Closed glabellar myotomy: a new surgical approach to treat wrinkles without scarring

INTRODUCTION: Hyperactivity of the glabellar musculature and resulting wrinkles are frequent complaints in the field of plastic surgery. Treatment consists of blocking the involved muscles. We propose a closed approach for the treatment of glabellar musculature. METHODS: Seventy-eight patients underwent operation between April 2012 and August 2015. Myotomy includes the use of markings and polyglactin 0 wire or steel wire, passing through the marked lines several times, entering the eyebrow and using the juxtaperiostal plane, returning through the same orifice of the needle toward the entry hole, and using the subcutaneous plane. RESULTS: Good results were obtained in all cases by preventing glabellar muscle activity during the period evaluated (at least 1 year), with improvement in wrinkles and muscle hyperactivity. The complications observed included temporary paresthesia in the frontal region (35 cases) and partial recurrence (4 cases). There was no case of total recurrence. The options for long-term surgical treatment of glabellar wrinkles are myotomy, partial neurotomy, or myectomy. Closed glabellar myotomy prevents some possible complications associated with these options, reduces the surgical time, requires the use of conventional surgical instruments, eliminates scarring, and causes asymmetric correction, less edema, and fewer bruises. CONCLUSION: Closed glabellar myotomy seems to be a good alternative compared to other traditional surgical options, because it eliminates scarring, allows correction of asymmetry, and presents good long-term results

Pectus excavatum and breast asymmetry: correction with breast augmentation

INTRODUCTION: Pectus excavatum is defined as a depression approaching the sternum and costal cartilages to the spine. Several theories explain its etiology, the most accepted of which is the exaggerated growth of the costal cartilages, which causes a posterior displacement of the sternum and consequent depression. The treatment includes correction of breast asymmetries by using silicone breast implants in patients without cardiopulmonary symptoms, only with esthetic complaints. METHODS: We reviewed the medical and photographic records of eight female patients diagnosed as having pectus excavatum, who underwent operation at a private hospital in the southern region of Brazil. These women sought consultation for local esthetic complaints and had no cardiorespiratory complaints. RESULTS: Six patients submitted only for breast prosthesis placement. One patient had a prosthesis implanted 15 years before, which was replaced by a new implant in the same plane. Another patient had undergone pectus repair with Nuss surgery 10 years before, and the patient came to the hospital with a complaint of hypomasty and asymmetry. The preferred anesthesia was general anesthesia in five of the cases. The prosthesis inclusion plane in almost all the cases was subglandular. Only one patient had a complication (seroma). CONCLUSIONS: In our sample, the placement of breast prostheses in the patients with pectus excavatum brought harmonic esthetic results, attenuating and/or masking the chest defect, with satisfactory esthetic results for the patients

Rhinophyma: a surgical treatment option

INTRODUCTION: Rhinophyma is a condition involving chronic inflammation of the nose and is characterized by progressive hypertrophy and hyperplasia of sebaceous glands and connective tissue. Rhinophyma leads to an appearance of nasal elephantiasis, which is caused by the congestion of dermis vessels. Its etiology is mostly associated with alcohol abuse. Rhinophyma is considered by some researchers to be an advanced stage of acne rosacea. Here, we report a case of rhinophyma that was surgically treated with decortication and electrocoagulation at the Plastic Surgery Service of the University Hospital of the Federal University of Santa Catarina. METHODS: A review of medical and photographic records of a case of rhinophyma was conducted. RESULTS: The patient was underwent surgical treatment with favorable outcomes. CONCLUSION: There are several treatments for rhinophyma, with decortication and electrocoagulation being an excellent therapeutic option

Carcinoma epidermoide: avaliação das margens cirúrgicas laterais pós exérese por bisturi de dupla lâmina

Dissertação (mestrado profissional) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde, Programa de Pós-Graduação em Cuidados Intensivos e Paliativos, Florianópolis, 2017.Introdução : O câncer da pele não melanoma é responsável por um terço dos tumores nos Estados Unidos da América. O Carcinoma espinocelular (CEC) é um dos seus subtipos, e se desenvolve em áreas fotoexpostas, apresentando alta taxa de cura após a excisão completa do tumor com margens periféricas. A cirurgia convencional pode apresentar resultados falso-negativos, o padrão ouro é a cirurgia micrográfica - porém tem alto custo e requer treinamento especializado e, como alternativa, pode ser usado o bisturi de dupla lâmina (DBL). O CEC afeta atividades diárias e hábitos sociais, causando influência negativa na Qualidade de Vida (QV). Objetivos: Descrever a implementação do DBL para ressecção de CEC, avaliando a efetividade do procedimento com a cirurgia convencional e avaliar a QV desses pacientes. Métodos: Estudo transversal realizado em um serviço de cirurgia plástica no sul do Brasil, em pacientes atendidos com diagnóstico clínico de CEC, corroborado pela dermatoscopia. Foi utilizado o DBL para excisar as bordas de CEC primários, para análise histopatológica das margens, seguindo protocolo cirúrgico proposto por Schultz. Foi aplicado o questionário de Qualidade de Vida em dermatologia (DLQI). As variáveis contínuas foram expressas em média (desvio-padrão) após realização de teste de normalidade de Kolmogonov-Smirnoff, ou mediana, e as variáveis categoricas foram descritas em valor absoluto e proporção. Resultados: dos 50 pacientes com diagnóstico clínico de CEC, auxiliado pela dermatoscopia, foram excluídos 4 (outro subtipo de tumor). Dos 46 avaliados, a idade média foi 67,1+-16,0 anos, com predomínio o sexo masculino (31(67,4%)), fototipo de pele Fitzpatrick II(58,7%) e baixo índice de escolaridade e de nível socioeconômico. Metade dos participantes tinha lesões múltiplas, sendo a localização mais comum cabeça\pescoço (52,2%). Foi observado 3(6,5%) casos com margens profundas acometidas, e 1(2,2%) caso com margens periféricas comprometidas quando utilizado a técnica de bisturi de dupla lâmina. Nesse último, a análise pela anatomia patológica foi falso-negativa com material obtido pela cirurgia convencional. Sendo o resultado falso negativo pela análise anatomopatológica convencional. O valor médio do DLQI foi de 4,02 ± 0,63, e na categorização, 11 (23,9%) apresentaram efeito negativo na QV, de moderado a grave. O escore DLQI, estratificado em =5 (moderada, grave e muito grave), não apresentou associação com nenhuma variável. O tumor de pele teve um percentual de influência negativa nas atividades diárias em 33% dos casos e, em 30%, quando considerado os efeitos do tratamento. Conclusão: O uso do BDL mostrou ser uma técnica de rápida e fácil execução, facilitando a análise histopatológica e reduzindo resultados falso-negativos, quando comparado a cirurgia convencional. O diagnóstico de CEC exerce impacto negativo na QV dos pacientes.Abstract : Introduction: Non-melanoma skin cancer accounts for a third of tumors in the United States. Squamous cell carcinoma (SCC) is one of its subtypes, and develops in photoexposed areas, presenting a high cure rate after complete excision of the tumor with peripheral margins. Conventional surgery may present false-negative results, the gold standard is micrographic surgery - however, it is expensive and requires specialized training - and the double-blade scalpel (DBL) can be used as an alternative. CEC affects daily activities and social habits, causing negative influence on Quality of Life (QoL). Objectives: To describe the implementation of DBL for resection of CPB, evaluating the effectiveness of the procedure with conventional surgery and to evaluate the QoL of these patients. Methods: A cross-sectional study performed at a plastic surgery service in southern Brazil, in patients with a clinical diagnosis of CPB, corroborated by dermoscopy. DBL was used to excision the edges of primary ECC, for histopathological analysis of the margins, following a surgical protocol proposed by Schultz. The Quality of Life questionnaire in dermatology (DLQI) was applied. Continuous variables were expressed as mean (standard deviation) after the Kolmogonov-Smirnoff normality test, or median, and the categorical variables were described in absolute value and proportion. Results: Out of the 50 patients with clinical diagnosis of CPB, assisted by dermatoscopy, 4 (another tumor subtype) were excluded. Of the 46 evaluated, mean age was 67.1 + -16.0 years, with a predominance of males (31 (67.4%)), Fitzpatrick II skin phototype (58.7%) and low schooling index socioeconomic level. Half of the participants had multiple lesions, with the most common head and neck location (52.2%). 3 (6.5%) cases with deep margins were affected, and 1 (2.2%) cases with peripheral margins compromised when using the double blade scalpel technique; in the latter, the analysis by the pathological anatomy was false-negative with material obtained by conventional surgery. The false negative result is the conventional anatomopathological analysis. The mean value of DLQI was 4.02 ± 0.63, and in the categorization, 11 (23.9%) presented a moderate to severe negative effect on QoL. The DLQI score, stratified by = 5 (moderate, severe and very severe), was not associated with any variable. The skin tumor had a negative influence on daily activities in 33% of cases and 30% when considering the effects of treatment. Conclusion: The use of BDL was shown to be a quick and easy technique, facilitating histopathological analysis and reducing false negative results when compared to conventional surgery. The diagnosis of CPB has a negative impact on patients' QoL

Retalho mediofrontal para reconstrução nasal

Introdução: O retalho mediofrontal foi descrito 600 anos antes de Cristo para a reconstrução nasal, mas é ainda muito utilizado na reconstrução das lesões nasais tumorais. Objetivo: Relatar a experiência de um serviço universitário de cirurgia plástica no uso desse retalho. Métodos: Foi realizado o estudo restrospectivo descritivo de uma série de 35 casos operados em período de dez anos e seis meses. Resultados: A idade média dos pacientes foi de 68,6 anos com predomínio do gênero masculino. O retalho mediofrontal foi utilizado para reconstrução após ressecção de tumores, sendo o carcinoma basocelular o mais frequente. Conclusões: O retalho mediofrontal representa a escolha ideal reconstrutiva para muitos pacientes com bom resultado estético e funcional

Fatores perinatais associados a recém-nascidos de termo com pH<7,1 na artéria umbilical e índice de Apgar <7,0 no 5º minuto Perinatal factors associated with pH<7.1 in umbilical artery and Apgar 5 min <7.0 in term newborn

OBJETIVO: Avaliar os fatores perinatais associados a recém-nascidos de termo com pH<7,1 na artéria umbilical e índice de Apgar no 5º min<7,0. MÉTODOS: Estudo retrospectivo com delineamento caso-controle, realizado após revisão dos prontuários de todos os nascimentos ocorridos entre setembro/1998 e março/2008, no Hospital Geral de Caxias do Sul. Foi considerado fator de inclusão os recém-nascidos de termo que apresentaram índice de Apgar no 5º min <7,0 e pH de artéria umbilical <7,1. Na análise univariada foi utilizado o teste t de Student e Mann-Whitney para as variáveis contínuas, o teste do c² para as variáveis dicotômicas e estimativa de risco pelo odds ratio (OR). Foi utilizado um valor de p<0,05 como estatisticamente significativo. RESULTADOS: De um total de 15.495 nascimentos consecutivos observaram-se 25 neonatos (0,16%) de termo com pH<7,1 na artéria umbilical e índice de Apgar no 5º min <7,0. Apresentaram associação significativa com o evento acidótico a apresentação pélvica (OR=12,9; p<0,005), parto cesáreo (OR=3,5; p<0,01) e cardiotocografia intraparto alterada (OR=7,8; p<0,02). Dentre as características fetais, associaram-se o déficit de base (-15,0 versus -4,5; p<0,0001), necessidade de internação em unidade de terapia intensiva neonatal (OR=79,7; p<0,0001) e necessidade de reanimação (OR=12,2; p<0,0001). CONCLUSÃO: Baixo índice de Apgar no 5º min de vida associado a pH<7,1 na artéria umbilical pode predizer desfechos neonatais desfavoráveis.<br>PURPOSE: To assess perinatal factors associated with term newborns with pH<7.1 in the umbilical artery and 5th min Apgar score<7,0. METHODS: Retrospective case-control study carried out after reviewing the medical records of all births from September/1998 to March/2008, that occurred at the General Hospital of Caxias do Sul. The inclusion criterion was term newborns who presented a 5th min Apgar score <7.0 and umbilical artery pH<7.10. In the univariate analysis, we used the Student's t-test and the Mann-Whitney test for continuous variables, the c² test for dichotomous variables and risk estimation by the odds ratio (OR). The level of significance was set at p<0.05. RESULTS: Of a total of 15,495 consecutive births, 25 term neonates (0.16%) had pH<7.1 in the umbilical artery and a 5th min Apgar score <7.0. Breech presentation (OR=12.9, p<0.005), cesarean section (OR=3.5, p<0.01) and modified intrapartum cardiotocography (OR=7.8, p<0.02) presented a significant association with the acidosis event. Among the fetal characteristics, need for hospitalization in the neonatal intensive care unit (OR=79.7, p <0.0001), need for resuscitation (OR=12.2, p <0.0001) and base deficit were associated with the event (15.0 versus -4.5, p<0.0001). CONCLUSION: Low Apgar score at the 5th min of life associated with pH<7.1 in the umbilical artery can predict adverse neonatal outcomes

Increased prevalence of low back pain among physiotherapy students compared to medical students

Some studies have demonstrated that physiotherapists have a high prevalence of low back pain (LBP). The association between physiotherapy students, who are potentially exposed to the same LBP occupational risks as graduates, and LBP has never been demonstrated. The objective of the study is to evaluate the association between undergraduate physiotherapy study and LBP. The study design includes a cross-sectional study. A questionnaire-based study was carried out with physiotherapy and medical students. LBP was measured as lifetime, 1-year and point prevalence. Bivariate and multivariate analyses were performed to find the factors associated with LBP. Bivariate analyses were also performed to assess differences between LBP characteristics in the two courses. 77.9% of the students had LBP at some point in their lives, 66.8% in the last year and 14.4% of them reported they were suffering from LBP at the moment of answering the questionnaire. Physiotherapy students reported a higher prevalence of LBP when compared with the medical students in all measures. In the logistic regression model, physiotherapy students (A-OR 2.51; 95% CI 1.35–4.67; p = 0.003), and being exposed to the undergraduate study for more than four semesters (A-OR 2.55; 95% CI 1.43–4.55; p = 0.001) were independently associated with LBP. There were no differences between the courses concerning pain intensity and disability. As it was a cross-sectional study, we were not able to observe accurately if there is an increasing incidence of LBP during the course. Also, we did not intend to identify which activities in the course were associated with the development of LBP. This study clearly demonstrated an association between undergraduate physiotherapy study and LBP. The length of course exposure is also associated with LBP