Francisco Felipe Laitano

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.

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.

Tattooing associated with C-V flap placement in one-stage reconstruction of the nipple-areola complex

Introduction: Reconstruction of the nipple-areola complex (NAC) is a fundamental step in the treatment of breast cancer. It is usually performed in two distinct stages. Tattooing is performed only after reconstruction and complete scarring of the nipple. Methods: This retrospective study was conducted from 2015 to 2016 at the Hospital São Lucas of the Pontifical Catholic University of Rio Grande do Sul. Twenty-one patients with a single NAC were included. One-stage reconstruction of the nipple using a local C-V flap associated with tattooing for pigmentation of the NAC is described. Data on the type of breast reconstruction performed, associated complications, and presence of previous breast radiotherapy were presented. Results: Most patients (48%) underwent reconstruction with an implant. Three complications (14%) were observed in the nipple, including one case of partial necrosis and two cases of small dehiscence. None of the patients had complications due to tattooing. Eleven patients (52%) underwent breast radiotherapy previously. Conclusion: Tattooing combined with one-stage reconstruction using a C-V flap is a simple technique with a low rate of complication. ■ ABSTRACT

Skin-reducing mastectomy using inferior pedicle dermal fat flaps in immediate reconstruction of medium and large hypertrophic breasts

Introduction: Breast cancer is the most common type of neoplasm among women (except for non-melanoma skin cancers), and in the past few years, its treatment greatly evolved with skin-sparing mastectomies. Breasts with grades II and III ptosis are difficult to approach and require an aesthetic reduction of the cutaneous envelope after adenomastectomy. Methods: A retrospective study was conducted from January 2013 to January 2016. This included all patients undergoing adenomastectomy and immediate reconstruction via reduction of the cutaneous envelope using Pitanguy’s marking technique associated with the use of a prosthesis or expander above the submuscular plane and below the dermal fat flap. Results: A total of 15 patients were operated on based on the proposed technique, accounting for a total of 25 breasts (10 cases were bilateral). Twelve patients had cancer; two underwent prophylactic surgery; and one developed juvenile giant fibroadenoma. In two cases, an expander was used, and in 23 breasts, a definitive prosthesis was placed in a single surgical period. In three breasts, the nipple-areolar complex (NAC) was resected for oncological reasons; of the 22 preserved, 15 underwent grafting, and seven underwent elevation through the superior pedicle flap. There were five complications (20%): three seromas (12%), one necrosis at the “T” junction (4%), and one total NAC necrosis (4%). Conclusion: The technique described is an effective and reproducible method of immediate breast reconstruction using implants in a single period in patients with large breasts. However, the right patients should be selected because the risks of complications cannot be neglected. ■ ABSTRACT

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