Resumen El colgajo perforante de la arteria circunfleja ilíaca superficial se utiliza para la reconstrucción de los miembros, sobre todo, en el dorso de las manos y los pies, en la zona de flexión articular y en cirugía maxilofacial, porque es un colgajo fino, flexible y versátil. Presentamos tres pacientes: dos casos pediátricos para la reconstrucción de secuelas traumáticas de la mano y el dorso del pie, y un adulto para la reconstrucción de una quemadura del dorso de la mano. Conclusiones: El colgajo perforante de la arteria circunfleja ilíaca superficial es ideal para el dorso de la mano, el pie y los pliegues articulares. Pese a las variaciones anatómicas en el nacimiento de la arteria circunfleja ilíaca superficial, el dominio de las técnicas microquirúrgicas y de la supermicrocirugía permite tomar, con seguridad, un colgajo de dimensiones moderadas o grandes, fino, con baja morbilidad en la zona dadora.

Abstract The superficial circumflex iliac artery perforator (SCIP) flap is a thin, pliable, and versatile flap used mainly for extremities and head and neck reconstruction. We presented 3 cases of SCIP flap reconstructions. Two pediatric cases for the reconstruction of traumatic sequelae of the hand and dorsal foot. One adult case for the reconstruction of a severe burn of the dorsal hand. Conclusion: The SCIP flap is ideal for the reconstruction of the dorsal aspect of the hand, foot, and flexion crease. Despite the anatomical variations in the origin of the superficial circumflex iliac artery, the use of microsurgical techniques and super-microsurgery allows safe harvesting of a thin flap of moderate to large dimensions, with low morbidity in the donor area.

Abstract Purpose: To compare the satisfaction levels about the surgery and anesthesia management, and to analyze the postoperative outcomes of patients undergoing Gastric Bypass and Sleeve Gastroplasty surgeries in a private hospital in Sao Luís-MA. Methods: The sample consisted of patients undergoing Bypass and Sleeve bariatric surgeries from August 2018 to August 2019, who were in the range of 18 and 70 years old and had not used drugs or presented cardiac arrhythmias, dilated cardiomyopathy, and conduction disorder heart. Data were collected from the evaluation forms and recorded in a form with closed questions. Results: Most patients were female (Bypass – 56% and Sleeve – 67.4%) and aged between 30 and 39 years old (Bypass – 32% and Sleeve – 55.8%). Information (Bypass – 92% and Sleeve – 86.1%) was the highest satisfaction index found. Sleepiness in the immediate postoperative period (Bypass – 92% and Sleeve – 93%) was the main side effect. There were no postoperative complications in patients between the two types of surgery. Conclusions: Patients submitted to Bypass and Sleeve were completely satisfied with the perioperative management. There was no statistically significant difference when comparing adverse effects between the techniques.

RESUMO JUSTIFICATIVA E OBJETIVOS: Os cuidados paliativos são um conjunto de práticas que abrangem pacientes portadores de doenças ameaçadoras da vida e cuja abordagem deixa de ser curativa e passa a ser baseada em conforto, incluindo cuidados com a família. O objetivo deste estudo foi verificar o perfil epidemiológico de pacientes oncológicos em cuidados paliativos. MÉTODOS: Foram entrevistados 100 pacientes oncológicos em cuidados paliativos quanto às variáveis sociodemográficas e biopsicossociais, utilizando-se o índice de Karnofsky, a Escala de Performance Paliativa e a Escala de Avaliação de Sintomas de Edmonton. RESULTADOS: Observou-se faixa etária mais prevalente entre 51 e 60 anos (34%), mais da metade do sexo feminino (77%), nível escolar fundamental incompleto (40%) e residente no interior do Maranhão (73%). Quanto ao uso de analgésicos, 52% relataram não esquecer de tomar o fármaco para dor; enquanto 56% tomam fármaco por conta própria. Quanto ao diagnóstico, apenas 13% dos entrevistados conhecem o diagnóstico paliativo, e mais da metade conhece o diagnóstico primário ou oncológico (65%). Quanto à avaliação da capacidade funcional, 52% tem índice de Karnofsky avaliado entre 70 e 90%; Escala de Performance Paliativa, 62% estão entre 80 e 90% e Escala de Avaliação de Sintomas de Edmonton as seguintes variáveis mais significantes em cansaço, (60%); tristeza, (84%); ansiedade, (73%); falta de apetite, (51%) e ausência de bem-estar (79%). CONCLUSÃO: Conhecer o perfil de pacientes é relevante para a identificação pontual de obstáculos na implementação efetiva dos cuidados paliativos. Possibilitando assim, a implementação de medidas direcionadas.

ABSTRACT BACKGROUND AND OBJECTIVES: Palliative care is a set of practices that encompasses patients with life-threatening diseases which approach is no longer curative, but comforting, including care for the family. The objective of this study was to verify the epidemiological profile of cancer patients in palliative care. METHODS: We interviewed 100 cancer patients in palliative care, as well as the sociodemographic and biopsychosocial variables, using the Karnofsky index, Palliative Performance Scale and Edmonton Symptom Assessment Scale. RESULTS: The prevalent age group was between 51-60 years (34%), more than half female (77%), incomplete elementary school (40%) and resident in the interior of Maranhão (73%). Concerning the use of pain drugs, 52% reported not forgetting to take their pain drug, while 56% took drug on their own. As to the diagnosis, only 13% of the interviewees were aware of a palliative diagnosis, and more than half of them were aware of primary or oncological diagnosis (65%). Regarding the evaluation of functional capacity, 52% had the Karnofskys index between 70 and 90%; Palliative Performance Scale, 62% between 80 and 90%, and Edmonton Symptom Assessment Scale the following most significant variables in tiredness, (60%); sadness, (84%); anxiety, (73%); lack of appetite, (51%) and absence of well-being (79%). CONCLUSION: Knowing the profile of patients is key to identify the obstacles to the effective implementation of palliative care, making it possible to implement targeted measures.

A alusão aos hologramas é identificada em diferentes contextos para denominar diversos dispositivos e apresentações, a exemplo das imagens exibidas através das pirâmides “holográficas”. Todavia, conforme apontamos neste artigo, as imagens exibidas por essas pirâmides, além de não serem hologramas de fato, não passam de imagens bidimensionais. Identificamos, entretanto, um rico potencial didático nas pirâmides “holográficas” para o ensino de Física, especialmente quando nos atentamos para a transição da curiosidade ingênua do educando em curiosidade epistemológica e para o ensino de determinados conceitos da óptica e da matemática. Assim, construímos uma pirâmide quadrangular utilizando chapas de acrílico e tecemos discussões sobre seu funcionamento. Por meio deste artigo, esperamos, dentre outras coisas, promover a consciência crítica dos docentes e educandos em geral frente aos artefatos tecnológicos em constantes mudanças ao seu redor, especialmente aqueles supostamente relacionados aos hologramas.

Allusion to holograms is identified in different contexts to refer to different devices and shows, like the images displayed by the pyramids “holographic”. However, as we pointed out in this article, the images displayed by these pyramids, besides not being holograms in fact, are just two-dimensional images. We identified, however, a rich didactic potential in “holographic” pyramids for the teaching of Physics, especially when we consider the transition from the student's naive curiosity to epistemological curiosity and the teaching of certain concepts of optics and mathematics. Therefore, we built a quadrangular pyramid using acrylic plates and we made discussions about their operation. Through this article, we hope, among other things, to promote the critical awareness of teachers and students in the face of technological artifacts in constant changes around them, especially those considered as holograms.

Background: In Dupuytren's contracture deciding the type of surgical incision is extremely important, and several options were described. The aim of this study is to evaluate retrospectively the usefulness of palmar commissural flap in Dupuytren's disease with adjacent fingers involvement. Methods: Between April 2009 and December 2012, 32 patients with Dupuytren's disease were operated on by the authors. Twelve patients with at least 2 adjacent fingers involvement and the design of a palmar commissural flap. The flaps were evaluated at days 3-5, 15-21, 45-60, and 6 months post-surgery. At the end of the follow-up, recurrence, satisfaction and Quick Dash score were evaluated. Results: Thirteen palmar commissural flaps were performed in 12 patients (6 right hands and 6 left hands). The affected adjacent rays were the 4th and 5th fingers (8 cases); the 3rd, 4th and 5th fingers (3 cases), and the 3rd and 4th fingers (one case). Average distances of the palmar commissural flap, commissure-vertex was 2.23 cm (range 1.2-4.3), and that of the transverse 2.42 cm (range 1.6 to 3.8). In all cases it was performed according to preoperative planning resection of pathological cords and partial fasciectomy. One case presented distal necrosis, which was treated with open palm technique. Conclusions: The palmar commissural flap can identify both the digital pedicle as pathological structures. Its vascularization makes it a safe and easy flap dissection.

Introducción: El diseño de las incisiones en la enfermedad de Dupuytren es probablemente el detalle técnico más importante en el tratamiento quirúrgico. El objetivo de este trabajo es realizar una valoración retrospectiva de la utilidad del colgajo comisural palmar en el abordaje de la enfermedad de Dupuytren con compromiso de dedos contiguos. Materiales y Métodos: Entre abril de 2009 y diciembre de 2012, los autores operaron a 32 pacientes con enfermedad de Dupuytren. Se incluyeron 12 pacientes con compromiso de, al menos, 2 dedos contiguos y el diseño de un colgajo comisural palmar. Se evaluaron entre los días 3-5, 15-21, 45-60 y a los 6 meses posoperatorios. Al final del seguimiento, se constataron las recidivas, la satisfacción y el puntaje QuickDASH. Resultados: Se realizaron 13 colgajos comisurales palmares en 12 pacientes, 6 manos derechas y 6 izquierdas. Los rayos contiguos afectados fueron el 4.° y 5.° dedos (8 casos), el 3.°, 4.° y 5.° dedos (3 casos), y el 3.° y 4.° dedos (un caso). La distancia promedio del colgajo comisural palmar comisura-vértice fue de 2,23 cm (rango 1,2-4,3) y la transversal, de 2,42 cm (rango 1,6-3,8). Siempre se pudo realizar la resección de las cuerdas patológicas y la fasciectomía parcial sin complicaciones intraoperatorias. Hubo una necrosis distal parcial, tratada con técnica de palma abierta. Conclusiones: El colgajo comisural palmar es de fácil disección y seguro a causa de su múltiple vascularización, permite una correcta visualización de las estructuras vasculonerviosas digitales y las bandas patológicas, útil en afección de dedos contiguos.

Objective: To retrospectively evaluate the clinical and radiological results of a consecutive series of patients with fracture and fracture-dislocations of the radius, treated with a monopolar radial head arthroplasty. Methods: Twenty patients were included. Inclusion criteria: <18 years old, with fracture and fracture-dislocations of the radius, treated with a titanium monopolar radial head arthroplasty and a minimun follow-up of one year. Fifteen were female, average age of 59 years old. Seven were isolated radial head fractures and 13 were fracturedislocations. Loosening of the implant, capitelar erosion, overstuffing and heterotopic ossification were evaluated. Average follow-up was 26 months. Results: Flexo-extension was 139°-5° and prono-supination 79°-79°. Total arc of motion was 134°. Grip strength was 84% of the contralateral side. Pain according to a visual analogue scale was 2, DASH: 11 points. Thirteen patients had excellent results and 6 good. Loosening of the implant (12 patients), capitelar erosion (4 patients) and overstuffing (2 patients) were detected. One patient had an ulnar neuropathy and he was operated on and one patient required implant removal due to loosening and pain. Conclusions: The replacement of the radial head in a non-reconstructable fracture is a feasible treatment option, with good functional results in a short and medium term. Joint stability was restored in all cases and the index of asymptomatic implant loosening was elevated.

Objetivo: Evaluar retrospectivamente los resultados clínicos y radiológicos de una serie consecutiva de pacientes con fracturas y luxofracturas de la cúpula radial a quienes se les realizó el reemplazo por una prótesis monopolar. Materiales y Métodos: Se incluyeron 20 pacientes. Criterios de inclusión: <18 años, con fracturas o luxofracturas de la cúpula radial, tratados con prótesis monoblock de titanio y seguimiento mínimo de un año. Quince eran mujeres, edad promedio 59 años. Siete eran fracturas aisladas y 13, luxofracturas. Se evaluaron el grado de aflojamiento protésico, la erosión capitelar, el ensanchamiento del espacio articular humeral lateral y las calcificaciones heterotópicas. El seguimiento fue de 26 meses. Resultados: La flexo-extensión fue de 139º-5º y la pronosupinación, de 79-79°. El arco total fue de 134°. Fuerza de puño: 84% del lado contralateral. El dolor según la escala analógica visual fue de 2, DASH: 11 puntos, 13 resultados excelentes y 6 buenos. Se detectó aflojamiento del implante (12 casos), aumento de la radiolucidez capitelar (4 casos) y ensanchamiento del espacio ulnohumeral lateral (2 casos). Hubo 2 complicaciones: una neurodocitis cubital que debió ser operada y una extracción de implante por aflojamiento y dolor. Conclusiones: El reemplazo de la cúpula radial en lesiones no reconstruibles es una opción terapéutica viable, con buenos resultados funcionales a corto y mediano plazo. La recuperación de la estabilidad articular fue posible en todos los casos y el índice de aflojamiento protésico asintomático fue elevado.

Background: Elbow dislocations associated with radial head and coronoid fractures have been termed the "terrible triad of the elbow" because of the difficulties in treatment and the poor reported outcomes. The purpose of this paper is to report the results of a consecutive series of patients with terrible triad and describe our protocol of treatment. Methods: We included 15 patients in which coronoid fracture, radial head fracture and lateral ligament had been repaired. Twelve were women and 3 men. Average age was 57 years old. The protocol of treatment was: 1) to restore the stability of coronoid fracture, 2) of the radial head, 3) to repair the lateral ligament, 4) to repair the medial collateral ligament if the stability was not obtained and 5) immobilization for 2 weeks. Pain was evaluated according to VAS and functional results with the DASH and Mayo Clinic Score. Follow-up was 34 months. Results: The flexo-extension was 139°-11º (total arc 128°). Pain was 2, DASH score was 12. Seven were excellent and 8 good. Complications: a radial head nonunion, a cubital neurodocitis, a stiff elbow and a valgus instability. Conclusions: The application of a correct protocol of treatment can favour the results. Some complications are expected.

Introducción: La asociación de la luxación del codo con la fractura de la cúpula radial y de la apófisis coronoides se denomina la "tríada terrible del codo" debido a las dificultades en su tratamiento y a sus pobres resultados. Objetivos: Evaluar los resultados de los pacientes con la tríada terrible del codo y describir el protocolo de tratamiento. Materiales y métodos: Se incluyeron 15 pacientes (12 eran mujeres) en los que se había tratado quirúrgicamente la coronoides, la cúpula radial y el ligamento lateral. Edad promedio: 57 años. El protocolo de tratamiento consistió en: restaurar la estabilidad de la coronoides, la cúpula radial y el ligamento lateral; reparar el ligamento medial en caso de inestabilidad residual; inmovilizar durante 2 semanas. El dolor se evaluó según la EVA, y los resultados funcionales, según el DASH y el puntaje de la Clínica Mayo. El seguimiento fue de 34 meses. Resultados: La flexión-extensión fue de 139°-11º (arco total 128°). El dolor fue de 2, el DASH de 12. Siete resultados fueron excelentes y 8 buenos. Complicaciones: una seudoartrosis de la cúpula, una neurodocitis cubital, una rigidez y una inestabilidad en valgo. Conclusiones: La aplicación de un correcto protocolo de tratamiento puede favorecer los resultados. Las complicaciones son esperables.