RESUMO
Introdução: Lesões por pressão são ocasionadas por aumento local da pressão externa, cursando com isquemia e necrose. Envolvem tratamento multidisciplinar e seu manejo engloba procedimentos conservadores e/ou cirúrgicos. O cirurgião plástico tem atuação primordial no tratamento cirúrgico destas lesões. Métodos: Análise de prontuários de 38 pacientes com lesões por pressão, únicas ou múltiplas, tratados pela Cirurgia Plástica no Hospital do Trabalhador, Curitiba-PR, entre junho de 2012 e março de 2020. Nesse estudo observacional, foram consideradas as características de 45 lesões por pressão juntamente com a técnica cirúrgica empregada e evolução. Resultados: A idade média dos pacientes foi de 35,4 anos, sendo a maioria homens. As lesões localizavam-se majoritariamente nas regiões isquiática, sacral e trocantérica, predominando os graus III e IV. Realizou-se debridamento, seguido por cobertura com retalhos e enxertos de pele, em maioria retalhos de avanço VY e em ilha de glúteo máximo. Alguns pacientes desenvolveram complicações no pós-operatório, principalmente deiscências de retalho e/ou infecção. Conclusão: As lesões por pressão predominaram em pacientes homens adultos jovens, diferentemente da prevalência global (idosos e/ou portadores de doenças crônicas). As maiores incidências ocorreram nas regiões isquiática e sacral, explicadas pela limitação de movimentos incumbida ao perfil de vítimas de grandes traumas. Para tratamento desta lesões, o retalho mais utilizado foi o de glúteo máximo.
Introduction: Pressure injuries are caused by a local increase in external pressure, leading to ischemia and necrosis. They involve multidisciplinary treatment, and their management includes conservative and/or surgical procedures. The plastic surgeon plays a key role in the surgical treatment of these injuries. Methods: Medical records of 38 patients with pressure injuries, single or multiple, treated by Plastic Surgery at Hospital do Trabalhador, Curitiba-PR, Brazil) from June 2012 to March 2020 were analyzed. In this observational study, the characteristics of 45 pressure injuries were considered together with the surgical techniques employed and their outcomes. Results: The average age of the patients were 35.4 years, the majority being men. The lesions were located mainly in the ischiatic and sacral regions, predominating the classification of the III and IV degrees. The lesions were mostly located in the ischial, sacral and trochanteric regions, predominantly grades III and IV. Debridement was performed, followed by coverage with flaps and skin grafts, mostly gluteal VY advancement flaps and gluteal island. Some patients developed complications in the postoperative period, mainly flap dehiscence and/or infection. Conclusion: Pressure injuries predominated in young adult male patients, unlike the global prevalence (elderly and/or patients with chronic diseases). The greatest incidences occurred in the ischial and sacral regions, explained by the limitation of movements charged to the profile of victims of major trauma. The most used flap was the gluteus maximus flap to treat these lesions.
RESUMO
Introduction: Radical surgical procedures are indicated for part of the patients with locally advanced breast cancer (LABC). The improvement in the use of myocutaneous flaps allowed surgeons to perform extensive resections, a procedure that can be traumatic for women, leading to several biopsychosocial complications in a shortened survival. Objectives: This study aimed at understanding the effects of surgical treatment on the quality of survival of patients with guarded and unchanging prognosis. Methodology: The project was designed in two stages: review of medical records with a sample of 27 cases and face-to-face interviews with the administration of questionnaires in a sample of five cases among the remaining patients who underwent LABC surgery at Hospital Erasto Gaertner in Curitiba (PR). Results: On average, the answers obtained with the World Health Organization Quality of Life (WHOQOL-BREF) instrument were "regular" for physical, psychological, and environmental domains and "good" for the social relations domain. In the 12-item short-form survey (SF-12), the means were 45,125 points for the mental component and 40,875 points for the physical one. These values show the impact of advanced disease, hygienic surgery, and chest reconstruction on the quality of life of the patients, reflecting the biopsychosocial damage caused by LABC. Conclusion: The data reveal that LABC treatment is aggressive, but in patients with survival, the surgical treatment associated with chest reconstruction had surprisingly positive results in relation to quality of life.
RESUMO
Introdução: Esta pesquisa tem como objetivo entender os fatores que determinam a escolha de um cirurgião plástico, na visão dos pacientes. É um projeto piloto que deve ser ampliado e aprofundado em outros estudos. Método: Foi idealizada uma pesquisa com 22 perguntas de múltipla escolha na forma de questionário. O tempo médio de resposta era de 8 minutos. As perguntas abordavam vários aspectos como a indicação/formação/titulação do cirurgião, percepção da primeira consulta e do consultório. Não havia possibilidade de identificação da paciente ou do cirurgião. O anonimato era garantido. Resultados: O índice de resposta foi de 86,66%. A maioria (92,22%) era do sexo feminino, com idade média de 35 anos. A maior parte tinha ensino médio e superior completos, com ganho familiar médio mensal de R$ 2 a 10 mil. Quase 40% não sabiam da titulação do cirurgião escolhido e 33,7% não sabia o tempo de formação do mesmo. A maioria (81,6%) acredita ter pago um valor na média pela sua cirurgia e metade não pesquisou a apresentação online do cirurgião. A maioria (67%) não tinha feito nenhuma cirurgia plástica previamente. Foi apresentada uma lista de 10 itens em ordem decrescente de importância. Conclusões: Os fatores determinantes para a escolha do cirurgião plástico nesta amostra, em ordem decrescente são: 1-Indicação, 2-Titulação e 3-Primeira consulta. Preço não está entre os primeiros atributos e apresentação online foi um dos últimos itens citados. Uma parte significativa dos pesquisados não conhece a titulação e nem o tempo de formação do seu cirurgião.
Introduction: This study aims to understand the factors that determine the choice of a plastic surgeon from the patient's perspective. This is a pilot project, which should be broadened and deepened by other studies. Method: A survey was devised in the form of a questionnaire with 22 multiple choice questions. The average response time was 8 minutes. The questions addressed various aspects, such as the recommendation, training, and accreditation of the surgeon; perception of the first consultation; and the clinic. There was no possibility of identifying the patient or surgeon; hence, anonymity was guaranteed. Results: The response rate was 86.66%. The majority (92.22%) of the respondents were female, with a mean age of 35 years. Most had completed secondary and higher education, with an average monthly family income of R$ 2,000 to 10,000. Almost 40% did not know the accreditation of the surgeon chosen and 33.7% did not know the length of training the surgeon had undergone. The majority (81.6%) believed they had paid an average amount for their surgery and half did not research the surgeon's online profile. The majority (67%) had not undergone any previous plastic surgery. A list of 10 items in descending order of importance was presented. Conclusions: The determining factors for the choice of the plastic surgeon in this sample, in descending order were: 1) Recommendation, 2) Accreditation, and 3) First consultation. Price was not the most important factor and online presence was one of the last items cited. A significant proportion of respondents did not know either the accreditation level or the length of training of their surgeon.
