BISHOP FLAP AND SIGMA FLAP TO REPAIR SURGICAL DEFECTS IN HIGH-TENSION ANATOMICAL REGIONS. / COLGAJO OBISPO Y COLGAJO SIGMA PARA DEFECTOS QUIRÚRGICOS EN ZONAS ANATÓMICAS DE ELEVADA TENSIÓN.

BACKGROUND: The reconstruction of surgical defects in high-tension anatomical regions is challenging due to the ischemia and subsequent necrosis associated with tension closure. Research on new flaps capable of closing these defects exerting less tension would be a tremendous advancement in dermatological surgery. PATIENTS AND METHODS: We conducted a multicenter, retrospective study that used 2 new flaps-the bishop and the sigma ones-to repair surgical defects in high-tension regions such as the scalp, lower extremities, and the nasal pyramid. The bishop flap was used in 9 patients, 5 of whom exhibited their lesion in the nasal pyramid, 2 in the legs and another 2 in the scalp. The sigma flap was used in 6 patients, 5 of whom exhibited scalp lesions and 1 leg lesion. RESULTS: Uneventful and excellent results were obtained in all 15 patients due to infection, dehiscence, or necrosis. CONCLUSIONS: Both the bishop and the sigma flaps are a good alternative to repair surgical defects in high-tension regions such as the scalp, lower extremities, or the nasal pyramid.

Colgajo nautilus y colgajo en muleta taurina para defectos quirúrgicos faciales periorificiales / Nautilus Flap and Bullfighter Crutch Flap for the Repair of Periorificial Surgical Defects of the Face

Antecedentes La reconstrucción de defectos quirúrgicos en regiones anatómicas próximas a bordes palpebrales, fosas nasales o boca es un reto debido su tendencia a ser deformadas por la tensión del cierre directo o los colgajos cutáneos. El empleo de nuevas técnicas reconstructivas que eviten la retracción de estas zonas sensibles puede suponer un avance importante. Pacientes y métodos Se emplean 2 nuevos diseños, el colgajo nautilus y el colgajo en muleta taurina, para la reconstrucción de defectos quirúrgicos periorificiales, realizando una recolección retrospectiva de los mismos en las zonas periparpebral, perivestibular nasal y peribucal. El colgajo nautilus se empleó en 4 pacientes con defectos periparpebrales y 2 peribucales. El colgajo en muleta taurina se utilizó para la reconstrucción de 14 defectos en ala nasal. Resultados En los 20 pacientes se obtuvieron resultados muy satisfactorios tanto a nivel estético como funcional, sin la aparición de ectropión, colapso del vestíbulo nasal o asimetría de borde labial. No se observó necrosis en ningún caso. Conclusiones Proponemos el colgajo nautilus y el colgajo en muleta taurina como una excelente opción reconstructiva para defectos quirúrgicos localizados en zonas periorificiales (AU)

Background Reconstruction of surgical defects located close to eyelid edges, nostrils, or the mouth is challenging, as tension generated by direct closure or skin flaps in these sensitive regions tends to cause distortion. New repair techniques that prevent retraction may significantly improve outcomes. Patients and methods Retrospective study of the use of 2 novel flap designs—the nautilus flap and the bullfighter crutch flap—to repair surgical defects in the peripalpebral, perivestibular, nasal, and perioral areas. The nautilus flap was used to repair 4 peripalpebral defects and 2 perioral defects, and the bullfighter crutch flap to repair 14 nasal ala defects.Results Cosmetic and functional outcomes were very satisfactory in all 20 patients, with no cases of ectropion, nasal vestibule collapse, or labial asymmetry. Necrosis did not occur in any of the cases. Conclusions The nautilus and bullfighter crutch flaps appear to be excellent choices for reconstructing surgical defects in periorificial areas (AU)

[Translated article] Nautilus Flap and Bullfighter Crutch Flap for the Repair of Periorificial Surgical Defects of the Face / Colgajo nautilus y colgajo en muleta taurina para defectos quirúrgicos faciales periorificiales

Background Reconstruction of surgical defects located close to eyelid edges, nostrils, or the mouth is challenging, as tension generated by direct closure or skin flaps in these sensitive regions tends to cause distortion. New repair techniques that prevent retraction may significantly improve outcomes. Patients and methods Retrospective study of the use of 2 novel flap designs—the nautilus flap and the bullfighter crutch flap—to repair surgical defects in the peripalpebral, perivestibular, nasal, and perioral areas. The nautilus flap was used to repair 4 peripalpebral defects and 2 perioral defects, and the bullfighter crutch flap to repair 14 nasal ala defects.Results Cosmetic and functional outcomes were very satisfactory in all 20 patients, with no cases of ectropion, nasal vestibule collapse, or labial asymmetry. Necrosis did not occur in any of the cases. Conclusions The nautilus and bullfighter crutch flaps appear to be excellent choices for reconstructing surgical defects in periorificial areas (AU)

Antecedentes La reconstrucción de defectos quirúrgicos en regiones anatómicas próximas a bordes palpebrales, fosas nasales o boca es un reto debido su tendencia a ser deformadas por la tensión del cierre directo o los colgajos cutáneos. El empleo de nuevas técnicas reconstructivas que eviten la retracción de estas zonas sensibles puede suponer un avance importante. Pacientes y métodos Se emplean 2 nuevos diseños, el colgajo nautilus y el colgajo en muleta taurina, para la reconstrucción de defectos quirúrgicos periorificiales, realizando una recolección retrospectiva de los mismos en las zonas periparpebral, perivestibular nasal y peribucal. El colgajo nautilus se empleó en 4 pacientes con defectos periparpebrales y 2 peribucales. El colgajo en muleta taurina se utilizó para la reconstrucción de 14 defectos en ala nasal. Resultados En los 20 pacientes se obtuvieron resultados muy satisfactorios tanto a nivel estético como funcional, sin la aparición de ectropión, colapso del vestíbulo nasal o asimetría de borde labial. No se observó necrosis en ningún caso. Conclusiones Proponemos el colgajo nautilus y el colgajo en muleta taurina como una excelente opción reconstructiva para defectos quirúrgicos localizados en zonas periorificiales (AU)

Nautilus Flap and Bullfighter Crutch Flap for the Repair of Periorificial Surgical Defects of the Face. / Colgajo nautilus y colgajo en muleta taurina para defectos quirúrgicos faciales periorificiales.

BACKGROUND: Reconstruction of surgical defects located close to eyelid edges, nostrils, or the mouth is challenging, as tension generated by direct closure or skin flaps in these sensitive regions tends to cause distortion. New repair techniques that prevent retraction may significantly improve outcomes. PATIENTS AND METHODS: Retrospective study of the use of 2 novel flap designs-the nautilus flap and the bullfighter crutch flap-to repair surgical defects in the peripalpebral, perivestibular, nasal, and perioral areas. The nautilus flap was used to repair 4 peripalpebral defects and 2 perioral defects, and the bullfighter crutch flap to repair 14 nasal ala defects. RESULTS: Cosmetic and functional outcomes were very satisfactory in all 20 patients, with no cases of ectropion, nasal vestibule collapse, or labial asymmetry. Necrosis did not occur in any of the cases. CONCLUSIONS: The nautilus and bullfighter crutch flaps appear to be excellent choices for reconstructing surgical defects in periorificial areas.

[Translated article] Nautilus Flap and Bullfighter Crutch Flap for the Repair of Periorificial Surgical Defects of the Face.

BACKGROUND: Reconstruction of surgical defects located close to eyelid edges, nostrils, or the mouth is challenging, as tension generated by direct closure or skin flaps in these sensitive regions tends to cause distortion. New repair techniques that prevent retraction may significantly improve outcomes. PATIENTS AND METHODS: Retrospective study of the use of 2 novel flap designs-the nautilus flap and the bullfighter crutch flap-to repair surgical defects in the peripalpebral, perivestibular, nasal, and perioral areas. The nautilus flap was used to repair 4 peripalpebral defects and 2 perioral defects, and the bullfighter crutch flap to repair 14 nasal ala defects. RESULTS: Cosmetic and functional outcomes were very satisfactory in all 20 patients, with no cases of ectropion, nasal vestibule collapse, or labial asymmetry. Necrosis did not occur in any of the cases. CONCLUSIONS: The nautilus and bullfighter crutch flaps appear to be excellent choices for reconstructing surgical defects in periorificial areas.

Análisis de las interacciones farmacológicas y recomendaciones terapéuticas asociadas a la utilización de isavuconazol / Analysis of drug interactions and therapeutic recommendations associated with the use of isavuconazole

Objetivos: Identificar, describir las interacciones farmacológicas potenciales de isavuconazol, estudiar el impacto clínico de aquellas más relevantes y establecer recomendaciones terapéuticas para las encontradas en pacientes ingresados.Métodos: Estudio observacional descriptivo retrospectivo que incluyó todos los pacientes tratados con isavuconazol desde su comercialización hasta diciembre 2019.Se recogieron variables demográficas y fármacos concomitantes a isavuconazol durante más de 48 horas que recibió el paciente. Se revisaron los tratamientos con Lexicomp® para detectar interacciones potenciales, se analizó su mecanismo de acción y se relacionó con los fármacos implicados, estableciéndose recomendaciones terapéuticas.Para establecer el impacto clínico, se revisaron las historias clínicas de los pacientes con interacciones de mayor gravedad (D y X de Lexicomp®). En el caso de hallar alguna reacción adversa, se aplicó el algoritmo de Horn para establecer la probabilidad de que el efecto esté producido por la interacción farmacológica.Resultados: Se analizaron 84 ingresos en 59 pacientes. Se produjeron 209 interacciones potenciales en el 84,5% de los ingresos. La mayoría, 84,7% fueron de carácter moderado (categoría C), la más frecuente con tacrolimus. El principal mecanismo de acción fue el efecto inhibidor sobre el citocromo CYP3A4 de isavuconazol (82,8%). Se detectó una paciente con aumento de fosfatasa alcalina coincidente con el inicio concomitante de isavuconazol y claritromicina. Al aplicar el algoritmo de Horn, se consideró la interacción como posible.Conclusiones: Se detectaron interacciones farmacológicas potenciales graves en un porcentaje inferior al 10% de los ingresos y solo se detectó una posible reacción adversa asociada a esta interacción, no pudiéndose clasificar como definitiva. (AU)

Objetive: Identify, describe the potential pharmacological interactions of isavuconazole, study the clinical impact of the most relevant ones and establish therapeutic recommendations for those found in hospitalized patients.Methods: Retrospective descriptive observational study that included all patients treated with isavuconazole from its marketing until December 2019.Demographic variables and drugs concomitant to isavuconazole for more than 48 hours received by the patient were collected. The treatments with Lexicomp® were reviewed to detect possible interactions, its mechanism of action was analyzed and it was related to the drugs involved, establishing therapeutic recommendations.To establish the clinical impact, the medical records of the patients with more severe interactions (D and X for Lexicomp®) were reviewed. In the case of finding any adverse reaction, Horn’s algorithm was applied to establish the probability that the effect is produced by the pharmacological interaction.Results: 84 admissions in 59 patients were analyzed. There were 209 potential interactions in 84.5% of the admissions. The majority, 84.7%, were of a moderate nature (category C), the most frequent with tacrolimus. The main mechanism of action was the inhibitory effect on cytochrome CYP3A4 of isavuconazole (82.8%).A patient with an increase in alkaline phosphatase coinciding with the concomitant initiation of isavuconazole and clarithromycin was detected. When applying Horn’s algorithm, the interaction is considered as possible.Conclusions: Potential serious drug interactions were detected in less than 10% of admissions and only one possible adverse reaction associated with this interaction was detected, and it could not be classified as definitive. (AU)

Efectividad y seguridad de ramucirumab en el tratamiento de adenocarcinoma gástrico / Effectiveness and safety of ramucirumab in the treatment of gastric adenocarcinoma

Objetivos: Evaluar la efectividad y seguridad de ramucirumab en el tratamiento de adenocarcinoma gástrico metastático (AGM) o adenocarcinoma de la unión gastroesofágica metastático (AUGEM) en un hospital de clase 5. Métodos: Estudio observacional retrospectivo en el que se incluyeron a todos los pacientes tratados con ramucirumab en el hospital. Se realizó un seguimiento a través de la historia clínica electrónica (HCE) de la que se recogieron edad, sexo, diagnóstico, estado funcional según ECOG y líneas previas de tratamiento. Como variables de efectividad se calcularon la supervivencia libre de progresión (SLP) y supervivencia global (SG). Como variables de seguridad se analizaron los efectos adversos recogidos en la HCE y se categorizaron por gravedad según CTCAE (v.5). Resultados: Se analizó un total de 40 pacientes (20% mujeres) con edad media al inicio del tratamiento de 62,5±12,4 años. Al inicio del tratamiento, el 67,5% de los pacientes tenían ECOG 1. El 78% de los tratamientos con ramucirumab fueron en segunda línea y el 22% en tercera. Respecto a la primera línea, el 100% de los esquemas estaban basados en platino y fluoropirimidinas.EL 90,1% de los pacientes fueron tratados con la combinación de paclitaxel 80 mg/m2 más ramucirumab 8 mg/kg; el resto se trató en monoterapia. Los pacientes recibieron de media 5,1±4,1 ciclos. La SLP fue de 4 (3,1-8,9) meses y la SG fue de 5,8 (4,6-13) meses.En cuanto a la seguridad, el 75,6% de los pacientes (n=31) presentó algún efecto adverso. El efecto adverso más observado fue astenia en el 48,8% de los pacientes (n=20). También se observó: hipertensión (17,1%), rash cutáneo (12,2%), alopecia (12,2%), neutropenia (9,7%), mucositis (9,7%) y náuseas (9,7%). Conclusiones: La SLP fue similar en este estudio a la obtenida en el ensayo clínico pivotal RAINBOW, aunque el valor de la SG obtenida fue de casi la mitad. La seguridad fue similar a la observada en el ensayo clínico mencionado. (AU)

Objetive: To assess the effectiveness and safety of ramucirumab in the treatment of metastatic gastric adenocarcinoma (MGA) or metastatic gastroesophageal junction adenocarcinoma (MGJA) in a class 5 hospital.Methods: Retrospective observational study in which all patients treated with ramucirumab in the hospital were included.A follow-up was carried out through the electronic medical history (HCE) from which age, sex, diagnosis, functional status according to ECOG and previous treatment lines were collected. As effectiveness variables, progression-free survival (PFS) and overall survival (OS) were calculated. As safety variables, the adverse effects recorded in the HCE were analyzed and categorized by severity according to CTCAE (v.5).Results: A total of 40 patients (20% women) with a mean age at the start of treatment of 62.5±12.4 years were analyzed. At the beginning of treatment, 67,5% of patients had ECOG 1.78% of the treatments with ramucirumab were in the second line and 22% in the third. Regarding the first line, 100% of the schemes were based on platinum and fluoropyrimidines.90.1% of the patients were treated with the combination of paclitaxel 80 mg/m2 plus ramucirumab 8 mg/kg; The rest was treated in monotherapy. Patients received on average 5.1±4.1 cycles. The PFS was 4 (3.1-8.9) months and the OS was 5.8 (4.6-13) months.Regarding safety, 75.6% of the patients (n=31) presented some adverse effect. The most observed adverse effect was asthenia in 48.8% of the patients (n=20). It was also observed: hypertension (17.1%), skin rash (12.2%), alopecia (12.2%), neutropenia (9.7%), mucositis (9.7%) and nausea (9.7%).Conclusions: The PFS was similar in this study to that obtained in the pivotal clinical trial RAINBOW, although the value of the OS obtained was almost half. Safety was similar to that observed in the clinical trial. (AU)

Congreso virtual de dermatología realizado a través de Telegram® durante el confinamiento de la COVID-19: especificaciones acerca de la organización y valoración de los asistentes / Attendee Survey and Practical Appraisal of a Telegram®-Based Dermatology Congress During the COVID-19 Confinement

INTRODUCCIÓN: La pandemia de COVID-19 introdujo cambios drásticos en nuestras vidas. Tratando de encontrar una herramienta adecuada para la formación y el debate dermatológico durante el confinamiento, se celebró un congreso médico on-line durante los días 25 y 26 de abril del 2020. El objetivo del presente estudio fue evaluar las características, la opinión y el grado de satisfacción de los asistentes a dicho congreso. En segundo lugar, se buscó explicar cómo se organizó este formato de reunión. MATERIAL Y MÉTODOS: Se entregó un cuestionario a los asistentes a un congreso on-line realizado a través de la aplicación Telegram® Messenger App. Se describió paso a paso su organización y planificación. No se necesitó apoyo financiero, ya que fue realizado de manera voluntaria. RESULTADOS: El grado de satisfacción tanto de los ponentes como de los asistentes fue muy elevado. Todos los participantes consideraron que este formato tenía un gran presente y futuro. La mayoría lo calificó como superior a las reuniones presenciales tradicionales. Ser del sexo femenino y tener una práctica clínica predominantemente privada favorecieron esta opinión. DISCUSIÓN: La pandemia obligó a cancelar la mayoría de las reuniones científicas presenciales. Esto fue visto por algunos autores como una excelente oportunidad para mejorar y liderar el cambio a las reuniones virtuales. Aunque el confinamiento no permitió un contacto real, nuestra reunión demostró que era posible asegurar la interacción entre los participantes. Los dermatólogos pudieron participar en una actividad formativa a pesar de que debido a las circunstancias se interrumpiera su actividad práctica diaria. La mayoría de los asistentes tuvieron la sensación de que esta era una actividad nueva y atractiva, que superaba incluso a las reuniones presenciales tradicionales

INTRODUCTION: The COVID-19 pandemic outbreak introduced dramatic changes in all our lives, daily practice, and medical conferences. In search of a tool to spread dermatologic knowledge during confinement, an online medical meeting was held on April 25th to 26th, 2020. In this study, we aimed to assess the characteristics, opinion and satisfaction of the attendees to a free-of-charge online congress. Secondarily, we intended to explain how this meeting was prepared. METHODS: Online survey administered to the attendees to an online congress organised via the Telegram® Messenger App. Its organisation and planning, which needed no financial support and was done by volunteer organisers, moderators and speakers, is described step by step. RESULTS: The satisfaction of both speakers and attendees was very high. All participants considered that this format had a great present and future, and most of them rated it as superior to regular face-to-face meetings. Female gender and predominantly private practice favoured this opinion. DISCUSSION: The COVID-19 pandemic has forced the cancellation of most scientific gatherings. This has been seen by some authors as an excellent opportunity, encouraging medical societies and organisations to lead the change to virtual meetings. Although confinement did not allow real contact, our online meeting showed it was possible to ensure interaction and participation between attendees, moderators and speakers. Dermatologists enjoyed some dermatologic science, even despite the extraordinary circumstances disrupting their daily clinical practice. Most of them felt they were participating in something new and compelling that many felt superior to traditional meetings

Attendee Survey and Practical Appraisal of a Telegram®-Based Dermatology Congress During the COVID-19 Confinement. / Congreso virtual de dermatología realizado a través de Telegram® durante el confinamiento de la COVID-19: organización y evaluación.

INTRODUCTION: The COVID-19 pandemic outbreak introduced dramatic changes in all our lives, daily practice, and medical conferences. In search of a tool to spread dermatologic knowledge during confinement, an online medical meeting was held on April 25th to 26th, 2020. In this study, we aimed to assess the characteristics, opinion and satisfaction of the attendees to a free-of-charge online congress. Secondarily, we intended to explain how this meeting was prepared. MATERIAL AND METHODS: Online survey administered to the attendees to an online congress organised via the Telegram® Messenger App. Its organisation and planning, which needed no financial support and was done by volunteer organisers, moderators and speakers, is described step by step. RESULTS: The satisfaction of both speakers and attendees was very high. All participants considered that this format had a great present and future, and most of them rated it as superior to regular face-to-face meetings. Female gender and predominantly private practice favoured this opinion. DISCUSSION: The COVID-19 pandemic has forced the cancellation of most scientific gatherings. This has been seen by some authors as an excellent opportunity, encouraging medical societies and organisations to lead the change to virtual meetings. Although confinement did not allow real contact, our online meeting showed it was possible to ensure interaction and participation between attendees, moderators and speakers. Dermatologists enjoyed some dermatologic science, even despite the extraordinary circumstances disrupting their daily clinical practice. Most of them felt they were participating in something new and compelling that many felt superior to traditional meetings.

Evidencia actual del tratamiento quirúrgico del melanoma cutáneo en un solo tiempo / One-Step Surgical Removal of a Cutaneous Melanoma: Current Evidence

No disponible

Consideraciones sobre los márgenes de resección lateral y profundo en las piezas de extirpación de tumores cutáneos / Considerations on Lateral and Deep Surgical Margins in Resected Skin Tumors

No disponible