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.

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.

Treatment of Irreparable Rotator Cuff Tears: Superior Capsular Reconstruction with Fascia Lata Allograft.

Objective The objective of the present study was to evaluate the efficacy and safety of superior capsular reconstruction (SCR) using fascia lata allograft. Methods A prospective case series of 15 patients with irreparable supraspinatus tear who underwent SCR using fascia lata allograft. The American Shoulder and Elbow Surgeons (ASES) scale at 12 months after surgery was the primary outcome. The University of California Los Angeles (UCLA), Constant-Murley, and Single Assessment Numeric Evaluation (SANE) scales, in addition to the range of motion, were secondary outcomes. Radiological parameters were also evaluated by simple radiographs and magnetic resonance imaging (MRI). Results Fifteen patients completed 12 months of postoperative follow-up. The ASES score increased from 34.0 to 73.0 ( p = 0.005). The UCLA, Constant-Murley, and SANE scales also showed statistically significant differences ( p = 0.001; p = 0.005; and p = 0.046). In the evaluation of range of motion, there was improvement in elevation and in external rotation (95 to 140°, p = 0.003; 30 to 60°, p = 0.007). Six patients (40%) had complete graft healing. The clinical outcomes were significantly higher in the patients who presented graft healing. Conclusions Superior capsular reconstruction using a fascia lata allograft is a safe and effective procedure in short follow-up. Level of Evidence IV; Therapeutic Study; Case Series.

Treatment of Irreparable Rotator Cuff Tears: Superior Capsular Reconstruction with Fascia Lata Allograft / Tratamento das rupturas irreparáveis do manguito rotador: Reconstrução capsular superior com aloenxerto de fáscia lata

Abstract Objective The objective of the present study was to evaluate the efficacy and safety of superior capsular reconstruction (SCR) using fascia lata allograft. Methods A prospective case series of 15 patients with irreparable supraspinatus tear who underwent SCR using fascia lata allograft. The American Shoulder and Elbow Surgeons (ASES) scale at 12 months after surgery was the primary outcome. The University of California Los Angeles (UCLA), Constant-Murley, and Single Assessment Numeric Evaluation (SANE) scales, in addition to the range of motion, were secondary outcomes. Radiological parameters were also evaluated by simple radiographs and magnetic resonance imaging (MRI). Results Fifteen patients completed 12 months of postoperative follow-up. The ASES score increased from 34.0 to 73.0 (p= 0.005). The UCLA, Constant-Murley, and SANE scales also showed statistically significant differences (p= 0.001; p= 0.005; and p= 0.046). In the evaluation of range of motion, there was improvement in elevation and in external rotation (95 to 140°, p= 0.003; 30 to 60°, p= 0.007). Six patients (40%) had complete graft healing. The clinical outcomes were significantly higher in the patients who presented graft healing. Conclusions Superior capsular reconstruction using a fascia lata allograft is a safe and effective procedure in short follow-up. Level of Evidence IV; Therapeutic Study; Case Series.

Resumo Objetivo O objetivo do presente estudo foi avaliar a eficácia e a segurança da reconstrução capsular superior (RCS) com a utilização do aloenxerto de fáscia lata. Métodos Uma série de casos prospectivos de 15 pacientes com ruptura irreparável do supraespinhal foi submetida a RCS com aloenxerto de fáscia lata, sendo adotada como desfecho primário a escala American Shoulder and Elbow Surgeons (ASES, na sigla em inglês) aos 12 meses do pós-operatório. Como desfechos secundários, foram adotadas as escalas da University of California Los Angeles (UCLA, na sigla em inglês), Constant-Murley, e Single Assessment Numeric Evaluation (SANE, na sigla em inglês), além da amplitude de movimento. Os parâmetros radiológicos também foram avaliados por radiografias simples e ressonância magnética (RM). Resultados Quinze pacientes completaram 12 meses de acompanhamento pós-operatório. O escore ASES aumentou de 34,0 para 73,0 (p= 0,005). As escalas UCLA, Constant-Murley e SANE também apresentaram diferenças estatisticamente significativas (p= 0,001; p= 0,005; e p= 0,046). Na avaliação da amplitude de movimento, houve melhora na elevação e rotação externa (95 a 140°, p= 0,003; 30 a 60°, p= 0,007). Seis pacientes (40%) tiveram cicatrização completa do enxerto. Os desfechos clínicos foram significativamente maiores nos pacientes que apresentaram cicatrização do enxerto. Conclusões A RCS com aloenxerto de fáscia lata é um procedimento seguro e eficaz com um curto acompanhamento de tempo. Nível de evidência IV; Estudo Terapêutico; Série de casos.

Repercusión biomecánica derivada de un osteoma en el tercio proximal del fémur: a propósito de un caso / Biomechanical Impact Derived From an Osteoma in the Proximal Third of the Femur: Report of a Case

Introducción: El osteoma osteoide es un tumor óseo benigno, que no tiene potencial de crecimiento por lo que su tamaño no supera 1,5 cm pese a que la esclerosis que lo rodea le da un aspecto mayor. Afecta con mayor frecuencia a los varones jóvenes, y la mayoría de las veces aparece en las tres primeras décadas de la vida. Objetivos: Mostrar las repercusiones biomecánicas derivadas de un osteoma osteoide en el trayecto de la cintilla iliotibial y sus influencias por cadenas musculares descendentes sobre el miembro inferior. Presentación del caso: Se presenta una paciente de 24 años que acude a la consulta por presentar dolor a nivel de la cara externa del fémur derecho desde hace dos años; que se agudiza fundamentalmente con la marcha. Tras realizar las pertinentes exploraciones y pruebas diagnósticas por imagen, no se observan hallazgos clínicos significativos, por tanto se pauta tratamiento antiinflamatorio por vía oral y se efectúa estudio biomecánico y postural en el cual se detecta pie valgos bilaterales, inestables, con mayor relevancia en el pie derecho. La paciente acude nuevamente al no encontrar mejoría, se realiza telemetría del miembro inferior y resonancia magnética del fémur derecho. La imagen para diagnóstico da como resultado la presencia de una masa compatible con un osteoma osteoide de 11 x 4 mm en el tercio proximal lateral del fémur derecho. Conclusiones: Una lesión neoplásica que afecte al trayecto de un grupo muscular con repercusión biomecánica puede realizar compensaciones a diferentes niveles, por tanto, es necesaria la actuación de un equipo multidisciplinario para restablecer la marcha. Las sinergias entre el tratamiento conservador y quirúrgico provocan un mayor porcentaje de éxito(AU)

Introduction: Osteoid osteoma is a benign bone tumor, which has no growth potential, consequently its size does not exceed 1.5 cm despite the fact that the surrounding sclerosis gives it a larger appearance. It most often affects young men, most often appearing in the first three decades of life. Objectives: To show the biomechanical repercussions derived from an osteoid osteoma in the trajectory of the iliotibial band and its influences by descending muscle chains on the lower limb. Case report: We report a 24-year-old female patient who came to the consultation due to pain on the external face of her right femur for two years. This pain worsened mainly by walking. After carrying out the pertinent explorations and diagnostic imaging tests, no significant clinical findings were observed, therefore, oral anti-inflammatory treatment was prescribed and biomechanical and postural study was carried out, which showed bilateral, unstable valgus foot, with higher relevance on the right foot. The patient came again when she had no improvement, telemetry of her lower limb and magnetic resonance imaging of her right femur were performed. The diagnostic image revealed the presence of a mass compatible with an 11 x 4 mm osteoid osteoma in the proximal lateral third of her right femur. Conclusions: A neoplastic lesion that affects the trajectory of a muscle group with biomechanical repercussions can carry out compensations at different levels, therefore, the action of a multidisciplinary team is necessary to restore gait. Synergies between conservative and surgical treatment lead to a higher success rate(AU)

Hybrid Sling for the Treatment of Concomitant Female Urethral Complex Diverticula and Stress Urinary Incontinence.

This study aims to present an alternative technique with the use of a transobturator hybrid sling (autologous fascia lata with a synthetic sling) in two patients with complex urethral diverticulum (CUD), urinary stress incontinence (SUI) and a large incisional infraumbilical hernia. Staged procedures could be performed, but considering the risk of persistence or worsening SUI, and no standard management strategy of SUI associated with CUD; simultaneous treatment was proposed. It is preferable to use autologous materials in such cases. However, the presence of incisional hernia protruded with its content covering the suprapubic area prohibits the retropubic sling technique due to visceral lesion risk. The diverticulum and SUI were repairs in the same surgery using a hybrid transobturator. The technique used for obtaining the fascia lata followed the literature, and a 6 cm segment was acquired. The patients were re-prepared in a lithotomy fashion, and diverticulectomy was performed. The segment of fascia lata was fixed to the mesh and sling was manipulated so that its middle part (fascia) rested directly below the urethra. After 6 months post-operatively, patients referred significant improvement in urinary symptoms. Patients have not had any storage symptoms, International Consultation on Incontinence Questionnaire - Short Form = zero, no SUI, and have not had any mesh-related complications. In conclusion, the present study evaluated a new technique for the treatment of CUD with SUI in a particular clinical scenario. Other studies with extended follow-up periods and larger sample sizes should be performed in this subset of patients.

Comparison of Different Bone Filling Materials and Resorbable Membranes by Means of Micro-Tomography. A Preliminary Study in Rabbits.

The purpose of this work was to evaluate the behavior of different membranes and bone filling materials used to fill critical defects in rabbit calvaria. Four defects were prepared in the cranial calvaria of female rabbits. They were randomly divided into three subgroups according to the type of barrier membrane to be used. Four animals carried cross-linked bovine collagen membranes (Mem-Lok, Bio-Horizons, Birmingham, AL, USA)), four human fascia lata membranes (Tissue, Inbiomed SA, Córdoba, Argentina) and four human chorioamniotic membranes (Tissue. Inbiomed SA, Córdoba, Argentina). The defects were filled with the deproteinized bovine bone particulate Bio-Oss® (Geistlich-Pharma AG, Wolhusen, Switzerland), with particulate human hydroxyapatite MinerOss® (Bio-Horizons, Birmingham, AL, USA), with particulate dental material (Tissue Bank Foundation, Inbiomed S.A., Córdoba, Argentina), and the last one was left without the addition of filler material. In the first group of four specimens, a resorbable cross-linked bovine collagen membrane was placed over the skull and defects, without additional fixing. In the second group, a human fascia lata membrane was placed, without additional fixing. In the third group, a human chorioamniotic membrane was placed, without additional fixing. The animals were sacrificed at 4 and 8 weeks. The highest percentages of relative radiological density (average) were recorded considering the amnio-chorionic membranes (83.63%) followed by collagen (81.44%) and finally the fascia lata membranes (80.63%), but the differences were not statistically significant (p > 0.05). The sites grafted with a decellularized tooth (96.83%) and Bio-Oss (88.42%), recorded the highest percentages of radiological density but did not differ significantly from each other (subset 2). The three membranes used did not show statistical differences between them, in any of the two time periods used. There were statistical differences between the filling materials evidencing the presence of a large quantity of calcified material in the defects treated with particulate tooth and deproteinized bovine bone and while smaller amounts of calcified material were registered in the case of defects treated with human hydroxyapatite and those that were not treated.

Resolución de úlcera trocantérea mediante colgajo musculocutáneo de fascia lata en isla con cierre en V-Y / Trochanteric ulcer reconstruction by tensor fascia lata musculocutaneous island flap with a V toY closure

Introducción. La úlcera trocantérea es una de las lesiones por presión más frecuente y está asociada generalmente a bursitis, por lo que su tratamiento es complejo. Materiales y Métodos. Se presenta el caso de un paciente masculino de 29 años, con antecedente de lesión medular asociada a paraplejía fláccida con desarrollo de úlcera trocantérea derecha elíptica vertical. Fue abordado de forma multidisciplinaria y resuelto con resección de la patología y reconstrucción con colgajo musculocutáneo de fascia lata. Resultado. El paciente fue dado de alta al 21 día posoperatorio. No presentó dehiscencias, infecciones de la herida ni recidiva al cumplirse 6 meses de la cirugía y el resultado estético y funcional fue satisfactorio. Conclusión. El colgajo musculocutáneo de fascia lata ascendido y con cierre de V en Y es una opción segura, versátil y reproducible para la resolución de úlceras trocantéreas. Sin embargo, deben respetarse todos los pasos de la técnica para evitar así complicaciones y recidivas.

Background. Trochanteric ulcer is one of the most frequent pressure sore and is usually related with bursitis, therefore its treatment is complex. Material and Methods. We present a case of a 29 year-old male patient with medical history of spinalcord injury (SCI) related to flaccid paraplegia and the development of right trochanteric vertical elliptical sore. He was treated by a multidisciplinary team and solved by the resection of the pathology and immediate reconstruction with tensor fascia lata (TFL) musculo cutaneous flap. Results. The patient was discharged from the institution on the 21st postoperative day. With a follow-up of a 6 months period, complications such as wound infection, suture dehiscense or recurrence were not observed. Aesthetic and functional results were satisfactory. Conclusion. Ascended TFL flap with a V-Y closure is a reproducible, reliable and versatile procedure for the coverage of trochanteric pressure sore defects. However all surgical techniques tages must be considered in order to avoid complications and recurrence of the disease

Tratamento cirúrgico da ptose palpebral moderada e grave: análise de resultados / Surgical treatment of moderate and severe ptosis: analysis of results

Introdução: A ptose palpebral é uma afecção comum na prática clínica na qual uma perfeita avaliação torna-se mandatória. Definimos ptose quando a margem palpebral encontra-se abaixo de 2 mm da junção córneo escleral e pode ser classificada em leve, moderada e grave. Existem inúmeras técnicas de reparo e a escolha dependerá da classificação da função do músculo levantador. Métodos: Foram analisados de forma prospectiva, no período de março de 2013 a maio de 2015, quatorze (n = 14) pacientes submetidos ao tratamento cirúrgico de ptose palpebral moderada e grave (n = 21). Inúmeros fatores foram estudados, tais como grau de ptose e função do músculo elevador da pálpebra, tipo de técnica de reparo, complicações imediatas e tardias, etc. Resultados: Quatorze pacientes foram opera-dos, totalizando 21 pálpebras, sendo que, 85% foram de etiologia adquirida e 15% congênita. Com relação ao grau de ptose, 64,3% (n = 9) foram moderadas e 35,7% (n = 5) graves. No que tange à função do músculo levantador, encontramos função boa 28,5% (n = 4), moderada 28,5% (n = 4) e pobre 43% (n = 6). Em relação às com-plicações, 2 casos de hiperemia conjutival e um caso de edema. Obtivemos um alto índice de satisfação com 85,7% (n = 12), com baixas taxas de complicações. Conclusão: A ptose palpebral é uma enfermidade comum na prática clínica e exige por parte do cirurgião um perfeito conhecimento anatômico da delicada estrutura palpebral e também de sua fisiopatologia. Uma perfeita avaliação desse paciente torna-se mandatória para o emprego do tratamento mais adequado.

Introduction: Eyelid ptosis is a common condition in clinical practice for which a complete evaluation is mandatory. Ptosis is defined when the eyelid margin is 2 mm below the corneoscleral junction and can be classified as mild, moderate, and severe. There are numerous repair techniques, and the choice will depend on the classification of the function of the levator muscle. Methods: We evaluated prospectively, from March 2013 to May 2015, 14 patients who underwent surgical treatment of moderate and severe ptosis (n = 21). Several factors were studied, such as degree of ptosis and function of the eyelid levator muscle, type of repair technique, and immediate and late complications. Results: Fourteen patients (21 eyelids) underwent operation. The etiology was acquired in 85% of the cases and congenital in 15%. With respect to the degree of ptosis, 64.3% (n = 9) of the cases were moderate and 35.7% (n = 5) were severe. With respect to the muscle function of the levator, good, moderate, and poor functions were observed in 28.5% (n = 4), 28.5% (n = 4), and 43% (n = 6) of the cases, respectively. With regard to complications, 2 cases of conjunctival hyperemia and one case of edema were observed. We obtained a high satisfaction rate of 85.7% (n = 12), with low complication rates. Conclusion: Eyelid ptosis is a common presentation in clinical practice and requires on the part of the surgeon a detailed anatomical knowledge of the delicate structure of the eyelid and its pathophysiology. A complete evaluation of these patients is mandatory for the employment of the most appropriate treatment.

Fascia lata como alternativa en tratamientos odontológicos / Fascia lata as an alternative in dental treatments

Resumen Introducción: La fascia lata es la parte más externa de la aponeurosis del muslo. Se trata de una membrana gruesa y resistente que posee elasticidad, flexibilidad y memoria. Actualmente es utilizada en el área médica para el tratamiento de defectos abdominales, incontinencia urinaria, ptosis palpebral y, en odontología, se utiliza para regeneración tisular guiada, coberturas radiculares, aumento de reborde y preservación de alveolo. Método: Se ha realizado una búsqueda electrónica en las bases de datos de Medline, PubMed y SciELO con el término fascia lata. Fueron incluidos textos compie-tos en idioma español e inglés que abarcan desde 1983 hasta 2015. La característica principal de estos textos es que exploran el uso de fascia lata en el área médica y odontológica. Discusión: Durante la realización de este trabajo surgieron situaciones limitantes debido a la escasa cantidad de artículos, investigaciones y casos clínicos documentados enfocados al uso de la fascia lata en el área odontológica. Conclusiones: La fascia lata es un material reabsorbible. biocompatible, que es bien tolerado por el lecho receptor, goza de características de seguridad y larga duración en su uso dentro de las especialidades medicas y odontológicas.

Abstract Introduction: Fascia lata is the most extreme section of the thigh's aponeurosis. It is a thick and resistant membrane possessing elasticity, flexibility and memory. It is presently used in the medical world to treat abdominal defects, urinary incontinence, and palpebral ptosis. In dentistry it is used in guided tissue regeneration, root coverage, ridge increase and socket (alveolus) preservation. Method: An electronic search was conducted in the following databases: Medline, PubMed and Sei ELO, with the term fascia lata. Full texts in English and Spanish were included in timeline spanning from 1983 to 2015. Main characteristic selected for these texts was they explored use of fascia lata and medical and dental areas. Discussion: Limiting situations arose during the execution of this project due to the scarcity found in articles and research papers and documented clinical cases targeting use of fascia lata ion dental areas. Conclusions: Fascia lata is a resorbable, biocompatible material, well tolerated by the recipient bed; when used in medical and dental specialties it exhibits characteristics of accuracy (security) and long duration.

Evaluation of the Grafted Fascia in the Vocal Fold of Dogs: A Histologic Study.

INTRODUCTION: There is no consensus on the ideal graft for medialization surgery of the vocal folds in the literature. One of the most favorable proposals is the use of autologous fascia, which seems limited by the lack of information regarding the integration of grafted tissue. Our study aims to evaluate the degree of fully engrafted fascia integration in the vocal fold lamina propria of dogs. MATERIALS AND METHODS: Fourteen adult mongrel dogs that underwent intravenous general anesthesia were selected and kept under spontaneous ventilation. A fascia lata fragment of 4 cm2 was obtained from the right leg of each dog. The dogs underwent laryngoscopy; a 3 mm incision was made in the vocal process, next to the vestibular process, and the fascia was grafted into the right vocal fold. The left vocal fold was used as a control. The animals were divided into two groups: group A, evaluated after 2 months of the procedure, and group B, evaluated after 6 months of the procedure. Histologic analysis was made semiquantitatively regarding the presence of inflammatory reaction, fibrosis, and neovascularization. RESULTS: Our final studied group comprised 12 dogs. Microscopic examination of the larynx revealed the absence of any detectable inflammation in the incision site. The lamina propria of the grafted vocal fold showed identifiable compact, thick, and eosinophilic collagen bands. The surrounding tissue showed thin collagen bands with some organization, similar to the contralateral vocal fold. CONCLUSION: The grafted fascia integrates into the vocal fold lamina propria and seems not to cause inflammatory reaction response.

EFEITO DA BANDAGEM ELÁSTICA NO POSICIONAMENTO DA PELVE COM INCLINAÇÃO POSTERIOR / EFFECT OF THE ELASTIC BANDAGE ON THE POSITIONING OF THE PELVIS WITH POSTERIOR TILT / EFECTO DEL VENDAJE NEUROMUSCULAR EN EL POSICIONAMIENTO DE LA PELVIS CON INCLINACIÓN POSTERIOR

RESUMO Introdução: A inclinação posterior da pelve (IPP) pode levar à perda da curvatura lombar fisiológica normal, predispondo o indivíduo a lesões. A bandagem elástica (BE) tem sido utilizada em disfunções musculoesqueléticas, podendo fornecer aos músculos um feedback para manter e perceber o alinhamento postural adequado. Não foram encontrados estudos sobre a influência do uso da bandagem na IPP. Objetivo: Avaliar o efeito da BE na ativação do músculo tensor da fáscia lata em indivíduos com IPP. Métodos: Trata-se de um ensaio clínico randomizado em que foi realizada uma avaliação do posicionamento da pelve de 20 homens com idade entre 18 e 28 anos. Os indivíduos foram divididos em dois grupos de forma aleatória; no grupo bandagem (GB), a bandagem foi aplicada com tensionamento no músculo tensor da fáscia lata e do trato iliotibial, e no grupo placebo (GP) foi aplicado o mesmo material, porém sem tensionamento, por um período de 72 horas. Os grupos foram reavaliados 30 minutos e 72 horas após a intervenção. Resultados: Houve diminuição significativa da IPP no GB (p = 0,002) quando comparado com o GP (p = 0,146). A resposta mais significativa da inclinação no GB foi observada no período imediato em comparação com 72 horas depois. Conclusão: Os achados deste estudo demonstram que a técnica da BE pode auxiliar na diminuição da IPP. São necessários mais estudos que avaliem a ativação muscular e a repercussão do uso da BE em indivíduos com IPP.

ABSTRACT Introduction: The posterior pelvic tilt (PPT) may lead to loss of the normal physiologic lumbar curve, predisposing the subject to injury. Elastic bandage (EB) has been used in musculoskeletal disorders and can provide feedback to the muscles, enabling them to perceive and keep adequate postural alignment. No studies were found on the influence of elastic bandage use in PPT. Objective: To evaluate the effect of EB on the muscular activation on the tensor fasciae latae muscle in subjects with PPT. Methods: This was a randomized clinical trial in which the pelvis positioning of 20 men aged 18 to 28 years was evaluated The subjects were randomly divided into two groups, the bandage group (BG) in which the EB was applied tensioning the tensor fasciae latae muscle and the iliotibial tract, and the placebo group (PG), with the same material applied to subjects, but without tension, for a period of 72 hours. The groups were reassessed 30 minutes and 72 hours after the intervention. Results: There was a significant decrease in PPT in the BG (p = 0.002) compared to the PG (p = 0.146). The largest inclination reduction in the BG was observed in the immediate period compared to 72 hours later. Conclusion: The findings of this demonstrate that the EB technique can help the reduction of PPT. Further studies are needed to evaluate the muscle activation and the repercussions of the use of EB in subjects with PPT.

RESUMEN Introducción: La inclinación pélvica posterior (IPP) puede llevar a la pérdida de la curvatura lumbar fisiológica normal, lo que predispone el individuo a una lesión. El vendaje neuromuscular (VN) se ha utilizado en los trastornos musculoesqueléticos y puede proporcionar feedback a los músculos para que mantengan y perciban la alineación postural adecuada. No se han encontrado estudios sobre la influencia del uso de vendaje sobre la IPP. Objetivo: Evaluar el efecto del VN en la activación del músculo tensor de la fascia lata en individuos con IPP. Métodos: Se trata de un ensayo clínico aleatorio en el cual se llevó a cabo una evaluación de la posición de la pelvis de 20 hombres de edades comprendidas entre los 18 y los 28 años. Se ha dividido los individuos en dos grupos de forma aleatoria; en el grupo de vendaje (GV), el vendaje se aplicó con tensión en el músculo tensor de la fascia lata y el tracto iliotibial, y en el grupo placebo (GP) se aplicó el mismo material, pero sin tensión, durante un período de 72 horas. Los grupos se evaluaron 30 minutos y 72 horas después de la intervención. Resultados: Se observó una disminución significativa de la IPP en GV (p = 0,002) en comparación con el GP (p = 0,146). La respuesta más significativa de la inclinación en el GV se observó en el período inmediato en comparación con las 72 horas. Conclusión: Los resultados de este estudio muestran que la técnica del VN puede ayudar a reducir la IPP. Se necesitan más estudios para evaluar la activación muscular y el efecto de la utilización del VN en pacientes con IPP.

Bilateral lid/brow elevation procedure for severe ptosis in Kearns-Sayre syndrome, a mitochondrial cytopathy.

BACKGROUND: The purpose of this work was to determine the effectiveness and possible complications encountered with bilateral fascia lata lid suspension used to correct blepharoptosis in patients with Kearns-Sayre syndrome. METHODS: This was a retrospective study of seven patients with Kearns-Sayre syndrome who had a minimum of 1 year of follow-up. A bilateral fascia lata sling was used to correct the ptosis. Preoperative and postoperative measurements of the vertical lid fissure width (VFW) and marginal reflex distance (MRD) were performed. The Student's t-test was used to analyze the results. RESULTS: The mean preoperative VFW and MRD measurements were 4±2.45 mm and 0.14±0.92 mm, respectively. The mean postoperative VFW and MRD measurements were 7.71±1.85 mm, and 2.86±1.69 mm, respectively. All preoperative and postoperative values were considered to be statistically significant (P<0.01). Adequate elevation of the lids was obtained in all patients, both functionally and aesthetically. All of the patients showed a mild symmetric postoperative inferior version lagophthalmos, and one patient developed corneal ulceration and scarring due to corneal exposure and a weak Bell's phenomenon. CONCLUSION: The surgical technique described to correct the blepharoptosis found in patients with Kearns-Sayre syndrome was found to be efficient and relatively safe. The correction should be conservative to decrease the risk of postoperative corneal damage that occurred in one patient.

Use of Human Fascia Lata in Rat Calvarial Bone Defects.

Tooth loss leads to a decrease in alveolar bone volume, and consequently to the need for guided bone regeneration (GBR) techniques to restore bone anatomy, and the adequate choice of therapy. Fascia lata membrane (FLM) has been used in surgical procedures in neurology, orthopedics, otorhinolaryngology, cardiology, vascular surgery, gynecology, and dentistry for guided tissue regeneration. The aim of the present preliminary study was to evaluate bone tissue response in rat calvarial bone defects covered with human fascia lata membrane (FLM). Eight Wistar rats, 230g body weight, were subjected to bone surgery to create a 5x5mm long/ 1mm deep calvarial bone defect on either side of the median suture, using a piezoelectric scalpel and irrigation. The animals were treated according to the following protocol: Group I (GI): placement of a single layer of FLM (Biotar, Rosario, Prov. de Santa Fe, Argentina) to cover the defects; Group II (GII): double layer of FLM to cover the defects; Group III: no membrane; Group IV: control. All the animals were euthanized 60 days post-surgery; the heads were resected, radiographed, decalcified, and processed for embedding in paraffin and Hematoxylin-Eosin and Masson's trichrome staining. All bone defects covered with a single or double layer of FLM showed adequate osteogenesis, and none exhibited an inflammatory response. Groups III and IV Control showed scant osteogenesis and no alterations in soft tissues. The results obtained with this experimental model show biocompatibility of FML with the surrounding tissues at the studied time points. No alterations were observed in osteocytic lacunae or osteocytes in the bone after osteotomy using a piezoelectric scalpel. Further studies need to be conducted to assess bone tissue response to FLM in combination with bone substitutes.

La pérdida de piezas dentarias conlleva la disminución volumétrica del hueso alveolar y la necesidad de recurrir a técnicas de regeneración ósea guiada (ROG) para restablecer las condiciones anatómicas y aplicar las terapéuticas adecuadas. La membrana de fascia lata (MFL) ha sido utilizada en intervenciones quirúrgicas del área neurológica, ortopédica, otorrinolaringológica, cardiológica, vascular, ginecológica y odontológica para regeneración tisular guiada. El objetivo de este trabajo preliminar fue evaluar la respuesta tisular de defectos óseos en calota de rata recubiertos con MFL. Se utilizaron 8 ratas Wistar de 230 gr de peso, a las que se les realizó en la calota 2 defectos óseos de 5 x 5 mm de lado por 1 mm de profundidad, con bisturí piezoeléctrico e irrigación, a ambos lados de la línea media, según técnica estandarizada. Se realizó el siguiente protocolo: Grupo I (G I): colocación de una sola capa de MFL (Biotar, Rosario, Prov. de Santa Fe, Argentina) para cubrir el defecto; Grupo II (G II): colocación de MFL en doble capa para cubrir el defecto; Grupo III (G III): sin membrana; Grupo IV (G IV): control. Se les provocó la eutanasia a los 60 días. Las calotas fueron resecadas, radiografiadas y procesadas, previa descalcificación, para su inclusión en parafina y coloración con Hematoxilina-Eosina y Tricrómico de Masson. En todos los defectos óseos recubiertos con MFL simple o doble se evidenció una adecuada osteogénesis y ausencia de respuesta inflamatoria y macrófagos. El G III y el G Sham evidenciaron escasa osteogénesis y no mostraron alteraciones en el tejido blando. La MFL en el modelo experimental utilizado evidenció una respuesta compatible con el tejido circundante en los períodos estudiados. El tejido óseo remanente a la osteotomía con bisturí piezoeléctrico presentó las lagunas osteocíticas ocupadas con osteocitos y sin alteraciones. En estudios futuros se evaluará la respuesta tisular con MFL y utilizando un sustituto óseo.

Use of human fascia lata in rat calvarial bone defects

Tooth loss leads to a decrease in alveolar bone volume, and consequently to the need for guided bone regeneration (GBR) techniques to restore bone anatomy, and the adequate choice of therapy. Fascia lata membrane (FLM) has been used in surgical procedures in neurology, orthopedics, otorhinolaryngology, cardiology, vascular surgery, gynecology, and dentistry for guided tissue regeneration. The aim of the present preliminary study was to evaluate bone tissue response in rat calvarial bone defects covered with human fascia lata membrane (FLM). Eight Wistar rats, 230g body weight, were subjected to bone surgery to create a 5x5mm long/ 1mm deep calvarial bone defect on either side of the median suture, using a piezoelectric scalpel and irrigation. The animals were treated according to the following protocol: Group I (GI): placement of a single layer of FLM (Biotar, Rosario, Prov. de Santa Fe, Argentina) to cover the defects; Group II (GII): double layer of FLM to cover the defects; Group III: no membrane; Group IV: control. All the animals were euthanized 60 days post-surgery; the heads were resected, radiographed, decalcified, and processed for embedding in paraffin and Hematoxylin-Eosin and Masson's trichrome staining. All bone defects covered with a single or double layer of FLM showed adequate osteogenesis, and none exhibited an inflammatory response. Groups III and IV Control showed scant osteogenesis and no alterations in soft tissues. The results obtained with this experimental model show biocompatibility of FML with the surrounding tissues at the studied time points. No alterations were observed in osteocytic lacunae or osteocytes in the bone after osteotomy using a piezoelectric scalpel. Further studies need to be conducted to assess bone tissue response to FLM in combination with bone substitutes.

La perdida de piezas dentarias conlleva la disminucion volumetrica del hueso alveolar y la necesidad de recurrir a tecnicas de regeneracion osea guiada (ROG) para restablecer las condiciones anatomicas y aplicar las terapeuticas adecuadas. La membrana de fascia lata (MFL) ha sido utilizada en intervenciones quirurgicas del area neurologica, ortopedica, otorrinolaringologica, cardiologica, vascular, ginecologica y odontologica para regeneracion tisular guiada. El objetivo de este trabajo preliminar fue evaluar la respuesta tisular de defectos oseos en calota de rata recubiertos con MFL. Se utilizaron 8 ratas Wistar de 230 gr de peso, a las que se les realizo en la calota 2 defectos oseos de 5 x 5 mm de lado por 1 mm de profundidad, con bisturi piezoelectrico e irrigacion, a ambos lados de la linea media, segun tecnica estandarizada. Se realizo el siguiente protocolo: Grupo I (G I): colocacion de una sola capa de MFL (Biotar, Rosario, Prov. de Santa Fe, Argentina) para cubrir el defecto; Grupo II (G II): colocacion de MFL en doble capa para cubrir el defecto; Grupo III (G III): sin membrana; Grupo IV (G IV): control. Se les provoco la eutanasia a los 60 dias. Las calotas fueron resecadas, radiografiadas y procesadas, previa descalcifica - cion, para su inclusion en parafina y coloracion con Hematoxilina-Eosina y Tricromico de Masson. En todos los defectos oseos recubiertos con MFL simple o doble se evidencio una adecuada osteogenesis y ausencia de respuesta inflamatoria y macrofagos. El G III y el G Sham evidenciaron escasa osteogenesis y no mostraron alteraciones en el tejido blando. La MFL en el modelo experimental utilizado evidencio una respuesta compatible con el tejido circundante en los periodos estudiados. El tejido oseo remanente a la osteotomia con bisturi piezoelectrico presento las lagunas osteociticas ocupadas con osteocitos y sin alteraciones. En estudios futuros se evaluara la respuesta tisular con MFL y utilizando un sustituto oseo.

Estudo descritivo comparativo da anatomia do músculo tensor da fáscia lata em macaco prego (Sapajus apella) e canídeos neotropicais / Comparative anatomy of the fascia lata tensor muscle in capuchin monkeys (Sapajus apella) and neotropical canides

A Anatomia comparativa vem se destacando nos tempos, como recurso que permite a avaliação da evolução de determinadas espécies, evidenciando suas adaptações ao meio em que vive. Com a intervenção humana, no bioma do cerrado diversas espécies entraram ou se encontram em vias de entrarem em risco de extinção sem nem ao menos terem a sua biologia estudada. Este trabalho visa descrever e comparar a anatomia do músculo tensor da fáscia lata de macaco-prego e canídeos neotropicais. Para tanto, foram utilizados dois espécimes de cada grupo taxonômico: macacoprego; raposa-do-campo; cachorro-do-mato e lobo-guará, comparando os resultados encontrados entre si, com a literatura humana e veterinária já bem estabelecidas. Os animais foram fixados em solução aquosa de formol a 10%, e dissecados sob técnicas usuais de dissecação utilizadas em Anatomia macroscópica, seguido de foto documentação. O músculo tensor da fáscia lata não apresenta divergências entre as espécies estudadas, possuindo formato aproximadamente triangular e localização na parte proximal da face lateral da coxa, constituído por uma parte cranial e outra caudal. As principais diferenças estão relacionadas, com o porte físico-postural de cada grupo, certamente atrelado ao modo de vida.

The comparative anatomy has been assuming an important role during the last decades as a tool that allows evaluatingthe evolution of certain species, showing their adaptations to the environment they live in. Due to human intervention in the cerrado biome, several species have been or are about to be endangered without even having their biology studied. This study aimed to describe and compare the anatomy of the Fascia Lata Tensor muscle in capuchin monkeys and neotropical canides. For such purpose, two specimens of each taxonomic group (capuchin monkey, field fox; forest dog and maned wolf) were used. The obtained results were compared among the studied species and discussed with the human and veterinary literature data, which are already well established. As the focus of this study was on the descriptive anatomy rather than on the statistical data, the dissection of a larger number of animals was not required. The pieces were fixed in 10% formalin aqueous solution, using dissection routine techniques in macroscopic anatomy. Next, the pieces were analyzed, described and photographed. Regarding the shape and location the fasciae latae tensor muscle presented no major differences, having an approximately triangular shape, locating in the proximal part of the thigh lateral side and comprising a cranial portion and another caudal one, both fleshy. The main differences were related to the postural-physical size of each group, certainly linked to the lifestyle.

Surgical application of fascia lata as a pericardial substitute in rabbits / Aplicação cirúrgica de fascia lata como substituto do pericárdio em coelhos

PURPOSE: To use fascia lata instead of pericardium and observe the presence of adhesions. METHODS: Twenty rabbits were divided into two group of ten. In group A, a 1×1 cm segment of pericardium was excised and resutured. In group B excised pericardium was substituted for autologous fascia lata. RESULTS: In the comparison of microscopic adhesion rate between two groups A, B after eight weeks, there was no significant statistical difference. CONCLUSION: Fascia lata is safe and it can be substituted for pericardium especially in repeat sternotomy in repairing congenital heart defects to avoid heart injury.

OBJETIVO: Utilizar fascia lata em vez de pericárdio e observar a presencça de aderências. MÉTODOS: Vinte coelhos foram distribuidos em dois grupos de dez. No grupo A, um 1×1 cm de segmento de pericárdio foi retirado e resuturado. No grupo B pericárdio retirado foi substituído por fáscia lata autóloga. RESULTADOS: Na comparação da taxa de aderência microscópica entre dois grupos A, B, após oito semanas, não houve diferença estatisticamente significante. CONCLUSÃO: A fascia lata é segura e pode ser substituta do pericárdio, especialmente em nova esternotomia na reparação de defeitos cardíacos congênitos para evitar lesão cardíaca.

Ruptura do ligamento cruzado cranial em um gato: reconstituição com fáscia lata / Cranial cruciate ligament rupture in a cat: reconstitution with fascia lata

Em gatos, a ruptura do ligamento cruzado cranial (RLCC) trata-se de diagnóstico raro e a correção cirúrgica propicia o retorno mais rápido à função do membro. Foi atendida, no Hospital Veterinário da Universidade Federal de Santa Maria (UFSM), uma gata apresentando claudicação aguda e dor à palpação do joelho direito. O diagnóstico de RLCC foi realizado através dos testes de compressão tibial e gaveta cranial positivos e confirmado na cirurgia. Optou-se por realizar a reconstituição do ligamento com fáscia lata e, após achados clínicos pós-operatórios e em longo prazo concluiu-se que a técnica apresentou resultados satisfatórios neste caso.

The cranial cruciate ligament rupture (CCLR) is rare diagnosis in cats and the surgical correction provides a faster return to limb function. A cat with acute lameness and pain on palpation of the right stifle was attended at the Veterinary Hospital of UFSM. The diagnosis of CCLR was performed by positive tibial compression test and positive cranial drawer sign and confirmed by surgery. We chose to perform the reconstruction of the ligament with fascia lata and after of the observe clinical postoperative and in the long-term it was concluded that the technique showed satisfactory results in this case.

Utilización de membrana de fascia lata y hueso en polvo liofilizado en cirugía apical: caso clínico / The use of fascia lata membrane and freeze drying bone powder in apical surgery: a clinical case

En un paciente con patología apical y endodoncia previa en la pieza 1.2, se realizó cirugía apical que incluyó el agregado de una membrana biológica reabsorbible de fascia lata entre el colgajo de espesor total y el tejido óseo. En medio de ellos, se colocó hueso en polvo humano liofilizado con el objetivo de proveer una adecuada recuperación del tejido óseo perirradicular. Luego, se efectuó el control clínico y radiográfico del paciente durante 24 meses.(AU)

Utilización de membrana de fascia lata y hueso en polvo liofilizado en cirugía apical: caso clínico / The use of fascia lata membrane and freeze drying bone powder in apical surgery: a clinical case

En un paciente con patología apical y endodoncia previa en la pieza 1.2, se realizó cirugía apical que incluyó el agregado de una membrana biológica reabsorbible de fascia lata entre el colgajo de espesor total y el tejido óseo. En medio de ellos, se colocó hueso en polvo humano liofilizado con el objetivo de proveer una adecuada recuperación del tejido óseo perirradicular. Luego, se efectuó el control clínico y radiográfico del paciente durante 24 meses.