Marcus Vinícius Jardini Barbosa

Seroma in lipoabdominoplasty and abdominoplasty: a comparative study using ultrasound.

Background: Abdominoplasty is one of the most frequently performed cosmetic procedures, and its combination with liposuction has become more common. Seroma is one of the most common complications in abdominoplasty. The aim of this study was to compare the rate of seroma formation in patients who underwent either abdominoplasty with or without the use of quilting sutures or lipoabdominoplasty. Methods: Fifty-eight female patients were divided into three groups and underwent one of the following procedures: group A (n = 21), abdominoplasty without quilting sutures; group B (n = 17), abdominoplasty with quilting sutures; and group C (n = 20), lipoabdominoplasty. To investigate seroma formation, abdominal ultrasound was performed in five regions of the abdominal wall (epigastrium, umbilical, hypogastrium, right iliac fossa, and left iliac fossa) at two postoperative periods (P1, between postoperative days 11 and 14; and P2, between postoperative days 18 and 21). Results: The rate of seroma formation at both P1 and P2 was significantly higher in group A. It was observed that in group A at P1, the regions of right iliac fossa and left iliac fossa developed larger fluid collections. In group B, there were no significant differences with respect to fluid collections among the five study regions at both P1 and P2. In group C, there were significantly larger fluid collections in the hypogastrium region at P1 and in the umbilical and hypogastrium regions at P2. Conclusion: Abdominoplasty with quilting sutures and lipoabdominoplasty are effective techniques for the prevention of seromas compared with abdominoplasty without quilting sutures.

Abdominoplasty and its effect on body image, self-esteem, and mental health.

The impact of abdominoplasty on the quality of life of abdominoplasty patients was assessed 1- and 6-months postoperatively. Forty women aged 25 to 60 years were divided into study group (25 patients who underwent abdominoplasty) and waiting-list control group (15 patients). Three questionnaires (Body Shape Questionnaire [BSQ], Rosenberg Self-Esteem Scale [RSE/UNIFESP], and Short Form 36 Health Survey Questionnaire [SF-36]) were administered to the study group (preoperatively, 1- and 6-months postoperatively) and control group (on 2 occasions 6 months apart). A significant positive impact on body image, self-esteem, and mental health was found 1- and 6-months postoperatively. Significant differences were observed in role physical, role emotional, and vitality 1-month postoperatively. In the control group, significant differences were found for vitality. There was a significant improvement in Comparative perception of body image (6-month assessment) in the study group compared with controls. Abdominoplasty improved body image, self-esteem, and mental health.

Basal cell carcinoma: an updated epidemiological and therapeutically profile of an urban population

PURPOSE To describe the epidemiological profile of basal cell carcinoma patients at a private hospital in São Paulo and to evaluate the treatment adopted. METHODS A prospective study of 202 patients, on which 253 lesions were diagnosed for histopathological exam as basal cell carcinoma within the period of January 2001 to September 2003, in the Plastic Surgery Residency Program at the Hospital Jaraguá. The susceptibility factor of the host, the environment variables, the characteristics of the lesions and the efficacy of the treatment were examined. The data were statistically evaluated. RESULTS The incidence of basal cell carcinoma was 126 cases per 100,000 patients in a period of 32 months (36 cases per 100,000 patients/year). The patients were evenly distributed in terms of sex: 48% male and 52% female. The greater incidence was in patients between the ages of 60 and 80 years and the average was 64 years. The survey revealed susceptibility factors such as white race and phototypes I and II in 95.5% of the patients. Exposition to ultraviolet radiation was reported by 77% of the patients and the most frequent location of tumors was on the face (71.2% of the cases). Actinic keratosis and a history of skin cancer were reported in 43.6% and in 25% of the cases, respectively. The adopted treatment was surgery in 99.4% of the cases and only one patient was treated with radiotherapy. Twenty lesions (8%) had incomplete excision. The recurrence rate was 2% (5 cases). There were no cases with metastasis or fatal outcome. CONCLUSIONS The factors related to the development of basal cell cancer which were significantly present in the population surveyed were: older age, white individuals, phototypes I and II, presence of actinic keratosis, previous history of non-melanoma skin cancer and exposure to ultra-violet rays both in recreational and in occupational form. The surgical treatment employed was effective with a rate of incomplete excision and recurrence similar to those found in the literature.

Modelos experimentais em pesquisa

The purpose of this study is to collect the main classifications of experimental research models and their possible applications in experimental research. Literature search was done using the most important data bank available on the internet (PUBMED, MEDLINE, SCIELO, LILACS, COCHRANE). A compilation of the experimental studies developed at the Plastic Surgery Post Graduate Program of the Federal University of Sao Paulo/Paulista School of Medicine was also done. Animals models were classified regarding sanitary and genotypical status. The understanding of the main classifications of the research experimental models is essential to improve and confirm procedures and techniques already described as well as the development of new ones.

An experimental model for the study of collagen fibers in skeletal muscle

PURPOSE To examine histological and histomorphometric techniques for measuring collagen in skeletal muscle. METHODS The following staining methods were used in the study: hematoxylin and eosin, Massons trichrome, reticulin, and picrosirius red, and immunostaining for collagen types I, II, III, IV, and V. Histomorphometric measurements were performed using Corel PhotoPaint and UTHSCSA Image Tool 3.0 software. RESULTS Both the Massons trichrome and picrosirius red staining provided the best visualization for the measurement of collagen content. CONCLUSION This methodology is important for the identification and quantification of the different types of collagen in muscles and can be used in the investigation of the qualitative and quantitative influence of collagen on physical activities, aging, and diseases.

A variation in the component separation technique that preserves linea semilunaris: a study in cadavers and a clinical case

The purpose of this study is to evaluate and compare the effect of the incision of the external oblique aponeurosis along the semilunaris in amount of tension present after the undermining of the anterior rectus sheaths. Forty fresh adult cadavers were studied and divided into two groups: group A (n=20) and group B (n=20). Traction indexes were compared in three situations: (1) before any aponeurotic undermining (similar on both groups); (2) after incision and undermining of the anterior rectus sheaths (similar on both groups) and (3) group A: after undermining of the external oblique muscles with the incision of their aponeurosis along the semilunaris and group B: undermining of a continuous layer of the anterior rectus sheaths and the external oblique aponeurosis, after release of the lateral aspect of the rectus sheaths. Significance of differences was assessed using non-parametric tests. There was a significant tension reduction after each stage of dissection in both supra- and infra-umbilical levels and on both groups. Comparisons between groups A and B did not show statistically significant differences in all sites and stages of the dissections. Therefore, both techniques showed similar aponeurotic tension reduction after each stage of the dissections in cadavers.

Immunohistochemical analysis of collagen content and types in the rectus abdominis muscle of cadavers of different ages

PURPOSE To assess the collagen content and types in the rectus abdominis muscle of cadavers of different ages. METHODS Forty fresh adult male cadavers, at room temperature, were obtained from the Institute of Legal Medicine of Franca and dissected within 24 hours of death. The cadavers were divided into two groups: Group A (n=20), 18 to 30 years of age, and Group B (n=20), 31 to 60 years of age. Bilateral incisions were made in the middle portion of anterior rectus sheath 3 cm superiorly and 2 cm inferiorly to the umbilicus and four fragments of the rectus abdominis muscle were dissected. The samples were fixed in 10% buffered formalin and sent for immunohistochemical analysis to determine collagen content and types. RESULTS Immunohistochemical results revealed higher amounts of type I and type III collagen in Group A. However, no difference in the amount of type IV collagen was found between the groups. CONCLUSION The amount of type I and type III collagen was higher in group A.

Use of the anterior rectus sheath for abdominal wall reconstruction: a study in cadavers.

Our aim was to evaluate the amount of tension present after incision and undermining of the anterior rectus sheaths and the external oblique muscles in 20 fresh adult cadavers. Resistance to traction of the anterior and posterior rectus sheaths towards the midline was measured at three stages of dissection: before any aponeurotic undermining; after incision and undermining of the anterior rectus sheaths; and after incision and undermining of the external oblique muscles associated with the previous dissection. Significance of differences was assessed using non-parametric tests. There was a significant reduction in tension in the anterior and posterior sheaths on both levels after each stage of dissection. The incision and undermining of the anterior rectus sheaths and the external oblique muscles promoted a progressive reduction in tension at the aponeurotic edges of the abdominal wall.

Post-bariatric abdominoplasty: skin sensation evaluation.

BackgroundThe number of bariatric surgeries is progressively increasing in the USA and in Brazil. The number of post-bariatric plastic surgeries also increases as a response to this phenomenon. Abdominoplasties performed in former morbidly obese patients present a larger number of postoperative complications. Studies show that abdominoplasty caused postoperative skin hypesthesia. This study aims at evaluating skin sensibility/sensation in post-bariatric patients submitted to anchor-line abdominoplasty with clinical, qualitative, reliable and reproductive methods.MethodsThirty-nine former morbidly obese women after open Roux-en-Y Gastric Bypass were evaluated for skin tactile pain, touch in movement, noxious and innocuous thermal sensibility and vibration. Fifteen patients composed the Control group (which did not undergo abdominoplasty) and 24 patients composed the Study group (which was submitted to anchor-line abdominoplasty without flap undermining). The sensations were evaluated before and after the abdominoplasty.ResultsThe Control group which did not undergo abdominoplasty showed nearly 100% of positivity to all sensory modalities exception made to vibration which was 56.4–62.2–64.9%. Surprisingly, the Study group showed the same sensation maintenance after the abdominoplasty for nearly all modalities, vibration showed improvement (56.7–71.1–78.3%) without statistical value (p = 0.67).ConclusionThere was skin sensation maintenance after anchor-line post-bariatric abdominoplasty. Non-undermining of xipho-pubic flap is a possible reason for this discovery.

Strategies in umbilical reconstruction.

This article describes two different strategies for umbilical reconstruction. One of the techniques included four skin flaps and was indicated for patients with no vertical scar on the abdomen. This approach was applied in a patient who presented with necrosis of the umbilicus secondary to abdominoplasty. The second technique was indicated for patients who presented with vertical scars. A semilunar skin flap was performed based on the normal skin close to the edge of the vertical scar. A vaginal tampon was used as a dressing in the neoumbilicus for 30 days. Both techniques showed to be effective, with no postoperative complications at the follow-up period.