Axillary ectopic breast tissue in the adolescent.

AIM: Ectopic breast tissue (EBT) includes a spectrum of disease that entails other entities based on the presence of glandular tissue, nipple, or areola. The diagnosis in adolescents is infrequent. METHODS: A retrospective study was performed including girls with axillary EBT (class IV or V of Kajava's Classification) operated in 2006-2020. Imagining studies, clinical and surgical reports, and histopathology were reviewed. RESULTS: Eleven girls from 13 to 16 years old were included. Two patients (18.2%) presented bilateral EBT. The most frequent clinical manifestation was 2-5 cm mass (100%), associating cyclic pain with menstruation (45%) and fluctuating volume (36%). Bilateral axillary ultrasonography allowed preoperative diagnosis. All of them were treated by open excision, through small incisions located in an axillary y fold. Clinical and aesthetic results were self-assessed as "very good", with normalization of the axillary y hollow and imperceptible scars. No recurrences were observed after one year of follow-up. An immediate postoperative hematoma was reported, which did not require drainage. Histopathology showed mature breast tissue without atypia. CONCLUSIONS: Axillary accessory breasts must be included in differential diagnosis of pediatric axillary masses. Bilateral ultrasonography is recommended for the preoperative diagnosis. Excision through minimal incision at this age seems to be safe and effective.

Techniques and results of palate fistula repair following palatoplasty: a 234-case multicenter study. / Técnicas y resultados de reparación de fístulas palatinas pospalatoplastia: estudio multicéntrico de 234 casos.

INTRODUCTION: Palate fistula is the most frequent complication following palatoplasty. The objectives of this study were: to describe the most widely used repair techniques; to study results and recurrence rate; to analyze potentially predictive recurrence variables; and to assess whether a specific technique is superior according to fistula size and location. MATERIALS AND METHODS: Retrospective study of patients undergoing palate fistula repair in 7 healthcare facilities from 2008 to 2018. All facilities had at least 20 new cases of cleft lift and palate annually (range: 20-80), with a fistula incidence of 14% (range: 1.5-20%). Minimum follow-up was 1 year. 8 variables were collected for statistical analysis purposes. RESULTS: 234 fistula patients underwent surgery. Most fistulas occurred in complete bilateral cleft lift and palate (Veau type IV). The most frequent location was the hard palate (Pittsburgh types IV and V (63.2%)), and fistulas were mostly large (42.1%) and medium (39.5%). The most frequent repair technique was re-palatoplasty (34.2%). Recurrence rate was 22%. The multivariate analysis demonstrated more recurrences in re-palatoplasty repaired type III fistulas in patients over 3 years old. CONCLUSION: A tendency towards using flap repair in large hard palate fistulas, re-palatoplasty in medium hard palate and soft and hard palate junction fistulas, and local flaps or re-palatoplasty in small fistulas at any location was observed. However, it could not be statistically demonstrated whether a specific repair technique was superior in different clinical situations.

INTRODUCCION: La fístula palatina es la complicación más frecuente tras una palatoplastia. Los objetivos de este estudio fueron: describir las técnicas de reparación más frecuentemente empleadas; estudiar los resultados y la tasa de recidiva; analizar posibles variables predictivas de recidiva y valorar la posible superioridad de una determinada técnica según el tamaño y la localización de la fístula. MATERIAL Y METODO: Estudio retrospectivo de pacientes operados de fístulas palatinas desde 2008 hasta 2018 en 7 centros. Todos operaban al menos 20 casos nuevos de fisuras labiopalatinas al año (rango 20-80) con una incidencia de fístulas de 14% (rango: 1,5-20%). El seguimiento mínimo fue de 1 año. Se recogieron 8 variables para el análisis estadístico. RESULTADOS: Se operaron 234 pacientes con fístulas. La mayoría ocurrieron en fisuras labiopalatinas bilateral completa (tipo IV de Veau). La localización más frecuente fue el paladar duro (tipos IV y V de Pittsburgh (63,2%) y la mayoría fueron grandes (42,1%) y medianas (39,5%). La técnica de reparación más frecuente fue la repalatoplastia (34,2%). La tasa de recidiva fue del 22%. El análisis multivariante mostró más recidivas en fístulas tipo III reparadas con repalatoplastia, en mayores de 3 años. CONCLUSION: Se observó una tendencia a utilizar más reparación con colgajo en fístulas grandes del paladar duro, repalatoplastia en fístulas medianas de paladar duro y de la unión, y colgajos locales o repalatoplastia en fístulas pequeñas en cualquier localización, pero no se pudo demostrar estadísticamente la superioridad de una técnica reparadora concreta en diferentes situaciones clínicas.

Técnicas y resultados de reparación de fístulas palatinas pospalatoplastia: estudio multicéntrico de 234 casos / Techniques and results of palate fistula repair following palatoplasty: a 234-case multicenter study

INTRODUCCIÓN: La fístula palatina es la complicación más frecuente tras una palatoplastia. Los objetivos de este estudio fueron: describir las técnicas de reparación más frecuentemente empleadas, estudiar los resultados y la tasa de recidiva, analizar posibles variables predictivas de recidiva y valorar la posible superioridad de una determinada técnica según el tamaño y la localización de la fístula. MATERIAL Y MÉTODO: Estudio retrospectivo de pacientes operados de fístulas palatinas desde 2008 hasta 2018 en 7 centros. Todos operaban al menos 20 casos nuevos de fisuras labiopalatinas al año (rango 20-80) con una incidencia de fístulas de 14% (rango: 1,5-20%). El seguimiento mínimo fue de 1 año. Se recogieron 8 variables para el análisis estadístico. RESULTADOS: Se operaron 234 pacientes con fístulas. La mayoría ocurrieron en fisuras labiopalatinas bilaterales completas (tipo IV de Veau). La localización más frecuente fue el paladar duro (tipos IV y V de Pittsburgh) (63,2%) y la mayoría fueron grandes (42,1%) y medianas (39,5%). La técnica de reparación más frecuente fue la repalatoplastia (34,2%). La tasa de recidiva fue del 22%. El análisis multivariante mostró más recidivas en fístulas tipo III reparadas con repalatoplastia en mayores de 3 años. CONCLUSIÓN: Se observó una tendencia a utilizar más reparación con colgajo en fístulas grandes del paladar duro, repalatoplastia en fístulas medianas de paladar duro y de la unión y colgajos locales o repalatoplastia en fístulas pequeñas en cualquier localización, pero no se pudo demostrar estadísticamente la superioridad de una técnica reparadora concreta en diferentes situaciones clínicas

INTRODUCTION: Palate fistula is the most frequent complication following palatoplasty. The objectives of this study were: to describe the most widely used repair techniques; to study results and recurrence rate; to analyze potentially predictive recurrence variables; and to assess whether a specific technique is superior according to fistula size and location. MATERIALS AND METHODS: Retrospective study of patients undergoing palate fistula repair in 7 healthcare facilities from 2008 to 2018. All facilities had at least 20 new cases of cleft lift and palate annually (range: 20-80), with a fistula incidence of 14% (range: 1.5-20%). Minimum follow-up was 1 year. 8 variables were collected for statistical analysis purposes. RESULTS: 234 fistula patients underwent surgery. Most fistulas occurred in complete bilateral cleft lift and palate (Veau type IV). The most frequent location was the hard palate (Pittsburgh types IV and V (63.2%)), and fistulas were mostly large (42.1%) and medium (39.5%). The most frequent repair technique was re-palatoplasty (34.2%). Recurrence rate was 22%. The multivariate analysis demonstrated more recurrences in re-palatoplasty repaired type III fistulas in patients over 3 years old. CONCLUSION: A tendency towards using flap repair in large hard palate fistulas, repalatoplasty in medium hard palate and soft and hard palate junction fistulas, and local flaps or re-palatoplasty in small fistulas at any location was observed. However, it could not be statistically demonstrated whether a specific repair technique was superior in different clinical situations

Histopathological hallmarks of cutaneous lesions of capillary malformation-arteriovenous malformation syndrome.

IMPORTANCE: Capillary malformation-arteriovenous malformation (CM-AVM) syndrome is a recently described syndrome with distinctive cutaneous lesions. Very little is known about the histopathology of these lesions. OBJECTIVE: The purpose of the study was to evaluate the histopathological characteristics of the pink macules of the CM-AVM syndrome and to investigate if these pink macules could be classified as capillary malformations or arteriovenous malformations based on their histopathological features. DESIGN-SETTINGS-PARTICIPANTS: We conducted a retrospective multicenter study involving eight hospitals in Spain. Fifteen biopsies from pink macules of the CM-AVM syndrome were analysed and compared with five biopsies of diverse capillary malformations and three stage I arteriovenous malformations. RESULTS: Pink macules' biopsies of the CM-AVM syndrome showed similar features including a high vascular density encompassing capillaries and numerous thick-walled arterioles mainly located in the superficial dermis, a predominance of elongated over round vessels, scarce or absent erythrocytes within the lumina and discrete perivascular inflammation. CMs were characterized by an increased number of capillary-type vessels mostly rounded and located in the upper dermis. AVMs were composed by highly increased numbers of vessels with a branching pattern involving the full thickness of the dermis, without erythrocytes within the lumina. Wilms tumour 1 protein was positive in the endothelial cells both in pink macules of the CM-AVM and in arteriovenous malformations. CONCLUSIONS AND RELEVANCE: Pink macules of the CM-AVM syndrome seem to be different from capillary malformations. Our results suggest that histologically and immunohistochemically they are closer to incipient arteriovenous malformations than to capillary malformations. A deepened knowledge about the nature of these skin lesions will contribute to the better understanding of capillary malformation-arteriovenous malformation syndrome, and will open the possibility of new and more specific treatments in the future.

Pediatric tumors of the buccal fat pad: lipoma and hemangioma.

Background: The buccal fat pad (BFP) has prompted numerous publications in anatomy, reconstructive and aesthetic surgery over the years; however, description of surgical treatment of pathologic conditions affecting this space is rare, especially in children. An extensive search of the English literature retrieved only five lipomas and one hemangioma in this age group.Methods: The authors report on two of these exceptional pediatric tumors of the BFP: one lipoma and one hemangioma referred to the outpatient clinic for diagnosis and treatment.Results: Both children had a similar clinical presentation and a characteristic MR image. The two lesions were excised through an intraoral approach, which proved to be a fast, safe and effective technique.Conclusions: Being extremely rare, tumors of the BFP in children have an indicative clinical presentation and radiologic image. A detailed intraoral approach is described and proposed as effective and safe surgical treatment.

Intubación orotraqueal a través de mascarilla laríngea Ambu(R) Auragain(TM) en paciente pediátrico con lipomatosis infiltrante congénita / Endotracheal intubation through laryngeal Ambu(R) Auragain(TM) mask airway mask in paediatric patients affected by congenital infiltrating lipomatosis

Las malformaciones congénitas que afectan a la vía aérea pueden generar problemas para realizar una ventilación efectiva, intubación o incluso ambas, con el consiguiente aumento del riesgo de hipoxemia. Es esencial para el anestesiólogo pediátrico el conocimiento exacto de la anatomía de la vía aérea del paciente, así como una planificación preoperatoria cuidadosa. Cada vez son más los dispositivos diseñados para el control de la vía aérea en el paciente pediátrico. Este caso clínico describe el uso de la mascarilla laríngea de tercera generación (Ambu(R) Auragain(TM)) para la intubación orotraqueal de un paciente pediátrico con vía aérea difícil prevista secundaria a lipomatosis infiltrante congénita en la región facial

Congenital defects that affect paediatric airway could lead to several difficulties for effective ventilation, intubation, or even both, increasing the risk of hypoxaemia. It is essential for the paediatric anaesthesiologist to have accurate knowledge of the anatomy of patient́s airway, as well as judicious preoperative planning. Increasingly, more devices have been designed for the control of difficult airway in the paediatric patient. This case report describes the application of a third-generation laryngeal mask (- Ambu(R) Auragain (TM)) for endotracheal intubation of a child with anticipated difficult airway, secondary to congenital diffuse infiltrating facial lipomatosis

Endotracheal intubation through laryngeal Ambu® Auragain™ mask airway mask in paediatric patients affected by congenital infiltrating lipomatosis. / Intubación orotraqueal a través de mascarilla laríngea Ambu® Auragain™ en paciente pediátrico con lipomatosis infiltrante congénita.

Congenital defects that affect paediatric airway could lead to several difficulties for effective ventilation, intubation, or even both, increasing the risk of hypoxaemia. It is essential for the paediatric anaesthesiologist to have accurate knowledge of the anatomy of patient́s airway, as well as judicious preoperative planning. Increasingly, more devices have been designed for the control of difficult airway in the paediatric patient. This case report describes the application of a third-generation laryngeal mask (- Ambu® Auragain ™) for endotracheal intubation of a child with anticipated difficult airway, secondary to congenital diffuse infiltrating facial lipomatosis.

[Fibrous hamartoma in childhood. A case description of large size and review of the literature]. / Hamartoma fibroso de la infancia. Descripción de un caso de gran tamaño y revisión de la literatura.

INTRODUCTION: Fibrous hamartoma of infancy is a rare soft tissue tumour that usually appears before 2 years of age, typically in the upper extremities of male infants. CASE REPORT: We report the case of a 2 year old boy with a large and rapidly growing tumour in the upper extremity. COMMENTS: We describe the case, its differential diagnosis and the immunhistological characteristics, and we discuss the non-aggressive surgical treatment, based on the benign behaviour of this tumour.

INTRODUCCION: El hamartoma fibroso de la infancia es un raro tumor de partes blandas, que aparece antes de los 2 años de edad, típicamente en varones, en las extremidades superiores. CASO CLINICO: Presentamos el caso de un niño de 2 años con una gran masa de crecimiento rápido en miembro superior. COMENTARIOS: Se realiza descripción del caso, del diagnóstico diferencial y de sus características inmunohistológicas y se discute el tratamiento quirúrgico no agresivo, basado en el comportamiento benigno del tumor.

Hamartoma fibroso de la infancia. descripción de un caso de gran tamaño y revisión de la literatura / Fibrous hamartoma in childhood. A case description of large size and review of the literature

Introducción. El hamartoma fibroso de la infancia es un raro tumor de partes blandas, que aparece antes de los 2 años de edad, típicamente en varones, en las extremidades superiores. Caso clínico. Presentamos el caso de un niño de 2 años con una gran masa de crecimiento rápido en miembro superior. Comentarios. Se realiza descripción del caso, del diagnóstico diferencial y de sus características inmunohistológicas y se discute el tratamiento quirúrgico no agresivo, basado en el comportamiento benigno del tumor (AU)

Introduction. Fibrous hamartoma of infancy is a rare soft tissue tumour that usually appears before 2 years of age, typically in the upper extremities of male infants. Case report. We report the case of a 2 year old boy with a large and rapidly growing tumour in the upper extremity. Comments. We describe the case, its differential diagnosis and the immunhistological characteristics, and we discuss the non-aggressive surgical treatment, based on the benign behaviour of this tumour (AU)

[Isolated bilateral macrostomia: case report and literature review]. / Macrostomía bilateral aislada: a propósito de un caso y revisión de la literatura.

INTRODUCTION: The macrostomia is a facial abnormality also called transverse facial cleft or Tessier cleft number 7. Macrostomia is a rare condition with an incidence from 1/80,000 to 1/300,000 live births. The left commisure is more commonly affected. Bilateral macrostomia is extremely rare, with only 10 to 20% of all cases of macrostomia, and 50% of bilateral cases are associated with different syndromes. To date just over 20 cases of isolated bilateral macrostomia have been described in the literature. CLINICAL OBSERVATION: We report the case of a patient with isolated bilateral macrostomia solved by surgery and with good aesthetic and functional results. COMMENTS: The treatment of bilateral macrostomia is surgical and should be done early. Although there are many techniques, the key is to recreate a new and correct commisure through a good reorientation of the orbicularis oris.

INTRODUCCION: La macrostomía es una anomalía facial denominada también fisura facial transversa o fisura tipo 7 de Tessier. Su aparición es muy rara, con una incidencia estimada de 1/80.000 a 1/300.000 nacidos vivos, siendo la forma unilateral izquierda la más frecuente. La macrostomía bilateral es extremadamente infrecuente, con solo 10 a 20% de todos los casos de macrostomía, y de estos el 50% se asocian a diferentes síndromes. Hasta la fecha solo se han descrito en la literatura poco más de 20 casos de macrostomía bilateral aislada. OBSERVACION CLINICA: Presentamos el caso de una paciente con macrostomía bilateral aislada resuelto mediante intervención quirúrgica y con buen resultado estético y funcional. COMENTARIOS: El tratamiento de la macrostomía bilateral es quirúrgico y debe realizarse precozmente. Aunque existen muchas técnicas, lo fundamental es recrear una nueva y correcta comisura a través de una buena reorientación del músculo orbicular de los labios.

Macrostomía bilateral aislada: a propósito de un caso y revisión de la literatura / Isolated bilateral macrostomia: case report and literature review

Introducción. La macrostomía es una anomalía facial denominada también fisura facial transversa o fisura tipo 7 de Tessier. Su aparición es muy rara, con una incidencia estimada de 1/80.000 a 1/300.000 nacidos vivos, siendo la forma unilateral izquierda la más frecuente. La macrostomía bilateral es extremadamente infrecuente, con solo 10 a 20% de todos los casos de macrostomía, y de estos el 50% se asocian a diferentes síndromes. Hasta la fecha solo se han descrito en la literatura poco más de 20 casos de macrostomía bilateral aislada. Observación clínica. Presentamos el caso de una paciente con macrostomía bilateral aislada resuelto mediante intervención quirúrgica y con buen resultado estético y funcional. Comentarios. El tratamiento de la macrostomía bilateral es quirúrgico y debe realizarse precozmente. Aunque existen muchas técnicas, lo fundamental es recrear una nueva y correcta comisura a través de una buena reorientación del músculo orbicular de los labios

Introduction. The macrostomia is a facial abnormality also called transverse facial cleft or Tessier cleft number 7. Macrostomia is a rare condition with an incidence from 1/80,000 to 1/300,000 live births. The left commisure is more commonly affected. Bilateral macrostomia is extremely rare, with only 10 to 20% of all cases of macrostomia, and 50% of bilateral cases are associated with different syndromes. To date just over 20 cases of isolated bilateral macrostomia have been described in the literature Clinical observation. We report the case of a patient with isolated bilateral macrostomia solved by surgery and with good aesthetic and functional results. Comments. The treatment of bilateral macrostomia is surgical and should be done early. Although there are many techniques, the key is to recreate a new and correct commisure through a good reorientation of the orbicularis oris

Polidactilia preaxial de la mano: experiencia de 15 años / Preaxial polydactyly of the hand: 15 years of experience

Introducción. La polidactilia preaxial es una de las malformaciones congénitas más frecuentes de la mano. El tratamiento es quirúrgico y debe realizarse precozmente entre los 6 y 12 meses de edad. El propósito de este trabajo es revisar nuestra experiencia, en cuanto a casuística, tratamiento y resultados funcionales y estéticos de duplicidad de pulgar, desde el año 2000 hasta la actualidad. Material y métodos. Se realizó un estudio retrospectivo de los pacientes con el diagnóstico de polidactilia preaxial en el periodo de 2000 a enero de 2016. Resultados. Se diagnosticaron 30 pacientes de duplicidad de pulgar y 31 pulgares bífidos. Sin diferencia en cuanto al sexo. La mano más afectada fue la derecha con 22 casos. El tipo IV de Wassel fue el más frecuente, seguido del tipo II. La edad en el momento de la cirugía tuvo una mediana y moda de 12 meses. Todos fueron tratados quirúrgicamente, el 97% siguiendo el modelo de conservación de pulgar dominante. De acuerdo al sistema publicado por Tada, nuestros resultados postoperatorios fueron buenos en 26 casos (83,8%). Nuestra complicación más frecuente fue la clinodactilia radial leve, que se encontró en 5 casos. Conclusiones. La polidactilia preaxial de la mano es una de las malformaciones congénitas más frecuentes. Suele ser unilateral y sin predominio de sexo. El tratamiento quirúrgico ofrece buenos resultados. La técnica más fomentada para la reconstrucción es el modelo de conservación de pulgar dominante. La clinodactilia es la complicación más frecuente post-cirugía, no obstante su presencia es más un problema estético que funcional

Introduction. Preaxial polydactyly is one of the most common congenital malformations of the hand. The treatment is surgical and should be done early, between 6 and 12 months old. The purpose of this paper is to review our experience in terms of casuistry, treatment and functional and aesthetic results of duplicity of thumb, since 2000 until today. Material and methods. A retrospective study of patients with diagnosis of preaxial polydactyly from 2000 to january 2016 was performed. Results. Thirty patients with duplicity of thumb and thirty one bifid thumbs were diagnosed. No difference was found in terms of gender. The right hand was the most affected. Wassel type IV was the most common, followed by type II. Age at time of surgery had a median and mode of 12 months. All were treated surgically, using the model of preservation of the dominant thumb in 97% of the cases. According to Tada system, our postoperative results were good in 26 cases (83.8%). Our most frequent complication was slight radial clinodactyly, which was found in 5 cases. Conclusions. Preaxial polydactyly of the hand is one of the most common congenital malformations. It is usually unilateral and without gender predominance. Surgical treatment provides good results. The most common technique for reconstruction is the model of preservation of the dominant thumb. Clinodactyly is the most common complication after surgery, however its presence is more aesthetic than a functional problem

Cirugía Plástica Infantil en campaña humanitaria en Guinea Ecuatorial / Humanitarian Pediatric Plastic Surgery mission in Equatorial Guinea

La medicina humanitaria tiene como objetivo mejorar el bienestar humano como acto de generosidad y solidaridad con los desfavorecidos, sin ninguna consideración de ganancia material. Va más allá del mero acto terapéutico, promueve, enseña, apoya y proporciona salud como un derecho humano. Presentamos de forma resumida el proyecto de Cirugía Plástica Infantil en campaña humanitaria en Guinea Ecuatorial, patrocinado por la organización Aldeas Infantiles SOS desde su origen hasta su situación actual, describiendo las principales acciones realizadas en el lugar de acogida y haciendo recomendaciones para mejorarla seguridad y eficacia en este tipo de campañas. Por último, recogemos algunas reflexiones sobre el impacto personal de campañas humanitarias como la que describimos (AU)

Humanitarian medicine aims to improve human welfare as an act of generosity and solidarity with the disadvantaged, without any consideration of material gain. It means more than a mere therapeutic act, it should promote, teach and provide health as a basic human right. In this paper, the authors summarize the project of humanitarian Pediatric Plastic Surgery mission developed in Equatorial Guinea and funded by the organization Aldeas Infantiles SOS, since its origin to its current state. The main actions performed in the host country are described, and recommendations are made to improve the safety and efficacy of these missions. Lastly some thoughts are outlined regarding the personal impact that such campaigns may bring about (AU)

Malformaciones linfáticas periorbitarias: A propósito de 2 casos / Periorbital lymphatic malformations: Report of two cases

Introducción. Las malformaciones linfáticas periorbitarias son una entidad poco frecuente cuyo diagnóstico y tratamiento puede suponer un reto para el cirujano. El manejo puede ser conservador, o pueden tratarse mediante escleroterapia, cirugía o combinación de ambas. Observación clínica. Presentamos dos casos de malformaciones linfáticas periorbitarias tratadas mediante escleroterapia (con OK-432 o bleomicina) y cirugía con buenos resultados y mínima morbilidad. Comentarios. La combinación de cirugía y escleroterapia es una buena opción de tratamiento de las malformaciones linfáticas periorbitarias; ya que nos permite ser más conservadores en la exéresis de las mismas y, por ello, las secuelas son menores

Introduction. Periorbital lymphatic malformations are a rare entity in which diagnosis and treatment could be a challenge for surgeons. Management may be conservative, or they can be treated by sclerotherapy, surgery or combination of both. Clinic observation. We present two cases of periorbital lymphatic malformations treated by sclerotherapy (OK-432 or bleomycin) and surgery in which we achieve good results with minimum morbidity. Comments. Surgery combined with sclerotherapy is a good option of treatment for periorbital lymphatic malformations because surgery can be more conservative and therefore, sequelae are lower

[Preaxial polydactyly of the hand: 15 years of experience]. / Polidactilia preaxial de la mano: experiencia de 15 años.

INTRODUCTION: Preaxial polydactyly is one of the most common congenital malformations of the hand. The treatment is surgical and should be done early, between 6 and 12 months old. The purpose of this paper is to review our experience in terms of casuistry, treatment and functional and aesthetic results of duplicity of thumb, since 2000 until today. MATERIAL AND METHODS: A retrospective study of patients with diagnosis of preaxial polydactyly from 2000 to january 2016 was performed. RESULTS: Thirty patients with duplicity of thumb and thirty one bifid thumbs were diagnosed. No difference was found in terms of gender. The right hand was the most affected. Wassel type IV was the most common, followed by type II. Age at time of surgery had a median and mode of 12 months. All were treated surgically, using the model of preservation of the dominant thumb in 97% of the cases. According to Tada system, our postoperative results were good in 26 cases (83.8%). Our most frequent complication was slight radial clinodactyly, which was found in 5 cases. CONCLUSIONS: Preaxial polydactyly of the hand is one of the most common congenital malformations. It is usually unilateral and without gender predominance. Surgical treatment provides good results. The most common technique for reconstruction is the model of preservation of the dominant thumb. Clinodactyly is the most common complication after surgery, however its presence is more aesthetic than a functional problem.

INTRODUCCION: La polidactilia preaxial es una de las malformaciones congénitas más frecuentes de la mano. El tratamiento es quirúrgico y debe realizarse precozmente entre los 6 y 12 meses de edad. El propósito de este trabajo es revisar nuestra experiencia, en cuanto a casuística, tratamiento y resultados funcionales y estéticos de duplicidad de pulgar, desde el año 2000 hasta la actualidad. MATERIAL Y METODOS: Se realizó un estudio retrospectivo de los pacientes con el diagnóstico de polidactilia preaxial en el periodo de 2000 a enero de 2016. RESULTADOS: Se diagnosticaron 30 pacientes de duplicidad de pulgar y 31 pulgares bífidos. Sin diferencia en cuanto al sexo. La mano más afectada fue la derecha con 22 casos. El tipo IV de Wassel fue el más frecuente, seguido del tipo II. La edad en el momento de la cirugía tuvo una mediana y moda de 12 meses. Todos fueron tratados quirúrgicamente, el 97% siguiendo el modelo de conservación de pulgar dominante. De acuerdo al sistema publicado por Tada, nuestros resultados postoperatorios fueron buenos en 26 casos (83,8%). Nuestra complicación más frecuente fue la clinodactilia radial leve, que se encontró en 5 casos. CONCLUSIONES: La polidactilia preaxial de la mano es una de las malformaciones congénitas más frecuentes. Suele ser unilateral y sin predominio de sexo. El tratamiento quirúrgico ofrece buenos resultados. La técnica más fomentada para la reconstrucción es el modelo de conservación de pulgar dominante. La clinodactilia es la complicación más frecuente post-cirugía, no obstante su presencia es más un problema estético que funcional.

[Periorbital lymphatic malformations: Report of two cases]. / Malformaciones linfáticas periorbitarias: A propósito de 2 casos.

INTRODUCTION: Periorbital lymphatic malformations are a rare entity in which diagnosis and treatment could be a challenge for surgeons. Management may be conservative, or they can be treated by sclerotherapy, surgery or combination of both. CLINICAL OBSERVATION: We present two cases of periorbital lymphatic malformations treated by sclerotherapy (OK-432 or bleomycin) and surgery in which we achieve good results with minimum morbidity. COMMENTS: Surgery combined with sclerotherapy is a good option of treatment for periorbital lymphatic malformations because surgery can be more conservative and therefore, sequelae are lower.

INTRODUCCION: Las malformaciones linfáticas periorbitarias son una entidad poco frecuente cuyo diagnóstico y tratamiento puede suponer un reto para el cirujano. El manejo puede ser conservador, o pueden tratarse mediante escleroterapia, cirugía o combinación de ambas. IBSERVACION CLINICA: Presentamos dos casos de malformaciones linfáticas periorbitarias tratadas mediante escleroterapia (con OK-432 o bleomicina) y cirugía con buenos resultados y mínima morbilidad. COMENTARIOS: La combinación de cirugía y escleroterapia es una buena opción de tratamiento de las malformaciones linfáticas periorbitarias; ya que nos permite ser más conservadores en la exéresis de las mismas y, por ello, las secuelas son menores.

Colgajos basados en arterias perforantes glúteas para la reconstrucción de úlceras sacras por presión en niños / Gluteal artery based perforator flaps for sacral pressure sore reconstruction in children

Introducción. Los niños tienen una incidencia menor de úlceras por presión (UPP) que los adultos y además se diagnostican en estadios más tempranos. Por ello la experiencia publicada con tratamiento quirúrgico para UPP avanzadas en niños es escasa. Material y métodos. Presentamos el tratamiento quirúrgico de 2 UPP crónicas, estadio IV, sacras, en niños de 11 y 14 años, utilizando colgajos basados en arterias perforantes glúteas: en el primer caso se utilizó un diseño personalizado (free-style), basado en una arteria perforante glútea medial izquierda y en el segundo un gran colgajo de avance-rotación reutilizable, basado en las arterias perforantes glúteas superior e inferior derechas. Resultados. En ambos casos logramos una rápida curación con una supervivencia del 100% de los colgajos y cierre estable con un seguimiento de 6 meses y 1 año, respectivamente. Conclusiones. Los colgajos basados en las arterias perforantes glúteas pueden proporcionar resultados excelentes y estables en el tratamiento reconstructivo de UPP sacras en niños. Estos colgajos tienen menor morbilidad que los colgajos musculocutáneos y son más seguros que los colgajos fasciocutáneos tradicionales. Además, mantienen mayor cantidad de opciones de rescate en caso de recidiva de UPPs a lo largo de la vida de estos niños

Introduction. Children have much lower incidence of pressure sores (PS) than adults and furthermore, they are diagnosed in earlier stages. Therefore, the reported experience with surgical treatment of advanced pediatric PS is scarce. Material and methods. We present the surgical treatment of 2 chronic PS stage IV in children aged 11 and 14 years, by means of perforator flaps based on the gluteal arteries: in the first case we used a free-style flap based on a left medial gluteal perforator and in the second a large reusable rotation-advancement flap based on both right superior and inferior gluteal artery perforators. Results. In both patients we achieved a rapid cure with 100% survival of the flaps and a stable cover over a 6 month and 1 year follow-up respectively. Conclusions. Gluteal artery perforator flaps can produce excellent and durable results in the reconstructive treatment of sacral pressure sores in children. These flaps carry lower morbidity than musculocutaneous flaps and are more reliable than traditional fasciocutaneous flaps. Furthermore they preserve more reconstructive options in case of recurrence during the children’s lifetime

[Gluteal artery based perforator flaps for sacral pressure sore reconstruction in children]. / Colgajos basados en arterias perforantes glúteas para la reconstrucción de úlceras sacras por presión en niños.

INTRODUCTION: Children have much lower incidence of pressure sores (PS) than adults and furthermore, they are diagnosed in earlier stages. Therefore, the reported experience with surgical treatment of advanced pediatric PS is scarce. MATERIAL AND METHODS: We present the surgical treatment of 2 chronic PS stage IV in children aged 11 and 14 years, by means of perforator flaps based on the gluteal arteries: in the first case we used a free-style flap based on a left medial gluteal perforator and in the second a large reusable rotation-advancement flap based on both right superior and inferior gluteal artery perforators. RESULTS: In both patients we achieved a rapid cure with 100% survival of the flaps and a stable cover over a 6 month and 1 year follow-up respectively. CONCLUSIONS: Gluteal artery perforator flaps can produce excellent and durable results in the reconstructive treatment of sacral pressure sores in children. These flaps carry lower morbidity than musculocutaneous flaps and are more reliable than traditional fasciocutaneous flaps. Furthermore they preserve more reconstructive options in case of recurrence during the children's lifetime.

[Intraparotid first branchial arch cyst: complex diagnostic and therapeutic process]. / Quiste de primer arco branquial intraparotídeo: complejo proceso diagnóstico y terapéutico.

First branchial arch cysts are uncommon. Therefore, together with its variable clinical and age presentation they are often misdiagnosed at first. The treatment is surgical, requiring a correct procedure to avoid future recurrences. In this paper we describe a typical case of first branchial arch cyst in which as described in other reports, we first made several misdiagnoses and therefore an inadequate treatment and lastly, with the correct diagnosis, we performed a meticulous complete excision under facial nerve monitoring.

[Extruded cochlear implant magnet covered with a temporoparietal fascial flap. A case report]. / Rescate de implante coclear expuesto mediante cobertura con colgajo de fascia temporoparietal. A propósito de un caso.

Complications are infrequent after cochlear implant surgery but they might occur despite careful preoperative planning and meticulous surgical technique. Among the most commonly encountered problems are those associated with the postauricular flap. An exposed, and therefore contaminated, device requires immediate attention and intervention. Cochlear implantation revision surgery is justified by two main reasons, the high price of these devices and the difficulty of reimplantation, due to cochlear fibrosis and ossification after its removal. There are multiple options in cochlear implantation revision surgery with infected device. However, the temporoparietal fascia flap is highly vascularized and provides some advantages over other alternatives. We report a case of a 5 year old boy with bilateral sensor neural hearing loss, who suffered a device extrusion three years after its implantation.