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Biomedical subjects

R de la Plaza

Publications and source records attributed to R de la Plaza.

15 recordsLinked to original sources
PubMed2005

The crossed dermal flaps technique for breast reduction.

BACKGROUND: More than100 techniques and variations of breast reduction have been published. In most, the principal differences involve the method of transpositioning the nipple-areola complex and the pattern of skin resection. Skin resection inevitably causes scarring, which has given rise to an ongoing debate over long scar techniques and short scar techniques. The debate would be mute if only the extent of the scar was evaluated: ideally, the shorter the better. However, this limitation of scar extension conditions other elements to be evaluated in the results. On the other hand, there is a great variety of clinical cases in which not only the volume must be considered, but also the degree of ptosis, the quality of the skin, the age, and, most importantly, the wishes of the patients. OBJECTIVES: The objective of the crossed dermal flaps procedure was to obtain optimum volume, position, and shape of the breast; well-located good-quality scars as short as possible; and early satisfactory and long-lasting results. METHODS: Between June 1986 and June 2003 136 women underwent this procedure, performed under controlled hypotension (median arterial blood pressure, 60 mmHg). The technique is based on Wise-type skin marking associated with glandular resection in the lower and lateral poles, and transpositioning of the nipple-areola complex with a superior medial dermoglandular pedicle. Two rectangular areas under each cutaneous vertex are delimited, which will correspond with the future dermal flaps. These flaps are crossed, then fixed to the musculoaponeurotic chest wall, and the rest of the wound is sutured by planes in a conventional manner. RESULTS: Two patients (1.4%) experienced minimum cutaneous epidermolysis without dehiscence at the union of the vertical and horizontal sutures, which later healed by second intention without interference with the aesthetic result. Three cases (2%) showed partial and superficial necrosis of one of the areolae, but healed during the following 3 weeks without secondary surgery. In three patients (2%), hematomas developed, which were drained in the dressing room with no complications. One patient experienced thickening of the scar. No infections were observed. CONCLUSIONS: The authors believe the cross dermal flaps technique is safe and applicable to an extensive variety of cases. It is easy to execute and to teach, and therefore, those who are beginning to use inverted T techniques such as that described, can, from the beginning, diminish the incidence of short- and long-term complications such as dehiscence that lead to scarring at the convergence of the flaps and bottoming out of the inferior pole, with the horizontal scar displaced upward and an increase in the distance between the later and the nipple areola complex.

Adolescent↗
PubMed2005

[Liposuction in children: clinical utility].

Liposuction has become one of the most frequent aesthetic procedures. The "typical" patient is a young female with fat deposits in the trochanteric region. Gradually the safety of the technique together with the high satisfaction rate of the patients have contributed to the widening of its indications to other pathologies of the adipose tissue in different age populations. However, there is scarce literature regarding liposuction in childhood. The authors present their experience with liposuction as the treatment of congenital as well as acquired lipodystrophies in the paediatric age. Some particular details of the technique are described and the advantages of liposuction versus open surgery in these cases are analyzed.

Adiposis Dolorosa↗
PubMed2000

Stromal tumors of the stomach. Review of our experience and reclassification of a series of patients.

OBJECTIVE: To retrospectively review a series of 12 patients operated on in our department for stromal tumor of the stomach. Clinical and morphological data, and the patients' postoperative course, were analyzed. METHODS: Medical records for 12 patients (mean age 63.3 years) were retrospectively reviewed to obtain data on clinical presentation, diagnosis and treatment. Surgical morbidity and mortality were analyzed. A pathologist reviewed the resected specimens to determine the morphological factors of prognostic value. The biological nature of the tumor was reclassified based exclusively on mitotic index, and all tumors were staged according to the TGM system. Recurrence and survival rates were also calculated. RESULTS: The most frequent clinical presentation was abdominal pain and gastrointestinal bleeding. The most sensitive diagnostic methods were computerized tomography and echographic endoscopy. Operability and resectability rates were 100% and 91.6% respectively. Local resection was done in 5 patients, partial gastrectomy in 5, and extended total gastrectomy in 1. Histologically, 6 cases were muscular tumors (2 leiomyomas, 3 low-grade leiomyosarcomas and 1 high-grade leiomyosarcoma), 2 were gastrointestinal autonomic nerve (GAN) tumors, and 4 were pure stomal tumors. The morbidity rate was 33.3% and the mortality rate was 8.3% (1 patient). All patients were followed up: 1 patient each died after 9 months and 4 years, 1 developed liver metastases after a disease-free interval of 14 months, and the other 9 patients were still alive and free of disease after intervals ranging from 4 months to 7 years. CONCLUSIONS: Stromal tumors include a group of tumors which may present muscular differentiation (the most frequent type), neural differentiation (GAN tumors) or no differentiation at all (pure stromal tumors). The mitotic index is the most valid parameter to determine biological nature, considering that classification as a benign tumor requires the total absence of mitoses. Treatment was mostly surgical, and local resection with adequate safety margins was effective. Prognosis was relatively good, but long-term follow-up is needed to assess the malignant potential of these tumors.

Adult↗
PubMed1999

The role of lipoaspiration in defeminization of Klinefelter syndrome: a case report.

Klinefelter syndrome is the most frequent sex chromosome anomaly. Affected men characteristically present a tall stature, eunuchoid contours with feminine fat distribution, gynecomastia, hypogonadism, infertility, and behavioral and psychiatric disorders. Diagnosis is confirmed by karyotype, which demonstrates an extra X chromosome. Treatment is mainly directed toward appropriate defeminization. Current treatment consists of testosterone replacement therapy and surgical correction of gynecomastia.

Abdomen↗
PubMed1998

Lifting of the upper two-thirds of the face: supraperiosteal-subSMAS versus subperiosteal approach. The quest for physiologic surgery.

The supraperiosteal-subSMAS lifting technique, which has been performed since 1985, for the rejuvenation of the upper two-thirds of the face is described, and the results obtained in a series of 128 cases treated, emphasizing the attainment of an effective rejuvenation together with a minimum of complications and undesired effects is presented. A discussion on the two dissection planes (supraperiosteal-subSMAS versus subperiosteal) used most commonly in the lifting of the upper two-thirds of the face is presented. From an anatomohistophysiologic basis, the tissue manipulations that the two techniques mandate are discussed and evaluated. Based on these facts, the supraperiosteal-subSMAS technique is the most logical physiologically, because it produces less tissue trauma, which leads to fewer complications and a more rapid recovery to a normal social life.

Adult↗
PubMed1989

The rationalization of liposuction: toward a safer and more accurate technique.

Liposuction, like all surgical procedures, is subject to complications and unfavorable results. Since it is a closed procedure and departs from the usual concept of surgery, its practice is, to a large extent, based on subjective intraoperative estimation. Therefore, it is liable to errors that might have serious local and systemic consequences. In an attempt to improve the technique, the authors have designed new instruments: the "tunnel tracer" and the "guided cannulae." They provide the basis for systematizing the procedure and applying it in a more rational manner. With these instruments and the methodology described in this article, over the last three years we have obtained very satisfactory results and notable reduced morbidity. The advantages are less trauma, less risk, less hemorrhage, less effort for the surgeon, and greater precision.

Equipment Design↗
PubMed1988

A new technique for the treatment of palpebral bags.

A new technique for the treatment of palpebral bags is presented. The technique consists of returning fat to the orbital cavity and retaining it by means of a continuous suture (with nonabsorbable filament) of the capsulopalpebral fascia to the periosteum of the lower orbital rim. The anatomic basis for the technique, after examination of the relevant literature and dissection on fresh cadavers, is analyzed. The procedure followed and results obtained are described in detail. Evaluation of the results suggests to the authors that this might be the method to be applied in the majority of patients.

Adipose Tissue↗
PubMed1983

Two cases of nevoid basal cell carcinoma syndrome.

Motivated by the diagnosis and treatment of two cases of nevoid or Goltz-Gorlin syndrome, we have taken a brief look at the literature and present these two cases, which display the four principal features defining this syndrome: multiple basal cell carcinomas, maxillary cysts, skeletal anomalies, and ectopic calcifications. Certain aspects are emphasized, including the association in one of them of basal cell carcinomas with a cystic adenoma or Brooke's tumor, which, although described by other authors, is infrequent.

Adult↗
PubMedDate not supplied

A new concept in blepharoplasty.

Apart from what may be considered complications, the intervention of any aesthetic surgery can have undesired effects (scar sequelae, normal regional dynamic disorders, edema, iatrogenic acceleration of the aging process in the area). The orbital region is particularly sensitive to these undesirable effects due to its situation and the importance of the eyelids in facial sign language. The sum of these undesirable effects and not infrequent complications often place the plastic surgeon in a compromising situation. It is for this reason that in recent years we have made a special effort to analyze causes, to design new techniques, and to evaluate the combination of different techniques in an attempt to minimize these undesirable effects, so as to be able to offer patients more natural and safer results. It is with this intention that this paper records some anatomical and functional details of the eyelids, analyzes the physiology of the aging process, and examines some classic and modern techniques.

Eyelids↗
PubMedDate not supplied

Liposuction in atypical cases.

Liposuction has become the most frequent aesthetic procedure, and its indications continue to expand to different areas of plastic surgery. In this article the authors present their experience with liposuction in the treatment of nine cases termed "atypical," for not being purely aesthetic. Included are four congenital lipodystrophies-occult spinal disraphism, osteogenesis imperfecta, congenital lipomatosis difusa, and Klinefelter syndrome-and five acquired ones-posttraumatic lipoma, posttraumatic asymmetry, insulinic hypertrophic lipodystrophy, adiposis dolorosa, and TRAM flap. Particular features of each lipodystrophy are reviewed and details of fat distribution and density are described. We also review some specific details of the technique. On the other hand, we wish to point out the importance of recognizing and correctly diagnosing some specific lipodystrophies that are part of defined clinical patterns and that require an integral therapeutic approach.

Adolescent↗