RESUMO
PURPOSE: To investigate the effects of pharmacological delay with insulin-like growth factor-1 (IGF-1) on skin flap survival. METHODS: Thirty Sprague-Dawley rats were submitted to dorsal skin flap (3x9 cm). Seven days before the surgery, the animals were subdivided into three groups of 10 rats. In group 1 (controls), no injection was done. Seven days before the elevation, saline had been injected to the marked skin flap area in group 2 (sham group), and group 3 (experimental group) underwent a pharmacological delay with subcutaneous IGF-1 injections. On the seventh postoperative day, flap area was analyzed for survival. Tissue samples were obtained for histological and biochemical evaluations. RESULTS: Survival rates were 43.55 ± 16%, 21.40 ± 8%, and 43.12 ± 14% in groups 1, 2, and 3, respectively. Differences between group 2 and other groups were statistically significant. No significant difference was detected between all three groups for tissue or plasma vascular endothelial growth factor (VEGF) levels. There was no significant histological difference between groups. CONCLUSION: Although a single injection of insulin-like growth factor-1 (IGF-1) did not significantly increase flap survival, its wound healing features are still encouraging and further meticulously planned studies, especially with repeated applications or controlled-release methods, and combinations with binding protein are required.
Assuntos
Anti-Inflamatórios/farmacologia , Sobrevivência de Enxerto/efeitos dos fármacos , Fator de Crescimento Insulin-Like I/farmacologia , Retalhos Cirúrgicos/fisiologia , Cicatrização/efeitos dos fármacos , Animais , Anti-Inflamatórios/administração & dosagem , Injeções Subcutâneas , Fator de Crescimento Insulin-Like I/administração & dosagem , Ratos , Ratos Sprague-Dawley , Retalhos Cirúrgicos/irrigação sanguínea , Fatores de Crescimento do Endotélio Vascular/sangueRESUMO
ABSTRACT PURPOSE: To investigate the effects of pharmacological delay with insulin-like growth factor-1 (IGF-1) on skin flap survival. METHODS: Thirty Sprague-Dawley rats were submitted to dorsal skin flap (3x9 cm). Seven days before the surgery, the animals were subdivided into three groups of 10 rats. In group 1 (controls), no injection was done. Seven days before the elevation, saline had been injected to the marked skin flap area in group 2 (sham group), and group 3 (experimental group) underwent a pharmacological delay with subcutaneous IGF-1 injections. On the seventh postoperative day, flap area was analyzed for survival. Tissue samples were obtained for histological and biochemical evaluations. RESULTS: Survival rates were 43.55 ± 16%, 21.40 ± 8%, and 43.12 ± 14% in groups 1, 2, and 3, respectively. Differences between group 2 and other groups were statistically significant. No significant difference was detected between all three groups for tissue or plasma vascular endothelial growth factor (VEGF) levels. There was no significant histological difference between groups. CONCLUSION: Although a single injection of insulin-like growth factor-1 (IGF-1) did not significantly increase flap survival, its wound healing features are still encouraging and further meticulously planned studies, especially with repeated applications or controlled-release methods, and combinations with binding protein are required.
Assuntos
Animais , Ratos , Retalhos Cirúrgicos/fisiologia , Cicatrização/efeitos dos fármacos , Fator de Crescimento Insulin-Like I/farmacologia , Sobrevivência de Enxerto/efeitos dos fármacos , Anti-Inflamatórios/farmacologia , Retalhos Cirúrgicos/irrigação sanguínea , Fator de Crescimento Insulin-Like I/administração & dosagem , Ratos Sprague-Dawley , Fatores de Crescimento do Endotélio Vascular/sangue , Injeções Subcutâneas , Anti-Inflamatórios/administração & dosagemRESUMO
PURPOSE: To evaluate the morphology, necrotic area and collagen content in skin flaps of rats subjected to hyperbaric oxygenation (HBO). METHODS: Forty adult rats were divided into four groups: GEC - epilated; GE/HBO - epilated subjected to HBO; GER - epilated submitted to skin flap (2 cm in width /8 cm length in the dorsal area) and GER/HBO - epilated, subjected to skin flap and HBO. HBO (2.4 ATA) was performed for two hours during seven consecutive days. In the eighth day, the rats were anesthetized and the skin flaps were removed and separated into three portions, relative to pedicle fixation. The material fixed in 10% formalin was processed for paraffin embedding; sections were stained by H.E and subjected to picrosirius-red method. The slides examined under light microscopy for evaluation of the collagen content in polarized light microscope and ImageLab(r) software (Bio-Rad). RESULTS: The data showed larger area of necrosis and lower levels of collagen in the three regions of the GER group, whereas in the GER/HBO group the collagen content was similar to the GEC and GE/HBO groups. CONCLUSION: Hyperbaric oxygenation reduced the area of necrosis and preserved the morphology and collagen content in skin flaps of rats.
Assuntos
Colágeno/análise , Oxigenoterapia Hiperbárica/métodos , Transplante de Pele/métodos , Pele/patologia , Retalhos Cirúrgicos/patologia , Retalhos Cirúrgicos/fisiologia , Animais , Biópsia , Necrose/patologia , Distribuição Aleatória , Ratos , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do Tratamento , CicatrizaçãoRESUMO
PURPOSE: To evaluate the morphology, necrotic area and collagen content in skin flaps of rats subjected to hyperbaric oxygenation (HBO). METHODS: Forty adult rats were divided into four groups: GEC - epilated; GE/HBO - epilated subjected to HBO; GER - epilated submitted to skin flap (2 cm in width /8 cm length in the dorsal area) and GER/HBO - epilated, subjected to skin flap and HBO. HBO (2.4 ATA) was performed for two hours during seven consecutive days. In the eighth day, the rats were anesthetized and the skin flaps were removed and separated into three portions, relative to pedicle fixation. The material fixed in 10% formalin was processed for paraffin embedding; sections were stained by H.E and subjected to picrosirius-red method. The slides examined under light microscopy for evaluation of the collagen content in polarized light microscope and ImageLab(r) software (Bio-Rad). RESULTS: The data showed larger area of necrosis and lower levels of collagen in the three regions of the GER group, whereas in the GER/HBO group the collagen content was similar to the GEC and GE/HBO groups. CONCLUSION: Hyperbaric oxygenation reduced the area of necrosis and preserved the morphology and collagen content in skin flaps of rats. .
Assuntos
Animais , Ratos , Colágeno/análise , Oxigenoterapia Hiperbárica/métodos , Transplante de Pele/métodos , Pele/patologia , Retalhos Cirúrgicos/patologia , Retalhos Cirúrgicos/fisiologia , Biópsia , Necrose/patologia , Distribuição Aleatória , Reprodutibilidade dos Testes , Fatores de Tempo , Resultado do Tratamento , CicatrizaçãoRESUMO
PURPOSE: To evaluate the effects of the adipose-derived stem cells (ADSC) in the viability of random skin flap in rats. METHODS: Thirty five adult male Wistar rats (weight 250-300 g) were used. ADSC were isolated from adult male rats (n=5). ADSC were separated, cultured and then analyzed. A dorsal skin flap measuring 10 x 4 cm was raised and a plastic barrier was placed between the flap and its bed. After the surgical procedure, the animals were randomized into two groups (n=15 each group), group control and group ADSC. In all groups the procedures were performed immediately after the surgery. The percentage of flap necrosis was measured on the seventh postoperative day. RESULTS: The ADSC were able to replicate in our culture conditions. We also induced their adipogenic, osteogenic and chondrogenic differentiation, verifying their mesenchymal stem cells potentiality in vitro. The results were statistically significant showing that the ADSC decreased the area of necrosis (p<0.05). CONCLUSION: The cells demonstrated adipogenic, osteogenic and chondrogenic differentiation potential in vitro. The administration of adipose-derived stem cells was effective to increase the viability of the random skin flaps in rats.
Assuntos
Tecido Adiposo/citologia , Sobrevivência de Enxerto/fisiologia , Pele/patologia , Células-Tronco/fisiologia , Retalhos Cirúrgicos/fisiologia , Animais , Diferenciação Celular , Sobrevivência Celular , Células Cultivadas , Masculino , Necrose , Distribuição Aleatória , Ratos Wistar , Retalhos Cirúrgicos/patologia , Sobrevivência de Tecidos/fisiologiaRESUMO
PURPOSE: To evaluate the effects of the adipose-derived stem cells (ADSC) in the viability of random skin flap in rats. METHODS: Thirty five adult male Wistar rats (weight 250-300 g) were used. ADSC were isolated from adult male rats (n=5). ADSC were separated, cultured and then analyzed. A dorsal skin flap measuring 10x4 cm was raised and a plastic barrier was placed between the flap and its bed. After the surgical procedure, the animals were randomized into two groups (n=15 each group), group control and group ADSC. In all groups the procedures were performed immediately after the surgery. The percentage of flap necrosis was measured on the seventh postoperative day. RESULTS: The ADSC were able to replicate in our culture conditions. We also induced their adipogenic, osteogenic and chondrogenic differentiation, verifying their mesenchymal stem cells potentiality in vitro. The results were statistically significant showing that the ADSC decreased the area of necrosis (p<0.05). CONCLUSION: The cells demonstrated adipogenic, osteogenic and chondrogenic differentiation potential in vitro. The administration of adipose-derived stem cells was effective to increase the viability of the random skin flaps in rats. .
Assuntos
Animais , Masculino , Tecido Adiposo/citologia , Sobrevivência de Enxerto/fisiologia , Pele/patologia , Células-Tronco/fisiologia , Retalhos Cirúrgicos/fisiologia , Diferenciação Celular , Sobrevivência Celular , Células Cultivadas , Necrose , Distribuição Aleatória , Ratos Wistar , Retalhos Cirúrgicos/patologia , Sobrevivência de Tecidos/fisiologiaRESUMO
PURPOSE: To develop an experimental model to study and radiologically monitor displacement of skin flaps in the pericranium of rats subjected to traction and surgical fixation using suture anchored in a skull bone tunnel or with N-butyl-2-cyanoacrylate (Histoacryl™) surgical adhesive. METHODS: Radiological markers were placed in the subcutis of Wistar rats undergoing subperiosteal detachment of the pericranium with pulling and fixation of the flap. We performed radiography on postoperative days 3, 7, 14, 21, and 45. A p-value of <0.05 was considered significant. RESULTS: Qualitative analysis of the data indicated that the flaps in the surgical adhesive group remained in place with no change from the immediate postoperative position. However, the flaps in the suture anchored in the skull bone tunnel group and in the control group showed similar healing, with a loss of attachment of 9.7% and 22%, respectively, compared with the immediate postoperative position. There was no quantitative difference between the groups. CONCLUSIONS: This experimental model created acceptable experimental conditions for testing different soft tissue fixation methods. The use of tissue fixatives contributed to better placement of pericranium-cutaneous flaps, and surgical adhesive was superior to suture anchor in the skull bone tunnel for fixation of pericranium-cutaneous flaps.
Assuntos
Modelos Animais , Crânio/cirurgia , Retalhos Cirúrgicos/fisiologia , Adesivos Teciduais , Fixação de Tecidos/métodos , Cicatrização/fisiologia , Animais , Endoscopia/métodos , Masculino , Período Pós-Operatório , Radiografia , Ratos Wistar , Ritidoplastia/métodos , Crânio/diagnóstico por imagem , Âncoras de Sutura , Fatores de TempoRESUMO
PURPOSE: To develop an experimental model to study and radiologically monitor displacement of skin flaps in the pericranium of rats subjected to traction and surgical fixation using suture anchored in a skull bone tunnel or with N-butyl-2-cyanoacrylate (HistoacrylTM) surgical adhesive. METHODS: Radiological markers were placed in the subcutis of Wistar rats undergoing subperiosteal detachment of the pericranium with pulling and fixation of the flap. We performed radiography on postoperative days 3, 7, 14, 21, and 45. A p-value of <0.05 was considered significant. RESULTS: Qualitative analysis of the data indicated that the flaps in the surgical adhesive group remained in place with no change from the immediate postoperative position. However, the flaps in the suture anchored in the skull bone tunnel group and in the control group showed similar healing, with a loss of attachment of 9.7% and 22%, respectively, compared with the immediate postoperative position. There was no quantitative difference between the groups. CONCLUSIONS: This experimental model created acceptable experimental conditions for testing different soft tissue fixation methods. The use of tissue fixatives contributed to better placement of pericranium-cutaneous flaps, and surgical adhesive was superior to suture anchor in the skull bone tunnel for fixation of pericranium-cutaneous flaps.
Assuntos
Animais , Masculino , Modelos Animais , Crânio/cirurgia , Retalhos Cirúrgicos/fisiologia , Adesivos Teciduais , Fixação de Tecidos/métodos , Cicatrização/fisiologia , Endoscopia/métodos , Período Pós-Operatório , Ratos Wistar , Ritidoplastia/métodos , Âncoras de Sutura , Crânio , Fatores de TempoRESUMO
PURPOSE: To evaluate the role of pedicle occlusion on the viable area of a skin island flap. METHODS: An epigastric skin island flap was performed in 160 Wistar rats. The animals were randomly divided into four groups: G-1: occlusion of inferior epigastric artery; G-2: inferior epigastric vein; G-3: inferior epigastric vessels (artery/vein). At varying times postoperatively (2,3,4,5th day), animals from each group were randomly selected, and the pedicle was occluded. On the 10th. postop. day, the skin flaps were evaluated by templates to determine the percentage of surviving skin. The computer HP 9830A captured the photographs and the mean flap necrosis area was assessed. RESULTS: An increasing area of flap survived with less area of necrosis with increased time of days intervals. In the G-1, the mean area of necrosis observed (two to five days) were 95.2, 60.8, 31 and 3.7 % respectively. In the G-2 were 95.5, 57.6, 19.5 and 5.6 % respectively. In the G-3, a 100, 80, 32.4 and 14.9 % of mean area was observed. CONCLUSIONS: The arterial suppy/venous drainage is important for flap circulation up to five days following pedicle occlusion. After this period, the pedicle can be interrupted once the circulation through the flap margins has already been established.(AU)
Assuntos
Animais , Ratos , Retalhos Cirúrgicos/fisiologia , Doenças Vasculares/patologia , Pele/anatomia & histologia , RatosRESUMO
PURPOSE: Compare fibrin glue (Tissucol®) and platelet-rich plasma in full-thickness mesh skin grafts in dogs. METHODS: Eighteen dogs were used, divided into two groups: fibrin glue (FG) and platelet-rich plasma (PRP). In all the animals, a full-thickness 3x3 cm mesh skin graft was implanted. In the left limb, the biomaterial was place between the graft and the receptor bed, according to the group, while the right limb served as the control group. All the animals were evaluated clinically every 48 hours until the 14th day, using the variables of exudation, coloration, edema and cosmetic appearance. Three animals were evaluated histologically, on the third, seventh and tenth postoperative days, using the variables of fibroblasts, collagen, granulation tissue, microscopic integration-adherence and acute inflammation. RESULTS: Clinical evaluations showed that the group CF showed better scores for all variables compared to PRP group. On the histological evaluations PRP group had a higher presence of fibroblasts in the seventh and fourteenth days. CONCLUSION: The fibrin glue group was clinically superior to the platelet-rich group when used on full-thickness skin grafts in dogs.(AU)
OBJETIVO: Comparar a cola de fibrina (Tissucol®) e o plasma rico em plaquetas em enxertos cutâneos de espessura completa em malha em cães. MÉTODOS: Foram utilizados 18 cães, distribuídos em dois grupos, cola de fibrina (CF) e plasma rico em plaquetas (PRP). Em todos os animais foi realizado um enxerto cutâneo de 3x3 cm, em malha de espessura completa. No membro esquerdo foi colocado o biomaterial entre o enxerto e o leito receptor, cada qual em seu grupo, o membro direito serviu como grupo controle. Todos os animais foram avaliados clinicamente a cada 48 horas até o décimo quarto dia, através das variáveis: exsudação, coloração, edema e aspecto cosmético; histologicamente em três animais, no terceiro, sétimo e décimo quarto dia de pós-operatório através das variáveis: fibroblastos, colágeno, tecido de granulação, integração-aderência microscópica e inflamação aguda. RESULTADOS: Avaliações clínicas demonstraram que o grupo CF apresentou melhor escores em todas variáveis quando comparado com o grupo PRP. Nas avaliações histológicas o grupo PRP apresentou maior presença de fibroblastos ao sétimo e décimo quarto dia. CONCLUSÃO: A cola de fibrina foi clinicamente superior ao grupo plasma rico em plaquetas quando usados em enxertos cutâneos de espessura completa em cães.(AU)
Assuntos
Animais , Cães , Retalhos Cirúrgicos/veterinária , Retalhos Cirúrgicos/fisiologia , Cicatrização , Materiais Biocompatíveis/efeitos adversos , Materiais Biocompatíveis , Regeneração , Cães/lesões , Procedimentos Cirúrgicos Dermatológicos/métodosRESUMO
Skin flaps are still a matter of concern among surgeons, as failures can occur leading to flap necrosis. However, low-level laser irradiation has been reported as an effective tool to improve the viability of ischemic flaps, yet its mechanisms of action remain unclear. We investigated the effect of low-level laser irradiation on the viability of random skin flaps in rats and determined COX-2 expression in the flap pedicle. The study animals comprised 24 EPM-1 Wistar rats which were randomly allocated into three equal groups. A cranially based dorsal random skin flap measuring 10 × 4 cm was created in all the animals. In one group, laser irradiation was simulated (sham group), and in the other two groups the animals were irradiated at 12 points with 0.29 J at 20 mW (energy density 10.36 J/cm(2), irradiance 0.71 W/cm(2)), or with 7.3 J at 100 mW (energy density 260.7 J/cm(2), irradiance 3.57 W/cm(2)). These procedures were applied to the cranial half of the flap immediately after surgery and were repeated on days 2 and 5 after surgery. The percentage necrotic area was determined on day 7 after surgery by the paper template method. The immunohistochemical expression of COX-2 in the samples was given scores from 0 to 3. The necrotic area was smaller in group irradiated at 7.3 J compared to sham-treated group and to the group irradiated at 0.29 J (P < 0.05); there was no difference between the sham-treated group and group irradiated at 0.29 J. COX-2 expression was lower in the group irradiated at 7.3 J than in the sham-treated group and the group irradiated at 0.29 J (P < 0.001). Low-level laser therapy was effective in decreasing random skin flap necrosis in rats using a laser energy of 7.30 J per point. Laser irradiation also decreased the expression of COX-2 in the flap pedicle.
Assuntos
Ciclo-Oxigenase 2/metabolismo , Terapia com Luz de Baixa Intensidade , Retalhos Cirúrgicos , Animais , Imuno-Histoquímica , Inflamação/prevenção & controle , Lasers Semicondutores/uso terapêutico , Masculino , Necrose , Ratos , Ratos Wistar , Pele/enzimologia , Pele/patologia , Pele/efeitos da radiação , Retalhos Cirúrgicos/efeitos adversos , Retalhos Cirúrgicos/patologia , Retalhos Cirúrgicos/fisiologiaRESUMO
BACKGROUND: This prospective clinical study aims to evaluate the influence of cigarette smoking on free gingival graft (FGG) healing, by assessing FGG dimensional changes and donor-site wound healing. METHODS: Twelve non-smokers and 10 smokers treatment planned for FGG to augment keratinized tissue dimensions in the mandibular incisor area completed the study. All subjects received standardized FGG of same dimensions. Probing depth, gingival margin position, clinical attachment level, keratinized tissue (KT) width, gingival thickness, and FGG dimensions (width, length, and area) were assessed and recorded before surgery, and 7, 15, 30, 60, and 90 days postoperatively. The palatal donor area was evaluated for immediate bleeding and complete wound epithelialization. Differences between the two groups (smokers and non-smokers) were statistically analyzed. RESULTS: FGG dimensions changed significantly postoperatively. At 90 days postoperatively, FGG width, length, and area were respectively reduced by 31%, 22%, and 44% in non-smokers and by 44%, 25%, and 58% in smokers (no significant differences between groups; P >0.05). Significant KT increases were observed in both non-smokers and smokers (5.4 and 4.8 mm, respectively). Donor-site immediate bleeding was significantly more prevalent in non-smokers (75%) compared to smokers (30%) (P = 0.04). At 15 days postoperatively, donor-site complete epithelialization was much more prevalent in non-smokers (92%) than in smokers (20%) (P <0.002). CONCLUSION: Smoking alters FGG donor-site wound healing by reducing immediate bleeding incidence and by delaying epithelialization, although it does not have discernible effects on postoperative FGG dimensional changes.
Assuntos
Gengiva/transplante , Sobrevivência de Enxerto/fisiologia , Fumar/fisiopatologia , Retalhos Cirúrgicos/patologia , Adulto , Índice de Placa Dentária , Epitélio/patologia , Feminino , Seguimentos , Gengiva/patologia , Hemorragia Gengival/cirurgia , Retração Gengival/cirurgia , Humanos , Queratinas , Masculino , Palato/fisiopatologia , Palato/cirurgia , Perda da Inserção Periodontal/cirurgia , Índice Periodontal , Bolsa Periodontal/cirurgia , Hemorragia Pós-Operatória/classificação , Estudos Prospectivos , Retalhos Cirúrgicos/fisiologia , Coleta de Tecidos e Órgãos , Cicatrização/fisiologiaRESUMO
INTRODUCTION: There are various options for covering soft tissue defects in the lower extremities, but the distal third of the leg continues to be a difficult area. The distally-based sural neurocutaneous flap which is based on the sural nerve and the superficial sural artery has been an important option since it was first proposed. METHODS AND MATERIALS: 16 children, with an average age of 9 years had different local lesions on the distal third of the leg or foot which compromised the Achilles tendon, extensor tendons in the foot and toes or the osteoarticular system, were treated using the distally-based sural flap. One patient had an amputation at midfoot caused by a garden strimmer, seven had lesions caused by motorcycle accidents and eight were caused by car accidents. RESULTS: The minimum follow up was 8 months. In all cases, the lesions were successfully covered. Only one showed necrosis of the flap, but the adipofascial tissue was well irrigated and was resurfaced by a free skin graft. CONCLUSION: The distally-based sural neurocutaneous flap is a good alternative for soft tissue defects in the distal area of the leg, a region where it is historically difficult to cover soft tissue defects.
Assuntos
Traumatismos da Perna/cirurgia , Regeneração Nervosa/fisiologia , Nervo Sural/transplante , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos/inervação , Tendão do Calcâneo/lesões , Tendão do Calcâneo/inervação , Tendão do Calcâneo/cirurgia , Criança , Feminino , Humanos , Masculino , Recuperação de Função Fisiológica/fisiologia , Nervo Sural/irrigação sanguínea , Nervo Sural/fisiologia , Retalhos Cirúrgicos/fisiologia , Cicatrização/fisiologiaRESUMO
Objetivo: O objetivo do trabalho é propor opções para correção da deformidade secundária do lábio fissurado baseado na experiência do serviço. Método: Realizou-se um estudo retrospectivo, descritivo e analítico de uma série de cinqüenta pacientes que foram submetidos a procedimento cirúrgico para correção de deformidade secundária do lábio fissurado no ano de 2007, com seguimento de 4 meses a 16 meses. Foram descritos e discutidos os principais procedimentos cirúrgicos utilizados no serviço para correção das alterações estéticas encontradas. Resultados: Propostas cirúrgicas para desalinhamento da transição cutâneo-mucosa: ressecção vertical em fuso de transição cutâneo-mucosa com quebra cutânea, zetaplastia de transição cutêneo-mucosa, ressecção em triângulo de pele e avanço de vermelhão. Para alterações de vermelhão: ressecção vertical e horizontal em fuso de vermelhão, aumento de vermelhão com retalho v-y de mucosa, aumento de vermelhão com retalho v-y de muscosa invertido, enxerto de gordura, ressecção em cruz de vermelhão, retalho de kaptansky, retalho de Abbé, retalho de rotação e avanço (Millard modificado - Técnica de Gotenborg). Para as alterações resultantes de cicatrizes inestéticas: ressecção em fuso de cicatriz, ressecção em diamante de cicatriz e zetaplastias. Conclusão: O lábio fissurado continua a ser um desafio para o cirurgião, o melhor resultado depende do correto diagnóstico e da escolha da melhor opção para a patologia encontrada.
Assuntos
Humanos , Lábio/anormalidades , Lábio/cirurgia , Retalhos Cirúrgicos/fisiologia , Retalhos Cirúrgicos , Transplante de TecidosRESUMO
Therapeutic ultrasound (TUS) is a widely used coadjuvant physical means to promote biological tissue repair. In the present investigation, the influence of TUS on the integration of full-thickness skin graft was studied in rabbits. Twenty female adult rabbits were used and two 2x2-cm square full-thickness skin grafts were obtained from both scapular regions and swapped, the one cut out on the right being placed on the left and vice versa. The graft on the right was irradiated with TUS (3 MHz, 0.5 W/cm2, 5-min duration) once a day for seven consecutive days, beginning on the third postoperative day; the graft on the left was submitted to simulated irradiation. The animals were killed on the 11th day and the grafted areas were resected (graft+safety margin) for histological examination. Five-mum-thick sections were alternatively stained with Gomori's trichrome, proliferating cell nuclear antigen (PCNA) and picrosirius red and examined under the light microscope, and the epidermal and dermal areas were measured and proliferating cells and new blood vessels counted. The results showed a significant increase (p=0.007) in the number of proliferating epidermal cells (12.18% and 7.34% of the total number of cells in the irradiated and control grafts, respectively) and new blood vessels per field (p=0.0001) in the irradiated grafts (6.27 compared with 3.07). Despite the increased number of proliferating cells and blood vessels, there was no significant difference between the epidermis (246,392 microm2 and 200,626 microm2 in groups 1 and 2, respectively; p=0.07) and dermis (2,157,730 microm2 and 2,109,150 microm2 in groups 1 and 2, respectively; p=0.21) areas as a function of thickness for both groups. We conclude that TUS induces morphological alterations in biological processes, such as epidermic germinative layer cell proliferation and neoangiogenesis, which are involved in the integration of full-thickness skin grafts. This has a potential for clinical use in humans.
Assuntos
Transplante de Pele/fisiologia , Retalhos Cirúrgicos/fisiologia , Terapia por Ultrassom/métodos , Animais , Divisão Celular/fisiologia , Derme/irrigação sanguínea , Derme/patologia , Derme/fisiopatologia , Epiderme/patologia , Epiderme/fisiopatologia , Feminino , Colágenos Fibrilares/fisiologia , Sobrevivência de Enxerto/fisiologia , Neovascularização Fisiológica/fisiologia , Coelhos , Pele/irrigação sanguínea , Pele/patologia , Pele/fisiopatologiaRESUMO
Introdução: O desafio da reconstrução nasal complexa está na necessidade de restaurar o forro e o suporte nasal, respeitando as subunidades do nariz, para obter um resultado estético e funcional satisfatório. Enxertos de cartilagem dependem do forro nasal para a sua vascularização e o forro nasal depende da cartilagem para o seu suporte. Freqüentemente um limitado e inadequado forro determina resultado também limitado. Objetivo: Demonstrar a aplicabilidade de retalhos intra- nasais na reconstrução do forro nasal e do esqueleto de sustentação, em pacientes submetidos a reconstrução nasal. Método e resultado: 03 pacientes com ressecção de carcinoma nasal prévia foram submetidos a reconstrução. O forro nasal foi reconstruído com retalho de mucosa septal pivô. Para estrutura de sustentação utilizou-se o retalho de cartilagem septal em dobradiça - retalho de dequervain. O resultado funcional e estético foi considerado satisfatório. Discussão: Reconstrução de defeitos nasais em espessura total necessitam adequada restauração do forro nasal. Retalhos intranasais de mucosa septal são finos, vascularizados e flexíveis e dão nutrição a cartilagem restaurada. O retalho de cartilagem septal em dobradiça restaura a parede lateral e serve de suporte ao forro. Conclusão: Retalhos intranasais de mucosa e cartilagem septal aplicam-se satisfatoriamente na restauração do forro em pacientes submetidos a reconstrução nasal.
Background: The Challenge of Complex Nasal Reconstruction Is The Necessity To Restore The Lining And The Nasal Support, Respecting The Subunits Of The Nose, To GetA SatisfatoryAesthetic And Functional Result. Cartilage Grafts Depend On Lining For Vascularization, And Lining Depends On The Cartilage Grafts For Support. Frequencily, One Limited And Inadequate Lining Determines A Limited Result. Objective: to demonstrate to the applicability of intranasal flaps in the reconstruction of the nasal lining and support in patients submitted nasal reconstruction. Methods And Results: 03 patients with previous ressection of nasal carcinoma had been submitted the reconstruction. The nasal lining was reconstructed with remnant of septal mucosa. For support it wal used the remnant of septal cartilage in hinge flap - described by de Quervain. The functional and aesthetic result was considered satisfactory. Discussion: Reconstruction of nasal defects in total thickness needs one adequate restoration the nasal lining. Intranasais flaps of septal mucosa are thin, upple and well vascularizated give to nutrition the restored cartilage. The septal cartilage flap in hinge restores the sidewall and serves of support to the lining. Conclusions: Intranasal flaps of mucosa and septal cartilage satisfactorily apply in the restoration of the lining in patients submitted the nasal reconstruction.
Assuntos
Humanos , Masculino , Feminino , Nariz , Retalhos Cirúrgicos , Nariz/anatomia & histologia , Nariz/anormalidades , Nariz/cirurgia , Retalhos Cirúrgicos/estatística & dados numéricos , Retalhos Cirúrgicos/fisiologia , Retalhos Cirúrgicos/patologiaRESUMO
A utilização do retalho total de coxa total thigh flap é um procedimento indicado para o tratamento de gran- des áreas de tecido mole comprometidas e envolvimento das articulações da cintura pélvica. É um retalho fixado no sítio receptor após desarticulação do membro. O trabalho descreve relato de caso de uso do retalho total de coxa para cobertura de escara trocantérica direita complicada com osteomielite e desarticulação acetábulo femoral, após debridamento cirúrgico .
Total thigh flap is indicated for large areas of compromised soft tissue and hip joint involvement. This flap is sutured in place after disarticulation of the extremity. This article describe a clinical case were it was used the total thigh flap for covering a trochanteric ulceration complicated with hip disarticulation osteomyelitis.
Assuntos
Humanos , Masculino , Feminino , Retalhos Cirúrgicos , Úlcera por Pressão , Retalhos Cirúrgicos/fisiologia , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos , Úlcera por Pressão/cirurgia , Úlcera por Pressão/complicaçõesRESUMO
BACKGROUND: Skin flaps are extensively used in plastic surgery, the main postoperative problems being ischemia and necrosis. Nicotine has acute vasoconstrictive properties, diminishing blood flow and increasing the risk of flap necrosis. Transcutaneous electrical nerve stimulation (TENS) was effective in reducing necrosis in random skin flaps in rats. Therefore, the authors decided to test the efficacy of TENS to reduce necrosis in the presence of nicotine. METHODS: Sixteen adult male Wistar-Escola Paulista de Medicina (EPM) rats were distributed, at random, in 2 groups of 8 animals. The nicotine group (NG) received this drug subcutaneously (1.2 mg/kg/d), for 1 week before flap elevation. The nicotine plus TENS group (NTG) followed the same routine. Immediately after the operative procedure and on the next 2 postoperative days, the treatment group (NTG) was submitted to TENS during an hour under anesthesia. NG animals were sham exposed. After 7 days, the percentages of necrosis were determined. RESULTS: The NG had a mean value of 45% and the NTG, 21% of necrosis, a difference statistically significant (P < 0.001). CONCLUSION: TENS was effective in the reduction of necrosis in this flap model.
Assuntos
Necrose/prevenção & controle , Nicotina/farmacologia , Agonistas Nicotínicos/farmacologia , Retalhos Cirúrgicos/patologia , Sobrevivência de Tecidos , Estimulação Elétrica Nervosa Transcutânea , Animais , Masculino , Ratos , Ratos Wistar , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos/fisiologia , Sobrevivência de Tecidos/efeitos dos fármacosRESUMO
OBJETIVO: Verificar se fragmentos de mucosa bucal autógena poderiam ser adequados para reconstrução uretral na presença de tecido fibroso, e se tal procedimento poderia determinar a formação de fístulas e ou saculações nos sítios implantares. MÉTODOS: Sete cães adultos foram submetidos à uretrostomia pré-escrotal. Após 40 dias, a uretrostomia foi corrigida por meio da implantação de fragmentos de mucosa bucal na parede ventral da uretra. Os animais foram observados durante 40 dias, quando então, foram submetidos a exames radiográficos e sacrificados para estudo histológico. RESULTADOS: Todos os animais apresentaram cistite e fístulas uretro-cutâneas de duração média de vinte dias foram observadas em seis deles. O aspecto radiográfico aos 40 dias após a reconstrução uretral mostrou: continuidade luminal em sete animais e presença de saculações na parede ventral da uretra em seis, sem interferência na qualidade do jato urinário. As características histológicas indicam integração completa da mucosa bucal ao sítio receptor. CONCLUSÃO: O implante em retalho ventral, com fragmentos de mucosa bucal autógena é adequado para correção de defeito uretral produzido por uretrostomia no cão embora possa ocorrer a formação de saculações no sítio do selamento.
Assuntos
Animais , Cães , Mucosa Bucal , Retalhos Cirúrgicos/fisiologia , Transplante Autólogo/métodos , UretraRESUMO
Realizou-se um estudo sobre o retalho transverso lombar, descrevendo sua anatomia, técnica operatória, aplicações clínicas e complicações. Baseado em dissecções anatômicas, este retalho é descrito como sendo do tipo axial, em sua porção proximal, nutrido pelos ramos perfurantes das artérias lombares e intercostais e, em sua porção distal, como sendo do tipo randomizado, baseado nos plexos vasculares subdérmicos, que cruzam a linha média da região lombar. Por ser um retalho de fácil execução, com um ótimo aporte sanguíneo e não inviabilizar futuras cirurgias, ele é indicado como primeira opção para o tratamento das úlceras de pressão da região sacral e das lesões localizadas na linha média e adjacências do terço inferior da região lombar.
This is a study concerning transverse lumbar flap that describes its anatomy, surgical technique, clinical applications and complications. Based upon anatomical dissections, this flap is described as with an axial pattern on its proximal portion, irrigated by perfurating branches of lumbar and intercostal arteries, and on its portion as with random pattern due to an uninterrupted subdermal vascular plexus across the midline of back. Being of simple execution, with a good blood supply and not interfiring in possible future operations, it can be indicated as first option for the treatment of sacral pressures sores as well as for lesions located on midline and nearby of the lower third of lumbar area.