Barreira cutânea para reconstrução mamária com prótese Dermal barrier for immediate prosthetic breast reconstruction

INTRODUÇÃO: A reconstrução mamária imediata com implante de silicone após mastectomia subcutânea tornou-se uma opção válida para médicos e pacientes devido à simplicidade das manobras cirúrgicas, menor tempo cirúrgico, cicatriz mínima e resultados estéticos imediatos. Os implantes submusculares também são recomendados, apesar de exigirem um procedimento cirúrgico mais agressivo. Ambos também podem causar problemas secundários que já foram descritos. Para reduzir esse tipo de problemas, neste artigo é descrita uma modificação da mastopexia circunvertical, redução do padrão de mamoplastia para mastectomia e a reconstrução mamária imediata com implante. MÉTODO: A pele entre as linhas de incisão cutânea medial e vertical lateral é desepitelizada, criando uma barreira cutânea para a prótese para reforçar a linha de sutura vertical. CONCLUSÕES: A técnica garante uma reconstrução segura, com resultados estéticos gratificantes.BACKGROUND: Immediate breast reconstruction with silicone implant after subcutaneous mastectomy became a valid option among doctors and patients based on the simplicity of the surgical maneuvers, shorter surgical period, minimal scarring and immediate aesthetic results. Submuscular implants also have been advocated despite its more aggressive surgical procedures. Both also may bring secondary already described diversification's problems. An in attempt to reduce this kind of problems, in this article, a modification of the circumvertical mastopexy, reduction mammoplasty pattern for mastectomy and immediate breast implant reconstruction is described. METHODS: The skin between the medial and lateral vertical skin incision lines is de-epithelialized, providing a dermal barrier over the prosthesis to reinforce the vertical suture line. CONCLUSIONS: The technique ensures a safe reconstruction with gratifying aesthetic results

Provision of essential surgery in remote and rural areas of developed as well as low and middle income countries

AbstractBackgroundSurgery is increasingly becoming an integral part of public health and health systems development worldwide. Such surgical care should be provided at the same type and level in both urban and rural settings. However, provision of essential surgery in remote and rural areas of developed as well as low and middle income countries remains totally inadequate and poses great challenges.MethodsThough not intended to be a systematic review, several aspects of primary health care and its surgical aspects in remote and rural areas were reviewed. Search tools included Medline, PubMed and Scopius. Health concerns such as quality health care and limitations, as well as infrastructures, surgical workforce as well as implications for planning, teaching and training for surgical care in remote areas were searched.ResultsThe dire shortage of surgeons and anesthesiologists in most low and middle income countries means task shifting and training of non-physician clinicians (NPCs) is the only option particularly in most developing poor countries.ConclusionThe best means of bringing surgical care to rural dwellers is yet to be clearly determined. However, modern surgical techniques integrated with the strategy as outlined by the World Health Organization can be brought to rural areas through specially organized camps. Sophisticated surgery can thus be performed in a high-volume and cost-effective manner, even in temporary settings. However, provision of essential surgery to rural and remote areas can only partly be met both in developed and in low and middle income countries and it will take years to solve the problem of unmet surgical needs in these areas

Original Article - The efficacy of moisture retentive ointment in the mangement of cutaneous wounds and ulcers: A multicenter clinical trial

Local management of chronic wounds and ulcers remains one of the most costly unsolved problems in health care today. With proper clinical management, most chronic wound healing problems can be resolved and healing expected, though recurrence may be common. The recent logarithmic growth in our knowledge about wound healing and the appreciation of the importance of a moist environment in optimal wound healing has led to the introduction of new and exciting therapeutic modalities. In view of the many practical disadvantages as well as the serious complications of currently available moisture retentive dressings when applied to chronic contaminated wounds, a prospective multicenter clinical trial was conducted from December 1999 to November 2000 to evaluate the safety and efficacy of a newly introduced moisture retentive ointment (MEBO: Moist Exposed Burn Ointment) (Julphar – Gulf Pharmaceutical Industries, UAE) in the local wound care of problematic non-healing wounds. The active component of the ointment is ß-sitosterol in a base of beeswax, sesame oil and other components. Though it was not a comparative study, the ointment was found to induce rapid reduction in ulcer size even after a prolonged stagnant state with other therapeutic modalities without complications such as skin maceration, unmanageable excessive exudation, and wound infection. As expected with such chronic wounds, the healing potential of local ointment application is limited by the mere size of the original defect and the underlying pathologies and associated diseases. however, the safety and practicality of simple ointment application was found to be a valid alternative treatment for local management of chronic wounds

Determination of Appropriate Umbilicus Position during Abdominoplasty in Male Patients

Background:. Abdominoplasty techniques are well documented. The ideal position of the umbilicus has, however, received limited attention. Unfortunately, umbilicus position is not universally agreed upon in male cosmetic abdominoplasty. This study was conducted to determine the ideal umbilicus anthropometric measurements in young men, and the relationships between umbilical position and anterior trunk and torso reference points that may be applicable to intraoperative positioning. It is aimed also at investigating whether umbilicus position would be more accurately determined by considering nipple position instead of the abdominal crease, as recently proposed. Methods:. Several anthropometric measurements of various anterior abdominal and thoracic landmarks were conducted on 60 young and middle-aged male volunteers and 30 cadavers at São Paulo city. All statistical analysis was completed using Stata software. Results:. Of all the measured reference points, a much stronger correlation (0.513) was demonstrated between umbilicus-anterior axillary fold (U-AX) and inter-nipple (N-N) distances with a constant golden number ratio relationship (N-N = U-AX × 0.618) compared with the weak correlation of 0.034 between umbilicus-xiphisternum and umbilicus-abdominal crease. In 75% of volunteers, the calculated U-AX was within ±3 cm of actual measurement, and in 33.33% within ±1 cm. Conclusions:. U-AX = 1.618 × N-N equation is more predictive of adequate umbilicus repositioning during abdominoplasty in male patients. Chest and abdomen of men are a single aesthetic unit. Proper positioning of the nipples and umbilicus, as well as harmonious abdominal and torso proportions are critical for an optimal final aesthetic outcome