Minimally invasive lipoabdominoplasty (MILA) tactic.

While diastasis recti (DR) was long neglected by general surgeons, plastic surgeons considered conventional abdominoplasty as the only repair option. However, this scenario has changed recently, either due to a better understanding of the correlation between DR and abdominal wall function and greater risk of recurrence in abdominal hernia repairs, or due to the development of new minimally invasive techniques for repairing DR. One of these surgical procedures consists of the concept of an abdominoplasty, that is, supra-aponeurotic dissection and plication of the DR (with or without abdominal hernia) but performed through three small supra-pubic incisions by laparoscopy or robotic approach. More recently, this procedure has gained new stages. Liposuction and skin retraction technology have been associated with MIS plication of DR, which increases the indications for the technique and potentially improves results. For the first time in the literature, we describe these steps and the synergy between them.

Minimally invasive lipoabdominoplasty (MILA) tactic / Lipoabdominoplastia minimamente invasiva - Tática MILA

ABSTRACT While diastasis recti (DR) was long neglected by general surgeons, plastic surgeons considered conventional abdominoplasty as the only repair option. However, this scenario has changed recently, either due to a better understanding of the correlation between DR and abdominal wall function and greater risk of recurrence in abdominal hernia repairs, or due to the development of new minimally invasive techniques for repairing DR. One of these surgical procedures consists of the concept of an abdominoplasty, that is, supra-aponeurotic dissection and plication of the DR (with or without abdominal hernia) but performed through three small supra-pubic incisions by laparoscopy or robotic approach. More recently, this procedure has gained new stages. Liposuction and skin retraction technology have been associated with MIS plication of DR, which increases the indications for the technique and potentially improves results. For the first time in the literature, we describe these steps and the synergy between them.

RESUMO Embora a diástase de reto abdominal (DR) tenha sido negligenciada por muito tempo pelos cirurgiões gerais, os cirurgiões plásticos consideravam a abdominoplastia convencional como a única opção de reparo. No entanto, esse cenário mudou recentemente, seja pelo melhor entendimento da correlação entre DR e a função da parede abdominal e o maior risco de recorrência na correção de hérnias abdominais, seja pelo desenvolvimento de novas técnicas minimamente invasivas (MIS) para reparo da DR. Um desses procedimentos cirúrgicos consiste no conceito de abdominoplastia, ou seja, dissecção supra-aponeurótica e plicatura da DR (com ou sem hérnia abdominal), mas realizada através de três pequenas incisões suprapúbicas por laparoscopia ou abordagem robótica. Mais recentemente, esse procedimento ganhou novas etapas. A lipoaspiração e a tecnologia de retração da pele têm sido associadas à plicatura MIS da DR, o que aumenta as indicações da técnica e potencialmente melhora os resultados. Pela primeira vez na literatura, descrevemos essas etapas e a sinergia entre elas.

Mastoplastia de aumento através da abdominoplastia / Breast augmentation through abdominoplasty

INTRODUÇÃO: Este trabalho demonstra a técnica de dissecção de espaço retroglandular através da abdominoplastia, com visualização de fibra óptica para inclusão de implantes mamários de silicone gel. MÉTODO: Foram avaliadas, retrospectivamente, 44 pacientes portadoras de flacidez abdominal e hipomastia, submetidas a mastoplastia de aumento através da abdominoplastia em um só estágio, durante o período de setembro de 2001 a abril de 2012. RESULTADOS: A técnica utilizada possibilitou melhora do contorno abdominal e aumento do volume mamário pela mesma incisão. As complicações ocorreram na área abdominal (hematoma, seroma, deiscência e cicatriz hipertrófica) e na região mamária (contratura capsular e infecção). CONCLUSÕES: A técnica de mastoplastia de aumento por via abdominal evita cicatrizes nas mamas ou axilas, é segura, reprodutível, com curva de aprendizado curta, e resultados satisfatórios e duradouros.

BACKGROUND: This study establishes a technique for dissection of the retroglandular space through abdominoplasty by using a lighted retractor for the introduction of silicone gel breast implants. METHODS: A retrospective study was carried out for 44 patients with abdominal flaccidity and hypomastia who underwent breast augmentation through a single-stage abdominoplasty between September 2001 and April 2012. RESULTS: This method enabled improvement of the abdominal contour and breast augmentation through the same incision. The complications observed affected the abdominal area (hematoma, seroma, dehiscence, and hypertrophic scarring) and the breast (capsular contracture and infection). CONCLUSIONS: Breast augmentation through abdominoplasty does not cause scars on the breast or armpit and is a safe and reproducible procedure with a short learning curve. Moreover, it provides satisfactory and long-lasting results.

Reconstrução perineal pós gangrena de Fournier com retalho miocutâneo de tensor de fáscia lata / Perineal reconstruction after Fournier's gangrene with flap of tensor fascia lata

A gangrena de Fournier pode ter conseqüências devastadoras. Geralmente em homens os testículos ficam expostos e requerem cobertura estética e funcional. O retalho miocutâneo do Tensor da Fascia Lata, pediculado na artéria femoral cincunflexa lateral, é muito versátil, propicia a elevação de grande quantidade de pele junto ao retalho sendo uma opção de tratamento para as lesões que acometem o períneo. Este relato de caso trata-se de um paciente de 57 anos, portador de Diabetes Mellitus sem tratamento, apresentando Gangrena de Fournier em períneo. Após tratamento com desbridamento, antibioticoterapia de amplo espectro, oxigenioterapia hiperbárica e compensão clínica, apresentava grande lesão perineal invadindo raiz da coxa esqauerda e exposição teticular. Foi realizado reconstrução com Retalho miocutâneo do Tensor da Fáscia Lata associado a retalho de avanço de escroto para cobertura testicular, procedimento realizado por Residente em Cirurgia Plástica sob supervisão

Reconstrução perineal pós gangrena de Fournier com retalho miocutâneo de tensor de fáscia lata

A gangrena de Fournier pode ter conseqüências devastadoras. Geralmente em homens os testículos ficam expostos e requerem cobertura estética e funcional. O retalho miocutâneo do Tensor da Fascia Lata, pediculado na artéria femoral cincunflexa lateral, é muito versátil, propicia a elevação de grande quantidade de pele junto ao retalho sendo uma opção de tratamento para as lesões que acometem o períneo. Este relato de caso trata-se de um paciente de 57 anos, portador de Diabetes Mellitus sem tratamento, apresentando Gangrena de Fournier em períneo. Após tratamento com desbridamento, antibioticoterapia de amplo espectro, oxigenioterapia hiperbárica e compensão clínica, apresentava grande lesão perineal invadindo raiz da coxa esqauerda e exposição teticular. Foi realizado reconstrução com Retalho miocutâneo do Tensor da Fáscia Lata associado a retalho de avanço de escroto para cobertura testicular, procedimento realizado por Residente em Cirurgia Plástica sob supervisão

Endocrine and metabolic response to trauma in hypovolemic patients treated at a trauma center in Brazil.

BACKGROUND: The metabolic changes in trauma patients with shock contribute directly to the survival of the patient. To understand these changes better, we made a rigorous analysis of the variations in the main examinations requested for seriously polytraumatized patients. METHODS: Prospective analysis of patients with blunt or penetrating trauma with hypovolemic shock, with systolic arterial pressure (SAP) equal to or lower than 90 mmHg at any time during initial treatment in the emergency room and aged between 14 and 60 years old. The following exams were analyzed: sodium, potassium, blood test, glycemia and arterial gasometry. The tests were carried out at intervals: T0 (the first exam, collected on admission) and followed by T24 (24 hours after admission), T48 (48 hours after admission), T72 (72 hours after admission). RESULTS: The test evaluations showed that there was a tendency towards hyperglycemia, which was more evident upon admission to hospital. The sodium in all the patients was found to be normal upon admission, with a later decline. However, no patient had significant hyponatremia; there was no significant variation in the potassium variable; the gasometry, low pH, BE (base excess) and bicarbonate levels when the first sample was collected and increased later with PO2 and PCO2 showing only slight variations, which meant an acidotic state during the hemorrhagic shock followed by a response from the organism to reestablish the equilibrium, retaining bicarbonate. The red blood count, shown by the GB (globular volume) and HB (hemoglobin) was normal upon entry but later it dropped steadily until it fell below normal; the white blood count (leukocytes, neutrophils and band neutrophil) remained high from the first moment of evaluation. CONCLUSION: In this study we demonstrated the main alterations that took place in patients with serious trauma, emphasizing that even commonly requested laboratory tests can help to estimate metabolic alterations. Suitable treatment for polytraumatized patients with hypovolemic shock is a challenge for the surgeon, who must be alert to endocrinal and metabolic changes in his patients. Based on these alterations, the surgeon can intervene earlier and make every effort to achieve a successful clinical result.