Gean Paulo Scopel

Nerve sources for facial reanimation with muscle transplant in patients with unilateral facial palsy: clinical analysis of 3 techniques.

Ninety-one patients with long-standing unilateral facial palsy and submitted to reanimation of the face with muscle transplant were divided into 3 nonrandomized groups: group I: 2-stage facial reanimation, cross face followed by gracilis muscle transplant, 58 patients; group II: 1-stage reanimation with latissimus dorsi muscle transplant, 11 patients (a branch of the facial nerve on the nonparalyzed side of the face was used as the nerve source for reanimation in groups I and II); group III: 1-stage reanimation with gracilis muscle transplant and neural coaptation of the respective nerve and the ipsilateral masseteric branch of the trigeminal nerve, 22 patients. No microvascular complications were observed. The average interval between surgery and initial muscle contractions was 11.1 months, 7.2 months, and 3.7 months in group I, group II, and group III, respectively. The quality (intensity and shape) of the smile, voluntary or involuntary, obtained on the reanimated side in relation to the unaffected side was considered good or excellent in 53.4%, 54.5%, and 86.3% of the patients in groups I, II, and III, respectively. In group I, the average age of the patients with excellent or good results (19.8 + 10.5 years) was significantly lower than that of the patients with fair or poor results or absence of movement (36.5 + 13.3 years). The smile was considered emotional or involuntary in 34% of the patients in group I and 45% in group II. Most of the patients in each group were only able to produce “voluntary smiles”. Crossed synkinesis with lip puckering was observed in 48% of the patients in group I and 90% in group II. The results obtained with 1-stage facial reanimation with masseteric nerve were more uniform and predictable than those obtained with the other techniques evaluated in this study.

Collagen and Elastic Content of Abdominal Skin After Surgical Weight Loss

BackgroundCollapsed skin folds after bariatric weight loss are often managed by plastic procedures, but changes in dermal composition and architecture have rarely been documented. Given the potential consequences on surgical outcome, a prospective histochemical study was designed. The hypothesis was that a deranged dermal fiber pattern would accompany major changes in adipose tissue.MethodsFemale surgical candidates undergoing postbariatric abdominoplasty (n = 40) and never obese women submitted to control procedures (n = 40) were submitted to double abdominal biopsy, respectively in the epigastrium and hypogastrium. Histomorphometric assessment of collagen and elastic fibers was executed by the Image Analyzer System (Kontron Electronic 300, Zeiss, Germany).ResultsDepletion of collagen, but not of elastic fibers, in cases with massive weight loss was confirmed. Changes were somewhat more severe in epigastrium (P = 0.001) than hypogastrium (P = 0.007). Correlation with age did not occur.Conclusions(1) Patients displayed lax, soft skin lacking sufficient collagen fiber network. (2) Elastic fiber content was not damaged, and was even moderately increased in epigastrium; (3) Preoperative obesity negatively correlated with hypogastric collagen concentration; (4) Future studies should pinpoint the roles of obesity, and especially of massive weight loss, on dermal architecture and response to surgery.

Facial Reanimation With Masseteric Nerve: Babysitter or Permanent Procedure? Preliminary Results

The authors are presenting a series of 10 cases of complete unilateral facial paralysis submitted to (I) end-to-end microsurgical coaptation of the masseteric branch of the trigeminal nerve and distal branches of the paralyzed facial nerve, and (II) cross-face sural nerve graft. The ages of the patients ranged from 5 to 63 years (mean: 44.1 years), and 8 (80%) of the patients were females. The duration of paralysis was no longer than 18 months (mean: 9.7 months). Follow-up varied from 6 to 18 months (mean: 12.6 months). Initial voluntary facial movements were observed between 3 and 6 months postoperatively (mean: 4.3 months). All patients were able to produce the appearance of a smile when asked to clench their teeth. Comparing the definition of the nasolabial fold and the degree of movement of the modiolus on both sides of the face, the voluntary smile was considered symmetrical in 8 cases. Recovery of the capacity to blink spontaneously was not observed. However, 8 patients were able to reduce or suspend the application of artificial tears. The authors suggest consideration of masseteric-facial nerve coaptation, whether temporary (baby-sitter) or permanent, as the principal alternative for reconstruction of facial paralysis due to irreversible nerve lesion with less than 18 months of duration.

Cirurgia do contorno corporal no paciente após perda ponderal maciça: experiência de três anos em hospital público secundário

OBJETIVO: Apresentar a experiencia clinico-cirurgica de tres anos relacionada as cirurgias de contorno corporal no paciente apos perda ponderal macica, realizadas pela equipe de Cirurgia Plastica do Hospital Estadual de Sapopemba. METODOS: Estudo retrospectivo realizado no Hospital Estadual de Sapopemba, vinculado ao Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, no periodo de julho de 2005 a julho de 2008. Foram operados 98 pacientes submetidos a tratamento de obesidade morbida por meio de gastroplastia redutora, com sucesso para a tecnica, ou emagrecimento por metodo nao-cirurgico. Os criterios de exclusao foram tabagismo, intencao gestacional e instabilidade ponderal, exigindo-se peso estavel por pelo menos seis meses apos atingido a perda ponderal satisfatoria. RESULTADOS: Dos 98 pacientes operados, 97% eram do sexo feminino, com idade media de 40,5 anos e o metodo de emagrecimento foi cirurgico em 88% deles. Das 177 cirurgias plasticas realizadas, 46% foram abdominoplastias, seguidas por mastoplastias (15%), suspensoes de coxa (13%) e braquioplastias (12%). O periodo medio de internacao foi dois dias e as principais complicacoes diagnosticadas foram: seroma (28%), necroses/deiscencias de pequeno porte (18%), necroses/ deiscencias de grande porte (4%), hematomas (4%), tromboflebite superficial de veia safena (2%) e trombose venosa profunda (1%). CONCLUSAO: O desejo de cirurgias para melhora do contorno corporal apos perda ponderal macica constitui demanda crescente. Cabe ao cirurgiao plastico conhecer as peculiaridades clinicas e os riscos maiores de complicacoes desses pacientes, ponderar suas expectativas, analisar os resultados e manter a busca constante pelo aperfeicoamento das tecnicas cirurgicas.

Muscle transplants for facial reanimation: rationale and results of insertion technique using the palmaris longus tendon.

Thirty-one patients with unilateral long-standing facial palsy underwent 1-stage reanimation with free gracilis muscle transplant innervated by the masseteric branch of the trigeminal nerve. They were divided into 2 nonrandomized groups according to insertion technique: group I (9 patients), interrupted suture between the free flap and the orbicularis oris of the upper and lower lip on the paralyzed side; group II (22 patients), palmaris longus tendon graft placed between the gracilis free flap and the orbicularis oris of the upper and lower lip on the nonparalyzed side. Qualitative evaluation of the smile demonstrated better results in patients from group II. Comparing the position of the Cupids bow at rest, pre- and postoperatively in each patient, we observed significant improvement of facial symmetry in both groups. During smile, however, there was a significantly higher rate of centralization of the Cupids bow in patients submitted to reanimation with the use of the palmaris longus tendon (group II).

Hematoma intraneural experimental em ratos: avaliação da recuperação funcional e histomorfometria neural

Emergence of intraneural hematoma with involvement of peripheral nerves can occur after trauma or coagulation disorders. The decision for expectant management or decompressive surgical techniques is still controversial. Forty male Wistar rats were divided into 4 groups. In group A, an intraneural injection of autologous blood was provided at the right sciatic nerve. In group B, after the hematoma creation, a longitudinal epineurotomy was performed. In the group C (sham-operated), the sciatic nerve was exposed without hematoma. In group D. immediately after the hematoma creation, an interfascicular neurolysis was performed. Nerve function recovery was assessed using the Bain-Mackinnon-Hunter Sciatic Function Index (SFI). At the end of the study, the animals were sacrificed and a specimen of the sciatic nerve at compression midpoint was removed for morphometric analysis. Group A displayed an initial SFI of -28.43, with full functional recovery on the fifth day. Immediate drainage of the hematoma by longitudinal epineurotomy (group B) promoted recovery of normal sciatic function on the first day (SFI -14.42). Addressing the hematoma via interfascicular neurolysis resulted in an initial SFI of -23.69 and recovery of normal sciatic function on the third day. The morphometric variables indicated an improvement of ischemic parameters following both types of surgical intervention.