Augmentation Gluteoplasty: A Brazilian Perspective.

According to recent data, augmentation gluteoplasty continues to gain popularity in the United States and globally, especially in procedures involving fat grafts. However, serious concerns about its safety have been raised over the past 2 years. Will this trend continue or has it already reached its peak? The answer depends on how the technique is going to be performed hereafter. In this article, the following seven learning objectives for performing gluteal augmentation safely and effectively are covered: (1) the concept of what is a beautiful buttock and how to select the patients who will have better outcomes; (2) diagram each patient's needs for liposuction and graft; (3) use maneuvers for contouring and projection; (4) compare specific indications for fat graft and gluteal implants; (5) evaluate ptosis grade to indicate whether volume repositioning is sufficient; (6) formulate care protocols for risk management; and (7) develop lasting and high-satisfaction-rate results. It is pivotal to recognize each patient's body characteristics and ability to achieve a good result, and to work on her expectations preoperatively and accordingly to perform the procedure in the safest manner possible. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.

Does Postoperative Erythropoietin Reduce Transfusions and Hemodynamic Instability Following Liposuction, Either Alone or Associated with Abdominoplasty or Mammaplasty? A Comparative, Prospective Study of 50 Consecutive Patients.

INTRODUCTION: Erythropoietin (EPO) is a hematopoietic growth factor and an alternative to avoid blood transfusion in high-blood-loss surgeries. We evaluate EPO efficacy to reduce clinically relevant anemia and dehydration in patients undergoing liposuction. METHODS: We prospectively evaluated 50 consecutive patients subjected to liposuction greater than 2.5 L and alternately assigned into two comparable groups (25 patients each), except for the postoperative administration of erythropoietin (4000 UI per day subcutaneously) during five consecutive days. Incidence data for blood transfusion or parenteral hydration were collected. Statistical analyses were performed with significance at p value <5%. RESULTS: There was no significant difference between groups related to any preoperative feature or the incidence of dehydration (p = 0.1099) or transfusion (p = 1.0). CONCLUSION: Postoperative erythropoietin administration was not effective in preventing blood transfusion for anemia or parenteral hydration for hemodynamic instability in patients undergoing major liposuction. 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 http://www.springer.com/00266.

Gluteoplasty with autologous fat tissue: experience with 106 consecutive cases.

BACKGROUND: The female waist-hip ratio of around 0.7 is reachable through liposuction and gluteal fat grafting. The authors evaluated the reliability of this technique. METHODS: Prospective evaluation was performed of all female patients subjected to gluteoplasty with autologous fat tissue between July of 2010 and July of 2013 without a weight change greater than 10 percent during follow-up. Results were evaluated through photographs. The degree of satisfaction (patient and surgeon) was assessed on a scale of 1 (poor outcome) to 4 (excellent improvement), and agreement was measured by Kappa statistics. The technique involved epidural anesthesia, tumescent infiltration, liposuction around the buttocks, fat decantation, and grafting with retrograde injection in different planes. RESULTS: A total of 106 patients were included. Patient age ranged between 18 and 62 years (mean, 33 years). The preoperative body mass index was between 19 and 31.6 kg/m (mean, 24.8 kg/m). The volume grafted to the buttocks ranged between 180 and 840 cc (mean, 505 cc). There were no medical complications. Five patients (4.7 percent) had seroma in the donor area, 103 patients felt satisfied (97.1 percent), scoring 3 and 4, one patient (0.94 percent) complained of volume resorption 4 months postoperatively, and two patients (1.88 percent) asked to diminish their lateral gluteal volume (score 2) and underwent revision surgery 6 months postoperatively. CONCLUSIONS: This gluteoplasty technique is simple and inexpensive, with minimal morbidity and excellent results. A good result depends on harmoniously combining fat elimination by liposuction and fat grafting for buttocks sculpting, with lasting results. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Effects of elevated perfusion pressure and pulsatile flow on human saphenous veins isolated from diabetic and non-diabetic patients.

OBJECTIVE: This study was carried out to determine high pressure and pulsatile flow perfusion effects on human saphenous vein (HSV) segments obtained from diabetic and non-diabetic patients. METHODS: The veins were perfused with oxygenated Krebs solution for 3 h, with a pulsatile flow rate of 100 mL/min and pressures of 250 × 200 or 300 × 250 mmHg. After perfusion, veins were studied by light microscopy; nitric oxide synthase (NOS) isoforms, CD34 and nitrotyrosine immunohistochemistry and tissue nitrite/nitrate (NO(x)) and malondialdehyde (MDA) quantification. RESULTS: Light microscopy revealed endothelial denuding areas in all HSV segments subjected to 300 × 250 mmHg perfusion pressure, but the luminal area was similar. The percentage of luminal perimeter covered by endothelium decreased as perfusion pressures increased, and significant differences were observed between groups. The endothelial nitric oxide synthase (eNOS) isoform immunostaining decreased significantly in diabetic patients' veins independent of the perfusion pressure levels. The inducible NOS (iNOS), neuronal NOS (nNOS) and nitrotyrosine immunostaining were similar. Significant CD34 differences were observed between the diabetic 300 × 250 mmHg perfusion pressure group and the non-diabetic control group. Tissue nitrite/nitrate and MDA were not different among groups. CONCLUSIONS: Pulsatile flow and elevated pressures for 3 h caused morphological changes and decreased the eNOS expression in the diabetic patients' veins.

Estudo comparativo entre técnicas de onfaloplastia / Comparative study between omphaloplasty techniques

Introdução: A formação de cicatriz patológica na onfaloplastia compromete o resultado daabdominoplastia. Várias técnicas foram propostas com o objetivo de evitar tal evolução desfavorável.Método: Setenta e cinco pacientes submetidas a abdominoplastia foram sucessivamentealocadas, alternadamente, em dois grupos. O primeiro grupo (n=38) era composto por três técnicascirculares e o segundo grupo (n=37) por três técnicas não-circulares. Os resultados foramanalisados com um, dois, quatro e seis meses pós-operatórios, quanto à presença de hipertrofiaou estenose cicatricial, à satisfação subjetiva da pacientes e à satisfação do cirurgião (baseadana incidência dos demais critérios). A análise estatística foi realizada com o teste exato de Fisher(significativo para p < 0,05). Resultados: Ao fim de seis meses, no grupo de técnicas circulares,sete (18,2%) pacientes mantinham estenose, oito (22,2%) diziam-se insatisfeitas quanto ao aspectoda cicatriz umbilical, e, na avaliação do cirurgião, nove (23,7%) pacientes apresentavamresultado inadequado. No grupo das técnicas não-circulares, uma (2,7%) paciente manteveestenose, uma (2,7%) dizia-se insatisfeita e, na avaliação do cirurgião, cinco (13,6%) pacientesapresentavam resultado inadequado. O uso de técnicas não-circulares mostrou diferença signi-ficativa quanto à satisfação da paciente (p=0,0286) e quase significativa (p=0,0561) quanto àformação de estenose. O uso de técnicas circulares mostrou risco relativo sete vezes maior naprevalência de estenose. Os demais parâmetros não mostraram diferença significativa entre osgrupos. Conclusão: As técnicas não-circulares de onfaloplastia, nesta casuística, proporcionarammaior satisfação às pacientes. A comparação de vários parâmetros entre diferentes técnicasde onfaloplastia contribui para a elaboração de um desenho ideal de cicatriz.

Introduction: The formation of pathological scar in omphaloplasty compromises the result ofthe abdominoplasty. Many techniques have been proposed with the objective to prevent suchunfavorable evolution. Method: Seventy five patients submitted to abdominoplasty successivelyhad been placed, randomized, into two groups. The first group (n=38) was composed forthree circular techniques and the second group (n=37) by three non-circular techniques. Theresults had been analyzed with one, two, four and six postoperative months, concerning thepresence of cicatricial hypertrophy or stenosis, the subjective satisfaction of the patients and thesatisfaction of the surgeon (based in the incidence of the other criteria). The statistic analysiswas carried through with the accurate test of Fisher (significant for p < 0.05). Results: By theend of six months, in the group of circular techniques, seven (18.2%) patient kept stenosis,eight (22.2%) said themselves unsatisfied with the aspect of the umbilical scar, and in the evaluationof the surgeon, nine (23.7%) patients presented inadequate result. In the group of thenon-circular techniques, one (2.7%) patient kept stenosis, one (2.7%) said herself unsatisfied,and in the evaluation of the surgeon, five (13.6%) patients presented inadequate result. Theuse of non-circular techniques showed significant difference concerning the satisfaction of thepatient (p=0.0286) and almost significant (p=0.0561) concerning the formation of stenosis.The use of circular techniques showed a relative risk seven times bigger in the prevalenceof stenosis. All other parameters had not shown significant difference between the groups.Conclusion: The non-circular techniques of omphaloplasty, in this casuistry, have providedgreater satisfaction to the patients. The comparison of several parameters between differenttechniques of omphaloplasty contributes for the elaboration of an ideal drawing of scar.

Uso de zafirlucaste para o tratamento de contraturacapsular: estudo preliminar / Zafirlukaste use for capsular contracture treatment: preliminary report

Introdução: A contratura capsular é definida como uma cicatrização esférica com contração da cápsula que envolve a prótese. Medicações usadas para o tratamento de asma brônquica foram relatadas em estudos anteriores como eficazes no tratamento de contratura capsular. Este estudo avaliou o uso de zafirlucaste para tratamento de contratura capsular. Método: Foram avaliadas oito pacientes (12 mamas) que desenvolveram contratura capsular após mamoplastia de aumento, mastopexia com uso de prótese e troca de prótese mamária. Depois de detectada contratura, foi instituído o uso de zafirlucaste 20 mg, via oral, de 12/12 horas, por um período que variou de 30 a 90 dias. Resultados: Houve resolução completa da contratura, com retorno a Baker grau I em seis pacientes (nove mamas). Houve redução dograu de contratura Baker III para Baker II em uma paciente (duas mamas). Não houve respostaao uso da medicação em uma paciente (uma mama), que manteve Baker grau III mesmo após90 dias de uso de zafirlucaste. A redução do grau de contratura com o uso de zafirlucaste foi estatisticamente significante (p= 0,001). Clinicamente nenhuma paciente apresentou efeitos colaterais ao uso da medicação. Conclusão: Os resultados desta análise clínica sugerem uma resposta favorável ao uso de zafirlucaste para o tratamento de contratura capsular.

Introduction: Capsular contracture is defined as a spherical scar with contraction of the capsule involving the prosthesis. Medications used for the treatment of bronchic asthma have being cited in previous studies as being efficient in capsular contracture treatment. This study assessed the use of zafirlukaste for the treatment of capsular contracture. Methods: Eight patients (12 breasts)were evaluated, who developed capsular contracture after augmentation mammoplasty, mastopexy and mammary prosthesis exchange. After the diagnosis of the contracture, it was begun the use of zafirlukaste 20mg oral intake twice daily for a period varying between 30 and 90 days. Results: There was complete resolution of the contracture, returning to Baker grade I in six patients (nine breasts). There was reduction on Baker grade from III to II in one patient (two breasts). There was no response to medication use in one patient (one breast) that maintained Baker grade III even after 90 days using zafirlukaste. The reduction of the grade of contracture with the use of zafirlukaste was statistically significant (p=0.001). Clinically, none patient presented the medication’s side effects. Conclusion: The results of this clinical assessment suggest a favorable response of the use of zafirlukaste for the treatment of capsular contracture.