Effectiveness of 5-Fluorouracil and Hypertonic Glucose in the Prevention of Post-mastectomy Seroma in an Experimental Animal Model.

INTRODUCTION: Seroma is a frequent complication that can affect the final result of reconstructive and cosmetic surgeries. METHODOLOGY: This study evaluated the effectiveness of 5-Fluorouracil and 75% hypertonic glucose in preventing seroma in a mastectomy rat model, as well as cellular and vascular events in adjacent tissues. A left mastectomy with lymphadenectomy was performed in 60 Wistar-Albino female rats. Animals randomly allocated to the control group (Group I; n = 20) were sutured right after mastectomy. The intervention groups received 1.0 mL of 75% hypertonic glucose (Group II; n = 20) or 1.0 mL of 5-Fluorouracil (Group III; n = 20) at the surgical site before suturing. The assessment of the presence of seroma was performed in all animals at 24, 48, and 72 h and on the 7th and 12th postoperative day. After the 12th day, a tissue sample was taken from the surgical site and sent for histological analysis. The occurrence of seroma was assessed using GEE. A significance level of 5% was adopted. RESULTS: Differences in seroma formation over time were observed for both Control Group I (p=0.041) and Intervention Group II (p<0.001). In Intervention Group III, there was no difference in the percentage and volume of seroma across the assessment points (p=0.627). When both the Control and Intervention Group II were compared to Intervention Group III, we found a reduction in seroma formation in the last group. The reduction in the inflammatory process was more regular to Intervention Group III. CONCLUSION: In this animal model, 5-Fluorouracil was more effective in preventing seroma formation than 75% Hypertonic Glucose. No Level Assigned This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .

Brazilian Portuguese version of the Patient Scar Assessment Questionnaire / Validação da versão em português do Patient Scar Assessment Questionnaire

Introduction: Scars and their associated signs and symptoms have the potential to impact many aspects of health. Given the growing number of individuals with new scars, it is essential to have reliable, sensitive, and specific assessment tools that analyze the influence that scars can have on the quality of life. The objective is translate the Patient Scar Assessment Questionnaire (PSAQ) into Portuguese, adapt it to the Brazilian cultural context, and test its reproducibility, reliability, and validity. Methods: The questionnaire was applied to 121 individuals with post-surgical scars consecutively selected at a plastic surgery clinic from January 2015 to June 2016. The PSAQ consists of 39 questions divided into five subscales: appearance, symptoms, perception, satisfaction with appearance, and symptoms. Then its reproducibility, face, content, and construct validity were analyzed. Internal consistency was tested using Cronbach's alpha coefficient, and construct validation was performed by correlating the translated instrument with the QualiFibro and Patient and Observer Scar Assessment Scale (POSAS) questionnaires. Results: Analysis of the internal consistency of the PSAQ subscales obtained values >0.70 in all domains, showing good internal consistency. Reproducibility was demonstrated using Pearson's correlation and the Bland-Altman method, and the outcomes showed good reproducibility. In construct validation, a significant correlation was observed in all PSAQ domains with POSAS and QualiFibro. Conclusion: The PSAQ was translated into Portuguese and adapted to Brazilian culture, reproducible and presenting face, content, and construct validity.

Introdução: Cicatrizes e seus sinais e sintomas associados têm potencial para impactar vários aspectos da saúde. Dado o número crescente de indivíduos que adquirem novas cicatrizes, é importante ter ferramentas de avaliação confiáveis, sensíveis e específicas que analisem a influência que as cicatrizes podem exercer sobre a qualidade de vida. O objetivo é traduzir o Patient Scar Assessment Questionnaire (PSAQ) para a língua portuguesa, adaptá-lo ao contexto cultural brasileiro e testar sua reprodutibilidade, confiabilidade e validade. Método: O questionário foi aplicado em 121 indivíduos portadores de cicatrizes pós-cirúrgicas selecionados consecutivamente em ambulatório de cirurgia plástica no período de janeiro de 2015 a junho de 2016. O PSAQ é constituído por 39 questões divididas em cinco subescalas: aparência, sintomas, percepção, satisfação com a aparência e com os sintomas. Foram analisados a reprodutibilidade, validade de face, conteúdo e construto. A consistência interna foi testada pelo alfa de Cronbach e a validação de construto foi realizada correlacionando o instrumento traduzido com os questionários QualiFibro e Patient and Observer Scar Assessment Scale (POSAS). Resultados: A análise da consistência interna das subescalas do PSAQ obteve valores maiores que 0,70 em todos os domínios, evidenciando uma boa consistência interna. A reprodutibilidade foi demonstrada através da correlação de Pearson e método de Bland-Altman, sendo observada boa reprodutibilidade. Na validação de construto observou-se correlação significativa entre todos os domínios do PSAQ com a POSAS e QualiFibro. Conclusão: O PSAQ foi traduzido para o português e adaptado à cultura brasileira, mostrando-se reprodutível e apresentando validade de face, conteúdo e construto.

REVIEW OF ARTICULATED ELBOW ORTHOTICS FOR JOINT STIFFNESS REHABILITATION.

Joint stiffness is the most common complication in elbow injuries, presenting several etiologies and pathophysiological mechanisms that hinder treatment and prognosis. Prevention and treatment of joint contracture depend on the cause of stiffness, and early intervention should modify its outcomes. The methods used may be conservative or surgical, alone or in combination, according to each individual situation. Objective: Review articles on articulated elbow orthosis for joint stiffness rehabilitation. Methods: A literature review was conducted in journals available at the PubMed, Medline and LILACS databases, using the following Health Science Descriptors (DeCS): orthotic devices; braces; elbow; elbow joint; contracture; joint disorders. It sought to retrieve and analyze studies with the highest level of evidence that have already been conducted on articulated elbow orthosis for joint stiffness rehabilitation. Results: After applying the inclusion and exclusion criteria, four articles were included from PubMed and none from Medline or LILACS. Of the four PubMed articles, two were systematic reviews and two were randomized clinical trials. Conclusion: Articulated elbow orthoses can benefit joint stiffness treatment, improving range of motion and pain, showing superior effect compared to non-articulated plaster orthotics. Level of Evidence III, Systematic Review of Level III Studies.

A rigidez articular é a principal complicação do cotovelo, afetando o tratamento e o prognóstico. O manejo da contratura articular se baseia na sua etiologia, e a intervenção precoce deve modificar o desfecho dessa complicação. Objetivo: Revisar artigos sobre órtese articulada de cotovelo para reabilitação de rigidez articular. Métodos: Foi realizada uma revisão bibliográfica em periódicos disponíveis do PubMed, Medline e LILACS, utilizando os Descritores em Ciências da Saúde (DeCS): aparelhos ortopédicos; braquetes; cotovelo; articulação do cotovelo; contratura; e transtornos da articulação. A intenção foi estabelecer e conhecer estudos de alto poder de evidência já realizados, que tenham tido como referência a temática de órteses articuladas de cotovelo para reabilitação de rigidez articular. Resultados: Após a aplicação dos critérios de inclusão e exclusão, revisaram-se artigos indexados no PubMed, Medline e LILACS, encontrando-se quatro artigos pelo PubMed e nenhum pelo Medline ou LILACS. Dos quatro artigos, dois eram revisões sistemáticas e dois eram ensaios clínicos randomizados. Conclusão: Órteses articuladas de cotovelo podem ser benéficas no tratamento de rigidez articular, sendo sugerido que melhoram amplitude de movimentos (ADM) e dor, inclusive com efeito superior em relação às órteses não articuladas gessadas. Nível de Evidência III, Revisão Sistemática de Estudos de Nível III.

Inovação em cânula de lipoaspiração para coleta de enxerto de gordura para uso em reconstrução mamária / Innovation in liposuction cannula to harvest fat graft to use in breast reconstruction

Introdução: A evolução da técnica de lipoaspiração e da enxertia de gordura associada a segurança oncológica permitiram utilizar a gordura como preenchedor autólogo em pacientes com neoplasia de mama que eram submetidas a reconstrução mamária. O objetivo é apresentar uma inovação no instrumento de coleta de gordura que será utilizada como enxerto, para uso em reconstrução mamária. Métodos: Foi realizada a busca de anterioridade nos bancos de dados internacionais e nacional e a confecção de um protótipo de cânula de coleta de gordura de 35cm de comprimento, com diâmetro do tubo de 4mm, com 10 furos redondos na sua extremidade distal com 2mm de diâmetro. Foi realizado um experimento de aspiração de substância viscosa comparando o protótipo com dois modelos de cânulas com desenho padrão da indústria, de três furos tipo Mercedes e de cinco furos tipo Pitanguy. Resultados: Foram encontrados quatro patentes de alta relevância e uma patente de média relevância, que diferem do modelo de utilidade proposto quando se comparam o tipo de desenho da extremidade distal das cânulas estudadas e a função dos instrumentos identificados. Quando comparou-se a eficiência do protótipo, a cânula de cinco furos foi a mais eficiente na aspiração da substância viscosa, e não houve diferença estatística na velocidade de aspiração entre o protótipo e a cânula de três furos tipo Mercedes. Conclusão: A inovação apresentada para a coleta de enxerto de gordura para uso em reconstrução mamária apresentou a mesma eficiência que a cânula Mercedes de três furos neste modelo experimental.

Introduction: The evolution of liposuction and fat graft technique with the oncologic safety allowed to use the fat as autologous filler in patients with breast cancer and submitted to breast reconstruction. The objective is to introduce an innovation in the instrument used to harvest fat grafts for breast reconstruction. Methods: Search of anteriority and trademarks were performed at international and national databases, and a prototype was built as a fat harvest instrument with 35cm in length, 4cm in diameter, with 10 holes at the distal extremity, with 2mm diameter each. It was experimented with a harvest of a viscous substance, comparing the prototype with two regular industry cannulas types: three holes Mercedes' type and five roles Pitanguy's type. Results: Four high-relevance patents and one medium-relevance patent were found, which differ from the proposed utility model when comparing the type of design of the distal end of the studied cannulas and the function of the instruments identified. When the prototype's efficiency was compared with the other cannulas, the cannula with five holes in Pitanguy's type was the most efficient, and it was no statistical difference between the prototype and the cannula with three roles in Mercedes' type. Conclusion: The innovation presented to harvest fat graft for breast reconstruction had the same efficiency in harvesting the viscose substance as the cannula Mercedes type with three holes in this experimental model.

Review of articulated elbow orthotics for joint stiffness rehabilitation / Revisão de órteses articuladas de cotovelo para reabilitação de rigidez articular

ABSTRACT Joint stiffness is the most common complication in elbow injuries, presenting several etiologies and pathophysiological mechanisms that hinder treatment and prognosis. Prevention and treatment of joint contracture depend on the cause of stiffness, and early intervention should modify its outcomes. The methods used may be conservative or surgical, alone or in combination, according to each individual situation. Objective: Review articles on articulated elbow orthosis for joint stiffness rehabilitation. Methods: A literature review was conducted in journals available at the PubMed, Medline and LILACS databases, using the following Health Science Descriptors (DeCS): orthotic devices; braces; elbow; elbow joint; contracture; joint disorders. It sought to retrieve and analyze studies with the highest level of evidence that have already been conducted on articulated elbow orthosis for joint stiffness rehabilitation. Results: After applying the inclusion and exclusion criteria, four articles were included from PubMed and none from Medline or LILACS. Of the four PubMed articles, two were systematic reviews and two were randomized clinical trials. Conclusion: Articulated elbow orthoses can benefit joint stiffness treatment, improving range of motion and pain, showing superior effect compared to non-articulated plaster orthotics. Level of Evidence III, Systematic Review of Level III Studies.

RESUMO A rigidez articular é a principal complicação do cotovelo, afetando o tratamento e o prognóstico. O manejo da contratura articular se baseia na sua etiologia, e a intervenção precoce deve modificar o desfecho dessa complicação. Objetivo: Revisar artigos sobre órtese articulada de cotovelo para reabilitação de rigidez articular. Métodos: Foi realizada uma revisão bibliográfica em periódicos disponíveis do PubMed, Medline e LILACS, utilizando os Descritores em Ciências da Saúde (DeCS): aparelhos ortopédicos; braquetes; cotovelo; articulação do cotovelo; contratura; e transtornos da articulação. A intenção foi estabelecer e conhecer estudos de alto poder de evidência já realizados, que tenham tido como referência a temática de órteses articuladas de cotovelo para reabilitação de rigidez articular. Resultados: Após a aplicação dos critérios de inclusão e exclusão, revisaram-se artigos indexados no PubMed, Medline e LILACS, encontrando-se quatro artigos pelo PubMed e nenhum pelo Medline ou LILACS. Dos quatro artigos, dois eram revisões sistemáticas e dois eram ensaios clínicos randomizados. Conclusão: Órteses articuladas de cotovelo podem ser benéficas no tratamento de rigidez articular, sendo sugerido que melhoram amplitude de movimentos (ADM) e dor, inclusive com efeito superior em relação às órteses não articuladas gessadas. Nível de Evidência III, Revisão Sistemática de Estudos de Nível III.

Algoritmos para manejo de cicatrizes: a importância da sistematização de condutas / Algorithms for the management of scars: the importance of systematizing behaviors

■ RESUMO Introdução: As cicatrizes patológicas ocorrem a partir de hiperproliferaçãoo de fibroblastos, podendo ser classificadas em cicatrizes hipertróficas e queloides, basicamente as cicatrizes hipertróficas não crescem além dos limites da ferida original, enquanto os queloides crescem horizontalmente de forma nodular. Apesar da diversidade de instrumentos utilizados para orientar a prevenção, tratamento e seguimento de cicatrizes patológicas, existe a necessidade de instrumentos que contemplem realidades locais. O objetivo é realizar uma revisão narrativa de literatura sobre algoritmos para manejo de cicatrizes e criar um algoritmo atualizado. Métodos: Estudo descritivo de revisão narrativa de literatura, sendo realizado uma pesquisa nas bases de dados PubMed, SciELO, LILACS, MEDLINE e Cochrane, no período de novembro de 2010 até novembro de 2020, publicados nos idiomas inglês, português e espanhol. Os descritores utilizados foram: "cicatrix", "keloid", "algorithms" e "wound healing". A seleção da amostra consistiu da identificação dos artigos, leitura dos títulos e resumos e seleção de estudos relacionados ao tema e, posteriormente, foi realizada a leitura na íntegra dos estudos selecionados e classificação segundo os critérios de elegibilidade. Resultados: Foram encontrados 209 artigos sendo eliminados 116 devido duplicidade resultando em 45 artigos. Foram identificados um total de 8 artigos que preencheram os critérios de inclusão e após análise e reunião de consenso foram excluídos quatro artigos devido à ausência de algoritmos com rigor científico sendo este estudo composto de quatro artigos. Conclusão: Foram encontrados quatro algoritmos na revisão de literatura que resultaram na elaboração de um algoritmo atualizado para cicatrizes.

■ ABSTRACT Introduction: Pathological scars occur from the hyperproliferation of fibroblasts and can be classified into hypertrophic scars and keloids. Basically, hypertrophic scars do not grow beyond the limits of the original wound, while keloids grow horizontally in a nodular form. Despite the diversity of instruments used to guide the prevention, treatment and follow-up of pathological scars, there is a need for instruments that address local realities. The objective is to carry out a narrative review of the literature on scar management algorithms and create an updated algorithm. Methods: Descriptive study of narrative literature review, with a search in PubMed, SciELO, LILACS, MEDLINE and Cochrane databases, from November 2010 to November 2020, published in English, Portuguese and Spanish. The descriptors used were: "cicatrix," "keloid," "algorithms," and "wound healing." The sample selection consisted of identifying the articles, reading the titles and abstracts, and selecting studies related to the topic. Subsequently, the full reading of the selected studies and classification according to the eligibility criteria were carried out. Results: 209 articles were found, and 116 were eliminated due to duplicity, resulting in 45 articles. A total of 8 articles that met the inclusion criteria were identified. Four articles were excluded after analysis and consensus meeting due to the absence of algorithms with scientific rigor; this study is composed of four articles. Conclusion: Four algorithms were found in the literature review that resulted in the development of an updated algorithm for scars.

Anchor-Line Abdominoplasty with Scarpa Fascia Preservation in Postbariatric Patients: A Comparative Randomized Study.

BACKGROUND: The number of bariatric surgeries for the treatment of morbid obesity has increased, and there is growing demand for postbariatric abdominoplasty. The aim of this study was to evaluate the impacts of Scarpa's fascia preservation on total drainage volume, time to drain removal, and seroma formation in anchor-line abdominoplasty. METHODS: A total of 42 postbariatric patients were randomly assigned to two groups and underwent anchor-line abdominoplasty. Scarpa's fascia was not preserved during abdominoplasty in one group (n = 21) but was preserved in the other group (n = 21). A suction drain was left in place until the drainage volume was less than 30 ml/24 h. Seroma formation was assessed by abdominal ultrasound on the twentieth postoperative day; only fluid collections greater than 30 ml were considered seromas. RESULTS: The time to drain removal was shorter, and the total drainage volume was lower in the fascial preservation group than in the fascial dissection group. However, no difference in the seroma formation rate was observed between the groups. CONCLUSION: Scarpa's fascia preservation decreased the drainage volume and the time to drain removal but not the rate of seroma formation. LEVEL OF EVIDENCE II: 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.

Fio de sutura elástico / Elastic suture thread

Introdução: O tratamento de grandes e médias feridas é um desafio para os cirurgiões quando precisam fechálas e, normalmente, são utilizadas técnicas cirúrgicas de enxertias ou retalhos, que podem deixar sequelas e até mesmo mutilações. Ao longo do tempo desenvolveu-se a técnica de "sutura elástica" que promove a cicatrização em curto espaço de tempo com sequelas menores, entretanto o procedimento tem sido realizado com material improvisado. Objetivo: Desenvolver um fio de sutura elástico cirúrgico que possa ser esterilizado e confeccionado nos moldes dos produtos médicos cirúrgicos. Métodos: Revisão das patentes existentes por meio da busca de anterioridade e comparação com o dispositivo do estudo. Pesquisa de materiais com as características necessárias como elasticidade e tensão. Teste destas características em laboratórios especializados. Resultados: O produto desenvolvido é um fio elástico com duplo agulhamento para suturas, com matéria prima de silicone que apresenta elasticidade e resistência a tensão. Conclusão: O fio de sutura elástico, com duplo agulhamento, para feridas de médio e grande porte foi desenvolvido.

Introduction: Closing large and medium wounds is challenging for surgeons and often leads to the use of graft or flap surgical techniques. These procedures can leave sequelae and even mutilations. An "elastic suture" technique was developed to promote wound healing in a short time span with minor sequelae; however, improvised materials have been used in this procedure. Objective: To develop a surgical elastic suture thread that can be manufactured and sterilized following the standards of surgical medical products. Methods: We conducted a patent search, compared the findings with the study device, and researched materials with necessary characteristics such as elasticity and tension. Testing these characteristics in specialized laboratories. Results: The developed device is a double-needled elastic suture made of silicone that presents tensile strength. Conclusion: Here, we developed a double-needled elastic suture for medium and large wounds.

Sexuality, depression and body image after breast reconstruction.

OBJECTIVES: To evaluate the impact of breast reconstruction after mastectomy on sexual function, body image, and depression. METHODS: This cross-sectional, comparative, controlled study was conducted with 90 women between 18 and 65 years of age who had undergone either mastectomy alone (mastectomy group, n=30) or mastectomy combined with breast reconstruction (mastectomy-reconstruction group, n=30) at least one year prior to the study or who had no breast cancer (control group, n=30). Patients were assessed for sexual function, depression, and body image using the validated Brazilian-Portuguese versions of the Female Sexual Function Index, the Beck Depression Inventory, and the Body Dysmorphic Disorder Examination, respectively. RESULTS: The three groups were homogeneous for age, marital status, body mass index, and education level. The women in the mastectomy group reported significantly worse sexual function, greater depressive symptoms, and lower body image than those in the mastectomy-reconstruction and control groups. In the mastectomy group, the frequency of sexual dysfunction was significantly greater among patients without a marital partner and those with a higher level of education than among patients in the other two groups with the same characteristics. CONCLUSION: Patients who had undergone breast reconstruction after mastectomy reported better sexual function and body image and fewer depressive symptoms than patients who had undergone mastectomy alone. Sexual dysfunction was associated with the absence of a marital partner and a higher level of education and was more frequent in the mastectomy group.

New Approach for Post-bariatric Abdominoplasty with Extended Vertical Resection: A Prospective Cohort Study.

INTRODUCTION: As the number of bariatric surgeries has increased, so has the demand for post-bariatric abdominoplasty. The aim of this study was to describe a new approach to anchor-line abdominoplasty for the treatment of post-bariatric surgery patients. METHODS: This prospective, longitudinal, single-center study was conducted with 20 women, 23-47 years of age, with a body mass index < 30 kg/m2, who had undergone gastroplasty. The vertical amount of tissue to be excised was estimated preoperatively by the pinch test. The amount of tissue to be removed by transverse resection was determined intraoperatively. Patient satisfaction with the body contour result was assessed. RESULTS: Patient self-assessment showed that 85% of patients were very satisfied, 10% were satisfied, and 5% were not very satisfied with the surgical results. There were no cases of flap necrosis or surgical wound dehiscence. CONCLUSION: The described technique resulted in improved body contour, good scar quality, and a high level of patient satisfaction. 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 .

Novas tecnologias e inovações em cirurgia mamária / New technologies and innovations in breast surgery

Introdução: A cirurgia de mama, especialmente as associadas aos implantes de silicone, teve uma crescente popularização, tornando-se a cirurgia plástica mais realizada no mundo. Junto com esta proliferação, observa-se um aumento da preocupação com a segurança dos implantes mamários de silicone, pelas intercorrências relacionadas. Objetivo: Revisar métodos existentes para minimizar as complicações relacionadas com implante mamário de silicone, bem como as tecnologias existentes e tendências tecnológicas para implantes mamários de silicone. Métodos: Foi realizada revisão de artigos científicos relacionados com novas tecnologias e tendências para redução das complicações relacionadas com implantes mamários de silicone, bem como as patentes e fabricantes de implante de silicone mamário. Resultados: Identificamos inicialmente 78 referências, sendo reduzido para 40 para publicação, todos com linhas de pesquisas que buscam melhores resultados e redução das complicações relacionadas com implantes de silicone, seja esta cirurgia com objetivo estético ou reconstrutivo. Conclusão: A busca por um implante mamário que reduza as possíveis e frequentes complicações, principalmente a formação do biofilme, processos infecciosos e resposta imune, é o foco da maioria das pesquisas encontradas. Com o mesmo objetivo, porém surgindo mais recentemente como alternativas, existem as pesquisas para o uso de matriz dérmica acelular e a lipoenxertia, com boas expectativas.

Introduction: Breast surgery with silicone implants is gaining popularity and has become the most performed plastic surgery worldwide. However, there is increasing concern about the safety of silicone breast implants due to associated complications. Objective: To review existing technologies, technological trends, and existing methods to minimize complications related to silicone breast implants. Methods: We conducted a literature review of articles describing new technologies and trends to reduce complications related to silicone breast implants, along with information on patents and manufacturers of silicone breast implants. Results: We initially identified 78 articles, out of which 40 were shortlisted for publication . All articles had a common aim of obtaining better results and reducing complications related to silicone implants, either in aesthetic or reconstructive surgeries. Conclusion: The search for a breast implant that reduces possible and frequent complications, especially biofilm formation, infectious processes, and abnormal immune response, was the focus of most articles studied. Acellular dermal matrix and fat grafting have been reported in the literature as promising alternatives.

Sexuality, depression and body image after breast reconstruction

OBJECTIVES: To evaluate the impact of breast reconstruction after mastectomy on sexual function, body image, and depression. METHODS: This cross-sectional, comparative, controlled study was conducted with 90 women between 18 and 65 years of age who had undergone either mastectomy alone (mastectomy group, n=30) or mastectomy combined with breast reconstruction (mastectomy-reconstruction group, n=30) at least one year prior to the study or who had no breast cancer (control group, n=30). Patients were assessed for sexual function, depression, and body image using the validated Brazilian-Portuguese versions of the Female Sexual Function Index, the Beck Depression Inventory, and the Body Dysmorphic Disorder Examination, respectively. RESULTS: The three groups were homogeneous for age, marital status, body mass index, and education level. The women in the mastectomy group reported significantly worse sexual function, greater depressive symptoms, and lower body image than those in the mastectomy-reconstruction and control groups. In the mastectomy group, the frequency of sexual dysfunction was significantly greater among patients without a marital partner and those with a higher level of education than among patients in the other two groups with the same characteristics. CONCLUSION: Patients who had undergone breast reconstruction after mastectomy reported better sexual function and body image and fewer depressive symptoms than patients who had undergone mastectomy alone. Sexual dysfunction was associated with the absence of a marital partner and a higher level of education and was more frequent in the mastectomy group.

Lipoaspiração abdominal de alta definição e tubos de silicone / High-definition abdominal liposuction with silicone tubing

Introdução: Recentemente, alguns autores têm descrito a lipoaspiração de alta definição, na qual, na região abdominal, é alcançada pela marcação vigorosa dos sulcos das linhas alba, semilunar e interseções tendíneas transversais do músculo reto abdominal. O objetivo é apresentar estudo piloto de técnica de lipoaspiração de alta definição abdominal utilizando material convencional e tubos de silicone nos curativos. Métodos: Foram descritos 20 casos, submetidos à lipoaspiração convencional e em seguida lipoaspiração superficial sob as linhas alba, semilunar e interseções tendíneas, até que se obtivesse a formação de um sulco nestes locais. Utilizamos tubos de silicone maleáveis nas linhas alba, semilunar bilateral e interseções tendíneas, fixados externamente com micropore, os quais foram removidos após 5 dias. Resultados: Houve um acréscimo médio de 20 minutos para realização destas etapas. As marcas dos tubos de silicone apresentaram-se muito evidentes no primeiro retorno, estando mais discretas no segundo retorno. Não foram observadas alterações de coloração, isquemia ou dor maior pela técnica empregada. Após 3 meses, não houve nenhum caso de dermatite, cútis marmorata, seroma, infecção, irregularidade de contorno ou necessidade de procedimentos adicionais. Conclusão: Foi realizada lipoaspiração de alta definição abdominal, com material convencional e uso de tubos de silicone temporários fixados externamente.

Introduction: Recently, some authors have described high definition liposuction in the abdominal region, achieved by the vigorous marking of the grooves of the linea alba, linea semilunaris, and transverse tendinous intersections within the rectus abdominis muscle. The aim is to present a pilot study of high-definition abdominal liposuction technique using conventional material and silicone tubing in the dressings . Methods: Twenty cases were submitted to conventional liposuction, followed by superficial liposuction under the linea alba, linea semilunaris, and tendinous intersections, until a groove was formed at these sites. Flexible silicone tubing was externally fixed with Micropore tape in the linea alba, bilateral linea semilunaris, and tendinous intersections, and removed after 5 days. Results: A mean increase of 20 minutes was required to perform these steps. The marks of the silicone tubing were evident at the first follow-up, and less prominent at the second follow-up. No color change, ischemia, or significant pain was observed using this technique. After 3 months, there were no cases of dermatitis, cutis marmorata, seroma, infection, contour irregularity or need for additional procedures. Conclusion: High-definition abdominal liposuction was performed using conventional materials and externally fixed temporary silicone tubing.

Instrumento de Marcação de Abdominoplastia / Abdominoplasty Marking Instrument

Introdução: A abdominoplastia, um dos procedimentos de cirurgia plástica mais comuns no Brasil, ficou em quarto lugar no ranking mundial, segundo dados da International Society of Aesthetic Plastic Surgery. Diversas técnicas cirúrgicas visam restaurar o contorno abdominal. A indicação da técnica utilizada deve visar a melhoria da deformidade individual presente no abdome. A marcação da abdominoplastia se faz por meio de régua, transferidor, compasso, fio de náilon, palito, canetas e/ou azul de metileno, de acordo com a preferência do cirurgião. O objetivo é produzir um instrumento cirúrgico com a finalidade de otimizar o tempo de marcação no procedimento de abdominoplastia. Métodos: O estudo foi aprovado pelo Comitê de Ética em Pesquisa, foram desenvolvidos desenhos gráficos para identificar cada uma das partes do instrumento, foi realizada a busca de anterioridade e, posteriormente, realizado o pedido de patente. Resultados: Foi desenvolvido um instrumento para marcação da abdominoplastia, que configura uma régua horizontal que recepciona uma régua vertical no seu ponto médio e duas réguas pivotantes com transferidor basal, todas essas peças milimetradas e com vazado central, que permitem o risco nessa região com o azul de metileno ou caneta afim e, por conseguinte, a marcação do procedimento de abdominoplastia. Além disso, também funciona como compasso e de cujas laterais derivam réguas pivotantes com transferidor de grau basal. Conclusão: O instrumento desse estudo foi criado para minimizar a quantidade de material utilizado e otimizar o tempo da marcação da abdominoplastia.

Introduction: Data from the International Society of Aesthetic Plastic Surgery indicate that abdominoplasty is the fourth most common plastic surgery performed worldwide. Several surgical techniques aim to restore the abdominal contour. The indication for the technique used should aim to improve any individual deformity present in the abdomen. Abdominoplasty marking is done using a ruler, protractor, compass, nylon thread, toothpick, pen, and/or methylene blue, according to the surgeon's preference. Here we aimed to produce a surgical instrument that optimizes the abdominoplasty marking procedure. Methods: The study was approved by the ethics research committee. Graphic designs were developed to identify each part of the instrument, a precedence search was performed, and a patent application was requested. Results: We developed an abdominoplasty marking instrument consisting of a horizontal ruler that receives a vertical ruler at its midpoint, two pivotal rulers with a basal protractor, all marked in millimeters, and a central area that allows marking in this region with methylene blue or a pen. Moreover, it acts as a compass and features side pivotal rulers derived from a basal grade protractor. Conclusion: The instrument developed in this study was designed to minimize the amount of material used and optimize abdominoplasty marking time.

Postoperative intravenously administered iron sucrose versus postoperative orally administered iron to treat post-bariatric abdominoplasty anaemia (ISAPA): the study protocol for a randomised controlled trial.

BACKGROUND: Anaemia and iron deficiency are common complications following post-bariatric abdominoplasty. Given the low oral absorbability of iron resulting from bariatric surgery, it has been hypothesised that postoperative intravenously administered iron supplementation could be used to treat anaemia and to prevent the development of iron deficiency in these patients. METHODS/DESIGN: In this multicentre open-label randomised clinical trial, 56 adult women undergoing post-bariatric anchor-line abdominoplasty will be allocated at a ratio of 1:1 for postoperative supplementation with two intravenously administered applications of 200 mg of iron saccharate or postoperative supplementation with 100 mg of iron polymaltose complex administered orally, twice a day for 8 weeks. The primary outcome is the difference in mean haemoglobin levels between the two groups at eight postoperative weeks. Secondary outcomes evaluated at one, four and eight postoperative weeks include iron profile, reticulocyte count, overall quality of life measured using the Short-Form 36 Health Survey (SF-36) questionnaire, fatigue measured using the Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F), adverse effects and postoperative complications. DISCUSSION: This randomised clinical trial aims to evaluate the haematopoietic effectiveness of intravenously administered iron supplementation in patients undergoing post-bariatric abdominoplasty. A more effective recovery of haemoglobin levels could help improve the patients' quality of life and could provide an improved haematological status in preparation for the subsequent and frequent plastic surgeries these patients undergo. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT01857011 (8 May 2013), Universal Trial Number U111-1169-6223, Brazilian Clinical Trials Registry (REBEC): RBR-2JGRKQ .

Classificação clínica de ptose da cauda do supercílio / Clinical classification of brow ptosis

INTRODUÇÃO: O estudo do supercílio se emoldura como um grande desafio para a cirurgia plástica por sua complexa relação com as estruturas faciais. O objetivo é descrever uma classificação clínica de ptose da cauda do supercílio. MÉTODOS: Estudo transversal, com pacientes de ambos os sexos, com idade de 18 a 100 anos, subdivididos em três grupos segundo a faixa etária. Grupo 1: 18 a 30 anos, Grupo 2: 31 a 60 anos e Grupo 3: 61 a 100 anos. Realizaram-se três medidas de cada lado por examinadores distintos, sem que cada um soubesse o valor da aferição dos demais. RESULTADOS: Total de 90 pacientes, com idades variando entre 18 e 94 anos, sendo 39 (43,3%) do sexo masculino e 51 (56,7%)do sexo feminino. As medidas do Grupo 1, considerado como normal, com média de idade de 26,7 anos, e com média de 2,14 cm em relação a medidas da ptose da cauda do supercílio. Já no Grupo 2, média da faixa etária foi de 44,2 anos e a média foi de 1,9 cm. No Grupo 3, média de idade de 72,6 anos com média de 1,27 cm. A tabela com a Classificação da Ptose da Cauda do Supercílio, em que se atribuiu a cada intervalo um grau de ptose, variando de grau I ao grau IV. Cada grau foi correlacionado com um intervalo numérico em que: > 1,8 cm representa a normalidade; 1,7-1,5 cm o grau I de ptose; 1,4-1,2 cm o grau II de ptose;1,1-0,9 cm o grau III de ptose e < 0,8 cm o grau IV de ptose. Em referência à indicação cirúrgica, essa teve sua indicação nos graus II, III e IV. CONCLUSÃO: A medida objetiva da posição da cauda do supercílio possibilitou classificação do grau de ptose e orientação quanto à necessidade de intervenção cirúrgica.

INTRODUCTION: The study of the eyebrow is a great challenge for plastic surgery because of its complex relationship with facial structures. The present study aims to describe a clinical classification of brow ptosis. METHODS: A cross-sectional study with patients of both sexes and ages ranging from 18 to 100 years, subdivided into 3 groups according to age. Group 1: 18 to 30 years of age, Group 2: 31 to 60 years of age, and Group 3: 61 to 100 years of age. Three measurements were taken on each side by different examiners blinded to each other's results. RESULTS: A total of 90 patients, with ages ranging from 18 to 94, including 39 (43.3%) men and 51 (56.7%) women, were studied. Group 1, with a mean age of 26.7 years was considered normal, with mean brow ptosis of 2.14 cm. In Group 2, with a mean age of 44.2 years, the mean brow measurement was 1.9 cm. In Group 3, the mean age was 72.6 years and the mean brow measurement was 1.27 cm. The table outlining the brow ptosis classification assigns a degree of ptosis to each interval, ranging from I to IV. Each degree was correlated with a numerical range in which > 1.8 cm is normal, 1.7-1.5 cm corresponds to degree I ptosis, 1.4-1.2 cm to degree II ptosis, 1.1-0.9 cm to degree III ptosis, and < 0.8 cm to degree IV ptosis. Surgery was indicated for degrees II, III, and IV. CONCLUSION: The objective measurement of brow tail position enabled classification of the degree of ptosis and guides surgical decision-making.

Seroma and quilting suture at the donor site of the TRAM flap in breast reconstruction: a prospective randomized double-blind clinical trial.

Seroma formation at the donor site of the transverse rectus abdominis myocutaneous flap was evaluated in 48 patients who underwent breast reconstruction with either quilting sutures and suction drains (QS+DN group) or quilting sutures alone (QS group) or suction drains alone (DN group). Clinical and ultrasound examinations were performed to assess seroma formation in 5 regions of the abdominal wall on postoperative days 7 and 14. The incidence of seroma detected by ultrasound examination was significantly higher in the DN group (P = 0.008) than that in the other 2 groups. No difference in seroma volume (puncture) was found between the QS+DN and QS groups (P = 1.00). Seroma formation was observed in the iliac region in the DN group but not in the QS+DN and QS groups (P = 0.028). Quilting sutures at the transverse rectus abdominis myocutaneous flap donor site were efficient in reducing seroma formation.

Sexuality after breast reconstruction post mastectomy.

BACKGROUND: Sexual dysfunction is a medical condition that can lead to relationship issues as well as depression and has a somatoform basis. It is estimated to affect 49 % of Brazilian women. Studies have shown that both cancer diagnosis and its surgical treatment (mastectomy) affect women psychologically and can lead to psychiatric disorders. The aim of this study was to evaluate and compare sexuality in women who underwent mastectomy alone with those who underwent breast reconstruction after mastectomy. METHOD: This descriptive transversal study analyzed two groups of patients, one with 17 women after mastectomy alone and another with 19 women who underwent breast reconstruction post mastectomy. The patients ranged in age from 18 to 60 years old. The exclusion criteria were illiteracy; ongoing chemotherapy, radiotherapy, or psychiatric treatment; or if any surgery had been performed the previous year. All patients were from the Gynecology and Plastic Surgery Department of the Federal University of São Paulo. They voluntarily answered the FSFI (Female Sexual Function Index) questionnaire. Statistical analyses were performed using Student's t test and Pearson's coefficient, and the significance level used was p < 0.05. RESULTS: Data showed a lower FSFI score for the mastectomy-alone group compared to the breast reconstruction group (median = 10.15 ± 2.636 and 22.44 ± 3.055, respectively; p = 0.0057). There was no relationship established between the scores and postoperative time (post, p = 0.9382; pre, p = 0.2142) or between scores and remuneration income (post, p = 0.7699; pre, p = 0.5245), stable relationship (post, p = 0.2613; pre, p = 0.5245), and age (post, p = 0.3951; pre, p = 0.8427) for both groups. Mean age has shown no significant difference (p = 0.4740; median post = 47.71 ± 2.012; medina pre = 46.69 ± 1.809). CONCLUSION: An improvement in sexual function has been observed in patients who underwent breast reconstruction after mastectomy, probably as a result of better self-esteem as well as body image, both of which are affected by a mastectomy. The aesthetic results were evaluated using a questionnaire, and all the patients answered positively. LEVEL OF EVIDENCE V: 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 .