RESUMOO presente estudo de revisão visa uniformizar a nomenclatura e os conceitos classificatórios existentes na literatura, relativos aos desenhos ou modelos de estudo científico mais comumente utilizados em pesquisas na área clínico-cirúrgica geral. Procurou-se facilitar a elaboração do delineamento de um projeto de pesquisa científica, visando sua aplicabilidade. Esta revisão também tem o intuito de auxiliar o cirurgião-pesquisador a identificar qual foi o delineamento proposto em um artigo, assim como desenvolver um senso de crítica metodológica mais apurada sobre o mesmo, além de desmistificar a miscelânea conceitual existente na literatura. Descritores: Pesquisa Biomédica. Modelos Epidemiológicos. Projetos de Pesquisa Epidemiológica. Ensaios Clínicos. Estudos de Coortes. ABSTRACTThe purpose of this study is to analyze the classifications and concepts found at the literature regarding the research models on scientific studies commonly used in medical articles. This paper provides elements to facilitate the creation of a research model. It also helps the researcher to identify which is the research model of an article. This article will enable the reader of a scientific paper to have a more accurate sense of criticism of the Methods of a study. Key words: Biomedical Research. Epidemiologic Models. Epidemiologic Research Design. Clinical Trials. Cohort Studies. IntroduçãoO ramo da Medicina que trata da metodologia das pesquisas é conhecido como Epidemiologia Clínica. Esse ramo, considerado uma área básica, constitui-se num importante alicerce no qual a Medicina moderna é praticada. Essa denominação é oriunda de duas disciplinas médicas: Epidemiologia e Medicina Clínica (ou Geral). A contribuição da Epidemiologia é representada pelo fato que vários dos métodos utilizados, para responder as questões das pesquisas, foram desenvolvidos por epidemiologistas, e pelo cuidado individual dos pacientes ser considerado num contexto da população maior, da qual o paciente faz apenas parte. A contribuição da Medicina Clínica reside na procura em responder a questões clínicas, assim como conduzir decisões clínicas baseadas nas melhores evidências disponíveis. 1 Porém, um fator considerado essencial ao progresso da pesquisa médica veio da área da Matemática. A Bioestatística introduziu a análise estatística para a confirmação de achados, assim como para a avaliação de tratamentos médicos, fornecendo-lhes maior solidez, confiabilidade e credibilidade.
The quilting suture seems to be an efficient technique with which to prevent seroma formation.
Abdominoplasty candidates showed the highest prevalence; rhytidectomy candidates exhibited the highest percentage of severe cases, and rhinoplasty candidates had the lowest percentage of severe cases.
Purpose: Preoperative imaging evaluation may be useful for determining the position of recti abdominis muscles before their correction. The purpose of this study is to evaluate the accuracy of ultrasonography to measure the width of rectus abdominis muscle diastasis. Methods: Rectus diastasis was measured by ultrasonography preoperatively in 20 females. Rectus diastasis was measured in seven levels along the anterior rectus sheath by ultrasound after sustained deep inspiration and after expiration. Rectus diastasis, at the same levels, was also measured after its exposition during abdominoplasty by two independent observers, using a surgical compass. These values were compared using Wilcoxon's statistical text, for non independent values. Results: There was no significant difference between the values obtained by ultrasound and those measured during surgery in the supra-umbilical levels and at the level of the umbilicus. However, below the umbilicus these values differed significantly, showing smaller values in the imaging evaluation. Conclusion: Ultrasonography is an accurate method to measure rectus diastasis above the umbilicus and at the umbilical level. Key words: Abdominal Wall. Abdominal Muscles. Ultrasonography. Diagnostic Imaging. Surgery, Plastic. Rectus Abdominis. RESUMO Objetivo:Estudos radiológicos pré-operatórios podem ser úteis para determinar a posição dos músculos retos do abdome antes de sua correção. O objetivo deste estudo é avaliar a acurácia da ultra-sonografia para medir a largura da diástase dos músculos retos do abdome. Métodos: A diástase dos músculos retos foi medida pela ultra-sonografia, no pré-operatório em 20 mulheres. A diástase dos retos foi medida em sete níveis da bainha anterior dos retos foram examinados com ultrasom após inspiração profunda sustentada e após expiração. A diástase dos retos, nos mesmos níveis, foi também medida após sua exposição durante a abdominoplastia, por dois observadores independentes, usando compasso cirúrgico. As medidas foram comparadas usando o teste estatístico de Wilcoxon para dados não independentes. Resultados: Não houve diferença significante entre as medidas ultra-sonográficas e intra-operatórias nos níveis supra-umbilicais e na cicatriz umbilical. Todavia, inferiormente à cicatriz umbilical, essas medidas diferiram significantemente sendo as ultrasonográficas menores nestes pontos. Conclusão: A ultra-sonografia é um método acurado para medir a diástase de retos na região supra-umbilical e no nível do umbigo.
Abdominoplasty with quilting sutures and lipoabdominoplasty are effective techniques for the prevention of seromas compared with abdominoplasty without quilting sutures.
Nylon and polydioxanone are two sutures commonly used to correct rectus diastasis. Polydioxanone, as an absorbable suture, has the advantage of not being palpable in thin patients. Because several forces act against the plication, an absorbable suture would not be efficient in these cases. In this study, two groups of 10 patients each were studied. These patients underwent abdominoplasty and correction of rectus diastasis. In the control group, 2-0 nylon was used to plicate the anterior aponeurosis and 0-polydioxanone was used in the experimental group. The tension of the abdominal wall was measured with a dynamometer in both groups. The width of rectus diastasis was measured 3 cm above and 2 cm below the umbilicus, using a computed tomography (CT) scan before the operation and 3 weeks and 6 months after surgery. The width of rectus diastasis was measured intraoperatively at the same levels. The data were analyzed by Student's t test. Both groups had similar abdominal wall tension on both levels. The diastasis recti was completely corrected at both levels, as confirmed by the 3-week postoperative CT scan and the 6-month CT scan. At the superior level, the width of the rectus diastasis on the preoperative CT scan (2.6 +/- 0.7 cm) was similar to the values obtained intraoperatively (2.7 +/- 0.6 cm), showing no significant statistical difference. At the inferior level, the largest difference between the preoperative CT scan and the intraoperative finding was 0.3 cm. In conclusion, the correction of rectus diastasis with 2-0 nylon and 0-polydioxanone was achieved and maintained after 6 months. CT scans are an accurate method for studying rectus diastasis and other muscles of the abdominal wall.
Davis DA. Combination forceps fuse both safety and efficiency. Dermatol Surg 2006; 32:717-20. 5 Schuckman MM, Bauland CG. Skin hook and forceps as a unified instrument: the Griffin forceps. Plast Reconstr Surg 2004; 113:462-3. 6 Lalonde DH. Hook forceps. Ann Plast Surg 1991; 26:597-9. 7 Kelly MBH. 'Tusked' forceps for rapid and atraumatic subcuticular closure of the skin. Br J Plast Surg 1998; 51:124-5.
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