Prevalência de cirurgia de contorno corporal em pacientes pós-bariátricos em um hospital universitário / Prevalence of body contouring surgery in post-bariatric patients at a university hospital

Introdução: O número crescente de pacientes com perda ponderal maciça, após cirurgias bariátricas, correlaciona-se com a procura por cirurgias de contorno corporal. Tais procedimentos reduzem queixas físicas e psicológicas, influenciando positivamente a qualidade de vida dessas pessoas. Todavia, há poucos dados quanto à resposta dos serviços que oferecem tratamento cirúrgico para obesidade mórbida frente a essa necessidade. O estudo tem como objetivo aferir a prevalência de cirurgia do contorno corporal entre 2015 e 2018, em pacientes previamente submetidos à cirurgia bariátrica, nos anos de 2014 e 2015, em um hospital universitário. Métodos: Consulta ao sistema de informação hospitalar e a prontuários médicos a fim de aferir prevalência institucional de cirurgia de contorno corporal pós-bariátrica. Foram excluídos pacientes que não tenham sido submetidos a ambas as cirurgias em nosso Serviço, os que realizaram os referidos procedimentos cirúrgicos em outros anos, bem como aqueles com registros incompletos. Resultados: Foram realizadas cirurgias bariátricas em 208 pacientes. Desses, 11% (n=23) foram submetidos a 27 cirurgias do contorno corporal, sendo a dermolipectomia abdominal (n=16) a mais realizada. A realização de mais de um procedimento para correção de deformidade corporal ocorreu em 13% (n=3) dos pacientes. A média de idade dos pacientes submetidos a cirurgia do contorno corporal foi de 37 anos, a maioria do sexo feminino (96%, n=22). Conclusão: A cirurgia do contorno corporal constitui etapa importante do tratamento da obesidade mórbida e tem caráter reparador. Há imensa carência dessa terapêutica, o que compromete irremediavelmente os resultados obtidos pela cirurgia bariátrica.

Introduction: The growing number of patients with massive weight loss after bariatric surgery is correlated with the demand for body contouring surgery. Such procedures reduce physical and psychological complaints, positively influencing the quality of life of these people. However, there is little data on the response of services that offer surgical treatment for morbid obesity to this need. The study aims to measure the prevalence of body contouring surgery between 2015 and 2018, in patients previously underwent on a bariatric surgery, in 2014 and 2015, at a University Hospital. Methods: Research in the hospital information system and medical records in order to assess the institutional prevalence of post-bariatric body contouring surgery. Patients who did not undergo both surgeries in our Service, those who underwent these surgical procedures in other years, as well as those with incomplete medical records were excluded. Results: Bariatric surgeries were performed in 208 patients. Of these, 11% (n=23) underwent 27 body contouring surgeries, with abdominal dermolipectomy (n=16) being the most frequently performed. The performance of more than one procedure to correct body deformity occurred in 13% (n=3) of patients. The mean age of patients undergoing body contouring surgery was 37 years, the majority was female (96%, n=22). Conclusion: Body contouring surgery is an important step in the treatment of morbid obesity and has a restorative feature. There is a huge lack of this therapy, which irreparably compromises the results obtained by bariatric surgery.

Análise de complicações de lipoenxertias realizadas em hospital público universitário entre 2015 e 2018: estudo retrospectivo transversal / Analysis of complications from fat grafting performed at a public university hospital between 2015 and 2018: a cross-sectional retrospective study

Introdução: A lipoenxertia consiste no processo de coleta de gordura de uma área doadora de gordura por meio de lipoaspiração seguida da realocação desse tecido em área receptora por meio de seringas e cânulas. É um processo seguro utilizado em cirurgias estéticas e reconstrutivas, de acordo com a literatura. O objetivo é avaliar as taxas de complicações dos procedimentos de lipoenxertia realizados em um hospital público universitário no período de 2015 a 2018, em comparação com dados previamente relatados na literatura. Métodos: Estudo observacional retrospectivo desenvolvido em hospital universitário público de Campinas - SP a partir da revisão de prontuários de pacientes submetidos a lipoenxertia nesta instituição de 2015 a 2018. Resultados: Em relação às complicações, a grande maioria correspondeu à reabsorção de gordura (62%). O hematoma correspondeu ao segundo mais comum (38% dos casos), seguido do edema (19%). Dor e discromia vieram em seguida, com 10% e 7% dos casos, respectivamente. Apenas um caso de infecção de ferida operatória foi descrito. Outras complicações menos frequentes foram hiperemia (5%), assimetrias (5%), descamação (2%), parestesia local (3%) e lesão cutânea (2%). Nenhuma outra complicação maior foi relatada, como embolia gordurosa ou complicações cirúrgicas graves como sangramento, sepse, anafilaxia, entre outras. Conclusão: Os procedimentos de lipoaspiração para coleta de gordura e lipoenxertia mostraram-se seguros e com baixo índice de complicações na amostra estudada, concordando com dados da literatura.

Introduction: Fat grafting consists of collecting fat from one fat donor area via liposuction, then reallocating this tissue into a receptor area through syringes and cannulas. According to the literature, it is a safe process used in aesthetic and reconstructive surgeries. The objective is to evaluate complication rates of fat grafting procedures performed in a public university hospital from 2015 to 2018 in comparison with data previously reported in the literature. Methods: A retrospective observational study developed at a public university hospital in Campinas-SP based on the revision of medical records of patients who underwent the fat grafting procedure in this institution from 2015 to 2018. Results: Regarding the complications, the vast majority corresponded to fat reabsorption (62%). Bruise corresponded to the second most common (38% of cases), followed by edema (19%). Pain and dyschromia followed next, with 10% and 7% of cases, respectively. Only one case of operative wound infection was described. Other less frequent complications included hyperemia (5%), asymmetries (5%), desquamation (2%), local paraesthesia (3%) and skin lesion (2%). No other larger complication was reported, such as fat embolism or severe surgical complications such as bleeding, sepsis, or anaphylaxis. Conclusion: The procedures of liposuction for fat collection and fat grafting were proved to be safe, yielding low complication rates in the studied sample, which agrees with data reported in the literature.

Effects of the lower energy and pulse stacking in carbon dioxide laser skin treatment: an objective analysis using second harmonic generation.

PURPOSE: To evaluate the effect of fractional carbon dioxide (CO2) laser treatment using lower power associated with pulse stacking within collagen fibers, using second harmonic generation microscopy and computerized image analysis. METHODS: Twenty male Wistar rats aging eight weeks were used. Each treatment area received a single-pass CO2 fractional laser with different parameters. The 20 animals were divided into two groups and euthanized after 30 and 60 days. Second harmonic generation images were obtained and program ImageJ was utilized to evaluate the collagen organization within all areas. Collagen anisotropy, entropy and optical density were quantified. RESULTS: Increased anisotropy over time was observed in all four areas, but only reached statistical significance (p = 0.0305) when the mildest parameters were used (area four). Entropy decreased over time in all areas, but without significance(p = 0.1779) in area four. Density showed an overtime increase only in area four, but no statistical significance was reached (p = 0.6534). CONCLUSIONS: When combined, the results obtained in this study regarding anisotropy, entropy and density tend to demonstrate that it is possible to achieve collagen remodeling with the use of lower power levels associated with stacked pulses.

Effects of the lower energy and pulse stacking in carbon dioxide laser skin treatment: an objective analysis using second harmonic generation

Purpose: To evaluate the effect of fractional carbon dioxide (CO2 ) laser treatment using lower power associated with pulse stacking within collagen fibers, using second harmonic generation microscopy and computerized image analysis. Methods: Twenty male Wistar rats aging eight weeks were used. Each treatment area received a single-pass CO2 fractional laser with different parameters. The 20 animals were divided into two groups and euthanized after 30 and 60 days. Second harmonic generation images were obtained and program ImageJ was utilized to evaluate the collagen organization within all areas. Collagen anisotropy, entropy and optical density were quantified. Results: Increased anisotropy over time was observed in all four areas, but only reached statistical significance (p = 0.0305) when the mildest parameters were used (area four). Entropy decreased over time in all areas, but without significance (p = 0.1779) in area four. Density showed an overtime increase only in area four, but no statistical significance was reached (p = 0.6534). Conclusion: When combined, the results obtained in this study regarding anisotropy, entropy and density tend to demonstrate that it is possible to achieve collagen remodeling with the use of lower power levels associated with stacked pulses.(AU)

Comparative clinical evaluation of breast augmentation using silicone foam coated implants and textured implants.

PURPOSE: To evaluate whether silicone foam implants have a different evolution pattern compared to conventional texture implants. METHODS: Fifty-eight female patients underwent surgery. They were divided into two groups (silicone foam - Lifesil® - and microtexturized silicone - Lifesil®). The evolution was analyzed in postoperative consultations, with physical examination, photographic documentation and filling in a satisfaction questionnaire, in the postoperative period of one month, four months, one year and then annually, up to a maximum of 3 years of follow-up. RESULTS: There were no statistically significant differences in presence of rippling, stretch marks, breast ptosis, capsular contracture and quality of scars. There was a higher rate of patients who were very satisfied with the outcome 360 days after surgery in the group receiving silicone foam implants (p = 0.036). CONCLUSION: In short time, silicone foam envelope implants proved to be as reliable as textured silicone envelope implants, making them an option for augmentation mammoplasty.

Comparative clinical evaluation of breast augmentation using silicone foam coated implants and textured implants

Purpose To evaluate whether silicone foam implants have a different evolution pattern compared to conventional texture implants. Methods Fifty-eight female patients underwent surgery. They were divided into two groups (silicone foam Lifesil® and microtexturized silicone Lifesil®). The evolution was analyzed in postoperative consultations, with physical examination, photographic documentation and filling in a satisfaction questionnaire, in the postoperative period of one month, four months, one year and then annually, up to a maximum of 3 years of follow-up. Results There were no statistically significant differences in presence of rippling, stretch marks, breast ptosis, capsular contracture and quality of scars. There was a higher rate of patients who were very satisfied with the outcome 360 days after surgery in the group receiving silicone foam implants (p = 0.036). Conclusion In short time, silicone foam envelope implants proved to be as reliable as textured silicone envelope implants, making them an option for augmentation mammoplasty.(AU)

Renal Function 1 Year After Bariatric Surgery: Influence of Roux-en-Y Gastric Bypass and Identification of Pre-Operative Predictors of Improvement.

BACKGROUND: While evidence of improved renal function following gastric bypass exists, pre-operative predictors of this improvement are not completely known. OBJECTIVES: To assess the glomerular filtration rate (GFR) 1 year after Roux-en-Y gastric bypass (RYGB) and to identify pre-operative predictors associated with the improvement of renal function. METHODS: A historical cohort study, which included 109 obese patients before and 12 months after RYGB, was classified into subgroups according to GFR (normofiltration, hypofiltration (GFR < 5th percentile), and hyperfiltration (GFR > 95th percentile)). The 5th and 95th percentiles were 90 and 120 mL/min/1.73 m2, respectively. The primary outcome was the variation of GFR (%GFR) estimated by the Chronic Kidney Disease - Epidemiology Collaboration (CKD-EPI) formula, calculated using serum creatinine, ethnicity, and gender. RESULTS: The mean age was 38.3 ± 10.3 years and 77% were female; 52.3% presented hypertension and 27.5% type 2 diabetes. One year after surgery, the mean BMI decreased from 36.7 ± 3.6 to 28.8 ± 3.3 kg/m2 (p < 0.001). Pre-surgically, 37.6% presented hypofiltration, 47.7% normofiltration, and 14.7% hyperfiltration. The overall GFR increased from 95.5 ± 19 to 104 ± 16.4 mL/min (10.9%) (p < 0.001). The overall post-surgical %GFR was negatively correlated with the pre-surgical GFR (R = - 0.687; p < 0.001). In the hypofiltration and normofiltration subgroups, the post-surgical %GFR was negatively correlated with age (R = - 0.328, p = 0.036; and R = - 0.355, p = 0.004, respectively) and pre-surgical GFR (R = - 0.436, p = 0.04; and R = - 0.528, p < 0.001, respectively). CONCLUSION: RYGB led to a significant improvement in renal function, mainly among patients with a worse pre-operative renal function. In the hypofiltration and normofiltration subgroups, a younger age was associated with better outcomes.

Comparative clinical evaluation of breast augmentation using silicone foam coated implants and textured implants

Abstract Purpose To evaluate whether silicone foam implants have a different evolution pattern compared to conventional texture implants. Methods Fifty-eight female patients underwent surgery. They were divided into two groups (silicone foam - Lifesil® - and microtexturized silicone - Lifesil®). The evolution was analyzed in postoperative consultations, with physical examination, photographic documentation and filling in a satisfaction questionnaire, in the postoperative period of one month, four months, one year and then annually, up to a maximum of 3 years of follow-up. Results There were no statistically significant differences in presence of rippling, stretch marks, breast ptosis, capsular contracture and quality of scars. There was a higher rate of patients who were very satisfied with the outcome 360 days after surgery in the group receiving silicone foam implants (p = 0.036). Conclusion In short time, silicone foam envelope implants proved to be as reliable as textured silicone envelope implants, making them an option for augmentation mammoplasty.

Liquid silicone used for esthetic purposes as a potentiator for occurrence of post-radiotherapy genital lymphedema: case report.

CONTEXT:: Lymphedema consists of extracellular fluid retention caused by lymphatic obstruction. In chronic forms, fat and fibrous tissue accumulation is observed. Genital lymphedema is a rare condition in developed countries and may have primary or acquired etiology. It generally leads to urinary, sexual and social impairment. Clinical treatment usually has low effectiveness, and surgical resection is frequently indicated. CASE REPORT:: We report a case of a male-to-female transgender patient who was referred for treatment of chronic genital lymphedema. She had a history of pelvic radiotherapy to treat anal cancer and of liquid silicone injections to the buttock and thigh regions for esthetic purposes. Radiological examinations showed signs both of tissue infiltration by liquid silicone and of granulomas, lymphadenopathy and lymphedema. Surgical treatment was performed on the area affected, in which lymphedematous tissue was excised from the scrotum while preserving the penis and testicles, with satisfactory results. Histopathological examination showed alterations compatible with tissue infiltration by exogenous material, along with chronic lymphedema. CONCLUSION:: Genital lymphedema may be caused by an association of lesions due to liquid silicone injections and radiotherapy in the pelvic region. Cancer treatment decisions for patients who previously underwent liquid silicone injection should take this information into account, since it may represent a risk factor for radiotherapy complications.

Liquid silicone used for esthetic purposes as a potentiator for occurrence of post-radiotherapy genital lymphedema: case report / Silicone líquido utilizado com finalidade estética como potencializador da ocorrência de linfedema genital pós-radioterapia: relato de caso

ABSTRACT CONTEXT: Lymphedema consists of extracellular fluid retention caused by lymphatic obstruction. In chronic forms, fat and fibrous tissue accumulation is observed. Genital lymphedema is a rare condition in developed countries and may have primary or acquired etiology. It generally leads to urinary, sexual and social impairment. Clinical treatment usually has low effectiveness, and surgical resection is frequently indicated. CASE REPORT: We report a case of a male-to-female transgender patient who was referred for treatment of chronic genital lymphedema. She had a history of pelvic radiotherapy to treat anal cancer and of liquid silicone injections to the buttock and thigh regions for esthetic purposes. Radiological examinations showed signs both of tissue infiltration by liquid silicone and of granulomas, lymphadenopathy and lymphedema. Surgical treatment was performed on the area affected, in which lymphedematous tissue was excised from the scrotum while preserving the penis and testicles, with satisfactory results. Histopathological examination showed alterations compatible with tissue infiltration by exogenous material, along with chronic lymphedema. CONCLUSION: Genital lymphedema may be caused by an association of lesions due to liquid silicone injections and radiotherapy in the pelvic region. Cancer treatment decisions for patients who previously underwent liquid silicone injection should take this information into account, since it may represent a risk factor for radiotherapy complications.

RESUMO CONTEXTO: O linfedema consiste de retenção de fluido extracelular causada por obstrução linfática. Nas formas crônicas, observa-se acúmulo de tecido adiposo e fibrose. O linfedema genital é uma doença rara em países desenvolvidos e pode ter etiologia primária ou adquirida, em geral cursando com disfunções urinária e sexual, bem como com prejuízo do convívio social. O tratamento clínico é, em geral, pouco efetivo, indicando-se com frequência a abordagem cirúrgica, com excisão da área afetada. RELATO DE CASO: Relata-se o caso de paciente feminina transgênero, encaminhada para tratamento de linfedema genital crônico. Havia antecedente pessoal de tratamento de câncer de canal anal com radioterapia pélvica e de injeções de silicone líquido em glúteos e coxas com finalidade estética. Exames radiológicos mostraram tanto sinais de infiltração tecidual por silicone líquido como granulomas e linfadenopatia como de linfedema. Foi realizado o tratamento cirúrgico da área afetada, com excisão do tecido linfadenomatoso do escroto, preservando o pênis e testículos, com resultado satisfatório. A análise histopatológica mostrou achados compatíveis com infiltração tecidual por material exógeno, bem como com linfedema crônico. CONCLUSÃO: O linfedema genital pode ser causado pela associação de lesão por injeção de silicone líquido e radioterapia na região pélvica. As decisões no tratamento de neoplasias em pacientes previamente submetidos a injeção de silicone líquido devem levar em conta esse fato, já que pode representar fator de risco para complicações de tratamento radioterápico.

Patient Versus Surgeon Preferences Between Traditional and Neo-omphaloplasty in Post-bariatric Abdominoplasty.

BACKGROUND: Abdominoplasty procedures have been proven highly valuable in promoting better quality of life for post-bariatric surgery patients. The literature reveals that the aspect of the navel is one of the most problematic issues regarding surgical results and many different surgical techniques have been proposed to obtain a satisfactory outcome. However, little is known about patients' preferences regarding these different techniques and their results. The aim of the present study was to compare evaluations made by plastic surgeons and patients of the results of two different techniques-traditional omphaloplasty and neo-omphaloplasty with lateral flaps. METHODS: Five plastic surgeons analyzed postoperative pictures of 54 post-bariatric abdominoplasties performed between 2008 and 2013 at the Unicamp Hospital. Pictures of 12 cases were selected and evaluated by 50 patients waiting for a post-bariatric abdominoplasty. A standardized scale was used that contained the following criteria: volume of the abdomen, lateral contour, quality of the scars, umbilicus and skin excess/flaccidity. RESULTS: Surgeons gave the highest scores to 71.6% of neo-omphaloplasty cases and patients to 43.7%. Both surgeons and patients graded navels operated on using this technique higher, although the comparison was not statistically significant for patient evaluations (p = 0.062). The navel aspect was considered the fourth most relevant aspect among those evaluated. CONCLUSION: Neo-omphaloplasty results were considered better than traditional omphaloplasty for surgeons and patients, although there was not a clear differentiation of results by the latter. The navel postoperative aspect was considered secondarily important by patients to the results of post-bariatric abdominoplasties. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Desenvolvimento e aplicação de um protocolo antropométrico para a avaliação de resultados de otoplastia / Development and implementation of an anthropometric protocol to evaluate results of otoplasty

INTRODUÇÃO: A proeminência dos pavilhões auriculares é a forma mais comum de deformidade desta estrutura, afetando em torno de 5% da população. A maioria dos trabalhos acerca da cirurgia de otoplastia apresenta avaliações subjetivas, não permitindo apreciar acuradamente os resultados no pós-operatório, bem como dificultando a comparação entre técnicas. Propõe-se o desenvolvimento e aplicação de protocolo específico para avaliação dos resultados. MÉTODO: Avaliação prospectiva pelo período de um ano de pacientes submetidos à otoplastia bilateral utilizando técnica baseada em modelagem cartilaginosa com suturas, utilizando medidas da distância hélice-mastoide em pontos padronizados. RESULTADOS: Foram operados 23 pacientes com idade média de 17,8 anos. A incidência de reoperação foi de 21,7% dos pacientes ou 10,7% das orelhas. Houve perda de cerca de 45% da correção obtida no ponto superior e 35% nos pontos médio e inferior nos pacientes não reoperados. CONCLUSÕES: O protocolo foi de fácil utilização e permitiu a avaliação objetiva tanto da deformidade no pré-operatório quanto dos resultados cirúrgicos. A técnica utilizada produziu resultados considerados adequados e comparáveis aos da literatura.

INTRODUCTION: Prominence is the most common deformity of the ear, affecting about 5% of the population. Most reports on otoplasty describe subjective evaluations, and do not provide accurate postoperative assessment or a comparison between techniques. We propose the development and implementation of a specific protocol to evaluate results. METHOD: A prospective evaluation for a period of one year in patients who underwent bilateral otoplasty was performed, using a technique based on modeling of the cartilage with sutures, and helix-to-mastoid distance measurements at standardized points. RESULTS: A total of 23 patients with an average age of 17.8 years underwent surgery. Reoperation was performed in 21.7% of the patients or 10.7% of the ears. Nearly 45% of the correction obtained at the upper point and 35% at the middle and lower points were lost in patients who did not undergo reoperation. CONCLUSIONS: The protocol was easily used and allowed objective evaluation of the preoperative deformity and surgical results. This technique produced results considered adequate and comparable to the literature.

Lower energy and pulse stacking. A safer alternative for skin tightening using fractional CO2 laser.

PURPOSE: To evaluate the effect of different energies and stacking in skin shrinkage. METHODS: Three decreasing settings of a fractional CO2 laser were applied to the abdomen of Twenty five Wistar rats divided into three groups. Group I (n=5) was histologically evaluated for microthermal zones dimensions. Groups II and III (n=10 each) were macroscopic evaluated with freeware ImageJ for area contraction immediately and after 30 and 60 days. RESULTS: No statistical significance was found within microthermal zone histological dimensions (Group I) in all settings studied. (Ablation depth: 76.90 to 97.18µm; Coagulation depth: 186.01 to 219.84 µm). In Group II, macroscopic evaluation showed that all settings cause significant immediate skin contraction. The highest setting cause significant more intense tightening effect initially, contracting skin area from 258.65 to 179.09 mm2. The same pattern was observed in Group III. At 30 and 60 days, the lowest setting significantly sustained contraction. CONCLUSION: Lower fractional CO2 laser energies associated to pulse stacking could cause consistent and long lasting tissue contraction in rats.

Lower energy and pulse stacking. A safer alternative for skin tightening using fractional CO2 laser

PURPOSE : To evaluate the effect of different energies and stacking in skin shrinkage. METHODS : Three decreasing settings of a fractional CO2 laser were applied to the abdomen of Twenty five Wistar rats divided into three groups. Group I (n=5) was histologically evaluated for microthermal zones dimensions. Groups II and III (n=10 each) were macroscopic evaluated with freeware ImageJ for area contraction immediately and after 30 and 60 days. RESULTS : No statistical significance was found within microthermal zone histological dimensions (Group I) in all settings studied. (Ablation depth: 76.90 to 97.18µm; Coagulation depth: 186.01 to 219.84 µm). In Group II, macroscopic evaluation showed that all settings cause significant immediate skin contraction. The highest setting cause significant more intense tightening effect initially, contracting skin area from 258.65 to 179.09 mm2. The same pattern was observed in Group III. At 30 and 60 days, the lowest setting significantly sustained contraction. CONCLUSION : Lower fractional CO2 laser energies associated to pulse stacking could cause consistent and long lasting tissue contraction in rats.

Lower energy and pulse stacking. A safer alternative for skin tightening using fractional CO2 laser

PURPOSE: To evaluate the effect of different energies and stacking in skin shrinkage.METHODS: Three decreasing settings of a fractional CO2 laser were applied to the abdomen of Twenty five Wistar rats divided into three groups. Group I (n=5) was histologically evaluated for microthermal zones dimensions. Groups II and III (n=10 each) were macroscopic evaluated with freeware ImageJ for area contraction immediately and after 30 and 60 days.RESULTS: No statistical significance was found within microthermal zone histological dimensions (Group I) in all settings studied. (Ablation depth: 76.90 to 97.18µm; Coagulation depth: 186.01 to 219.84 µm). In Group II, macroscopic evaluation showed that all settings cause significant immediate skin contraction. The highest setting cause significant more intense tightening effect initially, contracting skin area from 258.65 to 179.09 mm2. The same pattern was observed in Group III. At 30 and 60 days, the lowest setting significantly sustained contraction.CONCLUSION: Lower fractional CO2 laser energies associated to pulse stacking could cause consistent and long lasting tissue contraction in rats.(AU)

Cranial reconstruction: 3D biomodel and custom-built implant created using additive manufacturing.

Additive manufacturing (AM) technology from engineering has helped to achieve several advances in the medical field, particularly as far as fabrication of implants is concerned. The use of AM has made it possible to carry out surgical planning and simulation using a three-dimensional physical model which accurately represents the patient's anatomy. AM technology enables the production of models and implants directly from a 3D virtual model, facilitating surgical procedures and reducing risks. Furthermore, AM has been used to produce implants designed for individual patients in areas of medicine such as craniomaxillofacial surgery, with optimal size, shape and mechanical properties. This work presents AM technologies which were applied to design and fabricate a biomodel and customized implant for the surgical reconstruction of a large cranial defect. A series of computed tomography data was obtained and software was used to extract the cranial geometry. The protocol presented was used to create an anatomic biomodel of the bone defect for surgical planning and, finally, the design and manufacture of the patient-specific implant.

Paired evaluation of calvarial reconstruction with prototyped titanium implants with and without ceramic coating.

PURPOSE: To investigate the osseointegration properties of prototyped implants with tridimensionally interconnected pores made of the Ti6Al4V alloy and the influence of a thin calcium phosphate coating. METHODS: Bilateral critical size calvarial defects were created in thirty Wistar rats and filled with coated and uncoated implants in a randomized fashion. The animals were kept for 15, 45 and 90 days. Implant mechanical integration was evaluated with a push-out test. Bone-implant interface was analyzed using scanning electron microscopy. RESULTS: The maximum force to produce initial displacement of the implants increased during the study period, reaching values around 100N for both types of implants. Intimate contact between bone and implant was present, with progressive bone growth into the pores. No significant differences were seen between coated and uncoated implants. CONCLUSION: Adequate osseointegration can be achieved in calvarial reconstructions using prototyped Ti6Al4V Implants with the described characteristics of surface and porosity.

Paired evaluation of calvarial reconstruction with prototyped titanium implants with and without ceramic coating

PURPOSE: To investigate the osseointegration properties of prototyped implants with tridimensionally interconnected pores made of the Ti6Al4V alloy and the influence of a thin calcium phosphate coating. METHODS: Bilateral critical size calvarial defects were created in thirty Wistar rats and filled with coated and uncoated implants in a randomized fashion. The animals were kept for 15, 45 and 90 days. Implant mechanical integration was evaluated with a push-out test. Bone-implant interface was analyzed using scanning electron microscopy. RESULTS: The maximum force to produce initial displacement of the implants increased during the study period, reaching values around 100N for both types of implants. Intimate contact between bone and implant was present, with progressive bone growth into the pores. No significant differences were seen between coated and uncoated implants. CONCLUSION: Adequate osseointegration can be achieved in calvarial reconstructions using prototyped Ti6Al4V Implants with the described characteristics of surface and porosity. .

Paired evaluation of calvarial reconstruction with prototyped titanium implants with and without ceramic coating

PURPOSE:To investigate the osseointegration properties of prototyped implants with tridimensionally interconnected pores made of the Ti6Al4V alloy and the influence of a thin calcium phosphate coating.METHODS:Bilateral critical size calvarial defects were created in thirty Wistar rats and filled with coated and uncoated implants in a randomized fashion. The animals were kept for 15, 45 and 90 days. Implant mechanical integration was evaluated with a push-out test. Bone-implant interface was analyzed using scanning electron microscopy.RESULTS:The maximum force to produce initial displacement of the implants increased during the study period, reaching values around 100N for both types of implants. Intimate contact between bone and implant was present, with progressive bone growth into the pores. No significant differences were seen between coated and uncoated implants.CONCLUSION:Adequate osseointegration can be achieved in calvarial reconstructions using prototyped Ti6Al4V Implants with the described characteristics of surface and porosity.(AU)

Análise retrospectiva de pacientes pós-bariátrica submetidos à abdominoplastia com neo-onfaloplastia: 70 Casos / Retrospective analysis of 70 patients who underwent post-bariatric abdominoplasty with neo-omphaloplasty

Introdução: Com o crescente aumento do tratamento cirúrgico da obesidade, surge para o cirurgião plástico um grupo de pacientes com grande flacidez cutânea após perda ponderal. Para aqueles submetidos à gastroplastia redutora convencional ou aberta, a abdominoplastia vertical, em âncora ou em T invertido, tem sido largamente utilizada para a melhoria do contorno abdominal, e no presente trabalho foi associada à amputação umbilical seguida de neo-onfaloplastia. Método: Foram operados 70 pacientes, com peso estável há no mínimo 18 meses, procedentes do ambulatório de Cirurgia Plástica da UNICAMP, no período de março de 2011 a abril de 2013. Em todos foi utilizada a técnica de abdominoplastia em âncora com exérese do umbigo original, juntamente com a peça cirúrgica e confecção de neo-umbigo, através de retalhos dermo-gordurosos bilaterais. Procedeu-se à análise retrospectiva dos prontuários médicos e arquivo fotográfico dos mesmos. Resultados: Nos 70 pacientes operados, houve predominância do sexo feminino (91%) e da raça branca (83%), com média de 40 anos. Após tempo de espera de aproximadamente 16 meses, foram submetidos à abdominoplastia em âncora associada a neo-onfaloplastia, que durou em média 2 horas. Observaram-se complicações pós-operatórias em 29,85% - deiscências pequenas, cicatrizes inestéticas, alargadas ou hipertróficas, queloides, seromas, excessos dermo-gordurosos relevantes e infecção de ferida operatória. Os neoumbigos obtidos são muito semelhantes aos umbigos originais. Não observamos necroses, estenoses, distorções morfológicas e nem mau posicionamento dos mesmos. Conclusão: Esta técnica tem permitido a obtenção de umbigos com aspecto natural, é de fácil execução e reduz o tempo operatório.

Introduction: With the increasing surgical treatment of obesity, a new group of patients is being attended by plastic surgeons: those with large flaccid skin following weight loss. For patients treated with conventional or open bariatric surgery, vertical, anchorline, or inverted "T" abdominoplasty has been widely used to improve the abdominal contour. In this study, abdominoplasty was associated with umbilical amputation followed by neo-omphaloplasty. Methods: Seventy patients with stable weight for at least 18 months underwent surgery at the UNICAMP Plastic Surgery Outpatient Clinic, from March 2011 to April 2013. In all patients, anchor-line abdominoplasty with excision of the original navel was executed, together with the surgical specimen and preparation of neo-umbilicus, through bilateral dermal-fat flaps. A retrospective analysis of medical records and photographic archives was performed. Results: The 70 patients were predominantly female (91%) and white (83%) with a mean age of 40 years. After a wait time of approximately 16 months, they were subjected to anchorline abdominoplasty associated with neo-omphaloplasty, which lasted an average of 2 hours. There were post-operative complications in 29.85% of the patients, including small dehiscence, unsightly, enlarged, or hypertrophic scars, keloid, seroma, relevant dermo-fatty excesses, and wound infection. The neo-umbilicus obtained from the surgery is very similar to the original umbilicus. We did not observe necrosis, stenosis, morphological distortions, or bad positioning. Conclusion: This technique has made it possible to obtain an umbilicus with a natural look, is easy to perform, and shortens operating time.