LUIS HENRIQUE ISHIDA

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico

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  • article 6 Citação(ões) na Scopus
    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, Rolf
    BackgroundIn 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.
  • article 66 Citação(ões) na Scopus
    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.