress in most cases. Keloids, in turn, are pathological situations that may arise in the absence of injury and are related to areas with greater amounts of sebaceous glands and to production of melanin. They have nodular aspect and spread beyond the edges of the original injury, not regressing over the time. During wound repair an increased degradation of collagen synthesis may also happen resulting in the formation of ulcers that depending on the duration they areconsidered chronic and difficult to resolve.

Estudo comparativo de dois métodos para obtenção de células mesenquimais indiferenciadas de tecido adiposo / Comparative study of two different methods of harvesting adipose tissue derived stem cell

Introdução: Perdas de tecido mesenquimal podem acarretar grandes áreas cruentas, cujos tratamentos nem sempre são isentos de morbidade. A participação de células mesenquimais indiferenciadas, no processo de cura de feridas, tem sido amplamente estudada. Objetivo: comparar dois métodos de obtenção de células mesenquimais indiferenciadas de tecido adiposo...

Introduction: Mesenchymal tissue loose can lead to large wounds, which treatments are not completely free of morbidity. The adipose tissue derived stem cell participation in wound healing process has been widely studied. Objective: The aim of the study is to compare two different methods of harvesting adipose tissue derived stem cell.