Versatilidad y vigencia del colgajo TRAM en la reconstrucción mamaria postmastectomía. Nuestra experiencia / Versatility and validity of the TRAM fl ap in breast reconstruction postmastectomy. Our experience

El cáncer de mama es un importante problema de Salud Pública. En las pacientes mastectomizadas, es importante considerar la reconstrucción mamaria, de preferencia con tejidos autólogos, como el colgajo TRAM, que sigue siendo caballito de batalla hasta nuestros días; permite restaurar la forma mamaria y simetría con la mama contralateral, con benefi cios en la imagen corporal, autoestima, sexualidad y calidad de vida en general. Esta investigación evidencia la vigencia y versatilidad del colgajo TRAM en la reconstrucción mamaria, experiencia obtenida con la vinculación al centro oncológico y al grupo multidisciplinario de mastología a través de la reconstrucción mamaria de 11 pacientes mastectomizadas. Estas reconstrucciones muestran que el TRAM sigue presente en el arsenal quirúrgico de cirujanos plásticos y brinda excelentes resultados estéticos y satisfacción de las pacientes

Breast cancer is a major public health problem. In mastectomized patients, it is important to consider breast reconstruction, preferably with autologous tissues, such as the tram fl ap, which continues to be a "workhorse" to this day; Allowing to restore the breast shape and symmetry with the contralateral breast, with benefi ts in body image, self-esteem, sexuality, and quality of life in general. This research evidences the validity and versatility of the TRAM fl ap in breast reconstruction, experience obtained with the connection to the cancer center, and the multidisciplinary group of mastology, carrying out breast reconstruction of 11 mastectomized patients, showing that the TRAM is still present in the surgical arsenal of plastic surgeons with excellent aesthetic results and patient satisfaction

Effectiveness of pilates-based exercises on the diastasis recti abdominis in climacteric women: a randomized controlled trial

INTRODUCTION: Recent studies have related the climacteric period with changes in connective tissue elasticity that may be related to diastasis recti abdominis. Mat Pilates is a method of exercise without impact that currently has more practitioners, due to its satisfactory results. However, there are no studies that evaluate the effectiveness of mat Pilates for women with diastasis recti abdominis. OBJECTIVE: To evaluate the effectiveness of the mat Pilates program in climacteric women with diastasis recti abdominis. METHODS: This randomized single-blinded clinical trial evaluated climacteric women with diastasis recti abdominis. The participants were randomized into the experimental group, which participated in 3 weekly sessions of mat Pilates for 12 weeks for a total of 36 sessions, and the control group (without exercises). The inter-rectus distance was measured with a digital caliper. The G*Power Version 3.1.9.2. software was used for the sample calculation, and the SPSS 20.0 program was used for statistical analysis. RESULTS: The study comprised 21 women, including 10 in the control group and 11 in the experimental group, with mean ages of 54.3 ± 7.1 and 55.3 ± 6.0 years and body mass index values of 28.8 ± 5.5 kg/m2 and 29.9 ± 4.48 kg/m2, respectively. In the experimental group, reductions were observed in all the measures related to diastasis recti abdominis (p<0.05) in the supraumbilical, umbilical, and infra-umbilical regions. CONCLUSION: The mat Pilates method is effective for reducing diastasis recti abdominis in the climacteric period.

A preliminary report of laparoscopic extraperitoneal colostomy anterior to posterior sheath of rectus abdominis-transversus abdominis to prevent parastomal hernia / 中华外科杂志

Objective: To examine the preliminary effect of laparoscopic extraperitoneal colostomy anterior to posterior sheath of rectus abdominis-transversus abdominis for the prevention of parastomal hernia after abdominoperineal resection for rectal cancer. Methods: This study is a prospective case series study. From June 2021 to June 2022, patients with low rectal cancer underwent laparoscopic abdominoperineal resection combined with extraperitoneal colostomy anterior to posterior sheath of rectus abdominis-transversus abdominis at the First Department of General Surgery, Shaanxi Provincial People's Hospital were enrolled. The clinical data and postoperative CT images of patients were collected to analyze the incidence of surgical complication and parastomal hernia. Results: Totally 6 cases of patient were enrolled, including 3 males and 3 females, aging 72.5 (19.5) years (M(IQR)) (range: 55 to 79 years). The operation time was 250 (48) minutes (range: 190 to 275 minutes), the stoma operation time was 27.5 (10.7) minutes (range: 21 to 37 minutes), the bleeding volume was 30 (35) ml (range: 15 to 80 ml). All patients were cured and discharged without surgery-related complications. The follow-up time was 136 (105) days (range: 98 to 279 days). After physical examination and abdominal CT follow-up, no parastomal hernia occurred in the 6 patients up to this article. Conclusions: A method of laparoscopic extraperitoneal colostomy anterior to posterior sheath of rectus abdominis-transversus abdominis is established. Permanent stoma can be completed with this method safely. It may have a preventive effect on the occurrence of parastomal hernia, which is worthy of further study.

Effectiveness of lobulated pedicled rectus abdominis myocutaneous flap for repairing huge chest wall defect / 中国修复重建外科杂志

OBJECTIVE@#To explore the effectiveness of lobulated pedicled rectus abdominis myocutaneous flap to repair huge chest wall defect.@*METHODS@#Between June 2021 and June 2022, 14 patients with huge chest wall defects were treated with radical resection of the lesion and lobulated pedicled rectus abdominis myocutaneous flap transplantation for reconstruction of chest wall defects. The patients included 5 males and 9 females with an average age of 44.2 years (range, 32-57 years). The size of skin and soft tissue defect ranged from 20 cm×16 cm to 22 cm×22 cm. The bilateral pedicled rectus abdominis myocutaneous flaps in size of 26 cm×8 cm to 35 cm×14 cm were prepaired and cut into two skin paddles with basically equal area according to the actual defect size of the chest wall. After the lobulated pedicled rectus abdominis myocutaneous flap was transferred to the defect, there were two reshaping methods. The first method was that the skin paddle at the lower position and opposite side was unchanged, and the skin paddle at the effected side was rotated by 90° (7 cases). The second method was that the two skin paddles were rotated 90° respectively (7 cases). The donor site was sutured directly.@*RESULTS@#All 14 flaps survived successfully and the wound healed by first intention. The incisions at donor site healed by first intention. All patients were followed up 6-12 months (mean, 8.7 months). The appearance and texture of the flaps were satisfactory. Only linear scar was left at the donor site, and the appearance and activity of the abdominal wall were not affected. No local recurrence was found in all tumor patients, and distant metastasis occurred in 2 breast cancer patients (1 liver metastasis and 1 lung metastasis).@*CONCLUSION@#The lobulated pedicled rectus abdominis myocutaneous flap in repair of huge chest wall defect can ensure the safety of blood supply of the flap to the greatest extent, ensure the effective and full use of the flap tissue, and reduce postoperative complications.

Clinical application effect of pedunculated rectus abdominis muscle combined with bilateral ureters for repairing refractory bladder-vaginal stump fistula through external vesical drainage / 中华肿瘤杂志

Objective: To investigate the efficacy and safety of pedunculated rectus abdominis combined with bilateral ureteral extravestheter drainage in the treatment of refractory bladder-vaginal stump fistula. Methods: The clinical data of 8 cases of the refractory bladder-vaginal stump fistula were admitted to the Second Hospital of Hebei Medical University and Henan Cancer Hospital and underwent the clinical treatment of bladder-vaginal stump from December 2019 to December 2022 were collected. The reason of refractory bladder-vaginal stump fistula was analyzed, the operation manner of pedunculated rectus abdominis combined with peduncle and bilateral ureter for the treatment of bladder-vaginal stump through extrabladder drainage was explored. The operation time, bleeding volume and clinical effect were record. Results: The median operation time of 8 patients was 150 minutes(120~180 min), and the median blood loss was 400 ml(200~600 ml). During the perioperative period, there were 2 cases of incision infection, delayed healing by debridement and dressing, 2 cases of incision rupture and suture wound healing after reoperation, and 2 cases of urinary tract infection were cured by anti-infection. When followed up for 6 months, 8 cases of vesicovaginal stump fistula were cured. Conclusion: Bilateral ureteral external drainage of the rectus abdominis muscle, has a practical effect in the treatment of refractory bladder-vaginal stump fistula, which can be one of the clinical repairing treatment.

Clinical application effect of pedunculated rectus abdominis muscle combined with bilateral ureters for repairing refractory bladder-vaginal stump fistula through external vesical drainage / 中华肿瘤杂志

Objective: To investigate the efficacy and safety of pedunculated rectus abdominis combined with bilateral ureteral extravestheter drainage in the treatment of refractory bladder-vaginal stump fistula. Methods: The clinical data of 8 cases of the refractory bladder-vaginal stump fistula were admitted to the Second Hospital of Hebei Medical University and Henan Cancer Hospital and underwent the clinical treatment of bladder-vaginal stump from December 2019 to December 2022 were collected. The reason of refractory bladder-vaginal stump fistula was analyzed, the operation manner of pedunculated rectus abdominis combined with peduncle and bilateral ureter for the treatment of bladder-vaginal stump through extrabladder drainage was explored. The operation time, bleeding volume and clinical effect were record. Results: The median operation time of 8 patients was 150 minutes(120~180 min), and the median blood loss was 400 ml(200~600 ml). During the perioperative period, there were 2 cases of incision infection, delayed healing by debridement and dressing, 2 cases of incision rupture and suture wound healing after reoperation, and 2 cases of urinary tract infection were cured by anti-infection. When followed up for 6 months, 8 cases of vesicovaginal stump fistula were cured. Conclusion: Bilateral ureteral external drainage of the rectus abdominis muscle, has a practical effect in the treatment of refractory bladder-vaginal stump fistula, which can be one of the clinical repairing treatment.

Bilateral rectus sheath block as the sole anesthetic technique for urgent incarcerated umbilical hernia repair / Bloqueo de la vaina de los rectos bilateral como única técnica anestésica para reparación quirúrgica urgente de hernia umbilical incarcerada

Rectus sheath block is an interesting analgesic technique for umbilical hernia repair and there are some case reports where it was even used as the sole anesthetic. We describe the clinical case of a patient who required an urgent surgery for an incarcerated umbilical hernia and who was successfully managed with a bilateral rectus sheath block along with light sedation. Ultrasound-guided bilateral rectus sheath block provided anesthesia for our patient, avoiding the risks of the general and spinal anesthesia for his particular clinical situation and achieving an excellent postoperative analgesia, a fast recovery and hospital discharge without any complications.

El bloqueo de la vaina de los rectos es una técnica analgésica interesante para la reparación de la hernia umbilical y hay casos descritos donde incluso se ha usado como único anestésico. Describimos el caso clínico de un paciente que precisó reparación urgente de una hernia umbilical incarcerada y que fue manejado con éxito con un bloqueo de la vaina de los rectos bilateral junto con sedación ligera. El bloqueo ecoguiado de la vaina de los rectos bilateral aportó anestesia quirúrgica para nuestro paciente, evitando los riesgos de la anestesia general y espinal en su peculiar situación clínica y consiguió una analgesia postoperatoria excelente, una rápida recuperación y alta hospitalaria sin complicacione

Bilateral rectus sheath block as the sole anesthetic technique for urgent incarcerated umbilical hernia repair / Bloqueo de la vaina de los rectos bilateral como única técnica anestésica para reparación quirúrgica urgente de hernia umbilical incarcerada

Rectus sheath block is an interesting analgesic technique for umbilical hernia repair and there are some case reports where it was even used as the sole anesthetic. We describe the clinical case of a patient who required an urgent surgery for an incarcerated umbilical hernia and who was successfully managed with a bilateral rectus sheath block along with light sedation. Ultrasound-guided bilateral rectus sheath block provided anesthesia for our patient, avoiding the risks of the general and spinal anesthesia for his clinical situation, and achieving an excellent postoperative analgesia, a fast recovery and hospital discharge without any complications.

El bloqueo de la vaina de los rectos es una técnica analgésica interesante para la reparación de la hernia umbilical y hay casos descritos donde incluso se ha usado como único anestésico. Describimos el caso clínico de un paciente que precisó reparación urgente de una hernia umbilical incarcerada y que fue manejado con éxito con un bloqueo de la vaina de los rectos bilateral junto con sedación ligera. El bloqueo ecoguiado de la vaina de los rectos bilateral aportó anestesia quirúrgica para nuestro paciente, evitando los riesgos de la anestesia general y espinal en su peculiar situación clínica y consiguió una analgesia posoperatoria excelente, una rápida recuperación y alta hospitalaria sin complicaciones.

Versatilidad del colgajo VRAM / Versatility of the VRAM flap

Los defectos extensos de la pared abdominal y de la zona perineal derivados de las resecciones tumorales o posteriores a procesos infecciosos pueden ser resueltos de una manera rápida y sin la ayuda de técnicas microquirúrgicas mediante el colgajo VRAM, una herramienta reconstructiva importante que ha entrado en desuso, pero que sin lugar a dudas es una estrategia que proporciona seguridad para el cirujano plástico en los casos indicados. En nuestro trabajo se describe una serie de casos en los que se utilizó al colgajo VRAM para la reconstrucción de defectos en pared abdominal y la zona perineal; defectos amplios que fueron satisfactoriamente resueltos, en donde se denotan las ventajas que ofrece este colgajo para la resolución de problemas reconstructivos de las áreas anatómicas en cuestión.

Extensive defects of the abdominal wall and perineal area derived from tumor resections or after infectious processes can be resolved quickly and without the help of microsurgical techniques using the VRAM flap, an important reconstructive tool that an important reconstructive tool that that has gone into disuse, but without a doubt it is a strategy that provides security for the plastic surgeon in the indicated cases. In our work, a series of cases are described in which the VRAM flap was used for the reconstruction of defects in the abdominal wall and the perineal area; large defects that were satisfactorily resolved, where the advantages offered by this flap for the resolution of reconstructive problems of the anatomical areas in question are denoted.

Douleurs abdominales non traumatiques de l'enfant place de l'échographie dans la prise en charge au CHU de Bouake (Côte d'Ivoire)

Contexte et objectif. La douleur abdominalenon traumatique est un motif fréquent de consultation des enfants. Sa prise en charge nécessite des examens complémentaires comme l'échographie qui est demandée très souvent en première intention chez les enfants. L'objectif de cette étude était de déterminer le profi l épidémiologique et les principales pathologies responsables de douleurs abdominales non traumatiques de l'enfant à l'échographie. Méthodes. II s'agissait d'une étude rétrospective à visée descriptive réalisée au CHU de Bouaké du 1erJanvier 2019 au 31 Décembre 2019 soit 12 mois. Elle avait porté sur 300 enfants qui présentaient une douleur abdominale chez qui une échographie abdominale avait été réalisée par un médecin radiologue sénior. L'analyse statistique s'est faite à l'aide des tests de Khi2 et de Fisher au seuil de signifi cation situé à 5% (P<0,05). Résultats. Au total, il y avait 300 enfants. L'âge moyen était de 9 ans avec des extrêmes de 3 mois et 15 ans. Le sexe masculin représentait 60% des cas soit un sex ratio de 1,5. L'exploration échographique avait retrouvé une anomalie dans 75,3%. Il s'agissait de lésions organiques abdominales dans 65,6% et extraabdominales (9,7%). Les affections hépato-biliaires représentaient 54,4%, suivies des lésions spléno-ganglionnaires (40 %) puis des anomalies intestinales et rénales avec respectivement 21% et 15%. L'échographie avait confi rmé 55 % des hypothèses diagnostiques évoquées par les cliniciens et dans 20% des cas, un autre diagnostic avait été retenu à la fi n de l'examen. Conclusion. L'échographie occupe une place de choix dans la prise en charge des douleurs abdominales non traumatiques de l'enfant. C'est un moyen d'imagerie non irradiant, accessible, performant et reproductible permettant une exploration adéquate des lésions abdominales.

Relação entre a diástase do músculo reto abdominal supraumbilical e infraumbilical e a contração dos músculos do assoalho pélvico de puérperas / Relationship between supra- and infraumbilical diastasis recti abdominis and pelvic floor muscles contraction of puerperal women

Objetivo: Avaliar a relação entre diástase músculo reto abdominal (DMRA) supra- e infraumbilical com a contração da musculatura do assoalho pélvico (MAP) de mulheres no pós-parto imediato, internadas em uma maternidade pública. Metodologia: Estudo transversal aprovado pelo Comitê de Ética em Seres Humanos (nº 1.674.698; CAA 6163616.8.0000.0096). Participaram 60 puérperas de baixo risco, assistidas nas enfermarias de uma maternidade. A DMRA foi avaliada pela palpação abdominal e graduada conforme a quantidade de polpas digitais. A contração da MAP foi avaliada por meio da inspeção visual. A correlação das variáveis foi realizada pelo teste de Spearman, com nível de significância em p<0,05. Resultados: 40 puérperas (66,7%) apresentaram DMRA supraumbilical e 23 participantes (38,4%) mantinham DMRA infraumbilical maior do que 2 polpas digitais. Cerca de 71,4% das puérperas contraíram MAP isoladamente e 12,7% contraíram MAP utilizando mecanismos compensatórios; 14,3% das puérperas não conseguiram realizar a contração. A DMRA supraumbilical está correlacionada com a contração da MAP com músculos acessórios de primíparas (p=0,03; r=-0,46); a sustentação da contração da MAP em multíparas (p=0,03; r=-0,43); e a ausência da contração da MAP (=0,03; r=0,35) e ao tempo de sustentação da contração (p=0,02; r=-0,40) em puérperas que realizaram parto vaginal. Conclusão: A presença da DMRA supraumbilical apresenta correlação com a função da MAP de puérperas de acordo com a paridade e a via de parto do último parto. (AU)

Aim: to analyze the relationship between supra- and infraumbilical diastasis recti abdominis (DRA) and pelvic floor musculature (PFM) contraction of women at immediate postpartum, admitted in a public maternity hospital. Methodology: Cross-sectional study approved by the Human Ethics Committee (nº 1.674.698; CAA 56163616.8.0000.0096). Sixty low-risk puerperal women attended at the maternity participated were included. DRA was assessed by abdominal palpation and graded according to number of digital pulps. PFM contraction was assessed by visual inspection. The correlation of variables was performed using the Spearman test, with a significance level of p <0.05. Results: 40 participants (66.7%) had supraumbilical DRA and 23 participants (38.4%) had infraumbilical DRA greater than 2 digital pulps. About 71.4% of women contract only PFM and 12.7% contract PFM using compensatory mechanisms; 14.3% of puerperal women were unable to perform a contraction. Supraumbilical DRA is correlated with PFM contraction and accessory muscles (p = 0.03; r = -0.46); to time of sustained PFM contraction in multiparous women (p = 0.03; r = -0.43); and absence of PFM contraction (= 0.03; r = 0.35) and the time of sustained PFM contraction (p = 0.02; r = -0.40) in puerperal women who underwent vaginal delivery. Conclusion: The presence of supraumbilical DRA correlates with PFM function according to the parity and the type of delivery. (AU)

Anatomical study and clinical importance of the inferior epigastric artery / Estudio anatómico e importancia clínica de la arteria epigástrica inferior

SUMMARY: The inferior epigastric artery (IEA) is a major blood vessel that supplies the anterior abdominal wall. The aim of the current study was to provide clinicians, surgeons, and obstetricians with sufficient anatomical data on the inferior epigastric artery, such as its origin and branching pattern. The study included 20 embalmed cadavers, these cadavers were dissected, and the inferior epigastric artery and vena comitans/venae comitantes were identified and traced downwards to the external iliac vessels. The origins, caliber, course and pedicle length of both the artery and the vein(s) were studied. The inferior epigastric artery arose independently from the distal external iliac artery deep to the inguinal ligament in 19 (95 %) cadavers. The artery entered the rectus abdominis muscle at its middle third in 13 (65 %) cases and at its lower third in the remaining specimens. In this study, we found that the artery divided into two branches in 18 (90 %) of the cases; in the remaining two cases, it continued as one trunk. The average pedicle length was 7.2 cm. The mean caliber of the IEA was 3.7 mm. In 18 (90 %) dissections, the venous drainage consisted of a pair of venae comitantes that united to form a common vessel at their draining point on the external iliac vein. The average diameter was 3.9 mm. The current study focuses on the anatomical features of the inferior epigastric artery to increase the success rate of abdominal and pelvic operations in clinical practice.

RESUMEN: La arteria epigástrica inferior (AEI) es un vaso sanguíneo principal que irriga la pared abdominal anterior. El objetivo del presente estudio fue proporcionar a los médicos, cirujanos y obstetras suficientes datos anatómicos sobre la arteria epigástrica inferior, como su origen y patrón de ramificación. El estudio incluyó 20 cadáveres embalsamados, los que se disecaron y se identificó la arteria epigástrica inferior y la vena concomitante y se siguieron hasta los vasos ilíacos externos. Se estudiaron los orígenes, calibre, trayecto y longitud del pedículo tanto de la arteria como de la (s) vena (s). La arteria epigástrica inferior surgió independientemente de la arteria ilíaca externa profunda al ligamento inguinal en 19 (95 %) cadáveres. La arteria ingresó al músculo recto del abdomen en su tercio medio en 13 (65 %) casos y en su tercio inferior en las muestras restantes. En este estudio, encontramos que la arteria se dividió en dos ramas en 18 (90 %) de los casos; en los dos casos restantes, continuó como un tronco. La longitud media del pedículo fue de 7,2 cm. El calibre medio del AEI fue de 3,7 mm. En 18 (90 %) disecciones, el drenaje venoso consistió en un par de venas concomitantes las que formaron un vaso común en su punto de drenaje en la vena ilíaca externa. El diámetro medio fue de 3,9 mm. El estudio actual se centra en las características anatómicas de la arteria epigástrica inferior con el propósito de mejorar la tasa de éxito de las cirugías abdominales y pélvicas en la práctica clínica.

Free rectus abdominis myocutaneous flap for the reconstruction of major and complex defects in the craniofacial regions after ablation of advanced sinonasal carcinomas / 中华耳鼻咽喉头颈外科杂志

Objective: To explore the method and plausibility of using free rectus abdominis flap (FRAF) to reconstruct the major and complex defects in the craniofacial regions after ablation of advanced sinonasal carcinoma. Methods: From 2007 to 2018 at No. 980 Hospital of Joint Logistic Supportive Force of People's Liberation Army of China, 13 patients with advanced carcinoma of nasal cavity and paranasal sinuses, including 11 males and 2 females, aged from 33 to 67 years, were treated with FRAF to repair the invasion of skull base, face and orbit. Based on adequate and meticulous preoperative evaluations on patients and tumors, complete resection of tumor bulks was performed. According to the sites, characters and extents of the defects, FRAF was introduced in different ways into reconstruction of major and complex defects in the craniofacial regions after resection of advanced sinonasal carcinomas, restoring the structure and contour of the craniofacial region. Results: Complete resection of tumors was achieved in all cases. For repairing the major and complex defects resulted from tumor ablation, FRAF graft was conducted in 13 patients with advanced sinonasal carcinomas. The recipient vessels were facial artery and vein in 9 cases, superficial temporal artery and vein in 4 cases. Vascular bridging with the external jugular vein was carried out in 2 cases who underwent submandibular neck dissections, in which facial artery and vein were used as recipient vessels. Free fibular flap was used along with FRAF in a case undergone bilateral maxillectomy. Pedicled galea capitis and periosteal flap were applied simultaneously in 3 cases with dura defects at the skullbase resulted from tumor resection. All flaps used in 13 cases survived uneventfully without major complications, with successful repair of defects, reconstruction of structures and restoration of contour of craniofacial regions. Conclusion: With adequate evaluation of resectability of tumors as well as nature and extent of defects after tumor removal, FRAF transplantation is an ideal method and strategy of choice for reconstructing the major and complex defects in craniofacial regions resulted from tumor ablation of advanced sinonasal carcinomas.

Atuação fisioterapêutica na redução da diástase abdominal no puerpério imediato / Physiotherapy in the reduction of diastasis of the recti abdominis in inmediate pospartum / Fisioterapia para reducir la diástasis abdominal en el posparto inmediato

Objetivo: verificar se a intervenção fisioterapêutica no puerpério imediato contribui para a redução da diástase. Métodos: estudo de intervenção com randomização de dois grupos de 25 puérperas recrutadas em uma maternidade de Vitória-ES. Ambos foram submetidos à avaliação e mensuração da diástase através de um paquímetro, e no grupo de tratamento além da avaliação foi aplicado um protocolo de tratamento fisioterápico às 06 e 18 horas após o parto. Os dados foram analisados através dos testes de Wilcoxon, Mann-Whitney e teste t pareado. Resultados: houve diminuição da diástase abdominal entre a primeira e a última avaliação em ambos os grupos, no entanto, a análise entre grupos identificou uma redução mais acentuada no grupo de tratamento (p<0,001). Conclusão: os achados deste estudo mostram que o atendimento fisioterápico no puerpério imediato é capaz de influenciar positivamente na redução da diástase abdominal, proporcionando às puérperas uma recuperação mais rápida

Objective: to verify if the physiotherapeutic intervention in the immediate puerperium contributes to the reduction of the diastasis. Methods: randomized intervention study of two groups of 25 mothers recruited at a maternity hospital in Vitória-ES. Both were submitted to diastasis evaluation and measurement using a caliper, and in the treatment group, in addition to the evaluation, a physical therapy protocol was applied at 06 and 18 hours after delivery. Data were analyzed by Wilcoxon, Mann-Whitney and paired t-tests. Results: there was a decrease in the abdominal diastasis between the first and last evaluation in both groups and the variables studied, however, the analysis between groups identified a sharper decline in the treatment group (p <0.001). Conclusion: the findings of this study show that the physiotherapeutic care in the immediate puerperium is able to positively influence the reduction of the abdominal diastasis, providing a faster recovery to the puerperal women

Objetivo: verificar si la intervención de fisioterapia en el período posparto inmediato contribuye a la reducción de la diástasis. Métodos: estudio de intervención aleatorizado de dos grupos de 25 madres reclutadas en un hospital de maternidad en Vitória-ES. Ambos fueron sometidos a evaluación y medición de la diástasis utilizando un calibrador, y en el grupo de tratamiento, además de la evaluación, se aplicó un protocolo de fisioterapia a las 06 y 18 horas después del parto. Los datos fueron analizados por Wilcoxon, Mann-Whitney y pruebas t pareadas. Resultados: hubo una disminución en la diástasis abdominal entre la primera y la última evaluación en ambos grupos y las variables estudiadas, sin embargo, el análisis entre los grupos identificó una reducción más marcada en el grupo de tratamiento (p <0.001). Conclusión: los resultados de este estudio muestran que la atención de fisioterapia en el período posparto inmediato puede influir positivamente en la reducción de la diástasis abdominal, proporcionando a las mujeres puerperales una recuperación más rápida

Estado del arte de la plicatura de rectos / State-of-art of rectus shealth plication

Introducción. La abdominoplastia es un procedimiento que se utiliza para definir el contorno corporal actuando sobre todas las capas de la pared mediante la resección del exceso de piel y grasa subcutánea y la reparación del sistema músculo-aponeurótico. Uno de los componentes a tratar en toda abdominoplastia es la diastasis abdominal, que se logra a través de la plicatura de rectos. Muchas controversias han surgido acerca de la efectividad y duración de la corrección, del mejor tipo de sutura y las consecuencias sobre la presión intraabdominal y el embarazo. Materiales y metodos. Se llevó a cabo una revisión sistemática de la literatura utilizando las bases de datos MEDLINE, LILACS, MEDES y SciELO. Tanto artículos de habla inglesa como hispana fueron tenidos en cuenta. Las palabras clave utilizadas para la búsqueda inicial fueron rectus plication, rectus shealth plication, diastasis, abdominal closure, plicatura abdominal. Resultados. Luego de la búsqueda, 58 artículos fueron seleccionados y revisados. En base a la información obtenida, se dividió la información y se desarrollaron de manera objetiva en puntos separados. Conclusiones. A pesar de que la bibliografía muestra conclusiones disímiles y variables, la plicatura es un procedimiento seguro y potencialmente benefi cioso para la salud tanto en dolores lumbares como incontinencia urinaria, y puede usarse en aquellos casos intratables. Tanto suturas de reabsorción lenta como el PDS y las suturas no absorbibles pueden ser utilizadas para el cierre de la diastasis abdominal con excelentes resultados a largo plazo y sin riesgo de recurrencia

Introduction. Abdominoplasty is a body-contouring procedure for functional and aesthetic improvement that addresses deformity from excess skin and fat and musculofascial laxity. Diastasis repair by plication of the rectus sheath is an integral part of most abdominoplasty procedures. There is no consensus regarding what suture material is best and contradictory information about long term durability, changes in the intraabdominal pressure and pregnancy is seen in the literature. Material and methods. A systematic review of current available literature was performed using the MEDLINE, LILACS, MEDES and SciELO databases. Key words used for initial data bank searches included "rectus plication", "rectus shealth plication" "diastasis" "abdominal closure", "plicatura abdominal". Furthermore, bibliographies and individual plastic surgery journals were searched for additional reference information. Results. Fifty-eight articles met the criteria and were analyzed critically for inclusion. From this information, a narrative synthesis of data was undertaken. Conclusions. Although current literature shows diff erent conclusions, rectus shelth plication can be consider a safe and pottencially benefi tial procedure with signifi cant improvements in posture and quality of life. Absorbable and non absorbable sutures seems to be reliable sutures for the correction of rectus diastasis.

Perineal repair after abdominoperineal excision with rectus abdominis myocutaneous flap / Reconstrução do períneo após amputação abdominoperineal com retalho pediculado do músculo reto abdominal

ABSTRACT Background: Abdominoperineal excision of the rectum (APR) remains the only potential curative treatment for very low rectal adenocarcinoma and squamous cell carcinoma of the anus. Yet, it implies a significant perineal exenteration and has set the attention on the perineal reconstruction. Aim: To present technique used in one case of APR for anal cancer, with resection of the vaginal posterior wall with large perineal defect which has called for the necessity of a flap for reconstruction Method: To cover the large perineal defect and reconstruct the posterior vaginal wall was perform a standardized and reproducible surgical technique using oblique rectus abdominis myocutaneous (ORAM) flap. The overlying skin of this flap is thick and well vascularized by both superficial branches and perforators of the superior epigastric artery and the deep inferior epigastric artery which serves as the vascular pedicle for the ORAM flap. Results: This procedure was applied in a 65-year-old woman with recurrent squamous cell carcinoma of the anus infiltrating the posterior wall of the vagina. Was performed an APR with en-bloc resection of the vaginal posterior wall in order to achieve tumor-free margins. Postoperative course was uneventful and she was discharged home at postoperative day 9. Final pathological report confirmed the oncological adequacy of the procedure (R0) and showed a rypT4N0 lesion. Conclusion: Flap reconstruction is an effective way to cover the perineal wound reducing both perineal complication rate and wound healing delay. The ORAM is particularly interesting for female whose tumors require resection and subsequent reconstruction of the posterior wall of the vagina.

RESUMO Racional: A amputação abdominoperineal do reto (APR) continua sendo o único tratamento curativo nos casos de adenocarcinoma retal muito baixo e carcinoma espinocelular do ânus. No entanto, implica em exenteração perineal significativa e exige atenção na reconstrução perineal. Objetivo: Propor, ilustrando com um caso clinico, proposta de APR para câncer anal com ressecção da parede posterior da vagina com cobertura do grande defeito perineal através de reconstrução com retalho miocutâneo oblíquo do reto abdominal (ORAM). Método: Para cobrir o defeito e reconstruir a parede vaginal posterior, realizou-se técnica de retalho miocutâneo oblíquo do reto abdominal (ORAM). A pele subjacente desse retalho por ser espessa e bem vascularizada por ramos perforantes superficiais da artéria epigástrica superior e pela artéria epigástrica inferior profunda serviu como pedículo vascular. Resultado: Este procedimento foi aplicado em uma mulher de 65 anos com recidiva de carcinoma espinocelular do ânus infiltrado na parede posterior da vagina. Foi realizada APR com ressecção em bloco da parede posterior vaginal com o objetivo de obter margens livres de tumor. O pós-operatório transcorreu sem intercorrências e a paciente recebeu alta hospitalar no 9° dia pós-operatório. O relatório patológico final confirmou a adequação oncológica do procedimento (R0) e mostrou uma lesão rypT4N0 de 6,5 cm. Conclusão: A reconstrução perineal com utilização de retalho é maneira eficaz de fechar a ferida operatória, reduzindo a taxa de complicações perineais e o atraso na cicatrização. O retalho de tipo ORAM é particularmente interessante para mulheres cujos tumores requerem ressecção e subsequente reconstrução da parede posterior da vagina.

Is rectus abdominis thickness associated with survival among patients with liver cirrhosis? A prospective cohort study

ABSTRACT BACKGROUND: Sarcopenia may affect patients with liver cirrhosis and worsen disease outcomes. OBJECTIVES: To evaluate ultrasound-measured psoas major (PM) and rectus abdominis (RA) thickness for predicting survival among patients with liver cirrhosis. DESIGN AND SETTING: Prospective cohort study in a tertiary-level hospital. METHODS: 61 patients with liver cirrhosis were prospectively included during a 15-month period and followed up for at least six months. Cirrhosis was classified using the Child-Pugh score. Sarcopenia was assessed using surrogate parameters: handgrip strength (HGS), mid-arm muscle circumference (MAMC) and SGA (subjective global assessment). We used ultrasound to measure RA and PM thickness at admission. RESULTS: There were 41 men. The patients' mean age was 58.03 ± 10.8 years. 26.22% of them were Child-Pugh A, 45.9% B and 27.86% C. The patients were followed up for 11.9 ± 5.63 months. RA thickness correlated moderately with MAMC (r = 0. 596; P < 0.0001) and HGS (r = 0.515; P < 0.0001) and decreased with increasing SGA class (A, 10.6 ± 2.8 mm; B, 8.3 ± 1.9 mm; C, 6.5 ± 1.9 mm; P < 0.0001). Survival at six months was independently predicted by using the model for end-stage liver disease-serum sodium score (odds ratio, OR 1.305; 95% OR confidence interval 1.083-1.572; P = 0.005). Survival during follow-up was independently predicted by RA thickness (hazard ratio, HR 0.701; 95% HR confidence interval 0.533-0.922; P = 0.011) and ascites (HR 1.876; 95% HR confidence interval 1.078-3.267; P = 0.026). PM thickness did not have any predictive value. CONCLUSIONS: As a surrogate marker of sarcopenia, RA thickness may predict survival among patients with liver cirrhosis.

Redefinição natural do abdome em abdominoplastia com uso de lipoaspiração convencional: estudo prospectivo / Redefining natural abdominal anatomy in abdominoplasty using conventional liposuction: a prospective study

Introdução: A evolução da abdominoplastia se mantém constante desde 1899. Atualmente, com o avanço das técnicas de lipoaspiração, o conceito de lipoaspiração de alta definição tem como objetivo de corrigir estigmas causados pelo procedimento, como o aspecto "tenso" e a falta de convexidades e concavidades naturais abdominais. Métodos: Apresentamos uma proposta de busca da redefinição natural do abdome, através da lipoabdominoplastia tradicional com lipoaspiração seletiva, procurando obter resultados cirúrgicos com padrão natural, reproduzível para a maioria dos pacientes. Foram realizadas 21 abdominoplastias, entre novembro de 2018 e maio de 2019, utilizando a técnica descrita. Resultados: A técnica demonstrada apresentou resultados estéticos satisfatórios em obter a aparência abdominal natural através da lipoaspiração profunda e superficial, em áreas de sombras abdominais. Conclusão: O trabalho demonstrou-se seguro sob o ponto de vista vascular, além de ser reprodutível ao passo que utiliza lipoaspiração convencional, utilizada pela ampla maioria dos cirurgiões plásticos.

Introduction: Abdominoplasty techniques have constantly evolved since 1899. With modern liposuction techniques, the concept of high-definition liposuction aims to correct stigmas secondary to the procedure, such as a "tense" appearance and lack of natural abdominal convexity and concavity. Methods: Here we propose a technique to redefine the natural abdominal anatomy using traditional lipoabdominoplasty with selective liposuction to achieve more natural-looking surgical results that are reproducible for most patients. This study included 21 abdominoplasty procedures using the described technique performed between November 2018 and May 2019. The technique showed satisfactory ability to achieve a natural abdominal appearance using deep and superficial liposuction in abdominal shadow areas. Conclusion: The study showed that the technique is safe from a vascular point of view and reproducible due to the use of conventional liposuction, which is available to the vast majority of plastic surgeons.

Avaliação eletromiográfica do exercício swan na Wunda Chair: Co-ativação dos músculos do core / Electromyographic evaluation of the swan exercise in the Wunda Chair: Co-activation of the core muscles

A principal finalidade do método Pilates é desenvolver uma automação dos músculos do core. Sendo assim, o objetivo deste estudo foi analisar a razão eletromiográfica dos músculos Oblíquo Interno (OI) e Reto do Abdômen (RA) localizados na parte anterior do tronco, a razão eletromiográfica dos músculos Multífido (MU) e Longuíssimo do Tórax (LO) localizados na parte posterior do tronco, e também a razão ântero-posterior (A/P=RA+IO/LO+MU) desses músculos durante o exercício swan do método Pilates, realizado sobre a Wunda Chair. Na comparação entre as três razões, foram encontradas diferenças estatísticas (p = 0,0103), apenas entre as razões ântero-posterior (A/P), e entre a razão dos músculos localizados na parte posterior do tronco (MU/LO). Os resultados demonstraram que houve um predomínio na atividade eletromiográfica dos músculos da região posterior em relação aos músculos da região anterior do tronco e que os músculos estabilizadores apresentaram maior atividade eletromiográfica em comparação com os músculos globais ou mobilizadores. O exercício swan pode ser utilizado como forma de treinamento para a musculatura do tronco, e como consequência gerar maior estabilidade a coluna vertebral, pois o exercício prioriza a diminuição da carga sobre a coluna vertebral. (AU)

The main purpose of the Pilates method is to develop an automation of core muscles. Thus, the aim of this study was to analyze the electromyographic ratio of the Internal Oblique (IO) and Rectus Abdominis (RA) muscles located in the anterior part of the trunk, the electromyographic ratio of the Multifidus (MU) and Longissimus Thoracis (LO) muscles, located in the posterior part of the trunk, and also the ratio antero- posterior (A/P=RA+IO/LO+MU) of these muscles during the swan exercise of the Pilates, performed on the Wunda Chair. In the comparison between the three ratios, statistical differences (p = 0.0013) were found only between the antero-posterior (A/P) ratios and the ratio of the muscles located in the posterior part of the trunk (MU/LO). The results showed a predominance of the electromyographic activity in the muscles of the posterior region in relation to the muscles of the anterior region of the trunk. The stabilizing muscles presented greater electromyographic activity in comparison to the global or mobilizing muscles. The swan can be used as training for the trunk muscles, and therefore generates greater stability of the spine, since exercise prioritizes the decrease of the load on the spine. (AU)