CESAR ISAAC
Projetos de Pesquisa
Unidades Organizacionais
LIM/04 - Laboratório de Microcirurgia, Hospital das Clínicas, Faculdade de Medicina - Líder
9 resultados
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- Treatment of extrinsic ectropion on burned face with facial suspension technique(2014) VANA, Luiz Philipe Molina; ISAAC, Cesar; ALONSO, NivaldoThe extrinsic ectropion is a condition with low prevalence characterized by an ectropion with normal eyelid and anatomy unchanged and the cause is found in tissues adjacent orbits. There are not many studies in the literature regarding their treatment, especially without addressing the eyelid respecting its anatomical integrity. Purpose: To evaluate the outcome of 8 extrinsic ectropions secondary to facial burns treated with facial suspension technique. Patients and methods: Five patients were evaluated with sequelae of facial burns and extrinsic unilateral or bilateral ectropion, a total of 8 ectropions. The technique used was the endoscopic facial suspension with or without release of the facial scar retraction. We evaluated the position of the lower lid over medium-pupillary line, symptoms, complications and patient satisfaction in a 24 months follow-up. Results: 6 Peri-orbital regions showed good results and two moderate results, all cases had clinical improvement of the ectropion, the symptoms and the esthetic aspect; there was not any complication or reoperation. There was a gain of 2.2-26.2% of the lower eyelid margin position in relation to the horizontal mid-pupillary line. Conclusion: The endoscopic facial suspension proved to be a surgical technique with low morbidity and efficient treatment in 8 facial extrinsic ectropion.
- Estabelecimento de protocolo para armazenamento de pele autógena refrigerada(2017) CONCEIÇÃO, RENATA OLIVEIRA DA; PAGGIARO, ANDRÉ OLIVEIRA; POLO, EUGÊNIO FERRAMUNDO; MARTINES, KARINA; ISAAC, CESAR; CARVALHO, VIVIANE FERNANDES DE; GOMEZ, DAVID DE SOUZA; GEMPERLI, ROLFABSTRACT Introduction: Autologous skin grafts are used for treatment of burn patients. These grafts can be stored and preserved, as long as the storage process is performed with strict quality control to reduce the risk of infection. Methods: A retrospective cohort study was conducted in the Burn Unit of the Hospital das Clínicas de São Paulo from February 2015 to July 2016. During this period, a protocol was established to store refrigerated skin, with control of collection, preservation, and packaging, and recording of all processes. To ensure quality, graft biopsies were collected for preand poststorage microbiology testing and a cross-sectional study for contamination was performed. Results: Critical deficiencies included inadequate packaging, lack of processing records, lack of biopsies for microbiology testing, and failure to discard specimens. Most of the samples were contaminated before and after storage (84.2%). Only two samples were sterile before storage but became contaminated after storage, with growth of Gram-positive skin bacteria. Conclusion: A promising method for the storage of refrigerated skin was established, but requires minor adjustments in quality control.
- Sistematização de curativos para o tratamento clínico das feridas(2012) SMANIOTTO, Pedro Henrique de Souza; FERREIRA, Marcus Castro; ISAAC, Cesar; GALLI, RafaelThe treatment of cutaneous wounds includes both medical and surgical methods; dressing is one of the most commonly used clinical treatments. An extensive therapeutic toolkit comprising passive dressings or dressings with active principles can help repair wounds in various situations. Dressings are used to improve the conditions of the wound bed and may occasionally be considered the definitive treatment, whereas in some cases, they may be considered an intermediate step to surgical treatment. Intelligent and biological wound dressings are currently classified as dermal substitutes and will not be discussed in this article. Dressings should be selected on the basis of knowledge of the pathophysiology of wound healing and tissue repair while keeping the systemic problems of the patient in mind.
- Construção de substituto da pele composto por matriz de colágeno porcino povoada por fibroblastos dérmicos e queratinócitos humanos: avaliação histológica(2012) ISAAC, Cesar; REGO, Francinni M. P.; LADEIR, Pedro Ribeiro Soares de; ALTRAM, Silvana C.; OLIVEIRA, Renata C. de; ALDUNATE, Johnny L. C. B.; PAGGIARO, André O.; FERREIRA, Marcus CastroBACKGROUND: In the case of extensive lesions, the use of autologous grafts is limited by the extent of the donor area and the clinical condition of patients. Allografts collected from cadavers or volunteers are usually rejected after 1 to 2 weeks, thus serving only as temporary cover for these lesions. Treating major cutaneous lesions with reconstructed autologous skin is an attractive alternative, because it is possible to obtain cultures of cells that multiply rapidly and can be cryopreserved from a small fragment of the patient's skin, thereby facilitating its indefinite use in new treatments. This study evaluated the histological behavior of cultured human keratinocytes and fibroblasts on a collagen matrix derived from porcine small intestinal submucosa. METHODS: Cells from human epidermis and dermis were grown separately and seeded on porcine collagen matrix, which was maintained in a controlled environment for 21 days before being subjected to histological analysis. RESULTS: Fibroblasts invaded and colonized the collagen matrix, whereas keratinocytes were organized in laminated and stratified layers on the surface on which they were seeded. CONCLUSIONS: The use of porcine collagen matrix as a support for human skin cells is feasible, and the organization of these cells resembles the architecture of human skin.
- 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.
- Human fetal wound healing: a review of molecular and cellular aspects(2016) YAGI, Leticia Hitomi; WATANUKI, Larissa Martins; ISAAC, Cesar; GEMPERLI, Rolf; NAKAMURA, Yeda Midori; LADEIRA, Pedro Ribeiro SoaresThe physiological answer to after birth skin lesions is scarring, which compromises the function and the aesthetics of the injured area. However, fetuses in early gestation (24 weeks or less) respond to this damage with skin regeneration. To explain this difference, several factors are considered, such as increased production of collagen III in fetal fibroblasts and increased presence of this collagen in the skins of these fetuses. Increased hyaluronic acid in fetal matrix correlates with greater capacity for migration of fibroblasts in scarless repair. The fact that myofibroblasts in the wound appear only after the fetal stage of pregnancy which forms scars can also be correlated. Additionally, there is an increase in the amount of adhesion molecules in repair without scarring, which would multiply cell adhesion and migration. Lower levels of bTGF1 in fetal wound are correlated with reduced amounts of collagen I and may be the result of higher relative expression of bTGF3, which downregulates bTGF1. Amniotic fluid itself might be a stimulating factor to human skin's fibroblasts proliferation through cytokines such as bFGF and PDGF. A hypoxic environment in the fetal wound, associated with increased presence of Dot cells in blood, is also observed, and both facts can be related to a difference in the repair of the skin. Distinct gene expression guides those different responses and may also help to elucidate fetal skin regeneration. When the mechanisms responsible for the absence of scars in wounded fetuses are enlightened, it will be a significant mark in the studies of wound cicatrization and its therapeutic applications shall be extremely valuable.
- Análise do atendimento clínico de portadores de úlceras crônicas em membros inferiores(2015) AGUIAR JR, ARMANDO COSTA; ISAAC, CESAR; NICOLOSI, JULIA TEIXEIRA; MEDEIROS, MARIO MUCIO MAIA DE; PAGGIARO, ANDRÉ OLIVEIRA; GEMPERLI, ROLFABSTRACT Introduction: Chronic ulcers of the lower limbs may have different etiologies, with the most frequent being venous, arterial, traumatic, infectious, and diabetic. The treatment of these wounds is dynamic and depends on the evolution of tissue repair. This treatment includes clinical and surgical methods, and dressings are the most frequently used. Dressings can range from inert covers to vehicles for actuation of active substances in the wound bed. The main indication for these substances is related to the effects of debridement and control of the bacterial population, enabling the preparation of wound beds for surgical or spontaneous resolution. Methods: This study is an observational, cross-sectional, retrospective study, with random sampling, aimed at assessing the care provided to patients with chronic ulcers of the lower limbs in the Outpatient Clinic for chronic wounds of the Plastic Surgery Division, HCFMUSP, between 2011 and 2013. Results: The clinical charts of 481 patients of both sexes, with a mean age 60 years, were analyzed; all had chronic ulcers in different stages of evolution. Comorbidities, underlying disease, size of the lesion, treatments, and evolution of wounds were evaluated. A predominance of vascular disease (69.2%) was the underlying cause. All patients were initially treated with dressings containing active agents, for preparation of the wound bed. Of these, 84% were referred for surgical management of wounds. There was no spontaneous closure in 1.5% of cases. The remaining patients (14.5%) showed worsening of lesions with topical treatment, and required other forms of preparation of the wound bed. Conclusion: Topical agents may be an effective outpatient/home method to prepare the wound bed of chronic ulcers for surgical management.
- COMPARISONS OF THE RESULTS OF PERIPHERAL NERVE DEFECT REPAIR WITH FIBRIN CONDUIT AND AUTOLOGOUS NERVE GRAFT: AN EXPERIMENTAL STUDY IN RATS(2016) LONGO, Marco Vinicius Losso; FARIA, Jose Carlos Marques De; ISAAC, Cesar; NEPOMUCENO, Andre Coelho; TEIXEIRA, Nuberto Hopfgartner; GEMPERLI, RolfIntroduction: The standard treatment for nerve defects is nerve autograft. There is no conduit available that provides the same regenerative capacity of nerve autograft. This study evaluated the histological and functional recovery of nerve defects treated with fibrin conduit in comparison to the nerve autograft, in a rat model. Method: A sciatic nerve injury model (10-mm defect) was performed in 20 Wistar rats, nerve defect was reconstructed using a fibrin conduit (n=10). A nerve autograft was used as control (n=10). The walking behavior was measured by footprint analysis at 4, 8, and 12 weeks and sciatic function index was determined. After 12 weeks, histological analysis was performed to evaluate the regenerated nerve and measured axonal density. The triceps surae muscle weight was also evaluated. Results: The fibrin conduit group showed less improvement in walking behavior compared to nerve autograft (-53 +/- 2 vs. -36 +/- 2; P<0.001 at 12 weeks). The fibrin conduit group presented axonal density of 40.0 axons/10.995 mu m2 and the nerve autograft group had 67.2 axons/10.995 mu m2 (P<0.001). The triceps surae muscle weight ratio of the fibrin conduit group was 41 +/- 3% versus 71 +/- 4% of the nerve autograft group (P<0.001). Conclusion: The fibrin conduit could be used for nerve reconstruction following peripheral nerve injury in the rat model. However, the functional recovery in the fibrin conduit repair group was worse than that in nerve autograft group and the nerve repair with the fibrin conduit has less myelinated fibers when compared to the repair with nerve autograft. (C) 2015 Wiley Periodicals, Inc.
- Is allograft skin, the gold-standard for burn skin substitute? A systematic literature review and meta-analysis(2019) PAGGIARO, Andre O.; BASTIANELLI, Renata; CARVALHO, Viviane F.; ISAAC, Cesar; GENNPERLI, RolfBackground: Allograft skin (AS) transplantation has been considered to be the gold standard for replacing tissue damage, following burns. However, increasingly new biosynthetic skin substitutes are being developed as alternatives. The objective of this systematic review is to compare AS with other skin substitutes, which have been used in the treatment of burns. Methods: Randomized clinical trial (RCT) and nonrandomized clinical trial (NRCT) studies comparing AS to any other skin substitute in the treatment of burns were extracted from PubMed/Medline, Scopus, EMBASE, and Web of Science. For the risk of bias analysis, the Cochrane bias risk handbook was used for RCT studies and ROBINS-1 was used for NRCT studies. Outcomes such as healing, self-grafting, scar appearance, and mortality were evaluated. Results: Twelve RCT and six NRCT were selected, with most of the methodologies presenting a high risk of bias. Based on the outcomes of the studies, it was not possible to detect any advantages for using AS, as opposed to other skin substitutes. In the meta-analysis, only two outcomes could be evaluated: healing and graft take percentage; however, no significant differences were observed between the groups. Conclusion: Because of the poor quality of the primary studies, it was not possible to identify differences in the results that compared the use of AS with other substitutes in the treatment of patients with burns. These results support the fact that surgeons primarily base the choice of skin substitute on clinical experience and cost, at least when treating burns.