Julio Morais Besteiro

Complications after Polymethylmethacrylate Injections : Report of 32 Cases

Background: During the past 15 years, polymethylmethacrylate has been used as a synthetic permanent filler for soft-tissue augmentation. Methods: This article reports 32 cases of complications seen at Hospital das Clínicas, Faculty of Medicine, University of São Paulo, for procedures performed elsewhere. Results: The average age of the patients was 43.6 years (range, 22 to 70 years). Twenty-five patients were women. Sixteen injection procedures were performed by certified plastic surgeons, nine by dermatologists, two by urologists, and one by a nonphysician. Complications were classified into five groups according to main presentation as follows: tissue necrosis (five cases), an acute complication that can be related to technical mistakes but that can also be dependent on patient factors or caused by local infection; granuloma (10 cases), which usually presents as a subacute complication 6 to 12 months after the procedure; chronic inflammatory reactions (10 cases), which usually occur years later and can be related to a triggering event, such as another operation or infection in the area that was injected (these reactions are immunogenic in origin and may have cyclic periods of activation and remission); chronic inflammatory reaction in the lips (six cases), which may be present with severe symptoms, especially with lymphedema, because of mobility of the lip; and infections (one case), which are rare but possible complications after filling procedures. Conclusions: Polymethylmethacrylate filler complications, despite being rare, are often permanent and difficult or even impossible to treat. Safety guidelines should be observed when considering use of polymethylmethacrylate for augmentation.

Free flaps for reconstruction of the lower extremity.

Experience with the use of free flaps for lower extremity reconstruction during the period 1973 to 1980 is reviewed. From 1973 to 1977, 12 groin and 2 deltopectoral flaps were used, with 8 successes and 6 failures. From 1978 to 1980, 19 myocutaneous flaps (15 latissimus dorsi, 3 tensor fascia lata, and 1 osteocutaneous groin flap based on the deep circumflex vessels) were performed, 17 successfully and 2 unsuccessfully. The reasons for the improved results seem to be the longer and bigger vascular pedicle, the use of more end-to-side arterial anastomoses, and the choice of arterial trunks that are more distal and easier to work with. For these reasons, myocutaneous free flaps are the flap of choice for microsurgical soft tissue reconstruction of the lower limb.

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.