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Cutaneous metastases are a rare finding, and therefore frequently neglected. Among the possible clinical patterns of presentation, keratoacanthoma-like lesions are very infrequent and can be misrepresentative of the true diagnosis. We report a case of multiple cutaneous metastases of oesophageal squamous cell carcinoma affecting the scalp and neck that mimic keratoacanthoma. In spite of the typical clinical presentation, pathological findings corroborated the diagnosis of moderately differentiated squamous cell carcinoma. This case raises the possibility of such a clinical presentation being caused by haematogenous dissemination of distant site visceral tumours. Therefore, the differential diagnosis of multiple keratoacanthoma-like lesions should include metastases of distant site visceral malignancies.

Tissue Engineering offers a new route for the reconstruction of new organs and tissues that have suffered trauma or injury. With this respect, the production of tridimensional scaffolds to allow cells to attach, migrate and proliferate is the base of Tissue Engineering. In this study, a polyurethane scaffold was synthesized in a batch reactor by the reaction of bio-based polyol extracted from Euterpe oleracea Mart. seeds (açaí berry), a renewable raw material present in Amazon Region of Brazil, and a polyisocyanate derived from hexamethylene diisocyanate. The chemical structure of the scaffold was characterized by using proton nuclear magnetic resonance spectroscopy, the distribution of average porosity and pore size was characterized by X- ray microtomography, the thermal properties were determined by thermogravimetric analysis and the biocompatibility was studied by in vitro assays. The results showed that the scaffold presents excellent morphological, chemical and thermal properties, with an appropriate porosity for cell attachment, cell growth proliferation, it also shows no inflammatory response, a good biocompatibility making it applicable as a new biomaterial for future applications in Tissue Engineering.

The absorbable polyacid, poly (L-Lactide) (PLLA) is one of the most commonly used and studied materials in tissue engineering, for its biocompatibility and biodegradability. This work will show that the PLLA synthesized at our laboratory has the same biocompatibility as the PLDL Purac®. The PLLA was synthesized through ring- opening polymerization and manufactured into nanofibers through the electrospinning process. The cytotoxicity of the material was evaluated by the calorimetric MTT assay (Sigma), Live/Dead (Molecular Probes), Direct Contact, Elution and Agar Diffusion.The assays were performed using nanofibers membranes made with PLLA and with PLDL Purac®, where the biomaterials were in contact with the fibroblast cell culture, in the sense to compare the results between them. For the MTT, Live/Dead and Elution assays the nanofiber membranes were incubated with the fibroblast cell culture for 24h, 48h and 72h. For the Direct Contact and Agar Diffusion the nanofiber membranes were maintained in contact with the cells for 24h. For the assay controls we used DMEM-LG containing 0.5% phenol as the positive control of toxicity CT(+) and for negative control of toxicity CT(-) DMEM-LG containing 10% FBS. The ANOVA test was used to measure the MTT assay results, and within 24h of exposure, the cells in contact with the PLLA showed a higher proliferation rate than CT(-) and PLDL Purac®, being significantly different (p< 0,05). Whatsoever, there were no statistically significant differences between the PLLA, the PLDL Purac®, and the CT(-) after 48h and 72h of culture (p>0.05). The morphology of the cells in contact with both biomaterials was also considered normal, showing no signal of cytotoxicity. The high rates of proliferation and viability of the cells in contact with the PLLA, shown by the biocompatibility assays, demonstrate that the PLLA is a biocompatible material. The PLDL Purac® exhibited similar results, as expected. Those findings show that the PLLA synthesized has the same biocompatibility as the PLDL Purac®. Thus, the PLLA synthesized in our laboratory is a high quality biomaterial that can assist in the manufacturing of nanofibers that can be adapted for different biomedical applications.

Introduction: The mandible is the largest and strongest of the bones in the face. Due to its topography, it is vulnerable to trauma. Data analysis on mandible fractures is fundamental for treatment and public health policies. This study aims to conduct an epidemiological survey of surgically treated mandibular fractures. Method: Screening through the hospital information system, seeking patients undergoing surgery for jaw fracture performed at a teaching hospital by the plastic surgery team in Campinas-SP from April 2015 to April 2020. Data were then collected through analysis of medical records. Results: 50 patients were included, 90% male. The average age was 30.7 years. The predominant etiology was an automobile accident, and the most fractured region in the mandible was the parasymphysis. The median time between trauma and surgery was 19 days. Eleven (22%) patients had some comorbidity. Fourteen patients (28%) were admitted to the Intensive Care Unit (ICU), and 42% underwent surgery with another specialty besides Plastic Surgery. Ten (20%) patients had some complication of the surgery, the most common being surgical wound dehiscence. Conclusion: There was a predominance among young men and traffic accidents as etiology. Fractures were preferably located in the parasymphysis region and were treated using rigid internal fixation. The high rates of ICU admission, associated injuries, and surgical procedures carried out by other specialties demonstrate the severity of the patients assisted in the service.

Introduction: The growing number of patients with massive weight loss after bariatric surgery is correlated with the demand for body contouring surgery. Such procedures reduce physical and psychological complaints, positively influencing the quality of life of these people. However, there is little data on the response of services that offer surgical treatment for morbid obesity to this need. The study aims to measure the prevalence of body contouring surgery between 2015 and 2018, in patients previously underwent on a bariatric surgery, in 2014 and 2015, at a University Hospital. Methods: Research in the hospital information system and medical records in order to assess the institutional prevalence of post-bariatric body contouring surgery. Patients who did not undergo both surgeries in our Service, those who underwent these surgical procedures in other years, as well as those with incomplete medical records were excluded. Results: Bariatric surgeries were performed in 208 patients. Of these, 11% (n=23) underwent 27 body contouring surgeries, with abdominal dermolipectomy (n=16) being the most frequently performed. The performance of more than one procedure to correct body deformity occurred in 13% (n=3) of patients. The mean age of patients undergoing body contouring surgery was 37 years, the majority was female (96%, n=22). Conclusion: Body contouring surgery is an important step in the treatment of morbid obesity and has a restorative feature. There is a huge lack of this therapy, which irreparably compromises the results obtained by bariatric surgery.

El artículo examina la relación entre la realización de los derechos económicos y sociales y la regulación de los mercados basada en el derecho de la competencia y sus funciones en la realización del derecho a la alimentación en Brasil. Considerando el papel constitutivo del derecho en la economía política y sus instituciones, examinamos cómo la defensa de la competencia cumple funciones de facilitación o restricción de las actividades económicas, a partir de investigaciones jurisprudenciales sobre la actuación de la autoridad brasileña de defensa de la competencia en el sector de alimentos. Se verifica que, en el caso brasileño, existe la necesidad de un reconocimiento más explícito de la defensa de la competencia como herramienta de regulación económica y social, así como una discusión más detallada sobre los patrones típicos de competencia en el sector de alimentos, especialmente en las cadenas globales de valor. Se argumenta que el análisis antimonopolio sea más estructural, identificando los vínculos y las relaciones económicas en la cadena de valor de los alimentos, así como su impacto en los precios y otras variables clave, además de centrarse en los mercados relevantes y las superposiciones horizontales.

Introduction: Fat grafting consists of collecting fat from one fat donor area via liposuction, then reallocating this tissue into a receptor area through syringes and cannulas. According to the literature, it is a safe process used in aesthetic and reconstructive surgeries. The objective is to evaluate complication rates of fat grafting procedures performed in a public university hospital from 2015 to 2018 in comparison with data previously reported in the literature. Methods: A retrospective observational study developed at a public university hospital in Campinas-SP based on the revision of medical records of patients who underwent the fat grafting procedure in this institution from 2015 to 2018. Results: Regarding the complications, the vast majority corresponded to fat reabsorption (62%). Bruise corresponded to the second most common (38% of cases), followed by edema (19%). Pain and dyschromia followed next, with 10% and 7% of cases, respectively. Only one case of operative wound infection was described. Other less frequent complications included hyperemia (5%), asymmetries (5%), desquamation (2%), local paraesthesia (3%) and skin lesion (2%). No other larger complication was reported, such as fat embolism or severe surgical complications such as bleeding, sepsis, or anaphylaxis. Conclusion: The procedures of liposuction for fat collection and fat grafting were proved to be safe, yielding low complication rates in the studied sample, which agrees with data reported in the literature.

Introdução: A lipoenxertia consiste no processo de coleta de gordura de uma área doadora de gordura por meio de lipoaspiração seguida da realocação desse tecido em área receptora por meio de seringas e cânulas. É um processo seguro utilizado em cirurgias estéticas e reconstrutivas, de acordo com a literatura. O objetivo é avaliar as taxas de complicações dos procedimentos de lipoenxertia realizados em um hospital público universitário no período de 2015 a 2018, em comparação com dados previamente relatados na literatura. Métodos: Estudo observacional retrospectivo desenvolvido em hospital universitário público de Campinas - SP a partir da revisão de prontuários de pacientes submetidos a lipoenxertia nesta instituição de 2015 a 2018. Resultados: Em relação às complicações, a grande maioria correspondeu à reabsorção de gordura (62%). O hematoma correspondeu ao segundo mais comum (38% dos casos), seguido do edema (19%). Dor e discromia vieram em seguida, com 10% e 7% dos casos, respectivamente. Apenas um caso de infecção de ferida operatória foi descrito. Outras complicações menos frequentes foram hiperemia (5%), assimetrias (5%), descamação (2%), parestesia local (3%) e lesão cutânea (2%). Nenhuma outra complicação maior foi relatada, como embolia gordurosa ou complicações cirúrgicas graves como sangramento, sepse, anafilaxia, entre outras. Conclusão: Os procedimentos de lipoaspiração para coleta de gordura e lipoenxertia mostraram-se seguros e com baixo índice de complicações na amostra estudada, concordando com dados da literatura.

Apresentação do número especial realizado em parceria envolvendo o Grupo Direito e Políticas Públicas da Faculdade de Direito da Universidade de São Paulo, o Global Center for Legal Innovation on Food Environments do O’Neill Institute for National and Global Health Law (Georgetown University Law Center) e a Revista Estudos Institucionais (REI). A partnership between Grupo Direito e Políticas Públicas and the O’Neill Institute for National and Global Health Law (Global Center for Legal Innovation on Food Environments). The project “Law, Policy and Public Health: the regulation of food environments in Brazil”, a partnership between Grupo Direito e Políticas Públicas and the Global Center for Legal Innovation on Food Environments (O’Neill Institute for National and Global Health Law at Georgetown Law), aims to generate knowledge and raise awareness of the legal arrangements and strategies which impact on food environments in Brazil. The research developed under this project investigates rules, institutions and actors that shape food environments, and to what extent they act as enablers or obstacles to the protection of the rights of individual users and collectives, and to the promotion of their economic and social rights and interests in a sustainable and healthy way. In addition, it aims to create a new community of researchers and policymakers, centered on the ambition to inform policy and regulatory actions and responses.

Introduction: The lip is the body region more often affected by vascular anomalies (VAs). Identifying the appropriate etiology of the lesion is significantly important when determining the treatment of choice for the patient. This study aimed to determine the association between the anatomical positioning and the characteristics of the lesions and the etiological diagnosis of VAs of the lips to identify the appropriate tool to be used in clinical practice. Methods: A retrospective analysis was performed in 150 patients with VA of the lips evaluated between 1999 and 2017. The etiological diagnosis was based on the International Society for the Study of Vascular Anomalies 2014 classification. Clinical and photographic analysis was performed to assess the anatomical pattern of involvement and map the lesions. Results: An infantile hemangioma was observed to a lesser extent in only one lip and was situated more centrally, with rare involvement of the labial commissure. Venous and venous-lymphatic malformations and arteriovenous malformations (AVMs) involving the upper lip were predominantly located more laterally and caused significant deformity. However, AVMs more often extended beyond the limits of the vermilion. Capillary malformations were observed in the entire lower lip in some patients. Simple lymphatic malformations were observed in the entire upper lip with significant distortion in some patients. Conclusion: The initial presentation of VAs often comprises minimal changes; hence, establishing an assertive diagnosis is considered difficult. Specific patterns of involvement were observed for each etiological diagnosis studied. Anatomical mapping can be used as an auxiliary diagnostic tool and can possibly identify an appropriate clinical intervention in patients with VAs of the lip.

INTRODUCTION: Prominence is the most common deformity of the ear, affecting about 5% of the population. Most reports on otoplasty describe subjective evaluations, and do not provide accurate postoperative assessment or a comparison between techniques. We propose the development and implementation of a specific protocol to evaluate results. METHOD: A prospective evaluation for a period of one year in patients who underwent bilateral otoplasty was performed, using a technique based on modeling of the cartilage with sutures, and helix-to-mastoid distance measurements at standardized points. RESULTS: A total of 23 patients with an average age of 17.8 years underwent surgery. Reoperation was performed in 21.7% of the patients or 10.7% of the ears. Nearly 45% of the correction obtained at the upper point and 35% at the middle and lower points were lost in patients who did not undergo reoperation. CONCLUSIONS: The protocol was easily used and allowed objective evaluation of the preoperative deformity and surgical results. This technique produced results considered adequate and comparable to the literature.

BackgroundThe impact on quality of life attributed to treatment for rectal cancer remains high. Deterioration of the urinary function is a relevant complication within that context.ObjectiveTo detect the presence of urinary dysfunction and its risk factors among individuals underwent surgical treatment for rectal cancer.MethodsThe present prospective study analyzed 42 patients from both genders underwent surgical treatment for rectal adenocarcinoma with curative intent. The version of the International Prostatic Symptom Score (IPSS) questionnaire validated for the Portuguese language was applied at two time-points: immediately before and 6 months after surgery. Risk factors for urinary dysfunction were analysed by means of logistic regression and Student’s t-test.ResultsEight (19%) participants exhibited moderate-to-severe urinary dysfunction 6 months after surgery; the average IPSS increased from 1.43 at baseline to 4.62 six months after surgery (P

The absorbable polyacid is one of the most used and studied materials in tissue engineering. This work synthesized a poly (L-lactic acid) (PLLA) through ring-opening polymerization and produced with it nanofibers by the electrospinning process. The PLLA was analyzed by FTIR and its cytotoxicity was evaluated by the MTT assay and Live/Dead® (Molecular Probes). The tests were performed in contact with human mesenchymal cells at varying times. The high rates of viability and proliferation of cells in contact with the PLLA shown by MTT and Live/Dead® tests demonstrate that this PLLA is a biocompatible material. There was also the successful production of electrospinning nanofibers, which can be converted for specific biomedical applications in the future. [ABSTRACT FROM AUTHOR]

Additive manufacturing (AM) is a technology that enables the production of models and prosthesis directly from the 3D CAD model facilitating surgical procedures, implant quality and reducing risks. Furthermore, the additive manufacturing has been used to produce implants especially designed for a particular patient, with sizes, shapes and mechanical properties optimized, in many areas of medicine such as cranioplasty surgery. This work presents AM technologies applied to design and manufacture of a biomodel, in fact, an implant for the surgical reconstruction of a large cranial defect. A series of computed tomography data was obtained and software was used to extract the cranial geometry. The protocol presented was used for creation of anatomic biomodel of the bone defect for the surgical planning as well as to design and manufacture of the patient-specific implant, reducing duration of surgery besides improving the surgical accuracy due to preoperative planning of the anatomical details. [ABSTRACT FROM AUTHOR]

Introduction Chronic suppurative hidradenitis (CSH) is a benign condition that can affect the perineal region and often leads to the formation of abscesses and fistulas. It is rare for CSH to undergo malignant degeneration into mucinous adenocarcinoma. Presentation of case We report a case of a 55-year-old male patient with perineal CSH who suffered worsening long-term pain despite multiple surgical procedures to alleviate his symptoms. Pelvic magnetic resonance imaging (MRI) showed multiloculated cystic lesion on the left side wall of the distal rectum with gluteal extension. Pathological examination revealed mucinous adenocarcinoma. The patient underwent an abdominoperineal resection (APR) of the rectum with cutaneous muscle flap reconstruction. Although histopathological sections showed clear margins, the tumor recurred 6 months following surgery. Discussion Perineal mucinous adenocarcinoma arising in a patient with CSH is an extremely rare condition. This diagnosis is often difficult, due to the paucity of signs of malignant degeneration as well as the rarity of the disease itself. Surgical resection of the lesions is a well-established approach. In this case, diagnosing the tumor at such a late stage likely compromised his outcome. Conclusion Malignant degeneration to mucinous adenocarcinoma must be suspected in patients with a history of long-term CSH. In such cases, local biopsies and a radiological examination, such as MRI can help in the diagnosis. [ABSTRACT FROM AUTHOR]

Additive manufacturing (AM) technology from engineering has helped to achieve several advances in the medical field, particularly as far as fabrication of implants is concerned. The use of AM has made it possible to carry out surgical planning and simulation using a three-dimensional physical model which accurately represents the patient's anatomy. AM technology enables the production of models and implants directly from a 3D virtual model, facilitating surgical procedures and reducing risks. Furthermore, AM has been used to produce implants designed for individual patients in areas of medicine such as craniomaxillofacial surgery, with optimal size, shape and mechanical properties. This work presents AM technologies which were applied to design and fabricate a biomodel and customized implant for the surgical reconstruction of a large cranial defect. A series of computed tomography data was obtained and software was used to extract the cranial geometry. The protocol presented was used to create an anatomic biomodel of the bone defect for surgical planning and, finally, the design and manufacture of the patient-specific implant. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Facial trauma is a common injury in the urban setting. Many studies have been published on the epidemiology of facial fractures, but few of them conducted in Brazil. The purpose of this study was to analyze the epidemiological characteristics of patients treated for orbito-zygomatic fractures at our institution. Methods: Retrospective analysis of 141 patients with orbito-zygomatic complex fractures who underwent surgical treatment between May 2001 and May 2008. Results: The population studied consisted mostly of males (86.5% of patients), with a male:female ratio of 6.4:1. A marked predominance of patients aged 21–30 years was observed (34.3%). Traffic-related causes were the most common, with motorcycle accidents as the most frequent aetiology (24.8% of patients), followed by car accidents (19.2%) and interpersonal violence (15.2%). Associated injuries accounted for 88 lesions in 65 patients, and their occurrence was statistically associated with traffic-related causes. All patients enrolled in the study were managed with operative treatment. The most utilized method for treatment was internal fixation with miniplates and screws (83.7% of the cases). The complication rate was 24.8%. Conclusion: Orbito-zygomatic fractures can cause significant morbidity and impairment in patients’ quality of life. Despite recent improvements in legislation and educational campaigns, traffic remains the main cause of these injuries. More intensive efforts should be made in order to reduce its impact in the aetiology of facial trauma. [Copyright &y& Elsevier]

Summary: Thoraco-omphalopagus asymmetric conjoined twinning is a rare condition in which a grossly defective foetus (the parasite) is attached to the thorax and upper abdomen of the main foetus (the autosite). We describe a case of thoraco-omphalopagus asymmetric conjoined twins in which the autosite had an associated large-diameter omphalocoele that was successfully separated at our institution. Reconstruction of the resulting abdominal-wall defect was performed using a flap from the gluteal region and the proximal portion of the inferior limb of the parasite, which is demonstrated. In addition, a review of all previously published cases is presented, showing that overall positive results can be obtained in treating this condition and that the presence and degree of cardiac involvement have a major influence on the prognosis. [Copyright &y& Elsevier]

Introduction: Facial trauma presents aesthetic, social and economic relevance. Knowing its epidemiology makes it possible to formulate measures for prevention, education and systematization of care. Methods: Research through the hospital information system, looking for patients who needed to undergo surgery for face fracture between April 2015 and April 2020. Epidemiological data were then collected. Results: 141 patients were selected. The average age was 34 years, with most males (85%). The predominant etiology was motor vehicle accidents, and the most prevalent surgical fracture was orbit (67%). The median time between trauma and surgery was 18 days. Sixty patients had injuries associated with facial fractures, especially orthopedic and neurological injuries. Conclusion: The most common etiology of surgical facial fractures was a traffic accident, predominantly among men. Orbit fractures were the most surgically treated.

Resumo Objetivo: Verificar a presença das células-tronco mesenquimais (MSC) na área próxima ao nervo óptico de coelhos previamente lesado com álcool absoluto. Métodos: Os 12 coelhos da raça Nova Zelândia foram distribuídos em 2 lotes. Após sedação, cada olho do animal recebeu uma injeção retrobulbar de 1 ml de álcool absoluto em um dos olhos e de 1 ml de solução fisiológica 0,9% (SF) no olho contralateral. Após 15 dias deste procedimento inicial todos os olhos dos animais pertencentes ao lote A, receberam via retrobulbar, uma solução contendo MSC de tecido adiposo humano e previamente marcadas com Qdots,. Todos os olhos dos animais do lote B receberam solução PBS. Resultados: Após 15 dias desta última aplicação os animais foram sacrificados e as lâminas foram analisadas. A presença das MSC foi observada em 100% dos olhos dos animais do lote A. Conclusão: Os resultados sugerem que a marcação prévia das MSC com Qdots permitiu o acompanhamento das mesmas na região aplicada e em áreas mais internas do nervo óptico. A permanência de MSC após 15 dias de aplicação ao redor do nervo óptico sugere a viabilidade e possível participação das mesmas no processo de regeneração do tecido lesado. Nas condições deste estudo, a via de aplicação retrobulbar permitiu a mobilização das células tronco do local de aplicação até áreas centrais dos nervos ópticos nos animais do lote A, sugerindo que esta poderá ser uma via de acesso eficaz para as MSC no processo de regeneração de neuropatias ópticas.

ABSTRACT Purpose To evaluate the effect of fractional carbon dioxide (CO2) laser treatment using lower power associated with pulse stacking within collagen fibers, using second harmonic generation microscopy and computerized image analysis. Methods Twenty male Wistar rats aging eight weeks were used. Each treatment area received a single-pass CO2 fractional laser with different parameters. The 20 animals were divided into two groups and euthanized after 30 and 60 days. Second harmonic generation images were obtained and program ImageJ was utilized to evaluate the collagen organization within all areas. Collagen anisotropy, entropy and optical density were quantified. Results Increased anisotropy over time was observed in all four areas, but only reached statistical significance (p = 0.0305) when the mildest parameters were used (area four). Entropy decreased over time in all areas, but without significance(p = 0.1779) in area four. Density showed an overtime increase only in area four, but no statistical significance was reached (p = 0.6534). Conclusions When combined, the results obtained in this study regarding anisotropy, entropy and density tend to demonstrate that it is possible to achieve collagen remodeling with the use of lower power levels associated with stacked pulses.

Abstract Purpose To evaluate whether silicone foam implants have a different evolution pattern compared to conventional texture implants. Methods Fifty-eight female patients underwent surgery. They were divided into two groups (silicone foam – Lifesil® – and microtexturized silicone – Lifesil®). The evolution was analyzed in postoperative consultations, with physical examination, photographic documentation and filling in a satisfaction questionnaire, in the postoperative period of one month, four months, one year and then annually, up to a maximum of 3 years of follow-up. Results There were no statistically significant differences in presence of rippling, stretch marks, breast ptosis, capsular contracture and quality of scars. There was a higher rate of patients who were very satisfied with the outcome 360 days after surgery in the group receiving silicone foam implants (p = 0.036). Conclusion In short time, silicone foam envelope implants proved to be as reliable as textured silicone envelope implants, making them an option for augmentation mammoplasty.

PURPOSE : To evaluate the effect of different energies and stacking in skin shrinkage. METHODS : Three decreasing settings of a fractional CO2 laser were applied to the abdomen of Twenty five Wistar rats divided into three groups. Group I (n=5) was histologically evaluated for microthermal zones dimensions. Groups II and III (n=10 each) were macroscopic evaluated with freeware ImageJ for area contraction immediately and after 30 and 60 days. RESULTS : No statistical significance was found within microthermal zone histological dimensions (Group I) in all settings studied. (Ablation depth: 76.90 to 97.18µm; Coagulation depth: 186.01 to 219.84 µm). In Group II, macroscopic evaluation showed that all settings cause significant immediate skin contraction. The highest setting cause significant more intense tightening effect initially, contracting skin area from 258.65 to 179.09 mm2. The same pattern was observed in Group III. At 30 and 60 days, the lowest setting significantly sustained contraction. CONCLUSION : Lower fractional CO2 laser energies associated to pulse stacking could cause consistent and long lasting tissue contraction in rats.

Background: The availability of commercial tissue engineering skin repair products for veterinary use is scarce or non-existent. To assess features of novel veterinary tissue engineered medical devices, it is therefore reasonable to compare with currently available human devices. During the development and regulatory approval phases, human medical devices that may have been identified as comparable to a novel veterinary device, may serve as predicate devices and accelerate approval in the veterinary domain. The purpose of the study was to evaluate safety and efficacy of the biomembrane for use in skin repair indications. Methods: In the study as a whole (3 year total length), 15 patients (animals), dogs and cats (male/female, 2 cm), with a wound depth equivalent to 2nd/3rd degree burns are to be studied from Day 0 to Day 120-240, post-application of the biomembrane. This interim report covers the 5 patients assessed to date and deemed eligible, of which 3 enrolled, and 2 have completed the treatment. Wound beds were prepared and acellular collagen biomembranes (Eva Scientific Ltd, São Paulo, Brazil) applied directly onto the wounds, and sutured at the margins to the patient's adjacent tissue. Wound size over time, healing rate, general skin quality and suppleness were assessed as outcomes. Qualitative (appearance and palpation) and quantitative (based on Image Analysis of photographs) wound assessment techniques were used. Results: Both patients’ wounds healed fully, with no adverse effects, and the healing rate was comparable in both, maxing out at approximately 1 cm2/day. Conclusions: Early results on the biomembrane's safety and efficacy indicate suitability for skin repair usage in veterinary patients.

PURPOSE:To investigate the osseointegration properties of prototyped implants with tridimensionally interconnected pores made of the Ti6Al4V alloy and the influence of a thin calcium phosphate coating.METHODS: Bilateral critical size calvarial defects were created in thirty Wistar rats and filled with coated and uncoated implants in a randomized fashion. The animals were kept for 15, 45 and 90 days. Implant mechanical integration was evaluated with a push-out test. Bone-implant interface was analyzed using scanning electron microscopy.RESULTS: The maximum force to produce initial displacement of the implants increased during the study period, reaching values around 100N for both types of implants. Intimate contact between bone and implant was present, with progressive bone growth into the pores. No significant differences were seen between coated and uncoated implants.CONCLUSION:Adequate osseointegration can be achieved in calvarial reconstructions using prototyped Ti6Al4V Implants with the described characteristics of surface and porosity.

A lipoaspiração realizada para procedimentos estéticos tem como objetivo a retirada de gordura em pacientes saudáveis e redução do acúmulo de gordura localizada, a chamada lipodistrofia, levando à melhora no contorno corporal. Nas últimas três décadas, a lipoaspiração vem sendo aperfeiçoada; porém, como qualquer outro procedimento cirúrgico, não é isenta de complicações. O objetivo deste estudo é realizar revisão da bibliografia, por meio do PubMed, identificando as complicações após lipoaspiração clássica, incluindo apenas aquelas realizadas com finalidade estética. Foram encontrados 210 artigos empregando a expressão "complication in liposuction", 86 artigos com "complication after liposuction", 27 artigos com "fat embolism after liposuction", 7 artigos com "fat embolism following liposuction" e 16 artigos com "deaths related to liposuction". Dentre esses artigos, apenas 84 foram considerados relacionados ao assunto, sendo encontrados casos de embolia gordurosa após lipoaspiração, perfuração visceral, lesão vascular, cegueira e infecção por herpes zoster, entre outros relatos. Com base nos artigos analisados foi possível concluir que a lipoaspiração é um procedimento altamente eficaz quando bem indicado e bem realizado, porém existem riscos inerentes ao ato cirúrgico. Este levantamento constatou que existem muitos artigos abordando complicações após lipoaspiração para fins estéticos, e a embolia gordurosa pulmonar apresenta alta incidência.Liposuction for esthetic purposes aims to remove fat in healthy patients and reduce localized fat accumulation, called lipodystrophy, in order to improve body contour. In the last 3 decades, the liposuction technique has improved dramatically. However, like any other surgical procedure, it is not without complications. Here, we reviewed the literature on PubMed to identify complications after classic liposuction performed solely for esthetic purposes. In total, 210 articles were found using the term "complication in liposuction," 86 with "complication after liposuction," 27 with "fat embolism after liposuction," 7 with "fat embolism following liposuction," and 16 with "deaths related to liposuction." Among these articles, only 84 including cases of fat embolism after liposuction, visceral perforation, vascular injury, blindness, and herpes zoster infection among others were considered to be related to the subject. Based on the analyzed articles, we can conclude that liposuction is a highly effective procedure when well indicated and performed accurately. Despite this, there are inherent risks. This review found many articles addressing complications, predominantly pulmonary fat embolism, after liposuction for esthetic purposes.

INTRODUÇÃO: A correção da ptose mamária associada à flacidez de pele e baixa projeção é ainda tema de discussões e controvérsias na literatura. O objetivo deste estudo é descrever a experiência da Disciplina de Cirurgia Plástica da Universidade Estadual de Campinas (Unicamp) com a técnica de mastopexia com implante mamário associado a retalho de sustentação do músculo peitoral maior. MÉTODO: Foi realizado estudo retrospectivo de 20 pacientes com ptose mamária graus II ou III, operadas no período de junho de 2008 a setembro de 2010. RESULTADOS: Após seguimento pós-operatório entre 9 meses e 12 meses, não foram observados casos de deformidades mamárias ou torácicas e nenhuma paciente evoluiu com recidiva da ptose. Foram observados, em todas as pacientes, manutenção de boa projeção da mama e adequado preenchimento do polo superior mamário, gerando resultados duradouros e satisfatórios. CONCLUSÕES: A técnica de mastopexia com uso de implantes associados a retalho de músculo peitoral maior é de fácil realização, com curva de aprendizado relativamente curta, boa reprodutibilidade, e resultados duradouros e satisfatórios.BACKGROUND: The correction of breast ptosis associated with skin sagging and low projection is still a subject of controversy in the literature. This study aims to describe the experience of the Plastic Surgery Department of Universidade Estadual de Campinas (Unicamp) with the technique of mastopexy with breast implants in a double plane and the pectoralis major muscle flap. METHODS: A retrospective study of 20 patients with grade II or III mammary ptosis, who underwent surgery between June 2008 and September 2010, was performed. RESULTS: A 9- and 12-month follow-up of patients showed neither breast or chest deformities nor recurrence of ptosis. All patients presented with good breast projection and adequate upper pole fill, with long-lasting and satisfactory results. CONCLUSIONS: Mastopexy with breast implants and the pectoralis major muscle flap technique is easy to perform, with a relatively short learning curve, good reproducibility, and satisfactory long-lasting results.

Custom-built implants manufacture has always presented difficulties which result in high cost and complex fabrication, mainly due to patients’ anatomical differences. The solution has been to produce prostheses with different sizes and use the one that best suits each patient. Additive manufacturing technology, incorporated into the medical field in the late 80's, has made it possible to obtain solid biomodels facilitating surgical procedures and reducing risks. Furthermore, this technology has been used to produce implants especially designed for a particular patient, with sizes, shapes, and mechanical properties optimized, for different areas of medicine such as craniomaxillofacial surgery. In this work, the microstructural and mechanical properties of Ti6Al4V samples produced by direct metal laser sintering (DMLS) are studied. The microstructural and mechanical characterizations have been made by optical and scanning electron microscopy, X-ray diffraction, and microhardness and tensile tests. Samples produced by DMLS have a microstructure constituted by hexagonal α′ martensite with acicular morphology. An average microhardness of 370 HV was obtained and the tensile tests showed ultimate strength of 1172 MPa, yield strength of 957 MPa, and elongation at rupture of 11%.

INTRODUÇÃO: As grandes perdas ponderais pós-cirurgia bariátrica resultam, nos ex-obesos mórbidos, em grande flacidez cutânea nas áreas mais volumosas, com maiores depósitos adiposos nos membros, nas diversas regiões do tronco e, particularmente, na parede anterior do abdome. A abdominoplastia em âncora, também chamada tipo T invertido, tem sido o procedimento de eleição pelos especialistas, com ressecção concomitante do umbigo, seguida da neoumbilicoplastia no ato operatório. O objetivo do presente estudo é descrever nossa experiência com a técnica de neo-onfaloplastia no decurso das abdominoplastias em âncora em pacientes pós-cirurgia bariátrica, que consiste, basicamente, na utilização de 2 retalhos cutâneos, bilateralmente posicionados nas bordas da pele incisada, que, suturados à fáscia, determinam a umbilicação de aspecto natural. MÉTODO: Entre março de 2011 e junho de 2012, foram operados, pela Disciplina de Cirurgia Plástica do Hospital das Clínicas da Faculdade de Medicina da Universidade de Campinas, 50 pacientes submetidos a cirurgia bariátrica prévia, com estabilização do peso corpóreo por, no mínimo, 6 meses. RESULTADOS: Nos 50 pacientes operados, o neoumbigo ficou posicionado no local estabelecido pré-operatoriamente, apresentando características semelhantes às de indivíduos sem histórico de cirurgia abdominal prévia. Não ocorreram deiscência, necrose, estenose, alargamento das linhas de sutura no neoumbigo ou seromas nessa série de casos. CONCLUSÕES: A neo-onfaloplastia com emprego de 2 retalhos cutâneos e padronização de seu posicionamento na parede abdominal, distante 16 cm a 18 cm do apêndice xifoide, permitiu resultado estético compatível com o aspecto natural da cicatriz umbilical. Essa abordagem técnica é de fácil e rápida execução.

ABSTRACT CONTEXT: Lymphedema consists of extracellular fluid retention caused by lymphatic obstruction. In chronic forms, fat and fibrous tissue accumulation is observed. Genital lymphedema is a rare condition in developed countries and may have primary or acquired etiology. It generally leads to urinary, sexual and social impairment. Clinical treatment usually has low effectiveness, and surgical resection is frequently indicated. CASE REPORT: We report a case of a male-to-female transgender patient who was referred for treatment of chronic genital lymphedema. She had a history of pelvic radiotherapy to treat anal cancer and of liquid silicone injections to the buttock and thigh regions for esthetic purposes. Radiological examinations showed signs both of tissue infiltration by liquid silicone and of granulomas, lymphadenopathy and lymphedema. Surgical treatment was performed on the area affected, in which lymphedematous tissue was excised from the scrotum while preserving the penis and testicles, with satisfactory results. Histopathological examination showed alterations compatible with tissue infiltration by exogenous material, along with chronic lymphedema. CONCLUSION: Genital lymphedema may be caused by an association of lesions due to liquid silicone injections and radiotherapy in the pelvic region. Cancer treatment decisions for patients who previously underwent liquid silicone injection should take this information into account, since it may represent a risk factor for radiotherapy complications.

Background: The biomaterials engineering goal is to manufacture a biocompatible scaffold that adequately supports or improves tissue regeneration after implantation of the biomaterial in the injured area. Many requirements are demanded for a biomaterial, such as biocompatibility, elasticity, degradation time, and a very important factor is its cost of importation or synthesis, making its application inaccessible to some countries. Studies about biomaterials market show that Polylactic acid (PLLA) is one of the most used polymers, but expensive to produce. It becomes important to prove the biocompatibility of the new PLLA and to find strategies to produce biocompatible biopolymers at an acceptable production cost. Methods : In this work, the polylactic acid biomaterial was synthesized by ring-opening polymerization. The polymer was submitted to initial in vivo biocompatibility studies in 12 New Zealand female rabbits, assigned to two groups: (1) Lesion and PLLA group (n = 6), (2) Lesion No PLLA group (n = 6). Each group was divided into two subgroups at six and nine months post-surgical time. Before euthanasia clinical and biochemical studies were performed and after that tomographic (CT), histological (Hematoxylin and Eosin and Masson's trichrome) and histomorphometric analyses were performed to evaluate the injury site and prove biocompatibility. The final cost of this polymer was analyzed. Results: The statistical studies of hemogram and hepatocyte enzymes, showed that there were no significant differences between the groups for any of the times studied, in any of the variables considered and the results of CT and histology showed that there was an important process of neoregeneration. The cost analysis showed the biopolymer synthesis is between R$3,06 - R$5,49 cheaper than the import cost. Conclusions: It was possible to synthesize the PLLA biopolymer by cyclic ring opening, which proved to be biocompatible, potential osteoregenerative and cheaper than other imported biopolymers., Competing Interests: No competing interests were disclosed., (Copyright: © 2021 Xavier M et al.)

Purpose: To evaluate the effect of fractional carbon dioxide (CO2) laser treatment using lower power associated with pulse stacking within collagen fibers, using second harmonic generation microscopy and computerized image analysis., Methods: Twenty male Wistar rats aging eight weeks were used. Each treatment area received a single-pass CO2 fractional laser with different parameters. The 20 animals were divided into two groups and euthanized after 30 and 60 days. Second harmonic generation images were obtained and program ImageJ was utilized to evaluate the collagen organization within all areas. Collagen anisotropy, entropy and optical density were quantified., Results: Increased anisotropy over time was observed in all four areas, but only reached statistical significance (p = 0.0305) when the mildest parameters were used (area four). Entropy decreased over time in all areas, but without significance(p = 0.1779) in area four. Density showed an overtime increase only in area four, but no statistical significance was reached (p = 0.6534)., Conclusions: When combined, the results obtained in this study regarding anisotropy, entropy and density tend to demonstrate that it is possible to achieve collagen remodeling with the use of lower power levels associated with stacked pulses.

Purpose: To evaluate whether silicone foam implants have a different evolution pattern compared to conventional texture implants., Methods: Fifty-eight female patients underwent surgery. They were divided into two groups (silicone foam - Lifesil® - and microtexturized silicone - Lifesil®). The evolution was analyzed in postoperative consultations, with physical examination, photographic documentation and filling in a satisfaction questionnaire, in the postoperative period of one month, four months, one year and then annually, up to a maximum of 3 years of follow-up., Results: There were no statistically significant differences in presence of rippling, stretch marks, breast ptosis, capsular contracture and quality of scars. There was a higher rate of patients who were very satisfied with the outcome 360 days after surgery in the group receiving silicone foam implants (p = 0.036)., Conclusion: In short time, silicone foam envelope implants proved to be as reliable as textured silicone envelope implants, making them an option for augmentation mammoplasty.

Background: The availability of commercial tissue engineering skin repair products for veterinary use is scarce or non-existent. To assess features of novel veterinary tissue engineered medical devices, it is therefore reasonable to compare with currently available human devices. During the development and regulatory approval phases, human medical devices that may have been identified as comparable to a novel veterinary device, may serve as predicate devices and accelerate approval in the veterinary domain. The purpose of the study was to evaluate safety and efficacy of the biomembrane for use in skin repair indications. Methods: In the study as a whole (3 year total length), 15 patients (animals), dogs and cats (male/female, <8 years) with skin lesions of different etiologies considered difficult to heal (size, >2 cm), with a wound depth equivalent to 2nd/3rd degree burns are to be studied from Day 0 to Day 120-240, post-application of the biomembrane. This interim report covers the 5 patients assessed to date and deemed eligible, of which 3 enrolled, and 2 have completed the treatment. Wound beds were prepared and acellular collagen biomembranes (Eva Scientific Ltd, São Paulo, Brazil) applied directly onto the wounds, and sutured at the margins to the patient's adjacent tissue. Wound size over time, healing rate, general skin quality and suppleness were assessed as outcomes. Qualitative (appearance and palpation) and quantitative (based on Image Analysis of photographs) wound assessment techniques were used. Results: Both patients' wounds healed fully, with no adverse effects, and the healing rate was comparable in both, maxing out at approximately 1 cm 2 /day. Conclusions: Early results on the biomembrane's safety and efficacy indicate suitability for skin repair usage in veterinary patients., Competing Interests: Competing interests: The first author (A.K.) is the founder and shareholder of Eva Scientific Ltd, where the biomembrane used in this clinical trial was developed and is sold. The co-authors are veterinary practitioners of Sorocaba Veterinary Hospital (J.F.L.N., J.A.M.F. and M.H.S.C.) and full-time employees of University of Campinas (A.L.J. and P.K.). All co-authors read and agreed to the manuscript and had full access to the data, and attest to the study's impartiality as a whole, as well as declare no competing interests.

Purpose: To evaluate the effect of different energies and stacking in skin shrinkage., Methods: Three decreasing settings of a fractional CO2 laser were applied to the abdomen of Twenty five Wistar rats divided into three groups. Group I (n=5) was histologically evaluated for microthermal zones dimensions. Groups II and III (n=10 each) were macroscopic evaluated with freeware ImageJ for area contraction immediately and after 30 and 60 days., Results: No statistical significance was found within microthermal zone histological dimensions (Group I) in all settings studied. (Ablation depth: 76.90 to 97.18µm; Coagulation depth: 186.01 to 219.84 µm). In Group II, macroscopic evaluation showed that all settings cause significant immediate skin contraction. The highest setting cause significant more intense tightening effect initially, contracting skin area from 258.65 to 179.09 mm2. The same pattern was observed in Group III. At 30 and 60 days, the lowest setting significantly sustained contraction., Conclusion: Lower fractional CO2 laser energies associated to pulse stacking could cause consistent and long lasting tissue contraction in rats.

Background Aims: End-stage liver diseases frequently require liver transplantation. Cell therapy could be an alternative. This study aimed to analyze whether undifferentiated mesenchymal stromal cells (U-MSCs) or MSC-derived hepatocyte-like cells (DHLCs) from adipose tissue (AT), umbilical cord blood (UCB) and bone marrow (BM) would better restore damaged liver., Methods: AT was obtained from lipo-aspiration, UCB from an Umbilical Cord Blood Bank and BM from a BM Transplantation Unit. AT (collagenase digestion), UCB and BM (Ficoll gradient) were cultured (Dulbecco's modified Eagle's medium, low glucose, FBS) for 3 days. Detached adherent cells, at passage 4, were characterized as MSCs. Genetic stability was investigated by means of telomerase enzyme activity and karyotype. Hepatocyte differentiation protocol was performed with the use of Dulbecco's modified Eagle's medium, hepatocyte growth factor, basic fibroblast growth factor and nicotinamide (7 days); maturation medium (oncostatin, dexamethasone, insulin, transferrin and selenium) was added at 36 days. Hepatogenesis analyses were performed by use of morphology and albumin, AF, tyrosine-aminotransferase and glutamine synthetase gene expression and quantitative reverse transcription-polymerase chain reaction on days 9, 18, 25 and 36. Functionality was assessed through glycogen storage detection, indocyanine green absorption and transplantation procedure. U-MSCs and DHLCs were injected 48 h after induced fulminant hepatitis (intraperitoneal injection of carbon tetrachloride) in SCID/BALB-c mice. Histopathologic analyses were performed on days 7 and 15. Human origin included albumin and CK19 human markers., Results: All MSCs differentiated into functional hepatocyte-like cells, stored glycogen and absorbed indocyanine green. AT-MSC DHLC gene expression was more consistent with a normal hepatogenic-differentiation profile. UCB-MSCs expanded weakly, impairing their use for the transplantation procedure. AT and BM U-MSCs and DHLCs regenerated liver injury equally. Regenerated hepatocytes exhibited human origin., Conclusions: AT might be the source and U-MSCS the stem cells useful for liver-regenerative therapy., (Copyright © 2015 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.)