Desmistificando a técnica de deep plane facelift com dissecção anatômica em cadáveres frescos / Demystifying the deep plane facelift technique with anatomical dissection in fresh cadavers

Introdução: Os estudos de anatomia em cadáveres permitiram um melhor entendimento das estruturas da face e, consequentemente, mais segurança ao explorar os planos profundos da região facial. Uma boa técnica deve ser segura, reprodutível e respeitar os pontos anatômicos. O objetivo deste trabalho é desmistificar a técnica de deep plane facelifting por meio da dissecção de cadáveres e exposição das estruturas faciais. Método: A reprodução da técnica de "deep plane facelifting" foi realizada em 14 hemifaces de 7 peças de cadáveres frescos no Instituto de Treinamento de Cadáver em Curitiba no ano de 2021. A técnica cirúrgica foi realizada conforme nossa prática clínica e reproduzida no cadáver. Após o procedimento, as estruturas anatômicas faciais foram dissecadas para correlacionar seu posicionamento junto aos espaços anatômicos da face. Foram avaliados os posicionamentos dos ligamentos da face, vascularização e os ramos do nervo facial. Resultados: Foram identificados os espaços anatômicos relevantes à técnica de deep plane facelifting, como os espaços massetéricos inferior e superior, espaço pré-zigomático, espaço bucal e espaço cervical. Os ramos do nervo facial foram identificados no plano subSMAS e correlacionados com os espaços e planos anatômicos. Conclusão: A técnica de deep plane facelift pode ser reproduzida com segurança desde que sejam respeitados dois parâmetros. O primeiro é a entrada correta nos espaços a fim de respeitar a anatomia. O segundo é o uso de descoladores rombos para dissecção nos planos profundos da face a fim de evitar lesão nervosa dos ramos do nervo facial.

Introduction: Anatomy studies on cadavers have allowed a better understanding of the structures of the face and, consequently, greater safety when exploring the deep planes of the facial region. A good technique must be safe, reproducible, and respect anatomical points. The objective of this work is to demystify the deep plane facelifting technique through the dissection of cadavers and exposure of facial structures. Method: The reproduction of the "deep plane facelifting" technique was performed on 14 hemifaces of 7 pieces of fresh cadavers at the Instituto de Treinamento de Cadáver (Cadaver Training Institute) in Curitiba in 2021. The surgical technique was performed according to our clinical practice and reproduced on the cadaver. After the procedure, the facial anatomical structures were dissected to correlate their positioning with the anatomical spaces of the face. The positioning of the facial ligaments, vascularization, and branches of the facial nerve were evaluated. Results: The anatomical spaces relevant to the deep plane facelifting technique were identified, such as the inferior and superior masseteric spaces, prezygomatic space, buccal space, and cervical space. The facial nerve branches were identified in the sub-SMAS plane and correlated with the anatomical spaces and planes. Conclusion: The deep plane facelift technique can be reproduced safely as long as two parameters are respected. The first is the correct entry into spaces to respect the anatomy. The second is the use of blunt detachers for dissection in the deep planes of the face to avoid nerve damage to the branches of the facial nerve.

Tear Trough Treatment with Orbicularis Oculi Muscle Suspension.

BACKGROUND: Blepharoplasty is a very requested surgery for aesthetic rejuvenation of the eyes with grateful results. Lower blepharoplasty involving a variety of different techniques can be considered to refresh the oculopalpebral area. The approach of the treatment of the tear trough as releasing the tear trough ligament and plication of orbicularis oculi muscle in the palpebral portion to fill the tear trough concavity is essential in our surgical technique demonstrated here. METHODS: From July 2014 to January 2020, 435 patients were submitted to blepharoplasty surgery for rejuvenation of the eyes. Lower blepharoplasty was performed with releasing of the tear trough ligament and suspension and fixation of the palpebral part of the orbicularis oculi muscle in the medial part of orbital bone corresponding to the tear trough area. The follow-up was 12 months. RESULTS: Patient satisfaction was high, and no complications were observed. Ten patients (2.2%) needed the addition of hyaluronic acid fillers in the tear trough 12 months after the surgery. CONCLUSION: We conclude that the use of the orbicularis oculi muscle suspension improves the long-term aesthetic results for the tear trough and the technique is easy to perform. LEVEL OF EVIDENCE IV: 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 .

Breast Auto-augmentation (Mastopexy and Lipofilling): An Option for Quitting Breast Implants.

BACKGROUND: Breast augmentation with implants is one of the most commonly performed plastic surgical procedures, but has potential complications-asymmetry, implant displacement, rippling and wrinkling, capsular contracture, late seromas, and benign and malignant tumors-and potential financial costs. The auto-augmentation procedure, with mastopexy and lipofilling, is a second option to offer to patients who do not desire to continue with breast implants in secondary procedures. OBJECTIVE: This study aimed to present a series of patients who intended to quit having breast implants, and they went to an auto-augmentation procedure, with mastopexy and lipofilling. METHOD: The study included patients who underwent a mastopexy plus lipofilling following breast implant removal. The indications for the surgical procedure were: desire of not having breast implants anymore and smaller breasts, capsular contracture, and implant rupture. The surgical procedure is detailed. Fat grafting and mastopexy are done immediately at the time of explantation. RESULTS: A total of 26 patients (mean age 59.1 years) underwent mastopexy plus lipofilling following breast implant removal. The mean follow-up was 18 months. The mean amount of lipofilling was 258 cc. No major complications were observed, no infection, dehiscence, hematoma, or seroma. One patient had an oil cyst which was handled with resection. CONCLUSION: The auto-augmentation procedure after implant removal with local flaps and lipofilling is the better option for patients in whom breast implants are not an option anymore. Complication and reoperation rates are low and patient satisfaction is good. LEVEL OF EVIDENCE IV: 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 .

A non-invasive approach to monitor chronic lymphocytic leukemia engraftment in a xenograft mouse model using ultra-small superparamagnetic iron oxide-magnetic resonance imaging (USPIO-MRI).

Chronic lymphocytic leukemia (CLL) is the most prevalent leukemia among adults. Despite its indolent nature, CLL remains an incurable disease. Herein we aimed to monitor CLL disease engraftment and, progression/regression in a xenograft CLL mouse model using ultra-small superparamagnetic iron oxide-magnetic resonance imaging (USPIO-MRI). Spleen contrast enhancement, quantified as percentage change in signal intensity upon USPIO administration, demonstrated a difference due to a reduced USPIO uptake, in the spleens of mice injected with CLL cells (NSG-CLL, n=71) compared to controls (NSG-CTR, n=17). These differences were statistically significant both after 2 and 4weeks from CLL cells injection. In addition comparison of mice treated with rituximab with untreated controls for changes in spleen iron uptake confirmed that it is possible to monitor treatment efficacy in this mouse model of CLL using USPIO-enhanced MRI. Further applications could include the preclinical in vivo monitoring of new therapies and the clinical evaluation of CLL patients.

Correlation between Choline Peak at MR Spectroscopy and Calcium-Sensing Receptor Expression Level in Breast Cancer: A Preliminary Clinical Study.

PURPOSE: The calcium-sensing receptor (CaSR) is overexpressed in many pathological states including breast cancer. Since choline kinase may be activated in breast cancer cells by CaSR resulting in increased phosphocholine production, we sought to correlate the total choline peak in breast lesions as measured by in vivo proton magnetic resonance spectroscopy ((1)H-MRS) with the CaSR expression levels in surgical specimens. PROCEDURES: Thirty-six patients with breast lesions were MR scanned at 3T scanner. Tumour morphology and DCE-MR kinetics were evaluated. (1)H-MRS was applied for Cho detection and compared with the CaSR immunohistochemistry analysis (score 0-5) on surgical breast specimens. RESULTS: Thirty-four lesions demonstrated a DCE malignant kinetics curve (types 2 and 3), while two lesions showed a benign (type 1). Twenty of the 23 breast cancer lesions (87%) with a consistent Cho peak expressed a CaSR score of 3-5, and ten of the 11 breast lesions negative for Cho (91%) had a CaSR score of 1-2. The two benign lesions showed a non-uniform/weak intense expression of the CaSR (score 3) with a consistent Cho peak. CONCLUSIONS: The presence or absence of choline peak evaluated by (1)H-MRS, well correlated with the expression of CaSR in patients with breast lesions (p < 0.01), supports the hypothesis that CaSR may play an important role in the production of choline in breast cancer.

Brachial plexus MR imaging: accuracy and reproducibility of DTI-derived measurements and fibre tractography at 3.0-T.

OBJECTIVE: To estimate intrastudy, intraobserver and interobserver reproducibility of DTI-derived measurements and fibre tractography (FT) at 3.0 T MR imaging in subjects without known brachial plexus pathology. METHODS: IRB approval and written informed consent were obtained. Forty healthy volunteers underwent bilateral 3.0-T DTI of the brachial plexus. Postprocessing included FT and analysis of fractional anisotropy (FA) and apparent diffusion coefficient (ADC). Four authors performed postprocessing and analysis independently and in different sessions at baseline and after 4 weeks. Non-parametric tests and Bland-Altman statistics were used. RESULTS: Minimum and maximum percent variability were 6% and 20% for FA (85%-93% reproducibility). For ADC minimum and maximum percent variability were 6% and 18% (86%-97% reproducibility). Quality of fibre tract was rated equal in 80% and slightly different in 20% of subjects. Minimum detectable differences between limb were 37% for FA and 32% for ADC. Intra- and inter-observer agreement were good. Evaluating the combined influence of the observer and of the repeated measurements the reproducibility was 81-92%. CONCLUSION: DTI of brachial plexus nerves is reliable. The healthy contralateral side can be used as an internal control considering that changes in FA and ADC values of less that 37% and 32% will not be clinically detectable with confidence.

Abdominoplastia circunferencial após grande perda ponderal / Circumferential abdominoplasty after loss weight

Introdução: Em decorrência do aumento da obesidade na população, assim como a melhora nas técnicas cirúrgicas bariátricas, o número de pacientes com histórico de obesidade e perda acentuada de peso cresceu significativamente nos últimos anos. Existem várias técnicas cirúrgicas que visam à reconstrução dos tecidos frouxos da região abdominal, região dos flancos e trocantéricas nestes pacientes. Objetivo: O objetivo deste trabalho é a comparação entre o resultado da nossa técnica de abdominoplastia circunferencial realizada em pacientes após grande perda ponderal em relação às técnicas mais usadas atualmente, considerando-se: localização do retalho circunferencial a ser excisado, liberação das zonas de aderência, localização final da cicatriz, definição da cintura e aumento da região glútea. Método: A abdominoplastia circunferencial foi realizada em 8 pacientes, no período de abril de 2007 a dezembro de 2008. Resultados: Os pacientes operados apresentaram melhora do contorno corporal, melhor definição da cintura, e melhora do contorno da região glútea. Conclusão: A localização mais adequada do retalho circunferencial a ser excisado posteriormente é a região mais inferior do tronco, a liberação parcial das zonas de aderência promove a suspensão dos tecidos das regiões trocantéricas sem permitir a descida tão drástica da cicatriz; a localização final mais adequada da cicatriz é na parte superior do contorno glúteo; a definição da cintura está diretamente relacionada com a posição do retalho a ser ressecado e com a retirada do tecido adiposo desta área; o aumento da região glútea pode ser realizado com emprego de retalhos autólogos.

Background: Obesity is increasing all around the world and for this reason bariatric surgeries are better nowadays and patients are looking for these procedures. After loss weight, patients need plastic surgery to improve the body contouring. Many surgical techniques are available to treat the abdominal area, flanks and buttocks. Purpose: The purpose of this article is to compare our personal technique of circumferential abdominoplasty with the majors surgeons about the place of flap’s ressection, zones of adherence’s release, scars placement, waist definition and improvement of buttocks. Methods: The circumferential abdominoplasty were performed in 8 patients, between April 2007 and December 2008. Results: The patients showed up with better body contouring, better waist definition and improvement of the buttocks. Conclusion: The better place of flap’s ressection is in the lower aspect of the trunk, the partial release of the zones of adherence is important to allow the suspension of trochanteric areas; the most pleased scar’s placement is in the superior aspect of buttocks; the waist definition is according with the flap position and it’s ressection; and the buttocks improvement is better when autologous flaps are used in these areas.

Facial rejuvenation with SMASectomy and FAME using vertical vectors.

The quest for better results in the midface after a face lift has led to the repositioning of a structure called the malar fat pad. Finger-assisted malar elevation (FAME) consists of detaching the malar fat pad from the underlying SMAS, which allows for the elevation of this structure. Two hundred five patients (189 females and 16 males) from January 2002 to August 2007 underwent a facial rejuvenation procedure comprising short-scar rhytidoplasty, SMASectomy, and FAME, with or without a simultaneous endobrow, blepharoplasty, and lipofilling. The midface fixation technique consisted of a stitch from the malar fat pad and SMAS flap to the periosteum at the zygomatic arch which was performed in every case. Elevation of the midface and improvement of the nasolabial fold and the mandible contour were obtained in all cases. Facial aging should be evaluated as a global process instead of a segmented one. Aging occurs in every structure of the face in different ways, depending on the vector of descent, thereby treatment must be individualized. We have observed improvement of the midface when using the FAME procedure in a rhytidoplasty with SMASectomy with deep fixation.

Upper body lift.

An upper body lift is needed whenever a massive weight loss patient presents with a "dropped out" lateral inframammary crease. It is a combination of a brachioplasty, upper-back resection, and breast reconstruction. The operation is designed to reverse the particular deformity a patient presents with. This article describes three patterns of resection, one for males and two for females.

Lipoabdominoplasty: liposuction with reduced undermining and traditional abdominal skin flap resection.

Abdominoplasty surgery has spread universally, as both an aesthetic and a reconstructive procedure, and new techniques are appearing with the goal of minimizing ischemic complications of the flap and bettering body contour. The purpose of this article is to demonstrate that an abdominoplasty technique with limited undermining and preservation of the flap perforator vessels makes it possible to reduce the complication rate attributable to flap necrosis and seroma in abdominoplasty. Doppler flowmetry color study of the abdominal wall was performed before the surgical procedure and on postoperative day 15 after lipoabdominoplasty for a series of 20 patients to evaluate the blood supply of the abdominal wall. This study confirmed the preservation of perforator arteries in the periumbilicus area and right upper quadrant after abdominoplasty with liposuction and reduced undermining.

Brachioplasty in the patient with massive weight loss.

In performing brachioplasty, the authors have created a double-ellipse marking technique to avoid overresecting and leave adequate skin for closure. After resecting, they prevent the interference of soft-tissue swelling during wound closure by immediately closing each segment with temporary staples. Their technique is ideal for patients with massive weight loss.

Cirurgia videoendoscópica frontal e de terço médio: experiência de 8 anos / Endoscopic forehead and midface surgery: eight years experience

Desde o início dos anos 90, a técnica videoendoscópica em cirurgia plástica foi introduzida e aceita como método eficaz para o rejuvenescimento do terço superior da face, principalmente para elevação dos supercílios e região frontal. Este procedimento apresenta múltiplas indicações, sendo realizado para corrigir a ptose dos supercílios e rugas glabelares causadas pelos músculos depressores. No período de janeiro de 1996 a dezembro de 2004, 207 pacientes foram submetidas à cirurgia endoscópica da região frontal, associando ou não o tratamento do terço médio da face pela mesma técnica. Os resultados obtidos foram satisfatórios com manutenção da elevação dos supercílios, redução das rugas de expressão de glabela, rotação dos elementos óculo-palpebrais no sentido látero-superior e elevação do terço médio da face.

Mamaplastia vertical com retalho de parede torácica / Vertical mammaplasty with chest wall based flap

A cirurgia mamána sofreu grandes modificações nos últimos anos, visando á diminuiçáo das cicatrizes e á melhora e manutenção da sua forma no pós-operatório tardio, Os autores empregaram a filosofia da técnica periareolar à técnica de cicatriz vertical, com o objetivo de reduzir o comprimento da cicatriz, evitando o seu prolongamento abaixo do sulco submamário e compensando o excesso de pele ao redor da aréola, No período de março de 2001 a julho de 2004, 132 pacientes foram submetidas a mamaplastia redutora e/ou mastopexia utilizando-se a técnica de cicatriz vertical associada ao retalho de parede torácica mantido sob uma alça de músculo peitoral maior. O objetivo da utilização da combinação destas duas técnicas foi proporcionar um bom resuitado sob o ponto de vista estético: cicatriz reduzida, báscula mínima e preenchimento do pólo superior mamário.

Mamaplastia redutora e mastopexia com cicatriz vertical e retalho de parede torácica / Mammaplasty and mastopexia with vertical scar and flap of pectoralis major muscle

A cirurgia mamária sofreu grandes modificações nos últimos anos, visando a diminuição das cicatrizes e a melhora e manutenção da sua forma, no pós ope- ratório tardio. Empregando-se a filosofia da técnica periareolar à técnica de cicatriz vertical, podemos reduzir o comprimento da cicatriz, evitando o seu prolongamento abaixo do sulco submamário e compensando o excesso de pele em torno da aréola. No período de março de 2001 a julho de 2002, 53 pacientes foram submetidas à mamaplastia redutora e/ou mastopexia utilizando-se a técnica de cicatriz vertical associado ao retalho de parede torácica mantido sob uma alça de músculo peitoral maior. O objetivo da utilização da combinação destas duas técnicas foi o de proporcionar um bom resultado sob o ponto de vista estético: cicatriz reduzida, báscula mínima e preenchimento do pólo superior mamário.

Breast surgery has been greatly modified in the past few years looking for shortening of scars and improvement and maintenance of breast shape in the late post-operative period. Working with the philosophy of periareolar technique and vertical scar technique altogether, its possible to reduce scar length, avoiding the area below the inframammary crease by compensating skin excess around the areola. From March 2001 to July 2002, 53 patients were submitted to reduction mammaplasty and/or mastopexy with vertical scar technique associated to the chest wall based flap kept under a bipedicled flap of pectoralis major muscle. The goal of this combination is to achieve a good result under the aesthetic view: reduced scar, minimal breast descent and good upper pole fullness.

Avaliação do peso de cartilagem desidratada e hidratada / Weight assessment of dehydrated and hydrated cartilage

A cartilagem de banco pode ser utilizada para tratamento cirúrgico do lagoftalmia, reconstrução nasal e auricular, reconstrução do assoalho da órbita e cirurgia do mento. Este trabalho tem como objetivo avaliar o peso da cartilagem desidratada e hidratada e a variação do peso após a implantação de ambas as cartilagens em dorso de ratos. Foram utilizados 10 ratos Norvergicus submetidos a dois implantes de cartilagens conservadas em álcool etílico a 70, obtidas de cadá- veres. Uma cartilagem a ser implantada permaneceu em solução com a álcool 70 e outra, em solução fisiológica (NaCl 0,9), por 24 h antes do procedimento cirúrgico. O peso médio inicial era de 0,5 g e após a hidratação passou a pesar 1,2 g em média. As cartilagens foram então implantadas no dorso dos ratos e após 8 dias retiradas e pesadas novamente para avaliação estatística do ganho de peso.

The cartilage bank can be used for lagoftalmia surgical treatment, nose and ear reconstruction and low jaw surgery. This study has the objective of evaluating the weight of hydrated and dehydrate cartilage and the variation of weight after the implementation of both cartilages on the back of mice. Ten Norvergicus mice were submitted to the implanting of cartilages obtained from corpses and that were kept in alcohol etilic 70. One of the cartilage to be implanted was kept in a solution with alcohol 70 and the other one in SF (NaCl 0,9) for 24h before the surgery procedure. The medium initial weight was 0.5g and after the hydratation it medium weighted 1.2g. The cartilages were then implanted on the back of mice and taken out 8 days later and weighted again for statistic evaluation on weight increase.

Conduta no trauma da genitália masculina / Procedure on male genitalia trauma

O trauma da genitália masculina tornou-se mais freqüente em ambientes de trabalho, como em indústrias, nas quais os operários sofrem acidentes com má- quinas de alta velocidade e, no ambiente urbano, devido ao grande número de acidentes automobilísticos. Estes tipos de lesões requerem hospitalização imediata, cirurgias e um suporte psicológico intenso. O objetivo deste trabalho é revisar nossa conduta nos casos de trauma de pênis e bolsa escrotal. No período de 1986 a 2003, foram atendidos 10 pacientes com lesões de genitália, no Hospital Universitário Cajuru, submetidos a cirurgias e acompanhamento pós-operatório. A conduta cirúrgica adotada variou desde o enxerto de pele ao reimplante microcirúrgico. Os pacientes foram acompanhados no pós-operatório e apresentaram uma aparência estética satisfatória e micção e função erétil normal.

The trauma of the male genitalia are frequent events in the work enviroment of industries where the high velocity machinery are responsible for this injuri- es, and in the cities with a great number of car crashes. These injuries are both physically and mentally traumatic and require hospitalization, surgeries and psychological support. The purpose of this study is to review our approach taken in injuries of the genitalia and to present our experiences. During the period of 1986 and 2003, at Hospital Universitário Cajuru, we have taken cared of ten patients with injuries in the genitalia. The surgical condut addopted varied from skin graft until reimplant. Later on during the postoperative, all the patients had an acceptable appearance and normal mictural and erectile function.

Reduction mammaplasty and mastopexy using the vertical scar and thoracic wall flap technique.

Breast surgery has been greatly modified in the past few years as surgeons sought to shorten scars and improve and maintain of breast shape in the late postoperative period. Working with both the periareolar technique and vertical scar technique, it is possible to reduce scar length, avoiding the area below the inframammary crease by compensating skin excess around the areola. From January 2001 to July 2002, 53 patients underwent reduction mammaplasty and/or mastopexy using the vertical scar technique associated to a thoracic-based flap kept under a bipedicled flap of the pectoralis major muscle. The goal of this combination is to achieve a good aesthetic result: a reduced scar, minimal breast descent, and good upper pole fullness.