Η χειρουργική της παχυσαρκίας προσφέρει ικανοποιητικά μακροπρόθεσμα αποτελέσματα, με χαμηλό ποσοστό επιπλοκών. Μετά την εγχείρηση για την παχυσαρκία και την μεγάλη απώλεια βάρους, παρατηρείται περίσσεια δέρματος, η οποία προκαλεί λειτουργικά, δερματολογικά και αισθητικά προβλήματα. Οι ανατομικές περιοχές όπου παρατηρείται η δυσμορφία, είναι η έσω επιφάνεια των βραχιόνων, οι μαστοί, το θωρακικό και το κοιλιακό τοίχωμα καθώς και οι μηροί. Για την αποκατάσταση της δυσμορφίας, οι ασθενείς πρέπει να υποβληθούν σε μία ή περισσότερες περιοχικές δερμολιπεκτομές. Στην παρούσα μελέτη καταγράφουμε την εμπειρία μας, όσον αφορά την αντιμετώπιση των συγκεκριμένων ασθενών. Από τον Οκτώβριο 1996 μέχρι τον Δεκέμβριο 2002, 46 ασθενείς υπεβλήθησαν σε 67 περιοχικές δερμολιπεκτομές. Σαράντα πέντε ασθενείς, υπεβλήθησαν σε δερμολιπεκτομή του κοιλιακού τοιχώματος. Ο μέσος χειρουργικός χρόνος ήταν 188,1 min (105-420 min). Το μέσο βάρος των εκταμειθέντων ιστών ήταν 2839,2 gr (850-7525 gr). Τέσσερις ασθενείς (8,8%) μεταγγίσθηκαν. Επτά ασθενείς(15,5%) παρουσίασαν επιπλοκές στις οποίες περιλαμβάνονται, 1 μετεγχειρητική αιμορραγία, 3 διαπυήσεις τραύματος, 2 διασπάσεις και 1 ορώδης συλλογή. Ο μέσος χρόνος νοσηλείας ήταν 8,9 ημέρες (5-22 ημέρες). Είκοσι πέντε από τους ασθενείς (55,5%), υπεβλήθησαν σύγχρονα σε αποκατάσταση μετεγχειρητικής κήλης, ενώ σε 9 (20%) χρησιμοποιήθηκε πλέγμα goretex. Οκτώ ασθενείς (17,3%) υπεβλήθησαν σε πλαστική των μαστών και ο μέσος χειρουργικός χρόνος ήταν 166,2 min (130-210 min). Σε μια ασθενή τοποθετήθηκαν ενθέματα. Δεν υπήρξε νοσηρότητα και ο μέσος χρόνος νοσηλείας ήταν 7,1 ημέρες (4-9 ημέρες). Επτά ασθενείς (15,2%) υπεβλήθησαν σε εγκάρσια λαγονο-μηρο- γλουτιαία ανόρθωση, τέσσερις ασθενείς (8,6%) υπεβλήθησαν σε δερμολιπεκτομή των μηρών, ενώ άλλοι τρεις (6,5%) υπεβλήθησαν σε δερμολιπεκτομή των βραχιόνων. Ο μέσος χειρουργικός χρόνος ήταν 297,1 min (160-420 min), 246,2 min (230-280 min) και 203,3 min (180-240 min) αντίστοιχα. Το μέσο βάρος των εκταμειθέντων ιστών ήταν 2245gr (725-4403 gr), 1342,5 gr (1050-1550gr) και 572,7 gr (400-848gr) αντίστοιχα. Οι επιπλοκές περιλαμβάνουν την διαπύηση του τραύματος σε 2 ασθενείς, μικρές διασπάσεις του δέρματος σε 5 ασθενείς και παρατεταμένο οίδημα του αριστερού κάτω άκρου σε μία ασθενή. Ο μέσος χρόνος νοσηλείας ήταν 10,6 ημέρες (6-23 ημέρες), 8 ημέρες (7-9 ημέρες) και 6 ημέρες (5-7 ημέρες) αντίστοιχα. Οι περιοχικές δερμολιπεκτομές, αποτελούν την μόνη εφικτή αντιμετώπιση της δυσμορφίας που προκαλείται από την μεγάλη απώλεια βάρους. Σύμφωνα με την εμπειρία μας, οι εγχειρήσεις αυτές είναι ασφαλείς, δίχως σοβαρές επιπλοκές και προσφέρουν καλά λειτουργικά και αισθητικά αποτελέσματα. / Bariatric surgery has been shown to be effective in providing substantial and sustained long-term weight loss with minimum complications. Following bariatric surgery and consequent loss of body weight, the skin begins to sag in various regions of the body, forming skin-folds, which cause serious functional, dermatological and aesthetic deformities. The regions of the body most commonly affected by excess skin tissue are the medial part of the arms, the breasts, the thoracic and abdominal wall, especially in the lateral areas and the inner and outer thigh. In order to correct this deformity, it is essential that they undergo a series of one or more regional dermolipectomies. In this article, we present our experience on how we manage these patients. From October 1996 until December 2002, 46 patients had 67 regional dermolipectomies. Forty-five patients underwent abdominal dermolipectomy. The average operative time was 188,1 min (105-420min). The average amount of tissue excised was 2839,2 gr (850-7525gr). Four patients (8,8%) required blood transfusion. Seven patients (15,5%) developed complications, which included 1 case of post-operative bleeding, 3 wound infections, 2 skin dehiscences and 1 seroma. Average length of hospital stay was 8,9 days (5- 22 days). Twenty-five of these patients (55,5%) simultaneously underwent abdominal incisional hernia repair; in 9 (20%), a goretex mesh was used. Eight patients (17,3%) had mammaplasty, with average operative time 166,2 min (130-210 min). In one of them, breast implants were placed. There was no morbidity, and the average hospitalization was 7,1 days (4-9 days). Transverse flank-thigh-buttock lift was done in seven patients (8,6%), and arm reduction plasty in three (6,5%). The average operative time was 297,1 min (160-420 min), 246,2 min (230-280 min) and 203,3 min (180-240) respectively. Average tissue excised was 2245 gr (725-4403 gr), 1342,5 gr (1050-1550 gr) and 572,7 gr (400-848 gr) respectively. Morbidity was related to wound infection in 2 patients, minor skin dehiscence in 5 patients and persistent edema of the left lower extremity in another. Average hospitalization was 10,6 days (6-23 days), 8 days (7-8 days) and 6 days (5-7 days) respectively. Regional dermolipectomies constitute the only available treatment for deformities following massive weight loss after bariatric surgery. Based on our experience, these procedures are safe, without serious complications and with good functional and esthetic results.

No description available.

As cirurgias de reconstrução parcial ou total de orelha são um desafio na medicina, exigindo técnicas complexas e qualificadas, sendo as mais utilizadas àquelas que fazem uso de material autógeno (cartilagem da costela do próprio paciente). Trata-se de um processo artesanal em que o cirurgião deve esculpir manualmente a cartilagem para formar o modelo tridimensional da orelha, denominado framework, dessa forma, o resultado final depende, principalmente, da habilidade do cirurgião plástico. Tendo isso em vista, busca-se, neste trabalho, empregar as tecnologias computacionais utilizadas no Design Virtual para auxiliar o planejamento cirúrgico, utilizando digitalização tridimensional e fabricação digital para aprimorar o resultado da técnica de reconstrução auricular. A metodologia proposta sugere a digitalização tridimensional do paciente e, a partir disso, são projetados templates cirúrgicos para auxiliar a modelagem e o posicionamento do framework. A aplicação cirúrgica valida alguns pontos e possibilita o estudo de melhorias em determinados templates, utilizados então em outras duas reconstruções, obtendo-se resultados positivos. Assim, o uso do Design Virtual mostra-se confiável e útil na cirurgia de reconstrução auricular, levando à melhoria no planejamento e, assim, diminuição do tempo cirúrgico, sem riscos ou complicações ao paciente e com melhores resultados anatômicos. / The partial or total reconstruction of ear is a challenge in plastic surgery, requiring complex and skilled techniques. The most successful reconstructions use autogenous material (cartilage from the patient's own rib). It is a handmade process in which the surgeon must manually sculpt the cartilages to form the three-dimensional model of the ear, usually called as framework. Considering this, the final result depends mainly on the plastic surgeon's skill. In this scenario, the aim of this research is employ computer technologies used in Virtual Design to aid surgical planning, using three-dimensional scanning and digital manufacturing to improve the result of ear reconstruction technique. The proposed methodology suggests surgical templates, based on 3D patient scan, designed to assist the modeling and positioning of the framework. The surgical application validates some points and allows the study of improvements in certain templates, then used in other two surgeries, with positive results. Thus, the use of Virtual Design proves to be reliable and useful in ear reconstruction surgery, leading to improved planning and decreasing surgical time, without any risks or complications for the patient and with better anatomical results.

<b>BACKGROUND:</b> Evidence-based medicine has had a profound impact on healthcare. In the field of Plastic surgery, powerful examples include; less radical skin cancer excision margins and skin-sparing or even nipple-sparing mastectomies and microsurgical reconstruction. Sustained progression of the field, relies on the development of a high-quality evidence base, with strong use of peer-reviewed research protocols, which are publicly registered and completed studies transparently reported. The extent of compliance with these principles is currently unknown and the author hypothesised that it would be low. The author further hypothesised that registration could be improved by the development of a new global research registry and reporting quality can be improved by the mandatory implementation of reporting guidelines in a journal. <b>METHODS:</b> This thesis incorporated 11 studies. The first two studies used a literature review to determine; the levels of evidence, rates of study registration and protocol publication in the recent Plastic Surgery literature. Thirdly, the design, build and launch of a new global research registry to boost compliance with registration and to determine barriers to it using a survey amongst users. This would be followed by systematic reviews to determine compliance with the STROBE and PRISMA guidelines respectively. An analysis of each guide for authors (GFA) of the surgical journals listed in the Thomson Reuters journal citation report for surgery to determine support for reporting guidelines. The impact of the mandatory implementation of reporting guidelines in a surgical journal would be assessed using a before and after design. Finally, to develop a reporting guideline for surgical case reports (SCARE) and surgical case series (PROCESS) using a DELPHI consensus exercise amongst an expert panel. <b>RESULTS:</b> Protocols were registered in 4% of 595 recent research studies and 0.5% were published. There was a mean compliance of 12/22 for the STROBE guideline (n=94) and 16/27 for the PRISMA guideline (n=79). The Research Registry® was launched in February 2015. Analysis of the first 500 previously unregistered studies, showed they came from 57 countries and included 1.77 million patients. Key barriers to registration were a lack of awareness of the need to register and lack of time (n=149). In addition, 45% registered their study at the time of journal submission. The GFA analysis showed 62% didn’t mention reporting guidelines at all (n=193). Subsequent mandatory implementation in a single surgical journal, increased compliance with STROBE by 12% (n=152), with CONSORT by 40% (n=13) and with PRISMA by 58% (n=28). The SCARE and PROCESS reporting guidelines were developed and published in late 2016. According to Google Scholar, they have accumulated over 200 citations at the time of writing. <b>CONCLUSION:</b> Study registration, protocol use and reporting quality are poor in plastic surgery. Potential solutions to these long-standing problems have been developed and explored within this thesis. These include the development and use of the Research Registry® and the mandatory implementation of reporting guidelines, with both measures front-loaded within a gatekeeper framework for journals. It is now for Plastic Surgeons and the wider surgical community to pick up the gauntlet and drive forward high-quality research, evidence-based surgical practice and better outcomes for their patients and society at large.

As cirurgias de reconstrução parcial ou total de orelha são um desafio na medicina, exigindo técnicas complexas e qualificadas, sendo as mais utilizadas àquelas que fazem uso de material autógeno (cartilagem da costela do próprio paciente). Trata-se de um processo artesanal em que o cirurgião deve esculpir manualmente a cartilagem para formar o modelo tridimensional da orelha, denominado framework, dessa forma, o resultado final depende, principalmente, da habilidade do cirurgião plástico. Tendo isso em vista, busca-se, neste trabalho, empregar as tecnologias computacionais utilizadas no Design Virtual para auxiliar o planejamento cirúrgico, utilizando digitalização tridimensional e fabricação digital para aprimorar o resultado da técnica de reconstrução auricular. A metodologia proposta sugere a digitalização tridimensional do paciente e, a partir disso, são projetados templates cirúrgicos para auxiliar a modelagem e o posicionamento do framework. A aplicação cirúrgica valida alguns pontos e possibilita o estudo de melhorias em determinados templates, utilizados então em outras duas reconstruções, obtendo-se resultados positivos. Assim, o uso do Design Virtual mostra-se confiável e útil na cirurgia de reconstrução auricular, levando à melhoria no planejamento e, assim, diminuição do tempo cirúrgico, sem riscos ou complicações ao paciente e com melhores resultados anatômicos. / The partial or total reconstruction of ear is a challenge in plastic surgery, requiring complex and skilled techniques. The most successful reconstructions use autogenous material (cartilage from the patient's own rib). It is a handmade process in which the surgeon must manually sculpt the cartilages to form the three-dimensional model of the ear, usually called as framework. Considering this, the final result depends mainly on the plastic surgeon's skill. In this scenario, the aim of this research is employ computer technologies used in Virtual Design to aid surgical planning, using three-dimensional scanning and digital manufacturing to improve the result of ear reconstruction technique. The proposed methodology suggests surgical templates, based on 3D patient scan, designed to assist the modeling and positioning of the framework. The surgical application validates some points and allows the study of improvements in certain templates, then used in other two surgeries, with positive results. Thus, the use of Virtual Design proves to be reliable and useful in ear reconstruction surgery, leading to improved planning and decreasing surgical time, without any risks or complications for the patient and with better anatomical results.

Este trabalho resultou de uma investigação que objetivou verificar e analisar, do ponto de vista de trabalhadoras que se submeteram a cirurgia plástica estética, se e de que modo o embelezamento físico se mostra como requisito da gestão gerencialista para o exercício do trabalho imaterial. Para tanto a revisão da literatura abrangeu trabalho imaterial, através de autores como Gorz, Grisci e Pelbart, gestão gerencialista, através de autores como Gaulejac e Chanlat, e embelezamento físico, através de autores como Mansano, Bauman e Lipovetsky. Trata-se de uma pesquisa qualitativa e exploratória, e, para sua realização foram entrevistados seis cirurgiões plásticos e seis trabalhadoras, indicadas por estes, que se submeteram a cirurgia plástica estética. As entrevistas ocorreram em três cidades do Rio Grande do Sul. A análise dos dados deu-se segundo os parâmetros de Minayo (2001). As evidências empíricas mostraram que, no caso das trabalhadoras entrevistadas, o embelezamento físico pode ser considerado requisito da gestão gerencialista para o exercício do trabalho imaterial. Além disso, mostraram que características da gestão gerencialista e do trabalho imaterial encontravam-se na narrativa das trabalhadoras estudadas. Mostraram ainda que os cirurgiões plásticos estéticos entrevistados, confirmam a tese de que, no caso, das trabalhadoras analisadas, a cirurgia plástica estética pode ser considerada um elemento de embelezamento físico utilizado a fim de se conseguir retorno no trabalho de cada uma. Por fim, as narrativas revelaram que a cirurgia plástica estética é também um artifício utilizado pelas trabalhadoras entrevistadas na tentativa de manter-se dentro de um determinado padrão de embelezamento físico que pode gerar rendimentos ao trabalho imaterial. / This paper is the result of a study that aimed to verify and analyze, from the point of view of workers that underwent cosmetic plastic surgery, if and how physical beautification is a requirement of managerialism to perform immaterial labor. The literature review included immaterial labor, through authors such as Gorz, Grisci and Pelbart, managerialism, through authors such as Gaulejac and Chanlat, and physical beautification, through authors such as Mansano, Bauman and Lipovetsky. This is a qualitative and exploratory research, and six plastic surgeons and six female workers were interviewed, workers who were referred by the surgeons and had undergone plastic surgery. The interviews took place in three cities of Rio Grande do Sul. Data analysis was performed according to Minayo’s parameters (2001). Empirical evidence has shown that, in the case of female workers interviewed, physical beautification may be considered a requirement of managerial management for the exercise of immaterial labor. In addition, they showed that characteristics of managerialist management and immaterial work were found in the narrative of the workers studied. They also showed that the aesthetic plastic surgeons interviewed confirm the thesis that, in the case of the workers analyzed, cosmetic plastic surgery can be considered as a physical embellishment element used in order to achieve a return in the work of each one. Finally, the narratives revealed that cosmetic plastic surgery is also an artifice used by the workers interviewed in an attempt to keep within a certain pattern of physical beautification that can generate income for immaterial labor.

Possibilities of Breast Cancer Patients in Connection with Plastic Reconstructive Surgery Oncological disease is one of the diseases basically no one is able to influence. It is not a disease anyone would want. It starts slowly, stealthily and is often overlooked. Yet, oncological disease always changes our whole past life, within family, workplace, and our leisure activities, both in physical and psychological terms. Any patient deals with this disease differently, also the approach to these patients has to be highly individualized. Every patient goes through all the phases of the disease at a different pace and with varying success and every patient copes with it in a different way and is then able to return to his or her old life. Oncological disease is one of the most serious diseases and I dare say that breast cancer is for women very traumatic, changing their position in all roles; intensity is usually placed on a woman?s psyche. Every woman needs an individual approach from a physician, non-physician and especially from her family. The disease does not affect only the patient, but also the whole family and her environment. This diploma thesis deals with the possibilities of breast cancer patients in connection with plastic reconstructive surgery. Four objectives were set... The first objective was to determine the level of patient awareness of the possibilities of reconstructing the missing breast. The research showed that patients lack information and the majority of respondents received complete information from a mammologist, or a surgeon when dealing with the primary breast cancer diagnosis. The second objective was to find out whether patients are interested in co-decisions on the method of breast reconstruction. Based on the research, we concluded that yes, they are interested in deciding on the method, but it is important for them to have enough information and to know the doctor?s opinion. The third objective was to see whether patients have the opportunity to co-decide on the method of breast reconstruction. The results showed that patients have the possibility to decide on the choice of method, but in dependence on the possibilities, which are for each patient individual. It is not possible to use and select from all methods for each patient, it is necessary to approach each respondent individually and with complete knowledge of the course of her disease. The fourth objective was to define the most frequent patients? questions in connection with breast reconstruction. The results of interviews showed that the most frequently asked questions related to the length and number of hospitalizations and return to the social, professional and personal life. The diploma thesis is divided into two parts?theoretical and empirical. The theoretical part describes the historical development of reconstructing the missing breast, primary cancer disease and its classification. A greater part includes the possibilities of reconstructing the missing breast and specific nursing care for these patients. To process the empirical part of this thesis, qualitative research was chosen. The method of questioning, using semi-structured interviews with open questions, was selected. The research sample consisted of 11 patients at the Department of Plastic Surgery, University Hospital in Pilsen and 1 client of Mama Help Center in Pilsen. Three research questions were formulated. 1. What are the obstacles to the lack of information about breast reconstruction? The research shows that the patients outside the big specialized mammological centers have less access to specialized information and the research shows generally apparent absence of written information for patients on this topic.

Esta dissertação trata da construção dos valores acerca do corpo que transforma aspectos estéticos em problemas de saúde física. Com base na pressuposição do compromisso de aliviar o sofrimento o cirurgião plástico busca, dentro do campo da saúde, justificativas para sua atuação. Por outro lado, na aspiração por modelos de beleza socialmente prestigiados há também a procura pela transformação pessoal com a construção e afirmação de papéis sociais, o que contribui para a maior aceitação das intervenções cirúrgicas com finalidade estética. Seguindo tendências estéticas sempre em mutação, observa-se, na atualidade, uma grande demanda por cirurgia plástica para colocação de implantes de silicone com objetivo de aumento mamário. Tomando como recorte a utilização de tais implantes, buscou-se analisar a construção médica e social da beleza e compreender como a procura e a prática da cirurgia plástica estão ligadas a valores controversamente aceitos ou criticados na sociedade contemporânea. / This study treats the construction of values concerning the body which transform aesthetic appearance into physical health troubles. Based on the presupposition of the commitment of relieving the suffering, the plastic surgeon searches for inside the health field to justify his acts. On the other hand, in aspiration for beautiful socially well-known models looking for personal transformation also occurs, with the construction and affirmation of social roles which contributes to the wider acceptance of operations with aesthetic purpose. Following aesthetics trends always in mutations, it was observed in present times a great demand for cosmetics breast augmentation with silicone implants. It was searched to analyze the medical and social constructions of beauty and understand how the search and the practice of plastic surgery are binding to values controversially accepted or criticized in the contemporaries societies.

The object of the study is to examine the consumption of cosmetic tourism from the consumer's and the producer’s viewpoint and to examine what factors help individuals choose to travel overseas to consume cosmetic surgeries. The method used in the study was a qualitative examination, where we interviewed seven individuals. Five of the individuals have gone through the process of surgery overseas, one is a Swedish surgeon that’s working on Akademikliniken and lastly we interviewed one person who runs a company in Sweden that arranges trips overseas with the purpose of going through a surgery. The collected data was analyzed with support of the consumer society and Gidden's theory about modernity and self-identity. The final discussion shows that cosmetic tourism is a growing phenomenon and the extent of it is growing in today's society and that the main factors that have shown to affect the choice is trust and competence within the clinic and the surgeon, and women’s dissatisfaction with their bodies. / Syftet med studien var att undersöka konsumtionen av kosmetisk turism utifrån ett konsument- och producentperspektiv samt att se vilka faktorer det är som styr individen utomlands för att konsumera kosmetiska ingrepp. Studien genomfördes med en kvalitativ undersökning, varav vi intervjua sju personer. Fem av dem har utfört kosmetiska ingrepp utomlands, en av dem är en svensk kirurg som arbetar på Akademikliniken och slutligen intervjuade vi en kvinna som driver ett bolag i Sverige som arrangerar resor utomlands med syftet att genomgå kosmetiska ingrepp. Det insamlade materialet analyserades med bland annat stöd av utgångspunkten från konsumtionssamhället och Giddens teori om modernitet och självidentitet. Den slutliga diskussionen visar att kosmetisk turism är ett växande fenomen och vad fenomenet innebär samt att de utmärkande faktorerna som visat sig påverka valet av resan är tilliten, kompetensen hos kliniken och kvinnors missnöje med kroppen.

Esta dissertação trata da construção dos valores acerca do corpo que transforma aspectos estéticos em problemas de saúde física. Com base na pressuposição do compromisso de aliviar o sofrimento o cirurgião plástico busca, dentro do campo da saúde, justificativas para sua atuação. Por outro lado, na aspiração por modelos de beleza socialmente prestigiados há também a procura pela transformação pessoal com a construção e afirmação de papéis sociais, o que contribui para a maior aceitação das intervenções cirúrgicas com finalidade estética. Seguindo tendências estéticas sempre em mutação, observa-se, na atualidade, uma grande demanda por cirurgia plástica para colocação de implantes de silicone com objetivo de aumento mamário. Tomando como recorte a utilização de tais implantes, buscou-se analisar a construção médica e social da beleza e compreender como a procura e a prática da cirurgia plástica estão ligadas a valores controversamente aceitos ou criticados na sociedade contemporânea. / This study treats the construction of values concerning the body which transform aesthetic appearance into physical health troubles. Based on the presupposition of the commitment of relieving the suffering, the plastic surgeon searches for inside the health field to justify his acts. On the other hand, in aspiration for beautiful socially well-known models looking for personal transformation also occurs, with the construction and affirmation of social roles which contributes to the wider acceptance of operations with aesthetic purpose. Following aesthetics trends always in mutations, it was observed in present times a great demand for cosmetics breast augmentation with silicone implants. It was searched to analyze the medical and social constructions of beauty and understand how the search and the practice of plastic surgery are binding to values controversially accepted or criticized in the contemporaries societies.