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- ItemSomente MetadadadosCollagen fibers in the rectus abdominis muscle of cadavers of different age(Springer, 2014-08-01) Calvi, Eliziane Nitz de Carvalho [UNIFESP]; Nahas, Fabio Xerfan [UNIFESP]; Barbosa, Marcus Vinicius [UNIFESP]; Calil, J. A. [UNIFESP]; Ihara, S. S. M. [UNIFESP]; Juliano, Y.; Ferreira, Lydia Masako [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Univ Santo Amaro UNISATo assess collagen content and types in the rectus abdominis muscle of cadavers of different ages.Forty fresh adult male cadavers within 24 h of death were obtained from an Institute of Legal Medicine and divided by age at death into Group 1 (mean age, 23.3 years; range, 18-30 years; n = 20) and Group 2 (mean age, 46.2 years; range, 31-60 years; n = 20). From each cadaver, samples of the rectus abdominis muscle measuring 1 cm(2) were collected 3 cm superiorly and 2 cm inferiorly to the umbilicus. Histological sections were prepared and stained with picrosirius red and Masson's trichrome stain for visualization of total collagen fibers, and immunohistochemical analysis was performed to distinguish types I, II, III, IV and V collagen.No significant differences in total collagen were found between groups by Masson's trichrome staining. However, picrosirius red staining revealed a significantly greater amount and higher concentration of total collagen and types I and III collagen in Group 1 than in Group 2 (P < 0.05). All but type II collagen were detected by immunohistochemistry in both groups. No significant difference in type IV collagen was found between groups. Type V collagen was detected by immunohistochemistry in both groups, but quantification was not possible due to background staining.The amounts of types I and III collagen in the rectus abdominis muscle were significantly smaller in older subjects.
- ItemSomente MetadadadosIs it Possible to Repair Diastasis Recti and Shorten the Aponeurosis at the Same Time?(Springer, 2014-04-01) Veríssimo, Pamella [UNIFESP]; Nahas, Fabio Xerfan [UNIFESP]; Barbosa, Marcus Vinicius [UNIFESP]; Carvalho Gomes, Heitor Francisco de [UNIFESP]; Ferreira, Lydia Masako [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Mandaqui Hosp ComplexAbdominal wall deformity secondary to pregnancy is multidirectional. Plication of the anterior rectus sheath is the most widely used technique for correction of this condition. However, it would be desirable to simultaneously perform the transverse and longitudinal repair of this deformity. the aim of this study was to assess changes in the length of the musculoaponeurotic layer after diastasis recti repair using triangular mattress sutures.Thirty-one women with Nahas' type III/A deformity were divided into two groups: the triangular mattress suture (TS) group and the continuous suture (CS) group. All patients underwent conventional abdominoplasty and diastasis recti repair with medial longitudinal plication performed between two metal clips. the two types of suture were used in both groups. in the TS group, after a CS was performed and removed, TSs were used and maintained in place. in the CS group, the order of suture placement was reversed. the distance between clips was measured before and immediately after suturing and at 3 weeks and 6 months postoperatively using plain abdominal radiographs. Statistical analysis was conducted using Friedman's analysis of variance and Wilcoxon's test.The use of TSs significantly reduced the length of the aponeurosis compared with both the intraoperative situation without suture (P < 0.001) and the use of CS (intraoperatively and 6 months after surgery; P < 0.001).The repair of diastasis recti using TSs resulted in vertical shortening of musculoaponeurotic layer immediately after the procedure and in the long term.This journal requires that authors assign a level of evidence to each article. for a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
- ItemAcesso aberto (Open Access)Plicatura da lâmina anterior da bainha dos músculos retos do abdome com a técnica de sutura triangular(Universidade Federal de São Paulo (UNIFESP), 2013) Veríssimo, Pamella [UNIFESP]; Nahas, Fábio Xerfan; Gomes, Heitor Francisco de Carvalho [UNIFESP]; Barbosa, Marcus Vinícius Jardini [UNIFESP]; http://lattes.cnpq.br/2266460253828291; http://lattes.cnpq.br/3485738680161626; http://lattes.cnpq.br/3567288065904681; http://lattes.cnpq.br/2034024966821166; Universidade Federal de São Paulo (UNIFESP)A deformidade musculo-aponeurotica da parede abdominal decorrente da gestacao e multidirecional. A tecnica mais utilizada para sua correcao e a plicatura da aponeurose anterior. Seria desejavel obter ao mesmo tempo uma correcao transversal e longitudinal. O objetivo deste estudo e avaliar o eixo vertical do plano musculo-aponeurotico apos o uso da sutura triangular na correcao da diastase de retos. Metodos: Foram selecionadas 31 pacientes com deformidade abdominal tipo III/A de Nahas, divididas em dois grupos (GST- grupo sutura triangular e GSC u grupo sutura continua). Estas foram submetidas a abdominoplastia e correcao da diastase dos musculos retos com plicatura longitudinal mediana, feita entre dois clipes metalicos implantados. Os dois tipos de sutura foram realizados em todas as pacientes. No GST, apos a realizacao da sutura continua, foi realizada e mantida a sutura triangular e o oposto ocorreu no GSC. Apos cada sutura a distancia entre os clipes foi medida. Foram realizadas radiografias de abdome tres semanas e seis meses apos a cirurgia quando foi medida a distancia entre os clipes. Os dados foram comparados utilizando-se Analise de Variancia de Friedman e teste de Wilcoxon. Resultados: A sutura triangular promoveu reducao significante do eixo vertical da aponeurose quando comparada a sutura continua e a situacao sem sutura no periodo intraoperatorio (Wilcoxon p<0,001). Esta diferenca manteve-se nas radiografias de seis meses (Wilcoxon p<0,001). Conclusao: A sutura triangular produziu encurtamento do eixo vertical do plano musculo-aponeurotico da parede abdominal em longo prazo
- ItemAcesso aberto (Open Access)Resistência à tração dos componentes músculo-aponeuróticos na área doadora do retalho musculocutâneo transverso do reto do abdome(Universidade Federal de São Paulo (UNIFESP), 2010-11-24) Vidal, Ronaldo [UNIFESP]; Ferreira, Lydia Masako [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: The defect on the abdominal wall in the transverse rectus abdominis myocutaneos flap -TRAM flap- donor site is extensive, complex and predisposes the emergence of hernia, bulging and abdominal weakness. The closure of the abdominal wall must be anatomic and functional, preferably with autologous tissues, resistance synthesis material and minimal tension suture. The selective musculoaponeurotic undermining of the abdominal provide a abdominal wall closure with autologous tissue and reduced tension. Despite many clinical studies, no experimental researches prove the real efficacy of selective musculoaponeurotic undermining in the TRAM flap donor site. Objective: The aim of this study is to evaluate the resistance to medial traction of the musculoaponeurotic components in the bipedicled TRAM flap donor site. Methods: In the period of May of 2006 until May of 2008, 20 patients, with ages from 29 to 58 years old, submitted to mammary reconstruction with bipedicled TRAM flap were studied. The resistance to medial traction of the musculoaponeurotic components in the bipedicled TRAM flap donor site was measured with a dynamometer that was fixed in the lateral edge of the defect, 3 cm below the umbilicus. The traction coefficients obtained were compared in three situation: Initial Stage - with no incision or additional underminig in the flap donor site; Stage 1 - incision above the lateral edge of the rectus sheath; Stage 2 - undermining of the external oblique muscle. To the statistical analyses it was used the Wilcoxon and the t test to paired data in the comparison of the right and left traction coefficients in Initial Stage, Stage 1 and Stage 2. The Friedman test and the post hoc of Dunn test was used to compare traction coefficients in initial Stage, stage 1 and Stage 2, in the right and left sides. Results: There was a significant reduction of traction resistance after each stage of the dissection. Conclusion: The incision on the internal lateral edge of the rectus sheath and the external oblique undermining reduce the medial traction resistance of the musculoaponeurotic components in the TRAM flap donor site.
- ItemAcesso aberto (Open Access)Tensile strength of the posterior and anterior layer of the rectus abdominis muscle sheath in cadavers(Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2007-08-01) Amorim, Carlos Roberto [UNIFESP]; Nahas, Fabio Xerfan [UNIFESP]; Souza, Virgínio Cândido Tosta de; Ely, Pedro Bins; Silveira, Romar Ângelo Barbato [UNIFESP]; Novo, Neil Ferreira [UNIFESP]; Ferreira, Lydia Masako [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); UNIVÁS Department of Colon and Rectum Surgery; Santa Casa Porto Alegre Plastic Surgery Unit; University Santo AmaroPURPOSE: The aim of the present study was to assess, in cadavers, the resistance to medial traction of the posterior and anterior layer of the rectus abdominis muscle sheath. METHODS: An anatomical, prospective, self-controlled study was carried out in 20 male cadavers. An evaluation of the tension of the posterior and anterior layers of the rectus abdominis muscle sheath was performed following anatomical dissection of these structures. The traction necessary to advance the tissue ten millimeters was assessed using an analogic dynamometer. RESULTS: There was no significant statistical difference between the necessary traction at various levels of the anterior and posterior layers of the rectus sheath. However, medial advancement of the anterior layer of the rectus sheath required more traction strength than did advancement of the posterior layer to the midline. CONCLUSION: There is no difference in the tensile strength in the various levels of the anterior and posterior layers of the rectus sheath; however, medial advancement of the the anterior layer required more traction strength.
- ItemAcesso aberto (Open Access)Transverse rectus abdominis musculocutaneous flap (TRAM flap) - experimental model in rats(Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2003-01-01) Ely, Pedro Bins [UNIFESP]; Ferreira, Lydia Masako [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The objective of this paper was to report the use of an experimental model of the Transverse Rectus Abdominis Musculocutaneous flap (TRAM flap), in rats. Thirty male Wistar rats weighing 180 to 220 g were submitted to the TRAM flap procedure. This article reports on the use of the caudally based, right unipedicled TRAM flap.