Multi-Institutional Bladder Exstrophy Consortium After 8 Years: The Short- and Intermediate-Term Outcomes.

PURPOSE: Bladder exstrophy (BE) poses challenges both during the surgical repair and throughout follow-up. In 2013, a multi-institutional BE consortium was initiated, which included utilization of unified surgical principles for the complete primary repair of exstrophy (CPRE), real-time coaching, ongoing video capture and review of video footage, prospective data collection, and routine patient data analysis, with the goal of optimizing the surgical procedure to minimize devastating complications such as glans ischemia and bladder dehiscence while maximizing the rate of volitional voiding with continence and long-term protection of the upper tracts. This study reports on our short-term complications and intermediate-term continence outcomes. MATERIALS AND METHODS: A single prospective database for all patients undergoing surgery with a BE epispadias complex diagnosis at 3 institutions since February 2013 was used. For this study, data for children with a diagnosis of classic BE who underwent primary CPRE from February 2013 to February 2021 were collected. Data recorded included sex, age at CPRE, adjunct surgeries including ureteral reimplantations and hernia repairs at the time of CPRE, osteotomies, and immobilization techniques, and subsequent surgeries. Data on short-term postoperative outcomes, defined as those occurring within the first 90 days after surgery, were abstracted. In addition, intermediate-term outcomes were obtained for patients operated on between February 2013 and February 2017 to maintain a minimum follow-up of 4 years. Outcomes included upper tract dilation on renal and bladder ultrasound, presence of vesicoureteral reflux, cortical defects on nuclear scintigraphy, and continence status. Bladder emptying was assessed with respect to spontaneous voiding ability, need for clean intermittent catheterization, and duration of dry intervals. All operating room encounters that occurred subsequent to initial CPRE were recorded. RESULTS: CPRE was performed in 92 classic BE patients in the first 8 years of the collaboration (62 boys), including 46 (29 boys) during the first 4 years. In the complete cohort, the median (interquartile range) age at CPRE was 79 (50.3) days. Bilateral iliac osteotomies were performed in 89 (97%) patients (42 anterior and 47 posterior). Of those undergoing osteotomies 84 were immobilized in a spica cast (including the 3 patients who did not have an osteotomy), 6 in modified Bryant's traction, and 2 in external fixation with Buck's traction. Sixteen (17%) patients underwent bilateral ureteral reimplantations at the time of CPRE. Nineteen (21%) underwent hernia repair at the time of CPRE, 6 of which were associated with orchiopexy. Short-term complications within 90 days occurred in 31 (34%), and there were 13 subsequent surgeries within the first 90 days. Intermediate-term outcomes were available for 40 of the 46 patients, who have between 4 and 8 years of follow-up, at a median of 5.7 year old. Thirty-three patients void volitionally, with variable dry intervals. CONCLUSIONS: Cumulative efforts of prospective data collection have provided granular data for evaluation. Short-term outcomes demonstrate no devastating complications, that is, penile injury or bladder dehiscence, but there were other significant complications requiring further surgeries. Intermediate-term data show that boys in particular show encouraging spontaneous voiding and continence status post CPRE, while girls have required modification of the surgical technique over time to address concerns with urinary retention. Overall, 40% of children with at least 4 years of follow-up are voiding with dry intervals of > 1 hour.

Mandibular Myxoid Liposarcoma: a Case Study.

Liposarcomas are described as soft tissue sarcomas derived from adipose tissue. The finding of this tumor in the mandibular region is exceedingly rare. As of now, it has been described mainly in case reports and small series. A multidisciplinary approach is required to offer optimal treatment and may involve surgery, radiation and systemic therapies. Surgical repair of these defects represents a major challenge in oral and maxillofacial reconstructive surgery. We present the case of a 54-year-old man referred to our center with a progressively increasing mass in the anterior portion of the mandible. Biopsy revealed a well-differentiated myxoid liposarcoma. Resection of the tumor was performed with an additional primary reconstruction.

Análise epidemiológica das fraturas de mão em um hospital terciário / Epidemiological analysis of hand fractures in a tertiary hospital

Introdução: O trauma de mão constitui uma epidemia, ocorrendo por diversos fatores, como acidentes de trabalho e violência urbana. Isso gera um impacto significativo por ser uma unidade anatômica vulnerável e importante na realização de atividades cotidianas e para o trabalho. Desse modo, faz-se necessária uma avaliação epidemiológica mais aprofundada no que tange, sobretudo, às fraturas de mãos, entendendo sua elevada morbidade. Método: Estudo descritivo e retrospectivo, feito por análise de prontuários de pacientes conduzidos em um hospital terciário no período de janeiro de 2018 a dezembro de 2020. Resultados: Participaram do estudo 290 pacientes, sendo 85,7% do sexo masculino e 14,3% do sexo feminino. 138 indivíduos tinham entre 20 e 39 anos, representando um total de 47,6%. 51,6% eram do interior do estado do Ceará e 48,4% eram da capital. O principal mecanismo de trauma associado às fraturas foram os acidentes de trânsito (36,4%), seguidos por acidentes de trabalho (26,9%) e ferimentos por arma de fogo (14%). Em relação aos ossos fraturados, houve uma acentuada prevalência do acometimento das falangeanas, em todas as faixas etárias, representando 210 pacientes (72,4%). Conclusão: O presente estudo corrobora com os dados presentes na literatura. Desse modo, é evidenciada a repetição de prevalência de faixa etária, principais mecanismos de trauma envolvidos, bem como ossos acometidos nas fraturas de mão.

Introduction: Hand trauma is an epidemic occurring due to several factors, such as work accidents and urban violence. This significantly impacts it as it is a vulnerable and important anatomical unit for daily activities and work. Therefore, a more in-depth epidemiological assessment is necessary regarding hand fractures and understanding their high morbidity. Method: A descriptive and retrospective study was conducted by analyzing the medical records of patients treated in a tertiary hospital from January 2018 to December 2020. Results: 290 patients participated in the study, 85.7% male and 14.3 % female. One hundred thirty-eight individuals were between 20 and 39 years old, representing 47.6%. 51.6% were from the interior of the state of Ceará, and 48.4% were from the capital. The main trauma mechanism associated with fractures was traffic accidents (36.4%), followed by work accidents (26.9%) and firearm injuries (14%). Concerning fractured bones, there was a marked prevalence of phalangeal involvement in all age groups, representing 210 patients (72.4%). Conclusion: The present study corroborates the data present in the literature. In this way, the repetition of the prevalence of age group, main trauma mechanisms involved, as well as bones affected by hand fractures is evidenced.

Cost-effective Solution for Maxillofacial Reconstruction Surgery with Virtual Surgical Planning and 3D Printed Cutting Guides Reduces Operative Time.

Background: This study aimed to explore a low-cost solution for virtual surgical planning/3D printed surgical guides in a training hospital, assessing the impact on intraoperative time and bleeding. Material and Methods: We included a total of 13 patients. 8 who underwent maxillofacial reconstruction surgery with fibula-free flap utilizing virtual surgical planning/3D printed guides (VP/SG), and 5 using conventional surgery (CS) from 2017 to 2020. The surgical time, bleeding, length of hospital stay, and comorbidities were collected and compared in two groups. We recorded the average cost for the complete surgical planning and 3D printed guides. We applied a qualitative survey to the surgeons involved in the surgical procedures. Results The mean surgical time in the VP/SG group was 8.16 ± 2.7, compared to the CS group 12.5 ± 3.8, showing a 4.34 hours difference with statistical significance (p = 0.033). Patients from the CS group had a higher bleeding volume of 921 ± 467.6 mL VS 760 ± 633.8 mL in the VP/SG group. The average cost for the complete surgical planning and 3D printed guides was 914.44 ± 46.39 USD. All the surgeons who answered the survey preferred to perform the procedure utilizing the virtual planning/3D printed guides. Conclusions Virtual planning and 3D printed surgical guides have the potential to reduce operation time in maxillofacial reconstruction.

Contexte : Cette étude visait à explorer une solution peu coûteuse pour la planification chirurgicale virtuelle/l'impression 3D de guides chirurgicaux dans un hôpital d'enseignement, en évaluant leur impact sur le temps peropératoire et le saignement. Matériel et méthodes : Nous avons inclus un total de 13 patients; 8 patients ont subi une chirurgie de reconstruction faciale avec lambeau libre de péroné (fibula) utilisant une planification chirurgicale virtuelle/des guides imprimés en 3D (VP/SG) et 5 patients ont subi une chirurgie conventionnelle (CS) entre 2017 et 2020. Le temps opératoire, le saignement, la durée de l'hospitalisation et les comorbidités ont été consignés et comparés entre les deux groupes. Nous avons enregistré le coût moyen pour la planification chirurgicale complète et les guides imprimés en 3D. Nous avons appliqué une enquête qualitative aux chirurgiens impliqués dans les procédures chirurgicales. Résultats : Le temps opératoire moyen dans le groupe VP/SG a été de 8,16 ± 2,7, comparativement à 12,5 ± 3,8 dans le groupe CS, soit une différence de 4,4 heures avec une signification statistique (P = 0033). Des patients du groupe CS ont perdu un plus grand volume de sang que les patients du groupe VP/SG (respectivement, 921 ± 467.6 mL contre 760 ± 633.8 mL). Le coût moyen de la planification chirurgicale complète et des guides imprimés en 3D a été de 914,44 ± 46,39 US$. Tous les chirurgiens ayant répondu à l'enquête ont préféré utiliser la planification virtuelle/les guides imprimés en 3D pour la réalisation de la procédure. Conclusions : La planification virtuelle et les guides chirurgicaux imprimés en 3D ont le potentiel de réduire les temps opératoires pour la reconstruction maxillo-faciale.

Hand Reconstruction Using Anterolateral Thigh Free Flap by Terminal Perforator-to-Digital Artery Anastomosis: Retrospective Analysis.

This study aimed to analyze cases of anterolateral thigh (ALT) free flap used for hand reconstruction with terminal perforator-to-digital artery anastomosis. Patients who underwent ALT free flap placement with terminal perforator-to-digital artery anastomosis for hand reconstruction between January 2011 and August 2021 were included. The number, length, and diameter of the perforators and veins, flap size, and operative time were investigated through a retrospective review of charts and photographs. The occurrences of arterial thrombosis, venous thrombosis, arterial spasm, and flap necrosis were analyzed. In total, 50 patients were included in this study. The mean diameter and length of the perforators were 0.68 mm and 3.25 cm, respectively, and the mean number of veins anastomosed was 1.88, with a mean diameter of 0.54 mm. Complications included four cases of arterial thrombosis, one case of venous thrombosis, seven cases of partial necrosis, and one case of total flap failure. Regression analysis showed that a longer perforator was associated with arterial thrombosis whereas larger flap size and number of anastomosed veins were associated with partial necrosis ( p < 0.05). The terminal perforator-to-digital artery anastomosis offers advantages in using compact free flaps with short pedicle lengths to cover small hand defects.

Male epispadias repair: Outcomes at three sites prior to the establishment of a multi-institutional collaboration.

INTRODUCTION: Epispadias, which occurs on the more mild end of the Bladder Exstrophy Epispadias Complex (BEEC) spectrum, presents still with a wide range of severity in boys, from mild glanular epispadias to penopubic epispadias with severe urethral and bladder neck defects. Surgical management ranges from isolated epispadias repair to epispadias repair with bladder neck reconstruction (BNR) with or without pelvic osteotomies. OBJECTIVES: We aimed to evaluate outcomes in epispadias treated at three institutions prior to formation of a formal collaboration. In addition, we sought to delineate outcomes based on anatomic severity at time of diagnosis, and initial procedure performed in cases of penopubic epispadias. METHODS: IRB approved databases were retrospectively queried at three institutions for patients who underwent repair of epispadias between 1/1993 and 1/2013. Degree of epispadias, age and technique at initial repair, and self-reported continence status at last follow-up were recorded. Continence was categorized as: wet, intermediate (dry 2-3 h), or dry, while also distinguishing those who void and those who require clean intermittent catheterization (CIC). Those not seen since 1/1/2015, younger than 10 years at last follow up, or in whom continence data were not recorded were excluded. RESULTS: A total of 48 boys were identified; 36 met inclusion criteria. The epispadias cohort consisted of 8 glanular epispadias (GE) (22%); 8 penile epispadias (PE) (22%), and 20 penopubic epispadias (PPE) (56%) with a median follow-up of 11.3 years (3.2-26.2 years). Overall, 33 of 36 (92%) boys void per urethra. Within the group that voids, 19/33 (58%) are completely dry, while 6/33 (18%) are wet. Among patients who underwent initial epispadias repair without concurrent or subsequent bladder neck reconstruction, continence rates were: GE 63% (5/8); PE 75% (6/8); PPE 71% (5/7). Among the 9 boys with PPE who underwent initial epispadias repair with concurrent BNR, 22% (2/9) were dry with no further surgeries. Overall, 8/20 (40%) of boys with PPE void with complete dryness. DISCUSSION: This multi-center retrospective review of continence in epispadias demonstrates that even some boys with glanular and penile epispadias can have challenges with continence, and boys with penopubic epispadias may remain wet despite careful preoperative assessment of bladder neck functionality and concurrent BNR. CONCLUSION: Continence outcomes in boys with all degrees of epispadias can be variable. Even boys with more distal defects may have significant bladder neck deficiency. And those with the most severe form of epispadias may require bladder neck reconstruction to achieve continence.

[Posterolateral instability of the knee joint]. / Posterolaterale Instabilität des Kniegelenks.

The posterolateral corner of the knee is composed of a multilayered complex of ligamentous, musculotendinous, and capsular structures, which interact in a synergistic stabilizing manner with the central structures, particularly the posterior cruciate ligament. Injuries of the posterolateral corner are generally accompanied by rupture of the posterior cruciate ligament. Depending on the injured structures, injuries of the posterolateral corner result in posterolateral rotational instability alone (Fanelli A) or with lateral instability (Fanelli B/C). For rotational instability alone, isolated popliteus bypass is an effective procedure; with concomitant lateral instability in flexion, additional stabilization of the lateral collateral ligament is required. Most of the various available techniques are described as open reconstruction procedures. In recent years, arthroscopic techniques for posterolateral reconstruction have also been successfully developed.

Robot-assisted ureteric reconstructive surgeries for benign diseases: Initial single-center experience with point of technique.

INTRODUCTION: We present our initial experience with robot-assisted reconstructive surgeries with the Da Vinci Xi robotic system for benign ureteric pathologies. MATERIALS AND METHODS: This is a retrospective review of prospectively collected data of patients who underwent robot-assisted reconstructive procedures for benign diseases of the ureter at our department from April 2018 to November 2022. Demographic and perioperative details were recorded. Patients were followed up and surgical success was evaluated on the basis of symptomatic, functional, and radiological improvement. RESULTS: A total of 34 patients underwent robot-assisted reconstructions for benign ureteric pathologies by various techniques. Mean age, body mass index (BMI), hospital stay and follow-up duration were 36 years, 24.1 kg/m2, 5.29 days, and 7.08 months respectively. Procedures included pyeloplasty in eight, primary ureteroneocystostomy (UNC) in seven, Psoas hitch UNC in five, Boari flap UNC in six, Ureteroureterostomy in four, ureterocalicostomy in two and ileal ureteral transposition in two patients. Mean docking time, total operative time, and estimated blood loss were 31.5 min, 178 min, and 64.3 ml, respectively. All patients had radiologic or functional improvement on follow-up after 6 months. CONCLUSION: Robot-assisted reconstructive surgery for benign ureteric and bladder pathologies imparted excellent short-term outcomes without major complications with all the advantages of a minimally invasive approach.

Usefulness of external fixation and reverse Sural fasciocutaneous flap: Treatment of grade III B open tibial fractures in resource-limited settings.

PURPOSE: Sierra Leone is a low-income country located on the west coast of Africa where the majority of the population does not have free access to emergency medical and surgical services, the principal cause of open tibia fractures is motorcycle collision. Open fractures of the middle and distal third of the tibial segments, particularly those classified as type III B, represent a challenge for orthopedic surgeons because of the loss of soft tissue coverage. The Reverse Sural Fasciocutaneous Flap (RSFF) has been shown to be an ideal and reproducible option for the treatment of soft tissue defects. The main aim of this study was to demonstrate the experience in Resource Limited Settings (RLS) by means of a short series of the efficacy of using a combination of external fixation and RSFF in the treatment of grade III B open tibia fractures where plastic surgeons were not available. METHODS: This retrospective, descriptive, and non-experimental study included 8 patients who underwent surgical intervention between September 2020 and September 2021. RESULTS: The skin defects were of various sizes; the smallest size was 4 × 7 cm, and the biggest size of 12 × 18 cm. We obtained a success rate in seven of the eight cases. CONCLUSIONS: External fixation and reverse sural fasciocutaneous sural flap are excellent therapeutic options for the treatment of open grade III B diaphyseal and metaphyseal distal tibial fractures.

Maxillary and total nasal reconstruction with a scapulo dorsal perforator flap.

Facial gunshots injuries remain challenging and present functional and aesthetic problems. Such defects generally require composite tissue flaps for reconstruction. Rebuilding the palate and the maxilla is especially delicate because it requires reconstitution of the facial buttresses, and replacement of bony hard palate, based on occlusion, as well as the restoration of the thin intraoral and intranasal lining which normally constitute the soft palate. Various methods of reconstruction have been applied to this area in search of an ideal soft tissue and bone flap to restore the bony framework of the maxilla and palate while providing an internal lining. The scapula dorsal perforator flap is used in the case of a patient to successfully reconstruct the palate, the maxilla and the nasal pyramid in one stage. Free tissue transfer using thoracodorsal perforator flaps and scapula bone free flap have been already described in literature but never to perform the nasal pyramid reconstruction at the same time. Good functional and aesthetic results have been obtained in this case. This article also reviews, through the authors experience and literature, anatomical landmarks, indications, technical surgical tricks, advantages and disadvantages of this flap for palatal, maxillary and nose reconstruction.

Long-Term Bowel Vaginoplasty With a Single Yang-Monti Tube.

INTRODUCTION: The bowel remains the favored tissue for neo-vaginoplasty (NeoVP) in pediatric patients with vaginal agenesis. In 2001, the first description of NeoVP using the Yang-Monti technique with a sigmoid double tubular flap was published. We present our experience of NeoVP with a single Yang-Monti tube (SYMT) flap and report on the use of different segments of colon. METHODS: We conducted a retrospective review of patients who underwent NeoVP using a bowel SYMT between 2009 and 2021. The procedure was performed under open abdominal surgery by isolating 8 to 12 cm from the rectosigmoid, cecum, or ascending colon. Subsequently, this segment was detubularized near the mesenteric border, folded, and retubularized transversally, leaving the mesentery in a cephalic position. A channel was dissected in the pelvis to accommodate the NeoVP. RESULTS: Seventeen patients were identified. The median age was 16 years old. The principal diagnosis was Mayer-Rokitansky's syndrome (47.1%). The median follow-up was 50 months. The mean harvested bowel length was 9 cm, and the sigmoid was the preferred site (65%). The cecum-ascending colon was used in 3 (17.6%) patients. Complications were recorded in 6 patients (35%). Of these 6 patients, 4 had introital stenosis. There was 1 case of urethrovaginal fistula and another of left hematometrocolpos. Satisfactory sexual function has been reported in sexually active individuals. CONCLUSIONS: We described our experience in NeoVP using a large bowel SYMT as a safe and effective technique. It allows decreased tension on the vascular pedicle and the use of shorter colon segments.

Qualitative Analysis of Patient Experiences Reaching Urethroplasty for Recurrent Urethral Stricture Disease.

PURPOSE: Despite the inferior outcomes, urethral stricture patients often undergo multiple endoscopic procedures prior to undergoing definitive urethroplasty. We sought to qualitatively evaluate the patient experience of obtaining urethroplasty to better understand the impact of this experience on quality of life. MATERIALS AND METHODS: Patients treated with urethroplasty between September 2019 and July 2021 were identified and invited to participate in our study if they had undergone ≥ 2 endoscopic procedures prior to urethroplasty. Semistructured telephone interviews were conducted, coded, and analyzed using an iterative inductive-deductive approach. RESULTS: Of the 105 urethroplasty patients during the study period, 50 (47.6%) had undergone ≥ 2 endoscopic procedures prior (IQR 3-5), of whom 20 participated in the study. Qualitative themes related to repeat endoscopic procedures included unmet treatment expectations, dissatisfaction with catheterization and repeat procedures, and negative impacts of recurrent stricture symptoms and treatments on quality of life. External factors associated with a delay to urethroplasty included financial constraints, surgeon access, and time off work. CONCLUSIONS: A trajectory of declining quality of life and unmet treatment expectations are the primary factors driving the decision to proceed with urethroplasty. However, external factors such as recovery costs and access to specialists play important roles in delaying surgery. These findings illustrate the need for improved community provider education and patient counseling to better inform expectations of both patients and providers with various treatment outcomes. Furthermore, these data highlight the need to improve access to specialized care for urethral stricture patients.

Experience with Management of Radial Polydactyly: The Multicenter Analysis of 28 Surgical Procedures with Follow-Up.

Radial polydactyly or thumb duplication is a relatively common congenital malformation of the hand, whereby the surgical techniques can be broadly divided into simple excisions, reconstructions and a Bilhaut-Cloquet procedure. The aim of this study was to identify the appropriate surgical procedures and to present the clinical outcomes that can be achieved. We performed a multicenter analysis of cases of radial polydactyly surgically treated with reconstruction or a Bilhaut-Cloquet procedure between 2015 and 2022. The clinical outcome was assessed using a modification of the Tada score. A total of 28 cases of 27 patients with radial polydactyly were included in the study. The most common Wassel type was type IV (13 cases), and the most common surgical procedure was reconstruction (24 cases). Our study validates an algorithm from the literature as a helpful tool for decision making in selecting a surgical technique for radial polydactyly, although individual surgical experience should also be considered.

Comparison between the high-definition 3D exoscope and the operating microscope in head and neck reconstruction.

The purpose of this study was to compare the three-dimensional (3D) operating exoscope (OE) with the conventional operating microscope (OM) in head and neck reconstruction. A retrospective cohort study was performed including 50 consecutive patients with no history of previous surgery or irradiation (32 male, 18 female; mean age 59.2 ± 13.3 years), who underwent free flap head and neck reconstruction using a 3D OE (n = 25; OE group) or conventional OM (n = 25; OM group). The mean total operative time was 8.0 ± 1.53 h in the OE group and 7.6 ± 1.52 h in the OM group (P = 0.86). The median (interquartile range) anastomosis time was 78.0 (63.0-91.5) minutes in the OE group and 90.0 (75.5-115.0) minutes in the OM group (P = 0.06). The final free flap survival rate was 100%. Only seven patients experienced a free flap reconstruction-related complication, and they were similarly distributed between the two groups (four in the OE group, three in the OM group; P = 0.68). Secondary outcomes (length of hospital stay, tracheostomy dependence, feeding tube dependence) were comparable in the two groups (P > 0.05). The 3D OE is a viable alternative to the conventional OM for performing standard head and neck free flap reconstructive procedures.

Ankle function after reconstruction of post-traumatic soft tissue defects with soleus and/or gastrocnemius local muscle flaps.

Local muscle flaps are especially advantageous when treating soft tissue defects, but one disadvantage is the potential functional deficits associated with the muscle transfer. In this study, we evaluated ankle function among patients (cases) who underwent reconstruction of soft tissue defects in the leg using local flaps of the gastrocnemius and/or soleus muscle. Function was compared between the affected and contralateral non-affected limb and against patients (controls) with open tibial fractures who required no soft tissue reconstruction. In a retrospective cohort study, ankle function was accessed as range of motion (ROM) and plantar flexion strength, and using American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot summation and subscale scores. Among 31 patients who underwent soft-tissue reconstruction, 19 were available for functional evaluation. Controls were 23 patients with open tibial fractures not requiring flaps. Among cases, reconstruction was performed with a soleus flap in nine patients, a medial gastrocnemius flap in seven, a lateral gastrocnemius in one, and with both gastrocnemius and soleus flaps in one patient each. One patient developed partial flap necrosis. In cases, ankle dorsiflexion and plantar flexion were significantly decreased on the affected versus normal side. However, no deficit in plantar flexion strength was detected; nor any significant difference in AOFAS ankle-hindfoot scores in cases versus controls. Local muscle flaps are useful for reconstructing post-traumatic soft tissue defects in the leg. Some loss of ankle ROM should be expected, but likely no clinically-measurable deficit in overall ankle strength and function.

Retalho plantar medial para reconstrução de defeitos em calcanhar após ressecção de melanoma lentiginoso acral: Uma série de 7 casos / Medial plantar flap for reconstruction of heel defects after resection of acral lentiginous melanoma: A series of seven cases

Introdução: A reconstrução da região plantar ainda é um dos grandes desafios da cirurgia plástica reconstrutiva. Os tecidos dessa região apresentam características únicas e que são essenciais para a manutenção da funcionalidade do membro. De toda a região plantar, a região do calcanhar é a área de maior sustentação do peso e submetida ao maior impacto. O retalho fasciocutâneo plantar medial é uma das opções reconstrutivas, pois representa tecido semelhante e mantém a sensibilidade para a área receptora. Método: Foi realizado um estudo retrospectivo através da coleta de dados de prontuário de pacientes que realizaram reconstruções da região do calcanhar com retalho plantar medial, no período de julho de 2013 a setembro de 2019. O estudo foi aprovado pelo Comitê de Ética para Análise de Projetos de Pesquisa do HCFMUSP (Número CAAE: 56849422.0.0000.0068). Resultados: A reconstrução de calcanhar após ressecção de melanoma lentiginoso acral foi realizada em 7 pacientes. Complicações cirúrgicas foram observadas em 3 pacientes, sendo que todos eles tinham idade acima de 50 anos e/ou alguma comorbidade associada. Houve 57,1% de complicações, sendo 37,5% relacionadas ao retalho e 12,5% relacionadas à área doadora. Ocorreram 3 necroses totais de retalho (42,9%) e 1 perda total de enxerto na área doadora (14,3%). Conclusão: O retalho plantar medial se apresenta como uma boa alternativa para a realização de reconstruções oncológicas de defeitos na região plantar do pé. Contudo, deve-se ponderar a escolha do paciente ideal e lembrar que a dissecção do seu pedículo vascular não é de fácil execução.

Introduction: Resurfacing the sole is still one of the great challenges of reconstructive plastic surgery. The tissues on the sole of the foot have unique characteristics essential for maintaining the limbs functionality. The heel has the most significant weight support and is subjected to the entire soles greatest impact. The medial plantar artery flap is one of the reconstructive options, as it represents similar tissue and maintains sensitivity to the recipient area. Methods: A retrospective study was performed by collecting data from medical records of patients who underwent reconstructions of the heel with a medial plantar artery flap from July 2013 to September 2019. The study was approved by the Ethics Committee for Analysis of Research Projects of HCFMUSP (CAAE number: 56849422.0.0000.0068). Results: Heel reconstruction was performed in 7 patients after acral lentiginous melanoma excision. Surgical complications were observed in 3 patients, all of whom were aged over 50 years or have associated comorbidity. There were 57.1% of complications, 37.5% related to the flap, and 12.5% related to the donor area. There were three total flap necroses (42.9%) and one total graft loss in the donor area (14.3%). Conclusion: The medial plantar flap presents itself as a good alternative for performing oncological reconstructions of defects in the plantar region of the foot. However, the choice of the ideal patient should be considered and we must remember that the dissection of its vascular pedicle is not easily executed.

Perfil clínico e epidemiológico de pacientes vítimas de queimaduras, um estudo retrospectivo / Clinical and epidemiological profile of burn victims, a retrospective study

Introdução: No Brasil, queimaduras acometem cerca de um milhão de pessoas/ano, a maioria do sexo masculino. Além de prejuízos físicos e emocionais, há impacto econômico, com gastos para o sistema de saúde, indenizações e incapacidades laborais. Por estas razões, estudos epidemiológicos são importantes para traçar o perfil da população mais acometida, orientando a prevenção dessa afecção. Método: Revisão dos prontuários de 398 vítimas de queimaduras, internados na Santa Casa de Santos, de janeiro de 2016 até dezembro de 2019. Resultados: Os principais acometidos são homens, jovens, em ambiente doméstico, por líquidos aquecidos, causando em sua maioria queimaduras de segundo grau, atendidos em até 24 horas, considerados grandes queimados e internados em enfermaria por até duas semanas. Aproximadamente 90% recebeu alta com melhora, necessitando apenas de desbridamento e curativos. Conclusão: Nosso trabalho concorda com maioria das revisões em relação à prevalência do sexo masculino, jovens, economicamente ativos, em suas residências, com líquidos aquecidos, acidentalmente. Outros estudos apontaram crianças como as mais afetadas, mostrando necessidade de políticas voltadas a ambas as faixas etárias. Com relação à internação, a maioria permaneceu em enfermaria, com queimaduras de segundo grau, prevalecendo os grandes queimados, o que acarreta maior gravidade e custos. Esse dado vai contra alguns trabalhos, que apontam queimadura de segundo grau como principal, porém com menos de 10% da superfície corporal queimada. A maior parte dos pacientes, tanto neste quanto na maioria dos estudos, apresentou bom desfecho, sem necessidade de Unidade de Terapia Intensiva ou procedimentos cirúrgicos, mostrando a importância do desbridamento precoce e cuidados com curativos.

Introduction: In Brazil, burns affect around one million people/year, the majority of whom are male. In addition to physical and emotional losses, there is an economic impact, with costs for the health system, compensation, and work disabilities. For these reasons, epidemiological studies are important to outline the profile of the most affected population, guiding the prevention of this condition. Method: Review the medical records of 398 burn victims admitted to Santa Casa de Santos from January 2016 to December 2019. Results: The main victims were young men in a domestic environment, by heated liquids, mostly causing second degree burns, treated within 24 hours, considered major burns, and admitted to the infirmary for up to two weeks. Approximately 90% were discharged with improvement, requiring only debridement and dressings. Conclusion: Our work agrees with most reviews regarding the prevalence of young, economically active males with accidentally heated liquids in their homes. Other studies highlighted children as the most affected, showing the need for policies for both age groups. Regarding hospitalization, the majority remained in the ward, with second-degree burns, with major burns prevailing, which leads to greater severity and costs. This data goes against some studies, which indicate second-degree burns as the main burn, with less than 10% of the body surface burned. In both this and most studies, most patients had a good outcome, without needing an Intensive Care Unit or surgical procedures, showing the importance of early debridement and care with dressings.

Carcinoma de células escamosas de lábio inferior: Excisão e reconstrução com retalho nasolabial / Squamous cell carcinoma of the lower lip: Excision and reconstruction with nasolabial flap

Introdução: O carcinoma de células escamosas é o tumor maligno mais frequente dos lábios e acomete principalmente o lábio inferior. O tratamento adequado desta neoplasia deve ser precoce e radical, pois metástases podem ocorrer. Considerando que os lábios têm extrema relevância na dinâmica e motricidade da face, a reconstrução labial após grandes ressecções nesta região é um desafio para o cirurgião na busca de bons resultados estéticos e funcionais. Este estudo busca apresentar uma técnica já consagrada e confiável para a reconstrução do lábio inferior após ressecções tumorais, o retalho de Karapandizic. Método: Nesta revisão de casos são avaliados, retrospectivamente, 4 pacientes que tiveram o lábio inferior reconstruído por meio da técnica de Karapandzic no período de 2013-2022. Resultados: As complicações mais frequentemente observadas foram cicatriz hipertrófica, deiscência de sutura em vermelhão de lábio e microstomia (redução da abertura oral). A redução da fenda labial (microstomia) foi corrigida parcialmente através do uso de órteses odontológicas, não havendo necessidade de indicação de comissuroplastia em nenhum dos casos. Outra colaboração deste trabalho refere-se à utilização do ecoDoppler colorido pré-operatório, que permite o planejamento do retalho verificando a viabilidade do pedículo vascular e o real posicionamento deste pedículo, reduzindo as chances de lesão inadvertida dos vasos durante a cirurgia. Conclusão: Mesmo sendo a microstomia uma limitação deste retalho, concluímos que esta técnica atende à necessidade de reconstrução de lábio inferior em grandes ressecções, uma vez que é capaz de proporcionar resultados satisfatórios em termos oncológicos, funcionais e estéticos.

Introduction: Squamous cell carcinoma is the most common malignant tumor of the lips and mainly affects the lower lip. Adequate treatment of this neoplasm must be early and radical, as metastases can occur. Considering that the lips are extremely important in the dynamics and motricity of the face, lip reconstruction after major resections in this region is a challenge for the surgeon in the search for good aesthetic and functional results. This study seeks to present an already established and reliable technique for reconstructing the lower lip after tumor resection, the Karapandizic flap. Method: In this case review, 4 patients with lower lips reconstructed using the Karapandzic technique in 2013-2022 are retrospectively evaluated. Results: The most frequently observed complications were hypertrophic scar, lip vermilion suture dehiscence, and microstomia (reduction of oral opening). The cleft lip (microstomia) reduction was partially corrected through dental orthoses, with no need for commissuroplasty in any of the cases. Another contribution of this work is the use of preoperative color echoDoppler, which allows flap planning by checking the viability of the vascular pedicle and the actual positioning of this pedicle, reducing the chances of inadvertent injury to the vessels during surgery. Conclusion: Even though microstomy is a limitation of this flap, we conclude that this technique meets the need for lower lip reconstruction in large resections, as it can provide satisfactory results in oncological, functional, and aesthetic terms.

Diferenças no perfil de complicações pós-operatórias em pacientes submetidas a mamoplastia de aumento e mastopexia com prótese / Differences in the profile of postoperative complications in patients undergoing breast augmentation and mastopexy with prosthesis

Introdução: A mamoplastia de aumento é uma dos procedimentos mais realizados em Cirurgia Plástica em todo o mundo. A mastopexia com prótese também é um procedimento amplamente realizado, reservado para outro perfil de pacientes. Muitas complicações podem ser evitadas quando se estudam os fatores de risco para desfechos desfavoráveis. Método: Trata-se de um estudo retrospectivo realizado por meio da análise de prontuários de pacientes submetidas a mamoplastia primária de aumento e mastopexia com implantes mamários no período de janeiro de 2018 a dezembro de 2020. Resultados: Das 112 pacientes submetidas a mamoplastia com implante mamário no período do estudo, 76 foram submetidas a mamoplastia de aumento primária (67,86%) e 36 pacientes a mastopexia com implante mamário (32,14%). As pacientes submetidas a mastopexia apresentaram maior média de idade em relação àquelas submetidas a mamoplastia de aumento (p<0,001) e apresentaram menores volumes de implantes mamários (p=0,002). As complicações mais comuns em ambos os grupos incluem a deiscência da ferida operatória, mais comum após mastopexia com prótese. Conclusão: A mastopexia de aumento realizada em procedimento único apresenta maior índice de complicações quando comparada à mamoplastia de aumento realizada individualmente. No entanto, o maior número de complicações precoces observadas no procedimento combinado é a soma dos dois procedimentos distintamente individuais e não um aumento exponencial.

Introduction: Breast augmentation is one of the most performed procedures in Plastic Surgery worldwide. Mastopexy with prosthesis is also a widely performed procedure reserved for other patient profiles. Many complications can be avoided when studying risk factors for unfavorable outcomes. Method: This is a retrospective study carried out through the analysis of medical records of patients who underwent primary breast augmentation and mastopexy with breast implants from January 2018 to December 2020. Results: Of the 112 patients who underwent mammoplasty with the implant during the study period, 76 patients underwent primary breast augmentation (67.86%), and 36 underwent mastopexy with breast implant (32.14%). Patients undergoing mastopexy had a higher average age compared to those undergoing breast augmentation (p<0.001) and had smaller volumes of breast implants (p=0.002). The most common complications in both groups include surgical wound dehiscence, more common after mastopexy with prosthesis. Conclusion: Breast augmentation performed as a single procedure has a higher rate of complications when compared to breast augmentation performed individually. However, the greater number of early complications observed with the combined procedure is the sum of the two distinctly individual procedures and not an exponential increase.

Retalho supraclavicular para reconstrução oncológica em cabeça e pescoço: Uma série de 62 casos / Supraclavicular flap for head and neck oncological reconstruction: A series of 62 cases

Introdução: A reconstrução oncológica de defeitos extensos em cabeça e pescoço impõe ao cirurgião plástico a difícil decisão entre o uso de retalhos livres e retalhos pediculados. O retalho supraclavicular é um dos principais exemplos de retalho pediculado, sendo versátil, com espessura delgada e cor semelhante à região a ser reconstruída. Método: Um estudo retrospectivo foi realizado através da coleta de dados de prontuário de pacientes internados no Instituto do Câncer do Estado de São Paulo, entre dezembro de 2010 e março de 2020. Resultados: Dentre os 62 pacientes reconstruídos com retalho supraclavicular, 37 eram do sexo masculino e 25 do sexo feminino. Cinquenta e oito pacientes (93,5%) possuíam alguma comorbidade associada. Ao todo, 27 complicações relacionadas ao retalho (43,5%) foram registradas, sendo 5 necroses totais (8%). Conclusão: O retalho supraclavicular possui importante papel nas reconstruções oncológicas de cabeça e pescoço e deve ser considerado como opção em pacientes maus candidatos a retalhos microcirúrgicos.

Introduction: The oncological reconstruction of extensive defects in the head and neck requires the plastic surgeon to make a difficult decision between the use of free flaps and pedicled flaps. The supraclavicular flap is one of the main examples of a pedicled flap, being versatile, with a thin thickness and similar color to the region to be reconstructed. Method: A retrospective study was carried out by collecting data from medical records of patients admitted to the Cancer Institute of the State of São Paulo between December 2010 and March 2020. Results: Among the 62 patients reconstructed with a supraclavicular flap, 37 were male and 25 female. Fifty-eight patients (93.5%) had some associated comorbidity. In total, 27 complications related to the flap (43.5%) were recorded, 5 of which were total necrosis (8%). Conclusion: The supraclavicular flap plays an important role in head and neck oncological reconstructions and should be considered as an option in patients who are poor candidates for microsurgical flaps.