CARLOS FONTANA
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1
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
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- Orofacial rehabilitation after severe orofacial and neck burn: Experience in a Brazilian burn reference centre(2021) MAGNANI, Dicarla Motta; SASSI, Fernanda Chiarion; VANA, Luiz Philipe Molina; FONTANA, Carlos; ANDRADE, Claudia Regina Furquim deObjective: To quantify the benefits of a functional oral rehabilitation program for impairment caused by full thickness orofacial and neck burns, comparing the effects of early and late intervention. Methods: An observational cross-sectional study was conducted in a burn reference center over a two-year period. Patients with full thickness orofacial and neck burns were divided in two groups: Group 1 was composed by 14 patients who began the rehabilitation program 3 -12 months after the burn injury; Group 2 was composed by 15 patients who began the rehabilitation program more than 12 months after the burn injury. Treatment was based on current strategies of non-surgical exercises for orofacial contracture management. Outcome measurements included an oral motor clinical evaluation and the assessment of the mandibular range of movement. Results: The functional rehabilitation program was effective in reestablishing the oral motor functions (i.e deficits reduced to approximately 15% when compared to the optimal possible scores) and in restoring horizontal mouth opening dimensions, with more than 70% of the patients presenting measurements within the expected normal limits at the end of treatment. Our results did not indicate differences in performance between the group of patients in neither set of assessments, i.e. pre and post treatment (p > 0.05). Conclusion: The results of this study indicate that non-invasive orofacial contracture management is effective for patients with orofacial and neck burns, including those with long term sequelae.
- Uso de matriz dérmica associado ao curativo por pressão negativa na abordagem da contratura em pacientes queimados(2012) ALDUNATE, Johnny Leandro Conduta Borda; VANA, Luiz Philipe Molina; FONTANA, Carlos; FERREIRA, Marcus CastroBACKGROUND: Burn patients are initially treated with volume replacement and, importantly, subsequent excision and early grafting of their injuries. These first aid measures improve the progress and survival rates of burned individuals. However, this treatment creates a new challenge in reparative surgery with regard to the management of burn sequelae, which mainly include contractures. In this study, we aimed to assess the effect of artificial dermal matrix application and negative pressure therapy on the treatment of burn sequelae. METHODS: Ten patients with burn contractures were selected for this study and underwent scar contracture release, wound coverage with an artificial dermal matrix (Integra®), and negative pressure dressing according to the standard procedures. Dressing changes were performed every 5 days for 3-4 weeks. A skin graft was then laid on the wound bed. In the pre- and postoperative period, the patients were asked to rate their satisfaction with the aesthetic and functional aspects of the treated region. RESULTS: In the areas in which the contractures were resected, integration of almost 98% of the dermal regeneration matrix was observed. Also integration was observed in 85% of the grafts used. All the patients reported a significant aesthetic and, in particular, functional improvement of the treated region. CONCLUSIONS: The use of dermal regeneration matrix and negative pressure therapy for the treatment of scar contractures improves the success rate and the aesthetic and functional outcomes of patients with severe burn sequelae.
- Complications using tissue expanders in burn sequelae treatment at a reference university hospital: a retrospective study(2021) VANA, LUIZ PHILIPE MOLINA; LOBATO, RODOLFO COSTA; BRAGAGNOLLO, JOÃO PAULO FONTANA; LOPES, CRISTIANE PEREIRA; NAKAMOTO, HUGO ALBERTO; FONTANA, CARLOS; GEMPERLI, ROLFABSTRACT Background: tissue expanders have high relevance in plastic surgery and among indications it is worth mentioning their use in the treatment of burn reconstruction. Although it shows good results, its use requires special care because some complications can interrupt the reconstruction process. The objective of this study was to report the experience of the Clinics Hospital (University of Sao Paulo) with the use of tissue expanders to treat burn sequelae, establishing the incidence of complications, and identifying risk factors for their occurrence. Methods: a retrospective, observational, and analytical study, evaluating the use of expanders in burns sequelae treatment from 2009 to 2018. Results: 245 expanders were placed in 84 patients, 215 were female, with a mean age of 19.96 years, being 40% in the trunk and 20% in the scalp, with a predominance of rectangular shape in 76.7% of cases. Complications were classified as major and minor.Complications occurred in 17.95% of cases, and extrusion and infection were the most common. There was a higher incidence of complications in expanders used in the upper and lower limbs as well as in those who did not undergo concomitant expansion (p <0.05), with an even higher chance of major complications in patients submitted to additional expansion. From 2009 to 2018, we observed a decrease in the incidence of complications. Conclusion: the complication rate (17.95%) is similar to other studies of the literature, there was a higher rate of complication with expanders placed in the limbs and a higher rate of major complications when additional expansion was done.
bookPart Queimaduras(2013) FONTANA, Carlos; VANA, Luiz Philipe Molina; FERREIRA, Marcus Castro- Atualização e sistematização de sequelas em queimaduras(2020) VANA, Luiz Philipe Molina; FONTANA, Carlos; GEMPERLI, RolfAbstract Background and objective We define burn sequelae as any abnormal body condition related to or resulting from a burn, functional when lead to any limitation of function and non-functional when the sequel still exists but there is no limitation of function, formerly called aesthetic sequelae. The present study proposes a systematization of reasoning in the treatment of burn sequelae in order to facilitate and establish a standardization of care and of the surgical schedule of patients. Methods We conduct a study in the burn sequelae outpatient clinic of the Hospital das Clinicas at the Faculty of Medicine of the University of São Paulo (Brazil), treating 640 patients and generating a systematization of care for patients with burn sequelae. Results Due to the difficulty in treating burn sequelae, we developed an algorithm where the teaching of concepts and logical reasoning became easy. The standardization of procedures made the treatment of burn sequelae reproducible, easy to understand by plastic surgeons and even improving the results. In this way, we believe that academic training becomes easier and more effective. Conclusions Standardized medical reasoning and algorithms are a powerful weapon and simple and effective auxiliary methods to obtain consistent results in the daily practice of medicine.
- Reconstrução do complexo areolomamilar da mama queimada com retalho trilobado autonomizado(2015) VANA, LUIZ PHILIPE MOLINA; FONTANA, CARLOS; REIS, JULIANA; GOMEZ, DAVID SOUZA; GEMPERLI, ROLFABSTRACT Introduction: Reconstruction of the nipple-areola complex is the final stage of breast reconstruction. The most common nipple reconstruction techniques use local flaps or grafts. However, these techniques in cases of burns produce undesirable outcomes due to the decreased vascularization of damaged skin. The objective of this work was to evaluate the use of the autonomized star flap in the nipple reconstruction of burned breasts. Methods: Nipples were reconstructed in eight female patients in two surgeries each. Results: There were no complications such as necrosis, dehiscence, complete loss of projection of the new nipple, or infection. The mean projection at the end of surgery was 15.25 mm; 6 months after reconstruction, it was 3 mm, showing stability. All patients were satisfied with their results. Conclusion: We conclude that autonomization leads to safe reconstruction of the nipple on burned breasts and maintains a satisfactory minimal projection of the reconstructed nipple.
bookPart Condutas no paciente grande queimado(2016) FERNANDES JR., Constantino José; FONTANA, Carlos; VANA, Luiz Philipe Molina