Revisitando a puboplastia pós-bariátrica / Revisiting Postbariatric Monsplasty

INTRODUÇÃO: O tratamento da região pubiana é parte integrante do reajuste corporal inferior nos pacientes pós-bariátricos, tendo em vista a fisiopatologia e o caráter generalizado das deformidades de contorno após grandes emagrecimentos. O objetivo é apresentar nossa experiência no tratamento de pacientes pós-bariátricos, exclusivamente pela marcação baixa da abdominoplastia com vetores adequados de mobilização tecidual, sem a necessidade de cicatrizes verticais ou oblíquas na região do púbis. MÉTODOS: Foram avaliados retrospectivamente prontuários médicos e registros fotográficos de pacientes submetidos a diferentes abordagens abdominais, com aplicação dos princípios descritos acima no tratamento associado da região pubiana. Incisão cutânea anterior baixa, descolamento cranial angulado em direção ao plano aponeurótico (bisel preservando gordura profunda superior), e manutenção um excedente gorduroso nos bordos superiores para a facilitar a fixação dos retalhos através do Sistema Fascial Superficial. Uma avaliação subjetiva da qualidade dos resultados foi caracterizada por observador único. RESULTADOS: Numa casuística de 126 pacientes consecutivos, a tática empregada possibilitou restabelecer a melhor posição, tônus e formato do púbis em 100% dos casos, cujos resultados foram subjetivamente classificados como bom (40%) ou ótimo (60%). As intercorrências mais frequentemente encontradas na evolução pós-operatória foram pequenas deiscências da sutura (23,8%) e seromas (19%), com boa evolução pelos curativos e punções seriadas. CONCLUSÃO: A tática cirúrgica apresentada, com posicionamento baixo da incisão anterior e aproximação dos retalhos por fixação no sistema fascial superficial e pele, possibilita o tratamento adequado da região pubiana durante as abdominoplastias pós-bariátricas, sem a necessidade de ressecções e cicatrizes adicionais.

INTRODUCTION: The treatment of the pubic region is an integral part of lower body readjustment in post-bariatric patients, considering the pathophysiology and generalized characteristics of contour deformities after a considerable weight loss. The objective is to present our experience in the treatment of post-bariatric patients, exclusively by low marking of abdominoplasty with appropriate tissue mobilization vectors, without the necessity to leave vertical or oblique scars in the pubic region. METHODS: The medical and photographic records of patients subjected to different abdominal approaches were retrospectively evaluated, applying the principles described above in the combined treatment of the pubic region. A low anterior skin incision was created, and angled cranial detachment towards the aponeurotic plane (with the bevel preserving the deep upper fat) and maintenance of excess fat on the upper edges to facilitate the fixation of the flaps through the superficial fascial system were performed. The outcomes' quality was subjectively evaluated by a single observer. RESULTS: In the case series of 126 consecutive patients, the strategy used restored the best position, tone, and shape of the pubis in 100% of the cases; the results were subjectively classified as good (40%) or very good (60%). The complications more frequently found in the post-operative period were small suture dehiscence (23.8%) and seroma formation (19%), with good evolution provided by dressings and serial punctures. CONCLUSION: The surgical strategy presented involving low positioning of the anterior incision and flap alignment in the superficial fascial system and skin by fixation allows the proper treatment of the pubic region during post-bariatric abdominoplasty procedures, without the need for additional resections and scars.

Proposta de tratamento preventivo de pubalgia em jogadores juniores de futsal / Proposal for preventive treatment of pubic pain in junior futsal players

A pubalgia é uma síndrome caracterizada por processo inflamatório da sínfise púbica, predominante em esportes que envolvem esforços repetitivos com freqüentes mudanças de direção e arranques, como o futebol e o tênis. Os sintomas são freqüentemente inespecíficos e de difícil diagnóstico. Desta forma, proporcionam longos períodos de afastamento de atividades físicas e esportivas, perpetuando os desequilíbrios funcionais e dificultando o tratamento. A pubalgia pode ser tratada de três formas: preventiva, conservadora, ou cirúrgica. O estudo teve como objetivo propor um protocolo de tratamento preventivo de pubalgia, para prevenir desequilíbrios da musculatura da cintura pélvica. Participaram do presente estudo 13 atletas de futsal do sexo masculino, com idade média de 18 anos, da equipe sub-20 do Sport Club Corinthians Paulista. Todos foram submetidos a duas avaliações, inicial e final, e ao protocolo de tratamento preventivo realizado duas vezes por semana por período de dois meses. Os resultados demonstraram uma melhora de flexibilidade e do fortalecimento da musculatura abdominal nos jogadores. Assim, pode-se concluir que o protocolo se mostrou eficaz na melhora da flexibilidade e do fortalecimento da musculatura abdominal.

The pubic pain is a syndrome characterized by an inflammatory process of pubic symphysis. It is predominant in sports that use repetitive efforts with different changes in direction such as football and tennis. The symptoms are not frequently specific and the disease is difficult to diagnose. Therefore, long periods of absence from physical activities imply in difficulties in treatment. The pubic pain can be treated in three different ways: preventive, conservative or surgical. This study aimed at conducting a treatment and preventive protocol for preventing imbalances of pelvic muscles. Thirteen male athletes of futsal, average age 18 years, from the sub –20 team from the Sport Club Corinthians Paulista participated to the study. All of them were submitted to two evaluations, at the beginning and at the end, and to treatment and preventive protocol carried out twice a week for two months. The results showed improving in flexibility and stretching of players abdominal muscles. We can conclude that the protocol was effective to improve flexibility and abdominal muscles strengthening.

Differential distribution of elastic system fibers in the pubic symphysis of mice during prefnancy, partum and post-partum

The expansion of the pubic symphysis during pregnancy in some rodet depends on the growth of the interpubic ligament, primarily through the biosynthesis of extracellular matrix. Although there is a significant metabolism of elastin in the female reproductive tract during pregnancy, little is known of the architectural and ultrastructural aspects of the elastic system fibers in the mouse pubic symphysis. In this study, the main characteristics of the elastic system of the mouse pubic symphysis during pregnancy, partum and post-partum were determined by light and electron microscopy. A distinct arrangement of microfibrils, elastin deposition and development of the extracellular matrix formed a supporting framework that uniformly distributed stress in order to provide adequate interpubic resilience during delivery. These changes support a role for elastic system fibers in symphyseal maturation and reconstruction during pregnancy and after delivery.

Cloacal exstrophy: experience at King Abdulaziz University Hospital, Jeddah, Saudi Arabia

Cloacal exstrophy is one of the complex anomalies which challenge the pediatric surgeons infrequently. At King Abdulaziz University Hospital, Jeddah, we had the experience of managing four cases. The reconstruction was achieved in stages and involved gastrointestinal, urological, genital. and musculoskeletal systems. All the managed cases were raised as their original genotype. A fifth case died before any surgical intervention, due to a major cardiac congenital anomaly. The aim of the present study is to report such rare anomalies and to present our experience in their management