Surgical Research and Reviews

  • FACIAL FAT GRAFTING IN RECONSTRUCTIVE MAXILLOFACIAL SURGERY

    Aim: Facial Fat Grafting(FFG) was first described in the early 20th century but for many years remained a relatively underused technique due to the unreliability of long-term volume expansion and retention. FFG was initially used as a technique to improve facial aesthetics. Over the years the technique  has evolved into more complex reconstructive and regenerative procedures and new clinical applications. Methods: In the last two decades the indications of FFG have been extended into cranio-maxillofacial reconstructive surgery. This includes post-traumatic soft tissue defects,  aesthetics,congenital and other postsurgical volume deficits. Results: While several approaches were suggested for fat harvesting and grafting, the results were rather unsatisfactory due to the degeneration of many adipocytes that occurred during these manipulations. The technique of autologous fat transfer has then been perfectioned becoming an augmentation-regenerative process that can be used to treat a wide range of difficult and challenging reconstructive problems. The procedure  described herein has been performed in different patients with various pathology sequelae with sactisfactory morpho-aesthetic results and a low complication rate. Conclusion: FFG can be used in any facial area where is lack,of soft tissue or where there is scarring,producing natural and long-lasting results. Mesenchymal stem cells represent a great tool in regenerative medicine because of their ability to differentiate into a variety of specialized cells. However more definitive studies are still needed in order to answer specific questions regarding the best technique to be used and the role of ADSC’s.Clinical cases with volume paucity or deficiencies are presented with a long-term outcome in augmentation and regeneration.

  • SHORTTERM FOLLOW UP OF EVLA: COMPLICATIONS AND MANAGEMENTS, A SINGLE CENTER EXPERIENCE OF BANGLADESH

    Dodd and Cockett defined varicose veins, saying “a varicose vein is one which has permanently lost its valvular efficiency.” [1] Varicose veins constitute a progressive disease, remission of the disease does not occur, except after pregnancy and delivery. [2] The first documented reference of varicose veins was found as illustrations on Ebers Papyrus dated 1550 B.C. in Athens. [3]Greek philosopher Hippocrates (460-377 B.C.) described the use of compressive bandages and was advisor of small punctures in varicose veins. First patient who underwent operation for his varicose vein appears to be Canus Marius, the Roman tyrant. Giovanni Rima (1777-1843) introduced mid thigh ligation of the saphenous vein. Ligation of the sapheno-femoral junction as it is practiced today was first described by John Homans in his paper in 1916. [2] The Mayo Brothers, postulating that there would be additional benefit in removing the saphenous vein, pursued excision of the GSV through an incision extending from the groin to below the knee. The final technologic leap was introduction of the intraluminal stripper by Babcock. [2] In the era of minimally invasive surgery, the first documented case of Endovenous Laser Ablasion was published in 1999 using 810 nm Diode Laser. Since then several wavelengths were introduced; 810, 940, 980, 1064, 1320, 1470 and newly introduced 1940 nm. [4, 5] It is generally agreed that varicose veins affect from 40 to 60% of women and 15 to 30% men. [6] During the 1930s to 1960s, several large studies reported the prevalence of varicose veins to roughly average 2% in the general population. [7] However, more recently, large population studies such as Edinburgh Vein Study demonstrated an age-adjusted prevalence of truncal varices of 40% in men and 32% in women. [8] Vein ablation is the most modern treatment option for superficial venous disease. Several endovenous modalities…

  • COEXISTENCE OF FIVE TYPES OF INTRACRANIAL HEMORRHAGIC LESIONS AFTER BRAIN INJURY IN A YOUNG ADULT

    Posttraumatic intracranial hemorrhage is an entity frequently encountered in neurosurgical daily practice. These haemorrhagic lesions are classified according to their location as: extradural haematoma, acute subdural haematoma, intraparenchymal haemorrhage, subarachnoid haemorrhage and contusion. A brain scan is the key examination for the diagnosis. The simultaneous presence of these hemorrhagic lesions in a single traumatic brain injury is rare. We are reporting an unusual case of a 24-year-old who suffered from a brain injury due to road traffic accident, and whose brain CT scan showed five types of post-traumatic intracranial lesions. He benefitted from medical treatment and neurological surveillance. The evolution was favorable with a setback of the signs of intracranial hypertension. The follow-up brain CT scan performed one month after the trauma showed a complete resorption of the lesions.

  • INCISIONAL HERNIA IN PREGNANCY A SILENT BUT POTENTIAL FATALITY – CASE REPORT

    Rupture of incisional hernia, with consequent emergency laparotomy and repair, is an uncommon complication of pregnancy. The risk to the mother and baby is enormous. We present an un-booked 29 year old G4P2+1 (1- alive) with one previous caesarean section at 29 weeks of gestation. She had a huge anterior abdominal wall incisional hernia with gravid uterus as content. She was admitted on conservative management on account of abdominal pain and preterm contractions, but subsequently developed spontaneous rupture from an ulcer with bowel evisceration. She had emergency laparotomy and repair but unfortunately had unavoidable bowels injury as they were morbidly adherent to the anterior abdominal wall with injury necessitating resection and re-anastomosis with caesarean section. The neonate suffered early neonatal death. The presence of ulceration may be a predictor of adverse maternal and foetal outcome

  • EXERESIS OF SIALOLYTIASIS ASSOCIATED WITH CHRONIC FIBROSIS IN THE RIGHT SUBMANDIBULAR REGION

    Introduction: Known as inflammation of the salivary glands, sialodenitis can be classified as acute, subacute or chronic. It has obstructive factors as its main causality concomitant with the rare occurrence of sialolithiasis. These, in turn, can have severe consequences such as salivary thickening, ductal ectasia and swelling, associated with pain in the affected region. It has an epidemiologically predilection for men and its diagnosis is made through imaging tests such as ultrasound and panoramic radiography as well as through the digit-palmar evaluation of the professional. Surgical exeresis has been studied as the best approach for these cases, avoiding loss of function or recurrence. Objective: To report the case of a 71-year-old female patient diagnosed by the Oral and Maxillofacial Surgery and Traumatology Service of the Federal University of Pernambuco of School Dentistry with sialolithiasis injury associated with chronic sialodenitis with fibrosis in the submandibular gland. Methodology: The methodology of the study was the search for articles on the subject, organization in a brief literature review and its comparison with the case report that was described. Results: The patient attended the service because she complained of increased volume in the right submandibular region and during anamnesis presented pain on palpation and presence of purulent secretion in the oral cavity. After analysis of the imaging exam, which resulted in well-defined radiopaque pathology in the right mandibular body region, the patient underwent general anesthesia for lesion excision. Postoperatively, the patient evolved without phlogistic signs and after 1 year showed perfect healing and absent recurrence. Conclusion: It is essential, based on the case presented, the good preparation of the Dentist so that the correct diagnosis and treatment choice corroborate for a better quality of life of patients with lesions that severely compromise their stomatognathic function.

  • A THOROUGHGOING ATTRIBUTE OF SURGICAL WOUND ENRICHMENTS

    Injury to the skin provides a unique challenge, as wound healing is a complex and intricate process. Acute wounds have the potential to move from the acute wound to chronic wounds, requiring the physician to have a thorough understanding of outside interventions to bring these wounds back into the healing cascade. Surgical enrichment/dressings are applications for wounds, burns, and ulcers. They should be regarded as supportive of healing; are desirable but not essential in an emergency. There are currently plenty of dressings available in the market to aid in wound healing. Before choosing a dressing for a specific injury, a physician must assess carefully the needs of the wound to understand which dressing would ensure maximum interest. Basically, there is nothing called best choice, and it is crucial that the merits/demerits of each dressing system be understood. This article has provided a framework to assist in dressing assessment. This article reveals measurement of wound healing and the functions of wound dressings. A variety of dressings and their respective details are detailed. Purpose of the study: Discussion and projection of wound healing by market available surgical supplies. The present review traces the history of dressings from its earliest inception to the current status and also discusses the advantage and limitations of the dressing materials.Findings: There is an overwhelming amount of wound dressings available in the market. Modern world and technology gave rise to various way of wound healing with enrichments. Almost all sorts of enrichments are available in surgical outlets, a few of them are confined to hospital settings. This implies the lack of full understanding of wound care and management. The point of using advanced dressings is to improve upon specific wound characteristics to bring it as close to “ideal” as possible. It is only after properly assessing the wound…

  • Perception and Expression of Emotions: Psychological Intervention With Hospitalized Patients With Diabetis in a Surgical Clinic

    Illness is a non-expected situation that the patient isn’t prepared for, resulting it may cause an instability between mind and body. The diabetes mellitus is a chronic metabolic dysfunction resulted from the deficiency of insulin secretion. This condition decreases life quality, and is one of the main causes of death, kidney failure and lower members’ amputation. As an intervention for this situation of fragility, surgery is constantly indicated, inducing emotions as agony, fear and anxiety, and even triggering fantasies. The anxiety caused by the possibility of a surgical intervention can affect the patient, if these emotions aren’t expressed and acknowledged. Thus, it is important to be aware about the patients’ emotional state, as there is a relation between their reactions, the surgery and the postoperative. Objective: Reflect about the psychological intervention as a place for perceiving and expressing emotions of hospitalized diabetic patients. Methodology: Experiment report taken from hospital psychology experience. Results and Discussion: Psychological intervention in chronic patients’ groups, as the diabetics, is an important resource in face off the difficulties for acknowledge and express the experienced emotions. Using images that shows some of the emotions that are part of the context, like fear, anxiety, anger, hope and gratitude, for example, helps the reflection about how these emotions can be manifested in hospitalization process. This technique permits comprehension under different ways to express emotions, and by the exchange of experiences, it is important to strengthen coping strategies. This intervention enables behavior change, converting the tension in relaxation and anxiety relief. Conclusion: The intervention in groups is an important resource to provide reflection about the experienced emotions, to enable these patients to comprehend that these emotions are part of them and must be recognized and externalized, providing a better understanding of the diagnostic, acceptance and adhesion to the treatment.

  • Paresthesia After Exodontia of 3º Lower Molares: Causes and Treatment

    Introduction: Removal of the 3rd lower molars is nowadays a routine procedure in dentistry, but it is an action that can be damaged in the inferior alveolar (NAI) and lingual nerves, which are in association with the roots of the 3rd molars. Objective: To analyze causes, predisposing factors, symptomatology and treatment of NAI and Lingual paresthesia. Methodology: An integrative review was performed on the MEDLINE, LILACS and SCIELO databases, using the descriptors: Exodontia, Molares, Paresthesia. The inclusion criteria were: articles in Portuguese or English and published between 2013 and 2017. Result and Discussion: There were 637 articles related to the topic, 32 selected and 5 used as theoretical reference. Paresthesia is characterized by sensory loss of the affected nerve, resulting from iatrogenic injury or bacterial infections. The predisposing factors for this lesion range from the patient’s age, tooth root development, operator ability and teeth impaction. Weeks after surgery, the patient may report symptomatology related to NAI paresthesia as loss of lip sensitivity and on the affected side, altered sensitivity to cold, heat, pain, numbness, tingling and “pinching”. There may also be symptoms related to Lingual Nerve paresthesia as a burning sensation in the tongue, changes in taste and constant nibbling on the tongue. The treatment results from the regeneration of the injured nerve fibers. It usually does not require any iatrogenic intervention. However, it is used drugs (Cortisone and Vitamin B1), low intensity laser and microsurgeries for axonal regeneration. Conclusion: The frequency of 3rd molar extraction leads to a higher number of postoperative complications. Therefore, paraesthesia arises from lack of surgical planning, technical inability and incorrect instrumentation. Thus, detailed evaluations of complementary imaging (panoramic radiography and computed tomography) are of paramount importance, as well as prophylactic measures such as correct diagnosis, anatomical and technical knowledge of the professional, and adequate…

  • A Dentist Surgeon Conduct With Diabetic Patients

    Introduction: When treating a diabetic patient, it is important to consider a number of factors, such as the patient’s blood glucose behavior and rate. Objectives: To approach as situations and behaviors of the dental surgeon towards the diabetic and to explain actions that will lead to success without patient care. Methodology: A bibliographic review was done in the virtual libraries SCIELO and PubMed, use the articles: “Diabetes and Dentistry” and “Conduct of diabetics in dentistry”. It was used as inclusion criteria for published articles from 2013 to 2017, in the Portuguese and English languages, which relate diabetes to dentistry and conduct of the dental surgeon. Results and Discussion: The survey resulted in 3,011 articles, 18 of which were separated by presenting a greater relation with the subject, but only five attendants to the inclusion criteria. The most common clinical sign in diabetic patients is hypoglycaemia, causing pallor, cold sweat, drowsiness, headache and others. In case of unconsciousness or dental surgeon, administer ampoule with 10 ml of 25% glucose solution intravenously. Hyperglycemic patients show signs and symptoms characteristic of metabolic ketoacidosis, such as the presence of a hetero-oesthetic should be referred to the doctor. The dentist should suspect undiagnosed cases, ask about polyphagia, polydipsia, polyuria, and weight loss. If so, refer to laboratory tests and doctor. Controlled diabetics may be treated in a similar manner to the non-diabetic patient. Prioritize short appointments early in the morning after a meal. Normal diet is advised in the diet. An antibiotic prophylaxis for certain passages can be made. Oppose the blocking anesthesia, avoiding solutions with vasoconstrictor based on adrenaline, because we promote the breakdown of glycogen into glucose, causing hyperglycemia. Conclusion: The dental surgeon must know the systemic associations of diabetics in order to serve them more safely in all clinical procedures.

  • Nursing Care in Thoracic Drainage

    Introduction:Thoracic drainage aims to remove the collection of air or liquid accumulated in the pleural cavity. Although it is a relatively simple procedure, complications can occur due to little knowledge of respiratory physiology, the implementation technique of the drain, of care in maintaining the drainage system and his withdrawal. The appropriate management of thoracic drainage reduces the morbidity associated with the procedure. Knowing the complications related to the drain, their possible causes and how to prevent them, you can optimize the assistance. Objective: This article aims to discuss the nursing care and your importance since the insertion of the drain until your withdrawal. Methodology: It is an integrative review of literature, developed from published articles in databases Biblioteca Virtual em Saúde (BVS), National Library of Medicine (PUBMED) e SCIELO (Scientific Eletronic Library Online). Results and Discussion: 34 articles were found, in Portuguese and English languages. Of which 17 were available for reading. Of these, after selective reading, 7 relevant articles were selected, because it addressed specifically the theme. All articles addressed in nursing care related to the drain, with few theoretical subsidies and scientific evidence. Most articles highlighted in the elaboration of a protocol through the Systematization of Nursing Assistance (SAE) focused on this type of care. Nursing care involves the preoperative period up to the postoperative period. It includes guiding the patient, assisting the physician in the placement of the drain, performing post-surgical dressings, controlling the material circuit and clinical evaluation. Conclusion: The thorax tube requires some care mostly of nursing staff. In addition to performing routine care, the nursing should be attentive to changes in either the drainage pattern or the drain insertion site, since the nurse is the health professional in greater contact with the patient, being able to detect such alterations earlier.