RESUMO
Breast damage is likely to result in compensation according to the principle of full compensation. However, breast damage, little covered in the scales usually used, requires a specific methodology. The quantification of functional prejudice must be done with regard to the age of the victim and must take into account the possible repercussions on mobility (shoulder and/or spine) as well as the psychological repercussions. Whether or not the nipple and areola are preserved should be described. Temporary aesthetic damage (before breast reconstruction) must be assessed on the basis of objective elements, its duration and quantification on a scale of 0 to 7. Permanent aesthetic damage takes into account scars, deformities, amputations and quality of the prosthesis. A new scale for evaluating permanent aesthetic damage is proposed. Sexual prejudice must take into account an impairment of the pleasure related to sexuality and its erotic function, in line with the concept of sexual health. However, even after reconstruction, the areas of quality of sexual life and sexual satisfaction often remain affected. An exploration using standardized questions from validated questionnaires such as BREAST-Q can be useful. The sequelae linked to the damage on a breast can also lead the woman to limit certain pleasure activities, in particular because of psychological discomfort or even be the cause of a loss of opportunity to carry out a family's life plan.
Assuntos
Neoplasias da Mama , Mamoplastia , Neoplasias da Mama/cirurgia , Estética , Feminino , Humanos , Mamilos/cirurgia , Satisfação do Paciente , Inquéritos e QuestionáriosRESUMO
Aesthetic damage, defined as any detrimental modification of the individual morpho-functional exterior attributes, is difficult to assess, since the perception of its entity is rather subjective. This study aims to provide a medico-legal contribution to the assessment of this kind of damage. 60 photographic images, representing stabilized aesthetic damage, were collected and showed to 16 expert evaluators, who were required to exclusively quantify the objective component of the aesthetic impairment. The inter-observer agreement for the assessments was calculated using the Intraclass Correlation Coefficient (ICC). Looking into specific characteristics of both the injury and the damaged subject, the assessors were more consistent in quantifying the damage in male subjects (ICC 0.68) and in subjects aged over 50â¯years (ICC 0.81) as well as in assessing extensive damages (ICC 0.61) than those of mild severity (ICC 0.41). The assessment of impairments located in the facial area resulted in a high level of concordance (ICC 0.73), while damages located the head and neck regions presented the lowest concordance (ICC 0.35). The evaluators were more consistent in assessing the outcomes of burns (ICC 0.70). Regardless the various reasons underlying the different degree of concordance, these results and the high degree of the overall concordance (ICC 0.63) point out the skillfulness of medicolegal professionals to formulate a complex judgment as more objectively as possible. Finally, an operative proposal was outlined to guide medico-legal professionals or interns in evaluating the aesthetic damage as more objectively as possible.
Assuntos
Compensação e Reparação/legislação & jurisprudência , Estética , Imperícia/legislação & jurisprudência , Ferimentos e Lesões/complicações , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Prova Pericial , Feminino , Humanos , Doença Iatrogênica , Masculino , Pessoa de Meia-Idade , FotografaçãoRESUMO
El presente trabajo busca responder a la necesidad de contar con un estudio actualizado sobre valoración del perjuicio estético en el rostro en el campo de la medicina legal en Costa Rica. Para este estudio se utilizó una población de 239 casos valorados por secuelas de lesiones en el rostro extraídos de los expedientes de la Sección de Clínica Médico Forense del Departamento de Medicina Legal en el año 2011. Se utilizaron variables sociodemográficas y variables utilizadas en la caracterización y valoración del perjuicio estético en el rostro. dentro de los resultados más relevantes del estudio se evidenció un predominio de casos del sexo masculino y en el grupo de edad de los 20 a 29 años, las lesiones encontradas, en la mayoría de los casos, fueron producidas con un objeto contundente. El tipo de perjuicio estético más encontrado fueron las cicatrices, en más de la mitad de los casos no se indicó si las cicatrices producían alteración de la armonía facial o si eran retráctiles y en una tercera parte tampoco se mencionaba si producían alteración de la mímica facial. La mayoría de las cicatrices se describieron como hipocrómicas y planas. En cuanto a la visibilidad más de la tercera parte de los casos presentaban lesiones descritas como visibles a distancia de conversación y un 20% se describieron como visibles a distancia social. Solamente la quinta parte de los casos valorados, se catalogaron como con marca indeleble. En cerca de un 70% de los casos no se estableció porcentaje de incapacidad permanente. El presente estudio refleja la importancia de la valoración del perjuicio estético en la actualidad así como la necesidad de contar con criterios estandarizados para realizar este tipo de valoraciones así como para determinar la presencia de marca indeleble en el rostro.
The present study aims to answer the need to have an up to date study related to facial aesthetic damage assessment in the field of legal medicine in Costa Rica. For this study it was used a population of 239 cases evaluated for facial injury sequels extracted from the files of the Clinical Forensic Medicine Section of the Legal Medicine Department in Costa Rica during the year 2011. Variables used include socio demographic and others used in characterization and evaluation of facial aesthetic damage. Among the most relevant results of this study it was evidenced a predominance of masculine cases and in the group of 20 to 29 years, the injuries, in the majority of cases, were produced by a blunt object. The most frequent type of aesthetic damage encountered were the scars, in more than half of the cases it was not indicated if the scars produced alteration of the facial harmony or if they were retractable and in a third of cases it was not mention if there was facial mimic alteration. The majority of the scars were described as hipocromic and flat. In regard to visibility, in more than a third of the cases the alterations were described as visible in conversation distance and 20% as visible in social distance. Only a fifth part of the cases were cataloged as indelible mark. In nearly a 70% of the cases no percentage of permanent impairment were established The present study reflects the importance of the evaluation of the aesthetic damage nowadays and also the need to have standardized criteria to perform this kind of assessment and to determine the presence of facial indelible mark.
Assuntos
Humanos , Cicatriz , Costa Rica , Traumatismos Faciais , Medicina LegalRESUMO
El daño corporal es tema de gran discusión en el marco médico legal. Las repercusiones funcionales y estéticas constituyen una secuela de gran importancia para los pacientes. Es mediante técnicas quirúrgicas como los colgajos, que se ha logrado prevenir cicatrices retráctiles y marcas indelebles en el rostro. Siendo estos últimos bloques vascularizados de tejido que se movilizan a partir de un sitio donador y se clasifican según su composición, vascularización y el método de diseño y transferencia. Dichos puntos, se discutirán a continuación.
Bodily harm is the subject of much discussion in the forensic context. The functional and aesthetic impact constitute a sequel of great importance for patients. It is through surgical techniques such as flaps, which has been successful in preventing retractile scars and indelible facial mark. Latter being vascularized tissue blocks that move from a donor site and are classified according to their composition, vascularization and the design method and transfer. This subjects, are discussed below.
