Klaus Werner Fels

Outcome analysis of breast-conservation surgery and immediate latissimus dorsi flap reconstruction in patients with T1 to T2 breast cancer

Background: The latissimus dorsi myocutaneous flap is frequently used for total breast reconstruction; however, few reports have been available regarding clinical outcome following conservative breast surgery. The aim of this study was to perform a retrospective review on 48 patients undergoing immediate latissimus dorsi myocutaneous flap surgery following conservative breast surgery between 1999 and 2004. Methods: Information on age, body mass index, smoking history, comorbid medical conditions, and oncologic status was collected. Reconstructed breast and donor-site complications were evaluated. Results: Mean follow-up was 16 months. In 56.2 percent of patients, tumors measured 2 cm or less (T1) and in 47.9 percent were located in the upper outer quadrants. Flap complications occurred in seven and donor-site complications occurred in 12 of 48 patients. Dorsal seroma (20.8 percent), dorsal dehiscence (6.2 percent), and partial flap loss (6.2 percent) were the most common complications. Surgical intervention with skin suture was necessary in two cases of dorsal wound dehiscence. Partial flap losses were limited and were treated by a conservative approach. A significant as-sociation (p =0.035) was detected between dorsal seroma and obesity (body mass index ≥ 30 kg/m2) and was associated with a 5.2-fold increase in the odds of developing this complication. No significant association between complications and age, smoking history, hypertension, diabetes, axillary lymph node dissection, or chemotherapy was found. Conclusions: On the basis of our observations, the latissimus dorsi myocutaneous flap is a consistent technique for reconstruction following conservative breast surgery. Donor-site complications are more often observed in those who are obese; they are higher risk patients.

Sensibility of the breast after reduction mammaplasty.

Changes in breast sensibility after reduction mammaplasty remain a controversial subject and most previous studies report only qualitative results. There is more accurate measuring of the sensibility of the skin with the Pressure-Specified Sensory Device (PSSD), which measures the pressure perception of the skin in grams per square millimeter. The evaluation of breast sensibility before and after reduction mammaplasty using the upper medial pedicle technique was undertaken in 25 patients. The PSSD was used to measure one dynamic point threshold in nine points of the breast during the preoperative period and 6 months after surgery. After surgery all patients had decreased sensation in all points studied, and this was significant. There are few reports of breast sensibility after mammaplasty using the PSSD, and the discrepancy in results reported using other methods of evaluation could be related to precision in evaluation.

Evaluation of Cutaneous Abdominal Wall Sensibility After Abdominoplasty

Changes in cutaneous sensibility are common after diverse plastic surgical procedures. Although prior studies examined aesthetic results, combined procedures, and new abdominoplasty techniques, few examined the effect of undermining on cutaneous sensibility. This study aimed to analyze and quantify cutaneous sensibility after classic abdominoplasty. Two groups of patients were studied: a control group of 10 patients without surgery and another group of 25 patients who had undergone classic abdominoplasty. The abdominal wall surface was divided into nine regions. Pain sensibility was evaluated by tests with needles, and thermal sensibility by test tubes containing hot and cold water. Superficial tactile sensibility was tested using the Pressure-Specified Sensory Device (PSSD), which is capable of determining the cutaneous pressure threshold. Statistical analysis was conducted using Student’s ‘t-test’. The results showed a decrease in the three types of sensibility. Statistical analysis showed a significant difference (p < 0.05) between the groups for all regions tested. The centermost regions of the abdominal wall presented the highest index of analgesia and thermal anesthesia, as well as higher cutaneous pressure thresholds.

New method for evaluation of cutaneous sensibility in diabetic feet: preliminary report

UNLABELLED Diabetic neuropathy is an important complication of the disease, responsible for ulceration and amputation of the foot. Prevention of these problems is difficult mainly because there is no method to correctly access sensibility on the skin of the foot. The introduction of the Pressure-Specified Sensory Device (PSSD) in the last decade made possible the measurement of pressure thresholds sensed by the patient, such as touch, both static and in movement, on a continuous scale. This paper is the first in Brazil to report the use of this device to measure cutaneous sensibility in 3 areas of the foot: the hallux pulp, the calcaneus, and the dorsum, which are territories of the tibial and fibular nerves. METHOD Non-diabetic patients were measured as controls, and 2 groups of diabetic patients - with and without ulcers - were compared. The PSSD was used to test the 3 areas described above. The following were evaluated: 1 PS (1-point static), 1 PD (1-point dynamic), 2 PS (2-points static), 2 PD (2-points dynamic). RESULTS The diabetic group had poorer sensibility compared to controls and diabetics with ulcers had poorer sensibility when compared to diabetics without ulcers. The differences were statistically significant (P <.001). CONCLUSION Due to the small number of patients compared, the results should be taken as a preliminary report.

Fatores prognósticos na revascularização do miocárdio em pacientes idosos

The trend in Brazil of erroneously delaying myocardial revascularization in the elderly determined this study. Three hundred consecutive elderly patients (mean age: 73,92, standard deviation: 3.32). Between October 1992 and July 1995, 361 consecutive patients underwent isolated coronary artery bypass grafting, of whom 111 (30,7%) were females and 250 (69,35) males. There were 128 (35,5%) diabetic patients and 128 (36,7%) were in NYHA III/IV. Univariate analysis per-operatory of 19 factors followed by multivariate logistic regression analysis of the significant variables (p 0.005) were done. Major complication ocurred in 178 (49.3%) and were independent predictors of operative morbidity: Diabetes mellitus, NYHA funcional classification, urgent cases and DP2. There were 33 (9,1%) in hospital deaths, and diabetes mellitus, NYHA functional classification, unstable pre-operative angina and cerebral vascular acidents, renal failure, infection and insufficiency respiratory failure were independent predictors of operative mortality. We concluded that coronary artery bypass grafting is possible in elderly patients with a favorable outcome, especially when done in patients with normal to moderately depressed left ventricular function.

Estreptoquinase e oxigênio hiperbárico em congestão após reimplante de membro

OBJECTIVE: The effectiveness of streptokinase and hyperbaric oxygen therapy on venous occlusion after limb reimplantation was tested in rats. METHODS: Amputation with preservation of vessels and nerves of the right hind limb was carried out in 140 rats. Groups MG0, MG1, MG2, MG3 and MG4 were submitted to 0, 1, 2, 3 and 4 hours of venous occlusion. MG3 was elected as control for the experimental groups. Groups EG1 and EG2 were submitted to 3 hours of venous occlusion and were treated with streptokinase and hyperbaric oxygen therapy. Limbs were observed for 7 days and their mortality and survival rates were studied. RESULTS: Trans-operatory mortality rates in groups MG0, MG1, MG2, MG3 and MG4 were 0, 10, 15, 30 and 60% respectively and the postoperatory mortality rates were 5; 11.1; 11.7; 14.2 and 100% respectively. The limb survival rates were 100%, 87.5%, 80% and 66.67% respectively and 76.9% and 100% in EG1 and EG2. Model groups were statistically different, except for MG1 and MG2 in trans-operatory mortality rates. There were no statistical differences in postoperatory mortality rates between model groups except for MG3 and MG4. Model groups were statistically different, with the exception of MG1 and MG2, in limb survival rates. EG1 and MG3 showed no statistical difference in limb survival and EG2 had a better limb survival than MG3. CONCLUSION: Results suggest that the administration of streptokinase does not change effects of venous occlusion and that hyperbaric oxygen therapy may decrease the effects of venous occlusion in limbs.