Luiz Eduardo Felipe Abla

Effect of low-frequency transcutaneous electrical nerve stimulation (TENS) on the viability of ischemic skin flaps in the rat: An amplitude study

The purpose of this study was to determine the effect of low‐frequency (2 Hz) transcutaneous electrical nerve stimulation (TENS) on the viability of ischemic skin flaps in the rat. Seventy‐five EPM1‐Wistar rats were used. The random skin flap measuring 10 × 4 cm was raised and a plastic barrier was placed between the flap and its bed. After the surgical procedure, animals in all groups were kept anesthetized for 1 hour, with electrodes placed at the base of the flap, and received the assigned treatment. The animals were randomized into five groups (G1–G5) and each group was subjected to the following procedures, which were repeated on the 2 subsequent days: G1—sham stimulation (control); G2—transcutaneous electrical nerve stimulation, TENS (f=2 Hz, I=5 mA), G3—TENS (f=2 Hz, I=10 mA), G4—TENS (f=2 Hz, I=15 mA), G5—TENS (f=2 Hz, I=20 mA). Seven days after treatment, the percentage of flap necrosis was determined. For each group, the mean±SEM percentage of flap necrosis was as follows: G1 group (control), 43.88±2.02%; G2 group, 39.20±3.17%; G3 group, 38.57±4.08%; G4 group, 32.14±2.89%; and G5 group, 44.13±2.98%. The G4 group had the smallest necrotic area compared with the control group. The low‐frequency TENS treatment was effective in improving the viability of ischemic skin flap.

Effect of high frequency transcutaneous electrical nerve stimulation on viability of random skin flap in rats

PURPOSE To determine the effect of high frequency Transcutaneous Electrical Nerve Stimulation (TENS) on viability of random skin flap in rats. METHODS The sample of this study was 75 Wistar rats. The skin flap measured 10 x 4 cm and a plastic barrier was interposed between the flap and donor site. After the operative procedure, animals of all groups were maintained anesthetized one more hour with electrodes positioned in the base of the flap and submitted to treatment according of their respective group. This procedure was repeated on the two subsequent days. G1: sham stimulation (control), G2: TENS (f = 80 Hz and I = 5 mA), G3: TENS (f = 80 Hz and I = 10 mA), G4: TENS (f = 80 Hz and I = 15 mA), G5: TENS (f = 80 Hz and I = 20 mA). RESULTS The average percentage of necrotic area was 43,11, 34,65, 49,44, 23,52, 45,10 in groups 1, 2, 3, 4 and 5 respectively. CONCLUSION The amplitude of 15 mA presented a lower necrotic area than control group and Transcutaneous Electrical Nerve Stimulation was efficient in increasing the random skin flap viability.

Acetylcysteine in random skin flap in rats

PURPOSE Analyze the ability of Acetylcysteine to reduce distal necrosis in a random skin flap, in the rat. METHODS The present study utilized 28 adult male Wistar-EPM rats distributed, at random, in two groups of 14 animals. Control group rats (CG) received distilled water and Acetylcysteine group animals (NACG) received NAC (300 mg/kg) by oral infusion, 15 minutes before flap elevation. On the seventh postoperative day, percentage of distal necrosis was determined and skin samples collected in order to allow determination of MDA levels. RESULTS The mean necrotic area in CG group (control) was 66% and in NACG group (Acetylcysteine) 52%, a statistically significant difference according to the Mann-Whitney test (U calc = 25; U crit = 45). MDA levels were lower in the CG flap skin samples than in the NACG samples (U calc = 24; U crit = 45), the oposite being true in the normal skin samples (U calc = 10; U crit = 45). CONCLUSION Acetylcysteine was effective, according to the model used, reducing the percentage of distal necrosis in NACG rats.

Viability of a random pattern dorsal skin flap, in diabetic rats

PURPOSE Evaluation of the viability of a random pattern dorsal skin flap, in rats with experimentally induced diabetes mellitus. METHODS Thirty adult, male, Wistar EPM rats were distributed, at random, in two groups: I--Control (flap elevation) and II--Experimental (flap elevation ten days after alloxan induced diabetes). RESULTS The mean areas of necrosis in the different groups were 36.4% (Control) and 52.1% (Experimental). CONCLUSION The random pattern dorsal skin flap was less viable in the diabetic rats.

Seroma and Quilting Suture at the Donor Site of the Tram Flap in Breast Reconstruction: A Prospective Randomized Double-blind Clinical Trial

AbstractSeroma formation at the donor site of the transverse rectus abdominis myocutaneous flap was evaluated in 48 patients who underwent breast reconstruction with either quilting sutures and suction drains (QS+DN group) or quilting sutures alone (QS group) or suction drains alone (DN group). Clinical and ultrasound examinations were performed to assess seroma formation in 5 regions of the abdominal wall on postoperative days 7 and 14. The incidence of seroma detected by ultrasound examination was significantly higher in the DN group (P = 0.008) than that in the other 2 groups. No difference in seroma volume (puncture) was found between the QS+DN and QS groups (P = 1.00). Seroma formation was observed in the iliac region in the DN group but not in the QS+DN and QS groups (P = 0.028). Quilting sutures at the transverse rectus abdominis myocutaneous flap donor site were efficient in reducing seroma formation.

Depression and conservative surgery for breast cancer

BACKGROUND: Depression is prevalent among women and associated with reduced quality of life, and therefore it is important to determine its incidence in adult women, especially in those with breast cancer. OBJECTIVE: To determine the occurrence of depression in women who underwent conservative surgery for breast cancer with or without breast reconstruction. METHODS: Seventy‐five women aged between 18 and 65 years were enrolled. Patients had undergone conservative surgery for breast cancer with immediate breast reconstruction (n = 25) or without breast reconstruction (n = 25) at least one year before the study. The control group consisted of 25 women without cancer, but of similar age and educational level distribution as the other two groups. The Beck Depression Inventory was used to measure depression. The collected data were assessed using analysis of variance and the χ2 test. RESULTS: There were no significant differences between groups in age (p = 0.72) or educational level (p = 0.20). A smaller number of patients had undergone the menopause (p = 0.02) in the control group than in other groups. There were no significant differences in occurrence of depression between groups (χ2 = 9.97; p = 0.126). CONCLUSION: Conservative surgery for breast cancer did not affect the occurrence of depression in women, regardless of whether breast reconstruction was performed.

Qualidade de vida e autoestima de pacientes mastectomizadas submetidas ou não a reconstrução de mama

INTRODUCAO: O numero de casos de câncer de mama vem crescendo abruptamente na populacao brasileira. Portanto a qualidade de vida (QV) e a autoestima sao pautas importantes quando o assunto e abordado, visto que a retirada da mama pode causar grande impacto tanto psicologico como fisico. Entretanto, com o avanco de tecnicas cirurgicas, a reconstrucao de mama ja e pratica constante ate mesmo no Sistema Unico de Saude (SUS). METODO: Trata-se de um estudo qualitativo de carater exploratorio, que recrutou 22 voluntarias, divididas em dois grupos, de acordo com a cirurgia realizada. O grupo 1 (n = 11) foi formado por mulheres mastectomizadas e o grupo 2 (n = 11), por mulheres pos-reconstrucao da mama. As voluntarias dos dois grupos responderam aos questionarios de Rosenberg UNIFESP/EPM, EORTC QLQ-C30 e EVA. RESULTADOS: Os resultados sugerem que, em relacao a qualidade de vida, quando se observa a funcao emocional, as voluntarias do grupo 1 apresentam pior media em relacao ao grupo 2. Em relacao a autoestima, nao foi observada diferenca estatisticamente significante entre os dois grupos; porem, quando considerada a idade, os resultados apresentam diferencas estatisticamente significantes. Quanto ao nivel de dor, os grupos nao apresentaram diferenca estatisticamente significante. CONCLUSOES: Os resultados obtidos revelam que mulheres que ainda nao passaram pela reconstrucao mamaria possuem maior fragilidade emocional, porem novos estudos devem ser realizados para obtencao de valores estatisticamente mais relevantes.

Health-Related Quality of Life in Elderly Patients With Pressure Ulcers in Different Care Settings.

PURPOSE: The purpose of this study was to measure and compare health-related quality of life in elderly patients with pressure ulcers in different health care settings (home care acute care facility, and long-term care facility [LTCF]). DESIGN: Cross-sectional comparative study. SUBJECTS AND SETTING: One hundred ten elderly patients with (n = 36) and without (n = 74) pressure ulcers living in LTCFs, hospitals, or at home. The research setting included 1 tertiary and 2 community-based hospitals, 10 LTCFs, and 18 community health centers in Brazil. METHODS: The Mini-Mental State Examination, Braden Scale for Predicting Pressure Sore Risk, and Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) were used to assess cognitive status, pressure ulcer risk, and health-related quality of life, respectively. RESULTS: Compared with those without pressure ulcers, elderly patients with pressure ulcers reported significantly lower (worse) SF-36 scores on physical functioning (P < .001) and role physical (P < .05) in all settings, and on social functioning (P = .045) and role emotional (P = .036) in LTCFs. Subjects in hospitals with pressure ulcers scored significantly higher (better) SF-36 scores on mental health (P = .046) and vitality (P = .009). Hospitalized patients without pressure ulcers had lower SF-36 scores on bodily pain (P = .007) and general health (P = .026) than those living in LTCFs or at home. Patients without pressure ulcers in LTCFs had significantly lower Mini-Mental State Examination scores (lower cognitive status) than those living in other settings (P = .001). CONCLUSIONS: Elderly patients with pressure ulcers who were hospitalized and living at home or in LTCFs reported low scores on physical functioning and role physical, and LTCF residents also reported low scores on social functioning and role emotional. This shows the need for an environment that includes health care professionals prepared to implement strategies for pressure ulcer prevention.

Cost-Utility of Reduction Mammaplasty Assessed for the Brazilian Public Health System

BACKGROUND Economic evaluation is important for making decisions about resource allocation. Few cost-utility or cost-effectiveness studies on breast hypertrophy have been reported in the medical literature. OBJECTIVES The authors sought to determine the cost-utility of reduction mammaplasty in the Brazilian national health care system. METHODS This randomized controlled study was conducted in a university-affiliated hospital. Sixty patients with breast hypertrophy were enrolled prospectively and were assigned randomly to either the control group (n = 30 patients who received follow-up for 6 months) or the treatment group (n = 30 patients who underwent reduction mammaplasty). Direct costs were recorded, and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) was administered to both groups at the beginning of the study (preoperatively for the treatment group) and 3 and 6 months postoperatively. Utility was determined with Instrument 6D of the Brazilian version of the Short-Form Health Survey (SF-6D), from the SF-36 data. RESULTS At the 6-month follow-up, the treatment group showed an improvement in utility, with an average direct cost of approximately £104. CONCLUSIONS Reduction mammaplasty performed in the Brazilian national health care system provides a cost-utility ratio equivalent to approximately £142 per 1 quality-adjusted life year.

Effect of nasal deviation on quality of life.

Background: Nasal deviation is a common complaint in otorhinolaryngology and plastic surgery. This condition not only causes impairment of nasal function but also affects quality of life, leading to psychological distress. The subjective assessment of quality of life, as an important aspect of outcomes research, has received increasing attention in recent decades. Quality of life is measured using standardized questionnaires that have been tested for reliability, validity, and sensitivity. The aim of this study was to evaluate health-related quality of life, self-esteem, and depression in patients with nasal deviation. Methods: Sixty patients were selected for the study. Patients with nasal deviation (n = 32) were assigned to the study group, and patients without nasal deviation (n = 28) were assigned to the control group. The diagnosis of nasal deviation was made by digital photogrammetry. Quality of life was assessed using the Medical Outcomes Study 36-Item Short Form Health Survey questionnaire; the Rosenberg Self-Esteem/Federal University of São Paulo, Escola Paulista de Medicina Scale; and the 20-item Self-Report Questionnaire. Results: There were significant differences between groups in the physical functioning and general health subscales of the Medical Outcomes Study 36-Item Short Form Health Survey (p < 0.05). Depression was detected in 11 patients (34.4 percent) in the study group and in two patients in the control group, with a significant difference between groups (p < 0.05). Conclusions: Nasal deviation is an aspect of rhinoplasty of which the surgeon should be aware so that proper psychological diagnosis can be made and suitable treatment can be planned because psychologically the patients with nasal deviation have significantly worse quality of life and are more prone to depression. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II. Figure. No caption available.