Evaluation of the Vertical Movement of Ribeiro's Dermolipoglandular Mammary Flap One Year After Mammaplasties in Post-Bariatric Patients.

BACKGROUND: In 1971, Ribeiro isolated a segment in the inferior pole of the ptotic breast, nourished by muscular perforating vessels, and moved it cranially to the posterior region of the remaining detached breast tissue, where it was fixed to the pectoral fascia. This maneuver created a flap with autologous implant function, independent from the rest of the breast's support, that maintained long-term mammary projection. OBJECTIVES: The objectives of this study were to measure the vertical movement of this flap 1 year after mammaplasty and to evaluate the factors involved. METHODS: The sample included 13 patients who had previously undergone bariatric surgery. The position of a titanium marker attached to the Ribeiro flap was compared on chest radiographs taken 1 day and 1 year after the mammaplasty. The significance level was set at 5%. RESULTS: All of the titanium markers moved 0.6 cm to 4.1 cm caudally during the study period (average, 2.4 cm ± 1.02 cm). The greater the weight loss after the plastic surgery, the further the marker's descent. Weight loss between bariatric surgery and plastic surgery, the vertical dimension of the ptotic breast tissue immediately before plastic surgery, the vertical extent of the nipple-areola complex elevation during mammaplasty, the Ribeiro flap thickness and volume, and the breast volume after mammaplasty were not associated with the vertical movement of the flap. CONCLUSIONS: The Ribeiro flap employed in mammaplasty of patients who previously underwent bariatric surgery undergoes ptosis that is exacerbated by weight loss after mammaplasty.

Determination of Cu, Fe, Mn, and Zn in the leaves and tea of Arrabidaea chica (Humb. & Bompl.) Verl.

Arrabidaea chica (Humb. & Bompl.) Verl. is an herb popularly used in the treatment of anemia in the Brazilian Amazon region, and little is known about its mineral content. Therefore, the elemental contents of Cu, Fe, Mn, and Zn were determined in the dried leaves and tea obtained by decoction and infusion of the three varieties of the medicinal plant using flame atomic absorption spectrometry after acid wet digestion of the samples. In general, the levels of the minerals are in good agreement with other studies involving medicinal plants, and the variety AC2 had the highest concentrations of all elements both in dried leaves and tea. Iron was found to be the most abundant in dried leaves (38.4-115.5 µg g(-1)), whereas manganese had the highest extraction efficiencies both in decoction (56.1-62.7%) and infusion (45.6-63.6%). Additionally, the decoction was more efficient in the extraction of almost all elements. The consumption of the decoction of variety AC2 may contribute to a small proportion to the daily requirements of Mn.

Reverse-flow island sural flap.

The reverse flow island sural flap is presented as an alternative to flaps currently used for reconstruction of small and medium substance losses in the distal third of the leg, ankle, and heel. This is a random type of flap, based on the reverse flow of the superficial sural artery, which mainly depends on the anatomy of the perforators of the peroneal artery system. The anatomic structures that constitute the pedicle are the superficial and deep fascias, the sural nerve, the short saphenous vein, and the superficial sural artery. The skin island and the subcutaneous cellular tissue complement the flap proper. This skin island was demarcated at any point of the median or distal thirds of the leg, having the short saphenous vein and the sural nerve on its central axis. The distal dissection limit of the pedicle is located 5 centimeters above the lateral malleolus. This limit is established so as to ensure the integrity of the perforators from the principal arteries of the leg, mainly the peroneal artery, responsible for the reverse flow nourishing the flap. These perforators will affect anastomoses with the superficial sural artery in charge of irrigating the structures compounding the flap.A total of 71 patients were operated on with this technique, some of them with basic pathologic abnormalities limiting the distal blood flow, such as diabetes mellitus, and some others having proven vascular insufficiency or displaying unstable areas attributable to problems such as pseudarthrosis and osteomyelitis, which needed to be covered. Fifteen flaps (21.1 percent) suffered partial necrosis, which did not compromise the final result, and another three (4.2 percent) showed total loss. The flap in question has great mobility and versatility, allowing the treatment of specific areas of the lower limb, without sacrificing important arteries or mobilizing structures that might bring about functional deficits.