Natale Ferreira Gontijo de Amorim

Surgical treatment of hemangiomas of the nose.

The approach to a rapidly growing vascular tumor is determined by a number of objective and subjective factors. As a rule, treatment of a hemangioma in an infant is usually delayed, in the expectation that involution will be complete. While most hemangiomas are harmless vascular marks, some may grow to become large, infiltrating masses. Local factors that influence treatment decision making include volume, ulceration, secondary infection, and bleeding of the tumor. Hemangiomas situated on the nose are distinguished from other locations by a few but important aspects and may demand a more aggressive position from the surgeon. An important consideration is the potential for aplasia of the delicate nasal cartilages that are undergoing development, due to the mass effect of the tumor. Nasal tip hemangiomas are slow to regress, and contour deformities result from the fibrofatty tissue that invariably remains even after total involution. More importantly, hemangiomas of the nasal region are particularly prone to causing great social distress to the parents, who will request prompt treatment for such a visible, deforming lesion. A definite solution that ensures removal of affected tissue and preservation of anatomy seems to be the best treatment for these tumors. In this article, the experience of the senior author (IP) in treating hemangiomas located on the nose is reviewed. The elliptical midline incision over the nasal dorsum described in the text was developed to address three important aspects: an expedient procedure to treat a highly disfiguring disease; an open access to allow for complete resection and, at the same time, allow for the correction of underlying cartilaginous disruption; and placement of a scar in an anatomic location proven to be very satisfactory aesthetically, permitting access for secondary procedures for better definition of nasal contour. Careful patient selection for this surgical procedure is emphasized.

Repeated expansion in burn sequela.

This paper presents a retrospective study of the use of 346 expanders in 132 patients operated at the Ivo Pitanguy Clinic, between the period of 1985 and 2000. The expanders were used in the treatment of burn sequela. In the majority of cases, more than one expander was used at the same time. In 42 patients, repeated tissue expansion was done. The re-expanded flaps demonstrated good distension and viability. With the increase in area at each new expansion, larger volume expanders were employed, achieving an adequate advancement of the flaps to remove the injured tissue. The great advantage of using tissue re-expansion in the burned patient is the reconstruction of extensive areas with the same color and texture of neighboring tissues, without the addition of new scars.

Contour surgery in the patient with great weight loss.

Abstract. Obesity can be defined as a chronic disease in which there is excess of body adiposity, leading to severe secondary health problems. This metabolic pathology shortens life-span and is a main cause of diabetes, atherosclerosis, systemic arterial hypertension, and reduction of pulmonary function, among others. The plastic surgeon is involved with the obese patient under two circumstances: either the patient is currently overweight and requests reduction of excess adipose tissue, or has suffered a great weight loss and desires correction of one, or more, contour deformities. In either case, planning demands a close preoperative analysis and careful preparation of the patient, execution of a meticulous surgical routine, and close postoperative follow-up. In this article, various body contour deformities will be addressed, showing the senior authors strategy in treating the obese patient that has achieved the loss of considerable weight.

Treatment of the Aging Face Using the “Round-lifting” Technique

Abstract Background: Characteristics of the aging face include not only senescence and flaccidity of the skin, but also sagging of deeper tissues, especially in the fascial and fatty layers. Objective: This study was undertaken to evaluate the different surgical approaches to the aging face, specifically the techniques available for correction of the prominent nasolabial fold, which is a significant sign of facial aging. Methods: Through a total of 7446 cases in more than 40 years of experience in the surgical correction of the aging face, the senior author has emphasized the importance of the repositioning of the skin and the facial soft tissues. After appropriate treatment of the superficial musculoaponeurotic system (SMAS) and the malar fat pad has been completed, adequate placement of the skin flaps is done by rotation, as described in the round-lifting technique, rather than by direct traction. The anatomic basis of this correction is discussed. Results: Traction of the SMAS was found to soften the appearance of the nasolabial fold to varying degrees, but other complementary procedures such as collagen injection or fat grafting often were necessary to achieve a more satisfactory correction. Durability of nasolabial fold correction with simple SMAS traction varied with each individual and his or her unique aging process. Simple traction of the SMAS did not include treatment of the fascial fatty layer. The senior author has included the treatment of the fascial fatty layer in his standard rhytidectomy over the last 2 years, with improved aesthetic results. Again, long-term correction by this technique is related to the aging process, and the final result was deemed superior to treatment of the SMAS alone. Direct excision of the nasolabial fold was performed in patients ranging from 35 to 60 years of age who had extremely prominent folds. In these very select cases, the results were considered satisfactory to both the surgeon and patient, with correction of the fold and acceptable scars. Conclusions: There is as yet no ideal solution for the surgical correction of the naso-labial fold component of the aging face. However, all of the techniques described are considered safe and have precise indications. It should be stressed to the patient that the nasolabial fold is part of the anatomy of the face and that the goal of treatment is to soften the appearance of the fold, not to eliminate it completely.

Influence of negative pressure on the viability of adipocytes and mesenchymal stem cell, considering the device method used to harvest fat tissue.

BACKGROUND Transplanted adipose tissue has many applications in regenerative medicine. However, fat grafting yields unpredictable results because the fat that is transferred can suffer variable degrees of fat reabsorption. It is necessary to identify methods and maneuvers to minimize reabsorption rates and provide predictable long-term results. OBJECTIVES Our study aimed to identify the optimal method of harvesting, as well as the optimal pressure regime for fat aspiration. The primary objective was to assess the degree of adipocyte and mesenchymal stem cell death that occurred with the various devices and pressure levels used to harvest fat. METHODS This study was a prospective, randomized, comparative study in 15 healthy male and female subjects aged 25 to 60 who were undergoing abdominal cosmetic surgery. Various apparatuses and pressure regimens were used to harvest 8 samples of fat tissue. These samples (R1 = R8) underwent histological analysis in order to verify the integrity and functionality of the adipocytes and mesenchymal stem cells that had been harvested. RESULTS A total of 14 females and 1 male underwent abdominal cosmetic surgery. Quantitative analysis revealed that the adipocytes in all 8 samples had homogeneous quantitative profiles. The adipose mesenchymal stem cell (AMSC) analysis, according to Friedman ANOVA, revealed no significant variation in the percentage of mesenchymal stem cells (P = .045) between the various samples. CONCLUSIONS The type of device, nozzle diameter tip, and pressure regimen used in this study for harvesting fat tissue did not significantly affect the number of the adipocytes or viable AMSC harvested. LEVEL OF EVIDENCE 3 Therapeutic.

Tromboembolismo venoso em cirurgia plástica: protocolo de prevenção na Clínica Ivo Pitanguy

BACKGROUND: The deep vein thrombosis (DVT) and its most dangerous outcome, the pulmonary embolism (PE), are complications of high incidence in hospitalized patients and in those submitted to surgery. OBJECTIVE: This study presents the guideline to prevention of thromboembolism at Ivo Pitanguy Clinic and its incidence before and after the introduction of this protocol, in a period of five years. We also relate the incidence of hematoma before and after the beginning of the protocol. METHODS: The study consists of the revision of the medical records of all patients operated between July 2004 and May 2009. We compared the incidence of thromboembolic events before and after the beginning of the protocol as well as the incidence of hematomas that were submitted to revision at the surgery room. RESULTS: Analyzing 1700 medical records, since the introduction of the guideline of prevention of VTE, there is no case of VTE in 711 operated patients. The incidence of reoperated hematomas at the surgery room was reduced, maybe because there was a more rigorous control of the blood pression after the introduction of the guideline. CONCLUSION: The guideline has shown itself practical and simple use. There were reduction in cases of VTE and hematomas after its introduction.

Forehead lifting: the juxtapilose subperiosteal approach.

Aging in the upper face becomes more evident as the eyebrow level descends. Sometimes this may begin at an early age. The senior author has described a limited approach for the treatment of this aesthetic alteration. In selected cases, the juxtapilose incision, placed laterally at the margin of the anterior hairline, allows for the subperiosteal undermining of the entire forehead and dissection of the elements that cause the descent of the eyebrow. The procedure is safe and expedient, and permits for a controlled repositioning of the eyebrow. In this paper, the authors describe the juxtapilose incision and the subperiosteal approach of the forehead as a practical ancillary procedure for correction of the aging face.

Análise das trocas de implantes mamários nos últimos cinco anos na Clínica Ivo Pitanguy

Background: The breast augmentation surgery was the most performed in Brazil in 2008. With the evolution of the technique and the quality of the implants, complications have diminished, leading to a more secure procedure. Objective: To assess the profile of patients submitted to implant exchange in the last five years at Ivo Pitanguy Clinic, analyzing the causes that led to implant removal. Methods: We have analyzed all patients submitted to exchange, removal or replacement of mammary implants in the last five years, at a total of 59 patients, 68 procedures and 129 breasts operated. Results: The time interval from the inclusion to the removal of the implants ranged from one month to 34 years; 44 patients have first operated at our service and 24 at other services. Forty three implants were, before the exchange, made of polyurethane, 13 texturized and six smooth. The major cause of the exchange was esthetic, with 50 cases, followed by capsular contracture, 13 cases and five cases of infection, rupture or breast nodule. Conclusion: The major reason of implants exchange was esthetic, differing from the literature. The capsular contracture and infection rates, at this study, were comparable to several others.

Incisão transareolopapilar para mamoplastia de aumento: experiência dos últimos 10 anos do Instituto Ivo Pitanguy

INTRODUCAO: Varias vias de acesso foram criadas para a inclusao de implantes na cirurgia de aumento das mamas. Em 1966, Pitanguy descreveu a via de acesso transareolopapilar. O objetivo do presente estudo e avaliar as mamoplastias de aumento realizadas no Instituto Ivo Pitanguy (Rio de Janeiro, RJ, Brasil), nas quais se utilizou a incisao transareolopapilar, nos ultimos 10 anos. METODO: Realizado estudo retrospectivo, analisando-se os seguintes parâmetros: tamanho dos implantes, indicacao da incisao transareolopapilar e complicacoes pos-operatorias, como alteracoes cicatriciais. RESULTADOS: Foram incluidas no estudo 53 pacientes, com media de idade de 33,54 anos e tempo medio de seguimento de 11,6 meses. A maioria (60,4%) dos implantes possuia menos de 200 ml. Doze pacientes foram submetidas a reintervencoes pelas seguintes razoes: nodulo mamario (1 caso), infeccao (1 caso), contratura capsular (1 caso), e insatisfacao com a forma das mamas (4 casos), com o volume (4 casos) e com a cicatriz unilateral (1 caso). Dezesseis (30,2%) pacientes desenvolveram alguma complicacao menor no pos-operatorio e 13 (24,5%) apresentaram alguma alteracao cicatricial no pos-operatorio: hipocromia (18,9%), hipertrofia unilateral (1,9%), retracao cicatricial unilateral (1,9%), e areola bifida (1,9%). Vinte (37,7%) pacientes realizaram seguimento pos-operatorio superior a um ano e relataram satisfacao com a cicatriz. CONCLUSOES: A incisao transareolopapilar permite a inclusao de implantes de tamanho pequeno a moderado, com baixo indice de complicacoes pos-operatorias e cicatriciais, desde que seguida a correta tecnica cirurgica.

Protocolo de prevenção de tromboembolismo venoso no Instituto Ivo Pitanguy: eficácia e segurança em 1.351 pacientes

INTRODUCTION: Thromboembolic events are a serious concern due to the high rates of morbidity and mortality as well as the possibility of existing disease presenting with scarce and often nonspecific symptoms. Prevention is the most effective management method for this kind of event, which can quickly lead to death once it occurs. METHODS: A retrospective study was conducted between May 2009 and May 2010 on patients undergoing plastic surgery at the Ivo Pitanguy Institute. All patients underwent the protocol for the prevention of venous thromboembolism after being assessed for risk factors. These factors were summed to generate a score, which determined the prophylaxis to be implemented. RESULTS: During one year, 1351 patients were assessed. There was no incidence of venous thromboembolism. There were 16 cases of hematoma, 9 (56.25%) of which occurred after heparin prophylaxis and 7 (43.75%) of which occurred without the use of prophylaxis. CONCLUSIONS: The protocol for the prevention of venous thromboembolism at the Ivo Pitanguy Institute was effective, with no occurrence of VTE cases and the incidence of hematomas remained below that found in the medical literature.