Simple and composite circumferential abdominoplasty: technical evolution, 10-year experience and analysis of complications

Introduction: Morbidly obese patients undergoing bariatric surgery after massive weight loss evolve with large skin folds in various body regions, including the abdomen. In patients with dermofat excesses throughout the abdominal circumference and ptosis of the gluteal region, circumferential abdominoplasty (simple or composite) has been an effective surgical solution conventional or “anchor” abdominoplasty brings unsatisfactory results in those patients with severe dysmorphia. The objective is to analyze the technical evolution of simple and composite circumferential abdominoplasty and its complications. Methods: Twenty-nine patients were evaluated, 28 females, with a mean age of 41.17 years, submitted to circumferential abdominoplasty between 2002 and 2012. This retrospective study, conducted through data collected from medical records, evaluated: surgery time, the weight of the resected surgical specimen, length of hospital stays, antibiotic therapy used, associated complications, and changes in the surgical technique in this period. Results: Composite circumferential abdominoplasty was performed in 23 patients (79.3%) and the simple one in six (20.7%). The mean surgical time was 346 minutes, and the surgical specimen’s mean weight was 4323 grams. Three patients (10.3%) had significant complications (symptomatic anemia and major suture dehiscence) and five (17.2%) minor complications (minor dehiscence, slight spontaneous bleeding, seroma, and hypertrophic scarring). Between 2002 and 2004, 75% of the complications occurred. The reoperation rate was 6.9%. Conclusion: There was a significant technical evolution in circumferential abdominoplasty performance, and the incidence of complications and the rate of reoperation were similar to those found in the literature

Estudo histológico comparativo das cartilagens alares nasais em pacientes com fissura labial unilateral

Patients with unilateral cleft lip display characteristic nasal changes that are independent of the degree of deformity. Defenders of the intrinsic theory consider these deformities to be due to embryogenic alterations of the alar nasal cartilages. Those that propose the extrinsic theory defend the thesis that the deformity is due to disorganization of the perioral muscles deformed by the cleft. The purpose of this study is to contribute histological evidence to help clarify the issue. PATIENTS AND METHODS: Specimens of the lateral portion of both the healthy and the cleft side of the alar cartilages were obtained from 18 patients. These uniformly cut specimens were stained by hematoxylin and eosin. Samples from 2 patients were excluded due to imperfections. The same pathologist examined all the slides. He was unaware of the origins of the specimens; he counted the number of chondrocytes and quantified the cartilage matrixes. RESULTS: All data was analyzed statistically, and no significant statistical differences were apparent, either in the number of chondrocytes or the cartilage matrix between the healthy side and the cleft side. DISCUSSION: These results apparently support the group that defend the extrinsic theory; nevertheless, the doubt about the composition of the cartilage matrix remains, not only concerning the glycosaminoglycans that compose them, but also regarding elastin and collagen and its linkages that can cause different degrees of collagen consistency.Portadores de fissura labial unilateral, independentemente do grau da deformidade, apresentam uma alteração nasal característica. Alguns autores julgam que esta deformidade deve-se a alterações embriogenicas das cartilagens alares nasais, são os defensores da teoria intrínseca. Outros, que propõem a teoria extrínseca, defendem a tese de que a deformidade deve-se a ação desordenada da musculatura perioral deformada pela fissura. PACIENTES E MÉTODOS: Em uma tentativa de trazer alguma contribuição, neste trabalho obtiveram-se amostras da porção lateral das cartilagens alares -- tanto do lado são quanto do lado fissurado -- de 18 pacientes. Estas amostras cortadas, uniformemente, pelo mesmo micrômetro foram coradas pela hematoxilina-eosina, no entanto, as amostras de dois pacientes tiveram que ser desprezadas dada a imperfeições. Todos os cortes foram examinados pelo mesmo patologista que, ignorando as origens, contou o número de condrócitos e quantificou as matrizes cartilaginosas. RESULTADOS: Todos os dados obtidos foram submetidos a testes estatísticos que revelaram não haver qualquer diferença significativa, tanto quanto ao número de condrócitos quanto às matrizes cartilaginosas, entre os lados são e o fissurado. DISCUSSÃO: Tais resultados, aparentemente, apoiam aqueles que defendem a teoria extrínseca; todavia, permanece a dúvida quanto à composição das matrizes cartilaginosas, não só dos glicosaminoglicanos que as compõem como, também, quanto à elastina e ao colágeno e suas coligações que podem determinar diferentes graus de consciência à cartilagem

Tratamento cirúrgico do linfedema peno-escrotal

PURPOSE: Lymphedema of the penis and scrotum, regardless of its etiology, is determined by reduced lymphatic flow with subsequent enlargement of the penis and scrotum. The clinical course of this condition is characterized by extreme discomfort for patients, with limitation of local hygiene, ambulation, sexual intercourse, and voiding in the standing position. The purpose of the present study is to present the experience and results of the treatment of lymphedema of the penis and scrotum by removing affected tissues and correcting the penoscrotal region. MATERIALS AND METHODS: Seventeen patients with lymphedema of the penis and scrotum were treated with a modified Charles procedure, which consists of the excision of the affected skin followed by scrotoplasty and midline suture simulating the scrotal raphe. The penis is covered with a split-thickness skin graft by means of a zigzag suture on its ventral surface. RESULTS: Regression of symptoms and improvement of previous clinical conditions were verified in the follow-up which ranged from 6 months to 6 years. One patient who had undergone lymphadenectomy with radiation therapy due to penile cancer had recurrent scrotum lymphedema. CONCLUSIONS: The modified Charles procedure for the treatment of penoscrotal lymphedema is easily reproducible and allows better local hygiene, easier ambulation, voiding in the standing position, resuming sexual intercourse, and finally, better cosmetic results in the affected area with remarkable improvement in quality of life.INTRODUÇÃO: O linfedema peno-escrotal, independentemente da etiologia, é determinado pela redução do fluxo linfático com conseqüente aumento do volume do escroto e pênis. A evolução clínica da doença é caracterizada com extremo desconforto ao paciente, limitando a higiene local, a deambulação, o intercurso sexual e a micção em posição ortostática. OBJETIVO: Apresentar a experiência e resultados no tratamento da patologia com remoção dos tecidos comprometidos e correção peno-escrotal. MÉTODO: Foram tratados 17 pacientes com linfedema do escroto e pênis com a técnica de Charles modificada, que consiste na excisão da pele comprometida seguida de escrotoplastia e sutura mediana simulando a rafe escrotal. O pênis é recoberto com enxerto de pele parcial suturado em linha quebrada na face ventral. RESULTADOS: No seguimento dos pacientes, que variou entre 6 meses e 6 anos, constatou-se regressão dos sintomas e melhora das condições clínicas prévias. Um paciente submetido à linfadenectomia com radioterapia por câncer de pênis teve recidiva do linfedema escrotal. CONCLUSÃO: A técnica de Charles modificada no tratamento do linfedema peno-escrotal é facilmente reprodutível e possibilita com seus resultados melhor higiene local, melhor movimentação, micção em posição ortostática, retomada do intercurso sexual e, finalmente, melhor aparência à região comprometida com franca melhora da qualidade de vida

Prospective study of inflammatory response in patients submitted to abdominoplasty after bariatric surgery

Introduction: Obesity is a chronic inflammatory disease associated with changes in inflammatory markers such as interleukins and CRP. This study evaluates the inflammatory response, through variations in interleukins and CRP, in patients undergoing abdominoplasty. Methods: Fourteen patients underwent abdominoplasty after weight loss achieved through bariatric surgery to maintain weight loss for at least18 months. Il4, IL6, IL10 and PCR levels were verified at times: preoperative, during surgery, 24 hours after surgery, 7th postoperative day and 14th postoperative day. Results: IL4 increased in the 24 hours postoperatively and continued on the rise until the 14th day. IL10 went up during surgery and began to fall in the 24 hours postoperatively to levels lower than the initial ones. IL6 began to rise during surgery, being more expressive in the 24 hours postoperatively, followed by a fall until the 14th day. CRP increased 24 hours postoperatively and remained discharged until the 14th day. Conclusion: Abdominoplasty reduced the chronic inflammatory systemic condition

Treatment of coxofemoral dysmorphia in formerly obese patients

INTRODUÇÃO: Os pacientes que apresentam perda poderal maciça evoluem com sobras dermogordurosas em várias áreas corporais, incluindo os membros inferiores. Diante da heterogeneidade de localização, forma e conteúdo das dismorfias coxofemorais, este trabalho oferece um roteiro de planejamento e sistematização para tratamento de cada uma das deformidades. MÉTODO: Foram avaliadas 28 pacientes do sexo feminino que realizaram coxoplastias e que apresentavam basicamente 3 tipos de deformidade, que poderiam envolver apenas o terço superior, os terços superior e médio ou toda a face medial das coxas. Para cada tipo de deformidade foi aplicada técnica específica; além disso, quando necessário, foi associada suspensão da face lateral das coxas e lipoaspiração. A satisfação das pacientes com os resultados cirúrgicos foi avaliada por meio da aplicação de questionários e notas atribuídas a cada resposta. Foram enumerados intercorrências, complicações e tratamento aplicado. RESULTADOS: Os itens mobilidade, higiene, desempenho sexual, vestimentas e cicatrizes foram avaliados como ótimo (80,5%), bom (14,5%) e regular (5%). CONCLUSÕES: Considerando-se a grande heterogeneidade de dismorfias das coxas em pacientes ex-obesos, um roteiro de tratamento relacionando a deformidade ao tratamento deve ser incorporado ao arsenal cirúrgico

Monsplasty for Women After Massive Weight Loss

Ptosis with excess skin in the pubic area is a very common deformity in patients after massive weight loss. This deformity requires adequate surgical treatment whether combined with abdominoplasty or not. The enlarged pubogenital area may lead to psychosocial distress and impaired quality of life. A series of 23 women with a mean age of 39.5 years who previously underwent bariatric surgeries and later presented with pubogenital ptosis underwent monsplasty. The preoperative surgical markings and the surgical technique presented are easily reproducible. In this prospective study, the surgical outcomes were assessed by questionnaires applied to the patients, who scored the following parameters: movement dynamics, aesthetic appearance, sexual performance, improved hygiene, and use of clothing items. Four of the parameters assessed (movement dynamics, aesthetic appearance, hygiene, and use of clothing items) showed clear improvement, with scores ranging from good to very good. A small percentage of the patients (13%) reported fair improvement in sexual performance. The findings showed monsplasty to be a simple and reproducible technique with favorable outcomes and low morbidity rates

Mammaplasty with Inferior Pedicle Flap After Massive Weight Loss

After massive weight loss, one of the stigmas that afflict women is the remaining deformity of the breasts which become flaccid and ptotic, with an absent or flat upper pole. The authors propose the use of a well-established mammaplasty technique to fill the upper pole, reshape the breast cone, and correct ptosis with nipple-areola complex (NAC) repositioning. A total of 16 patients were analyzed; all underwent gastroplasty between 18 and 24 months prior to mammaplasty. The mean age was 41.6 years (range = 26-62) and the mean BMI previous to the mammaplasty was 29.2 kg/m(2) (range = 24.9-38.9). The technique included a dermo-lipo glandular flap pedicled on the inframammary fold (IMF) together with a superior flap containing the NAC. All patients who underwent surgery were satisfied with the outcomes since a more aesthetic breast shape was achieved, with projection of the upper pole and correction of ptosis. Adverse events included dehiscence at the junction point of the flaps in the inframammary fold, which resolved with secondary-intention wound healing in three patients; partial necrosis of the areola in one patient; epidermolysis in one of the NACs in one patient; and infection in one of the breasts in one patient, which resolved with proper antibiotic therapy. When compared to the current mammaplasty techniques performed in formerly obese patients, this is a good surgical option because it uses tissues adjacent to the breast itself and does not require silicone prosthesis for breast augmentation. The patients reported increased self-esteem and improvement in their quality of life

Tratamento das dismorfias coxofemorais em pacientes ex-obesos Treatment of coxofemoral dysmorphia in formerly obese patients

INTRODUÇÃO: Os pacientes que apresentam perda poderal maciça evoluem com sobras dermogordurosas em várias áreas corporais, incluindo os membros inferiores. Diante da heterogeneidade de localização, forma e conteúdo das dismorfias coxofemorais, este trabalho oferece um roteiro de planejamento e sistematização para tratamento de cada uma das deformidades. MÉTODO: Foram avaliadas 28 pacientes do sexo feminino que realizaram coxoplastias e que apresentavam basicamente 3 tipos de deformidade, que poderiam envolver apenas o terço superior, os terços superior e médio ou toda a face medial das coxas. Para cada tipo de deformidade foi aplicada técnica específica; além disso, quando necessário, foi associada suspensão da face lateral das coxas e lipoaspiração. A satisfação das pacientes com os resultados cirúrgicos foi avaliada por meio da aplicação de questionários e notas atribuídas a cada resposta. Foram enumerados intercorrências, complicações e tratamento aplicado. RESULTADOS: Os itens mobilidade, higiene, desempenho sexual, vestimentas e cicatrizes foram avaliados como ótimo (80,5%), bom (14,5%) e regular (5%). CONCLUSÕES: Considerando-se a grande heterogeneidade de dismorfias das coxas em pacientes ex-obesos, um roteiro de tratamento relacionando a deformidade ao tratamento deve ser incorporado ao arsenal cirúrgico.BACKGROUND: Patients showing massive weight loss eventually develop excessive skin and fat in several body parts, including the lower extremities. Given the diversity of the localization, shape, and content of coxofemoral dysmorphia, this study proposes guidelines for planning and systematizing the treatment of each deformity. METHODS: Twenty-eight female patients who underwent thigh lifts and showed 3 types of deformities were assessed. The deformities encompassed the upper third of the thigh alone, the upper and middle thirds, or the entire medial aspect of the thighs. A specific technique was used for treating each type of deformity. Moreover, when necessary, suspension of the lateral thigh was combined with liposuction. Patient satisfaction with the surgical results was assessed by a graded questionnaire. Unexpected events, complications, and treatments were recorded. RESULTS: Mobility, hygiene, sexual performance, use of clothing, and scars were assessed as excellent (80.5%), good (14.5%), and regular (5%). CONCLUSIONS: Considering the broad heterogeneity of thigh dysmorphia in formerly obese patients, therapeutic guidelines correlating each type of deformity with a specific treatment are necessary

Radical resection and local coverage of hidradenitis suppurativa - acne inversa: analysis of results

ABSTRACT Objective: to evaluate the primary outcome of local complications and late recurrence in patients with hidradenitis suppurativa undergoing radical resection and specific reconstruction. Methods: we conducted a retrospective analysis of the medical records of patients attended by the Plastic Surgery Service of the Clinics Hospital, Medical School, USP, between 2010 and 2016. We included patients who underwent radical resection of hidradenitis suppurativa in advanced stage and reconstruction through primary closure, grafts or flaps. Results: we analyzed 34 lesions in 19 patients, of which 64.5% had local complications, though with 73.5% efficient healing after 12 weeks postoperatively. We observed late recurrence in 47%, but in isolation, 22.2% of the reconstructions with locoregional flaps had recurrence after one year. Conclusion: extensive and radical resection of the disease associated with locoregional flap coverage (pedicled or perforating) has been shown to be the best management in terms of late results