Publications by authors named "Lydia Masako Ferreira"

355 Publications

Patient-Reported Outcomes after Subpectoral Breast Augmentation with Microtextured or Macrotextured Implants Using the BREAST-Q.

Arch Plast Surg 2022 May 27;49(3):352-359. Epub 2022 May 27.

Division of Plastic Surgery, Department of Surgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.

 Breast augmentation with implants is the most commonly performed cosmetic plastic surgery in Brazil and worldwide. The aim of this study was to assess patient satisfaction and quality of life following subpectoral breast augmentation with either microtextured or macrotextured implants, using the BREAST-Q.  A prospective study was conducted with 40 women with hypomastia undergoing subpectoral breast augmentation. The patients were randomly allocated to two groups to receive either microtextured or macrotextured breast implants. All participants were assessed preoperatively (baseline) and after 2 and 4 months of surgery for quality of life and patient satisfaction with the surgical results, using the BREAST-Q augmentation module, a patient-reported outcome measure.  The patients had a mean age of 28.9 ± 6.45 years. The microtextured (  = 20) and macrotextured (  = 20) groups were homogeneous for sex, age, education level, marital status, and number of children (  > 0.05). Both groups showed significant improvement in satisfaction with breasts (  < 0.001), psychosocial well-being (  < 0.001), and sexual well-being (  < 0.001) at the 2- and 4-month follow-up visits compared with baseline. The observed improvements were associated with high effect size values of 5.09, 3.44, and 3.90, respectively. In contrast, significant decreases from baseline in physical well-being scores (  = 0.001) were found 2 and 4 weeks after surgery in both groups.  Subpectoral breast augmentation with either microtextured or macrotextured breast implants improved satisfaction with breasts and quality of life in patients with hypomastia.
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http://dx.doi.org/10.1055/s-0042-1748649DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9142250PMC
May 2022

Do Abdominal Binders Prevent Seroma Formation and Recurrent Diastasis Following Abdominoplasty?

Aesthet Surg J 2022 Jul 13. Epub 2022 Jul 13.

Division of Plastic Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.

Background: For decades, the postoperative wearing of abdominal binders has been suggested to reduce dead space and prevent mobilization of the musculoaponeurotic layer, as an attempt to decrease the risk of seroma formation and recurrent diastasis.

Objectives: The study sought to evaluate whether the postoperative wearing of an abdominal binder provides any additional contribution to the reduction of either seroma formation or recurrent diastasis recti when abdominoplasty is performed with the use of quilting sutures.

Methods: Thirty-four women undergoing abdominoplasty were randomized into 2 groups: the binder group (n = 16) wore abdominal binders, and the control group (n = 18) did not wear abdominal binders during the postoperative period. Ultrasound examination was performed on postoperative days 7 and 14 to assess seroma formation and at 6 months postoperatively to assess recurrence of diastasis recti. Student's t-test for independent samples was applied to compare means between two numerical variables. Generalized Estimation Equation models were used to evaluate the seroma volume at different timepoints for the different groups.

Results: No significant differences in seroma volume were found between groups on postoperative days 7 (p = 0.830) and 14 (p = 0.882). Four and 3 cases of subclinical recurrent diastasis were observed by ultrasound examination in the supraumbilical and infraumbilical regions, respectively, but without significant differences (p = 1.000) between groups. Recurrent diastasis was not detected during physical examinations.

Conclusions: The postoperative wearing of abdominal binders was neither effective in preventing seroma formation nor recurrent diastasis following abdominoplasty with quilting sutures.
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http://dx.doi.org/10.1093/asj/sjac194DOI Listing
July 2022

Translation and cross-cultural adaptation of the Brazilian version of BREAST-Q©: breast reconstruction expectations module.

Rev Assoc Med Bras (1992) 2022 Apr;68(4):498-501

Universidade Federal de São Paulo, Translational Surgery Graduate Program - São Paulo (SP), Brazil.

Objective: This study aimed to translate the BREAST-Q© - Breast Reconstruction Expectations Module (preoperative) 2.0 into Portuguese and adapt it to the Brazilian cultural context.

Methods: Authorization for translation and cross-cultural adaptation of the questionnaire was obtained from the holders of the instrument's distribution rights. The questionnaire was translated and retro-translated. For cultural adaptation, the instrument was applied to 40 patients who had breast reconstruction surgery scheduled. Cronbach's alpha was used to assess the internal consistency.

Results: The mean age of the patients was 53.5 years, and the majority (72.5%) was undergoing reconstruction with implants. Good and excellent internal consistencies were observed for the Coping and Appearance expectations scales (Cronbach's alpha values of 0.878 and 0.909, respectively). For the Pain scale, the internal consistency was moderate (0.738), and it was acceptable (0.587) for the Medical team.

Conclusion: The BREAST-Q© - Breast Reconstruction Expectations Module (preoperative) 2.0 was successfully translated and adapted to the Brazilian context.
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http://dx.doi.org/10.1590/1806-9282.20211095DOI Listing
April 2022

Antibiotic Prophylaxis in Reduction Mammaplasty: A National Survey.

Aesthetic Plast Surg 2022 May 10. Epub 2022 May 10.

Translational Surgery Graduate Program, Universidade Federal de Sao Paulo, Rua Botucatu, 740, 2º andar. Vila Clementino, São Paulo, SP, Brazil.

Background: Although there is limited evidence for regulating the use of prophylactic antibiotics in reduction mammaplasty, many plastic surgeons prescribe them, even in the postoperative period. This study aimed to conduct a national survey to investigate the antibiotic prophylaxis protocols followed by Brazilian plastic surgeons in reduction mammaplasty.

Methods: An anonymous survey comprising 19 questions was sent to all 4864 active members of the Brazilian Society of Plastic Surgery (SBCP). The surgeons electronically received the invitation to participate in the survey and the link to fill out the electronic form.

Results: In total, 859 surgeons (17.7%) responded. Most respondents (77.8%) were men and aged 35-55 years (61.5%); 58.6% of them had 10-29 years of specialty training. Only a minor proportion of the respondents (0.5%) reported not prescribing antibiotics at any time (95% confidence interval [CI]: 0.0-0.9), 9.9% (95% CI: 7.9-11.9) prescribed them only preoperatively, and 14.6% (95% CI: 12.2-16.9) prescribed continued antibiotic use for 24 h. The majority of the respondents (75.1%; 95% CI: 72.1-77.9) prescribed antibiotics for additional days after discharge. There were significant associations between antibiotic prescription and the surgeons' age group (p = 0.015), time since graduation (p < 0.001), experience in the specialty practice (p = 0.003), SBCP membership (p < 0.001), and surgical site infection rates (p = 0.011).

Conclusion: Most responding plastic surgeons affirmed that they prescribed prophylactic antibiotics for more than 24 h in reduction mammaplasty cases.

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 .
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http://dx.doi.org/10.1007/s00266-022-02903-wDOI Listing
May 2022

A Variation of the Components' Separation Technique that Preserves the Semilunaris for Treatment of Abdominal Wall Deformities.

Indian J Plast Surg 2022 Feb 1;55(1):92-96. Epub 2021 Oct 1.

Department of Surgery, Division of Plastic Surgery of the Federal University of São Paulo, São Paulo, Brazil.

The variation of the components' separation technique, which uses the anterior rectus sheath and the release of the oblique muscles, proved to be effective in tension reduction. This paper aimed to present the initial experience using a variation that preserves semilunaris through the incision of the lateral aspect of the rectus sheath. All of the 12 patients presented an abdominal wall defect that included incisional hernia, peritoneostomy, lateral implantation of the rectus muscle, and defect secondary to TRAM flap. The separation was done in the following stages: stage 1-anterior rectus sheath and stage 2-external oblique muscles. From the 12 patients, three presented early complications: seroma (  = 2) and epitheliolysis (  = 1). There were no recurrences or other late complications (48 months follow-up period). The separation of the anterior rectus sheath, and incision in the lateral recess to undermine the oblique muscles, allowed the treatment of abdominal wall defects, without late complications.
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http://dx.doi.org/10.1055/s-0041-1735419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9015824PMC
February 2022

Changes in the Pattern of Superficial Lymphatic Drainage of the Abdomen after Abdominoplasty.

Plast Reconstr Surg 2022 06 5;149(6):1106e-1113e. Epub 2022 Apr 5.

From the Division of Plastic Surgery, Federal University of São Paulo; and Department of Physical Therapy, Federal University of São Carlos.

Background: The changes in the pattern of lymphatic drainage of the superficial abdominal wall after abdominoplasty are still unknown. These changes may increase the risk of numerous complications, including seroma formation. Depending on the alterations, the manual lymphatic drainage technique should be modified in postoperative patients. The aim of this study was to map the pattern of lymphatic drainage of the superficial infraumbilical abdominal wall after abdominoplasty.

Methods: Twenty women with indications for abdominoplasty were selected in the Plastic Surgery Division of the Federal University of São Paulo. Intradermal lymphoscintigraphy with dextran 500-99m-technetium was performed in 20 female patients in the preoperative phase and 1 and 6 months after abdominoplasty to evaluate superficial lymphatic drainage of the abdominal wall.

Results: Before surgery, all patients presented with abdominal lymphatic drainage toward the inguinal lymph nodes. One and 6 months after abdominoplasty, only 15 percent exhibited the same drainage pathway. Drainage toward the axillary lymph node chain occurred in 65 percent of the patients, 10 percent displayed a drainage pathway toward both the axillary and inguinal lymph nodes, and lymphatic drainage was indeterminate in 10 percent of the cases.

Conclusions: A significant change in lymphatic drainage pathway occurred in the infraumbilical region after abdominoplasty. The axillary drainage path was predominant after the operation, in contrast to the inguinal path observed in the preoperative period. However, 35 percent of cases exhibited alternative drainage. No significant changes were documented between 1 and 6 months postoperatively.

Clinical Question/level Of Evidence: Therapeutic, IV.
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http://dx.doi.org/10.1097/PRS.0000000000009114DOI Listing
June 2022

Fat obtained from plastic surgery procedures-stem cells derived from adipose tissue and their potential in technological innovation: a narrative literature review and perspective on dissociative methods.

Eur J Plast Surg 2022 Mar 11:1-31. Epub 2022 Mar 11.

Plastic Surgery Division at Universidade Federal de São Paulo (Unifesp), São Paulo, SP Brazil.

Background: Throughout its illustrious history, plastic surgery has searched for novel regenerative therapies and procedures. Recently, interest has emerged in using adipose tissue-derived stem cells (ASCs) in an ethical, easy, and reproducible manner. ASCs are generally not administered alone but as a constituent of the stromal vascular fraction (SVF) in clinical practice. Herein, we searched for innovative fat collection and ASC isolation technologies and applications and evaluated each study's relevance to plastic surgery.

Methods: A narrative literature review was carried out using the MEDLINE/PubMed databases. Studies published from January 1993 to August 2020 and written in English, Portuguese, or Spanish were considered.

Results: The selection process yielded 33 articles for subsequent review, involving exploratory, selective, and interpretive reading, material choice, and text analysis. Twenty-three articles employed enzymatic dissociation methods to isolate ASCs, and 25 employed liposuction as the plastic surgery technique. Moreover, articles describing new devices ( = 2), techniques ( = 4), computational models ( = 1), tissue scaffolds ( = 21), and therapies and/or treatments ( = 5) were identified.

Conclusions: Given the importance of fat tissue for plastic surgery purposes, innovative ASC isolation and liposuction technologies could change how the surgeon conducts surgeries and improve surgical outcomes. Furthermore, many articles investigating tissue scaffolds demonstrate the importance of this area of research and development in plastic surgery and regenerative medicine. Continued efforts in the identified research areas will eventually bring in vivo human plastic surgery applications and regenerative medicine into the operating room. Level of evidence: Not gradable.
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http://dx.doi.org/10.1007/s00238-022-01951-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8916487PMC
March 2022

Technique for Obtaining Mesenchymal Stem Cell from Adipose Tissue and Stromal Vascular Fraction Characterization in Long-Term Cryopreservation.

J Vis Exp 2021 12 30(178). Epub 2021 Dec 30.

Genetics Division, Universidade Federal de São Paulo (UNIFESP);

Human mesenchymal stem cells derived from adipose tissue have become increasingly attractive as they show appropriate features and are an accessible source for regenerative clinical applications. Different protocols have been used to obtain adipose-derived stem cells. This article describes different steps of an improved time-saving protocol to obtain a more significant amount of ADSC, showing how to cryopreserve and thaw ADSC to obtain viable cells for culture expansion. One hundred milliliters of lipoaspirate were collected, using a 26 cm three-hole and 3 mm caliber syringe liposuction, from the abdominal area of nine patients who subsequently underwent elective abdominoplasty. The stem cells isolation was carried out with a series of washes with Dulbecco's Phosphate Buffered Saline (DPBS) solution supplemented with calcium and the use of collagenase. Stromal Vascular Fraction (SVF) cells were cryopreserved, and their viability was checked by immunophenotyping. The SVF cellular yield was 15.7 x 10 cells/mL, ranging between 6.1-26.2 cells/mL. Adherent SVF cells reached confluence after an average of 7.5 (±4.5) days, with an average cellular yield of 12.3 (± 5.7) x 10 cells/mL. The viability of thawed SVF after 8 months, 1 year, and 2 years ranged between 23.06%-72.34% with an average of 47.7% (±24.64) with the lowest viability correlating with cases of two-year freezing. The use of DPBS solution supplemented with calcium and bag resting times for fat precipitation with a shorter time of collagenase digestion resulted in an increased stem cell final cellular yield. The detailed procedure for obtaining high yields of viable stem cells was more efficient regarding time and cellular yield than the techniques from previous studies. Even after a long period of cryopreservation, viable ADSC cells were found in the SVF.
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http://dx.doi.org/10.3791/63036DOI Listing
December 2021

Rhinogoniometer: Validation of an Instrument for Rhinoplasty.

Plast Reconstr Surg 2021 Dec;148(6):1264-1269

From the Postgraduate Program in Translational Surgery, Federal University of São Paulo; and State University of Ponta Grossa.

Summary: The position of the lower lateral cartilages is directly related to good nasal functionality. When these cartilages exhibit cephalic malposition, the angle of divergence between cartilages is usually less than 60 degrees, which can cause external nasal valve insufficiency. The objective of this study was to validate the rhinogoniometer, an innovative surgical instrument that allows for diagnosing the position of this cartilage intraoperatively. In the intraoperative period, the angle of divergence, which is the angle formed between the two lateral branches of the lower lateral cartilages, was measured in 31 primary rhinoplasty patients. The rhinogoniometer measurement was compared with that of the computerized analysis, and the reproducibility of measurements with the rhinogoniometer between two different surgeons was determined. When comparing the values obtained by the two methods, a significant difference was found (p = 0.034). On average, the angles measured by the rhinogoniometer were 3.7 degrees smaller than the measurements made by the software. It was observed that when the angles measured by both methods were above 75 degrees, the differences between the two measurements were higher (p = 0.022). However, for angles up to 75 degrees, the measurement using the rhinogoniometer was, on average, 0.79 degrees higher than the measurement taken by the software. When the difference in angles obtained by the two methods between different surgeons was evaluated, there was a significant difference (p < 0.023). In conclusion, at angles up to 75 degrees, the rhinogoniometer showed a negligible difference of 0.79 degrees higher than the measurement obtained via software. Measurements with the rhinogoniometer were also shown to be reproducible with different surgeons.
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http://dx.doi.org/10.1097/PRS.0000000000008587DOI Listing
December 2021

Predicting mortality for critically ill burns patients, using the Abbreviated Burn Severity Index and Simplified Acute Physiology Score 3.

Injury 2022 Feb 15;53(2):453-456. Epub 2021 Nov 15.

Discipline of Plastic Surgery, Surgery Department, (UNIFESP/EPM), Rua Botucatu, 740 - 2th floor, Sao Paulo, SP, Brazil.

Introduction: Reviewing the profile of patients admitted at the Burns Intensive Care Unit at São Paulo Hospital - UNIFESP, as well as the available literature, it becomes evident the need for tools able to predict those patients' outcomes. Distinct score models are used in different health centers, not only as prognostic models, but also as research and quality control tools. Amongst these prognostic scores, there are two strands, the burns specific scores - which consider the injury's characteristics - and the general critical patient's scores.

Objective: This study aims to analyze the differences and tendencies in mortality prediction of two broadly used scores when applied to São Paulo Hospital's Burns Intensive Care Unit patients, ABSI - burns specific score - and SAPS 3 - general score for critical patients.

Methods: This is an individual, observational, retrospective and comparative study, developed with medical records review. Both scores were applied to every patient admitted at São Paulo Hospital's Burns Intensive Care Unit from 2011 to 2016. Statistical analyses used the non-parametric test of Kolmogorov-Smirnov, a p-value <0.05 was considered significant.

Results: 122 patients were included, the average age was 34,4 years old. 70,5% of patients were male and 49% had a total body surface area burned of 20%. 27% of the patients died. Statistical analyses do not show significant differences between ABSI and SAPS3 mortality predictions for burns patients at this health center.

Conclusion: The study evidences that SAPS 3 score, frequently used at general Intensive Care Units, has a similar performance to ABSI score, which is specific for burns populations. ABSI score is easier to implement, as it is simpler and able to show instant results.
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http://dx.doi.org/10.1016/j.injury.2021.11.027DOI Listing
February 2022

Publications, by different surgical specialties, on patient-reported outcomes of oncoplastic surgery.

Rev Assoc Med Bras (1992) 2021 Jul;67(7):1069-1074

Universidade Federal de São Paulo, Escola Paulista de Medicina, Translational Surgery Graduate Program - São Paulo (SP), Brazil.

Objective: This study aimed to compare the publications authored by plastic surgeons with those from other specialties' surgeons on patient-reported outcomes of oncoplastic surgery.

Methods: A review was carried out on the Medline database, emcompassing five years (2015-2020). Studies about partial breast reconstruction after conservative treatment, immediate or delayed, by any technique, which presented patient-reported outcomes, were included.

Results: We found 292 articles, from which 142 met the eligibility criteria. Publications were stratified into groups 1 (plastic surgeons) and 2 (other surgical specialties), and also into groups A (only plastic surgeons), B (only other specialties) and C (both), and compared statistically. Most publications (60.6%) were attributed to specialties other than plastic surgery. Nineteen percent had only plastic surgeons as authors, 50% only other specialties' surgeons, and 31% had both. There was no difference between groups regarding the impact factor of the journals in any of the stratifications, and the majority was published in journals with impact factor ≤2. CONCLUSION: In the last years, surgeons from specialties other than plastic surgery published more about the results of the oncoplastic surgery reported by the patients. There was no statistical difference between the groups regarding the impact factor of the journals.
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http://dx.doi.org/10.1590/1806-9282.20210186DOI Listing
July 2021

The Effect of Quilting Sutures on the Tension Required to Advance the Abdominal Flap in Abdominoplasty.

Aesthet Surg J 2022 05;42(6):628-634

Division of Plastic Surgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.

Background: Quilting sutures attaching the abdominal flap to the aponeurosis contribute to the prevention of seroma formation following abdominoplasty. The sutures distribute the tension over the subcutaneous tissue along the flap length, theoretically decreasing tension at the distal (cutaneous) end of the flap. This is expected to reduce the risks of necrosis, dehiscence, and enlarged or hypertrophic scars.

Objectives: This study sought to verify whether quilting sutures decrease the tension required to advance the dermal-fat flap in abdominoplasty.

Methods: Thirty-four women undergoing abdominoplasty with quilting sutures participated in the study. The tensile force required for flap advancement was measured with a digital force gauge before and after placement of quilting sutures and then compared. Differences in tensile force were tested for correlations with BMI, age, weight of flap tissue removed, number of previous pregnancies, and postoperative complications, including seroma formation, hematoma, necrosis, dehiscence, and enlarged or hypertrophic scars.

Results: A mean reduction in tension of 27.7% was observed at the skin suture after the placement of quilting sutures (P < 0.001). No significant correlation was found between reduced flap tension and BMI, age, weight of tissue removed, or number of births. One case of seroma formation and 2 cases of enlarged scars were observed, but no case of hematoma, necrosis, or wound dehiscence was detected.

Conclusions: The use of quilting sutures to attach the abdominal flap to the aponeurosis of the anterior abdominal wall reduced tension at the advancing edge of the flap in abdominoplasty.
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http://dx.doi.org/10.1093/asj/sjab395DOI Listing
May 2022

Care protocol for acute traumatic tissue injuries in prehospital mobile service.

Rev Assoc Med Bras (1992) 2021 Aug;67(8):1109-1112

Universidade Federal de São Paulo, Departamento de Cirurgia Plástica - São Paulo (SP), Brazil.

Objective: The aim of this study is to elaborate a protocol for the care of acute traumatic tissue injuries in the prehospital mobile service.

Methods: An extensive search of anteriority that did not reveal the existence of such protocol in other services across the globe was carried out. Subsequently, the literature review was executed on Medline and Lilacs. Related and referenced scientific literature served as the basis for the elaboration and creation of the protocol and its flowchart. The complete protocol was then measured for expert judges with the Delphi methodology. A questionnaire (using the Likert scale) and the initial version protocol were sent by electronic means to 13 medical and nurse coordinators of all SAMU from Paraná. RESULTS: Seven experts returned completed questionnaires in the first round and five in the second round. Average required global content validation index was obtained for the validation requirements of the protocol and its flowchart.

Conclusions: A protocol for the care of acute traumatic tissue injuries in the prehospital mobile service was developed and authenticated with the viability of routine professional use by the health professional.
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http://dx.doi.org/10.1590/1806-9282.20210264DOI Listing
August 2021

The "Shirt Pocket" Technique-An Alternative for Augmentation-Mastopexy.

Indian J Plast Surg 2021 Sep 17;54(3):362-366. Epub 2021 Sep 17.

Division of Plastic Surgery of the Federal University of São Paulo, São Paulo, Brazil.

Augmentation-mastopexy is a frequent procedure with high rates of early recurrence of breast ptosis, mainly after subglandular approach. The dual-plane techniques, based on the cranial dissection of the pectoralis, is the most used, but this plane does not cover the inferior pole of the breast. Then, the possibility of a downward dissection of the muscle seems to be more reasonable to retain the implant and improve postoperative results. This study aimed to review the anatomy of the pectoralis in cadavers and the use of its downward dissection to create a pocket for breast implant as a "shirt pocket." This maneuver was associated with a superior-based dermoglandular flap to overprotect the inferior pole. No complications were related in the postoperative period. The anatomic review showed that the "shirt pocket" is a safe option if done carefully. The technique demonstrated to be feasible and seemed to be effective, being another alternative to prevent early recurrence of breast ptosis in these procedures.
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http://dx.doi.org/10.1055/s-0041-1733807DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8515320PMC
September 2021

Finding reduced Raman spectroscopy fingerprint of skin samples for melanoma diagnosis through machine learning.

Artif Intell Med 2021 10 28;120:102161. Epub 2021 Aug 28.

DERMiSCAN, Brazil. Electronic address:

Early-stage detection of cutaneous melanoma can vastly increase the chances of cure. Excision biopsy followed by histological examination is considered the gold standard for diagnosing the disease, but requires long high-cost processing time, and may be biased, as it involves qualitative assessment by a professional. In this paper, we present a new machine learning approach using raw data for skin Raman spectra as input. The approach is highly efficient for classifying benign versus malignant skin lesions (AUC 0.98, 95% CI 0.97-0.99). Furthermore, we present a high-performance model (AUC 0.97, 95% CI 0.95-0.98) using a miniaturized spectral range (896-1039 cm), thus demonstrating that only a single fragment of the biological fingerprint Raman region is needed for producing an accurate diagnosis. These findings could favor the future development of a cheaper and dedicated Raman spectrometer for fast and accurate cancer diagnosis.
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http://dx.doi.org/10.1016/j.artmed.2021.102161DOI Listing
October 2021

Comparative Analysis of Human Adipose-Derived Stromal/Stem Cells and Dermal Fibroblasts.

Stem Cells Dev 2021 12 8;30(23):1171-1178. Epub 2021 Oct 8.

La Cell LLC, New Orleans, Louisiana, USA.

Dermal fibroblasts (DFs) share several qualities with mesenchymal stem cell/multipotent stromal cells (MSCs) derived from various tissues, including adipose-derived stromal/stem cells (ASCs). ASCs and DFs are morphologically comparable and both cell types can be culture expanded through the utilization of their plastic-adherence properties. Despite these similar characteristics, numerous studies indicate that ASC and DF display distinct therapeutic benefits in clinical applications. To more accurately distinguish between these cell types, human DFs and ASCs isolated from three individual donors were analyzed for multipotency and cell surface marker expressions. The detection of cell surface markers, CD29, CD34, CD44, CD73, CD90, and CD105, were used for phenotypic characterization of the DFs and ASCs. Furthermore, both cell types underwent lineage differentiation based on histochemical staining and the expression of adipogenic related genes, CCAAT/Enhancer-Binding Protein alpha (CEBPα), Peroxisome proliferator-activated receptor gamma (PPARγ), UCP1, Leptin (LEP), and Adiponectin (ADIPOQ); and osteogenic related genes, Runt related transcription factor 2 (Runx2), Alkaline phosphatase (ALPL), Osteocalcin (OCN), and Osteopontin (OPN). Evidence provided by this study demonstrates similarities between donor-matched ASC and DF with respect to morphology, surface marker expression, differentiation potential, and gene expression, although appearance of enhanced adipogenesis in the ASC based solely on spectrophotometric analyses with no significant difference in real-time polymerase chain reaction detection of adipogenic biomarkers. Thus, there is substantial overlap between the ASC and DF phenotypes based on biochemical and differentiation metrics.
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http://dx.doi.org/10.1089/scd.2021.0164DOI Listing
December 2021

Components separation technique of the abdominal wall: Which muscle release produces the greatest reduction in tension on the mideline?

J Plast Reconstr Aesthet Surg 2021 Dec 5;74(12):3361-3370. Epub 2021 Jun 5.

Division of Plastic Surgery, Department of Surgery, Universidade Federal de São Paulo, São Paulo, SP, Brazil. Electronic address:

Background: The components separation technique (CS) is used for the reconstruction of complex abdominal wall defects. Release and undermining of the rectus abdominis muscle (RAM) and external oblique muscle (EOM) decrease tension on the abdominal midline, reducing recurrence of ventral hernia, but causes major changes in the physiology of abdominal wall. The purpose of the study was to determine which muscle release and undermining produces the lowest tension on the midline.

Methods: Twenty fresh cadavers were dissected and the anterior and posterior layers of the rectus sheath were isolated in the midline. The forces necessary to advance the layers of the rectus sheath to the mid abdomen were measured bilaterally at two points located 3 cm above and 2 cm below the umbilicus, and at 3 different stages: before any muscle release; after release and undermining of the right RAM and left EOM; and after release and undermining of the left RAM and right EOM. Comparisons of tensile forces were conducted separately for the different muscles involved, layers of the rectus sheath, measurement points, and stages of separation.

Results: Tension on the abdominal midline after the release and undermining of both the RAM and EOM was reduced by 56% (p <0.05), 42% after the release and undermining of the EOM alone (p <0.05), and 35% after release and undermining of the RAM alone (p <0.05).

Conclusion: Release and undermining of the EOM by CS led to lower tension on the abdominal midline compared to that associated with the release of the RAM alone.
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http://dx.doi.org/10.1016/j.bjps.2021.05.015DOI Listing
December 2021

Burn Specific Health Scale - Brief - Brazil and International Classification of Functioning, Disability and Health in Burn Patients.

J Burn Care Res 2022 01;43(1):30-36

Discipline of Plastic Surgery, Surgery Department, (UNIFESP/EPM), São Paulo, Brazil.

With better burn trauma survival rates, quality of life and functionality have become important outcomes in the evaluation of burn patients. The objective of this study was to evaluate the quality of life of burn survivors using the Burn Specific Health Scale-Brief-Br and their function and health using the International Classification of Functioning Disability and Health (ICF) in order to assess whether there is a correlation in the results obtained between the two instruments. A cross-sectional study with 80 burn patients who underwent outpatient follow-up was completed. Quality of life was assessed using the BSHS-B-Br, an instrument translated and validated in Brazilian Portuguese. Based on ICF category concepts, a data collection tool was used with "yes" and "no" answers. A "yes" answer represented the "8" qualifier, indicating a problem without a specific order of magnitude. Both instruments were self-applied in standardized conditions without complications during the process. Results were analyzed through Spearman's rank correlation coefficients. The BSHS-B-Br had an average score of 127.12 (SD ± 23.03). The correlation was moderate between the total BSHS-B-Br score and the answers of ICF for body functions (r = -.53; P < .001) and environmental factors (r = -.50; P < .001). It was weak for body structures (r = -.47; P < .001) and for activities and participation (r = -.43; P < .001). This study found a moderate correlation between the results of the Burn Specific Health Scale - Brief - Brazil and the International Classification of Functioning, Disability and Health for burn patients showing that both instruments provide complementary information about burned patients.
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http://dx.doi.org/10.1093/jbcr/irab055DOI Listing
January 2022

Cephalometric measures correlate with polysomnography parameters in individuals with midface deficiency.

Sci Rep 2021 04 12;11(1):7949. Epub 2021 Apr 12.

Postgraduate Program in Translational Surgery, Federal University of Sao Paulo, Rua Botucatu 740, 2nd floor, Vila Clementino, São Paulo, SP, CEP 04023-900, Brazil.

To determine the association between cephalometric measurements and polysomnographic parameters in Brazilian patients with midface deficiency. This was a primary, clinical, observational, longitudinal, retrospective, analytical, and single-center study. Forty-eight patients with midface deficiency were divided into two groups as follows: those who underwent surgically assisted rapid palatal expansion (SARME) and those who received maxillary advancement (MA). Pre- and post-operative cephalometric and polysomnography measurements were obtained. Pearson's correlation was used to verify the presence of any significant associations between PSG scores and cephalometric measurements. Associations between BMI (Body Mass Index) and AHI (Apnea Hypopnea Index) as well as arousals were observed. In the SARME group, associations between AHI and SNA, UAS and MP-H, arousals and SNA, and Co-A and MP-H were noted. Associations between AHI and Co-A, PoOr-A and MP-H, arousals and UAS, and between minimum saturation of O2 and SNA, SNB, and Co-A were observed in the MA group. This study demonstrates the alterations in the middle third of the face that were related to sleep disturbance. In addition, it shows the associations between the polysomnographic parameters and the cephalometric representations corresponding to the analyzed deformities and transverse or anteroposterior maxillary deficiencies.
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http://dx.doi.org/10.1038/s41598-021-85935-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8042057PMC
April 2021

Therapeutics of xeroderma pigmentosum: A PRISMA-compliant systematic review.

Indian J Dermatol Venereol Leprol 2021 Mar-Apr;87(2):176-189

Division of Plastic Surgery, Federal University of São Paulo, São Paulo, SP, Brazil.

Xeroderma pigmentosum is a rare hereditary autosomal recessive genodermatosis. At present, there are many treatment options for xeroderma pigmentosum, covering medical/procedural, surgical and combined modalities. However, the quality of these interventions has not been assessed. Our study aimed to perform a systematic review of the literature regarding the treatment of xeroderma pigmentosum. Multiple medical databases were accessed with the Medical Subject Headings terms; "xeroderma pigmentosum," "therapeutics" and "surgical procedures, operative" from January 2000 to April 2019, including articles published in Portuguese, Spanish and English (PROSPERO-CRD42018114858). Two hundred and ninety-eight studies were found in the databases researched, of which, after applying the inclusion criteria, only 33 studies remained. The 33 complete articles were read by three of the authors, having been found: 16 reported medical/procedural and 17 reported surgical treatments. Only one clinical study presented a good level of evidence (EL: 2): a randomized clinical trial using a T4 endonuclease V (T4N5) liposome lotion which reduced the development of skin lesions in patients with xeroderma pigmentosum. Amongst surgical modalities, all studies presented low evidence level (EL: 4). Three illustrative cases are also presented, to emphasize the multiple number of times that surgical modalities may be required in these patients. The therapeutic modalities, both clinical and surgical, for xeroderma pigmentosum presented a low level of scientific evidence which did not allow meta-analysis. More therapeutic studies, both clinical and surgical, with better scientific evidence are needed.
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http://dx.doi.org/10.25259/IJDVL_431_19DOI Listing
November 2021

Acellular dermal matrix in skin wound healing in rabbits - histological and histomorphometric analyses.

Clinics (Sao Paulo) 2021 8;76:e2066. Epub 2021 Mar 8.

Divisao de Cirurgia Plastica e Reconstrutiva, Universidade Federal de Sao Paulo, Sao Paulo, SP, BR.

Objectives: To analyze the histology and histomorphometry of healing associated with acellular dermal matrix in skin wounds in rabbits.

Methods: Twelve male rabbits were divided into two groups: the control group (CG) and the matrix group (MG). Three skin wounds with a total area of 20 × 20 mm were created on the dorsal region of each animal. Photographic records of the lesions taken over a 21-day period and use of the ImageJ program allowed calculation of the wound contraction rate. The lesions were biopsied on days 3, 14 and 21 for histomorphometric analysis to define the thicknesses of the dermis and epidermis (hematoxylin-eosin) and calculate the densities of type I and type III collagen (picrosirius).

Results: No significant difference in the healing rate was found between the groups (p>0.05). The MG presented greater epidermal thickness on day 3 (p<0.05) and on days 14 and 21 (p<0.001). The MG presented greater dermal thickness throughout the study period (p<0.05). The type I collagen density was higher in the MG throughout the study period (p<0.05), and the type III collagen density was higher in the MG on days 3 and 14 (p<0.05) and on day 21 (p<0.001).

Conclusion: The use of acellular dermal matrix increased the thickness of the dermal and epidermal layers and the amount of type I and III collagen during skin wound healing and did not alter the rate of wound contraction.
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http://dx.doi.org/10.6061/clinics/2021/e2066DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7920408PMC
April 2021

Improving the Use of Surgical Gloves as an Implant Sizer During Breast Augmentation.

Aesthetic Plast Surg 2021 08 8;45(4):1955-1956. Epub 2021 Feb 8.

Department of Surgery, Division of Plastic Surgery, Federal University of São Paulo, São Paulo, Brazil.

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http://dx.doi.org/10.1007/s00266-021-02159-wDOI Listing
August 2021

JPEG and raw image files compared to direct measurement of the breast region.

Acta Cir Bras 2020 30;35(10):e202001008. Epub 2020 Nov 30.

PhD, Postgraduate Program in Translational Surgery and Plastic Surgery Division, Universidade Federal de São Paulo (UNIFESP), Brazil. Analysis of data, manuscript preparation and writing, final approval.

Purpose: To compare JPEG and RAW image file extensions to direct measurement of the breast region.

Methods: Points were marked on the breasts and arms of 40 female volunteers. The joining of these points in each hemibody formed seven linear segments, one angular segment and one median segment common to both hemibodies. Volunteers were photographed in a standardized fashion and evaluated by three raters using the software Adobe Photoshop CS6® and three image file extensions (RAW, high resolution JPEG and low resolution JPEG); values were compared to direct anthropometry.

Results: All variables had interclass correlation coefficient higher than 0.8 (ICC>0.8). On average, all variables in all methods showed differences (p<0.05) when compared to direct measurement. A formula was created for each segment and each image file extension in comparison with the direct measurement.

Conclusion: Measurements were similar among the correlated JPEG and RAW image file extensions but differed from the actual breast measurement obtained with a caliper.
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http://dx.doi.org/10.1590/s0102-865020200100000008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7709897PMC
December 2020

Development of a Manual on the Technique of Applying the Unna Boot in Patients With Venous Leg Ulcers.

Wounds 2021 Jan 14;33(1):28-33. Epub 2020 Jul 14.

Division of Plastic Surgery, Department of Surgery, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.

Introduction: Providing adequate care for people with venous leg ulcers (VLUs) can be a challenge. Numerous publications have discussed the importance of compression therapies on the treatment of VLUs, but few have described the necessary materials and techniques for applying the Unna boot, contributing to the underutilization of this therapy. The use of manuals is one of the strategies in the training of health professionals.

Objective: The aim of this study was to develop and validate a manual on the technique of applying the Unna boot in patients with VLUs. The manual was created to improve the education and training of health professionals in the control of chronic VLUs.

Materials And Methods: This was a descriptive study involving 3 stages. The selection of content for the manual was based on a literature review of articles in the Portuguese, Spanish, and English languages published from January 2000 through December 2018, in which 8 key terms were searched across the Cochrane Library, MEDLINE, and SciELO databases, and Google Scholar search engine. The text, illustrations, and layout design of the manual as well as a video demonstration of the technique were created. The manual then was validated for content by an expert panel using the Delphi Technique and the content validity index (CVI).

Results: The manual showed an overall CVI of 0.98 after 2 rounds of consultation and its content, presentation, and relevance were rated as very adequate by the expert panel. The final version of the manual features 29 pages of text and illustrations and includes a video demonstration of the technique.

Conclusions: A manual on the technique of applying the Unna boot in patients with VLUs was developed and validated for content by an expert panel.
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January 2021

Aesthetic Contouring of the Chest wall with Rib Resection.

Aesthetic Plast Surg 2021 06 9;45(3):1099-1104. Epub 2020 Oct 9.

Plastic Surgery Division, Unifesp, Rua Botucatu, 740 - 2nd Floor, P.O. Box: 04039-002, São Paulo, SP, Brazil.

Background: In past decades, several invasive and noninvasive aesthetic procedures have been sought as a way to improve body contouring, and one may resort to uncertified and potentially dangerous procedures to achieve that goal. An example of this practice would be the resection of ribs to reduce the waist for aesthetic reasons. The objective was to check scientific evidence on the effectiveness and safety of removal of floating ribs for aesthetic purposes.

Methods: A systematic review of the literature was carried out in EMBASE/Elsevier, Cochrane, Scopus, Medline, PubMed, BVS, SciELO, OneFile, and Lilacs, throughout the period until June 2020, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: Fifty-six articles were found in all databases. After applying the inclusion criteria, by reading the title and abstract of the studies found, only two articles were definitively included. One addressed the possibility of removing the 7th and 8th ribs for improving body contouring in patients with an exaggerated anterior projection of the chest wall, without showing cases or surgical techniques. The other demonstrated procedures of body contouring in transgender by the removal of the 11th and 12th ribs in five of the 22 patients studied, just providing a brief description of the surgical technique used, without details.

Conclusions: Despite the relevance of the theme and its popularity, there is not enough scientific evidence to support the practice, effectiveness and safety of the resection of ribs for aesthetic purposes.

Level Of Evidence Iii: 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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http://dx.doi.org/10.1007/s00266-020-01988-5DOI Listing
June 2021

Antibiotic prophylaxis in breast cancer surgery. A randomized controlled trial.

Acta Cir Bras 2020 30;35(9):e202000907. Epub 2020 Sep 30.

PhD, Associate Professor, Professional Master's Program in Applied Health Sciences, UNIVÁS, Pouso Alegre-MG, and Postgraduate Program in Translational Surgery, UNIFESP, Sao Paulo-SP, Brazil. Conception, design, intellectual and scientific content of the study; interpretation and analysis of data; manuscript writing; critical revision; final approval.

Purpose: To assess the effect of antibiotic prophylaxis on surgical site infection (SSI) rates in women undergoing breast cancer surgery in two tertiary hospitals in Brazil.

Methods: This was a randomized, double-blind, placebo-controlled, parallel-group clinical trial. A total of 124 women without independent risk factors for SSI were randomly assigned to receive either cefazolin (antibiotic group, n = 62) or placebo (control group, n = 62) as preoperative prophylaxis. After surgery, all surgical wounds were examined once a week, for four weeks, according to the Centers for Disease Control and Prevention definitions and classifications for SSI.

Results: Baseline characteristics were homogeneous between the two groups. Only one patient in the antibiotic group developed SSI, which was classified as superficial incisional. The overall SSI rate was low, with no significant difference between groups.

Conclusion: Antibiotic prophylaxis had no significant effect on reducing SSI rates in women without independent risk factors for SSI undergoing breast cancer surgery.
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http://dx.doi.org/10.1590/s0102-865020200090000007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7531055PMC
October 2020

Brazilian version of the Breast-Q -Breast-Conserving Therapy Module 2.0: Translation, cross-cultural adaptation, and reproducibility.

Breast J 2021 01 28;27(1):72-74. Epub 2020 Sep 28.

Translational Surgery Graduate Program, Universidade Federal de Sao Paulo (UNIFESP), Sao Paulo, Brazil.

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http://dx.doi.org/10.1111/tbj.14064DOI Listing
January 2021

Effectiveness of Brazilian national health policy for mammogram screening in women aged over 50 years.

Breast J 2021 01 20;27(1):82-83. Epub 2020 Sep 20.

Professional Graduate Program in Sciences Applied to Health, Universidade do Vale do Sapucai (UNIVAS), Pouso Alegre, Brazil.

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http://dx.doi.org/10.1111/tbj.14055DOI Listing
January 2021

Electric Factors in Wound Healing.

Adv Wound Care (New Rochelle) 2021 08 6;10(8):461-476. Epub 2020 Oct 6.

Surgery Department, Plastic Surgery Division, Postgraduated Program in Translational Surgery, Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil.

Electric factors such as electric charges, electrodynamic field, skin battery, and interstitial exclusion permeate wound healing physiology and physiopathology from injury to re-epithelialization. The understanding of how electric factors contribute to wound healing and how treatments may interfere with them is fundamental for the development of better strategies for the management of pathological scarring and chronic wounds. Angiogenesis, cell migration, macrophage activation hemorheology, and microcirculation can interfere and be interfered with electric factors. New treatments with various types of electric currents, laser, light emitting diode, acupuncture, and weak electric fields applied directly on the wound have been developed to improve wound healing. Despite the basic and clinical development, pathological scars such as keloids and chronic wounds are still a challenge. New treatments can be developed to improve skin wound healing taking into account the influence of electrical charges. Monitoring electrical activity during skin healing and the influence of treatments on hemorheology and microcirculation are examples of how to use knowledge of electrical factors to increase their effectiveness.
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http://dx.doi.org/10.1089/wound.2019.1114DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8236302PMC
August 2021

Cross-cultural validation of the FACE-Q Satisfaction with Facial Appearance Overall Scale (FACE-Q SFAOS) in Brazilian rhytidoplasty patients.

Clinics (Sao Paulo) 2020 3;75:e1568. Epub 2020 Aug 3.

Programa de Pos-graduacao em Cirurgia Translacional Universidade Federal de Sao Paulo, Sao Paulo, SP, BR.

Objectives: This study aimed to culturally validate the FACE-Q - Satisfaction with Facial Appearance Overall Scale (Face-Q SFAOS) in a population of Brazilian rhytidoplasty patients.

Method: Authorization for the translation and validation of the questionnaire was obtained from the FACE-Q SFAOS distribution rights holders. The FACE-Q SFAOS was translated and then back-translated. For cultural validation, a total of 57 women were selected 5 to 8 months after undergoing rhytidoplasty. Twenty of them participated in the cultural adaptation, 30 participated in the reproducibility analysis, and 57 participated in the construct validation.

Results: The analysis identified two factors (general appearance and face geometry) that exhibited excellent internal consistency. The total satisfaction score, which comprised nine items, also presented excellent internal consistency. Good reproducibility was found for Overall Appearance, Geometry and Total. There was a difference in the satisfaction means (total and factors) between procedure locations; patients undergoing frontal, upper eyelid and lower eyelid procedures were less satisfied than those who did not undergo such procedures. Satisfaction was higher with geometry than with overall face appearance.

Conclusion: The FACE-Q SFAOS was adapted to the cultural context of Brazilian rhytidoplasty patients and was reproducible, and the scale exhibited face, content and construct validity.
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http://dx.doi.org/10.6061/clinics/2020/e1568DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7384204PMC
November 2020
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