Salustiano Gomes de Pinho Pessoa

Tratamento dos angiofibromas múltiplos da face com radiofrequência

Esclerose tuberosa e uma doenca genetica rara, com heranca autossomica dominante, associada a formacao de hamartomas multiplos em varios orgaos, como cerebro, pele, pulmoes, rins, coracao e olhos. Os autores deste estudo apresentam um caso de uma paciente do sexo feminino, com 30 anos de idade, portadora de esclerose tuberosa, apresentando multiplos angiofibromas em face, tratada com equipamento de alta frequencia (radiofrequencia), e discutem as opcoes terapeuticas para tratamento de individuos portadores de esclerose tuberosa com extenso envolvimento cutâneo

Treinamento inicial em microcirurgia

The microsurgical technique witch until the 1980s was an exclusion procedure, only chosen in extreme cases, due to easily observed advances seen in innumerous current publications, has become in various procedures the first surgical option, practically compelling all doctors who practice in the field of Plastic Surgery to perform training in the referred technique. The current article presents an easy executed model of microsurgery basic training.

Retalho TRAM com dissecção mínima para reconstrução mamária

Background: After the TRAM flap for breast reconstruction have been published, become the most popular autologous breast reconstructive procedure, although not free of donor site complications. Methods: Eleven patients underwent to immediately postmastectomy breast reconstruction with TRAM flap and minimal dissection on donor site using quilting suture’s and closed suction drainage were analyzed. The authors had evaluated prospectively the abdominal complications of the donor site. Results: None of the patients developed seroma, hematoma, wound infection, abdominal bulge or hernia. One patient developed partial skin loss, and one patient developed discomfort. Conclusion: The quilting suture’s plus closed suction drainage decrease the complications outcomes at TRAM donor site.

O retalho hipogástrico cutâneo no cão: modelo para o aprendizado experimental de microcirurgia

Microsurgical clinical training is done in several stages, including the practice in animals. Description of dog skin flaps for microsurgery are not often found in the literature. Objective: The authors propose a model of hypogastric cutaneous flap based on the lateral circumflex vessels in the dog. Methods: Nine dogs of unknown age and race were used, their weight ranging from 8 to 15 kg. The procedures for raising the flaps are described in details. Aanastomosis patency was demonstrated by means of empty-and-refill testing just after the completion of the anastomosis, after one hour of the procedure, by vascular doppler and by clinical evaluation (color and bleeding after prick with needle). Results: All flaps came out successfully. Conclusion: The authors believe that this model is valuable for those who want to learn microsurgery on their own.

Treinamento em microanastomoses utilizando tubos de látex

Introduction: Practice in inanimate materials are necessary for laboratorial and clinical microsurgical technique use. A new approach to microsurgical training is now propose. Methods: Rubber tubes from latex surgical gloves were made in different diameter (the smaller with 0.5mm) where end-to-end and end-to-side microanastomosis were done using 9, 10 and 11-0 Nylon microsurgical thread. Conclusions: The model is a contribution to the traditionals models of training in microsurgery as it diminish costs and spare experimentation animals.

Impacto da radioterapia adjuvante no resultado cosmético da reconstrução mamária imediata com retalho TRAM

INTRODUCAO: O efeito da radioterapia adjuvante apos a reconstrucao mamaria com retalhos autologos e controverso. O objetivo deste estudo e analisar se a radioterapia pos-operatoria causa alteracoes volumetricas e cosmeticas apos a reconstrucao mamaria imediata com retalho do musculo reto abdominal (TRAM, do ingles transverse rectus abdominis myocutaneous). METODO: No total, foram avaliadas 25 pacientes submetidas a reconstrucao autologa com retalho TRAM pediculado pos-mastectomia por câncer de mama e radioterapia adjuvante. Os resultados esteticos tardios foram coletados apos o intervalo minimo de 6 meses posteriormente ao esquema completo da radioterapia. RESULTADOS: A media de idade das pacientes foi de 42,2 anos, variando de 30 anos a 53 anos. Duas (8%) perdas completas do retalho ocorreram por necrose gordurosa macica, duas (8%) pacientes evoluiram com contratura do retalho e perda volumetrica, e 52% das pacientes apresentaram alteracoes cutâneas. Entretanto, a maioria das pacientes (84%) nao evoluiu com perda significativa do volume inicial do retalho ou com distorcao do contorno e contracao do retalho. CONCLUSOES: O resultado cosmetico apos a reconstrucao mamaria imediata com retalho TRAM irradiado foi aceitavel, comparativamente aos dados descritos na literatura. Esses achados indicam que os retalhos podem sofrer distorcoes de contorno pela contracao, alem de perda volumetrica significativa em pacientes candidatas a reconstrucao com TRAM e necessidade de radioterapia adjuvante pos-mastectomia. Assim, as complicacoes tardias da irradiacao pos-operatoria devem ser consideradas nesse contexto.

Complicações em reconstrução de mama com retalho pediculado do músculo reto abdominal transverso

BACKGROUND: Breast cancer is the leading cause of death in the female population. The treatment for breast cancer is primarily surgical, which has a great psychosocial impact on women. To reduce this trauma, reconstructive surgery offers different options including the use of a retail transverse rectus abdominis (TRAM) flap. This is an alternative reconstruction that has been widely used worldwide over the last 30 years. Although reconstruction using the TRAM flap is the most widely used technique that yields the best aesthetic and functional results, it is associated with certain complications. The aim of this study is to present the main complications of reconstruction using the TRAM flap according to its variants (ipsilateral, contralateral, and bilateral) and reconstruction time. METHODS: We evaluated 30 patients who had a mastectomy and breast reconstruction using the TRAM flap, including 25 immediate reconstructions and 5 late reconstructions, and analyzed the complications of the donor and recipient areas. RESULTS: Among the identified complications, fat necrosis in the breast was the most frequent, but we also observed cases of infection, seroma, abdominal hernia, skin injury at the donor and recipient areas, and deep vein thrombosis. Complications were more frequent in patients who underwent late reconstruction with a bilateral TRAM flap. CONCLUSIONS: Thus, similar to other types of surgery, breast reconstruction using the TRAM flap is associated with various postoperative complications, even 30 years after it was first introduced.

Strategies in complex reconstructions of the scalp and forehead: a series of 22 cases

Introduction: The cephalic region is exposed to various insults from the environment. Extensive lesions in the scalp are a great challenge for plastic surgeons, because the low mobility of the skin in this region hampers its closure. A great variety of techniques have been used to close defects on the scalp and forehead. Ideally, scalp closure should provide a better functional and aesthetic outcome, as well as low morbidity at the donor site. Methods: From January 2006 to December 2014, we performed a retrospective clinical study involving a series of 22 patients with advanced tumors of the scalp or forehead, or with extensive post-trauma skin loss. Results: Reconstructive surgeries with 11 local scalp flaps (bior tri-pedicled), three coronal forehead flaps, and eight free flaps were performed. One patient experienced late partial loss of a free flap after radiotherapy. Conclusion: Various techniques can be used to reconstruct the scalp and forehead; each case should be assessed individually. The present study indicated that flaps are safe and that they confer low morbidity at the donor area. These results were satisfactory and in agreement with the literature analyzed. ■ ABSTRACT

Prevalence of nasal reconstruction techniques used over the past four years at the Plastic Surgery Service of Ceará

Introduction: Nasal skin lesions are significance in plastic surgery because of the difficult of aesthetic and functional reconstruction. Central position of the nose on the face, and its structure, rigid architecture, and low mobility are among the possible causes. Several techniques used to correct nasal defects have been documented since the origins of plastic surgery. We evaluated retrospectively and analyzed the main surgical techniques and their indications in cases of nasal reconstruction performed at the Plastic Surgery Service of Ceará over a period of 4 years. Methods: This was a retrospective clinical study including 151 patients who underwent resection of nasal lesions from January 2010 to December 2014 at a public hospital in Fortaleza. Variables included were sex, age, and surgical technique. Results: Most of patients were men with a mean age of 63.2 years, they accounted for 52.3% of the sample. The main reconstruction forms were primary suture (28.5%), rotational flap (22.5%), bilobate (14.6%), advancement flap (8.6%), nasogenian (6%), frontal (4.7%) and skin graft (15.2%). Conclusion: Because of the different nasal reconstruction possibilities, the surgical technique choice, after resections, should consider defect location and size, contour and nasal anatomy for a better aesthetic and functional result. At our service, reconstruction with primary lesion synthesis was predominant with a slight predominance among men and older patients. Other techniques were used given the preference for better aesthetic and functional result for each patient. ■ ABSTRACT

Chest wall reconstruction using abdominal rectus and latissimus dorsi muscle flaps: case report

Introduction: Chest wall reconstruction remains one of the great plastic surgery repair challenges. The present work aims to report on cases of chest wall reconstruction using myocutaneous flaps after wall resection due to tumor/osteomyelitis. Methods: Four patients were included, among which three presented with osteomyelitis and the other presented with sarcoma; both of these conditions affected the chest wall. Each patient underwent wall resection and reconstruction using myocutaneous flaps from the latissimus dorsi (two cases) and abdominal rectus (two cases). Results: The flaps used were sufficient for skin–muscle covering and maintained good vitality. Partial flap injury occurred in one case. Chest cavity stability was preserved. Conclusions: The use of the above flaps to repair chest defects was satisfactory with the aim of covering the skin and providing well-vascularized muscles, the latter of which was fundamental to preventing local infection. ■ ABSTRACT