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a taxa de falha dos enxertos de pele de espessura total &#40;FTSG&#44; do ingl&#234;s <span class="elsevierStyleItalic">full&#8208;thickness skin grafts</span>&#41; no couro cabeludo pode chegar a 22&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">O impacto do estado de perfus&#227;o do leito receptor na viabilidade do enxerto na quarta semana ainda precisava ser quantificado em humanos <span class="elsevierStyleItalic">in vivo</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Laser speckle contrast imaging</span> &#40;LSCI&#41; &#233; uma t&#233;cnica n&#227;o invasiva&#44; em tempo real e sem contato&#44; que torna poss&#237;vel o estudo da microcircula&#231;&#227;o em grandes &#225;reas de superf&#237;cie nos per&#237;odos intra e perioperat&#243;rio&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Em pesquisas anteriores&#44; foi validado o estudo da microcircula&#231;&#227;o de diferentes tipos de enxertos de pele por meio da an&#225;lise com LSCI&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Seu papel na identifica&#231;&#227;o de pacientes de alto risco para necrose do enxerto ainda precisa ser explorado&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Neste estudo piloto&#44; os autores pretendem comparar os resultados dos FTSG no couro cabeludo com a estado da perfus&#227;o basal do leito do enxerto avaliada por LSCI&#46; Tamb&#233;m ser&#227;o descritas as mudan&#231;as na perfus&#227;o do FTSG ao longo de quatro semanas&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Ap&#243;s aprova&#231;&#227;o do comit&#234; de &#233;tica local e consentimento informado&#44; quatro pacientes consecutivos com c&#226;ncer de pele n&#227;o melanoma no couro cabeludo foram inclu&#237;dos&#58; todos masculinos&#44; com 71 anos &#40;paciente 1&#41;&#44; 90 anos &#40;paciente 2&#41;&#44; 81 anos &#40;paciente 3&#41; e 78 anos &#40;paciente 4&#41;&#46; As principais caracter&#237;sticas e comorbidades dos pacientes s&#227;o apresentadas na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46; Os tumores foram excisados ap&#243;s uso de lidoca&#237;na com infiltra&#231;&#227;o de epinefrina&#44; e FTSG foram colhidos da regi&#227;o infraclavicular&#46; Vinte minutos ap&#243;s a remo&#231;&#227;o da les&#227;o e antes da sutura do enxerto de pele&#44; a perfus&#227;o basal do leito da ferida cir&#250;rgica &#40;em unidades de perfus&#227;o arbitr&#225;ria&#44; UPA&#41; foi medida com LSCI por 1 minuto&#44; e a press&#227;o arterial m&#233;dia &#40;PAM&#44; em mmHg&#41; foi registrada&#46; A rela&#231;&#227;o UPA&#47;PAM resultou na condut&#226;ncia vascular cut&#226;nea &#40;CVC&#41;&#44; em UPA&#47;mmHg&#44; possibilitando a compara&#231;&#227;o dos valores de perfus&#227;o dos pacientes&#46; Por fim&#44; o FTSG foi suturado e o curativo foi aplicado por uma semana&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Nos dias &#40;D&#41; 7&#44; D14&#44; D21 e D28&#44; a perfus&#227;o do enxerto foi avaliada e comparada com a perfus&#227;o basal do leito do enxerto no D0&#46; Tamb&#233;m foram registradas imagens cl&#237;nicas&#46; As &#225;reas de necrose foram calculadas com SketchAndCalc Area Calculator&#8482; &#40;vers&#227;o 6&#46;2&#46;5&#44; 2018&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Em todos os pacientes&#44; a remo&#231;&#227;o do c&#226;ncer de pele possibilitou a preserva&#231;&#227;o de alguma g&#225;lea aponeur&#243;tica subjacente para suprimento vascular do enxerto de pele&#46; Nenhum dos pacientes desenvolveu infec&#231;&#227;o&#44; hematoma ou hemorragia p&#243;s&#8208;operat&#243;ria&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">As &#225;reas do defeito prim&#225;rio mediam 8&#44;4 cm<span class="elsevierStyleSup">2</span> &#40;paciente 1&#41;&#44; 12&#44;3 cm<span class="elsevierStyleSup">2</span> &#40;paciente 2&#41;&#44; 5&#44;8 cm<span class="elsevierStyleSup">2</span> &#40;paciente 3&#41; e 8&#44;7 cm<span class="elsevierStyleSup">2</span> &#40;paciente 4&#41;&#46; A evolu&#231;&#227;o dos valores da CVC ao longo das quatro semanas &#233; mostrada na <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46; As imagens cl&#237;nicas e LSCI sequenciais registradas no mesmo per&#237;odo s&#227;o apresentadas na <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Os valores basais de CVC do leito receptor foram 0&#44;22 UPA&#47;mmHg&#44; 0&#44;43 UPA&#47;mmHg&#44; 0&#44;51 UPA&#47;mmHg e 0&#44;70 UPA&#47;mmHg&#44; respectivamente&#44; nos pacientes 1&#44; 2&#44; 3 e 4&#46; A extens&#227;o da necrose do enxerto no D28 diminuiu com o aumento da perfus&#227;o no leito receptor &#40;CVC&#41; no D0 &#8211; 82&#37; no paciente 1&#44; 48&#37; no paciente 2&#44; 16&#37; no paciente 3 e 9&#37; no paciente 4&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Ap&#243;s diminui&#231;&#227;o inicial do D0 ao D7&#44; no D14 a CVC do enxerto superou a CVC basal do leito receptor em todos os pacientes&#46; O aumento da perfus&#227;o do enxerto foi mais acentuado do D7 ao D21&#44; com posterior tend&#234;ncia de diminui&#231;&#227;o &#40;nos pacientes 2 e 4&#41; ou pequeno aumento &#40;nos pacientes 1 e 3&#41;&#46; Quanto menor a &#225;rea sob as curvas de perfus&#227;o&#44; maior a extens&#227;o da necrose do enxerto no D28 em todos os pacientes&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">A partir da an&#225;lise das imagens de LSCI&#44; foi observado que a partir do D14 as regi&#245;es do enxerto de pele mal perfundidas &#40;preto a azulado&#41; permaneceram relativamente est&#225;veis em extens&#227;o&#46; Essas regi&#245;es mal perfundidas no D14 sobrepuseram&#8208;se &#224;s regi&#245;es de necrose cl&#237;nica no D28&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Existem algumas maneiras de avaliar a perfus&#227;o da pele de modo n&#227;o invasivo&#44; mas faltam evid&#234;ncias que apoiem seu uso no monitoramento da vasculariza&#231;&#227;o de enxertos de pele&#46; A tomografia de coer&#234;ncia &#243;ptica requer avalia&#231;&#245;es sequenciais de menos de 1 cm<span class="elsevierStyleSup">2</span> ao longo da superf&#237;cie do enxerto de pele&#46; Al&#233;m disso&#44; o contato direto com o enxerto de pele pode ser inadequado em ambiente intraoperat&#243;rio ass&#233;ptico&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> A imagem por <span class="elsevierStyleItalic">laser</span> Doppler &#40;LDI&#44; do ingl&#234;s <span class="elsevierStyleItalic">laser Doppler imaging</span>&#41; possibilita a avalia&#231;&#227;o sem contato do fluxo sangu&#237;neo cut&#226;neo&#44; com excelente resolu&#231;&#227;o espacial&#44; mas baixa resolu&#231;&#227;o temporal&#44; especialmente ao avaliar &#225;reas extensas&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> O LDI tem profundidade de penetra&#231;&#227;o de 0&#44;5 a 1&#44;0 mm&#44; mais profunda que o plexo d&#233;rmico superficial que comp&#245;e a microcircula&#231;&#227;o cut&#226;nea&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> O LSCI supera a maioria das limita&#231;&#245;es das outras t&#233;cnicas&#46; Ele torna poss&#237;vel a aquisi&#231;&#227;o r&#225;pida de imagens de perfus&#227;o de alta resolu&#231;&#227;o de extensas &#225;reas da superf&#237;cie do enxerto sem contato&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> A curta penetra&#231;&#227;o da radia&#231;&#227;o <span class="elsevierStyleItalic">laser</span> &#40;0&#44;3 mm&#41; abrange capilares&#44; v&#234;nulas e arter&#237;olas do plexo capilar superficial&#44; incluindo a vasculatura do enxerto&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">A despeito das vari&#225;veis individuais n&#227;o analisadas e do pequeno tamanho da amostra n&#227;o permitir qualquer estimativa de correla&#231;&#227;o estat&#237;stica&#44; foi demostrado que a &#225;rea de necrose do FTSG aumentou com a diminui&#231;&#227;o da perfus&#227;o basal&#46; Os enxertos com piores resultados&#44; 82&#37; e 48&#37; de necrose&#44; tiveram as menores perfus&#245;es basais&#44; como observado nos pacientes 1 e 2&#44; respectivamente&#46; Al&#233;m disso&#44; no paciente 1&#44; com necrose subtotal do enxerto&#44; a inclina&#231;&#227;o da curva de perfus&#227;o foi mais descendente do que as demais&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Foi demonstrado que o estado de perfus&#227;o do leito do enxerto pode afetar o resultado do FTSG&#44; corroborando assim o conhecimento emp&#237;rico estabelecido&#46; Que seja de conhecimento dos autores&#44; este &#233; o primeiro relato do uso de LSCI no intraoperat&#243;rio para identificar pacientes com leitos receptores de enxerto mal perfundidos que apresentam&#44; em teoria&#44; risco aumentado de necrose do enxerto&#46; Essa metodologia deve ser expandida em amostras maiores e em &#225;reas de alto risco para necrose de enxertos de pele al&#233;m do couro cabeludo&#44; como superf&#237;cies plantares ou membros inferiores&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Com dados mais robustos&#44; a identifica&#231;&#227;o de um limiar de perfus&#227;o &#40;CVC&#41; pode tornar o enxerto de pele tardio op&#231;&#227;o melhor do que o enxerto de pele imediato ap&#243;s a excis&#227;o do tumor&#46; Tamb&#233;m se especula que as diferen&#231;as nas curvas de CVC ao longo da cicatriza&#231;&#227;o inicial do enxerto podem ajudar a prever maior risco de necrose tardia&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">LSCI pode ser promissor na sele&#231;&#227;o dos melhores candidatos para reconstru&#231;&#227;o cir&#250;rgica com FTSG e na predi&#231;&#227;o intraoperat&#243;ria de necrose tardia&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0100" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0105" class="elsevierStylePara elsevierViewall">Andr&#233; Pinho&#58; Concep&#231;&#227;o&#44; investiga&#231;&#227;o &#40;l&#237;der&#41;&#44; an&#225;lise formal e elabora&#231;&#227;o&#8208;reda&#231;&#227;o original &#40;l&#237;der&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Ana Brinca&#58; Concep&#231;&#227;o e reda&#231;&#227;o&#8208;revis&#227;o e edi&#231;&#227;o &#40;l&#237;der&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Ana Figueiredo&#58; Investiga&#231;&#227;o &#40;suporte&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Duarte Flor&#58; Investiga&#231;&#227;o &#40;suporte&#41;&#44; an&#225;lise formal &#40;suporte&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Ricardo Vieira&#58; Concep&#231;&#227;o &#40;suporte&#41; e reda&#231;&#227;o&#8208;revis&#227;o e edi&#231;&#227;o &#40;suporte&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0130" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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          "pt" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evolu&#231;&#227;o da perfus&#227;o de enxertos de pele de espessura total no couro cabeludo&#46; A perfus&#227;o do enxerto de pele no D7 foi inferior &#224; perfus&#227;o basal do leito do enxerto em todos os pacientes&#46; Os pacientes 3 e 4 apresentaram maior perfus&#227;o basal e atingiram valores de pico no D21 e no D28&#44; respectivamente&#46; O paciente 1&#44; com pior evolu&#231;&#227;o cl&#237;nica&#44; apresentou curva ascendente at&#233; o D28&#44; mas com valores de perfus&#227;o persistentemente mais baixos&#46;</p>"
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          "pt" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Imagens cl&#237;nicas &#40;pain&#233;is &#224; esquerda&#41; e LSCI &#40;pain&#233;is &#224; direita&#41; de enxertos de pele de espessura total no couro cabeludo dos quatro pacientes&#46; As imagens de LSCI mostram diferen&#231;as na perfus&#227;o em escala semiquantitativa&#44; do preto &#40;sem perfus&#227;o&#41; ao vermelho &#40;perfus&#227;o intensa&#41;&#46; O paciente 1 apresentava leito receptor azulado a preto no D0&#44; e o enxerto permaneceu mal perfundido at&#233; o D28&#44; culminando com necrose subtotal do enxerto&#46; O paciente 2 apresentava leito de enxerto azulado &#40;baixa perfus&#227;o&#41;&#44; mas recuperou&#8208;se gradualmente ao longo de quatro semanas&#44; e a &#225;rea de necrose do enxerto foi inferior a 50&#37;&#46; Os pacientes 3 e 4 apresentaram leitos de enxerto melhor perfundidos e apresentaram perfus&#227;o acentuada a partir do D14&#46; No D28&#44; a extens&#227;o da necrose era de 16&#37; e 9&#37;&#44; respectivamente&#46; LSCI&#44; <span class="elsevierStyleItalic">laser speckle contrast imaging</span>&#59; UPA&#44; unidades de perfus&#227;o arbitr&#225;ria&#46;</p>"
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Outras comorbidades&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">71&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">LM&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#193;cido acetilsalic&#237;lico&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Hernia inguinal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Dislipidemia&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LMS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Glaucoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dislipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Osteoartrite&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CEC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transplante de rim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dislipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CBC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DAC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dislipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DM2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "imagenFichero" => array:1 [
                0 => "xTab3563636.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas e comorbidades dos pacientes &#40;do g&#234;nero masculino&#41; submetidos a enxerto de pele no couro cabeludo</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Refer&#234;ncias"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcomes of split vs full&#8208;thickness skin grafts in scalp reconstruction in outpatient local anaesthetic theatre"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46; Sun"
                            1 => "A&#46;J&#46; Patel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Scars Burn Heal&#46;"
                        "fecha" => "2021"
                        "volumen" => "7"
                      ]
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            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Full&#8208; or split&#8208;thickness skin grafting in scalp surgery&#63; Retrospective case series"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;M&#46;H&#46; Hilton"
                            1 => "L&#46;R&#46; H&#246;lmich"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.29252/wjps.8.3.331"
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Plast Surg&#46;"
                        "fecha" => "2019"
                        "volumen" => "8"
                        "paginaInicial" => "331"
                        "paginaFinal" => "337"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31620335"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
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                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Santos X&#44; Iglesias I&#46; Necrotic Complications After Skin Grafts&#46; In&#58; Skin Necrosis&#46; Vienna&#58; Springer Vienna&#59; 2015&#46; p&#46;201&#8208;6&#46;"
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reconstruction of a secondary scalp defect using the crane principle and a split&#8208;thickness skin graft"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Y&#46; Lu"
                            1 => "K&#46;C&#46; Chang"
                            2 => "C&#46;N&#46; Chang"
                            3 => "D&#46;H&#46; Chang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "BMC Surg&#46;"
                        "fecha" => "2021"
                        "volumen" => "21"
                        "paginaInicial" => "41"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessment of skin microvascular function and dysfunction with laser speckle contrast imaging"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46; Mah&#233;"
                            1 => "A&#46; Humeau-Heurtier"
                            2 => "S&#46; Durand"
                            3 => "G&#46; Leftheriotis"
                            4 => "P&#46; Abraham"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCIMAGING.111.970418"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Cardiovasc Imaging&#46;"
                        "fecha" => "2012"
                        "volumen" => "5"
                        "paginaInicial" => "155"
                        "paginaFinal" => "163"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22253335"
                            "web" => "Medline"
                          ]
                        ]
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            5 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Laser speckle contrast imaging for assessment of human skin graft microcirculation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Brinca"
                            1 => "A&#46; Pinho"
                            2 => "R&#46; Vieira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Eur Acad Dermat Venereol&#46;"
                        "fecha" => "2020"
                        "volumen" => "34"
                        "paginaInicial" => "e491"
                        "paginaFinal" => "e493"
                      ]
                    ]
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            6 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Imaging human skin autograft integration with optical coherence tomography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;J&#46; Deegan"
                            1 => "J&#46; Lu"
                            2 => "R&#46; Sharma"
                            3 => "S&#46;P&#46; Mandell"
                            4 => "R&#46;K&#46; Wang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.21037/qims-20-750"
                      "Revista" => array:6 [
                        "tituloSerie" => "Quant Imaging Med Surg&#46;"
                        "fecha" => "2021"
                        "volumen" => "11"
                        "paginaInicial" => "784"
                        "paginaFinal" => "796"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33532277"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
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            ]
            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison between laser speckle contrast imaging and laser Doppler imaging to assess skin blood flow in humans"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46; Millet"
                            1 => "M&#46; Roustit"
                            2 => "S&#46; Blaise"
                            3 => "J&#46;L&#46; Cracowski"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.mvr.2011.06.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Microvasc Res&#46;"
                        "fecha" => "2011"
                        "volumen" => "82"
                        "paginaInicial" => "147"
                        "paginaFinal" => "151"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21745482"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison of instruments for investigation of microcirculatory blood flow and red blood cell concentration"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; O&#8217;Doherty"
                            1 => "P&#46; McNamara"
                            2 => "N&#46;T&#46; Clancy"
                            3 => "J&#46;G&#46; Enfield"
                            4 => "M&#46;J&#46; Leahy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1117/1.3149863"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Biomed Opt&#46;"
                        "fecha" => "2009"
                        "volumen" => "14"
                        "paginaInicial" => "034025"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19566318"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Laser speckle contrast imaging accurately measures blood flow over moving skin surfaces"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "G&#46; Mah&#233;"
                            1 => "P&#46; Rousseau"
                            2 => "S&#46; Durand"
                            3 => "S&#46; Bricq"
                            4 => "G&#46; Leftheriotis"
                            5 => "P&#46; Abraham"
                          ]
                        ]
                      ]
                    ]
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Cartas ‐ Investigação
Predição de falha de enxertos de pele no couro cabeludo por análise intraoperatória com laserspeckle
André Pinhoa,b,
Autor para correspondência
andrecastropinho@gmail.com

Autor para correspondência.
, Ana Brincaa,b, Carolina Figueiredoa, Duarte Flora, Ricardo Vieiraa,b
a Departamento de Dermatologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
b Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
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a taxa de falha dos enxertos de pele de espessura total &#40;FTSG&#44; do ingl&#234;s <span class="elsevierStyleItalic">full&#8208;thickness skin grafts</span>&#41; no couro cabeludo pode chegar a 22&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">O impacto do estado de perfus&#227;o do leito receptor na viabilidade do enxerto na quarta semana ainda precisava ser quantificado em humanos <span class="elsevierStyleItalic">in vivo</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Laser speckle contrast imaging</span> &#40;LSCI&#41; &#233; uma t&#233;cnica n&#227;o invasiva&#44; em tempo real e sem contato&#44; que torna poss&#237;vel o estudo da microcircula&#231;&#227;o em grandes &#225;reas de superf&#237;cie nos per&#237;odos intra e perioperat&#243;rio&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Em pesquisas anteriores&#44; foi validado o estudo da microcircula&#231;&#227;o de diferentes tipos de enxertos de pele por meio da an&#225;lise com LSCI&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Seu papel na identifica&#231;&#227;o de pacientes de alto risco para necrose do enxerto ainda precisa ser explorado&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Neste estudo piloto&#44; os autores pretendem comparar os resultados dos FTSG no couro cabeludo com a estado da perfus&#227;o basal do leito do enxerto avaliada por LSCI&#46; Tamb&#233;m ser&#227;o descritas as mudan&#231;as na perfus&#227;o do FTSG ao longo de quatro semanas&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Ap&#243;s aprova&#231;&#227;o do comit&#234; de &#233;tica local e consentimento informado&#44; quatro pacientes consecutivos com c&#226;ncer de pele n&#227;o melanoma no couro cabeludo foram inclu&#237;dos&#58; todos masculinos&#44; com 71 anos &#40;paciente 1&#41;&#44; 90 anos &#40;paciente 2&#41;&#44; 81 anos &#40;paciente 3&#41; e 78 anos &#40;paciente 4&#41;&#46; As principais caracter&#237;sticas e comorbidades dos pacientes s&#227;o apresentadas na <a class="elsevierStyleCrossRef" href="#tbl0005">tabela 1</a>&#46; Os tumores foram excisados ap&#243;s uso de lidoca&#237;na com infiltra&#231;&#227;o de epinefrina&#44; e FTSG foram colhidos da regi&#227;o infraclavicular&#46; Vinte minutos ap&#243;s a remo&#231;&#227;o da les&#227;o e antes da sutura do enxerto de pele&#44; a perfus&#227;o basal do leito da ferida cir&#250;rgica &#40;em unidades de perfus&#227;o arbitr&#225;ria&#44; UPA&#41; foi medida com LSCI por 1 minuto&#44; e a press&#227;o arterial m&#233;dia &#40;PAM&#44; em mmHg&#41; foi registrada&#46; A rela&#231;&#227;o UPA&#47;PAM resultou na condut&#226;ncia vascular cut&#226;nea &#40;CVC&#41;&#44; em UPA&#47;mmHg&#44; possibilitando a compara&#231;&#227;o dos valores de perfus&#227;o dos pacientes&#46; Por fim&#44; o FTSG foi suturado e o curativo foi aplicado por uma semana&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Nos dias &#40;D&#41; 7&#44; D14&#44; D21 e D28&#44; a perfus&#227;o do enxerto foi avaliada e comparada com a perfus&#227;o basal do leito do enxerto no D0&#46; Tamb&#233;m foram registradas imagens cl&#237;nicas&#46; As &#225;reas de necrose foram calculadas com SketchAndCalc Area Calculator&#8482; &#40;vers&#227;o 6&#46;2&#46;5&#44; 2018&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Em todos os pacientes&#44; a remo&#231;&#227;o do c&#226;ncer de pele possibilitou a preserva&#231;&#227;o de alguma g&#225;lea aponeur&#243;tica subjacente para suprimento vascular do enxerto de pele&#46; Nenhum dos pacientes desenvolveu infec&#231;&#227;o&#44; hematoma ou hemorragia p&#243;s&#8208;operat&#243;ria&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">As &#225;reas do defeito prim&#225;rio mediam 8&#44;4 cm<span class="elsevierStyleSup">2</span> &#40;paciente 1&#41;&#44; 12&#44;3 cm<span class="elsevierStyleSup">2</span> &#40;paciente 2&#41;&#44; 5&#44;8 cm<span class="elsevierStyleSup">2</span> &#40;paciente 3&#41; e 8&#44;7 cm<span class="elsevierStyleSup">2</span> &#40;paciente 4&#41;&#46; A evolu&#231;&#227;o dos valores da CVC ao longo das quatro semanas &#233; mostrada na <a class="elsevierStyleCrossRef" href="#fig0005">figura 1</a>&#46; As imagens cl&#237;nicas e LSCI sequenciais registradas no mesmo per&#237;odo s&#227;o apresentadas na <a class="elsevierStyleCrossRef" href="#fig0010">figura 2</a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">Os valores basais de CVC do leito receptor foram 0&#44;22 UPA&#47;mmHg&#44; 0&#44;43 UPA&#47;mmHg&#44; 0&#44;51 UPA&#47;mmHg e 0&#44;70 UPA&#47;mmHg&#44; respectivamente&#44; nos pacientes 1&#44; 2&#44; 3 e 4&#46; A extens&#227;o da necrose do enxerto no D28 diminuiu com o aumento da perfus&#227;o no leito receptor &#40;CVC&#41; no D0 &#8211; 82&#37; no paciente 1&#44; 48&#37; no paciente 2&#44; 16&#37; no paciente 3 e 9&#37; no paciente 4&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">Ap&#243;s diminui&#231;&#227;o inicial do D0 ao D7&#44; no D14 a CVC do enxerto superou a CVC basal do leito receptor em todos os pacientes&#46; O aumento da perfus&#227;o do enxerto foi mais acentuado do D7 ao D21&#44; com posterior tend&#234;ncia de diminui&#231;&#227;o &#40;nos pacientes 2 e 4&#41; ou pequeno aumento &#40;nos pacientes 1 e 3&#41;&#46; Quanto menor a &#225;rea sob as curvas de perfus&#227;o&#44; maior a extens&#227;o da necrose do enxerto no D28 em todos os pacientes&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">A partir da an&#225;lise das imagens de LSCI&#44; foi observado que a partir do D14 as regi&#245;es do enxerto de pele mal perfundidas &#40;preto a azulado&#41; permaneceram relativamente est&#225;veis em extens&#227;o&#46; Essas regi&#245;es mal perfundidas no D14 sobrepuseram&#8208;se &#224;s regi&#245;es de necrose cl&#237;nica no D28&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Existem algumas maneiras de avaliar a perfus&#227;o da pele de modo n&#227;o invasivo&#44; mas faltam evid&#234;ncias que apoiem seu uso no monitoramento da vasculariza&#231;&#227;o de enxertos de pele&#46; A tomografia de coer&#234;ncia &#243;ptica requer avalia&#231;&#245;es sequenciais de menos de 1 cm<span class="elsevierStyleSup">2</span> ao longo da superf&#237;cie do enxerto de pele&#46; Al&#233;m disso&#44; o contato direto com o enxerto de pele pode ser inadequado em ambiente intraoperat&#243;rio ass&#233;ptico&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> A imagem por <span class="elsevierStyleItalic">laser</span> Doppler &#40;LDI&#44; do ingl&#234;s <span class="elsevierStyleItalic">laser Doppler imaging</span>&#41; possibilita a avalia&#231;&#227;o sem contato do fluxo sangu&#237;neo cut&#226;neo&#44; com excelente resolu&#231;&#227;o espacial&#44; mas baixa resolu&#231;&#227;o temporal&#44; especialmente ao avaliar &#225;reas extensas&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> O LDI tem profundidade de penetra&#231;&#227;o de 0&#44;5 a 1&#44;0 mm&#44; mais profunda que o plexo d&#233;rmico superficial que comp&#245;e a microcircula&#231;&#227;o cut&#226;nea&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> O LSCI supera a maioria das limita&#231;&#245;es das outras t&#233;cnicas&#46; Ele torna poss&#237;vel a aquisi&#231;&#227;o r&#225;pida de imagens de perfus&#227;o de alta resolu&#231;&#227;o de extensas &#225;reas da superf&#237;cie do enxerto sem contato&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> A curta penetra&#231;&#227;o da radia&#231;&#227;o <span class="elsevierStyleItalic">laser</span> &#40;0&#44;3 mm&#41; abrange capilares&#44; v&#234;nulas e arter&#237;olas do plexo capilar superficial&#44; incluindo a vasculatura do enxerto&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">A despeito das vari&#225;veis individuais n&#227;o analisadas e do pequeno tamanho da amostra n&#227;o permitir qualquer estimativa de correla&#231;&#227;o estat&#237;stica&#44; foi demostrado que a &#225;rea de necrose do FTSG aumentou com a diminui&#231;&#227;o da perfus&#227;o basal&#46; Os enxertos com piores resultados&#44; 82&#37; e 48&#37; de necrose&#44; tiveram as menores perfus&#245;es basais&#44; como observado nos pacientes 1 e 2&#44; respectivamente&#46; Al&#233;m disso&#44; no paciente 1&#44; com necrose subtotal do enxerto&#44; a inclina&#231;&#227;o da curva de perfus&#227;o foi mais descendente do que as demais&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Foi demonstrado que o estado de perfus&#227;o do leito do enxerto pode afetar o resultado do FTSG&#44; corroborando assim o conhecimento emp&#237;rico estabelecido&#46; Que seja de conhecimento dos autores&#44; este &#233; o primeiro relato do uso de LSCI no intraoperat&#243;rio para identificar pacientes com leitos receptores de enxerto mal perfundidos que apresentam&#44; em teoria&#44; risco aumentado de necrose do enxerto&#46; Essa metodologia deve ser expandida em amostras maiores e em &#225;reas de alto risco para necrose de enxertos de pele al&#233;m do couro cabeludo&#44; como superf&#237;cies plantares ou membros inferiores&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Com dados mais robustos&#44; a identifica&#231;&#227;o de um limiar de perfus&#227;o &#40;CVC&#41; pode tornar o enxerto de pele tardio op&#231;&#227;o melhor do que o enxerto de pele imediato ap&#243;s a excis&#227;o do tumor&#46; Tamb&#233;m se especula que as diferen&#231;as nas curvas de CVC ao longo da cicatriza&#231;&#227;o inicial do enxerto podem ajudar a prever maior risco de necrose tardia&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">LSCI pode ser promissor na sele&#231;&#227;o dos melhores candidatos para reconstru&#231;&#227;o cir&#250;rgica com FTSG e na predi&#231;&#227;o intraoperat&#243;ria de necrose tardia&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Suporte financeiro</span><p id="par0100" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Contribui&#231;&#227;o dos autores</span><p id="par0105" class="elsevierStylePara elsevierViewall">Andr&#233; Pinho&#58; Concep&#231;&#227;o&#44; investiga&#231;&#227;o &#40;l&#237;der&#41;&#44; an&#225;lise formal e elabora&#231;&#227;o&#8208;reda&#231;&#227;o original &#40;l&#237;der&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Ana Brinca&#58; Concep&#231;&#227;o e reda&#231;&#227;o&#8208;revis&#227;o e edi&#231;&#227;o &#40;l&#237;der&#41;&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Ana Figueiredo&#58; Investiga&#231;&#227;o &#40;suporte&#41;&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Duarte Flor&#58; Investiga&#231;&#227;o &#40;suporte&#41;&#44; an&#225;lise formal &#40;suporte&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Ricardo Vieira&#58; Concep&#231;&#227;o &#40;suporte&#41; e reda&#231;&#227;o&#8208;revis&#227;o e edi&#231;&#227;o &#40;suporte&#41;&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflito de interesses</span><p id="par0130" class="elsevierStylePara elsevierViewall">Nenhum&#46;</p></span></span>"
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dislipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LMS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Glaucoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dislipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Osteoartrite&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CEC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Transplante de rim&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dislipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CBC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Nenhum&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DAC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Dislipidemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">DM2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3563636.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "pt" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas e comorbidades dos pacientes &#40;do g&#234;nero masculino&#41; submetidos a enxerto de pele no couro cabeludo</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Refer&#234;ncias"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcomes of split vs full&#8208;thickness skin grafts in scalp reconstruction in outpatient local anaesthetic theatre"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46; Sun"
                            1 => "A&#46;J&#46; Patel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Scars Burn Heal&#46;"
                        "fecha" => "2021"
                        "volumen" => "7"
                      ]
                    ]
                  ]
                ]
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            1 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Full&#8208; or split&#8208;thickness skin grafting in scalp surgery&#63; Retrospective case series"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46;M&#46;H&#46; Hilton"
                            1 => "L&#46;R&#46; H&#246;lmich"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.29252/wjps.8.3.331"
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Plast Surg&#46;"
                        "fecha" => "2019"
                        "volumen" => "8"
                        "paginaInicial" => "331"
                        "paginaFinal" => "337"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31620335"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
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                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Santos X&#44; Iglesias I&#46; Necrotic Complications After Skin Grafts&#46; In&#58; Skin Necrosis&#46; Vienna&#58; Springer Vienna&#59; 2015&#46; p&#46;201&#8208;6&#46;"
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reconstruction of a secondary scalp defect using the crane principle and a split&#8208;thickness skin graft"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "Y&#46; Lu"
                            1 => "K&#46;C&#46; Chang"
                            2 => "C&#46;N&#46; Chang"
                            3 => "D&#46;H&#46; Chang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "BMC Surg&#46;"
                        "fecha" => "2021"
                        "volumen" => "21"
                        "paginaInicial" => "41"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Assessment of skin microvascular function and dysfunction with laser speckle contrast imaging"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46; Mah&#233;"
                            1 => "A&#46; Humeau-Heurtier"
                            2 => "S&#46; Durand"
                            3 => "G&#46; Leftheriotis"
                            4 => "P&#46; Abraham"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1161/CIRCIMAGING.111.970418"
                      "Revista" => array:6 [
                        "tituloSerie" => "Circ Cardiovasc Imaging&#46;"
                        "fecha" => "2012"
                        "volumen" => "5"
                        "paginaInicial" => "155"
                        "paginaFinal" => "163"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22253335"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
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                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Laser speckle contrast imaging for assessment of human skin graft microcirculation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Brinca"
                            1 => "A&#46; Pinho"
                            2 => "R&#46; Vieira"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Eur Acad Dermat Venereol&#46;"
                        "fecha" => "2020"
                        "volumen" => "34"
                        "paginaInicial" => "e491"
                        "paginaFinal" => "e493"
                      ]
                    ]
                  ]
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            6 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Imaging human skin autograft integration with optical coherence tomography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46;J&#46; Deegan"
                            1 => "J&#46; Lu"
                            2 => "R&#46; Sharma"
                            3 => "S&#46;P&#46; Mandell"
                            4 => "R&#46;K&#46; Wang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.21037/qims-20-750"
                      "Revista" => array:6 [
                        "tituloSerie" => "Quant Imaging Med Surg&#46;"
                        "fecha" => "2021"
                        "volumen" => "11"
                        "paginaInicial" => "784"
                        "paginaFinal" => "796"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33532277"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comparison between laser speckle contrast imaging and laser Doppler imaging to assess skin blood flow in humans"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46; Millet"
                            1 => "M&#46; Roustit"
                            2 => "S&#46; Blaise"
                            3 => "J&#46;L&#46; Cracowski"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.mvr.2011.06.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Microvasc Res&#46;"
                        "fecha" => "2011"
                        "volumen" => "82"
                        "paginaInicial" => "147"
                        "paginaFinal" => "151"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21745482"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
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ISSN: 26662752
Idioma original: Português
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