Result of the implementation of telematic consultations in orthopaedic surgery and traumatology during COVID-19 laparoscopic surgery. / Resultado de la implantación de consultas telemáticas en cirugía ortopédica y traumatología durante la pandemia COVID-19.

The COVID pandemic has made telematic consultations a basic tool in daily practice. AIMS: The main objective of the study is to assess the results of the application of telematic consultations to limit the mobility of patients. The operational objectives are; to propose a consultation plan, to know how attendance limits consultations and to define which pathologies benefit the most from this plan. METHODS: A scheme is proposed with the creation of pre-scheduled clinic to assess suitability and the possibility of carrying them out in a single non face-to-face act. RESULTS: Phone call to 5,619 patients were made with a lack of response of 19%. The cases of 74% of the patients that answered were resolved virtually. There is a difference between units, obtaining a higher answering rate from patients appointed to specific clinic units, OR = 0.60, or to general trauma ones, OR = 0.67. The lowest answering rate was obtained from those derived from the emergency department. Twenty per cent of the consultations were not accompanied by complementary tests that would have favored the resolution in a single act. The general trauma consultations, OR = 0.34, postoperative control, OR = 0.49, and specific unit ones, OR = 0.40, were the ones that better met this requirement. Out of the remaining patients, the general trauma consultations, OR = 0.50, and those referred to units, OR = 0.54, were the ones that had a higher resolution rate without in- person consultation. CONCLUSIONS: The cases of 74% of the patients who answered the phone call were resolved virtually. Cases of 20% of the patients cannot be solved in a single act because they are derived without complementary tests. Osteosynthesis and postoperative arthroscopic follow-up consultations are the ones that need to be carried out in person the most.

Bisphosphonate-related osteonecrosis. Application of adipose-derived stem cells in an experimental murine model.

BACKGROUND: Bisphosphonate-related osteonecrosis of the jaw is a pathological condition without effective established treatment and preventive strategies. The aim of this study was to analyse the effect of adipose-derived stem cells (ASC) in an experimental murine model of osteonecrosis. MATERIAL AND METHODS: 38 Wistar rats were injected intraperitoneally with zoledronic acid. After treatment, upper jaw molars were extracted. The animals were randomly assigned to one of two groups. In the control group, saline solution was applied over the alveolar sockets after the tooth extractions. In the treatment group, ASCs were applied instead of saline solution. The control and treatment groups were subdivided based on the time of euthanasia. A clinical and histological analysis was performed. RESULTS: The presence of osteonecrosis in alveolar bone was observed in a similar distribution in both groups. In the ASC-treated group, new bone formation was greater than in controls. CONCLUSION: In this study, application of ASCs showed greater new bone formation in an osteonecrosis-like murine model. Previous inhibited post-extraction bone remodelling could be reactivated, and these findings appeared to be secondary to implantation of ASCs.

Surgical Gown's Cuff Modification to Prevent Surgical Contamination.

The gown-glove interface is the weakest point in the barrier system of gown and glove protection for the surgeon. We are herein presenting an easy modification in the cuff of the gown that increases the security of the gown-glove interface.

Polyetheretherketone custom-made implants for craniofacial defects: Report of 14 cases and review of the literature.

BACKGROUND: Craniofacial defects tend to carry functional and esthetic consequences for the patient. The complex shapes in this region make such reconstructions a challenging procedure and the most suitable material to be used remains controversial. METHODS: We report a series of 14 patients whose craniofacial defects were reconstructed using a computer designed PEEK-PSI (Polyetheretherketone- Patient Specific Implant). We analyzed the complications and outcomes of PEEK custom-made implants and compared our results with those of other case series reported in the current literature. RESULTS: Fourteen patients underwent craniofacial reconstruction using a PEEK-PSI. Three cases involved a one-step primary reconstruction and the rest of cases underwent a delayed reconstruction. Two cases (14.3 %) presented infection and only in one case was the implant definitively removed. Esthetic results were considered to be highly satisfactory. CONCLUSION: With CAD-CAM techniques, it is possible to prefabricate an individual implant. The ideal material for reconstructing maxillofacial defects does not exist, but PEEK has demonstrated good outcomes. When autologous bone is not available or, in selected cases with large or complex defects in the maxillofacial area, PEEK is one of the best options to reconstruct these defects. However, further studies are needed to determine the long-term results.

The Guyuron retroauricular island flap for eyelid and eye socket reconstruction in children.

A complete loss of palpebral tissue can occur following a congenital malformation, tumour resection or traumatic injury. This article presents the authors' clinical experience with upper eyelid reconstruction in children using the Guyuron retroauricular island flap. Five cases of severe eyelid defects in children aged between 5 days and 10 years of age (three patients following enucleation and two presenting upper eyelid coloboma of approximately two-thirds of the upper eyelid surface) were treated using this technique. In all cases an optimal closure of the eyelid fissure was achieved and corneal exposure clinically improved. On average, 15% of the initial flap surface was lost. Only one major complication (40% flap necrosis) was reported in the postoperative period. This reconstructive technique can provide complete eyelid reconstruction leaving an inconspicuous scar and causing limited morbidity at the donor zone.

Fibula free flap splitting for mandible reconstruction: A technical note.

Conformation of the fibula flap to passively adapt to the remaining mandible may be indeed challenging. A review of the 'axial splitting' technique for fibula free flaps is presented with a novel method of osteosynthesis. Adequate mandibular angle shape is achieved by performing this type of osteotomy with a minimal use of titanium hardware for flap insetting.

[Cranial reconsctruction with titanium mesh and hydroxyapatite cement]. / Reconstrucción craneal mediante malla de titano y cemento de apatita carbonatada.

We report the case of a 45 year old patient who was affected by an infectious disease of the temporal bone, after the surgical treatment of a meningioma in the greater sphenoid wing. This infection healed after the resection of the craniotomy flap. The remaining bone defect was reconstructed using a titanium mesh covered by hydroxyapatite cement (Norian). The result was excellent due to the strength of the titanium mesh and the volume and contour offered by the hydroxyapatite cement.

Micellar behavior of tetradecyldimethylbenzylammonium chloride in water-alcohol mixtures.

The effect of butanol and benzyl alcohol on the critical micelle concentration and the degree of ionization of micelles of tetradecyldimethylbenzylammonium chloride has been studied conductometrically in the temperature range of 5 to 40 degrees C at 5 degrees C intervals. The results indicate that some self-association process of benzyl alcohol in the aqueous phase commences when its concentration amounts to ca 0.05 m. By applying the theoretical treatment suggested by Motomura for binary surfactant systems, the molar fraction of alcohol in the micelle and the standard free energy of solubilization were estimated from the dependence of cmc on temperature and alcohol concentration. For comparative purposes the micellar properties of tetradecyltrimethylammonium bromide in water-alcohol systems at 25 degrees C have also been studied.