Daniel Nunes e Silva’s research while affiliated with Federal University of Mato Grosso do Sul and other places

O abdômen é um importante segmento do corpo, sendo essencial para a autoestima e estética. Dentre as abordagens cirúrgicas para remoção de excesso de pele e gordura do abdômen, a abdominoplastia apresenta-se como a mais tradicional. No entanto, cirurgias prévias, como a pancreatectomia, podem deixar cicatrizes que impactam na escolha da técnica cirúrgica. Diante desse desafio, a reconstrução abdominal se apresenta como uma solução promissora. A literatura descreve inúmeras abordagens de reconstrução utilizando diferentes demarcações, como demarcação clássica, demarcação em âncora, demarcação circunferencial, embora nenhuma com o intuito de remover uma cicatriz proveniente de pancreatectomia. Reporta-se uma reconstrução do abdômen utilizando a demarcação em losango para correção de um grande excesso de pele pós gastroplastia e uma abordagem para a retirar a cicatriz em V invertido devido a pancreatectomia anterior. A técnica utilizada demonstrou-se eficaz para correção da cicatriz em V invertido acima do rebordo costal, apresentando facilidade técnica para resolução e bom resultado estético-funcional.

Introduction The nasal alar has always been a major reconstructive diflculty, and in the search for a flap with skin characteristics similar to this one, we came across the inferiorly based nasolabial flap. The objective of this study was to demonstrate the viability of the proposed flap for reconstruction of the nasal alar after removal of skin tumors. Methods This study analysed twenty cases of inferiorly based nasolabial flap performed with the same surgical technique in the period between 2008-2019 and followed up for one year of postoperative. Results Of the 20 studied cases, 13 (65%) did not present complications, being the most described: partial defect coverage and partial disappearance of the nasolabial sulcus. Conclusion The inferiorly based nasolabial flap proved to be a viable flap for nasal alar reconstruction due to the quality of the skin, easy execution, and minimal complication rates. Keywords: Skin neoplasms; Carcinoma; basal cell; Surgical flaps; Nasal surgical procedures; Reconstructive surgical procedures

Introdução: A asa nasal sempre foi uma grande dificuldade reconstrutiva e, na busca de um retalho com características da pele semelhantes a esta, deparamos com o retalho nasogeniano de pedículo inferior. O objetivo do trabalho foi demonstrar a viabilidade do retalho proposto para reconstrução da asa nasal após a retirada de tumores cutâneos. Métodos: Foram analisados 20 casos de retalho nasogeniano de pedículo inferior realizados com a mesma técnica cirúrgica no período entre 2008 e 2019 e acompanhados por um ano de pós-operatório. Resultados: Dos 20 casos estudados, 13 (65%) não apresentaram complicações, sendo as mais relatadas: cobertura parcial do defeito e desaparecimento parcial do sulco nasogeniano. Conclusão: O retalho nasogeniano de base inferior mostrou ser um retalho viável à reconstrução da asa nasal pela qualidade de pele, fácil execução e índices mínimos de complicações.

Introduction The increase in demand for post-bariatric plastic surgery has revealed a high prevalence of psychopathologies in patients undergoing the procedure, requiring the need to diagnose these diseases in the preoperative period. The use of specific psychological screening tools has been promoted; however, a gold-standard method has not yet been fully established. Objective To carry out a review of the literature for alternatives available for the preliminary psychological evaluation of patients who are candidates for post-bariatric plastic surgery, presenting the method recommended in the Post-Bariatric Plastic Surgery outpatient clinic of the Federal University of Mato Grosso do Sul (UFMS). Methods We reviewed the clinical trials which employed psychological screening tools preoperatively in patients who were candidates for post-bariatric plastic surgery; the MEDLINE/PubMed database was searched using keywords such as “bariatric surgery”, “body image”, “quality of life”, “obesity”, “plastic surgery” and “psychiatry”, for clinical trials published in the last 20 years. Herein, we discuss the findings and analyze the most common methodologies used. Results Only four clinical trials used psychopathology screening tools in post-bariatric plastic surgeries preoperatively, and one method could not be identified. Conclusion The use of appropriate strategies to screen for psychopathologies helps prevent significant losses in the postoperative period, but the tools still lack validation in the post-bariatric population. Besides possessing extensive clinical-surgical technical knowledge, the plastic surgeon must remain attentive to the signs and psychopathological symptoms in these patients, referring them for psychological and psychiatric evaluation when indicated. Keywords: Plastic surgery; Bariatric surgery; Body image; Quality of life; Obesity; Psychiatry

A hemiatrofia facial ou síndrome de Parry-Romberg é caracterizada por atrofia progressiva dos tecidos da hemiface, acometendo a pele e o subcutâneo. Suas manifestações clínicas são muito variadas. As estratégias terapêuticas de eleição para o tratamento da síndrome ainda não foram completamente estabelecidas. Os autores descrevem um caso de hemiatrofia facial leve, em que o paciente foi submetido a lipofilling (lipoenxertia autóloga), evoluindo com resultado satisfatório. As alternativas de tratamento, suas vantagens e desvantagens, são amplamente discutidas no estudo, sendo que a lipoenxertia autóloga desponta como excelente opção terapêutica, por sua segurança, baixo custo e reprodutibilidade.

Introdução: As múltiplas abordagens e a utilização de diferentes estratégias cirúrgicas contribuem para a obtenção de resultados mais agradáveis nas ritidoplastias. Nesse cenário, a lipoescultura vem ganhando cada vez mais relevância como alternativa para potencializar esses resultados, agregando maior valor estético final para o procedimento. Objetivos: Avaliar os resultados obtidos em pacientes submetidas à associação de ritidoplastia e lipoescultura facial. Métodos: Quatorze pacientes foram submetidas à ritidoplastia clássica de Pitanguy, associada à lipoescultura em áreas específicas da face, sendo acompanhadas por 12 meses. Os resultados pós-operatórios foram avaliados por 17 voluntários utilizando o método de Antell & Orseck. Resultados: Das 14 pacientes avaliadas, nove (64,2%) tiveram o resultado classificado como excelente, três (21,4%) como moderado e dois (14,2%) como fraco. Nenhuma paciente obteve resultados classificados como perfeito ou ruim. Conclusões: A ritidoplastia associada à lipoescultura da face se valida como alternativa importante para o tratamento do envelhecimento facial, proporcionando a obtenção de resultados agradáveis, seguros e duradouros.

Generally, the main complications of silicone implantation are local symptoms. However, some patients develop late-onset systemic symptoms often associated with a rare form of hyperactive immune response, as part of a syndrome known as autoimmune syndrome induced by adjuvants (ASIA). Reported cases of ASIA have shown resolution with explantation, but not with immunomodulatory therapy. In this report, we described a case of a previously healthy 23-year-old woman, who has undergone silicone breast implant augmentation, for aesthetic reasons, and developed localized cutaneous impairment 3 years postsurgery. She received a diagnosis of ASIA with a new presentation: Lupus-like manifestation through localized cutaneous impairment. This patient’s symptoms were managed without the need for surgical intervention, which has not been previously reported, because the patient did not want an explantation for aesthetic reasons. The patient was started on hydroxychloroquine, 400 mg per day, and remains asymptomatic after 2 years of treatment. The exact predisposition to ASIA is still unknown. Without implant explantation and with immunomodulatory treatment, this patient’s condition substantially improved. Based on our current understanding of this disease, it might not be prudent to indicate breast augmentation with silicone implants in patients with documented autoimmune reaction to an adjuvant, an established autoimmune condition, or genetic predisposition. However, if a patient does develop silicone-induced ASIA, explantation is no longer the only successfully reported option, as these symptoms can be managed with immune suppression.

Rhinophyma tends to determine important nasal changes, with aesthetic and functional impairment, especially in more advanced cases. Despite the various techniques already described, the search for the ideal treatment persists. Two patients with rhinophyma underwent tangential excision associated with electrocoagulation, with subsequent intensive cosmetic treatment. The described technique is effective, safe, with excellent aesthetic results and no recurrences during the study period. This proposed combined treatment appears as a great alternative for the treatment of rhinophyma due to its technical simplicity and its good long-term results.

Introduction An approach based on multiple anatomical structures and the use of different surgical strategies seems to achieve more lasting results in cervical rejuvenation surgery. Thus, extended cervicoplasty is an option with favorable results and low complication rates. However, little has been published regarding the durability of the results. This study aimed to objectively evaluate the long-term results obtained with extended cervicoplasty in difficult cases. Methods Twenty patients, classified as having a “difficult neck,” underwent extended cervicoplasty and were followed for 5 years. The results at 1- and 5-year post-operative follow-up were evaluated by eight plastic surgeons, using six objective criteria based on a theoretically ideal neck. The comparison of the results obtained at these time points was performed using a paired Student’s t-test, with a level of significance of 5%. Results There was no significant difference in five of the six items evaluated (p-value ranging from 0.137 to 1.000), in the comparison between the first and fifth postoperative years. Subhyoid depression displayed a significantly better mean score in the fifth evaluation year than that observed in the first year after surgery (p = 0.039): from 5.80 ± 0.25 points (mean ± standard error of the mean) in the first year, to 6.45 ± 0.30 points in the fifth postoperative year. Conclusion Extended cervicoplasty is an important alternative in the treatment of the neck region, and even provides lasting results in difficult cases. Keywords: Rhytidoplasty; Cervicoplasty; Neck muscles; Rejuvenation; Neck.