[External fixation in reconstructive surgery: crossed leg flap.] / La fijación externa en cirugía reconstructiva: colgajo de piernas cruzadas.

Introduction: Lower limb coverage defects are sometimes associated with disruption of vascular pedicles that make it impossible to perform free flaps. In these cases the crossed leg flap is a good therapeutic alternative. T Material and methods: wo patients presented a coverage defect non-treatable with microvascularized free flap after being operated on multiple times in the lower limbs. A cross leg flap was performed stabilizing both lower limbs with an external fixator. Both patients showed a satisfactory recovery returning to walk without additional help. Conclusion: Crossed leg flap stabilized by external fixation is a valid alternative for soft tissue defects.

Introducción: Los defectos de cobertura del miembro inferior van asociados en ocasiones con la disrupción de los pedículos vasculares que imposibilitan la realización de colgajos libres, siendo en estos casos el colgajo de piernas cruzadas una buena alternativa terapéutica. Material y métodos: se presentan 2 casos de pacientes que tras ser intervenidos en múltiples ocasiones en los miembros inferiores, presentaban un defecto de cobertura no tratable con un colgajo libre microvascularizado. Se realizó un colgajo de piernas cruzadas estabilizando ambas extremidades inferiores con un fijador externo. Ambos pacientes mostraron una recuperación satisfactoria con una vuelta a la deambulación sin ayudas adicionales. Conclusión: El colgajo de piernas cruzadas estabilizado mediante fijación externa es una alternativa válida para defectos de partes blandas.

Consulta quirúrgica de alta resolución en Cirugía Plástica / One-stop clinic in Plastic Surgery

Introducción y Objetivo: Mejorar la eficiencia de los procesos sanitarios es uno de los pilares fundamentales de los sistemas públicos de salud. En este sentido, las consultas de alta resolución representan una tendencia dentro del marco organizativo de muchos hospitales. En este artículo proponemos un modelo de cirugía de alta resolución en Cirugía Plástica. Material y Método: Durante un año recogimos 1247 pacientes con lesiones cutáneas sugerentes de malignidad tratables mediante procedimientos de cirugía menor. De ellos, 642 fueron remitidos a un programa de consultas de alta resolución quirúrgica. Resultados: Fueron intervenidos dentro del programa 522 de los 642 pacientes seleccionados presentando un índice de consultas sucesivas de 0.27 frente a 1.97 en los pacientes que entraron por el circuito normal de derivación a cirugía menor. Conclusiones: El diseño del programa de consultas de alta resolución ha demostrado reducir la carga asistencial en las consultas de Cirugía Plástica, proporcionando un tratamiento inicial precoz

Background and Objective: Improve the efficiency of health processes is one of the fundamental pillars of public health systems. In this regard, one-stop clinic represents a trend within the organizational framework of many hospitals. A model of see and treat program in Plastic Surgery is proposed in this paper. Methods: During a 1 year period we included 1247 patients with skin lesions suggestive of malignancy treatable by minor surgical procedures. Of these, 642 were referred to a see and treat surgical program. Results: Only 522 of 642 selected patients were involved in the program of one-stop clinic, presenting an index of successive queries of 0.27 against 1.97 in patients who entered the normal bypass circuit of minor surgery. Conclusions: The program design of one stop clinic was shown to reduce the burden of care in Plastic Surgery consultations, providing an early treatment

An Evaluation of Surgical Functional Reconstruction of the Foot Using Kinetic and Kinematic Systems: A Case Report.

Most pedobarographic studies of microsurgical foot reconstruction have been retrospective. In the present study, we report the results from a prospective pedobarographic study of a patient after microsurgical reconstruction of her foot with a latissimus dorsi flap and a cutaneous paddle, with a 42-month follow-up period. We describe the foot reconstruction plan and the pedobarographic measurements and analyzed its functional outcome. The goal of the present study was to demonstrate that pedobarography could have a role in the treatment of foot reconstruction from a quantitative perspective. The pedobarographic measurements were recorded after the initial coverage surgery and 2 subsequent foot remodeling procedures. A total of 4 pedobarographic measurements and 2 gait analyses were recorded and compared for both the noninvolved foot and the injured foot. Furthermore, the progress of the reconstructed foot was critically evaluated using this method. Both static and dynamic patterns were compared at subsequent follow-up visits after the foot reconstruction. The values and progression of the foot shape, peak foot pressure (kPa), average foot pressure (kPa), total contact surface (cm2), loading time (%), and step time (ms) were recorded. Initially, the pressure distribution of the reconstructed foot showed higher peak values at nonanatomic locations, revealing a greater ulceration risk. Over time, we found an improvement in the shape and values of these factors in the involved foot. To homogenize the pressure distribution and correct the imbalance between the 2 feet, patient-specific insoles were designed and fabricated. In our patient, pedobarography provided an objective, repeatable, and recordable method for the evaluation of the reconstructed foot. Pedobarography can therefore provide valuable insights into the prevention of pressure ulcers and optimization of rehabilitation.

Correction of tuberous breasts using the unfolded subareolar gland flap.

In this retrospective study, the authors present 12 years of experience using a modified Puckett's technique with a double unfolded strictly subareolar glandular flap for surgical correction of the deformity known as "tuberous breast." In 1976, Rees and Aston documented this congenital malformation of the mammary glands in women. Its cause is unknown, and it affects adolescent girls with varying severity uni- or bilaterally. The condition is characterized by a lack of development, primarily in the lower quadrants of the breast plus a rising of the inframammary fold, together with herniation and increased diameter of the areola. Many varied surgical techniques for correction of this malformation in its different degrees of severity have been documented in the available literature. This study examined the treatment of 42 breasts in 26 patients with a high percentage of full correction of the deformity. The advantages and achievements of the double unfolded strictly subareolar glandular flap include restructuring of the breast's lower pole in volume, length, and shape; reduction and even removal of the double-bubble effect as the flap covers the implant fitted; lowering of inframammary fold height; and correction of areola size and herniation. The procedure is performed through a hemi- or periareolar incision. The technique is versatile for managing the different variations of tuberous breasts, making it another interesting option for correction of the deformity. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .