Deep Back Liposuction: Ultrasound-Guided Deep Fat Liposuction of the Subiliac Crest.

In the past 5 years, aesthetic surgery of the buttock has changed a lot with the use of technologies like imaging ultrasound to get safer and more beautiful results. These techniques are not only used to make a safer fat infiltration in the buttock, but also for modeling it. The aim of this study was to describe ultrasound-guided subiliac crest deep fat liposuction for contouring the buttock-back region. This area is often overlooked in gluteal frame management because of the depth at which it is located. Healthy patients were chosen for whom this deep back ultrasound technique was performed to improve the gluteal frame. The technique involved making a small incision in the iliac crest of the ilium, followed by identification of the area of deep posterior fat below the iliac crest under ultrasonographic control. A cannula was positioned to deliver static tumescent infiltration and liposuction was performed. This study included 16 female patients aged 20 to 45 years old who underwent this procedure. The area was infiltrated with 150 to 200 mL of tumescent solution per side, and 175 to 200 mL of fat was obtained. The depth of the study area varied but was observed to be generally located between 3 and 5 cm from the skin. This study indicates that this technique is safe and effective in achieving aspiration of the subiliac crest deep fat, which enhances the frame for buttock-back contouring. Ultrasound was indispensable for locating the fat and infiltrating the area for subsequent liposuction.See the abstract translated into Hindi, Portuguese, Korean, German, Italian, Arabic, Chinese, and Taiwanese online here: https://doi.org/10.1093/asj/sjad236.

The Energy a Plastic Surgeon Expends during Liposuction.

It is generally accepted that liposuction requires a significant amount of energy from surgeons. This procedure involves the use of specialized equipment and techniques to remove fat cells from the body, which can be physically demanding for surgeons. The amount of effort required for liposuction must be evaluated in terms of energy consumption. Our goal was to conduct a study to record the energy that the surgeon uses during liposuction and correlate these results with the volume of fat obtained as well as other variables. Methods: A series of cases was carried out from April 2022 to November 1, 2022, in three different plastic surgery centers. Three plastic surgeons recorded the procedures using an Apple Watch, choosing from among Apple Watch training options and free indoor walking. The surgeon then concluded the registration at the time of finishing the surgery and removed the surgical gloves and gowns. Results: Complete data were obtained for 63 patients. The average fat obtained per 1 kcal of energy was 6.14 cm3 of fat, and 160 cal to obtain 1 cm3 of fat by liposuction. Other data that demonstrated statistically significant correlations were fat volume versus average pace (km), total fat volume versus average heart rate, fat volume versus surgical time, and fat volume versus distance. Conclusions: Liposuction is a surgical procedure that requires considerable effort. This study demonstrates the amount of energy required for regular liposuction. Compared with other single procedures, three times more energy is required to complete liposuction.

Incorporation of the UGRAFT Technique to High-definition Liposuction.

High-definition liposuction is now a reliable procedure that provides more athletic results. It is a trend among plastic surgeons and patients. The ultrasound-guided rectus abdominis fat transfer (UGRAFT) technique has expanded the range of patients who can benefit from rectus abdominis fat grafting, including those without skin laxity. Its advantage over isolated high-definition liposuction is a more natural-looking result because it increases muscle volume and provides a contoured abdomen even during movement, regardless of the patient's position. In this article, we describe one patient undergoing the UGRAFT technique after high-definition liposuction, versus one patient undergoing only high-definition liposuction. We determined that the use of the UGRAFT technique provides greater muscle definition over those in which this technique has not been performed. The UGRAFT technique opens the possibility of developing more complete body structures regarding definition, providing volume to muscular areas. The more muscle mass and less body fat, the greater the body definition in a liposuction. The less muscle mass and more body fat, the less definition a patient will have in a liposuction. Under these principles, we improve the result by increasing the volume of muscle mass.

Spreader Graft Easy and Stable Fixation.

The original spreader graft described by Sheen was dissecting a sub perichondrial flap along the anterior edge of the septum and inserting the grafts in place and occasionally, fixing them with a mattress suture. Although it has been done usually with mattress suture, it has some disadvantages as the instability of the graft while it is being fixated and others. We present a different fixation method with a simple running suture instead.

Ropivacaine in Breast Augmentation Surgery.

BACKGROUND: Breast augmentation surgery is still 1 of the most popular procedures in plastic surgery. Like other surgical procedures, it has been traditionally handled with nonsteroidal anti-inflammatory drugs and narcotics, which had many adverse effects; therefore, alternatives with the same effectiveness are being researched. The aim of this study was to investigate the efficacy of ropivacaine breast pocket irrigation during primary breast augmentation surgery to control pain during the first postoperative hours. METHODS: A multicenter, prospective, double-blind, randomized trial was performed on 52 primary breast augmentation procedures in which patients served as their own control: One breast received ropivacaine pocket irrigation and the other placebo. All patients received an oral analgesic. Pain was evaluated with a visual analogue scale at 30, 60, 90, and 120 minutes postoperatively. RESULTS: Pain was significantly less in ropivacaine breast at 90 and 120 minutes postoperatively (P = 0.027 and 0.022, respectively). There was no statistical significance when the type of anesthesia used, general or epidural, was compared (P = 0.33 and P = 0.37 at 90 and 120 minutes, respectively). CONCLUSIONS: Ropivacaine irrigation in breast pocket is able to diminish early postoperative pain safely, being an alternative to other analgesic methods.

[Evidence based surgery. A necessary tool]. / Cirugía basada en la evidencia. Una herramienta necesaria.

BACKGROUND: Evidence-based surgery is a tool that has been adopted worldwide by surgeons. As all decisions must be current and have a scientific basis, the approach for performing it must be standardised. Five important steps are required to perform surgery based on evidence. Convert the need for information into a question that can be answered, finding the best information to answer that question, critical evaluation of the evidence, and its validity, impact and applicability, integrating the evidence with your own experience, and with the evaluation of the patients. This should take into account their biology, values and specific circumstances, as well as to evaluate the effectiveness and efficiency of the execution of steps 1-4 and propose how to improve them. CONCLUSION: This article presents the main tools to perform surgery properly based on evidence.

Factores de riesgo para el desarrollo de hipomagnesemia en el paciente quemado / Risk Factors for Development of Hypomagnesemia in the Burn Patient

Las alteraciones electrolíticas son frecuentes en el paciente quemado, y en general se presentan enpacientes con quemaduras de mayor gravedad. Es poco conocida la frecuencia y magnitud de la hipomagnesemia, asicomo los factores de riesgo para presentarla en esta situación clínica. Se realizó un estudio retrospectivo observacional de revisión de casos, en 35 pacientes con quemaduras, manejados en el servicio de Cirugía Plástica Reconstructiva del Hospital Central Sur de PEMEX. Se determinó el comportamiento del magnesio sérico y se formaron dos grupos, un grupo de estudio que incluyó a 11 pacientes con quemaduras e hipomagnesemia, y un segundo grupo de 24 pacientes, con quemaduras y sin hipomagnesemia. Se determinaron los principales factores de riesgo relacionados con los episodios de hipomagnesemia. Se encontró que el paciente de mayor riesgo es aquel con quemaduras mayores de 40%de superficie corporal, de segundo y tercer grado, que se encuentra en el cuarto y el décimo día después de la quemadura, y que presenta hipocalemia, hipocalcemia o las dos y que además no ha recibido aporte por vía intravenosa este catión. La mejor manera de prevenirlo es identificar al paciente de alto riesgo o diagnosticar de manera oportuna para evitar mayores complicaciones.

Electrolyte abnormalities are common in the severely burned patient. There is little information with regard to the frequency and magnitude of hypomagnesemia, as well as on risk factors for this condition. We performed an observational, retrospective analysis of 35 burned patients treated at the Plastic and Reconstructive Surgery Service at the Hospital Central Sur PEMEX, Mexico City. We determined serum magnesium behavior and divided patients into two groups: the first included 11 patients with burns and hypomagnesemia, and the second, 24 patients with burns but without hypomagnesemia. Risk factor identification was performed. We found patient at riskwas the one with more than 40% of 2nd or 3rd degree total burned body area, in day 4 or 10 after the burn, and with hypokalemia, hypocalcemia, or both, and without intravenous (i.v.) supplementation of magnesium. The best way to prevent or avoid major complications is to identify the high-risk patient, or to diagnose earlier.

[Risk factors for development of hypomagnesemia in the burned patient]. / Factores de riesgo para el desarrollo de hipomagnesemia en el paciente quemado.

Electrolyte abnormalities are common in the severely burned patient. There is little information with regard to the frequency and magnitude of hypomagnesemia, as well as on risk factors for this condition. We performed an observational, retrospective analysis of 35 burned patients treated at the Plastic and Reconstructive Surgery Service at the Hospital Central Sur PEMEX, Mexico City. We determined serum magnesium behavior and divided patients into two groups: the first included 11 patients with burns and hypomagnesemia, and the second, 24 patients with burns but without hypomagnesemia. Risk factor identification was performed. We found patient at risk was the one with more than 40% of 2nd or 3rd degree total burned body area, in day 4 or 10 after the burn, and with hypokalemia, hypocalcemia, or both, and without intravenous (i.v.) supplementation of magnesium. The best way to prevent or avoid major complications is to identify the high-risk patient, or to diagnose earlier.

[Desmoid fibroma of the mandible in a child and one-stage reconstruction]. / Fibroma desmoide de la mandíbula de un niño y reconstrucción en un tiempo.

A 12-year-old patient case is reported, presented with a desmoid fibroma of the left pterygoid region, extended to the cortical and endosteal regions of the mandible, reconstructed immediately with a free peroneal flap, recovering with this both form and function. To date, 3 years from surgery, he has no complications. Evolution of this case and a brief review of the literature is reported. It is concluded that free peroneal graft for mandible reconstruction is safe and has excellent results, both aestethic and functional.

Fibroma desmoide de la mandíbula de un niño y reconstrucción en un tiempo / Desmoid fibroma of the mandible in a child and one-stage reconstruction

A 12-year-old patient case is reported, presented with a desmoid fibroma of the left pterygoid region, extended to the cortical and endosteal regions of the mandible, reconstructed immediately with a free peroneal flap, recovering with this both form and function. To date, 3 years from surgery, he has no complications. Evolution of this case and a brief review of the literature is reported. It is concluded that free peroneal graft for mandible reconstruction is safe and has excellent results, both aestethic and functional.

Hamartoma de vías biliares: reporte de un caso y revisión de la literatura / Bile duct hamartomas: case report and review of the literature

Objetivo: informe de un caso clínico y revisión de la literatura con relación al hamartoma de vías biliares (HVB). Antecedentes: el hamartoma de vías biliares es una lesión hepática rara descrita por primera vez en 1918 por Von Meyenburg, consistente en una deformación y desorganización de los conductos biliares, formando estructuras quísticas que varían de tamaño. Método: se trata de una mujer de 44 años de edad, asintomática. El ultrasonido mostró la presencia de lesiones diseminadas en el hígado que condicionaban irregularidades en el contorno. Posteriormente se realizó tomografía computada abdominal, donde se corroboró la presencia de lesiones hepáticas, múltiples e hipodensas de aspecto quístico, diseminadas en todo el órgano y una lesión en pelvis al nivel de útero en el infundíbulo izquierdo, interpretándose inicialmente como una probable tumoración maligna de ovario izquierdo con metástasis hepáticas. Se llevó a la paciente a laparotomía exploradora, con biopsias hepáticas, así como histerectomía radical. Resultados: el examen histológico transoperatorio reveló ser negativo a malignidad en todas las muestras. El resultado definitivo fue el de HVB y miomatosis uterina. Conclusiones: la presencia de HVB genera confusión en el diagnóstico y en el manejo de los pacientes que la presentan, por su apariencia como metástasis hepáticas.

Onda de Osborn en hemorragia subaracnoidea / Osborn wave in subarachnoid hemorrhage

Se presenta el caso de una paciente de 56 años previamente sana, quien ingresó al hospital en coma profundo con pupilas dilatadas y sin respuesta a la luz. Se practicó TAC de cráneo y se encontró hemorragia en Valle Silviano izquierdo. Se estableció el diagnóstico de rotura de aneurisma intracraneano. Finalmente presentó paro cardiaco irreversible a maniobras de reanimación