Cicatricial Ectropion: Repair with Full-Thickness Skin Graft

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Ectrópio Cicatricial: Correção com Enxerto de Pele Total

Mulher, 82 anos, caucasiana, submetida à excisão de car-cinoma espinocelular da região malar medial superior e pálpebra inferior medial direita e encerramento com re-talho malar (avanço e rotação). Registaram-se infeção e deiscência parcial de sutura no pós-operatório.

Treatment of retracted, postsurgical scars and reduction of locoregional edema using a combined three-dimensional approach of liposuction lipofilling, dissecting cannulas, and suspension sutures

Background : Post-surgical abdominal and inguinal scars are a frequent challenge in plastic surgery. There are limited non-invasive alternatives to address depressed and retracted scars. The associated retraction and fibrosis might cause lymphatic dysfunction with subsequent regional edema. The authors describe a combined surgical approach of liposuction, the use of dissecting cannulas, lipofilling, and Scarpa’s fascia suspension sutures in a prospective case series. Methods: The proposed procedure was performed in 22 consecutive patients between November 2012 and May 2015. Complications were assessed according to the Clavien-Dindo scale. Postoperative psychosocial, edema reduction, and patient satisfaction outcomes were gathered and analyzed based on blinded questionaries (Rosenberg Self-Esteem scale and a Cosmetic Procedures Screening Questionnaire (COPS)). Results: At 6 months, no major complications and 27.2% minor complications (Clavien-Dindo 1) were recorded. Four patients had superficial infections that settled with oral antibiotics and two patients developed a seroma. A significant improvement in self-esteem, aesthetic satisfaction, and social competence was found postoperatively in all patients. The novel technique reduced regional edema and scar-related self-consciousness. Patient satisfaction was rated very high, and all patients would recommend this surgery for abdominal or inguinal retracted scars. Conclusions: This study shows that the proposed technique is a safe minimally invasive alternative for the treatment of abdominal and inguinal retracted scars. The relatively high rate of minor complications is mainly due to the strict definition of the scale used. The results showed an improvement of local edema and high patient satisfaction. Level of evidence: Level IV, therapeuti

Reconstruction of a Major Facial Defect with Multiple Z-Plasty Dermatologic Surgery Article

A plastia em Z é uma técnica cirúrgica classicamente utilizada na correção de cicatrizes. Consiste numa dupla transposição de dois ou mais retalhos adjacentes de configuração triangular resultando numa cicatriz com a forma da letra Z. Este procedimento é especialmente vantajoso quando a incisão cirúrgica não é paralela às linhas de tensão da pele, pois permite o reposicionamento dos vetores de tensão, tendendo a um resultado cosmético mais favorável e prevenindo retrações cicatriciais. Apresenta-se o caso de uma mulher jovem com um carcinoma basocelular da região supraciliar esquerda cuja excisão resultou num defeito cirúrgico extenso o qual foi reconstruído com recurso a uma plastia em Z-múltipla. Os autores descrevem a técnica cirúrgica bem como as principais vantagens e aplicabilidade da mesma.  Z-plasty is a surgical technique classically used to correct scars. It consists of a double transposition of two or more adjacent triangular-shaped flaps resulting in a Z-shaped scar. This procedure is especially advantageous when the surgical incision is not parallel to the skin tension lines as it allows repositioning of the tension vectors, tending to a more favorable cosmetic result and preventing scar retractions. We present the case of a young woman with a left supraciliary basal cell carcinoma whose excision resulted in an extensive surgical defect which was reconstructed using a multiple Z-patch. The authors describe the surgical technique as well as its main advantages and applicability. &nbsp

Treatment of wounds: general principles

O tratamento de feridas complexas é considerado um desafio para os especialistas, pois envolve múltiplos aspectos locais e sistêmicos os quais influenciam o sucesso terapêutico. Este artigo tem por objetivo rever os princípios gerais do tratamento das feridas e esclarecer acadêmicos e médicos generalistas acerca de conceitos básicos a serem seguidos em todos pacientes portadores de feridas complexas. Os conceitos universais do tratamento das feridas incluem avaliação completa do paciente assim como controle de suas comorbidades. Ao tratar um paciente com ferida complexa atentar ao seu estado nutricional, ao controle de suas comorbidades e patologias de base, controlar infecção local na ferida ou sistêmica, aliviar a pressão nas feridas e nos plégicos aliviar as posições viciadas, contraturas e espasmosThe treatment of complex wounds is considered a challenge to experts, due to many local and systemic aspects involved in the therapeutic success. This article aimed to discuss the general principles of wound treatment, to provide students and general physicians about basic concepts to be followed in all patients who have complex wounds. The universal concepts of wound treatment include full assessment of the patient as well as control of their comorbidities. In order to correctly treat a complex wound all physicians must pay attention to the nutritional status of the patients, to the control of pathologies and comorbidities, to a local or systemic wound infection, to relieve pressure and the addicted positions due to paralysis as well as contractions and spasms

Z-plasty in the treatment of unilateral cleft lip: review of its history

The study reviews the use of Z-plasty in the cheiloplasty techniques used to treat unilateral cleft lip. It highlights the contribution of Brazilian authors, especially that of Perseu Lemos. It also reports the conduct adopted by the senior author in this type of cheiloplasty

Características: síntesis cutánea postcolecistectomía laparascópica en Hospitales José Carrasco Arteaga y Vicente Corral Moscoso 2013

La colecistectomía laparoscópica es la cirugía de elección para la colelitiasis; para la síntesis de las heridas producidas por los puertos laparoscópicos existen opciones como nylon, y poliglactina 910, materiales con características físicas y efectos tisulares específicos que marcan diferencias sobre el paciente. Objetivo general: describir las características clínicas que se presentan en la síntesis de heridas post colecistectomía laparoscópica con poliglactina 910 y nylon en los hospitales José Carrasco Arteaga y Vicente Corral Moscoso 2013. Materiales y método: estudio descriptivo longitudinal. Se incluyó pacientes de edades entre 18 a 90 años que acudieron al servicio de Cirugía de los hospitales Vicente Corral Moscoso y José Carrasco Arteaga y que se sometieron a colecistectomía laparoscópica. Resultados: con nylon el dolor postoperatorio a las 8 horas fue leve en 94,06%, a los 7 días no hubo dolor en el 98,75%. La cicatriz a los 7 días fue grado 1 en 99,06%. Presentó signos de infección a los 7 días el 1,56% y a los 15 días 0.31%. En cuanto a la poliglactina 910 el dolor a las 8 horas fue leve en un 70,93%, mientras que a los 7 días no hubo dolor en el 100 %. La cicatriz al día 7 fue grado 1 en un 100 %. Signos de infección se observó a los 7 y 15 días en el 1,16% de los pacientes. Discusión: al parecer el uso de las suturas absorbibles presenta un mejor resultado en cuanto a cicatriz y dolor posoperatorio. El índice de infecciones con las dos suturas no supera el índice internacional de infecciones esperada en laparoscopia (1 al 3%). Conclusión: la poliglactina 910 presenta mejores resultados en cuanto a cicatriz y dolor postoperatorio y similares porcentajes de infección con respecto al nylon. Descriptores DeCS: COLECISTECTOMIA LAPAROSCOPICA/EFECTOS ADVERSOS, NYLONS/EFECTOS ADVERSOS, POLIGLACTINA 910/EFECTOS ADVERSOS. CICATRIZ/CIRUGÍA, DOLOR POSTOPERATORIO, INFECCIÓN DE HERIDA OPERATORIA/COMPLICACIONES.Laparoscopic cholecystectomy is the gold standard for cholelithiasis. We have options like nylon and polyglactin 910 to close skin in laparoscopic procedures. These materials have specific physical characteristics and tissue effects that make a difference in the patient. Objective: To describe the clinical features presented in the close skin wounds after laparoscopic cholecystectomy with polyglactin 910 and nylon in and José Carrasco Arteaga and Vicente Corral Moscoso Hospitals 2013. Materials and methods: a longitudinal study. All patients between 18 to 90 years old that came to the surgery department of José Carrasco Arteaga and Vicente Corral Moscoso Hospitals were included in this research. Results: in patients that the skin wound were closed with nylon the postoperative pain at the 8 hours after operation were low in 94.06 % of patients; there were no pain in 98.75% at 7th day. Scars at 7th days were grade 1 in 99.06 %. The 1.56 % of patients showed signs of infection at 7th day and 0.31 % at 15th day. For polyglactin 910 the postoperative pain were low in 70.93 % of patients and there was no pain in the 100% at 7th day. Scars at 7th day were grade 1 in the 100%. Signs of infection were observed in the 1.16 % of the patients at 7 and 15 days. Discussion: apparently the use of absorbable sutures has a better outcome in terms of postoperative pain and scarring. The rate of infection is similar with these sutures and it is less than the expected laparoscopy index infections (1 to 3%). Conclusion: polyglactin 910 shows better results in terms of postoperative pain and scarring and similar rates of infection compared to nylon. DeCS Descriptors: NYLONS/ADVERSE EFFECTS, POLYGLACTIN 910/ADVERSE EFFECTS, CICATRIX/SURGERY, PAIN POSTOPERATIVE, SURGICAL WOUND INFECTION/COMPLICATIONS.Especialista en Cirugía GeneralCuenc