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Background: Patients undergoing perineal defect reconstruction with the internal pudendal artery perforator (IPAP) flap traditionally face 5 days of postoperative bed rest (BR) to minimize surgical risks. However, prolonged BR can exacerbate postoperative physiologic changes such as increased fatigue, reduced body mass, and declining lung function, while also leading to complications such as pneumonia, delirium, deep vein thrombosis, and pressure injuries. This study assessed the effectiveness, feasibility, and safety of an adapted early mobilization (EM) program for these patients., Methods: This prospective, randomized, controlled clinical study involved 51 patients assigned to adapted EM (n = 25) or BR (n = 26). Whereas EM included core exercises, orthostasis training, gait training, muscle strengthening, and aerobic exercises after surgery, BR followed standard bed rest protocols. The primary outcome was independent ambulation for 3 m on postoperative day 5. The secondary outcomes included 6-min walk test (6MWT) distances on days 5 and 30, hospital length of stay, healing time, postoperative complications, fatigue prevalence, and quality of life., Results: On day 5, EM improved ambulation significantly compared with BR (68.0% vs 38.5%; P = 0.035) and achieved greater 6MWT distances on days 5 (108.78 vs 47.73 m; P = 0.041) and 30 (243.8 vs 166.29 m; P = 0.018). The EM patients were discharged earlier (66.7% by day 10 vs 33.3% of the BR patients; P = 0.043), with comparable healing times (P = 0.06) and postoperative complication rates (68% vs 80.8%; P = 0.296). Fatigue prevalence and quality of life did not differ significantly between the two groups., Conclusion: Early mobilization after IPAP flap reconstruction is safe and feasible, promoting early ambulation and recovery and facilitating earlier discharge without increasing complications., Competing Interests: Disclosures: There are no conflicts of interest., (© 2024. Society of Surgical Oncology.)

Introduction: Fat graft (FG) absorption rate varies from 20 to 80% in two years. Recently, several bioengineering techniques were applied to improve FG retention rate. Numerous studies investigated the use of adipocyte-derived stem cells (ASC) as FG enrichment. However, ASC production is costly, complex, and time-consuming. In contrast, Nanofat, a combination of lipids, stem cells and growth factors, offers a faster, simpler, and more cost-effective alternative for FG enrichment., Objective: This study aims to compare the effects of ASC with those of Nanofat, as a viable option in FG enrichment., Material and Methods: Animals were allocated in three groups: Control group (1 mL fat), ASC group (1 mL fat +1x10 6  ASC), and NnF group (1 mL of fat + 0.3mL NnF). These groups were subdivided in three subgroups (4, 8, and 12 weeks, n = 6/group). We performed ultrasound and macroscopic measurements for FG volume, histology and expression of healing and inflammation genes., Results: At week 12, ASC and NnF groups showed a higher retention of FG when compared to the Control group (51%, 46%, 12% respectively, p < 0.01). Fibrosis was similar in ASC and Nanofat groups. The Nanofat group showed a higher vascular density then the Control group (p < 0.05). Il-10 gene expression was higher, and Mmp9 was lower in the Nanofat group when compared to the ASC and Control groups., Conclusion: This study indicates that enriching FG with both ASC and Nanofat led to an increased retention rate of the FG, suggesting that Nanofat might be a promising alternative for FG enrichment., No Level Assigned: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 ., Competing Interests: Declarations. Conflict of interest: The authors declare that they have no conflicts of interest to disclose. Ethical Approval: All applicable institutional and national guidelines for the care and use of animals were followed. This project was approved by the Animal Use Ethics Committee (CEUA) of the School of Medicine, University of São Paulo (1364/2019). Informed Consent: For this type of study informed consent is not required., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Skin flaps are employed to cover cutaneous denuded surfaces, but ensuing flap necrosis often occurs. Previously, rats with myocardial infarction treated with lipid-core nanoparticles (LDE) loaded with methotrexate (MTX) improved myocardial irrigation and reduced necrosis. Here, the aim was to investigate the efficacy of LDE-MTX to preserve the viability of cutaneous flaps and its implications for surgical wound healing. Twenty-eight male rats were divided into 4 groups: (1) LDE, injected intraperitoneally with LDE only; (2) MTX (1 mg/Kg commercial MTX): (3) LDE-MTX (1 mg/Kg MTX associated with LDE), and controls without treatment. LDE, MTX or LDE-MTX were repeated after 2 days. Then, flap surgery (9x3cm) was performed on the dorsal region. Injections were continued every other day until day 7 when animals were euthanized. LDE-MTX treatment improved the total viable area of the flaps with a fourfold increase in blood flow and reduced inflammatory cell number ( p  < 0.001), accompanied by decreased protein expression of pro-inflammatory factors. SOD-1 was higher in LDE-MTX-treated rats ( p  < 0.05). In conclusion, LDE-MTX treatment achieved total viability of cutaneous flaps, with increased irrigation and diminished local inflammation. LDE-MTX may offer efficient and cost-effective prevention of cutaneous flaps and treatment for wounds from surgical procedures to be tested in future clinical studies.

Background: Acute traumatic wounds often require prolonged healing time and hospitalization. Negative-pressure wound therapy with instillation and dwell time (NPWTi-d) has demonstrated effectiveness in accelerating patient healing over traditional NPWT, and its benefits are well established in the treatment of chronic infected wounds. However, randomized studies examining the use of NPWTi-d in acute traumatic wounds are scarce. This study aimed to examine the effectiveness of NPWTi-d compared to traditional gauze layer dressing and standard NPWT., Methods: This single-center, randomized, pragmatic, controlled clinical trial included 120 adult patients with acute traumatic wounds from traffic accidents randomized to NPWTi-d (n = 39), NPWT (n = 41), and gauze dressing (n = 40). Following surgical debridement of the wound bed, all patients underwent definitive wound closure with delayed primary closure, skin grafting, or surgical flaps. The primary outcomes were wound closure time, number of surgical procedures, and hospital length of stay. The secondary outcomes were primary closure type, amputations, complications, and death., Results: Wound closure time was significantly lower in patients with NPWTi-d compared to patients with NPWT and gauze dressing (6.1 vs. 10 vs. 11.7 days, respectively; p < 0.001). Patients with NPWTi-d had fewer surgical procedures than patients with NPWT and gauze dressing (3.0 vs. 3.5 vs. 6.2, respectively; p < 0.001). No significant differences in length of stay were observed among the groups., Conclusions: In this study, patients with acute traumatic wounds who received NPWTi-d experienced shorter wound closure time and fewer surgical procedures than patients who received NPWT or gauze dressing., Clinical Trial Registration: The current study is registered on the Brazilian Clinical Trials Registry (ReBec) platform under the name Comparison between Traditional Dressing, V.A.C. Dressing and V.A.C. Dressing with Instillation in Complex Wounds, ID nº RBR-658g535 at https://ensaiosclinicos.gov.br/rg/RBR-658g535., Competing Interests: Declaration of competing interests DAM declares having received personal fees for speaking engagements on behalf of Essity®, unrelated to the present study. DAM also declares having received personal fees from 3M® for consulting activities. GMC has nothing to declare. RASJ has nothing to declare. CVSG declares having received a doctorate scholarship from Coordination for the Improvement of Higher Education Personnel CAPES and personal fees for speaking on behalf Essity®, and BBraun®, not related to the present study. Declares personal fees from 3M® related to the study. AMA has nothing to declare. RG has nothing to declare., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Background: Abdominoplasty is one of the most commonly performed procedures. Despite improvements in the abdominoplasty technique, seroma is the most common complication, ranging from 5 to 43%. This study aimed to review the literature to compare therapeutic strategies to prevent common adverse events in abdominoplasty., Methods: This review analyzed patients of both sexes older than 18 years who underwent abdominoplasty with or without liposuction. This study analyzed the following endpoints: frequency of seromas, surgical site infection, hematoma, dehiscence, necrosis, death, treatment duration for adverse events, length of hospital stay, seroma/hematoma volume., Results: We analyzed 24 articles, totaling 2997 participants with ages ranging from 18 to 85 years. The meta-analysis of 4 studies, with 180 participants, showed a 69% reduction in the occurrence of seroma when Scarpa's fascia preservation was adopted (OR, 0.38; 95%CI 0.16-0.91). Regarding other complications, Scarpa's fascia preservation showed a lower risk of infection (OR 0.31; 95%CI 0.12-0.79) and also lower risk of hematoma (OR 0.29; 95% CI 0.09-0.95) in seroma for Scarpa's fascia preservation when compared to not fascia's preservation., Conclusion: This review suggests that Scarpa fascia preservation decreases seromas, infections, and hematomas. However, more randomized controlled trials are necessary to improve the level of certainty., Level of Evidence Ii: 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 Table of Contents or the online Instructions to Authors www.springer.com/00266 ., Competing Interests: Declarations. Conflict of interest: The authors declare that they have no conflicts of interest to disclose. Human and Animal Rights: This article does not contain any studies with human participants or animals performed by any of the authors. Informed Consent: No consent was required due to the study’s design., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Competing Interests: Disclosure: Caio Augusto Lima de Araujo, Fabio de Freitas Busnardo, Victor Augusto Thome Grillo, Carlos Henrique Chirnev Felício, Luciana Alexandra Antônia de Almeida, Carlos Frederico Sparapan Marques, Caio Sérgio Nahas, Antonio Rocco Imperialle, Rolf Gemperli, and Ulysses Ribeiro Jr have no disclosures to declare that may be relevant to the contents of this study.

Objective: Studies have suggested that ozone therapy stimulates antioxidant enzyme expression and activity, regulates growth factor production, increases local blood flow and provides antibacterial protection. We sought to analyse the evidence related to the use of ozone therapy in the treatment of diabetic foot ulcers (DFUs)., Method: A systematic review and meta-analysis was conducted using published clinical trials indexed in the PubMed, Embase and Web of Science databases up to December 2020. Outcomes analysed included: number of ulcers cured; ulcer area reduction; length of hospital stay; changes in blood glucose levels; antioxidant activity; and number of amputations., Results: Initially, 61 studies were identified; however, only six met all of the eligibility criteria for inclusion in the final sample. It was found that patients receiving ozone therapy displayed higher rates of healing (i.e., healed ulcers), shorter hospital stays, increased catalase activity and reduced blood glucose levels. There was an observed increase in the number of ulcers healed; however, there was a considerable risk of bias in the studies evaluated., Conclusion: Although many studies have suggested ozone therapy as a promising candidate in the treatment of DFUs, further research is required, with a better scientific outline, to validate the results.

Agents that inhibit programmed cell death (IPD-1) in T lymphocytes are indicated for patients with advanced cancer. However, some individuals may develop endocrinological conditions, such as diabetes, thyroid dysfunction, and lipodystrophy, after treatment. This systematic review and case report of IPD-1 lipodystrophies describes a patient who received nivolumab treatment for advanced clear cell renal carcinoma and subsequently developed diabetes as well as facial and body lipodystrophy. The patient complained of social distress due to her facial appearance. We treated the facial lipodystrophy with autologous fat grafting, which proved to be effective for more than three years. This study showed the efficacy of IPD-1 lipodystrophy treatment with long-term follow-up.

Introduction: The large mixture of races in Brazil gives the nose its distinctive composition, which makes rhinoplasty difficult for these patients. Every patient should have their anatomy thoroughly examined on an individual basis, as there is no unique strategy that works for all situations., Methodology: This is a narrative overview of the last 10 years' worth of literature that describes the ethnic traits of each nose, with a particular emphasis on the Brazilian nose, and talks about the major surgical approaches that can be applied in these situations., Results: The low dorsum, broad nasal bones, thick skin, and bulbous tip are the primary features of the Brazilian nose. Many times, lateral osteotomies, root grafting, isotretinoin treatment for skin thickness, and neodomus formation are required., Conclusion: The Brazilian nose presents a surgical challenge that calls for the mastery of multiple procedures, not simply structured rhinoplasty. In certain cases, preservation rhinoplasty may even be used., Level of Evidence Iv: 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 ., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Studies shows that 1%-2% of world population will develop chronic skin wound in their lifetime. Nowadays, the patient report outcome measure (PROM) questionnaires are used to evaluate the patient's quality of life. However, several PROM's questionnaires analyse specific chronic wounds. In this sense, WOUND-Q toll was designed to evaluate all types of wounds. Because of the WOUND-Q wide applicability, the use of WOUND-Q is helpful for other countries. This study aimed to translate and adapt WOUND-Q tool for Brazilian Portuguese language. Two independent translators translated the WOUND-Q questionnaire from English to Brazilian Portuguese. Then these translators build Version 1 (T1) and version 2 (T2). In a consensus meeting, a third senior author defined the final version. In the back translation process, an English proficient translator translated the Brazilian Portuguese version to the original version. After another consensus, a final version was defined. Then, our group performed a cognitive test to validate this version. After the first translation, the comparison of version T1 and T2 achieved an intraclass correlation coefficient of 77%. The back translation showed the need of few adjustments. For the cognitive test, the mean age was 44.1 ± 9.3 years. Only one question was changed to improve comprehensiveness. In the review phase, few adjustments were performed to the final Brazilian Portuguese version, mostly regarding verbal tense and prepositions. In conclusion, this study successfully translated and adapted the WOUND-Q questionnaire for a Brazilian Portuguese version., (© 2024 The Wound Healing Society.)

Introduction: Degloving soft tissue injuries (DSTIs) involve skin and tissue detachment from muscle or fascia. Surgical treatments exist, but they cannot prevent necrosis., Objective: Our aim was to investigate the effects of hyperbaric oxygen therapy (HOT) and adipocyte stem cell (ASC) treatment on tissue viability in degloving injuries in a murine model., Methods: 32 animals were submitted to a degloving flap surgery in the dorsal region and were allocated in four groups (n=8/group): Control: suture only; HOT: 2-hour daily therapy in 100% oxygen at 2.0 ATA for 7 days; ASC: injected with 1x106 stem cells; ASC+HOT: stem cells injection plus HOT therapy. We performed macroscopic measurements, blood flow, histology, and expression of inflammation genes., Results: After 7 days, HOT, ASC, and ASC+HOT groups had significantly more viable tissue compared to Control (97%, 90%, 81% vs. 6%). Viable area ratios were higher in HOT and ASC than Control. Blood flow in the injury's distal region was higher in HOT, ASC, and ASC+HOT compared to Control. Vascular density was higher in HOT and ASC+HOT than Control. Inflammatory cells decreased by 40% in HOT, 50% in ASC+HOT, and 75% in ASC. Gene Cd68 expression was lower in HOT than Control. Il10 expression was lower in HOT but higher in ASC and ASC+HOT than Control., Conclusion: This study suggests that the HOT can benefit the degloving injury flap model in the early phase of wound healing, and the association of ASC with HOT could benefit the wound healing in a later phase., No Level Assigned: This journal requires that authors assign a level of evidence to each submission to which evidence-based medicine rankings are applicable. This excludes review articles, book reviews, and manuscripts that concern basic science, animal studies, cadaver studies, and experimental studies. 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 ., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Background: Osteotomies are important maneuvers in the plastic surgeon's arsenal for the nasal dorsum treatment. However, there is a concern regarding a possible medialization of the inferior turbinate's heads and narrowing of the internal nasal valve if the Webster's triangle is not preserved., Objectives: To analyze the mobilization of the inferior turbinates during primary rhinoplasty after lateral osteotomies., Methods: This is a retrospective study in which we analyzed 37 patients who underwent very low-to-low osteotomies in our service, during primary rhinoplasties. Axial and coronal computed tomography scans were obtained, and preoperative and 6 months postoperative images were compared with Radiant DICOM Viewer software (Medixant, Poznan, Poland) in 3-dimensional multiplanar reconstruction., Results: There were no statistically significant differences between preoperative and postoperative measurements of the lower turbinate's osseous bases, both in axial ( P = .305) and coronal ( P = .08) images., Conclusions: Low-to-low osteotomies showed no medialization of the inferior turbinate's heads or narrowing of the internal nasal valve in this study., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Aesthetic Society.)

Background: Capsular contracture is a common complication affecting about 80% of patients who receive radiotherapy after breast reconstruction with silicone prostheses. This study examines the use of adipocyte stem cells (ASCs) to treat capsular contracture., Methods: Thirty rats were operated on to implant a minisilicone prosthesis in the dorsal region. The rats were divided into three groups: control (saline solution injection), radiotherapy (RDT), and RDT + ASC. After 3 months, the capsules were collected and submitted to histological analysis for inflammatory cell presence, vascular density, and collagen fibers, and gene expression of Tnf, Il1rap , Il10 , Cd68 , Mmp3 , and Mmp9 by qPCR., Results: In macroscopic analysis, the RTGO score showed a two-point reduction in RDT + ASC compared with the RDT ( P = 0.003). In histological analysis, ASC exhibited less than 50% of inflammatory cells compared with RDT ( P = 0.004), which was similar to control. This study demonstrated that Il1rap gene expression was identical in both RDT and RTD + ASC. Compared with control, treatment with ASC reduced Il1rap expression by 30%. Cd68 and Mmp3 expression levels were similar in both the control and RTD + ASC., Conclusion: This study suggests that ASC treatment decreases silicone prosthesis capsule inflammation., Competing Interests: The authors have no financial interest to declare in relation to the content of this article. This research was conducted with financial support from the Investigator-Initiated Study Program of Mentor Worldwide, LLC, and from Federal government funding (Luiza Erundina de Souza—protocol 8929494/2019)., (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Introduction: Post-burn hypertrophic scars are an important cause of physical discomfort, limitation of movements, psychological disorders, low self-esteem and reduced quality of life. Treatment for this condition is complex and involves several options. Microneedling, also known as minimally invasive percutaneous collagen induction, is an affordable minimally invasive option that can be combined with other treatments, including ablative ones., Objective: The goal of this study was to present our microneedling approach for the treatment of hypertrophic scars after burns., Method: A prospective study of 15 patients with post-burn hypertrophic scars was conducted between October 2016 and June 2022. All patients were treated with microneedling and drug delivery of triamcinolone. Scars were evaluated using Vancouver Scar Scale (VSS), Burn Scar Assessment Scale (BSAS) and angle measurement for amplitude of movement evaluation of joints., Results: A significant improvement in the VSS score was obtained after microneedling (8.8 ± 0.44 to 4.1 ± 0.98; p = 0.012), especially in the acute group (less than 1 year after burns): 9.3 ± 0.49 to 3.5 ± 1.36; p = 0.041. There was a significant and progressive improvement of the scars throughout the treatment sessions in all criteria evaluated and in the ranges of joint movement (p = 0.012)., Conclusion: Our microneedling protocol promoted a significant improvement of post-burn scars, especially in acute hypertrophic scars, and in the amplitude of joint motion. Sequential treatments provided progressive improvement., Level of Evidence Iv: 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 ., (© 2024. Springer Science+Business Media, LLC, part of Springer Nature and International Society of Aesthetic Plastic Surgery.)

Background:  Autologous tissue has become the gold standard in breast reconstruction. The use of a deep inferior epigastric perforator (DIEP) flap has the advantages of giving a natural appearance to the reconstructed breast and being associated with lower morbidity at the donor site when compared with the transverse rectus abdominis myocutaneous flap. Venous complications such as venous thrombosis and insufficiency remain the main causes of flap loss and surgical revisions. The aim of this study was to evaluate the influence of superficial venous drainage of the DIEP flap and the addition of a second venous anastomosis have on flap survival., Methods:  This was a retrospective cohort study collected from a prospective database maintained by our institution. Data was obtained from the medical records of female patients who underwent mastectomy and breast reconstruction with a DIEP flap between March 2010 and March 2017. We evaluated 137 DIEP patients with unilateral breast reconstructions. In 64 (46.7%) the deep venous system was chosen and 73 (53.3%) had an additional superficial vein anastomosed., Results:  Out of the 137 patients evaluated, there were 16 (11.67%) cases of revision, 14 (10.21%) were due to venous thrombosis. Twelve cases (8.75%) of flap loss were reported. Reoperation rate was lower in the dual venous drainage group when compared with the single venous drainage group ( p  = 0.005), as was the rate of flap loss ( p  = 0.006) and reoperation due to venous thrombosis ( p  = 0.002). Out of the 125 DIEP flaps, fat necrosis was clinically identified in 7 (5.1%) cases, and the rate was lower in the dual venous drainage system group ( p  = 0.01)., Conclusion:  Dual venous drainage of a DIEP flap appears to reduce the rates of venous thrombosis, reoperation, total flap loss, and fat necrosis., Competing Interests: None declared., (Thieme. All rights reserved.)

Background: The sudden increase of intensive care unit patients during the coronavirus pandemic led to an increase in the incidence of sacral pressure lesions. Despite being ambulating patients, in many cases the lesions were deep (Grade III and IV), mainly due to the long-term intubation and being bedridden during the pandemic. Most of these wounds necessitated surgical repair., Objectives: To measure the success and the rate of complications in reconstructions of grade III and IV hospital acquired sacral pressure lesions in ambulating patients after hospitalization for COVID-19. Developing a well-established protocol for surgical treatment of hospital acquired sacral pressure lesions during the COVID-19 pandemic., Methods: Prospective cohort involving ambulating patients with grades III and IV sacral pressure lesions developed after hospitalization for COVID-19 from May 2020 to August 2020 (4 months). All of them were submitted to reconstruction with fasciocutaneous flaps. Demographics, comorbidities, and preoperative laboratory tests were compared and multivariable-adjusted logistic regression was made in order to identify risk factors for complications., Results: Thirty-eight patients were submitted to fasciocutaneous flaps to repair sacral pressure lesions with a total complication rate of 36.0%. Hemoglobin levels lower than 9.0 mg/dl (p = 0,01), leukocyte levels higher than 11.000/mm 3 (p = 0,1), and C Reactive protein levels higher than 142 mg/dl (p = 0,06) at the time of reconstruction and bilateral flaps were independent factors for complications., Conclusion: Specific preoperative laboratory tests and surgical techniques were associated with a statistically significant increased complication risk. It was established a protocol for surgical treatment of hospital-acquired sacral pressure lesions to diminish these risks, focusing on ambulating patients during the COVID-19 pandemic., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2023. Published by Elsevier Ltd.)

Purpose: Enterocutaneous fistula (ECF) is a condition in which there is an abnormal connection between the intestinal tract and the skin. It can lead to high morbidity and mortality rates despite the availability of therapeutic options. Stem cells have emerged as a potential strategy to treat ECF. This study aimed to evaluate the effect of adipose tissue-derived stem cells (ASC) on ECF in an experimental model., Methods: ECF was induced in 21 Wistar rats, and after one month, they were divided into three groups: control group (C), culture medium without ASC group (CM), and allogeneic ASC group (ASC). After 30 days, the animals underwent macroscopic analysis of ECF diameter and histopathological analysis of inflammatory cells, tissue fibrosis, and vascular density., Results: The study found a 55% decrease in the ECF diameter in the ASC group (4.5 ± 1.4 mm) compared to the control group (10.0 ± 2.1 mm, p = 0.001) and a 59.1% decrease in the CM group (11.0 ± 4.3 mm, p = 0.003). The fibrosis score in the ASC group was 20.9% lower than the control group (p = 0.03). There were no significant differences in inflammation scores among the three groups., Conclusions: This study suggests that ASC treatment can reduce ECF diameter, and reduction in tissue fibrosis may be a related mechanism. Further studies are needed to understand the underlying mechanisms fully.

Introduction: obesity is one of the most common diseases worldwide, and the most effective treatment to it is the bariatric surgery. One of the negative impacts of this procedure is the body dysmorphia caused by overhanging skin. In Brazil, the national health system - Sistema Único de Sáude (SUS) - provide body contouring surgery to treat post-bariatric patients, since 2007. This article aims to describe the Brazilian public health approach to post bariatric patients and perform an analyze in the Brazilian health care database., Methods: in Brazilian Health System database, a search for the post-bariatric procedures performed between 2007 to 2021 was done. The variables analyzed were geographic location, year, mean days of hospitalization, death, and mortality rate. Also, we evaluated the number of bariatric procedures done in the same period. Statistical analysis was performed using the Student-t and the chi-square tests and p-value <0.5 was considered significant., Results: a total of 12,717 plastic surgery procedures in post bariatric patients were done, with a national prevalence of 13.8%. Dermolipectomy was the most performed procedure, with 6,719. The years of 2020 and 2021 suffered a decreased of 64.3% and 70.9% in the number of surgeries (p<0,001). Bariatric Procedures had a high rate and a higher percentage of growth comparing to post bariatric surgery (p<0,001), totalizing 93,589 surgeries., Conclusions: Brazil had a significant number of body contouring surgery, however with a low prevalence. Dermoliepctomy was the most common procedure performed. We could notice a significant impact of COVID pandemic in those procedures .

Background and Aims: Skin grafting is the single most effective method to close a chronic wound. The current standard of care is to use meshed split thickness skin grafts. This entails the use of surgical instruments that need to be autoclaved and to have a power source, which usually requires an OR facility. The minced skin technique uses single use, presterilized instruments and the procedure can be done under local anesthesia, by a wound care practitioner, in a wound clinic, a physician's office or even at the bedside. The current study was designed to determine if the results from micrografting were non inferior to conventional mesh grafting., Methods: In a prospective non inferiority study, 26 chronic ulcers were treated with micrografting (MSG) and 24 with conventional mesh grafts 1:3 (control group-CG) in a total of 21 patients, 10 male and 11 female. The donor site areas in the MSG group were predetermined to 2.5 × 5 cm and the mesh grafts expansion was set at 1:3., Results: In the first weeks postoperatively, micrograft healing initially lagged behind the conventional mesh grafts but at 60 days after grafting, all MSG wounds were healed. The MSG wounds had better pigmentation, less itching, and less scarring. The micrografting procedure was easy to learn and expeditious to perform. The MSG mean expansion was 9.1 compared to three times (CG)., Conclusion: The MSG procedure is not inferior to conventional mesh grafting, requires smaller donor sites, and can be done with single use instruments, under local anesthesia, with early discharge., Competing Interests: Dr Eriksson is the inventor of the Minced Skin Graft technique and he has patented devices and methods for harvesting and processing of skin grafts. He had no part of the design, evaluation or the conclusions of this study. The remaining authors declare no conflict of interest., (© 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.)

Background: The most accurate methods for assessing fat grafted volume, such as computed tomography (CT) scan and magnetic resonance imaging, use 3-dimensional (3D) evaluation of the recipient area. Currently, other measurement techniques such as photogrammetry (compilation of photos) are employed., Objectives: The aim of the present study was to compare 3D images obtained by CT scan with those obtained by photogrammetry in patients undergoing autogenous fat grafting to the chin., Methods: A prospective longitudinal study was undertaken to assess patients undergoing autologous fat grafting to the chin, capturing preoperative and postoperative (6 months) images with CT scan and photogrammetry. Captured images were submitted to 3D reconstruction with Blender image software., Results: A total of 40 patients were submitted to surgery. Seventy-five percent were female. Median age and BMI were 26.5 years and 23.6 kg/m2, respectively. Median volume of fat grafted was 10 mL (interquartile range 8-12.25 mL). Results showed that the median preoperative volume measured by CT scan was larger than the photogrammetry measurement (12.48 mL vs 12.01 mL, respectively, P < .001). Likewise, a larger volume was measured by CT scan than by photogrammetry (15.54 mL vs 14.94 mL respectively, P < .001) 6 months postoperatively. However, there was no difference between CT scan and photogrammetry measurements of the change in volume from preoperatively to postoperatively (P = .89)., Conclusions: There was no agreement between fat graft volume measurements obtained by 3D photogrammetry and CT scan techniques with regard to absolute values of fat graft volume measurements, however no difference was found between the 2 methods when comparing preoperative with postoperative fat graft volume variation., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Aesthetic Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Approximately 80% of patients submitted to radiotherapy develop radiodermatitis. Photobiomodulation based on light-emitted diode (LED) is one of the therapeutic strategies for treating inflammation. This study aimed to investigate the effect of the photobiomodulation with two wavelengths, in an acute radiodermatitis animal model., Methods: Twenty rats were submitted to one radiotherapy session. After 15 days, the rats that developed radiodermatitis were divided into control groups, LED-630 nm, LED-850 nm, and LED-630 + 850 nm. The treatment regimen was one session lasting 10 minutes on alternate days for 21 days. We analyzed macroscopy aspects (RTOG scale), vascular density, dermal appendages, VEGF-a, TNF-alpha, MMP-9, and MMP-9 genic expression level., Results: All LED groups revealed a two-point reduction on the radiodermatitis severity grade compared with the baseline classification. Dermal appendage and vascular analysis showed a higher counting in all LED groups compared to control. This study showed dermal appendages twice in the 630/850 nm group compared with the control group. The 630/850 nm group showed six times more arterioles than the control group. Regarding genic expression, this study showed a 10-fold decrease between LED-630 nm versus LED-630 + 850 nm ( P = 0.02) interleukin-10 expression and a 12-fold decrease between control versus LED-630 nm ( P = 0.006) and LED-850 nm ( P = 0.002) in TNF-alpha., Conclusion: LED (630 nm, 850 nm, and 630 nm + 850 nm) showed benefit in the treatment of radiodermatitis, and the association of the 630 nm + 850 nm and 630 nm parameters demonstrated the best macroscopic and microscopic results., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Burn injuries are a significant cause of morbidity and mortality in the Brazilian population. We conducted this study in a tertiary hospital in Brazil to discover the epidemiological characteristics of patients with burn injuries. We conducted a cohort review of patients admitted to the burn unit of our institute during a 5-year period. For each patient, we collected data that included age, gender, total percentage of burned body surface area, burn location, burn mode, and burn cause. We analyzed the data using the R programming language. We included a total of 496 patients in our study. The mean age of the patients was 28 ± 14.7 years. The median length of hospital stay was 2 weeks. We found a significant correlation between the total percentage of burned body surface area and the length of hospitalization (p < .001) and the length of hospitalization in the intensive care unit (p < .001). A total of 427 patients (86%) were discharged from the hospital after successful treatment. In contrast, 43 patients (8.67%) died. The mortality rate was highest in patients who had more than 70% of their total body surface area burned. The average length of hospitalization aligned with global and national statistics presented in the literature. The main causes of the burn injuries were thermal (e.g., fire, hot liquids). We found inhalation injuries present in more than one third of the patients who were hospitalized in the intensive care unit with thermal burns., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest., (Copyright © 2023 International Society of Plastic and Aesthetic Nurses. All rights reserved.)

Purpose: To analyze the cytotoxicity and cell in porcine-derived decellularized skin matrix., Methods: We analyzed the effect of multiple decellularization processes by histological analysis, DNA quantification, and flow cytometry. Subsequently, we analyzed the most appropriate hydrogel concentration to minimize cytotoxicity on fibroblast culture and to maximize cell proliferation., Results: After the fourth decellularization, the DNA quantification showed the lowest DNA concentration (< 50 ng/mg). Histological analysis showed no cell components in the hydrogel. Moreover, hematoxylin and eosin showed a heterogeneous structure of collagen fibers. The best hydrogel concentration ranged from 3 to 25%, and there was no significant difference between the 24 hours and seven days., Conclusions: The process of hydrogel production was effective for removing cells and DNA elements. The best hydrogel concentration ranged from 3 to 25%.

Insufficient vascularization is a recurring cause of impaired pedicled skin flap healing. The administration of adipose tissue-derived stromal cells' (ASCs') secretome is a novel approach to augment vascularization. Yet, the secretome comprised of soluble factors that require a sustained-release vehicle to increase residence time. We hypothesized that administration of a hydrogel derived from decellularized extracellular matrix (ECM) of porcine skin with bound trophic factors from ASCs enhances skin flap viability and wound repair in a rat model. Porcine skin was decellularized and pepsin-digested to form a hydrogel at 37°C. Conditioned medium (CMe) of human ASC was collected, concentrated 20-fold, and mixed with the hydrogel. Sixty Wistar rats were included. A dorsal skin flap (caudal based) of 3 × 10 cm was elevated for topical application of DMEM (group I), a prehydrogel with or without ASC CMe (groups II and III), or ASC CMe (group IV). After 7, 14, and 28 days, perfusion was measured, and skin flaps were harvested for wound healing assessment and immunohistochemical analysis. Decellularized skin ECM hydrogel contained negligible amounts of DNA (11.6 ± 0.6 ng/mg), was noncytotoxic and well tolerated by rats. Irrespective of ASC secretome, ECM hydrogel application resulted macroscopically and microscopically in similar dermal wound healing in terms of proliferation, immune response, and matrix remodeling as the control group. However, ASC CMe alone increased vessel density after 7 days. Porcine skin-derived ECM hydrogels loaded with ASC secretome are noncytotoxic but demand optimization to significantly augment wound healing of skin flaps.

Introduction: nose is the central point of the face and vulnerable to the occurence of non-melanoma skin cancer (NMSC), impacting on appearance. The paramedian forehead flap (PMFF) is considered the best option to treat extensive nasal defects. The objective of this study is to present the experience on PMFF for nasal reconstruction in the treatment of NMSC of a cancer referral center., Methods: retrospective study was carried out through data from medical records of patients who underwent nasal reconstruction with PMFF due to NMSC at the Cancer Institute of the State of São Paulo (ICESP)., Results: 111 patients were identified, mostly ederly, with comorbidities and on initial tumors (T1 and T2). Basal cell carcinoma (BCC) was the predominant histological type. Dorsum and tip were the most affected subunitis. In addition to skin coverage, reconstruction of the lining and structural framework was also performed in half of the cases. Second intention healing was the technique of choice in closing the donor area. Pedicle division ocurred predominantly in the second operation and the median time to complete reconstruction was 6 months. There were low complication rates., Conclusions: the PMFF is safe and effective to treat nose NMSC, even in cases of high complexity. Since the treatment time can be prolonged and impact on quality of life, it is essential to emphasize and discuss this aspect with the patients before surgery.