ALBERTO YOSHIKAZU OKADA
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/04 - Laboratório de Microcirurgia, Hospital das Clínicas, Faculdade de Medicina
LIM/04 - Laboratório de Microcirurgia, Hospital das Clínicas, Faculdade de Medicina
12 resultados
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bookPart Princípios de microcirurgia(2021) OKADA, Alberto Yoshikazu; NAKAZATO, Fabio Furutani; NAKAMOTO, Hugo Alberto- 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.
- Impact of Fat Graft Thickness and Harvesting Technique on Adipocyte Viability in a New Porcine Experimental Model: An Immunohistochemical Analysis(2021) ARRUDA, Eduardo Gustavo Pires de; MUNHOZ, Alexandre Mendonca; MATSUMOTO, Walter; UEDA, Thiago; MONTAG, Eduardo; OKADA, Alberto; COUDRY, Renata de Almeida; CASTRO, Isac de; GEMPERLI, RolfBackground: Autologous fat grafting (AFG) has been employed in surgical practice as a filling method. However, controversies remain on the specifics of this technique. So far, few relevant experimental large animal studies have objectively assessed factors related to AFG integration. Objectives: This study utilized an experimental, medium-sized animal model to compare the feasibility of AFG collected employing 2 different techniques with instruments of distinct thicknesses. Methods: Twenty minipigs (Sus scropha domesticus) were subjected to AFG harvesting via en bloc resection utilizing 3-(Group I) and 5-mm-diameter (Group II) round punch blades (PBs) and liposuction (LS) with 3- (Group III) and 5-mm-diameter cannulas (Group IV). Both samples were grafted intramuscularly (biceps femoralis). Hematoxylin and eosin staining was employed to identify intact adipocytes, fat necrosis, fibrosis, inflammation, and oil cysts. Immunohistochemical staining (perilipin-A, tumor necrosis factor alfa, and cluster of differentiation number 31) was utilized to quantify the feasibility of adipocytes, tissue necrosis, and neoangiogenesis, respectively. Results: Hematoxylin and eosin analysis showed that fat necrosis and histiocyte presence were significantly lower in the AFG harvested utilizing a PB than in LS. For perilipin-A, a statistical difference was observed between subgroups I and III (P = 0.001) and I and IV (P = 0.004). Instrument diameter had no effect on graft integration in comparisons between groups II and III (P = 0.059) and II and IV (P = 0.132). Conclusions: In this experimental study, fat collected utilizing a PB demonstrated higher adipocyte viability than fat collected with LS. The diameter of the collection instruments, whether PB or LS, had no effect on graft integration.
bookPart Reconstrução mamária(2019) OKADA, Alberto Yoshikazu; FONSECA, Alexandre Siqueira Franco; MUNHOZ, Alexandre Mendonça; ARRUDA, Eduardo Gustavo Pires de; MONTAG, Eduardo; GEMPERLI, Rolf- Avaliação do índice de infecção de implantes mamários utilizados na reconstrução de mama do Instituto do Câncer do Estado de São Paulo(2014) ALMEIDA, PATRÍCIA NORONHA DE; ARRUDA, EDUARDO GUSTAVO PIRES DE; OKADA, ALBERTO; MONTAG, EDUARDO; FERREIRA, MARCUS CASTRO; BUSNARDO, FÁBIO FREITAS; FONSECA, ALEXANDRE SIQUEIRAABSTRACT Introduction: Placement of breast implants is the most commonly used form of breast reconstruction. Despite its advantages, infection of the implant, either in the tissue expander or mammary prosthesis, can be a significant problem, including the need to remove it. The objective of this work is to evaluate the infection rate of breast implants used for breast reconstruction in patients submitted to surgery at the Cancer Institute of the State of São Paulo (ICESP), as well as its correlation with clinical, oncological, and surgical factors. Patients and methods: This is a retrospective study on 120 patients submitted to breast reconstruction with breast implants at the ICESP from February 2009 to March 2010. Results: The infection rate (24.3%) was statistically related to immediate reconstruction (88.9%), diabetes mellitus (25%), body mass index >30 (52.8%), systemic arterial hypertension (52.8%), and skin injury due to mastectomy (27.8%). Of the infected implants, 44% were removed, most of which were expanders placed during immediate reconstruction. Conclusions: Breast reconstruction with implants is the safest and most effective form of treatment. However, consideration should be given to patients who are prone to the development of infection, in order to optimize its prevention and attempt to perform its treatment at an early stage.
- Reconstruction of acquired ischiatic and perineal defects: an anatomical and clinical comparison between gluteal thigh and inferior gluteal perforator flaps(2018) MONTAG, Eduardo; UEDA, Thiago; OKADA, Alberto; ONISHI, Bruno; GEMPERLI, RolfBackground Flap coverage is the gold standard in treating pressure sores, and due to the high recurrence rate, the possibility of multiple surgical procedures should be considered during flap selection. The gluteal thigh (GT) flap has become a workhorse for ischiatic pressure sore treatment at our hospital. Follow-up revealed a group of patients presenting recurrence of the pressure sore that needed a second flap. The inferior gluteal artery perforator (IGAP) flap was chosen in this series. The positive experience with both flaps raised the question of which flap should be the first option for the treatment of ischiatic and perineal pressure sores. Methods IGAP and GT flaps were dissected in 21 fresh human cadavers to allow comparison of anatomical features. In a series of 60 patients, the authors used both the gluteal thigh and the IGAP flap to cover 76 ischiatic and perineal ulcers. Results The IGAP flap was found to be wider and thicker than the gluteal thigh, but presented a shorter pedicle. All flaps healed uneventfully. Recurrent ulcers were treated successfully with both flaps. Conclusions Both flaps are suitable for coverage ischiatic and perineal sores. Due to its anatomical features, the IGAP flap should be considered the first choice of treatment for ischiatic ulcers. The gluteal thigh flap should be used in the recurrent sores.
- Serratus anterior muscle flap as a salvage procedure in exposed implant-based breast reconstruction(2019) MONTAG, Eduardo; OKADA, Alberto; ARRUDA, Eduardo G. P.; MUNHOZ, Alexandre M.; BUSNARDO, Fabio F.; GEMPERLI, RolfBACKGROUND: Implant-based breast reconstruction (IBR) is the most common approach to reconstruct mastectomy deffects. Infection following breast reconstruction can be devastating and lead to loss of the reconstruction due to the need of implant removal. The serratus anterior muscle flap is widely used during breast reconstruction to provide coverage of the implant/expander. METHODS: We present the application of the serratus anterior muscle flap to treat implant exposure after breast reconstruction. CASES PRESENTATION: Two patients who experienced implant exposure after breast reconstruction were successfully treated with partial capsulectomy, pocket irrigation and implant coverage with a serratus anterior muscle flap. RESULTS: No post operative complications have been observed while implant retention was achieved in both cases. CONCLUSIONS: The serratus anterior muscle flap is an option to treat implant exposure following breast reconstruction in selected cases. This flap could be used to prevent implant exposure in critical cases. (C) 2019 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.
- Health effects of pollution on the residential population near a Brazilian airport: A perspective based on literature review(2019) FAJERSZTAJN, Lais; GUIMARAES, Mariana Tavares; DUIM, Etienne; SILVA, Tarsila Guimaraes Vieira da; OKAMURA, Mirna Namie; BRANDAO, Suzan Lucia Brancher; RIBEIRO, Ana Elisa; NAUD, Ludmila Macedo; O'SULLIVAN, Shane; SALDIVA, Paulo Hilario Nascimento; CARDOSO, Maria Regina AlvesIntroduction: Airport is an important source of air and noise pollution. Acute and chronic exposure to air pollution is harmful to human health with proven effects ranging from coryza, to eye irritation, and even to death. Both acute and chronic exposure to noise pollution are harmful to human health and have been related to cardiovascular diseases, hearing loss, cognitive disorders, sleep disorders, tinnitus and respiratory changes. It is plausible to consider that residing near airports increases the likelihood of developing health problems or exacerbate pre-existing conditions. In this study, we review the effects of pollution from airport activity on the health of the resident population located in the city of Guarulhos, near the International Airport of Sao Paulo. Methods: To perform this narrative review, a comprehensive search of published scientific literature on PubMed and a search in reference lists of selected papers were applied. Results: There is a widespread scarcity of international scientific literature relating to health effects of air and noise pollution on residents living near airports; none exists in Latin America. In general, airport activity is an important source of air and noise pollutants. Areas close to airports are usually more polluted. Conclusions: It is plausible to speculate that residing near airports (including Sao Paulo International Airport) increases the likelihood of developing health problems or exacerbating pre-existing conditions. Considering the volume and importance of air transport to society, it is incumbent to invest in mitigating alternatives to improve air quality and reduce noise around airports.
- Immediate Locally Advanced Breast Cancer and Chest Wall Reconstruction: Surgical Planning and Reconstruction Strategies with Extended V-Y Latissimus Dorsi Myocutaneous Flap(2011) MUNHOZ, Alexandre Mendonca; MONTAG, Eduardo; ARRUDA, Eduardo; OKADA, Alberto; BRASIL, Jose Augusto; GEMPERLI, Rolf; FILASSI, Jose Roberto; FERREIRA, Marcus CastroBackground: Surgical resection in locally advanced breast cancer produces large defects that may not be suitable for primary closure. Immediate reconstruction is controversial and presents a complicated scenario for breast surgeons and plastic surgeons. Methods: In this study, a different design was planned for the latissimus dorsi musculocutaneous flap with primary closure in V-Y for the correction of major lesions in the anterior chest wall. Twenty-five patients underwent immediate locally advanced breast cancer reconstruction with a V-Y latissimus dorsi musculocutaneous flap. This flap was raised from adjacent tissue located on the lateral and posterior thoracic region and presented a triangular shape whose base was the lateral aspect of the mastectomy wound. The technique was indicated in patients with large thoracic wounds. Results: Mean follow-up time was 16 months. Closure was obtained in the donor and recipient sites without the use of skin grafts or other more major procedures. Complications occurred in nine patients (36 percent), including dorsal wound dehiscence in five patients and seroma in three. All cases except one were treated by a conservative approach with a good result. No total flap loss was reported. All patients achieved a satisfactory thoracic reconstruction and adequate wound care. Conclusions: The V-Y latissimus dorsi musculocutaneous flap is a reliable technique for immediate locally advanced breast cancer reconstruction. The technique is advantageous because the V-Y design allows primary closure of the chest wound and donor defect. Success depends on patient selection, coordinated planning with the breast cancer surgeon, and careful intraoperative management. (Plast. Reconstr. Surg. 127: 2186, 2011.)
- 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.