DIMAS ANDRE MILCHESKI
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/04 - Laboratório de Microcirurgia, Hospital das Clínicas, Faculdade de Medicina
LIM/04 - Laboratório de Microcirurgia, Hospital das Clínicas, Faculdade de Medicina
13 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 13
- Complicação grave do uso irregular de silicone industrial em paciente transexual: relato de caso(2020) MENDES, MONIQUE; MONTEIRO, GUSTAVO GOMES RIBEIRO; BASTOS, EMILLY FREIRE BARBOSA; MILCHESKI, DIMAS ANDRÉ; MONTEIRO JUNIOR, ARALDO AYRES; GEMPERLI, ROLFABSTRACT The use of industrial liquid silicone as a material for aesthetic modification of body contour is a practice that has been carried out clandestine for about 60 years. Currently, most reports come from countries in Asia and South America, and the victims are mainly women and transsexuals. Due to the large number of cases with complications, the use of industrial silicone for aesthetic purposes has never been approved. However, it continues to be applied alone or associated with other products, determining severe local and systemic complications. We report a case of death of a transsexual patient after injecting industrial silicone in the thighs and buttocks.
- Opções de tratamento cirúrgico em lesões cutâneas por extravasamento acidental de drogas: experiência do Hospital das Clínicas da Faculdade de Medicina da USP.(2018) MILCHESKI, Dimas André; MOTA, Wellington Menezes; LOBATO, Rodolfo Costa; MONTEIRO JÚNIOR, Araldo Ayres; GEMPERLI, RolfABSTRACT Objective: to report the experience of the Division of Plastic Surgery of the Hospital das Clínicas of the Medical School of the University of São Paulo in the treatment of cutaneous lesions due to accidental extravasation of drugs. Methods: we included patients with lesions due to extravasation of drugs over a period of 18 months. We retrospectively evaluated the following parameters: age, diagnoses during hospitalization and comorbidities, serum levels of albumin and hemoglobin, place of hospitalization, drug involved, anatomic segment affected, therapeutic management and death during hospitalization. Results: we followed-up 14 patients. The main drug involved was noradrenaline (21%). All patients underwent debridement of tissue necrosis. Three patients were submitted to flaps after preparation of the wound bed with negative pressure therapy, with good results. Seven patients had no definitive treatment of their lesions due to lack of clinical conditions. Conclusion: in patients with favorable clinical conditions, the definitive treatment with flaps was adequate for cases of wounds due to extravasation of drugs in the subcutaneous tissue when there was exposure of noble structures.
- Avaliação do impacto no atendimento de pacientes com ferimentos descolantes durante a pandemia de COVID-19 em serviço especializado(2021) CLIVATTI, GUSTAVO MOREIRA; MILCHESKI, DIMAS ANDRé; BRIZA, DANIELLE NUNES; RIBEIRO, RENAN DIEGO AMéRICO; ABBAS, LAIELLY; MONTEIRO, GUSTAVO GOMES RIBEIRO; GEMPERLI, ROLF■ ABSTRACT Introduction: The COVID-19 pandemic was responsible for increasing social isolation rates, resulting in a reduction in traffic accidents. Trauma, in general, is among the most important public health problems worldwide. This study aims to evaluate the impact of social isolation in the city of São Paulo during the COVID-19 pandemic on the care of patients with detaching wounds. Methods: Observational, retrospective and descriptive study. All medical records of patients treated at the Emergency Room of the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (HCFMUSP), by the Complex Wounds Group of the Plastic Surgery Service, admitted for detaching wounds and undergoing surgical procedures, were reviewed, from April to June of the years 2019 and 2020. Results: Twenty patients with detaching injuries on the lower limbs were included. In 2019, 14 patients were seen, with a mean age of 47 years, 7 of which were victims of traffic accidents, 5 of being run over, 1 of crushing and 1 of falling from standing height. In 2020, 6 patients were treated with detaching wounds during the pandemic, with a mean age of 36.16 years, 5 of which were victims of motorcycle accidents and 1 of being run over. No patient had COVID-19. Conclusion: During social isolation, there was a numerical reduction in care for detaching trauma during the quarantine period.
- Surgical treatment of sacral pressure wounds in patients with COVID-19: A case series(2023) FERREIRA, Joao; NICOLAS, Gregory; VALENTE, Daniel; MILCHESKI, Dimas; SALIBA, Marita; GEMPERLI, Rolf
- 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.
bookPart Abordagem de ferimentos descolantes(2019) MILCHESKI, Dimas; MENDES, Rogério; FREITAS, Fernando Ramos de; GEMPERLI, Rolf- Complicação grave do uso irregular do PMMA: relato de caso e a situação brasileira atual(2019) KURIMORI, KLEBER TETSUO; MENDES, MONIQUE; MILCHESKI, DIMAS ANDRÉ; MONTEIRO JUNIOR, ARALDO AYRES; GEMPERLI, ROLF▪ ABSTRACT Introduction: Use of permanent fillers can lead to significant complications. In Brazil, polymethylmethacrylate (PMMA)is a product approved by the Agência Nacional de VigilânciaSanitária (ANVISA), but its use exceeds its indications, leadingto serious complications. Recommendations for restricteduse have been in place for more than a decade, but caseswith serious consequences due to inappropriate use are stillseen. Objective: To report a serious complication due to inappropriate use of PMMA and discuss the current status of PMMA use in Brazil based on recommendations of medical societies and regulatory agencies. Methods: This report describes a case of extensive necrosis of the gluteal region after injection of PMMA by a non-qualified practitioner; the report also reviews the literature on the current status of PMMA use in Brazil. Discussion Despite the efforts of medical societies, acute and chronic complications are still reported in the Brazilian literature. In 2016, more than 17,000 PMMArelated complications were reported; nevertheless, reliable epidemiological data remain unavailable because the number of treatments, the quality of the product, and the training of practitioners remain unregulated. Conclusion A significant number of repair procedures are performed in Brazil to correct complications resulting from the use of PMMA. The severity of the reported case highlights the need to combat bad practice by untrained professionals, as well as the need for greater control of PMMA marketing by regulatory agencies.
- Castleman disease. Interaction with dermatopathy: Case report(2020) MODOLIN, M. L. A.; CAMARGO, C. P.; MILCHESKI, D. A.; CINTRA JR., W.; ROCHA, R. I.; CLIVATTI, G. M.; NASCIMENTO, B.; GEMPERLI, R.INTRODUCTION: Castleman disease (CD) is a lymphoproliferative disorder with lymph node hypertrophy. In the unicentric form (UCD), it affects one lymph node or chain of lymph nodes. In the multicentric form (DCM), there is hypertrophy of several lymph node chains with the formation of tumor masses, causing compressive symptoms. This case report showed a case of CD in a different location(inguinal region) associated to a multiple skin lesions. PRESENTATION OF THE CASE: We reported a UCD in a 43-year-old female patient with no previous comorbidities. Since January 2016, this patient developed erysipelas lesions of the left leg (LL) from the thigh root to the foot. Concomitantly, a tumor mass appeared in the inguinal region. In 2019 we performed a biopsy that revealed changes characteristic of CD. Due to extremely poor trophic conditions, the skin area with erysipelas was resected, and the raw surface was grafted. DISCUSSION: As an inference, the erysipelas may have been responsible for the subsequent lymphangitis, lymphedema and lymph node hypertrophy. CONCLUSION: Resection of the diseased skin and lymph node excision constitute the treatment of UCD and result in improvement of the clinical picture. Nevertheless, further study of the inflammatory reaction and of markers such as interleukin-6 and the presence of skin disorders in DC is needed. (C) 2020 The Author(s).
- Retalho sural reverso como alternativa à reconstrução microcirúrgica de ferimento extenso em pé após queimadura elétrica: relato de caso(2022) CLIVATTI, GUSTAVO MOREIRA; RIBEIRO, RENAN DIEGO AMÉRICO; BRIZA, DANIELLE NUNES; GARCIA, CARLOS EDUARDO VERZINE; MILCHESKI, DIMAS ANDRÉ; GEMPERLI, ROLFABSTRACT Introduction: To present a reverse sural flap case report as an alternative to microsurgical flap in foot reconstruction after electrical trauma. The report presented is of a patient treated by the Burns and Complex Wounds groups of the Plastic Surgery Service of the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo in 2020. Case Report: Male patient, 35 years old, without comorbidities, victim of high voltage electrical trauma (1300V) at home, affecting upper and lower limbs bilaterally. Due to the severity of the injuries, he underwent left transtibial amputation and serial debridement in the contralateral limb, resulting in a defect in the medial face, hallux and entire dorsum of the right foot, with bone exposure. Due to the failure of reconstruction with a microsurgical flap of the vastus lateralis muscle, reconstruction with a reverse sural flap was chosen. It evolved with distal necrosis, requiring new debridement and re-advancement of the flap. In the follow-up, he presented a favorable evolution and is in the process of rehabilitation. Conclusion: The reverse sural flap proved to be suitable for the salvage treatment of extensive foot injuries after the failure of microsurgical therapy, offering stable coverage and excellent contour, thus allowing satisfactory patient rehabilitation.
- Brief hospitalization protocol for pressure ulcer surgical treatment: outpatient care and one-stage reconstruction(2017) MILCHESKI, Dimas André; MENDES, Rogério Rafael da Silva; FREITAS, Fernando Ramos de; ZANINETTI, Guilherme; MONEIRO JÚNIOR, Araldo Ayres; GEMPERLI, RolfABSTRACT Objective: to evaluate a brief hospitalization protocol for the treatment of pressure ulcers, proposed by the Complex Wound Group of Clinical Hospital of University of Sao Paulo Medical School, particularly in regard to selection of patients, hospitalization time, cutaneous covering, complications and sore recurrence. Methods: retrospective cohort of 20 consecutive patients with 25 pressure lesions Grade IV. All patients were ambulatorily prepared and were hospitalized for surgical one time procedure for pressure lesion closing. Results: in total, 27 flaps were performed to close 25 wounds. Three patients showed minor dehiscence (11.1%). There was no recurrence during the post-surgical follow-up period. No patient suffered a new surgery and no flap showed partial or total necrosis. Median time of hospitalization was 3.6 days (2-6 days) and median follow-up was 91 months (2-28 months). All patients maintained their lesions closed, and there was no recurrence during follow-up. Conclusion: the brief hospitalization protocol was considered adequate for the resolution of pressure wounds, showing an average time of hospitalization of 3.6 days and rate of minor surgical wound dehiscence of 11.1%.