Optical Properties of Human Skin Phototypes and Their Correlation with Individual Angle Typology.

Objective: This study aims to correlate human skin phototypes with complete optical characterization (absorption, scattering, effective attenuation, optical penetration, and albedo coefficients) based on individual typology angle (ITA) values and colorimetric parameters. Methods: A colorimeter was used to group 12, fresh, ex vivo human skin samples according to their phototype; the CIELAB color scale and ITA values were employed. An integrating sphere system and the inverse adding-doubling algorithm were applied during optical characterization, conducted from 500 to 1300 nm. Results: On the basis of ITA values and their classification, the skin samples were separated into six groups: two intermediates, two tan, and two brown. In the visible range, for lower ITA values (darker skins), the absorption and effective attenuation coefficient parameters increased, whereas the albedo and depth penetration parameters decreased. In the infrared region, all the phototypes had similar parameters. The scattering coefficient was similar for all the samples and did not change with ITA values. Conclusions: ITA analysis, a quantitative method, showed that the human skin tissue's optical properties and pigmentation colors were highly correlated.

The role of the perioperative prone position in the low recurrence of pressure injuries in the pelvic region.

OBJECTIVE: A pressure injury (PI) is a localised area of damage to the skin and/or underlying soft tissue as a result of a sustained mechanical loading. There are three key aetiological mechanisms to PI formation-direct cell deformation, inflammatory oedema and ischaemic damage-which are typically activated sequentially to drive a spiral of injury. This article discusses the role of the perioperative prone position as a rational approach to reducing the recurrence of pelvic PI after reconstructive surgery. METHOD: Patients with deep PI in the pelvic region, who were operated on from 2011 to 2019, were retrospectively evaluated. The protocol of care included training in the prone position, followed by maintenance of the prone position for 4-6 weeks postoperatively. The reconstruction was performed with fasciocutaneous and myocutaneous local or regional flaps. RESULTS: The study evaluated a total of 26 patients. The rate of recurrence of PIs was 15.4% (4/26) in the mean follow-up of 54 months. Regarding postoperative complications, four cases of partial dehiscence of the suture occurred. CONCLUSION: This perioperative protocol of maintaining a prone position seems to be safe for the patient, and it can be used to prevent or reduce the recurrence of deep PIs on the pelvic region after reconstructive surgery.

Treating complex palmar-plantar wounds using a bilaminar 'trapdoor' technique: a case series.

OBJECTIVE: Due to the similarities of glabrous skin, the plantar region is an excellent donor area for covering complex palmar-plantar wounds. However, taking grafts from the plantar area often results in significant morbidity at the donor site or non-integration of the graft due to the greater thickness of the plantar corneal layer. METHOD: This is a prospective case series including patients with burns or wounds who have been treated with a dermal graft using the bilaminar 'trapdoor' technique. This procedure is used to remove a thin graft from the deep plantar dermis after the partial elevation of the first layer including the entire epidermis and superficial part of the dermis. RESULTS: At the donor area in the four patients in this case series, we observed healing at around 10 days, and absence of hypertrophic scar in all patients. There was complete re-epithelialisation between two and three weeks from the periphery to the centre of the deep dermal graft, and from the glandular epithelium transferred with the graft. During the follow-up, patients presented aesthetic and functional features of glabrous and amelanotic skin, with similar resistance to those of the adjacent areas of the wound in the palmar-plantar region. CONCLUSION: This technique has some advantages, such as less surgical time, minimal morbidity in the plantar donor area, easy integration of the grafts, and maintenance of the functional and aesthetic properties of glabrous skin both in the plantar donor area and in the palmar-plantar recipient region. DECLARATION OF INTEREST: The authors have no conflicts of interest to declare.

Comparison Between Two Strategies of Topical Treatment in Tar Burn: A Case Report.

The management of tar burns presents a wide range of possible approaches, and several strategies can be used to reduce the damage regarding the removal of tar adhered to the patient's skin. Tar residues should preferably be emulsified with solvent solutions. Due to the low incidence of tar burns, it has not yet been possible to select the appropriate agent for the removal of the adhered tar. In this article, we reported a case of a 47-year-old man with a tar burn in his forehead region and his both upper limbs treated with two different approaches and the outcomes. In the right upper limb, the removal of tar with oil-based on essential fatty acids was attempted at the time of hospital admission, whereas in the left upper limb, he was treated with 1% silver sulfadiazine cream, sterile gauze, and bandage. On the right upper limb, the treatment was eventually performed with debridement and split-thickness skin grafting. On the left upper limb, there was complete re-epithelialization of the burns. The more conservative approach of keeping a dressing with 1% silver sulfadiazine on the tar itself, followed by removing the material in the dressing changes was considered better than the immediate removal of tar with an oily solution, especially about pain. Our impression was that the application of 1% silver sulfadiazine cream at the time of the admission, as well as in the following days, may be beneficial for the removal of the tar in close contact with the skin. Possibly, this approach leads to less trauma to the skin and, eventually, simplifies the treatment of burns by hot tar.

Covid-19 e cirurgia plástica: relato de caso de tratamento de ferida complexa / Covid-19 and Plastic Surgery: a case report of complex wound treatment

Introdução: A pandemia decorrente da Covid-19 modificou de forma significativa a rotina e o trabalho das especialidades médicas. Relatamos o caso de um paciente tratado pela cirurgia plástica que contraiu o vírus Sars- CoV-2. Relato de caso: Homem de 66 anos, com ferida complexa em tornozelo, foi tratado com desbridamento cirúrgico e terapia por pressão negativa, sendo posteriormente submetido à cobertura cutânea da ferida com enxerto de pele parcial. No pós-operatório imediato, iniciou quadro de tosse seca, sendo que nesse mesmo dia havia sido confirmado um exame positivo do novo coronavírus em outro paciente que estava no mesmo quarto. Diante disso, solicitamos testagem com PCR que também resultou positiva para presença de Sars-CoV-2. O paciente evoluiu bem, com alta hospitalar no 5º dia de pós-operatório, após a retirada do curativo de Brown, e com retorno após o período de isolamento preconizado (14 dias). Discussão: O manejo de pacientes que necessitam de procedimentos cirúrgicos em meio a uma pandemia viral deve considerar a adoção de medidas preventivas que reduzam a possibilidade de transmissão do vírus. Como exemplo, citamos a redução do tempo de internação hospitalar, o uso de terapias que aceleram o processo terapêutico, o isolamento do paciente em casos confirmados e o uso de equipamentos de proteção individual. Conclusão: Apesar da infecção deste paciente pelo Sars-CoV-2, enfatizamos que a equipe de cirurgia plástica deve atuar de maneira precoce durante o processo de tratamento. Tais ações reduzem a possibilidade de disseminação do novo coronavírus para outros pacientes e para equipe de saúde.

Introduction: A pandemic from Covid-19 has significantly changed the routine and work of medical specialties. We report the case of a patient treated by plastic surgery who was infected by the Sars-CoV-2 virus. Case report: A 66-year-old man, with a complex wound on his ankle, was treated with surgical debridement and negative pressure wound therapy, and subsequently underwent cutaneous coverage of the wound with split thickness skin graft. In the immediate postoperative period, dry cough started, and that same day a positive examination of the new coronavirus was confirmed in another patient who was in the same infirmary. Therefore, we requested a PCR test that was also positive for the presence of Sars- CoV-2. The patient evolved well, being discharged on the 5th postoperative day, after the removal of Browns dressing, and returning after the recommended isolation period (14 days). Discussion: The management of patients with surgical procedures in the midst of a viral pandemic should consider the adoption of preventive measures that reduce the possibility of virus transmission. As an example, we mention the reduction in hospital stay, the use of therapies that speed up the therapeutic process, the isolation of the patient in confirmed cases and the use of personal protective equipment. Conclusion: Despite the infection of this patient by Sars-CoV-2, we emphasize that the plastic surgery team must act early during the treatment process. These actions include the possibility of spreading a new coronavirus to other patients and the healthcare team.

Cirurgia reparadora no contexto da Covid-19: complicações evolutivas no tratamento de ferida complexa inguinal / Reconstructive surgery in the context of Covid-19: complications in the treatment of an inguinal complex wound

Introdução: No final de 2019, o mundo viu surgir uma nova síndrome respiratória denominada Covid-19, causada por um novo tipo de coronavírus, o Sars-CoV-2. Classificada como uma pandemia, ela tem causado impactos de magnitude ainda imensuráveis. Relato de caso: Homem de 57 anos desenvolveu ferida inguinal direita, após exploração cirúrgica por infecção de prótese usada em bypass femoro-poplíteo. A equipe de cirurgia plástica optou pelo tratamento com desbridamento cirúrgico, associado com terapia por pressão negativa para preparo do leito da ferida. No pós-operatório, apresentou síndrome respiratória aguda grave e suspeita de Covid-19, com necessidade de intubação e de cuidados intensivos. Foi colhido amostra para RT-PCR do Sars-CoV-2 e associado ao tratamento as medicações cloroquina e azitromicina. Apesar do tratamento intensivo, o paciente foi a óbito. O resultado do exame RT-PCR para o novo coronavírus foi positivo, sendo liberado dois dias após a morte. Discussão: A análise deste relato permite supor que o paciente provavelmente contraiu o novo coronavírus dentro do próprio hospital, pois o mesmo encontrava-se internado pelo período dos 35 dias anteriores à evolução para insuficiência respiratória. Esse fato, juntamente com sua evolução desfavorável, corrobora a orientação de minimizar ao máximo as internações e os procedimentos cirúrgicos a fim de promover maior segurança ao paciente e à equipe de saúde. Conclusão: Pacientes internados estão susceptíveis à infecção pelo novo coronavírus e podem configurar grupo de maior de risco, uma vez que muitos deles já se encontram debilitados.

Introduction: At the end of 2019, the world saw the emergence of a new respiratory syndrome called Covid-19, caused by a new type of coronavirus, Sars-CoV-2. Classified as a pandemic, it has caused impacts of considerable magnitude. Case Report: A 57-year-old man developed a right inguinal wound after surgical exploration for infection of a prosthesis used in a femur-popliteal bypass. The Plastic Surgery team opted for treatment with surgical debridement associated with negative pressure therapy to prepare the wound bed. In the postoperative period, he had severe acute respiratory syndrome and suspected Covid-19, requiring intubation and intensive care. A sample for RT-PCR of Sars-CoV-2 was collected, and the medications chloroquine and azithromycin were associated with the treatment. Despite intensive treatment, the patient died. The result of the RT-PCR test for the new coronavirus was positive, being released two days after death. Discussion: The analysis of this report allows us to suppose that the patient probably contracted the new coronavirus at the hospital, as he was hospitalized for 35 days before the evolution of respiratory failure. This fact, together with its unfavorable evolution, corroborates the orientation of minimizing hospitalizations and surgical procedures as much as possible to promote more safety for the patient and the health team. Conclusion: Inpatients are susceptible to infection with the new coronavirus and can set up a group at higher risk since many of them are already weakened.

Does postauricular fascial flap reduce suture complications in otoplasty?

Numerous suture techniques and covering flaps have been described to minimize complications related to sutures in otoplasty. The split postauricular fascial flap is one of such techniques, and it has been used to pad otoplasty suture. The aim of this study was to evaluate complications related to nonabsorbable cartilage sutures in otoplasty, using a variation of the split postauricular fascial flap. In this retrospective case series, we analyzed otoplasty patients in whom simplified split postauricular fascial flap was utilized. A postauricular skin ellipse was de-epithelialized (preserving dermis) and a longitudinally split in half. Flaps were dissected, and they were positioned on the cartilage to promote additional soft tissue coverage to the sutures. The lateral flap covered conchoscaphal sutures while the medial flap covered the conchomastoid sutures. Both the flaps were not sutured to cartilage. Early and late postoperative complications were evaluated. A total of 142 patients were included. Twenty-four (16.9%) patients developed late complications: 13 (9.1%) patients had palpable and visible sutures, nine (6.3%) had suture extrusion and two (1.4%) had hypertrophic scars. In this case series, the simplified split postauricular flap did not prevent or reduce late complications related to suture extrusion in otoplasty. It is possible that suturing the entire length of the flaps may play a role in our results. So, anchoring the flap and possibly tightening it a little may be an important technical step to prevent extrusion of sutures whenever the postauricular flap is used.

Application of Unilateral Pectoralis Major Muscle Flap in the Treatment of Sternal Wound Dehiscence.

OBJECTIVE: This study aims to report the use of the unilateral pectoralis major muscle flap for the treatment of the sternal wound dehiscence. METHODS: A retrospective study including patients who underwent unilateral pectoralis major muscle flap was performed for the treatment of sternotomy dehiscence due to coronary artery bypass, valve replacement, congenital heart disease correction and mediastinitis, between 1997 and 2016. Data from the epidemiological profile of patients, length of hospital stay, postoperative complications and mortality rate were obtained. RESULTS: During this period, 11 patients had their dehiscence of sternotomy treated by unilateral pectoralis major muscle flap. The patients had a mean age of 54.7 years, the mean hospital stay after flap reconstruction was 17.9 days (from 7 to 52 days). In two patients, it was necessary to harvest a flap from the rectus abdominis fascia, in association with the pectoralis major muscle flap, to facilitate the closure of the distal wound. In the postoperative period, seroma discharge from the surgical wound was observed in six patients, five reported intense pain (temporary), three had partial cutaneous dehiscence, and two presented granuloma of the incision. CONCLUSION: The complex wound from sternotomy dehiscences presents itself as a challenge to surgical teams. Treatment should include debridement of necrotic tissue and preferably coverage with well-vascularized tissue. We propose that the unilateral pectoralis major muscle flap is an interesting and low morbidity option for the reconstruction of sternal wound dehiscences, with proper sternum stability and satisfactory functional and aesthetic outcomes.

Application of unilateral pectoralis major muscle flap in the treatment of sternal wound dehiscence

Abstract Objective: This study aims to report the use of the unilateral pectoralis major muscle flap for the treatment of the sternal wound dehiscence. Methods: A retrospective study including patients who underwent unilateral pectoralis major muscle flap was performed for the treatment of sternotomy dehiscence due to coronary artery bypass, valve replacement, congenital heart disease correction and mediastinitis, between 1997 and 2016. Data from the epidemiological profile of patients, length of hospital stay, postoperative complications and mortality rate were obtained. Results: During this period, 11 patients had their dehiscence of sternotomy treated by unilateral pectoralis major muscle flap. The patients had a mean age of 54.7 years, the mean hospital stay after flap reconstruction was 17.9 days (from 7 to 52 days). In two patients, it was necessary to harvest a flap from the rectus abdominis fascia, in association with the pectoralis major muscle flap, to facilitate the closure of the distal wound. In the postoperative period, seroma discharge from the surgical wound was observed in six patients, five reported intense pain (temporary), three had partial cutaneous dehiscence, and two presented granuloma of the incision. Conclusion: The complex wound from sternotomy dehiscences presents itself as a challenge to surgical teams. Treatment should include debridement of necrotic tissue and preferably coverage with well-vascularized tissue. We propose that the unilateral pectoralis major muscle flap is an interesting and low morbidity option for the reconstruction of sternal wound dehiscences, with proper sternum stability and satisfactory functional and aesthetic outcomes.

Gluteal Augmentation With Intramuscular Implants in Patients With Human Immunodeficiency Virus With Lipoatrophy Related to the Use of Antiretroviral Therapy.

INTRODUCTION: Lipodystrophy syndrome associated with highly active antiretroviral therapy (HAART) may lead to low self-esteem and poor compliance with the drug treatment on patients infected with human immunodeficiency virus (HIV), which is a matter of concern for the health system. The aim of this study was to evaluate patients with HIV submitted to gluteal augmentation with intramuscular silicone implants to correct gluteal lipoatrophy related to the use of HAART. METHODS: This is a retrospective evaluation of 10 patients submitted to gluteal augmentation with intramuscular silicone implant for correction of gluteal lipoatrophy related to the use of HAART, operated between 2012 and 2015. Postoperative complications and the degree of patient's satisfaction were analyzed. RESULTS: There were 3 postoperative complications including 1 case of surgical wound dehiscence and 2 cases of seroma. Six months after surgery, 8 patients had an excellent degree of satisfaction, and 2 patients had a good degree of satisfaction related to the procedure. Although this intervention does not offer functional advantages, it improves the body contour, increases patients' self-esteem, and helps them to accept their body image. These advantages can lead to higher compliance with prolonged HAART. CONCLUSIONS: Gluteal augmentation with intramuscular silicone implant can be a viable option to treat patients with HIV with gluteal lipoatrophy related to the use of HAART. The patients were satisfied with the outcomes of the procedure, and there were only minor self-limited postoperative complications.

Negative pressure therapy for the treatment of complex wounds.

The objective of this study is to evaluate the effectiveness of negative pressure therapy (NPT) in the treatment of complex wounds, with emphasis on its mechanisms of action and main therapeutic indications. We searched the Pubmed / Medline database for articles published from 1997 to 2016, and selected the most relevant ones. The mechanisms of action of NPT involveboth physical effects, such as increased perfusion, control of edema and exudate, reduction of wound dimensions and bacterial clearance, and biological ones, such as the stimulation of granulation tissue formation, microdeformations and reduction of Inflammatory response. The main indications of NPT are complex wounds, such as pressure ulcers, traumatic wounds, operative wound dehiscences, burns, necrotizing wounds, venous ulcers, diabetic wounds, skin grafts, open abdomen, prevention of complications in closed incisions and in the association with instillation of solutions in infected wounds.

O objetivo desse estudo é avaliar a eficácia da terapia por pressão negativa (TPN) no tratamento de feridas complexas, com ênfase em seus mecanismos de ação e principais indicações terapêuticas. Foi realizada revisão na base de dados Pubmed / Medline, em artigos publicados de 1997 a 2016, e selecionados os mais relevantes. O mecanismo de ação da TPN envolve efeitos físicos, como o aumento da perfusão, controle do edema e do exsudato, redução das dimensões da ferida e depuração bacteriana, e biológicos, como o estímulo à formação de tecido de granulação, microdeformações e redução da resposta inflamatória local. As principais indicações da TPN são as feridas complexas como úlceras por pressão, feridas traumáticas, deiscências de ferida operatória, queimaduras, feridas necrotizantes, úlceras venosas, feridas diabéticas, os enxertos de pele, o abdome aberto, na prevenção de complicações em incisões fechadas e na associação com instilação de soluções em feridas infectadas.

Curativos de prata iônica como substitutos da sulfadiazina para feridas de queimaduras profundas: relato de caso / Ionic silver dressings as substitute for sulfadiazine for deep burn wounds: case report / Apósitos de plata iónica como sustitutos de sulfadiazina en las heridas por quemaduras profundas: reporte de caso

OBJETIVO: Este artigo tem por objetivo relatar as possíveis vantagens de curativos na forma de lâminas impregnadas com prata iônica (Atrauman®, Mepilex border Ag®, Mepilex-Ag® e Silvercel não aderente®) como agentes tópicos substitutos do creme de sulfadiazina de prata 1% nas queimaduras profundas. RELATO DOS CASOS: Foram tratados 31 pacientes. O Atrauman-Ag® foi empregado em 15 pacientes, o Mepilex border Ag® em três, Mepilex-Ag® em quatro e o Silvercel não aderente® em nove pacientes. Do total, relatamos a utilização destes novos curativos em dois pacientes do estudo com diagnóstico inicial de queimadura profunda. Em nenhum caso foram observados sinais de infecção nas feridas, apesar das trocas de curativos terem sido realizadas entre 4 a 7 dias, mesmo nas queimaduras de espessura total. O conforto propiciado por estes curativos foi evidente, minimizando o estresse e dor e as feridas de espessura parcial se apresentaram com sinais evidentes de rápida epitelização. CONCLUSÃO: Neste estudo preliminar, notamos que todos pacientes se beneficiaram de modo significativo do uso de curativos modernos com lâminas impregnadas por prata iônica quando comparados ao curativo convencional de sulfadiazina. Além da proteção contra infecção, mesmo nas queimaduras de espessura total, eles oferecem a enorme vantagem de as trocas serem espaçadas entre 4 a 7 dias, quando comparados à sulfadiazina, que exige a troca diária dos curativos, minimizando dor e desconforto aos pacientes e também o estresse da equipe de saúde envolvida nos Centros de Tratamento de Queimados.(AU)

OBJECTIVES: This article aims to evaluate the efficacy, and possible advantages of dressings in the form of ionic silver impregnated sheets (Atrauman Ag®, Mepilex Border Ag®, Mepilex - Ag® and Silvercel non - adherent®) as a local substitute agents for the cream of silver sulfadiazine-1% on deep burns. CASE REPORTS: 31 patients were treated. Atrauman-Ag® was used in 15 patients, Mepilex Border Ag® in three, Mepilex-Ag® in four and Silvercel non-adherent® in nine patients. Of the total, we report the use of these new dressings in two patients. In no case were signs of wound infection, even though dressing changes were performed between 4 and 7 days, also in total thickness burns. The comfort provided by these dressings was evident, minimizing stress and pain and partial thickness wounds presented with clear signs of rapid epithelization. CONCLUSION: In this preliminary study, we noticed that all patients benefited significantly from the use of new dressings with ionic silver impregnated sheets when compared to the conventional dressing of sulfadiazine cream. In addition to protection against infection, even in full-thickness burns, they offer the significant advantage that the changes of dressings are spaced between 4 and 7 days. Compared to sulfadiazine, which requires the daily exchange of dressings, they minimize pain and discomfort to patients, and also the stress to the health team involved in the treatment of the Burn Treatment Centers.(AU)

Objetivos: Este artículo tiene como objetivo evaluar la eficacia preliminar y los beneficios potenciales de la curación en forma de láminas impregnadas con plata iónica (Atrauman®, Mepilex Border Ag®, Mepilex-Ag® y Silvercel no aderente®) como sustitutos de crema de sulfadiazina de plata al 1% en quemaduras profundas. Casos Clínicos: Se han tratado 31 pacientes. El Atrauman-Ag® se utilizó en 15 pacientes, Mepilex Border Ag® en tres, Mepilex Ag® en cuatro y Silvercel no adherente® en nueve pacientes. Del total, se presenta la utilización de estos nuevos apósitos en dos pacientes. En ningún caso se observaron signos de infección en las heridas, a pesar de los cambios de apósito se llevaron a cabo entre los 4 y 7 días, incluso en quemaduras de espesor total. La comodidad ofrecida por éstos curación era evidente, lo que minimiza el estrés y el dolor y las heridas de espesor parcial se presentan con signos claros de una rápida epitelización. Conclusión: En este estudio preliminar, se observó que todos los pacientes se beneficiaron significativamente del uso de apósitos impregnados con plata iónica en comparación con sulfadiazina. Además de la protección contra la infección, incluso en quemaduras de espesor total, ofrecen la gran ventaja de las cambios están separadas de 4 a 7 días en comparación con sulfadiazina, que requiere el cambio diario de vendajes, minimizando dolor y malestar a los pacientes, e también el estrés del personal de salud de los centros de tratamiento de Queimados.(AU)

Gluteal Augmentation with Silicone Implants: A New Proposal for Intramuscular Dissection.

BACKGROUND: Gluteoplasty has gained notoriety over the last decades, which has motivated the development of various surgical techniques. Nevertheless, the fear of dissection of the intramuscular plane without direct visualization may inhibit learning and development of gluteal augmentation with implants. Moreover, literature detailing the technical steps of intramuscular dissection for the construction of the implant pocket is scarce. This study presents a new approach to intramuscular dissection for gluteal augmentation with silicone implants, a variation of the conventional surgical technique. METHODS: We performed a retrospective analysis of a series of 12 female patients submitted to a variation of the intramuscular dissection technique for gluteal augmentation with silicone implants. Data from patients, implants, follow-up time, postoperative complications, and the degree of patient satisfaction were obtained. This technique follows the principle of alternating spatulas to perform the blunt dissection of the implant pocket. RESULTS: In this series, the proposed technique is controlled and safe for intramuscular dissection, which can be used for both experienced and training surgeons. This technique is based on well-known anatomical points and references. We observed that the implant was well positioned and covered, the patients were satisfied with the result, and the number of complications was low. CONCLUSIONS: This variation of the intramuscular dissection technique for gluteal augmentation with silicone implants provides an easily reproducible and safe procedure that involves well-controlled technical steps, especially during dissection of the intramuscular pocket. In this series of patients, training surgeons learned faster, results were satisfactory, and the number of complications was low. LEVEL OF EVIDENCE V: 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 .