TULUA Lipoabdominoplasty: Transversal Aponeurotic Plication, No Undermining, and Unrestricted Liposuction. A Multicenter Study of 845 Cases.

BACKGROUND: TULUA (transverse plication, no undermining, full liposuction, neoumbilicoplasty, and low transverse abdominal scar) is the acronym for a radically different lipoabdominoplasty, intended to add simplicity, improve vascular safety, and attain good results. Modifications are unrestricted liposuction, no flap detachment, massive transverse infraumbilical plication, umbilicus amputation, neoumbilicoplasty, diminished tension wound closure, and low transverse scar settlement. The objectives of this article are to describe the technique and analyze a multicenter experience. METHODS: Sixty-eight plastic surgeons from 10 countries provided data for a retrospective review of 845 patients. Aesthetic results were scored by each surgeon using the Salles scale and analyzed in combination with complications to identify associations between patient and surgery characteristics. RESULTS: Of the patients, 95.5 percent were female, 19.7 percent were obese, 35.6 percent had prior scars, 10.4 percent had undergone previous abdominoplasty, 6.5 percent were postbariatric, and 6.6 percent were smokers. One patient had a kidney transplant, and 16.5 percent had comorbidities. Surgery characteristics varied widely, being on average as follows: lipoaspirate, 2967 ml; resection, 1388 g; and surgical time, 3.9 hours; 46.5 percent were not hospitalized. Averaged results were 8.68 of 10 points, besides adequate positioning and proportion of scar and umbilicus, without epigastric compensatory bulging (4.97 of 6 points). Overall complications were 16.2 percent, mostly seroma (8.8 percent); vascular-related complications (i.e., necrosis, wound dehiscence, and infection) constituted 2.7 percent. There were no fatalities. The logistic regression model demonstrated that smoking and obesity duplicate the risk of complications; if age older than 60 years is added, the risk of complication increases seven to nine times. Reported indications were multiple; however, pathologic diastasis was excluded. CONCLUSION: TULUA lipoabdominoplasty is a new reproducible procedure with good quantified results and an acceptable complication rate. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Comentario al artículo "Prótesis mamarias en plano submuscular con bloqueo anestésico intraoperatorio de ramas del plexo braquial a cielo abierto y con cánula" / No disponible

No disponible

Lipoabdominoplasty with Progressive Traction Sutures.

BACKGROUND: Proactively preserving Scarpa's fascia and thus its intrinsic lymphatic drainage and tensile strength for suture placement can eliminate the need for drains after lipoabdominoplasty and therefore reduce the rate of seroma development. In this article, we describe the effectiveness of a modified progressive traction suture (PTS) technique, which enables us to lessen the most common complications and avoid hospital readmission; these sutures take 3-5 minutes of additional surgery time. METHODS: Two hundred seventy-six patients (mean age, 38 years; range, 19-67 years), with a mean body mass index of 25 were included in this study. All patients underwent complete lipoabdominoplasty with ultrasound-assisted liposuction (VASER) throughout the abdomen and flanks. Abdominal rectus plication was performed in 100% of cases. All patients were operated on under spinal anesthesia and stayed overnight in hospital. RESULTS: Of the 276 patients, 1.8% developed postoperative seromas. No patients developed hematomas. New wound closure was needed in 1.4% of patients, performed within 7-10 days of surgery, scar revision in 4.7%, residual liposuction under local anesthesia in 9.7%, and liposuction under sedation in 1%; deep vein thrombosis without thromboembolic phenomenon developed in 1%, none resulting in death. In addition, the use of a PTS technique is a time-saving procedure because it takes the surgeons between 3-5 minutes of operative time, unlike that of adhesion and/or separate traction, which takes between 30 and 45 minutes. CONCLUSIONS: The use of PTSs helped diminish complications such as seroma and hematoma and prevent additional cost involving hospital readmission and/or further surgery. Furthermore, use of these sutures required only 3-5 minutes of additional operative time.

Planos en prótesis mamarias / Flat breast prosthesis

En esta comunicación queremos presentar nuestra evolución en la elección del plano de colocación de implantes mamarios. Evaluar los existentes y valorar parámetros cuantitativos y cualitativos para la indicación de uno u otro en función de las diversas características de las pacientes a ser operadas. Reafirmar la importancia y necesidad de conductas quirúrgicas personalizadas que se ajusten a las características propias de cada caso. Aceptar la premisa fundamental, de que no existe una prótesis ideal y que el criterio médico determina el uso de la más adecuada. Enfatizar que la actualización bibliográfica y la concurrencia a los eventos científicos en forma permanente es lo que diferencia a los médicos especialistas en Cirugía Plástica de los ocasionales y oportunos practicantes de las técnicas de la materia.

In this communication we present our experience in choosing the level of breast implants. Evaluate and assess existing quality and quantity parameters for the indications of one or another depending on various characteristics of the patients to be operated. Reaffirm the importance and necessity of surgical custom behaviors that fit the characteristics of each patient. Accept the fundamental premise that there is no ideal prosthesis.