Wrist Arthrodesis with Vascularized Fibular Graft after Failed Allograft Replacement for Giant-Cell Tumor Resection

Giant-cell tumor (GCT) is locally aggressive bone neoplasm, with an unpredictable pattern of biological aggressiveness. The optimal treatment had to achieve a negligible local recurrence rate while maximizing musculoskeletal function. Numerous options for reconstruction are available, but in the literature there is a lack of salvage surgery data. We present a case of a 67-year-old woman who underwent complete wrist arthrodesis with vascularized fibular graft as salvage procedure for allograft necrosis, after excision of a distal radius GCT. The patient did not complain of any impairment in daily use, and the functional score was 22 points (73%) at latest follow-up of 14 months. Despite joint salvage remains the most favorable treatment with regard to functional outcome for aggressive tumors of the distal radius, vascularized fibular grafts is a valuable alternative especially in salvage procedures, where the use of another allograft could lead to higher complications rate. Keywords: Vascularized fibular graft, Wrist arthrodesis, Giant-Cell Tumor, Fibula free flap.

Analysis of the Histopathological Profile and Surgical Margins Resulting from Resection of Nonmelanoma Skin Cancers

: Introduction: Non-melanoma skin cancer is a group of malignant neoplasms composed basically by sarcomas, basal cell carcinoma and squamous cell carcinoma. Its etiology is multifactorial with specificity for each of the two types, except for exposure to ultraviolet radiation, which is a common factor between both. When detected early, it has a high cure rate, and surgical excision with safety margins being the treatment of choice in most cases. Thus, it is important to recognize the profile of the patients, as well as the histopathological characteristics of the lesions and the medical approach used to avoid recurrences. Purpose: This study aimed to analyze the histopathological profile and surgical margins resulting from the resection of non-melanoma skin cancers in patients treated at a plastic surgery facility in Brazil. Methods: The cases of squamous cell carcinoma and the histopathological types of the basal cell carcinoma were individually analyzed for compromised margins, and later divided into a low-risk group and a high-risk group. Results: 228 lesions were resected from 141 patients. Gender distribution was 55.3% female and 44.6% male. The most affected age group was over 70 years old. The predominant histological type was basal cell carcinoma (74.6%) followed by squamous cell carcinoma (25.4%); the most affected site was the cephalic-cervical segment (71.92%). Surgical margins were compromised in 12.3% with no significant difference between the two types of carcinoma. Conclusion: There was a predominance of basal cell carcinoma (nodular type) in women over 40 years old, predominantly in the cephalic-cervical region. The number of recurrences was proportionally higher in the BCC, unrelated to the presence of positive margins. Keywords: Skin Neoplasms, Basal Cell Carcinoma, Squamous Cell Carcinoma, Recurrence, Margins of Excision.

Evaluation of Macular Function after Vitrectomy in Diabetic Macular Edema

Purpose: To document the effects of successful vitrectomy on retinal function and anatomy in diabetic patients. Methods: Three-port pars plana vitrectomy with detachment of posterior vitrous face was performed in 30 eyes of 25 patients with diabetic macular oedema DME (11 male, 14 Female).For each patients, visual acuity (VA) examination, measurement of retinal thickness using optical coherence tomography (OCT), full field electro-retinogram (ERG) and multifocal eletroretinogram (MF-ERG) were performed before and 1week,1month and 3months after vitrectomy. Results: Mean postoperative visual acuity was significantly improved (P<0.05); mean retinal thickness was significantly (P=0.001 ) decreased after 3monthes of surgery (from 450±150 into 220±50 micron ) .b-wave amplitudes of all cone and rod responses of ERG were significantly decreased in all vitrectomized eyes after 1 week. At one month, rod response was still unimproved but improved after 3months. Reduction in foveal Function as well as in para-foveal areas detected in the MF-ERG within 1st month. Then, mean P1 wave amplitude of MF-ERG of central ring increased and mean P1 wave implicit time decreased. These changes of MF-ERG parameters observed 3 months after vitrectomy. Conclusion: Multifocal electroretinogram can be useful to provide objective criteria for functional evaluation before and after vitrectomy in diabetic oedema.

Correlation of Caesarean Section Rates to Maternal and Neonatal Mortality in the Eastern Mediterranean Region; A Population-Based Ecological Study

The physiological reaction of postocclusive local reactive hyperemia is regulated by neurovascular mechanisms and it reflects the function of microcirculation. Thermoregulatory changes occur first, in the form of increased skin surface temperature, which is usually followed by an increase in local blood flow. This study investigated a correlation between tourniquet duration on the upper arm, and the appearance of reactive hyperemia in the distal parts of the upper limb. Changes were registered with infrared thermometer and infrared thermography, which provided us a highly precise view of distribution of reactive hyperemia. Changes of oxygen saturation of peripheral arterial blood and blood pressure were also recorded. Our research has shown that longer duration of tourniquet leads to more intense and longer lasting reactive hyperemia in the palmar region, followed by higher temperatures of the skin surface, without any changes in postocclusive values of SpO2. Keywords: Infrared thermography, Microcirculation, Postocclusive hyperemia, Skin temperature, Tourniquet, Thermoregulatory changes.

Applications of Bone Marrow Mesenchymal Stem Cell and Bioscaffolds in Skin Wound Healing

Introduction: Skin wound healing is a multi-step process. It involves coordinated interactions between growth factors, matrix, microenvironment around the wound, and various cells. Patients' quality of life in chronic wounds is affected because, in addition to sequential treatments, they incur significant medical costs. This review study aims to summarize the evidence and report current knowledge about tissue engineering, skin wound healing, and therapeutic strategies using bone marrow mesenchymal stem cells were performed. Methods: Thus, much effort has been focused on developing novel therapeutic approaches for wound treatment. Stem cell-based therapeutic strategies have been proposed to treat these wounds. They have shown significant potential for improving the speed and quality of wound healing and skin regeneration. A set of published data on the use of mesenchymal stem cells and a variety of biological scaffolds in wound healing is presented. Besides, we discussed different perspectives. Conclusion: We concluded that by activating bone marrow mesenchymal stem cells on a biological scaffold, the condition of the wound healing process can be improved. Keywords: Humans, Mesenchymal Stem Cells, Quality of Life, Tissue Engineering, Wound Healing, Skin, Stem Cells.

NAL Neck Artificial Ligament Lifting: Neck Rejuvenation with Polytetrafuotoethylene (PTFE) Bands

Background: The current surgical method allows a short recovery and minimally invasive technique with polytetrafluotoethylene (PTFE) bands application, minimal skin excision for a fallen platysma muscle and skin laxity in facelift surgery; the clinical advantage of this method is a short recovery and an anatomic less invasive dissection, ideal for also younger patients who want more and more short healing times. Methods: Retrospective analysis of a 294 cases series of patients seeking platysma and skin laxity increase of neck-face region were included in the study. All of them were primary neck-face lift performed with PTFE bands of dual mesh that are customized for suture to the platysma and anchored to the mastoid, creating a neck artificial ligament (NAL) that is buried into the muscle and tightened, without modifying the superficial musculoaponeurotic system and platysma. Result: Data collection on surgery time, implant dimension selection, and postoperative complications were included. The most frequent complications were rare and include 5 case of superficial epidermolysis (healed within 21 days) and 1 case of mild band infection (treated with antibiotics). The surgical results are still stable over time, like those of a normal facelift after 6 months. Conclusion: minimally invasive NAL application avoids a large dissection and deep modifications of the superficial musculoaponeurotic system and platysma getting a strong upward tension that lasts over time with stable results. Keywords: Cervicoplasty, Neck, Rejuvenation, Aging, Mandible, Platysma Muscle.

Intra-Articular Condylar Fractures: Is Necessary Surgical Treament?

The surgical treatment of mandibular condylar fractures represents one of the most discussed topics in maxillofacial trauma surgery. Over the years the literature has documented an increasing attitude towards open reduction and internal fixation (ORIF) of these fractures. Some authors have recently increased the indications for ORIF to include intra-articular fractures, which have historically been managed conservatively1,2,3. The authors present their experience in the surgical treatment of intra-articular condylar fractures over a period of five years, from 2009 to 2014. Surgical techniques, early and delayed complica-tions, clinical and radiological outcomes and comparison with conservative treatment are discussed. Keywords: Mandibular Fracture, Condylar Fracture, Trauma.

Abdominal Perimeter Reduction with a Non-Contact Transdermal Radiofrequency Device at 27.12 Mhz and 300 Atts of Power: Retrospective Results Study

Introduction: The global demand for non-invasive fat reduction procedures is continuously increasing. Numerous procedures have been developed for this purpose, such as ultrasound, focused ultrasound, cryolipolysis, radiofrequency, and laser, which can be used alone or combined. Several of these procedures do not have publications with evident results, and others, although they obtain results, have described adverse effects and moderate and severe complications. Methods: Retrospective patient records evaluation. Forty patients, twenty-three women and seventeen men, treated between August 2017 and December 2019, fulfilled a control at 30 days post-treatment (PT), with ages between 19 and 84 years, an average of 50 years, who underwent complete treatment of 6 and 8 sessions with non-contact transdermal radiofrequency equipment (NCTR) of 27.12 Mhz and 300 watts of power. Results: The patient's abdominal perimeter average reduction obtained was 1.35 cm (range of 0 cm to 6 cm) on patients who performed six sessions. The patient's abdominal perimeter average reduction was 2.47 cm (range 0.5 cm to 13 cm) on patients who completed eight sessions. The abdominal perimeter average reduction in all 40 patients was 1.91 cm (range 0 cm to 13 cm). Only two patients of the group of six sessions didn´t show any reduction. A significant abdominal perimeter reduction measure decreased according to the increase of sessions number: 54.65 % more reduction comparing the eight sessions group against the six sessions group of treated patients. More abdominal circumference reduction was found in males, an average of 2.7 cm, compared to females, an average of 1.5 cm, in the total of 40 patients comparing at 30 days post-treatment control results. It means that males obtain 55% more response to the treatment than females. Four fatty tissue induration that did not generate deformity or symptomatology appear as side effects. Resolved spontaneously without treatment in 7 days in the whole series appear. Conclusion: NCTR device at 27.12 Mhz and 300 watts of power turned out to be a safe and effective treatment to eliminate abdominal and flank fat, reduce circumference, and improve abdominal contour in most patients treated. A significant increase in abdominal perimeter reduction was found according to the rise in NCTR sessions. This significant reduction is noticed better at 30-day PT control than at the end of the treatment. Males obtain a better response to the treatment. Carrying out prospective studies with a larger number of subjects and long-term follow-up and adding better fat tissue reduction controls like ultrasound, computed axial tomography in all patients will make it possible to objectify better the results obtained.

Osteonecrosis of the Jaw in a Crohn's Disease Patient following Infliximab Therapy: A Case Report and Literature Review

Introduction: Medication-related osteonecrosis of the jaw (MRONJ) is a serious complication, occurring to patients undergoing treatment with antiresorptive medication, such as bisphosphonates, denosumab or bevacizumab, for different oncologic and non-oncologic diseases. The aim of this study is to report a case of MRONJ in a young patient treated with infliximab, a tumor necrosis factor-a inhibitor used in the treatment of immune-mediated inflammatory diseases such Crohn’s disease, ulcerative colitis, ankylosing spondylitis, rheumatoid and psoriatic arthritis. Case Report: A 27-year-old female patient diagnosed with Crohn’s disease, who had been undergoing intravenous infliximab therapy every seven weeks for 8 years, sought our oral and plastic maxillofacial department with a peri-mandibular abscess for further treatment. The patient underwent surgical treatment, including the extraoral sub-mandibular incision of the abscess and the extraction of the lower second premolar under the administration of intravenous antibiotics. We traced a wound dehiscence and delayed healing procedure of the extraction’s alveolar bone, and five weeks later, the patient returned with an abscess recurrence around the mandibular angle area. The patient underwent surgical treatment with wide bone resection and debridement of the necrotic tissues. After follow-up (4 months), the patient completely healed without signs of recurrence. Discussion: Osteomyelitis of the jaw by patients treated with infliximab has been sparsely described in publications. This case confirms the potential role of infliximab in the pathogenesis of MRONJ. Since the pathomechanism of MRONJ under infliximab therapy remains unclear, we recommend a regular oral check-up before starting therapy, as well as during the therapy with infliximab, in order to possibly prevent the MRONJ onset. Keywords: Medication-Related Osteonecrosis of the Jaw, Infliximab, TNF-a Inhibitors, Crohn’s Disease and Osteomyelitis.

Quality of Life and Emotional Impact after Immediate Breast Reconstruction

Background: Mastectomy is the main method of treating breast cancer and carries a mutilating stigma. Breast reconstruction restores body aesthetics, influencing psychosocial aspects and quality of life. Thus, the aim of the study was to analyze interpersonal and emotional relationships after immediate breast reconstruction. Methods: A qualitative, descriptive and prospective study, was performed through the application of a quality life questionnaire – Breast Evaluation Questionnaire (BEQ 55) in patients who had immediate breast reconstruction, between 2010 to 2019. Results: From the 89 (n=89) women registered in the clinic’s database during the study period, 15 (n=15) of them agreed to participate. The average age was 46 years. Physical domain showed high scores, regarding intimate and sexual activities, professional and work activities, as well as social and recreation activities. Patient’s comfort in front of men were progressive smaller regarding the body dressed, in a swimsuit and naked. The same pattern was observed intimate women and with health professionals. Considering sexual domain scores showed that the more covered, the greater the satisfaction, with an improvement regarding the breasts (73.3%) when compared to the whole body (60.0%). The same pattern was observed regarding the patients’ comfort when being alone, revealing an improvement in the valorization of the breasts in relation to the whole body in the sense of self-image. Conclusion: This study allowed a better understanding of the impact of immediate breast reconstruction showing that this experience can be less traumatic and gradually overcome if there is support from family and health professionals.