Lesiones de punta de dedo: experiencia en el manejo en los últimos 5 años en un centro pediátrico / Fingertip injuries: experience in handling the last 5 years in a pediatric center

Las lesiones de punta de dedo son comunes en pacientes pediátricos que acuden a salas de Emergencia; son causadas por accidentes en el hogar y con aplastamiento en puerta como principal mecanismo de trauma. El tratamiento se realiza individualizado por cirujanos plásticos y cirujanos pediátricos en dependencia de la herida y el compromiso tisular. El propósito de este estudio es describir el manejo de pacientes con lesiones de punta de dedo en un centro pediátrico. Se realizó un análisis de historias clínicas en el período entre enero 2015 y diciembre 2020, se evaluaron 228 pacientes atendidos en el Hospital de Niños Dr. Roberto Gilbert Elizalde, en Guayaquil, Ecuador. Los resultados incluyen un predominio de pacientes en edad preescolar (67%), masculinos (56%) y de mano derecha (53%). Los dedos más afectados fueron el medio y anular. Los procedimientos fueron realizados por cirujanos plásticos (55%) y la técnica electiva fue bajo anestesia general. La extensión del daño involucró tejidos blandos (92%), avulsión de uña (29%) y fracturas asociadas (15%). El 3% de los pacientes presentó complicaciones que requirieron seguimiento. El tipo de reparo se seleccionó en dependencia de la extensión de la herida, se realizaron suturas simples (37%) y suturas complejas con reparo de la uña (27%). Nuestros datos son similares a los descritos en la literatura internacional, con buenos resultados a largo plazo, menor tasa de complicaciones y respuestas similares en los reparos realizados por cirujanos plásticos y cirujanos pediatras.

Fingertip injuries are common in pediatric patients who present to the emergency room. They are usually caused by accidents at home, being door-crush the main mechanism. Treatment is performed on an individual basis, by a Plastic or General Pediatric Surgeon, according to the wound findings and tissue involvement. The purpose of this study is to describe the management on a pediatric center in patients with a fingertip wound. A descriptive and retrospective analysis of medical records was carried out from January 2015 until December 2020. In this period 228 patients were seen in the Dr. Roberto Gilbert Elizalde Children´s Hospital in Guayaquil, Ecuador. A high incidence was found in the preschool age with 67% of cases. The injuries were more common in males (56 %) and more predominant on the right hand (53%). The most affected fingers were the middle and annular. Procedures were mostly performed by Pediatric Surgeons (55%) and the elective technique was under general anesthesia. Damage extension of the fingertip included soft tissues in 92% of patients, nail avulsion in 29% and associated fractures in 15%. Only 3% of patients developed complications that required follow up. The type of repair was selected according to the extension of the injury. Mostly simple sutures (37%) and complex sutures with nail repair (27%)were used.Our data is similar to the one found in international literature, with good long-term outcomes, minor complications and similar results when the repair was performed by a Plastic or Pediatric surgeon

Olive oil promotes wound healing of mice pressure injuries through NOS-2 and Nrf2.

The pressure injury environment is characterized by overproduction of reactive oxygen species and exacerbated inflammation, which impair the healing of these lesions. Mediterranean-like diet may be a good intervention to improve the healing of pressure injury owing to its anti-inflammatory and antioxidant components. Thus, this study evaluated the hypothesis that olive oil, as a main source of lipid in Mediterranean diet, could improve cutaneous wound healing of pressure injury in mice. Male Swiss mice were randomly divided into standard, olive oil, or soybean oil plus olive oil groups and fat represented 10% of total calories in all groups. Four weeks after the beginning of diet administration, 2 cycles of ischemia-reperfusion (IR) by external application of 2 magnets disks were performed in the dorsal skin to induce pressure injury formation. Fourteen days after the end of the second IR cycle, olive oil-based diet reduced neutrophils cells and cyclooxygenase-2 protein expression and increased nitric oxide synthase-2 and protein and lipid oxidation. Olive oil based-diet also increased nuclear factor erythroid 2-related factor 2 protein expression and collagen type I precursor protein expression. In addition, administration of olive oil-based diet promoted wound closure at 7, 10, and 14 days after the end of the second IR cycle. These findings support the hypothesis that olive oil-based diet improves cutaneous wound healing of pressure injury in mice through the reduction of inflammation and stimulation of redox equilibrium.

A possible role of endoneurial fibroblast-like cells in the resolution of endoneurial oedema following nerve crush injury / El posible rol de los fibroblastos endoneurales en la resolución del edema endoneural después de una lesión por aplastamiento nervioso

SUMMARY: Endoneurial oedema is a salient feature of all types of neuropathy. Its elimination is crucial during the complications of nerve recovery. The objective was to study a possible role of the endoneurial fibroblasts in the resolution of nerve edema. Forty-two albino male rats aged between 30 and 40 days (weight 200 g to 250 g) were used in this study. The left sural nerves of 36 rats were subjected to crush injury at one to three-week intervals with six animals per interval. The right and left sural nerves of the remaining six rats were used as controls. At the end of the second week after crush injury, the endoneurium showed channel-like spaces that were lined by fibroblast-like cells and collagen bundles that contained degenerated myelin, and were connected to the subperineurial spaces. Flattened fibroblast-like cells were arranged in several layers in the subperineurial, forming barrier-like cellular sheets localizing to the endoneurial oedema in the space. Fibroblast-like cells also wrapped around the regenerating nerve fibres with their branching cytoplasmic processes. During the third week, the flattened fibroblast-like cells formed nearly continuous cellular sheets in the subperineurial spaces. Macrophages were frequently observed between these cellular barrier-like sheets and in the subperineurial. The endoneurial fibroblast-like cells form barrier-like cellular sheets that probably localise the endoneurial oedema in the subperineurial space. It also appear to create endoneurial channel-like spaces containing degenerated myelin and endoneurial oedema, which may be helpful in localizing and resolving such oedema.

RESUMEN: El edema endoneural es una característica destacada de todos los tipos de neuropatía. Su eliminación es importante durante las complicaciones de la recuperación nerviosa. El objetivo fue estudiar un posible papel de los fibroblastos endoneurales en la resolución del edema nervioso. En este estudio se utilizaron 42 ratas macho albinas con edades entre los 30 y 40 días (peso 200 a 250 g). Los nervios surales izquierdos de 36 ratas se sometieron a lesiones por aplastamiento en intervalos de una a tres semanas con seis animales por intervalo. Se usaron los nervios surales derecho e izquierdo de las seis ratas restantes como controles. Al final de la segunda semana después de la lesión por aplastamiento, el endoneuro mostró espacios en forma de canal que estaban revestidos por células similares a fibroblastos y haces de colágeno que contenían mielina degenerada y se conectaron a los espacios subperineurales. Las células aplanadas de fibroblastos se dispusieron en varias capas en el subperineuro, formando láminas celulares de tipo barrera que se localizaban en el espacio del edema endoneural. Las células similares a fibroblastos también envolvían las fibras nerviosas regeneradoras con sus procesos citoplásmicos ramificados. Durante la tercera semana, las células aplanadas de fibroblastos formaron láminas celulares casi continuas en los espacios subperineurales. Los macrófagos se observaron con frecuencia entre estas láminas similares a barreras celulares y en el subperineuro. Las células de tipo fibroblasto endoneural formaban láminas celulares de tipo barrera que probablemente localizan el edema endoneural en el espacio subperineural. También parece que crea espacios en forma de canal endoneural que contienen mielina degenerada y edema endoneural, que pueden ser útiles para localizar y resolver este edema.

Quantitative functional evaluation of a 3D-printed silicone-embedded prosthesis for partial hand amputation: A case report.

STUDY DESIGN: A male patient with partial hand amputation of his nondominant hand, with only stumps of the proximal phalanx of the first and fifth finger, was evaluated. The performance of using two alternative 3D printed silicone-embedded personalized prostheses was evaluated using the quantitative Jebsen Hand Function Test. INTRODUCTION: Custom design and fabrication of 3D printed prostheses appears to be a good technique for improving the clinical treatment of patients with partial hand amputations. Despite its importance the literature shows an absence of studies reporting on quantitative functional evaluations of 3D printed hand prostheses. PURPOSE OF THE STUDY: We aim at producing the first quantitative assessment of the impact of using 3D printed silicone-embedded prostheses that can be fabricated and customized within the clinical environment. METHODS: Alginate molds and computed tomographic scans were taken from the patient's hand. Each candidate prosthesis was modeled in Computer Aided Design software and then fabricated using a combination of 3D printed parts and silicone-embedded components. DISCUSSION: Incorporating the patient's feedback during the design loop was very important for obtaining a good aid on his work activities. Although the explored patient-centered design process still requires a multidisciplinary team, functional benefits are large. CONCLUSION(S): Quantitative data demonstrates better hand performance when using 3D printed silicone-embedded prosthesis vs not using any aid. The patient accomplished complex tasks such as driving a nail and opening plastic bags. This was impossible without the aid of produced prosthesis.