Abstract Objectives Prominent ear abnormalities affect 5% of the population. A prospective, double-blind study of patients who underwent otoplasty procedures to correct these abnormalities was conducted to compare two surgical techniques. They diverge by the preservation or not of conchal cartilage. Methods The two techniques were compared by measuring the cephalo-auricular and scapho-conchal angles. Measurements were performed in pre and 6-months post-operative periods using alginate molding. Twenty patients were randomly assigned to two groups (with and without cartilage preservation) with 10 participants each. Student’s t-test, Covariance Analysis Model (ANCOVA), and non-parametric Mann-Whitney were used in the statistical analyses. Results A significant reduction in the average of the cephalo-auricular and scapho-conchal angles was observed in both surgical procedures (p < 0.001). However, no significant difference was found between them (p = 0.887). Conclusion The two techniques analyzed in this study fulfilled their objectives. Therefore, further comparative studies are needed to confirm the superiority of one over the other. Level I Evidence obtained from at least one properly designed randomized controlled trial.

Abstract Reviews can be useful to provide an overview of specific knowledge areas to facilitate research guidelines and the comparison of study results. Therefore, we aimed to detect regions, environments, and taxonomic groups of elasmobranch that lack information on their feeding ecology and consequently need further attention. Using specific keywords on diet and feeding studies, we searched for articles on the trophic and feeding ecology of elasmobranchs. We found an increase in studies over the last 24 years, with an emphasis on stomach contents and stable isotopes. The USA, Australia, Mexico, Argentina, and Brazil were the countries with the highest number of published articles. Australia, the USA, Argentina, Brazil, Mexico, South Africa, Spain, Uruguay and India were the countries with the highest number of species studied. Estuarine and freshwater environments seem to need more attention, since studies on species in these environments were scarce (~3%). The total number of shark and ray species studied showed no significant differences (164 and 186, respectively), but most of the articles reviewed concerned sharks (67.5%). The larger elasmobranch families also need more attention, especially demersal species such as Rajidae, Dasyatidae, Arhynchobatidae, and Sycliorhinidae. Feeding studies only analyze some of the data deficient (DD) species (~7%) included in the IUCN Red List, pointing to the need to obtain more information about them.

■ abstract Introduction: Microsurgical techniques are characterized by the application of maneuvers and sutures to millimetric structures with the aid of magnifying lenses. These are complex techniques, used in various medical specialties, which require great skill and training before applying them to humans. The objective is to develop a low-cost and high-fidelity model for training microsurgery techniques using a fragment of bovine pericardium patch. Method: Remaining segments of a bovine pericardium plate, previously used in vascular repairs, are used to create this model. The material is cut into two symmetrical parts, and its ends are fixed to the surgical drapes with the aid of clamps. The upper edge of each part is then sutured to the lower edge with 8-0 Prolene thread so that each one forms a tubular structure. Subsequently, the free tubular ends undergo dissection of the adventitial layer and are sutured together, mimicking an end-to-end vascular anastomosis. Results: With the model, the same inconveniences/difficulties present in human vascular sutures are simulated, such as delamination of layers, excess of the adventitial layer, and risk of inadvertent suturing of the posterior wall, proving its usefulness in the acquisition of basic microsurgical skills, without need to manipulate human or animal tissues. Practice in this model can take place within the surgical center itself and uses materials that would otherwise be discarded. Conclusion: The use of bovine pericardium to create millimetric sutures mimics human vascular tissue and is a low-cost procedure that allows the training of microsurgical skills.

■ RESUMO Introdução: As técnicas microcirúrgicas caracterizam-se pela aplicação de manobras e suturas em estruturas milimétricas com o auxílio de lentes de aumento. São técnicas complexas, utilizadas em diversas especialidades médicas, que demandam grande habilidade e treinamento antes da aplicação em humanos. O objetivo é desenvolver um modelo de baixo custo e alta fidelidade, para o treinamento de técnicas de microcirurgia, utilizando um fragmento de patch de pericárdio bovino. Método: São utilizados para a confecção deste modelo segmentos remanescentes de uma placa de pericárdio bovino, previamente utilizado em reparos vasculares. O material é recortado em duas partes simétricas e suas extremidades fixadas aos campos cirúrgicos, com auxílio de clamps. A borda superior de cada uma das partes é, então, suturada à borda inferior com fio de Prolene 8-0, de maneira que cada uma forme uma estrutura tubular. Posteriormente, as extremidades tubulares livres passam pela dissecção da camada adventícia e são suturadas entre si, mimetizando uma anastomose vascular término-terminal. Resultados: Com o modelo, simulam-se os mesmos inconvenientes/dificuldades presentes nas suturas vasculares humanas, como a delaminação de camadas, excesso da camada adventícia e risco de sutura inadvertida da parede posterior, provando sua utilidade na aquisição de habilidades microcirúrgicas básicas, sem necessidade de manipulação de tecidos humanos ou animais. A prática neste modelo pode ocorrer dentro do próprio centro cirúrgico e emprega materiais que seriam descartados. Conclusão: A utilização do pericárdio bovino para confecção de suturas milimétricas mimetiza o tecido vascular humano e é um procedimento de baixo custo, que possibilita o treinamento de habilidades microcirúrgicas.

RESUMO O trauma de grande energia vem aumentando de maneira expressiva na última década, em boa parte de membros inferiores, necessitando, em muitos casos, de fasciotomia devido à síndrome compartimental subsequente. Neste contexto muitas vezes seu fechamento acaba por levar a um retardo no tratamento integral do paciente, do retorno a suas atividades e podendo levar a infecção local, além de gerar altos custos. Há muitas opções ao cirurgião plástico para a tentativa de aproximação de bordos e reconstrução das extremidades, como retalhos, enxertos, curativo a vácuo e sutura elástica, além de dispositivos de expansão, sendo, às vezes, com combinação das anteriores. O método de fechamento apresentado através do alongamento progressivo da pele com fio de Kirschnner representa uma forma de baixo custo e facilmente reproduzível para lidar com este tipo de ferida. década inferiores necessitando casos subsequente paciente local custos extremidades retalhos enxertos elástica expansão sendo anteriores ferida

ABSTRACT High-energy trauma has increased significantly in the last decade, mostly in the lower limbs, in many cases requiring fasciotomy due to the subsequent compartment syndrome. In this context, its closure often leads to a delay in the patient’s comprehensive treatment and the return to their activities and may lead to local infection, in addition to generating high costs. There are many options for the plastic surgeon to try to bring the edges together and reconstruct the extremities, such as flaps, grafts, vacuum dressings, and elastic sutures, in addition to expansion devices, sometimes with a combination of the above. Highenergy High energy decade limbs syndrome context patients patient s infection costs extremities flaps grafts dressings sutures devices above

ABSTRACT Adjuvant-induced autoimmune syndrome (ASIA) and its diagnostic criteria were described by Shoenfeld in 2011, relating symptoms of autoimmunity to adjuvants, such as silicone, present in breast implants. This systematic review aimed to gather data from the literature on symptomatology, incidence and proposed treatments for ASIA caused by silicone breast implants (SBI). Searches were carried out in PubMed, LILACS, Embase and Cochrane databases, using the descriptors “Autoimmune Syndrome Induced by Adjuvants,” “Breast implant,” and “Silicone Implant Incompatibility Syndrome.” The search strategy generated 95 articles, of which 20 were included in the review. The authors suggest three main theories to explain the development of the syndrome: genetic predisposition, silicone bleeding and the formation of a periprosthetic capsule. The most frequently described clinical manifestations include chronic fatigue, arthralgia, myalgia, and cognitive and sleep disorders. There is no consensus on laboratory findings and associated risk factors; recent studies propose expanding the diagnostic criteria initially described. Adequate treatment remains controversial, ranging from medications to prosthesis explantation. Although the reviewed articles suggest the existence of ASIA related to SBI, its precise pathophysiology is unknown, the symptoms reported are nonspecific, and the time between exposure and the onset of manifestations is uncertain. This systematic review concludes that, to date, there is not enough scientific evidence to establish the causality of the development of adjuvant-induced autoimmune syndrome resulting from silicone breast implants.

RESUMO A síndrome autoimune induzida por adjuvantes (ASIA) e seus critérios diagnósticos foram descritos por Shoenfeld em 2011, relacionando sintomas de autoimunidade a adjuvantes, como o silicone, presente em próteses mamárias. Essa revisão sistemática objetivou reunir dados da literatura sobre a sintomatologia, a incidência e os tratamentos propostos para ASIA causada por implantes mamários de silicone (IMS). Foram realizadas pesquisas nas bases de dados PubMed, LILACS, Embase e Cochrane, utilizando os descritores “Autoimmune Syndrome Induced by Adjuvants”, “Breast implant” e “Silicone Implant Incompatibility Syndrome”. A estratégia de busca gerou 95 artigos, dos quais 20 foram incluídos na revisão. São as três as principais teorias sugeridas pelos autores para explicar o desenvolvimento da síndrome: predisposição genética, silicone bleeding e a formação de uma cápsula periprótese. As manifestações clínicas mais frequentemente descritas incluem fadiga crônica, artralgia, mialgia, distúrbios cognitivos e do sono. Não há consenso sobre os achados laboratoriais e os fatores de risco associados, além disso, estudos recentes propõem a ampliação dos critérios diagnósticos inicialmente descritos. O tratamento adequado permanece controverso, envolvendo desde o uso de medicações até o explante da prótese. Apesar dos artigos revisados sugerirem a existência da ASIA relacionada aos IMS, sua fisiopatologia precisa é desconhecida, os sintomas relatados são inespecíficos e o tempo entre a exposição e o surgimento das manifestações é incerto. Por meio dessa revisão sistemática, conclui-se que, até o presente momento, não existem evidências científicas suficientes para estabelecer a causalidade do desenvolvimento da síndrome autoimune induzida por adjuvantes decorrente de implantes mamários de silicone.

RESUMO O tratamento das feridas complexas com grande perda de partes moles é um desafio para a cirurgia plástica, principalmente quando a ferida encontra-se infectada. Várias opções são consideradas para o tratamento, como sutura, enxertos, retalhos, expansores. Devido à complexidade dos casos, frequente associação de morbidades, necessidade de intervenções multidisciplinar e longos internamentos, os custos do tratamento são frequentemente elevados. Este trabalho vem demonstrar a técnica de sutura elástica empregada em um caso clínico, utilizando tração contínua da pele em associação ao curativo a vácuo, que possibilitou reabilitação do paciente sem a necessidade de intervenções mais agressivas para o fechamento da ferida traumática extensa. plástica encontrase encontra se infectada enxertos retalhos expansores casos morbidades internamentos elevados clínico vácuo extensa

ABSTRACT Treating complex wounds with great loss of soft tissues is a challenge for plastic surgery, especially when the wound is infected. Several options are considered for treatment, such as sutures, grafts, flaps, and expanders. Due to the complexity of the cases, the frequent association of morbidities, the need for multidisciplinary interventions, and long hospital stays, treatment costs are often high. This work demonstrates the elastic suture technique used in a clinical case, using continuous skin traction in association with a vacuum dressing, which enabled patient rehabilitation without the need for more aggressive interventions to close the extensive traumatic wound. surgery infected sutures grafts flaps expanders cases morbidities stays high case dressing

RESUMO Defeitos de orelha são frequentes e de etiologias diversas. Ainda assim, a reconstrução de orelha permanece um desafio dentro da cirurgia plástica reconstrutiva, principalmente devido a anatomia e a escassez de tecido local. Embora pouco utilizado, o retalho tubular retroauricular se apresenta como alternativa para reconstrução da hélice e lóbulo. No presente estudo os autores descrevem a técnica operatória, bem como relatam um caso em que foi utilizado. Realizou-se uma avaliação do resultado operatório de quatro casos de reconstrução de orelha utilizando o retalho tubular retroauricular, através de questionários encaminhados para avaliadores leigos e cirurgiões plásticos. O resultado estético final foi classificado como bom ou excelente por 35% dos avaliadores leigos e 50% dos cirurgiões plásticos. Já o resultado operatório foi avaliado como bom ou excelente por 70% dos leigos e 80% dos cirurgiões plásticos. Os resultados permitem concluir que a técnica do retalho tubular retroauricular para reconstrução de defeitos da borda de hélice pode ser indicada, com resultados satisfatórios.

ABSTRACT Ear defects are frequent and result of many etiologies, even though ear reconstruction remains a challenge in plastic reconstructive surgery due to anatomy and local tissue paucity. Despite being rarely used, the tubular retroauricular flap presents as an alternative for helix and lobule reconstruction. In this article, the authors describe the operative technique and report a case in which it was used. Also, plastic surgeons and laypeople rated the operative results of four cases of ear reconstructions using the tubular retroauricular flap. The final esthetic result was rated as good or excellent by 35% of laypeople and 50% of plastic surgeons, whereas the operative result was rated as good or excellent by 70% of laypeople and 80% of plastic surgeons. Thereby the findings and authors’ experience, we can recommend the tubular retroauricular flap technique for reconstructing ear helix border defects.

RESUMO Introdução: A obesidade é um dos principais problemas de saúde enfrentados pela população e sua incidência cresce gradativamente nas últimas décadas. Em meio à epidemia global de obesidade, os procedimentos bariátricos aumentaram expressivamente e, apesar do crescente número dos procedimentos pós-bariátricos, esses não se equivalem ao número de cirurgias bariátricas. Métodos: Foram coletados dados do registro de saúde pública (DATASUS) entre 2008 e 2019 para análise dos parâmetros selecionados, com avaliação das principais técnicas de dermolipectomia pós-bariátrica, sua distribuição em território nacional, seu tempo de internação, sua mortalidade, os custos para o Sistema Público, a comparação entre as dermolipectomias pós-bariátricas e a distribuição dos procedimentos bariátricos no território nacional. Além disso, comparou-se as dermolipectomias e a distribuição de cirurgiões plásticos no Brasil. Resultados: Um aumento de 164% foi evidenciado no número de dermolipectomias pós-bariátricas durante o período estudado. A dermolipectomia abdominal pós-bariátrica foi o procedimento mais realizado, sendo responsável por 65% dos procedimentos, seguido da dermolipectomia braquial (14,8%), crural (14,7%) e circunferencial (4,7%). Observou-se uma desigualdade na distribuição dos procedimentos pós-bariátricos entre as macrorregiões brasileiras, sendo a Região Sudeste com o maior número percentual (49,8%) de dermolipectomias. Conclusões: Apesar do aumento progressivo do número de dermolipectomias pós-bariátricas, elas não acompanharam o número de procedimentos bariátricos em território nacional. Por isso, há necessidade de um crescimento paralelo entre ambas, para que haja uma complementação no tratamento desses pacientes. Sendo assim, poderá existir melhora na distribuição das dermolipectomias no território nacional, fazendo com que mais pacientes possam ser beneficiados.

ABSTRACT Introduction: Obesity is one of the main health problems faced by the population, and its incidence has gradually increased in recent decades. Amid the global obesity epidemic, bariatric procedures have increased significantly and, despite the growing number of post-bariatric procedures, these are not equivalent to the number of bariatric surgeries. Methods: Data were collected from the public health registry (DATASUS) between 2008 and 2019 to analyze the selected parameters, with an assessment of the main post-bariatric dermolipectomy techniques, their distribution in the national territory, their length of stay, their mortality, costs for the Public System, the comparison between post-bariatric dermolipectomies and the distribution of bariatric procedures in the national territory. Furthermore, dermolipectomies and the distribution of plastic surgeons in Brazil were compared. Results: An increase of 164% was evidenced in the number of post-bariatric dermolipectomies during the studied period. Post-bariatric abdominal dermolipectomy was the most performed procedure, accounting for 65% of the procedures, followed by brachial (14.8%), crural (14.7%) and circumferential (4.7%) dermolipectomy. There was an inequality in the distribution of post-bariatric procedures among Brazilian macro-regions, with the Southeast Region having the highest percentage (49.8%) of dermolipectomies. Conclusions: Despite the progressive increase in post-bariatric dermolipectomies, they did not follow the number of bariatric procedures in the national territory. Therefore, there is a need for a parallel growth between both so that there is complementation in treating these patients. Then, there might be an improvement in the distribution of dermolipectomies in the national territory, allowing more patients to benefit.

EXEMPLIFYING THE USE OF MACRO ELEMENTAL MAPPING BY XRF (MA-XRF) SCANNING IN FORENSIC INVESTIGATION OF ARTWORKS. This work exemplifies the potential of employing macro elemental mapping by XRF (MA XRF) scanning in the forensic investigation of artworks. The results of the investigation of two artworks of different styles and periods are presented and discussed. The images provided by MA-XRF scanning have information about the elemental distribution, which is related to pigments used in the artwork. These images bring different information such as: if there are underlying paintings; if a given pigment was used for the purpose of restoration or in the creation. Therefore, through the images, it is possible to obtain information, which refers to the process of creating the artwork and the history of conservation and restoration. Through the results, it was possible to verify that the two artworks are probably false because they present anachronistic pigments with the supposed period of creation. The analyzes were performed using a portable MA-XRF scanning system, and in addition to presenting the utility of the instrument in these investigations, the work also presents possibilities to explore the MA-XRF data through multivariate statistical analysis and image correlation.

We demonstrate here for the first time an original and facile approach to preparing titanium oxide (TiO2) tubes using hydrogen peroxide (H2O2) and titanyl (IV) oxysulfate (TiOSO4) as sacrificial templates. The method involves dissolving TiOSO4 powder in H2O2 solution and subsequently applying thermal treatment on the resulting amorphous precipitate. Prepared samples were characterized by X-ray diffraction, scanning electron microscopy (SEM) images, thermogravimetric (TG) analysis, and UV-vis analysis. Experimental results indicated that the samples exhibit tube-like structures with lengths of approximately 1.9 mm in diameter and 11.5 mm in length. Anatase and rutile phases were formed after annealing at different temperatures in air. The crystallite size estimated by Rietveld refinement showed an increase from 34.69 to 354.28 nm with an increase in the annealing temperature from 600 to 1000 °C. At the same time, the band gap values decreased from 3.14 to 2.97 eV. The electron density maps were calculated, and the electronic density was observed to increase from 497.56 e- Å-2 (600 °C) to 533.10e- Å-2 (740 °C) and decrease with the annealing temperature of samples. A possible mechanism for the formation of TiO2 tubes was proposed.

BACKGROUND AND OBJECTIVES: The International Association for the Study of Pain recommends revising the definition of pain to "An unpleasant sensory and emotional experience associated with, or similar to that associated with actual or potential tissue damage." In fact, pain is a personal experience influenced to varying degrees by biological, psychological and social factors.1 The pandemic caused by (SARS-CoV-2) exposed health professionals who were not prepared for the unprecedented challenges. Many focused on ventilators, intensive care beds, but others will remain at the forefront of pain management. The aim of this paper was to present a review of the impact of the COVID-19 pandemic on pain management, in addition to proposing an alternative to the present context, such as telerehabilitation. CONTENTS: This is an integrative review carried out on the databases: LILACS, Scielo, Pubmed, Scopus, Web of Science, PubCovid and databases dedicated to the publication of Preprints on the COVID-19 theme, such as Psyarxiv and Preprint MedRxiv. In this review we intend to highlight the cognitive, emotional and behavioral impairments related to pain during a pandemic caused by COVID-19. CONCLUSION: The pandemic context and social isolation can negatively interfere in the sensitivity responses and in the treatment of pain, either by the increase in pain events in the population, impacted by social and psychological losses or by the interruption of face-to-face care during a pandemic. At this point, we recommend a gradual advance in addressing current treatment today and propose a future roadmap to face challenges that may arise.

JUSTIFICATIVA E OBJETIVOS: A Associação Internacional para o Estudo da Dor recomendou a revisão da definição de dor para "Uma experiência sensorial e emocional desagradável associada com, ou semelhante àquela associada a dano real ou potencial do tecido”. De fato, a dor é uma experiência pessoal influenciada em vários graus por fatores biológicos, psicológicos e sociais1. A pandemia provocada pela (SARS-CoV-2) expôs profissionais de saúde que não estavam preparados para os desafios sem precedentes. Muitos se concentraram em ventiladores, leitos de terapia intensiva, mas outros permaneceram na vanguarda do tratamento da dor. O objetivo deste trabalho foi apresentar uma revisão sobre o impacto da pandemia por COVID-19 no tratamento da dor, além da proposição de uma alternativa frente ao presente contexto, como a telereabilitação. CONTEÚDO: Trata-se de uma revisão integrativa realizada nas bases de dados: LILACS, Scielo, Pubmed, Scopus, Web of Science, PubCovid e bases de dados dedicadas a publicação de Preprints sobre a temática COVID-19, como Psyarxiv e Preprint MedRxiv. Na presente revisão pretendemos evidenciar os prejuízos cognitivos, emocionais e comportamentais relacionadas à dor durante a pandemia causada pela COVID-19. CONCLUSÃO: O contexto pandêmico e isolamento social pode interferir negativamente nas respostas de sensibilidade e no tratamento da dor, seja pelo aumento em eventos de dor na população, impactados pelos prejuízos sociais e psicológicos ou pela interrupção do atendimento presencial durante a pandemia. Neste ponto, recomendamos o avanço gradual na abordagem das limitações atuais do tratamento e propomos um roteiro futuro para enfrentar possíveis desafios que possam se apresentar.

Patients and the general public are under insurmountable psychological pressure which may lead to various psychological problems, such as anxiety, fear, depression, and insomnia, causing, consequently, the impaired quality of life. Psychological crisis intervention plays a pivotal role in the overall deployment of health-related quality of life and disease control. A novel Severe Acute Respiratory Syndrome Coronavirus-2 (SARSCoV-2), a pathogen of the new coronavirus disease (COVID-19), has affected several sector activities, including people's health. To enhance infection control methods, appropriate interventions, and public health policies, the present study aims to assess the fear and peri-traumatic stress during the Covid-19 in Brazil. Method: A cross-sectional survey has been conducted from April 12th to 18th using the Peri-Traumatic Distress Scale (CPDI) and the Fear Scale (FCV-19S) aiming to measure the peri-traumatic stress and fear as psychological reactions during the COVID-19 pandemic. For that purpose, an online spreadsheet was used to send the questionnaire and scales to a sample of 1844 participants as a collecting information tool. After the data analysis, the individuals were separated into 4 groups: Group 1 (1232) population without chronic health conditions; group 2 (298) patients with previous psychological suffering, group 3 (229) patients with cardiovascular diseases, group 4 (71) patients with diabetes. For analysis, G1 and were considered control for comparison with groups 2, 3 and 4 in accordance with One-Way Anova followed by Bonferroni test. Results: All the groups showed the CPDI and FCV-19S increased in comparison with the G1 group. Concerning CPDI, the G 3 was increased when compared to G1, G2 and G4. The G3 had the FCV-19S higher in comparison with G1, G2 and G4. The Wilcoxon-Mann-Whitney test showed a statistical difference between the control group in comparison with 2 and 3 groups (Mann-Whitney p&lt; 0.05). Conclusion: The COVID-19 pandemic had a significant impact on the Brazilian population, with patients with heart disease and hypertension presenting the highest numbers of stress and fear, with numbers comparable and even higher than those who reported previous psychological distress.

Covid-19 pandemic continues to spread exponentially worldwide, especially in America. By mid-June, 2020, Brazil is one of the most affected countries with more than one million cases and up to 50,000 deaths. This study aims to assess the fear and peri-traumatic stress during the Covid-19 pandemics in Brazil, to enhance infection control methods, appropriate interventions, and public health policies. A cross-sectional survey has been conducted from April 12th to 18th using the Peri-Traumatic Distress Scale (CPDI) and the Fear Scale (FCV-19S) aiming to measure the peri-traumatic stress and fear as psychological reactions during the Covid-19 pandemic. For that purpose, an online spreadsheet was used to send the questionnaire and scales to a sample of 1844 participants as a collecting information tool. Both scales showed a correlation factor of (r=0,660). Results highlight significant gender differences as in both scales women’s mean scores are higher showing that it is paramount that women’s voices were represented in policy spaces as socially constructed gender roles place them in a strategic position to enhance multi-level interventions (primary and secondary effects of Covid-19), equitable policies, and new approaches to control the pandemic.

In response to the outbreak of the novel Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), pathogen of the new coronavirus disease (COVID-19), several sectors and social activities have been affected, including education. At first, it is explained that educators and students can feel fragile during and after the SARS-CoV-2 outbreak. Subsequently, it is discussed that their relationship ought to be carefully established given the triggering of psychological and neuropsychiatric effects arising from neural coding and plasticity processes, which result in the formation of positive and negative memories in the short to long term. Finally, it is pointed out that the SARS-CoV-2 pandemic generates a need for adequacy and adaptation for the significant attention to students during the re-starting of studies, given that possible disorders of sensory modulation and involvement of limbic brain areas triggered in situations of risk of death, potential or real threat, can happen. It is assumed that at times of the SARS-CoV-2 pandemic, in addition to preserving life, one of the challenges is the behavioural (re)organisation, which includes habits from the educational context that need to contemplate a scientific perspective, seeking to transform the consequences of the pandemic fear on opportunities to reinforcement of familiar links. In the context of modern rationality, the SARS-CoV-2 pandemic is also a period to think about the relationship between scientific knowledge and common sense. With this logic, neurosciences can develop a new format for the teaching-learning process, so that educators and students experiencing the pandemic threatening do not manifest psychological distress and secondary consequences. Therefore, education can be considered a central space in decision-making in the face of SARS-CoV-2 pandemic. In this sense, the urgency of a multidisciplinary strategies development is highlighted, connecting the synergy between neurosciences and education after the COVID-19 pandemic.

ABSTRACT Introduction: Tissue expansion is an important reconstruction method to solve defects such as burns and giant nevi or breast reconstruction. This article aims to report the experience of the Plastic Surgery Service of the Hospital de Clínicas of the Federal University of Paraná (UFPR) with the use of expanders. Methods: This is a retrospective, descriptive, and analytical study of patients who underwent tissue expansion for reconstructive surgery at the Hospital de Clínicas da UFPR, from January 2010 to December 2016. Results: 61 patients and 80 surgeries were analyzed, including re-expansion procedures. Age ranged from 2 to 73 years (mean 31). The majority of patients were female (83.6%), aged over 40 years, undergoing breast reconstruction treatment after radical mastectomy (36%). The complications observed in these patients were: signs of infection (14.7%), suture dehiscence (3.2%), seroma (3.2%), defect in the expander (3.2%), exposure of the expander (3, 2%), necrosis (1.6%) and signs of hypoperfusion (1.6%). Patients undergoing breast reconstruction had the highest number of complications (40.1%). Reexpansion was necessary for 37.7% of patients. Conclusion: The skin expansion technique is indicated for several pathologies’ treatment. The tissue expansion procedure has high complication rates. Knowing the patient’s profile, the main types of complications, and the factors associated with these complications can help prevent them.

RESUMO Introdução: Expansão tecidual é um método de reconstrução importante para a cobertura de defeitos como queimaduras e nevos gigantes ou na reconstrução mamária. Esse artigo tem como objetivo relatar a experiência do Serviço de Cirurgia Plástica do Hospital de Clínicas da Universidade Federal do Paraná (UFPR) com o uso de expansores. Métodos: Esse é um estudo retrospectivo, descritivo e analítico dos pacientes que foram submetidos à expansão tecidual para cirurgia reconstrutora no Hospital de Clínicas da UFPR, entre o período de janeiro de 2010 a dezembro de 2016. Resultados: Foram analisados 61 pacientes e 80 cirurgias, incluindo os procedimentos de reexpansão. A idade variou entre 2 a 73 anos (média 31). A grande maioria dos pacientes pertenceu ao sexo feminino (83,6%), na faixa etária acima de 40 anos, sendo submetidos ao tratamento para reconstrução mamária após mastectomia radical (36%). As complicações observadas nesses pacientes foram: sinais de infecção (14,7%), deiscência da sutura (3,2%), seroma (3,2%), defeito no expansor (3,2%), exposição do expansor (3,2%), necrose (1,6%) e sinais de hipoperfusão (1,6%). Pacientes submetidos à reconstrução mamária tiveram o maior número de complicações (40,1%). A reexpansão foi necessária em 37,7% dos pacientes. Conclusão: A técnica de expansão de pele é indicada para o tratamento de diversas patologias. O procedimento de expansão tecidual apresenta taxas de complicações altas e o conhecimento do perfil do paciente, dos principais tipos de complicações e dos fatores associados a essas complicações podem auxiliar na sua prevenção.