Versatility in the use of cadaveric skin grafts for wound management.

BACKGROUND: Cadaveric skin grafts were initially used for the management of acute burn wounds. The biological coverage of the wound improves the quality of the wound bed, which prepares it to receive an autologous skin graft. The benefits of cadaveric skin graft in burn wounds have led to its use in the management of acute and chronic wounds of diverse etiologies. OBJECTIVE: To evaluate the use of cadaveric skin graft and subsequent autologous split-thickness skin graft (STSG) in the management of wounds of diverse etiologies at a single institution. MATERIALS AND METHODS: A retrospective analysis was performed of patients with wounds of different etiologies managed with cadaveric skin grafts followed by a second procedure in which autologous STSG was performed from May 2017 through May 2022 in the Plastic and Reconstructive Surgery Department of German Hospital, Buenos Aires, Argentina. RESULTS: A total of 25 patients with wounds of different etiologies were included. The mean affected body surface area (BSA) was 1.87%. The mean engraftment percentage of the cadaveric skin graft was 96.6%. The mean engraftment percentage of the STSG was 90.6%. All patients demonstrated improvement in local edema and inflammation, reduced secretions, and reduced pain after treatment. Two patients (8%) had complications, with 1 case of delayed healing of the donor site and 1 case of hypertrophic scarring. CONCLUSIONS: Cadaveric skin graft with subsequent STSG is a simple, safe, and effective alternative for the management of complex wounds of diverse etiologies. This technique is particularly useful in patients with multiple comorbidities who are at risk of recurrence and of developing multiple wounds during their lifetime.

Traumatismo anorrectal contuso. Reporte de un caso y revisión bibliográfica / Blunt anorectal trauma. Case reportand literature review

Introducción: El traumatismo anorrectal es una causa poco frecuente de consulta al servicio de emergencias, con una incidencia del 1 al 3%. A menudo está asociado a lesiones potencialmente mortales, por esta razón, es fundamental conocer los principios de diagnóstico y tratamiento, así como los protocolos de atención inicial de los pacientes politraumatizados. Método: Reportamos el caso de un paciente masculino de 47 años con trauma anorrectal contuso con compromiso del esfínter anal interno y externo, tratado con reparación primaria del complejo esfinteriano con técnica de overlapping, rafia de la mucosa, submucosa y muscular del recto. A los 12 meses presenta buena evolución sin incontinencia anal. Conclusión: El tratamiento del trauma rectal, basado en el dogma de las 4 D (desbridamiento, derivación fecal, drenaje presacro, lavado distal) fue exitoso. La técnica de overlapping para la lesión esfinteriana fue simple y efectiva para la reconstrucción anatómica y funcional. (AU)

Introduction: Anorectal trauma is a rare cause of consultation to the Emergency Department, with an incidence of 1 to 3%. It is often associated with life-threatening injuries, so it is essential to know the principles of diagnosis and treatment, as well as the initial care protocols for the polytrau-matized patient. Methods: We present the case of a 47-year-old man with a blunt anorectal trauma involving the internal and external anal sphincter, treated with primary overlapping repair of the sphincter complex and suturing of the rectal wall. At 12 months the patient presents good outcome, without anal incontinence. Conclusion: The treatment of rectal trauma, based on the 4 D ́s dogma (debridement, fecal diversion, presacral drainage, distal rectal washout lavage) was successful. Repair of the overlapping sphincter injury was simple and effective for anatomical and functional reconstruction. (AU)

Comparação entre abordagem cirúrgica versus tratamento conservador no trauma abdominal: síntese de evidências clínicas / Comparison between surgical approach versus conservative treatment in abdominal trauma: synthesis of clinical evidence

Introdução: O trauma abdominal penetrante (TAP) é considerado uma lesão bastante comum, causada principalmente por instrumentos perfurocortantes e armas de fogo, assim como o trauma contuso, decorrente principalmente de acidentes automobilísticos. A laparotomia obrigatória para todos os traumas abdominais penetrantes foi considerada o padrão de atendimento na maior parte da primeira metade do século XX. No entanto, cada vez mais o manejo conservador de pacientes selecionados com TAP ou contuso vem sendo utilizado por cirurgiões em todo o mundo. Não existe consenso na literatura nacional em relação ao melhor método para manejo de traumas abdominais tanto contusos quanto penetrantes. Neste sentido, a proposta deste trabalho é realizar o levantamento dos principais artigos que discutem as vantagens e desvantagens de cada abordagem, contribuindo para a melhor tomada de decisão clínica pelo cirurgião frente a um trauma abdominal. Objetivo: Realizar uma revisão da literatura visando comparar as vantagens e desvantagens da abordagem cirúrgica versus abordagem conservadora frente ao paciente com trauma abdominal contuso (TAC) ou TAP. Método: Esta revisão da literatura utilizou a base de dados PUBMED para seleção dos artigos, com base na seguinte estratégia de busca: trauma[title] AND penetr*[title] AND abdom*[title] AND (surgic*[title] OR operat*[title] OR conservat*[title]). Optou-se por selecionar apenas artigos que possuíssem as palavras-chave já no título, de forma a tornar a busca mais assertiva. Nenhum corte temporal foi estabelecido. Resultados: A busca identificou 15 artigos e após a leitura de seus títulos e resumos, três deles foram excluídos por não abordarem corretamente o tema proposto. Sendo assim, os 12 artigos restantes foram baixados, lidos na íntegra, resumidos e apresentados na seção de discussão. Conclusão: De modo geral, os artigos aqui revisados indicaram que em pacientes hemodinamicamente estáveis, sem peritonite e sem lesões isoladas de órgãos sólidos, o manejo seletivo não cirúrgico como tratamento do TAP provocado ferimentos tanto por armas de fogo quanto por armas brancas se mostrou seguro, resultando em um tempo de internação reduzido, menores custos, e reduzida morbidade e mortalidade. Palavras-chave: Cirurgia. Trauma. Abdome. Abordagem Cirúrgica. Tratamento Conservador.

Copaiba oil-resin (Copaifera langsdorfii Desf: Caesalpiniaceae) associated with laser therapy for skin wound treatment in Wistar rats / Óleo resina de copaíba (Copaifera langsdorfii Desf: Caesalpiniaceae) associada a laserterapia para o tratamento de feridas cutâneas em ratos Wistar

Alternative protocols for the treatment of skin lesions have been developed with the use of techniques such as photobiomodulation and phytotherapy, aiming to optimize this process. To evaluate the effectiveness of copaiba (Copaiferalangsdorffii) oil-resin and low-level laser therapy for treating cutaneous wounds, 15 Wistar rats (Rattusnorvergicus) were used, in whom five 8-mm lesions were produced. The following protocols were applied: negative control group (T1); positive control group (T2); laser therapy with AsGa (904 nm), continuous, focal mode for 10 s, dosage of 4 J/cm² (T3); copaiba oil-resin (T4); and association group (copaiba and low-level laser) (T5). The efficacy of each technique was evaluated based on macroscopic aspects of the lesion, wound healing rate, and histopathological analysis (inflammatory infiltrate and collagen expression). The Kruskal-Wallis test was used for statistical analyses (P> 0.05). Copaiba treatment showed an advantage in type III collagen expression, whereas laser therapy demonstrated an enhanced capacity for tissue regeneration. The significant advantage obtained from the association treatment is the improvement of the macroscopic aspect of the wound, with a reduction in crust formation.

Protocolos alternativos para o tratamento de feridas cutâneas têm sido desenvolvidos com a utilização de técnicas como a fotobiomodulação e fitoterapia, objetivando acelerar esse processo. Com o objetivo de avaliar a efetividade do óleo--resina de copaíba (Copaifera langsdorffii) e do laser terapêutico no tratamento de feridas cutâneas foram selecionados 15 ratos Wistar (Rattus norvergicus), nos quais foram produzidas cinco lesões cutâneas de 8mm. Os tratamentos empregados foram: controle negativo (T1); controle positivo (T2); laserterapia com AsGa (9,04nm) no modo contínuo, de maneira focal, com duração de 10 segundos e dosimetria de 4 J/cm² (T3); óleo resina de copaiba (T4) e a associação dos tratamentos (copaiba e laserterapia) (T5). A eficácia de cada técnica foi avaliada com base nos aspectos macroscópicos das lesões, taxa de cicatriza-ção e análise histopatológica (infiltrado inflamatório e expressão do colágeno). Os dados obtidos foram analisados pelo teste de Kruskal-Wallis (P>0,05). O tratamento com a copaíba mostrou vantagem na expressão do colágeno tipo III, enquanto a laserterapia demonstrou aumento da capacidade de regeneração tecidual. A vantagem significativa obtida pela associação dos tratamentos foi a melhora do aspecto macroscópico da ferida, com redução na formação de crostas.

Copaiba oil-resin (Copaifera langsdorfii Desf: Caesalpiniaceae) associated with laser therapy for skin wound treatment in Wistar rats / Óleo resina de copaíba (Copaifera langsdorfii Desf: Caesalpiniaceae) associada a laserterapia para o tratamento de feridas cutâneas em ratos Wistar

Alternative protocols for the treatment of skin lesions have been developed with the use of techniques such as photobiomodulation and phytotherapy, aiming to optimize this process. To evaluate the effectiveness of copaiba (Copaiferalangsdorffii) oil-resin and low-level laser therapy for treating cutaneous wounds, 15 Wistar rats (Rattusnorvergicus) were used, in whom five 8-mm lesions were produced. The following protocols were applied: negative control group (T1); positive control group (T2); laser therapy with AsGa (904 nm), continuous, focal mode for 10 s, dosage of 4 J/cm² (T3); copaiba oil-resin (T4); and association group (copaiba and low-level laser) (T5). The efficacy of each technique was evaluated based on macroscopic aspects of the lesion, wound healing rate, and histopathological analysis (inflammatory infiltrate and collagen expression). The Kruskal-Wallis test was used for statistical analyses (P> 0.05). Copaiba treatment showed an advantage in type III collagen expression, whereas laser therapy demonstrated an enhanced capacity for tissue regeneration. The significant advantage obtained from the association treatment is the improvement of the macroscopic aspect of the wound, with a reduction in crust formation.(AU)

Protocolos alternativos para o tratamento de feridas cutâneas têm sido desenvolvidos com a utilização de técnicas como a fotobiomodulação e fitoterapia, objetivando acelerar esse processo. Com o objetivo de avaliar a efetividade do óleo--resina de copaíba (Copaifera langsdorffii) e do laser terapêutico no tratamento de feridas cutâneas foram selecionados 15 ratos Wistar (Rattus norvergicus), nos quais foram produzidas cinco lesões cutâneas de 8mm. Os tratamentos empregados foram: controle negativo (T1); controle positivo (T2); laserterapia com AsGa (9,04nm) no modo contínuo, de maneira focal, com duração de 10 segundos e dosimetria de 4 J/cm² (T3); óleo resina de copaiba (T4) e a associação dos tratamentos (copaiba e laserterapia) (T5). A eficácia de cada técnica foi avaliada com base nos aspectos macroscópicos das lesões, taxa de cicatriza-ção e análise histopatológica (infiltrado inflamatório e expressão do colágeno). Os dados obtidos foram analisados pelo teste de Kruskal-Wallis (P>0,05). O tratamento com a copaíba mostrou vantagem na expressão do colágeno tipo III, enquanto a laserterapia demonstrou aumento da capacidade de regeneração tecidual. A vantagem significativa obtida pela associação dos tratamentos foi a melhora do aspecto macroscópico da ferida, com redução na formação de crostas.(AU)

Lesión traumática expuesta, compleja y grave de tibia, tratada con fijador externo Álvarez Cambras / Exposed, complex and severe traumatic injury of the tibia treated with Alvarez Cambra external fixation

RESUMEN Con el paulatino incremento de accidentes automovilísticos, de trabajo, y la violencia urbana, las fracturas expuestas y complejas constituyen traumatismos de creciente incidencia y de difícil solución, con largos períodos de convalecencia que ponen en peligro la vida o la conservación del miembro lesionado. Un gran número de ellas dejan secuelas invalidantes. Existen varios tratamientos, entre ellos la fijación externa, utilizando el sistema creado por el profesor Rodrigo Álvarez Cambras, con varias ventajas que proporcionan una mejor evolución. Se realizó este trabajo con el objetivo de mostrar la evolución y los resultados de un paciente ingresado y operado con el diagnóstico de lesión expuesta, compleja y grave de la extremidad inferior, específicamente de tibia. Este presentó varias complicaciones, por lo que se le colocó un aparato de osteosíntesis de fijación externa Álvarez Cambras en el Hospital Provincial Clínico Quirúrgico Docente José Ramón López Tabrane, de Matanzas (AU).

ABSTRACT With the gradual increase of automobile and work accidents as well as urban violence, exposed and complex fractures are traumas of increasing incidence and difficult solution, with long periods of convalescence that endanger the life or the conservation of the injured member. A large number of them leave invalidating sequels. There are several treatments, including external fixation using the system created by Professor Rodrigo Alvarez Cambra, with several advantages that provide a better evolution. The current work was carried out with the objective of showing the evolution and results of a patient who entered the Teaching Provincial Clinical-surgical Hospital Jose Ramon Lopez Tabrane, of Matanzas, and underwent a surgery with the diagnosis of exposed, complex and serious lesion in the lower limb, specifically of tibia. The patient had several complications and so he was put an Alvarez Cambra external fixation osteosynthesis devise (AU).

Manejo quirúrgico de heridas por mordeduras de perro en pacientes pediátricos: nuestra experiencia en 8 años / Surgical management of dog bite wounds in pediatric patients: our experience in 8 years

Introducción. Hasta un 90% de las mordeduras de animales son producidas por perros. Los niños son la población más vulnerable frente a las mordeduras ya que suelen afectar una mayor proporción de superficie corporal. Objetivo. Analizar la casuística de mordeduras de perro y su repercusión en nuestro entorno. Métodos. Estudio observacional, descriptivo, retrospectivo de un período de 8 años, que incluyó a todos los pacientes de 0 a 18 años con diagnóstico de mordedura de perro. Resultados. Se incluyeron 183 pacientes con diagnóstico de mordedura de perro. El promedio de edad fue de 6,1 años, y el grupo etario más afectado fue el de los niños de 3 a 5 años (38,3%). El tratamiento quirúrgico fue dividido en pacientes que requirieron rafia por planos (84,6%), colgajos (11,4%), injertos (3,4%) y puntos de aproximación (1%). Se reportaron 8 pacientes con complicaciones (4,4%). Conclusión. Los niños de 3 a 5 años son los más afectados por mordeduras de perro y la zona de cabeza y cuello es la más común. Un porcentaje importante de pacientes requirieron colgajos e injertos con buenos resultados.

Introduction. Up to 90% of animal bites are produced by dogs. Children are the most vulnerable population because bites tend to affect greater body surface area. Outcome. Analyze dog bites cases and their impact on our environment. Methods. An observational, descriptive, retrospective study during an 8 year period was carried out, which included all patients from 0 to 18 years with a diagnosis of dog bite. Results. A total of 183 patients with a diagnosis of dog bite were found. The average age was 6.1 years, and the age group most affected was children from 3 to 5 years old (38.3%). Surgical treatment was divided into: patients who required suture by planes (84.6%), flaps (11.4%) and grafts (3.4%) and approximation stitches (1%). Complications were reported in 8 patients (4.4%). Conclusion. Children from 3 to 5 years old are the most affected by dog bites, the head and neck area is the most common. A significant percentage of patients required flaps and grafts with good results.

Trauma urbano moderno en Caracas / Modern urban trauma in Caracas

A principios del nuevo milenio surgió el concepto del "Trauma urbano moderno", sustentando en la experiencia de varios conflagraciones en zonas densamente pobladas. Fue definido como un conflicto violento, cerrado, con heridas destructivas y de difícil acceso para su evacuación. Su manejo incluyo el cuestionamiento de viejos dogmas y la incorporación de nuevas estrategias. El motín del reten "La Planta", el incremento en las detonaciones por granadas fragmentarias y los graves enfrentamientos entre bandas delictivas o contra cuerpos de seguridad, en diversas zonas de Caracas indican el establecimiento de una modalidad mas agresiva de violencia. Los cirujanos capitalinos se enfrentan con más frecuencia a lesiones severas y múltiples. El personal medico requiere la adecuada comprensión y preparación para afrontar este nuevo tipo de heridas. La reciente enfermedad Covid 19 representa un desafió agregado en el abordaje de los pacientes con traumatismos(AU)

The experience in many combats in densely populated urban areas, determined the new concept of "Modern urban warfare" in the beginning of the new millennium. This definition is a warfare violent, close-quarter, with destructive injuries and the delayed of evacuation. New innovations were incorporate. The revolt in the "La Planta" prison, the increase of grenades explosions and engagement between criminal organized, in many zones of Caracas, illustrated this new definition. The venezuelans surgeons attended many severe and multiple injuries. The surgical personal need understand this new kind of injuries. The new disease Covid 19 represents a challenge in the attention of these patients(AU)

Lesiones precordiales: reporte de dos casos / Precordial injuries: report of two cases

Las heridas precordiales son una entidad poco frecuente y desafiante en cirugía de trauma en los servicios de Emergencia. La incidencia elevada de taponamiento y trauma cardiaco, así como su alta mortalidad obliga a tomar decisiones diagnósticas y terapéuticas rápidas y precisas. Material y Métodos: se presentan los casos de dos pacientes masculinos que ingresaron al servicio de Emergencia del Hospital Roosevelt con lesiones precordiales penetrantes con trauma pericárdico y cardiaco, con diferentes manifestaciones clínicas a los que se les realizó ventana pericárdica subxifoidea diagnóstica y seguido una esternotomía media con exposición pericárdica y cardiaca como abordaje y tratamiento quirúrgico definitivo. Discusión: Es de suma importancia reconocer los amplios escenarios de presentaciones clínicas del paciente con heridas en la región precordial y mantener un alto índice de sospecha de trauma y taponamiento cardiacos en todas las lesiones precordiales penetrantes en pacientes estables e inestables para no retrasar el diagnóstico y tratamiento quirúrgico temprano y adecuado. Las lesiones asociadas y complicaciones trans y postoperatorias aumentan la mortalidad de estos pacientes (AU)

Precordial wounds are rare and challenging lesions in Trauma Services. The high incidence of cardiac trauma and the high mortality requires fast and precise diagnostic and therapeutic decisions. Case report: Two male patients who were admitted to the Roosevelt Hospital Emergency Service with penetrating precordial injuries with pericardial and cardiac trauma are presented, with different clinical manifestations, who underwent a diagnostic subxiphoid pericardial window and a median sternotomy with pericardial and cardiac exposure as a definitive surgical approach and treatment. Discussion: Is important to recognize the broad scenarios of patients with wounds in the precordial region and to maintain a high index of suspicion of cardiac trauma and tamponade in all penetrating precordial injuries inclusive in stable patients to not delay diagnosis and treatment and a proper surgical intervention. Associated injuries and perioperative complications increase the mortality of these patients

Lesión quirúrgica de la vía biliar: experiencia en el Hospital José Ramón Vidal de Corrientes / Bile duct injury after cholecystectomy: the experience of Hospital José Ramón Vidal de Corrientes

RESUMEN Antecedentes: la lesión quirúrgica de la vía biliar representa un gran problema de salud y puede surgir ante cualquier cirujano que realice una colecistectomía. Objetivos: el objetivo del trabajo fue presentar nuestra experiencia en reparación de la vía biliar, ana lizando la morbimortalidad y la incidencia de dicha patología en nuestro Servicio. Material y métodos: estudio retrospectivo descriptivo; se tomaron las variables de las historias clínicas de los pacientes en un período de 8 años, de enero de 2011 a julio de 2019 donde fueron admitidos 19 pacientes que presentaron lesión quirúrgica de la vía biliar en el Hospital José Ramón Vidal de la provincia de Corrientes, Argentina. Resultados: 12 pacientes fueron tratados quirúrgicamente mediante hepático-yeyuno anastomosis, 2 por bihepático-yeyuno anastomosis y dos mediante sutura término-terminal bilio-biliar sobre tubo de Kehr. Tres pacientes fueron tratados mediante colocación de stent y dilatación posterior mediante colangiopancreatografia retrógrada endoscópica. Conclusión: los cirujanos deben entrenarse para disminuir al mínimo la posibilidad de una lesión. El objetivo de una colecistectomía debería ser no lesionar la vía biliar.

ABSTRACT Background: Bile duct injury represents a serious health problem and can occur after any cholecystectomy. Objectives: The aim of this study was to report our experience in repairing bile duct injuries analyzing morbidity, mortality and its incidence in our department. Material and Methods: We conducted a retrospective and descriptive study. The information was retrieved form the medical records of 19 patients with bile duct injury hospitalized at the Hospital José Ramón Vidal, Corrientes, Argentina, between January 2011 and July 2019. Results: A Roux-en-Y hepaticojejunostomy was performed in 12 patients, double hepaticojejunostomy in two patients, and two patients were treated with end-to-end ductal anastomosis with suture over a T tube. Three patients underwent endoscopic retrograde cholangiopancreatography with stent placement and dilation. Conclusion: Surgeons should be trained to avoid the possibility of bile duct injury. The main goal of cholecystectomy should be to avoid this complication.

Conducting an international curriculum review meeting in the age of COVID-19.

SUMMARY: The Canadian Network for International Surgery (CNIS) hosted a workshop in May of 2020 with a goal of critically evaluating Trauma Team Training courses. The workshop was held virtually because of the coronavirus disease 2019 (COVID-19) pandemic. Twenty-three participants attended from 8 countries: Canada, Guyana, Kenya, Nigeria, Switzerland, Tanzania, Uganda and the United States. More participants were able to attend the virtual meeting than the traditional in-person meetings. Web-based videoconference software was used, participants presented prerecorded PowerPoint videos, and questions were raised using a written chat. The review proved successful, with discussions and recommendations for improvements surrounding course quality, lecture content, skills sessions, curriculum variations and clinical practical scenarios. The CNIS's successful experience conducting an online curriculum review involving international participants may prove useful to others proceeding with collaborative projects during the COVID-19 pandemic.

Treatment of Deep Full-thickness Wounds Containing Exposed Muscle, Tendon, and/or Bone Using a Bioactive Human Skin Allograft: A Large Cohort Case Series.

BACKGROUND: Deep wounds with exposed muscle, tendon, and/or bone structures are especially difficult to treat, often requiring a multifaceted approach. Bioactive human skin allograft (BSA) has been proven to be effective in the treatment of deep wounds, but the mechanism of action and clinical use in the real-world setting is not as well known. OBJECTIVE: The aim of this case series is to study deep wounds treated with BSA to better understand how it is used in real-world patients and discuss its mechanism of action. MATERIALS AND METHODS: A total of 51 deep wounds of various etiologies and locations were included from 10 sites across the United States. To be included, patients must have failed wound care without BSA for at least 30 days, with more than 50% reduction in size prior to BSA application. RESULTS: The mean wound area was 50.37 cm2 and average wound duration was 3.67 months. The mean time to closure was 15.33 weeks, achieved with an average of 4.24 BSA applications. Many patients received adjunctive therapies either prior to or in combination with BSA. CONCLUSIONS: This study demonstrates the effectiveness of BSA in the treatment of deep wounds of various etiologies. The authors provide clinical information on using BSA either alone or in conjunction with other advanced modalities and offer insight into the hypothesized mechanism of action in which these grafts become incorporated. Ultimately, this information can guide best practices in the treatment of full-thickness wounds to improve outcomes.

Trauma quality indicators: a way to identify attention points in the treatment of elderly trauma patients.

PURPOSE: to trauma quality indicators as a tool to identify opportunities of improvement in elderly trauma patient's' treatment. METHODS: prospective analysis of data collected between 2014-2015, and stored in the iTreg software (by Ecossistemas). Trauma victims, aged older than 60 years and trauma quality indicators were assessed, based on those supported by SBAIT in 2013: (F1) Acute subdural hematoma drainage after 4 hours from admission, in patients with GCS<9; (F2) emergency room transference without definitive airway and GCS <9; (F3) Re-intubation within 48 hours from extubation; (F4) Admission-laparotomy time greater than 60 min. in hemodynamically uinstable patients with abdominal bleeding; (F5) Unprogrammed reoperation; (F6) Laparotomy after 4 hours from admission; (F7) Unfixed femur diaphyseal fracture; (F8) Non-operative treatment for abdominal gunshot; (F9) Admission-tibial exposure fracture treatment time greater than 6 hours; (F10) Surgery after 24 from admission. The indicators, treatments, adverse effects and deaths were analyzed, using the SPSS software, and the chi-squared and Fisher tests were used to calculate the statistical relevance. RESULTS: from the 92 cases, 36 (39,1%) had complications and 15 (16,3%) died. The adequate use of quality indicator's were substantially different among those who survived (was of 12%) compared to those who died (55,6%). The incidence of complications was of 77,8% (7/9) in patients with compromised indicators and 34,9% (28/83) in those without (p=0.017). CONCLUSIONS: trauma quality indicators are directly related with the occurrence of complications and deaths, in elderly trauma patients.

Tratamento cirúrgico de hemangioma infantil nasal e labial na fase involuída: relato de caso / Surgical treatment of infantile nasal and labial hemangioma in the involuted phase: a case report

Hemangioma infantil (HI) é o tumor vascular mais comum e a neoplasia benigna mais frequente da infância, com maior incidência no sexo feminino e na população branca. Quase 60% dos casos ocorrem em cabeça e pescoço, sendo o tratamento ativo durante a fase proliferativa mais frequentemente indicado, em decorrência dos possíveis problemas funcionais e do potencial desfigurante. Relatamos um caso de paciente com hemangioma infantil involuído de ponta nasal e lábio superior, tratado de forma expectante durante a infância, submetida à correção da deformidade residual com técnicas de rinoplastia, associado à zetaplastia e lipoenxertia do lábio superior com bom resultado e satisfação do paciente.

Infantile hemangioma (IH) is the most common vascular tumor and the most frequent benign neoplasm in childhood, with the highest incidence in females and the white population. Almost 60% of cases occur in the head and neck, and active treatment during the proliferative phase is the most frequently indicated, due to possible functional problems and disfiguring potential. We report a case of a patient with involute infantile hemangioma of the nasal tip and upper lip, treated expectantly during childhood, submitted to residual deformity correction with rhinoplasty techniques, associated with zetaplasty and upper lip grafting with good results and patient satisfaction.

Utilização da pele de tilápia-do-Nilo (Oreochromis niloticus) como xenoenxerto em um equino com ferimento traumático / Treatment of a traumatic equine wound using Nile tilapia (Oreochromis niloticus) skin as a xenograft

Background: Wounds are disruptions of the normal continuity of anatomic structures, generally due to local trauma. Theyare extremely prevalent in animals, especially horses, and a common reason for seeking veterinary attention. Their management aims to restore the function and integrity of the affected area in the shortest possible time and cost, while providingsatisfactory cosmetic results. This task becomes challenging when working with horses, considering the contact betweenwounds and contaminated environment is common. Thus, the present study aims to report the case of a traumatic equinewound treated with Nile Tilapia Fish Skin (NTFS).Case: A male 27-year-old horse previously castrated, with no defined breed (NDB), and weighing 400 kg presented a 6.0 x5.5 cm superficial wound in the distal left anterior limb (LAL) due to skin laceration. The animal belonged to the cavalry ofthe Military Police of Ceará, a public institution in Fortaleza, Brazil. Although in excellent general health, with no previouscomorbidities or restriction of movement, the animal was removed from its role in equine-assisted therapy (EAT) until completewound healing, aiming adequate evaluation of the novel biomaterial via lower influence of external factors. After informedconsent from the owner was obtained, Nile Tilapia Fish Skin was applied to the lesion. The Ethics Committee on the use ofanimals of the Drug Research and Development Center of the Federal University of Ceará, Fortaleza, Brazil, approved the studyprotocol. Compliance with regulations on the ethical treatment of animals was performed. Nile Tilapia Fish Skin applicationfollowed a protocol similar to that established in human clinical studies. Initially, the horse was submitted to wound cleaningwith tap water and 2% chlorhexidine gluconate, with no requirement of pre-treatment surgical...(AU)

Lesiones traumáticas más frecuentes producidas en 2 centros de detención penitenciario, un estudio observacional / Most frequent traumatic injury in 2 prison detention centers, an observational study

Resumen Introducción Las cárceles constituyen un foco de violencia inherente y un ambiente propicio de lesiones traumáticas. Objetivo Describir el perfil de ingreso y evolución de personas privadas de libertad hospitalizadas en nivel terciario por trauma acontecido en 2 complejos penitenciarios, que ingresan a nuestro Servicio. Materiales y Método Estudio descriptivo, incluyó la revisión de fichas clínicas en nuestro hospital (HUAP), durante el periodo entre agosto de 2009 y diciembre de 2016. Resultados 88 consultas de personas privadas de libertad, donde se obtuvieron 46 consultas por lesiones traumáticas. Se observó una distribución simétrica para las variables edad, presión arterial media, frecuencia cardíaca, hematocrito, hemoglobina y recuento de leucocitos. El sitio del trauma más frecuente fue el tórax y el abdomen (incluyendo cara anterior y posterior completa), cada uno con 18 pacientes (39,13% cada uno). El diagnóstico de ingreso más frecuente fue neumotórax en doce sujetos. Los principales tratamientos efectuados fueron 16 laparotomías exploradoras (34,78; IC 95%: 22,68 a 49,23) y 12 pleurostomías (26,09; IC 95%: 15,60 a 40,26). La duración de la hospitalización distribuyó en forma asimétrica, con mediana de 3 días. Tuvimos 6 reingresos (13,04%) en los primeros 30 días posteriores al alta y una mortalidad. Conclusiones Los hechos de violencia en estos 2 centros penitenciarios en Santiago, son un diagnóstico que se presenta en la urgencia de nuestro hospital, con lesiones de distinta gravedad y tratamiento. Resulta necesario adelantarse a estos escenarios, donde ahora sabemos que gran parte de ellos necesitará algún procedimiento o intervención.

Background Prisons are a source of inherent violence and an environment conducive to traumatic injuries. Aim The objective of this paper is to describe the income and evolution profile of hospitalized people deprived of liberty at the tertiary level due to trauma that occurred in two prison detention centers in Santiago, that enters our service. Materials and Method Descriptive study, included the review of clinical records in our hospital, during the period between August 2009 and December 2016. Results 88 consultations of people deprived of liberty, where 46 consultations for traumatic injuries were obtained. A symmetric distribution was observed for the variables age, mean arterial pressure, heart rate, hematocrit, hemoglobin and leukocyte count. The most frequent trauma site was the thorax and abdomen (including front face and full back), each with 18 patients (39.13% each). The most frequent diagnosis of admission was pneumothorax in twelve subjects. The main treatments were 16 exploratory laparotomies (34.78, 95% CI: 22.68 to 49.23) and 12 pleurostomies (26.09, 95% CI: 15.60 to 40.26). The duration of hospitalization distributed asymmetrically, with a median of 3 days. We had 6 readmissions (13.04%) in the first 30 days after discharge and one mortality. Conclusions The violence in this two prison detention centers, in Santiago, is a diagnosis that appears in the urgency of our hospital, with lesions of different severity and treatment. It is necessary to anticipate these scenarios, where we now know that a large part of them will need some procedure or intervention.