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1.
J Reconstr Microsurg ; 2023 Nov 03.
Article in English | MEDLINE | ID: mdl-37751879

ABSTRACT

BACKGROUND: Autologous tissue has become the gold standard in breast reconstruction. The use of a deep inferior epigastric perforator (DIEP) flap has the advantages of giving a natural appearance to the reconstructed breast and being associated with lower morbidity at the donor site when compared with the transverse rectus abdominis myocutaneous flap. Venous complications such as venous thrombosis and insufficiency remain the main causes of flap loss and surgical revisions. The aim of this study was to evaluate the influence of superficial venous drainage of the DIEP flap and the addition of a second venous anastomosis have on flap survival. METHODS: This was a retrospective cohort study collected from a prospective database maintained by our institution. Data was obtained from the medical records of female patients who underwent mastectomy and breast reconstruction with a DIEP flap between March 2010 and March 2017. We evaluated 137 DIEP patients with unilateral breast reconstructions. In 64 (46.7%) the deep venous system was chosen and 73 (53.3%) had an additional superficial vein anastomosed. RESULTS: Out of the 137 patients evaluated, there were 16 (11.67%) cases of revision, 14 (10.21%) were due to venous thrombosis. Twelve cases (8.75%) of flap loss were reported. Reoperation rate was lower in the dual venous drainage group when compared with the single venous drainage group (p = 0.005), as was the rate of flap loss (p = 0.006) and reoperation due to venous thrombosis (p = 0.002). Out of the 125 DIEP flaps, fat necrosis was clinically identified in 7 (5.1%) cases, and the rate was lower in the dual venous drainage system group (p = 0.01). CONCLUSION: Dual venous drainage of a DIEP flap appears to reduce the rates of venous thrombosis, reoperation, total flap loss, and fat necrosis.

2.
Aesthet Surg J ; 41(6): NP616-NP630, 2021 05 18.
Article in English | MEDLINE | ID: mdl-32875312

ABSTRACT

BACKGROUND: Autologous fat grafting (AFG) has been employed in surgical practice as a filling method. However, controversies remain on the specifics of this technique. So far, few relevant experimental large animal studies have objectively assessed factors related to AFG integration. OBJECTIVES: This study utilized an experimental, medium-sized animal model to compare the feasibility of AFG collected employing 2 different techniques with instruments of distinct thicknesses. METHODS: Twenty minipigs (Sus scropha domesticus) were subjected to AFG harvesting via en bloc resection utilizing 3- (Group I) and 5-mm-diameter (Group II) round punch blades (PBs) and liposuction (LS) with 3- (Group III) and 5-mm-diameter cannulas (Group IV). Both samples were grafted intramuscularly (biceps femoralis). Hematoxylin and eosin staining was employed to identify intact adipocytes, fat necrosis, fibrosis, inflammation, and oil cysts. Immunohistochemical staining (perilipin-A, tumor necrosis factor alfa, and cluster of differentiation number 31) was utilized to quantify the feasibility of adipocytes, tissue necrosis, and neoangiogenesis, respectively. RESULTS: Hematoxylin and eosin analysis showed that fat necrosis and histiocyte presence were significantly lower in the AFG harvested utilizing a PB than in LS. For perilipin-A, a statistical difference was observed between subgroups I and III (P = 0.001) and I and IV (P = 0.004). Instrument diameter had no effect on graft integration in comparisons between groups II and III (P = 0.059) and II and IV (P = 0.132). CONCLUSIONS: In this experimental study, fat collected utilizing a PB demonstrated higher adipocyte viability than fat collected with LS. The diameter of the collection instruments, whether PB or LS, had no effect on graft integration.


Subject(s)
Adipose Tissue , Lipectomy , Adipocytes , Animals , Swine , Swine, Miniature , Tissue and Organ Harvesting , Transplantation, Autologous
3.
Eur J Plast Surg ; 41(1): 41-48, 2018.
Article in English | MEDLINE | ID: mdl-29398784

ABSTRACT

BACKGROUND: Flap coverage is the gold standard in treating pressure sores, and due to the high recurrence rate, the possibility of multiple surgical procedures should be considered during flap selection. The gluteal thigh (GT) flap has become a workhorse for ischiatic pressure sore treatment at our hospital. Follow-up revealed a group of patients presenting recurrence of the pressure sore that needed a second flap. The inferior gluteal artery perforator (IGAP) flap was chosen in this series. The positive experience with both flaps raised the question of which flap should be the first option for the treatment of ischiatic and perineal pressure sores. METHODS: IGAP and GT flaps were dissected in 21 fresh human cadavers to allow comparison of anatomical features. In a series of 60 patients, the authors used both the gluteal thigh and the IGAP flap to cover 76 ischiatic and perineal ulcers. RESULTS: The IGAP flap was found to be wider and thicker than the gluteal thigh, but presented a shorter pedicle. All flaps healed uneventfully. Recurrent ulcers were treated successfully with both flaps. CONCLUSIONS: Both flaps are suitable for coverage ischiatic and perineal sores. Due to its anatomical features, the IGAP flap should be considered the first choice of treatment for ischiatic ulcers. The gluteal thigh flap should be used in the recurrent sores.Level of Evidence: Level IV, therapeutic study.

4.
Acta Cir Bras ; 32(11): 891-902, 2017 Nov.
Article in English | MEDLINE | ID: mdl-29236794

ABSTRACT

PURPOSE: To evaluate the feasibility of an experimental model of autologous fat graft (AFG) in different interstitial pressure (IP) environments. METHODS: Three mini-pigs(Minipig-BR) with age of 8 months (weight: 25-30 kg) were used. AFG were collected from the bucal fat pad, and grafted in the intramuscular pocket (biceps femoralis muscle). IP model was based on a fusiform ressection followed by primary closure "under tension". A blood pressure catheter located in the intramuscular region connected to a pressure module was applied to quantify IP. RESULTS: The mean operative time was 236 min (210 - 272 min). All the AFG and muscular segments were removed successfully. Average interstitial pressure CP and H were 3 and 10.6 mmHg respectively. The AFG were biopsied for histopathological analysis 30 days after graft. Hematoxylin-eosin staining and immunohistochemical analyzes (TNF-alpha, CD31 and Perilipine with monoclonal antibodies) were employed. CONCLUSION: The data show that minipigs model could be used as a recipient site for autologous fat graft techniques and allow the development of studies to explore the AFG intake and pathophysiology response.


Subject(s)
Adipose Tissue/transplantation , Disease Models, Animal , Plastic Surgery Procedures/methods , Transplantation, Autologous/methods , Animals , Feasibility Studies , Graft Survival , Immunohistochemistry , Male , Perilipins/analysis , Platelet Endothelial Cell Adhesion Molecule-1/analysis , Pressure , Plastic Surgery Procedures/standards , Swine , Swine, Miniature , Transplantation, Autologous/standards , Tumor Necrosis Factor-alpha
5.
Acta cir. bras ; 32(11): 891-902, Nov. 2017. tab, graf
Article in English | LILACS | ID: biblio-886185

ABSTRACT

Abstract Purpose: To evaluate the feasibility of an experimental model of autologous fat graft (AFG) in different interstitial pressure (IP) environments. Methods: Three mini-pigs(Minipig-BR) with age of 8 months (weight: 25-30 kg) were used. AFG were collected from the bucal fat pad, and grafted in the intramuscular pocket (biceps femoralis muscle). IP model was based on a fusiform ressection followed by primary closure "under tension". A blood pressure catheter located in the intramuscular region connected to a pressure module was applied to quantify IP. Results: The mean operative time was 236 min (210 - 272 min). All the AFG and muscular segments were removed successfully. Average interstitial pressure CP and H were 3 and 10.6 mmHg respectively. The AFG were biopsied for histopathological analysis 30 days after graft. Hematoxylin-eosin staining and immunohistochemical analyzes (TNF-alpha, CD31 and Perilipine with monoclonal antibodies) were employed. Conclusion: The data show that minipigs model could be used as a recipient site for autologous fat graft techniques and allow the development of studies to explore the AFG intake and pathophysiology response.


Subject(s)
Animals , Male , Transplantation, Autologous/methods , Adipose Tissue/transplantation , Plastic Surgery Procedures/methods , Disease Models, Animal , Pressure , Swine , Swine, Miniature , Transplantation, Autologous/standards , Immunohistochemistry , Feasibility Studies , Tumor Necrosis Factor-alpha , Platelet Endothelial Cell Adhesion Molecule-1/analysis , Plastic Surgery Procedures/standards , Perilipins/analysis , Graft Survival
6.
J Plast Reconstr Aesthet Surg ; 68(2): 252-61, 2015 Feb.
Article in English | MEDLINE | ID: mdl-25456285

ABSTRACT

BACKGROUND: In oncological perineal reconstructions, the internal pudendal artery perforator (IPAP) flap is our flap of choice, supplied by perforator vessels from the internal pudendal artery and innervated by branches from the pudendal nerve and the posterior femoral cutaneous nerve. Data related to the evaluation of its cutaneous sensibility are scarce, discrepant, and subject to methodological criticism. OBJECTIVE: The objective of this study was to evaluate the cutaneous sensibility of the IPAP flap 12 months after perineal reconstruction and compare it with the preoperative cutaneous sensibility of the gluteal fold (flap donor area). METHODS: A prospective study of 25 patients undergoing abdominoperineal excision of rectum (APER) and reconstruction with bilateral VY advancement IPAP flap was conducted. The tactile, pain, thermal, and vibration sensibilities were analyzed in four areas of the gluteal fold preoperatively and in the four corresponding areas of the flap 12 months after surgery. Tactile sensibility was assessed using the Pressure Specified Sensory Device™ (PSSD™), which measures the pressure applied to the skin. The other types of sensibility were analyzed using a needle for pain, hot/cold contact for thermal, and a tuning fork for vibration sensibility. RESULTS: A comparison between tactile sensibility thresholds on the gluteal fold preoperatively and on the flap 12 months after surgery showed no statistically significant difference, with p values>0.05 in all four areas evaluated. All patients had preserved pain, thermal, and vibration sensibility in all four areas, postoperatively. CONCLUSION: In oncological perineal reconstructions after APER, it is expected that the cutaneous sensibility on the IPAP flap be maintained.


Subject(s)
Buttocks/innervation , Perforator Flap/blood supply , Perforator Flap/innervation , Perineum/surgery , Touch , Adenocarcinoma/surgery , Adult , Aged , Anus Neoplasms/surgery , Carcinoma, Squamous Cell/surgery , Female , Humans , Male , Middle Aged , Neurologic Examination , Prospective Studies , Rectal Neoplasms/surgery , Sensory Thresholds
7.
Rev. bras. queimaduras ; 10(3): 89-92, jul-set. 2011. tab, ilus
Article in Portuguese | LILACS | ID: lil-750429

ABSTRACT

A mão é uma parte do corpo frequentemente acometida em pacientes queimados. Sua alta incidência é reconhecida no mundo todo, assim como o grande impacto na qualidade de vida dos pacientes. Por muitas vezes, seu tratamento é postergado pela presença de graves condições clínicas associadas. Nesse artigo, os autores relatam as características epidemiológicas dos pacientes internados na Divisão de Cirurgia Plástica e Queimaduras do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (São Paulo, Brasil), destacando a importância da mão queimada na população economicamente ativa e sua associação com o grande queimado, dificultando o seu tratamento.


The hand is one region from the human body frequently affected in burnt injuried patients. Its high incidence is not only worldwide recognized, but also its great impact in patients’ quality of life. For many times, its treatment is put off by the presence of associated severe clinical conditions. Here, we report the epidemiological data of inpatient cases from Plastic Surgery and Burn Division, Clinics Hospital, Medical School of São Paulo University (São Paulo, Brazil),highlighting the importance of the burned hand in the economically active population and its association with major burnt patient, complicating its management.


Subject(s)
Humans , Male , Female , Child, Preschool , Adult , Middle Aged , Burns , Epidemiology , Hand
8.
Rev. bras. queimaduras ; 9(4): 118-123, 2010.
Article in Portuguese | LILACS | ID: biblio-1391337

ABSTRACT

Introdução: A neuropatia diabética causa diminuição ou perda da sensibilidade protetora do pé, tornando-o mais vulnerável ao trauma mecânico e térmico. O Pressure Specified Sensory DeviceTM (PSSD) é um equipamento desenvolvido para quantificar o limiar de pressão, aplicada sobre a pele, necessária para que o paciente perceba o estímulo provocado por: um ponto estático, um ponto em movimento, dois pontos estáticos e dois pontos em movimento. Método: Denominamos grupo estudo, aos 34 pacientes diabéticos do tipo 2, sem história prévia de feridas e/ou amputações nos pés que foram submetidos à avaliação de sensibilidade cutânea utilizando-se o PSSDTM. Foram realizados testes nos territórios cutâneos dos nervos fibular profundo, plantar medial e ramo calcâneo do nervo tibial posterior. Estímulos foram provocados segundo as modalidades: um ponto estático (1 PE), um ponto em movimento (1 PD), dois pontos estáticos (2 PE) e dois pontos em movimento (2 PD), para as duas últimas modalidades. Previamente às modalidades 2PE e 2PD, determinou-se o limiar de discriminação entre dois pontos estáticos (D2PE) e em movimento (D2PD). Foram realizados apenas no grupo estudo, testes com o monofilamento de Semmes-Weisntein nº 5,07 (MSW) e com o diapasão de 128 Hz. Vinte e oito pacientes não-diabéticos, submetidos aos mesmos testes, formaram o grupo controle. Resultados: Para os limiares de sensibilidade, encontramos valores superiores no grupo estudo (p < 0,05). Ao compararmos os limiares de sensibilidade alcançados pelos pacientes diabéticos sensíveis e não sensíveis ao estímulo promovido pelo MSW nº 5,07, verificamos que o p-valor variou entre 0,018 < p < 0,113 para 1 PE e 0,002 < p < 0,083 para 2 PE, conforme o território cutâneo estudado. Na comparação dos limiares de sensibilidade da modalidade 1 PD entre diabéticos sensíveis e insensíveis à vibração do diapasão de 128 Hz, as diferenças não foram estatisticamente significantes (p = 0,183). Conclusão: Os resultados obtidos nos permitiram sugerir que o dispositivo PSSDTM seja utilizado como forma de acompanhamento do comprometimento da fibra nervosa.


Introduction: Neuropathy is a severe progressive loss of protective sensation on the feet, making the patient more vulnerable to mechanical trauma and consequently more suitable to the development of chronic wounds, major distortion of the foot bone architecture and eventually to limb amputation. The PSSD (Pressure Specified Sensory DeviceTM) was developed in order to quantify the threshold of pressure applied to the skin that could be recognized as positive by the patient. Pressure of one or two points is tested both statically and with movement, thus assessing the function of fast and slow response nerve fibers. Threshold of two-point discrimination was also measured in mm. Methods: Thirty four (n = 34) diabetic patients, type II, with no previous history of wounds on the lower extremity were studied using the tests, one point static (1PE), one point moving (1PD) and two points static (2 PE), and moving (2 PD) on the cutaneous territory of the fibular nerve and posterior tibial nerve (two territories - medial plantar and calcaneous nerves). The control group (28 non diabetic patients) was assessed by the same exams and the results were compared. In the diabetic group the cutaneous territories were also evaluated using the conventional Semmes-Weinstein filament nº 5.07 e vibrometer of the 128 Hz. Results: Altered values were o bserved for the static and dynamic tests over the three studied nerve territories. The differences were statistically significant (p < 0.05). Comparing the threshold of sensibility between sensitive and non sensitive diabetic patients to MSW nº 5.07 test, we observed that p-value range was 0.018 < p > 0.113 when 1PE test was applied, and 0.002 < p > 0.083 when 2PE test was applied, according to the cutaneous territories evaluated. Numeric quantification of the threshold of pressure allows us to determine the status of the fiber/receptor structures as well as the functional deficit of nerve fibers. Conclusion: Our findings suggest that PSSDTM is an adjuvant tool to evaluate the degree of loss of sensation on the skin.


Subject(s)
Humans , Diabetic Foot/physiopathology , Diabetic Neuropathies , Sensory Thresholds , Touch , Cross-Sectional Studies , Cohort Studies
9.
Rev Assoc Med Bras (1992) ; 55(1): 29-34, 2009.
Article in Portuguese | MEDLINE | ID: mdl-19360274

ABSTRACT

OBJECTIVES: Neuropathy is a severe progressive loss of protective sensation in the feet, increasing patient vulnerability to mechanical trauma and consequently more prone to development of chronic wounds, major distortion of the foot bone architecture and to eventual limb amputation. Prophylaxis should be enforced to avoid foot ulceration and for this purpose, evaluation of the degree of loss of sensation on the skin is essential. The PSSD (Pressure Specified Sensory Device) was developed to quantify the threshold of pressure applied to the skin that the patient might recognize as positive. Pressure of one or two points is tested both statically and with movement, thus assessing the function of fast and slow response nerve fibers. METHODS: 33 diabetic patients, type II, with no previous history of wounds on the lower extremity were studied. The tests used were, one point static, one point moving and two points, static and moving on the cutaneous territory of the fibular nerve and posterior tibial nerve (two territories - medial plantar and calcaneous nerves). RESULTS: Altered values were observed for the static and dynamic tests over the three nerve territories studied. Differences were statically significant (p < 0.05). This numeric quantification of the threshold of pressure supports the evaluation of the status of the fiber/receptor structures as well as the functional deficit subsequent to diabetic neuropathy.


Subject(s)
Diabetic Foot/physiopathology , Diabetic Neuropathies/physiopathology , Sensory Thresholds , Skin/innervation , Touch/physiology , Adolescent , Adult , Cross-Sectional Studies , Female , Foot/innervation , Humans , Male , Middle Aged , Young Adult
10.
Rev. Assoc. Med. Bras. (1992, Impr.) ; 55(1): 29-34, 2009. ilus, graf, tab
Article in Portuguese | LILACS | ID: lil-511062

ABSTRACT

OBJETIVO: A neuropatia diabética leva à diminuição ou perda da sensibilidade protetora do pé, tornando o diabético mais vulnerável ao trauma mecânico, consequentemente, levando-o à formação de feridas e eventualmente, perda segmentar nos membros inferiores. A profilaxia das complicações neuropáticas deve ser iniciada pela identificação do grau de neuropatia e, portanto, do comprometimento neurológico. O Pressure Specified Sensory DeviceTM foi desenvolvido para quantificar o limiar de pressão aplicada sobre a pele, necessário para que o paciente sinta o estímulo de um ponto estático, um ponto em movimento, dois pontos estáticos e dois pontos em movimento. É um meio direto para se avaliar os sistemas de fibras de adaptação lenta e rápida e seus respectivos receptores periféricos. MÉTODOS: Trinta e três pacientes diabéticos do tipo II, sem história prévia de feridas e/ou amputações nos pés foram avaliados neste estudo de corte transversal. A sensibilidade nos territórios cutâneos dos nervos plantar medial, calcâneo e o ramo profundo do nervo fibular foi avaliada usando os testes de um ponto estático (1PE), um ponto dinâmico (1PD), dois pontos estáticos (2PE) e dois dinâmicos (2PD). RESULTADOS: Nos três territórios nervosos examinados encontramos valores alterados para as modalidades estática e dinâmica em relação ao padrão de normalidade. As diferenças foram estatisticamente significantes com p < 0,05. CONCLUSÃO: A quantificação numérica do limiar de pressão cutânea nos permite tanto a avaliação do conjunto fibra/receptor, quanto à determinação do déficit funcional da fibra nervosa imposto pela neuropatia diabética.


OBJECTIVES: Neuropathy is a severe progressive loss of protective sensation in the feet, increasing patient vulnerability to mechanical trauma and consequently more prone to development of chronic wounds, major distortion of the foot bone architecture and to eventual limb amputation. Prophylaxis should be enforced to avoid foot ulceration and for this purpose, evaluation of the degree of loss of sensation on the skin is essential. The PSSD (Pressure Specified Sensory DeviceTM) was developed to quantify the threshold of pressure applied to the skin that the patient might recognize as positive. Pressure of one or two points is tested both statically and with movement, thus assessing the function of fast and slow response nerve fibers. METHODS: 33 diabetic patients, type II, with no previous history of wounds on the lower extremity were studied. The tests used were, one point static, one point moving and two points, static and moving on the cutaneous territory of the fibular nerve and posterior tibial nerve (two territories - medial plantar and calcaneous nerves). RESULTS: Altered values were observed for the static and dynamic tests over the three nerve territories studied. Differences were statically significant (p < 0.05). This numeric quantification of the threshold of pressure supports the evaluation of the status of the fiber/receptor structures as well as the functional deficit subsequent to diabetic neuropathy.


Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Diabetic Foot/physiopathology , Diabetic Neuropathies/physiopathology , Sensory Thresholds , Skin/innervation , Touch/physiology , Cross-Sectional Studies , Foot/innervation , Young Adult
11.
Rev. bras. Queimaduras ; 8(3): 82-86, 2009.
Article in Portuguese | LILACS | ID: biblio-1369749

ABSTRACT

Objetivo: O presente estudo pretendeu analisar os aspectos epidemiológicos envolvidos nas complicações tardias das queimaduras, bem como seu manejo. Método: Os autores revisaram, retrospectivamente, os prontuários dos pacientes atendidos no Serviço de Queimaduras da Divisão de Cirurgia Plástica do Hospital das Clínicas da Faculdade de Medicina da USP, interessando aqueles submetidos à intervenção cirúrgica por sequelas pós-queimadura. A análise abrangeu um período de 12 anos. Resultados: Os pacientes apresentaram um ou mais sítios anatômicos queimados exibindo sequelas com necessidade de tratamento cirúrgico. O número de cirurgias por paciente variou de 1 a 32, chegando a 10 anos fazendo uma ou mais cirurgias anualmente. Dentre as 2286 cirurgias realizadas em 977 pacientes, 60,6% dos procedimentos foram realizados em pacientes do sexo feminino. A contratura foi o diagnóstico de 52,8% dos pacientes operados, sendo os dois locais mais acometidos o pescoço (26%) e a axila (22%). Metade (50,5%) dos pacientes necessitou de duas ou mais operações, sendo realizadas, em média, de 2,34 cirurgias por doente. As ressecções foram o segundo procedimento mais realizado, representando 584 (25,5%) procedimentos. Conclusões: O conhecimento dos fatores epidemiológicos inerentes às sequelas de queimaduras faz-se importante para o reconhecimento do impacto das queimaduras e suas sequelas em nosso meio. Há, indubitavelmente, necessidade de atendimento multidisciplinar ao paciente queimado, desde a fase aguda até a fase tardia, incluindo o tratamento das sequelas e complicações.


Objective: This study sought to analyze the epidemiological aspects involved in the late complications of the burns and their management. Methods: The authors, retrospectively, reviewed the charts of patients seen at the Burns Service of the Division of Plastic Surgery, Hospital das Clinicas, Faculdade de Medicina da USP involving those submitted to surgery for post-burn sequelae. The analysis covered a period of twelve years. Results: The patients had one or more anatomical sites burned in need of sequels featuring surgical treatment. The number of surgeries per patient ranged from 1 to 32 surgery, reaching 10 years by one or more surgeries annually. Among the 2,286 surgeries performed in 977 patients, 60.6% of procedures were performed in female patients. The contraction was the diagnosis of 52.8% of patients, and the two sites most affected neck (26%) and axilla (22%). Half (50.5%) of the patients needed two or more surgeries. The average was 2.34 surgeries per patient. The resections were performed the second procedure being more in number of 584 (25.54%) procedures. Conclusions: The knowledge of epidemiological factors related to sequelae of burns it is important to recognize the impact of burns and their sequelae in our environment, and how they occur. There is undoubtedly need for multidisciplinary care to burned patients from the acute to late stage, including treatment of complications and sequelae.


Subject(s)
Humans , Burns/surgery , Burns/epidemiology , Statistics on Sequelae and Disability , Contracture/surgery , Burns/complications , Retrospective Studies
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