Nerve Injury and Peripheral Nerve Functional Loss From Injection and Suture Needles: An Experimental Study on Rats.

BACKGROUND: During invasive procedures involving needles, there is a chance of damage to peripheral nerves. Therefore, a method for experimentally simulating these situations is needed. OBJECTIVES: In this study we aimed to evaluate peripheral nerve lesions caused by the entry and exit of an injection needle, nerve transfixion through a suture stitch, and the injection of saline solution and lidocaine into the nerve. METHODS: After obtaining approval from the Animal Ethics Committee, we randomly divided 36 Wistar rats, weighing approximately 250 g each, into 6 groups (control, sham, suture, needle, saline, and lidocaine groups), with 6 animals in each group. All procedures were performed on the left paws of the rats. After the procedure, walking track analysis was performed to assess the walking function of rats for 8 weeks. Four months after the procedures, we performed bilateral electrophysiological studies (measuring the latency and amplitude of the electrical impulse in the peroneal nerve). Subsequently, the rats were euthanized, and bilateral tissue samples were collected from the peroneal nerve and tibialis cranialis muscle for morphometric histological analysis. RESULTS: In the walking track analysis, all groups showed normalization of walking functionality after 13 days. There was little histological change between the groups, and no functional loss related to the procedures was observed. CONCLUSIONS: Procedures involving the infusion of local anesthetic or saline solution, or suture needles, are safe with regard to peripheral nerve function loss. Accidents tend not to cause nerve impairment.

Use of Phosphodiesterase Inhibitors in the Postoperative Period of Skin Flaps: A Systematic Review.

Ischemia-reperfusion injury can occur in several clinical conditions, and it has been widely studied in the context of skin flaps. Vascular distress results in an imbalance between the supply and demand of oxygen to living tissues, and the result of this process is tissue necrosis. Several drugs have been studied to reduce vascular distress of skin flaps and tissue loss. Methods: The present study performed a systematic review of literature in the main databases (PubMed, Web of Science, LILACS, SciELO, and Cochrane), including articles published in the last 10 years. Results: It was observed that phosphodiesterase inhibitors, mainly types III and V, have shown promising results in terms of vascularization of the postoperative skin flap, especially when started on the first postoperative day and maintained for 7 days. Conclusion: New studies with different posology, duration of use, and new drugs are needed to better elucidate the use of this substance to optimize the circulation of skin flaps.

Temporal Branch Ablation for the Treatment of Facial Rhytids: A New Surgical Technique.

BACKGROUND: Frontal wrinkles are a cause of distress for many people as they age. Traditionally, these have been treated with botulinum toxin injections. However, this procedure is not free from complications and has a temporary result. This report describes a procedure involving temporal branch of facial nerve ablation, a novel and simple technique for the treatment and prevention of rhytids. OBJECTIVES: The objective of this study was to introduce this new technique of ablation for the treatment of frontal wrinkles after analyzing 3 options of approach based on the number of ablation lines. METHODS: Fifty-one patients with a mean age of 49 years underwent nerve ablation. The temporal nerve branches were located through electrostimulation. Through a skin puncture in the temporal region, an Abbocath, with part of the plastic coating removed at its base, was introduced. The nerve branches were cauterized in oblique lines with a monopolar electric scalpel. Patients were divided into 3 groups, depending on the number of ablation lines. RESULTS: The median follow-up period was 20 months (range, 1-50 months). Only 3 (5.7%) patients developed unilateral relapse of muscle activity in the frontal region. Group 6 was statistically superior to Group 1. There was no statistically significant difference between Group 4 and the other 2 groups. More than 70% of patients were satisfied or very satisfied with the results. CONCLUSIONS: Facial nerve branch ablation is a simple surgical technique for the treatment of forehead rhytids that produces less postoperative pain, features rapid recovery, and, above all, offers long-lasting results.

Coleta de fáscia lata para uso em retalho ortodrômico temporal no tratamento da paralisia facial / Harvest of fascia lata for use in a temporal orthodromic flap in the treatment of facial paralysis

Introdução: A paralisia facial necessita de um tratamento multidisciplinar e as opções cirúrgicas são individualizadas para cada paciente e conforme a experiência da equipe médica. O Retalho Ortodrômico Temporal (ROT) é uma forma de correção bem documentada na literatura, com resultados satisfatórios. Um dos passos de sua realização é a coleta da fáscia lata para ponte entre o tendão temporal e os lábios. O objetivo é propor uma padronização da quantidade necessária de fáscia lata e técnica de coleta simplificada. Métodos: Descrição cirúrgica da medida de fáscia necessária para o procedimento e sua coleta. Resultados: Procedimento replicável e seguro conforme experiência do autor sênior. Conclusão: A tática de coleta proposta pode facilitar a realização deste procedimento e torná-lo mais seguro para os pacientes em diferentes serviços de saúde.

Introduction: Facial paralysis requires a multidisciplinary treatment, and surgical options are individualized for each patient according to the medical team's experience. The Temporal Orthodromic Flap (TOF) is a well-documented form of correction in the literature, with satisfactory results. One of the steps of its accomplishment is the collection of the fascia lata to bridge between the temporal tendon and the lips. The objective is to propose a standardization of the required amount of fascia lata and a simplified collection technique. Methods: Surgical description of the fascia measure necessary for the procedure and collection. Results: Replicable and safe procedure according to the senior author's experience. Conclusion: The proposed collection tactic can facilitate the performance of this procedure and make it safer for patients in different health services.

Zygomatic Muscle Neurotization with Nerve Grafts and End-to-Side Neurorrhaphies: A New Technique for Facial Palsy.

Moebius syndrome is a rare congenital facial palsy that can generate serious emotional repercussions, mainly due to the inability to smile. Currently, no treatment is available; however, surgery can restore muscle function. This case report introduces a new technique for the treatment of Moebius syndrome with zygomatic muscle neurotization using nerve grafts and end-to-side neurorrhaphies, in a 3-year-old girl diagnosed with bilateral Moebius syndrome who was unable to smile on the left side. After 4 years, the patient presented with full smile restoration on the left side, with right and left independent movements and complete symmetry.

Clamp vascular de fio de mononylon em microcirurgia experimental / Vascular clamp of mononylon thread in experimental microsurgery

Introdução: A microcirurgia reparadora é ramo hoje indissociável e imprescindível na cirurgia plástica. O treinamento é longo, custo financeiro relativamente alto e exige muito dos proponentes. Para melhorar essa equação a favor da formação de novos microcirurgiões no Brasil, é fundamental facilitar o acesso ao treinamento experimental, utilizando materiais simples. Huaraca descreveu uma técnica utilizando um simples fio mononylon 5-0 para substituir o clamp vascular, que é instrumento indispensável da anastomose microcirúrgica e geralmente de alto custo. O objetivo é comparar a técnica de Huaraca com fio de mononylon e o clamp metálico tradicional durante anastomose microcirúrgica vascular. Métodos: Seis ratos da raça Wistar cujas duas artérias femorais foram aleatoriamente selecionadas para sutura término-terminal após secção completa, sendo um dos lados realizado com clamp vascular habitual e o contralateral com técnica de Huaraca, no mesmo tempo cirúrgico e pelo mesmo cirurgião. Resultados: Em ambas as situações, a taxa de patência foi de 67% após 72 horas, sendo que o tempo médio foi de 26 minutos com a técnica de Huaraca e de 18 minutos com o clamp tradicional (p=0,001). Conclusão: Apesar do tempo de execução mais longo, a técnica de Huaraca é medida simples e de baixo custo que pode substituir o clamp vascular tradicional.

Introduction: Reconstructive microsurgery is now an inseparable and essential branch of plastic surgery. The training is long, has a relatively high financial cost and requires a lot of the proponents. To improve this equation in favor of the formation of new microsurgeons in Brazil, it is essential to facilitate access to experimental training, using simple materials. Huaraca described a technique using a simple 5-0 mononylon thread to replace the vascular clamp, which is an indispensable instrument for microsurgical anastomosis and is generally expensive. The objective is to compare the Huaraca technique with mononylon thread and the traditional metal clamp during vascular microsurgical anastomosis. Methods: Six Wistar rats whose both femoral arteries were randomly selected for end-to-end suture after complete section, with one side performed with usual vascular clamp and the contralateral with Huaraca technique, at the same surgical time and by the same surgeon. Results: In both situations, the patency rate was 67% after 72 hours, with an average time of 26 minutes with the Huaraca technique and 18 minutes with the traditional clamp (p=0.001). Conclusion: Despite the longer execution time, the Huaraca technique is a simple and low-cost measure that can replace the traditional vascular clamp.

Fragmented Fat Transfer for Massive Weight Loss Gluteal Contouring.

SUMMARY: A recently introduced novel fragmentation technique has made it possible to convert fat tissue from apronectomy into large-scale viable lipograft, providing a glimpse of an alternative to traditional liposuction and its harvesting limitations. The purpose of this study was to assess the initial clinical evidence on fragmented fat transfer to restore volume and enhance deflated gluteal contours in a sample of massive weight loss patients. The authors retrospectively reviewed medical records of 20 women who received autologous buttock fat grafts that were harvested and fragmented following belt lipectomies and/or fleur-de-lis abdominoplasties. The average total volume subcutaneously grafted into the buttocks was 720 ml (bilateral), ranging from 500 ml to 960 ml. No local gluteal complications, such as seroma, infection, fat necrosis, or subcutaneous nodulations, were reported. Photographic observation of postoperative results over a 6- to 14-month follow-up period showed clear enhancement of body contouring in all patients, especially in those in whom fat transfer was combined with circumferential lifts. Fat fragmentation has proved useful and effective in providing great amounts of viable fat graft in a safe, simple, and reproducible technique without noticeable complications. The method eliminates the organic response to the insult of liposuction while using the entirety of formerly discarded apronectomy tissue to provide fine, transferable, autologous fat without increasing operative time. Although preliminary, the authors' clinical findings with this new technique support further studies of fragmented fat as an alternative to liposuction in gluteal fat grafting. Additional potential applications, including in wound healing and regenerative medicine, are worth exploring. . CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Stem cells in end-to-side neurorrhaphy. Experimental study in rats.

PURPOSE: To evaluate the influence of mesenchymal stem cells from adipose tissue in the end-to-side neurorrhaphy, focusing in the nerve regeneration and the muscle reinnervation in acute trauma. METHODS: 140 animals were randomly divided in seven groups: control, denervated, end-to-side neurorrhaphy between distal stump of common peroneal nerve and tibial nerve (ESN), ESN wrapped in fascia, ESN wrapped in fascia and platelet gel, ESN wrapped in platelet gel, ESN wrapped in fascia and platelet gel within stem cells (without culture) removed from the adipose tissue. Mass measurements of the animal and of cranial tibial muscles, electromyography, walking track analysis tests and histological examinations of the nerves and muscles after 180 days was performed. RESULTS: In the groups where the ESN was performed, the results were always better when compared to the denervated group, showing reinnervation in all ESN groups. The most sensitive methods were walking track and histological analysis. Only the group with stem cells showed values similar to the control group, as well as the functional indices of peroneal nerve and the number of nerve fibers in the peroneal nerve. CONCLUSIONS: Stem cells were effective in ESN according with the functional index of the peroneal nerve, evaluated by walking track analysis and the number of nerve fibers in the peroneal nerve.

Stem cells in end-to-side neurorrhaphy. Experimental study in rats

Abstract Purpose: To evaluate the influence of mesenchymal stem cells from adipose tissue in the end-to-side neurorrhaphy, focusing in the nerve regeneration and the muscle reinnervation in acute trauma. Methods: 140 animals were randomly divided in seven groups: control, denervated, end-to-side neurorrhaphy between distal stump of common peroneal nerve and tibial nerve (ESN), ESN wrapped in fascia, ESN wrapped in fascia and platelet gel, ESN wrapped in platelet gel, ESN wrapped in fascia and platelet gel within stem cells (without culture) removed from the adipose tissue. Mass measurements of the animal and of cranial tibial muscles, electromyography, walking track analysis tests and histological examinations of the nerves and muscles after 180 days was performed. Results: In the groups where the ESN was performed, the results were always better when compared to the denervated group, showing reinnervation in all ESN groups. The most sensitive methods were walking track and histological analysis. Only the group with stem cells showed values similar to the control group, as well as the functional indices of peroneal nerve and the number of nerve fibers in the peroneal nerve. Conclusions: Stem cells were effective in ESN according with the functional index of the peroneal nerve, evaluated by walking track analysis and the number of nerve fibers in the peroneal nerve.

Gliding Brow Lift (GBL): A New Concept.

BACKGROUND: Creating the ideal aesthetic eyebrow shape and position is an important goal in facial rejuvenation. One challenge of an eyebrow lift is to find a predictable procedure that balances the advantages and disadvantages of the available strategies. The gliding brow lifting (GBL) is a technique that provides minimal incisions, an effective and stable eyebrow lift, and offers the advantage of precise reshaping of the eyebrow. METHODS: In a retrospective review, 124 patients, who underwent GBL technique from November 2015 through April 2016, were evaluated. With minimal incisions and tumescent infiltration, the subcutaneous plane of the forehead, eyebrows and temporal face is undermined releasing the skin from the underlying frontalis muscle, orbicularis oculi muscle, corrugator muscle and temporal parietal fascia. Fixation of the repositioned and reshaped eyebrow is achieved with the use of a hemostatic net for temporary cutaneous fixation. RESULTS: The average follow-up period was 17 months. Adequate brow repositioning and/or reshaping was achieved in 118 patients. Six patients had bilateral or unilateral recurrence of ptosis. Of these patients with recurrence, four patients had the same procedure re-performed within 1 month postoperatively with successful repositioning and/or reshaping of their brow. There was no incidence of hematoma, seroma, infection, permanent sensory changes, motor dysfunction, skin flap necrosis or alopecia. CONCLUSION: The "gliding brow lifting" (GBL), which combines subcutaneous frontal undermining with minimal incisions, elevation and reshaping of eyebrow and use of a temporary cutaneous fixation with hemostatic net (Net), allows effective, long-lasting results with low rates of complications and satisfactory results. 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.

Enxerto de gordura: lipofragmentado x lipoaspirado / Fat grafting: Lipofragmentation x Liposuction

Introdução: Com o objetivo de obter lipoenxerto autógeno e injetável de tecido ressecado em dermolipectomias, este estudo propõe um novo método para colheita e processamento do tecido adiposo, através de um dispositivo fragmentador específico. O principal objetivo foi estabelecer uma análise comparativa das características de qualidade e viabilidade do novo lipofragmentado em relação ao já conhecido lipoaspirado, amplamente aceito como fonte viável de lipoenxerto. Ensaios in vivo e in vitro foram delineados para avaliar o comportamento biológico das amostras, a fim de orientar novos e possíveis estudos em humanos com aplicações clínicas. Métodos: Uma paciente pós-bariátrica que foi submetida a dermolipectomia abdominal teve sua peça cirúrgica ressecada e dividida em quatro partes que foram submetidas a Lipoaspiração e Lipofragmentação, sem e com infiltração prévia. Todas as amostras foram submetidas a centrifugação e então distribuídas para os ensaios que envolveram avaliação histológica, imunohistoquímica, citometria de fluxo, cultura celular e ainda a injeção de xenoenxerto no dorso de 10 ratos Wistar, retirados após seis semanas para avaliação de massa, volume e características histológicas. Resultados: As amostras de gordura fragmentada, seca e infiltrada, mostraram características estruturais e comportamento biológico semelhantes aos das amostras de lipoaspirado. Conclusões: A fragmentação da gordura transformou o tecido celular subcutâneo das dermolipectomias em uma nova variante de lipoenxerto injetável e viável, com características biológicas semelhantes àquelas do lipoaspirado tradicional. Embora ainda preliminares, nossos resultados embasam a realização de novas investigações buscando otimizar a técnica com vistas ao aprimoramento da enxertia gordurosa e suas possíveis aplicações na medicina regenerativa.

Introduction: Aiming to obtain autogenous and injectable lipografts from resected tissues in dermolipectomies, this study proposes a new method for harvesting and processing adipose tissue through a specific fragmenting device. The main objective was to establish a comparative analysis of the quality and viability characteristics of the new lipofragmentation technique and those of the well-known liposuction technique, widely accepted as a viable source of fat grafting. In vivo and in vitro assays were designed to evaluate the biological behavior of the samples to guide new and possible human studies with clinical applications. Methods: A post-bariatric patient who underwent abdominal dermolipectomy had her surgical specimen resected, which was divided into four parts that underwent liposuction and lipofragmentation, with and without prior infiltration. All samples were centrifuged and distributed for assays with assessments involving histological analysis, immunohistochemistry, flow cytometry, cell culture, and xenograft injection on the back of 10 Wistar rats, which was evaluated after six weeks for mass, volume, and histological features. Results: The structural characteristics and biological behaviors of fragmented, dry, and infiltrated fat samples were similar to those of liposuction samples. Conclusions: Fat fragmentation transformed the subcutaneous cellular tissue of dermolipectomies into a new, viable injectable lipograft variant, with biological characteristics similar to those of traditional liposuction. Although still preliminary, our results support further investigations to optimize the technique and improve fat grafting and its possible applications in regenerative medicine.

Ritidoplastia e paralisia facial: como lidar? / Facelift and Facial nerve injury: how to deal with?

Não é novidade para os cirurgiões plásticos, especialmente aos que se dedicam à cirurgia de face, que o nervo facial pode ser lesado virtualmente em qualquer cirurgia de ritidoplastia. Porém, apesar da importância contida nesse tema, não é tarefa simples encontrar na literatura artigos que abordem de forma objetiva a correlação entre lesão do nervo facial e cirurgia facial. Paralisias faciais, sejam elas completas ou não, podem se tornar situações potencialmente conflituosas na relação médicopaciente. Este artigo, portanto, visa propor de forma clara e sucinta, baseada na experiência dos autores, um guia de como evitar, identificar e tratar uma potencial lesão do nervo facial no contexto de uma cirurgia de face, em especial a ritidoplastia.

Is largely known that the facial nerve virtually can be injured in every facial lift. Even though its importance, it is difficult to find in the literature articles related to this theme. Complete or incomplete facial paralysis after a facial procedures, may become a very uncomfortable situation between the patient and the surgeon, that is why we propose in this article a guide which intends to help avoid, identify and manage a facial nerve injury in the event of a face lift. Identifying Facial palsy before the surgery: Intending to make the pre-op facial assessment as simple as possible, we suggest a systematic approach examination. Avoiding facial nerve injury during face lifting: Several technical details are discussed along the text aiming to minimize the risk of nerve damage during the surgical procedure. What to in the event of a post-operative facial palsy: The authors propose a logical approach to the facial palsy, suggesting a planning for diagnosis, classification of the lesion and a rational treatment for the injury. Conclusion: This article presents a guide showing some safe technical options to avoid nerve damage during rythidoplasty, how to identify the lesion and treat it if necessary.

Comparación de la reacción inflamatoria inducida por implantes faciales de silicona y politetrafluoroetileno. Estudio en conejos / Comparison of the inflammatory reaction induced by facial implants os silicone and polytetrafluoroethylene. Study in rabbits

Introducción y Objetivo: Existen diferentes tipos de injertos autólogos y materiales aloplásticos para el tratamiento de las diversas deformidades faciales. El politetrafluoroetileno (PTFE) tiene varias ventajas debido a su propiedad hidrofóbica, que induce menor reacción inflamatoria. Presentamos un estudio que evalúa y compara la reacción inflamatoria inducida por los implantes faciales de silicona y de PTFE. Material y Método: Colocamos fragmentos de implantes de silicona y de PTFE en orejas de conejos mediante incisión y disección de un bolsillo subcutáneo. Realizamos análisis histológico a las 8 semanas: tinción de las muestras con hematoxilina / eosina y calificación del grado de reacción inflamatoria crónica, presencia de neutrófilos, linfocitos, eosinófilos, neoangiogénesis, fibroblastos y edema, presencia o no de hemorragia y valoración de la cicatriz. Hicimos la recolección de muestras para análisis microbiológico y evaluación de la presencia de hematoma y absceso en el momento del sacrificio. Resultados: La prevalencia de abscesos en el sacrificio, el hematoma y el edema durante las primeras semanas, fueron significativamente menores (p <0.05) en el grupo de PTFE. Conclusiones: El PTFE indujo reacción inflamatoria crónica al igual que la silicona, pero con menos absceso, edema y formación de hematomas

Background and Objective: The treatment for many facial deformities uses many kinds of autologous grafts or alloplastic materials. Polytetrafluoroethylene (PTFE) has several advantages due to its hydrophobic properties, inducing less inflammatory reaction. Our study evaluates and compares the inflammatory reaction induced by silicone and PTFE stripes. Methods: Fragments of silicone and PTFE implants were placed in rabbits ears using an incision and a subcutaneous gap. The histological analysis was made 8 weeks later. The samples were stained with hematoxylin/eosin and classified as chronic inflammatory reaction graduation, the presence of neutrophils, lymphocytes, eosinophils, neoangiogenesis, fibroblasts, edema and presence of bleeding and scar. Samples to microbiological analysis and evaluation of bruise and abs- cess were collected at the moment of sacrifice. Results: Prevalence of abscess at sacrifice and hematoma during the first weeks were significantly higher (p>0.05) in the silicon group. Conclusions: PTFE induced as much inflammatory reaction as the silicon but with less abscess and hematoma formation

Inner Scar Umbilicus: New Horizons for Vertical Abdominoplasty.

BACKGROUND: It is reasonable that deflated tissue in massive weight loss patients may demand not only lifting but also some extent of central body tightening, by the fleur-de-lis procedure. Although achieving nice contouring results, poor visible scars, including umbilical complications, have restricted the indications for the anterior vertical approach. The purpose of this article is to present the authors' experience with the inner scar umbilical reconstruction, reflecting overall results in vertical abdominoplasties. METHODS: Massive weight loss patients who underwent fleur-de-lis abdominoplasties with the inner scar umbilicus were reviewed retrospectively. The original stalk was resected along with the surgical specimen, and two marked parallel skin flaps were kept and sutured against each other into the deep medial fascia, to reconstruct the umbilical base. Additional sutures were made to approximate fat tissue immediately under and above it, enhancing a deepening effect. Conventional upper and lower vertical closure helped to establish the tridimensional shape of the new navel. RESULTS: One hundred ten consecutive patients were studied, and 52 (47 percent) presented small inflammatory exudate arising from the inner suture, which resolved with conservative dry dressings. No further umbilical complications such as infection, necrosis, dehiscence, widening, or stenosis were reported, and all patients showed natural and scarless new navels with nice shapes and correct position. CONCLUSIONS: The inner scar umbilicus is a simple, safe, and reproducible technique, presenting low complication rates with sustainable and natural results. High-quality navel reconstruction favors the indication of vertical abdominoplasties, especially for post-bariatric surgery body contouring. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

End-to-side versus end-to-end neurorrhaphy at the peroneal nerve in rats.

PURPOSE: To evaluate three different kinds of neurorrhaphy of the peroneal nerve. METHODS: Eigthy rats were divided into 5 groups. Control: nerve had no intervention. End-to-end (EE): nerve was cut and elongated with a nerve graft with two end-to-end neurorrhaphies. End-to-side (ES): nerve was cut and sutured to the graft with at the lateral side of the nerve. Side-to-end (SE): the nerve was cut and sutured to the graft with end-to-end neurorrhaphy. Denervated: nerve was cut and both endings were buried into the muscle. The evaluation was done by walking track analysis, electrophysiology, body mass, cranial tibial muscle mass, nerve and muscle fibers morphometry. RESULTS: The EE, ES and SE have the same potential of reinnervation. CONCLUSION: There is no functional or histological difference between these different types of neurorrhaphy.

Inside-out and standard vein grafts associated with platelet-rich plasma (PRP) in sciatic nerve repair. A histomorphometric study.

PURPOSE:: To evaluated the tubulization technique with standard and inside-out vein, filled or not with platelet-rich plasma (PRP), in sciatic nerve repair. METHODS:: Seventy male Wistar rats were randomly divided into five groups: IOVNF (Inside-Out Vein with No Filling); IOVPRP (Inside-Out Vein filled with PRP); SVNF (Standard Vein with No Filling); SVPRP (Standard Vein filled with PRP); Sham (Control). The left external jugular vein was used as graft in a 10 mm nervous gap. RESULTS:: In the morphological analysis of all groups, myelinated nerve fibers with evident myelin sheath, neoformation of the epineurium and perineurium, organization of intraneural fascicles and blood vessels were observed. In the morphometry of the distal stump fibers, SVPRP group had the highest means regarding fiber diameter (3.63±0.42 µm), axon diameter (2.37±0.31 µm) and myelin sheath area (11.70±0.84 µm2). IOVPRP group had the highest means regarding axon area (4.39±1.16 µm2) and myelin sheath thickness (0.80±0.19 µm). As for values of the fiber area, IOVNF group shows highest means (15.54±0.67 µm2), but are still lower than the values of the Sham group. CONCLUSION:: The graft filled with platelet-rich plasma, with use standard (SVPRP) or inside-out vein (IOVPRP), promoted the improvement in axonal regeneration on sciatic nerve injury.

Revisitando a puboplastia pós-bariátrica / Revisiting Postbariatric Monsplasty

INTRODUÇÃO: O tratamento da região pubiana é parte integrante do reajuste corporal inferior nos pacientes pós-bariátricos, tendo em vista a fisiopatologia e o caráter generalizado das deformidades de contorno após grandes emagrecimentos. O objetivo é apresentar nossa experiência no tratamento de pacientes pós-bariátricos, exclusivamente pela marcação baixa da abdominoplastia com vetores adequados de mobilização tecidual, sem a necessidade de cicatrizes verticais ou oblíquas na região do púbis. MÉTODOS: Foram avaliados retrospectivamente prontuários médicos e registros fotográficos de pacientes submetidos a diferentes abordagens abdominais, com aplicação dos princípios descritos acima no tratamento associado da região pubiana. Incisão cutânea anterior baixa, descolamento cranial angulado em direção ao plano aponeurótico (bisel preservando gordura profunda superior), e manutenção um excedente gorduroso nos bordos superiores para a facilitar a fixação dos retalhos através do Sistema Fascial Superficial. Uma avaliação subjetiva da qualidade dos resultados foi caracterizada por observador único. RESULTADOS: Numa casuística de 126 pacientes consecutivos, a tática empregada possibilitou restabelecer a melhor posição, tônus e formato do púbis em 100% dos casos, cujos resultados foram subjetivamente classificados como bom (40%) ou ótimo (60%). As intercorrências mais frequentemente encontradas na evolução pós-operatória foram pequenas deiscências da sutura (23,8%) e seromas (19%), com boa evolução pelos curativos e punções seriadas. CONCLUSÃO: A tática cirúrgica apresentada, com posicionamento baixo da incisão anterior e aproximação dos retalhos por fixação no sistema fascial superficial e pele, possibilita o tratamento adequado da região pubiana durante as abdominoplastias pós-bariátricas, sem a necessidade de ressecções e cicatrizes adicionais.

INTRODUCTION: The treatment of the pubic region is an integral part of lower body readjustment in post-bariatric patients, considering the pathophysiology and generalized characteristics of contour deformities after a considerable weight loss. The objective is to present our experience in the treatment of post-bariatric patients, exclusively by low marking of abdominoplasty with appropriate tissue mobilization vectors, without the necessity to leave vertical or oblique scars in the pubic region. METHODS: The medical and photographic records of patients subjected to different abdominal approaches were retrospectively evaluated, applying the principles described above in the combined treatment of the pubic region. A low anterior skin incision was created, and angled cranial detachment towards the aponeurotic plane (with the bevel preserving the deep upper fat) and maintenance of excess fat on the upper edges to facilitate the fixation of the flaps through the superficial fascial system were performed. The outcomes' quality was subjectively evaluated by a single observer. RESULTS: In the case series of 126 consecutive patients, the strategy used restored the best position, tone, and shape of the pubis in 100% of the cases; the results were subjectively classified as good (40%) or very good (60%). The complications more frequently found in the post-operative period were small suture dehiscence (23.8%) and seroma formation (19%), with good evolution provided by dressings and serial punctures. CONCLUSION: The surgical strategy presented involving low positioning of the anterior incision and flap alignment in the superficial fascial system and skin by fixation allows the proper treatment of the pubic region during post-bariatric abdominoplasty procedures, without the need for additional resections and scars.

Miectomía frontal: una alternativa para reducir arrugas frontales / Frontal muscle miectomy: an alternative to reduce frontal wrinkles

Introducción y Objetivo. Los cambios cutáneos, subcutáneos y óseos son característicos del rostro envejecido a través del tiempo. La pérdida de elasticidad del tejido blando, los cambios volumétricos y la actividad facial muscular, son en gran parte responsables de las arrugas faciales y su tratamiento es la petición más frecuente de los pacientes que quieren un rejuvenecimiento facial El objetivo de este estudio es describir una técnica quirúrgica alternativa para tratar arrugas frontales con menos morbilidad y resultados más duraderos. Material y Método. Recogemos un total de 31 pacientes entre los 37 y 75 años de edad intervenidos mediante miectomía frontal entre los años 2003 y 2007. La incisión fue dividida sobre el párpado superior, precapilar y transcapilar. Resultados. El tiempo de recuperación postoperatoria fue corto, con edema en torno a los 5 a 7 días; retornaron a sus actividades habituales en 7 días. Ningún paciente tuvo complicaciones intra o postoperatorias. Conclusiones. El tratamiento de arrugas horizontales de la frente con miectomía frontal es un procedimiento rápido, mínimamente invasivo, y que ofrece un resultado satisfactorio (AU)

Background and Objective. The skin, subcutaneus and osseus changes over time are characteristic of the ageing face. Loss of soft tissue elasticity, volumetric changes, and facial muscular activity are largely responsible for facial wrinkles, and is the treatment of these that are the most frequent request of patients wanting to look younger. The objective of this study is to describe an alternative surgical technique to treat frontal wrinkles with less morbidity and longer results. Methods. Thirty-one patients from 37 to 75 years old were submitted to frontal miectomy from 2003 to 2007. The incision was divided on superior eyelid, precapilar and transcapilar. Results. Patients submitted to this technique had short recovery time with edema around 5 to 7 days. They returned to their normal activities in 7 days. No patients had intra or postoperative complications. All patients were satisfied with the result. Conclusions. Frontal horizontal wrinkles treatment with frontal miectomy is a quick and minimally invasive procedure, with a long term result (AU)