[Show abstract][Hide abstract] ABSTRACT: Fat embolism is defined as mechanical blockage of the vascular lumen by circulating fat globules. Although it primarily affects the lungs, it can also affect the central nervous system, retina, and skin. Fat embolism syndrome is a dysfunction of these organs caused by fat emboli. The most common causes of fat embolism and fat embolism syndrome are long bone fractures, although there are reports of its occurrence after cosmetic procedures. The diagnosis is made clinically, and treatment is still restricted to support measures. We report the case of a female patient who developed adult respiratory distress syndrome due to fat embolism in the postoperative period following liposuction and fat grafting. In this case, the patient responded well to alveolar recruitment maneuvers and protective mechanical ventilation. In addition, we present an epidemiological and pathophysiological analysis of fat embolism syndrome after cosmetic procedures.
Jornal brasileiro de pneumologia: publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia 09/2008; 34(8):622-5.
[Show abstract][Hide abstract] ABSTRACT: Use of topical negative pressure over difficult-to-heal wounds has been studied. The objective of this study was to analyze the effects from negative pressure in the treatment of complex wounds.
Case series developed at Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo.
Twenty-nine patients with complex wounds were treated with the vacuum system and then underwent a surgical procedure to close the wound.
85% of the skin grafts took well, and 87.5% of the local flaps were successful, thus demonstrating adequate wound preparation. The wounds were closed within shorter times than observed using other conventional treatments In two cases, the vacuum system was also used to stabilize the skin grafts over the wounds.
Use of the vacuum method is safe and efficient for preparing wounds for surgical closure. It allows for an improvement of local wound conditions, and healthy granulation tissue develops with control over local infection.
Sao Paulo Medical Journal 06/2006; 124(3):150-3. · 0.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The effect of allopurinol, superoxide-dismutase, and hyperbaric oxygen was compared on axial pattern skin flap survival. An abdominal flap based on the inferior epigastric pedicle was raised in rats for this purpose. Three experimental groups were studied. In the first group, adult male Wistar rats received 50 mg/kg I.P. of allopurinol. The second received 20,000 I.U./kg of superoxide-dismutase. The third group was submitted to hyperbaric oxygen therapy. The flaps were exposed to 8-h warm ischemia. Flap survival was evaluated on postoperative day 7. All flaps survived, and the mean survival areas were 63.53%, 83.03%, and 55.98%, respectively, in the allopurinol, superoxide-dismutase, and hyperbaric groups. The percentage of flap necrosis was significantly smaller in all experimental groups when compared to controls (P < 0.05). It was clear that the superoxide-dismutase group had better results on axial pattern ischemic skin flap survival, under the tested conditions. The tested methods improved flap survival to ischemic injury, and the flap designed is a reliable model for further investigations.
[Show abstract][Hide abstract] ABSTRACT: Hyperbaric oxygen has been successfully used on treatment of acute ischemic injuries involving soft tissues and chronic injuries. In nerve crush injuries, the mechanisms involved are very similar to those found in ischemic injuries. Consequently, it is logical to hypothesize that hyperbaric oxygen should improve nerve repair, which is a critical step on functional recovery. In the present study, we created standard nerve crush injuries on sciatic nerves of rats, which underwent treatment with hyperbaric oxygen. Results were assessed by functional evaluation using walking-track analysis. The functional recovery indexes observed did not differ from control group. We concluded that hyperbaric oxygen therapy, in the schedule used, had no influence on functional recovery after nerve crush injuries.
Revista do Hospital das Clínicas 06/1999; 54(3):81-4.
[Show abstract][Hide abstract] ABSTRACT: The authors analysed a series of 22 patients undergoing surgical correction of congenital hand syndactyly by the rectangular flap technique. Using our evaluation method, we found that good functional and aesthetic results were obtained in 77.3% of the patients, with a complication rate of 13.6%. We concluded that the rectangular flap technique has a simple design, is easily reproducible by in-training staff, has good results, and can be applied on the majority of the syndactyly cases.
Revista do Hospital das Clínicas 01/1999; 54(4):107-10.
[Show abstract][Hide abstract] ABSTRACT: Ainda que resulte na sobrevida do paciente, o tratamento atual de queimaduras profundas e extensas é imperfeito. A contratura cicatricial e o aspecto rendilhado persistentes na área enxertada produzem resultados estéticos e funcionais pobres. A principal dificuldade no adequado restabelecimento do tegumento destes pacientes é o déficit de derme, decorrente da reposição das perdas com enxertos relativamente finos. Neste trabalho são relatados quatro casos, decorrentes da familiaridade obtida em nossa prática clínica com o emprego de pele preservada em glicerol, nos quais foi utilizada a enxertia combinada, isto é, derme alógena residual sobreposta por enxertos de espessura parcial autógenos, como forma de reposição de matriz dérmica. Os tegumentos resultantes da enxertia combinada mostraram-se estáveis e duráveis, dentro do período de seguimento dos casos apresentados. Dissertação (Mestrado).