Daniela Francescato Veiga

Quality-of-life and self-esteem outcomes after oncoplastic breast-conserving surgery.

Background: This prospective trial was designed to assess the impact of oncoplastic surgery on quality of life and self-esteem of breast cancer patients undergoing breast-conserving treatment. Methods: Forty-five patients with primary breast cancer to be treated with breast-conserving surgery and immediate partial breast reconstruction were assessed with regard to quality-of-life and self-esteem outcomes preoperatively and 6 and 12 months postoperatively. Another 42 breast cancer patients, treated by conservative surgery without breast reconstruction at least 1 year previously, were assessed for the control group. Validated questionnaires (Short Form-36, Brazilian version, and the Rosenberg-EPM Self-Esteem Scale) were used. Data were analyzed by using the Mann-Whitney and Friedman tests. Results: Participation rates at the follow-up assessments were 95.5 percent at the 6-month follow-up and 88.9 percent at the 12-month follow-up. Control and reconstruction groups were matched for age, body mass index, and demographic and oncologic aspects. At postoperative month 12, the breast reconstruction group had significantly better health status than the control group with regard to physical functioning (p < 0.000), health perception (p < 0.002), vitality (p < 0.007), social functioning (p < 0.02), role emotional (p < 0.02), mental health (p < 0.000), and self-esteem (p < 0.02). Compared with preoperatively, breast reconstruction group scores were significantly higher at 12 months postoperatively for seven of the eight dimensions of the Short Form-36: physical functioning (p < 0.01), role physical (p < 0.02), health perception (p < 0.02), vitality (p < 0.01), social functioning (p < 0.02), role emotional (p < 0.05), and mental health (p < 0.02). Self-esteem was also significantly better at 12 months (p < 0.02). Conclusion: Oncoplastic surgery had a positive impact on quality of life and self-esteem of patients undergoing breast-conserving treatment.

Ultrasonography for measuring rectus abdominis muscles diastasis

PURPOSE Preoperative imaging evaluation may be useful for determining the position of recti abdominis muscles before their correction. The purpose of this study is to evaluate the accuracy of ultrasonography to measure the width of rectus abdominis muscle diastasis. METHODS Rectus diastasis was measured by ultrasonography preoperatively in 20 females. Rectus diastasis was measured in seven levels along the anterior rectus sheath by ultrasound after sustained deep inspiration and after expiration. Rectus diastasis, at the same levels, was also measured after its exposition during abdominoplasty by two independent observers, using a surgical compass. These values were compared using Wilcoxons statistical text, for non independent values. RESULTS There was no significant difference between the values obtained by ultrasound and those measured during surgery in the supra-umbilical levels and at the level of the umbilicus. However, below the umbilicus these values differed significantly, showing smaller values in the imaging evaluation. CONCLUSION Ultrasonography is an accurate method to measure rectus diastasis above the umbilicus and at the umbilical level.

Randomized Controlled Trial of the Effectiveness of Chlorhexidine Showers Before Elective Plastic Surgical Procedures

This randomized controlled trial was designed to assess the effect of preoperative chlorhexidine showers on skin colonization and postoperative infection rates associated with plastic surgical procedures involving the trunk. Chlorhexidine showers were effective in reducing skin colonization with coagulase-negative staphylococci and yeasts, but there was no difference in postoperative infection rates.

Povidone iodine versus chlorhexidine in skin antisepsis before elective plastic surgery procedures: a randomized controlled trial.

Sir:One of the most important risk factors for surgical-site infection is the presence of bacteria in the wound at the time of surgery. Thus, the purpose of preoperative skin preparation is to reduce bacteria on the skin before making an incision.1,2The antiseptics most commonly used for antisepsis

Late Hematoma After Aesthetic Breast Augmentation with Textured Silicone Prosthesis: A Case Report

Late hematoma is an extremely rare complication after augmentation mammaplasty with silicone prostheses. The authors present a case of late hematoma after breast augmentation with textured gel-filled silicone prostheses, which appeared after intense physical effort 1 year after the implantation of the prosthesis. The hematoma was drained in three subsequent ultrasound-guided percutaneous needle aspirations, with no need for removal of the implant. In a 9-month follow-up period, the patient had no other problems with the implants.

Evaluations of the aesthetic results and patient satisfaction with the late pedicled TRAM flap breast reconstruction

With the goal of evaluating the aesthetic results, testing the reliability of the rating systems used, and determining the patients’ level of satisfaction with their breast reconstruction, pedicled transverse rectus abdominis musculocutaneous flap reconstruction was performed in 20 patients who had undergone mastectomy. The results were evaluated and compared 3, 6, and 12 months after reconstruction using the patients’ own assessments (a rating of 0–10 points) and scoring by two senior plastic surgeons (using 0–10-point global rating scales as well as the five subscales of the modified Garbay system). The interrater and intrarater agreement was poor to fair for the majority of the subscales. When evaluating by grades, there was significant difference (p < 0.001) between the patients and the raters at postoperative months 3 and 6. At month 12, one of the raters attributed significantly lower grades (p < 0.001) than the patients and the other rater. The authors observed a higher level of satisfaction by the patients than by the raters.

Brazilian version of the Body Dysmorphic Disorder Examination

CONTEXT AND OBJECTIVE Body image improvement is considered to be the main reason for undergoing plastic surgery. The objective was to translate the Body Dysmorphic Disorder Examination (BDDE) into Brazilian Portuguese and to adapt and validate this questionnaire for use in Brazil. DESIGN AND SETTING Cross-sectional survey, at the Department of Plastic Surgery of Universidade Federal de São Paulo. METHODS The BDDE was first translated into Portuguese and then back-translated into English. These translations were then discussed by healthcare professionals in order to establish the final Brazilian version. In a second stage, the validity and reliability of the BDDE were assessed. For this, patients were initially interviewed by two interviewers and subsequently, by only one of these interviewers. On the first occasion, in addition to the BDDE, the body shape questionnaire (BSQ) and the Rosenberg self-esteem scale were also applied. These questionnaires were applied to 90 patients. RESULTS Six questions were modified during the assessment of cultural equivalence. Cronbachs alpha was 0.89 and the intraclass correlation coefficients for interobserver and test-retest reliability were 0.91 and 0.87, respectively. Pearsons coefficient showed no correlation between the BDDE and the Rosenberg self-esteem scale (0.22), whereas there was a moderate correlation between the BDDE and the BSQ (0.64). CONCLUSIONS The BDDE was successfully translated and adapted, with good internal consistency, reliability and construct validity.

Quality of reports of randomized clinical trials in plastic surgery

The randomized clinical trial is defined as a study design in which patients are allocated at random either to an intervention group undergoing a particular intervention, whether for diagnostic, preventive, or therapeutic purposes, or to a control group.1,2 Health care systems are expected to satisfy a growing demand for services with limited resources. To ensure that resource allocation is efficient, increasing interest is being placed in evidence-based research.3 Among research methods, the randomized clinical trial is considered the best source of available scientific evidence and the only scientifically reliable method for assessment of the efficacy (and risks) of an intervention.1,2 Regardless of whether or not the result of a randomized clinical trial reaches statistical significance, the design, conduct, and published report should be of high quality. High-quality trials and their reports should lead to better and more realistic estimates of treatment effects, more accurate estimates of treatment efficacy, and greater acceptance of these results within the health care community.4,5 Despite their scientific merit, randomized clinical trials are uncommon in most medical disciplines, particularly in surgical disciplines, including plastic surgery.6–8 In this Editorial, we present a survey of randomized clinical trials performed by plastic surgeons and published in the English language. A computerized search was conducted to identify the maximum number of articles published as randomized clinical trials in plastic surgery from 1966 to 2003. We elaborated strategies of electronic search for each database consulted: Latin-American and Caribbean Literature in Sciences of Health (LILACS), MEDLARS—Medical Literature Retrieval System, on-line (MEDLINE), Excerpta Medica Database (EMBASE), and Cochrane Controlled Trials Register (CCTR). Abstracts of randomized clinical trials in plastic surgery were identified and selected. Trials that had not been carried out by plastic surgeons or with the participation of at least one plastic surgeon were excluded. One author conducted the searches and the selection of trials. Whenever there was any doubt about the relevance of the study, the full text was assessed. After selection, the trials were classified into four categories, according to allocation concealment9: A, allocation concealment is appropriately described; B, allocation concealment is not described, but the authors mention in the text that the trial is a randomized one; C, allocation concealment is inappropriate; or D, the study is not a randomized clinical trial. Two reviewers independently classified the trials. Disagreements were resolved at a consensus meeting. Our sample was constituted by the trials classified into category A. These randomized clinical trials were then evaluated for their quality. The assessment was made independently by two raters and cross-checked. Two validated tools were used to assess the quality of the trials: the Delphi List10 and the quality scale described by Jadad et al.3

Impacto da obesidade na capacidade funcional de mulheres

OBJETIVO: Avaliar a capacidade funcional em mulheres eutroficas, com sobrepeso e obesas. METODOS: Estudo transversal analitico envolvendo 90 mulheres adultas com idade entre 40 e 60 anos, alocadas em tres grupos de acordo com a classificacao do indice de massa corporal: eutroficas (n=30), sobrepeso (n=30) e obesas (n=30). As pacientes foram entrevistadas usando um instrumento de avaliacao de qualidade de vida especifico para capacidade funcional o Stanford Health Assessment Questionnaire (HAQ-20). Tambem foram submetidas a teste de esforco para comparacao do consumo maximo de oxigenio (VO2max) entre os tres grupos. Para analise estatistica foram usados o teste do Qui quadrado, a analise de variância de Kruskal-Wallis e as correlacoes de Spearman e Pearson para p= 0,05. RESULTADOS: As mulheres obesas apresentaram escores do HAQ-20 (0,375) significantemente maiores (p<0,05) do que os outros grupos (0), refletindo pior capacidade funcional. O grupo obesas apresentou valores de VO2max (25,8±5,0ml/kg/min) significantemente menores (p<0,001) que sobrepeso (29,9±6,1ml/kg/min) e eutroficas (33,8±4,1ml/kg/min), indicando pior aptidao cardiorrespiratoria. Nao houve diferenca significante entre eutroficas e sobrepeso para VO2max e escores do HAQ-20. A hipertensao arterial foi mais frequente nas mulheres obesas (p=0,012) que tambem apresentaram menores niveis de escolaridade (p= 0,026). CONCLUSAO: As mulheres obesas apresentaram reducao da aptidao fisica e da capacidade funcional em relacao as eutroficas e sobrepeso, o que vem se somar ao pior prognostico para doencas cardiovasculares dessas pacientes.

Influence of povidone-iodine preoperative showers on skin colonization in elective plastic surgery procedures.

Background: Preoperative showering with antiseptic skin cleansers is common in elective operations, although the value of this procedure in reducing surgical wound infections has not been established. The authors designed a prospective study to assess the influence of povidone-iodine preoperative showers on skin colonization in elective plastic surgery procedures. Methods: Patients older than 18 years scheduled for elective and clean plastic surgery procedures on the thorax or abdomen were assigned randomly to the povidone-iodine group (n = 57) or to a control group (n = 57). Patients allocated to the povidone-iodine group took a shower with liquid detergent–based povidone-iodine 10% 2 hours before surgery. For the control group, no special instructions for showering were implemented before surgery. Quantitative skin cultures were obtained just before the preoperative scrub in the operating room. Samples were plated on hypertonic mannitol agar, blood agar, Sabouraud agar with chloramphenicol, and eosin-methylene blue agar. Samples were collected and processed, and results were assessed by blinded investigators. Results: Staphylococcal skin colonization was significantly lower in the povidone-iodine group (p < 0.001). No microorganism growth was observed on 33 percent of the postshower skin cultures from patients in the povidone-iodine shower group compared with 0 percent of the cultures from patients in the control group. Colonies of fungi and enterobacteria were recovered in small amounts in both groups, and povidone-iodine showers did not significantly reduce skin colonization by these microorganisms. Conclusion: Single preoperative povidone-iodine showers are effective in reducing staphylococcal skin colonization before elective clean plastic surgical procedures on the thorax and abdomen.