Liposucción en Cirugía Reparadora (desengrasamiento de colgajos cutáneos y miocutáneos, exéresis de acúmulos grasos y autotransplante de grasa) / Liposuction in reconstructive surgery (undermine of cutaneous and miocutaneous flaps, exeresis of fat deposits and autologous fat transplantation)

La liposucción es una técnica quirúrgica de gran utilidad para la remodelación de acúmulos grasos y para el desgrasamiento de los colgajos cutáneos, miocutáneos o musculares. Para el desgrasamiento de los colgajos la realizamos después del año de efectuado el colgajo. También la empleamos en acúmulos grasos, en la reconstrucción mamaria postmastectomía, y acúmulos grasos periféricos en la reducción mamaria. Igualmente en el tratamiento de cicatrices deprimidas con prominencia de tejidos vecinos. En zonas deprimidas la realización del autotransplante de grasa nos ha dado buenos resultados (AU)

Surgery of the forms is an important part of plastic surgery. Occasionally, the presence of adipose masses will interfere in certain reconstructive procedures. This is specifically true for breast surgery in reductive or reconstructive techniques. Suction lipectomy is an interesting procedure for the exeresis of fat deposits, and can also be used as an ancillary treatment in many other procedures. It is also of great use in the remodeling of skin flaps performed with a pedicle or microsurgically, as well as for myocutaneous and muscular flaps. In performing the remodeling, it is also convenient to undermine and release the edges of the flap from the peripheral scar, in order to facilitate the "lifting" procedure. The instrument set for the transplantation of autologus adipose tissue is presented. The trasnplant of fat can fill and raise depressed areas, and it must be done in an over-corrective fashion by injection into a closed preformed pouch. Thse adipose trasnplants have been followed and controlled by external assessment and biopsy, revealing a 20-30o per cent resorption of transplanted tissue, and capsule formation (AU)

The effects of liposuction removal of subcutaneous abdominal fat on lipid metabolism are independent of insulin sensitivity in normal-overweight individuals.

BACKGROUND: Abdominal fat (both visceral and subcutaneous) accumulation is associated with an increased risk of developing insulin resistance. The latter stands as the basis upon which diabetes, hypertension, and atherogenic dyslipidemia tend to build up. Hence, abdominal liposuction (AL) could theoretically hold metabolic benefits. We undertook the present study to assess the effects of AL on carbohydrate and lipid metabolism. METHODS: This is a prospective study including 20 healthy volunteers (M2/F18) aged 39.6 +/- 7.7 years old (24-52), body mass index (BMI) = 25.3 +/- 4.7 kg/m(2) (19.8-36) who underwent AL. Before and 4 months after AL, we measured glucose and insulin concentrations, HOMA index [glucose (mM) x IRI (microUI/l)/22.5], free fatty acids (FFA), glycerol, total cholesterol and triglycerides, high-density lipoprotein (HDL)-cholesterol (HDL-c), low-density lipoprotein (LDL)-cholesterol (LDL-c), very low-density lipoprotein (VLDL)-cholesterol (VLDL-c) and apolipoproteins (apo) B, AI and AII, adiponectin (Adp), and ultra-sensitive C-reactive protein (CRP). RESULTS: Lipo-aspirate averaged 5.494 +/- 5.297 cc (600-19.000). Weight, BMI, and waist circumference decreased significantly 4 months after surgery by 4.6, 4.6 and 5.9%, respectively. There were significant decrements in FFA (-35%, p < 0.0001), glycerol (-63%, p < 0.0005), VLDL-c (-15.2%; p < 0.001), and triglycerides (-21.3%, p < 0.002), an increase in HDL-c (+10%, p < 0.03), Apo AI (+10.1%, p < 0.02), and Apo AII (+11.8%, p < 0.001). Total cholesterol, LDL-c, ApoB, and the LDL-c/ApoB ratio raised by +15% (p < 0.0005), +27.3% (p < 0.000), +15.1% (p < 0.008) and +2.76% (p < 0.008), respectively. Glucose, insulin, the HOMA index, Adp, and CRP were not significantly altered after AL. CONCLUSION: AL in healthy normal weight or slightly overweight subjects improves the major lipoprotein components of obesity-associated dyslipidemia. This improvement occurs independent of insulin sensitivity.

Protocolos antienvejecimiento / Antiaging protocols

El autor presenta la necesidad de protocolizar los métodos de diagnóstico y tratamiento con el fin de sistematizar la terapia antienvejecimiento. En relación a los protocolos establecidos, remarca la importancia de valorar, de forma práctica, las distintas pruebas tanto químicas como biológicas: estudio de los componentes sanguíneos, de la composición corporal, el índice de masa corporal o BMl, el índice metabólico basal o BMR, los análisis del colesterol, lipoproteínas, triglicéridos y glucosa y el llamado estado biológico. A continuación expone como Se pueden valorar todos estos datos obtenidos para poder aplicar el correspondiente tratamiento mediante un aporte enzimático (enzimas digestivas, metabólicas y alimentarias), analizando la influencia corporal de los déficits de determinadas enzimas alimentarias (proteasa, amilasa, lipasa, celulasa, etc) así como sus mecanismos y niveles de actuación para finalmente exponer una serie de puntos clave y las diferentes soluciones recomendables para modificar el proceso del envejecimiento con especial énfasis en el ejercicio y sus diversas modalidades (AU)

Breast augmentation by an umbilical approach.

Augmentation mammaplasty through an umbilical approach is a technique that, since it was first described by Johnson and Christ in 1993, has gathered both supporters and detractors. The possibility of introducing the prosthesis through the umbilicus without visible scars on the breast area has attracted a considerable number of surgeons and patients. The purpose of this paper is to share our experience with 145 patients operated on between 1994 and 1998 in which this technique was used to insert inflatable saline implants. The indications, aesthetic outcome, and complications of this unique technique are discussed. Furthermore, we have modified the technique by utilizing a dismountable prosthesis introducing clamp (PIC) that was designed by us.

Transfer of vascularized extensor tendons from the foot to the hand with a dorsalis pedis flap.

The use of the dorsalis pedis flap with vascularized extensor tendons was presented. An anatomic study has been carried out that has shown that the vascularization of the foot extensor tendons can be exclusively dependent on the blood contribution coming from the dorsalis pedis artery. In two cases that are presented and followed up for over a year after the surgery, the functional results obtained are good in the hand and aesthetically acceptable in the foot.