Anne Karoline Groth

Assessment and nutritional aspects of wound healing

Purpose of reviewThe aim of this study is to review the physiopathology and the nutritional aspects of wound healing. Recent findingsWound healing consists of a perfect and coordinated cascade of events that result in tissue reconstitution. The healing process is common to all wounds, independent of the agent that has caused it. It is divided didactically into three phases: inflammation, proliferation, and remodeling or maturation. Collagen is the most abundant protein in the human body and is also the main component of the wound matrix. It is organized in a thick and dynamic net, resulting from constant collagen deposition and reabsorption. Wound scar is the result of the interaction between collagen synthesis, degradation, and remodeling. There are several ways to evaluate wound healing: tensiometry, collagen morphometry, immunohistochemistry, and, more recently, the dosage of growth factors. Malnutrition adversely affects wound healing. On the contrary, the healing process can be stimulated by preoperative feeding and by certain nutrients such as glutamine, arginine, butyrate, and antioxidants. SummaryWound healing is a complex process that started to be fully understood only in recent years. Recent research has been directed to act in the nutrition modulation of the healing process.

Facial rejuvenation with SMASectomy and FAME using vertical vectors.

The quest for better results in the midface after a face lift has led to the repositioning of a structure called the malar fat pad. Finger-assisted malar elevation (FAME) consists of detaching the malar fat pad from the underlying SMAS, which allows for the elevation of this structure. Two hundred five patients (189 females and 16 males) from January 2002 to August 2007 underwent a facial rejuvenation procedure comprising short-scar rhytidoplasty, SMASectomy, and FAME, with or without a simultaneous endobrow, blepharoplasty, and lipofilling. The midface fixation technique consisted of a stitch from the malar fat pad and SMAS flap to the periosteum at the zygomatic arch which was performed in every case. Elevation of the midface and improvement of the nasolabial fold and the mandible contour were obtained in all cases. Facial aging should be evaluated as a global process instead of a segmented one. Aging occurs in every structure of the face in different ways, depending on the vector of descent, thereby treatment must be individualized. We have observed improvement of the midface when using the FAME procedure in a rhytidoplasty with SMASectomy with deep fixation.

Influence of Preoperative Feeding on the Healing of Colonic Anastomoses in Malnourished Rats

BACKGROUND Malnutrition influences healing of gastrointestinal anastomoses. The authors hypothesize that colonic anastomotic healing is decreased by malnutrition and might be improved by preoperative feeding. METHODS Eighty adult male Wistar rats were divided into 4 groups: (1) control rats 1 (C1), fed regular chow ad libitum for 21 days; (2) malnourished pair-fed rats (M), fed 50% of the food ingested by the control rats for 21 days; (3) preoperative nutrition rats (PRE), fed 50% of the average of the controls for 21 days and then fed preoperative nutrition with regular chow ad libitum for 1 week before the operation; and (4) control rats 2 (C2), fed regular chow ad libitum for 28 days. On days 21 (C1 and M) and 28 (PRE and C2), rats underwent 2 colonic transections and, subsequently, 2 end-to-end anastomoses. Rats were killed on postoperative day 5. The anastomoses were resected for tensile strength and histological analysis. RESULTS PRE rats showed increased maximal tensile strength vs the M group (0.09+/-0.01 vs 0.15+/-0.01; P<.05) and similar values of maximal tensile strength as the controls (0.15+/-0.01 vs 0.15+/-0.02; P=.91). Collagen type I was higher in controls vs the PRE group (6.13+/-0.39 vs 4.90+/-1.53; P<.05); nevertheless, the PRE group showed higher collagen type I than M rats (4.90+/-0.36 vs 3.83+/-0.35; P<.05). CONCLUSIONS Preoperative feeding for 7 days increases the maximal tensile strength, as well as the percentage area of mature collagen, approaching similar values as the control group.

Influence of minoxidil on ischemic cutaneous flaps in rats

PURPOSE To evaluate the influence of minoxidil, a well known vasodilator, on ischemic flap necrosis prevention in rats. METHODS Ventral cutaneous flaps, measuring 8x4 cm, were designed in 20 Wistar rats based on the right cranial epigastric artery. In the experiment group, 50 mg/kg/day of minoxidil sulfate was administered by orogastric tube and the same amount of saline solution was administered to the control group. Such procedure was initiated 24 h before surgery and kept once a day through the 7th postoperative day. Microcirculation was evaluated with laser fluxometry 24 h before surgical procedure, at immediate postoperative and at the 7th postoperative day. Flap necrosis area was evaluated by 2 methods: planimetry and weight/paper ratio. RESULTS A significant flow increase in distal and medial extremity at M1 (medial point 1) (p=0.0484) was observed in the experiment group. There was significant difference in flap necrosis prevention in the experiment group (p=0.0433), although after necrosis took place there was no significant difference in necrosis size. (p=0.1051 and p=0.2799). CONCLUSION Minoxidil sulfate is effective in avoiding necrosis in ischemic flaps, but after necrosis is present there is no difference in survival area between experimental and control groups.

An alternative experimental model for training in microsurgery

OBJECTIVE to describe a new model of training in microsurgery with pig spleen after splenectomy performed by undergraduate students of the Discipline of Operative Technique of the UFPR Medical School. METHODS after the completion of splenectomy we performed dissection of the vascular pedicle, distal and proximal to the ligation performed for removal of the spleen. After complete dissection of the splenic artery and vein with microscope, clamps were placed and the vessels were cut. We then made the anastomosis of the vessels with 9.0 nylon. RESULT the microsurgical training with a well-defined routine, qualified supervision and using low cost experimental materials proved to be effective in the practice of initial microvascular surgery. CONCLUSION the use of pig spleen, which would be discarded after splenectomy, is an excellent model for microsurgical training, since besides having the consistency and sensitivity of a real model, it saves the sacrifice of a new animal model in the initial learning phase of this technique.

Retalho ósseo pré-fabricado com osso homógeno: estudo da maturação óssea em um modelo experimental

As conventional options for bone repair are not satisfactory, a new flap category was developed, the prefabricated flap (RPF). 42 metatarsic-I bone were obtained from 21 Wistar rats, and divided in two groups: group I (n=21) the bones were freeze- dryed and decalcified and group II (n=21) was frozen to - 70o C. After 3 weeks the bones were grafted in 21 rats, onto the left na right inferior epigastric vessels wrapped in silicon sheet. Groups I and II were subdivided in 3 groups each, following the period of permanence (1,2 or 4 weeks). In macroscopic histologic study, group I revealed loss of bone architecture and group II manteined its concistency and shape. In quantitative analysis, alterations were observed in group I, mainly inthe 2 weeks group. There is a histologic difference in prefabricated bone flaps betwenn groups I and II. Gradual bone reabsorption suggests that the flap should be rotated early. This study shows the applicability of homogenous bone for flap prefabrication.

Avaliação da integração de enxerto de pele com a utilização do 2-octilcianoacrilato: estudo experimental em ratos

A fixacao dos enxertos de pele total atraves da sutura demanda tempo cirurgico relativamente longo. O surgimento de adesivos teciduais tem se apresentado com varias aplicacoes clinicas, constituindo alternativa a sutura convencional. O objetivo deste estudo e avaliar a eficacia do adesivo 2-octilcianoacrilato, quando comparado a sutura simples, na fixacao de enxertos de pele total, analisando-se a integracao do enxerto. Foram retirados enxertos de pele total de 1 cm2, bilateralmente, do dorso de nove ratos machos, com peso medio de 150 gramas. A pele retirada para a enxertia foi recolocada sobre o defeito, a fixacao foi realizada atraves de sutura continua com fio monofilamentar de nailon 4-0 no lado esquerdo e adesivo de 2-octilcianoacrilato no lado direito. Os aspectos clinico e histologico da integracao do enxerto foram analisados no 7o e 14o dia de pos operatorio. Utilizou-se o software Sens-a-Ray para comparacao de resultados. Evidenciamos maior integracao do enxerto de pele total no lado do adesivo de 2-octilcianoacrilato (80%) em comparacao ao lado da sutura continua (44%), sendo que houve perda total do enxerto do lado da cola de 2-octilcianoacrilato em 11,1% do casos comparado a 33,3% da sutura continua. O tempo medio da fixacao do enxerto no grupo da cola de 2-octilcianoacrilato foi de 23 segundos, contra 4 minutos da sutura convencional. Foi demonstrado uma maior integracao e um menor tempo de fixacao do enxerto no grupo do adesivo 2- octilcianoacrilato.

Escolha do vaso receptor em reconstrução de mama microcirúrgica

BACKGROUND: Microvascular transfer of autogenous tissue have become the gold standard for breast reconstruction. As in any free tissue reconstruction, recipient vessel choice is fundamental for adequate planning in breast reconstruction. The purpose of the present study is to determine which of the available recipient vessels (the internal mammary artery and its perforators vessels or circumflex scapular vessels) are adequate for microvascular breast reconstruction. METHODS: A retrospective analysis of 117 consecutive patients who underwent microvascular breast reconstruction between January 2005 and December 2007 was performed. An algorithm that could be applied to the selection of the recipient vessel based in the axillary node dissection, immediate or late reconstruction, preoperative radiotherapy was established. Flap related complications, conversion rate and clinical outcomes were analised. RESULTS: The internal mammary perforator, the internal mammary and the circumflex scapular are adequate recipient vessels for breast reconstruction, with similar rates of complications and viability. We also observed a lower flap viability rate when using superficial inferior epigastric artery flap comparing to deep inferior epigastric artery perfurator and transverse rectus abdominis musculocutaneous with muscle preservation flaps. CONCLUSIONS: Microsurgical breast reconstruction is a safe and reliable method, with high flap viability and low complications.

Retalho músculo cutâneo de pálpebra superior para inferior com pedículo medial para correção de ectrópio

DOI: 10.5935/2177-1235.2018RBCP0060 Introdução: O ectrópio se caracteriza por uma eversão da margem palpebral, e é mais comum na pálpebra inferior. O processo de exposição ocular associado a esse quadro pode levar a sequelas graves, como a perda ocular. Muitos retalhos foram propostos para tratar esse quadro. Contudo, a taxa de recorrência pode ser alta, e quando o defeito se localiza na porção medial da pálpebra, ele se torna muito mais desafiador. Por isso, é fundamental que o cirurgião disponha de uma variedade de estratégias cirúrgicas para tratar adequadamente esses casos, definindo, em cada circunstância, qual a melhor técnica a ser adotada, entre as possibilidades disponíveis. O objetivo é apresentar o emprego do retalho miocutâneo de pálpebra superior para inferior, pediculado medialmente, como alternativa no tratamento de três casos de ectrópio Métodos: Tratamento de pálpebra inferior com retalho miocutâneo de pálpebra superior para inferior, pediculado medialmente. Três casos pós-ressecção de lesão oncológica que evoluíram com ectrópio de pálpebra inferior (um deles já recidivado) e que foram trados com retalho miocutâneo de pálpebra superior para inferior, pediculado medialmente; nenhum dos 3 casos apresentou recidiva após essa abordagem proposta. Conclusão: O retalho miocutâneo de pálpebra superior para inferior com pedículo medial demonstrouse uma opção viável, com resultado funcional e estético satisfatório, sem trazer grande prejuízo à área doadora e apresentando pele de cor, espessura e textura adequada à reconstrução da pálpebra inferior. ■ RESUMO

Ossification of vascular pedicle in fibula free flap: a case report

Introduction: The use of fibula flaps for the reconstruction of craniomaxillofacial defects has many advantages, including the low morbidity of the donor area, good bone quality for use of osseointegrated implants, and the possibility to include a skin island, when indicated. During the dissection of the flap, a muscle “cuff” and a periosteal strip are usually included near the region of the vascular pedicle. The Brazilian Society of PlaStic Surgery SOCIEDADE BrASIlEIrA DE CIrurgIA plaStICA Relato de Caso Rev. Bras. Cir. Plast. 2014;29(2):198-200 DOI: 10.5935/2177-1235.2014RBCP0037