RESUMO
Pyoderma gangrenosum is a rare idiopathic skin disease. It affects mainly adults, and only 4% of the cases are diagnosed on children and adolescents. There are four clinical forms of pyoderma gangrenosum: ulcerative, pustular, bullous, and vegetative (superficial granulomatous pyoderma). Superficial granulomatous pyoderma is considered the most benign and uncommon form of the disease. Patients who have undergone surgical procedures may occasionally present pyoderma gangrenosum manifestations on the surgical site. A case of a five-year-old child, victim of burn, who presented superficial granulomatous pyoderma on the skin graft donor sites is reported.
Assuntos
Pioderma Gangrenoso/etiologia , Transplante de Pele/efeitos adversos , Queimaduras/cirurgia , Pré-Escolar , Humanos , Masculino , Pioderma Gangrenoso/classificação , Pioderma Gangrenoso/patologia , Transplante de Pele/patologiaRESUMO
O pioderma gangrenoso é doença cutânea inflamatória rara, idiopática. Afeta principalmente adultos; apenas cerca de 4 por cento dos casos são diagnosticados em crianças e adolescentes. Existem quatro formas clínicas de pioderma gangrenoso: ulcerativa, pustular, bolhosa e vegetante (pioderma granulomatoso superficial). O pioderma granulomatoso superficial é considerado a forma mais benigna e incomum da doença. Em pacientes submetidos a manipulação cirúrgica, uma eventual manifestação do pioderma gangrenoso ocorre nos locais de intervenção. Relata-se o caso de criança de cinco anos de idade, vítima de queimadura, que apresentou pioderma granulomatoso superficial sobre áreas doadoras de enxertos.
Pyoderma gangrenosum is a rare idiopathic skin disease. It affects mainly adults, and only 4 percent of the cases are diagnosed on children and adolescents. There are four clinical forms of pyoderma gangrenosum: ulcerative, pustular, bullous, and vegetative (superficial granulomatous pyoderma). Superficial granulomatous pyoderma is considered the most benign and uncommon form of the disease. Patients who have undergone surgical procedures may occasionally present pyoderma gangrenosum manifestations on the surgical site. A case of a five-year-old child, victim of burn, who presented superficial granulomatous pyoderma on the skin graft donor sites is reported.
Assuntos
Pré-Escolar , Humanos , Masculino , Pioderma Gangrenoso/etiologia , Transplante de Pele/efeitos adversos , Queimaduras/cirurgia , Pioderma Gangrenoso/classificação , Pioderma Gangrenoso/patologia , Transplante de Pele/patologiaRESUMO
Tissues of the pectoral area such as skin and pectoralis major muscle are used in safe and extended flaps for cervical and neck reconstructions. As blood supply is derived from medial vessels (internal mammary artery) or lateral (thoracodorsal and lateral thoracic arteries), 2 different flaps can be constructed: medial and lateral deltopectoral flaps. Medial deltopectoral flap was developed by Bakamjian as an axial-pattern skin flap, and its blood supply depends on perforating branches from the internal mammary artery. When either parasternal skin or pectoralis major muscle must be resected, this flap obviously cannot be used. In this article, a new lateral deltopectoral flap based on lateral pedicles (from axilla and lateral thoracic area) is described. The successful use of this lateral deltopectoral flap in an extended cervical and thoracic reconstruction after resection of a giant basal cell carcinoma demonstrates that it must be considered as an alternative technique.
Assuntos
Músculos Peitorais/transplante , Procedimentos de Cirurgia Plástica/métodos , Transplante de Pele/métodos , Retalhos Cirúrgicos , Neoplasias Ósseas/cirurgia , Carcinoma Basocelular/cirurgia , Clavícula/cirurgia , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Musculares/cirurgia , Músculos do Pescoço/cirurgia , Invasividade Neoplásica , Músculos Peitorais/irrigação sanguínea , Neoplasias Cutâneas/cirurgia , Transplante de Pele/patologia , Esterno/cirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Neoplasias Torácicas/cirurgiaRESUMO
Being non-hair-bearing and relatively thin and having similar color and texture of the skin of the forehead provide an excellent characteristic not only for nasal reconstruction but also in other facial areas. A 28-year-old man presented in the Department of Plastic Surgery, Argerich Hospital, Buenos Aires, Argentina, with a giant congenital melanocytic nevus extended on complete left cheek, total nose, both upper and lower lids, ocular globe, and temporoparietal region. Tumor resection and reconstructive aspect were planned in 3 stages. (1) Excision of the tumor located in the cheek, nose, and both upper and lower left lids. The reconstruction of the cheek was made with a total forehead flap. The nose was resurfaced by means of a total skin graft. (2) resection of the temporoparietal nevus. (3) Treatment of the tumor involving the ocular structures. Total forehead flap was outlined, permitting carryout of skin of the total forehead area, and the blood supply was originated from the frontal and parietal branches of the temporal superficial artery and secondarily by anastomosis with the branches arising from both homolateral auricular and occipital vessels. Postoperative control 1 year after surgery showed an excellent aesthetic and functional result not only in the recipient area but also in the donor area.
Assuntos
Neoplasias Faciais/congênito , Nevo Pigmentado/congênito , Procedimentos de Cirurgia Plástica/métodos , Neoplasias Cutâneas/congênito , Transplante de Pele/métodos , Retalhos Cirúrgicos , Adulto , Bochecha/cirurgia , Neoplasias da Túnica Conjuntiva/congênito , Neoplasias da Túnica Conjuntiva/cirurgia , Neoplasias Palpebrais/congênito , Neoplasias Palpebrais/cirurgia , Neoplasias Faciais/cirurgia , Seguimentos , Testa , Neoplasias de Cabeça e Pescoço/congênito , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Masculino , Nevo Pigmentado/cirurgia , Neoplasias Nasais/congênito , Neoplasias Nasais/cirurgia , Couro Cabeludo/patologia , Neoplasias Cutâneas/cirurgia , Transplante de Pele/patologia , Retalhos Cirúrgicos/irrigação sanguínea , Artérias Temporais/patologia , Coleta de Tecidos e ÓrgãosRESUMO
OBJECTIVE AND DESIGN: We investigated the influence of acute inflammation in skin isograft acceptance. METHODS: Two mouse lines selected for maximal (AIRMAX) or minimal inflammatory response (AIRMIN) were transplanted with syngeneic skin. Cellular infiltrates and cytokine production were measured 1, 3, 7 or 14 days post-transplantation. The percentage of CD4+CD25+Foxp3+ cells in the lymph nodes was also evaluated. RESULTS: Grafts were totally accepted in 100% of AIRMAX and in 26% of AIRMIN mice. In the latter, partial acceptance was observed in 74% of the animals. Emigrated cells were basically PMN and were enhanced in AIRMAX transplants. IL-10 production by graft infiltrating cells showed no interline differences. IFN-gamma was increased in AIRMIN grafts at day 14 and lower percentages of CD4+CD25+Foxp3+ cells in the lymph nodes were observed in these mice. CONCLUSIONS: Our data suggest that differences in graft acceptance might be due to a lack of appropriate regulation of the inflammatory response in AIRMIN mice compromising the self/non-self recognition.
Assuntos
Sobrevivência de Enxerto/fisiologia , Inflamação/patologia , Macrófagos/patologia , Neutrófilos/patologia , Transplante de Pele/fisiologia , Transplante Isogênico/patologia , Animais , Antígenos CD4/metabolismo , Fatores de Transcrição Forkhead/metabolismo , Inflamação/metabolismo , Interferon gama/metabolismo , Interleucina-10/metabolismo , Subunidade alfa de Receptor de Interleucina-2/metabolismo , Linfonodos/metabolismo , Linfonodos/patologia , Macrófagos/metabolismo , Camundongos , Camundongos Endogâmicos , Modelos Animais , Neutrófilos/metabolismo , Transplante de Pele/patologia , Fator de Necrose Tumoral alfa/metabolismoRESUMO
Introdução: a cola de fibrina tem sido amplamente utilizada por várias especialidades médicas,principalmente pelas áreas cirúrgicas. Seu uso em enxertos de pele foi descrito em 1944 por Tidrick e Warner2, Apesar de apresentar inúmeras vantagensteóricas, seu uso não é comum no nosso meio. Objetivo: O objetivo do trabalho é demonstrar uma maneirasimplificada de produzir a cola de fibrina oriunda de material autólogo, Sua produção é simples e rápida epara isto se pode dispor de materiais prontamente acessíveis. Conclusão: Pode-se concluir que o uso decola autóloga de fibrina em enxertos de pele é um método adjuvante prático e rápido, com inúmeras vantagensteóricas, A usa produção depende de e materiais simples e facilmente acessíveis.
The fibrin glue has been widely used for some medical specialties, mainly for the surgical areas. Its use in skin grafts was described in 1944 by Tidrick andWarner 2. Despite several theoretical advantages, its use is not common practice. The objective of the work is to demonstrate a simplified way to produce the fibrin glue using the bloodof the patient . Its production is simple and fast and makes use of readily available materials. The use of fibrin glue on skin grafts is a practicaland fast method of securing it. The production utilises simple and easily accessible materials.
Assuntos
Humanos , Queimaduras , Adesivo Tecidual de Fibrina , Transplante de Pele , Cirurgia Plástica , Adesivo Tecidual de Fibrina/efeitos adversos , Cirurgia Plástica/reabilitação , Queimaduras/cirurgia , Queimaduras/patologia , Transplante de Pele/patologia , Transplante de Pele/reabilitaçãoRESUMO
OBJECTIVES: To determine the effectiveness of the negative pressure closure (NPC) technique in the integration of split-thickness skin grafts (STSG) to the recipient site. METHODS: Randomized, double-masked, controlled trial. SETTING: A tertiary burn unit. PATIENT CHARACTERISTICS: Between May 2003 and October 2004, 60 patients having wounds with skin loss which hindered primary closure, were incorporated to this study. We excluded patients with > or =20% of total body surface burns, polytraumatized, surgical contraindications, those who were enlisted in other clinical trials, and those who rejected the informed consent. INTERVENTIONS: In all the patients, surgical cleaning of the recipient site and STSG were performed after which they were randomly assigned between 2 groups: a group that received a NPC dressing and were connected to the central aspiration system at -80 mm Hg versus a control group with similar dressing but without connection to negative pressure. Loss of STSG area at the fourth postoperative day, days of hospital stay. RESULTS: Sixty patients were included. The median loss of the STSG in the NPC group was 0.0 cm versus 4.5 cm in the control group (P = 0.001). The median hospital stay was of 13.5 days in the NPC group versus 17 days in the control group (P < 0.001). CONCLUSIONS: The use of NPC significantly diminishes the loss of STSG area, as well as shortens the days of hospital stay. Therefore, it should be routinely used for these kinds of procedures.
Assuntos
Queimaduras/cirurgia , Transplante de Pele/métodos , Transplante de Pele/patologia , Pele/lesões , Adulto , Queimaduras/patologia , Método Duplo-Cego , Feminino , Seguimentos , Sobrevivência de Enxerto , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Pele/patologia , Resultado do Tratamento , Vácuo , CicatrizaçãoRESUMO
The present study evaluated the effects of thalidomide, cyclosporine, and diclofenac on skin allograft survival in 42 rabbits divided into the following groups (n = 6): group 1, autograft control; group 2, allograft control; group 3, allografts under thalidomide (100 mg/kg/d); group 4, allografts under sodium diclofenac (2 mg/kg/d); group 5, allografts under cyclosporine (10 mg/kg/d); group 6, allografts under cyclosporine (5 mg/kg/d); group 7, allografts under cyclosporine (5 mg/kg/d) plus thalidomide (100 mg/kg/d). The drugs were given via the orogastric tube the day before transplantation and daily during the postoperative period. Total circular skin grafts from the ear were exchanged between California and White New Zealand rabbits. Cyclosporine (10 mg/kg/d) increased allograft survival, an effect that was comparable to cyclosporine (5 mg/kg/d) plus thalidomide (100 mg/kg/d). Thalidomide and diclofenac given alone had minimally significant effects on the mean survival of skin allografts. The number of eosinophils around the necrotic skin was higher in the diclofenac group. The group receiving cyclosporine combined with thalidomide displayed the lowest number of eosinophils surrounding the allograft. In conclusion, the combination of thalidomide and cyclosporine in subtherapeutic doses may be useful for the treatment of skin allografts.
Assuntos
Ciclosporina/uso terapêutico , Diclofenaco/uso terapêutico , Imunossupressores/uso terapêutico , Transplante de Pele/imunologia , Talidomida/uso terapêutico , Animais , Modelos Animais de Doenças , Sobrevivência de Enxerto/efeitos dos fármacos , Coelhos , Transplante de Pele/patologia , Fatores de TempoRESUMO
A incidência de carcinomas de pele e lábio representa parcela significativa dos procedimentos cirúrgicos reconstrutivos. O presente estudo pretendeu analisar os aspectos epidemiológicos envolvidos e as solu- ções cirúrgicas. Os autores revisaram retrospectivamente os prontuários dos pacientes com tumores da área craniofacial atendidos no Serviço de Cirurgia Plástica do Hospital Ernesto Dornelles, cujas reconstruções se fizeram através de retalhos e enxertos, entre novembro de 2000 e novembro de 2002. Foram avaliados os dados referentes à epidemiologia e o manejo cirúrgico. Dentre os 12 casos estudados, 10 (83,3) eram do sexo masculino. A idade variou entre 56 e 94 anos(média de 76,5 anos). O conhecimento dos fatores epidemiológicos inerentes aos carcinomas de pele e lábio faz-se importante para o reconhecimento do impacto e do modo de ocorrência destas neoplasias em nosso meio.
The incidence of skin and lip carcinomas makes them an important part of the reconstructive surgeries. This paper intented to analyze the epidemiologic aspects and the surgical management. The authors reviewed all cases of skin and lip carcinomas of which flaps and skin grafts were required for reconstructions, attended between november 2000 and november 2002 in the Plastic Surgery Service at Ernesto Dornelles Hospital, Porto Alegre, RS, Brazil. Epidemiologic data and surgical management were analyzed. From 12 cases reviewed 10 (83,3) were masculine. The age changed from 56 to 94 years- old(average 76,5 y/o). Arquivos Catarinenses de Medicina - Volume 32 - Suplemento 01 - 2003 The knowledge of skin and lip carcinomas epidemiology is vital to perceive the importance and impact of this kind of pathology. The understanding of these factors allow adequate patient management and rehabilitation.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Carcinoma Basocelular , Transplante de Pele , Carcinoma Basocelular/cirurgia , Carcinoma Basocelular/classificação , Carcinoma Basocelular/epidemiologia , Carcinoma Basocelular/patologia , Carcinoma Basocelular/prevenção & controle , Transplante de Pele/patologiaRESUMO
Myofibroblasts and the contraction of split skin-graft donor sites were studied in 18 patients. For each patient five samples were studied, taken on days 0, 14, 21, 28, and 35. On each occasion the extensions and densities of myofibroblasts were calculated. After the initial measurement, the subsequent extensions were expressed in percentages of the first, resulting in mean measurements of 100, 95, 97, 99, and 99%, respectively. The myofibroblasts in 10 dermic fields were counted under light microscopy at a magnification of 1000 marked with anti-alpha-smooth muscle actin antibodies using immunoperoxidase, resulting in the means of 0.2, 3.8, 1.3, 1.3, and 0.4, respectively. The contraction and the increase in density of myofibroblasts were transitory and significant in the samples measured on day 14, but in sample 35 neither of the variables was significantly different from the initial sample. These variables evolved concurrently, corroborating the hypothesis that myofibroblasts are responsible for the contraction.