Pedro Alcântara da Silva

A new retroauricular flap for facial reconstruction

A retroauricular reverse flow flap based on the anastomosis of the frontal branch of the temporal superficial artery with the corresponding vessel of the opposite side as well as with the ipsilateral supraorbital and supratrochlear arteries, was used in two clinical cases for forehead and facial reconstructions. The arc of rotation associated with the length of the pedicle allows its transfer, in a one-stage procedure, to cover small to medium defects of any part of the forehead, face and parts of the scalp. The procedure is safe, simple and causes minimum donor site morbidity.

Individual and social determinants of self-rated health and well-being in the elderly population of Portugal

This article aims to identify the main determinants of self-rated health and well-being in the elderly Portuguese population, using a set of dimensions including demographic and socioeconomic indicators, characteristics of interpersonal networks and social activities, health, sexual activity, representations of aging, and feeling of happiness. Taking socioeconomic, behavioral, and attitudinal predictors into account to analyze the explanatory value of the interrelated dimensions and weights for each factor, the author argues that social capital, activities associated with active aging, and greater optimism towards aging can contribute greatly to better self-rated health and wellbeing among the elderly, partially offsetting the effect of socioeconomic factors and illness associated with age. Demographic Aging; Self-Assessment; Health of the Elderly Resumo Neste artigo pretende-se identificar os principais determinantes da autoavaliação do estado de saúde e do bem-estar da população sênior, tendo em conta um conjunto de dimensões que reúnem indicadores demográficos e socioeconômicos, características das redes interpessoais e atividades sociais praticadas, de saúde, atividade sexual, de representações sobre o envelhecimento e sentimento de felicidade. A equação em simultâneo de preditores socioeconômicos e de caráter comportamental e atitudinal dessas várias vertentes, com o intuito de analisar o valor explicativo de cada uma das dimensões inter-relacionadas e o peso de cada um dos fatores, permite concluir que o capital social, a prática de atividades associadas ao envelhecimento ativo e um maior otimismo em relação ao envelhecimento podem contribuir em grande medida para uma melhor autoavaliação do estado de saúde e do bemestar dos mais velhos, compensando, em parte, o efeito de fatores socioeconômicos e de doença associados à idade. Envelhecimento da População; Autoavaliação; Saúde do Idoso 1 ARTIGO ARTICLE http://dx.doi.org/10.1590/0102-311X00173813Abstract This article aims to identify the main determi-nants of self-rated health and well-being in the elderly Portuguese population, using a set of di-mensions including demographic and socioeco -nomic indicators, characteristics of interperson-al networks and social activities, health, sexual activity, representations of aging, and feeling of happiness. Taking socioeconomic, behavioral, and attitudinal predictors into account to ana-lyze the explanatory value of the interrelated di-mensions and weights for each factor, the author argues that social capital, activities associated with active aging, and greater optimism towards aging can contribute greatly to better self-rated health and wellbeing among the elderly, partial-ly offsetting the effect of socioeconomic factors and illness associated with age.Demographic Aging; Self-Assessment; Health of the Elderly Resumo Neste artigo pretende-se identificar os principais determinantes da autoavaliacao do estado de saude e do bem-estar da populacao senior, tendo em conta um conjunto de dimensoes que reunem indicadores demograficos e socioeconomi-cos, caracteristicas das redes interpessoais e ati-vidades sociais praticadas, de saude, atividade sexual, de representacoes sobre o envelhecimento e sentimento de felicidade. A equacao em simul-tâneo de preditores socioeconomicos e de carater comportamental e atitudinal dessas varias ver-tentes, com o intuito de analisar o valor explica-tivo de cada uma das dimensoes inter-relaciona -das e o peso de cada um dos fatores, permite con -cluir que o capital social, a pratica de atividades associadas ao envelhecimento ativo e um maior otimismo em relacao ao envelhecimento podem contribuir em grande medida para uma melhor autoavaliacao do estado de saude e do bem- estar dos mais velhos, compensando, em parte, o efeito de fatores socioeconomicos e de doenca associados a idade.Envelhecimento da Populacao; Autoavaliacao; Saude do IdosoThis article aims to identify the main determinants of self-rated health and well-being in the elderly Portuguese population, using a set of dimensions including demographic and socioeconomic indicators, characteristics of interpersonal networks and social activities, health, sexual activity, representations of aging, and feeling of happiness. Taking socioeconomic, behavioral, and attitudinal predictors into account to analyze the explanatory value of the interrelated dimensions and weights for each factor, the author argues that social capital, activities associated with active aging, and greater optimism towards aging can contribute greatly to better self-rated health and wellbeing among the elderly, partially offsetting the effect of socioeconomic factors and illness associated with age.

Facial reanimation with gracilis muscle transplantation and obturator nerve coaptation to the motor nerve of masseter muscle as a salvage procedure in an unreliable cross-face nerve graft

Surgical treatment of unilateral long-standing facial paralysis requires transposition of new musculature to restore function and a microneurovascular free-muscle flap is the procedure of choice. The gracilis muscle has been used with success but one of the critical factors of this procedure is the selection of a motor nerve to innervate the transplanted muscle. To achieve synchronous and spontaneous activity, the contralateral facial nerve is used by means of a cross-facial nerve graft when available. In 1995, Zuker et al. successfully used the nerve of the masseter muscle, branch of the trigeminal nerve in the treatment of Moebius syndrome (bilateral palsy), and the results suggested that this technique could be an option for treating unilateral facial paralysis as well. A comparison of commissure excursion following gracilis muscle free flap with a cross-face nerve graft versus the motor nerve to the masseter muscle was performed by Bae et al., showed that the extent of movement was greater using the masseteric muscle. Clinical analysis of different techniques, also found that one-stage unilateral facial reanimation with gracilis muscle innervated by the motor nerve to the masseter, produced more predictable and consistent results and the extent of movement is greater. However, the cross-face nerve graft provides a more spontaneous movement which is crucial in producing a normal appearing smile, but there is usually less movement and it is not suitable for the older patient (reinervation is difficult). Manktelow et al., speculated that there may be a larger role for the masseter motor nerve in innervation of patients with unilateral paralysis. The majority of patients develop the ability to smile spontaneously and without jaw movement. We report a case of a 32 years old man with established facial paralysis as sequelae of surgery for an acoustic neuroma (vestibulocochlear nerve tumor). (Fig. 1) We had chosen a cross-face sural nerve graft as we believed that the two-stage method provide better symmetry at rest and a spontaneous smile. During the first-stage a sural nerve graft (segment of 12 cm length) was harvested, coaptated to a buccal nerve of the facial nerve and transposed subcutaneously above the upper lip onto the contralateral hemiface. After 12 months, a second stage surgical procedure was planned for gracilis muscle transplantation. During the surgery, we found that the length of the sural nerve did not allow it to reach the contralateral facial side at the exact point for neurotherapy to the anterior branch of the obturator nerve and it was surrounded by fibrosis. After a rectangular portion of the gracilis muscle (7 3 6 cm) was settled into the cheek pocket, the obturator nerve was therefore coapted to the motor nerve of the masseter muscle, and microvascular anastomoses were done to the facial vessels. The postoperative course was uneventful. *Correspondence to:Ricardo Horta Oliveira, Avenida Menéres, no 234, bloco 2, 48 Frente Esquerdo 4450-189, Matosinhos SulPorto, Portugal. E-mail: rickhardinho@hotmail.com Received 12 July 2010; Accepted 9 September 2010

Ear replantation after human bite avulsion injury.

Traumatic auricular amputation due to human bite is not a common event, but it constitutes a difficult challenge for the reconstructive surgeon. Microsurgery can be performed in some cases, but replantation of a severed ear without microsurgery can be a safe alternative. We present a case of a 44-year-old male individual who was involved in a fight and sustained a human bite, resulting in almost a complete amputation of his right ear. The Baudet technique has been used successfully. It is a simple technique and very reliable because it allows a great surface of contact between the graft and the vascular bed, substantially increasing its odds of survival in cases presenting with high risk of infection such as human bite injury. It also produces excellent aesthetic results.

A simple "fishtail flap" for surgical correction of microstomia.

AbstractTreatment of microstomia, whether congenital or acquired, has long challenged the ingenuity of surgeons. In all instances, the challenge remains the ability to preserve function and provide and maintain reasonable aesthetics.The following case report presents 2 different cases of surgical correction of microstomia, resulting from flap reconstructions after perioral tumor surgery.We developed a technique that uses pericommissural mucomuscular advancement flap, “a simple fishtail flap,” and used this to correct deformed oral commissures in an attempt to elongate the oral aperture in a functional and aesthetically acceptable manner without recurrence.Results have shown that, with the use of our fishtail design, we can restore the unique architecture of the oral commissure with the postoperative intercommissural distance improved by more than 10 mm and the interincisal width enlarged by approximately 5 mm.Our solution was functional and aesthetically acceptable, as well as simpler and cheaper, in comparison with the traditional surgical methods that are usually expensive, complex, and less practical. We believe that, in cases in which either the contracture is mild or a commissurotomy can be expected to increase the width and the general size of the oral aperture, this relatively conservative technique, if judiciously used, can be performed with ease and safety with good results.

Use of Doppler in Breast Reduction with Superomedial or Superolateral Pedicles

The pedicle and the skin excision are two related but independent components of breast reduction. The inferior pedicle technique remains one of the most commonly used procedures in breast reduction surgery [1–5]. A safe technique with predictable results with regard to nipple preservation is the best option. Cyanosis, pallor, or an intermediate appearance usually creates a dilemma or demands an immediate explanation. Although conversion to a composite free graft is always a safe option, the aesthetic result may be inferior. The usual reliance on capillary refill as an indicator of vitality also is inaccurate and impossible in the dark nipple–areolar complex [1–3]. A Doppler ultrasound test uses reflected sound waves to evaluate blood as it flows through a blood vessel. A transducer (portable handheld instrument) passed over the skin sends or receives sound waves, which are amplified through a microphone. The doctor listens to the sound produced by the transducer, which can be useful for detecting the main perforators of the pedicle in a breast reduction. Doppler was used for 22 women with mammary hypertrophy submitted to breast reduction by the superomedial or superolateral pedicle technique. The main perforator was detected at the superior part of the Wise pattern according to the Doppler signal and followed to the previously designed pedicle (Figs. 1, 2). The perforator was marked and always included in the pedicle. The point of rotation was selected. A superomedial or superolateral pedicle was performed based on the final pedicle and skin excision pattern. Patients were evaluated for signal viability of the nipple–areola complex in the postoperative period. A total of 22 breast reductions (19 superomedial pedicles and 3 superolateral pedicles) using Doppler were reviewed. The average age of the patients was 34 years. Their body mass index ranged from 21 to 27 kg/m (average, 24 kg/m). The average duration of surgery was 1 h and 35 min (range, 1 h and 10 min to 2 h and 15 min).

Determinantes individuais e sociais do estado de saúde subjetivo e de bem-estar da população sênior de Portugal

This article aims to identify the main determinants of self-rated health and well-being in the elderly Portuguese population, using a set of dimensions including demographic and socioeconomic indicators, characteristics of interpersonal networks and social activities, health, sexual activity, representations of aging, and feeling of happiness. Taking socioeconomic, behavioral, and attitudinal predictors into account to analyze the explanatory value of the interrelated dimensions and weights for each factor, the author argues that social capital, activities associated with active aging, and greater optimism towards aging can contribute greatly to better self-rated health and wellbeing among the elderly, partially offsetting the effect of socioeconomic factors and illness associated with age. Demographic Aging; Self-Assessment; Health of the Elderly Resumo Neste artigo pretende-se identificar os principais determinantes da autoavaliação do estado de saúde e do bem-estar da população sênior, tendo em conta um conjunto de dimensões que reúnem indicadores demográficos e socioeconômicos, características das redes interpessoais e atividades sociais praticadas, de saúde, atividade sexual, de representações sobre o envelhecimento e sentimento de felicidade. A equação em simultâneo de preditores socioeconômicos e de caráter comportamental e atitudinal dessas várias vertentes, com o intuito de analisar o valor explicativo de cada uma das dimensões inter-relacionadas e o peso de cada um dos fatores, permite concluir que o capital social, a prática de atividades associadas ao envelhecimento ativo e um maior otimismo em relação ao envelhecimento podem contribuir em grande medida para uma melhor autoavaliação do estado de saúde e do bemestar dos mais velhos, compensando, em parte, o efeito de fatores socioeconômicos e de doença associados à idade. Envelhecimento da População; Autoavaliação; Saúde do Idoso 1 ARTIGO ARTICLE http://dx.doi.org/10.1590/0102-311X00173813Abstract This article aims to identify the main determi-nants of self-rated health and well-being in the elderly Portuguese population, using a set of di-mensions including demographic and socioeco -nomic indicators, characteristics of interperson-al networks and social activities, health, sexual activity, representations of aging, and feeling of happiness. Taking socioeconomic, behavioral, and attitudinal predictors into account to ana-lyze the explanatory value of the interrelated di-mensions and weights for each factor, the author argues that social capital, activities associated with active aging, and greater optimism towards aging can contribute greatly to better self-rated health and wellbeing among the elderly, partial-ly offsetting the effect of socioeconomic factors and illness associated with age.Demographic Aging; Self-Assessment; Health of the Elderly Resumo Neste artigo pretende-se identificar os principais determinantes da autoavaliacao do estado de saude e do bem-estar da populacao senior, tendo em conta um conjunto de dimensoes que reunem indicadores demograficos e socioeconomi-cos, caracteristicas das redes interpessoais e ati-vidades sociais praticadas, de saude, atividade sexual, de representacoes sobre o envelhecimento e sentimento de felicidade. A equacao em simul-tâneo de preditores socioeconomicos e de carater comportamental e atitudinal dessas varias ver-tentes, com o intuito de analisar o valor explica-tivo de cada uma das dimensoes inter-relaciona -das e o peso de cada um dos fatores, permite con -cluir que o capital social, a pratica de atividades associadas ao envelhecimento ativo e um maior otimismo em relacao ao envelhecimento podem contribuir em grande medida para uma melhor autoavaliacao do estado de saude e do bem- estar dos mais velhos, compensando, em parte, o efeito de fatores socioeconomicos e de doenca associados a idade.Envelhecimento da Populacao; Autoavaliacao; Saude do IdosoThis article aims to identify the main determinants of self-rated health and well-being in the elderly Portuguese population, using a set of dimensions including demographic and socioeconomic indicators, characteristics of interpersonal networks and social activities, health, sexual activity, representations of aging, and feeling of happiness. Taking socioeconomic, behavioral, and attitudinal predictors into account to analyze the explanatory value of the interrelated dimensions and weights for each factor, the author argues that social capital, activities associated with active aging, and greater optimism towards aging can contribute greatly to better self-rated health and wellbeing among the elderly, partially offsetting the effect of socioeconomic factors and illness associated with age.

Vertical rectus abdominis musculocutaneous flap: a good option for reconstruction of large inguinofemoral defects with exposure of the femoral vessels: brief report focusing on management of advanced vulvar carcinoma.

T he treatment of malignant tumors of the pelvic region often involves extensive resections, such as abdominoperineal resection or pelvic exenteration, combined with radiotherapy and chemotherapy. In the reconstruction of defects of the pelvic region, pedicled f laps of the thigh and rectus abdominis muscle are often used, especially the vertical rectus abdominis musculocutaneous (VRAM) flap, based on the deep inferior epigastric artery. Inferiorly based VRAM flap allows for coverage of large defects of the abdominal region, inguinal area, perineum, f lank, and thigh having a wide range of applications in traumatic pathology or oncology. We present a case of reconstruction of a large inguinofemoral defect with inferior pedicle-based VRAM flap.

Ipsilateral pedicled fibular flap for tibial reconstruction after Ewing sarcoma resection

Ewing sarcoma is a rare and lethal malignant bone tumor, mostly affecting young male patients, and has a predilection for the femur, tibia, pelvis, and humerus. Based on the use of improved staging systems, chemotherapy, radiation, and resective surgery, actually most patients live and retain function of their limbs. The concept of limb-sparing surgery has evolved over the last three decades and has become as effective as amputation in treating extremity sarcoma. Many centers have abandoned traditional reconstruction with avascular allografts, resection arthrodesis in favor of metallic endoprosthesis, or fibula free flap for long bone defects. The ipsilateral fibular pedicled flap is an excellent choice for tibial, large, segmental defects reconstruction, because it has a low rate of infection and malunion; the functional outcome is good and avoids contralateral donor site morbidity, and it is less time-consuming than free fibula flap. It also provides the advantage of one-stage reconstruction. We report a case of a 12-year-old patient with history of Ewing sarcoma on the 1/3 of the upper tibia. The bone defect after tumor excision was 12 cm; the flap was dissected until the vascular pedicle, rotated to 180°, and fixed with plate in T and screws. The patient had successful bone union and achieved good functional results at the end of the 1-year follow-up period. Full weight-bearing was achieved within 7 months. This technique should be considered for reconstructing large and complex bone defects resulting from tumor extirpation.

The silent impact of hearing loss: using longitudinal data to explore the effects on depression and social activity restriction among older people

ABSTRACT Hearing loss is frequent in old age and has been associated with fewer social activities and depression. However, hearing problems have also been associated with other comorbidities, which prevent more definitive conclusions about the unique role on older peoples wellbeing. Moreover, little attention has been paid to the psychological processes through which this relationship occurs. This study aims to investigate the effect of hearing loss on older adults’ wellbeing from a longitudinal perspective. Using data from three points in time, we investigated the mutual relationship between hearing loss, depression and social activities. Based on longitudinal data of the Survey of Health, Ageing and Retirement in Europe (SHARE) from ten European countries, we conducted the test of competing auto-regressive cross-lagged theoretical models. Results show that hearing loss reduces social activity, which is mediated by depression. The adequacy of this model (versus a model proposing that social activity restriction mediates the relationship between hearing loss and depression) was supported in each of the countries of the sample. Findings showing that hearing loss can contribute to depression and, subsequently, to restriction in social activities have implications for early detection and clinical interventions on hearing loss.