João Medeiros Tavares Filho

Dermolipectomy of the Pubic Area Associated with Abdominoplasty

Aesthetic alterations of the pubic area, whether constitutional or the result of excessive weight, if not treated, may become more evident after an abdominoplasty. The authors recommend a simple and effective technique to be performed simultaneously with abdominoplasty that leads to satisfactory results and does not interfere with the lymphatic drainage of the area.

Use of Autologous Fibrin Glue (Platelet-Poor Plasma) in Abdominal Dermolipectomies

BackgroundAutologous plasma is endowed with properties that speed up healing, hemostasis, and adhesiveness, in addition to growth factors. Through an established protocol, it was possible to isolate thrombin, as well as the platelet-rich plasma (PRP) and platelet-poor plasma (PPP) fractions. The purpose of this study was to analyze autologous use of thrombin and PPP to foster adhesion between an abdominal dermoadipose flap and the aponeurotic surface in abdominal dermolipectomies.MethodsThe data from 40 patients who underwent abdominal dermolipectomies were analyzed, with 20 patients using thrombin and autologous PPP (Plasma group) and 20 patients with no intervention (Control group). An attempt was made to assess adhesive power by quantifying the serohematic liquid volume gauged during the postoperative days (POD), and also noting the incidence of seroma. Other variables such as age and body mass index (BMI) were also analyzed.ResultsThe reduction in the aspiration drain debit was statistically relevant only on the first POD in the Plasma group. There was no reduction in the incidence of seroma in these patients. Similarly, age and BMI did not influence these outcomes.ConclusionThe PPP fostered adhesion between the abdominal dermoadipose flap and the aponeurotic surface only on the first POD and had no influence whatsoever on the incidence of seroma. There are few reports on the use of PPP for plastic surgery, particularly the autologous type, opening up possibilities for further research projects to expand its use.Level of Evidence IIIThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the table of contents or the online instructions to authors www.springer.com/00266

Postbariatric Buttock Contouring With Dermolipectomy and Gluteal Implants

The authors present their experience with the use of silicone implants in the buttocks after massive weight loss. The procedure is used in combination with gluteal dermolipectomy with or without dermal fat flaps. This report highlights the simplified method of identifying the gluteal muscles, recommends using the superior margin of the gluteus maximus muscle to access the space for implant placement, and prescribes placement of the implants in either the submuscular or the intramuscular space. The described procedure has been performed for two patients to date, with encouraging and long-lasting results.

Uso de expansores de tecidos nos membros inferiores

BACKGROUND: Tissue expansion is a physiological phenomenon, we observed in pregnancy and in tumors development. The expansion control was described for the first time in 1957, being improved and developed in almost all body areas ever since. Tissue expansion of the lower limb has shown difficult accomplishments, due to limited skin elasticity, mainly on the distal lower leg, lack of a hard plan, few axial vessels and developed sub dermal plexus, restraint of physical activities in patients during filling procedure, and high rate of complications, which may cause restriction of its usage. METHODS: We have achieved 24 procedures of expansion of the lower limbs for hemangioma (4.2%), sequelae of poliomyelitis (8.3%), post burn sequelae (33.3%) and post trauma (54.2%), expanding advancement flaps, transposition, and preparation of pockets in order to place calf implants, creation of protocols for indication, planning and routines, filling and removal of the expander with the goal of reducing complications. RESULTS: In all tissue expansions obtained we have been successful in the previous result planned in 19 procedures (79.1%), and unsuccessful in 4 procedures (16.7%) with final partial result, and in 1 procedure (4.2%) with prior interruption of tissue expansion having obtained no goals. CONCLUSION: A careful planning and a strict surgical protocol of these problems can be reduced and skin expansion can be used in the lower leg to achieve goals of otherwise impossible in reconstructive surgery.

Plastic surgery in chest wall reconstruction: relevant aspects - case series

OBJECTIVE to discuss the participation of Plastic Surgery in the reconstruction of the chest wall, highlighting relevant aspects of interdisciplinaryness. METHODS we analyzed charts from 20 patients who underwent extensive resection of the thoracic integument, between 2000 and 2014, recording the indication of resection, the extent and depth of the raw areas, types of reconstructions performed and complications. RESULTS among the 20 patients, averaging 55 years old, five were males and 15 females. They resections were: one squamous cell carcinoma, two basal cell carcinomas, five chondrosarcomas and 12 breast tumors. The extent of the bloody areas ranged from 4x9 cm to 25x40 cm. In 12 patients the resection included the muscular plane. In the remaining eight, the tumor removal achieved a total wall thickness. For reconstruction we used: one muscular flap associated with skin grafting, nine flaps and ten regional fasciocutaneous flaps. Two patients undergoing reconstruction with fasciocutaneous flaps had partially suffering of the flap, solved with employment of a myocutaneous flap. The other patients displayed no complications with the techniques used, requiring only one surgery. CONCLUSION the proper assessment of local tissues and flaps available for reconstruction, in addition to the successful integration of Plastic Surgery with the specialties involved in the treatment, enable extensive resections of the chest wall and reconstructions that provide patient recovery.

Elastic suture as an alternative for the initial wound care in the emergency room

This is a case report of a 44-year-old male patient who was admitted to the emergency room on November 17, 2013, after an accident with a Makita Disc. The patient presented with an extensive wound throughout the dorsal surface of the left thumb, with tendon exposure. The use of elastic suture is demonstrated as the initial care in the emergency department. We present satisfactory resolution in a single surgical procedure of traumatic wounds in a patient presenting with loss of tissue. The chosen surgical approach presented adequate aesthetic result and functional preservation. ■ ABSTRACT

Abdominoplasty on Patients with Previous Surgical Scars

In some situations, the abdomen may present scars that can limit the scope of the abdominoplasty and its aesthetic outcome. The final position of the scar will depend on the position of the old original scar and the amount of excess skin on the abdominal wall.

Implantes complementares na reconstrução mamária

INTRODUCAO: A depressao na parede anterior da axila pos-mastectomia gera insatisfacao das pacientes ao vestirem roupas mais decotadas; alem disso, pode haver dificuldade na elevacao do braco quando ha aderencias e retracoes nessa regiao. Nessas pacientes, utilizamos implantes complementares, que reconstituem a anatomia local de forma satisfatoria, oferecendo beneficios funcionais ao remover bridas cicatriciais. Esses implantes estao disponiveis em variados tamanhos e volumes, podendo ser empregada mais de uma protese no mesmo local, se necessario. O objetivo deste estudo e demonstrar a experiencia da Disciplina de Cirurgia Plastica da Universidade Federal do Rio de Janeiro (Rio de Janeiro, RJ, Brasil) com o emprego de implantes complementares na reconstrucao mamaria pos-mastectomia, buscando melhorar os aspectos estetico e funcional da regiao axilar. METODO: A inclusao de implantes de silicone complementares para reconstrucao mamaria pos-mastectomia foi realizada em 6 pacientes do sexo feminino, com idade entre 34 anos e 75 anos. O volume dos implantes variou de 20 ml a 120 ml. Largura, comprimento e profundidade da area da axila a ser preenchida foram mensurados, para definir volume, dimensoes e numero de implantes que seriam utilizados. A via de acesso utilizada para insercao dos implantes foi a cicatriz da reconstrucao mamaria. RESULTADOS: O seguimento pos-operatorio variou de 6 meses a 8 anos, nao sendo observada contratura capsular em nenhum caso. Todas as pacientes referiram melhora funcional na movimentacao do braco, bem como satisfacao com o resultado estetico pela possibilidade de uso de roupas mais decotadas. CONCLUSOES: A inclusao de implantes de silicone de formato semilunar no refinamento da reconstrucao mamaria e um metodo simples e de facil realizacao, com resultados bastante previsiveis, necessitando apenas de uma cirurgia. Os implantes podem ser substituidos, aumentados ou removidos, se necessario.