Is it possible to repair diastasis recti and shorten the aponeurosis at the same time?

BACKGROUND: Abdominal wall deformity secondary to pregnancy is multidirectional. Plication of the anterior rectus sheath is the most widely used technique for correction of this condition. However, it would be desirable to simultaneously perform the transverse and longitudinal repair of this deformity. The aim of this study was to assess changes in the length of the musculoaponeurotic layer after diastasis recti repair using triangular mattress sutures. METHODS: Thirty-one women with Nahas' type III/A deformity were divided into two groups: the triangular mattress suture (TS) group and the continuous suture (CS) group. All patients underwent conventional abdominoplasty and diastasis recti repair with medial longitudinal plication performed between two metal clips. The two types of suture were used in both groups. In the TS group, after a CS was performed and removed, TSs were used and maintained in place. In the CS group, the order of suture placement was reversed. The distance between clips was measured before and immediately after suturing and at 3 weeks and 6 months postoperatively using plain abdominal radiographs. Statistical analysis was conducted using Friedman's analysis of variance and Wilcoxon's test. RESULTS: The use of TSs significantly reduced the length of the aponeurosis compared with both the intraoperative situation without suture (P<0.001) and the use of CS (intraoperatively and 6 months after surgery; P<0.001). CONCLUSION: The repair of diastasis recti using TSs resulted in vertical shortening of musculoaponeurotic layer immediately after the procedure and in the long term. 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.

Tratamento cirúrgico dos tumores de pele nasal em idosos / Surgical treatment of the nasal skin tumors in elderly patients

Introdução: O câncer de pele é a neoplasia mais frequente no Brasil e acomete principalmenteindivíduos idosos. O local do corpo mais acometido é a face, especialmente onariz. O tratamento mais utilizado é a ressecção cirúrgica. Objetivo: Analisar a eficáciados procedimentos cirúrgicos realizados no tratamento do câncer de pele nasal em indivíduosidosos. Método: Foram revistos 101 prontuários de pacientes operados no períodode agosto de 2005 a junho de 2008 e analisados dados referentes a gênero, idade, fototipo,localização do tumor no nariz, margens cirúrgicas, tipos de reconstrução. Utilizaram-se ostestes estatísticos qui-quadrado de aderência, t de Student e teste exato de Fischer (p<0,05).Resultados: A faixa etária foi de 61 a 94 com média de 77 anos. A incidência foi maior emmulheres (67,3%) e em indivíduos de pele clara (65,3%). Os tumores distribuíram-se demodo heterogêneo entre as subunidades nasais (p=0,001 teste qui-quadrado). Dos tumoresmalignos, 92,9% eram do tipo carcinoma basocelular e 7,1% eram do tipo carcinoma espinocelular.A distribuição dos tumores entre homens e mulheres foi semelhante (p=0,672teste exato de Fischer). Os tipos de reconstrução mais utilizados foram os retalhos (54,9%).Houve ressecção incompleta de tumor em 8,4% e taxa de reoperação de 77,8%. O achado detumor residual nos espécimes foi de 14,2%. Não foi encontrada diferença estatisticamentesignificativa entre as idades dos pacientes reoperados e dos observados (p=0,486 teste t deStudent). Houve recidiva somente no grupo de tumores com ressecção completa (0,9%).Conclusão: Os procedimentos cirúrgicos utilizados tiveram sua eficácia comprovada parao tratamento do câncer de pele nasal em idosos.

Introduction: Skin cancer is the most common neoplasm in Brazil and mainly affects theelderly. The most affected location of the body is the face, especially the nose. Surgical resectionis also the most used treatment. Objective: To evaluate the effectiveness of surgicalprocedures performed in the treatment of nasal skin cancer in elderly patients. Method:They were reviewed 101 charts of patients who have been submitted to a surgical resectionof nasal skin tumor from August 2005 to June 2008. Data regarding gender, age, phototype,location of tumor in the nose, surgical margins and type of reconstruction were analyzed.The chi-square statistical test of adhesion, Student t test and Fischer exact test were usedfor statistical analysis. Statistical significance was consider when p< 0.05. Results: Agesranged between 61 to 94 years with an average of 77 years. The incidence was higher inwomen (67.3%) and in individuals with fair skin (65.3%). The tumors presented a heterogeneousdistribution on nasal subunits (p = 0.001 chi-square). Basal cell carcinoma wasthe most frequent malignant neoplasm (92.9%) and 7.1% were squamous cell carcinoma.The distribution of tumors between men and women was similar (p = 0.672 Fischer exacttest). Flaps were the most frequent type of reconstruction (54.9%). There was incompleteresection in 8.4% of the patients and the reoperation rate was 77.8%. Residual tumor waspresented in 14.2% of the surgical specimens. There was no significant difference betweenthe ages of the patients who were reoperated and the others who were observed (p = 0.486Student t test). Recurrence was observed only in the group of patients who had a completeresection of the tumor (0.9%). Conclusion: Surgical procedures performed in this studyhave proven their effectiveness for the treatment of nasal skin cancer in elderly patients.