Maria Cecília Closs Ono

Mastopexy After Massive Weight Loss: Extended Chest Wall–Based Flap Associated with a Loop of Pectoralis Muscle

Mammaplasty for patients who have experienced massive weight loss involves some concepts that differ from those that apply to mammaplasty for normal patients. Breast anatomic characteristics make this procedure a very challenging situation. The authors present their experience with a new mammaplasty technique using an extended thoracic wall flap associated with a loop of pectoralis. This procedure is a simple and reproducible method for patients with massive weight loss that results in a pleasing breast shape and long-lasting results.

Surgical correction of Tessier number 0 cleft.

The no. 0-14 cleft involves the midline of the face and cranium. It may include both a true and a false median cleft lip, with or without associated hypotelorism or hypertelorism. The no. 0 cleft is the most common of the craniofacial clefts. The objective of this study was to review the functional outcome and aesthetic results of the different techniques applied for each case. We have conducted a retrospective analysis of our series consisting of 32 cases of Tessier no. 0 cleft, in the period between 1997 and 2007. The patients were divided into 2 groups: those with the true median cleft and those with the false median cleft. The clinical findings, lip malformation, alveolar cleft, nasal appearance, septal involvement, associated deformities, and surgical procedures, were all reviewed. Holoprosencephaly was present in 9 cases, with a false median cleft upper lip and an absence of the premaxilla, septum, and columella (only 1 patient underwent lip and columella reconstruction at 2 years of age). Nine patients had an incomplete median cleft lip. Seven of these cases had associated median alveolar cleft, and 1 had an intranasal tumor, associated with lipoma of corpus callosum, characteristic of the Pai syndrome. Six cases of a bifid nose were seen, 2 of which were associated with an alveolar median cleft and hypertelorism. An isolated median alveolar cleft was present in 7 cases, 2 of them associated with a no. 30 cleft. This article presents a large series of Tessier no. 0 cleft, describing the differences between the false and the true median cleft. The surgical procedures may vary in relation to the type of involvement.

Transareolar Incision with Geometric Broken Line for Breast Augmentation: A Novel Approach

Along with implant location and size, incision location is an important variable that influences the final result of breast augmentation. The transareolar approach is not popular because of reported lactational difficulties, higher rates of capsular contracture, visibility of scars, and potential changes in nipple sensation. We describe a geometric zigzag transareolar incision for breast augmentation that can achieve imperceptible scarring. We believe that in selected patients the transareolar zigzag incision has its place among the different approaches used in breast augmentation today.

Retalho músculo cutâneo de pálpebra superior para inferior com pedículo medial para correção de ectrópio

DOI: 10.5935/2177-1235.2018RBCP0060 Introdução: O ectrópio se caracteriza por uma eversão da margem palpebral, e é mais comum na pálpebra inferior. O processo de exposição ocular associado a esse quadro pode levar a sequelas graves, como a perda ocular. Muitos retalhos foram propostos para tratar esse quadro. Contudo, a taxa de recorrência pode ser alta, e quando o defeito se localiza na porção medial da pálpebra, ele se torna muito mais desafiador. Por isso, é fundamental que o cirurgião disponha de uma variedade de estratégias cirúrgicas para tratar adequadamente esses casos, definindo, em cada circunstância, qual a melhor técnica a ser adotada, entre as possibilidades disponíveis. O objetivo é apresentar o emprego do retalho miocutâneo de pálpebra superior para inferior, pediculado medialmente, como alternativa no tratamento de três casos de ectrópio Métodos: Tratamento de pálpebra inferior com retalho miocutâneo de pálpebra superior para inferior, pediculado medialmente. Três casos pós-ressecção de lesão oncológica que evoluíram com ectrópio de pálpebra inferior (um deles já recidivado) e que foram trados com retalho miocutâneo de pálpebra superior para inferior, pediculado medialmente; nenhum dos 3 casos apresentou recidiva após essa abordagem proposta. Conclusão: O retalho miocutâneo de pálpebra superior para inferior com pedículo medial demonstrouse uma opção viável, com resultado funcional e estético satisfatório, sem trazer grande prejuízo à área doadora e apresentando pele de cor, espessura e textura adequada à reconstrução da pálpebra inferior. ■ RESUMO

Experiência de tratamento cirúrgico de fraturas de côndilo mandibular extracapsular do Hospital do Trabalhador - Curitiba

DOI: 10.5935/2177-1235.2018RBCP0045 Introdução: As fraturas condilares possuem elevada incidência entre as fraturas mandibulares, sendo consideradas as fraturas mandibulares mais controversas, tanto em relação ao diagnóstico como ao tratamento. De acordo com a literatura, os resultados obtidos com o tratamento de fraturas condilares são satisfatórios, porém ainda permanece controversa a indicação cirúrgica ou conservadora. Este artigo apresenta uma revisão mais recente da experiência do Hospital do Trabalhador usando uma abordagem cirúrgica menos invasiva e viável para o tratamento cirúrgico aberto de fraturas condilares extracapsulares da mandíbula. Métodos: Entre 2013 e 2018, 09 pacientes com fratura condílica extracapsular foram tratados cirurgicamente através da abordagem transparotídea minirretromandibular. Foram analisados dados pré e pós-operatórios dos pacientes. Resultados: No pós-operatório não houve casos de infeção e não foram observados problemas com cicatriz. Durante o perioperatório, foi necessário mudança de plano cirúrgico de um paciente, devido à presença de sangramento. Conclusão: A experiência no Hospital do Trabalhador com a abordagem transparotídea minirretromandibular mostrou-se uma opção segura, devendo ser incluída como uma opção para o tratamento aberto de fraturas condilares extracapsulares da mandíbula. ■ RESUMO

Re: “Impact of Acellular Dermal Matrix (ADM) Use Under Mastectomy Flap Necrosis on Perioperative Outcomes of Prosthetic Breast Reconstruction”

Level of Evidence V This 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 Table of

Prophylaxis of fat embolism syndrome: a current analysis

Introduction: To analyze data from the internet on deaths from fat embolism, time of onset, and other information that could determine current reality in Brazil regarding fat embolism syndrome incidence and any ,media repercussions, and also to review methods of prevention and what are the best methods available to treat this disease. Methods: A Google search was conducted from January 2000 to January 2014 using the keywords “plastic surgery” and “death.” We included and reviewed articles containing the words “embolism”, “fat embolism” and “complications in (or of) plastic surgery”. Results: We included 235 relevant news stories over the 14 included years. There were 45 cases of death related with plastic surgery that offered few data for individualization. Of these patients, 44 were women. Possible causes mentioned were pulmonary embolism (five cases), perforation of viscera (four cases), malignant hyperthermia (three cases), anesthesia (two cases), anaphylactic shock (two cases), fat embolism (one confirmed case), and “other” (five cases). Conclusion: Guidelines to prevent fat embolism in plastic surgery are needed, however, there is also the need of more evidence based studies to understand more clearly what methods are best.

Influence of immunonutritional supplementation on skin wound healing in rats

Introduction: The wound healing process is immediate and dynamic in order to restore anatomical and functional continuity, and there must be conditions for this process, which include a normal nutritional state. Among the existing supplemental formulas, immuno-enhancing diets have been proposed to improve the wound healing process and patients’ clinical conditions. The influence of an immunomodulating diet (Impact) on different variables of the skin healing process was evaluated. Method: Healthy adult rats were randomly divided into four groups of diet supplementation or control. Two groups received their diets only pre-operatively while the other two groups received theirs perioperatively. Rats were subjected to three types of skin lesions. We evaluated the following aspects: changes in weight, development of raw areas, tensiometry of incisional wounds, re-epithelialization rates, and histological parameters. Results: There was no difference in weight changes. There was better closing rates of excisional wounds in groups supplemented with Impact beginning on the fifth day after surgery (p = 0.02). The groups receiving the dietary supplements obtained the best results in tensiometry (p = 0.03), re-epithelialization rates (p = 0.04), differential cell counts (p < 0.001), and total amount of collagen (p < 0.001). Conclusions: The study diet (Impact) promoted better closure rates of raw wounds, faster re-epithelialization, scars with a greater tensile strength, and greater amounts of total collagen in wounds. There was no difference in any of the parameters analyzed compared with the groups supplemented with Impact preand perioperatively.

Ossification of vascular pedicle in fibula free flap: a case report

Introduction: The use of fibula flaps for the reconstruction of craniomaxillofacial defects has many advantages, including the low morbidity of the donor area, good bone quality for use of osseointegrated implants, and the possibility to include a skin island, when indicated. During the dissection of the flap, a muscle “cuff” and a periosteal strip are usually included near the region of the vascular pedicle. The Brazilian Society of PlaStic Surgery SOCIEDADE BrASIlEIrA DE CIrurgIA plaStICA Relato de Caso Rev. Bras. Cir. Plast. 2014;29(2):198-200 DOI: 10.5935/2177-1235.2014RBCP0037

Solving Sharp Edges of the Antihelix After Otoplasty

Pitanguy described a technique in which an island of cartilage is created on the anterior surface of the ear that is pushed forward to resemble a smooth antihelical fold by suturing of edges of the wound after resection of a generous ellipse of skin from the posterior surface. Other surgeons have published studies presenting their successful experience with this technique. The authors, however, have seen several cases of secondary deformities utilizing this technique, presenting with a good antihelical fold, but with excessive sharpness evident, providing a deformed antihelix due the cartilage island. The authors present a novel solution for correction of this deformity.