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1.
Rev. bras. cir. plást ; 34(4): 468-476, oct.-dec. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-1047904

RESUMO

Introdução: A lipoaspiração corporal e abdominoplastia são cirurgias muitas vezes realizadas em conjunto para obter melhores resultados na modelagem corporal. Cirurgias associadas sempre aumentam a espoliação, por isto conhecer o comportamento da hemoglobina (Hb) no pós-operatório e a recuperação do paciente submetido a estas cirurgias combinadas é importante para sua segurança. O objetivo deste trabalho foi estudar a queda da Hb e a recuperação clínica e laboratorial dos pacientes submetidos à cirurgia combinada de lipoaspiração corporal e lipoabdominoplastia. Métodos: Realizou-se um estudo prospectivo em pacientes submetidos à lipoaspiração corporal e lipoabdominoplastia, coletando-se hemogramas antes da indução anestésica, ao final da cirurgia, antes da alta hospitalar, após a 1ª, 2ª e 4ª semanas de pós-operatórios e também acompanhando suas evoluções clínicas. Resultados: A média da Hb ao final da cirurgia e na alta hospitalar foi de 10,4g/dl (desvio padrão (DP) 0,76) e 8,92g/dl (DP 0,86), respectivamente. A recuperação em média da Hb após 1ª, 2ª e 4ª semanas foi de 2,4% (DP 18,07), 41,6% (DP 18,4) e 74% (DP 15,2), respectivamente, em relação a redução que ocorreu entre a Hb inicial e a da alta hospitalar. Queixas de fraqueza e lipotimia foram frequentes até o segundo dia. Conclusão: A melhora clínica ocorreu até o segundo dia de pós-operatório (DPO) e a hemoglobina levou aproximadamente 1 mês para normalizar na maioria dos pacientes tratados apenas com reposição oral de ferro, sem necessidade de hemotransfusão.


Introduction: Body liposuction and abdominoplasty are surgeries often performed together to obtain superior results in body modeling. Since associated surgeries often increase spoliation, being aware of the evolution of hemoglobin (Hb) in the postoperative period and during the recovery of the patients undergoing these associated surgeries is important for their safety. This study aimed to analyze the decrease in Hb and the clinical and laboratory results throughout the recovery of patients undergoing body liposuction associated with lipoabdominoplasty. Methods: A prospective study was conducted with patients undergoing body liposuction and lipoabdominoplasty. CBCs were collected before anesthetic induction, at the end of the surgery, before hospital discharge, after the 1st, 2nd, and 4th postoperative weeks, and during their clinical follow-up period. Results: The average Hb values at the end of surgery and hospital discharge were 10.4 g/dL (standard deviation (SD) 0.76) and 8.92 g/dL (SD 0.86), respectively. The average values during the recovery of Hb after the 1st, 2nd, and 4th weeks were 2.4% (SD 18.07), 41.6% (SD 18.4), and 74% (SD 15.2), respectively. This is in relation to the reduction between the initial Hb and at hospital discharge. Complaints of weakness and lipothymia were frequent until the second day. Conclusion: Clinical improvement was observed until the second postoperative day (PO day). Hemoglobin required approximately 1 month to normalize in most patients. These patients were treated only with oral iron replacement and did not require blood transfusions.


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , História do Século XXI , Pacientes , Complicações Pós-Operatórias , Pesquisa , Cirurgia Plástica , Lipectomia , Evolução Clínica , Estudos Prospectivos , Abdome , Contorno Corporal , Anemia , Complicações Pós-Operatórias/sangue , Pesquisa/normas , Cirurgia Plástica/métodos , Lipectomia/efeitos adversos , Lipectomia/métodos , Evolução Clínica/métodos , Contorno Corporal/efeitos adversos , Contorno Corporal/métodos , Abdome/cirurgia , Anemia/complicações
2.
Cir. plást. ibero-latinoam ; 45(4): 355-360, oct.-dic. 2019. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-186019

RESUMO

Presentamos el caso de una paciente de 32 años que desarrolló ceguera legal posterior a liposucción y mamoplastia de aumento, evolucionando con anemia transitoria y disminución progresiva de la agudeza visual del ojo izquierdo (20/200). A pesar de la corrección de la anemia y la mejoría del estado general, continuó durante 2 meses con sintomatología ocular. Se estableció diagnóstico de neuropatía óptica isquémica anterior no arterítica (NOIA) de acuerdo con los hallazgos oftalmológicos. Revisamos las publicaciones previas para neuritis óptica isquémica anterior después de liposucción y las recomendaciones para prevenir dicha patología


We present the case of a 32-year-old woman who developed legal blindness posterior to liposuction and augmentation mammoplasty, with postoperative anemia and decreased vision of the left eye (20/200). Despite the correction of the anemia and improvement of the general status, the patient continued with vision loss for 2 months. According to ophthalmologic studies we could establish the diagnosis of non-arteritic ischemic optic neuropathy (NAION). We review the previous reports in the literature for anterior ischemic optic neuritis after liposuction and the recommendations to prevent this complicatio


Assuntos
Humanos , Feminino , Adulto , Neuropatia Óptica Isquêmica/complicações , Neuropatia Óptica Isquêmica/diagnóstico por imagem , Lipectomia/efeitos adversos , Mamoplastia/efeitos adversos , Acuidade Visual , Cegueira/complicações , Neuropatia Óptica Isquêmica/prevenção & controle , Seroma/prevenção & controle , Derrame Pleural/diagnóstico por imagem , Prednisona/uso terapêutico
3.
Cir Cir ; 87(S1): 8-16, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31501623

RESUMO

Background: Procedures to remove adiposities and skin, such as dermolipectomy, can develop wounds that are difficult to heal by conventional therapies. Mesenchymal stem cells are indicated as potential candidates for regenerative therapy in wounds, due to their multipotentiality, low immunogenicity, modulating capacity of inflammation and tissue modeling processes. Case report: Patient with dehiscent chronic ulcer secondary to dermolipectomy, who received cutaneous treatment with mesenchymal stem cells. The therapy induced scar formation and neovascularization, as well as the decrease of infiltrated leukocytes and proinflammatory cytokines. Mesenchymal cells are proposed as an interesting alternative for the treatment of postoperative lesions.


Assuntos
Contorno Corporal/efeitos adversos , Lipectomia/efeitos adversos , Transplante de Células-Tronco Mesenquimais , Medicina Regenerativa/métodos , Úlcera Cutânea/terapia , Deiscência da Ferida Operatória/terapia , Geleia de Wharton/citologia , Adipogenia , Adulto , Antígenos de Superfície/biossíntese , Antígenos de Superfície/genética , Separação Celular , Doença Crônica , Cicatriz/etiologia , Feminino , Expressão Gênica , Humanos , Inflamação , Células-Tronco Mesenquimais , Neovascularização Fisiológica , Osteogênese , Úlcera Cutânea/etiologia , Deiscência da Ferida Operatória/etiologia , Cicatrização
4.
Rev. bras. cir. plást ; 34(3): 336-343, jul.-sep. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-1047149

RESUMO

Introdução: A lipoaspiração de definição abdominal consiste na criação de sulcos em locais específicos do abdome através da retirada de gordura em toda sua espessura, incluindo a camada superficial, permitindo um maior detalhamento da musculatura. O objetivo deste estudo foi avaliar os resultados da técnica de lipoaspiração na definição abdominal. Métodos: Foram avaliadas 80 pacientes do sexo feminino no período de 2017 a 2018. O grau de definição e as complicações relacionadas ao procedimento foram avaliadas pelo autor. Todas as pacientes responderam um questionário padrão sobre grau de definição abdominal, satisfação, naturalidade do resultado, aumento da atividade física e melhora da alimentação. Resultados: A média de idade das pacientes foi de 38,97 anos e a média de índice de massa corporal, 24,01. Gestação prévia foi observada em 75% dos casos, cirurgia abdominal pregressa em 25% e tabagismo em 2,5%. Cirurgias simultâneas foram realizadas em 90%. Em relação ao tipo de cirurgia realizada, ocorreu a seguinte distribuição: 40% lipoaspiração isolada, 36,25% lipoabdominoplastia, 12,5% minilipoabdominoplastia, 10% lipoaspiração pós-abdominoplastia e 1,25% lipoabdominoplastia reversa. Grau 2 de definição abdominal foi observado em 86,25% e complicações ocorreram em 8 pacientes. O índice de satisfação foi de 91,7% e o resultado foi classificado como natural por 97,5% das pacientes. Conclusão: A lipoaspiração de definição abdominal promoveu um alto índice de satisfação e naturalidade à região abdominal. Esse resultado pode ser atingido através da técnica de lipoaspiração convencional, sem nenhum dispositivo tecnológico adicional. Contudo, são necessários novos estudos para avaliação dos resultados em longo prazo.


Introduction: Abdominal etching involves improvement of the appearance of the abdominal musculature by removing fat from several skin layers, including the superficial layer. This study evaluated the aesthetic results of abdominal etching using liposuction. Methods: The aesthetic results and surgical complications of female patients were evaluated between 2017 and 2018. All study patients answered a standard questionnaire about the extent of improvement in body image, overall satisfaction level, naturalness of the result, and changes in exercise and dietary habits. Results: The mean patient age was 38.97 years, while the mean body mass index was 24.01. In our sample, 75% of the subjects had previous pregnancies, 25% had previous abdominal surgeries, and 2.5% had a history of smoking. Simultaneous surgeries were performed in 90% of cases. The following surgery types were performed: liposuction alone (40.00%), liposuction + abdominoplasty (36.25%), miniabdominoplasty (12.50%), abdominoplasty + liposuction (10.00%), and reverse abdominoplasty (1.25%). Moderate aesthetic improvement was observed in 86.25% of the patients, and surgical complications occurred in eight patients. The satisfaction rate was 91.7%, and the result was classified as natural by 97.5% of the patients. Conclusion: Abdominal etching promoted high patient satisfaction and achieved a natural appearance of the abdomen. This surgical outcome was achieved using conventional liposuction without the need for additional techniques. However, further studies are needed to evaluate long-term outcomes.


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , História do Século XXI , Lipectomia , Satisfação do Paciente , Procedimentos Cirúrgicos Reconstrutivos , Gordura Subcutânea , Estética , Abdominoplastia , Contorno Corporal , Lipectomia/efeitos adversos , Lipectomia/métodos , Satisfação do Paciente/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Gordura Subcutânea/cirurgia , Estética/psicologia , Abdominoplastia/efeitos adversos , Abdominoplastia/métodos , Contorno Corporal/efeitos adversos , Contorno Corporal/métodos
5.
Rev. bras. cir. plást ; 34(3): 428-433, jul.-sep. 2019. ilus
Artigo em Inglês, Português | LILACS | ID: biblio-1047174

RESUMO

Introdução: A evolução da abdominoplastia se mantém constante desde 1899. Atualmente, com o avanço das técnicas de lipoaspiração, o conceito de lipoaspiração de alta definição tem como objetivo de corrigir estigmas causados pelo procedimento, como o aspecto "tenso" e a falta de convexidades e concavidades naturais abdominais. Métodos: Apresentamos uma proposta de busca da redefinição natural do abdome, através da lipoabdominoplastia tradicional com lipoaspiração seletiva, procurando obter resultados cirúrgicos com padrão natural, reproduzível para a maioria dos pacientes. Foram realizadas 21 abdominoplastias, entre novembro de 2018 e maio de 2019, utilizando a técnica descrita. Resultados: A técnica demonstrada apresentou resultados estéticos satisfatórios em obter a aparência abdominal natural através da lipoaspiração profunda e superficial, em áreas de sombras abdominais. Conclusão: O trabalho demonstrou-se seguro sob o ponto de vista vascular, além de ser reprodutível ao passo que utiliza lipoaspiração convencional, utilizada pela ampla maioria dos cirurgiões plásticos.


Introduction: Abdominoplasty techniques have constantly evolved since 1899. With modern liposuction techniques, the concept of high-definition liposuction aims to correct stigmas secondary to the procedure, such as a "tense" appearance and lack of natural abdominal convexity and concavity. Methods: Here we propose a technique to redefine the natural abdominal anatomy using traditional lipoabdominoplasty with selective liposuction to achieve more natural-looking surgical results that are reproducible for most patients. This study included 21 abdominoplasty procedures using the described technique performed between November 2018 and May 2019. The technique showed satisfactory ability to achieve a natural abdominal appearance using deep and superficial liposuction in abdominal shadow areas. Conclusion: The study showed that the technique is safe from a vascular point of view and reproducible due to the use of conventional liposuction, which is available to the vast majority of plastic surgeons.


Assuntos
Humanos , Feminino , Adulto , História do Século XXI , Pacientes , Lipectomia , Lipectomia/métodos , Reto do Abdome , Procedimentos Cirúrgicos Reconstrutivos , Estética , Lipectomia/efeitos adversos , Reto do Abdome/cirurgia , Reto do Abdome/fisiopatologia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Abdominoplastia/efeitos adversos , Abdominoplastia/métodos , Abdome/cirurgia
6.
Andrologia ; 51(9): e13351, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31264245

RESUMO

Until now, no reliable method is recognised in treating buried penis. This study explored a new method of penile length augmentation using acellular dermal matrix filler in infrapubic space combined with liposuction and penile suspensory release. Patients with "small-sized penis" received penile length augmentation procedure including suprapubic liposuction, penile suspensory ligament release and insertion of folded acellular dermal matrix between corpora cavernosa and pubis symphysis. Their penile length from tip to skin was measured pre-operatively and post-operatively. The post-operative complications and patients' satisfaction were also recorded. Fifteen adult male patients were included with the mean age of 33.2 ± 4.6 years old and BMI of 28.9 ± 5.3 kg/m2 . The average amount of liposuction was 430 ± 90.0 ml. The average penile length measured pre-operatively and post-operatively (on table and 3 months afterwards) was 3.0 ± 1.3 cm, 7.3 ± 2.1 cm and 5.4 ± 1.8 cm. The penile length has significantly increased by 4.3 ± 1.6 cm (on table) and 2.4 ± 0.8 cm (3 months post-operatively; p < 0.05). The post-operative complications included oedema of penis, ecchymosis of lower abdomen and poor wound healing. No patient was dissatisfied with the appearance and function. The new method using acellular dermal matrix combined with liposuction and penile suspensory ligament release is safe and effective. The method could be applied to selected patients with buried penis.


Assuntos
Derme Acelular , Preenchedores Dérmicos/uso terapêutico , Lipectomia/métodos , Doenças do Pênis/cirurgia , Pênis/cirurgia , Procedimentos Cirúrgicos Urológicos Masculinos/métodos , Adulto , Estudos de Viabilidade , Humanos , Ligamentos/cirurgia , Lipectomia/efeitos adversos , Masculino , Obesidade/complicações , Obesidade/terapia , Tamanho do Órgão , Satisfação do Paciente , Seleção de Pacientes , Doenças do Pênis/etiologia , Doenças do Pênis/patologia , Pênis/patologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/efeitos adversos
7.
Surgery ; 166(5): 934-939, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31248653

RESUMO

BACKGROUND: Gynecomastia is the most common benign enlargement of the mammary gland and adipose tissue in males. Because a feminine-looking chest contour can bring severe psychologic burden to patients, subcutaneous mastectomy has become the standard treatment for this condition. Conventional open surgery causes conspicuous scarring that may affect the appearance of the breast. We provide a novel surgical operative for the treatment of gynecomastia. METHOD: With approval from our institutional ethics committee and written informed consent, 22 patients with 33 abnormally hyperplastic breasts were enrolled at The First Affiliated Hospital with Nanjing Medical University between June 2016 and September 2018. Vacuum-assisted minimally invasive surgery was performed under general anesthesia. Patients were followed up with physical examination and ultrasonography. RESULT: Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on ultrasonography. The operation had a mean duration of 73.5 minutes per side, ranging from 40 to 102 minutes. An average of 320 specimens were excised from each side with mean blood loss of 34 mL. Of these 33 operative sides, 2 complications occurred, but satisfactory chest contour was attained eventually in all patients. All patients were satisfied with their cosmetic outcome, graded as excellent by 22 patients (100%). Redundant skin was observed in 1 patient at 1 month postoperatively, whose breast, defined as graded III, was the largest before operation. CONCLUSION: Vacuum-assisted, minimally invasive mastectomy is a feasible approach for the treatment of gynecomastia with acceptable complications.


Assuntos
Ginecomastia/cirurgia , Lipectomia/métodos , Mastectomia Subcutânea/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Mama/diagnóstico por imagem , Mama/cirurgia , Estética , Estudos de Viabilidade , Seguimentos , Ginecomastia/psicologia , Humanos , Lipectomia/efeitos adversos , Lipectomia/instrumentação , Masculino , Mastectomia Subcutânea/efeitos adversos , Mastectomia Subcutânea/instrumentação , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Satisfação do Paciente , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento , Ultrassonografia , Vácuo , Adulto Jovem
8.
Rev. bras. cir. plást ; 34(1): 15-22, jan.-mar. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-994537

RESUMO

Introdução: Abdominoplastia é um dos procedimentos cirúrgicos estéticos mais realizados. Seroma é a complicação local mais comum associada com abdominoplastia, com uma incidência média de 10%. A maior incidência de seroma pós-operatório (PO) ocorre no décimo primeiro dia PO. Ecografia abdominal é o método de escolha para o diagnóstico de seroma após abdominoplastia. Novas técnicas surgiram ao longo dos anos na tentativa de trazer melhores resultados estéticos com menos complicações, como lipoabdominoplastia descrita por Saldanha. Porém, estudos anatômicos recentes questionam a necessidade da manutenção da fáscia de Scarpa descrita na técnica de lipoabdominoplastia, descrevendo que em torno de 90% do sistema linfático abdominal está no plano subdérmico e 10% em um sistema linfático profundo justa-aponeurose abdominal. O objetivo é comparar a incidência de seroma na lipoabdominoplastia sem preservação da fáscia de Scarpa com a abdominoplastia clássica. Métodos: Coorte prospectiva, cega na qual serão analisados 40 pacientes consecutivos que realizaram abdominoplastia sem lipoaspiração associada (n = 20) ou lipoabdominoplastia (n = 20) no Hospital de Clínicas de Porto Alegre entre abril de 2016 e maio de 2017. Todos foram submetidos à ecografia de parede abdominal no 10o dia PO. Resultados: A incidência de seroma foi de 5% (n = 1) no grupo de abdominoplastia clássica e de 10% (n = 2) no grupo de lipoabdominoplastia, sem diferença estatística. Conclusão: Estes resultados, neste grupo de pacientes, mostram que não houve diferença estatística entre os dois grupos.


Introduction: Abdominoplasty is among the most commonly performed surgical procedures. Seroma is the most common local complication associated with abdominoplasty, with an average incidence of 10%. The highest incidence of postoperative (PO) seroma occurs on the eleventh postoperative day (POD). Abdominal ultrasound is the method of choice for diagnosing seroma after abdominoplasty. New techniques have emerged aiming to improve aesthetic results with fewer complications, such as lipoabdominoplasty described by Saldanha. However, recent anatomical studies have questioned the need for Scarpa fascia preservation recommended in the lipoabdominoplasty technique, describing that around 90% of the abdominal lymphatic system is in the subdermal plane, while the other 10% is in a deep lymphatic system near the abdominal aponeurosis. The objective is to compare the incidence of seroma in lipoabdominoplasty without Scarpa fascia preservation to that in classic abdominoplasty. Methods: Prospective blinded cohort in which 40 consecutive patients who underwent abdominoplasty without associated liposuction (n = 20) or lipoabdominoplasty (n = 20) at the Hospital de Clínicas of Porto Alegre between April 2016 and May 2017 were analyzed. All patients underwent abdominal wall ultrasonography on the tenth POD. Results: The incidence of seroma was 5% (n = 1) in the classic abdominoplasty group and 10% (n = 2) in the lipoabdominoplasty group, with no statistical difference. Conclusion: These results showed no statistically significant intergroup difference in seroma development.


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Lipectomia/efeitos adversos , Lipectomia/métodos , Ultrassonografia/efeitos adversos , Ultrassonografia/métodos , Seroma/cirurgia , Seroma/complicações , Abdominoplastia/efeitos adversos , Abdominoplastia/métodos , Contorno Corporal/efeitos adversos , Contorno Corporal/métodos , Lipodistrofia/complicações , Lipodistrofia/metabolismo
9.
Dermatol Ther ; 32(2): e12820, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30638291

RESUMO

Lipedema is a painful disease of subcutaneous adipose tissue leading to bilateral increase of leg and/or arm volume, but sparing hands and feet. Although conservative treatment with complex decongestive therapy has been considered as the fundamental treatment, micro-cannular liposuction in tumescent anesthesia has become a surgical option. We report on 111 patients mostly with advanced lipedema treated by this technique in our center between 2007 and 2018. The median age of the patients was 44 years. Eighty percent of patients had at least one comorbidity. There was an association of longstanding and advanced disease to obesity and diseases of the metabolic syndrome-spectrum. The median total amount of lipoaspirate was 4,700 ml, with a range of 950-14,250 ml. The median reduction of limb circumference was 6 cm. The median pain level before treatment was 7.8 and 2.2 at the end of the treatment. An improvement of mobility could be achieved in all patients. Bruising was also reduced. Serious adverse events were observed in 1.2% of procedures, the infection rate was 0% and the bleeding rate was 0.3%. Liposuction is an effective treatment for painful lipedema. The procedure should be performed in specialized centers.


Assuntos
Anestesia/métodos , Lipectomia/métodos , Lipedema/terapia , Dor/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Lipectomia/efeitos adversos , Síndrome Metabólica/epidemiologia , Pessoa de Meia-Idade , Obesidade/epidemiologia , Resultado do Tratamento , Adulto Jovem
10.
J Surg Res ; 236: 51-59, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30694779

RESUMO

BACKGROUND: Having posthospital syndrome (PHS) at the time of an elective surgery increases the risk of postoperative adverse outcomes. The purpose of this article was to identify incidence and risk factors for having PHS at the time of abdominal contouring surgeries. METHODS: Insurance claims from the Truven MarketScan Databases were used to identify patients who underwent outpatient abdominoplasty, liposuction, or panniculectomy between April 2010 and August 2015. Patients were presumed to have PHS if they were hospitalized within 90 d before surgery. Incidence rates of having PHS were calculated for patient groups defined by demographic data and comorbidities. Statistical inference based on adjusted odds ratios was used to evaluate the association of potential risk factors with PHS. A nonparametric regression method was used to demonstrate nonlinear effects of patient covariates on the risk of PHS. RESULTS: This study included 18,947 patients who underwent abdominal contouring; 77% were female, and the mean age was 48.7 y (SD = 14.7). Six percent (n = 1045) of patients had PHS at the time of surgery. A significantly stronger association with PHS (P < 0.001) was observed in patients with deep venous thrombosis (adjusted odds ratio = 3.56), Elixhauser score > 8 (3.28), and smokers (2.16). Age was found to have a piecewise linear effect on PHS, with odds increasing by 2.1% per year over the age of 45 y. CONCLUSIONS: Older patients have an increased risk of undergoing abdominal contouring surgery in a deconditioned state. Screening at-risk populations for PHS would help identify patients who need rehabilitation before operative intervention.


Assuntos
Abdominoplastia/efeitos adversos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Hospitalização/estatística & dados numéricos , Lipectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adulto , Fatores Etários , Idoso , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Razão de Chances , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Fatores de Risco
12.
J Invest Surg ; 32(3): 228-231, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29286843

RESUMO

INTRODUCTION: Liposuction is one of the most popular plastic surgery procedures. As in any surgery, there are risks and complications, especially when combined with fat injection. Case reports of fat embolism have been reported. A possible explanation is the puncture and tearing of gluteal vessels during the procedure, especially when a deep injection is planned. OBJECTIVE: To identify the places where fat can be located after injection during a fat graft in the gluteus. METHODS: An experimental study was done in which colorant was injected in four directions using four different quadrants of the gluteus. We Injected 10 cc six times following clock hands until 60 cc were injected, and the cutaneous flap and the muscles were then elevated. Our main purpose was to describe where the colorant went and if it was in contact with the vessels (superior and inferior gluteal vessels). In total, four gluteus muscles were injected and dissected. RESULTS: Injection in the lower lateral quadrant was mainly into the muscle, and colorant was observed in the hypogastric vessels. The injection in the upper quadrants stayed mainly in the subcutaneous tissue. CONCLUSIONS: During surgery, it is important to identify the location of the perforators and to avoid a deep injection, especially from the lower lateral quadrant to the superior medial quadrant (Q4 to Q1), as the probability of puncturing and injecting fat into the main vessels from this direction is higher.


Assuntos
Tecido Adiposo/transplante , Contorno Corporal/efeitos adversos , Embolia Gordurosa/prevenção & controle , Lipectomia/efeitos adversos , Contorno Corporal/métodos , Nádegas/irrigação sanguínea , Nádegas/cirurgia , Cadáver , Corantes/administração & dosagem , Dissecação , Humanos , Injeções Subcutâneas/efeitos adversos , Injeções Subcutâneas/métodos , Lipectomia/métodos
13.
Obes Surg ; 29(2): 426-433, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30238217

RESUMO

BACKGROUND: Widespread adoption of bariatric surgery in the treatment of obesity has led to greater numbers of patients seeking panniculectomy, including aged patients, who represent a rapidly growing proportion of the U.S population. Although the quality of life and functional benefits of abdominal panniculectomy have been established, its safety in patients 65 years and older has not been evaluated. METHODS: The American College of Surgeons National Surgical Quality Improvements (ACS-NSQIP) database was used to identify patients undergoing panniculectomy between 2010 and 2015. Age 65 years and older was the risk factor of interest, and primary outcomes included 30-day wound complications, overall complications, reoperation, readmission, and mortality. Multivariate regression was performed to control for confounders. RESULTS: Review of the database identified 7030 patients who underwent abdominal panniculectomy. When stratified by age, 6455 (91.8%) of patients were younger than 65, and 575 (8.2%) were 65 or older. Multivariate regression analysis demonstrated that age over 65 was a significant independent risk factor for wound complications (OR = 1.81; 95% CI 1.35-2.42; p < 0.001) and all complications (OR = 1.46; 95% CI 1.15-1.87; p = 0.002). BMI, smoking, diabetes, and partial or total dependence were also identified as significant independent risk factors for wound and all complications. CONCLUSION: Our analysis demonstrates that advanced age is an independent risk factor for wound and overall complications following abdominal panniculectomy. These results highlight the importance of preoperative evaluation and optimization of modifiable preoperative risk factors as well as close postoperative follow-up for safe outcomes in patients 65 and older.


Assuntos
Abdominoplastia/efeitos adversos , Lipectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Abdominoplastia/métodos , Abdominoplastia/mortalidade , Abdominoplastia/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/mortalidade , Cirurgia Bariátrica/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Mortalidade Hospitalar , Humanos , Lipectomia/métodos , Lipectomia/mortalidade , Lipectomia/estatística & dados numéricos , Masculino , Obesidade Mórbida/epidemiologia , Obesidade Mórbida/cirurgia , Readmissão do Paciente/estatística & dados numéricos , Qualidade de Vida , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco
14.
J Plast Reconstr Aesthet Surg ; 72(1): 43-51, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30291050

RESUMO

BACKGROUND: Breast reduction is one of the most common procedures performed by plastic surgeons. Despite good outcomes and high patient satisfaction, there are little national data on the predictors that lead to complications in this patient population. We accessed a national outcomes database to examine these factors. METHODS: This is a retrospective study examining the National Surgical Quality Improvement Program database from 2006 to 2015. Patients who underwent primary breast reduction were identified. Patients who underwent any cancer-related procedures were excluded. We identified patient-related and procedure-related factors for analysis. Univariate and multivariate logistic regression analyses were used to identify independent predictors of complications. RESULTS: In total, 16,812 individual cases were identified. The overall complication rate for the cohort was 6.2%, and the major complication rate was 3.0%. Diabetes, bleeding disorder, hypertension, obesity, smoking, steroid use, and prolonged operative time were associated with increased risk of complications (p < 0.05). Concurrent body contouring was a predictor of increased major complications; however, liposuction was not. CONCLUSIONS: Common surgical risk factors are associated with complications in breast reduction surgery. Although liposuction is not an independent risk factor, concurrent body contouring is associated with increased complications. Surgeons should be aware of these associations when discussing breast reduction with patients.


Assuntos
Mama/anormalidades , Hipertrofia/cirurgia , Mamoplastia/efeitos adversos , Adulto , Contorno Corporal/efeitos adversos , Índice de Massa Corporal , Mama/cirurgia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Lipectomia/efeitos adversos , Mamoplastia/estatística & dados numéricos , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Melhoria de Qualidade , Estudos Retrospectivos , Estados Unidos
15.
J Vasc Access ; 20(4): 374-379, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30370819

RESUMO

OBJECTIVE: Lipectomy is an acceptable method of cephalic vein superficialization in hemodialysis arteriovenous fistula. However, limiting it to be a secondary procedure may prolong time between fistula creation and successful cannulation posing more risk of central venous catheter use. AIM: The aim of this study is to evaluate primary surgical lipectomy performed at the time of arteriovenous fistula creation in comparison with secondary lipectomy. PATIENTS AND METHODS: Between June 2015 and January 2017, 59 adult end-stage renal disease patients were allocated non-randomly to group I, 35 patients had arteriovenous fistula with primary lipectomy of forearm or arm deep cephalic veins, and group II, 24 patients who had secondary lipectomy of deep forearm or arm cephalic veins after primary arteriovenous fistula. RESULTS: Mean body mass index was 28.2 ± 3.2 kg/m2 versus 29.4 ± 2.5 kg/m2 in group I versus II, respectively. Mean time from fistula creation to cannulation was 6 ± 0.5 weeks in group I versus 14.5 ± 5.5 weeks in group II (p < 0.0001*). Immediate technical success was achieved in all cases in both groups. Clinical success was 94.29% (33/35) versus 91.67% (22/24) in group I versus II, respectively. Cumulative 1-year primary patency rate was 88% in primary and 86.47% in secondary lipectomy; p = 0.842. CONCLUSION: Lipectomy is a minimally invasive procedure carried out through small incision(s). Primary and secondary lipectomy procedures have few complications, and acceptable technical and clinical success rates. Primary lipectomy has the advantage to hasten fistula use and diminish central venous catheter dependency.


Assuntos
Derivação Arteriovenosa Cirúrgica/métodos , Falência Renal Crônica/terapia , Lipectomia/métodos , Diálise Renal , Extremidade Superior/irrigação sanguínea , Veias/cirurgia , Adulto , Idoso , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Cateterismo Venoso Central , Estudos de Viabilidade , Feminino , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/fisiopatologia , Lipectomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Grau de Desobstrução Vascular , Veias/diagnóstico por imagem , Veias/fisiopatologia
16.
J Cosmet Dermatol ; 18(2): 594-601, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30203579

RESUMO

BACKGROUND: Minimally invasive techniques, including superficial liposuction with automatic shaver curettage (LC), subcutaneous laser treatment, and microwave-based therapy have been developed to treat osmidrosis. Few studies have compared these three techniques in relation to clinical efficacy, life quality improvement, and downtime. AIMS: We aim to evaluate clinical results and life quality improvement, in addition to downtime and complications, between these three techniques. PATIENTS/METHODS: Clinical records of patients treated with these three minimally invasive techniques for axillary osmidrosis were retrospectively reviewed. Hyperhidrosis disease severity scale, Dermatology Life of Quality Index, clinical improvement, complication, and recurrence were assessed. RESULTS: Among 403 patients, 168 received microwave-based therapy, 119 received subcutaneous laser treatment, and 116 received LC. All treatments showed significant improvements (P < 0.001) in HDSS, DLQI and clinical result after 3 and 12 months comparing to the baseline. But the improvements of subcutaneous laser were significantly inferior to microwave-base therapy and LC. Patients who received LC had a significantly longer downtime (P < 0.001) than those who received other treatments. The recurrence rate was significantly higher in the subcutaneous laser treatment group, and the microwave-based therapy group exhibited a longer recurrence duration (P < 0.001). LC group presented higher complication rate than other treatments. CONCLUSION: Comparing to other treatments, microwave-based therapy was effective in treating osmidrosis with minimal downtime, recurrence, and complications. It could be a durable and effective therapeutic modality for osmidrosis and is less operator-dependent. It may be considered as a first-line treatment for axillary osmidrosis.


Assuntos
Curetagem/métodos , Hiperidrose/terapia , Terapia a Laser/métodos , Lipectomia/métodos , Micro-Ondas/uso terapêutico , Adulto , Glândulas Apócrinas/efeitos da radiação , Glândulas Apócrinas/cirurgia , Axila , Curetagem/efeitos adversos , Curetagem/instrumentação , Feminino , Seguimentos , Humanos , Hiperidrose/diagnóstico , Hiperidrose/psicologia , Terapia a Laser/efeitos adversos , Terapia a Laser/instrumentação , Lasers de Estado Sólido/efeitos adversos , Lasers de Estado Sólido/uso terapêutico , Lipectomia/efeitos adversos , Lipectomia/instrumentação , Masculino , Micro-Ondas/efeitos adversos , Odorantes , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/etiologia , Satisfação do Paciente , Qualidade de Vida , Recidiva , Estudos Retrospectivos , Índice de Gravidade de Doença , Sudorese/efeitos da radiação , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
17.
Mol Cell Biochem ; 455(1-2): 207-217, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30483910

RESUMO

Studies designed to examine effects of fat mass reduction (including lipodystrophy and lipectomy) on human serum total and LDL-cholesterol concentrations are inconsistent. The purpose of this study was to examine effect of partial lipectomy in rats (as an experimental model of fat mass reduction in humans) on (1) circulating total cholesterol, LDL-cholesterol + VLDL-cholesterol and HDL-cholesterol concentrations, and (2) factors which may affect serum cholesterol concentrations such as: (a) liver LDL-receptor level, (b) expression of liver PCSK9 and (c) circulating PCSK9 concentration. Reduction of rat adipose tissue mass resulted in an increase in circulating total and LDL + VLDL-cholesterol concentrations, which was associated with (a) decrease in liver LDL-R level, (b) increase in liver PCSK9 expression, and (c) increase in circulating PCSK9 concentration as compared with sham controls. These changes were accompanied by elevated liver HNF1α (and HNF4α) mRNA levels. Silencing HNF1α in HepG2 cells by siRNA led to decrease in PCSK9 mRNA levels. This suggests that overexpression of HNF1α gene in liver of lipectomized rats can lead to overproduction of PCSK9. In conclusion, up-regulation of PCSK9, due to overexpression of HNF1α gene in liver of lipectomized rats and subsequently increase in circulating PCSK9 concentration lead to decrease in liver LDL-R level. This may contribute, at least in part, to an increase in the concentration of circulating cholesterol in rats with reduced fat mass. These findings provide a possible explanation for the molecular mechanism of hypercholesterolemia observed sometimes after reduction of fat mass in human.


Assuntos
Regulação Enzimológica da Expressão Gênica , Hipercolesterolemia/metabolismo , Lipectomia/efeitos adversos , Fígado/metabolismo , Complicações Pós-Operatórias/metabolismo , Pró-Proteína Convertase 9/biossíntese , Receptores de LDL/metabolismo , Regulação para Cima , Animais , Hipercolesterolemia/etiologia , Hipercolesterolemia/patologia , Fígado/patologia , Masculino , Complicações Pós-Operatórias/patologia , Ratos , Ratos Wistar
18.
Rev. bras. cir. plást ; 33(4): 567-571, out.-dez. 2018. ilus
Artigo em Português | LILACS | ID: biblio-980162

RESUMO

Introdução: Recentemente, alguns autores têm descrito a lipoaspiração de alta definição, na qual, na região abdominal, é alcançada pela marcação vigorosa dos sulcos das linhas alba, semilunar e interseções tendíneas transversais do músculo reto abdominal. O objetivo é apresentar estudo piloto de técnica de lipoaspiração de alta definição abdominal utilizando material convencional e tubos de silicone nos curativos. Métodos: Foram descritos 20 casos, submetidos à lipoaspiração convencional e em seguida lipoaspiração superficial sob as linhas alba, semilunar e interseções tendíneas, até que se obtivesse a formação de um sulco nestes locais. Utilizamos tubos de silicone maleáveis nas linhas alba, semilunar bilateral e interseções tendíneas, fixados externamente com micropore, os quais foram removidos após 5 dias. Resultados: Houve um acréscimo médio de 20 minutos para realização destas etapas. As marcas dos tubos de silicone apresentaram-se muito evidentes no primeiro retorno, estando mais discretas no segundo retorno. Não foram observadas alterações de coloração, isquemia ou dor maior pela técnica empregada. Após 3 meses, não houve nenhum caso de dermatite, cútis marmorata, seroma, infecção, irregularidade de contorno ou necessidade de procedimentos adicionais. Conclusão: Foi realizada lipoaspiração de alta definição abdominal, com material convencional e uso de tubos de silicone temporários fixados externamente.


Introduction: Recently, some authors have described high definition liposuction in the abdominal region, achieved by the vigorous marking of the grooves of the linea alba, linea semilunaris, and transverse tendinous intersections within the rectus abdominis muscle. The aim is to present a pilot study of high-definition abdominal liposuction technique using conventional material and silicone tubing in the dressings . Methods: Twenty cases were submitted to conventional liposuction, followed by superficial liposuction under the linea alba, linea semilunaris, and tendinous intersections, until a groove was formed at these sites. Flexible silicone tubing was externally fixed with Micropore tape in the linea alba, bilateral linea semilunaris, and tendinous intersections, and removed after 5 days. Results: A mean increase of 20 minutes was required to perform these steps. The marks of the silicone tubing were evident at the first follow-up, and less prominent at the second follow-up. No color change, ischemia, or significant pain was observed using this technique. After 3 months, there were no cases of dermatitis, cutis marmorata, seroma, infection, contour irregularity or need for additional procedures. Conclusion: High-definition abdominal liposuction was performed using conventional materials and externally fixed temporary silicone tubing.


Assuntos
Humanos , Masculino , Feminino , Lipectomia/efeitos adversos , Lipectomia/métodos , Lipectomia/tendências , Procedimentos Cirúrgicos Reconstrutivos/métodos , Relatos de Casos , Projetos Piloto , Método de Tubulação Múltiplo
19.
Proc Inst Mech Eng H ; 232(11): 1111-1116, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30284941

RESUMO

Breast augmentation using implants is the most common aesthetic and reconstructive breast surgical procedure. Complications such as implant rupture maybe related to surgical technique and damage to the implant. Autologous fat transfer (lipofilling) using metallic cannulae has become a standard adjunctive, yet there is little evidence on lipofilling safety in the presence of implants. The aims of this study are to verify the effects of different cannulae and to quantify the forces applied by surgeons during lipofilling. Silicone gel-filled textured implants (200 mL), mounted on a specially constructed mould were ruptured with two different cannulae: type A (hole at tip: sharp) and type B (hole away from tip: blunt), driven at three speeds (10, 100 and 1000 mm/min), and the force at rupture was recorded. In addition, the maximum 10 forces over a 30-s period applied by 11 plastic surgeons against a breast implant in an in vitro environment were recorded using a load cell attached to a type-A cannula. Statistical analysis of comparative results was performed using t-tests, with p < 0.05 considered significant. Results showed that the implant ruptured at forces up to 25% lower when cannula A was used compared to cannula B. This supports current technique in lipofilling in the use of a blunt tipped cannula. There was a significant difference between some displacement rates only, due to the viscoelastic nature of the material. The tactile force that surgeons use during lipofilling was modelled in vitro and showed a range of maximum forces between 0.23 and 16.8 N, with a mean maximum value of 6.9 N. Limitation of this study is that it may not reflect in vivo behaviour of breast implants. More studies are needed to confirm the safety of breast lipofilling in the presence of implants using these data as a starting point.


Assuntos
Lipectomia/instrumentação , Fenômenos Mecânicos , Implantes de Mama , Cânula , Lipectomia/efeitos adversos , Segurança
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