Jayme Adriano Farina Junior

Update on hypertrophic scar treatment

Scar formation is a consequence of the wound healing process that occurs when body tissues are damaged by a physical injury. Hypertrophic scars and keloids are pathological scars resulting from abnormal responses to trauma and can be itchy and painful, causing serious functional and cosmetic disability. The current review will focus on the definition of hypertrophic scars, distinguishing them from keloids and on the various methods for treating hypertrophic scarring that have been described in the literature, including treatments with clearly proven efficiency and therapies with doubtful benefits. Numerous methods have been described for the treatment of abnormal scars, but to date, the optimal treatment method has not been established. This review will explore the differences between different types of nonsurgical management of hypertrophic scars, focusing on the indications, uses, mechanisms of action, associations and efficacies of the following therapies: silicone, pressure garments, onion extract, intralesional corticoid injections and bleomycin.

Curbing Inflammation in Skin Wound Healing: A Review.

Wound healing is a complex regulated process that results in skin scar formation in postnatal mammals. Chronic wounds are major medical problems that can confer devastating consequences. Currently, there are no treatments to prevent scarring. In the early fetus wounds heal without scarring and the healing process is characterized by relatively less inflammation compared to adults; therefore, research aimed at reducing the inflammatory process related to wound healing might speed healing and improve the final scar appearance.

Absence of pathological scarring in the donor site of the scalp in burns: an analysis of 295 cases.

AIM This study aims to describe the incidence of complications on scalp from which a thin split-skin graft was harvested (0.005-0.007 in.) of the donor site in children and adult burn victims. METHODS We reviewed the medical records of 295 burn patients admitted in the Burn Unit of the Clinical Hospital of the Faculty of Medicine of Ribeirão Preto, from January 1998 to December 2007, whose scalps were used as donor site for grafts. Skin-graft thickness varied from 0.005 in. to 0.007 in. The occurrence of pathological healing was evaluated clinically and the time of epithelisation by the main surgeon and a plastic surgeon or a staff nurse. RESULTS Of the 295 patients whose scalps were used as donor site, 274 were followed from 6 months to 10 years after the procedure (median 18.2 months). Twenty-one patients were lost to follow-up in the first 6 months. No hypertrophic scarring or keloids on the donor site was observed. Five patients (1.82%) presented with folliculitis and two of them were evaluated with small areas of alopecia (0.7%), treated with resection of these areas and primary suture. The average time of epithelisation of the donor site was 7 days. CONCLUSION The harvest of thinner split graft from the scalp is a safe procedure.

Burns in the domestic environment: characteristics and circumstances of accidents.

This study characterizes burn accidents in the domestic environment and identifies the circumstances of accidents affecting children, adults or elderly people who need supervision or care. Demographic data and burn characteristics of 61 domestic environment burn victims were collected. The family members of 13 children and one aged adult, who needed supervision or special care, were selected to answer a semi-structured interview. Two thematic groups were identified: social and environmental factors that might have contributed to the burn accidents and circumstances involving the accidents. Risk factors were: low socioeconomic and educational levels of mothers and those responsible for the children at the moment of the accident, small houses considering the number of occupants and unsafe kitchen equipment. Although cases of domestic violence were not identified there was neglect from caregivers. Health professionals should be attentive and investigate the circumstances of accidents involving vulnerable individuals.Este estudo teve como objetivos caracterizar os acidentes por queimaduras, ocorridos em ambiente domestico e identificar as circunstâncias desses acidentes quando atingiram criancas, adultos ou idosos que necessitavam de supervisao. Foram coletados dados demograficos e sobre o trauma de 61 vitimas de queimaduras em ambiente domestico. Dessas, 13 criancas e um idoso, com necessidade de supervisao ou cuidado especial, tiveram os familiares selecionados para entrevista semiestruturada. Foram identificados dois nucleos tematicos: fatores que podem ter contribuido para a ocorrencia de acidentes por queimaduras: sociais e ambientais e circunstâncias que envolveram o acidente. Os fatores de risco foram: baixo nivel socioeconomico e de instrucao das maes e responsaveis pela crianca, no momento do acidente, moradias pequenas para o numero de residentes e equipamentos de cozinha precarios. Nao foram identificados casos de violencia domestica, mas de desatencao dos responsaveis. Os profissionais da saude devem estar atentos para investigar as circunstâncias dos acidentes em individuos vulneraveis.

Guanylate cyclase inhibition by methylene blue as an option in the treatment of vasoplegia after a severe burn. A medical hypothesis

Summary Today it is known that severe burns can be accompanied by the phenomenon of vasoplegic syndrome (VS), which is manifested by persistent and diffuse vasodilation, hypotension and low vascular resistance, resulting in circulatory and respiratory failure. The decrease in systemic vascular resistance observed in VS is associated with excessive production of nitric oxide (NO). In the last 2 decades, studies have reported promising results from the administration of an NO competitor, methylene blue (MB), which is an inhibitor of the soluble guanylate cyclase (sGC), in the treatment of refractory cases of vasoplegia. This medical hypothesis rationale is focused on the tripod of burns/vasoplegia catecholamine resistant/methylene blue. This article has 3 main objectives: 1) to study the guanylate cyclase inhibition by MB in burns; 2) to suggest MB as a viable, safe and useful co-adjuvant therapeutic tool of fluid resuscitation, and; 3) to suggest MB as burns hypotensive vasoplegia amine-resistant treatment.

Queimaduras em ambiente doméstico: características e circunstâncias do acidente

This study characterizes burn accidents in the domestic environment and identifies the circumstances of accidents affecting children, adults or elderly people who need supervision or care. Demographic data and burn characteristics of 61 domestic environment burn victims were collected. The family members of 13 children and one aged adult, who needed supervision or special care, were selected to answer a semi-structured interview. Two thematic groups were identified: social and environmental factors that might have contributed to the burn accidents and circumstances involving the accidents. Risk factors were: low socioeconomic and educational levels of mothers and those responsible for the children at the moment of the accident, small houses considering the number of occupants and unsafe kitchen equipment. Although cases of domestic violence were not identified there was neglect from caregivers. Health professionals should be attentive and investigate the circumstances of accidents involving vulnerable individuals.Este estudo teve como objetivos caracterizar os acidentes por queimaduras, ocorridos em ambiente domestico e identificar as circunstâncias desses acidentes quando atingiram criancas, adultos ou idosos que necessitavam de supervisao. Foram coletados dados demograficos e sobre o trauma de 61 vitimas de queimaduras em ambiente domestico. Dessas, 13 criancas e um idoso, com necessidade de supervisao ou cuidado especial, tiveram os familiares selecionados para entrevista semiestruturada. Foram identificados dois nucleos tematicos: fatores que podem ter contribuido para a ocorrencia de acidentes por queimaduras: sociais e ambientais e circunstâncias que envolveram o acidente. Os fatores de risco foram: baixo nivel socioeconomico e de instrucao das maes e responsaveis pela crianca, no momento do acidente, moradias pequenas para o numero de residentes e equipamentos de cozinha precarios. Nao foram identificados casos de violencia domestica, mas de desatencao dos responsaveis. Os profissionais da saude devem estar atentos para investigar as circunstâncias dos acidentes em individuos vulneraveis.

Is It Safe to Operate on Patients Taking Isotretinoin

BackgroundOral isotretinoin is increasingly being used to treat acne and other dermatological conditions. The number of patients who take isotretinoin and wish or need to undergo plastic surgery may be following a similar pattern. Although skin healing is an important concern in the case of patients who use isotretinoin, it is definitely not the only relevant issue when planning surgical intervention.MethodsEleven important points regarding surgery safety in patients taking oral isotretinoin were defined. A literature search of the PubMed database was conducted by employing the keywords isotretinoin OR 13-cis-retinoic acid. This returned the largest possible number of studies about isotretinoin.ResultsForty-seven studies matched the selection criteria. Most animal experimental models suggested that isotretinoin at doses commonly used to treat acne is not detrimental to wound healing. Human studies are controversial. However, healing of skeletal muscle could be at increased risk of necrosis.ConclusionsAssociation between isotretinoin and problematic skin healing after surgery is being challenged. Also, recommended time between discontinuation of isotretinoin and surgery should be reviewed. While muscle flaps may be endangered in patients taking isotretinoin, healing of other tissues and systemic effects that could compromise surgery safety are rare or detectable before surgery.Level of Evidence VThis journal requires that the authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Padronização cirúrgica das abdominoplastias em âncora pós-gastroplastia

INTRODUCTION: The authors propose changes in the post-bariatric abdominoplasty technique to address some imperfections (tension on the T-junction, poor placement of the horizontal scar and unaesthetic umbilical scar) seen with the classic standardization (e.g. en-bloc skin resection and maintenance of the umbilicus). METHODS: Assessment was realized on 67 patients who had previously been submitted to bariatric surgery and undergone modified vertical abdominoplasty with staged skin resection (first the vertical component and then the horizontal one), neo-onphaloplasty and dermolipectomy of the pubic area. RESULTS: The new standardization led to reduction on the previous described downsides of the technique (better scar positioning and less tension). CONCLUSIONS: The new systematization provided an easier pre-operatory marking and improved aesthetic results.

Gluteal Augmentation with Silicone Implants: A New Proposal for Intramuscular Dissection

BackgroundGluteoplasty has gained notoriety over the last decades, which has motivated the development of various surgical techniques. Nevertheless, the fear of dissection of the intramuscular plane without direct visualization may inhibit learning and development of gluteal augmentation with implants. Moreover, literature detailing the technical steps of intramuscular dissection for the construction of the implant pocket is scarce. This study presents a new approach to intramuscular dissection for gluteal augmentation with silicone implants, a variation of the conventional surgical technique.MethodsWe performed a retrospective analysis of a series of 12 female patients submitted to a variation of the intramuscular dissection technique for gluteal augmentation with silicone implants. Data from patients, implants, follow-up time, postoperative complications, and the degree of patient satisfaction were obtained. This technique follows the principle of alternating spatulas to perform the blunt dissection of the implant pocket.ResultsIn this series, the proposed technique is controlled and safe for intramuscular dissection, which can be used for both experienced and training surgeons. This technique is based on well-known anatomical points and references. We observed that the implant was well positioned and covered, the patients were satisfied with the result, and the number of complications was low.ConclusionsThis variation of the intramuscular dissection technique for gluteal augmentation with silicone implants provides an easily reproducible and safe procedure that involves well-controlled technical steps, especially during dissection of the intramuscular pocket. In this series of patients, training surgeons learned faster, results were satisfactory, and the number of complications was low.Level of Evidence VThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Morphometric and Functional Analysis of Axonal Regeneration after End-to-end and End-to-side Neurorrhaphy in Rats

Background: End-to-side neurorrhaphy is controversial in the literature and has sparked debate over its degree of recovery. In this study, nerve regeneration was assessed in rats after end-to-side neurorrhaphy by morphometric analysis, electromyography, electron microscopy, and retrograde horseradish peroxidase (HRP) and Fluoro-Gold (FG; Fluorochrome Inc., Denver, Colo.) transport and then compared to end-to-end neurorrhaphy and sham operation. Methods: Thirty-seven animals were operated on and divided randomly into 4 groups: group 1, sham; group 2, end-to-end neurorrhaphy; group 3, end-to-side neurorrhaphy with an epineural window; and group 4, end-to-side neurorrhaphy without an epineural window. Three months after surgery, HRP was injected into the peroneal muscles. After 48 hours, nerve segments and lumbar spine segments were collected. Electromyography data were compared between groups, and FG uptake was compared in 20 other animals. Analysis of variance with Tukey-Kramer correction was used for group comparison. Results: The fiber count after end-to-end neurorrhaphy was higher than after end-to-side neurorrhaphy with an epineural window (q = 5.243 and P < 0.01) or without an epineural window (q = 4.951 and P < 0.01). HRP labeling showed a difference between group 2 and end-to-side neurorrhaphy with an epineural window (q = 5.291 and P < 0.01) and without an epineural window (q = 5.617 and P < 0.01). There was also a difference in mean area labeled with FG. Furthermore, the amplitudes of the action potentials were significantly higher in groups 1 and 2. Conclusions: There was nerve regeneration in all groups studied. However, the end-to-end neurorrhaphy group had better reinnervation than the end-to-side neurorrhaphy groups.