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7th International Workshop on Adverse Drug Reactions and Lipodystrophy in HIV13–16 November 2005, Dublin, Ireland |
SURGICAL TREATMENT OF THE BUTTOCKS AND HIP ATROPHY IN FEMININE LIPODYSTROPHIC PATIENT
J Fontdevila1, J Benito1, E Martínez2, JM Serra-Renom1 and J Gatell2
1 Plastic Surgery Department, Hospital Clínic, University of Barcelona, Barcelona, Spain; 2 Infectious Diseases Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain
Antiviral Therapy 2005; Supplement 3:L27 (abstract no. 41)
AIMS: Effective treatments for the thinning of the legs and buttocks in the lipodystrophic patient have still not been described. The problem is worse in women because the loss of fat in the hips provides them with a masculine aspect, and the lack of anatomical reliefs impedes the subjection of the garments of dressing as the pants. We have developed a protocol of evaluation and surgical treatment.
METHODS: We classified three grades of affectation. From a lateral view we describe a minor grade (I) presenting lost of the gluteal relief, being located the maximum gluteal projection at the level of the sacrum’s projection, a medium grade (II) in which the sacrum projects more than the gluteus and a grade of major severity (III) in which a widespread skeletonization with multiple folds of cutaneous redundancy prevails. The patients are divided into those needing improvement of the gluteal relief or those also needing improvement of the trocantheric relief. In patients with a grade I or II we implanted round silicone prostheses and in the grade III oval prostheses in an intramuscular pocket. At hip level we implanted oval prostheses under the fascia latae, from an incision posterior to the anterosuperior iliac spine. Liposuction of adjacent areas of the sacroiliac area and infiltration of fat in the subgluteal folds contribute to enhance the results obtained.
RESULTS: We have treated eight female patients (three grade I, four grade II, one grade III). In three cases (two grade I, one grade II) we only performed gluteal implantation, while in five cases (one grade I, three grade II, one grade III) the gluteal implant was combined with hip implantation. Three weeks’ recovery is required to be able to walk normally. The only prominent complication has been in the case that major atrophy presented. The hip prostheses moved to the gluteal prostheses’ pocket, requiring their repositioning. None of them have as of yet presented with prosthesis infection or capsular contracture. The patients are very satisfied with the result, aesthetic and functional, but some are worried by the contrast of the treated area with the extreme thinness of legs and thighs.
CONCLUSIONS: At present, the increase of buttock volume by means of silicone prostheses is a much more sure and effective option long term that the infiltration of synthetic materials. A wider casuistic it is necessary to study the results of the treatment with objective parameters.
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2005-11-13
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