Ricardo Horta

Gangrena de Fournier: de urgencia urológica hasta el departamento de cirugía plástica

Resumen La gangrena de Fournier (GF) es una enfermedad infecciosa rara y potencialmente fatal, caracterizada por fascitis necrotica del perine y la pared abdominal junto con el escroto y el pene en los varones y la vulva en las mujeres. La perdida de piel puede ser muy incapacitante y de dificil resolucion. El tratamiento de esta entidad debe ser agresivo. Se han usado varias tecnicas para reconstruir la perdida de tejidos: injertos cutaneos, transposicion de los testiculos y del cordon para una bolsa subcutanea en el muslo, colgajo pediculado musculocutaneo, fasciocutaneo o varios otros tipos de colgajo pediculados miocutaneos. El pediculo cutaneo superomedial del muslo es un pediculo arterial probable y demostro ser un metodo eficaz en la reconstruccion de grandes defectos escrotales.

Microsurgical Soft-Tissue Hand Reconstruction: An Algorithm for Selection of the Best Procedure

Microsurgical hand reconstruction can be the first option to consider in some particular and complex clinical situations. An algorithm based on anatomical considerations and functional outcomes, may be useful for the plastic surgeon that deals with these challenging cases.

An Intelligent Weather Station

Accurate measurements of global solar radiation, atmospheric temperature and relative humidity, as well as the availability of the predictions of their evolution over time, are important for different areas of applications, such as agriculture, renewable energy and energy management, or thermal comfort in buildings. For this reason, an intelligent, light-weight, self-powered and portable sensor was developed, using a nearest-neighbors (NEN) algorithm and artificial neural network (ANN) models as the time-series predictor mechanisms. The hardware and software design of the implemented prototype are described, as well as the forecasting performance related to the three atmospheric variables, using both approaches, over a prediction horizon of 48-steps-ahead.

Fournier's gangrene: from urological emergency to plastic surgery

Fourniers gangrene (FG) is a rare and potentially fatal infectious disease characterised by necrotic fasciitis of the perineum and abdominal wall in addition to the scrotum and penis in men and the vulva in women. Skin loss can be very damaging and difficult to repair. This condition must be treated aggressively. Several techniques are used to reconstruct lost tissue: skin grafts, transposition of the testicles and spermatic cords to a subcutaneous pocket in the upper thigh, scrotal musculocutaneous flaps, fasciocutaneous flaps and several other types of pediculated myocutaneous flaps are all employed. The supero-medial thigh skin flap is a likely arterial flap and has been shown to be an effective method for reconstructing large scrotal defects.

Neurosensible reconstruction of the thumb in an emergency situation: review of 107 cases.

Coverage of a soft tissue defect of the thumb that cannot be replanted or without bone shortening is difficult to achieve, but it is essential to preserve key-pinch and to restore a sensible and painless pulp. We reviewed retrospectively 107 cases of thumb reconstruction in an emergency situation using the following flaps: Moberg, radial innervated cross-finger, Venkataswami-Subramanian, Foucher, Tezcan, and Littler. The choice of the flap was determined by the extension and location of the injury; Foucher flap (56 cases) was the most used one, and it proved to be the best choice as shown by the results. Nevertheless, Tezcan flap also proved to be a good alternative.

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

A facegram for spatial–temporal analysis of facial excursion: Applicability in the microsurgical reanimation of long-standing paralysis and pretransplantation

BACKGROUND There are several techniques available for facial reanimation, but clinicians do not have a simple tool to provide an objective and quantitative spatial-temporal analysis of facial movement in order to compare medical, surgical and physical therapy. METHODS We developed specialized software capable of simultaneously tracking the position over time of a number of anatomical points. This method was tested in 5 different clinical situations: one normal subject, and 4 patients with facial disfigurement. RESULTS A large amount of quantitative information can be extracted directly, such as symmetry assessment in the contraction and relaxation trajectories. The fact that this plot is on scale allows also direct measurements such as maximal extensions. Even smiles that at the macro-scale are essentially symmetrical show at the micro-scale small asymmetries/variability. CONCLUSION In this paper, we describe a novel quantitative, reliable method, which accurately assesses the fundamental aspects of the facial excursion, incorporating spatial and temporal components.

Resection and microvascular reconstruction of bisphosphonate-related osteonecrosis of the jaw: The role of microvascular reconstruction.

Current treatment guidelines caution against osseous reconstruction using free flap tissue to treat bisphosphonate‐related osteonecrosis of the jaw (BRONJ). The primary rationale for this stance is the theoretical risk of nonunion and recurrence of disease within the reconstruction. Emerging evidence suggests that these theoretical risks may be overestimated. We performed a literature review of this procedure for the treatment of advanced BRONJ. We also present a new case report of resection and microvascular reconstruction in a 58‐year‐old man with stage III BRONJ.

Improving a neural networks based HVAC predictive control approach

This paper improves an existing Model Based Predictive Control Approach (MBPC), applied for Heating Ventilation and Air Conditioning (HVAC) control in buildings. The existing approach uses the Predictive Mean Vote (PMV) to assess thermal comfort. It has been found that PMV estimation and forecasts deteriorate when the room is occupied. In order to solve this problem, we propose to incorporate measurements of activity inside the room in the predictive models of the inside air temperature. Another improvement to the existing approach is to use an economic cost function, reflecting the money needed for the HVAC control, instead of a cost function related with the consumption of energy.

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.