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A partir de uma abordagem do fenômeno das cirurgias plásticas enquanto algo que se conforma na prática, esta dissertação versa sobre os limites entre o reparador e o estético relativos a esses procedimentos. Tendo como espinha dorsal a formação das(os) médicas(os) e a constituição dessa especialidade da medicina, tais fronteiras serão abordadas a partir do entendimento de que não apenas auxiliam na conformação das cirurgias plásticas, mas são também constituídas em relação a essas últimas. Através da participação em eventos promovidos por Ligas de Cirurgia Plástica e entrevistas realizadas com graduandas, residentes, cirurgiãs e cirurgiões plásticos, este trabalho tem como objetivo construir uma narrativa, entre tantas outras possíveis, acerca dos modos como os limites entre o estético e o reparador têm se instituído discursivo-materialmente. Antes, contudo, parte-se de uma abordagem histórica a fim de uma compreensão mais situada a respeito de como essa especialidade tem se conformado ao longo do tempo. Por meio de diferentes investimentos esta dissertação trata, em síntese, sobre como esses procedimentos assumem diferentes realidades. Assim, contingências históricas, sociais, econômicas, políticas e materiais, entre inúmeras outras, são compreendidas de maneira indissociável como atuantes na conformação das cirurgias plásticas e dos limites concernentes a elas. Por fim, sugere-se que um entendimento dessas realidades enquanto múltiplas nos auxilia na construção de uma apreensão do conhecimento médico como algo que não está dado, mas como práticas histórico-materialmente situadas. Ainda, a partir da discussão central proposta por este trabalho são estabelecidos pontos de confluência entre as cirurgias plásticas e as fronteiras relativas ao corpo e aos binômios natureza/cultura, saúde/doença, forma/função, entre outros. / This dissertation addresses the limits between the cosmetic and the reconstructive surgeries from an approach of the plastic surgery phenomenon as something that conforms in practice. Having as a backbone the formation of the doctors and the constitution of this specialty of medicine, such boundaries will be approached from the understanding that they not only aid in the conformation of plastic surgeries but also are constituted of this last one. Through the participation in events promoted by Plastic Surgery Leagues and interviews with undergraduates, residents and plastic surgeons, this study aims to construct a narrative, among many others possible, about the ways in which the boundaries between the cosmetic and the reconstructive surgeries have been instituted discursive-materially. First, however, it starts with a historical approach in order to understand more about how this specialty has conformed over time. Through different investments, this dissertation deals, in short, with about how these procedures take on different realities. Thus, historical, social, economic, political, and material contingencies, among countless others, are understood as acting in the conformation of plastic surgeries and the limits concerning them. Finally, it suggests that an understanding of these realities as multiple helps us in constructing an apprehension of the medical knowledge as something that is not given but as historical-materially situated practices. Still, from the proposed discussion by this study, points of convergence between plastic surgeries and boundaries related to the body and to the binomials nature/culture, health/illness, form/function, among others, are established.

A partir de uma abordagem do fenômeno das cirurgias plásticas enquanto algo que se conforma na prática, esta dissertação versa sobre os limites entre o reparador e o estético relativos a esses procedimentos. Tendo como espinha dorsal a formação das(os) médicas(os) e a constituição dessa especialidade da medicina, tais fronteiras serão abordadas a partir do entendimento de que não apenas auxiliam na conformação das cirurgias plásticas, mas são também constituídas em relação a essas últimas. Através da participação em eventos promovidos por Ligas de Cirurgia Plástica e entrevistas realizadas com graduandas, residentes, cirurgiãs e cirurgiões plásticos, este trabalho tem como objetivo construir uma narrativa, entre tantas outras possíveis, acerca dos modos como os limites entre o estético e o reparador têm se instituído discursivo-materialmente. Antes, contudo, parte-se de uma abordagem histórica a fim de uma compreensão mais situada a respeito de como essa especialidade tem se conformado ao longo do tempo. Por meio de diferentes investimentos esta dissertação trata, em síntese, sobre como esses procedimentos assumem diferentes realidades. Assim, contingências históricas, sociais, econômicas, políticas e materiais, entre inúmeras outras, são compreendidas de maneira indissociável como atuantes na conformação das cirurgias plásticas e dos limites concernentes a elas. Por fim, sugere-se que um entendimento dessas realidades enquanto múltiplas nos auxilia na construção de uma apreensão do conhecimento médico como algo que não está dado, mas como práticas histórico-materialmente situadas. Ainda, a partir da discussão central proposta por este trabalho são estabelecidos pontos de confluência entre as cirurgias plásticas e as fronteiras relativas ao corpo e aos binômios natureza/cultura, saúde/doença, forma/função, entre outros. / This dissertation addresses the limits between the cosmetic and the reconstructive surgeries from an approach of the plastic surgery phenomenon as something that conforms in practice. Having as a backbone the formation of the doctors and the constitution of this specialty of medicine, such boundaries will be approached from the understanding that they not only aid in the conformation of plastic surgeries but also are constituted of this last one. Through the participation in events promoted by Plastic Surgery Leagues and interviews with undergraduates, residents and plastic surgeons, this study aims to construct a narrative, among many others possible, about the ways in which the boundaries between the cosmetic and the reconstructive surgeries have been instituted discursive-materially. First, however, it starts with a historical approach in order to understand more about how this specialty has conformed over time. Through different investments, this dissertation deals, in short, with about how these procedures take on different realities. Thus, historical, social, economic, political, and material contingencies, among countless others, are understood as acting in the conformation of plastic surgeries and the limits concerning them. Finally, it suggests that an understanding of these realities as multiple helps us in constructing an apprehension of the medical knowledge as something that is not given but as historical-materially situated practices. Still, from the proposed discussion by this study, points of convergence between plastic surgeries and boundaries related to the body and to the binomials nature/culture, health/illness, form/function, among others, are established.

Orientador: Sabryna Gouveia Calazans / Resumo: Cirurgias reconstrutivas são empregadas no fechamento de feridas na qual existe dificuldades de oclusão. Podem apresentar um pós-operatório doloroso devido a grande manipulação tecidual. Assim, o uso de técnicas como a de anestesia por tumescência com lidocaína, são importantes, em virtude de proporcionar melhor analgesia trans e pós-operatória. No entanto, a lidocaína pode interferir na cicatrização. Assim, delineou-se um estudo a fim de avaliar a cicatrização de defeitos cutâneos induzidos, fechados em padrão de figura geométrica, associado ao emprego de anestesia por tumescência com lidocaína em coelhos (Oryctolagus cuniculus). Ademais, avaliar sua influência em parâmetros cardiorrespiratórios e na analgesia pós-operatória. Foi realizado no Hospital Veterinário da UNESP, Câmpus de Jaboticabal – SP, um estudo com 27 coelhos, separados em três grupos, compreendidos em GC (fechamento em padrão de figura geométrica sem o emprego de tumescência), GS (fechamento em padrão de figura geométrica associado ao emprego de tumescência com solução fisiológica 0,9%) e GL (fechamento em padrão de figura geométrica associado ao emprego de anestesia por tumescência com lidocaína). Realizaram-se avaliações macroscópicas das lesões, observando-se exsudato, edema, coloração e aspecto cosmético da ferida e microscópicas, observando-se proliferação vascular, células mononucleares e polimorfonucleares, proliferação fibroblástica, colagenização, reepitelização e hemorragia. A avaliação da analge... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Reconstructive surgeries are used to close wounds in which there is difficulties of occlusion. Because of its large tissue manipulation it may have a painful post-operative. Thus, the use of techniques such as tumescent anesthesia with lidocaine are important because it provides better analgesia during and after the surgery. However, lidocaine can interfering in the healing process. Therefore, a study was devised to evaluate the healing process of induced cutaneous defects, closed in geometric figure associated with the use of tumescent anesthesia with lidocaine in rabbits (Oryctolagus cuniculus). Besides, to assess its influence in cardiorespiratory parameters and in postoperative analgesia. It was held at the Veterinary Teaching Hospital of UNESP, campus of Jaboticabal - SP, a study involving 27 rabbits, divided into three groups being GC (defects closed in geometric figure without the use of tumescence), GS (defects closed in geometric figure associated with the use of tumescence with saline solution 0,9 %) and GL (defects closed in geometric figure associated with the use of tumescent anesthesia with lidocaine). Macroscopic assessments were made observing exudate, edema, color and cosmetic aspect of the wound and microscopic evaluations, observing vascular proliferation, mononuclear cells and polymorphonuclear cells, fibroblast proliferation, collagen deposition, reepithelialization and bleeding. The evaluation of postoperative analgesia was made by Visual Analogue ... (Complete abstract click electronic access below) / Mestre

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Stable vascular networks are prerequisite for scaffold-guided reconstruction of large voluminous bony defects. However, induction of angiogenesis remains a major challenge for bone-tissue engineering. The present in vivo study evaluates human umbilical cord derived vascular endothelial cells (HUVEC) or hematopoietic stem cells(HSCs)-mediated formation of microvascular networks in a biocompatible PCL-ßTCP hybrid scaffold in an immuno-compromised nude mouse. The PCL-ßTCP scaffold (30% PCL: 70% ßTCP; 70% porosity) with interconnected open pores was fabricated in 6x6x6mm cubes. They were seeded with human mesenchymal stem cells (MSCs) plus HUVECs or HSCs. Groups (N=12) consisted of scaffold samples seeded with MSCs alone, MSCs and HUVECs, MSCs and HSCs, and no cells. Cell suspension containing thrombin was evenly seeded into the micro porous constructs, sealed with fibrinogen, and implanted into immunodeficient mice for 8 weeks. At the end of the 8th week, mouse blood vessels were perfused with radiopaque microfil. The scaffolds were harvested, demineralized and analyzed for neovasculature by microcomputed tomography (micro- CT). The formation of microvasculature was significantly higher in the MSC-HUVEC and MSC-HSC constructs than those seeded with MSC alone or cell-free constructs. Volumetric analysis showed that MSC-HUVEC constructs contained 250% more microvasculature than cell-free construct and 180% more microvasculature than MSC or MSC-HSC constructs. Furthermore, neovascularization in the cell free construct was limited to the surface of the construct. The development of neovascularization from noninvasive sources constitutes an important step in the development of clinical strategies for tissue vascularization of large craniofacial defects. / Oral Biology

Congenital Adrenal Hyperplasia (CAH) describes a set of autosomal recessive diseases which affect enzymes mediating steroid biochemistry in the adrenal glands. In chromosomal females, the excess androgens associated with CAH cause virilization. Females with a high degree of virilisation can undergo feminizing genitoplasty in infancy or later in life. Parents and guardians are the medical proxies for their infants and therefore make decisions on their behalf. However, decision-making about feminizing genitoplasty can be very difficult. One tool that could help in such a situation is an electronic patient decision aid (PtDA). However, a PtDA for feminizing genitoplasty does not exist and there is insufficient information in existing literature to inform its design and development. Thus, the objectives of this study were to: (1) Identify user requirements, (2) Develop specifications for the design and development of the PtDA, and (3) Understand the best way to implement and distribute the PtDA We used the persona-scenario methodology to acquire user-requirements. Persona-scenario sessions were conducted with four parents of children with CAH, two adult patients with CAH, and four healthcare practitioners. Participants created fictitious personas, and scenarios wherein their personas interacted with an idealized version of the PtDA. Transcripts of these persona-scenarios and facilitator notes were analyzed to identify user-requirements, which were interpreted into specifications. Participants provided user requirements about (1) information and decisional content in the PtDA, (2) proposed functionalities for the PtDA, (3) web usability, and (4) implementation context. Many of these requirements are supported by existing literature. The requirements identified in this project will inform the design and development of a PtDA for feminizing genitoplasty in patients with CAH. However, further research is necessary to understand how to best implement these requirements and to ensure that the gathered information is useful for a broad range of potential end users. / Thesis / Master of Science (MSc)

Thesis (MScEng (Industrial Engineering))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: As part of a growing trend in the medical industry of patient specific solutions, a need arises for means and methods that could grant surgeons the ability to improve their pre-operative planning, and help streamline their intra-operative proceedings relative to each individual patient. A suitable solution has emerged in the form of Additive Fabrication. Most of the traditional layer manufacturing technologies have been considered to be too expensive for medical application, and could not always be justified. However, more cost effective technologies, such as 3D Printing, have recently come to the scene and definitely require a fresh re-consideration for medical applications. In this report the research results are presented that look at the applications of 3D Printing in various fields of reconstructive surgery. Based on a variety of case studies the outcome strongly suggests that 3D Printing might become part of standard protocol in medical practice in the near future. / AFRIKAANSE OPSOMMING: Tans beweeg die mediese veld al hoe meer in die rigting van pasiënt uniekheid. Dit beteken dat behandeling begin weg beweeg van standaard prosedures en soveel moontlik aagepas word om aan te pas by elke unieke pasiënt. As deel hiervan ontstaan die behoefte by chirurge om hul operasies ook beter te beplan spesifiek tot elke individu, en sodoende te verseker dat die prosedures in teater so glad moontlik verloop. Daar is reeds tegnologië in die vorm van Addidatiewe Vervaardiging wat hierdie probleem aanspreek. Tot op hede was die finansiële implikasies vir meeste van die onderskeie tegnologië ‘n struikelblok wanneer dit kom by mediese toepassings. Tog, danksy meer koste effektiewe tegnologie soos 3D Drukwerk, is dit die moeite werd om weer op nuut te kyk na die moontlikhede wat die tegnologie kan bied. In hierdie verslag word daar gekyk na die verskillende toepassings van 3D Drukwerk in die veld van rekonstruktiewe chirurgie. Op grond van die resultate verkry vanaf ‘n wye verskeidenheid gevalle studies word die gevolgtrekking gemaak dat bekostigbare tegnologie soos 3D Drukwerk ‘n baie goeie kans het om in die nabye toekoms deel te word van standaard prosedure in die mediese praktyk.

Artificial tissue expansion is required to generate new skin prior to reconstructive surgery, in order to compensate for a deficit of healthy tissue. Hydrogel tissue expanders, which expand anisotropically, show great promise in overcoming clinical limitations in the field, thus allowing the technique to be used in a wider range of surgeries. These devices consist of pellets of dry poly(methyl methacrylate-co-vinylpyrrolidone), compressed into discs through a hot compression moulding process. However, a number of significant problems still exist in these devices, and this thesis aims to address these issues. To date, there has been a lack of investigation of the factors governing the behaviour of anisotropic swelling. For this reason, a range of different compression ratios have been investigated, with particular focus on the relationship between the material flow during compression and the swelling behaviour of the resulting device. It was found that samples of the same initial size expand to the same reference swelling dimensions, regardless of compression ratio. During hot pressing, the material flow was found to be governed by slip-stick behaviour at the interface between the hot press and the device, affecting the properties and swelling behaviour of the devices. Based on these findings, devices were developed which could expand from a disc into a non-prismatic shape (dome or wedge). Such devices could reduce complication rates and allow the growth of new tissue with anisotropic resting tension. The devices were tested in a small in vivo trial, where it was shown that there were no adverse effects on the tissue produced, and that the shape of the expander (dome) was retained. As devices are being produced for medical use, understanding the effect of sterilization by γ-irradiation is essential, but to date this has been overlooked in the literature. It was found that γ-irradiation caused an increase in cross-linking in the P(MMA-co-NVP). Whilst this produced little change in swelling behaviour for isotropic devices, in the case of anisotropic devices it caused a change in the shape of expansion, reducing the area of new skin which could be generated by the device. It was found that by reducing the concentration of impurities (residual molecules from the polymer synthesis) the impact of γ-irradiation could be greatly reduced. Finally, controlling the rate of expansion is essential in order to avoid clinical complications. In order to control the rate of expansion, particularly during the initial period of swelling, semi-permeable PDMS coatings were applied to the compressed devices. Coatings of thickness greater than 0.375mm were found to effectively control the rate of swelling, for both cylindrical and non-prismatic shapes. As the coating thickness increased, the maximum swelling size decreased. However, it has been shown that change in height (the parameter which governs the area of skin produced) is affected less than the change in mass or diameter.

Magister Scientiae - MSc / The purpose of this research project was to assess the safety and efficacy of a combination of drugs for conscious sedation in patients undergoing office-based plastic and reconstructive surgery. A pilot study was done to determine the safety of the co-administration of the drugs used in the sedation technique. / South Africa