Sistematização de flancoplastia baseada na anatomia cirúrgica / Flankplasty systematization based on surgical anatomy

Introdução: O estudo explora a cirurgia de contorno corporal em pacientes submetidos a cirurgias bariátricas. Nos últimos anos, esse tipo de intervenção cirúrgica ganhou destaque devido ao aumento na busca por procedimentos reparadores após significativa perda de peso. O texto enfatiza a importância da flancoplastia, técnica que visa melhorar o contorno corporal. Métodos: Foi realizada revisão da literatura para elucidação da anatomia da gordura profunda da fáscia toracolombar, e feito um paralelo com a técnica de flancoplastia utilizada em nosso serviço em pacientes pós-bariátricos submetidos a abdominoplastia 360° ou 270° no Hospital Daher Lago Sul, em Brasília- DF. Resultados: A lipoaspiração profunda dos flancos, muitas vezes necessária em cirurgias de contorno corporal, pode não ser suficiente para retirar a gordura profunda à fáscia toracolombar e durante esse procedimento observa-se risco aumentado de lesões retroperitoneais. No entanto, a flancoplastia, que envolve a ressecção da gordura profunda à fáscia toracolombar, demonstrou proporcionar resultados satisfatórios e minimizar esses riscos. Conclusão: O estudo enfoca a importância do conhecimento anatômico preciso, destacando a relevância da flancoplastia como uma técnica valiosa para melhorar os resultados estéticos e reduzir complicações em pacientes pós-bariátricos, complementando a cirurgia bariátrica e melhorando a qualidade de vida do paciente.

Introduction: The study explores body contouring surgery in patients undergoing bariatric surgery. In recent years, this type of surgical intervention has gained prominence due to the increase in the search for reparative procedures after significant weight loss. The text emphasizes the importance of flankplasty, a technique that aims to improve body contour. Methods: A literature review was carried out to elucidate the anatomy of the deep fat of the thoracolumbar fascia, and a parallel was made with the flankplasty technique used in our service in post-bariatric patients undergoing 360° or 270° abdominoplasty at Daher Lago Sul Hospital, in Brasília-DF. Results: Deep liposuction of the flanks, often necessary in body contouring surgeries, may not be sufficient to remove fat deep into the thoracolumbar fascia and during this procedure, there is an increased risk of retroperitoneal injuries. However, flankplasty, which involves resection of fat deep into the thoracolumbar fascia, has been shown to provide satisfactory results and minimize these risks. Conclusion: The study focuses on the importance of precise anatomical knowledge, highlighting the relevance of flankplasty as a valuable technique to improve aesthetic results and reduce complications in post-bariatric patients, complementing bariatric surgery and improving the patient's quality of life.

Asociación entre variables ecográficas de adiposidad abdominal y variables analíticas y antropométricas aplicando análisis de correlación canónica en gestantes normopeso / Association between echography variables of abdominal adiposity and analytical and anthropometric variables applying canonical correlation analysis in normal-weight pregnant

RESUMEN Fundamento: La obesidad abdominal en gestantes es un marcador de riesgo cardiometabólico independientemente de la adiposidad general, siendo la ultrasonografía de gran utilidad para distinguir los compartimientos adiposos del abdomen y diagnosticar tal peligro al inicio de la gestación. Objetivo: Determinar asociaciones entre variables ecográficas de adiposidad abdominal y variables analíticas y antropométricas en gestantes normopeso al inicio del embarazo según fenotipos metabólicos empleando análisis de correlación canónica. Metodología: Estudio transversal en 526 embarazadas normopeso, entre 12 y 14 semanas de edad gestacional, atendidas en consulta de ultrasonido del Policlínico Docente Chiqui Gómez, municipio Santa Clara. Se midieron las grasas abdominales subcutánea, preperitoneal y visceral, así como variables antropométricas y analíticas. Se conformaron 3 fenotipos metabólicos, y se aplicó la correlación canónica para determinar el nexo entre las mismas y su comportamiento en los diferentes fenotipos. Resultados: Se identificaron 2 conjuntos de variables con correlaciones canónicas que se incrementaron del fenotipo saludable al metabólicamente obeso con valores de 0.6930 a 0.8955 y 0.9298 respectivamente y alta significancia estadística (p=0.000). Conclusiones: Se demuestra el nexo entre las variables ecográficas de adiposidad abdominal grasa subcutánea y grasa visceral y las variables analíticas resistencia a Ia insulina, producto de acumulación lipídico, índice aterogénico y glucemia, evidenciado por los altos valores de correlaciones canónicas obtenidos según cambia el fenotipo de normopeso saludable al metabólicamente obeso; orientando un nuevo enfoque en la determinación de fenotipos de riesgo metabólico en la gestación temprana en mujeres normopeso.

ABSTRACT Background: Abdominal obesity in pregnant women is an indicator of cardiometabolic risk with non-independence of general adiposity, being the ultrasound very useful to distinguish the abdomen adipose compartments also diagnose this risk at the beginning of pregnancy. Objective: To determine possible associations between the ultrasound variables of abdominal adiposity and those analytical and anthropometric in normal-weight pregnant women at the beginning of pregnancy according to metabolic phenotypes using canonical correlation analysis. Methodology: A cross-sectional study in 526 normal-weight pregnant women, between 12 and 14 weeks of gestational age, assisted in the ultrasound office at Chiqui Gómez teaching polyclinic, in Santa Clara city. Subcutaneous, preperitoneal and visceral abdominal fats were measured, as well as anthropometric and analytical variables. Three metabolic phenotypes were formed, and canonical correlation was applied to determine their relation and also behavior among the different phenotypes. Results: 2 sets of variables were identified with canonical correlations that increased from the healthy to the metabolically obese phenotype with values from 0.6930 to 0.8955 and 0.9298 respectively and high statistical significance (p=0.000). Conclusions: The link between the ultrasound variables of abdominal adiposity, subcutaneous and visceral fat and the analytical insulin resistance, lipid accumulation product, atherogenic index and blood glucose is demonstrated, evidenced by the high values of canonical correlations obtained as the phenotype changes from healthy normal-weight to metabolically obese; guiding a new approach in the resolve of the metabolic risk phenotypes in early gestation in normal-weight women.

Asociación entre el espesor de la grasa subcutánea abdominal y la esteatosis hepática, las enzimas hepáticas y los lípidos séricos en niños obesos / Association of abdominal subcutaneous fat thickness with hepatic steatosis, liver enzymes, and serum lipids in obese children

Introducción. La obesidad infantil puede causar hiperlipidemia y esteatosis hepática y complicaciones crónicas. Nuestro objetivo fue evaluar la relación entre el espesor de la grasa subcutánea abdominal (GSA) y la esteatosis hepática, las transaminasas y los lípidos séricos en niños obesos.Población y métodos. Estudio retrospectivo en niños (4-18 años) que acudieron a los consultorios externos. Se evaluaron las asociaciones entre el espesor de la GSA mediante ecografía y la esteatosis hepática, alanina aminotransferasa (ALT), aspartato aminotransferasa (AST) y el perfil lipídico sérico.Resultados. Se identificaron 95 niños con esteatosis hepática; el grado 1 fue el más frecuente (73,6 %, n: 70), seguido del grado 2 (21,1 %) y del 3 (5,3 %). El espesor medio (en mm) de la GSA de línea media y flancos fue 38,48 ± 11,53 y 20,91 ± 8,00 en grado 1; 41,23 ± 10,03 y 19,84 ± 6,75 en grado 2, y 63,12 ± 12,08 y 23,22 ± 5,92 en grado 3, respectivamente. El espesor de la GSA de línea media y flancos se correlacionó positivamente con triglicéridos en grado 3; el espesor de la GSA de línea media se correlacionó con el índice de masa corporal, colesterol total, colesterol LDL y AST (r: 0,9; p: 0,037; r: 0,648; p: 0,001; r: 0,387; p: 0,001; r: 0,406; p: 0,001; r: 0,463; p: 0,001; respectivamente) en grado 1.Conclusión. El espesor de la GSA mediante ecografía puede predecir hiperlipidemia en niños obesos con esteatosis hepática de grado 3 e hipercolesterolemia en grado 1.

Introduction. Childhood obesity can cause hyperlipidemia and hepatic steatosis at early age and chronic disease complications in adult life. We aimed to evaluate the relationship between abdominal subcutaneous fat thickness (ASFT) and hepatic steatosis, serum lipid and transaminase levels in obese children.Population and methods. A retrospective study was conducted with children (aged 4-18 years) who presented to outpatient clinic due to obesity. Associations between ASFT as assessed by ultrasonography (US) and hepatic steatosis, alanine transaminase (ALT), aspartate transaminase (AST) and serum lipid profile were evaluated.Results. We identified 95 children, all of which were diagnosed as having hepatic steatosis; the most common type was grade 1 (73.6 %, n: 70), followed by grade 2 (21.1 %) and grade 3 (5.3 %). The mean values of midline and flank ASFT were measured as 38.48 ± 11.53 mm and 20.91 ± 8.00 mm in grade 1; 41.23 ± 10.03 and 19.84 ± 6.75 in grade 2 and 63.12 ± 12.08 and 23.22 ± 5.92 in grade 3 hepatic steatosis, respectively. Midline and flank ASFT correlated positively with triglycerides in grade 3 steatosis, while midline ASFT correlated with body mass index, total cholesterol, low-density lipoprotein cholesterol, and AST (r: 0.9; p: 0.037; r: 0.648, p: 0.001; r: 0.387, p: 0.001; r: 0.406, p: 0.001, r: 0.463, p: 0.001; respectively) in grade 1 steatosis.Conclusion. ASFT as assessed by US may be of predictive value for hyperlipidemia in grade 3 and for hypercholesterolemia in grade 1 hepatic steatosis in obese children.

Prediction of Gestational Diabetes Mellitus in Pregnant Korean Women Based on Abdominal Subcutaneous Fat Thickness as Measured by Ultrasonography

BACKGROUND: This study was performed to verify the correlation between abdominal subcutaneous fat thickness (ASFT) measured by ultrasonography (US) during the first trimester of pregnancy and gestational diabetes mellitus (GDM) of the second trimester in Korean women and to establish a standard of ASFT for predicting GDM. METHODS: A total of 333 singleton pregnant women participated in this study. Their ASFT was measured by US during the 10+6 to 13+6 weeks of pregnancy; then a GDM confirmatory test (100 g oral glucose tolerance test) was conducted during the 24 to 28 week period of pregnancy. Based on the GDM tests, comparative analyses of the ages of the subjects, pre-pregnancy body mass index (BMI), and weight gain during pregnancy were conducted. RESULTS: The ages of the subjects and weight gains during pregnancy were not correlated to the GDM of the second trimester of pregnancy, but the pre-pregnancy BMIs (22±3.3 kg/m²) and the ASFT (1.9±0.5 cm) measurements between the control group and subjects during the first trimester of pregnancy were found to show significant differences (P < 0.001). The cut-off value of the ASFT for predicting GDM was determined to be 2.4 cm (area under the curve=0.90, sensitivity 75.61%, specificity 91.78%, P < 0.001). The odds ratio was 2.91 (95% confidence interval, 1.07 to 7.92; P=0.034), which was higher than the 2.4 cm ASFT. CONCLUSION: It was determined that ASFT as measured by US during the first trimester of pregnancy can be used to predict the risk of developing GDM during the second trimester of pregnancy and for prognosis.

Efeitos de diferentes pressões de aspiração do tecido adiposo na obtenção de células-tronco mesenquimais / Effects of different liposuction techniques on the isolation of mesenchymal stem cells", "_e": "n

INTRODUÇÃO: O enxerto de gordura nos últimos anos voltou a ter destaque como aliado dos cirurgiões plásticos no preenchimento de partes moles, no rejuvenescimento facial volumétrico, nos refinamentos de reconstruções mamárias e por ser rica fonte de células-tronco de comportamento mesenquimal (células-tronco adipoderivadas). Considerando que essas células têm importante papel na angiogênese e na diferenciação adipogênica, com impacto direto na sobrevivência dos enxertos de gordura, determinar parâmetros que otimizem a sua obtenção é imperativo. Nesse contexto, o objetivo deste trabalho é avaliar e comparar dois métodos de obtenção do tecido adiposo da região abdominal quanto ao número de células viáveis presentes na fração vásculo-estromal e analisar a expressão de marcadores de superfície. MÉTODO: Foram selecionadas 9 pacientes do sexo feminino submetidas a lipoaspiração. O tecido adiposo foi obtido da região abdominal infraumbilical. Da metade direita foram coletados 20 ml de gordura, empregando-se cânula acoplada a uma seringa, cujo êmbolo foi tracionado de 2 cc em 2 cc, gerando baixas pressões de aspiração (grupo manual). O mesmo processo foi repetido na metade esquerda, entretanto a cânula estava acoplada a um coletor intermediário estéril e esse a uma máquina de vácuo sob pressão negativa constante de 350 mmHg (grupo a vácuo). As amostras foram centrifugadas e a gordura da camada intermediária dos dois grupos foi submetida a contagem celular, estabelecimento de culturas e posterior imunofenotipagem. RESULTADOS: Este estudo demonstrou que, apesar de não haver diferença estatisticamente significativa, a obtenção da gordura da região abdominal empregando-se lipoaspirador com pressão negativa de 350 mmHg proporcionou maior número de células presentes na fração vásculo-estromal quando comparado à obtenção por meio de seringas de 10 ml, com baixas pressões de aspiração. CONCLUSÕES: O emprego de pressão negativa de 350 mmHg é seguro para a obtenção das células-tronco adipoderivadas e o rendimento celular entre os dois grupos não apresentou diferença estatisticamente significativa.

BACKGROUND: In recent years, fat grafts have become useful in plastic surgery. They are mainly used to fill soft tissues, refine breast reconstructions, and for volumetric facial rejuvenation. They are also a rich source of mesenchymal stem cells (i.e., adipose-derived stem cells [ADSCs]), which directly influence fat graft survival. Since ADSCs play an important role in angiogenesis and adipogenic differentiation, it is essential to optimize their isolation. Therefore, in this study, we evaluated and compared 2 procedures used to isolate viable cells from the stromal vascular fraction of abdominal adipose tissue and assess the expressions of surface markers. METHODS: We examined 9 female subjects who were scheduled to undergo liposuction. The adipose tissue was isolated from the abdominal infraumbilical region. Fat (20 mL) was collected from the right side by using a cannula attached to a syringe; the plunger was pulled back every 2 cm³ to create low-pressure suction (manual group). The same procedure was repeated on the left side, but the cannula was attached to a sterile and intermediate collector coupled to a vacuum pump that provided a constant negative pressure of 350 mmHg (pump group). The samples were centrifuged, and the adipocytes of the intermediate layer were counted, cultured, and immunophenotyped. RESULTS: The isolation of abdominal adipocytes with a pump providing a negative pressure of 350 mmHg yielded a higher concentration of cells in the stromal vascular fraction than that obtained using 10-mL syringes and low-pressure suction, although the difference was not significant. CONCLUSIONS: A negative pressure of 350 mmHg may be safely applied to isolate ADSCs. The cell yield did not indicate any statistically significant difference between the techniques.