Avaliação da redução tensional sobre a cicatriz em abdominoplastia com o uso de pontos de adesão de Baroudi / Evaluation of Tension Reduction on Abdominoplasty Scar Using Baroudi Adhesion Sutures

Introdução: Em 1988, Baroudi et al. publicaram um trabalho descrevendo a utilização de pontos de adesão entre o retalho dermoadiposo e a bainha anterior do músculo reto do abdome, no intuito de diminuir a formação de seroma. O presente estudo propõe-se a demonstrar uma provável correlação entre os pontos de adesão de Baroudi com a força tensional do retalho, através da medida da distância da cicatriz abdominal inferior ao xifoide antes e após os pontos de Baroudi, no transoperatório de dermolipectomia. Métodos: Trata-se de um estudo prospectivo observacional. Foram selecionadas submetidas a lipoabdominoplastia no Serviço de Cirurgia Plástica da Santa Casa de Misericórdia de Porto Alegre, no período de janeiro a abril de 2019. Aferiram-se as medidas transoperatórias da distância do apêndice xifoide esternal à cicatriz umbilical, e da primeira à cicatriz cirúrgica, pré e pós-realização dos pontos de adesão de Baroudi. A análise estatística foi realizada com o software Excel®. Resultados: Verificou-se a diminuição das distâncias apêndice xifoidecicatriz umbilical e apêndice xifoide-cicatriz após a realização da sutura de Baroudi (média de 1,5cm), pressupondo-se diminuição da tensão da cicatriz. Conclusão: As medidas aferidas no presente estudo mostraram uma diminuição da distância xifoide-cicatriz umbilical e xifoide-cicatriz abdominal inferior após a realização dos pontos de Baroudi, evidenciando uma menor tensão na cicatriz. Sugere-se estudos para avaliar como essas medidas se comportam a longo prazo e se realmente se correlacionam a uma cicatriz de melhor qualidade.

Introduction: In 1988, Baroudi et al. published a paper describing the use of adhesion points between the dermoadipose flap and the anterior rectus abdominis sheath to reduce seroma formation. This study aimed to demonstrate a probable correlation between the use of Baroudi adhesion points and reduction in flap tension force by measuring the distance from the lower abdominal scar to the xiphoid before and after using Baroudi points in dermolipectomy transoperatory. Methods: This was a prospective observational study that selected patients who underwent lipoabdominoplasty at the Santa Casa de Misericórdia Plastic Surgery Service of Porto Alegre from January to April 2019. The transoperatory measurements of distance from the sternal xiphoid appendix to the umbilical scar and from the pre-xiphoid to the postxiphoid scar before and after execution of Baroudi's adhesion points were compared. Statistical analysis was performed using Excel® software. Results: A reduction in the distances between the xiphoid-umbilical scar appendix and xiphoidscar appendix was verified after execution of Baroudi suture (mean 1.5 cm), indicating a decrease in scar tension. Conclusion: There was a decrease in the xiphoid-umbilical scar and xiphoid-lower abdominal scar distance after Baroudi stitches, indicating lower scar-tissue tension. Further studies should be conducted to evaluate these measurements in the long term and their correlation with a better-quality scar.

A case of abdominal pregnancy on abdominal scar following in vitro fertilization and embryo transfer in a patient with bilateral tubal obstruction / 대한산부인과학회지

Abdominal pregnancy is a rare event following in vitro fertilization and embryo transfer. In case of early abdominal pregnancy, it is difficult to diagnose and treat early because of nonspecific symptoms. The abdominal pregnancy in a woman with tubal obstruction is very exceptional and an abdominal pregnancy on abdominal scar have not been reported. We reported the first abdominal pregnancy on abdominal scar following in vitro fertilization and embryo transfer in a woman with unilateral salpingectomy and contralateral tubal obstruction.

Abdominal Wall Endometriosis after Cesarean Section: A Report of Two Cases / 대한산부인과학회지

Extrapelvic endometriosis remains quite rare phenomenon. The majority of extrapelvic endometriosis involve scar tissue following obstetric/gynecologic procedures. Endometriosis involving a cesarean section scar may be more common than previously recongnized. The classic symptom is a painful scar that became swollen and more tender during menstruation. The cause of surgical scar endometriosis is believed to be iatrogenic transplantation of endometrial tissue to the surgical wound. The surgical excision remains the treatment of choice for expected cures and presents the most appropriate diagnostic and therapeutic intervention. We present two cases of endometriosis appearing on the abdominal wall scar of cesarean section with a brief review of the concerned literatures.

Three Cases of Endometriosis in the Abdominal Scar Following Cesarean Section / 대한산부인과학회잡지

Endometriosis in the abdominal scar following cesarean section is very rare condition among the extrapelvic endometriosis. Abdominal wall endometriosis secondary to cesarean section is being reported in less than 0.5% of patients undergoing cesarean section and has a distinct presentation and treatment. Three patients with history of cesarean section presented with a painful, enlarging mass involving the cesarean section scar. The pain was cyclic and the strongest just prior to menstruation. These patients were treated with surgical excision and specimens had endometriosis confirmed by histopathology. We have experienced three cases of endometriosis in the abdominal scar following cesarean section. So, we report the cases with a brief review of the concerned literatures.

Breast Reconstruction with Free TRAM Flap in Patients with Abdominal Scars

Breast reconstruction with free TRAM flap is a common procedure. However patients with abdominal scars can be confronted with a challenging problem in performing flap reconstruction. The inadequate blood supply around the scar can result in various skin complications in flap or donor site, but there are no reported guidelines in our country. From May 1999 to March 2003, a total of 38 breast reconstructions using free TRAM flaps were performed for 37 patients, of whom 12 had abdominal scars from previous operations; 7 had midline vertical scars and 4 had low transverse scars from Cesarean section or total hysterectomy, 3 had right lower quadrant oblique scars from appendectomy (2 also had transverse scars from Cesarean section). We attempted to minimize flap and donor site complications by modifying classic free TRAM flap designs and procedures according to the characteristics of the abdominal scars and performed periodic follow-up observations of flaps and donor sites for presence of complications and also gave surveys for patient satisfaction on the reconstructed breast. All 38 patients underwent successful breast reconstructions with neither skin complications around the scar nor flap loss and 96.4% patients reported being very satisfied or satisfied with the results.

Two Cases of Endometriosis at the site of Episiotomy Scar and Abdominal Scar following Cesarean Section / 대한산부인과학회잡지

The most frequent ectopic locations of endometriosis include, in descending order of frequency, the ovaries, uterine ligaments, the rectovaginal septum, and peritoneum covering the pelvic organs, that is, uterus, fallopian tubes, rectum, sigmoid colon, and bladder. Endometriosis at the site of episiotomy scar and abdominal scar following cesarean section are very rare conditions among the extrapelvic endometriosis. We have experienced two cases of endometriosis. One occurred from episiotomy scar and the other occurred from abdominal scar following cesarean section. The diagnosis of scar endometriosis is suggested if the symptoms are cyclic or in association with the patient's menstrual cycle. We can use ultrasonography, computerized tomography, magnetic resonance imaging to differentiate from other tumors. Surgical excision is the method of choice for diagnosis and treatment. We report the two cases with review of rare extrapelvic endometriosis.

Immediate Breast Reconstruction Using Pedicled TRAM flap in Patients with Lower Midline Abdominal Scar: Is Zone I and III Sufficient?

In reconstruction of breast after mastectomy, one of the main objectives is to achieve acceptable appearance compared to the contralateral breast. For patients with midline abdominal scar. however, breast reconstruction using pedicled TRAM flap may have limitations in flap availability due to the reduced circulation across the scar. For this reason, zone II and zone IV is reluctantly resected during the course of reconstruction. Western literature have reported that vascular augmentation using bipedicled free TRAM, applying the supercharging or turbocharging procedure may be necessary to boost circulation. This may be true when a large flap bulk is needed. However, in case of Korean woman whose size of the breast is relatively small, we have found that using only half of a TRAM flap may produce sufficient bulk for reconstruction. We analyzed the relationship between weight of the resected breast tissue and body mass index (BMI, weight(kg) / (height(m))2) of the Korean breast cancer patients with lower midline abdominal scar. Mean weight of the resected breast tissue was 545.9 g with the average BMI was 23.4 kg/m2. The mean ratio of the resected breast mass to BMI was 21.7, which was proportional to BMI. Two of three patients whose ratio of the resected breast tissue mass to BMI were higher than 34.1 answered in the questionnare that the reconstructed one was smaller in size than the other side. When the ratio of the resected breast tissue mass to BMI is 29.8 or lower than this, a hemi-TRAM flap consisted with zone I and zone III provided sufficient tissue for reconstruction. In conclusion, using the BMI and weight of resected breast tissue mass, we can effectively predict the amount of TRAM flap needed for reconstruction.

The Expressions of Matrix Metalloproteinase-9 and Tissue Inhibitors of Metalloproteinase-1 in Scar Endometriosis and Full Term Endometrium / 대한산부인과학회잡지

OBJECTIVE: Endometriosis in a surgical scar following cesarian section is rare condition. And its pathogenesis has not been well established. The purpose of this study is to observe the expressions of matrix metalloproteinase-9 (MMP-9) and tissue inhibitors of metalloproteinase-1 (TIMP-1) in scar endometriosis and full term endometrium during cesarian section. METHODS: Nineteen scar endometriotic tissue and ten full term pregnant endometrium during cesarian section were investigated by immunohistochemical stain for MMP-9 and TIMP-1. RESULTS: The MMP-9 was expressed in eleven of nineteen scar endometriotic tissue (57.9%) and eight of ten full term pregnant endometrium (80.0%). The TIMP-1 was not expressed in both scar endometriotic tissue and full term pregnant endometrium. CONCLUSION: These results suggest that the relationship between MMP-9 and TIMP-1 might play a role of pathogenesis of scar endometriosis.

The Expressions of Matrix Metalloproteinase-9 and Tissue Inhibitors of Metalloproteinase-1 in Scar Endometriosis and Full Term Endometrium / 대한산부인과학회잡지

OBJECTIVE: Endometriosis in a surgical scar following cesarian section is rare condition. And its pathogenesis has not been well established. The purpose of this study is to observe the expressions of matrix metalloproteinase-9 (MMP-9) and tissue inhibitors of metalloproteinase-1 (TIMP-1) in scar endometriosis and full term endometrium during cesarian section. METHODS: Nineteen scar endometriotic tissue and ten full term pregnant endometrium during cesarian section were investigated by immunohistochemical stain for MMP-9 and TIMP-1. RESULTS: The MMP-9 was expressed in eleven of nineteen scar endometriotic tissue (57.9%) and eight of ten full term pregnant endometrium (80.0%). The TIMP-1 was not expressed in both scar endometriotic tissue and full term pregnant endometrium. CONCLUSION: These results suggest that the relationship between MMP-9 and TIMP-1 might play a role of pathogenesis of scar endometriosis.

A Case Of Endometriosis At The Subcutaneous Tissue Of The Abdominal Scar After Cesarean Section / 대한산부인과학회잡지

Extrapelvic endometriosis is a fairly rare phenomenon. The majority of extrapelvic endometriosis involves scar tissue following obstetric/gynecologic procedures. Cesarean section scar endometriosis may be more common than reflected in the literature and has a distinct presentation and treatment. One patient with history of cesarean section presented with a painful, enlarging mass involving the cesarean section scar. The pain was cyclic and strongest just prior to menstruation. This patient was treated with surgical excision and specimens had endometriosis confirmed by histopathology. This case was reported with a brief review of the concerned literatures.

A Case Of Endometriosis At The Subcutaneous Tissue Of The Abdominal Scar After Cesarean Section / 대한산부인과학회잡지

Extrapelvic endometriosis is a fairly rare phenomenon. The majority of extrapelvic endometriosis involves scar tissue following obstetric/gynecologic procedures. Cesarean section scar endometriosis may be more common than reflected in the literature and has a distinct presentation and treatment. One patient with history of cesarean section presented with a painful, enlarging mass involving the cesarean section scar. The pain was cyclic and strongest just prior to menstruation. This patient was treated with surgical excision and specimens had endometriosis confirmed by histopathology. This case was reported with a brief review of the concerned literatures.

Five Cases of Endometriosis at the Site of Abdominal Scar following Cesarean Section and Episiotomy Scar / 대한산부인과학회잡지

Endometriosis at the site of episiotomy scar following vaginal delivery and abdominal scar following cesarean section are rare conditions among the extrapelvic endometriosis implantation. We have experienced five cases of extrapelvic endometriosis : four cases at the site of abdominal scar following cesarean section, and one case at the site of episiotomy scar following vaginal delivery. We report the five cases with brief review of the concerned literature.

A Case of Endometriosis in the Abdominal Scar Following Cesarean Section / 대한산부인과학회잡지

Although benign, endometriosis possesses the unique ability to invade tissue and to disseminate or metastasize by hematogeneous, lymphatic route, or direct implantation. Scar from operations are occasionally the site of endometriosis implatation. A case of endometriosis in the abdominal scar following cesarean section was experienced and treatd with complete surgical excision. We reported this case with brief review of the literature.