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- ItemSomente MetadadadosElectroporation of Vascular Endothelial Growth Factor Gene in a Unipedicle Transverse Rectus Abdominis Myocutaneous Flap Reduces Necrosis(Lippincott Williams & Wilkins, 2010-02-01) Rezende, Fernando C. [UNIFESP]; Gomes, Heitor C.; Lisboa, Bianca; Lucca, Aldrein F. [UNIFESP]; Han, Sang W.; Ferreira, Lydia M.; Div Plast Surg; Interdisciplinary Ctr Gene Therapy CINTERGEN; Universidade Federal de São Paulo (UNIFESP)Necrosis in TRAM (transverse rectus abdominis myocutaneous) still occurs in flap breast reconstruction. Blood flow may be improved by vascular endothelial growth factor (VEGF), an endogenous protein that stimulates neovascularization. Experimental studies of gene therapy with plasmid vector expressing human VEGF (hVEGF) presented inadequate results. Low level of gene expression could be the cause. To prove that high level of VEGF gene expression can minimize necrosis of TRAM flap, electroporation of VEGF plasmid was tested.Forty-two adult, male, Wistar-EPM rats were randomly distributed in 6 groups of 7 animals and 50 jig of vectors were injected in the intradermal layer of TRAM flap donor region, by electroporation: LacZ (beta-galactosidase gene): CG (no substance injected and flap elevated); P2G (empty gT plasmid in area 2); PV2G (gT-VEGF(165) in area 2); P4G (empty gT plasmid in area 4); PV4G (gT-VEGF(165) in area 4). Five days after flap elevation, the animals were euthanized and the degree of necrosis was analyzed by histology and paper template method.Dermal X-gal staining after electroporation with pSV(2)lacZ proved high rate of gene transfer. Mean values of necrosis by the paper template method were: CG (74.5%), P2G (62.2%), PV2G (41.1%), P4G (76.6%), and PV4G (59%). Degree of necrosis, preservation of muscle layer, and degree of infiltrates seen by histology were in accordance with mean values of necrosis.Intradermal injection of gT-VEGF(165) in area 2, by electroporation, was effective in reducing unipedicle I-RAM flap necrosis, in rats.
- ItemSomente MetadadadosQuilting Suture in the Donor Site of the Transverse Rectus Abdominis Musculocutaneous Flap in Breast Reconstruction(Lippincott Williams & Wilkins, 2009-03-01) Rossetto, Luis Antonio [UNIFESP]; Garcia, Elvio B. [UNIFESP]; Abla, Luiz Eduardo Felipe [UNIFESP]; Sabino Neto, Miguel [UNIFESP]; Ferreira, Lydia Masako [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: the purpose of this study was to evaluate the effects of quilting suture (placement of stitches between the superficial fascia in the supraumbilical remaining flap and the musculoaponeurotic layer of the anterior abdominal wall) at the donor site of the transverse rectus abdominis musculocutaneous flap in breast reconstruction.Methods: There is a theory that the use of quilting suture, during the closure of the donor site with the abdominal flap, causes collapse of the dead space and enables the flap to rest, thus diminishing factors that may interfere in its adherence and help to reduce complications. Between January 2004 and March 2005, we performed 30 breast reconstructions using a unipedicled transverse rectus abdominis musculocutaneous flap. the sample was randomly distributed in 2 groups: 15 patients with quilting suture (group A) and 15 patients without quilting suture (group 13). the study focused on daily drain output (mL), time to drain removal (days), and possible donor site complications (%).Results: Group A presented an average of 4.2 days for removal of the drain and group B, 6.93 days, with a statistically significant difference (P < 0.001). Concerning the total volume upon removal of the drain, group A presented an average of 434.7 mL and group B, 620.7 mL, with a statistically significant difference (P = 0.002). Group A presented 13.3% complications at the donor site and group B, 53.3%, with a statistically significant difference (P = 0.05).Conclusions: the quilting suture in this study reduces the permanence of drains, total volume of tissue fluids upon drain removal, and complication rates.
- ItemAcesso aberto (Open Access)Retalho venoso unipediculado transposto comparado ao não transposto: estudo experimental em coelhos(Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2000-01-01) Silva, Alfredo Benjamim Duarte da; Tenius, Daniel Pundek; Vialle, Luis; Bittencourt, Rogério; Paula, Josuê de; Greca, Fernando Hintz [UNIFESP]; Groth, Anne Karoline; Gonçalves, Carolina Gomes; Hospital Universitário Cajuru; Hospital Universitário Cajuru Ortopedia; Hospital Universitário Cajuru Disciplina de Ortopedia e Traumatologia; Hospital Universitário Cajuru Cirurgia Plástica; Pontifícia Universidade Católica do Paraná Disciplina de Técnica Operatória e Cirurgia Experimental; Universidade Federal de São Paulo (UNIFESP)Conventional flaps are caracterized by arterial blood inflow and venous blood outflow. Venous flaps have only one vein in their pedicle. Determination of survival area and vascularization in transpositioned venous flaps is the aim of this study. A 2x2 cm² skin flap, based in the distal pedicle of anterior marginal vein, was performed in 8 rabbits ears. The flaps were divided in two groups: group I (n=8)-the flaps were elevated are fixated in the same position.; group II (n=8)-the flaps were elevated and transpositioned in 90°. These two groups were compared in between and with group III (n=8), in which was performed a skin graft. Necrosis mean area in group I (6,5%) was smaller than in group II (43,5%), and in both groups I and II was smaller than group III (88,75%). Angiography didn't alterations in vascular pattern comparing groups I and II. Anterior marginal vein was important for flap survival. Necrosis area in group II, which was transpositioned, was wider than in group I.
- ItemSomente MetadadadosSeroma and Quilting Suture at the Donor Site of the TRAM Flap in Breast Reconstruction(Lippincott Williams & Wilkins, 2014-04-01) Rossetto, Luis Antonio [UNIFESP]; Garcia, Elvio Bueno [UNIFESP]; Felipe Abla, Luiz Eduardo [UNIFESP]; Ferreira, Lydia Masako [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Perola Byington HospSeroma formation at the donor site of the transverse rectus abdominis myocutaneous flap was evaluated in 48 patients who underwent breast reconstruction with either quilting sutures and suction drains (QS+DN group) or quilting sutures alone (QS group) or suction drains alone (DN group). Clinical and ultrasound examinations were performed to assess seroma formation in 5 regions of the abdominal wall on postoperative days 7 and 14. the incidence of seroma detected by ultrasound examination was significantly higher in the DN group (P = 0.008) than that in the other 2 groups. No difference in seroma volume (puncture) was found between the QS+DN and QS groups (P = 1.00). Seroma formation was observed in the iliac region in the DN group but not in the QS+DN and QS groups (P = 0.028). Quilting sutures at the transverse rectus abdominis myocutaneous flap donor site were efficient in reducing seroma formation.