The strength of correlation between female genital self-image and sexual function: a systematic review and meta-analysis.

BACKGROUND: Mounting evidence indicates that female genital aesthetic complaints impact sexual relationships. AIM: The study sought to determine the strength of the correlation between genital self-image and sexual function. METHODS: Electronic databases were comprehensively searched including PubMed, Web of Science, Scopus, PsycINFO, Embase, and the Cochrane Library from January 2000 to December 2022. After duplicate removal, 146 articles were retrieved by searching keywords in titles and abstracts. OUTCOMES: A positive correlation is noted between genital self-image and sexual function; the strength of this correlation was 0.375. RESULTS: By omitting irrelevant articles according to the eligibility criteria, 16 articles remained for a total of 13 505 participants. All but 1 of them indicated a statistically significant positive correlation between genital self-image and sexual function. For a more accurate result, a meta-analysis was conducted noting a considerable heterogeneity. CLINICAL IMPLICATIONS: The results of this study may be used in counseling women with sexual dysfunction who are dissatisfied with their genital appearance. STRENGTHS AND LIMITATIONS: This study is the first systematic review to reveal the strength of the correlation between genital self-image and sexual function. The most important limitation of this study is the heterogeneity of the studies reported. CONCLUSION: This systematic review indicates a positive correlation between genital self-image and sexual function. The results are restricted by inconsistency of the articles considered. Using different tools in different cultural contexts without considering confounding factors leads to a wide range of correlation sizes and significant heterogeneity is evident.

Reconstructive Procedures of the Auricular Concha after Cutaneous Oncologic Surgery: A Systematic Review.

Reconstruction of the auricular concha poses a challenge due to its difficult access and limited tissue flexibility; however, there are no recommendations in the literature on which reconstructive technique should be favored for this anatomical site. This systematic review intends to describe and compare the reconstructive techniques used in conchal bowl reconstruction following cutaneous oncologic surgery of this region, with regard to their complications and aesthetic results. In doing so, we aim to identify the best suited reconstructive procedure(s) for the conchal bowl. The six databases searched (PubMed, Scopus, Web of Science, Ovid, SciELO, and CENTRAL) yielded twelve eligible studies that explored the revolving door flap, split-thickness skin grafts (STSG), full-thickness skin grafts (FTSG), second intention healing, the preauricular translocation flap, subcutaneous pedicle grafts, and other local flaps. Qualitative synthesis of the results concluded that the revolving door flap could be the reconstructive procedure of choice for the auricular concha, following skin cancer excision. It has a low risk of necrosis, infection, and postoperative hemorrhage, as well as excellent aesthetic outcomes. STSG may be used as an alternative. Nonetheless, due to the low sample size and the high risk of bias in some studies, further investigations must be conducted on this subject.

A study on origin, termination, and course characteristics of internal thoracic artery relevant to coronary surgeries and reconstructive procedures.

Objectives: The internal thoracic artery is a favored vessel for coronary artery bypass grafting and is utilized for breast reconstructive surgeries. Our study focuses on the origin, termination, and course characteristics of the internal thoracic artery. A comprehension of these morphological features and possible variations will definitely aid a clinician in appropriate harvesting of the artery for clinical procedures. Materials and Methods: 200 thoracic halves (from 100 embalmed adult human cadavers of either sex) were obtained from the department of anatomy. The origin, course characteristics, termination levels, and patterns for the internal thoracic artery were studied. Results: The internal thoracic artery originated from the first part of subclavian artery. The most common course pattern observed was medial concavity (88.5%). In 10% of cases, a tortuous course was observed. No artery with lateral concavity or rectilinear course pattern was documented. The artery terminated in the sixth space in 93.5% of cases. In 98% of cases, bifurcation in termination was observed. Trifurcation in termination was also observed in 2% of cases. The average length of variant artery (third terminating branch) was documented to be 5.5 cm. Conclusion: The increased utilization of the internal thoracic artery for coronary bypass arterial surgery and its role in sternal wound healing has made it imperative for clinicians to keep in mind its anatomical characteristics and local variations. This knowledge definitely will improve prognosis and decrease intraoperative/postoperative complications in patients undergoing coronary surgeries, percutaneous subclavian catheterizations, and reconstructive procedures.

Allogeneic Bone Application in Association with Platelet-Rich Plasma for Alveolar Bone Grafting of Cleft Palate Defects.

AIM: The aim of this study is to compare allogeneic bone grafts associated with platelet-rich plasma (ALBGs-PRP) to autogenous bone grafts (ATBGs) for alveolar reconstructions in patients with cleft lip and palate (CLP). MATERIALS AND METHODS: The Maxillofacial Surgery Service of the Comprehensive Care Center for CLP (CCCLP) in Curitiba (Paraná, Brazil). PATIENTS: Thirty out of 46 patients with 8-12 years of age and pre- or trans-foramen unilateral clefts were operated by the same surgeon. Groups were selected randomly after coin-toss for the first surgery to be ALBG-PRP. INTERVENTIONS: Pre- and post-surgery cleft defect severity was registered by a score system using superimposed digitalized peri-apical radiographs. The hypothesis indicated ABG-PRP to be similar to the ABG was proved. RESULTS: There was no statistically significant difference (P < 0.05) in bone augmentation for the ABG-PRP group (79.88%) when compared to the ABG group (79.9%). CONCLUSION: ABG-PRP is indicated as a successful treatment modality to reduce the need for additional donor sites and reduce morbidity and hospital stay.

[Osteochondral lesions of the talus : Individualized approach based on established and innovative reconstruction techniques]. / Osteochondrale Läsionen des Talus : Individualisiertes Vorgehen mithilfe etablierter und innovativer Rekonstruktionsverfahren.

Osteochondral lesions (OCL) of the talus are defined as chondral damage with subchondral involvement. The traumatic etiology is important; in particular, sprains and fractures can lead to lesions of the articular surface and the subchondral plate. As a result, unstable lesions and subchondral cysts can trigger substantial persistent pain and functional impairments. A primary conservative treatment can be considered and is especially recommended in children and adolescents; however, return to previous sports activity and level is often not achieved. The principles of reconstructive surgical management include internal fixation of osteochondral fragments, bone marrow stimulation, autologous membrane-augmented chondrogenesis ± bone grafting, osteochondral transfer, retrograde techniques ± bone grafting, (matrix-associated) autologous chondrocyte implantation and autologous osteoperiosteal graft from the iliac crest. Additional surgical procedures for ankle stabilization and deformity correction should be considered if necessary.

Autologous breast reconstruction in older women: A retrospective single-centre analysis of complications and uptake of secondary reconstructive procedures.

BACKGROUND: Women aged ≥65 years have the highest age-specific rates of breast cancer incidence in the UK. However, national audit results demonstrate that the rates of post-mastectomy breast reconstruction offered to and performed on this age group are considerably lower than in younger women (Jeevan, 2009). This discrepancy may arise from unsubstantiated concerns over greater medical and surgical risk in older patients (James, 2015). In the present study, the first of its kind in the UK, we sought to evaluate potential differences in postoperative complications following autologous breast reconstruction between young and older patient populations. METHODS: We conducted a retrospective review of 59 patients (31 'younger' <65 years; 28 'older' ≥65 years) who underwent autologous breast reconstruction at Oxford University Hospitals, between 2008 and 2017. Clinical, operative, and outcome variables were compared across the two age groups. To examine the complete multi-stage process of breast reconstruction as a whole, we also compared rates of uptake of multiple secondary reconstructive and revisional procedures across age groups. KEY RESULTS: Major surgical, minor surgical, and medical complication rates, as well as length of stay, did not differ significantly by age group. The scar revision rate (at the flap donor site) was higher in the <65 group (19.4% vs. 0.0%; p = 0.025). Otherwise, rates of secondary reconstructive and revisional procedures were comparable across both groups. CONCLUSION: Patients aged ≥65 years were not at a significantly greater risk of complications following autologous breast reconstruction compared to younger patients. Chronological age, in itself, should not influence treatment decisions surrounding breast reconstruction.

Robotic surgery in infants and children: an argument for smaller and fewer incisions.

PURPOSE: Robotic-assisted laparoscopic (RAL) surgery has gained momentum in pediatric urology. Technological adaptations such as the development of 5 mm instruments have led to robotic procedures being performed on younger children and those having smaller body habitus, with improved cosmesis. However, concerns have been raised regarding decreased intra-abdominal working space and the absence of monopolar curved scissors (hot endoshears®) when using 5 mm instruments. The aim of this study is to examine the overall experience at a single pediatric urology center using 5 mm instruments with no planned additional assistant ports during common robotic procedures. We hypothesized this approach is safe and feasible for a variety of pediatric urologic reconstructive procedures. METHODS: We retrospectively reviewed all major robotic procedures entered into an IRB approved data registry. The analysis was performed only for procedures in which 5 mm instruments were used exclusively with hook diathermy. Procedures that utilized 8 mm instrumentation were excluded from the study. Data were abstracted according to patient age, weight and robotic surgery performed. Outcomes included post-operative complications (Clavien-Dindo classification), operative time, operative blood loss, need for assistant port placement and conversion rates to open or pure laparoscopic surgery. RESULTS: From 2012 to 2016, 220 consecutive pediatric RAL urological surgical cases were performed on 201 patients. These comprised pyeloplasty (n = 102) 46.4%, ureteral reimplants (n = 84) 38.2% and ipsilateral ureteroureterostomy (n = 34) 15.5%. Median age at surgery was 4 years (3 months to 18 years). There were no conversions to open or laparoscopic surgery. Placement of an additional Assist port was documented in seven cases. Severe (Clavien grade 4) complications occurred in two patients requiring ICU admission: one for sepsis and one ventilator-dependent patient having increased work of breathing post-op. Intra-operative blood loss was minimal ( < 50 ml) in 97% of cases. Patients ≤ 1 year of age comprised 28.6% of the study population. Univariate analysis revealed no association between age and occurrence of complications (p = 0.957) CONCLUSIONS: This study represents one of the largest series of consecutive RAL surgery using 5 mm instruments in pediatric urology. Acceptable complication rates, OR times and blood loss were achieved using this technique. We conclude that the use of 5 mm instruments gives excellent operative outcomes in pediatric reconstructive procedures.

Ablative fractional resurfacing for burn scar management affects the number and type of elective surgical reconstructive procedures, hospital admission patterns as well as length of stay.

BACKGROUND: Reconstructive surgery remains the main approach to address burn scar contractures. Ablative fractional resurfacing is an increasingly popular tool for severe burn scar management, but its effect on overall burns reconstructive case-mix, operating time and patterns of hospital admission have not been reported. METHODS: Retrospective analysis of hospital administrative data from September 2013 to June 2017 was performed evaluating these effects of ablative fractional CO2 laser (CO2-AFL). RESULTS: The total number of acute burn patients treated at CRGH increased substantially over this timeframe, resulting in 412 elective procedures including 82 before and 330 after introducing CO2-AFL. The proportion of traditional non-laser reconstructive procedures dropped considerably to 23.9% in about 2.5 years following CO2-AFL introduction. This change in approach had a profound effect on LOS with average LOS being 1.96days for non-laser and 0.36days for CO2-AFL-procedures (p<0.001). Anaesthetic times also decreased significantly, with median durations at 90min pre-laser and 64min post-laser introduction (p<0.001), and median anaesthetic times at 87min (non-AFL) and 57min (AFL procedures) (p<0.001). CONCLUSION: AFL profoundly affects elective reconstructive burn case mix with a replacement of conventional reconstructive operations in favour of AFL-procedures. This results in reductions of average LOS and anaesthetic times. Consequently, increased use of AFL in burn scar management could potentially reduce overall costs associated with burn scar reconstruction.

[Redo reconstruction of the digestive tract after gastric surgery]. / Povtornye rekonstruktsii pishchevaritel'nogo trakta posle operatsii na zheludke.

OBJECTIVE: To formulate the concept of physiological reconstruction of the digestive tract during redo gastric surgery. MATERIAL AND METHODS: There were 52 patients who underwent redo gastric surgery after previous resections, drainage and antireflux procedures in 2011-2017 at the Vishnevsky National Research Surgical Center. Redo resection of the stomach with Billroth-1 and Hofmeister reconstructions were performed in 5 (9.6%) and 1 patient (1.9%), respectively. Roux-en-Y reconstruction was performed in 4 (7.7%) patients after gastric remnant extirpation. Jejunogastroplasty was used in 30 (57.7%) patients. A segment of the transverse colon as the reconstructive material was used in 2 (3.8%) patients, left colon - in 8 (15.4%) after esophagectomy. One (1.9%) patient underwent extirpation of 'small' stomach and thoracic esophagus after previous gastric bypass. Gastric remnant was used as an isoperistaltic tube for subtotal esophagoplasty. Reconstruction was not possible in only 1 (1.9%) patient after advanced visceral resection for recurrent cancer within esophagojejunostomy due to deficit of visceral material. RESULTS: Postoperative complications were observed in 5 (9.6%) patients. Partial failure of esophagojejunostomy and duodenojejunostomy occurred in 2 (3.8%) and 1 patient (1.9%), respectively. Colon transplant necrosis was noted in 1 (1.9%) patient that required resection followed by colo- and esophagostomy nutrition. One patient died on the 1st postoperative day from progressive multiple organ failure. At the end of the study, 44 (86.2%) out of 51 patients were under follow-up. Good results were revealed in 26 (59.9%) patients, satisfactory outcomes - in 12 (27.4%) patients. Redo surgery was not effective in only 6 (13.7%) patients. CONCLUSION: Evaluation of our results demonstrates complete alleviation of pathological postoperative syndromes after gastric surgery in the majority of patients. Therefore, redo surgery with gastroplasty and restoration of duodenal passage are advisable.

Ceratoacantoma: aspectos morfológicos, clínicos e cirúrgicos / Keratoacanthoma: morphological, clinical, and surgical aspects

Introdução: O ceratoacantoma é uma neoplasia epitelial de rápido crescimento, mais frequente em áreas de exposição solar. Habitualmente, apresenta-se como lesão única, arredondada, com depressão central preenchida de queratina. As semelhanças clínicas e histopatológicas com o carcinoma de células escamosas, frequentemente, dificultam o diagnóstico diferencial. A biópsia excisional é a abordagem de escolha, permitindo diagnóstico e tratamento. Método: O presente estudo é observacional e retrospectivo, com dados de 162 pacientes tratados de 2005 a 2013, no Hospital Felício Rocho, em Belo Horizonte, MG. Todos os pacientes submeteram-se à excisão cirúrgica dos tumores. Foram estudados: sexo, idade, número de lesões, localização, tamanho do tumor e diagnóstico pré-operatório. Resultados: Dos 162 pacientes, totalizando 173 lesões, 154 (95,06%) apresentavam ceratoacantoma único. Noventa e dois eram do gênero masculino (56,80%) e 70 do feminino (43,20%). A idade dos pacientes variou de 11 a 96 anos, com média de 71,23 anos. As lesões localizavam-se predominantemente nos membros superiores (43,64%), na face (28,48%) e nos membros inferiores (17,58%). Nas hipóteses diagnósticas formuladas pelos cirurgiões, no pedido do exame anatomopatológico, houve diagnóstico correto em 63,13%. Conclusão: O ceratoacantoma é uma neoplasia epitelial de características morfológicas semelhantes ao carcinoma de células escamosas, o que, por muitas vezes, dificulta o diagnóstico. Torna-se necessária, portanto, a excisão cirúrgica completa das lesões suspeitas para diagnóstico e tratamento corretos.

Introduction: Keratoacanthoma is an epithelial neoplasm of rapid growth, more frequent in areas of sun exposure, and usually appears as a single, rounded lesion with a central depression filled with keratin. Clinical and histopathological similarities with squamous cell carcinoma often make differential diagnosis difficult. Excisional biopsy is the approach of choice, allowing diagnosis and treatment. Method: This is an observational and retrospective study, in which data of 162 patients treated at the Hospital Felício Rocho from 2005 to 2013, in Belo Horizonte, MG, were analyzed. All patients underwent surgical excision of tumors. Data on sex, age, number of lesions, location, tumor size, and preoperative diagnosis were studied. Results: Of the 162 patients, with a total of 173 lesions, only 154 (95.06%) had keratoacanthoma. There were 92 male (56.80%) and 70 female (43.20%) patients. The age of patients ranged from 11 to 96 years, with an average of 71.23 years. The lesions were located predominantly in the upper limbs (43.64%), face (28.48%), and lower limbs (17.58%). In the diagnostic hypotheses formulated by surgeons at the request of the pathology, the diagnosis was correct in 63.13%. Conclusion: Keratoacanthoma is an epithelial tumor with morphological characteristics similar to those of squamous cell carcinoma, which often complicates the diagnosis. Therefore, the complete excision of the suspicious lesions is necessary for correct diagnosis and treatment.

Brida amniótica abdominal, reporte de un caso / Precordial pain in pediatrics. Update

Existe un amplio espectro de deformidades causadas por bandas amnióticas, siendo las extremidades la ubicación más común. La banda de constricción en el abdomen es un lugar raro para el síndrome de brida amniótica. Presentamos un caso de banda de constricción circunferencial congénita del abdomen sin otras malformaciones. La condición no afectó la ventilación, la alimentación, las deposiciones o el crecimiento. Se planificaron múltiples Z-Plasties en el abdomen antes del primer mes de vida. Revisamos la literatura que hace hincapié en la presentación clínica y el tratamiento de esta rara entidad clínica.

There is a wide spectrum of deformities caused by amniotic bands, being the extremities the most common location. The constriction band in the abdomen is a rare location for constriction band syndrome. We report a case of congenital circumferential constriction band of abdomen without other malformations. The condition did not affect ventilation, feeding, bowel movements, or growth. Multiple Z-plasties were planned in the abdomen before the first month from birth. We reviewed the literature emphasizing on the clinical presentation and management of this rare clinical entity.

[Experience of reconstructive laparoscopic procedures in patients with terminal colostomy]. / Opyt osvoeniia vosstanovitel'nykh operatsii laparoskopicheski-assistirovannym sposobom u bol'nykh s kontsevoi kolostomoi.

AIM: To analyze the ways and terms of training for laparoscopy-assisted reconstruction operations via learning curves analysis and to compare the outcomes obtained both during training for technique and after that. MATERIAL AND METHODS: There were 93 reconstructive laparoscopic procedures in 58 (62.36%) patients with terminal colostomy. All patients were operated by the same surgeon. Learning curves have been created and analyzed. RESULTS: Analysis showed that all surgical features are achieved by the 30th intervention indicating the end of learning period. Significantly less surgical trauma has been observed along with development of surgery. CONCLUSION: Improved results are achieved by reduced dissection of adhesions, the use of mechanical suture for intestinal anastomosis and increased number of anastomoses made in intracorporeal fashion.

Avaliação pré e pós-operatória do efeito da cirurgia reparadora na qualidade de vida e da autoestima do paciente: um estudo prospectivo envolvendo 52 pacientes / Pre- and postoperative evaluation of the effect of reconstructive surgery on patient quality of life and self-esteem: a prospective study of 52 patients

Introdução: As lesões de pele benignas e malignas podem afetar a qualidade de vida (QV) e a autoestima dos pacientes, tendo a cirurgia plástica reparadora im-portante papel nesses indivíduos. O objetivo é estudar o efeito da cirurgia plástica reparadora sobre a QV e a autoestima de pacientes. Métodos: Foi realizado um estudo quase-experimental (antes e de-pois). A QV foi medida pelo questioná-rio SF-36. Para a medida da autoestima, foi utilizada a escala de autoestima de Rosemberg. Alterações nos escores de ambos os instrumentos foram medidas antes e após o procedimento cirúrgico e a significância estatística da diferença foi avaliada pelo teste t. A proporção de indivíduos com aumento de escore de QV e autoestima, segundo as categorias de variáveis sociodemográficas, caracte-rísticas da lesão ou da doença, classifica-ção do tratamento cirúrgico e eventos estressantes, foi medida, e a significância estatística foi avaliada pelo teste do Qui-quadrado. Resultados: Foram entrevis-tados 52 pacientes. Após a intervenção cirúrgica, houve melhora significativa no escore de QV na maioria dos domínios de SF-36 (aspectos emocionais, físicos, sociais, dor, estado geral de saúde e saú-de mental) e melhora na escala de autoes-tima de Rosemberg. Os fatores associa-dos a maior probabilidade de melhora na QV e autoestima após a cirurgia foram idade igual ou superior a 60 anos, cor de pele branca, maior escolaridade, ocorrên-cia de evento estressante e tipo maligno de neoplasia. Conclusões: A cirurgia reparadora teve um impacto positivo em vários domínios de QV e autoestima, mostrando outras melhorias na saúde do paciente, além dos benefícios clínicos.

Introduction: Benign and malignant skin lesions can affect patients' quality of life and self-esteem; thus, reconstructive plastic surgery is important for these individuals. The objective is to assess the effect of reconstructive plastic surgery on the quality of life (QoL) and self-esteem in patients with benign or malignant skin lesions. Methods: This quasi-experimental "prepost study" measured QoL using the 36-Item Short Form Health Survey (SF-36) questionnaire. For the measure of self-esteem, the Rosenberg Self-Esteem Scale was used. The changes in scores of both instruments were measured before and after surgery, and the statistical significance of the difference was evaluated using a paired sample t test. The proportion of individuals with an increased QoL score and self-esteem according to sociodemographic variables, lesion or disease characteristics, surgical treatment classification, and stressful events was measured, whereas the statistical significance was assessed using the chi-square test. Results: Fifty-two patients were interviewed. After the surgical intervention, significant improvement in QoL score in most SF-36 domains (emotional, physical, social, pain, general health, and mental health aspects) and improvement in the Rosenberg Self-Esteem Scale score were noted. The factors associated with a higher probability of improvements in QoL and self-esteem after surgery were age ≥60 years, white skin color, higher education level, occurrence of a stressful event, and malignant neoplasia. Conclusions: Reconstructive surgery positively affected several domains of QoL and self-esteem, showing other improvements in patient health beyond its technical and clinical benefits.

História da Cirurgia Plástica: Sir Harold Gillies, pioneiro da cirurgia plástica reconstrutiva / History of plastic surgery: Sir Harold Gillies, a pioneer of reconstructive plastic surgery

Historicamente, as guerras foram um dos maiores catalisadores para o avanço da Medicina, e especialmente da cirurgia. Sem dúvida, a maior autoridade da Cirurgia Plástica nas primeiras décadas do século XX foi o neozelandês radicado na Inglaterra Sir Harold Delf Gillies, que se destacou pelo tratamento de pacientes com lesões faciais no contexto da I Guerra Mundial. Nosso artigo faz uma análise da vida pessoal e do legado que Gillies deixou para a cirurgia plástica e reconstrutiva moderna; muitos de seus ensinamentos são atemporais e servem de reflexão para cirurgiões da atualidade.

Historically, wars have been among the greatest catalysts for advances in medicine in general, and surgery in particular. Without doubt, the greatest practitioner of plastic surgery in the early decades of the twentieth century was Sir Harold Delf Gillies, a New Zealander living in England, who advocated the treatment of patients with facial injuries in the context of the First World War. This article examines Gillies' personal life and the legacy he left for modern plastic and reconstructive surgery; many of his teachings are timeless and serve as an inspiration for the surgeons of today.

Revisitando a puboplastia pós-bariátrica / Revisiting Postbariatric Monsplasty

INTRODUÇÃO: O tratamento da região pubiana é parte integrante do reajuste corporal inferior nos pacientes pós-bariátricos, tendo em vista a fisiopatologia e o caráter generalizado das deformidades de contorno após grandes emagrecimentos. O objetivo é apresentar nossa experiência no tratamento de pacientes pós-bariátricos, exclusivamente pela marcação baixa da abdominoplastia com vetores adequados de mobilização tecidual, sem a necessidade de cicatrizes verticais ou oblíquas na região do púbis. MÉTODOS: Foram avaliados retrospectivamente prontuários médicos e registros fotográficos de pacientes submetidos a diferentes abordagens abdominais, com aplicação dos princípios descritos acima no tratamento associado da região pubiana. Incisão cutânea anterior baixa, descolamento cranial angulado em direção ao plano aponeurótico (bisel preservando gordura profunda superior), e manutenção um excedente gorduroso nos bordos superiores para a facilitar a fixação dos retalhos através do Sistema Fascial Superficial. Uma avaliação subjetiva da qualidade dos resultados foi caracterizada por observador único. RESULTADOS: Numa casuística de 126 pacientes consecutivos, a tática empregada possibilitou restabelecer a melhor posição, tônus e formato do púbis em 100% dos casos, cujos resultados foram subjetivamente classificados como bom (40%) ou ótimo (60%). As intercorrências mais frequentemente encontradas na evolução pós-operatória foram pequenas deiscências da sutura (23,8%) e seromas (19%), com boa evolução pelos curativos e punções seriadas. CONCLUSÃO: A tática cirúrgica apresentada, com posicionamento baixo da incisão anterior e aproximação dos retalhos por fixação no sistema fascial superficial e pele, possibilita o tratamento adequado da região pubiana durante as abdominoplastias pós-bariátricas, sem a necessidade de ressecções e cicatrizes adicionais.

INTRODUCTION: The treatment of the pubic region is an integral part of lower body readjustment in post-bariatric patients, considering the pathophysiology and generalized characteristics of contour deformities after a considerable weight loss. The objective is to present our experience in the treatment of post-bariatric patients, exclusively by low marking of abdominoplasty with appropriate tissue mobilization vectors, without the necessity to leave vertical or oblique scars in the pubic region. METHODS: The medical and photographic records of patients subjected to different abdominal approaches were retrospectively evaluated, applying the principles described above in the combined treatment of the pubic region. A low anterior skin incision was created, and angled cranial detachment towards the aponeurotic plane (with the bevel preserving the deep upper fat) and maintenance of excess fat on the upper edges to facilitate the fixation of the flaps through the superficial fascial system were performed. The outcomes' quality was subjectively evaluated by a single observer. RESULTS: In the case series of 126 consecutive patients, the strategy used restored the best position, tone, and shape of the pubis in 100% of the cases; the results were subjectively classified as good (40%) or very good (60%). The complications more frequently found in the post-operative period were small suture dehiscence (23.8%) and seroma formation (19%), with good evolution provided by dressings and serial punctures. CONCLUSION: The surgical strategy presented involving low positioning of the anterior incision and flap alignment in the superficial fascial system and skin by fixation allows the proper treatment of the pubic region during post-bariatric abdominoplasty procedures, without the need for additional resections and scars.

Rinofima: opção cirúrgica como tratamento / Rhinophyma: a surgical treatment option

Introdução: Rinofima é uma inflamação crônica dos tecidos do nariz, caracterizada por hipertrofia e hiperplasia progressivas das glândulas sebáceas e do tecido conjuntivo. Determina um aspecto de elefantíase nasal, secundária à congestão dos vasos da derme. Sua etiologia está associada, na maioria dos casos, ao uso abusivo de álcool. É considerada por alguns autores como sendo um estágio avançado de acne rosácea. O artigo tem como objetivo relatar um caso de rinofima, tratado cirurgicamente no Serviço de Cirurgia Plástica do Hospital Universitário da Universidade Federal de Santa Catarina com decorticação e eletrocoagulação. Método: Foi realizado revisão de prontuário e registro fotográfico de um caso de rinofima. Resultados: Paciente foi submetido a tratamento cirúrgico com evolução favorável. Conclusão: Existem diversos tratamentos para rinofima, sendo que a decorticação e a eletrocoagulação constituem uma excelente opção terapêutica.

Introduction: Rhinophyma is a condition involving chronic inflammation of the nose and is characterized by progressive hypertrophy and hyperplasia of sebaceous glands and connective tissue. Rhinophyma leads to an appearance of nasal elephantiasis, which is caused by the congestion of dermis vessels. Its etiology is mostly associated with alcohol abuse. Rhinophyma is considered by some researchers to be an advanced stage of acne rosacea. Here, we report a case of rhinophyma that was surgically treated with decortication and electrocoagulation at the Plastic Surgery Service of the University Hospital of the Federal University of Santa Catarina. Methods: A review of medical and photographic records of a case of rhinophyma was conducted. Results: The patient was underwent surgical treatment with favorable outcomes. Conclusion: There are several treatments for rhinophyma, with decortication and electrocoagulation being an excellent therapeutic option.

Labiaplasty and its current status / Plástica de pequenos lábios e suas possibilidades atuais

Introduction: Nymphoplasty or labiaplasty consists of a surgical approach to hypertrophy of the labia minora, and is aimed at correcting asymmetry and removing redundant tissue of the vulva. Hypertrophy of the labia minora is characterized by tissue that exceeds the limits of the labia majora under normal conditions. Surgery is an option in patients who complain of unpleasant odor, urinary infection, interference with sexual activity, and/or personal dissatisfaction; in the latter case, the surgical indication has an aesthetic purpose. The aim of this article was to report our experience with wedge resection of the labia minora in patients with hypertrophy. Methods: We retrospectively analyzed 53 cases of labiaplasty performed with the wedge resection technique from 2010 to 2015. The results were evaluated for postoperative anatomical appearance, the degree of patient satisfaction, and the effect on sexual activity. Results: Patients were satisfied with the postoperative aesthetic appearance. There was improvement in sexual satisfaction, ability to perform physical activities, and hygiene. No complications were observed, such as suture dehiscence, infection, or tissue necrosis. One patient required reoperation in the postoperative period due to asymmetry of the labia minora. Another patient complained of excessive exposure of the clitoris, but she had preexisting clitoral hypertrophy. Conclusion: Labiaplasty using the wedge resection technique relieved personal discomfort and provided functional and aesthetic improvement. Due to the lack of validation and standardization of labiaplasty techniques, further clinical research should be performed.

Introdução: A ninfoplastia consiste na abordagem cirúrgica da hipertrofia dos pequenos lábios, que visa ao aperfeiçoamento da assimetria destes e do tecido redundante da vulva. A hipertrofia de pequenos lábios caracteriza-se por aqueles que, em posição e condições normais, sobressaem-se aos grandes lábios. A cirurgia tem sido proposta na presença de transtornos, como odor desagradável, infecção urinária, comprometimento da atividade sexual e/ou insatisfação pessoal, cuja indicação cirúrgica possui fins estéticos. O objetivo deste artigo é relatar nossa experiência com a ressecção em cunha dos pequenos lábios nas pacientes que apresentam tal hipertrofia. Métodos: Foram analisados retrospectivamente 53 casos de ninfoplastia pela técnica de ressecção em cunha, no período de 2010 a 2015. Os resultados foram analisados quanto ao aspecto anatômico no pós-operatório, o grau de satisfação das pacientes e a interferência na atividade sexual. Resultados: As pacientes se mostraram satisfeitas com o aspecto estético pós-cirúrgico. Houve melhora no desempenho sexual, na prática de atividades físicas e condições de higiene. Não foram verificadas complicações, como deiscência de sutura, infecção ou necrose tecidual. Uma paciente precisou ser reoperada devido à assimetria de pequenos lábios no pós-operatório. Outra paciente queixou-se da excessiva exposição do clitóris, porém o mesmo já apresentava discreta hipertrofia prévia. Conclusão: A ninfoplastia pela técnica de ressecção em cunha apresentou benefícios em relação ao desconforto pessoal, melhora funcional e estética. Devido à ausência de validação e padronização nas técnicas de ninfoplastia atuais, novos estudos clínicos devem ser realizados.

Reconstructive management of degloving trauma of male external genitalia using dermal regeneration template: a case report.

Traumatic injuries of male external genitalia are rare and not usually life threatening; however, they can have psychological repercussions. The reconstructive management of these lesions is challenging and articulated. We report the case of a 38-year-old farmer suffering from a degloving wound on the external genitalia. The first reconstructive step used to treat the wound was the incorporation of a dermal regeneration template (Integra(®)) and accordingly partial-thickness skin grafts and local flaps. The follow-up 16 months after the first treatment was satisfying; sexual function had been restored.

Surgical restoration of arm and hand function in people with tetraplegia.

Improved hand and arm function is the most sought after function for people living with a cervical spinal cord injury (SCI). Surgical techniques have been established to increase upper extremity function for tetraplegics, focusing on restoring elbow extension, wrist movement, and hand opening and closing. Additionally, more innovative treatments that have been developed (implanted neuroprostheses and nerve transfers) provide more options for improving function and quality of life. One of the most important steps in the process of restoring upper extremity function in people with tetraplegia is identifying appropriate candidates - typically those with American Spinal Injury Association (ASIA) motor level C5 or greater. Secondary complications of SCI can pose barriers to restoring function, particularly upper extremity spasticity. A novel approach to managing spasticity through high-frequency alternating currents designed to block unwanted spasticity is being researched at the Cleveland FES Center and may improve the impact of reconstructive surgery for these individuals. The impact of these surgeries is best measured within the framework of the World Health Organization's International Classification of Function, Disability and Health. Outcome measures should be chosen to reflect changes within the domains of body functions and structures, activity, and participation. There is a need to strengthen the evidence in the area of reconstructive procedures for people with tetraplegia. Research continues to advance, providing more options for improved function in this population than ever before. The contribution of well-designed outcome studies to this evidence base will ultimately help to address the complications surrounding access to the procedures.

Reconstrução de maxila severamente atrófica via enxerto ósseo autógeno de calota craniana: descrição de técnica / Reconstruction of severely atrophic maxillary using calvarial autogenous bone graft: technical description

As reconstruções ósseas são tradicionalmente realizadas por meio de enxertos autógenos coletados de áreas doadoras intra e extrabucais, visando o restabelecimento do arcabouço perdido para posterior reabilitação implantoprotética. A calota craniana tem sido estudada como excelente opção em grandes atrofias, com baixa incidência de reabsorções, bem como de complicações e morbidade mínima. O tempo de hospitalização é curto, com baixo nível de dor, pequena limitação funcional e cicatriz imperceptível. A microarquitetura da calota craniana é predominantemente cortical com a presença de fatores de crescimento que evidenciam sua capacidade osteogênica, osteoindutora e osteocondutora acarretando baixa porcentagem de reabsorção e alta previsibilidade quando comparada a crista do ilíaco. Lacerações durais, hemorragias extra e subdurais, fístulas liquóricas e lesões cerebrais tem sido minimizadas em virtude do desenvolvimento da técnica cirúrgica. A delimitação da camada diploica, preservando a cortical interna do crânio, antes da realização das osteotomias no leito doador, possibilitou a diminuição de acidentes e complicações. O objetivo deste artigo foi apresentar nota técnica e discutir aspectos relativos à aplicação do osso de calota craniana na reconstrução de maxilas severamente atróficas, visando à reabilitação oral com implantes osseointegráveis.

Bone reconstructions are traditionally conducted with autogenous grafts harvested from intra- or extra-oral donor sites to reestablish the lost bone volume for further implant-prosthetic rehabilitation. The calvarial bone has been studied as an excellent donor site in large atrophic situations, presenting low resorption rates, as well as complications and minimal morbidity. The hospitalization time is short, with low pain levels, short functional limitations, and invisible scars. The skull microarchitecture is predominantly cortical in the presence of growth factors that demonstrate their osteogenic, osteoinductive, and osteoconductive abilities resulting in low resorption rate and high predictability when compared to the iliac crest. Dural lacerations, extra and subdural bleeding, cerebrospinal fluid leakage, and brain damage have been minimized due to the development of surgical technique. The delimitation of diploe, preserving the internal skull cortex before osteotomy at the donor made it possible to reduce accidents and complications. The aim of this paper is to show a technical and to discuss aspects of the use of calvarial bone in the reconstruction of severely atrophic maxilla for oral rehabilitation with osseointegrated implants.