Reestablishing anterior rectus fascial integrity remains a clinical challenge after transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction. The main concerns include herniation and bulging due to abdominal weakness. Mesh-assisted closure of the fascial defect has improved bulging and herniation rates but infection, extrusion, and encapsulation are serious concerns with mesh use. Biologic tissue matrices may overcome some of these mesh-related complications. The initial experience of using Strattice for fascial closure after TRAM flap procedure is described in this article. Strattice was in-lain and sutured between the anterior and posterior layers of the rectus fascia, at the rectus muscle donor site. The abdominal wall was closed with progressive tension sutures. Postoperative complications at the donor site were assessed. A total of 16 unilateral and 9 bilateral reconstructions were performed in 25 patients. Length of hospital stay was 2 to 3 days which is shorter than with mesh repair (typically 4-5 days). During a mean follow-up period of 14.0 months, complications occurred in 7 patients (28%): seroma formation (2), minor skin separation (2), superficial skin infection (2), and superficial wound dehiscence (1). Complications were not directly related to Strattice and all, except one (superficial skin infection), were resolved without surgical intervention. In all patients, routine abdominal functions were restored 4 months postoperatively. Strattice is a safe, alternative option to synthetic mesh for fascial repair following TRAM flap breast reconstruction. When used in conjunction with progressive tension suture closure of the abdominal wall, dynamic reconstruction of the abdominal wall with resumption of abdominal function is possible with Strattice.
Quintas RCS et al. Complex nasal reconstruction: surgical options in a series of cases Reconstrução nasal complexa: opções cirúrgicas numa série de casos
Problem. More than six times the number of applicants than can be accepted attempt to enter the theology program on the campus of the Adventist Brazilian University of São Paulo (UNASP). The number of applicants is increasing every year and the majority cannot follow their chosen career. Purpose. The purpose of this study was to investigate and identify the dominant characteristics and the discriminant factors that motivated the career choice of freshman theology students in a private denominational university in Brazil. The study also analyzed the demographic characteristics of those students and their perceived sense of mission for a ministerial career. Method. As a quantitative, descriptive and exploratory study, based on the survey research approach, this study found the dominant characteristics and the main discriminant factors that motivated the freshmen of the theology program of the Adventist Brazilian University, UNASP, by comparing the results of the applied socioeconomic and cultural questionnaires that are administered with the Exame Nacional de Cursos – ENC (National Exam of Study Programs) used yearly to test students on federal government campuses, between those theology students and the freshman students of other undergraduate programs of the same school. In addition, a questionnaire developed by the researcher was used to find the discriminant factors that motivated such choice. The results were obtained with a sample of 114 theology freshmen and 125 freshman students of other programs. Descriptive statistics was used to describe the students’ demographic profile, and relative frequency was used to make a comparison between students of theology, students of other programs, and students of the national sample. Exploratory factor analysis was used to develop a motivational scale with seven factors. In addition, discriminant analysis was used to identify which of those factors are discriminant factors (predictors) of career choice. Findings. It was observed that the theology freshmen students’ dominant characteristics were related to age, marital status, race, family income, work and self-support, reading habits, kinds of books read, newspaper reading, library use, study hours, and gender; and were among the seven predictive factors of looking for communion with God, sense of vocation, search for self-fulfillment, sense of mission, search for status, preparation for a job or career, and looking for self-realization. The discriminant factors were sense of vocation, sense of mission, and looking for status. The accuracy of classification was 91.5% of all the cases. Conclusions. The findings show that the theology freshman characteristics are in some aspects quite similar to the group of other students of the same school and of the national sample, but in some characteristics they are quite different in that they may be classified as a distinct group looking for a religious work or career. As far as predictive factors that motivate their career choice, there seems to be consistent predictive factors underlining the choice and motivation of a ministerial career, which are sense of vocation and sense of mission in contrast with the search for status and security.
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