Evandro José Siqueira

A new technique for reconstruction of lower-lip and labial commissure defects: a proposal for the association of Abbe–Estlander and vermilion myomucosal flap techniques

OBJECTIVE Reconstruction of large lower-lip defects is a complex surgical procedure, especially when associated with defects that compromise the oral commissure. Various wide resections have been proposed with the aim to preserve orolabial function and achieve a pleasant esthetic result. However, no consensus exists on the optimum procedure. We propose a new technique that combines an Abbe-Estlander flap with a vermilion myocutaneous lower-lip flap. STUDY DESIGN Five consecutive patients presenting with lower-lip and oral commissure defects underwent surgical procedure. Surgical outcomes were analyzed based on oral competence, symmetry, sensibility, ability to wear denture prostheses, and postoperative complications. RESULTS All patients achieved satisfactory functional and esthetic results during the 12-month follow-up period. CONCLUSIONS The association of the Abbe-Estlander flap and the vermilion myomucosal lower-lip flap provides reliable results for the reconstruction of small and large defects involving the lower lip and the oral commissure.

Uso de retalho cutâneo para reconstrução nasal após ressecção neoplásica

INTRODUCAO: A reconstrucao nasal e sempre desafiadora para o cirurgiao plastico. As perdas de substância nasal sao causadas principalmente por resseccao de neoplasias de pele. Existem muitas alternativas para cobertura cutânea e os retalhos cutâneos constituem a melhor opcao, tanto cosmetica como funcional. O objetivo deste trabalho e relatar a experiencia do Servico de Cirurgia Plastica do Hospital Sao Lucas da Pontificia Universidade Catolica do Rio Grande do Sul (Porto Alegre, RS, Brasil) na reconstrucao de perdas de substância do nariz secundarias a resseccao oncologica, descrevendo os retalhos cutâneos mais utilizados para cobertura dos defeitos segundo a subunidade anatomica. METODO: Foi realizada analise de 103 retalhos cutâneos nasais utilizados para reconstrucao de 102 perdas de substância secundarias a neoplasia, em 96 pacientes operadosno periodo de dezembro de 2008 a dezembro de 2011. As perdas de substância foram mapeadas de acordo com as subunidades anatomicas descritas por Burget & Menick, sendo registrado o numero de vezes em que cada opcao de reconstrucao foi utilizada em cada subunidade. RESULTADOS: A maioria dos pacientes era do sexo masculino (51%) e a media de idade do grupo estudado foi de 64,7 anos. Dentre os tumores cutâneos, o carcinoma basocelular foi o mais frequente (85,3%), seguido de carcinoma espinocelular (5,9%). Na asa nasal, o retalho mais utilizado foi o bilobado (44%); na regiao lateral, o retalho de avancamento em V-Y (72%); no dorso nasal, o retalho glabelar estendido (59,2%); na ponta, o retalho bilobado (46,2%); e no teto nasal, o retalho glabelar, utilizado em todos os casos. CONCLUSOES: Sao multiplas as opcoes cirurgicas para reconstrucao do nariz apos cirurgia oncologica, devendo-se escolher a mais adequada para cada caso, respeitando-se os contornos e a anatomia nasal, de acordo com os principios de Burget & Menick.

Estratégias em reconstrução do lábio inferior

BACKGROUND: The upper and lower lips represent the most important functional and aesthetic anatomical structures of the lower segment of the face. Given the complex functions of these structures, reconstruction of labial defects presents a challenge for plastic surgeons. METHODS: Thirty patients with full-thickness lower lip defects underwent lip reconstruction according to the extent of the defect after tumor resection. RESULTS: Six (20%) patients presented lesions of up to 30% of the total lip surface that required primary closure. Eighteen (60%) patients had lesions of 30-80% of the total area of the lower lip that were repaired using a myomucosal flap; in 14 of these patients, bilateral skin flaps were also used due to cutaneous involvement associated with the resection. Five (16.6%) patients had lesions on the lower lip that were adjacent to the oral commissure; therefore, they underwent reconstruction using an Abbe-Estlander flap with a myomucosal flap and bilateral skin flaps. One (3.5%) patient had a lesion covering 90% of the lower lip that was reconstructed using the Webster-Bernard technique and a tongue flap. CONCLUSIONS: Here, we present a simplified, systematic, and literature-based strategy for planning lower lip reconstructions that employs effective and reproducible techniques, which can be used for training resident physicians in the treatment of complex lower lip lesions according to the extent of tissue loss, thereby yielding appropriate aesthetic and functional results.

Use of the vermilion myomucosal flap with or without the mentolabial skin flap for lower lip reconstruction

BACKGROUND: Several techniques that have been described for reconstructing the lower lip often produce microstomia, commissure distortion, functional impairment, and decreased sensitivity. A technique for preserving neuromuscular tissue during a single-stage lip reconstruction is reported in this study. This technique involves the use of the vermilion myomucosal advancement flap with or without the mentolabial skin flap. METHODS: This study analyzed 17 male patients with squamous cell carcinoma. The mean patient age was 54.8 years, and incidence of lip defects after resection ranged from 20% to 85%. RESULTS: Infection, nerve damage, or the requirement for surgical revision was not observed in any patient during the follow-up period of three months. Three patients had microstomia with slight posterior enlargement of the lip. All patients had good sensitivity and adequate sphincter continence. CONCLUSIONS: The use of the vermilion myomucosal flap with or without the mentolabial skin flap resulted in a minimal risk of microstomia or functional incompetence. This procedure is performed in a single surgical stage and has good aesthetic and functional results for reconstruction of up to 80% of the lower lip

Aplicações do retalho romboide em reparações cutâneas

INTRODUCAO: O cirurgiao plastico frequentemente defronta-se com a reparacao dos mais diversos tipos de defeitos cutâneos; logo, e imprescindivel que possua o conhecimento de tecnicas versateis e apropriadas para cada caso. O retalho romboide de transposicao, proposto por Alexander Limberg, e um retalho extremamente util para os mais diversos tipos de reconstrucao. O objetivo deste trabalho e demonstrar a versatilidade, a seguranca e a aplicabilidade do retalho de Limberg para reconstrucao de perdas cutâneas localizadas nos mais diversos segmentos corporais. METODO: Foi realizada analise retrospectiva de 50 pacientes apresentando defeitos cutâneos, dos mais variados tipos, reconstruidos com o retalho romboide. A descricao da tecnica cirurgica e uma analise critica dos resultados sao apresentadas. RESULTADOS: A media de idade dos pacientes foi de 59,6 anos. As lesoes neoplasicas foram responsaveis pela maioria dos casos (84%). A face foi a area mais envolvida nas reconstrucoes, totalizando 36 (72%) casos, seguida da regiao lombossacral (8%), e do dorso e da regiao inguinoscrotal (6%). Complicacoes foram observadas em 4 (8%) pacientes. CONCLUSOES: O retalho romboide propicia resultados seguros e previsiveis, sendo a alternativa para a maioria dos defeitos encontrados.

Fasceíte necrotizante após aplicação de injeção intramuscular

E relatado o caso de um paciente do sexo masculino, de 1 ano e 2 meses, apresentando quadro de fasceite necrotizante comprometendo regiao inguinal e coxas apos injecao intramuscular de metoclopramida. Neste artigo, sao discutidos e apontados os aspectos fundamentais do diagnostico e tratamento da doenca, ressaltando a importância da identificacao precoce dos fatores que possam contribuir significativamente para melhora da sobrevida.

Complications in sefel-injection of chemicals to increase muscle

The number of gym goers who self-inject oily substances to increase muscle volume artificially and thereby improve the aesthetic appearance of their muscles that are unresponsive to training is increasing. Although immediate effects and satisfactory aesthetic results such as increased volume or changes in the contour of several areas of the body might be observed, oil infiltration might cause several shortand long-term complications, which are often irreversible. The awareness and actions of medical and health professional societies are fundamental for the prevention and control of this problem. In this article, possible complications are reviewed, and the case of a patient with severe local complications caused by oil injection is reported. ■ ABSTRACT

Benign lipoblastoma of the upper limb: a case report and literature review

Lipoblastoma is a rare mesenchymal tumor occurring primarily in pediatric patients and formed by lipoblasts that proliferate after the postnatal period. Despite its potential for local invasion and rapid growth, its prognosis is excellent. In this study, we report the case of a pediatric patient with a ponderous lesion in the right forearm that caused considerable functional impairment of the affected limb. We also discuss the relevant aspects concerning the differential diagnosis and management of the disease, as it has the potential to cause incapacity without proper treatment.