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ABSTRACT We present a case of a patient complaining of monocular diplopia due to a decentered ablation after LASIK. The patient underwent a wavefront-guided retreatment, which resulted in an epithelial ingrowth complication. Additionally, the patient developed cataract, with cataract surgery requiring reliable biometric measurements. Therefore, we opted for corneal treatment and corneal surface regularization. Although we attempted to lift the flap and wash the interface initially, the procedure proved unsuccessful, thereby necessitating immediate flap amputation. Once the corneal surface was regularized in the seventh postoperative month, transepithelial photorefractive keratectomy was successfully performed to homogenize the ocular surface, thereby significantly improving the patient's corrected visual acuity and resolving monocular diplopia. The surface and corneal curvature stabilized by the fifth month after the procedure. Phacoemulsification was then performed along with the implantation of a toric monofocal lens, which was selected using an appropriate formula, resulting in an excellent uncorrected visual acuity.
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INTRODUCTION AND IMPORTANCE: Sternotomy is the main surgical procedure used to access the heart and great vessels. Among its most important complications is post-sternotomy dehiscence with an incidence of 10 %; the main risk factors for its occurrence are diabetes mellitus, obesity or chronic obstructive pulmonary disease. CASE PRESENTATION: We present a clinical case of a 74-year-old male patient with sternal dehiscence secondary to sternotomy for myocardial revascularisation. CLINICAL DISCUSSION AND CONCLUSIONS: Surgical dehiscence of sternotomy presents remarkable complexity and poses a significant challenge to the medical team. The therapeutic approach focuses on addressing the infection, removing the necrotic tissue and then covering the area with highly vascularised tissue. Surgical alternatives include the possibility of using a unilateral pectoralis muscle flap, an option that provides adequate sternal stability and leads to satisfactory functional and cosmetic results.
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A bibliometria é uma excelente ferramenta que permite determinar as obras e autores mais citados, assuntos mais enfatizados, palavras-chave mais utilizadas, autores que mais publicaram, bem como suas respectivas áreas de formação, revelando, assim, parte da dinâmica de produção do conhecimento desse campo de pesquisas. O objetivo deste estudo foi realizar análise bibliométrica sobre a utilização do músculo fibular terceiro como retalho em cirurgia ortopédica. Para tal, realizou- se uma pesquisa bibliométrica, de caráter observacional e abordagem quantitativa, utilizando como palavras-chave as seguintes combinações booleanas ("fibularis tertius" OR "peroneus tertius" OR "fibularis anterior" AND "surgery" OR "Plastic surgery" OR "surgical flap" OR "Lower extremity" AND "human") através da plataforma SCOPUS. A análise bibliométrica encontrou 33 artigos publicados em periódicos de grande impacto em nível mundial, principalmente nos anos de 2018 e 2020. Ao associar as palavras-chave através da Lei de Bradford, lei esta que estima o grau de relevância de periódicos que atuam em áreas do conhecimento específicas, a revista mais relevante foi a Surgical And Radiologic Anatomy, seguida da Journal Of Foot And Ankle Surgery e Plastic And Reconstructive Surgery. O pesquisador Arnold et al., 1999, do Setor de Cirurgia Plástica e Reconstrutiva dos Estados Unidos, publicou o artigo intitulado "Muscle flaps in osteomyelitis of the lower extremity: A 20-year account", no periódico Plastic and Reconstructive Surgery, e obteve 61 citações e apresentou o maior fator H para a pesquisa realizada. As análises bibliométricas podem se configurar em uma metodologia tecnológica importante para a medicina, por revelar padrões de pesquisa e identificação de tendências, assim como podem também ser utilizadas em qualquer base de dados, sendo sugeridos novos estudos. O uso dos recursos disponíveis na base de dados SCOPUS se mostrou interessante para a realização de estudos desse tipo em curto espaço de tempo, além de propiciar a possibilidade de estudos posteriores com análise de outros indicadores, principalmente de um tema tão relevante para a cirurgia ortopédica.
Bibliometrics is an excellent tool that allows you to determine the most cited works and authors, the most emphasized subjects, the most used keywords, the most published authors, as well as their respective areas of training, thus revealing part of the dynamics of knowledge production of this field of research. The aim of this study was to perform a bibliometric analysis on the use of the third peroneus muscle as a flap in orthopedic surgery. To this end, a bibliometric research was carried out, with an observational character and a quantitative approach, using the following Boolean combinations as keywords ("fibularis tertius" OR "peroneus tertius" OR "fibularis anterior" AND "surgery" OR "Plastic surgery" OR "surgical flap" OR "Lower extremity" AND "human") through the SCOPUS platform. The bibliometric analysis found 33 articles published in high-impact journals worldwide, mainly in the years 2018 and 2020. By associating the keywords through the Bradford Law, this law estimates the degree of relevance of journals operating in areas of specific knowledge, the most relevant journal was Surgical And Radiologic Anatomy, followed by Journal Of Foot And Ankle Surgery and Plastic And Reconstructive Surgery. Researcher Arnold et al., 1999, from the US Plastic and Reconstructive Surgery Sector, published the article entitled "Muscle flaps in osteomyelitis of the lower extremity: A 20-year account", in the journal Plastic and Reconstructive Surgery, and obtained 61 citations and presented the biggest H factor for the research performed. Bibliometric analyzes can be configured as an important technological methodology for medicine, for revealing research patterns and identifying trends, as well as being used in any database, with further studies being suggested. The use of resources available in the SCOPUS database proved to be interesting for carrying out studies of this type in a short period of time, in addition to providing the possibility of further studies with analysis of other indicators, especially on a topic so relevant to orthopedic surgery.
La bibliometría es una excelente herramienta para determinar los trabajos y autores más citados, los temas más destacados, las palabras clave más utilizadas, los autores que más han publicado, así como sus respectivas áreas de formación, revelando así parte de la dinámica de producción de conocimiento en este campo de investigación. El objetivo de este estudio fue realizar un análisis bibliométrico sobre el uso del tercer músculo fibular como colgajo en cirugía ortopédica. Para ello, se realizó una investigación bibliométrica, observacional y cuantitativa utilizando como palabras clave las siguientes combinaciones booleanas ("fibularis tertius" OR "peroneus tertius" OR "fibularis anterior" AND "surgery" OR "Plastic surgery" OR "surgical flap" OR "Lower extremity" AND "human") a través de la plataforma SCOPUS. El análisis bibliométrico encontró 33 artículos publicados en revistas de alto impacto a nivel mundial, principalmente en los años 2018 y 2020. Al asociar las palabras clave mediante la Ley de Bradford, una ley que estima el grado de relevancia de las revistas que operan en áreas de conocimiento específicas, la revista más relevante fue Surgical And Radiologic Anatomy, seguida de Journal Of Foot And Ankle Surgery y Plastic And Reconstructive Surgery. El investigador Arnold et al. 1999, del Departamento de Cirugía Plástica y Reconstructiva de los Estados Unidos, publicó un artículo titulado "Muscle flaps in osteomyelitis of the lower extremity: A 20-year account" (Colgajos musculares en la osteomielitis de la extremidad inferior: un relato de 20 años), en la revista Plastic and Reconstructive Surgery, y obtuvo 61 citas y presentó el factor H más alto para la investigación realizada. Los análisis bibliométricos pueden configurarse como una importante metodología tecnológica para la medicina, al revelar patrones de investigación e identificar tendencias, así como también pueden utilizarse en cualquier base de datos, con la sugerencia de nuevos estudios. La utilización de los recursos disponibles en la base de datos SCOPUS resultó interesante para realizar estudios de este tipo en un corto periodo de tiempo, además de ofrecer la posibilidad de realizar estudios posteriores con análisis de otros indicadores, especialmente en un tema tan relevante para la cirugía ortopédica.
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Humanos , Nervo Fibular , Retalhos Cirúrgicos , Bibliometria , Procedimentos Ortopédicos , Cirurgia Plástica , Extremidade InferiorRESUMO
PURPOSE: This systematic review aimed to compare the efficacy, defined in terms of the mean percentage of root coverage (mRC), of surgical treatment approaches combined with adhesive restorations of non-carious cervical lesions (NCCLs) to that of root coverage alone in patients with a single gingival recession (GR) and NCCL. METHODS: A literature search was conducted to identify longitudinal studies reporting the mRC following treatment for the correction of GR defects associated with NCCLs using a combination of surgical and restorative techniques in systemically and periodontally healthy patients. RESULTS: The search resulted in the retrieval of 12,409 records. Seven publications met the inclusion criteria for the qualitative synthesis of data. The mRCs ranged from 69% to 97%. In the medium term, the gingival margin position was more stable when a connective tissue graft (CTG) was used, independently of whether restoration of teeth with NCCLs was performed. CONCLUSIONS: The strength of the evidence was limited by methodological heterogeneity in terms of study design as well as the unit and period of analysis, which precluded a meta-analysis. Although no definitive conclusion could be drawn due to the lack of sufficient evidence to estimate the effectiveness of the interventions, CTG-based procedures contributed to gingival margin stability regardless of the performance of restoration to treat NCCLs.
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Abstract Introduction Endoscopic transnasal access to the skull base, both for treatment and reconstruction, can cause olfactory morbidity. Knowing the main consequences of this intervention is essential to have objective criteria for decision-making regarding the appropriate surgical technique. Objectives The aim of this study is to determine the impact on olfactory function of the endonasal endoscopic access to the skull base with the creation of the nasoseptal flap. Methods A prospective research was carried out in which 22 patients who underwent endoscopic transnasal surgery at the skull base, with the creation of a nasoseptal flap. The Connecticut Chemosensory Clinical Research Center test was applied before and at the 1st, 3rd and 6th postoperative months. Results The results showed that only in the first month of follow-up the mean patient classification was statistically worse than at the other evaluation moments (p < 0.05), but there was no mean difference in the Connecticut score classification between the other moments (p > 0.05); that is, patients showed worsening in the 1st month and returned to the preoperative mean after the 3rd month of follow-up. Conclusion The present study showed that the postoperative decrease in olfaction is transient, since the patient's sense of smell returns to pre-surgical values in the 3rd postoperative month.
Resumo Introdução O acesso transnasal endoscópico à base do crânio, tanto no tratamento quanto na reconstrução, pode ocasionar morbidade olfatória. Conhecer as principais consequências dessa intervenção é fundamental para se dispor de elementos objetivos para a decisão da técnica cirúrgica adequada. Objetivo Determinar o impacto na função olfatória do acesso endoscópico endonasal à base do crânio com confecção do retalho nasosseptal. Método Foi feita pesquisa prospectiva na qual foram incluídos 22 pacientes submetidos à cirurgia endoscópica transnasal à base do crânio com confecção de retalho nasosseptal. Foi aplicado o teste Connecticut chemosensory clinical research center antes e após o 1°, 3° e 6° meses da cirurgia. Resultados Os resultados evidenciaram que apenas no 1° mês de seguimento a classificação média dos pacientes foi estatisticamente pior do que nos demais momentos de avaliação (p < 0,05), mas entre os demais momentos não houve diferença média na classificação do escore de Connecticut (p >0,05), ou seja, os pacientes pioraram no 1° mês e voltaram à média pré-operatória a partir do 3° mês de seguimento. Conclusão No presente estudo, demonstramos que a diminuição do olfato pós-operatória é transitória, já que, no 3° mês depois da cirurgia, o olfato do paciente retorna aos valores pré-cirúrgicos.
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INTRODUCTION: Endoscopic transnasal access to the skull base, both for treatment and reconstruction, can cause olfactory morbidity. Knowing the main consequences of this intervention is essential to have objective criteria for decision-making regarding the appropriate surgical technique. OBJECTIVES: The aim of this study is to determine the impact on olfactory function of the endonasal endoscopic access to the skull base with the creation of the nasoseptal flap. METHODS: A prospective research was carried out in which 22 patients who underwent endoscopic transnasal surgery at the skull base, with the creation of a nasoseptal flap. The Connecticut Chemosensory Clinical Research Center test was applied before and at the 1st, 3rd and 6th postoperative months. RESULTS: The results showed that only in the first month of follow-up the mean patient classification was statistically worse than at the other evaluation moments (p<0.05), but there was no mean difference in the Connecticut score classification between the other moments (p>0.05); that is, patients showed worsening in the 1st month and returned to the preoperative mean after the 3rd month of follow-up. CONCLUSION: The present study showed that the postoperative decrease in olfaction is transient, since the patient's sense of smell returns to pre-surgical values in the 3rd postoperative month.
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Neoplasias Hipofisárias , Procedimentos de Cirurgia Plástica , Endoscopia , Humanos , Neoplasias Hipofisárias/cirurgia , Estudos Prospectivos , Estudos Retrospectivos , Base do Crânio/diagnóstico por imagem , Base do Crânio/cirurgia , Resultado do TratamentoRESUMO
OBJECTIVE: To evaluate the esthetic and functional results of an osteoplastic flap for mastoid cavity closure in cochlear implant surgery. STUDY DESIGN: Double-blind, prospective, randomized clinical trial. SETTING: tertiary referral center. INTERVENTION(S): On hundred and twenty-six patients were randomized in 2 groups for cochlear implant surgery. Cases (n: 63) underwent simple mastoidectomy using an anteriorly pedicled osteoplastic flap for mastoid closure. In controls (n: 63), a traditional periosteal flap was used. Evaluation with the POSAS questionnaire was performed 1 year after surgery to assess surgical wound esthetics. Sixteen patients from each group had postoperative CT-scans and wideband tympanometry to assess mastoid aeration and middle ear absorbance. Gender and time after surgery were correlated. MAIN OUTCOME MEASURE(S): Evaluation of the quality of the surgical wound with the application of a questionnaire validated in the medical literature and translated into Portuguese language called POSAS, considering the perception of the blinded patient and doctor regarding the surgical technique proceeded. A lower POSAS score suggests better esthetics of the surgical wound. Secondary outcomes are volumetric measurement of aeration inside mastoid cavity using 3D computer tomography exam, which aims to analyze the influence of fibrocicatricial retraction in the surgical wound into the mastoid and the interference of its aeration volume in the absorption of sound in the middle ear, using the wideband tympanometry exam. RESULTS: The POSAS questionnaire in the Case group showed a lower level of local pain and itchiness, a skin color and thickness more similar to the surrounding skin and less irregularity and stiffness, with no influence from time after surgery and gender compared to the Control group. The median tomographic volume was 6.37 cc in the cases and 4.60 cc in controls. Wideband tympanometry showed general smaller sound absorbance in the Case group results, specially, at 1000 Hz frequency. No intraoperative or postoperative complications were observed with the osteoplastic flap. CONCLUSIONS: This technique is an effective and safe alternative to alleviate common problems of mastoid surgery for cochlear implantation. In addition to esthetic benefits, it has less interference in middle ear physiology of sound absorbance and less fibrous tissue into the mastoid cavity during the follow-up of more than 1 year.
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Colesteatoma da Orelha Média , Implante Coclear , Implantes Cocleares , Ferida Cirúrgica , Colesteatoma da Orelha Média/cirurgia , Implante Coclear/métodos , Humanos , Processo Mastoide/cirurgia , Mastoidectomia , Estudos Prospectivos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
El mixoma odontogénico es una neoplasia benigna, localmente agresiva, con una baja prevalencia (frecuencia del 2% al 5% de los tumores odontogénicos) en los maxilares. Este tumor a menudo se presenta como una lesión expansiva asintomática sin cambios nerviosos sensoriales. El objetivo del presente trabajo es detallar el caso de un paciente masculino de 42 años quien acude al servicio de Cirugía Bucal y Maxilofacial del Hospital Nacional Hipólito Unanue por presentar una tumoración de crecimiento lento en maxilar superior, que fue aumentando de tamaño con el tiempo y desplazando órganos dentarios, y que se extiende al paladar duro y parte de paladar blando, el diagnóstico anatomopatológico fue de mixoma odontogénico y recibió un tratamiento radical (hemimaxilectomia) por la naturaleza agresiva del tumor. En este trabajo discutimos la presentación del mixoma odontogénico en el maxilar superior, los enfoques de trata- miento; detallando la importancia de plantear alternativas de tratamiento que permitan la reconstrucción inmediata generando la menor morbilidad posible.
Odontogenic myxoma is a locally aggressive benign neoplasm with a low prevalence (frequency 2% to 5% of odontogenic tumors) in the jaws. This tumor often presents as an asymptomatic expansive lesion without sensory nerve changes. The aim of this study is to detail the case of a 42-year-old male patient who attends the Oral and Maxillofacial Surgery service of the Hipólito Unanue National Hospital due to a slow-growing tumor in the upper jaw, which increased in size over time and displacing dental organs, and extending to the hard palate and part of the soft palate, the pathological diagnosis was odontogenic myxoma and received radical treatment (hemimaxilectomy) due to the aggressive nature of the tumor. In this work we discuss the presentation of odontogenic myxoma in the maxilla, treatment approaches; detailing the importance of proposing treatment alternatives that allow immediate reconstruction generating the least possible morbidity.
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Las lesiones digitales son extremadamente frecuentes y cuando estas involucran al pulgar pueden comprometer importantemente la función de la mano, tanto así que su amputación afecta hasta un 50% la función global de la mano y disminuye su fuerza hasta en un 20%. Para poder mantener el largo del pulgar en muchas ocasiones se requiere de cobertura mediante el uso de colgajos, los cuales no siempre son realizados por un cirujano de mano. La elección correcta del colgajo es esencial para evitar la restricción de movilidad y limitación funcional del dedo lesionado, existiendo múltiples alternativas descritas, que varían en su capacidad de cobertura y complejidad, haciendo difícil una adecuada elección. Nuestro objetivo es resumir y entregar una estrategia de análisis de lesiones del pulgar que permita comprender el tipo de lesión y objetivos del tratamiento quirúrgico, para así optimizar la cobertura según cada caso y los resultados a largo plazo.
Digital injuries are frequent in medical practice. When they involve the thumb, it is important to consider that an amputation affects up to 50% of the hands' function and decreases its strength by up to 20%. Management of thumb injuries often requires coverage with local flaps, which are not always performed by hand surgeons. Choosing the right flap is essential to avoid restrictions in mobility and functional limitations of the injured finger. Our objective is to summarize and provide a strategy for the analysis of thumb injuries that may help to understand the different types of lesions, and the surgical approaches recommend in order to optimize coverage and long term results.
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Humanos , Polegar , Retalhos Cirúrgicos , Procedimentos de Cirurgia Plástica , MãosRESUMO
Introducción: Las secuelas de quemadura juegan un papel fundamental en la recuperación del paciente quemado, ya que tiene una repercusión funcional y estética; para decidir el tratamiento de las contracturas cicatriciales, se necesita una evaluación cuidadosa y una clasificación de las contracturas por sitio, se debe explorar las articulaciones afectadas y notar los rangos de movilidad y las deformidades resaltando cualquier contractura cicatrizal y una vez que se establezca adecua-damente el tipo de secuela se tomara decisiones para orientar a un óptimo tratamiento. Los avances en el conocimiento de la anatomía vascular, en conjunto con el método de disección de colgajos "estilo libre", han permitido el desarrollo de los colgajos en hélice (propeller flap). Presentación de casos: Durante el período de un año (2018-2019) se presentaron seis casos de secuelas de quemaduras que comprometieron articulaciones mayores y que fueron tratadas con colgajo de pedículo perforante en hélice. La edad de los pacientes se ubicó entre 5 a 60 años con una mediana de 29 años con secuelas de quemaduras. Un caso con infección de sitio quirúrgico y seis sin complicaciones. El tiempo quirúrgico entre 120 a 170 min, la estancia hospitalaria tuvo una me-diana de 19 días (rango 6 a 55días). El diámetro del colgajo fue entre 24cm2 y 84cm2, con diferentes diseños lobulado (un caso), bilobulado (tres casos), tetralobulado (dos casos); permitiendo que el defecto secundario se cierre de forma directa en cinco de ellos y en un caso se colocara injerto de piel. Discusión: La literatura científica provee evidencia de las ventajas al utilizar colgajos en hélice por la capacidad de recons-trucción del tejido en un procedimiento de una sola etapa, logrando obtener resultados similares que ofrecen los colgajos libres microvascularizados.Conclusiones: El colgajo en hélice mejora las retracciones en las articulaciones mayores devolviendo el rango de movili-dad, preserva el músculo subyacente, proporciona una menor morbilidad del sitio donante.
Introduction: The sequelae of burns play a fundamental role in the recovery of the burned patient, since they have a func-tional and aesthetic impact; To decide on the treatment of scar contractures, a careful evaluation and classification of the contractures by site is needed, the affected joints should be explored and ranges of motion and deformities noted highli-ghting any scar contractures and once the type of sequel, decisions will be made to guide a better treatment. Advances in the knowledge of vascular anatomy, together with the "freestyle" flap dissection method, have allowed the development of propeller flaps. Case presentation: During a one-year period (2018-2019), there were six cases of burn sequelae that compromised major joints and that were treated with a pedicled propeller flaps. The age of the patients ranged from 5 to 60 years with a median of 29 years with burn sequelae. One case with surgical site infection and six without complications. The surgery time between 120 and 170 min, the hospital stay had a median of 19 days (range 6 to 55 days). The diameter of the flap was between 24cm2and 84cm2, with different designs: lobed (one case), bilobed (three cases), tetralobed (two cases); considering that the secon-dary defect is closed directly in five of them and in one case a skin graft is placed. Discussion: The scientific literature provides evidence of the advantages of using pedicled propeller flaps due to the ability to reconstruct the tissue in a single-stage procedure, achieving similar results as those offered by microvascularized free flaps.Conclusions: The pedicled propeller flaps improves retractions in major joints, restoring the range of motion, preserving the underlying muscle, and providing less donor site morbidity.
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Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Retalhos Cirúrgicos , Queimaduras , Queimaduras por Corrente Elétrica , Queimaduras por Corrente Elétrica/cirurgia , Queimaduras por Corrente Elétrica/complicaçõesRESUMO
ABSTRACT Introduction: The volumetric preservation of bone and soft tissue after a tooth extraction has special relevance in the esthetic zone when it will be rehabilitated by a dental implant. Objective: Describe the prosthodontics treatment in a socket with advanced buccal bone resorption, with a flapless technique for guided bone regeneration and with a dental implant and implant-supported single fixed prosthesis. Case presentation: A case is presented of a male 62-year-old partially dentate patient. Radiographic examination showed the presence of advanced buccal bone resorption in relation to the maxillary left lateral incisor. It was a result of the root displacement secondary to root fracture. In a first surgical phase the lateral incisor was extracted using an atraumatic periotome technique. Particulate cortical bone allograft was compacted into the site to fill the space that was previously occupied by the root of the tooth. Temporary restoration was performed using the extracted natural tooth, which was adhesively bonded to the adjacent teeth. Four months after grafting the extraction site showed an adequate height and width of the bone. In a second surgical phase, an implant was placed. Six months after implant placement, osseointegration was clinically confirmed and a provisional crown was screwed on the implant performed. The final restoration with a zirconium dioxide abutment and a full ceramic crown was obtained and cemented. Conclusions: Regeneration of the buccal plate was possible through the use of particulate cortical bone allograft and a resorbable collagen membrane adapted to the bone defect and placed in a position to recreate the buccal plate. This allowed the installation of an implant 4 months later, the procedure allowing esthetic and functional results using a single fixed prosthesis(AU)
RESUMEN Introducción: La preservación volumétrica de los huesos y tejidos blandos después de una extracción dental tiene especial relevancia en la zona estética cuando será rehabilitada por un implante dental. Objetivo: Describir el tratamiento de prótesis en una cavidad con reabsorción ósea bucal avanzada, con una técnica sin colgajo para la regeneración ósea guiada y con un implante dental y una prótesis fija única con soporte de implante. Presentación del caso: Paciente masculino de 62 años, edente parcial. El examen radiográfico mostró la presencia de reabsorción ósea bucal avanzada en relación con el incisivo lateral superior izquierdo. Fue el resultado del desplazamiento de la raíz secundario a la fractura de esta. En una primera fase quirúrgica, el incisivo lateral se extrajo utilizando una técnica de periotoma atraumático. El aloinjerto de hueso cortical particulado se compactó en el sitio para llenar el espacio que anteriormente ocupaba la raíz del diente. La restauración temporal se realizó utilizando el diente natural extraído, que se unió adhesivamente a los dientes adyacentes. Cuatro meses después del injerto, el sitio de extracción mostró una altura y anchura adecuadas del hueso. En una segunda fase quirúrgica, se colocó un implante. Seis meses después de la colocación del implante, se confirmó clínicamente la osteointegración y se realizó una corona provisional atornillada al implante. La restauración final con un pilar de dióxido de circonio y una corona de cerámica completa se obtuvo y se cementó. Conclusiones: La regeneración de la placa bucal fue posible mediante el uso de aloinjerto de hueso cortical particulado y una membrana de colágeno reabsorbible adaptada al defecto óseo y colocada en una posición para recrear la placa bucal. Esto permitió la instalación de un implante 4 meses después. El procedimiento permitió la estética y los resultados funcionales utilizando una única prótesis fija(AU)
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Humanos , Masculino , Pessoa de Meia-Idade , Implantes Dentários/efeitos adversos , Osseointegração/fisiologia , Regeneração Tecidual Guiada/métodos , Aloenxertos/transplanteRESUMO
Introdução: Câncer de mama é o segundo tipo mais comum de câncer entre mulheres no Brasil. Estimam-se 59.700 casos novos de câncer de mama para o biênio 2018-2019. Reconstrução mamária é um procedimento seguro e vários procedimentos cirúrgicos são descritos para sua realização: técnicas conservadoras, retalhos de vizinhança, materiais aloplásticos, retalhos miocutâneos pediculados e microcirúrgicos. O objetivo deste estudo foi analisar os casos de reconstrução mamária pósmastectomia por câncer de mama, realizados em um período de 16 anos. Métodos: Foi realizada revisão de prontuários de pacientes submetidas à reconstrução mamária pós-mastectomia por câncer de mama, no período de janeiro de 2002 a dezembro de 2017. Resultados: No período analisado, 586 pacientes foram submetidas à reconstrução mamária. Em 160 pacientes a reconstrução mamária foi realizada com retalho miocutâneo do músculo retoabdominal (TRAM), 107 com técnicas conservadoras, 156 com retalho miocutâneo do músculo grande dorsal (RGD), 113 com próteses e 50 secundárias. Previamente a outubro de 2007, a porcentagem de pacientes submetidas a cirurgias bilaterais, somando-se TRAM e RGD, era de 30%, e a partir desse período a porcentagem passou para 83,3%. Houve algum tipo de complicação ou intercorrência em 203 (34,64%) pacientes operadas, totalizando de 335 complicações. Grande maioria apresentou intercorrências tratadas ambulatorialmente sem necessidade de reabordagem cirúrgica. Conclusão: Houve aumento da incidência de cirurgias bilaterais, fato atribuído ao aumento das mastectomias profiláticas na mama contralateral e aumento do número de reconstruções utilizando RGD em comparação com o TRAM, bem como o aumento significativo das reconstruções com implante de silicone.
Introduction: Breast cancer is the second most common type of cancer among women in Brazil. An estimated 59,700 new cases of breast cancer were reported in the 20182019 biennium. Breast reconstruction is a safe procedure, and various surgical procedures have been described, including conservative techniques and use of neighborhood flaps, alloplastic materials, and pedicled and microsurgical myocutaneous flaps. The objective of this study was to analyze cases of breast reconstruction after mastectomy for breast cancer performed over a period of 16 years. Methods: We reviewed the medical records of patients who underwent breast reconstruction after mastectomy for breast cancer between January 2002 and December 2017. Results: Within the study period, 586 patients underwent breast reconstruction. Breast reconstruction was performed with a transverse rectus abdominis myocutaneous muscle (TRAM) flap in 160 patients, with conservative techniques in 107 patients, with a latissimus dorsi myocutaneous flap (LDMF) in 156 patients, with prostheses in 113 patients, and secondarily in 50 patients. Before October 2007, the proportion of patients who underwent bilateral surgeries with a TRAM flap and LDMF was 30%, and since then, the percentage has increased to 83.3%. One or more types of complications occurred in 203 patients (34.64%) who underwent surgery, with a total of 335 complications . Most outpatient complications did not require surgical reassessment. Conclusion: The incidence of bilateral surgery increased, which is attributed to the increase in the number of prophylactic mastectomies in the contralateral breast and in the number of reconstructions using a LDMF compared with that using a TRAM flap. A significant increase in the number of reconstructions with silicone implants was also observed.
Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Retalhos Cirúrgicos/cirurgia , Neoplasias da Mama/cirurgia , Procedimentos de Cirurgia Plástica/efeitos adversos , Procedimentos de Cirurgia Plástica/métodos , Mastectomia/efeitos adversos , Mastectomia/métodos , Implantes de MamaRESUMO
Introdução: O melhor método para reconstruir uma unidade anatômica é substituir a área lesada pelos mesmos tecidos. Métodos: Três pacientes que apresentavam carcinomas basocelulares na pálpebra inferior foram submetidos à excisão, seguida de reconstrução imediata com a transposição em espessura total de tecido da pálpebra superior em um só tempo. Resultados: Os pacientes evoluíram quase sem complicações, as pálpebras mantiveram suas funções de fechamento total e proteção do globo ocular. Conclusão: O retalho se mostrou factível e é mais uma alternativa para reconstruir a pálpebra inferior.
Introduction: The best method to reconstruct an anatomical unit is to replace the injured area with the same tissues. Methods: Three patients with basal cell carcinoma in the lower eyelid underwent full-thickness lower eyelid excision, followed by immediate reconstruction with a single-stage fullthickness transposition of the upper eyelid tissue. Results: The patients had almost no complications, and the functions of total closure and protection of the eyeballs of the eyelids were maintained. Conclusion: The flap proved to be feasible and is an alternative choice for reconstruction of the lower eyelid.
Assuntos
Humanos , Retalhos Cirúrgicos/cirurgia , Carcinoma Basocelular/cirurgia , Carcinoma Basocelular/diagnóstico , Procedimentos de Cirurgia Plástica/métodos , Neoplasias Palpebrais/cirurgia , Neoplasias Palpebrais/diagnósticoRESUMO
OBJECTIVES: To evaluate the treatment of gingival recessions by semilunar coronally positioned flap plus enamel matrix derivative (SCPF + EMD). MATERIALS AND METHODS: Thirty patients with class I localized gingival recession were included. They were randomly allocated in two groups: SCPF + EMD and SCPF. Recession height (RH), recession width (RW), width of keratinized tissue (WKT), thickness of keratinized tissue (TKT), probing depth (PD), and clinical attachment level (CAL) were measured at baseline, 6 and 12 months post-surgery. Patient/professional evaluation of esthetics and root sensitivity was performed. RESULTS: After 12 months, mean root coverage was 1.98 ± 0.33 mm for SCPF + EMD (90.86 ± 14.69%) and 1.85 ± 0.41 mm (79.76 ± 17.44%) for SCPF (p > 0.05). The esthetic evaluation by the patient showed preference for SCPF + EMD. According to the professional evaluation (QCE), the use of EMD decreases the appearance of postoperative scar tissue line. There was a significant reduction in root hypersensitivity with no further complaints by the patients. CONCLUSIONS: The addition of EMD provides significantly better esthetics to SCPF, according to patient and professional assessments. SCPF + EMD is effective but not superior to SCPF for root coverage, after 12 months. CLINICAL RELEVANCE: Previous clinical trials showed that the combination of EMD with coronally advanced flaps may enhance the outcome of root coverage. There is a lack of studies testing the combination of EMD with SCPF. The combination SCPF + EMD provides better esthetics when compared to the SCPF and is effective, but not superior, to SCPF for root coverage, after 12 months. TRIAL REGISTRATION: NCT02459704.
Assuntos
Proteínas do Esmalte Dentário/farmacologia , Retração Gengival/cirurgia , Gengivoplastia/métodos , Retalhos Cirúrgicos , Adulto , Método Duplo-Cego , Estética Dentária , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Preferência do Paciente , Resultado do TratamentoRESUMO
Apresentamos o caso de um paciente de 70 anos de idade que evoluiu com extenso defeito cutâneo em parede torácica anterior após ter sido submetido a revascularização do miocárdio e mediastinite pós-operatória. Pela impossibilidade de utilização de retalhos cutâneos e musculares da região, fizemos a reconstrução com a rotação de retalho de omento baseado na artéria gastroepiploica esquerda e enxerto de pele em malha.
We report the case of a 70-year-old patient who developed an extensive skin defect in the anterior chest wall after undergoing myocardial revascularization and postoperative mediastinitis. Owing to the impossibility of using cutaneous and muscular flaps on the region, we performed the reconstruction with an omentum flap based on the left gastroepiploic artery and meshed skin graft.
Assuntos
Humanos , Masculino , Idoso , Omento , Complicações Pós-Operatórias , Retalhos Cirúrgicos , Procedimentos de Cirurgia Plástica , Parede Torácica , Omento/cirurgia , Omento/lesões , Complicações Pós-Operatórias/diagnóstico , Retalhos Cirúrgicos/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Parede Torácica/cirurgia , Parede Torácica/lesõesRESUMO
Introdução: A radiação influencia negativamente os resultados das reconstruções de mama que utilizam implantes. No entanto, os efeitos da radiação sobre as reconstruções de mama apenas com tecidos autólogos ainda não está clara. O objetivo do trabalho é avaliar as complicações pós-operatórias de pacientes submetidas à reconstrução de mama com retalho do músculo reto abdominal (TRAM) imediato e tardio e correlacionar estatisticamente essas complicações com a presença ou não da radioterapia (RT). Métodos: Levantamento retrospectivo de prontuários de pacientes submetidas à reconstrução mamária, das quais 126 pacientes realizaram reconstrução mamária com TRAM no período de 2004 a 2011. Foram analisadas a presença ou não de RT e as complicações pós-operatórias nas reconstruções imediatas e tardias. As pacientes foram divididas em 3 grupos: 1) sem RT (somente TRAM), 2) (TRAMâRT), 3) (RTâTRAM). Para cada grupo foi avaliada a presença e ausência de complicações menores e maiores e aplicados testes estatísticos. Resultados: Os grupos estudados foram considerados homogêneos quanto a idade e índice de massa corporal. Houve maior incidência de complicações maiores nos grupos com RT após o TRAM (29,6%) em relação aos demais grupos: sem RT (23,4%) e RT antes do TRAM (5,6%). Entretanto, a diferença entre os grupos não se mostra estatisticamente significativa. Para as Complicações Menores, também não há evidências de diferenças estatisticamente significativas entre os grupos. Conclusão: Nesse estudo a radioterapia adjuvante não se mostrou como fator potencializador de complicações nas pacientes submetidas à reconstrução imediata com TRAM pós-mastectomia.
Introduction: Radiation negatively influences the results of breast reconstruction using implants. However, the effects of radiation on breast reconstruction with autologous tissue is still unclear. The objective of this study was to evaluate the postoperative complications in patients who underwent immediate and late breast reconstruction with a transverse rectus abdominis myocutaneous (TRAM) flap and statistically correlate these complications with the use of radiotherapy (RT). Methods: A retrospective survey of the medical records of patients who underwent breast reconstruction was conducted. Of the patients, 126 underwent breast reconstruction with a TRAM flap between 2004 and 2011. The presence or absence of RT and postoperative complications in the immediate and late reconstructions was assessed. The patients were divided into 3 groups as follows: 1) without RT (TRAM alone group), 2) TRAMâRT group, and 3) RTâTRAM group. The patients in each group were evaluated for the presence and absence of minor and major complications, and results were statistically analyzed. Results: The groups were considered homogenous for age and body mass index. The incidence of major complications was higher in the groups with RT after TRAM (29.6%) than in the other groups, namely the groups without RT (23.4%) and with RT before TRAM flap reconstruction (5.6%). However, the differences among the groups were not statistically significant. No evidence of statistically significant differences in minor complications were found among the groups. Conclusion: In this study, adjuvant RT was not a potentiating factor of complications in the patients who underwent immediate reconstruction with a TRAM flap after mastectomy.
Assuntos
Humanos , Feminino , História do Século XXI , Complicações Pós-Operatórias , Radioterapia , Retalhos Cirúrgicos , Mama , Prontuários Médicos , Estudos Retrospectivos , Procedimentos de Cirurgia Plástica , Complicações Pós-Operatórias/diagnóstico , Radioterapia/métodos , Retalhos Cirúrgicos/cirurgia , Mama/cirurgia , Mama/efeitos da radiação , Prontuários Médicos/normas , Prontuários Médicos/estatística & dados numéricos , Procedimentos de Cirurgia Plástica/métodosRESUMO
Introdução: O retalho miomucoso de músculo bucinador, descrito em 1989, pode ser utilizado para corrigir fístulas palatinas, fissuras com alongamento do palato mole ou cobrir áreas cruentas após ressecções de tumores. Métodos: Trata-se da análise do resultado após 27 anos de 6 casos de pacientes operados no Hospital de Base e na Santa Casa de São José do Rio Preto, no período de 1984 a 1989, e reavaliados em 2016, nos quais foram realizados retalhos miomucosos de bucinador para correção de fissura palatina. Resultados: Dos 36 casos operados, 6 foram reavaliados após 27 anos, dos quais 5 trataram-se de correção primária e 1 de correção secundária (fístula após fechamento de fissura palatina). Todos os casos obtiveram resultados satisfatórios no crescimento maxilar, na correção da fistula palatina e na função da fala. Conclusão: Apesar de estatisticamente não significativo, o presente estudo demonstrou que o retalho miomucoso de músculo bucinador para correção e alongamento do palato é um procedimento adequado, com resultados de crescimento maxilar normal ou próximo disso e fala praticamente normal, mesmo sem adequado tratamento fonoaudiológico.
Introduction: The buccal musculo-mucosal patch, described in 1989, can be used to correct palatine fistulas and fissures with stretching of the soft palate, or to cover bloody areas after tumor resection. Methods: This is an analysis of the 27-year postoperative results for 6 patients who underwent operation at Base Hospital and Santa Casa de São José do Rio Preto between 1984 and 1989, and reassessed in 2016, when a myo-buccinator mucosa was used for cleft palate correction. Results: Of the 36 operated cases, 6 were reevaluated after 27 years, of which 5 had primary correction and 1 had a secondary correction (fistula after cleft palate closure). All the cases had satisfactory results in terms of maxillary growth, correction of the palatine fistula, and speech function. Conclusion: Although not statistically significant, the present study demonstrated that the buccal musculo-mucosal flap is an adequate procedure for correction and stretching of the palate, with normal or near-normal maxillary growth and practically normal speech even without adequate phono-audiological treatment.
Assuntos
Humanos , História do Século XXI , Palato Mole , Retalhos Cirúrgicos , Insuficiência Velofaríngea , Fenda Labial , Fissura Palatina , Procedimentos Cirúrgicos Bucais , Fístula , Palato Mole/anatomia & histologia , Palato Mole/anormalidades , Palato Mole/cirurgia , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Retalhos Cirúrgicos/cirurgia , Insuficiência Velofaríngea/cirurgia , Insuficiência Velofaríngea/complicações , Insuficiência Velofaríngea/reabilitação , Fenda Labial/cirurgia , Fenda Labial/complicações , Fissura Palatina/cirurgia , Procedimentos Cirúrgicos Bucais/métodos , Fístula/cirurgia , Fístula/complicações , Fístula/reabilitaçãoRESUMO
Mastectomy has been, in the past, the first treatment of choice for locally advanced breast tumors, especially when the neoadjuvant response is partial, and the tumor's location doesn't allow an aesthetic outcome when using usual quadrantectomy. Oncoplastic techniques are good solutions for these tumors allowing to resect big areas, removing the whole tumor and preserving breast symmetry. This case describes a dermoglandular flap technique to be used in advanced upper quadrant tumors in post neoadjuvance patients
A mastectomia foi, no passado, o tratamento de escolha para tumores localmente avançados da mama, especialmente quando a resposta neoadjuvante é parcial e a localização tumoral não permite um bom resultado estético usando como técnica a quadrantectomia. Técnicas oncoplásticas são ótimas opções para esses tumores, uma vez que se ressecam grandes áreas, removendo todo o tumor e preservando a simetria mamária. Este caso descreve uma técnica de retalho dermoglandular a ser usado em tumores do quadrante superior em uma paciente pós-neoadjuvância
RESUMO
Introdução: A reconstrução do complexo areolopapilar (CAP) é etapa fundamental no tratamento do câncer de mama. Tipicamente, é realizada em dois tempos distintos, sendo primeiro a papila reconstruída e somente após sua completa cicatrização que a tatuagem é realizada. Métodos: Estudo retrospectivo realizado no período de 2015 a 2016 no Hospital São Lucas da PUCRS. Foram incluídas 21 pacientes com ausência do CAP unilateral. É descrita a técnica de reconstrução da papila com retalho local em C-V associado à tatuagem para pigmentação do CAP em tempo único. Foram apresentados os dados referentes ao tipo de reconstrução mamária realizada, às complicações e à presença de radioterapia prévia. Resultados: A maioria das pacientes foi reconstruída com implante (48%). Houve três complicações relacionadas à papila (14%), uma necrose parcial e duas deiscências pequenas. Não houve complicação relacionada à tatuagem. Onze pacientes (52%) haviam realizado radioterapia prévia na mama. Conclusão: A tatuagem associada ao retalho em C-V em tempo único é uma técnica simples e com baixo índice de complicações.
Introduction: Reconstruction of the nipple-areola complex (NAC) is a fundamental step in the treatment of breast cancer. It is usually performed in two distinct stages. Tattooing is performed only after reconstruction and complete scarring of the nipple. Methods: This retrospective study was conducted from 2015 to 2016 at the Hospital São Lucas of the Pontifical Catholic University of Rio Grande do Sul. Twenty-one patients with a single NAC were included. One-stage reconstruction of the nipple using a local C-V flap associated with tattooing for pigmentation of the NAC is described. Data on the type of breast reconstruction performed, associated complications, and presence of previous breast radiotherapy were presented. Results: Most patients (48%) underwent reconstruction with an implant. Three complications (14%) were observed in the nipple, including one case of partial necrosis and two cases of small dehiscence. None of the patients had complications due to tattooing. Eleven patients (52%) underwent breast radiotherapy previously. Conclusion: Tattooing combined with one-stage reconstruction using a C-V flap is a simple technique with a low rate of complication.
Assuntos
Humanos , Adulto , Retalhos Cirúrgicos , Tatuagem , Mama , Estudos Retrospectivos , Procedimentos de Cirurgia Plástica , Mamilos , Retalhos Cirúrgicos/cirurgia , Retalhos Cirúrgicos/efeitos adversos , Tatuagem/instrumentação , Tatuagem/métodos , Mama/cirurgia , Procedimentos de Cirurgia Plástica/efeitos adversos , Procedimentos de Cirurgia Plástica/instrumentação , Procedimentos de Cirurgia Plástica/métodos , Mamilos/cirurgia , Mamilos/lesõesRESUMO
INTRODUÇÃO: A cirurgia plástica da mama, por se tratar de um dos procedimentos mais realizados no nosso meio, traz consigo muitas variações técnicas e de táticas cirúrgicas, que proporcionam ao profissional da área da Cirurgia Plástica várias opções técnicas. O objetivo foi avaliar a técnica do retalho superior delgado nas mamoplastias. MÉTODOS: Foram selecionadas 30 pacientes, no período de 2 anos, que apresentavam hipertrofia mamária e/ou ptose mamária. Foi realizada uma técnica utilizando a marcação em T invertido e um retalho inferior número IV de Ribeiro. A modificação introduzida foi a confecção do retalho superior delgado com aproximadamente 2 cm de espessura computando 30% do volume mamário, sendo o retalho inferior responsável por 70% do volume. RESULTADOS: Três colegas especialistas em Cirurgia Plástica por mais de 10 anos avaliaram as pacientes e pudemos observar um resultado no qual 91,5% das pacientes avaliadas se mostraram de ótima qualidade, 6,9% de boa qualidade e apenas 1,6% de resultados regulares, sem resultados ruins. Foram computados 2,6% de complicações, com um caso de infecção, um de assimetria e dois de cicatriz inestética. CONCLUSÃO: O retalho superior delgado se mostrou muito eficaz nas mamoplastias.
INTRODUCTION: For being one of the procedures mostly performed in our environment, breast plastic surgery involves many technical variations and surgical strategies that provide the plastic surgeon with several options. The objective of this study was to evaluate the use of thin superior flap technique in mammoplasties. METHODS: Over a period of 2 years, we selected 30 patients presenting with mammary hypertrophy and/or breast ptosis. A technique based on the inverted-T marking and Ribeiro's type IV inferiorly based flap was carried out. The intervention involved the production of a thin superior flap with a thickness of approximately 2 cm. This comprised 30% of the breast volume, while the inferior flap was responsible for the remaining 70%. RESULTS: Three expert plastic surgeons evaluated the patients. The results showed that 91.5% of the women who underwent this procedure presented with excellent quality outcomes, while 6.9% had a good outcome. Further, a fair outcome was observed only in 1.6% of the patients, while poor outcomes were not obtained. The procedure had a complication rate of 2.6%, which included one case of infection, one of asymmetry, and two of unsightly scars. CONCLUSION: The thin superior flap proved to be very effective in mammoplasties.