Chest wall reconstruction using abdominal rectus and latissimus dorsi muscle flaps: case report

INTRODUCTION: Chest wall reconstruction remains one of the great plastic surgery repair challenges. The present work aims to report on cases of chest wall reconstruction using myocutaneous flaps after wall resection due to tumor/osteomyelitis. METHODS: Four patients were included, among which three presented with osteomyelitis and the other presented with sarcoma; both of these conditions affected the chest wall. Each patient underwent wall resection and reconstruction using myocutaneous flaps from the latissimus dorsi (two cases) and abdominal rectus (two cases). RESULTS: The flaps used were sufficient for skin-muscle covering and maintained good vitality. Partial flap injury occurred in one case. Chest cavity stability was preserved. CONCLUSIONS: The use of the above flaps to repair chest defects was satisfactory with the aim of covering the skin and providing well-vascularized muscles, the latter of which was fundamental to preventing local infection

Reconstrução de polegar utilizando o segundo pododáctilo: Thumb reconstruction using the second pododactyl

Introdução: O polegar permite uma grande amplitude de movimentos essenciais para as atividades cotidianas. Portanto, a amputação traumática do primeiro quirodáctilo provoca um significativo comprometimento estético e funcional. Nesses casos, a reconstrução do polegar utilizando dedo do pé constitui-se como opção terapêutica, devendo-se avaliar cada caso individualmente. Objetivos: Descrever e avaliar as técnicas cirúrgicas realizadas em dois pacientes com transferência do segundo pododáctilo para a mão devido à amputação traumática. Caso clínico: Dois pacientes do sexo masculino foram submetidos a cirurgias de reconstrução do polegar com transferência do segundo pododáctilo para a mão numa clínica privada localizada na cidade de Fortaleza – Ceará. O primeiro paciente teve amputação total, inclusive do metacarpo, já o segundo teve amputação de falange média e distal. Em ambos os casos, utilizou-se o segundo pododáctilo para a reconstrução do polegar. No pós-operatório tardio, os pacientes evoluíram estética e funcionalmente bem. Considerações finais:  O transplante de dedos do pé para a mão, em casos de trauma, como a amputação do polegar, apesar da sua complexidade e dos riscos de complicações, apresenta resultados estéticos e funcionais favoráveis ao paciente

Blepharoplasty with canthopexy in a patient with cutis laxa: A case report

Cutis laxa is a rare connective tissue disease characterized by dysfunction of elastic fibers. Individuals affected by this disease complain about their aged appearance. Treatments are based on the use of cosmetics or surgical techniques, with plastic surgery being an extremely relevant tool. Blepharoplasty aims to improve the senile appearance and provide rejuvenation in the area around the eyes, making the look appear more rested and alert. This is a retrospective observational study using medical record data. Case Report: A female patient, 17 years old, was referred to the Plastic Surgery Service of the Walter Cantídio University Hospital, Fortaleza-CE, for treatment due to dissatisfaction with her appearance. She underwent upper and lower blepharoplasty associated with canthopexy without canthotomy. In the postoperative period, a satisfactory result was observed for the proposed surgery and adequate correction of existing changes. Conclusion: The importance of facial surgical correction in cases of lax skin is observed, highlighting the relevance of applying appropriate surgical techniques and improving them in this patient profile

Effect of lung recruitment and titrated Positive End-Expiratory Pressure (PEEP) vs low PEEP on mortality in patients with acute respiratory distress syndrome - A randomized clinical trial

IMPORTANCE: The effects of recruitment maneuvers and positive end-expiratory pressure (PEEP) titration on clinical outcomes in patients with acute respiratory distress syndrome (ARDS) remain uncertain. OBJECTIVE: To determine if lung recruitment associated with PEEP titration according to the best respiratory-system compliance decreases 28-day mortality of patients with moderate to severe ARDS compared with a conventional low-PEEP strategy. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, randomized trial conducted at 120 intensive care units (ICUs) from 9 countries from November 17, 2011, through April 25, 2017, enrolling adults with moderate to severe ARDS. INTERVENTIONS: An experimental strategy with a lung recruitment maneuver and PEEP titration according to the best respiratory-system compliance (n = 501; experimental group) or a control strategy of low PEEP (n = 509). All patients received volume-assist control mode until weaning. MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause mortality until 28 days. Secondary outcomes were length of ICU and hospital stay; ventilator-free days through day 28; pneumothorax requiring drainage within 7 days; barotrauma within 7 days; and ICU, in-hospital, and 6-month mortality. RESULTS: A total of 1010 patients (37.5% female; mean [SD] age, 50.9 [17.4] years) were enrolled and followed up. At 28 days, 277 of 501 patients (55.3%) in the experimental group and 251 of 509 patients (49.3%) in the control group had died (hazard ratio [HR], 1.20; 95% CI, 1.01 to 1.42; P = .041). Compared with the control group, the experimental group strategy increased 6-month mortality (65.3% vs 59.9%; HR, 1.18; 95% CI, 1.01 to 1.38; P = .04), decreased the number of mean ventilator-free days (5.3 vs 6.4; difference, −1.1; 95% CI, −2.1 to −0.1; P = .03), increased the risk of pneumothorax requiring drainage (3.2% vs 1.2%; difference, 2.0%; 95% CI, 0.0% to 4.0%; P = .03), and the risk of barotrauma (5.6% vs 1.6%; difference, 4.0%; 95% CI, 1.5% to 6.5%; P = .001). There were no significant differences in the length of ICU stay, length of hospital stay, ICU mortality, and in-hospital mortality. CONCLUSIONS AND RELEVANCE: In patients with moderate to severe ARDS, a strategy with lung recruitment and titrated PEEP compared with low PEEP increased 28-day all-cause mortality. These findings do not support the routine use of lung recruitment maneuver and PEEP titration in these patients. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01374022