Condutas em lipoaspiraçã o entre cirurgiões brasileiros / Liposuction Practices among Brazilian Surgeons

Introdução: Desde a década de 1980, com Illouz, a lipoaspiração ganhou popularidade e representa hoje um dos procedimentos mais realizados no mundo. Algumas de suas complicações são graves e potencialmente letais. Não existe, contudo, uma uniformidade em sua prática ou no seu ensino. A avaliação das técnicas empregadas por cirurgiões plásticos pode ser o início de uma padronização. Métodos: Foi aplicado um questionário sobre lipoaspiração no 52º Congresso Brasileiro de Cirurgia Plástica para cirurgiões plásticos de diferentes faixas etárias e regiões do Brasil, presentes no evento. Resultados: Foram contabilizados 243 questionários preenchidos (n = 243). O número médio de incisões foi de 9 (2 - 16). Duzentos e quarenta e um cirurgiões (99%) realizam incisões na linha mediana/ paramediana anteriormente e 236 (97%) incisam na linha mediana/paramediana na região posterior. Aproximadamente metade dos questionados utilizam a anestesia geral. Duzentos e nove cirurgiões (86%) posicionam o paciente em decúbito ventral durante o procedimento. A lipoaspiração superficial é realizada por 146 (60%) entrevistados, sendo que 22 (9%) fazem a aspiração apenas desta camada adiposa. Oitenta e cinco (35%) participantes relatam controlar a pressão do aparelho durante o procedimento. Conclusão: A lipoaspiração realizada no Brasil apresenta grande variação técnica. Essa constatação nos faz refletir sobre a necessidade de uma uniformização de sua prática e ensino a fim de aumentar o controle e a segurança do procedimento.

Introduction: Since the 1980s, with Illouz, liposuction has gained popularity and represents one of the most commonly performed procedures in the world today. Some of the complications are serious and potentially lethal. Nevertheless, uniformity in its practice or the manner in which it is taught does not exist. Evaluating techniques employed by plastic surgeons may be the start toward standardization. Methods: A questionnaire on liposuction was given to plastic surgeons of different age groups and from regions of Brazil who were present at the 52nd Brazilian Conference for Plastic Surgery. Results: Two hundred forty-three questionnaires were filled out (n = 243). The average number of incisions was 9 (2­16). Two hundred fortyone surgeons (99%) made incisions along the anterior median/ paramedian line, and 236 (97%) made incisions on the posterior median/paramedian line. Approximately half of those surveyed utilized general anesthesia. Two hundred nine surgeons (86%) placed the patient in the prone position during the procedure. One hundred forty-six (60%) interviewees performed superficial liposuction, with 22 (9%) performing liposuction only on this adipose layer. Eighty-five (35%) participants reported controlling the apparatus's pressure during the procedure. Conclusion: Liposuction procedures performed in Brazil have significant technical variations. This finding encourages us to reflect on the need to standardize liposuction practice and the manner in which it is taught so as to increase control over the procedure and its safety.

Relation of body composition to body mass index in HIV-infected patients with metabolic abnormalities.

OBJECTIVE: To determine visceral adiposity (VAT), subcutaneous adiposity (SAT), and regional body adipose differences between HIV-infected and non-HIV-infected subjects in relation to body mass index (BMI) and World Health Organization BMI categories. DESIGN, SETTING, AND PARTICIPANTS: Analyses were conducted of 306 HIV-infected and 107 community-derived HIV-negative subjects evaluated for metabolic studies between 1999 and 2006. Analyses were stratified by gender. Additional analyses were performed stratifying subjects by metabolic syndrome status. RESULTS: HIV-infected men and women demonstrated decreased total extremity fat by 1.1 kg and 0.85 kg, respectively, relative to non-HIV-infected control subjects. VAT was increased among HIV-infected men and women in the normal (18.5 to 24.9 kg/m2) and overweight (25.0 to 29.9 kg/m2) categories relative to control subjects but not among those in the obese category (> or =30.0 kg/m2). In contrast, abdominal SAT was reduced among HIV-infected men in the normal and overweight categories but was similar among HIV-infected women and control subjects in these categories. Abdominal SAT was increased among HIV-infected women in the obese category relative to control subjects. Similar results were obtained limiting the analysis to HIV-infected (n = 204) and control subjects (n = 89) without the metabolic syndrome. CONCLUSIONS: Peripheral lipoatrophy is a consistent finding among HIV-infected men and women with metabolic abnormalities. Relative increases in VAT are most pronounced among male and female HIV-infected subjects in the normal weight and overweight categories. Gender differences in abdominal SAT accumulation are observed, with preservation of SAT among HIV-infected women relative to control subjects.