Introdução: A cirurgia de retalho faríngeo (CRF) é um procedimento indicado para o tratamento da insuficiência velofaríngea, cujo principal sintoma é a hipernasalidade. Para complementar os achados perceptivos dos resultados de fala da CRF são utilizados métodos instrumentais, como a nasometria e a técnica fluxo-pressão. Objetivos: Verificar os resultados de fala da cirurgia de retalho faríngeo comparando-se os três tipos de fissura labiopalatina mais incidentes: fissura de lábio e palato unilateral (FLPU), fissura de lábio e palato bilateral (FLPB) e fissura isolada de palato (FP). Material e Métodos: Estudo transversal, por meio da análise retrospectiva de registros pré e pós-operatórios quanto à avaliação nasométrica e aerodinâmica de 290 pacientes (73 FLPU, 105 FLPB e 112 FP) submetidos à CRF de pedículo superior. A nasalância (correlato acústico da nasalidade) é determinada durante a leitura de amostras de fala padronizadas, utilizando-se um nasômetro (Kay Elemetrics Corp.). Valores de nasalância superiores a 27% são considerados sugestivos de hipernasalidade. Na avaliação aerodinâmica, o fechamento velofaríngeo é estimado a partir da medida da área seccional velofaríngea (sistema PERCI-SARS), durante a produção do fone [p] inserido no vocábulo rampa, permitindo estimá-lo de acordo com a seguinte classificação: valores de 0 a 4,9 mm2=fechamento adequado, 5 a 9,9 mm2=adequado para marginal, 10 a 19,9 mm2=marginal para inadequado e 20 mm2=fechamento inadequado. O teste t pareado comparou os valores de nasalância pré e pós-operatórios em cada tipo de fissura labiopalatina. e os testes ANOVA e Tukey verificaram as diferenças entre os três tipos de fissuras labiopalatinas, nas condições pré e pós-operatória. A área velofaríngea pré e pós-operatória foi analisada por meio do teste de Wilcoxon, em cada tipo de fissura labiopalatina. O teste de Kruskal-Wallis verificou a comparação intergrupos antes e após a cirurgia. Resultados: Os valores médios de nasalância obtidos foram de 40%, 39% e 44% (Pré) e 25%, 24% e 26% (Pós), respectivamente, para FLPB, FLPU e FP. As proporções de casos com fechamento velofaríngeo adequado no pré-cirúrgico e fechamento velofaríngeo adequado no pós-cirúrgico, para os três grupos (FLPB, FLPU e FP) foram de 27%, 6% e 12% e 78%, 75% e 72%, respectivamente. Em ambos os métodos não houve diferença entre os resultados obtidos nos três tipos de fissuras. Conclusão: A CRF mostrou-se igualmente efetiva na correção da insuficiência velofaríngea nos três tipos de fissuras labiopalatinas analisadas: FLPB, FLPU e FP / Introduction: Pharyngeal flap surgery (PFS) is a procedure employed in the treatment of velopharyngeal insufficiency, which main symptom is hypernasality. In order to complement the perceptual findings of speech results of the PFS, instrumental methods such as nasometry and pressure-flow technique are used. Purpose: To investigate the effect of PFS on speech outcomes comparing the three types of more incidents cleft lip and palate: unilateral cleft lip and palate (UCLP), bilateral cleft lip and palate (BCLP) and isolated cleft palate (CP). Methods: Cross-sectional study by means of retrospective analysis of pre- and postoperative findings on nasometric and aerodynamic assessments of 290 patients (73 UCLP, 105 BCLP and 112 CP) who underwent superiorly based pharyngeal flap surgery. Nasalance (acoustic correlate of nasality) is determined during the reading of standardized speech samples, using a nasometer (Kay Elemetrics Corp.), with a cutoff of 27%. In the aerodynamic assessment, the velopharyngeal closure is estimated from the measure of the velopharyngeal minimum cross-sectional area (PERCI-SARS system), during the production of the phone [p], inserted in the word \"rampa\", allowing to estimate it according to the following classification: values from 0 to 4,9 mm2=adequate closure, 5 to 9,9 mm2=adequate-borderline, 10 to 19,9 mm2=borderline-inadequate and 20 mm2=inadequate closure. Paired t-test compared pre and postoperative nasalance scores for each cleft typeand Anova and Tukey tests verified the differences among the three types of cleft lip and palate, in pre- and postoperative condition. Pre- and postoperative velopharyngeal area was analyzed using the Wilcoxon test for each cleft type. The Kruskal-Wallis test verified the comparison between groups before and after surgery. Results: Mean nasalance scores obtained were 40%, 39% and 44% (Pre) and 25%, 24% and 26% (Post), respectively, for BCLP, UCLP and CP. The proportions of cases with inadequate velopharyngeal closure preoperatively and adequate velopharyngeal closure postoperatively for the three groups (BCLP, UCLP and CP), were 67%, 69% and 80% and 78%, 75% and 72%. In both methods there was no difference in the outcomes between cleft type. Conclusion: PFS was shown to be equally effective in correcting velopharyngeal insufficiency in the three types of cleft lip and palate analyzed: BCLP, UCLP and CP

INTRODUÇÃO: As ressecções oncológicas da cavidade oral, orofaringe, hipofaringe e laringe, que têm como objetivo a extirpação completa do tumor com margens de segurança, podem determinar grandes defeitos anatômicos tridimensionais e que afetam funções nobres, entre elas a deglutição, a fala e a respiração. Entre as alternativas de reconstrução o retalho miocutâneo de platisma (RMP) pode ser empregado, dada sua versatilidade e facilidade de execução técnica, com a vantagem de ser menos espesso que os outros retalhos miocutâneos e adaptar-se melhor a uma série de condições clínicas. O objetivo deste trabalho foi estudar os resultados do RMP empregado nas reconstruções após ressecções oncológicas de tumores da cavidade oral, orofaringe, hipofaringe e laringe do ponto de vista funcional e complicações. CASUÍSTICA E MÉTODO: Estudo retrospectivo, aprovado pelo CEP-FMUSP.O banco de dados utilizado é constituído de pacientes matriculados no ambulatório do Hospital Santa Marcelina (Serviço de Cirurgia de Cabeça e Pescoço), com o diagnóstico de neoplasias malignas de boca, orofaringe, hipofaringe e laringe, sendo critério de inclusão todos aqueles que foram operados e reconstruídos com o RMP de pedículo superior e de exclusão aqueles submetidos a outro tipo de reconstrução ou tratamento oncológico, o diagnóstico foi sempre confirmado com biópsia prévia e o estadiamento clínico, TNM, Classificação de Tumores Malignos, seguiu a padronização da União Internacional Contra o Câncer. Foram operados 250 casos de tumores malignos de cabeça e pescoço no período de janeiro de 1990 a dezembro de 2015, todos reconstruídos com o RMP. Destes 184 casos eram elegíveis para o presente estudo. A técnica utilizada para a reconstrução foi o RMP com pedículo superior. A avaliação funcional da reconstrução pelo retalho foi realizada para a respiração, deglutição, aspiração e comunicação. RESULTADOS: Dos 184 casos, 90,2% eram do estádio III e IVA. A dieta ficou normal em 153 (83,1%) dos pacientes, 29(15,8%) ficaram com dieta pastosa e líquida e 2(1,1%) somente com dieta liquida, 146(79,3%) dos casos ficaram com voz laríngea e 38(20,7) com outro tipo de voz. A aspiração da dieta ocorreu em 60,5% dos pacientes e 39,5% não tiveram. Os tumores da base de língua tiveram aspiração em 40,4% dos casos, nos primeiros 7 a 15 dias comparado com outras regiões (p < 0,001). Os pacientes com tumores da hipofaringe tiveram aspiração moderada e os da cavidade oral tiveram a taxa mais baixa. Necroses parciais ocorreram em 10 (4,5%) e foram mais frequentes na cavidade oral 6(3,3%) dos casos. As fístulas ocorreram em 15(8,1%) dos pacientes, a mais alta incidência ocorreu na hipofaringe com 8(4,3%) dos casos. CONCLUSÕES: A reabilitação funcional quanto à deglutição, aspiração, respiração e comunicação foi efetiva, a maioria dos pacientes ficaram com dieta normal por via oral. O RMP mostrou-se um procedimento cirúrgico seguro com índices de complicações baixos, mesmo em pacientes de estádios oncológicos avançados / INTRODUCTION: Oncological resections of the oral cavity, oropharynx, hypopharynx and larynx, which aim at the complete removal of the tumor with safety margins, can determine large anatomical defects in three dimensions and affect noble functions, such as swallowing, speech and breathing. Among the alternatives of reconstruction, the platysma myocutaneous flap (PMF) have been employed given its versatility and ease of technical execution with the advantage of being less thick than the other myocutaneous flaps, making it better for adaptation in a series of clinical conditions. To study the results of PMF used in reconstructions after resections of tumors of oral cavity, oropharynx and hypopharynx from a functional point of view as well as its possible complications. PATIENTS AND METHOD: Retrospective study of patients enrolled in the outpatient clinic of Santa Marcelina Hospital (Department of Head and Neck Surgery), with the diagnosis of malignant neoplasms of the oral cavity, oropharynx, hypopharynx an larynx, being inclusion criteria all those that were operated and reconstructed with RMP. The diagnosis was always confirmed by previous biopsy and clinical staging TNM, followed the standardization of the UICC, There were 250 cases of malignant head and neck tumors from January 1990 to December 2015. Of these, 184 cases were eligible for the present study. The reconstructive technique used was PMF with superior pedicle and the functional evaluation was performed for breathing, swallowing, aspiration and communication Project approved by the Research Ethics Committee of the Faculty of Medicine of the University of São Paulo. RESULTS: From 184 cases operated, 90.2% of the cases were stage III and IVa. The diet was normal in 153 (83.1%) of the patients, 29 (15.8%) had a pasty and liquid diet and 2 (1.1%) had a liquid diet. As for the type of speech: 146 (79.3%), another type of speech 38 (20.7%) had laryngeal voice. The postoperative diet aspiration occurred in 60.5% and did not have aspiration 39.5 % of cases. Tumors of the tongue base when compared to other regions had aspiration in 40.3% in the first 7 to 15 days. Those of the hypopharynx had intermediate aspiration and those of the mouth had the lowest aspiration. Partial necrosis occurred in 10 (4.5%) and total 6 (3.3%) were more frequent in the oral cavity. We had a total of 15 (8.1%) fistulas, the highest incidence occurred in the hypopharynx in 8 (4.3%). CONCLUSIONS: Functional rehabilitation was effective regarding swallowing, breathing and communication, most of the patients were on a normal oral diet. PMF has shown to be a safe technique with low complications rates, even in patients with advanced oncologic stages

Objetivos: Avaliar se o comprimento do pedículo do retalho miocutâneo de peitoral maior assim como seu alcance para diversos sítios da região cervicofacial são influenciados por dados antropométricos e pelo lado de dissecção do retalho. O trabalho busca também determinar se a rotação infraclavicular proporciona ganho significativo quanto ao alcance do retalho em comparação à rotação supraclavicular. Delineamento: Estudo prospectivo anatômico em cadáveres e em pacientes tipo transversal. Materiais: Foram estudados 50 retalhos miocutâneos de peitoral maior em 25 cadáveres adultos não formolizados com menos de 24 horas de óbito fornecidos pelo Serviço de Verificação de Óbitos da Universidade de São Paulo e, a seguir, 15 pacientes submetidos à reconstrução de defeitos cervicofaciais com este retalho. Métodos: Padronizou-se em todos os casos estudados uma ilha de pele quadrangular, medindo 8x6 cm (altura x largura) localizada sobre a porção esternocostal do músculo peitoral maior, medialmente ao mamilo e tendo como limite caudal a borda superior da sétima costela. Todos os retalhos foram baseados apenas no ramo peitoral da artéria toracoacromial e a rotação foi realizada inicialmente sobre a clavícula. O comprimento do pedículo foi medido após a rotação, do ponto médio clavicular até o nível da borda superior da ilha de pele. Testou-se o alcance do centro da ilha de pele do retalho para as seguintes regiões: proeminência laríngea da cartilagem tireoide, mento, ângulo da mandíbula, conduto auditivo externo e órbita. Analisou-se a relação do comprimento do pedículo e do alcance do retalho com dados antropométricos e com o lado de dissecção. Posteriormente, realizou-se a rotação do retalho por baixo da clavícula apenas nos cadáveres e testou-se novamente seu alcance para as mesmas regiões, comparando com os resultados da rotação supraclavicular. Resultados: Nos cadáveres, o comprimento do pedículo apresentou um valor médio de 17,67 ± 2,24 cm, já para os pacientes, encontramos uma média de 16,03 ± 1,35 cm. Todos os retalhos obtiveram alcance para todas as regiões estudadas, com exceção da órbita, que foi alcançada nos cadáveres em 20 casos por rotação supraclavicular (40%) e 21 casos por rotação infraclavicular (42%). Nos pacientes, a óbita foi alcançada em 13,3% dos casos. Nos cadáveres, a rotação infraclavicular não apresentou ganho significativo para o alcance à órbita (p=0,839 - qui-quadrado) nem para as outras regiões estudadas, embora tenha havido um ganho de 0,61 cm na média do comprimento do pedículo, dado com significância estatística (p=0,01; pela Correlação de Person). Considerando os cadáveres, na análise univariada, foi observado que houve diferença estatisticamente significativa para o alcance do retalho à órbita em indivíduos com maior distância acrômiotrocantérica - DAT (p= 0,008 - teste \"t\" de Student), maior distância biacromial - DBA (p= 0,024 - teste \"t\" de Student) e menor valor da razão entre a distância mastoide-fúrcula esternal pela distância acrômio-trocantérica - DMF/DAT (p= 0,005 - teste \"t\" de Student). Também se observou que os cadáveres cujos retalhos alcançaram a órbita, apresentavam peso estatisticamente superior (p=0,036 - teste \"t\" de Student). Em relação ao comprimento do pedículo, na análise univariada, houve correlação positiva e estatisticamente significativo entre o comprimento do pedículo e a distância biacromial - DBA (r= 0,311; p= 0,028 - correlação de Pearson); correlação negativa e também significativo com a razão entre a distância mastoide-fúrcula esternal pela distância biacromial - DMF/DBA (r= -0,362; p= 0,010 - correlação de Pearson) e com a razão entre a distância mastoide-fúrcula esternal pela distância acrômio-trocantérica - DMF/DAT (r= -0,403; p= 0,004 - correlação de Pearson). Já nos pacientes, a análise univariada mostrou correlação positiva e estatisticamente significativo entre o comprimento do pedículo e o comprimento do esterno - CE (r= 0,722; p= 0,002 - correlação de Sperman) e correlação negativa e também significativo com a razão entre a distância mastoide-fúrcula esternal pelo comprimento do esterno - DMF/CE (r= -0,587; p= 0,021 - correlação de Sperman). Com os resultados obtidos nesta última análise, as variáveis nos pacientes com p < 0,20 foram submetidas à análise multivariada por modelo de regressão linear, visando estabelecer as variáveis que podem determinar o comprimento do pedículo vascular do retalho. Desta forma, identificou-se o comprimento do esterno como a única variável capaz de determinar o comprimento do pedículo vascular do RMPM (p=0,004). Com base nestes dados de regressão, foi então estabelecida uma equação capaz de determinar o comprimento do pedículo vascular do RMPM (COMP) baseada no comprimento do esterno, como demonstrada a seguir: COMP = 2,54 + 0,64 X CE. Conclusões: A rotação infraclavicular do retalho miocutâneo de peitoral maior não proporciona ganho no alcance do retalho em relação à região cervicofacial em comparação à rotação supraclavicular; o alcance do retalho miocutâneo peitoral maior não é influenciado pelo lado de dissecção e por dados antropométricos; o comprimento do pedículo vascular não é influenciado pelo lado de dissecção, mas sofre influência positiva do comprimento esternal. Apesar do alcance do retalho não sofrer influência de dados antropométricos, por este modelo anatômico infere-se que a equação determinante do comprimento do pedículo pode, na prática clínica, contribuir para o planejamento de reconstruções utilizando o retalho miocutâneo de peitoral maior, sobretudo para defeitos mais craniais / Objectives: Determine whether the length of the pectoralis major myocutaneous pedicled flap and its ability to reach multiple head and neck sites are influenced by anthropometric data and by the side of flap dissection. The study is also designed to determine whether infraclavicular rotation provides a significant gain in flap reach over supraclavicular rotation. Design: Prospective, cross-sectional and anatomical study on cadavers and patients. Materials: Fifty pectoral major myocutaneous flaps were studied in fresh adult cadavers less than 24 hours after death provided by the Serviço de Verificação de Óbitos of the University of São Paulo, and later in 15 patients undergoing head and neck reconstruction using this flap. Methods: For all cases a standardized quadrangular skin island measuring 8 cm x 6 cm (height x width) was employed, located over the sternocostal portion of the major pectoralis muscle, with the nipple as the medial limit and the muscle\'s inferior border as the caudal limit. All flaps were based only on the pectoralis branch of the thoracoacromial artery and the rotation was initially performed over the clavicle. Pedicle length was measured after rotation, from the midpoint of the clavicle to the superior border of the skin island. The reach of the skin island center was tested to the following sites: laryngeal prominence of the thyroid cartilage, chin, angle of the mandibule, external auditive canal and orbit. Ratios of the length of the pedicle and the reach of the flap and the anthropometric data and dissection side were analyzed. Afterwards, only in the cadavers, the flap was rotated beneath the clavicle and its reach to the same regions was measured again, and then compared to the result obtained from supraclavicular rotation. Results: In the cadavers, the average pedicule flap length was 17.67 ± 2.24 cm, while for the patients, the average length was 16.03 ± 1.35 cm. All flaps reached all studied sites, except for the orbit, which was reached in 20 cases by supraclavicular rotation (40%), and in 21 cases beneath the clavicle (42%) in the cadavers, and in 13.3% of the patients. In the cadavers, infraclavicular rotation did not result in a significant gain in reach to the orbit or to any other studied site (P=0.839 - chi-square), although there was a statistically significant (p=001; Pearson Correlation) gain of 0.61 cm in the average length of the flap. In the univariate analysis, there was a statistically significant difference in the cadavers for the reach of the flap to the orbit in individuals with a greater acromion-trochanter distance (DAT; p= 0.008 - Student\'s t-test), greater biacromial distance (DBA; p= 0.024 - Student\'s t-test) and a smaller value for the ratio of the mastoidsuprasternal notch distance over the acromion-trochanter distance - DMF/DAT (p= 0.005 - Student\'s t-test). It was also observed that the cadavers whose flaps reached the orbit had statistically higher body weights (p=0.036 - Student\'s t-test). With regard to the length of the flap, in the univariate analysis, there was a positive and statistically significant correlation between the length of the flap and the biacromial distance - DBA (r= 0.311; p= 0.028 - Pearson correlation); a negative and statistically significant correlation with the ratio of the mastoid-suprasternal notch distance over the biacromial distance - DMF/DBA (r= -0.362; p= 0.010 - Pearson correlation) and with the ratio between the mastoid-suprasternal notch distance over the acromion-trochanter distance - DMF/DAT (r= -0.403; p= 0.004 - Pearson correlation). Whereas in the patients, the univariate analysis showed a positive and statistically significant correlation between the length of the flap and the length of the sternum (CE) (r= 0.722; p= 0.002 - Spearman correlation) and a negative and statistically significant correlation with the ratio between the mastoidsuprasternal notch distance over the length of the sternum - DMF/CE (r= - 0.587; p= 0.021 - Spearman correlation). With the results obtained in this last analysis, the variables in the patients with p < 0.20 were submitted to multivariate analysis using linear regression in an effort to establish an equation to predict the length of the vascular flap. Sternum length (p=0.004) was the only variable found that was capable of determining the length of the vascular pedicle of the PMMC flap. Based on these regression data, an equation was formulated to determine the length of the vascular pedicle of the PMMC flap (COMP) based on the length of the sternum (CE), as follows: COMP = 2.54 + 0.64 X CE. Conclusions: Infraclavicular rotation of the pectoral major myocutaneous flap does not add to the reach of the flap to the head and neck region as compared to supraclavicular rotation; the reach of the pectoral major myocutaneous flap is not influenced by the side of the dissection or by anthropometric measures; and the length of the vascular pedicle is not influenced by the side of dissection, but is positively influenced by sternum length. Although anthropometric measures do not influence the reach of the flap according to this anatomical model, it can be inferred that the determinant equation of the length of the pedicle can, in practice, contribute to the planning of head and neck reconstruction using the pectoral major myocutaneous flap, especially for more cranial defects

Artificial tissue expansion is required to generate new skin prior to reconstructive surgery, in order to compensate for a deficit of healthy tissue. Hydrogel tissue expanders, which expand anisotropically, show great promise in overcoming clinical limitations in the field, thus allowing the technique to be used in a wider range of surgeries. These devices consist of pellets of dry poly(methyl methacrylate-co-vinylpyrrolidone), compressed into discs through a hot compression moulding process. However, a number of significant problems still exist in these devices, and this thesis aims to address these issues. To date, there has been a lack of investigation of the factors governing the behaviour of anisotropic swelling. For this reason, a range of different compression ratios have been investigated, with particular focus on the relationship between the material flow during compression and the swelling behaviour of the resulting device. It was found that samples of the same initial size expand to the same reference swelling dimensions, regardless of compression ratio. During hot pressing, the material flow was found to be governed by slip-stick behaviour at the interface between the hot press and the device, affecting the properties and swelling behaviour of the devices. Based on these findings, devices were developed which could expand from a disc into a non-prismatic shape (dome or wedge). Such devices could reduce complication rates and allow the growth of new tissue with anisotropic resting tension. The devices were tested in a small in vivo trial, where it was shown that there were no adverse effects on the tissue produced, and that the shape of the expander (dome) was retained. As devices are being produced for medical use, understanding the effect of sterilization by &gamma;-irradiation is essential, but to date this has been overlooked in the literature. It was found that γ-irradiation caused an increase in cross-linking in the P(MMA-co-NVP). Whilst this produced little change in swelling behaviour for isotropic devices, in the case of anisotropic devices it caused a change in the shape of expansion, reducing the area of new skin which could be generated by the device. It was found that by reducing the concentration of impurities (residual molecules from the polymer synthesis) the impact of &gamma;-irradiation could be greatly reduced. Finally, controlling the rate of expansion is essential in order to avoid clinical complications. In order to control the rate of expansion, particularly during the initial period of swelling, semi-permeable PDMS coatings were applied to the compressed devices. Coatings of thickness greater than 0.375mm were found to effectively control the rate of swelling, for both cylindrical and non-prismatic shapes. As the coating thickness increased, the maximum swelling size decreased. However, it has been shown that change in height (the parameter which governs the area of skin produced) is affected less than the change in mass or diameter.

Magister Scientiae - MSc / The purpose of this research project was to assess the safety and efficacy of a combination of drugs for conscious sedation in patients undergoing office-based plastic and reconstructive surgery. A pilot study was done to determine the safety of the co-administration of the drugs used in the sedation technique. / South Africa

No description available.

Yes / Beneficial effects have been observed following the transplant of lipoaspirates containing adipose-derived stem cells into chronic wounds caused by oncologic radiotherapy. It is not yet certain whether adipose-derived stem cells are resistant to radiation exposure. Therefore, the aims of this study were to isolate stromal vascular fraction from human breast tissue exposed to radiotherapy and determine the presence of adipose-derived stem cells. Stromal vascular fraction from irradiated donor tissue was compared to commercially sourced pre-adipocytes. Immunocytochemistry was used to determine the presence of adipose-derived stem cell markers. Conditioned media from stromal vascular fraction isolated from irradiated donors was used as a treatment in a scratch wound assay of dermal fibroblasts also isolated from irradiated donors and compared to pre-adipocyte conditioned media and serum free control. This is the first report of human stromal vascular fraction being cultured from previously irradiated breast tissue. Stromal vascular fraction conditioned media from irradiated donors had a similar effect in increasing the migration of dermal fibroblasts from irradiated skin to pre-adipocyte conditioned media from healthy donors. Therefore, the ability of adipose-derived stem cells in the stromal vascular fraction to stimulate dermal fibroblasts in wound healing appears to be preserved following radiotherapy. This study demonstrates that stromal vascular fraction from irradiated patients is viable, functional and may have potential for regenerative medicine techniques following radiotherapy. / This research was funded by a Bradford City FC Supporters Fellowship for L.V.T. administered through the Plastic Surgery and Burns Research Unit, University of Bradford. / Research Development Fund Publication Prize Award winner, Mar 2023.

As more patients with large body surface area burns are surviving and requiring reconstructive surgery, there is a necessity for advances in the provision of bioengineered alternatives to autologous skin cover. The aims of this Thesis are to identify feasible source tissues of Endothelial Colony Forming Cells and Mesenchymal Stem/Stromal Cells for microvascular network formation in vitro with three-dimensional dermal substitute scaffolds. The working hypothesis is that pre-vascularised dermal scaffolds will result in better quality scarring when used with split thickness skin grafts. Human umbilical cord blood, peripheral blood and adipose tissue were collected and processed with ethical approval and informed consent. Samples were cultured to form endothelial outgrowth colonies and confluent Mesenchymal Stem/Stromal Cells, which were characterised using flow cytometry and expanded in vitro. Mesenchymal Stem/Stromal Cell multipotency was confirmed with tri-lineage mesenchymal differentiation. Primary cells were tested in a two-dimensional tubule formation co-culture assay and differences assessed using a proangiogenic antibody array. Tubule formation was tested in four different acellular dermal substitute scaffolds; Integra® Dermal Regeneration Template, Matriderm®, Neuskin-F® and De-cellularised Human Cadaveric Dermis. Umbilical cord blood was the most reliable source of Endothelial Colony Forming Cells, the yield of which could be predicted from placental weight. Microvasculature dissected free from adipose tissue was a reliable source of Mesenchymal Stem/Stromal Cells which supported significantly more tubule formation than Mesenchymal Stem/Stromal Cells from whole adipose tissue. Microvasculature Mesenchymal Stem/Stromal Cells secreted significantly higher levels of the proangiogenic hormone leptin, and addition of exogenous leptin to the tubule formation assay resulted in significantly increased tubule formation. Microvasculature was cultured in all four of the scaffolds tested, but depth of penetration was limited to 100µm. The artificial oxygen carrier perfluorocarbon was shown to increase two-dimensional tubule formation and may be useful in further three-dimensional scaffolds studies to improve microvascular penetration.

Improvements in the treatment of breast cancer have resulted in better survival rates and less breast cancer related morbidity. Nevertheless, a significant group of patients still experience a diminished quality of life as a result of lymphedema. In the early, often reversible, stage of lymphedema patients can experience subjective changes in the affected area. However, with the traditionally available tools the lymphedema often remains clinically undetectable and patients are denied essential care that can prevent worsening. Furthermore, most lymphedema assessment tools fail to support a clear unambiguous definition of lymphedema. This underlines the need for a sensitive objective measurement method that can assess lymphedema in a subclinical stage. In this study we demonstrated that measuring tissue dielectric constant (TDC) using the MoistureMeter-D is an effective method to detect tissue water changes and could potentially provide a cost-effective adequate tool to measure the early onset of breast cancer related lymphedema (BCRL). Secondarily, we established the correlation between the novel TDC method and the frequently used arm volume measurements and self-assessment questionnaires. A group of 20 female patients with clinically BCRL were included. TDC measurements in both arms and all quadrant of both breast were recorded along with volumetric measurements of both arms. All patients were asked to complete a self-report questionnaire. The novel TDC method detected significantly higher tissue water levels in the affected arm and breast compared to the control side. The TDC ratio between control and affected side showed significant correlation with self-reported pain and discomfort in both arm and breast. In the arm, the TDC method also showed correlation with the volume measurement method. The TDC value of the arm was correlated to age, but not to BMI. This study demonstrates that measuring TDC using the MMD is an effective method for quantifying lymphedema in arm and breast and is an important tool in detecting early TWC changes.

INTRODUÇÃO: A microanastomose vascular é um componente importante na cirurgia de transferência livre de tecidos. Atualmente, a técnica de sutura convencional ainda é considerada o padrão ouro, no entanto, ela apresenta alguns inconvenientes por ser tecnicamente difícil, consumir muito tempo e ter uma longa curva de aprendizado. Na busca de uma técnica mais fácil e rápida, métodos alternativos de anastomose são estudados incluindo a cola de fibrina. Apesar dos bons resultados publicados, a sua aceitação na prática clínica ainda é limitada. Controvérsias a cerca de sua trombogenicidade e resistência mecânica geram dúvidas em relação a sua segurança. A ausência de um modelo experimental mais fidedigno impede que os potenciais benefícios de sua aplicação clínica sejam apreciados. O objetivo deste estudo é esclarecer essas controvérsias e estudar os benefícios da aplicação da cola de fibrina em um ambiente que simule a prática clínica. MÉTODOS: O modelo experimental utilizado foi a transferência livre de um retalho inguinal para a região cervical anterior. A circulação do retalho era restaurada através de microanastomoses vasculares entre as artérias femoral e carótida (término-lateral) e entre as veias femoral e jugular externa (término-terminal). Utilizamos 20 coelhos que foram divididos em dois grupos (n= 10) de acordo com a técnica de sutura empregada: Grupo I (sutura convencional) e Grupo II (sutura com cola). RESULTADOS: A aplicação da cola de fibrina reduziu significativamente o número de pontos necessários para se completar as anastomoses, 4 pontos a menos nas artérias e 4,5 pontos a menos nas veias. No Grupo I, a média do tempo de anastomose arterial foi de 17,21 minutos, contra 12,72 minutos no Grupo II. Nas anastomoses venosas, a média de tempo no Grupo I foi de 22,93 minutos, contra 16,57 minutos no Grupo II. A aplicação da cola de fibrina também diminuiu o tempo de isquemia do retalho e o tempo de cirurgia em 11,5 minutos e 15,67 minutos, respectivamente. A taxa de sobrevida do retalho foi de 90% nos dois grupos. CONCLUSÕES: A aplicação da cola de fibrina em microanastomoses vasculares demonstrou ser confiável e eficiente no presente estudo. / INTRODUCTION: Microvascular anastomosis is an important component of the free flap surgical procedure. Currently, the conventional suture is still considered the gold standard technique. However, it presents some problems for being technically demanding, time consuming and with a long learning curve. In looking for an easier and faster technique, alternative methods of anastomosis were studied including the fibrin glue. Despite the good results reported in the literature, its acceptance in the clinical setting is still small Controversies regarding its thrombogenicity and mechanical resistance create some concerns about its safeness. The absence of a more realistic experimental model has not allow a full aprecciation of its potencial benefits in clinical use. The aim of this study is clarify these controversies and demonstrate the advantages of fibrin glue application in an environment that can reproduce the clinical practice. METHODS: A free inguinal flap transfer to the anterior cervical region was used as experimental model. The circulation of the flap was restored by means of microvascular anastomosis between the femoral and carotid arteries (end-to-side) and between the femoral and jugular veins (end-to end). The procedures were performed in 20 rabbits that were divided into two groups (n= 10) according to the anastomosis technique: Group I (conventional) and Group II (fibrin glue). RESULTS: The application of fibrin glue significantly reduced the amount of sutures required to complete the anastomoses: 4 less sutures in the arteries and 4,5 less sutures in the veins. In Group I, the mean arterial anastomosis time was 17,21 minutes against 12,72 minutes in Group II. In the veins, the mean anastomosis time in Group I was 22,93 minutes against 16,57 minutes in Group II. The application of fibrin glue also reduced the flap ischemic time and the total operative time by 11,5 minutes and 15,67 minutes, respectively. The flaps\' survival rate was 90% in both groups. CONCLUSIONS: The application of fibrin glue in microvascular anastomoses was reliable and effective in this study.