Epidemiological Profile of Victim Patients of Facial Canine and Human Bites in a Public Hospital.

INTRODUCTION: Bites are among the most common types of trauma to which humans are exposed. The possibility of disfiguring lesions and the transmission of infectious diseases with high morbidity make this trauma a public health problem. METHOD: This was a retrospective, descriptive study that analyzed the medical records of patients treated at the Emergency Unit of the Plastic Surgery Service of the Asa Norte Regional Hospital from March 2019 to March 2020. The variables analyzed included age, sex, origin, time interval from aggression to hospital care, aggressor agent, wound site, lesion characteristics, and treatment. RESULTS: A total of 103 patients with a mean age of 25 years were evaluated. Most patients were male (57.3%), and 73.8% were from the Federal District. The most common type of treatment was direct suturing in 77.7% of cases, followed by local flaps (15.5%) or grafts (4.9%). There were no deaths or infections reported. CONCLUSION: The predominant profile of a facial bite victim is a young male adult living in the Federal District, bitten by a canine and treated with direct sutures. Adequate treatment for animal bites should include prevention of infection, such as rabies and tetanus, as well as primary wound closure for achieving a better prognosis and satisfactory esthetics for the patient.

Quality of life and predictive factors for complications in patients undergoing abdominoplasty after gastric bypass: A retrospective cohort.

BACKGROUND: Obesity is a major health risk factor associated with medical complications, such as cardiovascular disease, that may compromise outcomes. Furthermore, obesity may lead to difficulties in daily life, altering the quality of life and generating psychological disorders such as devalued self-image and depression. OBJECTIVES: This study evaluated the quality of life and predictive factors of postoperative complications in patients who underwent abdominoplasty after Roux-en-Y gastric bypass. SETTING: Bariatric and postbariatric center, North Wing Regional Hospital, Brasília, Brazil. METHODS: Data were analyzed from a prospective registry of postbariatric patients who underwent abdominoplasty from January 2011 to December 2016. Variables examined included age, sex, body mass index (BMI), complications, and comorbidities. Multivariate analyses were performed to assess outcome measures. The quality-of-life assessment was measured with the Moorehead-Ardelt quality-of-life questionnaire. RESULTS: One hundred and seven postbariatric patients were included. The mean age of the patients was 41 years. BMI at the time of abdominoplasty (current BMI) was 27.6 ± 3.7 kg/m2, and the average weight loss before abdominoplasty was 47.7 ± 17.3 kg. Pre-weight loss BMI (max BMI) was 45.5 ± 7.6 kg/m2, and ∆BMI was 18.6 ± 9.3 kg/m2. The overall rate of complications was 23.4%. Among the studied factors in the multivariate analysis, amount of removed tissue in the abdomen >2000 g, ∆BMI >20 kg/m2, and age >40 years significantly increased the rates of postoperative complications. In our study, abdominoplasty improved the quality of life of patients (mean quality-of-life scores, 2.1 ± 0.9). CONCLUSION: The amount of removed tissue in the abdomen, ∆BMI >20 kg/m2, and age >40 years led to significantly more complications in patients undergoing abdominoplasty after gastroplasty. In addition, this study demonstrated that abdominoplasty should be proposed to patients with massive weight loss to improve quality of life.

Abdominoplastia em pacientes pós-bariátricos: perfil antropométrico, comorbidades e complicações / Abdominoplasty in gastric bypass patients: anthropometric profile, comorbidities, and complications

Introdução: Os pacientes submetidos à gastroplastia apresentam importante perda de peso e a cirurgia plástica representa um importante meio de tratamento do excesso de pele. Método: Estudo prospectivo foi realizado em pacientes submetidos à abdominoplastia pós-gastroplastia no período de janeiro de 2011 a dezembro de 2016 em hospital público. As variáveis analisadas foram: IMC (Índice de Massa Corporal) antes da gastroplastia e antes da cirurgia plástica, perda de peso, peso do retalho retirado, comorbidades e complicações. Resultados: 107 pacientes que realizaram abdominoplastia foram incluídos. Média de idade foi 41 anos. O IMC médio antes da cirurgia plástica foi 27,6 ± 3,7 Kg/m2. Perda de peso médio foi 47,7 ± 17,3 Kg. O IMC máximo antes da gastroplastia foi 45,5 ± 7,5 Kg/m2 e o IMC foi 18,6 ± 9,3 Kg/m2. Comorbidades presentes antes da plástica foram: hipertensão arterial (11,1%), artropatia (4,6%), diabete melito (5,6%) e síndrome metabólica (5,6%). Catorze (13,1%) pacientes realizaram herniorrafia durante a abdominoplastia. A taxa de complicações foi 31,5%. O peso antes da gastroplastia, IMC antes da gastroplastia, perda de peso médio, comorbidades, peso do retalho do abdome e IMC > 20Kg/m2 foram fatores associados significativamente a complicações pós-operatórias. Conclusões: A gastroplastia em Y de Roux foi uma terapêutica efetiva na resolução de comorbidades em obesos. Comorbidades, peso antes da gastroplastia, perda de peso médio, quantidade de tecido retirado do abdome e IMC > 20Kg/m2 levaram significativamente a mais complicações em pacientes pósbariátricos submetidos à abdominoplastia. A cirurgia plástica é importante no cuidado integral ao paciente obeso e otimizou os resultados alcançados com a cirurgia bariátrica.

Introduction: Patients who undergo vertical-banded gastroplasty- Roux-en-Y gastric bypass (VBG-RYGB) have significant weight loss, and abdominoplasty (AP) is an effective corrective surgery for removing excess skin. Methods: A prospective study conducted from January 2011 to December 2016 in a public hospital evaluated patients who underwent AP after VBG-RYGB. The analyzed variables were body mass index (BMI) before VBG-RYGB, BMI before AP, weight loss, weight of the excised abdominal flap, comorbidities, and complications. Results: For this study, 107 patients who underwent AP were included. The patients' mean age was 41 years; BMI before AP, 27.6 ± 3.7 kg/m2; and mean weight loss, 47.7 ± 17.3 kg. The maximum BMI before bariatric surgery was 45.5 ± 7.5 kg/m2, and the difference between the maximum BMI before VBG-RYGB and before corrective surgery was 18.6 ± 9.3 kg/m2. The comorbidities observed before VBG-RYGB were arterial hypertension (11.1%), arthropathy (4.6%), diabetes mellitus (5.6%), and metabolic syndrome (5.6%). Fourteen patients (13.1%) underwent herniorrhaphy during AP. The overall complication rate was 31.5%. Weight before VBGRYGB, BMI before VBG-RYGB, mean weight loss, comorbidities, abdominal flap weight, and BMI of >20 kg/m2 were significantly associated with postoperative complications. Conclusions: VBGRYGB was an effective approach to reduce comorbidities in obese patients. Comorbidities, weight before VBG-RYGB, mean weight loss, amount of tissue removed from the abdomen, and BMI of >20 kg/m2 significantly increased the complication rate in the gastric bypass patients who underwent AP. Furthermore, AP is fundamental for the comprehensive care of obese patients and has optimized the results achieved with VBG-RYGB.

Anthropometric and clinical profiles of post-bariatric patients submitted to procedures in plastic surgery.

OBJECTIVE: to evaluate the profile of patients submitted to post-bariatric plastic surgery at the North Wing Regional Hospital, Brasília, DF. METHODS: we conducted a prospective, descriptive and analytical study of patients submitted to Roux-en-Y gastroplasty, and subsequently to plastic surgery, from January 2011 to December 2016. We assessed body mass index before gastroplasty and after surgery plastic surgery, postoperative complications and comorbidities. RESULTS: we studied 139 patients (130 women and nine men), with a mean age of 41 years, who underwent 233 operations. The mean BMI at the time of plastic surgery was 27.44kg/m2. The mean weight loss was 47.02kg and the mean maximum BMI was 45.17kg/m2. The mean time between bariatric surgery and plastic surgery was 42 months. The most important co-morbidities before plastic surgery were arterial hypertension (11.5%), arthropathy (5.4%), diabetes mellitus (5%) and metabolic syndrome (4.3%) (p<0.01). Of the 139 patients operated on, 76.97% underwent abdominoplasty followed by mammoplasty (42.46%), rhytidoplasty (17.27%) and brachioplasty (13.67%). Fourteen (13.08%) patients underwent herniorrhaphy combined with abdominoplasty. We performed anchor abdominoplasty in 19.42%. The rate of postoperative complications was 26.65%. CONCLUSION: the epidemiological profile of post-bariatric patients who underwent plastic surgery was similar to that reported in the literature, except for the low rate of associated surgeries and postoperative complications. Plastic surgery in post-bariatric patients has led to an improvement in the quality of life in most of these patients.

Anthropometric and clinical profiles of post-bariatric patients submitted to procedures in plastic surgery / Perfil antropométrico e clínico de pacientes pós-bariátricos submetidos a procedimentos em cirurgia plástica

ABSTRACT Objective: to evaluate the profile of patients submitted to post-bariatric plastic surgery at the North Wing Regional Hospital, Brasília, DF. Methods: we conducted a prospective, descriptive and analytical study of patients submitted to Roux-en-Y gastroplasty, and subsequently to plastic surgery, from January 2011 to December 2016. We assessed body mass index before gastroplasty and after surgery plastic surgery, postoperative complications and comorbidities. Results: we studied 139 patients (130 women and nine men), with a mean age of 41 years, who underwent 233 operations. The mean BMI at the time of plastic surgery was 27.44kg/m2. The mean weight loss was 47.02kg and the mean maximum BMI was 45.17kg/m2. The mean time between bariatric surgery and plastic surgery was 42 months. The most important co-morbidities before plastic surgery were arterial hypertension (11.5%), arthropathy (5.4%), diabetes mellitus (5%) and metabolic syndrome (4.3%) (p<0.01). Of the 139 patients operated on, 76.97% underwent abdominoplasty followed by mammoplasty (42.46%), rhytidoplasty (17.27%) and brachioplasty (13.67%). Fourteen (13.08%) patients underwent herniorrhaphy combined with abdominoplasty. We performed anchor abdominoplasty in 19.42%. The rate of postoperative complications was 26.65%. Conclusion: the epidemiological profile of post-bariatric patients who underwent plastic surgery was similar to that reported in the literature, except for the low rate of associated surgeries and postoperative complications. Plastic surgery in post-bariatric patients has led to an improvement in the quality of life in most of these patients.

RESUMO Objetivo: avaliar o perfil de pacientes submetidos à cirurgia plástica pós-bariátrica no Hospital Regional da Asa Norte, Brasília, DF. Métodos: estudo prospectivo, descritivo e analítico de pacientes submetidos à gastroplastia em Y- Roux e, posteriormente, à cirurgia plástica, no período de janeiro de 2011 a dezembro de 2016. Foram avaliados o índice de massa corporal antes da gastroplastia e depois da cirurgia plástica, as complicações pós-operatórias e as comorbidades. Resultados: foram estudados 139 pacientes (130 mulheres e nove homens) com média de idade de 41 anos e submetidos a 233 operações. O IMC médio no momento da cirurgia plástica foi de 27,44Kg/m2. A média de perda de peso foi de 47,02Kg e a média de IMC máximo foi de 45,17Kg/m2. O tempo médio entre a cirurgia bariátrica e a cirurgia plástica foi de 42 meses. As comorbidades antes da cirurgia plástica mais importantes foram: hipertensão arterial (11,5%), artropatia (5,4%), diabetes mellitus (5%) e síndrome metabólica (4,3%) (p<0,01). Dos 139 pacientes operados, 76,97% foram submetidos à abdominoplastia seguida de mamoplastia (42,46%), ritidoplastia (17,27%) e braquioplastia (13,67%). Quatorze (13,08%) pacientes foram submetidos à herniorrafia combinada à abdominoplastia. Abdominoplastia em âncora foi feita em 19,42%. A taxa de complicações pós-operatórias foi de 26,65%. Conclusão: o perfil epidemiológico dos pacientes pós-bariátricos que foram submetidos a cirurgia plástica foi semelhante ao relatado na literatura, exceto pela baixa taxa de cirurgias associadas e complicações pós-operatórias. A cirurgia plástica nos pacientes pós-bariátricos gerou uma melhora da qualidade de vida na maioria desses pacientes.

Reconstruction of soft-tissue lesions of the foot with the use of the medial plantar flap.

OBJECTIVE: To study use of the medial plantar flap for reconstruction of the heel and foot. METHOD: The authors share their clinical experience with the use of the medial plantar artery flap for coverage of tissue defects around the foot and heel after trauma. Twelve cases of medial plantar artery flap performed from January 2001 to December 2013 were included. RESULTS: Of the 12 patients, ten were male and two were female. The indications were traumatic loss of the heel pad in ten cases and the dorsal foot in two cases. All the flaps healed uneventfully without major complications, except one case with partial flap loss. The donor site was covered with a split-thickness skin graft. The flaps had slightly inferior protective sensation compared with the normal side. CONCLUSION: From these results, the authors suggest that the medial plantar artery flap is a good addition to the existing armamentarium for coverage of the foot and heel. It is versatile flap that can cover defects on the heel, over the Achilles tendon and plantar surface, as well as the dorsal foot. It provides tissue to the plantar skin with a similar texture and intact protective sensation.

OBJETIVO: Estudar casos de retalho plantar medial na reconstrução do calcanhar e do pé. MÉTODO: Os autores apresentam sua experiência com o uso do retalho baseado na artéria plantar medial para cobertura de defeitos teciduais no pé, especialmente do calcanhar. Doze retalhos da artéria plantar medial, feitos entre janeiro de 2001 e dezembro de 2013, foram incluídos. RESULTADOS: Dos 12 pacientes, dez eram homens e duas mulheres. As indicações foram perda traumática do coxim do calcanhar em dez pacientes e dorso do pé em dois casos. Todos os retalhos cicatrizaram sem maiores complicações, exceto um caso com perda parcial. A área doadora foi coberta com enxerto de pele parcial. Os retalhos apresentaram uma sensibilidade protetora levemente inferior ao lado normal. CONCLUSÃO: De acordo com os resultados, o retalho plantar medial é uma boa opção para cobertura do pé, especialmente da região do calcanhar. A versatilidade do retalho permite a cobertura de defeitos no calcanhar, sobre o tendão de Aquiles e apoio plantar, assim como o dorso do pé. Esse retalho confere para região plantar uma pele de textura similar e sensibilidade protetora intacta.

Reconstruction of soft-tissue lesions of the foot with the use of the medial plantar flap / Reconstrução de lesões de partes moles de pé com o uso de retalho plantar medial

ABSTRACT OBJECTIVE: To study use of the medial plantar flap for reconstruction of the heel and foot. METHOD: The authors share their clinical experience with the use of the medial plantar artery flap for coverage of tissue defects around the foot and heel after trauma. Twelve cases of medial plantar artery flap performed from January 2001 to December 2013 were included. RESULTS: Of the 12 patients, ten were male and two were female. The indications were traumatic loss of the heel pad in ten cases and the dorsal foot in two cases. All the flaps healed uneventfully without major complications, except one case with partial flap loss. The donor site was covered with a split-thickness skin graft. The flaps had slightly inferior protective sensation compared with the normal side. CONCLUSION: From these results, the authors suggest that the medial plantar artery flap is a good addition to the existing armamentarium for coverage of the foot and heel. It is versatile flap that can cover defects on the heel, over the Achilles tendon and plantar surface, as well as the dorsal foot. It provides tissue to the plantar skin with a similar texture and intact protective sensation.

RESUMO OBJETIVO: Estudar casos de retalho plantar medial na reconstrução do calcanhar e do pé. MÉTODO: Os autores apresentam sua experiência com o uso do retalho baseado na artéria plantar medial para cobertura de defeitos teciduais no pé, especialmente do calcanhar. Doze retalhos da artéria plantar medial, feitos entre janeiro de 2001 e dezembro de 2013, foram incluídos. RESULTADOS: Dos 12 pacientes, dez eram homens e duas mulheres. As indicações foram perda traumática do coxim do calcanhar em dez pacientes e dorso do pé em dois casos. Todos os retalhos cicatrizaram sem maiores complicações, exceto um caso com perda parcial. A área doadora foi coberta com enxerto de pele parcial. Os retalhos apresentaram uma sensibilidade protetora levemente inferior ao lado normal. CONCLUSÃO: De acordo com os resultados, o retalho plantar medial é uma boa opção para cobertura do pé, especialmente da região do calcanhar. A versatilidade do retalho permite a cobertura de defeitos no calcanhar, sobre o tendão de Aquiles e apoio plantar, assim como o dorso do pé. Esse retalho confere para região plantar uma pele de textura similar e sensibilidade protetora intacta.

Retalho plantar medial de fluxo retrógrado para reconstrução de defeitos de dorso de pé / Retrograde flow medial plantar artery flap reconstruction for defects of the dorsal metatarsophalangeal region

Introdução: As reconstruções complexas da região do pé são planejadas com base nas subunidades anatômicas acometidas e pelo fator etiológico da lesão. Para coberturas de defeitos de dorso de pé, temos várias opções, desde as mais simples como enxertia local e retalhos locais ao acaso e retalhos pediculados locorregionais e as complexas com retalhos livres. Este trabalho tem por objetivo relatar um caso, cuja tática cirúrgica inédita na literatura utilizou um retalho plantar medial de fluxo retrógrado na reconstrução dorso-distais do pé. Sua originalidade consiste na passagem do retalho da planta para o dorso através do primeiro espaço intermetatársico. Métodos: Paciente 20 anos, sexo feminino, vítima de acidente de moto com trauma no pé, com perda de substância de dorso ao nível de 1 ao 5 metatarso, com exposição de osso e tendão. Foi utilizado um retalho plantar medial de fluxo retrógrado, com transposição para o dorso do pé. Resultados: A reconstrução da região distal do antepé e dedos são desafios. Os enxertos não são ideais para defeitos profundos e com exposição de estruturas nobres. Retalhos locais não são acessíveis para defeitos de dedos. E os retalhos livres são bem indicados para defeitos grandes. Os retalhos de fluxo reverso da artéria plantar medial está indicado e consagrado para a região do antepé e alguns autores modificaram para região de dorso do primeiro metatarso. Conclusão: Este retalho se mostra útil também para lesões de dorso de pé por meio dessa nova tática cirúrgica inédita na literatura, com a originalidade da passagem do pedículo da planta para o dorso através do primeiro espaço intermetatársico.

Introduction: Complex reconstructions of the foot region are planned based on the anatomical subunits affected by the etiological factors of lesions. We have several options for covering defects of the back of the feet, from the simpler ones, such as local graft and local flap at random and locoregional pedicled flaps, to the more complex ones, such as free flaps. Here, we report a case in which an unpublished technique using a retrograde flow medial plantar flap in the reconstruction of dorso-distal structures of the foot was used. Its originality consisted in the passage of the flap of the plant to the back through the first intermetatarsal space. Methods: The patient was a 20-year-old woman who had a motorcycle accident, wherein she sustained foot trauma with loss of back substance at the first to fifth metatarsal level, with bone and tendon exposure, and retrograde flow medial plantar flap was used, with transposition to the back of the foot. Results: The reconstruction of the distal region of the forefoot and fingers is a challenge. Grafts are not ideal for deep defects and exposure of noble structures. Local flaps are inaccessible for finger defects. Furthermore, the free flaps are well indicated for large defects. The flaps of the medial plantar artery are indicated and consecrated to the forefoot region, and some authors have modified to the dorsum region of the first metatarsal. Conclusion: This flap is useful for reconstruction of feet with dorsal lesions through this new technique that is unpublished in the literature, with the originality of the passage of the pedicle from the plant to the back through the first intermetatarsal space.

Epidemiological profile and treatment of substance losses by trauma to the lower limbs.

OBJECTIVES: to evaluate the epidemiological profile, the surgical treatment and the postoperative results of patients with complex traumatic injuries to the lower limbs. METHODS: we conducted a retrospective study of patients with traumatic complex injuries treated by the Plastic Surgery Service of a regional hospital in Brasília. We analyzed clinical-epidemiological data, type of surgical procedure and functional recovery of the limb after six months of treatment. RESULTS: 119 patients were treated, with a mean age of 29 years, predominantly men (76.4%). Motorcycle accident was responsible for most of the injuries, in 37.8% of cases. The most frequent surgical treatment was skin grafting (62.1%), followed by the fasciocutaneous flap (21.9%), muscular flap (12.6%) and microsurgical flap (3.4%). Six months after completion of the surgical treatment, 35.3% of the patients needed crutches to move, characterizing a delay in limb functional recovery that, however, was significantly related to the presence of fractures, external fixation or bone exposure in the preoperative period. CONCLUSION: the profile of the patient with complex traumatic lower limb injury was a male, motorcycle accident victim, and grafting was the most used treatment. Orthopedic trauma with bone fracture, bone exposure and the presence of external fixator were significantly associated with a higher risk of limb functional impairment, requiring locomotion crutches after six months of treatment.

Epidemiological profile and treatment of substance losses by trauma to the lower limbs / Perfil epidemiológico e tratamento de perdas de substância por trauma em membros inferiores

ABSTRACT Objectives: to evaluate the epidemiological profile, the surgical treatment and the postoperative results of patients with complex traumatic injuries to the lower limbs. Methods: we conducted a retrospective study of patients with traumatic complex injuries treated by the Plastic Surgery Service of a regional hospital in Brasília. We analyzed clinical-epidemiological data, type of surgical procedure and functional recovery of the limb after six months of treatment. Results: 119 patients were treated, with a mean age of 29 years, predominantly men (76.4%). Motorcycle accident was responsible for most of the injuries, in 37.8% of cases. The most frequent surgical treatment was skin grafting (62.1%), followed by the fasciocutaneous flap (21.9%), muscular flap (12.6%) and microsurgical flap (3.4%). Six months after completion of the surgical treatment, 35.3% of the patients needed crutches to move, characterizing a delay in limb functional recovery that, however, was significantly related to the presence of fractures, external fixation or bone exposure in the preoperative period. Conclusion: the profile of the patient with complex traumatic lower limb injury was a male, motorcycle accident victim, and grafting was the most used treatment. Orthopedic trauma with bone fracture, bone exposure and the presence of external fixator were significantly associated with a higher risk of limb functional impairment, requiring locomotion crutches after six months of treatment.

RESUMO Objetivo: avaliar o perfil epidemiológico, o tratamento cirúrgico e os resultados pós-operatórios de pacientes com feridas complexas traumáticas de membros inferiores. Método: estudo retrospectivo dos pacientes com ferimentos complexos traumáticos tratados pelo Serviço de Cirurgia Plástica de um hospital regional de Brasília. Foram analisados os dados clínico-epidemiológicos, o tipo de procedimento cirúrgico e a recuperação funcional do membro após seis meses do tratamento. Resultados: foram tratados 119 pacientes, com média de idade de 29 anos, predominantemente homens (76,4%). O acidente moto ciclístico foi responsável pela maioria das lesões, em 37,8% dos casos. O tratamento cirúrgico mais realizado foi o enxerto de pele (62,1% dos casos), seguido pelo retalho fascio-cutâneo (21,9%), o retalho muscular (12,6%) e o retalho microcirúrgico (3,4%). Seis meses após a conclusão do tratamento cirúrgico, 35,3% dos pacientes necessitavam de muletas para se locomover, caracterizando um atraso na recuperação funcional do membro que, no entanto, estava relacionado significativamente à presença de fratura, de fixador externo ou de exposição óssea no pré-operatório. Conclusão: o perfil do paciente com ferida complexa traumática de membros inferiores foi homem, vítima de acidente motociclístico e o enxerto foi o tratamento mais utilizado. O trauma ortopédico com fratura óssea, exposição óssea e a presença de fixador externo estiveram associados significativamente a um maior risco de prejuízo funcional do membro com necessidade de muletas para locomoção após seis meses de tratamento.

Retalho plantar medial: uma série de casos / The medial plantar flap: a case series

Introdução: A cobertura do pé e especialmente da região do calcâneo são desafios técnicos para o cirurgião devido ao alto grau de especialização dos tecidos envolvidos e à relativa imobilidade dos tecidos próximos. Métodos: No presente estudo, apresentamos nossa experiência com uso do retalho baseado na artéria plantar medial para cobertura de defeitos teciduais no pé, especialmente na região de apoio plantar no calcâneo. Doze retalhos da artéria plantar medial feitos de 2001 a 2013 no Hospital Regional da Asa Norte, Brasília, DF, foram incluídos. Resultados: Dos 12 pacientes, 10 eram homens e dois eram mulheres. As indicações foram perda traumática do coxim do calcâneo em 10 pacientes e dorso do pé em dois casos. Todos os retalhos foram elevados como retalhos pediculados fasciocutâneos baseados na artéria plantar medial. Todos os retalhos cicatrizaram sem maiores complicações, exceto um caso com perda parcial. A área doadora foi coberta com enxerto de pele parcial e houve um caso de perda parcial do enxerto. Os retalhos apresentaram uma sensibilidade protetora levemente inferior ao lado normal. Conclusão: De acordo com os resultados, o retalho plantar medial é uma boa opção para cobertura do pé, especialmente do calcâneo. A versatilidade do retalho permite a cobertura de defeitos no calcâneo sobre o tendão de Aquiles e apoio plantar, assim como o dorso do pé. A cobertura da região de apoio plantar com pele de textura similar e sensibilidade protetora confere a esse retalho uma grande vantagem sobre outros retalhos para reconstrução dessa região.

Introduction: Reconstructive coverage of foot defects, especially those of the calcaneus region, is a unique technical challenge for the surgeon due to the high degree of specialization of the tissues involved and the relative immobility of the proximal tissues. Methods: In the present study, we present our experience with the use of the flap based on the medial plantar artery to cover tissue defects in the foot, especially in the region of the calcaneal fat pad. Twelve medial plantar artery flaps constructed from 2001 to 2013 at the As a Norte Regional Hospital, Brasília, DF, were included. Results: Of the 12 patients with the medial plantar artery flaps, 10 were men and 2 were women. The indications were traumatic tissue loss of the plantar fat pad in 10 patients and of the dorsum of the foot in two cases. All flaps were elevated as fasciocutaneous pedicle flaps based on the medial plantar artery. All the flaps healed without major complications, except one case that involved partial loss . The donor area was covered with a partial skin graft and there was one case of partial graft loss. The flap displayed a slightly lower protective sensitivity than the normal side. Conclusion: According to the results, the medial plantar flap is a good option for covering traumatic foot defects, especially those affecting the calcaneus. The versatility of the flap allows the coverage of defects of the calcaneus (e.g., the Achilles tendon and plantar fat pad regions), as well as those affecting the dorsum of the foot. The coverage of the plantar fat pad region with skin of similar texture and protective sensitivity confers to the medial plantar flap a large advantage over other flaps for reconstruction of this region.

Versatility of the medial gastrocnemius muscle flap in reconstructing lower limb soft tissue lesions / Versatilidade do uso do retalho do músculo gastrocnêmio medial na reconstrução de lesões de partes moles de membros inferiores

Introduction: Covering complex lower limb wounds is a major challenge. The medial gastrocnemius muscle flap is usually indicated for reconstruction of loss of substance of the knee and proximal third of the leg. The objective of this study was to evaluate the results using gastrocnemius muscle flaps in lower limb wounds. Methods: A total of 28 patients with loss of substance in the lower limbs were treated with medial gastrocnemius muscle flaps. Data were obtained from clinical records of patients who underwent surgery from 2003 to 2012. Results: In 28 patients who underwent surgery, the age range was 4 to 57 years, with a mean of 30.6 years. The etiology of the lesions was a motorcycle accident in 16 cases (57.1%), being run over in 8 cases (28.6%), car crash in 2 cases (7.2%), meningococcemia in 1 case (3.6%), and snake bite in 1 case (3.6%). After an average follow-up of 15 months (range: 6 to 26 months), all patients had stable coverage. The mean number of preoperative debridements was 2.4 (range: 1 to 8). In 22 patients, the flaps were made without the release of the muscle origin and in 6 patients the muscle flaps were separated from their origin in the femur. Conclusions: Transfer of a gastrocnemius muscle flap is a simple and safe procedure in the treatment of lower limb injuries. The application of the medial gastrocnemius muscle flap was demonstrated in different situations, with satisfactory results and easy reproducibility.

Introdução: A cobertura de feridas complexas de membros inferiores é um grande desafio. O retalho muscular do gastrocnêmio medial é comumente indicado para reconstrução de perdas de substância do joelho e terço proximal da perna. O objetivo desse trabalho é avaliar os resultados da utilização do retalho muscular do gastrocnêmio nos casos de ferida em membros inferiores. Métodos: Um total de 28 pacientes com perda de substância de membros inferiores foi tratado com retalho muscular do gastrocnêmio medial. Os dados foram obtidos em registros clínicos dos pacientes operados no período de 2003 a 2012. Resultados: Vinte e oito pacientes foram operados, com idades variando de 4 a 57 anos, e média de 30,6 anos. A etiologia das lesões foi acidente por motocicleta em 16 casos (57,1%), atropelamentos em oito casos (28,6%), acidente automobilístico em dois casos (7,2%), meningococcemia em um caso (3,6%) e acidente ofídico em um caso (3,6%). Depois de um seguimento médio de 15 meses (variação de 6 a 26 meses), todos pacientes mostraram cobertura estável. O número médio de desbridamentos pré-operatórios foi 2,4 (variação de 1 a 8). Em 22 pacientes, os retalhos foram confeccionados sem a liberação da origem muscular e em seis pacientes os retalhos musculares foram separados de sua origem no fêmur. Conclusões: A transferência do retalho muscular do gastrocnêmio é um procedimento simples e seguro no tratamento de lesões de membros inferiores. Foi demonstrada a aplicação do retalho muscular do gastrocnêmio medial em diferentes situações, com resultados satisfatórios e fácil reprodução.

Queimaduras: pacientes autoinfligidos / Burn injuries: self-inflicted patients

INTRODUÇÃO: As queimaduras autoinfligidas geram consequências físicas, psicológicas e financeiras não só para a vítima, mas também para familiares e para sociedade. A prevalência desse tipo de acidente tem ampla variedade na literatura. O trabalho tem como objetivo analisar o perfil epidemiológico, a conduta e a taxa de letalidade dos pacientes com queimaduras por autoagressão atendidos em centro de tratamento de queimados, como uma forma de contribuir para intervenção efetiva em fatores e comportamentos de risco para tais acidentes. MÉTODO: Estudo retrospectivo por meio da análise dos prontuários de pacientes internados na Unidade de Queimados do Hospital Regional da Asa Norte, Brasília - DF, no período de janeiro de 2008 a dezembro de 2012. RESULTADOS: Foram incluídos no estudo 88 pacientes autoinfligidos, 54,5% do gênero feminino, idade média de 33 anos, média da superfície corporal queimada de 36%. A média de tempo de internação foi de 23 dias. A chama aberta foi o agente etiológico das queimaduras em 97,7% dos casos e o álcool foi o agente acelerador em 68,2%. A taxa de letalidade foi de 32,9%. Sessenta pacientes apresentavam comorbidades, sendo os distúrbios psiquiátricos e o etilismo os principais. CONCLUSÃO: As vítimas de queimaduras por autoagressão são geralmente mulheres, com idade média de 33 anos, utilizando álcool como agente da queimadura, afetando em média 36% da superfície corporal, com distúrbios psiquiátricos associados em 32,9% e com taxa de letalidade de 32,9%. No âmbito social, deve-se pensar em medidas públicas que detectem os pacientes em potencial para que seja instituída terapêutica adequada.

INTRODUCTION: Self-inflicted burn injuries lead to physical, psychological, and economic consequences not only to the victims but also to their families and the society. The prevalence of this type of accident varies greatly throughout the existing literatures. This study aimed to analyze the epidemiological profile, behavior, and lethality rate in patients with self-inflicted burn injuries who received treatment in a burn unit, as a way to contribute to the effective intervention to minimize the effects of risk factors and behaviors associated with this type of accident. METHOD: We conducted a retrospective study in which we analyzed medical records of patients hospitalized in the burn unit of Asa Norte's Regional Hospital, DF, Brazil, during the period between January 2008 and December 2012. RESULTS: The study sample consisted of 88 patients with self-inflicted burn injuries, of whom 54.5% were female, with a mean age of 33 years and mean burned body surface area of 36%. The mean hospitalization time was 23 days. Open flame was the etiological agent in 97.7% of the burn cases, and alcohol was the accelerating agent in 68.2% of these cases. The lethality rate was 32.9%. Sixty patients had comorbidities, with psychiatric disorders and alcoholism being the most common. CONCLUSION: The patients with self-inflicted burn injuries were generally women, with a mean age of 33 years, who used alcohol as accelerating agent. The mean body surface area affected was 36%. Of the patients, 32.9% had associated psychiatric disorders. The lethality rate was 32.9%. From a social perspective, public measures should be established to detect potential patients in order to administer appropriate therapies.

Epidemiologia da fratura de face de pacientes atendidos no pronto socorro de cirurgia plástica do Distrito Federal / Epidemiology of patients with facial fractures treated by the plastic surgery team in an emergency room in the Federal District of Brazil

Introdução: O trauma permanece como uma das principais causas de morbidade e mortalidade, no mundo ocidental, entre os adultos jovens. A prevalência de lesões traumáticas na face é alta devido à enorme exposição dessa região e a sua pouca proteção. Objetivo: Avaliar a etiologia, a idade, o gênero, a localização, os sintomas e o tipo de tratamento das vítimas de traumas de face dos atendidos no Hospital Regional da Asa Norte (HRAN), Brasília, Distrito Federal. Método: Trata-se de um estudo retrospectivo, realizado no pronto socorro do HRAN-DF, visando avaliar o perfil epidemiológico de vítimas de trauma de face, no período do 2° semestre de 2012. Resultados: O estudo compreendeu 46 pacientes, destacando-se o gênero masculino, com 32 pacientes (69,56%). Quanto à causa, predominou a agressão física, em ambos os sexos, com 22 casos (47,82%), seguida pelas quedas, com 11(23,91%). As quedas foram as causas predominantes das lesões em crianças, mas se verificou a participação cada vez maior da agressão física como mecanismo de trauma facial com o aumento da idade. A principal faixa etária foi de 21 a 30 anos, compreendendo 43,47% dos casos. O nariz foi o local mais acometido nas fraturas de face, correspondendo a 62,96% dos casos. O tempo médio de internação foi de dois dias e o tempo entre o primeiro atendimento e a operação foi de seis dias. Conclusão: O perfil epidemiológico do paciente com fratura de face é de um jovem, do gênero masculino, vítima de agressão física, com fratura de nariz e quadro clínico desse tipo de lesão e submetido a redução fechada.

Introduction: Trauma remains a major cause of morbidity and mortality amongst young adults in the Western world. The prevalence of traumatic lesions on the face is especially high, as the facial area is generally exposed with little protection. Objective: To evaluate the etiology, age, sex, location, symptoms, and the type of treatment given to victims of facial trauma treated at the North Wing Regional Hospital (NWRH), Brasilia, Federal District. Method: This was a retrospective study conducted in the emergency room of the NWRH to evaluate the epidemiological profile of patients with facial trauma who presented during the 2nd half of 2012. Results: The study included 46 patients, of which 32 patients (69.56%) were male. Physical aggression was the prevailing cause in both sexes with 22 cases (47.82%), followed by falls with 11 (23.91%). Falls were the predominant cause of injuries in children. Physical aggression as a mechanism for facial trauma became more common with age. The main age group affected was the 21 to 30 years group, comprising 43.47% of cases. The nose was the most commonly affected bone in facial fractures, with nasal fractures occurring in 62.96% of cases. The mean hospital stay was two days and the mean time between the first visit and the operation was six days. Conclusion: The predominant epidemiological profile of a patient with facial fracture is that of a young male, victim of physical aggression, presenting with a nasal fracture and a clinical picture of this type of injury, and treated with closed reduction.

Tempo para acesso ao tratamento do câncer de mama no Distrito Federal, Brasil Central / Interval for access to treatment for breast cancer in the Federal District, Brazil

OBJETIVO: Analisar o tempo desde o primeiro sintoma até o tratamento de pacientes tratadas para o câncer de mama em hospitais públicos do Distrito Federal, no Brasil Central. MÉTODOS: Trata-se de um estudo transversal analítico. Foram entrevistadas 250 mulheres com diagnóstico de câncer de mama tratadas em 6 hospitais da Secretaria de Estado de Saúde do Distrito Federal (Brasil) no período de novembro de 2009 a janeiro de 2011. Os intervalos de tempo estudados foram o período entre a detecção do sintoma e o tratamento, subdividido nos intervalos até a primeira consulta e após. As outras variáveis analisadas foram: a idade, o estado menopausal, a cor, o nível de escolaridade, a renda familiar média mensal, a procedência, o motivo da primeira consulta, o estadiamento, o tamanho do tumor, a lateralidade, a metástase para linfonodos axilares, a realização de quimioterapia neoadjuvante e o tipo de cirurgia. Para verificar a associação das variáveis com os intervalos de tempo até o tratamento, foi utilizado o teste de Mann-Whitney. RESULTADOS: A média de idade foi de 52 anos, predominando mulheres brancas (57,6%), residentes no Distrito Federal (62,4%), com renda familiar de até dois salários mínimos (78%), que estudaram por até 4 anos (52,4%). O estadiamento da doença em 78,8% das mulheres variou de II a IV. O tempo entre o primeiro sintoma e o tratamento foi de 229 dias (mediana). Após a detecção do primeiro sintoma, 52,9% das mulheres compareceram a uma consulta em até 30 dias e 88,8% tiveram demora de mais de 90 dias para iniciar o tratamento. As mulheres com nível primário de escolaridade apresentaram maior atraso para início do tratamento (p=0,04). CONCLUSÕES: Houve um importante atraso para iniciar o tratamento das mulheres com câncer de mama em hospitais públicos do Distrito Federal sugerindo que esforços devem ser feitos para a redução dos tempos necessários para agendar a consulta médica, diagnosticar e tratar essas pacientes.

PURPOSE: To analyze the time between the first symptom and treatment in patients treated for breast cancer in public hospitals in the Federal District. METHODS: This was a cross-sectional analysis. We interviewed 250 women diagnosed with breast cancer treated in six hospitals of the State Department of Health of the Federal District from November 2009 to January 2011. The time intervals studied were the time between the detection of the symptoms and treatment subdivided into intervals until and after the first medical appointment. The variables were: age, menopausal status, color, educational level, average monthly household income, origin, reason for the initial consultation, staging, tumor size, laterality, metastasis to axillary lymph nodes, neoadjuvant chemotherapy, and type of surgery. The Mann-Whtney test was used to assess the association of these variables with the time intervals until treatment. RESULTS: The mean age was 52 years, with a predominance of white women (57.6%), from the Federal District (62.4%), with a family income of up to 2 minimum wages (78%), and up to four years of schooling (52.4%). The staging of the disease ranged from II to IV in 78.8% of the women. The time between the first symptom and treatment was 229 days (median). After detection of the first symptom, 52.9% of the women attended a consultation within 30 days and 88.8% took more than 90 days to start treatment. Women with elementary school education had a greater delay to the start of treatment (p=0.049). CONCLUSIONS: There was a significant delay to start treatment of women with breast cancer in public hospitals of the Federal District, suggesting that efforts should be made to reduce the time needed to schedule medical appointments and to diagnose and treat these patients.

Leiomioma de mão / Leiomyoma of hand

The aim of this report was to present the case of a leiomyoma with a rare anatomical location and an unusual age of disease onset. The patient was a 17-year-old girl who developed a leiomyoma of the hand. Leiomyoma is a benign smooth musc1e tumor that most frequently occurs in the uterine cavity. When it occurs in the extremities, it is most common in the legs, feet, and ankles. Leiomyoma usually develops between the third and fourth decades of life and is rarely identified before surgical resection. Thus, a histological examination is necessary to confirm the diagnosis.

O objetivo deste trabalho é relatar o caso de uma jovem de 17 anos que desenvolveu leiomiomana mão esquerda: raro sítio anatômico de localização e idade incomuns de desenvolvimento da doença. O leiomioma é um tumor benigno de músculo liso, raro e incomum na mão, apresentando-se com maior frequência na parede da cavidade uterina. Quando de ocorrência em extremidades é mais comum na região das pernas, dos pés e dos tornozelos. Em geral se desenvolve entre a terceira e a quarta décadas de vida e raramente é identificado antes da ressecção cirúrgica. Dessa forma, faz-se necessário, para a confirmação do diagnóstico, um exame histológico.