Aesthetic Contouring of the Chest wall with Rib Resection.

BACKGROUND: In past decades, several invasive and noninvasive aesthetic procedures have been sought as a way to improve body contouring, and one may resort to uncertified and potentially dangerous procedures to achieve that goal. An example of this practice would be the resection of ribs to reduce the waist for aesthetic reasons. The objective was to check scientific evidence on the effectiveness and safety of removal of floating ribs for aesthetic purposes. METHODS: A systematic review of the literature was carried out in EMBASE/Elsevier, Cochrane, Scopus, Medline, PubMed, BVS, SciELO, OneFile, and Lilacs, throughout the period until June 2020, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: Fifty-six articles were found in all databases. After applying the inclusion criteria, by reading the title and abstract of the studies found, only two articles were definitively included. One addressed the possibility of removing the 7th and 8th ribs for improving body contouring in patients with an exaggerated anterior projection of the chest wall, without showing cases or surgical techniques. The other demonstrated procedures of body contouring in transgender by the removal of the 11th and 12th ribs in five of the 22 patients studied, just providing a brief description of the surgical technique used, without details. CONCLUSIONS: Despite the relevance of the theme and its popularity, there is not enough scientific evidence to support the practice, effectiveness and safety of the resection of ribs for aesthetic purposes. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. 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 .

Silicone gel em cicatrizes de cirurgia plástica: estudo clínico prospectivo / Silicone gel in plastic surgery scars: a prospective study

Introdução: O uso de gel de silicone em cicatrizes data do começo da década de 1980. Desde então, um grande número de trabalhos científicos, e dezenas de diferentes fórmulas do produto, vêm sendo publicados e experimentados, atestando os benefícios do gel de silicone na prevenção de cicatrizes hipertróficas e quelóides. Apesar do mecanismo exato de ação do silicone ainda ser desconhecido, a hipótese mais aceita é que o curativo oclusivo estimula os queratinócitos à maior secreção de fatores de crescimento localmente, influenciando consequentemente a regulação dos fibroblastos. Método: Com o objetivo de comprovar os benefícios do silicone gel na melhora clínica das cicatrizes de etiologia cirúrgica eletiva,foi realizado um estudo prospectivo, numa população miscigenada, no Serviço de Cirurgia Plástica na 38ª Enfermaria da Santa Casa da Misericórdia do Rio de Janeiro. Resultados: O gel de silicone demonstrou ação favorável em cicatrizes pós-cirurgia plástica. Conclusão: O uso de silicone gel mostrou-se útil na melhora de cicatrizes recentes, melhorando parâmetros subjetivos e objetivos, como eritema, prurido e endurecimento.

Background: The use of silicone gel on surgical wounds began in the 1980’s. Since then, a large number of scientific papers and dozens of different formulas have been published and experimented, attesting the benefits of this product in the prevention of hypertrophic scars and keloids. Although the exact mechanism of action of silicone gel has not yet been elucidated, the most widely accepted theory explains that the occlusive film stimulates the keratinocytes to increase the local secretion of growth factors, subsequently influencing the regulation of fibroblasts. Methods: A prospective study was undertaken at the 38th Ward of the Santa Casa General Hospital, Rio de Janeiro, to evaluate the positive effects of silicone gel on surgical wounds, in a mixed race population. Results: Silicone gel demonstrated apositive effect on surgical wounds following plastic surgery. Conclusion: Silicone gel is useful to enhance the quality of recent scars, in both subjective and objective parameters, such as erythema, pruritus and firmness.

Tissue engineering in plastic surgery: an up-to-date review of the current literature.

Tissue engineering is an interdisciplinary field that applies the principles of engineering and life sciences toward the development of biological substitutes that restore, maintain, or improve tissue function. This field has enjoyed tremendous growth in the past 10 years fuelled by its potential role in regenerating new tissues and naturally healing injured or diseased organs. Stem cells due to their pluripotentiality and unlimited capacity for self-renewal, may allow significant advances for distinct reconstructive and cosmetic procedures. This review aims at outlining the principles of tissue engineering, focusing on the use of adult-derived stem cells as applied to the research and practice of plastic surgery. Review categories have been divided into tissue engineering of the skin and connective tissue, bone marrow, cartilage, adipose tissue, and breast tissue. An analytical review of the current literature on stem cell technology on the above mentioned areas is presented. There have been reports of side effects and unsuccessful treatments. The key to the progress of tissue engineering is an understanding between basic scientists, biochemical engineers, clinicians, and industry. Although there has been an ongoing research pointing to the enormous potential of using stem cells in cosmetic and reconstructive surgery, at this stage, stem cell therapy is still a hope that has not been fully studied and approved. More long-term studies are needed and many questions remain to be answered.

Tissue engineering and auricular reconstruction: a review.

This article provides an up-to-date review of the strategies used in auricular cartilage engineering. The currently available options in stem cell, biomaterial and bio-molecules and the crucial issues for the auricular cartilage engineering are presented. Researchers have demonstrated that neo-cartilage can be constituted in a predetermined shape and in complex three-dimensional structures, such as a human ear, by using cell transplantation on polymer constructs. Despite this, many unsolved problems still remain. No perfect materials and methods have been found to substitute the shapely elastic cartilage normally present in the ear, and the current constructs have not proven to be durable over time. The recent advances in surgical techniques and biotechnology can promise clinical application of bio-engineered cultured cartilage in the future. Further long-term in vitro and in vivo studies must be done before tissue engineering can be applied to reconstructive surgery of the auricle.

Lipodistrofia cutânea localizada: bloqueador da lipogênese celular

The associated use of liposuction and transdermal application of a liporeducer emulsion was studied in 51 patients with localized cutaneous lipodystrophy. Patients were divided into 3 groups: group A or control (n=9, liposuction alone); group B (n=27, application of emulsion before and after liposuction) and Group C(n=15, application of emulsion after liposuction). Results were assessed by both photographic documentation and clinical criteria: measurement of the affected region perimeter, skin visual aspect, cutaneous clamping, and skin firmness, softness and mildness. The associated use of emulsion was shown to be better than liposuction alone, with and evident improvement of skin aspect and perimeter reduction mostly of thighs and knees.

Tratamento da síndrome de Romberg com associaçäo do enxerto de gordura aspirada, PTFE-E e MEDPOR / Treatment of Romberg's disease with a combination of aspirated fat graft PTFE-E, and MEDPOR

Os autores apresentam uma nova proposta para o tratamento cirúrgico da síndrome da síndrome de Romberg. Associa o enxerto de gordura aspirada a materiais aloplásticos com três ou mais tempos cirúrgicos. O enxerto de gordura aspirado serve como base para inclusäo do PTFE-E e o implante de MEDPOR para a correçäo das deformidades ósseas

Tratamento das fístulas oronasais pós-palatoplastias / Treatment of oronasal fistulas in pos-palatoplasties

Analisa-se a incidência, etiologia e características das fístulas oronasais pós-palatoplastias. Faz-se uma revisäo de 428 palatoplastias primárias efetuadas na 38ª Enfermaria da Santa Casa da Misericórdia do Rio de Janeiro, onde observou-se o aparecimento de fístulas oronasais em 10,28% dos casos. Foram revistas também 90 palatoplastias primárias onde as fístulas oronasais aparecem em 8,89% dos casos operados. Realizou-se também um estudo sobre o tratamento cirúrgico efetuado em 54 casos de fístulas oronasais na 38ª Enfermaria da Santa Casa da Misericórdia do Rio de Janeiro e de 41 fístulas tratadas pelo primeiro autor pessoalmente. Conclui-se que näo deve haver um método único para o tratamento das fístulas oronasais, devendo ser considerada a sintomatologia, as repercussöes funcionais e as características anatômicas das fístulas para a determinaçäo do tratamento ideal. Finalmente, propöe-se uma conduta própria para o tratamento de cada tipo de fístula oronasal

Abdominoplastia vertical uma tecnica a ser relembrada. / Vertical abdominoplasty: a technic to be remembered

Os autores apresentam um trabalho sobre abdominoplastia vertical, mostram a evolucao historica desta tecnica, salientando suas vantagens e limitacoes. Apresentam um estudo de nove casos onde a abdominoplastia vertical foi utilizada para a cura de eventracoes com cicatrizes xifo-pubianas da linha media. Nos casos de eventracoes maiores (seis casos), foi utilizada tela de material plastico para a reconstrucao da parede abdominal. Os resultados nao apresentaram recidivas, o que atesta pela validade da tecnica. Houve, tambem, acentuada melhora estetica da silhueta e das cicatrizes, o que e demonstrado pela documentacao apresentada

Uso de telas nas reconstruçöes da parede abdominal / Use of mesh in reconstruction of the abdominal wall

Apresenta-se um estudo de correlaçäo clínico experimental sobre o uso das telas de material plástico na reconstruçäo da parede abdominal. Analisam-se as consequências da perda da funçäo do complexo músculo-aponeurótico-fascial da parede abdominal e a filosofia que deve envolver a sua reparaçäo. Pelo estudo desta fisiopatologia e baseados em estudo experimental anterior, considera-se a tela de material plástico (marlex) o elemento mais adequado para a correçäo deste tipo de defeito. Descreve-se a técnica utilizada em 16 casos com resultados muito bons