Background Mechanically isolated stromal vascular fraction (tSVF, tissue SVF) is a potent regenerative solution, increasingly used as a therapeutic modality for a variety of pathologies. With recent evidence conclusively favoring mechanical isolation over enzymatic alternatives, the therapeutic share and indications of tSVF are expected to grow even further. Objectives The aim of this study was to provide a systematic review of all studies reporting on the use of tSVF. Methods A systematic search was undertaken of the Embase, PubMed, Web of Science, and Cochrane Central Register of Controlled Trials databases. Outcome measures included clinical indications, such as recipient area, adverse events, clinical results recipient area, method of application, follow-up duration and evaluation methods. Results Of the total of 4505 articles identified, 186 full-texts were screened. Thirty-four studies, reporting on 1443 patients were included. tSVF-based therapy was observed for 10 different pathologies, including aged skin (8 studies), scars (5), wounds (6), osteoarthritis (6), tendinopathy (2), temporomandibular joint disorders (1), androgenic alopecia (1), perianal fistula (3), migraine (1), and vocal fold scarring (1). Across all studies, tSVF-based therapy resulted in favorable clinical results. Overall, 50 (3.43%) minor and one (0.07%) major adverse events were observed, mainly related to the liposuction procedure. Conclusions tSVF offers a safe, easy and legal treatment modality for a range of indications. Future research is indicated to identify the optimal isolation protocol, dose and timing. In addition, basic research remains crucial to identify the mechanism of action of SVF within different pathologies. Level of Evidence: 4

Background The Hospital das Clínicas-University of Sao Paulo Medical School (HCFMUSP) is the largest university hospital complex in Brazil. HCFMUSP has been converted into a reference center for coronavirus disease 2019. The Division of Plastic Surgery postponed non-essential surgeries and outpatient consultations, accomplishing new guidelines (ANG) of national and international organizations. Even with these challenges arising from the pandemic, alternatives were considered to maintain institutional characteristics. This study aims to analyze this new scenario and the impact on patients' assistance and Plastic Surgery residents training. Methods Total number of surgeries, type of procedures, and outpatient consultations in 2020, before (pre-ANG) and after (post-ANG) ANG, were compared with the same period in 2019 (2019-pre and 2020-post). Results A marked reduction in the total number of surgeries and outpatient consultations was observed in the post-ANG period. In the post-ANG period, 267 operations were performed (26.7 ± 20.3/week), while in the 2019-post period, 1036 surgeries were performed (103.6 ± 9.7/week) (p = 0.0002). Similarly, 1571 consultations were conducted in the post-ANG period (157.1 ± 93.6/ week), while in the 2019-post period, 3907 were performed (390.7 ± 43.1/week) (p = 0.0003). However, in the post-ANG period, an increase in the proportion of reconstructive compared with aesthetic surgery was observed. The maintenance of highly complex procedures such as microsurgical transplants was also identified. Conclusions The predominant profile of reconstructive surgeries at the Division of Plastic Surgery allowed the continuity of procedures at all technical complexity levels, patient care maintenance, and Plastic Surgery residents training.

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.

Purpose: To verify the copaiba balsam (Copaifera officinalis) effect on Walker 256 carcinoma inoculated into vagina and uterine cervix of rats. Methods: Eighteen female Wistar rats weighing between 180-250g were used, distributed into 2 groups (GCop, GC). On the 1st day of the experiment, 0.3 ml of Walker 256 carcinoma (2x10 6 concentration) was inoculated in both groups; on the 3rd day of the experiment, it was given 4.8 ml/kg of distilled water to the GC group, and 4.8 ml/kg of copaiba balsam to the GCop group. On the 12th day, euthanasia was performed and the tumor was grafted, being weighted and verified its volume. The data were submitted to statistical analysis with ANOVA test. Results: It was observed that copaiba balsam presented a negative inhibitory potential of 70%. Conclusion:The copaiba balsam stimulated the tumor growth. Key words: Plants, Medicinal. Carcinoma 256, Walker. Uterine Cervical Neoplasms. Rats. RESUMOObjetivo: Verificar o efeito do óleo de copaíba da espécie Copaifera officinalis no carcinoma de Walker 256 inoculado em vagina e colo de útero de ratas. Métodos: Foram utilizadas 18 ratas da linhagem Wistar, pesando entre 180-250g, distribuídas em dois grupos (CCop, GC). No 1º dia de experimento, em ambos os grupos foi inoculado 0,3ml de tumor de Walker 256 na concentração de 2x10 6 ; no 3º dia após essa inoculação, foi iniciada a administração de água destilada na dose de 4,8 ml/kg ao GC, e copaíba na dose de 4,8 ml/kg ao GCop. No 12° dia foi realizada a eutanásia das ratas e ressecado o tumor, sendo este pesado e averiguado seu volume. Os dados obtidos foram submetidos à análise estatística pelo método ANOVA. Resultados: Observou-se que o óleo de copaíba apresentou um potencial inibitório negativo de 70%. Conclusão: O óleo de copaíba estimulou o crescimento tumoral. Descritores: Plantas Medicinais. Carcinoma 256 de Walker. Neoplasias do Colo do Útero. Ratos.

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PURPOSE:To investigate the immunohistochemistry of the uterine cervix of 20 Wistar rats (Rattus norvegicus) bearing the Walker 256 tumor, treated with copaiba oil (Copaifera officinalis). METHODS:The animals were grouped into four subgroups, with five rats each: the GCT and GCopT received distilled water and topically copaiba, respectively, while the GCG and GCopG received distilled water and copaiba by gavage, respectively. The substances were administered for nine days. On the 12 th day, after euthanasia, the tumor pieces were sent to the identification of T CD4 + , T CD8 + and Natural Killer cells. RESULTS: It was found that the pattern of expression for specific markers of phenotypes of cells involved in tumor immune responsewas similar in all groups, regardless the administration way of copaiba oil (topical or gavage). CONCLUSION:Copaiba balsam, administered either topically or by gavage, did not alter the pattern of tumor immune response in rats bearing Walker 256 Tumor.

Purpose: Verify the effect of oophorectomy on the evolution of the Walker 256 tumor inoculated into the vagina and cervix of female rats. Methods: Ten Wistar, female rats were used, distributed into two groups with 05 animals each: Tumor group (TG): Rats inoculated with Walker 256 tumor; Oophorectomy group (OG): oophorectomized rats inoculated with Walker 256 tumor. The day before the tumor vaginal inoculation, acetic acid was inoculated into the vaginas of both groups of rats; the following day, the vaginal walls were scarified with an endocervix brush, and then Walker 256 tumor was inoculated. After 12 days, the tumor was removed together with the vagina and uterine horns for macro and microscopic analyses. The data were submitted to statistical analyses. Results: There was no statistical difference between the two groups; however it was observed that the behavior of tumor growth on the OG group presented greater invasion, compromising the uterine horns. Conclusion: The results of the study on the GO group presented a macroscopic behavior different from the TG group, however, both of them presented similar development in terms of tumor mass. Keywords: Ovariectomy. Cervix Uteri. Vagina. Carcinoma 256, Walker. Rats. RESUMOObjetivo: Verificar o efeito da ooforectomia à inoculação do tumor de Walker 256 em vagina e colo de útero de ratas. Métodos: Foram utilizadas 10 ratas Wistar, fêmeas, virgens, adultas, distribuídas em dois grupos de estudo com 05 animais cada: grupo tumor (GT): ratas inoculadas com tumor de Walker 256, e grupo Ooforectomia (GO): ratas ooforectomizadas e inoculadas com tumor de Walker 256. No dia anterior à inoculação vaginal do tumor, foram inoculados 0,3ml de ácido acético na vagina das ratas de ambos os grupos; no dia seguinte, foi realizada a escarificação da parede vaginal com uma escova de endocérvice e inoculado tumor de Walker 256. Após 12 dias, foi removido o tumor em bloco com vagina e cornos uterinos para análise macro e microscópica. Os dados foram submetidos à análise estatística. Resultados: Não houve diferença estatística entre os dois grupos; no entanto, notou-se que o comportamento de crescimento do tumor no grupo GO apresentou maior invasividade em extensão, comprometendo cornos uterinos. Conclusão: Observou-se que o grupo GO apresentou comportamento macroscópico diferente ao grupo GT, no entanto, em termos totais de massa tumoral ambos apresentam desenvolvimento similar. Descritores: Ovariectomia. Colo do Útero. Vagina. Carcinoma 256 Walker. Rats.

Highlights Massive penoscrotal lymphedema is an aggressive type of lymphedema with great functional impairment for the patient. The treatment of this type of lesion is eminently surgical, requiring ablative surgery. Our technique consists of a posterior scrotal flap and a split-thickness skin graft for penis’ body reconstruction. The key maneuver to avoid retraction of the penis is Z-plasty in the topography of the median raphe.