Keloids in male genitalia-Systematic review and illustrative case report.

Keloid is the maximum expression of pathological fibroproliferative skin wound healing, whose pathophysiology is not yet fully understood. Its occurrence in the perineum and genitalia is uncommon. A systematic review was carried out regarding the occurrence and treatment of keloids on the penis. An illustrative case was also reported. The review used the PRISMA checklist and was registered in PROSPERO. The entire literature period up to April 2023 was searched in the EMBASE/Elsevier, Cochrane, Scopus, Medline, BVS, SciELO, and Lilacs databases. The inclusion criteria embraced primary studies, clinical trials, prospective or retrospective cohorts, case series, case-control studies and case reports. Three hundred and sixty-one studies were found and 12 of them were included, consisting of 9 case reports and 3 case series. The most common triggering factor for keloid formation was circumcision, in 11 of the cases, of which more than half occurred in prepubescent children. Several therapies, associated or isolated, were used to treat the cases. Only one of the reported patients had scar recurrence after surgical treatment. Studies with better scientific evidence are needed to understand the involvement of keloids in male genitalia. However, keloid formation in this topography is rare, making it difficult to carry out more elaborate studies.

Effect of Compression Garments on the Ventilatory Function After Abdominoplasty.

BACKGROUND: The use of compression garments in the postoperative period of abdominoplasty seems to be a consensus, but the incidents of complications arising from this have been described, related to an increase in intraabdominal pressure and reduction of the femoral vein blood flow that may facilitate thromboembolic events. There are no studies that have evaluated the isolated effect of postoperative compression garments on respiratory function. OBJECTIVES: The purpose of this study was to evaluate the effect of compression garments on respiratory function after abdominoplasty. METHODS: Thirty-four female patients who underwent standard abdominoplasty were divided into 2 groups, the garment group (n = 18) and the no garment group (n = 16). Respiratory function assessment (with spirometry and manovacuometry) was performed in the preoperative and postoperative periods. RESULTS: Forced vital capacity assessment revealed a greater ventilatory restriction in the garment group. Forced expiratory volume in 1 second (FEV1) showed differences between the evaluation time points in the garment group; the intergroup comparisons showed that the no garment group had a lower FEV1. Slow vital capacity was evaluated with no significant differences found on both intergroup comparisons. The inspiratory capacity was reduced in the garment group, representing ventilatory restriction. Measurements of the maximum inspiratory pressure showed no significant differences between the groups. The maximum expiratory pressure showed significantly lower values on postoperative day 7 in the garment group. CONCLUSIONS: The use of compression garments after abdominoplasty impairs ventilatory function. Not wearing this type of garment can improve ventilation, decreasing the risk of pulmonary complications.

Qualidade das informações sobre lipoaspiração para o público leigo: Uma revisão de escopo / Quality of information about liposuction for the lay public: A scoping review

Introdução: Esta revisão de escopo tem por objetivo analisar a qualidade das informações sobre lipoaspiração para o público leigo. Método: Foi realizada busca na literatura no período de 18 de novembro a 12 de dezembro de 2021 nas seguintes plataformas de base de dados: Medline, Cochrane, LILACS, Embase e BVS. A estratégia de busca envolveu a combinação de vários descritores. Três investigadores independentes leram o resumo dos estudos que foram obtidos usando a estratégia de busca para avaliar aqueles que preenchiam os critérios de elegibilidade. Resultados: Inicialmente, foram levantados 33 artigos utilizando a estratégia de busca. Dentre esses, 23 estudos foram excluídos após a leitura dos resumos e avaliação dos critérios de elegibilidade, por não possuírem desfechos de interesse ao tema proposto. Assim, dez estudos preenchiam os critérios de inclusão, sendo nove estudos transversais e uma revisão de literatura. Dentre os dez artigos incluídos, nove relatam que as informações sobre lipoaspiração são precárias e imprecisas. Conclusão: O conteúdo sobre lipoaspiração disponibilizado ao público leigo por meio da Internet é, na sua maioria, insatisfatório.

Introduction: This scoping review aims to analyze the quality of information about liposuction for the lay public. Method: A literature search was carried out from November 18 to December 12, 2021, on the following database platforms: Medline, Cochrane, LILACS, Embase, and VHL. The search strategy involved the combination of several descriptors. Three independent investigators read the abstract of studies obtained using the search strategy to evaluate those that met the eligibility criteria. Results: Initially, 33 articles were collected using the search strategy. Among these, 23 studies were excluded after reading the abstracts and evaluating the eligibility criteria, as they did not have outcomes of interest to the proposed topic. Thus, ten studies met the inclusion criteria, nine of which were cross-sectional and one literature review. Among the ten articles included, nine report that information about liposuction is poor and inaccurate. Conclusion: The content on liposuction made available to the lay public via the Internet is, for the most part, unsatisfactory.

Modelo alternativo para o treinamento de técnicas de microssuturas em "patch" de pericárdio bovino / Alternative model for training microsuture techniques in bovine pericardium patches

Introdução: As técnicas microcirúrgicas caracterizam-se pela aplicação de manobras e suturas em estruturas milimétricas com o auxílio de lentes de aumento. São técnicas complexas, utilizadas em diversas especialidades médicas, que demandam grande habilidade e treinamento antes da aplicação em humanos. O objetivo é desenvolver um modelo de baixo custo e alta fidelidade, para o treinamento de técnicas de microcirurgia, utilizando um fragmento de patch de pericárdio bovino. Método: São utilizados para a confecção deste modelo segmentos remanescentes de uma placa de pericárdio bovino, previamente utilizado em reparos vasculares. O material é recortado em duas partes simétricas e suas extremidades fixadas aos campos cirúrgicos, com auxílio de clamps. A borda superior de cada uma das partes é, então, suturada à borda inferior com fio de Prolene 8-0, de maneira que cada uma forme uma estrutura tubular. Posteriormente, as extremidades tubulares livres passam pela dissecção da camada adventícia e são suturadas entre si, mimetizando uma anastomose vascular término-terminal. Resultados: Com o modelo, simulam-se os mesmos inconvenientes/ dificuldades presentes nas suturas vasculares humanas, como a delaminação de camadas, excesso da camada adventícia e risco de sutura inadvertida da parede posterior, provando sua utilidade na aquisição de habilidades microcirúrgicas básicas, sem necessidade de manipulação de tecidos humanos ou animais. A prática neste modelo pode ocorrer dentro do próprio centro cirúrgico e emprega materiais que seriam descartados. Conclusão: A utilização do pericárdio bovino para confecção de suturas milimétricas mimetiza o tecido vascular humano e é um procedimento de baixo custo, que possibilita o treinamento de habilidades microcirúrgicas.

Introduction: Microsurgical techniques are characterized by the application of maneuvers and sutures to millimetric structures with the aid of magnifying lenses. These are complex techniques, used in various medical specialties, which require great skill and training before applying them to humans. The objective is to develop a lowcost and high-fidelity model for training microsurgery techniques using a fragment of bovine pericardium patch. Method: Remaining segments of a bovine pericardium plate, previously used in vascular repairs, are used to create this model. The material is cut into two symmetrical parts, and its ends are fixed to the surgical drapes with the aid of clamps. The upper edge of each part is then sutured to the lower edge with 8-0 Prolene thread so that each one forms a tubular structure. Subsequently, the free tubular ends undergo dissection of the adventitial layer and are sutured together, mimicking an end-to-end vascular anastomosis. Results: With the model, the same inconveniences/ difficulties present in human vascular sutures are simulated, such as delamination of layers, excess of the adventitial layer, and risk of inadvertent suturing of the posterior wall, proving its usefulness in the acquisition of basic microsurgical skills, without need to manipulate human or animal tissues. Practice in this model can take place within the surgical center itself and uses materials that would otherwise be discarded. Conclusion: The use of bovine pericardium to create millimetric sutures mimics human vascular tissue and is a low-cost procedure that allows the training of microsurgical skills.

Evaluating the quality of studies reporting on clinical applications of stromal vascular fraction: A systematic review and proposed reporting guidelines (CLINIC-STRA-SVF).

Background: The stromal vascular fraction (SVF) has been widely explored in a number of therapeutic applications in several specialties. Its therapeutic potential is being increasingly demonstrated, although its mechanism of action is still unclear. Objective: To evaluate the quality of studies reporting on clinical applications of SVF. Method: This is a systematic literature review that followed the PRISMA guidelines with the search of the studies from December 1, 2012, to December 1, 2022, in the following databases: MEDLINE, LILACS and EMBASE. The level of evidence of the studies was assessed using the GRADE system, and the rigor used in the publication of the results was assessed in relation to adherence to the guidelines indicated by the EQUATOR Network Group. The CLINIC - STRA-SVF reporting guideline was developed after the completion of this systematic review. Results: A total of 538 articles were found, and 77 articles were selected after reading the titles and abstracts and removing duplicates. Then, 15 studies were removed for not meeting the inclusion criteria, leaving 62 studies. The CLINIC - STRA-SVF was developed and consists of 33 items and two tables. Conclusion: There is scientific evidence, although mostly with a low level of evidence, that the use of SVF in clinical applications is safe and effective. The information published in these studies should be standardized, and the CLINIC - STRA-SVF reporting guideline proposed in this study may assist in the design, conduct, recording and reporting of clinical trials and others clinical studies involving the SVF.

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 .

Impact of breast augmentation on female sexuality.

INTRODUCTION: The breasts are symbols of femininity, sexuality, and maternity. Breast augmentation is among the most sought-after procedures for women and has a positive impact on quality of life. Sexuality is one of the items that contribute to increased quality of life. Surgical outcomes can be evaluated from the patients' perspective using developed and validated questionnaires. For the assessment of sexuality, the most commonly used instruments are the Female Sexual Quotient and the Female Sexual Function Index, which estimate several domains of sexuality and can be used to evaluate the impact of surgery on it. OBJECTIVE: The objective of this study was to evaluate the impact of breast augmentation on female sexuality. METHODS: We selected 87 patients from the Plastic Surgery Outpatient Clinic of Hospital São Paulo (Federal University of São Paulo) who wished to undergo breast augmentation. The patients were classified into two groups: the Female Sexual Quotient questionnaire was applied to one group, and the Female Sexual Function Index questionnaire was applied to the other group to evaluate sexuality preoperatively as well as at 2 and 4 months postoperatively. RESULTS: In both groups, there was a significant increase in the total score of the Female Sexual Quotient and Female Sexual Function Index questionnaires, and an individual increase in each domain assessed, with a significant increase in the domains of orgasm and sexual satisfaction, as well as foreplay and arousal, indicating an improvement in the patients' sexuality postoperatively. CONCLUSION: Breast augmentation has a positive impact on female sexuality; furthermore, the Female Sexual Quotient and Female Sexual Function Index are sensitive in detecting this impact.

Mesenchymal stem cells in lung diseases and their potential use in COVID-19 ARDS: A systematized review.

COVID-19 can converge with the pro-inflammatory immunoregulatory mechanisms of chronic lung diseases. Given the disorders inherent to lung transplantation and the inexistence of other definitive therapeutic alternatives, Adipose tissue-derived Stem Cells (ASCs) presented themselves as a therapeutic hope. The purpose of this review is to assess the basis for the potential use of ASCs in lung diseases unresponsive to conventional therapy, relating to their possible use in COVID-19 ARDS. 35 studies comprised this review, 14 being narrative reviews, 19 preclinical trials and two proofs of concept. COVID-19 can converge with the pro-inflammatory immunoregulatory mechanisms of chronic lung diseases. In view of the disorders inherent to lung transplantation and the inexistence of definitive therapeutic alternatives, Adipose tissue-derived Stem Cells (ASCs) presented themselves as a therapeutic hope. Its detailed reading indicated the absence of serious adverse effects and toxicity to the administration of ASCs and suggested possible effectiveness in reducing lung damage, in addition to promoting the recovery of leukocytes and lymphocytes with its immunomodulatory and anti-apoptotic effects. The revised clinical data suggests optimism in the applicability of ASCs in other immunoinflammatory diseases and in severe COVID-19 ARDS. However, further studies are needed to develop a consensus on the methods of collection of ASCs, the ideal dosage schedule, the most effective time and route of administration, as well as on the definition of indications for the administration of ASCs in cases of COVID-19 for conducting clinical trials in near future.

A promising alternative for mature skin: the effects of phytoestrogens on human skin and its topical use / Alternativa promissora para peles maduras: os efeitos dos fitoestrógenos na pele humana e seu uso tópico

Skin quality deteriorates with age for various reasons, including hormone deficiencies. In women, the decline in estrogen levels during menopause plays an important role in skin degeneration, with consequent atrophy, collagen reduction, loss of elasticity, and impaired wound healing. Research has demonstrated the beneficial effects of topical phytoestrogen in preventing and repairing skin aging, with localized action and without side effects. The objective of this study was to review the relevant literature, demonstrating that this can be a safe and effective alternative for treating the skin of perimenopausal women.

A qualidade da pele deteriora-se com a idade por vários motivos, incluindo as deficiências hormonais. Nas mulheres, o declínio dos níveis de estrógeno, durante a menopausa, tem papel importante na degeneração cutânea, com consequente atrofia, redução do colágeno, perda de elasticidade e deficiência da cicatrização de feridas. Pesquisas têm demonstrado efeitos benéficos do fitoestrogênio tópico na prevenção e reparação do envelhecimento cutâneo, com ação localizada e sem efeitos colaterais. O objetivo deste estudo foi revisar a literatura pertinente ao assunto, demonstrando que esta pode ser uma alternativa segura e eficaz para o tratamento da pele de mulheres na perimenopausa.

Milky secretion after late breast reconstruction with latissimus dorsi musculocutaneous flap with implant / Produção de secreção leitosa após reconstrução mamária tardia com retalho musculocutâneo de latíssimo do dorso com implante

We present a rare case of a 28-year-old patient with invasive ductal carcinoma who underwent neoadjuvant chemotherapy, modified radical mastectomy, radiotherapy, and late breast reconstruction with latissimus dorsi flap associated with the implant. One year later, she underwent reconstruction of the nipple-areola complex over the cutaneous island of the latissimus dorsi flap with a total skin graft from the thigh and graft from the caudal portion of the contralateral papilla. She became pregnant six months after the reconstruction of the nipple-areola complex and, unexpectedly, presented milk production by the reconstructed breast.

Apresentamos um caso raro de uma paciente de 28 anos com carcinoma ductal invasivo submetida a quimioterapia neoadjuvante, mastectomia radical modificada, radioterapia e reconstrução mamária tardia com retalho de latíssimo do dorso associado a implante. Um ano depois, foi submetida a reconstrução do complexo areolopapilar sobre a ilha cutânea do retalho do grande dorsal com enxerto de pele total da coxa e enxerto da porção caudal da papila contralateral. Ela engravidou seis meses após a reconstrução do complexo areolopapilar e, inesperadamente, apresentou produção de leite pela mama reconstruída.

Quality of breast reconstruction service at a university hospital as assessed by the patients.

PURPOSE: To evaluate the quality of breast reconstruction service at a university hospital, as assessed by the patients. METHODS: This cross-sectional study enrolled adult women who underwent immediate or delayed breast reconstruction by any technique performed at a university hospital between 1 and 24 months before the assessment. The Brazilian version of the Health Service Quality Scale (HSQS) was self-applied to the participants. The HSQS produces percentage scores, which are expressed in values ranging from 0 to 10 for each domain of the scale, and into an overall percentage quality score. The management team was asked to establish a minimum satisfactory score for the breast reconstruction service. RESULTS: Ninety patients were included. The management team considered 8.00 the minimum satisfactory score for the service. The overall percentage score was 93.3%. Only one domain, 'Support,' had an average score lower than that considered satisfactory (7.22 ± 3.0); while the others had higher scores. The domain that scored highest was 'Qualification' (9.94 ± 0.3), followed by 'Result' (9.86 ± 0.4). There was a positive correlation between 'type of oncologic surgery' and 'intentions of loyalty to the service' (ρ = 0.272; p = 0.009) and a negative correlation between 'education' and 'quality of the environment' (ρ = -0.218; p = 0.039). The higher the patient's level of education, the higher the score attributed to 'relationship' (ρ = 0.261; p = 0.013) and the lower the score of 'aesthetics and functionality' (ρ = -0.237; p = 0.024). CONCLUSIONS: The quality of the breast reconstruction service was considered satisfactory, but there is a demand for structural improvements, better interpersonal relationships, and a stronger support network for patients.

Best practice for wound repair and regeneration use of cellular, acellular and matrix-like products (CAMPs).

There are currently over 80 biomaterials derived from autologous, allogeneic, synthetic and xenogeneic sources, or a combination of any or all these types of materials, available for soft-tissue coverage to effect wound closure. Often generically referred to as cellular and/or tissue-based products (CTPs), they are manufactured under various trade names and marketed for a variety of indications.

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.

Frailty syndrome, feelings of impotence and functional capacity in elderly patients with venous ulcers / Síndrome de fragilidade, sentimento de impotência e capacidade funcional em idosos portadores de úlcera venosa

Introduction: Chronic venous ulcers have a negative impact on the physical, psychic, and social domains, affecting the quality of life of patients, especially the elderly. This study aimed to assess frailty, functional capacity, and feelings of helplessness in older people with venous ulcers. Method: 112 older people were divided into two groups according to the presence or absence of venous ulcers. All patients were interviewed using the Edmonton Frail Scale (EFS), Health Assessment Questionnaire-20 (HAQ20), and the Impotence Feelings Measurement Instrument (IMSI) from May 2017 to August 2018. Results: Regarding the EFS score, 76.8% of patients with venous ulcers were classified as vulnerable and frail, compared to 28.6% of patients in the group without ulcers. Scores on the HAQ-20 showed statistically significant differences between groups in all categories of the instrument, indicating that older people with venous ulcers had reduced general functional capacity compared to older people without ulcers. The mean IMSI score was 41.2 for the group with venous ulcers and 33.4 for the group without ulcers. Conclusion: Venous ulcers had a negative impact on functional capacity and increased frailty and feelings of powerlessness in the elderly.

Introdução: Úlceras venosas crônicas exercem impacto negativo nos domínios físico, psíquico e social, afetando a qualidade de vida de pacientes, especialmente os idosos. O objetivo deste estudo foi avaliar o nível de fragilidade, capacidade funcional e sentimento de impotência em idosos com úlcera venosa. Método: Um total de 112 idosos foram distribuídos em dois grupos de acordo com a presença ou ausência úlcera venosa. Todos os pacientes foram entrevistados utilizando-se os questionários Edmonton Frail Scale (EFS), Health Assessment Questionnaire-20 (HAQ-20) e o Instrumento de Medida de Sentimento de Impotência (IMSI) no período de maio de 2017 a agosto de 2018. Resultados: Em relação à pontuação na EFS, 76,8% dos pacientes com úlcera venosa foram classificados como vulneráveis e frágeis, em comparação a 28,6% dos pacientes do grupo sem úlcera. Pontuações no HAQ-20 mostraram diferenças estatisticamente significantes entre os grupos em todas as categorias do instrumento, indicando que idosos com úlcera venosa apresentavam redução da capacidade funcional geral em comparação aos idosos sem úlcera. A pontuação média para o IMSI foi de 41,2 para o grupo com úlcera venosa e 33,4 para o grupo sem úlcera. Conclusão: Úlceras venosas causaram impacto negativo na capacidade funcional e aumento de fragilidade e sentimento de impotência nos idosos.

Augmentation mammoplasty and autologous fat transplantation: an alternative for the treatment of hypomastia and mild pectus excavatum - Case report / Mamoplastia de aumento e transplante de gordura autóloga: uma alternativa para o tratamento da hipomastia e pectus excavatum leve - Relato de caso

Pectus excavatum(PE) is a congenital chest deformity characterized by deep depression in the sternum. Autologous fat transplantation has been used for aesthetic purposes, mainly on the face, and has recently gained relevance in thoracic and breast surgeries. The present study aims to present a case of mild PE associated with hypomastia. A 24-year-old female patient attended the consultation for breast augmentation due to hypomastia, but the clinical examination also revealed an associated mild PE that the patient did not notice. Surgical planning included breast augmentation and autologous fat transfer. A 260ml silicone breast implant was used, and 250ml of fat was injected in the sternal region and the lower medial contour of the breasts. There were no complications during the 12-month follow-up period. The combination of augmentation mammoplasty and fat transplantation in treating PE deformity proved to be a minimally invasive, good, safe option with high patient satisfaction.

Pectus excavatum (PE) é uma deformidade torácica congênita, caracterizada como uma depressão profunda no esterno. O transplante autólogo de gordura tem sido utilizado para fins estéticos, principalmente na face, e recentemente ganhou relevância nas cirurgias torácica e das mamas. O objetivo do presente estudo é apresentar um caso de PE leve associado a hipomastia. Uma paciente de 24 anos compareceu à consulta para mamoplastia de aumento por hipomastia, mas o exame clínico também revelou um PE leve associado que não foi percebido pela paciente. O planejamento cirúrgico incluiu a mamoplastia de aumento e a transferência de gordura autóloga. Foi utilizado um implante mamário de silicone de 260ml, e uma quantidade total de 250ml de gordura foi injetada na região esternal e no contorno medial inferior das mamas. Não houve complicações durante o período de acompanhamento de 12 meses. A associação de mamoplastia de aumento e transplante de gordura no tratamento da deformidade de PE revelou-se uma opção minimamente invasiva, boa, segura e com alta satisfação da paciente.

Quality Regarding the Systematic Reviews in Breast Plastic Surgery.

There are few data in the literature evaluating the quality of systematic reviews in breast plastic surgery. This study aimed to evaluate the quality of SR in breast plastic surgery. This is a secondary, observational and analytical study. SR studies on breast plastic surgery, published until 2020, were included. The search for articles was performed in the CCTR, LILACS, MEDLINE and SCIELO databases. After selection and full reading of the studies, they were evaluated according to the AMSTAR-2 instrument. The search identified 810 references, among which 583 did not meet the eligibility criteria, and 227 studies were evaluated. The median publication time of the articles was 57.0 ± 59.0 months, the average impact factor was 0.65 citations per month, and the AMSTAR-2 score was 66.2 ± 32.3. Among the articles evaluated, 39.65% performed a meta-analysis, 52.42% used PRISMA, and most articles pointed out the need for further studies to answer their proposed question (92.95%). Articles that used PRISMA had shorter publication times (39.0 ± 34.0 months) and higher AMSTAR-2 scores (77.6 ± 17.7). An increase in the number of publications and a tendency to increase the AMSTAR-2 score and decrease the impact factor of the article were observed (p < 0.001). In conclusion, the quality of SR in breast plastic surgery has been improving over the years; however, improved methodology and the development of randomized clinical trials are still needed to serve as a basis for SR.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 .

Do Compression Garments Prevent Subcutaneous Edema After Abdominoplasty?

BACKGROUND: The main disadvantages of wearing a compression garment following abdominoplasty are the increase in intra-abdominal pressure and risk of venous stasis. On the one hand, the wearing of garments may increase the risk of venous thromboembolism. On the other hand, it may be beneficial in decreasing edema formation after surgery. OBJECTIVES: The authors sought to evaluate the effectiveness of compression garments in reducing subcutaneous edema after abdominoplasty. METHODS: Thirty-two women aged 19 to 50 years were selected and randomly allocated to either the garment (n = 16) or no-garment (n = 16) group. All patients underwent abdominoplasty and received 10 sessions of manual lymphatic drainage during the postoperative period. Postoperative edema formation was assessed by perimetry and bioimpedance, and seroma formation was assessed by ultrasound. Statistical tests included t test, mixed linear models, analysis of variance with repeated measures, and the Kolmogorov-Smirnov test, which were performed at a significance level α of .05 (P ≤ .05). RESULTS: The no-garment group showed a trend toward lower mean waist circumference at 29 days following abdominoplasty and significantly lower waist circumference after postoperative day 35 compared with the garment group (P < .001). The mean total body water was slightly lower in the no-garment group than in the garment group 7 days after surgery (P = .05). CONCLUSIONS: Patients who did not wear a compression garment after abdominoplasty showed less subcutaneous edema formation after 24 days of surgery than those who wore the garment.

Quality of breast reconstruction service at a university hospital as assessed by the patients

Purpose: To evaluate the quality of breast reconstruction service at a university hospital, as assessed by the patients. Methods: This cross-sectional study enrolled adult women who underwent immediate or delayed breast reconstruction by any technique performed at a university hospital between 1 and 24 months before the assessment. The Brazilian version of the Health Service Quality Scale (HSQS) was self-applied to the participants. The HSQS produces percentage scores, which are expressed in values ranging from 0 to 10 for each domain of the scale, and into an overall percentage quality score. The management team was asked to establish a minimum satisfactory score for the breast reconstruction service. Results: Ninety patients were included. The management team considered 8.00 the minimum satisfactory score for the service. The overall percentage score was 93.3%. Only one domain, 'Support,' had an average score lower than that considered satisfactory (7.22 ± 3.0); while the others had higher scores. The domain that scored highest was 'Qualification' (9.94 ± 0.3), followed by 'Result' (9.86 ± 0.4). There was a positive correlation between 'type of oncologic surgery' and 'intentions of loyalty to the service' (ρ = 0.272; p = 0.009) and a negative correlation between 'education' and 'quality of the environment' (ρ = ­0.218; p = 0.039). The higher the patient's level of education, the higher the score attributed to 'relationship' (ρ = 0.261; p = 0.013) and the lower the score of 'aesthetics and functionality' (ρ = ­0.237; p = 0.024). Conclusion: The quality of the breast reconstruction service was considered satisfactory, but there is a demand for structural improvements, better interpersonal relationships, and a stronger support network for patients.

Mesenchymal stem cells in lung diseases and their potential use in COVID-19 ARDS: A systematized review

Abstract COVID-19 can converge with the pro-inflammatory immunoregulatory mechanisms of chronic lung diseases. Given the disorders inherent to lung transplantation and the inexistence of other definitive therapeutic alternatives, Adipose tissue-derived Stem Cells (ASCs) presented themselves as a therapeutic hope. The purpose of this review is to assess the basis for the potential use of ASCs in lung diseases unresponsive to conventional therapy, relating to their possible use in COVID-19 ARDS. 35 studies comprised this review, 14 being narrative reviews, 19 preclinical trials and two proofs of concept. COVID-19 can converge with the pro-inflammatory immunoregulatory mechanisms of chronic lung diseases. In view of the disorders inherent to lung transplantation and the inexistence of definitive therapeutic alternatives, Adipose tissue-derived Stem Cells (ASCs) presented themselves as a therapeutic hope. Its detailed reading indicated the absence of serious adverse effects and toxicity to the administration of ASCs and suggested possible effectiveness in reducing lung damage, in addition to promoting the recovery of leukocytes and lymphocytes with its immunomodulatory and anti-apoptotic effects. The revised clinical data suggests optimism in the applicability of ASCs in other immunoinflammatory diseases and in severe COVID-19 ARDS. However, further studies are needed to develop a consensus on the methods of collection of ASCs, the ideal dosage schedule, the most effective time and route of administration, as well as on the definition of indications for the administration of ASCs in cases of COVID-19 for conducting clinical trials in near future.

Impact of breast augmentation on female sexuality

SUMMARY INTRODUCTION: The breasts are symbols of femininity, sexuality, and maternity. Breast augmentation is among the most sought-after procedures for women and has a positive impact on quality of life. Sexuality is one of the items that contribute to increased quality of life. Surgical outcomes can be evaluated from the patients' perspective using developed and validated questionnaires. For the assessment of sexuality, the most commonly used instruments are the Female Sexual Quotient and the Female Sexual Function Index, which estimate several domains of sexuality and can be used to evaluate the impact of surgery on it. OBJECTIVE: The objective of this study was to evaluate the impact of breast augmentation on female sexuality. METHODS: We selected 87 patients from the Plastic Surgery Outpatient Clinic of Hospital São Paulo (Federal University of São Paulo) who wished to undergo breast augmentation. The patients were classified into two groups: the Female Sexual Quotient questionnaire was applied to one group, and the Female Sexual Function Index questionnaire was applied to the other group to evaluate sexuality preoperatively as well as at 2 and 4 months postoperatively. RESULTS: In both groups, there was a significant increase in the total score of the Female Sexual Quotient and Female Sexual Function Index questionnaires, and an individual increase in each domain assessed, with a significant increase in the domains of orgasm and sexual satisfaction, as well as foreplay and arousal, indicating an improvement in the patients' sexuality postoperatively. CONCLUSION: Breast augmentation has a positive impact on female sexuality; furthermore, the Female Sexual Quotient and Female Sexual Function Index are sensitive in detecting this impact.