Marilho Tadeu Dornelas

Síndrome de Fournier: 10 anos de avaliação

INTRODUCAO: A gangrena de Fournier e uma fasciite necrosante sinergica do perineo e parede abdominal, que tem origem no escroto e penis, no homem, e vulva e virilha, na mulher. O processo inicialmente foi descrito como idiopatico, mas atualmente sabe-se que se trata de grave afeccao causada por bacterias Gram positivas, Gram negativas ou anaerobios, que pode levar a comprometimento sistemico importante e, eventualmente, morte. METODO: Foi realizado estudo retrospectivo, baseado na analise de prontuarios medicos de 23 pacientes portadores de sindrome de Fournier, no periodo de janeiro de 2002 a janeiro de 2012. O tratamento dos pacientes incluiu intervencao precoce, com antibioticoterapia de largo espectro e desbridamentos consecutivos. O procedimento terapeutico empregado para a reconstrucao variou desde a aproximacao das bordas com sutura simples ate uso de retalhos e enxertos, nas lesoes extensas. RESULTADOS: As tecnicas de reparacao cutânea foram eficientes e a reparacao escrotal foi tambem efetiva em todos os casos, obtendo-se bons resultados esteticos. Houve 3 (13%) obitos, 2 deles em pacientes com doencas pregressas e portadores de comorbidades. CONCLUSOES: Apesar da reconhecida gravidade da Sindrome de Fournier, as medidas terapeuticas adotadas, como rapida intervencao, desbridamento precoce e antibioticoterapia de amplo espectro, juntamente com abordagem multidisciplinar, demonstraram-se bastante eficazes no controle da doenca, permitindo reconstrucao cirurgica das areas atingidas, com baixa mortalidade.

Assessment of quality of life in patients who underwent breast reduction using BREAST-Q

1. Mundy LR, Homa K, Klassen AF, Pusic AL, Kerrigan CL. Breast cancer and reconstruction: normative data for interpreting the BREAST-Q. Plast Reconstr Surg 2017;139:1046e–1055e. 2. Pusic AL, Klassen AF, Scott AM, Klok JA, Cordeiro PG, Cano SJ. Development of a new patient-reported outcome measure for breast surgery: theBREAST-Q.PlastReconstr Surg2009;124:345–53. 3. Cano S, Klassen A, Scott A, Pusic A. A closer look at the BREAST-Q. Clin Plast Surg 2013;40:287–96. 4. Macadam SA, Zhong T, Weichman K, et al. Quality of life and patient-reported outcomes in breast cancer survivors: a multicenter comparison of four abdominally based autologous reconstruction. Plast Reconstr Surg 2016;137:758–71. 5. Saad A, Sadeghi A, Allen RJ. The anatomic basis of the profunda femoris artery perforator flap: a new option for autologous breast reconstruction – a cadaveric and computer tomography angiogram study. J Reconstr Microsurg 2012;28:381–6.

Rhinophyma: analysis of the shave excision technique

Introduction: The rhinophyma is an extremely stigmatizing condition for a patient. The first descriptions of this disease dates back to the time of Hippocrates, which was popular known as alcoholic nose or nasal elephantiasis is responsible for generating a huge deformity in the nose. This deformity derives from a process of hyperplasia and hypertrophy of the sebaceous glands in nasal skin associated with fibrosis and dilated local blood vessels and connective tissue. Surgery is considered the treatment of choice for aesthetic improvement of the injury. Methods: This was a retrospective study based on analysis of results from 11 patients (10 men and 1 woman) who underwent treatment for rhinophyma between January 2010 to January 2016 at the Plastic Surgery Service of the Teaching Hospital of Federal University of Juiz de Fora and Clinical Plastic Center. Results: Of 11 patients who underwent surgery, a 72-year-old man had basal expansive invasive carcinoma with positive surgical margins after pathological examination of the surgical specimen, however, the patient had pathological free margins after reoperation. Other 3 patients had hypercromy in the intervention region during the immediate postoperative. Conclusion: Despite technological advances, the removal of the injury with a cold scalpel technique and the use of postoperative dressings are highly efficient, when combined, provide excellent aesthetic results with low complication rates and high rates of patients’ satisfaction, whom mostly had improvement in quality of life after the procedure. ■ ABSTRACT

The impact of dermolipectomy in improving the quality of life in patients with abdominal lipodystrophy

1 Hospital Universitário, Faculdade de Medicina, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, Brazil. 2 Sociedade Brasileira de Cirurgia Plástica, São Paulo, SP, Brazil. 3 Faculdade de Medicina da Universidade Federal de Viçosa, Viçosa, MG, Brazil. 4 Faculdade de Ciência Médica e da Saúde de Juiz de Fora Suprema, Juiz de Fora, MG, Brazil. Conflicts of interest: none. Introduction: The valuation of appearance, combined with patterns and parameters imposed by the beauty and fashion industries, and disseminated by the media, generates questions about the real value of beauty. Distortions in these parameters lead patients, dissatisfied with their bodies, to medical clinics. Concomitantly, there are dysfunctional physical complaints and their consequences. Plastic Surgery, in this context, aims at improving the quality of life and acceptance of one’s body. Abdominoplasty, or abdominal dermolipectomy, is a highly used surgical procedure. However, few evaluations regarding the personal image and the quality of life in the postoperative period exist. The objective is to evaluate the improvement of the quality of life and the body image in patients who underwent an abdominal dermolipectomy as an elective procedure, and to understand the physical-psychological implications related to body disorders. Methods: The WHOQOL-BREF instrument was administered to 15 patients with abdominal lipodystrophy who underwent an abdominal dermolipectomy at the Clinic of Plastic Surgery at the University Hospital of the Federal University of Juiz de Fora and Plastic Center Clinic. The instrument was administered thrice: once during the pre-operative period and then at two and six months postoperatively. Results: On comparing the pre and postoperative stages, we found a statistically significant improvement in the quality of life of patients with respect to the psychological domain (p < 0.05). In the physical domain, the relationship between the three stages was also statistically significant, considering a p value < 0.07. Conclusions: The use of abdominoplasty in the treatment of abdominal lipodystrophy has an impact on the improvement of the quality of life of these patients, mainly in the physical and psychological domains; this is in agreement with previous studies. ■ ABSTRACT

Liposuction-related complications and death: survey conducted by the BSPS commission on liposuction

Introduction: Liposuction is a surgical procedure that was developed approximately 30 years ago by Fournier, Illouz, and others. In 2011, a total of 211,108 liposuction procedures were performed in Brazil versus 325,332 in the United States. Over the years, liposuction performed with the tumescent technique has had a good safety profile. It is also performed by other specialists, including dermatologists, and has been described as an outpatient procedure in public institutions in Brazil. The scarcity of data on the subject has led the Brazilian Society of Plastic Surgery (BSPS) to create a commission composed of 10 full members with the aim of investigating the factors involved in severe liposuction-related complications and death in Brazil. Methods: An online questionnaire was created using an anonymous link on the BSPS website. The questionnaire was sent to the registered email addresses of 4,441 associate and full members of the BSPS. The first question was about the occurrence of liposuction-related complications. The respondents could only continue to answer the questionnaire if the answer to this question was “yes.” In addition to the questionnaire, the BSPS sent letters to the official state and federal institutions in which the case or complication/death-related records and/or deaths as a consequence of liposuction were expected to exist. The significance of the association between death and the various factors was determined using the chi-square test. The significant variables were included in Poisson Regression Models. The significance level was set at 5%. The data were analyzed using STATA software version 10.0. Results: Thromboembolic events, combined surgical procedures, and the facilities where the procedure was performed were risk factors involved in liposuction-related mortality. Conclusion: The implementation of programs that aim to standardize liposuction procedures may effectively reduce liposuction-related mortality rates. This study aimed to make a positive educational impact on the development of future safe liposuction protocols.

Tratamento cirúrgico da ginecomastia: uma análise criteriosa

INTRODUCAO: A ginecomastia e o aumento no tamanho da glândula mamaria masculina, que pode ser fisiologico ou patologico, sendo condicao passivel de correcao. OBJETIVO: Analisar o tratamento cirurgico da ginecomastia, apontando suas principais complicacoes. METODO: Duzentos e oitenta e quatro pacientes foram submetidos a cirurgia para correcao da ginecomastia entre janeiro de 1998 e setembro de 2008, sendo 94,37% dos pacientes graus I e II e 5,63%, grau III. RESULTADOS: Em relacao ao total de pacientes, 3,87% apresentaram seroma e 2,11%, hematoma (p<0,001). A analise dos pacientes graus I e II revela que 0,74% apresentaram cicatrizes hipertroficas nas incisoes de lipoaspiracao (p<0,001). Dentre os pacientes submetidos a tecnica de Davidson, 18,75% apresentaram alargamento do complexo areolo-mamilar (p=0,108) e foram submetidos a cirurgia para correcao. CONCLUSAO: As tecnicas utilizadas para correcao de ginecomastia se mostraram eficazes e seguras.