Evaluation and Optimization of the Wallace Rule of Nines for the Estimation of Total Body Surface Area in Obese and Nonobese Populations.

BACKGROUND: Currently, the Wallace Rule of Nines is the most widely used method to measure total body surface area (TBSA) in burned patients due to its practicality and speed in its application; however, it often provides inaccurate estimations in obese patients, affecting the fluid resuscitation process. OBJECTIVE: In this study, we aimed to modify and optimize the Rule of Nines' values for its application in these patients. METHODS: We compared the estimations of the TBSA established by the Wallace Rule of Nines against the measurements of the three-dimensional (3D) software Skanect - Meshmixer 3.5Ⓡ in participants without different obesity grades. Based on our results, we generate an optimized guideline for the evaluation of TBSA in normal body mass index (BMI) and obese patients. RESULTS: In our study, 32 participants were recruited with a mean age of 28.5 ± 3.3 years. In the general population, we observed a poor correlation between the Wallace Rule of Nines and the 3D method measures in all body regions (e.g., Anterior Trunk: 18.0 vs. 16.61 ± 2.11, p = 0.0008) except the anterior arm. Interestingly, these differences narrowed in the Trunk and Leg regions as the participants' BMI increased (e.g., Anterior Trunk in Obesity Grade II patients: 18.0 vs. 18.66 ± 1.69, p = 0.3089). CONCLUSIONS: We found important differences in TBSA determination using the 3D Skanect-MeshmixerⓇ software compared with the Wallace Rule of Nines. Therefore, we generated a modified and optimized Wallace Rule of Nines estimations based on BMI. Future studies are needed to assess the safety and efficacy of this optimized table.

Lipoinjection with Adipose Stem Cells for Nasal Modeling: Rhino Cell, a Highly Versatile Alternative.

It is undeniable that a significant number of patients who want to improve their facial appearance is increasingly interested in nonsurgical procedures. Without a doubt, the use of autologous fat could not be left out as a magnificent alternative for nasal modeling simply because of four influential factors: ease of collection, compatibility, the temporality of the results, and safety. This work describes an innovative alternative technique for nasal modeling using micrografts enriched with adipose-derived mesenchymal stem cells (ASCs). With this technique, fat was collected and divided into two samples, nanofat and microfat. Nanofat was used to isolate the ASCs; microfat was enriched with ASCs and used for nasal modeling. Lipoinjection was performed in a supraperiosteal plane on the nasal dorsum. Through a retrolabial access, the nasal tip and base of the columella were lipoinjected. We consider that nonsurgical nasal modeling using micrografts enriched with ASCs can be an attractive and innovative alternative. This technique will never be a substitute for surgical rhinoplasty. It can be performed in a minor procedure area with rapid recovery and return to the patient's daily activities the next day. If necessary, the procedure can be repeated.

Effect of exogenous lipase on subcutaneous adipose tissue in a porcine animal model.

BACKGROUND: Topical exogenous lipase has been approved for cosmetic use and has been used to mobilize fat from adipocytes. The objective of this study was to determine the effects of exogenous lipase in the subcutaneous adipose tissue. METHODS: Three different concentrations of exogenous lipase 1× (2 Units per ml), 5× (10 units per ml), and 10× (20 units per ml) were applied in a porcine model. Normal saline (NS) solution (as negative control) and phosphatidylcholine (as positive control) were also injected. Skin and subcutaneous tissue biopsies, up to the fascia, were obtained from each injection site on the 3rd day after injection. The number of cells per 20× field was counted as an indirect measurement of the size of the adipocytes. RESULTS: For 1× lipase, the number of cells per field was 47.80 (±7.63) versus 27.26 (±4.93), and 34.66 (±6.84) for NS, and phosphatidylcholine, respectively. For 5× lipase, the count was 36.06 (±4.74) versus 24.13 (±5.18), and 33.2 (±9.34). For 10× lipase, it was 40.06 (±4.35) versus 29.26 (±2.34) and 32.66 (±6.30) (p < .05 for all groups). CONCLUSIONS: A higher number of cells per field were observed in the lipase samples, inferring a decreased volume of adipocytes. No inflammation and/or loss of cell architecture were evidenced in the exogenous lipase groups.

Effectiveness of surgical treatment in chronic migraine.

OBJECTIVE: Migraine affects more than 35 million people in the United States of America, and 10% of the population in the world. The purpose of this study was to evaluate the effectiveness of surgical treatment in chronic migraine with frontal or occipital trigger areas. METHODS: We designed a pilot, proof of concept, and prospective study to analyze the effectiveness of surgical release of trigger nerves in severe frontal or occipital chronic migraines. The study was approved by the Ethics and Investigation Committee of Hospital Universitario Dr. José Eleuterio González (Monterrey, N.L., Mexico). We included patients diagnosed with chronic migraine by the neurology service of Hospital Universitario Dr. José Eleuterio González that attended our consult from March to December 2012. The patients were assessed by the MIDAS questionnaire and the diagnosis confirmed by injecting 2% lidocaine in the trigger sites. We realized a superior palpebral approach in frontal migraines to resection the glabellar muscles and an occipital approach to free the greater occipital nerve bilaterally. We evaluated complete and partial clinical response measuring the frequency, intensity, and duration of migraine episodes. RESULTS: We included three patients with Stage IV (severe incapacitating) frontal or occipital chronic migraines. Two were occipital trigger sites and one frontal. We obtained complete clinical response in two patients and a partial response in one. Pain intensity decreased in all patients. CONCLUSION: Surgical treatment is effective in Stage IV (severe incapacitating) frontal or occipital trigger chronic migraines.

OBJETIVOS: La migraña crónica afecta a más de 35 millones de personas en los EE.UU. y al 10% de la población en México. El objetivo de este estudio fue valorar la efectividad del tratamiento quirúrgico en la migraña crónica con sitios detonantes frontal u occipital para proponerla como alternativa quirúrgica en nuestro medio. MÉTODO: Se incluyeron pacientes con diagnóstico de migraña crónica con sitios detonantes frontal u occipital valorados por el servicio de neurología del Hospital Universitario Dr. José Eleuterio González (Monterrey, N.L., México) que acudieron a consulta de marzo a diciembre de 2012, con la autorización del Comité de Ética e Investigación. Se valoraron mediante el cuestionario MIDAS, y los sitios gatillo se confirmaron con la inyección de lidocaína al 2%. Se realizó un abordaje en el surco palpebral superior para liberar los músculos corrugadores y procerus en caso de detonante frontal, y un abordaje occipital para liberar el nervio occipital mayor bilateral. Se valoró la respuesta clínica total y parcial según la intensidad, la frecuencia y la duración de los episodios migrañosos mensuales. RESULTADOS: Se incluyeron tres pacientes con migraña crónica en etapa IV (incapacidad grave), a los que correspondían dos sitios detonantes frontal y uno occipital. Obtuvimos dos pacientes con respuesta clínica completa y una con respuesta parcial. La intensidad del dolor mejoró en todos los pacientes. CONCLUSIONES: El tratamiento quirúrgico es efectivo en la migraña crónica con sitios detonantes frontal u occipital en pacientes con incapacidad grave.

Effectiveness of surgical treatment in chronic migraine.

Objective: Migraine affects more than 35 million people in the United States of America, and 10% of the population in the world. The purpose of this study was to evaluate the effectiveness of surgical treatment in chronic migraine with frontal or occipital trigger areas. Methods: We designed a pilot, proof of concept, and prospective study to analyze the effectiveness of surgical release of trigger nerves in severe frontal or occipital chronic migraines. The study was approved by the Ethics and Investigation Committee of Hospital Universitario Dr. José Eleuterio González (Monterrey, N.L., Mexico). We included patients diagnosed with chronic migraine by the neurology service of Hospital Universitario Dr. José Eleuterio González that attended our consult from March to December 2012. The patients were assessed by the MIDAS questionnaire and the diagnosis confirmed by injecting 2% lidocaine in the trigger sites. We realized a superior palpebral approach in frontal migraines to resection the glabellar muscles and an occipital approach to free the greater occipital nerve bilaterally. We evaluated complete and partial clinical response measuring the frequency, intensity, and duration of migraine episodes. Results: We included three patients with Stage IV (severe incapacitating) frontal or occipital chronic migraines. Two were occipital trigger sites and one frontal. We obtained complete clinical response in two patients and a partial response in one. Pain intensity decreased in all patients. Conclusion: Surgical treatment is effective in Stage IV (severe incapacitating) frontal or occipital trigger chronic migraines.

Objetivos: La migraña crónica afecta a más de 35 millones de personas en los EE.UU. y al 10% de la población en México. El objetivo de este estudio fue valorar la efectividad del tratamiento quirúrgico en la migraña crónica con sitios detonantes frontal u occipital para proponerla como alternativa quirúrgica en nuestro medio. Método: Se incluyeron pacientes con diagnóstico de migraña crónica con sitios detonantes frontal u occipital valorados por el servicio de neurología del Hospital Universitario Dr. José Eleuterio González (Monterrey, N.L., México) que acudieron a consulta de marzo a diciembre de 2012, con la autorización del Comité de Ética e Investigación. Se valoraron mediante el cuestionario MIDAS, y los sitios gatillo se confirmaron con la inyección de lidocaína al 2%. Se realizó un abordaje en el surco palpebral superior para liberar los músculos corrugadores y procerus en caso de detonante frontal, y un abordaje occipital para liberar el nervio occipital mayor bilateral. Se valoró la respuesta clínica total y parcial según la intensidad, la frecuencia y la duración de los episodios migrañosos mensuales. Resultados: Se incluyeron tres pacientes con migraña crónica en etapa IV (incapacidad grave), a los que correspondían dos sitios detonantes frontal y uno occipital. Obtuvimos dos pacientes con respuesta clínica completa y una con respuesta parcial. La intensidad del dolor mejoró en todos los pacientes. Conclusiones: El tratamiento quirúrgico es efectivo en la migraña crónica con sitios detonantes frontal u occipital en pacientes con incapacidad grave.

An alternative technique to define and visualize columellar and nasal tip vectors. Improvement of mestizo nose.

BACKGROUND: With some frequency, in mestizo rhinoplasty, we focus much of our attention on the nasal tip. This work also highlights the importance of obtaining a proper balance of the columella, achieving a pleasing visual effect of the vector lines that make up the nasal profile (columella and nasal tip vectors). METHODS: We performed a complete medical history in all patients and developed a surgical plan after nasal anatomy analysis. Pre- and postoperative photographs were obtained for medium and long term control. RESULTS: We treated 112 patients with this surgical technique, 77 with an open approach and 35 with a closed approach. The results were documented in the short and long term with a range of 6 months to 5 years. CONCLUSIONS: We feel that the use of an angulated extended columellar graft is highly polyfunctional, providing length, definition and support to nasal tip grafts. Because of the graft design, it is possible to predetermine the new columella length/tip, thus visualizing the columella and nasal tip vectors of the nasal profile. The angulated extension prevents cephalic-lateral-caudal displacements of the tip graft, and to some degree it is possible to increase or decrease nasal length depending on the angularity of the extension.