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
12 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 12
- Tradução, adaptação e validação linguística do FACE-Q Câncer de Cabeça e Pescoço para o português do Brasil(2022) PAGOTTO, VITOR PENTEADO FIGUEIREDO; LOBATO, RODOLFO COSTA; BUSTILLO, ADRIANA MARGARITA BUELVAS; LOPES, CRISTIANE PEREIRA; TUTIHASHI, RAFAEL MAMORU CARNEIRO; BUSNARDO, FÁBIO DE FREITAS; GEMPERLI, ROLFABSTRACT Introduction: Head and neck neoplasms often affect fundamental functions, such as swallowing, speech, eating, and socializing. Evaluating their treatment should consider the physician’s opinion and the patient’s perspective. This difficulty in assessing the success of treatment led to the development of the FACE-Q Head and Neck Cancer Module, a questionnaire of patient-reported outcomes that measure the appearance, facial function, quality of life, and experience of care to head and neck neoplasms. The objective is to translation, cultural adaptation, and linguistic validation of the FACE-Q Head and Neck Cancer questionnaire for Brazilian Portuguese. Methods: The translation, cultural adaptation, and linguistic validation of the full questionnaire took place in four stages, using official guidelines from the World Health Organization and the International Society of Pharmacoeconomics and Outcomes Research. Results: A semantic, idiomatic, and conceptually equivalent Brazilian Portuguese version was achieved through a linguistically validated translation of the English FACE-Q Head and Neck Cancer module. Conclusion: The Brazilian Portuguese version presents a version equivalent to the original English instrument, which can be used as a critical patient-reported outcome assessment.
- Posttraumatic stress disorder in burn patient: A systematic review(2022) PAGGIARO, Andre Oliveira; PAGGIARO, Patricia Bergantin Soares; FERNANDES, Rosa Aurea Quintela; FREITAS, Noelle Oliveira; CARVALHO, Viviane Fernandes; GEMPERLI, RolfSummary Introduction: Burns often cause severe physical and mental suffering and can become a trigger for the development of permanent psychological diseases, even after wound healing. Posttraumatic stress disorder (PTSD) is one such disorder, which involves the reexperiencing of many symptoms provoked by a previous traumatic situation. Method: This study is a systematic review of interventions used to reduce or prevent PTSD symptoms in burn victims. We included randomized clinical trials that described therapeutic interventions for the prevention of PTSD in burn patients. The search was conducted in the databases EMBASE and PUBMED/Medline between 2009 and 2020, and the main variables evaluated were%TBSA, age, number of hospitalization days, type of intervention, follow-up time and results. The analysis of the bias risk was carried out according to the guidance in the Cochrane Handbook for Bias Risk Assessment. Results: Eight clinical trials were selected: three of them were performed in children, and five involved adults. The most common bias risks were related to participant/researcher blinding and loss of follow-up. Two interventions were identified: a pharmacological intervention and a psychological intervention. Medications (sertraline and propanolol) were not effective in reducing stress symptoms. Four studies used cognitive-behavioral therapies, which achieved the best results for PTSD improvement in burn patients. Hypnosis and an informational education program were also evaluated and did not show success in reducing PTSD.
- Management of Post-Facelift Facial Paralysis With Botulinum Toxin Type A(2022) SALLES, Alessandra Grassi; MOTA, Wellington Menezes; REMIGIO, Adelina Fatima do Nascimento; ANDRADE, Antonio Carlos Herrmann de; GEMPERLI, RolfBackground Facial nerve injury after facelift is rare; hence, its treatment is poorly established. Botulinum toxin type A (BTXA) can be employed to resolve the asymmetry. To our knowledge, there is no protocol in the literature about the best timing for this treatment, injection sites, or recommended dose. Objectives The authors sought to propose a protocol to guide the management of asymmetries post-facelift. Methods Fifteen patients with post-rhytidectomy facial palsies were treated in the non-paralyzed side with BTXA. After analysis of the smile deviation vectors, it is possible to identify the muscles that should be treated. The dose varied from 1 to 2 volume-unit per point. Patients were examined after 15 days for outcomes evaluation and touch-up if needed. Patients were re-treated after 5 to 6 months in case of asymmetry recurrence. Results Symmetry was achieved in all cases. Six patients had definitive nerve lesions and required treatment every 6 months after the first session. Five patients had lesions affecting the upper third of the face; 4 of them were definitive nerve lesions. Two of the 4 patients who were treated less than 2 weeks after surgery recovered early from the post-facelift paralysis and developed reversed asymmetry due to the BTXA. In 7 patients, the post-facelift asymmetry was due to neuropraxis: the recovery from the nerve injury and BTXA treatment occurred symmetrically on both sides of the face in the following months after 1 single session. Conclusions Asymmetries post-facelift were successfully managed with the proposed protocol. The best time for injection was 2 to 4 weeks after surgery.
- Impacto socioeconômico da pandemia da COVID-19 entre cirurgiões plásticos do Brasil(2022) RIBEIRO, RENAN DIEGO AMÉRICO; CARNEIRO, IGOR CASTRO; CLIVATTI, GUSTAVO MOREIRA; ABBAS, LAIELLY; MONTEIRO, GUSTAVO GOMES RIBEIRO; GOLDENBERG, DOV; GEMPERLI, ROLFABSTRACT Introduction: Global sanitary crisis caused by the spread of COVID-19 induced many health services to stop performing non-urgent surgical procedures. In the scenario of plastic surgery, where most procedures are elective, socioeconomic consequences are estimated for these specialists. The objective of this study is to measure this impact. Methods: Effects of the pandemic within the clinical practice of Brazilian plastic surgeons were investigated through an online questionnaire addressed to members of the Sociedade Brasileira de Cirurgia Plástica. Results: A survey was applied to 645 surgeons. Most respondents reported operation restrictions on procedures and income reduction, especially in regions severely affected by the pandemic. Plastic surgeons with more than 10 years of experience were the most affected. High contamination rates, mental overload, decreased physical activity, and psychiatric medications have also been reported. Conclusion: COVID-19 pandemic brought changes to the personal and professional life of the Brazilian plastic surgeon. Due to the significant reduction in the workload, there were financial impacts on specialists from all country regions, besides physical and mental health issues. Adaptations were mandatory to maintain services and explore new areas of activity to supply the low demand for cosmetic surgery during the crisis.
- 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.
- Comparison of three different strategies to treat sciatic nerve regeneration: an experimental study(2022) SMANIOTTO, Pedro Henrique; CAMARGO, Cristina Pires; KUBRUSLY, Marcia Saldanha; GEMPERLI, RolfPurpose: To compare the effect of vein conduit filled with adipose tissue stem cells (ASC) on peripheral nerve injury regeneration. Methods: We analyzed 30 male Wistar rats surgically submitted to a 5-mm gap on the sciatic nerve. Then, the animals were divided into three groups: nerve autografting (AG, n=10), autogenous inverted glycerol-conserved vein (VG, n=10), and autogenous inverted glycerol-conserved vein + ASC (VASCG, n=10). The study endpoints were neuromotor functional analysis, gastrocnemius muscle weight, and sciatic nerve graft histomorphometry analysis. In the histologic analysis, we added a control group (naive nerve). Results: Regarding functional analysis (Walking tract- score), the findings at week 3 showed a difference between the AG and the VG (-96.6 vs. -59.6, p=0.01, respectively) and between the VG and the inverted vein + VASCG (-59.9 vs. -88.92, p=0.02). At week 12, this study showed a difference between the AG and the VG (-64.8 vs. -47.3, p=0.004, respectively), and also a difference between the VG and the VASCG (-47.3 vs. -57.4, p=0.02, respectively). There was no difference in the histomorphometry analysis (nerve diameter, Schwann cells counting). The gastrocnemius muscles on the intervention side were more atrophic when compared to the gastrocnemius muscles on the control side. Conclusion: Our results suggested better functional recovery in the inverted vein group when compared to control group, and inverted vein + ASC group.
- A versatilidade e confiabilidade do retalho Keystone em reconstruções oncológicas(2022) RIBEIRO, RENAN DIEGO AMÉRICO; PAGOTTO, VITOR PENTEADO FIGUEIREDO; CLIVATTI, GUSTAVO MOREIRA; TAKAHASHI, GIULIA GODOY; BUSNARDO, FÁBIO DE FREITAS; GEMPERLI, ROLFABSTRACT Introduction: The Keystone flap is an island flap with reliable vascularization and simple dissection, first described in 2003. Despite its distinct advantages, there are few scientific publications on this matter, and it is not a common option in the clinical practice of reconstructive surgery. This article aims to report the experience of a cancer referral center with Keystone flaps in oncological reconstructions. Methods: A retrospective study was carried out data from medical records of patients who performed oncological plastic reconstruction with keystone flaps, operated by the Surgery team of the Cancer Institute of the State of São Paulo, in addition to the analysis of pre, intra and postoperative photographic records. Results: Nine patients were identified, all with comorbidities and a mean age of 52.7. Skin defects followed after oncological resections: five in the lower extremities, three in the trunk and one in the face. The mean of the skin resected area was 52.6cm2. The reconstructions were performed under shortened surgical time. There were no postoperative complications or flap losses. The average hospital stay was 2.2 days. Conclusion: The Keystone flap is technically simple and a reproducible option for covering wounds of different sizes and locations. Due to its reliability, simple and quick dissection, shortened hospital stay and low morbidity in the donor area, it should be considered for reconstructing cancer wounds from different locations in patients of all ages.
- REVERSE SURAL FLAP FOR LOWER LIMB RECONSTRUCTION(2022) CLIVATTI, Gustavo Moreira; NASCIMENTO, Bruno Bapatista do; RIBEIRO, Renan Diego Americo; MILCHESKI, Dimas Andre; AYRES, Araldo Monteiro; GEMPERLI, RolfIntroduction: Reconstruction of distal wounds in lower extremi-ties can be challenging due to the lack of tissue to perform local flaps. Fasciocutaneous and muscular flaps are some options for coverage, such as the reverse-flow fasciocutaneous sural flap. Objective: To present an 18-month experience on ankle, calcaneus, and foot reconstruction using the reverse-flow sural flap, performed by the Complex Wounds Group of the Plastic Surgery Department of the University of Sao Paulo Medical School. Methods: An observational, retrospective and descriptive study was performed through data survey on medical records of all patients treated between November 2018 and June 2020. Results: Nine reverse-flow fasciocutaneous sural flaps were performed. All patients were men. The mean age was 38 years old. Five patients had acute wounds for traffic collision, one electrical trauma and three chronic post-traumatic injuries. The ankle was the most common injury site (6), followed by foot (2) and calcaneus (1). Four patients had complications, three of which were partial necrosis and one distal epitheliosis. No case of total necrosis was recorded. The average hospital stay was 30.1 days. Conclusion: The reverse-flow fasciocu-taneous sural flap proved to be a viable, reproducible, and reliable option for distal lower limb reconstruction. Level of Evidence IV, Case Series.
- Paramedian forehead flap in the treatment of nasal, non-melanoma skin cancer: a cross-sectional study(2022) RIBEIRO, RENAN DIEGO AMÉRICO; PAGOTTO, VITOR PENTEADO FIGUEIREDO; TAKAHASHI, GIULIA GODOY; TUTIHASHI, RAFAEL MAMORU CARNEIRO; CAMARGO, CRISTINA PIRES; BUSNARDO, FABIO DE FREITAS; GEMPERLI, ROLFABSTRACT Introduction: nose is the central point of the face and vulnerable to the occurence of non-melanoma skin cancer (NMSC), impacting on appearance. The paramedian forehead flap (PMFF) is considered the best option to treat extensive nasal defects. The objective of this study is to present the experience on PMFF for nasal reconstruction in the treatment of NMSC of a cancer referral center. Methods: retrospective study was carried out through data from medical records of patients who underwent nasal reconstruction with PMFF due to NMSC at the Cancer Institute of the State of São Paulo (ICESP). Results: 111 patients were identified, mostly ederly, with comorbidities and on initial tumors (T1 and T2). Basal cell carcinoma (BCC) was the predominant histological type. Dorsum and tip were the most affected subunitis. In addition to skin coverage, reconstruction of the lining and structural framework was also performed in half of the cases. Second intention healing was the technique of choice in closing the donor area. Pedicle division ocurred predominantly in the second operation and the median time to complete reconstruction was 6 months. There were low complication rates. Conclusions: the PMFF is safe and effective to treat nose NMSC, even in cases of high complexity. Since the treatment time can be prolonged and impact on quality of life, it is essential to emphasize and discuss this aspect with the patients before surgery.
- Limited Efficacy of Adipose Stromal Cell Secretome-Loaded Skin-Derived Hydrogels to Augment Skin Flap Regeneration in Rats(2022) VRIEND, Linda; DONGEN, Joris A. van; SINKUNAS, Viktor; BROUWER, Linda A.; BUIKEMA, Henk J.; MOREIRA, Luiz F.; GEMPERLI, Rolf; BONGIOVANNI, Laura; BRUIN, Alain de; LEI, Berend van der; CAMARGO, Cristina P.; HARMSEN, Martin C.Insufficient vascularization is a recurring cause of impaired pedicled skin flap healing. The administration of adipose tissue-derived stromal cells' (ASCs') secretome is a novel approach to augment vascularization. Yet, the secretome comprised of soluble factors that require a sustained-release vehicle to increase residence time. We hypothesized that administration of a hydrogel derived from decellularized extracellular matrix (ECM) of porcine skin with bound trophic factors from ASCs enhances skin flap viability and wound repair in a rat model. Porcine skin was decellularized and pepsin-digested to form a hydrogel at 37 degrees C. Conditioned medium (CMe) of human ASC was collected, concentrated 20-fold, and mixed with the hydrogel. Sixty Wistar rats were included. A dorsal skin flap (caudal based) of 3 x 10 cm was elevated for topical application of DMEM (group I), a prehydrogel with or without ASC CMe (groups II and III), or ASC CMe (group IV). After 7, 14, and 28 days, perfusion was measured, and skin flaps were harvested for wound healing assessment and immunohistochemical analysis. Decellularized skin ECM hydrogel contained negligible amounts of DNA (11.6 +/- 0.6 ng/mg), was noncytotoxic and well tolerated by rats. Irrespective of ASC secretome, ECM hydrogel application resulted macroscopically and microscopically in similar dermal wound healing in terms of proliferation, immune response, and matrix remodeling as the control group. However, ASC CMe alone increased vessel density after 7 days. Porcine skin-derived ECM hydrogels loaded with ASC secretome are noncytotoxic but demand optimization to significantly augment wound healing of skin flaps.