Postsurgical complications of aortic valve replacement in middle-aged people: an exploratory review of the literature / Complicaciones postquirúrgicas de reemplazo de válvula aórtica en personas de mediana edad: una revisión exploratoria de literatura

Introduction: Cardiovascular Disease (CVD) is the world's leading cause of death, claiming the lives of approximately 18 million people each year, 80% of them in low- and middle-income countries . We say that it is the most difficult intervention because of its cardiac and vascular anatomical composition. Its injury would be extremely dangerous because it would compromise the circulatory and respiratory system, which would generate an aggravation of the patient or his death. That is why the WHO in 2016 calculated the number of deaths attributed to cardiovascular diseases for Colombia at 83,987, added to the post-surgical complications derived from them. The causes that affect the heart and especially the aortic valve range from circulatory difficulty to mechanical failure, so we know that every year more people die from cardiovascular diseases (CVD) than from any other cause. This means the high need and demand for a surgical intervention; indispensable to safeguard the life of patients, for this reason we wonder what are the post-surgical complications of aortic valve replacement surgery in middle-aged people? Objective: To identify the types of post-surgical complications of aortic valve replacement in middle-aged people in the first six months after surgery. Methodology: PRISMA protocol for exploratory literature reviews and its extension for exploratory literature reviews. Methodological quality was assessed with PEDro, and study characteristics were extracted independently. Result: 28 studies included in the review, with scores between 6 and 9, of good and excellent methodological quality. The most frequent post-surgical complications were surgical reintervention, post-surgical bleeding, thrombosis or thromboembolism. Conclusion: Complications of aortic valve replacement are frequent in the middle-aged population.

Introducción: Las Enfermedades Cardiovasculares (ECV) son la principal causa mundial de muerte, y cobran la vida de aproximadamente 18 millones de personas cada año, el 80% de ellas en países de ingresos bajos y medios . Decimos que es la intervención con mayor dificultad por su compuesto anatómico cardiaco y vascular. Su lesión sería sumamente peligrosa porque comprometería el sistema circulatorio y respiratorio, lo cual generaría un agravamiento del paciente o su fallecimiento. Por eso la OMS en el 2016 calculó el número de muertes atribuidas a enfermedades cardiovasculares para Colombia en 83.987, sumado a las complicaciones postquirúrgicas derivadas de ellas. Las causas que afectan al corazón y especialmente la válvula aórtica van desde una dificultad circulatoria hasta una falla mecánica, por lo que sabemos que cada año mueren más personas por enfermedades cardiovasculares (ECV) que por cualquier otra causa. Lo que significa la alta necesidad y demanda de una intervención quirúrgica, la cual es indispensable para salvaguardar la vida de los pacientes, por esta razón nos preguntamos ¿cuáles son las complicaciones postquirúrgicas de una cirugía de reemplazo de válvula aórtica en personas de mediana edad en el primer semestre post cirugía? Objetivo: Identificar los tipos de complicaciones postquirúrgicas de reemplazo de válvula aórtica en personas de mediana edad en el primer semestre post cirugía Metodología: Protocolo PRISMA para revisiones exploratorias de literatura y su extensión para revisiones exploratorias de literatura. Se evaluó la calidad metodológica con PEDro, y se extrajeron de forma independiente las características de los estudios. Resultado: 28 estudios incluidos en la revisión, con puntuaciones entre 6 y 9, de calidad metodológica buena y excelente. Las complicaciones postquirúrgicas más frecuentes fueron: reintervención quirúrgica, hemorragias post cirugía, trombosis o tromboembolismo. Conclusión: Las complicaciones por reemplazo de válvula aortica son frecuentes entre la población de mediana edad.

Introdução: A doença cardiovascular é a principal causa de morte no mundo, causando a morte de cerca de 18 milhões de pessoas a cada ano, 80% dos quais em países de baixa e média renda. Dizemos que é a intervenção mais difícil devido à sua composição anatômica cardíaca e vascular. Sua lesão seria extremamente perigosa porque comprometeria o sistema circulatório e respiratório, o que geraria um agravamento do paciente ou sua morte. É por isso que a OMS calculou em 2016 o número de mortes atribuídas a doenças cardiovasculares para a Colômbia em 83.987, acrescido das complicações pós-cirúrgicas derivadas delas. As causas que afetam o coração e especialmente a válvula aórtica variam de dificuldade circulatória a falha mecânica, por isso sabemos que a cada ano mais pessoas morrem de doenças cardiovasculares (CVD) do que de qualquer outra causa. Isto significa a alta necessidade e demanda de uma intervenção cirúrgica; indispensável para salvaguardar a vida dos pacientes, por esta razão nos perguntamos quais são as complicações pós-cirúrgicas da cirurgia de substituição da válvula aórtica em pessoas de meia-idade? Objectivo: Identificar os tipos de complicações pós-cirúrgicas da substituição da válvula aórtica em pessoas de meia-idade nos primeiros seis meses após a cirurgia. Metodologia: Protocolo PRISMA para a revisão da literatura exploratória e sua extensão para as revisões exploratórias da literatura. A qualidade metodológica foi avaliada com PEDro, e as características do estudo foram extraídas de forma independente. Resultado: 28 estudos incluídos na revisão, com pontuações entre 6 e 9, de boa e excelente qualidade metodológica. As complicações pós-cirúrgicas mais frequentes foram reintervenção cirúrgica, hemorragia pós - cirurgia, trombose ou tromboembolismo. Conclusão: As complicações da substituição da válvula aórtica são frequentes na população de meia-idade.

Extremity reconstruction with superficial circumflex iliac artery perforator free flap: Refinements and innovations after 101 cases.

INTRODUCTION: The superficial circumflex iliac artery perforator flap is based on perforators originated on the superficial circumflex iliac artery. This flap is thin and pliable, of moderate size, and has a concealed donor site. The authors report their experience, innovations, and refinements in both planning and execution, and the outcomes obtained after 101 extremity reconstruction consecutive cases. PATIENTS AND METHODS: A total of 101 superficial circumflex iliac artery perforator flaps were prospectively reviewed and followed up for at least one year at Hospital del Trabajador. The flaps were used for both upper (n = 21) and lower limbs (n = 80), planned with computed tomography angiography/augmented reality, and raised above the superficial fascia using a standardized approach. Demographic data, anatomy of the flap, surgical technique, and the results were assessed. RESULTS: Average flap size was 90.5 cm2, ranging from 25 to 212 cm2. Total flap loss occurred in 6 flaps (5.9%). Four patients developed complications at the donor site. Debulking surgery was performed in 7 patients (6.9%). The average follow-up period was 850 days (range, 370-1405 days). CONCLUSIONS: The superficial circumflex iliac artery perforator flap is versatile, thin, and pliable, suitable for covering even large defects in either the upper or lower extremities, obtaining a shallow contour and optimal esthetics results. The elevation can be standardized, but requires training and proper planning. This is the largest series in a Western country reporting the experience, refinements, and innovation that allows for better results in limb reconstruction.

Case report: Long-term follow-up of a large full-thickness skin defect treated with a photosynthetic scaffold for dermal regeneration.

It is broadly described that almost every step of the regeneration process requires proper levels of oxygen supply; however, due to the vascular disruption in wounds, oxygen availability is reduced, being detrimental to the regeneration process. Therefore, the development of novel biomaterials combined with improved clinical procedures to promote wound oxygenation is an active field of research in regenerative medicine. This case report derives from a cohort of patients enrolled in a previously published ongoing phase I clinical trial (NCT03960164), to assess safety of photosynthetic scaffolds for the treatment of full skin defects. Here, we present a 56 year old patient, with a scar contracture in the cubital fossa, which impaired the elbow extension significantly affecting her quality of life. As part of the treatment, the scar contracture was removed, and the full-thickness wound generated was surgically covered with a photosynthetic scaffold for dermal regeneration, which was illuminated to promote local oxygen production. Then, in a second procedure, an autograft was implanted on top of the scaffold and the patient's progress was followed for up to 17 months. Successful outcome of the whole procedure was measured as improvement in functionality, clinical appearance, and self-perception of the treated area. This case report underscores the long-term safety and applicability of photosynthetic scaffolds for dermal regeneration and their stable compatibility with other surgical procedures such as autograft application. Moreover, this report also shows the ability to further improve the clinical outcome of this procedure by means of dermal vacuum massage therapy and, more importantly, shows an overall long-term improvement in patient´s quality of life, supporting the translation of photosynthetic therapies into human patients.

A First in Human Trial Implanting Microalgae Shows Safety of Photosynthetic Therapy for the Effective Treatment of Full Thickness Skin Wounds.

Insufficient oxygen supply represents a relevant issue in several fields of human physiology and medicine. It has been suggested that the implantation of photosynthetic cells can provide oxygen to tissues in the absence of a vascular supply. This approach has been demonstrated to be successful in several in vitro and in vivo models; however, no data is available about their safety in human patients. Here, an early phase-1 clinical trial (ClinicalTrials.gov identifier: NCT03960164, https://clinicaltrials.gov/ct2/show/NCT03960164) is presented to evaluate the safety and feasibility of implanting photosynthetic scaffolds for dermal regeneration in eight patients with full-thickness skin wounds. Overall, this trial shows that the presence of the photosynthetic microalgae Chlamydomonas reinhardtii in the implanted scaffolds did not trigger any deleterious local or systemic immune responses in a 90 days follow-up, allowing full tissue regeneration in humans. The results presented here represent the first attempt to treat patients with photosynthetic cells, supporting the translation of photosynthetic therapies into clinics. Clinical Trial Registration: www.clinicaltrials.gov/ct2/show/NCT03960164, identifier: NCT03960164.

Colgajo sural superficial a pedículo distal excluyendo nervio sural: casuística / Superficial distally based sural flap with exclusion of the sural nerve: clinical cases

Introducción y objetivo: El colgajo fasciocutáneo sural superficial a pedículo distal ha sido utilizado desde hace tiempo para la reconstrucción del tercio distal de la pierna, tobillo y talón, y su irrigación también ha sido establecida.Presentamos nuestra casuística demostrando que este colgajo puede sobrevivir excluyendo de su composición el nervio sural y por lo tanto conservar la sensibilidad de tercio distal póstero-lateral de pierna y borde lateral del pié, conservando también su irrigación indemne.Material y método.Recogemos 40 pacientes con fractura expuesta de tercio distal de pierna, tobillo y talón, sometidos a reconstrucción con colgajo sural superficial a pedículo distal excluyendo el nervio sural, desde 1998 hasta 2019.Las edades fuctuaron entre 20 y 55 años; 35 hombres y 5 mujeres.En todos los pacientes realizamos prueba de presión cutánea suave con plumilla (pinch test ) y prueba del pinchazo cutáneo (pin prick), y en 4 neurografía sensorial.Resultados.La irrigación del colgajo no se vio alterada al excluir el nervio sural. Hubo 2 necrosis distales del colgajo solucionadas con injerto dermo-epidérmico y/o avance del colgajo. En 3 pacientes hubo edema resuelto con elevación de pierna y vendaje suave. En 4 pacientes hubo celulitis que cedió con antibióticos. La sensibilidad cutánea en el tercio distal de la pierna en su porción posterior y lateral, y en el borde lateral del pie se conservó sin alteraciones.Conclusiones.En nuestra casuística, la exclusión del nervio sural no alteró la irrigación del colgajo En nuestros pacientes, la sensibilidad cutánea del tercio distal de la cara póstero-lateral de la pierna y el borde lateral del pié no se alteró, siendo corroborada por la clínica y por la neurografía sensorial. (AU)

Background and objective: Background and objective. The distally based superficial sural artery flap has been used for lower limb reconstruction for long time. The blood supply for this flap has been studied for many authors.We present our casuistry showing that this flap can survive excluding the sural nerve from its composition and therefore preserve the sensitivity of the distal postero-lateral third of the leg and the lateral border of the foot, also preserving its undamaged irrigation.Methods.We have operated on 40 patients since 1998 to 2019, 35 men and 5 female, age ranged from 20 to 55 years old, using a superficial distally based sural flap, excluding the sural nerve. The pinch and the pin prick test were done in all patients.Results.In spite of excluding the sural nerve, the arterial blood supply to the flap was not compromised. There were 2 distal partial necrosis healed with flap advance and or split thickness skin graft. Edema was presented in 3 patients disappearing with limb elevation and light dressing. Cellulitis was presented in 4 patients and disappeared with antibiotics. Cutaneous sensitivity in the posterior and lateral distal third portion of the leg and in the edge of the foot was unalterable.Conclusions.In our clinical cases, the arterial blood supply to the distally based sural flap is not compromised with the exclusion of the sural nerve. The clinic and neurography show the patency of the sensation in the skin of the lateral and posterior part of the distal third of the leg and the lateral aspects of the foot.These findings allow to exclude the sural nerve from the flap insuring the blood supply and avoiding the possible pressure sores when the workers use their security shoes. (AU)

Manejo de queloides mediante combinación de cirugía y radioterapia con haz de electrones / Management of keloid through combination of surgery and radiotherapy with electron beam

INTRODUCCIÓN Y OBJETIVO: La formación de queloides condiciona un deterioro en la calidad de vida de los pacientes por causar desfiguración cosmética, dolor y prurito. A pesar de que existe una amplia gama de opciones terapéuticas e incluso combinación de estas, aún existen tasas de recurrencia elevadas que hacen del tratamiento de los queloides un desafío complejo. Recogemos nuestra tasa de recurrencia de queloides en diferentes áreas corporales tras cirugía asociada a radioterapia con haz de electrones en el postoperatorio inmediato mediante un protocolo de radioterapia definido. MATERIAL Y MÉTODO: Estudio de tipo ambispectivo en los centros de Cirugía Plástica del Hospital del Salvador y Clínica Santa María en Santiago (Chile) entre 2010 y 2017 sobre pacientes intervenidos por queloides mediante cirugía y tratamiento protocolizado con radioterapia de electrones. Excluimos pacientes que no asistieron al tratamiento con radioterapia, o se realizó después de 24 horas, o no se les realizó seguimiento durante al menos 3 meses. Evaluamos datos demográficos, clínicos, antecedentes de procedimientos anteriores frustrados, número de queloides y recurrencia. Utilizamos como prueba estadística chi-cuadrado con significancia estadística p ≤ 0.05. RESULTADOS: Estudiamos un total de 15 pacientes con un total de 32 queloides intervenidos en distintas áreas corporales con seguimiento promedio de 862 días. En todos realizamos el procedimiento sin inconvenientes y con buena tolerancia. El promedio de recidiva total fue del 34%, siendo la zona de mayor recurrencia la dorsal (83%) y la de menor la auricular donde no hubo recidivas. CONCLUSIONES: En nuestra experiencia, el tratamiento quirúrgico escisional de los queloides, seguido de radioterapia con haz de electrones según el protocolo expuesto, resultó sin recidivas en la zona auricular

BACKGROUND AND OBJECTIVE: Keloids cause deterioration in the quality of life of patients due to cosmetic disfigurement, pain and pruritus. Although there is a wide range of therapeutic options and even a combination of these, there are still high recurrence rates that make keloids treatment a challenge. We report our rate of recurrence of keloid in different body areas after surgery associated with radiotherapy electron beam in the immediate postoperative period using a defined radiotherapy protocol. METHODS: An ambispective study was carried out in the Plastic Surgery Unit at Salvador Hospital and Santa María Clinic in Santiago (Chile) between 2010 and 2017, colleting patients operated on by keloids with surgery and protocolized treatment of electron radiation therapy. Patients who did not attend the radiotherapy treatment, it was performed after 24 hours, or they were not followed up for at least 3 months, were excluded. We evaluated demographic, clinical data, past history of frustrated procedures, keloid number and keloid recurrence. Chi-square statistical test was used using statistical significance p ≤ 0.05. RESULTS: A total of 15 patients with 321 keloids in different body areas were treated, with an average follow-up time of 862 days. All patients underwent surgical and radiotherapy treatment without inconveniences and good tolerance. The average total recurrence was 34%, with the greatest recurrence in the dorsal area (83%) and with no recurrences in the auricular one. CONCLUSIONS: Excisional surgical treatment of keloids, followed by beam radiation therapy according to the protocol described, results in no recurrence in the auricular área

Injerto dermo-epidérmico como tratamiento del siliconoma de extremidad inferior / Dermoepidermal graft as treatment of lower extremity siliconoma

Resumen Introducción A pesar de la evidencia sobre los malos resultados y riesgos del uso de inyecciones subcutáneas de silicona para mejorar el contorno corporal, esta técnica sigue siendo utilizada por personas no calificadas. Caso clínico Paciente de 56 años quien consultó por cuadro de celulitis en pierna izquierda. Se obtuvo el antecedente de intervención con silicona en cara, dorso de las manos, glúteos y piernas el año 2000. El cuadro progresó con múltiples abscesos en la totalidad de la pierna y sepsis. Se realizaron aseos quirúrgicos exponiendo planos fascial y muscular, se utilizó terapia local con sistemas de presión negativa y posterior injerto dermo-epidérmico (IDE). El manejo multidisciplinario se realizó en unidades críticas. Los resultados del manejo fueron satisfactorios, salvando la extremidad con cobertura total, logrando el alta luego de 4 meses. Conclusión A pesar de conocerse los peligros de la inyección de silicona, este sigue siendo un procedimiento frecuente. En nuestra paciente se manifestó como fascitis de la pierna, requiriendo tratamiento quirúrgico agresivo. Conocer esta entidad, su diagnóstico y tratamiento es fundamental para tratar pacientes con complicaciones graves.

Introduction Despite the evidence of poor performance and risks of using silicone subcutaneous injections to improve body contour, this technique is still used by untrained people, generating an iatrogenic entity with serious complications. Case report 56 year old female presented left lower extremity cellulitis. A history of previous intervention with silicone injections in face, back of hands, buttocks and legs in year 2000 was obtained. An inflammatory process progressed locally and systemically with multiple abscesses, subcutaneous thickness in the entire leg and sepsis, requiring multiple surgical procedures, reaching fascial and muscle planes exposition of the left leg. The patient underwent local therapy with negative pressure systems and subsequent dermoepidermal graft. Multidisciplinary management was performed on a critical unit. The results were satisfactory, preserving the limb with full coverage. She was discharged after four months of inpatient management. Conclusion Despite knowing the risks of silicone injection (industrial or medical) it remains a common procedure. In our patient she presented as leg fasciitis, requiring aggressive surgical treatment. Knowing this entity, its diagnosis and treatment is essential to treat patients with serious complications.