Systemic sclerosis is a rare, autoimmune, progressive disease that affects connective tissues and... more Systemic sclerosis is a rare, autoimmune, progressive disease that affects connective tissues and internal organs by inflammation, which can cause calcinosis cutis. It can progress to painful and disabling conditions, and can become infected, especially when skin ulceration is present. Objective: To present a case of calcinosis in the inguinal region and its surgical recovery. Case Report: A female patient with calcinosis in the bilateral inguinal region presenting with moderate/severe pain had a failed clinical treatment. We performed surgical resection of the calcinosis cutis, which had formed clusters of fibrosis with adhesion to the fascia of the external oblique muscle. We used simple nylon 2.0 sutures along the subdermal plane to perform primary closure and continuous nylon 3.0 sutures along the intradermal plane for aesthetic closure and minimal inflammatory reaction. Her postoperative recovery was positive. Conclusion: The best treatment for calcinosis cutis is still unclear. Treating complications becomes essential for reducing patients' morbidity and increasing their quality of life.
Background: Non-melanoma skin cancer accounts for a third of all malignancies registered in Brazi... more Background: Non-melanoma skin cancer accounts for a third of all malignancies registered in Brazil, with squamous cell carcinoma (SCC) being one of its subtypes. It develops in photo-exposed areas, affecting social habits and causing negative influence on quality of life (QoL). oBjectives: To evaluate QoL in patients with primary cutaneous SCC. Methods: A cross-sectional study was performed in patients with clinical diagnosis of SCC, corroborated by dermoscopy and confirmed by histopathology; prior to resection of the tumor using the double-blade scalpel technique, a questionnaire on the Dermatology Life Quality Index (DLQI) was applied. results: Among the 46 evaluated patients, mean age was 67.1 ± 16.0 years, with a predominance of males, low educational level and socioeconomic status, Fitzpatrick II phototype, history of outdoor work, and tumor location in exposed photo areas. Mean DLQI was 4.02 ± 0.63, and in the categorization, 11 (23.9%) had a moderate to severe negative effect on QoL. The skin tumor had a negative impact on daily activities (33% of cases), treatment effects (30%), and symptoms and feelings (29%). study liMitations: There is no gold standard instrument for assessing QoL in dermatological patients. conclusion: In the study sample, one-fourth of patients with SCC had a moderate to severe negative effect on quality of life.
Journal of Plastic Reconstructive and Aesthetic Surgery, Mar 1, 2020
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Early reconstruction after mastectomy for breast cancer with definitive implants has been widely ... more Early reconstruction after mastectomy for breast cancer with definitive implants has been widely used, especially with the evolution of conservative surgical breast cancer treatments. We aimed to identify different characteristics associated with plastic surgery, based on immediate or delayed reconstruction time and evaluate quality of life in patients undergoing mastectomy for cancer. This is a cross-sectional analytical study that evaluated adult patients undergoing mastectomy for breast cancer and breast reconstruction in Plastic Surgery Service at a tertiary hospital. Between March 2011 and November 2015, 58 patients who underwent mastectomy were included, with a mean age of 51.6±10.6 years and 98.3% of them being women. Eighty percent of the patients underwent a radical mastectomy and 20% underwent segmentectomies. Immediate and delayed surgical reconstructions occurred in 22.4% and 77.6% of the cases, respectively, including immediate reconstruction with the local flap trade (15.5%), immediate reconstruction with prosthesis (6.9%), transverse rectus abdominis myocutaneous (TRAM) flap (6.9%), delayed reconstruction with local flap (8.6%), expander and prosthesis (35.7%), and reconstruction with latissimus dorsi flap and prosthesis (22.4%). When comparing subjects undergoing reconstructive surgery based on timing of reconstruction, it was observed that patients undergoing delayed breast reconstruction surgery presented a higher proportion of radical mastectomy (90.7% vs. 41.7%; P=0.001) and the need for two or more surgical interventions (64.1% vs. 20.0%; P=0.029). There was no difference in the quality of life according to reconstruction time. The characteristics associated with postmastectomy reconstruction timing are related to preoperative factors such as the procedure employed and the number of interventions performed and have no influence on complications or the quality of life.
Objective: Despite advances in medical care, patients who are hospitalized or have spinal cord in... more Objective: Despite advances in medical care, patients who are hospitalized or have spinal cord injuries often develop pressure sores. The objective of this study was to describe the epidemiological characteristics of pressure sores and evaluate factors associated with recurrence and cure. Methods: In this historical cohort study, clinical and laboratory data were collected from medical records between 1997 and 2016. Results: Sixty individuals with pressure ulcers were included; mean patient age was 38.1±16.5 (37.0) years, 83.3% were men, and 86.8% identified as white. Most patients (85.1%) had paraplegia, amputation, or trauma of the lower limbs with motor sequelae; the remainder (14.9%) were quadriplegic. Most (78.3%) underwent surgery, and the mean follow-up time was 1.8±2.5 years. The lesions were cured in 25 patients; they recurred in 25% of the patients, and recurrence was seen to be associated with the location of the lesions. Patients with recurrent lesions had more medical consultations and a longer treatment time. Individuals whose ulcers had healed had fewer lesions, higher body mass index (BMI), and a higher proportion of these patients underwent surgery. Conclusions: BMI and location and number of lesions are prognostic factors. Level of Evidence IV, Case Series.
Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery, 2018
Pouco se sabe sobre os casos de angioedema pós-operatórios graves e muitas vezes essa entidade é ... more Pouco se sabe sobre os casos de angioedema pós-operatórios graves e muitas vezes essa entidade é de difícil diagnóstico e pode passar despercebida, com repercussões no desfecho dos pacientes. Dentre os diagnósticos diferenciais, estão o angioedema hereditário, angioedema não hereditário, alérfico, andioedema adquirido, idiopático. Diferenciar essas entidades é importante para que o tratamento seja rapidamente instituído e o paciente evolua de forma favorável. Objetivo: Relatar o caso de um paciente que desenvolveu angioedema de face grave após uma cirurgia de lifting facial. Métodos: As informações foram obtidas por meio de revisão do prontuário, entrevista com a paciente, registro fotográfico e revisão da literatura. Resultados/Relato do Caso: Paciente feminino, 64 anos, submetida à cirurgia de lifting facial completo evoluiu com angioedema agudo no terceiro dia pós-operatório, com necessidade de suporte ventilatório. Inicialmente, o tratamento instituído foi com anti-histamínicos, glicocorticoides e adrenalina na suspeita de angioedema alérgico, porém, a paciente não teve melhora dos sintomas. Frente à suspeita de angioedema idiopático, iniciou-se terapia com plasma fresco congelado, quando houve melhora paulatina do quadro clínico. A paciente seguiu acompanhamento ambulatorial frequente. Teve como complicação do angioedema o sofrimento isquêmico do retalho retroauricular, necessitando de desbridamento, o qual foi deixado cicatrizar por segunda intenção. Atualmente, paciente encontra-se bem, sem quaisquer queixas. Conclusão: O cirurgião plástico deve estar alerta para complicações pós-operatórias como a descrita, pois a terapêutica deve ser iniciada com maior brevidade para melhores desfechos. A rápida evolução do caso nos atenta para a gravidade da complicação e necessidade do conhecimento desta entidade.
Resumo A hidradenite supurativa é definida como doença crônica, supurativa, bacteriana, que compr... more Resumo A hidradenite supurativa é definida como doença crônica, supurativa, bacteriana, que compromete as glândulas sudoríparas. Em sua grande maioria esta presente no períneo, região glútea e escrotal. Este trabalho vem relatar um caso de hidradenite ...
Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery, 2018
Introdução: No Brasil e no mundo, o câncer de mama é o mais incidente em mulheres. De todos os ca... more Introdução: No Brasil e no mundo, o câncer de mama é o mais incidente em mulheres. De todos os casos, aproximadamente, 20 são submetidos à reconstrução imediata. Desde que foi realizada pela primeira vez, a reconstrução mamária teve aprimoramentos, variando de uso de tecidos autólogos, expansores, implantes mamários e mais recentemente o uso de matrizes dérmicas e sintéticas. Objetivo: Relatar a experiência do autor com uso de matriz sintética e biológica na reconstrução mamária imediata. Métodos: Análise descritiva dos dados por meio de revisão de prontuário; foi avaliado o perfil epidemiológico das pacientes e os resultados estético-funcionais, além das complicações. Resultados: Foram analisadas 4 pacientes que foram submetidas à mastectomia por câncer de mama e reconstrução imediata em estágio único com uso de implantes mamários e matriz dérmica. A idade de 37,25 ± 8,53 anos, o tipo de câncer de mama prevalente foi carcinoma ductal invasor 2 (66,6%), em todos 3 casos com neoplasia foi realizada mastectomia radical (skin sparing), todas pacientes pós-mastectomia foram submetidas à colocação de prótese submuscular, uma delas colocou expansor e 2 implante mamário, perfil moderado, cujo tamanho variou de 330ml a 475ml. Do total, 3 pacientes usaram a matriz dérmica sintética absorvível (Gore ®) e 1 paciente a matriz biológica de origem porcina (Strattice ®); a indicação do uso da matriz foi principalmente para compor o revestimento e dar sustentação ao polo inferior da prótese. Apenas 1paciente fez radioterapia pós-operatória como terapia adjuvante devido a características patológicas da neoplasia que aumentavam risco de recorrência local; 2 delas fizeram quimioterapia perioperatória. Uma paciente apresentou seroma pósoperatório (subgrupo da tela sintética Gore ®), que foi resolvido com punção simples. Não houve outras complicações como hematoma, extrusão ou infecção da prótese e matriz dérmica. Em todas pacientes, foram obtidos resultados satisfatórios (avaliação subjetiva). Conclusão: O uso de matriz dérmica do Brasil é incipiente, porém promissor. Acreditamos que o uso dessa tecnologia é importante num grupo de pacientes cuidadosamente selecionado para que o custo-benefício seja favorável. A experiência do autor mostra bons resultados. Para avaliação da incidência/complicação, necessitamos mais casos e maior seguimento.
Systemic sclerosis is a rare, autoimmune, progressive disease that affects connective tissues and... more Systemic sclerosis is a rare, autoimmune, progressive disease that affects connective tissues and internal organs by inflammation, which can cause calcinosis cutis. It can progress to painful and disabling conditions, and can become infected, especially when skin ulceration is present. Objective: To present a case of calcinosis in the inguinal region and its surgical recovery. Case Report: A female patient with calcinosis in the bilateral inguinal region presenting with moderate/severe pain had a failed clinical treatment. We performed surgical resection of the calcinosis cutis, which had formed clusters of fibrosis with adhesion to the fascia of the external oblique muscle. We used simple nylon 2.0 sutures along the subdermal plane to perform primary closure and continuous nylon 3.0 sutures along the intradermal plane for aesthetic closure and minimal inflammatory reaction. Her postoperative recovery was positive. Conclusion: The best treatment for calcinosis cutis is still unclear. Treating complications becomes essential for reducing patients' morbidity and increasing their quality of life.
Background: Non-melanoma skin cancer accounts for a third of all malignancies registered in Brazi... more Background: Non-melanoma skin cancer accounts for a third of all malignancies registered in Brazil, with squamous cell carcinoma (SCC) being one of its subtypes. It develops in photo-exposed areas, affecting social habits and causing negative influence on quality of life (QoL). oBjectives: To evaluate QoL in patients with primary cutaneous SCC. Methods: A cross-sectional study was performed in patients with clinical diagnosis of SCC, corroborated by dermoscopy and confirmed by histopathology; prior to resection of the tumor using the double-blade scalpel technique, a questionnaire on the Dermatology Life Quality Index (DLQI) was applied. results: Among the 46 evaluated patients, mean age was 67.1 ± 16.0 years, with a predominance of males, low educational level and socioeconomic status, Fitzpatrick II phototype, history of outdoor work, and tumor location in exposed photo areas. Mean DLQI was 4.02 ± 0.63, and in the categorization, 11 (23.9%) had a moderate to severe negative effect on QoL. The skin tumor had a negative impact on daily activities (33% of cases), treatment effects (30%), and symptoms and feelings (29%). study liMitations: There is no gold standard instrument for assessing QoL in dermatological patients. conclusion: In the study sample, one-fourth of patients with SCC had a moderate to severe negative effect on quality of life.
Journal of Plastic Reconstructive and Aesthetic Surgery, Mar 1, 2020
This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Early reconstruction after mastectomy for breast cancer with definitive implants has been widely ... more Early reconstruction after mastectomy for breast cancer with definitive implants has been widely used, especially with the evolution of conservative surgical breast cancer treatments. We aimed to identify different characteristics associated with plastic surgery, based on immediate or delayed reconstruction time and evaluate quality of life in patients undergoing mastectomy for cancer. This is a cross-sectional analytical study that evaluated adult patients undergoing mastectomy for breast cancer and breast reconstruction in Plastic Surgery Service at a tertiary hospital. Between March 2011 and November 2015, 58 patients who underwent mastectomy were included, with a mean age of 51.6±10.6 years and 98.3% of them being women. Eighty percent of the patients underwent a radical mastectomy and 20% underwent segmentectomies. Immediate and delayed surgical reconstructions occurred in 22.4% and 77.6% of the cases, respectively, including immediate reconstruction with the local flap trade (15.5%), immediate reconstruction with prosthesis (6.9%), transverse rectus abdominis myocutaneous (TRAM) flap (6.9%), delayed reconstruction with local flap (8.6%), expander and prosthesis (35.7%), and reconstruction with latissimus dorsi flap and prosthesis (22.4%). When comparing subjects undergoing reconstructive surgery based on timing of reconstruction, it was observed that patients undergoing delayed breast reconstruction surgery presented a higher proportion of radical mastectomy (90.7% vs. 41.7%; P=0.001) and the need for two or more surgical interventions (64.1% vs. 20.0%; P=0.029). There was no difference in the quality of life according to reconstruction time. The characteristics associated with postmastectomy reconstruction timing are related to preoperative factors such as the procedure employed and the number of interventions performed and have no influence on complications or the quality of life.
Objective: Despite advances in medical care, patients who are hospitalized or have spinal cord in... more Objective: Despite advances in medical care, patients who are hospitalized or have spinal cord injuries often develop pressure sores. The objective of this study was to describe the epidemiological characteristics of pressure sores and evaluate factors associated with recurrence and cure. Methods: In this historical cohort study, clinical and laboratory data were collected from medical records between 1997 and 2016. Results: Sixty individuals with pressure ulcers were included; mean patient age was 38.1±16.5 (37.0) years, 83.3% were men, and 86.8% identified as white. Most patients (85.1%) had paraplegia, amputation, or trauma of the lower limbs with motor sequelae; the remainder (14.9%) were quadriplegic. Most (78.3%) underwent surgery, and the mean follow-up time was 1.8±2.5 years. The lesions were cured in 25 patients; they recurred in 25% of the patients, and recurrence was seen to be associated with the location of the lesions. Patients with recurrent lesions had more medical consultations and a longer treatment time. Individuals whose ulcers had healed had fewer lesions, higher body mass index (BMI), and a higher proportion of these patients underwent surgery. Conclusions: BMI and location and number of lesions are prognostic factors. Level of Evidence IV, Case Series.
Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery, 2018
Pouco se sabe sobre os casos de angioedema pós-operatórios graves e muitas vezes essa entidade é ... more Pouco se sabe sobre os casos de angioedema pós-operatórios graves e muitas vezes essa entidade é de difícil diagnóstico e pode passar despercebida, com repercussões no desfecho dos pacientes. Dentre os diagnósticos diferenciais, estão o angioedema hereditário, angioedema não hereditário, alérfico, andioedema adquirido, idiopático. Diferenciar essas entidades é importante para que o tratamento seja rapidamente instituído e o paciente evolua de forma favorável. Objetivo: Relatar o caso de um paciente que desenvolveu angioedema de face grave após uma cirurgia de lifting facial. Métodos: As informações foram obtidas por meio de revisão do prontuário, entrevista com a paciente, registro fotográfico e revisão da literatura. Resultados/Relato do Caso: Paciente feminino, 64 anos, submetida à cirurgia de lifting facial completo evoluiu com angioedema agudo no terceiro dia pós-operatório, com necessidade de suporte ventilatório. Inicialmente, o tratamento instituído foi com anti-histamínicos, glicocorticoides e adrenalina na suspeita de angioedema alérgico, porém, a paciente não teve melhora dos sintomas. Frente à suspeita de angioedema idiopático, iniciou-se terapia com plasma fresco congelado, quando houve melhora paulatina do quadro clínico. A paciente seguiu acompanhamento ambulatorial frequente. Teve como complicação do angioedema o sofrimento isquêmico do retalho retroauricular, necessitando de desbridamento, o qual foi deixado cicatrizar por segunda intenção. Atualmente, paciente encontra-se bem, sem quaisquer queixas. Conclusão: O cirurgião plástico deve estar alerta para complicações pós-operatórias como a descrita, pois a terapêutica deve ser iniciada com maior brevidade para melhores desfechos. A rápida evolução do caso nos atenta para a gravidade da complicação e necessidade do conhecimento desta entidade.
Resumo A hidradenite supurativa é definida como doença crônica, supurativa, bacteriana, que compr... more Resumo A hidradenite supurativa é definida como doença crônica, supurativa, bacteriana, que compromete as glândulas sudoríparas. Em sua grande maioria esta presente no períneo, região glútea e escrotal. Este trabalho vem relatar um caso de hidradenite ...
Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery, 2018
Introdução: No Brasil e no mundo, o câncer de mama é o mais incidente em mulheres. De todos os ca... more Introdução: No Brasil e no mundo, o câncer de mama é o mais incidente em mulheres. De todos os casos, aproximadamente, 20 são submetidos à reconstrução imediata. Desde que foi realizada pela primeira vez, a reconstrução mamária teve aprimoramentos, variando de uso de tecidos autólogos, expansores, implantes mamários e mais recentemente o uso de matrizes dérmicas e sintéticas. Objetivo: Relatar a experiência do autor com uso de matriz sintética e biológica na reconstrução mamária imediata. Métodos: Análise descritiva dos dados por meio de revisão de prontuário; foi avaliado o perfil epidemiológico das pacientes e os resultados estético-funcionais, além das complicações. Resultados: Foram analisadas 4 pacientes que foram submetidas à mastectomia por câncer de mama e reconstrução imediata em estágio único com uso de implantes mamários e matriz dérmica. A idade de 37,25 ± 8,53 anos, o tipo de câncer de mama prevalente foi carcinoma ductal invasor 2 (66,6%), em todos 3 casos com neoplasia foi realizada mastectomia radical (skin sparing), todas pacientes pós-mastectomia foram submetidas à colocação de prótese submuscular, uma delas colocou expansor e 2 implante mamário, perfil moderado, cujo tamanho variou de 330ml a 475ml. Do total, 3 pacientes usaram a matriz dérmica sintética absorvível (Gore ®) e 1 paciente a matriz biológica de origem porcina (Strattice ®); a indicação do uso da matriz foi principalmente para compor o revestimento e dar sustentação ao polo inferior da prótese. Apenas 1paciente fez radioterapia pós-operatória como terapia adjuvante devido a características patológicas da neoplasia que aumentavam risco de recorrência local; 2 delas fizeram quimioterapia perioperatória. Uma paciente apresentou seroma pósoperatório (subgrupo da tela sintética Gore ®), que foi resolvido com punção simples. Não houve outras complicações como hematoma, extrusão ou infecção da prótese e matriz dérmica. Em todas pacientes, foram obtidos resultados satisfatórios (avaliação subjetiva). Conclusão: O uso de matriz dérmica do Brasil é incipiente, porém promissor. Acreditamos que o uso dessa tecnologia é importante num grupo de pacientes cuidadosamente selecionado para que o custo-benefício seja favorável. A experiência do autor mostra bons resultados. Para avaliação da incidência/complicação, necessitamos mais casos e maior seguimento.
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