Determination of the Anthropometric Measures of the Lips by Age Groups in the Mestiza Population.

Measurements from a certain population may show a similar pattern that allows an alteration to be easily recognized and enable a better surgical approach. In our population, the changes in the anthropometric measurements of the lips are unknown, so our objective is to determine the variations in these measurements by decades of age to achieve a better aesthetic and reconstructive surgical approach. Anthropometric measurements of the lips were taken with a vernier in relation to the previously marked anatomical points. The sample consists of 174 patients who came for care not related to labial pathologies with ages between 20 and 80 years with Mexican nationality. We use the sample calculation formula to estimate an average, with an alpha error of 0.5 and a tolerance of 2 mm of the data for the measurements of the height of the lower face with an average measurement of 56.2 mm and a SD of 8.87 mm of the Marzena's article. Wyganowska-Swiatkowska and colleagues Average measurements were obtained, where a progressive longitudinal increase in measures: al-ch, sbl-cph, sn-Is, li-sto, cph-Is, li-sl, ch-li, li-pg according to aging is confirmed. In contrast, the ch-cph and ch-sbl measures, remain the same despite the aging, showing greater changes in the sagittal plane than in the parasagittal. The study only shows measures of length, so caring out a magnetic resonance imaging study to also measure the volume and perform it with a larger sample to have the optimal standard is further needed.

Variante de colgajo de rotación tipo Hamstring para reconstrucción de úlcera isquiática / Hamstring rotation fl ap variant for ischial ulcer reconstruction

Antecedentes. El colgajo Hamstring es una opción válida para la reconstrucción de úlceras isquiáticas. Las úlceras por presión representan un verdadero desafío para el cirujano plástico. Requieren un tratamiento especializado y multidisciplinario por su alta probabilidad de recidiva y las complicaciones en su manejo. Por lo general, ocurren por presión sostenida sobre la tuberosidad isquiática. Caso clínico. Se presenta el caso de un paciente parapléjico desde el nacimiento secundario a mielomeningocele con diagnóstico actual de úlcera isquiática. Se le realizaron durante 3 años múltiples intentos de cierre quirúrgico alternando medidas conservadoras, sin éxito. A la exploración física presenta una úlcera isquiática izquierda de 6x6 cm a la que se le realizó aseo y desbridación quirúrgica más cierre por medio de un colgajo Hamstring modificado. A los 7 días presentó dehiscencia de herida la cual se manejó de manera conservadora y cierre primario diferido a las 4 semanas. A 8 meses de posoperatorio el paciente se encuentra con buena evolución y con resultado estético y funcional aceptable, por otra parte, se encuentra sin recidiva, lo que ha permitido su reinserción laboral y un buen equilibrio físico-psico-emocional. Conclusión. El objetivo de este colgajo es brindar cobertura al área isquiática sin afectar estructuras adyacentes, lo cual requiere de un amplio conocimiento de la anatomía de la región femoral, así como de los colgados tanto locales como regionales que podemos utilizar para la reconstrucción. Actualmente este colgajo es una opción terapéutica efectiva para el tratamiento de úlceras isquiáticas refractarias en centros que cuentan con cirujanos plásticos no especializados en microcirugía.

Background. The Hamstring fl ap is an adequate option for ischial ulcers reconstruction. Pressure ulcers represent a real challenge for the plastic surgeon. They require specialized and multidisciplinary treatment due to their high recurrence probability and complications in their management. Regularly, pressure ulcers occur when sustained pressure is applied on the ischial tuberosity. Case report. We report a case of a 23-year-old paraplegic male with myelomeningocele complaining for an ischial ulcer. Multiple attempts to surgical closure were made during three years along with conservative management, without success. Physical examination revealed a 6x6 cm left ischial ulcer, which was managed with surgical debridement and closure with a modifi ed Hamstring fl ap. After 7 days, the patient presented wound dehiscence, which was managed conservatively and primary delayed closure after 4 weeks. 8 months postoperatively the patient has a good evolution and an acceptable functional and aesthetic result, without recurrence, which has allowed his reintegration into work and a good physical-psycho-emotional balance. Conclusion. The objective of this fl ap is to provide coverage to the ischial area without aff ecting adjacent structures, which requires a broad knowledge of the anatomy of the femoral region, as well as the local and regional fl aps that can be used for reconstruction. Nowadays this fl ap is an eff ective therapeutic option for the treatment of refractary ischial ulcers in plastis suergery centers without microsurgery.

Morbidity in Patients With Separation of Cartilaginous Framework: Temporoparietal Fascia Flap and Treatment With Dermal Regeneration Template.

BACKGROUND: The full creation of an ear requires 2 reconstruction stages. In the second stage of reconstruction, the cartilaginous framework placed at first stage is separated from the head creating an auriculocephalic sulcus. Then a piece of rib cartilage is placed in the sulcus to maintain this separation and is covered with tissue that allows the integration of a full-thickness skin graft. METHODS: A descriptive study based on the pre and postoperative medical records and photographic archives of patients diagnosed with microtia who underwent separation of the cartilaginous framework from February 2010 to July 2015 in the Plastic and Reconstructive Surgery Department at Hospital General Dr. Manuel Gea González. RESULTS: Fifty-four patients met the selection criteria. The temporoparietal fascial flap was performed on 85% (n = 46), and 8 cases with random occipito-temporal fascial flap in association to a dermal regeneration template. The average time at the operating room was 177 minutes in patients with temporoparietal fascial flap versus 84.5 minutes in dermal regeneration template. The complication rate was 25.9% (n = 14), being similar rate with both techniques. CONCLUSIONS: Coverage with dermal regeneration template and random occipito-temporal fascia flap as an alternative use instead of temporoparietal fascial flaps, offers good postoperative results, lower operating times, and similar rate of complications, with the advantage of producing no visible scars and reserve the temporoparietal fascial flap for possible exposure of the cartilaginous framework.

Goldenhar syndrome: surgical management protocol in a reference center.

OBJECTIVE: To present our experience treating 42 patients with Goldenhar syndrome. METHOD: A descriptive, observational, retrospective study was carried out using the medical and photographic record of all patients diagnosed with Goldenhar syndrome treated by the craniofacial surgery unit of the plastic and reconstructive surgery department of the Dr. Manuel Gea González hospital between 2010 and 2018. RESULTS: A total of 42 patients were obtained,54% male of which all underwent at least one procedure. The majority of patients were of the first decade of age (57%). Surgical procedures could be divided mainly into 14 auricular (20%), 17 mandibular (24%), 2 Lefort (4%), 10 volume (14%), 9 macrostoma (13%) and 16 other (21%). A total of 71 procedures were performed. CONCLUSION: Goldenhar syndrome is a rare entity that affects various structures, which is why an early diagnosis and multidisciplinary management headed by a team of plastic surgeons is necessary.

OBJETIVO: Presentar nuestra experiencia en el diagnóstico y el tratamiento de 42 pacientes con síndrome de Goldenhar. MÉTODO: Se realizó un estudio descriptivo, observacional y retrospectivo usando el registro médico y fotográfico de todos los pacientes diagnosticados con síndrome de Goldenhar tratados por la unidad de cirugía craneofacial del departamento de cirugía plástica y reconstructiva del hospital Dr. Manuel Gea González entre 2010 y 2018. RESULTADOS: Se obtuvieron 42 pacientes, el 54% varones, con predominio de menores de 10 años (57%), de los cuales todos se sometieron al menos a un procedimiento. Los procedimientos quirúrgicos se dividieron en: 14 auriculares (20%), 17 mandibulares (24%), 2 Lefort (4%), 10 volumen (14%), 9 macrostoma (13%) y 16 otros (21%). En total se realizaron 71 procedimientos. CONCLUSIÓN: El síndrome de Goldenhar es una enfermedad poco frecuente que afecta diversas estructuras y se presenta predominantemente en varones. Es necesario un diagnóstico precoz y un manejo individualizado llevado a cabo por un equipo multidisciplinario encabezado por cirujanos plásticos.

Reconstrucción de piel cabelluda (SCALP) con injerto de espesor parcial y expansor tisular secundario a mordedura de perro en paciente pediátrico / Reconstruction of SCALP with partial thickness graft and tissue expander following a dog bite in a pediatric patient

Introducción. Los defectos grandes y complejos de piel cabelluda en los pacientes pediátricos representan un reto para el cirujano plástico que se enfrenta a este tipo de lesiones, debido a la dificultad de las técnicas quirúrgicas disponibles en este grupo de edad. El objetivo primario en el manejo de este tipo de heridas es lograr una cobertura adecuada de la bóveda craneana, con el propósito fundamental de prevenir la exposición y desecación ósea y la sepsis. El objetivo secundario será el resultado estético, en el cual se buscará atenuar la alopecia y esconder las cicatrices. Objetivo. El objetivo de este trabajo es dar a conocer el manejo quirúrgico para la reconstrucción de heridas complejas de cuero cabelludo en forma secuencial con buenos resultados estéticos. Material y métodos. Se presenta el caso de masculino de 1 año quien fue víctima de mordedura de perro, presentando herida de espesor total en piel cabelluda en región parietooccipital, con pérdida de cobertura cutánea, reconstrucción primaria con injerto de espesor parcial y en segundo tiempo quirúrgico el uso de expansores tisulares con fines estéticos. Resultados. Posterior a 8 meses con un total de 4 tiempos quirúrgicos (1- lavado quirúrgico, remodelación de bordes, avance de colgajos locales,toma y aplicación de injerto de espesor parcial con fijación por medio de sistema de presión negativa, 2- retiro de sistema de presión negativa, 3- colocación de expansores, 4- retiro de expansores, avance de colgajo occipital y cierre primario) se obtiene un resultado estético favorable. Conclusiones. El manejo de heridas complejas en piel cabelluda en población pediátrica con injertos de espesor parcial ha demostrado eficacia al lograr una cobertura inmediata del defecto con menor morbilidad que otras técnicas, aún más cuando se apoyan de herramientas como el sistema de presión negativa. La reconstrucción posterior con expansores tisulares es aconsejable para lograr la disminución de secuelas.

Introduction. Large and complex scalp defects in pediatric patients represent a challenge for the plastic surgeon who faces this kind of injuries, due to the difficulty of the surgical techniques available in this age group. The primary goal in the management of this kind of wounds is to achieve adequate coverage of the cranial vault, with the main purpose of preventing bone exposure and sepsis. The secondary goal is to reach an aesthetic result, where alopecia can be attenuated, and the scars hidden. Objective. The objective of this work is to present the sequential surgical management for the reconstruction of complex scalp wounds with adequate aesthetic results. Material and methods. We present the case of a 1-year-old child who was bitten by a dog, presenting a full-thickness wound on the scalp in the parieto-occipital region, with skin coverage loss, primary reconstruction with a partial-thickness graft, and in the second surgical procedure, the use of tissue expanders for aesthetic purposes. Results: After 8 months with a total of 4 surgical procedures (1- antisepsis, edges remodeling, local flaps advance, harvesting and application of partial thickness skin graft with negative pressure system, 2- removal of negative pressure system, 3- placement of tissue expanders, 4- removal of tissue expanders, occipital flap advance and primary closure) a favorable aesthetic result is obtained. Conclusions. The management of scalp complex wounds in the pediatric population with partial thickness skin grafts has demonstrated efficacy by achieving immediate coverage of the defect with lower morbidity than other techniques, even more when using tools such as the negative pressure system, subsequent reconstruction with tissue expanders is an option in order to achieve sequelae reduction

Oreja de Stahl y su manejo quirúrgico / Stahl ear and its surgical management

RESUMEN Introducción: La oreja de Stahl presenta una baja incidencia, aún en centros especializados de reconstrucción auricular. Se caracteriza por presentar un remanente cartilaginoso anormal que se extiende desde el antihélix hasta el borde del hélix, formando una tercer crura. Caso clínico: Varón de 17 años de edad, con deformidad auricular caracterizada por hipoplasia de la raíz del antihélix y presencia de una tercer crura, que comunica el antihélix al hélix. Se realiza resección de la tercer crura y reconstrucción cartilaginosa del pabellón auricular, logrando una adecuada reconstrucción, con buen resultado estético, sin alteración de tamaño en comparación con la oreja contralateral. Conclusiones: Esta es una rara deformidad auricular, muchas veces subdiagnosticada, incluso en centros especializados. Puede acarrear trastornos y estigmas sociales importantes al paciente. El tratamiento quirúrgico es manejo preferencial, y se centra principalmente en la corrección de la tercer crura.

ABSTRACT Introduction: Stahl's ear presents a low incidence, even in specialized ear reconstruction centers. It is characterized by an abno rmal cartilaginous remnant, extending from the antihelix to the edge of the helix, forming a third crura. Case report: A 17-year-old man presented an ear deformity characterized by hypoplasia of the root of the antihelix and the presence of a third crura, which communicates the antihelix to the helix. A resection of third crura and cartilaginous reconstruction of the auricular pavilion was performed, achieving an adequate reconstruction, with good aesthetic results, without size alteration in comparison to the contralateral ear. Conclusions: Stahl's deformity is a rare ear deformity that can lead to significant social disruption and stigma. Surgical treatment is the preferential option for handling this deformity, and focuses mainly on the correction of the third crura.

Malformación vascular capilar y venosa en la mano. Reporte de caso de una extraña patología quirúrgica / Vascular capillary and venous malformation in the hand. Case report of a strange surgical pathology

Resumen Introducción: Las anomalías vasculares representan un amplio panorama de distintas lesiones donde los tumores son los más frecuentes. Las malformaciones vasculares suelen presentarse en etapas tardías de la vida secundarias al lento crecimiento y a los síntomas que padecen los pacientes. Debe de darse un manejo multidisciplinario donde el diagnóstico es la piedra angular. Los casos de malformaciones venosas o linfáticas suelen tratarse mediante la resección de la malformación en su totalidad. Presentación del caso clínico: Varón de 35 años de edad quién presenta aumento de volumen y dolor de 3 meses de evolución en la mano derecha. A la exploración física se observa una masa en la región tenar de dicha mano, con bordes bien definidos de aproximadamente 3 × 3 cm, no móvil, adherida a planos profundos, dolorosa a palpación, con hiperestesias en trayecto del nervio mediano. Se realizaron ultrasonido Doppler y resonancia magnética, los cuales sugirieron una lesión vascular. Se realizó exploración quirúrgica y se observó una lesión vascular adherida a las estructuras nerviosa y tendinosa, las cuales se liberaron y se extrajo la tumoración. Se envió la pieza quirúrgica a patología, que reportó hemangioma capilar y venoso. Conclusiones: Las malformaciones vasculares mixtas (venoso y capilar) en la mano son una entidad poco frecuente que requiere de un manejo quirúrgico preciso. Estas lesiones generan síntomas asociados al aumento de volumen, entre los que destacan: dolor, disminución del rango de movimientos. El tratamiento quirúrgico se asocia a una mejoría de los síntomas.

Abstract Introduction: Vascular anomalies in the hand represent a rare disease that needs an accurate diagnosis and prompt surgical treatment. One of the uncommon anomalies is the mixed vascular one. The diagnosis of these malformations is clinical but radiological studies such as magnetic resonance and Doppler ultrasound are mandatory. Once the diagnosis is made, surgery is the next and final step. Recurrence is rare when the entire tumor is resected. Clinical Case Study: A 35-year-old male presented with an increase in volume and pain of three months of evolution in the right hand. On physical examination, a mass in the righthand thenar region was observed, with well-defined edges of approximately 3 x 3 cm, not mobile, adhered to deep planes, painful to palpation, with hyperesthesias in the median nerve pathway. A magnetic resonance and a Doppler ultrasound were applied showing a well-circumscribed tumor. The patient underwent surgery and the whole vascular malformation was removed with no damage of neighbor structures. Pathology reported a venous and capillary hemangioma. Conclusions: Mixed vascular malformations in the hand are uncommon pathologies that require a correct diagnosis and a prompt surgical resolution. The most frequent symptoms associated with these tumors are: tenderness, pain and limitation in the movement of the hand. Surgical treatment is always recommended.

Reconstrucción auricular traumática con colgajo retroauricular. Una alternativa vigente y reproducible para los médicos residentes en formación / Traumatic auricular reconstruction with a retroauricular flap. A current and reproducible alternative for resident doctors in training

Resumen Introducción La reconstrucción auricular traumática es un reto para el cirujano plástico. Su objetivo es reproducir y recrear la forma y topografía de la región auricular, haciendo que los estigmas propios de la reconstrucción sean mínimos. Caso clínico Se presenta el caso de un paciente varón de 5 años de edad, con lesión por mordedura de perro en la oreja derecha, y lesión corto-contusa en pabellón auricular con pérdida de cobertura cutánea, pérdida parcial de cartílago auricular y exposición cartilaginosa a nivel de hélix y porción retroauricular. Se realizó reconstrucción auricular mediante reparación auricular y colgajo retroauricular. En un segundo tiempo quirúrgico, se realizó sección de la base del colgajo, y se logró un adecuado contorno auricular, así como cobertura cutánea definitiva Conclusiones Las lesiones auriculares, por su situación anatómica, son frecuentes en la práctica profesional de un cirujano plástico y reconstructivo. Existen múltiples técnicas quirúrgicas para la reconstrucción de defectos auriculares, sin embargo, el colgajo retroauricular ofrece una técnica sencilla y versátil.

Abstract Introduction Traumatic auricular reconstruction is a challenge for the plastic surgeon. The purpose of this reconstruction is to reproduce and recreate the shape and topography of the auricular region, diminishing the typical stigmas of a reconstruction. Clinical case The case of a 5-year-old male patient with right bite of a dog in a right ear presenting a short-contusional lesion in the auricular hall with loss of cutaneous cover, partial loss of atrial cartilage and cartilage exposure At the level of helix and retroauricular portion. Auricular reconstruction is performed by atrial repair and retroauricular flap. In a second surgical time, a section of the base of the flap is performed, achieving a suitable atrial contour and definitive skin coverage. Conclusions Auricular injuries, due to their anatomical situation, are frequent in the professional practice of a plastic and reconstructive surgeon. There are multiple surgical techniques for the reconstruction of atrial defects, however, the retroauricular flap offers a simple and versatile technique.

Surgical Resection of Vascular Lesions Involving the Buccal Fat Pad.

Vascular abnormalities are localized structural irregularities, which are performed during vasculogenesis, angiogenesis, and lymphangiogenesis. The involvement of soft tissue in such vascular malformations is frequent; however, the compromising of the buccal fat pads (Bichat bags) is uncommon, even in specialized centers, such as the plastic clinic of our institution, in which very few patients have been reported in the literature. The purpose of this article is to present a series of 2 patients in which vascular malformations involving the buccal fat pads, which were extracted by intraoral approach.

Mozart Ear Deformity: a Rare Diagnosis in the Ear Reconstruction Clinic.

Mozart ear is a rare auricular deformity; clinically the auricle is characterized by the bulging appearance of the anterosuperior portion of the auricle due to fusion of the crura of the antihelix, an inversion in the normal form of the cavum conchae resulting in its convexity and a slit-like narrowing of the orifice of the external auditory meatus.A retrospective review of clinical and photographic records of patients attended at the ear reconstruction clinic of our hospital between June of 2010 and May 2016 was performed; out of 576 consecutive patients only 3 fulfilled the inclusion criteria, with a prevalence of 0.5%. The authors present these patients.Surgical interventions mainly focus on the correction of the convex concha; however, the procedure should be tailored to the severity of the deformity and the wishes of the patient.

[Reconstruction of the ear in the burns patient]. / Reconstrucción auricular en el paciente quemado.

Face burns are a singular pathology with great functional and psychological impact in the patients suffering them. The ears play a fundamental role in personal interactions and damage to this organ results in physical and emotional distress. The reconstructive treatment of the burned ear is a challenge. Multiple procedures have been described to achieve success in the reconstruction of the burned ear; immediate reconstruction with autologous rib cartilage, secondary reconstruction, alloplastic material reconstruction, tissue expansion, skin grafts and also microvascular flaps are some of the most common procedures used in this patients. All these techniques focus on giving a natural appearance to the patient. Burns to the ears affect 30% of the patients with facial burns, they require an excellent treatment given by a multidisciplinary team.