Estudio comparativo de efectividad de un apósitode plata nanocristalina frente a sulfadiazinaargéntica en el tratamiento de pacientes quemados / Comparative study on the effectiveness of a dressing of nanocrystalline silver opposite to the use of silver sulfadiazine in burned patients treatment

La plata es un producto utilizado como agente antimicrobiano desde la antigüedad y ya a finales del siglo XIX se empezaron a utilizar compuestos de plata con finalidades médicas. La utilización tópica de la crema de sulfadiazina argéntica al 1% se considera mayoritariamente como tratamiento de elección para las quemaduras a fin de tratar o prevenir la infección local. El objetivo de este artículo es comparar el tratamiento con Acticoat® (plata nanocristalina 15 nanómetros) frente al tratamiento con sulfadiazina argéntica, ambos regímenes en igualdad de condiciones y un mismo centro de quemados. También se realiza una revisión de la literatura reciente sobre los factores de riesgo para la infección en quemaduras, las medidas que se utilizan para prevenirla y su importancia en la disminución de la morbi-mortalidad (AU)

Silver is a product that has been used as antimicrobialagent from ancient times; at the end of the XIXth century silver compounds were used with medical purposes. The use of silver sulfadiazine to 1 % cream is considered as gold standard for local treatment of burns in order to prevent or to treat local infection We compare treatment with Acticoat ® (nanocrystalline silver 15 nanometers) and silver sulfadiazine, both systems on equal terms and in the same medical burned enter. We review recent literature of risk factors for burn infection, methods to prevent it and to diminish morbimortality in burned patients (AU)

Colgajos de las perforantes del pie: problemas y posibles soluciones / Foot perforator flaps: problems and possible solutions

A pesar de diversas publicaciones existentes sobre el colgajo mediano plantar tradicional, los colgajos de las perforantes del pie no están suficientemente estudiados. Es necesario ampliar nuestros conocimientos sobre la anatomía vascular de esta región, los problemas que pueden surgir durante la disección de la zona y las posibles soluciones. Realizamos disección anatómica de 10 pies de cadáver utilizando relleno vascular con látex coloreado. Definimos la secuencia de la disección de las perforantes de la arteria plantar medial. Medimos los puntos de salida de las perforantes dominantes en relación con 3 puntos de referencia, diámetro y longitud de cada perforante. Evaluamos la utilidad de cada colgajo para su uso en reconstrucción local o a distancia en función del diámetro y la longitud de la perforante, grosor del colgajo y morbilidad de la zona donante. Los colgajos de los vasos perforantes del pie son una buena opción para la reconstrucción tanto local como a distancia, con una mínima morbilidad de la zona donante y con un buen resultado funcional gracias a las características del tejido del pie cuando se usa para reconstrucción en mano (AU)

Traditional medial plantar flap is widely described in the literature, but foot perforator flap is a relatively new subject which still needs more detailed anatomical investigation. We need to amplify our knowledge about this surgically challenging region, dissection difficulties and possible solutions. We performed anatomical dissection on 10 cadaver feet with dyed latex intravascular injection and then dissected out the perforators arising from the medial plantarartery. We measured the origin of the dominant perforators in relationship to 3 reference points, diameter and length of each perforator. We analyzed the application of flaps based on these perforators as local and freeflaps in relation to pedicle length and diameter, flapthickness and donor site morbidity. Foot perforator flaps are a good option for local and distant reconstruction. Donor site morbidity is low and functional result is good due to tissue characteristics of the foot region when used for hand reconstruction (AU)

Estudio de la vascularización arterial del músculoflexor digitorum superficialis / Anatomical study of the arterial vascularization of the flexor digitorum superficialis muscle

El objetivo de nuestro estudio es describir la distribución de la vascularización del músculo flexor digitorum superficialis para optimizar sus indicaciones en Cirugía Reconstructiva de miembro superior. Disecamos 15antebrazos fijados según el método Thiel y coloreados mediante la inyección de látex en los vasos femorales. Centramos nuestro estudio en la disección del músculo flexor digitorum superficialis, seleccionando únicamente los pedículos vasculares que superan los 2 mm, valorando los resultados en función de sus relaciones anatómicas y de su longitud. El número total hallado de arterias nutrientes del vientre muscular fue de 219, localizándose en mayor porcentaje en el tercio medio del antebrazo. De los resultados obtenidos de nuestro estudio podemos deducir que las arterias cubital y cubital recurrente aportan la vascularización dominante. Medialmente, el músculo recibe ramas de la arteria cubital y cubital recurrente, en la parte profunda del vientre muscular. Lateral y proximalmente, recibe ramas de la arteria mediana, mientras que lateral y distalmente recibe ramas de la arteria radial, que penetran en la superficie del músculo (AU)

We present an anatomical study that describes the distribution of the muscular perforators of the flexor digitorum superficialis muscle. In this study we dissected15 forearms fixed according to Thiel method and coloured latex injection in the femoral vessels. The study was centered on the flexor digitorum superficialis muscle. Only muscular perforator arteries with diameters over2mm were selected. The vascular origin and length were also studied. In all cases, measurements were taken from the bicondyle line. The total number of arteries obtained from the muscle belly was 219, with the greatest percentage located in the half of the forearm. The principal vascular origin of the perforator arteries was the cubital artery. From the results obtained in our work, we can deduce that the ulnar and the ulnar recurrent arteries are the most dominant supply of the muscle. Medially, it receives many large branches from the ulnar recurrent and the ulnar artery. Laterally and proximally, it receives small branches from the median artery, and distally, it receives several small branches from the radial artery that enter the superficial surface of the muscle (AU)

Vascularización arterial del músculo flexor digitorum superficialis. Estudio anatómico y aplicaciones clínicas / Arterial vascularisation of the flexor digitorum superficialis muscle. Anatomical study and clinical aplications

El objetivo de nuestro estudio es describir la distribución de la vascularización del músculo flexor digitorum superficialis para optimizar sus indicaciones en cirugía reconstructiva de miembro superior. MATERIAL Y MÉTODOS. Disecamos 15 antebrazos fijados según el método Thiel y coloreados mediante la inyección de latex en los vasos femorales. Centramos nuestro estudio en la disección del músculo flexor digitorum superficialis, seleccionando únicamente los pedículos vasculares que superan los 2 mm, valorando los resultados en función de sus relaciones anatómicas y longitud. RESULTADOS. El número total de arterias nutrientes del vientre muscular era de 219, localizándose en mayor porcentaje en el tercio medio del antebrazo. CONCLUSIÓN. De los resultados obtenidos de nuestro estudio podemos deducir que la arteria cubital y cubital recurrente aportan la vascularización dominante. Medialmente recibe ramas de la arteria cubital y cubital recurrente, en la parte profunda del vientre muscular. Lateral y proximalmente recibe ramas de la arteria mediana, mientras que lateral y distalmente recibe ramas de la arteria radial, que penetran en la superficie del músculo (AU)

We present an anatomical study that describes the distribution of the muscular perforators of the flexor digitorum superficialis muscle. MATERIAL AND METHODS. In this study we dissected 15 forearms fixed according to Thiel method and coloured latex injection in the femoral vessels. The study was centered on the flexor digitorum superficialis muscle. Only muscular perforator arteries with diameters over 2mm were selected. The vascular origin and length were also studied. In all cases, measurements were taken from the bicondyle line. RESULTS. The total number of arteries obtained from the muscle belly was 219, with the greatest percentage located in the half of the forearm. The principal vascular origin of the perforator arteries was the cubital artery. ONCLUSION. From the results obtained in our work, we can deduce that the ulnar and the ulnar recurrent arteries are the most dominant supply of the muscle. Medially , it receives many large branches from the ulnar recurrent and the ulnar artery. Laterally and proximally, it receives small branches from the median artery, and distally, it receives several small branches from the radial artery that enter the superficial surface of the muscle (AU)

Corrección de ptosis palpebral por la incisión de blefaroplastia / Upper eyelid ptosis treatment using blepharoplasty incision

Se entiende por blefaroptosis el nivel anormalmente bajo del párpado superior durante la mirada directa. Los mejores resultados se obtienen con las técnicas de resección o avance del músculo elevador o su aponeurosis, siempre que el elevador posea una función adecuada. Nuestra intención es presentar una modificación a la técnica de Blaskovics para la corrección de blefaroptosis moderadas, con buena función del elevador Presentamos una serie de 10 casos donde se utilizó una variante de la operación de Blaskovics de resección del elevador para la corrección quirúrgica de la ptosis palpebral. De los 10 casos, 7 fueron bilaterales y 3 unilaterales. En todos ellos la función del elevador se situaba entre 4 y 8 mm y el grado de ptosis fue mayor de 4 mm con disminución del campo visual en la mirada directa. La técnica quirúrgica incluyó un abordaje cutáneo mediante la incisión horizontal de Blefaroplastia superior, la exposición amplia del músculo elevador y su aponeurosis, respetando las bolsas grasas orbiculares y separándolo de la conjuntiva palpebral. En todos los casos se obtuvo corrección de las ptosis. El grado de asimetría fue inferior a 0,3 cm. Un caso presentó en el postoperatorio inmediato dehiscencia de la sutura en su lado medial y tuvo que ser reintervenido a los10 días. El edema palpebral postoperatorio se resolvió a partir del 2º día postoperatorio desapareciendo hacia el día 8º y permitiendo una valoración fiable en dicha fecha. El grado de satisfacción de los paciente fue bueno o muy bueno y el campo visual fue completo en todos los pacientes Las técnicas clásicas y sus modificaciones para la corrección de los casos de ptosis siguen teniendo validez. Con esta modificación que respeta la conjuntiva palpebral ocular se evita añadir morbilidad al proceso quirúrgico. Pensamos que la integridad de la conjuntiva redunda en un mayor confort postoperatorio al paciente, disminuye el edema conjuntival y por tanto la recuperación es más rápida; posibilita también la cirugía de rescate en caso de correcciones insuficientes y evita el problema de sobre corrección con exceso de resección de tejido conjuntival. En resumen se trata de una modificación quirúrgica que facilita la técnica, disminuye las complicaciones postoperatorias, mejora la recuperación y evita la sensación de cuerpo extraño intraocular de una resección conjuntival (AU)

Blepharoptosis is the abnormally low of the top eyelid during the direct look. Best results are obtained by resection or advance of the elevator muscle or aponeurosis, whenever the elevator has a suitable function. We present a modification to the Blaskovics´s technique for correction of moderate blepharoptosis, with good function of the elevator muscle. We present a serie of 10 cases where we used a variant of Blaskovics’s technique of resection of the elevator for surgical correction of ptosis. Seven were bilateral cases and 3 unilateral ones. In all the cases the elevator function was between 4 and 8 mm and ptosis was major than 4mm with visual field decrease in the direct look. Surgical technique included a cutaneous horizontal incision of Blepharoplasty, wide exhibition of elevator muscle and aponeurosis, respecting orbicular fatty bags and separating it from the palpebral conjunctive. In all the cases correction of the ptosis were obtained. The grade of asymmetry was lower than 0,3 cm. One case presented in the inmediate postoperatory opening of the suture in his medial side and had to be re-taken after 10 days. The palpebral postoperative edema was solved between 2 – 8th day allowing evaluation in that moment. Patient’s satisfaction was good or very good and the visual field was complete in all patients Classic surgical techniques and its modifications for correction of ptosis keep on being valid. With this modification that respects conjuctive we avoid to add morbidity to the surgical process. We think that conjunctive integrity produces a major postoperative comfort to the patient, diminishes the edema and improve the recovery; additionally it makes possible the rescue surgery in case of insufficient correction and avoids over-correction with excess of resection of conjuntive tissue. In summary is a surgical modification that facilitates the technique, diminishes postoperative complications, improves the postoperative recovery and avoids the sensation of intraocular strange body of the conjuntival resection (AU)

Anatomical study of the cutaneous perforator arteries and vascularisation of the biceps femoris muscle.

UNLABELLED: We present an anatomical study that describes the distribution of the cutaneous perforators (CP) of both heads of the biceps femoris muscle. MATERIAL AND METHODS: In this study, we dissected 18 legs from nine cadavers. The study was centered on the biceps femoris muscle and musculocutaneous perforator arteries from both muscular heads. Only perforator arteries with comitant vein diameters of over 0.5 mm were selected. The vascular origin and length were also studied. In all cases, measurements were taken from the bicondyle line. RESULTS: The measurements taken from the muscle bellies of the biceps gave the following results; for the long head 33.91 cm as medium length (SD = 2.70) and for the short head 23.85 cm as medium length (SD = 2.96). The total number of perforator arteries obtained from the two muscle bellies was 139, with the greatest percentage located in the lower half of the thigh. The majority follow an intramuscular route (80.48%) and less frequently they are septals (19.52%). The lengths of perforator arteries from its origin in the axial vessel of the muscle to the subcutaneous fat were, for the short head 5.01+/-1.33 (3.0-10.0), whereas the same measurement, in the long head was 4.54+/-1.36 (2.5-9.0). The principal vascular origin of the perforator arteries was the popliteal artery in both muscle bellies, whilst the second arterial vessel in importance was the first and second profunda perforator artery. CONCLUSION: From the results obtained in our work, we can deduce that it is always possible to locate perforator arteries in both muscle bellies; most frequently they have intramuscular distribution and are located in the proximity of the vascular septum. Their most common origins are the popliteal artery and first and second profunda perforator artery. Finally, it is possible to design pedicle and free flaps, with less morbidity and more versatility than musculocutaneous flaps.

Spanish version of the Burn-Specific Health Scale.

OBJECTIVE: To study the viability, reliability, and validity of the Spanish version of the Burn-Specific Health Scale. METHODS: The questionnaire was cross-culturally adapted and translated and its psychometric properties were tested regarding their viability, reliability, and validity. A total of 115 patients discharged from the Burn Care Unit of the Alicante General Hospital were included in the study. RESULTS: One hundred fifteen patients were interviewed and completed a total of 156 questionnaires. Of these, 112 were self-administered (71.79%) by the patient, with an average completion time of 12 to 13 minutes (SD = 3.44 minutes). The test-retest reliability, internal consistency, criterion validity, and construct validity all proved satisfactory. CONCLUSION: The Spanish version of the Burn-Specific Health Scale is a reliable and valid instrument for use in the Spanish population, and its results are perfectly comparable with those obtained in the original English version.