Components separation technique of the abdominal wall: Which muscle release produces the greatest reduction in tension on the mideline?

BACKGROUND: The components separation technique (CS) is used for the reconstruction of complex abdominal wall defects. Release and undermining of the rectus abdominis muscle (RAM) and external oblique muscle (EOM) decrease tension on the abdominal midline, reducing recurrence of ventral hernia, but causes major changes in the physiology of abdominal wall. The purpose of the study was to determine which muscle release and undermining produces the lowest tension on the midline. METHODS: Twenty fresh cadavers were dissected and the anterior and posterior layers of the rectus sheath were isolated in the midline. The forces necessary to advance the layers of the rectus sheath to the mid abdomen were measured bilaterally at two points located 3 cm above and 2 cm below the umbilicus, and at 3 different stages: before any muscle release; after release and undermining of the right RAM and left EOM; and after release and undermining of the left RAM and right EOM. Comparisons of tensile forces were conducted separately for the different muscles involved, layers of the rectus sheath, measurement points, and stages of separation. RESULTS: Tension on the abdominal midline after the release and undermining of both the RAM and EOM was reduced by 56% (p <0.05), 42% after the release and undermining of the EOM alone (p <0.05), and 35% after release and undermining of the RAM alone (p <0.05). CONCLUSION: Release and undermining of the EOM by CS led to lower tension on the abdominal midline compared to that associated with the release of the RAM alone.

Anestesia regional guiada por ultrassom em cirurgias plásticas estéticas das mamas / Ultrasound-guided regional anesthesia in cosmetic plastic surgeries of the breasts

RESUMO A cirurgia de aumento primário de mamas ocupa o topo do ranking dos procedimentos estéticos mais realizado entre as mulheres. Na população masculina, outra cirurgia mamária ocupa lugar de destaque: a ginecomastia. A anestesia regional para as cirurgias plásticas faz parte de uma estratégia de analgesia multimodal que pode reduzir custos, diminuir a hospitalização e a dor no período pós-operatório. O objetivo deste trabalho é revisar e comparar as técnicas de anestesia regional guiadas por ultrassom mais utilizadas para analgesia perioperatória nas cirurgias plásticas estéticas das mamas. Foi realizada a revisão de estudos clínicos que investigaram a associação dos bloqueios anestésicos regionais guiados por ultrassom com cirurgias plásticas estéticas das mamas nos últimos 5 anos na base de dados MEDLINE/PubMed. Foram selecionados 14 artigos para revisão. As técnicas de anestesia regional guiada por ultrassom mais frequentemente relatadas foram o bloqueio paravertebral (BPV), os bloqueios interfasciais (PECS 1 e PECS 2), bloqueio do plano do serrátil (BPS) e bloqueio intercostal (BI). O menor consumo de opioides e melhor controle álgico pós-operatório foi associado ao BPV, PECS 1 e PECS 2 e BPS. O BPV apresentou maior incidência de complicações e os PECS 1 e PECS 2 mostraram-se de execução mais fácil. Os bloqueios interfasciais (PECS 1 e PECS 2) se mostraram mais seguros e de fácil execução nas cirurgias plásticas estéticas das mamas do que as outras modalidades de bloqueios. Promovem diminuição do uso de opioides e seus efeitos colaterais, redução no tempo de internação e na recuperação no pós-operatório.

Abstract Primary breast augmentation surgery is one of the most performed cosmetic procedures among women. In the male population, another breast surgery occupies a prominent place: gynecomastia. Regional anesthesia for plastic surgery is part of a multimodal analgesia strategy that can reduce costs, reduce hospitalization, and pain in the postoperative period. The purpose of this article is to review and compare the most used ultrasound-guided regional anesthesia techniques for perioperative analgesia in aesthetic plastic surgery of the breasts. A review of clinical studies that investigated the association of regional anesthesia techniques guided by ultrasound with cosmetic plastic surgery of the breast in the last 5 years was carried out in the MEDLINE/PubMed database. Fourteen articles were selected for review. The most frequently reported techniques of regional anesthesia guided by ultrasound were paravertebral block (PVB), interfascial block (PECS 1 and PECS 2), serratus plane block (SPB), and intercostal block (IB). The lower consumption of opioids and better postoperative pain control were associated with PVB, PECS 1 and PECS 2, and SPB. PVB had a higher incidence of complications and PECS 1 and PECS 2 proved to be easier to perform. Interfascial blocks (PECS 1 and PECS 2) proved to be safer and easier to perform in cosmetic plastic surgery of the breasts than other types of blocks. They decrease the use of opioids and its side effects, reduce the length of hospital stay and recovery in the postoperative period.

Abdominal Wall Plication and Correction of Deformities of the Myoaponeurotic Layer: Focusing on Materials and Techniques Used for Synthesis.

The different types of sutures utilized in plications and for correction of diastasis during abdominoplasty are reviewed and discussed. Because correction of abdominal deformities also involves fascia and muscle advancement, this review also covers the suture materials used in muscle advancement. The selection of specific techniques to treat different types of abdominal wall deformity is also considered. This is important, because the outcome when correcting these deformities depends not only on suture materials but also on employing the optimum technique. A PubMed/Medline search was performed with the following search terms: rectus diastasis, diastasis recti, diastasis recti abdominis, correction of rectus diastasis, abdominoplasty. Relevant articles identifying the type of suture (rapidly absorbable, slowly absorbable, nonabsorbable), monofilament or multifilament sutures, antibiotic-coated sutures, and barbed sutures were evaluated. In addition, articles about surgical technique comparing continuous and interrupted sutures, in both the anterior and posterior aponeurosis, to correct rectus diastasis are discussed. Efficacy of suture materials was evaluated based on the long-term results and recurrence rates reported in these articles. The current literature provides sufficient data to recommend a single-layer continuous suture, with slowly absorbable sutures of 0 polydioxanone or 2-0 nylon, for correction of abdominal diastasis. An interrupted triangular suture is a good alternative to correct the vertical elongation of the myoaponeurotic layer that occurs after pregnancy.

Bilateral maculopathy following electrical burn: case report / Maculopatia bilateral após queimadura elétrica: relato de caso

CONTEXT: Electrical burns are an important etiology in dealing with patients suffering from burns. In situations of extensive deep lesions of multiple organs and systems affecting young and economically active people, there is a need for expensive multidisciplinary treatment, with a high socioeconomic cost for the community. Among the permanent injuries that explain this high cost, eye injuries stand out, since they are widely disabling. Although rare, lesions of the posterior segment of the eye are associated with higher incidence of major sequelae, and thus deserve special attention for dissemination and discussion of the few cases observed. CASE REPORT: The authors report the case of a patient who suffered high-voltage electrical burns and presented bilateral maculopathy, which evolved with a need for a surgical approach to repair retinal detachment and permanent low visual acuity. CONCLUSION: This report highlights the rarity of the etiology of maculopathy and the need for campaigns for prevention not only of burns in general, but also especially of electrical burns. .

CONTEXTO: As queimaduras elétricas representam etiologia importante na abordagem de pacientes vítimas de queimaduras. Lesões extensas e profundas de múltiplos órgãos e sistemas e o acometimento de população jovem economicamente ativa apontam para a necessidade de tratamento multidisciplinar dispendioso, com alto custo socioeconômico para as comunidades. Dentre as lesões permanentes que justificam esse alto custo, as oculares têm local de destaque, porque são amplamente incapacitantes. Embora raras, as lesões do segmento posterior do olho estão associadas a maior incidência de sequelas importantes, merecendo atenção especial para divulgação e discussão dos poucos casos observados. RELATO DE CASO: Os autores relatam o caso de paciente vítima de queimadura elétrica com fio de alta voltagem que apresentou maculopatia bilateral, evoluindo com necessidade de abordagem cirúrgica para correção de descolamento de retina e baixa acuidade visual permanente. CONCLUSÃO: Este relato destaca a raridade da etiologia da maculopatia e a necessidade de campanhas de prevenção não só das queimaduras em geral, mas especialmente das queimaduras elétricas. .

Bilateral maculopathy following electrical burn: case report.

CONTEXT: Electrical burns are an important etiology in dealing with patients suffering from burns. In situations of extensive deep lesions of multiple organs and systems affecting young and economically active people, there is a need for expensive multidisciplinary treatment, with a high socioeconomic cost for the community. Among the permanent injuries that explain this high cost, eye injuries stand out, since they are widely disabling. Although rare, lesions of the posterior segment of the eye are associated with higher incidence of major sequelae, and thus deserve special attention for dissemination and discussion of the few cases observed. CASE REPORT: The authors report the case of a patient who suffered high-voltage electrical burns and presented bilateral maculopathy, which evolved with a need for a surgical approach to repair retinal detachment and permanent low visual acuity. CONCLUSION: This report highlights the rarity of the etiology of maculopathy and the need for campaigns for prevention not only of burns in general, but also especially of electrical burns.