aula cirurgia estética dos membros
TRANSCRIPT
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Rio de Janeiro - RJ, 2010
R3 Romeo PohlmannServiço de Cirurgia Plástica
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Cirurgia Estética dos Membros
Braquioplastia e Lifting de Coxas
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Causas de Lipodistrofia e Ptose dos Membros
• Envelhecimento
• Genética
• Perda Ponderal Expressiva
Arquivo fotográfico do Serviço de Cirurgia Plástica do Hospital Geral de Ipanema
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Indicação de Braquioplastia e Lifting de Coxas
• Estética• Higiene corporal• Dor local (peso
excedente)• Intertrigo• Retorno à atividade
física
Arquivo fotográfico do Serviço de Cirurgia Plástica do Hospital Geral de Ipanema
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Braquioplastia
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Braquioplastia
• Aumento de 2845 % - 2000 a 2004• Causa: cirurgias bariátricas• 76 % das braquioplastias: ex-obesos
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Braquioplastia
- Primeira descrição há 79 anos:
• Thorek – 1930• Correa-Iturraspe - 1954• Pitanguy – 1975• Baroudi - 1975• Guerrero-Santos- 1979• Lipoaspiração
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Braquioplastia – Técnica de Pitanguy
Pitanguy, I. Correction of lipodystrophy of the lateral thoracic
aspect and inner side of the arm and elbow dermosenescence. Clin. Plast. Surg. 2: 477, 1975.
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Braquioplastia – Guerrero Santos
Guerro-Santos, J. Brachioplasty. Aesthetic Plast. Surg. 3: 1, 1979.
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Classificação Atual da Ptose Braquial e Tratamento
Classification of brachial ptosis: strategy for treatment. El Khatib HA. Plast Reconstr Surg. 2007 Apr 1;119(4):1337-42.
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Descrição da Técnica - Marcação
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Trans-operatório
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Trans-operatório
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Trans-operatório
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Resultados
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Resultados
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Complicações
• 25 % dos pacientes• 95 % menores: seroma, cicatriz hipertrófica,
celulite, deiscência, abscesso• 5 % maiores: lesão do nervo cutâneo
antebraquial medial (parestesia ou dor local por > 1 ano)
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Nervo Cutâneo Antebraquial Medial• Emerge através da fáscia profunda (em média 14
cm proximal ao epicôndilo medial)
• Prevenção: 1 cm de gordura residual junto à fáscia profunda
• Tratamento: fisioterapia, antidepressivo, gabapentina
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Lifting de Coxas
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Coxas• Flacidez cutânea e lipoacúmulo geralmente acometem a “face medial” da
coxa• Pele fina e pouco elástica: um dos primeiros sinais do envelhecimento
corporal ou da perda ponderal • Local mais difícil para melhorar o contorno corporal
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Classificação e Tratamento
a) Acúmulo de gordura moderado a severo (face medial da coxa)
f) Mínimo acúmulo de gordura e flacidez severa (ex-obesos)
Boa elasticidade
Pouca elasticidade
Lipoaspiração exclusiva
Lipoaspiração inicial e após 6 meses: ressecção cutânea
Ressecção cutânea exclusiva
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Ressecção Cutâneaa) Flacidez Cutânea
Restrita ao 1/3 Proximal da Coxa
g) Flacidez além do 1/3 Proximal da Coxa
INCISÃO HORIZONTAL NA VIRILHA
INCISÃO VERTICAL NA COXA
Cicatriz Vertical + Horizontal
Cicatriz Vertical Exclusiva
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Lifting de Coxas com Cicatriz Vertical Exclusiva - Marcação
Marcação: coxas fletidas e joelhos abduzidos
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Descolamento
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Sutura
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Curativos
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Liftinf com Cicatriz Horizontal e Vertical Associadas
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Resultados
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Resultados
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Complicações
• Cicatrizes: hipertróficas, mal-posicionadas, assimétricas, deiscência
• Tração vulvar• Hematoma• Seroma• Linfocele• Linforréria• Edema de membros inferiores
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Seroma
Tratamento: punções repetidas, dreno transcutaneo por 7 dias
Seroma development following body contouring surgery for massive weight loss: patient risk factors and treatment strategies.
Shermak MA, Rotellini-Coltvet LA, Chang D.
Plast Reconstr Surg. 2008 Jul;122(1):280-8.T
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Posicionamento Inadequado da Cicatriz
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Distorção da Vulva
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Considerações Finais
• “Braços e coxas de ex-obesos são áreas difíceis de serem tratadas. Os pacientes devem conhecer o tamanho e a forma das cicatrizes resultantes e saber que são a única maneira de ter um contorno corporal aceitável e agradável.”
Marking and operative techniques.
Plast Reconstr Surg. 2006 Jan;117(1 Suppl):45S-73S; discussion 82S-83S.
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Referências BibliográficasBraquioplastia
Brachioplasty and concomitant procedures after massive weight loss: a statistical analysis from a prospective registry.
Gusenoff JA, Coon D, Rubin JP.Plast Reconstr Surg. 2008 Aug;122(2):595-603.
Limited incision medial brachioplasty: technical refinements in upper arm contouring.
Trussler AP, Rohrich RJ.Plast Reconstr Surg. 2008 Jan;121(1):305-7.
Classification of brachial ptosis: strategy for treatment.El Khatib HA.Plast Reconstr Surg. 2007 Apr 1;119(4):1337-42.
Long-term outcomes and complications associated with brachioplasty: a retrospective review and cadaveric study.
Knoetgen J 3rd, Moran SL.Plast Reconstr Surg. 2006 Jun;117(7):2219-23.]
The L brachioplasty: an innovative approach to correct excess tissue of the upper arm, axilla, and lateral chest.
Hurwitz DJ, Holland SW.Plast Reconstr Surg. 2006 Feb;117(2):403-11; discussion 412-3.
A technique in brachioplasty.Mahjouri F.Plast Reconstr Surg. 2005 Aug;116(2):678-9; author reply 679-80. No abstract
available.
Minibrachioplasty: minimizing scars while maximizing results.Abramson DL.Plast Reconstr Surg. 2004 Nov;114(6):1631-4; discussion 1635-7.
A technique of brachioplasty.Strauch B, Greenspun D, Levine J, Baum T.Plast Reconstr Surg. 2004 Mar;113(3):1044-8; discussion 1049.Plast Reconstr Surg. 2006 Feb;117(2):414-30.
LIFTING DE COXAS
Single-staged total body lift after massive weight loss.
Hurwitz DJ.
Ann Plast Surg. 2004 May;52(5):435-41; discussion 441.
Medial thigh lift.
Kenkel JM, Eaves FF 3rd.
Plast Reconstr Surg. 2008 Aug;122(2):621-2. No abstract available.
Seroma development following body contouring surgery for massive weight loss: patient risk factors and treatment strategies.
Shermak MA, Rotellini-Coltvet LA, Chang D.
Plast Reconstr Surg. 2008 Jul;122(1):280-8.
New management algorithm for lymphocele following medial thigh lift.
Borud LJ, Cooper JS, Slavin SA.
Plast Reconstr Surg. 2008 Apr;121(4):1450-5. No abstract available.
Mid-body contouring in the post-bariatric surgery patient.
Strauch B, Herman C, Rohde C, Baum T.
Plast Reconstr Surg. 2006 Jun;117(7):2200-11.
Body lift: an account of 200 consecutive cases in the massive weight loss patient.
Nemerofsky RB, Oliak DA, Capella JF.