RESUMEN
OBJECTIVES: The treatment of keloid scars is based on multiple lines of therapy, with varying levels of efficacy(1), and there is currently no single treatment that guarantees cure and prevents recurrence. In the pediatric population, the treatments used are not standardized, and there is insufficient evidence to support efficacy and complications. The objective of this study was to analyze the patients who required brachytherapy as an adjuvant to surgical resection in recurrent keloid scars. MATERIALS AND METHODS: A retrospective analysis of patients diagnosed with keloids and undergoing adjuvant brachytherapy in our institution was carried out, while assessing efficacy and implementation in our treatment protocol for keloid scarring. RESULTS: After various therapeutic lines, 4 patients aged 9-17 years old with recurrent keloid scars around the ear and eligible for adjuvant brachytherapy - administered after surgical resection, in two sessions - were studied and followed up for up to 18-21 months. CONCLUSIONS: Despite our limited experience in the use of adjuvant brachytherapy, the results obtained to date support its efficacy, as reported in the literature. We therefore consider its inclusion in the treatment of keloid scars that have recurred after other treatments to be appropriate.
OBJETIVOS: El tratamiento de las cicatrices queloideas se basa en múltiples líneas terapéuticas, con diferentes niveles de eficacia(1), sin existir actualmente un tratamiento que garantice su curación y prevenga su recurrencia. En la población pediátrica los tratamientos empleados no están estandarizados y no hay evidencia suficiente que avale su eficacia y sus complicaciones. Este trabajo tiene como objetivo analizar los pacientes que han precisado braquiterapia coadyuvante a la resección quirúrgica en cicatrices queloideas recidivantes. MATERIAL Y METODOS: Análisis retrospectivo de los pacientes diagnosticados en nuestro centro de cicatriz queloidea, en los que se realizó braquiterapia coadyuvante, valorando su eficacia y su implementación en nuestro protocolo de tratamiento de la cicatriz queloidea. RESULTADOS: Se estudiaron 4 pacientes entre 9-17 años con cicatrices queloideas a nivel auricular, recidivantes a varias líneas terapéuticas, que fueron candidatos para el uso de braquiterapia coadyuvante, administrada posterior a la resección quirúrgica, en dos sesiones, se realizó seguimiento hasta 18-21 meses. CONCLUSIONES: A pesar de nuestra limitada experiencia en el uso de la braquiterapia coadyuvante, los resultados obtenidos hasta la fecha avalan su eficacia, de acuerdo con lo publicado en la literatura. Consideramos adecuada su inclusión en el tratamiento de cicatrices queloideas recidivantes a otros tratamientos.
Asunto(s)
Braquiterapia , Queloide , Adolescente , Braquiterapia/métodos , Niño , Humanos , Queloide/complicaciones , Queloide/radioterapia , Queloide/cirugía , Recurrencia , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
INTRODUCTION AND OBJECTIVE: The coronavirus disease 2019 (COVID-19) has caused a pandemic of global impact that forced social-political measures to be taken, such as the declaration of the state of alarm in Spain. At the same time, the reorganization of the pediatric medical-surgical activities and infrastructures was carried out, with the consequent suspension of the non-urgent surgical activity of Pediatric Urology. We analyzed the impact of the COVID-19 pandemic on surgical activity in a Pediatric Urology division, as well as surgical complications according to the Clavien-Dindo classification. MATERIALS AND METHODS: A systematic review of epidemiological, clinical and surgical data was carried out, including complications and readmissions of all patients operated on in the division of Pediatric Urology within the duration of the state of alarm. Five time periods have been created according to the de-escalation phases. RESULTS: Forty-nine surgical procedures were carried out on 45 patients (8 prior to the implementation of the de-escalation phases). High priority pathologies were the most frequent in the first phases, being the ureteropelvic junction (UPJ) obstruction the most prevalent. Four complications were recorded (8.8%), none of them were respiratory. CONCLUSIONS: The EAU recommendations for the resumption of surgical activity have allowed a correct, safe and gradual transition to the routine surgical activity in Pediatric Urology. The Clavien-Dindo classification is useful and valid for application in this division. No respiratory complications have been reported that could be attributable to the pandemic situation.