A New Planning Method to Easily Harvest the Superficial Circumflex Iliac Artery Perforator Flap.

BACKGROUND: The superficial circumflex iliac artery perforator flap (SCIP) is a thin, pliable, and versatile flap used mainly for extremities and head and neck reconstruction. Different planning methods have been described, but these are not yet standardized like in other flaps. The aim of this study is to present a fast, effective, and reliable method for SCIP flap planning using computed tomography angiography (CTA). PATIENTS AND METHODS: Between October 2017 and September 2018, CTA was performed on 40 patients. Preoperative planning of SCIP flaps based on the medial branch was performed analyzing CTA images. The perforating sites of the medial branch on the deep (point D) and superficial fascia (point S) were identified. Distances to those points, from the center of the umbilicus in the "y-axis" and the midline perpendicularly in the "x-axis," were measured. These measurements were transferred to the patient's skin as a guide for dissection. RESULTS: Eighty areas were studied identifying points D and S in CTA. Forty-three SCIP flaps were performed using this planning method. In 100% of the flaps, points D and S matched perfectly with handheld Doppler and surgical findings. CONCLUSION: Points D and S method for medial branch based SCIP planning with CTA is an easy to learn, efficient, fast, and reliable technique for preoperative planning, allowing a safe and predictable elevation of the flap.

Augmented Reality Microsurgical Planning with a Smartphone (ARM-PS): A dissection route map in your pocket.

INTRODUCTION: Perioperative microsurgical planning increases the likelihood of successful results. Augmented reality (AR) is the addition of artificial information to allow the user to perform tasks more efficiently. The aim of our study is to report the use of AR for microsurgical planning with a smartphone (ARM-PS) as a dissection route map. PATIENTS AND METHODS: AR was used for superficial circumflex iliac artery perforator (SCIP) flap planning. Three-dimensional (3D) reconstruction images of the inguinal and lower abdomen vascular anatomy were obtained by computed tomography angiography. These 3D images were imported to a smartphone and an AR app was used to superimpose them with the camera. The drawings performed with ARM-PS were correlated with handheld Doppler and intraoperative findings. RESULTS: The correlation of ARM-PS drawings with handheld Doppler results was 100% for superficial inferior epigastric artery (SIEA) and superficial and deep branches of SCIP in 60 inguinal areas studied. Intraoperative findings matched perfectly in all 30 cases with ARM-PS drawings for the location of the mentioned vessels and lymph nodes. Flap harvest time decreased in 20% compared with our traditional timing. CONCLUSIONS: ARM-PS is an easy, noninvasive, and accurate method that provides a dissection route map, thereby standardizing flap harvesting, and shows a perfect correlation with intraoperative findings. It reduces operating time and may improve operative results, thus decreasing donor site morbidity.

Comparación In Vitro de la adaptación marginal entre incrustaciones MOD maquinadas con el sistema IPS e: max CAD y restauraciones MOD en oro colado tipo III / valuation of marginal adaptation In Vitro of MOD fillings with an enamel finish manufactured with IPS e: max CAD (computer assisted design) and with gold type III

Objetivo: comparar la adaptación marginal In Vitro de incrustaciones MOD con terminación en esmalte fabricadas con IPS e.max CAD (Computer Asisted Desing) y fabricadas en oro tipo III. Materiales y métodos: En este estudio experimental exploratorio se uso una muestra no probabilística de 15 premolares sanos por cada uno de los dos grupos; IPS e.max CAD y oro tipo III.A todos los premolares se les realizó cavidades MOD estandarizadas para los 2 grupos. Los dientes preparados fueron asignados aleatoriamente a cada grupo. Las incrustaciones del grupo IPS e.max CAD fueron elaboradas con el sistema CEREC 3 y las incrustaciones en oro fueron elaboradas por los investigadores. Se tomaron estereo microfotografías de todas las muestras sobre papel milimetrado, y las imágenes fueron analizadas mediante el programa ImageTool. Se tomaron tres medidas adaptación marginal en el área proximal mesial o distal de cada muestra, que fueron promediadas y reportadas en micras. Los datos fueron analizados mediante ANOVA y Test de Mann-Whitney. Resultados: el 98% del total de las incrustaciones en oro y el 47% del total de las incrustaciones de IPS e.max CAD presentaron una adaptación marginal < a 120 micras. El promedio de desadaptación marginal del grupo IPS e.max CAD fue 122.8 μ + 44.1, mientras que para el grupo oro fue de 75.3 μ+42,6 encontrándose diferencias estadísticamente significativas entre los dos. Conclusiones: El oro reporta mejor adaptación marginal en restauraciones inlays MOD que los sistemas maquinados como el sistema IPS e.max CAD.

Objective: To compare In Vitro, the marginal adaptation of MOD fillings with an enamel finish manufactured with IPS e.max CAD (Computer Assisted Design) and those manufactured with gold type III. Materials and methods: In this exploratory experimental study, a non-probabilistic sample of 15 healthy premolars for each of the two groups (IPS e.max CAD and gold type III) was used. Standardized MOD cavities were made in all the premolars for both groups. The prepared teeth were randomly assigned to each group. The IPS e.max CAD fillings were made using the CEREC 3 system and the gold fillings were made by the researchers. Stereo microphotographs of all the samples were taken on millimeter paper and the images were analyzed using the Image Tool software. Three marginal adaptation measurements in the mesial proximal or distal area were taken for every sample; they were averaged and reported in microns. The data was analyzed using ANOVA and the Mann-Whitney test. Results: 98% of all the gold fillings and 47% of all the IPS e.max CAD fillings showed a marginal adaptation of less than or equal to 120 microns. The marginal unfitness average for the IPD e.max CAD group was 122.8 + 44.1 μm, and for the gold fillings group it was 75.3 + 42.6 μm. There was a statistically significant differences between the groups. Conclusions: Gold reports a better marginal adaptation for inlay MOD fillings than manufactured systems like IPS e.max CAD system.

Presentación de un caso de tricobezoar en el Hospital Erasmo Meoz de la ciudad de San José de Cúcuta (Colombia) / Case presentation of Tricobezoar at the Hospital Erasmo Meoz in Cúcuta (Colombia)

El tricobezoar es una concreción de cabellos que se puede encontrar en el tracto digestivo humanodebido a tricofagia y que puede causar una gran variedad de signos y síntomas hasta llegar a laoclusión, perforación o ulceración del tracto digestivo; su incidencia es bastante rara, y suele ocurriren pacientes con problemas siquiátricos de sexo femenino. El tratamiento de esta entidad es muyvariado, desde la sola extracción o/y fragmentación endoscopica o quirúrgica hasta la reparación oresección intestinal.Se presenta el caso de una paciente femenina del Hospital Erasmo Meoz de la ciudad de San José deCúcuta en su puerperio tardío con un tricobezoar gástrico y que aparentemente no poseía un trastornode base ni sintomatología relacionada previa al embarazo.

The trichobezoar is a concentration of hair that can be found in the human digestive system due totrichophagy and that can cause a great variety of sings and symptoms inducing obstruction,ulceration or perforation of the gastrointestinal tract; it’s incidence is rare and usually occurs inpatients with psiaquiatric problems and female. The treatment options of this entity vary and includethe extraction endoscopic or surgical fragmentation and even intestinal resection.He present a case of a female patient is Erasmo Meoz Hospital en San José de Cúcuta city in herpuerperium with a gastric trichobezoar that apparently is not related to a psiaquiatric disorder or othersintomatology during or before her pregnancy.