Talita Franco

Plasma rico em plaquetas e fatores de crescimento: técnica de preparo e utilização em cirurgia plástica

BACKGROUND: Platelet-rich plasma is an autologous concentration of human platelets in a small volume of plasma. The vast majority of publications reports a significant healing enhancement following its use. This study aim to establish a low-cost method to prepare a platelet-rich plasma and growth factors to be used in plastic surgery. METHODS: Blood was submitted to two centrifugations to obtain platelet-rich plasma. Twenty tests were performed changing the intensity and time of centrifugation, aim to establish the method that achieves the optimal platelet enrichment; and ten tests were performed to confirm the reproducibility of this method. RESULTS: The optimal platelets enrichment, over 4.5 times baseline, values was obtained using 300 g for 10 minutes on the first centrifugation and 640 g for 10 minutes on the second centrifugation. CONCLUSION: Platelet-rich plasma with high platelets counts can be prepared using this method and the gel can be obtained with the addition of autologous thrombin, obtained in the same procedure. This autologous platelet gel enhanced wound healing, therefore showing improved results in skin and bone grafts.

Umbilical Reconstruction for Patients with a Midline Scar

The authors describe an approach to neo-umbilicoplasty for patients with vertical midline scars and those who have undergone extensive tegumental resections after bariatric surgery. Two lateral pedicle flaps sutured to each other are used to shape a cutaneous wall tube in which the inverted end is anchored to the aponeurotic plane. A navel cavity of adequate scoop is shaped with no surrounding scar, in addition to relief of the strain along the vertical scar, which will be less prone to hypertrophy and will have a better cosmetic appearance. This article presents seven cases of umbilical reconstruction using this technique.

Neoomphaloplasty: An Old and New Technique

Abstract. The authors review several proposed approaches to neoomphaloplasty, with emphasis on the use of three flaps anchored to the fascia, allowing the exposed central area to heal unaided. The procedure is straightforward and can be performed singly or during abdominoplasty. Results are both cosmetic and natural-looking.

Supernumerary nostril: Case report and review of the literature

Supernumerary nostrils are extremely rare. A review of the literature revealed 21 published cases since 1906. We present a case of supernumerary nostril located above and to the side of the left nostril in a male patient. We discuss differences between published reports, surgical techniques proposed, and the outcome of our treatment approach.

Management of cleft lip and palate in Brazil

We aimed to evaluate the treatment protocols for cleft lip and palate that are used in Brazil, to compare them with the ones proposed from elsewhere, and to discuss the official data about admission for treatment of cleft lip or palate, or both, in Brazil. We also assessed the importance of integrated action of different specialities to treat this condition. A questionnaire related to attendance protocols was developed and sent out to all Brazilian Plastic Surgery Services connected to the Brazilian Society of Plastic Surgery, and to other units involved in such treatment. We also studied the data produced by the Brazilian Department of Health about the operations done during the past five years. Many protocols were identified, but despite much controversy in many areas, a consensus was reached about the surgical techniques, the age group most suitable to be operated on, and there was total agreement about the need for multidisciplinary management. According to the State Department of Health, the number of operations done in 1995 was 9696, and this had increased to 21 022 in 1999. The state of São Paulo had done 17 636 (84%) of all procedures in 1999.

Dermolipectomy of the Pubic Area Associated with Abdominoplasty

Aesthetic alterations of the pubic area, whether constitutional or the result of excessive weight, if not treated, may become more evident after an abdominoplasty. The authors recommend a simple and effective technique to be performed simultaneously with abdominoplasty that leads to satisfactory results and does not interfere with the lymphatic drainage of the area.

Transgenitalização masculino / feminino: experiência do Hospital Universitário da UFRJ

OBJETIVO: Mostrar a experiencia do tratamento cirurgico do transgenitalismo (masculino/feminino) realizado no Programa de Transgenitalizacao do Hospital Universitario Clementino Fraga Filho, - UFRJ. METODOS: A selecao dos pacientes para operacao de transgenitalismo obedeceu a avaliacao de equipe multidisciplinar, atendendo aos criterios definidos, apos dois anos de acompanhamento conjunto: diagnostico medico de transexualismo; paciente maior de 21 anos; ausencia de caracteristicas fisicas inapropriadas para a mudanca; apoio de pelo menos um familiar proximo. RESULTADOS: De 1997 a 2004 foram atendidas dezessete, pessoas quinze confirmaram a condicao transexual, uma foi afastada por ter trazido exames falsos. Do total de dezesseis transexuais, foram realizadas seis operacoes. As pacientes operadas situavam-se na faixa de 25 a 40 anos com media de 31 anos. O procedimento cirurgico foi concluido sem dificuldades tecnicas em todas as pacientes . Uma paciente apresentou estenose do neo meato e em outra foi necessario encurtar um pouco mais a uretra. CONCLUSAO: A tecnica operatoria nao oferece maiores dificuldades em sua execucao, mas pode depender das condicoes locais e da criatividade do cirurgiao. A dificuldade maior esta em preparar estes pacientes para que nao haja frustracoes ou expectativas demasiadas.

Use of Autologous Fibrin Glue (Platelet-Poor Plasma) in Abdominal Dermolipectomies

BackgroundAutologous plasma is endowed with properties that speed up healing, hemostasis, and adhesiveness, in addition to growth factors. Through an established protocol, it was possible to isolate thrombin, as well as the platelet-rich plasma (PRP) and platelet-poor plasma (PPP) fractions. The purpose of this study was to analyze autologous use of thrombin and PPP to foster adhesion between an abdominal dermoadipose flap and the aponeurotic surface in abdominal dermolipectomies.MethodsThe data from 40 patients who underwent abdominal dermolipectomies were analyzed, with 20 patients using thrombin and autologous PPP (Plasma group) and 20 patients with no intervention (Control group). An attempt was made to assess adhesive power by quantifying the serohematic liquid volume gauged during the postoperative days (POD), and also noting the incidence of seroma. Other variables such as age and body mass index (BMI) were also analyzed.ResultsThe reduction in the aspiration drain debit was statistically relevant only on the first POD in the Plasma group. There was no reduction in the incidence of seroma in these patients. Similarly, age and BMI did not influence these outcomes.ConclusionThe PPP fostered adhesion between the abdominal dermoadipose flap and the aponeurotic surface only on the first POD and had no influence whatsoever on the incidence of seroma. There are few reports on the use of PPP for plastic surgery, particularly the autologous type, opening up possibilities for further research projects to expand its use.Level of Evidence IIIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the table of contents or the online instructions to authors www.springer.com/00266

Uso de plasma autólogo em dermolipectomia abdominal: nota prévia

Autologous plasma began to be studied in the 90s, mainly because its adhesive and angiogenic properties and the presence of growth factors of platelet origin. In fact, plasma can be isolated from autologous manner, from the patients own blood and obtained in its two parts: a high concentration of platelets (platelet-rich plasma - PRP) and one with low concentration of platelets (platelet-poor plasma - PPP). The present study is in development at the Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro (UFRJ-HUCFF) and Marcilio Dias Naval Hospital (HNMD), both in Rio de Janeiro. The objective is to evaluate the properties of platelet-poor plasma, particularly its adhesive action, in patients referred for restorative abdominal dermolipectomy, to reduce postoperative collections, such as hematoma and seroma, two major complications in this type of surgery.

Utilização do plasma rico em plaquetas autólogo nas cirurgias de enxertos cutâneos em feridas crônicas

BACKGROUND: The platelet-rich plasma (PRP) is a product that improves the healing and can help integrate the grafts in chronic wounds. This study aimed to evaluate the results of application of PRP in surgery for skin grafting in chronic wounds. METHOD: We conducted a prospective study, randomized and blinded, in relation to the appraiser, to the use of PRP in skin grafting in chronic wounds. Patients were divided into two groups: group A (control), who received a skin graft, without the use of PRP, and group B, who received a skin graft and the wound was partly used PRP, while the other part served for comparison. RESULTS: There was better graft integration on the side that used the PRP (88.99% in 14th POD and 89.81% at 28 th POD) than the same side of the wound, without PRP (integration was 78.22% in 14th POD and 76.83% at 28th POD). In group A, the integration was even lower (77.85% in 14th POD and 53.45% on the 28th POD). The side that used the PRP has evolved more favorably than group A (p-value = 0.0004) and there was less total loss of the graft in group B than in group A (p-value = 0.049). CONCLUSIONS: The application of PRP in chronic wounds at the time of surgery, improve the integration and evolution of skin grafts and reduces the incidence of total loss.