[Approach of the unilateral cleft lip with Meara's cheiloplasty technique]. / Abordaje de la fisura labial unilateral mediante la queiloplastia de Meara.

INTRODUCTION: Isolated cleft lip is the mildest form of the cleft lip and palate spectrum; however those patients are often treated with the same surgical techniques that are used for the more severe cases (advancement-rotation flaps, quadrangular flaps). Meara's cheiloplasty technique may be a less aggressive option for lip repair in isolated cleft lip or whenever the gap between labial segments is not wide. MATERIAL AND METHODS: All children that had their cleft lip repaired following Meara's cheiloplasty between May 2014 and December 2015 were retrospectively reviewed. Duration of the surgical procedure, time to hospital discharge and complications were noted. Aesthetic results were evaluated in terms of lip height and symmetry, nose shape and symmetry, and scar appearance. RESULTS: Thirteen patients underwent Meara's cheiloplasty during this period. The average age was 6.11 months (5 to 12 months). A primary rhinoplasty was done at the same time in case of nasal asymmetry. Duration of the lip repair averaged 85 minutes. Oral feeding was started 4 hours after the procedure; bottle-feeding was withheld for 2 weeks postoperatively, as our protocol recommends after other lip repair techniques. In all 13 cases the result was a symmetrical, adequately high upper lip and a well-balanced nose, except for one case of lip scar retraction that was solved with triamcinolone infiltration. There were no other intra or postoperative complications. CONCLUSIONS: Meara's cheiloplasty corrects small or moderate gap cleft lip (usually cleft lip without cleft alveolus). Benefits over other teccniques are a shorter procedure and less geometric, undulate flaps that produce a harmonic lip.

INTRODUCCION: La fisura labial aislada es la forma menos grave de presentación del espectro de las fisuras labiopalatinas; sin embargo, para tratarla, usamos las mismas técnicas quirúrgicas que para las formas más graves (colgajos de avance-rotación, cuadrangulares). Presentamos la técnica de queiloplastia publicada por Meara, como alternativa menos agresiva para la reconstrucción del labio, en la fisura labial aislada o cuando los segmentos labiales están próximos entre sí. MATERIAL Y METODOS: Se realizó una revisión retrospectiva de las queiloplastias con técnica de Meara de mayo 2014 a diciembre 2015. Se revisó el tiempo quirúrgico, tiempo medio de ingreso, complicaciones y resultados estéticos, evaluando la altura y simetría del labio superior, la forma y simetría nasal y el aspecto de la cicatriz. RESULTADOS: Trece pacientes han sido intervenidos. La edad media al momento de la intervención fue de 6,11 meses (rango 5-12 meses). Se asoció una rinoplastia en casos con asimetría nasal. El tiempo quirúrgico medio de la queiloplastia aislada fue de 85 minutos. Se reinició alimentación oral a las 4 horas de la intervención, reanudando la alimentación mediante biberón a las 2 semanas, siguiendo el mismo protocolo que con las otras técnicas. En los 13 casos se consiguió un labio superior simétrico con altura adecuada y nariz armónica (excepto 1 que presentó retracción, tratada con infiltración de triamcinolona). No hubo otras complicaciones intra/postoperatorias. CONCLUSIONES: La queiloplastia de Meara corrige de forma muy armónica la fisura labial con poca o moderada separación de los segmentos labiales (habitualmente la fisura labial sin fisura alveolar). Como ventajas frente a otras técnicas permite, en una intervención más corta, la queiloplastia utilizando colgajos ondulados, que son menos geométricos y aportan armonía al resultado.

[Poland's syndrome and free autologous fat grafts]. / Síndrome de Poland e injertos libres de grasa autóloga.

OBJECTIVE: To evaluate the final reconstructive results in 6 cases of female Poland syndrome treated in a first stage with an anatomical high cohesive breast implants and in a second stage with free autologous fat grafts. METHODS: Six females were submitted to bilateral breast reconstruction. The reconstruction was done using anatomical breast implants as first step and after 11 to 18 months the free autologous fat grafting using the Coleman technique as well as treating the contralateral breast to achieve a better symmetry and volume. Photographies taken pre and postoperatively and the Foucras Classification were used to determine volume. Four months after the last surgery the patients answered a satisfaction questionnaire. RESULTS: In all 6 patients there was an improvement of the thoracic contour a year after the last surgery in terms of volume, projection and width of the breast. CONCLUSIONS: The use of free autologous fat grafts improves the results in cases of Poland's syndrome previously treated with breast implants making possible to correct the anterior axillary fold, projection and symmetry with a versatile method, with a low morbidity rate, allowing for a personalized treatment.

[Keloid scars of the external ear: a non solved problem]. / Cicatrices queloideas en pabellón auricular: un problema no resuelto.

The external ear is a location with high risk of keloid scar formation. Its incidence is growing since general use of piercings and performance of plastic surgery of the external ear. The external ear keloid can be a devasting process for adolescent population which is worried about their appearance. Our aim is to attract attention about the risk of keloid scars of the external ear, reviewing our experience. After dismissing radiotherapy, corticoid infiltration and surgical removal are the most used options, with a high recurrence risk. We have reviewed traumatic, surgical and piercing wounds of the external ear, with a subsequent keloid formation treated in our outpatient clinic, collecting data about wound etiology, treatment and results. During the last 10 years we have found 11 keloid scars, 2 of them improved with topical corticosteroid. Treatment has been surgical in 9 cases, 4 of them with skin graft: 5 recovered and 4 recurred; 2 of them were reoperated. 2 of them were treated with intralesional corticosteroid solely, one recovered and the other one had improved. Treatment management of keloid scars is complex and there isn't a procedure with superior results than the others. Risk of complication must be explained within adolescent population.

[Treatment of chronic ischial ulcer in the pediatric patient refractory to conventional treatments]. / Tratamiento de la úlcera crónica isquiática en el paciente pediátrico refractaria a medidas convencionales.

BACKGROUND: Pressure ulcers are an emerging disease, due to survival increase of pediatric patients at risk (myelomeningocele, infantile cerebral paralysis, paraplegic, prematures with neurological sequelae, etc.), including as well, long time staging patients at intensive care units. OBJECTIVES: Provide for long-term treatment to pressure ulcer refractory to debridement procedures. METHODS: We used the biceps femoris muscular flap technique associated with fasciocutaneous flap in two patients, 16 year-olded, with tetraparesis secondary to cerebral palsy and, another 18 year-olded, with myelomeningocele sequelae. Both had sciatic ulcers refractory to treatment, 2 and 3 years evolutioned, respectively. RESULTS: The outcome was excellent in both cases, with definitive healing of the ulcer and no recurrence during one and two month follow-up. CONCLUSIONS: This technique, used in adults, can be applied to pediatric patients if no possibility of wandering. Muscle acts as a cuff between bone and skin and provides coating to the zone suffering pressure as an hypervascularized and no-functioning for active movement structure, but feasible in terms of trophism.