Browsing by Author "Mata Ribeiro, L"
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- Comparison of Outcomes in Immediate Implant-Based Breast Reconstruction: Acellular Dermal Matrix versus Inferior Dermal FlapPublication . Mata Ribeiro, L; Meireles, R; Brito, I; Costa, P; Rebelo, M; Barbosa, R; Choupina, M; Pinho, C; Ribeiro, MBackground Implant-based breast reconstruction has evolved tremendously in the last decades, mainly due to the development of new products and techniques that make the procedure safer and more reliable. The purpose of this study was to compare the outcomes in immediate one-stage breast reconstruction between acellular dermal matrix (ADM) and inferior dermal flap (IDF). Methods We conducted a retrospective comparative study of patients submitted to immediate breast reconstructions with an anatomical implant and ADM or IDF in a single center between 2016 and 2018. Outcomes evaluated included major complications, early complications, reinterventions, readmissions, and reconstruction failure. Simple descriptive statistics and univariate analysis were performed. Results A total of 118 breast reconstructions (85 patients) were included in the analysis. Patients in the IDF group had a higher body mass index (median = 27.0) than patients in the ADM group (median = 24). There were no statistically significant differences among both groups regarding immediate major complication, early complications, readmissions, and reinterventions. Conclusion There are no significant differences in complications between the ADM and IDF approach to immediate implant breast reconstruction. In patients with higher body mass index and large, ptotic breasts, we recommend an immediate implant reconstruction with IDF.
- Hidrosadenite Supurativa: Tratamento Combinado com Matriz Dérmica, Enxerto de Pele Parcial e Vacuoterapia, um Caso ClínicoPublication . Mata Ribeiro, L; Silva Guerra, AA hidrosadenite supurativa é uma doença inflamatória crónica com grande impacto a nível físico e psicológico. Apesar de tratamentos conservadores serem utilizados em casos de doença ligeira, nos casos mais graves preconiza-se a excisão alargada da área afetada e posterior reconstrução. O objetivo deste trabalho é descrever o nosso procedimento reconstrutivo em dois passos para o tratamento deste tipo de lesões. Apresentamos o caso clínico de uma doente com hidrosadenite axilar bilateral grave. Num primeiro tempo cirúrgico realizámos a excisão alargada das lesões e cobrimos o defeito com uma matriz de regeneração dérmica sob vacuoterapia. Num segundo tempo cirúrgico realizou-se a cobertura com enxerto de pele parcial sob o qual se aplicou, novamente, vacuoterapia. Os enxertos ficaram completamente integrados. O aspeto estético final é aceitável e não foram observadas limitações funcionais. Não foi detetada nenhuma recorrência (follow-up de nove meses).
- Impact of Body Mass Index, Age and Tobacco Use on the Outcomes of Immediate Breast Reconstruction with Implants and Acellular Dermal MatrixPublication . Mata Ribeiro, L; Meireles, R; Brito, I; Costa, P; Rebelo, M; Barbosa, R; Choupina, M; Pinho, C; Ribeiro, MBackground This study aimed to analyze the effect of body mass index (BMI), age, and tobacco use on alloplastic breast reconstruction. Methods We conducted a retrospective study of patients who submitted to immediate breast reconstructions with an anatomical implant and acellular dermal matrix in a single center between 2016 and 2018. Outcomes evaluated included immediate complications, early complications, reinterventions, readmissions, and reconstruction failure. Patients were divided into two groups concerning each potential risk factor (BMI < or ≥25; age < or ≥ 50 years; and smokers vs nonsmokers). Simple descriptive statistics and univariate analysis were performed. Results A total of 101 breast reconstructions (73 patients) were included in the analysis. The mean BMI was 24, and the mean age was 44.5 years old. Smokers accounted for 14 breast reconstructions (13.9%). The rate of early infections, mastectomy flap necrosis, and implant removal was significantly higher in overweight patients. The total volume of breast drainage was higher in the age ≥ 50 years group. Smoking did not alter the outcomes. Conclusions A BMI ≥ 25 is a risk factor for early infections and reconstructive failure. Age ≥ 50 years is associated with a higher volume of breast drainage but does not seem to impact the success of the reconstruction. Smoking does not appear to affect the outcomes significantly in this type of reconstruction. Surgeons should consider delaying the reconstruction or using autologous tissue when patients are overweight.
- Seasonal Impact in Burn Profiles in a Dedicated Burn UnitPublication . Mata Ribeiro, L; Vieira, L; Sousa, J; Silva Guerra, AIntroduction: The number of burns in Portugal remains considerably large and therefore constitutes a major public health problem. There is a shortage of studies describing the epidemiological and clinical impact of seasonality on burn centre admissions, particularly in high income countries. Methods: This retrospective analysis included all patients (>18 years old) with acute burns admitted to a specialized Burn Center in Lisbon (Hospital São José) between 20 of September 2010 and 19 of September 2017 (7 years). Clinical data was obtained from electronic medical records. The patients were categorized into four groups, according to each season. Results: Six hundred and sixteen (616) patients were included in this analysis, the majority being male (55.2%). There were no significant differences between the number of patients admitted in each season nor in gender distribution. Older patients were admitted during winter. Hospitalisation time was higher for patients admitted in the winter and surface area injured was higher for those admitted during summer. Fire burns were the most common aetiology in all seasons. Work related burns and suicide attempts were more frequent in the summer. Most patients had more than one anatomical area affected (73.9%) and winter was specifically associated with more frequent isolated lower limb burns. Winter and fire burns were associated with deeper injuries. More patients underwent surgery during winter (80.7%) than in the remaining seasons (average 65%) but the average number of surgeries per season did not change significantly. The overall mortality rate was 6.8% and the need for mechanical ventilation was 28.9%. Concerning both variables we did not find major differences across seasons. Mortality was associated with older patients, deeper and more extensive burns and need for mechanical ventilation. Conclusion: Winter seems to be associated with older patients and with the most severe burns (deeper and more often needing surgery). This study was designed to fill the gap in seasonal burn profile in Portugal and it helps in establishing preventive strategies and better resource allocation.
- Ulnar Head Arthroplasty with Posterior Interosseous Nerve Neurectomy: A Case ReportPublication . Mata Ribeiro, L; Botton, MBACKGROUND: Distal Radioulnar joint (DRUJ) arthropathy can occur as a consequence of multiple mechanisms, including trauma, inflammatory or degenerative arthritis or even congenital anomalies. Ulnar head arthroplasty has been proposed as a viable therapeutic option, potentially restoring wrist function and improving pain control. This can also be achieved by complete wrist neurectomy but it has several risks associated with the procedure. A selective neurectomy may be more effective. CASE PRESENTATION: We report the case of a 51-year-old man, Tool-Colector, who suffered from constant diffuse left wrist pain aggravated with activities and had a swollen and tender wrist at physical examination with limited range of motion on prono-supination. Radiographic and magnetic resonance imaging showed degenerative changes in the radiocarpal joint and distal radioulnar joint. In order to preserve the remaining mobility and reduce the wrist pain we proceeded with an ulnar head arthroplasty and a posterior interosseous nerve neurectomy, through a single skin incision in the dorso-ulnar side of the wrist. Afterwards, the patient followed a strict rehabilitation program with a hand therapist. Six months later he returned to his previous job with no limitations. CONCLUSIONS: Ulnar head arthroplasty seems to be a very good option in the treatment of severe DRUJ arthrosis. It significantly improves pain control while maintains or even improves range of motion. Posterior interosseous nerve neurectomy is a simple technique and highly effective.