Malformación vascular de la rodilla simulando una artritis idiopática juvenil / Vascular malformation of the knee simulating juvenile idiopathic arthritis

No disponible

Reconstrucción mamaria en el síndrome de Poland / Mammary reconstruction in Poland´s syndrome

El síndrome de Poland actualmente se considera como un síndrome polimalformativo que se expresa con diferentes grados de severidad. Hemos realizado un estudio clínico retrospectivo de los pacientes diagnosticados en nuestro hospital entre el año 2000 y el 2006 con el objetivo de revisar las opciones de tratamiento quirúrgico para la reconstrucción mamaria según el grado de la malformación, basados en nuestra propia experiencia y en la revisión de la literatura. Recogimos un total de 13pacientes (5 hombres y 8 mujeres) de los cuales fueron operados 6 (1hombre y 5 mujeres). La indicación quirúrgica se basó en la clasificación propuesta por Foucras que divide la deformidad en 3 estadios de severidad. Proponemos una estrategia terapéutica adecuada para cada estadio así como técnicas de refinamiento para mejorar el resultado estético. La mayoría de los pacientes manifestaron un alto grado de satisfacción con el resultado a pesar de tratarse de intervenciones complejas con una tasa de complicaciones no desdeñable (AU)

Poland’s syndrome is considered to be a polimalformativeentity with different degrees of severity. We retrospectively reviewed our patients with Poland’s syndrome diagnosis, treated between 2000and 2006. The aim of our study is to assess the different choices of surgical treatment for mammary reconstruction according to the importance of malformation and taking into account our own experience and literature references. A total of 13 patients (5 males and 8 females) were studied and only 6 of them (1 male and 5 females) underwent surgery. Surgical indication was based on Foucras’s classification, considering3 grades of severity. We propose a surgical approach adapted to each stage, as well as surgical refinements to improve the aesthetic aspect. Most of our patients were very satisfied with final results even though they underwent complex procedures with a considerable rate of complications (AU)

[Complications and sequelae after nasal trauma]. / Complicaciones y secuela postraumatismo nasal.

Septal haematoma after nasal trauma is a complication that can lead to septal abscess if unrecognized or early intervention is not performed. It can cause compression and thereby necrosis that evolve to a septal abscess in which cultures reveal saprophyte bacteria. Cartilage necrosis and destruction can produce impaired breathing and aesthetic deformities with collapse of the dorsum and the tip of the nose. We present a 10 year old masculine infant, that suffered a nasal fracture with a septal haematoma that remained undiagnosed. The patient developed a septal abscess that required drainage and resulted in nasal sequelae with collapse of dorsum and cranial displacement of tip and columella. Functional and aesthetic reconstruction was performed using rib cartilage grafts. No complications occurred. Functional and aesthetic improvement was observed. Result after 2 months of follow-up is considered favourable.

Complicaciones y secuela postraumatismo nasal / Complications and sequelae after nasal trauma

El hematoma septal después de un traumatismo nasal es una complicación que de no ser diagnosticada y tratada precozmente puede evolucionar a absceso septal. El hematoma septal crea necrosis por compresión del cartílago cuadrangular subyacente y posteriormente puede complicarse con un absceso septal en el que se aisla flora saprófita. La necrosis y destrucción del septo nasal puede afectar a la función respiratoria y estéticamente se manifiesta en hundimiento del dorso y punta nasal. Presentamos el caso de un varón de 10 años que sufrió fractura de huesos propios de la nariz con hematoma septal que pasó desapercibido. El cuadro evolucionó a un absceso septal que fue drenado y que originó como secuelas hundimiento del dorso nasal y retracción craneal de la punta y columela. Se realizó corrección funcional y estética nasal mediante injerto osteocartilaginoso de parrilla costal en dorso y columela. No se observaron complicaciones. Se observó mejoría estética y funcional. El resultado tras 2 meses de seguimiento ha sido favorable (AU)

Septal haematoma after nasal trauma is a complication that can lead to septal abscess if unrecognized or early intervention is not performed. It can cause compression and thereby necrosis that evolve to a septal abscess in which cultures reveal saprophyte bacteria. Cartilage necrosis and destruction can produce impaired breathing and aesthetic deformities with collapse of the dorsum and the tip of the nose. We present a 10 year old masculine infant, that suffered a nasal fracture with a septal haematoma that remained undiagnosed. The patient developed a septal abscess that required drainage and resulted in nasal sequelae with collapse of dorsum and cranial displacement of tip and columella. Functional and aesthetic reconstruction was performed using rib cartilage grafts. No complications occurred. Functional and aesthetic improvement was observed. Result after 2 months of follow-up is considered favourable (AU)

Lipoinfiltración de gran volumen en un caso de lipodistrofia glútea profunda / Lipofilling of large volume in a case of deep gluteal lipodistrophy

La lipoinyección de grasa autóloga es una técnica habitual en Cirugía Estética. Los refinamientos en los procesos de extracción, preparación y reintroducción de la grasa han permitido una mayor supervivencia ylos buenos resultados obtenidos han contribuido a extender las indicaciones de la lipoinfiltración al terreno de la Cirugía Reconstructiva y a defectos mayores. Presentamos un caso de lipodistrofia glútea profunda, secundaria a una vacuna, que se trató mediante trasplante de 300cc de grasa autóloga. Se describen los detalles técnicos y las ventajas de este procedimiento frente a otras alternativas terapeúticas. El resultado inicial mejoró durante 6 meses y fue muy satisfactorio para la paciente y los cirujanos. Pensamos que este es otro caso que apoya la “teoría de la supervivencia” de adipocitos y adipoblastos (AU)

Lipofilling is a common technnique in Aesthetic Surgery. Refinements in the process of extraction, preparation and reintroduction of the fat have allowed an increased survival and the excellent obtained results have contributed to extend the indications of lipoinfiltration to the field of Reconstructive Surgery and therefore to cover larger defects. We present a case of deep gluteal lipodistrophy, secondary to vaccination, was treated with a 300 autologous fat transplant. We describe technical details and advantages of this procedure versus other therapeutic options. The initial result improved over 6 months and was very satisfactory for the patient and the surgeons. We believe this is another case that supports the “survival theory” of adipocytes and adipoblasts (AU)

Liposucción en niños: utilidad clínica / Liposuction in children: clinical utility

La liposucción se ha convertido en una de las operaciones estéticas más frecuentes. La paciente «típica» es una mujer joven con acúmulos grasos en las regiones trocantéreas. Gradualmente, la seguridad de esta técnica, unido a la gran satisfacción que expresan la mayoría de las pacientes, ha contribuido a que sus indicaciones se hayan ido extendiendo a otras patologías del tejido graso y a poblaciones de edad muy diversa. Sin embargo es muy escasa la literatura acerca de la liposucción infantil. Los autores presentan la experiencia con la liposucción en el tratamiento de lipodistrofias, congénitas o adquiridas, en la edad infantil. Se describen los detalles particulares de la técnica y se analizan las ventajas de la liposucción frente a la cirugía abierta en estos casos (AU)

Liposuction has become one of the most frequent aesthetic procedures. The «typical» patient is a young female with fat deposits in the trochanteric region. Gradually the safety of the technique together with the high satisfaction rate of the patients have contributed to the widening of its indications to other pathologies of the adipose tissue in different age populations. However, there is scarce literature regarding liposuction in childhood. The authors present their experience with liposuction as the treatment of congenital as well as acquired lipodystrophies in the paediatric age. Some particular details of the technique are described and the advantages of liposuction versus open surgery in these cases are analysed (AU)

[Free fat flap for the treatment of Parry-Romberg disease in children]. / Trasplante libre de grasa para tratamiento de la enfermedad de Parry-Romberg infantil.

Progressive hemifacial Atrophy (PHA) or Romberg's Disease is a rare entity of unknown etiology, which most often affects only one side of the face and can include all tissue planes in different grades of severity. Of the several treatments proposed, pedicled or free flaps seem to achieve the best cosmetic results in severe cases. In mild to moderate cases, free autologous fat transplant may obtain optimal results with lower complexity, cost and morbidity. The presence of multiple adipoblasts might increase the possibilities of graft take, particularly in children. Furthermore, refinements in the processes of extraction, preparation and reintroduction of the fat have contributed to improve the results that may be long lasting. We present 2 cases of PHA in 2 girls (11 and 13 years old), that were treated by lipofilling. No complications occurred. In both cases we observed a small reduction in the volume of the initial graft. Thus the procedure was repeated 6 months later to improve facial symmetry. Results have been excellent in one year follow-up.

[Gas-containing hepatic abscess from an unusual etiology]. / Absceso hepático gaseoso de etiología inusual.

Pyogenic hepatic abscesses used to be caused by an abdominal infection. Cholangitis due to stones is the commonest cause, followed by diverticulitis or appendicitis. Most patients presenting with pyogenic liver abscesses have a polymicrobial infection usually with Gram negative aerobic and anaerobic organisms. Escherichia coli or Klebsiella pneumoniae are frequently implicated but they do not usually produce gas into the abscesses. We comment a case of a gas-containing liver abscess after an acute pancreatitis without any risk factor associated.

Absceso hepático gaseodo de etiología inusual / Gas-containing hepatic abscess from an unusual etiology

Los abscesos hepáticos piógenos suelen tener su origen en una infección abdominal. Las colangitis por cálculos son la causa más frecuente seguida de las diverticulitis o apendicitis. Sus causantes suelen ser aerobios gram negativos o anaerobios de origen abdominal. Los gérmenes del tipo Escherichia coli o Klebsiella pneumoniae se ven frecuentemente implicados; lo que no es tan habitual es que este tipo de microorganismos produzcan gas dentro de las colecciones. Comentamos un caso en el que esto sucede tras un episodio de pancreatitis aguda en una paciente sin factores de riesgo

Pyogenic hepatic abscesses used to be caused by an abdominal infection. Cholangitis due to stones is the commonest cause, followed by diverticulitis or apendicitis. Most patients presenting with pyogenic liver abscesses have a polymicrobial infection usually with Gram negative aerobic and anaerobic organisms. Escherichia coli or Klebsiella pneumoniae are frequently implicated but they do not usually produce gas into the abscesses. We comment a case of a gas-containing liver abscess after an acute pancreatitis without any risk factor associated

Congenital melanotic macules and Sebaceous Choristoma arising on the tongue of a newborn: epidermal choristoma?

Oral hyperpigmentation is a common event in older individuals, however, is exceptional in neonates (congenital melanotic macules). Conversely, 70-80% of people have sebaceous glands in the oral mucosa, with the tongue representing an ectopic location and termed sebaceous choristoma by some authors. We report a case that fulfills both conditions in a tongue lesion. A 1-month-old boy presented with a pigmented macula on his tongue noted at birth. An excisional biopsy was performed showing a lesion lined by an epidermal-like epithelium with basal pigmentation, under which, sebaceous glands, abortive hair follicles and ductal structures mimicking apocrine glands were found. Seven cases of congenital melanotic macules of the tongue have been reported, however, none of them showed sebaceous glands under the lesion. Furthermore, there has not been a reported case of sebaceous choristoma of the tongue present at birth. We present a case that shares clinical and histological features of both conditions and propose the name 'epidermal choristoma'.

Trasplante libre de grasa para tratamiento de la enfermedad de Parry-Romberg infantil / Acute secundary abdomen to pancreatic hydatid cyst

La hemiatrofia facial progresiva (HAFP) o enfermedad de Romberg es una rara entidad de etiología desconocida, que mayoritariamente afecta a un solo lado de la cara, pudiendo incluir todos los planos tisulares en diferentes grados de severidad. De los diferentes tratamientos propuestos, en los casos severos, los colgajos pediculados o libres parecen lograr los mejores resultados estéticos. Para los casos leves o moderados, el trasplante libre de grasa autóloga puede obtener resultados óptimos con menor complejidad, coste y morbilidad. La presencia de múltiples adipoblastos en los niños puede aumentar las posibilidades de prendimiento del injerto. Además los refinamientos en los procesos de extracción, procesado y reintroducción de la grasa han contribuido a perfeccionar los resultados y a que éstos sean más duraderos. Presentamos dos casos de HAFP en 2 niñas de 11 y 13 años que fueron tratados mediante lipoinfiltración. No se observaron complicaciones. En ambos casos se observó una discreta reducción del volumen inicial, por lo que se repitió el procedimiento a los 6 meses para mejorar la simetría facial. Los resultados han sido excelentes tras un año de seguimiento (AU)

Progressive hemifacial Atrophy (PHA) or Romberg’s Disease is a rare entity of unknown etiology, which most often affects only one side of the face and can include all tissue planes in different grades of severity. Of the several treatments proposed, pedicled or free flaps seem to achieve the best cosmetic results in severe cases. In mild to moderate cases, free autologous fat transplant may obtain optimal results with lower complexity, cost and morbidity. The presence of multiple adipoblasts might increase the possibilities of graft take, particularly in children. Furthermore, refinements in the processes of extraction, preparation and reintroduction of the fat have contributed to improve the results that may be long lasting. We present 2 cases of PHA in 2 girls (11 and 13 years old), that were treated by lipofilling. No complications occurred. In both cases we observed a small reduction in the volume of the initial graft. Thus the procedure was repeated 6 months later to improve facial symmetry. Results have been excellent in one year follow-up (AU)

[Liposuction in children: clinical utility]. / Liposucción en niños: utilidad clínica.

Liposuction has become one of the most frequent aesthetic procedures. The "typical" patient is a young female with fat deposits in the trochanteric region. Gradually the safety of the technique together with the high satisfaction rate of the patients have contributed to the widening of its indications to other pathologies of the adipose tissue in different age populations. However, there is scarce literature regarding liposuction in childhood. The authors present their experience with liposuction as the treatment of congenital as well as acquired lipodystrophies in the paediatric age. Some particular details of the technique are described and the advantages of liposuction versus open surgery in these cases are analyzed.

[Intramuscular juvenile xantogranuloma]. / Xantogranuloma juvenil intramuscular.

Deep or intramuscular juvenile xanthogranuloma (JXG) is very rare. There are, however, some clinical and histological similarities between the case we present and the few cases that have been published in the literature. Although most of them will need histologic confirmation to establish the final diagnosis, surgeons who are operating tumors of infancy should consider it in the differential diagnosis of well circumscribed, rapidly growing dorsal masses in children under 3 years of age. Macroscopic appearance upon excision can help to support the diagnosis. Knowledge of this variant of JXG may avoid aggressive diagnostic or therapeutic procedures.

[Nasal neuroglial heterotopy in children]. / Heterotopia neuroglial nasal en niños.

Nasal gliomas are tumors of extracranial neuroglial tissue. The incidence is very low, with little more than 300 cases described unliterature. It is important to make a correct diagnosis study of this lesion, to avoid the possible complications derived from an erroneous treatment. We review a case of one girl with midline nasal tumor, she was operated on with total extirpation of the tumor, we analyze the previous diagnosis study and their histopathology.