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- ItemSomente MetadadadosBiometria e sintopia da arteria epigastrica superior(Universidade Federal de São Paulo (UNIFESP), 2005) Rocha, Amauri Clemente da [UNIFESP]; Herani Filho, Benedito [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Tem-se demonstrado que os vasos da parede anterior do abdome, em especial as artérias epigástricas superiores, podem ser lesados em diversos procedimentos cirúrgicos. Os procedimentos videolaparoscópicos têm uma chance maior de produzir injúrias nestes vasos, uma vez que, a maioria dos trocáteres, utilizados nestes procedimentos são introduzidos através da parede anterior do abdome, próximo ou no trajeto destes vasos. Assim, diversos procedimentos podem provocar lesões nestas artérias, produzindo desde pequenos hematomas à procedimentos cirúrgicos para ligadura destes vasos. OBJETIVO: O objetivo deste trabalho, é estudar a relação da artéria epigástrica superior e de seus ramos lateral e medial com a linha mediana e a margem lateral do músculo reto do abdome. MÉTODO: Foram estudados 32 cadáveres adultos, não fixados, do sexo masculino, brancos e não brancos cedidos à Universidade Federal de Alagoas e Fundação Universitária de Ciências da Saúde de Alagoas e mensurados à distância da artéria epigástrica superior e de seus ramos lateral e medial à linha mediana e à margem lateral do músculo reto do abdome. Foi mensurado também o comprimento das artérias epigástricas superiores visíveis à dissecação, o comprimento e a largura do espaço xifoumbilical, à distância entre as cartilagens costais das sétimas costelas e a medida do ângulo infra-esternal. Foram obtidas as média e o desvio padrão de todas as variáveis. Para a análise univariada e multivariada, foi usado o coeficiente de determinação (R2) para um p≤0,05 determinando significância estatística. RESULTADOS: À distância das artérias epigástricas superiores à linha mediana encontravam-se entre 02 cm e 10 cm com média 4,0 cm (±3,18DP) à direita e entre 1,5 cm e 09 cm com média 3,27cm (±3,24DP) à esquerda. À distância dos ramos laterais das artérias epigástricas superiores direita e esquerda à linha mediana estavam entre 1,4 cm e 7,8 cm com média de 4.23 cm (±1,47DP) e entre 2,5 cm a 8,2 cm com média de 5,18 cm (±2,05DP) respectivamente. Os ramos mediais das artérias epigástricas superiores distaram da linha mediana em 2,0 cm a 6,8 cm com média de 3,36 cm (±1,45DP) à direita e em 2,0 cm e 5,1 cm com média de 2,96 cm (±1,25DP) à esquerda. À distância entre as artérias epigástricas superiores direita e esquerda e a margem lateral do músculo reto do abdome encontrava-se entre 2,4 cm 12,6 cm com média de 6,25 cm (±2,94DP) e entre 1,5 cm e 16,8 cm com média de 7,38 cm (±3,19DP) respectivamente. À distância entre os ramos laterais das artérias epigástricas superiores à margem lateral do músculo reto do abdome encontrava-se entre 3,2 cm e 13,6 cm com média de 6,23 cm (±3,80DP) e entre 2,4 cm e 8,2 cm com média de 5,31 cm (±1,55DP) à direita e à esquerda respectivamente. À distância entre os ramos mediais das artérias epigástricas superior direita e esquerda à margem lateral do músculo reto do abdome encontrava-se entre 2,4 cm e 10,2 cm com média de 5,31cm (±1,55DP) e entre 1,5 cm e 4,9 cm com média de 3,58 cm (±1,10DP), respectivamente. A análise univariada demonstrou forte correlação com a variável largura do músculo reto do abdome pelo lado direito e com o comprimento do músculo reto do abdome pelo lado esquerdo. Na análise multivariada, demonstrou-se, que há forte correlação com à distância da artéria epigástrica superior com a margem lateral do músculo reto do abdome com significância
- ItemAcesso aberto (Open Access)Cadaver as an experimental a model for the study of midline incisional hernia(Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2011-08-01) Silveira, Romar Ângelo Barbato [UNIFESP]; Nahas, Fabio Xerfan [UNIFESP]; Hochman, Bernardo [UNIFESP]; Bazzano, Felix Carlos Ocariz; Amorim, Carlos Roberto [UNIFESP]; Ferreira, Lydia Masako [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); UNIVAS Bioethical Postgraduate ProgramPURPOSE: To describe a cadaver model and to compare different techniques to correct midline incisional hernia using the tension at the musculoaponeurotic layer as a parameter. METHODS: Twenty-four male cadavers were used to characterize the model. The tensile force applied to the anterior layers of the rectus abdominis muscle was measured after the linea alba was resected to create an abdominal wall defect. A dynamometer was used to measure the tensile force necessary to cause a 10-mm displacement of the tissues towards the midline. An index that allows comparison of tensile forces from different points was calculated by dividing the tensile force by the distance between the point of force application at the aponeurosis and the midline. RESULTS: Cadaver is a good model for the study of midline incisional hernia. CONCLUSION: Cadaver can be used effectively as a model to evaluate tension of the abdominal wall when tissue advancement and musculoaponeurotic flaps are performed in the repair of midline incisional hernia.
- ItemAcesso aberto (Open Access)An experimental model for the study of collagen fibers in skeletal muscle(Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2012-10-01) Calvi, Eliziane Nitz de Carvalho [UNIFESP]; Nahas, Fabio Xerfan [UNIFESP]; Barbosa, Marcus Vinicius [UNIFESP]; Calil, José Augusto; Ihara, Silvia Saiuli Miki [UNIFESP]; Silva, Marcelo de Souza; Franco, Marcello Fabiano de [UNIFESP]; Ferreira, Lydia Masako [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To examine histological and histomorphometric techniques for measuring collagen in skeletal muscle. METHODS: The following staining methods were used in the study: hematoxylin and eosin, Masson's trichrome, reticulin, and picrosirius red, and immunostaining for collagen types I, II, III, IV, and V. Histomorphometric measurements were performed using Corel PhotoPaint and UTHSCSA Image Tool 3.0 software. RESULTS: Both the Masson's trichrome and picrosirius red staining provided the best visualization for the measurement of collagen content. CONCLUSION: This methodology is important for the identification and quantification of the different types of collagen in muscles and can be used in the investigation of the qualitative and quantitative influence of collagen on physical activities, aging, and diseases.
- ItemAcesso aberto (Open Access)Fator de crescimento do endotélio vascular na viabilidade do retalho musculofasciocutâneo abdominal transverso do músculo reto do abdome, após abdominoplastia, em ratos(Universidade Federal de São Paulo (UNIFESP), 2009-03-25) Freitas, André Luiz Pires de [UNIFESP]; Ferreira, Lydia Masako [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Introduction: Transverse rectus abdominis musculocutaneous (TRAM) flap may present necrosis, in pacients with risk factors. Abdominoplasty is a risk factor due to disruption and transection of vascular perforators. Perspectives on naked plasmid DNA encoding vascular endothelial growth factor (VEGF) as gene therapy for angiogenesis and neovascularization of TRAM flap harvesting after abdominoplasty, originated this study. Objective: The objective of this study was to determine the effect of VEGF plasmid DNA in TRAM flap’s rat model viability after abdominoplasty. Methods: Thirty-two Wistar rats were distributed into four groups (n=8). The caudal pedicled TRAM flap was harvested in all animals and it was the only procedure in the group I (TRAM). In groups II (Abdominoplasty) and III (Plasmid), an abdominoplasty procedure was performed with intramuscularly injection of saline solution and plasmid DNA without VEGF gene, respectively. In Group IV (VEGF) 100 micrograms of plasmid encoding VEGF, was injected into the rectus muscle. TRAM flaps were harvested thirty days after abdominoplasty. Results: TRAM group, Abdominoplasty group, Plasmid group and VEGF group showed a mean percentage of necrosis of 24.65%, 62.49%, 57.80% and 18,33%, respectively (p=0,001). TRAM flap’s immunohistochemical analysis with antibody HHF-35 showed a significant increase in number of vessels in the group IV. Conclusion: The plasmid vector including VEGF after abdominoplasty improved TRAM flap viability and the number of the vessels in rats.
- ItemAcesso aberto (Open Access)Immunohistochemical analysis of collagen content and types in the rectus abdominis muscle of cadavers of different ages(Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2011-01-01) Calvi, Eliziane Nitz de Carvalho [UNIFESP]; Nahas, Fabio Xerfan [UNIFESP]; Barbosa, Marcus Vinicius [UNIFESP]; Ihara, Silvia Saiuli Miki [UNIFESP]; Calil, José Augusto; Ferreira, Lydia Masako [UNIFESP]; UNINOVE Department of Physical Therapy; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To assess the collagen content and types in the rectus abdominis muscle of cadavers of different ages. METHODS: Forty fresh adult male cadavers, at room temperature, were obtained from the Institute of Legal Medicine of Franca and dissected within 24 hours of death. The cadavers were divided into two groups: Group A (n=20), 18 to 30 years of age, and Group B (n=20), 31 to 60 years of age. Bilateral incisions were made in the middle portion of anterior rectus sheath 3 cm superiorly and 2 cm inferiorly to the umbilicus and four fragments of the rectus abdominis muscle were dissected. The samples were fixed in 10% buffered formalin and sent for immunohistochemical analysis to determine collagen content and types. RESULTS: Immunohistochemical results revealed higher amounts of type I and type III collagen in Group A. However, no difference in the amount of type IV collagen was found between the groups. CONCLUSION: The amount of type I and type III collagen was higher in group A.
- ItemAcesso aberto (Open Access)Nicotine on rat TRAM flap(Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2009-06-01) Ely, Pedro Bins; Kobayashi, Ludmila Aimi [UNIFESP]; Campos, José Humberto Oliveira; Gomes, Heitor Carvalho [UNIFESP]; Juliano, Yara [UNIFESP]; Ferreira, Lydia Masako [UNIFESP]; Unit Santa Casa de Porto Alegre Plastic Surgery; Universidade Federal de São Paulo (UNIFESP); Escola Bahiana de Medicina Department of Surgery Head of Operative Technique and Experimental Surgery DivisionPURPOSE: The transverse rectus abdominis myocutaneous (TRAM) flap is one of the preferential techniques used in breast reconstruction following mastectomy. Nicotine has a detrimental effect on cutaneous flap survival; although there are no experimental studies proving this effect on musculocutaneous flaps. The aim of this study is to verify the effect of nicotine on the rat TRAM flap. METHODS: 30 Wistar EPM-1 rats were randomly distributed in two groups: control and experimental. The animals of the control group received saline solution injected subcutaneously, in a volume of 0.2 ml, twice a day, during 28 days in the preoperative period. The animals of the experimental group were treated with nicotine, injected subcutaneously, in a dose of 2 mg/kg twice a day, during 28 days in the preoperative period. All the animals were submitted to the caudally based, right unipedicled TRAM flap. 48 hours after the procedure, a study of the viable area of the flap was done through photographic documentation. Statistical analysis was performed with nonparametric Mann-Whitney's test. RESULTS: The experimental group had significantly greater area of necrosis when compared with the control group (p<0.001). CONCLUSION: Nicotine increased the area of necrosis of the TRAM flap, in rats.
- 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)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)Ultrasonography for measuring rectus abdominis muscles diastasis(Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2007-06-01) Mendes, Denise de Almeida [UNIFESP]; Nahas, Fabio Xerfan [UNIFESP]; Veiga, Daniela Francescato; Mendes, Fernando Vilela; Figueiras, Ricardo Góes; Gomes, Heitor Carvalho [UNIFESP]; Ely, Pedro Bins; Novo, Neil Ferreira [UNIFESP]; Ferreira, Lydia Masako [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); UNIVAS; UNIVAS Surgery Department Plastic Surgery Division; Minas Center of Mastology and Imaging; UNIVAS Surgery Department Plastic Division; Santa Casa Plastic Surgery UnitPURPOSE: Preoperative imaging evaluation may be useful for determining the position of recti abdominis muscles before their correction. The purpose of this study is to evaluate the accuracy of ultrasonography to measure the width of rectus abdominis muscle diastasis. METHODS: Rectus diastasis was measured by ultrasonography preoperatively in 20 females. Rectus diastasis was measured in seven levels along the anterior rectus sheath by ultrasound after sustained deep inspiration and after expiration. Rectus diastasis, at the same levels, was also measured after its exposition during abdominoplasty by two independent observers, using a surgical compass. These values were compared using Wilcoxon's statistical text, for non independent values. RESULTS: There was no significant difference between the values obtained by ultrasound and those measured during surgery in the supra-umbilical levels and at the level of the umbilicus. However, below the umbilicus these values differed significantly, showing smaller values in the imaging evaluation. CONCLUSION: Ultrasonography is an accurate method to measure rectus diastasis above the umbilicus and at the umbilical level.