Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.567
Facial Plast Surg Aesthet Med ; 22(6): 464-470, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33054375


Introduction: The objectives of this study among facial plastic and reconstructive surgeons (FPRS), include (1) quantifying the use of telemedicine, (2) examining the impact of novel coronavirus-19 (COVID-19) on telemedicine practices, (3) highlighting the types of telemedicine employed, (4) anticipating how telemedicine will be utilized in the future, and (5) describing FPRS' attitudes and understanding of telemedicine technologies. Study Type: Cross-sectional survey. Methods: A 6-13 question survey was sent to the American Academy of Facial Plastic and Reconstructive Surgery membership. Descriptive analyses were performed, along with a Fisher's exact test. Results: We received 100 responses from a diverse group of surgeons across the United States. Overall, 91% of responders utilize telemedicine, of which 76.9% began during the COVID-19 pandemic. 33.3% of responders thought that their platforms were not Health Insurance Portability and Accountability Act compliant or were unsure. Of those that utilize telemedicine, the two biggest concerns were difficulties with physical examination (69.2%) and lack of human connection (44%). 75.8% of telemedicine utilizers plan to incorporate telemedicine into their practice moving forward. Of all responders, 71% believed that telemedicine will have a positive effect on the field of FPRS, although on univariate analysis those in practice >20 years were more likely to believe that there will be no effect or a negative effect (p = 0.014). Conclusions: The COVID-19 pandemic has accelerated the adoption of telemedicine among FPRS in the United States. The great majority of responders plan to incorporate telemedicine into their practice even after the pandemic subsides and believe that telemedicine will have a net positive effect on the field of FPRS.

Atitude do Pessoal de Saúde , Infecções por Coronavirus , Pandemias , Assistência Perioperatória/tendências , Pneumonia Viral , Padrões de Prática Médica/tendências , Procedimentos Cirúrgicos Reconstrutivos , Cirurgia Plástica/tendências , Telemedicina/tendências , Estudos Transversais , Humanos , Assistência Perioperatória/métodos , Cirurgiões , Cirurgia Plástica/métodos , Inquéritos e Questionários , Telemedicina/métodos , Estados Unidos
Cir. plást. ibero-latinoam ; 46(3): 291-301, jul.-sept. 2020. ilus, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-196919


INTRODUCCIÓN Y OBJETIVO: El labio senescente se produce por cambios relacionados con el paso del tiempo a nivel de piel, tejido celular subcutáneo, músculo y hueso, con el resultado de elongación y pérdida de volumen del labio. Proponemos una clasificación clínica del labio senescente a fin de establecer el tratamiento quirúrgico del mismo según sus grados. MATERIAL Y MÉTODO: La investigación fue de tipo no experimental, descriptiva y prospectiva. Constó de 2 fases: la primera donde se recolectaron 180 pacientes a quienes se tomaron medidas clínicas del labio blanco, y la segunda con 20 pacientes clasificados según grado de ritidosis labial a los que se les aplicó el tratamiento correspondiente. Realizamos pruebas estadísticas tipo chi-cuadrado y Shapiro-Wilk para asociación y significancia estadística. RESULTADOS: Evidenciamos el inicio de la ritidosis labial a partir del grupo etario de 30 a 34 años y clasificamos la ritidosis labial en 4 grados. Aplicamos tratamiento quirúrgico modificado en "cuerno de toro". Identificamos complicaciones postoperatorias: hematoma, dehiscencia parcial y recidivas. El 100% de los pacientes mostraron alta satisfacción con los resultados. CONCLUSIONES: La clasificación propuesta permite establecer un tratamiento quirúrgico de la ritidosis labial seguro y efectivo, adaptado a las características anatómicas de cada paciente

BACKGROUND AND OBJECTIVE: The aged lip is produced by changes related to the passage of time at the level of skin, subcutaneous cellular tissue, muscle and bone, resulting in elongation and loss of volume of the lip. We propose a clinical classification of the senescent lip to establish its surgical treatment according to its grades. METHODS: We conduct a non-experimental, descriptive and prospective research in 2 phases: the first one with 180 patients taking the clinical measurements of the white lip, and a second one consisting on 20 patients who were classified according to the degree of labial rhytidosis and the corresponding treatment was applied. Statistical tests chi-square and Shapiro-Wilk were applied for association and statistical significance. RESULTS: It was evidenced the beginning of the labial rhytidosis from the age group of 30 to 34 years and it was possible to classify the labial rhytidosis in 4 grades. Modified surgical treatment was applied in "bull's horn". Postoperative complications were identified: hematoma, partial dehiscence and recurrences. All the patients reported high satisfaction with the results. CONCLUSIONS: The proposed classification allows to establish a safe and effective surgical treatment of labial rhytidosis, adapted to the anatomical characteristics of each patient

Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Lábio/cirurgia , Cirurgia Plástica/métodos , Técnicas Cosméticas , Ritidoplastia/métodos , Rejuvenescimento , Envelhecimento da Pele , Estudos Prospectivos , Cuidados Pós-Operatórios , Complicações Pós-Operatórias , Satisfação do Paciente , Estética , Procedimentos Cirúrgicos Reconstrutivos/métodos , Envelhecimento/fisiologia , Face/fisiologia
Plast Reconstr Surg ; 146(5): 680e-683e, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32732794


Telemedicine holds vast amounts of potential in changing the way outpatient plastic and reconstructive surgery is practiced. Before the coronavirus disease 2019 (COVID-19) pandemic, video conferencing was used by a small fraction of medical specialties. However, since the start of the pandemic, the Centers for Medicare and Medicaid Services and the largest private health insurance companies have relaxed regulations to allow the majority of specialties to use video conferencing in lieu of in-person visits. Most importantly, video conferencing minimizes patient and physician exposure in situations such as these, and decreases risk in the immunocompromised population. Video conferencing, which has been shown to be just as safe and efficacious in treating patients, offers the ability to follow up with physicians while saving travel time and travel-related expenses. This in turn correlates with increased patient satisfaction. Video conferencing also allows physicians to expand their reach to patients in rural areas seeking advanced professional advice. Incorporating video conferencing into existing practices will make for a more efficient practice, improve patient satisfaction, and decrease cost to patients and the health care system.

Procedimentos Cirúrgicos Ambulatórios , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Procedimentos Cirúrgicos Reconstrutivos , Cirurgia Plástica , Telemedicina/métodos , Comunicação por Videoconferência , Infecções por Coronavirus/prevenção & controle , Acesso aos Serviços de Saúde/organização & administração , Humanos , Pandemias/prevenção & controle , Satisfação do Paciente , Pneumonia Viral/prevenção & controle , Cirurgia Plástica/métodos , Cirurgia Plástica/organização & administração , Telemedicina/organização & administração , Estados Unidos , Comunicação por Videoconferência/organização & administração
PLoS One ; 15(8): e0237812, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32817716


Bhutan is one of the biological hotspots in the world where humans and natural flora and fauna co-exist in close proximity. Bhutan is home to two species of bears: Sloth Bear and Himalayan Black Bear. Human conflicts with bears are reported from all over the country. This study describes the profile of the victims and the pattern of injury resulting from bear attacks and circumstances around human conflicts with bears in Bhutan between 2015 and 2019. This was a cross-sectional study with a review of hospital records of patients treated at the National Referral Hospital from 01 January 2015 till 31 December 2019. Data were extracted into a structured pro forma and entered into EpiData Entry 3.1 and analysed in STATA 13.1. There were thirty-four patients who were provided care for bear maul injuries, with an average annual caseload of 6.8 cases per year. The injury prevalence was 100% and the kill prevalence was 0%. Bear attacks were reported from fourteen of twenty districts of the country. The mean age of the victims was 49 (±13) years. Males (26, 76%) and farmers (26, 76%) were the common victims; the risk of bear attacks was 0.16 per 100,000 farmers per year. The commonest region of the body attacked was the face (29, 85%) and victims were provided emergency and rehabilitative care within and outside the country. Thirty-three victims (97%) were provided post-exposure prophylaxis for rabies. All victims received antibiotics despite the lack of national guidelines on the choice of antibiotics post-bear maul. Human-bear conflict is multi-faceted, puts a considerable strain on bear-conservation efforts and requires multi-disciplinary efforts in the prevention of human injury and socioeconomic losses.

Agressão/fisiologia , Comportamento Animal/fisiologia , Mordeduras e Picadas/epidemiologia , Ursidae/fisiologia , Adolescente , Adulto , Agressão/psicologia , Animais , Animais Selvagens/psicologia , Animais Selvagens/virologia , Butão/epidemiologia , Mordeduras e Picadas/fisiopatologia , Mordeduras e Picadas/cirurgia , Mordeduras e Picadas/virologia , Orelha/lesões , Orelha/fisiopatologia , Orelha/cirurgia , Serviço Hospitalar de Emergência , Fazendeiros , Feminino , Florestas , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/fisiopatologia , Fraturas Ósseas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Raiva/epidemiologia , Raiva/patologia , Raiva/virologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Cirurgia Plástica/métodos , Ursidae/psicologia , Adulto Jovem
Plast Reconstr Surg ; 146(4): 482e-493e, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32639423


BACKGROUND: Coronavirus disease 2019 (COVID-19), known as the "coronavirus," has spread to over 170 countries. In response, many organizations have spoken out and called for cancellation of all elective surgical procedures. This study aimed to provide clear recommendations for plastic surgeons to follow by addressing the following issues: (1) What defines elective surgery, and where does one draw the line between essential versus nonessential services? (2) How does this differ in the hospital versus private practice setting? (3) If called on to operate on a patient with COVID-19, how do plastic surgeons protect themselves and still provide excellent medical care? METHODS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review of the literature on plastic surgery in the setting of a pandemic was performed on March 19, 2020. An ethical analysis was conducted using the four principles of medical ethics. RESULTS: The initial search yielded 118 articles. Eighteen articles were relevant and included for analysis. Only one editorial article was published in a plastic surgery journal. Accordingly, no peer-reviewed published COVID-19 guidelines exist for plastic surgery. Given that this pandemic may place health care systems under undue stress with an unpredictable trajectory, it is the responsibility of the plastic surgeon to assess and postpone cases whenever possible to properly contribute to adequate resource allocation and patient safety measures. CONCLUSIONS: This article fills an important gap in the literature by addressing COVID-19 and providing guidelines for upholding ethics and responsible resource allocation. By upholding these standards, plastic surgeons can do their part to help minimize the spread of this virus.

Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos/ética , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Cirurgia Plástica/ética , Cirurgia Plástica/métodos , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/prevenção & controle , Procedimentos Cirúrgicos Eletivos/métodos , Análise Ética , Feminino , Humanos , Controle de Infecções/organização & administração , Masculino , Pandemias/prevenção & controle , Segurança do Paciente , Pneumonia Viral/prevenção & controle , Guias de Prática Clínica como Assunto , Prognóstico , Medição de Risco
Aesthetic Plast Surg ; 44(5): 1926-1928, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32671446


The COVID-19 pandemic has had an unprecedented impact on the delivery of healthcare services around the globe. This has resulted in important loss of life for our communities, including health professionals that have been exposed to the disease in their workplace. A human factors approach to the recent changes introduced due to the pandemic can help identify how we can minimize the impact of human error in these circumstances. We hereby present a case study illustrating the application of human factors in the difficult times we are going through at present.Level of Evidence V 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 .

Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Erros Médicos/prevenção & controle , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Cirurgia Plástica/métodos , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Controle de Infecções/organização & administração , Masculino , Saúde do Trabalhador , Pandemias/prevenção & controle , Segurança do Paciente , Pneumonia Viral/prevenção & controle , Medição de Risco , Cirurgia Plástica/estatística & dados numéricos
Aesthetic Plast Surg ; 44(5): 1937-1939, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32500322


In this letter, we describe an attachment on conventional headbands recommended for the postoperative period in prominent ear patients to confidently wear surgical masks without disturbing the posterior auricular incision. LEVEL OF EVIDENCE V: 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 .

Vestuário , Infecções por Coronavirus/prevenção & controle , Pavilhão Auricular/cirurgia , Máscaras/efeitos adversos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Cirurgia Plástica/métodos , Infecções por Coronavirus/epidemiologia , Pavilhão Auricular/anormalidades , Feminino , Humanos , Masculino , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Cuidados Pós-Operatórios/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos
Plast Reconstr Surg ; 146(1): 91-103, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32590651


BACKGROUND: Host defense peptides are a family of endogenous short peptides that are found in all living beings and play a critical role in innate immunity against infection. METHODS: A nonsystematic review of host defense peptides was conducted with specific interest in properties and applications relevant to plastic and reconstructive surgery. RESULTS: In addition to their direct antimicrobial actions against pathogens, including multidrug-resistant bacteria, they also demonstrate important functions in immunomodulation, tumor cell lysis, and tissue regeneration. These properties have made them a topic of clinical interest for plastic surgeons because of their potential applications as novel antibiotics, wound healing medications, and cancer therapies. The rising clinical interest has led to a robust body of literature describing host defense peptides in great depth and breadth. Numerous mechanisms have been observed to explain their diverse functions, which rely on specific structural characteristics. However, these peptides remain mostly experimental, with limited translation to clinical practice because of numerous failures to achieve acceptable results in human trials. CONCLUSIONS: Despite the broad ranging potential of these peptides for use in the field of plastic and reconstructive surgery, they are rarely discussed in the literature or at scientific meetings. In this review, the authors provide a summary of the background, structure, function, bacterial resistance, and clinical applications of host defense peptides with the goal of stimulating host defense peptide-based innovation within the field of plastic and reconstructive surgery.

Peptídeos Catiônicos Antimicrobianos , Imunidade Inata/fisiologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Cirurgia Plástica/métodos , Anti-Infecciosos/química , Peptídeos Catiônicos Antimicrobianos/fisiologia , Peptídeos Catiônicos Antimicrobianos/uso terapêutico , Farmacorresistência Bacteriana/fisiologia , Humanos , Cicatrização/fisiologia
Plast Reconstr Surg ; 146(1): 157-170, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32590660


BACKGROUND: Since their introduction to clinical medicine in 1989, botulinum toxin injections have been used for many indications. First used for nonsurgical management of strabismus, botulinum toxin injections are now widely used in plastic and reconstructive surgery for aesthetic indications; however, nonaesthetic indications of botulinum toxin have grown tremendously over the past two decades and span numerous specialties, including urology, dermatology, ophthalmology, otolaryngology, gynecology, plastic surgery, general surgery, and neurology. The present review aims to highlight nonaesthetic indications of botulinum toxin that are most relevant to the plastic surgeon with an emphasis on evidence-based practice. METHODS: A PubMed search with manual reference checking was conducted to find the most relevant and influential articles on the nonaesthetic uses of botulinum toxin within the realm of adult plastic surgery. Studies were then categorized into areas of use, and quality of evidence for each category was highlighted. RESULTS: Botulinum toxin has numerous nonaesthetic indications in plastic surgery, including for select pain-related disorders, skeletal muscle activity disorders, exocrine gland hyperfunction, wound healing, Raynaud phenomenon, abdominal wall reconstruction, and prosthetic breast reconstruction and augmentation. Although these indications have been widely reported, high-quality evidence supporting efficacy, optimal dose, and injection protocol with randomized controlled trials is lacking in many areas. CONCLUSIONS: Botulinum toxin is widely used in plastic surgery for a variety of nonaesthetic indications. Future studies should focus on investigating efficacy and best practice with high level of evidence research.

Toxinas Botulínicas Tipo A/uso terapêutico , Fármacos Neuromusculares/uso terapêutico , Cirurgia Plástica , Humanos , Neuralgia/tratamento farmacológico , Manejo da Dor/métodos , Complicações Pós-Operatórias/tratamento farmacológico , Cirurgia Plástica/métodos
Rev. bras. cir. plást ; 35(2): 249-253, apr.-jun. 2020. ilus
Artigo em Inglês, Português | LILACS | ID: biblio-1103841


Introdução: Atualmente com o aumento das gastroplastias redutoras (cirurgia bariátrica) e grande perda ponderal, há também um aumento na procura destes pacientes pela cirurgia plástica. Uma das características destes pacientes é o excesso de tecido dermogorduroso que causa deformidades, principalmente nos membros inferiores, acometendo a região trocantérica. Objetivo: Relatar um caso de dermolipectomia trocantérica em paciente pós-cirurgia bariátrica, onde a lipoaspiração por si só não resolveria a correção da deformidade. Relato de caso: IPMS, sexo feminino, 55 anos, histórico de gastroplastia redutora (cirurgia bariátrica) com grande perda ponderal. Relata desconforto importante com a lipodistrofia e extensa flacidez em região trocantérica bilateral. Após avaliação pela equipe, foi optado por realizar dermolipectomia trocantérica bilateral, em janeiro de 2019, no Serviço de Cirurgia Plástica Osvaldo Saldanha. Discussão: Nos casos de lipodistrofia trocantérica com deformidades graves, a cicatriz da dermolipectomia em relação à deformidade é favorável quanto a escolha desta técnica, pois a lipoaspiração poderá agravar ainda mais a deformidade, sendo mandatório utilizar a técnica de dermolipectomia trocantérica para corrigila. Quanto à lipodistrofia com deformidade moderada há dúvida entre a relação do benefício e a deformidade resultante, sendo aplicada a técnica de acordo com a necessidade do paciente e, por fim, nos casos de lipodistrofia com deformidade leve, opta-se pela lipoaspiração devido à correção ser realizada sem grandes cicatrizes aparentes. Conclusão: Portanto, a lipoaspiração tem benefício nos casos de adiposidade localizada, limitando as indicações da técnica de dermolipectomia, em especial na região trocantérica, sem invalidá-la para casos selecionados, como o descrito neste relato de caso.

Introduction: Currently, with the increase in reducing gastroplasty (bariatric surgery) and the great weight loss, there is also an increase in the demand of these patients for plastic surgery. One of the characteristics of these patients is the excess of dermal adipose tissue that causes deformities, especially in the lower limbs, affecting the trochanteric region. Objective: To report a case of trochanteric dermolipectomy in a patient after bariatric surgery, where liposuction alone would not solve the correction of the deformity. Case report: IPMS, female, 55 years old, history of reducing gastroplasty (bariatric surgery) with great weight loss. She reports significant discomfort with lipodystrophy and extensive flacidity in the bilateral trochanteric region. After the team's evaluation, it was decided to perform bilateral trochanteric dermolipectomy, in January 2019, at the Plastic Surgery Service Osvaldo Saldanha Discussion: In cases of trochanteric lipodystrophy with severe deformities, the scar of dermolipectomy in relation to the deformity is favorable in terms of the choice of this technique, since liposuction may further aggravate the deformity, and it is mandatory to use the trochanteric dermolipectomy technique to correct it. Conclusion: Therefore, liposuction is beneficial in cases of localized adiposity, limiting the indications for the dermolipectomy technique, especially in the trochanteric region, without invalidating it for selected cases, as described in this case report.

Humanos , Feminino , Pessoa de Meia-Idade , História do Século XXI , Complicações Pós-Operatórias , Cirurgia Plástica , Obesidade Mórbida , Relatos de Casos , Cicatriz , Estudo de Avaliação , Extremidade Inferior , Cirurgia Bariátrica , Lipodistrofia/patologia , Complicações Pós-Operatórias/cirurgia , Cirurgia Plástica/efeitos adversos , Cirurgia Plástica/métodos , Obesidade Mórbida/cirurgia , Obesidade Mórbida/complicações , Obesidade Mórbida/patologia , Cicatriz/cirurgia , Extremidade Inferior/cirurgia , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Lipodistrofia , Lipodistrofia/cirurgia , Lipodistrofia/complicações
Cir. plást. ibero-latinoam ; 46(2): 177-186, abr.-jun. 2020. ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-194720


INTRODUCCIÓN Y OBJETIVO: La cicatriz queloide es uno de los problemas clínicos más frustrantes en la curación de heridas y un gran desafío para los médicos. Los diversos tratamientos (escisión parcial o total), inyección de drogas intralesionales, radioterapia, láser, silicona, prendas de lycra, entre otros, tienen un alto riesgo de recurrencia (10-45%). Los desafíos que enfrenta la comunidad dedicada a la rehabilitación incluyen la investigación del proceso de curación, los efectos de los diferentes factores involucrados en la cicatrización de heridas y el desarrollo de cicatrices, y la mejor combinación de intervenciones quirúrgicas, farmacológicas y terapéuticas para maximizar el resultado. La cirugía se puede realizar para tratar los queloides de dos maneras: primero, resección radical de los queloides y, en segundo lugar, reducción de la masa queloide. El objetivo que proponemos es mejorar las cicatrices hipertróficas y queloides mediante múltiples zetaplastias o con resección parcial más múltiples zetaplastias. MATERIAL Y MÉTODO: Realizamos un estudio prospectivo sobre un total de 335 cicatrices clasificadas según la escala de Vancouver entre febrero de 2013 y julio de 2018. Se intervinieron cicatrices lineales con zetaplastia múltiple teniendo en cuenta las líneas de menor tensión, tanto en cicatrices hipertróficas como en queloides extensos; si el tejido vecino lo permitía, la cicatriz se resecó parcialmente y se hizo zetaplastia múltiple; si el tejido vecino no permitía la resección, se seleccionaron algunas áreas para realizar la primera sesión de zetaplastia y en intervenciones posteriores se realizaron otras para poder intervenir en toda el área en función de las fuerzas de tensión. RESULTADOS: Revisamos un total de 335 cicatrices, 188 (56.1%) hipertróficas y 147 (43.9%) queloides, en pacientes entre 1 y 56 años, durante un promedio de 13 años. Cara y cuello 123 (37%), extremidades superiores 85 (25,3%), extremidades inferiores 63 (18,8%), tórax 53 (15,8%) y oreja 11 (3,3%) fueron las principales áreas tratadas. De las 123 fotografías intraopoeratorias revisadas, 4 (3%) tenían solo 1 zetaplastia, 3 (2.4%) tenían 2, 27 (21.9%) tenían 3 y 89 (72.3%) más de 4 zetaplastias múltiples (promedio de 6). Con los buenos resultados obtenidos, la cirugía también se realizó en cicatrices durante el proceso de maduración, 3 o 4 meses después de la qemadura. Setenta y ocho pacientes (23.2%) con seguimiento de 5 años no presentan recurrencia, ni 35 (10.4%) a los 4 años. CONCLUSIONES: La zetaplastia múltiple, con o sin resección parcial de cicatriz hipertófica o queloidea, puede realizarse en cicatrices activas inmaduras, rompiendo el paradigma de esperar hasta que la cicatriz esté madura o incluso cuando los tratamientos terapéuticos hayan fallado. La sutura continua con monofilamento es una contribución técnica que permite reducir el tiempo quirúrgico y facilita la extracción

BACKGROUND AND OBJECTIVE: The keloid scar is one of the most frustrating clinical problems in wound healing and a great challenge for doctors. The various treatments (partial or total excision), intralesional drug injection, radiotherapy, laser, silicone, lycra garments, among others, have a high risk of recurrence (10-45%). The challenges facing the rehabilitation community include the investigation of the healing process, the effects of the different factors involved in wound healing and the development of scars, and the best combination of surgical, pharmacological and therapeutic interventions to maximize the result. Surgery can be performed to treat keloids in two ways: first, radical resection of keloids and, secondly, reduction of keloid mass. Our general objective is to improve hypertrophic and keloid scars with multiple zetaplasties or with partial resection plus multiple zetaplasties. METHODS: A prospective study was conducted on 335 scars classified based on the Vancouver scale between February 2013 and July 2018. Linear scars were intervened with multiple zetaplasty taking into account the lines of least tension; in hypertrophic scars or extensive keoids, if the neighboring tissue allowed it, the scar was partially resected, and perform multiple zetaplasty; if the neighboring tissue did not allow resection, some areas were selected to perform the first zetaplasty session and in subsequent interventions the others were performed to be able to intervene the entire area based on the tension forces. RESULTS: A total of 335 scars, 188 (56.1%) hypetrophic and 147 (43.9%) keloyds, were treated in patients between 1 and 56 years, for an average of 13 years. Face and neck 123 (37%), upper extremities 85 (25.3%), lower extremities 63 (18.8%), thorax 53 (15.8%) and ear 11 (3.3%) were the main areas treated. Of 123 intraopoeratory photographs reviewed, 4 (3%) had only one zetaplasty, 3 (2.4%) had 2 zetaplasties, 27 (21.9%) had 3 zetaplasties and 89 (72.3%) had more than 4 multiple zetaplasties (with one average of 6). With the good results obtained, surgery was also performed on patients with scars during the maturation process as soon as 3 or 4 months post burn. Seventy eight patients (23.2%) who have 5-year follow-up do not present recurrence nor 35 (10.4%) at 4 years. CONCLUSIONS: Multiple zetaplasty, with or without partial resection of hypertorphic scar o keloyd, can be performed on immature active scars, breaking the paradigm of waiting until the scar is mature or even when therapeutic treatments have failed. The continuous suture with monofilament is a technical contribution that allows to reduce surgical time and facilitates the removal of the stitches

Humanos , Pré-Escolar , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Cicatriz Hipertrófica/cirurgia , Queloide/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Técnicas de Sutura/instrumentação , Estudos Prospectivos , Queimaduras/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/classificação , Cirurgia Plástica/métodos
Aesthetic Plast Surg ; 44(3): 1014-1042, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32410196


BACKGROUND: The worldwide spread of a novel coronavirus disease (COVID-19) has led to a near total stop of non-urgent, elective surgeries across all specialties in most affected countries. In the field of aesthetic surgery, the self-imposed moratorium for all aesthetic surgery procedures recommended by most international scientific societies has been adopted by many surgeons worldwide and resulted in a huge socioeconomic impact for most private practices and clinics. An important question still unanswered in most countries is when and how should elective/aesthetic procedures be scheduled again and what kind of organizational changes are necessary to protect patients and healthcare workers when clinics and practices reopen. Defining manageable, evidence-based protocols for testing, surgical/procedural risk mitigation and clinical flow management/contamination management will be paramount for the safety of non-urgent surgical procedures. METHODS: We conducted a MEDLINE/PubMed research for all available publications on COVID-19 and surgery and COVID-19 and anesthesia. Articles and referenced literature describing possible procedural impact factors leading to exacerbation of the clinical evolution of COVID-19-positive patients were identified to perform risk stratification for elective surgery. Based on these impact factors, considerations for patient selection, choice of procedural complexity, duration of procedure, type of anesthesia, etc., are discussed in this article and translated into algorithms for surgical/anesthesia risk management and clinical management. Current recommendations and published protocols on contamination control, avoidance of cross-contamination and procedural patient flow are reviewed. A COVID-19 testing guideline protocol for patients planning to undergo elective aesthetic surgery is presented and recommendations are made regarding adaptation of current patient information/informed consent forms and patient health questionnaires. CONCLUSION: The COVID-19 crisis has led to unprecedented challenges in the acute management of the crisis, and the wave only recently seems to flatten out in some countries. The adaptation of surgical and procedural steps for a risk-minimizing management of potential COVID-19-positive patients seeking to undergo elective aesthetic procedures in the wake of that wave will present the next big challenge for the aesthetic surgery community. We propose a clinical algorithm to enhance patient safety in elective surgery in the context of COVID-19 and to minimize cross-contamination between healthcare workers and patients. New evidence-based guidelines regarding surgical risk stratification, testing, and clinical flow management/contamination management are proposed. We believe that only the continuous development and broad implementation of guidelines like the ones proposed in this paper will allow an early reintegration of all aesthetic procedures into the scope of surgical care currently performed and to prepare the elective surgical specialties better for a possible second wave of the pandemic. LEVEL OF EVIDENCE V: 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

Infecções por Coronavirus/prevenção & controle , Procedimentos Cirúrgicos Eletivos/métodos , Controle de Infecções/métodos , Pandemias/prevenção & controle , Segurança do Paciente , Pneumonia Viral/prevenção & controle , Cirurgia Plástica/métodos , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Técnicas de Laboratório Clínico/métodos , Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Gerenciamento Clínico , Estudos de Viabilidade , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Saúde do Trabalhador , Equipamento de Proteção Individual/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Cuidados Pós-Operatórios/métodos , Cuidados Pré-Operatórios/métodos , Fatores Sexuais