Introduction: Fournier gangrene is a polymicrobial life threatening infection of perineal subcutaneous soft tissues with its point of origin in urologic, colorectal or skin diseases. Although more frequent in elderly and men, it can affect all genders and age groups. Perianal abscess, diabetes mellitus and Escherichia coli are the most frequent cause, predisposing comorbidity, and microorganism found in tissue culture analysis respectively. The objective of this study was to describe the experience of a Plastic Surgery Department of a tertiary Hospital in reconstructing Fournier’s gangrene perineal defects and its detailed demography.Material and Methods: The sample is composed of all patients with Fournier gangrene admitted in the Plastic Surgery and Burns Department. The authors retrospectively collected and analyzed demographic and clinical data during a period of 10 years including gender, age, length of stay, cause, number of debridements, predisposing factors, microbial culture results, surgical reconstructive techniques and its associated complications, additional surgical procedures and outcomes.Results: Fifteen patients were identified: 14 males (93%) and one female (7%); mean age was 66.9 years (range: 46 - 86); mean, length of stay was 46.8 days (range: 20 - 71 days) and mean number of debridements was 3.3 (range: 1 - 4). The most frequent predisposing factor was diabetes mellitus, the major cause was perianal (n = 2) and skin abscess (n = 2). Eight (53.3%) patients had no identifiable source of Fournier gangrene. Various types of reconstructive techniques were employed; and 5 additional surgical interventions (33.3%) were undertaken (one cystostomy, two orchidectomy, two ileostomy); six patients (40%) presented reconstructive technique complications with adequate final outcome.Discussion: In contrast with the literature, where Escherichia coli was the most frequently isolated agent, Staphylococcus aureus was the most frequent microorganism found in tissue biopsy/pus collection analysis. A higher than expected number of patients (n = 8) had no identifiable source of Fournier gangrene. This findings can be explained by the retrospective non-multicentre study limitation, with a potencial source of bias patients that were transferred from other hospitals in advanced stage, without point of origin of Fournier’s gangrene identified.Conclusion: Early recognition and extensive necrotic tissue debridement, along with prompt and adequate antimicrobial treatment, are the mainstay of Fournier gangrene management, thus reducing morbidity and mortality in these patients. Surgical reconstruction challenges derived from this condition should be addressed by specialized teams due to the risk of dysfunctional sequelae and conspicuous deformities. Taking in account the single-center and retrospective observational character of the present study, these premises require proper validation from a multicenter prospective study.

Madelung disease is characterized by the formation of diffuse uncapsulated lipomata in different body areas and is responsible for severe cosmetic deformities. Although it is described as a rare entity in the literature, at our department it is seen quite often. The authors make a revision of the literature on this disease and then report on the cases of Madelung disease operated between January 2003 and October 2008 at the Plastic surgery department of Coimbra University Hospital.

Introduction: Evaluating the impact of surgical treatment on health-related quality of life of breast cancer patients has become increasingly relevant, particularly for reconstructive procedures. The BREAST-Q consists of a broadly used patient-reported outcome measure to assess the impact of breast surgery on the health-related quality of life of these patients. The aim of this study was to translate and linguistically validate the BREAST-Q reconstructive module to European Portuguese.Material and Methods: The translation and linguistic validation process was based on the International Society for Pharmacoeconomics and Outcomes Research guidelines and started after obtaining permission from the original authors (developers). It involved two direct English to European Portuguese translations and a back translation, maintaining conceptual and cultural equivalence, an expert panel discussion, cognitive interviews with five patients and a final consensus.Results: The forward translations led to the revision of three conceptually distinct items. The backward translation resulted in predominantly wording discrepancies and the three conceptual disparities noted in the back translation were revised on a consensual version. All material was openly discussed with the original authors and in an expert panel meeting. One item was changed after the cognitive interviews. The final consensual version was obtained.Conclusion: This stepwise approach allowed to linguistically validate the BREAST-Q reconstructive module to European Portuguese so that it can be used in the Portuguese population. Additionally, the applied methodology may serve to support and guide other instruments for linguistic validation.

No abstract

Gender dysphoria (GD) is characterized by a marked discordance between the psychological perception of individual sex and the biological phenotype. In the present article, the authors aimed to analyze the clinical data of a cohort of subjects diagnosed with GD, referred to a national unit, specialized in the endocrine, psychiatric and surgical treatment of this entity. Methods: Data about demographics and response to treatment, were retrospectively analysed in 85 subjects diagnosed with GD, who were observed in the Endocrinology Consultation, during a 12-year period. Results: It was verifi ed that among 85 patients included in the study, 38 (44.7%) were transgender females and 47 (55.3%) were transgender males. The number of patients seeking treatment substantially increased in the last 5 years, with an inferior age of referral in transgender males. Sixty-three patients (74.1%) started cross-sex hormone therapy, deprived of signifi cant adverse events, and gender affi rming surgery was performed in 25 patients (29.4%). Conclusion: Our study revealed a progressively growing number of patients seeking sexual reassignment, being predominantly transgender males. The majority of subjects started hormone therapy without substantial related adverse events, corroborating that it may be considered as a relatively safe treatment. Gender affi rming surgery was performed in a reasonable number of patients, which was comparable with the experience of other centers.