The role of the perioperative prone position in the low recurrence of pressure injuries in the pelvic region.

Objective: A pressure injury (PI) is a localised area of damage to the skin and/or underlying soft tissue as a result of a sustained mechanical loading. There are three key aetiological mechanisms to PI formation-direct cell deformation, inflammatory oedema and ischaemic damage-which are typically activated sequentially to drive a spiral of injury. This article discusses the role of the perioperative prone position as a rational approach to reducing the recurrence of pelvic PI after reconstructive surgery.

Epidemiologic Overview of Synkinesis in 353 Patients with Longstanding Facial Paralysis under Treatment with Botulinum Toxin for 11 Years.

Background: Patients with longstanding facial paralysis often exhibit synkinesis. Few reports describe the prevalence and factors related to the development of synkinesis after facial paralysis. Botulinum toxin type A injection is an important adjunct treatment for facial paralysis-induced asymmetry and synkinesis.

Pseudoxanthoma Elasticum Treatment with Fractional CO2 Laser.

Pseudoxanthoma elasticum (PE) is a rare genetic disease characterized by calcification and fragmentation of elastic fibers of the skin, retina, and cardiovascular system. We report a case of PE in which fractional carbon dioxide laser treatment was successfully used to achieve improvement of the cervical skin with 2-year follow-up, in a patient with Fitzpatrick skin type IV. After the fifth session, the patient presented with a local herpes infection.

Comparison of the efficacy of onabotulinumtoxinA and abobotulinumtoxinA at the 1: 3 conversion ratio for the treatment of asymmetry after long-term facial paralysis.

Background: Botulinum toxin A injection into the nonparalyzed side is used to treat asymmetry resulting from facial palsy. OnabotulinumtoxinA and abobotulinumtoxinA units are not equivalent. The authors compared the conversion ratio of 1:3 in patients with facial palsy.

Face transplantation in rats. Reproducibility of the experimental model in Brazil.

Purpose: To investigate the reproducibility of the experimental model of face allotransplantation in rats in Brazil.

Methods: Eighteen rats were operated, nine-nine donors recipients. Animals underwent transplantation of the left hemiface, with periorbital and scalp.

Lymph fasciocutaneous lateral thoracic artery flap: anatomical study and clinical use.

Background:  The lateral thoracic flap was first studied in the mid-1970s but its use has been limited because of pedicle anatomical variations. However, after the development of lymph node transfer surgery, the axilla/upper lateral thorax presented as a promising donor area. Through a detailed anatomical study, the lateral thoracic flap was evaluated regarding its vascularization and composition.

Characterization of critically ill adult burn patients admitted to a Brazilian intensive care unit.

Introduction: To characterize the evolution of clinical and physiological variables in severe adult burn patients admitted to a Brazilian burn ICU, we hypothesized that characteristics of survivors are different from non-survivors after ICU admission.

Methods: A five-year observational study was carried out. The clinical characteristics, physiological variables, and outcomes were collected during this period.

Subatmospheric pressure therapy in the treatment of traumatic soft tissue injuries.

Objective: To evaluate the use of subatmospheric pressure therapy in the treatment of acute traumatic injuries of the soft tissues, especially in the limbs.

Methods: One hundred and seventy-eight patients with traumatic wounds were treated by the Center for Complex Wounds in the period from January 2010 to December 2011, and submitted to subatmospheric pressure therapy (SPT).

Results: Of the 178 patients who underwent SPT, 129 (72.

An outcome analysis and long-term viability of cryopreserved cultured epidermal allografts: assessment of the conservation of transplantable human skin allografts.

Purpose: To assess the viability of cultured epithelium and preserved by freezing for periods varying from one month to one year.

Methods: Samples of cultured epithelium were incubated in cryoprotectant medium (Group A), packed in aluminum envelopes and packed in polystyrene boxes. The boxes were subjected to a temperature of-70 ºC.

Prefabricated bone flap: an experimental study comparing deep-frozen and lyophilized-demineralized allogenic bones and tissue expression of transforming growth factor β.

Background: Extensive bone defects are still a challenge for reconstructive surgery. Allogenic bones can be an alternative with no donor area morbidity and unlimited amount of tissue. Better results can be achieved after allogenic bone preparation and adding a vascular supply, which can be done along with flap prefabrication.

Negative pressure wound therapy in complex trauma of perineum.

Objective: To review the experience (2011 and 2012) of Wound Center of Plastic Surgery Service, Clinics Hospital, Faculty of Medicine, University of São Paulo, with treatment of complex traumatic wounds in the perineal region with the association of negative pressure wound therapy followed by a surgical skin coverage procedure.

Methods: This was retrospective analysis of ten patients with complex wound in the perineum resulting from trauma assisted by the Department of Plastic Surgery in HC-USP. Negative pressure was used as an alternative for improving local conditions, seeking definitive treatment with skin grafts or flaps.

Clinical outcomes following nipple-areola-sparing mastectomy with immediate implant-based breast reconstruction: a 12-year experience with an analysis of patient and breast-related factors for complications.

Nipple-sparing mastectomy (NSM) is increasingly offered to women for therapeutic and prophylactic indications. Although, clinical series have been described, there are few studies describing risk factors for complications. The objective of this study is to evaluate the incidence of complications in a series of consecutive patients submitted to NSM and differences between clinical risk factors, breast volume, and different incision types.

Sensory testing in patients with hemodialysis-associated carpal tunnel syndrome submitted to surgical decompression.

Background: Carpal tunnel syndrome (CTS) is the most common compression neuropathy of the upper limb. Close to 5% of patients with chronic renal failure who need hemodialysis present CTS. Clinical history and physical examination remain the most adequate tools for diagnosis, and there is still controversy regarding the most reliable test to complement it.

Evaluation of nerve regeneration in diabetic rats.

Purpose: To compare sciatic nerve regeneration between non-diabetic (control) and streptozotocin-induced diabetic Wistar rats.

Methods: Four subgroups were evaluated. CN: Non-diabetic rats submitted to neurorrhaphy (n=9); DN: Diabetic rats submitted to neurorrhaphy (n=9); CG: Non-diabetic rats submitted to nerve grafting (n=10); DG: Diabetic rats submitted to nerve grafting (n=9).

Alternative surgical treatment of paralytic lagophthalmos using autogenic cartilage grafts and canthopexy.

Purpose: This study aims to analyze the use of autogenic auricular cartilage grafts as weight for the upper eyelid in conjunction with lateral canthopexy for patients with mild paralytic lagophthalmos. This procedure was also accompanied by elevation of the lower eyelid using the cartilage graft for moderate cases.

Methods: We conducted a retrospective study including case series of 30 patients with paralytic lagophthalmos from 1997 to 2010.

PROSPECTIVE STUDY ON TACTILE SENSITIVITY IN THE HANDS OF A BRAZILIAN POPULATION USING THE PRESSURE-SPECIFIED SENSORY DEVICE.

Objective: To evaluate the pressure perception thresholds on the pulp of two fingers (index and little fingers), among a Brazilian population with no nerve injury or neuropathy.

Methods: We used the Pressure-Specified Sensory Device (a computerized device) to derive static and dynamic normal pressure perception thresholds and two-point discrimination distances.

Results: We tested finger sensitivity on 30 volunteers.

Role of plastic surgery on the treatment complex wounds.

Objective: To report the performance of plastic surgery in the treatment of complex wounds in a tertiary hospital, analyzing its characteristics, types of injuries and approaches adopted, with emphasis on surgical treatment.

Methods: We conducted a etrospective analysis of patients with complex wounds treated by plastic surgery in a tertiary hospital in a period of five years (2006 to 2010). Data collection was obtained from visits made, serial assessments and records of the medical charts.

Monsplasty for women after massive weight loss.

Background: Ptosis with excess skin in the pubic area is a very common deformity in patients after massive weight loss. This deformity requires adequate surgical treatment whether combined with abdominoplasty or not. The enlarged pubogenital area may lead to psychosocial distress and impaired quality of life.

Study of the anatomy of the tibial nerve and its branches in the distal medial leg.

Objective: Determine, through dissection in fresh cadavers, the topographic anatomy of the tibial nerve and its branches at the ankle, in relation to the tarsal tunnel.

Methods: Bilateral dissections were performed on 26 fresh cadavers and the locations of the tibial nerve bifurcation and its branches were measured in millimeters. For the calcaneal branches, the amount and their respective nerves of origin were also analyzed.

Mechanical evaluation of the resistance and elastance of post-burn scars after topical treatment with tretinoin.

Objective: After burn injuries, scarred skin lacks elasticity, especially in hypertrophic scars. Topical treatment with tretinoin can improve the appearance and quality of the skin (i.e.

Clinical trial comparing 3 different wound dressings for the management of partial-thickness skin graft donor sites.

Purpose: A review of the literature reveals a lack of consensus regarding local management of skin graft donor sites. This study was undertaken to determine the effects of 3 different dressings on healing of donor sites and patient discomfort related to donor sites.

Design: This study is a comparison cohort study.

Superficial inferior epigastric artery (SIEA) free flap using perforator vessels as a recipient site: clinical implications in autologous breast reconstruction.

Background: Breast reconstruction with autogenous tissue is a well-established technique, but there are some limitations related to donor-site morbidity. Among available techniques, the superficial inferior epigastric artery (SIEA) flap is the least invasive procedure because it does not require harvesting or incision of the rectus muscle or the abdominal fascia. Besides adequate flap choice, the proper selection of the recipient vessels is an important factor.

Evaluation of aesthetic abdominal surgery using a new clinical scale.

Background: Evaluation of outcomes after aesthetic surgery still is a challenge in plastic surgery. The evaluation frequently is based on subjective criteria. This study used a new clinical grading scale to evaluate aesthetic results for plastic surgeries to the abdomen.

Immediate locally advanced breast cancer and chest wall reconstruction: surgical planning and reconstruction strategies with extended V-Y latissimus dorsi myocutaneous flap.

Background: 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.