Reconstrução da ponta nasal: relatos de casos e revisão histórica / Nasal tip reconstruction: case reports and historical review

As amputações traumáticas da ponta nasal são lesões desfigurantes, que determinam importante rejeição social, impondo ao paciente um sofrimento adicional, além daqueles já causados pela ferida e suas limitações funcionais decorrentes do traumatismo. Tais defeitos representam um desafio para os cirurgiões plásticos, e existem diversas técnicas que poderão ser adotadas para tratar este mesmo tipo de defeito. Neste trabalho são mostrados inicialmente três casos de amputação traumática exclusivamente da ponta nasal com seus respectivos tratamentos, para em seguida apresentar uma revisão histórica e discussão das diversas técnicas utilizadas para reconstrução da ponta nasal, avaliando comparativamente e enfatizando a evolução técnica no armamentário da cirurgia plástica.

Traumatic amputations of the nasal tip are disfiguring injuries, which determine important social rejection, imposing additional suffering on the patient and those already caused by the wound and its functional limitations resulting from the trauma. Such defects represent a challenge for plastic surgeons, and several techniques can be adopted to treat this type of defect. This work shows three cases of traumatic amputation exclusively of the nasal tip with their respective treatments. They present a historical review and discussion of the different techniques used for nasal tip reconstruction, comparatively evaluating and emphasizing the technical evolution in plastic surgery armament.

Magnetic transcutaneous fixation: an experimental study in pigs.

BACKGROUND: Magnetic subdermal implants have never been studied in the context of magnetic fixation of an external device to the body's surface. Excessive attractive force between the implant and the external device may compromise local circulation due to mechanical compression, leading to necrosis. OBJECTIVE: To evaluate the feasibility of transcutaneous magnetic fixation and assess secondary skin changes when subjected to a continuous static magnetic field. METHODS: Using the pig as an animal model, 72 implants were introduced in 12 animals. After wound healing, ultrasonography was performed to measure implant depths. Computer simulations were applied to allow magnetic attachment between implants and external devices without impairing local blood flow. External devices of different magnetic strengths were applied over the skin for 7 days. Local skin was examined and collected for analysis. A senior dermatopathologist blindly examined skin specimens and controls for abnormal findings, measuring dermal and epidermal thickness. Statistical analysis (P <0.05) was performed over the data. RESULTS: Nineteen implants presented extrusion. The remaining 53 skin sites underwent magnetic compression, of which 43 (81%) evolved uneventfully. Implant depth varied between 4.6 mm and 8.3 mm (5.8 mm; ± 8.6 mm) with estimated pressure levels between 13.28 mmHg and 37.04 mmHg (27.6 mmHg; ±6.0 mmHg). Stronger magnets were associated with an increase in dermal thickness (P = 0.011) and neovascularization (P = 0.045). CONCLUSIONS: Transcutaneous magnetic fixation is compatible with skin viability in vivo, under experimental conditions. Skin interposition between two permanent magnets resulted in a continuous static magnetic field stimulation, which showed similar effects to pulsed electromagnetic fields reported on scientific literature.

Effects of local pressure on cutaneous blood flow in pigs.

OBJECTIVE: to evaluate the effects of increasing pressures on the cutaneous blood flow in the skin of pigs. METHODS: we conducted an experimental study in pigs submitted to subcutaneous magnetic implants (n=30). After healing, were applied external magnets with varying magnetic forces to the skin, generating compression. We evaluated the cutaneous circulation of the skin under compression by the Laser Speckle Contrast Imaging (LSCI) technique. We measured the depth of the implants by ultrasonography, and applied computational simulations to the calculation of the different pressure values, considering the different distances between implants and external magnets. RESULTS: nineteen implants presented complications. The remaining 11 were submitted to different magnetic compression forces and perfusion analysis. Two linear regression models showed an inverse correlation between exerted pressure and cutaneous perfusion, with significant variation, mainly in the initial pressure increases, of up to 20mmHg. CONCLUSION: The main reduction in cutaneous blood flow resulted from initial increases of up to 20 mmHg. The results suggest that tissue ischemia can occur even in low-pressure regimes, which could contribute to the appearance of skin lesions, particularly ulcers related to medical devices.

Effects of local pressure on cutaneous blood flow in pigs / Efeitos da pressão local no fluxo sanguíneo cutâneo de porcos

ABSTRACT Objective: to evaluate the effects of increasing pressures on the cutaneous blood flow in the skin of pigs. Methods: we conducted an experimental study in pigs submitted to subcutaneous magnetic implants (n=30). After healing, were applied external magnets with varying magnetic forces to the skin, generating compression. We evaluated the cutaneous circulation of the skin under compression by the Laser Speckle Contrast Imaging (LSCI) technique. We measured the depth of the implants by ultrasonography, and applied computational simulations to the calculation of the different pressure values, considering the different distances between implants and external magnets. Results: nineteen implants presented complications. The remaining 11 were submitted to different magnetic compression forces and perfusion analysis. Two linear regression models showed an inverse correlation between exerted pressure and cutaneous perfusion, with significant variation, mainly in the initial pressure increases, of up to 20mmHg. Conclusion: The main reduction in cutaneous blood flow resulted from initial increases of up to 20 mmHg. The results suggest that tissue ischemia can occur even in low-pressure regimes, which could contribute to the appearance of skin lesions, particularly ulcers related to medical devices.

RESUMO Objetivo: avaliar os efeitos de pressões crescentes exercidas sobre a pele de porcos no fluxo sanguíneo cutâneo. Métodos: estudo experimental em porcos submetidos a implantes magnéticos subcutâneos (n=30). Após a cicatrização, foram aplicados sobre a pele, ímãs externos com forças magnéticas variadas, gerando compressão. A circulação cutânea da pele submetida à compressão foi avaliada pela técnica Laser Speckle Contrast Imaging (LSCI). A profundidade dos implantes foi medida por ultrassonografia, e simulações computacionais foram aplicadas para o cálculo dos diferentes valores de pressão, considerando-se as variadas distâncias entre implantes e ímãs externos. Resultados: dezenove implantes apresentaram complicações. Os 11 restantes foram submetidos à diferentes compressões magnéticas e análise de perfusão. Dois modelos de regressão linear mostraram uma correlação inversa entre pressão exercida e perfusão cutânea com variação significativa principalmente nos acréscimos iniciais de pressão até 20mmHg. Conclusão: a principal redução do fluxo sanguíneo cutâneo resulta dos acréscimos iniciais de pressão de até 20mmHg. Os resultados sugerem que a isquemia tecidual pode ocorrer mesmo em regimes de baixa pressão, o que poderia contribuir para surgimento de lesões de pele, particularmente as úlceras relacionadas a dispositivos médicos.

Single block costal cartilage graft in rhinoplasty / Enxerto de cartilagem costal em monobloco na rinoplastia

INTRODUCTION: It is often necessary to use inclusion materials in rhinoplasty for nose restructuring. The costal cartilage graft is one of the inclusion material options, and its use is indicated when septal cartilage is not available or is not sufficient to provide necessary remodeling of the nose. METHODS: Four patients who, for diverse reasons, had saddle nose or poor projection of the nasal dorsum underwent rhinoplasty. All received a costal cartilage graft carved in an "L" shape. The long branch of the "L" was used to reconstruct the dorsum and the short branch was used to support the new dorsum and the columella, repositioning the nasal tip. RESULTS: All patients had a good postoperative evolution and had no significant complications. There was a clear reconstruction of the dorsum and harmonization of the nasal tip. The results were as expected and were long-lasting. CONCLUSIONS: The use of a costal cartilage graft carved in a single block in rhinoplasty provides enhancement of the nasal dorsum and tip projection, promoting appropriate nasal remodeling.

INTRODUÇÃO: Na rinoplastia frequentemente é necessário o uso de materiais de inclusão para que se obtenha a reestruturação nasal. O enxerto de cartilagem costal é uma das opções e tem seu uso indicado quando a cartilagem septal não está disponível ou não é suficiente para promover o necessário remodelamento nasal. MÉTODO: Quatro pacientes que, por motivos diversos, apresentavam nariz em sela ou dorso nasal pouco projetado foram submetidos a rinoplastia. Todos receberam enxerto de cartilagem costal esculpido em formato de "L". O ramo longo do "L" teve como objetivo reconstituir o dorso e o ramo curto, dar suporte ao novo dorso e à columela, reposicionando a ponta nasal. RESULTADOS: Todos os pacientes evoluíram bem no pós-operatório e não apresentaram complicação significativa. Houve nítida reconstituição do dorso e harmonização da ponta do nariz. Os resultados mostraram-se previsíveis e duradouros. CONCLUSÕES: O emprego de enxerto de cartilagem costal esculpido em monobloco na rinoplastia proporciona ganho de projeção do dorso e da ponta nasais, promovendo adequado remodelamento nasal.

Relative implant volume and sensibility alterations after breast augmentation.

BACKGROUND: Recent studies have provided diverging results regarding the factors that may affect sensibility after primary breast augmentation. Implant volume is believed to be an important factor, but the relation of implant size to breast volume has not been adequately addressed. In addition, the literature shows that a conflict exists when the periareolar and inframammary approaches are compared. This study aimed to refine the volumetric analysis comparing the implant and final breast size as well as the intrinsic association of these two factors with postoperative sensory alteration of the breast. METHODS: A prospective study investigated patients who underwent aesthetic breast augmentation between June 2004 and October 2005 (i.e., a 16-month period) at the Ivo Pitanguy Institute. The sensibility in nine regions of the breast was tested before and after surgery using Semmes-Weinstein monofilaments. Breast sizers were used to compare the pre- and postoperative breast volumes. Statistical analysis of the data took into consideration the relative volume of the implant, the surgical approach, the presence of minor complications, the breast-feeding history, and the subjective evaluation of sensory changes in the patients. RESULTS: A total of 37 patients who underwent breast augmentation were examined preoperatively. The relative volume of the implant was found to be associated with sensibility alterations. No difference was found between the periareolar and inframammary incision approaches. Other factors such as previous breast-feeding, minor complications, and subjective alterations were not associated with sensory alterations. CONCLUSIONS: The study findings suggest that larger implants and smaller breasts show an increased association with postoperative sensory alterations of the breast. Plastic surgeons and their patients should be aware of this possibility. Implant volume should be considered together with breast size to avoid sensory complications, and this is summarized in the concept of relative volume.

Automedicaçäo na populaçäo idosa do Núcleo de Atençäo ao Idoso da UnATI/UERJ / Self medication of the elderly population from Nucleous of Attention of Old Age - UnATI/UERJ

Aborda variáveis como percepção de morbidade, natureza dos medicamentos ingeridos, motivos para sua ingestão e origem de sua prescrição. Os achados indicam um padrão de consumo de medicamentos substancialmente baixo para a faixa etária estudada, sugerindo uma conduta diferenciada e sóbria por parte da equipe de saúde da UnATI, no que tange à prescrição de medicamentos (Org)

Automedicaçäo na populaçäo idosa do núcleo de atençäo ao idoso da UnATI-UERJ / Self medication of the elderly population from Nucleous of Attention of Old Age, UnATI-UERJ

Realizou-se um inquérito, junto à população do ambulatório do Núcleo de Atenção ao Idoso (NAI) da Universidade Aberta da Terceira Idade (UnATI), da Universidade do Estado do Rio de Janeiro (UERJ), para se conhecer o padrão de automedicação da população idosa ali atendida. Foram colhidos 140 questionários de perguntas fechadas com váriaveis sexo, idade, residência, percepção de morbidade, medicamentos ingeridos na véspera, na última semana e nos últimos 30 dias, motivos para ingestão e origem da prescrição. Encontrou-se uma média de ingestão de medicamentos mais baixa do que a relatada na literatura, de 2,7 por cento por entrevistado, e um índice de automedicação de até 23,3 por cento. Comparados esses dados aos de uma população semelhante, da UnATI como um todo, percebeu-se um índice de uso de medicamentos sensivelmente mais baixo na população do ambulatório, sugerindo que os médicos da Instituição apresentam uma conduta diferenciada e mais sóbria na prescrição.