ABSTRACT
INTRODUÇÃO: A reconstrução mamária com retalho do músculo reto abdominal (TRAM, do inglês transverse rectus abdominis myocutaneous) tem se tornado um procedimento comumente realizado desde a década de 1990. O TRAM ipsilateral vem demonstrando ser tão seguro quanto o retalho contralateral na reconstrução mamária. Entretanto, estudos avaliando o resultado estético com as duas técnicas são escassos na literatura. A proposta deste estudo é comparar os resultados cosméticos entre os retalhos pediculados ipsilateral e contralateral. MÉTODO: Foi realizada avaliação prospectiva de 29 pacientes submetidas a reconstrução imediata com TRAM ipsilateral e contralateral. Os grupos foram comparados entre si, analisando-se os resultados estéticos. RESULTADOS: O estudo incluiu 29 pacientes, com média de idade foi 43 + 7 anos. O grupo 1 (TRAM ipsilateral) apresentou o sulco inframamário bem definido em 91,7% dos casos, comparativamente a 52,9% no grupo 2 (TRAM contralateral). Observou-se abaulamento na região xifoide em 8,3% dos pacientes do grupo 1 e em 23,5% dos pacientes do grupo 2. A diferença na forma global da mama reconstruída não foi importante, com 66,7% e 70,6% de simetria nos grupos 1 e 2, respectivamente. CONCLUSÕES: O TRAM ipsilateral demonstrou melhor manutenção do sulco inframamário e menor abaulamento na região xifoide. Entretanto, a forma global da mama e a projeção do polo inferior da mama foram similares entre os dois grupos.
BACKGROUND: Breast reconstruction by using the rectus abdominis muscle (transverse rectus abdominis myocutaneous, TRAM) flaps is a common procedure that has been performed since the 1990s. Ipsilateral TRAM flaps were proven to be as safe as contralateral flaps for breast reconstruction. However, studies comparing the aesthetic outcomes of the two procedures are poorly described in the literature. The aim of this study was to compare the cosmetic outcomes of ipsilateral and contralateral pedicled flaps. METHODS: We prospectively evaluated 29 cases of immediate reconstruction with ipsilateral (group 1) or contralateral (group 2) TRAM flaps. The aesthetic outcomes were analyzed and the two groups were compared. RESULTS: The average age of the patients was 43 ± 7 years. In group 1 (ipsilateral TRAM), 91.7% of the patients presented a well-defined inframammary fold, as compared to 52.9% of the patients in group 2 (contralateral TRAM). In group 1, 8.3% of patients showed xiphoid bulges, whereas they were observed in 23.5% of patients in group 2. The difference in the overall shape of the reconstructed breast was not significant; symmetry was observed in 66.7% and 70.6% of patients in groups 1 and 2, respectively. CONCLUSIONS: Ipsilateral TRAM flaps allow better preservation of the inframammary fold and cause less xiphoid bulge. However, the overall shape of the breast and the projection of its lower pole were similar between the two groups.
Subject(s)
Humans , Female , Adult , Abdominal Muscles , Mammaplasty , Microsurgery , Breast/surgery , Xiphoid Bone/surgery , Plastic Surgery Procedures , Surgical Flaps , Diagnostic Techniques and Procedures , Esthetics , Methods , PatientsABSTRACT
Presentar nuestra experiencia en 18 colecistectomías laparoscópicas con un sólo puerto visible subxifoideo de 5 mm, obtenida en el Departamento de Cirugía de dos hospitales privados, con el fin de introducir en nuestro país las técnicas que disminuyan aún más el trauma de la laparoscopia tradicional. Estudio prospectivo, observacional. Fueron intervenidos 18 pacientes con la técnica de colecistectomía laparoscópica con un sólo puerto visible subxifoideo, en el período de enero a abril de 2008. Se excluyeron casos de colecistitis aguda, coledocolitiasis y cáncer. Se analizaron la edad, sexo, el tiempo quirúrgico, la estancia hospitalaria, las complicaciones, el índice de conversión y los efectos estéticos. Predominó el sexo femenino (17 a 1). La edad promedio fue de 41 años. El tiempo quirúrgico promedio fue de 67 minutos (58 minutos promedio con el uso del ligasure y 98 minutos sin este equipo). El tiempo de hospitalización fue de 24 horas. Se evidenció una sola cicatriz a nivel subxifoideo, en contraste con la técnica laparoscópica habitual, con 3 cicatrices visibles. No hubo conversiones. No hubo morbilidad ni mortalidad. La técnica es perfectamente reproducible en nuestro medio, aportando beneficios adicionales estéticos a la colecistectomía laparoscópica tradicional.
Subject(s)
Humans , Male , Adult , Female , Ampicillin/administration & dosage , Cholecystectomy, Laparoscopic/methods , Urinary Bladder Calculi/complications , Urinary Bladder Calculi/diagnosis , Ampicillin/pharmacology , Xiphoid Bone/surgery , Cystic Duct/surgeryABSTRACT
The use of the subxiphoid pericardial window (SPW) in evaluating stable patients with cardiac proximity injuries is presented in a short case series. There were 11 patients with four positive and seven negative SPW. There was one false positive and no false negatives. Review of the literature on the use of the SPW as a diagnostic tool in evaluating cardiac proximity injuries shows the SPW to be a rapid and reliable method of detecting occult cardiac injuries, and is especially useful in areas where emergency echocardiography is not available