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Papers by ivan maluf

Research paper thumbnail of Evaluation of Maxillary Growth

The Journal of craniofacial surgery (Print), 2014

Scar retraction due to exposed bone in palatoplasty is the leading cause of constricted maxilla. ... more Scar retraction due to exposed bone in palatoplasty is the leading cause of constricted maxilla. Modern techniques have focused on minimizing the effects of scarring by reducing the exposure of the bone area. The objective of the study was to compare the palatal mucoperiosteal detachment with minimal lateral incision, followed by their synthesis, with the maintenance of lateral areas for relaxation (similar to the von Langenbeck technique) and evaluate the transversal development of the maxilla. A prospective, randomized study was conducted, in which the molding of the dental arch of 14 pigs in 2 stages (at 1 month and 5 months) was performed. The pigs were divided into 3 groups: group 1 underwent lateral incision of the palate for mucoperiosteal detachment and maintenance of bone exposure; group 2 underwent mucoperiosteal palatal detachment with lateral access and no bone exposure; and group 3, the control animals, did not undergo any surgical procedures. Measurements of the dental arches were compared between the groups to assess differences in the development of the maxillary transverse diameter. There were no animals lost during the study. Group 1 showed greater growth restriction of the transverse diameter of the maxilla (36%) when compared with groups 2 (56%) and 3 (59%). Groups 2 and 3 showed similar transverse maxillary development, with no statistical difference. The technique of mucoperiosteal detachment without lateral relief incision has the advantage of reducing future morbidity of a constricted maxilla. This study demonstrated that the technique described can reduce rates of maxillary underdevelopment, a significant complication inherent in the procedure for palatoplasty. The lateral incisions reduce maxillary growth by approximately 20% as compared with this technique. Level II of evidence.

Research paper thumbnail of Submitted to SGP (Sistema de

Modified zigzag periareolar incision: alternative technique for augmentation mammaplasty Modified... more Modified zigzag periareolar incision: alternative technique for augmentation mammaplasty Modified zigzag periareolar incision: alternative technique for augmentation mammaplasty Incisão periareolar em zigue-zague modificada: técnica alternativa para mastoplastia de aumento This study was performed at the Hospital de Clínicas da Universidade Federal do Paraná

Research paper thumbnail of (Revista Brasileira de Cirurgia

Romberg’s syndrome: a series of cases Romberg’s syndrome: a series of cases Síndrome de Romberg: ... more Romberg’s syndrome: a series of cases Romberg’s syndrome: a series of cases Síndrome de Romberg: uma série de casos This study was performed at the Hospital de Clínicas da

Research paper thumbnail of Modelo experimental alternativo para treinamento em Modelo experimental alternativo para treinamento em Modelo experimental alternativo para treinamento em Modelo experimental alternativo para treinamento em Modelo experimental alternativo para treinamento em microcirurgia

Objective: To describe a new model of training in microsurgery with pig spleen after splenectomy ... more Objective: To describe a new model of training in microsurgery with pig spleen after splenectomy performed by undergraduatestudents of the Discipline of Operative Technique of the UFPR Medical School. Methods: After the completion of splenectomy weperformed dissection of the vascular pedicle, distal and proximal to the ligation performed for removal of the spleen. After completedissection of the splenic artery and vein with microscope, clamps were placed and the vessels were cut. We then made theanastomosis of the vessels with 9.0 nylon. Result: the microsurgical training with a well-defined routine, qualified supervision andusing low cost experimental materials proved to be effective in the practice of initial microvascular surgery. Conclusion: The use ofpig spleen, which would be discarded after splenectomy, is an excellent model for microsurgical training, since besides having theconsistency and sensitivity of a real model, it saves the sacrifice of a new animal model in the init...

Research paper thumbnail of Síndrome de Proteus: relato de casos

DOI: 10.5935/2177-1235.2015RBCP0150 Institution: Disciplina de Cirurgia Plastica da Universidade ... more DOI: 10.5935/2177-1235.2015RBCP0150 Institution: Disciplina de Cirurgia Plastica da Universidade Federal do Parana, Curitiba, PR, Brazil. Introduction: Proteus syndrome is a complex and rare disorder classified as a hamartomatous disease. It was first described in two patients in 1979, by Cohen and Hayden. Proteus syndrome is difficult to diagnose, and is often confused with KlippelTrenaunay-Weber syndrome, neurofibromatosis, or SturgeWeber syndrome. In this study we describe two patients who were treated at the Plastic and Reconstructive Surgery Service of the Federal University of Parana. Method: A 6-year-old male patient (case 1) presented to the Service with lipomatosis and asymmetry, as the primary findings. A 20-year-old (case 2) was admitted to the Service with a diagnosis of KlippelTrenaunay-Weber syndrome, which later was shown to be Proteus syndrome. Conclusion: The etiological hypothesis that is most accepted for this disease is genetic. It is believed that somatic mosaic...

Research paper thumbnail of Proteus Syndrome : case reports Case Report Síndrome de Proteus : relato de casos

DOI: 10.5935/2177-1235.2015RBCP0150 Institution: Disciplina de Cirurgia Plástica da Universidade ... more DOI: 10.5935/2177-1235.2015RBCP0150 Institution: Disciplina de Cirurgia Plástica da Universidade Federal do Paraná, Curitiba, PR, Brazil. Introduction: Proteus syndrome is a complex and rare disorder classified as a hamartomatous disease. It was first described in two patients in 1979, by Cohen and Hayden. Proteus syndrome is difficult to diagnose, and is often confused with KlippelTrenaunay-Weber syndrome, neurofibromatosis, or SturgeWeber syndrome. In this study we describe two patients who were treated at the Plastic and Reconstructive Surgery Service of the Federal University of Paraná. Method: A 6-year-old male patient (case 1) presented to the Service with lipomatosis and asymmetry, as the primary findings. A 20-year-old (case 2) was admitted to the Service with a diagnosis of KlippelTrenaunay-Weber syndrome, which later was shown to be Proteus syndrome. Conclusion: The etiological hypothesis that is most accepted for this disease is genetic. It is believed that somatic mosaic...

Research paper thumbnail of Galactorreia: como abordar essa complicação incomum após mamoplastia de aumento

Research paper thumbnail of Subfascial versus Subglandular Breast Augmentation: A Randomized Prospective Evaluation Considering a 5-Year Follow-Up

Plastic & Reconstructive Surgery

Background: Subfascial breast augmentation is becoming popular because of a better understanding ... more Background: Subfascial breast augmentation is becoming popular because of a better understanding of breast anatomy. However, because the subglandular approach is also another popular method, it is critical to assess the influence of the superficial fascia of the pectoralis major muscle on the subfascial and subglandular pockets to determine if one method is superior to another. This study investigated whether there are clinical/radiological differences between subfascial and subglandular pockets following primary breast augmentation. Methods: Twenty patients were recruited, and each was randomly sorted to the subfascial and/or subglandular pocket per breast. Both patients and surgeons were blinded. Differences were evaluated through five independent surgeons and by magnetic resonance imaging scans. Subsequently, 1-year and 5-year follow-ups were conducted. Results: The results of the 5-year follow-up considering the aesthetics of the breast contour were significantly different between groups, with more good and excellent evaluations in the subfascial group. Regarding breast shape, there were also statistical differences, also with more good and excellent evaluations in the subfascial group. For breast consistency, subglandular had 84.20 percent of patients classified into Baker I and II, whereas subfascial had 100 percent. Magnetic resonance imaging scans showed a smaller implant base in the subglandular pockets, which was a significant result. There were no significant differences in implant projection. Comparison of the number of folds revealed significant differences between groups, with more folds in the subglandular group. Conclusion: Statistical differences between methods were found regarding breast shape and contour, capsular contracture, implant base, and the number of folds, showing that subfascial breast augmentation is superior to subglandular breast augmentation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Research paper thumbnail of Galactorrhea: how to address this unusual complication after augmentation mammoplasty

Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery

Galactorreia: como abordar essa complicação incomum após mamoplastia de aumento Introduction: Gal... more Galactorreia: como abordar essa complicação incomum após mamoplastia de aumento Introduction: Galactorrhea and galactocele formation after breast augmentation are complications reported in the literature, but the cause remains unknown. Methods: We present a case of a 28-year-old patient who underwent breast augmentation surgery via the inframammary fold with an implant placed in the subfascial plane, which developed galactorrhea from the incision on the seventh postoperative day, and we propose an algorithm for the diagnosis and treatment of galactorrhea after mammoplasties. Results: The complication was treated with the use of a lactation suppressor, cabergoline, presenting good outcomes. Conclusion: Galactorrhea is an uncommon complication after augmentation mammoplasties, which should always be considered in cases of secretions from an incision because it is a differential diagnosis for infections.

Research paper thumbnail of Galactorrhea: how to address this unusual complication after augmentation mammoplasty

Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery, 2016

Galactorreia: como abordar essa complicação incomum após mamoplastia de aumento Introduction: Gal... more Galactorreia: como abordar essa complicação incomum após mamoplastia de aumento Introduction: Galactorrhea and galactocele formation after breast augmentation are complications reported in the literature, but the cause remains unknown. Methods: We present a case of a 28-year-old patient who underwent breast augmentation surgery via the inframammary fold with an implant placed in the subfascial plane, which developed galactorrhea from the incision on the seventh postoperative day, and we propose an algorithm for the diagnosis and treatment of galactorrhea after mammoplasties. Results: The complication was treated with the use of a lactation suppressor, cabergoline, presenting good outcomes. Conclusion: Galactorrhea is an uncommon complication after augmentation mammoplasties, which should always be considered in cases of secretions from an incision because it is a differential diagnosis for infections.

Research paper thumbnail of Is There a Breast Augmentation Outcome Difference Between Subfascial and Subglandular Implant Placement? A Prospective Randomized Double-Blinded Study

Aesthetic Plastic Surgery

Subfascial breast augmentation is gaining popularity because of no distortion when the pectoral m... more Subfascial breast augmentation is gaining popularity because of no distortion when the pectoral muscle is contracted and minimizing visualization of the edges of the implant. Although some studies have reported a satisfactory outcome with subfascial technique, it still is controversial the influence of the pectoral fascia and outcome compared to the subglandular technique. Therefore, this prospective randomized study aimed to investigate whether there are clinical/radiological differences between subfascial and subglandular pockets following primary breast augmentation. Twenty patient candidates for primary breast augmentation were recruited. Each patient was selected for subfascial or subglandular pockets in a randomized fashion. Both patient and surgeon were blinded. Clinical and radiological differences were evaluated through five independent surgeons and MRI (capsule, folds, fluids, base and projection). Median follow-up was 12 months. Breast consistency (p = 0.24), implant pocket (p = 0.52), symmetry (p = 1), contour, and shape (p = 0.09) demonstrated no statistically significant difference after the surgeons’ assessments at 3 and 12 months after surgery. MRIs demonstrated a larger implant base in the subfascial group (p = 0.024). No differences were observed in capsule thickness (p = 0.42), folds (p = 0.51), fluids (p = 0.28), or projection (0.20). The choice between subfascial and subglandular planes shows no clinical differences and can be selected according to individual professional experience, not evidencing any advantages of one over the other. 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.

Research paper thumbnail of Prophylaxis of fat embolism syndrome: a current analysis

Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery, 2016

Introduction: To analyze data from the internet on deaths from fat embolism, time of onset, and o... more Introduction: To analyze data from the internet on deaths from fat embolism, time of onset, and other information that could determine current reality in Brazil regarding fat embolism syndrome incidence and any ,media repercussions, and also to review methods of prevention and what are the best methods available to treat this disease. Methods: A Google search was conducted from January 2000 to January 2014 using the keywords "plastic surgery" and "death." We included and reviewed articles containing the words "embolism", "fat embolism" and "complications in (or of) plastic surgery". Results: We included 235 relevant news stories over the 14 included years. There were 45 cases of death related with plastic surgery that offered few data for individualization. Of these patients, 44 were women. Possible causes mentioned were pulmonary embolism (five cases), perforation of viscera (four cases), malignant hyperthermia (three cases), anesthesia (two cases), anaphylactic shock (two cases), fat embolism (one confirmed case), and "other" (five cases). Conclusion: Guidelines to prevent fat embolism in plastic surgery are needed, however, there is also the need of more evidence based studies to understand more clearly what methods are best.

Research paper thumbnail of Tumor sólido pseudopapilar do pâncreas

Revista Brasileira de Medicina de Família e Comunidade, 2008

O tumor sólido pseudopapilar de pâncreas é uma neoplasia rara, que acomete usualmente mulheres jo... more O tumor sólido pseudopapilar de pâncreas é uma neoplasia rara, que acomete usualmente mulheres jovens na segunda ou terceira década de vida. Foi descrito pela primeira vez em 1959. É considerada uma doença com baixo potencial de malignidade e é encontrado na maioria dos casos em adolescentes do sexo feminino, sugerindo a associação de fatores hormonais em sua patogênese. Metástases são raras e a ressecção completa do tumor é geralmente curativa. O caso descrito é sobre uma paciente de 13 anos. Os aspectos clínicos envolvidos neste caso foram atípicos pelo fato do surgimento dos sintomas associados a trauma direto com aumento de volume abdominal. O tumor pode acometer qualquer área do pâncreas, porém, na maioria das séries, acomete, preferencialmente, o corpo e a cauda pancreática. A ressecção do tumor, quando possível, é curativa na maioria dos casos, porém recidivas locais podem ocorrer. A taxa de sobrevida mesmo após metástase hepática é alta pela natureza benigna do tumor. Conclu...

Research paper thumbnail of Doença de Lyme: diagnóstico e tratamento

Revista Brasileira de Medicina de Família e Comunidade, 2007

A doença de Lyme é uma infecção bacteriana sistêmica causada pela espiroqueta Borrelia burgdofer... more A doença de Lyme é uma infecção bacteriana sistêmica causada pela espiroqueta Borrelia burgdoferi e transmitida por carrapatos do gênero Ixodes e Amblyomma. Ela é doença endêmica em áreas de animais silvestres, carrapatos e florestas, sendo pouco relatada no Brasil. É a patologia mais comum transmitida por carrapatos. As manifestações clínicas iniciam-se com aparecimento de eritema migratório no local da picada, seguido de sintomas semelhantes ao da gripe. Com a evolução da doença, pode ocorrer acometimento dos sistemas nervoso central, cardiovascular, ocular e articulações.Odiagnóstico é feito pelas características clínicas, dados epidemiológicos e exames laboratoriais; já o tratamento é realizado com administração de antibióticos conforme o estágio da doença.

Research paper thumbnail of Hepatite A: avaliação do custo-beneficio da prevenção pela vacina - Paraná, Brasil

Revista Brasileira de Medicina de Família e Comunidade, 2009

Objetivos: conhecer a magnitude do problema da Hepatite A no Parana. , Brasil, e avaliar custo-be... more Objetivos: conhecer a magnitude do problema da Hepatite A no Parana. , Brasil, e avaliar custo-beneficio davacinação. Materiais e métodos: o estudo é descritivo e de farmacoeconomia. Para avaliar a magnitude do problema,foram coletados dados sobre os casos de hepatite A do Sistema de Informação de Agravos de Notificação, (SIN AN),Sistema de Informação em Mortalidade (SIM) e Autorização de Internação Hospitalar (A114) da Secretaria de Estado daSaúde do Paraná ao período de 2000 a 2003. Foi estimada a probabilidade de uma coorte de crianças adquirirHepatite A durante a vida e os custos dos tratamentos. Esses gastos foram comparados corn o custo da vacinação.Resultados: foram 14.682 notificações das quais 12.102 (82,4%) ocorreram em menores de 15 anos. A incidência napopulação foi de 37,5/100000. Ocorreram 20 óbitos, sendo sete por insuficiência hepática. O custo com a doença foicomprovaciamente alto. 0 investimento para a vacinação de crianças, com duas doses (10 LTSD/dose), também fo...

Research paper thumbnail of Doença de Lyme: diagnóstico e tratamento

Revista Brasileira De Medicina De Familia E Comunidade, 2007

Research paper thumbnail of Proteus Syndrome: case Reports

Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery, 2015

Research paper thumbnail of Therapeutic options in the management of giant congenital nevus: Experience of the Plastic and Reconstructing Service at Hospital de Clínicas, Federal University of Paraná

Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery, 2015

Introduction: Several modalities are available for the treatment of giant congenital nevus (GCN).... more Introduction: Several modalities are available for the treatment of giant congenital nevus (GCN). The surgical approach includes partial serial resection or total excision. Objective: To demonstrate the main therapeutic modalities in the treatment of GCN and to assess the incidence of location, age, and size of this lesion at the Plastic and Reconstructive Surgery Service of the Hospital de Clínicas, Federal University of Paraná. Methods: This retrospective study included patients who had undergone surgical treatment for GCN between January 2004 and January 2010. We collected data such as age, sex, treatment performed, number of surgeries carried out, evolution, and complications. Results: We evaluated 11 patients (8 female and 3 male). The average age was 12.4 years (range, 3-25 years). The GCN subtype most commonly found was intradermal melanocytic nevus, which accounted for 90.9% of cases, with melanocytic nevus accounting for the remaining 9.1%. No cases of melanoma were identified. The most common location was the head and neck. The average diameter of the lesions was 9.1 cm. The techniques used for the reconstruction included primary suture, local flaps, skin graft, and the use of expanders. In the follow-up period, 63.6% of the patients still presented a residual nevus, 27.3% underwent complete resection, and 9.1% were not monitored. Conclusion: A higher incidence of GCN was observed in patients aged 3-25 years. The most common location was the face, and the average size was 9.1 cm. The main treatment of patients with GCN was splitting resection, which resulted in satisfactory outcomes.

Research paper thumbnail of Fournier gangrene: Reconstruction of the scrotal sac with a fasciocutaneous flap from the internal thigh region

Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery, 2015

Introduction: Fournier gangrene is a rapidly progressing multi-bacterial infection in the perinea... more Introduction: Fournier gangrene is a rapidly progressing multi-bacterial infection in the perineal region. The treatment of this condition includes debridement, broad-spectrum antibiotic therapy, and oxygen therapy in a hyperbaric chamber. Aggressive debridement typically results in the loss of skin coverage of the entire scrotal sac, and the exposure of both testes. During treatment, it is essential to use wellvascularized flaps to ensure the recovery of function. Method: We describe the application of a fasciocutaneous flap-which takes advantage of the rich arterial network of the internal region of the thigh-in the perineal reconstruction method proposed by Ferreira et al. that allows for the treatment of large defects. Conclusion: The flap is quite versatile. Its advantages include its utility in various clinical situations, low risk of gangrene in the donor area, single-stage reconstruction, and adequate flap thickness for reconstruction.

Research paper thumbnail of Gestational gigantomastia: how to address this clinical situation

Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery, 2015

Gestational gigantomastia is a rare disorder characterized by an excessive and rapid enlargement ... more Gestational gigantomastia is a rare disorder characterized by an excessive and rapid enlargement of the breasts, resulting in edema and venous congestion of breast tissue. It is a painful condition that causes skin ulceration and local infection. In some cases, these complications lead to an emergency mastectomy or induced abortion. The most probable etiology is an abnormal stimulation of breast tissue that is probably triggered by an abnormally elevated level of hormones or by the hypersensitivity of breast tissue to normal hormone levels. Although the breast volume decreases after pregnancy, it rarely returns to its original state; therefore, breast reduction through mastectomy or mammaplasty is usually necessary. Moreover, there is a high likelihood of recurrence in subsequent pregnancies. The authors report a case of gigantomastia in a primigravida that required pregnancy termination, because of the risk of maternal death, and a subsequent breast reduction surgery.

Research paper thumbnail of Evaluation of Maxillary Growth

The Journal of craniofacial surgery (Print), 2014

Scar retraction due to exposed bone in palatoplasty is the leading cause of constricted maxilla. ... more Scar retraction due to exposed bone in palatoplasty is the leading cause of constricted maxilla. Modern techniques have focused on minimizing the effects of scarring by reducing the exposure of the bone area. The objective of the study was to compare the palatal mucoperiosteal detachment with minimal lateral incision, followed by their synthesis, with the maintenance of lateral areas for relaxation (similar to the von Langenbeck technique) and evaluate the transversal development of the maxilla. A prospective, randomized study was conducted, in which the molding of the dental arch of 14 pigs in 2 stages (at 1 month and 5 months) was performed. The pigs were divided into 3 groups: group 1 underwent lateral incision of the palate for mucoperiosteal detachment and maintenance of bone exposure; group 2 underwent mucoperiosteal palatal detachment with lateral access and no bone exposure; and group 3, the control animals, did not undergo any surgical procedures. Measurements of the dental arches were compared between the groups to assess differences in the development of the maxillary transverse diameter. There were no animals lost during the study. Group 1 showed greater growth restriction of the transverse diameter of the maxilla (36%) when compared with groups 2 (56%) and 3 (59%). Groups 2 and 3 showed similar transverse maxillary development, with no statistical difference. The technique of mucoperiosteal detachment without lateral relief incision has the advantage of reducing future morbidity of a constricted maxilla. This study demonstrated that the technique described can reduce rates of maxillary underdevelopment, a significant complication inherent in the procedure for palatoplasty. The lateral incisions reduce maxillary growth by approximately 20% as compared with this technique. Level II of evidence.

Research paper thumbnail of Submitted to SGP (Sistema de

Modified zigzag periareolar incision: alternative technique for augmentation mammaplasty Modified... more Modified zigzag periareolar incision: alternative technique for augmentation mammaplasty Modified zigzag periareolar incision: alternative technique for augmentation mammaplasty Incisão periareolar em zigue-zague modificada: técnica alternativa para mastoplastia de aumento This study was performed at the Hospital de Clínicas da Universidade Federal do Paraná

Research paper thumbnail of (Revista Brasileira de Cirurgia

Romberg’s syndrome: a series of cases Romberg’s syndrome: a series of cases Síndrome de Romberg: ... more Romberg’s syndrome: a series of cases Romberg’s syndrome: a series of cases Síndrome de Romberg: uma série de casos This study was performed at the Hospital de Clínicas da

Research paper thumbnail of Modelo experimental alternativo para treinamento em Modelo experimental alternativo para treinamento em Modelo experimental alternativo para treinamento em Modelo experimental alternativo para treinamento em Modelo experimental alternativo para treinamento em microcirurgia

Objective: To describe a new model of training in microsurgery with pig spleen after splenectomy ... more Objective: To describe a new model of training in microsurgery with pig spleen after splenectomy performed by undergraduatestudents of the Discipline of Operative Technique of the UFPR Medical School. Methods: After the completion of splenectomy weperformed dissection of the vascular pedicle, distal and proximal to the ligation performed for removal of the spleen. After completedissection of the splenic artery and vein with microscope, clamps were placed and the vessels were cut. We then made theanastomosis of the vessels with 9.0 nylon. Result: the microsurgical training with a well-defined routine, qualified supervision andusing low cost experimental materials proved to be effective in the practice of initial microvascular surgery. Conclusion: The use ofpig spleen, which would be discarded after splenectomy, is an excellent model for microsurgical training, since besides having theconsistency and sensitivity of a real model, it saves the sacrifice of a new animal model in the init...

Research paper thumbnail of Síndrome de Proteus: relato de casos

DOI: 10.5935/2177-1235.2015RBCP0150 Institution: Disciplina de Cirurgia Plastica da Universidade ... more DOI: 10.5935/2177-1235.2015RBCP0150 Institution: Disciplina de Cirurgia Plastica da Universidade Federal do Parana, Curitiba, PR, Brazil. Introduction: Proteus syndrome is a complex and rare disorder classified as a hamartomatous disease. It was first described in two patients in 1979, by Cohen and Hayden. Proteus syndrome is difficult to diagnose, and is often confused with KlippelTrenaunay-Weber syndrome, neurofibromatosis, or SturgeWeber syndrome. In this study we describe two patients who were treated at the Plastic and Reconstructive Surgery Service of the Federal University of Parana. Method: A 6-year-old male patient (case 1) presented to the Service with lipomatosis and asymmetry, as the primary findings. A 20-year-old (case 2) was admitted to the Service with a diagnosis of KlippelTrenaunay-Weber syndrome, which later was shown to be Proteus syndrome. Conclusion: The etiological hypothesis that is most accepted for this disease is genetic. It is believed that somatic mosaic...

Research paper thumbnail of Proteus Syndrome : case reports Case Report Síndrome de Proteus : relato de casos

DOI: 10.5935/2177-1235.2015RBCP0150 Institution: Disciplina de Cirurgia Plástica da Universidade ... more DOI: 10.5935/2177-1235.2015RBCP0150 Institution: Disciplina de Cirurgia Plástica da Universidade Federal do Paraná, Curitiba, PR, Brazil. Introduction: Proteus syndrome is a complex and rare disorder classified as a hamartomatous disease. It was first described in two patients in 1979, by Cohen and Hayden. Proteus syndrome is difficult to diagnose, and is often confused with KlippelTrenaunay-Weber syndrome, neurofibromatosis, or SturgeWeber syndrome. In this study we describe two patients who were treated at the Plastic and Reconstructive Surgery Service of the Federal University of Paraná. Method: A 6-year-old male patient (case 1) presented to the Service with lipomatosis and asymmetry, as the primary findings. A 20-year-old (case 2) was admitted to the Service with a diagnosis of KlippelTrenaunay-Weber syndrome, which later was shown to be Proteus syndrome. Conclusion: The etiological hypothesis that is most accepted for this disease is genetic. It is believed that somatic mosaic...

Research paper thumbnail of Galactorreia: como abordar essa complicação incomum após mamoplastia de aumento

Research paper thumbnail of Subfascial versus Subglandular Breast Augmentation: A Randomized Prospective Evaluation Considering a 5-Year Follow-Up

Plastic & Reconstructive Surgery

Background: Subfascial breast augmentation is becoming popular because of a better understanding ... more Background: Subfascial breast augmentation is becoming popular because of a better understanding of breast anatomy. However, because the subglandular approach is also another popular method, it is critical to assess the influence of the superficial fascia of the pectoralis major muscle on the subfascial and subglandular pockets to determine if one method is superior to another. This study investigated whether there are clinical/radiological differences between subfascial and subglandular pockets following primary breast augmentation. Methods: Twenty patients were recruited, and each was randomly sorted to the subfascial and/or subglandular pocket per breast. Both patients and surgeons were blinded. Differences were evaluated through five independent surgeons and by magnetic resonance imaging scans. Subsequently, 1-year and 5-year follow-ups were conducted. Results: The results of the 5-year follow-up considering the aesthetics of the breast contour were significantly different between groups, with more good and excellent evaluations in the subfascial group. Regarding breast shape, there were also statistical differences, also with more good and excellent evaluations in the subfascial group. For breast consistency, subglandular had 84.20 percent of patients classified into Baker I and II, whereas subfascial had 100 percent. Magnetic resonance imaging scans showed a smaller implant base in the subglandular pockets, which was a significant result. There were no significant differences in implant projection. Comparison of the number of folds revealed significant differences between groups, with more folds in the subglandular group. Conclusion: Statistical differences between methods were found regarding breast shape and contour, capsular contracture, implant base, and the number of folds, showing that subfascial breast augmentation is superior to subglandular breast augmentation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Research paper thumbnail of Galactorrhea: how to address this unusual complication after augmentation mammoplasty

Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery

Galactorreia: como abordar essa complicação incomum após mamoplastia de aumento Introduction: Gal... more Galactorreia: como abordar essa complicação incomum após mamoplastia de aumento Introduction: Galactorrhea and galactocele formation after breast augmentation are complications reported in the literature, but the cause remains unknown. Methods: We present a case of a 28-year-old patient who underwent breast augmentation surgery via the inframammary fold with an implant placed in the subfascial plane, which developed galactorrhea from the incision on the seventh postoperative day, and we propose an algorithm for the diagnosis and treatment of galactorrhea after mammoplasties. Results: The complication was treated with the use of a lactation suppressor, cabergoline, presenting good outcomes. Conclusion: Galactorrhea is an uncommon complication after augmentation mammoplasties, which should always be considered in cases of secretions from an incision because it is a differential diagnosis for infections.

Research paper thumbnail of Galactorrhea: how to address this unusual complication after augmentation mammoplasty

Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery, 2016

Galactorreia: como abordar essa complicação incomum após mamoplastia de aumento Introduction: Gal... more Galactorreia: como abordar essa complicação incomum após mamoplastia de aumento Introduction: Galactorrhea and galactocele formation after breast augmentation are complications reported in the literature, but the cause remains unknown. Methods: We present a case of a 28-year-old patient who underwent breast augmentation surgery via the inframammary fold with an implant placed in the subfascial plane, which developed galactorrhea from the incision on the seventh postoperative day, and we propose an algorithm for the diagnosis and treatment of galactorrhea after mammoplasties. Results: The complication was treated with the use of a lactation suppressor, cabergoline, presenting good outcomes. Conclusion: Galactorrhea is an uncommon complication after augmentation mammoplasties, which should always be considered in cases of secretions from an incision because it is a differential diagnosis for infections.

Research paper thumbnail of Is There a Breast Augmentation Outcome Difference Between Subfascial and Subglandular Implant Placement? A Prospective Randomized Double-Blinded Study

Aesthetic Plastic Surgery

Subfascial breast augmentation is gaining popularity because of no distortion when the pectoral m... more Subfascial breast augmentation is gaining popularity because of no distortion when the pectoral muscle is contracted and minimizing visualization of the edges of the implant. Although some studies have reported a satisfactory outcome with subfascial technique, it still is controversial the influence of the pectoral fascia and outcome compared to the subglandular technique. Therefore, this prospective randomized study aimed to investigate whether there are clinical/radiological differences between subfascial and subglandular pockets following primary breast augmentation. Twenty patient candidates for primary breast augmentation were recruited. Each patient was selected for subfascial or subglandular pockets in a randomized fashion. Both patient and surgeon were blinded. Clinical and radiological differences were evaluated through five independent surgeons and MRI (capsule, folds, fluids, base and projection). Median follow-up was 12 months. Breast consistency (p = 0.24), implant pocket (p = 0.52), symmetry (p = 1), contour, and shape (p = 0.09) demonstrated no statistically significant difference after the surgeons’ assessments at 3 and 12 months after surgery. MRIs demonstrated a larger implant base in the subfascial group (p = 0.024). No differences were observed in capsule thickness (p = 0.42), folds (p = 0.51), fluids (p = 0.28), or projection (0.20). The choice between subfascial and subglandular planes shows no clinical differences and can be selected according to individual professional experience, not evidencing any advantages of one over the other. 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.

Research paper thumbnail of Prophylaxis of fat embolism syndrome: a current analysis

Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery, 2016

Introduction: To analyze data from the internet on deaths from fat embolism, time of onset, and o... more Introduction: To analyze data from the internet on deaths from fat embolism, time of onset, and other information that could determine current reality in Brazil regarding fat embolism syndrome incidence and any ,media repercussions, and also to review methods of prevention and what are the best methods available to treat this disease. Methods: A Google search was conducted from January 2000 to January 2014 using the keywords "plastic surgery" and "death." We included and reviewed articles containing the words "embolism", "fat embolism" and "complications in (or of) plastic surgery". Results: We included 235 relevant news stories over the 14 included years. There were 45 cases of death related with plastic surgery that offered few data for individualization. Of these patients, 44 were women. Possible causes mentioned were pulmonary embolism (five cases), perforation of viscera (four cases), malignant hyperthermia (three cases), anesthesia (two cases), anaphylactic shock (two cases), fat embolism (one confirmed case), and "other" (five cases). Conclusion: Guidelines to prevent fat embolism in plastic surgery are needed, however, there is also the need of more evidence based studies to understand more clearly what methods are best.

Research paper thumbnail of Tumor sólido pseudopapilar do pâncreas

Revista Brasileira de Medicina de Família e Comunidade, 2008

O tumor sólido pseudopapilar de pâncreas é uma neoplasia rara, que acomete usualmente mulheres jo... more O tumor sólido pseudopapilar de pâncreas é uma neoplasia rara, que acomete usualmente mulheres jovens na segunda ou terceira década de vida. Foi descrito pela primeira vez em 1959. É considerada uma doença com baixo potencial de malignidade e é encontrado na maioria dos casos em adolescentes do sexo feminino, sugerindo a associação de fatores hormonais em sua patogênese. Metástases são raras e a ressecção completa do tumor é geralmente curativa. O caso descrito é sobre uma paciente de 13 anos. Os aspectos clínicos envolvidos neste caso foram atípicos pelo fato do surgimento dos sintomas associados a trauma direto com aumento de volume abdominal. O tumor pode acometer qualquer área do pâncreas, porém, na maioria das séries, acomete, preferencialmente, o corpo e a cauda pancreática. A ressecção do tumor, quando possível, é curativa na maioria dos casos, porém recidivas locais podem ocorrer. A taxa de sobrevida mesmo após metástase hepática é alta pela natureza benigna do tumor. Conclu...

Research paper thumbnail of Doença de Lyme: diagnóstico e tratamento

Revista Brasileira de Medicina de Família e Comunidade, 2007

A doença de Lyme é uma infecção bacteriana sistêmica causada pela espiroqueta Borrelia burgdofer... more A doença de Lyme é uma infecção bacteriana sistêmica causada pela espiroqueta Borrelia burgdoferi e transmitida por carrapatos do gênero Ixodes e Amblyomma. Ela é doença endêmica em áreas de animais silvestres, carrapatos e florestas, sendo pouco relatada no Brasil. É a patologia mais comum transmitida por carrapatos. As manifestações clínicas iniciam-se com aparecimento de eritema migratório no local da picada, seguido de sintomas semelhantes ao da gripe. Com a evolução da doença, pode ocorrer acometimento dos sistemas nervoso central, cardiovascular, ocular e articulações.Odiagnóstico é feito pelas características clínicas, dados epidemiológicos e exames laboratoriais; já o tratamento é realizado com administração de antibióticos conforme o estágio da doença.

Research paper thumbnail of Hepatite A: avaliação do custo-beneficio da prevenção pela vacina - Paraná, Brasil

Revista Brasileira de Medicina de Família e Comunidade, 2009

Objetivos: conhecer a magnitude do problema da Hepatite A no Parana. , Brasil, e avaliar custo-be... more Objetivos: conhecer a magnitude do problema da Hepatite A no Parana. , Brasil, e avaliar custo-beneficio davacinação. Materiais e métodos: o estudo é descritivo e de farmacoeconomia. Para avaliar a magnitude do problema,foram coletados dados sobre os casos de hepatite A do Sistema de Informação de Agravos de Notificação, (SIN AN),Sistema de Informação em Mortalidade (SIM) e Autorização de Internação Hospitalar (A114) da Secretaria de Estado daSaúde do Paraná ao período de 2000 a 2003. Foi estimada a probabilidade de uma coorte de crianças adquirirHepatite A durante a vida e os custos dos tratamentos. Esses gastos foram comparados corn o custo da vacinação.Resultados: foram 14.682 notificações das quais 12.102 (82,4%) ocorreram em menores de 15 anos. A incidência napopulação foi de 37,5/100000. Ocorreram 20 óbitos, sendo sete por insuficiência hepática. O custo com a doença foicomprovaciamente alto. 0 investimento para a vacinação de crianças, com duas doses (10 LTSD/dose), também fo...

Research paper thumbnail of Doença de Lyme: diagnóstico e tratamento

Revista Brasileira De Medicina De Familia E Comunidade, 2007

Research paper thumbnail of Proteus Syndrome: case Reports

Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery, 2015

Research paper thumbnail of Therapeutic options in the management of giant congenital nevus: Experience of the Plastic and Reconstructing Service at Hospital de Clínicas, Federal University of Paraná

Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery, 2015

Introduction: Several modalities are available for the treatment of giant congenital nevus (GCN).... more Introduction: Several modalities are available for the treatment of giant congenital nevus (GCN). The surgical approach includes partial serial resection or total excision. Objective: To demonstrate the main therapeutic modalities in the treatment of GCN and to assess the incidence of location, age, and size of this lesion at the Plastic and Reconstructive Surgery Service of the Hospital de Clínicas, Federal University of Paraná. Methods: This retrospective study included patients who had undergone surgical treatment for GCN between January 2004 and January 2010. We collected data such as age, sex, treatment performed, number of surgeries carried out, evolution, and complications. Results: We evaluated 11 patients (8 female and 3 male). The average age was 12.4 years (range, 3-25 years). The GCN subtype most commonly found was intradermal melanocytic nevus, which accounted for 90.9% of cases, with melanocytic nevus accounting for the remaining 9.1%. No cases of melanoma were identified. The most common location was the head and neck. The average diameter of the lesions was 9.1 cm. The techniques used for the reconstruction included primary suture, local flaps, skin graft, and the use of expanders. In the follow-up period, 63.6% of the patients still presented a residual nevus, 27.3% underwent complete resection, and 9.1% were not monitored. Conclusion: A higher incidence of GCN was observed in patients aged 3-25 years. The most common location was the face, and the average size was 9.1 cm. The main treatment of patients with GCN was splitting resection, which resulted in satisfactory outcomes.

Research paper thumbnail of Fournier gangrene: Reconstruction of the scrotal sac with a fasciocutaneous flap from the internal thigh region

Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery, 2015

Introduction: Fournier gangrene is a rapidly progressing multi-bacterial infection in the perinea... more Introduction: Fournier gangrene is a rapidly progressing multi-bacterial infection in the perineal region. The treatment of this condition includes debridement, broad-spectrum antibiotic therapy, and oxygen therapy in a hyperbaric chamber. Aggressive debridement typically results in the loss of skin coverage of the entire scrotal sac, and the exposure of both testes. During treatment, it is essential to use wellvascularized flaps to ensure the recovery of function. Method: We describe the application of a fasciocutaneous flap-which takes advantage of the rich arterial network of the internal region of the thigh-in the perineal reconstruction method proposed by Ferreira et al. that allows for the treatment of large defects. Conclusion: The flap is quite versatile. Its advantages include its utility in various clinical situations, low risk of gangrene in the donor area, single-stage reconstruction, and adequate flap thickness for reconstruction.

Research paper thumbnail of Gestational gigantomastia: how to address this clinical situation

Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery, 2015

Gestational gigantomastia is a rare disorder characterized by an excessive and rapid enlargement ... more Gestational gigantomastia is a rare disorder characterized by an excessive and rapid enlargement of the breasts, resulting in edema and venous congestion of breast tissue. It is a painful condition that causes skin ulceration and local infection. In some cases, these complications lead to an emergency mastectomy or induced abortion. The most probable etiology is an abnormal stimulation of breast tissue that is probably triggered by an abnormally elevated level of hormones or by the hypersensitivity of breast tissue to normal hormone levels. Although the breast volume decreases after pregnancy, it rarely returns to its original state; therefore, breast reduction through mastectomy or mammaplasty is usually necessary. Moreover, there is a high likelihood of recurrence in subsequent pregnancies. The authors report a case of gigantomastia in a primigravida that required pregnancy termination, because of the risk of maternal death, and a subsequent breast reduction surgery.