Edna Frasson de Souza Montero

Purpose: Traumatic lumbar hernia (TLH) is a rare and challenging abdominal wall defect. In these patients, treatment success is usually assessed by recurrence, although persistent postoperative bulging or asymmetry may remain clinically relevant even without true failure of repair. This study evaluated the abdominal symmetry index (ASI), defined as a CT-based side-to-side ratio of lateral abdominal wall distance, as an objective morphologic parameter after TLH reconstruction with dual polypropylene mesh. Methods: A single-center retrospective comparative study was performed at a tertiary academic referral center from 2006 to 2025. The study included 25 consecutive eligible patients with TLH who underwent elective open abdominal wall reconstruction with dual polypropylene mesh and 25 controls without abdominal wall disease. In the TLH group, ASI was assessed on CT before and after surgery; controls underwent a single CT-based assessment. The operative repair consisted of deep preperitoneal/retroperitoneal reinforcement whenever feasible, muscle reapproximation when possible, and preaponeurotic/onlay reinforcement. Results: Sex distribution did not differ significantly between groups. Mean age was 42 +/- 13 years in the hernia group and 37 +/- 13 years in controls, while mean body mass index was 31 +/- 4 and 28 +/- 5 kg/m2, respectively ( p = 0.023). Hernia volume was estimated using the ellipsoid formula and had a median value of 443 cm3 (range, 244–1013 cm3). Clinical follow-up was 62 +/- 47 months, and the interval between surgical repair and the latest postoperative CT scan was 687.3 +/- 712.6 days. No recurrence was observed. Before surgery, the measurement on the hernia side was significantly greater than on the contralateral side (185 +/- 24 mm vs. 144 +/- 12 mm; p < 0.0001). After reconstruction, this difference was no longer statistically significant (154 +/- 15 mm vs. 149 +/- 13 mm; p = 0.1022). Mean ASI was 1.29 +/- 0.18 preoperatively, 1.03 +/- 0.07 postoperatively, and 0.99 +/- 0.03 in controls (overall p < 0.0001). Holm-Sidak adjusted pairwise comparisons showed significant differences between preoperative TLH and controls ( p = 1.14 × 10^-13) and between preoperative and postoperative TLH ( p = 1.64 × 10^-11), whereas postoperative TLH did not differ significantly from controls ( p = 0.2142). Conclusion: ASI was feasible as an exploratory CT-based morphologic index for postoperative evaluation of TLH repair. Reconstruction with dual polypropylene mesh was associated with substantial improvement in abdominal wall symmetry, with postoperative values approaching those of controls. Further validation, including interobserver reproducibility and correlation with patient-reported outcomes, is required before broader adoption.

Se analiza la relevancia de las buenas prácticas editoriales en el contexto de la ciencia abierta, destacando su papel en la integridad y credibilidad de la comunicación científica. Se describe la labor de ABEC Brasil, fundada en 1985, como principal promotora de la ética, la profesionalización y la innovación editorial en el país. A través de programas como ABEC Educação y los ABEC Meetings, la asociación fomenta la capacitación, la adopción de normas internacionales y la actualización continua, contribuyendo al fortalecimiento de la comunidad científica y a la mayor visibilidad e impacto de la ciencia brasileña.

Purpose: To perform a systematic review about microsurgical training for medical students. Methods: A systematic search was conducted in several databases. Screening was performed by two independent reviewers based on predetermined criteria, following PRISMA 2020 guidelines. Results: A total of 433 articles were obtained. After screening, 40 were included. Teaching methods were heterogeneous and restricted to a few countries. There are specific methods to assess microsurgery training, general surgical activities, learning curve and anxiety. The most used materials were surgical gloves, silicone tubes, chicken thighs and rats. Animals were not essential in early stages of education. There was a variation between one and 24 sessions regarding teaching frequency and between 3 and 120 hours of teaching period. The average age of students was 23.7, and 67.5% were men. Teaching groups had an average of 5.8 students per group. Physical activity and anxiety had negative effect on microsurgical ability gain, while caffeine had positive effect. Alcohol and sleep deprivation had no significant effect. Conclusion: Students with adequate training could achieve performance similar to that obtained by experts. Microsurgical education is realistic during medical graduation and may enable better career choices. More investigations are needed to improve this training and expand knowledge to other medical schools.