RESUMO
The possibility of treatment of endocrine exophthalmos by resection of orbital fat has been discussed by Olivari. The orbital fat is located in two spaces: the outer space which surrounds the extraocular muscles the anterior extensions of which form the palpebral bags, and the inner space which surrounds the optic nerve, being crossed by the oculomotor, abducens and trochlear nerves. The surgical anatomy of orbital fat is discussed and the preliminary results of the resection of orbital fat for treatment of the residual exophthalmos are presented.
Assuntos
Tecido Adiposo/cirurgia , Exoftalmia/cirurgia , Órbita/cirurgia , Adulto , Cadáver , Feminino , Hemostasia Cirúrgica , Humanos , Masculino , Métodos , Pessoa de Meia-IdadeRESUMO
Cryptotia is a congenital abnormality represented by the absence of the retroauricular sulcus in its superior portion. As the physiopathology of the problem involves the lack of skin tissue in the superior part of the ear sulcus, Mulliken suggested for the first time in 1988, the use of skin expanders as a method to obtain the extra skin necessary to correct this deformity. We bring forward our experience in the use of skin expanders in the treatment of three patients with cryptotia, bilateral in one of them. The technical aspects of the operations as well as the types of expanders used are described in detail. In all cases the correction of the cartilagenous deformities, freeing of the superior pole of the ear and redefinition of the retroauricular sulcus were performed. There were no significant complications. There was no change of the initial good results after a two years follow-up.
Assuntos
Orelha Externa/anormalidades , Orelha Externa/cirurgia , Couro Cabeludo/anormalidades , Couro Cabeludo/cirurgia , Dispositivos para Expansão de Tecidos , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Fatores de Tempo , Expansão de Tecido/métodosRESUMO
Among the conscious or unconscious reasons that lead a woman to ask for an esthetic procedure are the need to improve his self-appreciation and the desire to receive more love and approval from other people. We have found no article in the Brazilian literature regarding the psychological aspects of patients submitted to mastoplasty. Fifty-three patients awaiting mastoplasty were studied in the period between September 1990 and january 1992 as for their motivation, as well as for characteristics of their personality. The method used included an interview and tests of "Human being figure drawn" and "Crown-Crisp Experimental Index (CCEI)". The results of the interview and the "Human being Figure Drawn" showed that the majority of the patients was young, without children or with only one child. They were determined, self-centered, with some difficulties, related to their sexuality and sociality.
Assuntos
Mamoplastia/psicologia , Motivação , Personalidade , Adolescente , Adulto , Idoso , Imagem Corporal , Brasil , Feminino , Humanos , Entrevista Psicológica , Mamoplastia/estatística & dados numéricos , Pessoa de Meia-Idade , Testes Psicológicos/estatística & dados numéricosRESUMO
The correction of cranial and limb malformations of the Apert's syndrome requires efforts of a multidisciplinary team. The esthetic and functional repercussions that this syndrome brings to their carriers are severe and so the treatment should aim tom improve the function of the hands in order to integrate these patients in a more normal social live. In our Service, in the period from 1989 to 1992 five patients carrying this syndrome had their hand correction completed before the age of three years. It was observed that surgery was possible in this early stage with no additional complication rate. Quadrangular flaps for the neocomissure and for the coverage of the fingers were successfully used even with skeletal deviations. There was improvement of the esthetics of the hands, but their function could not be evaluated properly. Anyway, because of complex abnormalities the results will never be perfect. The early treatment of these alterations allows the gain of a better hand function and moreover accelerates the physical and intellectual development of the children.
Assuntos
Acrocefalossindactilia/cirurgia , Deformidades Congênitas da Mão/cirurgia , Feminino , Mãos/cirurgia , Humanos , Lactente , Masculino , Métodos , Reoperação/métodos , Técnicas de Sutura , Fatores de TempoRESUMO
One hundred three patients underwent abdominoplasty combined with other intraabdominal procedures including 67 tubal ligations, 34 total abdominal hysterectomies and 2 cholecystectomies, from January 1983 to July 1991. The patients were divided into two groups, those undergoing the standard or total abdominoplasty and those undergoing limited abdominoplasty with or without liposuction in delimited areas. In this series of 103 patients, we found only two minor complications and only three patients were transfused with autologous units of blood. When performed by well-schooled surgical teams, abdominoplasty may be combined with intraabdominal procedures with gratifying results.
PIP: Between January 1983 and July 1991, well trained surgical teams performed either standard abdominoplasty or miniabdominoplasty on 103 patients who also underwent tubal ligation, total abdominal hysterectomy, or cholecystectomy to determine whether surgeons can effectively combine abdominoplasty with other intraabdominal procedures. Prescribed preoperative procedures included respiratory exercises. Physicians advised patients to stop smoking 2 weeks before surgery. Physicians also instructed them not to take any aspirin or other drugs with anticoagulant effects 2 weeks before surgery. Tubal ligation patients who also underwent standard abdominoplasty were in the operating room for 3 hours and for 2 hours if they underwent miniabdominoplasty. Total abdominal hysterectomy patients were in the operating room for either 3-4 hours (standard abdominoplasty) or 2.5-3 hours (miniabdominoplasty). Surgeons performed cholecystectomy in those patients who only underwent standard abdominoplasty. They were in the operating room for 4-5 hours. The combination of intraabdominal procedure and standard abdominoplasty increased the time in the operating room by 40-90 minutes. Number of days in the hospital for standard abdominoplasty patients included 2-3 for tubal ligation, 5 for total abdominal hysterectomy, an 5-7 for cholecystectomy. Miniabdominoplasty patients were in the hospital 1-2 days for tubal ligation and 5 days for total abdominal hysterectomy. Only 2 minor complications occurred: a seroma and a minor skin slough. 3 patients required transfusion of autologous units of blood and non of them lost more than 500 ml of blood. The physicians encouraged all patients to become ambulatory soon after the operation and to wear elastic stockings to prevent thromboembolic events. As a result, none of the patients suffered a pulmonary embolism. In conclusion, good surgical teams can safely and effectively combine abdominoplasty with intraabdominal procedures.
Assuntos
Músculos Abdominais/cirurgia , Colecistectomia , Histerectomia , Lipectomia/métodos , Esterilização Tubária , Perda Sanguínea Cirúrgica , Feminino , Seguimentos , Humanos , Tempo de Internação , Complicações Pós-Operatórias/etiologia , Técnicas de SuturaRESUMO
Com o advento dos expansores de tecidos surgiu uma nova opçao no tratamento da alopecia pela expansao do couro cabeludo adjacente ao defeito, evitando-se desvantagens das tecnicas anteriormente utilizadas, tais como, sequelas nas areas doadoras e deficiencia na densidade de foliculos pilosos na area reparada. Apresentamos a experiencia do grupo no tratamento de 32 pacientes portadores de alopecia com a utilizacao de expansores de tecido. As areas de alopecia variaram entre 30 e 150 cm quadrados. As patologias consistiram de 12 sequelas de queimadura, dez sequelas de trauma, dez sequelas de resseccao tumoral, quatro nevus pilosos gigantes e dois casos de calvice (padrao masculino). Em todos os casos foi possivel a remocao da area da alopecia e substituicao por couro cabeludo com pilificacao normal, sem sequelas nas areas doadoras. Como desvantagem citamos a necessidade de dois procedimentos cirurgicos e o periodo de dois a quatro meses de expansoes semanais, durante o qual ocorre deformidade evidente do segmento cefalico.
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Alopecia/cirurgia , Couro Cabeludo/cirurgia , Dispositivos para Expansão de Tecidos , Expansão de Tecido/métodos , Retalhos CirúrgicosRESUMO
Os resultados de 21 pacientes submetidos a 22 reconstrucoes na cabeca e pescoco com retalhos microcirurgicos foram analisados. Todas as cirurgias foram motivadas por resseccoes de tumores com invasao da dura-mater. Em cinco pacientes foi usado o musculo grande dorsal, em 14, o musculo reto abdominal, em dois, o grande omento e em um, o retalho para-escapular. Houve 83 por cento de sucesso na transferencia microcirurgica. Tres retalhos foram perdidos devido a trombose arterial, sendo que dois ocorreram no mesmo paciente. Em um caso houve infeccao e deiscencia da area receptora.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Neoplasias de Cabeça e Pescoço/cirurgia , Retalhos Cirúrgicos , Dura-Máter/cirurgia , Microcirurgia , PrognósticoRESUMO
Foram operados dez pacientes com perda de substancia na regiao frontal utilizando-se enxerto de tabua externa da regiao parietal, obtidos sem craniotomia. Em todos os casos foi restaurado o contorno da regiao frontal, sem sequela na area doadora. Os resultados avaliados clinica e radiologicamente mantiveram-se no acompanhamento de um ano. A utilizacao do enxerto de tabua externa da regiao parietal permite correcao dos defeitos da regiao frontal, com bons resultados esteticos. A morbidade na area e menor que na regiao da crista iliaca e ha menor reabsorcao ossea do enxerto.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Transplante Ósseo/métodos , Osso Frontal/transplante , Osso Parietal/cirurgia , Transplante AutólogoRESUMO
O labio duplo congenito e deformidade pouco relatada na literatura, nao ha registro da associacao de labio duplo congenito bilabial. Consiste de prega mucosa localizada na borda livre do labio que e salientada a abertura da boca e ao sorriso. Histologicamente apresenta glandulas salivares mucosas de aspecto hipertrofico ou normal, com pouco tecido conjuntivo, recoberto por epitelio cornificado. Nao ha musculo. Apresentamos o relato de dois casos de associacao de labio duplo congenito bilabial tratados cirurgicamente pela resseccao em elipse das pregas mucosas com resultado estetico e funcional satisfatorio.
Assuntos
Humanos , Masculino , Feminino , Adulto , Lábio/anormalidades , Lábio/cirurgia , Mucosa Bucal/cirurgiaRESUMO
O aumento do volume mamario para tratamento das hipomastias, assimetrias mamarias ou para repor volume de tecidos retirados cirurgicamente, e um problema que frequentemente traz dificuldades ao cirurgiao plastico. Nestes 28 anos de utilizacao das proteses de Cronin, surgiram algumas questoes sobre as indicacoes das proteses mamarias. Apresenta-se uma serie de dez doentes insatisfeitos com o resultado estetico obtido pela inclusao de proteses mamarias, devido a ptose, retracao capsular, assimetria e mastodinia. O tratamento constitui na retirada da protese e reconstrucao com retalhos dermo-gorduroso-glandulares locais. Em dois casos foi associada a reducao do volume mamario. Em todos os casos obtiveram-se bons resultados esteticos e remissao dos sintomas dolorosos.
Assuntos
Humanos , Feminino , Mama/cirurgia , Mamoplastia , Próteses e Implantes/efeitos adversos , Silicones/efeitos adversosRESUMO
A arteria interossea posterior irriga a pele da face dorsal do antebraco atraves de arterias septo-cutaneas. O retalho fascio-cutaneo com pediculo distal pode ser usado para reparacoes do antebraco e mao, pois promove cobertura cutanea de boa qualidade e baixa morbidade da area doadora. O emprego da expansao previa do retalho permitiu a ampliacao de suas indicacoes e o fechamento borda a borda da area doadora sem uso de enxerto de pele.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Antebraço/cirurgia , Traumatismos da Mão/cirurgia , Retalhos Cirúrgicos/métodos , Traumatismos do Punho/cirurgia , Antebraço/irrigação sanguíneaRESUMO
A hidradenite supurativa e uma doenca cutanea de evolucao cronica e localizacao peculiar, intimamente relacionada a presenca de glandulas sudoriparas do tipo apocrino. Resulta de obstrucao dos foliculos glandulares com subsequente rotura e infeccao local. Apresenta progressiva evolucao se nao tratada adequadamente, incorrendo em acentuada morbidade. Devido a escassez de relatos semelhantes, o tratamento da hidradenite permanece assunto controverso, nao havendo ate o momento, normatizacao das condutas a serem empregadas em tais casos. O presente estudo visou a analise da eficacia das medidas terapeuticas empregadas em 32 casos de pacientes que necessitaram de internacao no HCFMUSP, no periodo de 1985 a 1990. Com relacao a localizacao, 75 por cento dos pacientes possuiam lesoes perianais, seguida por incidencia similar de lesoes axilares e inguinoperineais em cerca de 40 por cento dos casos. Utilizando-se os indices de recidiva e evolucao morbida da doenca, pode-se verificar a eficiencia dos metodos terapeuticos. Tendo em vista a necessidade de intervencao com resultados mais imediatos e eficazes, o tratamento cirurgico constitui-se na melhor opcao.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Hidradenite Supurativa/cirurgia , Grupos Raciais , Estudos RetrospectivosRESUMO
The treatment of 21 patients who had cranio-facial reconstructions for extensive malignancies is reviewed. Microsurgical flaps obtained from latissimus dorsi, rectus abdominis, greater omentum and para-scapular regions were used. Good results were obtained in 86% of cases. Three flaps were lost in this series due to thrombosis of the microvascular anastomoses. Donor site morbidity occurred in only one case in which a dehiscence required a re-suture.
Assuntos
Neoplasias de Cabeça e Pescoço/cirurgia , Retalhos Cirúrgicos , Adulto , Idoso , Dura-Máter/cirurgia , Feminino , Humanos , Masculino , Microcirurgia , Pessoa de Meia-Idade , PrognósticoRESUMO
Tissue expanders have emerged recently as a new option for the treatment of alopecia. The method consists in expanding the scalp beyond the defective area. In this way, some disadvantages like the alterations in the donor area and low density of hair follicles, that may result from other techniques, are avoided. We present our experience with tissue expanders in the treatment of 32 patients with alopecia. The extent of these areas varied from 30 to 150 cm2, and the causes were: burn sequels in 12 patients; trauma sequels in ten; tumoral resections in ten; giant nevus pilosus in four and baldness (male standard) in two patients. The resection of the area with alopecia and the replacement by normal adjacent tissue was possible without any complications in all cases. However some disadvantages were observed. They included the necessity for a second surgical procedure because of marked deformity of the cephalic segment.
Assuntos
Alopecia/cirurgia , Couro Cabeludo/cirurgia , Expansão de Tecido/métodos , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Retalhos CirúrgicosRESUMO
Ten patients with losses of frontal bone were operated with the use of bone grafts taken from the parietal area without craniotomy. In all patients the contour was restored without complications at the donor area. Results were evaluated clinically and radiologically one year later and no absorption was observed. We conclude that bone grafts from outer layer of parietal bone offer a satisfactory esthetic results. The morbidity at the donor area was not significant.
Assuntos
Transplante Ósseo/métodos , Osso Frontal/transplante , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osso Parietal/cirurgia , Transplante AutólogoRESUMO
Plastic surgeons with a certain frequency have to face the problems of increased mammary volume in patients treated for hypomastias, mammary asymmetries or just for replacement of tissues surgically resected. In 28 years of using the Cronin prosthesis some questions appeared about the correct indications of mammary prosthesis. We present 10 patients unsatisfied with the esthetic results of a mammary prosthesis because of ptosis, capsular retraction, asymmetry as well as pain. The treatment consisted of taking away the prosthesis and reconstruction of the breast with local dermo-fat-glandular flaps. We achieved good esthetic results and remission of pain.
Assuntos
Mama/cirurgia , Mamoplastia , Complicações Pós-Operatórias/cirurgia , Próteses e Implantes , Feminino , Humanos , Satisfação do Paciente , Reoperação , Silicones/efeitos adversosRESUMO
The frequency of the congenital double lip is scarcely mentioned in the literature. There is no previous report on the bilabial congenital double lip. This association consists of a mucosae fold at the free edge of the lip, which is projected at smiling and opening of the mouth. Histologically, the mucous salivary glands are either hypertrophic or normal with little connective tissue and covered by a cornified epithelium. There is no muscle tissue found. We present the report of two cases of bilabial congenital double lip treated surgically by the elliptical resection of the mucosae folds.
Assuntos
Lábio/anormalidades , Mucosa Bucal/anormalidades , Adulto , Feminino , Humanos , Lábio/cirurgia , Masculino , Mucosa Bucal/cirurgiaRESUMO
Hidradenitis suppurativa is a cutaneous disease of peculiar localization, related to the presence of apocrine glands. It results from the obstruction of the glandular follicle with subsequent rupture and local infection. The evolution uses to be prolonged and follows progressive course if not adequately treated. The therapeutic options have not been standardized yet. This study aims to analyze the therapeutic procedures applied in 32 patients of the University Hospital of São Paulo. Concerning to localization, 75% of the lesions were perianal, followed by a similar incidence at axillary and inguino-perineal regions. Considering the recurrence index and evolution of the disease we came to the conclusion that the surgical treatment produced the best results.
Assuntos
Hidradenite Supurativa/cirurgia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Raciais , Estudos RetrospectivosRESUMO
The posterior interosseous vessels give a significant contribution to the fascial plexus which supplies the skin of the forearm. This vascular arrangement forms the basis for an island fasciocutaneous flap which can be based either proximally or distally. Its principal advantage is that it is a thin flap with excellent circulation and that the donor area can be closed primarily. The design and usage of an island fasciocutaneous flap with possibility of expansion is also described.