Prof Ricardo Cavalcanti Ribeiro - Academia.edu (original) (raw)

Papers by Prof Ricardo Cavalcanti Ribeiro

Background: The Poland’s syndrome is a rare congenital alteration of the thoracic region, mainly ... more Background: The Poland’s syndrome is a rare congenital alteration of the thoracic region, mainly characterized by the partial or complete absence of the pectoralis major muscle. It has one higher incidence in males, with a predominance of the right side of the chest. Several factors have been associated as possible causes, but currently a main ethology has not been found. Patient and methods: We report the case of a 32-year-old male patient, who presents absence of the pectoralis major on the right side, with only preservation of the portion upper distal of the muscle. Through the use of a mold that is adapted to the region of the defect, we obtained a customized implant with exact measurements of the desired area, the which was placed the day of surgery. A 3D thoracic computerized tomography was perfomed in order to achieve better shape. Results: With the use of this customized prosthesis, we achieve adequate correction of the defect, obtaining the desired symmetry of the thoracic ...

The journal of nutrition, health & aging, 2015

Objectives: To assess body composition, nutritional status and its differences between genders in... more Objectives: To assess body composition, nutritional status and its differences between genders in a sample of Portuguese centenarians. Design: Observational cross-sectional study. Setting: Centenarians recruited in Portugal, able to give informed consent. Participants: A total of 252 subjects, with a median age of 100 years, mostly women (77.8%) who accepted to participate in the study, during the period of 2012 to 2014. Measurements: Anthropometric data collected (weight, height, BMI, waist circumference, hip and waist/ hip ratio) were evaluated according to WHO criteria. A portable tetrapolar bioimpedance analyzer was used to calculate body composition and to assess resting metabolism. Nutritional status was evaluated according to three different criteria: BMI, waist circumference and body fat percentage using anthropometric equations and bioimpedance. Results: We observed an overall mean weight of 51.02±11.03Kg, height of 1.55±0.07m and a BMI of 21.07±3.69Kg/m2. For most of the evaluated parameters, we found substantial differences between genders. The prevalence of underweight and overweight were 25.3% and 13.3%, respectively. Only 5 subjects were obese. Overweight subjects were mostly men (W=10.6% vs. M=22.6%), whereas women were more underweight (W=28.7% vs. M=13.2%). When considering the waist circumference, 26.5% were above the cutoff value. Most of centenarians (72.9%) had a healthy level of visceral fat. This measurement was highly correlated with waist circumference (r= 0.687, p<0.001). The mean of body fat mass was 10.69±6.50Kg, fatfree mass 40.87±7.60Kg and total body water 27.54±6.25Kg. According to body fat mass criteria assessed by bioimpedance, the prevalence of obesity in study population was 6.0% with no gender differences (p = 0.225). Obesity prevalence using anthropometric equations was higher (Deurenberg: 77.7% and Gallagher: 42.8%) than the obtained value by bioimpedance analysis, although according to Bland-Altman analysis both equations showed a good agreement (Deurenberg: 95.8% and Gallagher: 97%) with bioimpedance method. The prevalence of hypohydration (12.9%) was tendentiously higher in women compared to men (W= 15.4% vs. M= 5.0%, p=0.087). Despite the frequency of osteoporosis was higher in women (W = 71.85% vs. M = 28.15%), 95% of men revealed criteria for osteoporosis. Resting metabolic rate (RMR) was significantly different between genders using bioimpedance analysis (W= 1123.33± 173.91; M= 1350.10± 188.88; p<0.001) or Harris Benedict equation (W= 934.92± 102.60; M= 1018.85± 171.68; p=0.001). Bland-Altman analysis between methods indicate that there was an agreement of 97.6%. The overall mean metabolic age obtained was 83.52±1.11 years, well below the chronologic age (p<0.001). Conclusion: In Portuguese centenarians, clinical and nutritional approach should be improved on the gender basis. In relation to nutritional status, centenarians were more frequently underweight than overweight. The thinness could be a natural process, contributing for the longevity being rather overweight a reducing factor in life expectancy. BMI and waist circumference showed a good correlation with body fat percentage. Despite the results of Bland-Altman analysis, Deurenberg and Gallagher equations are not suitable to evaluate obesity prevalence in centenarians. Harris Benedict equation seems to be a good option to measure RMR in centenaries, when BIA is not available. Body composition and nutritional characterization of Portuguese centenarians are relevant contribution in scientific evidence production for the action plan of healthy ageing in Europe (2012-2020) and also for clinical practice. .

Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery, 2016

Queimaduras elétricas por alta voltagem: cinco anos de análise epidemiológica e tratamento cirúrg... more Queimaduras elétricas por alta voltagem: cinco anos de análise epidemiológica e tratamento cirúrgico atualizado Introduction: Evaluation of a 5-year epidemiological analysis and updated surgical treatment of high-voltage electrical burns. Methods: A descriptive, retrospective cross-sectional study was conducted in the Center of Burn Treatment Dr.

Aesthetic Surgery Journal, 2006

Background: Lipoabdominoplasty, the combination of lipoplasty with classical abdominoplasty, pres... more Background: Lipoabdominoplasty, the combination of lipoplasty with classical abdominoplasty, presents new opportunities for the treatment of abdominal lipodystrophy. Objective: The author analyzed 211 patients who underwent lipoabdominoplasty from 2000 to 2004. Methods: After the preoperative physical examination, the patients were classified into 9 different groups according to the indications for the most appropriate technique in each case. Patient groups ranged from those presenting with mild fat panniculus and good quality skin to massive weight loss patients with a high degree of flaccidity. Techniques used in treating the various patient groups included lipoplasty alone, 3 variations of lipominiabdominoplasty, 4 variations of lipoabdominoplasty, and abdominoplasty alone. The surgical principles used in the variations of lipoabdominoplasty included dissection and sculpturing of the subcutaneous deep layer and superficial layer through lipoplasty, selective undermining and plication of the anterior rectus sheath, preservation of the perforator vessels, preservation of Scarpa's fascia and deep fat, skin resection, and umbilical transposition. Results: Two hundred eleven patients were treated between January 2000 and May 2004. Results were good, with high patient satisfaction regardless of variations in technique. There was no loss of sensibility in the suprapubic region in any patients. Among patients who underwent lipoabdominoplasty, there were low complication rates of epidermolysis (1.5%), seroma (1%), hematoma (1%), and necrosis (0.1%). There was no incidence of seroma, necrosis, or hematoma in the lipominiabdominoplasty subgroups I and II; in subgroup III, there was a 2% incidence of necrosis. Seroma was noted in 2% of patients who underwent reverse lipominiabdominoplasty. Similar low complication rates were observed in other groups. Conclusions: The classification of lipoabdominoplasty indications offers good options for treatment of the abdominal region. Lipoplasty, selective undermining, and maintenance of Scarpa's fascia help reduce surgical trauma that is the main factor affecting hematoma and necrosis rates. The learning curve for these classifications is fast because the described procedures are already familiar to most plastic surgeons.

Aesthetic Plastic Surgery

Breast Reconstruction, 2020

There are several breast reconstruction techniques. Each one has specific advantages and disadvan... more There are several breast reconstruction techniques. Each one has specific advantages and disadvantages. The transverse rectus abdominis muscle (TRAM) flap was first described as a free flap by Holmstrom (Scand J Plast Reconstr Surg 13:423–427, 1979). Use of this flap gained popularity as a pedicled flap described by Hartrampf et al. (Plast Reconstr Surg 69:216–225, 1982). TRAM flap allows for the transposition of a considerable volume of autologous tissue suitable for reconstruction of the breast and satisfactory aesthetic results in the donor area. Among the disadvantages of this technique are complications, such as the partial necrosis of the flap, fat necrosis, and weakening of the abdominal wall due to impairment of the rectus abdominis muscle that accompanies the flap.

Aesthetic Plastic Surgery, 2021

The Poland´s Syndrome (PS) was initially described for Alfred Poland in 1941 and is characterized... more The Poland´s Syndrome (PS) was initially described for Alfred Poland in 1941 and is characterized for a set of congenital alterations that involves the chest wall and the ipsilateral superior member in different severity cases. It is a rare illness whose etiology still is unknown. However, studies suggest that it can still have genetic influence or, that extrinsic factors during the pregnancy, can come to intervene with the process of migration of the pectoral great muscle and the separation of the fingers during this period. We defend a detailed clinical evaluation of all the PS cases, in view of the great number of congenital anomalies that can be associates to the illness, with a complete imagen studies including Chest X-Ray, TC scan and in some cases MRI as needed characterize each case in their severity expression. Based in clinical and image studies we propose a Clinical and Radiographic Poland’s Syndrome Classification (CRPS algorithm) to identify each severity level by the c...

Aesthetic Facial Surgery, 2021

Aesthetic Plastic Surgery, 2020

Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery, 2018

A técnica de Baroudi-Ferreira reduz o seroma pós-abdominoplastia?

European Journal of Plastic Surgery, 2019

Background The umbiIicus is a natural scar, and the periumbilical area is characterized by a roun... more Background The umbiIicus is a natural scar, and the periumbilical area is characterized by a round or ellipsoid shape with a slight depression of 2.5-3.0 cm in diameter. It represents an essential feature in the overall body contour, and consequently exists as one of the most esthetically recognized landmarks on the abdominal wall. The umbilicus lies along the midline at the level of the intervertebral discs between the third and fourth lumbar vertebrae and is considered the only admissible scar on the human body. Given that the umbilicus aids in defining the median abdominal sulcus, it is considered the greatest esthetic component of the abdomen. Thus, the effect of the umbilicus on the esthetic appearance of the abdomen remains key-its position on the abdominal wall and its shape and depth represent important factors influencing conceptions of beauty and psychological wellbeing. Methods The aim of this study was to establish a quantitative index by evaluating skeletal landmarks surrounding the anterior wall of abdomen to determine the normal anatomical position of the umbilicus in a sample of Latin-American young women. In this descriptive cross-sectional study, 100 nulliparous Latin-American women, aged 21 to 32 years, were enrolled and examined in the supine position. The mathematical relationship of the umbilicus to various nearby anatomical structures (xiphoid process, pubic symphysis, vulvar commissure, and iliac crests) was determined in order to define its ideal localization. Results In the majority of patients, we observed a slight lateral deviation of the umbilicus, an average distance measuring 14.55 cm between the xiphoid process and the umbilicus, and an average distance measuring 13.14 cm between the umbilicus and the pubic symphysis, with a ratio of 1.10:1. In patients on whom the umbilicus was located medially, the relationship of the distance between the umbilicus and the anterior superior iliac crest, and the distance between both iliac crests, had a ratio of 0.53:1. Conclusions Although numerous studies have examined what constitutes the esthetically ideal umbilicus, no publication, up until now, reports mathematical values. Level of Evidence: Level III, risk / prognostic study.

Aesthetic Surgery Journal, 2009

P oland syndrome (PS) is a rare abnormality with a sporadic presentation characterized by congeni... more P oland syndrome (PS) is a rare abnormality with a sporadic presentation characterized by congenital malformations of the chest wall, with or without alterations to the ipsilateral superior limbs and hands. 1,2 Classically, it consists of a combination of unilateral aplasia of the sternocostal portion of the pectoralis major muscle (PMM) and hypoplasia of the ipsilateral hand, with syndactyly 3,4 and synbrachydactyly. 5 Only 400 cases of PS were reported by 1990; in these cases, several degrees of chest wall malformations extending to the superior limbs were seen. 1 The incidence of PS has a male-to-female ratio of 3:1 and its frequency is estimated at one in 30,000 live births, 6-11 with the right side being affected twice as often as the left side. 12,13 The etiology of PS is still unknown. Several studies have suggested that a genetic factor or, even more likely, extrinsic factors between the sixth and eighth weeks of pregnancy may interfere with PMM migration and the separation of the digits (chirodactile) that occurs in this period. 6-12 The recent vascular hypothesis for the etiology of PS implies that hypoplasia of the ipsilateral subclavian artery is the origin of this birth anomaly. 13-16 The main deformities associated with PS are as follows: (1) Muscles-Absence of the pectoralis minor muscle (PMM), absence of the clavicular and sternal segments of the PMM, 17 and hypoplasia of the serratus anterior, 18,19 latissimus dorsi, deltoid, and infraspinatus and supraspinatus muscles. 20 (2) Mammary glands-Areolar abnormalities, mammary absences, or hypoplasia. 17,18-21 Background: Many chest wall deformities have a characteristic radiologic appearance that can be the basis for a definitive diagnosis. Consequently, imaging techniques have fundamental roles in the detection, location, and characterization of these disorders. Objective: The authors propose a clinical and radiographic Poland syndrome (CRPS) classification system and possible treatment algorithm for the thoracic manifestations of Poland syndrome (PS) in women, based on both clinical examinations and imaging studies. Methods: A retrospective study was conducted of 28 female patients evaluated over 17 years in the 28th Infirmary, Plastic and Reconstructive Surgery Division of the Hospital Santa Casa da Misericórdia do Rio de Janeiro, Rio de Janeiro, Brazil. After clinical examination, all patients underwent radiographic examination with chest radiographs, conventional computed tomography scans, magnetic resonance imaging and, in some cases, additional imaging studies. All clinical and radiologic variables were compiled in a database and used in the classification system, which included three levels of disease severity. Results: Based on the CRPS classification of the 28 female patients, 10 patients had first-degree PS, 14 patients had second-degree PS, and four patients had third-degree PS. Eighteen patients underwent surgical correction; a total of 39 surgical procedures were performed using the CRPS algorithm. Conclusions: Identification of the severity of PS using the proposed classification system provided an accurate study of each patient and enabled better planning for the surgical correction of functional and aesthetic deformities.

Aesthetic Plastic Surgery, 2008

Lipomas are benign tumors composed of mature fat, usually encapsulated. A literature review showe... more Lipomas are benign tumors composed of mature fat, usually encapsulated. A literature review showed that the vast majority of lipomas are small, weighing only a few grams, and grow slowly. According to Hawary et al. (Ann Saudi Med 19(2):174-176, 1999) a giant breast lipoma is characterized by a lesion of at least 5 cm in one dimension and weighs more than 500 g. We present a rare case of a giant breast lipoma with slow growth over 22 years that compromised the entire hemithorax through the right iliac fossa. A 49-year-old woman was referred to our plastic surgery unit because of complaints of severe breast asymmetry due to an enormous mass in the right breast. Twenty-two years earlier she had noticed a soft, mobile, nonpulsatile mass in the inferior quadrant of her right breast. She did not look for medical treatment for all those years for fear of it being cancer. Ultrasound suggested a lipomatous lesion. Open mass biopsy revealed lipoma. The patient underwent a whole mass resection, reconstruction with a parenchymal cross flap, and left breast symmetrization with an inverted T technique. An excellent result with a high degree of patient satisfaction was achieved with the procedure. Parenchymal cross flaps seem to be an option in these situations.

Rev. bras. …, 1996

Base de dados : LILACS. Pesquisa : 169865 [Identificador único]. Referências encontradas : 1 [ref... more Base de dados : LILACS. Pesquisa : 169865 [Identificador único]. Referências encontradas : 1 [refinar]. Mostrando: 1 .. 1 no formato [Detalhado]. página 1 de 1, 1 / 1, LILACS, seleciona. para imprimir. Fotocópia. experimental, Documentos relacionados. Id: 169865. ...