Temporoparietal fascia flap for auricular reconstruction. / Colgajo de fascia temporoparietal para reconstrucción auricular.

INTRODUCTION: Microtia is a congenital malformation of the auricle. The most common complication of microtia surgical repair is costal cartilage exposure. We describe the case of a patient with costal cartilage exposure and the use of temporoparietal fascia flap (TPFF) for covering purposes. CLINICAL CASE: 12-year-old male patient with right microtia undergoing two auricle reconstruction surgeries. One month following the second surgery, costal cartilage exposure was noted, with loss of grafted skin. A TPFF and a scalp skin graft were performed to cover the exposed cartilage. COMMENTS: An adequate and critical management of costal cartilage exposure is required to avoid cartilage reabsorption. TPFF represents a useful tool in ear reconstruction surgeries and should be considered in potential face reconstruction surgeries.

INTRODUCCION: La microtia es una malformación congénita del pabellón auricular. Dentro de las complicaciones de la reparación quirúrgica, la más frecuente es la exposición del cartílago costal. Describimos el caso de un paciente con exposición del cartílago costal y la utilización del colgajo de fascia temporoparietal (CFTP) para su cobertura. CASO CLINICO: Paciente varón de 12 años con microtia derecha intervenido de primer y segundo tiempo de reconstrucción del pabellón auricular. Al mes de la segunda cirugía se evidencia exposición del cartílago costal, con pérdida de la piel injertada. Se realiza un CFTP e injerto de piel de cuero cabelludo para cubrir el cartílago expuesto. COMENTARIOS: Un manejo adecuado y crítico de la exposición del cartílago costal es necesario para evitar la reabsorción de dicho cartílago. El CFTP representa una herramienta para cirugías reconstructivas de la oreja y se ha de conocer para eventuales cirugías de reconstrucción facial.

[Approach of the unilateral cleft lip with Meara's cheiloplasty technique]. / Abordaje de la fisura labial unilateral mediante la queiloplastia de Meara.

INTRODUCTION: Isolated cleft lip is the mildest form of the cleft lip and palate spectrum; however those patients are often treated with the same surgical techniques that are used for the more severe cases (advancement-rotation flaps, quadrangular flaps). Meara's cheiloplasty technique may be a less aggressive option for lip repair in isolated cleft lip or whenever the gap between labial segments is not wide. MATERIAL AND METHODS: All children that had their cleft lip repaired following Meara's cheiloplasty between May 2014 and December 2015 were retrospectively reviewed. Duration of the surgical procedure, time to hospital discharge and complications were noted. Aesthetic results were evaluated in terms of lip height and symmetry, nose shape and symmetry, and scar appearance. RESULTS: Thirteen patients underwent Meara's cheiloplasty during this period. The average age was 6.11 months (5 to 12 months). A primary rhinoplasty was done at the same time in case of nasal asymmetry. Duration of the lip repair averaged 85 minutes. Oral feeding was started 4 hours after the procedure; bottle-feeding was withheld for 2 weeks postoperatively, as our protocol recommends after other lip repair techniques. In all 13 cases the result was a symmetrical, adequately high upper lip and a well-balanced nose, except for one case of lip scar retraction that was solved with triamcinolone infiltration. There were no other intra or postoperative complications. CONCLUSIONS: Meara's cheiloplasty corrects small or moderate gap cleft lip (usually cleft lip without cleft alveolus). Benefits over other teccniques are a shorter procedure and less geometric, undulate flaps that produce a harmonic lip.

INTRODUCCION: La fisura labial aislada es la forma menos grave de presentación del espectro de las fisuras labiopalatinas; sin embargo, para tratarla, usamos las mismas técnicas quirúrgicas que para las formas más graves (colgajos de avance-rotación, cuadrangulares). Presentamos la técnica de queiloplastia publicada por Meara, como alternativa menos agresiva para la reconstrucción del labio, en la fisura labial aislada o cuando los segmentos labiales están próximos entre sí. MATERIAL Y METODOS: Se realizó una revisión retrospectiva de las queiloplastias con técnica de Meara de mayo 2014 a diciembre 2015. Se revisó el tiempo quirúrgico, tiempo medio de ingreso, complicaciones y resultados estéticos, evaluando la altura y simetría del labio superior, la forma y simetría nasal y el aspecto de la cicatriz. RESULTADOS: Trece pacientes han sido intervenidos. La edad media al momento de la intervención fue de 6,11 meses (rango 5-12 meses). Se asoció una rinoplastia en casos con asimetría nasal. El tiempo quirúrgico medio de la queiloplastia aislada fue de 85 minutos. Se reinició alimentación oral a las 4 horas de la intervención, reanudando la alimentación mediante biberón a las 2 semanas, siguiendo el mismo protocolo que con las otras técnicas. En los 13 casos se consiguió un labio superior simétrico con altura adecuada y nariz armónica (excepto 1 que presentó retracción, tratada con infiltración de triamcinolona). No hubo otras complicaciones intra/postoperatorias. CONCLUSIONES: La queiloplastia de Meara corrige de forma muy armónica la fisura labial con poca o moderada separación de los segmentos labiales (habitualmente la fisura labial sin fisura alveolar). Como ventajas frente a otras técnicas permite, en una intervención más corta, la queiloplastia utilizando colgajos ondulados, que son menos geométricos y aportan armonía al resultado.

[Keloid scars of the external ear: a non solved problem]. / Cicatrices queloideas en pabellón auricular: un problema no resuelto.

The external ear is a location with high risk of keloid scar formation. Its incidence is growing since general use of piercings and performance of plastic surgery of the external ear. The external ear keloid can be a devasting process for adolescent population which is worried about their appearance. Our aim is to attract attention about the risk of keloid scars of the external ear, reviewing our experience. After dismissing radiotherapy, corticoid infiltration and surgical removal are the most used options, with a high recurrence risk. We have reviewed traumatic, surgical and piercing wounds of the external ear, with a subsequent keloid formation treated in our outpatient clinic, collecting data about wound etiology, treatment and results. During the last 10 years we have found 11 keloid scars, 2 of them improved with topical corticosteroid. Treatment has been surgical in 9 cases, 4 of them with skin graft: 5 recovered and 4 recurred; 2 of them were reoperated. 2 of them were treated with intralesional corticosteroid solely, one recovered and the other one had improved. Treatment management of keloid scars is complex and there isn't a procedure with superior results than the others. Risk of complication must be explained within adolescent population.

[Poland's syndrome and free autologous fat grafts]. / Síndrome de Poland e injertos libres de grasa autóloga.

OBJECTIVE: To evaluate the final reconstructive results in 6 cases of female Poland syndrome treated in a first stage with an anatomical high cohesive breast implants and in a second stage with free autologous fat grafts. METHODS: Six females were submitted to bilateral breast reconstruction. The reconstruction was done using anatomical breast implants as first step and after 11 to 18 months the free autologous fat grafting using the Coleman technique as well as treating the contralateral breast to achieve a better symmetry and volume. Photographies taken pre and postoperatively and the Foucras Classification were used to determine volume. Four months after the last surgery the patients answered a satisfaction questionnaire. RESULTS: In all 6 patients there was an improvement of the thoracic contour a year after the last surgery in terms of volume, projection and width of the breast. CONCLUSIONS: The use of free autologous fat grafts improves the results in cases of Poland's syndrome previously treated with breast implants making possible to correct the anterior axillary fold, projection and symmetry with a versatile method, with a low morbidity rate, allowing for a personalized treatment.

Síndrome de Poland e injertos libres de grasa autóloga / Poland’s syndrome and free autologous fat grafts

Objetivos. Evaluar el resultado final reconstructivo en 6 casos de síndrome de Poland tratados en un primer tiempo con prótesis mamaria de gel cohesivo y en un segundo tiempo con injertos libres de grasa autóloga. Material y métodos. Seis chicas fueron sometidas a reconstrucción mamaria bilateral, realizándose en un primer tiempo la reconstrucción con prótesis mamaria anatómica de gel cohesivo y en un segundo tiempo se realizaron injertos de tejido adiposo en la mama reconstruida así como simetrización de la mama contralateral incluyendo injertos libres de grasa autóloga, reducción mamaria o bien mastopexia. Se tomaron fotos pre y postoperatorias y se realizó la clasificación de Foucras para determinar el volumen necesario. Asimismo, se determinó también el grado de satisfacción postoperatoria con un cuestionario que las pacientes contestaron 4 meses después de la última cirugía. Resultados. En las 6 pacientes se observó mejoría del contorno torácico al año de la última intervención, tanto desde el punto de vista del volumen como de proyección y anchura de la mama. Conclusiones. El uso de injertos libres de grasa autóloga mejora el resultado en casos de síndrome de Poland ya reconstruidos con prótesis mamaria ya que se puede corregir el pliegue axilar anterior, el hundimiento infraclavicular, la proyección y la simetría con un método versátil, con poca morbilidad, pudiendo personalizar el tratamiento

Objective. To evaluate the final reconstructive results in 6 cases of female Poland syndrome treated in a first stage with an anatomical high cohesive breast implants and in a second stage with free autologous fat grafts. Methods. Six females were submitted to bilateral breast reconstruction. The reconstruction was done using anatomical breast implants as first step and after 11 to 18 months the free autologous fat grafting using the Coleman technique as well as treating the contralateral breast to achieve a better symmetry and volume. Photographies taken pre and postoperatively and the Foucras Classification were used to determine volume. Four months after the last surgery the patients answered a satisfaction questionnaire. Results. In all 6 patients there was an improvement of the thoracic contour a year after the last surgery in terms of volume, projection and width of the breast. Conclusions. The use of free autologous fat grafts improves the results in cases of Poland’s syndrome previously treated with breast implants making possible to correct the anterior axillary fold, projection and symmetry with a versatile method, with a low morbidity rate, allowing for a personalized treatment

[Utility of octyl 2-cyanoacrylate in pediatric surgery]. / Utilidad del adhesivo tisular 2-octil cianoacrilato en cirugía pediátrica.

OBJECTIVE: The aim this study was to demonstrate the utility and suitability of octyl-2-cianocrylate in cutaneus repair of different conditions in the pediatric population. Octyl-2-cianocrylate is a topical tissular adhesive which can be used on skin and which has been tested in surgical practice as a wound sealant, avoiding the use of conventional sutures. MATERIAL AND METHODS: We applied octyl-2-cianocrylate in 100 patients with skin wounds smaller than 5 cm. The patients were distributed as follows: Emergency department: simple sharp wounds in the face and extremities (20 patients); surgical block: surgical wounds in 80 patients with the following conditions: inguinal hernia (20 patients), cryptorchidism (20 patients), umbilical hernia (10 patients), hypospadias (17 patients), post-hypospadias fistula repair (8 patients) and cleft lip (5 patients). The results were analyzed in terms of efficacy, cosmetic result, procedure time, material used, and patient comfort. CONCLUSIONS: Octyl-2-cianocrylate was easier to use than conventional sutures in all its applications, requiring less time than conventional sutures and therefore lowering the cost per procedure.

[Nasal congenital cysts and fistulas: clinical and surgical aspects]. / Quistes y fístulas congénitas nasales: aspectos clínicos y quirúrgicos.

Eight patients affected with cysts or fistulae on the midline at the nose bridge (back of the nose) have been treated at the Pediatric Surgery Service of the Hospital Sant Joan de Dèu in Barcelona from march 1995 to october 1996. Six patients had a cystic mass (four of them having an intranasal prolongation) and two had a fistulous orifice (one of them also having intranasal prolongation). The test with the highest diagnostic sensibility was the CT-scan, which showed a bifid crista galli and intranasal prolongation in 5 of the patients. Pathologic exam confirmed the diagnosis of dermoid cyst. At follow-up, all patients were doing well. Congenital cysts and fistulae at the nose bridge (back of the nose) may appear as a trivial condition; the possibility of them being the only clinical feature of an intranasal or intracranial prolongation is the reason for a deeper study in order to determine the extension of the lesion. The treatment is always surgical removal of the cyst and the fistulous pathway at the time of diagnosis, regardless of the patient's age, thus avoiding possible infectious complications.

[The behavior of a striated muscle implant in contact with the intestinal wall. An experimental study]. / Comportamiento de un implante de musculo estriado en contacto con la pared intestinal. Estudio experimental.

Based on the experiences of Thompson and Hakelius, we wanted to study the behaviour of a previously denervated skeletal muscle, in close contact with the intestinal wall, as a possible high pressure mechanism. We used 60 Sprague-Dawley rats. Two surgical procedures were performed: sciatic nerve section and a plantaris muscle transplant at the ileum, the interval between these two procedures was zero, two and four weeks. The implant area was studied by histochemical and histological techniques at different posttransplant times. Live muscle fibers were seen in all implants. The best results were seen in those implants that has been denervated 4 weeks prior to the seconds procedure. During the first phase, there was considerable postimplant inflammation. In the later phases, healthy muscle fiber remained, but with partial fibrous substitution. An implant of skeletal muscle, prior denervated, in contact with the intestinal wall, survive the posttransplant ischemia. The implant showed live muscle fibers with structural capacity for contraction. This experimental model, that is described for the first time, allows for the functional study of pre- and postimplant behaviour.