RESUMEN
La hidradenitis supurativa (HS) es una enfermedad inflamatoria crónica de la piel que afecta a las glándulas sudoríparas apocrinas y causa nódulos inflamatorios, abscesos y fistulas dolorosas en áreas como las axilas, la ingle y los glúteos. Su impacto en la calidad de vida de los pacientes es significativo. La HS afecta al 1- 4% de la población mundial y se asocia con factores como el sobrepeso, el tabaquismo y antecedentes familiares. Su patogenia es compleja, involucrando inflamación y disfunción inmunológica. Su diagnóstico y tratamiento son desafiantes, especialmente en casos graves. El diagnóstico se basa en la presentación clínica, que a menudo se confunde con otras afecciones cutáneas. Se clasifica en etapas de Hurley según la gravedad. El tratamiento se centra en controlar los síntomas y prevenir recurrencias. Incluye educación del paciente, tratamiento médico y cirugía. La elección de la terapia antibiótica depende de la severidad y las cepas bacterianas presentes. Para casos graves, se investigan terapias biológicas. La cirugía, como la escisión simple o con injertos de piel, es efectiva en el control de la enfermedad. Presentamos un caso clínico de un paciente con HS, revisamos la epidemiología, etiopatogenia y su diagnóstico acompañado de las opciones terapéuticas existentes
A hidradenite supurativa (HS) é uma doença inflamatoria crônica da pele que afeta as glândulas sudoríparas apócrinas e causa nódulos inflamatórios, abscessos e fístulas dolorosas em áreas como axilas, virilha e nádegas. Seu impacto naqualidade de vida dos pacientes é significativo. A EH afeta de 1 a 4% da população mundial e está associada a fatores como excesso de peso, tabagismo e histórico familiar. Suapatogênese é complexa, envolvendoinflamação e disfunçãoimunológica, sendoseu diagnóstico e tratamento desafiadores, principalmente nos casos graves. O diagnóstico é baseadonaapresentação clínica, que muitasvezes é confundida comoutrasdoenças da pele. É classificado em estágios de Hurley com base nagravidade. O tratamento se concentra no controle dos sintomas e naprevenção de recorrências. Incluieducação do paciente, tratamento médico e cirurgia. A escolha da antibioticoterapia depende da gravidade e das cepas bacterianas presentes. Para casos graves, terapias biológicas são investigadas. A cirurgia, como excisão simples ouenxertos de pele, é eficaz no controle da doença. Apresentamosum caso clínico de umdoentecom HS, revisamos a epidemiologia, a etiopatogenia e o seu diagnóstico acompanhado das opçõesterapêuticas existentes.
Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease that affects the apocrine sweat glands and causes inflammatory nodules, abscesses, and painful fistulas in areas such as the armpits, groin, and buttocks. Its impact on patients' quality of life is significant. HS affects 1-4% of the world's population and is associated with factors such as overweight, smoking, and family history. Its pathogenesis is complex, involving inflammation and immune dysfunction. Its diagnosis and treatment are challenging, especially in severe cases. Diagnosis is based on clinical presentation, which is often confused with other skin conditions. It is classified into Hurley stages based on severity. Treatment focuses on controlling symptoms and preventing recurrences. Includes patient education, medical treatment and surgery. The choice of antibiotic therapy depends on the severity and the bacterial strains present. For severe cases, biological therapies are investigated. Surgery, such as simple excision or skin grafts, is effective in controlling the disease. We present a clinical case of a patient with HS, we review the epidemiology, etiopathogenesis and its diagnosis accompanied by the existing therapeutic options.
Asunto(s)
Humanos , Masculino , Adulto , Nalgas/cirugía , Glándulas Perianales/cirugía , Hidradenitis Supurativa/cirugía , Nalgas/patología , Glándulas Perianales/patología , Enfermedad Crónica , Hidradenitis Supurativa/terapia , Procedimientos Quirúrgicos Dermatologicos/métodosRESUMEN
Introduction: Sacrococcygeal pilonidal disease (SPD) is a chronic suppurative condition of the sacrococcygeal region causing chronic sinus tract or cyst. It is an acquired complex disease more common in young adult males, causing considerable morbidity and long periods of interruption in work or education. From simple conservative techniques to complex flap reconstruction, many debatable treatment options are offered; however clear dynamics toward the widespread use of minimally invasive methods and off-midline flap reconstruction are suggested in all guidelines, which recommend the Karydakis and Limberg flap modification. The plethora of literature compares procedures for identification of a single best treatment approach, which has proven to be difficult. The surgical outcome of both techniques is compared in the present study. Objective: To compare the surgical outcomes of the modified Karydakis flap (MKF) versus the modified Limberg flap (MLF) in SPD. Materials and Methods: The present study was conducted at the general surgery department on SPD patients who were ≥18 years old. A total of 67 participants were included after obtaining the informed consent, with group A comprising 33 patients undergoing the MLF procedure and group B comprising 34 patients undergoing the MKF procedure. Results: The mean patient age was 28.85 (range, 18-44) years old. For the MKF and MLF methods, the average operating duration was 32.5 (range, 25-40) and 54.5 (range, 45-65) minutes, respectively. The MKF approach was found to significantly improve pain score, mean sitting painless time, return to normal activity, wound healing time, and patient satisfaction. Conclusion: Comparative outcomes were seen between both MKF and MLF; however, our findings show that MKF is a more favourable method than MLF with superior outcomes. (AU)
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Humanos , Adolescente , Adulto , Seno Pilonidal/terapia , Resultado del Tratamiento , Procedimientos Quirúrgicos Dermatologicos/métodos , Complicaciones Posoperatorias , Periodo Posoperatorio , Recurrencia , Región Sacrococcígea/cirugíaRESUMEN
INTRODUCTION: The skin flap is a surgical technique widely used in clinical practice and generally presents postoperative complications. Therefore, elucidating interventions that assist in tissue conservation is essential. Photobiomodulation (PBM) and therapeutic ultrasound (TUS) are non-invasive alternatives for assisting tissue repair, however, there is no consensus on the parameters used. OBJECTIVE: To describe the effectiveness of the different parameters of PBM and TUS in the viability of the dorsal random pattern skin flap in mice. METHODS: Fifty-five Swiss mice were used, distributed in eleven groups. The animals were submitted to surgical technique including revascularization of the area limited through a plastic barrier (polyester/polyethylene) with the same dimension as the flap. PBM or TUS was applied for five consecutive days. Photographic and thermographic recordings were performed with Cyber-Shot DSC-P72 and FlirC2 cameras and analyzed using the ImageJ® and FLIR Tools software, respectively. In the statistical analysis, the data were submitted to the GraphPad Prism® 8.0 software. Analysis of variance (ANOVA Two-way) and Tukey's post-test was performed, considering 5% significance level. RESULTS: Groups 5 (PBM830 nm; 10 J/cm²) and 6 (TUS 3 MHz; 0.4 W/cm²) showed percentages of viable tissue significantly higher on the third and fifth day of the experiment, when compared to the other groups. The temperature decreased significantly in group 1 when compared to the others in the postoperative period. CONCLUSION: The continuous TUS at 3 MHz and PBM 830 nm were more effective in improving the viability of the dorsal random pattern skin flap in mice.
INTRODUÇÃO: O retalho cutâneo é uma técnica cirúrgica amplamente empregada na prática clínica e comumente apresenta complicações pós-operatórias. Portanto, elucidar intervenções que auxiliem na conservação do tecido são fundamentais. A fotobiomodulação (FBM) e o ultrassom terapêutico (UST) são alternativas não invasivas que auxiliam no reparo tecidual, contudo, ainda não há consenso sobre os parâmetros a serem utilizados. OBJETIVO: Descrever a efetividade dos diferentes parâmetros da FBM e do UST na viabilidade do retalho cutâneo randômico dorsal em camundongos. MÉTODOS: Utilizou-se 55 camundongos Swiss, distribuídos em onze grupos. Os animais foram submetidos à técnica cirúrgica com a revascularização da área limitada através de uma barreira plástica (poliéster/polietileno) da mesma dimensão do retalho. Aplicou-se a FBM ou UST durante cinco dias consecutivos. O registro fotográfico e termográfico foi realizado com as câmeras Cyber-Shot DSC-P72 e FlirC2, sendo posteriormente analisados nos softwares ImageJ® e FLIR Tools, respectivamente. Na análise estatística, os dados foram submetidos ao software GraphPad Prism® 8.0 e ao teste Shapiro-Wilk para a análise da normalidade. Realizou-se a análise de variância (ANOVA Two-way) e pós-teste de Tukey, com nível de significância de 5%. RESULTADOS: Os grupos 5 (FBM 830 nm; 10 J/cm²) e 6 (UST 3 MHz; 0,4W/cm²) apresentaram porcentagens de tecido viável significativamente maiores no terceiro e quinto dia do experimento. A temperatura reduziu significativamente no grupo-1 quando comparado aos demais no pós-operatório. CONCLUSÃO: O UST contínuo a 3 MHz e FBM 830 nm, foram mais eficazes melhorando a viabilidade a do retalho cutâneo randômico dorsal em camundongos.
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Animales , Masculino , Ratones , Colgajos Quirúrgicos , Terapia por Ultrasonido , Terapia por Luz de Baja Intensidad , Procedimientos Quirúrgicos DermatologicosRESUMEN
Xeroderma pigmentosum is a rare hereditary autosomal recessive genodermatosis. At present, there are many treatment options for xeroderma pigmentosum, covering medical/procedural, surgical and combined modalities. However, the quality of these interventions has not been assessed. Our study aimed to perform a systematic review of the literature regarding the treatment of xeroderma pigmentosum. Multiple medical databases were accessed with the Medical Subject Headings terms; "xeroderma pigmentosum," "therapeutics" and "surgical procedures, operative" from January 2000 to April 2019, including articles published in Portuguese, Spanish and English (PROSPERO-CRD42018114858). Two hundred and ninety-eight studies were found in the databases researched, of which, after applying the inclusion criteria, only 33 studies remained. The 33 complete articles were read by three of the authors, having been found: 16 reported medical/procedural and 17 reported surgical treatments. Only one clinical study presented a good level of evidence (EL: 2): a randomized clinical trial using a T4 endonuclease V (T4N5) liposome lotion which reduced the development of skin lesions in patients with xeroderma pigmentosum. Amongst surgical modalities, all studies presented low evidence level (EL: 4). Three illustrative cases are also presented, to emphasize the multiple number of times that surgical modalities may be required in these patients. The therapeutic modalities, both clinical and surgical, for xeroderma pigmentosum presented a low level of scientific evidence which did not allow meta-analysis. More therapeutic studies, both clinical and surgical, with better scientific evidence are needed.
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Neoplasias Cutáneas/terapia , Xerodermia Pigmentosa/terapia , Antineoplásicos/uso terapéutico , Procedimientos Quirúrgicos Dermatologicos , Fluorouracilo/uso terapéutico , Humanos , Imiquimod/uso terapéutico , Pomadas , FotoquimioterapiaRESUMEN
BACKGROUND: Extramammary Paget disease (EMPD) poses treatment challenges. Invasive and noninvasive treatment modalities exist with variable success reported. Reflectance confocal microscopy (RCM) is emerging as an adjuvant diagnostic tool. OBJECTIVE: To evaluate the treatment of EMPD patients and the role of RCM. METHODS: Prospective study. Demographic and tumor characteristics were recorded. Handheld-RCM was performed and correlated with histology. Treatment, clearance, pathology, and follow-up were all recorded. RESULTS: Thirty-six EMPD lesions in 33 patients were included. Mean age was 71.7 years, and 23 were men. Mean number of surgical stages needed to clear margins was 1.9 (SD, 0.9; 1.0-3.0 stages), and mean margin needed to clear was 1.8 cm. Reflectance confocal microscopy correlated well with scouting punch biopsies (kappa, 0.93; p < .001). Disruption of the dermoepidermal junction was associated with invasive EMPD versus in situ (83.3% vs 25.9%) on histology (p = .01). LIMITATIONS: Relatively small sample size. CONCLUSION: Extramammary Paget disease is challenging, and lesion demarcation is of the utmost importance. Using a staged surgical excision approach, the mean margins needed were 1.8 cm, less than previously reported. Nonsurgical modalities, including radiation therapy, imiquimod, or photodynamic therapy can be considered if surgery is not pursued. Reflectance confocal microscopy is a valuable noninvasive imaging modality for the management of EMPD.
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Procedimientos Quirúrgicos Dermatologicos/métodos , Márgenes de Escisión , Microscopía Confocal/métodos , Enfermedad de Paget Extramamaria/cirugía , Neoplasias Cutáneas/cirugía , Anciano , Anciano de 80 o más Años , Biopsia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de Paget Extramamaria/diagnóstico , Estudios Prospectivos , Neoplasias Cutáneas/diagnósticoRESUMEN
BACKGROUND: Dermatologic surgery services are largely absent in Africa and in Afro-Caribbean counties. In the USA, studies of people of African ancestry have demonstrated health care gaps, but there are no data for Africa nor a Afro-Caribbean country. Dermatology surgery has been largely absent from global health because there are few data to demonstrate the need. We sought to determine skin cancer tumor types, and local knowledge and perception in an Afro-Caribbean country. OBJECTIVE: We sought to determine whether there exist knowledge gaps and whether a dermatology surgery medical missions program would improve the health of Afro-Caribbean people. METHODS: First, we conducted a survey of knowledge and behaviors related to skin cancer. Second, we analyzed the number and types of tumors treated during a multi-year surgical dermatology project. RESULTS: In the survey, 62% did not know what melanoma was. Eighty-one percent did not think skin cancer is preventable. Of 163 surgical specimens, 64 were malignancies with 91% related to UV exposure. CONCLUSION: There is a need for a skin cancer treatment and education program in a country of mostly African-ancestry people.
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Procedimientos Quirúrgicos Dermatologicos , Necesidades y Demandas de Servicios de Salud , Misiones Médicas , Neoplasias Cutáneas/cirugía , Adulto , Femenino , Salud Global , Grenada , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Estudios Retrospectivos , Encuestas y CuestionariosRESUMEN
BACKGROUND: Nonpigmented intradermal melanocytic nevi (IMN) are benign lesions often removed for cosmetic reasons. There is no consensus as to the best technique for IMN excision. OBJECTIVE: To compare cosmetic outcomes and risk of recurrence after shave excision versus elliptical excision of IMN. MATERIALS AND METHODS: In this randomized clinical trial, patients underwent shave excision or elliptical excision with sutured closure of IMN of the face or back. Recurrence, patient satisfaction, cosmetic outcome, postoperative discomfort, scar size, discoloration, and presence of hypertrophic or keloid scars were evaluated at 3, 6, and 9 months. RESULTS: Overall, 145 nevi were removed from 45 patients (86.7% women, mean age 52.1 ± 12.5 years). The recurrence rate was 11.7%, occurring only after shave excision; 94.1% of recurrences were observed at 3-month follow-up. Shave excision was associated with less discomfort 48 hours after intervention but a greater likelihood of involved lateral and deep margins (p < .001). Scars were larger after elliptical excision and suture than after shave excision (p < .01). The mean patient satisfaction was higher in the shave excision group (p < .004). CONCLUSION: Shave excision of IMN is associated with higher rates of involved surgical margins and recurrence than elliptical excision but provides superior cosmesis and patient satisfaction.
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Cicatriz/epidemiología , Procedimientos Quirúrgicos Dermatologicos/efectos adversos , Recurrencia Local de Neoplasia/epidemiología , Nevo Intradérmico/cirugía , Neoplasias Cutáneas/cirugía , Adulto , Cicatriz/diagnóstico , Cicatriz/etiología , Procedimientos Quirúrgicos Dermatologicos/métodos , Estética , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/prevención & control , Nevo Intradérmico/epidemiología , Satisfacción del Paciente , Índice de Severidad de la Enfermedad , Neoplasias Cutáneas/epidemiología , Resultado del TratamientoRESUMEN
INTRODUCCIÓN. El proceso de cicatrización puede derivar en anomalías, que afectan el aspecto estético y funcional de la zona afectada; la combinación de tratamientos ha permi-tido resultados favorables. OBJETIVOS. Describir los factores que se dan en las recidivas de cicatriz queloide en pacientes tratados con resección quirúrgica más radioterapia. MA-TERIALES Y MÉTODOS. Estudio observacional, descriptivo y retrospectivo. Población de 2 960 Historias Clínicas, se tomó muestra de 100. Criterios de inclusión: diagnóstico de cicatriz queloide, edad de 12 a 75 años, combinación de tratamiento quirúrgico y radiotera-pia. Criterios de exclusión: edades fuera del rango, tratamiento diferente, en la Unidad de Plástica y Reconstructiva del Hospital de Especialidades Carlos Andrade Marín durante el período enero 2013 a diciembre 2019. Los datos fueron tomados del sistema AS400, el análisis se realizó en el programa estadístico International Business Machines Statistical Package for the Social Sciences, versión 22. RESULTADOS. La localización frecuente fue en el pabellón auricular con 83% (83; 100), de estos el 57% (57; 100) fueron poste-rior a perforación; la recidiva se presentó en el 24% (24; 100) y la principal complicación en los pacientes fue Radiodermitis. DISCUSIÓN. La evidencia científica guardó relación con el estudio referente a técnica, sexo, localización del queloide, causa y complicación. CONCLUSIÓN. Se pudo describir los factores que se dieron en las recidivas de cicatriz queloide en pacientes tratados con resección quirúrgica más radioterapia.
INTRODUCTION. The healing process can lead to anomalies, which affect the aesthe-tic and functional appearance of the affected area; the combination of treatments have allowed favorable results. OBJECTIVES. Describe the factors that occur in keloid scar recurrences in patients treated with surgical resection plus radiotherapy. MATERIALS AND METHODS. Observational, descriptive and retrospective study. Population of 2 960 Clini-cal Histories, a sample of 100 was taken. Inclusion criteria: diagnosis of keloid scar, age 12 to 75 years, combination of surgical treatment and radiotherapy. Exclusion criteria: ages outside the range, different treatment, in the Plastic and Reconstructive Unit of the Carlos Andrade Marín Specialty Hospital during the period January 2013 to December 2019. The data were taken from the AS400 system, the analysis was carried out in the program Sta-tistical International Business Machines Statistical Package for the Social Sciences, ver-sion 22. RESULTS. The frequent location was in the auricle with 83% (83; 100), of these 57% (57; 100) were after perforation; recurrence occurred in 24% (24; 100) and the main complication in patients was Radiodermatitis. DISCUSSION. The scientific evidence was related to the study referring to technique, sex, location of the keloid, cause and compli-cation. CONCLUSION. It was possible to describe the factors that occurred in keloid scar recurrences in patients treated with surgical resection plus radiotherapy.
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Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Adulto Joven , Radioterapia , Dehiscencia de la Herida Operatoria , Cicatriz , Cicatriz Hipertrófica , Oído Externo , Queloide , Cirugía Plástica , Terapéutica , Heridas y Lesiones , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Pabellón Auricular , Procedimientos Quirúrgicos DermatologicosAsunto(s)
Fármacos Dermatológicos/farmacología , Procedimientos Quirúrgicos Dermatologicos/métodos , Hidradenitis Supurativa/terapia , Fármacos Dermatológicos/uso terapéutico , Progresión de la Enfermedad , Resistencia a Medicamentos , Hidradenitis Supurativa/diagnóstico , Humanos , Selección de Paciente , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: There is a growing demand for procedures to treat cellulite. Subcision™ is widely used for cellulite correction, and injectable poly-L-lactic acid (PLLA) has been shown to be an effective option for various body conditions. AIMS: Present the results of combining Subcision™ plus PLLA, in the same session, in patients with cellulite and flaccidity. PATIENTS/METHODS: Twenty-four women underwent Subcision™ followed by PLLA injections. An expert panel of dermatologists evaluated before and after photographs according to Global Aesthetic Improvement Scale (GAIS). Patients also answered a satisfaction questionnaire. RESULTS: The author describes the results, as well as number of sessions and dose used. The most frequent GAIS score was "great improvement." No nodules or granulomas appeared in the treated areas. CONCLUSION: The combination of Subcision™ plus PLLA, in the same treatment session, promotes safe and desirable results for cellulite associated with flaccidity.
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Celulitis/terapia , Celulosa/administración & dosificación , Técnicas Cosméticas/efectos adversos , Procedimientos Quirúrgicos Dermatologicos/métodos , Ácido Láctico/administración & dosificación , Manitol/administración & dosificación , Adulto , Nalgas , Celulitis/diagnóstico , Celulosa/efectos adversos , Terapia Combinada/efectos adversos , Terapia Combinada/instrumentación , Terapia Combinada/métodos , Técnicas Cosméticas/instrumentación , Procedimientos Quirúrgicos Dermatologicos/efectos adversos , Procedimientos Quirúrgicos Dermatologicos/instrumentación , Femenino , Estudios de Seguimiento , Humanos , Inyecciones Subcutáneas , Ácido Láctico/efectos adversos , Manitol/efectos adversos , Persona de Mediana Edad , Agujas , Satisfacción del Paciente , Fotograbar , Índice de Severidad de la Enfermedad , Muslo , Adulto JovenRESUMEN
PURPOSE: Composite flaps used in reconstructive surgery may intra- and postoperatively suffer from hypoperfusion and/or ischemia-reperfusion influencing wound healing. We aimed to follow-up the effect of ischemia on adipocutaneous flaps' wound healing and microcirculation. METHODS: In anesthetized rats groin flaps were formed bilaterally. In Control group the flaps were repositioned and sutured back. In Ischemia-Reperfusion (I/R) group before repositioning and suturing the flap pedicles were clamped for 60 minutes. Laser Doppler (LD) fluxmetry and temperature probes were applied on the cranial, central and caudal flap regions before/after preparation and ischemia, re-suturing, and on the 1st-3rd-5th-7th-14th postoperative days, before the final examinations and biopsies for histology. RESULTS: Flaps' skin temperature quickly recovered after repositioning. LD values were lower in the I/R group, reaching a significant level by the 3rd postoperative day, and remained lowered till the 14th day. The magnitude of alterations differed in the flap regions. Histologically normal wound healing process was seen, except for some I/R flaps, where hypertrophized mammary glands were found. CONCLUSIONS: Short-term ischemia could influence flap microcirculation and wound healing, and may result in hypertrophized mammary glands. Laser Doppler could be used to evaluate intra- and postoperative microcirculatory changes and may have significance in predicting complications.
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Procedimientos Quirúrgicos Dermatologicos/efectos adversos , Microcirculación/fisiología , Colgajo Miocutáneo/irrigación sanguínea , Daño por Reperfusión/complicaciones , Piel/irrigación sanguínea , Cicatrización de Heridas/fisiología , Animales , Biopsia , Temperatura Corporal , Modelos Animales de Enfermedad , Flujometría por Láser-Doppler , Masculino , Colgajo Miocutáneo/patología , Periodo Posoperatorio , Ratas , Valores de Referencia , Daño por Reperfusión/patología , Reproducibilidad de los Resultados , Piel/patología , Factores de Tiempo , Resultado del TratamientoRESUMEN
INTRODUÇÃO: Nas últimas décadas, o uso de anticoagulantes vem se tornando mais frequente na população e em faixas etárias mais jovens.OBJETIVO: O objetivo desse artigo é abordar o risco das medicações anticoagulantes mais utilizadas em cirurgia dermatológica.MÉTODOS: Foi realizada revisão das medicações anticoagulantes mais utilizadas.RESULTADOS: A consulta pré-cirúrgica realizada adequadamente, com ênfase ao histórico clínico do paciente (incluindo função renal nos casos de uso dos novos anticoagulantes orais), a localização anatômica abordada e a exata programação do tratamento cirúrgico são essenciais para um desfecho adequado.CONCLUSÕES: A utilização de medicações anticoagulantes é cada vez mais frequente na prática médica. Em pacientes recebendo medicações anticoagulantes é essencial a estrita adesão às boas práticas cirúrgicas, com especial atenção à hemostasia adequada do campo cirúrgico, aos curativos adequados e compressivos e aos cuidados pós-operatórios, sendo o paciente devidamente informado sobre os maiores riscos aos quais está sujeito(AU).
Introduction: In the last decades, anticoagulants have become more frequent in the population and younger age groups. Objective: This article aims to address the risk of the most used anticoagulant medications in dermatological surgeries. Methods: We reviewed the most common anticoagulant medications. Results: The pre-surgical consultation performed correctly, emphasizing the patient's clinical history (including renal function in cases of use of new oral anticoagulants), the anatomical site addressed, and the surgical treatment schedule is essential for a satisfactory outcome. Conclusions: The use of anticoagulant medications is increasingly common in medical practice. In patients receiving anticoagulant medications, strict adherence to good surgical practices is essential. Special attention to adequate hemostasis of the surgical field, adequate and compressive dressings and postoperative care must be given. The patient should be adequately informed about the most significant risks to which he is subject(AU).
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Procedimientos Quirúrgicos Dermatologicos , Anticoagulantes/uso terapéutico , Warfarina/uso terapéutico , Aspirina/uso terapéutico , Dipiridamol/uso terapéutico , Clorhidrato de Prasugrel/uso terapéutico , Rivaroxabán/uso terapéutico , Dabigatrán/uso terapéutico , Clopidogrel/uso terapéutico , Ticagrelor/uso terapéuticoRESUMEN
Antecedentes: Aunque las complicaciones globales en la dermatología quirúrgica referidas en la bibliografía mundial son bajas (1,64- 4,58%), las publicaciones regionales con datos prospectivos sobre ellas son escasas y, a nivel nacional, inexistentes. Objetivos: Estimar la incidencia de complicaciones intraquirúrgicas (CI) y posquirúrgicas (CP) en los procedimientos de cirugía dermatológica y caracterizarlas en el ámbito de una sala de procedimientos de un hospital de referencia de la Ciudad Autónoma de Buenos Aires. Diseño: Trabajo de investigación descriptivo, prospectivo, observacional y longitudinal. Materiales y métodos: Se recolectó información demográfica del paciente y operativa en el momento del procedimiento quirúrgico. Se clasificaron las complicaciones quirúrgicas que se presentaron hasta un mes posterior al procedimiento en los pacientes intervenidos en la sección de Dermatología Quirúrgica del Hospital F. J. Muñiz, en el período comprendido entre febrero de 2015 y marzo de 2018. Resultados: Se halló una incidencia de 0% (IC 95%: 0 a 0,4) para las CI y de 4,4% (IC 95%: 3,2 a 5,9) para las CP en una serie de 765 pacientes (937 procedimientos). La CP más frecuente fue dehiscencia (68%), seguida de infección (16%), variantes de sangrado (9%) y necrosis (7%). Ninguna fue grave ni incluyó muerte, hospitalización o secuelas permanentes. Conclusiones: La dermatología quirúrgica en el ámbito de una sala de procedimientos es segura y el porcentaje de complicaciones es bajo comparable con lo publicado en la bibliografía internacional. (AU)
Background: Although the global complications in surgical dermatology referred to in the worldwide literature are low (1.64- 4.58%), regional publications with prospective data on them are scarce and nationally non-existent. Objectives: Estimate the incidence of intra-surgical complications (IC) and post-surgical complications (PC) in dermatological surgery procedures and characterize them within the scope of a reference hospital in the Autonomous City of Buenos Aires. Design: Descriptive, prospective, observational and longitudinal research work. Materials and methods: Demographic information of the patient and operative data were collected at the time of the surgical procedure. Surgical complications that occurred up to one month after the procedure on patients undergoing surgery in the surgical dermatology section of the F. J. Muñiz Hospital between February 2015 to March 2018 were classified. Results: The incidence found was 0% (95% CI 0-0.4) for IC and 4.4% (95% CI 3.2-5.9) for PC in a series of 765 patients (937 procedures). The most frequent PC was dehiscence (68%), followed by infection (16%), bleeding variants (9%) and necrosis (7%). Neither the PC were severe, not included death, hospitalization or permanent sequelae. Conclusions: Office based dermatologic surgery is safe and the percentage of complications is low, comparable to that published in the international literature. (AU)
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Complicaciones Posoperatorias/epidemiología , Procedimientos Quirúrgicos Dermatologicos/efectos adversos , Quirófanos , Dehiscencia de la Herida Operatoria/epidemiología , Infección de la Herida Quirúrgica/epidemiología , Incidencia , Estudios Prospectivos , Estudios Longitudinales , Hemorragia Posoperatoria/epidemiología , Seguridad del Paciente , Necrosis/epidemiologíaRESUMEN
Objetivo: identificar e caracterizar os indicadores de qualidade mais frequentes utilizados em um Centro Cirúrgico público especializado em dermatologia. Método: estudo transversal seccional, pelo qual fez-se um levantamento, com registros diários, dos mais frequentes indicadores entre os 20 existentes na unidade, no período de agosto de 2015 a julho de 2016. Considerou-se: médias, medianas, valores mínimos/máximos, desvios padrões, frequências simples e percentuais. O valor de p<0,05 foi considerado como nível de significância. Resultados: das 595 cirurgias eletivas, destacaram-se as ambulatoriais (87,9%), as dermatológicas (81,3%), em pacientes do sexo masculino (52,6%), com média de 54,9 anos. Os cinco indicadores mais frequentes foram: cirurgias suspensas (17,6%); registros de enfermagem incompletos (14%); absenteísmo (6,5%); infecção em sítio cirúrgico em cirurgias limpas (2,7%) e acidentes de trabalho (2,2%). Conclusões: a identificação e a caracterização dos indicadores de qualidade proporcionaram visibilidade aos processos locais, viabilizando a tomada de decisões e o aperfeiçoamento dos serviços prestados(AU).
Objetivo: Identificar y caracterizar los indicadores de calidad más frecuentemente utilizados en un centro quirúrgico público especializado en dermatología. Método: Estudio transversal seccional, requiriendo relevamiento, con registros diarios de los indicadores más frecuentes entre los 20 existentes en la unidad, de agosto de 2015 a julio de 2016. Se consideraron: promedios, medianas, valores mínimos/máximos, desvíos estándar, frecuencias simples y porcentuales. Nivel de significancia establecido en p<0,05. Resultados: De 595 cirugías electivas, se destacaron las ambulatorias (87,9%), las dermatológicas (81,3%), en pacientes masculinos (52,6%) con promedio de 54,9 años. Los cinco indicadores más frecuentes fueron: cirugías suspendidas (17,6%); registros de enfermería incompletos (14%); ausentismo (6,5%), infección en sitio quirúrgico en cirugías limpias (2,7%) y accidentes laborales (2,2%). Conclusiones: La identificación y caracterización de indicadores de calidad otorgó visibilidad a los procesos locales, haciendo posible la toma de decisiones y el mejoramiento de los servicios brindados(AU).
Objective: to identify and characterize the most frequent quality indicators used at a public surgical center specialized in dermatology. Methods: cross-sectional study in which a survey consisting of daily records of the most frequent quality indicators among the 20 existing at the unit was carried out between August 2015 and July 2016. Mean, median minimum and maximum values, standard deviations, and absolute and percentage frequencies were obtained. A p-value lower than 0.05 (p<0.05) was considered as the level of significance. Results: in a total of 595 elective surgeries, outpatient (87.9%), dermatologic (81.3%), and those performed in men (52.6%) with an average age of 54.9 years stood out. The five most frequent indicators were: cancelled surgeries (17.6%), incomplete nursing records (14%), absenteeism (6.5%), infection in surgical sites in clean surgeries (2.7%), and occupational accidents (2.2%). Conclusions: identifying and characterizing quality indicators give visibility to local processes and enable decision-making and improvement of the offered services(AU).
Asunto(s)
Humanos , Masculino , Femenino , Enfermería de Quirófano , Enfermería Perioperatoria/organización & administración , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Procedimientos Quirúrgicos Dermatologicos/estadística & datos numéricos , Estudios Transversales , Gestión de la Práctica ProfesionalRESUMEN
Considerando los avances en las investigaciones que relacionan los efectos terapéuticos de la miel en el proceso de cicatrización de heridas, la presente investigación tuvo como objetivo evaluar y comparar cualitativamente, a través de una análisis morfológico, la respuesta tisular local entre sutura convencional coadyuvada con Ulmoplus® y sin Ulmoplus® en el cierre de la incisión de piel de conejo. Se utilizaron 10 conejos adultos, divididos en grupo S (sutura) y grupo S+U (sutura más Ulmoplus®). Se les realizó una incisión de 10 mm de largo, en la región anterior de la pierna, a través de la epidermis y dermis, hasta llegar a la fascia profunda que cubría al músculo tibial anterior. Posteriormente, solo al grupo S+U se le aplicó Ulmoplus®. Luego, en ambos grupos, la incisión fue suturada con dos puntos intradérmicos de ácido poliglicólico (vicryl 2/0). Después de 10 días post incisión fueron tomadas las biopsias de la piel y procesadas para su observación en microscopio de luz. El estudio se llevó a cabo considerando las recomendaciones de la Guía para el Cuidado y Uso de Animales de Laboratorio. Ambos grupos presentaron una incisión cerrada al día 10, con características microscópicas propias de una fase proliferativa. No obstante, el grupo S+U mostró una cicatriz de menor longitud y de aspecto más plano, cuya epidermis estaba mejor organizada y era de menor grosor, con células basales diferenciadas. A nivel dérmico se observó contracción de la herida, evidenciándose una zona cicatrizal de menor tamaño. Ulmoplus®, es una buena alternativa como coadyuvante en el proceso de cierre de heridas quirúrgicas utilizando sutura convencional, ya que acelera el proceso de cicatrización y permite mejores resultados estéticos de la cicatriz.
Considering the advances in research that relate honey therapeutic effects in wound healing process, the present investigation aimed to evaluate and compare qualitatively, through morphological analysis, the local tissue response between conventional suture with Ulmoplus ® and without Ulmoplus ® in the closure of the rabbit skin incision. We used 10 adult rabbits, divided into group S (suture) and group S + U (suture plus Ulmoplus®). An 10 mm long incision was made in the anterior region of the leg, passing through epidermis and dermis, until reaching the deep fascia that covered the anterior tibial muscle. Subsequently, only the S + U group was given Ulmoplus®. Then, in both groups, the incision was sutured with two intradermal points of polyglycolic acid (vicryl 2/0). After 10 days post incision, biopsies of the skin were taken and processed for observation in a light microscope. The study was carried out considering the recommendations of the Guide for the Care and Use of Laboratory Animals. Both groups had a closed incision at day 10 with microscopic characteristics of a proliferative phase. However, the S + U group showed a scar of shorter length and flatter appearance, whose epidermis was more organized and thinner, with differentiated basal cells. At the dermal level, wound contraction was observed, evidencing a smaller scar area. Ulmoplus®, as a coadjuvant in closing surgical wounds process using conventional suture is a good alternative, since it accelerates the healing process and allows better aesthetic results of the scar.
Asunto(s)
Animales , Conejos , Piel/efectos de los fármacos , Cicatrización de Heridas/efectos de los fármacos , Técnicas de Sutura , Miel , Piel/ultraestructura , Técnicas de Cierre de Heridas , Procedimientos Quirúrgicos Dermatologicos , Herida QuirúrgicaRESUMEN
Procedimentos de rejuvenescimento facial substitutos da cirurgia tradicional tornaram-se cada vez mais populares para promover uma aparência jovial com procedimentos minimamente invasivos, como toxina botulínica injetável, preenchimento de tecidos moles e peelings químicos. No entanto, complicações podem ocorrer mesmo na presença de um injetor habilidoso e experiente. Apresentamos o caso de uma paciente submetida a reanimação labial estática usando retalho dermoadiposo para lesão do nervo facial direito após remoção de nódulos como complicação de preenchimento. A "abordagem modificada de bull horn" foi realizada para elevação do lábio superior em torno das asas nasais e columela e ao longo do sulco nasolabial direito. O retalho foi desepitelizado e obtido. Usando a ponta aberta de uma pequena cânula de lipoaspiração, a porção distal do retalho foi encapsulada e fixada diretamente em C-loop e foram utilizados pontos U, transfixando o retalho para o periósteo do arco zigomático. Nos três anos de seguimento não foram observadas complicações significativas e a paciente não relatou nenhuma limitação funcional ou insatisfação com o aspecto das cicatrizes no sulco nasolabial e ao redor das asas nasais e da columela.
Facial rejuvenation procedures to circumvent traditional surgery have become increasingly popular to promote a youthful appearance with minimally invasive procedures such as injectable botulinum toxin, soft-tissue fillers, and chemical peels. Nevertheless, complications can occur even with an astute and experienced injector. Here we present the case of a patient who underwent static lip reanimation using a dermoadiposal flap for right facial nerve damage following nodule removal as a filler complication. A "modified bulls horn approach" to the upper lip lift was performed around the nasal wings and columella and along the right nasolabial fold. The flap was de-epithelized and harvested. Using the open tip of a small liposuction cannula, the distal portion of the flap was tunneled and fixed directly in a C-loop fashion using U stitches, transfixing the flap to the periosteum of the zygomatic arch. At 3 years follow-up, no significant complications were observed, and the patient reported no functional limitations or dissatisfaction with the scars in the nasolabial fold or around the nasal wings and columella.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Historia del Siglo XXI , Rejuvenecimiento , Cirugía Plástica , Toxinas Botulínicas , Procedimientos de Cirugía Plástica , Cara , Traumatismos Faciales , Parálisis Facial , Procedimientos Quirúrgicos Dermatologicos , Rellenos Dérmicos , Labio , Cirugía Plástica/efectos adversos , Cirugía Plástica/métodos , Toxinas Botulínicas/análisis , Toxinas Botulínicas/efectos adversos , Toxinas Botulínicas/uso terapéutico , Procedimientos de Cirugía Plástica/métodos , Procedimientos de Cirugía Plástica/rehabilitación , Cara/cirugía , Traumatismos Faciales/cirugía , Traumatismos Faciales/complicaciones , Traumatismos Faciales/rehabilitación , Parálisis Facial/cirugía , Parálisis Facial/complicaciones , Procedimientos Quirúrgicos Dermatologicos/métodos , Rellenos Dérmicos/análisis , Rellenos Dérmicos/efectos adversos , Labio/anomalías , Labio/cirugíaRESUMEN
Introdução: Queloides surgem de resposta excessiva à lesão da derme, resultando em proliferação de fibroblastos, produção exagerada de colágeno e comprometimento da pele sadia adjacente. O diagnóstico é clínico e muitos métodos conservadores e cirúrgicos já foram utilizados para tratamento. Porém, dados da eficácia desses tratamentos são limitados e não há consenso na literatura quanto a melhor técnica a ser empregada, permanecendo uma lacuna que necessita ser preenchida, a fim de que seus usos sejam indicados com maior confiabilidade, em um modelo de medicina baseada em evidências. Métodos: Revisão não sistemática da literatura sobre "queloides" nas bases de dados PubMed, Scielo, MEDLINE, UptoDate e livros-texto das áreas de Dermatologia e Cirurgia Dermatológica. Revisão de Literatura: Foram enumeradas e abordadas as principais informações sobre técnicas cirúrgicas e adjuvantes empregadas para essas lesões, que são: excisão, injeções intralesionais, crioterapia, laserterapia, revestimento com gel de silicone, radioterapia e pressoterapia. Torna-se relevante o levantamento dessas informações, tendo em vista que, além de poder causar dor, prurido e restrição de movimento, o principal motivo da procura de assistência médica para queloide é devido ao aspecto cosmético/estético, e as taxas de reincidência e falha terapêutica ainda são altas, sendo necessário conscientizar o paciente sobre o procedimento e seus efeitos. Conclusão: São muitos os tratamentos disponíveis para o queloide, sejam cirúrgicos ou não, todavia não há consenso sobre uma abordagem universalmente aceita. São necessários mais estudos, com a finalidade de definir a melhor conduta e atingir melhores resultados, visto a qualidade mediana das evidências apresentadas nos estudos.
Introduction: Keloids are characterized by an abnormal response to dermal trauma, resulting in fibroblast proliferation, excessive collagen production, and impairment of adjacent healthy tissue. The diagnosis is clinical, and many conservative and surgical methods can be used as treatments. However, data on the efficacy of these treatments are limited, and there is no consensus regarding the best treatment option. This gap needs to be filled by developing comprehensive evidence-based therapies. Methods: A non-systematic literature review of keloid scars was carried out using PubMed, Scielo, MEDLINE, UptoDate, and dermatology and dermatological surgery textbooks. Literature review: The search retrieved relevant information on surgical and adjuvant therapies used for keloids, including excision, intralesional injections, cryotherapy, laser therapy, silicone gel sheeting, radiation therapy, and pressure therapy. These data are crucial because, in addition to complaints of pain, itching, and restriction of movement, the main reason for seeking treatment for keloids is for cosmetic and aesthetic improvement, and the rates of recurrence and treatment failure are high, emphasizing the importance of creating awareness regarding the available procedures and their effectiveness. Conclusion: Many surgical and adjuvant therapies for keloids are available. Nonetheless, there is no consensus on a universally accepted treatment. Therefore, additional high-quality studies are needed to identify the most effective therapeutic approaches to achieve better results.