Effect of extracorporeal shockwave therapy on plantar fascia thickness in plantar fasciitis: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: Extracorporeal shockwave therapy (ESWT) has been used as a therapeutic option for plantar fasciitis. The objective was to investigate the effect of ESWT over the plantar fascia thickness. METHODS: MEDLINE, Embase, Web of Science, and SCOPUS databases were searched for randomized controlled trials evaluating the effect of ESWT in patients with plantar fasciitis, comparing ESWT with another treatment. Meta-analysis was conducted using a random-effects model and the generic inverse variance method. Meta-regression and subgroup analyses were also carried out. RESULTS: A total of 14 studies (867 participants) were included. ESWT significantly decreased plantar fascia thickness (weighted mean difference [WMD], -0.21 mm [95% CI -0.39, -0.02]; p = 0.03). No significant improvement in pain was observed (WMD, -0.51 cm [95% CI -1.04, 0.01]; p = 0.06) compared with non-surgical interventions. CONCLUSIONS: Our results suggest that plantar fascia thickness is significantly decreased after ESWT intervention in patients with plantar fasciitis. However, pain relief was not significantly improved compared to other non-surgical interventions.

Analgesia by fascia manipulation is mediated by peripheral and spinal adenosine A1 receptor in a mouse model of peripheral inflammation.

The role of adenosine receptors in fascial manipulation-induced analgesia has not yet been investigated. The purpose of this study was to evaluate the involvement of the adenosine A1 receptor (A1R) in the antihyperalgesic effect of plantar fascia manipulation (PFM), specifically in mice with peripheral inflammation. Mice injected with Complete Freund's Adjuvant (CFA) underwent behavioral, i.e. mechanical hyperalgesia and edema. The mice underwent PFM for either 3, 9 or 15 min. Response frequency to mechanical stimuli was then assessed at 24 and 96 h after plantar CFA injection. The adenosinergic receptors were assessed by systemic (intraperitoneal, i.p.), central (intrathecal, i.t.), and peripheral (intraplantar, i.pl.) administration of caffeine. The participation of the A1R was investigated using the 1,3-dipropyl-8-cyclopentylxanthine (DPCPX), a selective A1R subtype antagonist. PFM inhibited mechanical hyperalgesia induced by CFA injection and did not reduce paw edema. Furthermore, the antihyperalgesic effect of PFM was prevented by pretreatment of the animals with caffeine given by i.p., i.pl., and i.t. routes. In addition, i.pl. and i.t. administrations of DPCPX blocked the antihyperalgesia caused by PFM. These observations indicate that adenosine receptors mediate the antihyperalgesic effect of PFM. Caffeine's inhibition of PFM-induced antihyperalgesia suggests that a more precise understanding of how fascia-manipulation and caffeine interact is warranted.

Alterations in the Structure, Composition, and Organization of Galactosaminoglycan-Containing Proteoglycans and Collagen Correspond to the Progressive Stages of Dupuytren's Disease.

Dupuytren's disease (DD) is a prevalent fibroproliferative disorder of the hand, shaped by genetic, epigenetic, and environmental influences. The extracellular matrix (ECM) is a complex assembly of diverse macromolecules. Alterations in the ECM's content, structure and organization can impact both normal physiological functions and pathological conditions. This study explored the content and organization of glycosaminoglycans, proteoglycans, and collagen in the ECM of patients at various stages of DD, assessing their potential as prognostic indicators. This research reveals, for the first time, relevant changes in the complexity of chondroitin/dermatan sulfate structures, specifically an increase of disaccharides containing iduronic acid residues covalently linked to either N-acetylgalactosamine 6-O-sulfated or N-acetylgalactosamine 4-O-sulfated, correlating with the disease's severity. Additionally, we noted an increase in versican expression, a high molecular weight proteoglycan, across stages I to IV, while decorin, a small leucine-rich proteoglycan, significantly diminishes as DD progresses, both confirmed by mRNA analysis and protein detection via confocal microscopy. Coherent anti-Stokes Raman scattering (CARS) microscopy further demonstrated that collagen fibril architecture in DD varies importantly with disease stages. Moreover, the urinary excretion of both hyaluronic and sulfated glycosaminoglycans markedly decreased among DD patients.Our findings indicate that specific proteoglycans with galactosaminoglycan chains and collagen arrangements could serve as biomarkers for DD progression. The reduction in glycosaminoglycan excretion suggests a systemic manifestation of the disease.

Lipoabdominoplastia con definición anatómica. Actualización / Lipoabdominoplasty with anatomical defi nition. Update

Existe en la práctica diaria de los cirujanos plásticos una búsqueda continua de mejores alternativas técnicas para el tratamiento de las deformidades del contorno abdominal. La LADE (Lipoabdominoplastia con defi nición anatómica) da un paso más adelante de la técnica LAP tradicional. Esta técnica incorpora los principios de resaltar la defi nición de la musculatura abdominal, consiguiendo resultados más naturales y con menos estigmas de una intervención quirúrgica. Los resultados estéticos son mucho más armoniosos, con un verdadero aspecto abdominal rejuvenecido. Logramos reducir la morbilidad preservando los vasos sanguíneos perforantes y suspendiendo la fascia de Scarpa. Una correcta selección del paciente asociado a la estandarización de esta técnica hace que el procedimiento sea seguro y reproducible

There is a continuous search for better technical alternatives for the treatment of abdominal contour deformities in the practice of plastic surgeons. LADE ­ Lipoabdominoplasty with Anatomical Defi nition ­ is a step ahead of the traditional LAP technique. This technique incorporated the principles of highlighting the defi nition of the abdominal musculature, achieving more natural results with fewer reminders of a surgical intervention. The aesthetic results are much harmonious, with a true abdominal rejuvenated appearance. We can reduce morbidity by preservation of perforating blood vessels and suspension of Scarpa's fascia. The correct selection of the patient associated with the standardization of this technique makes the procedure safe and reproducible

Outcomes after elevation of serratus anterior fascia flap versus serratus muscle flap in direct-to-implant breast reconstruction following mastectomy: a prospective study.

Objective: The purpose of this study was to compare postoperative pain between SF flap and serratus anterior muscle (SM) in direct-to-implant breast reconstruction. Methods: This is a prospective cohort study that included 53 women diagnosed with breast cancer who underwent mastectomy and one-stage implant-based breast reconstruction from January 2020 to March 2021. Twenty-nine patients (54.7%) had SF elevation, and 24 patients (45.3%) underwent SM elevation. We evaluated patient-reported early postoperative pain on the first day after surgery. Also, it was reported that all surgical complications in the first month and patient reported outcomes (PROs) were measured with the BRECON 23 questionnaire. Results: The serratus fascia group used implants with larger volumes, 407.6 ± 98.9 cc (p < 0.01). There was no significant difference between the fascial and muscular groups regarding the postoperative pain score reported by the patients (2 versus 3; p = 0.30). Also, there was no difference between the groups regarding early surgical complications and PROs after breast reconstruction. Conclusion: The use of SF seems to cause less morbidity, which makes the technique an alternative to be considered in breast reconstruction. Although there was no statistical difference in postoperative pain scores between the fascia and serratus muscle groups.

Application of hip capsule peripheral nerve block in early analgesia in elderly patients with hip fracture.

Objective: The objective of the study is to investigate the effect of pericapsular nerve group (PENG) block in early analgesia in elderly patients with hip fracture. Methods: A total of 44 elderly patients with hip fracture admitted to our hospital from August 2021 to December 2022 were selected and divided into 2 groups according to different analgesia programs. Results: At T1~T4, the resting and active visual analog scale (VAS) scores in group P were lower than group F (p < 0.05). The resting and active VAS scores at T5 in both groups were no visible differences (p > 0.05). After 30 min of block, systolic blood pressure, diastolic blood pressure, and heart rate were decreased in both groups (p < 0.05), but no obvious difference was found in the two groups (p > 0.05). Before surgery, Pittsburgh Sleep Quality Index (PSQI) and mini-mental state scale (MMSE) scores in both groups were reduced, and PSQI score in group P was lower than that in group F and MMSE score was higher than group F (p < 0.05). Conclusion: PENG technology is safe and effective in the early analgesia of elderly hip fractures. It can effectively block physiological stress response caused by acute trauma, improve pre-operative sleep quality, and reduce the incidence of cognitive dysfunction.

Objetivo: Investigar el efecto del bloqueo del grupo del nervio pericapsular en analgesia temprana en pacientes ancianos con fractura de cadera. Método: Se seleccionaron 44 pacientes ancianos con fractura de cadera ingresados en nuestro hospital entre agosto de 2021 y diciembre de 2022, divididos en dos grupos según diferentes programas de analgesia. Resultados: En T1~T4, los valores de la escala visual análoga (EVA) en reposo y con actividad en el grupo P fueron menores que en el grupo F (p < 0.05). Los puntajes de la EVA en reposo y en actividad en T5 en ambos grupos no mostraron diferencias visibles (p > 0.05). Después de 30 minutos de bloqueo, la presión arterial sistólica y diastólica, y la frecuencia cardiaca, disminuyeron en ambos grupos (p < 0.05), pero no se encontró una diferencia obvia entre ellos (p > 0.05). Antes de la cirugía, las puntuaciones del Pittsburgh Sleep Quality Index (PSQI) y de la Mini-Mental State Scale (MMSE) en ambos grupos eran reducidas, y la puntuación del PSQI en el grupo P fue menor que en el grupo F, y la puntuación del MMSE fue mayor que en el grupo F (p < 0.05). Conclusiones: La técnica de bloqueo del grupo del nervio pericapsular es segura y efectiva en la analgesia temprana de fracturas de cadera en ancianos. Puede bloquear eficazmente la respuesta al estrés fisiológico causado por un trauma agudo, mejorar la calidad del sueño preoperatorio y reducir la incidencia de disfunción cognitiva.

Cerclage sling technique using temporalis muscle fascia to manage paralytic lagophthalmos: A preliminary study.

PURPOSE: Despite various existing surgical techniques, treatment of facial nerve palsy remains difficult. The purpose of this report is to present the cerclage sling technique using temporalis fascia to manage paralytic lagophthalmos. METHODS: A series of six patients underwent a cerclage sling technique using temporalis muscle fascia to treat paralytic lagophthalmos. The technique is presented in detail. Symptoms, palpebral fissures, and lagophthalmos were assessed pre- and postoperatively. Data were submitted for statistical analysis. RESULTS: After surgery, all patients achieved a reduction in clinical symptoms. The upper eyelids had lowered, and the inferior eyelids had elevated, reducing ocular exposure even if mild residual lagophthalmos was present. CONCLUSION: Cerclage using the temporalis muscle fascia sling technique is a safe and effective procedure to treat facial nerve paralytic lagophthalmos. A reduction in ocular exposure and lagophthalmos provides improvement in clinical symptoms and eyelid function.

Leg length discrepancy is not a risk factor for plantar fasciitis.

PURPOSE: Plantar fasciitis (PF) is a main source of heel pain, and only about one-third of patients have bilateral symptomatic involvement, although age, body mass index (BMI), and physical activities are known risk factors. The high prevalence of unilateral involvement is poorly understood. We aimed to assess the potential association between PF and the leg length discrepancy (LLD) in unilateral PF. METHODS: A transversal case-control study was conducted from January 2019 to December 2020, including 120 participants allocated to two groups matched by BMI and sex: cases (with a diagnosis of PF; 50 ± 13 years) and control (without foot pain; 40 ± 15 years). For both groups, a difference greater than 0.64 cm in the scanometry determined the criteria for the presence of LLD. RESULTS: The multivariate logistic regression analysis showed an independent association of PF only with age (p < 0.001), and no association with LLD. We did not observe differences in the mean discrepancy (1.37 ± 0.83 cm in the PF group in comparison with 1.13 ± 0.37 cm in the control group, [p > 0.05]) or in the prevalence of LLD between groups (48% [n = 29] in the PF group compared with 42% [n = 25] in the control group, [p > 0.05]). In the PF group, 80% of the participants reported unilateral pain. We observed a higher prevalence of pain in the shorter limb (p < 0.05). CONCLUSION: Age was the only factor associated with the diagnosis of PF when groups were matched by sex and BMI. LLD was not an independent factor associated with the diagnosis of PF. However, when PF is unilateral, the shorter limb is more affected with 70% of prevalence. LEVEL OF EVIDENCE: Level III, case-control.

Efeito da auto liberação miofascial na flexibilidade de escolares: uma proposta acessível / Effects of self myofascial release on the flexibility of students: an accessible proposal

RESUMO Diversas pesquisas têm avaliado a aplicabilidade da técnica de auto liberação miofascial (ALM) na melhora aguda da flexibilidade em inúmeros esportes e/ou populações diferentes. No entanto, torna-se difícil sua inserção nas aulas de educação física escolar pelo elevado custo dos materiais. Dessa forma, buscou-se investigar o efeito da ALM em escolares por meio da utilização de rolos de espumas originais e com rolos confeccionados com materiais adaptados de baixo custo. Participaram da pesquisa 30 escolares, que foram aleatoriamente agrupados em: Grupo Controle (GCT), Grupo Rolo Original (GRO) e Grupo Rolo Adaptado (GRA). A flexibilidade foi avaliada antes e após a aplicação da ALM. A ALM foi realizada em músculos alvos uma vez por 30 segundos com intervalos de 15 segundos entre os estímulos. As comparações na flexibilidade pré e pós ALM foram avaliadas utilizando o teste de t student, com nível de significância adotado de p<0,05. Verificou-se que a ALM no GRO e GRA aumentaram agudamente a flexibilidade dos escolares em 7,53 e 16,5%, respectivamente. Assim, a utilização de rolos confeccionados com material alternativo (adaptado) para aplicação da ALM se mostra uma forma mais acessível financeiramente para ser utilizada nas aulas de educação física e abre possibilidades para sua aplicação para além das escolas.

ABSTRACT Several studies have assessed the applicability of the Myofascial Self-Release Technique (MSRT) in the acute improvement of flexibility in various sports and/or different populations. However, its integration into school physical education classes becomes challenging due to the high cost of materials. Therefore, the aim was to investigate the effect of MSRT on schoolchildren using both original foam rollers and rollers made from low-cost adapted materials. Thirty schoolchildren participated in the study and were randomly grouped into: Control Group (CG), Original Roller Group (ORG), and Adapted Roller Group (ARG). Flexibility was evaluated before and after the application of MSRT. MSRT was performed on target muscles once for 30 seconds with intervals of 15 seconds between stimuli. Comparisons in pre- and post-MSRT flexibility were assessed using the Student's t-test, with a significance level adopted of p <0.05. It was found that MSRT in ORG and ARG significantly increased schoolchildren's flexibility by 7.53% and 16.5%, respectively. Therefore, the use of rollers made with alternative (adapted) material for applying MSRT appears to be a more financially accessible way to be used in physical education classes and opens possibilities for its application beyond schools.

Outcomes after elevation of serratus anterior fascia flap versus serratus muscle flap in direct-to-implant breast reconstruction following mastectomy: a prospective study

Abstract Objective: The purpose of this study was to compare postoperative pain between SF flap and serratus anterior muscle (SM) in direct-to-implant breast reconstruction. Methods: This is a prospective cohort study that included 53 women diagnosed with breast cancer who underwent mastectomy and one-stage implant-based breast reconstruction from January 2020 to March 2021. Twenty-nine patients (54.7%) had SF elevation, and 24 patients (45.3%) underwent SM elevation. We evaluated patient-reported early postoperative pain on the first day after surgery. Also, it was reported that all surgical complications in the first month and patient reported outcomes (PROs) were measured with the BRECON 23 questionnaire. Results: The serratus fascia group used implants with larger volumes, 407.6 ± 98.9 cc (p < 0.01). There was no significant difference between the fascial and muscular groups regarding the postoperative pain score reported by the patients (2 versus 3; p = 0.30). Also, there was no difference between the groups regarding early surgical complications and PROs after breast reconstruction. Conclusion: The use of SF seems to cause less morbidity, which makes the technique an alternative to be considered in breast reconstruction. Although there was no statistical difference in postoperative pain scores between the fascia and serratus muscle groups.

Pericapsular Nerve Group (PENG) block versus fascia iliaca compartment (FI) block for hip surgery: a systematic review and meta-analysis of randomized controlled trials

Abstract Background: This study compares Fascia Iliaca compartment (FI) block and Pericapsular Nerve Group (PENG) block for hip surgery. Methods: Pubmed, Embase and Cochrane were systematically searched in April 2022. Inclusion criteria were: Randomized Controlled Trials (RCTs); comparing PENG block versus FI block for hip surgery; patients over 18 years of age; and reporting outcomes immediately postoperative. We excluded studies with overlapped populations and without a head-to-head comparison of the PENG block vs. FI block. Mean-Difference (MD) with 95% Confidence Intervals (CI) were pooled. Trial Sequential Analyses (TSA) were performed to assess inconsistency. Quality assessment and risk of bias were performed according to Cochrane recommendations. Results: Eight RCTs comprising 384 patients were included, of whom 196 (51%) underwent PENG block. After hip surgery, PENG block reduced static pain score at 12h post-surgery (MD = 0.61 mm; 95% CI 1.12 to -0.09; p = 0.02) and cumulative postoperative oral morphine consumption in the first 24h (MD = -6.93 mg; 95% CI -13.60 to -0.25; p = 0.04) compared with the FI group. However, no differences were found between the two techniques regarding dynamic and static pain scores at 6 h or 24 h post-surgery, or in the time to the first analgesic rescue after surgery. Conclusion: The findings suggest that PENG block reduced opioid consumption in the first 24 h after surgery and reduced pain scores at rest at 12 h post-surgery. Further research is needed to fully understand the effects of the PENG block and its potential benefits compared to FI block. PROSPERO registration: CRD42022339628 PROSPERO registration: https://www.crd.york.ac.uk/prospero/display_record.php? RecordID=339628

Primer caso comunicado en el Perú de cabestrillo de fascia lata en incontinencia urinaria de esfuerzo / First reported case of fascia lata sling in stress urinary incontinence in Peru

RESUMEN La incontinencia urinaria de esfuerzo es frecuente en las mujeres desde la adultez media. La técnica más frecuente para tratar estos casos es el cabestrillo sintético. Sin embargo, el cabestrillo autólogo tiene buenos resultados comparables con el material sintético en los diversos estudios publicados. Presentamos un caso tratado con cabestrillo de fascia lata, describiendo la técnica y evolución.

ABSTRACT Stress urinary incontinence is common in women from middle adulthood onwards. The most frequent technique to treat these cases is the synthetic sling. However, the autologous sling has good results comparable with the synthetic material in the various studies published. We present a case treated with fascia lata sling, describing the technique and evolution.

Pericapsular Nerve Group (PENG) block versus fascia iliaca compartment (FI) block for hip surgery: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: This study compares Fascia Iliaca compartment (FI) block and Pericapsular Nerve Group (PENG) block for hip surgery. METHODS: Pubmed, Embase and Cochrane were systematically searched in April 2022. Inclusion criteria were: Randomized Controlled Trials (RCTs); comparing PENG block versus FI block for hip surgery; patients over 18 years of age; and reporting outcomes immediately postoperative. We excluded studies with overlapped populations and without a head-to-head comparison of the PENG block vs. FI block. Mean-Difference (MD) with 95% Confidence Intervals (CI) were pooled. Trial Sequential Analyses (TSA) were performed to assess inconsistency. Quality assessment and risk of bias were performed according to Cochrane recommendations. RESULTS: Eight RCTs comprising 384 patients were included, of whom 196 (51%) underwent PENG block. After hip surgery, PENG block reduced static pain score at 12h post-surgery (MD = 0.61 mm; 95% CI 1.12 to -0.09; p = 0.02) and cumulative postoperative oral morphine consumption in the first 24h (MD = -6.93 mg; 95% CI -13.60 to -0.25; p = 0.04) compared with the FI group. However, no differences were found between the two techniques regarding dynamic and static pain scores at 6 h or 24 h post-surgery, or in the time to the first analgesic rescue after surgery. CONCLUSION: The findings suggest that PENG block reduced opioid consumption in the first 24 h after surgery and reduced pain scores at rest at 12 h post-surgery. Further research is needed to fully understand the effects of the PENG block and its potential benefits compared to FI block. PROSPERO REGISTRATION: CRD42022339628 PROSPERO REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=339628.

Colgajo axial de fascia temporoparietal (TPFF) para cobertura de dispositivo de estimulación cerebral profunda. Reporte de caso / Axial temporoparietal fascia flap (TPFF) for deep brain stimulation device coverage. Case report

Presentamos el caso de una paciente con enfermedad de Parkinson y extrusión del fijador craneal del electrodo de estimulación cerebral profunda. Luego del explante de todo el sistema, se realizó un colgajo axial de fascia temporoparietal (TPFF) para cobertura del trépano residual y en el segundo tiempo se utilizó el colgajo para cubrir el nuevo implante. La paciente no presentó complicaciones durante el seguimiento de 2 años

We present the case of a patient with Parkinson's disease and extrusion of the cranial fixation of the deep brain stimulation electrode. After explantation of the entire system, an axial flap of temporoparietal fascia (TPFF) was performed to cover the residual Burr hole, and in the second procedure, the flap was used to cover the new implant. The patient did not experience any complications during the 2-year follow-up period.

(In)tensões em fluxo no corpo vivo / (In)tensions influx in the living body / (In)tensiones que fluyen en el cuerpo vivo

Este artigo traz reflexões sobre o sistema fascial na aproximação com os estudos somáticos e a Educação Física. Deste escopo, apresenta-se um caminho de sensibilização que pretende dar visibilidade para a perspectiva facial na orientação do trabalho corporal. Tal caminho chama a atenção para o fato de que somos seres de natureza viscoelástica, e, enquanto tais, embora sejamos amplamente sujeitos à lógica biomecânica newtoniana, pulsamos nas entrelinhas dessa leitura calculista de compreensão da vida, de modo a afirmar a linguagem das (in)tensões, de onde se evidencia o sistema fascial. Neste sentido, as fáscias oferecem possibilidades interessantes para ingressarmos a fundo na linguagem e na compreensão do movimento humano, ao oportunizar a composição de visões mais amplas e conectivas acerca do corpo, que se apresentam à percepção como um universo fluído (aquoso), no qual irrompem as energias sutis, no ebulir das sensações, das emoções e dos sentimentos que preenchem de sentidos a experiência de movimento.

This article brings reflections about the fascial system in the approach to somatic studies and Physical Education. From this scope, a path of awarenessis presented, which aims to give visibility to the fascial perspective on bodywork orientation. This path draws our attention to the fact that we, as human beings, have viscoelastic properties, and, as such, although we are widely prone to the Newtonian biomechanical logic, we pulse in between the lines from its calculating classical literature of life comprehension, in such a way as to reaffirm the language of (in)tensions. In this sense, the qualification of the Physical Education intervention, which involves the need to seek greater attention and awareness of this (in)tensions flow, without which we do not ascend into the language and comprehension of the human movement, by providing the opportunity for the composition of broader and more connective views about the body, that are presented to the perception as a fluid (watery) universe, in which erupt the subtle energies, in the ebullition of sensations, emotions and feelings that fill of meaning the movement experience.

Este artículo trae reflexiones sobre sistema fascial en la aproximación con el estudios somáticos y la Educación Fisica. Desde este ámbito, se presenta um caminho de sensibilización, que pretende dar visibilidad a la perspectiva fascial en la orientación del trabajo corporal. Este caminho llama la atención sobre el hecho de que somos seres de naturaleza viscoelástica y, como tal, aunque estamos en gran parte sujetos a la lógica biomecânica newtoniana pulsamos entre las líneas de esta comprensión calculadora de la vida para afirmar el linguaje de las (in)tensiones. En este sentido, la calificación de la intervención en Educación Fisica implica la necesidade de buscar una major atención y conciencia de este (in)tensionalidades, sin las cuales lo llegaremos al fondo em el linguaje y comprensión del movimiento humano, al brindar oportunidades para la composición de miradas más amplas y conectivas sobre el cuerpo que se presentan a la percepción como un universo fluido (acuoso), en el que irrumpen energias sutiles, en la ebullición de sensaciones, emociones y sentimentos que llenan de sentidos la experiencia del movimiento.

Necrotizing Fasciitis: Myalgia Is Diagnostic? A Case Series and Literature Review.

Necrotizing fasciitis, commonly known as "flesh-eating disease," is an aggressive soft tissue infection that destroys the fascia, subcutaneous tissue, and skin. Specific clinical features (crepitus or radiologic features of gas in tissues) either appear late or are of poor sensitivity. Thus, a high index of clinical suspicion is required for early diagnosis and prompt treatment, which are the best methods of minimizing its high associated morbidity and mortality. We present 3 cases to demonstrate diagnostic difficulties and challenges in management and highlight the feature of pain on muscular activity.

Técnica modificada de colporrafia anterior por ausencia de fascia prevesical: reporte de caso / Modified technique of anterior colporraphy due to absence of prevesical fascia: case report

Resumen ANTECEDENTES: El prolapso de órganos pélvicos es frecuente en pacientes posmenopáusicas. El tratamiento definitivo, cuando el compartimiento anterior está afectado, es el quirúrgico (colporrafia anterior). Aquí se describen los desenlaces clínicos derivados de la aplicación de una técnica modificada de colporrafia anterior en una paciente con ausencia de fascia prevesical, con una estadificación POP-Q estadio II, con afectación en el compartimiento anterior. CASO CLÍNICO: Paciente de 64 años, con antecedentes de una colporrafia anterior a los 56 años, prolapso de órgano pélvico con afectación del compartimiento anterior. En el examen ginecológico se evidenció la afectación del compartimiento anterior, específicamente en el nivel II conforme a la nueva clasificación POP-Q. Debido a los antecedentes quirúrgicos se optó por la colporrafia anterior, con punto de poliglactina 910 y colpopexia por vía vaginal, con puntos de polipropileno aplicados con un dispositivo de captura de sutura para reparación de tejido nativo. El desenlace quirúrgico fue satisfactorio. CONCLUSIÓN: En el contexto de la colporrafia es importante tener en cuenta las diferentes estrategias quirúrgicas, cada vez menos invasivas, con correcciones sitio-específicas que permitan reparar el defecto anatómico, desaparecer los síntomas, disminuir el riesgo y la probabilidad de recidivas.

Abstract BACKGROUND: Pelvic organ prolapse is common in postmenopausal women. The definitive treatment when the anterior compartment is involved is surgical (anterior colporrhaphy). Here we describe the clinical results obtained using a modified anterior colporrhaphy technique in a patient with absence of prevesical fascia, POP-Q stage II, with involvement of the anterior compartment. CLINICAL CASE: 64-year-old female patient with a history of a previous colporrhaphy at the age of 56, pelvic organ prolapse with involvement of the anterior compartment. Gynaecological examination revealed anterior compartment involvement, specifically level II according to the new POP-Q classification. Based on the surgical history, anterior colporrhaphy with polyglactin 910 suture and vaginal colpopexy with polypropylene sutures using a suture capture device for native tissue repair was chosen. Surgical outcome was satisfactory. CONCLUSION: In the context of colporrhaphy, it is important to take into account the different surgical strategies, increasingly less invasive, with site-specific corrections that allow repair of the anatomical defect, disappearance of symptoms, reducing the risk and probability of recurrence.

Use of the serratus anterior fascia in immediate implant-based breast reconstruction

Using the serratus anterior fascia may be a safe and effective option to recreate the lateral breast profile during subpectoral breast reconstruction, with minimal functional impact on the donor site. However, the literature is scarce when it comes to studies on this fascia flap in implant-based reconstruction. This article aimed to review the use of the serratus anterior fascia in immediate implant-based breast reconstruction, searching the electronic databases PubMed, Embase, Lilacs, and SciELO. The search was carried out by combining the following keywords: 'breast reconstruction' and 'serratus anterior fascia'. In the Pubmed and Embase databases, the search yielded a total of 12 and 15 articles, respectively, of which seven were selected according to the scope of this article. We found no studies on serratus anterior fascia and breast reconstruction in the Lilacs and SciELO databases. All works have results favorable for the use of the serratus anterior fascia flap and agree that this technique can be considered in the algorithm for the coverage of the inferolateral portion during subpectoral breast reconstruction

Erector Spinae Plane Block. A narrative review / Bloqueo del plano del músculo erector de la espina. Revisión narrativa de la literatura

Abstract The erector spinae plane (ESP) block is an interfascial block described in 2016 by Forero and collaborators, with wide clinical uses and benefits when it comes to analgesic control in different surgeries. This block consists of the application of local anesthetic (LA) in a deep plane over the transverse process, anterior to the erector spinae muscle in the anatomical site where dorsal and ventral branches of the spinal nerve roots are located. This review will cover its clinical uses according to different surgical models, the existing evidence and complications described to date.

Resumen El bloqueo del plano del músculo erector de la espina (ESP, por sus siglas en inglés) es un bloqueo interfascial descrito en 2016 por Forero y colaboradores, con amplios usos clínicos y beneficios en relación con el control analgésico de diferentes modelos quirúrgicos. Este consiste en la aplicación de anestésico local (AL) en un plano profundo sobre apófisis transversa anterior al músculo erector de la espina, sitio anatómico donde se encuentra la bifurcación de los ramos dorsal y ventral de las raíces nerviosas espinales. En esta revisión, se expondrán los usos clínicos según diferentes modelos quirúrgicos, la evidencia que existe de ellos y las complicaciones descritas hasta la actualidad.

Coleta de fáscia lata para uso em retalho ortodrômico temporal no tratamento da paralisia facial / Harvest of fascia lata for use in a temporal orthodromic flap in the treatment of facial paralysis

Introdução: A paralisia facial necessita de um tratamento multidisciplinar e as opções cirúrgicas são individualizadas para cada paciente e conforme a experiência da equipe médica. O Retalho Ortodrômico Temporal (ROT) é uma forma de correção bem documentada na literatura, com resultados satisfatórios. Um dos passos de sua realização é a coleta da fáscia lata para ponte entre o tendão temporal e os lábios. O objetivo é propor uma padronização da quantidade necessária de fáscia lata e técnica de coleta simplificada. Métodos: Descrição cirúrgica da medida de fáscia necessária para o procedimento e sua coleta. Resultados: Procedimento replicável e seguro conforme experiência do autor sênior. Conclusão: A tática de coleta proposta pode facilitar a realização deste procedimento e torná-lo mais seguro para os pacientes em diferentes serviços de saúde.

Introduction: Facial paralysis requires a multidisciplinary treatment, and surgical options are individualized for each patient according to the medical team's experience. The Temporal Orthodromic Flap (TOF) is a well-documented form of correction in the literature, with satisfactory results. One of the steps of its accomplishment is the collection of the fascia lata to bridge between the temporal tendon and the lips. The objective is to propose a standardization of the required amount of fascia lata and a simplified collection technique. Methods: Surgical description of the fascia measure necessary for the procedure and collection. Results: Replicable and safe procedure according to the senior author's experience. Conclusion: The proposed collection tactic can facilitate the performance of this procedure and make it safer for patients in different health services.