Cost-effective Solution for Maxillofacial Reconstruction Surgery with Virtual Surgical Planning and 3D Printed Cutting Guides Reduces Operative Time.

Background: This study aimed to explore a low-cost solution for virtual surgical planning/3D printed surgical guides in a training hospital, assessing the impact on intraoperative time and bleeding. Material and Methods: We included a total of 13 patients. 8 who underwent maxillofacial reconstruction surgery with fibula-free flap utilizing virtual surgical planning/3D printed guides (VP/SG), and 5 using conventional surgery (CS) from 2017 to 2020. The surgical time, bleeding, length of hospital stay, and comorbidities were collected and compared in two groups. We recorded the average cost for the complete surgical planning and 3D printed guides. We applied a qualitative survey to the surgeons involved in the surgical procedures. Results The mean surgical time in the VP/SG group was 8.16 ± 2.7, compared to the CS group 12.5 ± 3.8, showing a 4.34 hours difference with statistical significance (p = 0.033). Patients from the CS group had a higher bleeding volume of 921 ± 467.6 mL VS 760 ± 633.8 mL in the VP/SG group. The average cost for the complete surgical planning and 3D printed guides was 914.44 ± 46.39 USD. All the surgeons who answered the survey preferred to perform the procedure utilizing the virtual planning/3D printed guides. Conclusions Virtual planning and 3D printed surgical guides have the potential to reduce operation time in maxillofacial reconstruction.

Contexte : Cette étude visait à explorer une solution peu coûteuse pour la planification chirurgicale virtuelle/l'impression 3D de guides chirurgicaux dans un hôpital d'enseignement, en évaluant leur impact sur le temps peropératoire et le saignement. Matériel et méthodes : Nous avons inclus un total de 13 patients; 8 patients ont subi une chirurgie de reconstruction faciale avec lambeau libre de péroné (fibula) utilisant une planification chirurgicale virtuelle/des guides imprimés en 3D (VP/SG) et 5 patients ont subi une chirurgie conventionnelle (CS) entre 2017 et 2020. Le temps opératoire, le saignement, la durée de l'hospitalisation et les comorbidités ont été consignés et comparés entre les deux groupes. Nous avons enregistré le coût moyen pour la planification chirurgicale complète et les guides imprimés en 3D. Nous avons appliqué une enquête qualitative aux chirurgiens impliqués dans les procédures chirurgicales. Résultats : Le temps opératoire moyen dans le groupe VP/SG a été de 8,16 ± 2,7, comparativement à 12,5 ± 3,8 dans le groupe CS, soit une différence de 4,4 heures avec une signification statistique (P = 0033). Des patients du groupe CS ont perdu un plus grand volume de sang que les patients du groupe VP/SG (respectivement, 921 ± 467.6 mL contre 760 ± 633.8 mL). Le coût moyen de la planification chirurgicale complète et des guides imprimés en 3D a été de 914,44 ± 46,39 US$. Tous les chirurgiens ayant répondu à l'enquête ont préféré utiliser la planification virtuelle/les guides imprimés en 3D pour la réalisation de la procédure. Conclusions : La planification virtuelle et les guides chirurgicaux imprimés en 3D ont le potentiel de réduire les temps opératoires pour la reconstruction maxillo-faciale.

Association Between Pro-inflammatory Cytokine Levels (IL-1ß, IL-6, and TNF-α) in Human Colostrum and Maternal Body Composition Components.

Background: Obesity is characterized as a low-grade chronic inflammatory state, marked by elevated inflammatory biomarkers. Breast milk (BM) is rich in nutritional elements, vitamins, minerals, immunological factors, and bioactive components. These bioactive components, capable of influencing biological processes, may vary in concentration based on maternal body composition. Research Aim/Question(s): This study aimed to explore the association between pro-inflammatory cytokine levels (interleukin-1 beta [IL-1ß], interleukin-6 [IL-6], and tumor necrosis factor-alpha [TNF-α]) in human colostrum and maternal body composition, as analyzed through bioelectrical impedance vector analysis (BIVA). Method: In this cross-sectional study, 117 healthy postpartum participants were included, with each group (normal weight, overweight, and obese) comprising 39 individuals, as classified by BIVA. Colostrum samples were collected within the first 24 hours postpartum. Results: IL-1ß levels did not significantly differ across the groups, with concentrations of 69.5 ± 103 pg/mL in normal-weight, 79.7 ± 97.9 pg/mL in overweight, and 68.7 ± 108 pg/mL in obese women. IL-6 levels were significantly higher in the overweight group (55 ± 72.4 pg/mL) than in the normal-weight (48.1 ± 74.1 pg/mL) and obese groups (28.9 ± 36.2 pg/mL) (p = 0.02). Similarly, TNF-α levels were higher in the overweight group, with concentrations of 58.7 ± 74.9 pg/mL, than in the normal-weight group, with concentrations of 38.6 ± 95.4 pg/mL, and 52.6 ± 115 pg/mL in obese women (p = 0.02). Conclusion: This study shows that IL-6 and TNF-α concentrations were statistically higher in the colostrum of overweight women, suggesting that maternal body composition may influence the inflammatory profile of BM.

Fibrosis Management Algorithm in Secondary Liposculpture.

Liposuction is considered one of the most common procedures in plastic surgery. However, major postoperative complications such as visceral injury, fluid overload, and necrotizing fasciitis still occur. Likewise, minor complications such as ecchymosis, seromas, infections, and contour irregularities that do not threaten the life of the patient do generate significant dissatisfaction. Current evidence regarding the management of fibrosis after previous liposuction remains limited. The objective of this article is to standardize a management algorithm based on the extensive experience and successful results of the primary author. Patients who underwent secondary liposculpture between August 2022 and May 2023 were evaluated prospectively. Inclusion criteria: Women between 18 and 60 years, non-smokers, with a body mass index (BMI) <35 kg/m2, history of previous body contouring surgeries. Identification of the patient's skin condition and subcutaneous lesions in the adipose tissue were obtained in detail. Statistical analysis of preoperative and postoperative medical photographs was also performed with Fiji Biological image analyzer. Photographic analysis showed a statistically significant difference between the areas affected by fibrosis from the preoperative photos compared to that from the postoperative ones (p<.001). The most frequent clinical findings were depressions in 99% of the women (74), followed by soft nodules in 95% (70), hard nodules in 81% (61), adherences in 47% (35), and finally, cutaneous bursas in 4%. Our classification system and management algorithm for fibrosis and contour irregularities is a safe and reliable tool and results were objectively verified, yielding statistically significant outcomes.

The efficacy of hypnosis compared with the tell/show/do technique for the reduction of anxiety/pain in children undergoing pulpotomies: a randomized controlled trial.

Anxiety/pain is a combined experience that can hinder dental treatment in children and lead to the development of negative behaviours in any form of surgical treatment. Hypnosis is a suitable option with which to reduce anxiety and pain during dental treatment. In this study, we aimed to evaluate the efficacy of hypnosis compared to the tell/show/do technique for the reduction of anxiety and pain as measured by Face, Legs, Activity, Crying, Consolability (FLACC) scale in children undergoing pulpotomies. We performed a randomized and controlled clinical trial involving 60 children aged 5 to 7 years without previous dental experiences but with clinical and radiographic indications for pulpotomy in the primary mandibular right or left first or second molar. The children were divided into two groups: a control group (treated by conventional behaviour management techniques) and an experimental group (treated by hypnosis). The FLACC scale was used to evaluate anxiety/pain during preoperative, transoperative and postoperative pulpotomy treatment; we also analysed variations in heart rate and skin conductance. The trial was registered at ClinicalTrials.gov (NCT03739346). Statistical analysis was performed in R Studio version 1.2.1335. The FLACC scale was significantly lower in the experimental group (p = 0.022) throughout the entire treatment duration. In addition, heart rate and global skin conductance were both significantly lower in the experimental group when measured at different times (p = 0.005 and p = 0.032, respectively). When compared to conventional behavioural management techniques, the FLACC scale demonstrated that hypnosis was associated with significant reductions in heart rate, skin conductance and anxiety/pain throughout the entire duration of treatment. decreases anxiety/pain during the entire operative procedure. There was clear improvements in anxiety and pain control in patients receiving hypnotic therapy.

92 Mb/s Fat-Intrabody Communication (Fat-IBC) With Low-Cost WLAN Hardware.

The human subcutaneous fat layer, skin and muscle together act as a waveguide for microwave transmissions and provide a low-loss communication medium for implantable and wearable body area networks (BAN). In this work, fat-intrabody communication (Fat-IBC) as a human body-centric wireless communication link is explored. To reach a target 64 Mb/s inbody communication, wireless LAN in the 2.4 GHz band was tested using low-cost Raspberry Pi single-board computers. The link was characterized using scattering parameters, bit error rate (BER) for different modulation schemes, and IEEE 802.11n wireless communication using inbody (implanted) and onbody (on the skin) antenna combinations. The human body was emulated by phantoms of different lengths. All measurements were done in a shielded chamber to isolate the phantoms from external interference and to suppress unwanted transmission paths. The BER measurements show that, except when using dual on-body antennas with longer phantoms, the Fat-IBC link is very linear and can handle modulations as complex as 512-QAM without any significant degradation of the BER. For all antenna combinations and phantoms lengths, link speeds of 92 Mb/s were achieved using 40 MHz bandwidth provided by the IEEE 802.11n standard in the 2.4 GHz band. This speed is most likely limited by the used radio circuits, not the Fat-IBC link. The results show that Fat-IBC, using low-cost off-the-shelf hardware and established IEEE 802.11 wireless communication, can achieve high-speed data communication within the body. The obtained data rate is among the fastest measured with intrabody communication.

Construction and validation of a scale of stigma against individuals diagnosed with schizophrenia

Antecedents: Individuals diagnosed with schizophrenia are not just dealing with their diagnoses. They are facing stigma due to their pathology. International research has proposed that individuals diagnosed with schizophrenia suffer more stigma than other types of mental issues. However, in Chile, a valid scale is not available to measure stigma against individuals diagnosed with schizophrenia. Objectives: To fill this gap, this research is aimed to develop and validate a scale to measure stigma against individuals diagnosed with schizophrenia. Methods: Two stages were completed to achieve the research objective. First, a pool of items was developed based on the three critical components of stigma, cognitive, affective and behavioral. Three independent judges were asked to assess the content aspects of the content validity of the items. Second, following an instrumental and longitudinal design with non-probabilistic with a quota sampling by gender (N = 607) the validity and reliability of the final scale was assessed. Results: A one-dimensional scale composed of 22 items showed good statistical boundaries. The observed factor loadings suggest that the items adequately represent the dimension (λ>, 6), and the reliability estimates are optimal (α>, 8; ω>, 8). Results suggest that the scale can be used the respondents' gender irrespectively.

Antecedentes: Las personas diagnosticadas con esquizofrenia no solo enfrentan su diagnóstico. Ellos también tienen que enfrentar el estigma producto de su patología. Investigaciones internacionales han propuesto que las personas diagnosticas con esquizofrenia sufren más de estigma que otras patologías mentales. Sin embargo, en Chile no existe una escala validada para medir el estigma hacia personas diagnosticadas con esquizofrenia. Objetivos: Para cubrir esta necesidad en la literatura, esta investigación tiene como objetivo desarrollar y validar un instrumento para medir el estigma hacia personas diagnosticadas con esquizofrenia. Métodos: Dos etapas fueron completadas para lograr el objetivo de investigación. En primer lugar, se desarrolló un set de ítems basados en los "tres componentes centrales del estigma: creencia, emoción y conducta". Se les solicitó a tres jueces independientes evaluar estas preguntas de acuerdo con su contenido y validez. En segundo lugar, siguiendo un diseño instrumental y longitudinal con muestreo no probabilístico por cuotas por género (N = 607) se evaluó la validez y confiabilidad de la escala final. Resultados: Una escala unidimensional compuesta por 22 ítems mostró buenos límites estadísticos. Las saturaciones de factores observadas sugieren que los ítems representan adecuadamente la dimensión (λ>, 6), y las estimaciones de confiabilidad son óptimas (α>, 8; ω>, 8). Los resultados sugieren que la escala se puede utilizar independientemente del género de los encuestados

Evaluation and Optimization of the Wallace Rule of Nines for the Estimation of Total Body Surface Area in Obese and Nonobese Populations.

BACKGROUND: Currently, the Wallace Rule of Nines is the most widely used method to measure total body surface area (TBSA) in burned patients due to its practicality and speed in its application; however, it often provides inaccurate estimations in obese patients, affecting the fluid resuscitation process. OBJECTIVE: In this study, we aimed to modify and optimize the Rule of Nines' values for its application in these patients. METHODS: We compared the estimations of the TBSA established by the Wallace Rule of Nines against the measurements of the three-dimensional (3D) software Skanect - Meshmixer 3.5Ⓡ in participants without different obesity grades. Based on our results, we generate an optimized guideline for the evaluation of TBSA in normal body mass index (BMI) and obese patients. RESULTS: In our study, 32 participants were recruited with a mean age of 28.5 ± 3.3 years. In the general population, we observed a poor correlation between the Wallace Rule of Nines and the 3D method measures in all body regions (e.g., Anterior Trunk: 18.0 vs. 16.61 ± 2.11, p = 0.0008) except the anterior arm. Interestingly, these differences narrowed in the Trunk and Leg regions as the participants' BMI increased (e.g., Anterior Trunk in Obesity Grade II patients: 18.0 vs. 18.66 ± 1.69, p = 0.3089). CONCLUSIONS: We found important differences in TBSA determination using the 3D Skanect-MeshmixerⓇ software compared with the Wallace Rule of Nines. Therefore, we generated a modified and optimized Wallace Rule of Nines estimations based on BMI. Future studies are needed to assess the safety and efficacy of this optimized table.

Comparison between Wright and Shukla formulas: which is better for the placement of umbilical catheters in newborns ≤ 1500 g?

BACKGROUND: Intravascular venous (VUC) or arterial (AUC) umbilical catheter placement is the most frequent invasive procedure in the neonatal intensive care unit (NICU). Either Wright's or Shukla's formula is used to introduce the catheters. However, Shukla's formula is associated with incorrect insertion, especially for newborns < 1500 g. This study aimed to determine by chest X-ray if Wright's formula is better than Shukla's formula for the correct placement of umbilical catheters in newborns ≤ 1500 g. METHODS: We included patients admitted to the NICU of a secondary-level hospital between 2021-2022 who received VUC or AUC through the Wright or Shukla formulas. RESULTS: A total of 129 newborns were included: 78 with VUC and 51 with AUC. In VUC, 50% with Wright and 36.8% with Shukla formulas had the correct location, (p = 0.24). In AUC, 56.6 % with Wright and 52.4% with Shukla formulas were placed correctly placed, (p = 0.76). VUC with weight < 1000 g were correctly placed in 36.4% with Wright and 33.3% with Shukla formulas (p = 0.58). VUC in newborns > 1000 g were correctly placed in 66.6% with Wright and 38.4% with Shukla formulas (p = 0.065). AUC in newborns < 1000 g were correctly placed in 45% using Wright and 42.9% Shukla formulas (p = 0.63). AUC in newborns > 1000 g were correctly placed in 80% using Wright and 57.1% Shukla formulas (p = 0.23). CONCLUSIONS: We found 13% more correctly placed VUC using Wright's formula. Moreover, Wright's formula was 29% above Shukla's VUC placement in neonates > 1000 g, although there was no significant difference due to the sample size.

INTRODUCCIÓN: La colocación de catéteres intravasculares venosos umbilicales (CVU) y arteriales (CAU) es el procedimiento invasivo más frecuente en la unidad de cuidados intensivos neonatales (UCIN). Para introducirlos se utilizan las fórmulas de Wright y de Shukla, aunque esta última podría estar asociada con una inserción incorrecta, especialmente en neonatos < 1500 g. El objetivo de este estudio fue determinar mediante radiografía de tórax cuál fórmula es mejor para la correcta colocación de catéteres umbilicales en recién nacidos ≤ 1500 g. MÉTODOS: Se incluyeron los pacientes ingresados en la UCIN de un hospital de segundo nivel entre 2021-2022 que recibieron CVU o CAU mediante las fórmulas de Wrigth o Shukla. RESULTADOS: Se incluyeron en total 129 recién nacidos: 78 CVU y 51 CAU. En CVU, Wright 50% y Shukla 36.8% tuvieron localización correcta, p = 0.24. En las CAU, Wright 56.6% y Shukla 52.4% tenían una ubicación correcta, p = 0.76. En CVU con peso < 1000 g, Wright 36.4% y Shukla 33.3% bien situados, p = 0.58. En CVU > 1000 g, Wright 66.6% y Shukla 38.4% bien situados, p = 0.065. En CAU < 1000 g, Wright 45% y Shukla 42.9%, p = 0.63. En CAU con peso > 1000 g, Wright 80% y Shukla 57.1%, p = 0.23. CONCLUSIONES: La colocación del CVU fue 13% mejor con la fórmula de Wright. La fórmula de Wright superó en el 29% la colocación del CVU en los neonatos > 1000 g en comparación con la de Shukla, aunque no hubo diferencia significativa debido al tamaño de la muestra.

Comparison between Wright and Shukla formulas: which is better for the placement of umbilical catheters in newborns ≤ 1500 g? / Comparación entre las fórmulas de Wright y de Shukla: ¿cuál es mejor para la colocación de catéteres umbilicales en recién nacidos ≤ 1500 g?

Abstract Background: Intravascular venous (VUC) or arterial (AUC) umbilical catheter placement is the most frequent invasive procedure in the neonatal intensive care unit (NICU). Either Wright's or Shukla's formula is used to introduce the catheters. However, Shukla's formula is associated with incorrect insertion, especially for newborns < 1500 g. This study aimed to determine by chest X-ray if Wright's formula is better than Shukla's formula for the correct placement of umbilical catheters in newborns ≤ 1500 g. Methods: We included patients admitted to the NICU of a secondary-level hospital between 2021-2022 who received VUC or AUC through the Wright or Shukla formulas. Results: A total of 129 newborns were included: 78 with VUC and 51 with AUC. In VUC, 50% with Wright and 36.8% with Shukla formulas had the correct location, (p = 0.24). In AUC, 56.6 % with Wright and 52.4% with Shukla formulas were placed correctly placed, (p = 0.76). VUC with weight < 1000 g were correctly placed in 36.4% with Wright and 33.3% with Shukla formulas (p = 0.58). VUC in newborns > 1000 g were correctly placed in 66.6% with Wright and 38.4% with Shukla formulas (p = 0.065). AUC in newborns < 1000 g were correctly placed in 45% using Wright and 42.9% Shukla formulas (p = 0.63). AUC in newborns > 1000 g were correctly placed in 80% using Wright and 57.1% Shukla formulas (p = 0.23). Conclusions: We found 13% more correctly placed VUC using Wright's formula. Moreover, Wright's formula was 29% above Shukla's VUC placement in neonates > 1000 g, although there was no significant difference due to the sample size.

Resumen Introducción: La colocación de catéteres intravasculares venosos umbilicales (CVU) y arteriales (CAU) es el procedimiento invasivo más frecuente en la unidad de cuidados intensivos neonatales (UCIN). Para introducirlos se utilizan las fórmulas de Wright y de Shukla, aunque esta última podría estar asociada con una inserción incorrecta, especialmente en neonatos < 1500 g. El objetivo de este estudio fue determinar mediante radiografía de tórax cuál fórmula es mejor para la correcta colocación de catéteres umbilicales en recién nacidos ≤ 1500 g. Métodos: Se incluyeron los pacientes ingresados en la UCIN de un hospital de segundo nivel entre 2021-2022 que recibieron CVU o CAU mediante las fórmulas de Wrigth o Shukla. Resultados: Se incluyeron en total 129 recién nacidos: 78 CVU y 51 CAU. En CVU, Wright 50% y Shukla 36.8% tuvieron localización correcta, p = 0.24. En las CAU, Wright 56.6% y Shukla 52.4% tenían una ubicación correcta, p = 0.76. En CVU con peso < 1000 g, Wright 36.4% y Shukla 33.3% bien situados, p = 0.58. En CVU > 1000 g, Wright 66.6% y Shukla 38.4% bien situados, p = 0.065. En CAU < 1000 g, Wright 45% y Shukla 42.9%, p = 0.63. En CAU con peso > 1000 g, Wright 80% y Shukla 57.1%, p = 0.23. Conclusiones: La colocación del CVU fue 13% mejor con la fórmula de Wright. La fórmula de Wright superó en el 29% la colocación del CVU en los neonatos > 1000 g en comparación con la de Shukla, aunque no hubo diferencia significativa debido al tamaño de la muestra.

Menor aerolización con bloqueo del nervio laríngeo superior comparado con lidocaína intravenosa a la extubación / Less aerolization with superior laryngeal nerve block compared to intravenous lidocaine at extubation

Resumen: Introducción: La tos es una respuesta fisiológica de protección de la vía aérea, produce aerosoles que se identifican por imagen y alcanza una velocidad de hasta ocho metros por segundo. La extubación produce tos, hipertensión, taquicardia, apnea y laringoespasmo, existen métodos para minimizar su aparición. Debido a la pandemia de COVID-19 se han utilizado como profilaxis del reflejo tusígeno, la lidocaína intravenosa y el bloqueo del nervio laríngeo superior. El objetivo fue compararlos en la inhibición de la tos. Material y métodos: Se seleccionaron pacientes entre 18-60 años, cirugía electiva con anestesia general balanceada, ASA 1-3, con intubación menor a tres horas. Se aleatorizó un total de 90 pacientes, 45 en cada grupo, se eliminó un total de 10 pacientes por presentar inestabilidad hemodinámica al final de la cirugía o por no administrar dosis intravenosa de lidocaína en el tiempo establecido. Resultados: No hubo diferencia estadísticamente significativa en el número de pacientes que presentaron tos en ambos grupos (13 vs 10, p = 0.4684), de éstos se obtuvo una diferencia estadísticamente significativa en el número de decibeles a favor del grupo de bloqueo (75.6 vs 67, p < 0.001). Conclusiones: El bloqueo (selectivo) presenta menos aerolización que la lidocaína intravenosa en la extubación.

Abstract: Introduction: Coughing is a physiological response to protect the airway, it produces aerosols that are identified by imaging reaching a speed of up to 8 meters per second. Extubation produces cough, hypertension, tachycardia, apnea and laryngospasm, there are methods to minimize its occurrence. Due to the COVID-19 pandemic, intravenous lidocaine and superior laryngeal nerve block have been used as cough reflex prophylaxis. The aim was to compare them in cough inhibition. Material and methods: Patients aged 18-60 years, elective surgery with balanced general anesthesia, ASA 1-3, with intubation less than 3 hours, were selected. A total of 90 patients were randomized, 45 in each group. A total of 10 patients were eliminated because they presented hemodynamic instability at the end of surgery, and because the intravenous dose of lidocaine was not administered within the established time. Results: There was no statistically significant difference in the number of patients who presented cough in both groups (13 vs 10, p = 0.4684), of these there was a statistically significant difference in the number of decibels in favor of the block group (75.6 vs 67, p < 0.001). Conclusions: Block presents less aerolization than intravenous lidocaine in extubation.

Risk Factors, Clinical Presentation, Therapeutic Trends, and Outcomes in Arterial Thrombosis Complicating Unvaccinated COVID-19 Patients: A Systematic Review.

Data on characteristics and outcomes of coronavirus (COVID)-19 patients complicated with arterial thrombosis (AT) are scarce. Therefore, we carried out a systematic review (PRISMA, PROSPERO statements; PubMed, Scopus, and Web of Science) to identify risk factors, clinical presentation, treatment, and outcomes. We included publications from December 2019 to October 2020. Groups: (a) ischemic stroke, (b) thrombotic storm, (c) peripheral vascular thrombosis, (d) myocardial infarction, and (e) left cardiac thrombus or in-transit thrombus (venous system thrombus floating or attaching to the right heart). We considered 131 studies. The most frequent cardiovascular risk factors were: hypertension, diabetes, and dyslipidemia. A high proportion presented with asymptomatic, mild, or moderate COVID-19 (n = 91, 41.4%). We identified a high percentage of isolated ischemic stroke and thrombotic storm. Groups with higher mortality rate: intracardiac thrombus (1/2, 50.0%), thrombotic storm (18/49, 36.7%), and ischemic stroke (48/131, 36.6%). A small number received thromboprophylaxis. Most patients received antithrombotic treatment. The most frequent bleeding complication was intracranial hemorrhage, primarily with isolated stroke. Overall mortality was 33.6% (74/220). Despite a wide range of COVID-19 severity, a high proportion had AT as a complication of non-severe disease. AT can affect different vascular territories; mortality is associated with stroke, intensive care unit stay, and severe COVID-19.

Efecto del confinamiento durante la pandemia de Covid-19 en los niveles séricos de lípidos y composición corporal de estudiantes universitarios.

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Adipose Tissue Transfer in Dynamic Definition Liposculpture PART III. The Arms: Biceps, Triceps, and Deltoids.

Arm contouring usually represents a challenge for the surgeon due to zones with high risk of irregularities/asymmetries, the variable degree of skin laxity, and the differences between patient/gender preferences. In men, the bigger and muscular the arms the better, while women tend to prefer a slim and soft silhouette. Methods: We performed arm cadaveric dissections and also searched our records for patients who underwent fat grafting of the arm in addition to HD2, from January 2016 to May 2022 at a single center in Bogotá, Colombia. Results: Two hundred eighty-nine consecutive patients (275 men and 14 women) underwent high-definition lipoplasty/HD2 plus fat grafting of the biceps (72 muscles), the triceps (46 muscles), the deltoids (426 muscles), or a combination of them. Mean age was 39 and 36 years for men and women, respectively. Range of the fat graft volume was 30-150 ml. No major complications were reported. Follow-up period ranged from 2 to 24 months. Most patients were satisfied with the results. Conclusions: Men usually seek an overall well-toned and muscular extremity, while women tend to prefer a slim but also athletic contour. Such outcomes can be achieved through intramuscular fat grafting of the biceps, triceps, and deltoids. The proper recognition of the pedicles and a precise surgical technique will ensure both its safety and the reproducibility of the results.

Adipose Tissue Transfer in Dynamic Definition Liposculpture Part II. The Lower Limb: Gastrocnemius, Vastus Medialis, Vastus Lateralis, and Rectus Femoris Muscles.

One big challenge of body contouring surgery is the liposculpture of the lower limbs, probably because of the imperative symmetry and the risk of contour irregularities. We are reporting our experience in fat grafting of the thighs and calves for men and women undergoing dynamic definition liposculpture. Methods: We did cadaveric dissections of the vastus lateralis, vastus medialis, rectus femoris, and gastrocnemius muscles and identified each of their primary pedicles. We also performed fat grafting of these muscles in the contralateral virgin cadaveric specimen. We searched our records for patients who underwent fat grafting of the lower extremity in addition to dynamic definition liposculpture, from January 2016 to May 2022 at a single center in Bogotá, Colombia. Results: Seventy-three consecutive patients met the inclusion criteria (26 men and 47 women). We grafted 102 gastrocnemius muscles, 86 vastus medialis muscles, 98 vastus lateralis muscles, and 22 rectus femoris muscles. Mean age was 34 and 41 years for men and women, respectively. Range of the fat graft volume was 50-200 mL. No complications were recorded related to fat grafting. Almost all patients were satisfied with the procedure (89%). Follow-up period ranged from 2 to 36 months. Conclusions: Fat grafting of the lower limb muscles should be considered an alternative operative technique to enhance volume and athletic appearance of this body segment. Based on cadaveric dissections and clinical evidence, our technique is considered reliable and reproducible with remarkable outcomes and a very low complication rate.

High-Definition Liposculpture 18-Year Evolution: Patient Safety and Aesthetic Outcomes.

BACKGROUND: High-definition liposculpture (HDL) emerged as an innovative surgical technique that allowed plastic surgeons to achieve improved aesthetic results with a natural and athletic appearance using minimal incisions and with imperceptible scarring. Its targets are high aesthetic standards and patient safety. PURPOSE: This article summarizes the evolution of HDL by explaining upgrades to the original technique and comparing the complication rates among them. METHODS: The authors retrospectively reviewed records from four private medical centers (Evolution Medical Center, Santa Barbara Medical Center, and Dhara Clinic in Bogota and FOSCAL in Bucaramanga, Colombia) of patients who underwent HDL performed by the senior author (A.E.H) over an 18-year period (2002 through 2019). Patients were classified into three groups: suction-assisted lipoplasty (period 1), vibration amplification of sound energy at resonance-assisted HDL (period 2), and dynamic definition liposculpture (period 3). RESULTS: The authors established a cohort of 5052 patients (4300 women and 752 men): 923 in period 1, 1272 in period 2, and 2857 in period 3. The most common complications included seroma, bruising, hematoma, acute anemia, hyperchromia, wrinkled skin, wound dehiscence, and local infections. CONCLUSIONS: HDL and dynamic-definition liposculpture procedures are safe and reproducible techniques to achieve an athletic and natural body contour. Complication rates, especially those related to bleeding, decreased as the technique evolved. These procedures are aimed toward patient safety to provide higher aesthetic outcomes using extensive medical, anatomic, artistic, and technological knowledge. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

False-Positive Nodes With Axillary Silicone Lymphadenopathy in an Oncologic Patient With a Rare Breast Cancer and Implant Rupture.

In this case, a 43-year-old woman with a rare breast tumor and a history of augmentation mammoplasty is presented. The patient arrived at the clinic reporting a palpable lump in the right mammary gland and two ipsilateral axillary nodes with pain on palpation. Mammography and ultrasound confirmed the presence of a 4 cm tumor and 2 metastatic lymph nodes of 2 cm each, histopathological diagnosis was an encapsulated papillary cancer and two siliconomas, respectively. Interestingly, these nodes were able to take up technetium 99 and methylene blue contrast media. Due to these findings, adequate patient management was carried out with a skin-sparing mastectomy and hormonal treatment with tamoxifen. This report is relevant as it shows that axillary lymphadenopathy caused by silicone must be considered in the evaluation of a patient with a cancer diagnosis and history of augmentation mammoplasty, especially breast cancer as the node siliconomas present a high risk of being considered a false positive metastasis.

Adipose Tissue Transfer in Dynamic Definition Liposculpture-PART I. Back: Latissimus Dorsi and Trapezius Muscles.

The aesthetics for the male posterior torso remain a topic not fully studied in body contouring surgery, neither the lipoinjection of its muscles have been considered before. As a result, we carried out a retrospective cohort study including patients who underwent fat grafting of either the trapezius or the latissimus dorsi muscles as part of dynamic definition liposculpture (HD2). Methods: We performed cadaveric dissections to support the fat grafting technique for both the trapezius and the latissimus dorsi muscles. We also searched our records for patients who underwent fat grafting of these muscles in addition to HD2 from January 2016 to November 2021 at a single center in Bogotá, Colombia. Results: Thirty-five consecutive patients met the inclusion criteria. In total, 22 (63%) and 7 (20%) of 35 underwent fat grafting at the trapezius and the latissimus dorsi muscles alone, respectively, and 6 out of 35 (17%) of both. Mean age is 39 years (range = 22-63). All patients were men. No complications were recorded related to fat grafting. Almost all patients were satisfied with the procedure (97%). Follow-up period ranged from 2 to 48 months. Conclusions: Liposuction might not be enough to achieve the ideal V-shape of the men's back in some cases; hence, fat grafting of the power muscles becomes the best option. Recognition of the main neurovascular pedicle, proper preoperative markings, and a correct surgical technique ensure both the safety and the reproducibility of the technique.