RESUMO
ABSTRACT BACKGROUND: Breast cancer is the second most frequent type of cancer worldwide and the most common type among women. The treatment for this condition has evolved over recent decades with therapeutic and technological advances. Breast reconstruction techniques using musculocutaneous flaps from the latissimus dorsi and rectus abdominis have aroused interest regarding patients' quality of life. Our goal here was to compare patients' satisfaction scores after they underwent breast reconstruction using musculocutaneous flaps from either the latissimus dorsi or the rectus abdominis. DESIGN AND SETTING: Primary, clinical, analytical, observational and cross-sectional study conducted in a federal university and a public hospital. METHODS: Demographic and clinical data were collected. The Mini-Mental State Examination was then applied, with testing for specificity and sensitivity. Lastly, a breast evaluation questionnaire was applied to evaluate breast satisfaction among 90 women, who were divided into three groups: mastectomy (control; n = 30); breast reconstruction using flap from the latissimus dorsi (n = 30); and reconstruction using flap from the rectus abdominis (n = 30). RESULTS: The groups were homogeneous regarding the main demographic data and the questionnaire responses (P < 0.05). Compared with the control group, the reconstruction groups showed significant improvement in satisfaction (P < 0.0002) after one year. CONCLUSION: Within our sample, women who underwent breast reconstruction with flaps from either the latissimus dorsi or the rectus abdominis had similar satisfaction scores.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Satisfação do Paciente , Mamoplastia/métodos , Reto do Abdome/cirurgia , Músculos Superficiais do Dorso/cirurgia , Neoplasias da Mama/cirurgia , Estudos de Casos e Controles , Estudos Transversais , Mamoplastia/psicologia , Retalho MiocutâneoRESUMO
BACKGROUND: Breast cancer is the second most frequent type of cancer worldwide and the most common type among women. The treatment for this condition has evolved over recent decades with therapeutic and technological advances. Breast reconstruction techniques using musculocutaneous flaps from the latissimus dorsi and rectus abdominis have aroused interest regarding patients' quality of life. Our goal here was to compare patients' satisfaction scores after they underwent breast reconstruction using musculocutaneous flaps from either the latissimus dorsi or the rectus abdominis. DESIGN AND SETTING: Primary, clinical, analytical, observational and cross-sectional study conducted in a federal university and a public hospital. METHODS: Demographic and clinical data were collected. The Mini-Mental State Examination was then applied, with testing for specificity and sensitivity. Lastly, a breast evaluation questionnaire was applied to evaluate breast satisfaction among 90 women, who were divided into three groups: mastectomy (control; n = 30); breast reconstruction using flap from the latissimus dorsi (n = 30); and reconstruction using flap from the rectus abdominis (n = 30). RESULTS: The groups were homogeneous regarding the main demographic data and the questionnaire responses (P < 0.05). Compared with the control group, the reconstruction groups showed significant improvement in satisfaction (P < 0.0002) after one year. CONCLUSION: Within our sample, women who underwent breast reconstruction with flaps from either the latissimus dorsi or the rectus abdominis had similar satisfaction scores.
Assuntos
Mamoplastia/métodos , Satisfação do Paciente , Reto do Abdome/cirurgia , Músculos Superficiais do Dorso/cirurgia , Adulto , Neoplasias da Mama/cirurgia , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Mamoplastia/psicologia , Pessoa de Meia-Idade , Retalho MiocutâneoRESUMO
Introdução: Após o diagnóstico e tratamento do câncer de mama, algumas mulheres passam por alterações físicas, sociais e emocionais que repercutem muitas vezes na qualidade de vida e na autoestima. O objetivo é avaliar a qualidade de vida e autoestima de pacientes mastectomizadas submetidas ou não à reconstrução mamária após um mês de cirurgia. Métodos: A casuística foi composta por 89 pacientes, com idade igual ou superior a 30 anos, submetidas ou não à reconstrução mamária, e oriundas dos ambulatórios de Cirurgia Plástica e Mastologia do Hospital São Paulo e do Hospital Pérola Byington. O grupo 1 (n = 30) composto pelas pacientes mastectomizadas sem reconstrução mamária; o grupo 2 (n = 29) mastectomizadas com reconstrução mamária; e o grupo 3 (n = 30) pacientes sem alterações nas mamas. Para a avaliação da qualidade de vida, foram aplicados os instrumentos validados para uso no Brasil EORTC QLQ-C30 e Escala de Autoestima de Rosenberg UNIFESP/EPM. Resultados: Não foram observadas repercussões na qualidade de vida e autoestima das pacientes submetidas à mastectomia com ou sem a reconstrução mamária após um mês de cirurgia. Conclusão: Mulheres mastectomizadas com ou sem reconstrução mamária após um mês da cirurgia não apresentaram repercussões na qualidade de vida e na autoestima, quando comparadas entre si, bem como comparadas às mulheres sem história de câncer. É necessário que este tipo de avaliação, por meio dos questionários EORTC QLQ-C30 e QLQ-BR23, seja realizado no momento do diagnóstico do câncer de mama até o momento da pós-reconstrução mamária, com a finalidade de identificar em que fase se instalam as repercussões na qualidade de vida e autoestima.
Introduction: After diagnosis and treatment of breast cancer, some women go through physical, social, and emotional changes that often have an impact on their quality of life and self-esteem. This study aimed to assess the quality of life and self-esteem of mastectomized patients with or without breast reconstruction a month after surgery. Methods: The study consisted of 89 patients aged ≥ 30 years with or without breast reconstruction. They were recruited from the Plastic Surgery and Mastology clinic of São Paulo Hospital and Pérola Byington Hospital. Group 1 (n = 30) consisted of mastectomized patients without breast reconstruction; group 2 (n = 29) consisted of mastectomized patients with breast reconstruction; and group 3 (n = 30) consisted of patients without changes in the breasts. The EORTC QLQ-C30 and Rosenberg Self-Esteem Scale UNIFESP/EPM instruments, which are validated in Brazil, were used to assess their quality of life. Results: There were no observed effects in the quality of life and self-esteem of the patients who underwent mastectomy with or without breast reconstruction a month after surgery. Conclusion: The women with mastectomy with or without breast reconstruction a month after surgery showed no changes in their quality of life and self-esteem when compared among themselves and to women with no cancer history. It is necessary that this assessment, employing the EORTC QLQ-C30 and QLQ-BR23 questionnaires, be performed from the time of breast cancer diagnosis until after breast reconstruction to identify the stage when the quality of life and self-esteem are affected.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , História do Século XXI , Qualidade de Vida , Autoimagem , Mama , Neoplasias da Mama , Estudos Transversais , Satisfação do Paciente , Mamoplastia , Procedimentos de Cirurgia Plástica , Estudo de Avaliação , Estudos Observacionais como Assunto , Mastectomia , Qualidade de Vida/psicologia , Mama/cirurgia , Neoplasias da Mama/cirurgia , Neoplasias da Mama/terapia , Estudos Transversais/métodos , Satisfação do Paciente/estatística & dados numéricos , Mamoplastia/métodos , Procedimentos de Cirurgia Plástica/métodos , Mastectomia/métodos , Mastectomia/psicologia , Mastectomia/estatística & dados numéricosRESUMO
INTRODUÇÃO: Pacientes submetidas à mastectomia radical, com extensa perda tecidual, necessitam de procedimento cirúrgico de fechamento rápido e simples da lesão, com boa cobertura cutânea e mínima morbidade, para que possam receber precocemente tratamentos complementares. Estudamos a eficácia e a segurança de um novo formato do retalho toracoepigástrico com o posicionamento semissentado (Fowler) da paciente durante a cirurgia. A hipótese é de que o procedimento, além de obter adequado fechamento de grandes lesões, permita garantir a sobrevivência do retalho. MÉTODOS: Foram analisadas todas as pacientes consecutivamente operadas com mastectomias radicais entre 2009 e 2014 submetidas a reconstruções torácicas. Os principais desfechos analisados foram a viabilidade do retalho e a eficácia no fechamento cirúrgico. RESULTADOS: No período do estudo, foram operadas 29 pacientes com tumor localmente avançado (90%) ou recidivado (10%), uma operada bilateralmente (30 retalhos); vinte e três (79%) com estadiamento III e seis (21%), estadiamento IV. A extensão das áreas ressecadas variou de 20 x 15 cm a 13 x 9 cm (média 15,5 x 11,6 cm). Retalho toracoepigástrico foi utilizado com dimensões variando de 25 x 12 cm a 18 x 8 cm (média de 21,3 x 10,4 cm). Houve apenas duas deiscências (7%), que cicatrizaram sem necessidade de intervenção cirúrgica, e um hematoma, drenado cirurgicamente. Uma paciente faleceu no 11º dia pós-operatório. CONCLUSÃO: O retalho toracoepigástrico foi eficaz e seguro, sem necessidade do uso de outros retalhos ou enxertos cutâneos, fechando a área doadora adequadamente em todos os casos. Todas as pacientes, excluindo o óbito, estavam aptas para o tratamento complementar após um mês.
INTRODUCTION: Patients who undergo radical mastectomy with extensive tissue loss require a surgical procedure for rapid and simple closure of the lesion, with good skin coverage and minimal morbidity, to make them eligible for early complementary treatments. We evaluated the efficacy and safety of a new format of thoracoepigastric flap with patients in the Semi-Fowler position during surgery. We hypothesized that this procedure would achieve proper closure of large lesions and ensure the survival of the flap. METHODS: All consecutive patients who underwent radical mastectomy between 2009 and 2014 and had chest wall reconstruction were evaluated. The main outcomes evaluated were the viability of the flap and effectiveness of the surgical closure. RESULTS: During the study period, we operated on 29 patients with locally advanced (90%) or recurrent tumor (10%), and one patient was operated on bilaterally (total of 30 flaps). Of the study sample, 23 patients (79%) were at stage III and 6 (21%), at stage IV. The dimensions of the resected areas varied from 20 x 15 cm to 13 x 9 cm (average 15.5 x 11.6 cm). The dimensions of the thoracoepigastric flaps varied from 25 x 12 to 18 x 8 cm (average 21.3 x 10.4 cm). There were only 2 cases of dehiscence (7%), which resolved without surgical intervention, and one case of hematoma, which was drained surgically. One patient died on the eleventh postoperative day. CONCLUSION: Thoracoepigastric flaps were effective and safe, did not require the use of other flaps or skin grafting, and adequately closed the donor areas in all cases. All patients, except the patient who died, were eligible for complementary treatment one month after surgery.
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Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , História do Século XXI , Retalhos Cirúrgicos , Tórax , Estudos Transversais , Estudos Retrospectivos , Procedimentos de Cirurgia Plástica , Procedimentos Cirúrgicos Torácicos , Estudo de Avaliação , Parede Torácica , Mastectomia , Retalhos Cirúrgicos/cirurgia , Tórax/patologia , Procedimentos de Cirurgia Plástica/métodos , Procedimentos Cirúrgicos Torácicos/métodos , Parede Torácica/cirurgia , Mastectomia/métodosRESUMO
INTRODUÇÃO: A reconstrução mamária com uso de expansores/implantes é uma das técnicas mais empregadas para tratamento das sequelas de mastectomia devido ao menor tempo cirúrgico e menor morbidade. No entanto, a manutenção da simetria com a mama contralateral a longo prazo continua a ser um grande desafio. É proposta, então, técnica de mastoplastia redutora com colocação de implante submuscular na mama contralateral de pacientes com reconstrução mamária. MÉTODOS: Foram incluídas 31 pacientes submetidas a esta técnica, cujas características principais são ressecção glandular associada à inclusão de prótese em plano subpeitoral total. Foram avaliadas as complicações e simetria de forma e volume obtida. RESULTADOS: Observou-se baixa incidência de complicações e revisões cirúrgicas, nenhum caso de perda do implante e bons resultados de simetria. CONCLUSÃO: A mastoplastia redutora com implante submuscular mostrou-se técnica segura, com bons resultados de simetria em pacientes mastectomizadas.
INTRODUCTION: Breast reconstruction with expanders/implants is one of the most common techniques used for the treatment of mastectomy-induced sequelae, due to the reduced surgical time and morbidity. However, the maintenance of long-term symmetrization in the contralateral breast remains a major challenge. The procedure of reduction mastoplasty has been developed, and is performed by positioning a submuscular implant in the contralateral breast of patients undergoing breast reconstruction. METHODS: A total of 31 patients were included in the study. Their primary characteristics were glandular resection, combined with implant insertion in the subpectoral plane. Complications, shape, symmetry, and volume were subsequently evaluated. RESULTS: A low incidence of complications and surgical revisions was observed, with no cases of implant loss. Good breast symmetry was achieved. CONCLUSION: Reduction mastoplasty with submuscular implants proved to be a safe procedure, and resulted in good breast symmetry in patients who underwent mastectomy.
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Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , História do Século XXI , Complicações Pós-Operatórias , Próteses e Implantes , Mama , Neoplasias da Mama , Dispositivos para Expansão de Tecidos , Estudos Retrospectivos , Mamoplastia , Implantes de Mama , Procedimentos de Cirurgia Plástica , Estudo de Avaliação , Glândulas Mamárias Humanas , Mastectomia , Complicações Pós-Operatórias/cirurgia , Próteses e Implantes/efeitos adversos , Próteses e Implantes/normas , Mama/cirurgia , Neoplasias da Mama/cirurgia , Dispositivos para Expansão de Tecidos/normas , Mamoplastia/efeitos adversos , Mamoplastia/métodos , Implantes de Mama/normas , Procedimentos de Cirurgia Plástica/métodos , Glândulas Mamárias Humanas/cirurgia , Mastectomia/métodosRESUMO
Introdução: A mama é símbolo de feminilidade, maternidade e sexualidade. Mamoplastia de aumento é a segunda cirurgia estética mais realizada no Brasil, e está relacionada à melhora da imagem corporal, autoestima e qualidade de vida. Sexualidade é importante componente da qualidade de vida. O quociente sexual feminino (QS-F) é questionário desenvolvido e validado que avalia sexualidade, aplicado para avaliar o impacto do tratamento na saúde sexual. Consiste em 10 questões, que avaliam quatro domínios: desejo, excitação, conforto e satisfação sexual. O objetivo é avaliar a sexualidade após mamoplastia de aumento. Métodos: 47 candidatas a aumento das mamas foram selecionadas, tratadas cirurgicamente, e responderam ao questionário QS-F no pré e no pós-operatório de 2, 4 e 18 meses. A técnica adotada foi semelhante para todas pacientes: incisão no sulco mamário, loja subglandular, implante redondo entre 260 e 325 mL. Foram formados os grupos: com ou sem relacionamento estável; e com ou sem estrias. Resultados: 45 pacientes concluíram o estudo, com idade média de 26 anos. As complicações observadas foram: simastia (1), galactorreia (1), e estrias (10). Houve melhora significante entre o escore total do QS-F no pré e no pós-operatório de 4 (p = 0,001) e 18 meses (p = 0,001), relacionado ao significante aumento da pontuação dos domínios excitação (p < 0,001) e satisfação sexual (p = 0,001). Nas pacientes que apresentaram estrias não houve melhora significante da sexualidade (p = 0,627), ao contrário das que não apresentaram (p < 0,001). Não houve diferença significante na sexualidade entre o grupo com ou sem relacionamento estável. Conclusão: A sexualidade aumentou significantemente após mamoplastia de aumento.
Introduction: The breasts are symbol of femininity, motherhood and sexuality. Breast augmentation is the second most performed cosmetic surgery in Brazil, and it is related to improvement of body image, self-esteem and quality of life. Sexuality is a significant component of quality of life. The female sexual quotient questionnaire (FS-Q) was validated as an evaluation tool for sexuality, and it is used to evaluate the impact of many treatments for sexual health. The questionnaire entails 10 questions, which assess four domains of sexuality: sexual desire, sexual arousal, comfort and sexual satisfaction. To evaluate sexuality after breast augmentation. Methods: We selected 47 patients with interest in breast enlargement. During treatment patients completed the FSQ questionnaire before and after 2, 4 and 18 months of the surgery. The surgical technique used was the same for all patients: inframammary incision, subglandular pocket, round implant, volume 260 to 325 mL. There were four groups: with or without stable relationship, and with or without striae. Results: A total of 45 patients were considered for the study. Patients' mean age was 26 years. Complications observed were: symmastia (1), galactorrhea (1), and striae distensae(10). Significant improvement was observed between the total FSQ score at preoperative, 4 months (p = 0.001), and postoperative, 18 months (p = 0.001), and also related with the significant increase in arousal scores (p < 0.001), and sexual satisfaction (p = 0.001). Patients with striae did not show significant improvement in sexuality (p=0.627), differently of patients without striae (p < 0.001). No significant difference in sexuality was seen between the group with or without stable relationship. Conclusion: Sexuality increases significantly after breast augmentation.
Assuntos
Humanos , Feminino , Adulto , História do Século XXI , Complicações Pós-Operatórias , Mama , Inquéritos e Questionários , Mamoplastia , Sexualidade , Procedimentos de Cirurgia Plástica , Glândulas Mamárias Humanas , Ferida Cirúrgica , Complicações Pós-Operatórias/cirurgia , Mama/cirurgia , Inquéritos e Questionários/normas , Mamoplastia/efeitos adversos , Mamoplastia/métodos , Procedimentos de Cirurgia Plástica/métodos , Glândulas Mamárias Humanas/cirurgia , Ferida Cirúrgica/cirurgia , Ferida Cirúrgica/terapiaRESUMO
BACKGROUND: The breasts are important for a woman's psychological well-being, which may be negatively affected by distortions of breast size and shape. Improvements in self-esteem and sexuality are important psychological factors associated with motivation for cosmetic surgery. Mammaplasty is among the most sought-after and performed cosmetic procedures. The aim of this study was to evaluate the impact of aesthetic breast surgery on a woman's sexuality. METHODS: This study was conducted in a plastic surgery clinic of a hospital university in Brazil, between 2009 and 2012. Forty-six patients with hypomastia and 30 patients with breast hypertrophy, who expressed the desire for aesthetic breast surgery, were selected for the study. The patients were assessed preoperatively and 6 months postoperatively using the sexual quotient-Female version scale (QS-F). The QS-F is a validated Brazilian questionnaire to assess sexual function. It contains ten items covering five domains of female sexual function: desire and interest, foreplay, excitement and harmony, comfort, and orgasm and satisfaction. Higher QS-F scores indicate better sexual functioning. RESULTS: There was a significant increase in the mean total QS-F score after surgery in both groups (p < 0.001). No significant improvement in desire and comfort was reported by patients who underwent breast augmentation and in comfort by patients who underwent breast reduction. Improvement in sexuality after surgery was observed in both groups, which is consistent with the literature. CONCLUSION: Aesthetic breast surgery has a positive impact on the sexuality of patients. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Mamoplastia/psicologia , Sexualidade , Adulto , Brasil , Feminino , HumanosRESUMO
BACKGROUND: Economic evaluation is important for making decisions about resource allocation. Few cost-utility or cost-effectiveness studies on breast hypertrophy have been reported in the medical literature. OBJECTIVES: The authors sought to determine the cost-utility of reduction mammaplasty in the Brazilian national health care system. METHODS: This randomized controlled study was conducted in a university-affiliated hospital. Sixty patients with breast hypertrophy were enrolled prospectively and were assigned randomly to either the control group (n = 30 patients who received follow-up for 6 months) or the treatment group (n = 30 patients who underwent reduction mammaplasty). Direct costs were recorded, and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) was administered to both groups at the beginning of the study (preoperatively for the treatment group) and 3 and 6 months postoperatively. Utility was determined with Instrument 6D of the Brazilian version of the Short-Form Health Survey (SF-6D), from the SF-36 data. RESULTS: At the 6-month follow-up, the treatment group showed an improvement in utility, with an average direct cost of approximately £104. CONCLUSIONS: Reduction mammaplasty performed in the Brazilian national health care system provides a cost-utility ratio equivalent to approximately £142 per 1 quality-adjusted life year.
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Análise Custo-Benefício/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Mamoplastia/economia , Programas Nacionais de Saúde/economia , Saúde Pública/economia , Adolescente , Adulto , Brasil , Análise Custo-Benefício/métodos , Feminino , Seguimentos , Humanos , Mamoplastia/métodos , Pessoa de Meia-Idade , Programas Nacionais de Saúde/estatística & dados numéricos , Estudos Prospectivos , Saúde Pública/estatística & dados numéricos , Qualidade de Vida , Adulto JovemRESUMO
The aim of this study was to describe concepts of health economics in order to update and provide the orthopedic practitioner decision making parameters based on preferences. Four basic types of studies of economical evaluation were presented (cost minimization analysis, cost-benefit, cost-effectiveness and cost-utility), as well as the origin, the concept, advantages and disadvantages of using QALY and utility. It was discussed the importance of costs and of SF-6D, an instrument able to get through the utility data from the Medical Outcomes Study 36-item Short Form Health Survey (SF-36). Physicians, especially orthopedic practitioners, are increasingly using technologies which are progressively expensive, thus, they should be able to understand health economics concepts, the importance of utility in clinical decision making process and economic analysis in health.09+
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Introdução: A reconstrução de mama visa melhorar a qualidade de vida das pacientes que se submeteram à mastectomia, e o uso do retalho miocutâneo transverso do abdome (TRAM) é uma opção valiosa. Objetivo: Avaliar a influência da reconstrução mamária tardia com o retalho TRAM na qualidade de vida das pacientes. Método: 30 pacientes com câncer de mama, mastectomizadas foram incluídas neste estudo transversal. 15 delas (Grupo Estudo - GE) foram submetidas à reconstrução mamária com retalho TRAM seis meses antes, e as outras 15 (Grupo Controle - GC) foram programadas para a operação. Para avaliar a qualidade de vida, foi utilizado a versão brasileira do Medical Outcomes Study 36-item Short-form Health SurveyQuestionnaire (SF-36). Os dados foram comparados estatisticamente. Resultados: Em comparação com o GC, as pacientes do GE apresentaram melhores escores do SF-36 nos domínios: aspecto social (p<0.001), saúde mental (p=0.002) e estado geral de saúde (p=0.008). Nenhuma significância estatística foi alcançada para os outros domínios do SF-36. Conclusão: A reconstrução mamária tardia com retalho TRAM tem influência positiva na qualidade de vida das pacientes.
Introduction: Breast reconstruction is intended to improve the quality of life of patients who underwent mastectomy, and the use of the Transverse Rectus Abdominis Myocutaneous (TRAM) flap is a valuable option. Objective: To assess the influence of delayed TRAM flap breast reconstruction on patient's quality of life. Methods: 30 breast cancer patients who had undergone mastectomy were enrolled in this cross-sectional study. Fifty of them (Study Group - SG) had undergone delayed TRAM flap breast reconstruction six months before, and the other 15 (Control Group) were scheduled for the operation. To assess quality of life, the Brazilian version of the Medical Outcomes Study 36-item Short-form Health Survey (SF-36) was used. Data were statistically compared. Results: Compared to CG, patients in SG had better quality of life scores for the SF-36 domains social aspect (p<0.001), mental health (p=0.002) and general health (p=0.008). No statistical significances were reached for the other SF-36 domains. Conclusion: The delayed TRAM flap breast reconstruction had a positive influence on patient's quality of life.
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , História do Século XXI , Qualidade de Vida , Mama , Estudo Comparativo , Estudos Transversais , Procedimentos de Cirurgia Plástica , Estudo de Avaliação , Glândulas Mamárias Humanas , Estudo Clínico , Mastectomia , Mama/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Glândulas Mamárias Humanas/cirurgia , Mastectomia/efeitos adversos , Mastectomia/métodosRESUMO
Seroma formation at the donor site of the transverse rectus abdominis myocutaneous flap was evaluated in 48 patients who underwent breast reconstruction with either quilting sutures and suction drains (QS+DN group) or quilting sutures alone (QS group) or suction drains alone (DN group). Clinical and ultrasound examinations were performed to assess seroma formation in 5 regions of the abdominal wall on postoperative days 7 and 14. The incidence of seroma detected by ultrasound examination was significantly higher in the DN group (P = 0.008) than that in the other 2 groups. No difference in seroma volume (puncture) was found between the QS+DN and QS groups (P = 1.00). Seroma formation was observed in the iliac region in the DN group but not in the QS+DN and QS groups (P = 0.028). Quilting sutures at the transverse rectus abdominis myocutaneous flap donor site were efficient in reducing seroma formation.
Assuntos
Mamoplastia/métodos , Retalho Miocutâneo , Complicações Pós-Operatórias/prevenção & controle , Seroma/prevenção & controle , Técnicas de Sutura , Adulto , Idoso , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Incidência , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Seroma/epidemiologia , Seroma/etiologia , Sucção , Resultado do TratamentoRESUMO
The aim of this study was to describe concepts of health economics in order to update and provide the orthopedic practitioner decision making parameters based on preferences. Four basic types of studies of economical evaluation were presented (cost minimization analysis, cost-benefit, cost-effectiveness and cost-utility), as well as the origin, the concept, advantages and disadvantages of using QALY and utility. It was discussed the importance of costs and of SF-6D, an instrument able to get through the utility data from the Medical Outcomes Study 36-item Short Form Health Survey (SF-36). Physicians, especially orthopedic practitioners, are increasingly using technologies which are progressively expensive, thus, they should be able to understand health economics concepts, the importance of utility in clinical decision making process and economic analysis in health.09+.
RESUMO
INTRODUÇÃO: O número de casos de câncer de mama vem crescendo abruptamente na população brasileira. Portanto a qualidade de vida (QV) e a autoestima são pautas importantes quando o assunto é abordado, visto que a retirada da mama pode causar grande impacto tanto psicológico como físico. Entretanto, com o avanço de técnicas cirúrgicas, a reconstrução de mama já é prática constante até mesmo no Sistema Único de Saúde (SUS). MÉTODO: Trata-se de um estudo qualitativo de caráter exploratório, que recrutou 22 voluntárias, divididas em dois grupos, de acordo com a cirurgia realizada. O grupo 1 (n = 11) foi formado por mulheres mastectomizadas e o grupo 2 (n = 11), por mulheres pós-reconstrução da mama. As voluntárias dos dois grupos responderam aos questionários de Rosenberg UNIFESP/EPM, EORTC QLQ-C30 e EVA. RESULTADOS: Os resultados sugerem que, em relação à qualidade de vida, quando se observa a função emocional, as voluntárias do grupo 1 apresentam pior média em relação ao grupo 2. Em relação à autoestima, não foi observada diferença estatisticamente significante entre os dois grupos; porém, quando considerada a idade, os resultados apresentam diferenças estatisticamente significantes. Quanto ao nível de dor, os grupos não apresentaram diferença estatisticamente significante. CONCLUSÕES: Os resultados obtidos revelam que mulheres que ainda não passaram pela reconstrução mamária possuem maior fragilidade emocional, porém novos estudos devem ser realizados para obtenção de valores estatisticamente mais relevantes.
BACKGROUND: The number of breast cancer cases has sharply increased in the Brazilian population. Therefore, quality of life (QOL) and self-esteem (SE) are major causes of concern since removal of the breast can have substantial psychological and physical impacts. With the advancement of surgical techniques, however, breast reconstruction has become a standard procedure, even in the Brazilian Public Health System. METHODS: In this exploratory qualitative study, 22 recruited volunteers were divided into 2 groups: Group 1 (n = 11) consisted of women who underwent mastectomy, whereas Group 2 (n = 11) comprised women who underwent mastectomy plus breast reconstruction. All subjects completed the Rosenberg Universidade Federal de Sao Paulo/Escola Paulista de Medicina, European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30, and Visual Analogue Scale questionnaires. RESULTS: Group 1 subjects had a lower average emotional function than Group 2 subjects. No statistically significant difference between the two groups was observed in the SE; however, statistically significant differences were noted according to age. No differences in pain level were seen between groups . CONCLUSIONS: Women who did not undergo breast reconstruction were more emotionally fragile; however, further studies are required in an effort to obtain more statistically relevant values.
Assuntos
Humanos , Feminino , Sintomas Afetivos , Neoplasias da Mama , Mastectomia , Mama/cirurgia , Avaliação de Processos e Resultados em Cuidados de Saúde , Qualidade de Vida , Procedimentos de Cirurgia Plástica , Afeto , Métodos , PacientesRESUMO
BACKGROUND: Sexual dysfunction is a medical condition that can lead to relationship issues as well as depression and has a somatoform basis. It is estimated to affect 49 % of Brazilian women. Studies have shown that both cancer diagnosis and its surgical treatment (mastectomy) affect women psychologically and can lead to psychiatric disorders. The aim of this study was to evaluate and compare sexuality in women who underwent mastectomy alone with those who underwent breast reconstruction after mastectomy. METHOD: This descriptive transversal study analyzed two groups of patients, one with 17 women after mastectomy alone and another with 19 women who underwent breast reconstruction post mastectomy. The patients ranged in age from 18 to 60 years old. The exclusion criteria were illiteracy; ongoing chemotherapy, radiotherapy, or psychiatric treatment; or if any surgery had been performed the previous year. All patients were from the Gynecology and Plastic Surgery Department of the Federal University of São Paulo. They voluntarily answered the FSFI (Female Sexual Function Index) questionnaire. Statistical analyses were performed using Student's t test and Pearson's coefficient, and the significance level used was p < 0.05. RESULTS: Data showed a lower FSFI score for the mastectomy-alone group compared to the breast reconstruction group (median = 10.15 ± 2.636 and 22.44 ± 3.055, respectively; p = 0.0057). There was no relationship established between the scores and postoperative time (post, p = 0.9382; pre, p = 0.2142) or between scores and remuneration income (post, p = 0.7699; pre, p = 0.5245), stable relationship (post, p = 0.2613; pre, p = 0.5245), and age (post, p = 0.3951; pre, p = 0.8427) for both groups. Mean age has shown no significant difference (p = 0.4740; median post = 47.71 ± 2.012; medina pre = 46.69 ± 1.809). CONCLUSION: An improvement in sexual function has been observed in patients who underwent breast reconstruction after mastectomy, probably as a result of better self-esteem as well as body image, both of which are affected by a mastectomy. The aesthetic results were evaluated using a questionnaire, and all the patients answered positively. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Assuntos
Mamoplastia , Mastectomia , Comportamento Sexual , Adulto , Neoplasias da Mama/psicologia , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mamoplastia/psicologia , Mastectomia/psicologia , Pessoa de Meia-Idade , Período Pós-Operatório , SexualidadeRESUMO
Introdução: O mini-lifting modificado se baseia em uma técnica padronizada, que consiste em um descolamento mínimo demarcado no pré-operatório. A plicatura do sistema músculo-aponeurótico superficial (SMAS) é realizada tracionando-se todos os tecidos da face, a fim de promover o seu rejuvenescimento com a manutenção de um retalho que apresenta menor risco de necrose por ter menor descolamento e, por isso, uma mínima área para formação de hematomas. Método: Foram operadas 36 pacientes submetidas a ritidoplastia pela técnica do mini-lifting modificado, que preencheram critérios pré-estabelecidos. Foram coletados os dados antropométricos e um interrogatório sobre a história clínica do paciente realizado. Resultados: No período de fevereiro de 2008 a março de 2009, foram operadas consecutivamente 36 pacientes pela técnica de mini-lifting modificado. A idade variou entre 44 e 67 anos, sendo a média de 57 anos. O retorno das pacientes às atividades habituais variou de 7 a 14 dias, período que coincide com a redução em mais de 80% do edema pós-operatório. O dreno a vácuo foi retirado na manhã seguinte em 34 (94,4%) pacientes, no 2º dia pós-operatório em 1 (2,94%) caso e houve 1 (2,94%) caso de hematoma pós-operatório. Não houve caso de necrose do retalho. Houve 1 (2,94%) caso de neuropraxia do facial, que foi resolvida espontaneamente. Conclusão: A técnica de mini-lifting modificado foi considerada satisfatória, por apresentar bons resultados, baixo índice de complicações e retorno precoce das pacientes às suas atividades.
Introduction: The modified mini-face lift is based on a standardized tecnic consisting of a minimum undermining marked preoperatively. The plication of the muscle-aponeurotic superficial (SMAS) is done pulling all the tissues of the face, promoting facial rejuvenation with the maintenance of a flap with a lower risk of necrosis by maintaining smaller undermining area and minimum area for hematomas. Methods: We operated on 36 patients under going rhytidectomy technique of modified mini-lifting as they fulfilled the some criteria. Anthropometric data were collected, a questionnaire about the patients history wasper formed. Results: From February 2008 to March 2009, 36 patients were consecutively operated by the modified mini-facelift technique. The age ranged from 44 to 67 years, with a mean 57 anos. The patients return to normal activities ranged from 7 to 14 days, a period that coincides with a reduction in more than 80% of post operative edema. The vacuum drain was removed the next morning (1st day after surgery) in 34 patients (94.4%), the 2nd post operative day in 1 (2.94%) case and in 1 (2.94%) case of post operative hematoma. There were no cases of necrosis of the flap. There was 1 (2.94%) neuropraxia facial which was resolved spontaneously. Conclusion: The technique of modified mini-lifting is satisfactory for presenting good results, low complication rate and early return of patients to their activities.
Assuntos
Humanos , Feminino , Adulto , Face/cirurgia , Hematoma , Necrose , Ritidoplastia , Retalhos Cirúrgicos , Técnicas e Procedimentos Diagnósticos , Métodos , Pacientes , Complicações Pós-Operatórias , Rejuvenescimento , Cirurgia PlásticaRESUMO
To evaluate the improvement of quality of life and self-esteem of the patient as a result of Breast Augmentation and retropeitoral subglandular. Method: Forty women with hypomastia aged between 18 and 43 years were selected consecutively from a waiting list and randomly allocated into two groups. For the evaluation of health utilizes the widely used instrument "The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36)", and "Rosenberg SLF-esteem Scale, a tool specifically for the assessment of self-esteem . Evaluations were performed preoperatively and on the second and fourth postoperative months. Results: We observed significant improvements in five of eight aspects of the SF-36 and self-esteem after two and four months of surgery, but no diferança between groups and retropeitoral subglandular. Conclusion: Breast Augmentation promoted a significant increase in quality of life and self-esteem of patients, with no difference in the positioning of the prosthesis.
Avaliar a melhoria da qualidade de vida e autoestima do paciente como resultado da mastoplastia de aumento retropeitoral e subglandular. Método: quarenta mulheres com hipomastia com idade entre 18 e 43 anos foram selecionadas consecutivamente a partir de uma lista de espera e distribuídas aleatoriamente em dois grupos. Para a avaliação de saúde, empregou-se o instrumento amplamente utilizado The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), e Rosenberg Slf-esteem Scale, uma ferramenta específica para a avaliação de autoestima. As avaliações foram realizadas no pré-operatório e no segundo e quarto meses pós-operatórios. Resultados: Foram observadas melhorias significativas em cinco de oito aspectos avaliados pelo SF-36 e na autoestima após dois e quatro meses da cirurgia, mas não houve diferança entre os grupos retropeitoral e subglandular. Conclusão: A mastoplastia de aumento promoveu importante incremento na qualidade de vida e autoestima das pacientes, não havendo diferença em relação ao posicionamento das próteses.
Assuntos
Humanos , Feminino , Autoimagem , Mamoplastia/psicologia , Neoplasias da Mama/psicologia , Implantes de Mama , Qualidade de VidaRESUMO
The purpose of this study was to determine the effect of low-frequency (2 Hz) transcutaneous electrical nerve stimulation (TENS) on the viability of ischemic skin flaps in the rat. Seventy-five EPM1-Wistar rats were used. The random skin flap measuring 10 x 4 cm was raised and a plastic barrier was placed between the flap and its bed. After the surgical procedure, animals in all groups were kept anesthetized for 1 hour, with electrodes placed at the base of the flap, and received the assigned treatment. The animals were randomized into five groups (G1-G5) and each group was subjected to the following procedures, which were repeated on the 2 subsequent days: G1-sham stimulation (control); G2-transcutaneous electrical nerve stimulation, TENS (f=2 Hz, I=5 mA), G3-TENS (f=2 Hz, I=10 mA), G4-TENS (f=2 Hz, I=15 mA), G5-TENS (f=2 Hz, I=20 mA). Seven days after treatment, the percentage of flap necrosis was determined. For each group, the mean+/-SEM percentage of flap necrosis was as follows: G1 group (control), 43.88+/-2.02%; G2 group, 39.20+/-3.17%; G3 group, 38.57+/-4.08%; G4 group, 32.14+/-2.89%; and G5 group, 44.13+/-2.98%. The G4 group had the smallest necrotic area compared with the control group. The low-frequency TENS treatment was effective in improving the viability of ischemic skin flap.
Assuntos
Isquemia/terapia , Pele/irrigação sanguínea , Retalhos Cirúrgicos/irrigação sanguínea , Estimulação Elétrica Nervosa Transcutânea , Animais , Modelos Animais de Doenças , Masculino , Ratos , Ratos Wistar , Sobrevivência de Tecidos/efeitos da radiaçãoRESUMO
PURPOSE: To determine the effect of high frequency Transcutaneous Electrical Nerve Stimulation (TENS) on viability of random skin flap in rats. METHODS: The sample of this study was 75 Wistar rats. The skin flap measured 10 x 4 cm and a plastic barrier was interposed between the flap and donor site. After the operative procedure, animals of all groups were maintained anesthetized one more hour with electrodes positioned in the base of the flap and submitted to treatment according of their respective group. This procedure was repeated on the two subsequent days. G1: sham stimulation (control), G2: TENS (f = 80 Hz and I = 5 mA), G3: TENS (f = 80 Hz and I = 10 mA), G4: TENS (f = 80 Hz and I = 15 mA), G5: TENS (f = 80 Hz and I = 20 mA). RESULTS: The average percentage of necrotic area was 43,11, 34,65, 49,44, 23,52, 45,10 in groups 1, 2, 3, 4 and 5 respectively. CONCLUSION: The amplitude of 15 mA presented a lower necrotic area than control group and Transcutaneous Electrical Nerve Stimulation was efficient in increasing the random skin flap viability.
Assuntos
Sobrevivência de Enxerto/fisiologia , Retalhos Cirúrgicos , Estimulação Elétrica Nervosa Transcutânea , Análise de Variância , Animais , Masculino , Modelos Animais , Necrose , Ratos , Ratos Wistar , Retalhos Cirúrgicos/irrigação sanguínea , Retalhos Cirúrgicos/patologiaRESUMO
OBJETIVO: Avaliar o efeito da Estimulação Elétrica Nervosa Transcutânea (TENS) em alta freqüência na viabilidade do retalho cutâneo randômico em ratos. MÉTODOS: Foram utilizados 75 ratos da linhagem Wistar. O retalho cutâneo apresentava 10 x 4 cm, sendo que entre o mesmo e a área doadora foi realizada a interposição de uma barreira plástica. Após o procedimento operatório todos os animais permaneceram anestesiados por mais uma hora com os eletrodos posicionados na base do retalho e submetidos ao tratamento de acordo com seus respectivos grupos. Este procedimento se repetiu nos outros dois dias subseqüentes. G1: simulação da TENS, G2: TENS (f = 80 Hz e I = 5 mA), G3: TENS (f = 80 Hz e I = 10 mA), G4: TENS (f = 80 Hz e I = 15 mA), G5: TENS (f = 80 Hz e I = 20 mA). RESULTADOS: A porcentagem média de área de necrose foi de 43,11, 34,65, 49,44, 23,52, 45,10 nos grupos 1, 2, 3, 4 e 5 respectivamente. CONCLUSÃO: Os animais estimulados com amplitude de 15 mA apresentaram menor área de necrose quando comparados ao grupo controle e a Estimulação Elétrica Nervosa Transcutânea foi eficiente no aumento de viabilidade do retalho cutâneo randômico em ratos.(AU)
PURPOSE: To determine the effect of high frequency Transcutaneous Electrical Nerve Stimulation (TENS) on viability of random skin flap in rats. METHODS: The sample of this study was 75 Wistar rats. The skin flap measured 10 x 4 cm and a plastic barrier was interposed between the flap and donor site. After the operative procedure, animals of all groups were maintained anesthetized one more hour with electrodes positioned in the base of the flap and submitted to treatment according of their respective group. This procedure was repeated on the two subsequent days. G1: sham stimulation (control), G2: TENS (f = 80 Hz and I = 5 mA), G3: TENS (f = 80 Hz and I = 10 mA), G4: TENS (f = 80 Hz and I = 15 mA), G5: TENS (f = 80 Hz and I = 20 mA). RESULTS: The average percentage of necrotic area was 43,11, 34,65, 49,44, 23,52, 45,10 in groups 1, 2, 3, 4 and 5 respectively. CONCLUSION: The amplitude of 15 mA presented a lower necrotic area than control group and Transcutaneous Electrical Nerve Stimulation was efficient in increasing the random skin flap viability.(AU)
Assuntos
Animais , Estimulação Elétrica Nervosa Transcutânea/efeitos adversos , Estimulação Elétrica Nervosa Transcutânea/métodos , Retalhos Cirúrgicos/efeitos adversos , Retalhos Cirúrgicos/veterinária , Ratos Wistar , Sobrevivência de Tecidos/fisiologiaRESUMO
OBJETIVO: Avaliar o efeito da Estimulação Elétrica Nervosa Transcutânea (TENS) em alta freqüência na viabilidade do retalho cutâneo randômico em ratos. MÉTODOS: Foram utilizados 75 ratos da linhagem Wistar. O retalho cutâneo apresentava 10 x 4 cm, sendo que entre o mesmo e a área doadora foi realizada a interposição de uma barreira plástica. Após o procedimento operatório todos os animais permaneceram anestesiados por mais uma hora com os eletrodos posicionados na base do retalho e submetidos ao tratamento de acordo com seus respectivos grupos. Este procedimento se repetiu nos outros dois dias subseqüentes. G1: simulação da TENS, G2: TENS (f = 80 Hz e I = 5 mA), G3: TENS (f = 80 Hz e I = 10 mA), G4: TENS (f = 80 Hz e I = 15 mA), G5: TENS (f = 80 Hz e I = 20 mA). RESULTADOS: A porcentagem média de área de necrose foi de 43,11, 34,65, 49,44, 23,52, 45,10 nos grupos 1, 2, 3, 4 e 5 respectivamente. CONCLUSÃO: Os animais estimulados com amplitude de 15 mA apresentaram menor área de necrose quando comparados ao grupo controle e a Estimulação Elétrica Nervosa Transcutânea foi eficiente no aumento de viabilidade do retalho cutâneo randômico em ratos.