Posicionamento ideal das cartilagens laterais inferiores associado à otimização da válvula nasal externa / Ideal positioning of the lower lateral cartilages associated with the optimization of the external nasal valve

Introdução: O posicionamento das Cartilagens Laterais Inferiores (CLI) está diretamente relacionado à boa funcionalidade nasal. Quando essas cartilagens apresentam um mau posicionamento cefálico, a parede lateral da válvula nasal externa fica sem suporte adequado, podendo levar à insuficiência valvular. O objetivo é definir qual o posicionamento anatômico ideal das CLI associado à otimização da válvula nasal externa. Métodos: Revisão de literatura narrativa nas seguintes bases de dados: SciELO, LILACS e Medline. Os descritores utilizados foram: "cartilagens nasais"; "obstrução nasal" e "rinoplastia", sendo selecionados 15 artigos essenciais para o entendimento do assunto. Revisão de literatura: O posicionamento do ramo lateral das CLI forma o contorno da ponta nasal e dá estabilidade à parede lateral da válvula nasal externa. Constantian definiu que o posicionamento ideal do ramo lateral das CLI à margem da asa nasal deve ser 45° ou menos. Para Toriumi, o ângulo é mensurado a partir do ramo lateral das CLI em relação ao plano sagital mediano e o valor adequado é de aproximadamente 45°. Para Silva, o posicionamento das CLI é mensurado pelo ângulo de divergência entre as CLI e tem como valor apropriado aproximadamente 90°. Conclusão: A válvula nasal externa apresenta melhor funcionamento quando as CLI estão bem posicionadas, a saber: o ângulo formado entre a borda lateral das CLI e a margem alar é próximo de 45° ou menos; o ângulo formado entre as CLI e o plano sagital mediano é próximo de 45°; o ângulo de divergência formado entre as CLI é próximo a 90°.

Introduction: The Lower Lateral Cartilages (LLC) positioning is directly related to good nasal functionality. When these cartilages have cephalic malpositioning, the lateral wall of the external nasal valve is not adequately supported, which can lead to valvular insufficiency. The objective is to define the ideal anatomical positioning of the LLC associated with optimizing the external nasal valve. Methods: Review narrative literature in the following databases: SciELO, LILACS and Medline. The descriptors used were: "nasal cartilages,"; "nasal obstruction," and "rhinoplasty," being selected 15 essential articles for the understanding of the subject. Literature review: Positioning the lateral crura of the LLC forms the contour of the nasal tip and provides stability to the lateral wall of the external nasal valve. Constantian defined the ideal positioning of the lateral crura of the LLC at the margin of the nasal alae should be 45° or less. For Toriumi, the angle is measured from the lateral crura of the LLC concerning the midsagittal plane, and the appropriate value is approximately 45°. For Silva, the positioning of the LLC is measured by the angle of divergence between the LLCs, and its appropriate value is approximately 90°. Conclusion: The external nasal valve works better when the LLCs are well-positioned, namely: the angle formed between the lateral edge of the LLCs and the alar margin is close to 45° or less; the angle formed between the LLC and the midsagittal plane is close to 45°; the divergence angle formed between the LLC is close to 90°.

TGF-ß1 and CD68 immunoexpression in capsules formed by textured implants with and without mesh coverage: a study on female rats.

PURPOSE: To evaluate fibrosis formation and number of macrophages in capsules formed around textured implants without and with mesh coverage. METHODS: Fibrosis was analyzed through transforming growth factor-beta 1 (TGF-ß1) immunomarker expression and the number of macrophages through CD68 percentage of cells in magnified field. Sixty female Wistar rats were distributed into two groups of 30 rats (unmeshed and meshed). Each group was then subdivided into two subgroups for postoperative evaluation after 30 and 90 days. The p value was adjusted by Bonferroni lower than 0.012. RESULTS: No difference was observed in fibrosis between meshed and unmeshed groups (30 days p = 0.436; 90 days p = 0.079) and from 30 to 90 days in the unmeshed group (p = 0.426). The meshed group showed higher fibrosis on the 90th day (p = 0.001). The number of macrophages was similar between groups without and with mesh coverage (30 days p = 0.218; 90 days p = 0.044), and similar between subgroups 30 and 90 days (unmeshed p = 0.085; meshed p = 0.059). CONCLUSIONS: In the meshed group, fibrosis formation was higher at 90 days and the mesh-covered implants produced capsules similar to microtextured ones when analyzing macrophages. Due to these characteristics, mesh coating did not seem to significantly affect the local fibrosis formation.

TGF-ß1 and CD68 immunoexpression in capsules formed by textured implants with and without mesh coverage: a study on female rats

Purpose: To evaluate fibrosis formation and number of macrophages in capsules formed around textured implants without and with mesh coverage. Methods: Fibrosis was analyzed through transforming growth factor-beta 1 (TGF-ß1) immunomarker expression and the number of macrophages through CD68 percentage of cells in magnified field. Sixty female Wistar rats were distributed into two groups of 30 rats (unmeshed and meshed). Each group was then subdivided into two subgroups for postoperative evaluation after 30 and 90 days. The p value was adjusted by Bonferroni lower than 0.012. Results: No difference was observed in fibrosis between meshed and unmeshed groups (30 days p = 0.436; 90 days p = 0.079) and from 30 to 90 days in the unmeshed group (p = 0.426). The meshed group showed higher fibrosis on the 90th day (p = 0.001). The number of macrophages was similar between groups without and with mesh coverage (30 days p = 0.218; 90 days p = 0.044), and similar between subgroups 30 and 90 days (unmeshed p = 0.085; meshed p = 0.059). Conclusions: In the meshed group, fibrosis formation was higher at 90 days and the mesh-covered implants produced capsules similar to microtextured ones when analyzing macrophages. Due to these characteristics, mesh coating did not seem to significantly affect the local fibrosis formation.

Rhinogoniometer: Validation of an Instrument for Rhinoplasty.

SUMMARY: The position of the lower lateral cartilages is directly related to good nasal functionality. When these cartilages exhibit cephalic malposition, the angle of divergence between cartilages is usually less than 60 degrees, which can cause external nasal valve insufficiency. The objective of this study was to validate the rhinogoniometer, an innovative surgical instrument that allows for diagnosing the position of this cartilage intraoperatively. In the intraoperative period, the angle of divergence, which is the angle formed between the two lateral branches of the lower lateral cartilages, was measured in 31 primary rhinoplasty patients. The rhinogoniometer measurement was compared with that of the computerized analysis, and the reproducibility of measurements with the rhinogoniometer between two different surgeons was determined. When comparing the values obtained by the two methods, a significant difference was found (p = 0.034). On average, the angles measured by the rhinogoniometer were 3.7 degrees smaller than the measurements made by the software. It was observed that when the angles measured by both methods were above 75 degrees, the differences between the two measurements were higher (p = 0.022). However, for angles up to 75 degrees, the measurement using the rhinogoniometer was, on average, 0.79 degrees higher than the measurement taken by the software. When the difference in angles obtained by the two methods between different surgeons was evaluated, there was a significant difference (p < 0.023). In conclusion, at angles up to 75 degrees, the rhinogoniometer showed a negligible difference of 0.79 degrees higher than the measurement obtained via software. Measurements with the rhinogoniometer were also shown to be reproducible with different surgeons.

Avaliação da absorção de proteínas em ratas submetidas à colocação de mini-implantes de silicone nanotexturizados e revestidos pela espuma de poliuretano / Evaluation of protein adsorption in rats submitted to nanotextured and polyurethane foam-coated silicone mini-implants

RESUMO Introdução: O controle da absorção de proteínas é necessário para a definição das propriedades dos biomateriais e de seus usos específicos. O plasma sanguíneo contém diversas proteínas diferentes, dentre elas o fibrinogênio, que apresenta importante papel na adesão celular e nos resultados de biocompatibilidade em implantes. Os objetivos deste estudo foram avaliar laboratorialmente as ratas submetidas à colocação de mini-implantes de silicone nanotexturizados e revestidos por espuma de poliuretano a partir da aferição do fibrinogênio sérico e mensuração da proteína plasmática. Métodos: Foram utilizadas 60 ratas albinas, divididas em dois grupos de 30 animais para cada tipo de mini-implante de silicone (nanotexturizado e espuma de poliuretano) e subdivididas em 3 subgrupos, conforme o tempo de eutanásia dos animais (30, 60 e 90 dias). Os mini-implantes foram inseridos no dorso dos animais abaixo do Panniculus carnosus. No momento das eutanásias, amostras de sangue foram obtidas por punção cardíaca. Utilizou-se a técnica de precipitação térmica para determinação das proteínas plasmáticas total e sérica, e o valor do fibrinogênio foi obtido mediante a diferença entre estas duas últimas. Resultados: Quando comparados os grupos entre si, observou-se que o grupo nanotexturizado apresentou uma maior quantidade de fibrinogênio e da proteína plasmática no subgrupo de 90 dias, com significância estatística (p=0,004). Ao comparar os subgrupos entre si, em ambos os grupos, evidenciou-se uma diferença significativa (p<0,001). Conclusão: Os mini-implantes nanotexturizados mostraram uma menor absorção de proteínas em relação aos implantes revestidos pela espuma de poliuretano, no subgrupo de 90 dias.

ABSTRACT Introduction: The control of protein absorption is necessary to define biomaterials' properties and their specific uses. Blood plasma contains several different proteins, including fibrinogen, which plays an important role in cell adhesion and biocompatibility results in implants. This study's objectives were to evaluate in the laboratory rats subjected to the placement of nano-textured silicone mini-implants and polyurethane foam-coated mini-implants based on the measurement of serum fibrinogen and plasma proteins. Methods: Sixty albino rats were used, divided into two groups of 30 animals for each type of silicone mini-implant (nanotextured and polyurethane foam) and subdivided into three subgroups, according to the animals' euthanasia time (30, 60 and 90 days). The mini-implants were inserted in the animals' backs below the Panniculus carnosus. At the time of euthanasia, blood samples were obtained by cardiac puncture. The thermal precipitation technique was used to determine total and serum plasma proteins, and the difference between the latter two obtained the fibrinogen value. Results: When the groups were compared, it was observed that the nanotextured group presented a higher amount of fibrinogen and plasma protein in the 90-day subgroup, with statistical significance (p=0.004). When comparing the subgroups among themselves, a significant difference was evidenced (p<0.001). Conclusion: The nanotextured mini-implants showed a lower protein absorption concerning polyurethane foam-coated implants in the 90-day subgroup.

Avaliação de biomarcadores sanguíneos em ratas submetidas à colocação de implantes de silicone nanotexturizados e revestidos pela espuma de poliuretano / Evaluation of blood biomarkers in rats submitted to nanotextured and polyurethane foam-coated silicone implants

RESUMO Introdução: Nas últimas décadas houve uma grande evolução na superfície de revestimento dos implantes mamários, o que resultou na diminuição das complicações. No pós-operatório a inflamação é uma constante e pode ser avaliada pelo hemograma, pois é um exame rápido, barato e com alta disponibilidade. O presente estudo tem como objetivo avaliar os biomarcadores sanguíneos em ratas submetidas à colocação de mini-implantes de silicone nanotexturizados e revestidos por espuma de poliuretano. Métodos: Foram utilizadas 60 ratas Wistar divididas em dois grupos para utilização de mini-implantes nanotexturizados e revestidos com espuma de poliuretano, subdivididos em subgrupos de acordo com a eutanásia dos animais nos 30, 60 e 90 dias. No momento da eutanásia, as amostras de sangue foram obtidas por punção cardíaca e foi analisado o hemograma. Resultados: A hemoglobina, o hematócrito, a hemoglobina corpuscular média, os leucócitos, os neutrófilos, os linfócitos e as plaquetas tiveram os resultados muito semelhantes em todos os subgrupos avaliados (30, 60 e 90 dias). Entretanto, quando os diferentes subgrupos foram comparados entre si dentro de cada grupo, obteve-se resultados estatisticamente significantes na hemoglobina corpuscular média (nanotexturizado p=0,032 e poliuretano p=0,007) e nos leucócitos (nanotexturizado p=0,038 e poliuretano p=0,034). Sobre as alterações dos biomarcadores sanguíneos no pós-operatório encontrou-se anemia hipocrômica, contagem de leucócitos normais, neutrofilia, linfopenia e trombocitopenia. Conclusão: Após a colocação de mini-implantes de silicone, as ratas de ambos os grupos evoluíram com anemia hipocrômica, contagem de leucócitos normais às custas de neutrofilia e linfopenia, e trombocitopenia.

ABSTRACT Introduction: In recent decades, there has been a great evolution in breast implants' lining surface, which has resulted in decreased complications. In the postoperative period, the inflammation is constant and can be evaluated by the blood count, as it is a fast, inexpensive, and highly available examination. The present study evaluates blood biomarkers in rats submitted to the placement of nanotextured silicone implants and implants coated with polyurethane foam. Methods: 60 Wistar rats were used divided into two groups for nanotextured mini-implants and others mini-implants coated with polyurethane foam, subdivided into subgroups according to the animals' euthanasia in the 30, 60, and 90 days. At the time of euthanasia, blood samples were obtained by cardiac puncture and the blood count was analyzed. Results: Hemoglobin, hematocrit, mean corpuscular hemoglobin, leukocytes, neutrophils, lymphocytes, and platelets had very similar results in all subgroups evaluated (30, 60, and 90 days). However, when the different subgroups were compared within each group, statistically significant results were obtained in the mean corpuscular hemoglobin (nanotextured p=0.032 and polyurethane p=0.007) and leukocytes (nanotextured p=0.038 and polyurethane p=0.034). Changes in postoperative blood biomarkers were hypochromic anemia, normal leukocyte count, neutrophilia, lymphopenia, and thrombocytopenia. Conclusion: After the placement of mini-silicone implants, the rats of both groups evolved with hypochromic anemia, normal leukocyte count at the expense of neutrophilia and lymphopenia, and thrombocytopenia.

Histological evaluation of capsules formed by texturized silicone implants with and without polyester mesh coverage (Parietex®). A study on female rats.

PURPOSE: To evaluate capsules formed by microtextured silicone implants with and without Parietex® mesh coverage histologically. METHODS: Sixty Wistar rats were divided in two groups (meshed and unmeshed). Each group was, then, divided into two subgroups for evaluation at 30 and 90 days. Capsules were analyzed based on hematoxylin and eosin (HE) and picrosirius staining. RESULTS: The number of fibroblasts, neutrophils and macrophages was similar among all subgroups. There was a higher lymphocyte reaction in the 30-day meshed group (p = 0.003). Giant cell reaction, granulation tissue and neoangiogenesis were similar among the subgroups. Synovial metaplasia was milder at 90-day in the unmeshed (p = 0.002) and meshed group (p < 0.001). Capsular thickness was significantly greater in the meshed samples (30-day p < 0.001 and 90-day p < 0.001). There was a similar amount of collagen types I and III in both groups. CONCLUSIONS: The mesh-covered implants produced capsules similar to the microtextured ones when analyzing inflammatory variables. Synovial metaplasia was milder at 90 than at 30 days, and the capsular thickness was significantly greater in the meshed group. A similar amount of collagen types I and III was observed. Due to these characteristics, the mesh coverage did not seem to significantly affect the local inflammatory activity.

Reduced Remodeling Biomarkers Tissue Expression in Nanotextured Compared With Polyurethane Implants Capsules: A Study in Rats.

BACKGROUND: In the biological response to biomaterials, the implant shell plays a key role in immune and inflammatory reactions. We hypothesized that the capsules formed around nanotextured implants exhibit an immunohistochemical behavior different to those formed around polyurethane implants. OBJECTIVES: The aim of this study was to evaluate through immunohistochemistry markers the capsules formed around nanotextured and polyurethane implants. METHODS: Sixty albino female Wistar rats were divided into 2 groups (nanotextured and polyurethane), with 30 animals in each group. A mini silicone implant was inserted on the back of the animals. After a predetermined period, the animals were killed, and the capsules formed around the implants were studied. The capsules in the 30-, 60-, and 90-day subgroups were analyzed via immunohistochemistry to detect markers for fibroblast α smooth muscle actin (α-SMA), transforming growth factor ß (TGF-ß), cluster of differentiation 34 (CD34), and CD68, via picrosirius staining to determine the density of type I and III collagen fibers and via hematoxylin and eosin staining to assess capsule thickness. A Wilcoxon-Mann-Whitney test was used to compare the groups, and a Kruskal-Wallis test was used to compare the subgroups. RESULTS: Lower α-SMA, TGF-ß, CD34 and CD68 immunoexpression was observed in the nanotextured 30- and 60-day subgroups than in the corresponding polyurethane subgroups. In the 90-day subgroup, more pronounced α-SMA and CD34 immunoexpression was observed in the nanotextured group; however, TGF-ß and CD68 immunoexpression remained lower. The nanotextured implants showed reduced capsular thickness and greater formation of type I collagen in all the analyzed subgroups. CONCLUSIONS: Nanotextured implants led to reduced immune and inflammatory reactions compared with polyurethane implants according to all analyzed variables.

Histological evaluation of capsules formed by texturized silicone implants with and without polyester mesh coverage (Parietex®). A study on female rats

ABSTRACT Purpose To evaluate capsules formed by microtextured silicone implants with and without Parietex® mesh coverage histologically. Methods Sixty Wistar rats were divided in two groups (meshed and unmeshed). Each group was, then, divided into two subgroups for evaluation at 30 and 90 days. Capsules were analyzed based on hematoxylin and eosin (HE) and picrosirius staining. Results The number of fibroblasts, neutrophils and macrophages was similar among all subgroups. There was a higher lymphocyte reaction in the 30-day meshed group (p = 0.003). Giant cell reaction, granulation tissue and neoangiogenesis were similar among the subgroups. Synovial metaplasia was milder at 90-day in the unmeshed (p = 0.002) and meshed group (p < 0.001). Capsular thickness was significantly greater in the meshed samples (30-day p < 0.001 and 90-day p < 0.001). There was a similar amount of collagen types I and III in both groups. Conclusions The mesh-covered implants produced capsules similar to the microtextured ones when analyzing inflammatory variables. Synovial metaplasia was milder at 90 than at 30 days, and the capsular thickness was significantly greater in the meshed group. A similar amount of collagen types I and III was observed. Due to these characteristics, the mesh coverage did not seem to significantly affect the local inflammatory activity.

Smooth Muscle Alpha Actin Immunoexpression (α-Sma) and CD-117 Antibody (C-Kit) in Capsules Formed by Polyurethane Foam-Coated Silicone Implants and with Textured Surface: A Study on Rats.

BACKGROUND: One of the undesirable complications that might occur after breast augmentation with silicone implants is capsular contracture. In its etiology, the relations between mast cells and myofibroblasts play an important role in collagen synthesis. Mast cells are able to activate fibroblasts into myofibroblasts, through paracrine secretions, inducing collagen production. The objectives of this study were to analyze the myofibroblast concentration through the α-SMA immunomarker and evaluate the intensity of mast cell expression against the C-Kit immunomarker. MATERIAL AND METHOD: Sixty-four Wistar rats were used, divided into two groups (polyurethane foam and textured surface) with 32 animals in each. The animals received silicone implants on the back, below the panniculus carnosus, and after the determined period, they were killed and the capsules formed around the implants were studied. The capsules were analyzed employing the immunohistochemical technique, with the α-SMA and C-Kit immunomarkers in subgroups of 30, 50, 70 and 90 days. RESULTS: The myofibroblast concentration was higher in the polyurethane group when compared to the textured group (30 days p = 0.105; 50 days p = 0.247; 70 days p = 0.014 and 90 days p = 0.536). The intensity of mast cell expression was more pronounced in the polyurethane group when compared to the textured group (30 days p = 0.798; 50 days p = 0.537; 70 days p = 0.094 and 90 days p = 0.536). CONCLUSIONS: Polyurethane-coated implants induced higher concentrations of myofibroblasts and higher expression of mast cells, when compared to the textured surface implants. NO LEVEL ASSIGNED: 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 .

The Relation Between the Lower Lateral Cartilages and the Function of the External Nasal Valve.

INTRODUCTION: The position of the lower lateral cartilages (LLC) is closely related to the function of the external nasal valve (ENV). When there is a cephalic malposition of these cartilages, the nasal alae have inadequate support, which leads to ENV insufficiency during deep inspiration. METHODS: Retrospective study with 60 patients evaluated: the positioning of the LLC and the occurrence of ENV insufficiency; the effectiveness of structuring the medial and lateral walls of the ENV; and the frequency of the grafts used for structuring it. RESULTS: Of the 60 operated cases, 37 patients (62%) had ENV insufficiency, in 23 cases there was cephalic malposition of the LLC, and in the latter group 17 patients (74%) presented this insufficiency. A structured ENV was effective in the treatment of this insufficiency (p = 0.001). A lateral crural strut graft was performed in 24 cases (40%) of 60 patients operated. The alar contour graft was performed from 2013 to 2015 in 4 patients (22%) of 18 cases operated, and between 2016 and 2018 it was performed in 29 patients (69%) out of 42 cases. The columellar strut was routinely used from 2013 to mid-2016 in 33 cases (100%), and after that period until the present day the tongue-in-groove technique was performed in 11 cases (41%) and in the remaining 16 cases (59%) the caudal septal extension graft was performed. CONCLUSION: Cephalic malposition of the LLC is an important red flag of ENV insufficiency. This insufficiency should be treated by structuring the walls of the ENV. LEVEL OF EVIDENCE IV: 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 .

Avaliação pré e pós-operatória da válvula nasal externa em rinoplastia / Preoperative and postoperative assessment of external nasal valve in rhinoplasty

Introdução: A válvula nasal externa está localizada no rebordo das narinas e é composta por tecidos moles e cartilagem. Caso haja algum desequilíbrio entre estas estruturas, invariavelmente ocorrerá insuficiência desta válvula nasal externa, podendo ser parcial ou total, dependendo do grau das alterações. Avaliou-se a válvula nasal externa no pré e pós-operatório em rinoplastia verificando a eficiência da técnica utilizada. Métodos: Estudo retrospectivo de 34 pacientes operados em hospitais particulares. Foram avaliados o colabamento da asa nasal durante a inspiração profunda e o vetor das cartilagens laterais inferiores. Para estruturação da asa nasal, utilizou-se o enxerto de suporte da cruz lateral e/ou enxerto de contorno alar. Resultados: O vetor não adequado da cartilagem lateral inferior está relacionado com a insuficiência da válvula nasal externa (p = 0,006) e a estruturação da asa nasal, mediante o uso de enxertos, corrigiu esta afecção na maioria dos casos (p = 0,006). Houve diferença na frequência de utilização de enxertos na rinoplastia primária (66%) e secundária (80%). Conclusão: O vetor inadequado das cartilagens laterais inferiores geralmente resultou em uma asa nasal desestruturada, com insuficiência da válvula nasal externa. A estruturação da asa nasal com enxerto de suporte da cruz lateral e/ou enxerto de contorno alar se mostrou eficaz na correção da insuficiência da válvula nasal externa em 90% dos casos, além de conferir proporções e contornos mais belos ao nariz. A frequência de utilização dos enxertos na rinoplastia secundária (80%) foi maior do que na primária (66%) e nos mostrou a necessidade dos enxertos numa cirurgia mais complexa.

Introduction: The external nasal valve is located on the rim of the nostrils and is composed of soft tissues and cartilage. Any imbalance between these structures always leads to external nasal valve insufficiency, which may be partial or total, depending on the degree of alteration. The external nasal valve was evaluated before and after rhinoplasty to assess the efficiency of the technique used. Methods: This is a retrospective study that included 34 patients operated at private hospitals. The collapse of the nasal alae during deep inspiration and the vector of the lower lateral cartilage were evaluated. To provide more structure to the nasal alae, the lateral crural strut graft and/or alar contour graft were used. Results: The inappropriate vector of the lower lateral cartilage is related to the external nasal valve insufficiency (p = 0.006), which was corrected with grafts providing nasal alae remodeling in most of the cases (p = 0.006). A significant difference was observed in the frequency of using grafts in primary (66%) and secondary rhinoplasty (80%). Conclusion: The inappropriate vector of the lower lateral cartilages usually resulted in an unstructured nasal alae, presenting external nasal valve insufficiency. Structuring the nasal alae with a lateral crural strut graft and/or alar contour graft was proven effective to correct external nasal valve insufficiency in 90% of the cases and to provide better aesthetic proportions and nasal contour. The frequency of grafts used in secondary rhinoplasty (80%) was higher than that in primary (66%), which indicates the need for grafts in a more complex surgery.

Histological evaluation of capsules formed by silicon implants coated with polyurethane foam and with a textured surface in rats

ABSTRACT PURPOSE: To assess the capsules formed by silicone implants coated with polyurethane foam and with a textured surface. METHODS: Sixty-four Wistar albinus rats were divided into two groups of 32 each using polyurethane foam and textured surface. The capsules around the implants were analyzed for 30, 50, 70 and 90 days. Were analyzed the following parameters: foreign body reaction, granulation tissue, presence of myofibroblasts, neoangiogenesis, presence of synovial metaplasia, capsular thickness, total area and collagen percentage of type I and III, in capsules formed around silicone implants in both groups. RESULTS: The foreign body reaction was only present in the four polyurethane subgroups. The formation of granulation tissue and the presence of myofibroblasts were higher in the four polyurethane subgroups. Regarding to neoangiogenesis and synovial metaplasia, there was no statistical difference between the groups. Polyurethane group presented (all subgroups) a greater capsule thickness, a smaller total area and collagen percentage of type I and a higher percentage area of type III, with statistical difference. CONCLUSION: The use of polyurethane-coated implants should be stimulated by the long-term results in a more stable capsule and a lower incidence of capsular contracture, despite developing a more intense and delayed inflammatory reaction in relation to implants with textured surface.

Histological evaluation of capsules formed by silicon implants coated with polyurethane foam and with a textured surface in rats.

PURPOSE:: To assess the capsules formed by silicone implants coated with polyurethane foam and with a textured surface. METHODS:: Sixty-four Wistar albinus rats were divided into two groups of 32 each using polyurethane foam and textured surface. The capsules around the implants were analyzed for 30, 50, 70 and 90 days. Were analyzed the following parameters: foreign body reaction, granulation tissue, presence of myofibroblasts, neoangiogenesis, presence of synovial metaplasia, capsular thickness, total area and collagen percentage of type I and III, in capsules formed around silicone implants in both groups. RESULTS:: The foreign body reaction was only present in the four polyurethane subgroups. The formation of granulation tissue and the presence of myofibroblasts were higher in the four polyurethane subgroups. Regarding to neoangiogenesis and synovial metaplasia, there was no statistical difference between the groups. Polyurethane group presented (all subgroups) a greater capsule thickness, a smaller total area and collagen percentage of type I and a higher percentage area of type III, with statistical difference. CONCLUSION:: The use of polyurethane-coated implants should be stimulated by the long-term results in a more stable capsule and a lower incidence of capsular contracture, despite developing a more intense and delayed inflammatory reaction in relation to implants with textured surface.

Anatomia aplicada da ponta nasal em rinoplastia / Applied anatomy of the nasal tip in the rhinoplasty

Introdução: A insatisfação com a própria aparência facial leva muitas pessoas a buscarem a rinoplastia, sendo esse o quinto procedimento cirúrgico mais realizado na cirurgia plástica segundo a ISAPS. Devido essa cirurgia ser complexa, podendo gerar problemas estéticos e funcionais, o conhecimento aprofundado da anatomia dessa região, em especial a da ponta nasal, é imprescindível. Métodos: Realizou-se revisão na literatura em 17 artigos e 2 livros sobre a anatomia do nariz e sua repercussão na rinoplastia. Revisão da literatura: As primeiras menções sobre rinoplastia datam final do século XIV, desde lá houve muita evolução passando de uma técnica puramente reducional para uma estruturada que prioriza a melhora da função e estética nasal. O sucesso desse procedimento depende do conhecimento anatômico do profissional que o está realizando e também da escolha da técnica ideal. O nariz é constituído por ossos e principalmente cartilagens, as quais, junto com a musculatura, são responsáveis na determinação da aparência da ponta nasal. Essas cartilagens quando não são trabalhadas da forma correta, originam problemas funcionais, como colapso da válvula nasal externa. Conclusões: O conhecimento da anatomia da ponta nasal é fundamental para o sucesso da rinoplastia, devendo sempre equilibrar a função e a estética do nariz.

Introduction: Dissatisfaction with own facial appearance leads many people to seek for rhinoplasty, which is the fifth most common procedure in plastic surgery worldwide according to ISAPS. It is known as a very complex surgery that can cause aesthetic and functional problems, an in-depth knowledge of the anatomy of this region, especially the nasal tip, it is essential. Methods: A literature review was done in 17 articles and 2 books on the anatomy of the nose and its impact on rhinoplasty. Literature review: The first mention of rhinoplasty was in the late fourteenth century, since then much has been evolved, from a purely reductional technique to a structure done that prioritizes the improvement of nasal function and aesthetics. The success of it depends on the anatomical knowledge of the professional who is performing the procedure and also the choice of the ideal technique. The nose has in it constitution bones and cartilages, together with the muscles, are responsible for determining the appearance of the nasal tip. The cartilage if not properly crafted, it might cause functional problems such as collapse of the external nasal valve. Conclusions: The knowledge of the nasal tip anatomy is crucial to the success of rhinoplasty, and it must always find the balance between function and aesthetic of the nose.

Insuficiência da válvula nasal externa: planejamento e execução / External nasal valve insufficiency: planning and performing

A cirurgia reducional do nariz é uma técnica imprevisível e com consequências catastróficas na ponta nasal: retração alar, assimetria de ponta, exposição de ângulo septal, insuficiência valvular externa, dentre outras. Muitas destas sequelas residem muito mais na imprevisibilidade da contração cicatricial do que na inabilidade do cirurgião. Foram operados 72 pacientes entre dezembro-2010 à julho-2013. A técnica de eleição foi rinoplastia funcional estruturada. Todos os pacientes no pré-operatório foram submetidos à criterioso exame da válvula nasal externa sendo divididos em três grupos de acordo com o seu respectivo tratamento: a) Insuficiência válvula nasal externa com vetor adequado da cartilagem lateral inferior: enxerto de suporte da cruz lateral, "turn-in flap", "turn-over flap" e enxerto alar de Batten, b) Cartilagem alar fraca com vetor adequado da cartilagem lateral inferior e ponta bulbosa: "turn-in flap", "turn-over flap" e retalho articulado de cruz lateral, c) Cartilagem alar com vetor inadequado da cartilagem lateral inferior: enxerto de suporte da cruz lateral. Os 72 pacientes foram seguidos por 6 meses à 1 ano e meio. Houve revisão cirúrgica em 2 casos por indefinição de ponta devido à intensa retração cicatricial. Serão apresentados seis casos pós-operatórios. Nas rinoplastias primárias um adequado estudo anátomo-funcional das cartilagens laterais inferiores é fundamental para um bom resultado, pois as variantes anatômicas são diversas e cada caso tem sua particularidade. Já nas rinoplastias secundárias o cirurgião deve ter formação sólida em rinoplastia e estar preparado para as mais diversas situações

The reductive nose surgery is an unpredictable technique with catastrophic consequences on the nasal tip: alar retraction, tip asymmetry, septal angle exposure, external nasal valve insufficiency, among others. Many of these sequelae are more related to the unpredictability of scar contraction than on the inability of the surgeon. 72 patients underwent surgery between December 2010 and March 2014. The technique of choice was structured functional rhinoplasty. All patients in the preoperative period had their external nasal valve carefully examinated and they were divided in three groups in accordance with their treatment: The cases could be divided into groups with their respective treatment: a) External nasal valve insufficiency with appropriate lower lateral cartilage vector: lateral crural strut graft, turn-in flap, turn-over flap and alar Batten graft, b) Weak alar cartilage with appropriate lower lateral cartilage vector and bulbous tip: turn-in flap, turn-over flap and cephalic hinged flap of the lateral crura, c) Alar cartilage with inadequate lower lateral cartilage vector: lateral crural strut graft. The 72 patients were followed from 6 to 18 months. There was surgical revision in 2 cases by tip non-definition due to intense scar contraction. Six postoperative cases will be presented. In primary rhinoplasty an anatomical and functional adequate study of the lower lateral cartilages is essential for a good result because the anatomical variants are different and each case has its particularity. In secondary rhinoplasty surgeons must have solid training in rhinoplasty and be prepared for many different situations

Festoons: compreensão de conceitos e customização de técnicas / Festoons: understanding the concepts and customization of techniques

Com o passar dos anos pode ocorrer na pálpebra inferior flacidez de pele, alteração do tônus e comprimento tarsal, pseudoherniação da gordura periorbital pelo enfraquecimento do septo orbitário, alargamento e adelgaçamento do músculo orbicular, e "festoons". "Festoons" são dobras de pele e músculo delimitadas pelo arcus marginalis, local onde há uma firme aderência do septo malar. Foram operados 34 pacientes no período de março de 2010 à março de 2015. Como critérios diagnósticos de "festoons" estabeleceu-se: pálpebra inferior com excesso de pele e flacidez muscular delimitadas pelo arcus marginalis, frouxidão tarsal e pseudoherniação da gordura intra-orbital. Observou-se também vetor negativo na fenda palpebral. Na pálpebra inferior foi realizada incisão cutânea subciliar distando 2 mm dos cílios, dissecção do retalho cutâneo além do rebordo orbitário com liberação do septo malar, abertura da porção pré-tarsal do músculo orbicular desde lateralmente à órbita até medialmente sobre a bolsa de gordura medial. Abertura de todo o septo orbitário, ressecção das bolsas de gordura, septorrafia e ajuste da tensão septal com mononylon 6.0, suspensão muscular da pálpebra inferior como proposto por Mladick com mononylon 5.0. Cantopexia de Flowers, sem cantotomia, com mononylon 5.0 seguida de ancoramento cutâneo na incisão lateral com mononylon 6.0. Os pacientes foramacompanhados por 6 meses no pós-operatório. Existem várias opções para se atingir um bom resultado. O importante é com o tratamento reestabelecer ao máximo a anátomo-fisiologia prévia ao processo patológico. Nestes casos, pela alta complexidade, optamos por tratar cada estrutura individualmente, utilizando técnicas reprodutíveis e amplamente divulgadas

Trough the years can occur in the lower eyelid laxity of skin, change of tone and tarsal length, pseudo herniation of periorbital fat by weakening of the orbital septum, enlargement and thinning of the orbicularis oculi muscle, and "festoons". "Festoons" are folds of skin and muscle bounded by arcus marginalis, where there is a firm grip of malar septum. Were operated 34 patients in the period from March 2010 to March 2015. As diagnostic criteria for "festoons" was defined: lower eyelid with excess of skin and muscle flaccidity bounded by arcus marginalis, laxity and tarsal pseudo herniation of periorbital fat. It was also observed negative vector in palpebral fissure. In the lower eyelid was performed subciliar cutaneous incision 2 mm below of eyelashes, undermining of the skin flap in addition to the orbital rimwith release of malar septum, opening of pre tarsal orbicularis oculi muscle from the orbit(laterally) to the medial fat pad(medially). Opening up of all the orbital septum, resection of theexcess of periorbital fat pads, septoraphy and septal tension adjust with 6.0 mononylon, muscle suspension of the lower eyelid as proposed by Mladick with 5.0 mononylon. Flowers's canthopexy, without canthotomy, using5.0 mononylon followed by anchoring of cutaneous lateral incision with 6.0 mononylon. Patients were postoperatively followed for 6 months. There are several manners to achieve a good result. The most important thing is the treatment reestablishes the anatomy and physiology priors to the pathological process. In these cases, due to the high complexity, we chose to treat each structure individually, using reproducible techniques and widely broadcasted

Gluteoplastia unilateral para o tratamento de sequela de esclerodermia / Unilateral gluteoplasty for the treatment of scleroderma sequelae

A esclerodermia é uma doença autoimune com incidência de 0,4-2,7 para cada 100.000 pessoas com predominância pelo sexo feminino. Ela se apresenta de diversas formas, sendo a linear a forma mais prevalente em crianças, afetando 60% dos casos. Acomete membros e tronco, causando atrofia muscular e do subcutâneo, discrepância no comprimento dos membros, contraturas articulares, podendo levar inclusive à incapacidade física. Relatar uma indicação incomum para a gluteoplastia com resultado satisfatório usando- -se técnicas sedimentadas. J.B., feminino, 26 anos, branca, tratada de esclerodermia cutânea dos 3 aos 10 anos com remissão completa da atividade da doença. Apresentava sequela com atrofia cutânea, subcutânea e muscular somente no lado direito, localizada principalmente no sulco mamário, glúteo e face interna da coxa. A cirurgia foirealizada em dois tempos. O primeiro tempo consistiu em gluteoplastia unilateral de aumento com implante de silicone no plano intramuscular, lipoenxertia glútea e crural associados à mamoplastia de aumento bilateral. Num segundo momento uma nova lipoenxertia atenuou as assimetrias remanescentes. Devido à versatilidade e segurança da gluteoplastia associando-se inclusão de implante de silicone com a lipoenxertia é possível, em situações inusitadas, como esta paciente com uma sequela de esclerodermia unilateral, reestabelecer o contorno corporal com harmonia e resultados naturais

Scleroderma is an autoimmune disease with an incidence of 0.4 - 2.7 for every 100.000 people with preference by women. It shows itself in many ways, the linear form is more prevalent in children, affecting 60% of the cases. Affects limbs and trunk, causing muscle and subcutaneous atrophy, discrepancy in the length of the members, joint contractures, and may lead to physical disability. To report a rare indication for gluteoplasty with satisfactory results using known techniques. J. B., female, 26 years old, white, treated in cutaneous scleroderma from 3 to 10 years old with complete remission of the disease activity. She developed sequelae with cutaneous, subcutaneous and muscular atrophy only in the right side, located mainly in the inframammary fold, buttocks and inner thigh. The surgery was performed in two stages. The first time was a unilateral augmentation gluteoplasty with silicone gel implant positioned in the muscular plane, gluteal and crural lipofilling associated with bilateral augmentation mammoplasty. In a second moment a new lipofilling attenuated the remaining asymmetries. Due to the versatility and safety of gluteoplasty associating the inclusion of silicone gel implant with the lipofilling is possible, in unusual situations, such as this patient with a sequelae of unilateral scleroderma, reestablish the body contour with harmony and natural results

Península e suas variantes / Península and its variations

A técnica da península foi criada para contornar o problema da ascensão do pé do cabelo nas ritidoplastias. Sua indicação foi ampliada, tornando-se imprescindível nos casos primários de implantação alta de cabelo e naqueles pacientes com excessiva flacidez do terço médio que necessitam de grande ressecção de pele. Objetivo: apresenta-se como um recurso para permitir generosa ressecção de pele sem alterar a implantação capilar. Divulgar a técnica da península. Resultados: a península é uma parte do conjunto das incisões. Tem por dimensões os pontos BC, distando 5-8 cm entre si (sentido da tração), AC (mesma distância) e AB (contorno do pé do cabelo) de 2,5-3 cm. A incisão no pé do cabelo forma uma nova linha, ignorando a rarefação capilar porventura existente. A península divide-se em frontal (somando-se a um traçado coronal típico), frontal pré-capilar (pacientes com região frontal ampla) e temporal (eleva a cauda do supercílio e limpa a região lateral superior da órbita). Independente da variante ressalta-se a importância do retorno do ponto B à posição original, evitando qualquer tipo de degrau. A literatura mostra inúmeras técnicas de ritidoplastias, nas quais, existe a preocupação pelo não surgimento de estigmas indesejáveis, como a ascensão do pé do cabelo. Conclusão: nesse contexto, a península demonstra resultados consistentes, pois agrega vantagens em faces primárias e secundárias. Técnica de fácil execução. Proporciona o pé do cabelo na posição correta, evitando assim uma sequela estigmatizante, com ônus cicatricial mínimo.

This technique was created to solve the problem of lifted sideburns after rhytidoplasties. The indication was expanded, becoming essential in primary cases of high implantation of hair and in those patients with excessive flaccidity of middle third of the face that require large resection of skin. It presents itself as a resource to allow generous resection of skin without changing the capillary implantation. Península's technique broadcasting. Península is a part of all of the facial and skull incisions. It has the following dimensions: points BC 5-8 cm between themselves (direction of traction), AC (same distance) and AB (contour of the sideburns) between 2,5-3 cm. The incision at the sideburns forms a new line, bypassing the possible capillary rarefaction. Península can be frontal (adding to a typical coronal incision), frontal pre-capillary (patients with frontal region wide) and temporal (lifts the tail of the eyebrow and clears the upper lateral orbital region).Regardless of variant used, we emphasize the importance of the return of the point B to the original position, avoiding any type of step in the hair. The literature shows many techniques of rhytidoplasties, in which, there is a concern by not appearance of undesirable stigmas, as the lifted sideburns. In this context, Península shows consistent results, because adds advantages in primary and secondary rhytidoplasties. Technique of easy execution. Provides the sideburns in correct position, thus avoiding a stigmatizing sequelae, with small scars.

Comparação entre a utilização ou não de plasma rico em plaquetas em enxertos de pele: análise de casos clínicos / Comparison between the use or non-use of platelet-rich plasma in skin grafts: analysis of clinical cases

A reparação das feridas cutâneas ainda constitui um grande desafio para os cirurgiões plásticos. Em função de a literatura mencionar altas taxas de perda de enxerto diversos autores têm sugerido que a utilização do plasma rico em plaquetas para otimização do processo cicatricial. O presente estudo tem por finalidade comparar a técnica de enxertia de pele convencional com a utilização de embebição do enxerto em plasma rico em plaquetas analisando a integração do enxerto. Ensaio clínico randomizado duplo-cego. Um grupo de 9 pacientes candidatos a receber o enxerto de pele com plasma rico em plaquetas e outro grupo de mesmo número que foi submetido à técnica convencional. Antes de se submeterem ao procedimento cirúrgico, os pacientes de ambos os grupos foram encaminhados ao hemocentro e coletado 40 ml de sangue. Durante o ato cirúrgico no grupo do plasma rico em plaquetas o preparado foi infiltrado na área receptora para que o enxerto ficasse embebido no plasma. 18 pacientes no total sendo 9 de cada grupo. Técnica convencional: Úlcera de estase: 4 casos. Um paciente com integração total do enxerto e os outros três com integração parcial de 30 %. Neoplasia de pele: 2 casos. Carcinoma basocelular e carcinoma espinocelular. Integração total do enxerto.Queimadura: 2 casos. Um pacientecom integração parcial (70%) e outro com perda do enxerto. Fasciotomia: 1 caso. Tratamento de síndrome compartimental de extremidades com integração total do enxerto. Plasma Rico em Plaquetas:Úlcera de estase: 3 casos. Um paciente com integração total do enxerto e outros dois pacientes com integração parcial:90% e 50%. Neoplasia de pele: um paciente com carcinoma espinocelular em estágio evoluído. Enxertia pela Cirurgia Plástica em um segundo tempo com integração parcial (50%). Hemocultura positiva. Queimadura: uma criança de 6 anos com área corporal queimada de 10%. Integração total do enxerto. Fasciotomia: um paciente com trombose venosa profunda em antebraço esquerdo após uso de intravenoso de cocaína. Integração total do enxerto. Microangiopatia diabética (2 casos) e atropelamento (1 caso) só estiveram presentes neste grupo. Por ser um projeto Piloto ainda não foi possível tirar conclusões devido à insignificância estatística (p>0,05), mas este estudo até o presente momento vai de encontro com a literatura principalmente nos casos com comprometimento da vascularização local.

The repair of skin wounds still represents a major challenge for the plastic surgeons. According to the literature mention high rates of skin graft loss several authors have suggested the use of platelet-rich plasma for optimization of the healing process. The present study aims to compare the conventional skin grafting technique with the use of platelet-rich plasma under the graft by analyzing the integration of the graft. Randomized, double blind clinical trial. A group of 9 patients who are candidates to receive the skin graft with platelet-rich plasma and another group of the same number that was submitted to the conventional technique.Before being submitted to the surgical procedure, the patients of both groups were forwarded to hematology center and collected 40 ml of blood. During the surgical procedure in the group of platelet-rich plasma the preparation was infiltrated into the recipient area to the graft would be soaked in the plasma. Total of18 patients with 9 for each group. Conventional Technique: Stasis ulcer: 4 cases. One patient with full integration of the graft and other three with 30 % of integration. Skin neoplasm: 2 cases. Basal cell carcinoma and squamous cell carcinoma. Full integration of the graft. Burns: 2 cases. A patient with partial integration (70 %) and another with graft loss. Fasciotomy: 1 case. Treatment of compartmental syndrome of limbs with full integration of the graft. Platelet-rich Plasma:Stasis ulcer: 3 cases. One patient with full integration of the graft and the other two patients with partial integration: 90% and 50 %. Skin neoplasm: one patient with squamous cell carcinoma in advanced stage. Grafting by Plastic Surgery in a second time with partial integration (50 %). Positive hemoculture. Burns: one child of 6 years with body surface area burned of 10 %. Full Integration of the graft. Because it's a Pilot project we can't draw any conclusions due to statistical insignificance (p> 0.05), but this study up to the present time is in accordance with the literature especially in cases with involvement of local vascularization.