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

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

Post-mammoplasty symmastia augmentation with silicone implants: treatment with quilting sutures

Introduction: Augmentation mammoplasty is the most commonly performed esthetic surgical procedure in the United States and second in Brazil. Symmastia is one of its possible complications. This is defined as incorrect medial positioning of the breast implants, which cross the midline, losing the intermammary sulcus. Methods: Work type, series of cases. Two patients underwent symmastia repair after breast augmentation. The access route used was the previous inframammary incision. The repair of the intermammary sulcus was performed by scarification of the anterior and posterior capsule surfaces, associated with adhesion suture with non-absorbable monofilament threat (4 lines with 6 points each, comprising a vertical band of approximately 4 cm wide in the presternal region). In one of the cases, the implant was immediately replaced, and in the other, the procedure was done 3 months later. Results: In both cases, we obtained a new satisfactory intermammary sulcus, with proper esthetic result. No recurrence was observed on follow-ups at 9 and 11 months. Conclusions: The approach with adhesion sutures to redefine the intermammary sulcus was effective in the treatment of symmastia after breast augmentation

Nicotine on the transverse rectus abdominis musculocutaneous flap (TRAM flap), in rats

Introdução: O retalho musculocutâneo transverso do músculo reto do abdome (TRAM é uma das principais opções na reconstrução do relevo mamário pós-mastectomia. A nicotina tem efeito deletério na viabilidade de retalhos cutâneos; porém, não foram encontrados trabalhos experimentais comprovando este efeito em retalhos musculocutâneos. Objetivo: Investigar o efeito da nicotina na viabilidade do retalho TRAM, em ratos. Métodos: Foram utilizados 30 ratos da linhagem Wistar EPM-1. Os animais foram distribuídos aleatoriamente em dois grupos: controle e experimento. Os animais do grupo controle foram tratados com solução salina injetada no tecido celular subcutâneo num volume de 0,2 ml, duas vezes ao dia, durante 28 dias no período pré-operatório. Os animais do grupo experimento foram tratados com nicotina injetada no tecido celular subcutâneo em uma dose de 2 mg/kg/2 vezes ao dia, durante 28 dias no período pré-operatório. Todos os animais foram submetidos ao procedimento do retalho TRAM de base caudal unilateral à direita (pedículo não dominante). 48 horas depois, foi feita a avaliação da área viável de superficie do retalho, por documentação fotográfica e coletadas amostras de pele para dosagens bioquímicas do malondialdeído (MDA). Para análise dos resultados foram utilizados testes não paramétricos: MANNWHITNEY, WILCOXON e Análise de Variância de FRIEDMAN. Resultados: O grupo experimento apresentou uma área de necrose maior, quando comparado com o grupo controle, com significância estatística (p<0,001). Entre os dois grupos não houve diferença nas medidas do MDA. Conclusão: A nicotina aumentou a área de necrose do retalho musculocutâneo transverso do músculo reto do abdome, em ratos.BV UNIFESP: Teses e dissertaçõe

Effect of surgical delay in the transverse rectus abdominis musculocutaneos flap (TRAM flap), in rats

BV UNIFESP: Teses e dissertaçõe