Pedro Djacir Escobar Martins

Sources of processed lipoaspirate cells: influence of donor site on cell concentration.

Background: Recently, adipose tissue harvested by liposuction has been identified as a source of processed lipoaspirate cells. The aim of this study was to determine the concentration of processed lipoaspirate cells in adipose tissue obtained by liposuction from different harvest areas in women. Methods: A prospective cross-sectional study was conducted in 25 women in whom liposuction in four or more different zones in the same procedure was indicated. After selective liposuction, the material was sent to the laboratory, where it was processed for extraction of processed lipoaspirate cells, which were separated from the adipose tissue, quantified, and characterized through determination of c-kit expression. The following harvest regions were evaluated: upper abdomen, lower abdomen, trochanteric region, inner thigh, knee, and flank. The cell concentration obtained at each site was compared by analysis of variance for mixed models. Results: A significant difference was found for cell concentration obtained at the different harvest sites. The cell concentration in the lower abdomen was greater than in other areas, but no significant difference was found in relation to the inner thigh. Conclusions: The lower abdomen and the inner thigh may have higher processed lipoaspirate cell concentrations. These sites may turn out to be better sources of adult mesenchymal stem cells.

Uso de retalho cutâneo para reconstrução nasal após ressecção neoplásica

INTRODUCAO: A reconstrucao nasal e sempre desafiadora para o cirurgiao plastico. As perdas de substância nasal sao causadas principalmente por resseccao de neoplasias de pele. Existem muitas alternativas para cobertura cutânea e os retalhos cutâneos constituem a melhor opcao, tanto cosmetica como funcional. O objetivo deste trabalho e relatar a experiencia do Servico de Cirurgia Plastica do Hospital Sao Lucas da Pontificia Universidade Catolica do Rio Grande do Sul (Porto Alegre, RS, Brasil) na reconstrucao de perdas de substância do nariz secundarias a resseccao oncologica, descrevendo os retalhos cutâneos mais utilizados para cobertura dos defeitos segundo a subunidade anatomica. METODO: Foi realizada analise de 103 retalhos cutâneos nasais utilizados para reconstrucao de 102 perdas de substância secundarias a neoplasia, em 96 pacientes operadosno periodo de dezembro de 2008 a dezembro de 2011. As perdas de substância foram mapeadas de acordo com as subunidades anatomicas descritas por Burget & Menick, sendo registrado o numero de vezes em que cada opcao de reconstrucao foi utilizada em cada subunidade. RESULTADOS: A maioria dos pacientes era do sexo masculino (51%) e a media de idade do grupo estudado foi de 64,7 anos. Dentre os tumores cutâneos, o carcinoma basocelular foi o mais frequente (85,3%), seguido de carcinoma espinocelular (5,9%). Na asa nasal, o retalho mais utilizado foi o bilobado (44%); na regiao lateral, o retalho de avancamento em V-Y (72%); no dorso nasal, o retalho glabelar estendido (59,2%); na ponta, o retalho bilobado (46,2%); e no teto nasal, o retalho glabelar, utilizado em todos os casos. CONCLUSOES: Sao multiplas as opcoes cirurgicas para reconstrucao do nariz apos cirurgia oncologica, devendo-se escolher a mais adequada para cada caso, respeitando-se os contornos e a anatomia nasal, de acordo com os principios de Burget & Menick.

Estratégias em reconstrução do lábio inferior

BACKGROUND: The upper and lower lips represent the most important functional and aesthetic anatomical structures of the lower segment of the face. Given the complex functions of these structures, reconstruction of labial defects presents a challenge for plastic surgeons. METHODS: Thirty patients with full-thickness lower lip defects underwent lip reconstruction according to the extent of the defect after tumor resection. RESULTS: Six (20%) patients presented lesions of up to 30% of the total lip surface that required primary closure. Eighteen (60%) patients had lesions of 30-80% of the total area of the lower lip that were repaired using a myomucosal flap; in 14 of these patients, bilateral skin flaps were also used due to cutaneous involvement associated with the resection. Five (16.6%) patients had lesions on the lower lip that were adjacent to the oral commissure; therefore, they underwent reconstruction using an Abbe-Estlander flap with a myomucosal flap and bilateral skin flaps. One (3.5%) patient had a lesion covering 90% of the lower lip that was reconstructed using the Webster-Bernard technique and a tongue flap. CONCLUSIONS: Here, we present a simplified, systematic, and literature-based strategy for planning lower lip reconstructions that employs effective and reproducible techniques, which can be used for training resident physicians in the treatment of complex lower lip lesions according to the extent of tissue loss, thereby yielding appropriate aesthetic and functional results.

Use of the vermilion myomucosal flap with or without the mentolabial skin flap for lower lip reconstruction

BACKGROUND: Several techniques that have been described for reconstructing the lower lip often produce microstomia, commissure distortion, functional impairment, and decreased sensitivity. A technique for preserving neuromuscular tissue during a single-stage lip reconstruction is reported in this study. This technique involves the use of the vermilion myomucosal advancement flap with or without the mentolabial skin flap. METHODS: This study analyzed 17 male patients with squamous cell carcinoma. The mean patient age was 54.8 years, and incidence of lip defects after resection ranged from 20% to 85%. RESULTS: Infection, nerve damage, or the requirement for surgical revision was not observed in any patient during the follow-up period of three months. Three patients had microstomia with slight posterior enlargement of the lip. All patients had good sensitivity and adequate sphincter continence. CONCLUSIONS: The use of the vermilion myomucosal flap with or without the mentolabial skin flap resulted in a minimal risk of microstomia or functional incompetence. This procedure is performed in a single surgical stage and has good aesthetic and functional results for reconstruction of up to 80% of the lower lip

Aplicações do retalho romboide em reparações cutâneas

INTRODUCAO: O cirurgiao plastico frequentemente defronta-se com a reparacao dos mais diversos tipos de defeitos cutâneos; logo, e imprescindivel que possua o conhecimento de tecnicas versateis e apropriadas para cada caso. O retalho romboide de transposicao, proposto por Alexander Limberg, e um retalho extremamente util para os mais diversos tipos de reconstrucao. O objetivo deste trabalho e demonstrar a versatilidade, a seguranca e a aplicabilidade do retalho de Limberg para reconstrucao de perdas cutâneas localizadas nos mais diversos segmentos corporais. METODO: Foi realizada analise retrospectiva de 50 pacientes apresentando defeitos cutâneos, dos mais variados tipos, reconstruidos com o retalho romboide. A descricao da tecnica cirurgica e uma analise critica dos resultados sao apresentadas. RESULTADOS: A media de idade dos pacientes foi de 59,6 anos. As lesoes neoplasicas foram responsaveis pela maioria dos casos (84%). A face foi a area mais envolvida nas reconstrucoes, totalizando 36 (72%) casos, seguida da regiao lombossacral (8%), e do dorso e da regiao inguinoscrotal (6%). Complicacoes foram observadas em 4 (8%) pacientes. CONCLUSOES: O retalho romboide propicia resultados seguros e previsiveis, sendo a alternativa para a maioria dos defeitos encontrados.

Fasceíte necrotizante após aplicação de injeção intramuscular

E relatado o caso de um paciente do sexo masculino, de 1 ano e 2 meses, apresentando quadro de fasceite necrotizante comprometendo regiao inguinal e coxas apos injecao intramuscular de metoclopramida. Neste artigo, sao discutidos e apontados os aspectos fundamentais do diagnostico e tratamento da doenca, ressaltando a importância da identificacao precoce dos fatores que possam contribuir significativamente para melhora da sobrevida.

Complications in sefel-injection of chemicals to increase muscle

The number of gym goers who self-inject oily substances to increase muscle volume artificially and thereby improve the aesthetic appearance of their muscles that are unresponsive to training is increasing. Although immediate effects and satisfactory aesthetic results such as increased volume or changes in the contour of several areas of the body might be observed, oil infiltration might cause several shortand long-term complications, which are often irreversible. The awareness and actions of medical and health professional societies are fundamental for the prevention and control of this problem. In this article, possible complications are reviewed, and the case of a patient with severe local complications caused by oil injection is reported. ■ ABSTRACT

Megassessões de unidades foliculares e fatores de crescimento plaquetário

Hair loss, whether partial or complete, is a cause of significant concern to both men and women, and is viewed as unaesthetic and a visible sign of aging. Advances and refinements in hair restoration techniques have culminated in the introduction of micrograft and minigraft megasessions. This technique has become widely accepted as a simple and safe procedure that recreates natural random-pattern hairlines. The hair follicles are harvested from the posterior cervical area, where 500 to 1500 follicular units can be obtained. Implantation in the bald area is performed via punctiform incisions using the No. 11 blade. After the procedure, gauze moistened in saline solution is applied over the implanted area for 24 hours. The stitches are removed on the 7th postoperative day. The final result is visible after 8 to 12 months in men and after 12 to 14 months in women. If an additional procedure is necessary, this can be performed 1 year after the initial transplantation. The quality and strength of the implanted hair persists for an indefinite period in some patients because of 1 the following particular characteristics: high histological quality of the donor area, heredity, hormones, or aging. This article also addresses the role of platelet-rich plasma growth factors in surgical treatment of male and female pattern baldness. The results of hair transplant surgery suggest that the use of autologous platelet growth factors improves capillary density. This offers a new perspective on hair transplantation and is an important contribution to implantation surgery with follicular unit megasessions.

Adipose tissue mature stem cells in skin healing: a controlled randomized study

INTRODUCAO: Fatores que diferenciam a cicatrizacao fetal e a do adulto instigam a possibilidade de manipulacao das solucoes de continuidade da pele. Este estudo teve como objetivo avaliar se o uso de celulas-tronco adultas do tecido adiposo e benefico a cicatrizacao da pele. METODO: Estudo controlado, randomizado, para o qual foram selecionadas 18 pacientes, considerando-se criterios de inclusao e exclusao. As celulas-tronco adultas utilizadas eram autologas, extraidas do tecido adiposo da regiao infraumbilical, precedendo a realizacao da abdominoplastia. Essas celulas, antes da sintese da pele, foram implantadas na derme da ferida operatoria, na regiao suprapubica. A avaliacao dos resultados foi realizada com base na escala de Draaijers, por tres avaliadores medicos cegados, e pelas proprias pacientes, por autoavaliacao. Foi realizada, tambem, avaliacao fotometrica por fotografia digital. RESULTADOS: Dentre as 18 pacientes operadas, sob o ponto de vista cirurgico, 17 (94,4%) apresentaram resultados excelentes ou bons e uma (5,5%) apresentou deiscencia de sutura, considerado mau resultado. Quanto a cicatrizacao da pele na area pesquisada, a avaliacao fotometrica, nao houve diferenca estatisticamente significante; a autoavaliacao pelas pacientes, os resultados atingiram nivel de significância a favor da intervencao com celulas-tronco (P = 0,12); e a avaliacao pelos medicos, foi atingido nivel de significância a favor da intervencao por celulas-tronco (P = 0,003). Considerando-se todas as avaliacoes realizadas (medicos, pacientes e fotometrica), foi encontrada diferenca estatisticamente significante favoravel ao implante de celulas-tronco adultas do tecido adipose (P < 0,001). CONCLUSOES: Os resultados da cicatrizacao da pele, apos implante de celulas-tronco adultas derivadas de tecido adiposo, foram satisfatorios.