Uso de células-tronco derivadas de tecido adiposo para redução de complicações da cicatrização cutânea em indivíduos tabagistas : um modelo experimental em ratos

Objetivo: Testar o uso das células-tronco derivadas de tecido adiposo (CTDA) para redução da área de necrose em um modelo experimental de retalho cutâneo randômico isquêmico em ratos, com injeção de nicotina subcutânea para simular um indivíduo tabagista. Métodos: Em um estudo experimental, 30 ratos foram operados utilizando um modelo de retalho cutâneo isquêmico no dorso, à partir da injeção de nicotina subcutânea. Outros 10 ratos foram utilizados apenas para obtenção das CTDA. O primeiro grupo, de tratamento (n=15), recebeu injeção com CTDA ao final da cirurgia; o outro grupo, controle (n=15), não recebeu intervenções adicionais. Após a eutanásia, foi realizado um decalque de toda a área do retalho do dorso de ambos os grupos, definindo com exatidão a transição da necrose com a região saudável. Fotos de todos animais foram tiradas e avaliadas por escalas padronizadas pelo programa Paint-Autocad-2015 para definir a área de necrose de retalho em cada rato. O teste T de Student foi usado para comparar os grupos, sendo p<0,05 considerado significativo. Resultados calculado no SPSS IBM® versão 18. Resultados: Por meio da análise das imagens pelo programa Paint-Autocad- 2015 e área de decalque obtido pela folha transparente, obteve-se uma média de 46% de necrose da área total do retalho no grupo tratamento e 69,4% no grupo controle. Na análise descritiva, foi evidenciado no grupo tratamento uma média de 3,7cm de necrose IC 95% (3,2 - 4,2) e no grupo controle uma média de 5,56 cm IC 95% (5,2 – 5,9) com p< 0,001. Conclusões: Concluímos que a aplicação das CTDA em um modelo experimental de retalho cutâneo randômico em ratos com injeção de nicotina subcutânea reduz o percentual de necrose nos mesmos.Objectives: To test the use of adipose-derived stem cells (ADSC) in reducing the necrosis area in an experimental model of cutaneous ischemic flap in rats submitted to subcutaneous nicotine injection to simulate a smoker patient. Methods: In an experimental study, 30 rats were enrolled. Divided into two experimental groups of 15 animals all submitted to a subcutaneous nicotine injection to created an ischemic cutaneous flaps on their backs. Other 10 animals were used only to obtain adipose tissue derived stem cells (ADSC). The first group (n = 15) received ADSC treatment at the end of surgery while the other group, the control (n = 15), received no other interventions. After euthanasia, a decal was performed on the whole area of the flap, accurately defining the transition from necrosis to healthy region. Photos of all animals were collected and evaluated by scales standardized by PaintAutocad- 2015 software to define the area of flap necrosis in each rat. Student T test were performed to compared the groups, considering a p< 0.05 significant. Data were analyzed using SPSS IBM® 18 version. Results: Through the analysis of the images by the program Paint-Autocad-2015 and the area of decal obtained by the transparent sheet, we obtained a mean of 46% necrosis of the total area of the flap in the treatment group and 69.4% in the control group. In the descriptive analysis, a mean of 3.7 cm of necrosis CI95% (3.2 - 4.2) was evident in the treatment group whereas a mean value of 5.56 CI 95% (5.2 - 5.9) was found in control group, with p value <0.001 for this comparison. Conclusions: We concluded that the application of ADSC reduces the percentage of necrosis in an experimental model of randomized cutaneous flap in rats submitted to subcutaneous nicotine injection

Nanofat injector: a low-cost disposable device for standardization and optimization of grafting time

Introduction: Nanofat graft improves skin quality in damage secondary to aging and scar sequelae. We present the initial results of the nanofat graft using a low-cost disposable device, proposing a standardization of its use according to the area to be treated. Methods: A prospective cohort was conducted from July 2019 to March 2020. The inclusion criterion was patients who underwent nanofat grafting for skin treatment. The exclusion criterion was the previous performance of some invasive treatment of the skin. Twenty consecutive patients who met the prerequisites were analyzed. The results were evaluated in the 6th postoperative month. The patients answered a questionnaire, classifying from 1 - very bad to 10 - excellent, changes in skin quality. Results: The twenty patients followed did not present any postoperative complications. Edema after the application was reduced between three and seven days. There was no hematoma or infection. Patients who underwent only nanofat grafting without another associated surgery could return to their activities after 24 hours. The scores reported by patients at 6 months were between 7 and 10, with a mean of 8. Conclusion: The use of the SmartneedleTM system for nanofat grafting presents patient satisfaction similar to other application methods and allows a uniform and standardized distribution of the graft according to the anatomical region and optimizing surgical tim

Clinical profile and outcomes of primary percutaneous coronary intervention in young patients

AbstractBackgroundThe epidemiology of acute myocardial infarction with ST-segment elevation (STEMI) has been modified in recent years, focusing on young people. Our goal was compare the clinical profile, laboratory, angiographic, and 30-day clinical outcomes of patients ≤ 40 years with those > 40 years undergoing primary percutaneous coronary intervention (pPCI).MethodsProspective cohort study of consecutive patients undergoing pPCI between 2009 and 2011.ResultsA total of 1,055 patients were included, 3.3% of them ≤ 40 years. Young patients were more often black, smokers and with a family history of coronary artery disease, and less often hypertensive and dyslipidemic. In patients ≤ 40 years, leukocyte count and ultrasensitive troponin levels at admission were higher, and high density lipoprotein-cholesterol, lower. The left anterior descending artery as a culprit vessel and left ventricular ejection fraction did not differ between groups. Although the TIMI 3 flow pre-intervention was similar, young people showed higher prevalence of myocardial blush 3 pre-procedure. The door-to-balloon time was lower in younger patients (1.0 hour [0.8-1.4 hour] vs. 1.3 hour [0.9-1.7 hour]; p = 0.03). At 30 days, patients ≤ 40 years had a mortality of 0% vs. 8.8% for patients > 40 years (p = 0.07).ConclusionsPatients ≤ 40 years with STEMI and undergoing pPCI show differences in clinical, angiographic and procedural characteristics compared to those > 40 years. In this analysis, representative of the current medical practice, the 30-day mortality of these patients was very low

Complications of lipoabdominoplasty without Scarpa fascia preservation versus classic abdominoplasty : a prospective blind study

Introdução: Abdominoplastia é um dos procedimentos cirúrgicos estéticos mais realizados. Seroma é a complicação local mais comum associada com abdominoplastia, com uma incidência média de 10%. A maior incidência de seroma pósoperatório (PO) ocorre no décimo primeiro dia PO. Ecografia abdominal é o método de escolha para o diagnóstico de seroma após abdominoplastia. Novas técnicas surgiram ao longo dos anos na tentativa de trazer melhores resultados estéticos com menos complicações, como lipoabdominoplastia descrita por Saldanha. Porém, estudos anatômicos recentes questionam a necessidade da manutenção da fáscia de Scarpa descrita na técnica de lipoabdominoplastia, descrevendo que em torno de 90% do sistema linfático abdominal está no plano subdérmico e 10% em um sistema linfático profundo justaaponeurose abdominal. O objetivo é comparar a incidência de seroma na lipoabdominoplastia sem preservação da fáscia de Scarpa com a abdominoplastia clássica. Métodos: Coorte prospectiva, cega na qual serão analisados 40 pacientes consecutivos que realizaram abdominoplastia sem lipoaspiração associada (n = 20) ou lipoabdominoplastia (n = 20) no Hospital de Clínicas de Porto Alegre entre abril de 2016 e maio de 2017. Todos foram submetidos à ecografia de parede abdominal no 10o dia PO. Resultados: A incidência de seroma foi de 5% (n = 1) no grupo de abdominoplastia clássica e de 10% (n = 2) no grupo de lipoabdominoplastia, sem diferença estatística. Conclusão: Estes resultados, neste grupo de pacientes, mostram que não houve diferença estatística entre os dois grupos.Introduction: Abdominoplasty is among the most commonly performed surgical procedures. Seroma is the most common local complication associated with abdominoplasty, with an average incidence of 10%. The highest incidence of postoperative (PO) seroma occurs on the eleventh postoperative day (POD). Abdominal ultrasound is the method of choice for diagnosing seroma after abdominoplasty. New techniques have emerged aiming to improve aesthetic results with fewer complications, such as lipoabdominoplasty described by Saldanha. However, recent anatomical studies have questioned the need for Scarpa fascia preservation recommended in the lipoabdominoplasty technique, describing that around 90% of the abdominal lymphatic system is in the subdermal plane, while the other 10% is in a deep lymphatic system near the abdominal aponeurosis. The objective is to compare the incidence of seroma in lipoabdominoplasty without Scarpa fascia preservation to that in classic abdominoplasty. Methods: Prospective blinded cohort in which 40 consecutive patients who underwent abdominoplasty without associated liposuction (n = 20) or lipoabdominoplasty (n = 20) at the Hospital de Clínicas of Porto Alegre between April 2016 and May 2017 were analyzed. All patients underwent abdominal wall ultrasonography on the tenth POD. Results: The incidence of seroma was 5% (n = 1) in the classic abdominoplasty group and 10% (n = 2) in the lipoabdominoplasty group, with no statistical difference. Conclusion: These results showed no statistically significant intergroup difference in seroma development