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Introduction: The Transverse Rectus Abdominis Myocutaneous (TRAM) flap is used for breast reconstruction, but involves the risk of necrosis. Adipose tissue-derived mesenchymal Stem Cells (ADSCs) can be used to stimulate neovascularization and reduce the risk of TRAM flap necrosis., Aim: Determine the effect of ADSCs on TRAM flap viability in rats., Methods: Twenty-four Wistar-EPM rats were distributed into three groups (n = 8). A right caudal pedicled TRAM flap was performed in all the animals and was the only procedure performed in Group TRAM. The additional procedures of intradermal injection of α-MEM culture medium and intradermal injection of α-MEM containing ADSCs labeled with a fluorescent marker were performed in Groups α-MEM and α-MEM-SC, respectively. The percentage of flap necrosis was determined, and the level of neovascularization and distribution of stem cells in the TRAM flap was assessed using immunohistochemical analysis and fluorescence microscopy, respectively., Results: The percentage of necrosis observed in Group α-MEM-SC was lower than that observed in Groups TRAM and α-MEM, namely 23.36 % vs. 50.42 % and 53.57 %, respectively (p < 0.05). In Zone IV of the flap, the number of vessels was greater in Group α-MEM-SC than in the other groups (p < 0.05). Multiple stem cells were observed in the four zones of the flap in Group α-MEM-SC. No stem cells were observed in Groups TRAM or α-MEM., Conclusion: ADSCs increased TRAM flap viability and the number of vessels in Zone IV of the flap in rats., Competing Interests: Declaration of competing interest The authors have no financial interest or commercial association with any of the subject matter or products mentioned in this manuscript., (Copyright © 2025. Published by Elsevier España, S.L.U.)

Background: Rhinoplasty may improve negative psychological aspects, such as mild to moderate body dysmorphic disorder; however, the repercussions on the self-image and quality of life of patients after the procedure are unknown., Objective: To evaluate self-image, self-esteem, anxiety, and functional capacity of patients undergoing open-structure rhinoplasty., Methods: A primary, analytical, clinical, longitudinal, and prospective study was conducted, which included 30 female patients, aged between 18 and 50 years with elongated nose and nasal hump, who underwent open and structured rhinoplasty. All procedures were performed by a team from the Rhinology DCP/Unifesp. The Rosenberg Self-Esteem Scale - EPM, BDSS, BDD-YBOCS, SF-36, SRQ-20, and STAI (T/E) questionnaires were administered before the surgery and at 6, 12, and 18 months after surgery., Results: The results showed statistically significant differences in the Rosenberg scale - EPM (p = 0.017), BDSS (p < 0.001), BDD (p = 0.006), SF-36 (p = 0.041), SRQ-20 (p = 0.012), and STAI-T (p = 0.001) scores in general analyses. Additionally, the statistically significant changes persisted in various stratified postoperative periods. In the qualitative analysis, there was only statistical significance for the classification of the BDSS score, where the "Absent" (absence of body dysmorphism) index increased from 70.0% in the preoperative state to 96.7% in 18 months postoperatively. The "Present" (presence of body dysmorphism) index fell from 30.0% to 3.3% in the same period (p = 0.001)., Conclusion: Open-structure rhinoplasty improved the patients' self-image, self-esteem, anxiety, and mental health., (Copyright © 2024 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

COVID-19 can converge with the pro-inflammatory immunoregulatory mechanisms of chronic lung diseases. Given the disorders inherent to lung transplantation and the inexistence of other definitive therapeutic alternatives, Adipose tissue-derived Stem Cells (ASCs) presented themselves as a therapeutic hope. The purpose of this review is to assess the basis for the potential use of ASCs in lung diseases unresponsive to conventional therapy, relating to their possible use in COVID-19 ARDS. 35 studies comprised this review, 14 being narrative reviews, 19 preclinical trials and two proofs of concept. COVID-19 can converge with the pro-inflammatory immunoregulatory mechanisms of chronic lung diseases. In view of the disorders inherent to lung transplantation and the inexistence of definitive therapeutic alternatives, Adipose tissue-derived Stem Cells (ASCs) presented themselves as a therapeutic hope. Its detailed reading indicated the absence of serious adverse effects and toxicity to the administration of ASCs and suggested possible effectiveness in reducing lung damage, in addition to promoting the recovery of leukocytes and lymphocytes with its immunomodulatory and anti-apoptotic effects. The revised clinical data suggests optimism in the applicability of ASCs in other immunoinflammatory diseases and in severe COVID-19 ARDS. However, further studies are needed to develop a consensus on the methods of collection of ASCs, the ideal dosage schedule, the most effective time and route of administration, as well as on the definition of indications for the administration of ASCs in cases of COVID-19 for conducting clinical trials in near future., Competing Interests: Declration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2023 HCFMUSP. Published by Elsevier España, S.L.U. All rights reserved.)

Nipple hypertrophy is a rare deformity that affects women's self-esteem. Several surgical techniques have been described for its treatment, but there is no gold standard technique, leaving the choice to the surgeon based on preference. A systematic review was performed using PRISMA guidelines on the surgical treatment of nipple hypertrophy over the period available. An illustrative case series was also included with 24 women, mean age 34.5 years, with nipple hypertrophy, treated with a functional preservation technique. This consisted of the removal of a circular segment of nipple tissue between the base and the tip, preserving its central structures, in conjunction with breast surgeries. The nipple-areola complex also underwent a procedure to achieve a 1:3 ratio. Postoperative follow-up was 12 months for the metric assessment, occurrence of complications, and tactile and pain sensitivities. A total of 1,064 articles were found, but only 19 were eligible. Most studies were classified with a low evidence level, homogeneous series, without the possibility of meta-analysis. Regarding the case series, the measurements of the vertical and horizontal axes varied, on average, 1.4 and 1.25 cm, respectively, in the preoperative period. No changes in the sensitivity were reported. No women had any of local or systemic complications. All of them were followed for at least 12 months, with preservation of the nipple-areola metrics. There is a need for better scientific evidence regarding the surgical treatment of nipple hypertrophy. The present surgical technique demonstrated the long-term preservation of nipple metrics without sensory or functional impairment., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

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., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

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., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

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.

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.

Objectives: To evaluate the impact of breast reconstruction after mastectomy on sexual function, body image, and depression., Methods: This cross-sectional, comparative, controlled study was conducted with 90 women between 18 and 65 years of age who had undergone either mastectomy alone (mastectomy group, n=30) or mastectomy combined with breast reconstruction (mastectomy-reconstruction group, n=30) at least one year prior to the study or who had no breast cancer (control group, n=30). Patients were assessed for sexual function, depression, and body image using the validated Brazilian-Portuguese versions of the Female Sexual Function Index, the Beck Depression Inventory, and the Body Dysmorphic Disorder Examination, respectively., Results: The three groups were homogeneous for age, marital status, body mass index, and education level. The women in the mastectomy group reported significantly worse sexual function, greater depressive symptoms, and lower body image than those in the mastectomy-reconstruction and control groups. In the mastectomy group, the frequency of sexual dysfunction was significantly greater among patients without a marital partner and those with a higher level of education than among patients in the other two groups with the same characteristics., Conclusion: Patients who had undergone breast reconstruction after mastectomy reported better sexual function and body image and fewer depressive symptoms than patients who had undergone mastectomy alone. Sexual dysfunction was associated with the absence of a marital partner and a higher level of education and was more frequent in the mastectomy group.

Background/objectives: Keloid is a healing disorder that occurs exclusively in humans. This pathology is considered a benign cicatricial neoplasm, whose physiopathogenesis has not yet completely clarified. Its disfiguring appearance often could potentially cause a disturbance in the patient regarding his/her body image. The objective is to evaluate the impact of keloid on body image., Methods: 61 patients with keloid in socially exposed regions of the body were included. The participants were submitted to clinical evaluation, composed of anamnesis and physical examination, and answered two questionnaires: the Body Dysmorphic Symptoms Scale (BDSS) questionnaire and the Rosenberg Self-Esteem Scale - Unifesp/EPM., Results: Forty percent of the patients had negative aspects of body image (BDSS score≥6). The scores of these patients on the Rosenberg Scale reached an average of 10.5 (p<0.03)., Conclusions: The presence of a keloid negatively affects body image., (Copyright © 2018 Elsevier Ltd and ISBI. All rights reserved.)

Objectives: The aim of this study was to evaluate the histomorphometry of the skin of women during the reproductive period according to the Fitzpatrick classification., Methods: Thirty women aged 30 to 45 years were included in this study. We studied the surgical sites of extracted nevi. The material was processed for routine histology and then stained with haematoxylin and eosin as well as Picrosirius red. Four-micrometre histological sections were analysed according the Fitzpatrick criteria (skin pigmentation). The skin thickness and collagen concentration were determined for the reticular dermal skin. The data were statistically analysed with ANOVA., Results: Fitzpatrick skin types I and II were thicker than the other skin types., Conclusions: Our data suggest that white skin may be less thick than dark skin.

Objectives: The objective of this study was to develop a free smartphone application with reliable and useful information for the lay public on the most frequently performed plastic surgeries worldwide., Methods: The five most frequently performed surgeries worldwide according to ISAPS (International Society of Aesthetic Plastic Surgery) were selected. Information from the websites of the American Society of Plastic Surgeons (ASPS), American Society for Aesthetic Plastic Surgery (ASAPS) and Brazilian Society of Plastic Surgery (SBCP) and from the Outpatient and Hospital Medicine Guide of the Plastic Surgery Division at the Federal University of São Paulo (UNIFESP) was used for content assembly. YouTube videos with patients' postoperative testimonials were used for an improved understanding of their real concerns. Printed text was distributed to patients in Brazil's Unified Health Service to improve comprehensibility. Content on each of the five surgeries was presented in the application with the following layout: What is the surgery?; Who are the candidates?; Preparations for surgery; Stages of surgery; Recovery after surgery; Complications; Choice of surgeon; Consultation; What is the cost? and Glossary. All material was delivered to an outsourced company to produce the application software., Results: The result was the creation of an application with extensive content on the most frequently performed plastic surgeries., Conclusion: The UNIFESP Info Plastica application is an academically based, free and reliable source of information for the lay public interested in all aspects of the most frequently performed plastic surgeries worldwide.

Objective: The aim of this study was to analyse patient-reported outcomes of reduction mammoplasty among Brazilian women., Methods: A total of 100 women were enrolled in this cross-sectional controlled study, 50 with breast hypertrophy (Hypertrophy Group) and 50 who had undergone breast reduction at least six and up to 12 months before (Mammoplasty Group). The Brazilian version of the BREAST-Q® was applied to assess patient-reported outcomes. The module reduction/mastopexy was used, and the preoperative and postoperative versions were applied to the hypertrophy and mammoplasty groups, respectively., Results: The mammoplasty group presented higher scores for the subscales satisfaction with breasts, psychosocial well-being, sexual well-being and physical well-being (p=0.0001 for all of these subscales)., Conclusion: These results suggest that patients submitted to reduction mammoplasty are satisfied with the outcomes and present better quality of life scores compared with women with breast hypertrophy.

This study presents 3 cases of women ages ranged from 25 to 52 years with anterior cervical contractures caused by burns that resulted in functional and aesthetic deficit. Contracture release in 3 patients and reconstruction was done using a sub-fascial flap whose main pedicle was the supraclavicular artery and the occipito-postero-cervical vessels that were preserved. The flap was designed differently from the classically described that uses the skin of the shoulder but which presents differences of color and texture with relation to the skin of the neck. The results were satisfactory and no complications such as infections or necrosis., (Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.)

Purpose: A major fire occurred on January 27, 2013, at 02:30 at Kiss nightclub in the city of Santa Maria, State of Rio Grande do Sul, in Southern Brazil. In this retrospective report, we aimed to describe the nightclub fire event, its immediate consequences, and evaluated its impact on legislation. Our objective was to disseminate the lessons we learned from this large-scale nightclub fire disaster., Methods: We conducted a literature review in PubMed and Lilacs database from 2013 to 2015 related to the nightclub Kiss, Santa Maria, fire, burns, and similar events worldwide over the past 15 years. We searched in the general press and online media information sites, and seeking legislation about this topic at the federal level in Brazil. We reported on the legislation changes that resulted from this nightclub fire., Results: Current federal legislation on fire prevention and the scope of public safety, including night clubs and discos, states is the duty of the state and everyone's responsibility, pursuant to Article 144 of the Federal Constitution of Brazil. Thus, the federal union, individual states and municipalities have the power to legislate on fire prevention, and especially to ensure the security of the population. A state law called "Law Kiss", was passed in 2014, establishing standards on safety, prevention and protection against fire in buildings and areas of fire risk in the state of Rio Grande do Sul. On a national level, a law of prevention and fire fighting in Brazil was also drafted after the Santa Maria disaster (Law project no. 4923, 2013). Currently, this bill is still awaiting sanction before it can take effect., Conclusion: As we push for enactment of the national law of prevention and fire fighting in Brazil, we will continue emphasizing fire prevention, fire protection, fire fighting, means of escape and proper management. All similar events in this and other countries remind us that similar tragedies may occur anywhere, and that the analysis of facts, previous mistakes, during and after the incident are crucial to our understanding, and will help us lessen the chance of future occurrences., (Copyright © 2016 Elsevier Ltd and ISBI. All rights reserved.)

Objective: The purpose of this study was to assess patient-reported outcomes of breast reconstruction with implants, using the BREAST-Q, in the late postoperative period., Materials and Methods: A total of 114 women previously operated due to breast cancer, in the late postoperative period (range 6-24 months) were enrolled in this cross-sectional study, and were allocated to either the mastectomy group (MG, n = 57) or reconstruction group (RG, n = 57). Patients in MG and RG, respectively, completed the Brazilian versions of Mastectomy and Reconstruction Modules of the BREAST-Q., Results: The mean age of patients was 46.6 and 44.3 years in MG and RG, respectively. All patients underwent chemotherapy and 6% and 11% of patients underwent radiotherapy in MG and RG, respectively. Patients in the RG reported higher satisfaction with surgical outcome (P < 0.0001). However, no significant between-group differences were found in physical and sexual well-being, or satisfaction with the plastic surgeon, medical team, and office staff., Conclusion: Breast reconstruction with implants increased patient satisfaction with the surgical outcome, but did not influence patients' physical and sexual well-being or their satisfaction with the treatment received., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Introduction: Progressive increases in survival rates from burn trauma have shifted attention to patient rehabilitation and posttraumatic quality of life. The assessment of quality of life is strongly dependent on reliable instruments for its measurement. A literature review has revealed that the Burn Specific Health Scale-Brief (BSHS-B) questionnaire is the most commonly used instrument worldwide., Objectives: The aim of this study was to translate the BSHS-B into the Portuguese language, adapt it culturally to the Brazilian population, and test its psychometric properties., Methods: The questionnaire was translated into Portuguese; culturally adapted; and tested for reproducibility, face validity, content validity, and construct validity. The translated version was tested on 92 patients with burns. Internal consistency was tested by means of Cronbach's alpha. Construct validity was performed by correlating the BSHS-B questionnaire with the Burn Specific Health Scale-Revised (BSHS-R), BurnSexQ-Escola Paulista de Medicina (EPM)/Universidade Federal De São Paulo (UNIFESP), the Rosenberg Self-Esteem Scale (RSES), and the Beck Depression Inventory (BDI)., Results: Cronbach's alpha was 0.85. The Pearson correlation coefficients were significant at three time points of the reliability analysis. A significant correlation was observed between BSHS-B domains and BSHS-R, and between RSES and BDI domains. A significant correlation was also observed between BSHS-B and the BurnSexQ-EPM/UNIFESP social comfort and body image domains., Conclusion: The BSHS-B questionnaire was translated into Portuguese. It is a reliable tool in this language, showing face, content, and construct validity. The modified instrument has been named BSHS-B-Br., (Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.)

In recent years, there has been an increased use of neuroleptic agents in the unit care in trauma patients. There is a lack of prospective data, and most of the information is obtained from related cases. It is needed to have a high index of suspicion with regard to excluding neuroleptic malignant syndrome (NMS) in patients taking neuroleptics and presenting with hyperthermia, because of the potentially fatal consequences. It is a rare syndrome in the burn patient with a lack of proven treatments, and high morbidity and mortality are related. In the actual literature there are few related cases of NMS in the polytrauma patient, particularly in association with psychiatric conditions. In burn NMS is a rare complication with difficult diagnosis, because of the similar symptoms that can occur either in patients in the Burn Unit Care with other fatal conditions that are present in the acute phase response. Actually, there is no marker for the NMS, which difficult the early diagnosis and prognosis. The treatment still is based on case reports, with lack of clinical trials, but remain as standard and universally accepted. Besides that, the neural signaling of the NMS indicates possibilities for better understanding of the pathophysiology treatment protocol., (Copyright © 2015 Elsevier Ltd and ISBI. All rights reserved.)

Decompensation of epilepsy in burned patients may be caused by several factors. Burn is a classic etiology of systemic inflammatory response syndrome, and evolves into two physiological phases. The first 48h after injury corresponds to the first phase involving severe hypovolemic shock. The second phase corresponds to the hypermetabolic response to burns. Altered pharmacokinetics of anticonvulsant drugs is observed. Albumin and other plasma proteins are reduced, leading to increased free fraction of phenytoin, resulting in greater clearance and a lower total drug concentration. Associated with metabolic changes of burned patient, this fact predisposes to seizures in epileptic burned patients. The authors present the case of an epileptic 36-year-old-woman who developed recurrent seizures after a thermal injury, despite using the same medications and doses of anticonvulsant drugs of last 12 years, with controlled epilepsy., (Copyright © 2014 Elsevier Ltd and ISBI. All rights reserved.)

Body dysmorphic disorder (BDD) is one of the most common psychiatric conditions found in patients seeking cosmetic surgery. BDD is also a challenge for plastic surgeons because it is still an underdiagnosed mental disorder. The aims of this study were to prospectively investigate whether patients with mild to moderate BDD are suitable for rhinoplasty, and to assess BDD severity and patient satisfaction with the surgical outcome 1 year after the intervention. All women (n = 116) seeking rhinoplasty at a university hospital between September 2009 and August 2010 were recruited for the study and assessed for BDD. The final sample consisted of 31 patients aged 32 (standard deviation (SD), 10) years with mild to moderate BDD who underwent rhinoplasty. The participants were assessed preoperatively (baseline) and 1 year postoperatively with the Body Dysmorphic Disorder Examination (BDDE). Most patients (22/31, 71%) were of African descent. Socio-demographic variables and the extent of the nasal deformities had no effect on the severity of BDD symptoms and patient satisfaction with surgery outcome. At the 1-year postoperative follow-up, there was a significant decrease from baseline in BDDE scores and time spent by patients worrying about their appearance; 25 (25/31, 81%) patients experienced complete remission from BDD and 28 (28/31, 90%) were satisfied with the results of surgery. Rhinoplasty may be indicated in the treatment of female patients with mild to moderate BDD., (Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

In measuring the quality of life of burn victims, it is essential that we find reliable and valid means. The Burn Sexuality Questionnaire (BSQ) is a specific instrument that assesses sexuality in the context of quality of life of burn victims. We set out to translate, validate and culturally adapt the BSQ into Brazilian Portuguese. The Portuguese version was applied to 80 patients. After translation, cultural adaptation was performed with 30 patients. We also tested the final version for reliability in 20 patients, and for face, content and construct validities in 30 patients, according to standard procedures. Total Cronbach's alpha was 0.87. Pearson's correlation was significant between scores for different time points. Construct validity was demonstrated with the correlation of the BSQ with the Burn Specific Health Scale-Revised (BSHS-R) questionnaire. It showed significant correlation between the BSQ social comfort domain and the BSHS-R affect and body image (p=0.025), simple function ability (p=0.008), work (p=0.016) and treatment (p=0.037) domains. This cultural adaptation of the BSQ suggests that it is a reliable tool and has construct validity for the social comfort domain. There is still need for a better-structured tool that could possibly evaluate functional and psychological aspects of sexuality, because one could easily overlook the psychosocial aspects of patients with major, complex burns., (Copyright © 2012 Elsevier Ltd and ISBI. All rights reserved.)

Patients who survive a major burn must live with emotional and physical sequela. In a literature review, we found that sexuality concerns of burn victims are rarely a focus of therapy. After suggestions from Rimmer et al. [12], using their questionnaire translated into Portuguese, we held a survey of burn-care professionals at the VII Brazilian Burn Congress. More than 120 practitioners from 41 centres, aged in average 41.2 years (1 standard deviation 10.96), completed the survey. A proportion of 63.7% were female, and 58.1% were Caucasians; 37.1% were physicians, 20.9% nurse practitioners and 16.9 were occupational therapists/physical therapists (OTs/PT)s. Psychologists made up 3.2%. Only 28% of the respondents felt comfortable in initiating a conversation about sexual intimacy with their patients. The vast majority believed it should be done by the psychologist. Only 38% felt their burn centre did an adequate job in that area. When compared with a study of our country's general population, we find similar results indicating that intimacy, sexuality and sexual intercourse are considered most important in a relationship. There is a significant lack of literature in sexuality after burn; most likely meaning it is ignored by most centres. There is a need for other similar surveys to be performed, as well as a collective consciousness of the need for discussions about sexuality with patients and their partners, providing counselling and treatment, when need., (Copyright © 2011 Elsevier Ltd and ISBI. All rights reserved.)

Objective: The aim of this study was to evaluate the effects of laser therapy on bone regeneration in the midpalatal anterior suture (MPAS) after surgically assisted rapid maxillary expansion (SARME)., Methods: Thirteen patients aged between 18 and 33 years old with maxillary transverse deficiency (> or =7.0 mm) were evaluated. All patients underwent subtotal Le Fort I osteotomy with separation of the pterygomaxillary suture with the use of Hyrax expander, and were divided into 2 groups: control group (n = 6) and laser group (n = 7). A GaAlAs laser (P = 100 mW, lambda = 830 nm, Ø = 0.06 cm(2)) was used. The laser was applied in 8 treatment sessions with intervals of 48 hours. Each treatment session consisted of laser applications, per point (E = 8.4J, ED = 140J/cm(2)), at 3 points on the MPAS, and total dose of E = 25.2 J, ED = 420 J/cm(2). Digital radiographs were taken before the surgical procedure and at 1-, 2-, 3-, 4-, and 7-month follow-up visits. Optical density analysis of the regenerated bone was performed using Adobe Photoshop 8.0 software., Results: Bone regeneration associated with the use of laser after SARME showed a statistically significant difference. A higher mineralization rate was found in the laser group (26.3%, P < .001) than the control group., Conclusion: Low-level laser irradiation (GaAlAs) accelerates bone regeneration in MPAS after SARME. However, the optical density measurements after 7 months of follow-up were lower in comparison with the preoperative measurements., (Copyright 2010 Mosby, Inc. All rights reserved.)

The purpose of this study is to evaluate and compare the effect of the incision of the external oblique aponeurosis along the semilunaris in amount of tension present after the undermining of the anterior rectus sheaths. Forty fresh adult cadavers were studied and divided into two groups: group A (n=20) and group B (n=20). Traction indexes were compared in three situations: (1) before any aponeurotic undermining (similar on both groups); (2) after incision and undermining of the anterior rectus sheaths (similar on both groups) and (3) group A: after undermining of the external oblique muscles with the incision of their aponeurosis along the semilunaris and group B: undermining of a continuous layer of the anterior rectus sheaths and the external oblique aponeurosis, after release of the lateral aspect of the rectus sheaths. Significance of differences was assessed using non-parametric tests. There was a significant tension reduction after each stage of dissection in both supra- and infra-umbilical levels and on both groups. Comparisons between groups A and B did not show statistically significant differences in all sites and stages of the dissections. Therefore, both techniques showed similar aponeurotic tension reduction after each stage of the dissections in cadavers., ((c) 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.)

Objective: The objective of this study was to evaluate the effects of surgically assisted rapid maxillary expansion (SARME) on nasal dimensions using acoustic rhinometry., Study Design: Twenty-seven patients ranging in age from 18 to 53 years were evaluated as having a maxillary transverse deficiency larger than 7 mm, a bilateral cross-bite, and no evidence of nasal obstruction. All patients underwent evaluation of the nasal cavity by acoustic rhinometry both before and 6 months after SARME. The Wilcoxon test was used to evaluate minor cross-sectional areas (MCA) and the nasal volume of the right and left nasal cavities, and these parameters were measured with and without the application of topical nasal decongestant before and after SARME., Results: In comparison with preoperative measurements, minor cross-sectional areas and nasal volumes were significantly larger after SARME. There was a statistically significant difference associated with the use of nasal decongestant; the minor cross-sectional areas and nasal volume of the right and left nasal cavities were smaller when nasal decongestants were not used., Conclusions: Surgically assisted rapid maxillary expansion increases the minor cross-sectional areas and volume of the nasal cavities. Acoustic rhinometry is an objective method for evaluating the geometry of the nasal cavity in patients with transverse maxillary deficiency., (Copyright (c) 2010 Mosby, Inc. All rights reserved.)

This article describes two different strategies for umbilical reconstruction. One of the techniques included four skin flaps and was indicated for patients with no vertical scar on the abdomen. This approach was applied in a patient who presented with necrosis of the umbilicus secondary to abdominoplasty. The second technique was indicated for patients who presented with vertical scars. A semilunar skin flap was performed based on the normal skin close to the edge of the vertical scar. A vaginal tampon was used as a dressing in the neoumbilicus for 30 days. Both techniques showed to be effective, with no postoperative complications at the follow-up period.