ROLF GEMPERLI
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cirurgia, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/04 - Laboratório de Microcirurgia, Hospital das Clínicas, Faculdade de Medicina - Líder
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/04 - Laboratório de Microcirurgia, Hospital das Clínicas, Faculdade de Medicina - Líder
187 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 187
- Aos autores do artigo: “Estudo prospectivo da resposta inflamatória em pacientes submetidas à abdominoplastia pós-cirurgia bariátrica”(2021) OLIVEIRA, PEDRO RODRIGUES DE; DO-NASCIMENTO, LUDMILA CORRêA; DOS-SANTOS, ELIANE MAZZUCO; GOMES, ELONIR; GIULIANI, NáDIA DE ROSSO; MODOLIN, MIGUEL; CINTRA-JUNIOR, WILSON; ROCHA, RODRIGO ITOCAZO; GEMPERLI, ROLF
- Clinical Outcome and Antimicrobial Therapeutic Drug Monitoring for the Treatment of Infections in Acute Burn Patients(2017) MACHADO, Anna Silva; OLIVEIRA, Maura S.; SANCHES, Cristina; SILVA JUNIOR, Carlindo Vieira da; GOMEZ, David S.; GEMPERLI, Rolf; SANTOS, Silvia Regina Cavani Jorge; LEVIN, Anna S.Purpose: In critical burn patients, the pharmacokinetic parameters (absorption, distribution, metabolism, and excretion) of many classes of drugs, including antibiotics, are altered. The aim of this study was to compare 2 groups of burn patients undergoing treatment for health care associated infections with and without therapeutic drug monitoring. Methods: A retrospective analysis of a clinical intervention (ie, a before/after study) was conducted with patients with health care associated pneumonia, burn infection, bloodstream infection, and urinary tract infection in the burn intensive care unit of a tertiary care hospital. The patients were divided into 2 groups: (1) those admitted from May 2005 to October 2008 who received conventional antimicrobial dose regimens; and (2) those admitted from November 2008 to June 2011 who received antibiotics (imipenem, meropenem, piperacillin, and vancomycin) with doses adjusted according to plasma monitoring and pharmacokinetic modeling. General characteristics of the groups were analyzed, as were clinical outcomes and 14-day and in-hospital mortality. Findings: Sixty-three patients formed the conventional treatment group, and 77 comprised the monitored treatment group. The groups were homogeneous, median age was 31 years (range: 1-90) and 66% were male. Improvement occurred in 60% of the patients under monitored treatment (vs 52% with conventional treatment); 14-day mortality was 16% vs 14%; and the in-hospital mortality was similar between groups (39% vs 36%). In the final multivariate models, variables significantly associated with in-hospital mortality were total burn surface area >= 30%, older age, and male sex. Treatment group did not affect the prognosis.
- Effect of neoadjuvant chemotherapy on women undergoing breast cancer surgery and immediate breast reconstruction with latissimus dorsi flap and silicone implants(2017) D'ALESSANDRO, Gabriel Salum; POVEDANO, Alejandro; SANTOS, Lauren Klas Kurk Leme dos; MUNHOZ, Alexandre Mendonca; GEMPERLI, Rolf; GOES, Joao Carlos de SampaioThe use of the latissimus dorsi flap in immediate breast reconstruction is a relatively simple procedure using a flap with a very reliable and consistent vascularity. Neoadjuvant chemotherapy improves local surgical conditions; however, most chemotherapeutic agents are cytotoxic and may increase the risk of postoperative complications. This study evaluated the effects of neoadjuvant chemotherapy on women with cancer who underwent immediate breast reconstruction with latissimus dorsi flap and silicone implants. Data were collected from medical records of 102 patients with cancer who had undergone immediate breast reconstruction with latissimus dorsi flap and silicone implants from August 2010 to December 2014. Thirty-three patients received neoadjuvant chemotherapy (study group) and 69 patients underwent primary surgical treatment (control group). Three (2.9%) patients in the study group had a major postoperative complication (two cases of hematoma requiring surgical drainage and a case of flap necrosis), which was the only variable showing a significant difference between groups (P = 0.032). Neoadjuvant chemotherapy followed by cancer surgery with immediate breast reconstruction with latissimus dorsi flap and silicone implants was not associated with an increased risk of postoperative surgical and clinical minor complications. It was associated with a significant increase in postoperative major complications, despite the small number of cases. However, patients who received neoadjuvant chemotherapy had a significantly more aggressive disease and advanced-stage cancer, and required a more extensive cancer surgery.
- Usefulness of Radio Frequency Identification Device in Diagnosing Rotation of Motiva SmoothSilk Implants after Augmentation Mammoplasty(2019) MUNHOZ, Alexandre Mendonca; CHALA, Luciano; MELO, Giselle Guedes de; MARQUES FILHO, Ary de Azevedo; TUCUNDUVA, Tatiana; GEMPERLI, RolfBreast implant displacement has been described as a significant risk following augmentation mammoplasty. Magnetic resonance imaging (MRI) is considered the method of choice for diagnosing implant complications, but it has its limits in assessing correct implant position and displacement. Motiva SmoothSilk/SilkSurface (R) Implants (MSS) are the first to incorporate a radio frequency identification device (RFID), which produces an imaging artifact in MRI sequences. Given the frequency of breast augmentation procedures and the recent US Food and Drug Administration prospective trial involving SS with RFID, further analysis of implant stability and diagnostic imaging methods to evaluate implant positioning is necessary. The objective of this study was to assess the use of MRI with this new RFID-containing implant as a new tool to assess correct implant positioning. The authors performed this technique in 5 patients (10 implants) undergoing primary breast augmentation or revision surgery with MSS implants (255-385 cc, mean = 325 cc). The average area and volume of the artifact were 15.7 cm(2) and 31.75 cm(3), respectively. All cases presented satisfactory results, with 1 case of implant displacement. Our clinical and radiological outcome demonstrated that RFID technology is a useful tool for correct visualization of the implant position and diagnosis of complications such as slight displacements or rotation. To our knowledge, this is the first RFID breast implant that has been objectively evaluated for MRI issues.
bookPart Iniciação científica em cirurgia plástica na graduação médica(2015) MUNHOZ, Alexandre Mendonça; GEMPERLI, Rolf- Chimerical anterolateral thigh flap for plantar reconstruction(2015) OLIVAN, Marcelo V.; BUSNARDO, Fabio F.; FARIA, Jose C.; COLTRO, Pedro S.; GRILLO, Victor A.; GEMPERLI, RolfObjectiveThe purpose of this study is to evaluate the results of reconstruction and rehabilitation of patients with plantar defects by using a chimerical flap of muscle and skin from anterolateral thigh. MethodsTwenty-five patients with plantar defects were reconstructed with a chimerical anterolateral thigh (ALT) flap, composed by a vastus lateralis muscle segment and a thinned skin island. Neurorrhaphy between lateral femoral cutaneous nerve and calcaneal nerve was performed in 7 patients. Evaluation of flap contour and stability and patient ambulation was performed 6 and 12 months after surgery. Evaluation of cutaneous sensiblity of ALT flap and contralateral thigh was performed 12 months after surgery using Pressure Specified Sensory Device (PSSD). ResultsFlap viability was complete in 23 patients and 2 patients had complications with partial flap loss of its cutaneous component. Six months postoperatively, flap contour, and stability was considered good in 19 and 21 patients respectively, and all 25 patients presented good ambulation. Twelve months postoperatively, all 25 patients presented good flap contour and stability, as well as good ambulation. All 7 flaps undergoing to reinnervation partially recovered cutaneous sensibility in comparison to donor site (contralateral thigh). Cutaneous tactile thresholds (g/mm(2)) of static one-point test and moving one-point test from the ALT flap and the contralateral thigh presented statistically significant differences, for both comparisons (P=0.009, P=0.002). ConclusionThis flap is suitable for reconstruction of plantar defects, with good flap contour and stability, proper patient ambulation and low complication rates. (c) 2015 Wiley Periodicals, Inc. Microsurgery 35:546-552, 2015.
- Case Report: Stage VI Morel-Lavallee Lesion with a Large Challenging Defect(2021) NICOLAS, Gregory; ABBAS, Laielly; PRADO, Ariadne; TAKEMURA, Rafael Eiki; WADA, Alexandre; GOMEZ, David Souza; GEMPERLI, RolfMorel-Lavallee lesion (MLL) is a closed degloving soft-tissue injury that results in the accumulation of a hemolymphatic fluid between the skin/superficial fascia and the deep fascia. This is a rare injury that may be challenging to diagnose, and necessitates early identification and treatment to achieve the best outcomes. We report the case of a 45-year-old male patient who was referred to our institution for large wound closure after undergoing debridement of a misdiagnosed MLL that became complicated by infection and sepsis. The patient was retrospectively diagnosed with a Stage VI MLL and had to undergo 4 operations with skin grafting and vacuum-assisted closure therapy playing an essential role in achieving tissue closure. This case was presented as a reminder of this rare diagnosis, and the importance of considering it when faced with a patient presenting with a relevant clinical picture post trauma. An early diagnosis is important because early intervention can prevent complications and lead to better outcomes. The misdiagnosis in the case of our patient and delayed treatment led to an aggressive debridement with a large wound that was challenging to close.
- Braquioplastia pós-gastroplastia: avaliação da satisfação dos pacientes(2014) CINTRA JUNIOR, WILSON; MODOLIN, MIGUEL; KASABKOJIAN, STEPHANIE TOSCANO; ROCHA, RODRIGO ITOCAZO; ZAMPIERI, LÍGIA; GEMPERLI, ROLFABSTRACT Introduction: Upper limb deformity caused by massive weight loss can be corrected by brachioplasty. This plastic surgery improves limb contour, facilitates hygiene, and enables use of certain clothing. Objective: To present the cases, describe interventions and complications, and evaluate the satisfaction of patients who underwent brachioplasty after bariatric surgery. Method: Herein, 34 patients (including 33 females) aged 46.6 ± 12 years, who underwent brachioplasty after bariatric surgery, were recruited for the study. Interventions and complications associated with the surgical procedure were described, and the satisfaction of 33 patients was evaluated by a qualitative interview and specific questionnaire. Results: As a minor complication, slight dehiscence was observed in five patients (14.7%), but no major surgical complications were seen. Some degree of satisfaction was reported by 81.8% of the patients, and the outcome achieved in 69.7% was close to that expected. Conclusions: The brachioplasty techniques that were used restored proper arm contour with a low rate of minor complications, and a high degree of satisfaction among the patients evaluated.
- Outcome Analysis of Immediate and Delayed Conservative Breast Surgery Reconstruction With Mastopexy and Reduction Mammaplasty Techniques(2011) MUNHOZ, Alexandre Mendonca; ALDRIGHI, Claudia Maria; MONTAG, Eduardo; ARRUDA, Eduardo; BRASIL, Jose Augusto; FILASSI, Jose Roberto; ALDRIGHI, Jose Mendes; GEMPERLI, Rolf; FERREIRA, Marcus CastroBackground: Bilateral mammaplasty or mastopexy is frequently used for oncoplastic objectives. However, little information has been available regarding outcome following immediate and delayed reconstruction. Method: Patients were divided into Group I (immediate reconstruction) and Group II (delayed reconstruction). Retrospective review was performed to compare complications, length of hospital stay, revision surgeries, and satisfaction. The associations between the complications with potential risk factors (timing, age, body mass index, smoking, and comorbid medical conditions) were analyzed. Results: There were a total of 144 patients with a mean follow-up of 47 months. Of the 106 patients in Group I, complications occurred in 24 (22.6%), skin necrosis was observed in 7.5%, fat necrosis in 5.6%, and 6.6% patients developed local recurrence. Mean period of hospitalization was 1.89 days. Of the 38 patients of the Group II, complications occurred in 12 (31.5%), skin necrosis was observed in 7 (18.4%), fat necrosis in 4 (10.5%), and 5.2% patients developed local recurrence. Mean period of hospitalization was 1.35 days. Increased length of hospital stay greater than 1 day (P < 0.001) and the number of revision surgeries (P = 0.043) were associated with the timing of the reconstruction. In univariate analysis, no difference between groups was found with respect to complication incidence (P = 0.275); however, after adjusting for other risk factors, the probability of complications tend to be higher for Group II (OR = 2.65; 95% confidence interval - 1.01-7.00; P = 0.049). Conclusions: On the basis of the results of our study, the probability of complications tends to be higher for delayed reconstructions, and it is demonstrated that obesity and smoking are risk factors for complications. Ultimately, these data may facilitate the provision of individualized risk information for shared medical decision-making.
article 13 Citação(ões) na Scopus Current Approaches to Managing Partial Breast Defects: The Role of Conservative Breast Surgery Reconstruction(2014) MUNHOZ, Alexandre Mendoca; MONTAG, Eduardo; FILASSI, Jose Roberto; GEMPERLI, RolfRecently breast surgeons can offer patients a variety of treatment and reconstructive alternatives when early breast cancer is diagnosed. In fact, advances in reconstructive techniques have reduced surgical trauma and thus are capable of preserving the breast form as well as quality of life. Depending on a variety of different factors, including stage, tumor size, location, hystological type, but also breast volume, a reconstructive schedule is established. The main techniques are related to volume displacement or replacement procedures including local flaps, latissimus dorsi myocutaneous flap and reduction mammaplasty/ masthopexy. Regardless of the fact that there are is no consensus over the best approach, the criteria are determined by the surgeon's experience and the size of the defect in relation to the size of the remaining breast. Aim of every reconstructive procedure decision should be breast preservation and an adequate aesthetic outcome. Additionally, reconstruction permits wider excision of the tumor, with a superior mean volume of the specimen and potentially reducing the incidence of margin involvement. The objective of this review is to give an overview of reconstructive modalities for conservative breast surgery, based not only on traditional but also on the latest studies regarding the outcome of the main techniques employed. Surgical approaches, as well as conservative treatment options, such as lumpectomy and quadrantectomy, are further discussed. Surgical planning should include the patients' preferences, while chiefly addressing individual reconstructive requirements, and enabling each patient to receive an individual ""custom-made"" reconstruction.