Does the Nail Bed Regenerate?

BACKGROUND: The regenerative potential of the nail bed after trauma remains controversial. METHODS: We performed a retrospective review of 51 patients who underwent nail bed reconstruction with 2 techniques (direct flow island flap or a Tranquilli-Leali "Atasoy" flap) due to trauma involving the nail bed complex. These 2 flaps were used to support the loss of distal substance and to allow the regeneration of the nail bed. Outcomes were analyzed for at least 18 months. There were 34 men (66.7%), and the average age was 16.1 years. Most patients (56.9%) had crush injuries. The little (16) and index (14) fingers were the most affected. Twenty-seven were children (range: 4-11) with an average age of 7.4 ± 1.9 years. The middle finger was the most affected (29.2%). RESULTS: The outcomes were good to excellent in 41 operated patients (80.4%). Hook nail was absent in 84.3% of the patients. Most patients (98%) did not develop necrosis. Children had an excellent/good outcome rate of 85.2%, while in adults, the rate was 75% of cases (P = .485). CONCLUSION: The direct flow island flap is superior in terms of outcome, regardless of age, sex, affected finger, dominant hand, type of trauma, and injury zone. In cases where there was a correct reconstruction of the hyponychium, there was regeneration of the nail bed.

Is There Room for Microsurgery in Robotic Surgery?

Robotic surgery opened a new era of minimally-invasive procedures, through its improved precision, elimination of tremors, greater degrees of freedom, and other facilitating aspects. The field of robotic microsurgery showed great growth in recent years in particular, since robotics offers a potentially-ideal configuration to perform the sensitive manipulations required in microsurgery. We conducted a systematic review to assess the benefits of robotic surgery and its contributions to microsurgery, comparing it with other surgical techniques used in patients of all age groups. We assessed 25 articles found in the PubMed and Cochrane databases using the terms ' robotic surgery ' AND microsurgery , with a filter for studies published in the last five years, and studies conducted in humans and published in English or Portuguese. We concluded that there is plenty of room for robotic surgery in microsurgery, such as in male infertility procedures, neurological microsurgery, ocular and otological surgeries, and transoral, hepatobiliary, microvascular, plastic and reconstructive surgeries.

Is There Room for Microsurgery in Robotic Surgery? / Existe espaço para a microcirurgia na cirurgia robótica?

Abstract Robotic surgery opened a new era of minimally-invasive procedures, through its improved precision, elimination of tremors, greater degrees of freedom, and other facilitating aspects. The field of robotic microsurgery showed great growth in recent years in particular, since robotics offers a potentially-ideal configuration to perform the sensitive manipulations required in microsurgery. We conducted a systematic review to assess the benefits of robotic surgery and its contributions to microsurgery, comparing it with other surgical techniques used in patients of all age groups. We assessed 25 articles found in the PubMed and Cochrane databases using the terms 'robotic surgery' AND microsurgery, with a filter for studies published in the last five years, and studies conducted in humans and published in English or Portuguese. We concluded that there is plenty of room for robotic surgery in microsurgery, such as in male infertility procedures, neurological microsurgery, ocular and otological surgeries, and transoral, hepatobiliary, microvascular, plastic and reconstructive surgeries.

Resumo A cirurgia robótica abriu uma nova era de procedimentos minimamente invasivos, por meio da sua precisão, da eliminação dos tremores, e dos maiores graus de liberdade e demais aspectos facilitadores. O campo da microcirurgia robótica apresentou grande crescimento nos últimos anos em especial, uma vez que a robótica oferece uma configuração potencialmente ideal para realização das manipulações delicadas exigidas na microcirurgia. Assim, conduzimos uma revisão sistemática com o objetivo de avaliar os benefícios da cirurgia robótica e sua contribuição para a microcirurgia, comparando-a com as demais técnicas cirúrgicas utilizadas em pacientes de todas as faixas etárias. Foram analisados 25 artigos encontrados nas bases de dados PubMed e Cochrane utilizando os descritores robotic surgery AND microsurgery com filtro para os últimos cinco anos, e estudos realizados em humanos e publicados em inglês ou português. Concluímos que existe grande espaço para a cirurgia robótica na microcirurgia, como em procedimentos primários de infertilidade masculina, microcirurgia neurológica, cirurgias oculares e otológicas, cirurgia transoral, hepatobiliar, microvascular, e cirurgia plástica e reconstrutiva.

Effect of Tacrolimus and Cyclosporine Immunosuppressants on Peripheral Nerve Regeneration: Systematic Review and Meta-analysis.

Peripheral nerve damage is an important cause of seeking medical attention. It occurs when the continuity of structures is interrupted and the propagation of nervous impulses is blocked, affecting the functional capacity of individuals. To assess the effects of the immunosuppressants tacrolimus and cyclosporine on the regeneration of peripheral nerves, a systematic review of the literature was carried out. The articles included were published until September 2018 and proposed to evaluate the effects of the immunosuppressants tacrolimus and cyclosporine on nerve regeneration and neuroprotection, available in the MEDLINE, EMBASE, Cochrane Library, Web of Science, Oxford Pain Relief Database, and LILACS databases. The research analysed a total of 56 articles, of which 22 were included in the meta-analysis. Statistical analysis suggests the protective effect of tacrolimus in the regeneration of the number of myelinated axons (95% confidence interval [CI]: 0.93-2.39; p < 0.01); however, such effect was not observed in relation to cyclosporine (95%CI: - 0.38-1.18; p = 0.08) It also suggests that there is a significant relationship between the use of tacrolimus and myelin thickness (95%CI= 2.00-5.71; p < 0. 01). The use of immunosuppressants in the regeneration of peripheral nerve damage promotes an increase in the number of myelinated axons in general, regardless of the administered dose. In addition, it ensures greater myelin thickness, muscle weight and recovery of the sciatic functional index. However, heterogeneity was high in most analyses performed.

Effect of Tacrolimus and Cyclosporine Immunosuppressants on Peripheral Nerve Regeneration: Systematic Review and Meta-analysis / Efeito dos imunossupressores tacrolimus e ciclosporina na regeneração de nervos periféricos: Revisão sistemática e metanálises

Abstract Peripheral nerve damage is an important cause of seeking medical attention. It occurs when the continuity of structures is interrupted and the propagation of nervous impulses is blocked, affecting the functional capacity of individuals. To assess the effects of the immunosuppressants tacrolimus and cyclosporine on the regeneration of peripheral nerves, a systematic review of the literature was carried out. The articles included were published until September 2018 and proposed to evaluate the effects of the immunosuppressants tacrolimus and cyclosporine on nerve regeneration and neuroprotection, available in the MEDLINE, EMBASE, Cochrane Library, Web of Science, Oxford Pain Relief Database, and LILACS databases. The research analysed a total of 56 articles, of which 22 were included in the meta-analysis. Statistical analysis suggests the protective effect of tacrolimus in the regeneration of the number of myelinated axons (95% confidence interval [CI]: 0.93-2.39; p< 0.01); however, such effect was not observed in relation to cyclosporine (95%CI: - 0.38-1.18; p» 0.08) It also suggests that there is a significant relationship between the use of tacrolimus and myelin thickness (95%CI» 2.00-5.71; p< 0. 01). The use of immunosuppressants in the regeneration of peripheral nerve damage promotes an increase in the number of myelinated axons in general, regardless of the administered dose. In addition, it ensures greater myelin thickness, muscle weight and recovery of the sciatic functional index. However, heterogeneity was high in most analyses performed.

Resumo As lesões nervosas periféricas são uma causa importante de busca por atendimento médico. Elas ocorrem quando há a interrupção da continuidade das estruturas e do bloqueio da propagação dos impulsos nervosos, afetando a capacidade funcional dos indivíduos. Para avaliar os efeitos dos imunossupressores tacrolimus e ciclosporina na regeneração de nervos periféricos, foi realizada uma revisão sistemática da literatura. Foram incluídos artigos publicados até setembro de 2018, que se propunham avaliar os efeitos dos imunossupressores tacrolimus e ciclosporina na regeneração nervosa e neuroproteção, disponíveis nas bases de dados MEDLINE, EMBASE, Cochrane Library, Web of Science, Oxford Pain Relief Database e LILACS. A pesquisa analisou um total de 56 artigos, dos quais 22 foram para metanálise. A análise estatística sugere o efeito protetor do tacrolimus na regeneração do número de axônios mielinizados (intervalo de confiança [IC] 95%: 0,93-2,39; p< 0,01); todavia tal efeito não foi observado em relação à ciclosporina (IC95%: - 0,38-1,18; p» 0,08). Ela também sugere haver uma relação significativa entre o uso do tacrolimus e a espessura da mielina (IC95%: 2,00-5,71; p< 0,01). O uso de imunossupressores na regeneração de lesão nervosa periférica promove um aumento no número de axônios mielinizados de forma geral, independentemente da dose administrada. Além disso, garante uma maior espessura da mielina, um maior peso muscular e restabelecimento do índice da função do nervo ciático. Todavia, a heterogeneidade foi alta na maioria das análises realizadas.

Neural Regenerative Potential of Stem Cells Derived from the Tooth Apical Papilla.

The regenerative effects of stem cells derived from dental tissues have been previously investigated. This study assessed the potential of human tooth stem cells from apical papilla (SCAP) on nerve regeneration. The SCAP collected from nine individuals were characterized and polarized by exposure to interferon-γ (IFN-γ). IFN-γ increased kynurenine and interleukin-6 (IL-6) production by SCAP, without affecting the cell viability. IFN-γ-primed SCAP exhibited a decrease of brain-derived neurotrophic factor (BDNF) mRNA levels, followed by an upregulation of glial cell-derived neurotrophic factor mRNA. Ex vivo, the co-culture of SCAP with neurons isolated from the rat dorsal root ganglion induced neurite outgrowth, accompanied by increased BDNF secretion, irrespective of IFN-γ priming. In vivo, the local application of SCAP reduced the mechanical and thermal hypersensitivity in Wistar rats that had been submitted to sciatic chronic constriction injury. The SCAP also reduced the pain scores, according to the evaluation of the Grimace scale, partially restoring the myelin damage and BDNF immunopositivity secondary to nerve lesion. Altogether, our results provide novel evidence about the regenerative effects of human SCAP, indicating their potential to handle nerve injury-related complications.

Trauma do nervo facial e terapias de tratamento / Facial nerve trauma and treatment therapies

Os traumatismos bucomaxilofaciais, associados com as fraturas do osso temporal e lacerações na face, muitas vezes acabam causando algumas lesões em nervos periféricos, em específico, o nervo facial. Quando lesionado, o VII par craniano pode comprometer profundamente a vida dos pacientes, tanto com alterações fisiológicas significativas, quanto alterações psicológicas. O tratamento dessas lesões, geralmente é cirúrgico; no entanto, os resultados muitas vezes ainda são insatisfatórios. Com o intuito de aprimorar as técnicas cirúrgicas no tratamento das lesões aos nervos periféricos, muitos estudos têm sidos realizados pela engenharia de tecidos com o objetivo de desenvolver biomateriais associados com fatores neuroindutores, principalmente nas lesões nervosas em que há perda de substância. O estudo desses biomateriais parece ser bastante promissor, tornando-se uma fonte viável em substituição ao enxerto autólogo, que; embora seja o "padrão ouro", ainda apresenta limitações. Sendo assim, esse artigo consiste de uma revisão de literatura livre, pelo pubmed, sobre trauma de nervo facial e alternativas de tratamento.

Buccomaxillofacial trauma, associated with temporal bone fractures and lacerations on the face, often end up causing some lesions on peripheral nerves, specifically the facial nerve. When injured, the VII cranial torque can profoundly compromise patients' lives, both with significant physiological changes and psychological changes. The treatment of these lesions is usually surgical; However, the results are often still unsatisfactory. In order to improve surgical techniques in the treatment of peripheral nerve injuries, many studies have been carried out by tissue engineering in order to develop biomaterials associated with neuroindustrial factors, especially in nerve lesions in which there is loss of substance. The study of these biomaterials seems to be quite promising, becoming a viable source in replacement of the autologous graft, which; Although it is the "gold standard", still has limitations. Thus, this article consists of a review of free literature, by pubmed, on facial nerve trauma and treatment alternatives.

Photobiomodulation Improved the First Stages of Wound Healing Process After Abdominoplasty: An Experimental, Double-Blinded, Non-randomized Clinical Trial.

BACKGROUND: Photobiomodulation is widely studied for its potential benefits in the wound healing process. Numerous scientific studies have highlighted its effect on various phases of wound repair, but clinical validations are few. This comparative trial aims to evaluate the influence of photobiomodulation on the post-abdominoplasty healing process. METHODS: Seventeen Caucasian women (aged 18-55) who underwent an abdominoplasty were enrolled in this double-blinded, controlled clinical trial. The postoperative scars were divided into two areas; the right side of the scars was treated with ten sessions of photobiomodulation (consisting in three types of wavelengths). The other part of the scars was used as control and did not receive any additional treatment. Clinical assessments of both parts of the scars were scheduled at 1, 6 and 12 months postoperative. RESULTS: Within six months following surgery, significantly improved quality of the scars on the treated side compared with the untreated side was reported by patients and experienced professionals according to Vancouver Scar Scale, Patient and Observer Scar Assessment Scale (p < 0.05) and standardized photographs (p < 0.05). At 1 year of follow-up, patients observed no differences between the treated and untreated sides of the scars. This suggests that photobiomodulation appears to play an early role in the wound healing process, accelerating the first stages of cicatrization. CONCLUSION: This study statistically validates the positive impact of photobiomodulation treatment on the first stages of the postoperative healing process. Carried out on Caucasians participants only, this study should, however, be performed on a more heterogeneous population to definitively confirm these effects on an international population. CLINICAL TRIAL REGISTRY: Registro Brasileiro de ensaios clínicos: http://www.ensaiosclinicos.gov.br , Trial RBR-49PK78. LEVEL OF EVIDENCE II: 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 .

Effect of platelet-rich plasma on rat Achilles tendon healing is related to microbiota.

Background and purpose - In 3 papers in Acta Orthopaedica 10 years ago, we described that platelet-rich plasma (PRP) improves tendon healing in a rat Achilles transection model. Later, we found that microtrauma has similar effects, probably acting via inflammation. This raised the suspicion that the effect ascribed to growth factors within PRP could instead be due to unspecific influences on inflammation. While testing this hypothesis, we noted that the effect seemed to be related to the microbiota. Material and methods - We tried to reproduce our old findings with local injection of PRP 6 h after tendon transection, followed by mechanical testing after 11 days. This failed. After fruitless variations in PRP production protocols, leukocyte concentration, and physical activity, we finally tried rats carrying potentially pathogenic bacteria. In all, 242 rats were used. Results - In 4 consecutive experiments on pathogen-free rats, no effect of PRP on healing was found. In contrast, apparently healthy rats carrying Staphylococcus aureus showed increased strength of the healing tendon after PRP treatment. These rats had lower [corrected] levels of cytotoxic T-cells in their spleens. Interpretation - The failure to reproduce older experiments in clean rats was striking, and the difference in response between these and Staphylococcus-carrying rats suggests that the PRP effect is dependent on the immune status. PRP functions may be more complex than just the release of growth factors. Extrapolation from our previous findings with PRP to the situation in humans therefore becomes even more uncertain.

Validation of a Method for Estimation of Facial Age by Plastic Surgeons.

IMPORTANCE: Within cosmetic facial plastic surgery, there is considerable difficulty in producing high-quality scientific publications because of the lack of scientific tools that serve to transform sensations, such as more beautiful or rejuvenated, into numbers capable of being used in statistical analysis. OBJECTIVE: To validate an objective evaluation method that can be used to define the perception of facial age in scientific studies. DESIGN, SETTING, AND PARTICIPANTS: This is a cross-sectional, observational study of evaluation by plastic surgeons of 70 photographs of patients from a private care hospital performed from March 1, 2015, through April 30, 2016. When evaluating the photographs, 7 plastic surgeons wrote down the perceived age of each patient. The photographs of each patient were randomly presented twice to each evaluator (photograph 1 and photograph 2) and analyzed singly using a trimmed mean. Three evaluators were randomly chosen for further statistical analysis in an attempt to make the assessment technique more practical. EXPOSURES: Usual aging process. MAIN OUTCOMES AND MEASURES: Estimated mean age and chronological age. RESULTS: Photographs of 70 patients were evaluated (mean [SD] age, 41.5 [13.8] years; 48 women [68.6%]; and mean [SD] body mass index, 22.5 [2.7]). No significant differences were observed between photographs 1 and 2 for any of the evaluators. A significant difference in the mean ages was not observed when comparing evaluators. For photograph 1 (evaluated by only 3 evaluators), the difference was 0.16 years (P = .52). For photograph 2, the difference was 0.05 years (P = .86). The difference between the mean perceived age for the 3 evaluators and the chronological age was only 0.8 years (<10 months). CONCLUSIONS AND RELEVANCE: The intraevaluator and interevaluator agreement suggests that 3 plastic surgeons can estimate the age of a person with a margin of error of 10 months by analyzing a photograph. This article is important to facial plastic surgeons because it reveals how the results of rejuvenation procedures can be assessed. LEVEL OF EVIDENCE: NA.

Synovial tuberculosis of the hand: An ancient disease in an unusual localisation.

BACKGROUND: Tuberculosis is the most prevalent infectious disease in the world. It is mainly caused by Mycobacterium tuberculosis. Osteoarticular tuberculosis represents 1%-3%. Tenosynovitis is the most common form of the disease in the hand. AIMS: The aim of this study is to present an update of synovial tuberculosis. MATERIALS AND METHODS: The authors present a literature review, the clinical and surgical management and case reports. RESULTS: The outcomes were satisfactory and were not report complications. CONCLUSIONS: Early diagnosis, surgical transection of the transverse carpal ligament, debridement and complete excision of the infected synovium may be required, along with antituberculosis drugs. Knowledge of this disease in the hand can provide a better diagnosis and outcome.

Curso básico em cirurgia plástica para acadêmicos: enxertos e retalhos / Basic course in plastic surgery for medical students: grafts and flaps

O processo de ensino na Medicina, principalmente nas áreas cirúrgicas, ocorre pela observação do ato cirúrgico e pela participação direta do estudante. A prática em cadáveres de seres humanos e em animais vivos está associada a custos elevados, risco de infecções, necessidade de instalações especializadas, bem como com aspectos legais e éticos a serem observados. A educação médica é baseada em modelos de simulação para o treinamento de habilidades, sendo de grande ajuda na aquisição e manutenção de habilidades cirúrgicas. O objetivo deste artigo é descrever uma metodologia para o ensino e a aprendizagem dos princípios básicos de retalhos cutâneos em um programa de graduação em Medicina, utilizando um modelo em pele suína (pele de porco). O curso baseia-se na formação em técnica cirúrgica básica de retalhos cutâneos entre acadêmicos de Medicina e residentes de áreas cirúrgicas, através do treinamento prático após uma aula teórica presencial. Os autores concluem que o ensino de uma metodologia para os princípios de cirurgia de retalhos cutâneos, utilizando um modelo de pele de porco, é versátil, fácil de montar e de baixo custo. Mostrou-se uma opção complementar ao arsenal de métodos baseados em outros modelos descritos (AU)

The teaching process in medicine, especially in the surgical areas, occurs through observation of the surgical act and direct student participation. The practice in human cadavers and live animals is associated with high costs, risk of infection, need for specialized facilities, as well as legal and ethical aspects to be observed. Medical education is based on simulation models for skills training, which are very helpful in acquiring and maintaining surgical skills. The aim of this article is to describe a methodology for teaching and learning the basic principles of cutaneous flaps in a medical degree program using a porcine skin model. The course is based on training in basic surgical technique of cutaneous flaps for medical students and residents of surgical areas through practical training after a theoretical lecture in person. The authors conclude that teaching a methodology for the principles of skin flap surgery using a pig skin model is versatile, easy to implement and inexpensive. It turned out to be a complementary option to the arsenal of methods based on other described models (AU)

Microcirurgia: modelo de treinamento básico para estudantes de Medicina / Microsurgery: basic training model for medical students

Introdução: Atualmente, existe uma carência de exposição à cirurgia plástica durante a graduação. A maioria dos currículos universitários não possui uma forma específica de ensino em cirurgia plástica. Para reverter essa situação, algumas universidades fomentam o contato precoce com a cirurgia plástica através de cursos extracurriculares. Método: Foi desenvolvido um Curso Básico de Microcirurgia para acadêmicos de Medicina com uma aula teórica e uma prática, anualmente e ao longo de 3 anos; na última edição, foi aplicado um questionário sobre o interesse na área e a importância no ensino durante a graduação. Resultados: Dentre os alunos, 65% apresentaram grande interesse pela microcirurgia, 95% relataram um aumento de interesse. Todos os alunos concordaram que os acadêmicos de Medicina devem ser mais envolvidos e treinados na área microcirúrgica durante a graduação. Conclusões: O desenvolvimento de um curso de treinamento básico de microcirurgia para acadêmicos de Medicina é benéfico para o aprendizado dos alunos, para obtenção de informações acerca da disciplina e para o aprimoramento de habilidades(AU)

Introduction: Currently there is a lack of exposure to plastic surgery during medical graduation. Most college curricula do not have a specific form of education in plastic surgery. To reverse this situation, some universities encourage early contact with plastic surgery through extracurricular courses. Methods: We developed a basic course of microsurgery for medical students with a lecture and a practical class, annually and over 3 years; in the last edition, a questionnaire on the interest in the area and the importance in education during graduation was applied. Results: Among the students, 65% showed great interest in microsurgery, and 95% reported an increase of interest. All students agreed that medical students should be more involved and trained in the microsurgical area during graduation. Conclusions: The development of a basic training course of microsurgery for medical students is beneficial for student learning, obtaining information about the discipline, and improving skills(AU)

Tumores da mão parte III: tumores de pele da mão / Tumors of the hand, Part III: Skin tumors of the hand

O tumor de pele da mão corresponde ao câncer primário mais comum dessa região. Apesar de proporcionalmente cobrir uma pequena superfície do corpo, corresponde a uma parte considerável de todos os tumores de pele. O objetivo principal deste trabalho é mostrar de forma simples e clara as lesões mais prevalentes e encontradas no ambulatório médico, de uma forma que este pode ser usado para consulta e orientação do profi ssional médico das mais diversas especialidades, objetivando um diagnóstico rápido e assertivo, que interferirá positivamente no desfecho da doença. Nesta terceira parte do trabalho são abordados fundamentos, conceitos, classifi cações e abordagens para o melhor prognóstico do paciente.

Skin tumor of the hand is the most common primary cancer of this region. Although covering a proportionally small surface of the body, it accounts for a substantial part of all skin tumors. The main aim of this work is to show simply and clearly the most prevalent injuries found in the outpatient clinic, so that it can be used by healthcare providers from various specialties as a consultation and guidance resource, aiming at a quick and assertive diagnosis that will interfere positively with disease outcome. This third part of the work covers the fundamentals, concepts, classifi cations and approaches for a better prognosis.

Modificação na técnica de Webster para reconstrução total de lábio inferior, com uso da pele da região nasogeniana para aumentar o volume do vermelhão / Modification in Webster technique for lower lip reconstruction, using bilateral nasolabial flaps to improve reconstruction of vermilion

INTRODUÇÃO: A técnica de Bernard modificada por Webster é considerada por diversos autores a primeira escolha para reconstrução total de lábio inferior. Ela preserva as linhas e pontos de referência estética da face, e proporciona boa sensibilidade no lábio reconstruído, permitindo alcançar resultados estéticos e funcionais satisfatórios. Apesar de concordar com os princípios da técnica de Webster, uma modificação é proposta visando aperfeiçoar a reconstrução do vermelhão, usando retalhos nasogenianos bilaterais associados aos retalhos de avançamento originais. MÉTODOS: São apresentados cinco casos operados pelo autor no período de 2003 a 2008, e os resultados são discutidos. RESULTADOS: Demonstrou-se que a dissecção necessária para avançar os retalhos da bochecha na técnica de Bernard-Webster não inviabiliza os retalhos nasogenianos, e estes podem ser rotados adequadamente para acrescentar pele e volume ao vermelhão reconstruído. CONCLUSÃO: A modificação proposta não impõe risco aumentado ou prejuízo sobre a técnica original, e mantém ou aumenta a sua capacidade reconstrutiva.

INTRODUCTION: Many authors consider the Bernard technique modified by Webster the first choice for total lower lip reconstruction. This technique preserves skin folds and anatomical landmarks on the face, and interferes minimally with the tactile sensibility of the reconstructed lip, resulting in satisfying cosmetic and functional outcomes. Despite agreeing with the principles of the Webster technique, a modification is proposed to improve reconstruction of vermilion, by using bilateral nasolabial flaps associated with the original advancement flaps. METHODS: We report five surgical cases carried out between 2003 and 2008, and discussion of results. RESULTS: Dissection need to advance flaps in Bernard-Webster technique does not make nasolabial flaps unviable, and they can be rotated properly to add volume and skin to the reconstructed vermilion. CONCLUSION: Proposed modification of Bernard-Webster technique does not increase risk or damage compared with classic technique, and it maintains the same reconstructive capabilities or even enhances it.

Tumores da mão parte II: Tumores ósseos da mão / Hand tumors – Part II: bone tumors of the hand

Tumores ósseos da mão podem ser divididos em benignos, malignos ou metastáticos. Os benignos são os mais comuns, sendo que destes os encondromas são os mais prevalentes (1). A incidência de tumores na mão é relativamente baixa; entretanto, caso esses tumores sejam malignos, podem ser localmente invasivos e comprometer a função da mão. Geralmente para tumores benignos é realizada ressecção intralesional do tumor; porém, para tumores malignos pode ser necessária ampla excisão ou até eventualmente amputação para que não ocorra recidiva tumoral. Este trabalho foi desenvolvido no Serviço de Cirurgia da Mão e Microcirurgia Reconstrutiva do Hospital São Lucas da PUCRS. Nosso objetivo é relatar os principais tipos de tumores da mão, dividindo-os em benignos e malignos, e orientar os médicos que realizarão seu primeiro atendimento em relação à clínica, exames necessários e opção de tratamentos.

Bone tumors of the hand can be divided into benign, malignant or metastatic. Benign tumors are the most common, and of these enchondromas are the most prevalent (1). The incidence of tumors in the hand is relatively low. If these are malignant tumors, however, they may be locally invasive and compromise the function of the hand. Generally for benign tumors intralesional tumor resection is performed, but malignant tumors can require wide excision or possibly even amputation so as to avoid tumor recurrence. This work was developed in the Service of Hand Surgery and Reconstructive Microsurgery at Hospital São Lucas of PUCRS. Our aim here is to describe the main types of hand tumors, dividing them into benign and malignant, and guide physicians seeing their fi rst patient with regard to clinical practice, necessary examinations and treatments choices.

Retalho tenar adipofascial reverso para cobertura do nervo mediano hipertrofiado em macrodactilia / The reverse adipofascial thenar flap for coverage of the hypertrophied median nerve in macrodactyly

A macrodactilia é uma anomalia congênita infrequente, caracterizada pelo crescimento desproporcional dos tecidos ósseo, gorduroso, nervoso, vascular e dérmico nos dedos das mãos ou dos pés. Existem muitas teorias sobre a sua etiopatogenia, sendo a mais aceita a hiperestimulação por fatores de crescimento enviados através dos nervos. Foram descritos alguns casos associados com a síndrome do túnel do carpo. Apresenta-se um caso clínico de síndrome do túnel do carpo por hipertrofia do nervo mediano, evidenciando um aumento de conteúdo dentro do retináculo flexor, o qual foi tratado cirurgicamente com sucesso pela realização de uma retinaculotomia do ligamento anular do carpo junto a um retalho de transposição tenar adipofascial reverso da região tenariana hipertrofiada visando à cobertura do nervo mediano na região do punho.

Macrodactyly is a rare congenital anomaly characterized by the disproportionate growth of bone, fat, nervous, vascular, and dermal tissue in the digits . There are many different theories about its etiopathogenesis, the most accepted being a hyperstimulation by growth factors conducted through nerves. A few cases have been described in conjunction with carpal tunnel syndrome. Here, a clinical case of carpal tunnel syndrome due to hypertrophy of the median nerve is presented, showing an increase of content within the flexor retinaculum. Successful surgical treatment was accomplished by conducting a retinaculotomy of the anterior annular ligament along with a reverse transposition adipofascial flap of the hypertrophied thenar region for coverage of the median nerve at the wrist.

Syndrome of fascial incarceration of the long thoracic nerve: winged scapula.

OBJECTIVE: To analyze the results from early intervention surgery in patients with the syndrome of fascial incarceration of the long thoracic nerve and consequent winged scapula. METHODS: Six patients with a syndrome of nerve trapping without specific nerve strain limitations were followed up. RESULTS: The patients achieved improvement of their symptoms 6-20 months after the procedure. The motor symptoms completely disappeared, without any persistent pain. The medial deformity of the winged scapula improved in all cases, without any residual esthetic disorders. CONCLUSION: The approach of early surgical release seems to be a better predictor for recovery from non-traumatic paralysis of the anterior serratus muscle.

OBJETIVO: Analisar os resultados de cirurgia de intervenção precoce em pacientes com síndrome do aprisionamento fascial do nervo torácico longo e consequente escápula alada. MÉTODOS: Acompanhamos seis pacientes com uma síndrome de aprisionamento sem restrições específicas de estiramento ao nervo. RESULTADOS: Pacientes tiveram melhoria em seus sintomas seis a 20 meses após o procedimento. Sintomas motores melhoraram completamente sem qualquer dor persistente. A deformidade medial da escápula alada melhorou em todos os casos sem distúrbios estéticos residuais. CONCLUSÃO: A abordagem de liberação cirúrgica precoce parece ser um melhor preditor na recuperação de paralisia não traumática do músculo serrátil anterior.

Síndrome do aprisionamento fascial do nervo torácico longo: escápula alada / Syndrome of fascial incarceration of the long thoracic nerve: winged scapula

Analisar os resultados de cirurgia de intervenção precoce em pacientes com sín drome do aprisionamento fascial do nervo torácico longo e consequente escápula alada. Métodos: Acompanhamos seis pacientes com uma síndrome de aprisionamento sem restricões específicas de estiramento ao nervo. Resultados: Pacientes tiveram melhoria em seus sintomas seis a 20 meses após o proce dimento. Sintomas motores melhoraram completamente sem qualquer dor persistente. A deformidade medial da escápula alada melhorou em todos os casos sem distúrbios estéticos residuais. Conclusão: A abordagem de liberação cirúrgica precoce parece ser um melhor preditor na recuperação de paralisia não traumática do músculo serrátil anterior.

To analyze the results from early intervention surgery in patients with the syndrome of fascial incarceration of the long thoracic nerve and consequent winged scapula. METHODS: Six patients with a syndrome of nerve trapping without specific nerve strain limitations were followed up. RESULTS: The patients achieved improvement of their symptoms 6-20 months after the procedure. The motor symptoms completely disappeared, without any persistent pain. The medial deformity of the winged scapula improved in all cases, without any residual esthetic disorders. CONCLUSION: The approach of early surgical release seems to be a better predictor for recovery from non-traumatic paralysis of the anterior serratus muscle.