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INTRODUÇÃO: Tradicionalmente, a fissura palatina é corrigida em duas camadas - uma camada mucosa nasal e camada muco-periosteal oral. Este estudo avaliou os resultados do fechamento em camada única de fissura palatina comparado ao fechamento tradicional em camada dupla. MÉTODOS: Trata se de revisão de prontuários de 101 casos de correção de fissura palatina realizados entre 1981 e 2012 em uma clínica assistencial/hospital terciário localizado no centro de Wisconsin. Os casos utilizaram fechamento em camada única e foram acompanhados em Clínica de Lábio Leporino por 12 meses. Foram incluídas fissura labial e palatina também como fissura palatina isolada. RESULTADOS: Todos os casos apresentaram cicatrização satisfatória exceto dois casos que necessitaram de correção posterior de pequena fistula. CONCLUSÃO: O fechamento em camada única de fissura palatina é tão efetivo quanto o fechamento tradicional em camada dupla, além disso apresenta mínimas complicações.

INTRODUCTION: Traditionally, cleft of the hard palate is repaired in two layers, with a nasal mucosal layer and an oral mucoperiosteal layer. The aim of this study was to evaluate the results of one layer closure of hard palate cleft compared to the traditional two layers closure. METHODS: The charts of 101 consecutive cases of repair of hard palate cleft performed by the authors from 1981 to 2012 at a tertiary care clinic/hospital in central Wisconsin were reviewed. The cases utilized the single layer closure and were followed in the Cleft Palate Clinic on a yearly basis. Cases included unilateral and bilateral cleft lip and palate as well as isolated cleft palate. RESULTS: All cases healed satisfactorily except for two cases that later required small fistulae repair. CONCLUSION: Single layer closure of the hard palate cleft is as effective as traditional two-layer closure, with minimal complications.

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Suture application varies for different tissues, different patients, and different circumstances. The large array of new sutures, staples, tapes, and topical adhesives can make the proper choice for closure a challenge. This review of the available materials for skin closure, and their biomechanical properties, advantages, and disadvantages, creates a structure for better understanding of the limitations, indications, and numerous choices to be considered before choosing a suture material.

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BACKGROUND: We hypothesized that total skin-sparing mastectomy (TSM) including where the skin overlying the nipple and areola is preserved would be oncologically safe and facilitate improved cosmetic reconstruction. METHODS: A review (May 2003 through January 2005) was completed on all procedures that were performed through an inframammary incision or a previous scar with reconstruction using Botox, AlloDerm, and a subpectoral tissue implant. RESULTS: Thirty-one patients had 50 TSMs. Twelve percent (6/50) of TSMs had the skin of the nipple and areola resected: 4 (14% of tumors) because of tumor involvement and 2 (4%) because of skin necrosis. Fourteen percent of patients had other complications: 4% (2/50) had infection and/or flap necrosis and 10% (5/50) had superficial epidermolysis requiring no intervention, for a total complication rate of 18%. Average cosmetic score was 8.5 (range 4 to 10). No recurrences are evident after mean follow-up of 7.9 +/- 5.4 months. CONCLUSION: Our short-term experience suggests that TSM has an acceptable complication rate, is theoretically oncologically safe, and facilitates an improved cosmetic result.

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INTRODUCTION: We hypothesized botulinum toxin (BT) infiltration of the chest wall musculature after mastectomy would create a prolonged inhibition of muscle spasm and postoperative pain, facilitating tissue expander reconstruction. METHODS: An Institutional Review Board (IRB)-approved prospective study was conducted of all patients undergoing mastectomy with tissue expander placement during a 2-year period. Study patients versus controls had 100 units of diluted BT injected into the pectoralis major, serratus anterior, and rectus abdominis insertion. Pain was scored using a visual analog scale of 0 to 10. Wilcoxon rank sum test was used for continuous variables and the chi2 test for nominal level data to test for significance. RESULTS: Forty-eight patients were entered into the study; 22 (46%) with and 26 (54%) without BT infiltration. Groups were comparable in terms of age (55 +/- 11 years versus 52 +/- 10 years; P = 0.46), bilateral procedure (59% versus 61%; P = 0.86), tumor size (2 +/- 2 cm versus 2 +/- 3 cm; P = 0.4), expander size and volume (429 +/- 119 mL versus 510 +/- 138 mL; P = 0.5). The BT group did significantly better with pain postoperatively (score of 3 +/- 1 versus 7 +/- 2; P < 0.0001), during initial (score of 2 +/- 2 versus 6 +/- 3; P = 1.6 x 10(-6)), and final expansion (1 +/- 1 versus 3 +/- 2; P = 0.009). Volume of expansion per session was greater thus expansion sessions required less in the BT group (5 +/- 1 versus 7 +/- 3; P = 0.025). There was a significant increase in narcotic use in control patients in the first 24 hours (17 +/- 10 mg versus 3 +/- 3 mg; P < 0.0001), initial as well as final expansion periods (P = 0.0123 and 0.0367, respectively). One expander in the BT group versus 5 in the control group required removal (P = 0.13). There were no BT-related complications. CONCLUSION: Muscular infiltration of botulinum toxin for mastectomy and tissue expander placement significantly reduced postoperative pain and discomfort without complications.

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BACKGROUND: We re-examine the adequacy of an albino (hairless) mouse dorsal distally based skin flap model by determining elastic modulus and by assessing viability after application of rapid intermittent stretch to facilitate wound closure. MATERIAL/METHODS: Modulus of elasticity was determined with materials testing. Viability was accessed by laser Doppler flowmetry and by quantifying marginal tissue necrosis (mm2) at 5 days. Effective length gained and tension relieved were measured by subjecting flaps to simple undermining plus 3-10 g of initial tension (linear stretch) using a skin hook. Immediate hemispherical stretch was applied with an implanted subcutaneous silicone balloon (Rapid Intraoperative Tissue Expansion or RITE) at 1 or 2 cycles of 3-8 min and 6-12 ml for each cycle. Flaps subjected to simple and extensive undermining with or without application of initial linear stretch served as postoperative controls. RESULTS: The elastic modulus of 9.85 (1.02) N/mm2 approximated the skin of the human face. Flowmetry demonstrated that all flaps were adequately perfused. Stretching significantly decreased flap tension and increased flap length over simple undermining alone. It drastically improved flap viability by provoking a 50-75% decline in 5-day necrosis. The benefits were dependent upon the initial linear tension applied, but independent of the timing, cycling, and volume selected for RITE and the flap dimensions at closure. CONCLUSIONS: Results demonstrate that the albino (hairless) mouse dorsal distally based skin flap is a reliable model for studying wound closure and that rapid intermittent stretching in this model facilitates closure and wound healing.

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A method of rapid skin stretching, i.e. hemispherical load cycling with an inflated subcutaneous silicone balloon (Rapid Intraoperative Tissue Expansion or RITE), permits the surgeon to rapidly elongate skin and create a flap of greater length for reconstructive plastic surgery. We have previously developed an experimental mouse model to evaluate RITE, and have shown that rapid stretching prevents ischemia and significantly reduces necrosis. Although the advantages of RITE have been demonstrated both clinically and experimentally, the cellular and molecular mechanisms underlying these benefits were unknown. In the study reported here, we used differential display reverse transcription polymerase chain reaction to identify genes that are specifically induced by RITE. Among four differential gene fragments, the expression of one was confirmed by Northern blot hybridization. The cDNA fragment was extended and the resultant sequence analyzed to reveal induction of truncated long interspersed nucleotide element 1 (LINE-1 or L1). Truncated L1 elements are located inside introns of many genes and among these genes myotubularin and insulin I are known to regulate cell growth. Northern hybridization using specific cDNA probes for myotubularin and insulin I demonstrated that it also was induced by RITE. This is the first reported study to show that L1, myotubularin and insulin I are responsive to rapid hemispherical and not rapid linear stretch.

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A luz de modernas tecnicas disponiveis na Cirurgia Plastica Reconstrutiva, realizamos uma sistematizacao da reconstrucao da parede abdominal. Os defeitos a serem corrigidos podem ser de diversos niveis e a possibilidade de utilizacao de retalhos musculares e miocutaneos e enfatizada. A escolha do metodo, seu adequado planejamento e execucao, assim como o momento ideal para submeter o paciente a cirurgia consistem os fundamentos da reconstrucao do continente abdominal

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A cobertura das grandes meningomieloceles constitui um desafio à técnica dos cirurgiöes. Seu fechamento precoce tem uma direta influência no prognóstico. Os autores descreveu sua experiência com a abordagem multidisciplinar do problema e a eficaz utilizaçäo de expansäo tecidual transoperatória, retalhos fasciocutâneos e miocutâneos

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