ALEXANDRE SIQUEIRA FRANCO FONSECA
Projetos de Pesquisa
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bookPart Reconstrução da mama(2015) MUNHOZ, Alexandre Mendonça; FONSECA, Alexandre Siqueira; MONTAG, Eduardo; GEMPERLI, Rolf- Optimizing Outcomes in Free Flap Breast Reconstruction in the Community Hospital Setting: A Stepwise Approach to DIEP/SIEA Flap Procedures with Banking a Hemiabdominal Flap(2017) OKADA, Alberto; PEREIRA, Diego Daniel; MONTAG, Eduardo; PORTOCARRERO, Marcelo; FELICIO, Carlos; ARRUDA, Eduardo Gustavo; FONSECA, Alexandre; GEMPERLI, Rolf; MUNHOZ, Alexandre MendoncaBackground Free flap breast reconstruction is a conventional procedure in many countries; however, microvascular compromise remains a devastating outcome. Given the morbidity of total necrosis, optimizing free flap salvage stands out as an important area for research, especially among surgeons to overcome the learning curve period and in resource constrained scenario such as community hospitals. To ensure free deep inferior epigastric perforator (DIEP)/superficial inferior epigastric artery (SIEA) flap breast reconstruction, the authors present a technique involving raising a hemiabdominal flap as a free flap, and banking the remaining flap to be utilized if needed in a subsequent procedure. Methods A retrospective review was performed on all free flap breast reconstructions. In this period, 84 patients (mean age: 50.18 years) were included. Results In this study, 65.5% patients underwent immediate reconstruction, and 51.2% received DIEP reconstruction; 9.52% patients were returned to the operating room, and salvage reconstruction using the banked flap was performed in all patients. No differences were observed regarding early complications and age, body mass index, American Society of Anesthesiologists status, diabetes, smoking history, chemotherapy, radiotherapy, and type of flap used ( p >0.05). Hypertension was significantly associated with early complications ( p <0.05). Donor-site complications were associated with RT ( p <0.05). Conclusion The banked flap is a reliable method for ensuring DIEP/SIEA flap survival and should be considered in higher risk reconstructions and community hospitals. We believe that the present technique can be a good addition to the arsenal of plastic surgeons dealing with free flap breast reconstructions in selected patients.
- Validation of Videoconference With Smartphones in Telemedicine Facial Trauma Care: Analysis of Concordance to On-Site Evaluation(2016) FONSECA, Alexandre Siqueira Franco; GOLDENBERG, Dov Charles; STOCCHERO, Guilherme Flosi; LUIZ, Arthur Vicentini Costa; GEMPERLI, RolfBackground The continental size of some countries and heterogeneous hospital network prevents patients who live in remote areas from getting adequate initial assessment of facial trauma. The authors present an alternative model for trauma assessment by videoconference via smartphones and analyze the concordance between telemedicine and face-to-face management. Methods Fifty patients with either a confirmed or suspected diagnosis of facial trauma were independently evaluated by 2 teams of physicians: Face-to-face and telemedicine-based. The face-to-face team attended patients at bedside (physical examination and computed tomography scan analysis). The telemedicine team consisted of a general surgery resident on duty in the emergency room and a plastic surgeon researcher remotely communicating via smartphones. Both teams answered a questionnaire, which contained data concerning patient's epidemiology, physical examination, computed tomography (CT) scan findings, and treatment option to be followed. Data were analyzed and compared regarding the similarity of answers. Results The sample studied was consistent with the literature, showing a predominance of young males. Traffic accidents and personal violence were the main causes of trauma. The concurrency of answers for physical examination findings was considered substantial ( = 0.720). For CT scan findings, it was almost perfect ( = 0.899); for defining the treatment option, it was almost perfect ( = 0.891). High concurrency of face CT scan findings was observed after we calculated the positive predictive value (89.9%), negative predictive value (99.3%), sensitivity (94.2%), specificity (98.8%), and accuracy (98.3%). Conclusions The proposed model to facial assessment trauma by videoconference via smartphones is feasible, showing high concordance level with face-to-face assessment.
bookPart Reconstrução mamária(2019) OKADA, Alberto Yoshikazu; FONSECA, Alexandre Siqueira Franco; MUNHOZ, Alexandre Mendonça; ARRUDA, Eduardo Gustavo Pires de; MONTAG, Eduardo; GEMPERLI, RolfbookPart Cirurgia estética da mama(2015) MUNHOZ, Alexandre Mendonça; FONSECA, Alexandre Siqueira; MARQUES NETO, Ary de Azevedo; GEMPERLI, Rolf- Influência do posicionamento do retalho linfonodal vascularizado na resposta ao tratamento cirúrgico do linfedema secundário ao câncer de mama.(2019) MONTAG, Eduardo; OKADA, Alberto Yoshikazu; ARRUDA, Eduardo Gustavo Pires; FONSECA, Alexandre Siqueira; BROMLEY, Miluska; MUNHOZ, Alexandre Mendonça; BUSNARDO, Fábio Freitas; GEMPERLI, RolfABSTRACT Objective: to evaluate the initial therapeutic experience of transplantation of vascularized lymph nodes in patients with lymphedema of the upper limbs secondary to the treatment of breast cancer, and to verify if the positioning of the transplant influences the surgical result. Methods: we conducted a prospective, comparative test of two therapeutic modalities, with 24 patients with lymphedema of the upper limb after breast cancer treatment, classified as grades 2 and 3, according to the International Lymphedema Society. The two types of procedures performed were: 1) total breast reconstruction with - deep inferior epigastric perforator (DIEP) flap associated with lymph node flap, in patients with no previous breast reconstruction or loss of previous reconstruction (axillary positioning); 2) isolated inguinal lymph node flap performed in patients with completed breast reconstruction or without the desire to perform the breast reconstruction (wrist positioning). Results: the reduction percentage of the affected limb volume was 20.1% (p=0.0370). The number of infectious episodes (cellulites) also decreased significantly, from 41% in the preoperative period to 12.5% in the postoperative one (p=0.004). There were no differences between the proximal and distal groups. Conclusion: the transplantation of lymph nodes positively affected the postoperative evolution of patients with lymphedema secondary to breast cancer. We observed no differences in relation to flap positioning.
- The use of contralateral free extended latissimus dorsi myocutaneous flap for a tertiary failed breast reconstruction: Is it still an option?(2016) MUNHOZ, Alexandre Mendonca; MONTAG, Eduardo; ARRUDA, Eduardo Gustavo; OKADA, Alberto; FONSECA, Alexandre; FILASSI, Jose Roberto; GEMPERLI, RolfBackground: Unsuccessful breast reconstruction management represents a complex challenge for the plastic surgeon. Although these events rarely occur, many patients are not suitable candidates for conventional flaps, because of either previous donor-site surgery or lack of sufficient tissue. Methods: In this study, a contralateral free latissimus dorsi musculocutaneous flap (CL-LDMF) was planned for correction of major lesions in the anterior chest wall. Twelve patients underwent secondary/tertiary breast reconstruction with CL-LDMF with a customized shape (horizontal, oblique, or ""fleur-de-lis"") depending on the amount of tissue necessary. The technique was indicated in patients with large thoracic defects who lacked a donor site and had undergone previous unsuccessful pedicled LDMF. Results: The mean follow-up time was 42.5 months (range: 18-72 months). Five local complications occurred in four of the 12 patients. Dorsal dehiscence was observed in one, local wound infection in one, small partial CL-LDMF necrosis in one, and dorsal seroma in one patient. All cases of complications were limited and treated with a conservative approach except for one implant extrusion 4 months after reconstruction. No total flap loss was reported. All patients achieved a satisfactory thoracic and breast reconstruction. Conclusion: The results of this study demonstrate that free CL-LDMF is a reliable technique and should be considered in selected cases of tertiary reconstructions. The majority of complications were immediate, minor, and comparable to other reconstructive techniques. We believe that in selected patients, especially those who do not have available donor-site areas, free CL-LDMF is advantageous and should be part of the armamentarium of all plastic surgeons who deal with tertiary breast reconstructions.