Patricio Andrades
Universidad de Chile, Santiago De Chile, Faculty Member
Chest wall shape is an important aspect to consider when planning a breast augmentation. Minor chest wall deformities are usually underestimated by the patient and surgeon and may compromise postoperative outcomes. Lower costal cartilage... more
Chest wall shape is an important aspect to consider when planning a breast augmentation. Minor chest wall deformities are usually underestimated by the patient and surgeon and may compromise postoperative outcomes. Lower costal cartilage dysmorphia or winged rib is one of these minor underestimated chest wall deformities characterized by a visible and palpable cartilaginous prominence under the inframammary fold and causes discomfort in patients decreasing the satisfaction with the breast augmentation surgery. For these patients, the author utilized an innovative surgical technique that allows resection of the protruding cartilages and placement of breast implants through the same surgical incision. Six patients with winged ribs underwent breast augmentation and costal cartilage resection via this method and there were no intraoperative or early postoperative complications, and all patients were satisfied with the aesthetical result after 6 months of follow-up. The presented surgical technique has a short learning curve with excellent postoperative results. Cases are presented to demonstrate the improved postoperative chest wall contour combined with breast augmentation outcome.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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SUMMARY The Lichtenstein's technique (LT) for hernia repair has become popular due to its good results. We adopted this technique in 1997. The goal of this report is to present the results of LT. The medical records of 178 patients... more
SUMMARY The Lichtenstein's technique (LT) for hernia repair has become popular due to its good results. We adopted this technique in 1997. The goal of this report is to present the results of LT. The medical records of 178 patients submitted to inguinal hernia repair with the LT between January and December 1998 were reviewed. The series is composed of 147 males (83%) and 31 females (17%, with an average age of 59 years (range 15-86). A total of 196 hernias were repaired; of them, 83 (42%) were direct, 78 (40%) were indirect, 12 (6%) were inguino-scrotal and 12 (6%) were mixed. In 11 patients (6%), the hernia was a recurrence. Local anesthesia was used in 115 (64%) cases, regional anesthesia was used in 49 (28%) cases and general anesthesia was used in 14 (8%) of the cases. Average hospital stay was 1.38 days. In 24% of the cases surgery was performed as an outpatient procedure. The most frequent early complications were 7 seromas and 6 operative wound infections. Follow up was ...
Introducción: La incorporación de tecnologías en la práctica quirúrgica, ha cambiado la forma de enfrentar el proceso quirúrgico. Objetivo: Describir la experiencia de los últimos 9 años, en cirugía ortognática, con la incorporación de la... more
Introducción: La incorporación de tecnologías en la práctica quirúrgica, ha cambiado la forma de enfrentar el proceso quirúrgico. Objetivo: Describir la experiencia de los últimos 9 años, en cirugía ortognática, con la incorporación de la cefalometría 3D. Materiales y metodos: Se realizó una revisión retrospectiva de pacientes operados de cirugía ortognática durante el período enero 2011 a agosto 2018. Se registraron datos demográficos, quirúrgicos, tipo de planificación quirúrgica, complicaciones y resultados a largo plazo. Resultados: 21 pacientes requirieron cirugías ortognáticas. Se realizaron 16 cirugías bimaxilares (76%), 3 cirugías de avance maxilar superior (14%) y 2 cirugías de osteotomía sagital de rama (10%). Las principales etiologías fueron: 67% Maloclusión clase III (n=14), 28% maloclusión clase II (n=6) y 5% desviación mandibular (n=1). La planificación pre-quirúrgica virtual fue utilizada en 11 pacientes (52%). La tasa de complicaciones Clavien-Dindo >III fue 4.8%...
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Acute compartment syndrome (ACS) is the increase of pressure in a closed osteofascial space. This reduces capillary perfusion below the level necessary for tissue viability. Injury could be irreversible if proper treatment is not... more
Acute compartment syndrome (ACS) is the increase of pressure in a closed osteofascial space. This reduces capillary perfusion below the level necessary for tissue viability. Injury could be irreversible if proper treatment is not performed. Hand ACS secondary to cutaneous loxoscelism with edematous predominance is extremely infrequent. We present a clinical case of a 22-year-old patient who started a hand compartment syndrome secondary to cutaneous loxoscelism (CL), requiring emergency surgical treatment with dorsal and palmar fasciotomy.
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The aim of the study was to describe the normal orbital volume and its most important relationships with other clinical variables. We designed a correlation study and consecutive normal CTs scans were included. Orbital volume and facial... more
The aim of the study was to describe the normal orbital volume and its most important relationships with other clinical variables. We designed a correlation study and consecutive normal CTs scans were included. Orbital volume and facial anthropometrics were measured and correlated between them. Two independent and blind observers made all the measurements. Uni and multivariate statistical analysis were performed in order to create a predicting model for orbital volume. A total of 199 consecutive patients were included in the study (398 orbits). The mean Orbital Volume (OV) was 24.5 ± 3.08 cc. Adequate intra and interobserver reliability was observed. There were no differences between the right and left orbit (p=0.73). The male average OV was 24.9 ± 3.03 cc, the female OV was 23.9 ± 3.08 cc. Age group analysis demonstrated a slow increase in OV beyond thirty years, but these differences were not significant (p=0.98). Only the age, total facial height, facial width and the interorbita...
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Resumen Introduccion La calidad de vida es uno de los resultados en cirugia de contorno corporal mas importantes. La evidencia sobre la calidad de vida de estos pacientes a largo plazo es escasa. El objetivo de este estudio fue determinar... more
Resumen Introduccion La calidad de vida es uno de los resultados en cirugia de contorno corporal mas importantes. La evidencia sobre la calidad de vida de estos pacientes a largo plazo es escasa. El objetivo de este estudio fue determinar si la calidad de vida obtenida en el postoperatorio temprano posterior a la cirugia de contorno corporal se mantiene a largo plazo. Metodos Se diseno un estudio de cohorte prospectiva compuesta por pacientes postoperados de cirugia de contorno corporal con mas de un ano de seguimiento. La calidad de vida fue medida con el instrumento Body-Qol ® . Se compararon los puntajes preoperatorios, postoperatorios tempranos y postoperatorios tardios. Se realizo el analisis estadistico con las pruebas de Kruskal-Wallis y Kolmogorov-Smirnov. Resultados La cohorte se compuso de 112 pacientes con un seguimiento a largo plazo del 75%. En toda la cohorte la calidad de vida mejoro entre el preoperatorio (43,9 ± 14,1 puntos) y ambas mediciones postoperatorias (85,2 ± 16,8 postoperatorio temprano y 83,6 ± 13,5 postoperatorio tardio), siendo estadisticamente significativo (p Conclusiones La calidad de vida mejora significativamente posterior a la cirugia de contorno corporal de forma temprana, y esta mejoria es estable en el tiempo. Esto se observa tanto en los pacientes esteticos como en los posteriores a la perdida masiva de peso.
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This study aimed to determine the diagnostic accuracy of different diagnostic tests in predicting nasal septum deformities during preoperative planning for septorhinoplasty. Consecutive patients who underwent septorhinoplasty between June... more
This study aimed to determine the diagnostic accuracy of different diagnostic tests in predicting nasal septum deformities during preoperative planning for septorhinoplasty. Consecutive patients who underwent septorhinoplasty between June 2011 and August 2012 were included (n = 30) and underwent a protocol of diagnostic tests, including nasal speculoscopy, craniofacial computed tomography (CT), three-dimensional (3D) reconstruction of the nasal septum by CT and nasal endoscopy. A modified Guyuron classification of septal deformities was used for classifying the septal deviations. Direct surgical assessment of the nasal septum during open septorhinoplasty was the reference standard with which each of the diagnostic tests was compared. Sensitivity, specificity and predictive values of each test were calculated. The preoperative diagnosis was nasal bone fracture in 11 patients, nasal septal fracture in 15 and post-traumatic nasal deformity in four. For type A deviations (localised), craniofacial CT showed the highest performance with a sensitivity of 100%, specificity of 100%, positive predictive value (PPV) of 100% and negative predictive value (NPV) of 99%. For type B septal deformations (C shape), nasal endoscopy (sensitivity, 100%; specificity, 87.5%; PPV, 87.7%; and NPV, 100%) showed the highest performance. For type C deformities (S shape), nasal endoscopy (sensitivity, 70%; specificity, 100%; PPV, 100%; and NPV, 87%) showed the highest performance. The accuracy for nasal endoscopy was 27/30 (90%), 26/30 (87%) for craniofacial CT, 22/30 (73%) for 3D reconstruction and 10/28 (36%) for speculoscopy. Nasal endoscopy and craniofacial CT were more accurate and precise than nasal speculoscopy and 3D reconstruction for preoperative evaluation of the nasal septum, thus enabling more appropriate surgical planning for septorhinoplasty.
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... study included a group of patients who underwent breast reduction via the B technique, and two other groups, one which underwent reduction via the Eren technique, and ... Peterson and Tobin retrospectively reviewed 40 patients who... more
... study included a group of patients who underwent breast reduction via the B technique, and two other groups, one which underwent reduction via the Eren technique, and ... Peterson and Tobin retrospectively reviewed 40 patients who underwent B-technique mastopexy in 2007. ...
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... Arturo S. Prado, MD. Patricio Andrades, MD. Susana Benitez, MD. ... Brown, SL, Middleton, MS, Berg, WA, Soo, MS, and Pennello, G. Prevalence of rupture of silicone gel breast implants revealed on MR imaging in a population of women in... more
... Arturo S. Prado, MD. Patricio Andrades, MD. Susana Benitez, MD. ... Brown, SL, Middleton, MS, Berg, WA, Soo, MS, and Pennello, G. Prevalence of rupture of silicone gel breast implants revealed on MR imaging in a population of women in Birmingham, Alabama. AJR Am. ...
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The extensive list of treatments for the nasolabial area illustrates that the problem is not solved yet. Although a better understanding of the anatomy and physiology of the nasolabial area has been developed, the ideal treatment has not... more
The extensive list of treatments for the nasolabial area illustrates that the problem is not solved yet. Although a better understanding of the anatomy and physiology of the nasolabial area has been developed, the ideal treatment has not been found. It seems that a combined approach based on summation of partially effective modalities is the best option. The authors present their experience with combined deep plane rhytidectomy, malar fat lift, and superficial musculoaponeurotic system graft in the treatment of the aging nasolabial area. Results in 70 consecutive patients are presented with this simple, nonscarring, inexpensive technique.
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Nasal reconstruction has been analyzed extensively in adults but not in children. The purpose of this article is to review the authors' experience with the... more
Nasal reconstruction has been analyzed extensively in adults but not in children. The purpose of this article is to review the authors' experience with the forehead flap for nasal reconstruction in 10 children under the age of 10 during a 10-year period. Outcomes were assessed by an objective grading system for cosmetic surgical results. Subjective criteria were also applied by an assistant surgeon and by the patients' relatives. Appropriate results were obtained by the following principles: (1) A modified approach that considers three subunits consisting of the dorsum, tip, and ala was used; (2) a forehead flap is the best option for an entire subunit or a full-thickness defect repair; (3) the forehead flap design should be paramedian, oblique, and opposite to the major defect to avoid the hairline and allow better caudal advancement; (4) ear or costal cartilages are good options for structural support (the septum is a nasal growth center that should not be touched); (5) infundibular undermining of vestibular mucosa, turnover flaps, and skin grafts are good options for internal lining; (6) reconstruction is a three-stage procedure (an intermediate operation is added to thin the flap and perform secondary revisions for lining and support); (7) reconstruction should be completed before the child is school aged, to achieve good aesthetic results immediately and avoid psychosocial repercussions; and (8) the reconstructed nose, with skin, lining, and support, will grow with the child (no final surgery should be planned at the age of 18, other than revisions of late complications).
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The purpose of this article is to describe an alternative nonresective treatment of the fat-septum component of the eyelids during blepharoplasty, using shrinkage desiccation with two low-energy modalities: a carbon dioxide laser and a... more
The purpose of this article is to describe an alternative nonresective treatment of the fat-septum component of the eyelids during blepharoplasty, using shrinkage desiccation with two low-energy modalities: a carbon dioxide laser and a low-range grid of electrocautery with a Colorado microdissection needle. Thirty-six patients underwent a four-lid blepharoplasty. During surgery, after exposure (not opening) of the septum and assessment of the amount of bulging by gentle globe compression, a grid spray of electrocautery (right eye) and carbon dioxide laser (left eye) was applied over the entire septum until shrinkage and correction of the bulging was achieved. Preoperative, postoperative day 15, and 1-year follow-up photographs were evaluated using an objective grading system by blinded surgeons. For statistical analysis, the Wilcoxon matched-pairs signed-ranks test was used, with p < 0.05 indicating statistical significance. All the patients completed the 15-day evaluation, but only 32 completed the 1-year follow-up. No major eye or eyelids complications were observed. There were no statistical differences in surgical time and postoperative pain on either side. In this study, laser fat-septum shrinkage achieved substandard results compared with electrocautery when analyzed as a continuous variable, but it did not influence the categorical Strasser scale final result in the short- and long-term follow-up. The method described is simple and safe, and provides a subtle but long-lasting, adequate result. No statistical clinical differences were observed between the electrocautery and laser fat-septum shrinkage techniques.
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The purpose of this article is to describe an alternative nonresective treatment of the fat-septum component of the eyelids during blepharoplasty, using shrinkage desiccation with two low-energy modalities: a carbon dioxide laser and a... more
The purpose of this article is to describe an alternative nonresective treatment of the fat-septum component of the eyelids during blepharoplasty, using shrinkage desiccation with two low-energy modalities: a carbon dioxide laser and a low-range grid of electrocautery with a Colorado microdissection needle. Thirty-six patients underwent a four-lid blepharoplasty. During surgery, after exposure (not opening) of the septum and assessment of the amount of bulging by gentle globe compression, a grid spray of electrocautery (right eye) and carbon dioxide laser (left eye) was applied over the entire septum until shrinkage and correction of the bulging was achieved. Preoperative, postoperative day 15, and 1-year follow-up photographs were evaluated using an objective grading system by blinded surgeons. For statistical analysis, the Wilcoxon matched-pairs signed-ranks test was used, with p < 0.05 indicating statistical significance. All the patients completed the 15-day evaluation, but only 32 completed the 1-year follow-up. No major eye or eyelids complications were observed. There were no statistical differences in surgical time and postoperative pain on either side. In this study, laser fat-septum shrinkage achieved substandard results compared with electrocautery when analyzed as a continuous variable, but it did not influence the categorical Strasser scale final result in the short- and long-term follow-up. The method described is simple and safe, and provides a subtle but long-lasting, adequate result. No statistical clinical differences were observed between the electrocautery and laser fat-septum shrinkage techniques.
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Skip Navigation Links Home > April 1, 2002 - Volume 109 - Issue 4 > Caution in Using Botox in Patients with Previous Frontal Sur... ... Caution in Using Botox in Patients with Previous Frontal Surgery. Prado, Arturo CMD; Andrades,... more
Skip Navigation Links Home > April 1, 2002 - Volume 109 - Issue 4 > Caution in Using Botox in Patients with Previous Frontal Sur... ... Caution in Using Botox in Patients with Previous Frontal Surgery. Prado, Arturo CMD; Andrades, Patricio RMD. Article Outline. Collapse Box ...
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Close Window. Close Window. Thank you for choosing to subscribe to the eTOC for Plastic and Reconstructive Surgery. Enter your Email address: Wolters Kluwer Health may email you for journal alerts and information, but is ...
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... Arturo S. Prado, MD. Patricio Andrades, MD. Susana Benitez, MD. ... Brown, SL, Middleton, MS, Berg, WA, Soo, MS, and Pennello, G. Prevalence of rupture of silicone gel breast implants revealed on MR imaging in a population of women in... more
... Arturo S. Prado, MD. Patricio Andrades, MD. Susana Benitez, MD. ... Brown, SL, Middleton, MS, Berg, WA, Soo, MS, and Pennello, G. Prevalence of rupture of silicone gel breast implants revealed on MR imaging in a population of women in Birmingham, Alabama. AJR Am. ...
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The extensive list of treatments for the nasolabial area illustrates that the problem is not solved yet. Although a better understanding of the anatomy and physiology of the nasolabial area has been developed, the ideal treatment has not... more
The extensive list of treatments for the nasolabial area illustrates that the problem is not solved yet. Although a better understanding of the anatomy and physiology of the nasolabial area has been developed, the ideal treatment has not been found. It seems that a combined approach based on summation of partially effective modalities is the best option. The authors present their experience with combined deep plane rhytidectomy, malar fat lift, and superficial musculoaponeurotic system graft in the treatment of the aging nasolabial area. Results in 70 consecutive patients are presented with this simple, nonscarring, inexpensive technique.
Research Interests:
Nasal reconstruction has been analyzed extensively in adults but not in children. The purpose of this article is to review the authors' experience with the... more
Nasal reconstruction has been analyzed extensively in adults but not in children. The purpose of this article is to review the authors' experience with the forehead flap for nasal reconstruction in 10 children under the age of 10 during a 10-year period. Outcomes were assessed by an objective grading system for cosmetic surgical results. Subjective criteria were also applied by an assistant surgeon and by the patients' relatives. Appropriate results were obtained by the following principles: (1) A modified approach that considers three subunits consisting of the dorsum, tip, and ala was used; (2) a forehead flap is the best option for an entire subunit or a full-thickness defect repair; (3) the forehead flap design should be paramedian, oblique, and opposite to the major defect to avoid the hairline and allow better caudal advancement; (4) ear or costal cartilages are good options for structural support (the septum is a nasal growth center that should not be touched); (5) infundibular undermining of vestibular mucosa, turnover flaps, and skin grafts are good options for internal lining; (6) reconstruction is a three-stage procedure (an intermediate operation is added to thin the flap and perform secondary revisions for lining and support); (7) reconstruction should be completed before the child is school aged, to achieve good aesthetic results immediately and avoid psychosocial repercussions; and (8) the reconstructed nose, with skin, lining, and support, will grow with the child (no final surgery should be planned at the age of 18, other than revisions of late complications).
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Geometry is fundamental in the comprehension of local flap design. The purpose of this study was to discuss the differences between the V-Y advancement flap and other local flaps, understand its geometry, and analyze its clinical... more
Geometry is fundamental in the comprehension of local flap design. The purpose of this study was to discuss the differences between the V-Y advancement flap and other local flaps, understand its geometry, and analyze its clinical applications. The analysis was based on qualitative measurements of an injury, taking into consideration the following dimensions: largest diameter, shortest diameter, and depth. Standardization of the flap design consisted of directing its advancement over the shortest diameter and making the V base match the size of the largest diameter. The flap was analyzed in two planes: the horizontal plane includes the V-Y design and the vertical plane includes the flap pedicle. The height of the flap can be obtained by simple trigonometry, taking into consideration the largest diameter and alpha angle in the horizontal plane. In the vertical plane, where the pedicle and pivot plane are positioned, for known shortest diameter and depth, the final depth of the pivot plane can be calculated using Pythagoras' principles. This analysis was applied to 25 patients with adequate skin coverage at follow-up. A correction factor was added to reduce the overdeepening of the vertical plane calculations. The final concepts for clinical application in the classic deep pedicle V-Y flap design are to calculate the length of the V by modifying the alpha angle and to move the pivot plane deeper to accomplish optimal flap movement. Using these principles, tension-free closure of the Y and appropriate advancement of the flap are obtained.
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ABSTRACT
Salvage of a failed autologous breast reconstruction is a complex and challenging problem. The purpose of this study was to analyze the indications, methods, and outcomes of tertiary surgery in patients with a failed autologous breast... more
Salvage of a failed autologous breast reconstruction is a complex and challenging problem. The purpose of this study was to analyze the indications, methods, and outcomes of tertiary surgery in patients with a failed autologous breast reconstruction. A retrospective chart review was performed for all patients who underwent breast reconstruction with autologous tissue performed by the senior author (M.H.) between 2002 and 2009. Special emphasis was made to evaluate the first reconstruction performed, causes of failure, indications for tertiary reconstruction, and outcomes. A preoperative hematologic workout was performed. For patients who were classified within the highest group of thromboembolism, specific prophylactic measurements were taken for the tertiary surgery. Of 688 patients who underwent autologous breast reconstruction, a total of 14 patients required tertiary breast reconstruction. Hypercoagulability was found in three patients resulting from disorders such as lupus anti...