HELIO RICARDO NOGUEIRA ALVES
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
10 resultados
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- Supraclavicular flap as a salvage procedure in reconstruction of head and neck complex defects(2019) ALVES, Helio R. N.; FARIA, Jose Carlos Marques de; SANTOS, Rafael Varella dos; CERNEA, Claudio; BUSNARDO, Fabio; GEMPERLI, RolfThe supraclavicular island flap (SCIF) is an interesting therapeutic option in head and neck reconstruction. Since popularized by Pallua in the late 90s, several clinical series have been published showing its versatility and usefulness. However, only a few studies have focused on factors associated with complications from SCIF use. In this study, we analyzed the factors contributing to SCIF unreliability. We performed a retrospective review of the data of 87 patients undergoing SCIF reconstruction between 2008 and 2015. No significant differences in mean complication rates were observed when the SCIF was used for primary or salvage reconstruction (28% versus 25%, respectively, p = 0.816) or for cutaneous or intraoral reconstruction (27% versus 28%, respectively, p= 0.932). Flap folding, preoperative radiotherapy, and microsurgery were associated with significantly increased complication rates (p =0.002, p= 0.043, and p= 0.001, respectively), whereas smoking (p =0.431) had no impact with regard to this. In conclusion, the SCIF is a versatile flap and an important therapeutic tool for use in salvage surgeries, particularly in those performed in patients with poor clinical conditions and limited flap options.
- Gluteoplasty With Lumbar Gluteal Flap Associated With Liposuction and Fat Grafting: A Safe Technique for Massive Weight Loss Patients(2024) ALVES, Helio Ricardo Nogueira; NICOLAS, GregoryBackground Weight loss leads to excessive flaccidity, volume loss, and tissue descent in the gluteal region. Translated autologous flaps during lower body lifting have been utilized in patients; they address sagging tissue and the lack of volume. However, sometimes use of these autologous flaps does not provide adequate gluteal projection, and a second procedure with fat injection may be required.Objectives The authors describe their technique of a lower body lift with a lumbosacral flap in association with liposuction and lipofilling for gluteoplasty.Methods A prospective series of 23 post-bariatric surgery individuals who underwent a lower body lift with lumbosacral flap gluteal augmentation, liposuction, and lipofilling between January 2021 and September 2022 were described. The satisfaction rate and complications were assessed 6 months postoperatively with a validated questionnaire (BODY-Q scale).Results The patients had a mean age of 38.18 (range, 28-56 years) and median body mass index of 26. Four patients with dehiscence were diagnosed and treated conservatively. All wound breakdowns were observed in the paramedian plane of the torsoplasty. No reoperations were performed. The mean satisfaction percentage of the BODY-Q scale transformed score was 97.5.Conclusions A technique for a lower body lift with buttock augmentation combined with liposuction and fat grafting was presented. In future studies other techniques to maximize gluteal contouring should be investigated.
- 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.
- INTERNAL MAMMARY PERFORATOR VESSELS AS RECIPIENT SITE FOR MICROSURGICAL BREAST RECONSTRUCTION: A COMPARATIVE HISTOMORPHOMETRIC ANALYSIS AND INCIDENCE OF DEGENERATIVE VASCULAR CHANGES(2014) MUNHOZ, Alexandre Mendonca; ISHIDA, Luis H.; MONTAG, Eduardo; SAITO, Fabio L.; MENDES, Marcio; ALVES, Helio; GEMPERLI, RolfBackgroundIn microsurgical breast reconstruction, an adequate selection of recipient vessels is crucial for a successful outcome. Although the internal mammary (IM) vessels offer an attractive option, the internal mammary perforator (IMP) vessels are becoming a reliable alternative. The purpose of this study is to investigate the external diameters, lumen area, and atherosclerotic lesions changes of the IMP, IM, and deep inferior epigastric (DIE) vessels through quantitative and qualitative histomorphometric analysis. MethodsNinety-six vessels of bilateral IM, IMP, and DIE vessels from 16 fresh female cadavers were evaluated. Mean age was 54.065.7 years. External diameters, lumen area, and degenerative changes of the tunica intimae and media were analyzed by qualitative histomorphometric analysis. ResultsSeventy-one vessels (20 IM, 31 IMP, and 20 DIE vessels) were included in the final histological analysis. A statistically lower external diameters and lumen area were presented by the IMP. The DIE vessels showed a lower incidence (10%) of moderate and severe intimal layer degenerative changes (P=0.0589). The IMP and DIE vessels showed a lower incidence (9.4 and 25%, respectively) of major media layer degenerative changes (P=0.0001). No major arterial degenerative lesions were observed in the IMP arteries. ConclusionAlthough the IMP external diameters and lumen area were lower than the IM, the results of this study indicated that the tunica media layer in the IMP is less damaged than the other recipient vessels. The results of the comparative histological study permitted to describe additional advantages and disadvantages of using IMP as a recipient vessel for free flap breast reconstruction. (c) 2013 Wiley Periodicals, Inc. Microsurgery 34:217-223, 2014.
- A clinical experience of the supraclavicular flap used to reconstruct head and neck defects in late-stage cancer patients(2012) ALVES, Helio R. N.; ISHIDA, Luis C.; ISHIDA, Luis H.; BESTEIRO, Julio M.; GEMPERLI, Rolf; FARIA, Jose C. M.; FERREIRA, Marcus C.The supraclavicular island flap has been widely used in head and neck reconstruction, providing an alternative to the traditional techniques like regional or free flaps, mainly because of its thin skin island tissue and reliable vascularity. Head and neck patients who require large reconstructions usually present poor clinical and healing conditions. An early experience using this flap for late-stage head and neck tumour treatment is reported. Forty-seven supraclavicular artery flaps were used to treat head and neck oncologic defects after cutaneous, intraoral and pharyngeal tumour resections. Dissection time, complications, donor and reconstructed area outcomes were assessed. The mean time for harvesting the flaps was 50 min by the senior author. All donor sites were closed primarily. Three cases of laryngopharyngectomy reconstruction developed a small controlled (salivary) leak that was resolved with conservative measures. Small or no strictures were detected on radiologic swallowing examinations and all patients regained normal swallowing function. Five patients developed donor site dehiscence. These wounds were treated with regular dressing until healing was complete. There were four distal flap necroses in this series. These necroses were debrided and closed primarily. The supraclavicular flap is pliable for head and neck oncologic reconstruction in late-stage patients. High-risk patients and modified radical neck dissection are not contraindications for its use. The absence of the need to isolate the pedicle offers quick and reliable harvesting. The arc of rotation on the base of the neck provides adequate length for pharyngeal, oral lining and to reconstruct the middle and superior third of the face.
- How to Perform a Supraclavicular Fasciocutaneous Flap for Head and Neck Reconstruction(2012) ALVES, Helio R. N.; BESTEIRO, Julio M.; CERNEA, Claudio C.
- Analysis of the Strength of the Abdominal Fascia in Different Sutures Used in Abdominoplasties(2011) ISHIDA, Luis Henrique; GEMPERLI, Rolf; LONGO, Marco Vinicius Losso; ALVES, Helio Ricardo Nogueira; SILVA, Pedro Henrique Quintino da; ISHIDA, Luis Carlos; FERREIRA, Marcus CastroProtrusion of the abdominal wall secondary to abdominoplasty may occur in patients with weakness of the aponeurotic structures. The anterior layer of the rectus abdominis muscle consists of fibers that are transverse rather than vertical. Based on this anatomical feature, vertical sutures are suggested for the correction of diastasis recti, since they include a greater amount of fascial fibers and thus would be more resistant to tensile strength than horizontal ones. The anterior layers of the rectus abdominis muscles of 15 fresh cadavers were dissected. Two vertical lines were marked on each side of the linea alba, corresponding to the site where plication is usually performed in abdominoplasties. Three abdominal levels were evaluated: the supraumbilical, umbilical, and infraumbilical levels. A simple suture was placed in the vertical direction in one group and in the horizontal direction in the other group, at each of the three levels previously described. These sutures were connected to a dynamometer, which was pulled medially toward the linea alba until rupture of the aponeurosis occurred. The mean strength required to rupture the aponeurotic structures in which the vertical sutures had been placed was greater than for the horizontal ones (p < 0.0001). The vertical suture of the rectus abdominis sheaths was stronger than the horizontal suture because of the more transversal arrangement of its aponeurotic fibers. Thus, routine use of the vertical suture in plications of the aponeurosis of the rectus abdominis muscles is suggested.
- Sensibility of the Ear After Otoplasty(2012) COLTRO, Pedro S.; ALVES, Helio R. N.; GALLAFRIO, Samuel T.; BUSNARDO, Fabio F.; FERREIRA, Marcus C.Changes in skin sensibility occur in various postoperative plastic surgeries, especially when they involve major skin and subcutaneous dissection. There were no studies so far that objectively compared changes of ear sensibility. This prospective study was conducted to compare ear sensibility before and after otoplasty. Patients with prominent ears (n = 15) underwent bilateral otoplasty. Ear tactile sensibility was tested preoperatively and 6 and 12 months after surgery by Pressure Specified Sensory Device, an apparatus that quantifies cutaneous pressure sensation (g/mm(2)). Comparison between preoperative and 6-months postoperative results indicated an increment on mean skin pressure thresholds; however, mean thresholds between pre- and 12 months postoperative period were similar. Vibratory and hot/cold sensibility did not present any difference during this period. This is the first comparative assessment of ear tactile sensibility using quantitative methods. After otoplasty, initially there was reduction in an ear tactile sensibility, followed by a return to levels similar to preoperative sensibility.
- Prelaminated Supraclavicular Island Flap for Total Ear Reconstruction: A New Technique(2020) ALVES, Helio R. N.; RODRIGUEZ, Juan Felippe G. U. M. de; FERNANDES, Thadeu R. R.; BUSNARDO, Fabio F.; BESTEIRO, Julio M.; CERNEA, Claudio Roberto; GEMPERLI, RolfMajor ear reconstruction has progressed over the past years with the emergence of new techniques directed mainly to patients without available or usable local skin. However, microsurgical transfer requires specific training and eligible patients. The authors report a successful ear reconstruction with a prelaminated supraclavicular island flap in 3 stages, which may be a valuable resource for selected patients or when microsurgery is not available. Advantages and disadvantages of this new technique are discussed, and a possible solution to achieve a more satisfactory result is suggested.
- Forehead reconstruction using supraclavicular flap with microsurgical technique: Free flap and a pedicle supercharged flap(2017) ALVES, H. R. N.; FARIA, J. C. M. de; BUSNARDO, F.; CERNEA, C.; RANGEL, T.; GEMPERLI, R.Large and deep defects in foreheads are best repaired with flaps. In these types of cases, reconstructions are made through the transfer of distant flaps, due to the small amount of available local tissue. The supraclavicular island flap (SCIF) has been extensive used for head and neck reconstructions during the last two decades. However, the flap extension is limited to the reconstruction of the superior third of the face, which may increase the risk of distal flap necrosis. The authors describe two cases of forehead reconstruction with the SCIF using a microsurgical technique. © 2017 The Author(s)