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1.
Aesthetic Plast Surg ; 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33483780

RESUMO

BACKGROUND: Simulation training has become an integral part of plastic surgery postgraduate curricula. It facilitates the acquisition of skills in a safe environment that can be later transferred to real-life settings. A variety of models have been described covering some aspects of the specialty better than others. The aim of this study was to identify and classify all the previously reported plastic surgery simulation models and the possible gaps having the Accreditation Council for Graduate Medical Education (ACGME) list of competencies as a guide. METHODS: Through a Delphi process, the complete list of ACGME minimum requirements for certification was analyzed to identify domains amenable for simulation training. A systematic search was conducted in Pubmed looking for all previously reported simulation models in plastic surgery. Predefined inclusion and exclusion criteria and parallel blind review were used to identify eligible models. RESULTS: A total of 81 ACGME competencies were identified. Following a 3-round Delphi process, consensus was reached on 19 reconstructive and 15 aesthetic surgery domains suitable for simulation training. 1667 articles were initially retrieved from Pubmed, of which 66 articles were eligible for inclusion. Descriptive (65%), quasi-experimental (24%) and experimental studies (11%) were found. For the 34 identified ACGME competencies, there were simulation models described for 58.8% of these, mostly covering reconstructive surgery (84.2%) while for aesthetic surgery it was 13.3%. CONCLUSIONS: This scoping review has identified that there are still gaps in ACGME competencies that could benefit from new simulation training models, especially in those related to aesthetic surgery. 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 .

3.
Rev. Asoc. Odontol. Argent ; 106(2): 41-43, abr.-jun. 2018.
Artigo em Espanhol | LILACS | ID: biblio-912408

RESUMO

La presente comunicación se propone compartir con la comunidad educativa odontológica la importancia de la decisión y los fundamentos de incluir la enseñanza de los conceptos sobre seguridad del paciente en la formación de grado del futuro odontólogo (AU)


The purpose of this communication is to share with the dentistry educating community the importance of the decision and the fundamental for the inclusion of "patient safety" concepts in the undergraduate dental education curriculum (AU)


Assuntos
Educação Pré-Odontológica , Segurança do Paciente , Estudantes de Odontologia , Relações Dentista-Paciente
4.
Radiol Med ; 122(9): 639-650, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28429207

RESUMO

The European Society of Breast Cancer Specialists has created quality indicators for breast units to establish the minimum standards of care for patients. In Italy, each region differs, indeed, in terms of health care and services warranted to patients suffering from breast cancer. Since Sicilian Regional Administration today is still disregarding implementation of the provisions contained in the proposal of the Ministry of Health entitled "Guidelines on Organizational and Health Care Methods of Breast Centers Network" in November 2015 the Sicilian Regional Group of the Italian Society of Radiology (SIRM) decided to carry out a survey to see the position of the Sicilian Healthcare System and define the gap to bridge over. Sicilian breast imaging radiologists were asked to fill in a questionnaire concerning the type of job relationship (public or private sector), qualification (Manager, Department Manager, Freelancer) and years of experience on breast imaging. With regard to technological requirements, were answered the questions about the number, type, age and completeness of accessories of the equipment supplied in the Sicilian healthcare facilities. The data showed that over 64% of breast imagers in Sicilian centers work in breast units, whereas only 18% are involved in screening programs. A majority of radiologists (81%) working in the breast health care system is very experienced (more than 10 years of experience in the field). The result provided concerning the medical and technical staff demonstrates an uneven situation, but overall an inadequate value compared with the required guidelines especially in interventional procedures. The aim of this paper is to illustrate the method used and the results obtained. These data have to be shared with policy makers to enhance quality improvement in Sicilian Breast Center Network.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Neoplasias da Mama/diagnóstico por imagem , Padrões de Prática Médica/estatística & dados numéricos , Área de Atuação Profissional , Indicadores de Qualidade em Assistência à Saúde , Radiologistas/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Organizacionais , Guias de Prática Clínica como Assunto , Sicília , Inquéritos e Questionários
5.
Rev. chil. cir ; 68(5): 349-354, oct. 2016. ilus, graf
Artigo em Espanhol | LILACS | ID: lil-797344

RESUMO

Objetivo: Determinar la factibilidad de la monitorización en microcirugía por medio de la evaluación no invasiva de la microcirculación con sidestream dark field (SDF) y compararla con otros métodos. Materiales y métodos: Estudio experimental. En 8 cerdos se elevó colgajo pectoral y se disecó pedículo. Se llevó a cabo una instalación sucesiva de dispositivos cutáneos para la evaluación de la microcirculación: SDF para evaluar flujo, y near infrared spectroscopy (NIRS) para evaluar saturación de O2 (SatO2). Posteriormente se evaluó la oclusión venosa, arterial y total con pinzamiento durante 180 s. Resultados: SDF en oclusión venosa: disminución del flujo: 51 s (59-62); SDF en oclusión arterial: disminución del flujo: 3 s (1-5); SDF en oclusión vascular total: disminución del flujo: 3,5 s (2-5). NIRS en oclusión venosa: disminución de la SatO2:15,2 ± 5,3%; NIRS en oclusión arterial: disminución de la SatO2 23,9 ± 13,8%; NIRS en oclusión vascular total: disminución de la SatO2 23,85 ± 13,9%. Doppler en oclusión venosa: no desapareció; Doppler en oclusión arterial y oclusión vascular total: desapareció a los 2 s. En cada una de las mediciones, los cambios clínicos fueron más tardíos que los observados con SDF. Conclusión: Es factible la monitorización en microcirugía por medio de la evaluación de la microcirculación con Microscan®. Este método permite realizar el diagnóstico de oclusión vascular más tempranamente que con NIRS y evaluación clínica.


Aim: Determine the feasibility of using SDF Microscan® as a non-invasive method for monitoring free flap microcirculation, and compare it to other methods. Materials and methods: Experimental study. In 8 pigs a pectoral myocutaneous flap was raised. Microcirculation was evaluated using: SDF Microscan®, near infrared spectroscopy (NIRS), clinical examination and Doppler. Venous, arterial and total occlusion was performed by clamping the vascular pedicle. Mean time to blood flow impairment diagnosis was measured. Results: SDF in venous occlusion: reduced microcirculatory flow index at: 51 s (59-62). SDF in arterial occlusion: reduced microcirculatory flow index at: 3 s (1-5). SDF in total vascular occlusion: reduced microcirculatory flow index at: 3.5 s (2-5). NIRS in venous occlusion: SatO2 decrease was 15.2 ± 5.3%. NIRS in arterial occlusion: SatO2 decrease was 23.9 ± 13.8%. NIRS in total vascular occlusion: SatO2 decrease was 23.85 ± 13.9%. Doppler in venous occlusion: The signal did not disappear. Doppler arterial and total vascular occlusion disappears at 2 s. The clinical changes were later than SDF. Conclusion: Microcirculation monitoring is feasible using SDF Microscan® in a pig model. This method allows to detect blood flow disruption earlier than NIRS and clinical evaluation.


Assuntos
Animais , Retalhos Cirúrgicos/irrigação sanguínea , Microscopia de Vídeo , Microcirculação/fisiologia , Microcirurgia/métodos , Monitorização Fisiológica/instrumentação , Suínos , Modelos Animais
6.
Pediatr Dermatol ; 33(1): 75-9, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26758090

RESUMO

BACKGROUND: The current treatment of keloids includes surgery, intralesional steroids, and radiotherapy, among others. Radiotherapy is not recommended in children due to its effects on growing tissues. Our aim was to study intralesional triamcinilone therapy of keloids in children and analyze the impact of body location, age of the lesion, and etiology of the keloid on clinical response. METHODS: We conducted a prospective clinical trial with patients 1 to 14 years of age evaluated for keloid treatment. A soft tissue ultrasound was performed to measure the keloid volume, prior to intralesional infiltration with triamcinolone acetonide. A posttreatment ultrasound quantified the volume differences attributed to therapy. For the analysis, Mann-Whitney/Wilcoxon test for paired samples and a multiple regression analysis were performed. RESULTS: Twenty-one patients with a total of 25 keloids were enrolled, with a median age of 12 years (range 6-14 yrs). The initial lesional volume was 1.25 cc (range 0.2-6.3 cc) and the final volume was 0.2 cc (range 0.0-1.53 cc), corresponding to 82.7% of size reduction (p < 0.001). Regarding the relationships between response and body location, etiology and age of the lesion, the multiple regression analyses obtained p-values of 0.46, 0.16, and 0.87, respectively. One patient failed to improve. Average follow-up was 30 months. CONCLUSIONS: Triamcinolone acetonide is highly effective for the treatment of pediatric keloids. There is no relationship between clinical response and the factors evaluated, such as lesion location, etiology and age of the keloid.


Assuntos
Glucocorticoides/administração & dosagem , Queloide/tratamento farmacológico , Triancinolona Acetonida/administração & dosagem , Adolescente , Criança , Pré-Escolar , Seguimentos , Humanos , Lactente , Injeções Intralesionais , Estudos Prospectivos , Resultado do Tratamento
7.
Stud Health Technol Inform ; 217: 282-7, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26294485

RESUMO

As the average age of the EU population increases, ICT solutions are going to play a key role in order to find answers to the new challenges the demographic change is carrying on. At the University of Parma an AAL (Ambient Assisted Living) system named CARDEA has been developed during the last 10 years. Within CARDEA, behavioral analysis is carried out, based on environmental sensors. If multiple users live in the same environment, however, data coming from sensors need to be properly tagged: in this paper, a simple technique for such tagging is proposed, which exploits the same wireless transmission used for transmitting data, thus not requiring additional hardware components and avoiding more complex and expensive (radio)localization techniques. Preliminary results are shown, featuring a satisfactory accuracy.


Assuntos
Atividades Cotidianas , Moradias Assistidas , Atividades Cotidianas/psicologia , Comportamento , Meio Ambiente , Planejamento Ambiental , Habitação para Idosos , Humanos , Equipamentos de Autoajuda , Tecnologia sem Fio
8.
Med Sci Law ; 55(4): 304-11, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25628338

RESUMO

In recent years, modern imaging techniques have gained ground in forensics. A crucial question is whether virtual autopsy is capable of replacing traditional autopsy. Forensic diagnosis of freshwater drowning (FWD) is based on the evidence of findings from external inspection (e.g. frothy fluid exuding from the mouth and nostrils), internal examination (e.g. pulmonary congestion, enlargement of heart chambers) and biochemical analysis (haemodilution), findings which are non-specific. The detection of diatoms in organs of the systemic circulation may be of some assistance, but this analysis is rarely performed and is of debatable validity. An 18-month-old child was found dead at home in a swimming pool. Considering the family's wishes to avoid autopsy, the district attorney authorised a whole-body post-mortem computed tomography scan (PMCT). The main imaging findings were frothy fluid in the upper airways, fluid in the trachea and main bronchi, many pulmonary nodular ground glass opacities (GGO) in non-dependent regions and haemodilution. CT imaging did not show any other forensically relevant abnormality.A high concordance was found between the CT findings reported in the literature in cases of FWD and the imaging results. Thus, after the exclusion of other causes of death, advised by the forensic pathologist, the district attorney closed the case and the death was attributed to FWD. This case report demonstrates that PMCT imaging in cases of suspected FWD can provide some important findings for the diagnosis of FWD as the cause of death.


Assuntos
Afogamento/diagnóstico por imagem , Água Doce , Autopsia/métodos , Brônquios/diagnóstico por imagem , Patologia Legal/métodos , Humanos , Lactente , Pulmão/diagnóstico por imagem , Seio Maxilar/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Traqueia/diagnóstico por imagem
10.
Artigo em Inglês | MEDLINE | ID: mdl-26737423

RESUMO

EU population is getting older, so that ICT-based solutions are expected to provide support in the challenges implied by the demographic change. At the University of Parma an AAL (Ambient Assisted Living) system, named CARDEA, has been developed. In this paper a new feature of the system is introduced, in which environmental and personal (i.e., wearable) sensors coexist, providing an accurate picture of the user's activity and needs. Environmental devices may greatly help in performing activity recognition and behavioral analysis tasks. However, in a multi-user environment, this implies the need of attributing environmental sensors outcome to a specific user, i.e., identifying the user when he performs a task detected by an environmental device. We implemented such an "action tagging" feature, based on information fusion, within the CARDEA environment, as an inexpensive, alternative solution to the problematic issue of indoor locationing.


Assuntos
Comportamento/fisiologia , Movimento/fisiologia , Telemetria/métodos , Humanos , Telemetria/instrumentação
11.
Rev. Asoc. Odontol. Argent ; 102(4): 151-153, oct.-dic. 2014.
Artigo em Espanhol | LILACS | ID: lil-744935

RESUMO

La gran cantidad de conocimientos que se producen en la actualidad, sumados al avance tecnológico y a las reflexiones acerca del perfil del profesional del siglo XXI, implican la necesidad de cambios en las instituciones educativas, que sólo son posibles de implementar y mantener por medio de la capacitación de los docentes


Assuntos
Capacitação Profissional/métodos , Educação Continuada em Odontologia/métodos , Política Organizacional , Sociedades Odontológicas/tendências , Argentina , Tecnologia Odontológica/tendências
12.
FEM (Ed. impr.) ; 17(4): 229-237, dic. 2014. ilus, mapas
Artigo em Espanhol | IBECS | ID: ibc-132982

RESUMO

Introducción: Las escuelas de medicina del mundo están reformulando sus estructuras curriculares, contenidos y estrategias para integrar las tendencias actuales de la educación superior. Esto implicará un cambio en la evaluación: las técnicas tradicionales ya no serán congruentes con los nuevos modelos curriculares, si se requiere una contribución al aprendizaje. La bibliografía señala al portafolio como una herramienta que permite la evaluación del desempeño y estimula el aprendizaje. Su uso en la educación médica de pregrado no se ha explorado extensamente y se halla poca evidencia sobre su aplicación específica en odontología. Materiales y métodos: Bajo una investigación educativa de acción, se puso en práctica en la asignatura 'Prostodoncia I', del segundo año de la carrera de odontología. La utilización de esta herramienta tuvo como objetivo que docentes y alumnos se conciencien sobre la responsabilidad compartida de enseñar y aprender valorando las potencialidades de la implementación del portafolio. Se realizó a partir de reuniones docentes, entrevistas y encuestas a los alumnos. Resultados: La opinión de los estudiantes en las encuestas expresa que el portafolio mejoró su aprendizaje significativamente y fue una buena herramienta de enseñanza, contribuyendo a la reflexión en su trabajo académico. Los profesores reconocieron la importancia de un espacio para el acercamiento al alumno, permitiendo realizar un análisis de sus producciones y su relación con los contenidos de la asignatura. Conclusiones: Se demostró que el portafolio se considera una herramienta que permite enriquecer las prácticas educativas, generando conocimientos desde las construcciones de los alumnos y las intervenciones de los profesores


Introduction: The schools of medicine in the world are reformulating their contents, strategies and curricular structures to integrate current trends in higher education. This will involve a change in the evaluation: traditional techniques are no longer consistent with the new curriculum models, if required a contribution to learning. The literature points to the portfolio as a tool for performance evaluation and stimulates learning. Its use in undergraduate medical education has not been explored extensively, finding little evidence of their specific application in dentistry. Materials and methods: It was decided its application in coincidence with the educational objectives of a course from the second year of the career of dentistry. The use of this tool, as a subject in the curriculum of the career of dentistry has the purpose that teachers and pupils get conscience about responsibility they must shake learning and teaching but giving value to the potentialities in the implementation of portfolio. It was done since meetings with teachers, interviews and surveys to the pupils. Results: student opinion surveys state that the portfolio significantly improved their learning and it was a good teaching tool, helping to reflect on their academic work. The teachers recognized the importance of space for student-centered approach, allowing analysis of its productions and its relation to the contents of the subject. Conclusions: After analyzing the results, it was demonstrated that portfolio is considered a tool that let enrich educational practices, creating new knowledge since pupils' constructions and teachers' participations


Assuntos
Humanos , Materiais Educativos e de Divulgação , Educação em Odontologia/métodos , Aprendizagem Baseada em Problemas/métodos , Estudantes de Odontologia/estatística & dados numéricos , Avaliação Educacional/métodos , Autoavaliação
13.
Rev. Fac. Odontol. (B.Aires) ; 28(64): 17-21, ene.-jun. 2013.
Artigo em Espanhol | LILACS | ID: lil-762470

RESUMO

Al cumplirse cien años del aún vigente “Informe Flexner” los educadores de las ciencias de la salud de todo el mundo generaron reflexiones y nuevas metas para las mismas. Son muchos los cambios producidos desde la presentación de Abraham Flexner en 1910 pero muy importantes son los ocurridos sobre el fin del siglo XX. La aparición de las tecnologías de la información y de la comunicación fueron precipitantes. Este ensayo pretende dar muestra de la evolución y alertar que esa combinación nos obliga a los docentes a estar informados y atentos a su influencia en el ámbito de la educación superior y entender que debemos estar dispuestos a cambios personales y a brindar una mayor colaboración para producir los cambios institucionales que nos permitan entregar a la sociedad mejores egresados.


To celebrate one hundred years of the still current "Flexner report" worldwide health science educators generated reflections and new goals for them. There have been many changes since the submission of Abraham Flexner in 1910 but more important are the ones which took place at the end of the 20th century. The emergence of information and communication technologies were swift. This essay is intended to alert that that combination forces us teachers to be informed and aware of its influence in the field of higher education and understand that we must be prepared to personal changes and to provide greater collaboration to produce the institutional enabling us to deliver better graduates to society.


Assuntos
Humanos , Avaliação Educacional , Educação em Odontologia/tendências , Educação Médica/tendências , Capacitação Profissional , América , Europa (Continente) , Faculdades de Odontologia , Modelos Educacionais , Odontologia , Estados Unidos
14.
Muscles Ligaments Tendons J ; 2(2): 104-7, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23738282

RESUMO

BACKGROUND AND PURPOSE: shock waves are defined as a sequence of single sonic pulses largely used in the treatment of bone and tendon diseases and recently on muscular hypertonia in stroke patients. Our purpose is to investigate the short and long term effect of extra-corporeal shock wave therapy (ESWT) on the peripheral nerve conduction and central conductions from the treated muscles in normal human subjects in order to define safety criteria. METHODS: we studied 10 patients normal subjects. Motor and sensory nerve conduction velocity and F response from right ipothenar eminence (abductor digiti minimi) of the hand was recorded. Furthermore MEP latency and amplitude and central conduction from the same muscles by transcranial magnetic stimulation was evaluated. In all subjects each neurophysiological measures were monitored before, immediately after, 15 minutes and after 30 minutes from the active ESWT treatment (1600 shots with an energy applied of 0.030 mj/mm(2)). RESULTS: no significant short or long term changes were noted in sensory and motor peripheral nerve conduction and in central motor conduction in all the subjects evaluated after ESWT. CONCLUSIONS: the ESWT has no effect on sensory and motor peripheral nerve conduction and in central motor conduction. The ESWT using low level of energy represent a safety method for treating the muscles in human subjects without involvement of motor or sensory nervous trunks. Different mechanisms of action of ESWT are discussed.

15.
Rev. estomatol. Hered ; 21(1): 20-23, ene.-mar. 2011.
Artigo em Espanhol | LILACS, LIPECS | ID: lil-644396

RESUMO

La enseñanza modular para el aprendizaje de la clínica intensiva ha probado ser un método de enseñanza excelente durante los últimos cuarenta años de actividades educativas en la Facultad de Estomatología de la Universidad Peruana CAYETANO HEREDIA, en Lima-Perú. Este artículo discute el proceso que se sigue para la planeación de la enseñanza modular. Cada función odontológica constituye un módulo de aprendizaje integral (Dominios: cognitivo, afectivo, psicomotor y volitivo). Aspectos importantes de la metodología son: enseñanza por equipo de profesores, participación activa del estudiante, práctica mínima en material inerte, demostración clínica y práctica inmediata en pacientes. La duración promedio de cada módulo es de doce horas en un plan continuo de actividades.


Modular teaching for intensive dental clinical learning has proved to be an excellent teaching model during the last forty years educating dental students at the Facultad de Estomatología of the Peruvian University CAYETANO HEREDIA, in Lima-Perú. This paper discusses the process to be followed for modular clinical teaching planning. Each integral module (Cognitive, affective, psychomotor and volitive domains), contains a dental function. Important features of this methodology are: teaching by teams of instructors, student active participation, minimum inert material practice, clinical demonstration by the instructors in patients, and immediate student clinical intervention in patients. The average duration for each module is of about twelve hours in a continuous plan of activities.


Assuntos
Aprendizagem Baseada em Problemas , Educação Baseada em Competências , Educação em Odontologia
16.
Rev. Asoc. Odontol. Argent ; 99(1): 25-30, ene.-mar. 2011.
Artigo em Espanhol | LILACS | ID: lil-601458

RESUMO

En la formación de los nuevos odontólogos lo hecho hasta hoy está siendo revisado, por no garantir la idoneidad deseable del egresado en términos de lo necesario para resolver su vida profesional inicial. Este ensayo tiene la intención de llevar al conocimiento de la comunidad odontológica distintas opiniones y diversos factores del ámbito de la educación superior que devienen en la creación de las tendencias actuales en educación médica que se aplicarán en las escuelas y facultades.


Assuntos
Educação de Pós-Graduação em Odontologia/tendências , Estudantes de Odontologia/psicologia , Competência Profissional , Avaliação Educacional , Serviços de Integração Docente-Assistencial
17.
Rheumatol Int ; 31(5): 651-6, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-20066427

RESUMO

Vasculopathy, immunological abnormalities, and excessive tissue fibrosis are key elements in the pathogenesis of progressive systemic sclerosis (SSc). Extracorporeal shock waves (ESW) have anti-inflammatory and regenerative effects on different tissues. We hypothesized that ESW can reduce endothelial cell damage and skin fibrosis in patients with SSc. We enrolled 30 patients affected by SSc, 29 females and 1 male. Rodnan Skin Score (RSS) and Visuo-Analogical Scale (VAS) for skin wellness were performed before and immediately after ESW therapy (ESWT) and at 7, 30, 60, and 90 days after the treatment. Sonographic examination of the patients' arms was performed before and 7, 30, 60, 90 days after treatment. Blood samples were obtained before and 30 and 60 days after treatment to measure serological levels of von Willebrand factor, vascular endothelial growth factor, intracellular adhesion molecule-1, monocyte chemotactic protein-1. The number of endothelial progenitor cells (EPCs) and circulating endothelial cells (CECs) were determined at the same time points. After ESWT we observed a rapid and persistent reduction of RSS and decrease of VAS. There was no difference in skin thickness before and after ESWT; however, we observed a more regular skin structure and an improvement in skin vascularization 90 days after treatment. EPCs and CECs increased 60 and 90 days after treatment, while serological biomarkers showed no variation before and after therapy. In conclusion, ESWT resulted in an improvement of VAS, RSS, and of skin vascular score, and in an increase of CECs and EPCs.


Assuntos
Ondas de Choque de Alta Energia/uso terapêutico , Esclerodermia Difusa/terapia , Pele/patologia , Terapia por Ultrassom/métodos , Adulto , Idoso , Biomarcadores/sangue , Quimiocina CCL2/sangue , Células Endoteliais/metabolismo , Células Endoteliais/patologia , Feminino , Fibrose , Humanos , Molécula 1 de Adesão Intercelular/sangue , Itália , Masculino , Pessoa de Meia-Idade , Óxido Nítrico/sangue , Projetos Piloto , Esclerodermia Difusa/sangue , Esclerodermia Difusa/patologia , Pele/irrigação sanguínea , Pele/diagnóstico por imagem , Células-Tronco/metabolismo , Células-Tronco/patologia , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler em Cores , Fator A de Crescimento do Endotélio Vascular/sangue , Fator de von Willebrand/metabolismo
19.
Plast Reconstr Surg ; 120(4): 935-46; discussion 947-51, 2007 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-17805122

RESUMO

BACKGROUND: The purpose of this study was to evaluate the seroma reduction capabilities of progressive tension sutures and compare them with the conventional use of drains. METHODS: Sixty female patients were randomized into four groups: group 1 (control, no drains, and no progressive tension sutures), group 2 (progressive tension sutures alone), group 3 (drains alone), and group 4 (progressive tension sutures and drains). All patients underwent a classic abdominoplasty and drains were left for 7 days in the corresponding groups. Clinical and ultrasound assessments were performed 2 weeks after the operation by blinded evaluators. Punctures, volumes, nonseroma complications, and aesthetic outcome were also measured. RESULTS: Surgical time was 50 minutes longer in groups 2 and 4. Drain outputs were higher in group 3 than in group 4. The clinical and ultrasound seroma frequency was 35 percent and 90 percent respectively, without significant differences among the groups. The control group was interrupted at 10 patients because of considerably larger seromas and an increased amount of punctures needed for treatment. No differences were found in the other groups. There were no differences with respect to complication rates and aesthetic outcome after follow-up. CONCLUSIONS: Progressive tension sutures increase surgical time, reduce drain outputs, and have the same clinical and ultrasound seroma frequency as the use of drains alone. The combination of both methods simultaneously does not add any advantages. However, complications and interventions increase if at least one of them is not used. The mechanism of action of progressive tension sutures could be the compartmentalization of the fluid collection under the flap facilitating absorption.


Assuntos
Parede Abdominal/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Seroma/prevenção & controle , Técnicas de Sutura/instrumentação , Adulto , Método Duplo-Cego , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Resistência à Tração , Resultado do Tratamento
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