Lipodistrofia CORPORAL
     
  
  
TRATAMENTO DA LIPODISTROFIA CORPORAL COM PMMA EM PACIENTES PORTADORES DE HIV/AIDS


Objetivo: H� 6 anos estamos tratando atrofia facial com PMMA com sucesso (Fig. 1), mas nos 䩭os anos pacientes come硲am a reclamar de mudan硳 nas formas do corpo.



Principalmente para mulheres, exacerba磯 da aparꮣia superficial das veias de bra篳 e pernas, perdendo a forma do quadril, se tornou um problema,com mudan硳 no hᢩto de se vestir. Para ambos os sexos a perda de gordura nas nᤥgas come硠a ser dolorosa quando tꭠque estar sentados por um longo per�o e ೠvezes pode expor o ⮵s, tendo problemas com roupas novamente (Fig.2). Transplante de gordura � uma excelente op磯 para tratamento dessas Ქas, mas n㯠s㯠todos os pacientes que tꭠuma Ქa doadora. Nesses casos n㠣ome硭os a utilizar implantes com PMMA para tratamento de lipodistrofia corporal relacionada � perda de gordura.



M鴯dos: reas de atrofia corporal foram tratadas com a solu磯 de PMMA contendo metilcelulose e lidoca�. O tratamento consiste de retro � inje絥s, paralelas e t飮ica em rede, de solu絥s de PMMA em tr고diferentes concentra絥s nas Ქas de subcut⮥o: 30% para nᤥgas, coxas e ao redor dos joelhos; 30% ou 20 % para pernas; e 10 % para bra篳 e m㯳. Foram prescritos para cada sess㯬 5 dias de antibioticoterapia, analg鳩cos e antiinflamat⩯s, come确do no primeiro dia logo ap㠯 procedimento. Pacientes foram fotografados e acompanhados a cada 45 dias. Sess峠foram realizadas com um intervalo m�mo de 10-12 semanas para cada Ქa tratada.





Resultados: 22 pacientes foram inclu�s neste estudo, 10 homens e 12 mulheres, com um tempo m餩o de acompanhamento de 11 meses (4-23). 27 Ქas foram tratadas: 14 nᤥgas , 9 pernas, 3 bra篳 e 1 p鳠e Ქa perineal. Nᤥgas foram tratadas com 40 ml de solu磯 de PMMA em cada sess㯬 coxas e pernas em torno de 20-30 ml, bra篳 e m㯳 com 5-10 ml de PMMA em cada sess㯮 Pacientes precisaram, em m餩a, de 2-3 sess峠para atingirem bons resultados est鴩cos. Alguns pacientes referiram excelentes resultados em esconder a aparꮣia das veias dos bra篳 e pernas. Boa melhora da aparꮣia geral de bra篳 e pernas ap㠯 preenchimento de depress峠entre os m㵬os foi observada, assim como a melhora da exposi磯 do ⮵s. Todos os pacientes com implantes nas nᤥgas se sentiram mais confortᶥis quando tiveram que ficar sentados por um longo per�o.

Efeitos adversos observados foram: edema e eritema da Ქa tratada; e leve a moderada dor por dois a tr고dias que melhorou com analg鳩cos e antiinflamat⩯s. Nenhuma infec磯 ou granulomas inflamat⩯s foram observados. Pacientes ficaram satisfeitos com os resultados do tratamento e referiram mais auto confian确 Mulheres, especialmente, ficaram satisfeitas com o fato que elas poderiam usar cal硳 com camisas curtas novamente e poderiam ser capazes de usar saias curtas, referindo melhora na qualidade de vida ( Fig.: 3 � pernas; 4 � bra篳; 5 e 6 - nᤥgas).





Conclus㯺

O uso da solu磯 de PMMA para tratamento do contorno corporal na lipodistrofia mostrou ser seguro e efetivo, com bons resultados est鴩cos, ajudando pacientes (especialmente mulheres) conseguirem mais auto confian硠e melhora na qualidade de vida.

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