Influência do envelhecimento na qualidade da pele de mulheres brancas: o papel do colágeno, da densidade de material elástico e da vascularização / Influence of aging on the skin quality of white-skinned women: the role of collagen, elastic material density, and vascularization

INTRODUÇÃO: O objetivo deste estudo é avaliar a influência do envelhecimento na qualidade da pele de mulheres brancas, analisando o colágeno, as fibras elásticas e a vascularização. MÉTODO: Foi realizada análise histológica e morfométrica de 218 retalhos pré-auriculares de mulheres brancas, que se submeteram a cirurgia estética facial. Foram utilizados o imunomarcador AntiCD 34, que evidencia os vasos sanguíneos, a coloração de Weigert, para visibilização das fibras elásticas, e a coloração de Picrosirius Ultrared, para analisar e quantificar os colágenos I, III e total. Os dados foram analisados de acordo com a faixa etárias das doadoras: < 40 anos, 40 anos a 49 anos, 50 anos a 59 anos, 60 anos a 69 anos, e > 70 anos. RESULTADOS: Foi observada fragmentação e desorganização das fibras de colágeno, especialmente acima de 60 anos. Não houve diferenças significantes entre a idade e a espessura da derme e da epiderme, porém foi identificada relação com as porcentagens de colágeno I, III e total (P < 0,001). Houve aumento da densidade de fibras elásticas com a progressão da idade (P < 0,001). Comparando-se as peles das pacientes de faixas etárias vizinhas, com diferença de uma década entre elas, não houve diferença significativa na quantidade de material elástico dessas peles; porém, ao se comparar aquelas com diferença de 2 ou mais décadas nas faixas etárias, o aumento foi significante (P < 0,05). A diferença do número de vasos não foi significante (P = 0,112). CONCLUSÕES: O envelhecimento promoveu redução do colágeno, degradação e fragmentação das fibras, e aumento da densidade de material elástico desorganizado, e não influenciou no número de vasos sanguíneos da derme.

BACKGROUND: In the present study, we aimed to evaluate the influence of aging on the skin quality of white-skinned women by assessing collagen levels, elastic material density, and vascularization. METHODS: Histological and morphometric analyses were performed on 218 preauricular skin fragments from white-skinned women who underwent facial cosmetic surgery. Anti-CD34 was used to identify the blood vessels, Weigert's staining was used to visualize elastic fibers, and Picro-sirius Ultra Red staining was employed for analyzing and quantifying the expression of type I, III, and total collagen. Data were analyzed according to the following donor age groups: < 40, 40-49, 50-59, 60-69, and > 70 years. RESULTS: Fragmentation and disorganization of collagen fibers were observed in certain samples, particularly in samples from patients aged > 60 years. Significant differences between age and the thickness of the dermis and epidermis were not detected. However, a relationship was identified between age and the percentages of type I, III, and total collagen, and an increase of elastic fibers density was associated with age progression (P < 0.001). The comparison of the skin of patients with a decade difference in age did not reveal a significant difference in the elastic material quality; however, when the age difference was of 2 decades or more, there was a significant difference in elastic fibers (P < 0.05). The difference in the number of blood vessels between the groups was not significant (P = 0.112). CONCLUSIONS: Aging promoted collagen reduction, fiber degradation and fragmentation, and increased disorganized elastic material density; however, it did not affect the number of dermal blood vessels.

Influence of aging on the quality of the skin of white women: the role of collagen.

PURPOSE: Evaluate the influence of aging on the quality of the skin of white women, analyzing the dermal collagen. METHODS: Pre-auricular flaps were collected for histological and morphometric analysis of 218 white women who underwent spontaneous facial aesthetic plastic surgery. Picrosirius ultrared stain was used for analysis and quantification of collagen in five age groups (<40 years, 40 to 49 years, 50 to 59 years, 60 to 69 years and 70 to 79 years) . RESULTS: Histological analysis showed changes suggestive of skin aging (fragmentation and disorganization of collagen fibers), especially in patients over 60 years. There were no significant changes in the relationship of age with the thickness of the dermis and epidermis, but there was with the percentage of the collagen I, III and total (p<0.001), which decreased with increasing aging. CONCLUSION: There is reduction in collagen with increasing age, and an increase in its degradation, leading to fragmentation of the fibers.

Influence of aging on the quality of the skin of white women: the role of collagen / Influência do envelhecimento na qualidade da pele de mulheres brancas: o papel do colágeno

PURPOSE: Evaluate the influence of aging on the quality of the skin of white women, analyzing the dermal collagen. METHODS: Pre-auricular flaps were collected for histological and morphometric analysis of 218 white women who underwent spontaneous facial aesthetic plastic surgery. Picrosirius ultrared stain was used for analysis and quantification of collagen in five age groups (<40 years, 40 to 49 years, 50 to 59 years, 60 to 69 years and 70 to 79 years) . RESULTS: Histological analysis showed changes suggestive of skin aging (fragmentation and disorganization of collagen fibers), especially in patients over 60 years. There were no significant changes in the relationship of age with the thickness of the dermis and epidermis, but there was with the percentage of the collagen I, III and total (p<0.001), which decreased with increasing aging. CONCLUSION: There is reduction in collagen with increasing age, and an increase in its degradation, leading to fragmentation of the fibers.

OBJETIVO: Avaliar a influência do envelhecimento na qualidade da pele de mulheres brancas analisando o colágeno dérmico. MÉTODOS: Realizou-se análise histológica e morfométrica de 218 retalhos pré-auriculares de mulheres brancas que se submeteram espontaneamente à cirurgia estética facial. Foi usada a coloração de Picrosirius Ultrared para analisar e quantificar os colágenos I, III e total em cinco grupos etários (<40 anos, 40 a 49 anos, 50 a 59 anos, 60 a 69 anos e 70 a 79 anos). RESULTADOS: A análise histológica mostrou alterações sugestivas de envelhecimento cutâneo (fragmentação e desorganização das fibras de colágeno), especialmente em pacientes acima de 60 anos. Não houve diferenças significantes entre a idade e a espessura da derme e da epiderme, mas houve diferenças significantes entre as percentagens de colágeno I, III e total (p<0,001) com o aumento da idade. CONCLUSÃO: Existe redução do colágeno com o aumento da idade e um aumento na sua degradação, levando à fragmentação das fibras.

Rede hemostática: uma alternativa para a prevenção de hematoma em ritidoplastia / Hemostatic net: an alternative for the prevention of hematoma in rhytidoplasty

INTRODUÇÃO: Hematoma é a complicação pós-operatória mais frequente em ritidoplastia. Sua ocorrência aumenta a morbidade e prejudica a recuperação. Pontos de adesão internos para fechamento das áreas descoladas em abdominoplastias evitam o surgimento de seroma. Baseados neste princípio, e com o objetivo de reduzir o número de pacientes com hematomas em ritidoplastia, foi desenvolvida tática cirúrgica análoga em que se confecciona uma rede hemostática de pontos contínuos e transfixantes de náilon 4-0, englobando a pele e o SMAS-platisma. MÉTODO: Foram incluídos no estudo 366 pacientes consecutivos, submetidos a ritidoplastia de pelo menos o terço médio da face, entre julho de 2009 e setembro de 2011. O grupo A, incluindo os primeiros 120 pacientes avaliados retrospectivamente, foi considerado controle. O grupo B foi constituído pelos demais 246 pacientes, operados com a tática cirúrgica proposta e avaliados prospectivamente. Observaram-se as incidências de hematoma, isquemia e necrose nas primeiras 72 horas de pós-operatório. RESULTADOS: No grupo A, 17 (14,2%) pacientes apresentaram hematoma, enquanto no grupo B não houve nenhum caso. A tática cirúrgica não aumentou significativamente a ocorrência de isquemia: 11 (9,2%) pacientes no grupo A e 16 (6,5%) no grupo B tiveram essa complicação (P < 0,3964). Também não houve alteração significativa na incidência de necrose, complicação observada em 3 (2,5%) pacientes do grupo A e em 4 (1,6%) do grupo B (P < 0,4298). CONCLUSÕES: A rede hemostática é método eficaz na prevenção de hematomas precoces em ritidoplastias. Essa tática cirúrgica não levou a aumento significativo da incidência de isquemia e necrose.

BACKGROUND: Hematoma is the most common postoperative complication of rhytidoplasty. Its occurrence increases morbidity and impairs recovery. Internal sutures to close detached areas are used in abdominoplasty to prevent seromas. Taking this into account and in order to reduce the number of patients with hematomas post rhytidoplasty, we have developed a similar surgical procedure in which a hemostatic net is made of continuous nylon 4-0 transfixing stitches to include the skin and the superficial musculoaponeurotic system-platysma. METHODS: A total of 366 patients who underwent rhytidoplasty of at least the middle third of the face between July 2009 and September 2011 were included in the study. Group A was identified as the control group; it included the first 120 patients assessed retrospectively. The remaining 246 patients, who underwent the surgical procedure here proposed and who were evaluated prospectively formed group B. We observed the incidence of hematoma, ischemia, and necrosis in the first 72 postoperative hours. RESULTS: In group A, 17 (14.2%) patients developed hematomas, whereas none occurred in group B. The surgical procedure did not significantly increase the occurrence of ischemia: 11 (9.2%) patients in group A and 16 (6.5%) in group B had this complication (P < 0.3964). There was also no significant increase in the incidence of necrosis, which was observed in 3 (2.5%) patients in group A and 4 (1.6%) in group B (P < 0.4298). CONCLUSIONS: The hemostatic net is an efficient method for the prevention of early hematomas following rhytidoplasty. This surgical procedure did not result in a significant increase in the incidence of ischemia and necrosis.

Breast augmentation and mastopexy using a pectoral muscle loop.

BACKGROUND: Augmentation mastopexy has historically challenged the creativity of plastic surgeons. Recurrent breast ptosis is the main cause for revision after such a primary operation. Avoiding the need for reoperation and achieving long-term projection and upper pole fullness have been the main focus for the work of many authors. In this study, a new approach for a stable and lasting breast shape based on the use of the pectoral muscle was conceived. METHOD: Augmentation mastopexy was performed for patients with breast ptosis grades 2 and 3 according to Regnault's classification. With the proposed surgical technique, a loop of the pectoral muscle was used to keep the implant in a stable position. An inferior chest wall-based flap optimized coverage of the lower pole of the prosthesis. RESULTS: From 2008 to 2009, 22 patients underwent augmentation mastopexy using the described technique. Of these 22 patients, 12 were indicated for grade 2 and 10 for grade 3 ptosis. The mean follow-up period was 11.9 months. A high level of satisfaction was observed. No major complications occurred. CONCLUSIONS: Augmentation mastopexy using a loop of the pectoral muscle to hold the implant is a new and effective way to obtain long-lasting projection and upper pole fullness.

Intraabdominal pressure in abdominoplasty patients.

Abdominal compartment syndrome is directly related to an increase in intraabdominal pressure (IAP), which can lead in severe cases to serious clinical consequences. Routine measurement of IAP in specific cases has been advocated by some surgical specialties. However, few studies in plastic surgery have focused on the use of IAP. The authors review the literature and describe a method of IAP analysis used for 12 patients who underwent abdominoplasty.

Saúde: uma análise crítica e propostas para implementaçäo no município de Londrina e regiäo / Healt: a critical analysis and proposals of implementation of health policies in Londrina and surrounding region

Através deste trabalho, os autores fazem uma análise crítica sobre a conjuntura nacional na área da saúde, e estabelecem uma correlaçäo com a problemática vivenciada pelo município de Londrina. Analisam a responsabilidade do governo, em seus vários escalöes, pela insuficiência de recursos financeiros para aplicaçäo na área, e pelo mau gerenciamento desses recursos. A estrutura de serviços de saúde de Londrina é descrita em detalhes, enfatizando-se o papel representado por esta cidade, na condiçäo de polo regional para todo o norte do Paraná. É dada ênfase à sobrecarga de pacientes hoje verificada - principalmente - em relaçäo aos hospitais gerais, em funçäo da defasagem na oferta de leitos. Na parte final do trabalho, säo feitas consideraçöes a respeito da legislaçäo do SUS/Sistema Unico de Saúde, e apresentadas diversas sugestöes visando regularizar a situaçäo no município de Londrina