José Manuel LopesTeixeira Amarante

Plastic Surgery, Oral and Maxillofacial Surgery, Surgery

MD,PhD (Plastic, Reconstrutive, Aesthetic and Maxillo-Facial Sugeon)
37.46

Publications


  • No preview · Chapter · Jan 2016

  • No preview · Article · Nov 2015 · Burns: journal of the International Society for Burn Injuries

  • No preview · Article · Sep 2015 · The Breast Journal
  • Messias H · Ferreira P · Amarante j

    No preview · Article · Jul 2015 · Journal of Hand Surgery (European Volume)
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    ABSTRACT: Congenital diaphragmatic hernia is a severe developmental anomaly characterized by the malformation of the diaphragm. An innervated reversed latissimus dorsi flap reconstruction for recurrent congenital diaphragmatic hernia has been described as an alternative to prosthetic patch repair to achieve pleuroperitoneal separation. However, there is very little supporting scientific data; therefore, there is no real basic understanding of the condition of the phrenic nerve in the absence of diaphragmatic muscle or even the neurotization options for restoring neodiaphragmatic muscle motion. We have reviewed the literature regarding phrenic nerve anatomy and neurotization options, and to our knowledge, this is the first time that the application of a fascicular repair is being described where the continuity of one remaining fascicle of the diaphragm has been preserved close to the phrenic nerve distal division. The procedure was undertaken in a 3 year-old boy, with the diagnosis of congenital large posteromedial diaphragmatic hernia and dependence of mechanical ventilation in consequence of severe bronchopulmonary dysplasia.The phrenic nerve divides itself into several terminal branches, usually three, at the diaphragm level, or just above it. This allows the selective coaptation of separate fascicular branches. In the case described, videofluoroscopy evaluation showed no evidence of paradoxical neodiaphragmatic motion, with synchronous contraction movements and intact pleura-peritoneal separation. The child is now asymptomatic and shows improvement of his previous restrictive pulmonary disease.We believe that fascicular repair can achieve some reinnervation of the flap without jeopardizing the potential of diaphragmatic function by contraction of reminiscent native diaphragm.
    No preview · Article · Jun 2015 · Annals of plastic surgery

  • No preview · Article · Jun 2015

  • No preview · Article · Apr 2015 · Plastic and Reconstructive Surgery
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    ABSTRACT: Rhinoplasty is a demanding task, especially when augmentation of the nasal contour is required. Autologous cartilage grafts are challenging. Contour and alignment of the graft are difficult goals. It is presented a case of a successfully nasal dorsum augmentation in a secondary rhinoplasty with the Turkish Delight technique and a brief review of literature. A 33-years-old female, with history of complete unilateral cleft nasal deformity on the right, and severe nasal deformity, previously submitted to other procedures, was referred to our Center. As she presented a visible cartilage graft, it was decided to perform the Turkish Delight technique. The autograft was effective for increasing of the nasal dorsum, at four years post-operative. There was no evidence of extrusion. The patient is satisfied with the result. The technique is effective in the reconstruction of complex dimorphism of the nasal dorsum, particularly in secondary rhinoplasty.
    No preview · Article · Mar 2015 · Acta medica portuguesa
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    ABSTRACT: The authors performed a retrospective study to clarify the occurrence, causes, severity and predictors of concomitant injuries in pediatric patients with facial fractures in Portugal. The clinical records of children and adolescents (0-18 years) with facial fractures treated by the Department of Plastic, Reconstructive, and Aesthetic Surgery and of Maxillofacial Surgery of São João Hospital, in Porto, Portugal, over a period of 20 years (1993-2012) were reviewed. A total of 1416 patients with facial fractures were included in this study. Concomitant injuries were observed in 1015 (71.7%) patients. No significant associations were found between sex and concomitant injury. Head and neck injuries other than facial fractures occurred in 962 patients (67.7%), lower limb injuries in 122 (8.6%), upper limb injuries in 115 (8.1%), thoracic injuries in 89 (6.3%) and abdominal injuries in 47 (3.3%). Concomitant injuries occurred more frequently after motor vehicle accidents (car accident, motorcycle accident and car-pedestrian accident) compared with other etiologies (p < 0.001). The incidence of these facial fractures and their concomitant injuries is very high in Portugal. It is necessary to continue with the implementation of control measures and educational programs for the population, so that the number and severity of accidents causing fractures and their associated injuries continue to decrease. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.
    Full-text · Article · Jan 2015 · Journal of Cranio-Maxillofacial Surgery
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    ABSTRACT: We investigated the changes in the characteristics of facial fractures in children and adolescents during a 20-year period in Portugal to try to find out how to prevent such fractures in future. We reviewed the clinical records of patients aged 0–18 years old who had facial fractures treated at the Department of Plastic Surgery, São João Hospital, Porto, during the 20-year period 1993–2012. The patients were divided into two 10-year periods: January 1993 to December 2002, and January 2003 to December 2012, and these were compared and analysed. A total of 1416 patients with 2071 fractures were diagnosed. There was a significant reduction (p < 0.001) in the number of patients treated during the two decades. In both groups the number of patients increased with increasing age (p < 0.001), and there was a male preponderance in all age groups. Motor vehicle collisions were the main cause of the fractures, and the mandible was the most common site (49.7%). Other injuries were recorded in 1015 patients (71.7%), and the head and neck was the most common site in both decades. Facial fractures in children are usually associated with severe trauma, and their characteristics can be influenced by social and economic factors. Although the number of children injured has decreased significantly during the last decade, facial fractures remain common in Portugal.
    No preview · Article · Jan 2015 · British Journal of Oral and Maxillofacial Surgery
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    ABSTRACT: Background: The purpose of this study was to evaluate the effect of the dissection technique on outcomes and complications after a full abdominoplasty, comparing 2 different techniques used to raise the abdominal flap: the steel scalpel and the diathermocoagulation device on coagulation mode. Methods: A prospective study was performed at a single center from January 2009 to December 2011 of patients submitted to abdominoplasty with umbilical transposition. Two groups were identified: group A, abdominoplasty performed with steel scalpel/knife; and group B, abdominoplasty performed with diathermocoagulation on coagulation mode. Several variables were determined: general characteristics, time until drain removal, daily and total volume of drain output, length of hospital stay, operative time, readmission, reoperation, emergency department visits, and local and systemic complications. Results: A total of 119 full abdominoplasties were performed in women (group A, 39 patients; group B, 80 patients). There were no statistically significant differences between groups with respect to general characteristics, except for body mass index, comorbidities, and weight of the surgical specimen; there were no differences for operative time, systemic complications, hematoma, and necrosis incidence. The scalpel group had a highly significant reduction of 54.56% on total drain output, and a 2.65 day reduction on time to drain removal and no reported cases of seroma or healing problems (difference of 81.25% and 90.00%, respectively, between the 2 groups). Conclusions: Performing abdominal dissection with scalpel had a beneficial effect on patient recovery, as it reduced time requested for drain removal, total drain output, and incidence of seroma and wound healing problems.
    Full-text · Article · Jan 2015
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    ABSTRACT: The reconstruction of massive head and neck defects is a difficult challenge, requiring restoration of bone, skin, and oral lining. Their complex three-dimensional nature often dictates the need of more than a single osteocutaneous flap for intra- and extra-oral reconstruction.Conventional reconstructive options can be considered, but there is no single ideal osteocutaneous free or pedicled flap providing an unlimited length of bone and skin paddle, or that could orient the skin paddle independently of the vascularized bone. The surgeon should then be aware of more complex options for reconstruction of extensive three-dimensional defects, namely chimeric free flaps and "their variations." They can be stratified in three types, either based on their intrinsic vasculature-perforated-based, branch-based, or whether they are prefabricated (surgical junction by microanastomosis).Despite morbidity and not perfect matching in terms of skin texture and pliability, these techniques are a good alternative in the presence of partial defects, especially in the context of immediate oncological reconstruction, where facial transplantation is not considered.
    No preview · Article · Oct 2014 · Facial Plastic Surgery
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    Full-text · Article · Oct 2014 · Injury
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    ABSTRACT: INTRODUCTION: Due to its popularity and high complication rate, abdominoplasty techniques have undergone a continuous process of evolution to provide better and safer results.1-2 The technique used to raise the abdominal flap has been implicated, but there are few studies, none is prospective and the results are contradictory.3-4 The aim of this study was to evaluate its effect on outcomes and complications after a full abdominoplasty, comparing two different techniques, the scalpel and the diathermocoagulation device (coagulation mode). METHODS: Prospective study that included women submitted to abdominoplasty with umbilical transposition, between January 2009 and December 2011, at a single centre. Two groups identified: group A, abdominoplasty performed with steel scalpel; and group B, abdominoplasty performed with diathermocoagulation. Several variables were determined including general characteristics, time until drain removal, daily and total volume of drain output, operative time, local and systemic complications; statistical analysis using SPSS v21.0; uni and multivariate analysis performed. RESULTS: A total of 119 full abdominoplasties were performed (group A, 39 patients; group B, 80 patients). There were no statistically significant differences between groups with respect to general characteristics, except for BMI, comorbidities and weight of surgical specimen; no differences for operative time, systemic complications, hematoma and necrosis incidence. The scalpel group had a significant reduction of 54,56 percent on total drain output, 2,65 days on time to drain removal; no cases of seroma or healing problems (Table 1). There was a statistical difference on daily drain output (day 2, 3), with lower levels on scalpel group (Figure 1). CONCLUSION: Performing abdominal dissection with scalpel showed benefits on patient recovery, reducing time requested for drain removal, drain output, seroma and healing problems incidence.
    Full-text · Article · Oct 2014 · Plastic & Reconstructive Surgery
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    Ricardo Horta · Paulo Aguiar · Diana Monteiro · Alvaro Silva · José Manuel Amarante
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    ABSTRACT: Background There are several techniques available for facial reanimation, but clinicians do not have a simple tool to provide an objective and quantitative spatial-temporal analysis of facial movement in order to compare medical, surgical and physical therapy. Methods We developed specialized software capable of simultaneously tracking the position over time of a number of anatomical points. This method was tested in 5 different clinical situations: one normal subject, and 4 patients with facial disfigurement. Results A large amount of quantitative information can be extracted directly, such as symmetry assessment in the contraction and relaxation trajectories. The fact that this plot is on scale allows also direct measurements such as maximal extensions. Even smiles that at the macro-scale are essentially symmetrical show at the micro-scale small asymmetries/variability. Conclusion In this paper, we describe a novel quantitative, reliable method, which accurately assesses the fundamental aspects of the facial excursion, incorporating spatial and temporal components.
    Full-text · Article · Oct 2014 · Journal of Cranio-Maxillofacial Surgery
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    ABSTRACT: Background: Facial fractures are infrequent in children and adolescents, and there are only few reports that review a significant number of patients. The objective of this study was to analyze the pattern of maxillofacial fractures in pediatric patients of Portugal. Study design: We reviewed the clinical records of a series of 1416 patients 18 years or younger with facial fractures, treated by the Department of Plastic Reconstructive, Aesthetic and of Maxillofacial Surgery of São João Hospital, Porto, Portugal, between 1993 and 2012. The following parameters were evaluated: age; sex; cause of the accident; hour, day, and month of hospital admission; location and type of fractures; presence and location of associated injuries; treatment methods; length of in-hospital stay; and complications. Results: A total of 2071 fractures were treated. The ratio of boys to girls was 3.1:1. Patients between 16 and 18 years old were the major group (43.9%). Motor vehicle accident was the most common cause of injuries (48.7% of patients). Mandibular fractures were the most common (44.4%). Associated injuries occurred in 1015 patients (71.7%). Conclusions: Pediatric facial fractures are usually associated with severe trauma. There has been a highly significant decrease (P < 0.001) in pediatric facial fractures in Portugal for the past 20 years.
    No preview · Article · Sep 2014 · Annals of plastic surgery
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    ABSTRACT: Background: Abdominoplasty using a more superficial plane of dissection has several advantages. Previous studies described a trilaminar structure (superficial and deep fat compartments separated by the Scarpa fascia) in the lower abdominal wall. This study aimed to gain a clearer understanding of compartment dominance and changes with increasing adiposity. Methods: The study was performed on the surgical specimens of 41 female patients submitted to a full abdominoplasty. A morphometric study was performed on 82 sides to evaluate the thickness of the fat layers at predetermined locations (point A over the external oblique muscle and point B over the rectus abdominis muscle). A histologic study was performed in 31 samples to analyze the structure of the fat compartments and Scarpa fascia. Results: A trilaminar structure was always present, and the Scarpa fascia did not become vestigial with increasing adiposity. Total thickness at point B was significantly higher than that at point A; this difference was mainly attributable to the superficial compartment. The deep fat compartment was always thinner than the superficial, corresponding to 25 percent of total thickness in point A and 23 percent in point B. It was less susceptible to an increase in thickness in cases of obesity. Histologic analysis demonstrated constant morphology, with an average Scarpa fascia thickness of 0.29 mm (point A) and 0.28 mm (point B). Conclusions: This study demonstrates a trilaminar structure with superficial compartment dominance and Scarpa fascia presence irrespective of adiposity in the lower abdominal wall. The deep fat compartment has a minor contribution to the lower abdominal wall thickness.
    Full-text · Article · Sep 2014 · Plastic & Reconstructive Surgery

  • No preview · Article · Sep 2014 · Microsurgery
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    ABSTRACT: Background: Radiation- and bisphosphonate-induced mandible osteonecrosis have distinct underlying physiopathologic mechanisms, but both can constitute a serious problem and lead to functional impairment and facial disfigurement. Methods and results: We describe different clinical situations related to several grades of osteonecrosis, where different options of free transfer should be considered based on case-specific physiopathologic mechanisms. We propose a simple clinical grading system to predict the best treatment option. Conclusions: For patients with advanced refractory disease, pathologic fracture, orocutaneous fistula, and severe osteolysis, resection associated with microvascular reconstruction seems to be a valid option that stops the underlying pathophysiology of overinfected avascular bone necrosis. Physicians who understand the specific physiopathologic mechanisms of each case can incorporate them into the assessment of the required reconstruction and treatment plans.
    No preview · Article · Aug 2014 · The Journal of craniofacial surgery
  • Ricardo Horta · Joana Costa · Rita Valença-Filipe · José Manuel Amarante

    No preview · Article · May 2014 · British Journal of Oral and Maxillofacial Surgery

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