Use of the vascularized iliac-crest flap in musculoskeletal lesions.

Bone loss was in the past treated by several methods, such as bone distraction and the use of nonvascularized or tissue-bank bone grafts. With the advent of modern microsurgical techniques, the vascularized bone flap has been used with good results; it resolves local nutritional problems, repairs soft tissue that is often damaged by severe trauma, and treats bone loss due to tumors, pseudarthroses, and osteomyelitis. This paper reports the authors' experience with the use of vascularized iliac-crest flaps to treat orthopedic pathologies in five patients with traumatic bone loss (<10 cm), three with osteomyelitis, and three with atrophic nonunion. In all cases, the same surgeon obtained a vascularized iliac-crest flap with a pedicle based on the deep iliac circumflex artery. All flaps consolidated within a mean period of 3 months. These findings demonstrate that the use of an iliac-crest flap is a treatment option in cases of bone loss and that it is associated with good functional results and minimal donor-site morbidity.

ARTHROSCOPIC RELEASE OF THE SUPRASCAPULAR NERVE: SURGICAL TECHNIQUE AND EVALUATION OF CLINICAL CASES.

UNLABELLED: To describe a specific surgical technique for arthroscopic decompression of the suprascapular nerve (SSN) and evaluate its preliminary results. METHODS: Ten shoulders of nine patients were operated using a technique with portals differing from the already-known techniques, which did not use traction and made use of materials available within the public healthcare system. RESULTS: Among the ten shoulders of nine patients, eight were right shoulders and two were left shoulders. The mean age was 69.5 years. The UCLA score increased from 11.7 to 26.1 points over the postoperative follow-up of 16.6 months. The SF-36 questionnaire score was 122.9 and the raw pain scale value was 88%. CONCLUSION: Arthroscopic decompression of the SSN in accordance with the described technique is reproducible and less traumatic than the open techniques. The patients achieved improvements in many of the parameters evaluated, particularly with regard to pain. Arthroscopic decompression of the SSN may be a therapeutic option for pathological compression of the SSN.

Liberação artroscópica do nervo supraescapular: técnica cirúrgica e avaliação de casos clínicos / Arthroscopic release of the suprascapular nerve: surgical technique and evaluation of clinical cases

OBJETIVO: Descrever uma técnica cirúrgica própria de descompressão artroscópica do nervo supraescapular (NSE) e avaliar seus resultados preliminares. MÉTODOS: 10 ombros de nove pacientes foram operados com uma técnica que utiliza portais diferentes das técnicas conhecidas, não usa tração e faz uso de materiais disponíveis na rede pública de saúde. RESULTADOS: 10 ombros de nove pacientes, sendo oito à direita e dois à esquerda, com média de idade de 69,5 anos, apresentaram mudança no escore UCLA de 11,7 para 26,1 no seguimento de 16,6 meses de pós-operatório. O questionário SF-36 teve pontuação de 122,9 e a escala bruta de dor de 88 por cento. CONCLUSÃO: A descompressão artroscópica do NSE, segundo a técnica descrita, é reprodutível e menos traumática que as técnicas abertas. Os pacientes obtiveram melhora em vários parâmetros avaliados, principalmente no que se refere à dor. A descompressão artroscópica do NSE pode ser uma opção terapêutica para a patologia compressiva do NSE.

OBJECTIVE: To describe a specific surgical technique for arthroscopic decompression of the suprascapular nerve (SSN) and evaluate its preliminary results. METHODS: Ten shoulders of nine patients were operated using a technique with portals differing from the already-known techniques, which did not use traction and made use of materials available within the public healthcare system. RESULTS: Among the ten shoulders of nine patients, eight were right shoulders and two were left shoulders. The mean age was 69.5 years. The UCLA score increased from 11.7 to 26.1 points over the postoperative follow-up of 16.6 months. The SF-36 questionnaire score was 122.9 and the raw pain scale value was 88 percent. CONCLUSION: Arthroscopic decompression of the SSN in accordance with the described technique is reproducible and less traumatic than the open techniques. The patients achieved improvements in many of the parameters evaluated, particularly with regard to pain. Arthroscopic decompression of the SSN may be a therapeutic option for pathological compression of the SSN.

Estesioneuroblastoma / Esthesioneuroblastoma

O estesioneuroblastoma é uma neoplasia maligna incomum, que tem origem no epitélio olfatório e corresponde de 4% a 6% dos tumores malignos dos seios paranasais. A última grande revisão sobre esses tumores mostra que, desde sua descoberta, há oitenta anos, menos de mil casos foram publicados na literatura mundial. As manifestações clínicas usuais constituem-se por anosmia, obstrução nasal e epistaxe. Devido às características microscópicas serem bastante variadas e inespecíficas, é importante que o diagnóstico seja bem estabelecido pela histoquímica e imunoistoquímica, pois disso dependerá o prognóstico do paciente. Por se tratar de uma doença rara, ainda não há consenso quanto ao melhor tipo de tratamento, mas os relatos de casos bem sucedidos incluíram tratamento multidisciplinar com quimioterapia, ressecção cirúrgica e radioterapia. Em um período de seis anos (janeiro/ 2000 a janeiro/2006), ocorreram quatro casos no serviço do Hospital e Maternidade Celso Pierro, que são aqui reportados

Esthesioneuroblastoma is an uncommon malignant neoplasm that arises from the olfactory epithelium and corresponds to 4% - 6% of all malignant tumors in the paranasal sinuses. The last extensive review on these tumors reveals that less than one thousand cases have been published in the literature since its discovery eighty years ago. The common clinical manifestations are anosmia, nasal obstruction and epistaxis. Since its microscopic characteristics vary greatly and are unspecific, a precise diagnosis using histochemical and immunohistochemical techniques cannot be overemphasized as the patient?s prognosis depends on the diagnosis. As it is a rare disease, there is no consensus regarding the best treatment, but reports of cases treated successfully cite a multidisciplinary approach, which includes chemotherapy, surgical resection and radiation therapy. Our service has treated four cases over a period of six years (January 2000 - January 2006) that are reported here