LINCOLN SAITO MILLAN
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- Outcomes of Immediate Internal Pudendal Artery Perforator Flap Reconstruction for Irradiated Abdominoperineal Resection Defects(2017) COLTRO, Pedro S.; BUSNARDO, Fabio F.; MONACO FILHO, Franklin C.; OLIVAN, Marcelo V.; MILLAN, Lincoln S.; GRILLO, Victor A.; MARQUES, Carlos F.; NAHAS, Caio S.; NAHAS, Sergio C.; RIBEIRO JR., Ulysses; GEMPERLI, RolfBACKGROUND: There are many previous reports for using the internal pudendal artery perforator flap in vulvovaginal reconstruction; however, reports of this flap for perineal reconstruction after abdominoperineal excision of the rectum are scarce. OBJECTIVE: The purpose of this study was to evaluate the outcomes of immediate internal pudendal artery perforator flap reconstruction for irradiated abdominoperineal resection defects. DESIGN: This was a prospective case series. SETTINGS: This flap could represent a step forward over other perineal flap approaches or primary closure. PATIENTS: A total of 73 consecutive patients with anorectal tumors were included. INTERVENTIONS: The study included immediate perineal reconstruction using 122 internal pudendal artery perforator flaps after abdominoperineal excision of the rectum. MAIN OUTCOME MEASURES: Dimensions of the perineal defect (in centimeters squared), hospital stay (days), healing time (days), and postoperative complications (Clavien-Dindo grades) were measured. RESULTS: The means of the perineal defect, hospital stay, and healing time were 51.62 cm(2), 15.94 days, and 38.52 days. The higher the patient BMI, the longer healing time (p = 0.02); Clavien-Dindo complications grades III to IV were greater in patients with perineal defect >= 60 cm(2) (p = 0.03; OR = 10.56); postoperative complications were higher both in patients with anal squamous cell carcinoma (p = 0.005; OR = 6.09) and in patients with comorbidities (p = 0.04; OR = 2.78); hospital stay (p = 0.001) and healing time (p < 0.001) were higher in patients who had postoperative complications. The complete perineal wound healing at 12 weeks was achieved by 95% of patients, and our 30-day mortality rate was 4%. LIMITATIONS: As a nonrandomized study, our results have to be interpreted with caution. CONCLUSIONS: Multiple previously described advantages associated with internal pudendal artery perforator flap were also observed here, reinforcing the idea that it is reliable, versatile, and a useful option for perineal reconstruction after abdominoperineal excision of the rectum. Therefore, we propose that this flap could be considered as the first choice for perineal reconstruction in selected patients with moderate and some large defects after abdominoperineal excision of the rectum. See Video Abstract at http://links.lww.com/DCR/A367.
- Comparative Morphometric Analysis of 5 Interpositional Arterial Autograft Options for Adult Living Donor Liver Transplantation(2014) IMAKUMA, E. S.; BORDINI, A. L.; MILLAN, L. S.; MASSAROLLO, P. C. B.; CALDINI, E. T. E. G.In living donor liver transplantation, the right-sided graft presents thin and short vessels, bringing forward a more difficult anastomosis. In these cases, an interpositional arterial autograft can be used to favor the performance of the arterial anastomosis, making the procedure easier and avoiding surgical complications. Objective. We compared the inferior mesenteric artery (IMA), the splenic artery (SA), the inferior epigastric artery (TEA), the descending branch of the lateral circumflex femoral artery (LCFA), and the proper hepatic artery (PHA) as options for interpositional autograft in living donor liver transplantation. Method. Segments of at least 3 cm of all 5 arteries were harvested from 16 fresh adult cadavers from both genders through standardized dissection. The analyzed measures were proximal and distal diameter and length. The proximal diameter of the RHA and the distal diameter of the SA, IMA, IEA and the LCFA were compared to the distal diameter of the RHA. The proximal and distal diameters of the SA, TEA and LCFA were compared to study caliber gain of each artery. Results. All arteries except the IMA showed statistical significant difference in relation to the RHA in terms of diameter. Regarding caliber gain, the arteries demonstrated statistical significant difference. All the harvested arteries except PHA were 3 cm in length. Conclusion. The IMA demonstrated the best compatibility with the RI-TA in terms of diameter and showed sufficient length to be employed as interpositional graft. The PHA, the SA, the TEA and the LCFA presented statistically significant different diameters when compared to the RHA. Among these vessels, only the PHA did not show sufficient mean length.
- Calcanectomia subtotal para tratamento de úlcera de pressão com osteomielite associada: relato de 2 casos(2014) MILLAN, LINCOLN SAITO; CARVALHO, JULIO GRYNGLAS DE; BATISTA, BERNARDO PINHEIRO DE SENNA NOGUEIRA; GALLAFRIO, SAMUEL TERRA; TUMA JUNIOR, PAULO; FERREIRA, MARCUS CASTROABSTRACT Introduction: Feet wounds are very common and require multidisciplinary approach for prevention, treatment and rehabilitation. When involving the calcaneus, they offer even greater difficulty and may complicate with osteomyelitis. Debridement of devitalized tissue and antibiotics are important steps for treatment. For the reconstruction, local or free flaps are needed. However, not all patients, due to systemic conditions or local blood supply, are not candidates for this type of reconstruction and some times are submitted to amputations. Cases Report: The authors report two cases in which subtotals calcanectomies were used for the treatment of wounds in the calcaneus. In both cases, amputations were avoided.
bookPart Suturas de pele(2017) PRADO, Ariadne Juna Fernandes do; IUAMOTO, Leandro Ryuchi; SHIDA, Felipe Seiji; MILLAN, Lincoln Saito- Curativo da área doadora de enxerto de pele parcial com curativo de colágeno e alginato (Fibracol®): uma experiência de 35 pacientes(2015) MILLAN, LINCOLN SAITO; SILVA, DIEGO BARÃO DA; COLTRO, PEDRO SOLER; ALMEIDA, PAULO CEZAR CAVALCANTE DE; MATTAR, CARLOS ALBERTO; FAIWICHOW, LEÃOABSTRACT Introduction: The objective of this study was to report our findings with a collagen and alginate dressing (Fibracol®) used to cover donor areas of partial-thickness skin grafts. Method: We retrospectively evaluated the medical records of 35 patients in whom Fibracol® was used on donor areas. The routine used to manage the donor area is as follows: The area is covered with one or more units of Fibracol®, followed by application of a waterproof film. After three or four days, the dressing is removed and the area cleaned gently with saline and gauze; the area is dressed again if necessary. The mean patient age was 25.52 years (range, 1-65 years). Results: The thigh was used as the donor area in 29 patients, the arm in 2, the leg in 4, and the trunk in 3. Two patients had more than one donor area. The mean time needed for epithelization was 4.51 days (range, 3-8 days). The Pearson correlation coefficient value correlating age and time of epithelization was -0.0755; p = 0.6685. None of the patients experienced an infection in the donor area. The ideal dressing for the donor area of split-thickness skin grafts would have multiple characteristics including low price, good patient comfort, low infection rate, and a short epithelization period. Conclusion: The authors report a positive experience with the use of Fibracol® in 35 patients over a period of 22 months. The mean epithelization period was 4.51 days, shorter than that in the majority of published studies, and had no correlation with the age of the patient.