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Introduction: Cullen’s postoperative gangrene, also called pyoderma gangrenosum (PG) or sterile neutrophilic abscess, was first described in the medical literature by Cullen in 1924. Later Brusting et al., in 1930, described PG in more detail. Objective: To report a rare case of pyoderma gangrenosum (PG) in an extraneous limb that was triggered by blunt trauma to the dorsum of the hand. Discussion: A histopathological exam is not sufficient to diagnose PG, Therefore, a PG diagnosis is based on clinical evidence. The clinical presentation is variable and includes rare bullous, pustular and vegetative forms. Other rare forms of PG occur at sites of pathergy (20-30%), periostomal skin, the dorsum of the hand, the head and neck. PG can also be multisystemic and paraneoplastic. Conclusion: The appearance of sudden-onset PG is rare in the dorsum of the hand. It is important to classify PG’s clinical forms, and to establish associations between PG and underlying pathologies. It is also very important to avoid surgery during early PG. The many drugs used to treat PG, and the multiple patient responses, demonstrate the difficulty of standardizing treatment. Physicians may have to use an empirical approach to select the appropriate drug for each patient.

Introduction: Patients who undergo vertical-banded gastroplasty- Roux-en-Y gastric bypass (VBG-RYGB) have significant weight loss, and abdominoplasty (AP) is an effective corrective surgery for removing excess skin. Methods: A prospective study conducted from January 2011 to December 2016 in a public hospital evaluated patients who underwent AP after VBG-RYGB. The analyzed variables were body mass index (BMI) before VBG-RYGB, BMI before AP, weight loss, weight of the excised abdominal flap, comorbidities, and complications. Results: For this study, 107 patients who underwent AP were included. The patients' mean age was 41 years; BMI before AP, 27.6 ± 3.7 kg/m2; and mean weight loss, 47.7 ± 17.3 kg. The maximum BMI before bariatric surgery was 45.5 ± 7.5 kg/m2, and the difference between the maximum BMI before VBG-RYGB and before corrective surgery was 18.6 ± 9.3 kg/m2. The comorbidities observed before VBG-RYGB were arterial hypertension (11.1%), arthropathy (4.6%), diabetes mellitus (5.6%), and metabolic syndrome (5.6%). Fourteen patients (13.1%) underwent herniorrhaphy during AP. The overall complication rate was 31.5%. Weight before VBGRYGB, BMI before VBG-RYGB, mean weight loss, comorbidities, abdominal flap weight, and BMI of >20 kg/m2 were significantly associated with postoperative complications. Conclusions: VBGRYGB was an effective approach to reduce comorbidities in obese patients. Comorbidities, weight before VBG-RYGB, mean weight loss, amount of tissue removed from the abdomen, and BMI of >20 kg/m2 significantly increased the complication rate in the gastric bypass patients who underwent AP. Furthermore, AP is fundamental for the comprehensive care of obese patients and has optimized the results achieved with VBG-RYGB.

INTRODUCTION: Complex reconstructions of the foot region are planned based on the anatomical subunits affected by the etiological factors of lesions. We have several options for covering defects of the back of the feet, from the simpler ones, such as local graft and local flap at random and locoregional pedicled flaps, to the more complex ones, such as free flaps. Here, we report a case in which an unpublished technique using a retrograde flow medial plantar flap in the reconstruction of dorso-distal structures of the foot was used. Its originality consisted in the passage of the flap of the plant to the back through the first intermetatarsal space. METHODS: The patient was a 20-year-old woman who had a motorcycle accident, wherein she sustained foot trauma with loss of back substance at the first to fifth metatarsal level, with bone and tendon exposure, and retrograde flow medial plantar flap was used, with transposition to the back of the foot. RESULTS: The reconstruction of the distal region of the forefoot and fingers is a challenge. Grafts are not ideal for deep defects and exposure of noble structures. Local flaps are inaccessible for finger defects. Furthermore, the free flaps are well indicated for large defects. The flaps of the medial plantar artery are indicated and consecrated to the forefoot region, and some authors have modified to the dorsum region of the first metatarsal. CONCLUSION: This flap is useful for reconstruction of feet with dorsal lesions through this new technique that is unpublished in the literature, with the originality of the passage of the pedicle from the plant to the back through the first intermetatarsal space.

INTRODUCTION: Reconstructive coverage of foot defects, especially those of the calcaneus region, is a unique technical challenge for the surgeon due to the high degree of specialization of the tissues involved and the relative immobility of the proximal tissues. METHODS: In the present study, we present our experience with the use of the flap based on the medial plantar artery to cover tissue defects in the foot, especially in the region of the calcaneal fat pad. Twelve medial plantar artery flaps constructed from 2001 to 2013 at the As a Norte Regional Hospital, Brasília, DF, were included. RESULTS: Of the 12 patients with the medial plantar artery flaps, 10 were men and 2 were women. The indications were traumatic tissue loss of the plantar fat pad in 10 patients and of the dorsum of the foot in two cases. All flaps were elevated as fasciocutaneous pedicle flaps based on the medial plantar artery. All the flaps healed without major complications, except one case that involved partial loss . The donor area was covered with a partial skin graft and there was one case of partial graft loss. The flap displayed a slightly lower protective sensitivity than the normal side. CONCLUSION: According to the results, the medial plantar flap is a good option for covering traumatic foot defects, especially those affecting the calcaneus. The versatility of the flap allows the coverage of defects of the calcaneus (e.g., the Achilles tendon and plantar fat pad regions), as well as those affecting the dorsum of the foot. The coverage of the plantar fat pad region with skin of similar texture and protective sensitivity confers to the medial plantar flap a large advantage over other flaps for reconstruction of this region.

ABSTRACT Objective: to evaluate the profile of patients submitted to post-bariatric plastic surgery at the North Wing Regional Hospital, Brasília, DF. Methods: we conducted a prospective, descriptive and analytical study of patients submitted to Roux-en-Y gastroplasty, and subsequently to plastic surgery, from January 2011 to December 2016. We assessed body mass index before gastroplasty and after surgery plastic surgery, postoperative complications and comorbidities. Results: we studied 139 patients (130 women and nine men), with a mean age of 41 years, who underwent 233 operations. The mean BMI at the time of plastic surgery was 27.44kg/m2. The mean weight loss was 47.02kg and the mean maximum BMI was 45.17kg/m2. The mean time between bariatric surgery and plastic surgery was 42 months. The most important co-morbidities before plastic surgery were arterial hypertension (11.5%), arthropathy (5.4%), diabetes mellitus (5%) and metabolic syndrome (4.3%) (p

OBJETIVO: Os avanços no tratamento de queimados têm reduzido as taxas de mortalidade e melhorado a qualidade de vida das vítimas de queimaduras. Entretanto, a sepse continua sendo um desafio e umas das principais causas de óbito no queimado. O objetivo deste trabalho é investigar, através de um estudo caso-controle, os fatores de risco da sepse em pacientes queimados. MÉTODO: O estudo caso-controle foi conduzido durante 12 meses, compreendendo os pacientes que foram tratados em regime de internação hospitalar na Unidade de Queimados do Hospital Regional da Asa Norte (HRAN), Brasília-DF. RESULTADOS: Quarenta e nove (19,4%) pacientes tiveram sepse, de um total de 252 queimados internados na Unidade de Queimados durante o periodo do estudo. Eles tiveram um ou no maximo tres episodios de sepse durante a internacao, totalizando 62 episodios. Vinte e seis (53,1%) eram homens e a media de idade foi de 21,9 ± 18,9 anos (variacao de um a 89 anos). A superficie corporal queimada dos pacientes que tiveram sepse variou de sete a 84%, com uma media de 37,7 ± 18,4%, sendo significativamente superior aos controles. As principais bacterias causadoras de sepse foram Staphylococcus aureus (46,5%), Staphylococcus coagulase negativo (20,7%), Acinetobacter baumannii (12,1%) e Enterobacter cloacae (12,1%). Trinta (61,2%) pacientes tiveram seu primeiro episodio de sepse na primeira semana de internacao. Quanto aos fatores de risco para a ocorrencia de sepse, destacam-se os seguintes, conforme seu poder de associacao "odds ratio": o uso de tres ou mais cateteres, a presenca de duas ou mais complicacoes, a superficie corporal queimada > 30%, o agente chama aberta e o sexo feminino. No geral, a taxa de letalidade por sepse foi de 24,5%. CONCLUSÃO: Um melhor conhecimento dos fatores de risco da sepse no paciente queimado permite o tratamento precoce dessa complicação, com antibioticoterapia sistêmica adequada, contribuindo para reduzir a morbidade e a mortalidade desses pacientes.

ABSTRACT Objective: to evaluate the management of lower limbs complex traumatic injuries by analyzing their characteristics, types, conduct and evolution, with emphasis on surgical treatment. Methods: we conducted a prospective study of patients treated by Plastic Surgery at a regional hospital of the Federal District during a one-year period. We collected data through serial evaluations and telephone contact records. Results: we studied 40 patients, with a mean age of 25.6 years, predominantly male (62.5%). The most frequent wounds were of the distal third of the lower limb (37.5%). Bone or tendon exposures occurred in 55% had and there was a 35% rate of exposed lower limb fractures. The treatments employed were skin grafting (57.5%), local fasciocutaneous flap (15%), muscle flap (12.5%), cross-leg fasciocutaneous flap, reverse sural flap (12.5%) and microsurgical flap (2.5%). Short-term evaluation showed that 35 patients had excellent or good results (87.5%), four had a regular result (10%), and one had an unsatisfactory result (2.5%). In the long term, of the 18 patients who answered the questionnaire, ten resumed walking, even with support, in the first three months after surgery (55.6%). Conclusion: young men involved in motorcycle accidents during leisure time represented the profile of patients with lower limb trauma requiring surgical reconstruction; the distal third of the leg was the most affected region. Grafting was the most used technique for reconstruction and postoperative functional evaluation showed that, despite complex lesions, most patients evolved with a favorable healing process and successful functional evolution.

OBJETIVO: Avaliar os dados epidemiológicos e a localização dos traumas de face de pacientes atendidos no Hospital Regional da Asa Norte (HRAN), Brasília, Distrito Federal. MÉTODO: Trata-se de um estudo retrospectivo, realizado no pronto socorro do HRAN-DF, visando avaliar o perfil epidemiológico dos pacientes atendidos pela equipe da Unidade de Cirurgia Plástica vítimas de trauma de face no período de 1 de janeiro a 31 dezembro de 2004. RESULTADOS: O estudo compreendeu 711 pacientes, destacando-se o sexo masculino (72,8%). Quanto à causa, predominou a agressão física, seguida por acidente com veículos/motos. As quedas foram a causa predominante das lesões em crianças, mas verificou-se a participação cada vez maior da agressão física como mecanismo de trauma facial com o aumento da idade. A relação de homem:mulher foi de 3:1. A faixa etária mais atingida foi de 21 a 30 anos, representando 35,3% dos pacientes. As fraturas foram encontradas em 24,9% das lesões faciais. O nariz foi o local mais acometido nas fraturas de face (76,8%). CONCLUSÃO: A violência interpessoal foi a principal causa de trauma de face. A queda da própria altura mostrou-se como importante mecanismo de trauma nos extremos de idade.

ABSTRACT Objectives: to evaluate the epidemiological profile, the surgical treatment and the postoperative results of patients with complex traumatic injuries to the lower limbs. Methods: we conducted a retrospective study of patients with traumatic complex injuries treated by the Plastic Surgery Service of a regional hospital in Brasília. We analyzed clinical-epidemiological data, type of surgical procedure and functional recovery of the limb after six months of treatment. Results: 119 patients were treated, with a mean age of 29 years, predominantly men (76.4%). Motorcycle accident was responsible for most of the injuries, in 37.8% of cases. The most frequent surgical treatment was skin grafting (62.1%), followed by the fasciocutaneous flap (21.9%), muscular flap (12.6%) and microsurgical flap (3.4%). Six months after completion of the surgical treatment, 35.3% of the patients needed crutches to move, characterizing a delay in limb functional recovery that, however, was significantly related to the presence of fractures, external fixation or bone exposure in the preoperative period. Conclusion: the profile of the patient with complex traumatic lower limb injury was a male, motorcycle accident victim, and grafting was the most used treatment. Orthopedic trauma with bone fracture, bone exposure and the presence of external fixator were significantly associated with a higher risk of limb functional impairment, requiring locomotion crutches after six months of treatment.

ABSTRACT Objective: to evaluate the immediate reconstruction of face and scalp after canine bites in children. Methods: we conducted a prospective series of cases treated at the Emergency Unit of the Asa Norte Regional Hospital, Brasília - DF, from January 1999 to December 2014. At the time of patient admission to the emergency, the primary wound closure of the face and scalp bite was performed, regardless of the time or day of the event. The primary treatment of the bites was by means of direct suture, flaps rotation or grafting, depending on the type of wound and surgeon's decision. Results: the study comprised 146 children, with the zygomatic region and scalp being the main sites of head bites. All patients received surgical treatment within the first 24 hours after admission. There were no infectious complications in the cases studied. Conclusion: the findings suggest that the immediate closure of canine bites on the face and scalp in children is safe, even when carried out several hours after injury.

OBJETIVO: Analisar a incidência, características, conduta e taxa de mortalidade de pacientes com autolesão por queimaduras internados no Centro de Queimaduras de Brasília, Distrito Federal, Brasil. MÉTODOS: Os pacientes do estudo consistiram das vítimas de queimaduras consecutivamente internadas na Unidade de Queimados do Hospital Regional da Asa Norte, Brasília, Distrito Federal, Brasil, durante o período de fevereiro de 2008 e fevereiro de 2009. Os dados foram obtidos na admissão e foram registrados prospectivamente durante a internação. Os pacientes foram seguidos até a alta ou o óbito. RESULTADOS: No período do estudo, foram admitidos 15 casos de autolesão por queimaduras na Unidade de Queimados. A média de idade foi 38,0 ± 20,6 anos; 66,7% dos casos de autolesão por queimadura eram mulheres. Na maioria dos casos eram casadas, provedoras do lar, e pobres. O maior motivo foi conflito conjugal. A taxa de mortalidade foi 40%. A área média de superfície corporal queimada foi 38,7 ± 26,1%. O álcool foi usado por 66,7% dos pacientes como causa das queimaduras. A média de duração do tratamento foi 20,1 ± 14,8 dias. Pacientes com autoinjúria por queimadura apresentaram lesões mais extensas, permaneceram mais tempo no hospital e pior prognóstico. CONCLUSÃO: Pacientes com autolesão por queimaduras apresentaram média de idade mais elevada, maior superfície corporal queimada, maior período de internação, mais complicações infecciosas e maior taxa de letalidade do que os pacientes com queimaduras acidentais. Esses pacientes precisam de constante suporte psiquiátrico, o qual pode ser útil na prevenção de futuros episódios de autoagressão.

OBJETIVO: Avaliar a conduta de reconstrução imediata das mordeduras caninas em couro cabeludo. MÉTODO: Foram avaliados prospectivamente 55 pacientes vítimas de mordedura canina na cabeça, atendidos na emergência do Serviço de Cirurgia Plástica, Hospital Regional da Asa Norte (HRAN, Brasília-DF) de janeiro de 1999 a dezembro de 2001. RESULTADOS: Nove (16,4%) dos 55 pacientes apresentavam lesões extensas de couro cabeludo, dos quais sete eram menores de 10 anos. Nesses nove casos, o tratamento mais utilizado foi a sutura direta (77,8%), seguido pelo enxerto do couro cabeludo avulsionado em 22,2% dos casos. Não houve infecção nos casos estudos. CONCLUSÕES: O fechamento primário das lesões em couro cabeludo após mordeduras caninas mostrou-se seguro.

INTRODUCTION: Covering complex lower limb wounds is a major challenge. The medial gastrocnemius muscle flap is usually indicated for reconstruction of loss of substance of the knee and proximal third of the leg. The objective of this study was to evaluate the results using gastrocnemius muscle flaps in lower limb wounds. METHODS: A total of 28 patients with loss of substance in the lower limbs were treated with medial gastrocnemius muscle flaps. Data were obtained from clinical records of patients who underwent surgery from 2003 to 2012. RESULTS: In 28 patients who underwent surgery, the age range was 4 to 57 years, with a mean of 30.6 years. The etiology of the lesions was a motorcycle accident in 16 cases (57.1%), being run over in 8 cases (28.6%), car crash in 2 cases (7.2%), meningococcemia in 1 case (3.6%), and snake bite in 1 case (3.6%). After an average follow-up of 15 months (range: 6 to 26 months), all patients had stable coverage. The mean number of preoperative debridements was 2.4 (range: 1 to 8). In 22 patients, the flaps were made without the release of the muscle origin and in 6 patients the muscle flaps were separated from their origin in the femur. CONCLUSIONS: Transfer of a gastrocnemius muscle flap is a simple and safe procedure in the treatment of lower limb injuries. The application of the medial gastrocnemius muscle flap was demonstrated in different situations, with satisfactory results and easy reproducibility.