Braquioplastia pós-gastroplastia: avaliação da satisfação dos pacientes / Brachioplasty after bariatric surgery: evaluation of patient satisfaction

Introdução: A deformidade dos membros superiores, causada pela perda ponderal maciça, pode ser corrigida por meio da braquioplastia. Essa cirurgia plástica visa melhorar o contorno dos membros, facilitar a higiene e possibilitar o uso de determinadas vestimentas. Objetivo: Demonstrar casuística, relatar intercorrências e complicações e avaliar a satisfação de pacientes submetidos à braquioplastia após gastroplastia. Método: Trinta e quatro pacientes (97% mulheres, idade 46,6 ± 12 anos) submetidos à braquioplastia após cirurgia bariátrica foram recrutados para o estudo. Descrevemos a ocorrência de intercorrências e complicações associadas ao procedimento cirúrgico e avaliamos a satisfação de 33 pacientes por meio de entrevista qualitativa e questionário específico. Resultados: Como complicações menores, observou-se pequena deiscência em cinco pacientes (14,7%); não foram observadas complicações cirúrgicas maiores. O grau de satisfação foi obtido em 81,8% dos pacientes e o resultado alcançado ficou próximo das expectativas de 69,7% deles. Conclusões: As técnicas utilizadas de braquioplastia pós-bariátrica restabeleceram o adequado contorno braquial, com baixo índice de complicações menores e alto grau de satisfação dos pacientes avaliados.

Introduction: Upper limb deformity caused by massive weight loss can be corrected by brachioplasty. This plastic surgery improves limb contour, facilitates hygiene, and enables use of certain clothing. Objective: To present the cases, describe interventions and complications, and evaluate the satisfaction of patients who underwent brachioplasty after bariatric surgery. Method: Herein, 34 patients (including 33 females) aged 46.6 ± 12 years, who underwent brachioplasty after bariatric surgery, were recruited for the study. Interventions and complications associated with the surgical procedure were described, and the satisfaction of 33 patients was evaluated by a qualitative interview and specific questionnaire. Results: As a minor complication, slight dehiscence was observed in five patients (14.7%), but no major surgical complications were seen. Some degree of satisfaction was reported by 81.8% of the patients, and the outcome achieved in 69.7% was close to that expected. Conclusions: The brachioplasty techniques that were used restored proper arm contour with a low rate of minor complications, and a high degree of satisfaction among the patients evaluated.

Clinical and functional significance of accessory brachialis muscle: an unique anatomical variant / Significado clínico y funcional del músculo braquial accesorio: una variante anatómica única

A thorough knowledge of the variations in the patterns of muscle insertion and the consequent neurovascular entrapment due to them is important for orthopedic and plastic surgeons. During routine dissection, we encountered a unique occurrence of an accessory brachialis muscle (acBr) blending with the medial aspect of bicipital aponeurosis in the cubital fossa. It also entrapped the median nerve and brachial artery due to its superficial position. The abnormality reported here might result in neurovascular compression symptoms in the upper limb and possible mechanical advantages or disadvantage in the flexion of elbow joint. To the best of our knowledge, the brachialis variant insertion we present here is rare in the list of its anomalies. We also discuss in this report the embryological background and the clinical application of the variation that can abet clinicians in evaluating symptoms involving the upper limb.

Es importante para los cirujanos ortopédicos y plásticos, el conocimiento integral de las variaciones en los patrones de inserción de los músculos y el consiguiente atrapamiento neurovascular. Durante una disección de rutina, encontramos un caso único de un músculo accesorio braquial con aponeurosis bicipital en el lado medial de la fosa cubital. También cubre la arteria braquial y nervio mediano debido a su posición superficial. La anomalía informada aquí podría resultar en síntomas de compresión neurovascular en el miembro superior y las posibles ventajas o desventajas mecánicas de flexión de la articulación del codo. De acuerdo a lo estudiado, la inserción variante braquial que presentamos aquí es un caso raro dentro de la lista de sus variaciones. También se discuten en este informe la base embriológica y la aplicación clínica de la variación que puede ser útil para los clínicos en la evaluación de los síntomas relacionados con el miembro superior.

Malformación vascular capilar extensa asociada a defecto terminal transverso de la extremidad: descripción de una nueva asociación / Extensive capillary vascular malformation associated with terminal transverse defect of the limb: description of a new partenership

Paciente de tres años de edad que nació con una malformación vascular capilar (MVC) extensa, del tipo mancha en vino de Oporto o nevus flammeus, en hemitórax y brazo derecho asociada a agenesia distal de dicha extremidad. El niño fue un recién nacido de 39 semanas, sin patologías del embarazo, complicaciones perinatales ni consumo materno de drogas o fármacos. Al nacer se estudió la alteración musculoesquelética con radiografía que mostró hipoplasia radiocubital y agenesia de los huesos del carpo así como de los restantes huesos de la mano. Se realizó búsqueda de otras malformaciones la que fue negativa. Evaluado por genetista, se descartó genopatía. El diagnóstico definitivo fue de defecto terminal transverso asociado a MVC gigante. El paciente presentó crecimiento pondoestatural adecuado y desarrollo psicomotor normal. Las malformaciones vasculares pueden asociarse a diversas malformaciones musculoesqueléticas. En términos generales, las malformaciones venosas pueden asociarse a alteraciones del crecimiento de la extremidad y las malformaciones capilares a hipertrofia. Sin embargo, no existen descripciones de casos de malformaciones vasculares coexistentes con agenesia de la extremidad, por lo que creemos que ésta es una nueva asociación que requiere mayor estudio

We report a case of a three years old boy that was born with an extended capillary malformation (CM), of the port-wine stain or nevus flammeus type, that covered his right arm, shoulder and hemithorax associated with distal agenesis of the same extremity. Patient was a 39-weeks new born without any diseases during pregnancy, use of maternal drugs nor perinatal complications. A radiography of the arm showed radius and ulna hypoplasia and complete agenesis of carpal and other bones of the hand. Different exams were made to exclude other malformations, with no pathological findings. A Geneticist ruled out any genopathy. Final diagnosis was terminal transverse defect of the right arm associated with a CM of the extremity. Vascular malformations may be associated with musculoskeletal malformations. Generally, venous malformations may have bone growth alterations of extremities and CM may be associated with hypertrophy. However, there are no reported cases of a vascular malformations associated with agenesis of the extremity. Therefore, we think this is a new association that needs to be studied

Entrapment of the median nerves and brachial arteries in the lower arms bilaterally and additional origin of biceps brachii muscle: case report / Compresión bilateral del nervio mediano y de la arteria braquial en la parte distal del brazo y origen adicional del músculo bíceps braquial: reporte de caso

Neuro-vascular entrapments associated with variations observed in the origins of muscles in the arm are not uncommon. Though additional heads of biceps brachii muscle and extra fibres of brachialis muscles have been demonstrated earlier, bilateral additional heads of the biceps are rarely seen, especially with entrapment of the median nerve and the brachial arteries in both the arms. The present study reports conspicuous heads of the biceps brachii originating extensively from the medial inter-muscular septum, sharing its origin with the brachialis muscle. The extra origins of the muscle formed long musculo-aponeurotic tunnels. The tunnels measured eight centimeters in length extending from the lower arm to the cubital-fossa. Both the median nerve and the brachial arteries passed through the tunnel. The lower aspect of the left tunnel exhibited origins of fibres belonging to the superficial flexors of the forearm. The neuro-vascular structures did not give any branches in the tunnel. Awareness of such variations can aid clinicians in diagnosing and treating such neuropathies and vascular compromise.

No es infrecuente observar atrapamientos neuro-vasculares asociados con variaciones en el origen de los músculos del brazo. A pesar de haberse observado cabezas adicionales del músculo bíceps braquial y fibras extra del músculo braquial raramente estas cabezas adicionales bilaterales han sido causantes de la compresión del nervio mediano y de la arteria braquial. En este trabajo presentamos las cabezas del músculo bíceps braquial originándose en gran parte en el tabique intermuscular medial compartiendo su origen con el músculo braquial. Los orígenes adicionales del músculo forman largos túneles músculo fasciales. Los túneles miden 8 cm de longitud, y se extienden desde la parte inferior del brazo hasta la fosa cubital. Tanto el nervio mediano como la arteria braquial pasan por el túnel. La parte inferior del túnel izquierdo dio origen a fibras pertenecientes al músculo flexor superficial del antebrazo. Las estructuras neurovasculares no otorgaron colaterales en el túnel. El conocimiento de estas variaciones puede ayudar a los clínicos en el diagnóstico y el tratamiento de neuropatías y compromiso vascular.

Humero - bicipito - articularis: a rare accessory muscle of the arm

Anomalies related to the musculature of the upper limb are extremely important for plastic and orthopedic surgeons in their clinical practice. The present study reports the presence of a rare accessory muscle in the flexor compartment of the arm with its morphological description and also highlights its clinical relevance. We encountered a rare accessory muscle in the region of upper arm of an adult male Indian cadaver in the Anatomy department. The anatomical details of this accessory muscle were studied in detail and appropriate photograph was taken. An accessory muscle in the flexor compartment of the right upper arm was observed. The muscle originated from the proximal part of the humeral shaft and displayed insertion into the lateral border of the short head of biceps brachii It's fibers also blended with the fibrous capsule of the shoulder joint. The plethora of muscular variations in this important anatomic area is of utmost significance to the surgeon performing reconstructive and explorative procedures

Rejuvenescimento do braço: sistematização de tratamento / Arm renewing: treatment systematization

Este estudo avaliou 10 pacientes operadas com o objetivo de rejuvenescimento do braço, no período de março a novembro de 2002, no Hospital de Clínicas da Universidade Federal do Paraná. Os pacientes foram divididos em quatro grupos conforme o grau de flacidez e o volume de tecido celular subcutâneo do braço, segundo a classificação de TEIMOURIAN (1998). O tratamento cirúrgico foi individualizado para cada grupo. O primeiro grupo (duas pacientes) apresentava adiposidade moderada e flacidez mínima e foi submetido a lipoaspiração com bons resultados. O segundo grupo, (duas pacientes) apresentava moderada adiposidade e moderada flacidez de pele e optou-se pela realização de lipoaspiração do braço seguido de sutura externa formando uma prega de pele na axila. As pregas axilares evoluíram com resultado estético insatisfatório, necessitando reoperação após 6 meses com ressecção do excesso de pele, além de serem mais dolorosos que os demais grupos. O terceiro grupo (3 pacientes) apresentava flacidez moderada e adiposidade intensa, onde se indicou lipoaspiração seguido de braquioplastia com ressecção pele e fechamento em forma de “T”, obtendo-se bons resultados. O quarto grupo (duas pacientes) apresentava mínima adiposidade e intensa flacidez de pele e foram submetidas a braquioplastia tradicional com ressecção do excesso de pele evoluindo com cicatrizes extensas, porém de boa qualidade.

This study has availed 10 operated patients looking for the arm rejuvenation, in the period from march to november of 2002 in Hosp. das Clínicas da Universidade Federal do Paraná. The patients were divided in four groups according to the flaccid level and to the arm loose tissue volume, due to the TEIMOURIAN classification (1998).The surgical approach was individualized for each group. The first group(two patients) presented moderate adiposity and a few flaccid and underwent to liposuction with good results. The second group(two patients) presented mild adiposity and skin limpness, and decided a arm liposuction followed by a extern suture forming a skin ridge in the axilla. The axillary rigde developed with unsatisfactory. The third group (two patients) consists of patients who have excess fat and a fair amount of loose skin, decided a liposuction followed by a resected skin defect with the T excision with good results. The fourth group (two patients) consist of patients who skin laxity and depletion of subcutaneous fat making brachioplasty the procedure of choice, with extensive scars and visible, but tolerate.

Lucio leprosy with lucio phenomenon.

Leprosy is one of the commonly seen disease in any dermatology outpatient department in our country. India accounts for a major portion of the leprosy patients in the world. All types of the disease, such as tuberculoid, borderline, lepromatous, neuritic and indeterminate leprosy, are seen. However, "lucio leprosy" which is considered a special type of lepromatous leprosy characterised by diffuse involvement has not been reported from India. We are presenting here two cases of "lucio leprosy" with "lucio phenomenon", the lucio phenomenon being a special type of lepra reaction seen in lucio leprosy.

Flebangiomatosis litogénica de servelle y trinquecoste: presentación de 1 caso / Lithogenic phlebangiomatosis of Servelle and Trinquecoste: a case report

Se informa el caso de una paciente de 17 años de edad y de la raza blanca, con flebangiomatosis de Servelle y Trinquecoste que le afecta el miembro superior izquierdo. Se hace una revisión de los casos reportados en la literatura médica. El tratamiento quirúrgico que se realizó posibilitó obtener un resultado funcional y estético muy satisfactorio(AU)

The case of a 17-year-old white patient with phlebangiomatosis of Servelle and Trinquecoste, affecting his left upper limb, is presented. A review of those cases reported in medical literature is made. The surgical treatment applied allowed to obtain a more satisfactory functional and aesthetic result(AU)

Prenatal diagnosis of VACTERL association: a case report.

A prenatal diagnosis of VACTERL association, a combination of vertebral (V), anal (A), cardiac (C), tracheoesophageal (TE), renal (R) and limb (L) anomalies was made at 30 weeks of gestation, based on the sonographic demonstration of vertebral defects, bilateral renal agenesis, and left lower limb defects. Additionally, severe oligohydramnios and fetal growth restriction were also documented. After proper counseling, elective termination of pregnancy was done, resulting in a stillborn infant with multiple malformations compatible with the VACTERL association. The postnatal X-ray and autopsy revealed verterbral defects, anorectal atresia with undetermined sex, cardiac defect of ventricular septal defect, tracheal agenesis with distal atresia of esophagus, bilateral renal agenesis, and limbs defects. The chromosomal study revealed normal, 46,XY. This report emphasizes the important role of prenatal ultrasound in the diagnosis and management of this disorder.

Multiple pterygium syndrome.

Severely involved female child with Multiple Pterygium Syndrome (Escobar) is described. She had the typical findings of the syndrome such as multiple pterygiums, characteristic facial appearance, genital anomalies. She also had bilateral optic atrophy. This is the first case described so far with optic atrophy in Multiple Pterygium Syndrome (Escobar).

Dermolipectomia braquial / Brachial dermolipectomy

Os autores fazem uma análise das deformidades localizadas na regiäo braquial e na parede lateral do tórax. Discutem as indicaçöes cirúrgicas e suas limitaçöes