Is Latin America Ready to Identify Anaplastic Large Cell Lymphoma in Breast Implants Patients? Regional Encounter During the National Plastic Surgery Meeting in Cancun, Mexico.

INTRODUCTION: Anaplastic large cell lymphoma associated with breast implants is receiving increased attention. Most cases have been reported in Europe, North America (USA and Canada), Australia and New Zealand. Fewer cases have been reported in Latin America (including Mexico), Africa and Asia. METHODS: This report was delivered during our national plastic surgery meeting in Cancun in May 2017. Before the meeting, two participants reviewed the literature. The review was performed using the following information sources: PubMed, Embase, Cochrane, Fisterra, Google Scholar and LILACS, with entries from 1980 to August 2015 in several languages (English, Spanish, French and Portuguese). The results were revealed during the meeting to the other participants. The consensus was divided into two parts. The first part included an open-ended question regarding the incidence and prevalence of the problem. The second part included clinical scenarios with different items that were rated by the participants. After this activity, accordance among the responses was evaluated. RESULTS: Seven cases were reported during the meeting (3 from Mexico, 3 from Chile and 1 from Argentina). Fifty percent of the participants reported consulting with guidelines and clinical centers to help with potential cases. Most agreed that further studies must be done in cases of chronic seroma where the capsule plays an important role. DISCUSSION: A current debate exists about the incidence of this problem in Latin America because we did not report the same number of cases as Europe, Australia or North America. More studies are required to determine the differences among reports in Latin America. CONCLUSION: Most representatives agreed that further studies must be done. Concern is increasing, and the problem is known. Other factors involved may be considered, and the problem must not be ignored. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Estratificación del riesgo quirúrgico infeccioso en pacientes sometidos a cirugía plástica estética y posbariátrica / Infectious surgical risk strafication in aesthetic plastic surgery and postbariatric patients

ANTECEDENTES: en Venezuela, nos encontramos con una falta de disponibilidad de los antibióticos sugeridos en las guías internacionales para la profilaxis preoperatoria, así como también es un hecho los niveles en ascenso de la resistencia bacteriana a los antibióticos OBJETIVO: desarrollar un sistema de puntuación que permita diseñar un esquema de profilaxis antimicrobiana para las infecciones del sitio quirúrgico adaptado a los factores de riesgo en cirugía plástica estética y posbariátrica. METODOLOGÍA: se realizó un trabajo de corte longitudinal, descriptivo y retrospectivo entre enero de 2016 y marzo de 2018. La muestra estuvo integrada por 100 pacientes a quienes se les practicó alguna cirugía y que fue evaluado por el médico internista infectólogo de la Unidad. Se revisaron las historias médicas y se registraron datos generales (edad, índice de masa corporal), antecedentes (hábito tabáquico, diabetes mellitus, patologías de piel, infecciones urinarias en los últimos 6 meses, ser portador de S. aureus, uso de antibióticos en los últimos 6 meses, cirugías previas), datos de la cirugía (área quirúrgica, tiempo quirúrgico, uso de drenajes), profilaxis antimicrobiana (transoperatoria y postoperatoria) y las complicaciones infecciosas. RESULTADOS Y CONCLUSIONES: la muestra fue 96% pacientes femeninos y 4% masculinos. La media de edad fue de 39 años. IMC: 98% < 30 Kg/m2. La profilaxis antimicrobiana transoperatoria fue cefalotina (83%) y la profilaxis postoperatoria fue trimetoprim/sulfametoxazol (79%), la incidencia global de ISQ 5%. En cirugía mamaria el porcentaje de infección fue 1,45%, en cirugía de abdomen 2,7% y en cirugías de mus-los 66,6%. Proponemos un sistema de puntuación para la estratificación del riesgo quirúrgico infeccioso en cirugía plástica estética y posbariátrica que sea práctico, sencillo y que permita la aplicación de un esquema de profilaxis antimicrobiana adaptado a la situación de la región

BACKGROUND: in Venezuela, there is a lack of availability of the antibiotics suggested in the international guide-lines for the preoperative prophylaxis, and also growing levels of bacterial resistance. OBJECTIVES: to develop a score system which allows to design an antimicrobial prophylactic scheme for surgical site infections based on the risk factors in aesthetic plastic and posbariatric surgery. METHODOLOGY: a longitudinal, descriptive, and retrospective study was performed between January 2016 and March 2018. The sample was constituted of 100 patients to whom plastic surgery was performed and was evaluated by the Unit's infectologist. Reviewing of medical history was performed and general data was registered (age, body mass index), background (smoking habit, diabetes, skin pathology, urinary infections in past 6 months, S. aureus carrier, antibiotic use in the last 6 mon-ths), surgical data (surgical area, surgical time, drainage use), antimicrobial prophylaxis (transo-perative and postoperative) and infectious complications. RESULTS AND CONCLUSIONS: the sample was 96% female patients and 4% male. The average age was 39 years. BMI: 98% < 30 Kg/m2. The transoperative antimicrobial prophylaxis was cephalotin (83%) and the postopera-tive prophylaxis was trimethoprim/sulfamethoxazole (79%), the overall incidence of SSI 5%. In mammary surgery the percentage of infection was 1.45%, in abdomen surgery 2.7% and in thigh surgeries 66.6%. We propose a scoring system practical and simple for the stratification of infec-tious surgical risk in aesthetic plastic and postbariatric surgery that allows the application of an antimicrobial prophylaxis scheme adapted to the situation of the region

Dermolipectomía en flor de lis asociada a cura operatoria de eventración / Fleur de lis abdominoplasty combined with incisional hernia repair

Antecedentes y objetivos. Las deformidades de la pared abdominal representan un motivo de consulta frecuente en cirugía general y cirugía plástica. En los pacientes con pérdida masiva de peso, la deformidad del contorno abdominal puede ser consecuencia tanto de la flaccidez y exceso cutáneo como de eventraciones abdominales secundarias a cirugía bariátrica o de otro origen. Determinar si el tratamiento combinado de dermolipectomía abdominal en flor de lis con cura operatoria de eventración representa una opción segura, efectiva y con mayores beneficios tanto desde el punto de vista estético como funcional. Materiales y métodos. Se incluyeron 38 pacientes posbariátricos con diagnóstico de eventración abdominal que acudieron a la Unidad de Cirugía Plástica y Postbariátrica en Caracas, Venezuela, en el período 2009-2015, para reconstrucción de la pared abdominal. A todos los pacientes se les realizó una dermolipectomía abdominal en flor de lis asociada en el mismo tiempo quirúrgico a una cura operatoria de eventración. Se determinó el tipo de complicaciones y su frecuencia. Resultados. Las complicaciones fueron dehiscencia (23,68%) e infecciones (21,05%). No se presentó seroma, necrosis grasa, hematoma, extrusión de la malla ni recidiva de la hernia incisional. Conclusiones. La asociación de dermolipectomía abdominal en flor de lis con cura operatoria de eventración representa una opción segura y efectiva

Background and objectives. The abdominal wall deformities are a frequent reason for consultation in general and plastic surgery. In patient with massive weight loss, the abdominal contour deformities are secondary to both fl accidity and cutaneous excess, and also to incisional hernias secondary to bariatric surgery or from another origin. To determine if the combined treatment of Fleur de Lis abdominoplasty and incisional hernia repair is a safe and eff ective option with more aesthetic and functional benefi ts. Materials and methods. 38 postbariatric patients diagnosed with incisional hernia who consulted to the Postbariatric and Plastic Surgery Unit in Caracas, Venezuela, between 2009-2015 were included for abdominal wall reconstruction. A combined procedure of fl eur de lis abdominoplasty with incisional hernia repair was performed in all patients. The complications of the procedure were determined. Results. The complications were: suture dehiscence (23,68%) and infections (21,05%). Seroma, fat necrosis, hematoma, mesh extrusion nor incisional hernia recurrence were present. Conclusions. The combination of a fl eur de lis abdominoplasty with an incisional hernia repair in a single surgical time is a safe and eff ective procedure.