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
15 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 15
- 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.
- Surgical Treatment of Extracranial Arteriovenous Malformations after Multiple Embolizations: Outcomes in a Series of 31 Patients(2015) GOLDENBERG, Dov C.; HIRAKI, Patricia Y.; CALDAS, Jose Guilherme; PUGLIA, Paulo; MARQUES, Tatiana M.; GEMPERLI, RolfBackground: Surgical resection after embolization is the most accepted approach to treating arteriovenous malformations. The authors analyzed the outcome of surgically treated patients and how surgical resection was influenced by multiple embolizations. Methods: Thirty-one patients were included from January of 2000 to December of 2012. The mean patient age was 24.9 years. Anatomical involvement, definition of limits, functional impairment, number of embolizations, type of resection, reconstruction method, blood transfusion, and hospital stay were evaluated. Morbidity, mortality, and regrowth rates and need for additional procedures were evaluated. Results: Lesions were preferentially located at the orbits, cheeks, and lips. The number of embolizations per patient increased with lesion complexity. In 22 cases, total excision was accomplished, and in nine, subtotal resections were performed to favor function. After multiple embolizations, better lesion identification was observed. Primary closure was performed in 20 cases, local flaps were performed in seven cases, axial flaps were performed in two patients, and free flaps were performed in two cases. There were no deaths. Regrowth rates were influenced by limits between arteriovenous malformations and surrounding tissues (15.8 percent of cases with precise limits versus 58.3 percent of lesions with imprecise limits; p = 0.021) and by type of resection (18.2 percent of cases after total resection versus 66.7 percent after subtotal resections; p = 0.015). Conclusions: Multiple therapeutic embolizations seem to increase safety in the treatment of arteriovenous vascular malformations and suggest an additional positive effect besides bleeding control. Preoperative definition of limits and establishment of conditions for total resection are critical to determine management and risk of regrowth.
- Comparison of neurosensory devices in detecting cutaneous thresholds related to protective sensibility: A cross-sectional study in Sao Paulo, Brazil(2019) CARVALHO, V. F.; UEDA, T.; PAGGIARO, A. O.; NASCIMENTO, A. R. F.; FERREIRA, M. C.; GEMPERLI, R.Aims: To quantify the static and moving cutaneous sensibility threshold of diabetic patients using a neurosensory device for quantitative pressure detection. Methods: Three hundred thirty-four (n = 334) patients with type 2 diabetes and no previous history of wounds on the feet were studied using the one- and two-point static (1SP;2 SP) and one- and two-point moving (1MP;2 MP) tests through the pressure-specified sensory device (PSSD) on the cutaneous territory of the dorsal first web, hallux pulp, and medial calcaneal. In addition, patients were evaluated using the Semmes-Weinstein monofilament (SWM) No. 5.07 and tuning fork (128 Hz), which were used as normality parameters to detect the loss of protective sensibility. The same examinations were used to assess the control group (228 nondiabetic). Results: Altered values were observed for the static and moving tests over the three studied nerve territories. In comparing the sensibility threshold between diabetic patients who were sensitive and nonsensitive to SWM 5.07, we observed that this filament is not the most indicated for identifying the loss of sensibility in these patients. The prevalence of patients at risk varied between 85 and 89%. The biochemical marker associated with these high rates was HbA1c (p = 0.02). Conclusions: Numeric quantification of the pressure threshold allowed us to determine the functional deficit of nerve fibers. Our findings suggest that the neurosensory device should be used as an adjuvant tool to evaluate the degree of loss of sensation on the skin. (C) 2019 Published by Elsevier B.V.
- Treatment and Chest Reconstruction for Mediastinitis Following Sternotomy for Cardiac Surgery at the Heart Institute of the University of Sao Paulo Medical School(2021) PAGOTTO, Vitor Penteado Figueiredo; GALLAFRIO, Samuel Terra; CARNEIRO, Igor Castro; GEMPERLI, Rolf; JATENE, Fabio B.This study presents the method used for chest reconstruction and treatment of mediastinitis following cardiac surgery at the Heart Institute of the University of Sao Paulo Medical School. After infection control with antibiotic therapy associated with aggressive surgical debridement and negative pressure wound therapy, chest reconstruction is performed using flaps. The advantages and disadvantages of negative pressure wound therapy are discussed, as well as options for flap-based chest reconstruction according to the characteristics of the patient and sternum. Further studies are needed to provide evidence to support the decisions when facing this great challenge.
- Comparative study of Silver Sulfadiazine with other materials for healing and infection prevention in burns: A systematic review and meta-analysis(2019) NIMIA, Heloisa Helena; CARVALHO, Viviane Fernandes; ISAAC, Cesar; SOUZA, Francisley Avila; GEMPERLI, Rolf; PAGGIARO, Andre OliveiraThe aim of this systematic review with meta-analysis was to compare the effect of Silver Sulfadiazine (SSD) with other new dressings, with or without silver, on healing and infection prevention in burns. The electronic search was carried out in the electronic databases of Pubmed, ScienceDirect, Lilacs and BVS. The articles included were randomized clinical trials about burn treatment with SSD, which evaluated the healing and infection of burn wounds in humans. The exclusion criteria included articles, editorials and letters published in the form of abstracts, unpublished reports and case series, cross-sectional, observational experimental studies, and the use of sulfadiazine for other types of wounds. The search identified 873 references, and 24 studies were included in accordance with the eligibility criteria. The results showed a statistically favorable difference related to the time of healing for silver dressings (p< 0.0001; MD 3.83; 95% CI 2.03-5.62) and dressings without silver (p< 0.007; MD 2.9; 95% CI 0.81-5.00) in comparison with SSD. The rate of infection showed no difference in the group treated with SSD compared with the group treated with dressings containing silver (p> 0.05). The rate of infection was significantly higher in the SSD group compared with the group treated with dressings without silver (p< 0.005; MD 25.29% and MD 12.97%). Considering the clinical trials conducted up to the present time, the authors concluded that new dressings withand without silver show better results than SSD for wound healing, and burn streated with dressings without silver are less likely to become infected than burns with SSD. No differences between SSD and new silver materials were observed in relation to infection prevention.
- Successful Treatment of a Complex Vascular Malformation With Sirolimus and Surgical Resection(2017) GOLDENBERG, Dov C.; CARVAS, Marcelo; ADAMS, Denise; GIANNOTTI, Marcelo; GEMPERLI, RolfManagement of complex vascular malformation represents a challenge as it may include a wide variety of options such as embolization, laser therapy, sclerotherapy, and surgical resection but may lead to significant morbidity and is associated with high recurrence rates. In extreme and/or recurrent cases, successful use of sirolimus has been described. We report a case of large unresectable complex venous malformation treated with oral sirolimus for 24 months. Therapy was well tolerated. Patient had substantial improvement in symptoms and shrinkage of the lesion. The Medical Therapy made excision of the malformation possible and patient had a successful surgical procedure. This report provides further evidence that sirolimus should be considered as part of the armamentarium in the management of these rare conditions.
- Effect of Light Emitted by Diode as Treatment of Radiodermatitis(2022) CAMARGO, Cristina Pires; CARVALHO, H. A.; GEMPERLI, R.; TABUSE, Cindy Lie; SANTOS, Pedro Henrique Gianjoppe dos; GONCALES, Lara Andressa Ordonhe; REGO, Carolina Lopo; SILVA, B. M.; TEIXEIRA, M. H. A. S.; FEITOSA, Y. O.; VIDEIRA, F. H. P.; CAMPELLO, G. A.Radiotherapy can cause radiodermatitis in 85-90% in oncologic patients. There are several therapeutic alternatives to treat radiodermatitis with variable results. A new option is the use of light emitted-diode (LED) to treat this condition. We analyzed twenty male Wistar rats weighing 200-250 g. All the animals underwent a radiotherapy session. After 15 days, the animals were divided into four groups: control (no treatment) and LED 630 nm, 850 nm, 630 + 850 nm. The LED treatment was applied every two days until the 21 days). We analyzed the macroscopic aspect of radiodermatitis before and after treatment. After this phase, samples were collected for histological (HE). Macro and microscopic analysis indicated positive effects with exposure to light, especially with the association between wavelengths 630 and 850 nm, resulting in a reduction in the severity of radiodermatitis to grade 2-2.5. In the histological analysis, photobiomodulation increased the division and migration of cells in the basal layer of the epidermis, demonstrating the regenerative potential of this treatment in the effects of radiotherapy, increasing the speed of epithelialization of the lesion. This study suggested that the association of 630 + 850 nm improved radiodermatitis regeneration.
- Reconstruction of acquired ischiatic and perineal defects: an anatomical and clinical comparison between gluteal thigh and inferior gluteal perforator flaps(2018) MONTAG, Eduardo; UEDA, Thiago; OKADA, Alberto; ONISHI, Bruno; GEMPERLI, RolfBackground Flap coverage is the gold standard in treating pressure sores, and due to the high recurrence rate, the possibility of multiple surgical procedures should be considered during flap selection. The gluteal thigh (GT) flap has become a workhorse for ischiatic pressure sore treatment at our hospital. Follow-up revealed a group of patients presenting recurrence of the pressure sore that needed a second flap. The inferior gluteal artery perforator (IGAP) flap was chosen in this series. The positive experience with both flaps raised the question of which flap should be the first option for the treatment of ischiatic and perineal pressure sores. Methods IGAP and GT flaps were dissected in 21 fresh human cadavers to allow comparison of anatomical features. In a series of 60 patients, the authors used both the gluteal thigh and the IGAP flap to cover 76 ischiatic and perineal ulcers. Results The IGAP flap was found to be wider and thicker than the gluteal thigh, but presented a shorter pedicle. All flaps healed uneventfully. Recurrent ulcers were treated successfully with both flaps. Conclusions Both flaps are suitable for coverage ischiatic and perineal sores. Due to its anatomical features, the IGAP flap should be considered the first choice of treatment for ischiatic ulcers. The gluteal thigh flap should be used in the recurrent sores.
- Serratus anterior muscle flap as a salvage procedure in exposed implant-based breast reconstruction(2019) MONTAG, Eduardo; OKADA, Alberto; ARRUDA, Eduardo G. P.; MUNHOZ, Alexandre M.; BUSNARDO, Fabio F.; GEMPERLI, RolfBACKGROUND: Implant-based breast reconstruction (IBR) is the most common approach to reconstruct mastectomy deffects. Infection following breast reconstruction can be devastating and lead to loss of the reconstruction due to the need of implant removal. The serratus anterior muscle flap is widely used during breast reconstruction to provide coverage of the implant/expander. METHODS: We present the application of the serratus anterior muscle flap to treat implant exposure after breast reconstruction. CASES PRESENTATION: Two patients who experienced implant exposure after breast reconstruction were successfully treated with partial capsulectomy, pocket irrigation and implant coverage with a serratus anterior muscle flap. RESULTS: No post operative complications have been observed while implant retention was achieved in both cases. CONCLUSIONS: The serratus anterior muscle flap is an option to treat implant exposure following breast reconstruction in selected cases. This flap could be used to prevent implant exposure in critical cases. (C) 2019 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.
- Congenital nasal pyriform aperture stenosis: report of two cases(2021) ZATZ, Rafael Ferreira; GOLDENBERG, Julia Alice Cavicchioli; KHARMANDAYAN, Vania; GEMPERLI, Rolf; GOLDENBERG, Dov CharlesCongenital nasal pyriform aperture stenosis is a rare cause for congenital nasal obstruction. There are few publications about this severe condition. We report two cases of newborns diagnosed with congenital nasal pyriform aperture stenosis submitted to surgical treatment. Both had respiratory difficulty since birth, represented clinically by the difficulty during breastfeeding. No concomitant comorbidities were identified. The first patient underwent early surgical treatment, as she presented with severe respiratory distress. The second patient had failed conservative treatment and was also subjected to the surgical widening of the pyriform aperture. Both patients evolved uneventfully in the postoperative period. Congenital nasal pyriform aperture stenosis is part of the differential diagnosis of congenital nasal obstruction, being choanal atresia the most common finding. Its clinical presentation can vary from mild respiratory distress, which only disables breastfeeding, to respiratory failure at rest. As it is a rare occurrence, with few publications, its management is still controversial. The need for surgical management in both reported cases and a favorable evolution are highlighted, allowing hospital discharge and adequate breastfeeding.