INTRODUCTION:Tissue expanders have been of great value in plastic surgery. Tissue expansion was developed for a specific indication; however, within a very short time, the concept of tissue expansion found wide applicability. From 1990 to 1999, 315 expanders in 164 patients were utilized. A retrospective analysis of complications and prognostic factors for complications were done. METHODS:The indications for tissue expansion were burns (50%), trauma (32%), and sequelae of previous surgery (8.8%). The expanders were inserted most frequently in the scalp, trunk and neck.RESULTS: There were 22.2% of complications and the most common were expander exposure (50%), infection (24%) and bad function of the expander (12.8%). The present study revealed an increased rate of minor complications in the group of 0 to 10 years of age and an increased rate of major complications for face and neck expansions compared to trunk expansion. There were no increased complication rates for the other age and anatomic site groups, previous expansion, concomitant expansion and type of expander used. CONCLUSIONS:The outcomes from tissue expansion procedures done in our hospital are similar to those reported in the literature. Tissue expansion is a good and safe technique.

This flap is an alternative to myocutaneous flaps, as it preserves local musculature without functional sequelae in patients who walk. It also preserves the local musculature in the event of recurrence, as is usually seen in paralytic patients with pressure sores.

O s ferimentos descolantes nos membros inferiores caracterizam-se frequentemente como lesões graves, e apresentam dificuldades de decisão sobre qual seria o tratamento mais adequado a ser instituído 1 . Observamos, atualmente, um aumento da incidência de ferimentos descolantes. As lesões são secundá-rias à preensão da extremidade entre uma superfície mó-vel e uma superfície fixa como nos casos de atropelamentos. Há, frequentemente, alta energia envolvida, envolvimento de veículos pesados e alta velocidade associada à pouca proteção (motociclistas) 2 . A pele e o subcutâneo desenluvados ficam presos apenas pela extremidade proximal ou distal do membro. Se não houver avaliação adequada e conduta correta, pode ocorrer insuficiência circulatória seja venosa ou arterial e evolução com necrose do tecido descolado 3 . A circulação da porção avulsionada deve ser avaliada através de parâmetros clínicos, como o sangramento das bordas, a textura da pele e presença de trombose no plexo venoso subdérmico. Pode-se ainda utilizar a fluoresceína para corar a parte viável do tecido, permitindo assim a identificação da porção a ser ressecada do retalho 3 . A limpezada ferida e o simples reposicionamento e sutura do retalho à posição original resultam geralmente na necrose do tecido avulsionado, levando à perda do retalho, maior risco de infecção, aumento da morbidade, necessidade de novas áreas doadoras, aumento do núme-ro de procedimentos cirúrgicos e prolongamento da internação. Segundo a literatura, a conduta mais apropriada consiste em completar a ressecção do tecido descolado, emagrecer este tecido, retirar a gordura deste tecido, deixando somente a pele com espessura total ou parcial e realizar a re-enxertia desta pele assim preparada como enxerto em malha, sobre o leito cruento, no mesmo ato cirúrgico [1][2][3][4][5] . Estas considerações são encontradas na literatura especializada de maneira esparsa, mas ainda não é usual

The plastic surgeon played an important role in the treatment of complex wounds by adopting early surgical treatment, contributing to the effective resolution of cases.

MC. Study of warm ischemia followed by reperfusion on a lower limb model in rats: effect of allopurinol and streptokinase. Clinics. 2005;60(3):213-20. Prolonged tissue ischemia leads to changes in microcirculation and production of oxygen free radicals. The event eventually responsible for tissue death is the no-reflow phenomenon and its management is a challenge for the surgeon dealing with replantation or transplantation. We introduce a model of warm ischemia and reperfusion of the lower limb of rats with which we studied the effect of allopurinol and streptokinase. METHOD: Section of the lower limb with preservation of vessels and nerves was performed in 110 rats. Femoral vessels clamped for periods of 0, 2, 4, 6, and 8 hours of ischemia were allowed to reperfuse (groups M0, M2, M4, M6, and M8 respectively). Other groups, E1, E2, and E3, received streptokinase, allopurinol, or a combination of the two drugs after 6 hours of ischemia. RESULTS: Viability rates of the ischemic limbs after 7 days were 100% (M0), 80% (M2), 63.6% (M4), 50% (M6), and 20% (M8). In the experimental groups, E1, E2, and E3, viability rates were 67% (E1), 70% (E2), and 70% (E3). Groups M0, M2, M4, M6, and M8 differed among themselves except for groups M4 and M6. Group E1 had a higher rate of limb viability than M6 (control group) but not than M4. Groups E1, E2 and E3 had higher rates of limb viability than M6 but not than M2 or M4. DISCUSSION: The results suggest that increased viability of limbs after 6 hours of ischemia occurs when allopurinol or streptokinase is used. The combination of the two drugs does not appear to produce any additional effect.

The areas of necrosis observed in the degloved flaps of the rats' hind limbs were smaller in the pentoxifylline and allopurinol groups. Although allopurinol seems to be more efficient, the difference was not significant.

Background:We consider the use of dermal matrix associated with a skin graft to cover deep wounds in the extremities when tendon and bone are exposed. The objective of this article was to evaluate the efficacy of covering acute deep wounds through the use of a dermal regeneration template (Integra) associated with vacuum therapy and subsequent skin grafting.Methods:Twenty patients were evaluated prospectively. All of them had acute (up to 3 weeks) deep wounds in the limbs. We consider a deep wound to be that with exposure of bone, tendon, or joint.Results:The average area of integration of the dermal regeneration template was 86.5%. There was complete integration of the skin graft over the dermal matrix in 14 patients (70%), partial integration in 5 patients (25%), and total loss in 1 case (5%). The wound has completely closed in 95% of patients.Conclusions:The use of Integra dermal template associated with negative-pressure therapy and skin grafting showed an adequate rate of resolution of deep wounds with low morbidity.

Objective: To evaluate the factors that influence the survival rate of replantation and revascularization of the thumb and/or fingers. Methods: We included fifty cases treated in our department from May 2012 to October 2013 with total or partial finger amputations, which had blood perfusion deficit and underwent vascular anastomosis. The parameters evaluated were: age, gender, comorbidities, trauma, time and type of ischemia, mechanism, the injured area, number of anastomosed vessels and use of vein grafts. The results were statistically analyzed and type I error value was set at p <0.05 .Results: Fifty four percent of the 50 performed replantation survived. Of 15 revascularizations performed, the survival rate was 93.3%. The only factor that affected the survival of the amputated limb was the necessity of venous anastomosis. Conclusion: We could not establish contraindications or absolute indications for the replantation and revascularization of finger amputations in this study. Level of Evidence III, Retropective Study.