[Unusual and fatal type of burn injury: hot air sauna burn]. / Quemaduras por aire caliente en saunas: lesiones fatales y poco frecuentes.

Sauna bathing is a popular recreational activity in Finland and is generally considered safe even for pregnant women and patients suffering from heart problems; but mixing alcohol with sauna bathing can be hazardous. In the normal Finnish recreational sauna the temperature is usually between 80 and 90 degrees C. A wide variety of burn injuries, in all age groups, are related to sauna bathing; scalds and contact burns account for over 85% while hot air, steam and flame burns for only 15%. Dehydration in patients under the influence of alcohol heightens the risk of hypotension which impairs skin blood circulation. This increased warming of the skin is an effect that is more marked on the outer and upper parts of the body exposed to hot air. Such patients require intensive care on admission: fluid replacement according to the Parkland formula, forced diuresis and immediate correction of acidosis and myoglobinuria. These patients have significant rhabdomyolysis on admission. The best predictor of survival is the creatine kinase level on the second post-injury day. CT scans are necessary to diagnose the underlying conditions of unconsciousness. The necrotic area extends to subcutaneous fat tissue and even to the underlying muscles. The level of excision is typically fascial and, in some areas, layers of the muscle must be removed. Owing to the popularity of sauna bathing throughout the world, it is important to know the extent of damage in this type of injury, in order not to underestimate the severity of such lesions.

Preoperative planning of deep inferior epigastric artery perforator flap reconstruction with multislice-CT angiography: imaging findings and initial experience.

BACKGROUND: Autologous breast reconstruction with abdominal tissue is one of the best options after mastectomy. Reconstruction with deep inferior epigastric perforator (DIEAP) flaps requires a precise location and preoperative evaluation of perforating vessels. The objective of this report is to demonstrate the usefulness of multislice-CT (MSCT) angiography for preoperative planning in patients undergoing DIEAP flap reconstruction. METHODS: Six consecutive women were considered for breast reconstruction with DIEAP flaps after previous mastectomy for breast cancer. Preoperative MSCT angiography was performed to localise the arterial perforators. Axial images, multiplanar reconstructions (MPR) and 3D volume-rendered images were analysed. Findings were correlated with surgery. Initial experience and imaging findings will be described. RESULTS: Accurate identification of the main perforators was achieved in all six patients with a very satisfactory concordance between MSCT angiography and surgical findings. No unreported vessels were found. Location, course, anatomical variations and relations of the superficial inferior epigastric artery were reported. The very small perforators, were equally evaluated and described. CONCLUSIONS: Preoperative evaluation of perforator arteries with MSCT angiography is feasible in patients undergoing breast reconstruction. This technique provides a noninvasive global approach of the vascular anatomy and the entire anterior abdominal wall. However, more patients need to be evaluated in order to clarify the potential aspects pointed in this report.

[Surgical treatment of penile lymphedema associated with hidradenitis suppurativa]. / Tratamiento quirúrgico de linfedema peneano secundario a hidrosadenitis supurativa.

Penoscrotal lymphedema is a rare disease in the developed countries, although it is relatively frequent in tropical countries. The most common cause is filariasis, although in our practice usually is associate to neoplasic and inflammatory processes, surgery, radiotherapy, hidroelectrolitic disbalances and idiopathic. We present a 22 years old patient with penoscrotal lymphedema due to hidradenitis suppurativa. After unsuccessful medical treatment, was performed a total excision of the penile skin and subcutaneous tissue to Buck's fascia. Split thickness skin grafts were used to cover the defect. Even medical management of penoscrotal lymphedema is not effective for most patients, surgery is a safe and effective procedure that gives excellent functional and cosmetic results.

Vaginal reconstruction using a modified rectus abdominis musculocutaneous flap in pelvic cancer surgery.

The authors present a modification of the design for the classic cutaneous pattern of the rectus abdominis musculocutaneous flap for vaginal reconstruction after pelvic cancer surgery. The authors designed a paramedial and supraumbilical dermo-cutaneous flap with paraumbilical randomized vascularization, which was sutured to the classic cutaneous TRAM flap pattern and rotated around a longitudinal axis to form the neo-introitus. The use of this new cutaneous design allows for a perfect cylindrical shape all along the length of the new vagina, thus achieving a more anatomic reconstruction than those currently obtained with the classic cutaneous patterns, and with fewer tendencies to distal retraction, necrosis, and partial stenosis.

Endoscopic transaxillary subglandular breast augmentation using silicone gel textured implants.

We present our experience with endoscopic transaxillary subglandular breast augmentation using textured silicon gel implants. Fourteen implants were placed in seven patients through a 4 cm axillary incision, in a subglandular pocket, with the help of a 10 mm, 30 degrees endoscope with a subcutaneous retractor and endoscopic diathermy. The implant was inserted with the help of a plastic bag. No drains were left in place. The duration of the procedure was 1 h 30 min in the most recent cases. Bleeding during surgery was kept to a minimum, and there were no complications such as capsular contracture, hematoma, or hypertrophic scar. Infection occurred in one implant and it was necessary to extract it. This technique is an excellent tool for patients requiring subglandular implants who prefer a distant incision. It provides good control over dissection and allows the use of silicone gel implants, thus avoiding the risk of deflation. In addition, recovery is faster and there is less bruising and pain.

Aggressive basal cell carcinoma of the temporal region in a patient with Gorlin-Goltz syndrome.

Gorlin-Goltz syndrome is an autosomal dominant disorder with variable penetration characterized primarily by five major findings: multiple basal cell carcinomas presenting at a young age, pits on the palms and soles, skeletal abnormalities, jaw cysts, and ectopic calcification of the falx cerebri and other structures. When the basal cell carcinomas are located in the head and neck there is a high risk of invasion of deep structures if early and radical treatment is not performed. The authors present a 59-year-old man affected by basal cell carcinoma in the context of Gorlin-Goltz syndrome. Although patients with this syndrome can present aggressive basal cell carcinomas, it is unusual to find them involving the craniofacial bones. In this patient the basal cell carcinoma involved the middle ear, the intrapetrous aspect of the facial nerve, and the dura mater. The reconstruction of a wide three-dimensional defect, in which the brain was exposed, was achieved with local flaps and a free musculocutaneous rectus abdominis flap. Factors affecting reconstruction in the lateral cranial base are discussed.

Radiotransparency of the triglyceride mammary prosthesis: a quantitative analysis with mastectomy specimens.

Breast cancer is the most frequent malignant tumor in women. It is estimated that 10 percent of women will present with a breast cancer during their lives. It is well known that mammography is the best technique for the early diagnosis of nonpalpable tumors, thus improving life expectancy. However, mammary prostheses may hide between 23 and 82 percent of the normal mammary tissue in mammography, and thus may delay the diagnosis of malignant mammary tumors, making prognosis worse. To solve this problem, oil-filled prostheses have been developed. In this study, 14 mastectomy specimens were used. Mammograms of the tissue pieces alone and also mammograms of the tissue pieces covering a 270-cc Trilucent prosthesis were used to verify whether the prosthesis allows observation of malignant signs in mammography. Mammograms were evaluated by an independent experienced radiologist. The following variables were studied: number of mammograms necessary to examine each specimen; kilovoltage and milliamperage necessary for each mammogram; number of microcalcification groups (malignant); number of macroscopic calcifications (benign); and rarefaction areas that were suspected for malignancy. All of these variables were measured for both mammograms for which the mastectomy specimens were covering and those for which the specimens were not covering the prothesis. Finally, the kilovoltage and milliamperage increases necessary to visualize the mammograms with mastectomy specimens covering the prosthesis were determined. Statistical analysis of the results obtained was performed. There were no significant differences in the number of mammograms (p = 0.391), the number of microcalcifications (p = 0.890), the number of macrocalcifications (p = 0.239), and finally in the presence of rarefaction areas (p = 1.000) observed in the mammograms in specimens either covering or not covering the prosthesis. However, there were significant differences (p < 0.001) between the kilovoltage and milliamperage applied to carry out the mammograms of specimens with and without the prosthesis. Thus, Trilucent prostheses allow visualization of the microscopic and macroscopic calcifications as well as rarefaction areas in mammograms. However, these mammograms required a higher kilovoltage and milliamperage compared with specimens not covering the prosthesis. To explore the whole gland, it might be necessary to perform two series of mammograms: one to detect the area shadowed by the prosthesis and one to observe the rest of the peripheral gland.

The viability of cryopreserved onlay cranial bone allografts: a comparative experimental study versus fresh autografts.

It is well known that calvarial bone autografts are the bone grafts that are the least reabsorbent and have the best long-term evolution in craniofacial surgery. However, they do have certain limitations: (1) reabsorption results in repeated surgery and the need for new donor areas, (2) a limited amount of autogenous cranial bone is available (due to avoiding areas close to cranial sutures and venous sinuses, and because the temporal bone is very fragile and the cranium has not fully developed in children), and (3) graft extraction increases surgical time and morbidity. Because of this, we present an alternative to calvarial bone autografts: cryopreserved allografts. This paper is an experimental prospective study carried out on sheep with the following goals: (1) to assess the behavior of calvarial onlay bone grafts cryopreserved at -80 degrees C, using fresh autografts implanted under the same conditions as controls; (2) to compare reabsorption percentages statistically over time; and (3) to study qualitatively any histological variations. The results obtained are (1) more reabsorption of allografts when compared to autografts (at 90 days, 21.97% versus 20.21% of grafted volume), although this difference is not statistically significant; (2) a reduction in height in all onlay grafts as a consequence of the loss of the diplöe; (3) the absence of any type of inflammation caused by a reaction to cryopreserved allografts; and (4) bone substitution performed using frozen allografts is histologically similar to that using fresh autografts.