LIM/04 - Laboratório de Microcirurgia - Cirurgia Plástica
URI Permanente desta comunidade
O Laboratório de Microcirurgia - Cirurgia Plástica é ligado ao Departamento de Cirurgia da Faculdade de Medicina da Universidade de São Paulo (FMUSP).
Linhas de pesquisa: investigação experimental e clínica dos mecanismos de formação das cicatrizes patológicas; técnicas cirúrgicas e fatores determinantes do resultado dos transplantes de tecidos; técnicas modernas da microcirurgia de nervos periféricos: avaliação crítica; cutânea em cirurgia plástica; perspectiva do uso da informática na educação médica, entre outras.
Site oficial: http://limhc.fm.usp.br/portal/lim04-laboratorio-de-microcirurgia-cirurgia-plastica/
Linhas de pesquisa: investigação experimental e clínica dos mecanismos de formação das cicatrizes patológicas; técnicas cirúrgicas e fatores determinantes do resultado dos transplantes de tecidos; técnicas modernas da microcirurgia de nervos periféricos: avaliação crítica; cutânea em cirurgia plástica; perspectiva do uso da informática na educação médica, entre outras.
Site oficial: http://limhc.fm.usp.br/portal/lim04-laboratorio-de-microcirurgia-cirurgia-plastica/
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- LIM/04 - Laboratório de Microcirurgia
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- LIM/04 - Laboratório de Microcirurgia
Submissões Recentes
Educational interventions on preventing pressure injuries targeted at nurses: systematic review and meta-analysis
(2023) KITAMURA, J. C.; NICOLOSI, J. T.; PAGGIARO, A. O.; CARVALHO, V. F. de
Background: Although preventable, pressure injuries are commonly observed in the hospital setting and are estimated to be the third most costly condition, after cancer and cardiovascular disease. Aim: Nurses play a crucial role in the prevention and management of pressure injuries, however, published evidence on the effectiveness of educational interventions, directed specifically at nurses in the hospital environment, is scarce. Method: The authors retrieved published studies on the subject from selected databases (Pubmed/Medline, Embase, Web of Science and the Cochrane Library) in a number of languages (Portuguese, English, French and Spanish). The search yielded randomised controlled trials, as well as quasi-experimental and comparative studies. Findings: In total, 11 studies were selected. The outcomes analysed, following some type of educational intervention, included the attitudes and knowledge of the nursing professionals, as well as the incidence of pressure injuries. Conclusion: The present study demonstrated that different educational strategies can help prevent pressure injuries in the hospital environment.
Skin-sparing mastectomy for the treatment of breast cancer
(2023) MOTA, B. S.; BEVILACQUA, J. L. B.; BARRETT, J.; RICCI, M. D.; MUNHOZ, A. M.; FILASSI, J. R.; BARACAT, E. C.; RIERA, R.
Background: Skin-sparing mastectomy (SSM) is a surgical technique that aims to maximize skin preservation, facilitate breast reconstruction, and improve cosmetic outcomes. Despite its use in clinical practice, the benefits and harms related to SSM are not well established. Objectives: To assess the effectiveness and safety of skin-sparing mastectomy for the treatment of breast cancer. Search methods: We searched Cochrane Breast Cancer's Specialized Register, CENTRAL, MEDLINE, Embase, LILACS, the World Health Organization's International Clinical Trials Registry Platform (WHO ICTRP), and ClinicalTrials.gov on 9 August 2019. Selection criteria: Randomized controlled trials (RCTs), quasi-randomized or non-randomized studies (cohort and case-control) comparing SSM to conventional mastectomy for treating ductal carcinoma in situ (DCIS) or invasive breast cancer. Data collection and analysis: We used standard methodological procedures expected by Cochrane. The primary outcome was overall survival. Secondary outcomes were local recurrence free-survival, adverse events (including overall complications, breast reconstruction loss, skin necrosis, infection and hemorrhage), cosmetic results, and quality of life. We performed a descriptive analysis and meta-analysis of the data. Main results: We found no RCTs or quasi-RCTs. We included two prospective cohort studies and twelve retrospective cohort studies. These studies included 12,211 participants involving 12,283 surgeries (3183 SSM and 9100 conventional mastectomies). It was not possible to perform a meta-analysis for overall survival and local recurrence free-survival due to clinical heterogeneity across studies and a lack of data to calculate hazard ratios (HR). Based on one study, the evidence suggests that SSM may not reduce overall survival for participants with DCIS tumors (HR 0.41, 95% CI 0.17 to 1.02; P = 0.06; 399 participants; very low-certainty evidence) or for participants with invasive carcinoma (HR 0.81, 95% CI 0.48 to 1.38; P = 0.44; 907 participants; very low-certainty evidence). For local recurrence-free survival, meta-analysis was not possible, due to high risk of bias in nine of the ten studies that measured this outcome. Informal visual examination of effect sizes from nine studies suggested the size of the HR may be similar between groups. Based on one study that adjusted for confounders, SSM may not reduce local recurrence-free survival (HR 0.82, 95% CI 0.47 to 1.42; P = 0.48; 5690 participants; very low-certainty evidence). The effect of SSM on overall complications is unclear (RR 1.55, 95% CI 0.97 to 2.46; P = 0.07, I2 = 88%; 4 studies, 677 participants; very low-certainty evidence). Skin-sparing mastectomy may not reduce the risk of breast reconstruction loss (RR 1.79, 95% CI 0.31 to 10.35; P = 0.52; 3 studies, 475 participants; very low-certainty evidence), skin necrosis (RR 1.15, 95% CI 0.62 to 2.12; P = 0.22, I2 = 33%; 4 studies, 677 participants; very low-certainty evidence), local infection (RR 2.04, 95% CI 0.03 to 142.71; P = 0.74, I2 = 88%; 2 studies, 371 participants; very low-certainty evidence), nor hemorrhage (RR 1.23, 95% CI 0.47 to 3.27; P = 0.67, I2 = 0%; 4 studies, 677 participants; very low-certainty evidence). We downgraded the certainty of the evidence due to the risk of bias, imprecision, and inconsistency among the studies. There were no data available on the following outcomes: systemic surgical complications, local complications, explantation of implant/expander, hematoma, seroma, rehospitalization, skin necrosis with revisional surgery, and capsular contracture of the implant. It was not possible to perform a meta-analysis for cosmetic and quality of life outcomes due to a lack of data. One study performed an evaluation of aesthetic outcome after SSM: 77.7% of participants with immediate breast reconstruction had an overall aesthetic result of excellent or good versus 87% of participants with delayed breast reconstruction. Authors' conclusions: Based on very low-certainty evidence from observational studies, it was not possible to draw definitive conclusions on the effectiveness and safety of SSM for breast cancer treatment. The decision for this technique of breast surgery for treatment of DCIS or invasive breast cancer must be individualized and shared between the physician and the patient while considering the potential risks and benefits of available surgical options.
Bilateral V-Y medial fasciocutaneous thigh flap in perineal reconstruction for hidradenitis suppurativa: Case report
(2023) VICENTE-RIVAS, A. F.; PAGOTTO, V. P. F.; BUSCARIOL, S.; ITO, M.; GEMPERLI, R.
Introduction: Hidradenitis suppurativa (HS) is a chronic inflammatory disease that preferentially affects the intertriginous skin and is associated with numerous systemic comorbidities. The perineal area is the second most commonly affected area after the armpit. Wide excision is the treatment most likely to achieve better results with a lower risk of recurrence. With extensive surgical excision, flap closure offers a greater likelihood of definitive treatment. Some flaps have been described to reconstruct defects in the perineal region after cancer, but few have been studied in treating HS. Case Report: A 43-year-old woman with perineal HS underwent resection of the lesions and reconstruction with a bilateral V-Y medial thigh fasciocutaneous flap to treat the disease. The flap allowed complete closure of the total perineum without serious complications. Conclusion: This case shows that it is useful and practical to use the V-Y medial thigh fasciocutaneous flap for perineal reconstruction after wide resections of skin, apocrine glands, and hair follicles in the treatment of HS, offering good skin coverage and subcutaneous cellular tissue with supply reliable vascular flap, which avoids sequelae associated with muscle sacrifice and reaches larger dimensions than other flaps, and can be considered in selected cases as an alternative in the surgical treatment of perineal HS.
Supraclavicular flap for head and neck oncological reconstruction: A series of 62 cases
(2023) TAKAHASHI, G. G.; RIBEIRO, R. D. A.; PAGOTTO, V. P. F.; FERNANDES, T. R. R.; ALVES, H. R. N.; BUSNARDO, F. D. F.; GEMPERLI, R.
Introduction: The oncological reconstruction of extensive defects in the head and neck requires the plastic surgeon to make a difficult decision between the use of free flaps and pedicled flaps. The supraclavicular flap is one of the main examples of a pedicled flap, being versatile, with a thin thickness and similar color to the region to be reconstructed. Method: A retrospective study was carried out by collecting data from medical records of patients admitted to the Cancer Institute of the State of São Paulo between December 2010 and March 2020. Results: Among the 62 patients reconstructed with a supraclavicular flap, 37 were male and 25 female. Fifty-eight patients (93.5%) had some associated comorbidity. In total, 27 complications related to the flap (43.5%) were recorded, 5 of which were total necrosis (8%). Conclusion: The supraclavicular flap plays an important role in head and neck oncological reconstructions and should be considered as an option in patients who are poor candidates for microsurgical flaps.
Treatments of palpebral congenital melanocytic nevus: a systematic review
(2023) CAMARGO, Cristina Pires; SALIBA, Marita; SAAD, Elio Assaad; MILAN, Milanie; CALDERA, Jose Mauricio
Purpose: Palpebral congenital melanocytic nevi (PCMN) is a rare congenital skin lesion affecting the eyelids that can lead to cosmetic and psychological concerns and potential health risks such as malignancy. Several authors have analyzed therapeutical strategies to treat PCMN. However, there was no consensus in the literature. This systematic review aimed to evaluate the effectiveness, safety, and success of treatments of PCMN. Methods: We conducted a systematic review following PRISMA guidelines from October 2022 to April 2023. We included all types of study designs that described or compared PCMN treatments and interventions, as well as histology, recurrence, adverse events, patient satisfaction, and malignant transformation. The search strategy was based on specific search words through the following databases: PubMed, Embase, Latin American and Caribbean Health Sciences Literature (Lilacs), Web of Science, and Scopus. Ongoing studies and gray literature studies were included. Results: We analyzed 25 case reports with 148 participants. The effectiveness, success, and satisfaction with various treatments for PCMN depend on the specific treatment method and the individual patient's case. Conclusion: Most of the studies showed that surgical procedures (exeresis) are able to treat PCMN in the eyelid. The variability in outcomes emphasizes the importance of further research to better understand the most effective and safe approaches for treating congenital melanocytic nevi.
Brazilian Two-Societal Bi-Annual Congress on Cleft Lip and Palate and Craniofacial Surgery: ABCCMF and ABFLP Partnership
(2023) RAPOSO-AMARAL, Cassio E.; URMENYI, Geza L.; BASTOS, Endrigo O.
Outcome analysis and assessment of the lower pole expansion following breast augmentation with ergonomic implants: Optimizing results with patient selection based on 5-year data
(2024) MUNHOZ, Alexandre Mendonca; NETO, Ary de Azevedo Marques; MAXIMILIANO, Joao; FRAGA, Murillo
Background: Silicone implants have gone through adaptations to improve esthetic outcomes. With the progress of technology, including gel rheology, different properties have been introduced. Ergonomic style implants (ESI) feature enhanced rheological properties and provide a shaped contour with a round base.Objectives: This study investigated outcomes for ESI in breast augmentation concerning lower pole stretching (LPS) and implant stability and describes an algorithm to assist in decision- making.Methods: A total of 148 patients (296 breasts) underwent breast augmentation with ESI; this procedure was indicated in patients with good skin quality and < 6 cm between the nip- ple-areola complex and the inframammary fold.Results: The mean patient age was 29.6 years (range: 19-39), and 93 patients (62.8%) under- went primary breast augmentation with demi/full projection (average volume of 245 cc [175-375 cc]). Axillary incision and subfascial pocket were indicated in 115 (77.7%) and 72 (48%) cases, respectively. Average LPS values were 32.2% (24.91 mm) and 10.86% (9.42 mm) at up to 10 days and 10 days to 12 months postprocedure, respectively. Patients were followed for a mean of 29.9 +/- 26.4 months (range: 6-66). Complication rates per breast and per patient were 5% and 10%, respectively, and included subcutaneous banding in the axilla (1.6%), implant displacement (1.2%), and wound dehiscence (0.8%). No cases of infection, seroma, or rippling complications were observed.Conclusions: The present decision-making algorithm summarizes the process involved in breast augmentation using ESI and is intended to help standardize decisions. With correct planning, long-lasting outcomes can be achieved due to favorable interactions between ESI and the patient's tissues.(c) 2023 British Association of Plastic, Reconstructive and Aesthetic Surgeons.
International consensus recommendations for the optimal prioritisation and distribution of surgical services in low-income and middle-income countries: a modified Delphi process
(2023) HENRY, Jaymie A.; REYES, Ana M.; AMEH, Emmanuel; YIP, Cheng-Har; NTHUMBA, Peter; MEHES, Mira; LELCHUK, Ashley; HOLLIER, Larry; WAQAINABETE, Ifereimi; ABDULLAH, Noor Hisham; HILL, Andrew; FERGUSON, Mark K.
Objectives To develop consensus statements regarding the regional-level or district-level distribution of surgical services in low and middle-income countries (LMICs) and prioritisation of service scale-up. Design This work was conducted using a modified Delphi consensus process. Initial statements were developed by the International Standards and Guidelines for Quality Safe Surgery and Anesthesia Working Group of the Global Alliance for Surgical, Obstetric, Trauma and Anesthesia Care (G4 Alliance) and the International Society of Surgery based on previously published literature and clinical expertise. The Guidance on Conducting and REporting DElphi Studies framework was applied. Setting The Working Group convened in Suva, Fiji for a meeting hosted by the Ministry of Health and Medical Services to develop the initial statements. Local experts were invited to participate. The modified Delphi process was conducted through an electronically administered anonymised survey. Participants Expert LMIC surgeons were nominated for participation in the modified Delphi process based on criteria developed by the Working Group. Primary outcome measures The consensus panel voted on statements regarding the organisation of surgical services, principles for scale-up and prioritisation of scale-up. Statements reached consensus if there was >= 80% agreement among participants. Results Fifty-three nominated experts from 27 LMICs voted on 27 statements in two rounds. Ultimately, 26 statements reached consensus and comprise the current recommendations. The statements covered three major themes: which surgical services should be decentralised or regionalised; how the implementation of these services should be prioritised; and principles to guide LMIC governments and international visiting teams in scaling up safe, accessible and affordable surgical care. Conclusions These recommendations represent the first step towards the development of international guidelines for the scaling up of surgical services in LMICs. They constitute the best available basis for policymaking, planning and allocation of resources for strengthening surgical systems.
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
Access to reconstructive plastic surgery for patients undergoing bariatric surgery in the Unified Health System (SUS)
(2023) SECANHO, MURILO SGARBI; CINTRA JR, WILSON; CARNEIRO, IGOR CASTRO; ALVES, GUILHERME FREDERICO FERRO; GEMPERLI, ROLF
ABSTRACT Introduction: obesity is one of the most common diseases worldwide, and the most effective treatment to it is the bariatric surgery. One of the negative impacts of this procedure is the body dysmorphia caused by overhanging skin. In Brazil, the national health system - Sistema Único de Sáude (SUS) - provide body contouring surgery to treat post-bariatric patients, since 2007. This article aims to describe the Brazilian public health approach to post bariatric patients and perform an analyze in the Brazilian health care database. Methods: in Brazilian Health System database, a search for the post-bariatric procedures performed between 2007 to 2021 was done. The variables analyzed were geographic location, year, mean days of hospitalization, death, and mortality rate. Also, we evaluated the number of bariatric procedures done in the same period. Statistical analysis was performed using the Student-t and the chi-square tests and p-value <0.5 was considered significant. Results: a total of 12,717 plastic surgery procedures in post bariatric patients were done, with a national prevalence of 13.8%. Dermolipectomy was the most performed procedure, with 6,719. The years of 2020 and 2021 suffered a decreased of 64.3% and 70.9% in the number of surgeries (p<0,001). Bariatric Procedures had a high rate and a higher percentage of growth comparing to post bariatric surgery (p<0,001), totalizing 93,589 surgeries. Conclusions: Brazil had a significant number of body contouring surgery, however with a low prevalence. Dermoliepctomy was the most common procedure performed. We could notice a significant impact of COVID pandemic in those procedures .