Outras tendências na abdominoplastia: novo desenho e importância da lipomidiabdominoplastia na cirurgia do contorno corporal / Other trends in abdominoplasty: new design and importance of lipomid- abdominoplasty in body contour surgery

Introdução: Durante os últimos anos, os princípios cirúrgicos da abdominoplastia permaneceram inalterados. Portanto, muitos resultados observados apresentam desalinhamento, cicatrizes transversais altas e retas do abdome, levando ao posicionamento final da cicatriz umbilical a ser muito próximo da cicatriz transversal, o que dá a impressão de abdome curto. Propomos que a abdominoplastia modifique a concepção básica de sua marcação, pois acreditamos que é importante posicionar a cicatriz transversal mais baixa na região medial e púbica, e mais alta nas extremidades laterais, permitindo, no nível dos flancos, a rotação dos retalhos lombares no sentido anterior em direção inferomedial. Métodos: Foram analisados de forma retrospectiva 146 pacientes portadores de deformidades abdominais e os submetemos a lipomidiabdominoplastia, marcando com forte concavidade superior e orientando os lados da cicatriz em direção à linha transversa inferior do abdômen, 4cm equidistantes da raiz da coxa. Também associamos a lipoaspiração como um tratamento complementar ao contorno corporal. Resultados: Consideramos que os parâmetros da midiabdominoplastia são aplicáveis na maioria dos casos, obtendo resultados igualmente satisfatórios, tanto nos pacientes com flacidez e lipodistrofia abdominal supraumbilical, quanto nos pacientes com abdome em avental com importante flacidez e diástase dos retos abdominais. Conclusão: É importante determinar a área da deformidade abdominal e sua classificação, para estabelecer as estratégias do tratamento e associação de procedimentos complementares. Uma marcação mais baixa, respeitando as áreas de tratamento, permitirá uma melhor cicatriz estética e um contorno corporal harmônico, além de uma adequada colocação dos elementos: cicatriz umbilical, púbis e extremidades laterais da cicatriz abdominal transversa.

Introduction: During the last few years, the surgical principles of abdominoplasty have remained unchanged. Therefore, many patients undergoing this technique have misalignment and high and straight transverse scars of the abdomen, with the final position of the umbilical scar being very close to the transverse scar, making the abdomen seem short. We propose modifying the basic concept of marking in abdominoplasty, because we believe it is important to position the transverse scar lower in the medial and pubic region and higher at the lateral ends, allowing anterior lumbar flap rotation in an inferomedial direction. Methods: We retrospectively analyzed 146 patients with abdominal defects and subjected them to lipo-mid-abdominoplasty, marking with strong upper concavity and guiding the sides of the scar towards the lower transverse line of the abdomen, 4 cm equidistant from the root of the thigh. We also define liposuction as a complementary treatment to body contouring. Results: We consider that midabdominoplasty parameters are applicable in most cases, obtaining satisfactory results both in patients with flatness and supraumbilical abdominal lipodystrophy and patients with an "apron" abdomen with considerable flaccidity and diastasis of the abdominal rectus. Conclusion: It is important to determine the area of the abdominal defect and its classification to establish treatment strategies and association with complementary procedures. A lower marking with respect to the treatment areas will allow a more aesthetic scar and a harmonic body contour as well as an adequate placement of the umbilical scar, pubis, and lateral ends of the transverse abdominal scar.

Reconstrução torácica com retalhos do músculo reto abdominal e grande dorsal: relato de casos / Chest wall reconstruction using abdominal rectus and latissimus dorsi muscle flaps: case report

INTRODUÇÃO: A reconstrução da parede torácica ainda permanece como um dos grandes desafios da cirurgia plástica reparadora. O presente estudo tem como objetivo apresentar o relato de pacientes submetidos à reconstrução de parede torácica com a utilização de retalhos miocutâneos, após ressecções de parede por tumores/osteomielite. MÉTODOS: Foram incluídos quatro pacientes, três deles portadores de osteomielite e o último apresentando-se com sarcoma, todas as afecções acometendo a parede torácica. Foram submetidos à ressecção de parede e reconstrução com retalhos miocutâneos do grande dorsal (dois casos) e reto abdominal (dois casos). RESULTADOS: Os retalhos utilizados foram suficientes para cobertura cutâneo-muscular e mantiveram boa vitalidade. Em apenas um caso, houve sofrimento parcial do retalho. Não houve recidiva precoce da doença. A estabilidade da caixa torácica foi preservada. CONCLUSÕES: A utilização dos retalhos citados no reparo dos defeitos torácicos mostrou-se satisfatória na intenção de prover revestimento cutâneo e músculo bem vascularizado, este fundamental no combate aos quadros infecciosos locais.

INTRODUCTION: Chest wall reconstruction remains one of the great plastic surgery repair challenges. The present work aims to report on cases of chest wall reconstruction using myocutaneous flaps after wall resection due to tumor/osteomyelitis. METHODS: Four patients were included, among which three presented with osteomyelitis and the other presented with sarcoma; both of these conditions affected the chest wall. Each patient underwent wall resection and reconstruction using myocutaneous flaps from the latissimus dorsi (two cases) and abdominal rectus (two cases). RESULTS: The flaps used were sufficient for skin-muscle covering and maintained good vitality. Partial flap injury occurred in one case. Chest cavity stability was preserved. CONCLUSIONS: The use of the above flaps to repair chest defects was satisfactory with the aim of covering the skin and providing well-vascularized muscles, the latter of which was fundamental to preventing local infection.

Anatomical Evaluation of Shofukukyuketsu by 3D Image Analysis / 日本東洋医学雑誌

Lower abdominal cramps, or <I>shofukukyuketsu</I> in Japanese, are thought to be one indication to use tokakujokito for the abdominal symptom of <I>oketsu</I>. To clarify the condition, anatomical analysis was performed using 3 D imaging.There were 20 women and11men entered in this study who consulted our hospital for lower abdominal pain or a sense of discomfort. Width and the thickness of the rectus muscle of the abdomen were analyzed. Moreover, gas images and feces in the intestinal tract under the abdominal wall were also observed. In addition, the presence of rectus abdominal muscle separation, or <I>shofukufujin</I> in Japanese, was evaluated. In the women, where lower abdominal cramps were a complaint, young age (53.1 ± 18.3 vs. 30.4 ± 9.8, p < 0.05), low parity (1.5 ± 1.0 vs. 0.25 ± 0.5, p < 0.05), and thickness of the abdominal rectus muscle (8.14 ± 2.5 mm vs. 12.4 ± 1.6 mm, p < 0.05) were confirmed. Also in several cases of lower abdominal cramps, feces were seen at the sigmoid colon. A significant difference was seen in the male group. Cases with lower abdominal cramps suggest involvement of local muscle spasms at the bottom of abdominal rectus muscle, which may contribute to the seemed symptom of abdominal formation. On the other hand, a mechanism different from that in women was considered in the men. This suggests that it is necessary to consider gender differences when making a Kampo diagnosis.

Anatomical Evaluation of Shofukukyuketsu by 3D Image Analysis / 日本東洋医学雑誌

Lower abdominal cramps, or <i>shofukukyuketsu</i> in Japanese, are thought to be one indication to use tokakujokito for the abdominal symptom of <i>oketsu</i>. To clarify the condition, anatomical analysis was performed using 3 D imaging. There were 20 women and11men entered in this study who consulted our hospital for lower abdominal pain or a sense of discomfort. Width and the thickness of the rectus muscle of the abdomen were analyzed. Moreover, gas images and feces in the intestinal tract under the abdominal wall were also observed. In addition, the presence of rectus abdominal muscle separation, or <i>shofukufujin</i> in Japanese, was evaluated. In the women, where lower abdominal cramps were a complaint, young age (53.1 ± 18.3 vs. 30.4 ± 9.8, p < 0.05), low parity (1.5 ± 1.0 vs. 0.25 ± 0.5, p < 0.05), and thickness of the abdominal rectus muscle (8.14 ± 2.5 mm vs. 12.4 ± 1.6 mm, p < 0.05) were confirmed. Also in several cases of lower abdominal cramps, feces were seen at the sigmoid colon. A significant difference was seen in the male group. Cases with lower abdominal cramps suggest involvement of local muscle spasms at the bottom of abdominal rectus muscle, which may contribute to the seemed symptom of abdominal formation. On the other hand, a mechanism different from that in women was considered in the men. This suggests that it is necessary to consider gender differences when making a Kampo diagnosis.