Luiz Roberto Reis de Araujo

Lipoabdominoplasty: Liposuction with Reduced Undermining and Traditional Abdominal Skin Flap Resection

Abdominoplasty surgery has spread universally, as both an aesthetic and a reconstructive procedure, and new techniques are appearing with the goal of minimizing ischemic complications of the flap and bettering body contour. The purpose of this article is to demonstrate that an abdominoplasty technique with limited undermining and preservation of the flap perforator vessels makes it possible to reduce the complication rate attributable to flap necrosis and seroma in abdominoplasty. Doppler flowmetry color study of the abdominal wall was performed before the surgical procedure and on postoperative day 15 after lipoabdominoplasty for a series of 20 patients to evaluate the blood supply of the abdominal wall. This study confirmed the preservation of perforator arteries in the periumbilicus area and right upper quadrant after abdominoplasty with liposuction and reduced undermining.

Reduction mammaplasty and mastopexy using the vertical scar and thoracic wall flap technique

Breast surgery has been greatly modified in the past few years as surgeons sought to shorten scars and improve and maintain of breast shape in the late postoperative period. Working with both the periareolar technique and vertical scar technique, it is possible to reduce scar length, avoiding the area below the inframammary crease by compensating skin excess around the areola. From January 2001 to July 2002, 53 patients underwent reduction mammaplasty and/or mastopexy using the vertical scar technique associated to a thoracic-based flap kept under a bipedicled flap of the pectoralis major muscle. The goal of this combination is to achieve a good aesthetic result: a reduced scar, minimal breast descent, and good upper pole fullness.

Intraabdominal Pressure in Abdominoplasty Patients

Abdominal compartment syndrome is directly related to an increase in intraabdominal pressure (IAP), which can lead in severe cases to serious clinical consequences. Routine measurement of IAP in specific cases has been advocated by some surgical specialties. However, few studies in plastic surgery have focused on the use of IAP. The authors review the literature and describe a method of IAP analysis used for 12 patients who underwent abdominoplasty.

Análise da cicatrização do cólon com uso do extrato aquoso da Orbignya phalerata (Babaçu) em ratos

INTRODUCAO: A cicatrizacao e processo complexo, com diferentes fases. Embora exista grande variedade de plantas medicinais poucas tem sido investigadas com intencao de melhorar a cicatrizacao de orgaos e tecidos, dentre elas, a Orbignya phalerata (babacu). OBJETIVO: Analisar comparativamente as alteracoes tensiometricas e histologicas na cicatrizacao de anastomoses colonicas proporcionadas pelo uso do extrato aquoso do mesocarpo do babacu (Orbignya phalerata). METODOS: Utilizaram-se 40 ratos Wistar, machos, separados em dois grupos de vinte, denominados grupos controle e experimento, Os ratos de cada grupo foram divididos em dois sub-grupos de 10 animais cada e avaliados no terceiro e setimo dia de pos-operatorio. Realizaram-se colotomia e colorrafia em plano unico. Os animais do grupo controle receberam no ato operatorio dose unica de solucao salina isotonica em dose e via de administracao semelhantes ao grupo experimento e os do grupo experimento receberam extrato aquoso de babacu em dose de 50 mg/kg/peso, concentracao de 25 mg/ml por via intraperitoneal. Foram analisados os seguintes parâmetros: a) avaliacao macroscopica da parede e cavidade abdominal; b) avaliacao tensiometrica da anastomose (pressao e ruptura); c) caracteristicas histologicas da anastomose. RESULTADOS: O exame macroscopico evidenciou a presenca de aderencias em todos os animais, sendo estatisticamente maior no grupo experimento de tres dias quando comparados com o grupo controle. Nos animais do grupo de sete dias nao houve diferenca. Nao houve ocorrencia de deiscencia de anastomose, fistulas, abscessos e/ou hemorragia. Com relacao a tensiometria, constatou-se que a media de ruptura dos grupos controle e experimento tanto para os animais do grupo de tres dias (25,4 mmHg - 14,8 mmHg) quanto para os de sete dias (183 mmHg - 175 mmHg), foram iguais, nao ocorrendo diferenca estatisticamente significante. A analise histologica dos animais do grupo de tres dias mostrou... INTRODUCTION: Healing is a highly complex process with different phases. Because some medicinal plants have antiinflamatory properties, they could influence the wound healing process. There are many species of medicinal plants used for research, among them the Orbignya phalerata (Babassu). PURPOSE: To analyze, comparatively, the tensiometric and histologic alterations in the healing process of colon anastomosis with the use of aqueous extract of the babacu mesocarp. METHODS: Forty Wistar male rats were used, divided in two groups of 20 animals named control and experimental group. Each group was further divided in two sub-groups of 10 animals and evaluated on the third and seventh post-operative days. Colotomy and one suture line coloraphy was performed in all animals. The control group received an intraperitoneal single dose of isotonic saline solution at the time of the surgery. The animals from the experimental group received babassu aqueous extract dose with 50mg/kg/weight, concentration of 25 mg/ml dose, with the same administration method. The following parameters were evaluated: a) macroscopic appearance of abdominal wall and cavity; b) tensiometric evaluation of anastomosis (bursting pressure); c) histologic characteristics of anastomosis. RESULTS: The macroscopic examination showed the presence of adherences in all animals with statistical significance in the ones from the experimental group at third day when compared to the control group. No difference was observed in the seventh-day group. No fistulae, abscesses and/or hemorrhage were observed. In regard to the tensiometric variation, the bursting pressure for the control and experimental groups, both for the third day (25.4 mmHg - 14.8 mmHg) and at seventh (183 mmHg - 175 mmHg), were similar with no significant difference. Histological analysis for the third day showed significant difference in the experimental group in relation to the controls, in regard the presence ofto...INTRODUCTION Healing is a highly complex process with different phases. Because some medicinal plants have antiinflammatory properties, they could influence the wound healing process. There are many species of medicinal plants used for research, among them the Orbignya phalerata (Babassu). PURPOSE To analyze, comparatively, the tensiometric and histologic alterations in the healing process of colon anastomosis with the use of aqueous extract of the babaçu mesocarp. METHODS Forty Wistar male rats were used, divided in two groups of 20 animals named control and experimental group. Each group was further divided in two sub-groups of 10 animals and evaluated on the third and seventh post-operative days. Colotomy and one suture line coloraphy was performed in all animals. The control group received an intraperitoneal single dose of isotonic saline solution at the time of the surgery. The animals from the experimental group received babassu aqueous extract dose with 50mg/kg/weight, concentration of 25 mg/ml dose, with the same administration method. The following parameters were evaluated: a) macroscopic appearance of abdominal wall and cavity; b) tensiometric evaluation of anastomosis (bursting pressure); c) histologic characteristics of anastomosis. RESULTS The macroscopic examination showed the presence of adherences in all animals with statistical significance in the ones from the experimental group at third day when compared to the control group. No difference was observed in the seventh-day group. No fistulae, abscesses and/or hemorrhage were observed. In regard to the tensiometric variation, the bursting pressure for the control and experimental groups, both for the third day (25.4 mmHg - 14.8 mmHg) and at seventh (183 mmHg - 175 mmHg), were similar with no significant difference. Histological analysis for the third day showed significant difference in the experimental group in relation to the controls, in regard the presence ofto mononuclear ones whereas at seventh day there was significant statistical difference in all variables from the experimental group compared to the control one. CONCLUSION A favorable effect with administration of the aqueous extract of the babaçu mesocarp was seen in histological parameters of the healing process of colon anastomosis however there was no difference in the tensiometric evaluation between the control and experimental group.

Reply: The Ruth Graf Technique

Reply: The Ruth Graf Technique: Measurements Do Not Support the Efficacy of an Inferior Pedicle and Pectoralis Muscle Loop in Mammaplasty Sir: Swanson has questioned several aspects of the technique. We will try to clarify some points that may not have been illustrated well enough and were challenged by Dr. Swanson. The technique of one of the authors (R.G.) was first published in Aesthetic Plastic Surgery in 20001 and subsequently published in Plastic and Reconstructive Surgery in 2002.2 In these and the current publications, the technique is described in detail and mentions the lower pedicle flap by Ribeiro3 and the Daniel4 muscle sling, giving credit to their original authors. Graf popularized the technique, presenting it at several meetings around the world, much as occurred with Tonnard et al., who popularized the face-lift technique, first described by Saylan in 1999.5 Swanson criticized the patient positioning in the photographs. Although the photographs are not perfectly standardized, if one observes the position of the arm on the postoperative photographs (6 months to 4 years), it is possible to make a reasonable comparison, especially on the profile view. The arm in the photograph is situated in a position more anterior than in the preoperative photograph, which makes accurate evaluation problematic, as it puts the breast in a position with less upper pole projection, appearing to be more ptotic. A study using the measurement methodology proposed by Dr. Swanson is an important step in objectively evaluating results in breast surgery, especially at a time when there is an increasing demand for evidence-based medicine.6 As such, using Swanson’s measurement technique, we have immediately initiated a reevaluation of our entire series of secondary mastopexies/reductions performed with the described technique. We are confident that these new measurements will confirm the satisfactory results observed in our daily practice. Regarding the longevity of the breast position: a study with metal clips published in 2010 in the Brazilian Plastic Surgery Journal showed that the vertical changes in clip position (descent of the flap) were followed by stabilization of their height in the group with the muscular loop, whereas a continuous descent was observed in the group without the muscular loop (p < 0.05). Also, the horizontal pattern of movement (lateralization) was less evident in the group with the loop compared with the group without the loop, which was confirmed at several time points (p < 0.05).7 Dr. Swanson misinterprets the function of the magnetic resonance imaging scan. The magnetic resonance imaging scan is obviously not intended to show upper pole fullness, because the patient is lying down for that examination, but rather to serve as an illustration of the perfusion and viability of the flap. However, with a mammogram, we can observe the dermis around the chest wall–based flap and the flap in its original position, and clearly see the upper pole fullness and projection of the nipple-areola complex (Fig. 1). Swanson’s statement that the flap is flattened because it is fixated to the chest wall is demonstrably not true. The flap is fixed in a particular manner (as described in the article published in 2000, referenced above) to hold it in the superior position with minimal tension, avoiding any flattening both immediately and over time by the muscle sling/ loop. The elevated tissue offers the appearance of an oval structure, creating a full upper pole. Our study was obviously retrospective, but contrary to the allusion by Swanson, all cases that met the selection criteria and that were performed in the referenced period were included. There was no selection of best cases. Inclusion criteria were as follows:

Vertical vectors in SMASectomy to reshape the aging face

According to the authors, advantages of short scar face lift associated with lateral SMASectomy and vertical vector closure include a lower rate of hematomas and facial nerve injury, less skin tailoring, no retroauricular skin slough, and reduced operative time. Results in 96 patients demonstrate good neck redefinition, excellent facial contour, and elevated midface. (Aesthetic Surg J 2003;23:198-201.).

To Be Real or Virtual? That is the Question…

AbstractThis editorial describes a crossroad that many plastic surgeons face when they have to decide how to manage their career. Level of Evidence V This journal requires that the 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.

Perfil do cirurgião plástico paranaense

INTRODUCTION: In the present study, we aimed to outline the overall practice profile of plastic surgeons in the state of Parana. It represents an initial project that aimed not to provide generalizations but to understand how plastic surgeons think and their professional aspirations, goals, and performance. METHODS: A survey was conducted using a questionnaire consisting of 37 multiple-choice questions, mostly focusing on the current job market for plastic surgeons. The link to the online questionnaire was e-mailed to 263 members of the Brazilian Society of Plastic Surgery-Regional Parana (SBCP-PR), which was also accessible via the SBCP-PR website, through a banner on its home page. The overall time to complete the questionnaire ranged from 3 to 5 minutes. RESULTS: The response rate was 40.5%. Most interviewees operated only in one city, and more than half provided services only through health-care insurance plans and private practice. Half of the participants considered the market as extremely competitive and searched for several alternatives for self-maintenance, including increasing installment payment terms, lowering prices, and working at other locations. A significant proportion of the respondents believed that they lost more than 30 patients owing to pricing in the previous year and performed 10-20 surgeries per month on average. Most of the surgeons did not operate with an auxiliary plastic surgeon because this would increase their operational cost or because technologists could perform this function. Most participants believe that the number of trained residents in the state of Parana is excessive. CONCLUSIONS: In Parana, plastic surgeons are concerned about the job market and therefore search for alternatives to remain competitive.