Colgajo de avance y rotación celuloadiposo de pulpejo para reconstrucción de lecho ungueal / Cell adipose finger pad advancement and rotation flap for nail bed reconstruction

Introducción y Objetivo. Las lesiones de punta de dedo, y en especial de lecho ungueal, son de las más frecuentes en el trauma de mano, generalmente asociadas a traumatismo por agresión y accidentes laborales, con una incidencia y prevalencia elevada en nuestro medio. Presentamos la experiencia con nuestra técnica quirúrgica para reconstrucción de lecho ungueal consiste en el avance y rotación de un colgajo celuloadiposo de pulpejo de dedo basando su vascularización en las arterias palmares ascendentes. Material y Método. La técnica consiste en elevar un colgajo de tejido celuloadiposo del pulpejo desde la falange distal de acuerdo con el tamaño del defecto tisular a nivel del lecho ungueal, realizando una rotación, si se requiere, y un avance, brindando una completa y adecuada cobertura. Hay que destacar que con esta técnica se preservan los tabiques fibrosos favoreciendo la vascularización del colgajo y como ventaja adicional no deja cicatriz en el pulpejo. Resultados. Hemos llevado a cabo la técnica descrita en un total de 120 pacientes (70% hombres, 26% mujeres y 4% niños) con una edad media de 36.5 años, siendo la principal causa traumatismo en accidente laboral: 110 fueron exitosos, 3 se perdieron sufriendo necrosis total, y 7 presentaron sufrimiento inicial sin pérdida. Conclusiones. Esta técnica constituye una herramienta práctica, segura y eficiente como alternativa para la reconstrucción del lecho ungueal, brindado resultados óptimos para este tipo de lesiones (AU)

Background and Objective. Fingertip injuries and nail bed lesions are associated with trauma aggression and work accidents with a high incidence and prevalence in our environment. We present the experience with our surgical technique for reconstruction of nail bed with the advancement and rotation of a cell adipose flap of finger pad, basing its vascularization in the palmar arteries. Methods. The technique consists on lifting the flap (cell adipose finger pad tissue) from the distal phalange according to the size of the tissue defect at the level of the nail bed, performing a rotation, if required, and an advance flap, providing a complete and adequate coverage. It is necessary to emphasize that with this technique the fibrous bands are preserved favoring flap vascularization and, as an additional advantage, does not leave scar in the finger pad. Results. The technique was performed in a total of 120 patients (70% men, 26% women and 4% children) with a mean age of 36.5 years, being the main cause a work-related injury: 110 were successful, 3 were lost suffering total necrosis, and 7 presented suffer without loss. Conclusions. This technique is a practical, safe and efficient tool and an alternative for nail bed reconstruction, providing optimal results for this type of injury (AU)

Aggregatibacter actinomycetemcomitans osteomyelitis in a 12 year old boy: case report emphasizing the importance of tissue culture, and review of literature.

BACKGROUND: Aggregatibacter actinomycetemcomitans most commonly causes periodontitis but has been reported to infect heart valves, soft tissue, brain and lungs, and distal bones. Osteomyelitis distal to the jaw is rarely described. CASE PRESENTATION: We report an unusual and rare case of chronic osteomyelitis caused by A. actinomycetemcomitans in the toe of a paediatric patient, and review the available literature. The infection was managed with intravenous antibiotics followed by oral antibiotics. CONCLUSION: This is an unusual presentation of A. actinomycetemcomitans causing chronic osteomyelitis presumed due to nidation in a minimally damaged bone, associated with bacteraemia of an oral commensal. It occurred in the toe, without obvious dental predisposition; associated with minimal clinical disturbance and with muted immune response.

Toenail Onychomycosis-A Canadian Approach With a New Transungual Treatment: Development of a Clinical Pathway.

BACKGROUND: Onychomycosis is a difficult-to-treat infection whose current treatment paradigm relies primarily on oral antifungals. The emergence of new topical drugs broadens the therapeutic options and prompts a re-evaluation of the current Canadian treatment strategy. OBJECTIVE: To define a patient-centred Canadian treatment strategy for onychomycosis. METHODS: An expert panel of doctors who treat onychomycosis was convened. A systematic review of the literature on treatments for onychomycosis was conducted. Based on the results, a survey was designed to determine a consensus treatment system. RESULTS: First-line therapy should be selected based on nail plate involvement, with terbinafine for severe onychomycosis (>60% involvement), terbinafine or efinaconazole for moderate onychomycosis (20%-60% involvement), and efinaconazole for mild onychomycosis (<20% involvement). Comorbidities, patient preference and adherence, or nail thickness may result in the use of alternative oral or topical antifungals. CONCLUSION: These guidelines allow healthcare providers and patients to make informed choices about preventing and treating onychomycosis.