Macrostomia: a spectrum of deformity.

BACKGROUND: Macrostomia is a rare facial cleft, with an incompletely described pathogenesis. This series highlights cases of isolated macrostomia presenting with several distinct phenotypes. We examine phenotypic differences in macrostomia patients, to further elucidate the etiopathogenesis. MATERIALS AND METHODS: We performed a retrospective review of macrostomia patients evaluated during a 10-year period. Patient demographics and clinical features are reported. RESULTS: We identified 25 macrostomia patients (13M/12F). Right-sided macrostomia occurred in 15, left-sided macrostomia occurred in 6, and bilateral macrostomia occurred in 4 patients. Of the bilateral cases, 100% existed in isolation of craniofacial microsomia (CFM) or other craniofacial abnormalities. Twelve patients presented with macrostomia in isolation of CFM; in this subgroup, the male-to-female ratio was 1:1. Bilateral macrostomia was present in 33% of patients. Unilateral macrostomia occurred more often on the right (5:2). Phenotypes included simple unilateral or bilateral macrostomia (67%), macrostomia associated with severe diastasis of the cheek musculature (8%), macrostomia associated with lateral facial clefts (17%), and diastasis of cheek musculature without significant macrostomia (8%). CONCLUSIONS: Macrostomia seen in isolation of CFM presents in phenotypically distinct forms. It is unlikely that a single mechanism is responsible for this range of phenotypes. We believe that both intrauterine trauma and failure of fusion of the mandibular and maxillary processes secondary to an aberration in FGF8 function are responsible. Additionally, diastasis of facial musculature may result from delayed fusion and subsequent decreased mesodermal penetration of the mandibular and maxillary processes.

Congenital midline cervical cleft: Management of a case series and literature review.

Congenital midline cervical cleft is a rare anomaly classified as a malformation of the branchial arches and represents less than 2% of congenital cervical malformations. Its clinical presentation involves cervical midline deformities: cephalic nodular lesion, linear groove with atrophic surface, and/or caudal sinus. Other midline alterations of variable complexity may also be present. Early treatment allows for avoiding long-term complications. Based on our experience in four clinical cases, a performed literature search on the topic in the last twenty years, and subsequent discussion of the employed surgical approaches, we included 150 reported cases in our review. Correct diagnosis and early treatment with complete removal of the fibrous midline band is paramount to avoid patient complaints until adolescence or adulthood.

Epidemiological Modeling of the Impact of Public Health Policies on Hepatitis C: Protocol for a Gamification Tool Targeting Microelimination.

BACKGROUND: Hepatitis C is a disease with a strong social component, as its main transmission route is via blood, making it associated with lifestyle. Therefore, it is suitable to be worked on from the perspective of public health policy, which still has a lot of room to explore and improve, contrary to diagnoses and treatments, which are already very refined and effective. OBJECTIVE: An interactive gamified policy tool, designated as Let's End HepC (LEHC), was created to understand the impact of policies related to hepatitis C on the disease's epidemiology on a yearly basis until 2030. METHODS: To this end, an innovative epidemiological model was developed, integrating Markov chains to model the natural history of the disease and adaptive conjoint analysis to reflect the degree of application of each of the 24 public health policies included in the model. This double imputation model makes it possible to assess a set of indicators such as liver transplant, incidence, and deaths year by year until 2030 in different risk groups. Populations at a higher risk were integrated into the model to understand the specific epidemiological dynamics within the total population of each country and within segments that comprise people who have received blood products, prisoners, people who inject drugs, people infected through vertical transmission, and the remaining population. RESULTS: The model has already been applied to a group of countries, and studies in 5 of these countries have already been concluded, showing results very close to those obtained through other forms of evaluation. CONCLUSIONS: The LEHC model allows the simulation of different degrees of implementation of each policy and thus the verification of its epidemiological impact on each studied population. The gamification feature allows assessing the adequate fulfillment of the World Health Organization goals for the elimination of hepatitis C by 2030. LEHC supports health decision makers and people who practice patient advocacy in making decisions based on science, and because LEHC is democratically shared, it ends up contributing to the increase of citizenship in health. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR1-10.2196/38521.

IRF6 is a risk factor for nonsyndromic cleft lip in the Brazilian population.

Nonsyndromic cleft lip with or without cleft palate (NSCL/P) is a complex disorder with a worldwide incidence estimated at 1:700. Among the putative susceptibility loci, the IRF6 gene and a region at 8q24.21 have been corroborated in different populations. To test the role of IRF6 in NSCL/P predisposition in the Brazilian population, we conducted a structured association study with the SNPs rs642961 and rs590223, respectively, located at 5' and 3' of the IRF6 gene and not in strong linkage disequilibrium (LD), in patients from five different Brazilian locations. We also evaluated the effect of these SNPs in IRF6 expression in mesenchymal stem cells (MSC). We observed association between rs642961 and cleft lip only (CLO) (P=0.009; odds ratio (OR) for AA genotype=1.83 [95% Confidence interval (CI), 0.64-5.31]; OR for AG genotype=1.72 [95% CI, 1.03-2.84]). This association seems to be driven by the affected patients from Barbalha, a location which presents the highest heritability estimate (H2=0.85), and the A allele at rs642961 is acting through a dominant model. No association was detected for the SNP rs590223. We did not find any correlation between expression levels and genotypes of the two loci, and it is possible that these SNPs have a functional role in some specific period of embryogenesis.

Region 8q24 is a susceptibility locus for nonsyndromic oral clefting in Brazil.

BACKGROUND: Nonsyndromic cleft lip with or without cleft palate is a relatively common craniofacial defect with multifactorial inheritance. The association of the rs987525 single nucleotide variant, located in a gene desert at 8q24.21 region, has been consistently replicated in European populations. We performed a structured association approach combined with transcriptional analysis of the MYC gene to dissect the role of rs987525 in oral clefting susceptibility in the ethnically admixed Brazilian population. METHODS: We performed the association study conditioned on the individual ancestry proportions in a sample of 563 patients and 336 controls, and in an independent sample of 221 patients and 261 controls. The correlation between rs987525 genotypes and MYC transcriptional levels in orbicularis oris muscle mesenchymal stem cells was also investigated in 42 patients and 4 controls. RESULTS: We found a significant association in the larger sample (p = 0.0016; OR = 1.80 [95% confidence interval {CI}, 1.21-2.69], for heterozygous genotype, and 2.71 [95% CI, 1.47-4.96] for homozygous genotype). We did not find a significant correlation between rs987525 genotypes and MYC transcriptional levels (p = 0.14; r = -0.22, Spearman Correlation). CONCLUSIONS: We present a positive association of rs987525 in the Brazilian population for the first time, and it is likely that the European contribution to our population is driving this association. We also cannot discard a role of rs987515 in MYC regulation, because this locus behaves as an expression quantitative locus of MYC in another tissue.

Protocol for obtaining platelet-rich plasma (PRP), platelet-poor plasma (PPP), and thrombin for autologous use.

BACKGROUND: Plasma has been widely studied and used in many different situations to speed up healing with better tissue adherence and hemostasis. Research projects are now attempting to isolate platelet-rich plasma (PRP) and platelet-poor plasma (PPP), making better use of their properties, particularly during operations and for wounds that are slow to heal. In view of the wide diversity of industrial machines and extraction protocols, together with the variety of industrially produced biologic glues, this article suggests an option for obtaining PRP, PPP, and human thrombin for autologous use. METHODS: A way of obtaining PRP, PPP, and thrombin is reproduced through a protocol defined and established by the authors. Autologous thrombin and plasma were obtained through the collection and successive centrifugation of ten whole blood samples, until the desired hemocomponents were isolated, followed by quantitative and qualitative analyses of the elements obtained. RESULTS: The mean platelet concentration obtained was 6.03 × 10(8) platelets/ml, with a mean thrombin concentration of 33.54 nM, both values compatible with reports in the literature when different protocols are applied. CONCLUSIONS: The protocol described is a good option for the preparation and application of PRP, PPP, and autologous thrombin, particularly as they can be obtained simultaneously, eliminating the possibilities of viral contamination and allergic reactions. Moreover, the cost of this procedure is low, it is easy to perform, and replicable. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article.

Use of autologous fibrin glue (platelet-poor plasma) in abdominal dermolipectomies.

BACKGROUND: Autologous plasma is endowed with properties that speed up healing, hemostasis, and adhesiveness, in addition to growth factors. Through an established protocol, it was possible to isolate thrombin, as well as the platelet-rich plasma (PRP) and platelet-poor plasma (PPP) fractions. The purpose of this study was to analyze autologous use of thrombin and PPP to foster adhesion between an abdominal dermoadipose flap and the aponeurotic surface in abdominal dermolipectomies. METHODS: The data from 40 patients who underwent abdominal dermolipectomies were analyzed, with 20 patients using thrombin and autologous PPP (Plasma group) and 20 patients with no intervention (Control group). An attempt was made to assess adhesive power by quantifying the serohematic liquid volume gauged during the postoperative days (POD), and also noting the incidence of seroma. Other variables such as age and body mass index (BMI) were also analyzed. RESULTS: The reduction in the aspiration drain debit was statistically relevant only on the first POD in the Plasma group. There was no reduction in the incidence of seroma in these patients. Similarly, age and BMI did not influence these outcomes. CONCLUSION: The PPP fostered adhesion between the abdominal dermoadipose flap and the aponeurotic surface only on the first POD and had no influence whatsoever on the incidence of seroma. There are few reports on the use of PPP for plastic surgery, particularly the autologous type, opening up possibilities for further research projects to expand its use. LEVEL OF EVIDENCE III: 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.

Genetic contribution for non-syndromic cleft lip with or without cleft palate (NS CL/P) in different regions of Brazil and implications for association studies.

Non-syndromic cleft lip with or without cleft palate (NS CL/P) is a complex disease in which heritability estimates vary widely depending on the population studied. To evaluate the importance of genetic contribution to NS CL/P in the Brazilian population, we conducted a study with 1,042 families from five different locations (Santarém, Fortaleza, Barbalha, Maceió, and Rio de Janeiro). We also evaluated the role of consanguinity and ethnic background. The proportion of familial cases varied significantly across locations, with the highest values found in Santarém (44%) and the lowest in Maceió (23%). Heritability estimates showed a higher genetic contribution to NS CL/P in Barbalha (85%), followed by Santarém (71%), Rio de Janeiro (70%), Fortaleza (64%), and Maceió (45%). Ancestry was not correlated with the occurrence of NS CL/P or with the variability in heritability. Only in Rio de Janeiro was the coefficient of inbreeding significantly larger in NS CL/P families than in the local population. Recurrence risk for the total sample was approximately 1.5-1.6%, varying according to the location studied (0.6-0.7% in Maceió to 2.2-2.8% in Barbalha). Our findings show that the degree of genetic contribution to NS CL/P varies according to the geographic region studied, and this difference cannot be attributed to consanguinity or ancestry. These findings suggest that Barbalha is a promising region for genetic studies. The data presented here will be useful in interpreting results from molecular analyses and show that care must be taken when pooling samples from different populations for association studies.

Postbariatric buttock contouring with dermolipectomy and gluteal implants.

The authors present their experience with the use of silicone implants in the buttocks after massive weight loss. The procedure is used in combination with gluteal dermolipectomy with or without dermal fat flaps. This report highlights the simplified method of identifying the gluteal muscles, recommends using the superior margin of the gluteus maximus muscle to access the space for implant placement, and prescribes placement of the implants in either the submuscular or the intramuscular space. The described procedure has been performed for two patients to date, with encouraging and long-lasting results.

Integrating public health policies in the epidemiological modeling of hepatitis C with LEHC tool: application in Austria.

BACKGROUND: Eliminating hepatitis C requires addressing issues other than medicines or therapies. Public health policies focused on the hepatitis C virus (HCV) must be emphasized and worked to know the impacts on its epidemiologic dynamics. This research aims to provide a tool to evaluate and simulate alternatives by redefining policies meeting specific needs in each country towards the HCV elimination target by 2030. METHODS: The development of a gamified model with 24 public health policies focused on HCV was conducted to evaluate the impact of measures in the disease epidemiologic dynamics. The Let's End HepC (LEHC) project encompassed key populations (people who inject drugs [PWID], prisoners, blood products and remnant population) in Austria and other countries, presenting prospects for every year from 2019 to 2030. The LEHC epidemiological model comprised an integrated solution for HCV, with adaptive conjoint analysis (ACA) and Markov chains constituting its main processes. RESULTS: Despite Austria's efforts towards achieving the HCV elimination goal by 2030, the LEHC model forecast quantitative analysis predicts that it is still not enough to meet the target; however, prospects are very optimistic if public health policies are adapted to the country's needs, being possible to achieve the goal as early as 2026. CONCLUSION: In Austria, the LEHC tool allowed to forecast the HCV elimination year anticipation to 2026, instead of being achieved after 2030. This target will only be valid if adequate management of the 24 public health policies focused on this pathology is further implemented.

Real-World Evidence: The Low Validity of Temperature Screening for COVID-19 Triage.

Background: The COVID-19 pandemic forced health-related organizations to rapidly launch country-wide procedures that were easy to use and inexpensive. Body temperature measurement with non-contact infrared thermometers (NCITs) is among the most common procedures, both in hospital settings and in many other entities. However, practical hospital experiences have raised great doubts about the procedure's validity. Aim: This study aimed to evaluate the validity of the body temperature measured using NCITs among oncological and transplant patients who took the polymerase chain reaction test for SARS-Cov-2 PCR+ and PCR- in a Romanian Hospital. Methods: Body temperature was measured for 5,231 inpatients using NCITs. The cutoff point for fever was equal to or above 37.3°C. Patients then completed a questionnaire about their symptoms, contact, and travel history. Findings: Fever was detected in five of 53 persons with PCR+, resulting in a sensitivity of 9.43% (95% CI, 3.13-20.66%). No fever was verified in 5,131 of 5,171 persons with PCR-, resulting in a specificity of 99.15% (95% CI, 98.86-99.38%). A defensive vision of NCIT procedure (maximum standard error only in favor) had a sensitivity of 15.09% (95% CI, 6.75-27.59%). Conclusions: The use of NCITs in a triage provides little value for detection of COVID-19. Moreover, it provides a false sense of protection against the disease while possibly discriminating individuals that could present fever due to other reasons, such as oncologic treatments, where fever is a common therapeutical consequence. The consumption of qualified human resources should be considered, especially in the context of the shortage of healthcare professionals worldwide.

Let's End HepC: Modelling Public Health Epidemiological Policies Applied to Hepatitis C in Spain.

Background: The WHO has defined international targets toward the elimination of hepatitis C by 2030. Most countries cannot be on track to achieve this goal unless many challenges are surpassed. The Let's End HepC (LEHC) tool aims to contribute to the control of hepatitis C. The innovation of this tool combines the modelling of public health policies (PHP) focused on hepatitis C with epidemiological modelling of the disease, obtaining a unique result that allows to forecast the impact of policy outcomes. The model was applied to several countries, including Spain. Methods: To address the stated objective, we applied the "Adaptive Conjoint Analysis" for PHP decision-making and Markov Chains in the LEHC modelling tool. The tool also aims to be used as an element of health literacy for patient advocacy through gamification mechanisms and country comparability. The LEHC project has been conducted in several countries, including Spain. The population segments comprised in the project are: People Who Inject Drugs (PWID), prisoners, blood products, remnant population. Results: A total of 24 PHP related to hepatitis C were included in the LEHC project. It was identified that Spain had fully implemented 14 of those policies to control hepatitis C. According to LEHC's model forecast, the WHO's Hepatitis C elimination goal on reducing the number of patients living with Hepatitis C to 10% can be achieved in Spain by 2026 if current policies are maintained. The model estimates that the total population in Spain, by 2026, is expected to comprise 26,367 individuals living with hepatitis C. Moreover, if the 24 PHP considered for this study are fully implemented in Spain, the elimination goal may be achieved in 2024, with 29,615 individuals living with hepatitis C by that year. Conclusion: The findings corroborate the view that Spain has set great efforts in directing PHP toward Hepatitis C Virus (HCV) elimination by 2030. However, there is still room for improvement, namely in further implementing 10 of the 24 PHP considered for the LEHC project. By maintaining the 14 PHP in force, the LEHC model estimates the HCV elimination in the country by 2026, and by 2024 if further measures are employed to control the disease.

Modeling the Puzzle of Hepatitis C Epidemiology in Romania: A Pathway to Control.

BACKGROUND AND AIMS: To combat hepatitis C virus (HCV) and achieve its elimination by 2030, the emphasis should be on public health policies. In this study, we investigated the dynamics of epidemiology of HCV in Romanian risk groups that are characterized by higher occurrence densities with the aid of The Let's End HepC (LEHC) project. METHODS: The LEHC project addressed the modelling of HCV epidemiology, being applied in several countries, one of which is Romania. The model comprised an integrated solution of public health policies focused on the disease, using Adaptive Conjoint Analysis and Markov chains systems. This tool allowed the quantitative evaluation of public health policies' impact, for every year until 2030, in five population groups: people who inject drugs (PWID), prisoners, individuals who have received blood products, children at risk for vertical transmission, and the remnant population. RESULTS: It appears that Romania was already making great efforts in the context of public policies, allowing the achievement of HCV elimination by 2028 if current policies were maintained. Through additional work and greater efforts in further implementing public policies, the LEHC model estimated the possibility of anticipating this outcome to 2026. CONCLUSION: The LEHC model estimated an anticipation of the HCV elimination year in Romania to be 2026 if the twenty-four health policies in the study are fully implemented and consistently maintained over the years.

Transsphenoidal meningoencephalocele associated with cleft lip and palate: challenges for diagnosis and surgical treatment.

PURPOSE: The aim of this study was to highlight the challenges for early diagnosis and the difficulties observed in surgical treatment of patients with transsphenoidal meningoencephalocele associated with cleft lip and/or palate. METHOD: We evaluated six male patients treated over the course of 4 years. Five patients presented encephalic herniation with nonfunctional brain tissue; one of these presented herniation of the pituitary gland and cerebral ventricles. RESULTS: All the patients received surgical treatment for the cleft lip and/or palate. Only one patient underwent repair of the meningoencephalocele, via nasal endoscopy. There were no postprocedural clinical or surgical complications. CONCLUSION: The tendency is to avoid neurosurgery, opting for periodic follow-up with magnetic resonance imaging. In the presence of cleft palate, palatoplasty is essential to protect the meningoencephalocele.

Chondrocutaneous marginal ear flap.

This paper discusses a technique for the treatment of helical tumors that most times occur in aging patients with precarious clinical conditions and who wish to solve the problem in a single-stage operation. For these reasons, we have used a chondrocutaneous marginal flap of up to 4.0 cm in length based on the artery of the lobe that penetrates the helix at the level of the antitragushelicin cleft. This flap is also convenient for repairing circumscribed traumatic injuries of the helical rim.

Bilateral pseudoangiomatous stromal hyperplasia in childhood gigantomastia: A challenge in reconstruction and management.

The presence of mammary nodules during childhood and adolescence is somewhat unusual, generally consisting of benign lesions. Despite the range of possible diagnoses, they are generally similar in clinical terms. In the rare cases where these lesions constitute a case of gigantomastia, the differential diagnosis must be between juvenile fibroadenomatosis, phyllodes tumours and other even less common diseases of the mammary gland, such as Pseudoangiomatous Stromal Hyperplasia (PASH). This is caused by the exacerbated proliferation of mature fibroblasts and myofibroblasts, with the trigger factor still unknown. This study reports on a rare case of bilateral PASH in a young patient, describing its diagnosis and the surgical technique used.

Tissue expansion in burn sequelae repair.

Burns may cause emotional, aesthetic and functional sequelae. Extended or hypertrophic scars are usually difficult to repair using local tissues, and the use of skin grafts may cause further injuries to the donor sites. The use of tissue expanders may offer a better option in the treatment of burn sequelae. This is a report on our experience using tissue expanders in 54 cases (23 patients) of burn sequelae located in different anatomical areas. Fourteen of the patients were female and nine male ranging in age between 5 and 48. The expanders were placed in the subgaleal, submuscular, subfascial or subcutaneous planes. Skin expansion was completed in 50 cases (92.5%). The injured area was removed by advancement flaps in 44 cases and by transposition flaps in 6 of them. Primary expansion was performed in 42 cases and reexpansion in 12. The rate of complications was 24.07%, of which 30.8% were considered to be absolute and 69.2% relative. Tissue expansion is an excellent option for burn sequelae treatment because it provides skin of similar local characteristics and does not damage the donor site. The procedure can be repeated in the event of major sequelae (reexpansion).

Red hemostática en el tratamento quirúrgico de la ginecomastia para prevenir hematomas / Hemostatic net to avoid haematoma in gynecomastia surgery

Introducción y objetivo: La corrección de la ginecomastia se encuentra entre las cirugías estéticas más solicitadas por los pacientes masculinos. La principal complicación de este procedimiento es el hematoma postoperatorio. Describimos nuestra experiencia con el uso de la red hemostática percutánea para reducir la incidencia de hematoma postoperatorio, sin el uso de drenajes. Material y método: Evaluamos 13 pacientes operados de ginecomastia con edades compreendidas entre los 15 y los 59 años; un total de 25 mamas. Realizamos la red hemostática en los segmentos superior, inferior y areolar, con hilo de Prolene 2.0 o 3.0 y aguja cilíndrica, después de la hemostasia y antes de cerrar la incisión de la adenectomía, por lo tanto, bajo observación directa. No utilizamos drenajes en ninguno de los pacientes de esta serie y retiramos la malla entre 48 y 96 horas de postoperatorio. Resultados: Del total de 25 mamas operadas, solo 1 presentó hematoma limitado a la región retroareolar, siendo el primer caso de esta serie en el que no habíamos realizado la malla en el segmento areolar. La red no causó ninguna secuela cicatricial (marcas em la piel) ni pigmentación em los punto de transfixión de la aguja. Conclusiones: En nuestra experiencia, el uso de la red hemostática fue un procedimiento adicional al tratamiento de la ginecomastia y resultó eficaz en la prevención del hematoma postoperatorio. (AU)

Background and objective: Correction of gynecomastia is among the most requested cosmetic surgeries by male patients. The main complication of this procedure is postoperative hematoma. We describe the use of a percutaneous hemostatic network to reduce the incidence of postoperative hematoma, without the use of drains. Methods: Thirteen patients were evaluated, aged between 15 and 59 years, in a total of 25 breasts. The hemostatic net was performed in the upper, lower and areolar segments, with 2.0 or 3.0 Prolene with a cylindrical needle, after hemostasis, before closing the adenectomy incision, therefore under direct vision. Drains were not used in any of the patients in this series. The mesh was removed between 48 and 96 hours. Results: Of the total of 25 breasts, only 1 had a hematoma, limited to the retro-areolar region, which was the first case in this series in which the mesh was not performed in the areolar segment. Net did not produced any sequel scar (skin marks) not pigmentation at the needle transfixation sites. Conclusions: In our experience, the use of the hemostatic net was an additional procedure to the treatment of gynecomastia, having been efficient in the prevention of postoperative hematoma. (AU)

Screening Cervical Cancer by the Pap Test ­ Relevance of Age Ranges Recommended by the Brazilian Programme for Prevention and Control

Objective: To evaluate screening by the Papanicolaou smear (Pap) and the frequency of cervical abnormalities in the age range recommended by the Brazilian programme for prevention and control of cervical cancer (CC) in the years 2012 and 2013 in a high prevalence city. Methods: This retrospective study covered results of Pap examinations performed on women aged ≥12 years residing in urban areas of the city of Maringá, Paraná in Brazil. The examinations were performed in the years 2012 and 2013 for the System of Public Health (SPH) which maintains a city database. The age ranges were grouped as recommended into <15-24, 25-64, and >64 years. Results: A total 40,866 women were screened, 19,606 in 2012 and 21,260 in 2013. The Pap exams performed for the age range 25-64 years accounted for 80.7% of the total in 2012 and 80.3% in 2013 (p=0.13), while those for <15 to 24 years accounted for 11.7% and 11.3%, respectively. There were more tests performed in the >64 years age group in 2013 (8.46%) than in 2012 (7.52%) (p<0.001). A total of 1,354 (3.31%) women presented with abnormal test results, with atypical squamous cells of undetermined significance (ASC-US) as the most prevalent finding (2.12%) in 2012, while in 2013 it was LSIL (1.56%) (p<0.001 for both). Women with ASC-US showed a lower mean age than did those with other lesions in both years. Conclusions: This study detected a significant expansion of women screened for CC in age ranges not recommended by the Brazilian government.

Ajuste sacral en lifting glúteo tras grandes perdidas ponderales / Sacral contouring in gluteal lifts after massive weight loss

Introducción y objetivo: Las alteraciones en la región glútea después de una pérdida significativa de peso o una cirugía bariátrica aparecen como piel fácida, reducción de tejido adiposo y pérdida de masa muscular, provocando diversas quejas entre los pacientes. A diferencia de los autores que predefinen la cantidad de tejido a resecar en la región sacra, empleamos este refinamiento al final de la operación, permitiendo la retirada de más piel, corrigiendo asimetrías y dando forma al surco glúteo, según la anatomia de cada individuo.Material y método.Sometimos a lifting glúteo a 15 pacientes. En 12 usamos un colgajo adiposo para proyectar la mitad superior de la región glútea. En 3, además del colgajo adiposo incluimos una prótesis de silicona a través de la misma incisión.Resultados.Entre los 15 pacientes atendidos recogimos las siguientes complicaciones: 1 caso de hematoma tratado solo con aspiración mediante punción; 2 casos de seroma con drenaje espontáneo a través de la herida quirúrgica; y 2 casos de dehiscencia parcial de suturas, con revisión de la cicatriz solo en 1 de estos casos.Conclusiones.En nuestra experiência, el ajuste cutáneo de la región sacra realizado al final de un lifting de glúteos, proporciona una mejor simetría y un posicionamiento más preciso del nuevo surco glúteo. (AU)

Background and objective: Alterations in the gluteal region after significant weight loss or bariatric surgery appear as sagging skin, reduced adipose tissue and loss of muscle mass, causing a variety of complaints from patients. Unlike the authors who pre-define the amount of tissue to be resected in the sacral region, we performed this refinement at the end of the operation, allowing the removal of more skin, correcting asymmetric aspects and shaping the gluteal sulcus, depending on the individual anatomy.Methods.Fifteen patients underwent gluteal lifting. In 12 we used an adipose flap to project the upper half of the gluteal region. In 3 of them, in addition to the adipose flap, we included a silicone prosthesis through the same incision.Results.Among our 15 patients we noticed the following occurrences: 1 case of hematoma treated only with aspiration puncture; 2 cases of seroma with spontaneous drainage through the surgical wound; and 2 cases of partial dehiscence of the sutures, with scar revision required in only 1 of these cases.Conclusions.In our experience, the skin adjustment of the sacral region performed at the end of a gluteal lifting, provides better symmetry and more precise positioning of the new gluteal groove. (AU)