Reconstrução mamária com retalho do músculo grande dorsal e materiais aloplásticos: análise de resultados e proposta de nova tática para cobertura do implante Breast reconstruction with the latissimus dorsi muscle flap and alloplastic materials: analysis of results and proposal of a new technique to cover the implant

INTRODUÇÃO: A reconstrução mamária ocupa lugar de destaque na cirurgia plástica e exige maior doação, entrosamento e confiança entre as especialidades médicas envolvidas e a paciente. O objetivo deste trabalho é analisar os resultados das reconstruções mamárias com o músculo grande dorsal e propor uma tática para melhor cobertura e posicionamento do implante. MÉTODO: Dezenove pacientes, 2 delas submetidas a cirurgia bilateral, totalizando 21 reconstruções, foram operadas entre junho de 2006 e junho de 2009. As pacientes foram analisadas por meio de questionário sobre aspectos estéticos e funcionais da reconstrução. Foram estudadas intercorrências, complicações e melhora estética com uso do implante sob dupla camada muscular. RESULTADOS: O índice de complicações foi pequeno, e em apenas um caso houve necessidade de reabordagem cirúrgica para reposicionar o implante em relação ao sulco submamário. Após o procedimento, 94% das pacientes afirmaram que tiveram suas expectativas atingidas, 64% não referiram limitações funcionais e 18% referiram limitações leves. O fato de colocar os implantes (próteses ou expansores) sob o músculo peitoral maior e cobrir o conjunto com o retalho do músculo dorsal melhora o contorno, pois abole ou suaviza as dobras e a aparência dos implantes nos quadrantes superiores e mediais das neomamas. CONCLUSÕES: As reconstruções mamárias com retalho do músculo grande dorsal associado a implantes de silicone podem oferecer excelentes resultados, com baixos índices de complicações. A colocação do implante sob dupla camada muscular proporciona a obtenção de mais harmonia nos quadrantes superiores das neomamas.BACKGROUND: Breast reconstruction is distinct among plastic surgery techniques in that it requires the integration of several medical specialties as well as coordination with the patient. The aim of the present study was to analyze the results of breast reconstruction with the latissimus dorsi myocutaneous flap, and propose a strategy for better coverage and positioning of the implant. METHODS: The study included 19 patients who underwent surgery between June 2006 and June 2009. Bilateral surgery was performed in 2 patients, and a total of 21 reconstructions were analyzed. The patients filled out a questionnaire on the aesthetic and functional aspects of the reconstruction. The complications, problems, and aesthetic improvement associated with the use of implants placed under a double layer of muscle were assessed. RESULTS: A low rate of complications was reported, and only one case required a new surgical intervention to reposition the implant in relation to the inframammary crease. After the procedure, 94% of the patients reported that their expectations had been met, 64% reported no functional limitations, and 18% reported mild limitations. The placement of implants (prostheses or expanders) under the pectoralis major muscle, using the latissimus dorsi muscle flap to cover the implant improved the breast contour by softening the inframammary crease and positioning the implants in the upper and medial quadrants of the new breasts. CONCLUSIONS: Breast reconstruction using silicone implants and the latissimus dorsi muscle flap can have excellent outcomes, with low rates of complications. Placing the implant under a double layer of muscle improves the harmony of the upper quadrants during breast reconstruction

Reconstrução mamária de resgate: a importância dos retalhos miocutâneos

INTRODUÇÃO: A reconstrução mamária pode apresentar um resultado estético insatisfatório ou complicações que comprometam o resultado final. Nesses casos, pode-se realizar a reconstrução mamária de resgate, que é definida como uma revisão completa de uma reconstrução prévia, em caso de resultado insatisfatório ou falha da primeira reconstrução. Este trabalho tem como objetivo reportar a experiência dos autores na realização da reconstrução mamária de resgate pós-mastectomia por câncer de mama. MÉTODO: Estudo retrospectivo de prontuários de pacientes submetidas a reconstrução mamária de resgate, no período de março de 2002 a março de 2012. RESULTADOS: Foram identificados 57 casos de reconstrução mamária de resgate. Com relação à cirurgia inicial, 20 foram realizadas com próteses, 16 com retalho miocutâneo do músculo reto abdominal (TRAM), 11 com expansores, 6 cirurgias conservadoras e 4 com retalho miocutâneo do músculo grande dorsal (RGD). A principal causa de falha das reconstruções foi por motivos estéticos, seguida de necrose, contratura capsular e infecção e/ou exposição de implantes. A reconstrução de resgate foi realizada em 27 pacientes com emprego de RGD (P < 0,0001), em 16, com TRAM, e em 14, com material aloplástico. Em 57,9% dos casos, o cirurgião que realizou a reconstrução de resgate não foi o cirurgião da reconstrução inicial. CONCLUSÕES: A maioria das cirurgias que apresentaram resultados insatisfatórios foi realizada com materiais aloplásticos, sendo a principal causa o aspecto estético deficiente. As reconstruções de resgate foram realizadas principalmente com retalhos miocutâneos e por profissionais diferentes da primeira cirurgia. Os retalhos miocutâneos apresentam boa aplicabilidade nas reconstruções de resgate, por fornecerem tecido sadio e bem vascularizado a uma área manipulada previamente

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data

NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics

Xenarthrans—anteaters, sloths, and armadillos—have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, 10 anteaters, and 6 sloths. Our data set includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the southern United States, Mexico, and Caribbean countries at the northern portion of the Neotropics, to the austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n = 5,941), and Cyclopes sp. have the fewest (n = 240). The armadillo species with the most data is Dasypus novemcinctus (n = 11,588), and the fewest data are recorded for Calyptophractus retusus (n = 33). With regard to sloth species, Bradypus variegatus has the most records (n = 962), and Bradypus pygmaeus has the fewest (n = 12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other data sets of Neotropical Series that will become available very soon (i.e., Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans data set. Please cite this data paper when using its data in publications. We also request that researchers and teachers inform us of how they are using these data