Tratamento da ptose mamária bilateral e do pectus excavatum através da mesma incisão no mesmo tempo cirúrgico

CONTEXT: Congenital deformities of the anterior thoracic wall are characterized by unusual development of the costal cartilages. All these medical conditions are frequently associated with a variety of breast deformities. Several surgical techniques have been described for correcting them, going from sternochondroplasty to, nowadays, minimally invasive techniques and silicone prosthesis implantation. CASE REPORT: The present article reports the case of a young female patient who presented bilateral mammary ptosis and moderate pectus excavatum that caused a protrusion between the eighth and the tenth ribs and consequent esthetic disharmony. The proposed surgical treatment included not only subglandular breast implants of polyurethane, but also resection of part of the rib cartilage and a bone segment from the eighth, ninth and tenth ribs by means of a single submammary incision in order to make the scar minimally visible. Correction through a single incision benefited the patient and provided an excellent esthetic result. CONCLUSIONS: The techniques used to repair bilateral mammary ptosis and pectus excavatum by plastic and thoracic surgery teams, respectively, have been shown to be efficient for correcting both deformities. An excellent esthetic and functional result was obtained, with consequent reestablishment of the patient's self-esteem.CONTEXTO: Deformidades congênitas da parede torácica anterior são caracterizadas pelo desenvolvimento anormal das cartilagens costais. Todas essas afecções são frequentemente associadas com as mais diferentes deformidades da mama. Várias técnicas cirúrgicas têm sido utilizadas para a correção desde as esternocondroplastias até, atualmente, técnicas minimamente invasivas e próteses de silicone. RELATO DE CASO: O presente artigo relata o caso de uma paciente jovem que apresentava ptose mamária bilateral e uma forma moderada de pectus excavatum que ocasionava uma protrusão entre a oitava e a décima costelas, tendo como consequencia a desarmonia estética. O tratamento cirúrgico proposto incluiu, além de implantes mamários sub-glandulares de poliuretano, ressecção de parte da cartilagem da costela e parte do segmento ósseo da oitava, nona e décima costelas por uma única incisão sub-mamária para tornar a cicatriz minimamente visível. A correção por meio de uma única incisão beneficiou a paciente, proporcionando excelente resultado estético. CONCLUSÕES: As técnicas utilizadas para reparação da ptose mamária bilateral e do pectus excavatum pelas equipes de cirurgia plástica e torácica, respectivamente, demonstraram-se eficazes para correção de ambas as deformidades. Foi obtido ótimo resultado estético e funcional com consequente retomada da auto-estima da paciente.Universidade Católica de PelotasUniversidade Federal de PelotasUniversidade Federal de São Paulo (UNIFESP) Department of Surgery Division of Operative Technique and Experimental SurgeryUNIFESP, Department of Surgery Division of Operative Technique and Experimental SurgerySciEL

A gastrocnemius heterotopical transplant model with end-to-side neurorraphy

PURPOSE: To present an animal model to assess the effects of end-to-side innervation in the heterotopically transplanted model with reduced chances of neural contamination.METHODS:The medial portion of the gastrocnemius muscle in wistar male rats was isolated and its pedicle dissected and performed a flap in the abdominal portion. To prevent neural contamination in the abdominal region, the muscle was wrapped with a Goretex(r) sheet. The specimens were divided into 2 groups (G). In G1 was performed an end-to-end suture between tibial nerve of the gastrocnemius and femoral motor nerve and between the saphenous sensory nerve and the motor nerve. In G2 was performed a end-to-side suture between the tibial nerve and the motor femoral and between the tibial nerve and saphenous motor nerve. The specimens were evaluated 60 days later to check the structure of the neurorraphy. Sections were obtained proximal and distal to the coaptation site.RESULTS:The medial gastrocnemius muscle had the advantage of maintaining visible mass after 60 days. No disruption of the coaptation site was found. No major injury to the donor nerve was seen in group 2.CONCLUSION: The proposed model is simple, reproduciple and prevent the neural contamination in the flap in end-to-side suture.Federal University of São Paulo Paulista School of MedicinePontifícia Universidade Católica do Rio Grande do Sul Hospital São LucasMcMaster UniversityFederal University of Health ScienceFederal University of Pelotas Departament of SurgeryUNIFESPUNIFESP, EPMSciEL

An experimental model to retraining in microvascular suture

PURPOSE: To demonstrate an experimental model of up to four hours a week of independent study that allows relearning in microvascular sutures.METHODS: Wistar rats between 200 and 500 grams surplus research experiments were used. Femoral vessels are covered on one or both sides through a groin incision obliquely along the inguinal ligament. Femoral artery and vein are isolated and measured being clamped and cut. The individual performs in microvascular anastomosis complexity arterial and venous terminoterminal sequence. terminolateral and venous and arterial grafts in vessels. Permeability is evaluated by testing vascular patency after creation of microvascular anastomosis.RESULTS: In the first specimen, only arterial and venous vascular anastomosis are performed terminoterminal. The average diameter of the femoral veins varies from 0.8 to 2 mm between rodents (artery, between 0.6 and 1.4 mm, between 0.8 and 2 mm vein). The superficiality of the vessels allows faster dissection, may also be held in other inguinal region.CONCLUSION: The model of individual retraining allows learning microvascular suture in individuals of permanent staff.Federal University of São Paulo Paulista School of MedicineFederal University of Health ScienceFederal University of Pelotas Department of SurgeryUNIFESPUNIFESP, EPMSciEL

Does hyperbaric oxygenation have a protective effect on random skin flaps?: an immunohistochemical study of cellular apoptosis and vascular endothelial growth factor

BACKGROUND: Hyperbaric oxygenation (HBO) therapy aims to increase oxygen tissue pressure by at least 10 times and decrease the adverse effects of ischemia. The aim of this study was to investigate the effect of HBO on the immunohistochemical expressions of caspase 3 and vascular endothelial growth factor (VEGF) in random flaps in rats. METHODS: Thirty-two male Wistar rats were randomly divided into 4 groups: the sham group (GS), the N-acetylcysteine group (GNAC), the HBO group, and the HBO + N-acetylcysteine group. A rectangular skin flap (2 × 8 cm) was dissected from the dorsal muscle layer, and a cranial pedicle was preserved. A polyethylene film was placed on the muscle layer, and the flap was fixed in the original site. On the eighth day, biopsy samples (2 × 1 cm) of the entire thickness of the proximal, medial, and cranial areas as well as of the site outside the flap, which was used as a control, were collected. RESULTS: VEGF expression in the skin layers and vessels was not significantly different between the groups. The number of apoptotic cells was significantly increased in the area of the flap in all groups. The highest increase was noted in the GS and GNAC groups. HBO significantly reduced the number of caspase 3-positive cells in the skin layers and vessels of the 3 areas. CONCLUSIONS: HBO was associated with decreased apoptosis. VEGF expression in the skin layers and vessels did not differ significantly. The results suggest that oxygen diffusion through the interstitial space was the determining factor for the positive effect of HBO on the decrease in apoptosis.INTRODUÇÃO: A oxigenação hiperbárica (OHB) tem por objetivo aumentar em pelo menos 10 vezes a pressão tecidual de oxigênio, diminuindo os efeitos deletérios da isquemia. O objetivo deste estudo é investigar o papel da oxigenação hiperbárica na expressão imuno-histoquímica da caspase 3 e do fator de crescimento endotelial vascular (VEGF) em retalhos randômicos em ratos. MÉTODO: Trinta e dois ratos Wistar machos foram divididos aleatoriamente em quatro grupos: grupo sham (GS), grupo N-acetilcisteína (GNAC), grupo OHB (GOHB) e grupo OHB + N-acetilcisteína (GHN). Um retalho de pele retangular (2 cm x 8 cm) foi dissecado a partir da camada muscular dorsal, preservando um pedículo cranial. Uma lâmina de polietileno foi colocada sobre a camada muscular e fixou-se o retalho no local original. No 8º dia, foram coletadas biópsias (2 cm x 1 cm) de espessura total das áreas proximal, média e cranial e de um local fora do retalho, que serviu como área de controle. RESULTADOS: A expressão de VEGF nas camadas da pele e nos vasos não apresentou diferenças significativas entre os grupos. As células apoptóticas estavam significativamente aumentadas na área central do retalho em todos os grupos. O maior aumento ocorreu nos grupos GS e GNAC. A OHB diminuiu significativamente o número de células caspase 3 positivas nas camadas da pele e nos vasos das três áreas. CONCLUSÕES: A OHB foi associada a expressão reduzida de apoptose. A expressão de VEGF em camadas da pele e vasos não demonstrou diferença significativa. Os resultados sugerem que a difusão do oxigênio através do espaço intersticial foi o fator determinante para os resultados mais favoráveis da OHB na diminuição da expressão de apoptose.Sociedade Brasileira de Cirurgia PlásticaUniversidade Católica de Pelotas Departamento de CirurgiaUniversidade Federal de São Paulo (UNIFESP) Departamento de CirurgiaUniversidade Federal de PelotasUniversidade Federal de Pelotas Liga Acadêmica de Cirurgia PlásticaUNIFESP, Depto. de CirurgiaSciEL

Effects of hyperbaric oxygenation and N-acetylcysteine on the survival of random-pattern skin flaps in rats

BACKGROUND: Advances in plastic surgery techniques have enabled reconstruction of extensive wound damage, especially through the use of random flaps. However, the limiting factor for the use of these flaps is the unpredictable blood supply, which may produce irreversible damage to the microcirculation and result in partial or complete flap necrosis, making the wound more susceptible to infection. Therefore, improvement of random flaps, especially in the distal extremity, has been an essential goal for the success of this technique. The objective of this study was to investigate the effects of hyperbaric oxygenation (HBO), N-acetylcysteine (NAC), and the combination of both (HBO + NAC) on the degree of necrosis in modified McFarlane random skin flaps on Wistar rats. METHODS: A total of 32 male Wistar rats were randomly divided into a sham treatment group (SG, n = 8), N-acetylcysteine group (NACG, n = 8), hyperbaric oxygenation group (HBOG, n = 8), and hyperbaric oxygenation plus N-acetylcysteine group (HNG, n = 8). Modified McFarlane random flaps were created in the dorsal region of the rats. RESULTS: The average area of the flaps exhibiting necrosis was 18.3%, 24.3%, 12.6%, and 14.9%, in the SG, NACG, HBOG, and HNG, respectively. The necrotic areas in the HBOG and HNG were significantly smaller than that in the NACG. CONCLUSIONS: HBO treatment was associated with a reduction in the area of necrosis in the skin flaps. NAC treatment alone gave poor results. The use of HBO and NAC in combination did not improve the outcome compared with the use of HBO alone. The findings suggest that oxygen diffusion through the interstitial space was the factor responsible for the favorable results of HBO.INTRODUÇÃO: Os avanços das técnicas em cirurgia plástica permitiram a reconstrução de extensos defeitos causados por ferimentos, entre as quais destaca-se a utilização dos retalhos randômicos. No entanto, o fator limitante para a utilização desses retalhos é a imprevisibilidade de sua vascularização distal, o que poderá ocasionar danos irreversíveis à microcirculação, resultando em necrose parcial ou completa do retalho, tornando a ferida mais suscetível a infecção. Portanto, melhorar a viabilidade do retalho randômico, principalmente em sua extremidade distal, tem sido uma meta importante para o sucesso dessa técnica. O objetivo deste estudo foi investigar o papel da oxigenação hiperbárica (OHB), da N-acetilcisteína (NAC) e da associação de ambas (OHB + NAC) na área de necrose em retalhos randômicos modificados de McFarlane em pele de ratos Wistar. MÉTODO: No total, 32 ratos Wistar machos foram divididos aleatoriamente em grupo Sham (GS, n = 8), grupo N-acetilcisteína (GNAC, n = 8), grupo oxigênio hiperbárico (GOHB, n = 8) e grupo oxigênio hiperbárico + N-acetilcisteína (GHN, n = 8). Sob anestesia geral, foi executado um retalho randômico modificado de McFarlane na região dorsal dos ratos. RESULTADOS: A necrose média foi de 18,3%, 24,3%, 12,6% e 14,9%, respectivamente, nos grupos GS, GNAC, GOHB e GHN. Os grupos GOHB e GHN apresentaram diferença significativa quando comparados ao grupo GNAC. CONCLUSÕES: A OHB está associada a redução da área de necrose do retalho cutâneo. A NAC foi associada a maus resultados quando usada isoladamente. A associação dos dois procedimentos, OHB e NAC, não potencializou os resultados favoráveis observados com o uso da OHB isoladamente. As descobertas sugerem que a difusão de oxigênio através do espaço intersticial foi o fator determinante de resultados mais favoráveis da OHB.Universidade Federal de São Paulo (UNIFESP) Departamento de CirurgiaUNIFESP, Depto. de CirurgiaSciEL

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Consistent patterns of common species across tropical tree communities

Trees structure the Earth’s most biodiverse ecosystem, tropical forests. The vast number of tree species presents a formidable challenge to understanding these forests, including their response to environmental change, as very little is known about most tropical tree species. A focus on the common species may circumvent this challenge. Here we investigate abundance patterns of common tree species using inventory data on 1,003,805 trees with trunk diameters of at least 10 cm across 1,568 locations1,2,3,4,5,6 in closed-canopy, structurally intact old-growth tropical forests in Africa, Amazonia and Southeast Asia. We estimate that 2.2%, 2.2% and 2.3% of species comprise 50% of the tropical trees in these regions, respectively. Extrapolating across all closed-canopy tropical forests, we estimate that just 1,053 species comprise half of Earth’s 800 billion tropical trees with trunk diameters of at least 10 cm. Despite differing biogeographic, climatic and anthropogenic histories7, we find notably consistent patterns of common species and species abundance distributions across the continents. This suggests that fundamental mechanisms of tree community assembly may apply to all tropical forests. Resampling analyses show that the most common species are likely to belong to a manageable list of known species, enabling targeted efforts to understand their ecology. Although they do not detract from the importance of rare species, our results open new opportunities to understand the world’s most diverse forests, including modelling their response to environmental change, by focusing on the common species that constitute the majority of their trees.Publisher PDFPeer reviewe